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HomeMy WebLinkAbout018-2011-88-000 Wis ^onsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix �y and Building Division Sanitary Permit No: , INSPECTION REPORT 515102 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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: Birr, Adam & Mindy I Hammond, Town of 01 -2-0-& CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: /0( . U TS �� LorG 30.29. TANK INFORMATION 9 E!LEVAT ON DATA TYPE MANUFACTURER CAP CITY STATION BS HI FS ELEV. �7 Septic S 2 Benchma Dosing ^ s� Alt. BM -fro S-r, Aeration t �it� B ldg. Sewer % /6�•9 Holding S t Inlet TANK SETBACK INFORMATION S Ht Outlet b�p� TANK TO P/L WE BLDG. Vent to Air Intake ROAD Dt Inlet �- I, / Septic I / +�l r /� Dt Bottom Dosing Header /Man 00 7f Aeration Dist. Pipe f1.0 v o� Holding Bot. System Z Final Grade V1 0 PUMP /SIP ON INFORMATION (� ,- Z .d D Manufacturer Demand St C&er GPM - Z! V. Model Numbe TDH Lift Friction Loss Head H Ft Forcemain L Dia. Dist. to Well SOIL ABSORPTION SYSTEM 2 BED/TRENCH Width Length No. Of Trenches PIT DIME NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '&d + 3 SETBACK SYSTEM TO P/L JBLDG IWEL L LAKE /STREAM LEACHING M tur�f7f IN CHAM R i'] Typ Of System: /, , / ��j f UNIT Model Number/1 IBUTION SYSTEM C Header anifold JD istri ution x Hole Size x Hole Spacing Vent to Air Intake `w Length / Di� Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only > 26 Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [E No H Yes R No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/�/ Inspection #2: Location: 792 157th Street Roberts, WI 54023 (NW 1/4 NE 1/4 30 T29N R17W) NA Lot 88 Parcel No: 30.29.17. 1.) Alt BM Description 2.) Bldg sewer length - amount of cover 7a� > Ighd �WU,a.¢� Yvm �XX1GtJ��6I"� UDC,' GA r Plan revision Required? Yes s. No Use other side for additional information. Date Insepctor's SignaYtjV Cert. No. SBD -6710 (R.3/97) S PAID x A.9ov Safety and Buildings Division County t ` 201 W. Washington Ave., P.O. Box 7162 r' / J scon s i n Madison, WI 53707-7162 Sanitary Permit Number ( to be filled in by Co.) I tlep arbnarkt ot Co 5 /5 A) Sanitary Permit Application State Transaction Number A In accordance with s. Comm. 83.21(2), Wis. Aden Code, submission of this fora to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provRECl � secondary - purpo ses in accordance with the Privacy Law, s. 15. 1)(m), Stats. 1 5 14 �b I. Application Information - Please Print All Informs ' Property Owner's Na ' JUL 2. nog Parcel # ` Propery Owners mailing Address ST CROIX COUNTY P"DP°`ty Locatwn PLANNING & ZONING OFFICE e e 41 �Ci� P v Govt. Lot n City , State Zip Code Phone Number y,, 1/1= y., Section C t cycle o T �/� N; RAE W II. ype Building (check all that apply) Dk ak, Lot # Subdivision Name or 2 Family Dwelling -Number of Bedroo 4 y b, k" W Bloc ❑ Public/Commercial - Describe Use _ ° 1 �� ❑ City of CSM Numbe r `1 ❑ Village of ❑ State Owned - Describe Use < 6 . 9 75 ✓ Town of ��r1/ ,.,.) Z5 }25QZS r B. FlBefom mit: (Check only o e box on line A. Complete line B if applicable) stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System (explain) List Previous Permit Number and Date Issued Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New piration Owner,��� IZ VIV. T e of POWTS System/Component/Device: Check all that appl on- 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. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required Dispersal Area Proposed (st) System Elev - on VI. Tank Info Capacity in Total I # of Manufacturer Gallons Gallons 13nits a New Tanks Existing Tanks C4 Septic or Holding Tank j s Dosing Chamber VII. Responsibility Statement - I, the undersigned, aam pousibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb ' ature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zi ode VIII. Coun /De artment Use Onl Permit Fee Date Issued Issuing A Signature proved 70 Reason ial $ 60, ZJ " IX. ConditiI�ssons for Disapproval 4a ' /(J t 1. Septic.tank;.efflt tnt Lifter and dispersal cell must all be services / maintained �,ra..�..a►- as per management plan provided by plumber. 2. AN setbackreguirements must be maintained as per 11 A think_ system and submit to the County only OR paper not less than 81A x I I inches in du SBD -6398 (R. 01/07) Valid thru 01/09 P T PLAN PROJECT Adam Birr ADDRESS 1404 Sweet Grass Hudson Wi 54016 NW 1/4 NE 1 /4S 30 /T 29/ /R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 7/15/09 4 DATE BEDROOM CONVENTIONAL XXX IN -GROG PRESSURE, CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1517 # of chambers 75 BENCHMARK V.R.P. Top of Ste Fence Post ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all ..�/ setbacks required by W'' SYSTEM ELEVATION 99.5/98.7/98.0 5' below qrade WDNR 180 S� �d lt�t�'� B • ` Ct Rd TT 580' Property Line L,O,U i 3 -3' X 102' Cells with >3' spacing Plans Designed Using rr7f B -3 Conventional Powts 2% Slope Manual Version 2.0 150' ents 20' 30' Scale is 1" = 40' ' unless otherwise ,,�, B -2 si noted 0' T v 30' I � ' SGT 377' Property Line e P Be ! om 612' Property Line Hous Vent L �jN >6 Quick4 Standard -W of Cover Leaching Chamber 121y� with 20.0 ft2 of Area � 0 4' Long 12" 5.8ft ^2 /pair of end caps IE 34" Grade at System Elevation J9� T PLAN PROJECT Adam Birr DDRESS 1404 Sweet Grass Hudson Wi 54016 NW 1/4 NE 1 /4S 30 /T 17 W TO WN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE7/15/09 BEDROOM 4 CONVENTIONAL XXX IN -GRO{J PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1517 # of chambers 75 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 99.5/98.7/98.0 5' below qr ade setbacks required by WDNR 180' B.M. Cty Rd TT 580' Property Line 3 -3' X 102' Cells with >3' spacing 101' Plans Designed Using B -3 12% Slope Conventional Powts Manual Version 2.0 150' Vents 20' 30' Scale is 1" = 40' unless otherwise B -2 noted 20 ST 30' 377' Property Line IF Pro 4 Bedroom House 612' Property Line Vent > 699 Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 1299 5.8ft ^2 /pair of end caps 3 4" Grade at System Elevation r PAI Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Par l/lJ\ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - Please print all information. Review"d y&t Date UU rn Personal inforabon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / aj' -PVPX C' Property Owner Property Location PLANNING & NING OFFICE �O S T Go of („ J 1/4 1/4 SJ T a N R E Property Owner's Mailing Address of # , lock # 1 Subd. Name or CSM# 92 u r ' l .r /d��' / Gfrtt City State ip Code Phone Number ❑ Village � To Nearest Road u / ) S# z [if New Construction Use: esidential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ✓ __.__, p lion if applicable General oornmerds �; el Ue �?2 G and recornmendations: �� / ° /F� ' System Type System Elevation / Boring # ��E{{ Boring � IG pit Ground surface elev. /4 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 qj . Boring / IN Boring Pit Ground surface eley! • S Depth to limiting factor Z L 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 0 -0 Jam, / LIL ' �t- ma y~ ,!►� /J'4 /,� . �- r r rr � (D Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 —'�'20 ��, 715- 246 -4516 } Property Owner _ of Wz_ Parcel ID # Page EI )Boring # ❑Boring Y r� pit Ground surface ele . ft. Depth to limiting factor �n Soil lication 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 0 , 3t�- L 1 � rt N 3 3� 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 GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD, < 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. SBD4330 (R.NW) ) Y Property Owner _ Parcel ID # Page of E P Boring # ❑Boring �� Pit Ground surface ele/ f1�— 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 o /- 311✓ - 'I r ✓� J "V r 3 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ` Effluent #2 = BOD, < 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 altemate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SB0.8330 (8.6(00) f Soil Test Plot Pla Project Name Kernon Bast Sh Bird Address (948 Labarge Rd Hudson Wi 54016 M #226900 L�t 88� �/ � Subdivision - --- - --- Date /20/09 N W E 1 /4S 3 0 T 29 N /R17 W Township Hammond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel fence post System Elevation 99.5/98.7/98.0 *HRpSame as Benchmark 180' B. C Rd TT (e lo i 580' Property Line 101' Q,d 12% Slope 1 50; 20' 30' B -1 40' Scale is 1" = 40' 103' unless otherwise B -2 noted 105' 377' Property Line 612' Property Line IN 1 \ � 1053.1 ° x 1047.1 --- - - - - -- --- - - - - -- ° 1049.3 X x - - x 1047.0 1049.1 1051.2 \ 104 O 1 N __. -202-.15! - - -- -- - - -- _ }. -- -- - o- --- - -- - - -- - M:hI:L. 1053 00 10542 X 1052.6 > _� X.......... x 1052.6 1. '52.5... 1052.4 ........ .1...... •1055. ......... ............ 4 ..... `. .......... ... .... LOT 57 Q 3 � �.� \� 0) 0 _ 9 196 SQ. FT. r ♦ o 0 1057.2 LOT 61 ��\ Lo x 02 A �� ❑T 64 87918 SQ. FT. �\ 02 ACR (2,0 1 .1 8 87 SQ 55. 3 � (2 A 184.911 10 2.22 ACRE 96912 SQ. FT. ❑T 6 \ AC.) 2. ACRES \ / 88939 Q. FT. \ o� (1.6 A L.B. = 105 v 063.5 r- L 1 .0 ❑T - x 1.97 CRE x 1075.5 (2.0 A ,) c(o I so co 1075.2 L 60 47'± LOT 59 X - 00 ACR 50' / \ .0 n7 ororc ��\ 871 - Q. FT. Project Name. K Soil Test Plot Pla ernon Bast Sh Bird' Address F �( 948 Labarge Rd ( r� Hudson Wi 54016 V — M #226900 t 88 r:, Subdivision -- - ----- Date /20/09 N E 1/4S 30 T 29 N /R W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel fence post System Elevation 9 9.5/98.7/98.0 *HRpSame as Benchmark 180' * B.M. Cty Rd TT �� ���� 80' Property Line 10 1' i - 12% Slope ' 156 , 20' 30' B -1 40' Scale is 1" = 40' 20 103' unless otherwise B -2 noted 105' 377' Property Line 612' Property Line • • : IIIIIillllll'' "'''Iilllllllillllllllllllllllf IIII 899675 BETH PABST REGISTER OF DEEDS CERTI FI EO SURVEY MAP RECEIVED RECORD LOCATED IN PART OF THE NW1 /4 OF THE NE1 /4 07/08/2009 11:30AM OF SECTION 30, T29N, R1 7W, TOWN OF CERTIFIED SURVEY MAP VOL: 24 PAGE: 5637 HAMMOND, ST. CROIX COUNTY, WISCONSIN; REC FEE: 13.00 BEING LOTS 61, 62 AND 63 OF THE PLAT OF COPY FEE: 3.00 EMERALD ACRES 1 ST ADDITION. PAGES: 2 OWNER SURVEYOR NOTE: KERNON BAST EDWIN C FLANUM THIS LOT IS PROHIBITED FROM 948 LABARGE ROAD NORTHLAND SURVEYING, INC. DIRECT ACCESS TO COUNTY HUDSON, WI 54016 P.O. BOX 14 TRUNK HIGHWAY'TT' ROBERTS, WI 54023 MMPf�La44GD dLQG`JD - - - -- _ - - - - -- � -- -- C.T.H. "TT' - � - - - - -- -- - - -- - - ------------------ 0 11'33 "E 560.66 166 141.3--------- - -- — 180.03'... ... -. 1 20,601-1 I E DRAINAGE AREA TO :; ; ; r HIGH WAT8R LINE i� j 1� ) F�`Oo �� I mg 238.7pZf ' �lti 9 � W I 'gr7 0 � QR�4,� so t ° oo00 ( s"Wfls ! tL I LU r X06 � c7- � I ----- ------- 1 4 69 i G � P I �; � `, ° h d 004 64 i Z Z - - o - - -- -- - -- - I w o 0 I oe ��oa I O I LL o s O LOWEST BUILDING I JP 1 Z OPENING ELEVATION �� a � 4' I — — — — — — = 1055.00 I �1'w d042 LOT d-00- I� 8*3 ` �, ` a .0 to in 0 Aft q . NOTE- 0s. C4 f i 1 THE PROPOSE OF THIS MAP IS TO I j COMBINE LOTS 61, 62 AND 63 OF I THE PLAT OF EMERALD ACRES 1 ST I ADDITION. NO NEW LOTS ARE CREATED BY THIS MAP. / LOT 88 / 6.66 ACRES ox D 157TH_STR_EET -ti/ 290,092sQ.FT. NOTE: �` M NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE / OPERATION OF THE APPROVED COMPREHENSIVE LEGEND WATER DRAINAGE AND SOIL EROSION PLAN FOR THIS PLAT. THIS INCLUDES BUT IS NOT LIMITED TO ■ 3/4' IRON REBAR FOUND BUILDING UPON, OBSTRUCTING, ALTERING, FILLING, OR EXCAVATING OR PLANTING IN ANY DRAINAGE • • • • • • • 50' ROADWAY SETBACK LIN AREAS OR EASEMENTS. WATER DRAINAGE DITCHES. (UNLESS OTHERWISE SHOWN) WATER RUNWAYS, WATER CULVERTS, BERMS OR - - GRASS SEEDINGS. - -'- - - — 12 UTILITY EASEMENT CURVE DATA TABLE NUMBER C1 C2 C3 C4 EDWIN p, ADIUS 80,00' 80.00' 80.00' 80.00' FLANUM :_, CENTRAL ANGLE 94'04'23' 24'21'43' 20'59'13' 48'43'27' =:4 S �.MER _ CHORD BEARING S42'45'48.5'W S77 S54'56'40.5'W S20'05'20.5'W ' ` CHORD LENGTH 117.09' 33,76' 29.14' 66.00' ARC LENGTH 131.35' 34.02' 29.30' 68.03' TANGENT IN S89'48'00'W S89'48'00'W S65'26'17'W S44'27'04'W �.. o.:. • �/1�� TANGENT OUT SO4 S65'26'17'W IS4 4 SO4'16'23'E THIS INSTRUMENT DRAFTED BY KEVIN REED SCALE IN FEET 1" = 150' JOB NO. 07 -24 DATE 03 -07 -07 DRAWING;CSSM2 SHEET 1 OF 2 SHEETS 150 0 150 iL Vol. 24 Page 5637 CERTI FI En SURVEY MAP LOCATED IN PART OF THE NW7 /4 OF THE NE1 /4 OF SECTION 30, T29N, R1 7W, TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN; BEING LOTS 61, 62 AND 63 OF THE PLAT OF EMERALD ACRES 1 ST ADDITION. OWNER SURVEYOR KERNON BAST EDWIN C FLANUM 946 LABARGE ROAD NORTHLAND SURVEYING, INC. HUDSON, WI 54016 P.O. BOX 14 ROBERTS. WI 54023 SURVEYOR'S CERTIFICATE I, Edwin C. Flanum, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Kernon Bast, I have surveyed, mapped and described the parcel of land which is represented by this Certified Survey Map; that the exterior boundary of the parcel of land surveyed and mapped is described as follows: A parcel of land located in part of the NW1 /4 of the NE1 14 of Section 30, T29N, RI 7W, Town of Hammond, St. Croix County, Wisconsin; being Lots 61, 62 and 63 of the Plat of Emerald Acres 1 st Addition; described as follows: Beginning at the northwest corner of Lot 61 of the Plat of Emerald Acres 1 st Addition Recorded at the St. Croix County Register of Deeds Office: thence N89 °1 1'33 "E, along the north line of said Lot 61 and the north line of Lots 62 and 63 of the Plat of Emerald Acres 1 st Addition Recorded at above said Office also being the southerly right -of -way of C.T.H. "TT ", 580.66 feet to the easterly line of said Lot 63; thence S00 ° 1 0'44 "E, along said easterly line, 353.71 feet; thence S24 °3344"E, along said easterly line, 171.19 feet to an 80.00 foot radius curve, concave southeasterly, whose central angle measures 94 °04'23" and whose chord bears S42 °45'48.5 "W and measures 117.09 feet also being the northerly right -of -way of 157th Street; thence southeasterly, along the arc of said curve and said northerly right -of -way, 131.35 feet to the southerly line of said Lot 61; thence N69'54'49 W, along said southerly line, 612.05 feet to the west line of said Lot 61; thence N00 °13'14 "E, along said west line, 376.96 feet to the point of beginning. Described parcel contains 6.66 acres (290,092 Sq. Ft.). Parcel is subject to other easements, restrictions, and covenants of record. 1• also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes, the Land Subdivision Ordinance of the County of St. Croix, and the Subdivision Ordinance of the Town of Hammond, in surveying and mapping same. EDWIN C. FLANUN S-2487 y AMERY / li COUNTY TREASURER'S CERTIFICATE '' 4 STATE OF WISCONSIN)SS COUNTY OF ST. CROIX) = b N oboe. 1,iirl, being the duly elected, qualified and acting Treasurer of St. Croix County, do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of la (3 l O affecting the land included in this Certified Survey Map. � - � k.aactc/�. Date County Treasurer POb Each parcel shown on this map (plat) is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Hammond. PARCEL COMPUTER NUMBER. 018- 2011 -61 -000 PARCEL MAP NUMBER: 30.29.17.1076 PARCEL COMPUTER NUMBER: 018 - 2011 - 62-000 PARCEL MAP NUMBER: 30.29.17.1077 PARCEL COMPUTER NUMBER: 018 - 2011 - 63.000 PARCEL MAP NUMBER: 30.29.17.1078 SHEET 2 OF 2 SHEETS 2 of 2 Vol. 24 Page 5637 ST. CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer X d 411 T Mailing Address `1� ` S W �P 6 -. Property Address q Xs 7 (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 6 i 0 `l, 6 `` LEGAL DESCRIPTION - S© G� Property Location/ -c� 1 /4 ,� 1 /a , Sec. , T N R W, Town of 4rn Subdivision , Lot # l5 Certified Survey Map # , Volume 7 , Page # to 3 Warran ty gig Deed # 0 J Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumpiis out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number b ms 7121 K IM ATM 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 (REV. 08105) Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned ponce a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingent Plan Option #1. ystem fails, determine cause of failure, use alternate area and install new m in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 -246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 -246-5148 Shaun Bird #226900 .. � � I I #1111 Iilll #III! iilll Ilii1 i111i 11111 #1111 liil fill 4 9 0 0 2 5 3 2 900253 STATE BAR OF WISCONSIN FORM 2- 2000 BETH PABST REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI THIS DEED, made between Kernon J. Bast, a Married Person and RECEIVED FOR RECORD Richard O. Stout, A Married Person, as tenants in common, as to '/2 interest 07/16/2009 11: 55AM each, Grantor,.and Mindy M. Iiirr and Adam J. Birr, WARRANTY DEED EXEMPT Wife and Husband as Survivorship Marital REC FEE: 13.00 Property, Grantee TRANS FEE: 127.50 Grantor, for a valuable consideration, conveys and warrants to Grantee PAGES: 2 the following described real estate in St. Croix County, State of Wisconsin: See Attached Exhibit A Recording Area 'jam Name and Return Address: Edina Realty it{ , / 400 South 2nd d Street, Suite 11 S U Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. *10@ . 1212 f 018- 2011 - }s- 00 2811- � 8 Qa8 11 -62 -0 Parcel Identification Number (PIN) This is not homestead property, Awe ated this , 1009 R4��r�� *Kerr n J. Bast Richard O. Stout AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) St. Croix COUNTY. ) ss. authenticated this I" day of July, 2009 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Personally came before me this 1 day of July, 2009 the above a1er Kernon J. Bast, a Married Person, and Richard O. i Bro Married Person, as tenants in common, as to % 2 nary Public interest each < authorized by § 706.06, Wis. Stats.)� to me lcno on who executed the foregoing ;t r)j Wisconsin instrume d me THIS INSTRUMENT WAS DRAFT% *Cheri Brown Peterson, Fram & Bergman — Steven H. Bruns Notary Public, State of Wisconsin 50 East Fifth Street, St. Paul, MN 55101 My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 2/27/11 ) `Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 1 of 2 EXRWIT A Lot 88 of Certified Survey Map filed July 8, 2009 in Volume 24, Page 5637, as Document No. 899675, located in part of the NW' /. of the NE' /, of Section 30, T29N, RI 7W, Town of Hammond, St. Croix County, Wisconsin; being Lots 61, 62 and 63 of the PIat of Emerald Acres 1st Addition. 2of2 r W - cousin Department of Comm SOIL EVALUATION REPORT Page _ � of _ 3 'Division of Safety and BuiWin P �Q L- 111 ith Conan 85, Wis. Adrn. Code '� County � Alladr complete site plan oil paper ,IVt Ics3 ttrari 11 n iches In size. Plo rllua - - Include, h-it not Ihnited to: vertical and horizontal reference point (BM), direction and I'awrl I.D. /� 7 percent rlope, scale or dimensions, nor0i arrow, and location and distance to nearest road. Cale- .20 // _ ( 9 — ^ � , l �D Please print all 1 truill [e91 Ro ' e Dale / Personal Intwmarlon you provide maybe used for a ondary pulp � �t�r a. 15.0 (1) 00). PropertyOwner Plop tyLocallon vkcv-, 5 p � OU 2 1 2 Gov Lot Aj w_ 1/4lu�_t! s 5 0 1- 29 N I t 17 E(er& Properly Owner's Mailing Address Lot Blvck # Sulnl. Name or CSM# T. CROIX COUNTY � e � f �e? f�w Zip h 1 � `3S 3 �� City Slate de (Iloilo _ City I D Village 'p4 own Nearest fluid U3 ( 01 5)- `t 1 0 4 v. (26 - TT New Construction Use.' Residential / Number of bedrooms_ Code derived design flow rate _ �� J 1 _ �? __ —_ GPD ❑ Replacement // D Public or commercial - Describe: Parent material _.? __ ______ Flood Plain elevation if applicable - _ - - _ . /V General comments S and recornmendalions: r (� Z7 o Borin # ❑ Boring G 5 , i o �j� _ -- *Pit Ground surface elev. __- _ - - - -_ It. DepUr to Ihniting factor -- -�1____ in. _ Sol Application Rate horizon Deptli Dominant Color Redox Description Texture Shucture Consistence Boundary Flouts GPD /I P _ In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ 'E ff #1 'Eff #2 I -1 Z _L 4 r , 3 SL 5b o--&r S -- 1 �1 (� 60 Z (Z-31 10yr4 SL Z rr)5bk. rn�— — �_ 1-0 ,3 14 qIq - SZ C 5 �i -DSO I Z 5 , , Fz-1 Boring # ❑ Boring /� `_ �Pit Ground surface elev.") ( L' SV - it. Depth to limiting factor _ J 1 — in. Sol Application Rate Horizon Deplli Daninant Color Redox Description Texture Structure Consistence Boundary Roots GPDlih in. Munsell Qu. Sz. ConL Color Gr. Sz. Sir. _ 'Eff #1 'Eff #2 I 0 -1Z to 31 SL Zrr) r-r�- C5 Z I Z -3I 4 S i' a m k r�nfr c- S 3 31- v P' .5 S e f 5 e rr1 t Effluent #1 = BOO > 30 220 i g/L and TSS >30 < 150 mg /L ' Effluent 112 = BUD < 30 ing/L and TSS < 30 nlg/L CST Narks (Please Print) Signature CST Number _ ,}, , 5ch LA. m akCC 33 Address .. Date Evaluation Conducted I elephone Number 2113 �O' S4. Z mer5et W1 5 _ - -` ------ (g(5)-7[ov _CZ7 .. �n -- Pa - -2— of �-3 Properly Owner _ Parcel ID I!G"' - - - - -- — ❑ Boring Boring # Q —. _ V4 Ground surface elev. `J.qO 1t. Dep to Gneting factor 01 ' Soil A) licatiorr Rate florizon DepUr Dominant Color Redox Des(- .riplion Texture Structure Consistence 2 Boundary Roots •EII! ►GPDIff�Eftg2 in. Mtrrrseli Qu. Sz. Corrt Color _ Gr. Sz. Sir. _ I ) r • V 5L. [rn5 m � r- S 1 _ 2 13 3 _ S. c 2m bk -_na c— _. ��__- _ = - - � — 3 38-4.1 (u r8) F P 1.5 q to ❑ ❑ Boring # Boring ❑ pi Ground surface elev. fl. Depth to limiting [actor SoilSoil AR &U RaleRate liorizorr Ueplh Dominant cokx Redox Description Texture St Consistence Boundary Roots GPDIfF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Elf #1 TIM ❑Boring ❑ Boring # Ground surface elev. ______ ft. Depth to limiting factor ❑ Pit _ _ Sol kpplk alion Rate Horizon Depth Dominant Color Redox Desaiptiun Texture Structure Consistence Boundary Roots GPD/FF In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. TIM 'Eff #2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOO, < 30 mglL and TSS < 30 rngfl- The Department of Conmicrce is an equal opportunity service provider and employer. If you aced assistauce to access services or nett material in an allemate fomiat, please contact lire department at 608 -266 -3151 or 'ITY 608 -264 -8777. sno -aro rrt.omror 1� .. � f'AGL• �l)F� irQ t SCALE: I "_ _U_ — _ - - -- -- - - - -- - - -- - - -- - -- �l 6 ELEVATION: BNt l DESCRII' BNI 2 ELL' V;\ I P )H: cq. Q t BM 2 DESCRIPH )Id: SYSTEM TYPE - - -- M a 4-1 -4 p - - i . I ZZS 0 SIGtlA"I Ultl:: - - - - - - -- AD -- Wi• --consinDepaitmentot mn►e RECElVE —S OIL EVALUATION REPORT Page of a Division of Safety and Bu IW ►gs !� D ill accordance witi► Co 5, Wis. Actin. Code • county Attach complete site p on paAL It 10-vi ((�� 2, x 11 s' Plan must Include, hot not Ilmlted vertical and horizon t fdfAlance 01111( lo 1 and Pawrl I.D. percent � 1ope, scale or nens+s�r►��� and lacatl n and I tr e est road. _ I VUNT} R 'owed Dale eas tlltl� �pf�{rpttna( l 11. Personal Informelion you provide maybe used for secon ary pi sos (Privacy Lavv, s. 1 O ) 40). 6 Property Owr►er Property Locallun GavL Lot t v 1/4 ,vC -114 S 3 ©r Z-9 N R 1 E (ova) (C- - Properly Owners Mailing Address Lot # Bh1ck Name a CS la f 353 � kee r (A 1 :_�n� c p— -15-7 O 4ion City State IJp Coda Phone Number ❑ City u Village rp�-1 own Nearest Road i Ny Rd t�f Rew Construcliw► Use: [IResideni'ial J Number of bedrooms _ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: — —___ -- ---- Parent material 1 Flood Plain elovalion if applicable General comments v� of Cd, I 6� and recommendations: Boring # E) Buriny �yI —}Tit Ground surface elev. -1 p - 410— It. Depth to Ilmiling factor - -- _ Sol Application Rate Horizon Depu1 Dominant Color RedoxDescription Texture Structure Cunsistence Boundary Rrx►Is GPDlI _ In. M unsell _ Qu. Sz. Cont. Color Gr. Sz. Sir. 'E I1#1 'Eff #2 I -IZ fC 31 Z SL Zm5bk rtes - —� — — S / 0 Z t2 - l0 4) — -5� ZmSbk m•� �5 — . � r. o 3 27 -y 10 :Sh 5L ►�-�r- s — 1. v u Y--7b I 0 s CIP -Cg 4 4 _ s _ Ito Boring # Boling Q--f-it Ground surface also. _:.3_? ft. Depth b —_(, limiting factor _ _— in. Sol Application Rate Horizon Deptl► Daninant Color Redox Description Texture Sbuctuie Consistence Boundary Roots _ GPDIfI= Ill. Munsell Qu. S Cord. Color Gr. Sz. Sir. _ _ 1 - *Effftl 'Eff #2 0-- li p Ste_ 2mshL _m� C S_ 1 v _ - C p I.O 2- 14 o q44 5L 3 3S I c.1 n-lP— — Effluent #1 = BOO > 30s 220 ng(L and TSS >30 < 150 rny(L ' Effluent #2 = BUD < 30 mglL and TSS < 30 n►g/L CST Name (Please t i ore / CST Number ` ff) -_ 309 , A diess Uale Evaluation Conducted l elephonn Number 7ba-,02 79 w ' �1 Parcel ID 11 _ -- - - - -- Page -- of Properly Owner _�_ El Boring _ Boring # 9 t�,� It. Depth to Girvilin factor t7tr Pit Ground swface elev. P g Sol A r iication Rate Horizon Depth Dominant Color RedoxDesc. Texlure Struc�we Consistence Boundary Roots •Eff in. Munse Qu. Sz. Cunt- Color _ Gr. Sz. Sh. 5L _Z CO F] Boling L� Boring # u El Pit Ground surface elev. it. Depth to limiting factor in. Sol A licatlon Rate I lorizorr Depth Dominant Gokx Redox Description Texture St ruc t ure Consistence Boundary Roots GPD11? In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. E. 11#1 •ERN2 F-1 Boring # El Boling R. Ground surface elev. _,__ Depth to limitiny factor _ _ __.____ in. rs ❑ Pit _ atio n Rate Horizon Deptli Dominant Color Redox Description Texlure Structure Consistence Boundary RoD1fF Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #2 I Effluent #1 = BOD 30 < 220 rnglL and TSS >30 < 150 rng1L ' Effluent 112 = BOD < 30 mg/L and TSS < 30 nrg1L The Department of Commerce is an equal opportunity service ptvvider and employer. if you need assistance to access services or need material in an alternate format, please contact live depatttncut at 608 -266 -3151 or TFY 608 -2(A -8777. sso-rnvorrt.ouonv ( LUCN f.L(,r�l. Ul.�l�ltll 11�7t1:�jr,Jl /�l Q_G � NAME: J- - - - 6�rnl ELL'VA'1'101A: (Od' BM 1 DL•SCR11'1'IOhl:�� Q + - -_ f� _.P,�2 BM 2 ELEVA'I ION: BM 2 DESCRIPT SYS'1'ENI ELEVXFB �l1: �� S 0\ M r�. C got SIGNATURE. f - - 0 el SW Cdr row( S e er RECEIVED Wisconsin Department of Com n ame OC SO EVALUATION REPORT Page I of Division of Safety and Building 2 1 2004 in accordance with Co m 85, Wis. Adm. Code County Attach complete site an on papeA Tb& "P9Y,�IX 1 in in size. Plan must r include, but not limited to: 'cal anaQi ?Wr c Parcel e ), direction and Par I.D. J percent slope, scale or dimensions, no arrow, an ocatio to nearest road. 6 / / - — (O / t_ viewed by Date _ Please print all information. /s a Personal information you provide may be used for secondary purposes (Privacy Law, 5.04 (t) (m)). Property Own Property Location 3h - A Govt. Lot 1/4 V(=_1/4 S T Z 3 N R E (or)g Property Owner's Address Au i Mc T , Lot # Block # Subd. Name or CSM# c�,T l l DJ City State zip Code Phone Num ❑ City ❑ Village � Town Nearest Road (/ w�rno T T New Construction Use: ER Residential / Number of bedrooms — Code derived design flow rate O 61 GPD ❑ Replacement ❑ Public or commercial - Describe: _ G (..J u1 « /0 ft. Parent material S Flood Plain elevation if ap le General comments j�jy� Sf and recommendations: Sy,S4 e k „r. (-e V. y J d die a Bori , > � Boring # (� a g _ a y� pit Ground surface elev. [' C) G ft. Depth to limiting factor �� in. • + 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#1 •Eff#2 I 0--Ia 51 (V 2 7 1 ( S r' c Z r C5 `—� 2 Akl s �f sy 5 Wtwi Garr. FL Boring #, Boring 5 Ground surface elev. • C (O ft. Depth to limiting factor I 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 I 7 10 l Z SH C V 2 I D-27 - L 7 g 2 - ctp M -- r d • Effluent #1 = BOD > 30 220 mg/L and TSS >30 1 150 mgA- ' Effluent #2 = BOD 1 30 mg/L and TSS 1 30 mg/L M me (PI Print) Signature / CST N 1W \Xkan�e'( 4� Z ,r Address Date Evaluation Conducted Telephone Number 2113 to - 1�4 —a ? -� t Property Owner sb Parcel ID # /0 Page of F31 Boring # F Boring j' Pit Ground surface elev. ft. I Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 l _2 41 ' e- 2m-5b c- 5 - 3 2 lb — 2' vY-XY- c 4 -%-?q 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 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. 1:1 pit 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 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg& 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. seo4330 P M) PA e - 3 0r Ajor NAME: SCALE: e BM I DESCRIPTION: A Q_kl q q, 0 BM2E-LI_'-VA'1I r qT Im — -------- SIG Yol!� o N O C c v o CD a CD v 0 C `•; m (e ' 'D 3 I� O C/) p N o cn _o w o CD m m r. m ~ (D M« o = p N n o N _ N O. O a O J O _U O (D 00 p A . N 3 0 o 7 O D/ O n v D W G - ro N O. N CO 3 ro ° o� V (D r- Z J (n C� O N N C T (D O O ('D !n O C O O C Ou S O O O aE' ����' 0 co3 @ C D O NA. Q h ID m w n D (rNj m N O m rn m (D w N I 7 V f N , D z z a D o a � •' ;z m v �. CL a CD 'fir (D N C) m ro a 0 s (D v m CL N (D 3 0 (D (D cn .a O ' p Z n C A C v + O A Z O a C) D) N Z N O (o (CD Z R. CL o o " z 3 m N p 7 0 D C C O C �3 3 3 N Q Q 6 Cr N ( j O TI 0- O d v C 3 0 0 o L � N !I (D N O ��.. N M � R. (D S C _ 7 n O ' O C C S p NN (O 7 v oav m o =. CL �. a a <� o_• � y w N O L O O W — b g (D 7p o O *- Parcel #: 018 - 2011 -88 -000 04/12/2010 01:27 PM PAGE 1 OF 1 Alt. Parcel #: 30.29.17.1101 B 018 - TOWN OF HAMMOND Current 1X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 07/08/2009 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - BIRR, MINDY M & ADAM J MINDY M & ADAM J BIRR 1404 SWEET GRASS HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ` 792 157TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 6.660 Plat: 5637 -CSM 24 -5637 018/2009 SEC 30 T29N R17W PT NW NE BEING EMERALD Block/Condo Bldg: LOT 88 ACRES 1 ST LOTS 61, 62, 63; NKA CSM 24 -5637 LOT 88 (6.660AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 30- 29N -17W NW NE Notes: Parcel History: NEW FOR 2010; LOTS 61, 62, 63 EMERALD Date Doc # Vol /Page Type ACRES 1 ST(01 8-2011-61) 018 - 2011 -62, 07/16/2009 900253 WD 018- 2011 -63 (1076, 1077 & 1078) TO CSM 07/08/2009 899675 24/5637 CSM 24-5637; LOT 88; 018 - 2011 -88 (1101 B) 12/17/2004 782881 10/42 PLAT 06/16/2004 766092 2597/300 WD 2010 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/05/2010 Description Class Acres Land Improve Total State Reason Totals for 2010: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00