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HomeMy WebLinkAbout030-2137-08-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 463392 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: Plahn, Gregory St. Joseph, Town of 030 - 2137 -08 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range /Map No: 165, — -j 05.29.19.2034 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( Z Benchmark b / '4 /40:5 d S 'fe6 ring Alt. BM 3.74 64 . 4 t ( , ,. t 1 Ci Gr t Aeration Bldg. Sewer Holding St/Ht Inlet r K2 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 �� i Dt Bottom Dosing Header /Man. �. /Q3.3 Aeration Dist. Pipe - 7- 1 io3 3 Holding Bot. System ` O /0Z . CA Final Grade PUMP /SIPHON INFORMATION ��� ' Manufacturer Demand St Cover /' / t � , –7 GPM r' Model Number�� TDH Lift Friction Loss System Head T Ft Forcemain Length Dia- ' Dist. to wen 1 1 1 :�] SOIL ABSORPTION SYSTEM BED/TRENCH Width ► Length INoAf Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �� e �� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: �� INFORMATION CHAMBER OR Type Of System: ZfZ Z/ - 7 VK-4 / UNIT Model Number. a DISTRIBUTION SYSTEM J T 16 f" /d 36 Header /Manifol Distribution x Hole Size x Hole Spacing Vent to Air I to - q � Pipe(s) 'a,,y- %, v...... Z �a Length " Dia Length Dia Spacing w� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ed /Sodded xx Mulched Depth Over Depth Over j xx Depth of xx Seed Bed /Trench Center Bed/Trench Edges\ Topsoil ` Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 450 Bluebird Drive Hudson, WI 54016 (NE 1/4 NW 1/4 5 T29N R19W) Bluebird Bluffs Lot 8 Parcel No: 05.2 Q 4 1.) Alt BM Description = �`'� a+� G t �` �� d �^"�' La�S Off "� J �O /Jj 2.) Bldg sewer length = 3 Pl Jw`^^°' 62, - amount of cover I 7 71 Plan revision Required? i 1 Yes e-- c y Use other side for additional information. T � � � 1 0 � (o �� Date Insepcto s Sign Cert. No. SBD -6710 (R.3/97) Safely and Buildings Division f JIM 201 W. Watdtingtoo Ave., P.O. Maio$. WI 33 '�� Permit Number (to betU filled in by Co -) De artment of Commerce (W) 2 151 4 (o . Perrmit A S►�Iil •�a 1 I. D. Number In Accord with C== 8121. Wis. Adm. Code. V,R 1 ma be tined far secondary pan•poses Privacy !3. t GRO�X ress (if d i " than - 'ling sddress_)� Property Owner's Na the Peed If _ Lot i Block A (' Property s M Address Property tocatton � t cay. Stan, — — ��. . Lo 'f 7.ip Code T p]anoe Nu mber t b (circle ) Q• Type of (check aN that ) ___�__._ T N; R�E Or Ci,S P� 1 or 2 FFamily Dwellin - Number V�OUSL- of f Subdivision Name CSM Number ❑ Public/Comimrcial - Describe U. Stir Owned - Dexcrtbe se i_ICity Avillagr ownship of - 'IL Type of ParWb ( check mettle otse boat an Noe A. (CengvWe Nine B it appNrabie) A. Systt:m ❑ Rtpiacemena System ❑ Trestvrttru/HaWimg Tank Replaexmettt Only U Other Modification to Existing System j i N ❑ Permit Review's] ❑ Permit Revision CI Change of C7 permit Transfer to New List Previous Permit Number and Date issued j Before Expiradon plwnw Owner IV. Type of POWTS 5ys6m; (Check an Nat Pf esmriaed hrGround U Mound > 24 in. of suitable soil U Maud < 24 in. of susuibie soil U At -Grade ❑ Single Pass Surd Filter ❑ Constructed Weiland U Pressuriand l" Ground U Holding Tank 1.1 Ptat Filter U Asrobic'l etxt Unit U Recirculating Sand Filter ❑ Rexi 0"ting SynthaiC Media Filter ❑ " Chamber ❑ Drip Lame Gravel -im U otber (eNd �' V. Atls Iafot matoe: Decriers Row (gpd} Dot SoB Appaicadon RaWndsl) Dispersal Arta Reapeiread (sf) Area (sf) System Elevation z) t 1 COO ` I p /lS %� �e _ VI. Tsmk Into Capacity in Totai Number Muufat turer Prefab Site Steel Ft PIaS Gallons Gallarn Of Units Cotrrete Constructed Glass New Exisautg _ Tacos Talcs Aerobic Treaunem Unit Dasgg C]earrtber � rsm me �- / y of the POWTS shetnen inn the aUsebed plains. 's S gnature Business Phone Number ( Qa Ow 2rS �a s Plumber's Adze sa (street. City. State. Z Code) N -- g5 /V , 0_w ©n . 0�7 __ _ Use - -, Apvroved ❑ Disapproved 5 } Fee Ondudes Groundwxw Detae Issuing Si re o ❑ sumbaw Owner Given Reason for Demur 3 � ab 14 b li1C. CORdidew of A for Dbapproval n � c 3. Kee t a� o SYSTEM OWNER: u I 1 Septic tank, effluent filter and cep Ic< "`�'�'� ( rem /YL - ;[ — a dispersal cell must all be serviced / maintained Verve✓ S 5 l��L as per management plan provided by plrMnbeG q `l __ / -- as per applicable co a or nan es. O° � �`' "' �` ��u a C t r .o "" Sec S 0�4 R[4 W Ist N` b3c� -l o lFS s - coy;. ' V i ��' �e.v�C�.�s l� d � \• l A r f 3c� ' i -c s 7 , 1 C A i I I j 1 /� '. P I a1, NE s - rag t Rt4 31y E . cA nA _ QNtu e St Jds�e Iti ST Qro r1C ��l�t'!s LG6 �' �r •eve C•4s j ©�J / �/� � 2 a 3I -cis A vp: Q Ott a `� Pvc fe l f '.9o' f i C� + 1 i b too ly a59`� =928.5 S89 43g 98 E � 104.35 S387741 E Q . N � 2 4 NWL y —\- -i 55.63' Irr) { 61.35 Nun S89'48'S8" E 45. 465.96' } IdN-� ���.. ..254.73'. . . .. 0 211.23' w � �-� �7nH 714H C I = vow H I— I I i s . 57 53 89 E ,58754 36" - 253.97 { � I I `c�o o Consenvn #ion O I ��� co Easement JIQI �� co LL- 10 I rK > ' w : U I I 4 58 E �, N90 OD'00 E NO . 355.09 .45 44' •cn o LOT 9 z (A- LOT 8 •o o p J�� .5 �. O o . Ponding :U'_ w ��- Easement 0 .' I H.W.L =951.0 I . L 7.12: L - 6r 8l N89'56'17 " E — G 214.13' N89'5 6'17"E— k' 214.13' — _ C5— 80' RADIUS TEMPORARY • ' - CUL —DE —SAC EASEMENT • • . • ' ' ' ' ' ' . ' . • • ' I ' ' •- Ln TO BE REMOVED UPON I o EXTENSION OF THE ROAD. CA I •o w' .cr cfl N= L0T7 •W South A N8979 JJ E of the 1 52.92 ' ' HWI. NOOVJ'41 "W 104.17' �� �`' � Pondmg Losement 1" IRON PIPE FOUND S857152 E �� � H. W.L. =943 0 v ' 0.85' FROM COMPUTED_ CORNER 66.44 172.36' 589.17'07 "W 44.38 S89 .� _ AIr 1 /.r 1 nT 1075 Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Sal Service Attach complete site plan on paper not less than 8%z x 11 inches in size. Plan must County St. Crob( include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest mad. Parcel I.D. 3 6 pen in Please print all information. Reviewed B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 03 Property Owner Property Location Derrick Construction Inc. Govt. Lot NE 1/4 NW 1/4 S 5 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1505 Hwy. 65 8 na Bluebird Bluffs City State Zip Code Phone Number City Y Village Town Nearest Road New Richmond WI 54017 715 - 246 - 2320 St.Joseph Rolling Hills Trail New Construction Use: Residential / Number of bedrooms 4 I= 69E �l�I�esign ow rate 600 GPD Replacement Public or commercial - Describe: Parent material Pitted outwash plains A 2 Flele if applicable na General comments and recommendations: system elevation 1 01.40ft, trenches spaced a d deIkit f 2d*a;OW "low rade ZONING OFF;(; !/1^' Boring # `' °" Boring Pit Ground Surface elev. 105.40 ft. Depth to limiting factor 96 in- Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0-8 1Oyr3/3 none sil 2msbk mfr cs 1f .5 .8 2 8 -16 1Oyr4/4 none sicl 2msbk mfr cs na .4 .6 3 16 -50 7.5yr4/4 none scl 2msbk mfr gw na .4 6 4 50 7.5yr4/4 none !sc I 2msbk mfr gw na .4 .6 5 84 -96 7.5yr4/6 none is osg mvfr na na .7 1.2 Fi -1 Boring # Bering JIM Pit Ground Surface elev. 105.40 ft. Depth to limiting factor 96 in. Soi Appination Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDtft *Eff#1 *Eff#2 1 0 -7 1Oyr3/3 none sil 2msbk mfr cs 1f .5 .8 2 7-45 1Oyr4/4 none scl 2msbk mfr gw na .4 .6 3 45-84 7.5yr4/4 none scl/sl 2msbk mfr gw na .4 .6 4 84 -96 7.5yr4/6 none is osg mfr na na (4) .6 -ry Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg/L and TSS <-;0 mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel Sal Service - Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, Wl 540 8/20/2002 715- 246 -5085 Property Owner Derrick Construction Inc. Parcel ID # pending Page 2 of 3 3] Boring # Boring Pit Grand Surface elev. 100.00 ft. Depth to limiting factor 96 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 1 0 -10 10yr3/3 none sl 2msbk mfr cs 1f .5 .8 2 10-46 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 3 46 -96 7.5yr4/4 none SeVS1 2msbk mfr na na CA .6 4] Boring # Boring Pit Ground Surface elev. 100.00 ft. Depth to limiting factor 96 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0 -12 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 12 -35 10yr4/4 none Sid 2msbk mfr cs na .4 .6 3 35 -52 7.5yr4/4 none scV 2msbk mfr 9w na .4 .6 4 52 -96 7.5yr4/4 none ScVSI 2msbk mfr na na ` .4 .6 F-1 Boring # Boring d Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/t_ and TSS >30 < 150 mg/L * 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 Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST- POWTSM Derrick Construction, Inc New Richmond, Wl 54017 Lic. # 248956 NE1 /4,NWl /4,S 5,T29,Rl9W (715) 246 -6200 Town of St. Joseph, St Croix Co. (715) 246 -5085 Bluebird Bluffs lot # 8 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. 9 y' 6v� f vaad�r £v3 Ydtr �Fa� �o�r � (.)'F sF ® - � # /X Hictl' l r, l r Cl0 �l- �31 — '� I RV /os jZ o;' E- l33 = /0 S W ->-& �0 1�7' o 5' 5-.'AA ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Cell C o 1 t Mailing Address 3 6a4 V< iqw" Ci t ; W f � t t Property Address xx /mil W i z4 n-t v` (Verification required from Planning Department for new construction City /State 4 fit I AII Parcel Identification Number 30 . 1 LEGAL DESCRIPTION Property Location ' /,, " - f ' /,, Sec. 5 , T � N -R t 9 W, Town of J0 S -�fi N Subdivisio 4Z:' i k f-t—S 9 Lot # Certified Survey Map # Volume . Page # Warranty Deed # 7 ' Volume 2 --/ "7 2 , Page # '9 Spec house ❑ yes )<no Lot lines identifiableXyes ❑ 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplfmber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been intained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration da e SIGNATURE OF'APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described abov , by vi a w rranty deed recorded in Register of Deeds Office. SIGNA APPI:ICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ILE DWOMATON SYSiENd scATioNs + To* M�fa:bm W ; S , 0 Q �S E3 NA . t Permit # Septic O Goss O Holding vol. j � ga Tank Manufacturer ❑ NA 1>E8 PARAMErBIS O NA Q Septic 0 O Holding Vol. gal Number of Barrooms Humber of Public Facility Units O NA Effluent M� � � f! a K ❑ NA EsSmated taverage) flow �xl © Efflunt e Model L - 5 Design (peaini flow . (Esti 0 U pump ❑ NA Sod Application Rate t Pump Model Standard irnfl¢rerR/Efflrntrit Quaity • prateetmant lnnit ❑ NA Fats, ON & Grease (FOG) 530 mglL O SandK3revel Filter O Pent Filter &odwnical oxygen Demand (80D 5220 mg/L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids fi'SS) 5160 MOIL 0 Dhkdaction 0 Off: Pretreated Effluent Quality Monthly average Manufacturer D �) ❑ NA Biochemical oxygen Demand (BODJ 530 mgA- ❑Urn- Qrawhd 4mmurized) Total Suspended Solids (TSS) 530 nVIL ❑ NA ln - Ground (gravity) Mound Feral Conform (gaonnatric maen) 510 cfut100ml O At -Grade ❑ Other: Maximum Effluent Particle Size Y in dia. 01 NA Cl �� p-i O ❑ NA Other: Cl NA •values typical for dowmstic waswwater and septic tank efflusm. odor. 0 NA NAWTENANf :E SCHEDULE - Service Event Service FIGIOMICY nrn moma) i� 3 Years) O NA inspect condition of tankte) At least once every: s) one -third tY�) of tank voWme When combined sludge an d arum equate O NA Pump out contents of tenk(s) 'p When On WO w8W Rhin is activated - taornh(s) (1Ytaxinann g yes ❑ NA kespect dispersal cell(s) At least once every: p ) El s1 Clean 81 0 NA effluent filter At least once every: O month(s) O NA Inspect Pump, pump contrds & Wwm At least once every: O , ) D nVulth(a) ❑ NA Rush laterals and pressure test At least once every: O (s) O mwnth(s) ❑ NA At best once every: O Yearw ❑ NA MAMITEMAINCE V TRUCTIONS one of the fogowmg licenses or certifications: lrnspections of tanks and calls shall be made by an nndrvndn+at carrYnrnA Operator (pumper) Master Plumber, Master Plumber Restricted Sevier; POWTS k"psctor; POWTS Mskwmkner% Septage Servicing g Per cracks or Tank inspections must include a visual inspection of the tenk(s) to tdentifY any missing or broken hardware, identify any leaks, measure the vdk mne of combined sludge and scum and a check for any back up or porndM9 of effluent on the ground surface. The dispersal cuts) shall be visusily inspected to check the effluent levels in the O k for any Pins of effitont on the ground surface. The ponding of effluent on the group surface may s f affft check and requires the immediate notification of the local regulatory authority � treatmnernt tank equals one -third tY31 or more of the tank volwmme, the of sludge and sour any When the combined accumulation of ance with chapter Nn 113 entire contents of the tank shag be removed by a Septa Servicing operator and disposed of m accord Wisconsin Administrative Code. Aft other services, including but not limited to the servicing of effluent fitters, mechanical o pressurized components, pretreatmen units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local reguktoy auOWRY within 10 days of completion of any service event. GMW tzraa START UP AND OPERATION pate Sf _ For new construction. prior to use of the POWTS cheat treatment tanks) for the presence of painting products, solvents or other have the contents of removed by sent cps /er servicing n cp the sod dispersal celt(s). If him are detected erator prim to use. System start up shall not occur when sod conditions are frozen at the infiltrative surface. During extended Power outages pump tanks may fill above normal flghwater levels. When power is restored the excess wastewater wilt be discharged to the dispersal call(s) in one large don and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the Pump controls to restore normal levels within the puns tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or within 15 feet down slope of any mound or at -grade soil absorption area. compact, the area Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; rxudoms: tx>tton swabs; degreasers: dental floss; diapers; disinfectants; fat; painting products; sump Pump) discharge: fruit and vapetW* peelings; 08304me: grease; herbicides; meat scraps; medications; oil; pesticides; sanitary napkins: tampons: and water softerw brine. ABANDONMENT When the POWTS faits and/or is permanently taken out of service the following steps shag be taken to rostra that the system is ProPerty and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • AN piping to tanks and pits shall be disconnected and the abandoned Pipe openings sealed. • The cOr#tw s of all tanks and ph& shag be rernov!ad and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with sod, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS falls 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 absorpt system. The replacement area should be protected from disturbance an d ti u pon by corrgactitsn etd should not be infringed upon by existing and Proposed structune, lot Ines and weft. Failure to protect the replacement area will result in the reed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that Lune. Ca 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. 17 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 test resort to replace the failed POWTS. 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the ciomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC- PUMP AND OTHER TREATMEfNT TANKS MAY CONTAW LETHAL GASSES AND/OR iNSUFFiCitINT OXYGEN. DO NOT 81tT A SEPTIC, HUMP OA OTHER TAEJ4TMENT TANK UNDER Ally tMSTANCES. DEATH MAY RESULT. RESCUE OF A MtSON FROM THE INTERIOR OF A TANK MAY BE DFRCULT OR INPOSSiBLE. ADDITIONAL t DL"WE NTS POWTS iMSTAL.LER POW= UMAWrAliVER Name l u ` Name Phone LS Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name � Phone Phone S .a c S4 t - has document was drafted by the staffs of the Green Lake, Marquette and 7Waustwe County Z srd Sankttion 3 agencies compliance with Comm 83 .22(2)(b)11)(d) &ff) and 83.54(7). (2) & (1. Wisconsin Administrative Code. I " ._ i f - �t EL 1 2Q _ -.. 3H j� � rrrwsrt i. j i •.errs♦ , � trrrtr♦ . i 24" �! ' °' , •••e•t• 1 j YF ..y 2~ t _ �� ..♦ l t 4 "1525 of ... V ,..• 1/2 Cimc = 18.84" •� I ter l.1t ♦ ►.! ••!!!!t t c wV. VV s 24.1 r� 12 -112„ DI.A. (typ Iaa m t U.D. ofd^ 1a: 1Q EL t ( s PIP% = 4.623 mc1� ( S� -*11 (2 S"de'raftsl , = IQ.EIin 4 (nd ,,Wiw Pef lMeu R. = 3. i i =1 2.312jip f ZU1 3. i 1 j 1 0-117 R{ f►octwn i ft � t3.O. of '" cy' m 4 mxft; of j / , TOW Snit Iwterbcc Are. ctaFp c?'4 ,.1 6 ..-.�r. 1 2.J t2 S.14 SQ, i t i T�Mfft 1 14 "1 .`w 574 421 W Z {{ {777 Vmd vQ(ur"c to oatsi4c erh++dcxs Projected TrenN Area i2w!q, s1. r 901 [N I ��Mall Height - 12 m f b Oki volu ac = 2.00 Sq.Fi 0ut>am trerwcc, cyti Zia e Boteum = 3b IR 1 _ 00 $q. Ft. J 1 ligffl l � �1. ].ttf l2 , ) ° i3<3 S ft. t » � PrO0"ed Trewci Area i i ! Snld vgty� at � � uumdc SAp Sq-Rt. t p Tutol vol d vglmow .= 0.1 Tb7 t ( of voW +mlamr yesy �ph^�rsl 0 215 _ 09 R' f fl.dYZr0.901 ' Q. l 08 = F ?� fiagont P' F1 49 r 3: egbeq 4 r g f j r � r i EPS A ggregate Trench YStem EZ 1203H f 10 IV I Ring lndust,i GrQUp 65 ►ndustriat Park Rd. i oukland, TN 38060 F1Mf tzlmJrt ti,1 I Parcel #: 030 - 2137 -08 -000 04/12/2005 03:32 PM • PAGE 1 OF 1 Alt. Parcel M 05.29.19.2034 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/22/2004 00 0 Tax Address: Owner(s): " = Current Owner " GREGORY J & ANGELA K PLAHN PLAHN, GREGORY J & ANGELA K � 314 EDGEWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description 450 BLUEBIRD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.000 Plat: 10/01- BLUEBIRD BLUFFS 030/04 LOTS 3/13 SEC 5 T29N R19W FRL NW NE & PT NE NW Block/Condo Bldg: LOT 08 BEING BLUEBIRD BLUFFS '04 LOT 8 (3.00AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 29N -19W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 05/14/2004 762617 2572/052 WD 03122/2004 757255 10/01 PLAT 12/02/2002 700547 2065/474 WD 07/23/1997 1095/410 QC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 03/02/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • I 7626, 1 7 U -;257 P 0 5 2 �. KATHLEEN H. W ALSH REGISTER OF DEWS ST. CROIH CO NJ WARRANTY DEED Document Number RECEIVED FO RECORD THIS DEED made between Brushy Mound Partners, LLP, a 05/1412004 01:30Pf! Wisconsin Limited Liability Partnership ( "Grantor ") and Gregory J. WARRANTY r DEED Plahn and Angela K. Plahn, husband and wife, as survivorship marital property, ( "Grantee "), REC FEE; 11.08 WITNESSETH, that the said Grantor, for valuable consideration TRANS M.- 262.50 conveys to Grantee the following described real estate in St. Croix CC COPY FEE: County, State of Wisconsin: PAGES.-* 1 Lot Eight (8), Plat of Bluebird Bluffs in the Township of St. Joseph, Recording Area St. Croix County, Wisconsin Name and Return Address RAJ LecAIrv Part of 030. 1018.50 -000 and 030 - 1017. 80.000 (Parcel Identification Number) This IS not homestead property. Grantor, Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership, is an affiliate of Derrick Homes, LLC, a Wisconsin Limited Liability Corporation. Grantor develops land and Derrick Homes, LLC is a home construction contractor. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC will be the builder of the home for Grantee. If Grantee does not commence construction with Derrick Homes, LLC as the contractor /builder within two (2) years of the date of sale of this lot to Grantee. Grantee gives Grantor the irrevocable right to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. If Grantee desires to sell the lot to another purchaser before constructing a home upon this lot, Grantee gives Grantor the right of first refusal to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. Dated this 6th day of May , 2004. ' Michael R. Steven / � /.• AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me tliis 6th day of May , 2004, the authenticated this day of . 59_ above named Michael R. Stevens and Ronald L. aetTiai , mt partnars of Rrushv Mnund Partners. LLP. a Wlaeonsln Limited Llablllty Partnership to me known to be the persons signature who oxe told the foregoing instrument and acknowledge the same. type or print name NMI L LUM Notary Pij TITLE, MEMBER STATE BAR OF WISCONSIN I State of Wlscon$h (If not, authorized by' 706.06, Wis. Stats.) type or print name He L. - Lutz Notary Public St. Croix County, Wisconsin. THIS INSTRUMENT WAS DRAFTED BY My Commission Expires- March 26,,2006 Brushy Mound Partners 'Names of persons signing In any capacity should be typed or PO BOX 445 printed below their signatures. New Richmond, WI 54017 N W N r. O 2 eo Ul 3 3. 71 O o y Cr — a O p o w A� .7 �. � A '! 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