Loading...
HomeMy WebLinkAbout040-1067-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538794 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: Welsh, George & Diane I Troy, Town of 040 - 1067 -50 -000 CST BM Elev: Insp. BM El v: BM Description: Section /Town /Range /Map No: 067 17.28.19.25713 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ; CAPACITY STATION BS HI FS ELEV. Septic Benchmark t e%A. Alt. B t6k, 4521's Aeration U Bldg. Sewer ?• . Holding St/Ht Inlet zo TANK SETBACK INFORMATION SUHt Outlet �. TANK TO )J P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / ' Dt Bottom ` Dosing Header /Man. Aeration Dist. Pipe 7. Holding Bot. System ?I 93 PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover Model Number TDH Lift Friction Loss System He TD Ft Forcemain Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ►7j� _ 1� `_ ` SETBACK SYSTEM TO � P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:�s INFORMATION CHAMBER OR Type Of System: C G Model Number. .o,^ca J 7 J ( �y UNIT e •��► DISTRIBUTION SYSTEM ( ;�- 3 Header /Manifol� Distribution x Hole Size x Hole Spacing Vent to Au In !ke --7 Pipe(s) ` Length / Dia_ '� Length � Dia ` Spacing %___ E^: SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 'Se v Depth Over Depth Over 1xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges ` Topsoil Yes C No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 464W OMAHA RD Hudson, WI 54016 (NW 1/4 NE 1/4 17 T28N R19W) metes & bounds Lot // Par c I No: 17 1.) Alt BM Description = �• �'�`^' b�� L (.D� �— •� 2.) Bldg sewer length = 54 - amount of cover ?�irs ll Plan revision Required? F&I Yes No 2 Use other side for additional information. SBD -6710 (R.3/97) Date Insepct r Signat a Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538794 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: Welsh, George & Diane I Troy, Town of 040- 1067 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: 17.28.19.257B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 Bed /Trench Edges Topsoil 0 Yes [] No Yes r No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 464W OMAHA RD Hudson, WI 54016 (NW 1/4 NE 1/4 17 T28N R19W) metes & bounds Lot Parcel No: 17.28.19.257B 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? E Yes R] No Use other side for additional information. LL - 1 -1 SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. PAID commerce..Wl.gov Saf!Ly and Bttildifge4)xvision County W. 201 W Washington Ave., P.O. Box 7162 j s^o n s n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce - - 1 5 3 Sanitary Permit Appli ati State T ra nsa ction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of th s form to the appropriate governmen /VI - `Ts unit is required prior to obtaining a sanitary permit. Note: Applicati forms stat -owned POWTS Project Address (if different than mailing address) submitted to the Department of Commerce. Persona] information yo providg� y t 4e f 01 Iecori /.�. L[ purp oses in accordance with the Privacy Law, s. 15.04 1 m , Stats. A- 'J � L/r 4 I. Application Information - Please Print All Infor do CROIX COUNTY Pro rty Owner's Name / OFFICE Parcel # /r 0 i Property Uwne4smailingAddress Property Location 2 5 - 7 4 64 Govt. Lot City, , State Zip Code Phone Number ALL y. �� y, Section le one) II. Type of B ilding (check all that apply) Lot # I or 2 Family Dwelling -Number of Bedrooms .� Subdivision Name Block # ❑ Public /Commercial - Describe Use 4 ' M El city of CSM Number ❑Village of El state Owned - Describe Use � XT r own of rO V 2. &t (, -) 1 „koe. III. Type of Permit; (Check only dne box on line A. Complete line B if applicable) p` ❑ Treatment/Holdin ❑ New System ,Replacement System g Tank Replacement Only ❑Other Modification to Existing System (explain List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. T pe of POWTS System/Component/Device: Check all that appl ]K Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) V. Dis ersaVrreat ntArea Information: Design Flow (gpd) Design Soil Application Rate sf) Dispersal Area Required Dispe Area Proposed System Elevation VI. Tank Info Capacity in Total # of Manufacturer o Gallons Gallons Units .c 2 U 2 tC V V New Tanks Existing Tanks 2 o `—� v a U in rn w c7 a Septic or ^'�ng wan 7 or N Dosing Chamber V1I. Responsibility Statement- 1, the undersigned, assume responsibility for inst Ilation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's/Si ature MP /MPRS Num ber Bu Phone Number Plumber's Address (Street, City, State, Zip Code) VII ount /Department Use Onl pproved ved Permit Fee Date Is d Issuing ent Signat $ 7S Ow en Reaso Denial � °b IX. Condit' easons for Disapproval 3 ` ��� _ ^ 1: Septic tank, effluent frker and dispersal cell must all be seryleig / maintained as per managemerit plan provided by pluw4w. "a ck *400wrlis must be MsinWr1W Attac to comp ete plans ror the system and submit to the County only on paper not less than 8 lit x 11 inches in size SBD -6398 (R. 01/07) Valid thnt 01/09 Plot Plan page Aft Propert P Owner � � WELS" 1 » =4©f Legal DesicAption A- PARc - uxwrim ma o;--' (except where noted) Q = Backhoe pit North LZ Pf lop" i w ►' ma sue` .00 oo G At2AGf y � cR 5 o �Qs6 mo o! ,W to Location: 9. ry sew 1 7 Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Q,�P-O94& � DIAN& WeUSH Project Name and System Type: Cm) vA NT iONA L 'T)4- &P, 0 uK)-V - T9Z0-wM Location: 'i 1 4 Ind ©,MAMA 'KOA D ; tl to SON w 5L+O t (� Street Address N W 1 14 OF 'SH NE L4 SF.C. ('7 , TZB N I R (4 vJ Legal Descri lion TKO .5 Cwt X Township/ ounty Contents: Page 1: .fN DU A6 - f I l ,Sid EET Page 2: PLAA y t tivJ Page 3: F�JyT pL-AA Page 4: PO W - S, 0Wn1gRs M,1kA) %.tAL Mr) MAN AGFM�r Page 5: Page 6: Page 7: At�c • �C ? Hllp • • D 1859 � amvr.n •.,•' •: Plumber/Dpi' iK :J0 Signed: C Credential Number: K51-00 Date: Cy- 21- Z10 i I ja r CTloti j. C�wrs�ri�t Waft tywK 77M 11 rNttui `' lls -il�1 Tww tme � " As�b�l�. - Yip rte, t7�1� LA +V , Z _ SIM Z0. 'Olt tkN %TS FtiR I� �.c,� iN Ett�H —trztrz b$ fo R E}�Nrl ENS . - 1nJ ". A o r,,, -ri-o' - tv 8 ........�.�.._ IIJ Ploif Plan Page � Property Owner Co � - 01^ms wsLs" Leg al DeSic'rlpdon A- OAAML u,cxrgD ur Wirc Nw /4 0� (e wept wh ere note -x294 R — %qW, -, ;bwiV of - M V.� Sr. Backhoepit �xoUC ..rry ��s`n• R 2. SO �lCR North �,Y tip t - ..cC►���p 3 s t� £xis � � 3 a .r„o oz` ay s6t Da'E`�'Nr+ 3 w f or Site Location: q Sad 37 s POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS ' Owner CvttoiZag DIAM-G, EEffluent Ca act J D 1 ❑ NA Permit # Manufacturer C3 NA ME DESIGN PARATERS er Manufacturer GOK ❑ NA Number of Bedrooms 100 droom ❑ NA er Model Z f2 ❑ NA Number of Commercial Units NA Ca aci al 151 NA Estimated flow (average)* Uda Manufacturer ANA Design flow (peak), estimated x 1.5* - -"day facturer 9 NA Soil Application Rate d� al/da l t1rNA Pretreatment Unit Influent/Effluent Quality (NA ❑) Month ly Average *' jci NA C3 Fats. Oil &Grease (FOG) Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 30 mg/L ❑Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) < 220 mg/L ❑ Disinfection ❑ Other: 5 250 L I Manufacturer: Model: Pretreated Effluent Quality ❑ Monthly Average * ** Dispersal Cell(s) Biochemical Oxygen Demand (BOD { 'k In-ground (gravity) E3 In-ground (pressurized) Total Suspended Solids (TSS) 30 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) 5 30 mg/L ❑ Dri -line ❑ Other: <_10 cfu/100m1 7 Leaching Chamber Manufacturer .TaN /LTJ�"V rMa ffluent Particle Size 1/8 inch diarneter M F 3 L F Laying Length/Cham er — r Flow Verification and Calculations: Soil Application Ra te 0�d/� Area Req. � 3 �f bedroom based) Infiltrative Surface/Chamber ESIA Ratin 2O . C Minimum Number of Chambers /to pical for domestic (non - commercial wastewater ❑'�' a ate Desi Flow/Loading Rate= Materials: all materials must comply with WI Adm Code ic tank effluent. COMM84 and be installed per manufacturers specifications typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At - grade Soil Absorption System, Siting, Design & Construction Manual' (Converse et.al.1990) E3 "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 CO3 "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9:6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625 /1 -80 -012 October 1980 ❑ SBD — 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD — 10567—P (R.6/99) "In Ground Absorption Component Manual" /,X SBD — 10705—P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD — 10628 —P (N.6/99) "Recirculating Sand Filter System Component Manual' ❑ SBD — 10656 —P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual' ❑ SBD - 10572 —P (R.6/99) "Mound Component Manual" ❑ SBD - 10691—P (N.01 101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 —P (8.6/99) "Single Pass Sand Filter Component Manual' ❑ SBD - 10657 P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 —P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 —P (N.Oi /Ol) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE MONITORING SCHEDULE MAIN TENANCE AND MANAGEMENT Service Event Service Frequenc Ins ect condition of tank s At least once eve 3 ❑months s P out contents of tank s When combined slud a and scum a uals one -third 1/3 of tank volume 3 s. Ins ect saI cell s) At least once eve Clean effluent filter ❑ months e s 3 At least once every Ins ct ❑ months ] s controls &alarm At least once eve Flush laterals and ressure test ❑ months E3 s 29 NA At least once eve ❑ months ❑ s K NA Valves At least once eve Other: ❑ months ❑ ears 19 NA At least once every ❑ months ❑ year(s) 'g NA Page_of • ❑ Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading; or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each Iateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiply, laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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 other 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 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. p 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. 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 CONTIAN 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 D C-N AI %S t► aW i Name `.S rt E MA "TT Phone ( 3b° 8' Phone t 3 SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REG ATORY AUCH RITY Name - TV j- Cotkjo SAmiTl4Tid Agency Rs�l X t!'Utl, ZpN(/1� Phone 1 3 - 001 Phone K: \WPDATA\EH\POWTS OWNER'S MANUAL.doc Page 1D of D , Z C O rT-- c) w I cn C= p o x �mCQ N = r ---I z (31 OC pp C;) can Cn = O a O n m�� cn,F n m = r -U O '0 90 cn m r m � G) — m i Z i m m = m o�_ m Z o N � o O Z 0 Oo 00 0 o cn ° -------- L w 0 o cn N 0 0 0 i = O F9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND © OWNERSHIP CERTIFICATION FORM Owner/Buyer Mail ing Address Property Address i 01n w (Verification required from Planning & Zoning Department for new construction.) City /State /��C✓Sc� �j Parcel Identification Number LEGAL DESCRIPT �y Property Location '/4, Sec. / , T ,4F N R_&_W, Town of �� V Subdivision Lot # Certified Survey Map # , Volume , Page # . Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable 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. I /we, 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 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 tp 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 bedrooms SIGI WLTRE OF APPLICANT(S) DATE ** *Any information that is nusrepresented 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) Wisconsin Department ofCom roe RECEIVEItO EVALUAT &� D Page 1 of 3 Division of Safety and Buildings in accordance with Co 85, Wis. Adm. Cod II Attach complete site plan on per ndt �� t1��13 �/®>� � 1 inch in size. Plan must County ST. CROIX include, but not limited to: ve I ark I,((eefererx� point BM), direction and Parcel I.D. 040 - 1067 - 50 - 000 percent slope, scale or dime 'cs i `ttion an distance to nearest road. ZS ZONING OFFICE Re d by % Date Personal information you provide may be used forsecondary purposes (Privacy Law, S. 15.04 (1) (m)). 6 Properly Owner ~ _ Property Location GEORGE &DIANE WELSH Govt. L - - -- NW 1/4 NE 1/4 S 17 T 28 N R 19 E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 464 W. Omaha Road __ __ City State Zip Code Phone Number O cit y village L:jTown Nearest Road Hudson, WI 1 54016 1 ( ) W. Omaha Road New Construction Use[B Residential / Number of bedrooms 3 Code derived design flow rate 4 GPD Replacement Public or commercial - Describe: Parent material sandstone Flood Plain elevation if applicable ATE, ft. General comments Conventional in-g trenches -- 0.7 loading and recommendations: $ro g rate Boring # u Boring Q pit Ground surface elev. 97.85 ft. Depth to limiting factor 110 in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eft#2 1 0 -13 10YR2/2 — 1 3fgr mvfr cvv 3vf-co 0.6 0.8 2 13 -29 10YR3 /6 sl 2f -msbk mvfr cw 2vf-co 0.6 1.0 3 29 -36 7.5YR3/4 a sl 2f -msbk mvfr cs lvf-m 0.6 1.0 4 36 -48 7.5YR3/4 it s Osg ml a lvf -f 0.7 1.6 5 48 -110 7.5YR4/6 s Osg ml -- -- 0.7 1.6 Horizons 2& 3 have some gr 10 -15 % ; few cobs. 2] Boring # Boring 96.00 115 El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe In. Munsell Qu. SZ. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10YR2/2 1 3fgr mvfr cvv 3vf -co 0.6 0.8 2 12 -16 1OYR2/2 — 1 2f- -mabk mvfr cs 2vf-co 0.6 0.8 3 16 -32 10YR3/6 — sil 2f -m 2vf-m sbk mfr cs 0.6 0.8 4 32 -60 7.5YR3/4 s Osg ml cs lvf-f 0.7 1.6 5 60 -115 7.5YR4/4 s Osg ml -- __ 0.7 1.6 Horizon 3 has some gr; <10% * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S'49alure � CST Number M o Hu ert ollisters Soil Testin & Desi Jo 224832 Address Date Eva n Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 06-20-11 (715) 426 -1775 STATE ;!-CE, OF WXC'C Y11 ff1DE31( t ._yF$Z c � , mLW wao rase a�as a.' oa 364259 W ATI A- MM DEED P,-4 nfFICE S cko1X CQ.„ `ytrA. ate., sai.ae ju�it ��sao �---- •_.___ � V araaL _. P 1ST >_3Ya. >e_ - ---- -- ! t:20 A �. iGrextee. - Sa�ii�ie of +Dwd' i£II(' eth, That the sm a# Gr Q'ar ad ad =Lbk eonsitlaa - ..r. 0f*n- zas.ro Grsxsa- the So d s:�7 --maw in _ _•__CC.- ,�xaZi� - - - - - __ �" CIH[bi -y. S44te Of A. pazcel of 2_8 arras tic -sated in the Q,ostbwest Quarter clf tbO V'ort`sIeast Q a-r rtr of Section 17, TovnshIp 23 North. Ran ge 29 West. fc:rthar described as !Follows: Ts: I~c=- c1he Norch Quarter s owes ;tr -- Section 17, go South 52 0 35' tast 696,4 feet to poLnF of heginmLog Fos zhe parcel to 5e Conveyed herein; thence North $1 ° 3$' Ea-st 3 feet:, thence South 5'08' Fast M_5 feet, thence South 7$ ° 1$' wart 342.0 feet, rhflnce N'Orth 7 ° 33' West 303. feet along tke town road centerline, thence North 31'38' East 33 -0 `eec to the pa, of GeginnSngs subject to easement for travel over South 33 feet of said parcal.. Thi3 At3, 8hs o t<aacl isralaer y. Togttet r cobs? -%0 a-nd siat lna iha he and appurtenances thercunto belonging, Aml WeSley .X_ banes.. d . jSaa'q4'4jCi0 - �T..3cyles.. .• w2 rraals ahos th'e title itt ex Krx►d, �aw'!Z('c.�!!+t_a i n fft+s; simple end frrc and clear of cncumbrancey except Eas- ements of record. it any- a sJ wili warrant sacd defend Lite see. Vau-41 flans Jny of ---April- .(SEAL) . (SEAL) . WESLEY R. ANES __...- ( SEAL ) ....(S€F1L) BARBARt� - -H, ........ -. AUTBB.NTICATSaN ACKNOWLEDGMENT Signatuse(s) ............................. ............................... STATE OF WISCONSIN � as. ...... ..... ..County. autheaticatrd this ...._..alas et ......... ................ 19 ...._. Personally came before me this ._.. a?? L,daq of A Pril----- --- ---- - -- - -- 19,_x3__ the above named _ .. ............•- •---.._.._._........_..._...... -- --------- - Wesle R _ Sores and Barbara H. .Jones �' °•_. ....... -................................... ..... _........ .-. ............... TITLE: S1E]1Ii1:;R. fi,ATF: BAR OF PitSC4ivS(N (If not, both Wi . .............. _.... -.... *_rrized by � 706.06. Sr in. Slats.) - -•--°----:._...._.; ...... ............ °,.- --•-• °-_--,.._. to me known to be the p&W-� f? _- who executed the fore I g instrument a a�Gn .iedg - .be sa THIS WN S GRAFTFD P.Y HE't1 OQD CART & MURRAY By. Lois A. Murray '.. _ :. ---_ -•_- - -... Hod oA Slis�gnsin_ 54016 Notary Public ?- .. G (5'P -T may he authenticatc�.1 or acb.nowlcdged. Both My Commission is pe anent.' (, not, ,.elate expiration aren n ot ne race:: <ary.) date: ... .. •'4-- of 6e ts�a� ar Drinkcd 6slr.;c choir sigrtaau- WARRA,vrr DEED STATE BAR OF PVISCONSIN ni =can_cii L-1 Blank Co. Ina FORM No, 1 1982 314waukee, Wis. Parcel #: 040 - 1067 -50 -000 06/30/2011 02 06 PM PAGE 1 OF 1 Alt. Parcel M 17.28.19.257B 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 - WELSH, GEORGE & DIANE GEORGE & DIANE WELSH 464 W OMAHA RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 464 W OMAHA RD SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 2.800 Plat: N/A -NOT AVAILABLE SEC 17 T28N R19W 2.8 AC IN NW NE COM Block /Condo Bldg: N1/4 COR, TH S 52 DEG E 696.4 FT TO POB: N 81 DEG E 320 FT, S 5 DEG E 2841/2 FT, Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) S 78 DEG W 342 FT N 7 DEG W 303.7 FT, N 17- 28N -19W 81 DEG E 33 FT TO POB Parcel History: rY : Date Doc # Vol /Page Type 9C/c--)5 W6 2011 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve ' Total State Reason RESIDENTIAL G1 2.800 82,500 145,300 227,800 NO Totals for 2011: General Property 2.800 82,500 145,300 227,800 Woodland 0.000 0 0 Totals for 2010: General Property 2.800 82,500 145,300 227,800 Woodland 0.000 0 0 I Lottery Credit: Claim Count: 1 Certification Date: Batch M 301 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00