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018-2007-01-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and ~'suilding 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 Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: 9~ , ~ 1 d- n'L 5-~- TANK INFORMATION ~ TYPE MANUFACTURER ~ti CAPACITY e tic P ~J ~ v ~- F.~ ' /~~ Dosing 5 Co~~o ~wP ~ F.rw Qe ~- Cam- /a Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Airlntake ROAD Septic SQ / ~~ ~ ~~ ~ '7 3~ / Dosing ~ / ~4+ ~~~ 7 3~, -.. Aeration Hoiding PUMP/SIPHON INFORMATION /~n,,,,(tl-~~ ~~ Manufacturer ~ r Demand ~ t ~,~ GPM y Model Number {.4 ~ ~ TDH Lift Friction Loss System Head TDH Ft Forcemain Le~ t~ ~ Dia. ~~ Dist. to Well I: -~ i Z SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 514832 0 State Plan ID No: Parcel Tax No: 018-2007-01-000 Section/Town/Range/Map No: 05.29.17.940 STATION BS HI FS ELEV. Benchmark 3 00 •? 9 s• y Alt. BM ~~ 5 S ~ - L Bldg. Sewer ~0 • ~ ~ , SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom /` I ~ 7 Header/Man. c.~ G ~ ~~ j_L . Dist. Pipe z,~ L ~$.S Bot. System c~ Z l ~7•~ Final Grade ,, `~ • 5 St Cover ]] // ~~ ~l+~ (,r~J S ~ 5 gs z Lo,,.,~-ate r .~ ~ 96 -~ BED/TRENCH Width J Length ! No. Of rent s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS p- D S 7 `~- `- \~ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: stem: T e S ~ ~ / yp y 7 Z6. ~~) ~ ~~~ ,~ ],n /vt~~ UNIT Model Number: o.~ ~-- DISTRIBUTION SYSTEM ~r~,d.l _ T~ Header/Manifol~ ~ ~ / Distribution /~ ~ ~ ~ Pipe(s) S J 1 ~ x Hole Size „ 3 x Hole Spacing Vea( to Air Intake J Length " _Dia_ . Dia Z Spacing TT Length v / ~ Z SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center + ~ ~ Bed/Trench Edges Topsoil I ,~.~ ~es ~ No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~~/ ~S/ ~ $ ~spection #2: / /_ Location: 1697 113th Ave Hammond, WI 54015 (NE 1(4 SE 1/4 5 T29N R17W) Farm View Ridge Lot 1 n.~ Parcel No: 05_.219-.17.0 F.• ~ ~ L~ ~-~._. 1.) Alt BM Description = ,- 2.) Bldg sewer length = ~Q ~ ~/ >7 w ~ - amount of cover = ~ o r. ~-- 1 I/ ~-. Plan revision Re wired? Yes ~o Use other side for additional information. ~_.1 `~ ~_ ~~~~ i_"' ~ _____ Date Cert. No. SBD-6710 (R.3/97) Cp1riR1@fC@. .QO afe and Buildings Division County ~ t ~ ~ 201 W. W ington Ave., P.O. Box 7162 r , J . ~~C~~ ~~FEB Mac n, WI 53707-7162 ~ N (Z -edh-by~•) Sea' ~P 9 X008 ~3 ~ _ Sans ar~~'i~,~li.~rPli arson state Transaction Number ~ ~/ ~ / In accordance with s. Comm. 83.21( ,Wis. Ad9N3btib,QF6Etii~on of thi form to the ap ropriate Bove unit is required prior to obtaining a sanitary perms • forms for state POWTS are t Address (if different thantnaiting address) submitted to the Department of Commerce. Personal information you provide may be used for u ses in accordance wilt the Privac Law, s. !5. ! m , Slats. ~ ~~ j I. A lication Informat[on -Please Print All Information Property Owner's Name ~' n ~~ Parce4l # Property Owner's Mailing Address Property Location /f ~~ f~~ ( T Q . ~ , i3 C..7 ~ ~ u Govt Lot City, State Zip Code Phoae Nttmbar /d/~ y., .S~ '/., Section J ~i ~1'L..Q~~~ ~) ~. (~ ~ ~ cle onp}q T ~~ Ni R ~ E of W J ~ Js l ll h Lot # t at app y ~ 6(c. a II. Type of Building (check a / - Subdivision Name Ior2FamilyDwelling-NumberofBedroo __ _ ^ Public/Commercial -Describe Use ~ ^ Ciry of ~ ' ~ ~ VAf"i ~w CSM Number ^ Village of ^ State Owned -Describe Use ~wn of ~ ~ --- ~ ~ x-57 0~ ~ III. Type of PermiC (Check only one box online A. Complete line B if applicable) A' System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existirig System (explain) B. e ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer toNew List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POWTS S stem/Com onent/Device: Check all that a I ^ Non-Pressurized !n-Ground ^ Pressurized ]n-Ground ^ At-Grade and >_ 24 in. ofsuitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ~'reirb'iltMent Device (explain) V. Dis ersal/Creatment Area Information: Des n Flow (gpd) Design Soil Applicatan pdsf) Dispersal Area Requir f) Dispersal Area Propo '(`b w' ~ Sysum Elevati~ V i. Tank Info Capacity in Gallons Total Gallons # of Units Manufacturer a ~ ~ ~ ~ _ y r ~ New Tanks Fatistiag Tanks 1 , ~e` L fs t N / ~` 6 ~ a Cg °= ~ 'v: y ~ to ~ ~ 'w C7 a. Septic or Holding Tank ~~ UosingChamber ~'j ~G7 VII. Responsibility Statement- !, dre undersigned, assume res lily [or installation ofthe POW TS shown on the attached plans. , Number Business Photte Number MP/MF RS ' s Si Plumbe/r's Name (Print) Plumber ~ / eet, City, State. Zip Code) / _ Plumber's Address (Str ~( v G p ~c'..~Z~ O VIII. Coun /De artment Use Onl h~..:..n e • C:an9n nr Approved $ (~ ~ da 3 .~ a Fs ^ O iven Reason or Denial I?C. CondltiQUS.~€~l~easons for Disapproval 3 j~ J r ~ ~ ~ (~ u; ~ ~ O 1. Septic tank, effluent fitter and ~7 ; ~ 1 t~~~~~,~~r ce,~,~~ dispersal cell must all be servtces / maintainer) 1,.) ~ ~ 3 P as per management plan provided by plumber. ~ r ~~ ~Q 2 .AN semack require~nta metal be mlMirttaiMd `(' LO~,~":~ ~ J~ ~,E.. c to complete p ens or t e system and submit to the C n only qn pape`'r~no~ less tltan•8~ x 1 ~nches i G "MI')t.~. e~wr.. ~ ~. SBD-6398 (R. 01/07) Valid thru 01/09 • PLOT PLAN • PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NE 1/4 SE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 99.0' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 none # of chambers BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST GF1O- 8 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark 1 13th Ave Tank is to be pr perly bedded and provi ed with lockdown c vers with approved w rning labels ~ 9 8' 99' Huffcutt Pro 3 combo tan Bedroom House 97' B-2 2 Acre Parcel cale = 1 /4" = 10' d Area 15' below system is to remain undisturbed .+~8% Slope -3 ~~ 8 Grading is to be done to ~ divert run-off away from system B -1 170th St. Well is to meet all setbacks found in 3g Comm. 83 ~~ (~'~ O e C~ICO rPY dt ~ j erty Line W~ S (~' 250' PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NE I /4 SE I/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 99.0' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. TOp Of 1/2" pipe ASSUME ELEVATION I00' Filter BEST GF10-8 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 1 13th Ave Tank is to be properly bedded and provided with lockdown covers with approved warning labels Huffcutt Pro 3 combo tank Bedroom House 99' Gradin divert from Area 15' below system is to remain undisturbed 8% Slope 2 Acre Parcel Scale = 1 /4" = 10' 170th St. Well is to meet all setbacks found in Comm. 83 Line commerce.wi.gov ^ ^ ~scons~n Department of Commerce Safety and Buildings 3824 CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary February 28, 2008 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING INC 1008 192 ND AVE NEW RICHMOND WI ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/28/2010 SITE: P.C. Collova Bldrs 170TH Street Town of Hammond St Croix County NE1/4, SE1/4, S5, T29N, R17W Subdivision: Farm View Ridge Identification Numbers Transaction ID No. 1513157 Site ID No. 734963 Please refer to both.identification numbers, above, in all corres ondence with the a enc . FOR: Description: Mound /Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1172820 Maintenance required; 450 GPD Flow rate; 24 in Soii minimum depth to limiting factor from original grade; System: Mound Component Manual-Version 2.0, SBD-10691-P (N.01/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/01); , Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrafve Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component arm. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The minimum distal pressure at the end of the distribution lateral is to meet three feet. This amount of pressure will supply a discharge of 0.72 gallons per minute through the 3/16 inch orifice • The well must be a minimum of ZS feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c G RED SEES • 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 2/28/2008 • Inspection of the POWTS installation is required. Arrangements for inspection shall bemade with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized reLresentatives of the Department which m~ include local inspectors. Owner Responsibilities: • Comm 83.52 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. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 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. 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 Safety & Buildings reserves the right to require changes a 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 bemade 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles. bratz@wiscons in. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. FS. Yr ~` ., ;, ~~;: \ ~~,t~, Shaun Bird `~'? Bird Plumbing Inc:-~' 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Cover Page Date: 2/ 26/08 Owner: P.C. Collova Bldrs. Inc. Location:NE1/4 SE1/4 S 5 T29 N,R17 W Lot 1 Farmview Ridge Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound 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 Shaun Birc Signature License rn 'ftio~~rdly ~~'O~i~® NT QF COMMERCE ~Bi1ttU(NGS .fzESPOND CE /'~• • _ ~,~ • ..•s ~ •-, ~r~ ~~~~~ . ~ 4" (lbsezvat;3o~t Pipe Perfcirated --~ Be3.v~r liter Fabric • 1Sffi tr33 Sond tcs "Topsoil s Noa-Wovem F3.1,tar Fabric • ~DistriDutio~ Pipe r ., .. "'~~ ~_ ~ j . .• ~ Siope $eef Ot ~ 2 `~ Force #~o~ Pibwcd ~f~ ~ Fto+e~ Pump Lpysr • t2rnin Rock • ., _/~:_ . ~~ Crass Section D! A Mpund ~ sse~ LTsiet ~,~ •. ~' • A Bed Far 7ise ADsor tiai+ Arta ~' ;•: r ~.~ ' ~~ ~ ~i g.~ 7" ft- ~ ~ . rr ~ ... _ _ '~?~' ~. !"'mot. 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When ~'w+ec is tSSbOf19C~ the f Ocrran9 ° t~P oeft(sy in one tarye dose. o~s3oadmA ~ O°~s;and rr~Y moult in me ~wS be ~ /fee avo"sd Zf>is gave the canberrts r1f the pcirllg i~utic ternoved by a orr ~'~ P ~, the etttuent purrlp or s P~mbeccr PO'WTS ~ m ~ ~~ to r+~ote notmat fgveLs wi[hin ttae pumA C~k, do not ~e ~ paalc vehicles ovaE ~ ~ ~' Do rat drnre of plc ty+retj or ~ d orb tt~e arm t5 feet down sbpe ot~Y rn°`ar'd or at-grade sot! a6sbc~~or+ ~rea- f~tlle ~ ~'~'the >fi~ sirsam may lmPc~e ~ perfatman~ and pmtoog file 6te ~ °~ ~~ bc~s; car~doms, t~tban swabs* degreases: dfsr~d drapefs ~~ tat: fncaid~oa dia~t {sump ~F3 : fiat and veget~e p 8% 9 ~ ~ s~ap~. m~ ~ ~ ~ ~~ ~' tampof:s and wa5~s'sa~Efiener txine. gBANOON~ifilEi~iT .~cen out o€ service the fnittf~ing snaps strait ~ ia~ to ~ur1r that fie vYtfen tffe ~]VSr't''S ~ aQrdlor is pe~miatreyrttY . rs ptopedY~atitd safety ~ in eosrlpt'rance witif d'i_ Comm 83.33. ~ 14,dn~ Codes ,pq plp6lg 6o tonics and Pits shag ~s drsoonrfected and the abandoned pipe OQerth>$S ses¢~cad. ... ~ ooez~ of a~(:a>n>oa erld P~ sttal! be retrsoved and propertyr dssposed of tsy a SePtage ~ ~~ 1~f~c pcsnetpit[g, aII farrics and ~ Shat[ be excavated 8rtd rerrtoyed or thei2r aoKners npi>,orrd~and the e-aeeE space frftedwll~sa0.grav~etos2tr:ott'ret+~tso~caaDariaL . COlsf TfNGEt*TCY PIAAT ttsa Mowing measun~ have been. oc must be do Pie a code If the POW,TS.farls and Confect be r oacapGant ~ ~~ O .4 suisabie r~rt'ae+eat hays beetr evacuated and may fie ut~ized far the n of a r~aemeatt s~ awn - -~ ~t area shoucd be pcoLected from drsfurbarlce~ and wed Fsr7tu+e to t~t be ~ ~n by ~~ s from e~csSng $r1d proposed strucxstire. pr+opecx the ~ ~tsM v~ r+estrit in Ur8 need lot a new soft ancF si6a sevattfatioEf '~ ~ a ~rlCSble repfaaerrfertt area. T{,ep~ptnenL s must aampty with the rotes in ef~Ct at ffsrat carte. Q A s~bte rsaptt.'~tssa es not asrzr7able~due Lo setback and/or soft Grrfitafwrfs. adVBric~s In P01NTS ~~ a ~ tarlk.nfay ~ as a last reesort io replace tha fat7ed POINTS '~Tf~e sBEe h~ oat beer? eva&aaeed bo irientsfY a surtabte replacement area Upon failurfe Of fife POWT"S a sDa.attd srt8 e+rs(EtatiOn trWSt t,7e pertiorcrsed to locate a' suitable repkzaernerrt arses. ff no sseplasas3ctsentorea is asra~ab~ a, tanfc may be i,~t6ed ~s a Est resort fro repcaoe the faf~ed pOWTS. rarnovat ~ ttre biosm~ at tom, and at-~g~cade soil abeotption 5 n'~Y be reoonstnic.Ccd ir: place fig e t~ srrr#~v" Reconsi~sdlorss sof such sySLearls must oompty w'fth the Rites in ~ at fief tirsfa SEPTIC, pulidP AI~1D OTHER'tRF,ATMENT TANfCS &tAY Ot?N't"r4INt LEYHRL ,.,ASSES ANQtOR WSMFPtCLf-M OXYGEIrL t3fl HOT Ehii'ER A ~F.~'TIC. PtJll[P OR QTHER TREA7MEHT TANK vHDER ~I~tY C(RCETtf~STANCF.S. E~Erf1TK 1~[AY RF_St31_l : ,RESCUE •OF A PERSON 1~ROM THL'- INTERIOR O~ A TANK iilfAY f3E DtFFIGLiLT OR IidP05Sf8d.E. ADDt170NItL t~~MFNTS Powys ~rALLr~~R ~ ~ POWTS MAt3tiT~ t~alrfe .~ ,r.~ ~ Name ~ r1.~..~' : ~ Phone f, _~,-/~, p~n~ ~.; _a ~/6' ~~l 6 s~Tac>E S~RV[dNG oP~[TOR L,OtAt. R~UtATt1RY ~tot~trY Name ~ ~ ' ~/~' c~ ~ ,agency ~ _ t!i/` /~/ - c9cl.a Phone ~/~ ''d2 "_ ~ ~. Phone f/~ ~•. ~~O rnb aooueera~rasQrsmadbl*tfisss itaAs aftJhs q~11wa tasks, iRzrgzretm and Wausisara Covnh?.wrtrr9 arld 17tis u:c rn+~ +~ of eh. Caernsa ~J(6]t!l(~'df3 and 83.St(S). (2) S f3?. w~sa AQcrf4~tsLriEre Coda tJs'e of (his Qoaument dQE6 n~ gvata~ee the pabanaaoe ef.!#~e Pt)VifiS. t~W t~fl SOIL EVALUATION REPORT Page of Wisconsin Department of Commerce . division of Safety and Buildings in accordance with Comm B5, Wis. Adm. Code c-- r ? County J j-: I r.,, Attach complete site plan on paper not less than 8 ~/2 x 'i 1 in n e BM s'd,~ed on ands path LQ. indude. but not limited to: vertical and horizontal reference po' ( )~ Date percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed by Please print a/1 inforrnatio ~ Pnva~ t~ :. ~s.aa it- (my. Psrsenal information you prrn~ide may ix used for secondary PurPos t location f ~ property ~ T~ PmpertY ~ ~~ ~/4 N R ~ / E (o ~} ~ / ~ ~ ,Q ~ !.~ Govt. Lot 'I la S r ~ - ~ j • / ~ Lot # i3lock # Sutad. Name or CSNt# ` A f '~ ,,,~ ~~Q•YM V i~t~:. prnpef~Owner s Mailing Address ~ - ~ N6 "' ~`° ~. C p Vtlage Nearest Road ' ~ , ' ~ Phone Number / D ~ Code fi' ~ .~ ~, ~ State ' ~ !~ ~ ( /.:'S~~'~ J t~n.,en -~ GPD Code derived design flow rate New Cansa~uction Use. esidential !Number of bedrooms ~ __~^~_ blic or gmmerdal-Describe: --"_ fL (] Replacement Flood Plain elevation it appll~ble ~'~ ~ ~" Parent matetial C General gmmer><s ./l d~,~~~ ~' 1, v and recornritendations: i i G Boring ~ 7 tn. # ^ ~ `~ ~' ~. Deptfi to limiting factor ~ So8 Ap liration Rate a ~~ ~ Ground surface elev. ~_ Ptt Roots• GPD/fi: Depth pomirtant Color Redox Destziption Texture Structure Consistence Boundary •Sff#1 'EtT#2 Horitcvt Gr. Sz. Sh. l ~... . Mansell Qu. Sz Cont. Color ~ z r' J'} !/J~~/ ()~ Sam/ ~~'s ., a ~~# Horizon Del _ i ~~ . page of Parcel ID SF Property Owner ~~ [~ Boring ~ ~j ~ $onng # Ground surface elev. -~,...sc- ft' `Pit a Depth to limiting factor ~• -Sod I'~cation Rat GPDIff ots R ,, Redox Description TexNre Structure Consistence Boundary o 'Ef(#1 'EfF#2 .Horizon pepth Dominant Color in. Muruell Qu. Sz Cont. Color r Gr. Sz Sh. ~ d „". ( ~ ~ J ` r ,~ ~ ^ Hosing Sol Aa lication Ra D goring # Ground surface elev. ft. Depth to limiting factor ,~_ th• ^ Pit Roots GPDifP Hor>zon Depth Dominant Cot Redox Description Texture Structure Consistence Boundary •Eff#1 'E1f;r2 Qu, ~, ContCoior Gr. Sz Sh. in, Munsell_ Boring ft. Boring # Ground surface elev. - ^ Pit Deptfi to IimiGng factor 'r'• The Deparmment of Commerce is an equal opportue~ry Scontactpthe department at 608-Z66-31 S Ivor TTY 608-264 8777 services or need tnaurial in an alternate format, p SBD-6330 (R.6I00) • Effluent #2 = BDD, ` 30 ~- and 7SS < 30 mglL ' Effluent #1 = BOD; > 30 < 220 rmyt and TSS >30 <_ 150 mg~'L . ,, , Sy S o11 Test Plot Pl eject Name P.C. COllova Bldrs. Inc. S B' ' dress P.O. Box 489 \ Somerset Wi 54025 -~ ~ ~ STM #226900 t ~_ Subdivision ------- Date 1 /30/04 1/4 sE 1/4S 5 T 29 N/R j 7 W Township Hammond Boring Q Well PL Property Line County ST. CRO1X BM or VRP Assume Elevation 100 ft. Top of 1 /2" Pipe tem Elevation 99.0' *HRpSame as Benchmark BM Top of 1/2" Pipe C 99.4' Scale is 1" = 40' unless otherwise noted 97' 99' % Slope 40.' B-1 * 1 .M. tlA 1 , .M. 60' Line Survey was not completed at the time of testing, all lot lines and setbacks must be verified before installation 0 r` r, 250' :: ~~.. .,,' h- J l SOIL EVALUATION REPORT Page~of Wisconsin Department of Commerce Division of Safety and Buildings . in accordance wit(h~ Comm 85, Wish Adm,_.y~ County Attach complete site plan on paper not less than 8 112 x 'I 1 inche~;~`i{~~ ~ indude, but not limited to: vertical and horizontal referencelpoint ( i n Parcel LD. percent slope, scale or dimensions, north arrow, and locatipn and distance to nearest r ~d~__~ _ Review please print all infoimati~n. ~,`*s~ (3 ~,~ !~~~f` Personal information you provide may be used forseeondary purp~ses (Privacy Law s t5.lkl (t) (m)). ~ ~/` ~ ~ ,~ t~hi~_ ~kdcation property s ~ . ~. . ~ t-! ~ ,i ~~ Date ~~~~~~ /'~ ~ ~ i! e ~ •8't7oC"t~' - 1 /4 ~ f /4 S f lr • ~ ~ ~ ~ J c.'`i ame or M~ Proper~„Ownef s Mailing Address Lot # Block # ~., ~ ) (rj NCW ftio~ s ~ ~ I Villa e State 'p Code Phone Number City 9 ~ E (or~'W ~- FVR+dqs J ~'+.~^• ,,.j Code derived deli n flow rate ~ GPO New Construction Use. esidential /Number of bedrooms g ^ Replacement ~~blic or commerdal -Describe: ------- -----v-"--`~------ Parent material Flood °iain elevation if ap cable ~L_1~- ~ ~ ~` General ~ , ~, ~ -~(~ ~ ~~~r//~ ~ P~~/< d recommendations: /~~SZ%~-~Sl ~ ~ ~` U GA'`t, t `'~'~, ~-Y G'~~_ ~~ ~l . an ~ ,~ .r L f Boring ) ~ ~ ` ~ ~' ~ ~~ # Htorizon Depth in. ~ '~ ~ ft. D ` ~ Ground surface elev. ~ Pit Dominant Color Redoz Desaip6on Texture Munsell flu. Sz. Cont. Cdor ' ~ ~, ~- G~~ ~S ~, ~-~< epth to limiting f Structure Gr. Sz. Sh. J°-rte-- in. actor Consistence Boundary // 1./ ~ ` Roots • Soil lic GP 'Eff#1 adon Rate D/fF 'Eff#2 , Boring ~ ' i Bing # . ~ ft. Depth to limiting factor in. pit Ground surface elev. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#GPD~Eff#2 in. Munseit Qu. Sz. Cord- Color Gr. Sz. Sh. ~ .r-- ~ ~ , ~; ~ i , ._ J /~ .- ~ ~~~ ~--^ , f ~- ~~~ ~ t ~ -~ ~ ~- ~~ ~ ~ " - .~~- ~- e ~~~ __ _ __ _ _,. _ _ • cm „o.,r fn . an n < 3(') ma/L and TSS < 30 mglL " Effluent #~ = tiUU ~ ~u ,<~ tcv nny~ o. w , ~+~ - ~~ . -- ...~ - r Sig ~l CST Number CS7 Name (Please PrinU 226900 Bird Plumbing, Inc. Shaun Bird Date Evaluation Conducted Telephone Number Address '-? Q C,"/ 715-246-4516 1008 192nd Ave, New Richmond, WI 54017 ~ ~~--~ ; ; ProP~Y Owner Parcel ID # ^ Boring Bonng # ~ ~ft. _____ Pit Ground surface elev. Depth to limiting factor V in• Lf Bonng in . Bonng # Ground surface elev. ft. Depth to limiting factor ^ Pit Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. in Soil ication Rate .E~GPD/ffE . ' Effluent #1 = BOD; > 30 <_ 220 mglL and TSS >30 _< 150 mglL 'Effluent #2 =GODS < 30 mglL and TSS < 30 mg(L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 1 Fa ~M Vr f~ ~t ~g ~ Page of SBD-8330 (R-6/00) ^ Boring Bonng # in. ^ Pit Ground surface elev. ft. Depth to limiting factor Soil lication Rate Hewn Depth Dominant Color Redox Description Texture SWCture Consistence Boundary Roots fE~GPD/iFE~ in. Munseil Qu. Sz. ContColor Gr. Sz. Sh. Soil Test Plot Pl Project Name P.C. Collova Bfdrs. Inc. Sh n B~ d Address p.O. Box 489 ~~v~(~~'``~ _ Somerset Wi 54025 ' ~~(~ is _Now ~,,,,-r ~. FA+~+~ Ut ~w r~~~y STM #226900 Lot 4 Subdivision ------- Date 1 /30/04 NE sE 1/4S 5 T 29 N/R 17 W Township Hammond Boring O Well PL Property Line BM or VRP Assume Elevation 100 ft. System Elevation 99.0' Alt. BM Top of 1/2" Pipe @ 99.4' County ST. CROIX Top of 1 /2" Pipe *HRPSame as Benchmark RECEIVED ~ /1~ „~~;~-~ ,-~,~ ~~ ~` , , i FEB 0 2 20 501E VALUATION REPORT Page of Wisbnsin Department of Comm ce ^ Division of Safety and Buildings S ~~Cx_CO~JY ``~~``~~ h Com 85, Wis. Adm. bode Canty ~ - ~~ ~ , Attach complete site plan on paper not less than 8 1/2 x 11 inc es in size. Plan mu t inducts, but not limited to: vertical and horizontal reference point (BM), diredionand parcel.. f,D. d t o . r a percent slope, scale or dimensions, north arrow, and location and distance to neares Reviewed by Please print all information. Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.44 (1) (m)). P t / -'oPertY ~~ ~ ~ Property Location G of ~~ 1 /4s 1 /4 S~ T ~ ~ N R~ E (or W ~~ t L • Props Owner's Mailing Address G t # 81odc # Subd ry me or CSM# ~-- (iG2p~~2 ' l--0T 3 Is u~ t ~ ~f 7R . ~ ,< City State 'p Code Phone Number oad R ~Ilage Nearest / J ~ Code derived design flow rate JJ ~ GPD New Construction Use: esidential / Number of bedrooms ^ Replacement [~j blic or commercial -Describe: -~._-___ -_--.---- /' ~ ---------- --- R ~~ - Parent material // Flood ~n elevation if applicable V ~j Lj j/ q General corrtments ~~~Z~~'-'L-~ ~ ! ` v ~ ~ r~ /1 l-®' j' I a ~ nd recomme tions: ,~ ` / f G` ~/f~---~ V) ~ G~1 ~ `~ Z SLR ~+~ a l ~ / <~, . ...~ ..... ® Horizo ~ # U Boring '~ ~ ; f ~ Ground surface elev. ~_ ft. Depth to limiting fact ` i pit n Depth Dominant Cdor Redox Description Texture Structure Consists undary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _D ~j~z ~, ~' Soil lication Rate Roots GPDIfF 'Efl#1 'Eff#2 ~w~ -S ~~/ ~~ # u Boring ~ /~~~j pit Ground surface elev. ' J ft. Depth to limiting factor 'n• Soif lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. CoM. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 r~rL ~.^ ~~ ` ~ a - J s~ ~ ~~~ ~~~ .sue' ~ ~ .-... . _ _. _ ni. n , on ...,.n .,...~ TCC r 1n rwrA ' Effluent #1 = BoD > 3u < uu mgru ano ~ ~ ~,x, _ ~:r, ~~y,~ _...~-.....- --- - ~ - - CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Condycted Telephone Number i 1008 192nd Ave, New Richmond, WI 54017 ~--- ~~ ~ 715-246-4516 ~ G- ~ ,~,,, 9 property Owner Parcel ID # Page of ® Ong # Boring /~ Ground surface elev. ft. Depth to limiting fador~ ~/ in• Soil ication Rate Pit , Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#~PD~Eff#2 in. Munsel{ Qu. Sz. Cont. Color Gr. Sz. Sh. 2 - 6 ,- --- ~ ~ ~ Boring # U Boring ^ pit Ground surface elev. ft. Depth to limiting factor ~n~ Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E~GPDfffE~ in. Munsel) Qu. Sz. Cont. Color Gr. Sz. Sh. Lj Bonng Bonng # Ground surface elev. ft. Depth to limiting factor in• ^ Pit Soil ication Rate Horizon Depth Dominant Color Redox pesrxip6on. Texture Structure Consistence. Boundary Roots •E~GPD Eff#2 in. Munsel) Qu. Sz. Cont. Color Gr. Sz. Sh. ' Effluent #1 = BOD; > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS _< 30 mglL and TSS _< 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. seo-ea3o cesrool ,~~ ~;~ Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Shaun Bird Address P.O. Box 489 ~ Somerset Wi 54025 L t 4 Subdivision Ok N sE 1l4S 5 T 29 ~~~ - CSTM #226900 °----- Date 1 /30!04 _ NJR 17 W Township Hammond ~~ ~ Boring O Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" Pipe System Elevation 99.0' *HRPSame as Benchmark Alt. BM Top of l/2" Pipe C 99.4' Scale is 1" = 40' unless otherwise noted 97' 9$' B-2 99' S' 8% Slope 40' f~i B-1 ~ 1 .M. ~lA 1 , .M. 60' Line Survey was not completed at the time of testing, all lot lines and setbacks must be verified before installation 250' r ~a~-~fl~ W ~W V 1 WW W `~ ~~ ^w ~~ 1~ O ifl J ~ U N ~ O W U Q F- ~ p 00 W N 00 N M ~ N 61 h O~ h t~ p,j d' N M r O ~ 00 O M 00 O ~ O ~ ~ O i(') 00 ~; h .- m ~ 00 ~ ~ M c0 h d' c0 01 O Nj d' N ~ O h O r` c0 ) d- ~ I'7 O OD CV d' - d' 00 to N ~ h cp ~ fj d' O~ '-- ~ N ~ •- ~ N `~ N N ~ h N _ ~ cp O ~ N O N N ~ c0 ~ ~ ~ ~ M N it M ~ ~ 3 a w a ~ w w a 3 - ~ c w e 3 e w - w - w a 3 w 3 w w 3 3 3 3 3 3 3 ~ 3 w ~ 4 Z ~ O a i~ - O N N M N ~ r'') ~ O - ~ - w a ~ ~ N' ~ a e O d' ~ _ cD M ~ d O ! ) _r O ~ ~ F- t'") M N N N ~ N N O N N I'7 ~ ~ ~ ~ ~ 0 ~ ~ ~p f~ ~ O ~ O f~ h Ir ~' ~ O d0 h Q~ In h CO ~ ' 0 0 0 ~ 0 0 F-- p~ 0 _ ~ ~"' ~ O e- O N t .-- ~ ~ n - ~ O 00 O t0 ~ .- ~ d t0 O O OD O OD O fn d0 00 O (n O ) O N h O ~ O 0 N 00 O O ~ 00 h O 00 Q o z z z z z z z z z z z z z z z Q w z z z w 3 z z z z z z z z z z ~ w m O N ~ ~, ~ (D h 00 0~ O ~ N ~ d' ~ (O h OJ O N Z J J J J J J J J J J J J J J J J J J J J N N N N N N N N N ~ M J J J J J J J J J J SaN`d~ a~11b~dNf1 ~/ L ~S ~Hl ~0 ~Ni~ lsb~ 170TH STREET "? ~ '~ ~? -~ i~ - ' ~ - -- --~ i ~ Sri ~ ~ ~ rn `_ ~I ~ ~ -~ o IL CV ~ { O ` rn ~ 1 r~l>I~ o ~ w f- ~ z p cn C7 N~ - ~ J,UId.I to ~ f h ~ I ~~ 00 ~- S 00'02'06" E cn ~' ~ 292.32' ,~ S 00 05 29 E 479.12' ~ N 00'23'36 " W 479,49' C° 0 8.00 '',---L J~-! 33--- ---------- '~~ 399 49' -- - 1 o a ~ ~~ ~= o ~ . o 0 o o w ~ ~° ° ~i ~ ~~o ~ ~ °~ -- I~ 00 p ~- W F---- ~ ~ cn ~ o o ~- r- vi ~ Q c~ z Q w o yin rn 00 ~ II 11 ~ ° z w o~ ~ rn Q o ~ ~ w~_'.' °m N ~ rr Q ~~ ~ W I d' I ~ ~ o `~ I I ~ ` ~ ~ I '~ IIv ~o IoI U Il o_ N O1°14'37" W 398.79' J ~ Iv, I ~~~~~y N B9'28'3J' E 1258.A2' JL t~~~ !/ ~~J GV ~~~~~L LOCAIEU IN PART OF TH[ SOUTHWEST I/1 OF THE NOR THE ASL 1/4 ANU ~N PART OI '.HE SOUTHEAST I/6 OF 111! NCRTHE ASI 1/4 ANU IN PART C1F THE NORTHWEST I/N OF THE SCU iI-TEAS` 1/n ANf. IN HAFT 1)!" 'nE NORTHEAST 1/1 OF THE SOI~fHEAST I/4 Df SFC ZION 5, TOWNSHIP 29 NOR fII, RANGC I] Wk:ST, TOWN OF 4AMML`h D, ~I. f,R01% COUNTY, WISCONSIN. I~NP~A t'[E[I LN(J~ I IjI ._ __ _ .. .. it I I '1 I H i01 3 fSM Vp.. td N 00'23'36" W ~I i rn ].00' I II I 5 89'5]'53" E ~ 5 84'51'~J".~ I 44.10' 135 -3' _. nl . G1 r :~ ,__ ,oo.Dp' " I ds{SS $ '°~ s" [ ROA- 5 ~,s /89' S010.Y I 211.68' _ _ _1]8.16.._ _. 1T~.9= ~ _. Jl e.d_5' _ L.w]~ ~ la ~ !~ I I~ ~ I I~ Ito Ito 65!56 SF. I J 43 lu 44 I II+' 83 m55.f. 50 Ac u 65350 AcT ' £ aSJ~cA I IM -50 4. I -ci ,J ~q i im ~ II I~w _l _~ ~S _J L. _ .9 h1 62 --- s 6 ~~~J^ W ~ _ _ cs_ _ F;A ~~, w 32%e-,F,~,~y` I- 5 ~'-- 5- ~ N ^ N 1 w I ~ „1r ~CSd-. r=~~ -- -- ~ I I ~+ I ` „I i " ~ I ~ euza sF. I am A:. I I ~ I I 3 I ~: °0,:e M.E. ~ ~f i vl ( gl I I ~u la ~ L 33Y.TN' _J L..- -,2Bdd.- II -281:51 _..._ J 1• .-. ,1lNPLATTjp y~NQS. - ~, ~ S00'l7'3t _.~ I n - i i ).DO 0 I~ 7 ~ ~ o S11 3,1 I I> I 1 0 l UI ~1 I.°3 I t I i I26 l F. ] Im ~.98 AC` ~ ~ I J al If ~ ml Ixi I m I ! % I ~ ~1 im A: MENT ~ Ie H J ~ _ __ d e:i5'- - 109. S 89~5'Ot' W 26J9.2B' SOUTH LINE OF THEN 1/2 OF THE. SE1/1 SURVEYOR'S CERTIFICAT 1. POffll HIIIFHWEY. BE6ElLeEW M1SLtlISW LAND SWIWYCR a-r,ee, m HEREBY CpITiY THAI I HAW wRYETFA, DINDEO NFW WOLF. LOCATED W PMT OF Tlr sWTIBFST I/N of NmTEAST 1/A AND W PMT Of !NE SOOTEABT ,/~ K iK NOMINGST 1/N AMD W PMT OE 111E NORMIICSr t/N DF iNf sODTKAST ,/t AM W PMi aF M NONHEAST ,/B d 1HE SOOlNEAST ,/A ALL W SECTON k W rOW15NIP A Nmlx, RAII¢ ,T WST, TDWI a HAfLUpb. Si. N1a% mIMTY. W90ONSIN. Alp IIOR PM11gAAllY OCYYbBFD AS ftl10K: GL,1[IIFIIG AT TE N(WM I/A myTEe OF SAW 6ELr1fN1 nW>r¢ revarsE'W ,We.,, s¢r ro IIIE wwr o IC9NeLW0, nvF¢ Ilra,']YE Alf1N0 ME NLWTH LBC Q TILE FRACTWMN SOUMNE6T 1/t aE THE NgLTIEASr ,/+ la,em far: rtfEN¢ suYra'r xca Ff£T: noFlx >,6r.+o'.e-E ,ee.aT aEr, naE sDSara•1E aTfn FEEr; 111LNa SN1e'aYW 2]0.2a aET ALONG TIE THE EAST-BEST ,/1 ONE W SAW SEOlION k 1NFNOE SeDae'm'N SS>.OA FaT: THENCE NMae'N'E ,958X0 fE[T: rIIENC[ SDOOYW [ 201.aS RLT: TIIFTra a nFE Mc o A fume ro rNE mcHr WTH M ARC IENCM DF t:a.9e far, A cHwD LfalcM a t:a.ea far MAr BFABa Nuwws2 AND A B.DUS of uim IaT: nlEfl¢ srarerE a.TO FaT; ud¢ NDD7]']e^Y 9.m FEET: nLUTLE swarsrE ,ss.es fEET: THWmE seDma9"E ALaw nc usr LWE of ,HE MEASr ,/~ a'ro.u rtEr: ,» ,n Lr THE suuMEAST ,/A 96a9se aE*: .,IUTCE x~aczy»t ALaNC rrLE N~DBrMiI-swra,/. zcmTWr. LWE zsel..e faT To ME Pw«. a aunNWa SND PA,NYl CDNTAWS NO)6eel S0. fl. OH 9139 ACMS IaDRE OIL tIss Wllb, IS 9118ELT TO ALL EA6EYFMTS. RE91PWTq,B PE9FWVATONS. AND CdIWYANaS aF MC(ND. MAT 1 NAW MADE 9T01 STALKY, lANO pN51011 AND wBpN9pl RAF BY TIIE DlacnW Df P.C. CDLLMA BUlOFRS, IHC., OWIFMS W SAW MAT S1M81 FLIT IS A COPRELT AEPRESENTAMM! 6 1NE EN1FAlla1 BDONOMIES 6 ME LAM wRWIED MD ME wmIN9 ao% mufr, AND a HNWaNDpamlNew waN.Na W wRWnxc, OMWO, Aw N,wwNC sANE.N~s a s. rwWY. Ixs x, •A AT~ 4 ItlFaAYSeS ~ M1WEe~F oArE: B O ~f111 YTDDOWLE <~Wa a~ ~eN I ~I. `? .n SF CORNER, r ~ I iEf. 110N 5, TOUNO `hI SURVEY N41. DRAiNAGE__ EASEMENT LINE 'FABLE: - i~iY I N,~"'''I n l.' I v~ A_ ___ ~~ -.. -~ SHEt ~ .~i OF .i CURVE DATA TABLE: U 2S36P 3y7 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number , waxx.4lvTY DEED This Deed, made between Michael B. Marshall and Dawn Marshall husband and wife Grantor, and P. C. Collova Builders. Inc,. a Minnesota Corporation Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): See Attached Exhibit "A" 75795 KATHLEfiI~ H. MALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 03/29/2004 12:50P?1 IiARRAATY DEED EXEMfrT ! REC FEE: 13.00 TRANS FEE: 2012.40 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Address ols-loos-6o-o00; ols-loos-so-ooo 018-1008-90-000: 018-1010-00-000: 018-1010-10-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this L~~~ day of March , 2004 * * AUTHENTICATION Signature(s) Michael-B. Marshall and Dawn Marshall, _ husband and wife --77,,--~ authenticated this C~LP day of March , 2004 * Kristine O Ig and ___ _. _ _ _ _ _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.Ob, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney_Kristina Ogland___ _ ___ ____ Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) * Michael B. MarhsaQ - ~,-~,--~~-Q-_ -_._..----- _ * Dawn Marshall ACKNOWLEDGMENT STATE OF _ _ _ _ ) ss. County ) Personally came before me this __ _ _ day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Notary Public, State of _ _ ___ My Commission is permanent. (If not, state expiration date: .) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800-6SS-2021 WARRANTY DEED FORM Na. 2 - 1999 U 2536P 3~8 EXHIBIT "A" Part of the NE'/. of the SE'/ and Part of the NW'/ of the SE'/. and Part of the SW'/ of the NE '/< and Part of the SE % of the NE'/. of Section 5, All in Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin described as foliows: Commencing at the Southeast comer of said Section 5; thence N00°05'29"VN 1315.84 feet along the East line of the SE'/4 of said Section 5 to the point of beginning; thence N89°25'01 "W 2639.28 feet along the South line of the N % of the SE'/. of said Section 5; thence N00°21'34"E 2581.45 feet along the North-South'/. section line; thence N89°51'32"E 1316.00 feet along the North line of the SW'/. of the NE'/.; thence S14°12'09"W 566.08 feet; thence S56°30'45"E 166.57 feet; thence 505°58'41"W 617.95 feet; thence S89°26'33"W 230.23 feet; thence S00°08'03"W 557.04 feet; thence N89°26'33"E 1601.66 feet; thence S00°05'29"E 758.82 feet along the East line of the SE'/. to point of beginning. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P• C. Collova Builders, Inc. Mailing Address ! I.J~ I`~I ~t~~~ CJ~~ ~L~I ~ ~~ Property Address I v` 1 ~ ~ ~~ w (Verification required from Planning Department for new construction.) City/State Hammond, WI parcel Identification NumberdC 7 ~~~ ~~OU LEGAL DESCRIPTION Property Location ~ `/4 , SE `14 ,Sec. 5 , T 29 N R 1 ~ W, Town of subdivision Farm View Ridge Hainlmond Lot # ~. Certified Survey Map # .~ ,Volume r, Page # '' Warranty Deed # ~ ~~~ ~ ~7 1 ,Volume ~O ,Page # ~ Spec house Ryes U no Lot lines identifiable~l yes U no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix County 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 I/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 Zoning Depa ~ ~n 30 days of the three year expiration date. a?l~5/08 SIGNATURE OF APPLICANT DATE OWNER CERTLFICATION ertify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the pr erty des a above, b virtue a wa ty deed recorded in Register of Deeds Office. a /~s, a~ SIGNATURE OF APPLI ANT DATE ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. ****** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed.