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HomeMy WebLinkAbout018-2013-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 561065 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: Oeverin Homes LLC, aka Oeverin Pro ertie Hammond, Town of 018-2013-13-000 CST BM Elev: Insp. BM Elev: BM Description: ,~/1 Section/Town/Range/Map No. Q M 1 G ( 08.29.17.1114 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Z ~f 00 qs 7 Alt. BAIJ/t,l~.. C 77 Aeration Bldg. Sewer -713 Q? • C Holding St/Ht Inlet SZ . g, • 3 TANK SETBACK INFORMATION St/Ht Outlet $Z TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 4 0 Septic 3 to A)A- z-7 / 135 , Dt Bottom Dosing Header/Man. d • T2 Aeration Dist. Pipe -31-7 82 •1 I?Z Holding Bot. System -7 PUMP/SIPHON INFORMATION Final Grade 3 5 17.3 Manufacturer Demand St Cover 9D .g 3 3 17.5 GPM ~l) o Model Number TDH Lift Friction Loss System He Ft th Dist. to Well Forcemain 1 11 1 -f I 4-~ SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches ` A PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z -Trt, ,C'%o SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR ! UNIT Model ber: ~ j /J Type ~y~teem d I# -3Q AJ~ A DISTRIBUTION SYSTEM 1 ~1)Ll. ~`/+L' kdr-4- j f't 28 r t$ Header/Manifold Distribution x Hole Size x Hole Spacing Vent tt/to' Air Intake / Pipe(s) GQb Length 7 Dia Al Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / IN Depth Over xx Depth of xx Seeded/Sodded jxx Mulched Bed/Trench Center 403 Bed/Trench Edges '4-~ Topsoil No Yes L No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 1003 167th Stree ammond, 154015 (SE 1/4 SE 1/4 8 T29N R1 7W) Corner Stone Ridge Lot 13 Parcel No: 08.29.17.1114 Iit,,,. 6o 1.) Alt BM Description = / G d, : w a 2.) Bldg sewer length = `7 - amount of cover = - n n Plan revision Required? ❑ Yes No Use other side for additional information. - - - - - Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/30/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 131 # of chambers 56 BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' Filter BEAR Filter ❑BOREHOLE O WELL *H.R.P. Same as Benchmark All ' 'ng shall be SDR 30/34, within 10' SYSTEM ELEVATION 88.2/88.0 5' below qrade tank, 'ping shall be Schedule 40. B.M 200' Property Line 60' Scale is 1" = 40' 20' unless otherwise B-1 Lent noted 2-3'X 114' Vents >6" Quick4 Standard cells with of Cover eaching Chamber >3'spacing ith 20.0 ft2 of Area .6ft^2/pair of end caps 4' LonGrade at System Elevation 100' 3419 2% Slope B-2 -3 40' 70' ST 93' P perty Line 20' 92' G Pro Well is t eet all 100th ave droom se cks equired by se NR ~r I G e, ~ Cq Safety and Buildings Division County C i hr fi... S,rS 201 W. Washington Ave., P.O. Box 7162 sanitary a ~ Madison, IP37-1 ~ y Permit Number (t0 be filled in by Co.) 5~ o~S Sanitary Permit Application State Transactio Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to th e approprr a governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned P@1 are submitted to Project Address (if different than mailing address the Department of Safety and Professional Servies. Personal information you provide may b for secondary purposes in accordance with the Privacy Law s. 15,04(1)(m , Slats. ~J y~ 1h I. A liCation Information - Please Print All for i / _/1 If Property Owner's Name / < (7 -f G ~7` !arse! N 01S- e ,26Z Owners Marling A ess - /C ~ 7 3 el, ~ r t , Property Location Z City, State Zi Code - Govt. Lot J p Phone Number SAE ~4, et- i' 01 -7 T Section ff. Type of Building (check all that app, V i 4 _ 1Z ~ E on W T N~ ozr 2 Family Dwelling - Number of Bedr Subdivision Name ❑ Public/Commercial -Describe Use Qk Block a Q of ❑ City of~- © State Owned - Describe Use / CSM Number ❑ Village of 2 l 1 "Town of i~ A,,.SL r,_1 - n, 4"" 0L_ W. Type of Permit: (Check onl one box on line A. Complete line B if'applicable) New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only - ❑ Other Modification to Existing System (explain) fl. El Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer ew List Previous Permit Number and Date Lssued Before Expiration Owner ltV T e of POWYS System/Component/Device: Check all that apply n-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil t_I Holding Tank Other Dispersal Component (explain) _ ❑ Pretreatment Device (explain) Drs ersal/Treat nt Area Information: - Iiesign Flow (gpd) Design Soil Application ate{gpdsf} Dispersal Area Re uired f A q ) Dispersal Area Proposed (sf) System Ele ati r 11. Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units 2 New Tanks Existing Tanks g y S. tic or Holding Tank Ir r u, C~ a„ 15061119 Chamber V1I. Responsibility Statement- I, the undersigned, ass responsibility for installation of the POWTS sbown on the attached plans. Plumber's Name (Print) Plumb ignature MP/MFRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code 7,1 L'V_ 112 VIII, Coun /De artment Use Onl C Approved nsa Pernut Fee Date sued Issuitt~ nt Signature ❑ Given Reason fo )enW $ #7 5 06 1 y-3 TX. Condi6VAGNT Reasons for Disapproval /n~ 1. Septic tank, etnt lifter and 3 ~Jl'dLa,~, / G!~ v /1 r8 cJi /~e~ dispersal cefl must all be services I maintained / as per management plan provided by plumber. 9 .t r f ✓~a~'~.~o /L . 2., AN sel$ack requirements must be maintained as per applicable code / ordinances; i t /Ve o r Attach to complete plans for the system and submit to the Co ntY ~eu~l o~n, n less than 8 1/1 111 inches in sue 313D-5398 (R 1 1/il) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 I 715-246-4516 Date: 4/30/13 Owner:Oevering Homes Location: SE1/4 SE1/4 S8 T29N,R17W lot 13 Cornerstone Ridge Hammond System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications t Signature License nu #226900 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4.SE 1/4S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/30/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 131 # of chambers 56 BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 88.2/88.0 5' below grade of tank, piping shall be Schedule 40. B.M. 200' Property Line 60' Scale is 1" = 40' 20' unless otherwise B-1 Vent noted 2-3' X 114' Vents >6„ Quick4 Standard cells with Leaching Chamber >3's acin of Cover with 20.0 ft2 of Area p g 12„ 5.6ft^2/pair of end caps 4' Long Grade at System Elevation 100' 34 2% Slope B-2 -3 40' 70' i ST 93' P perty Line 20' 92' Pro 3 Well is to meet all 100th ave Bedroom setbacks required by House WDNR Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 93.0' Vent ~ Grade Vent 3' 4" 3' ~~30/34 Septic Tank 5' Long 1 5' 5' Long 1 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 114' Cells Same on other end Observation tubeNent At end of cell A B 28 chambers per cell System elevations: A_88.2 B 88.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _ FILE INFORMATION SYSTEM SPECIFICATIONS Owner e 2/ a Septic Tank Capacity al ❑ NA 10 Permit # Septic Tank Manufacturer ❑ NA )ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units A Pump Tank Capacity al fN A Estimated flow (average) al/dg Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) t~J t~ gal/day Pump Manufacturer A Soil Application Rate ai/da /ft2 Pump Model A St andard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats,' Oil & Grease (FOG) 53o mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 59 50 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5904 cfu/100m1 0 Drip-Line ❑ Other: iMaximum Effluent Particle Size 36 in dia. p NA Other: NA (Other: 0 NA Other: NA "Values typical for domestic wastewater and septic tank effluent. Other: ~NA MAINTENANCE SCHEDULE f Service Event Service Frequency ) Unspect condition of tank(s) At least once every' 11 month(s ar s (Maximum 3 years) ❑ NA Kw( !Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At feast once eve El month(s) ry' ar(s) (Maximum 3 years) [3 NA Clean effluent filter At least once every: ❑ ea~ts)s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) NA 1-lush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) ether: ❑ month(s) At least once every: ❑ year(s) NA 'Dther 9 ❑ A MAINTENANCE INSTRUCTIONS Ilnspectlons 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 linclude a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of i.-ombined 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 1~egulatory authority. INhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of ]:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. III other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, i-ind any servicing at intervals of 512 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 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thElt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thla tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will bie discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to thie effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area, Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTI>, antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dra)n (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All 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 If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compllilint replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the ncled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruteal In effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to fdendfy a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NIOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OI A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFF=ICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name c 1 Phone SEPTAGE SERVICING OPERATOR LIMPER LOCAL REGULATORY AUTHORITY r Name ` Name /.~ru ~ ; Phone - Phone { This document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM - Owner/.Buyer Oe d e It Mailing .Address eTjl,~ S~017 Property Address (Verification required from Planning & Zoning Department for new construction.) - - City/State , Paces. Identification Numbero ~ d l 3 y 3 b LEGAL DESCRIPTION p ProPertY Location ``/n ,Sec. T 2~-N.R _ ?W, Town o:f # / 3 Subdivision Lot , Page # Certified Survey Map # Volume r , Votumt; Warranty Deed # Page # Spec house ON 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 purnping out the septic tank every fhree years or sooner, if needed, by'a, licensed pumper. What: you pat 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. I/we, 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 Toning Department within 30 days of. the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms-_ ) ~ TCN OF -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. 08105) Div LTER CARTRIDGE INSTRUCTIONS InSWINUO" s'r'Eey x ory tit the llllaei' cash ,rlnta the taw at thr, nuClet pipe to ensure it is tentured urrder the aCCVyz>t npwr+ing. If not, than tither insert mare ptpo iloto 1:13" tank through the outlet or vviuxat Yclerlel (Vltre) bddiilohal pips . pipe onto tile outlet r b -P 2 WhUm the case Is AM vey fitted frrl the Nutlet blot, trcmaisuru tiwr lurnytt, of 46-Inch Wipe needed to bract, the filter to the tirtk weld wall if utIlf 9 the wptional Supplemental Wde strppurt, If side support ntathud. is not utilized, proceed to step four. 'ril"l" x Fur installatkrrrxs tdYlzirig the Ot1rOUnill tstlplrltantental side support: soluetrt wrdd the 5t',-ihcsh pipe orrto the filtbr cacti. If bide support hiethatl is trot utilized, protewtl to step foul. 5oltrent weld the filter i:aue urtto the nutFat pipe. for w t efts V filter' ?:4 ' cartridge into the case, p+"aetsiq' ag' t~ the rasrr_ down Until the filter Irrcki; Ititrt the iiutt,rt:1 Of r' v, U if a VRS switch is utlli:Aird: itysett• hrto tiro Otter ~i• 3• clockwise 900. and igek by titrMm{ fd cA?r Maintenance 1. 't'he eftluent fitter Should be fleshed uvery done the Vtlptlc tank In serviced. 2. Open the outlet access otier•,irtn to Inspect the tank vid Utter, 5. Pump the septic tank cotnplott.ly, making :sate to retrkols the Sludge laydt' irg the bottom of this tank and not juat the scorn and efffueat. ;a a_ ance tire u*kraht level has liven towered below the brvert of the outlet pipe, firmly pull up are the filter handle t'u dlalodge the cartrklye frono the cave. c S. Slide tine cartridge up and at It of the rraya for tlieanhtg. G. if a vA6 swiirb cunnected to art alarm Is lrrdsent, the smott.iti should be removed by tornaefr t: qurd:arduckwiss 904 kind deaned with water only, 7. While hulding the Lartridge rh its side (large flat satf tce horinp down) over the 441c*" opimb-og, rki6e at the mit rWi,is With Wxtue only, itrakitly aura all eeptagcx rowterial is rillsed bank, Into the tank- ` 8, If VRs uwitth is utilized, repiwovt try limattlpg into Hfter and turning dockwtre !3U°. t 9. Ynsosrt tho fiiter cartridge back itito the cvi:e, preaslnl{ doWri'tlntil the filter, lacks hitu the bottom of Lire case. f.U.ftapiaca and secure the am ebb tfl>ehirrg an the taint. Y. r 1r• •m~.," d tt ••yq ' qN *OR:J,trti • h.~.. ,'+,t,! , hot' LIB :.V:,3lIt1.7?1 ww+i beamlwJt e.rcom o i i t E lt~.~. b ~ wig •i~ ~ ! I (ICI i I ~ o° ~ r < v; ~ oW~~ I ! ~I d w A z I ! m IC ,r I ~m LL1 I III 11 f ° W MLI II ' I I' I i I I I I ~ ,ill) I~ I ! I ,,llii 11 I I W I 9 I I I ~ I ~ 19 W ~I _ f 70672 S.F. 1.62 Ac. - z LC f a 701. / w Q f// N 89'04`20" E 474.73' r~ 1.6 l cn LO T 13 0' ~~5 0' QS. 96291 S.F. W2.3 W _,_,_-._2.2t Ac. :a } } l.B.Q.=1028.25 ( oRMAc T --13 0 33' 33` }°p co 41 284.4V 2. ' m 482.46' g -_~J* 66100' tom.! S 89'04'17" Vii 1796.45' rn m S 89004'1Im W 1830 -TS- LINE OF THE SE 1 OF SEC' LOT 31 LOT 30 f it i I~ IIIIIIIIIIIIBIIIIOIIII I III $ Tx:4123006 1 977673 STATE BAR OF WISCONSIN FORAM 6 - BETH PABST 2000 REGISTER OF DEEDS Document Number ST. CROIX CO., WI SPECIAL WARRANTY DEED 04/29/2013 3:08 PM THIS DEED, made between Anchorbank, FSB, Grantor, EXEMPT#: NA and OeveringHomes , LLC, Grantee. REC FEE: 30.00 Grantor ~f a vale ble consideration, conveys to Grantee the following TRANS FEE: 180.00 described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lots 9, 10, 13 14, 16, and 17, Plat of Cornerstone Ridge, St. Croix County, Wisconsin Recording Area Name and Return Address: Title One 706 19t" St. S Hudson, Wl 54016 File #19424 Together with all appurtenant rights, title and interests. 018-2013-17-000; 018-2013-16-000; 018-2013- 14-000; 018-2013-13-000; 018-2013-10-000; 018-2013-09-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances, arising by, through or under Grantor, except reservations, restrictions and easements of record, if any, and public highways, zoning and uilding regulations. Dated this 93rY day of April. 2013 Anchorb Bv: James R Day VP OREO MARM AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) DANE COIJ-- TY. ) ss. authenticated this Q,tg Personaliv came before me this a3 day of April, 2013 the above named -J-O- n .S R. bkViS * 2: Anchorbank to me known to be the person(s) who TITLE:MEAMBERSTA'AO. F S(~I E executed the foregoing instrument and acknowledged the (If not, y same. authorized by § 70b.0~y-w?Sst-ft THIS INSTRUMENT 44fhS,DT So rick INotary Public, State of Wisconsin Michael H. Forecki My commiss'on is permanent. (If not, state expiration date: as 13 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature. SPECIAL WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 6-2000 1 of 1 I a;g o O ~ j M I F ~ g tt gg ~ ~ O}} a 3rd}: 1 9? O O I a i I I ~ i 30 I I i °w . UT~ I I I ~ a m I I i I I i i - f" n i I j lq I I ;voa«anan.~vrr~ lug ___I 1 I ~ R 1 it III 1 L I d 1 1 ih 1 I ~ ; _J 1 I 1 r 1 i f I 10 r ~I a J 1 ~ i II I - i ..o s.u. unnna.ro~. s. I i 1 i ' j L. I 1 fill I i i ffi ` o des 't=. I m f" s phi )i N J t d. $ .f "s I i ' "ws ¢w ~ I j I i I I i oa ~ ¢i i i I ( I I I6 - . KI i L DIX ~ j <171 es< J i) Wisconsin Deylartrnent of Commerce ~IL EVALUATION REPORT Page of Divisicn of Safety and Buildings i m 8s ihRS€ ;frf in accordance with Com n ~y Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and roel I.D. percent slope, scale or dimensions, north arrow, and location and dista to rieahesYrbBd. ~D & Date Please print all information. eview by Personal information you provide may be used for secondary purposes (Privacy LaA~3 15b>t Property Owner f 45- LC ` Govt. Lot 1/ 3'1/4 S T N R E ( r) property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3 r /I City State Zi P e Number ❑ City El Village own Nearest Road ,g p Code 10 GL GPD 100, New Construction Use Residential / Number of bedrooms Code derived design flow rate ❑ Replacement ❑ Public or commerd I - Describe: Parent miiteriakJ f f L~ c t ✓zQ ~ ~ s Flood Plain elevation if applicable General comments nd ,en e-- A O S/ OI v 1l' -"r{-; Lr'~ ® # Boring 9 ? - 1191 Ground surface elev. ` ft. Depth to limiting factor in. Pit soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD,'ft •Eff#1 T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 2- 3,1 3 31-1 ~U ,y 5 I m % rY1 N/ Ile t► ~Z. Pit Ground surface elev. / ft. Depth to limiting factor in• Soil Application Rate fflBoring # ❑ nn9 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 G" 1 ) 01 -4 r 3~ 1 m m w F Jag Z /'f 3 1 5/ C► CL- .l ~ ~2. Effluent #1 = BOD > 30:< 220 mg/L and >30:5 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mr CST Name (Please Print) - Si 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 Property Owner _ Parcel ID # / Page of ❑ Boring F11 Boring # pit Ground surface elev. )--1L Depth to limiting factor 9 D in•lApplication e Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if ! in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I d /L 10, , r`3J SI t cS r Z- -`1~ 5 1 51-11 5/ s m ► ct_ . Boring # ❑ Boring F-1 ❑ 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 'Eff#2 ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit 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 Effluent #1 = BOD3 > 30 < 720 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg1L and TSS 5 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.6MO) T t i ' Soil Test Plot Plan Project Name Cornerstone Properties LLC Shaun Address 1025 170th Ave Hammond Wi 54015 CS 4226900 Lot 13 Subdivision Corner Stone Ridge Date 1105 S 1/2 SE 1/4S 8 T 29 N/R17 W Township Hammond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Fence Post System Elevation 87.8/88.0/88.2 *HRPSame as Benchmark Alternate Benchmark is Top of Survey Iron (495.7' 1B.M. 200' Property Line 60' Scale is 1" = 40' 20' B-1 unless otherwise noted 100' 2% Slope -3 70' B-2 93' ' P perty Line 92' 100th Ave 1 • LEGEND COUNTY PLAT OF: p PROPOSED 0 O R N E R S T N E RIDGE ---12' UTILITY EASEMENT PROPOSED J DRAINAGE EASEMENT LINE HWE HIGH WATER LOCATED IN PART OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 Leo LOWEST BUII AND IN PART OF THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4 66' JOINT DRIVEWAY EASEMENT SECTION 8, TOWNSHIP 29 NORTH, RANGE 17 WEST, TOWN OF COUNTY SE1 HAMMOND, ST. CROIX COUNTY. WISCONSIN. - - - - - SETBACK LINE (FOUND AS SET 1 1/4' PIN Wi. 4.1 T SET 3/4' E WEIGHING 1. PER LINEAR OTHER LOT q~ rf N N 84'31'05" E 46! z rn - ~ } vsolo+l 1m i SCMP W'21, '0l i 8 590 S.F. o so 100 200 N 6 i a i n 2.01 Ac. LOT 6 HWE-,o3afio E d/ V 78285 S.F. Le0=103260 yry 1.80 Ac. $ k9"° HWE=1029.1 ^ ? Leo-1031.1 O iJ LOCATION MAP Z 102 a~ 'r 79'3' w i ~ 2. 3 OD (NOT. TO SCAM LOT 5 90.e4' ' - SEC710N 8, T29N, R17W, 73793 S.F. ah 1.69 Ac. HWE-1028.00 1 w K xio Leo=,o30.0o IO 1 i N 82'285+ E 44 723&5p LOT 9 Ay w5O69 75629 S.1 LOT 4 .2~~~ 1.74 Ac. Z 'ntd 112545 S.F. Tara 2.58 Ac. //I ®I N 8147 HWE=1026.50 483.7 PLAT LOCATION Lao-1026.50 M C ' tea;/ ro ss l u~i ~1 01 LOT 10 / 3eye. /07 / 86121 S.F. a mos LOT 3 w 1.98 Ac. 84368 S.F. s1y06 So`/ 1.94 Ac. W j' HWE=1ozs.oo ,p , % j ~~D N 76-4-3'49- N 6 teo=lOV.oo g.,y6 / / / 513.60, f ,kkk / r js. / s0- LOT 11 I 2g• w *s ' 80567 S.F. X70 f 1.84 Ac. of 127 803 S.F. / 5o"k5 / N 6j593s' k <I o I 1.94 Ac. 2919s- 1 HWE-1024.50 / _ oI 1 j I Leo-1026.50 / 0 LOT 12 N 8935'14' E 2: ' 70672 S.F. o I W 1.62 Ac. o z LOT 14 ZI N N 87'06'45' W 348.52' 70135 S.F 1 a LOT 1 1 N 89'04'20" E 471.73 m 1.61 Ac. a e ~a 4 804 S.F. Z Ac. 50 rso• LOT 13 Z J HWE-1024.00 ( IzM 96291 S.F. .o w teo-lozfi.oo NI J o I srir r - - -2,2L Ac- - - - - o°r - m-° - - -.t. O I O J J b 4 HWE=1026.25 ro ■ rw yt r 1lipy o I i 00 L.B.O.=102815 kc uv o 1 1 - -1388.84'- [w~ff o - 33' 133' y • rwYr c 6111? O , 341.61' -230 2- - 66100' - - - - - S 8904'17' W 1796.45' 33.04' w S 89'04'17' W 1830.54' - T SOUTH LINE OF SECJ-8 T.29N, R.17W -LOT 31 I _-LOT 30 I _LOT 29 I, p, r9 I -LOT 9_ IhII~I FINAL PLAT _IF PRAIRIE RUN {GRICULTURE-RES¢ FINAL PLAT OF PRAIRIE RUN IIM rl I I~ UP.W L eY. .UF MKA