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Home My WebLink About020-1479-16-000 • l Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ;afety and Building Division INSPECTION REPORT Sanitary Permit No: 538726 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: Bast, Kernon J. Hudson, Town of 020- 1479 -16 -000 CST BM Elev: Insp. BM Elev: / BM Description: 2 Section/Town /Range /Map No: _ /do _b 44 / G57' 36.29.19.3037 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER A/3 CAPACITY STATION BS HI FS ELEV. Septic -VA.- Z / � Benchmark 3. tom, ! R t y r J Alt. BM f- t... 6O _ r I ASZ I 3 Aeration Bldg. Sewer Holding SUHt Inlet , b 7� G 9 / St/Ht Outlet 3 1 7 I, TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet wZSa' sr+, - `-....., Septic 3-1 / 41— /5 / 7 /Q6 _ Dt Bottom Dosing � Header /Man. 94' s `i f Aeratio Dist. Pipe qr Y' 91 Holdin \ Bot. System /645 9z O1 Final Grade PUMP /SIPHON INFORMATION 3.7— /66 r Manufacturer Demand St Cover /r 13 (---, Model Number TDH JL Friction Loss System Head TDH Ft Forcemain Le ni •ist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid DIMENSIONS 3 /Zb Z TeAc --,......_ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: _� INFORMATION / pe Of System: c O (� � / / I TyLV�G�C. 32, N ,� j CH AMBER OR .� �i c,�'�, _ „/ UNIT Model Number t `'V DISTRIBUTION SYSTEM lJesd- 36 4- 36 = (064- Header/Manifg 1 Distribution x Hole Size x Hole Spacing Vent to Air Intake Hi— Q�/ 4 Pipe(s) ` \, �, Clese.1.k.'�IN. Length Q Dia Length Dia Spacing t...ea(,iu. SOIL COVER y ' x Pressure Systems Only xx Mound Or At -Grade S ystems Only VEw� 5E 1Ye.... 60.4 Depth Over i Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 7 5 Bed/Trench Edges N...... Topsoil Ng...yes 0 No Yes Ei No • COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 827 Settlementt Drive Hudson, WI 54016 (SE 1/4 SW 1/4 36 T29N R19W) Cottonwood South '07 Lot 16 Parcel No: 36.29.19.3037 1.) Alt BM Description = r' GD e_A— / �I t / 2.) Bldg sewer length = ZSf VV`a� c.I G 6 aye - amount of cover = Plan revision Required? V Yes No �j( Use other side for additional information. ' I '� i k Gdgz SBD -6710 (R.3/97) Date Insepctor / ign, ure Cert. No. 1 PA commerc,w,gov Safety and ings Division _ County 1 201 W. Washington Avg., P.U. box i 1 oz C I i scans i n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5 3 O 72 Co State Transaction Number Sanitary Permit Application In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form 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 y. • • • ,. ', secon' i r ) `� . ,t• .ses in accordance with the Privac Law, s. 15.04 1 m , Stats, ..; I. Application Information — Please Print All Info t' r �1 Properrty�Owner's Natge P arcel # t e ✓ n e.7)^-- NOV 1 1 2010 Dao – /Y7' – /1I Property Owner's Mailing Address 1 Property Location / 363 ST. CROIX COUNT �-' / � P ' NNING 8. ZO NING OFFICE Govt. tL Lot _ City, tate Zip Code `u r /lr y sv„) y4, Section (7 1,(J) 0/ I rcleo -e / '(J C-, T . � C N; R 7/1 , ype of Building (check all that apply a Subdi vision Name // - - lJ o amity Dwelling - Number of Bedroo �f 13 Public /Commercial - Describe Use I "�_ ❑City of CSM Number ❑ Village of ❑ State Owned - Describe Use 2 �1:oi- �1�� w 3a�31� G�. �� — , �ownof _ _' _ // J - - -- III. Type of Permit: (Check onhy one box on line A. Complete line B if applicable) w • System ❑ Replacement System ❑ 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 B efore Expiration Owner --,...c,.14-f-44._ IV. T pe of POWTS System/Component/Device: (Check all that apply) w _ _ _ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitab e soil ❑ Holding Tank Other Dispersal Component (explain) _ ❑ Pretreatment Device (explain V. Dispersal/Treat ent Area Information. 0 •€ /�- v ' i ' I ' 8 .3 Design Flow (gpd) / Design Soil Applicatiote(gpdsf) Dispersal Area Required (s Dispersal Area Proposed • i System Eleva s n / SQO ' /t V /O? /�',� '` ✓ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U ' .� New Tanks Existing Tanks o `� W p y ,may N y ____ � Septic or Holding Tank /a 5 r // I// - x Dosing Chamber ( —" _ VII. Responsibility Statement - 1, the undersigned, ass esponsibility for installation of the POWTS shown on the attached plans. Plum Name (Print) / Plumb ,e t gnature MP/MPRS Number Business Phone Number a- c_ , Z07.2 7/ -1 , '- ? / Plumber's Address (Street, City, State, Zip C..4� r lam S r , ___ �) s yo/ VIII. County /Department Use Only Approved Cisappr Permit Fce Date Is ued `r Issuing nt Signature / , tven Reason for Denial $y75• / / / / 1 A% IX. Conditimf for Disapproval 1. • Septic tank, effluent filter and 3) I'r /'4 - ' ' " �/- � 1 Aek A � � dispersal cell must all be services / maintaine4 •� �4 Ygr.aa.T +�'1 as per management plan provided by plumber. t i S 2 .AD Setback requirements must bee�maintained , ,4 f 1 61 ' 64/1/72 / P2 ✓�� as l '- :Cti - a`c /Oo rnmplete r th oi system and submi+ the County only on paper not less Monti t inches In size eC /+ 5 � dC SBD -6398 (R. 01/07) Valid thtu 01/09 / ao t,4 PLOT PLAN PROJECT Kernon Bast ADDRESS 948 LaBarae Rd Hudson Wi 54016 SE 1/4 SW 1 /4S 36 IT 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 11/10/10 BEDROOM 4 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 60 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.2/94.1 7.5' below grade B.M* Settlement Drive t ,/'Well is to meet all • setbacks required by WDNR Plans Designed Using Conventional Powts Manual Version 2.0 ; e - Pro 4 120' s , _ Bedroom House 1t 0 ' B -1 Scale is 1" = 40' 30' ^ u' unless otherwise 30' I noted 5% Slope 60' • ❑ B -3 120' 2 -3' X 122' cells with >3' spacing 'i 30' B2t alp Vent >6 „ Quick4 Standard -W System elevation may be of Cover Leaching Chamber 455' lowered to make sure cells with 20.0 ft2 of Area are installed deep enough 5.8ft ^2 /pair of end caps 4' Long 34" Grade at System Elevation c Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 11/10/10 Owner: Kernon Bast Location:SE1 /4 SW1 /4 S36 T29 N,R19W Lot 16 Cottonwood South Hudson System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance and Contingen Plan 6. Filter Specifications Sheet I Signature / ar License number #22.900 PLOT PLAN PROJECT Kernon Bast ADDRESS 948 LaBarae Rd Hudson Wi 54016 SE 1/4 SW 1/4S 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX 11/10/10 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 60 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.2/94.1 7.5' below grade B . M * Settlement Drive /Well is to meet all V setbacks required by WDNR Plans Designed Using Conventional Powts Manual Version 2.0 Pro 4 120' Bedroom House 30' 0' Scale is 1" = 40' 30' B -1 unless otherwise 30' noted 5% Slope 60' • ❑ B -3 120' 2 -3' X 122' cells with >3' spacing 30' B2 op Vent >6 „ Quick4 Standard -W System elevation may be of Cover Leaching Chamber 455' lowered to make sure cells with 20.0 ft2 of Area are installed deep enough 5.8ftA2/pair of end caps 4' Long Grade at System Elevation 34" V Cross Section of Quick 4 Standard -W Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard -W Leaching Chamber with 20.0 ft2 of Area per Chamber 5.8ft ^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 101.0 Vent / Grade 40,Vent 4' 4„ 4' • x.30/34 Septic Tank O 4' Long 5' 4' Long 34" Grade at System Elevation 34 „ Grade at System Elevation Spacing 5' 2 - 3' X 122' Cells Observation tubeNent Same on other end Located at ends of Cell 30 chambers per cell System elevations: A__94.2 B 94.1 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 C • • - ncy Plan Option #1. f system fails, determine cause of failure, use alternate area and install new `AL- 742 ested replacement area. Opti •�;,� . Install system at a lower elevation, by removing chambers, removing biomat, a stall 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 r BOI.JIMEESTER EXC 7158779820 09/14/05 07e02axn P. 001 ST. CROIX COUNTY SEPTIC TANK MATNTE. ANCE AGREEMENT AND OWNS HIP CERT ;FICATION FORM Owner/Buyer ee_ V - no Gl .C---- Mailing Address 9 l /gam Niv/--- ,.�i, Property Address FP? 7 f� 4 - 7 7 -/. j // /2' - A) J /et (Verification required from Planning & Zo ' 1 g g Department for new construction,) City/State //U j S mo t/ 7 Parce Identi ;semen Number ( ,�' 4/ ' 47 -•- / < . 7I -, LEGAL DESCRIPTION Property Location 16 V, , fit) it) / , Sec. y4 , T N R 15 W, Town of R Subdivision CO fd,-1 SO z37 , Lot #, . Certified Survey Map # , Volume , Page # . Warranty Deed 33 L / ____ Volume , Page # • Spec house no Lot lines identifiabl10 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature faihme to handle wastes. Proper maintenance consists of punipin out the septic tank every three year,. 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 stn, ie 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 Pla oning & 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 :Tree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce air the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained muss be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are true to the belt of my /our knowledge. Uwe am /are the owner(s) of the property desci. r' above by virtue of a warranty deed recorded in Register of Deeds Office. Nun .ero ..,r,, , 4 SI .. , E /(/ �/ /a OF AP ICANT(S) DATE ** Any information that is misrepresented may result in the sanitary ;emit being revoked by the Planning & Zoning Departtncnt *' ** hiclude reference is m thhis i the a p p l i c a tion a recorded warranty deed from. the Regis'er of Du Office and a copy of the certified survey map if warranty deed. (REV. 08/05) -&- litiddididdidia 5L''' ce -it >- ° co cs, 0, -- lint i�i�Miil �l �liilil�i al it l�lj,liiliil �� s■ g o 0 0 W ..- 0 0 - - -.. �. ZU 0 0 U1 Z l ��'Iw hI`�ihi� ihll1 `�'ia- ll._!I_11Ihil� h �, H - Z I . 1 - �� - ? .. 1 . , l .. m F- - rn �� a a` � �: ,r , a +�+ L �' �I r' rr rr rrrrrr h rrrrl 0d w Q m gt \\ \ \ \ \ \ \ \\ `chi ( it 1. *,..0. r i re i s i. it l i. , v� �� ' ��lii�ilii�i�li� )illill�i�l�� li�il�ii�=i,�l W"--- 1111110111 g l �l�i .M�y�,1�hl�l�l�1�1� N A�� Rogok room s LL ��_ _ ) i��11) ) - � a � 1111 r i •I lal5l•l•lilela•l_Iclaali11.01 travo a_ i•ia_ is l�a:i ,,i iw +_ l . As, loomower `'", laltiiu 4/44irk 44111401 ti , ' alI 1 1I ` + �� \ te r , �l _ __ III J „, - �— a N x° 0 1 , T O 'd la 4 w5 o L LAi l lir-aib:1.9 46 : n 5' .00 ' III _ a, - -- Ill \,• si l -- I -i'l‘.■1.',1110)/4- . lk 03_0 Alli :II ai • PAID Wisconsin Department of Commerce SOIL EVALUA :'��PORT — Page of Pe 9 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S_f . e re, / Attach complete site plan on paper not Tess than 8 1/2 x 11 inches in size. Plan must 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. 0 rg6 — 4/ , : ‘ ) Please print all information. Revie ` • by / Date Personal information you provide may be used for secondary purposes Pr - - _ .° 1) (m)). _ _ ,, Property Owner R 1 --rope Location / / k [ ,i-� / Govt. L. S,g 1 /4 ,5U)1 / S36 T 29 N R /g E (or Property Owner's Mailing Address , / V 1 ?AI got # Block # Subd. Na - or CSM# A No b • J' D oi: t 42 / State Code Ph• a Nun . G0 I ' c O• i lla r ❑Vi own Nearest Road 9 i� ( PLANNING & ZONIN f // _ J II JeLP�meM Dr ; s2r )New Construction Us sidential / Number of bedrooms Code derived design flow rate 6 GPD ❑ Replacement ❑ Public or rpercal - Describe: Parent material 6 1.00- G Flood PI 'n levation if applicable CY ft. General comments 3 J -i �� 7..Y- / and recommendations: �� (/ O' '(vv e.J r I System Type UYt /t' System Elevation . : i Boring # 0 Boring Mg ' in. Pit Ground surface elev/Z h�J 1, • lJ ft. Depth to limiting factor / CJ 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 a -3 n �` 7_, ',9-30 r raiz, - ■ , -, MillIMIN - 7.- ,‘. ciffifi►Iri91il T MEWAI :MIS - a te / 7a/ q - / hi / /0 #Z Boring # 0 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/fe In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 oaf /r`l/ 2 Z!" � /� — s/ ` ,;�i, �� lis , Y , t! , 3 , r � ('/ �S6k�� ,v11 , 0 gY,z • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 / ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) -�. ture CST Number Bird Plumbing, Inc. Shaun Bird 226900 i Address ate Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 // !0 / 0 715- 246 -4516 I I 1 441;` Property Owner _ Parcel ID # Page of Boring # ❑ Boring / / � pit Ground surface elev. ` D(/ /ft. Depth to limiting factor H23___ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. *EMI 'Eff#2 1 0 3‘0 1, L 7— 3 e.:-.9-/ /a ,,2/2... .„....‹i / -51 / r . Z/ 4 ✓YIly' ,C- Al /4- - g ,.____3 7 y A o..sy J // w7 - , b tf 111 "" y p'l 00 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 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I Soil Application Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BO; < 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. 580.8330 (8.6/00) I Property Owner Parcel ID # Page of 3 Boring # ❑ Boring /0/ pit Ground surface elev. D . 7ft. Depth to limiting factor j in. ( Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. 'Eff #1 *Eff#2 1 0 3o . ---- � . 4 l / - - - - z 3S//2/2 --�-, s fie m ' ems 1 / , C 5 - - 2$ / ( d �r/ Z/ s i fl-- / A /1}- - g • --- 78 1 D-sy_. i .44 / /vi...9 It/ii,- - ,5 t7 ti, _ io n at 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 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/1.. 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 (8.6/00) • Soil Test Plot Plan . Project Name Kernon Bast Shaun r; rd Address 948 LaBarge Rd Hudson Wi 54016 ►fi #226900 Lot 16 Subdivision Cottonwood South Da - /10/10 SE 1/4 S W 1/4S 36 T 2 9 N /R19 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 94.2/94.1 *HRpSame as Benchmark B.M* Settlement Drive 120' Scale is 1" = 40' • • 30 loi unless otherwise noted 5% Slope 60' B -3 120' 30' ■❑ B -2 455' 100' 102' V 83 34-1E. KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD . Document Number WARRANTY DEED 08 /302006 01: gyp!( WARRANTY DEED THIS DEED, made between Michael E. Larson and Joann L. Larson, EXEMPT # husband and wife, Grantor, and Kernon J. Bast and Donalda J. Speer -Bast, REC FEE: 13, 00 husband and wife, Grantee. COPY TRANS 2580.00 Grantor, for a valuable consideration, conveys and warrants to Grantee CC FEE: the following described real estate in St. Croix County, State of Wisconsin: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. . 2 St. Suite 115 Exceptions �1 cepttons to warranties: Hudson, WI 54016 } ( } Easements, restrictions and rights -of -way of record, if any. 511203 1 1— 111 —'1 -111 020 - 1109 -60 -000.. 020 - 1109 -90 -100 Parcel Identification Number (PIN) This is homestead property. Dated this 18th day of August, 2006. -afro * �� * Michael E. Larson * J.1 L. Larson * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) chRri grown STATE OF WISCONSIN Noted P u bUCST. CROIX COUNTY. ) ss. authenticated this 18th day of August, 2006 State O� � jSCO'ns Personally came before me this August 18, 2006 the above * named Michael E. Larson and Joann L. Larson, husband and wife to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing ' • trument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) i ' / THIS INSTRUMENT WAS DRAFTED BY *Cheri B • wn Notary Public, State of Wisconsin • Peterson, Fram & Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date: • 50 East Fifth Street, St. Paul, MN 55101 3/11/2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *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 EXHIBIT A A PARCEL OF LAND LOCATED IN PART OF THE NE ''A OF THE SW Y AND PART OF THE SE ''A OF THE SW ''A OF SECTION 36, T29N, R19W, TOWN OF HUDSON, AND IN PART OF THE NE 14 OF THE NW ''A OF SECTION 1, T28N, R19W, TOWN OF TROY, ALL IN ST. CROIX COUNTY, WISCONSIN; INCLUDING LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 6, PAGE 1642 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE; MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE S ''A CORNER OF SAID SECTION 36 BEING THE N CORNER OF SAID SECTION 1; THENCE S00 °26'27 "E, ALONG THE NORTH -SOUTH 'A LINE OF SAID SECTION 1, 24.00 FEET; THENCE N45 °18'02 "W 34.02 FEET TO THE SOUTH LINE OF THE SW ''A OF SAID SECTION 36; THENCE S89 °50'23 "W, ALONG SAID SOUTH LINE, 1268.60 FEET; THENCE N44 °48'35 "W 33.73 FEET TO THE WEST LINE OF THE E % OF THE SW ''A OF SAID SECTION 36; THENCE N00 ° 32'26 "E, ALONG SAID WEST LINE, 1480.62 FEET TO THE CENTERLINE OF COUNTY TRUNK HIGHWAY "N" AND A PONIT ON A 1999.00 FOOT RADIUS CURVE, CONCAVE SOUTHERLY, WHOSE CENTRAL ANGLE MEASURES 2 °43'02 ", WHOSE CHORD BEARS S79 °16'37 "E AND MEASURES 94.79 FEET; THENCE EASTERLY, ALONG THE ARC OF SAID CENTERLINE AND SAID CURVE, 94.80 FEET TO THE POINT OF TANGENCY; THENCE S77 °55'06 "E, ALONG SAID CENTERLINE, 967.65 FEET; THENCE S76 °47'47 "E, ALONG SAID CENTERLINE, 280.04 FEET TO THE NORTH -SOUTH '/4 LINE OF SAID SECTION 36; THENCE S00 °27'05 "W, ALONG LAST SAID ''A LINE, 1216.78 FEET TO THE POINT OF BEGINNING. NOTE: Lot 1 of Certified Survey Map filed April 8, 1986 in Volume "6 ", page 1642, as Document No. 410755 is included in the above described lands. 2 of 2 eL Z '�'tU4 ', • ■ IOO OZ►� I - 1 I 1Oa 0L►! .{ 11 I p • I 1 ~ W I l 1 � • W zo .4. W I I: cD Nla. a -.-___,__.+L a, � I ' � I I �OZ i m 69'6LZ - -- It° �O Z O Lli W •N 0 TI C .1.9 •Lbb 3,LZ,9Z,OOS p r l ` O Z W W N ^ '---- - - - - -- 3Auia N3TVMH _ e= > i ■ � z, - -- t p a z al c, { ZE'b9 I III 'ZC'9bb IIMLZSZ,00N M.6E N !0) a p b1 � � . I ZS,OOS - - - -- - - - -- ---- - - - - -- _ _ _ • p p • Z i IL ., a N // L8 I .9,9 I I / �I 1 4 / / O I o O �� i I 7. 0" ° IT i F y� � y `�. 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OW 111°C0006 >> ¢m CO p 1-C F W 0 g � Z aeAZZW�n 20 CC0F DO Zi F U 0 w ecZC G U 20s(7�¢�t1J 0co go 0 SI CRXCOUN TY PLANNING & ZONING EROSION & SEDIMENT CONTROL PLAN Site location: 827 Settlement Drive, Lot 16, Cottonwood South Subd, Town of Hudson r, Owner(s): Kernon Bast - Jon Hokeness, Builder Parcel ID #36.29.19.3037 Code Administ Mr 715 386 - 4680 p Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may we attach reasonable erosion prevention conditions to a permit approved for issuance ". Land Informatio Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit applicant Planning and /or landowner to follow erosion control procedures and maintain them until the site has 715 - 386 - 4674 I been stabilized. (UDC Comm 21: www. commerce. state. wi .us /SB /SB- DivCodesListing.html) Real Property The Owner of the above parcel is responsible for notification of all contractors performing 715 386 - 4677 construction activities on this site that an Erosion & Sediment Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: Recycling 715 rv` 1. Maintain existing vegetation wherever possible to minimize erosion and sediment movement. The primary source for construction site runoff will be the house foundation and driveway excavation, well drilling, and soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. Surface drainage is toward a drainage easement to the south of the POWTS and toward the road drainage ditch on the north. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and /or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Do not allow contaminated runoff to be directed onto neighboring property or into surface water conveyances. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. (A specification sheet for temporary diversions is available from county). 4. If contaminated runoff cannot be contained with temporary diversions, installation of approved sediment control products (straw wattles, silt fence, etc.) as shown on engineer's site plan may be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and recommend additional action required to comply with applicable regulations. Control measures should be installed prior to POWTS excavation activities. Sr. CROIX COUNTY GOVERNMENT CENTER 1101 CARMICHAEL ROAD, HUDSON, WI 54016 715386 -4686 Fax PZ @CO. SAINT'CROIX wi. us W W W. C O. SAI NT -C ROIX. W I. US Page Two — ESC Plan Acknowledgement Form 5. S ?. bilize exposed soils (septic system included) with seed and mulch immediately after installation - DO (ST wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site. hen late- season weather conditions will not permit seed germination, a heavy straw mulch cover will p -nt erosion until vegetation can be established. Erosion control matting can be applied any time of year and, stalled properly, will provide protection even if seed germination is delayed. The owner ®k: rd during site construction will be responsible for compliance with state and county code requirement; T. ,l.ecified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions regarding ere & sediment control product installation. PLAN PREPA '44 BY PAMELA QUINN, SOIL EROSION INSPECTOR #665054 Owner/Builder aJi owled h ement of ESC Plan re. uirements: /// 9/2010 (Please sign an :. eturn original ESC form to Planning & Zonin_ •ept. A copy is attached to the owner's permit and maintenanc. greement, which is given to the plumber at time of permit issuance.) Provide copies for excavation contract. k "'• lumber, and town building inspector as needed. Thi- •roperty is subject to conditions contained the Board of Adjustment decision to approve Special Exception rmit SE0159, specifically: 5. Prior to commencing construction on each lot, the applicant shall submit to and have approved by the Zoning -4, • ministrator a construction plan and checklist including but not limited to a project narrative, construction schedule, ce ` • actor list and contact information, and site plan with erosion control measures as outlined in the application. The plan r also include additional information on the grading limits, location of temporary stockpiles, winter cessation plans, a • . emporary seeding to control erosion. The plan shall be accompanied by a $100 nonrefundable staff review fee and a " h compliance deposit for the lot. The compliance deposit for the six lots under construction shall be $1,100 ea• and the compliance deposit for the remaining lots in the subdivision shall be $300 each The cash complia - deposit will be held by the Zoning Administrator until construction is complete, permanent vegetation has been es ished, and the project is found to be in compliance with the conditions of this approval, at which time the deposit -.,111 be refunded in full. Upon completing construction on each lot, the applicant shall submit to the Zoning Admini •i�x for photos of the completed construction and certification from the project engineer that the construction has bee . +mpleted as approved to serve as proof of compliance. Within 30 days of this decision, the applicant shall submit . - the -fact construction plans, review fees, and compliance deposits for the six lots already under construe . k ; , . Required Compliance deposit $ "Ma per receipt # LI S bt1 n on t. ` 11 , 2010 #6. Prior to : mencing construction on each lot, the applicant shall install the erosion control measures in accordance f't! the approved plans. During construction, the smallest amount of bare ground shall be exposed for as short a time a ,r sible. Upon completing construction, temporary ground cover such as mulch shall be used, until permanent co as successfully established. Phosphorous fertilizers shall not be used to establish and maintain vegetation of. - disturbed area of the site, unless a soil test confirms that phosphorous is needed. ST. CRO /X COUNTY GOVERNMENT CENTER 1101 CARM/CHAEL ROAD, HUDSON, WI 54016 715 - 386 - 4686 FAX FZ@CO.SAINT-CROIX. WI. US WWW. CO.SAINT- CROIX.WI.US Page Two — ESC Plan Acknowledgement Form ffiF -v,. 5. S bilize exposed soils (septic system included) with seed and mulch immediately after installation - DO 4T wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site. hen late- season weather conditions will not permit seed germination, a heavy straw mulch cover will p:: „• nt erosion until vegetation can be established. Erosion control matting can be applied any time of year stalled properly, will provide protection even if seed germination is delayed. The owner ree, : ,rd during site construction will be responsible for compliance with state and county code requiremen E ° ' 4 j. ecified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions regarding erg '. ? & sediment control product installation. PLAN PREPA °? BY: PAMELA QUINN, SOIL EROSION INSPECTOR #665054 Owner /Builder a a owledgement of ESC Plan requirements: II/ 9/2010 (Please sign an., eturn original ESC form to Planning & Zoni ept. A copy is attached to the owner's permit and maintenanc; : greement, which is given to the plumber at time of permit issuance.) Provide copies for excavation contract. ° dumber, and town building inspector as needed. T c , ' I roperty is subject to conditions contained the Board of Adjustment decision to approve Special Exception ' =rmit SE0159, specifically: 5. Prior to commencing construction on each lot, the applicant shall submit to and have approved by the Zoning • ministrator a construction plan and checklist including but not limited to a project narrative, construction schedule, c... ctor list and contact information, and site plan with erosion control measures as outlined in the application. The plan h also include additional information on the grading limits, location of temporary stockpiles, winter cessation plans, a emporary seeding to control erosion. The plan shall be accompanied by a $100 nonrefundable staff review fee and a •; h compliance deposit for the lot. The compliance deposit for the six lots under construction shall be $1,100 ear, and the compliance deposit for the remaining lots in the subdivision shall be $300 each. The cash compli. deposit will be held by the Zoning Administrator until construction is complete, permanent vegetation has been es . :: ished, and the project is found to be in compliance with the conditions of this approval, at which time the deposit :., 11 be refunded in full. Upon completing construction on each lot, the applicant shall submit to the Zoning Admini for photos of the completed construction and certification from the project engineer that the construction has bee , :.•mpleted as approved to serve as proof of compliance. Within 30 days of this decision, the applicant shall submit , -the -fact construction plans, review fees, and compliance deposits for the six lots already under construc . Required Compliance deposit $ '/dam per receipt # b (7Qj11 on (� J 11 , 2010 #6. Prior to mencing construction on each lot, the applicant shall install the erosion control measures in accordance the approved plans. During construction, the smallest amount of bare ground shall be exposed for as short a time a sible. Upon completing construction, temporary ground cover such as mulch shall be used, until permanent co as successfully established. Phosphorous fertilizers shall not be used to establish and maintain vegetation o disturbed area of the site, unless a soil test confirms that phosphorous is needed. Sr. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, WI 54016 715386 -4686 FAX PZOCO.SAINT- CROIX.W /.US WWW.CO.SAINT•CROIX.WI.US Dmp m m Ei5 ii 0i� pA CD a y mm �n ° * -* 4 D C m. pm ��mZZ�D o zz fn St m m -1 • 0 " ° � m01, a � y p � i� lz � az �vs oo m N °mz 4 > ' V ; c-4 -Wr ° m z3 m � • '�� <320p- -13213 1Z m mmZ D p i O a y � a rz O � m= C3 4t - Im zz O zvc� � zmx - m 1 mov w 9mv =ac - � mc r n . 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