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040-1280-00-000
. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division Sanitary Permit No: INSPECTION REPORT 561062 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: Dostal, Jonathan & Rebecca Tro , Town of 040-1280-00-000 CST BM Elev: Insp. BM Elev: BM Description: / Section/Town/Range/Map No: 1 146-161 ~Q4 V-. 6 M G 17.28.19.1572 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark d #4, Week ±5 /Z(VIS Dosing a, s , Alt. BM a~ 7I t~ At 1~,,d Bldg. Sewer < ~ro4ioa Holding St/Ht Inlet St/Ht Outlet / DQ c?t, s~ .)N (0 D I7 TANK SETBACK .)N TANK TO WELL BLDG. Vent to Air Intake ROAD Dt Inlet i, / ps 2. Septic gy Dt Bottom qtr .3 91 $/p Dosing Header/Man sa /az y45 ~t,S - e; 5'5 14 .3 .(A Aeration Dist. ipe 13 &J. Holding Bot. System 6 l~ OZ, /3 Final Grade PUMP/SIPHON INFORMATION Z. 167 xa(, Manufacturer Lo-'ll "s Demand St/Fover Za GPM ea 1) AA #7 7 Model Number 3 TDH Lift l' Z5 Friction l,oss~ System Head TD 1 IFF Forcemain Length IDia. If I Dist. to well ~u / I J~ D O J qy SOIL ABSORPTION SYSTEM ^ c. l~C~.1 a~ Ir (o . ZS 9 S , 77 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid ;th DIMENSIONS 3 lQ~ ~ e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufac INFORMATION CHAMBER OR J..tiC i c~-le. Type Of System: r nn 1/6 ieo j I - .It. / / UNIT Model Nu ell _ A-t A DISTRIBUTION SYSTEM 16 /S4-/5,&-1S = 616rt Header/Manifol/ d Distribution \ x Hole Size Hole Spacing Vent o Air intake 114 A0 1.rAO' Pin(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 Al d Bed/Trench Edges Topsoil Yes No es ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 477 Omaha Ro Hudson, WI 54016 (NE 1/4 NE 1/4 17 T28N R1 9W) Eagle Bluff Lot 40 Parcel No: 17.28.19.1572 1.) Alt BM Description = 2.) Bldg sewer length 0 G(,c, - amount of cover = LL Plan revision Required? ❑ Yes No Use other side for additional information. lp - Date Insepctor' Signatur Cert. No. SBD-6710 (R.3/97) I • dV ~~o~oer+Ey.sF~.~e E~: S~'nq G 1 e ✓a~:r~-~ Qc~ ~,zg/j fonr~E(w 4 Qa6000q F es '77 0,~« h 4 Rd. ,Lots ~o ,o/a.E o~Ea,,qle tlu T . c{7roy, Lit. ~cJ. s~o --a~-az ,os v~ ti j ~waJe. Coner~~e o ~ dfiJCway Z7 t ■ (32`1 ~ oj ------6- 115 l°7 s~(3edre~om ~Pcs,da.~cc. ` J' e Ser ~onGr<- (1~5ffi bu~toh box IOU 14.tr 0 ~y ~ ~t/Jr E e. s /d0. W r 83 c, ~oS ; or'9.92.36~i.t.SGs O % A!b• 6.r► ;Tp a Stpb~ -,4 2 ~ r r l ~ E ~ ~ Nic3, ~o ~crt~P /~or~ kole Cn • E/e - 9B. 2( ' wry lptu ~Du,,,,Pe~v,.rn bv' O -e-,-Exls~,' t.vec.Ys C~•,~rvEc, sef,E.'c- r 9717 ,f' /5c1.4-ice/u«,t Propcs~(.~ O0-E1I-,E~~~ 95.5~5~ ord. o✓+~.~ d;ver5;on of ' valve 97.7r ti S TM ~ County ~rj Q^ Safety and Buildings Division St. Croix $ ' I 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) p Madison, WI 53707~A62 ~ ~ D 4 c_ rV ~O l ~Z Sigiftary Permit Application State Transaction Numb In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the Nmy go~yi~fQQ~~tal unit A is required prior to obtaining a sanitary permit. Note: Application forms for state owS are su}fmitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you prov~ for secondary e s in accordance with the Priv Law, s. 15. 1 m , Slats. N Same 1. Application Information - Please Print All Information Properly Owner's Name Parcel # Jonathan & Rebecca Dostal 040-1280-00-000 Property Owner's Mailing Address Property Location (116-7-2-) 477 Omaha Road Govt. Lot City, State Zip Code Phone Number NE section 117 (circle one) Hudson, WI 54016 (715 386-5811 T 28 N; R 19 E or W IL Ty of Building (check all that apply) Lot # r 2 Family Dwelling -Number of Bedrooms 4~ - V577A 40 Subdivision Name Block # Plat of Eagle Bluff El Public/Commercial -Describe Use Na ❑Ciry of ❑ State Owned - Describe Use CSM Number /Village of Na Il~^T'own of Troy III. Type of Permit: (Ch e x o A. Complete line B if applicable) A. New System eplacerrent System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal Permit evision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 316-1-77-- 2001 IV. T e of POWTS System/Component/Device: Check all that a 1 on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil Mound <24 surtabl soil 14 5Z vtoe xplam) , ❑ Holding Tank ❑ Other Dispersal Component (explain t2 4_~PCl( ent V. Dis rsal/Treatment Area Informatio • 6o Infiltrator ` Plus" standard chambers & 8 endca Design Flow (gpd) Design Soil Application Rate(gpdsf) ispers a e r a Proposed (sf) System Elevation 600 Gpd 0.50 Gpd/Sq. Ft. 1,200.00 sq. ft. 1,240.80 Sq. Ft. 102.00' VI. Tank Info Capacity in Total # of Manufacturer Gallons_ Gallons Units t; New Tanks Existing Tanks w ~ y k Q in A H F. Septic or Holding Tank 1,250 1 Weeks Concrete X Dosing Chamber 1,000 Na 1,000 1 Wieser Concrete X VII. Responsibility Statement- I, a undersig , assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S' ature MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, ode) 340 P ulson Lake Lane, Osceola, WI 54020 oun /De artment Use Only VIII. jilt ung Agen ignature pproved 11 Disapproved Permit Fee Dat71720(3ri~ ❑ Owner Given Reason for Denial $ I IX. q' 1%"bQ~ ?Ff- oval/Reasons for Disapproval 3 AJd ' V&~_ 46 W" 1. Septic tank, effluent filter and ?,O;jq 7-0 13 ~a v cX,e-r-o dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained to co plans for the system and submit to the County only on paper not less then 8 1/2 a 11 incbes in size SBD-6398(R 11/11) Conventional POWTS Index & Tilte Sheet Project Name: Dostal 4 bedroom Replacement Dose Conventional POWTS Owners Name: Jonathan & Rebecca Dostal Owner's adress: 477 Omaha Road, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 40, Plat of Eagle Bluff Legal Description: NE1/4 NE1/4, Sec. 17, T.28N., R. 19W., Town of Troy, St. Croix Co., WI. Parcel ID 040-1280-00-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 System Cross Section Page 4 Dispersal Cell & Dose Chamber Sizing Calculations Page 5 Dose Chamber Cross Section & Pump Curve Page 6 Dose Chamber Specifications Page 7 Distribution Box Cross section Page 8 Existing Filter Specifications Page 9 Dose Conventional System Management Plan Page 10 Septic Tank Maintenance Agreement Page 1 I Parcel Map Page 12 Deed Attachments: Soil Evaluation Report Mater PI er Res Jcted Service: James K. Thompson, DSPS Credential #30021 Signature: s---- Date: Page 1 Of 12 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N,01101) Ex:36 nq G 1 e da~:u-~ Qc! X1..3/4 Jongf(,an 4 Qa~cccq ~s~•-1 5177Colah Rd. tt ~o~ Flo P/a.E oFEa~/e ~/u~ r. T. orToy G~7c G., uo aM-ao -av was ..4. , ~ar4Je Co~C.~~Ee o ~ driJCwar • 62~u ~ !y - CX,S-Firi lo7 EXi.3 ~i~~1 I LtJG!( ~(3ed~Xo.r1 ~Pcs~dc.,cL ` wJ'ieSee 0-0oc.r4,4-G U+S~/'i F~u_fi o h boX Gov Maze: x160 ~y~~ v u~r E e . a Ldp. Gv . 63 5 / oryjl.3G~u.54s &Tin Io p % 16- 6-ol- Top o s ,a C, 2 "C I ~'E '~i.~,tse ~►crl.~l° N'lon/tslQ ca . Elegy`- y8. Z/,' ~ 97.77 ,f' /~bc(.4-ice rF,F/u•wt xet W" &P P-opos.~( ~ owE/t~lobe yS.01 Ord• 004e, dive! Si aq o v- /st 3 97.77. ~ V. yo P1 fE Ta ('l)f"N AAJk- As T/4 i l 9 I = ~ i I y " ~N J, opQ ' I ~ r 1 N v o ~ O i i r I 1 Ii F7,~ti 1 I 0 ~ 0 d I J 0 t ! I O ~ z 5. Dostal 4 bedroom Dose Conventional Dispersal Cell Sizing Calculations 1. (4 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 600.00 Gpd desi ng_flow 2. Infiltrative capacity of native soil = 0.5gpd/sq. ft. 3. Absorption area required: 1.200.00 N ft. 4. Absorption area as proposed: 630.60 sq. ft. (60 chambers total) Infiltrator "Quick 4 Plus" Standard = 20.00 sq.ft. EISA/chamber, "Quick 4 Plus" end cap = 5.10 sq.ft, EISA 1,200.00 sq. ft. - (8 endcaps)(5.10) = 1,173.99 sq. ft. 1,173.99 sq. ft./20.00 = 58.70 chambers required Number of trenches: 4@@15 chambers per trench Trench width: 2.83' Trench length: 63.00' Trench spacing: 9.00' on center Total system area w/ 6' trench spacing: 30.00x 63.00' Trench Elevations: 102.00' Pump Chamber Calculations 1. Force Main: Diameter 2" Length 100' Flow rate 25.00 gal./min.t Friction loss 1.39' (100')(1.39 ft./100') = 1.94 ft. 2. Total dynamic head: Min. supply pressure 0.00, (forcemain will discharge to distribution box & gravity feed to trenches) Vertical lift 10.75' (P.C. bottom = 91.75',Off float = 92.751, Dist. box invert =103.50') friction loss 1.39' Total dynamic head = 12.14' 3. Pump selection: Manufacturer & Model number: Zoeller BN 53 Pump will discharge approx. 27.0 gpm @ 12.14' TDH (Flow Velocity 2.75 ft./second) 4. Dose chamber. Wieser WI,P1000-MR- 36" liquid depth @ 27.83 gal /inch (1.001.88 gal. actual) A) One day holding capacity: 17.00" = 473.11 g 1. B) Alarm setting: 2.00" = 55.66 gat. C) Dose volume: 5.00" = 139.15ga1. (600gal.)(200/.) + (.164x 100) = 141.40 gal. max. dose D) Reserve storage: 12.00" = 333.96 gal. Pg. 4 of 12 Dose Tank Information Locking cover with warning label and locking device and seated watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is property vented Alternate outlet location Forcemain diameter Wieser WLP1000-MR Manufacturer 1.5 in. Capacityl 1001.88 Gallons Volume 27.83 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 17.00 473.03 B 2 00 55.66 C Pump off elevation (ft) C 5.00 139.23 _t 92.75 D 12.00 333.96 D Total 36.00 1001.88 Dose tank elevation (ft) 3" Bedding under tank. 91.75 Alarm Manuafacturer SJ Rhombus - Alarm Model Number SJE 1011421 Pump Manufacturer Zoeller Pump Model Number BN 53 TOTAL DYNAMIC HEAD/FLOW LLJ w PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENTAND DEWATERING 0 6 20 MODEL 53/55/57/59 Q - = Feet Meters Gal. Liters 15 5 1.5 43 163 } 4 10 3.0 34 129 10 15 4.6 19 72 0 007 Shut-off Head: 19.25 ft.(5.9m) 2 5 378 sans 4 5M 11rz-11 112 Nar 0 wok T 10 20 30 40 50 37/8 GALLONS LITERS + 0 80 160 FLOW PER MINUTE ® 4 I CONSULT FACTORY FOR SPECIAL APPLICATIONS ' j • Variable level float switches available. j j • Variable level long cycle systems available. nn • Available with special cord lengths of 15', 25', 35' and 50'. i P5. So~/Z • Alarm systems available. ,A,,g i i z Z x N r m 61 86„ zZ C n 42" 0 z r - m m N ~ O __A I @\ m m 1 m UP 41" / O 4" CAS A m (n / N m 3" 36" ( 4" I O O < I D < I Fri r c/) N D~ D UP 38" o r \m / . 4" CAS N N J I X 17 m c o c r. TIN O _;l m D O A v z ° 39" ~ o< 0 D Nmi mDZ >r D o rn r- I O D N r1~ m-i m ~000 m r~ X A Z D Z 0 m c DO D r 2 r Z Z v O O D r r mo ?~A v o o mi mi z D AN mz 0 oco o O--IIgz D+sz OW 0Z m~0 ODD z CO °x ~W m nmD 2 n0 An0 =a O OrN N mo om N r~Z D AZO mN0 fir-- -iOr N > m (7 C 1 C c -v O\ ~A ZG) =N Z >0 -4. M nDm J m =O~ON =N aN vv 0D Dm N NW (n or ~o;'-4m, o=1 O tlz4k __j (n v D z ow z➢ 0 7~ J NmD I m r~N' ~On_ Zn n Q o A v N f/Z \N c L4 rNmm Dr w , : OGV Nc+ -Ti O n° D n ~O o z ~m D riDm (j) a) o ~f~T1X , n c<D T1 °z cc- - D 00 00 i r z ~ _I Z7 Z o o o m< ;v 0 co r. z 0 A.A. O X O Z ~pv O~ \ONi ° 23 O Gl D D D O o DV) r X m r- r- -4 m spo : z m N 0 0 A O~ O Z L4 CIO -0 N ern co _v z A D 0 O C X Z O N Or m W O co o c D H z r ;u t- m m 0 -1 m WLP1000-MR MIERER CCIICAETE DRAWN BY: SME SREV.• 1 4"-1 -0' PRE-POUR: \\\n z SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2012 DATE:. POST-POUR: Z ° REVISED JAN. 2012 800-325-8456 FILE: W01000-MR Gop8 ?'%C1~`2FIC16 14: 21 ?1564'5181 WIENER CONCRETE PAGE 0'2 %Cl2 y ..r r.~w I I N N U1 I ~ ~ I - ICY-. U fT1 ~ ~ nxd i IVF~• L In mmomw W I ~ z `s S m G7 'ri m ~ > ~ N +rj :N e 'w t rn W N W : o rm ~ o N o O p q 1 o 0 C z vn 0 x i 6 HOLE RISTRiBUMN BOX nil scuEa° i' REV No. DATF-- E pRAWT! BY:SMfY O~\o SEPTIC MANUAL y~8 US Mwr10 MIUD41 ROQC, M 54750 DA-M; JI~NUARY 2005 REV. AN. 2005 800--325-8456 FR.F-6 HOLE DISTRIBUTION BOX 7 c'! 2 Zabel" A Division of Polylok Inc. +?l T FILTER TYPE FILTRATION k. F Zabel A1801 4x18 1/16 800 , 80 Zabel A1801 4 x22 1/16" 800 80 AIOQ$x_18VC 1/16",, 1,2O,Q 78, rl I ` 4,500 24 A100 8x26 VC 1/16" 800 1 1 . 00 8x5 VC , 1 / 16"409; 156 A10012x20V 1/16" 3,000 173 116" All" A 100 12X36 VC 1/16" 6,000 329 A300 ,8X 18 VC 1/3Z',,,: 1`;200 78 A300 8X26 VC 1/32" 1,800 123 A300,8X32_ ; 2-, '2;40A 162 A300 12X20 VC 1/32" 3,000 173 430012X28 VC ' 1/32'x'":x;500, .251_ A300 12X36 VC 1/32" 6,000 338 A600 8X 18 VC1 /64 . 1;200 "J8 A600 8X26 VC 1/64" 1,800 123 A6Q0._8X32 VCS ..,.1 /64' 2,00 162 A600 12X20 VC 1/64" 3,000 173 y 4600 12X28 VC 1/64"', X1,00; 251, A600 12X36 VC 1/64" 6,000 338 I I~Mlnc. Innovations in Precast, Drainage & Wastewater Products Dose Conventional Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SOD-10705-P (N.01101). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at (715) 386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(lxe). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s, 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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. Septic tank manholes 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 the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pumg Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed at the pump discharge, it shall be inspected and serviced as necessary. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency 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 properoperating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg. 9 of 12 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Jonathan & Rebecca Dostal Mailing Address 477 Omaha Road, Hudson, WI 54016 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 040.1280-00-000 LEGAL DESCRIPTION Property Location NE '/4 , NE '/4, Sec. 17 , T 28 -NR 19 W, Town of Troy Subdivision Plat: Eagle Bluff , Lot # 40 Certified Survey Map # Na Volume Na , Page # Na Warranty Deed # (P Y-7 13 (before 2007)Volume , Page # 2-~ Z Spec house Oye pn Lot lines identifiabl 9 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 §SPS. 383.52(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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu ber of bedrooms 4 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) o~/2. P~ / 0 ='8•p°0 OS~ `.k /`7 ~j©l~cY .g "v' 000, ~k2 .2 1.615 ACRES , I~ N O to 70,356 S.F. 41 `~.h` cY ` OUTLOT 2 u R l /guy/1.000 ACRE rao OUTLOt 7.292 ACRES /ry 43,583 SF. 263.91' \ 317.625 S.F. ° g ,7 r 134. 9' \ I_g_' ` g. 314' 2 3.000 ACRES g C19 . 1 /2" 13 3/4„ 130,689 S.F. t9 ►7 117.iM 81 57, 12,.E 631.OI 1 c eN~ o v. 8 0 1.0 i Q, $ w i 2.: 1 iv u l op 10 1 r s f m ti N f` 1 1 B 'ti 8 N cN` .~nr I t ( I g m ~ o~ ~ ` ~ \ ~ rro 1.470 ACRES I o 1 64.045 S.F. r$ m DAD L O Q4 81.5 ' 7~''S6, 116. 5' t4 260.15 ' e P~ 1 N 40 ~I ~J) Itr 1.097 ACRES \ ~P tai ( 1 I7,33b SF. p) yo r c~ ~ ~ CsB ` ~ . . ter- M r` °i cb, rn 39 1.029 ACRES rr 4i~ C6 C67 1 1 f 44,824 S.F. ~ti 73 14.14, JL 1 ~ ~,$g~ 38 i 1 SS+x1.030 ACRE ^r r w 1 w 44 868 S.F. ^ ri r N y1 r 3 r / 37 19 i 3/4•. .065 0, f M' 36 - : 1.063 A S 1 1 1'r !s. 391 1.050 A S 6.289 S.F. r y W 4 SS r'' r v' r 45.721 SF. to r J+.~ 1 1 W 1 /2.. f2 3 31. 179.61' 176.7 ' 13 .0 N 89.3 ' 00" W 31' S 78~ 1 OUTLOT 5 10.558 ACRES i 459,904 S.F. 1 1791.41' SOUTH LINE OF THE NE 1/4 OF THE NE •4 UNPL A T TED L.4 NOTES: 1. ALL LINEAR MEASUREMENTS HAVE BEEN MADE TO THE NEAREST ONE HUNDREDTH OF A FOOT AND ALL ANGULAR MEASUREMENTS HAVE BEEN MADE TO THE NEAREST FIVE SECONDS AND COMPUTED TO THE VALUES SHOW. STATE BAR OF WISCONSIN FORM I - 1998 WARRANTY DEED 6'4.6-.71 Z3 M5 KATHLEEN H. WALSH Document Number VOL 166 ~ REGISTER OF DEEDS PAGE 242 5T. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Troy Development Corporation, a Tinnesota Corporation 06-19-2001 10:50 AM - Grantor. WARRANTY DEED Jonathan Robert Dostal and EXEMPT N and CERT COPY FEE: Rebecca Jean-Dostal, husband_ and wife COPY FEE: TRANSFER FEE. 201.60 Grantee. RECORDING FEE: 10.00 Grantor, for a valuahtr consideration, conveys to Granter the following PAGES: I described real estate in St . Croix County. State of Wisconsin (the 'Property-) Name and Return Address Lot 40 of the Plat of Eagle Bluff in the Town of J a an and Rebecca Dostal Troy, St. Croix County, Wisconsin. 252 Gershwin Avenue N. Subject to Declarations of Covenants, Conditions and OaJofd;k.1e, MN 55128 Restrictions for Eagle Bluff, recorded in Vol. 1589 401 Page 516 , as Doc. No. 638946 , as appearing in the office of the Register of Deeds for. St. Croix County, 11isconsin, and such other easements, _040-1280-00-000 _ restrictions and reservations of record, or in use, Parcel Identif"lion Number (PIN) and the "Buyer." obligations contained in the Purchase Agreement for this lot. This is not_ hontesteact property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 13th day of June 2001 (SEAL) (SEAL) . Charles S. Cook, President Troy Development Corporation (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Minnesota State of Vi-seensi»: ss. Anoka Coun authenticated this day of Personally came before me this 1c . ~t day of June 2002 the above named Charles S. Cook, President Troy Development Corporation TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Il_,C L~y C 'LLT / Troy Development Corporation - Nancy L. Clift Notary Public. Svta.o[1.v3scoaci., Anoka County, Minn. Charles S. Cook, President My cottunissiort is permanent. (If riot, state expiration date: (Signatures may be authenticated or acknowledged. Both are not January 31 2005 necessary.) ' Nantes o! Ixrsorrs sipping m -y caparny nn~sI be ryp.d or printrd b.•Iuw their s.g- -nr. WARRANTY DEED STATE BAR OF WISCONSIN w,scoruin Legal Blank Co.. Inc. FORM Nn. t - 1998 Mil-kee. wu r+..-v NANCY L. CLIFT NOTARY PUBuC -uss4ESOTA MY COMMISSION EXPIRES ,I#MARY 31, 2005 Pi. U 2319 Wisconsin Department of Commerce UATION REPORT Page 1 of 3 Division of Safety and Buildings in 4Knce.. omm 85, Wis. Adm. Code,, A.C.E. Soil & Site Evaluations `f otln Attach complete site plan on paper not less than 8'%x 11 inches in size. Plan must St. Croix include, but not lanRed to: vertical and horizontal reference point (BM), direction and /~R I I.D ~r I.D. percent slope, scale or dimernsions, north arrow, and location and distance to nearest road. P 040-1280-00-000 Please print all information, st Reviewed By Date Personal inba,nalion you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). C~O~ C O Property Owner Property Location Jonathan R. & Rebecca J Dostal Govt Lot NE 114 NE 19 S 17 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 477 Omaha Rd. 40 na Eagle Bluff City State Zip Code Phone Number City J Village 0 Town Nearest Road Hudson WI 54016 (715) 386-5811 Troy Omaha Rd. I New Construction Use: J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD e Replacement J Public or commercial - Describe: Parent material Glacial O twash - Flood p in elp~vg~t>>io~n__, if applica le Na General comments and recommendatio : Site suitable for conventional POWTS dispersal cell with 0.5 gpd sq.ft./day loading rate. Re mmend installing 4 trenches at 102.00'- dosing required to reach system area. Boring # -1 Boring u Pit Ground Surface elev. 105.94 ft. Depth to limiting factor >104" in. Sod Application Rate F Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ff#1 'E 2 fl# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 0-7 1Oyr3/3 none sit 2fgr mvfr cs 2fmc 0.6 0.8 7-28 10yr4/4 none sicl 2f&msbk nvfr cs 2fmc 0.4 0.6 3 28-37 1 Oyr4/4 none jtrats&g Osg dl cw 2f,1 me 0.5 1.0 4 37-46 1Oyr4/6 none Osg dl cw 1vf,f 0.7 1.6 5 46-104 1Oyr5/6 none Osg dl - - 0.5 1.0 Horizon #5 contains 1/16" - 1/2" bands of 7.5yr4/6 Ifs at approx. 12" - 24" intervals. Loading rate reflects reduced permiabilty o horizon associated with banding. Boring # J Boring III, ~ VI Pit Ground Surface elev. 107.63 ft. Depth to limiting factor >111" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIR2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-7 1Oyr3/3 none siVsl fit na na na 2fm na na 2 7-20 10yr4/4 none sl 2f&msbk mvfr cs 2fm 0.6 1.0 3 20-37 7.5yr4/6 none Is Osg dl cw 2f,1 me 0.7 1.6 4 37-47 10yr4/4 none Is Osg dl cw 1vf,f 0.7 1.6 5 47-111 1Oyr5/6 none trat s&g Osg dl - - 0.5 1.0 Horizon #5 contains 1/16" -1/8" bands of 7.5yr4/4 Ifs at approx. 10" - 20" intervals. Loading rate reflects reduced permiabilty of horizon associated with banding. * Effluent #1 = BOD s> 30 < 220 mg/L a rd TSS >30 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS <_30 mgIL CST Name (Please Print) Signat CST Number James K. Thompson - 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 4/24/2013 715-248-7767 Property Owner Jonathan R. & Rebecca 7 Dostal Parcel ID # 040-1280-00-000 Page 2 of 3 3] Boring # -j Boring $01 Pit Ground Surface elev. 105.68 ft. Depth to limiting factor > 105" in. SoN Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 1Oyr3/3 none sil 2fggr mvfr cs 2fmc 0.6 0.8 2 8-20 1Oyr4/4 none sl 2f&msbk mvfr cs 2fmc 0.6 1.0 3 20-38 7.5yr4/6 none Is Osg dl cw 2f,1 me 0.7 1.6 4 38-44 1Oyr4/4 none Is Osg dl C w 1vf,f 0.7 1.6 5 44105 10yr5/6 none 3trat s&g Osg dl - - 0.5 1.0 Horizon #5 contains 1/16" -1/8" bands of 7.5yr4/4 Ifs at approx. 12" - 30" intervals. Loading rate reflects reduced penniabitty of horizon associated with banding. 4 ] Boring # Boring 16 Pit Ground Surface elev. 96.78 ft. Depth to limiting factor >104" in. Sod Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Conk Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-9 1Oyr313 none sit 2fgr mvfr es 2fmc 0.6 0.8 2 9-28 1Oyr4/4 none Sid 2f&msbk nvfr Cs 2fmc 0.4 0.6 3 28-42 1 Oyr4/4 m 1 d 7.5yr5/8 sil 1 fsbk di cw 2f,1 me 0.5 1.0 4 42-48 1Oyr414 none Is Osg dl cw 1vf,f 0.7 1.6 5 48-104 1 Oyr416 none atrat s&g Osg dl - - 0.5 1.0 Horizon #5 contains 1/1&'- 1/8" bands of 7.5yr4/61fs at approx. 12" - 24" intervals. Loading rate reflects reduced permiabilty, of horizon associated with banding. F rJ Boring # Boring i1. Pd Ground Surface elev. 97.72 ft. Depth to limiting factor >94 in. Sod Apples Rate Horizon Depth Dominant Color Redox Description Texture Stnxture Consistence Boundary Roots GPDfit' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-28 1Oyr4/4 none SON fil na na na 2frn na na 2 28-48 1Oyr3/3 none sin lfsbk mvfr cs 2fm 0.4 0.6 3 48-72 1 Oyr4/4 none sid 1 fsbk mfr cw 1 fm 0.2 0.3 4 72-94 7.5yr4/4 none cosl 1 esbk mfr - - 0.4 0.7 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S.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. SDD-8330 (R07/00) A.C.E. Sod & 516E EvaluatbM Joru~~lv~.~ 4 Pt6ccca QasF•-1 Y NudsOitr rah/. ss/O/~ T • o~Toy ~ G,ar~C G., c..) CY c c, q q Ccecr'~4.e o ~ d(iJC~Jaj, 62- CXr:S~inoi EXii6"7'g v we'll ,1, 3edrZn ~ rPl S, e/ir1CG ~ \ FC wi/, . AC.Ii Mrr1 : ~nr;sliad urn E t : ~ /ce. w' 83 Z r ~!p X0/ or931.3Gru•SGS CcN.arh :Topo sc,O~iL,~ p✓l w kele Co el, V.' .re,,A. ExrSEr- w~3 CrnLlv'~a S~P6Z 91771 ~ l ~•.r•~. f owfl.~• .~nvtr~6 e}F Prop o6ed ~ ocA*J gape - 95..11 11-4. dive Qr`0~+ ~r a 97.771 Ve~i' a i I i • 3 0~3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner S TArL, Septic Tank Capacity gal ❑ NA Permit # 5~ ~ © Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units 541 A Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate S~ gal/day/ftz Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ~NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :51 ° OOml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 ears) ❑ NA Y' year(s) y Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 IN-year(g) ❑ ,month(s) ❑ NA Clean effluent filter At least once every: 3 r(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA Z year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must c~iply with the rules in effect at that time. A suitable replacement area is not available ue to setback and-lo soil limitations. Bang advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. aluat' a o ing ank T ~j be ' e ai e '9RD+4I5 TI'S nR- A/6sb✓ Ca&157 9(J~ ON ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS I I POWTS INSTALLER POWTS MAINTAINER Name ,aan /L12s 3W2-- r Name Phone ~~S 2 1 _ 7 7l0 -7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name - / [IName Cn (J ( _Q (j 20A l AJ Phone Phone l S- 3 g4' (p This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d)&M and 83.54(1), (2) & (3), Wisconsin Administrative Code. 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: • 395177 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: Dostal, John Troy Township 040-1280-00-000 CST BM Elev: Insp. BM Elev: BM Description: ~aa TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 63 2 n Alt. BM Aeration ;Bldg. Sewer v L~ Holding Ht Inlet Z, 3 s Z, 7P. 3:S-' TANK SETBACK INFORMATION Ht Outlet 2, 9 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom _ Dosin Header/Man. Aeration Dist. Pipe L`~ D ZY~ M e&.7 9 ?2 -P1 H ding Bot. System f„LL 9Lz' Qz3, Final Grade -~d 2 'X. C7 PUMP/SIPHON INFORMATION M IS Manufacturer _g, y f2 77. Demand St Cover /O ?zs : 6 0 GPM Model Number TDH Lift Friction Loss stem Head TDH Ft For in Length Dia. Dist. ell SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LG Ma fa urer• INFORMATION ~IiAMBjR OR Type Of System: NIT Mode umber: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake r Pipe(s) / I / ~s- r LengthJ~ Dia r _ IL ength_ 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_i/L Inspection #2: / / BLUFF/Lot 4Q Parcel No: 17.28.19.1572 Location: 477 Omaha Road Hudson, WI 54016 (NE 1/4 NE 1/4/17 T28N 1119W) EA IL 5 1.) Alt BM Description = 6 y.~av ~el 1 / / 2.) Bldg sewer length = 4 y 9 //y 'As Wk 5; ?4ft-4 - amount of cover= y~ p I 3 )065/rl/ % P.Pes e(' ~N-~ k%k 6 4P 0~ TVOILC4 S (.v~rt S lit/ [fan rewsio" n Required? ❑ Yes No Use other side for additional information. t( 16 X01 Date Insepctor's S' ature Cert. No. SBD-6710 (R.3/97) Y. Over N .L J i k 9 -7 fo 7. x ~qzS l~~ I i Safe and Buildin s Divtstan - C°' -_T_ 201 W. Washington Ave., P.O. Box 7162 cy T C~0 ~X \Visconsin Madison, WI 53707 - 7162 S_,w Addresi De artmt3nt of Commerce - ~Y~~ Q~~. Sanitary Permit Application sai : Lary F e;Tr a. in accord with Comm 83.21, Wis. Adm. Code, personal information you v e 11 { 2 3 S-1 ( It if R ma be used for secondary g loses Privacy Law, s15. 1 _ _ 1. Application Information - Please Print ~dl Information RC-CE Sac Property OwnerO e O - Pill c;l m e f Z Z dp.- O JSO o s~ - Property Owner's Mailing Address c n~ Pr.: l e: ca r j c s~ wf~ V ZC~tr1MG N 3 / 72N, :2 ( _ City, State Zip Code Phone - l ber t/ - 2loc;k Number e ul', ivision Nr;n': ~CSM Number U. Type of Building (check all that apply) k per r - C , ty /c a►. s CI Al or 2 Family Dwelling - Number of Bedrooms S b w. ; e d ❑ Public/Commercial - Describe Use -+»nnsaip y ❑ State Owned III. Type of Permit: (Check only one box online A (numbering scheme for internal. use). Camp' ; .e ll_,te B ? ;y _al gale} For A. :~e 1 New 2 11 Replacement System 3 Replacement of 6 C1 Addition to Co unty ; i S stem Tank Onl Existing System _ - B. ❑ Check if Sanitary Permit Previously Issue;d Permit Number De t 7 I IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 441KNon -Pressurized In-Ground 2111 Mound 4711 Sand Filter 501, :'onstruaz :I ar 22 ❑ Pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 G :,rip I.Jr.e 45 ❑ At-Grade 46 ❑ Aerobic Treatment Unit 4911 Recirculating 30 C Onet V. Dispersal/Treatment Area Information: 1-9 - ijJ - Design Flow (gpd) Dispersal Are Dispersal Area Soil Application Percok.uou Race Syseen. iia• atic3_ - Fi:. I Grade equir Proposed Rate(Gals./Day Sq.Ft.) (Min./]ncl) D L 26 "II~__tigyryt ?,v 0 9 ? 54", q VI. Tank Info Ca achy in Total Number Manufacturer Pri 1 VtZt~ fit;. Gallons Gallons of Tanks T Con.: 1:1e. Corg(:1... ~d` [ Z Sri New Existing j Tanks Tanks j Septic or Holding Tank Dosing chamber - ter t-~-Z-- VII. Responsibility Statement- I, the undersigned, assume r n ibillty for installation of the POW I'S sit iva on the .a;_ , ;sec a an Pi is Name (Print) Plumber's 'nature MP/!rslC51`'uu;ber Pl bar's Address (Street, City, Stag, Zip Code) ~-C-5 w l SS~QII VIII. Coln e artment Use Unl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater L ate 1 ; r.ced f. c. E Si Z13; T ,i•?c; Stamps Surcharge Fee) D ❑ Owner Given Initial Adverse . y Z ZS U v 0 >v~ Determination WJ IX. Conditions of Apl(proval/ReFjs Ions for Disapproval II f(- I1- - I - l.~ SySyGw` Yd be ~~ti5 ~a.'(P0~ ~rlptJ Ll;w~ IOrh~ Gfh~J~l,~r I(hE ~ 25~Q5ri5h 1JG-ioP~ ex cdU i~r^ I / / 1 r ( 1 Z JE ~F ~[c~Y T~~der {+v U2 ~KI~a~(Cq` aKG W~a:v~4~i eat Pei In~ah k fa~t(~re~s vCGOIry.Nnew~jGLT15. Attach complete plans (to the County only) for the system on paper ad less thiLa 8 U2 11 1 l~u her OIL;! 1SBD-6398 (R. 05/01) l~ v 4- fjA kl P ~,1J D6 e t2° A--D E t3 ~ ® fRE~c 1253 qp-'f.7 ~ f ~ ZA~FL c(3 too"- ~m OSM I ~1I) fl REA a c o ~ M Q E (15 CD `'V( t J O C -0 CO > C ` X CO vi - - E CCJ -U C 0 X 0) Cl) C\l Q) co C\j co ~o 61 L r j ~ ~o C o o Cd ~ o~ 0 ro ~ U C) = Q - (D 0 _j .0 ct C/) C: (D n :D L) -0 CL -0 co v \ C i LL. ?3 N -C 0) Cn T i 2) 0 Q J _1 O = _N O CU CS, l in o0 Cn Cl) a 'i Jo a~ ~ y g~ V m N MH C\l TO g nd~an y n s IM. w F 7 - . z m N 11k1 rn E ci9AA$q ra..' - - LU c N e 11111 .r I ~ 10 O ~ ° E V! 7 1 n H w~yy • E' 11 ira Y lip' a m c ~a A J n"E n Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 5T. C12A t A Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. wed by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 5 S. e00 fto.-L,& 4C 1/4 mg 1/4 S 17 T 27 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 11 o R ERDe ST- NE Ski,cr 1 tab Li C) E BLIAFf City State Zip Code Phone Number ❑ City ❑ VillageCjj Town Nearest Road 3LAINe IM Lt4 (b )75 - 56 TRo -rowNsvhLLVY RD. ~ZNew Construction User Residential/ Number of bedrooms Code derived design flow rate 100 O,.-. _ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 5ANUSTQ AYE Flood Plain elevation if applicable A !0.` General comments fYCCEIV RT- coP.,gt S`t ST E /U~ - r76~~AbR ~tiTE~tM W~ TO ~ i. L D + ti and recommendations: P Rfla1't 1D►JAt- Bolt tNGS Cov.W t:[e12Mvv1E CCIA~UCJOTIOI O v- t 2000 i ST CFjC)jy COUNTY Boring# n Boring ZONINGOFFICE ® Pit Ground surface elev. ft. Depth to limiting factor in. _ Soil an ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary (s P In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 1 'Eff#2 0'3 10v tZ-42 S 1 I 3J~C ,5 U 3,✓ Z 3- 21stl If'0.bK z~-rn 0 2- 3 q-20 0 3)3 - s1I bK 3- 5h tN -c 0,5 4 3 10412 --ILI- stckr IM 5by, s z -m 6, v Z~ ~Zo -L4 '5 3-52 1014-~q 's Y 0s dl 0,-7 1E 1. . 52-5 ,5 \1 ff~ 14 Is I 5b ml Gtv1 - 0 I. z 7 154-59 l0jR14 - s ml u) 0,-7 I,z_ Boring # ❑ Boring t9 pit Ground surface elev. q24.(,3 ft. Depth to limiting. factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' rf`~~t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff42 5q-b1 5 V 3~ - IS I rnsbK rn aU3 0,-7 1 Z 61-20 10 V Nib -7 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) 'nature CST Number SiQ 224832 Amok W Wvalp go Address Date Evaluation Conducted Telephone Number W98-15 (02 P-, vVeK FANS tAr 51-1b2.-Z- Il-oz-00 C-7115)4z6-1-717 Lzr 40 Property Owner r O E RliElSEP Parcel ID # Page of 11-31 1 Boring # Boring 1 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 • d-5 o rz~Z - = s~ 1 Y MA)r ab If-CO 1 0 S 0 , ' MV[V cxb f 0.Z 0 3 2 -I - 5.1 I ab 6 In \t 2 -4-1-1 3 10-IS l ov f2~0 S'r l 1 ds C5 z -tm 15-25- 0\4VZ s'• I 3msbK es - O,S ,g 5 Z5-3 IOv►2* 5 l 2 !-r~, Cs D,S 0,$ ✓ -43 o' 12 41 14A. I I- s d h a~ d Z 0 ~3 syl 1n) U,4 '0,1o ✓ 5 Y P4~ -7. -5 IV 1' t 3 Cu S -LMSbK- d - 43-.50 7, Boring Boring in. Fz~ ( GON, pit Ground surface elev. 112j,.? ft. Depth to limiting factor - GPD/FF Soil A l D/ff ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 g SU-Ioo I y y G;U~ 5 r 0 \ 0.w - 0 ,1 1, ✓ 5 ~L I S ( Z✓ 21 (W44 Boring # Boring Ground surface elev. 427 9 Z ft. Depth to limiting factor '7 in. Soil Ilcation 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 1. 0-7 1 o'4r< z Sit 3 F m ,j b -CO ,S 2- -16 lov 2/1 - 50 -mabk m e CS 2J-Co 0,2- 0,'?> at a0.A~ 3 Ib Z9 o14K 511 f-mct. 1< 016 Zf- rn U 2-1 '0 ✓ -164 Q 0,-7 39 10\1 W-4/6 Y-r\ Effluent #1 = BOD, > 30:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS 5 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. seD•8330 (RAM) ~.L Li P~Of PLAN pAG~~~ PPOFFM OWNrp: COO K 1=5 I, aw: 1~--,qol I, 6& T 6 LEAGUE uF - PM- • - 0F AIL Al LA'tNe K IOCATrcD W CttE N o enae y 0uNDSUtKFAce. 41:2.- op I 2X 1Z► W OF KO PVC PIPE (S 1500 a &kGUA S U .ST. C20 lSC0A51 , F -1 501L f30QNG W/ f3ACKHa NO COMM 85 %fPACK FROMM5 ~o ~nyoG ~g140 s EL g2'~gZ Zj.. 1 NeLg2b la b3' x 9 Z. d~ ^ E. cooe RD'T ~0 I L 516Wf7 CST (J YJ 22-4 9 3 Z PATE: -02-60 Awe y of y i CO►JtOuK LANES FOR Cars - W F}aLc- ISLLkFF 51wo- f 7 0 r 1 k \ 40 \ xB-40 - i % B-40B - \ B-P52 / $A 396 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _.L of Z_ Division of Safety and Buildings in accordance with Comm 85, Wb. Adm. Code County ST CK01 x Attach complete she plan on paper not less then 8 112 x 11 Inches In size. Plan must Indude. W not Wrtited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0H6- ia O r 40- 000 percent slope, scale or dimensions, north a location and distance to nearest road. JR ~"dbbyy Date Please II i1!'Intdrloist! Personal information you provide K 6~1 seoondery purpoa"-( aay L#w. a. 15.04 (1) (m))• Z. Owner Property Location TKG4 DEVE OV0,4AT& t, OSDI►4.:> 1~E 114 ►OE 114 S T Z$ N R 1 W Property Owner's Melling Addr~sa,-' Lot # Stook # Subd. Name or CSMAr y0 EAGLE $v~LF F 1160 E►2 is t r n E~ fete r City ❑ MIlege .Town Nearest Road TKO`I Tav.MLSdA R~~ - 8 4 Bt.Aw E n1w 7 1• nstruction Use Re e4rtln)~f+lurrlh. F ' ^T. Code derived design Row rate GPO New Co © Replacement ❑ Public ~ al • be: Patent material Q Flood Plain elevation it applicable /L R. ~ t"'~'~LL General comments and reoorrtrriendatlons: TN- (b9.01M1O C.ot3~EN't 1 or jp.L Tt2,e /~Ct1i:,S sT,1r,-rt Fx_ AS 00 L0,%0iM(6 PLAIIE 2: `12-3.0 t3wita END OF ~3 ; azZ, o' S4S'TC-^ AIMA- Boring 7Jr in. a Bering # 1pf Pit Ground surface elev. 1 R. Depth to limiting factor in ~Z Sod Application Rate h. Crxisletence Boundary Roots •E GP 'EM Horizon Depth Dominant Color Redox Desctiptbn Texture Structure In. Munsell Qu. Sz. Cont. Color Gr. 2 D z IS M3bK C-5 7 1'Z'i 3 -20 1 3 1s S rn f OLS -co Co-, 7 y 3 - s 0 rn 0,? , ,9 15 r ct 24-0 0.7- f rZ v S - -01 7,511 to - 31-5L 7.3-10Z 1s r zs MJ~'r MW i4-co O. Z ~ O 5 M~ 1 , ✓ 1a 2'✓ 7 5-645 1')611 3 0 Boring If ❑ Boring - Ground surface elev. R. Depth to limttlng.fador in. Sotl Application Rate ❑ Pit Horizon Depth Dominant Color Redox Descriptlon Texture Structure Conslstenee Boundary Roots *Eff#l GPD1 in. Munselt Qu Sz ConL Color Gr. Sz. Sh. Effor, T 5 T fZll^olA1~ Tc 0 • Effluent #1 = SOD > 30 220 rrgll. end TSS >30 1180 mgA. ' Effluent #2 a 800 130 mg& and TSS 5 30 mg1L posture CST Name (Please Print) CST Number ZLL{ $'S 12, ~0 N ou-~ sT>` Date Evaluation Conducted Telephone Number Address W9g75 6904"-Mt.., R\vILK FALL:: wI 402-2, 0s-ZR-o1 JIS LIZ6- 1-775' p~ 2~L PLOf PLAN i~lOC'EEiZfY OtiM~ER: 'f IZD I,EG~ND: / yd ~ W_LokitG AT 0 Ntyu DE- E GRDtWO OF 501L aOR1NG W/ [~ACKNOE NO COMM 83 5ETPLK FROOLEM5 1, rig I ACRES ~Mf~ilf► Lod yD voc , i D8 7,qZ ~L9Z 1 2. Z5 'A`yr ~~yo'D ~1 N fl ypA / EL 9?-1 • b3 o~ F. ryvE ~ ~ 5lGNEt7 CSt `i~7/`~ »ll►~ Zzy 8 3 Z SEC. %7 PKE. QS-Z9'01 ST CROIX COUNTY SEPTIC TANK MAINTEI? ANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 2~z l' ~wle~ t+VY--, r~ -Qcc~C~c2 MAJ. Property Address a l- ~Q q77 GQ - U CU S C~/lo (Verification required from Planning Department for new construction;; 'C City/State t,J( Parcel Identification Number 2 0 -60- LEGAL DESCRIPTION Property Location IV 6 /4, VGSec. L7, T2 ON-R W; Town of Subdivision A-GL. L V Lot # V. Certified Survey Map # , Volume Page # Warranty Deed # 449 7 Volume Pa?e # 2- 2 Spec house ❑ yes )i no Lot lines identifiable 'kN,es O n:--, SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to hand:e wastes. Pi r ir.4.i::tenar.:re consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. hat you or:t into th systera can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, s ,,red by the owner and b) a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) he on-sir-. waste waurdisposalsystEm is in proper operating condition and/or (2) after inspection and pumping (if necessary), tl:.e septic tank J.s 1.°ss thaa P .ill of s udge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispo;ia' system with a.e standards set forth, herein, as set by the Department of Commerce and the Department of Natural Reso,.:rces, Statc of Wisconsin. Certificatiia stating that your septic system has been maintained must be completed and retun-.ed to th. St. Croix Ccunty Zo_ii:>g Office within 30 d e year expiration date. ~ . 6 r SIG OF APPLICANT ;SATE OWNER CERTIFICATION I certify that all statements on this form are true to the best of my (our) knowcdge. I ~e air; are) t:e owner(s) s.` the ro e s ibed above, by virtue of a warranty deed recorded in Register of Deeds Office. GNATURE OF APPLICANT iA1L Any information that is mis-represented may result in the sanitary permi: being revokcJ by the Zc:.ling Depar n-_ent. Include with this application; a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if referenc, is made in the warrant.,, deer *.AJ P Private Onsite Wastewater Treatilne t System Management Plan Seoc Tank Atwd Gravity tn4round'~Sflii Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintainft the system within. the parameters of Comm 83 and -64, and the c ond0ons of approval by the department, agent, or governmental unit. The approved plans wA permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.Mg). Table 1: S Des n S , eciflr ions Sanita Permit Number Number of Bedrooms a'U DUQn Pliny * Peak (Ed) Jl_ Esl ted k* - Ave e d Septic Tank ; al Z 9 Soil Absor tion Component ize T of Weetewoter Domestic nernt - Urrrlts of Diable O eration Table 2: Soil Absor tlon 2on Septic Tank m-' neat Soil Absorption Component t3asi Flow - P®si¢; Maximum lnfltient, PeAcI6 S1ze in 1 /8 Ma nurn BOD I 220 F:::PaxkrK*n TSS .m 150 Table 3: MednUmto Schedule S c Tank lrts c and/or serV+ once eyffy 3 years Outlet Fliter I ect once a Mr and c n at least once every 3 years Soil Absor tlon Coat nent " nsp!d once eve 3 ears 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 on .axc~da ^ca with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shale be assessed at least once every 3 years by inspection. The outlet filter shall be caned as necessary to ensure proper operation. The filter cartridge should not be remove unless provisions are made ,.o retain solids in the tank that may slough off the fluter when remove from its enclosure. If the Management Plan for a Septic Tank and Sail Absorp':i::r,i Corrpcci+ent filter is equipped with an alarm, the filter shall be servicec if tl-e elar is act -,oed continuously. Intermittent filter alarms may indicate surge flows or an imperdi ig nmtinuou.s alarm!. The septic tank shall have its contents removed when the volume of scu-n and ,ju,Jge in the rank exceeds 1/3 the liquid volume of the tank. If the contents of the tan., are nc' nov ;d al the time of an assessment, maintenance personnel shall adv se the ow++ar of w tl e next service needs to be performed to maintain less than maximum scum and sl..dge acc;u i,ulation in the tank. Manhole risers, access risers and covers should Le insp3ct d for were'.:, 'tightness and soundness. Access openings used for service and assessment shall be ses+lc=:d watertight upon the completion of service. Any opening deemed unsounc, de-"ec;tiwi, or subject to failure must be replaced. Exposed access openings greater than 8-inches it di.:rneter sl+,_ 1 be secured by an effective locking device to prevent accidental or unauthorizec entry into tl,i 'Lark. No one should enter a septic or other treatment or Bolding tank for any reason without being in full compliance with OShA sitarr'L,.rds for entering a confined space. The atmospheres wifhbi tl b Septic Cpl' ether treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult Tank abandonment shall be in accordance with Comm 8.3.3:: Wis. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is d3signed to Fil ;c:cpt domestic wastewater from a residential facility. The limits of operation of this ::omporF r': are shown in Table 2. The longevity of a soil absorption component depEnds graatl,,, on arci, and timely maintenance, and system use within or below the limits of reliable operation. Oood water conservation practices by all occupants and the installation of water :;DnseR.ir.i- plumbing fixtures are key factors in extending the useful life of this c:omponer - The soil absorption component's operation must be asse3sel by ins P Lion at least once every three years. The inspection shall include recording the ;::eels of p-c,:-+ding, if any, in the observation pipes, and a visual inspection for any evidence cf s: i1`ace seepage or discharge from the component. On steeply sloping sites, areas of erosion `3hoWd be icer+tified and reported to the owner for repair. The surface discharge of dorriestic ~vastewatel or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should e avoid,, ci har icuiariy during winter months. The compaction or removal of snow cove.* ove: r the ct rcponent may lead to hydraulic failure by freezing. This type of failure is usually tern por;::+y, but ~s :aifficilt or impossible to repair until weather conditions improve. In cene-al, sc; ro t~p~+::ai n cver this component will reduce diffusion of oxygen into the soil and dis°Jersal .:ell, whi::; may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorpticr :'ornpo,"; j nt Plantings of deep-rooted trees and shrubs directly ever or witHri ten fe-, cif the component should be avoided since root intrusion into the component. may ~h~t: i ct wastewater flow. '7 . 0,AJ Co IU C (7- (5 4- 3 STATE BAR OF WISCONSIN FORM I - 1998 WARRANTY DEED 6-9h43 KATHLEEN H. WALSH Document Number REGISTER OF DEEDS VOL 1663pAGE242 ST. CROIX CO., WI This Deed, made beiween RECEIVED FOR RECORD Troy [~vel.pment Corporation, a tlinnesota Corporation 06-19-2001 10:54 AM - - Grantor. WARRANTY DEED and -Jonathan Robert Dostal and EXEMPT A _Rebecca Jean Dostal, husband and wife - CERT COPY FEE: j - - COPY FEE: - - - TRANSFER FEE: 201.60 - - - - - _ Crantco. RECORDING FEE: 10.00 Granmt. for a vawabn• ronslder:n Wn, convoys to Granter III(, following PAGES: 1 described real estate in St • CroiX, _ - County, State of \Nisronsm (the -Property..) . Lot 40 of the Plat of Eagle Bluff in the Town of Name and Return Address Troy, St. Croix County, ivisconsin. Jan and Rebecca Dostal 252 Gershwin Avenue N. Subject to Declarations of Covenants, Conditions and 0 d le, ?4N 551~i28 Restrictions for Eagle Bluff, recorded in Vol. 1589 Page 516 , as Doc. No. 638946 , as appearing in the office of the Register of Deeds for. St. Croix County, IJisconsin, and such other easements, restrictions and reservations of record, or in use, 040_1280-00-000 and the "Buyer" obligations contained in the Parcei Identification Number (PIN) - Purchase Agreement for this lot. This -is not 1-11c te'la property. (is) (is not) Together with all appurtenant rights, title and interests Grantor warrants that the title to the Property is good. indefeasible in fee simple and free and clear of encumbrances except Dated this 13th r /day of June 2001 e44-4. (SEAL) (SEAL) Charles S. Cook, President Troy Development Corporation (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Minnesota State of Wieeenakr• sz. _ Anoka - Count I. authenticated this day of Personally came before me this It day of June 2001, the above named Charles S. Cook, President Troy Development Corporation TITLE. MEMBER STATE BAR OF WISCONSIN to (If not. me known to be the person i- who executed the foregoing authorized by §706.06, Wis. Stats.) Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED By Troy Development Corporation Nancy L. Clift ' Charles S. Cook, President Notary PublicSwW_a aucr,c,r, Anoka County, Minn. My conunission is permanent. (If not, slate expiration date' (Signatures may be authenticated or acknowledged. Both are not January 31 2005 ) necessary} ------N.men nl pr,wns aR,~ing in m,y cape. ny nviu br lypad o, Pnm i tr•loa (heir s,Kna"ve WARRANTY" DEED STATE BAR OF WISCONSIN Waconvn Laga Black CO., I— FORM N,,. I - 1998 M-M ukea. ws ~-r NANCY L. CLIFT tMMARf ROX-1411INNES07A MY COMMISSION EXPIRES JANUARY 31, 2005 CONTINENTAL DEV CORP TEL NO. 57-25:x2 Oct 19,>O 1.07 P.02 . 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