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018-2013-02-000
z ;U ~ O ~ ~ O a 3 m m ~ ~~~ 3 ~ ~' m G ~ 3 ~ D °, z 0 W I~ a ~ ~ ~ v 7 O 3 ro ro o ~ oo °. o ~?- (OD ~ V p ~ ~ n ~ ~ ~ m d N ~ a_ 7 O N N 'O O O ~ N 7 ~ CD ~ ~ ~ O O 3 ~ oa m a ~ ~ N O ~ (D y p 3 (p (D O ~~ o ~. N ~ o~ 0 ~ ~ o ~ o ° ' ~ ~ ~ ~ .~ V ; ~ ~3 3 - 1 ~ ~ ^.• c i ~ ~ O p ~ ~ O O H ~ O' ~~ ! W ~ n ~ N w~ N C7 c rn R° ~. I tU 3 iv °° ~" C (/1 (D (D ~ a fU C p ~ ~ ~ p v W C "t O N p. fi "' p O Q ~ N ~ N ~ O~~ O C i pZ O W O -~ O p I O p N ~ O e~ 1 1 7 N N fA p -O O ~ N N N C ~ O C .,, ~ ~ ~ ~~ ? ~D a a ~ a ~ i .. .. ~ ~ c o m ~ o O coo ~ M W i r., OZ ~ ~ / N N N N o o h ! N r ~ ! ~ _ ~ .~ . _ a ~ ~ O ill O z ~ '~ ~ N O //~~~ f~l1 f~A N ~ ( ~, ~ ~ ~ ~ S V ~ 0 m 0 ~ ice'. ~o a c m v C 0 m N ~ m 1 ~ d ~ N ~ - ~ m .d. ~ N ~ ~ 1 . i ~ m ~ _ z 3 ~ ~ ° z -°- t z ao z z g O 1 ~ I o C 3Q ~ ~ 0 fD A ' ~ ~ N ~ ~ ~ ~ ~ N C O , '. ~ C ~~ CD A ' + ~ V N ~ C ~ ~ O' '. II W N N d =D 7 Ia. ~ O O y ~' ~ D ~ c o u' ~ ~ ~` ,`~ ~_ ~ a ~ Iw Q A Z ~ O ~o' ~ N ~ ~ ~ i, W ~ ~ ~ N O z '0 3 ~ c 3 cn ' ~ N c =: y ~ m ~' vC Z ~ . A N ~ N = W W t p CD o ~ r D ~ n o d ~ 3 ~ C < 3 N ~ 4 a G 7 c n~ a 'o -o w ~ ~ ~ a '°- c~ o a o O ~ N p N O N ~' ~ 3 O.~ ~ ~ O Z I j ~ B. c (D O O Q N o ~ 0 ~- m m ' ~ `- O V' N fD 3 ~ ti (D ~ N om I O . ~ CD 6p N ~ ~ ~ ~ w J ° ~ : ,' a ' o . s Wisconsin De~`tment of Commerce Safety and Bu,~ding Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ~.- City Village X Township C & M Pro erties & Construction, Inc. Hammond, Town of CST BM Elev: insp. BM Elev: BM Description: f3~1 a i o~ cs s TANK INFORMATION ~(!,`,n,y~ TYPE MANUFACTURER ,jam 2 ~':~ 3, , CAPACITY Septic l J~~~- /ano (~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7~~ N f 9 ~ > 33 -' Dosing ----, Aeration Holding PUMP/SIPHO IN NFOR ATM ION Manufacturer Demand GPM Model Number -- TDH ift Friction Loss System Head TDH Ft Forcemain L`e~ftgth------ Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 506326 0 State Plan ID No: Parcel Tax No: 018-2013-02-000 SectionlTown/Range/Map No: 08.29.17.1103 STATION BS HI FS ELEV. Benchmark 3~ 4 /~3, 1 loZ~ Alt. BM I LO vta ~~ Bldg. Sewer ,~~ ZC~ ~ ~ 4 SUHt Inlet .,7, ,,,~ 95 St/Ht Outlet ?,97 9S d3 Dt Inlet ~ ~ Dt Bottom ` ~ Header/Man. d ~ 0 t~ p~j Dist. Pipe g. 4 S ~ ~ 3 Bot. System ~1.3b 93 Final Grade 3 .~ St Cove r,"via,~„ Goy 3 . \ / aC,~ BED/TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 _t.~, l~ Z, ~-~~`~ ~_ "~-.._ ~.., SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: (('' ~ ~ INFORMATION CHAMBER OR ~t" : Type Of System r Ggn,J~„~ta 725 ~ 33 ~y'[- ~' UNIT Model Number: ~~ rJ r DISTRIBUTION SYSTEM f1-11 Header/Manifold / ~ i Distribution Pipe(s) x Hole Side '\ x Hole Spacing ~ Vent to Ai nta Z r / f L th Di "'F n L th Di ~ S i ` „ w eng a g e pac ng a ,,`, SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 5 ~ („ Bed/Trench Edges ~ Topsoil ~~ Yes [] No ~ - Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 1006 167th Street ammond, WI 54015 (S 1/2 SE 1/4 8 T29N R17W) Corner Stone Ridge Lot 2 1.) Alt BM Description = ~ ~ Go `~~'~" ~ ~~ ~~ ~- ~ ac 2.) Bldg sewer length = ~ 9 V~ - amount of cover = / O,/4 G~ ~" _ _ _ _ _ Plan revision Required? ^ Yes No ~ I ~ ~ q b~'J ~' Use other side for additional information i ~ _ ~ SBD-6710 (R.3/97) I Datte ( nsepctor's Signa4 inspection #2: / / Parcel No: 08.29.17.1103 t:ORf11r1ef~C8,riVi-90Y Safety and Btildutgs Division Catty ~ 201 W. Washington Ave., P.O. Box 7162 St. Croht Madison, WI 53707-71 b2 Sani~ry Pe~rn^g Nw/nb-er (to be filled in by Co.) J 0 t(J ~p Sanitary Permit Application State Tranvaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate govtxnntattsl N~~I trait is required prior b obtsingtg a sanitary pumit. Note: Applicatiat forms for sEato-owvsott TS ars Address (it'di#~ than ms0i~ address} submitted to the Department of Commerce. Petsoml information you provide may be f ~ in accordance with ibe Law 5.15. 1 m StatS. .*~ / /j~ )~ /~ ~ C~- i w / J L A ieat oa Iefortnatiota -Please Print Ad Information Property Owner's C a M Propettiea ody FiBpt~ait ~ I -~, G ~' ~Q ~? ~?o t 3 -va IGGO Property owners ~ Address Property L 9305 Murphy Latin /f / ~ () ~j) GOYC Ld 1 r City, State Zip Code Phone Number SE '/S SE '/4 Section 8 Eau Claire WI 54703 71574-4225 cO'~ T N R II. Type ~ 13nih~ (cheek aN that apply) Lot 4 2g ; 1T ^ E /`] W Q 1 or 2 Family Dwelling -Number of Bedroo 3 C G+ E' Subdivision Name G Cornsr ~6one Rfdgs Bock i{ ^ P l ' 0~ ub id( .o~ial -Describe use u f - S E P 1 3 Q Q ] City of v ^ State Owned - Describe use CSM N ^ viifa$e of ST. CROIX C UNTY ~~~ ~ Townof Hanxnond III. Type of Permit: (Check only one boa on n e app ' bk) A' / New System Replatxarunt TreatmentlHolding Tank Replacement Only Other Modification to Existing System (explain) System B. Permit Renewal Before Permit Rerision Change of Plumber Permit Transfer to New Owner Last ~`~ Permit Number and Dace issta~d L lg °~ ~ ~~ ~Q// 3 Q i~ / IV. T of POWTS S stem/C nentlDeviee: Check all that , ~ _ / Non-Pn;ssurized In-Growid Presswized In-Cnotmd At-Grade Mound > 24 in. of soil Mound < 24 in. of suitable ^ IloldmgTank o ot~>~( ~' o,~ioe ~' ~ -~~1~-t~ ~ ~~ `~ ~~ ~ V. ifFraittment Area Infertnatisn- Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requited (sf) Dispersal Area Proposed (sf) .System Elevation 450 .7 ~ 643 661 + ~ !4' VL Tank Lfo Capacity in Total # of Manufacturer Material Gallons Gatioas Units New Tacks Existing Tanks Septic °` Hddr6 Tack XX 1000 1 Fit~kt:rtlt tsefah Concrete Dosing Chamber ~~ VII. Responsibili Statement- I, the nndersisred, a~nme responsibility for irsta0atiw of the POWT5 sLo~rn oa Ute attscbed ptara. ~untber's Name f Printl 's S' MP/AtPRS Nub Businetiss Pbooe Ni®ber Lynn M. Misfeldt '`(liY~ 224828 715-720-8362 Plumber's Address (Street, Crty, State, Ztp Code) 7089 CTH K Chippewa Falls WI 54729 onn /De rlment Use On pproved Disapproved r Given Reason for Denial $ ~ ~~~ ~ ~ ~ . , // ~ ,~ ~g SYSTE M O 1V Q l~~ ~ xX_ L~ Y~-~ ~Z'4~/L IIK. ~ #or 1~s v t 1 J ~ ersal cell must all be service rr~ipa r'~t~hed ~~ r.k' ~ii.~ ywC~-a--°/ ~ , '~ E~.~- 7-''~'~'h~~ di ~~ sp ,( ~/H ~-~-~- as per management plan provided by plumber. ~~~ f j ~-.~,( ~~~--~~~.h. ~~%'~~ 2. All setback requirements must be maintained ~ ~ , ~2 d T~ ~ as per applicable code/ordinances. ~ ~ ~ vz y 7 U , Aaach to comp4ae plans for me system sad wbmit to the Caety osdy oa paper Dot teas tiw 8 vs ~ haehea is glee ~ r ~,c. SBD-b398 (R. 01/07) Valid thtu 01/09 ~~ A ~3 ~ =o ~" '"~ g~ -.~ P r~ ~' ~ Z m Ri i Private Onsite Wastewater Treatment System Title and Index Page Project Name: C & M Properties 3 BR Codv. Owner's Name: Cody Filipczak Owner's Address: 9 3 0 5 Murphy Lane Eau Claire WI 54703 715-874-4225 Legal Description: S E S E 8 2 9 N 1 7 W Municipality: Town, ^ Village, ~ City of _ County: S t. C r o i x Subdivision Name: Corner Stone Ridge Lot Number: 2 Block Number: Parcel LD. Number: Page 1 Title and Index Page Page 2 Site Plan Page 3 Cross Section & Plan View Page 4 Management Plan Page 5 Management Plan Page 6 .BEST GF10-8 Filter Maintenance Page 7 Page 8 Page 9 Name of Designer: Lynn M. Misfeldt Telephone Number: 715-720-8362 License Number: D-1133 Date: 9 -1 1- 0 7 Designed Pursuant To The Following POWTS Component Manuals And Comm 81-85 N/A ,~r~*~4 t r L~ ~. Soil Absorption Component Manual (Version 2.0) SBD-10705-P (N.O1/O1) a Page 1 of 6 Hammond Y •'~ +~~ ~~~~~~r ~' , P ~~ ~~ '1 g ~' -.g P r r' ~ m 0 ~~ z Soil Absorption System Cross Section 99 ft 4° Schedule 40 Final Grade PVC Vent Pipe 9 5 ft Wdh Vent Cap ~ Leaching ~ Chamber ~_ 9 4 ft ti System Elevation 3 ft 7 ft Soil Absorption System Plan View 66 ft 3 ft ~ ft r Leaching Trench 1 { Vent Or Observation Pipe ~ Chambers ®`~`~' 4" Dia. Trench 2 Header Leaching Chamber Saecifications Manufacturer And Model Infiltrater:~Q4W EISA Rating 2 0 sq ft per chamber Soil Application Rate • ~ gpd/sq ft 4 5 0 gpd Design Flow :~ . 7 Soil Application Rater 2 0 EISA = 3 2 Chambers 2 rows of ~ 6 chambers each. Page 3 of 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 4 of 6 FILE INFORMATION owner C & M PRoperties Permit # DESIGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units ^ NA Estimated (average) flow 3 0 0 al/da Design (peak) flow = (Estimated x 1.5) 4 5 0 al/da In Situ Soil Application Rate • ~ al/da /ftz Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (RODS) <220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (SODS) _<30 mg/L Total Suspended Solids (TSS} s30 mg/L ^ NA Fecal Coliform (geometric mean) s10° cful100m1 Maximum Effluent Partide Size '~ in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Tank Manufacturer Huf f Cutt ^ NA ^ Septic ^ Dose ^ Holding vol. 1 0 0 0 gal Tank Manufacturer ^ NA ^ Septic ^ Dose ^ Holding vol. gat Effluent Fifter Manufacturer BEST ^ NA Effluent Filter Model GF 1 0 Pump Manufacturer ^ NA Pump Model Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ^ NA ~ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other. Other: ^ NA ~'~~ ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: 3 ^ month(s) (Maximum 3 years) ^ ear s ^ NA Pump out contents of tank(s) ®When combined sludge and scum equals one-third ('~) of tank volume ^ ~ ^ When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 ^ month(s) Maximum 3 years) ^ year(s) ^ NA Clean effluent filter At least once every: 1 _ 3 ^ month(s) ^ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) ^ NA other: At least once every: ^ month(s) ^ year s) ^ NA other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servidng Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any bade up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing cendition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third ('~) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Serviang Operator and disposed of in acxordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servidng of effluent filters, mechanical or pressurized components, pretreatment unfts, that require servidng at intervals of 12 months or less require documentation recorded on the deed regarciing maintenance requirements. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GAAW (12!02) Page 5 of 6 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank{s) for the presence of painting products, solvents or other chemicals that may impede the Vestment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resumng in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore nortnai levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or wmpad, 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cmtton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicdes; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Serviang 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 tf the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and corrpaction and should not be infringed upon by Required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Baring 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 evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Ly II >I Misfeldt Phone 715-720-8362 POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name St. Croix Cty. ZO li >I Phone Phone 71 5- 3 8 6- 4 6 7 4 This document was drafted by the Chippewa County Zoning Department in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) 8 (3), Wisconsin Administrative Code. r "A'~ 1 , O ~~ "~ O W W f C!` O ~C CC K J ~~ .~.+. ~ K ^. n ,~..r .~.~ v ~- ~~ ~~ ~~ ~~ n f ~"~' ~Y ~• /` n '?~+ ~--' v rt ~ .yam ~ .. s ~. ~_ n CJ^r~ ~~ ~~ ~' `f '-« '~ n ~ e~f ~- ~ J J• ~j ~, ;s .yam ~ ~ ~ n .-r r 9: r-r .:+ ~i ~' .~":r CA ~ J a-n f v K ~+ ~"~ ~/"1 V ~f n f N v K e+ J ~. ~~ ~., ~v G C: :~ V: of _~ C ~ ~ v .:+ ^' ;. %"' f ~ ~~ v U. .~.r ~ n ~. _ r ~• ~~ :... ~< ~~ :~ ~~ ~~ J ~ r~ V r"f J ~Y K ~~~ ,..' X ro Y. C^v (~ ~ "~ r~y I 7~~ `^ ~y~ V ~~ !~}' "~ ~ Cfl "T ~tt /~_~~ 1~ pY~[ ~1 o~ O r/• (~' ~~ o~ ~- ~, ~. ~~ O r~ A `~ A7 ~ f'D !'"f- l"P • !~ ICI ZZ 1~ V f^v Cu y ~'~. Q. .-. "" D ~~. UR ~ . ~ ~ ~ ~ J J ~ ~ r J tt ~ ~ C ~: C^G .:+ i~ n a+ ~ nJ J ~"h, Uj ~• a^.i~ ~ T ~. ~~~ ~~ ~~~ ~~ ~~ .~ +~ V ~ f ~K. ~ ~ •'f ~K ~ < ~~ ~• ~ ~. O n. m % `G t~ C: ~ ^' CL ('r ,~'r.'. .., ~ .-' ~ ~.. G.. C O .7'~ "'' ~ C ~ ~~ S r.. ~~. ^~ W :A C , ^"t ^~ i~++ z z 0 ~~ O ~~ 6 ,~ s '. Vu De~arbrierd ~ Corrirrrrerce Division of Safety and Blrldirx,Is SOIL EVALUATION REPORT ~ 1 ~ 3 w~ a~wwnv vrrtn wrrerr a7, vvrs, saran. ~.vw COVtdy St. CIOIR Attach OOmplete site plant On paper not less that 812 x 11 lnd~es in sue Plan must . include, but not limited to: vertical and horizordai reference poir>t (BM), direr3ion and l d l d Parma I.D. ~i~' - , 3 ~ ~- ~ C~ penaer ope, sca e or s rrrrerrsiorrs, rtorNt arrow, and location and distance to r med. . ~ Please print all information. Revje~ed ' .~ Personal information you provide may be used for secondary proposes (Privacy law, s. 15.04 (1) (m)). ~ Property Owner location C & M Properties Cody Filipczak SE f K SE t/4 S 8 T 29 M R 17 ~ ~ yy Property Owner's Mailing Address # # Subd. Name a CSM# 9305 Murphy Lane 2 Cotner Stone Ridge Stye Zp Code Phone QY awn {~ Eau Claire WI 54703 ~ 7} 5-87 25 100th Ave. New Construdlon Use Residerdial ! Number of bedrooms 3 Code derived design lbw rate 450 G~ Replacemerd ~ Pub6c or corrur~rrtiai - Desaibe: Parted material loess over elevation A applicable R Ger-eraf c~rrur>errts Convert SE = 94' and nsc~rnrirerxlatiorrs: SEP 1 3 2007 0 # ° ~ a Pit ~~ ~~ elev. 99 R Depth to uniting factor +101 ~. Soi Race Horizon Depth Dominant Odor Redox Desaiption Texture Stnrdure Consistence Boundary Roots iri. Murtseli t]u. Sz. Cord. Color Gr. Sz. Sh. "Bflr1 'E!f#2 I 0-16 IOYR 2/2 ~ sl 3msbk ds cs lm .6 1 2 16-40 lOYR 4J6 none 1 Icsbk dh gs - .4 .6 3 4¢60 IOYR 4(6 Ana s Osg d1 _ .7 1.6 4 60-101 lOYR S/6 none s Os d1 _ - .7 1.6 ^ ~~ # Q p Ground surface elev. 1 ~ g, ~ ~ ~rtdit>4 teHar 110 n Sol Rate Horizon Depth Dorrtinard Redox Desdiption Tex~i+e SUuctue Corrs~enoe Borrrdery Roams GPI XtF in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Etf#2 1 a18 lOYR 2/2 sl 3msbk ds cs lm .6 1 2 18-30 lOYR 4/6 >~ 1 lcsbk dh Ss - .4 .6 3 30-42 I OYR 4/6 ,~ s Osg df &s _ .7 3.6 4 42-110 20YR 5!6 >~ s Osg d1 - - .7 1.6 * Eflluerd #1 = 8«? > 30 < 220 rt>gll. and TSS >30 < t50 mgrt. * EfAuerd #2 = BOD < 30 mglL and TSS < 30 mgll. CST Name (Please Pont) Sitpe c CST Number L M. Misfeldt 1(Uy`, ( 224628 Address Evahratian Conducted Telephone Number 7089 CTH K Chippewa FAlls, WI 54729 9-7-07 715-720-8362 ORIGINAL Y C. Filipczak Parse! ID Ik 2 3 Page of _ 3 V ~~ ~9 ~ ^ Pit Grotu-d surface elev. 99.5 ~ ~ ~ ~9 ~~ +120 ~ Sal Race Horizon Depth Dominant Col Redox Description Texture Stnrdure Consistence Boundary Roots tiP DlfF in. tilt flu. Sz. Cont. Cola Gr. Sz. 5h. 'Eiftr'I 'EftiZ 1 0-17 lOYR 212 none sl 2 17-48 IOYR 4/b none 1 3 ~-~ 1 OYR Mb acne s 4 66-120 IOYR 5/6 none s ~ ~ ~9 Pit GrDUrxl ~~ elev. ft. Depth to Gnwting factor in. Sal Rye Hor¢on Depth Dorr>ir~t Redox Description Texture Strudtre Coruatence Bo~dary Roots GP DIIF in. lAAunseN Qa_ Sz. Coat Caton Gr. ~. Sh. 'Eft 'Et~2 ~9 ~ ~ Boring Pit Ground surfaos elev. tt. Depth io tirrr~ng factor in. Sol t~ Flotizon DepUt Dorrrnarrt Redox Description Tex4ae Ssudue Come Socndary Roots GP DAP in. Mansell Qu. Sz. Cont. Cotor Gr. Sz. Sh. 'Effifl 'Etf~2 EfAuert #1 = BOD, > ~ _< 220 mgll. arxi TSS >30 _< 150 mg/L ' EfikrerY ~2 = BOD, < 30 mgll and TSS <_ 30 mglL 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. seos3xrrasccr~anno~ CO .r 6' ti .• a g G .,0 J /~' ~o ~ D M T~ 8, y G Z n f -o ~~ N o ~ Z m N 6~ m 3 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address v4S 1 YLtcf; , '' 11~ City/State ~;1,(j~1~~(' ~ W~ Parcel Identification Number 0~~ `~ LEGAL DESCRIPTION Property Location t/a , ~'/a ,Sec. , T~N R ~~ W, Town of Subdivision L/©I`V1P.J~~l9 -~- ~~~~~~~~ ,Lot # ~. Certified Survey Map # ,Volume ,Page # Warranty Deed # ~ p ~~ ~v ,Volume ~ ~ ,Page # Spec hous J yes~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 standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of A' ***Any information OF APPLICANT(S) DATE is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) (Verification required from Planning & Zoning Department for new construction.) Parcel #: 018-2013-02-000 09/14/2007 02:08 PM PAGE 1 OF 1 Alt. Parcel #: 08.29.17.1103 018 -TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/10/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - C & M PROPERTIES AND CONSTRUCTION INC C & M PROPERTIES AND CONSTRUCTION INC 9305 MURPHY LN EAU CLAIRE WI 54703 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 1006 167TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.840 Plat: 10/092-CORNERSTONE RIDGE 018/06 LOTS 1/18 SEC 8 T29N R17W PT SW SE BEING Block/Condo Bldg: LOT 02 CORNERSTONE RIDGE LOT 2 (1.840AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-17W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 09/07/2007 860080 WD 04/09/2007 848085 QC 01/10!2006 816125 10/0092 PLAT 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class Acres AGRICULTURAL G4 1.840 Totals for 2007: General Property 1.840 Woodland 0.000 Last Changed: 07/19/2007 Land Improve Total State Reason 300 0 300 NO 05 300 0 300 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 State Bar of Wisconsin Form 1-2003 WARRANTY DEED Number THIS DEED, made between Fetch Investments, LLC, a Wisconsin limited leability company, a 66.6% interest, and Craig Shermoen, a married person, a 33.4% interest, as tenants in common ("Grantor", whether one or more}, and C & M Properties and Construction, lne. ("Grantee", whether one or more). Grantor, for a valuable consideration conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 2 of Cornerstone Ridge to the Town of Hammond, St. Croiz County, State of Wisconsin. REC FEE: 11.00 TRANS FEE: 105.00 PAGES: 1 RETURN TO'. C & M Properties and Construction, [nc. 930.5 Murphy Lane Eau Claire, W 154703 Tax Parcel No. This is not homestead property. Together with alI and singular the hereditaments and appurtenances thereunto belonging; and Fletch Investments, LLC, a Wisconsin limited liability company, a 66.6% interest, and Craig Shermoen, a married person, a 33.4% interest, as tenants in common warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, encumbrances and encroachments of record, and all exclusions or exceptions from coverage, if any, as set forth in the title insurance policy issued to Grantee as a Hart of this transaction, if such a policy was issued. Dated .~ 2007 `1\NiIVUIII/!! /~////~i Seiler ```;`~~FE ~LjG ~~~i c2: ~~, Seller = ~.•~` _' AUTHENTICATI(3~1 •~'•. •• ~ Signature(s) ~'~. `p~'~' .... •'~c~G~~~~`~ ~~~i,.. 0 F W , .. Authenticated on TITLE: MEMBER STATE BAR OF W[SCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Schrader Law Office, Tonv R. Schrader f7I5)232-7770 i,/~ ~~ w ~~. ~l{f~ ~..,.- LLB W'lliarn Fletch for Fletch Inv., LLC Jay fetch signing for Fletch investments, LLC Jaylf'tetch as Power of Attorney for Craig Shermoen * s s o a s o 1 ~~d~~~ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09J07/2007 11:OOAM ItARRANTY DEED E%EMPT p ACKNOWLEDGMENT STATE OF WISCONSIN ) } SS. St. Croix COUN'T'Y j Personally came before me on ~1LlQNYt.(_lol~ ~R. 2007, the above named Jay Fletch for Fletch Investments, LLC and as Power of Attorney for Craig Shermoen to me known to be the person(s) who executed the foregoing instrument and ac ow ged the sam . * a d William Fletch Nota~y~"ublic, State f~Wfsconsin My commrssron (is permanent) (expires: (Signatures may be authenticated or acknow9edged. Both arc not necessary.) NOTE; THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 2003 STATE BAR OF WISCONSIN FORM NO. I-2W3 1 of 1 File No.: 07-03846-ATSH State Bar of Wisconsin Form t-2003 WARRANTY DEED TIiIS DEED, made between Fletch Investments, LI:.C, a Wisconstn limited liability company, a 66.G% interest, and Craig Shermoen, a married person, a 33.4% interest, as tenants m common ("Grantor" whether' one or more), and C & M Properties and Construction, Inc. ("Grantee", whether one or more). Grantor, for a vaiuahle consideration conveys to Grantee the following described real estate, together with the rents, profits, fixtures and outer appurtenant interests, to St. Croix County, State of Wisconsin ("Property") (if more space rs needed, please attach addendum): Lot 2 of Cornerstone Ridge to the Town of Hammond, St. Croix County, State of Wisconsut. ___.._ n, ;' n ~1 n ) ~~ i l~ V C RETURN TO: C & M Properties and Construction, Inc. 9305 Murphy Lane Eau Claire, WI 54703 Tax Parcel No. This is not homestead properly. Together with ail and singular the nereditaments and appurtenances thereunto belonging; and Fletch Investments, LLC, a Wisconsin limited Iiabitity company, a 6G.G% interest, and Craig Shermoen, a married person, a 33.4% interest, as tenants m common warrants that the title is good, indefeasible m fee simple and free and clear of encumbrances except; Easements, encumbrances and encroachments of record, and all exclusions or exceptions from coverage, if any, as set forth m the title insurance policy issued to Grantee as a part of this transaction, if such a policy was issued. (( , Dated ,~ A ~ ,g ,/ rU 2007 :./~ w ~ `~- ~i ~it~ T`«v-. L.Z,t;,_ Seller \`` ~~. .,~~~ii \~~ a~ /C~,~~ `~ Seller = ~ ~ '_ AUTIIENTICATII~t ~ P~z\1 Signature(s) ~~ sp. ,.,.... -- GO `~ ,. .,~~W~S ~O Authenticated on TITLE: MEMBER STATE BAROF WISCONSIN {If not, authorized by Wis. Slat. § 70GAG) THIS INSTRUMENT DRAFTED BY: Schrader Law Of1lce Tonv R Schrader (7[5)232-7770 `'~~" ... b~• F!e-~cl. lnty, tae .Tay Fletch signing for Fletch Investments, LLC ~~ a4 ~O~Q i°/ ~~4tA S~~w+ativ lay letch as Power of Attorney for Craig Shermoen Personally came before me on ~e [1rLJ,vin.flpY ( 2007, the above named Jay Fletch for Fletch Investments, LLC and as Power of Attorney for Craig Shermoen to ine known to be the person(s) who executed the foregoing instrument and ac ow ged the same. 0 t ~~I Not u lic, State f sconsin I i My commission (is permanent) (expires:/ ) (Signahires may De authenticated or acitnowiengcd. Both are oot necessary.) NOTE: THIS IS A STANDARD hORA1. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDEN'CIFIED. WARRANTY DEED 2003 STATE BAR OF \'4ISCONSIN FORM NO. t-20o3 ACKNOWLEDGMENT •``~ STATE OF WISCONSIN ) ss. St. Croix COUNTY File No.: 07-03646-ATSH eRt;TR Pablze View-Receipt Page 1 of 1 PL)JCT120N1C 12>/AL ESTAT>; TRANSFER RIrCE1PT WISCONSIN DG.1!AIYrAtb;N'I' OR R[iVCNI!I+, ms'raacrlo~s i ,Grantors and grantees must review this recelpt, noting grantor and grantee responsibilities. 2, Mail or deliver the following Items to: St, Crax County Register of Deeds, ; 101 CARMICHAEL RD, HUDSON, WI 54016-7773 • This recelpt page, along with a transfer fee of $105.00. • The deed or instrument of conveyance, along with a recording fee of $1 1.00 for the first page and $2.00 for each additional page. To view the details of the real estate transfer return online, go to https://ww2.revenue.wi.gov/RETRWebPublic/application. You will need to know the recelpt number, the total value of the real estate transferred, and the last name of one grantor or grantee. Receipt S4A1. Filed on September 5, 2007 at 2:18 PM. Value transferred $35,000 Transfer fee $105.00 Value subject to fee 535,000 Fee exemption number Grantors Fletch investments ILC: Shermoen, Craig Grantees C & M Properties and Construction, Inc. Tax bill address C & M Properties and Constructron, Inc., 9305 Murphy Lane,Eau Claire, Wisconsn 54703 Property Location 1006 167th Street, Hammond, Wi 54015 Parcels 018-2013-02-000 (Cornerstone Ridge/Z/) Short legal description Lot 2 of Cornerstone Ridge to the Town of Hammond, St. Croix County, State of Wisconsin. Grantor responsibilities: Grantors are responsible for paying the proper fee amount-verify the total property value, fee amount and fee exemption before sending this recelpt to the county Register of Deeds.? Grantee responsibilities: Grantees assert that this property is not a primary resldencez, and that the property is S14t subfect to weatherizaUOn standards with eXClusion Code "W-7" 3 Preparer Schrader Law Office, 715-232-7770, tonys@amtitleservices.com Grantor agent Jay Retch, 715-760-1189 Grantee agent Cody Filipczaic, 715-87a-4225 If you have any questions about the Real Estate Transfer Return visit the Real Estate Transfer Web site at h You can also contact your County Register of Deeds see -~~"-'~i'..fL4~state.wi.cc/u;~t1ES0,.html.. ( blkp://www.wrca nrn/), Intormanon on the real estate transfer return is used to administer Wisconsm•s laws of income tax, real estate iransrers, rental unit energy efficiency, lottery tax credit and general property tax. The transfer of Wisconsin real estate in a taxable transact+on must be reported on your Wisconsin income lax return. This is true whether Yeu were aresident, apart-v¢ar resident, or a nonresident of Wisrnnsm. If you are a nonresident of Wisconsin, you must file Form 1 NPR to report the sale. Penalties ror use of an improper exemption are imposed per s. 77.26(8), Stets. Penalties for falsifying the property value are imposetl pers. 77.27, Stets. 2 Penalties for improperly claiming the lottery & flaming Credit as Primary Residence are imposed per Chapter Taz 20.7 9. 3 Penalties relating to Weathenzabon claims are imposed per s. ~ 07.7 22. Stets, " For more mtonnation sae Chapter COMM67, s. 67.03 and 67.04. hltnc•//urtnr~ trim»no ~xn nn.r/RFTD\XIo1~1J.,i.7:,./C..,.,..,,«u....,~..,.n._...___r^r_.. n r__r, r.-r.r r.r,.n ..,~,..,.,,_ ,/ ' ~ + ~' \ HWE=10 -8X ~. ~ \ LBO=10 .' ~1 9~~ }~ 3 84368 S.F. (B \ 1.94 Ac. HWE=1o2s.oo \ N.B. = 71286 S.F. LB0=1028.00 4!A ~ N.B. = 1.63 AC. / '~~ , 200 \ ____ -- \ o LLJ ~ °I~IQI ~ 80273 S. F. HWE=io26.o0 QIQIzI ~ LB0=1028.00 / ( ~ 1.84 Ac. ~ ~ W N.B. = 62931 S.F. ~ Iml ~I W N.B. = 1.44 AC. 2 ~ ~ ° ~ 3481' alzl~l p~ 6 N 80481 S. F. N ~ r --- d- 1.85 Ac. ~ N.B. = 43897 S.F. ~--- N.B. = 1.01 AC. HWE=1024.00 i ocvv^--r'r^v-26.0 I ~ ,z ~ 1-~{` ~ _ '. I. ~I .~ ' V 6 0' , .__•_33.04 ____ - ---- _ ~--~. LOT 9 FINAL PLAT OF PRAIRIE RUN \i i . i~~ TENT OF SERVICES AND ARE THE PROPERTY OF HEI AND MAY NOT BE USED OR COPIED WITHOUT PRIOR WRITTEN CONSENT. :W ~ t ~,n~ineers - L~ ~ 221 1 Q'n(ei~ Road 7 i 5.53 t .0525 ^ s66.59: www.humP~re~ sconsin Department of Commerce PRIVATE SEWAGE SYSTEM ,fety and Building Division INSPECTION REPORT GENER~IL 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: Corner Stone Pro ernes City Village X Township Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL ~. BLDG. Vent to Air Intake ROAD Septic '~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer mand Model Number TDH Lift Friction Loss System Head TDH Forcemain Length Dia. Dist. to well SAII oRSARPTInN SYSTEM / ELEVATION DATA County: St. CroiX Sanitary Permit No: 487940 0 State Plan ID No: Parcel Tax No: ~. Section/Town/Range/Map No: 08.29.17. STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet St/Ht Ou t ~ a Dt Inl D ottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH DIMENSIONS Width Length No Of Trenches PIT DIM SIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/ BLDG WELL LAKE/STREA LEACHING CHAMBER OR Manufacturer. Type Of System: UNIT Model Number. r11CTRIR11T1f1A1 CYSTFM / \ Header/Manifold Distribution x Hole Size x le Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing CAII ~'(1VFR ., o~,.~~...-e e..~~e.,,~ n.,r.. ..,, 11Anunri (lr et.Ararla Svctpms ~nlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges. Topsoil ( ~ Yes [] No ~ l Yes ~ ' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: Hammond, WI 54015 (S 1/2 SE 1/4 8 T29N R17W) Comer Stone Ridge Lot 2 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover Inspection #2: / .` Parcel No: 08.29.1 . o i1 ~ I Plan revision Required. , Yes ,~>] No - - J' ~ -- - I I__ I --i- ' - -- _~. Use other side for additional information. L__ ~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) - Safety and _ 201 W. Washin n Ave., P.O. Box 7162 ~- I SC Madison, ~~SI~ (60 ) 266- .R .. ~~ 1?~..., Department of Commerce S ry Permit APPlica on ~ ~; ~: In accord wi anl~nta3 21,'~is. Adm. Code, personal inform tion you provide may be used for secondary purposes Privacy Law, s15 (I)(~ i ~ h l) I h. ~t3U tI~T ' _ k,. fir, f7Ff=1C~- ~ I. Application Information -Please Print All Information ~- •_•~ -~--w...-.a--~-- property Owner's Name ~Ity, ~ Cam/ ~ I J~f`O 1 ~~ - ri rw ~ silo N., l~ II. Typ` a of Buitding (check all that apply) ~ tS~ a.~ ~2 Family Dwelling -Number of Bedrooms d~ J a ~_ ^ Public/Cornmercial -Describe Usen , , ~~ 1 I t(1 C>^e..~b ~~ ^ State Owned- Describe Use ~ ~ C `~ W III. Type Permit: (Check only one box on line A. Complete line B if applicable) ^ Replacement System ^ Treatment/Holding Tank Replacement Only p'• New System -- ~r 13. ^ Permit Renewal ^ Permit Revision Before Expiration "~~ -fro 1l ~-- ry Pe/r/mit Numberq(toLC f/filled in by y' ~ ~ / ~7` Plan I.D. NumII /b~e~r ;t Address (f d ff ens ~ mailing ~P~ ~ ~ tarter o (,; ~ Properly Lo • bon Subdivision Name CSM/`-rJG~' Cj~~~ ^City_^ Vill ,C~f _ ` ~/M S `~'/., ~~'/•, Section ~_ rrcl on ~~, N: ~~E r W ^ Other Modification to Existing System ~_. ,,..-..:,.,,~ vP„n;t Numbec and Date Ts: ^ Change of I ^ Permit Transfer to New r Plumber pwner 2 N. T e of pOWTS S stem: Check all that a 1 on_-Pressurized In-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ N ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ er, and Pressurized In-Gro ^ Holding Tank ^ Peat Filter i./ J ~ Constru 7 thetic Media Filte"r hing Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explaz° Recirculating Syn g Elevati n V. Dis ersaUTreatment Area ormation: Dispersal Area Require Dispersal Ar~o/ (s~ _` Design J~ ) ~ Design So~ PPlication Raje(gPds fl ~ ~~ L // .r/ ~ g Fiber 'Plastic / Prefab Site Total Number Manufacnuer Concrete Constructed Glass VI. Tank Info Capacity in Gallons Gallons of Units ~ (~~ New E~~S l~ t~1G Tanks Tanks Septic ox Holding lank , Aerobic Treatment Unit Dosing Chamber - I, the unders ,assume responsibility for installation otthe POW'1'S shown on the B n s PhoneNumber /~ VII. Responsibility State MP/MPRS Number ~ 1 /~ ~~ Plu Si re ~ ~j ~ l mger's Name (Print),, G.~ t. ///l ~-/% Code) Plumber's Address (S~ City, State, ~ `~~, ~, J /~~-~ 'iJ"U-'/ Date Issu Issuin ent Signa VIII. Conn /De artlnent Use On SanitaD, permit Fee (includes Groundwater proved Surcharge Fee) ~~ ~ (~ ~6 /,3 ^ Given R or Denial 31 C~J i ~ ~~-~ ~~ ~` a.: ~~~eQ._ IX. Conditions of ApprovaUReasons for Disapproval J C~ ~~- TEMOMVNEtt: ~.~~ /1~~t.J n~.Q.c~t.~.~r-PJI... dlspsrssl eeN must au be senrir•es / malntai~St ,~ . ~ l~U~ ~ ~ management plan provided by p T) /5~ ~~, Z AfI se(beck requirements muss be maintained J ~ar~~ ~"a.( `~ J~~ ~ ~`( ZD ~ U l ti, pef applicable code 1 ordinances. ~ 0 6 ~ - ;5 I'U15~ atn- y rein on a er not teas than 81/Z x 31 inches in size ~ ~ I Attach complete plans (to the County only) for the sys p P ~D J, ~~ e SBD-6398 (R. 01/03) OT PLAN PROTECT Cornerstone Properties LLC AD RESS 1025 170th Ave Hammond Wi 54015 S i/2 SE 1/4S 8 /T 2 N/R W TOWN Hammond COUNTY ST.CROtX 10/10/05 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 ,BENCHMARK V.R.P. Top Of Fence POSt ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL *H.R,P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 95.1 /94.8 4.5' below grade setbacks required by Plans Designed Using WDNR Conventional Powts Manual Version 2.0 Alternate Benchmark is Top of Survey Iron @ 95.7' nVent >6" of Cover 6' Long, jl l " Property Line Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 2-3' X 69' Cells with >3' Spacing 0' 30' 50' 20' B 2 5% Slope B.M. at System Elevation Scale is 1" = 40' unless otherwise noted Pro 3 Bedroom House 25' ST B-3 30~ 5 ~- Vents , - ~. s~ ~.,~ ~ w '^ B-1 349' Propertv Line PROJECT Cornerstone Proaerties LLC A S 1/2 SE 1/4S 8 /T 2 N/R PLAN PRESS 1025 170th Ave Hammond Wi 54015 W TOWN Hammond COUNTY ST. CROIX ~~ BEDROOM MPRS Shaun Bird 226900 ._. DATE 10/10/05 3 CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 ,BENCHMARK V.R.P. Top of Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 95.1194.8 4.5' below grade setbacks required by Plans Designed Using WDNR Conventional Powts Manual Version 2.0 Scale is 1" = 40~ Alternate Benchmark is Top of Survey Iron C 95.7' unless otherwise nVent noted >6" of Cover 6' Long111" ' Property Line Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 2-3' X 69' Cells with >3' Spacing 0' 30' 50' 20' B 2 5% Slope B.M. at System Elevation Pro 3 Bedroom House 25' ST B-3 30~ S Vents '~ B-1 349' Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings ' ~ '~' in actor m m. C e County Attach complete site plan on paper not less t / x ruches in size. Plan must include, but not limited to: vertical and horizontal re pqi~ (Bl~+t} tlir~icjn and parcel Lb. ,~ percent slope, scale or dimensions, north arrow, and locati'o~1 g ii distance to hearest oad. 2 ~ Revie by Date Please print all information.,:h~~)Ixc:;,>lJN1~ Porsonal irdormatron you provide may be used for second' ry PurPose~l',E~4iY'i$YlVaW i ~ 5-04 (1) ))_ ~`~ property Owner Property location n ¢ ~~ J ~ ~ ~ f a;j ~~ Govt. Lot ~ 1/ ~~,1/4 T ~ N R E Property Owners Mailing Address Lot # Block # Subd. Name or CSM# State Zip Code P e Number ^ C' ^ Village own Nearest Road New Construction Use Residential /Number of bedrooms Code derived design flow rate GPD ^ Replacement ^ Public or commerce I - De/scribe: _______L_~ __- -- Parent materiakS7'~!'P u ~~ ~ ~"~ ~'~~/'• /3~ Flcod Plain elevation if applica/ble A.I~~ ~ ` ~ ft- General corrrnents ~ J ~ .), f~'~ ~'~ ~' T / ~ '~ and ~ec«n~ ~~ ~ ~ ~~ ~~c:i~~ -- -~~ ~ _ - t ~~ ~ Ground surface elev. l / ft. Depth to limiting factor / ! v in. Pit Horizon Depth Dominant Cotar Redox Description Texture Structure Consistence Boundary in. MunseN Qu. Sz. Cont. Color Gr. Sz. Sh. 't U r 3~ L ~ J.~ Roots Soil ication Rate GPD/fF `Eft#1 /Etf#2 l ~ /+ 19oring # ~ pit Ground surface elev. i ft. Depth to limiting factor ~• Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E~GPD `Eff#2 in. Munsell Qu. Sz. Conf. Color Gr. Sz. Sh. l0 3~z - S 2 -r Z , r(7 Z l ~ I J ~ I~ ~ .-~--~-- L ~ -'~ ~ r ~ ..- . _ -. _ r," n ~ 7n .....11 -~...~ TRC ~ 'an rrfnA 'Effluent #1 = BOD > 3iJ c 71V mcy~ ana ~ a~ ~.w _ ~a, ., ~...__.....- - - _ _ _ CST 1Vart>Q (Ple2lse Print) S' to CST Number Bird Plumbing, Inc. Shaun Bird /" 226900 Address ~' Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ -~~/~- ~ ,~- 715-246-4516 Property Owner _ Parcel ID # Page of ® ~~ # ^ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ~~ Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ''~, ~~ S .-~~ G I 5 ~ a '~- U ,~ yl S 1 , 7 II ~~~ # p Boring ^ Pit Ground surface elev. ft. Depth to limiting factor ~• Soil ication Rate Horizon Depth Dominant Rector Description Texture Stnrdure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 U Boring ~~ # Ground surface elev. it. Depth to limiting factor in. ^ Pit Soil ication Rate Horizon Depth Dominant Cd Redox Description- Texture Structure Consistence Boundary Roots GPD/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Efl#2 • Effluent #1 = BODE > 30 < 220 mgll. and TSS >30 <_ 150 mgA. ' 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 608-266-3151 or TTY 608-264-8777. sao-eaw(R.6mo) .. foil Test Plot Plan Project Name Cornerstone Properties LLC Shaun Bi Address 1025 170th Ave Hammond Wi 54015 CS #226900 Lot 2 Subdivision Corner Stone Ridge Date 811 /05 S 1/2 SE 1/4S $ 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 95.1 /94.7' *HRpSame as Benchmark Alternate Benchmark is Top of Survey Iron @ 95.7' 20 Maintenance and Contingency Plan for a Septic System Maintenance Plan 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 order to 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 ncy Plan ption #1. system fails, determine cause of failure, use alternate area and install new s ested 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 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FO/RM/ OwnerBuyer ~~ /i'-L~'t~ ~a~ ~~~~;fi~Q/f-i~'Q !,'` G ; Mailing Address ~Doz -~ ~ ~~~r7i, ~~/ 1 ~y~~ ~f J~~~ Property Address dU~O ~ ~~ ~ ~l ~ 1 . (Verification required from Planning & Zoning Depaztment for new construction.) City/State Parcel Identification Number ,ndC~` ~ LEGAL DESCRIPTION '~ !1 ~ Property Location ~ 1/ , ~~ '/a ,Sec. ~ , ~~ N ~~W, Town of Lot # °,,,~. Subdivision c~/'2~~t /~5~~ ~ ~ Certified Survey Map # ,Volume ,Page # Deed # %`( ~~ ~~~'~ ,Volume ,Page # Spec house 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 Sanitazy 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 standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amaze the pwner(s) of the property ribed above, y virtue of a warranty deed recorded in Register of Deeds Office. '_ ~D~nlC~-r' SIGN URE OF APPLICANT(S) DATE 1 ~D h~ ~ C`7 ~t~ ~~~1/ ** Any information that is misrepresented may result in the sanitazy 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. (1tEV. 08/05) ! ~/ 802537 U. 2860 P Oy8 State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number I Document Name THIS DEED, made between Kenneth J. Roberts as Trustee of Josephine E. Roberts Trust, aone-half interest ("Grantor," whether one or more), and Cornerstone Ridae, LLC, a Wisconsin limited liability company ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See Attached Legal Description KATHLEEN H. 11ALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 08/05/2005 11:10A1! TRUSTEES DEED EXEIipT # REC FEE: 13.00 TRANS FEE: 3000.00 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Address Thomas R. Schumacher 900 M~iti Street P. O. Bo Baldwin, WI 54002 S .t C ~Z ~ ~ ~~S C.t) Syor'~ See Attached Parcel Identification Numbers Parcel Identification Number (PIN) Dated July 29.2005 * Kenneth J. R6tierts, Trustee of Josephine E. Roberts Trust EAL) (SEAL) (SEAL) * * AUTHENTICATION Signature(s) Kenneth J. Roberts authenticated o 7 - Z- 9 * Thomas R. Schumacher TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat, § 706.06) THIS INSTRUMENT DRAFTED BY: ACKNOWLEDGMENT STATE OF WISCONSIN Personally came before me on the above-named ss. COUNTY ) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Thomas R. Schumacher Notary Public, State of Wisconsin My Commission (is permanent} (expires: ) (Signatures may be authenticated or acknowledged. Both are ant accessary.) NOTE: THIS [S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY H)ENTIFIED. TRUSTEE'S DEED ®2003 STATE BAR OF WISCONSIN FORM N0.7-2003 • Type namc below signatures. U, 2860 P 0`19 Roberts Estate /Township of Hammond Property LEGAL DESCRIPTION An undivided one half (1/2) interest in the following described property: (1) The East Half of the East Half of Southwest Quarter (E '/z E 'lz SW '/+} and West Half of the West Half of Southeast Quarter (W %Z W '/z SE '/) of Section Eight (8), Township Twenty-nine (29) North, Range Seventeen (17) West. (2) The East Half (E %Z) of the Southeast Quarter (SE %,) of Section 8, Township 29 North, Range 17 West. The East Half (E %2) of the West Half (W %z) of the Southeast Quarter (SE '/. ) of Section 8, Township Twenty-nine (29) North, Range 17 West. Except the following parcel: Part of the East Half of the Southeast Quarter (E '/s of SE '/+) of Section 8, Township 29 North, Range 17 West described as follows: Commencing at Northeast corner of the Southeast Quarter (SE '/4) of said Section 8, thence West on North line of said Southeast Quarter 335 feet, thence South parallel with East line of said Section Eight (8) 1388 feet; thence West parallel with North Line of said Southeast Quarter (SE '/a), 275 feet; thence South parallel with East line of said Section 8, 618 feet; thence East 610 feet to East line of said Section 8, thence north 2006 feet to the point of beginning, St. Croix County, Wisconsin. Tax Parcel ID Numbers: 1 018-1016-50-000 ~ ~G~e~~ w~z ~~`~`'- ~ 018-1017-00-000 ~ ~G ~e 5 ~ ~1 Z 5~ Sc~ 018-1017-10-000 9 B3 ~8'o~e5 ASE 5E 2~ 018-1017-30-000 Z~ ~~Ce1j W ~~z a ~ ~ ~ 018-1017-44-000 ~p , oa E t~L ~w % ~ t 018-1017-50-000 ~ ~CCel~ ~,,~ ~~L a~' Sw E 018-1o17-so-ool Za ~~ce~ E~~Z ~w E 018-1017-60-000 3~ g ~ ~ ~/ ~ '~ SE ,~ , ~ ~3 a5 ~~ 1 Ca,~W-< X11 S~WOH rJN I ~13ft~ : WO?~~ Zld WdbT:O~ b00z ~ti 'oaQ ZBZtiZ~SS~L: 'DN Xkl~ I' ZZd WdbZ:OT p00Z Gti 'aaQ zSZ~Z~SStiL: '(JN 7{tid ~~~ S3b10H JNI~1~(l~f]: w0?!d ~t•arc.arane~ra.u~ni..uye.a.n.~t.aino-rr~c~.~.a ~n.~ L.wnanncnra_.pyru~r~~/~ i_~.nn~ r_.n .~ i a`a_~¢ .+~+_rr~.u_......u.u..v~. •.aa~u_u~uiu_..urun~uuz~~avaut~i..w~ ~- COUNTY OF ST. CR1D~X Wells Fargo Bank N.A. w~ ~'~;.,,".~.::; 600 2nd St. Hudson, WI. 54016 STATE OF WISCONSIN :M ~~~ - VOID AFTER SIX MONTHS :Check Date Check No. plfllOntit 10/17/07 01010810 $357.00 ~ PAY z o THREE HUNDRED FIFTY SEVEN DOLLARS AND 00 CENTS:< ~ c v c F < t TO THE CODY FILIPCZAK - ORDER C & M PROPERTIES & CONSTRUCTION OF 9305 MURPHY LANE { horized Signatures , EAU CLAIRE WI 54703 ~._ __r ~ ~ 11'0 i0 108 1011' ~:0 7 5 9 i i 988: 38 ~ 7 9 i 98 i 511' ., .,.., ._-_ _ _ -- ,. y Check Number: Vendor Number: County of St Croix Finance Department Vendor: Cody Filipczak C & M Properties & Construction 9305 Murphy Lane Eau Claire, WI 54703 Check Date: Total Check Amount: $357.00 ~F~~E COPY /~ Approved: `~ File Date: © /G o ~ Invoice Number Invoice Date 10/15/07 Invoice Amount $357.00 ~ Account Description Number Overpa ment for Sanitary Permit 4501-44401 Amount $357.00 Permit # 506326 y s' ~~~~~ . r -~~ ~ ~e ZQ~+ ~ ~r ~~ ~. . Total Check $357.00 ~~ . ~ ~, O CASN E ~ ACCOUNT j O MONEY FROM TO { DER _ , PAYMENT •`~ ! ~~ ~, 1 ~ ~ ECK .~; n raFDIT RY ~' ~ DATE ~ {~ ~ ~ ~. RECEIVED FROM 1~ ~~ ~ l'~') /~~~~~ ~~ ~~ DOLLARS QFOR RENT ? t ,~ I I a~l'~ :_~"~~~~' ~ -~G%' 1 Q FOR ~''St f 1 .j BAL. DUE L------------ s