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HomeMy WebLinkAbout040-1306-15-000 Wiscomiti Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515078 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: Creative Homes Construction, LLC I Troy, Town of 040 - 1306 -15 -000 CST BM Elev: Insp. BM Elev: BM D cription: Section/Town /Range /Map No: I) W S- 1 , /V uJ GB a� pfih h 08.28.19.1842 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / 2 �S' Benchmark 2• y �o S Dosing Alt. BM Aeration V Bldg. Sewer Holding S t Inlet S _ S- St/ t Outlet TANK SETBACK INFORMATION TANK TO P/L WE�L BLDG. Vent to Air Intake ROAD Dt Inlet Septic ��� �� f 2 5 Dt Bottom Dosing Heade an. ih�v sad"- & Aeration Dis�e a Holding B ot. Sys tem 7,? • � O � Final Grade PUMP /SIPHON INFORMATION Manufacturer De St Cov r 2 i �_ Model Number Z / d TDH Lift Friction Loss tem Head TDH Ft Forcemain Length Dia. Dist. ell SOIL ABSORPTION SYSTEM BED /TRENCH Width 3/ Length ,1 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS V Z SETBACK SYSTEM TO P/L B WELL LAKE /STREA LEACHING Manufa er• , INFORMATION CHAMBER Type. Of System: / Model Number: / �`Q , "� 3 � u DI IBUTION SYSTEM Bader/ anifold Distribution ze x Hole Spacing Vent to iL ke ngth W �//�� 7 h Pipes) q Le Di a Length Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: //� Inspection #2: Location: 432 Jordyn Lane Hudson, WI 54016 (NE 1/4 SE 1/4 8 T2 N Sunset View Lot 15 Parcel No: 08.28.19.1842 1.) Alt BM Description = ? %NWO ` 1 �i�P/L ` :7h v" t1C.(� � 2.) Bldg sewer length= - amount of cover Plan revision Required? Yes NO I ,D Use other side for additional information. -� Date Insepctors Sign. re Cert. No. SBD -6710 (R.3/97) ' PROJECT Creative Home Construction PL T PLAN /ADDRESS 1301 Coule Rd. Suite #1 Hudson Wi 54016 NE 1/4 SE 1 /4S 8 /T 28 / �19W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/10/09 BEDROOM 4 CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44 IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 98.5' Filter BEST Filter ❑ BOREHOLE • WELL * H. R. P. Same as Benchmark B. M. @ 98.5' SYSTEM ELEVATION 93.4/93.5 5' below qrade 130' Property Line B.M. #2 @ 100.0 Well is to meet all setbacks required by Plans Designed Using ° lo jw WDNR Conventional Powts 2 -3' X 88' Cells with >3' spacing Manual Version 2.0 Vent 5' >6„ Quick4 Standard -W of Cover Leaching Chamber B -3 with 20.0 ft2 of Area 5' 4' 12 Long 5.8ft ^2 /pair of end caps Lo B -2 34 Grade at System Elevation 70 Ic � - S 30' o 4 B droom House 265' Property Line -7 Town Road �2 P A I �➢ Safety sad B»ildings Division County ) /1 carrune>rc�.tNi.�av 201 W. Washington Ave., P.O. �Q �? ,1 r L parha» SC-O s' n Madison, WI 53707- 71198bV nary Permit Number (to be filled in by Co.) aorMgwn. 5 4 t i 15 20 �mteTrahonNntnbex Sanitary Permit' Application A, In accordance with s. Comm. 83.21(2), Wis. Ad- Code, submission of this form to the appropriate governtennl � Address (if diffearmtt than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application form for state-0 wt 0!>HYIiJ fY°1 submitted to the Department of Commerce. Personal intatmation you provide may i mposes in accordance with die Law, s. 15. 1 m „Stars. NO OF - I. lication Information - Ptean Print AR Informatlon parcel # Property Owrter's Nari e property owner's Mailing Address J i1 GovL Lot — ��C , Zi Phone Number P Ye E V Section _ City, Sinto - trcle J ! T ` 2 ' —N; R r TL Type of Building (check all that apply) Oft. Lot J � — gubdivision Name or 2 Family Dwelling - Number of Bedrooms l atr�. NQ f ✓� ✓f BI/JS / ❑ public/Cortprerciai - Describe Use ❑ City of i row ' CSM Number ❑ Village of ❑ State Owned - Describe Use own of { l w Z2 i-ZZ. Cam. j III, Type of Permit: ((C;heck o one box on line omplete line B if applicable) A. System ❑ geplacenmtrtt System ❑ Tteatmemt/Hoiding Tank Replacement Only ❑ Other Moddicafion to Sxisting SYetem (explain) B. ❑ Permit Renewal ❑Permit Revision ❑ Change of Ptinnber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner rv, of ppWTS S tem/Com neat/Device: Check all that a I on - Pressurized In - Cironnd ❑Pressurized In - Ground ❑ At - Grade ❑ Mound >_ 24 in. of suitable soil [3 Mound < 24 im. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (exPlaut) ❑ Pretreatment Device (explain V. Dig r tment Area Worms (g}) Systeun n i D M Design sou Appli on Rate(gpdsfl Dispersal Area Required (sf) Dispersal 4 Capacity in Total # of Manufacturer VI. Tank Info Gallons Gallons Units a 8 g New Tanpu Existing Tanks 'V '[ - . C7 - 0 1 . Septic or Holding Tank Dosing Chamber VIL Responsibility Statement - 1, the undersigned, a ility for iostallatlon of the POWTS shown on the attsiebed plans. Plumber's Name (Print) Pitw MPIMPRS Number I Business Phone Number Plumber's Address (Sheet, City, State. L oun /De t Uge Onl Permit Fee Date Issued Issuing Signature Approved ❑ D' $ ' �`75 • Qa (� / a� ❑ va► Reason for n - IX. CondidM IVA VAqjVkjWns for Disapp val 3 �a �J� p�b►li b�¢, / ^ f > f r 1. Septic tank, effluent filter and dispersal cell must.all be serv_t / maintained as per management plan provided by plumber. 1 G r 2. AN setback requirements must be Inainiained rea 4 z b Amalt is comle pleas ter the system and submit a Co ty only on paper sot lea tbsn 81/2:11 bashes i• sb» SBD -6398 (R. 01/07) Valid tbru 01/09 PL T PLAN PROJECT Creative Home Construction DDRES 1301 Coule Rd. Suite #1 Hudson Wi 54016 NE 1/4 SE 1 /4S 8 /T 28 /R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 6/10/09 BEDROOM 4 DATE CONVENTIONAL XXX IN-GROU97PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 98.5' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark B.M.* @ 98.5' SYSTEM ELEVATION 93.4/93.5 5' below grade 130' Property Line B.M.#2 @ 100.0 B -1 >5' Well is to meet all setbacks required by Plans Designed Using WDNR Conventional Powts 2 -3' X 88' Cells with >3' spacing Manual Version 2.0 Vent 5' >6„ Quick4 Standard -W of Cover Leaching Chamber B -3 with 20.0 ft2 of Area 5' 4' Long 12" 5.8f A2 /pair of end caps Grade at System Elevation B -2 70 34" 30' S 30' Pro 4 Bedroom House 265' Property Line Town Road Wisconsin Departmen o �gEXv SOIL EVALUATION REPORT Pa \ ct � ' Division of Safety and uiidin s QQ cin �f��dance ith Comm 85, Wis. Adm. Code ' Attach complete site p n on Apnott less than 1/2 x 11 inches in size. Plan must County `� 1 Cam ) include, but not limited : vertical a 'b eferen point (BM), direction and Percent slope, scale or 'men �o 'aF cation and distance to nearest road. Parcel I.D. rint all information. Revi ed by ''Date Personal information you provide may be used for secondary purposes (Privacy Law, s, 15.04 (1) (m)). \ Property Owner W WL^ ^ 22 , 2,V-S Property Location KD 1/4fJF1/4. 7 S T N Property Owner's Mailing Address R E (off) W Lot # Block # Subd. Name or CSM# P • o. Sox 3 3 \ S - SUr�S l State Zip Code Phone Number E] City E3 Village Town Nearest Road — I New Construction Use: Residential / Number of bedrooms 1 4 � — Cade derived design flow rate Q — lip Ub GPD ' ❑ Replacement Public or commercial - Describe: Parent material C� t_�el R L � 1 Ll, }-t Flood Plain elevation if applicable General comments ft• and recommendations: �C1M M Boring # ❑ Boring c^,� ® Pit Ground surface el v — 1 �o " t F68 . ZW4,7W e • ft• Depth to limiting factor 7 �8 in. * I.- Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application GPD /ft Rate in. Munsell Qu. Sz. Cont. Color Z Gr. Sz. Sh. 'Eff #1 'Eff #2 G . 3 ` ti? s v�2 `F1- eS S • u u� U i g. i 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - 1f� 411Z3LZ — St I Zf�b1 -c Z )� -BLS 10y2 s16 - s � l Zen sbk wl.`fl- �g — . s • d . 1 , 3 �g -R9 ln�r2yl6 — S o s� _ -� t , z ' 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) Signa CST Number Arthur L: Wegerer O WE L L - 1�,1�+r 03=Z1S - 1S 220254 Address `Ed e g e r e r Soi T e s t i n g & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, UI 54022 \Z -ZZ -O� 715 -425 -0165 Property Owne `- �� P — Parcel ID # Page ' of PEI Boring # ❑ Boring C� ® Pit Ground surface elev. a y ' ft. Depth to limiting factor t u O in Soil Application Rate Horizon EDe Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 II3'l23 L Z 51I Z`� M Ct�j Z�' •S �� Z 1y -3� tpY i2 316 �� ( Z 7 CS 3 3 -tn� lo-� R y j 14 jV ...... t F -1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring # ❑ Boring El 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 • 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. SBD4330 (R.6100) . Property Owner `V �� (7 M Ls��- Parcel ID # �'h ✓1� i /lJ G Page Z of Boring # El Boring ® Pit Ground surface elev. C ? ft. Depth to limiting factor 0 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /il' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I t �cri23�Z -- si f z�s�k l0 Yz 31 ��, Z • .� Z `� 6 � � V4 s b 1'c h'1 `Fl-- CS tort R V f 6 S c� s 9 1�1 1 ,1 t. Z ❑ 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 /ft= 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 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM' 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 T1te 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. SDU4330 (R.6/00) i Wisconsin Department of Commerc SOIL EVALUATION REPORT Division of Safety and Buildi Page cf - • in acccrdance with Ccmm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inc ^es in size. Plan must County ` C 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 road. Parcel I.D. Please print all information. Reviewed by • 'Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner _ Propert Location � Z 114 1/4. S T'Z U N R Property Owner's Mailing Address E (cr) W y 4 m CS �Qx 3 Lot Block Subd. Nae cr "M;; City State Zip Code Phone Number ❑City Vi llage lage To Town Nearest Road _ New Construction Use: 3 Residential ! Number of bedrooms -� � Code derived design flow rate � S ❑ Replacement _ ❑ Public or commercial - Describe: _ GPD Parent material G L.-,e) } ; t � Flood Plain elevation if applicable f� F�1 General comments ft and recommendations: � t etc S 'ZD Boring # ❑ Boring ® Pit Ground surface elev. `1 ft. Depth to limiting factor 7 �9 in. Horizon Depth Dominant Colorl Re Soil Application Rate dex Description I Texture I Structure I Consistence Boundary Rocts GPD /ft2 in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. kD -�3 10`' �z 3 L Z I — _ � n 'Eff #1 'Eff#2 z `% M `� I C w - g U � — E Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor R 9 in. Horizon Depth Dominant Color Redcx Description Texture Structure Consistence Boundary Rcots Soil Ap plicatio n Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 I 0- t 1 0't231Z Z' 1Z -qg 10 2316 — si I Z�nsbk yrL` �3 — .s •S )o�2VA — S o s� I �• z ' Effluent #1 = BOD, > 30 _< 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 m CST Name (Please Print) - s _ 9n. and TSS < 30 mg/L Signa re • IT Number Arthur L: - �Wegerer �_ � 03 Z1S — 1S • Address W egerer Soil Testine & Design Service Z2 �p one Number 421 1. Hain St. River Falls, (dI 54022 Date \Zati Z� O 3 Tete 715 -425 -0165 PLOT PLAN Page of 3 ` Scale 1'= L bT t 9 B� �o 96 1 L�� ► LO T 1 S PE Lo-' CvZjjEe 715- 425 -0165 220254 o3 -ZLS -\ S CST Signature Date Telephone No. CST No. Job PTO. 24 \\ \ 21 \ \\ \ S \ , \ N 655 Ds�s. � \ Q v� 1� ��� LOT 17 \ �`� 5 5�. 56874 S.F. \\ ��� LOT 2 tx i 1.31 Ac. >;Q 48947 S.1 p 25 1.12 Ac. - - - - -- N 89'36'11 "E 302.91' 1/\ 6 20 162.26' 140.65' — f \ S 85_24 '444_W 320.E 1 �1 { LOT 14 N LOT 16 LOT 1 w LOT 15 3433 S;F. I 51986 S (43603 S.F. I o 1 45252 S.F. 1 cr �+ o rj 1 1.23 Ac. 1.19 Ac 1 1.00 Ac. I o I 1.04 Ac. N � „, ►v E I p I 11 / X0'$2 4 \ nD co 1 9 �.8 LOT 2 19 \ 89845 S.F /^ \\ 26 \ 2.06 Ac. k \ LOT 25 61036 S.F. 1.40 Ac. F j Y -k IT, 7 CSX I SSECTION 30.10 - Lot I S � ,J� -T I ' ' (N�NNI�01_ l SUNSET VIEW I uNPIgnED LANDS � _________ ------ - ------ ------ - - - - -- v - N!�!1'11t s 9s1'64'E nu.16' - - - - - -__ DEVELOPMENT VMI KOF - r1l -- -- ' - - - - -- N 951' ' LOCATED N THE SIR I/4 OF OE NE 1/4, 118 SE I/4 OF AE NN 1 /4, .. OE NN 1/4 OF AE SE 1/1 ND N AE K I/1 OF OE SE 1/4 OF $800011 A 3713, RIO, TOO OF TAD,', 9CAC9 COIJI MIX" TT.W TArE U �\ CURVE DATA TABL s - - - - --- ----- - - - - - .1 \ 0 -- - - - - -1 OjJ / , \ . 3441'• all M all W I AI I . N 91171•. 0I .. WIN I 11013 31IX 31.01' Ir1Yl1' Na Y 971'' I I 21171' A31 Xoo 411 [ W,CE 177a LOT 20 \ a a V )TICS, 1941' N Nor F n J • r 111 F A • N SYIYn' I ! O INN 5.1 Cliff 111.9' piYIO' Ina X IJIAUI' r n 5 X'07' I LOT 19 I g IN Sloq' I 1.1 109 Nr 441'6 1117 X Mar n , . N mN9r I At 1.41 Sr71'Ir. 1017 ° I • a1X ; 4' . i0 1.1 plot 37711' 19921' 1159 S N W E n 1.1 NX11'r n 1 • s 94"r 1 I 1'a Az i0 7 109 NO 171'"1' Ila' r 2S4AO0 $.F. 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N91rE .24 117.1' "X.51' 11X9 I ma SII'119 ° 23•SOlpIr. NN•f 3411'9[ .X 111177 Xffr n0•I n3•S "If . 1 / f LOT 21 1 w' D 17.21 ax W 1 w X 73"41' IoLN X91, ON s 34'1"61 '• � ------- - - -•- - - - - -; ,'1 1, \ A "+IN 1Apl' IOLN' N7rN• woa SNOW( 11 +" LOT 10 w . wm "; 9 ;, I \ s6r4s s r. w N SA9 "41 XA7r r 7 Mao Sr I S W I I SE -Nw I 741 k. w 21 Ara m9 9 3"401 110% s 4199• r k. +' '� I I \ LOT 21 mar In.w vvW "Ar s )MY r � I 5 I 1 \\ I ;+ V -3 7319 MX 0934' 211.X N N NrN • . n1 3 699,1 021.. VN'N• 1T a map Igor N INu'N' NA' . N it 0 u IO LA9 IAN' rail' "X.41' NN21b'. IN N ANN 51,I4' 111111• 340' N 19'1' 3 I p�q '3 #••.) ' ' 15� 5 I \ ° 21 -30 m.N' NuY 1 9ru' Ia11' ,417"1'" nN 11 9921'. n X • S .N)1Nxr ,I X. N VN3rr 1 . 4 pp X S 4 al 1 i I 1 \ 1 31 -37 Wit 111,9 4171' Ill" f , 711771. 0 . r 9g1i' I vNININ , O i , 4,� �,qrN 1 ®\ \\ U ; 33.34 moo' 19"11 Sr10'3 14134 s 1411 r u JS • 19110•. 9.4 -3 N71A' N 500.27' ' 0 \ O I� \ \\ a • ' / ,i -- - •IORDYµ LANE s °,+ 1y°j0 It 1 \ a, a , \ 59.27 -0 \I ' 0 /' l a X96.15,.. ; 1*.61' ` \ / L T I ) I I i � y). 3 �---- r LOT 34 LOT 33 \ 1 4. "� I . $ LOT 17 \\ ti b. s 7 j' L 1195 F. % LOT 12 I ° N° 137 k. s (( r J' ( 1 191 Al. ) 5 ( NGi O7. 0 1 u i LOO k 1„ z 1 979 37- 1, S , ' 1 0 \ 1.17 k, Q 1 �L_ J X x291' _______. -_ /h Ii 1 I.IS k. 2 0 ' ® O '� W 936'1"8 /\ lkedem - 162. 140.9 ( \\ \, - 97 Sc1N11.7NIA7N71Nd71371pIWW IN.Smm ,N I �. '' ✓• 3 117E - - 7 I --- '•1 S 9'2134 110 - Wk 9e. I :/ N ,, I I' I 11 10 I LOT 23 n L - - - -J L_J // 11 �I LOT 13 I$ LOT 14,^ "LOT 151 ; I "LOT 161 I ° Z c.Eer, 199.1:' an.a• /LOT - + ` 1. 4X9 sa w 1 •pw sr .1 l SINS e7 ° \ �� 1 41094 S.F. B 140 3 . 1 °. La k. ! LID A. EAST 1)0 cow, (4058 SF 1 , u a. I V• \ j ° TOO k 1 1.04 Ac 1 "I / I \\ r SECTION e, TO IfY I 11 p L11 k. I '8 SiLId7M CONTY I•(_14dM11NAW� I9 1 I$ I I u / QD - L ALA NgYA(NT \ \_ -_ �__ -z -- &�/ / 3441 / • y A n U L\. - a J .,_- <� Qp 73.7" � 97 is3le' _ � LOT 24 \,' r 45137 / N 0 LOT 31 /e` \ 5 sr51'SI' 4A31' 417 / \ b \ 7.9 k. N +"NOON +q De42! 16619 141377 1.19 k, b3' �y O . 19340 D z 29.1' z N./9' © i / \;� \ 141 \\ 0 N 4 Agl�dlp NN -SE " �' / /j r. " __�$ - ©_ $ /1� I \\ \\ I�1� \\ M.P. R.O�W III /LOT 30 8 / 3 LOT 25 \ 0.J /1" / r r ra r I, I \. \ I D .r • ,INX o " /LOT 29 w I LOT 28 I I i 1� 1 " \\ \\ ` wn�•°v LOT 27 LOT 26 b / / 4" / ,7511 Or in 1 4361 sI I 171061". u 47137 Or I s I \ \ u , /4l / I.a k. 1 = 1.00 k N k . ' I9 k. : I. I I i . I� 1 \ \ \ \ "W NC- - -- -� J L ia1 - ii -J L_-o10'_ L__I .4 5 WWII IT 14" in IIIaU m mrANXm X m m NE -SE NN UNPLATiED LANDS °o 1 ITN or ! I /1. (ITT= fO0111 '4 i INmm mu I9 0 I9 200 1 59 SOITI(AST COW, SECTION O, FOND DA1770C xU - ra3 SHEET 2 OF 3 k wn M OM DENT THIS INSTWIIT 9Af3FD V JANSS N. VERA ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNP.RMHjp CERTIFICATION FORM OwnerBuyer �i e ��� �� p � �� Sf�� ,/� �� Mailing Address 0 �o� / ) `� r Property Address r.10 � (Verification required from Planning & ZAAng,Department for new construction) ` City /State Parcel Identification Number 7�0 7 LEGAL DESCRIPTION Property Location 1 /4 , 1 /4 , Sec. v , T ZI N W, Town of / D Subdivision - �� r's� - ' E%i' Lot # Certified Survey Map # zr Volume r , Page # Warranty Deed # 0 d Volume , Page # Spec house (�no Lot lines identifiable no SYSTE MAINTENANCE AND OWNER CERTI Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumgm out the septic tank every three years or sooner, if needed, by a licesised 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 e 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 p lumber, restricted p that 1 the o si lumber or a licensed pumper verifying ( ) wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), s ep tic teak is less than 1/3 full of sludge. Uwc, the undersiped have read he above requirements and agree to naaintnin the private sewage disposal system with the st mdards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Stale 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 that all statements on this form are true to the best of my /our knowledge. Uwe am/we the owaer(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of edrooms OF LICANT(S) DATE * ** I � GNATLJVE ation 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. 08105) Maintenance and Contingency Plan for a Septic System I 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. a 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 (Fem go c Plan stem fails, determine cause of failure, use alternate area and install new 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 f Illill iilll Illli f1f1111f11 IIIII IIII Illlll IIII IIII * 8 9 8 0 0 3 2 State Bar of Wisconsin Form 1 -2003 898003 WARRANTY DEED BETH PABST REGISTER OF DEEDS Document Number Document Name ST CROIX CO., WI RECEIVED FOR RECORD 06/15/2009 09:10AM THIS DEED, made between B & L Land Development, Inc., a Wisconsin WARRANTY DEED Corporation EXEMPT 11 ( "Grantor," whether one or more), REC FEE: 13.00 and Creative Home Construction, Inc., a Wisconsin Corporation TRANS FEE: 225.00 PAGES: 2 ( "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 3� St. Croix County, State of Wisconsin ( "Property") (if more space is Name and R Address needed, please attach addendum): �VXk I k J G I q o fit) rcr L&4 9d, 51e- zoo Lot 15, Plat of Sunset View Development in the Town of Troy, St. Croix County, k)rW Wisconsin 040 - 1306 - 15-000 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 June i ,`��, , 2009 B & L Land Development, Inc. (SEA (SEAL) * * Lyle eatherho t, President e (SEAL) (SEAL) * Geissinger, Secre </Treasurer AUTHENTICATION AC X - DGMENT Signature(s) STATE OF WISCONSIN ) ss. St. Croix COUNTY authenticated on "t J, y " ) ) * Personally came before me on June 12, 2009 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Lyle Weatherholt, President of B & L Land Development (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrume nd ackno led d THIS INSTRUMENT DRAFTED BY: * r Attorney Doug Berg Notary Publi6 of Wisconsin 1200 Hosford Street, Suite 201 Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 * Type name below signatures. 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