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HomeMy WebLinkAbout018-2013-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 561074 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: Oeverin Homes LLC, aka Oeverin tPropertie Hammond, Town of 018-2013-10-000 CST BM Elev: Insp. BM Elev: Description: Section/Town/Range/Map No. /bd - 08.29.17.1111 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (c Benchmark U /D~ dam' 3 9 Dosing Alt. BM -P . .7 76. 7 CO ow ~ o S ° e>6 9 Bldg. Sewer I7, $ 7-7 8 Holding St/Ht Inlet 11 ,7 7 I . ~ TANK SETBACK INFORMATION St/Ht Outlet TANK TO ' P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /V C FAI Septic $7 AA_ Dt Bottom Dosing 6_7 1VA-- Ao / Z Z/ Header/Man. 3.6 9Z , 7 Aeration Dist. Pipe 3.o yZ. Holding Bot. System ( Final Grade 2 . 0 C1 PUMP/SIPHON INFORMATION !?,1~. ZIP Manufacturer l i Demand St Cover GPM rt" Ca q , $-s M 1''! w d z4,-3 I Model Number il ~ / Good-b,. r TDH Li Friction Loss System Head TD t ZaI "1•(4 AFUXW Forcemain Leng IDia. Z it Dist. to well A ^ 2 f7' SOIL ABSORPTI N SYSTEM , BEDITRENCH Width / Length / No. Of Tren s PIT DIMENSIONS No. Of Pits Inside Da. Liquid Depth DIMENSIONS Z 2 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: / u CHAMBER OR Z~ /77 ~I ) A Model Number: DISTRIBUTION SYSTEM Ne r", Header/Manifold Distribution / it x Hole Size Hole Spacing r Ver)hto Air Intake Pipe(s) Length \ Dia Length 15'9 Dia z Spacing -~Z Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 7 Depth Over xx Depth of xx Seeded/Sodded u Mulched Bed/Trench Center ~..i Bed/Trench Edges Topsoil ' P*_ Yes 0 No ` Yes r i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /3 Inspection #2: Location: 1015 167th Street Hammond, WI 54015 (SE 1/4 SE 1/4 8 T29N R17W) Corner Stone Ridge Lot 1 Parcel No: 08.29 17 1111 10 1.) Alt BM Description 2.) Bldg sewer length = n~ - amount of cover = / ~D 1 6 I 0 /6 Plan revision Required? ❑ Yes No Use other side for additional informati n. I 10 ~J 7 SBD-6710 (R.3/97) Date Insepctor's ature Cert. No PLOT PLAN PROJECT Oeverino 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 SYSTEM ELEVATION 91.1' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL * H. R. P. same as benchmark 484' Property Line , Scale = 1/4„ _ 10' B. 2 Acre Parcel Huffcutt 150' Combo Tank 20 B-1 Pro 3 3 Bedroom Grading i s to be done House Wei I is to meet al I to divert run-off WD N R setbacks away f ro m syste m B-3 ❑ 4% Slope Area 15' below system Tank is to be properly is to remain B-2 bedded and provided undisturbed with lockdown covers 91.5' with approved warning 90.5' 91.1 ' labels 199' Property Line 519' Property Line Pro Town Road { Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled to h Madison, ' Co. WI 53707-7162 y Permit Application StateTransactio~nJNumber In acc rdanee with 2), W' Code, submission of this form to the appropriate governmental unit G y "7 37/ is required prior to ing ary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different an mailing address) the Departnlt nt of Professional Servies. Personal information you provide may be used for secondary purposes in at cordarwe with the Privacy Law s. 15.041 (m , Stats. 1. A lication Information - Please Print All Information Property Owner's Name , Party! # U'L,? e i(n G 41 b)AF Z9 I Property Owner's Mailing Address - Property Location ~ t 7 Govt- Lot City, State / Zip Code Phone Number S,9 yi° SESection Q cle o H. Type of Building (chock all that apply Lot # 1 _2 N, It~ E r 2 Family Dwelling -Number of Bed011t roo-~ Subdivision Name Block r ❑ Public/Commercial - Describe Use j jjL h ( ❑ City of _ ❑ State Owned - Describe Use f- _ CSM Number ❑ Village at' ~Z A rja ~rov Town of iyt /)4f % , .eR Type of Permit: (Check only one box on line A. Complete line B if applicable) 4- ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) .11, ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ]IV. Type of POWTS System/Component/Device: Ch a o [TN,,-Pressurized In-Ground ❑ Pressurized In-Gro d rade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil L~ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatm nt Area Information: Design Flow (gpd) Design Soil Application {gpdsf) Dispersal Area Required Dispersal Area Proposed System Elevation VI. Tank Info Capacity in Total # Of allnfaC(WCC Gallons Gallons Units B n d New Tanks Existing Tanks 41 >u -QC i~ 0 All, Septic or Holding Tank 0 a Dosiug Chamber - / V1L Responsibility Statement- I, the undersigned, assume res ibility for installation of t~h`ee~PO'V TS shown on the attached plans. - Plumber's Name (Print) Plumber's Si MP/MFRS Number Business one N ber Plumber's Address (Street, City, State, Zip Code G ~/J G/J~ VIII. Coun /De artment Use Ont pproyed Permit Feee Date sued Issuurg tt Signature - - ~ e r Given Reaso or Menial $ 2 J ✓ Zd 3 IX. Condi easons fbr Disapproval c,'-,3406 tank, effhuIoNor dispersal cell must all be servlt;eal rrialntain a w i ~ Q t~ti~ f t as Marinpnient plan providedby'phltg6et, nn . t AN Eck roquirei ni* tta Must:to mawairw <OL Attach to complete plans for the systam and submit to the County only on paper not I' than 8 in x i ches is size t SBP-5398 (R- 11/11) / 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 SYSTEM ELEVATION 91.1' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK 1000 gallons DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark 484' Property Line Scale = 1/4" = 10' B.M.* 2 Acre Parcel Huffcutt 20' 150' Combo Tank B-1 Pro 3 Grading is to be done Bedroom Well is to meet al I to divert run-off Ho use W D H R setbacks await from system B-3 ❑ i 4% Slope Area 15' below system to remain B-2 Tank is to be properly is bedded and provided with lockdown corers 91.5' with approved warning 90.5' 91.1' labels 199' Property Line 519' Property Line Pro Town Road o~enxra~~r DIVISION OF INDUSTRY SERVICES o~°' os 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 3 t K Contact Through Relay y www.dsps.wi.gov/sb/ _ Gw www.msconsin.gov ~"Fss101N ~ Scott Walker, Governor Dave Ross, Secretary May 13, 2013 CUST ID No. 226900 A7TN.• PO WTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/13/2015 Identification Numbers Transaction ID No. 2244371 SITE: Site ID No. 790657 Oevering Homes Please refer to both identification numbers, Stone Ridge above, in all correspondence with the Town of Hammond agency. St Croix County SE1/4, SE1/4, S8, T29N, R17W Lot: 10, FOR: Description: At-Grade, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1427370 Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans angeth the At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), and the Pressure Di nbution C~Qmpoftgvianual - Version 2.0, SBD-10706-P (N.01101 ) Lj ~Q t~ O, s o qo In the event this soil absorption system or any of its component parts malfunctions so t 11d, the property owner must follow the contingency plan as described in th prov ~ the must comply with the operation, maintenance and monitoring duties as de ' din se .on t e th1jgrade component manual. A copy of this information must be given to the owner ion o t. F Maintenance information must be given to the owner of the tank explaining that eanxtg of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product app nditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 5/13/2013 Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated coup official in accordance with the Pr tY ovrsions of Sec. 145.20O2(d), Wis. S tats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2 , Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSN ART coder 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. i r RECEIVED Cover Page MAY - 6 2013 INDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/1/13 Owner: Oevering Homes Location:SE1/4 SE1/4 S8 T29 N,R17W Lot 10 Cornerstone Ridge Hammond System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications Shaun Bird Signature License number 2 ~C Fs 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 SYSTEM ELEVATION 91.1' 3 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark 484' Property Line Scale= 1/411 = 10' B. M. 2 Acre Parcel Huffeutt 20, 150' Combo Tank B-1 Pro 3 Bedroom Grading is to be done Hausa Wei I is to meet al I to divert run-off 1DNR setbacks away from system B-30 4% Slope Area 15' below system Tank is to be properly is to remain B-2 bedded and provided undisturbed with lockdown covers 91.51 with approved warning 90.5' 91.1' labels 199' Property Line 519' Property Line Pro Town Road At-grade System Sloping Site Cross Section and Plan View ' ,q.r v. : •N ar. ,I•' Y•• ry !!f : T' ''!r '4'•' r xM T•.: r.y w 1 Dimension Feet 1.1+y1■yy• ti~'Ir1 1 1■S+y■y y+"~•y•L+1+y 1 w.1•w■1 y'4■y■y■L■y L 1•S•yy 1•y+y1•'4• 1 r■r• •r■r•r•r■r•r■ ■r■rrr■r■r•r■r r■rrr■r■,.,■■■r■r■r r r +r■r+x.r•3'•r•x■r■xrx•r•rrr+r+ YL•y~1,y yYyYSry■ytuyYlYy ;r Yyr1 yr1Y r Y 5 • •*r YMx • Y r r y y y y y•1 ' 1•y 1 y Sr1 L Sr1.y•y;•+..;.;. f A I r•r•r•J•rt•r•r•r•r+•r•~ J•~•r J•r•~•r•J•r+J•r• •J■r•r r•,r■J■J+~'■J•r■Jr~'•Jrr■J■JM■r J■ r}■y■yYy YyYyYy Yyr•, I•~1 ~■•~r•1■y,■,•ti•y■y1■;YyYyr;fi yry YyYy■yy ~i"~ 1•w,yw■yrywr'r, S•'rY r r•r•r•f !+!•r•!•x•r• r rri r•~ r r•! r.x• r•7'!r~s• r rrr•r.rrl' r• r• r■!•r•r•x■r~r+rYr~Y y rlry■y■y L•SYy■yr uy.y'~y 1 y ■y "YY ■ ■yYy Yy■y■ ry■ ■y■y■ ■y~'.1''~'i'~ryry ry■L■yY rL B ~•!•r r.r• x■r•r~x.l.x+~•~'•rrr.r~r7'.r•3 r r~'r■r~r•r+r~'rr r rY~"~r r.r•r}r w•yrL■L•i.{'L•L.•Y•L.L.y.'L•y Yyr•Lr;ry+1•1•L•1•L 'V~•wr1 L S.L•w•w L•11•~•L+;■~+•rr1•L■~■, !•x•r•r•r•r•r•x■r•r•rY+x+ ~'x•x•r xYr•xrr•r•!•r•r•r■,i'•~• yw.x=Np.F.rrr+gYxrx■r r•rYr r• 1/6 B 'Y y y•L•'~•L+y06-%-A x+ .1 1'1.1+L•..LryY;.;.yry,yy•y1•y1.1 yS+yr1+'~•1+ ':•1 uy~Y;,,r•r r•xY!•x•r+.~~f r•r•r+r+r•r•r•r,r,,l"J••r•l"rr,{.r+.,y■r,r.l~1■~'■r•J•J■r+J. . 1 L•yYyYyyyy~w•y■L 't•yy 1•L•LYy,y■y y■LryL 1 L•y y y y L•w• w•w w•w M6f w• + A r ~'•!.}•lM,r■rYr■rrY rJrr•r•rxY••,r•J err Yr•r■iYJ,y■+rJ' il'Y•I'..f+J'rd'+.7'■r,r`~'rrlYsrr•■r r w•1 yry■Lry■y■yr1Yy.1.1 1.yYy.y■;', 1■Sry.y.y.y.;r;YQ.y.w•y•y1.y.;■S,YSYti,Lr1Lr'~'"Y1;1•. !,!r•~' r■r•r.x+rrx■r■x■x•}rlrr r•r r rrxYrrrY r r. 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J x r~ r■rrrrrrrY.~~'r■r•r „•.!r L•w•L•'L•L•wi L.r..LY;.'L, 'iyry.;.Lr'U•L•L•L+w 1R1.1•w'~1 YLYS'~i 1.•'~Y'~ wY1.1 L "r•L•1•wY•~ry;•: . r•r■rrr■r■r■r•r•r+r■r+r7' ■r■r•J•r•r•r+r■J•~■~I'■r+r r•~'r'• r■r■;'■r■l+rr•~' 3'■rYr+r•r•r•rY ~ F 0.5 y+SryL+yL•y 1.1.1~1•yryL•yyw•w•L 1„• • , ;r yYw• w•yy1•Sryr;. ~•r•r•r•r•!•r• 1'•r•r.."+J•r•r•r•r•!•r•r•r•r•r~'J~'J~' '~r•r•r~J~f•rr u•■r+r~r •!•J, yryr;Yy■y■y■ r ~:yYL•y •yy■1■y+y •y■y•yyry■yYy 1{ ■y■LYyry• L y yr•y L~.SAr; G l.U MW IF M 44.20 E L 1/6 B 4 W 56 E B L % .Slope 1 ''1 = Plowed r;r;'' = Clean aggregate ■ti■y. Q = 4 in. sch. 40 pvc basal area :5:1• %z to 2 `/z in• dia. observation pipe Lateral with 2" Topsoil Cap aggregate over pipe Observation Pipe Geotextile' 11 3 With Cap Fabric .{il'' J •xya r 916 Ft Lateral Invert •rr~ yryY~.■ x ~'•x r~jr .r:r:r-r:r:r:r:r:r• ~Y1•y■'~ y'r■~+=. •yyy'L•1■y'Nyr1r1 y { ' ~j ~~ri Ca { •r■~ r•J•r■r■r•J■r r■ ■x.r+r xM■r•r+x•rrxr~{Ic ! ■wYSW~i~•S+yr1,w ■y~,yry y+'~,,y■yr~.1■yYy;.; p .r. Topsoil J■r~r.r•r.rr.r x■~ x r■ ,x C": sr: d•,■?', U. C. ■ ti 3 ff44j€ 111tL `•SyMYYlryryry rrrl F yr■ - LIZ Y■.. 11 tY u { itl i r [ Llll~ I{il: r YJ .rrr.. , r.r. , Y, f ;Yy.w.1, ■ Tt 1 t (,ontour L•'~ 'L•yL+y J,. r ~ 5. • r r r+- J 1 Sr'L , - r~!Y :r:r:x"r:r•x.~+.r•r !•r.r•x r•x. ...'r N, .,q, Syr yr;r'Lr;■yr+■r'~`Yy,y D Plowed Surface L,w~ r C- Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow, Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a baekhoe . Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After•the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05 lg j Page of Pressure Lateral Layout One Lateral - End Manifold Threaded Cleanout Force Main Lateral Turn-up - ► Plug X -T L Long Sweep 90 Bend Pressure System Construction Distribution Network Specifications Lateral Diameter j ,ZIn. Laterals are constructed of Schedule 40 PVC Orifice Diameter S/~ y In. pipe. Orifices are drilled perpendicular to X (Orifice Spacing) _ In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded Force Main Diameter In. cleanout plug and are enclosed in a 6-8 inch Force Main Length 6- Ft. diameter lawn sprinlder valve box accessible from finished grade. Grade ;O: 6-8 Inch Lawn Sprinkler Valve Box 03/051gi Page _ of Septic-I:)ose 'ahk Cross Section And Pump Perfonnlance Specifications Tank Manuiaclurer pump Manufacturer VAtXZ7 rank. Model Number - - - - - - - ~ I'urtip 1V.CotlallVurnla _ F L7 'Total Tank Capacity Alarm Manufacture___. Masc. Bury Model Number switch Type Filter Manuf"l!u;turer Total Dynamic Head ('ruff) meet Filter Model 'N'umber Distal Pressure s Network. Loss Force Main Logs _T._..~.~_.. Minirntun Pump e Required Ft Tbh Total i S" Outlet Manhole 11~ & 4" Above Grrado With Looking Device. Inlet Manhole Manhole Min. 4"" Above Crrade tip? Below Grade Sealed Watertimlrt - Securely Mounted With Locking Device `1 0wherWproof j 7~ Junction Boy. ~Iy ,r„ r.r tea Ylr Finished Grade New r.l trr ww tIw ,r,~„ ,Yrr y..r 4 lent Min. 12Y' Disconnect Aborts Grade !19leahs With Went Cap f/rr Y~/r~Yf lrr /~rrrr rlrlr rltil>rri rrl r. ff / V ♦ 1 I V Y Y i./ 1•J . a 1 t/ .~'1 yr 1 1 1 1 1 1• i . r r~1 1•.~. ICY I t yay I+r;, 1 y/ r s r r r Y / e r r rY/ I~f~ / / ' rl r' r'r 1 r f _ .ref X11 Outlet Filter Inlet Inlet Baffle 1~1r ~tr1 " witch_Settings and Rosme Capacity . 1 .V ,a' IIIIY r V4YY Tank Volume _ 5- CIP1 y'r Weser) Dimension; Inches Volume Gal. - 13 Ilcte ;I~Y1, .a....r... AArne .11,• . •yy. ._.(rerierve) Cis (alarm) B, 12 Off Elevation 1 liars pY 1 f•Y r' J ~Y . lyre ~ - ! ✓ I VT.r • Y✓ A r r / (dead) D Bottom ' Flee ~Total - C~ ,rty aiiian rya y /`y~- • ~ yY~~ ''t yi Iy.•.•ayly,y: ly.y. .y 1 SJ "~N. Ft r 7-1^3~i'.-1-a"F'FTFf"i~R•r~~-r~y-• ~t-s-r-y-v-r-rr~-y--rr'y-r•rw-ry-s-s-y a• • ,r~ .~MMWW mill r r •r~l . If f r rIr 1 / f r1Y r11a1i1 a1.t lYI IYIr'}I>Ia1yY11"IytlfyYSia<y lrf•<r1;/;<; iyfy.y.l.y ay rl.l.lr"r'T•r-~t'~ 1 P Y Y ral i 1 raV r 1 rV a. Y r a . • 7 r 1'; ,~1 t~l~.y l~i~s. ~..~1 I... ~.f.4r ty V~l:.1./ r . r . 1 . r < r r , . . r 1 1 1 1 ♦ I t . / t . 1 r t . t t / V IF, 1 i / { 1 / f { { 1 Y 1'V 1 1 1•. Irl', ly. V•:'y'• l 1 GENERAL INSTALLA",rXON: 1110 80ptic3/dose tank is bedded rid back tilled in accordance with the manufactiver% prodtwt approval apeo&gtions bn exceeded without . Maximum deprth of burg as speared by the manufacturer may not prior sipprovaf. installed. Manhole covers exposed to grade have an efleotive looking device Piping at the inlet and outlet is of approved material, connected to the tank with watertight 1'i iugs, and laid ote stable soil to prevent stealing or sagging. The force main is sleeved with 411 Sch. 40 PVC to bridge the tank excav:rtec"n mid the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16..2$. 02/05 LI page ^ of Wa~ SEN-4Q Series 4/10 hp Submersible Effluent pump, 3/4" Solids Construction Flow - Liters/Minute 0 so 100 150 200 250 300 Cover Epoxy-coated cast Iron 35 i 30 10 ltJrQllliwl~a1~l1: e IrnpHller Material Thermoplastic Elastomer 25 20 a 0 Volute,., * F'poxy•coated cast iron 15 5 10 3 z Mechanical Shaft. Nitrile with cargQn and Seal ~r ceramIQ faces 5 p$Stfl~ ~rsR ~t a 1 0 0 :Shafl Steel 0 20 40 50 80 low Gallons/Minute f3 tf ve -e.co• _ i y, Y 1b" i + a.is ue~ SEN-40-AF SEN-40 Specifications Nos 9 01 • ~ ~e2 , 4/10 116 ~ u~ ~ 1 a,1 2 IPT 9/8 0 € 80 70 30~ 45~ 25 : 32 14 29b 1750 SEN-40 AF 50J213" 4110 _ 11 1 1, F FY , ~G 1 2 14 ~ t 118D 9/@2A 60 70 46 Pl'r ~p 26 32 14 20 27 5 0"' icranklln Electric 400 East Spring Street, Bluffton, IN 46714 Tel: 260.824.2900 9 Fax. 260.824.2909 Form: 988189 7-11 www,franklin-electric.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of BILE INFORMATION SYSTEM SPECIFICATIONS Owner - i Septic Tank Capacity ~hrx? gal E3 NA PErrm tt # Septic Tank Manufacturer ❑ NA 7ESIGi~ N pA METERS Effluent Filter Manufacturer _ " ❑ NA Number of Bedrooms O NA Effluent Filter Model D NA Number of Public Facility Units -A4 NA 'Pump Tank Capacity 6:3 y _ al G NA Estimated flow (average) tTL7 al/day Pump Tank Manufacturer' O NA I Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA I_ Pump Model ❑ NA >oll Appllcation Rate gal/day/1`1:2 S-tandard Influent/Effluent Quality Monthly average" Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg/L D SandlGravel Filter D Peat Filter Biochemical Oxygen Demand (BODr,) 5220 mg/L ❑ NA 0 Mechanical Aeration D Wetland Total Suspended Solids (m) 5160 mg/L ❑ Disinfection 0 other: ~ etreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L 0 In-Ground (gravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) SW mg/L ><NA tKAt-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 0113 ip-Line ❑ Other: Other: d NA ihilaximum Effluent Particle Slze A in die, ❑ NA `other: 0 NA Other: i] NA i-~ *Values typical for domestic wastewater and septic tank effluent. other: [J NA I~IAiNTENANCE SCHEDULE =A Service Event Service Frequency 0 mont s (Maximum 3 years) DNA ilnspect condition of tank(s) At least once every: year(s) IF),ump out contents of tank(s) When combined sludge and scum equals one-third (14) of tank volume El NA - ❑ month(s) At least once every: (Maximum 3 years) © NA bnspect dispersal ceA(s} .g~year(s) CI month(s) 0 NA i:~lean effluent filter At least once every: ~Z //jcear(s~ ❑ month(s) LI NA Inspect primp, pump controls & alarm At least once every: --wear(s) ❑ month(s) ❑ NA blush laterals and pressure test At least once every: ear(s) I7ther: iD month(s) r1 NA At least once every: ❑ year s) I~ther: © NA MAINTENANCE INSTRUCTIONS 'inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master iplumber; Master Plumber Restricted Sewer; POW'TS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must Identify any cracks or leaks, measure the volume of iinclude a visual Inspection of the tank(s) to identify any missing or broken hardware, (combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be Asually 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 (Yi) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. INI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at Intervals of 512 months, shall be performed by a certified POW1 S Maintainer. .A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting may impede the treatment process and/or damage the dspersai ce11(s). If high concentrations are detected have the cont nts loftthi 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, luring power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will bg discharged to the dispersal cell(s) In one large dose, overloading the call(s) and may result in the backup or surface discha To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to effluen[tthle 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 othenNiee 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 POWT'0: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produc4s; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system Is property 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 property 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 complislint replacement system; © A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requlpled setbacks from exisling and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulel 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 identify a suitable replacement area. Upon failure of the POWTS a soil and site evalual~on must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be installedl 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,. a<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 Off' A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name j Name Phone - Phone ~ ` ~ ~s~ k SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name k" Phone 7 j Y e t7' `y~'L~e PhoneI~ 56 _m"'s This document was dished in compliance with chapter SPS 383.22(2)(b)(1)(d)9(f) and 383.54(1), (2) & (3), wisrojisin Administrative Code. Wisconsin Department of Commerce OIL EVALUATION REPORT Page of Wisconsin - ~ D Divi.ion of Safety and Buildings - in accdrdance C - f k'Code minty ,lit `t~ Attach complete site plan on paper not less than 8 112 x 11 inches irrsize. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LD. percent slope, scale or dimensions, north arrow, and location and distance to neplla st'road. C'/ 0 J Re a ed by Dja Please print all information. !3 OSPersonal information you provide may be used for secondary purposes (Privacy t.a`w3 Fn15" m))- Property Owner ; t) 11 cation Govt. Lot 1J~ 1/4 S T f N R E( r) property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 170 r c~SL State Zip Code P e Number ❑ C. 173 Village own Nearest Road /`t mod'' ltJf (7 6_ l-I*;lJY' lL New Construction use Residential J Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commerce I - Describe: Parent c^ 7~i Flood Plain elevation if applicable JAG ft. materiak-~ 7~~` r..~ n~.r ~ ~ r✓'a~-G General corrrti .~4"<Ae n and recommendations: ,4 ire e- 0 ~ 191 l " Bori Boring g / 01ng # Pit Ground surface elev. ! ! ' ft. Depth to limiting factor in. Soil ication Rate y Roots GPD/ft= Florizon Depth Dominant Color Redox Description Texture Structure Consistence Boundar in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 -21-261 '2- Irl 1'1)4 IVIeL ' ❑ Boring # ring ✓ soil p pit Ground surface elev. Depth to limiting factor - LCL in. ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIf? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 loi p~~L r 3, amc 6,17 , C-S / rn r iC Z- D 3 38~ - o r s~i rl J17 • Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mg/l ' Effluent #2 = BOD < 30 ngJL and TSS < 30 mg& CST Name (Please Prlrtt) _ Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017~~ Ca 715-246-4516 C f «M ^ 0 Property Owner _ Parcel ID # Page of Boring # ❑ Boring l ® Pit Ground surface elev. ' ft. Depth to limiting factorl~fn. 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 'Elf#2 (9-1 L 31S/ 4-764 r /Yie~ c S 'P)421 62 Z-0 .7 Z_ J z-5 6! ZA 5c/ '0 34-70 4//V Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil licafion Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD_ > 30 1220 mg/L and TSS >30 < 150 mgA_ ' Effluent #2 = BODS < 30 mglL and TSS 30 mg1L 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. SOD-9330(RAW) Soil Test Plot Plan Project Name Cornerstone Properties LLC sh it Address 1025 170th Ave Hammond Wi 54015 TM #226900 Lot 10 Subdivision Corner Stone Ridge Date 8/11/05 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 91.1 *HRPSame as Benchmark ' Alternate Benchmark is Top of Survey Iron @ 95.7 B.M. 199' Property Line Scale is 1" = 40' unless otherwise 150' noted B-2 1.5' 0' B-1 0' 10' 90.5' 20 0' B_3 4% Slope 484' Property Line 4 0 PROPOSED DRIVEWAY NOTES: DRAINAGE EASEMENT ® PROPOSED JOINT DRIVEWAY ALL BUL OM CONSIRIICIm N PRMOW17Y OF NOTE- HIOH MAIM EIEVAIION 9UW, HAVE A I.OYEST NO OWNER OR RESIDENT SHALL DD.ALIYNM WHICH BtRDNO OPENING N0T LESS THAN 7W0 FEET WOULD INTERFERE WITH OR OHANCE THE OPERATION NWE HIGH WATER ELEVATION ABOVE U HIa WATER ElEVA.- 9N1111L OF IM APPROVED COMPREHENSIVE WATER DRAINAGE Lao LOWEST BURRING OPENING SEIBACM FRONT - 30 AND SON. EIMSI N PLAN FOR THIS PLAT. THIS ]~Q(T REAR . 2S' (utaESS OIIUERMISE NOTED) INCLUDES BUT IS NOT UNITED 70 BUISMO URON, SIDE - 25 (COIRINED) AJ1NN Pa10 WA7FTRp' COUNTY SECTION MONUMENT DRAiNACE DITCHES WA70t RUNWAY; WATER (FOUND AS NOTED) CULVERTS. emus OR GRASS SEEDNQL SET 1 1/4" BY 111" IRON GENER~`AL NOTICE PIN WT. 4.172 LBS./FT. STATEMENT: SET 314- BY 18- IRON PIN EACH PARCEL SHOWN ON THIS NM N WEIGHING 1.50 POUNDS SUBJECT 70 STATE, COUNTY Aa To uwS PER LINEAR FOOT AT ALL RULES AND REGIA.A7IONS B'E' WETIANIM NHIYUK LOT STG ACCESS 70 PARCEL, ETC.) BEFORE OTHER LOT CORNERS ~ HE ST ~ ANY PARCEL OF ILAN% AND THE APPROPRAIE TOM BOARD FOR ADWCE. UTILITY EASEMENTS: NO PALE OR INURED CANES ARE 70 BE PLACID SUCH THAT THE INSTALLATION WOULD DISTURB ANY SURVEY SLAW- OR OBSTRUCT U904 ALUM ANY 465.51' LOT UNE OR STREET ~ THE DISTURBANCE OF A N 8431'05 E - - - - - - - SURVEY STAKE BY ANYONE HI A VIOLATION OF SECTION 276.3E WISCONSIN STATUTES IUTWITY EASEMM15 AS MOM SET FORTH ARE FOR DIE Gam, It UUSKE OF HPKUNOW AVING A RS I AND NA ND iNE RECEIVED LOT 7 87590 S.F. g AUG 2 3 2005 2.01 Ac. 6~9k9 0 AWE-1030.60 Leo-,o326O 9L1'`'ry LIT ST. CROIX COUNTY NAT 8 ZONING OFFICE 102663 S.F. c 2.36 Ac. w I 1 E 440.05 C -N82-2l7;576 LOT 9 E 1/4 COR SEC 75629 S.F. 8 T29N R77W FOUND P.K. NAIL I 1.74 Ac, v om UNPLATTED LANDS $ o0 1 Mi 1 N a147-39. W 48&74, N 89'20'10" E 610.00' 1 g LOT 10 • 1 577.W 86121 S.F. s 1 100' u 1.98 ac. 3• W LOT 18 1 I $ 116164 S.F. gl e I 2.67 Ac. 1I 33 33' N 76 43'49. r I (A 1 rn z 51~8p. 1 I a D T 11 W 80 67 S.F. Z N 89'34'21' E 585.59• I o I~ /.W 1 1.84 Ac. 93.46' Z 492.13• N.a' F=11 kyO" ry'J 1 3&W oO LOT 17 c 83. 93446 S.F. u N 8935'14' E 230.17 2.14 Ac. LOT 15 88639 S.F, ¢4T 'O LOT 14 Z 2.03 ac. - N 70135 S.F. W°o g 1.61 AC. o^' N 89'41'34' E 439.12'1 (A0 100' I ~N LOT 16 90914 S.F. Z 2.09 Ac. J w (A ~I IA MINAIatma fO --138M&84 =2-i 6 ~i wo .8~~ (p . o _ 230 2' 11 i i 245.826 - ®429.84'------33 33'L ` S 89 04'17- W 1798.45' 01 - - - - u s a9V4.17" W 1830.54' 100TH AVENUE _ LINE OF SEC. 8, 29N, R.17W - _ - - - - - -r - - - - - - - SE COR - - 1 _LOT 29 1 _LOT 1 I LOT 2 1 I I SEC 8 TUN RICULTURE-RESIDENTIAL I CERTIFIED SURVEY MAP - I _CERTIFIED SURVEY MAP - 1 I I R17W SHEET 1 OF 2 O)v FILTER CARTRIDGE Installation ST-tp :t 17r centered u Y ar 1lt Ile filter ar rase ante the end N ~ in of the nutlet pipe to ensure it is . It tank through apan then AIPethe nutlet or solvent ~vei¢n' either Inse# pert rnore . (glue) additional ; pipe into t onto the outlet he ofy "P '2 While the rase is still d ral h p) suPPl Pe "ceded to bra re the fitted apHonaf on the outlet "'I" measure the length arnsrntal side support, If tank end proceed to ste four, ride su wall if utilizing the P #POrt method is not utilized, For installations utlftxing the optional s solvent weld the fk-inch pipe onto the fi utilized, proceed to step four,. upplemental side support: lker case. If side su r ort K p rnekhod is not Solvent weld cartrld the filter case onto the outlet i } y a erP• 4 into the ras the case. e, pressing down anti( the fil Ape, Insert Lhe fitter ter kooks into the bottom of ;...::.,,•y; r If a AS switch is Utilized: clockwse 90°. insert into the filter and dock bY : ti:•, r;..,y,l aiming ' } y~4 Maintenance f. The effluent filter should he serviced. cleaned eve i ry time the ptic tank Is Open the outlet access o s' Pump the septic tank rornplatel to inspect the tank and filter. ( layer on the bottom of the tank a making sure to remove dire sludpa _ n+ 1 once the not just file scum and effluent. effluent level has been lowered below the invert of the outlet pipe, ffrmlY Pull up cartridge from the, case on the flter handle to dislodge the 5, Slide the cartridge ` up and out of the arse for rleaning. S: 6• If a VRS awl" connected to an alarm is present, the switch should he remove with water only, by turning caunkerciotkwisp 90° and cleaned 7• 1hlhiFe ha►ding the cartridge on Its side 4: % down) over the access opening, {large flat surface faclnc only, makln rins® off the g sure all se tap cartridge with water , ' 'ry + Nr~., If bR5 switch p g material is rinsed back Into the tank. ' Is utilized, replace by irtserEln turning clockwise go-, g intO filter and 9. Insert the lifter cartridge back into the rase. pressing into the bdttam of the case, down until 20. Replace and ~4.~•,.,'• secure the actess +opening on the tank, y . %'WW bear0aSlb'--C* nr, 877-ML-'tL,'I'Ett (653-4S83 12 ST. tCR.OIX COUNT- SEPTIC TANK MAINTENANCE. AGREEMENT AND OWN:E?WSI-11P CERTIFICATION FORM r Owner/I3u er . - ~'~,rr? p Mailin .Address _A/5 S Property Address ~ (Verification required ff orn Planning & Toning Department for new constrnction) City/state I.Im-cel. Identification Nuin:ber 4 O!V- ~ 2 - LEGAL DESCRIP`T'ION C ~ I Property Location S - Yi 1/4 -Y . N !t. Wjown of Lot # _.L-.U.. SubdivisiUii Volume Page # Certified Survey Map C~l Warranty Deed # ~ -7 7-6 fate# ";pec house (J U0} Lot lines identifiable yes no 1-1 SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system couid result in its premature :Failure to handle wastes. Proper maintenance consists of pumping out the septic lank every drive 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 flue waste disposal system. Owner maintenance responsibilities are specified in §Conim. 8352(1) and in Chapter t2 - St. Croix County Sanitary Ordinance. `.1'he property owner agrees to submit to 83t:. Croix County Planning & Zoning Deparunent a certification form, signed by the owner and by a master plumber, :journeyman phirnber, 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. 1/we, the undersigned have read the above regnirernents and agree; to maintain the private sewage disposal system with the standards set: forth, herein, as set by the Department of Counnerce 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 & Toiling Department within 30 days of the three trear expiration date. Uwe certify that. all statements on this t orrn are true to the best of ray/our knowledge. X/we. arn/are the owner(s) of the property described above, by virtue of a Warr my deed recorded in Register of Deeds Office. Number of bedrooms I .r C5 ,IGNA'1' r ()F' AI'PLICAN'T(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) I I I I I I I I I I I I I I I I I I I I I I i l l l l l III 8151111 Tx:4123006 977673 STATE BAR OF WISCONSIN FOXM 6 - BETH PABST 2000 REGISTER OF DEEDS Document Number SPECIAL WARRANTY DEED ST. CRONIX CO., WI 04/29/2013 3:08 PM THIS DEED, made between Anchorbank, FSB, Grantor, EXEMPT#: NA and Oevering Homes, LLC, Grantee. ✓ REC FEE: 30.00 Grantor, for a valuable 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, isconsin Recording Area Name and Return Address: Title One 706 19'h St. S Hudson, WI 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 air' day of April. 2013 Anchorb B" James R DAVIS - UP OREO N9anaa M * x AUTHENTICATION ACI NOWLEDGMENT Signature(s) STATE OF WISCONSIN ) DANE COUNTY. ) ss. authenticated this Personally came before me this oZ3 day of April, 2013 the above named Seams R .frJt's * Z Z Anchorbank to me known to be the person(s) who . F S(I executed the foregoing instrument and acknowledged the TITLE: MEMBER STA O'- AA (If not, iffy same. authorized by § 706.06'yWi. tats. THIS INSTRUMENT D Y~~~~ * -So~nr+ P~Ck rJr/J~p1tpA1tN1~~~,` Notary Public, State of Wisconsin Michael H. Forecki My commiss'on is ermanent. (If not, state expiration date: a~ i3 ~ (Signatures may be authenticated or acknowledged. Both are not necessary.) xNames 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 1 ~ ! 1 LOT 9 75629 S.F. 1.74 Ac. co f I f € 47 39" W 483.74- LOT 10 0 I 86121 S. F. c 1.98 Ac. w f ` N ! 513-60P 0 / LOT 1.1 Z r 80567 S.F. 1.85 Ac. qj 05 .a ++rr,, ro LO T 12 N 89.35'14" E 230.17' 1 70672 S. F. C~ LOT 1.62 Ac. Q z 88839 LCD T 14 Q 2.03 c4 q °0 70135 S. F. o" HWE=11 9'04'20" E 471.73' us 1. fit Ac. C4 CI L.B.0.=1 v LOT 13 " 891m•5- filS. f}0' 96201 S.F. BB" JOINT _ - _ tai W DRIVEWAY sr I N ' I-/ EASEMENT HWE=1026.25 tic (A ~ N ! 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