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HomeMy WebLinkAbout040-1278-80-000 .,nsin DeparV'lert of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix F,� afetyankUuildingf)ivisio6l INSPECTION REPORT sanitary Permit No: 404997 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: S asic, Slobodan I Troy Township 040- 1278 -80 -000 CST BM Elev: Insp. BM Elev: IBM Description: Z. . � Dj 4, s TANK INFORMATION ELF-VAIICY DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 9 Z4'91 Septic Benchmark �• � 3 � l ` � Dosing 1 Alt. BM C. • I D 4�. 3�• �� Aeration T � Bldg. Sewer 2. (b 4 733.11 Holding St/Ht Inlet 1 S 8 ,�� J U St/Ht Outlet TANK SETBACK INFORMATION C�'� �•�a `I �• b� � TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet JAJJL Septic } 5V W Z ' Dt Bottom Dosing 1 Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade \ PUMP /SIPHON INFORMATION L4 M tu 6 Manufac rer Demand St Cover J GPM Model Numbe TDH Lift ctl oss System Head TDH Ft Forcemai Length Dia. IL ABSORPTION SYSTEM BEDITRENCH Width Length _ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 t SETBACK SYSTEM TO P/L 15LDG IWELL LAKE /STREAM LEACHING Manufacturer: ,II INFORMATION CHAMBER OR $� 17C - �• Type Of System: � �,L� UNIT Mod umbEe - ^ l I/wo dta.� DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake i Pipes) �✓ �" S L I L Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes l No COM MENTS: Incl discre enc s, r4ons re nt, etc.) Inspection #1. l ft Z Inspection #2: ` 41 Z(- � Lo cation: 384 Cedar Crt. River Falls, WI 54022 (NW 1/ NW 6 T28N R19 ) EAGL BLUF Lot 28 Parcel 1.) Alt Description = l b I 2.) Bldg g s sewer length = �/ gzi2 •'� (a' z0 '� ' `• t �d amount of cover = Zq �4 !u• (� • 2 I S S' = ° IZ( •Z� \ Y> J - - - - #- r.-S Pla revision Required . k1141 Yes � o �i nal information �- i, ther si a or ad tio �-r• - � ' - ���LLL111 .p c}j 1 - - -j - .i — I Insepctor's Signature Cert. No. r Sanitary Permit Application Safety & Buildings Division In accord with Comm, 3.21, Wis. Adm. Code 201 W. Washington Aye. m See reverse side for instructions for completing this application PO Box 7302 * Wi l sco. ns lni Personal information you provide may be used for secondary purposes Madison, W[ 53707 -7302 Department of Commerce (Privacy Law, s. 15.04(l)(m)] (Submit completed form to county if not state owned. Attach complete plans to the county copy only) for the System, on paper not less than x I I inches in size. County State Sanitary Pe 't Number ❑ Check if revision to previous application State Plan I� . N C'ro 1 I. A lication Information - Please Print all Information Location:' Property Owner Name Property Location W1 14 n4j14, S It, T 28,N, \V Property Owners M 'ling Address Lot Number Block `umber 3 ka.n ak 2B City, State Zip Code Phone Number Subdivision Name or CSM Number tO c©d bC -e_ SSl2 c 9 - S6Gb E(Z /.e ❑ Cit 1I. of Buildin : (check one) ❑ Village 1 or 2 Family Dwelling - No, of Bedrooms :_ tG�E � Rlown of • Public/Commercial (describe use):_ V T o • State -Owned _.--- IN eazest Road PR 4 1 2002 .IL Cec�a.,- ono -i -Eo III. T e of P nit: Check onf one box on line A. Check box o line f G. ❑ Addition to A) 1. New 2. ❑ Replacement 3. Li ZQN Replacement of 4. - 1 5. Existing System system System Tank Onl Date Issued B) Permit Number ❑ A Sanitary Permit was previously issued IV. ype of POWT System: (Check all that apply) -)e �fo0 I2'14on r In ssurized gro In nd ❑Holding Tank ❑ Single ❑ Mound O Sand Filter ❑ Constructed Wetland ❑ Pressurized In p ass ❑ Drip Line g - P p 11 At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. D[s ersal/Treatment Area Information: (v 414k etti n '� Erb 1. Dc Flow (gpd) Dispersal Area 3. Dispersa 4. Soil A lication 5. Percolation Rate 6. Sy tam levat�on 7. Final Grad — ,./, inJ[nch ,1 Ele�at equired Propose 1n�9.�Y R at (M ) �Z•�7 ,6� 0. y 0 (p. it O v7/. 3 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crate structed I Tanks Tanks t4—) le 69w 5.•� l &0 — (QOO r tJ _e 5 e l ❑ ❑ ❑ ❑ cc Lae_ VIII. Responsibility Statement L "re under igred, assume res sibilit for irstal!ation of the POWTS shown on the attached plans. Busis Pl:ore Number Plus Name (print) P is Signature (no stamps): MP/MP loo. X2. 0 853 L� ( 3378 j Plumber's Address (Street, City, State, Zip e) 82 1Jald Win W I. SyDO.Z -- Ix. County /Department Use Only ❑ Disapproved Sanitary Permit Fee Includes Groundwater Date Issued Iss ing Agent S[gnatme (No stamps) Ap X. Condition of Approval /Reaso proved ❑ Owner Given Initial Adverse Surcharge eel Determination ' s n for �pp yal: 5 "%A1 L�� Kaw G a l - Q � C � C3 tn►,� -- ,r a�"" t a � • 3 3 �, � �'"" -�'° ►ems �(b i t 5 e-a&: Top of lob 5�e. clef Prot►" S s-E Aroa using (o / Tr,�a 'ti'ene�S a f, 3;ri15�zoin���- o- �"se�Jy One- / b Sys�e,n All �renc.�ees tube P 3. , Ace 6'ne,5 � proposed (,,9Q,! h t Proposed Sb v P2O 8 C q s� A.S.T..�l. 3o3s�P. ✓. C- e� /u� /.-ae.. Terr�por'4.y i � C�.L -cue -sac af�D "tx.bod'e� . Pro posed 1,MOA w�ty, V RECEIVED d a 2002 t3 APR ST. CROIX COUNTY Ka ZONING OFFICE r a � N - 6Wr �I 11 11 mOW U� c - , Ut '' B o W � o IIJG> o o � 0 B cm LA w s ZON w 09 -OS -oZ 0 r , y Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST. Ct2OlX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location G H fVKLES 5 . COO K .rev . Lvt- N Vj 1 /4 ,AJ W 1/4 S 1( T 2V N R Ili NOV Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# (I R 1 E"60J 5T. ME, sU✓tTT- 1 2$ - EAGX -rc B FI City State Zip Code Phone Number ❑ City ❑ Village tO Town Nearest Road INE M4 I 55LM 1 (763) - 757 -7,514 New Construction User Residential / Number of bedrooms Code derived design flow rate 1,06 ' " ? GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material SSW A S"i lyJ� Flood Plain elevation if applicable N • A .� . ft. General comments 3t�V(.I- mipj"IC-5 E0 and recommendations: �� , 1 e� NOV 200 Ud ST rQ wS 16►+A S COUN!Y A, ^, Boring # Boring , ;; ZONING OFFICE / ® Pit Ground surface ft. Depth to limiting factor 710 in. S ' A licatio 7 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 2 0 - for �2 I Z- &5 C 30► s a,8 2 -IZ oYK,�3 -" 1 Zvi'\ CS 0 5 o. 3 IZ-2-7 10`(►-4 I 1 rnsb cs Z 0.4 0.6 7-131, 1 0YP- - I rn d01 C5 z fm b,4 O,b t 5 3b IOYK� — S� I m mJ 6,k 2- VA 01 4 040 �, nA' p 10` 6 511 1 L th r a� ((• b.2- U.3 � 7 54-&9 1 7 � . 7 .JKYy 1 1 5 1 rn5u I MNITr I Q,tZ I I 11 Z- ° I ° b2-�j0 Boring — � f 5 055 m — 04 h Z Boring # R Pit Ground surface elev. _ ft. Depth to limiting factor _ 7q in. Soil Application Rate GYi Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. f r 'Eff #1 `Eff#2 10 312. — 15 (gym r S C5 3J4 0,1 112 z 5 -I2- 10 51 1 M-I r d s t; b 2 0 ,4 0, {, 3 1Z-Iq fob Z 5 dsh 2 +m 0.4 0.1. 4 -3b i n IK 43 — 5j Z PWO a z O. �5 OR a6�7 f ONK J 5 1 m sb m R, 2f- 0.'a 0.6 G 4 .516 0 rC 3 � — 5 £y r 5 ml 1 - F -M 0. 1,2 I� (0 5 O m i 0. I. Z t o3 ent #1 BOD > 30:5 220 mg /L and TSS >30 5 150 mg /L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L ST Name (Please Print) lure CST Number u,4g 3Z Address Date Evaluation Conducted Telephone Number I�gSd�b' (,q() hRkg FALL5 Lam• 54 022- I D- 2,5 -00 7 )S 4 Zb- 1�'T5 LM zg y Property Owner CNflt2lS _ Parcel ID # ^_ Page Z of Boring # ❑Boring .� pit Ground surface elev. gZ�o.50 ft. Depth to limiting factor 7 1e• 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 C) Z -11 3J3 f t I l ab Cs sh e� .z (3 3 3 I I -Ib 3 �4 S� rr�ab C- 2-f- m 0 •` i 0'(0 y Ib -Sp b y y b S rn) MI a s Z�- 0.'1 112 5 %-(.0 7.5 W . )%I J 5b M4fr I M D 01 K' 5 El Boring # E] E] ❑ 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 /fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E:] Boring a Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 L EE Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg /L and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD- 8330(R.6100) P�Of PLAN rpofft fY ovmr : C OOK AKALes L. CZ f7: I.�6AI.1I I Z (✓ C- LU.FF 13M- #I -?0 d AIL W UAR e CA Tti MWYLi of tiE e) DUNE) SuRFAC.E, 00 AZ— ToP a F see, 16 rzgN RI W - MWA) D 'F7riDY puc piP� 10 "AFove c- AouNDau.RQyE C o IS A)sI F - 1 - 501L PRING W/ PACKHa NO COMM 83 SNACK WOLUM5 LOT Z` l aZ 6$I; C18 -pub • � I tFj— - I ON SLOP EL921A C1 328G , ® E1.9 Zb" 50 EL 929,19 1 ID CBDPvf- . Z 6tAVE�R �� SSRTIOA) G n 51CUP C5f Ls 4� ZZ41?3Z �, SEC.110 VATS: 16-25'-00 HOLLISTER'S SOIL TESTING Mary J 8owster W4575 WO Avenue River Fa]L. WI 54022 (715) 426 -1775 aye t - LDSS+ D 6i NRL- 'P r.LZ 01MS C /L" X6 -1 _ I n� �? - . S Zvi L'Stp --- RECEIVED 2 ST. CR NING OFFICE �- . • 1 1 PAGiE �11F�. ..� R POT P�AN PIt Y ARK'S ' ' SI __� Sl lib ��" • �1 7 0 - LDT fOC FIDE !0 "A"AvG !�.IDMAR .Q Lt s r b 7 -sou. "m w� vKka NO COMM 83 5Ett3/a paO fM5 ® o � W o zv LU > L ' 0 V ° o z LDT 29 W WZ CL. o Q ) N � G]B -P4V, $� s �• Q, 5'v • P i C � � Q Base L 50 W rrL EL X00.53 f 1 1D s W- I \ STArt�ur1 PAQE y OF y CO OTO(XK L OES Lcrf 1u EAc;L !-LkFF q. go —29D E 298 i B -29C � j ` 7� 13 BA r j — 286 i B— 8C 843.0 r • y Wisconsin Department of Commelce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST, C 1�' 0 l x Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1) (m)). Property Owner Property Location GN f{ IZL E5 5, Uo K 6evt -Lot N Vj 1/4 AJW 1/4 S I G T 24( N R ) q NO Property Owners Mailing Address Lot # Block # Sutxf. Name or CSIVI# I I X500 A 6QM G0J 5T. N IOd Z$ - EAc -, 3u,xF�- City State Zip Code Phone Number ❑ City ❑ Village . tO Town Nearest Road BLA INC I MAI 5LIy9 1 ( 757 -V I "1A0 I 'T - D, New Construction Use: ;4 Residential / Number of bedrooms _ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material SANA L1 W L Flood Plain elevation if applicable N tt• General comments 3 1 4 1"Z>C*{ 1 F,:55 and recommendations: SUS�F� �lbV�tt ON of Zt (5�� a ca. , E] Boring l Boring # ` ® pit Ground surface elev. 1�( ft. Depth to limiting factor 7R0 in. -Soil ApplicatiorL Rate ; Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft? _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. �EI1-' - 'Eft #2 I 0- IO`1 ?J 2- I Z &5 C -36-f ,S 0- Z -Iz oYK�3 - I ZIM C-5 0•s o. 3 IZ-Z7 10y K.gl I I (K SbK c4. cs 1 Z- - vn o•y 0.e 2-1 31, 1 I� r I I rn d5Y1 C5 v4 b,4 0.6 5 3b IovK. - 5` 1 m 5b (Ks f OAZ 2 F-m 0, W. 10`jK ( Si 1 L - r a� 1 0.2- 0,3 7 54 7 - :50q - 15 1 MJ'r 0, U) 1 F 0,-7 I, z (,Z-.go Bonng - a .�1p) S 0 t'5 d. ► 0 13 Boring # �Iyeo Depth to limiti factor _ 7q in. Pi; Ground surface elev. ng- Soil iiption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. f 'Eff#1 'Eff#2 15 mcr S C,5 0.1 1.2 I Z dS Cb ?_ 0.4 0,L 5 -IL toy <312- � 5 � I rn -I r w� 3 1 L-Iq toll 7 -) n\5 Gl sh 2 0.4 0.6, I q -31 I o `F -13 - 51 Z TWO K � U , O. �5 OR a b } i 7 10 3 SI 1 msh fn �t Z�- 0.4 0-6 C. 47 6(o 10'4 IC3� '" 5 £r r 05 ml aw I-� -(A 0- I, 2 m i a,W 1. q , 1, Z by p �t 5 5r I 1 Effluent #1'= BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) lure CST Number AW 5D 1 200 Address Date Evaluation Conducted Telephone Number Wgq c qo•+�' At Z��E2 FALLS t.. -402-0 to - Zs -oo (�,$ )tize �Il75 t' LOT 22 y Property Owner _ CJQb CH FlRIXIs _ �I ,;� Parcel ID # _ Page of � ❑ C Boring # Boring ® Pit Ground surface elev. q 6 ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0=7 — X11 Z�-rn CS 3 - •S 0. Z -11 3I 3 J 1 1 alb( d sh C� z D 3 3 II -Ib 3 �4 J S� q ab d` C- 2--m O.4 0-(0 `i I6 1 0101 b — S rn� 0. If 12 S 50 7. `{ - D Z p 3 �v (,:,D- q3 K5 S ❑ Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. F—I E] Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i F1 ❑ ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots •Eff#1 GPDM Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 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 forniat, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. R.6f00 SOD-9330 ( ) Ill PLOf PLAN pAGE_OF PPOPEP OWNC�: oQK 'Nt\xL&c L. CZNV: U AI. CIS PI 0 ?T GAGLe LuFF 13Ma #I -?oPOF AIt_ w LP-Itie ?-�- CAT I Tti MW OF tiE 6R DU^1QSafAce. A2 - - 'TOP 0P sEC,I(,, T z4f 1J R 1 W 7 bwA) 0F"rt20`/ puc pips )o "AP,pve c couA�E) --kk9,00cl CRoi k T ISC .0 S I til . r—l-5011. C30t;IN6 W/ f3ACKNa NO COMM 65 5VTPACK PPON W5 o LOT Z'� (_0 FL 5.33) P,m 4 0 �L g 2b ,50" 0(0 SLDP� aS �S C i q � g qLI EL 929,19 1 ID 1 COuyz� LCAe gw� Z 47— -� x � St A 4 51CAW9 C5t c �` 5 EC.Ito PAT: 10 -25-00 fie y y COnn'Ow2 WOES LcFr — -- 1 N F1'S+ -E ISLU.F F t� . go t —29D 8 298 i P % 'B -48A 1 K I • { 1 I lI / ,� -288 943.0 ;; BidDif f user S r� 76" ��00 OO OO 00 O� O OO 00 00 DD oO O[� oo DD o0 00 0o OD OD OD OO oo DO OO L�� OO DD Chamber OD DO 00 OD OO OO OO DO OCR Heigh! } � 0 00 00 00 00 � o 00 00 00 � 0 00 00 00 00 00 00 00 0 I o0 00 00 00 E== oo �0 00 00 z �r ins Ma z i M Chamber Height -for 4' O End View — Ca�acik�io � A m� f; 34" re uired for n { i 4 Knockout Universal End Cap Available Sizes I f fi s ; 6 }�.. r �!� 1� id yy 4 t , �4 34 17 � He!ght 11�� t Pt 'Invert,C 9 11.3 g r Conventional System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (8.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall ad ' owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. Th outlet filt shall be cleaned as necessary to ensure proper operation The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to your county zoning or health inspector. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBEMBNT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 73 9 Za �► da u a 16 Property Address 3 (Verification required from Planning Department for new construction) 7 lSbo) City/State l i d e Ctl Parcel Identification Number bV6 - /z7r -^ YO LEGAL DESCRIPTION Properly Location 17 cJ %4, A W i /4, Sec. T — Z-6 N -RAW, Town of 7 / o)�_ Subdivision E A dlu Y . Lot # Z� Certified Survey Map # — , Volume — . Page # Warranty Deed # (o7 Vq- 7 ( , Volume / � O Page # Spec house ❑ yes L7 no Lot lines identifiable Ery'es ❑ 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 mas pl journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zo ning Office within 30 da expiration date. � / 2-1 02 SIGNATURE OF APP ANT 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 the p perry described above, by irtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLIC 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 • STATE VAR oJAfi'IEIIi FORl 19J8 Er 7 4 4 7 8 WARRANTY DEED KATHLEEN H. YALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between - 03 -25 -2002 11:30 AN Troy Development Corporation, a Minnesota Corporation - i1nRRANT)' DEED Grantor. EXEMPT 4 and ` 't I t AS i �' REC FEE • 11.00 4{ M> r> D a •- W A g. TRANS FEE: 269.70 - COPY FEE: _ Crantee. PAGESCOPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County. State of Wisconsin I l : ••i.e ,t •vrn (the 'Propertyl: Nara and Return Pgdssa Lot of the Plat of Eagle Bluff in the Town of S O dam Troy, St. Croix County, Wisconsin. � L e- Subject to Declarations of Covenants, Conditions and Restrictions for Eagle Bluff, recorded in Vol. 1589 page 516 , as Doc. No. 638946 , as appearing in U - Nx - `'S r the office of the Register of Deeds for St. Croix County, Wisconsin, and such other easements, O y0 _ restrictions and reservations of record, Or. in use, Parcal ldanlitcation Number(PIN) and the , Buyer ,, obligations contained in the This is not homestead property. Purchase Agreement for this lot. (is) (is not) Together with all appurtenant rights, title and Interests. Grantor warrants that the title to the Property is goal. Indefeasible In fee simple and free and clear of enaunbrances except Dated this a '4'N- day of ' ��aVL�L. s (SEAL) (SEAL) Charles S. Cook, President Troy Development Corporat on (SEAL) (SEAL) - AUTHENTICATION ACKNOWLEDGMENT Minnesota Signatures) State of LVi•seenakn s s. _AnOk71 _ __ Got,niy. Personally came before nu tills �' b day of authenticated this day of ,N1 1_ , �,�01 , the above named Charle S. Cook President Troy nevelopment Corporation to TITLE: MEMBER STATE BAR OF WISCONSIN who executed the foregoing (If not, me known to be the person �_ I authorized by §706.06. Wis. $tats.) ns / tn / unent and arknow!M c tile same. THIS INSTRUMENT WAS DRAFTED BY Troy Development Corporation _ Rick Johnson Notary Public,Sww.nCy4%Qack Anoka County, Hinn. Charles S. Cook, President My commission Janua Is permanent. (if not, state expiratlnn date: (Signatures may be authenticated or acknowledged. Both are not r. 31 2006 .) necessary) •N.nr...tlx„uxa,Igab,gm,ny ulw „x u, h ,yl,eaa , Pr,n Jbelow,t - ", syVounr. w„eanm L.aa elan. Co ..W STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 1 - 1988 VVVV� ►s RKA JO I�41ON WOODNr I ■ ■ CQNTYswim cm" . I� IN�T130 "*K IIA • e MAMMY GP. F01N0. 0 � - • 11101 PIPC- FOUND (OIAMnU WM). M11La110 Sum= LIM 1 1.000 4 ■ 3/4 RED FOUND. 10' W109 1RILITY EA1b 2 x 30" IRON PIPE %WIGHING 3.63KINEAlt OMI1M09 E400M (01111 o FOOT. SE 1 x 24" IRON PIPE NEIGHING �� BVILa1N0 L1 � AND SET AT ALL OTHER LOT VAIZIAN0IE 0 1 x 24' IRON PIPE WEIGHING pm lo-my Imp INF a I- SWLINEAR FOOT. SET. OF 1EcaPf" UNRA TTED LAND N 811'69' 00" E 2614.30' NORTH L K Of CORNER 57mr Isom SECTM 17 T211K RR I VW c 1306.15' m C 1.286 ACRES 20 7. A SF. \ 311.4 13 SF. 2.544 AGES 4g OUTLOT 4 11o.11w Sr. 4A= ACM \`/ w � 192.768 SF. ` f R-110' .. r ' \ T OP OF 1 PE W A .00 1.182 ACRES ZZ77jj S 1.478 Sr. Z169 ACIM w • 94x4116 SF. • I 7 . • TOP � 2.518 ACRES 1 (NAVO27) 232 •' 109.0113 S.F. 1.477 CN .036 6 17 — 101, 45.953 SF. .277 ACRES I — s A7, 22 . ORANA I $ 20011 A CM ' EARIA 4 9 2 sF. i CL C41 , 20P — I 30 31 1 .2211 ACRES 3 • '" ,.299 33.609 SF. s 56,680 sF s 25 • 33 � 32 ,.202 ACRES 52.34s Sr. e9,bs 34 .r ► i. s 29 Or 1.093 A 47.1119 � � 'c Q' 26 �• 1.164 ACRES 1 30,701 S.F. OMOT 5 r ` 3.461 ACRES 28 134.8113 S.F. ° , 27 ACKS 1 32.284 SF. , ACHES 53 .9011 SF. THE NE I 12CLAr Li41ZR1 , — 1119.26• MO LAND I �'L7J 3 am'r 5 , . - S0 M LIM OF THE NW 1/4 OF THE R11 1/4 r ` i r J r f � 0� g V C� oil zy � � I W l �2 0 i