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HomeMy WebLinkAbout018-2021-26-000 f7 fA p '' ~ '9 (~ O ~ O ~, ~ ~ ~ ',, ' O .fl ~ I 6 ~ ~ O ~ ..: 3 ~ ~c n ~ ~ o can 2 2 ~ o m i n ~ ~ ~ ~ ~ ~ v ~ ~ ~ -: o p ~ ro N m ~ ~ N O ~ ~~ j v N o o ~ iv ~ N Q _ ~ d d ...a ~ O ~ O ~ N ~ O ~ p N ' ' ~ O ° ~ m N N m y , I o ~ d . -' d ~p 61 ~ v rrr v ~ d a m CA ~ ~ ~ ^' cO0 OOD ~ N ~ - Z COO (NT O ''. p ~ N N Q '. N ~ O O N ' N ~ G ,p ~ O N '~.. ~ .. a C p .. ro n O ~ D D N ', N m ~ m° °• ~ '~ 3 N m a cn ! p ~ ~ ~ ~ ~ a ! ' ~ , , m .. fD ~ y ~ Z D ~ Z ~ ~ , i ~ !I y O ~, fl1 ~ CO 0 N ~ ' fA SA C ~D d ~ C < ~ ~ a O 7 O ' ' ~_ N 1] ~ C O U1 ' A ~ ' ~ Z ~D ~ .ni. a _ , ~ li ~' !i (~ N ~ w W ~ ~ ~ a ~ ~ Z 0 3 i ~ ~ 3 r. i ;'m N ~ ~ z N A W O fD (D ~ Q. N ~ ~ ~ Q O (D a n TI N N v C ~ ~ ~ a 7 D ° a Z p a gw ~ m 3 ~ ~ N S N a c m m m ~_ a 3 a , CD O ~ O ~ D 0 ~ 3 ~ ° ~ ?~ o ~ ~ cn o -o ; I 61 ~ 0 N ~ 7 N ~ ~ V to ~ i NO o ~- m 0 ~ 'i m ~ O i o g i °o ~- WlScon~Q Department of Commerce SafE~ty and BuildiR~ division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Hammond Hills Estates LLC, c/o Oranzo Oeve Hammond, Town of SST BM Elev: Insp. BM Elev: BM Descrip ~~ _ /~~ ~~ TANK INFORMATION TYPE ~ N MANUFACTURER CAPACITY Septic ///,_ \ /i J /O'1 V Dosing ~ ~ J '7~~' Aeration Holding ~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent o Air Intake N ROAD Septic ~ O +~ ~ Z ~ / Dosing I~ 1 „ , „e ""' Aeration Holding t PUMP/SIPHON INFORMATION~~,,~ n,,,, .n , ELEVATION DATA county: St. Croix Sanitary Permit No: 515129 0 State Plan ID No: Parcel Tax No: 018-2021-26-000 SectionlTown/Range/Map No: 08.29.17.1307 STATION BS HI FS ELEV. Benchma - '' r AI- VlJ ~N.. p 2'. lS' / ~.3 Bld~wer 3 • ~ ~ ~ Z. SUHi Inlet ~~~ S boo • y sUHt o~ (~_ 1 / Qo - Dt Inlet ~ Dt Bottom / / Header/Man.ti~/i ~ ~ ~,~ q7.~ Dist. Pipe I,Y~~U , ~,~,~ ? $a Bot. System O,~ q,, nys• Fi e ~~cttit.~7lIM~ ' p _ O stc~y 2i 3.f Jp3.Z BED/TRENCH ONS Width ~ ~ Length / ~ ~j No. Of Trenches PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth DIMENSI „~ ll~ ?/ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING ER O Manuf ef,~ I L/ ,a INFORMATION Typ f System: ~~ ~~ c ~ ~O/ ~~ , ~ CHA uN Model Numb ~ I J nICTRIR11TInAl CVSTFM 11.1r-~ 1;,.__ L...._l /Il nk 1 ,~-,~ ...~~ ~- pr.~.~ 1 ~ ~-., ead aQnif Id 9 Distribution / v ~ ~/ ~/ ~~' ~ L n x Hole Size ~- x Hole Spacing / ij Intake C~ (~ Dia Length V Dia Spacing gth SOIL COVER x PI'P_SSIIrP Systems Only xx Mound Or At-Grade Systems Only '~`~ Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched ~ Bed/Trench Center ~/ Bed/Trench Edges Topsoil o~~ Yes ~ No Q Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ ~~,~!)Inspection #2: / / Location: 1015 166th Street Hammond, WI 54/0.15~(SfW~//4 SE 1/4 8 T29N R17W) Ham and Hills Estates Lot 26 c~ Parcel No: 08.29.17.130!7~~ ~ 1.) Alt BM Description =~~~ Lv~`-~ ~ "'•~ ' ~, N~~ ~-~ ~~ ps~"~~~ ~~ 6]'2.(Y~¢sr 2.) Bldg sewer length = 20 ~ ~~ - amount of cover = -~ p ff _ ~r ./~~~ L, ~ ~ ~ ~ ~~' V~ `~~ ~/ a Plan revision Required? a Yes i o /~~ ~/ ~~ Use other side for additional information. 6! ~/],~, Dat , ,',~{~ Insepctor's Signature Cert. No. / SBD-6710 (R.3/97) ~ (N"'" ~~ `'(~ A-~ flYI~Z6n 4' ~l ~ Q~It'l..~j~/ j I ~i~- gz q ~ s~~ ~~s 111 enu eRCnRPTIn1U SYRTFM commerCe.wi.goV Saft,nd Buildings Division 201 ~t7;~W ngton Ave. P.O. B~7 ~~ ~ County` d ~- ~~ ~ ~~ X ` i sco n s i n lson, WI Q V Sanitary Permit Num be r (to be filled in by Co.) Department of Commerce t G ~ 15 f Z Sanitary Permit ApplicationA State Transaction y1nber Q In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the pr o~~~~glVAttental // +!,,, ~ unit is required prior to obtaining a sanitary permit. Note: Application fonns„~ol~~~6FdfeE Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provid ay a used for secondary ses in accordance with the Privac Law, s. 15.04 1 m , Stats. 1 !}y 1oi 5 l I. A lication Information -Please Print All Information 77 ~~ ~„ Property Owner's Name ..n~ ~ ~ Parcel # ~~ // vr,~ ~,' .S GSTk~ls ~LGs ^Z OLI.- Z f: -G ~ 0 Property Owner's Mailing ddre ss Property Location / / ~ ~ / I ~/ 3 3 ~F.G.ci f°I U u-i5 ~ ~,~, . V V Govt. Lot C . City, State Zip Code Phone Number p c~ y, ~' rc Y,, Section p Ew ~~Cl-/-'-'+d~-C~ ~Il.~> S~vI ~ c~rcleone) T 'L~1 N; R ~ E or W II. Type of Building (check all that apply) p ~ Lot # ~ ~'1-or 2 Family Dwelling - Number of Bedroom s Z ~ Subdivision Name / t L s {~ V M1tis ~ ~ B10C y ' I c j O[..~+ /s9s J N K ~ ~ ~/ L ~k'/f.~ ^ Public/Commercial -Describe Use ~ ~ ^ City of ^ State Owned -Describe Use CSM Number ^ Village of ~ t ~ ~' GI Z ~ ~ f ~ Town of a ..n, /1,g' J ,,.. G ~nJ B,, 1 t III. Type of Permit: (Check only one bo on line A. Complete line B if applicable) A. ~Iew S stem y ....~~' ^ Re lacement S stem p y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~ ` a IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 ~ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersal/I'reatment Area Information: Design Flow (gpd) Design Soil Application Rat~gpdsfJ Dispersal Area Require (sf) Dispersal Area Pro osed (sf) System Elevation '~ ~ 7 ~ (. y 3 (oPa y 2 9 ~. la 9 3. ~' VI. Tank Info Capacity in Total # of Manufacture Gallons Gallons Units ~ o '° y ~ New Tanks Existing Tanks ~ 7 y = Y ~ ~ ~ ` ~' / ~ `~ l.2 ~ f 0 ~f~ a U v~ ~ v, w C7 a, epti or Holding Tank ~ /~ ~ O / ~.. ~ ~N Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. lumber's Name Print - ( ~~ ~ Plumber's Si afore ~ MP Number Business Phone Number ~ S GZ, C lt. C k' w ~ Z 2.2. $ 7 2.- t-17 L - Z i1 Z J P ber' Address (Street, City, State, Zip Code) Z (~ S 5 ~ ~ -t~, S~ . ~~ ~ K ~~ SYs S3 VIII. Coon /De artment Use Onl Approved ^ pp isa rove Permit ee ate Issued $ Issuing Ag ignature ^ ~ ~ ZS a5 ~f 75 iven Reason for Denial . IX. Con itions of ApprovaUReasons for Disapproval d 3~ pwN ; / ~ v Cr o .~^ a0 0 ~- t ~- f ~'f Q ~ u-~ l ~_ S 'tank, effluent faker and ' tdispersal ceti must all be s tees / m in ~'/~~ '"'/0 6 ~/ ~lv. o i, (j /~ >ts I~r management plan provided by plu vE.L ~°<~J ,~ Z . U 2 All ttetback r~lretnents mint be . aq ~ trade ! tNd1t1~ACli. Attach to complete plans for the system and submit to the Countp~ oply on paper not less than 81/2 z 11 inches in size 3' - ~.o•_ dv ~. ~e~ved~ !. '~~ /Jo ~...~" o ~' S adzes.. ~ ~.~. P~ ~ , Tib:aQ ~N~..-t, F'J~ zo„~.. . SBD-6398 (R. 02/09) Valid thtu 02/11 S~ ~ ~~~ M~~ , Z ~~(~ {~ ~ ~o ~ ~~ -„ ,~ ~. ('ti ,~ i A ~ `v n o ~- \~~ 3 3 ~ ~~~ ~ ~ ~ L~ ~ l\ o ~' ~' ~" \ 5'C ~ ~J COPY ~~ ^~~ / ~~ ~~, ~' ~s ~~ /~ a_ 7~ a r e ~ '~ j~,~ r N ~o ~ e ~1- "~ ~ ~ ~ ~ N ~ h ~ -S a m~ ~ ~T ~ ~ ~ 4 ~ ~ 1 ~ '~ W . ~ V ~ ~ ~ I~ w ~ ~ I-~ `^ , ~. _ _ ~ R ~~~~~_ ~_ r_. S ~ - _ ~; - - T:.~ y 4 :t .^ *.~-' ~ - _ ~ ~.~. ~1 +f.- -_ _~ i T. 1 Y~ 2 ~ _ ~ ~ 0 ~~ ~~ Js - 9 'JL` ~ ' ~ ~' r 134- ~-~_ ro. - ~ : - a ~``~ ~~ ~ ~'~_ t ' s3~ ~_ 'p~~ 1 yh _, r. ~; fy 3 , `' '~K ~<'~ ?~`»~t_ ~ .~. ,4 # mot' ~_ ."M"~. *.~.~. r_'t'y~...,~y, I ~J. L~.~y'sc aKo~.v ~ - v.~-1 - _ ~ _ 3 ' ~ - r - 'x ~ . ~^~~5~ ' 4~ ~ . 3.. ~ - "~ ~~•• p 'awl '~~ ~.'~ ~ ~ ti. ~~'b,~ a .- f •'~ w r ~ A ~. i ~. 7 .v a -~. N`j.~ e , e .,t, ~ ~ "' .i~., ~, ;-I .. _.l A~ `iii ,. .i 1 ~ r~ 6 ~.JJ' Y /y A ~'* y ~ ^ ~ 4 ~1 ._ ^ ~ ~ ._ ~ +~ .. • 5 k Y~ G f _9 4:K it ^ a h 1 ~ ~~ ~ ~ \ ~~ ~ a~ '~ ~ ~ v ~' ~` ~ ~ 3~ T ~`~ N h ~~ ~ W '1y cL ,~ N d ~ C~ ~ ~ '~ N ° ~' ~T ~ ~ ~ 4 ti W ~ ~ ~ 'a d v ~ °e ~ w ~ ~~ L ~ ~ Wiscon§in Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings __..-,,,~__~____. Ps1s5 of in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan muss County ~~~ ~ ~ ~~ inducts, but not limited to: vertical and horizontal reference point (BM), direction and p~ I,p. percent slope, scale or dimensions, north artow, and location and distance to nearest road. Please print all lnformafion. Revi by DaEa Personal intortnatiort you prrwida may be used for ary t) (m)). /! ~a/d 7 Property Owner / rope Location ~~ t~ ~ /" f ,? _ D i~- vt. ,~C:~ 1/4 114 $ T ~ ~ N R ~ E ( yy P rty Owner's Ma' Address lot # Block # S Name or City to p Code ^ C' ^ Vllage Town Nearest Road u ~r~C~ 3 S~vt ( l6' ,~ New Construction Use Residential / Number of bedrooms ~ Code derived design flow rate '~ GPD ^ Replac8ment ~~ ~~ ^ pu/~/1ac or oommerdal - p/~~cnbe: _ _ __ _ Parent material .~~"t1~n O. a...tY l.3lt~cc,~~.rr~' Flood Plain elevation ff appGgble .~/,s*~ ~ ft. General ootrvrients and recarrwrrendations: ~lr C System Type ~D j?/V ~' ~ l System Elevation Boring # n p~~ Ground surface elev. ~ ~ 1 1 Vft. Depth to limiting factor ~~-~fn. Soil ication Rate Horlmn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fB in. MunseA Qu. Sz Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 -~ Z ~a~ ,-3r ~---- y ~ ~. ,z- - s - P----- ~ ~ ~ ,~ a ~ i ~b ;~ Pit Ground surface elev. ft. Depth to limiting factor _L.~ in. So~1 ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GPD/ftr in. MurtseU Qu. Sz. Cont. Cakx Gr. Sz. Sh. 'Eff#1 'EB#2 Z- S- S L O ~ rte/ --~- C ' arnsl~t_ rrrn w ~ y ,~ '~ 11 ~ © r ~/ S s ni I ~ ,~ l , ~' .l ~Z l=flluent #i = BOD > 30 < 220 mg4. and TSS >30 < 150 " E119uent #2 = BOD < 30 tnglL artd TSS < 30 mgll. CST Name (Please Prirrt) Sig CST Number Bird Plumbing, inc. Shaun Bird ~ 226900 Address Date Evaluation Conducted '• Telephone Number 1008 192nd Ave, New Richmond, WI 54017. ~ _ ~ 715-246-4516 a~ property Oumer Parcel ID # ~~ ~~ I 1 ~? Page of L~ ~ w...~ .. Pit Gnwnd surfaceelevj/ G~' ~ ` r ft. Depth to urruung raaor ~- ~ r~ ~. Horizon Depth Dominant Color Redox Description Texture Stn,~cture Consistence Boundary Roots in. MunseA Qu. Sz. Cont. Odor Gr. Sz. Sh. Sod ication Rate GPDIff `Eff#1 •Etf#2 2 (L~ lO r ~~ ~ C f . vns {~ k 1~r' ~ n • (p _ `~ ~ ~, ----- S Q S ,,.,~, I n a~ ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~ ~~ Rate ^ # ~ ~~ Horizon Depth Dominant Redox Description Texture Strumrue .Consistence Boundary Roots GPD/fF in. Murtsell Qu. Sz. Cont Cda Gr. Sz. Sh. `Etf#1 'Etf#2 ^ Boring # ° Bonng ^ Pit Ground surface elev. ft. Depth m ('uniting factor in. Sal tion Rate H i 'l th minart Cd D Redox Description Texture Stnx~ure Consisterres Boundary Roots GP D1fP or zon ep in. o Mansell . t1tr. Sz. Cont. Cdor Gr. Sz. Sh. 'Eif#1 'Etf#2 ~` . Effluent #1 =BOOS > 30 _< 710 mgJL and TSS >30 =150 mgfL • Etfluerrt #2 =BODE <_ 30 mgA.. arx~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. saosaw cR.6roo- . ~ . Soil Test Plot Plan Project Name Oevering Homes LLC Shaun Bir Address P.O. Box 179 New Richmond Wi 54017 CST 26900 Lot 26 Subdivision Hammond Hills Estates Date 6/2/0 S W 1/4 SE 1/4S $ T 29 N/R17 W Township Hammond Boring ~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation 97.6/97.0 *HRpSame as Benchmark 166th St. 7% Slope \ ~~ \B-3 444' Property Line 9U' \ \\45' 20' 30' B-1 Scale is 1" = 40' l03' unless otherwise 1so' 101' noted B.M. Please note: survey was not ~ complete at the time of testing, 1s0' installer must check all setbacks prior to installation. 148' Property Line Soil Absorption System Cross Section ft 4" Schedule 40 Final Grade PVC Vent Pipe ~~'8, ~ f ~~ . S With Vent Cap G ` ft Leaching Chamber --- 9 7 ~~ 9~ ~ J =-.,, ~ •- System Elevation 3 ft S ft Soit Absorption System Plan View ~~ ft S ft ~ ft 4" Dia. Header Leaching Chamber Specifications Manufacturer And Model _~ ~k ~ c..K ~+ 3 EISA Rating Za - `'sq ft per chamber Soil Application Rate =~ gpd/scj ft J~ gpd Design Flow T 7 Soil Application Rate ~ Z °' v EISA = 3 3 Chambers 2 rows of 17 chambers each. Page of c ~ p~,~ ~zz~7z POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __ of FILE INFORMATION Owner £lif'rC , ~. d n~r- f 3 Permit # DESIGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~f gal/day Design flow Ipeak-, (Estimated x 1.5) ~ ~ al/day Soil Application Rate ~j al/da /ft2 Standard Influent/Effluent Quality Monthly averag e' Fats, Oil & Grease IFOG) 530 mg/L Biochemical Oxygen Demand IBODS) 5220 mg/L ~A Total Suspended Solids (TSS1 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODS) S30 mg/L Total Suspended Solids (TSS) 530 mg/L p~jA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ya in dia. ~A Other: ~'NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity p o 0 al ^ NA Septic Tank Manufacturer ~ ^ NA ~ w, Effluent Filter Manufacturer F3 ~ ^ NA Effluent Filter Model ~ ~ ~ ^ Nq Pump Tank Capacity al ^,pq Pump Tank Manufacturer ~Nq Pump Manufacturer ~q Pump Model .~q Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA ~-Ground (gravity) ^ In-Ground (press urized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls- At least once ever y' ~ ^ month(s) (Maximum 3 ears) ^ ear(s) y ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third (Y3) of tank volume ^ NA inspect dispersal cellls) At least once every: Z ^ month(s) (Maximum 3 years) .6-yearls) ^ NA Clean effluent filter At least once every: (~ -~'rnonthfs- ^ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ~~ ~ p yea~(s)(s) O NA Flush laterals and pressure test At least once every: Z ^ 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 Piumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be 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 condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 1 ~,,,~„"„ GMW (4/011 /'~ P~~ zZL 87Z ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer G~'v Mailing Address Property Address ~a ~s- srn C S ;~, S ~~ S~ ~.~.,^S y~~7 (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number O! g- Zo 2l -Zb -~ ~ ~ LEGAL DESCRIPTION Property Location 5 tti., ~/4 , ~F_ %4 , Sec. 8 , T Z 5 N R ~ 7 W, Town of ~`~tt ,,,.,, ~ ~,~ Subdivision Plat:~~,.,,,,, ~,,,, ~,,,~ l~,/ fs ~~ f~ ~~~ ,Lot # ~ L . Certified Survey Map # Warranty Deed # Spec house 'yes xno Volume ,Page # (before 2007)Volume ,Page # 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 phnnber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1!3 full of sludge. 1/we, the undersigned have read the above 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE OF APPLICANT(S) ~ ~z 3/ o q DATE ***Any infornlation that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number ~~ Document Name THIS DEED, made between D&T3 Equipment LLC A Wisconsin Limited Liability Company ("Grantor," whether one or more), and Hammond Hills Estates Development LLC ("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 County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See Attached PINS: part of the following parcels 018-1016-50-000; 018-1017-00-000; 018-1017-30-000; 018-1017-40-000; 018-1017-50-000; 018-1017-50-001 111111 Ilill Illil 111111111111111 II11 111111 IIII IIII * 8 5 0 4 1 8 2 85Q418 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , UlI RECEIVED FOR RECORD 05/11/2007 03:15PM ~#ARRANTY DEED EXEMPT s REC FEE: 13.00 TRANS FEE: 1333.20 PAGES: 2 Recording Area Name and Retarn Address Assured Title, LLC 1810 Crest View Drive, # 1 B Hudson, WI 54016 This IS NOT homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements, Restrictions, and Rights of Way of Record Dated `7 ~ ~ ~~ - (SEAL}_ ~lQ,t)-"~ ~ ~ ~ (SEAL} * Ronald C. Bonte, Member * Steven M. Dalton, Member (SEAL) (SEAL) * -~~ _ ~, AITTH J cy~ Signatures} ~~ 0 authenticated on V~LtC TITLE: MEMBER ST. (If not, authorized by Wis. Stat. § 706.06) THIS Ii~1STRUMENT DRAFTED BY. ACKNOWLEDGMENT STATE OF WISCONSIN ss. St. Croix COUNTY ) Personally came before me on ~'~ ~ 0 ~, the above-named Ronald C. Bonte and Steven .Dalton as the Members of D&B.Eouiom L be Richard K.Y. Lau - Redmon Law Chartered Notary Public, State 2217 Vine St., Ste. 204 ~ Hudson, WI 54016 My Commission (is the Parcel Identification Number (PIN) executed the foregoing .) (Signatures may be authenticated or acknowledgcd. Both are not otcessary.) ~ NOTE: THIS lS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WLSCONSIN FORM NO.1-2003 * Type name below signatures. 1 of 2 Property Description: A parcel of land located in part of the Northwest Quarter of the Southeast Quarter (NWl/4 of SE'/4), the Southwest Quarter of the Southeast Quarter (SWl/4 of SE'/4), the Northeast Quarter of the Southwest Quarter {NE'/ of SWI/4 and the Southeast Quarter of the Southwest Quarter (SE'/a of SWl/4), Section 8, Township 29 North, Range 17 West, all in the Town of Hammond, St. Croix County, Wisconsin, and more particularly described as follows: Commencing at the Southeast corner of said Section 8; thence on an assumed bearing of 5.89°04' 17"W., along the South line of the SE'/a of said Section, a distance of 1830.54 feet to the point of beginning of the land to be described; thence N.O1°42'49"E., a distance of 572.10 feet; thence N.29°05'43 "E., a distance of 549.73 feet; thence N.68°22'03"E., a distance of 144.43 feet; thence N.21°37'S7"W., a distance of S 10.00 feet; thence S.68°22'03"W., a distance of 100.55 feet; thence Southwesterly, a distance of 200.76 feet, along a tangential curve, concave to the Southeast, having a delta of 18° 10'20", a radius of 633.00 feet and a chord bearing of 5.59° 16'53 "W.; thence N.49°49'36"W., not tangent to said curve, a distance of 333.73 feet; thence S.89°20'10"W., a distance of 217.62 feet; thence N.73°12'01"W., a distance of 516.b9 feet; thence N.89°20'53"W., a distance of 444.00 feet; thence 5.00°39'07"E., a distance of 1808.96 feet to the South line of said SE1/4 of SW'/4; thence 5.89°54`26"E., along said South line, a distance of 653.68 feet to the South'/4 corner of said section; thence N.89°04' 17"E., along said South line of the SE'/4, a distance of 771.74 feet to the point of beginning. 2 of 2 COUNTY PLAT OF; ~ 6 89'20'63 W 144.00' ~tli916 i ' ISO.OC' i !SO.G~ ~' '.41.C0' I' C'it;pO~• S! Cr~;E u.. Si I 6.24' N ~ &:i^'A iS Pi;~; HA1~~IOND KILLS ~ I t 25,~,~ 3y~'o7. W,;~~ ,5 i W 51 mm P,:. 6.6g' UNRA`iE0 LANGS L: it PA:: 7. I i ~ PiGL6:. LOT Z LOT z ~ Z "~ s e97o')0' w nz62' ~ ~S TATES ~ ~'~~ I 14 ~ 15 0 ~~~ ~~ LOT 16 LouTEONPAJ¢iaTxENWwanlESEIN,nIESwINa1NESE ! "°'' °I "~" ' ~ S.II IN,tlff NE lNa1LE SW INAH111E SE INa1NE SW1N aSECTNN a .S!. I<. o :n:. c ~'.Jn<~ o LOT 17 ~ J 9N 49• ~•5D} y W ~~ t }' \ +11 B, it9N,RI7W,tOWWaNANIgIp. S1.CR0IX C0INIY.WI5CON6N. .~ -eS I~ ~ ro7:/i av rn 'V,>-' ~- SE6 ~ o t>* < I I x ' ` „`I--- I J LOT 19 LOT 21 a1~ J ~ 1 _ w ~, DRAINAGEIEASEMENTNDTE: 1 ~' 1' ~ ~ NDCWNER ORRESgENi SIW10OWMWNGYAIR'N WgAO WTERFERE WifH - ~ ~ is< s) IO (~0 Sq•~) ~. ~~ E2 :.,.. p164NGElHEOPEMRONafIENNRC4EDCqlA3'IEN~4YE ~!._ '` ~: i J: ~ i i 0114 $TORWQiEN1A4UCELEMPV~N~SEgMEN1AMEROSgNCONfROI%AN .. I dr ,R ~ I p \ °\q ® ~~ ' t ':' fgi1H$PUi, TWS NCLUDES,RUIGNOTLWIfDTONNOIWOPOl1, w ~_ O }ILI , 1. `, OSSIAOOtNSi, k1EAlI1G, F10.NG.IXUVAING, gLPUNLNGNANYOWlUGE ~, • ~ ! ~ _ _~ I b ; I _ . " ' I - ~ i ? / LQ I 2O ~ ~ t+i Wd, Y EASBFNLS,SiOPolNA1FAPON06~WA1ER0RAW.GE pTdIES, WAffR .vv:til _~.QS~,~5i ® I %,;. ~ r ALNNAYS,WATERLULS4RRpiBFA)JS. i ~I '~' xnJ I: .45 - ,® / ~)i"=` `~. - .. ~~1i9 ~ N 991953 E t92,9v ~16Ce r ~ ~ ~ GENERAL NOTICE STATEMENT: ~E._ ~~ _~-_. _-- -- re ~ -';), 7 ~ ~ f i, EACNP,uxasNOWr4axnosLUrpurtssuegcriosrA>E, I o s e9~'tosa w ~a9o ~~ ~O 4 \ LOT 22 . s w CdMFY,AtATOANUW3,AUESANDREGLU1pN5 hE \ ... rq 'S~~ .' ru S; '{~ 0 WEIUNO, MNRAAILOTS~.ICa65TOPNiCEt,ETG18EF0RE ~ '7aCC /i ~ i75.~J.... n2 SC'J~-: 7 ~ ,4z ,,~. ~ ~ '0 rM~r~,u i I ~ i ®.. ~\ LOT 19 Q / '~ 6 J 0. PLRCwsNCaaoEUEwPNCENrLOraL,wo,caxrAnnlE sT / i ~ ~ ~ ~~2 ~; ~c F J y °'\ CROIXCOUNIY'N/NNINGd IINRlGaPARiLENEV8111ETONX ~ ~' .... -.. _ aP~AaaJONwmloRfovOE. ,y , Irr ? ® ~:t^ I Np ~ „ e`' o, ~, UTN.ITYEASEMENTNDTE; '~ ~D" """ ' ~I I ~ ~ A~'N~s { q ^~ ~ ® IAT 23 t~ ?,`, n s+rn~ . s2. Lay . r ' lwca NoraEaRN>PoEOCfaLESU~roaEPLAceosaNixArnf ~ z i LOT Z "s ~)~~~c` e , ' `- ,,- wSfHLA1pN44yLlod5T4PSAWYSU44EYSrNF,aiO95TR11C1 ~ LOT o LOT 11 eta.; Nq_ /F4 'se a 1. v>Sn,KOwcwnLOiunwa+sn~unw,ao~snlPa~ I 13 °~~ l2 a) ,:a •, ry s) .,Vei n. oh ~y ro s, aASUgvErsrfxE9vfarorEaAwaLAnowasEaaNr~az m ,.,;1 ~ .,' „ 04, ,r~ .\ ~,rZ~ ~ )•~. / .- F^ WRCOXSN SiATU1E5. UfUlYFASENEMS/S IIEPoENSET FOR?N - -)''S`- ° .s!< ~I ~~ bee ~ -.~~ ''. \~~''~ p} uaioRiieusfaPUa~cROaIESA~PPJaAii7PUaw ~/~ ` ~^ LOT 24 " \ ~~'1A6} ~c~6 NIRIFE NAVWGANG}ITTOSERYE THEAREA. 5 ~~ f e ~~ LOT lOV !~ y \ 14 \d __ I S NDTES; I o ~ i , a x_ o~ L, `~:,`r a° ~7 " ;; /, ` _ cJ f~WiSEiHW(=SPM1KESSOIHERN9SEIp1E01 ~ p~ ~ ~ i __- i j_tt _7o c' Z W /7/ k SS1ESEi81U•t2Sp5WNBPffDI ; 4q IFf awSEteAa•u f e '~ b o° a~ ~' WEnuos6ieACx•w Go. ,~ 1 ~-5 o LOT 9 LOT 25 r 'FRONTSET640(dEl3LiFOPROM ROW I JI ,~ ~ M1a ~'IJ7 ::. ~. \ S ~ ~mi clnJ.. i ~~+ Ise<-~'. " ,.6.k ~ c r i, ~7 <•'~ ALLSUDNO$iO~Cdd1Po1C1®NPROIN1RrWI1NOR4NfLE D RS.CO ~ ~ 175.00 ]5. 7 ~ /A'''y ~ ,.st _x - 9. EJLSdaEr7LSSwux~YEALOawsrNnaNCOPfNNCaRWwoari ~ m t; LOTS hA, a ! ,, ,~ '<"~ yw WEUNEVAT10111pi1E56 MWTAUFEETABOrE7XEWGi1 Ps O. ..4 89'205, _C 115.57'-.. -' / •c ;57)C i'. r y JY( ~ R J6 ~ L' .k. ~ ~ ® tq WATENEIflATA7N ro ~ I - !:.. cy, M1 ~ ~. ~ ~ ', ~, m. -\r9N~ ~ ~ -~: < / ; ~`" ~ LOT 26 ~'' y • I a, . .. m:y'i ra nl'i Iz .r S>C S' i A LDCATION MAP: -•~_ ~ e u ,y, a' ~ 4 sD. s ~ / a i_ IAT 6 160, c OJ~ ry / `4i) ~h_:a{s .Y h ~ h ~ MOTTOSCALE) _' _ emJV. m &•r~:ns 2 ~tp" ~ f ' ,~ 2 2'~ 11 ~ypyE SECTKNI9,T29N,RI7W, i ... >a ~ L.\ tests A /~4 M1a' +eq ~, 5• r ~' 0 t ~ i _ IIO~A~ I ~~ ~ Ie::Ji f "_~• ,~ LOT 27 N; ~ to aco °~r ~ 1 ~---~--~ y ~ I '' ' LOT 7 co' ;~~ J ; mT ~ / \k /y~i~ I II ' / ~ I, nl - to N ~ 1 tr ~ ry pr, 11 ____~_ ~~ _tk~. _SS. 171 . ~~ 1 d 'T a i yyr~. 1 QO .gyp p iGUt: - N ~ I I ~ pp ~ % : e3'~, ~A 7J6.<5' e LOT 28 AuBFAAEJDS NFREtERENCEO io ~ I ~! • /~~ •~. ~ ° _--101ST AVENUE '- .i ~'\ ',~, }.~ a•y / ,.~. ~~••",;i~:x:.. ILE SOIILNINEa OESE.IN a I / -- N 99'34'19' W 206,.9 ~ Cl ~ :~j5 r'6 ... - s ,7; ' SECigNA, RSN,RIM, ASSUW ' umN \ ~,L -. IOSFANNNVI'11'E~ST.fROIX ~yt\' ~ ® 176.67 - - 7931' ~I ~` COUN"C0°A°""'s srsrEN1 PLnnocAnoN i -' LOT 5 ® ~ \ ~, 4 93'4I'i6' E ; , 'c ' lut 2 I i ~Ff{.Itao: 6nh r0 - I i. ~~~, ~~ '° Jr` °I LEGEND: lSi,r,.caol ~r~M' ql '•0'~ ~ c ~ o 5wRON517BAQ(IIIf f FOLOp11N'NONPN I AL•E1M10~ 6 0 ~~I ~ ~~ ° ,'~ - - IrIJISmEA3ENENi t ~ ,L TYS` a ~I wI .,.~ LOT 29 '? NN.ESSaxoWnsEl~tEO1 P LS~~'9Y1S'NONPNW1.1.717 I ~ LOT 3 LOT 2 LOT 1 ~~ !a < LOT 4 =~ f ~> ~ ~ ;'o al cNr, s. a;' , _ _ ._ _ ORnkUGEUSEMENTl1VE aS?: i; o •9 i. n I i SEiYI'BY IF PU)N PIN WI. I,NI l.ii k. I^ i5dn. cI ~' S' _ ,• h Z IBS.fi. AtAIL CTNfN LOY .. iENCELNF ~ CORNEAS Y ~~ 2I .''~t' ~ ~ '. 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