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HomeMy WebLinkAbout018-1016-50-000~ o °~' ° I ~ "~ ~ O ~ I N C i y ti a ~ O N N oii a ~ I I '~ '~ I I r I y I ~ ~ Z ~ ~i o a 3 ~. a Y i Q 3 M I ~ ~ m Z ~ I w a ~ = °o ~ I °' ~ a m I ~ r ~ i I o ~ o ia' ~ I ;, a ~ ' ' w d z ~ cnr~ ' ~ z° ~ M •~ ~ L C ~ 0 N w O Q Z Z N ~ .. ~~ Z o ~ I N ~{ '! lA 16 ~ N O > ~ d C }~ y ~ m~ • ~ N ~ I E c c a a .~ U n rr rr ' m 3 3~ °' m ~ 0 ~ '=a I Z • a aa y a ~ C N I: fn co co r o ° ' o I W J U o , Z ', m ~ M •o I ~ ~ ~ O ~ ~ O ~ , N O `- ~ w ~~i ~'I to 'O m y Q C m d ~ ~j • ~ 'C d Q Z _ cA m I ~ o a ~ .`'~ ', ~ I ~ O C , ~ y C ' O ~ ° Q ~ ~n ~ ' ~ ~ v ~ ca a m a m ° u a °O C d tD C ~ O fn C ~ ~ c~ N ~ ~ M ~ O E ~ I N ~ i.., Oj cb c~ E N ', E rn ~ N C .. ~ •5 C 'S ~ ~ . -- •~ s • o 0 2 pp ', C7 v o Z `~ Y Y ~~ O t: v v~ d •~o € a +• v `IV ~ a v 'c c ;: ~ A ciao o nci , Parcel #: 018-1016-50-000 Alt. Parcel #: 08.29.17.121A 018 -TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -CORNERSTONE RIDGE LLC CORNERSTONE RIDGE LLC PO BOX 462 NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 08 T29N R17W 20A E 1/2 NE SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 08/05/2005 802537 2860/048 TD 08/05/2005 802535 2860/043 TD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 20.000 2,500 0 2,500 NO Totals for 2006: General Property 20.000 2,500 0 2,500 Woodland 0.000 0 0 Totals for 2005: General Property 20.000 2,500 0 2,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 11/20/2006 11:30 AM PAGE 1 OF 1 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Dgpartment of Commerce PRIVATE SEWAGE SYSTEM Sa~ety and By~!iding 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)I. 'ermit Holder's Name: City Village X Township Corner Stone Pro erties Hammond, Town of :ST BM Elev: q~ Insp. BM Elev: BMyD~escription: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Q0~ /(7 3D Dosing ~ 4 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ -L. ~~~ Dosing << ~,, -. ~~ Aeration Holding PUMP/SIPHON INFORMATION ~/ % 43 ~O Manufacturer T~~ ~ Demand ~ Ig-~, 7'~L,~,-- GPM odel Number ~ ~ ~~ , Lift ~ Friction Loss System Head TDH Ft 2 ~ ~ O. O 1 - Forcemain Length 1 Dia. ~ ~~ Dis . to well S(lll ~RSt;~RPTI(~N SYSTEM ELEVATION DATA ~"""`' St. Croix Sanitary Permit No: 499200 0 St a Plan ID No' 132' 3~ = ~~s gyp. ~ arcel Tax No: 6t '~~ 01 Section/Town/Range/Map No: 08.29.17. 20 STATION BS HI FS ELEV. Benchmark , /~ /0 -~ /~ Iv ~ Alt. BM D .Zv Bldg. Sewer ~ • ~ ~~•,-r~ 1 W SUHt Inlet • ~ ~~ • / S r St/Ht Outlet Dtlnlet Dt Bottom I~''D ~~ • ~ ~ Header/Man. ~ ~~ . ~ / Disi. Pipe ~ ~01 Bot. System a~, 3• F ~1 wd71~ ~ ~ ~Z rit. ^ ~ over ~^^~~ f ~ ~ Z ~ ~ I•~- NC DIM S Width 1 Length ~ O No. Of Trenches PIT DIMENSIONS No. Of Pits de Dia. Liquid Depth SETBACK SYSTEM TO P/L LDG WELL LAKE/STREAM LEA G Manufacturer: INFORMATION CHAM R Type O Syst~tm~L ~ ~O~ ~ NIT el Number: I'11CTRIRI ITI(1NI CVSTFM / I 1 -4.., .-,..r Ya _ .,/)/1 1 Header/Manifold U Length Dia ~ Distribution tl V P O Q'~ Length V`+ Dia ~~~ Spacing -~ x Hole Size 11 Z x Hole Spacing Z ~ t. Vent to Air Intake ~. SClll CCIVFR ., o.e«~~.-o c.,~ro..,~ n., i., Yv nn~~~.,r~ nr Ot_Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No C ~OMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~(91l-~,Zov(00 Inspectio _ ocation: 1023 167th Street Ha~µmon , WI 54015 (S 1/2 'S-E_ e1-/4 8 T29N R17W) Corner Stone Ridge Lot 7 Parcel No: 08.29.17. 1.) Alt BM Description = 5~ ~ '~--~~~ k ~ 1/~6ti1<18S~C0+~~ • r 2.) Bldg sewer length = ~p - amount of cover = ..~ Af 't~ Plan revision Required? 'Yes ~(I~lo ~OV • ~~/ ~ ~ ~ f~~ ill _. '(~`-- - Use other side for additional information. ____ _ ____ --- - - --- - -- - - L -- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County /I ~_JL ` Madison, WI 53707 - 7162 i i Sanitary ermi N ber (to be filled in by Co.) n scons (608)266-3151 9 ~~ Department of Commerce Sta Plan LD. Number Sanitary Permit Application -- ~ ^ ersonal info n y od de Wi Ad C 83 21 ~ ~ _ _ ~'~ S , p o s. m. . , In accord with Comm tnay be used for secondary purposes Privacy Law, s 1 'ect Address (if different than ling ad s) ~ / V ~ ~ ~ ~~~~ rint All Information I. Application Information - Please P Ol A,. _ ~ P O Property Owner's ame . ~~ ~ L.ot # Block # Parcel # ~ cc ~ Property Owner's Mailing Address roperty Location/''' !ti, ~~%., Section ode Zi C "~. City, State rri p1 ~ 5 Z ~~ ECENED T~_yN, R ~..,(SaScIeW ~~ II. ype of Building (check all that apply) CC ~ 20OU Subdivision Name CSMNumber or Family Dwelling-Number ofBedroo s ~ ~ t7 ~ ~ ^ public/Commercial -.Describe Use ST. CROIX CO ^C;ry ^v;llag~gowrtship of ^ State Owned-Describe Use _ III. Type of Permit: ' (Check only one box on line A. Compl e - applicable) A' a ystem ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration - Plumber Owner r IV. a of POWTS S stem: Check all that a 1 0 r7 ~~-~- ^ ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soi ^ Mound < 24 in. of suitable soil - rade ^ Single Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/TreatmentArxc Information: Design Flow (gpd) 'Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevati~ - ( te , s • / r J VI. Tank Info Capacity in Total Number Manufa~ `1-t ~ Prefab Site Steel Fiber P18StiC Gallons Gallons of Units lwi / ~~ oncrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Cbambcr 3 ~' VII. Responsibility Statement- I, the unders' d, assume responsibility for installation of the POWTS shown on the attached plans. iness Phone Number B ~ us Plumber's Name (Print) Plumb Signature MP/MPRS Number u r-~ }~ ` Z ~ / ~ J Plumbejr's~Address (Street, City, Sta tp e) ~, ] n ~ ""`~ ~ f ~ I v ~ iL-~ L~) VIII. Coun /De artment Use Onl d Sanitary Permit Fee ~ cludes Groundwater Date Issued Issuing Agent Signature o Stamps) ^ ' Approve Approved !! Swcharge Fee) SL-pl ,--- O ..~, VV • ^ 0 er rven Reason for Denial IX. Conditions o A~ r t t t, SYSTEM OWNER: ~) ~~~~ C~ ~: 6p,p~Qµ~A~ C6-M~~ 1 Septic tank, effluent filter and dispersal'cell must all be serviced !maintained ~-C9~^~ o` ~ ~~,~.uti as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. wt[acn compren: plans tco me wunry umy~ w, „~o,~~.~....... i.o~.,...,,..- ~l SBD-6398 (R. 01/03) PLOT PLAN ' T Cornerstone Properties LLC ADDRESS 1025 170th Ave Hammond Wi 54015 1/2 SE 1/4S 8 /T 29 N!R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 99.5' 3 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 H~LDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of Fence Post ASSUME ELEVATION 100' ^ BOREHOLE O WELL *g,R,p, Same as Benchmark B.M. 465' P Area 15' Below system is to remain undisturbed B-1 3% Slope is to a done to un away r Line Filter BEST GF10-8 2 Acre Lot Scale = 1 /4" = 10' B- Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 3 Bedroom House Well is to meet all setbacks found in Comm. 83 316' Property Line ~~ 100th Ave cornmerce.wi.gov i ^ isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October O5, 2006 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: 10/05/2008 Identification Numbers Transaction ID No. 1327340 SITE• Site ID No. 719051 Cornerstone Properties LLC Please refer to both identification numbers, 100TH Ave above, in all corres ondence with the a enc . Town of Hammond ~ " St Croix County ~SE1/4, S8, T29N, R17W Lot: ,Subdivision: Corner Stone Ridge FOR: Descriptio : At-Grade Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1100944 Maintenance required; 450 GPD Flow rate; SO in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative 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 ~`"~ T~ OFD~; l~Ce • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE COf component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and . dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAUN R BIRD Page 2 10/5/2006 • Comm 83 22(71 A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection ly authorized representatives of the Department which may 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 or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, f ,~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charlie.bratz@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633' cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 RECEIVED o c r - 2 2006 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 SAFETY & BUILDINGS Date: 9/28/06 Owner:Cornerstone Properties LLC Location:S1/2 SE1/4 S 8 T29 N,R17W Lot 7 Cornerstone Ridge Hammond System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and ContiJ~e y plan 9-11. Soil test tI Shaun Bird Signature License number ~~. ~',~. y c i ~., ~~ C~~ f,~r~r `~ %EY,q , ~, +~GS SPpND~NCF . PLOT PLAN PROJECT Cornerstone Properties LLC ADDRESS 1025 170th Ave Hammond Wi 54015 S 1/2 SE i/4S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 99.5' 3 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of Fence Post ASSUME ELEVATION 100' Filter BEST GF10-8 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark B.M. 46 5' Area 15' Below system is to remain undisturbed B-1 3% Slope ~- ^ B-3 Grading is to be done to divert run-off away from system 316' Property Line / Line 2 Acre Lot Scale = 1 /4" = 10' B-2 Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 3 Bedroom House 100th Ave Well is to meet all setbacks found in Comm. 83 ~.. >'~~~~". 7 Yv ~a >Ji `~~~ P~t~ ~aAfE,MA~~I.~- ~; _ ~~-~tltR~-- t14S" ..__. ~STA$}~.i ~` ~~3 O$~2.~`[R'ft~r~ 1~ELt y .~..i vsa' Pt = ~ ~~- S = ~ ~~E. _/~ ~-~, ~ ~! ~t. ~~~~,t~a SY~.trt~~c. i='ab~s~ s~Bzt~~~a ~bserva~~c~~ ~e ~ t i. - - 1 . 7. ~ ~ ~ ~ ~ ~~~~~ Pura Viev and Cross Section of ~LTiscortsi~ At-,~rada snit wit.~a a 5itagle A~~at'gti.on Area on a Sloping Site i/6B I/2 B CE #.t ~ f %z - Z % ~tsbaCEC-a~T~E Dis~ribu~ior~ La#eral Sai} Cover i"~ ~--- ~#.6V1tED SAYER. ~tift~t~Tu R.~- " Page Of i~istri~utiar~ Pipe i3et~ai~ far Lateral ~etarark .~ • ~ .. ~- * Last Hole Sold ~e #ext To ttsR~- tiP _~.~, u ~~~~ - uP" {cu~htiut~ PYC ~=nrce Main ~ pYC flistrib~tion ripe p - Afire s~' ~, 3~: Q q Hole t~ia;neter ~!/ ~_~-.~~ch Lateral Diameter _ inth(es~ X d2~ __ I~hes y~yy - I~hes Pore Main I~ia~aeter ~l~._~ Itrct~es .~^ ~~ Of Hales/Pipe < ~ - Invert E~ evatir~n Of Laterals ~~; J fit. 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E+E~INMICENi~Q~1 S7EnNF 17ERE3A. r ~ 4EK) Ot~l • q NR M4 p'w.lSl NEi'i0.lFpli p tt tS' ~ tFt1 i R gE}{~ 509330 ll4'CSA 4('0 115 314 13.0 1000 70 54 55 41 32 13.8 20' 24 9.17 z17,64zB.94 9[3M(9`F 50934D U' IOSA 4"~0 t30 34 6S 1000 7f! [d 55 d1 32 13.8 2P 2L 9.11 z 11.64x6.90 99i-~9P5 508350 UtK;SA 4"0 115 314 13A 1000 70 6d 55 41 32 13.8 Z0 Z7 9.11 zltb4xB.93 """" " 314 5 1040 6 7p fit 55 n 32 13.8 2P 2T Q.11 x1t.64%8.93 . as<n_ace ~ 0 230 3 IB.RSA dl Co~neaus OutyReteA-•LAIk C,iadMhO~s LAe talsOCO~wousd~ryas pnpasAxl`~erunwF~fi 9xput~hea ra~Ystor9~ese pn11DS. FtOw- tETErtS/HOUR a Eooo eooo 3000 io Motor Housing Impeller Material Epoxy Coated Call Iran Poly Carbonate Closed Vane ABS _ ..._.. __. ~-.-.- ~2`~ i~ 7S W Yower l.:oru W Mechanical Shaft Sea[ z< s Fasteners .- x Shaft -~ -------- ----~ e.s Bearings u ... .. .r Nitrite with carbon and ceraulic faces ~... Stainless Stcel ... _ Stainlecs.Steel Upper Sleeve and tower Ball Bearings Little Glaut Pump Co. P%) Eix: taait- • UId~Aom>t t5t_v, o1C 73157 phoae:115.9A7.2511 • Fo: gp5.2ZtR1S50 ht Form 945235-07/03 FIDw- GAI.tONS/rtNUTE PUMP PERFDRMANCE Ci1RVE tISV 60H2 2 ~. 3~~'~'` www.LittteGia~~Yump.com ' ~ ERAS MANUAL 8~ MAt+lAG~MEN~TioNs PANTS QYYi~t SYSTF-M SPECiFt _-. ._ 0 1 _ ~ . Septic Tantc t;at~' ~~ of Bedrooms N~t6et ~ Cotrltrte>~i Units Estin~ tbw f~] .a .c ..:.mated x 'i.~ Sod App~^ Fiat lefluetttlE~~ Quarrty Fatsr Ofl b Grease {FOG) 6atx~ ~ ~~ SoGdst C7' DS) Pr~eated Etiiuent QuaGtY ODD B"~emirai DXY9~d~ ~ S ASS) Total Suspen metric mean) Fecal cor'fonr- (geo Maximum Effiuerrt Pariide $Qe Monthly ~~e' S30 nng/L 5124 rnglL Motttriy average`. ~i0 mgn- ~Q mgt 510` cfuJ` I Y inc:hdiameter Septic Tank Manuta Efflueri€ Filter Mcxurer ~ Efl9aent Ffber"Model ~ Pump~~ank t:apa~Y pump Tank Mani~~mr `' . pump Man~~r z Pump Model -_ Page ~ > cal ^ NA ~rlli~~ ru- ~s ~ Q NA ~.~~ pNA ~ ~ DNA y~ NA c ^ ~lA Pre ~~~"~ ration D Peat Fittsr LI yt(e~nd ~ M~anicat Ae D OS-er. ^ Disinfection _ - DisP Ceit(s? - p [n-ground (pnsssur¢ed) ^ Jn~rou~ ~~~~ p Mound grade ^ pther_ ~ On •ne ~~ mr snd . v ~ ~~t for aamestic t .. Ya[ues types ~~~ Service F~quency Service Event inspect cpndnton of tank(s) Pump out contents of tank(s) tnsped ¢~persai salt(s) Glean effluent Biter ~p controls & atarn'+ tnsped P~P~ P Flush faLerals and pressure test (Nlaximua+~_l At feast once every uals one-third (~) °f tank volume When combined sludge and scum ~ ~ s) (Maximum 3 Yom-) At least once emery At least once every fit least once every At least once every pt least once every At least once every t3 fT101.u.s ^ months or(s) s) ^ NA p mo 5) Q biA f~ months p rsionths fl Year(S) ~ IAA a myths fl years? t7 NA on,er_ or one of ttte foitowinB licenses CE tNg~UC?[ONS ti be made b5' an~•ieviduai c3rTYif 9 ~~r. PLSYV'~tS 1+ltalntarrter; ~ bl been u6AINTENAN ~~~ anQ Qiypersal Celts stra Restricts r, ppYYrS tp idertBfY any mr~ang tnspec5ons Master Plumber: t++t~er Plum ~ de a visual Inspection of !fie tank(s) m and ~ ~~ for any back uP S tior. Tanis ensQedions must ore the volume of combined stud3e and scu ~ c~~c the effluent levels cracks or leaks. trteas rsal Deli{s) s2laii be visually ponding of effluent on the npund surfatoe- nding of effluent txl the ground surface- $uti,ority. ~ ~ of ~ Pith and to sheds for any po a tiisPe lion of the local rt:guladorY in the o~ ~ir~es the "immediate not•fKa or mare of the tacik volume, the indreate a fading oondtion and eeq vvitt+ tank equals one-third (l~ t~ NR gr~aund stttf2oe may sand scorn in any rotor and dispo~ of In ~~dance YVhen the pomtuned aaumuiaLion of siudg a SeP~9Q ,ervscing ~ Ls of the tank shall be removed by t oomPonents; and any entire cortten Administratnre Code- onents, preueat~n 113, Wiscons>r nicai or pressurized P©Y11TS taomP a ~~ POy1tTS Maiat~~• ~~ ~ event Tfte setvipng ~ ~uer>t fitteefs, t •rztenrats of 12 morlttts or less shat! be p? _ ulatory authority wifhin 4~ days of ~mPtetion of ar>y seivis~ other mal!>~noe or monitorin9~ A selviQe repo>:t shad ~ ~'~ to the local leg rptluCtS or ath~ ertt tonic{s} for tfte pl~esenre of paitttin9 P . START tJP ANO OPERATIOJ-l PODS chec~.tr~~? - et'~ Ceil(sy. if high conoeritrdbo~ ate Fa new oortsttuction. Pn°r ~ use of the rocess andlor damage the disp ,R, a the treatment P a septage servicing operator p~ Lo use- ct~emicais that may • P'~ removed b"! dt3te~ed fiance the oantents of the tartx(s? .~' ', re frozen at the snfrifrative sttrfaee- Page of~_ shat[ not occvir wt'teti scnl condfions a n is t ~ e gym ~rt uP es Puc:3P tanks +'~Y ~ above normal higttwaier levers. Whe i Durnn9 P~ °~' cents} in one Large dose, ovet4oadng the +ae6Cs} anti maY resu3t in ~e ~~[ tie d[schar+9ad to the d~ fantc removed a t, Tu avoid this siEuation have the contents a~P{~ t7t' POWT$ Mair;tainer to t ~ s7irfdce dcsdtiasge of ef[ksen ~ to She effluent pump ~' ~taai Sew 'g'°r ~~~ ' S two tt~tof'e normal levels r~ift-in €he pump Tank-. assist ir[ rrlancraRY oP~'~` lfte ptmtp y over Panics and dSp~ ~. ~M riot dmre or ¢atk overt or oft[etwise dsti[rb or compact, Do not drive or park mt~ or at-g[ade sal abs4rptiQn area- ihe arm wiH~in 1s feet dawn sbpe of ~Y and pmtong !fie fd~ Redlichion or-el'rrninaftoa of the ~1to+~inJ f?i°m the wastewater strz?atn may improve the Pe d~eitt+aF boss; dlapets; dg-arette buffs; condoms, cotton swabs; degreasers: of !tie POWTS- ant<bio6~; '~ 't ~ ~ y,~r, fruR and YegetabFe pee!"ings: gasoCme: Sr+ease'r herbicc~s meat drsinfectatsts; fat; ftxitida~vn diakt ~scnrtp P. F} . r:~ oti~ fxau~9 P~~~ Pesiiades: sariifary rrapicins: tampons: "and s~ofrener brine. AgpNOOt~MF_NT taken out of service trie follorfririg steps shat! [~ taken ~ instite that ffie vYhen the POVYTS fails andlor is permatrerctly~ . ~,m ~ pr+opecijran~ safety abandoned in comptiance with ch_ Comm 83.33, 4~ESOOnsin Adrn[tsistrafive Coda: All piping in tanks and Pits shall-be disoonriected and tf~e abandoned Pipe o~n~SeP~ge•~rvi~ng t7p~atar_ .. TT+e contents of aff tanks and D~ shall be removed and property disposed and tine mid spaee After Pumping. ad t~ks bnd P~ shaft tae excavated and removed or their covers . ~~ yy~ ~(, graver of another inert sand material COD[TiNGENCY PLAP[ thte following measures have teen, or must be fiaken, ~ pnavide a code if the POLYtS fails and cannot be repaa~ed compliant rePtacs~nent system: ^ A suitable ,~1epi~cnent'ar+ea has teen evacuated and may be utE'lized far the location of a replacement sod -~Q rep~cernent area should be protected from dstu~not Trues and wel~n =allure to ~ trot absorpfian system- fired setfsa~ from e~ng and Proposed sFructure, be infringed upon by nrqu result in the need for a new sail and site=evaluatcon to establish a sciAabte pr+oied the replacement anew wdl replacement area. Rep~ment Systems must comply with the rules in effect at Sfiat lime- advances in P4WTS D A suitable rePtacersient area is not dual ~ as a last resor# to place lthe iced POY~tTS- g technology a t~oldrng tank may Ise ~? n failure of the POWTS a sod.and e site ttas axst. been evaluated to identify a surtahfe replacement area Upo t area ~ available a rte evaluation must t?e performed ~ ~~ a suitable reF~cement area tf no replacemen holding tank maybe installed as a last resort to replace the failed POYYTS_ rerrtovdl o€ the biomat at Mound and at-grade sal ai~orPbOn teems may be reconstructed in place fnd~ng ~-e fnfiftratiYe surfaOB< R~~~ons of such systems must comply witfi the rules in et#ectatthattirne. <.MfARNIN©> SEPTIC, PUMP AND OTHER ZRF.ATMENT T~~ ~Y Coi~rAlly Li~AL GASSES Af1lD10R [NSUFF[C[ENTOXYfEN. DO N10T ENTER A SEPTIC, PUMP OR OTHER T14EATl4l>/N'[' TA1tilK UMDER AI~tY C[RCUMSTANCES. DEATH MAY RESUL7_ .RESCUE OF A PERSO[~I FR01511 THE [NTEWOR flP A TAh[K MAY BE DtFF[CLJL7 OR [MPOSS[BLE. ADDiTtONAL COMMENTS . POYif~S INSTALiER Name ~~~,.~ ` Qtlone 7 ~ s-- ~- C' ~ ~ ~ !o POWT511ttAlltTi A[1tiFR Name ...5/j~-u K/ - Pticne ~l S~ 02~~ J SEPTAGE SERVICING'OPERATOR PUMP LOCAL REGULATORY AtJFHORj7Y . Name ~C9 ~-~r~ ~ ~ '4genc3` .s7'~ /•c~ ~~- ~ Ll /1 Phone /`i 6 -~ ~ ?tr3n8 /.~ "~ O ~~ meets Th~ dcannertt 7Ais aoam«a was dcatl;ad try the stafrss of the L,seea Lake. fVtarqustfs acrd Waushara County Z.artL7g and Sanr'ta6on ageRdt~ t does dot u,e rnirtrcnvm mpvirements of dt Comm g3~(6}{t}(d}it{$ acrd 83.5dj1}. Clt ~ C3}. yytsppnsin A+6mlrttstratire Ccrf~ Use of this docrttnen - ~nrcImtt guarantee the performance of the POYYCS_ Sep 28 06 05:03p Ron Honte 715 796 2519 S~~soonsinDe~rsnentofcor,,,„erce SOIL. EVALUATION REPORT Division of safety and Buildings in accordanra with CorMn 85. Wis. Adm. Code minty i !1 ' ~ t- i p~tta~Cf- complete site plan on paper not less than S 12 x 11 inches In size. Plan must indttde, taH not limited to: vertical and horizontal reference point (SM~, dvedion end Parod I.D. petcertt slope. scale or dimensions, rx7rth arcow, and location and distance to nearest road Reviewed by Please print aJ! frriormatlort. p~pnd Mformslion Y~ Drams msy bt wad for saca~dlrY OwPOSas tPa'ti~'tsw, s. 15.tH l1i lmti• Property Owner f PropertyLocaUcOn t„ /3 ~` r~7 ~l 1fS~1~ i Govt. Lot ,.7 1 ,~ X114 S T t~roperty Owners Marling Address Lot # Block # Su¢d. Namo or CSMq ~-' C r ~ State rip Number ^ C' ^ Vllage own d flow rate p.2 Page of .__ Date 1 N R E( rst Road ~x~ ,.r2,~_.__,_ Coda derived asrgn , ,~_ GPD New ConstrueNan Residential / Number of bedrooms ~ ^ Roplaoement ^ PubGc or oonunrua - Descr~e: -~-- p'arettttil8terie~7'~r~ /w-f'L'rr i2.~Ts~~TY t"bodPlainelevat'wnifieppGcablo _,,j~„f~ ft' ~"' # ~Bodng Grotxld stetaoe elev. ~- U -'~ H. D~th to finidtx~ factor ! L7 in. r~i Rate klarimn Depth pwnirtartt Redox Description Texture Strttcbure Consistence Boundary Roots GPDlf! in. Mansell Qu. Sz Cont. Color Gr. Sz. Sh. `Et!#1 'Eff#2 ~~ # L.1 Pit ~ Ground stxfaoe elev. ~~ ft' ~~ 1D l°"l~ factor ..~= ir-. Soti Non Rate tiormon Depth DorrNnant Redox Desaiplion Texture Strucniro Consistence Bwmdary Roots GP •EffN1 { OIfF 'EMl2 ~. Mansell Gu. Sz Cont. Calor Gr. Sz Sh. ~ ~z -30 ~ , ~ .-r.--- G. ~ b- ,~ ~ ~ ~' . ~ , , ' D 3 . cam ......, a» r t~M a 7n .nnA aivf TSS < '~ rnOlL • EfllUertl tOFl ~ f3UU ~ .!U ~ GN rn~ra. +wa~ ~ ~ ~w :~ . w .. y - -- - - - C5i Name l l~I ~ e CST Nutrlber Bird Piumbing, inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 ~ ~- .-. p ~-- ~ 715-246-4516 Sep 28 06 05:03p Ron Honte 715 796 2519 ~..., • . y OMrtter Parcel ID # ~ d p.l '~ Bonng # -. ~ ~_ ~9 ~~J~ ~~ to feotar .~~_ in. d GroundsurFaoeeiev.L~~tt ~~ Soil Rate tion i D Texture Strtxhre ~ Rtx~s C' ~ F~orimn Depth in DominarN Mansell p escr Redox 17u. Sz Coat Color Gt. Sz. Sh 'Etfp1 '~` ~-- i~ a , 3~a -~ ~ a ~ t ~ ~, , ~ i. h ^ ~ ~ ~ y r y/ r------- s Q. ~, . ~ ~ ~ D ^ Pit Ground wrtaoe elev. E. Depth to bndting tailor in. Sal ~ bate ~# ° t rc tion Redox Descri Texture Strucorre Corrcistence Boundary Roots GPDJIE Hoti~on Depth in. tanl )om Mansell p tZu. Sz Cont~Coitu Gr. Sz Sh 'EIN11 'Ettll2 a ~^~ # ^ Pik[ g G~~ mace elev. ft. Deptl~ to imidng taGtar in. SoM Rate -todian Depth DAminant Redox Description- Texture Slrudure Gonsisterxxr Boundary Roohc in. Munss9 tlu. Sz Coro. Color Gr. Sz Sh. 'E~7 '~ ' E111utd8 #1 - BODs ~ 30 <_ 220 mg1l. and TSS >30 <150 tngiL ' EIS>ustrt it2 =1300s < 3D nrglL and TSS _< 30 itgf L The Depattuent of Commerce is an equa3 opportunity seNice provider and employer. If you need assistance to access services or Hoed material in an aloernate forr7lat, please eontaM the department at 608-266-3151 of TTY 608-264-8777. i0o~a3otRbao) Sep 28 06 05:04p Ron Honte 715 796 2519 p.3 Soil Test Plot Plan Pro;ect Name Cornerstone Properties LLC Sha it Address 1025 f 70th Ave Hammond Wi 54015 CS #2260 Lot ~ Subdivision Corner Stone Ridge Date /~ 105 S 1/2 SE 1/4S $ T 29 N/R17 W township Hammond [~ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 it. Top of Fence Post System Elevation ~•5' 'HRPSameasBenchmark Alternate Benclunark is Top of Survey Iron @ 95.9' ;r. 'Ksconsin Department of commerce /j' ~ SOIL EVALUATION REPORT Page of Div~,ion of Safety and Buildings ' in accord c~yAtta~Tomm 4 n drT(-'~ ounty Attach complete site plan on paper not less than 8 1/2 xJ 1 inches m s1z0". Plan must --~~~ ~ t ntal reference int BM), direction and arcel I.D. indude, but not limited to: vertical and honzo po percent slope, scale or dimensions, north arrow, and location and dist1aance to ~earestlgad. 1 r ; ;> Date Please print all information. {2eview by /2 7~5 Personal information you provide may be used for secondary purposes (Privacy ~$~t~i ~I fQ.Q~ 91Ji (G'i1T Properly Owner ~--~. ~ - . n ~ ~ ~ J ~ ~ ~ ~r ~r~j"'~~, Govt. Lot ~ 1/ ~t1/4 S T ~ N R E ( r) Property Owners Mailing Address Lot # Block # Subd. Name or CSM# -- ~ ,- Nearest Road City State ~ Zip Code P e Number ^ C' ^ Village own New Construction Use Residential I Number of bedrooms Code derived design flow rate GPO ^ Replaoement~^ [] Public or commerd I - De/s'c/ribs: ----- ---- '--"~- Parent materiak~ f f e~' /ds. 'F ~ ~'/sa'-'G+Z'~~/'• / 'S"~ Flood Plain elevation if applicable ~~ ~` ft- General currvrierrts .)~~ ~~ ~ ~/ ~' ~' and recomS ~-~ .~W ~ ~~ r/~~ ~ ~ ~ ~ f a~tX~C./ ~~ ~- , Boring ~ r in• pit Ground surface elev. ft. Depth to limiting factor t ~~ # Soil ica6on Rate St t Consistence Boundary Roots GP D/fP Horizon Depth in. Dominant color Munsell Redox Description Qu. Sz. Cont. Cdor Texture ure ruc Gr. Sz. Sh. •Eff#1 'EtT#2 ' ~, I L' ~ .~ ~-' ~ tU ~ ~~ ~~ # U pit ~ Ground surface elev. C ~ F/ft. Depth to limiting factor ~J -' u'i. ~i tication Rate Horizon Depth Dominant Cdor Redox Descxiption Texture Structure Consistence Boundary Roots GPDIFf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2 ' ' ` ~ 1 z -3 b /0 3 .----- L s bk ~ +F ~..~ 1 ~ f ' to / to _ _. a.n _ on n ~ ~n ..,.,n ~.vr T~Q c ~(1 rt1a1L • Effluent #1 = BODS > 30 < 7~ mgn. ana ~ a> >su = ~ au CST Name (Please Print) Si Bird Plumbing, Inc. Shaun Bird Address 1008 192nd Ave, New Richmond, WI 540 . ..- --- - CST Number 226900 Date Evaluation Conducted Telephone Number ..-~~,,~ ~ ~- 715-246-4516 Property Owner Parcel ID # Page of ® ~~ # ^ Boring / Ground surface elev.~~ ft• Depth to limiting factor rn• Sal ication Rate pit ri ti Texture SUucture Consistence Boundary Roots GPDfff Horizon Depth in. Dominant Color Munsell on p Redox Desc Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Etf#2 ! „ ~ r Y/ ---f S ~ n < 7 /-.~ 1 ~p , 3 (~ ~~, , ~- '' ~~ # ^ Bonng ^ pit Ground surface elev. ft. Depth to limiting factor in• $oil ication Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDifE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Etf#2 ^ Bonng ~~ # Ground surface elev. ft. Depth to limiting factor ~• ^ Pit Soil ication Ra Horizon Depth Dominant Color Redox Description. Texture Stnxture Consistence. Boundary Roots GPD/lf in. Munsep Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Ettluent #1 = BOD; > 30 < 220 m9fl-and TSS >30 < 150 mgll. ' EftlueM #2 = BODS < 30 rrrglL 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 608-266-31St or TTY 608-264-8777. seo-a~wcx.uroo) • ~"~ • ~ Soil Test Plot Plan Project Name Cornerstone Properties LLC Sha it Address 1025 170th Ave Hammond Wi 54015 CS M #226900 Lot 7 Subdivision Corner Stone Ridge Date /11 /05 S 1/2 SE 1/4S $ T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Fence Post System Elevation 99.5' *HRPSameasBenchmark Alternate Benchmark is Top of Survey Iron @ 95.9' 1 r ' •' COUNTY PLAT OF: CORNERSTONE RIDGE LOCATED MI PART OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 AND IN PART OF THE SOUTHEAST 1/4 ~ THE SOUTHEAST 1/4 SECTION 8, TOWNSHIP 29 NORTH, RANGE 17 WEST, TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN. L~.GE.ND ® PROPOSED --- 12' U71UTY EASEMENT ® PROPOSED -"--------- DRAINAGE EASEMENT UNE HWE HIGH WA'IE Leo LowEST 8L ------------------ 68' JOINT DRIVEWAY EASEMENT NE - - - - - SET -~- COUNTY SI BACK U (FOUND A! SET 1 1 /4 ~ PIN Wi. 4 T SET 3/4' WEIGHING PER UNEA OTHER LO' p 8431'05 E ~ ~ ~iOS - ,~. O / ' raa wm°n 76~ P~ ~4 25 ~ / ~ ~ scue P/ E v~. ~p3• %~ ~, ~ LOT 7 50 loo 200 N 6~ // vs 87590 S.F. _ % "' 2.U1 AC. qA LOT 6 `" = • tnwE_to3a.so tr,`' eo ' ` 78285 S.F. L =to32so yry A ~rtq,. ~~,p~ 1.80 Ac. a° M9~ ----- ------ Hv~-to29.t Leo tav t ° ~ I - _ - . z "s' 10: I~?CATION MAP 79", _ _ /:~ h ~ 3+ 2 v' ~ W /~ ~~ ~ ~ 3sO (NOT TO SCALE) - es• 1pT 5 SECTION 8, T29N, R77W, ~~ 73793 S.F. ' ~ "~ ~ ~ ~r 1.69 Ac. ~ ` HWE-102a 00 ®\ . ~ ~~* Leo=toao.oo I© 1 N 82'28'x+ E 4 tc ~ I v~ ~~ 3a5p. ~ / LOT ~ JJ~ ~ WSass ~ ~ ~ // V 75629 S. ~ y ~ ey°j LOT 4 i°~~ ' /vet ~ 1.74 Ac .Z '°'° 112545 S.F. ~ I tape, •~ 2.58 Ac. I MWE=1026.50 ' ~ aI/ ~ I Leo-to2eso N 8147'3g• W ~~.. PLAT LOCATION / / a„~ ~~ ~ N ~~~ ~ ®~ ~y LOT 10 ~ Bs. ; , 3e•2e, ~([~/ ~ / 86121 S_F. / ~ ~' LOT 3 w s s / ~ / u~ ~ / ~ 1.98 Ac. 84368 S.F. SoG/ / i 1.94 Ac. / // ~/ HME=tozs.oo /p , / ~ / ~~ Leo=tov oo N , ' / / N ~ 843'48+ K, 513 . /a5 e4 ~ ,80• LOT 11 I ?g, w 4s2 /~p sy~~ ~~ ~_ / ' ~ / 80567 S.F. •>a• ~' ~~ s ~ / ' N s 1.84 Ac. Zj I ~ 80273 S.F. ' / sg35` K, /'/s~~ 84 Ac ~ / ~ /~~ ?gz ' 1 ~ . ~ . / g5, ( ~ ''~~ h HYiE~1024.50 ` / / i Le0~1026.50 ®/ ~ ' / LOT 12 N 89'35'14' E 2 ~i w ~ / // 70672 S.F. ~ ~ o SI • a ~ 1.62 Ac. / u/ / / / ' ' ' / o z LOT 14 ~i N t N 87 06 45 W 348.52' K~' 1 70135 S.F ~ ~ ~ // 73' N 89'04'20' E 477 LOT 1 m 1.61 Ac. it . ~ ~ • 80481 S.F. I I ~' Z ~ \,~ 1.85 Ac. 50'I Yso• LOT 13 f v ~ ap :may Hxt=-to2a.oo rni ( LBO-1026.00 J ~ N ~? I ~~ar 96291 S.F. IzM'{ d - L--~ ~ 2~ A,: ,~ -~ a ~.nr- o ~m!dr ` O - - -~'a~„ ~~°.~I . . . . - o~ Iw, 4411\ HW1:=toza.2s ~ ~ m eenMl.Z CA4lE(f Q e AVID W 116 J~ I ~•~ 33' i~ ~ ~ O LB.O.=102815 CY' "~ A J `\'` O _ ---_ ~" fAIIl1A1T M M'011T C - e11W -1388.84'- 341.61•-- rn~ I~ ~` ---482_46' ~- --- ------ ---- 66.'00' Iri ------ - '°°°-- ----230_72'- - - - - S 89'04'17 W 1798.45' 33.04' 1u,, --^- s asro4'n• w 1830.54' - - ~ly _ _ _ __ ,l~~ ~ SOUTH UNE OF SEC. T.29N, R.17W i "~~g ~ + + i LOT 31 I -LOT 30 LOT 9 I hII~ - - - I LOT 29 , ~ , jll. b I _ I FINAL PLAT~F PRAIRIE RUN I~ ~~ PGRICULTURE-REST[ I FINAL PLAT OF PRAIRIE RUN /~ m ~ll I - ------ I . l`I n I ~ nrtAf>En en .~ maA ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM pwnerBuyer Mailing Address Property Address ~ v De aztmeat for new construction) ~ ' (Verification required from Planning P ~~~ Parcel Identification N ~ n ~~ ~cQty n r t-~ LEGAL DESCRIPTION 1 S t' ~ Z' Z N-R ,Town of ~ n~ p~p~r Location .S 1~ 5~ /., Sec. ~, Lot # Subdivision ~ ~"'- ,Volume ~ ,.Page # '- Certified Survey Map # - ~ g ~ ~" (~~- ~ ~ ~ ,Volume Z Pa e # Warranty Deed # Lot lines identifiab/~es D no Spec hous~~es D no SYSTEM MAIN'T`ENANCE remature failure to handle wastes. Proper n°aintenance Improper use and maintcnanceof your septic system could result m its b a licensed P~• What you put into ~ system consists of pumping out the septic tank every three years or sooner, waste disposal system. can erect the function of the septic tank as a treatment stage in the b the owner and by a a ~tification form, signed Y 'Tha property owner agrees to submit tol~Cro a licensedp ~rerrfYmg that (1) the oa-site wastowater ~ s~ mastCrPlumbez; journeymanPlumbcr, restrictedp in Lf necessary), the septic tank is less than 113 Ling conditionand/or 2 after inspection and pump S { is is proper opera () ~h the standards have read the alxive requirements and agree to maintain the Private scwagc disposal system ~ fiction ~' ~ ~d~ga~ ent of Commerce and the Departm~t of Natural Resources, State of Wisoonsin- set forth, herein,. as set by the Departm must be completed an returned to the St; Croix County Zonrng Office within 30 Ming that your septic system has becn maintarned f the threc Year expiration date. ~~ /~ DATE SIGNATURE OF APPLICAN'T' O•~Ei g CE12T7FICATION our la~owledgo. I {wc) am (are) the owncr{s) of I (we) certify that all statements on this form are true to the best of tmer of Deeds Office. the property descn`bed above, by virtue of a warranty deed recorded in Regis ~~ DATE ~~A'TURE OF APPLICANT ***,~*, Any information that is mis-represented may result in the sanitary pcrmit bring revoked by the Zoning DcPa~~' «««««s «« Include vc~ith this application: a stamped warranty deed From the Register of Dccds office a copy of the certificd survey map if rcference is made in the war~tY dud U. 2860 P Oy8 State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number ~ Document Name THIS DEED, made between Kenneth J. Roberts as Trustee of Josephine E. Roberts Trust, cone-half interest ("Grantor," whether one or more), and Cornerstone Ridge, 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 802537 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROI3i CO. , MI REGEIIIED FOR RECURD 08/05/2005 11:10AM TRUSTEES DEED E;<EF~T 1€ REC FEE: 13.00 TRANS FEE: 30.00 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Address Thomas R. Schumacher 900 MAip Street P. O. Bo 4 Baldwin, WI 54002 Be-IC `f 7 S ~~ SYo~7 See Attached Parcel Identification Numbers Parcel Identification Number (PIN) Dated July 29.2005 * Kenneth J. Fid6erts, Trustee of Josephine E. Roberts Trust (SEAL) (SEAL) s * 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. Star. § 706.06) THIS INSTRUMENT DRAFTED BY: ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. __ _ COUNTY ) Personally came before me on the above-named 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 sot necessary.) NOTE: THIS [S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED ®2003 STATE BAR OF WISCONSIN FORM N0.7-2003 * TYPc name below signatures. ~~ j COUNTY PLAT OF: TEGEHfl ® PROPOSED dnw:wAr ~. • O T~ N E R S T O N E RIDGE - -_ - - - -- - - ,r URUTr EASEMENT PROPOSED JOINT DeYEwAY ~; _;~~.;n.~N.w: ~P, ~e.etdl~,xNN.wWWP.e. IIeONP VM9 tlrf IO 1NYt wD (B WO WIYFp[ ~M OI Oixt K w4Ai ._..-.. - ORANA4E EASEMENT LINE NWE MW mid EIEVAliON x10w x trel nm elweet BWG s x wEewm eBF~emt[ rm Bw Nw m. ee01IYXMMMC M LOCATED IN PART OF 7ME SOUTXWEST 1/{ OF 7NE SOUINEAST 7/1 LBO LOWEST BUIDNLG OPEHBLO >[IEran nar • 0 0nd eoeee WWm rlRm twr s eoT tArlm w xeBe tro AND IN PART ai lNE SOUTHEAST 1/4 ai 7NE SWINEAST 1/a aF __________________ tu' Joer OPo~EwAr Gg4ENT ~: wLmelml W.Ym~is..,,,1L°1,e c11Rt.n,n .:">a " SECOON 0. TOWN911P 29 NORTH, RANGE 17 WEST. TOWN OF CWNTY SEOININ x10eMdT BAt~Bxlt i °'a et~i m XAMMOND. ST. CR01% COUNIY. oSCONSIN. __ -_-. -_- - - SflBAa UNE ~ (FOND AS NO1FD) e sEr 7 7µ• Br la• IRaN GENERAL NOTICE Pw wr. {.nz LBS./TT. gTATEMENT: ryu~ T SET ]/{• BY 18• MIDI! 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