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HomeMy WebLinkAbout030-2131-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buil6irig Division INSPECTION REPORT Sanitary Permit No: 430472 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: Plummer, Joe I St. Joseph Townshi CST BM Elev: Insp. BM Elev: BM Description: / Section/Town /Range/Map No: C79 . g0 bb ,$�� l P �- = C Sr B V" 2 - (A � 23.30.20. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z� Bench r Dosing u=p Ll Alt. B Aeration Bldg. Sewer Holding St/Ht Inlet l-5—T r �0•q3 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � _ I Dt Bottom 1 3- 1 3 c a S / Dosing � " Io3� Header /Man. 5 33 m.q:fl Aeration Dist. Pipe -� jp 101.0 CC Holding Bot. System . Zd 1 00. 1 � El 2 r Final Grade PUMP /SIPHON INFORMATION © 2 ' Oj Manufacturer Demand St Cover 1 6LLXbeL - GPM S� ab • S2 Model Number 4 fl H Lift .VSO Friction Loss , System Head TDH Ft 41 D orcemain Length Dia. 211 I Dist.toWell i too SOIL ABSORPTION SYSTEM 4WFtf idth 1 Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI 3 V - SETBACK SYSTEM TO b P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR V t 00 1�'��•S Type Of S tem: 1 UNIT �n0 Model Number: DISTRIBUTION SYSTEM Header /Manifo Distributio x Hole Size x Hole Spacing Vent to Air Intake ��,,,q.� 4 Pi e Lengtf Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes 0 No l =i= Yes I J No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: NOV/, 7-1 3 Inspection #2: - t ---- 7 Location: 125 Heritage Trail Hudson, WI 54016 (NE 1/4 SW 1/4 23 T30N R20W) Settler's Glen Lot Parcel No: 23.30.20. 1.) Alt BM Description = 5 .T. Gecr+� . '�� j�Eye.Q Ar' f 00 2.) Bldg sewer length = 5'2 ( - amount of cover = cfZ u.f.• � 2� - 3) 04wvcvh N /Uew-{- cJfl�+w�v5 -R �nOUS -- - -- Plan revision Required? i Yes )_( I Use other side for additional informatio zf 1 L _J SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. l t Safety and Buildings Division County t 201 W. Washington Ave., P.O. Box 7082 � IN Visomonsin Madison, WI 53707 — 7082 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 261 -6546 q3D / y � - Sanitary Permit Application State Plan LD Number In accord with Comm 8311, Wis. Adm. Code, i � ; J may be used for secondary purposes Pri Y Law Project Address (if iffere t than mailing address) I. Application Information — Please Print All Informat on /as N a /��y L SEP l i 2003 's Name Parcel # - -I Block # 0 / 'T. Proper CROIX COUNTY _ �- Owner's Mailing Address Property Location 5 0 1 0 City, State Zip Code Phone urn � /` .� D 1 S circle one) N; 1E or W II, of Building (check all that apply) / 1 ee 2 Family Dwelling — Number of Bedrooms y T � 1 Subdivision N C / Number ❑ PubliclCommercial — Describe Use Ile ❑ State Owned — Describe Use �" icy ❑Villag ownshipj�• �O III. 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 ❑ Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check al! that a I — Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable 4il b At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Press In round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching ChwQbet ❑ Drip Line ❑ Gravel -less Pipe ❑ qlQ p 'n) • e V. Dispersal/Treatment Area Inf r tion: ST ���) Design Soil Application Rate(gpdsf) Dispersal (sf) Disposal ed (� ystern E hio z mR 8Z r (/ r VI. Tank Info Capacity in Total Number � banT Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Exrstrog T�ao Tanks Septic or Holding Tank �/ C Aerobic Treatment Uoit /� ZL Dosing Gumrber .S' Zia VII. Respo nsibill ty Statement- 1, the undersigned responsibility for Installation of the POWTS shown OR the attached pleas. Plum 's Name (Print) Plumber's re MPlI�PR$� Business Phone Number J / Plumber's Address (Street, City, State, Zi r � VIII OUR /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes GroundwaaW Date Issued ssuing Age Signature ` ❑ Owner Given Reason for Denial Surcharge Fee) Septic tank, effluent filter a n 1 for Disappro � � � r A dispersal cell must all be serviced main aindtl as per management plan provided by plumber. All setback requirements must be maintained t/ v as per applicable code /ordinances -( ,. Aak AttaeM c pkte plans (to he Cwaty ly) f r tYe • sot lea 81R. s t l lackey In sleet l eD-3 1 98 i .08/0 . PLOT PLAN PROJECT Joe Plummer A ADDRESS N50105 635th St. Ellsworth Wi 54011 NE 1/4 SW 1 /4 s 23 iT 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 2269W DATE 9/17/03 BEDROOM 4 CONVENTIONAL )00( IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chamber BENCHMARK V.R.P. Top of 1/2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H. R. P. Same as Benchmark SYSTEM ELEVATION 99.0/99.8 4.5' below grade Alt. BM Top of 1/2" Pipe @ 100.8' Plans Designed Using S Conventional Powts Scale is 1" = 40' Manual Version 2.0 unless otherwise noted eritage Trail Settler's Wa Pro 4 Bedroom ouse Huffcutt 1 Combo '�' Tank ' 2 -3' X 88' 35 Cells with >3' Vents B -1 Spacing 6% 413' Property Line 5 Slope h � o 40' '° B -3 B -2 h e 5• ' 40' yents Vent 0 9 >6 " Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 40' Alt ` 11" Ong 3499 Grade at System Elevation 10, B ` PLOT PLAN PROJECT Joe Plummer ADDRESS N50105 635th St. Ellsworth Wi 54011 NE . 1/4 SW 1 /4S 23 /T BEDROOM 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 4 CONVENTIONAL XXX IN-GRaND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chamber 28 BENCHMARK V.R.P. Top of 1/2" Pipe ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL 'H.R.P. Same as Benchmark SYSTEM ELEVATION 99.0/99.8 4.5' below grade Alt. BM Top of 1/2" Pipe @ 100.8' Plans Designed Using S Conventional Powts Scale is 1" = 4O' Manual Version 2.0 unless otherwise noted eritage Trail Settler's Wa Pro 4 Bedroom Ouse Huffcutt Combo Tank 70' 2 -3' X 88' Cells with >3' Vents B -1 3 5 Spacing 6% 413' Property Li 5 Slope o 40' b B -3 B -2 r 40' Vents Vent 0 9 >6" Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 40' Alt ` 6' Long 11 B. 3 4" Grade at System Elevation 10' CR I � : : / / \� \\ c� chi � � .•�/ / . I 0 c I M M M I W a, cc cm LO LO cm I z W C% co �`�� 0 w o���\ 7. I I �. Q� < N —100' I i I 100' �–► �/ T 0 ' / / E' a: ��' w ri UJ CO co ,ppN \ \\ •odo / •' // // a te' _ / C6 cO w ° ed / T CO co CO LU �Q0 , / r 0 C6 9 C5 T I\ . I I m m cm S00°1 5'40 "E 172.03' Z S00 °15'40" E 191.54' SETTLER S - —T - —- - WAY 1 i N00 15 40"W 172. -` 03 N 15 40"W 191.54 ......... 4 20 00 I — -- -- 71.58' L J 33HS 338 SECT ION AND SPECIFICATIONS SEPTIC TANK & PUMP CHAMBER CROSS wEaTHERPR04F 4" CI VENT PIPE 12" MIN. ABOVE GRADE £ JUNCTION BOX APPROVED > 25 FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE CODER � FRESH AIR INTAKE W1 PADLOCK WARNING LABEL FINISHED GRADE � r 4 1, MIN. 4 K�►• Zya 18" IN • 'ttE INLET •• ' � `� i l WATER TIGHT SEALS �" GAS- TIGHT, VAPPRAVEO A SEAL i JOINTS WITH FILTER _ �_ s ALM APPROVED PIPE a 3 ' ONTO APPROVED ON SOLID SOIL PIPE 3' C ONTO SOLID OFF SOIL PUMP OFF ELEV . _____ FT • D 3" APPROVED BEDDING UNDER TANK NCAETE PAD SPECIFICATIONS ✓ /� NUMBER DOSES PER DAY: SEPTIC / DOSE / TANK MANUFACTURER J ,GAL , DOSE VOLUME F INC LO BAC� GAL � „..,,// TANK SIZES: I GAL. � .SGAL< DOSE t 2 GAL. J CAPACITIES: A INCHES '..._._.. ALARM MANUrACIURER: �GJ $ = 2 INCHES GAL. MODEL NUMBER' SWITCH TYPE: C = 7 � INCHES =/ , J I” z PUMP MANUrACTURER D = INCHES = /�`J L MODEL NUMBER:- 16, 23 wAC SWITCH TYPE: PUMP & ALARM WIRING AS PER ILHR v GPM ' FEET REQUIRED DISCHARGE RATE __ _.__ Z! ,2„FEET VER TICAL DIFFERENCE BETWEEN PUMP OFF . AND DISTRIBUT - ON PIP£ ; / FEET +MINIMUM NETWORK SUPPLY PRES, T /100 ET. FRICTION FACTOR _ FEET FEET FORCEMAIN X TOTAL DYNAMIC HEAAD j I TANK: LENGTH ; W iDTHC7�, ..,.� DIAMETER INTERNAL DIMENSIONS OF PUMP LIQUID '�- ,�- ��- � -----" LICENSE NUM DATE: 5IGNED: 1/88 TOTAL DYNAMIC HEADICAPACITY PER MINUTE NO R=M= KmmEmcm �, Emma== Kmmzmm ' �� ��►��� NNE ����� i MEMOS 0 210MEMENNO NNE SkIMEMMEMEMEME `►.111 ►����������� W IN l ,%kMMMMMMMM IN NINE MENNEN �� w. 11 � I ME WEEMEM NOWL11il! No MENEM MENEM EMIZA, 0 OEM m UK iffimom l , WisconsinDe�artNilintofCommerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 7T Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must �J ' 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. Please print all information eviewed by Da 7/ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). `� /'`' v ✓'� (/ Gr �� Property Owner Property Locatio Govt. Lot 1 /4 j 4 3T j' N P,;, E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# �.�_ a s1- �� City State Zip Code Phone Number ❑ City ❑Village own N st Roa J _ / "Utz New Construction Use;ZErQesidential / Number of bedrooms Code derived design flow rate /+ C `' F 1� D ❑ Replacement C1 Public or mmercial - Describe: _ Fr F l Y Parent material �G- '�2�T.t�'!e Flood Plain ele if applicable General comments � >�j� c //' S E P 1 7 2003 and recommendation y r✓ r ./ ST. CROIX COUNTY �/� ��� /��✓ ZONI G O Boring # ❑ Boring C � S Pit Ground surface elev 1 Depth to limiting factor�n. Sal 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 s • 0 1) Wq0 7, 7 6 7. wt� Ot Z q „ 4 - 33 Boring # Fa Boring it Ground surface ele Depth to limiting factor in. // Sal 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 7Y Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1 150 mglL ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 —/ —� 715 - 246 -4516 1 Property Owner _ Parcel ID # Page of F-31 Boring # Boring Pit Ground surface ele�v i eft. Depth to limiting factor in. Soil TPplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. M unsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 e7 I J F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. _§o�flApplicafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F ❑ Pit Soil ication 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 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 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. seg -8330 (RAM) Soil Test Plot Plan Project Amea Joe Plummer Sha Address N50105 635th St. Ellsworth Wi 54011 OM #226900 Lot 2 3 Subdivision Settler's Glen Date 9/ 17/03 NE 1/4 S W 1/4S 23 T 30 N /R20 W Township St. Joseph ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" Pipe y- System Elevation 99.0/99.8 *HRPSame as Benchmark Alt. BM Top of 1/2" Pipe @ 100.8' Scale is 1" = 40' unless otherwise noted Settler's Way Heritage Trail Pro 4 Bedroom Ouse 103' 104' B -1 6% 413' Property Line 25 ' Slope N O 40' B -3 h B -2 40' 20 40' Alt B. 10' 10' f ' r 3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings r in accordance with Comm 85. Wis. Adm. Code County . CroW Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must 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. Please print all ink a n. eviewed b Date s. 15.04 1 m Privy La ) ( )) / U provide may He used for seco ary purposes (Privacy �t!.vJ�1�Y�� Personal information you P Y Property Owner ' Prope Locati �1,� 2 8 Q f3ovt t i�/ 1/4�1u 1/4 S 23 T .� N R 26 E (or W& c \G e Property Owner's Mailing Add , t # Biodc # Subd. Name or CSM# .SQ 6 4e yJ �2C� ��l 11 >o.1ef City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road � 4 -2 � 5 4. s 2 5) q � ® New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ` I I ❑ Public or commercial - Describe: ft. Parent material �. Flood Plain elevation if applicable �J / General comments 5-15yprpj .P /eV' and recommendations: I ❑ a Boring # Boring q� , Co ft. D to limitin factor 3� in. pit Ground surface elev. P g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. - Eff#1 - Eff#2 St_ �� cS I v 5 9 2 - Lv 5 s rn l c v 5jcc c2 p - Lt 1p Sl'e 1 3r n � r4y Boring # ❑ Boring 72— ® pit Ground surface elev. (co .OU ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I U-lO I 313 5L- Z m C I `� 19 1 . 2 -y0 LU mI �S - 1 /, Z L 4 to d TSS >30 < 150 m ' Effluent #2 = BOD < 30 mg/L and TSS < 30 M91L Effluent #1 GOD > 30 < _220 mg/L an _ !� CST Name Please Print gnature CST Number I 2 Address Date Evaluation Conducted Telephone Number az C715� I� - Property Owner Lcc 0 1AaT e-s Parcel ID# ' ❑ Boring Page - � of i 3 3 Boring # . II;; fr11 / t1�i Pit Ground surface elev. 9G • 2C� ft to limiting factor _ lD5 in. Horizon Depth Dominant Color Redox Description Texhrre Structure Consistence Soil Application Ra Boundary Roots GPD/fl= In. Munsell Qu. Sz. C-O L Color • - ���-. Gr. Sz Sh. Eff #1 •Efff /2 lb 5L... 2 fn c_S I�X S C� Z y0 10 �c�s �S mI c s — 1.2 a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Description.., _, Texture - Structure Consistence Boundary Roots GPD /11= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Effll2 F-1 Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rats Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ft= In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff #2 j • ' Effluent #1 = BODS > 30 < 220 nvJ4- and TS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/14 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. SBa8770 (R071'00) 1 Y PAGE_.�' OF NAME i OT #,?3 LEGAL DESCRIPTION ,UF Y4-':4u X 03 T30 N.R. Zo E(or1 SCALE: I"= � a BM I ELEVATION 10d. 0 BM I DESCRIPTION p c I3M 2 ELEVATION ,,36 BM 2 DESCRIPTION f UrP o l D yG P< 9e — - -- SYSTEM ELEVATION SYSTEM TYPE MOU pct CONTOUR ELEVATION 7 , 7 ,9 It I l I � x u V I qo 99. SIG TURF DATE O �� Maintenance a nd C ontingency tin ency Plan for a Septic System Maintenance Plan once ever 3 years. 1. Septic Tank is to be pumped Y 2. Effluent filter is to b e cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. es the inspections pipes at the ends of 3. Once every 3 years, cells are to be inspected v the cells. 4. owner a g rees to limit greases, garbag e , and water conditioner discharge into the system. a 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. Y 8. Discharge into system is not exceed those required as per Comm. 83 � Contingency Plan ifs Y stem fails, determine cause of failure, use alternate area and install new system or 1. install system at a lower elevation. 2. 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer .Ib+ei lCG✓ �n�i✓ Mailing Address Property Address (Verification required from Planning partment for new construction) City/State Parcel Identification Number 1 LEGAL DESCRIPTION Property Location /., sl� /., Sec. 42 3 9 T.?L2 N -R � W, Town of fps Subdivision Lot # C Certified Survey Map # , Volume � Page # Warranty Deed ## -7 33 6 l , Volume Page # Spec house ❑ yes / kno Lot lines identifiablees ❑ 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, journeyman plumber, restrictedplumber or a licensedpumper 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days th/tmnhr ye ar expiration date. NA". 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 p perry de bed above, by virtue of a warranty deed recorded in Register of Deeds Office. 9 Z Af GNATtJRE OF APPLICANT 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 I U 2390P 076 733011 y STATE BAR OF WISCONSIN FORM I - 1998 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD 030204310000 3030203210000 07/31/2003 09:30AH 030203270000 , 030203340000 030203320000 030203250000 WARRANTY DEED Parcel Identification Number (PIN) EXEIQT ii REC FEE: 11.00 THIS DEED, made between St Joseph Development Corporation, a TRANS FEE: 251.70 Minnesota corporation, Grantor, and Joseph Plummer, Grantee. COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following CC FEE: described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lot 23, Settlers Glen located in the Town of St. Joseph, St. Croix County, Wilco Recording Area Name and Return Address: ! Land Title Inc This is not homestead property. 1900 silver Lake Road Together with all appurtenant rights, title and interests. New Brighton, MN 55112 Grantor warrants that the title to the P 1= rae22t�o� roperiy is, good, indefeasible in fee simple and free and clear of encumbrances except Dated this. I St. Joseph Development Corporation (SEAL) (SEAL) • Kellei St. Martin, Vice President • (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA }SS. WASHINGTON COUNTY. authenticated this Kellei St. Martin the vice president of St Joseph Development Corporation, a coporation under the laws of Minnesota on behalf of the corporation personally came before • me this 3rd day of June, 2003, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by. §'706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY k (d Gregory Booth • N Lentz 1900 Silver Lake Road New Brighton, MN 55112 -1789 Notary Public, State�j Minnesota My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons sigping in any capacity must be typed or printed below their sigoatum. r-„ NANCY J. LENTZ NOTARY PUBLIC- MINNESOTA My Comm. Expires Jan. 31. 2005 ■ L I r A COUNTY PLAT OF: S ETTLER'S GLEN 1✓ �m LOCATED IN PART OF THE NWIA OF THE SWIA, PART OF THE NEIA OF THE SWIA, a N89 .45'31'E PART OF THE SETA OF THE SWIA, PART OF THE NWIA OF THE SETA, THE SWIA OF 14 .89 THE SETA OF SECTION 23, AND IN PART OF THE NEIA OF THE NW 1/4 OF SECTION 26, 8 I ALL IN T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. I I 25 I Q I � 1 a m / / CI — o n n - - -- / / N S89 44 - 574W 899.88' o I ............... 24 .. : s a...................... ......... ........................ qp a • J� Wp I Y: LOT 2 S89 °44'57"W 349.84' LOT (. 3. :.............. ••••••� •••••• ......... ....... 1 / 1 300DACRES , I 13.mso. FT. / 130.669 SO. FT. O I '- : Z 100' —�• ._•'`' A p I :... ...•••''• / � rte• /' _ S89'4 1'57W 323.08' 17.61' \ \\ N ................... ... \ `\ W 9°44'20•w 129 \ \ 4r. �•.�` \ \\ W 33'33 T - - - - -- \ \ ° ••t W \ 6r LOT 22 i p I i 6� 9 0 •�• 3.001 ACRES \. Rr \ N N� \ \` \�'"✓ 130,ro7 S0. FT. •� 8 , j • ' • 1!"�_ LOT 23 '��?�\ \ ; 2 CONSERVATgN ` '�••\ : : I I 3.001 ACRES �\ \ •� EASEMENT 130.70960. FT. \ \\ 'V •. 7' T_____-` L.e.oaez.o ��\ \\ LOT 21 g I \ ' \ .= \\ "• •., • 3.001 ACRES LOT 20 ''••.,• H.W.L. =880.0 \� \ \•., 130.731 SO. FT. \� STORM WATER �� \ \• I \ , \ \ \ \\ RETENTION AREA B \��\ I \�. \\ \!,p -•••• 3W ACRES 130.nl SO. FT. •• \. \\ •'•. Bl1_��_Bip ; :� • \ '• 20 CREA RETIONAL I •\ ', \\ nom, \� '�T�� �� a1 -t'• • ••'\ •••TRNL EASEMEM I •: \\ �.\ 9� 1T; CONSERVATION \ \ "'CSC \\ •• i L.B.O. =866.0 pp TOWN TREE \ '• ga ••�. •' ••• \•. / \ � T 1 I STORM WATER STATE OF LOT 24 1 I RETEN ON AREA Q ' COUNTY [IF 3000 ACRES • : Y6 0• •• '••., `K(. '' C\ '�, 1. CAIOLLE \ `\ •�•'•.,. • t3D.e96 so. FT . ;' SSA •. 47- •W6s ACTING M\ \\ \ \ •� ,: STORM WATER • ' \ \ \\ TIERS ARE SOUTH LINE OF THE NEVe of THE swVe \'•�•�' RETENTION — RETENON AREAS - �4•.. =� }•• — PLAT OF '. �D \ NORTHUNEOFTIIE SEl7<OFTNE SW114 wl \• r ••••••••••f NWW4tE2 7 8.59' \ \ 6 \ py� ''\,• LO 3.O T OD ACRES ti s ?• \ ° 9.?.. \ •' \,• 130.696 S0. FT. ��� •��; TO CALLT E \ "\ r ° ? \ \ \'• \. `�� I STORM WATER ••• • ••'` \`\ \ \ ' \, RETENT7ON AREA D;• ••\ \ O. =866.0 \I ''.\ \• L.B. l r \ `�� \ n �'•� % \ LOST 26 \ ll�� LOT 36 \\ \ \ '~i I \� ' H�� L..�.o: 3002ACRES :" : 3ODI ACRES •• :• ''.� . 130.760 s0. Fr. ; \ \� \\ \\ ... 130.720 SO. FT. I '•A k \ \ \02 L.B.O. =878.5 :5l \\ N66v6a6w 231.'5• '•••• ••\ \ ••••� :STORM WATER : : LOT 35 C1� .0. =866.0 • •'• :• • STOAKWATER \ N \ LB I RETENTION AREA G \ \ \\ \ I ? \•• RETENTb%4 AREA D •�' • : 3.001 ACRES � .ro9 SO. FT \ 1 Sj > _ 130 S0 FT I I \ LOT 27 \\ H W.L.= 976 ............... ............................... A Z I I •�. . CEM�TERY : { 00�� I 3 ACRES 130 \ \ Izol f _ m I �• L.B.0.�902.0 lev 13 .1 ' — 727.78 25.I •• \ � P �.• ' '/' 7,1 I //i --- ------- FARIVF -— sa�ro7orE35e.72' a ' Na7ro7o7w ----- ;R�Ai�- 'F' 4 - / �-i "-- -- - u2..rL_. - -- 946.62• �` \ •• Je �/ \ C t7' H.W.L. =873.5 LOT 34 - ; 1 ....................... \ ` H W i� / .✓ /\ � . .N.ODOAGES .......................... {. .. ..... .......•....................... �_..\ C. \ / ' \.