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HomeMy WebLinkAbout030-2131-28-000 pr Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division -- INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 506113 0 GENERAL INFORMATION 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: Watuak, Mark I St. Joseph, Town of 030 - 2131 -28 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 23.30.20.1082 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic :N "L Benchmark i F . , 3 ion - 3 /zlc> [YOSIrig Alt. BM .�.- Aeration Bldg. Sewer .� rad Holding St/Ht Inlet St/Ht Outlet I t r � 9 o TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / . Dt Bottom 5a IVA 3� - 7 39 Dosing Header /Man. CrT Aeration Dist. Pipe y 8 Z 5 Holding Bot. System �.$ Qa• c y 7:� Final Grade 5 - � � � PUMP /SIPHON INFORMATION Manufacturer Demand St Cover /� y g- M J Model Nu TDH ift Friction Loss System H TD Ft Forcemain L Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. iid<th DIMENSIONS Z I SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System > / ! ^ CHAMBER UNIT OR � ` N IA /q Model Numb j 1 , DISTRIBUTION SYSTEM ZZ k Z = `i+ 4 �'��•Q Header /Manifold 11 Distribution x Hole Size x Hole Spacing Vent to Air Intake / Pipe(s) Z Length 7 Dia Length Dia \ Spacing \ \ \ d SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only ` ded Depth Over 1 Depth Over xx Depth of xx Seeded /Sod Mulched Bed/Trench Center 3. cr 1 xx Bed /Trench Edges ` Topsoil \ Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / «( \ \\ Inspection #2: / / Location: 1428 Thelen Farm Trail Somer set, WI 54025 (SW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 28 Parcel No: 23.30.20.1082 1.) Alt BM Description= ` •` `•� G ;.^ S �— , , M C 16 6 O Vi- length = r ' 2.) Bldg sewer - amount of cover = U 5 Plan revision Required? Yes )< No 1l� Zo 3 Use other side for additional information. 7 Date Inse tor's Signa re Cert. No. SBD -6710 (R.3/97) r �,yy�_9py Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �✓-� / o Madison, WI 53707 -7162 Sanitary Permit Number be filled in by Co.) Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. N 'te: Application forms for state-owned POWTS are Project Address (1f different than mailing address) submitted to the Department of Commerce. Personal i>orrnation you provide may be used for secondary in accordance with the Privacy Law, s. 15.04(l) m', Stats. "' l h !�O �arw� rj +' I. A lication Information Please Print All Information Property Owner's Name Parcel # qr�- G�/�c, ,COQ MAR 2 8 2007 031) --t /3 ► — $ WD Propcxty Owner's ;ng Address Proporty loeation / ��� Z '— ST. CROIX COUNTY Govt Lot � City, State Zip de ✓ 'b ' /., Section N; R,L/ l E r W II. - of Building (check ailthat - apply) + - 3 Lot # _ ' tl a 'vision Name or 2 Family Dwelling - Number of Bedrooms r /f n J Block # (� ❑ Public/Commercial - Describe Use ° "d ❑ City of CSM Number C1 Village of _ ❑ State Owned - Describe Use Town Z- }- ZZ GIn M. (Check only o e box on line �' Complete line B if applicable) List Previous Permit Number and Date Issued ❑ Replacement System I ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) al ❑ Permit Revision ❑Change of Plumber 11 Permit Transfer to New n Owner IV a of POWTS S stem/Com onent/Device: C heck all that appl - Pressurized In- Ground ❑ Pressurized In -Gro ❑ At -Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explaip) ❑Pretreatment lain) V. Dis ersal/Treatment Area Information: De ign Flow (gpd) Design Soil Appli 'on Ratdmwa Dispersal Area uired st) Dispersal Area oposed (af) LTM E10 619211 .1-1 -0 VL Tank. Info Capacity in Total # of Manufacturer Gallons Gallons Units a New Tanks Fxisdng To Septic or Holding Tank � �� �[ �' � - Dosing Chamber VII. Responsibility Statement -1, the undersigned, anume r ility for installation of the powTS shown on the attached plans. Pl s Name (Print) Plum is Si MP/1v0 "Number Business Phone Number n- Plumber's Address (Street, City, State, Z' Code) Z un /De artment Use Onl miit Fee Date Issued Issuing Sigoatlue pproved $ y5o • d° i f IX. Conditions of ApprovsMeasons for Disappr ' val 3, SYSTEM OWNER: / // i . Septic tank, effluent filter and e4.1 ev�.A L 6 f Ca � SCC L n C i a, dispersal cefl must all b an provided plumbN. n S d eP, M b� `t as per management pl p A w asd� �'� 2. AN Ck iremertts must be maintained a$ per �� #e system and submit to the County only on pa not less than 8112 x l l iacheE I s t \ I Y I t Pl�t� SBD -6398 (R 01/07) Valid thru 01/09 b J (`�� &�7 �j brow l` n� 5 r� , �•`� e t�� -- i r� re�,c,� t esr�. r - PLOT PLAN PROJECT MarkWatczak ADDRESS 1409 Tall Grass Hudson Wi 54016 SW 1/4 SE 1 /4S 23 /T 30 N 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/23/07 BEDROOM 4 CONVENTIONAL XXX IN- GROUND PIWSSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R . Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Alternate Benchmark SYSTEM ELEVATION 96.6/97.4 4.5 below qrade top of 3/4" pipe @ 99.0' Well is to meet all setbacks required by Plans Designed Using Scale is 1 " = 40' WDNR Conventional Powts unless otherwise ' Property Line °f" Manual Version 2.0 t � noted 13 � ° rte k, 80' 150' L 7 At1.B.M. 4+ 10' B.M. v B- 10 2-3' X 90' Cells with >3' Spacing 20' 30' ST 10% Slope 5 B -3 3`� Road B -2 Pro 4 Bedroom .� House v 104' Vent >6 „ Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of rea 5.8ft ^2 /pair of e d caps 4' Long 12" Grade at Syste Elevati 34" o e PLOT PLAN PROJECT Mark Watczak ADDRESS 1409 Tall Grass Hudson Wi 54016 SW 1/4 SE 1/4S 23 /T 30 L2O W TOWN St. Joseph COUNTY ST. CROIX - -A MPRS Shaun Bird 226900 DATE3 /23/07 BEDROOM 4 CONVENTIONAL XXX IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100° Filter BEST Filte ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Alternate Benchmark SYSTEM ELEVATION 96.6/97.4 4.5' below qrade top of 3/4" pipe @ 99.0' Well is to meet all setbacks required by Plans Designed Using Scale is 1" = 40' WDNR Conventional Powts Manual Version 2.0 unless otherwise ' t� Property Line noted Ob 80' 150' At1.B.M. 10' B.M. 10, B -1 2 -3' X 90' Cells with >3' Spacing 20' 30' ST 10% Slope 15 30' B -3 Road B-2 Pro 4 Bedroom House 104' Vent >6 „ Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 5.8ft ^2 /pair of end caps Grade at System Elevation 34" A 'V DRAINAGE 20 ' RECREATIONAL \4's — EASEMENT C , \ TRAIL EASEMENT \ \•e SEE DETAIL — — `� \ \ ,�� \ �- -t - cs c4 °s EASEMEI •.� � , "C1� •�'' 4 62 \ \ • . �i�e� ti \' �' `\ c Or 0 \0 \ \ C 0D Ors \ \ , \C \ \oj DRAINAGE j�'•. \ -- _ \ EASEMENT D '� \ \\ SEE DETAIL 20' RECREATIONAL O \Qs'�°�\ -TRAIL EASEMENT LOT 26 � °r4 �� \ ACRES 7 SQ. FT. \ \ O, =886.0 \ �` \ \ \ \\ \ o LOT 27 ....... `•' 3.001 ACRES ,` \�•: '�� 130,709 SO. Fr. \ \ X L.B.O. =902.0 \ C� .- 09 IN. to CONSERVATION \ EASEMENT ...... N \�s�� LOT 28 \ s \�• \ 3.001 ACRES 130,711 SQ. Fr. DRAINAGE L.B.O. =902.0 \ to EASEMENT E \ . H.W.L. \ =900.0 \ 00 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 8,rjwisjftm. Code County S � r Attach complete site plan on paper not less than 8 1/ 1 in must include, but not limited to: vertical and horizontal refe oint (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and loca t�nar�se4e %%rest road. ' Please print all information. Revs ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner r party Location _ p( r b-11 � Go . Lot J-'-1,L) 1/4<2� 1j 2_3T N R DE (or) Property Owner's Mailing Add re Lot Block # Subd. Name or CSM# city State Zip Code hone r ❑ C C3 Villag e own Nearest Road Y .Tv New Construction Use - Residential / Nu er of bedr Code derived design flow rate 0D GPD ❑ Replacement ❑ Public or commer - Describe: Parent material n Flood Plain elevation if applicable General comments oZ C> 0 /b C p and recommendations: System Type Z �' System Elevation Boring # Boring / Pit Ground surface elev! ft. Depth to limiting factor in. Soil Applicationfate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 - Boris # ❑ Boring @,pit Ground surface elew&/ ft. Depth to limiting factor /—� (( D in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Lo Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 -- -- 0 715- 246 -4516 I �.5 bq5 Property Owner _ Parcel ID # + Page of F7 Boring # E] Boring _ 1 I Pit Ground surface elev. ft. Depth to IimitjOg 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 Z-�� �- � � DS ✓l w 1 ,r F-1 Boring # E] 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/ft: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDifF 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 < 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. ssa8330 (a.6=) 1 .5 b'S Property Owner _ jj Parcel ID # # "' Page of U� Boring # r Boring 1 VQ Pit Ground surface elev. ` l ( ft. Depth to lirruiQog 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 0- (, lofjr 31 5 1^, C-Ld 1 1 11 n�� �� In Z a C- ✓1 �v' 1 F 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 'EfW F-1 Ong # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L 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 need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD•8330 (8.6/00) li Soil Test Plot Plan Project Name Mark Watczak Shau i d Address 1409 Tall Grass Hudson Wi 54016 cS #226900 Lot 2 8 Subdivision Settler's Glen Date 3/23/07 S W 1/4 SE 1/4S 23T 30 N /R W Township St. Joseph Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation 96.6/97.4 *HRpSameasBenchmark Alternate Benchmark top of 3/4' pipe @ 99.0' Scale is 1" = 40' Property Line unless otherwise noted go' 150' AtI.B.M. 10' B.M. 10' B -1 30' 10% Slope 15' B -3 Road 70' B -2 Pro 4 Bedroom 101' House 104' .0 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of-3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must C r 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 anon. _ Review by Date ' Personal information you provide may be used for nd (�rY aw, s. 15.04 (1) Property Owner r P operty Location f I B arr loo I�DYYr' s H U' 2 c 2 1 n y vt. Lot S (,,j 1/4 S E 1/4 S Z 3 T 3 Q N R 2 U E (or) G� Property Owner's Mailing Addless L # Block # Subd. Name or CSM# 20 `6 Se o ,eIrs 44e City State Zip Code City Village Nj,Town crest Road F 2 ( 5� >�! _ I ® New Construction Use: ? Residential /Number of bedrooms tl_ Code derived design flow rate to O Q GPD 0 Replacement ❑ Public or commercial - Describe: c3 , cc Flood Plain elevation if applicable Parent material 6 Sl^ `U / n• General comments / �6 and recommendations: S C vr� 2 e t1 • �• e� © Boring # ❑ Boring �( pit Ground surface elev. 6 U - z ft- Depth to limiting factor J4 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD11`1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 13 -- 5L 2rr-o-16k Cs 2 -ILO lQ r y ly Si I Zms mfr- C,S Cv5 Zms I n( _ 'Z Boring # ❑ Boring ® pit Ground surface elev. /UU '0 R Depth to limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z_nvb f n r ( , 5 9 Z _z} 10 ry ILA — Si 1 2mSbk o 3 Lf� -IZ9 (O r`+l(.Q ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS ! 30 mg/L CST Name (Please Print) i ture CST Number Acm �clnu 25 3308 Date E Address valuation Conducted Telephone Number Z`� 7 - E Property Owner Lwr10n Parcel ID # 3 Page 2 - of Boring #• [] Boring ' 6th Pit Ground surface eiev. /0 ft. Depth to limiting factor �JO in. Horizon Soil Application Ra Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Chu. Sz. Cone Color Ge. Sz. Sh. } Eft#1 -- 'Elf #2 Z ( 0 - 3 1 jo ID LA 2rn-5bk r F J g rye ins Zry, k 1.2- F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Descripfion__ .. Texture _Structure Consistence Boundary Roots GPD /ft= In. Munsell 0U. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 7 I Bonn # ❑Boring F © ❑ Pit ' Ground surface elev. fL Depth to limiting factor In. Soil Application I2alt Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E1f#1 'Eff #2 i Effluent #1 = BODS > 30 < 220 mg/L and TS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/1 and TSS < 30 mg /t_ 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 departm at 608 266 -315 1 n _ ep ... ... r TTY 608- 264 -8777. seo-uro (RO•►mo) i Property Owner lY Parcel to .# 2 2 Boring # ❑ Boring Page of Pit Ground surface _elev. "02—.10 R Depth to limiting factor 3U in. _ Horizon Depth Dominant Color Redox Description Soil Application f P Texture Structure Consistence Boundary Roots GPD/fl' In. Munseli Qu. Sz. ConL Color Gr. Sz. Sh. C) -to (D r3) 3 'Eff#1 •Effi SL.. Z 2-ry -I CC3 r F1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth , Soil Application R p Dominant Color Redox Description _ Texture Structure Consistence Boundary Roots GPD /ft= In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Effg1 'EffiC. a Boring # E] Boring - ❑ Pit • Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture . Struchue Consistence Boundary R Soil Appli oots G /ft cation Ra In. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 Effluent #1 = BOD ;> 30 < 220 mgA_ and TSS >30 < 150 malt • Effluent #2 = 30 m < _ g/h and TSS < 30 mg /l. r 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 6 08 -264 -8777. seamo rR07 ool i PAGE ? j OF DAM LOT# Zg LEGAL DESCRIPTIONSw Y SE Y4 ,S Z :5 T 30 N.R. Z o .(orb SCALE: 1 BM I ELEVATION BM 1 DESCRIPTION BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION SYSTEM TYPE ('on c.r,no rti ( — i CONTOUR ELEVATION 16o , o 0 U o ktV wb d � SIGNATURE DATE 8 - - -- ° °UN'Y PST °F: SETTLER'S GLEN 9 7 _ NOTE: .Vaww scot LOCATED IN PART OF THE NW V4 OF THE SW V0. AN rTHE CONSE u tam EA WENT PART OF THE SEV4 OF THE SWV4, PART OF THE NWV4 OF THE SEV4, THE SWV4 OF 6ERVATON EA4EMENT i SHOVO4 ON THIS GUT ME OON t ED L _ a THE SEV4 OF SECTION 23, AND IN PART OF THE NEV4 OF THE NW V4 OF SECTION 26, To IVE TOWN OF ST. JOSEGN. i ! ALL IN T3■N, R"W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. i pr w� 1 w,w � I I 0799 DETAIL:ORw■fAOe■AIWWT ewweihnrsw.v - - - - - -J -------- \�\ :2 LOT 2 y _ ................... ..._.......................... p \ LOT t 300 j !!! a000.arg !! tx.eeo LOT, apop ACA® 1 - �_-- _— H■RITAOE TRAI L &O.- O 4g c E ............. „� Lora �. ,.. ..., aLp+ ADS �,sJ 21 L \ I/ g OT pO — e4 I R 4 LOT \ 23 & �'� ,aO,Taa e . Fr. ' 'k LOT 20 I ; N.W L -lB00 � 9001 ACiVer `. ~ � ' 'f tt\ !\ fA®.,BlrB ` te n ` .• ` ``,y �j 3. Al:q '•�. DETAtL:aun+AO■■A■■&tentro Le.a -aara LOT 24 DiwNAOE j ♦ l ��,P 'W aHnvvl .• � . Y ,•. �G�p a(? ♦ - t'C3" T.'1 @ EASEMENT , Ro . aaaaa l y \ n ` �\ a.pooAao ik' \ DaAnAOr .. \ -- 2s w LOT a■ R \ �...,. LOT 36 t«AeuoE son AO,ae \' ° �\\ FAaeaea a [ \ t OUTLOT 1 �Iaw.t....n.al ....... I ,.pOpACli® i 2T I \Y �� Ao� {�i.. ^.^ .- -' - -'J I • - -. -� - Le o. wpa.p i± : 2l n\ \ t t' ii ^7f1 rLEN= - — 72 N.W.L -naa LOT 24 r�mr Illaar `L 1. r LOTH . LOT 23 M � ' ♦ � " !F �.8 F Le.o..am.a a �ADg \\ `\ 6 \ / � W � a Lno. -aa¢n a J .� n / ....................................................................................... ............................... , a .. ............................... \ `w1wo.lo, 6■P6if9'■t04.1T oaf, I I r� S&N LAND SURVEYING INC. S IC NN Is Z Town foewp llfaneN I amwttansT A i f ] t TRVOf. DOP M o-IEMf TmK W iCT fitN N n N DIOT 1 f , : TV ROI�l. OVlih MPIp'IE➢ n - i ................. �..�'� T M OMWWN 5 , NDEIY rmnn THAT M nazmtra la A W'T OF A 41■= rrtur 4 nvpri, W a0,f AOL.UTI A�iLT ➢Y M TOHr Ie,RR � M T01rM V t<. ASVIL GllMwtO ro,E Nwl sDVnT 1nos,ww,e,auo.NO. ar i e enuwAmt,fi uaae aCA1e W,w -,OO Gla: 1011 : fOANOf11W SHEET 2 CV 5 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer M CIL T W tx Mailing Address AIL? C" W Property Address 1 "� a- Q, y_"Q�- '�.v�.� ,�fit.�'a✓ (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number b _ l �, �- �' vim LEGAL DESCRIPTION 2 Property Location /a LJ ' , S ' /a , Sec. 2 —� , T ✓1Z R � W, Town of Subdivision �- ��""� , Lot # � . Certified Survey Map # , Volume , Page # Warranty Deed # �. / ,� , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify at all state tits on this form are true to the best of my /our knowledge. we am/are the owner(s) of the prop y escribed ove, by A of a warranty deed recorded in Register of Deeds Office. SIGNATU F APPLICANT(S) DATE ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 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 plant trees nor park 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 onting cy Plan Option #1. f system fails, determine cause of failure, use alternate area and install new system i ested replacement area. p ion #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 843E324 KATHLEEN H. WALSH State Bar of Wisconsin Form 1 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Document Number Document Name 01/31/2007 10: 30AH WARRANTY DEED THIS DEED, made between Lee Signature Homes LLC, a Wisconsin Limited EXEMPT I Liability Company — REC FEE: 11.00 ("Grantor," whether one or more), TRANS FEE: 327.00 and Mark Walczak and Janelle Walczak husband and wife as survivorship marital COPY FEE: CC FEE: property PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): THE RIVERBANK P.O. Box 188 Osceola, WI 54020 Lot 28, Plat of Settler's Glen in the Town of Hudson, St. Croix County, Wisconsin 030 -2131 -28 -000 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 except: Easements, restrictions and rights -of -way of record, if any. Dated January J 9 , 2007 Lee Signature Homes LLC (SEAL) �-✓ (SEAL) * * David L. Lee - Member (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. • St. Croix COUNTY ) * Personally came before me on January H 2007 TITLE: MEMBER STATE BAR OF WISCONSIN the above -named David L. Lee - Member (If not, . : authorized b Wis. Stat. 7 to me known to be the person(s) who executed the foregoing y �DP� instru ent and ackno kedged the same. THIS INSTRUMENT DRAFTE BY 14GTaRY Attorney Doug Berg No lc State of Wisconsin 1200 Hosford Street Suite 201 H 4016 My Commission (is permanent) (expires: �� ) (Si 61fy�iE1;�1� ted or acknowledged. Both are not necessary.) NOTE: THIS IS A STAND MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 • Type name below signatures. ZS25P 693 3.1 Conservation Easement A part of certain Lots in the Property is subject to a conservation easement granted to the Town pursuant to that Conservation Easement executed by Declarant on February 21, 2003 and accepted by the Town on February 25, 2003, recorded in the office of the Register of Deeds for St. Croix County, Wisconsin, on May 28, 2003, as Document No. 723176 (the "Conservation Easement ") for the purpose of preserving the natural topography, native trees, vegetation, grasses and shrubs within the area described in the Conservation Easement. Except as reasonably required to maintain storm water structures and the public recreational trail pursuant to the Recreational Trail Easement, alteration of the natural topography and the cutting of trees (except to remove dead, dying, diseased or damaged trees) is prohibited within the Conservation Easement area. 3.2 Recreational Trail Easement. A part of certain Lots in the Property is subject to a recreational trail easement granted to the Town over which a trail open to the public for use for recreational purposes is maintained as provided in the Conservation Easement. The use of the trail is subject to the restrictions set forth in the Conservation Easement. The Board may adopt Rules, or the Town may adopt ordinances, for the regulation and safety of the trail. Unless otherwise provided in a recorded easement document signed by the Association and the Town, such trail shall be restricted to pedestrian, cross - country skiing and non - motorized biking use, and no motorized vehicles or other motorized transportation devices shall be permitted on any such trail except for motorized devices used by disabled or handicapped persons. 3.3 Drainage Pond Easements There are non - exclusive easements (the "Drainage Pond Easements ") for installation and maintenance of storm water drainage ponds and facilities (the "Drainage Pond Easement Areas ") as reserved on the Plat. No structure, planting or other material which may change the direction of the flow or drainage channels within any Drainage Pond Easement Area shall be placed or permitted to remain upon or within the Drainage Pond Easement Areas. 3.4 Utility Easement Each Lot is subject to and is the beneficiary of non - exclusive easements as shown on the Plat for services and utilities serving the Lots, and for maintenance, repair and replacement of such utilities (the "Utility Easements "), I 3.5 Other Easements The Property is subject to such other non - exclusive easements as may be recorded against it or otherwise shown on the Plat. 3.6 Easements are Appurtenant All easements and similar rights burdening or benefiting a Lot or any other part of the Property shall run with the land, and shall be permanent, subject only to termination in accordance with law or the terms of the easement. Any recorded easement benefiting or burdening the Property shall be construed in a manner consistent with, and not in conflict with, the documents creating such easements. 3.7 Association Access There is an easement in favor of the Association, and any management agent or service vendor retained by the Association, for access on and across the Property, including the yard areas of Lots, as reasonably necessary to permit the Association, its management agent and its service vendors to perform the Association's obligations under the Governing Documents, including its obligations of Maintenance set forth in Section 6. Such easement includes, without limitation, the right to implement erosion control procedures, the MPGS 229406 -1 4