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HomeMy WebLinkAbout040-1261-30-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division r INSPECTION REPORT Sanitary Permit No: 479473 0 GENERAL INFORMATION- (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Murphy, Sean I Troy, Town of 040 - 1261 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: G5 _ 18.28.19.1402 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 5 Benchmark 25�-- Z I/. 11 111 11 /00 Z ' Alt. BM J 6 I a � 5.`71 /0 Y Aeration Bldg. Sewer ,9 Z Holding St/Ht Inlet C N . 7 3 TANK SETBACK INFORMATION St/Ht Outlet C r 31 TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic - r� Dt Bottom Dosing /� Header /Man. 13 9 7 • Z Aeration Dist. Pipe J3,(6 g7• y(p Holding Bot. System 1 14-37 9( 7Y Qj �Zj Z PUMP /SIPHON INFORMATION Final Grade 16b,cl Manufacturer Demand St Coverr� \ //' � L f ( GPM F���,t� Co c J•�]� /OS' Model Numbe TDH Lift Friction Loss System Head TD Ft Forcemain Length � � � ist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length / No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 90 Z 1/^� SETBACK SYSTEM TO v P/L BLDG 1 WELL LAKE /STREAM LEACHING Manufacturer. � INFORMATION CHAMBER OR Type Of System: ` 7 � / n i n /� UNIT Model Number. 5 - / � U /- J' �V CJV' DISTRIBUTION SYSTEM / S d - a Header/Manifold / Distribution x Hole Size x Hole Spacing Ve�too AirInJake / Pipe(s) ! 44 Length g Dia Length Dia \ Spacing \ \ \ V SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over J Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center L�, 1 T Bed/Trench Edges Topsoil ` Yes 0 No es No COMMENTS (Include code discrepencies, persons present, etc.) Inspecti #1: / / Inspection #2: Location: 385 Whitetail Lane J Hudson, WI 54016 (NE 1/4 NE 1/4 18 T28N R1 9W) Deer Valley Lot 23 Parcel o: 18.28.19.1402 1.) Alt BM Description= 2.) Bldg sewer length = L�5 J� IQ J��c,.�- 14e0. a �p - amount of cover = ,' A5J t.J e j . v 16 Plan revision Required? � J Yes 'No !� I Use other side for additional information. - - -- Date Insepc is Sign re Cart. No. SBD -6710 (R.3/97) m Safety and Buildings Division County ` ,� Madison, Wl 201 W. Washing n; 53707p x 162 Departm tgnt of Commerce (608) 6- 315 {t,:� tNumber(tobetiti in yco.) VEF Sanita - 7 Appjicati C71 In accord with Comm 83.21, Wis. Adm. Code, Privacy Law, C State an I.D. Number Personal w r ,r may be used for secondary purpos provide 1 '- �' �I(, lj , Orin You s15.04 )(m} �-R I. Application Information - P 57. Pro.► Address (if different lease Print All Information 01.�( 1- ddress) 1NG OFFICE ) 5 t a t f Property Owner's Name Parcel # Lot # Block # I 'fOpeO Owner's Mai'lipg Address 3 J nl Property Location city, State !� Zip Code Phone Number VZ Y., - ALA /,, Section II. TYpe of Build' g (check all that a p p l y ) irc / (/ Q� (cle } +' (!QZ - 2 Family Dwelling - Number or Bedrooms Q "� T N; R I E ar� ' ) �� Subdiv ision Name D escribe Use J CSM Number, „/ ❑ State Owned - cruse t �•�,Q NN /P III. T .p ❑City QVillage Town ip of Ty pe of Permit: ( heck only one box on lin A. line" if applicable) A. ew System ❑ Replacement Syste omplete ❑ Tmatment/Holding Tank Replacement only ❑ Other Modification to Existing System B• El Permit Renewal ❑ Permit Revision ❑ Change of Previous Permit Number and Date Issued Before Expiration g ❑ Permit Transfer to New List Plumber Owner ( n IV, T ofPOWTS System* Check all that a l Non - Pressurized In- Ground ❑ Mound 1 24 in. of suitable soil ❑ Mound < 24 in. of suitable soi Constructed Wetl l ❑ At -Grade ❑ Single Pass Sand Filter and ❑Pressurized In-Ground ❑ Holdin Tank ❑ g ❑Peat Filter ❑Aerobic Treatment Unit ❑Recirculating Sand Filter Recirculating Synthetic Media Fitter El V. Dis ravel-less Leaching Chamber ❑Drip Line Gel -less Pi rsal/Treatment Area Information; er (explain) Design Flow (gpd) Design Soil Application Ra w(gpdsf) Disper ( (s0 Dis f �U J 7 A rea pos (st) System EJevatio/ VI. Tank Info Capacity in Total ( JV Z 4 t Gallons Number Manufacturer Gallons of Units Prefab Site Steel Fiber Plastic New Existing Concrete Constructed Tanks Tanks Glass Septic a Holding Tank Aerobic Treatment Unit Dosing Chamber • " ! Sa VII. Responsibility $ tement- h the undersigned, assume responsibility for in P ber's Name (Print) the POWTg shown on the attached plans Plumber's Signature RS N bi�er!!-- Business Phone Number is Address (Street, City, State, Zi Code) on /D artment Use On - O pproved ❑Disapproved Sanitary Permit Fee (includes Groundwa er Surcharge Fee) Date Issued wing Ag Signature s) ❑ Owner Given Reason for Denial IX. Conditions ofApproval/Reasons for Disapproval 3 d YSTEM OWNER: e luent filter and �/ > dispersal cell must all be serviced / maintained Q d4�H as per management plan provided by plumber. — TO 2. All setback requirements must be maintained ,�� � Q` '� � as per applicable code /ordinances. ,� �,/s�� 4��u �n 36, ����:�'d'Yt/ Attach compkle pMas (to the County only) ror tlK systen u pa xr a t ka. uxt 1/Z z 1 in / �- s a� A tze SBD -639$ (R. 01/03) l �C/`r- 2 3S o �//'� 0 k 4 A) r R w 30 53 Jlk.L It Af • it ' j�l.i1 �Q� I (� ��� �G E ° - _� 05 r 1 , eiA • 4I Coy is ( k14 J + s PR rag N P iR L j 3o S3 �k r�`► r al o Afo- td f g o "A -n'. lol l 3� I d -N�5 � ►11 ' � ci� �l he�i.a.. � �Sr 9d �, i o� Mu ir 1 n EZ1203H vOP OPPV r �� �.�•. �,` POV ♦POP ♦vvvvvv ` Psevvvo vvo •: :• ;.�•..`�. 'r � ♦vvvvvv �}2 /f PPP '�•• �• � :PPP 1 VVV 24 vvo vvo vvv 4.625 P P - avo 0 0 1 " 1/2 Circ. = 18.84" vvv oeP eve vvv vvov evv vvv vv vvvvvv ♦vvVVv♦ vvv ♦vvvvvv v. evVevv'VVOVV ♦vvvvvv vvvvvv' evvvvvvovovtvv ♦vvvvvv P PPPPOP vvvovPVevPVVVVV vvvovov 24t A Bottom 36f 12 -1/2" DIA,. (typ.) void Volume Soil Interface Area in. 12EL 52L Void Coefficient in Aggregate given at 57.4°,x.. Sidewall (2 Sidewalls) 2 * 18.84in — 3.14 O.D. of 4" pipe — 4.625 inches i2in — Void volume per linear ft. = 3.14 • 2.3125in Ift = 0.1 17 ft' tR Bottom 2.00 12in / ft , O.D. of center cylinder — f2.5 inches Total Soil Interface Area 5.14 SQ.FT Void volume in aggregate of center cylinder ° 3.14 • - 3,14 } l 8a 6.35in y �12intft) •� 3125in 12in /ff I ` =.422 ft' Q.D. of outside cylinders= 12 inches ))) Projected Trench Area Void volume in outside cylinders ¢ 2.3.14(( 6 ` n ft) - 574 - ,901 ft Sidewall Height = 12 in. `2 = 2.00 Sq.Ft. `12ia / • Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders i t 24in • 6in bin y a `I2ur/ft 7 212in/ft) �1 =0.215 ft' Projected Trench Area 5.00 Sq.Ft. Void volume at outside bottom comers (IR of void volume between cylinders) 0.215 12 - 0.108 ft' Total void volume - 0.1 17 + 0.422 + 0.901 + 0.215 + 0.108 = 1.763 cubic ft ! ft Gallons per ft = 1.763 X 7.43 = 13.2 gallons ner linear ft tI / EPS Aggregate Trench System EZ1203H EzflOw Ring - 'industrial Group 65 Industrial Park Rd. Oakland, TN Z,8060 SCALE FILE NAW& EZI203H —vat SHEET: 1 of 1 11 -27 - 01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer — 5ci 4 t4 A- t.�y Mailing Address o 5� �� p �, Ca o b vt),kL -j �l �.l G r, l Z Property Address`+ (Verification required from Planning Department for new construction) City /State _ b" to yy Parcel Identification Number O+G ° 2S4 i " `943 —4 0 a LEGAL DESCRIPTION Property Location W %4, � %4, Sec. �' , T 10 b N -R L W, Town of �� Subdivision bcCY- V Lot # -'� Certified Survey Map # , Volume , Page # Warranty Deed # 7/ © $ , Volume �-`t l . Page # Spec house ❑ yes <no Lot lines identifiable)4es ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the, system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and' by a master plumber, journeymanplymber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic,tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic sy m has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year tion da . SIG ATURE OF APP LICANIV DATE OWN ER CERTIFICATION I (we) certify t all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr?opell, describe bove, by virtue of a warranty deed recorded in Register of Deeds Office. ?, siGR<ffjPds bf APPLE DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed �w . . Pa OWNER'S MANUAL & MANAGEMENT PLAN Pa e r of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ' AGO gal ❑ NA Permit # Septic Tank Manufacturer ` ❑ NA DESIGN PARAMETERS Effluent Fifter Manufacturer L ❑ NA Number of Bedrooms A4 ❑ NA Effluent Filter Model L ❑ NA Number of Public Facility Units A Pump Tank Capacity g al 13 NA Estimated flow (average) C� g al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) O C7 al /day Pump Manufacturer NA Soil Application Rate gal/day/ft' Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit b NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) - Cl NA Biochemical Oxygen Demand (BOD 530 mg /L !n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L YNA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ❑ month(s) s) At least once every: 3 ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third ()3) of tank volume ❑ NA Inspect dispersal cell(s) At feast once eve ^ ❑ month(s) (Maximum 3 ears) ❑ NA every: d� 9 year(s) y Clean effluent filter At least once every: ❑ Y anf h(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) R ❑ yeaa r(s) ush laterals and pressure test At once every: ❑ m r(s ) ❑ NA Other: ❑ month(s) At least once every: ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third IY3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. f l START UP AND OPERATION Page _ of For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. 4 Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 11 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS, p� r s" s no�bn evaluated to identify a su' able replacem a. Upon fa' o e POWTS a soil and site n ust orm Cate a su' le rep area. If ement area is tank m y be inst ort to r e failed POWTS. 11 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INS ALLER POWTS MAINTAINER Name % Q., C Name Phone S o 5 ` Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ('10 20 i Y1 Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. WisconsiD Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 ,Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site playa on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to �d 040- 1070 -10 APPLICANT INFORMATION- PLEASE PR 4'ALL' tNFO#i1N'%k ?T(�N R IEWED BY DATE 2 -J� 7,Odfl PROPERTY OWNER: 'PROPERTY LOCATION Derrick Construction Inc .. ` t.r r`� _GpVT. LOT NE 1/4 NE 1/4,S T N,R X %or) W 18 98 PROPERTY OWNER':S MAILING ADDRESS tai # BLOCK # SUBD. NAME OR CSM # 1505 Hwy #65 «' 1 fo 2 na Deer Valle CITY, STATE ZIP COD i PHONE k ITY ❑VILLAGE SOWN NEAREST ROAD New Richmond, WI. 54017 ®303 Tro [ )4 New Construction Use [X ] Residential mtrPf Cdr 4'' ( ]Addition to existing building j ]Replacement [ ] Public or Comm / sctrl�i e; Code derived daily flow 600 gpd Recommended design loading rate _.7 ed, gpd /ft gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate ._ bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 101.20 ft (as referred to site plan benchmark) Additional design / site considerations x#atrenches spaced to code ,3 50' below grade Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem WS ❑ U ® S ❑ U ® S ❑ U ® S ❑ U ® S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertdi ................. .................. ................. .................. 1 1 - 1 2msbk mfr qw 2c .5 .6 2 10 - 10 r 4/4 none sil 2csbk mfr crw 2m .5 �.6 Ground 3 19 -8 ml na na .7 .8 elev. 10 ft. �� y, Depth to V KC l 0 aaa 3 to �- limiting factor / 3 0 +84 Remarks: Boring # 1 0 -12 10 r 4/3 none sl 2msbk mfr Cfw 2c .5 .6 2 12-84 cos 0SCI ml na na .7 .8 Ground elev. 1 OA - B - ft. Depth to limiting factor +84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 New Richmond I 54017 Signature: Date: 6 -10 -99 CST Number: m02298 f 1 PROPERTYOWNER Derrick Construction SOIL DESCRIPTION REPORT Page 2 -ofd PARCEL I.D. # 040- 1070 -10 Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bourxiary Roots Bed Trench .................. ................. .................. ................. .................. 1 0 -11 10 r 3/3 none 1 2msbk mfr gw 2c .5 .6 3 `> 2 11 -18 10 r 4/4 none sil 2csbk mfr gw 2m .5 .6 Ground 3 18_ cos 0SQ ml na na .7 .8 elev. 1 02. O ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -19 10 r 3/3 none 1 2msbk mfr gw 2c .5 .6 2 19 -36 1 r 4 4 none ail 2csbk mfr gw 2m .5 .6 Ground 3 36 -84 7.5 r 4/6 none c'os osg ml na na .7 .8 elev. 99.8 ft. — Depth to limiting factor { t ✓ L'`f • 't r factor +84 Remarks: Boring # 1 0 -12 10 r 3/3 none 1 2msbk mfr gw 2c .5 .6 5 2 12 -30 10 r 4/4 none s'1 2csbk mfr gw 2m .5 .6 Ground 3 30 -80 7.5 r 4/6 none cos osg ml na na .7 .8 elev. 9 9.4 ft. Depth to limiting factor +84 , 1 Remarks: Boring # Ground elev. ft. Depth to limiting factor l Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 NE4NE4 S18- T28N -R19w Nei Richmond, WI 54017 MPRSW -3254 lot #23 -Deer valley (715) 246 -6200 This soil evaluation was conducted to satisfy a zoning requirement, it Day or may not be suitable for your use. The location of the test may or may not te as shown as permanent lot lines were not established at the time the test was co acted. _N 1 " =40' -ABM.= nail in Pine tree C el. 100.00 Alt. BM.= nail in pine tree @ el. 105.10' r 110 b� ��► 1 25 r �3q Gary L. Steel 6 -10 -99 09/08/2005 17:04 FAX 715 386 9174 FNB HUDSON 1a002/002 I. U. 24 15P- 305 74 4 0 x438 WA RRANTY DEE KAYLA E (I fl� Doc ument Number BEGS (I DEEDS ST. X CO., MI THIS DEED made between Deer Valley Partners ( "Grantor") RECE E'DR RECORD and Sean A. Murphy and Laura J. Murphy, husband and wife, as survivorship marital property ( "Grantee'), 89/2 6:{ 08:20AN WITNESSET that the said Grantor, for valuable consideration conveys to Grantee the following described reel estate In St, Croix WARR IIEED County, State of Wisconsin: I REC 11 .1110 TRAM E: 287. ,f0 Lot 23 (twenty - three), Plat of Deer Valley In the Town of Troy, COPY 5t, Croix County, Wisconsin Recardina AreCC F t Name and Re -w- WV j 0404261 -30-M (ParcelldemNeation Nur bar) This Is not homestead p pony Grantor, Deer Valley partners, a Wisconsin Limned liability Partnership, Is an affiliate of Derrick Ho nes, LLC, a Wisconsin Limited Liability Corporation. Grantor develops land and Derrick Homes. LLC is a home onstruction contractor. Grantor agrees to *ell this lot to Grantee on the condition that Derrick Homes, LLC will the builder o f the home for Grantee. If Grantee does not commence eonstructior with Derrick Homes, LC as the contractor /builder within two (2) year* of the date of sale of this lot to Grantee, Grantee gives Grantor the irrevocable right to re- purchase the tot for the some price as Grantee paid Grantor for it when Gra a bought 4 from Grantor. If Grantee desires to sell the lot to another purchaser befom constructing a home n this lot, Grantee gives Grantor the right of first refusal to re- purchase the lot for the some price as Grantee pe Grantor for It when Grantee bought it from Grantor. Dated this 1Aip day a' a ember, 200. • chael R. Stevens AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN $7, CROIX COUNTY Personally rams tnfore me this 151h day of apte twl, 2003 euthenkicaM this _ day of . 19—_ the above named Michael R. Stevens ond Ronald L. Derrick, as partners of Deer Valley Partno rs to m known to be the persona who executed the foregoin 1 instrument and signature acknowledge the smm . type or print name &w- o _ TITLE; MEMBER STATE BAR 05 WISCONSIN signature (If not type or print name T erri L. Woulfe authorized by' 706,06, Wis. Scats.) Notary Public St. Croix County, Wisconsin. My rAT I�QE-x Z August 14, 2=. THrS wS e was DRAFTED BY .N eta a ryp or D ee r r Val Valley Partners p berow N � PO Sax 445 r"�IrJllli New Richmond, WI 54017 STATE; U WI .", , Parcel #: 040- 1261 -30 -000 09/13/2005 04:13 PM PAGE 1 OF 1 Alt. Parcel #: 18.28.19.1402 040 - TOWN OF TROY Current `, ST. CROIX OUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Perm t Type 00 0 Tax Address: Owner(s): O = Current Ow r, C = Current Co -Owner SEAN A & LAURA J MURPHY O - MURPHY, SEAN A & LAURA J PO BOX 25793 WOODBURY MN 55125 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 385 WHITETAIL LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.656 Plat: 1899 -DEER VALLEY SEC 18 T28N R19W PT NE NE LOT 23 DEER Block/Condo Bldg: LOT 23 VALLEY Tract(s): (Sec- Twn -Rng 401 ) 4 1601/4) 18- 28N -19W NE NE Notes: Parcel History: Date Doc # Vol /P ge Type 09/23/2003 740888 2416/305 WD 09/23/2003 740887 2416 04 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed w h: 0 Valuations: Last Chz riged: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.656 95,900 0 95,1100 NO Totals for 2005: General Property 2.656 95,900 0 95, 00 Woodland 0.000 0 0 Totals for 2004: General Property 2.656 95,900 0 95, 00 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 Parcel #: 040- 1261 -30 -000 09/13/2005 04:26 PM PAGE 1 OF 1 Alt. Parcel #: 18.28.19.1402 040 - TOWN OF TROY Current [Xi ST. CROIX OUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Per t Type 00 0 Tax Address: Owner(s): O = Current Owr 3r, C = Current Co-owner SEAN A & LAURA J MURPHY O - MURPHY, SEAN A & LAURA J PO BOX 25793 WOODBURY MN 55125 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 385 WHITETAIL LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.656 Plat: 1899 -DEER VALLEY SEC 18 T28N R1 9W PT NE NE LOT 23 DEER Block/Condo Bldg: LOT 23 VALLEY Tract(s): (Sec- Twn -Rng 40 114 1601/4) 18- 28N -19W NE NE Notes: Parcel History: Date Doc # Vol /P ige Type 09/23/2003 740888 2416 05 WD 09/23/2003 740887 2416 04 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed w h: 0 Valuations: Last Cha nged: 07/23/2004 Description Class Acres Land Improve T tal State Reason RESIDENTIAL G1 2.656 95,900 0 95,100 NO Totals for 2005: General Property 2.656 95,900 0 95,100 Woodland 0.000 0 0 Totals for 2004: General Property 2.656 95,900 0 95, 00 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 I DEER VALLEY Located in the NE1 /4 of the NEi /4, Part of the SE1 /4 of the NEi /4,.Part of thel SWIM of the NE1 /4, and part of the NW1 /4 of the NE 1/4, of Section 18, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY; WISCONSIN LOT 1 2.3 Acri is LOT 11 2.7 Acres LOT 13 H 4_E Acres 0 Z Q ' LOT 10 W 2.7 Acres LOT 14 J 32 Acres 0. 9 Z .3 Acres W d Z LOT IS U14PLATTED LANDS LOT 16 2.3 J 2.3 Acres LOT 6 w Acres 3.4 Aces Q J LOT 17 24 Acres LOT I* LOT 23 LOT 7 LOT 26 2_S Acres 2-6 4.7 Aces LOT 22 Acre' 2'9 2.7 LOT 29 Acres IL 6.5 Acres L07 LOT 6 w LOT 19 2_4 2.7 Acres 0 2.3 Acres Acres LOT " L 3.4 Acres 3 0 LOT S U 2.7 Acres LOT 4 LOT 2S 4.8 Acres 2.3 Acres LOT L DT 2 3.7 Acres 2.a Acres LOT 26 3.3 Acres LOT 27 2.7 Ames T 1 2.3 Acres Existing House East Cove Road 3 7976. 1 1 VOL 19 PAGE 4996 KATH= H. WALSH REGISTER OF DEEDS ST. CROIX CID MI RECEIVED FOR ECORD 06/14/2005 62:16PK CERTIFIED SURVEY MAP Rw 1 0. fe 0 Y E: 3.00 CERTIFIED SURVEY 1V� , : 2 LOCATED IN PART OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 SECTION 30. TOWNSHIP 30 NORTH, RANGE 19 WEST, TOWN OF ST. JOSEPH, ST. CROIX COUNTY. WISCONSIN. OWNERS NORTHWEST CORNER NORTH 1/4 CORNER OF JOYCE BROWN OF SECTION 30, SECTION 30, FOUND 340 COUNTY E FOUND PK NAIL. NORTH BERNTSEN CAP HOULTON, WI 54082 LINE OF THENWI 4 / S 89 22 19 E 2553.60 JERRY AND MARLO SCHNOBRICH 1244.09' 3 1309.51' 2105 WHITE PINE ROAD, HUDSON, WI 54016 OR NOTE: o N UNPLATTED LANDS 0 P3 BEARINGS ARE REFERENCED TO v) THE NORTH LINE OF THE V I N $9 W 247.47' NORTHWEST 1/4 OF SECTION 30, 3 ASSUMED TO BEAR S89'22'19'E. o I wl r - — — — — — — — — — - � NOTE: I I 1 LOTS MAY BE SUBJECT TO wl I I FUTURE SPECIAL ASSESSMENTS o 120' 20'�� FOR ANY UPGRADES AND nommw IMPROVEMENTS TO THE RO `� o �` � i I I GON o SETBACKS: •••• LOT 1 SIDE = 20' �} • ROGER LYNN � I I M REAR - 25' HUtpt I 130660 S. F. I of FRONT 100 Z I S,21�6 � I 3.00 Ac. I a _ I w �I MLLE � 3 I I LEGEND: z I I W I 1= FOUND 1 IRON PIPE q C4 ul 1 I 00 J O SET 3/4" BY 18" IRON w I I $4 j PIN WT. 1.50 LBS. /FT. z 3 l I O COUNTY SECTION MONUMENT w I I Z co (FOUND AS NOTED) l7� M Lo I I w 09 SOIL TEST LOCATION I p w �J BUILDING SETBACK i 12' UTILITY EASEMENT o i r I / �— PROPOSED DRIVEWAY ~o i I C4 ©° L3 W - L2 DEDICATED TO C2 _ _ _ L " 14 ' _ THE PUBLIC L1 . _ _T R OAD w SC i goo _ — — — _ _ \ — � — — — 4441 S.F. o so goo \ / C5 0.10 Ac. 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