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HomeMy WebLinkAbout040-1260-50-000 ,nsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix y and Building Division INSPECTION REPORT Sanitary Permit No: 430273 0 ENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: arsonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: City Village X Township Parcel Tax No: Eastman, Jerry Troy Township 040 - 1260 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No. 100-0 J v 0• Q l p [/ G P 18.28.19.1394 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - Benchmark i 2�S �► a, l v 162j > Dosing Alt. BM 76 a f und On Aeration r / BI g. Sewer rMl� -e.G a T l r ;5 7 , SUHtlnlet TANK SETBACK INFORMATION St/Ht Outlet 71 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / SepticJ ovi St� 18 � J Dt Bottom/ T W Dosing Header /Man. A O+� q 3. Aeration Holding Bot. System 1 9 4 - 7 7 s Pu y� Final Grade PUMP /SIPHON INFORMATION 6 .18 Manufacturer Derrand St Cover' . GPM Model Number (, v'� TDH Lift Friction -Loss System Hea TDH Ft Force ain Length Dia. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches 1- 4ryAW PIT DIMENSIONS No. Of Pits Inside Dia. a th DIMENSIONS ( I d SETBACK SYSTEM TO / P/L BLDG WELL LAKE /STREAM LEACHING Manufacurer: -f INFORMATION CHAMBER OR /• - E - Type Of System: y�) N UNIT Model Number: 014� � -31' �y ;k s i-� _- DISTRIBUTION SYSTEM Header /Manifold Distribution 0, x Hole Size x Hole Spacing Vent to Air Intake c ' f/ Pipe(s) wI Length Dia Length 1 Dia_ Spacing—SL 1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Seeded /Sodded xx Mu Bed/Tre Topsoil soil p Yes / ` � �No No - J! Yes L COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 386 Whitetail Lane Hudson, WI 54016 (NE 1//4 NE 1/4 18 T28N R18W) Deer Valley Lot 15 f S(�rrl Parcel No: 18.28.19.1394 r-� 1.) Alt BM Description = ►r d &1 � `t S e Ph C -,4-4 n k- G UW, 2.) Bldg sewer length= 3b - amount of cover = Zu // 6dl V Plan revision Required? [ `_l Yes V No Use other side for additional information. � _ to 0 SBD -6710 (R.3/97) Date sepctors Signature Cert. No. r Sa trawl Bemldmsis Division COOKY 201 W. washiftM Ave, P.O. Box 7082 � n Madison, Wi 53707 - 7082 Sanitary Permp Number (to be Red in by Co.) Department of Commerce (60) 26145" Sanitary Permit Application Stm Part LD. Number In accord wpb Cmem 9321, Wit. Adm. Ctiak personal W&MMOian You P'VX§V may be used for secondary psapova tl S.43iL�Gs1� Ptaject Address Qtdiffivam doe maimad�ess) E. l PPOCatioa Eaternotla - dense Mat AN I •s Nam 2 0 0 3 Paul x Lw Bkxk # 5� V7 . 1 nuar L A 10. LL+JV Osnrws ry S( AC City state bap cod, [ILJ�'°'• _1 1 Pb— Number 5 v T.�j X R A Eg ) EL Type of B (dredc aB dw appl,Y) �I or 2 Fsmiiy Dwdlarg - Number of Bedrooms ��v SaldIM iaa None CSM Number P%AdidCoonwarcbkl O .. O Swaa Owned - Dmc be Use D 157 u/ C IE f [�!�2 ! S P� c 0C*tY — ►Urge owad�ip of III.. 'Type Of PerneW. (Cbeck anly sae but a Mae A. complete New B if app6coMe) A. Near System O Ravbtaemmt Systom O Traaam MoRdmS Task Rgdwe uxa Only O Ocher Mo&f cation to &KUM Sysum B. O Pan it Renewal O Perwit Revision O List Yr�evicus Permit Number and Date bxrsed Change of ❑ Fmnit Transfer to New Be6are Expiration Pbrmber oweer IV, of POWTS SISkm (meek d that Nan -Pressrriaed k-ca and O Mond > 24 err. of vAwble aaI O Monad < 2s m or sumbse sail O At trade O Sw4* Pus Seed Freer O Constructed wedmw O Pressurized w4rotnnd O HoMft Teak O Par Fiha O Aerobic Trcaamew unit O R edroeh ing Saari Finer O S Media Faller O Chamber ODnpLme Gravekieas O ( ) V. Area Iaforaadon: t rAS lovJ Demigm Flow (9P) Daip Soil Apphaboo, RMe(Wdd) Arm Rawaod (sn DaperW Area (st) , System Elevation 7 1 9 S - 7 A I q ©o 34 1 e l qd) 9 X VR. Tacit Info Capacity in Total I Number Man Site Steel Fibs F lashc Gailms Gallons of Units Conafte Coasuwud rib" �' Exert 71aia Teaks Sepue Teak c 1 1,%-)� Aaabk Tw*xwM Uale Uosi�t�asDer VM Star W"I I, tie aiaafgaed, ter ed the POWTS sbowe ee Oe at#acbed plans. `s Nsme P •s r $vinr" Pbone Number Asa 's Address (Street. City, Sufic. Tap �h A ` q p� serer the out Approved O Sanirsty PA Fee includes Groundwater BAeed Sigasewe ) Disiffroved O Owner Gwe9a Reatao for oenial Far) !n— o, � Q FX CsatBBaas of ApprevaURens for Disapproval �✓l�C( a.�e- .� 61'4• ' 3 '.LQ e 40 C 7 0 - / k Rb= CM cis C awlfl fir the rases M !*v ass bar aaa a 1 zkxbft SBD -6398 (R. 08/02) I I r ► ( i f Gill Po AS .-1_. N - -t- r - -�- - ;,- 1 -- - -- -- -- --� - -- p - -' - -I - ' - - -; -- - —}— 1 ( � I ! -- -� 1 I 1 ; f ' — i - - -- i ( I • I I I i ' i I i I I � i j ' I I I I ' i I I i I I , j I I i i.. I of I IN ' I i i - I J _ i I , , II11 J � , _ Plot �4 W o c> ci`p u r m! N 1 l� �o If - Z-J;�ka 4 44 .._- 4 Q3 t/ i, 's ... .. _. ._. �_.. _....__ ._ _... _.._ ....._.. '. [. _ '. 4 o _. � _ _. F '. � _ J� P 7 c ;Xs htia r` b�oQr Vakoy Lo Ls EZ1203H 4.625- 12h R lRR ►� R _ l •iss�.vR -,. , iii • ►► ¢�,�� R ►flRf ! -w la Cim. ► "" ►�is� +rte ► ��� ! ss►r, "� = l$.$•t 4 �3 V typ ) -.. m� P" liar ft ., s , a • ! "-=' O _ S'de"4)► f2 3 !iL .ig Ei 58 ' �; is 2. ►2 S �n r � VOW k , I °d 1 .f ?Nr'/i�t 37s" 90J ft' ,cctpti M Are, €r Lpp� wivmc Sr�l►ai' Fie- f�; u I + 12 m '2 a.Up yQ.ft i L yoi ` •2wr�x�'� J. r� — _ i 36 3 pp $q - Ft. ! otat Y Pt;;Wled Tic• At ; a'd "ahoft t22 " a.4Ql . •3tS . :t U,.t IS 8er / ' 16 3X 7.1 t, R =r �'h 'ur"w J ` t CP j ' r Aggre9Q�e , Trench a ' E'7 �� Ystem WIC tri— f OAV " �r �okla d � Rd. P 'AiFS: t at r ! f tt'27^OT G S CALE t Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Divisign, if Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dist � Xl n� }es' oaf. 0401070 -10 APPLICANT INFORMATION - PLEASE f7 LL INFOIfiA N RE IEWED BY DATE EASE a- f�{ - 2ctra PROPERTY OWNER: " � PROPERTY LOCATION <.- n Derrick Construction, I G �u GOVT. LOT NE 1/4 NE 1i4,S lg T 28 AR lg EX(or) W PROPERTY OWNER':S MAILING ADDRESS I ,? SLOT # BLOCK # SUBD. NAME OR CSM # 1505 Hwy #65 sr 19 15 na Deer Valley CITY, STATE ZIP C R , ❑CITY ❑VILLAGE MOWN NEAREST ROAD New Richmond, WI. 54017 ,,> , -2320' Troy E. Cove Rd. [ 4 New Construction Use [X] Residenti7 rdoi s, '4 [ ] Addition to existing building ( ] Replacement [ ] Public or C o cmmer rrt Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) _ - - ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S El ®S ❑ U ® S El C$S ❑ U X] S E:] U ❑ S KYj U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft ................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tre & .................. ................. 1 0 -20 10 r 3/3 none 1 2m mfr 2f .5 1.6 1 2 20- 10 r 4/4 none 2csbk mfr qw if .5 .6 Ground 3 9 -90 7.5 r 4/4 none cos os ml na na .7 .8 elev. 9 6.7 ft. ll Depth to limiting factor +90 4(o S $2 'g 1,47 1 Remarks: 4b Q Boring # 1 -ID 10 r 3/3 none 1 2msbk mfr 9W 2f .5 6 ' 2 2 .10-17 10yr 4/4 none sil 2csbk mfr gw if .5 .6 ................. Ground 3 17 -90 7.5 r 4/4 none cos OSQ ml na na .7 s . 8 elev. 9 5.7 ft. Depth to limiting factor 3q ` $ +90 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave-, New Richmond I 54017 Signature: Date: 6 - 4 -99 CST Number: m02298 - 1 PROPERTYOWNER Derrick Construction SOIL DESCRIPTION REPORT Page,. _2_ of 3 PARCEL I.D. # 040 - 1070 -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench `....3 `' 1 0 -9 10 r 3/3 none 1 2msbk mfr 2 9 -13 10 r 4/4 none sil Ground 3 13 -90 7.5 r 4/4 none cos 0SCI ml na na .7 elev. 97. 31t. Depth to limiting fact 4; - Qz - eD 9�f•� SY��o 34• � �'. (� Remarks: Boring # 1 0 -11 10yr 3/3 none 1 2msbk mfr 2f .5 .6 2 11 - 24 10 r 4/4 none sil 2csbk mfr qw if .5 .6 Ground 3 24 - .8 elev. 98.0 ft. — Depth to limiting qy o factor Remarks: Boring # 1 0 -11 10yr 3/3 none 1 2msbk mfr 9w 2f .5 .6 5. ' 2 11 -90 7.5 r 4/4 none cos 0SQ ml na na .7 .8 Ground elev. 9 7.3 ft. Depth to limiting b 315, factor 9 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: I SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc'. 1554 200th Ave. CSTM2298 NE S18- T28N -R19w New Richmond, WI 54017 MPRSW -3254 town of Troy (715) 246 -6200 lot #15 - Deer Valley This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. -N 'l l' =40 ' top of 1 pvc pipe C el. 100.00' t. BM.= top of 1 pvc pipe C el. 99.40 42 All � /y� 2 s �F Gary L. Steel 6 -4 -99 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address !RG "7 / Property Address �� fd W f 12- t L- LA-r.[ C (Verification required from Planning Department for new construction) 05014 � a �L(oQ SES -d City/State t � Parcel Identification Number Q LEGAL DESCRIPTION Property Location rvk %., %4, Sec. 1g . T Zg N -R W, Town of Subdivision c�L- �[� t L �c Lot (C� # Certified Survey Map # . Volume . Page # Warranty Deed # ­ 70 - 7 4 S Z Volume Page # Spec house ❑ yes ><no Lot lines identifiabl yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 fimetion 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, signed by the owner and`by a masterplumber, joumeymanpIgmber, restrictedplumber or a licensed pamper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da a three year e�x te. . F APPLICANT DATE OWNER CERTIFICATION 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 by virtue of a warranty deed recorded in Register of Deeds Office. p 1 F APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed OWNER'S MANUAL & MANAGEMENT PLAN �° -- of PpW�'S s�rsTElwl gPl�'{�tTiflNS 4LE. OMFWATM Tank Manufachm i `�5'E'irS ❑ NA owner �. ,ma a Dose 11 Holding Vol. gal permit # 3 Tank Nh PAP p NA O Sept{C a Dose p How vol. got Number of Bade' (� NA Effluent Mar Numlher of Public FaWtty Unto Mode{ C Estimated {ahf�9e} flow � C? NA x 1.5) O Pump Manufacturer Design (POW flow ¢ (� Modal Pump Model Soil Application Rate f P tment Unit Standard khfl goWEftlu�t Ou8ft awe p $gavel Filter fl Peat tamer Fats, ON & Grease (FOG) 530 ' p Meet�cal Aeration O wetland oxygen Demand {BON 5+220 ma& ❑ NA O Other. Biochemical oxygen a�sinfectlon Total Suspended Solids (T3S) 5150 mgtL Manufacturer pretreated Effluent Quality Montmy average ) ❑ NA Biochemical oxygen Dernand (BOD 530 mgit- NA {gravkty) O kw.. r d {peed Total Suspended Sow �} 530 max t3 At - Grade O Mound 1 fecal Cokform {geometric mom) c a Othe fW1 r: D NA 0 Drip-LiQe O NA Maaarnum Effluent Particle Size Y� in clue. O NA otter D NA *Values typical for 00 aws m "s"wow snit c tank effiuefR• NTENANCE SMM*AE Service FNmpM1CY Saltutae EvernE morrd {s) (lA 3 yam) ❑ NA At best Once every: Inspect condition of tank {s) of tank volume When combined clurl9e and tin ° -tt►kd {� DNA P out clan" of tank {s} Wier► tine h*lh watef dwm Is activated O NA rr�rt�El j{� �� yews) 8 ys1 Inspect � cots, At least once every: ❑ nwntl s} ❑ NA � { Clean effluent fitter At bast once every: ❑ mornhts) O NA At least orate every: C) ) Inspect PUMP, PAPt€o!sc alarm O } ❑ NA At least once every: s Push laterals and P" suns test O mo i(s) O ILIA At least once every: O NA licenses or Certifications: MAWMAME }NSTi )MMS calls slhalt b made by an � carry" one of the to Operator {pumper). inspections o1` hanks snit �� Sewer, POWTS Inspector% �a MaIntameroen ware. identify an y cracks of Master Plumber, Fluurrrluar of the tank {s} to Identify any of effka� on the ground Tank inspections must Include s vksual inapactiar► scan+ and a c k for any back uP or P and m c th for anti leaks, measure the volume of all b v sludge and to the effluent levels b the observation ate a failing ssufaice. The disposal cols) sh all be vesu�y surface may irrdicatfailing corugt)on em of effluent on the groturxk sur face. The pondkng of effluent on the ground Pf�� the immediate notifmOdOn of the local rY Ou*""ity ty9) more equals ww When b � rwlatiaon of sludge and of the tank volume, tta requires Se in any Servicing glent tank Operator of in accordance with chapter NR 113 entire con tents of the tank shall be rer'noh'ed by a S+aP� Sary Wisconsin Admit Code- mechanical or pressurized components, pretreatmer Al 1 oow services, including but not limited to the servicing of effluent fitters, by a certifoad poWTS Maintainer. units, and any Seth c ng at intervals of sl 2 months, shall P 10 days of lion of any service event. A service report shall be Pfd to the local regulatory cNSw (2)02 I Page of START UP AND OPERATION For new construction, prior to use of the POWTS dock treatment tanks) for the presence of painting products, solvents or other chemicals drat may impede the treatment process and /or damage the son dispersal cell(s). If high are detected have the contents of the tank(s) removed by a ssptage servicing ping operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages is restored the excess tanks fill above normal ' water wets. When ed � may � Po w wastewater will be discharged to the dispersal coI(sl in one large dose and may overload them resukM in the backup or surface discharge of effluent. To avoid this alt soon have On ccntsna of the pump tank removed by a Septape Servicing Operator prior to restoring power to the effluent pump or contact a Plu aber or POWTS Mawdmner 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 sod absorption area. Reduction or elimination of the following from the wastewater zoom may improve the performance and prolong the We of the POWTS: antibiotics: baby wipes; cigarette butts; condoms; lotion swabs: degreasers: dental floss; diapers; disinfectants; fat; foundation dry (sump fop) discharge; Irvin and vagetable P ; s» herbicides; mne nt owaps; medications; oil: painting products pis. saatery ; tornpow. 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 Property and safely abandoned in compliance with chapter Comma 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 property disposed of by a Septage Servicing Opera tor. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with sod, gravel or another inert solid material. CONTINGENCY PLAN If the POVVTS fails and cannot be repaired the following measures have bear, or must be taken, to provide a code compliant replacement system: A suit" replacement area ties been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area shourld be protected from disturbance and compacti a W should not be Infringed upon by reourired setbacks from wdshW and proposed structure, lot lines and wells. Failure to protect the replacement area will refit in the creed for a new soar avid site evrnuefion to establish a suitable replacement area. Replacement system must comply with the nubs in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacarnent area. Upon failure of the POWTS a sari and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a fast resort to replace the faded POWTS. ❑ Mound and at -grade son absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface_ Recenstruc of such system must comply with the ides in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR NNSUFRCIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK CINDER ANY CIRCIAWANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DWRCULT OR IMPOSSMt.E. ADDITIONAL COMMENTS POINTS If ST POWTS MAAINTTANIIER N Name Pfxr�et S S t 35 Phone SEPi'AGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Nana /dare S < u Phone Phone � -1 This document was drafted by the staffs of the Green Lake, Marquette and Wauashare Cowry Zoning and Sanitation agendas in compliance with chapter Comm 83.22(2)(b)(1)(d)de(f) and 83.5411), (2) a (3). Wisconsin Administrative Code. VV / V I/ VV l lily i V. Y l l AA • LFj u u z U 21,2 9 P 0 65 1 70 NOS � REGISTER R LEE H. WALSH Document Number WARRANTY DEED ST CROIX Co., MI RECEIVED FIOR RECORD THIS DEED made between Deer Valley Partners ( "Grantor") 01/29/2003 eg. -30AM and Jerry M. Eastman and JoAnn M. Eastman, husband and wife, as survivorship marital property ("Grantee')* , EXIST # WITNESSETH, that the said Grantor, for valuable consideration REC FEE-. 11.00 conveys to Grantee the following described real estate in St, Croix TRANS FEE; 232.5e County, State of Wisconsin: COPY FEE: CERT COPY FEE: PAGES: 1 Lot 15 (fifteen), Plat of Deer Valley in the Town of Troy, St. Croix County, Wisconsin Recording Area Name and Return Address The First National Bank of Hudson Attn: Pat PO Box 187 Hudson WI 54016 #016032700 040- 1260 -50 -000 (Parvcal Identification Number) This is not homestead property. Grantor, Deer Valley partners, a Wisconsin Limited Liability Partnership, is an affiliate of Derrick Homes, LLC, a Wisconsin Limited Liability Corporation. Grantor develops land and Derrick Homes, LLC is a home construction contractor. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC will be the builder of the home for Grantee. If Grantee does not commence construction with Derrick Homes, LLC as the contractoribuilder within two (2) years of the date of sale of this lot to Grantee, Grantee gives Grantor the irrevocable right to repurchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. If Grantee desires to sell the lot to another purchaser before constructing a home upon this lot, Grantee gives Grantor the right of first refusal to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. Dated this 22n4 day of January 2003. * * Ron L. D rr' * " ichael R. -Stevens AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 22nd day of Janu , 2003, authenticated this day of , 19 _ = thQ_ above named Michael R. Stevens and Ronatd Derrick, as partners of Leer Valley Partners to me known signature iu da uie persons wn wep utea the roregoing instrument and acknowledge the sa type or print name ' (,(f TERRI WOULFE TITLE; MEMBER STATE BAR OF WISCONSIN signatureCN (If not, type or print name Ter ' � 1 &L duau authorized by' 706.06, Wis. Stats,) Notary Public St. Croix County, Wisconsin. My Commission Expires: AQQg 14, 2005 THIS INSTRUMENT WAS DRAFTED BY *Names of persons signing in any capacity should be typed or Deer Valley Partners printed below their signatures. PO Box 445 New Richmond, WI 54017 DEER VALLEY Located in the NEi/4 of the NE1 /4, Part of the SE1 /4 of the NE1 /4,.Part of the SWIM of the NE1 /4, and part of the NW1/4 of the NE1 /4, of Section 18, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN LOT 12 2.3 Acres LIT 11 2.7 Acres LOT 13 4_8 Apes 2 A LOT 10 2.7 Apes LIT 14 3.2 Apes Z LOT 9 z 3-3 Acres co Q 2 MPLATTED LAHM LOT 16 2.3 p 2.3 AA410=6., r... LOT • Acres 3.4 Apes Q J CL Z LOT 17 2_4 Acres LOT is LOr 23 LOT 7 T 28 2.5 Acres 2.6 4.7 Apes LOT LOT 22 Apes 2.7 LOT 29 Acres IL 6.8 Acres LOT LOT 6 rV LOT 19 2.4 2.7 Acres G 2_3 Apes Acres d LOT 20 C 3A Apes 0 LOW tj 2.7 Acres LIr4 LOT 25 4.8 Apes 2.3 Acres LOT 3 LOT 2 3.7 Acres 2.8 Apes LOT 26 3_3 Acres LOT 27 2.7 Acres LOT 1 2.3 Apes Existing House east Coves Aosd