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040-1318-00-012
4 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506262 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: Glen Johnson Construction I Troy, Town of 040 - 1318 -00 -012 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: /67f, a`' �, Gi7 11.28.19.2087 TANK INFORMATION E DATA 3 .( _ 0 103. at) TYPE MANUFACTURER , wji CAPACITY STATION BS HI FS ELEV. 2.45 /QZ.. 14 Septic T,� t} B chm k LJ ems_ F, ��... s z a a ,ti S b !41`1, io 714 Z Dosing S BM JU I. PBTIdT. S ewer / z 7 Holding V St/Ht Inlet J* - 73. � TANK SETBACK INFORMATION St/Ht Outlet TANK TO R/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2,4 7 75 5' I 5 1 1 Dt Bottom y Dosing J Q G , Header/Man. 7 V I z4 ��s /M s� s, 3.35 �r.� Aeration - Dist. Pipe 3 -q s Holding Bot. System 94 1 6 T �S Final Gr de PUMP /SIPHON INFORMATION �; r . 2 — .4 Manufacturer Oy � Demand St Cp `gr J ,y ' 5 q g � 1 GPM . �„� o )' I Model Number 15 P oS - 41,11 � �• Z C.t7� U TDH Lift, Friction L oss � System Head TD � ' Forcemain Len th / Dia 11 Dist. to Well > / J SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length lNo. Of T nche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (V / + SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type System: _ , 7 5a� 7 / UNIT Model Number: �J DISTRIBUTION SYSTEM 75 e- Header/Manifold C,, Distribution , L} / I x Hole Size /� I x Hole Spacing f V t oAirIInta /� /LAG Length lJ , Dia 'v Length Dia I 1 Z Spacing z � 1 �••__ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only L C spy Depth Over I Depth Over xx Depth of xx Seeded/Sodd I C xx Mulched Bed /Trench Center / • (_ Bed /Trench Edges \ Topsoil r Yes No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: - 7 / c f / Inspection Location: 741 Mount Curve Chase Hudson, WI 54016 (NE 1/4 NW 1/4 11 T28N R19W) Hills of Troy 12 Parcel? 011 8.19.2087 1.) Alt BM Description 2.) Bldg sewer length = �-+ "" 1 i 0 �J - amount of cover = - J:7 � 6 5 4 1 nsepct Plan revision Required? Yes No 3 Use other side for additional information, �_ Date na e Cert. No SBD -6710 (R.3/97) 1 �g , eommerce.W1.9w Safety and Buildings Division County 201 W. Washington Ave., .O'Box 7162 St. Croix i seon s i n Madison, Wl 53 7162 Sanitary Permit Number (to be filled in by Co.) °l rce Sot, Z(oZ Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to th\appr*ate t z z8 1 tal Project Address (if d ifferent than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for submitted to the Department of Commerce. Personal information you provide mcondary purpos es in accordance with the Privacy Law s. 15.04 1 m , Stats. 741 Mount Curve Chase I. Application Information - Please PjW All Information Pro Owner's Name Parcel # Jo �on Constructio 040- 1318 -00-012 Property Owner's Mailing Address Property Location ST. CROIX COUNTY r �$ P.O. Box 890 Govt. Lot city, state zip code NE NW %, Section _ 11_ (circle one) Hudson, W1 54016 T 28 N. R 19 W II. Type of Building (check all that apply) dk ab 1 13 1 or 2 Family Dwelling -Number of Bedrooms 4 6 u�j,M . Z Subdivision Name 1,00 -w Hills of Tro ❑ Public/Commercial - Describe Use Na ❑city of ❑ State Owned - Describe Use _ ��� D d,n _ CSM Number ❑ Village of Ce I Na ❑ Town of Tro III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Tmatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Owner IV. Type of POWTS S stem/Component/Device: Check 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 Dispersal Component (explain) ❑ Pretreatment Device (explain) V. soersa lfTreatment Area Information: a•� (gpd) Design Soil Application Rate(gpdst) Dispersal Area Req ' (sf) Dispersal Area Proposed (sf) Sys Elevation 600 gpd 1.0 ASTM C -33 sand 600 sq. ft. 600 sq. ft. �!� L� 1 " above //�/�) 0.6 in -situ soil — w VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks n n �v �/) septic or Holding Tank 1,200 _ 1,200 1 W 1 ser Concrete X DO,ng Clainber 800 _ 800 1 Wieser Concrete X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Bill Schumaker 1 227990 715 386 -3121 Plumber's Address (Street, City, State, Zip Code) 1070 Scott Road, Hudson, WI 54016 VIII, Voun !De artment Use Onl Approved 9 2 > Pe F Date ued Issuing t Sign Given Reas e�foi•_Denial nn n IX. Condit�'Q g M p��r {ons for Disap 4DJ roval 3, ,1b4� CJL SYi7Wl�f4 - �/� " eas �b �rdrl� O�J�a -tom /1M�i J. Septic tank,-affluent filter and dispersal cell must all be servlces / maintained C.t A as per management plan provided by plumber. 2. AN edlbsck tegtriratents must be maintained Attach to complete plans for the system and submit to are County only on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 i r c /e lzzzrq —�� A( 76 Curve C�.ase /off / ?, ��yy,,wiy 6ec.11 9 J. 7n. St• Cr�;, Cn., cJ�. ,Oc/. k o5lp 131B•00- C.S.T. 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S3 ' e �1u «+ E , k✓ &'xi�d Co's f/. / f /rCGMCL� �'r� '`� YP "�%r<'C�J ,�cCc✓a�E-.Z.O /,' fna,. rC' 990 - ' p ad, 3 �5 9B.sd b 22 1 t 2 98 S.F. 00 p� 6 r w «mo . R � 1 141 ACRES 4 .Fr S 9 wwnM R M1111WY M wiI R S p� i N K) I I +w � 6�p�yi 24 �7 i 6 C y �ww.= c e 31 ACRES O x yy r R � w w�xw�n s senrw + rw�aw n � w �rnxa w wrAna� w aas�a w q { w ea $ i p waa w aaaMR wRwnR� �RM io , M,��"'a'Pm'wnwww`oNlwWwwrcwr'r ` f 4.20 r _ •� 13..C' 131- 85.99` 0 3 e „ 90"00'0 E 77' 28+21 er 2 . C4 8 w "' w � R , � y pww�M wRw LO 1.031 ACRE L . 44 *90 B S .F. T Q 6.416 ACRES 279 S.F. O N 00 f co .51 _ : oer•°a a wRrw O w °'"""+� " R ,� 0 00, r"g � @ j Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 III www.commerce.wi.gov /sb/ s co n s' n www.wisconsin.gov , to epartme of Commerce Jim Doyle, Governor Mary P. Burke, Secretary July 05, 2007 CUST ID No. 227990 ATTN: POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/05/2009 Identification Numbers Transaction ID No. 1412281 SITE: Site ID No. 727179 Glen Johnson Construction Please refer to both identification numbers, 741 Mount Curve Chase above, in 411 correspondence with the agenc Town of Troy St Croix County NEIA, NWl /4, S11, T28N, R19W Lot: 12R, Subdivision: Hills of Troy FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS our Manual Regulated Object ID No.: 1138826 Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. Coyle • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption APP area. chs. NR 811 & 812c Dewomf OF • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE COO • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat WILLIAM C SCHUMAKER Page 2 7/5/2007 I • Comm 83.22(7) A copy of the approved plans, specifications shall be on -site during and this g construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall .provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, . Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633' (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DES( Residential Application O INDEX AND TITLE PAGE � Oj Project Name: Johnson Construction 4- bedroom residential mound / Owners Name: Glen Johnson Construction Owner's Address: P.O. Box 890 Hudson, WI 54016 Site Address: 741 Mount Curve Chase Legal Description: NE1 /4 NW1 /4, Sec.11, T.28N., R.19W. Township: Troy County: St. Croix Subdivision Name: Hills of Troy Lot Number: 12 Block Number: Na Parcel I.D. Number: 040 - 1318 -00 -012 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached soil evaluation report Designer: Bill Schumaker License Number: 227990 Date: 06/12/07 Phone Number: (715) 386 -3121 Signature: � .,h Wonally Designed Pursuant to the ZQVED Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both VT OF COMM" SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and �, Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) RESPONDENC Version 5.1 (R. 06/06) Page 1 of 9 l Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 40040' Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50; Peaking Factor (e.g. 1.5 = 150 %) coliform of <- 36 inches. 600.00 Design Flow (gpd) 5.00'. Site Slope ( %) 99.00' Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.601 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /fi 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.125. Orifice Diameter (in) 2.00, Estimated Orifice Spacing (ft) = 6.00 ft /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 91.50' Pump Tank Elevation ft Enter Y or N 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) Ibb 8.50 Vertical Lift (ft) 62.76 5x Void Volume (gal) 1.39 Friction Loss (ft) 69.28 Minimum Dose Volume (gal) 0.00' In -line Filter Loss (ft) 41.19 System Demand (gpm) 16.39 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information 800.64! Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 1 22.24 gal /in (enter result in cell 1349) Dose Tank Information Effluent Filter Information 800.64' Dose Tank Capacity (gal) PolyLok Filter Manufacturer 22.24 Dose Tank Volume (gal /in) PL -525 Filter Model Number Wieser Concrete Manufacturer Project: Johnson Construction 4- bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views - .... T 1/10B 'Observation Pipe . . ' ' J A B ... UU . I �— L Mound Component Dimensions A 6.00ft E 21.60 in H 1.00 ft K Nmft ft B 100.00 ft F 9.25 in z 10.84 ft L ft D 18.00 in G 0.50 ft J 7.23 ft W 600.00 (ft Dispersal Cell Area 1 1683.82 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.27 (ft) —► H t rrirrrri 2 G •1 F ; : ; : ; 101.00 (ft) Lateral rrrrr ri rr rfi r rrrrr... Dispersal Cell 100.50 (ft) - i1 — Invert Dispersal Cell 3[] Elevation E i4 - i, - _ _ 99.00 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key fl Dispersal Cell See lateral details on 10 = Topsoil Cap ° 1.5 ft Page 4 for number, size, © rrrrr Subsoil Cap 5 and spacing of laterals. LILLJ ASTM C33 Sand `6 A Laterals are equally Z „.. F `i Tilled Layer c d 0.5 ft Typical Lateral spaced from the n5 Aggregate a c 5 ' distribution cell's centerline in the — A distribution cell (AxB). Project: Johnson Construction 4- bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Diagram Foroe mai n connection via tee or cross to manifold at ang point. Laterals are identical I P S •- Turn -up vt'ball valve or IF X--- �,Ex12 x1241 Laterals & force main of PVC Soh 40 of ea n out pl u g per COMM Table 84.30.6 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 6.00 ft /orifice Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 41.19 gpm Manifold Diameter 1.25 in Total Dynamic Head 16.39 ft Forcemain Velocity 4.21 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -�► Comm 16.28 WAC 4 in, min. ii Disconnect Tank component is properly vented E-- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Cap acityl 800.64 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.88 420.00 C B 2.00 44.48 Pump off elevation (ft) C 3.12 69.28 92.50 D 12.00 266.88 D Total 36.00 800.64 Dose tank elevation (ft) 3" Bedding uncTer tank. 91.50 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds Pump Model Number 3871 EP05 Pump Must Deliver 1 41.19 gpm at 16.39 ft TDH Project: Johnson Construction 4- bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Bill Schum aker Phone 715 386 -3121 POWTS Regulator's Name � St — Croix . ix County Zoning Dept. Phone 715 386 -4680 System Flow and Load Parameter Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 fe Maximum FOG 30 mg1L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 du /100 mL Service FMguency Septic and Pump Tank lns t and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materialg Staldilrds 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • ... ......... • Grade" 6-8" Diameter Lawn _...��� Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Johnson Construction 4- bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an Individual certified to service septic tanks under s. 281 48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specked in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 �� GOULDS PUMPS Submersible Effluent Pump i, 3871 EPO4 EP05 414 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and cwe, grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance, construction following uses: heat transfer. • Effluent systems ■Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion SP Canadian Standards Association Heavy duty sump matic models include resistance. • 'VVater transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewaterin for efficient heat transfer Goulds Pumps is ISO 9001 Registered. 9 assembled and preset at the factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. maximum. ■ EPO4 Impeller: Thermoplas- ■ Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1' 12" NPT. seal protection. • Mechanical seal: carbon - rotaryi'ceramic- stationary, BUNA -N elastomers. • Temperatures. 104=F (40' - C) continuous 140 - F (60 - 'C) Intermittent. METERS FEET • Fasteners: 300 series stainless steel, 9 30 ��. 5GPM • Capable of running dry without damage to 8 2 S Fr components. zs � /^ °a z Motor: i • EPO4 Single phase: 0 4 HP, v 6 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with o T d 15 automatic reset. 4 • EP05 Single phase: 0.5 HP, a EPOS 115 V or 230V, 60 Hz, 1550 3 10' RPM, built in overload with PO4 automatic reset. z • Power cord: 10 foot s standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 0 0 0 10 20 30 40 so GPM foot length, grounding three prong ding with 5/��y6!,p,� 1n"4"mat» - /v ,standard on EP05). ra�e J eo�l groding plug 0 2 4 5 8 �10� Q h CAPACITY Goulds Pumps ?uU2 Gou Pumps ITT Industries :fiective September, 2002 �/ ' - F -- 4 �3 Wisconsin Department of Commerce I•' LUATION REPORT Page 1 of Division of Safety and Buildings _ c ith C m 85, Wis. Adm. Code S i . i 157 7 Attach complete site plan old es in size. Plan must County ST. CROIX 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 near est r oad. (PENDING) Please print all information. Review Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location NORTH DAKOTA STATE UNIVERSITY C/O Leo Beskar - - -- NE ❑ 0 i Govt. Lot 1/4 NW 1/4 S 11 T 28 19 N R E (or) W Property Owners Mailing Address Lot # Block # Sub;Na or CSM# Rodli, Beskar, Boles, & Krueger SC, 219 N. Main Street 12R - -- Hills of Troy ❑City City State Zip Code Phone Number ❑ Village Town Nearest Road River Falls, WI 1 54022 ( 715 425 -7281 Coulee Trail 0 New Construction UseG] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable Ij1> ft General comments and re c me dations: Mound System -- 1.50 ft. sand fill -- 0.6 loading rate L rd, 5' �� (If pre - treatment - 0.50 ft. mourffl sand -- 0.8 loading rate) F1 Boring # ❑ Boring a Pit Ground surface elev. I C /• Y@ ft, Depth to limiting factor 36 in. Soil Application Rate Hor Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF Mun Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 A 0 -4 10 y/ 2 sil 3fgr ds cb 3vf -co 0.6 0.8 2 4 -1 IOYR2 /2 — sit 3fsbk ds a1 2vf -co 0.6 0.8 3 13 -36 IOYR3 /4 sil 3fabk dsh cw 2vf -m 0.6 0.8 4 36 -38 1 OYR3 /6 f2f 1oYR4 /6 scl Om dh -- -- 0.0 0.0 E Boring # ❑ Boring 30 0 Pit Ground surface elev. 1076. fl. Depth to limiting factor in. S Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#2 0 - 10YR3/2 sil 3fgr mvfr 0.8 2 5 -13 10YR3/2 sil 3fabk mfr a1 2vf -co 0.6 0.8 3 13 -30 1OYR3 /4 sil 3fabk mfr cw 1 of -m 0.6 0.8 4 30 -31 10YR3 /4 f2f 10YR4/6 &10YR6/1 sil 2fabk mfi cs 0.6 0.8 5 31-34 10YR3/6 f2d 10YR5 /6 scl Om dh 0.0 0.0 Horizon 5 has some g. ' 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) ignature _ CST Number Mary Jo Hollister (Z•�f, ���✓� 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 09- 10- 05 (715) 426 - 1775 Property Owner NDSU (Lot 12R) Parcel ID # (pending) Page 2 of F] Boring i1 Boring 18 Pit Ground surface elev. 1014,7C ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 0 H -4 10YR3 /2 -- sil 3fgr mvfr cb 3vf -co 0.6 0.8 1 2 4 10YR3 /2 - sil 3f -msbk ds a 2vf -co 0.6 0.8 3 9-18 10YR3 /4 - sil 3fabk dsh cb 2vf -co 0.6 0.8 4 18 -22 - lsbr - 17 Boring # n 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 ❑ 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 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 altemate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777. SBD- 8330Test (R_07/00) Vf • Plot Plan for Hills of Troy Page 3 of Town of Troy, St Croix County, Wisconsin ffi Lot 1 I = 40 ft. Legal Description y �r THE �v� /4� Ste, i1 T2N 2 ft- conto >;I "tom TDWIn Or Tggj = packhoe pit f I 12 I R=1 R -1,2/ 1 C r;i� ic i ' f i i R -138 � f NCH MARK: BENCH MAR TOP OF 1 1/4" ��j Q / TOP OF/ 1 K: 1/4" IRON PIPE IRON PIPE r > EC6VAT�= �/ ELEVATION = 10�f• i r � `r.1 K r Wisconsin Department of Commerce' "'� Cy Ia LUATION REPORT Page 1 of 3 Division of Safety and Buildings ---- I �r(#�+r With C m 85, Wis. Adm. Code County ST. CROIX Attach complete site plan o es in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. (PENDING) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. eviewe y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G�Nf' ✓' ` Q CJ Property Owner Property Location NORTH DAKOTA STATE UNIVERSITY C/O Leo Beskar Govt. Lot ---- NE 1/4 NW 114 S I I T 28 N R 19 E Property Owner's Mailing Address Lot # Block # Subd. Name or CSW Rodli, Beskar, Boles, & Krueger SC, 219 N. Main Street 12R I - -- I Hills of Troy City State Zip Code Phone Number ity [3 Village [ETown Nearest Road River Falls, WI 1 54022 ( 715 425-7281 Coulee Trail E] New Construction Use>] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement E] Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable NA ft. General comments Mound Systegm,� -- 1.50 ft. sand fill -- 0.6 loading rate and = d � / '7('j (If pre - treatment - 0.50 ft. moussand -- 0.8 loading rate) a Boring # D Boring Q Pit Ground surface elev. 110 ft. Depth to limiting factor 36 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0 -4 10YR2/2 - sil 3fgr ds cb 3vf -co 0.6 0.8 2 4 -1 10YR2/2 - sit 3fsbk ds ai 2vf -co 0.6 0.8 3 13 -36 10YR3/4 sil 3fabk dsh cw 2vf -m 0.6 0.8 4 36 -38 10YR3/6 f2f 10YR4 scl Om dh -- -- 0.0 0.0 FBI Boring # ❑ Boring 30 Q Pit Ground surface elev. 1076. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0 -5 10YR3/2 - sil 3fgr mvfr cb 3vf -co 0.6 0.8 2 5 -13 10YR3 /2 sil 3fabk mfr ai 2vf -co 0.6 0.8 3 13 -30 10YR3 /4 sil 3fabk mfr cW lvf -m 0.6 0.8 4 30 -31 10YR3 /4 f2f 10YR4 /6 &IOYR6 /1 sil 2fabk mfi cs -- 0.6 0.8 5 31 -34 10YR3/6 f2d 10YR5 /6 scl Om dh -- -- 0.0 0.0 Horizon 5 has some gr. 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) ignature � CST Number Ma Jo Hollister �W� 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 09-10-05 (715) 426 - 1775 4 9 Property Owner NDSU (Lot 12R) Parcel ID # ( Pending) Page 2 of 3 Boring It Boring ❑ 0 Pit Ground surface elev. W14,10 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -4 10YR3/2 -- sil 3fgr mvfr cb 3vf -co 0.6 0.8 2 4- 10YR3/2 - sil 3f -msbk ds ai 2vf -co 0.6 0.8 3 9-18 l0YR3 /4 4 -- A 3fabk dsh cb 2vf -co 0.6 0.8 4 18 -22 -- -- lsbr -- -- -- -- -- -- Boring # U Boring a 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 Boring E Boring # -- Ground surface elev. ft. Depth to limiting factor in. 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 < 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- 8330Tw (R.07 /00) Plot Plan for Hills of Troy Page 3 of 3 Town of Troy, St. Croix County, Wisconsin Lot i z 1 " = 40 ft. Legal Description � �y a ,= TH , m i4., sGe. +w, 2i2 4, 2 ft contours RIRuJ� - rcN �� T oy = Backhoe pit _f- L4 I 12 , I R -12 , IN R - 1 I C E 1 0 X4 7a �( \ R -13B t , ,CBI =NCH MARK: BENCH MARK: TOP 0 TOP OF 1 1/4" \� �� RON PIPE 1 /4" ' IRON PIPE i ELEV EL ATION = 7 EVATION i TILLS OF TROY SE 1/4 OF THE NE 1/4 OF SECTION 10, THE NW 1/4 OF THE NW 1/4, THE /4, THE SW 1/4 OF THE NW 1/4, THE NW 1/4 OF THE NE 1/4, THE NE 1/4 THE SW 1/4 OF THE NE 1/4 OF SECTION 11, ALL IN T28N, R1 9W, TOWN LUDING LOT 2, CERTIFIED SURVEY MAP, VOLUME 16, PAGE 4332, DOCUMENT Y MAP, VOLUME 9, PAGE 2427, DOCUMENT NUMBER 476499. OUTLOT 5 0.521 ACRE 22,706 S.F. S 87. 30'52" E 2681.78' R-W \ ' . AVRM LIMB' 01 7}E NW 114 CY 5E'C770Y 11 S 32 6oe.6r \ G ` `6J� I N 7J• \ 1218 ACRES 1 0 S�J,033 SF. *. E R LL LL OUTLOT 4 w /\ 11 0'. C iz9es 36 URT E W Lu ,• — 1 / 38 sE— s `•� .�%/ 47760A/ \� C52 _ MOUNT CURVE CHA I y ,J 1 S i6 ` •�/ 8 �'� jai 1. 42 I I 41 6JJ3J�r 10 _ 40 n 51551 I . 1 OOACRESI L I 1404 APES I e 1 1.133 39 ACRES I/ / �~ -/ . `10 i I i i • r I i 1.086 ACRES 43.741 SF. 40,3533 S.F. 46,417 S.F. J I I 11 1 112 13 •_._.. `� t,y 15175 ��� I I � , I i • \.`,�, i Ay�. I. I ����I I 1 �� I ._._.. h CRE CUR VE _ I 4iAaS ss I .t� I I I l y o14 CRES 58 ov a I j L._.I L._.i L ,� >` .172 SF. 11420'• $ C79 90.00'' 1 Ob' i ~ 1 I Ct N 00 E 377.6 1' us, 17 I� I 53 _ I 1.031 ACRES \ • I 1.004 ACRES I I I I 1A3i ACtES� , 1 44,406 S.F. OUTLOT 2 ? -- • 4 _ ,>54 �. -- I I 50 I 51 i 5[/2F� i L «4 A01I SF. -� J• 6,418 ACRES � ' h t` 4 — _ 1 270460 SF. . .E i �CY i= i ��` I I I • r ._., —.._ N _ " _ —•� x.00. 8 18 I I I 54' �._• F 1.080 ACRES RIES c i c 47,035 S.F. _•� I I 1451 1 ACRE5 T' I 1 1. �\ z - - - - -- 4S.,7779 S.F. ` I 1 T' /\/ \,\ .N 6800'00" 1-- V �. ti s - l 65 WIDE SNARED 7 ' J I' 3.3' �• � ' ,�, 1281 ACRES ,� 1.041 ACRES O ORIy 54022 S .F. 59 I 7 EwgY 8 — cb97.\ F ,aa3o sF. 2318 ACRES K '�' �'a i+ ,IEME,yf W Cl ` P• 100.978 S.F / 55 / % �, ~ (, " R--80' ` teo.ta6sal l 30, '�•� 2 `•�•� �, vu ACRES' 5f> AS O MINENC ti' 12 SF/ / 1.043 PE `1 ~� - URT T . �' a' yea \.44422 sF. CO 1'' 1 20 • - - = !••w �1081Cj/ .\, - 1, \ I �/ a •0 % 5 •_• - I .322 A T 1 ACRES , S.F. W 1.301 ACRES 56.652 S.F. 1.0n A 46.W 21 �! 8 1 b• 5 6d1 t, 58 " ,�,•_ '�i.67�4'.4Q:. 1.585 ACRES S. - `r;7A01 / N 22.�� 15 A ' • .� 9.051 S.F. co �� ,.•� QPE. '8 �" I 1.104 ACRES '` -A •, \ A T TED LAND \ \ s a• a a : ` 1'993 sF. ?rat OCJ7-�o 212M I SF. I \ \ � \•� ��K �� Z �� • e u- G MONUMENT "TROY C.P.S. " I ELEVATION - 1090.08 (NAVp 881 \1 W \ \ N I W UNPLATTEO LAND SHEET 2 OF 4 � •� iii / • r • op O WN 41 • • � ri .4 �. nut 37 � e 4° r nu„ . u.,nu r -v�cr� ruw o�iru rr7n iru. r 1JJOOJtci aep. r� tv�r�J iu. JJrU 1 rc T- O � GR ix GovlvTx SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuycr -- � o k nso.ii Don,< Mailing Address ►�'lt� �f ' i�� L� _ q-1 Property Address i^ Y - _ 4e -- (Verification requited from Planning & Zoning Deparment for new oonstruction.) City /State �L)A V1 , (;) Parcel Identification Number 4`1 — 13 1 _ .0 - VDT �. LEGAL. DESCRIPTION Property Location t/. , U) 1 14 , Sec. I T R�W,'fown of/ r5 Subdivision —._ A _ _ . Lot # . Certifted Survey Map # _ _ , Volume , ,,,,,,_ Page # Warranty Deed # ` . Volume . Page # _ Spec houses y no Lot lines tdeatifiablc�'yew no SVSTEM MAINTENANCE AND OWNER COI CATION Improper use and maintenance of your septic system could result in Its p., tam fafte to handle wastes. Proper maintenance consists of pumping out the septic tank every thrcc years or sooner, if needed, by a licensed pumper. Wbat you put into the system can affect the function of the septic tank ac a treatment stage in the waste disposal system Owner inaintenanee responsibilities are specified in §Conan. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The prvperty uwiwr agrees to submit to St. Croix County Planning &t 7ontng Department a certification form, signe.ct by the owner and by a matter plumber, journeyman plurnbor, mtrictod plumber or a lteonsed pumper vorifying that (1) the on -site waxtewatcr disposal system is in proper operating condition and/or (2) aRer inspoctiou and pumping (if noeosswy), the septic tank is less chart 113 fall 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 Reso State of Wisconsin. Certification stating that your septic system has bean maintained must be completed and tetumed to the St. Croix County Plarming & Zoning Dcpartnunt within 30 days of the three year expiratirm date. 1 /we certify that all statements on this form are true to the boat of my /our knowledge. Uwe anVare the owner(R) of the property described above, by virtue of warranty deed recorded in Register of Deeds Office. N f bedr ms e SI 'I'[ U OF APPLICANTS) DATE "`Any information that is misrepresented rruy 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 sun'ey map if reference is trade in the warranty deed. rV. otua ' � I Ililil lilil !1111 IIlll fill! IIlII IIII llllll IIII fill 8 5 2 8 2 4 2 State Bar of Wisconsin Form 2 -2003 852824 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 06/13/2007 03:15PM THIS DEED, made between Troy Development Cor oration WARRANTY DEED EXEMPT I ( "Grantor," whether one or more), REC FEE: 13.00 and Glen Johnson Construction, Inc. TRANS FEE: 427.50 PAGES: 2 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County County, State of Wisconsin ( "Property ") (if more Name and Return Address space is needed, please attach addendum): Glen Johnson Construction, Inc. 634 Commerce Drive See Attached Addendum. Hudson, WI 54016 Part of No. PIN 040 - 1318 -00 -012 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Dated 6 1 J & ' (SEAL) (SEAL) * Charles S. Cook, President, Troy Development Corp (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) authenticated on )ss. Anoka COUNTY ) * Personally came before me on /n , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Charles S. Cook, President Troy Development Corporation (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: GZ.AAx� � ' Troy Development Corporation * a r r t_ A. r e C Charles S. Cook, President Notary Public, State of Minnesota My Commission (is permanent) (expires: / 3 ' .ZQ /( ) (Signatures may be authenticated or acknowledged. Botb are not nwm NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FO.Y WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN CABBIE A. �- 3 • Type name below signatures. NOTARY PUBLIC - MINNESOTA 1 of 2 MI' Ctxnatsan Expires Jan. 31, 2010 ADDENDUM #1 TO WARRANTY DEED Lot 12 of the Plat of Hills of Troy, Town of Troy, St. Croix County, Wisconsin. Subject to the terms and conditions of the Declaration of Covenants and Restrictions for Hills of Troy recorded January 17, 2006 as document number 816569 and the terms and conditions of a Landscaping Easement recorded January 17, 2006 as document number 816571 all being recorded in the office of the Register of Deeds for St. Croix County, Wisconsin and FURTHER being subject to easements, restrictions, reservations of record, or in use, and the "Buyer" obligations and conditions contained in the Purchase Agreement for this lot and any addendum thereto between Grantor and Grantee herein, which includes, without limitation, requirements for approval of plans by an Architectural Review Committee, approval of home builder by Grantor, compliance with Grantor's approved builder requirements and potential fees related thereto and commencement of construction deadlines together with related rights of redemption and/or lot maintenance fees, all of which shall survive closing and conveyance of this property and shall be binding upon Grantee, and his/her /their successors and assigns. This property is being conveyed subject to Grantors existing mortgage financing and shall be subject to mortgage financing provided by Grantor to Grantee. 2of2 53" 96„ 41" 1s = m 3 ., ( I I I i i 6" K0 DD� 0701) n20 DMr mOz N N m cNilmrD D N D m �- m m = r� m 44" m z > c V I I s D 0 z C z N D 39 m D Z C C) T1 C D N C) O Z O Q m m m -t- x' c D 0 c� Lo Z aZ r- DiOp5Zmy00DQ Z T S W z o m° n ° z- O=CR -IrZ Co M co m Ll t " N D r > 1 rTl m rn W *-A �� 0 C� N w � N 71 rl 0 O A ^ rrl O D 10 N O y D Kc) 00- 0 " S (n N m -q r Oo : ° OD 0 r- Z 0D m O a0 O ♦/ O y D\ D 0 O \- z D O c ° tDm ^G� - m r m 0 X m c m O ,Z,^ ° - W N r g L LD V N m \ = O WLP1200 /800 -MR SCALE: 1/4 " =1' REV N0. DATE: O m MIESER soUGHETE DRAWN BY:SWT z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2001 ° REV. JAN. 2004 800 - 325 -8456 FILE: WLP?200 800 -MR ..r 0 I z O u.t +H i 1193 � Ul z w O� J *R 0. tu _Q _ � w l� J y i M v 0 Q A r a III Mill HIM UQ C. Q 0 Lu W Uns L1 Q m O J D 0 J i a ny ) TTIT 11111111111,4 9 6 d o Z Q. ell E. cm wl all LL J '1 99rVA1. NNOMM e .77 :T— xm • Y � ilia r 7t � v I 4a4 'tFt J AWW J V IL 0 }l{ � 1'1G►il � Il m 73 xx. s � {a t N I A OL �I o N O w y i � N O �4 Z I`