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Home My WebLink About018-2013-01-000Wisconsin D?partmentof Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Fletch Investments LLC, Crai Shermoen Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: /~ _ Ibb rJ~ l G~ TANIK INF(1RMATICINI FI FVATION DATA TYPE MANUFACTURER l~ a CAPACITY Septic ~) / _ ~, 4 ~ ~Q~Q Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 50, ~~ 3,~ ~ ~" Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number __"~' TDH Lift Friction Loss System Head H Ft Forcemain Length Dist. to well County: St. CroiX Sanitary Permit No 506334 0 State Plan ID No: Parcel Tax No: 018-2013-01-000 Section/Town/Range/Map No: 08.29.17.1102 STATION BS HI FS ELEV. Benchmark Q I ~ '~+ ~ s,ir~ Alt. BM ~•S ~7 . ~e Bldg. Sewer / , ~ ',3 ~ C J SUHt Inlet 7•~0 7Z . S SUHt Outlet 7.g yZ. 3 Dtlnlet ` ~ Dt Bottom ~ \ Header/Man. ~' ~ T~ ~ 7 Dist. Pipe ~ ~ g•5 ~' /•~ Bot. System .5 96.-1 To. V Final Grade 3•Z ~~ ~ G St Cover ~ ~~!) ~7 ~ ~ SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ / _ ~ `l 'f' ~ w G~A L-- +~ ~'- ~"- ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ ~lr~) _~ ~' " CHAMBER OR h 7 INFORMATION Type Of System: ~ til-~'Q n~c C ~ ~~ / ~~ ~ ~ UNIT Model Number: /~v \• _ L W lJ~- . ~ 111CTOI~I IT1/lAl CVCTCIIA A/ ~ .L Header/Manifol~ i~ Distribution ` x Hole Size x Hole Spacing Vent t~o^Ai~'nta ? `er-~- `.Z ~ Pipe(s) ~ i Di ~ S ~ ` \ r' . Y-~dC , t Length Dia pac ng a Length , l+l111 /~A\/CD __ ..________ e._._._.v_ ~_~.. .... ~~........ n. A/_!_r~~ln Cvc4mm~ C)n Iv Depth Over t ~ ! d/T h C B 5 Depth Over Bed/Trench Edges ~ xx Depth of Topsoil ` xx Seeded/Sodded N xx Mulched Ye;s No en er renc e ~ 2 ~v ~i o ,Yes ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: ~ / Location: 1002 167th Street Hammond, WI 54015 (SW 1/4 SE 1/4 8 T29N R17W Corner Stone Ridge Lot 1 Parcel No: 08.29.17.1102 1.) Alt BM Description = ~ ~\'^'S 2.) Bldg sewer length = 3rj CommBCt:e.Wi.gov Safety and Buil Di 'ion County. 201 W. Washington P ox 2 f,> / ~+ ^ Q ~ ~ /+'~ Madison, WI 537 - Sanitary Permit Number (to be filled in by Co.) oepatYtnartt or Camme^roaa 5 0 ~ 3 3 Sanitary Permit Application Sta"T`g"Sacrt'~tr~ber /v submission of this form to the appropriate governmental Wis Adm. Code 21(2) In accordance with s Comm 83 , , . . . . unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(ifdifferentthanmailingaddress) submitted to the Department of Commerce. Personal information you provide may be used for secondary u oses in accordance with the Privab Law, s. 15.04(! m , Stats. / ~ /~ ~ / I. A lication information -Please Print All Information c. Property Owner's Name i ~~ // ~, ,~- # 618-zo+3-ot ~ ! Property Owner's Mailing Address - o Location /~ ~~ O (. ~~ ~ ~ ~U~y' ~l Lo Govt. n City State _ l~t,dt Zip Code PhorR ~ S 'V /~ ~ ~ ~/,, Sectio , O ^~ / ll /~ '~/ , ~ ~~~ rcle on~(' ~~ N; R ~ E o/ WJ Lot ~T. (~ a a~ (check all that apply e of Buildin II T ~ „ j g . yp D N ~ or 2 Family Dwellin8- Numberof Bedroo ,_ _ r ame Subdivision ~ S..fDwr. cc![. `^ svtit. Block# S ^ Public/Commercial -Describe Use `~~ ^ Ciry of CSM Number ^ State Owned -Describe Use ^ Village of -- „ /X/S Town of Z w f G ~ lll. T ype of Permit: (Check only one b x on line A. Complete 'rte B if applicable) A' New System ^ Replacement System ^ TreatmenUHoldin Tank Re lacement Onl g p Y ^ Other Modification to Existing System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Previous Permit Number and Date Issued /' ~ ~ Before Expiration ~ Ga CTL.. IV. a of POWTS S stem/Com onent/Device: Check all that a 1 Non-Pressurized !n-Ground ^ 'Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. ofsuitable soil ^ Mound < 24 in of suitable soil ^ Ho ding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersalll'reatment Area Information: Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal A rea~Required (s Dispersal Area Propos (s ys Elevatio ` VI. Tank Info Capacity in Total # of Manufacturer y ~ ' Gallons Gallons Units ~ v ~ S U ti New Tanks Existing Tanks a` i c _? ~ ~ °d ~ ~ R w C5~ t t~ a U v, rn 'w C7 a Septic or Hgld;ng Tank Dosing Chamber VIl. Responsibility Statement- 1, the undersigned, assume nsibitity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's tore MP/MFRS Number Business Phor~ Number ~ z~ ~~-~ ~y~ f Plumber's Address (Street, City, State, Zip Cod "~ , C~J ~ VIII. Court /De artment Use Onl ~~pproved << 11 isappro Permit Fee l $ oo Date Issued ' Issuing M Signature ^ r Given Reason r Denial ~j . ~j y ~ a 1 IX. Conditi~lfS~flfNfE~+easons for Disapproval ..11-- t : effluent fitter and 3, l!'3+t 5 Se tic tank 1 ~~ ~.., ~Z ~ ~ •~ 6ela,J e, fac~„ p , . dispersal cell must all be services /maintained d ~ ~ ~ ~~ , ~ Sq,. S , as per management plan provided by pltttnber. 2 •Alf sfdtback tlgtlifeR!lentarnoat tre rnakttsirted as wde / ate. Atrach to complete plans for the system and submit the o my only on papffr not 1 than 8 tk x 11 !aches ins e t ~ o tit' r,~ ~ t,~. ~ ~o.¢_ ,.. SBD-6398 (R. 01/07) Vaiid thnt 01/09 ~ t Qt e.Gy13s>I_ ~~ L.ak 2 : ~ ~ISLZ , tafo N ~ cotes ~ ~wE ; a /QZ~ .' PROJECT Bill Fletch `~Q'~JC1`r S i/2 SE i/4S 8 /T 29 I'I]' PLAN DRESS 1025 170th Ave Hammond Wi 54015 17 W TOWN Hammond COUNTY ST. CROIX ~ 9/19/07 3 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 ,BENCHMARK v.R.P. Top o f Fence Post ASSUME ELEVATION 100' ^ BOREHOLE O WELL *H.R.P. Same as Benchmark W ll ' t 11 Scale is 1" = 40' unless otherwise noted e Is o meet a setbacks required by SYSTEM ELEVATION 92.7/92.3 5' below grade WDNR Alternate Benchmark is Top of Survey Iron @ g5 7' ~,B.M. 349' Property Line Plans Designed Using Conventional Powts Manual Version 2.0 2-3' X 65' Cells with >3' spacing 100' 100' Vents B-1 30 '_`pf ~ 1 ~ 25' Filter BEST Filter Pro 3 Bedroom House ~re. ~ B-3 5% Slope Vent 249' Property Line >6" of Cover 12" 4' Long 34" 100th aye Quick4 Standard-W Leaching Chamber with 20.0 ft2 of Area 5.8ft^2/pair of end caps Grade at System Elevation PROJECT Bill Fletch 1~(\9 S ~ 1 / 2 S E 1 /4 S 8 /T 29 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 ~ DATE9/19/07 BEDROOM 3 CONVENTIONAL XXX IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 ,BENCHMARK V.R.P. Top o f Fence Post ASSUME ELEVATION 100' Filter BEST Filter ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all setbacks required by SYSTEM ELEVATION 92.7/92.3 5' below grade WDNR Aln*rnate Benchmark is Top of Survey Iron @ AS ~' I ,B.M. 349' Property Line _ Plans Designed Using Conventional Powts Manual Version 2.0 2-3' X 65' Cells with >3' spacing 100' 100' 249' Property Line Vents B-1 "~' PLAN DRESS 1025 170th Ave Hammond Wi 54015 Scale is 1" = 40' unless otherwise noted Pro 3 Bedroom House B-2 25' ST 10' 30' / 50' B-3 5% Slope Vent >6" of Cover 12" 4' Long 34" Quick4 Standard-W Leaching Chamber with 20.0 ft2 of Area 5.8ft^2/pair of end caps at System Elevation 100th ave Wisconsin Department of Commerce , ~~ v ~OIL\fAL~9r~l R ORT Page of Division of Safety and Buildings ~~`~~\~ U finn/ ., 1....ati.,LJ,.,•r~...,.,.., oc ~nr,. na.., r`..ae .~,,,,,, yy....,,,..~.,.,,.. , „n,... i ,.1, c z = :: ;~ ; . Attach complete site plan on paper not less than 8 1/ es in size. Plan must ~ County ~ !' >J ~ ~.. indude, but not limited to: vertical and horizontal reference. point (BM), direction and , . i d di d l t ~t'b~ ~l ~ ~ parcel LD. r 1a . mensions, north arrow, an ocal n and a r percent slope, scale or is ZONING OFFICE Please print all informati Revie by Date Personal iMortnation you provide may be used for secondary purposes (Privacy Law, s. 15.1)4 (1) (m)). Property Owner L //// C , Property Locat/io'n S ~ E f~7 Qr I;S,Ci. !~ ~ Govt. Lot ( r) N R 1/ ~~1/4 S T Property Owners Mailing Address Lot # Block # SL~bd. Name or CSM# ~ "-- C f ~ City State Zip Code P e Number ^ C' ^ Village own Nearest Road New Construction Use Residential /Number of bedrooms Code derived design flow rate GPD ^ Replaoement~^,1 ^ Public or commer I -Describe: ________ __-_ -______.__ _~ Parent materiak~ / !'2 rx na.,..~ C'r/IU.-G ~.~~~ l~ j- Flood Plain elevation if applica//ble ~/G~'~ ~ / ft. General comments ~~`/~` ~ ` ~~ ~ T p~-~ .'n/L ~C~ r/T/ ~,~ and recommetldations: y, ~ Q ~ ~} 'C ~ ~,`_ r ~- Boring # ~~ng ~ pit Ground surface elev. ~ ' '~ ft. pepth to limfing factor (Z- ~ in. Soil lication Rate Horizon Depth Dominant Odor Redox Description Texture Structure Consistence Boundary Roots GP DIfg in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •E ff# 2 1 /'} ~)7 , _ ---~ I d ® 9 ~~ # rin Pit Ground surface elev. (' ft. Depth to limiting factor ~ L ~ in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Et1#1 'Eff#2 -~ L 3 - r a _ ~ S Z t-Y, ~ i L-~y s --- ~ ~ s -~ w ~ ~°l r `I ~ I oL ~~ ~` ' Effluent #1 = BOD > 30 < 220 mglL and il-SS >30 < 150 mgll ' Effluent 1'12 = 8oD < 3u mg/L and TSS < ~ mg/t_ CST Name (Please Print) Signa ~ '~~/ CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ ~/.... p ~- 715-246-4516 Property Owner Parcel fD # Page of ® Ong # ^ Boring ~it Ground surface elev. ft. Depth to limiting factor in. Soil ~~ Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 a ~~ # ^ Bonng ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Effif2 a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Cola Redox Description. Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eft#2 'Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/l `Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-6330 (8.6./00) property Owner Parcel ID # / Page ~~ # Boring r ~ ~ ~it Ground surface elev.~~ ft. Depth to limiting factor in• Soil ication Rate Horizon Depth Dominant Color Redox Description Texture SUvcture Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eif#2 -r ~ 3 ~--= 1 2 rric ~ C s 2 ~~ f 6 ~. ~-~~ ~1 =~ ~i ~ ' 1 Boring # ^ Boring ^ pit Ground surface elev. tt. Depth to limiting factor M• Soil igtion Rate Horizon Depth Dominant Color Redox Description Texture Stn~cture Consistence Boundary Roots GPD/ftt in. Munsetl Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Etf#2 U Bonng ~~ # Ground surface elev. ft. Depth to IimiSng tailor in. ^ Pit Sort icadon Rate Horizon Depth in. Dominant Cdor Munsell Redox Description. Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence. Boundary Roots GP 'Eff#1 D/fF 'Eff#2 • EftlueM #1 = BODE > 30 < 220 mglL and TSS >30 _< 150 mglL 'Effluent #2 = BODS < 30 nrglL acrd TSS <_ 30 ntglL The Department of Commerce is an equal opportunity service providec 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. SBp-BS3o (R6~no) Soil Test Plot Plan ProtectName Cornerstone Properties LLC Sha rd Ads #025 170th Ave Hammond Wi 54015 TM #226900 Lot ~__.__ Subdivision Corner Stone Ridge Dat 8/11 /05 S 112 SE 1l4S 8 T 29 N/R17 W Township Hammond Well PL Property Line County ST. CROIX gM ~ ~gp Assume Elevation 100 ft. Top of Fence Post System Elevation 92.7/92.3 * H R pSame as Benchmark w ~, " `- ~~ ~~ "~2 ^~ ,~ ~ 38.5 h ~~~/ 0 A . ~ ry°' / LOT 4 112545 S.I 2.58 Ac. HWE=1026.50 L80=1028.50 on~j/ t~' ~~~,; ~~~ N 66:3 . 8~ „ 8 aT LocAT~oN ~' LOT 3 ~ 5'9os• eM ToP of ~~ 84368 S.F. 1 1/4"~IRON PIN 1.94 Ac. ELEV=1022.66' , , I N HWE=1025.00 s" 64. 180=1027.00 I ~~ ~~ b 4~) )O~ ~ LOT 2 Zj _ j 80273 S.F. ~ al ~ ~ 0 1.84 Ac. ~ ~ N of ~ • 0' ^ I ~„~ HWE=1024.50 ~ ~ ~ L80=1026.50 O ~ ' 1 / / Q~ W s a~ ~ ~ ~/ V^ Z~ ~' ,s N 87'06'45" W 348.52' ~ ., ~~ ~ / ~ ~~. LOT 1 ~ ~ ~ ,~, ~ o' ~ ' ~ 80481 S. F. I ' Z ~ \,~ 1.85 Ac. 50'I ~ / f` ~ ~~'~, H WE=1024.00 Z ~ I U N ~'~-~ LBO=1026.00 C O I C C ~ S 1 /4 COR, SEC 8, o~~cE E„s~,T o " 87D1-~' "''~°~' ~ o I 33' 133' I T29N, R17W °- , I (FOUND 2" IRON PIPE) _ _ _ _ _ _ 341.61' _ _ _ _ _ _~J~ 66 0' ~ N 89'04'17" E 771.74' 33.04' w ~--- - - - - -~ -- --- --- --~'~~i ~~ _ LOT 8 _ LOT 9 ~ ~ ~1 I PLAT OF I I ~~ I'C I II~II • ~ ss' i , COUNTY PLAT OF: ;ORNERSTONE RIDGE LOCATED IN PART OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 AND IN PART OF THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4 SECTION 8, TOWNSHIP 29 NORTH, RANGE 17 WEST, TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN. g~ LS ~~ N ~a~ ~< ~~c v, W m~~ ~~ o so loo zoo LOCATION MAP (NOT TO SCALE) SECTION 8, T29N, R17W, Hi K ;! sr WIOM A1M[ PLAT LOCATION 0 I c al JI 4-i N I W al ~ ~I N 1 0 Z LEGEND PROPOSED --- 12' UTILITY EASEMENT ® PROPOSED ------------ DRAINAGE EASEMENT LINE HWE HIGH WATE Leo LowEST Bt ------------------ 66' JOINT DRIVEWAY EASEMENT COUNTY S - - - - - SETBACK LINE (FOUND A! SET 1 1/~ ~ PIN 1Yf. 4 T SET 3/4' WEIGHING PER UNEI OTHER LO N 84'31'05W E 'H ~~O ~k Zg i i. ~~e~' U3 E i " ~ LOT 7 6g'1~' i i ,g 87590 S.F. N i "~ 2.01 Ac. yyl W HWE=1030.60 ~ ,r/- 7885 S.F. LBO=103260 ,yry' N ~° LOT 5 ~'~ 73793 S.F. ~~ _~f~• a~ 1.69 Ac. HWE+1028.00 ~3 in,r lso=1030.00 .o• / / ~ N 72385p. Iy 4; A ~ 5 4y / LOT 4 2. ~1d 112545 S.F. 2.58 Ac. MNE=1026.50 LBO-1028.50 ~~* N 86 36.28. w -nom s2s os LOT 3 84368 S.F. ~ 1.94 Ac. 1 MWE=1025.00 H6 LBO-1022.00 f1 ,~ . ~y.,ye a 5e, ?8. W 4f?> ~k 1 /~iy0~ O . ° ~ ,~ LOT 2 80273 S.F. / 1.84 Ac. / / / / / HNE+1024.50 /~ i/ 180=1026.50 / i ~ / UN /// / / // 17'08'45' W 348.52' LOT1 ~a KJ ~l , 80481 S.F. , i S°~ , A ~' ' YS . c. I HWE=1024.00 I ry. . 1BO+1ozs.ooJ I ° IZ ai' --~- pM ~~ , O - 4 JAI o W om~x- W ua4W ~- I ~\ ' I~; 33' f 33' ~ y II I~ - - 341.61' ---- 33.04' u f ) 9 a '1 '. ~ C ~~ p ,~? y aa~,• b~ ,~ ~ _LOT 9 ~~~~~~) ~ ~ I FINAL PLAT OF PRAIRIE RUN ~Im I~ - - - - - - - - il"~Ii~I 1.80 Ac. ~ M9~° HWE=1029.1 n0 1.80=1031.1 Z 10 /~. - ~\ ~` !i 1 1 ~ 'O ~ N 82'28.58 E 4 \ i \~ ~ ~ ~ LOT ! 75629 5 \ ~ ~~ i /~ i 1.74 Al I I ~ Q ' I / I I N 81'47'39. 1Y 483. ' / ~~ ~ ~' ®~ LOT 10 / ~ / i ` / 86121 S.F. / / ~ ~J ~ i / 1.98 Ac. / 'SOG ~ / i i // i i i ~/ / N 7843'4g• W ~ / J3. s• / So- ~ 523.60 LOT 11 ~ / 80567 S.F. ~, N 6j 1.84 Ac. ~y / 5935~ w ?9 1 ~ ,F ~ 2g . lJ' S LOT 12 N 89'35'14' E 70672 S.F. U 1.62 Ac. o z LOT 1 $ 70135 S. N 89'04'20' E 477.73' ~ 1.61 Ac LOT la ' (+ o~ron •~•~ - -2.21 AG. ._ -~ - ~, HN£-1026.25 ~-'~ o l.e.o.=lo2s.25 rr-~~~ '~ 'T ~ ~ / m ~ --1388.84' ~'--------482_46' '~-~---- ~~--r----230_72" S 89'0417 W 1796.45 _ __ s 89roa•n• w 183064' - - - T SOUTH LINE OF SEC. T.29N, R.1T LOT 31 I LOT 30 { LOT 29 FINAL PLAT qF PRAIRIE RUN pcHlcuLruRE-REs oa~tea L1Y: JFFF YMa,A ~, Document Number State Bar of Wisconsin Form 3-2003 QUIT CLAIlVI DEED Document Name THIS DEED, made between Cornerstone Ridge LLC a Wisconsin limited liability cpllnAaTly - ("Grantor," whether one or more), ~ a 6b , 6~ and Fletch Investments LLC a Wisconsin limited liability comnanv~and Crate 3hermoen. a marred nerson.~ ~3•_"ti~~_].Ilt~l~ta as t- an G i n common ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Pr erty") (if more space is needed, please attach addendum): Lot 1, 2, 5, 6, 8, 9, 10, l1, 12, 13, 14, 1S, 16 and 17, Plat of Cornerstone Ridge, St. Crotx County, Wisconsin This deed is given pursuant to a partition agreement, pursuant to Sec. 77.25(S) of the Wisconsin Statutes by and between Cornerstone Ridge, LLC, a Wisconsin limited company and its members. 11ii1i~ 11111 i1ii11i111 ii1i11i1i11111 ililli 11i(1i11 *$ 4 S 0 8 5 2 rt KATHLEEN H. WALSN REGISTER OF DEEDS Si. CftQIX CU., WI REGEI~ED FQR RECORD 04j08f2007. 03:50PM . BUTT Gi_AAIM DEED EKE~Pi ~ 5 .terest REG FEE: 13.00 PAGES: 2 Recording Area Name and Return Address KRiS71NA OGIAND ES7REEN & OGlANp ~/ 3Q4 Locust Hudson, Wi 54016 see attached Parcel Identification Number (PII~') This is not homestead property. (is} (is not) Dated ~~ ~~~ ~~ Cornerstone Ridge, LLC Fletch Inves ents, LLC Fletch Investments LLC BY: ''J, ~~-'~+ ~, ~ br (SBAL)sy: t+~?sJC~~ ~ -~-~- '",•~`" . (SEAL) *~ Ja etc member * William Fletch, member '~Y~ (SEAL ~---~y,~ ~ ~ *Steve Dalton, member Signature(s) _, authenticated on *TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Krishna Ogland, Estreen & Ogland 3U4 Locust Street, Hudson,~WI 54016 STATE OF ) ~ ) ss. -< ~t~J~~~ti COUNTY ) ,. ~: Personally came before me on (t 1~~ ~~ ,' '' ~ 4, , ,~ , the above-named Cornerstone Rid e LLC a Wis nnsin 1' ~~~, liabili com an b :Fletch Investments LLC bat Ja le~~~ '~ ~' member and Crai Shermoen member ~' ~.' '-'''' ~~ to me known to be the person(s) who executed,' _ .~' e ent and aclrno~'!ledged the same. '~^ ~;' ~';~#;~ Notary Public, State of My Commission (is permanent) (expires: ~ o (Slgnaturea msy be anthenficated or acknowledgcd. Both are not necessary.) , NOTE: THIS IS A STANDARD FORM.. ANY MODIFICATIONS TO THIS FORM SHOULD I3E CLEAI2LX IDENTIFIED. QUIT CLAIM DEED ~ 2003 STATE IiAR OF yVLSCONSIN FORM N0.3-200:r t of 2 AUTHENTICATION ACKNOWLEDGMENT -~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIl' CERTIFICATION FORM OwnerBuyer Mailing Address Property Address ~/~ ~-, ~~ ~, (Verification required from Planning & Zoning Department for new construction.) CitylState Parcel Identification Number LEGAL DESCRIPTION ~J / Pro ert Location -s '/ , ~i/a ,Sec. O , T~~ N R/ ~W, Town of/ i~~ P Y ~ _ Subdivision Lot # Certified Survey Map # `- ,Volume -- ,Page # ~~ b ~~ ,Volume ~ ,Page # Warranty Deed # Spec house es 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 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. 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property describe ove, by virtue of a warranty deed recorded in Register of Deeds Office. ~~~~ SIGNA OF ICANT(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 trap if reference is made in the warranty deed. (REV. 08/05) Maintenance and Contingency Plan for a Septic System Maintenance Pian 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in orderto extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contin cy Pian lion #1. system fails, determine cause of failure, use alternate area and install new em in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 SEi~. 5.1~ i?.' ~-- ~u .w~es,.~.aoaem..,~e~s ~~~~ t~#~i~ twit a SEP. 5.207 t7: ~~5~t P. 8 ...,_ ~~ ~i~