HomeMy WebLinkAbout040-1260-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
567249 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:
McCormack Classic Construction LLC, do Sc Troy, Town of 040-1260-80-000
CST BM Elev: L� Insp.BM Elev: BM Description: Section/Town/Range/Map No:
�1 _ Ti-ft. -°� Z �� PV __ i e• 18.28.19.1397
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic W L / z 1 Benchmark 7 /0 2 7Y. y6
Dosing Alt. BM ` ti +
V‘)/ ~#'�}.-( U g ,- y- �---/o�p o-F, ��i�. 9 S
Aeration Bldg.Sewer
— 3 0 3 t-) /6 , .s•C H cid -7.3 96 . ?
Holding St/Ht Inlet g.,3 9 S`7
TANK SETBACK INFORMATION St/Ht Outlet .5 �i jet
3011 y 4.5
TANK TO P/L ELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic >_.2.0 / I
V /`b r [ Dt ea Bottom
Dosing a 6� Head r/ a
n. -i- v .V
Aeration Dist. Pie GErk>i 1 3, �/ / �12�':,> ______/:::
Holding Bot. System_
1_ ra
Final Grade , / h 7
PUMP/SIPHON INFORMATIO y M t'c( ,jl g. 95 c�
Manufacturer 1/t�y M St Cov ,r ,J/r te I� �/ v' `l
Model Number / /
Td p atr I r,4 -F - - ---
TDH (Lift Friction Loss .- em Hea• TDH Ft
G'LY
Aid sI_c--P;
N•
Forcemain Length Dia. Dist.to Well _el
SOIL
ABSORPTION SYSTEM I U. + / tit, " / c 0-4,-(7-073-c07)
BED/TRENCH Width r Length No.9f Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 r✓,R+9 "J 3
SETBACK SYSTEM TO 7 VG> 79CP/L G)G BLDG WELL LAKE/STREAM ' �1
INFORMATION rCEACHING Manufacturer
CHAMBER O Q LA., C. a 7
Te Of System: f r UNIT
Model Number:vtveAA.1'-641(t k>2D 1;70 , IOU �//r
LP O
DI r BUTION SYSTEM (bNI. !p._ i.1t,; l`,
l r anifold v Distribution r ( x Hole Size x Hole Spacing Ven Air Intaka `, _
r U 9 Pipe(s) G .� I /
Length Dia / Length r `' Dia Spacing —' �j
g 9 P g �10fi �� df
SOIL COVER '
x Pressure Systems Only xx Mound Or At-Grade Systems Only LC-�.-k
'Depth Over r Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center / /, Bed/Trench Edges Topsoil
0 Yes ge No 0 Yes g No
COMMENTS: (Include code discrepencies,persons p se ,etc.) o Inspection#1: i y/ / /`�► Inspection#2: / /
Location: 374 Whitetail Lane Hudson,WI 54016(NW 1/4 E /4 18 T28N R19 Deer Valle I. 18 // / Parcel No: 18.28.19.1397
�� ��a,,t j-r0.st �, �' -5 1/c-L/gc 2gj9
1.)Alt BM Description= !tid"1 A - 1
2.)Bldg sewer length= 2a• t �'" 7 w wrl(L e i (ei� - o �/``"r' ' i ti
-amount of cover .7 r a-�'�t�tA emu. -I--D P 'y�-41/1 i-L t/ tc��Ir/ exr Yl2C 414,-K. r tile-
.7 vK _ l i -b At rcro
Plan revision Required? M Yes o I 7 I 1
I Z / 13 Oil-. 6 0 3
Use other side for additional information.
SBD-6710(R.3/97)
Date Insepctor's�ture Cert.No.
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•!*v>~.,, County
lam: Industry Services Division Sr. 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
a a T=IE
_ P.O. Box 7162
$ t
Madison, WI 53707-7162 d Z
Stet Transaction Number ,
mit Application < ;3
In accordance with SP 2 Wi m. Code, submission of this form to the appropriate govern P nit
is required prior to obtat a s ry permit. Note: Application forms for state-owned POWTS are submitfts tect Address (if dill nt than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary'
purposes in accordance with the Privacy Law, s. 15.04(1 xm), Stars. 3' l / TG TG[
1. Application Information - Please Print All Information
Property Owner's Name Parcel # r7 / 0 dpol•~(/
M31
G Le,~^94A- CLAS o.J ucT/o.J UGC, G(O
Property Owner's Mailing Address Property Location / /3f-7
S~o7 ~d8 d9!/E Govt. Lot C
City, State Zip Code Phone Number
/VItJ NE Section -8
/Y~lDSe.1~ I fM /G 715 Zed -.7a7// circle one
II. Type of Building check all that apply) Lot # T d8 N; R ~i of V~
XI or 2 Family Dwelling Number of Bedrooms 7 f Subdivision Name 64,444-y
Block# dAL-CA ❑ Public/Commercial - Describe Use Iit3~of
❑ State Owned - Describe Use CSM Number 8-fi`mne of
$Townof 7-9.0t,
Ill. Type of Per ' (Check only one box on line A. Complete line B if applicable)
A. New S stem
y ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. 13 Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: (Check all that apply)
XNon-Pressurized In-Ground ❑ Pressurized In-Ground At-Grade El nMo(/un_d 24 in. o,.f, su' 1e s~~s,it ❑ M and < 24 in. of suitae soil
❑ Holding Tank ❑ Other Dispersal Component (explain)2 Ce_lyy+ ff 0" ^Q/ P e-eFeaagent vic (ex l-.424`7 L• Y.
V. Dispersal/Treat ent Area Information: ~I►L
Design Flow (gpd) Design Soil Applicatio te(gpdsf) Dispersal Area Req ired (sf) Dispersal Area Proposed (sf) System Elevation 3
00 .7 3 857. 873.8 19VA "9.s,a 91
VI;. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units d o ,g
,0 u U U N t0 .2
New Tanks Existing Tanks c ~ B w _
w U in n cn C7 a
Septic or Welding-Tbnk J!';L-> _ Lo.,l eArrE
DSO / E~ ✓
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Si store MP/MP" Number Business Phone Number
Io?3/3Yr. 7/S G 7.? ~S.TGG
Plumber's Address (Street, City, State, Zip Code)
G.? 98 Sr. ~wy a3". u.~v,~o 4,44 SV7?6
VII . Coun /De epartiment Use Only
Approved ❑ Disapproved Permit Fee Date Issued ssuing Age Sign re C-0 0/N
El Owner Given Reason for Denial $ 417 S / "13 /3
IX. Conditions of Approval/Reasons for Disapproval q
SYSTEM OWNED: jqq
1 5p
1. Septic tank, effluent filter and 0 y ~ ~/d~
dispersal cell must b~2e[v%cd~ maintained
as per management plan provided by plumber. sys 1L7~ n 7 ~
2. All setback requirements /
as per applicable'Lb'i9 9l afff►q t' i'T6r the system and submit to the County only on paper not Less than S Y12 x 11 inches in size
L F,1,WCA WVC
SBD-6348 (R031 1 't' U
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1-/ of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Tank Manufacturer: G~>ESE~ Co.✓c.tlrE❑ NA
C"'g M t D.✓ tAyZ /o..)
Permit # J' Septic ❑ Dose ❑ Holding Volume: 1W_4-6 (gal)
DESIGN PARAMETERS Tank Manufacturer: I*NA
Number of Bedrooms: Y ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: Iff NA Vertical Distance Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flow : %0C) (gal/day) Horizontal Distance Tank(s) to Service Pad: 80 (ft)
Speck servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): /0 p (gallday) if horizontal is >150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: .7 (gallday/fe) Effluent Filter Manufacturer: ❑ NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Gf ID
Fats, Oil & Grease (FOG) s30 mg/L Pump Manufacturer: ®'NA
Biochemical Oxygen Demand (6005) _220 mg/L ❑ NA
Total Suspended Solids (TSS) 5150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer
(BODs) >220 mg/L ❑ NA tR NA
(TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter
❑ bisinfection ❑ Wetland
Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other.
(BODO _<30 mg/L Soil Absorption System
(rSS) s30oGmg/L ❑ NA
Fecal Coliform (geometric mean) 9In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA
❑ At-Grade ❑ Mound
Maximum Effluent Particle Size %a in dia. ❑ NA ❑ Drip-tine ❑ Other.
Other: ❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) When combined sludge and scum equals one-third (h) of tank volume
❑ When the high water alarm is activated
Inspect condition of tanks -At least once ev ❑ month(s) (Maximum 3 years) ❑ NA
3 year(s)
Inspect dispersal cells At least once everY ❑ month(s) (Maximum 3 years) C1 NA
3 year(s)
Clean effluent filter At least once every: 13 ~ month(s) ❑ NA
❑ year(s) W NA
pump, pump controls & alarm At feast once every: 0 yea~(sjs) ,~'"A
Flush laterals and pressure test 'At least once every C3 month(s) ❑ NA
❑ year(s)
Other: At least once every: ❑ month(s) C1 year(s) ❑ NA
Other: ❑ NA i
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
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 a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 treatment tank equals one-third (Ya) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) 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 30 days of completion of any service event.
START UP AND OPERATION Page ..S of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage- the soil absorption system. If high concentrations are
detected have the contents of the tank(s)
removed b
by a Septage Servicing Operator (pumper) prior to use.
Pump tanks ks may fill . above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will b&discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to-the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment
tanks and soil absorption system: acids, antibiotics, baby wipes; cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, *and water softener brine discharge. -
ABANDONMENT
When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is property
and safely abandoned in compliance with s..541383.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
e The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper).
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:
f 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 the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
i
POWTS INSTALLER POWTS MAINTAINER.
Name o&w ELKS Name J_0 *11 Af"w
LKE `L rar~~t
Phone /1r- GT.d -Sd" Phone 7115'
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name j; ~,EoiX G~ou~►rr Zo,rj,~i L~~f/L[~
Phone Phone
'715" .38G - y~8o
•
Private Onsite Wastewater Treatment Systems.
Index and Title Page
Project Name: ~oQr1'.PGK ~ASSiG C.O.rsrcaol-//~ - `7~it~•c ~.✓ltocs.~o°~,11s
Owner's Name: Ca A~~ CLASS/L ~o.✓S Tiryc)-io.✓
Owner's Address: S U /W.? t-° xv-c
/Yme so,✓, CJZ- Sya Id
ZiS 740 - oV//
Legal Description: _ _ZV/_/. ; ZA a tJ
Municipality: Tower verge, - e#Y of ~!1 o Y
County: A, ZA0,IX
SabdivisionName. ®E6,c lJ.¢rc~r
Lot Number:. Block Number:
0 71 - ao
Parcel I.D. Number: O YO -I
Page 1 1-440-&-x
P- .Sf1E~ r
Page t ori' 6"[Ad "ZjLAo fS - SEG l'Io.✓ ~ A✓ ~lE~,J
Page 3 J~e~ooriG f~ A~✓K .~PEGtf~cAr~o.~1 s
Page 4 10oAlr,S a4l~~-a `s .~'>.4,✓~r at f /'9AdA¢~'r~ ,r r
Page-5 1! t1
Page 6 /wit rre rzW,0.X, e ra
Page 7 /I
Page 8 Em,+ymEvrs - SoiG 4y4 a.-y rio r ~E,~oa r'
Page 9
Name of Designer. a#,v Al. 41- License Number: I_ e a~/33'G
Signature: Date: A> ,?y-,&AJ
Designed pursuant to the Following POWs Component Manual and Comm 81-85:
TS (Ver 2.0) SBD-10705-P fN. 011011
Tn Ground Soil Action Component Manual for POW
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\ = W1250-MR MIENER COOCRETE
-m+ SEPTIC MANUAL REV.
W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR:
Z
° REVISED JAN. 2010 800-325-8456
FILE: WI2W-YR
Wisconsin, Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
At,+tech complete site plan 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 (Pf0)_,:yR*d, tiora,and % of slope, scale or PARCEL I.D. # 02
-
dimensioned, north arrow, and location and disWr~ce,;to nearest road 040 3 Q
APPLICANT INFORMATION-PLEASE ,R1"4T AL I ORMATip REVIEWED Y DATE
PROPERTY OWNER: ROPERTY LOCATION
Derrick Construction, I 0VT. LOT 1/4 /as lg T 28 N,R lg f(or) W
PROPERTY OWNER':S MAILING ADDRESS } s~~ OT # BLOCK # SUED. NAME OR CSM #
1505 H #65 COX "18 na Deer Valley
CITY, STATE ZIP CO r ' R ❑CITY ❑VILLAGE :}GOWN NEAREST ROAD
New Richmond, WI. 54017 "-''t715) 2 =FM30 ' ' Troy E. Cove Rd.
Yp4 New Construction Use [K ] Residential I orri berJof*r 4 [ ]Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2
Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 98.5 ft o site p ark)
Additional design /site considerations 19 trenches spaced to code, 3.50' below grade
Parent material outwash Flood p a le na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
❑S [21U
U=Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S Elul
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T
1 0-10 10yr 2 none sl 2msbk mfr 2c .51 J.6
2 10-24 10 r 4/4 none sl 2msbk mvfr gw 2c .5 Ground 3 4-84 7.5 r 4/6 none ms osg ml na na .7 elev.
Lf10.21t
.
Depth to wtl '2' 36
limiting
factor
+84"
Remarks:
Boring #
1 010 r 3/3 none sl 2mgr mvfr gw 2c .5 .6
><'2 2 10\84 7.5yr 4/6 none ms osg ml na na .7 .8
Ground
elev.
100.2 ft.
Depth to
limiting
factor
+84"
Remarks:
CST Name:--Please Print Gary L. Steel Phone: 715-246- 0
Address: 1554 200th. v New Richm d WI 54017
Signature: Date 6_11- CST Number: m02298
r
PROPERTYOWNER Derrick Construction SOIL DESCRIPTION REPORT 'Page_ of 3
PARCEL I.D. # 040-1071-20
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1_ 0-12 10 r 2/2 none sl 2msbk mfr gw 2c .5 .6
2 12-36 10 r 4 4 none sl 2msbk mvfr gw 2c .5 .6
Ground 3 36-84 7.5 r 4/6 none ms os ml na na .7 .8
elev.
98.2 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-12 10 r 3/3 none 1 2msbk mfr 2c .5 .6
4 2 12-26 10 r 4/4 none sil 2msbk mfr w 2m .5 .6
Ground 3 26-47 10 r 4/4 none lfs os ? mvfr gw 2f .5 .6
elev.
95.4 ft. 4 47-84 7.5 r 4/6 none ms os ml na na .7 .8
.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-12 10 r 2/2 none sl 2msbk mfr gw 2c .5 .6
2 12-28 10 r 4/4
none sl 2msbk mvfr gw 2c .5 .6
Ground 3 28-84 7.5 r 4/6 none ms osg ml an na ~.7 .8
elev.
99-1 ft.
Depth to
limiting
facto+84
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
A
STEEL'S SOIL SERVICE
Gary L. Steel Derrick Construction, Inc. 1554 200th Ave.
CSTM2298 Nw4NE4 S18-T28N-R19w New Richmond, WI 54017
MPRSW-3254 town of Troy (715) 246-6200
lot #18-Deer Valley
This soil evaluation was conducted to satisfy.a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
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LEG AL I}1'ti(-'12IPTION
Propert i v Ittci i AA''1a . /"C :'a. Sec, 1- Z0 N R / / fir. To"n o TROY
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',It i\ NTtJRE OF , PPP I(ANTtS) DATE
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Parcel 040-1260-80-000 10/30/2013 08:55 AM
PAGE 1 OF 1
Alt. Parcel 18.28.19.1397 040 - TOWN OF TROY
Current ❑ 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 - SHIMP, ROBERT S & WENDY K
ROBERT S & WENDY K SHIMP
447 WREN LN
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 374 WHITETAIL LN
SC 2611 SCH DIST OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.578 Plat: 07-068-DEER VALLEY 040-99
SEC 18 T28N R19W PT NW NE LOT 18 DEER Block/Condo Bldg: LOT 18
VALLEY
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
18-28N-19W NW NE
Notes: Parcel History:
Date Doc # Vol/Page Type
01/17/2007 842678 WD
08/24/2001 654656 1705/353 WD
2013 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/09/2009
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.578 95,800 0 95,800 NO
Totals for 2013:
General Property 2.578 95,800 0 95,800
Woodland 0.000 0 0
Totals for 2012:
General Property 2.578 95,800 0 95,800
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
lil ((I I ((I I (f I I I I
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8183439
Tx: 4151887
STATE BAR OF WISCONSIN FORM 1 - 2000 986105
BETH PABST
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between Robert S Shimp and Wendy K Shimp, 09/18/2013 2:13 PM
husband and wife Grantor, and McCormack Classic Construction, LLC, a EXEMPT*: N/A
Wisconsin Limited Liability Company, Grantee. REC FEE: 30.00
Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 258.00
described real estate in St. Croix County, State of Wisconsin (the PAGES: 1
"Property"):
Lot Eighteen (18), Plat of Deer Valley in the Town of Troy, St. Croix
County, Wisconsin.
Recording Area
Name and Return Address: .
Land Title Inc #408347
2200 W County Road C, Suite 2205
Roseville, MN 551 13
Together with all appurtenant rights, title and interests. 040-1260-80-000
Parcel Identification Number (PIN)
This is not homestead property.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Easements, Restrictions, Reservations, Roadways and Rights of way, if any, of record
Dated this 13th day of September, 2013.
7
LZ2
* obert S. Shim * Wendy K Shimp
AUTHENTICAT ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
T. CROIX COUNTY. ) ss.
authenticated this 13th day of Septe r, 13 P jjBLjC Z Personally came before me this 13th day of September,
013 the above named Robert S Shimp and Wendy K Shimp,
* - }ausband and wife, to me known to be the person(s) who
TITLE: MEMBER STATE BAR OF WIS j= i executed the foregoing inst a nd acknowledged the same.
(If not, A- 40"
authorized by § 706.06, Wis. Slats.) r~ ee J. Bune
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin
My commission is permanent. (If not, state expiration date:
Larry S. Mountain, Attorney at Law 10/27/2013 )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Namcs ol'persons signing in any capacity must be typed or primed below their signature
1 of 1
WARRANTY DEED STATE BAR OP NYISCONSIN F0101 No. 1-2111111
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