HomeMy WebLinkAbout600230 032-2174-02-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit H!EIev
's Name: City Village Township
OEVING HOMES TOWN OF SOMERSET
CST BM Insp BMElev. BM Description
TI(1KI ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
D v0
Dosing
Aeration
4 1cm
Holding
uv c�cTMArl! IAIGrII?MAT10N
TANK TO
` P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
CI "DISSIPHON INFORMATION
Manufacturer Demand
h GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
BS
HI
FS
ELEV.
EBenchEmark
EJ
Alt. BM
Bldg. Sewer-
i
St/Ht Inlet
N p
SUHt Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bot. System
Final Grade
St Cover
r.
SOIL ABSORPTION SY5 I tM
BEDlTRENCH Width Length No, Of Trenches PIT DIMEN:
DIMENSIONS
SETBACK SYSTEM TO P!L BLDG WELL LAKE/STF
INFORMATION Type Of System:
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size
Pipes)
No. Of Pits Inside Dia. Liquid Depth
CHAMBER OR
UNIT Model N
x Hole Spacing Vent to Air Intake
Length Dia Length Dia Spacing I
y
SOIL COVER x Pressure Systems Only rxxD—epth
Mound Or At -Grade Systems Only xx Mulched
Depth Over of xx Seeded/Sodded
Depth Over soil —
Bed/Trench Center Bedrrrench Edges _' Yes I No Yes I_' No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: j� ,/ 4 f y . '
Inspection #2:
Location: 2022 57TH ST
B
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? [ Yes n No
Use other side for additional information. — — — Date Insepctor's Signature Cert. No
SBD-6710 (R.3/97)
S/try - &j 1')-'; 3 a
ryJr+rrM
RECEIVED Safety and Buildings Division
Comity
8 K r/1 201 W. Washington Ave., P.O. Box 7162
Sanirary Permit Number (to be filled in by Co.)
:f t e Madison, Wl 53707-7162
OCT O I i p
Z
-WAIVnollmS��PRpR� WY
� I �v Aug,'..._ 4E0
�3�
SlateTrans�ti-amber
AM -
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the approptLvc b.. _
Project Address (if different than mailing address)
is required prior to obtaining a sanitary pemuL Note: Application forms for state-owned POWTS are.subm=d to
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Eqng Law, s. 15. 1 m), Stan.
n � , C L
iJ J 5k
L A lication Information - Please Print All Informatio
Property Owner's Name /
Parcel #
ae, je /) I (- "
J�-13 -�-
Property OwncrTsMailing Address
J
%
Propertyvtot Location a s , 1 1 q . 57
J
`
L.�i G�
Section
City, State
Zip Code
Phone Number_
CZ,
�t
/�E�ycle oy�'N
T N; R 7- Fi6r W J
( `�
II Type of Building (check all that apply
Subdivision Name
2 Family Dwelling - Number of Bedroo
��
Block
❑ City of
❑ Public/Commercial - Describe Use
C{i
�.---
❑ State Owned - Describe Use
❑ Village of
CSM Number
2-; b� f
,,. Le,
Town
III. Type of Permit: (Check only one Ox on line A. Complete line B if applicable)
A.
System
❑ Replacement System
❑ Treatment/Holding Tank Replacement Only
G Other Modification to Existing System (explain)
B•
❑ Permit Renewal
❑ Permit Revision
❑ Change of Plumber
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration
Owner
IV. T ofPOWTS System/Component/Device: (Check all that apply)
it (J
-Press sized In -Gm ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) [],pretreatment Device (explain)
V. Dis rsanreat ent Area Information:
l
E�sign Flow (gpd)
Desi� So lication Rate(gp
Area Required (sf)
Dispe�&()
�1]�. Propose sf) System
Elev
7,
I
VL Tank Info
Capacity in Total
# of
Manufacturer
JON
Gallons Gallons
Units
o
New Tanks
Existing Tacks
�
j, 4 Joe
f.
d
o v `
.2
Septic or Holding Tank
Dosing Chamber
VIE. Responsibility Ststemen - I, the undersigned, assu esponsibility for installation of the POWTS shown on the attached plans
Plumber's Name (Print)
Plum a
MP/MPRS Number
Business Phone Number
L
1. "� y
Pi 's Address (Street, CitySt-, Code �n
O� ,S/A" Gti,/
VIM Couuty/De artment Use Only
Approved ❑ isapproved Pelmet Fee Date sued `7 Lssuin
$
cut Signattue
oi�
canon for Denial I /4
DL Coudi .% PProval
3� Da.�O . r a %�,�
/--�__�x1
<iKoentbj musks �!
t0 ngi��S:
by
11
t �
as per inarayemenl. plan prvlideA p'lurllber. ka „Aw1V,4,
M�t�4
2. Ai sell k re g iw.tren;�s must be r hint; irtd
as per aWftnbl* co& I :.rdinancel. _ X, IAMDA—
I IDCA -� CIN YVZO45 �I
Attacb to complete plans for the ys em and submit 1n ti]e County only on paper not less than 8 112 z 11 inchq� sun
SBD-6398 (R. 11/11)
.f
IV I
AA—
System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
SW 1/4 SE 1/4S 22 /T 31 N/R 19 W TOWN Somerset COUNTY ST.CROIX
SYSTEM ELEVATION 97.7/97.4 2.1' below grade DATE 10/3/17 BEDROOM 3
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT XXX HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of EZ-Flowsl 8
BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
N
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 10/3/17
Owner: Oevering Homes
Location: SW 1/4 SE 1/4 S 22 T31 N,R19W 2022 57th St. Somerset
System type: In -ground absorbtion system (conventional)
Manuals Used: In -ground absorbtion system (version 2.0)
Pressure Distribution Manual (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Gamer Cross Section
4-6, Maintanance and Contingency Plan
7. Filter Specifications SIet
8. Dose Tank Cross i ciion
9. Pump Curve'
Signature
License ny ,er #226900
.. System PLOT PLAN
PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
SW 1/4 SE 1/4S 22 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
SYSTEM ELEVATION 97.7/97.4 2.1' below grade DATE 10/3/17 BEDROOM 3
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT XXX HOLDING TANK
MOUND SEPTIC TANK SIZE
1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of EZ-Flows18
IL BENCHMARK V.R.P. Top of 1"pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL +H.R.P. same as benchmark
Cross Section of a Two Cell EZ Flow In -Ground Dispersal Component
Design Flow `�
Required dispersal area � 50 (EISA) _ �S (number of units)
�-O Loading Rate . -!5' = Required dispersal area 9( L' Sq Ft
Geotextile fabric to meet Comm 84.30(6)(g) Wis. Adm. Code
Minimum of 12" of cover over top of cell
Two observation/vent pipes to be provided per cell
Not to scale
Cell #1 Cell #2
System Elevation: / /i Ft
Final Grade. i/-3Ft
System Elevation: Ft
Final Grader S Ft
Final Grade
Observation Pipe
Geotextile Fabric
System Elevation
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION
Owner , ,
J
Permit #
13ESIGN PARAMETERS
Number of Bedrooms
❑ NA
j Number of Public Facility UnitsJA
I
j Estimated flow (average)
gal/day
i Design flow (peak), (Estimated x 1.5)
7gal/day
Soil Application Rate
gaudawtE
i
1 Standard Influent/Effluent Quality
Monthly average*
Fats, Oil & Grease (FOG)
530 mg/L
Biochemical Oxygen Demand (BOD5)
<1` 20 mglL ❑ NA
Total Suspended Solids (TSS)
<150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BODs)
530 mg/L
Total Suspended Solids (TSS)
530 mg/L
Fecal Coliform (geometric mean)
5104 cfu/100ml
Maximum Effluent Particle Size
Ya in dia. ❑ NA
Other:
"Values typical for domestic wastewater and septic tank effluent
SYSTEM SPECIFICATIONS
Septic Tank Capacity
gav,❑
NA
Septic Tank Manufacturer
El NA
Effluent Filter Manufacturer
��
❑ NA
Effluent Filter Model
❑ NA
Pump Tank Capacity
gal
NA
Pump Tank Manufacturer
❑ NA
Pump Manufacturer
❑ NA
Pump Model
❑ NA
Pretreatment Unit
❑ Sand/Gravel Filter
❑ Mechanical Aeration
❑ Disinfection
❑ Peat Filter
❑ Wetland
❑ Other
Dispersal Cell(s)
n-Ground (gravity)
❑ At -Grade
❑ Drip -Line
❑ NA
❑ In -Ground (pressurized)
❑ Mound
❑ Other:
Other.
❑ NA
Other:
❑ NA
Other.
❑ NA
IAINTENANCE SCH
Service Event
Service Frequency
IInspect condition of tanks)
At least once every: :ears
❑ month(s) Maximum 3 years)
❑ NA
Pump out contents of tank(s)
When combined sludge and scum equals one-third of tank volume
❑ NA
Inspect dispersal cell(s)
At least once every:
month
� ❑ year(s)s) (Maximum 3 years)
❑ NA
(Clean effluent filter
At least once every:
❑ onth(s)
, year(s)
❑ NA
inspect pump, pump controls &alarm
At least once every:
month s
-> Cy)
year s
❑ NA
I=lush laterals and pressure test
At least once every:
moth
p Year(s)s)
❑ NA
7ther.
every:
At least once eve
❑ month(s)
❑ year(s)
❑ NA
ether.
❑ NA
MAINTENANCE INSTRUCTIONS
!Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
!Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
!include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
ixmbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (%) or more of the tank volume, the entire contents of
j;he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
land any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION nti Products or other chemicals that
cells If high concermations are detected have the contents of the
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of pat ng
may impede the treatment Process and/or damage the dispersal ()�
tank(s) removed by a 5eptage Sen"cing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface. oar is restored the excess wastewater will ble
effluent -
During power outages pump tanks may frill above normal highwater levels. When p in the backup or surface dWftrge of effluent -
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result pig Operates prior to restoring power to tide
To avoid this situation have the contents of the pump tank removed by a Septage the Rump controls to restore normal levels
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating
within the pump tank. disturb or compact, the area within
Do not drive or park Vehicles
eh dm over
oval-grade dos persa. absorption area.I cells, Do �e or park over, or otherwise
15 feet down slope Y and prolong the life of the p0VTT,$'
Reduction or elimination of the following from the wastewater stream may improve the performance
dissnfectants; fat; foundation drakn
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers;
um water, fruit and vegetable peelings; gasoline; grease; herbiades; meat scraps; medications; oil; painting P
(sump pump)
pesticides: san'dM napkins; tampons; and water softener brine.
ABANDONMENT followinsteps shall be taken to insure that the system is propetiY
When the POWTS fails and/or is permanently taken out of service the g
and safely abandoned in compliance with chapter Comm 93.33, Wisconsin Administrative Code:.
• Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly 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 soil,
gravel or another inert solid material.
CONTINGENCY PLAN e a code corrtpiient
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provrd
replacement system: of a laceent soil aeon systeim.
_. A suitable replacement area has been evaluated and may be utilized for the locatid should not mbe infringed upon by requiiled
The replacement area should be protected from disturbance and compaction meeed
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nmust comply with the ruled in
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems
effect at that time. fiances in POWTS technologlr a
❑ A suitable replacement area is not available due to setback and/or soil limitations. 8amng
holding tank may be installed as a last resort to replace the failed POW TS.
the soil and site evaluallion
❑ The site has not been ev ed suidentify a suitable itable replacement arealacement area. if no replacement on failure
ai►s availablea0hokiing tank may be installed) as
must be performed to locate a
a last resort to replace the failed POVVTS. lace following
❑ Mound and at -grade soil absorption systems may be reconstructedhe rulesin effect at that time moves/ of the biomat at the infiltrative
surface. Reconstructions of such systems must comply
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND►OR INSUFFICIENT OXYGEN. DO O
ENTER A SEPTIC, PUMP OR OTHER TREATMENTY E DIFFICULT UNDER
O IMPOSSIBLE.R CIRCUANCESDEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TA
ADDITIONAL COMMENTS
POWTS INSTALLER pOWTS MAINTAINER
Name. -
�.��, , l _ Phone
Phone
SEPTAGE SERVICING OPERATOR MPER LOCAL REGULATORY AUTHORITY
Name Name
Phone = J Y Phone
This docurnentwas drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.WI), (2) & (3), Visconsin Administrative Code.
A A
9
0 1 G01) between Case and Se,penline
SECTION A -A
Septic -Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer
Tank Model Number J
Total Tank Capacity
Max. Bury Depth �
Filter Manufacturer i
Filter Model Number j �
Minimum Pump f erformance Required
GPM Z;7"I .S Ft TDH
outlet Manhole Min. 4" Above Grade With
Locking Device. inlet Manhole
< 6" Below GrrWe Sealed Waterti-2ht
Famed Grade
r I{
Pump Manufacturer
Pump Model Number
Alarm Manufacturer
i' S
Alarm Model Number
Switch Type
c 4, , G ci
Total Dynamic
Head (TDH) - Feet
JEievation Head
�tal
Pressureetwork
Loss
�-
Force Main Loss
P S-
Total
—
Manhole Min. 4" Above Grade
Securely Mounted With Locking Device
Weather-proof
Junction Box --
Vent Min. 12"
Above Grade
With vent Cap
Disconnect
Means
Qutlet Filter --�
----
-
-- - -
_ _
Inlet BaffleInlet
A
1/4"
Switch Sett ugs and. Reserve Capacity
;:;
Weep
'
Tank Volume = / GPI
B
Hole
Dimension: Inches Volume Gal.
`
(reserve) A
off Elevation C
B 2�
c �-
y
Bottom
(dose)
D
?;: D
Elevation
(dead)
L� Ft
..
Total
Septic,/dose tank is bedded and back filled in accordance with the
GENERAL INSTALLATION: The depth of bury as specified by the manufacturer may not
manufacturer's product approval specifications. Maximum dep device (padlock)
Manhole covers exposed to grade have an effective locking t fittings, and
be exceeded without prior approval.
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight g',
laid on stable soil to prevent settling or agog• The force is sleeved with 4" Sch. 44 PVC to bridge the tank
and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.21
excavation
Page of
02105 U
o
cn
HEAD CAPACITY CURVE
Uj
MODELS 53/55/57/59
25
6 J 20
4
10
5
0 1
j.S. GALLCNS 10 2 30 1
80
-L
OW PER MINUTE
TOTAL DYNAMIC HEAD/CAPACITY
PER MINUTE
FIFFLUENT AND DEWATERING
Model i
53/55/57/59
t. Meters I
Gal.
5 1.5
�Oli
43
'63
"
'29
4 6
15' 4.6 i
19
72 72
s"ut—off H e cd
19.25 ft.
',5.9r-.')
3 '5/16 6 5/32
4 5/8 "1
/2 -11 /2 NFT
1
4 5 0 1 0
15/16
-4
009897 4 / 1 6
j
Variable level float switches available.
Variable level long cycle systems available.
Available with special cord lengths of 15', 25', 35'and 50'.
Alarm systems available.
Duplex systems available.
Single Seal
Model
Control selection
Volta Phase Mode I Amps simplex Duplex
Listings
UL
M /59
1`15
1 Auto 9.7
_ I
y I
y
N53/55 & N57159
11-2
1 W 9.7
:3
2 or 4& 5
BN53
115
i A0 9.7
y
y
BN57
"5
1 Auto 9.7
N
Y
BE53157
23-0
Auto 4.8
y
iyvy
y
H
D53155 & D57/59
230
Auto 4.8
y
y
E53/55 & E57159
230
Non 4.8
Single piggyback switch included.
10
S/32
SK858
SELECTION n-b;-DE
1. Integral float operated mechanical switch, no external control squired.
2. Single piggyback -variable level float switch or double piggyback variable level
float switch. Refer to FM0477.
3. Mechanical alternator -M-PW 10-0072 or 10-0075.
4. See FM0712 for correct model of Electrical Alternator.
5. Variable level control switch 10-0225 used as a control activator, with I
Alternator (3) or (4) float system.
e ON
, d.e,C
; �s anc,.,;,lng
For information on additional Zoeller products reter to catalog on Piggyback Variable Level Float Switches, FM0477; s
Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FIVI6487; and Single Phase 3iecui-al and safet%r '�r 2�s zr. "Id �c 4�:; wc-: i� C"-61g me.
cc sn n- z�p� ta: ssfety =rd
Simplex Pump ControVAlarm Systems, FM0732.
R E S-5 ED,'i V E P 0V R
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL To., P.O. BOX
Louisville, KY 40256 Manufacturers of
SHIP TO: 3649 Cane Run Road
p o r Louisville, KY 40211-1961 ar, / UL 14 f r -5 S/A 1z T llq� 7-q
(502) 778-2731 - 1 (800) 928-PUMP
htfp.,,7www.zOclier.corn FAX (502) 774-3624
@ Copyright 2002 Zoeller Co. All rights reserved.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address' ,
(Verification required from Planning &Zoning
City/State
LEGAL DESCRIPTION
Property Locatiou'<Or/ V�
Subdivision
Certified Survey Map #
,J lL+d�
ror new construction.)
Parcel Identification Number (% 5�� % %��—� 60� — 07T
''/a, Sec T 3/ N R #W, Town of
1 - �'
Warranty Deed # + �' _ 7Z L l�
Volume Page #
—' , Volume
Page #
Spec house res
no Lot lines icleatifiabl _e no
SYSTEM �—� M MAINTENANCE AND OWNER CERTIFICATION
Lot # � .
Improper use and maintenance of your septic system could result in its premature failure to handle wastes_ Proper
maintenance consists of pumping ont the septic tank every three years or sooner, if needed, by a licensedspumper.
the system can a#fect the function of the septic tank as a treatment stage in the waste dis al s stem. OwneWhat you pat into
responsibilities are specified in §Coum . 83_52(l) and in Chapter 12 - St. Croix Coup SanitarySy maintenance
County Ordinance.
The property owner agrees to submit to St. Croix Coup Planning owner and by a master plumber, journeyman plumber, restricted plumber f &Zoning Department a certification form, signed by the
wastewater disposal system is in proper operating condition and/or (2) after inspection sed artPumping verifying that (i} the on -site
less than 1/3 full of sludge. (if necessary), the septic tank is
liwe, 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 that all statements on ss
b
Property described above, by virtue of a w aform are true to the best of my/our knowledge. Uwe am/are the owners of the
nty deed recorded in Register of Deeds Office. ( )
Number of bedrooms
�IGN�A�OF APPLICANTS)
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. os/os)
m I- I
\ NORTH 114 CORNER
z � S£C. 27-• JT -19
�
o (FOUND A: t JAWNUM
W
c, MONUMENT)
u
NORTN UNE OF THE SW 1/4 OF THE SE 1/4 OF SEC. 22
o
u
1320.61'
l
N 99045'49" E —
---
799.70'
1
464.91•
Jy y °
o m \ BO' RADIUS TEMPORARY LYlL -DE-SAC
r
f
F£Nce
W = D _Z EASEMENT (TO HE EXIINCUISHED
S SS°454v' UPON EX7EN5JOV OF ROAD)
i
LOT X
195, 724 sq. ft.
4.49 acres
LOT 1
y
.T 02f acres h
r0 O. H. W. Id,
s\�*s•
LOT 2 y�
J. 15Y acres
rO O.H. WU o�
3
LOT 3
o,.
o
\ ry
J 02t acres
TO O. H. W. M.
z
'A � \
A
J �
w c
LOT 4
3.02f acres
V1
ri
1�n "�f"281j. S1T5
W
O
Z3 1^ \ .
O
V-.
\�,,
�,
cars
.�= o.............. �.
J.03f acres
TO O.H W.M.-
o
01
R
5
W
N
~ PROPERTY ADDRESS'
I / 2022 57TH STREET
/ 80'T£ SOMERSET WI 54025
CU DER C \ + l m a
t � ep
3-Z5o,ACRFs
��� M I @ a! G A
032 21�42- 0
7,�
�y
Ott, Epgel J?p `xqR
i�
.y Q �
LEGEND
r
DRAINAGE DIRECTION '9
X =WOOD LATH OR PIN FLAG SET
® =WOOD HUB SET AT 10' OFFSET
OR ON BUILDING EXTENSION
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Division of Safety and Buildings
in accordance with Comm 8 Wis. Adm. Code
(( County
Attach complete site plan on papal pot le ig than 8 3/sir 111aches in ize. Plan must
include, but not limited to: vertical and horizontal �eTere-hce' direction and Parcel I.D. ll
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 03 d r
Please print all information. R
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
'roperty Owner > Property Location
Page of
Date
Govt. Lot , 1 /4 -, 1 /4 T N R ,' E (or&
Property 0 er's Mailing Address Lot # BI Subd. Name or CSM#
C' Stat Y Zip Code Phone Number ❑ C%' ❑ Village ,®Town Nearest Road
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New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable -7 p ft.
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Address Date Evaluation Conducted Telephone Number
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The Del)artment of Commerce is an equal opportunity : ervice 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.
SB0.8330 (RR6 1)0)
OWNER
Name
Address
Benchmark I Ll 160, 0 /V W
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Benchmark 2 Ea 10a.l?, --Cl MOST
Sol! BcirllLY
Suitable Area
Page 3 of 3
Brian Parnell
CST 231314
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Document Number
State Bar of Wisconsin Form 2-2003
WARRANTY DEED
Document Name
THIS DEED, made between Alan J. Vanasse and Patricia H. Vanasse, husband
and wife
("Grantor," whether one or more),
and Oevering Homes, LLC, a Wisconsin limited liability company
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys and wan -ants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant
interests, in St. Croix County, State of Wisconsin ("Property") (if more
space is needed, please attach addendum):
Lot 2, County Plat of River Hawk Ridge in the Town of Somerset, St. Croix County,
Wisconsin.
Exceptions to warranties: Subject to all easements, restrictions and covenants of record.
Dated � rn G r /D o
* Alan J. V
AUTHENTICATION
Signature(s)
authenticated on
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
Ronald L. Siler of Williamson & Siler, S.C.
201 S. Knowles Ave., New Richmond, WI 54017
II IIIIIIIIIIIIIIfllllllilllllll
8468729
Tx:4395080
1053644
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
09/07/2017 10:16 AM
EXEMPT#:
REC FEE: 30.00
TRANS FEE: 130.50
PAGES; 1
Recording Area
Name and Return Address
konald. 1_
01111Gt-M5ona j�tor,s G
ZDI S. 9nowlt5 Aye,
NOW n,ILhrnvliocl h/I 5Hd11
032-2174-02-ON
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
````p N,mnrrrrq,•q
P S
.O
yam•. ALB L IG •'�� .
`rrr,u(SEAL)
* Patricia H. Vanasse
(SEAL)
ACKNOWLEDGMENT
STATE OF WISCONSIN )
) ss.
STIR COUNTY )
Personally came before me on p�uy� �� ��'7
the above -named it I a_ Y1y n 7A_ f Y _
to mknown to be the person(s) who executed the foregoing
in ment and ac owledged the same.
Notary Public, State of Wisconsin
My Commission (is permanent) (expires: rJ 22 2D2-c)
(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 C 2003 STATE BAR OF WISCONSIN FORM NO.2-2003
* Type name below signatures.
St, Croix County 1053644 Page 1 of 1