Loading...
HomeMy WebLinkAbout026-1153-28-000 wisconsi . of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: � 463425 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: Halle Custom Homes Inc. I Richmond, Town of 026- 1153 -28 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: I� m T Q�vZ ow �a� 19.30.18.1166 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( l Benchmark GJ�e —7, 1 Iv -7• t , .�. ;�. /uXJ pose Alt. BM 3 . 163 •35 Aeration Bldg. Sewer Holding St/Ht Inlet Ib` 7 3 g TANK SETBACK INFORMATION St/Ht Outlet 'Ti. ' —Z_ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �o/ �7 DtBottom Dosing Header /Man. 11 95.75 Aeration Dist. Pipe Holding Bot, System Q`Z1 PUMP /SIPHON INFORMATION Final Grade S Id Manufacturer Demand St Cover +� 3 /�3L' AP M 7 .7 Model Number —= C, /� t ! It.55 ! TDH Friction Loss System Hea T Ft S _ �Z 1Z qy. Forcem ' Length Qia. ist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length ! No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturerr� INFORMATION CHAMBER OR �AAA�r Type Of System: ! UNIT Model Number: 1 � �7L �7 I -- DISTRIBUTION SYSTEM 7 Gc_,_� 3 y Header /Manifold 11 Distribution x Hole Size x Hole Spacing Vent to A� Intakes �/ Pipe(s) \ Length 1 ' Dia Length ` Dia Spacing � ` V�� n SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only dS Depth Over o Depth Over xx Depth of xx SeededlSodded xx Mulched Bed /Trench Center r„ Bed/Trench Edges \ Topsoil \ Yes i! No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 921 145th Avenue New Richmond, WI 54017 (SW 1/4 NW 1/4 19 T30N R19W) Glen View Lot 28 Parcel No: 19.30.18.1166 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes No — Cert. No. Use other side for additional information. Inse cto Signa ✓ Date p SBD -6710 (R.3197) Safety d Bui on tunty _ . ashi n Ave., P.O. Box 7162 gto 201 W W �O��I� M ad iso ,8W265� - 205 taryPermitNumber(�din , Department of Commerce () 4 /6 3ya.� ,,' Sanitary Permit A P P OFFICE liea i N s to Plan I.D. D. Number In accord with Comm 83.21, Wis. Adm. Code, personal infor may be used for secondary purposes Privacy Law, s15.04(1)(t 0 Project Address (if different than mailing address) 1. Application Information - Please Print All Information / Prope Owner's Name Parcel # Lot # Block # P 7 ag Property Owner's Mailing Address Property Location / I I - v _�w '' /Jb <, Section City, 5 tat Zip Code Phone Number "." - t/ S7 U 1 2 J CO 22 T 36 N; R�E oe� ) II. Type of Building (check all that apply) n Subdivision Name CSM Number all or 2 Family Dwelling - Number of Bedrooms (. A I ✓ ' / ❑ Public /Commercial - Describe Use V [I State Owned - Describe Use ❑City _❑ 'llag ownship f III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ArNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal Permit Revision [I Change of [I Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl YNon - 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 ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -les Pipe ther (explain) V. Dispersal/Treat ent Area Information: — Design Flow (gpd) Design Soil A plication Rate(gpdst) Dispersal Area Required (sf) Dispersal Area (sf) System Elevation / Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing 7�1 _ n ./l _ /M Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VI1. Responsibility Statement- I, the undersigned, assume responsibility for in allation of the POWTS shown on the attached plans. 9 PI tuber's Name (Print) Plum 's Si ature MPRS Number Business Phone Number Plumber's Address (Street, City, Stat ,Zip C a c VIII. ountV /De artment Use Onl pproved ❑ Dis ove Sanitary Permit Fee (includes Groundwat r Date ssu Issuing t Signatur (N tamps) Surcharge Fee) , � $ 5 ❑ Owt Gi 1 Reas Denial V IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 1. Septic timk, of lettt filter and dbpersal CON must all be services / nlaitttaitted w per MWMWnWt play provided by p1mber. Z AN sst eck mqulrwm is must be nalirtsinw n par q*kw la cede / Wdilal IM. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) } .'')b .!1fiq 1 ?tt' °e;i"' '`:1'. d6 t�4t't6lfiG ! „�' !e� C1fiIoo: NA as. 'Aq *a 3 -� �- -ld0 - 7, / ' ; V0 N L)-� a8 5 Y�Lt le �3 /vo To -aL, 136k 6.3 13. m t aaa3 --7 r` ' RECEIVED O tMscansin Department of C rce JUN 0 6 2005 SO E O Division of Safety and Building ON REPORT POP at C U N WWth m 85, Wis. Code Aitach complete site plan on n x Inches in size. Plan must County S fa r include, but not limited to. vertical and horizontal reference point (BM), direction and Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Z 6 — // � P 5.3 P(or lease int all pr Information. Revie by enoeal Information you P Provide may Iw u for secwrdary Purposes (Privaey Law. s. ! 5.04 (i) (m)). Property Owner Property Location Govt. Lot 1/4 1/4 T Q N R Pro perty Owner's Mailing Address Lot # Block # Subd. t�arrre or WIN S (� e w ki tate p Phone {� City 0 Village CaTown Nearest Road ) l� iL � v,1� ✓col ��/s ��, New Construction U se: � Resldentlal / Number of bedrooms 3 - �/ Code derived de [' Replacement flow rate GPD ❑ Public or commercial - Describe: _ Parent material 0 r S k I Flood Plain elevation if applicable �~ h General oomments and t+ econtmendations: S yf/e ,*A ate# ❑ SoI © Pit Ground surface elev. /0 . ym ft. Depth to limiting factor i In. Soil Application Rate. Horizon Depth Dominant Color Radox Description Texture Smi jcbxe Consistence Bflurxfary Roots G PON h Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EM 'Ef#2 Z to t "i 3 i S U 5 VVA r t ❑ Borin a D Pit Ground surface elev. M Depth to IkNting factor / In. Sob lion Rate Horizon Depth Dominant color Radox Description Texture Structure Consistence Boundary Roots GPW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 o 7r / Z Vl't r c ? v L Z d 16 / / �G wSl v' IK CS G 5 �c ��? wx Vh (G✓ !.� . CO L-1 78 4 1 ,aa 4 / G n ` Efluent #1 - BOD > 30 � 220 nVL and TSS >30 c 150 r VIL ' Effluent #2 F pop 130 mg& and TSS 1 30 not CST lease / CST Number C/ �v/✓toC CCU c - Z 3 30 Address 10, Date Evelpation Conducted Telephone Number 7 Property Owner �1 L(-� Parcel ID ff �O � Z $ &-(A el Page �_ of _ D Boring 0 a so" L' y Pm ing _-L.. � ki. pit Ground surface Slay. ft. De to limit factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ff In. Munsell Ou. Sz. Cont. Color Gr, Sz. Sh. •Eff#1 •Eff#2 )v - r Hf S'G 2m C vy\� A .Z q� F # ❑ Pit Ground surface v. R. Depth to limiting factor ,(Q in. Soli AW11cation 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 Zrn w► ,, Z X" Lo / Ow l — Zwes� rv� C S C zo 16Z 0- 0 Bo pit Boring # ° ring around surface elev. ft. Depth to limiting factor in. Soil Noication Rate Horizon Depth Dominant Redox Description. Texture Structure Consistence Boundary Roots GPDM In. Munsell tau. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I Efllimit #1 SOD > 30 <_ M mpt and TSS >30 <_ 150 n9t • EfRusat #2 s BOD _ 30 mg& and TSS <_ 30 mgt 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. san- ruo�.sroo� • PAGE - 3 O F NAME e� 4.,v LOT# LEGAL DESCRIPTION 1 /a 1 /4,S iq T 30,N,R i,� SCALE: I" = SM I ELEVATION O BM I DESCRIPTION BM 2 ELEVATION BM 2 DESCRIPTION r SYSTEM ELEVATION SYSTEM TYPE ���, u z ✓L �. �a ; i I :D . I u I � J i SIGNATURE DATE l SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I mai RCEIVED as per management plan provided by plumber, 2. All setback requirements must be maintained APR 1 20� as per applicable code /ordinances� ST. CROIX COUNTY ZONING OFFICE Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7082 1 fisconsin Madison, W1 53707 - 7082 Sanitary Permit Number (to filled in by Co.) De artment of Commerce (608) 261 -6546 anitary Permit Application State Plan In accord omm 83.2 1, Wis. Adm. Code, personal information you provide may ed for secondary purposes Privacy Law, a15.04(lXm) Project ess (if different than mailing address) M I. Application Information - e Print All Information 92 I I YN P MOwn'Tame &reel # Lot # Block # V OWer Ma Address Property at - t we p Code Phone Number �� �'' tat 17 t rcle IL T N; R� Type of Building E g (check all that apply) Igor 2 Family Dwelling - Number of Bedrooms Subdivisio Name CSM Number -31 ❑ Public/Commercial - Desrn'be Use ' ❑ State Owned - Describe Use ❑City ❑V' ge Township o III. Type of Permit: (Check only one box on line A. Comple tin if applicable) 2(p _ _ 140 1/53 A New System — ys ❑ Replacement System ❑ Treatmen ding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑Chan f ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plum weer IV. Type of POW'I'S System: Check all that appl Non - Pressurized In -Ground ❑ Mound > 24 in. of suits soil ❑ Mound < 2 ' . or suitable soil ❑ At -Grade ❑ Single Pau Sand Filter ❑ Constructed Wetland C1 Pressurized In- Ground ❑ Ho g Tank ❑ Peat Filter Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leachin C ❑ Drip Line ❑ Gravel -I Pipe ❑ Other (explain) m V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate( so Dispersal Area Required (so ispersal Area Proposed (SO Syste tp Elevation p 70 / 1 9 , 36 / VI. t ank Info Capacity in T 1 Number Manufacture A Prefab Site Steel Fiber Plastic Gallons Ta G ons of Uni J _ J Concrete Constructed Glass New n king I Teaks Tanks Septic or Inkling Teak t� LK Aerobic Trenmcat Usk Dosing Chamber VII. Responsibility Statement be undersigned, assume responsibility for Installation of the POWTS sbo on the attached plans. be's a (Print Plum s �� MP/MPRS Number Business Phone Nu mber -Wei Plumber's Ad ( ity, State, Zip e) ^� VI . County/Department Use Onl Approved ❑ Di v Sanitary Permit Fee ' eludes Groundwater Date Issued I ui Agent Signature o Stamps) Surcharge Fee) ❑ Own en Reas for Denial IX. Conditions of Approval/Reasons for Disapproval � 5"CL C'k' (3q-) 3 A ) L OO tj s Sy - A x x 6 -3 0 6r 3 5,x.0 f-� �°� , qo r°f °f sal s Z.� ��" a8 gy.7 X i t -1 � ��aao 35 sy.�v� Vi=a 89.30 Wisconsin Department of Commerce. SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code n County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ` I include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. P percent slope, scale or dimensions, north arrow, and location and distance to nearest road. y Re�+ewed by Date ._ Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law,, s. 15.04 (1) (m)). ' W ritU Property Owner Property Locations Ir -e/ Govt. Lot Stl-� >Mt 1/4 S / T N R E (o W Property Owner's Mailing Address �jof Block At Subd. Name or M# / city tale Zip Code P one,Number ❑City ❑Village To Nearest Road New Construction Use:A Residential / Number of bedrooms Code derived design flow rate " GPD ❑ Replacement ❑ Public or commercial - Describe: - -___ __-------- - - - - -- - - -- Parent material ��G C Z`�C/ a �) iC/ Flood Plain elevation if applicable General mm en comments data and recommendations / / r Boring # ❑ Boring Pit Ground surface elev. � ft. Depth to limiting factor / Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 2 07 S s G r kll YL 3 y ® Boring # Boring R Pit Ground surface elev. ft. Depth to limiting factor I Z in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff #2 r am r (P 0 12 1 � o--; -- 2 -3X S �- CL- )ms b IL �4.o,tl�' o � 3 Z Os rn! n c r. z �. W, 3° Effluent #1 = BOD > 30 < 220 mg(L and TSS >30 < 1 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Pratt) e CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 /1— a 715 - 246 -4516 I Property Owner, Parcel ID # Page of ❑ Boring # ❑ Boring I Pit Ground surface elev. ft. Depth to limiting factor b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 1 o-z l 3 M( e S ®rh s .9 Z o 1 - sIq I L ms Ile F-1 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 # Ground surface elev. ft. Depth to limiting factor in. F 0 Pit Soil AtxAcation 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 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD <_ 30 n01 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 - 2648777. SBD -8330 (RAW) Soil Test Plot Plan Project Name Lakes and Hill Development Shaun rd Address P.O. Box 10598 White Bear Lake Mn 55110 CST4 #226900 Lot 2 8 Subdivision Glen View Date 7/18/03 1/4 N W 1/4S 1 9 T 30 N /R W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 89.7/89.4 *HRPSame as Benchmark Alt. BM Top of Survey Iron @ _96.6 Scale is 1" = 40' Please note: survey was not unless otherwise completed at time of testing, B M. noted setbacks from lot lines may change. Installer must verify M' 140' all lot lines and setbacks before installation. 10' 328' Property Line B -1 255' Property Line 4% Slo P 80 Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. B -3 50 B -2 94' 95' 96' = 7 t'7 V.- N ILMd lQ N N N h Ow 3l 3S N a ° j Cat - ______ ` of W Cq y W ,'',- � ' _�`` _- -_ 3 of ►�. 1 1 ' 1 � - - - -' ------------------ --- - - - - --- z a: - I 1 4C u 1 DO 7 1 1 m / .} / to \ t m� 1 i• w � / �'�8 / �n \ \\ 8 i 0R AINAGE I 1 �, �� / /m W ~ EASEMENT h i 'Z•BF / � tj' ;g 1 (�. Z 7 � h : MI La �Fti o! w LLJ E lm SA m m STREET UL Z blo o nYi LL ~ U c O% p i i C) W O J V L; I _ _ Z r - - - -- - - -- = 0 a00 } - v 0 c N Z, _ ��,0 - -- , y 000 �Z x Q O 9 LLJ M a a Y ) v LLJ ^OD O Z t - ZuZ V N LLJ 1-- S. Z J •� ; < W o w 4; F - W 3 O zo Z o � m 4A O LLJ � W CL (n a moavl Q co Q L6.a o a CL 0 Z o� r zm 0 d W F• Q' VI � POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a l ❑ NA Permit 49e , 3 4 7 - 6— j 2 S Septic Tank Manufacturer 11 NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al P Estimated flow (average) Q gal/day Pump Tank Manufacturer P NA Design flow (peak), (Estimated x 1.5) Q g al/day Pump Manufacturer IrNA Soil Application Rate al /da /ft2 Pump Model F' NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 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 /100m1 ❑ 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 ❑ month(s) (Maximum 3 ears) 13 NA ry' year(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA every: year(s) y Clean effluent filter At least once every: Cl month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) A ❑ year(s) ❑ month(s) Flush laterals and pressure test At least once every: E&A ❑ year(s) Other: At least once every: p month(s) e PENNA Other. I, NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 9p03 9n11eJis1u1wpy u!suoos!M '(£) 1 8 (Z) '(j)t+9'£8 pug (;)V(p)( l)(q)(Z)ZZ'£8 wwo� Jaideyo yunn eou911 wO3 u! p9:4 seen luewnoop s!yl a — auoyd au fYl f voz 4 ) j eweN GLUM A11a0H1m AlIOmnD3a IV301 (a3dwnd) ui01Va3d0 aNI01Aa3S 30V1d3S 9uoyd auo4d GLUM aweN U3NIV1NIVW SIMOd H311V1SNl SIMOd S1N3WWO3 IVNOI11aaV '3181SSOdWI Ii0 iimlddla 38 AVW )INVI V d0 U01831NI 3Hl WOW N0SH3d V d0 3n3S3M 'iinsm AVW HIV30 MONV1Swnou1O ANV ui3aNn )INVI 1N3W1V3HI 83HIO UO dwnd '3I1d3S V U31N3 10N Oa 'N3JAX0 mma(d nsm u!O /aNV S3SSVS 1VH131 NIVINO3 AVW SHNVI 1N3W1VR11 83HIO aNV dwnd '3I1d3S < <DNINUVM> > •ew!i ieyi le loe ; ;e u! s01nJ 9yl 4i!M Aldwoo isnw swelsAs yons ;o suolionJisuooeH •9oepns aA11eJ11! ;ul ayi le iewo!q ayi ;o IenowaJ Bu1Mollo; ooeld ui polonnsuooaJ eq Aew sweisAs u011dJosge 1!os apeJB -ie pue punoyy p )lue� 1L',�f)X1�Sn►�j /W3JY 2!� �� gl/-IQ�j� a ie e q Bwpl_� ou a a {g ^IDAD cl DAID t11D111d9D11�A1 fill �1 'DAID 7l1All1A!IP_I[�AJ alaeil�_ r �._._._ BaIP_ / //�I 'SIMOd pop; ayi eoeldeJ of lios9J isel a se polleisu! eq Aew luei Bu!ploy a ABolouyoGi S1MOd u! Saouenpe BuuJeq •suoliei!w!i 1!os Jo /pue joegies of onp algel!ene iou s1 eaJe luawooe!daJ elgel!ns V p •owll ieyi ie ioa ; ;0 ui solni ayi yi!M Aldwoo isnw swelsAs luawooeldoU eaJe 3uewooeldoi eigei!ns a ysilgelso of uolienlenG ails pue 1!OS Mau a Jo; poeu ayi u! 1 1nseJ Il!M eaJe luawaoeld9J ayi 3oaloJd of aJnl!ed •sllenn pue souy lot 'GJnionns posodoid pue Bulis!xe woJ; sjoegies peJlnbeJ Aq uodn paBu!J ;ui aq iou pinoys pue uolioedwoo pue eouegJnls!p woJ; paloaloJd eq p1no4s eaJe wewaoeldGJ ayi •welsAs uo!ldJosge I!os luawaoeldeJ a ;o uo!ieool ayi Jo; pazipn eq Aew pue p9lenlena ueaq sey eaJe wouisoeld9J algei!ns V :w9jsAs luawooeldaJ lue!Idwoo apoo a ap!Aoid of 'ue)ei aq isnw •Jo 'uoeq aney s9Jnseew Bu1Mollo; eyi paJ!edoi eq iouueo pue s!!e; SIMOd 9 41 11 NVId A3N30NIINO3 'IelJalew p1los lJ9u! JGyloue Jo IOAeJB 'I!Os 41!M pall!; coeds p!OA ayi pue penoweJ SJanoo J1941 Jo panowaJ pue p03ene3xa eq pet's si!d pue Sjuei 11e 'Buldwnd Jai ;V • JoleJadO BulowoS 9BeldeS a Aq ;o posodslp AlJedoid pue penoweJ eq Ileys si!d pue sluei Ile ;o sivaiuoo ayi 0 •poleas sBuluado edld peuopuege ayi pue peloauuoos!p aq Ileys si!d pue sluel of Buldid 11V o :GpoO aA13eJislu!wpV U1SUO3S1 '££'£8 wwoO Jaideyo yl!M eoue!Idwoo u! p euopuege Ala ;es pue AliadoJd si welsAs ayi ieyi emsul of u9jei eq Ileys sdeis Buimollo; ayi 93lAJas 1 1no uslel AlluauewJad s! Jo /pue sl1e; SIMOd ayi uayM 1N3WNOaNVBV •ou!Jq Jeuoi JeieM pue :suodwel :suj4deu A Jel!ues :seppasod :sionpoJd Bullu!ed :1!o :suoampow :sdeJos leow :sop!o14Jay :eseeJB :eulloseB :sBullood 9lgel9BGA pue 1!nJ; :JaleM (dwnd dwns) uleJp uoliepuno; :ie; :siueioa ;uls!p :sJadelp :Ssol; leivap :sJeseeJBap :sgenns uolloo :swopuoo :siinq auaJeBlo :sad!M Aqeq :so!lolq!lue :S1MOd ayi ;o a ;!1 ayi Buoloid pue aouewJo ;Jed ayi OAoidw1 Aew weeJis JaleMelseM eyi woJ; BulMollo; ayi ;o uo!leu!w!la Jo uolionpea •eaJe uolidJosge 11os apeJB -ie Jo punow Aue ;o adols u 1 I u!yi!M e9Je ayi 'ioedwoo Jo gJnislp asimiayio Jo 'Jeno lied Jo aA1Jp iou oa •spao IesJedslp pue SjUei Jeno 9810148A died Jo GAUP iou oa •juei dwnd ayi ulyl!M SIGAGI IeUJJOU 9JOisaJ of sloJluoo dwnd ayi Bu11eiedo Allenuew ut islsse o J9u!eiuleIN S1M0d Jo Jagwnld a ioeluoo Jo dwnd want; ;e ayi o JaM Bu!JoisaJ of JoIJd JoleJadO Bulo!AJaS 9BeidaS a Aq panowaJ jue1 dwnd Gyi ;o sivaiuoo eyi GAey uo!leni!s s!yl p!OAe of 'luanl ; ;a ;o oBJeyos!p 9oepns Jo dnjoeq eyi u! ilnsaJ Aew pue (s)11 ayi Bu!peOIJano '9sop aBJe1 GUO u! (s)II90 IesJedslp ayi of paBJeyos!p aq 11!M JaleMaiseM ssaoxa 941 p9Jois0J s! J9Mod uayM 'siGAGI JalennyBly lewJou GAoge III; Aew sluei dwnd seBeino Jennod Bu!Jno •ooe ;Jns OA!leJil!bu! 9 41 ie uezoJ; aie suoll!puoo I!os uayM Jn000 iou Ileys do iJels wG1sAS •asn of Joud JoleJado BU131AJGS GBeides a Aq p9AOUJ (s)Juei Gyl ;o Swaluoo ayi aney paloGiap We SU011eJluGDUOO 4 11 '(s)llao IesJ9dslp ayi GBeuJep Jo /pue ss000id luewieen 941 spedwl Aew ieyi sleolwayo Jeylo Jo sionpoJd Bul ;o eouesoid ayi JO; (s IM I UGUlle9J 1 100140 SIMOd 9 41 ;o asn of Joud 'uo!lonJisuoo Mau JOd N011VH3d0 aNV do luiV1S 2 10 2 aged ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSffW CERTIFICATION FORM owner/Buyer &j&M gr�� Mailing Address /j/3 A,4 —IPY A , ?J - t0 t Lo 1 S Property Address � Z 1 4 S (Verification required from Planning Department for now construction) City /State ,A)�-;j ,�� 1 ✓1 Parcel Identification Number oai - 1153 -a8 - WO LEGAL DESCRIPTION Property Location /., w ' /,, Sec. , T N -RW, Town of T11Got -� Subdivision _ -5- � V ��>� - Lot # Certified Survey Map # �- , Volume . Page # Warranty Deed # -1 q a � , Volume Page # (5 a Spec house ® yes ❑ no Lot lines identifiable 3 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. The property owner agrees to submit to St. Croix 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 113 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 Zoning Office within 30 days of the three year xp' tion date. _ /!o' SOS < �; GNA 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 (arc) the owner(s) of ; ;GNA property descri bov , by virtue of a warranty deed recorded in Register of Deeds Office. F APPLICANT DATE * ** *** Any information that is mis- represented may result in the sanitary permit being revoked by the 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 ' 792607 U 2 7 8 6 P 15 2 KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST. CROIX Co., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 04/19/2005 09:36AN WARRANTY DEED EXEIPT # THIS DEED, made between Hillvale Development Limited Liability Partnership REC FEE: 11.99 TRANS FEE: 264.30 ( "Grantor," whether one or more), COPY FEE: CC FEE: and Halle Custom Homes LLC PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is need e ease attach addendum): Lol 28 d 32, Plat of GlenVie in the Town of Richmond, St. Croix County, WistWsin. 026- 1153 -28- 000.026 - 1153 -32 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated (SEAL) (SEAL) * *Hillvale Development, L ited Liability Partnership (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signatures) authenticated on STATE OF ) ss. COUNTY ) a TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named Hillvale Develo men imited Liabili authorized by Wis. Stat. § 706.06) Partnership to me known to be the erson(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: ins ent and a n ledged the same. Attorney Kristina Oland Hudson, WI 54016 * L Notary Public, tate of My Commission (is permanent) (expires: (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. TraCy L. Turner INFO -PROTM Legal Forms 800 -655 -2021 w m.infoproforrns.win Notary Public State Ot Wisconsin State Bar of Wisconsin Form 2 -2003 WARRANTY DEED Document Number Document Name THIS DEED, made between Hillvale Development Limited Liability Partnership ( "Grantor," whether one or more), and Halle Custom Homes, LLC ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Lots 28 and 32, Plat of GlenView in the Town of Richmond, St. Croix County, Wisconsin. �� r ^ on l� 026- 1153 -28- 000,026- 1153 -32 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptionsto warranties: Easements, restrictions and rights -of -way of record, if any. Dated (SEAL) - -�' (SEAL) * *Hillvale Development, Limited Liability Partnership (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF ss. COUNTY ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named Hillvale Develo ment imited Liabilit authorized by Wis. Stat. § 706.06) Partnership to me known to be the erson(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: ins Ma n leldgJ�ed the same. Attorney Kristina Ogland Hudson, WI 54016 * ti L Li ✓ Notary Public, tate of My Commission (is permanent) (expires: I L -1 (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 (D 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. Tracy L. Turner INFO -PROTm Legal Forms 800 - 655 -2021 www.infoproforms.com Notary Public State of Wisconsin •• 19 �� �i SOUTH QUARTER CORNER • 86,087 S.F. / SEC. 19, T30N, R1 8W N FOUND 1 1/4 IRON BAR (1.98 ACRES) ' 3� s'� 3 / P7 3,11 i / REGMIMVS ST. CROIX CO. WM sl Received fo Record C tr A.D., 2Q 2 0 1 M. Rccorded V At 87,517 S.F. / (201 ACRES) / C') ; LE GEND GOVERNMENT CORNER (AS NOTED) • ____ FOUND 3/4' IRON BAR 2.08, N , SEI IGHING 4 0 RE 4 .30LBS./L.INEAL WE FOOT 1 91,5 4 , j 1_ SET 3/4' xx 24' IRON RE —ROD WEIGHING 39S �8 I / OTHER LOT CORNERS T AT ALL BENCHMARKS ON PROPERTY CORNERS [ELEVATION ELEVATION REFERENCED TO U.S.G.S. (NAVD 29) d3� 33, —.. — —PROPOSED DRIVEWAY LOCATION j 6 s , f J —RECORDED BEARING/DISTANCE 25 FOOT WIDE UTILITY EASEMENT ALONG ROADWAYS AS SHOWN ON PLAT i L.B.O. EL — 927.00 —LOW BUILDING OPENING ELEVATION H.W.L. - 920.35 —HIGH WATER LEVEL ELEVATION u 10 SZE r -- 100' N I THE NORTH LINE REAR 'FRONT rn 19, T30N, R18W I ; m 488 0 49'54 "E ll ► —� :OORDINATE SYSTEM) ' 1 10' 100, TYPICAL � UILDING OFFSETS 200' irwAl"mnn �r I Z O w Q Z I— J V h— LL- 0 ZO CL' Q p U cL z OJ o V) }' w CD Z w S OC) Z ' U 11-1 0 ~ Li— O w Ln Ld �— U 7 • W ?- p z C o w �-- w °- M s ^ CL_ ° ,bg ssl 04/19/2005 10:03 7152467227 HALLE BUILDERS INC PAGE 05 V VV) � 8 Q AA SW� a w ® Oar Q \ co � 4 h �/ ? rye„• � VL d Q , J LLli 0 � Z Z Q Z V7 Q O w wz LLI �Q STREET 0 2 o � ;, 9 A LL- 0 _ a -•� U Z l --