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HomeMy WebLinkAbout040-1308-00-152 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safe4 and Building Division INSPECTION REPORT Sanitary Permit No: 538742 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: Bethel LLC I Troy, Town of 040 - 1308 -00 -152 CST BM Elev: Insp. BM Elew BM Description: Section/Town /Range/Map No: arr\ k X51 24.28.20.1971 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t CAPACITY STATION BS HI FS ELEV. Septic W arl / Benchmark Dosing �� / / AI.B P6 z Bldg. Sewer fl Holding St/Ht Inlet S. TANK SETBACK INFORMATION Outlet , 2 i a � TANK TO P/L WEL L BLDG. Vent to Air Intake ROAD Dt Inlet �\ Li Gb� Si>I't IF Septic Dt Bottom - 72- 1-7 72 \ Dosing Header /Man. Aeration Dist. Pipe 2 s r v - A.- Holding Bot. Systenlli Final Grade PUMP /SIPHON INFORMATION 3 • Z d Z - dl Manufacturer Demand St Cover Model Nu GPM T;1Je4__ C0 er / TDH L Friction Loss System He TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 3 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR p Type Of System: � �� 1 A) UNIT Model Number: DISTRIBUTION SYSTEM Sr d - 5 - S = JS Header/Manifold / J/ Distribution x Hole Size x Hole Sp cing Vent to Air ^ Intake Length /J• Dia Length Dia \ acing S 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 3.5 7 Bed/Trench Edges Topsoil \ Yes ❑ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 312 Lindsay Rd Hudson, WI 54016 (SE 1/4 SE 1/4 24 T2 R20W) Troy Village 6th Addition Lot 152 Parcel No: 24.28.20.1971 1.) Alt BM Description = C . �Q Lals a 2.) Bldg sewer length = ZL J• /� - amount of cover = nn ' e7 J F.C..r'es.; ti:...� (�►� �j ilk v � � � � S Q /� _ Plan revision Required? ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctoes ignature Cert. No. Wisconsin Department of Commerce Count Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix I b INSPECTION REPORT Sanitary Permit No: 538742 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: Bethel LLC I Troy, Town of 040 - 1308 -00 -152 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 24.28.20.1971 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft � Forcemain 7ength 7 Dia. Dist. to well 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 LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) L Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 312 Lindsay Rd Hudson, WI 54016 (SE 1/4 SE 1/4 24 T28N R20W) Troy Village 6th Addition Lot 152 Parcel No: 24.28.20.1971 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover _T] Plan revision Required? a No Yes W � q ❑ ❑ Use other side for additional information. FT I L: SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. u -0icli 1Ur; 1G:L0 !'PIA 115 satf 4U5tf S'1' GRA CU ZONING 1¢1003 / D and Buildings Division County amnington Ave., P.0, Box 7162 St. Croix FN Visconsi ioInif W1 53707 — 7162 Sanitary`Perm Number (to be filled in by Co.) Department of Commerce 530 Sanitary Permit Appli mtion Spate Pan I.D. Number In accord will( Comm 33.2 1. Wis. Adm. Code, personal inj irmation you provide N/A MAY he used for secondary purposes Privacy law, 15,04(LtM 0 7 � n � i project Addrem (if different than mailing address) BCD U U *, 312 Lindsay Road 1. Application Information — PleasePrintAllInformation ST. CROIXCOUNTY Hudson, WI 54016 Property Owner's NeUm PLANNING & Z 2 I O,.a ,,,1..,— ly r ds~I u bat ry IIloc k rt & 4 e_A 14-C. / Joseph K. Paulose 040- 1308 -00 -152 152 Properly Owner's Mailing Addross �' Properly (..oration (� 1737 Skater Drive City, tate S E % — S E %. Section 2 4 tY.• Zip Cadc Pltorie Number Eagan, MN 55122 (1nje 1e) U. Type of Building (e t"e k all that apply) - - -� T 28 N. . 2-1- C ii or g g 7 1 of 2 Family Dwelling- Number of Bedrooms 3 Subdivision Name ('SM Number ❑ Public/Commercial - IescribeUse Troy Village ❑Suite Owned - Describe Use — - ����.� S,}- ` �a-� 1 ❑City ❑VillagcE'ownship of Trod - v Ill. Type of Permit: (Check only one box on line A. Complete line B if appRe4ble) z 16Lj A ' New S mcae y 0 Rcploceanent Syslem ❑ 1'tratment/HoldingTsnk Replacement Only ❑ Odter Modification to Existing $ysrern H. ❑Permit Retewnl lJ fu'mit Reviswn ❑ Change of ❑ Permit Transfer to Now List Previous Pcmait Nuuibei And Mote Issuer( More L'xpimtion Plumper Owner I'V. T of POW System: (Check all that apply) 13 Non - Prevurized In- Gtound ❑ Mound >24 in. of suitable soil ❑ Mound - 24 in. of Suitable Soil 0 At -Grade ❑ Single Pass Sand Filter ❑ Constructed Weiland ❑ Pressurized In -Ground ❑ H oldin g Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter 0 Recirculating J ntltetic Media fitter ❑ L,caching Chamber ❑ Drip Line ❑ Gravel -less Pipc ❑ Other (explain) ( V. Dis al/Trentment Arcs Xnt'or'miition: Design Flow'(Spd) 1)eSign Soil Application Ra gpdst) Dispersal Are Rcquircd (sfy nispersal Arco Proposed (sf) System Elevation ' 450 .7 642 - /6b VI. Tank Info Capacity in Total Number Manuract ater Pre ab Site SL 'Fiber plastic Gallons Giflnn> ofunits Concrete Construcrod Glass Now lirrixring Tanks Tanks 4/ /a /lee- 15 Scpric or I bldin� Tnnk """iiirrr"` 1000 1000 1 We ?° X Aerarbie Tneatmrm (foil °� P � Ctoslirg Chamber VII. Ricsponsibillity Statement 1, the undersigned, sommene responsibililly for ioitallatan of the POWTS shown an the attached plans. Plumber's Name (Print) Plumber's 8i MP/MPRS Number Business Phone Number Paul R. Koehler 225410 715 - 246 -2660 Plumber's Address ($treat, Ciiy, Site. Zip Code) 321 Wi sconsin Drive, New Richmond, WI 54017 VIII. Cuun /Dc rtment Use Onl �... Approved C� �Van r Denial Santary i erenit Fee (includes Groundwater Dale Issue ssniup ream ion. ue f Surohargc Fec) S 7S • Il T L 7 / / Ix. Cauditions of Approvut/Ressons for Disapproval — �_...•- ..._,_ _ SYSTEM OWNER: 1. - Septic tank, effluent filter and dispersal cell must all be services / maim ' VVV arced r e ,'it; pe management plan provided b lumber. G YP ' 2.:: All setback requirements must .be maintained ` � �- as Per aPplk�ble � Code / "ruinees. e Q c1�o �5 p 5�4�� -; • Attack complete plan (to the tvaugty uny) for the iYatcM uw rlapcs awi leas eha� 11 � io ieae SBD -6398 (R. 01/03) 7/ z I r &5 ✓ 1. �-u e C / iO J PiL. t) l;l. C_ t tCa rtitlC�rs t r 9L 2 ' belaJ t t s�s� r^- a � k�L b CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: BETHEL, LLC /Joseph K. Paulose Owner's Name: Joseph' K. Paulose Owner's Address: 1737 Skater Drive, Eagan, MN 55122 Legal Description: SE 1/4, SE 1/4, Sec. 24, T 28 N R 20 W Township: Town of Troy County: St. Croix Subdivision Name: T roy v i l lage Lot Number: 152 Parcel ID Number: 040-- 1308 -00 -152 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing & Cross- Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cry Septic Tank Maintenanc Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer /Plumber: Paul R. Koehler License Number: MP225410 Date: February 4, 2011 Phone Number 715- 246 -2660 Signature Designed pursuant to the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01/01). Pagel Joseph K. Paulose 1737 Skater Drive Eagan, MN 55122 1000 Gallon Septic /Weiser /Filter PL525 3 Trenches EZ Flows Date: 2 -4 -11 Scale: 1 - 40 � BM 1 -1/4" Galvanized Stake BM = 100 System Elevation. SE 1/4, SE 1/4 Sec 24, T 2&L—R Town of Troy . P.N. 040 - 1308 -00 -152 312 Lindsay Road Hudson, WI 54016 1 \ S` ` \ y t ITV M !i \ � L f 7Z \ ' t �o � Joseph K. Paulose 1737 Skater Drive Eagan, MN 55122 1000 Gallon Septic /Weiser /Filter PL525 3 Trenches EZ Flows Date: 2 -4 -11 Scale: 1" = 40' BM 1 -1/4" Galvanized Stake BM t 100 System Elevation SE 1/4, SE 1/4 Sec 24, T 28N R 2O -N Town of Troy P.N. 040 - 1308 -00 -152 312 Lindsay Road Hudson, WI 54016 3 1 7 � c \ \ \) S.' O 0 • i \ 5 Leo \ 7z .73•� \� CZ EZ : ! 2033 11 Ttr7r♦ v= .• 4. •,t ; - : •• •r ►t1TT ' "a' TTTtOTt � rC� :.+w+t. i • 7: • . t . ` .. w '�'... #�.►•. rTrTrrT ►00 �',r,-,�r... . � • �..w ..tom ' i a;'rrr ►'►♦ �I yr ►: y. r•y .» r + . . �Y �°:' tee, ♦ - rr;♦ . +v Sri ► 1 ' y III Cim vv rrr rr r�i r !'i rTT ►s rVv i ►r rvr r t►t��Fr►r VrT t�ei . - xssT.w�►wrrY rVr�rrvt A .._.. y , nom. (ms.) Void CftaW i4 e -a 57AW O.D. af4° t 18.8�ti/t SkkwW1(Z �� 20 12in s 3.14 pi p 4.625 _ Void valu,neperiilxar R. = S.i4.1l ' • 1S t.12mfR }w iR = 0.1171!° 801ltxri 2.00 O.D. of cmkwvyliwer =17 5 id,, TOW Sal! ln'hw&oe Aran vol VOW _ (( _ id ume 13.IS sf l 23itn — S.t!•r l 1 � s --. .422 Qs ` tl ll lYieflt � .ST4 O.D. ofuab* o ayad ns =12 b bas Projected TrtWA Area Void volume is outsida CY%Wk s= 2+3.11 t2i f R )' . 2:00 S9•F1• .574 • .901 t1• SitlCwall HOW = W in. = Void vsh me al boom baw�u Z�ie � 6iu S Bottom a 36111. +• 3.00 Sq ih. ryNadas -[c /& 1 & —( 121afR ��' 02tStN PrQectedTi� kA m S,SgSqft Yoid votame at oumd& baton, cmums (N2 of void v-k-- (i-__ _AWM) a,13 12 0.10E fe Tout void vokaae - 0.117 + 0. 422 + 0.901 +0-215 * 0.108 a 1.7.63 ta6k a f ft. CfAUM Par$ 1.763 X 7.4E = 13.2 ea -umna ner OWE EPS. Aggregate Trenc S s -ern �g- EZ � Ow . RinU Group 65 Park ' Rd. Oakland. TN' 38060 ' SCAM Far mum.-"Y207iwsi t 12 13 INSTALLATION INSTRUCTIONS °rsr:, eerPr A O ts za�f PL-52.5/PL-62.5 F I LT E R § fY2sreaa•.er odacs Pvision o` � olgt ^k mc. PL- 5251PL -625 FEATURES & BENEFITS Features & Benefits: • Rated for 10,000 GPD • PL -525 = 525 Linear Feet of 1/18" Filtration PL - 625 = 625 Linear Feet of 1132" Filtration PL -525 PL -625 *Accepts 4" and 6" SCHD. 40 pipe The PL- 5251625 Effluent Filter should operate efficiently * Built in Gas Deflector for several years under normal conditions before *Automatic Shut -Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Filter i Extension Handle -- IM A 11 Risers & Riser Covers Extend & LokTM Riser Safety Screens Filter Alarm Panel and Polylok risers bring your Polylok Extend & LokT" Polylok safety screens SmartFilterTm Control septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual and time saving by elimi- make filter and /or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending filter and tank entrance. Fits 3" and 4" pipe. servicing. For a full list of Polylok products please visit our web site at: www.polylok -com ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Pie - ViEmL- �. t. C. �. pAM tr Sic Mailing Address es 5 WRTeL flfiL 4� A-" , Al 0 S S 1 ZL Property Address :�- Z L-1 t JDS 1:�- (Verification required from Planning & Zoning Department for new construction.) City /State fir`A D 5,-1 t-A, r 1 11/4 t Parcel Identification Number Z-- LEGAL DESCRIPTION Property Location 5E t /4 , %a , Sec. , T 22 N R 3 W, - Town of Subdivision — _ f1.4 �/ V1 lA,A L4 4E , Lot # IF Certified Survey Map # , Volume , Page # Warranty Deed # Volume , Page, # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site, wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu drooms SIGNAIURE 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. 08105) r. Fm ul ~ { th ca { 47 � a a n ► �\ non c . t Sim i r . 1. t } •r y� j . I A f Yll 'i 41 f L SOIL EVALUATION REPORT Page _ f o► 3 ' Wisconsin Department of Commerce i Division o(Satety and Buildings i In accordance with Comm 85, me. Adm. Code Colxtty, I ST. C t Attach complete site plan on paper not toss than 8 112 x i t ixties tPpM t D � LD '� { of — �js include, but not fimitod to_ vertical and hortzontai reference int (B 6a�e11cL.. t percent slooe, scale or dimensions, north arrow, and locetio I and distance to nearest road. Date u Please print all /nformatlo 7 . U L T 2 9 2 a ad b 0 0� - Personal a+iormauon you provide may De uSoo for secondary pwpo as (Prwacy 1.aw, a. 15.04 (1) (n' • 1 Property Owner ST, C 1 �K*on ,, CowvlmENTAL DE ELiDPMEM CAS ZONI ES 9 1 14 -% 114 S T 2S N R 1 Q W Property Owner's Mailing Address Lot fa Block # S_ Name a CSIN1t i 1 QUO r 6T. E SutZE too �5z- T C W tAGE Co wA City State p Cade Phone Number Q City ❑ Village Town Nearest Road r t_�INE t 55449 (763)1 1 -754 N i ND �• GPD i Code derived design now rate ! (� New Construction User Resldentlat J Number of bedrooms i Q Replacement 1Q PubAc or commercial - Describe: y a cy tA L_- Flood Flain elevation i(applicabte Parent material _ _- t2S�I1dtB.5ttS.� /j 5 - General comments and recommandetfons: CON J Et�'t1aNRt_ Z.JU-Cd�►J� TREr►G><4ES 1 O.'1 L.0 AD t N RAE 1 ❑ Boring [:A] Ground surlace atev. 3oring tJ m. p f r. � _ ft. Depth to Ifmiting factor _ _ li�Uon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EtfIt EtW2 in. MunseU Qu. Sz. Cont. Color Gr. Sz. Sh. 0.5 ' z a -t4 0� — 5►1 _m Zug -w% o. 7 ; 3 i - o �� ' s S d 1 la -yY 3 — 5 r d i r s 0.1 & . z y 5 � 5 � o. }. } 4 t Boring i ® Borings f Pit Ground eur(ace elev. 7. ft. Depth to limiting factor . �S C�- in suit {cation Rate ± Horizon Depth Dominant Cot Redox Description -exture Structure Boundary Roots GPO / f in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. •Etlg1 Etttt2 1 [0 Z ""' 3 ( - - -- ji d - J ZD- 311, to 6LV � r _ d. i• Z j 5 z tiN 5 0-54 e o s 5 i, Effluent p1 z BOD > 30 � 220 mg/L and TSS >30 < 1 50 mgA- • EBfuent 82 BOO 130 mgtt, and TSS _< 30 mgtL CST Name (Please Print) gnature ` CST Number Address Date Evetusdon nducted Telephone Number uJ`�a�s c�QO�� Rt u E F AuS W1 Stio22 - 30 -t�3 L7tS 141.6 - 17,5 r r - h ' r ♦ I i CL-OT S ISz) z-- of Property Owner �'Or1TINE1�1f�11- DE+z+n 5T Parcel ID# Pege ❑ Goring COX1 ! i Boring # n pt r © }�( P Ground surface elev. o. h. Depth to limiting factor �l �Q__ in. Soil Application Rate 1 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff f in. Munsell Ou. Sz. Cont. Color I Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0'y IOYIC3�4 _ 51 Z -M5bK d S 0.5 3 4GM 0,7 1.Z � -d 31 s Os i t C5 aS - 0, 7 1. z 10 1Z r a 1 ZZ 3B t %40 5 5 I C5 vT rh v.7 I• L i 5 �- S I 0. 7 11 Z t _ �l 0 5 -ro0 v►t !3 1 C- v H IzoN 5 t t, 1 Boring # ❑ Boring i a ❑ pit Ground surface elev. `__ ft. Depth to limiting factor _•.�_ in• Soil Application Rate Roo Horizon Depth Dominant Colw Redox Description Texture Structure Consistence Boundary GPDIff in. Munsell I Qu. Sz. Cont. Color Gr. Sz. Sh. Efl#1 Eff #2 t Y 1 ' � I r Boring a Boring # Ground surface eiev. ___^ ft. Depth to limiting factor , in. ❑ Pit Soll A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOtff in. MunseA Cu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 f Effluent #1 = BOO, > 30 1220 mg/L and TSS >30 < 150 mg/L ' Effluent 1i2 = BOD, < 30 mg/L and TSS < 30 mg/L 'rhe Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or i need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBp•t130 tK.6l00u i ' V ' r PROF EKfY OWNEtz; t 1+,1 �- f EGENU: / yd 3M 0 1 16t IAJ 4 ca sl Tfl � t � � F TRD`{�.ST C[L44 " �r 0.5Ep (�t.IZS► ' i -5011. i OPNG W/ IDPCga e. ''f3PCK p�Oa. E,�/+5 jO COMM 83 k The .itc �cas ra�icd �1tic1 soil e� tiluat ere romhlctc (sec INa Ic „ ith final cicv ations). S� stem cic%ations should not be affcctCd. but dclith belmv ��ra�fc ��ill need to be determined r � hased on the amotmt ()i cut or fill. BNI elevations should h,i\e remained constant. �. 8152A \� \ LEV. 897.9\ _ - 81528 ELEV. 897.4 DoT LSZ 8152C ELEV. 896. 7 / ELEV. 893,51 i w E El 893.72 I . NUS F l 5160) C5t DAIS: Ott T:;D-0 4 PLAN ChhA R: C o TAt LEGEIW. � T �- 5OL 00" W/ PAOUiGe r ( } R.AD > =,LE�1 AT 10 N S i 1 f 1� f LoT B152A LEV. $95.9 B 152B ELEV® 9 B152C ELEV. `��)�'' B 153A ELEV$Rio�4 STATE BAR OF WISCONSIN FORM 2 - 199.8 ;� 1 WARRANTY DEED 8. n• 1" 4 1 9 5 Tx.4n1ng 1 Document Number This Deed, made between Troy Develo � I � p€rent Corporation BETH PABST , REGISTER OF LEEDS CR'C`XX -CO., WX Grantor, RECEIVED FOR RE - CORD i, 12/03 j 20itl 3:47 PM and RPth 1, I I_( EXEMPT #: N/A % REC FEE: 30,0 0 TRANS IEEE: 119,70 Grantee. ;i PAGES; I Grantor, for a valuable consideration, conveys and warrants to Grantee the following t described real estate in St. Croix County, State of Wisconsin: Lot of the Plat of Arm 1 f Troy Village 6th Addition in the Town 1 of roT y, St. Croix County, Wisconsin . !! Name and Return Address ..Subject to the Declaration of Covenants, Conditions and Restrictions Bethel, LLC a Arent R Johnson, Attorney for Troy Village, recorded in Vol. 1241, Page 256, as Doc. No. 559964, Grandview Professional Building Fact ding and the Declaration of Golf Course Covenants, Conditions and Easements, l 400 South 2nd S treet, Suite 210 recorded in Vol. 1241, Page 301, as Doc. No. 559969, as appearing „Hudson, WI ` 54016 _ in the office of the Register of Deeds for St. Croix County, Wisconsin, - -- -- - - :and such other easements, restrictions and reservations of record, or in use, and the "Buyer" obligations and conditions contained in 040-1308- 00-152 the Purchase Agreement 'for thi s 1 of and any addendum thereto between Parcel iderrtf Number (PIN) Grantor and Grantee herein, which includes, without limitation, This is not homestead property requirements for approval of plans *by an Architectural Review (is) (is not) Camittee, approval of home builder by Grantor, compliance with :Grantor's approved builder requirements, pa not of the Developer :'Service Fee and comlencerent of construction deadlines together with related.rights'•of redemption, all of which shall survive closing and J' .conveyance of this property and shall be binding upon Grantee, and his /her /thei'r successors and assigns. e; l� Exceptions to warranties: ,1 I Dated this ro day CW UX ` (SEAL) (SEAL) " Courtnie Kirvelay, Vi a President * ti Troy Development Corporation SEAL i ( SEAL ) ( ) i ACKNOWLEDGMENT AUTHENTICATION . ,. •� M Signature(s) i` State of Wisconsin 1l l v St- Croix County, 9 authenticated this day of Personally came before me this -s day of. € .2010 —. the above nam � 1 Cou 6 U vel ay, Yi ce _Pr r1Pn - Troy Development Corporation to TITLE: MEMBER STATE BAR OF WISCONSIN it i (If riot, me known to be the person Who executed the. foregoing I: authorized by §706.06, Wis. Stets.) instrum d acknowledge the m . I . II • 1 THIS INSTRUMENT WAS DRAFTED BY 1 +� t, Troy Development Corporation�! +! Notary Public itate of Wisconsin Charley S. Cook President My commission is permanent- (if not, state expiration- date: �• . s (Signatures ;may be authenticated or acknowledged. Both are not / 3 ° 0 necessary) 1 I •N of persons signing in any capacity must be typed or printed below their signature, Wisconsin Legal Blank Co., Ina f STATE BAR OF WISCONSIN Milwaukee, Wis !, WARRANTY DEED FORM No. 2 -1998 t