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Maplewood Mn 55109 S 1/2 NW 1/4S 2AIT N/R 18 W TOW N Richmond COUNTY ST.CROIX MPRS Shaun Blyd 22690 DATE /x /04 BEDROOM 3 CONVENTIONAL )00C IN SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .3 ABSORPTION AREA 1586 # of chamber 51 IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.0/99.5/99.0 Alt. BM Top of 2" Pipe @ 100.2' Alt. ES.M. 393' Property Line B.M. Well is to meet all Plans Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 105' Vents 3 -3' X 107' cells with >3' Spacing 103' B -1 80' Pro 3 5' Bedroom 6% House Slope 30' 45' 30' ST Please note: system 45' was oversized due 5' to the presence of jL— Standard Biodiffuser B -2 pockets of massive Leaching Chamber sandy loam with 31.1 ft2 of Area Please note: Inst aller must 34 Grade at System Elevation verify all lot lines and setbacks before installation. Scale is 1" = 40' unless otherwise 346 Property Y noted Line 1 s R 200a _ t Wisconsin 'Department of Commerce PRIVATE SEWAGE SYSTEM unty: r . C fety and Building Division � INSPECTION REPORT Sanitary Permit No: 430691 0 GENERAL JNFORMATION i (ATTACH TO PERMIT) State Plan No: /� Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. W Z� Permit Holder's Name: City Village X Township Parcel Tax No: Willow Creek Homes L.L.C. Richmond Township 0 t - / /too - //— ODb CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 23.30.18. /2 1 7 TANK INFORMATION ELEVATION DATA K TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark -< Dosing Alt. BM Aeration Bldg. Sewer Ho ing St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic 5 / } 7 � 7 t Dt Bottom \ f �i Dosing Header /Man. 8.7— Aeration Dist. Pipe 3 i4 ti� Holding Bot. System �l • I 45 • �� C Final Grade /V U' PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Num TDH Fri ' Loss System Head TDH :Ft rcemain , Length Dia. SOIL ABSORPTION SYSTEM B DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS N its Inside Dia. Liquid Depth DIMENSIONS � SETBACK SYSTEM TO P/L BLDG t LAKE /STREAM CAL Manufacturer: INFORMATION CHAMBER OR 6 i v C{ ; Type Of System: t r- : 7 : : o UNIT / Model Gc n va r� �: •, �� / N um b er: ST DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length . Dia �( ` Length I " > /0 o r SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over 3o 5 Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center as ' F l o Bed /Trench Edges Topsoil i „.�_ Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 6 / 4--, / 0 Y Inspection #2: / / Mw ) Location: 1473 132nd Street New Richmond, WI 54017 (SW 1/ 1/ /44 23 T�3�0�Nr�R118W) Whitetai Meadows t 11 rcel No: 23.30.18. 1.) Alt BM Description = � �'�,C -s P �S 2.) Bldg sewer length = Gk-7' "7 hid s a r2dy /or/iy+r 3u - amount of cover = `i Z. 3 'Ian revision Required? se other side for additional o ' �? �� °`�'_� "' 7c,o T Yes — in rm o ' BD - 6710 (R.3/97) Date Insepctor's Signature Cert. No. �F � V J i r� t v "7i o0 ��'taA ��! Safety and Buildings Division County 201 W. Wash8t in on Ave. P.O. Box 7162 7 � 1 vsconsi Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) ffn Department of Commerce (608) 266 -3151 Rey Ri Sanitary Permit Application Smote Plan I.D. In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes privacy Law, s 15.04(1)(m) Project Address (if different than mailing address) L Application Information - Please Print All Information 1 //-/ 1 3 , 2- �- s7 X4 property , Name Parcel # # Block # 3 i &Lo s Mailing A �y Location 6oa �� G!/t' : ✓ , Section oC City, Staw Zip Code ° Nwn4pt ,,, . /v J / j T-a N: jL of Building (check a that apply) 1 or 2 Family Dwelling - Number of Bedmo ' ' 1-' � b j di / visi N CS Nu rubiwComrucrcial - Describe Use State Owned - Describe Use 3 D 1 S-n cAeU -s j -4?A� Cl ty Township of Type of Permit: (Check only one box on line A. Complete line B if applicable) A. System Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System B. Permit Renewal t Revision Change of Permit Transfer to New fast Previous Permit Number and Date Lssuod Before Expiration Plumber Owner '1 y IV, Type of POWTS System: (Check all that appl p � a - Pressurized In- Ground Mound> 24 in. of suitable soil Mound <24 in. of suitable soil At -Grade Single Pass Sand Filter Constructed Weiland Pressurized In- Ground Holding Tank Peat Filter Aerobic Treatment Unit Recirculating Sand Filter Recirculating Synthetic Media Filter g Chamber Drip Line Gmvel4ess Pi ) jKn V. Di spersatIffma tment Area Information: 5?„p Design Flow (gpd) Design Soil Application f) Dispersal Area Required (st) DispAqW Area Proosed (s System Elevation VL Tank Info Capa«ty in Number Manaf tcturer Prefab Site Steel Fawr Plastic Gallons Gallons of Units Concrete Constructed Glass New Existi Tanks Tanks Septic or Holding Tank, l Aerobic Treatment Unit W D Dosing Ch&m tr VII. Fispondbility Statement - 14 the undersigned, UW ..rtisibllity for installation of the PORTS shown on the attached Plumber• Name (Print) Plumber's Si MPIMPRS Number Business Phone N mber Plumbers A�dd (Street, City, , � �� A�e !ti /C S 2 VIII. Coun /De artment Use Onl A tfii° v roved Sanitary Permit I= (includes Groundwater Date issued Aged gnattrro o tamps) >P Surcharge Fee) Owner Given Reason for Denial =tank Disapproval s for Di� r a {�lc� / T serviced / maintained f as per management plan provided by plumber 3 44 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on papa not has than 8112 x 11 inches in size C c P PLAN PitOJECr Willow Creek Homes ADDRESS 1880 Howard St. N. Maplewood Mn 55109 S 1/2 NW 1 /4s 23' /T 30 / 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/24/04 BEDROOM 3 CONVENTIONAL XXX IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RAT 4 ABSORPTION AREA 1212 # of chambe 39 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 100.0/99.5/99.0 Alt. BM Top of 2" Pipe C 100.2' it. B.M. 393' Property Line B.M. Well is to meet all Plans Designed Using setbacks required by Conventional Powts -j WDNR Manual Version 2.0 1 3- X 83' cells with >3' Spacing 6% e 39 -1 80'��5 �t Pro 3 59 Bedroom a '0 Sa House - (j_ S� a,y1 45' gi p„" G' a 30' 30' - ,0 c/s4a- ST �+ I Vent 5' 45' , 2 aT-� _ >6" Standard Biodiffuser B - M �oG of Cover Leaching Chamber 'T� S ol/h with 31.1 ft2 of Area 6' Long 11 Please note: Installer must ` Grade at System Elevation verify Si „ y Y all lot lines and setbacks 3 4 before installation. Scale is 1" = 40'x' unless otherwise P46' Pro -� P Y 0 f noted Line HOMES, LLC QUALITY WITHOUT COMPROMISE To whom it may concern, This is a different plan then what was submitted originally for the septic system. Should you have any questions please contact me. 3B 0 Thank you, Scott Merrigan Willow Creek Homes LLC" Cell 651- 276 -9851 -7-7 q - 3 l Safety and Buildings Division 0 h - - 201 W. Washington Ave., PA Box 70$2 *iscojisin Madison, WI 53707 - 7082 Sanitary Perini N � filled in by Co.) (608) U 1-6546 c Department of Commerce State Plant Number Sanitary Permit Application 406 N /4 in accord with Comm 83.21, Wis. Adm. Code, personal information you provide O Project Ad ass (if di ff t than mailing address) may be used for secondary purposes Privacy Law, sI5.040)(m) I. Application Information - Please Pri t II Inf rmatio L Parcel # Lot # Block # Property Owner's Name (� / to tion property Owner's Mailing dress Lip Code Phone Number City, State , (circl one) IL of check all tha PPIY) �,(r �Q/1� -� Subdivisi N e CS Nam 1 or 2 Family Dwelling - Number of B ooms L/ / ❑ pubwCornmercial - Describe Use ❑City ❑Village - tship o ❑ State Owned - Descn'be Use / IIL Type of Permit: (Check only one box on a A. Co ' `, ew System E] Replacement System C] Treatment/Holding Tank Rep meet Only ❑ Oth M if ont . ❑ ha of Own Transfer to New List 'ous t ber and Date Issued B permit Renewal ❑ Permit Revision Before Expiration Pi u e IV. T e of POYM System: Check all that a 1 1 W1 on _pressurized In Ground ❑ Mound > 24 in. of suitable soil Mound 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetiand ❑ Pressurized In round ❑Holding Tack Peat Ater [I Aerobic Treatment Unit El Recircula I ter Lin Gravel4ess Pipe ❑ Oth r ( xplain) c Recirculating Synthetic Media Filter ping Chamber p V. Dis ersaltTreatment Area nformation: r aired {s Dispe ! Proposed 00 Syst Design Flow (gpd) Design Soil App 'cation Rate(gpdsl) Dispersal ea eq prefab Site S 1 Fiber Plastic VL Tank Info Cs try in Total Number /0� Concrete Constructed Glass Gallons Gallons of Units New Existing Talcs Tanks Septic or Holding Tank Aerobic Trntmeat Unit Dosing Cbamber VII. ResponsibWty Statement- 1, the undersign me responsibility for installation of the OWTS shown on the at Phone Number P 's Name (Prins) / � Plumber' a MP/MPRS Number / a Plumber's Address (Street, City, Stale, C" l -11 .�-- VIII oun /D epartme nt Use Onl Sanitary Permit Fee (includes Groundwater t Issu suing Agent t tore ps) ` Approved ❑ Disapproved Surcharge Fee) ❑Owner Given Reason fo ia1 IX. Conditions of Approva= ns or Disapproval ,_ YSTEM OWNER: VIM� (� 1 Septic tank, effluen dispersal cell must alt be serviced I mai lumbe b r. p3. S L as er a ement Ian rovided by n �i��r. S - ��✓�Ll�'� - 2 All setback) c able codelordinanbes. al / as per app i / ' 3 Attack complete plans (to the County only) for the system on Paper not teas than 8112 s 11 Inch" 15 rlre SBD -6398 (R. 08/02) .. . � - 0 ? 0 / % (D ƒ M 2 / S - ) 0 0 k � �- + ° ( \ {� 3 ■ \ 0 0 � � ° _ � ƒ { p Q JCA 9 § ƒ / § £ % R E� i / \� R ~ Q CO G) ° 2 k § 0 CA rr o o o } r � 2 � A§ )22 CD / Cl) 7 ` « �- �gdo E 0 ( CL § _ \ 0 [ k i _ o _ $ ƒ % 0 (n C. 3 k 3 E E _ § § c � ■ _ + § R T 2 § E § z ;o : k d .. £ � im =2k k� /&$ § \D c �k §/ k CD » ƒ � 2gƒ \aJ 5 §7/ ■ } /7 ee $ _ « #E 7 a /(§ % E 0 o < § % C:, / \ ST. CROIX COUNTY WISCONSIN 0"a �'ti _ _ ��...'' ZONING DEPARTMENT N N a r ■ r.■�r. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 Memo to File From: Pam Quinn Date: 4/14/2004 Re: Soil On -site Determinations for Lots 32, 37 & 43 Richmond Meadows Subd. On April 8, 2004 on -site determinations of soil conditions at the above lots was performed to evaluate conflicting soil reports submitted by Adam Schumaker and Shaun Bird. At 11:00 a.m. the weather /lighting conditions were acceptable, with temp. 50 °F, clear and. These determinations were requested by the property owner, Orenzo Oevering and the plumber /permit applicant, Dave Fogerty, who were present during the test pit excavations. Additional test pits were located next to borings on the original soil reports to better compare soil conditions in the tested areas. On lot 32 (see attached description) the soil profile contained massive sandy loams at approximately 36 inches below grade, which does not conflict with the soil tester's recommendation for using an at -grade system. What it did reveal, however, is that both Adam and Shaun likely misinterpreted the structure of the sandy loams: Adam called the sandy loam horizon a "2msbk" and Shaun uses "lmgr ". There apparently has been a misunderstanding between "structure" caused by handling samples of the soil during texturing versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand texture, parted easily into "crumbs" that appeared at first to be subangular or granular in shape. However, these were not true peds that broke apart along planes of weakness , but fragments created by handling. The soil when observed in the horizon did not have distinct units of structure and should have been reported as "massive ". Two test pits were evaluated on Lot 37, since the sanitary permit has already been issued. Due to the current house and well location, additional tested area will be required to meet setbacks to the POWTS. A pit closest to Shaun's B2 did have a sandy horizon as reported, but only to a depth of 60 ", then underlain by a massive sandy loam. Unfortunately, the boundary between the sands and sandy loam horizon was very irregular, with tongues of sandy loam much closer to grade than 60 ". The recommended loading rate for this site would need to be lowered to adjust for varying pore space at system elevation. Lot 43 had conflicting reports, where Shaun's tested area (near the front of the lot) reported conditions allowing a conventional system and Adam's (closer to the rear of the lot) reported mottling at 32" with a mound system recommendation. Additional test pit B4 was excavated next to Shaun's B3 (see attached description) and massive sandy loams were encountered at 17 inches below grade. Weathered cobbles (break into smaller pieces upon disturbance) and oxidized iron deposits around individual gravel/cobbles were observed in the pit wall, but no mottling was identified to 68 ". Shaun's B3 description of sandy loam with "2mgr" structure starting at 18 ", then sandy loam "lmgr" from 36- 110 ". Again, I think there was a misinterpretation of texture after a sample had been handled. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this situation and advised the zoning department to require on -site verifications for any lots with this potential misinterpretation on the reports. Obviously, one of the concerns is to make sure loading rates for the soils are not in error and allow undersized POWTS to be installed. For example, in December 2003, Lot 35 had to have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy loam at the system elevation. The sandy loam horizon was described on the soil report as "I mgr" with firm consistence. The zoning department will have a note placed on all soil reports with this type of description as requiring a design using the current code's soil application rate for massive sandy loam @ 0.2 gpd/sq. ft. unless additional soil testing proves otherwise. (e 4 PL QT PLAN PROJECT SecUberfiaan 1 ADDRES 1880 Howard St. N. Maplewood Mn 55109 1/4 NW 1 /4s. 23 * /T 30 /R 1 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/8/04 BEDROOM 4 CONVENTIONAL XXX IN- GROURESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chambers 51 IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (D WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.0/99.5/99.0 4.5' below arade Alt. BM Top of 2" Pipe @ 100.2' M.E1 .11A 393' Property Line �v� I � she note: Installer must verify y as of tl an setbacks before installatio t v , 6% Pro 4 Slope B -1 80' Bedroom 15' House 30' 45' S 45' 30' V ent Vents 45' >6„ Standard Biodiffuser 51 3' X 107' cells with >3' Leaching Chamber B-2 of Cover with 31.1 ft2 of Area Spacing g 6' Long 11„ Well is to meet all Grade at System Elevatioi 34 setbacks required by WDNR Scale is 1" = 40' unless otherwise 3461) Property noted Line Plans Designed Using Conventional Powts Manual Version 2.0 � PL QT PLAN PROJECT Seer�iaan il ADDRES 1880 Howard St. N. Maplewood Mn 55109 1/4 NW 1/4S 23 /T 30 /R 1 W TOw1 Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/8/04 BEDROOM 4 CONVENTIONAL XXX IN -GROU f .PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chambers 51 ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.0/99.5/99.0 4.5' below grade Alt. BM Top of 2" Pipe @ 100.2' M.8 .11A 393' Pro ert Line lease note: Installer must verify all lot lines and setbackE before installation. Vents 6% Pro 4 Slope B-1 80 ' Bedroom House 15' 30' 45' 45' 30' V ent Vents 5 , 45' Standard Biodiffuser >6 3 X 107 cells with >3 of Cover Leaching Chamber B -2 Spacing with 31.1 ft2 of Area 'Long 11„ Well is to meet all Grade at System ElevatioT 4 ° setbacks required by WDNR Scale is F = 40' unless otherwise 346' Property noted Line Plans Designed Using Conventional Powts Manual Version 2.0 Wisconsir. epartr,�entofCommerce SOIL EVALUATION REPORT Page — L of Division of Safety and Buildings ' in accordance with Comm 85, Wis. Adm. Code County ter i Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must J. rvi� include, but not limited to: vertical and horizontal reference point (BM) direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. eviewed Date Please print all information. Personal information you provide may 4e used for secondary pu"' ' es jPrivacy Law, s. 15.04 (1) (m)). Property Owner Property Location G �� J Govt. Lot 6 1 /4 S�3T N R E( W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# , e own Nearest Road City State Zip Code Phone Number ❑City ❑ lllag .S ) ( f rooms j Code derived design flow rate yl, S U GPD New Construction Use: Residential / N umber o bed ❑ Replacement ❑ Publi or commercial -Describe: —� - - -- - -- - - -- - -- Parent material ��rif� Flood Plain elevation if applicable > ' ft. General comments / (�/'e and recommendations S Boring # El Boring Ul I t Ground surface elev. D �' � 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 j! S - s r 2 . /0 -30 G .J Boring # Boring Pit Ground surface elev. o / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 3 �b� y/L 5 `� PvtrTr v G 7 Effluent #1 = SOD > 30 < 220 mglL and TSS >30 1 150 mg/L ' Effluent #2 = BOD < 30 mYL and TSS < 30 mg(L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 _ 715 - 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring t� it Ground surface elev. 1O ft. Depth to limiting factor 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 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA. ` Effluent #2 = BOD < 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. SOD -8330 (R.6100) Soil Test Plot Plan o Project 'Natne W Dalton Sha 3 Address 1748 112th St. New Richmond Wi 54017 TM #226900 Lot 11 Subdivision Whitetail Meadows Date 8/15/03 S 112 N W 114S 23 T 30 N/13 W Township Richmond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 100.0/99.5 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.2' M • 9 • fib° ' 393' Property Line M. H Please note: Installer must 105' verify all lot lines and setbacks ore installation. 103' 6% B -1 80' Slope 15' Please Note: Tested area -3 may not be suitable for 45' desired building area. Check system location 45' before excavating. 5 45' , YVLX,h ' B -2 Scale is 1" = 40' unless otherwise 346' noted Property Line ST CROIX COUNTY �� SEPTIC - TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ,L. e. o 0 t Mailing Address Property Address (Verification required from Planning Department for new construction) (-ity /State Parcel Identification Number I 1 LEGAL DESCRIPTION /) , .� ._�Y� R W, Town of Property Location S a_ Sec. . T N- Lot #. Subdivision Certified Survey Map # �--- -' _, Volume , Page # Warranty Deed # — 7 53 Volume a SO � _ , Page # 12 Spec houSP6 es ❑ no Lot lines identifiab f;d�es 0 no SYSTEM MAINTENANCE 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 agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a The property that 1 the on -site wastewaterdisposal system masterplumber, journeyman Plumber, r (2) aft dplumber or a lic pumping (if pu m p er verifying the septic (2) after inspection and pumping (if necessary), P tic tank is less than 1/3 full of sludge. is in proper operating condition and/or Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards cation set forth, herein, as set by the 'Department of Commerce and the Department of Natural Resources, State of W isconsin. fr thin 30 statin t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 7s� the three year expiration date. /QI /��Z : URE OF APPLICANT V G2 �K S l / W11 w �� O s L (-C DATE OWNER CERTIFICATION j knowledge. I we am are the owner(s) of I (we) certify that all stateme nts on this form are true to the best of my {ours g • ( ) (are) warranty deed recorded in Register of Deeds Office. the pr erty escribed above, by virtue of a DATE S NATURE OF APPLICANT . Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****" ** Include with this application: a stamped warranty deed from the Register of D eeds 0 i the warranty deed a copy of the certified survey map e r Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not P I n r nor Y a t trees or ark nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 En y Plan system fails, determine cause of failure, use alternate area and install new ted replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option #3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 U 25Q5a 20, 4 30. OTHER TERMS. If checked, the following are applicable to this Security Instrument: Q(I Line of Credit. The Secured Debt includes a revolving line of credit provision. ❑ Agricultural Property. Mortgagor covenants and warrants that the Proper will be used principally for agricultural or 9 tY farming purposes and that Mortgagor is an individual or entity allowed to own agricultural land as specified by law. Cl Additional Terms. FOR WISCONSIN RESIDENTS ONLY: The Secured Debt is incurred in the interest of undersigned Mortgagors' marriages or families. [Seal] [Seal) (Signature) Mate) (Signature) (Date) SIGNATURES: By signing under seal below, Mortgagor agrees to the terms and covenants contained in this Security Instrument and in any attachments. Mortgagor also acknowledges receipt of a copy of this Security-lnstrurne the date stated on page 1. Entity ame: W ILLOW CREEK v ILLO HOMES LLC tLm T Smjgz ,;2 (Seal (Seal] (s re)MIKE SAMPLE, PRESIDENT (Date) i tun l t ►SCOTT MERRIGAN, VICE PRESIDENT Metal (Seal [Seal (Signaturel (Date) (Signature) (Date) ACKNOWLEDGMENT: STATE OF W ► SC O N S i N , COUNTY OF )as. tlndivduel) This instrument was acknowledged before me this h da of by 1 My commission expires: (Seal) (Notary Public) w Entity STATE OF WISCONSIN , COUNTY OF AosnoeAedement) This instrument was acknowledged before me this 4TH day of FEBRUARY 2004 by MIKE SAMPLE, PRESIDENT: SCOTT MERRIGAN. VICE PRESIDENT trtate►► of WILLOW CREEK HOMES LLC INeme of Business or Entity) a MINNESO LLC on behalf of the business or entity. My commission expires: IS PERMANENT iSeal) If � _ r KRISTINA OG INotar Pub_lic-!! s A�'T01�1VEY~ AT LAiJ/ This instrument was drafted by SECURITY STATE BANK OF MARINE Iname). '" 0 1994, 2001 Bankers Systems, Inc„ St. Cloud, MN Form AGCO- RESIVI 5/28/2001 10a9a 7 of 7) - U 2505' 197 it 753628 STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Dalstock, LLC REC FOR RECORD and Willow Creek Homes LLC Grantor, 02/06/2004 10: 20AN Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXOPT # the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 245.70 Lots 11 and 22, White Tail Meadows. St. Croix County, Wisconsin. COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address David J. Estreen 304 Locust Street Hudson, Wt 54016 i �. ta �ila rL 026 -1068- 90-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of February 2004 Dalstock, * * By: - AUTHENTICATION ACKNOWLEDGMENT Signature(s) Dalstock, LLC By: STATE OF ) ` - - - - -- - - -- — - - -- - ) ss. County ) authenticated this day of February , 2004 Personally came before me this _ - - -� day of (�— the above named * Krishna O gland - - - -- -- - -- - - - -- - - - -- - - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, -_ __- to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Krist Ogla -- -- - * - - -- - - Huds WI 54 016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, Wl STATE BAR OF WISCONSIN 800-655 -2021 WARRANTY DEED FORM No. 2 -1999 V L4 / \ oO ,8S'66l - M „8Z,6Z.00N' • 5' n O O W •,, 1 a ` , ,8 L'LO£ ww 3„ ro J 8Z,6Z.00S ° ` - 2 ,tl V66l -3„ 8Z,6Z.00S Cb v •.'. ' I Cb U Cb , i v� • ap � O O C i o W O W y b / Z a1 $. —'� �6�/ ti ' ”' o �• °, ?. 0 w Cb / s 00 \ •�� \ . ' I w o O .E -110- � \� � � • � N � `SS � ? �. ,• ) a ^ �'l II V S O L j A %Q ti, ° c l �. A o 4IN -3S L a 0 ti as \�s' �9tiy CL Q rn NO3� 49 E 23827' a - 0 � 1 U) o O Cb z j S03494 49 W 2 *2.30' a' \z N - I O