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HomeMy WebLinkAbout026-1304-07-000 Wisconsin Department of Commerce Count 'Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 0 GENERAL INFORMATION State Plan ID No: 491/41 '7 Personal information you pr%rJ?ormay be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Grand Properties L.P. I Richmond, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/ /Range /Map No: db Q rn G 5 T 07.30.18. / TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR R CAPACITY STATION BS HI FS ELEV. Septic ' r s 2. Benchmark 3.71 163. - / J� 40-0 Alt. BM 5 11% Aeration Bldg. Sewer 4 5 . o I g . 73 Holding St/Ht Inlet b� 1 7 1 4.7 TANK SETBACK INFORMATION St/Ht Outlet Z7 9w�- -q7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Ve -` Septic 5 i / A 1 Z , 7 / Dt Bottom ` Dosing / Header /Man. q3.7f' Aeration Dist. Pipe lb. 44 93 . 3 Holding Bot. System / I. 5 9Z z< PUMP /SIPHON INFORMATION Final Grade 6.5 c 17 Manufacturer Demand St Cover .l-7 q 7. 5 7 Model Nu TDH Lift Friction Loss Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width i Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 q� 2, SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR �h Odl Q'Gl� Type Of System: / 1 UNIT Model Number 5 Z 7 7 Z G o h� C+n� -, o� Iro" DISTRIBUTION SYSTEM / 8 !- P? Header/Manifold Distributior� x Hole Size x Hole Spicing Pipe(s) Vegt t e, o Air Int e \,, \/ Length Dia 4 Length Dia Spacing 1 4 0 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 5, b.4k-, Depth Over . Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 5 L Bedlrrench Edges \ Topsoil \ Yes �j No Yes i d No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: New Richmond, WI 54017 (SE 1/4 SW 1/4 7 T30N R1 8W) Hayde 's Rolling Acres Lot 18 Parcel No: 07.30.18. 1.) Alt BM Description � 2.) Bldg sewer length = - amount of cover = �/ Plan revision Required? l j Yes No Use other side for additional information. Date I insepct ignatur Cert. No. SBD -6710 (8.3197) Safety and Building ivisl County lw 201 W. Washington Ave., P. Box 62 o fiConsin s Madison, WI 53707 - Sanitary Permit Number (to be filled in by Co.) 3- Department of Commerce IV �� / ~ State Plan I.D. Number Sanitary Permit Appl foirm!61NK on f�A- In accord with Comm 83.21, Wis. Adm. Code, personal p @vi4e 2006 may be used for secondary purposes Privacy La4(1 xm) Project Address (if different. than mailing address) 1. Application Information - Please Print All Information A4 Parcel Property Owner's Name / # Lot # Block # Property Owner's Mailing Address I Property Location &' /., S UJ 'h, Section 7 City, State Zip Code Phone Number _ O _S circleo e) T R Eo& [I. Type of Building (check all diatt apply) 00,( ® l or Family Dwelling - Number of Bedrooms /�O J s.� I Plate Subdivision Name CSM Number ❑ Public/Commercial - Describe Usenn tt L N ES ❑ State Owned -Describe Use Z r 7 ���t B � ✓v`bL' �5 ❑Ci ❑Village ®Township of `Chf Alo t7 4f - 7 o$Z III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' 10 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal El Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl IN Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground 11 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit 1) Recirculating Sand Filter ❑ .,� (�� t Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) A t ' S V. Dispersal/Treatment Area Information: . 5 P Design Flow (gpd) Design Soil -S ,5 a Application e(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) S tem Elevation 9y s I Lo . S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing �1 n Tr e f) t Tanks Tanks /�/ ►2¢SC CAF wl Septic cw Holding Tank Aerobic Treamtent Unit G Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for InstallaUgn of the POWIPS shown on the attached plans. Plumber's Name (Print) is Signature PRS umber Business Phone Number 1 215 0.-1 AIa 4Z JA/ C � /"-' �Wffz r 't I � - 517 P —umber's Address (Street, City, State, Zip Code) VA LLB &W /� VIII. County e artment Use Onl Approved ❑ isapprov Sanitary Permit Fee (includes Groundwater Dat Issue Issuin ent Signa ire Stamps) Surcharge Fee) Z� �l 110 en Reason nial C.CJ l� IX. Conditions of Approval /Reasons for Disapproval 3 ` Zp SYSTEM OWNER: J , _ " `' t +-D 1. Septic tank, effluent flNer and r 4 � diaper" cell must all be,services / maintairied � as per managemettt plan provided by plumber. 2. AN Bo bo& requirements must be maintained as per applicable trade / ordinances. Attach County the to lane complete for the system on paper not less than 81R x 11 inches in size P P ( tY onl Y) SBD -6398 (R. 01/03) S ` 8 S alas ly ' F � /� v 14 SCALE On A Tap a py c )' /, = A;74 /Oo , 10,P74 Tdp ol PVC- P/p e4 /0,2.22 ' /000 C-1- s: ,. /30R - r# A 100 a AAEC FATE /y�GES PROPOsEO an SYST & EL. /1i. yys 3 /SED IFO ,E4 LO CAT .7 /�fi4�r(� � jV ROU IA16 A0005 1 Q3 PRO p �,2 \ 0y Y , '51ouroy L. o r RENO ��v�c�r Tics Y-1 e)6 nor /�v& d y� _ 7 1 l'ilVARd S T vavo -" o� # �Z/7Y/ L5omc -,T sF i chi - 586 V ALL46� y Wh Fa) 7 - R U)Y .S VO I S' I I 1 ' i i l_. a I i i ly L i it a1-7 A Tap a / ID O -- - Atr 817L1 /d �'G / cL �oa,22 000 at, L _ A 4thL ice% �-TE ,� f3oRc J1acES {�RoPosEO w. iob SYS7671 mac. , :. y ys 3 BED goo M 'EL L p - �fi4y ` cn _ - I✓' flv lw A S ® \ (f FRO p oa 1- ' n I V llr7/Il� �2aj� �7'�Cs y - /8 - L96 Of /11�� 131a ?t fl /UA IUD ST- Of ?j ,.50MEF ,q Ste' % a)l 5 VA U oPy VJFW 7 -- - - s 9 zs _ A 1363 / / - SOIL EVAL ATION REPORT Wisconsin Departrr>b to o V ( J q� j OL�`� Page 1 of 3 Division of Safety an in in ac ,! darns Ih Comm 85, is. Adm. Code Tom Schmitt Attach complete site plan on paper not less thk*/.(rr�'F4&Y ' I �lan 1 t County St. Croix include, but not limited to: vertical and horizontal r� irectio percent slope, scale or dimensions, norh ance o nearest road. Parcel I.D. Please print all infonnation. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Grand Properties, LP Govt. Lot SW 19 SW 19 S 7 T 30 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 7 Hayden's Rolling Acres City State Zip Code Phone Number I City _j Village 16 Town Nearest Road Somerset I WI 1 54025 715 - 247 -5900 Richmond I 160Th Ave. New Construction Use: jo Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with 0.5 pd/sq ft rating. Possible system elevation for Area 1 is high trench 9 low trench 94.5'. Slope is 8 %. Boring # Boring sm Pit Ground Surface elev. 101.17 ft. Depth to limiting factor 120+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz 'Eff#1 'Eff#2 1 0 -8 1Oyr3/4 none sl 2msbk mfr as 2vf .6 1.0 2 8-14 1Oyr4/4 none gns► 2msbk mvfr gw 1vf .6 1.0 3 14 -35 1Oyr5/4 none grls Osg ml gw — .7 1.6 4 35 -120 1Oyr6/4 none s Osg ml — — .7 1.6 Boring # Boring 0 Pit Ground Surface elev. 100.07 ft. Depth to limiting factor 120+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF 'Eff#1 'Eff#2 1 0 -9 10yr3/4 none sl 2msbk mfr as 2vf .6 1.0 2 9 -19 1Oyr5/3 none sl 2msbk mfr gw 1vf .6 1.0 3 19-42 10yr4/4 none grls 1 msbk mvfr cw .7 1.6 4 42 -122 1Oyr6/4 none s Osg ml — — .7 1.6 "'1 111 1 6 A C 1 ,1 ti Effluent #1 = BOD s' 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS <,0 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 6/25/05 715- 247 -2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 a Boring # Boring jim Pit Ground Surface elev. 96.90 ft. Depth to limiting factor 120+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -13 1Oyr3/3 none sl 2msbk mfr as 2vf .6 1.0 2 13 -29 1Oyr4/3 none grsl 2msbk mfr gw 1vf .6 1.0 3 29-62 1 Oyr4 /4 none gds 1 msbk mvfr gw — .5 1.0 4 62 -120 10yr5/6 none s Osg ml — .7 1.6 II V 4] Boring # Boring IM Pit Ground Surface elev. 98.20 ft. Depth to limiting factor 118+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP *Eff#1 *Eff#2 1 0 -10 1Oyr3/3 none sl 2msbk mfr as 2vf .6 1.0 2 10 -24 1Oyr4/4 none sicl 3msbk mfr gw 1vf .4 .6 3 24 -35 7.5yr416 none Is 1 msbk mvfr gw — .7 1.6 4 35-61 1 Oyr5 /4 none grlfs 1 csbk mfr cw — .5 1.0 5 61 -118 1Oyr5 /6 none � s Osg ml — — .7 1.6 YJ It F Pit Boring # Boring Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *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/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. Pagel of 3 Conducted by: Conducted For: Ref. No. 1, 3 Schmitt Soil Testing Inc. Name: Grand Properties, LP. Thomas I Schmitt, CST 227429 Address: 712 Rivard St. Suite100 1595 72nd St. City, State, Zip: Somerset, WI. 54025 New Richmond, WL 54017 Phone: 715 -24 Subd.Name: Hayden's Rolling Acres � Lot No.: Legal Description: ,S`J 1 /4,54/1/4 S7 T30N RI 8W ® Backhoe Pit Township of: Richmond, St. Croix County ® Bench Mark El. 100.00' Top of Alternate Bench Mark El. 1W Top of ,2 / 7 /7 4!5 : ' - Slope= ey Contour Line El. Contour Line Length /1` Rd Scale 1" = 40' � This soil report was done to fulfill a zoning requirement. The road and permanent lot markers were not in at the time the test was mndurted. The area in which the test was done may or may not he suitahle for vour use. Doc 11 919 D?. a HAYDEN S ROLLING ACRES STCISMR*COOMC (A COUNTY PLAT) .ULU$ -- esk,Q_µ A.ewOW ix e ro Located in port of the Southwest 114 of the Southwest 114, and part of the Southeost 114 of the Southwest 8 t14 of Section 7, Township JO North, Range /B West, Town of Richmond, St. Croix Counly, Wl'sconsin. en Jl. tCMlah a.µre•nm. .2C1.u. Car'9J•eOA, West //4 Comer E]adM.L( Sacftar 7 -JO -18 (F -d I • Iran Pipe) Z / '43'22" E 1676.78 wo N°rtn u e If tna l/4 UNPLATTED l ANDS WO 5 1/2 If the SW ------ - - - - -_ r9'RAALS R3B°a9MY M- uF-51C 4 UN �/ P°O1 � 971.7 FA,Y.1tlY7 ro H' /dF9101aD 9JI.0 P U' 94.15 _ 9TH0 _ ] ' I 1 „s fYJT _ _ _ aP4Y• 6 ]Aa' WOAa / - . - _ _ N 88' Ds' - rn' SBBB{ 6 a l 246.00' 2- I m4. • :961.1 12 t I > \I I 17 fan SfE C 9 4 Ny 16' KW. E. =970.0 �¢ Y 1.50 acres 1 �I m I 2.62 acres B L", 8 65, JOJ sq. !t, L N4,2J8 sq. ft. - 2 i 1.50 om s E n . S. 0. 930. 0 1.51 acres e i IM la 65,456 sq. ft.. iy3'[ rnrr snwYrx �y 65,591 s . It 9s "�"� •A]r - a z g 9 Leo s3ao Nn >,NU• Aw,9'vr : - ra y ..... "I "" ... g 10 I I NBe'STSB'E 152.01" I 7 51 4. 1 . ...,. u °. I ,x d II n I h 535.33' II /� a7 seaer tc¢ -aE sAa 65,576 ft. `I B.O. ' �r NBB'sl'ze'E L.- rO 8 �..1 „1 ... 1.54 acres z{5 l R R io 67,020 sq. 30.0 1 1 I 297 z{71 126,599 sq. s ft Ne7•TS'as �' at3.xe' 'IT \�sx'9 \,\ � °'\ \ .2]T.Se• -- - - 139.95' __ '^` 4bF ,4 y _ • 115 AT� �. m _______ sia'o>' Need 2eE s{S9r u n . _ ..... a N.W.E. �� / a ry ° A 1.51 acres ° 7.51 acres „ 5 ,94.15 p1 76. 2.JJcres o 66,569 s !t. $ l.67 acres r M•YY ="z . 4 . '"• 1 d 4. ° 6572) sq. ft. r .. 2.2T acres �� a ` 701, 5J9 sq. ft. P S 72, 920 sq. ft. \ L c 1\ o ", \ .... 96,41J s9 !t. L.B.O.= 9455 L.B.O.- 945.5'. \ \• a 947.7 952.8 9516 .9 948.0 sy'F s'� \ \ , 6 .NBB'st'xe'E .01 210.0{' 210 • 10.04 z S89 "W 630.12 I ieswro]•E (R= NB9U5'52 E 6Ja 12) su•]r T< _ _ I 1. LIP y - 101. 2 G 4. L l 0 m 2.28 acres I ], N 99,762 sq. ft. L.9.0- 945.5 0'l 931.] I� v 17 Se6�e'x5'E {99.aT / M o' S 2 b l ' 1 ^ 1p 95, 2. 1 94�q. s it . LO 2 [.0T J Lora u; L1 205 ocres q/ / m - m 89,404 sq. ft. D. S CERTIF /E U_SUR BEY MAP q rn ° _ ` N SBBR6'25•E 4{1.43 - N '• ry 2.13 acres � � � 2.71 cres N 92,950 sq. !t. l• / .. , 118 ; 996 s4. fL..._. ..... ..... .... ._ .. _........., ... Nao•lo•s0- I C I C I iz ° ° 3- - -_ - _ -_ �- -_ -_ -� ° esoroa - 1 " T3D' - _ _ _ _ _ nrmr w -- -_ s4o. vs l� " S89L5'S2 "W - <° - 1042.44' 66 0.1 3 v u ` 1 / Na0']3 J1 E a01.fiB • _ _ 160THAION -g .21' J -- - - - - -- S89'05'S2'_W_ 1027 589'05'52 "W 630.12' - _ - - -- - -- - -- -- ------ -- S89'05'52 "W 2699.77' Section 7 - J0 -,B -South Line of eh, SW I14 (Found A/u Mm Southwest Lamar _- - -- Caunfy Monumenr) EA_SfMEN7 TO aAIRYLANa POWER section 7 -JO -18 (/ NPLATTf. - /. (ANn,$ - -- �'vni �/Yl /N D(K�'S9)99_4 -- (Found ANTA+Mm - - - - - LYX_ 1904 �7B7 Loamy MOn,.ment) _UN?(ATT1 LANDS CURVE TABLE LEGEND CURVE RADIUS DELTA ARC CHORD CHORD BEARING TANGENT BEARINGS VICINITY MAP CI E33.00 17'16'4B' 70.27' 70.00' NOB NDO'10'53•E NI7'27'41'E SEC. 7, T. 30 N., R. 18 W. C2 167.00 36 106.71' 104.90' N00'50 N17 N19 - W TOWN OF RICHMOND, ST. CROIX COUNTY, WI $ Section Corner Monument of Record C3 233.00 37 152.42' 149.71' N85 S76 N66'27'16'V NOT TO SCALE Found 1' Iron Pipe C4 167.0U 20'48'19' 60.64' 6031' 476'51'25.5'V N66'27'16'V N87'15'35'V C5 23300 20 84.61' 84.14' S76'51'25.5'E S87 566 - E p Set I -1/4' x 18" Iron Reba, LOT 10 233100 20 81476' 81.34' S77 S87•i5'35'E S67 (weighing 4.303 Iba. per linear fool) LOT 11 23300 0 295' 2.84' S66'48'15'E S67 S66 _ _ 170TH AVENUE ALL OTHER LOT CORNERS MARKED WITH A 1" CIS 167.00 37'28147' 10924' 107.30' S85 S66 N76 'E 18" IRON PIPE (NEIGHING 1.13 L85. PER C7 23300 15'/1'24' 61.77' 61.59' 1401 NOS'47'31'V N09 LINEAR FOOT) UNLESS OTHERWISE SHOWN. C8 167.00 7 22.08' 22.07' N65 N09'23'S3'E N01'49'IB'E • Building Setback Line C9 233.00 0 34.38' 34.35' SO5 S00'56 509 - W _ - (100' 1- Right of way) CIO 167.00 28 83.21' 82.35' SO4'S2'31'E S09'23'S3'V S19 N W 4 1 N E CI1 233.00 36'36'36' 148.80' 146.36' S00'S0'37'E S19-0 55-E S17 e h - Approximate Driveway Location CIE I 167.00 1 17-16- 1 -11 1 SOB'49'17'W Sl7'27'41'V S00'10'S3'W II � R- Recorded as r L.B.O. Elevation or Lowest Allowable Building Opening H.W.E. 100 -Year High Water Elevation GpG S W .. 1 " S E O,p 12 Benchmark - Top of I ron Reb U tility Easement along roadways or or Pipe OILING -II I NOTES ACRE - -- - - ' ?, ELEVATIONS ARE N IS BASED ON OBSERVATIONS. 111E PARCELS SNO SHOWN ON ON T HIS MAP ARE SUB „E TO STALE. COUNTY AND ✓ •N511 160TH AVENUE TO-SHIP LAWS, RULES AND REGULAtIOVS (I.E. WETLANDS. MINIMUM LOT SIZE. 'J ACCESS TO PARCEL, ETC.). BEFORE PURCHASING OR DEVELOPING ANY PARCEL. CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE APPROPRIATE TOM JOB (! W1057SD44A BEARINGS ARE REFERENCED TO THE WEST LINE OF BOARD FOR ADWCE. Prepared by THE SW 1/4 OF SECTION 7, T30N, R18W, WHICH IS No OWNER CR RESIDENT SHALL 00 ANYTHING MICH WOULD INTERFERE WITH ASSUMED TO BEAR N00'10'53 "E. c .w OR CHANCE THE OPERATION OF THE APPROVED COMPREHENSIVE WATER DRAINAGE �® AND SOIL EROSION PLAN FOR THIS PLAT. THIS INCLUDES BUT IS NOT LIMITED TO � consulting Group, Inc GRAPHIC SCAUE BUILDING UPON, OBSTRUCTING, ALTERING, DL11NG, EXCAVATING OR PLANTING IN SCALE IN -1 1 Itch � LOO reel ANY DRAINAGE EASEMENTS. WATER DRAINAGE DITCHES, WATER RUNWAYS, WATER Phone No. (715) 246 - 4319 CULVERTS. BERMS OR GRASS SEEDINCS. FOX No. (715) 246 -3830 P.O. Box 325 New Richmond, N 54017 SHEET 1 OF 2 SHEETS U 2813P 558 796514 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX Co., WI Document Number Document Name RECEIVED FOR RECORD 06/02/2005 12:30PH WARRANTY DEED THIS DEED, made between Rolling Hills Dairy, Inc. EXEIPT i ("Grantor," whether one or more), REC FEE: 13.00 and _Grand Proaerties LP TRANS FEE: 1397.40 ( "Grantee," whether one or more). COPY FEE: CC FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee the following PAGES: 2 described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address See Attached Exhibit "A„ W N0' 50- David J. Estreen 304 Locust Street Hudson, W154016 of 0 :0264025-10-069 Parcel Identification Number (PN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated d SQ L ��'�� Rolling Hills Dairy, Inc. (SEAL) _ 'O (SEAL) ' * *B Gera d A. Kieckhoefer (SEAL) yO (SEAL) * *By: Rita A. Kieckhoefer AUTHENTICATION ACKNOWLEDGMENT Signature(s) Rolling Hills Dairy, Inc. By: Gerald A. Kieckhoefer and Rita A. Kieckhoefer STATE OF ) _ ) ss. authenticated on 54 7-& 70 - COUNTY ) Personally came before me on , *Kristina O land the above -named TITLE: MEMBER ITATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Notary Public, State of Attorney Kristina Ogland My Commission (is permanent) (expires: ) Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO -PROTM Legal Forms 800. 855 -2021 www.inloproform$.eom U 2813P 559 EXHIBIT " A " Located in part of the Fractional Southwest Quarter of the Southwest Quarter and part of the Southeast Quarter of the Southwest Quarter of Section 7, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin, being more fully described as follows: Commencing at the Southwest corner of said Section 7; thence North 00 degrees 10 minutes 53 seconds East, along the west line of said section and being the west line of Certified Survey Map Volume 15 Page 4145, a distance of 663.12 feet to the point of beginning (POB); thence continue North 00 degrees 11 minutes 01 seconds East along said West line 640.71 feet; thence North 88 degrees 43 minutes 22 seconds East 1676.75 feet; thence South 01 degree 01 minutes 04 seconds West 1315.31 feet to the south line of said Section; thence South 89 degrees 05 minutes 52 seconds West along said south line 1027.21 feet to the east line of said Certified Survey Map; thence North 00 degrees 10 minutes 53 seconds East along said east line 663.12 feet to the northeast comer of said Certified Survey Map; thence South 89 degrees 05 minutes 52 seconds West along the north line of said Certified Survey Map a distance of 630.12 feet back to the point of beginning. St. Croix County, Wisconsin. ST CROIX COUNTY SLPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 6 gi aml-) T'i D� �� % /C� �I`% //T� a E/1/' &4 Mailing Address 7/1 4210,4121-2 S7 Property Address p7 (Verification required from Planning Department for new construction) � viz.& —ion s ao -000 City/State &W fl/C YP LOX12 CU% _ Parcel Identification Number e3a e. - .SD LEGAL DESCRIPTION Property Location S_aL '/4, 3 C/ '/4, Sec. _Z, T 30 N -R-,O_W, Town of Subdivision A oa 7 5 -91 Dc c wz Ar-Ae S Lot # _ 1 Certified Survey Map # . Volume , Page # Warranty Deed # :2 9� S/ y , Volume 18 13 , Page # S S6 - Spec house ❑ yes Erno Lot lines identifiable 99 yes ❑ no SYSTEM MAINTENANCE 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. i The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, 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. Itwe, 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 Zoning Office within 30 days of the three year expiration date. _ y / / SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of t the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * *• * ** Any information that is mis- represented may result in the sanitary permit being revoked by tha?Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1 r r 1 v N 0 n p o n n o 0 0 o W p 0 0 0 Q F ° o o Q 0. r C IAN r P- t C r-: CN n: 04 r-: C ON 0)N 0) (7) ON TN ON W N �! !9 �4 �2 r �4 �2 �2 �2 �2 �! � m 0 N O W (O T O Of (o O (D M O m (O O O O) MO OT W C) 0) CF) OM MO) MM W C) 0 •- N N_ N_ N_ N_ N_ N_ N_ N_ N_ N N N CL m r v ao v eo v �o v ao ao v ao v 06 v ao Q n0) n0) n0) nC) n0) n0) n0) n0) N N N N N N N N N N N N N N N N L m L m L " II • II X d N a 2! w II .9 II :tf II C 3L 3L m O m O m 3L 3L 3L O 3 it! Q rng Q m L S E v E Q rn Q rn a Q rn0 Q (n (!) x x O (q C N N C L (n c (n y M W °� y u? 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O_ m U U m m 0) Q m Q 9 m m m F- O w = z z U Q Q Q U Z LL Z O O U U U Q Q LL 2 W W O O O U Lt �O O w J J > > > a m J U U w w w = m � w o m g 4 U = Z U ( 1 z w = U F- Z J U) U) W (7 W E Z U) Z (A rn O o z z z z z U V U (U ++ j z Q O O O J O m O D > > Q Q Q ? z v Q Q U U 2 = S l POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner — Septic Tank Capacity a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA - G1J�E .S' DESIGN PARAMETERS Effluent Filter Manufacturer L ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A _ ❑ NA Number of Public Facility Units i NA Pump Tank Capacity a l ® NA Estimated flow (average) 30 g al/day Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) S� g al /day Pump Manufacturer 0 NA Soil Application R al /da /ft2 Pump Model 91 NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit A NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) 530 mg /L ■ In- Ground (gravity) ❑ In - Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ 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 eve ry ❑ month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y.) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ® mon J(s) (Maximum 3 years) ❑ NA i month(s) ❑ NA Clean effluent filter At least once every: ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ® NA ❑ year(s) ' Flush laterals and pressure test At least once every: ❑ month(s) 0' NA -` ❑ year(s) + Other: ❑ month(s) ❑ NA k : ( ;i At least once every: ❑ year(s) ' Other. , Zx MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications -f Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator Tank ' t` inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, F €. measure the volume of combined sludge and scum and to check for.any back up or ponding of effluent on the ground surface �Mal. The dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding3. t of effluent on the ground surface. The ponding of effluent on the ground surface may.indicate a failing condition and requires*.tha ? 3 `? ?. I immediate notification of the local regulatory authority.` When the combined accumulation of sludge � ti Y€ and scum in any tank equals one -third (Y or more of the;tankvolume „theenUre contents of_the tank shall be removed by a Septage Servicing Operator.and disposed of in accordance with;chapter 113, g r Wisconsc AdmimstraUve 3 f?t s •`""c :'.tt'� r° t 3. > r ,�.,.e� S?' F., `r'r':�`d;:C3 >�ka' other seances, includin but not limited to the servicin of effluent filters; mecharncal,orpressuriied components, - pretreatment All 9 9 unrts, and any senncmg at intervals of 512 months, shall be performed by a certified POWTS Ma�ntamer�`.:A A service r port,shall be provided to the.local regulatory authority within 10 days of completion of any service "event T- a � :r t k � - .',.,2 •d f r ' S s � z f t,. � Gj { , 2 d ry e i t � a ; � a � � � 3 (.���.�„ � �µ�`, Y Page of START UP AND OPERATION For now 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 call(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 i PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. , ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER r Name of Phone L EE] . _3 f SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATOR AUTHORITY < °� ? Hame _ i' Yh 't� }fk. a`C:'ov Phone • Phone ZZ This document. was draped in compliance wrth chapter Comm 83 22(2I(b1f1)(d1 &(f) and 83 54(1) (2) &,(3) Wisconsin Administrative Code ( r .� , ;� .s � }_ n `� c6- tr ;� `fF. y'..� . . ; b $ %t x+ ,+ ^S -.2i_ ^ �� 1 ��� y '. >. 'D� ='n ^�''•. �.i ,� .� fin.- tT Rs % �,� $�, ;,.r J� 7; nc � �'z����'1�''4aa �+si y �s'`{ x �� x' - r a �:� �a�.r ,� �•srt � ., e ._ ,! 4 te�1` a� �N t ^r 1£ L - ♦'F L -, z u ,, r t l �, c r � r Parcel #: 026.102.5 -10 -060 04/21/20 P M Alt. Parcel #: 07.30.18.97A -1 026 - TOWN OF RICHMOND Current [ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/28/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - GRAND PROPERTIES LP GRAND PROPERTIES LP 712 RIVARD ST STE 300 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 7 T30N R1 8W 39.79A SW SW PT SE SW Block/Condo Bldg: COM SW CORNER SEC 7; TH N 00 DEG E ALONG W LINE & BEING THE W LINE OF CSM 15 -4145 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 663.12 FT TO POB;TH N 00 DEG E ALONG W 07- 30N -18W LINE 640.71 FT; TH N 88 DEG E 1676.75 FT; TH S 01 DEG W 1315.31 FT TO S LINE More Notes: Parcel History: Date Doc # Vol /Page Type 06/02/2005 796514 2813/558 WD 06/02/2005 796514 2813/558 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/28/2006 Description Class Acres Land Improve Total State Reason Totals for 2006: 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