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HomeMy WebLinkAbout040-1276-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St, Croix Safety and Building Division , INSPECTION REPORT Sanitary Permit No: 420714 0 ATTACH TO PERMIT) GENERAL INFORMATION ( State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. /i Permit Holder's Name: City Village X Township Parcel Tax No: Coleman, Larry Troy Township 040 - 1276 -20 -000 CST BM Elev: Insp. BM Elev: BM Des ion: Section/Town /Range /Map No: 611 61 ql , - 71 11Z 17.28.19.1534 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS FS ELEV. 7 j� l y Septic Benchmark ZS. Dosing Alt. BM , I�� 30- IV • Aeration Bldg. Sewer tigIVIl, q, Holding . 131.3t 3. TANK SETBACK INFORMATION St/Ht Outlet TANK TO L BLDG. Vent Intake ROAD Dt Inlet Septic �s / � � f �/ C � Dt Bottom Dosing V Header /Man. Aeration Dist. Pipe �J 4 (� 3 Holding Bot. tOqdW PUMP /SIPHON INFORMATION Final Grade -3 v �l Manufacturer Demand St Cover i 3 p 132, Model Number ) TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dist. to Wel SOIL ABSORPTION SYSTEM 6 4- BED/TRENCH Width Lengtt} No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth DIMENSIONS / 2� SETBACK SYSTEM TO 10 /L BLDG WELL LAKE /STREAM LEACHING Man ckurer: S INFORMATION Ty Of System: f CHAMBER O/ b . 7 �- n � � \ �( y � UN Model Number: DISTRIBUTION SYSTEM (� Header /Manifold Distribution x Hole Size x Hole Spacing lVent to Air Intake h Pipe(s) / Length Dia Length Dia Spacin f �� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of o eeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx S D Yes FS] No � Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: D 122 0 3 Inspection #2: Location: 472 Omaha Rd Hudson, WI 54016 (NE 1/4 NE 1/4 17 T28 R EAGLE ,Bt,L.UFF;L�ot`2. "� Parcel No: 17.28.19.1534 1.) Alt BM Description = ��� Df A i n �IZ �j wv�� ! °:� �(� !�yf / tv�'h� �Wd 2.) Bldg sewer length = 2 60 11" � � C`70 `r*f 4-Ai ptt�L - amount of cover I .:"/ 7 j i�a, Gr had Plan revision Required? L-I Yes io Z 3� Use other side for additional information. L Date � InsepctOrs Si g n ature � �n Z Cert. N SBD -6710 (R.3/97) C _�' f• _/ ON/ �� ( ��A ^ ,�n J�' ° 10H u� �� ok -Ae ,fie- g � R p , Sarety do Buildings Division N*I sconsln I01 W. Washington Ave. Sanitary Permit Application PO Box 7302 In accord with Comm 83.2 1, Wis. Adm. Cole Madison, Wi 33707 -7302 (apartment or Commoreat Personal information you provide may be used for secondary purposes (Submit completed form to county If not (Privacy Law, s. 15.04(1)(m)j stateownd. Attach comill ets plans to the county copy onlyl for the s lem on paper not less than 8 -1/2 x 1 I inches in size. County �` State Sanitary Permit Number ❑ Check If revision to previous application State Plan 1. D. No= �A , C i k I. Application Information - Please Print all Information Location: Property Owner Name - -- -- Properly Location N� lAr 1 /4 ,S 11 T RI or w Property Owner's Mailing Ad eaa l Lot Number Block Number City. State V v N r• Zip Cod l e Phone Nmnber Subdivision Name or CSM Number REGFIVFn II Type of Buildings (check one) O City I or 2 Family Dwelling -No. of Bedrooms: O Village O Publiic/Commerciai (describe use):`_ FE.B_ 2 6 2003 FA'I'u I or O State -owned — - - - - — - III Type of Permit: (Check only one box on line A. Check box Initie t3T.:ti�YsbRN Ty Nearest Rom ZO ING OFFICE A) I. New System 2. 11 Rep 3. D Replacemen o I ion to Parcel Tax Number(a) . / 53� S stem Tank Onl Existing Systent _ `� - Permit Number I)ale Issued - i--d 44 O A Sanitary Permit was revioual issued IV. Type of POM T System: (Check all that apply) t, Non- pressurized In- ground ❑ Mound D Sand Filter D Constructed Wetland." O Pressurized In- ground Cl IIolJing'Tank O Single Pass O Drip _, O At -grade D Aerobic Treatment Unit D Recirculating O Other: 921 hP V Dis ersaUTreatmenI Area Information: 1. Design Flow 2. IfAspenslAres 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. Sys lion 7. Final Onde R aired Proposed Rate (Gals. /Jay /sq. It.) (Min./ioch) Elevolion SO- VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Plastic Information Galion Oalions 'Tanks Con- Con- glass New Existing crcte struc er Tanks Tanks [7 -- - -� -- CI ❑ O VII Responsibility Statement 1 the updersi asauttte Fes sibilit for installation of the POW'1'S shown on the atlecl p ietas. Plamber s Namat — -- -- -- - -- - -- Plumber's Siguta no tnpar MP/MPRS No. tluslnea Pitons No 160 - Plumber's Address (Street, City, State, Zip Code) - -- -- - - -- - - -- P VIII County/Departme t Use Only 1 Disapprove =lnitialAdverse Sanitary Permit Fee (Includes Groundwater Date Issued issuing 1Signawm (No stamps) Approved O Owner GivSurcha rge Fes) Determination t 2Z IX�C ditions of��vai /Reasons for Dlaipprova • Z �` 5 5• �a%�c+o.+� Ifii `uS�{ ©• t �O.Z�aQ/tCZ$se.JS °'`r� -- s•�(st 1-46 � t S,a�jarc,Q[_ Je�tNilM� v wnttuM7t�•ns.d , _ n (� S U d+ CJ(QL f. '0 /`" -/U .t" 17/1 N_ J' /L-� s- �O' S w a6o C �teOf- G,eu�"' f A ,. 36 4- L ot - t o 4 � O IV m ��• °ern l - � W l x ;* Q Z 3 n ci a► w a b c� o f p -� y W�a_ 3c: o x LL x R • • • • vlv.t /'/ /, Una _5 1*d e u)i - rs !z /171 :'m_ - - - - -- - � �u.m�.es der.. _ B' for of G a'l,u,, 4s 3 3 Y ,, (Jolhr,�, I o er � L ot t o 041 Iv m 1�� 0 M I r � (A-k N E to l pp W t �y 0 � v � 43) CL A , p t11 0 V/ v! in O 7 a W` maa� � z 11, 11-1A LGE Go) v ED CL Wisconsin Department of Commerce SOIL EVALUATION REPORT Page - A— of —'I f Safe and Buildings Division ° h in accordance with Comm 85, Ws Adm. Code County S'r, C4 1, Attach complete site plan on paper not less than 8 112 x 11 Inches In size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ( P�O IN G/ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date Re owy please print all Information. ed b p personal Information you provide may be used for secondary purposes (Privaoy Law, s. 15.04 (1) (m)). O� Proparty Owner Property Location 2 0 F 1 4k E 4 S a T N R a u 1 C R1�5 CQO S� 1! sa� 0 property Owner s Melling Address Lot K Block q Subd. Name or CS" 11500 ABE�EtJ Sr AJE sut too 2 E�16L>^ BI-uFF State Zip Code Phone Number ❑ City ❑ Village T Nearest � E r 55�4q t 7 �3 75� -7s� rCRO W Code derived design flow rate —r - -, �PD New Constriction Use:Wosldendal / Number of bedrooms _ _ __ `' ❑ Replacement ❑ Public or commercial • Desuibe: - - -- - Parent material SAI�OSTD Flood Plain elevation if applicable General comments EST C'O t ZUL eD AF rc t LpT L1 N E5 6 l_ t 5f 1 G SA and recommendation s: a rt `. �G - M F c. N U E N P e ,w •� N� '''i` Lohoi �E 0."7 3) 5X S`� l /Z 7t�FAtAES € q , Boring 7 Q7 In. I� Boring # Soil iicabon Rate r $4 pit Ground surface elev. ZZ. ft. Depth to limiting factor Horizon DeRERedox; scripti O,b on Texture Structure Consistence Boundary Roots .E GPD E i. Sznt. Color Gr. Sz. Sh. s 11 L a 4 /Zr FKpsr o Boring # Boring ZG� s`Io0 ry. Depth to limiting factor -- In Sdi licalion Rate pl; Ground surface elev. nonion Dep `. Dominant Ca!or Rector Description Texture Structure Consistence Boundary Roots *E r-77 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. t r mJ r C5 -CO 2 5 10 - si I m qW t^vkr R ��+ C X m 0.15 0. 3 L 2V to ' mJf cis aE-m 0 ', k , 2 S 3y `+R4 s r � — --F t. -7 1 r 2- S 5 1{ �► i �_ Effluent #2 = 800 < 30 mgll and TSS < mg/L Effluent #1 � BCD > 30 < 220 and TSS >30 < 150 mglL � CST Number CST Name (Please Print) no u 2z Q'3Z LL Conducted I� R Telephone Number � Date Evaluation Address �14g�5 o +ti R,�� �,� its O2 tS3• ►s- Is �— I t� Lor 2 ' , r�w 1 I�IN Page 2 of q_ p owner _ Parcel ID # �L_�+ -- - Boring ` �C7S In. Boring ' Pit Ground surface elev. # g� j 3 it. Depth to limiting factor _/_L_ -- Soil Ilcatlon Rate a � _ u Texture Structure Consistence Boundary Roots GPDIff r Redox Description 1 'Eff#2 Horizon Depth Dominant Colo Gr. Sz. Sh. �Etf# In. Munsell Qu, Sz. Cont. Color , 5 Ch 2 Z s•1 p •Ss! 1.5.3 10 S1 to J $� b5 3 L] Boring Boring # El Pit Ground surface elev. it. Depth to limiting factor _ In• S011 lication Rate GPD /ff orizon Depth Dominant Color Redox Description Texture Gr. Sz. Sh C onsistence Boundary Roots *Eff#1 •Eti#2 in Munsell au. Sz. Cont. Color Z i in. ❑ Boring # Boring _ _ n. Depth to limiting factor Soil Application Rate ❑ Pit Ground surface elev. GPDIff horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E1f#2 Effluent #1 = BOD > 30 <_ 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD, < 30 mg /L and TSS 5 30 mg/L The Departm n need atenal inran i an please v department at 608-266-3151 e orr TYt608c264a services or 8777. SeD•8330 (A.6N0) P�OpE121Y �; C+#ARU-.s CDOK &ew: S Z tt , i E E OF n c comer ❑" 501L [30�IN6 W/ WKHOE NO COMM 83 %TPACK f'KOMEM5 NI lx k ^S £L 4 2 z 3s' , OJT t� SL -1 . `o v v y �o, 'v � �f'2z,43 dot Z A / IT w 1 c.sr e� - I NEn C5t C- 54G i ZZLI 9 3 2 Phr> : 03- J 5- 01 P Lk of Lo T"Z E-aGLF- BLUFF 8� q Y EL 925 �o i \ ` E L X112 t3 1 � I v�f Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number ZO TI Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average ( pd) N Septic Tank Capacity (gal) Soil Absorption Component Size (ft 8 C" Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Com onent Design Flow - Peak ( pd) I � 4 () Rl _ Maximum Influent Particle Size (in) 1 Maximum BOD (m /L) 220 Maximum TSS (mg /L) Ise 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 ears Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the segg'alanik and outlet filter shall be assessed at least once every 3 years by inspection. The utlet filte shall be cleaned as necessa[y toe sn im proper operation The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases,, and rescue of a person from the Interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited hazard. y p ohibi ed and considered a human health a Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system / at owner's expense. Alternate area must be left undistur St Croix County Zoning Office 386 -4680 Boumeester & Sons Excavating 386 -9020 Tri- County Sanitation 386 -2130 3 S'1' CI(OIX COt1N'I'Y SEP'T'IC 'TANK MAINTENANCE ACREEME -19T AND OWNERSIIIP CERTIFICA'T'ION FORM Owner/Buyer "n Mailing Address ___ 3 P � � � : �� W � �} C � ai � ' I � N ^,' Property Address .� (Verification required from Planning Department for new construction) City /State .�n.,� �� Parcel Idenliftcatioit Number oyo - 1z - -T6 - zo -Ow Property Location S %,, S F %,, Sec. � , '1' h N -I? W, 'Town of Subdivision tb c 1 -� 1 L,A_� ,Lot N Certffled Survey Map # Volume — , Page N r, Warranty Decd # %� !_ Volume ,Page Spec 601190 ❑ yes 0^ no Lot lines identifiable 0 yes O no improper use sad maintenanceof your septic system could result in its premature failure to handle wastes. Proper maiatemem non" of Pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into 160 system can affect the flmetiou of tie $Optic tank as a treatment stage in the waste disposal system. The aastetplumberPropertY owner agrf:es to submit to St. Croix Zoning Department a certification form, signed by the owner and by • Mt ietedplumber or a licensed pumper verifying that (1) the on -site wastewaterdlsposel sysleos b in Proper Vcmftg condition and/or (1) s ection and pumping (if necessary), the septic tank is less t I/3,i>adl of sludge. Vwe, the undersigned have read the abov ,and agree to maintain the private sewage disposals standtds Not fork be* as set by the Department and the Department of Natural Resources, State of W htcooaio, ° "Oettitiwtioa that your Septic system has been on must be comp returne to the St. leted and d days of the year exp da Croix County Zesrlog Office within 30 It APPLICANT r ' k DATE I (we) txrdfy that all statements oath fonp are true to the best of m ) B ( ) ( ) wnm(s) of the y ( out ) knowled 1 we a m are the o described • o virtue of a,Wturagty deed recorded in Register of Deeds Office. (lNA APP A DATJH •••••• An y information that is mie represegtedlnay in the sanitary permit being revoked by the Zoning DepartmeM. +••••• .� •• Include with this ipplicallon: a sta mped,y►arniply deed from the Register of Deeds office a copy of dte eedified survey rasp If reference is made in the warranty deed Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County JT.C1ZDt)( Attach complete site plan on paper not less lha ties in size. Plan must include, but not limited to: vertical and hon I r '1' n epo�n ), direction and Parcel I.D. percent slope, scale or dimensions, nort Wi i nce to nearest road. P inf Please rn�l on Reviewed by Date Personal information you provide may e for seco,�ihlQ3p� (Privacw, s. 15.04 (1) (m)). ProperiyOwner _ ; 1 ropertyLocation 5 2 oFTNti CNAt2i_ES S, C�7pK NO 0 � �� I• SE 1/4 EE 1/4 S g T Z% N R 1 W Property Owner's Mailing Address a ti of # Block # Subd. Name or CSM# C UNTY 4WICE 2 — ER6� -E 1�41AF� City State Zip C ,i ;Phone Number ❑ City ❑ Village W Town Nearest Road LA\ PV TRO W fl X>. New Construction Use:4 Residential / Number of bedrooms y Code derived design Row rate (60 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material - ')A 5TONIC Flood Plain elevation if applicable AJ A• R. General comments and recommendations: X� (ZAM ADD %T \OhW $O'( AM(- 5 CO\ -lL-D JPV Coil W T1OA)A% -- Boring FA ® Pit Ground surface elev. Boring # q22. ?3 ft. Depth to limiting factor ��� in. =Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 Y 2 M Y�r 34 O. (7 z- o t2g — 5(1 I f b Cs T ,2 ,3 3 6- n (23 S►l bK ds 2 --f- a 0,5 OR 14 - I �4vL _ Sll lmsbK dh CS 1 Gm. 0 Q. cA 5 51 5 7 51A P Z YLI - s cw 61 QA t� tf Vm l, z a k El Boring Boring # tc� Pit Ground surface elev. 0 h9, 31 ft. Depth to limiting factor _ 87 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 0 -' I 3 -m or rO r a b 3 05 0. Z -1 z/ s� 1 I s As M-6 ZT -c0 I 0'a - 5 3 g; 1 d C -Co 0,2— 0.3 1 - 7 -26 1 ON 4 2 � 5 I I sb d V, 0 O. Z 0,3 S zb -35 si:,l( 8 h CS ' 0,S b S 5i ( ZrnsbK d�' d o bz -b3 (oYrc ail 1 msbK d5h 0JA -- oly O • Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD 5 30 mg/L and TSS 5 30 mg/I_ CST Name (Please Print) Si nature CST Number it S E 224832 'ss Date Evaluation Conducted Telephone Number b90�h UG. lq3v eK FALLS %AX 5k102? 1 I-OZ - 0 0 C"115)4Z6 -1 -715' r I ! y Property Owner [`ObK CN At2L�� Parcel ID # _ Page 2 of F-cl Boring # Bo ❑ ring Pit Ground surface elev. q ZI , � ft. Depth to limiting factor y � in • Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .EGPD /Eff #2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. t p _ Ip — : I 2 w\ r Qb J�-rn p �5 0,g \,rnsbl� - - 0,4 0 3 . 4 -3 IOV y�Z t1 mSbK C e S 012- 0,3 1 L sbk _ MEL 4 -b 3 / 7. tircy�ro£ lov+2�°�) CI 0 m� OA O,a 64- 12`16\ Y, Boring Boring # F ❑ Boring ❑ Pit Ground surface elev. it. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EGPD /ffEff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. F-1 Bodng # E] Boring El Pit Ground surface elev. _ it. Depth to limiting factor in' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .E GPD /ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS <_ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate forniat, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -6770 (R.6100) � 1 . � 4 POT PLAN PVOPFV Y OVUP: Ck)aK LE V� t;l 0 Z LE 13M- 091 -TOP O+= L- iA L*rt EA rj(A Ill't £ S� OF TNE i VDUA)0sL I2FAcIE. - OF 5� c. T7 N w 7 ` PVC Pi 7" U- -54 C& o sT c o► �T �sca�s� nl . ❑ -501L POPING W/ PACKN0� NO COMM 83 %VPCK PROPLW5 0 i3Z8 eL- g(q. (( o fl i Ep x.`63 FL q 21.34 C za EL92-1, 7R' J e� � �HA}_ A $ 51CUP C51 awJ 2zy�3Z x 12ATE: ii-oz-0o Pp 4 of 4 CONTOLLK L-I NHS FC:R L(JTS - 1'4 EA6Lle 3LuFF 4 /0 ) B -2B B -2A Y' r 'J 2141P 298 7 051630 t` r STATE BAR OF WISCONSIN FORM I - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIR CO., yI Document Number RECEIVED FOR RECORD This Deed made between 02/13/2003 01:00PM Troy Development Corporation, a 14innesota Corporation EXEMPT # REG FEE: _. Grantor. 11.00 Larr uzanne Coleman and TRANS FEE: 269.70 COPY FEE: CERT COPY FEE: PAGES: 1 _ _ _ _ _ __ Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate In St. Croix County. State of Wisconsin (the 'Property'): m„ A,.. Name and Reium Address Lot 2 of the Plat of Eagle Bluff in the Town of Troy, St. Croix County, Wisconsin. Larry & Suzanne Coleman Subject to Declarations of Covenants, Conditions and 7633 Nature Path Restrictions for Eagle Bluff, recorded in Vol. 1589 Woodbury, MN 55125 Page 516 , as Doc, No. 636946 , as appearing in the office of the Register of Deeds for St. Croix County, Wisconsin, and such other easements, 040 - 1276 - 20000 restrictions and reservations of record, or. in use, and the "Buyer" obligations contained in the Parcel IdenuRcalion Number (P1N) Purchase Agreement for this lot. This is not homestead property. (Is) (Is not) Together with all appurtenant rights. title and Interests. Grantor warrants that the tide to the Property is good, indefeasible in fee simple and Gce and clear of encumbrances except Dated this 31st day of December 2002 r (SEAL) (SEAL) Charles S. Cook, President Troy Development Corporation (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Minnesota State of W+seenahr, ss. Anoka-- Cou �{ authenticated this day of Persoiwily came bcfom me this ` day of December — Z D� t� named Charles S. Cook, Presiden Troy Development Corporation TITLE: MEMBER STATE BAR OF WISCONSIN to (1f not, me known to be the person _ who executed the foregoing authorized by 5706.06, Wis. State.) instrument and acknm a the same. f i THIS INSTRUMENT WAS GRAFTED BY Troy Development Corporation Rick Johnson Charles S. Cook, President Notary Public. Suiw aMAwaaain Anoka County, 141nn. My commission is permanent, (If not, state expiratinn date: (Signatures may be authenticated or acknowledged. Both are not January 31 ? Q D 6 ,) rarcnssary) N--F,--% sit, g,,airyutm unia 1,,yl-4 w' P W. I—. sigiwuur. STATE BAR OF WISCONSIN W+scwuin legr &anx C....+c. WARRANTY DEED FORM No. I - 1999 md-Ow, Wis. ■ NDanf K" -MKEM My COMMON EWIFI s ,W4lM 31,1008 N' itIN," EAGLE BLUFF SECTIO ' s T20N R /.W �� 11 LOCATED IN THE SW 1/4 OF THE SE 1/4 AND THE SE 1J4 OF THE SE 1/4 0 THE NW 1/4 OF SECTION 16, AND THE NW 1/4 OF THE NE 1/4 AND THE NE 1 17, ALL IN T28N , R 19W, TON OF TROY. ST. CRO I X COUNTY, WISCONSIN / r•. '�`� y i Qua{ AND OUTLOT 1 OF THE CERTIFIED SURVEY MAP RECORDED IN VOLUME 9, PA 'Ick Q� � I ,I I 3� I � IAVPLA i UAPLATTED LAND /\ I 1 IIOR7N LINE of THE s 1/2 OF LINE N00.7r29• 204047 � $ , NORTH t OF THE S 1/ OF THE 911 1/4 OF TH E S E 1/1 197 \ 1 OUTLOT 1 3.400 AGES 270,241 Sf. kills 1 PROPOSED 1 1 (COVENANTS) i LOT 1 ' I \ \ 62aieu ►/QM9 1 I ; 5 • �" d 3 PAS£ ��7 IF. 6 ` \\ \ 40 ` \-- - - - - -� -- 49818 1 44770 >u. S I �ILPT L �,� I 4 �' 0 \ / :o 44.10111 St. J 1 3 E PONT OF .�'�--- - -- _ - \ �. a- t T20K RIOW `BEC00'OIK' _ - • fjrjr59- Q �" = r 1310 ACRES O I N 00'31• - - E 4S7.7r \ L 729 SF. ' SECTION R1� \` • 1i \ b ';+ `� 1 _� � 7 � - - - - - - - - - - - - Y v{ W j I LOT 1 ; W 1AIS ACRES OUTLOT 2 I = C.S.M ^.g. 7osss S.F. • �ID00 A A `� OUTLOt\CZ \ i t1,, / zW \ 317A ACRES V 1 1 6 43507 Sf. ,• \ ]17/23 S.F. ` I PAGE 1.564 s ` DO_C.: 404222 '" l L +" I /4 ; ` ' \• tc 43 lK PROPOSED \ 1 ( e R UE r) I TOWNSVALLEY ROAD ��; 1 ' •\ 15.707 AGES ' \ 1\ � 544.717 Sf. 1 i ' 1 , 38 `� u 1 j K 1 � I I , 1 3 /4" 1/2' � ♦ \ \ 7450' PS J- I OU ` S►. , I L------ - - - - a 170,.N 1 SOUTH LIE OF im NW 1/4 OF TIE NE 1/4 NOTES: 1. ALL LINEAR LEAARmEMS HAVE BEEN IVA TO THE NEAREST ONE i ` MEASUREMENTS HAVE SEEM N10E TO THE NEAREST FIVE SECONDS AN ' 2. 719 ►IACELS ON 1N15 IYl ARE Ll�IECT To STATE CONTV UIVPLATTED LAND \� L�� REau' -S I.E. aETlwoa ACr T YINIM IE ST. GIOIX Y lOT S13E Ra UITY s ro rN �\ DEVELOI ►MCEI. ooNf oO ZONING FOR ADVICE. ' - 7. ZU LDINO SETBACKS ARE AS FOLLOWS: Q - YINIYY OF 79 FROM THE ROAD MIGHT-CF-WAY FOR LOTS 2-42 A 1�4bl FOR Lon 1 " (4(7. FROM fCR�l.OT AND LOT 451 IF 119 ST ro S NEAIEST BU IL - MIN NINNY OF 57 107 FOII LOTS 1 AID 47). - YINIYY OF 29 FROM TIE REM LAT NINES. 4. THE FOLLOWING LOTS SWILL HAVE A NINIUM FLOOD PROOF ELEVAT ' S t/s CORNER FOLLOWS: LOTS 10 AND 17, 024.0; LOOS 21 T19IOUGN 24. 012.0. SECTION 17 5. ALL OF OUTLOTS 1 711 9 M 0 ME SLISACT TO AOE A ORAIN EASEN T201L R19W THIS P STRUMENT DRAFTED BY DANIEL P. KUCEL 9. EASEMENTS FOR TOMMY GlI-0E - SACS (R-00) ARE TO BE AUTO I Parcel #: 040 - 1276 -20 -000 1210812005 09:45 AM PAGE 1 OF 1 Alt. Parcel #: 17.28.19.1534 040 - TOWN OF TROY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner PAUL D & SHEILA J TR WIEMERSLAGE O - WIEMERSLAGE, PAUL D & SHEILA J TR 472 OMAHA RD HUDSON WI 54016 i Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 472 OMAHA RD SC 2611 SCH D OF HUDSON 2 SP 1700 WITC '2,0 D Legal Description: Acres: 1.168 Plat: 1924 -EAGLE BLUFF 040/01 SEC 08 T28N R19W S112 SE1 /4 SEC 17 T28N Block/Condo Bldg: LOT 02 R19W N1 /2 NE1 /4 LOT 2 EAGLE BLUFF Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 28N -19W SE Notes: Parcel History: Date Doc # Vol /Page Type 08/17/2004 771915 2639/405 WD 02/13/2003 709630 2141/298 WD 02/21/2001 638939 1589/491 TD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 104185 465,000 Valuations: Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.168 87,900 359,700 447,600 NO Totals for 2005: General Property 1.168 87,900 359,700 447,600 Woodland 0.000 0 0 Totals for 2004: General Property 1.168 87,900 324,500 412,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00