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HomeMy WebLinkAbout040-1131-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556381 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: L Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 2-1 (P 5S4 3 Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Daniel & Annette Troy, Town of 040-1131-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 106A too d (/+(j.e - 35.28.19.547A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. w . 2 in 3. Septic a ch ark Dosing Alt. BM 751 h"unA./- Aeration Bld er / ~ 2!~ /032 n 'Z .2 Holding St/Ht Inlet /a.7s 9a. v.s ~ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. . Ven /Air Intake ROAD Dt Inlet el On Septic I / I ) US Dt , 00 Bo _ / Z v 916 Dosing Z 3 Header/ an. G 551 3 Aeration Dist. Pipe _745 t~S . ,Z Holding Bot. System ~•7 . ~ 9y -S Fin~ede PUMP/SIPHON INFORMATION a Manufacturer Demand St Cover / GPM Model Number TDH Lift, Frictio~Loss ~ Syst Head J T9H Ft Forcemai~ L th IDia Dist. o Well i/ Db / 15- j SOIL ABSORPTION SYSTEM BEDITRENCH Width I / Length/ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STRE LEACHING Manufacturer: INFORMATION Type Of maik~ System: \ 5V' UNIT Model Number: DISTRI ION SYSTEM kS al o' 6 Heade anif Distribution ~,x Hole Size x Hole Spacing r Veto Air Intake ` Pipe(s) ~ ? ~ ii 7.2G / 0 Length 6 ~ Dia 6 Length Dia Spacing SOIL COVER x Pressure Systems Only xx M n Or At-Grade Systen s Only Depth Over Depth Over Depth of Seed! Sodded ulche Bed/Trench Center Bed/Trench Edges Topsoil ~U 41, d E] Yes ❑ No ❑ Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 774'Cty Rd MM River Falls, WI 54022 (NW 1/4 NE 1/4 35 T28N R19W ,mete bounds Lot Parcel No: 35.28.19.547A 1.) Aft BM Description = U ✓ VA 2.) Bldg sewer length =1~,~ ~~a7 r= 10 Pik :Yd4_1 Uti` - amount of cover = U d Plan revision Required? ❑ Yes No - - GZ%YV~~ - - IS Use other side for additional information. 3~ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Q h ' \C)o\ tv Ln w p\ Q p e o p ~ Al b a r y' `c Qp n N v ~ p a k. x v~ to h © o p n` g 0 e- o w 3 R o ~ to VJ ~ v . County Safety and Buildings Division g D $ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P~ Madison, WI 53707-7162 n~`~~ ' lel it Application 2r s,S j In accordance with SPS` N.21(2), Wis. Adm. Code, submission of this form to the appropriate Bove unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than Mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 xm , Stats. L Application Information - Please P ' 11 Information Property Owner's Name Parcel # J~'A,ti Coo Property Owner's Mailing Address Property Location 77 C. 1.4. A~ Govt. Lot City, State Zip Code Phone Number A'14,A(,6_ /f Section 8 3 S l/C. V--ZX iOLI ~l Sy6,?o? N cmcleone N; R ~ o H. Type of Building (check all that apply) Lot # ,91 or 2 Family Dwelling -Number of Bedrooms Subdivision Name ❑ Public/Commercial -Describe Use Block # 19 eit9-of ❑ State Owned - Describe Use CSM Number Q Vit Wuf 7 / O✓ JdTown of T/I o y III. Type of Permit: (Check only one boz on line A. Complete line B if applicable) A ❑ New System XReplaceoumt System ❑ TreatmentMolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T of POWTS S stem/Coos nent/Device: Check all that a 1 6 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade RrMound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil , ❑ Holding Tank 11 r Dispersal Component (explain) ❑ Pretreatment Device (explain) S~ w~ ~O V. Dis rsaUTreat ent Area Information: Design Flow (gpd) Design Soil Application e( pdsf) Dispersal Area Require sue~-- Dispersal Area Pro Ms f) evation a 93 7~e.~revic ,/so /.o yso ~~b ySS 9313 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o v New Tanks Fxistmg Tanks c Y a 2 c`r Septic or I aek vo 1 411""--t ~onJfitE rE Dosing Chamber ~6D 466/ .11 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's igna re MP/MW Number Business Phone Number oy,I ESE' ,?3/3yG /S Plumber's Address (Street, City, State, Zip Code) 1" ,9,9 <r- A,r. ~S u,~,o too C+Jr 13 Y/. _ VIII. Comity/Department Use On pproved isapprov Permit Fee Date I ued Issuing rrt Signature rven Reason for De ' 1&26.6c, IX. Condi~VV6keV"easons for Disapproval \ 1 b~ e~ Sybi t.~ q 1. Septic tank, effluent finer and 3) dispersal cell must all be services I maintained J ~J G O n _ 1 PA- as per management plan provided by pluigb " CAb d~ 2. All setpack requirements must be rrutintg* as per ble 60&1 off. Attach to complete plans for the system and submit to the County only on paper not less than 8 ra 111 inches ht size SBD-6398 (R. 11/11) ARTMF~T Safety and Buildings • - 5v o~ 10541 N RANCH ROAD S 9F HAYWARD WI 54843 3 j S Contact Through Relay www.dsps.wi.gov/sb/ r~ y www.wisconsin.gov A Scott Walker, Governor s1MS Atis Dave Ross, Secretary October 30, 2012 CUST ID No. 231346 ATTN: POWTS Inspector JOHN HERBERT PELKE ZONING OFFICE PELKE PLUMBING ST CROIX COUNTY SPIA N 6298 ST HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/30/2014 Identification Numbers Transaction ID No. 2165543 SITE: Site ID No. 785295 Dan Johnson Please refer to both identification numbers, 774 CO RD MM above, in all correspondence with the agency. Town of Troy St Croix County P.0 SWIA, NEIA, S35, T28N, R19W coyt FOR: S Description: Mound, 3 bedroom residence ~ r Object Type: POWTS Component Manual Regulated Object ID No.: 1397764 Maintenance required; Replacement system; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from pIV1S~ON pF original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter S E G The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Cod - and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • This system is not designed for and may not be sited on a concave slope. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder JOHN HERBERT PELKE Page 2 10/30/2012 • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integra d vices VViSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: ~A~ foN~daN . 775 Ce /10 ~.y ~~~-,c PALLS lJI' "'O.U Project Name and System Type: ,yAN T,y„/So..1 - 3 ,6,t. /y a vo ~ow 1'S ~E-~IL,oGE/YE.d T Location: 77y Co !lo %~~l Street Address 4 _4 S41 V 3S d8N 9t J Legal Description of ~a0Y Sr. C.toix Co. °.onall y Township/County Contents: Page 1: Page 2: d'L o r o~ yRRES Page 3: - Gloss- .~rc r.,,. i ,o.ro ~i.✓ L/r✓ of /J~.~o ~7t- Page 4: Page 5: _ ~~.~rla . ...x ~.diya~•~ Doff - Page 6: Page DOwts O.v rrc s zv",,,ga ~,o.✓.vsEirsrr ozi.✓ Page 8: Page 9: A/L re-1- Attachments: lio. So / a Eda~ao Mvw /1E/iA r Plumber/Desiger: -ro y j ~*,4 CE' Signed:, Credential Number. /1A- ,?3/.3 yG Date: G1sEO se.0 - JoG 91--~° /~iuvo CDi'JPO.urvr /'.✓~,aL ~ !/£as~..✓ .T. o G1s`o ~.S,rfO - /o lot -P . Qi! ftaw~ ~s r.~.aa r...+ 'r!~ I ~ ~e.e►P~wrrr~gG~NAL ~E~SI/d 1•d o a A ` o r~ ^ y OO s n a h •c tv LN , o t~ a Z ~ o ~ ~A w o o 14 ~i c o Q~ r. A I i 4. ~ _ vl a ~ ~ a col .t a O ~ v 1 w a. 9K v` I t © wz a o A t n ~e ~v . 0 o I-o C V? n R ~ Z a; s .0 ir N ~C y H 'd. a !C 4~ ~1 ,bpi C o ~ Od e~ Z OD 1' 1 '1 t• 1. . 4& - CF C+ F cF !1' !1' ` sF ~F . CI' .0 CI' ra , d o~ a H > ys A - • t i t - k hi tD - 8j U. v, ;j o ~pp1ls Q Cc? s w ( oq til M ; ! m r o ~ b h o cI ib 1.4. C ` j K~rnb~ x t t t t o ~ o w y w C-3 H t1i E~3 x s ~ t ~ t t c C ~ ~ n ^t tlcLd3i i ~ " Y ~p k .6v a i Al ~ i o M x d n ~ V u~ w a h O En K 0 o ~ Q tri v i Page .S' Of 9 SEPTIC TANK &*PUMP CHAMBER CROSS SECTION'AND SPECIFICATIONS •s .Scr. S'o. 4" CI VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF /p' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS ~i.~~svra y ar~cw W/ PADLOCK 6 ~.rAoE WARNING LABEL 4" MIN. 18" INLET GAS- WATER TIGHT SEALS (f Es T ~ ~ TIGHT i VAPPROVED not A SEAL ; JOINTS WITH APPROVED --f-- , ALM APPROVED PIPE PIPE 3' B ON 3' ONTO •01170 SOLID _ ' SOLID SOIL SOIL' PUMP OFF ELEV . 87 7 FT. --C ~ f OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC./ DOSE TANK MANUFACTURER: ,~/jESE,a ~o„JC rE NUMBER DOSES PER DAY: S.! (,Td9) TANK SIZES: SEPTIC o0o GAL.' DOSE VOLUME INCLUDING 3.3 = DOSE Goo GAL.. FLOWBACK: 9, y GAL. ALARM MANUFACTURER: E o~ysuS CAPACITIES: A = o?I INCHES = 3S,F GAL. MODEL NUMBER: aK per SWITCH TYPE: B ' 2 INCHES = 33.6 GAL.- PUMP MANUFACTURER: Z6 ex C = S:S INCHES = 9.71/ GAL. MODEL NUMBER : SWITCH TYPE: D = 7 S INCHES = 1,740 GAL. REQUIRED DISCHARGE RATE GPM PUMP ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL'DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 7,o FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . 3,,3 FEET + ,?o FEET FORCEMAIN `X /_67 FT/ 100 FT. FRICTION FACTOR , -3 FEET TATAL DYNAMIC HEAD = /o.G ` FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH f'3& ; WIDTH 78 DIAMETER LIQUID DEPTH .~G" TOTAL PUMP PERFORMANCE CURVE DYNAMIC HEAD/FLOW LL MINUTE MODEL 151/152/153 PER EFFLUENT AND DEWATERING 14 45 153 12 40 MODEL 151 152 153 Feet Meters Gal. Liters Gal. Liters Gal. Liters 9 35 = 10 152 5 1.5 50 189 69 261 77 291 30 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 6 25 151 20 6.1 29 110 44 167 52 197 25 7.6 16 61 34 129 42 159 6 20- 30 9.1 23 - - 87 33 125 35 10.7 - - 15 - - 22 85 4 40 - - 11 42 ,0 Shut-08 Head: 30 ft. (9.1m) 38 ft. (11.6m) 44 ft. (13.4m) 2 0146 -B s Model 151 Models 152 1153 10 20 30 40 50 60 70 80 90 100 GALLONS 67132 67432 - LITERS 0 40 80 1211 160 200 240 260 320 360 3718 4518 3716 4516 - FLOW PER MINUTE I 014508A " B i .,•t,f^i "3718 3718 1„d t- 1 r n i P rt td' AT! Q 1 3718 i 37/8 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See 1111/16 . 12,18 -i • Over er 13 130°F (54'C) special quotation required. - - -i, _ 411s116 s lire 1 l 1'i 5'2 L . •1 - SK2444 SK2064 15111521153 MODELS ff6.0,"d.d Selection Model Volts-Ph Mode Du lex N151 115 1 Non 2 or 3 BN151 115 1 Auto 2 or 3 E151 230 1 Non 2 or 3BE151 230 1 Auto .2or3 "Easy assembly" (pump & disdwrge pipe N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 not included.) E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 SE. G.'Silviv GUs.ii..... 1. Single piggyback variable level float switch or double piggyback variable level i R P t C/ i N A L tl 'u j' iV11 i P," • 1 , float switch. Refer to FM0477. Reduces potential clogging by debris. 2. See FM0712 for correct model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. 3. Variable level control switch 10-0743 used as a control activator, specify duplex Made of durable, noncorrosive ABS. Raises pump 2" off bottom of basin. (3) or (4) float system. Provides the ability to raise intake by adding sections of 1'/2" or 2" PVC piping. O CAUTION Attaches securely to pump. u J Accommodates sump, dewatering and effluent applications. e7<el e'. ~'ai Cava I NOTE: Make sure float is free from obstruction. +~t%.. 1 ica 6m Act ( SA,(AI. a^y w^'+ P'q "w•, V"s a. P M^' N-L • k t T'" Ww°'A W" P^a. d"'k W ! t.:'.w w, i For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2008 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner A Septic J e a~ Tank Capacity /dap al ❑ NA Permit # Septic Tank Manufacturer ,c Ca.,ict. ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer EST ❑ NA Number of Bedrooms (100 d/bedroom Effluent Filter Model Gf-/o ❑ NA Number of Commercial Units _ Pump Tank Capacity ao al ❑ NA Estimated flow (average) do gal/day Pump Tank Manufacturer EsE.~ f..►~~, ❑ NA ySo aUda Pump Manufacturer ❑ NA ~ Design flow (DWF , estimated x 1.5 Zo~sc~.c Pum Model Soil Application Rate al/da S~ ❑ NA Influent/Effluent Pretreatment Unit ;!a-NA Quality (NA❑) Monthly Average ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/ L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) Total Suspended Solids (TSS) ~ 220 mg/L ❑ Disinfection ❑ Other: 150 m L Manufacturer: Model: Pretreated Effluent Quality ❑ Monthly Average Soil Absorption Component ❑ In-ground avi Biochemical Oxygen Demand (BOD5) < 30 mg/L gr(grty) ❑ In-ground (pressurized) 'Total Suspended Solids (TSS) ❑ At-grade J~'Mound Fecal Coliform (geometric mean) ~ 30 mg/L ❑ Drip-line ❑ Other: <10 cfu/I00ml ❑ Dispersal Units - Manufacturer Maximum Effluent Particle Size 1/8 inch diameter ❑ Aggregate Cell(s) Model Calculations: Soil Dispersal (EISA) or DWF _ Application rate = Area Required _ (Ag reg_ate Trench Width) Units or Total Length of Aggregate Trench(s) 7 S DESIGN CRITERIA ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "ICC Flowtech Mound Component Manual" Version 1.2 ❑ "EzFlow Mound Component Manual" Version 8/20/2007 ❑ SBD - 10854-P (R.1/12) "At-Grade Component Manual Using Pressure Distribution" Version 2.0 ❑ SBD - 10705-P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 SBD - 10691-P (N.01101) "Mound Component Manual" Version 2.0 ❑ SBD - 10657-P (8.6/99) "Drip-line Effluent Disposal Component Manual" j8(SBD - 10706-P (N.01101) "Pressure Distribution Component Manual" Version 2.0 ❑ Other - MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT Service Event 13 Y.,.,. Service Frequency Pump/inspect tank(s), inspect dispersal cell s), clean filter At least once every: Ur 13 months 3 years Other - Inspect um & um controls, alarm, pretreatment unit At least once eve : ❑ months 3 ears ❑ NA Flush and pressure test laterals At least once eve : ❑ months 3 ears ❑ NA 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. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only gaper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins :ondoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page 7 of 9 disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made b an individual certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Mamtaine or one of the following licenses or Maintenance r or Se ce Schedule . ptage Servicing Operator Tank in (per spections must include i the attached a visual ms ectio identify any cracks or leaks, measure the volume of p n of the tank to identify any missing or broken n hardware, combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. An defects shall greater than 8 inches in dia y be promptly corrected. meter shall be secured with effective lockin Exposed openings g devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third 1/3 tank ( or more of the shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's s ecificatiwashed from the filter shall be retained in the tank. Filter cleaning may be necessary at more fre uent interval s p on Solids maintenance schedule to k q than stated ee the system teed n th e p operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS There is normally a 1 day reserve under regular. operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps s that the system is ro erl and shall be p P Y safely abandoned in compliance with Ch. SPS 383 g P taken to ensure All i in to .33, Wisconsin Administrative P P g tanks and pits shall be disconnected and the Code. abandoned pipe The contents of all tanks and pits shall be removed and properly disposed of b openings Se sealed. - After tae um ' Y Servicing p m all p g Operator. P tanks g and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other 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 render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. X The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. j'$( Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative - - surface.-Reconstructions ofsuch-systems must comply with the rule§ in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 POWTS INSTALLER POWTS MAINTAINER Name 0 AN fkX /y - .?3/3 Phone y 3- d 7,? _ s.~ Name Q//N l.,rE ELKE LN~x6i.~a SEPTAGE SERVICING OPERATOR (Pumper _ c/,rlr.Jo.+d LPhone Name OCAL ULATORY AUTHORITY Phone enc 4,toix Z6,✓i,.#c [:PA hone 71.f „3g - G 80 Page 8 of 9 eb to L7 f~ ID O r.r . VJ A .Ci to e* ~ to ~ rF ty+ ~ Gl :C n r °.d ~h."y.. 1~.. .•f ='O C r% I ~r F+ @a O O _ I O_ j d I r w ld m~ S N N F M~ S r, 0 CL sy E. 0 ~ o 'tor F~ e ° mmmdm h~ D l.. N d S N O - N W L C 7 Q j d 6 O T p'f a E < o rD rA 3 S a Q to n d K d d O N N O rc e3o Z, o J 3 rp d O n u ; H a C » _ N a 0 C O C 7 O_I m rD L e,, Q oTI p 3 ? m Sfl; y < 7 S O I O O` N 7 N 0~ Aso ~~o,~^,°va ro © ~ S ~v o 7 M+ tom s n c m° ro w i = . ,~-D~ lyl m Er ;own, ~IJ °a, o d,0 a C yv~am~ 1 ID 15D 0, ~ C u rn d 0 0 d N A C j '~q"I n Cr v d s 0,0 0) d a 3 rho _ _ p~.r g+ 'O d N O S {A 3 O N n N D D a .Co j N F r(D 'O m H o 3 °O''o ° m- Cm 'e N N © j d Q W d T S d c 3 fl o a- m CD -.3 21 ro Z ~ a A ? O n N M Z O T n o t° o^ N r► ? m o a o < S rD a~D n m fD v s 'y, m r"4 a 3 d a fD c< 0 v m v s rc v© W Q. C o n ~I \ d 1n f j, N d {Y W O. ~G u; a m C d rp m (p m r+~ m M= L, Ca 0 Ma CD o. S O x O. O =r 1 {Y„~ r'P d ? n mm m~ ~2^`~n O 7 ~°w ~1J eD =r Ot CL m 3 rD d o NEl z~ a' I I N rr ~F °n 5 H o n A Gy m 7r N 1 Z „ m . N O• H N = fD m a' x- © O f"r d O r} E; m m30° j. .mot p fp `C d 1 'a 13 :3 0- rD m 0 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer D I e 1 • ~O h RS An n-r-4e_ m, zO h w SO is Mailing Address "t C'► Property Address v+'"" M VV\ (Verification required om Planning & Zoning Department for new construction.) City/State 1` U" I-5, Parcel Identification Number b 40-'1 131-VUD' C000 LEGAL DESCRIPTION Property Location r7~ 1/4 , 1/4 , Sec. 3 5, T g N R W, Town of Subdivision , Lot # Certified Su ey Map # , Volume , Page # ~~d~ci nTTDeed 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 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statemenfts on this rm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue o a :va my deed recorded in Register of Deeds Office. Number of bedrooms /p /a3 , 0__ SI ATURE 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. 08/05) Vft. Dept of Safety and Professional Services' SOIL EVALUATION REF -17" p~ / of 3 Division of Safety and Buildings :y~ a in cr>x~rtiyaddrtunt SPS 385, Wis. Adm. Code Cou Attach complete site plan on paper not less thao -8 y d(~rib)fes in size. Plan must d~ X include, but not Umited to: vertical and h o nce point (BM), direction and Parcel LD. percent slope, scale or dimensions, arrow, and location and distance to nearest road. Please print all information. Rev' by Dat " Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I Property Owner Property Location ~f1N o/%tlSd.J Govt Lot ,SG/ 114/x/'114 S 35T,7,f N R / 9 A (000 Property Owners Mailing Address ti a Lot # Block # Subd-Nerve or CSM# 77 eo. 140. /Y/-/ - - City State Zip Code Phone Number Q-G*y gMllage ®Town Nearest Road I&IFIt F/Aus al- S5'6,~d ( ) ~ilo Y e-c. 11a. r>ir! ❑ New Construction Use: ff Residential / Number of bedrooms J Code derived design flow rate V510 GPD 9 Replacement ❑ Public or commercial - Describe: Parent material ZdESS d a.-,L ° w r-wA SN ,ye, S.S. 6.,C. Flood Plain elevation if applicable A)A fL General comments l01G5 Su/J'/f,3LE ddic A~"- 6/t4Or eAfr sir-' /.$AJ1r. e'L/iy/rav e-a , r-.4. rw) and recommendations: i /lEGo~i~/E✓D G "c lvoaw e 11ou/rs, 7 X ,/,f Slit/~r/Tio.J GE[C LE,*/~rN .SEG. of fY3 oo 9.?. 7 Lo,uMwA S ~ SLaPE aPE~ LA~./~ Boring # ❑ Boring ® Pit Ground surface elev. 93.7 ft Depth to limiting factor yS in. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Y in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. NMI ff#2 pa. r / O /S Y/c 3/3 ads e u r, C /d rs y/y - ,v a ads s G 8 -31 .f PA -Y/l S. / 6~ ash 4 s . 8 Yx .7 Z-4 I S ~11 EArvr a /yorrtco /oYti y S.S. If le. Boring # F-;] Boring Ground surface elev. 9,?. 7 ®Pit ft Depth to flmfin9 factor yO in. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2 in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 f(#2 "?PY 45 ?c -,WO 7. 1- At -f silk 41,X as /V ZO -30 7 Yn 'Y L - Si a6k d s - 3o-Yo om s 6 - S c/S 4S S yo-y IYA e111 c.~ .c S G s d ~rJ - S /.O orr -rw ~'grN~7tep lexa ss ,l. • Effluent #1= BOO > 30:5 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 n g/L and TSS < 30 mgA- CST Name (Please Print) CST Ntgnber i' AE .~ssErr ,?y97V Address Evaluation Conducted Telephone Number /So3 ~ifitw.e>- fir. E/ou ~.~icE w ~ S~' /6 ,?oiz /S 83~~81/0 SBD-8330 (x11/11) Property Owner VA•J -TCA, ,Sa.) Parcel ID # Page •2 of 3 F-fl Boring # ❑ Boft ® Pit Ground surface elev. 93. S ft Depth to 4tnfg factor 4/f , in Sod Rate Horizon Depth Dominant Color Redox Description Te)dm Structure aonsistence Boundary Roots GPW z Yr. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. RM *OW / o - 13 162M Jl-f - I A' ov XAA fr ~ s C bs .12-WO 7 r c J,? 7 y i .eJE rNctto S. S. .,e!. I Bo ft # ❑ Boring i/ Pit Ground surface elev. R Depth to knbV factor .j y in. Soil Application Rate Horizon Depth Dorninant Color Redo) (Description Texture Structure onsislence Boundary Roots GPDIR 2 in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 2 o -i8 .t is W Jbt 1114 - s / .18-3'Y o s - S 3Y at .r✓6A r S S. ❑ Bor~rg ❑ Sontg # Ground surface elev. R ❑ Pit Depth g factor in Sod Rate Horizon Depth DOrnln wd Color Redox Description Texture Structure aortsistance Boundary Roots Cult z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • I #1- BOD e > 30:S 77A rrq& and TSS >30 < 150 ffQ& • Effluent #2= BOD s < 30 n'gA_ and TSS < 30 M9& The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact ttre department at 608-266-3151 or TTy through Relay. SBD8330ag1111) . - ,QARnJ ~ FA~rI 61414,0114 5 1v N n ►sl w Y > C C') H H ~ ' yb o . d 1 ~o ra ~ \ z ir6 V3 z r, Q = ,C3AcK~ote- ,airs) s /7i,✓o 3'•rEE's _ to o o A[ t .SPS 383. y3 Se-r~ac,rs t' I woao + z foe" yo f ,44A ' MAZE& A_~3alld~ rOP of 1JE44 /00.7s ra.v s~~- 5,460" 1 R/e•-4 s ti.✓e' Q ranOC I o I a ~ pots 1 ~ I AaICA 4 ~t I c I r. l I gAtd I Fi~t,o I I D I F~ 7- 74 ( I i 4~ I Ann J air 9ss 4 l S ~o _ ~gsfyn~ 3 ~ ~ I 9.7.7' I I I PPA ~1 l t ~ I t~ 7711 F" !1q a W i 8 0 5 7 6 4 7 State Bar of Wisconsin Form 11-2003 Tx:4042807 LAND CONTRACT 956849 (TO BE USED FOR NON-CONSUMER ACT TRANSACTIONS) BETH PABST Documeni. Numbcr Document Name REGISTER OF DEEDS ST. CROIX CO., WI CONTRACT, by and between Orin E. Johnson and Nancy K. Johnson, 05/22/2012 1:30 PM husband and wife as marital property EXEMPT#:8 ("Vendor," whether one or more), REC FEE: 30.00 and Daniel E. Johnson and Annette M. Johnson, husband and wife as TRANS FEE: 1092.00 survivorship marital property ("Purchaser," whether one or more). PAGES: 5 Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this Contract by Purchaser, the following real estate, together with the rents, profits, fixtures and other appurtenant interests ("Property"), in Recording Area GJ St. Croix County, State of Wisconsin: Name and Return Address 1 Leo A. Deskar See attached Exhibit A Rodh, Beskar, Krut_er&.Pletcher,S.C. 219 North Main Street t it River Falls, WI 54022 040-1131-20-000; 040-11331-40-000;040-1131-80-000: 040-1135-60Pa00;10d0-ifi la[o nNomber (PIN) Purchaser agrees to purchase the Property and to pay to Vendor at a place This is homestead property. from time to time determined (is) (is not) ! This is a purchase money mortgage. the sum of $ 546,000.00 in the following manner: (is) (is not) (a) $ -0- at the execution of this Contract; and (b) $182,000.00 gift from Vendor to Purchasers; and (c) the balance of $ 364,000.00 , together with interest from the date hereof on the balance outstanding from time to time at the rate of 1.080 % per annum until paid in full as follows: Commencing on October 15, 2012, and yearly thereafter on October 15, principal and interest payments in the amount $16,000.00 provided the entire outstanding balance shall be paid in full on or before October 15, 2020 ("Maturity Date'). Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal As and for additional provisions to the Land Contract, Vendors and Purchasers agree that in the event Purchasers sell said property (or a portion thereof), that Vendors shall receive the following percentage of the profit received: (a) if said property is sold prior to May 2, 2017, Vendors shall receive 25% of the profit received; (b) If said property is sold between May 3, 2017 and May 3, 2021, Vendors shall received 15% of the profit received; and (c) If the property is sold after May 3, 2021, Vendors shall not receive any portion of the profit received. In the event that Purchasers satisfy their monetary obligation to Vendors (in full or in part), the above provision shall survive until May 3, 2021. CHOOSE ONE OF THE FOLLOWING OPTIONS; IF NO OPTION IS CHOSEN, OPTION A SHALL APPLY: ® A. Any amount may be prepaid without premium or fee upon principal at any time. ❑ B. Any amount may be prepaid without premium or fee upon principal at any time after ❑ C. There may be no prepayment of principal without written permission of Vendor. State Bar Form 11-Page 1 0 2003 STATE BAR OF WISCONSIN 1 of 5 CHOOSE ONE OF THE FOLLOWING OPTIONS: IF NEITHER IS CHOSEN, OPTION A SHALL APPLY: ® A. Any prepayment shall be applied to principal in the inverse order of maturity and shall not delay the due dates or change the amount of the remaining payments until the unpaid balance of principal and interest is paid in full. ❑ B. In the event of any prepayment, this Contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as specified above; provided that monthly payments shall continue in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded from this Contract. i Purchaser shall pay prior to delinquency all taxes and assessments levied on the Property at the time of the execution of this Contract and thereafter, and deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the• improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the amount of the full replacement value of the improvements on the Property. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of Vendor's interest, and evidence of such policies covering the Property shall be provided to Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided Vendor deems the restoration or repair to be economically feasible. ❑ Purchaser is required to pay Vendor amounts sufficient to pay reasonably anticipated taxes, assessments, and insurance premiums as part of Purchaser's regular payments [CHECK BOX AT LEFT IF APPLICABLE). Purchaser shall not commit waste nor allow waste to be committed on the Property, keep the Property in good tenantable condition and repair, and free from liens superior to the lien of this Contract, and comply with all laws, ordinances and regulations affecting the Property. If a repair required of Purchaser relates to an insured casualty, Purchaser shall not be responsible for performing such repair if Vendor does not make available to Purchaser the insurance proceeds therefor. Vendor agrees that if the purchase price with interest is fully paid and all conditions fully performed as specified herein, Vendor will execute and deliver to Purchaser a Warranty Deed in fee simple of the Property, free and clear of all liens and encumbrances, except those created by the act or default of Purchaser, and: CHOOSE ONE OF THE FOLLOWING OPTIONS; IF NO OPTION IS CHOSEN, OPTION A SHALL APPLY: ® A. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination, at the time of execution of this Contract. ❑ B. Purchaser states that the following exceptions set forth in the title evidence submitted to Purchaser for examination, at the time of execution of this Contract, are unsatisfactory to Purchaser: ❑ C. No title evidence was provided prior to execution of this Contract. State Bar Form 11-Page 2 © 2003 STA,rG BAR OF WISCONSIN 2of5 CHOOSE ONE OF THE FOLLOWING OPTIONS; IF NEITHER IS CHOSEN, OPTION A SHALL APPLY: ® A. Purchaser agrees to pay the cost of future title evidence. ❑ B. Vendor agrees to pay the cost of future title evidence. Purchaser shall be entitled to take possession of the Property on the date of closing Time is of the essence as to all provisions hereunder. Purchaser agrees that in the event of a default in the payment of principal or interest which continues for a period of 30 days following the due date or a default in performance of any other obligation of Purchaser which continues for a period of 30 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), the entire outstanding balance under this contract shall become immediately due and payable at Vendor's option and without notice (which Purchaser hereby waives), and Vendor may singly, alternatively or in combination: (i) terminate this Contract and either recover the Property through strict foreclosure or have the Property sold by foreclosure sale; in either event, with a period of redemption, in the court's discretion, to be conditioned on full payment of the entire outstanding balance, with interest thereon from the date of default and other amounts due hereunder (failing which all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property); (ii) sue for specific performance of this Contract; (iii) sue for the unpaid purchase price or any portion thereof; (iv) declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; (v) have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits; or (vi) pursue any other remedy available in law or equity. An election of any of the foregoing remedies shall only be binding on Vendor if and when pursued in litigation. All costs and expenses including reasonable attorney fees of Vendor incurred to pursue any remedy hereunder to the extent not prohibited by law and expenses of title evidence shall be paid by Purchaser and included in any judgment. The parties agree that Vendor shall have the options set forth in this paragraph available to exercise in Vendor's sole discretion. Following any default in payment, interest shall accrue at the rate of 1.080 % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. Purchaser may not transfer, sell or convey any legal or equitable interest in the Property, including but not limited to a lease for a term greater than one year, without the prior written consent of Vendor unless the outstanding balance payable under this Contract is paid in full. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full at Vendor's option without notice. Vendor may mortgage the Property, including the continuation of any mortgage in force on the date of this Contract, provided Vendor shall make timely payment of all amounts due under any mortgage, and the total due under such mortgages shall not at any time exceed the then remaining principal balance under this Contract. If Vendor defaults under such mortgages and Purchaser is not in default hereunder, Purchaser may make payments directly to Vendor's mortgagee and Such payments will be credited as payments hereunder. All terms of this Contract shall be binding upon and inure to the benefit of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. State Bar Form I I -Page 3 © 2003 STATE, BAR OF WISCONSIN 3of5 i Dated VENDOR: PURCHASER: (SEAL) (SEAL) *-Orin E. Joh 1 * Daniel E. Johnson (SEAL) l \el M6A (1). _JG~(ti3'RDCS'{) (SEAL) *-Nancy K. J hnson * Annette M. Johnson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Orin E. Johnson and Nancy K. Johnson husband and STATE OF WISCONSIN ) wife and Daniel E. J n and Annette M. Johnson, husband and wife ) ss. authenticated n - (9 COUNTY ) Perso came before me on , *Leo A. Beska % qC the above-named TITLE: MEM TATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Leo A. Beskar, Rodli, Beskar, Krueger& Pletcher, Notary Public, State of Wisconsin S.C., 219 N. Main Street, River Falls, WI 54016 My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY iIODIFICA'I'lONS'1'0'1'1-IIS FORM SHOULD BE CLEARLY IDENTIFIED. LAND CONTRACT STATE BAR OF WISCONSIN FORM NO. I1-2003 * Type name below signatures. 4of5 EXHIBIT A Part of Northeast Quarter (NE 1/4) of Section Thirty Five (35), Township Twenty Eight (28) North, Range Nineteen (19) West, Town of Troy bounded and described as follows: Beginning at the Southeast corner of said Northeast Quarter of said Section 35; running thence North on East line of said Section 95 rods; thence Southwesterly to West Line of said Northeast Quarter to a point 85 rods North of Southwest corner of said Northeast Quarter; thence South on said West Line 85 rods to Southwest corner of said Northeast Quarter; thence East on South Line of said Northeast Quarter, 160 rods to the place of beginning. I Subject to C.T.M. "MM" right of way. The Northwest Quarter of the Southeast Quarter (NW 1/4 of SE 1/4) of Section Thirty Five (35), Township Twenty Eight (28) North, Range Nineteen (19) West, Town of Troy. i 5 of 5 I