HomeMy WebLinkAbout032-1064-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 572817 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Kinde, David & Katie I Somerset, Town of 032-1064-20-000
CST BM Elev: Insp.BM Elev: BM Description: nn Section/Town/Range/Map No:
p M 1 64sr 24.31.19.320A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER �• CAPACITY STATION BS HI FS ELEV.
Septic -X% Benchmark 6A3 /06 /
it earitng Alt. BM ,
Aeration Bld .Sewer ail. 7.
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. (Y#t to Air Intake ROAD Dt Inlet
Septic -7 Z0 / 7 lZO i Dt Bottom \`
Dosing Header/Man. 747 91 'l-
Aeration Dist. Pipe ' /6 r Z5 9`•Sg
Holding Bot. System io 3 r ,S
PUMP/SIPHON INFORMATION Final Grade
Manufacturer GPM 47 St Cover �d L- G 3.75 �d3.
Model Number
TDH Lift Friction Loss System Head Ft
Forcemain Length la. Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 7y -3 -FGw
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR —E.,
�i�/�/•� ��
Type Of System: Z7 /fj I il/ /1 _ UNIT Model Number: ,r �rw A 1 A4
DISTRIBUTION SYSTEM / }( 3
Header/Manifolds �/ Distribution x Hole Size x Hole Spacing Vent to Air Intake
7lkl' Pipe(s) t_ tje- .
Length IN.S Dia Length Dia Spacing ��- _� ! S
SOIL COVER x Pressure 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
` `� .Yes 0 No ,° Yes 0 No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 773 210th Ave Somerset,WI 54025(NW 1/4 NE 1/4 24 T31 N R19W) NA Lot Parcel No: 24.31.19.320A
1.)Alt BM Description C
2.)Bldg sewer length qZX-amount of coverPlan revision Required? Yes o Use other side for additional information.SBD-6710(R.3/97) Date Cert.No.
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RECEIVED 1 dustry Services Division ��
3 1400 E Washington Ave
O. Box 7162 Sanitary Permit Number(to be filled in by Co.)
OCT 1 2014 --- n,WI 53707-7162
1015 57Z "9 17
,OMMUNI M &Vmit Application State Transaction Number
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit A-
the required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address(if different than mailing address)
purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. 2
I. Application Information-Please Print All Inforrnotiqn 4773 C:.)/D_t",a v£
Property Ownerr��Name / 4' KG. ;e— Parcel# 6r
.URV 10 32 /04 '� Lo -o vo
Property Owner's Mailing Address Property Location /
3_83 t Svc c z_y c-� X , Go
vt.Lot
City,State Zip Code Phone Number A,Ley<, /V C11,, Section a T
Je"-M f;�L,5-C lxya Z_5- 4J-I- 3 Z y- 7.70 T 3/ N (circle�one)
R ,/ E`f�
II Type of Building(check all that apply) Lot# �
1 or 2 Family Dwelling-Number of Bedrooms Subdivision Name
❑Public/Commercial-Describe Use 6k o ' Block#
w ❑ City of
❑State Owned-Describe Use
_ II p �/ CSM Number ❑ Village of
�- Ce-'a t aJ O O Town of LTo/Yw fiC
III.Ty a of Permit: Check o ly one box on line A. Complete line B if applicable)
A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV.Type of POWTS System/Component/Device: (Check all that apply)
Non-Pressurized hi-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil
LJ Holding Tank =Other Component(explain) ❑Pretreatment Device(explain)
V.Dis ersal/Treatmen rea Information: 3 C f Z k 7 Z' 5 -77o v c/L V
Design Flow(gpd) Design Soil Application Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation
Z '5'0 Rate(gpdsf) . 7 1071
VI.Tank Info Capacity in
Gallons Total #of fl c
Gallons Units y Manufacturer 12. ;,
New Tanks Existing Tanks IJf,J /d ✓ p U tin w 0 CL.
eptic r Holding Tank (pt9 C� Std u w 2L ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
P ber's Name(Pr' Plumber's Signature M) IP �Number Business Phone Number
k a -fS�`� J y�-- Z ZL 87l_ r,7-Y9'1 36
Plumbers Address(Street,City,State,Zip Code)
.® (A CIC CA,_,i cT 8
V11L.Count /De artment Use Only
Approved approve Permit Fee Date Issue Issuin4gent Signature
rven Reason f-0?-Denial $ '
IX.Conditions of Approval/Reasons for Disapproval YSTEI OW
1 Septic tan effl� fitterand .
disper cell'.must all be serviegs i maintalned
as per management plan provided by plumber.
o S R� '-t d t� ( — �lti U I c� 1 �p srsck retreFtieMs moat DewmaintatlrNd
n per apps code-i ortlM>•now:
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398(R03/14)
Feb-06-2014 03:45 PM St. Croix County Plan/Zoning 715-386-4686 1/11
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: D c{.V�` ,-(A f.
Owner's Address: �8o✓r»t.L�$G �,
Legal Description: /V w— ,V �s•�' �? -T"3l .L/Q r.✓
Township: t dam^ f�!,Y'-
County: -�� C.L o
Subdivision Name:
Lot Number.
Parcel ID Number. a 3 .2- -/ v G Z a -0 O G
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing&Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St Croix Cty Septic Tank Maintenance Form
Page S Warranty Deed
Page 9 CSM or Plat
Attachments:Soil Test&House Plans
Deslgner/Plumber, c q k 0,wY;,,s License Number 2- 2-7-o-72—
Date: o Y13 -t Phone Number 71;r- Y
Slgnatur
Designed pursu the In-Ground Soil Absorption component Manual for PQWTS Version 2.0 S90-147015-P(N.01101).
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Soil Absorption Svstem Cross Section
ft
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4"Schedule 40 Final Grade
PVC Vent Pipe 9 7 j—
oft
Vent Cap ft
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Leaching
Chamber - ► ♦_ �� .SD ft
System Elevation
a ft S ft S ft
Soil Absorption System Plan View
7 ft
j ft {
J' ft Leaching Trench 1
Chambers
4" Dia.
Trench.2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Model
EISA Rating LO,b sq ft per chamber Soil Application Rate -7 gpd/sq ft
71� gpd Design Flow - -7 Soil Application Rate - Z° • ° EISA= Sy Chambers
3 rows of l chambers each.
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Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conterits
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 power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result 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 normal 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 compact, 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; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; 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 Servicing 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
If 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 compaction 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. Barring 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 INSTALL R POWTS MAINTAINER
Name � ^,3 - 7j,"� Name
Phone Phone
SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY
Name cf cS El'rC, Name
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d)&(f)and 83.540), (2) &(3),Wisconsin Administrative Code.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner f Septic Tank Capacity 1460 gal ❑ NA
Permit # �d Septic Tank Manufacturer —TW a,t, ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 6'-J1 ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model 6' /p ❑ NA
Number of Public Facility Units 42-MA Pump Tank Capacity gal -ANA
Estimated flow (average) gal/day Pump Tank Manufacturer ,..2-NA
Design flow (peak), (Estimated x 1.5) / /Z J gal/day Pump Manufacturer 'A
Soil Application Rate - 7 gal/day/ft' Pump Model NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit -.2"NA
Fats, Oil & Grease (FOG) 5_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) 5220 mg/L 4TNA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) 5_30 mg/L 9In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) :530 mg/L _Q-NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) :00° cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y. in dia. .p,NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once ever ❑ month(s)Er—year(s)
(Maximum 3 years) ❑ NA
Y� �.� O'year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: �, j �ea�lsl(s) (Maximum 3 years) ❑ NA
❑ month(s) ❑ NA
Clean effluent filter At least once every: /, 43-year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month❑ yeaarr((ss)) ) A
❑ month(s) „B1TA
Flush laterals and pressure test At least once every: ❑ year(s)
❑ month(s)
Other: At least once every: ❑ year(s) -ETNA
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 Servicing Operator. 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 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 (Y3) 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.
GMW(4/01)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the 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 power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result 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 normal 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 compact, 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; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; 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 Servicing 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
If 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 compaction 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. Barring 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 INSTALL 4R POWTS MAINTAINER
Name c K-�i� S 71" Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name eta Name �. eil 0"'x G -e�•
Phone Phone 71,3r__ 36(-- YGO O
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) &(3),Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNER,SSHIP CERTIFICATION FORM
Owner/Buyer `'i
Mailing Address J'P 3 Jo.- t14-s r e%*,rA_J r: i S Y6 Z.-I—
Property Address
(Verification required from Planning&Zoning Department for new construction.) ),6'
City/State Parcel Identification Number 0 G
LEGAL DESCRIPTION '3 Z-0
Property Location J//w 14 Pr _ '4 , Sec. �� , T .31 N R W, Town of Jpev"tx.C f
Subdivision Plat: , Lot#
Certified Survey Map # , Volume , Page #
Warranty Deed # $� (before 2007)Volume Page #
Spec house yes Yo Lot lines identifiabler-y_es 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(I)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.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning&
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this f rm 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 wawa ty deed recorded in Register of Deeds Office.
Number of bedrooms S
SIG ATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REN'. 08/05)
f
998845
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
Return To: RECEIVED FOR RECORD
6 CAMPUS CIRCLE,SUITE 430 07/21/2014 08:00 AM
EXEMPT # NA
WESTLAKE,TX 76262 REC FEE: 30.00
TRANS FEE: 180.00
PAGES: 3
Drafted By: **The above recording information
SARA HOLLIDAY,CHANGE OF TITLE,INC. verifies that this document has
160 S.OLD SPRINGS ROAD,SUITE 260 been electronically recorded
$returned to the submitter
ANAHEIM HILLS CA 92808
Parcel Identification Number: 032-1064-20-000 This is not a homestead property
SPECIAL WARRANTY DEED
_ ---—
WELLS FARGO BANK,N.A.,hereinafter GRANTOR and DAVID A.KINDE AND KATIE J.KINDE,
HUSBAND AND WIFE,AS JOINT TENANTS WITH RIGHT OF SURVIVORSHIP,hereinafter GRANTEE:
WI'T'14ESSETIL that GRANTOR for a valuable consideration conveys to Grantees and to their successors and
assigns,but without recourse,representation of warrdnty,except as expressed herein,all of its right,title and interest
in and to that certain tract or parcel of land described as follows,to wit(the"Property"):
s
THE EAST ONE-HALF(I/2)OF THE EAST ONE-HALF(1/2)OF THE NORTHWEST ONE-QUARTER
(1/4)OF THE NORTHEAST ONE-QUARTER(114),SECTION TWENTY-FOUR(24),TOWNSHIP
THIRTY-ONE(31)NORTH,RANGE NINETEEN(19)WEST,TOWN OF SOMERSET,ST.CROIX
COUNTY,WISCONSIN.
PROPERTY ADDRESS:XXX 210TH AVENUE,SOMERSET,WI 54025
APN: 032-1064-20-000
TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging,or in anywise
appertaining;and the reversion or reversions,remainder or remainders,rents,issues and profits thereof,and all the
estate,right,title,interest,claim or demands whatsoever,of the said GRANTOR,either in law or equity,or,in and
to the above bargained premises,with the said hereditaments and appurtenances.TO HAVE AND TO HOLD the
premises as before described,with the appurtenances,unto the said Grantees,their successors and assigns.
And GRANTOR,warrants only against the acts of the GRANTOR and all claiming by,through or under it,and that
title is free and clear of encumbrances arising by,through,or under Grantor,except any municipal and zoning
ordinances and agreements entered under them,recorded easements for the distribution of utility and municipal
services,recorded building and use restrictions and covenants,present uses of the Property in violation of the
foregoing,and general taxes levied in the year of closing.
220-WI-V 1
St. Croix County 998845 Page 1 of 3
By accepting this Special Warranty Deed,GRANTEE acknowledges that they have had adequate opportunity to
inspect the Property conveyed herein as well as all improvements located thereon.Except as specifically set forth in
this Special Warranty Deed,this conveyance is made without warranty or representation either expresses or implied
and is on an"AS IS,WHERE IS AND WITH ALL FAULTS"basis. See also Exhibit A attached.
Grantor makes no warranty or representation expressed or implied,or arising by operation of law,including,but not
limited to,any warranty of condition,title,habitability,merchantability or fitness for a particular purpose with
respect to the Property of any portion thereof.
IN WITNESS WHEREOF,said GRANTOR has caused its name to be signed to this deed on June 30,2014,
WELLS FARGO BAN , .A.
ame: Je ames Hardwick
itle:
_. _ VP _Documentation
- -
State of California )
County of San Bernardino)
On_,'SAN& 30 , '3ot_q before me, Yvonne Granillo ,Notary Public
personally appeared 3eremy larnes Hardwick
who proved to me on the basis of satisfactory evidence to be the person($)whose name(p)Qre subscribed to the
within instrument and acknowledged to me tha e/ e/they executed the same in(o/her/their authorized
capacity(W4,and that by&er/their signature on the instrument the personf,,or the entity upon behalf of
which the person acted,executed the instrument.
1 certify under PENALTY OF PERJURY under the laws of the
State of California that the foregouig paragraph is true and correct.
YVONNE GRAM LO
Commission#1906657
i Notary Public-Calftmis
WITNESS my hand and official seal. _ San Samardino County
My Comm.Expires Oct 3,2014
Signature
(Seal)
220-WI-VI
St.Croix County 998845 Page 2 of 3
EXHIBIT A
i
TO SPECIAL WARRANTY DEED
AS IS,WHERE IS DISCLAIMER OF SELLER
GRANTOR HAS NOT MADE, DOES NOT MAKE AND SPECIFICALLY NEGATES, DISCLAIMS
ANY AND ALL REPRESENTATIONS, WARRANTIES (OTHER THAN THE WARRANTY OF TITLE),
PROMISES, COVENANTS, AGREEMENTS OR GUARANTIES OF ANY KIND OR CHARACTER
WHATSOEVER, WHETHER EXPRESS OR IMPLIED, ORAL OR WRITTEN,PAST, PRESENT OR FUTURE,
OF,AS TO,CONCERNING OR WITH RESPECT TO(A)THE VALUE,NATURE,QUALITY OR CONDITION
OF THE PROPERTY,INCLUDING,WITHOUT LIMITATION,THE WATER,SOIL AND GEOLOGY,(B)THE
INCOME TO BE DERIVED FROM THE PROPERTY,(C)THE SUITABILITY OF THE PROPERTY FOR ANY
AND ALL ACTIVITIES AND USES WHICH GRANTEE MAY CONDUCT THEREON, (D) THE
COMPLIANCE OF OR BY THE PROPERTY OR ITS OPERATION WITH ANY LAW, RULE, ORDINANCE
OR REGULATION OF ANY APPLICABLE GOVERNMENTAL AUTHORITY OR BODY, (E) THE
HABITABILITY, MERCHANTABILITY, MARKETABILITY, PROFITABILITY OR FITNESS FOR A
PARTICULAR PURPOSE OF THE PROPERTY,(F)THE MANNER OR QUALITY OF THE CONSTRUCTION
OR MATERIALS, IF ANY, INCORPORATED INTO THE PROPERTY, (G) THE MANNER, QUALITY,
STATE OF REPAIR OR LACK OF REPAIR OF ANY PORTION, COMPONENT OR ASPECT OF THE
PROPERTY, OR(IT) ANY OTHER MATTER WITH RESPECT TO THE PROPERTY, AND SPECIFICALLY,
THAT GRANTOR HAS NOT MADE, DOES NOT MAKE AND SPECIFICALLY DISCLAIMS ANY
ATIONS—REGAIURNG CONIPLTA-NICE'—WITFI-..ANY--ENVIR-ONVEIVTAT✓R�QUI _
PROTECTION, POLLUTION OR LAND USE LAWS, RULES, REGULATIONS OR ORDERS, INCLUDING
THE EXISTENCE IN OR ON THE PROPERTY OF HAZARDOUS MATERIALS. GRANTEE
ACKNOWLEDGES AND AGREES HAVING BEEN GIVEN THE OPPORTUNITY TO INSPECT THE
PROPERTY, AND GRANTEE IS RELYING SOLELY ON ITS OWN INVESTIGATION OF THE PROPERTY
AND NOT ON ANY INFORMATION PROVIDED OR TO BE PROVIDED BY GRANTOR AND ACCEPTS
THE PROPERTY"AS IS,WHERE IS,WITH ALL FAULTS." GRANTEE FURTHER ACKNOWLEDGES AND
AGREES THAT ANY INFORMATION PROVIDED WITH RESPECT TO THE PROPERTY WAS OBTAINED
FROM A VARIETY OF SOURCES AND THAT GRANTOR HAD NOT MADE ANY INDEPENDENT
INVESTIGATION OR VERIFICATION OF SUCH INFORMATION AND MAKES NO REPRESENTATION AS
TO THE ACCURACY OR COMPLETENESS OF SUCH INFORMATION. GRANTOR IS NOT LIABLE OR
BOUND IN ANY MANNER BY ANY VERBAL OR WRITTEN STATEMENTS, REPRESENTATIONS, OR
INFORMATION PERTAINING TO THE PROPERTY OR THE OPERATION THEREOF, FURNISHED BY
ANY REAL ESTATE BROKER, AGENT, EMPLOYEE, SERVANT OR OTHER PERSON. GRANTEE
FURTHER ACKNOWLEDGES AND AGREES THAT,TO THE MAXIMUM EXTENT PERMITTED BY LAW,
THE SALE OF THE PROPERTY AS PROVIDED FOR HEREIN IS MADE ON AN"AS IS,WHERE IS"BASIS
WITH ALL FAULTS.
220-WI-VI
St.Croix County 998845 Page 3 of 3
f
Property Owner_ Parcel ID# Page of
113 Ong# Boring / �/
Pit Ground surface elev. ft. Depth to limiting factor �n Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff##11 'Eff#2
G /
F-1 Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2
F-1 ❑ Boring Boring# Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil ication Rate
Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2
I
I
Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg/L and TSS 130 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330(8.600)
REcFINJED �; PAIID
4
Wisconsin Department of Com
mjW 27 2014 SOIL EVALUATION REPORT Page of
Division of Safety and Buildings COUNTY
,,,,,��,gUN V D wTch Comm 85,Wis. Adm. Code County
Attach complete site plglftiff'paper not less than 8 112 x 11 inches in size.Plan must 1(`/0 i x
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road.
Please print all information. nRewed Daate J)
Personal information you provide may be used fo sewn ry purposes(Privacy Law,s.15.04(1)(m)). G�v � / Z
Property Own e-r ,L-WW Property Location
Govt.Lot n/✓ o 1/4 joE 1/4 S 2 9(T 31 N R E(o W
Trope Owner's Mailing Address // Lot# Block# Subd. Name or CSM#
So me f std G� r�� — /0 /�
City State Zip Code Phone Number ❑City ❑Village &Town Nearest Road
a < ) 2J
SLRew Construction UseResidenYial/Number of bedrooms Code derived design flow rate a GPD
❑Replacement ,c1 ❑ Public%commercial-Describe:
Parent material Flood Plain elevation if applicable
General comments
and recommendations:
System Type t, Al t� System Elevation
/1 Boring# Boring
Pit Ground surface elev. O ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
I z0 L C G , v
Z z-- l c l
®
Boring# � Boring
,1xit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence EBound,ry Roots GPD/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
Z / ------ - C�
I l
ZT
Effluent#1 =BOD >30:5 220 mg1L and TSS>30<150 'E uent#2=BOD <30 mg/L and TSS<30 mg/L
CST Name(Please Print) re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 ZZLIF 715-246-4516
Property Owner Parcel ID# Page of
�..� Boring# Boring /
pit Ground surface elev. ft. Depth to limiting factor // in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2
�S- < Z2
Boring# Boring
v 7
a pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. i 'Eff#1 'Eff#2
Z
it
F-1 Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate.
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2
Effluent#1 =BOD5>30 1220 mg/L and TSS>30 1150 mg/L 'Effluent#2=BOD5<30 mg/L and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8730(8.6/00)
e
r
Soil Test Plot Plan
Project Name David Kinde Shaun B'
Address
583 Somerset Lane /
Somerset Wi 54025 C 2 900
Lot ------ Subdivision --------- Date /18/14
NW 1/4 NE 1/4S 24 T 31 N/R19 W Township Somerset
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe
System Elevation TBD *HRPSame as Benchmark
210th Ave
Scale is 1" = 40'
unless otherwise
noted
250'
Area of poor soils
B.M.* B 1 15' B-1
75'
2% Slope
45' B-3 101'
100'
1320' Property Line