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HomeMy WebLinkAbout040-1303-00-024 Wisconsin,'Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 514900 0 GENERAL INFORMATION 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: Meyer, Gregory & Nicole I Troy, Town of 040 - 1303 -00 -024 CST BM Elev: Insp. BM Elev: BM Description: A Section/Town /Range /Map No: D , � �, �,S'(" 22.28.19.1759 TANK INFORMATION n ELEVATION DATA TYPE MANUFACTURER %,ivy CAPACITY STATION BS HI FS ELEV. Septic 'T.� Benchmark / Z"6 b _ % Gs-' 7. Ve 16 8.1}) Alt. BM //.5 z /63 , $9 Aeration Bldg. Sewer 8. 5 5 C )9/ Holding SUHt Inlet St/Ht Outlet 99 , TANK SETBACK INFORMATION i Z7 , `I[ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt inlet Septic / � _ U Dt Bottom \ Dosing Header /Man. 17- Aeration Dist. Pipe �+ 7(0 . gr Holding Sot. System 1 7� g f! 7 PUMP /SIPHON INFORMATION Final Grade 7•$ /Gl7 • 5T Manufacturer Demand St GPM �.S C-O .ljZ /03. -5 Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain ength Dia. s . to well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length/ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1(0 4 - 5(o ""re.,► C'AU '*_1 SETBACK SYSTEM TO P/L BLDG + WELL LAKE /STREAM LEACHING Manufacturer:l INFORMATION CHAMBER OR Type / Of System: 3f y , ' n UNIT Model Number: O W *2 DISTRIBUTION SYSTEM e( Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Ai n Length Dia Length Dia Spacing P_ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over f IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center L f. 77 1 Bed/Trench Edges \ Topsoil ` Yes [] No '11�y E] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 262 Walnut Hill Wa River Falls, yVl 54022 (SW 1/4 SE 1/4 22 T28N R19W) alnut Hill Farm aka The Tribute Parcel No: 22.28.19.1759 G J 1.) Alt BM Description = 2.) Bldg sewer length = Z - amount of cover = � Plan revision Required? ❑ Yes Use other side for additional information. L. 1 j� _ _ ; _ _ __ __ ___ _ ___ l___ SBD -6710 (R.3/97) Date Insepctor's Sign ure Cart. No. d D Safety and BuildiI�ivision County W 201 W. Washington Ave. P.O. Box 7162 S1.CPD+ �sevnsin Madison, W 370 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 26 51 5 /'y 60 I.D. Number Sanitary Permit Application State Plan N In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1 D Project Address ( / ifdiffere than mailing address) 1. Application Information — ease Print All Informd ton &d rrt/C,c /h I L � ✓ l� Property Owner's Name U Parcel # Lo -­ Block # (, re M� e S v v o5�0 . / 60 - Property ier's Mailing Address S1 CR O1G U'- Property Location , 7S5 l�1 I � t e. S�+ zo N'N � J City, State Zip Code Phone Number - Section R \ l vt r Fa S �V T 5419 as � 51- A — t�J 1p / (circle one) T ,,&N; R_,?9�E or W II. Type of Building (check all that apply) � ,t \ O L ` , 4 S J tt Subdivision Name CSM Number �I or 2 Family Dwellin g �i• Number of Bedrooms 1 Iy r i(f ❑ Public/Commercial — Describe Use / ❑ State Owned — Describe Use t �� ❑City _❑Village •Township of �rd y M III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. �y iOt New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System ----- Previous Permit Number and Date Issued ❑ Permit Renewal El Permit Revision El Change of El Permit Transfer to New Before Expiration Plumber Owner �� e IV.'Vype of POWTS System: Check all that apply) 'n WNOn — Pressurized In- Ground 11 Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil El At-Grade 11 Single Pass Sand Filter ❑'�" S — p Constructed Wetland ❑ Pressurized In- Ground 11 Holding Tank El Peat Filter El Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ � / , Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required ( f) Dispersal Area Propos d (st) Syste El ti oo ✓ 87 857, 1 E5 1 560.. A VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New 2 Existing Tanks Tanks Septic or Holdinz Tank �O wt) / ! e r Aerobic Treatment Unit 7 Dosing Chamber VII. Responsibility Statement- I, the undersigned, a ssume responsibility fo iSajallation of the POWTS showl on the attached plans. Plumber's Name (Print) Plumber's Signature MP/ PRS Number ' It t; B Phone Number bou -te 9th / 3 � Plumb Address (S City, State Zip Coc ' n I/ nT .A 7b `0 rl r �J I i YI a W.+, 420 Vlll. Count /De artment Ilse Onl pproved ved Sanitary Permit Fee (includes Groundwater Date Issued Issuing nt Signature /10 S nps) Surcharge Fee) z156 . 4 / O OG iven Rea brr�or Denial y / JU U IX. Conditions of Approval /Reasons for Disapproval c; SYSTEM OWNER: 1. Septic tank, effluent filter and ✓✓ {^ f ` twr� ^ 7 dispersal cell must all be services'/ maintained as per management plan provided by pkl llw. t� f 2. AD setback ►ltWitements aKW be mWntWhed ae per apps th tro / 0*in . A `f .)e_ Q Attach complete plans (to the County only) for the system on paper not less tha 8112 x 11 inches in size SBD -6398 (R. 01/03) a a. t !� . \ 2 22� E I § ƒ■ *6d, 2 \ e § 2 LLI ` q & d Cal A7d w w § 7 k iz 2 ■ �� m w � ■ § E § oCL _ a » a2m w � % § 2@ s LL- � � E £ 6 ƒ & Go ie kk k 0 \ k e � a . Pmposed ' y L ° �e � , w FENCEuNE 4-- Ecqp r O ' a s 0 OD N i M H ca N O Y a a 5 CO 05 e N 's5 a Z 0 H W ao ¢ Cal° U W W %� m° o a. !7 U d v. c N 0 _ 0.— J a O o� m$ LD c o co � S Q c c° c 4 o � o CV � CCC...777 O O Proposed Driveway L ' M FENCEI.INE 4- U i / Wisconsin Departrnent of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code county ST Ze O/ Attach include, p of EROSION CONTROL PLAN must be i I.D. 1 - 0 7 percent slope, sc completed before sanitary permit issuance P D!_*3 Cry b R 'wed by Date Personal Wornu ion you Provide may be used for secondary purposes (Pm aay Law. s. 15.04 (1) (m)). Property owner C Tovv IJ Property Locatiion 0 7-L- T PP 17 ERS Te � / A 1/� IY4 Gout. Lot 14! 1A J � 114 S T 2 i/ N R /g & ( W �l Property Owner's Mailing Address Lot Block # Subd. Name or CSM# too 1 .7 y [ - 1 5 CA Wi 1-1- Atj-e- • 41ALWOr Kill FARAf � City SN Wk> State Zip Code Phone Number ❑ City ❑ village (A Town Nearest Road m (-ROVE HTT I MAJ 1 550 We ( &5r ZY8• t09 _rRoy So. &lovER 0 R New Construction Use: (9 Residential ! Number of bedroorns Code derived design flow rate 0 D a GPD ❑ Replacement ❑ Public or commercial - Describe: Panent material s A,D Flood Pion elevation if applicable General con rents 6of 41,fA and reoorrxrrendatiorrs: S i 7 TES 7TH SA R p .�S M e # ® Pit Ground surface elev. / oa it Depth to listing factor ,! " m- Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffF b in. Munsell Qu. Sz. Cart Color Gr. Sz Sh. *M1 'Eff#2 / o i5 G 2,A s h A) , S z If - ?/31 o v.4 sa L l S s G 4,) 3 3- D /o sip v 4 --5 • 2 — 3 �srR S o • '� r o Ej 0 Boring 1 Q ,� ® pit Ground surface elev. ft Depth to Ding factor . Sofl Rate Horizon Depth Dominant Color Redgx Description Texbxe Structkxe Consistence Boundary Roots GPDlfP in. Mtmseil Qu. Sz. Cont Color Gr. Sz Sh. 'Ef1#1 'Efi#2 (� L 24M f AW 6e -3 S Y N 3 0 ion si 17 dx A et 5 / z . 3 f GS - / 'Effluent #! = 8013 30 < 220 nnglL and TSS >30 1 150 rrglL ' Effluent #2 = BOD < 30 and TSS < 30 rrgfL CST Name (Please Prirrtj •� • - A Lz P, ` G t► .�___ �9 22 5 Address Ulbricht & Ass9ciates Date Evalta" Coed Telephone Number Z Private S a l — (' 7t f • 77A • `�`� 2812 1 Oth Ave. Spring Valley, WI 54767 ©yp • dogs • so • � O /o�� • /D • oar oyp • /ogG • _0 • o� oyo•/o81�- &0•� oyo•io *6 - 70- � o yo . ,��� �o • o� G,; i• N A , i r 4 'J I f r Tov� l3 JE e sTEDT PMPWtyOwner Pancet iD Ga f Zy Z or 3 0 Q Bottog PVe 3 Pit Ground surface elev. . � ft- Depth to 1knwv factor � tn. lforizott Depth Dominant Redox 5oa mate t'ti«+ Textuns sbuctrxs Consisterzae Y Roofs G POM In. MunseB Qu. Sz Cont. color Gr. Sz. Sh. 'Eff#1 'Eff#2 �y /d L /) m J W S T/ 3 /a S/L /-Cs cs / o,S •"7 g • it r Bvdn # ❑ Pit GMWndsurfaceelev. tt.. Depth to Umiting factor . horizon Depth Doman SON art Rate Redoxl?esairpGart — Texture Sure ConsistOnCe Boundary izz GPLJRF - MunseB tau. Sz. Cont. Color Gr. Sz Sh. t . I t i ❑ Pit Ground surface eiev, f{. Depth to limiting factor #n 1 iorizon Sod Appkabw Rate t)eptlt D�ttinattt RecW Desa"on T Structure Consistence Botxrduy Roots GPM In. Munsel Qu. Sz Cont. Color Gr. Sz Sh. °F.fl 1 `Efl#Z soft # i 3 tl S(Xing Pit Ground surface lt. Depth bo grating factor in. Hohzon Depth DomNmt R Sod Rite Description- Texture Structure Consistence 8armdaey Routs GPOtfF in. Munsev Sz Cont. Color Gr. SZ Sh. °Eft#1 TOM LE i Effluent #1 = 8 > 30 = 220 rngti_ and TSS >30 1 1.50 PxYL ° Effluent #2 = BOD < 30 mglt. and TSS < 30 tnWL The Department of Cornmcrce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608-264-.8777. SBD33 -LO (R[JOOt r TODD 131 E 12 5 TED7` /� Property owner Parcel to ,, t Ground surface etev. Depth to limiting factor � } ttorizon . Depth Dominant Color Soil Rate Redox D Texture Structure Consistence Boundary Roots GPDJAY In. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. o 'Etf#1 'Eff#2 L' � r) r &,1, # 0 Boring El Ground su Pit dace elev. ft. flepftr to flrr3iGrrg factor Solt Application Rate Redox CaesaipGon Texture �x�xe Ctxrststenoe �- H Boundary Roots GF[?� Qu. Sz. Cont Color Gr. Sz Sh. Boring Q pit Ground surface elev. ft, Depth to limiting factor in. y SON Rate Depot Darrenant Cot Redox Description_ Te Structure Consistence Bnutxfaq Roots Gp[} in - Mrmsep Qu. Sz. Cont Colon Gi: Sa Sh. °Eff#1 'Ef #2 t - � honing # � Boring Pit Ground surface a fi. Depth to limiting factor in. Soil AvO lion Efate Hortzon Depth Doinkont Color R Desription. Texture Structure Consistence Boundary Roans GPDW in. Munseil Qu Sz Cont. Color Gr. Sz Sh. °Eff#1 °Eff#2 Mont #1 = i0l), > 30 < 220 apt and TSS >30 150 rngI ° Effluent #2 = 800,:S 30 mg1L and TSS < 30 nwyL The Department of Commerce N an equal opportunity service provider and employer. if you creed assistance to access services or treed material in an alternate format, please contact the department at 608 -266 -3151 or TTY 648 - 264 -8777, se�aa3o Rra�ao} y ti PLOT PLAN WALNUT HILLS FARM. LOT # 2 / Pg. 3 of 3 = Contour elevation lines. • = Backhoe Soil pits. O = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE: 1" = 30 t ,nn K ,SIP. i z3 `1 0 133 35 B I a b 03 Sm 2 1 , 103,6q 00L 5 v 3 Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring valley, Wl 54767 i r i .LD'LK 3_ ff.- 0 N /` ei t,- El " I:i r p � I � � 1('"R a J w I S E i s I � n � _.. ��Jl n a, �Y+,� _ / 8 ^` ' �p l < � / W n t- — — N O'r3D•\5- I • i- � � � 1' 0. O, S �f � 3 s / 1 1 ' _ - � O -i U N J _Z gl h� i w 111. i I N \i`h •`fy\`� -�( n . l 1 a `� p af, � � � N \6 I I 1� , I � � H \$ � I" Dr 3.(f, ^II 11 "�Fr \ 1 � *a w ' � �^u� � \ I � <sr •� ��.�1' �( 1 t -m +. // _ ;� ��J � -__ _ � �' /�j /�! ' �" ° a 5 o.?6 - 1 — _ �' .� �%�, i // �•� / a � "�ra� ten. �/ � I 1y� . _ �• i� — >a � r�`rN /�- -.—."- � / / v I Ala • ' ° /(.o�.� /+ �/(j(pl _ \•N N��. / Vl Nn 1 -� 0 // �m _- � I�'� I I � I �� 1 _ tip. /,,�• // o I $ vs ari w *0 NI - I w' I � -, � C � / _ � _ _ N 02•]9 w — — _ lRI / € 0: rcz 3 t N� o L $- mrc W 5o c U3< W<H OOO -, °2`"'3'< z j�SYr i. 0 � u , \N 1 --1-H Ir - �:.Of� 6NW OZ VfK ZOZ <� �� < wp�0Fw N N N w <a <r 1 1 arz N,q <z b - FB I •i. Fd00��0 S °Ins r a v+ W a Z' m � WW o o ° Z o� of u X00 m 1�OrF a r = W 1 �Q OO O Q� f � Za < N Q N m (W N $a3W <U i ° O bi g L1] W ° o <�g 08 'w' W p <r W ^^ y� Z IE ZZm�� IIryN Z Q2�NNI/,NZO �53aV3 W 7Q k Y II ]Y OWZ_ 7�j W V WUI < 2 5( < a~W33WWm1U/1aF2� m UY��s < OW W1 (�m7j=1 -W aam zry ov o� o�i�o=> yz W �Ylz=� a WW � < znzz yI I r �� z <1�$ aa� O H Z Nm H r °< ° i$� &�1 a~NKN ~~ W 00 <y OV -V K 4w °��< i A °zE3?� ,`.It'� SYSTEMS INC Calculations and Drawings Site Conditions Infiltration Elevations Site Type: Private Trench #1 Trench #2 Trench #3 %Slope 6% Cont 101.001 101.501 102.00 Ft # of Bedrooms 4 Infiltration Elev: 98.501 99.001 Ft Depth to limiting factor 98 inches Limiting Factor Elev: 92.83 93.33 93.83 Soil Application Rate: 0.7 gal /ft ^2 /day Treatment and Dispersal Zone: 5.67 5.67 5.67 Effluent Quality Eff #i V Cover Material Required: 0 0 0 In Design Flow: 600 gal /day Finished Grade Over Cell: 101.00 101.50 102.00 Max BOD 220 mg /I Max TSS 150 mg /I Distribution Cell Choose chamber type: Septic Tank Infiltrator Quick 4 Standard Manufacturer: Wieser # of trenches: 3 Volume Chosen: 1250 Chamber Length: 4.00 Ft Effluent Filter Selected: Zabel A100 Chamber EISA: 19.1 Ft2 Note: Access opening of sufficient size to be provided to allow removal of filter. Endcap EISA: 5.8 Ft2 Opening to terminate at or above grade. Required Infiltrative Area: 857.1 Ft2 Actual Infiltrative Area: 857.8 Ft2 Total # of Chambers: 44 Cross Section of Septic Tank Total # of Endcaps: 6 Combined Length of Cells: 182.0 Ft 12" Min Grade Cross Section of Cell 18" Min Cover Material Observation Pipe cif required) Final Grade All joints to - be water tight D3034 or Ground �Effluent Sch40 Contour Filter Pipe Leaching System Chamber Elevation 3" Bedding Under Tank I-enq -- 0 Y , 0 A5fM 051 06*eryaUat w1dik or 5ck -10 4" i'Ipe I' ie PVC P Ipe I Infiltrator and the Infiltrator logo are trademarks of Infiltrator Systems, Inc. Spreadsheet provided under license to Infiltator Systems, Inc by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 I In- Ground System Management Plan pursuant to comm 83.54W. A. C. Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and /or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical /biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Absorbtion Cell The absorbtion component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems /failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter conditions. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank or other components therein (including floats, alarms, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the absorbtion component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by removing the clogged bacterial mat, aggregate /leaching chamber cell, and distribution piping within the cell and replacing failing components in order to return system to proper working order as required. If repair is not feasible, a new system is to be constructed in a designated replacement area ST. CROIX CO UNTY SEPTIC TANK MARM NANCE AGREMdENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L;4M MfMe� Mailing Address /'71 y (J �;d��� - � • i V�.���5 , r ©c2 Property Address a (Verifiaat=r d from Phnmatg & Zonng forne �,� n) W a IV U-1 ; l City /State Parcel Identification Number i- LEGAL R&S ON Property Location '/� , '/o ,Sec. c;?,l TN R�W, Town of "f!'0 y Subdivision it/,41A&+ l -r/-l'M , Lot # 94 Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines idea fubie yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and mamicnance 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 pamper. What you put into tie system can affect the fimcdon of the septic tank as a treatment stage m the waste disposal system. Owner maitneniance responsibilities are specified in §Comm 8352(1) and in Chapter 12 - St Croix County Sanitary Ordunanoe. The property owner agrees to sirbmit to St. Croix County Planning & Zoning Department a certification foam, signed by the owner and by a master pbimber, journeyman plumber, restricted phmnber or a licensed pumper verifying that (1) the on-aft wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary),, the septic tank is less than In fill of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal sysam with the standards set forth, herein, as set by the Depaument of Coa>incrcx and floe Departnient of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained mast be completed and returned to the St Croix County Plain fang & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amlare the owner(s) of On property described above, by virtue of a warranty deed recorded in Register of Ikeda Office. Number of bedrooms A 'A,A �I ' 1D7 $1 GRATWE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. lrmhude with this application a recorded warranty deed from the Register of Deeds Office and a copy of flue certified survey map if reference is made in the warranty deed.. (REV.1iMS) . g366, 01 j( STATE BAR OF WISCONSIN FORM 2 — 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., W1 Document Number RECEIVED FOR RECORD This Deed made between BrightKEYS Development Corporation, a Minnesota Corporation Grantor, and Gregory W. Meyer and Nicole K. Meyer, 10/13/2W6 10:40AK Husband and Wife, Grantee. WARRANTY DEED EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more REC FEE: 11.00 space is needed, please attach addendum): TRAMS FEE: 192.00 COPY FEE: CC FEE: Lot 24, Plat of Walnut Hill Farm in the Town of Troy, St. Croix County, PAGES: 1 Wisconsin. Exceptions to warranties: Easements, restrictions and right -of -way of Recording Area record if any. Name and Return Address PUgT — �coQ 1345 040 - 1303 -00 -024 Parcel Identification Number (PIN) This is not homestead property. Dated this 6th day of October, 2006. Brigh YS Development Corpo n • 7. * * Donna M. Caywood * * ACKNOWLEDGMENT AUTHENTICATION STATE OF MINNESOTA ) ) ss. Signature(s) authenticated this day t: (Kounty ) of > Personally came before me this I day of to , the above named BrightKEYS * Development Corporation, a Minnesota Corporation to me known TITLE: MEMBER STATE BAR OF WISCONSIN to be the person who executed the foregoing instrument and (If not, authorized by § acknowledged the s me. 706.06, Wis. Stats.) I -C CoAt/ THIS INSTRUMENT WAS DRAFTED BY BrightKEYS Development Corporation, Donna M. Caywood, Notary Public, 707 Commerce Drive, Woodbury, MN 55125 My Commissio i : y afiNE f , €*ir on date: ry ( Signatures may be authenticated or acknowledged. Both are not necessary.) y Commission Expires January 31, 2010 *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 — 2000 1of1 I Parcel #: 040 - 1303 -00 -024 06/18/2008 12:39 PM PAGE 1 OF 1 Alt. Parcel #: 22.28.19.1759 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): O = Current Owner, C = Current Co -Owner O - MEYER, GREGORY W & NICOLE K GREGORY W & NICOLE K MEYER 644 PATRICK CT RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): r (* = Primary Type Dist # Description * 262 T R4B4T - 9- Y SC 4893 RIVER FALLS r-1 SP 0100 CHIP VALLEY VOTECH J �� Legal Description: Acres: 1.300 Plat: 09- 092 - WALNUT HILL FARM 1/75 040 -03 SEC 22 T28N R19W PT SW SE WALNUT HILL Block/Condo Bldg: LOT 024 FARM LOT 24 (1.300AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 22- 28N -19W SW SE Notes: Parcel History: Date Doc # Vol /Page Type 10/13/2006 836601 WD 03/28/2006 821622 WD 12/10/2003 748768 2471/594 WD 11/19/2003 747018 9/92 PLAT 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.300 69,900 0 69,900 NO Totals for 2008: General Property 1.300 69,900 0 69,900 Woodland 0.000 0 0 Totals for 2007: General Property 1.300 69,900 0 69,900 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