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HomeMy WebLinkAbout040-1318-00-049 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574391 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: Schneider, Travis &Alicia I Troy, Town of 040-1318-00-049 CST BM Elev: Insp.BM Elev; BMpescription: Section/Town/Range/Map No: d M 66'r 11.28.19.2124 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 75 CAPACITY STATION BS HI FS ELEV. Septic ` Benchmark 10 73.A- Z SO //- / Be2ft Go a �'• -7✓5b Alt. BM !.._ f o 2,. 1 /68 z. s Aeration Bldg.Sewer 0 2 .25 /6SrZ•7 Holding St/Ht Inlet /6'T4 S TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent to it Intake ROAD Dt Inlet '1 dr Septic / N-4 Q' Dt Bottom 6.Z A7i/• 7 Dosing J14' N� Sri Header/Man. 3 .7-5 ,Og,f a Aeration Dist. Pipe 1.5-75 /d-1/4/7 Holding Bot. System 1q,45 /Jva.4/y Final Grade Z.-75 /n Z ./g PUMP/SIPHON INFORMATION I Manufacturer O �� DeP^and St Cover /o -Z . /d'�L.8'K Model Number , f L 46 �— �, s /67`y, 4/ C� IV J dw ov I TDH Lift•,'L Friction Loss System Head r5H Ft 'f5 ��• S Forcemain Lenj,I Dia.Z# I Dist.to Well SOIL ABSORPTION S STEM BEDITRENCH Width Length N PIT DIMEN IONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS e SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of em: / /�� A _ A /� UNIT Model Number: �a 4 /v DISTRIBUTION SYSTEM e Header/Manifold 1/ Distributio , / x Hole Size Ix Hole Spacing/ VenT/ta Air Inta Pipe(s) .LLi 5 �L R. Length_Dia iLength Dia Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At xx Systems Only IJ Depth Over Depth Over xx Depth of xx Seeded/-Grade xx Mulched Bed/Trench Center /117 Bed/Trench Edges �_ Topsoil ' a�� Yes [T] No 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /0 1 Z-31 17 Inspection#2: "04-A-- Parcel No: 11.28.19.2124 Location: 715 Crest Curve Hudson,WI 54016(NW 1/4 NW 1/4 1I1_T28N R19W) Hills of Troy Lot 4 ij;.. Q 1.)Alt BM Description= ' ' I J t' �'/w" CL-%A6 A6 �— 0`-j I� 2.)Bldg sewer length= S3 -amount of cover �z o� Plan revision Required? z$ Yes 'WNo / �O Use other side for additional information. Cert.No. Date Insepcto s Signatur SBD-6710(R.3/97) r PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Dr. Suite 410 Woodbury Mn 55125 NW 1/4 NW 1/4S 11 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 225900 DATE 7/29/14 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none 1k BENCHMARK V.R.P. top of survey iron ASSUME ELEVATION Filter BEAR Filter ❑BOREHOLE SWELL 1073.64' H.R.P. Same as Benchmark Crest Curve SYSTEM ELEVATION 1081.0' Property Line (not to Well is to meet all Scale = 1/4 = 10' scale) WDNR setbacks 1 Acre Lot All piping shall be SDR 30134,within 10' of tank,piping shall be Schedule 40. Pro 4 Bedroom House Tank is to be properly bedded and provided with Property Line (not to lockdown covers with scale) approved warning labels Huffcutt Combo Tank Grading is to be done to divert run-off away from system B-'1026 1082' 1080' 078' 0 B-1 02A 14% Slop B-1020 1076' 13 Area 15' below B.M.* system is to remain i bI s.� undisturbed Property Line i County 40 (1-D 1` Safety and Buildings Division 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) 2T Madison,Wt 5 162 5 7�3 / State Transaction Number S'c �,�� Sanitary Permit App is cJ in SPS 38321(2),Wis.Aden Code,submission of this form to the appropriate governmental trait is requ prior to obtaiaitrg a sanitary Permit Note:Application forms for stat""ed 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 n r SOS in accords=with the p' w,s.15. 2 in Stets. L A Iiea4ion Information—IN a Print Alt Information Parcel# property Owner's Name COQ ry ' Property Location U(J property Owner's Mailing ess / 2- 12-4 0 -2 1�n M Ire✓ Govt Lot C, City State Zip Code one Number 6U 2 /,, /ti Section r tacit LV �C f + 2 � T N; R E err IL Type of Building eck all that appI Lot# Subdivision Name 2 Family Dwelling-Number of Bedro t11s / Q�r C�J.. 1 'G, Block# 11 Public/Commemisl—Describe Use ❑City of CSM Number ❑V'iliage of ❑State Owned-Describe Use own of /k 7 0 v III.Type of Permit: (Check only one box on line A. Complete line B if applicable) 2 A. gys� ❑Replacement System ❑Treatment/Holding Tank Replacement Only El Other Modification to Existing Systt on(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List previous Permit Number and Date Issued Before Expiration Amer IV.Type of POW 1 S S stem/Com onent/Device: Check all that a 1 O ❑Non-h=wized In-Ground ❑Pressurized in-Ground ❑At-Grade Quad>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑ a Dispersal ComoPment(explain) ❑preatatrnent Device(explain) a v� V.DisperuVrres eat Area Information: Des ipp Flow(gpd) Design Soil Application ds Dispersal Area Requir� sf)� Dis � �� o Qs �Elevation ^ VL Tank�Jln'fo ' aP�rtY m� ' l'Totaf #of 5 Manufacnuer / e s Gallons Gallons Units Nca Tamlcs Exiling Tanks Septic a Holding Tank �/ �.S S/ J� r Dosing Chamber VII.Responsibility Statement-1,the undersigned,assi ation of the POWTS shown on the attached plans. PI 's Name(Print) Plum ignature MP/MPRS Number Business Phone Number Plumber's Address(Street,City.State,Rp Code) /,J /�3 ZIP 5� VIII.CountYA)e artment Use Only Permit Fee Date Issued Issuing Signature Approved ❑ isappr S J /-5 co 41 ❑ on for ial t0 J UL Condit$1 pW ons for Disapproval t s ('p is Septic tank,efflurtt filter at1� 3) dispersal cell must ail k services 1'rr%_lmntatnetl r,,j� i^ CA-) as per management plan provided by plum*. 1-c. 2. MSS requirements 1m. t r isintakte pia code/ordinances. Attach to comipkie plan a for the ryaeem and submit to the ounty only n paper not less than 81/1111 inches in see SBD-6398(R. 11/11) r . SHAUN R BIRD Page 2 9/19/2014 • SPS 383.22(7)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. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services 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$ 170.00 IZ-g;0-T This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (608)789-7893 ,7:45 am-4:30 pm Monday-Friday WiSMART code:7633 charles.bratz@wisconsin.gov cc:..Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm i �9tiYT�F�T DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov O sSIONPtiS�w Scott Walker,Governor Dave Ross,Secretary September 19,2014 CUST ID No. 226900 ATTIC•POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/19/2016 Identification Numbers Transaction ID No.2456855 SITE: Site ID No. 804936 Creatvie Homes Please refer to both identification numbers, 715 Crest Curve above,in all correspondence with the agency. Town of Troy St Croix County NW1/4,NW1/4, S11,T28N,R19W FOR: Description:Mound/Four Bedroom/Sloping Site Object Type:POWTS Component Manual Regulated Object ID No.: 1502856 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual-Ver.2.0, SBD-10691-P(N.01 101,R. 10/12), Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01 101,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above,limited activities are allowed in the area 15 feet down slope of the component area. DOND Soil compaction,excavation,vehicular traffic and other similar activities that impact the treatment and AP dispersal are prohibited. DEPT OF • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption PROFESSI area. chs.NR 811 &812c DIVISION OF I • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis. Stats. • Inspection of the POWTS installation is required.Arrangements for inspection shall be made with the designated SEE CO county official in accordance with the provisions of Sec. 145.20(2)(d),Wis. Stat SHAUN R BIRD Page 2 9/19/2014 • SPS 383.22(7)A cozy 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. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services 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$ 170.00 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. ... ........... . (608)789-7893 ,7:45 am-4:30 pm Monday-Friday WiSMART code:7633 charles.bratz@wisconsin.gov cc:~Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm } y c Cover Page c,�,vEo AVG r oI4 Shaun Bird 1NDt/srRYSERV Bird Plumbing Inc. ICES 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: ?/29/14 Cwner:Creative Homes "Z-O .5e Location: NW1/4 NW1/4 S11 T28 N,R19W 715 Crest Curve Troy Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0(01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintjte ncy plan 9-11. Sail 12.Filter Scrass sec n Shaun Bir Signature TIONALLY License n 'ROVEQ SAFETY AND )NAL SERVICES .DUSTR Y SERVICES 'RESPpryp,Eiy PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Dr. Suite 410 Woodbury Mn 55125 NW 1/4 NW 1 14S 11 /'I' 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7/29/14 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANI{ MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. top of survey iron ASSUME ELEVATION Filter BEAR Filter ❑BOREHOLF WELL - 1073.64' H.R.P. Same as Benchmark Crest Curve SYSTEM ELEVATION 1081.0' Property Line (not to Well is to meet all Scale = 1/4 = 10' scale) WDNR setbacks 1 Acre Lot All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Pro 4 Bedroom House Tank is to be properly bedded and provided with Property Line (not to lockdown covers with scale) approved warning labels Huffcutt Combo Tank Grading is to be done to divert run-off away from system B-1 02B 1082' 1080' 078' ❑ B-1 02A 14% Slop B-1020 1076' 0 Area 15' below B.M'* system is to -._ remain MS•� undisturbed Property Line Mound System Cross Se didn and Plan View , � M -"`T `%h Dimension Feet A.- B s J w a• ` . t D „..,. E i 1 l T A G W z :y Ii H t. _ 1 k. - J 1 .x. r� :=a 1C r.Y. - 4- T�: �r L �. t 3ti�> S s��• "i• 7 t - W 4'i- ' 4` s27r, i�,” 1�'�'"S� fWfiwy��ai'a.•W7w..s ?-dri:`iY>t •�:tT+•'iii 'r'.r•"'w z AI 'zit rr:wi tic:7it•Sir':�" K g_ . • T SIG % L ASTM C-33 =Clean aggregate O =4 in. sch..40 pvc Topsail n pipe %Z to 2'/i in.,dia. observation Cap Material sand fill H Geotextile Fabric F Ft �v _ E L'. t,fi • . Plowed Surface ,� �,•� Ft Contour . Slope Direction The mound area is staked out along the design contour. Existing GENERAL INSTALLATION: is plowed with a moldboard or area vegetation is mowed and raked rafted if the soil is mound t basal at the plow depth to form a'/.inch soil wire chisel plow. Flowing may not p when a sample is rolled between the palms of the hand STM more inches of sand under to cks or after plowing. Sand is placed with a tracked machine keeping is laced overhead by a backhoe. Special care must be.used the when topsoil cap i placedethetentire mound p thickness to minimize compaction of the plowed surface. A p protect from is seeded and mulched freezing. The to promote vegetative growth, limit erosion and p observation pipes are slotted in the Tower 6 inches and secured in place with rebar or a closet,flange. iPage of 101071gj ' i Pressure Lateral Layout Two Laterals -- End Manifold �� .4�-Threaded Cleanout 0��' Lateral Turn-up ---�► Plug Manifold M • L Long Force Main = Swamp 94 Bend pistribution Network S ecifications pressure System Construction Lateral Diameter In. Manifold Diameter T In. Laterals are conscdrilled perpendicularVt ' In. pipe. Orifices Orifice Diameter x�~ the pipe with a sharp drill bit and face down. X Orifice S acin s In. ' . Ft. Lateral turn L ateral Len -ups terminate with a threaded L Manifold Len Ft. cleanout plug and are enclosed in a 6-8 inch ' ?� In diameter lawn sprinkler valve box accessible Force Main Diameter Farce Main Len h _' Ft. from finished grade. • • • • • Grade • • • • • • :Q • 6-8 Inch Lawn Sprinkler Valve Box S ' page of - 03105 Igl ' se lank l Cross Section And Pump Perforzruc Spoc�icati©n� PnEM Sep�c-Do . Tank Manu$ac>turar Mangy Mal Numbax Tank Model Numbar Alarm M�pwtf� S �Z. a " Alarm Model N�unbeoc c.. t � Svdtoh m i . ' Hand H)-Foct i A al Tout Flltac Blavad� Minor Nwabes . > i Netwgt9c Lam : poraa riWu Loss /. Minimum Pmog ez�Re4 b , e M Ft TDH Total tArtlet ManholeI� 4"Above®rode With Manhole Min.4"Above Grade. LockinSDaVice �t M�►� ,tad w�`Looking BOX . Went Mia. 12" Disconnect Above©raw Moans W V4*CAP a a,a,•, a aa• is + •a�', , r� ., ••1•a'• �' as a r alai •{� ' ' wet ♦ .a Va, a, � �•'• a; ' a r� r°►•, '/s' Weep Switch Hole �.��ryp� VOlutne Off EWVI&OA +�' Bo A C . S p Elevatiot -10 '' F rar ' f •• r Total •i'a `, , • .y, r r,a • • a,a,1a'';ri r ir t i'ia;.liit '�•14a s a�a ar • ► • l' ia�a a y .ar ra ai.•,'► •► '•'a•� fbaa►r��..�1 �a a a' a '.'d.�a I'1 .• ra .► a•. c is bedded-A>Qd b in Accc�° with the GMI�RAI" NS'T 'l�oNt The s rtbc/dare the Mufaatmr net loeei$ctit+etsoasr Miximum dep4h of W5.. new�"ce(pA 10*) ManufA '8 P � .dI Mob*corer$ ' a .. te>idc &fittings,and be exa *Md w �c"A to the; W. at rite ittlat+rnd outlet is of !' wE�i a"Scb.,gi}•p''tTC to brld&e tiw te�c l o fosc°'nau� irw vent Nl 3U0 a�ad16.28. w ou rtabla coil tq ie gxcsvatlanu►dtM.eloa". pf , 0W05 `�:3, wJ • .1 aD sgrjrro serves 4114 hp Submersible Effluent Pump, 3/4" Solids Colon now-ttter*/MK to � �xy�3jo 9t1 C iryn� 0 6o itl0 150 soo 254 204 36 10 ,'..M ' -ThenQplaa�4�I�s�lar 30 s h id two 4 ; 0 0 gp 4 0 64 80 Flow-Oallom/Mirn# .w an• &SY SEN-40 SEW40-AF sp•dffcwdQ m Fr®nklin Itiootrlo 400 East Spring Street,Bluffton,161 46714 Tel:260.824.2900'Pax;250.824.2904 www.tranklln-sled+loCOm Fans:9081HB 7.11 POWTSIQWNERIS MANUAL&MANAGEMENT PLAN S F t3T SpaCIFICATIONS N SaNtc Tam C.apY gal D NA' Penult. '` t3ePtl0Tetnk IYtan� NA EffkN*-RWMWWWOW q NA of, s gM WWent FOW MOdel ©KAA trteyyl�er a car,,,,e,rNsl unit$ °:., yrcnp Tattle tih+ r Via") ;.y: PwwTattleumu r Nn poop ( x 1.5) p i�latiesfaaf DNA' �- r 0 NA t3oll A A u In�uelw +se+yt tY y ' t 0 a Peat Fftr Fate,Oe&Grease (FOG) sat)mgfL Ilerat�Dn Q WstWM ` 8k>e yeaitetal O"sn Demand (SON a20 ©Dbsliy��don 1]4tfter. &Wpended Solids (IA ) all Pretr+satsd i yt OuOW MextthlyA"Iffaw 0.2-4- Demand (BUUs) s34 �("V*) 13 n-gr*WW.(pressurized) $oids (TB ,M mgk 17 At-jrade D ch F -�. � NMellt PaRlcle Size yo Inc 11,01amew Vom jar dwwolgOo4wmerdA waWntrr wW ' « �pN *pepeeled tsr. t3CH Ui^ty garytca Sent Service Pf"MOc►ey Inspect oorxfNtari O ta,nk(s)` t dealt af+c+e ev®ry Q months (s) .L Y •1 pW� of tanks) W yen-'Qoin*ad studgo and sctp equals Qa�a4*d(K).of.ta�nk vol!me Inspsat $� At i"O eayae et!ary c CI month s) (Maxfmur+� yrs.) t�iaai Atle�pitOriCe.OMY l O nyexyths.' rte) lryfipel�c# ;p�cxo VO&�alarm At tit oryo6 aY+ory !�months r(s) OWA 1Wei and Qreasure test A3 best exyoq evgty © Yea) Q NA At least once Orrery ❑months Q yea s) Q NA vaya: At Leapt biros every. Q months Q year($) aNA IYtllllsrlk�VW*INSTRUCTIO ' tyf taryks:41W dispmal coifs shall be made by an Indleridupi+cB"ft one of the fakwing licenses or M"W'PkjMb*r M"W Plumber Resb W'SekW,POVM inspe*C..POwrS:MainlaEtyei; > :OMVW. Tank Inspections must.Include a vlsM kwpeodm of the tank(qto identify any mWft m`broken *i00 Iet t styy cs ar teaks. the yroltiryye aka and serum$ to chw*the effluelnlisvais 0(p" ytp of N'Aueat qa tt+e ground surface. "e (e);Zgftw be sAsur irt-the ebse tvAll n POO w to chew for any panigng of 0111.iat�k Ais suri aoe. T�Ong�` ;art the gMund s�soe may indkate a%Wig condition and requirels ttye 7�rnpyee�pta_nom of.the locsl raagulatorY authority. ww the cmWrwd acourmrl&*w of skxlge and swm b any tank 0"0' ng-third(yg or of ft lank ve�ttarys,the ee�ro ca4rttre►rets of the tank steal be'rexnoved by a Sege. n!�j to and dispOset� with ch.tit 11`x;Wisoonskt Administrative Code.,. The servk:ing.4t effluent fitter's, ical or pressurized POWTS oornponee►ts,#xetteatt t womponisntII�and anY of 12 n> or.less styafl be ItwWT%ed by a oertill�d POtARS Maintainer. other.ryye'tbytertaano9 ex nyonkarhyg - - A� shop be provided to the local re UlatwY audyQrity within 4t)days of oomptetion E►f any service ant. STARI( P AND OPt.RATION �. ti etas of other i For new oonsttuotion.prior to use of the POWYS check treasrWt tardc(s)for the Pr $wm Pab P chernic�als that may impede the treatment process and/or damags the dispersal csll(s). If,,th trations are detected have the contents of the tank ge s)removed by a septa SorviCing operator pripr•to use. Page.—of other START UP AND OPERATION M tank(e)far.0%press eve the i �°fttho For rota ccmetruoWn,Prior to use of the pOWT&check trsattrs r eil(s). n high con may impede ilia treatment process and/or damage the dlaperssl tank(o)removed by a 690896 servicing operator prior to 6". when soil conditions are frozen at the infiltrative surface, le red excess wastewatar will by system start up shall not r levels. When Po`11$r or surface disc ar9e at efiluor t. During power outages pump to may fill above normal hlg the eti(e)and may tdt to the backup r to restoring Power to t1'te discharged to the dispersal oeil(s)in one large dose,over' Clip a by a Sgpy�s Servicing a pump controls to restore+��GIs To avoid this situation love the contents of the PUMP operating the p P effluent pump or contact a Plumber or pOWTS MaintalrW to asslet In manually oP a disturb or compact,the area Wnhln within the Pump tank over tanks and die P�,i calls, Do not drive or park over,or otherwls Do not drive or park vehicles 16 feet down slope mound or at-grade sal{absorption area. ,and praion8 the tie of the POWr4n eb of any stream may Improve ilia perMmmtia imam the dasn� flora; sgaPera, dbirtfectsnts;fat; foundation tln9 Produ�: Raduction or allmInnat sn Hof v oa st COW whim; degreasero; t s ; medications; oil; pa antlbibtics; baby Pa Stmt and vegetable 0 paetings; gaaollne; gfroa; herbicides,, rise (sump pump) water; and water softener brine, pestiddes;sanitary naptctne;tampons; ABANDONMENT taken out of&811 Abe the following Steps shall be taken to inaure that file system is progeny When the POWTS falls and/or Is permanently t83.33,yvlarsonaln Administrative Code:. and saf*abandoned M compliance with chap ter e abandoned P"oPen{nP sealed' • Ali piping to tanks and pits shall be dlsooneSl and the Servicing Operator. • The contents of all tanks and pits shaft be removed and property dlsposed of by a Sep" • m ing,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with 901.Aft er pump gravel or another inert solid material. comPII*M CONTINGENCY PLAN to provide a Dods If the POWTB falls and carnet be repaired the following measures have teen, or must be taken, On replacement system: ant soil absorption syet be Utilized A A suitable replaoerrient area has been evaluated da tabence and comrpactlan andna mid W be lfMrhtged �by �the n4st The mplooament area should be pretested cram mOnt area will the ruled it sattsacks from existing and proposed structure,lot lines and wells.�Faalull t Fie eoement eyebsms must cornpty for a new soli and site avafuatiort to establish a auitabb rep{seem affect at that time. D A suitable replacement arsri is not available due to satbadc and/or soa Iimltetfona. Barring advances In pOWTfi tech ogY' holding tank may be installed as a last resort to reptaci►the failed P0VYfi8. rent area. Upon follure of the POW',,S atar�dc may eta{lad e The site has not been evaluated to Identity a suitable replace cement area Is"abie a holding must be performed to locate a suitable replacement area. if no reply a fast resort to replace the failed POt/VTs. Mound and at-grads soil absorption systems may be reconstructed�n pleoe Mme roust of the f>fomat at the inflltra{it with surface, Recartstruolions of such systems must mP Y <tWARN1NQa> SEPTIC,PUMP AND OTH�1R TREATMHNT TANKMTANK CONTAIN UNp R A TCIRl3UGASSED AN DRAT"MAY INSUFFICIENT R�Uk. oR�C�O ENTER A SEPTIC,PUMP OR OTHER TREATMENT PERSON FROM THE INTERIOR OF A TANK MAY BE DIRFICULT OR IMP088IOLL ADDITIONAL COMMENTS POWTB MAl -INER } j POWf'8 INSTALLER Name �j Name Phone LOCAf,R6QUL kTORY AUT RITY SEPrAO&S RVICIN OPE OR PU PER Name < Name � �r�- Phone Phone J—_ ti' This document was draW in compliance with ohapter BPS 3e8.22(2)(bXi)td?a�tfl amid 3a3.$4(t},(2}&(3),W�oorNkr Adminirtrsiks Coco. FILTER CARTRIDGE INSTRUCTIONS 000 TM Installation STEP i Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. 2. Open the outlet access opening to inspect the tank and filter. ik 3. Pump the septic tank completely, making sure to remove the sludge ..' layer on the bottom of the tank and not just the scum and effluent. „ 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. " 6. If a VRS switch connected to an alarm is present,the switch ,', should be removed by turning counterclockwise 900 and cleaned with water only. 7. While holding the cartridge on its side (large flat surface facing w " down) over the access opening, rinse off the cartridge with water E�„ only, making sure all septage material is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until "3 the filter locks into the bottom of the case. 10.Replace and secure the access opening on the tank. BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of consumer purchase. BEAR ONSITET"Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make appropriate adjustment.Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear Onsite is not responsible for labor charges,removal charges,installation,or other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. Wisconsin Department of Commerce TCiN REPORT Page 1 of 3 Division of Safety and Buildings _ !` #' in acco 85,,V, Adm. Code County ST.CROIX Attach complete site plan on paper not less than 84/2 x V inches jk,slke.Plan must, include,but not limited to:vertical and horizontal referen point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and locat n and distance to nearest road. 0416Q_1MflTFZ4'7'6_1 Please print all informati n. �r �,;? {�� ,.�_ R sewed Date, Personal information you provide may be used for secondary purposes(Privacy Law,s 15 04(1)(in U� Property Owner Property Location LEONARD&MARGARET DELAURIERS Govt.Lot ----NW 1/4 NW 1/4 S 11 T 28 N R 19 ©r)© Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 706 Coulee Trail N49 --- Hills of Troy City State Zip Code Phone Number City M Village Town Nearest Road Hudson, I WI 1 54016 ( ) !Toy C.T.H.U New Construction UseE] Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement [j Public or commercial-Describe: Parent material loess over till Flood Plain elevation if applicable -;A ft• General comments Mound System-- 0.50 ft.sand fill--0.4 loading rate and recommendations: h L ���0 ytf�AAi V•" (If pre-treatment system-below-ground drip irrigation--0.6 loading rate) J�- a Boring# Boring 'G I—J Q 30 pit Ground surface elev. 1076.60 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-6 10YR2/2 - sil 3f-mgr mvfr cb 3vf-co 0.6 0.8 2 6-12 10YR2/2 - sil 3fabk mfr as 2vf-m 0.6 0.8 3 12-16 10YR4/3 - sil 2f-msbk mfr ci 2vf-m 0.6 0.8 4 16-30 10YR3/4 - sil 2f-mabk mfr as lvf-m 0.6 0.8 5 30-32 10YR3/4 f2f 10YR4/6&10YR6/1 sil lmsbk mfi -- -- 0.4c 0.6 Horizons 3& 4 have some si cts. l U� Boring# P t rig 1081.90 34 D 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 I *Eff#2 1 0-9 10YR3/2 -- sil 2fa&sbk mvfr as 2vf-m 0.6 0.8 2 9-24 7 5YR4/4 - sl if--msbk mvfr as 2vf-m 0.4 0.7 3 24-34 7.5YR4/4 - A Om mfr -- lvf-f 0.2 0.6 Some gr between Horizon 2&3;few cobbles *Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name (Please Print) Signature CST Number Ma Jo Hollister .S 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 09-06-05 (715)426-1775 s Property Owner DELAURIERS(Lot N49) Parcel ID# (Pending) Page 2 of 3 C Boring# Boring C E] Pit Ground surface elev. i'G73 50 ft. Depth to limiting factor 30 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 1 0-9 10YR3/2 -- 1 3f-ma&sbk mvfr as 3vf-M' 0.6 0.8 2 9-15 10YR3/3 -- 1 3fabk mfr as 2vf-m 0.6 0.8 3 15-22 10YR3/4 -- sl Om mfr as Ivf-m 0.2 0.6 4 22-30 10YR2/ -/S f cos Osg dt as lvf-m 0.7 1.6 5 30-34 7.5YR4/4 f2f 7.5YR3/4 A Om mfr -- -- 0.2 0.6 Some gr. arc- F-1 Boring# �Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 Boring ❑ Boring# Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Test(R.07/00) Plot Plan for Hills of Troy Page 3 of 3 Town of Troy, St. Croix County, Wisconsin Lot q 199 = Oft. Legal Description m -� ; 2 ft. contours �� l , ,,raw -mwA PE_- -Tpzy _Backhoe ph. 10877 N -105A v / ' I ' ' I i / I 1088. 4 ' 9 ' I i 9F � ,R o ti,y I O O,r q,Q R-101 B R-102A =1171 102C MARK: \ TO"OF' 1 1/4" ,IRS 64` / � ELEVATION`=-- F-- � 0 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ - � --- Mailing Address 7 D Go m>m�✓.��_ ru u— Property Address - (Verification required from Planning&Zoning Departure for;new construction.) City/State __ Parcel Identification Nut:z r �'' LEGAL DESCRIPTION Property Location 1/� ,/ � r/4 , Sec. , T N RL_W, Town of y -� Subdivision ! i S _ _1�� —- Lot Certified Survey Map #_ '�_ __ --- ,V( lurrze_ ,Page#— ---- `—' Warranty Deed# -- -, Volume Page# Spec house 0 no Lot lirx-s identifiabl . 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, 0 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(l) 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 Plannuug& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to th est of my/our k aowledge. I/we andare the owner(s)of the property described above,by virtue of a warranty deed recorded Register of Deet.is Office, Nu edroo SIC 'ATURE OF L C-ANT(S) �\ 0�7�►�-c� DATE ��✓en1 %� ***Any,rn ormauon rs rrusrepresented may result in the sanitary permit being r,°-yoked 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 _____ i N o �- 536.16' .w W,� N - T 1700.76' (BLOCK LENGTH) o �m ,,LPG colQ o°O , ° 220.77 . . ii . R 80, ------ "p '�+�.`••�. ��-, CO R.. . 1.422 ACRES 1 m^ �r \ G6a S ,. 61,934 S.F. _j n /9tt y �•�•. . i�'�• 6, y G5? \ f�7$.02' G S x84.8$,`, .�.�.� A3Q 0 54. 0, 75°00'0p,. N X30„ W 2 ` Cg3 f90 �� E 513300 \` 8 /7 I3 / \3 568030 2s� • 0 � N _3._4O 12 .c_R.ES m W 36 N 35 9 \jam 534Q7 S.F. I ACRES. ._.-._._.-. I 704S.F. / �A 86°00'00" W . 37 0 ! 44 o,\w� (-.-.-.-._325_51`__-__. rn° L. I ' //2 / 43,561 S.F. i 1.176 ACRES o N z f o 51,210 sF. ,`l'3�� i rsssa,'� L.__ % i/ i= ry% 3 43 ;, 4s.le' rs _i i 1i 14'7.790 °"�.� 9 1.065 ACRES 7 yq hp 754.86' 2 00, L.�,�_ t oa;• / ?p y� -� cn •. 46,386 S.F. % .• rl• o �- O 1,53 , \ %j 'LS B ^ 10 N j 15 IS \ 45 m 1.050 ACRES 2 p• E 633.`•. c 0't 45,715 p 0\ 41 o 6 ► a oo°.n I 40 S 71. , R=BO .001 ACRESI 39(3 1.11,84 AS 1.004 ACRES 1.133 ACRES 143.589 S.F. j ° 49,353 S.F.553 CFE 43.741 S.F. I ty7g°085p 9 6,S7yg23 65.31 199.11' G/3 �� / C+rn� \ �'� I.-._._.-.J z I._.-.......J �_. 00'00„ 164.95' / z z \ao g1e00'00" W 23 407 55' ` \� ����. 37.34' J5175' 172.00' 219.Q0' % `D>bl 5 84.45' s ,31,. \ `g7 a>t N 90°00'00" W 580.09' CREST CURVE-------- -t--• ,��%/ 46 \ic^ ^^ � A`C`T?\0?o y� 'I'�.� \' C76 `""_ N 90°00'00" E 580.09' rMi / 1.566 ACRES % 47 \F1�o %A9e�? "�• C`�- 68,222 S.F. j b� o° 1.109 ACRES i/\ 5�� `�i��0. ry 78 �° C79 40.04' 132.00' 132.00' 7226.00' /ry� /by 48,299 S.F.,, y� 1 i/ ?B%�, ryt° 0 ^td I _!^° %� i/ay11� i i 48 %�w 8352'47"W N �.-.-._.t r•-.-•-•t o. t-•-.-.-I'-'--1 ,� ; 2.00`'_. ,� 264.38' J °y ; 1.007 ACRES / 1 0 0, I ,o N 71 0 p Op„ /�y<� 43,868 S.F. /%ti�o%/ 1 M. ( w j i t'' I I n m ( 15g , ACRES1 .--.... ;... O . N 3°•1�' W ^-•J/.di°'° / f I I 0I o I V��. w 44,891) S.F. -.---.- 49 50 51 l 52 i L.�._. 50' 001, 4� p 86 0 50, 1.002 ACRES F1' 43.645 S.F. I o I GQ F• I °o M I Q y' I o j Q�' I c 251.40 x•,584°00'oo"i E o l O�Ob�O� I z I ooyoo I z �•`•1\\Af•As 0?0, 6 s\?1B 32.Q0.�.�.. Z L I f �, j I I I I ^dam- j I j I ^p•00' I I z°o r j�.�45 5�,77•�9 I t 1 t ACRE l 1.051 4 80.83' _,_.-.-.i _.-.-.-.j M S 8!°00 0p„ 159.12 00" 132.100'00" E 264.00'9.95.033 ACRES N 90 219,241 S.F. ! "T oN 66'WIDE SHARED S 76° 25' BUILD/NG j I ( Oft 1 00'00, 1 z $p, ro j 5g ;/ '0 N 90°00'0011 EE 272.35' S 7�A�EgSElyg j ° h T 2 is.1 a T- 56.21' s 00,00„ 150 so' j }�,� ! ! �001,978CS FS !^vim I 1 5p� r _ E 801LQ1N65 i L30=1063.61 / n /2.715REST / 56 3 57 1' (118,212 S.F.% ^` 1.043 ACRESI (R-S T9°37'48" w) Al 7 eG°??'� ' 45.422 S.F. N 17°46'49" E 2 13' 7?" �. I l 20 �p9,t Yj M LBO= 66.95' 328611„ wf� �. ,�_ j 90,o, .1. S 7g 3 SN 1063.61 S l 00 EXISTING 66' WIDE o. Q %5 5°�'+• _ EAS£M.£NT FOR INGRESS o 0' ! ( f °° w;o % n. -AND�ORESS R�COROED h o � o h ,(� 1.000 ACRE 1 1 ` C86 IIV VZ._192_4, PAGE;- S� ° ono 02 / ,er 43,560 S.F. t / C8 DO_C.X683754 m ^ Q W ;m /8 6a I ?� 6, 3, 1 C3 • •"�` 18Q �PG� Z "� rn RYy� y07 9 - � 'y 0 00'• \p4• fip� o y1 ;vo f� j�;� �• E 331 00,. \,21718 69 O e°^ 1.081 ACRES 7 •y 5 47,091 S t t N 4.g5,� .180.86, ro 1Y 87 91' o°Q S 72315 O6 , �n q uatuttt tunnpn 214, t/��Qr 20,00, ` A6�c®ms�/�/����'�.�1 044 A k _ 3F- A MES D. _4\SRE �� ° o 0 _ c F1U(INS '' UNPL A T TED L A_ND_ `6��a y�RTAE DrF'� U - RIVER FALLS, ` N There are no objections to this platwith respect to `" �`C'mp•. 7,;h 16,9,16 2d and 236.21(1)and(2).Wis. 986503 BETH PABST REGISTER OF DEEDS State Bar of Wisconsin Form 6-2003 ST. CROIX CO., WI SPECIAL WARRANTY DEED RECEIVED FOR RECORD 09/25/2013 09:20 AM Document Number Document Name EXEMPT # N/A REC FEE: 30.00 TRANS FEE: 69.00 THIS DEED,made between BMO Harris Bank National Association,successor by PAGES: 2 merger with M&I Marshall&Ilsley Bank ("Grantor,"whether one or more),and **The above recording information Travis J.Schneider and Alicia N.Schneider,Husband and Wife ; As Survivor hi verifies that this document has Marital Property ("Grantee,"whether one or more). been ur electronically d to he recorded Grantor for a valuable consideration, conveys to Grantee the following described real returned to the aubmitter estate,together with the rents,profits,fixtures and other appurtenant interests, in St.Croix County, State of Wisconsin("Property")(if more space is Recording Area needed,please attach addendum): Name and Return Address Lot 49,Plat of Hills of Troy, in the Town of Troy, St.Croix County, Travis J.and Alicia N.Schneider Wisconsin. Hudson,WI 54016 040-1318-00-049 Parcel Identification Number(PIN) This is not homestead property. (is)(is not) Grantor warrants that the title to the Property is good,indefeasible,in fee simple and free and clear of encumbrances arising by,through,or under Grantor,except municipal and zoning ordinances and agreements entered under them,recorded easements for the distribution of utility and municipal services,recorded building and use restrictions and covenants,general taxes levied in the year 2013,and Permitted Encumbrances described on the attached Exhibit A. Dated August 16,2013 BMO HARRIS BANK NATIONAL ASSOCIATION success o me qr with M&I Marshall&Ilsley Bank (SEAL) (SEAL) * *B ar S.Kau r ice President (SEAL) (SEAL) By: AUTHE)_fIC Y ACKNOWLEDGMENT Signature(s) ^' •r _. � STATE OF WISCONSIN ) F. authenticated on .� Oi��� )ss. • MILWAUKEE COUNTY ) * !pl,�SCONS� Personally came before me on August �� ,2013 , TITLE:MEMBER STATE BAR 0VINI SCONSIN the above-named Gary S. Kautzer, Vice President, BMO Harris Bank, N.A. (If not, to me known to be the person(s)who executed the foregoing authorized by Wis.Stat. §706.06) instrument and ackno ledged t me. THIS INSTRUMENT DRAFTED BY: Rebecca K.Hamrin,Godfrey&Kahn,S.C. *.Carol Lee Hopkins Notary Public,State of Wisconsin My Commission(ij A)(expires:April 6,2014 ) 9904854.1 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. SPECIAL WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO.6-2003 *T3ff2ame below signatures. VF.,Zl- ------------- tu Z LU 'ou z n V071 J---]A"Q•c *s 7/ 777-TT" ie UPPER LEVEL FLOOR PLAN Sa II U6_ IRE I DINETTE i GRZAT RM. lu lu T dRM1 tu is L LLI f r9 LARA&E Oym DEN w. lit �o a MAIN LEVEL FLOOR PLAN BRACED WALL LINE PANEL VETAII-5 AV LF rAMILY LU lu BABEMENT FOUNDATION PLAN 77 1 U