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040-1153-60-000
r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bu :ling Division INSPECTION REPORT Sanitary Permit No: • 515052 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Lee, Thomas B. & Robert E. I Troy, Town of 040 - 1153 -60 -000 CST BM Elev: Insp. BM Elev: BM Descrip fin: Section/Town /Range /Map No: 23.28.20.603 604 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. �L Septic Benchmark <— - -- j . P o, /5 rJ, I. �'� '7o7. � Dosing �� Alt. BM 7SZ' c s Aeration k 5 .J S Bldg. Sewer y 3 P Holding t Inlet L iJ• t/ 9 St/Ht Outlet TANK SETBACK INFORMATION p TANK TO P/L WELL BLDG. Vent it Intake ROAD Dt Inlet Septic D B�ott rn / < , _ s_ / / � e 3 10 t� c.4 n� �,., 713,P Dosing j f , p\ � �� Header /Mang 1 _ (s 7 Aeration XL.Ct )L Qist. P' e n Holding , ' , Bot. System 2- Final Grade PUMP /SIPHON INFORMATION CO� –==— I _ ( e - 72.3, 7 Manufacturer Dem nd §L Qaw— GPM �, A�1 n , �1 Model Number / 3 V"" " kl/. 3 Z /9` �9 TDH Li Friction Loss System Hpa /�1 TDH Ft - S Forcemain Length Dia. Dist. to Well 31 . lS SOIL ABSORPTION SYSTEM = 125� BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 2 SETBACK SYSTEM TO P/L PJ JBLDG WELL LAKE /STREAM LEACHING Manufa u , „ _ - } INFORMATION CH l�✓� Type f System: T UNIT Model Number: DIS IBUTION SYSTEM Bader/ a(n/i�fol tr' ution / I x Hole Size x Hole Spacing ent to A Intake I Length "' O D Length Z Dia Spacing ! Y— SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center I Bed /Trench Edges Topsoil Yes No * Yes D -No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: _5 ,�ry�� --��� Inspection #2: 3 S �a 23.28.20.603 604 Location: 190 Cove Rd. Hudson, WI 54016 (N 1/2 NE 1/4 23 T28N R20W) St. Croix 7B c© �t 1, 1 1.) Alt BM Description = S �pa d • ! / 2.) Bldg sewer length = l ss v�/�LG� - amount of cover = _ Ch'.r cJ 3 jp a` a 67�4pel ct CAU , ision Required? Yes XJN, side for additional information. � —_ i _ Date Inn sse y p p ctor's Signature �` 9 /�� Cert. No. I 1 E. j 1 h LOT 20 I 1 `` ST. CROIX BEACH PROPOSED 1 I N 750 GALLON 2 I I 0 �O P v r�0 POLYETHYLENE 1 PUMP TANK h o 1 hl ,gyp � ELM � o, DIST TION LATERAL ", � / J PROPOSED 3 WIDE EZ FLOW TRENCH, / J TYPICAL, SEE DETAIL h 2 2 " CHE RR Y o 3 0 f • � ' S SE I i LOT 19 ST. CROIX B, 4' Y E 3' , 6 6 I t I o •' I HERRY o � +� I 2 „ CHE Y 0 t 72" & 14 " PROPOSED OAKS V , 1000 GALLON I B6 POLYETHYLENE OPES < 12% w SEPTIC TANK �•� - _ , _ _ - _ _ _ - dtil PP OX /�A TE EX/ TlN � - _ - _ _ 20 AK 4 k EP C t/ED TJ4NK TO BE r s "" IRON- 3b j WOOD ` '° 5 f jyh yc Bs LOT 18 ® ST. CRO/X BEACj 50 , ¢ �+ W p V o 7 10'0 D 1 gti WELL 50 ' SETBACK B FROM OHWM B3 114' I BENCH MARK: v 1 I TOP OF 1 1/4' o.d. IRON PIPE c o I I ELEVATi0N-707.42 (MSL 1912) LOT 17 0 I I Sr CROIX BEACH SCALE: OGDEN ENGINEERING CO. PROTECT LE Civil Engineering & Land Surveying NAME: E SEPTIC REPLACEMF 1234 S. Wasson Lane, River Falls, WI 54022 TOWN OF TROY, ST. CROIX COL Phone: (715) 425 -7631 SHEET TITLE: m ber192008.scj Web: ogdenengineeringinc.com TOPOGRAPHIC SUR' commerce.wi.gov Jatety and buildings Division county 201 W. Washington Ave., P.O. Box 7162 � Cr61X s n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) e Commerce _/5 0 anitar Y PP Permit Application State Transaction Number In accordance with Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental AJ A unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide,ft ondary p urposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Information - Please Print All Information Property Owner's Name Parcel # 2_t_ , Tum I�ee; APR 22 2009 - !1 - (;,o_o�i✓ Property Owner's Mailing Address P Pr Location �S 3 Yn D i �T cic�tX COUNTY p y l 4 3�� rl G PLANNING & ZONING OFFICE Govt. Lot G City, State ST n v� Zip Code O Phone Number y., 'A, Section ,? 3 7T i ('6Z_ 47 (p_ `613 y (circle one) II. Type of Building (check all that apply) Lot # O Tom' N; R ZCJ W I or 2 Family Dwelling - Number of Bedrooms / � I i�_ I `1 Subdivision Name 1�S Yry /' Block # ❑Public /Commercial - Describe Use cYl, l /J- 01A ❑ City of ❑ State Owned - Describe Use G' CSM Number ❑ Village of �" Cyc'lk fsea a 12 Town of �Y t Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System g Replacement ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) System B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List / Previous Permit ( Number and Date Issued Renewal Before Plumber New Owner Expiration IV. Type of POWTS System/Component/ Ch eck all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dis ers Component (exgl in) ' ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Q/ Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (ispersal Area Proposed (sf) System Elevation 5 Ptr)c%C 300 ,S ' i r p lc st D lU? ` cif uch french moo pi Vl. Tank Info Capacity in Total # of Manufactu er Gallons Gallons Units p Q rl�Ei �dl /v s' a U v F New Tanks Existing Tanks �zj O w a w w Q 4 P/A'/ v F i a Septic OM /000 13 ( 0 r e-S L o ❑ ❑ ❑ �I Dosing Chamber ' 750 175P 1 ❑ VII. Responsibility Statement- 1, the undersigned, assumSxqponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' ur MP / MRR Fia nber Business Phone Number Plumber's Address (Street, City, State, Zip Code) Rive'r - culls; 14%27 S.{ ()Z2_ VIII. County/ e artment Use Onl Approved _ Disapproved Permit Fee ffb Dot, Issued [ssUing Age t S' atu e y _ Owner Given Reason for Denial $ L IX. Conditions of Approval /Reasons for Disapproval : 3 n „ SYSTEM OWNER: ;+ " 1 Septic tank, effluent filter and S�te� -Util J ��.D Lcs dispersal cell must all be serviced /maintained V� as per management plan provided by plumber. t1 P All setback ire ij-qt hp 7 N1' co � e tans for the submit to the Co unty o nty only on a er not thap 8 112 x 11 inch in s ize as per applica _.� ble f�1fH . p _ p p ot less t (lmT/ s� �G� -4�- moved SB 6398 (R. 01/07) Vali thru 01 /10 Ilk TOTAL DYNAMIC HEAD /CAPACITY v HEAD CAPACITY ' CURVE.' PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 - MODEL 152 153 50 - — -- F Meters Gal, Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 70 265 15 4.6 53 201 61 231 _ 20 6.1 44 167 52 197 30 8— 25 7.6 34 129 42 159 " >_ 30 9.1 23 87 33 125 20 35 10.7 -- — 22 85 40 12.2 — -- 11 42 10 Lock V 38.0 Ft. (11.6m) 44.0 Ft. (114m) o+aeos 0 20 40 60 80 too GALLONS LITERS 0 80 160 240 320 — s 1 ja FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27132 • Timed dosing panels available. 0 3 27/32 Electrical altemators, for duplex systems, are available and supplied with an alarm,' Variable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. Sealed Qwik -Box available for outdoor installations. See FM1420. Over 130 °F: (54 0 10) special quotation required. 1521153 Series 12 1/8 1521153 MODELS Control Selection i Model Volts -Ph Mode Amps Simplex Duplex N152 115 1 Non 8,5 1 2 or 3 8N152 115 1 Auto 8.5 included 2 or 3 sKZCea E152 230 1 Non 4.3 1 2 or 3 BE152 230 1" Auto 43 included 2 or 3 N153 115 1 Non 10.5 1 2 or3 BN153 115 1 Auto 10,5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float SE1531 230 1 1 Auto 5.3 included 2 or 3 switch. Refer to FM0477. o CAUTION 2. See FMO712 for correct model of Electrical Alternator E -Pak, All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN � For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0; P.O. BOX 16347 Louisville, KY 40256-0347 Manufacturers of.. 0 SHIP T0; 3649 Cane Run Road p ♦'1�,Ip "1r' a Louisville, KY 40211 -1961 Qva[irYRIJAIRA S1, C6 /9 ,79 http.1Aaww.zoe11er com N ! L 0 ( 2) 7 FAX (502) 77744 -03624 PUMP O Copyright 2000 Zoeller Co. All rights reserved. PUMP CIIAMiIFIt CROSS SF.CTIO14 Atli) SPF.CTFICATIONS Vent Cap Weather Proof Approved Locking Junction Box Manhole Cover Hin Vent Pipe Final 4" min Crude ' F -T � u Conduit 18 Min 18" Min -- --' -- ' -- - ' - - t Approved Inlet 'it Joints w/ i ,;; C.I. Pipe aprovecl "' Extending ' pint w/ 3' Onto � ��� .I. Pipe Solid K t e n d i n g A Ground ' Onto „ )lid i ���Alarm -- 'ound B i On C Yu mp G Off _ Concrete Block D S PI_C TF ICATI ONS TANK PUHI' inufac turer :_L_+' linnuf ac curer : e ink Matcriul: %,y Model Number nnk Size: 7 a — Ca 11on-9 Switch' Tyro f Total Dynamic head FL. CAPACITIES Pump Diacharl,u Rata: 3S GPM L, Total Daily Effluent: 300 Gallons f�•• a`1�,�" or "779 Cnllons Numher of Doges: 3 per Day fj- or Gallons Dose Volume: zo6 Gallons C- or CO Gallons Iaotes - 1. See pump curve for p- lost or Cnllons ndclitionnl performance :)tal Tank informntion. jpacity Requirc.d - Gallons 2. 1'uinp and alarm me Lu be inatrilled on ticparat circuit ALAIIM au per I LIIR 16.19 WAC . nnuf ncturer: L Aioe -rv. Ddel Number: j i [ ch Type. � L m m D n < < m =r R CATER L AKE ST, C v 6 2pq$ ELEVATION =675,7 RO�x W (MSL r j C 1P .A i 0 0 0 �, a • -- — ... -- .. 00;K2 n =��> �rn��v m F m m m r p NCZ - r < < < M :c D p o >a- m `� ° om � y I r 0 0 - +m* ,�Z _� I z o 11 -� v m P a� + p z _ I rp CID O N 0 � N a I m I g m C p °0 O$ m < mmm 80 _ . -. Ro 690 _ - --�• _ _ m v 700 CD 0 68 S °o Pp 50 RETE 50 10 S A T / �O . to OD —_ -- I , 69 ` � _. —� - -- WALK 6 95 n - - 50' ` 50' IF IN m rOm O o� n a� ? I n �� ->° z�> I o �OOa - 4 o, ® . ` '°s K3 I \ a /O„ O _ k N 0 r .0 O W 710 oil (A o sW z z o I _ C , 1 0 C y 1 m Z c I Mo0;0 , w 0 � � ro r O OO d W73 „9 f m %? SD m �-� O -4 Q° s 7�s <� fl m oo�c I z a v - - - - -- o „ :U v� mo * - 0 s= c Z n ti I "mz . -. I PV 73 o` O y -ov-4v M >O ^�� 12" OAK w j cocnm M n n o I +•...-- ' -..-• 5' MIN: -f �' r -° m p p I 3" ELM -4 -4> N tit M w cs 0 - rn - m - v 17 � —1 CO) _E W - O n y I nro ca 70 �� I i ti ca rho = n .md m W O N t7 70 y I (7 rn rn _ z (/) O ..L C r o O r o R1 � I tf' O O D rn rn z rn �' I 10A� r ? - r I 2 0 CA p �— 50' I ° 50' _ a �� \ +n o \\� f7 i I m O n cn a ®� z SAINT o M z I I o CROIX c r o W �o m -0 , OO moo- - _ -2 ROAD R1 M Q o R E a - o o z D' -� -� -i rn � Z C P - m --izow mmp ork D6 z, � (NOT CONSTRUCTED m Z c rn uv p� �m� D ZZ _ u r Ai-1 0 mo M - n IM f ror-cn N0 p(p� O a-+1 C o tV O 0q cn�� - WZM m * o M - r m -h N .,� w w �p j z o c �c0 o tC - 'm m 000 °m O zm N ----- - - - - -- z m • o � x Wisconsin Department of Comm PA j ,)SOIL EVALUATION REPORT Page of Division of Safety and Buildings s th Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z Q Property Owner �C�F-%VE Property Location � I e-� o f Zee Govt. Lot � 114 °i' 1!4 S . � T � N R � ' E Property Owner's Mailing Address APR ry rt�0( Lot # Block # Subd. Name or CSM# City -' State Zip Code Phone Num8WU,A �,OUN � 4( p City ❑ Village Town Nearest Road � � r ❑ New Construction User Residential / Number of bedrooms Code derived design flow rate GPD ® Replacement ❑ Public or commercial - Describe: Parent material As , O ! Flood Plain elevation if applicable ft. General comments and recommendations: 4 Boring # Boring',e pit Ground surface elev. - , 7 ft. Depth to limiting factor + in. F sooApoication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y *Eff#1 *Eff#2 f "a .,� `� ` zir +,y''' (,® ...a ° „;•6'' r°” 1 4 It .te 4 � sr a -b3 a Boring # F] Boring ® pit Ground surface elev r 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 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CSTT Number Ad ress Date Evaluation Conducted Telephone Number F .."...,. 3 �;�_..., •,;. ,.. L.«�� !?' �a v�•t f" �`.. ��. i 1.�. ���� .. .r � w ,,. �.4�^�' J"' ,wn :� Property Owner Parcel ID # " 1/ � A Page d- of a Boring # ❑ Boring' pit Ground surface elev ' - ft. Depth to limiting factor 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 Ly r'w'u u.,-j - Aanr4 r65 4 ❑ Boring # Boring s in. pit Ground surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r 'Eff#1 I 'Eff#2 o Q C54 i �?��,?, { / Boring # E] Boring r+, X pit Ground surface elev. `; � ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i - Eff#1 I `Eff#2 =1 ° " 0 X12 (v 5 M 4 Al n ye r " * 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 format, please contact the department at 608= 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Property Owner - 7 - . - r, Le Parcel ID # "` 3 ° 0'"' ob 0 Page of 4 Boring # ❑ Boring _ Pit Ground surface elev. ft. Depth to limiting factor . ` in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF 9 in. 9 Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 'a t" rn V f . ,, 2v4w rn i * 3 2-6 f, 34' 8 /2 ' ! , EdIP A b d' RAiN F -1 Boring # El F1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mgtL and TSS >30 < 150 mglL * Effluent #2 = BOD < 30 mg1L and TSS < 30 mglL 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 format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -8330 (807700) M r Property Owner " ? Parcel ID # ` ' "° "` Page 4 o EDGE OF WATER ON SITE PLAN OCTO BER 8, 2008 ELEVA�ONE675. 77 CROIX 12 I ) I ORDINAR I MARK (OHW HIG M�, pER C LINTY TER h: NOTE: ST. CROIX I + LOT LINES + pOIICY, LEVATION -680 BENCH MARK: ARE APPROXIMATE, TOP OF 1 1/4" o.d. (-) b) IR ELEVATION= 09.92 �Q 0 g9 (MSL 1912 FLOODPLAIN & 680. .. ............... ......... ...I ............ FLOODFRINGE 6 ` ELEV =692 700 CONCRET � PA r/0 690 _ BENCH MARK: _ WA TOP OF 1 1/4" o.d. 5p' 50' IRON PIPE ELEVATION =707.42 x WELL (MSL 1912) STRUCTURE) LOT 17 71 to ti I ST. CROIX BEACH BI ® 'os 1 �),ro �eaG T'r DECK 50' SETBACK 1715 FROM OHWM L,4 /Lt� �/6,5cR 3 BEDROOM CABIN J y . ( 4 4 I a 0 _ 120 fl BS 725 12 ' B3 I B6 SHED SOIL BORING, i I TYPICAL LOT 18 ST. CROIX BEACH I LOT 19 1 ST. CROIX BEACH s r. r O I cRax SLOPES > 12% BEACH IRON PIPE I SLOPES> 12% • 50' 50' SCALE IN FEET SAINT CROIX ROAD (NOT CONSTRUCTED) jRON PIPE a- E a eLlll OGDEN ENGINEERING CO. DANIEL P. KUGEL CST #260693 Civil Engineering & Land Surveying 0 10 20 40 ' 1234 S. Wasson Lane, River Falls, WI 54022 CONTOUR INTERVAL =1' DATE �p Zvo� (715) 425 -7631 v;uX0 N G) v �.. 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT R ECEIVE® AND OWNERSHIP CERTIFICATION FORM APR 2 8 2009 '� /w /vl ; �,ruN7Y Owne ryer RIO � � L� � � �L s� Mailing Address 2 ' klN� ,/> k 4 V / Property Address qd �ff 7 1 1 BAR) ✓� �� (Verification quired from Planning & Zoning Department for new construction.) City /State U t l Parcel Identification Number —6.0 6 LEGAL DESCRIPTION (60 :3 3 �/ 66 Property Location GA Y /4 _ ' , Sec. Z , T 2d N R W, Town of U� Subdivision Plat: ST C't� D(u �� , Lot # M /l Certified Survey Map # , Volume , Page # Warranty Deed # �C� (before 2007)Volume Page # Spec house i yes / Lot lines identifiable lk es':. no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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. 1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set torth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of edrooms G�2- -- '!Y oky SIGNA IG OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of 71_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner OBZ (/ 1 � � L Septic Tank Capacity �I a l ❑ NA Permit # — Y Septic Tank Manufacturer r f� ❑ NA DESIGN PARAMETERS fffuent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units A Pum ,76—lj a l ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer /Ub'`1.((/�C2� ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ❑ NA Soil Application Rate 0 gal /day /ft2 Pump Model Z ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit XNA 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) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) L ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L XNA ❑ At -Grade C E )' ,./ 101do Mund Fecal Coliform (geometric mean) c 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(s) At least once every: V i►onth(s) (Maximum 3 years) 13 NA years) Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Clean effluent filter !�n month(s) ❑ NA At least once every: 2- ❑ year(s) Inspect pump, pump controls & alarm At least once every: months) ❑ NA 2 ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ year( ❑ 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 (Y 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. GMW (4/01) Page t — f START UP AND OPERATION 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. 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 mply with the rules in effect at that time. 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 INSTALLER POWTS MAINTAINER Name Name V Phone $' 2 J 4 �. O �y Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST< C1P0{ X , Phone Phone -71 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(7), (2) & (3), Wisconsin Administrative Code. Parcel #: 040- 1153 -60 -000 04/23/2009 03:49 PM PAGE 1 OF 1 Alt. Parcel M 23.28.20.603 -604 040 - TOWN OF TROY Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 I Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner O - LEE, THOMAS B & ROBERT E THOMAS B & - ROBE ` 853 FAIRMONT AVE ST PAUL MN 55105 Districts _ . SC =School SP =Special Property Address(es): " = Primary Type Dist # Description ' 190 COVE RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.262 Plat: N/A -NOT AVAILABLE SEC 23 T28N R20W PLAT ST CROIX BEACH Block/Condo Bldg: LOTS 18 & 19 AS IN VOL 324 P 310 INCL LAND TO RIVER - Tract(s): (Sec- Twn -Rng 40 1/4 160 114) ,C 23- 28N -20W otes: a LL� Parcel History: 7 /26105 /CHECKED, AND NEE LOTS 18 & 19 Date Doc # Vol /Page Type ADDED TO DEED /SMC DELETE NOTES AFTER 06 /20/2006 827888 WD CORRECTIVE DEED RECORDED 07/08/2005 799795 2839/327 WD 04/01/2005 791157 2776/148 TI 08/30/1973 318288 502/442 WD 2009 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations Last Changed: 08/23/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.262 189,800 115,100 304,900 NO Totals for 2009: General Property 0.262 189,800 115,100 304,900 Woodland 0.000 0 0 Totals for 2008: General Property 0.262 189,800 115,100 304,900 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount es Special Charges Delinquent Char Special Assessments p g q 9 Total 0.00 0.00 0.00 II 4E3 d=-a -7 43 4E3e KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 1 - 2000 REGISTER OF DEEDS ST. CRDIX CO. � WI Document Number 'WARRANTY DEED I RECEIVED FOR RECORD This Deed, made between Richard Myles Lee a /k/a Richard M. Lee 86/28/2006 03: 25PM WARRANTY DEED EXEMPT # Grantor, and Thomas B. Lee and Robert E. Lee, as tenants in common TRANS F EE: 11.00 COPY FEE: CC 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 ") (if more space is needed, please attach addendum): Recording Area Lots eighteen (18) and nineteen (19), Plat of St. Croix Beach, Town of Name and Return Address Troy, St. Croix County, Wisconsin. William J. Radosevich 502 Second Street 04 Hudson, WI 54016 040 -1153- 60-000 Parcel identification Number (PIN) This is not homestead property. bix) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this day of May 2006 s • Richard M. L a /k/a Richard Myle Lee AUTHENTICATION A N EDGMENT Signature(s) STATE OF MINNESOTA ) ) ss. County ) authenticated this day of 3/ ST day of Personally came before me this y May 2006 the above named Richard M. Lee a /k/a Richard Myles Lee s TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY + William J. Radosevich Notary Public, State of MINNESOTA 502 Second Street, Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) .) " Names of persons signing in any capacity must be typed or printed below their signature. Pt�ioal STATE BAR OF WISCONSIN WARRANTY DEED FORM No. l - 2000 rms.com loft Parcel #: 040- 1153 -60 -000 04/23/2009 03:50 PM PAGE 1 OF 1 Alt. Parcel #: 23.28.20.603 - 604 040 - TOWN OF TROY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner THOMAS B & ROBERT E LEE 0 - LEE, THOMAS B & ROBERT E 853 FAIRMONT AVE ST PAUL MN 55105 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description " 190 COVE RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.262 Plat: NJA -NOT AVAILABLE SEC 23 T28N R20W PLAT ST CROIX BEACH Block/Condo Bldg: LOTS 18 & 19 AS IN VOL 324 P 310 INCL LAND TO RIVER Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 23- 28N -20W Notes: Parcel History: 7/26/05 /CHECKED, AND NEEDS LOTS 18 & 19 Date Doc # Vol /Page Type ADDED TO DEED /SMC DELETE NOTES AFTER 06/20/2006 827888 WD CORRECTIVE DEED RECORDED 07/08/2005 799795 2839/327 WD 04/01/2005 791157 2776/148 TI 08/30/1973 318288 502/442 WD 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/23/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.262 189,800 115,100 304,900 NO Totals for 2009: General Property 0.262 189,800 115,100 304,900 Woodland 0.000 0 0 Totals for 2008: General Property 0.262 189,800 115,100 304,900 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 Wisconsin Department of Commerce SO L PVAY REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code „ County ,, °, Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must`'' include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road.„ Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location °t, � Govt. Lot 1!4 1!4 S T N R o E (or�W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ].Town Nearest Road ().�� Erma , ❑ New Construction Use: D Residential i Number of bedrooms Code derived design flow rate GPD J9 Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: Boring # Boring > ® pit Ground surface elev . d 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 W F S. T • Boring # Boring „ ^" X pit Ground surface elev -- .* 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 rl � g/�R. � .� s „ �N� r^�"fy �[ {y '[ C } 0— d' f o 4 J rr { ✓ E8"+✓ 1 1 r T"t m acr a F' * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg /L CST Name (Please Print) Signature CST Number Ad ress a Date Evaluation Conducted Telephone Number k e ` ,7 Property Owner Parcel ID # Page of 2, Boring # Boring pit Ground surface elev. 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 I 'Eff#2 0. ............ - o Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. 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 I 'Eff#2 / 60 A6 V 4, o Boring Bodng # F] Depth to limiting factor in. 9 pit Ground surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Ya I Ile A 7 Effluent #1 = BOD, > 305 220 mg/L and TSS >305 150 mg/L Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg1L 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 format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R,07100) p Property Owner - l'. - r, Parcel ID # '" 4- o - Page of Boring # F Boring lel�� [a pit Ground surface elev. 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 I., i on F-1 Boring # ❑ Boring ❑ pit Ground surface elev. 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 E] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F ❑ pit 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 Effluent #1 = BOD > 30 < 220 mg/L and TSS; >30 < 150 mg/L Effluent #2 = BOD, S 30 mg1L 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 format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 907/00) ` 7 - 1 Property Owner o-, Parcel ID# %�` ' Page 4 of EDGE OF WATER ON LAKE S T ; CROIX SITE PLAN OCTOBER 8, 2008 ELEVATION =675.7 (MSL 1912) I � O RDINAR Y HIGH WATER ( � RK (OHW M). PER NOTE: I OLICROIX COUNTY I + LOT LINES I ELEVATION--68o BENCH MARK: o, ARE APPROXIMATE. + TOP OF 1 1/4" o.d. IRO ELEVATION= 09.92 ti 0 G9 (MSL 1912 FLOODPLAIN & 680 FLOODFRINGE 690 ELEV.--692 700 � 6 165 i CONCRET 5 690 _ PA T/ WAL BENCH MARK: 05 — TOP OF 1 1/4" o.d. 50' 50' IRON PIPE ELEVATION= 707.42 x WELL (INSIDE rRq I p9i (MSL 1912) STRUCTURE) LOT 17 710 ST. CROIX BEACH B1 ® c os DECK �o•`� a ' 50' SETBACK (715 ' FROM OH WM --- ® 3 BEDROOM CA8 /N 1 Q� n vI �¢ Ba 0 B s 725 1 25 B3 I B6 SOIL BORING, ( SHED TYPICAL I 0 LOT 98 i B2 ST. CROIX BEACH I LOT 99 LOT 20 ST. CROIX BEACH ST. CROIX SLOPES > 12% BEACH I" o.d. ' SLOPES > 12% IRON PIPE 50 , 50' SCALE IN FEET SAINT CROIX ROAD (NOT CONSTRUCTED) IRON PIPE IIII■ OGDEN ENGINEERING CO. DANIEL P. KUGEL CST #250693 Civil Engineering & Land Surveying 0 10 20 40 1234 S. Wasson n La ne, Riv r Falls, WI 54022 CONTOUR INTERVAL =1 ` DATE to Qi +a' i !68.20 a 18 •.20' f OD 07 Z 0 `9' O �NM-§ �.0 .Z T6.80 W c� C, aD X O OD co 1. cn r C) \ w tJ ! S y d4 N s 1 (wry •� 8 Cn y rn Q Q 371 Cill _._ f g c NO Parcel #: 040 - 1153 -70 -000 05/20/2009 10:28 AM PAGE 1 OF 1 Alt. Parcel #: 23.28.20.605 040 - TOWN OF TROY Current [XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner O - PUGH, JEANNETTE C TR JEANNETTE C TR PUGH 11839 GRANT AVE NW MAPLE LAKE MN 55358 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.275 Plat: N/A -NOT AVAILABLE SEC 23 T28N R20W LOT 20 PLAT ST CROIX Block/Condo Bldg: BEACH Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 28N -20W Notes: Parcel History: Date Doc # Vol /Page Type 08/06/2004 770898 2632/467 WD 06/09/2004 765313 2592/39 PR 06/09/2004 765312 2592/37 LTTR 07/23/1997 1185/284 QC 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.275 69,000 0 69,000 NO Totals for 2009: General Property 0.275 69,000 0 69,000 Woodland 0.000 0 0 Totals for 2008: General Property 0.275 69,000 0 69,000 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 OM Parcel #: 040 - 1150 -70 -000 o5/2or2oo9 11:17 AM PAGE 1 OF 1 Alt. Parcel #: 23.28.20.581 F 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - PUGH, JEANNETTE C TR JEANNETTE C TR PUGH 11839 GRANT AVE NW MAPLE LAKE MN 55358 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.600 Plat: N/A -NOT AVAILABLE SEC 23 T28N R20W PT GL 1 BEG NE COR LOT Block/Condo Bldg: 20 OF PLAT ST CROIX BEACH, TH SLY 200',ELY 151', NLY 200' TO POB ALSO PT Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) GL 1 AS IN VOL 402 P 566 & VOL 402 P 569 23- 28N -20W Notes: Parcel History: Date Doc # Vol /Page Type 08/06/2004 770898 2632/467 WD 06/09/2004 765313 2592/39 PR 06/09/2004 765312 2592137 LTTR 07/23/1997 1185/284 QC 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.600 99,000 0 99,000 NO Totals for 2009: General Property 0.600 99,000 0 99,000 Woodland 0.000 0 0 Totals for 2008: General Property 0.600 99,000 0 99,000 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 OW Parcel #: 040- 1152 -10 -000 05120/2009 04:20 PM PAGE 1 O 1 Alt. Parcel #; 23.28.20.584 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner ARTHUR F PARTRIDGE O - PARTRIDGE, ARTHUR F 4117 WASHBURN S MINNEAPOLIS MN 55410 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 23 T28N R20W 40A NE SE Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 28N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 856/328 07/23/1997 746120 07/23/1997 737/247 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason MFL BEFORE '05 CLOSED W8 40.000 220,000 0 220,000 NO Totals for 2009: General Property 0.000 0 0 0 Woodland 40.000 220,000 220,000 Totals for 2008: General Property 0.000 0 0 0 Woodland 40.000 220,000 220,000 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