HomeMy WebLinkAbout040-1310-00-019 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 488235 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:
Warner, Phillip & Kristi Troy, Town of 040 - 1310 -00 -019
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
f t� PO PA 17.28.19.2006
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 3 Benchmark
we'e.'kS c /Z(0U 7,�3 Joz.e3 i�
F') P to k - 57,5 FA, Alt. BM z.-%:5 99.78
Aeration Z , G; !�.` Bldg. Sewer
3•�3 99
Holding St/Ht Inlet
�,b5 95.5
�ls • (03
TANK SETBACK INFORMATION St/Ht Outlet 7• b
TANK TO PIL WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic r Jj Dt Bottom
1 74 - S 7 S>' S � (03 �--
Dosing Header /Man.
7.1 Q'{.q3
Aeration Dist. Pipe
Holding Bot. System
PUMP /SIPHON INFORMATION Final Gr �ad s• Z 7y Y3
r � ie ac- �--
Manufacturer Demand St Cover ,V. II ,, xY
GPM �NI >PA" C oy 2.15. • D
Model Number
TDH Lift Friction Loss J S7!m Hea T Ft
Forcemain Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Tre nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L jBLDG IWELL LAKE /STREAM LEACHING Manufacturer: n ,
INFORMATION CHAMBER OR
Type Of ` / > g� / /� f UNIT Model Numb
o
DISTRIBUTION SYSTEM ZD r ZO+ZU = So b
Header /Manifold �� Distribution x Hole Size x Hole Spacing Vent to AirJ�takp�
If Pipes) / r d
Len th Dia Length Dia Spacin
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over / Depth Over xx Depth of eded /Sodded xx Mulched
Bed/Trench Center -5.6-7 Bed/Trench Edges \ Topsoil \ T <es Q No I es Fa� No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 477 Meadow Ridge Trail River Falls, WI 54022 (NE 1/4 SE 1/4 17 T28N R19W) M ( adow Ridge of Troy Lot 19 Parcel No: 17.28.19.2006
lvE coo. I'_ 6'z cz je� i aco. A ► 5
1.) Alt BM Description = �
2.) Bldg sewer length - amount of cover = y Z r
Plan revision Required? 0 Yes >(No
Use other side for additional information. 75�
SBD -6710 (R.3/97) Date Insepctor's Si ature Cart. No.
Safety and Buildings Division County
s 201 W. Washington Ave., P.O. Box 7162
seonsin Madison, WI 53707 - 7162 Sanitary Penn# Number (to be filled in by Co.)
1 (608) 26 1
F N i
ar tment of Commerce
Sanitary Permit Applieati State Plan 1.9. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal information y ovide !�
maybe used for secondary purposes Pri .04(Ixm) Project Address (if different than mailing address)
I. Application Information - Please Print All Info tion
Property is Name l
9 4 2C�� Parcel # Lot# Block
Property Owner's Mait&g Address COUNTY Pr6perty Location ./
W Zi Code
- %, —%, Section C �
p Phone Number
-(circle )
T R Cr E: f Building check all that apply) na y / , / -
I or 2 Family Dwelling - Number of Bedrooms v Subdivision Name fiber
❑ Public /Commercial - Describe Use
❑ State Owned - Describe Use City ❑Village,Township of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A_ New System ❑ Re Y ep S ystem ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner A � A
IV. T of POWTS System: Check all. that a (/ "
g 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 ❑ Holding Tank ❑ Peat Filter . ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel Pie ❑ Other (explain)
V. Dis ersalfrreatment Area Informa on:
Design Flow (gpd) Design Soil Ap lication �rte(gp�sfj Dispersal Area Required (sf) Dispefsal Area Prop (st) System�levati�
� -� yy s i
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel ibex Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank _
Aerobic Trc=Q Unit
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, asspine responsibility for installation of the POWTS shown on the attached plans,
Plumb 's a Print) Plumber Si MP/MPRS Number Business Phone Number
Pl ber' Address (Street, Ci State, Zip e)
VIII oun /De artment Use Onl
Permit Fee includes Groundwater D Issu Iss
Appr Sanitary oved ❑ Disapproved Surcharge Fee) ( G // B Agent 'gn (No ps) c
❑ Owner Given Reason for Denial 60 / !O
IX. Conditions of Approval/Reasons for Disapproval (3 J D / ' t� ' �J o" O s-J
SYSTEM OWNER: �('
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach eomph:te plain (to the County oaly),for the system on paper not lsz than 8112 : I 1 i a in� / � / � J �
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SBD -6398 (R. 01/03)
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Wisconsin Department of Commerce SOIL EV ATION REPORT Page Of 3
Division of Safety and Buildings
in accordance with Comm Wis.
County
Attach complete site plan on paper not less than S 1/2 x 11 inches in size. m
include, but not limited to: vertical and horizontal reference point (BM), directio nd Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nea t roam
Please print all i rma*W— y y E J v E p R sewed Date
Personal Information you provide may be used for secon ary purposes (Privacy Law, a. 15.04 (1) m)).
Property Owner t ! 4 2 Tparty rcation
` ° Govt. Lot - 114 114 S N R (or) W
Property Owner's Mailing dress ST. CROIXCO I Blo # Subd. Name orCSMff
City State Zip Code Phone Number ❑ City ❑ Village 2 Town Nearest Roa
New Construction User Residential / Number of bedrooms Code derived design flow rate e' fl/? GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material z Flood Plain elevation if applicable ft.
General comments /
and recommendations:
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. *Efr#1 *Eff#2
Ik
I �3
r A
4� er
Ae
5
❑ Boring # Boring
® Pit Ground surface elev. J e_ ft. Depth to limiting facto 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
1
* Effluent #1 BOD > 30 220 mg1L and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mglL and TSS _< 30 mg1L
CST Name (PI ht) Signature CST Number
r /
Address ,� ate Evaluation Conducted Telephone Number
41
Property Owner Pareal ID # Page J of
7 Boring #
❑ Boring
pit Ground surface elev. 9 ft. Depth to limiting factor 5 / / i^ in.
- Soil Application Rai
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f'f
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E
t 7
4
G 4
a ? — c
❑ '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/fP
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 Ram
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
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/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.07 /OD)
y
.ga —
de �-
Wisco nsin Department ofCommeme EVALUATION REPORT p 1 of 3
Division of Safety and Buildings
in a Co 85, Wis. Adm. Code
Attach complete site plan on paper not 81/2 County St. Croix
include, but not limited to: vertical and ho Mal re poi Parcel I.D. pi g 12 percent slope, scale or dimensions, north arro d I ion and distance to nearest road
Please print all inform tion. S E P 2 1 2005 Review y D
Personal information you provide maybe used for secondary rposes (Privacy Law, s. 15.04(l) (m)).
Property Owner ST. CROIX ca " ® 0
DCCI Land Planners Inc ZONING 1/4 SE 1/4 S 7 T 28 N R 19 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1 505 RWY 65 19 1 1 Meadow Ridge Of Troy
City State Zip Code Phone Number []City Village ■ Town Nearest Road
New Richmond i WI 1 54017 ( ) East Cove Road
New Construction UselD Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
0 Replacement Public or commercial - Describe:
Parent material Loess over glacial till Flood Plain elevation if applicable W A ft.
General comments *with several continuous layers, I" sl, Om, 5yr414
and recomm¢ndatt'ons: �--
� I � u /Y1ev e. 'k or t+ Cge.Sle.
F71 Boring # 0 Boring
Pit Ground surface elev. 959.55 ft. Depth to limiting factor 1 >100 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -7 10yr3 /2 sil 2msbk dsh as 2f .6 .8
2 7 -20 1 1 4/4 - sil lmsbk dsh cw If .4 .6
3 20 -37 7.5yr4/4 sl Otn dh cw _ .6
4 37 -57 7.5yr4/4 Is* Osg* dl cw - 2* .6*
5 57 -100 7.5yr5/6 s Osg dl - - 7 1.6
2 Boring # Boring 960.18 >90
El Pit Ground surface elev. ft. Depth to limiting factor 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 0-6 10yr3 /2 sil 2msbk dsh as 2f .6 .8
2 6 -22 1 4/4 sil lmsbk dsh cw if .4 .6
3 22-37 IOyr4 /4 - is Osg dl cw _ .7 1.6
4 37 -90 5yr4/4 sl Om dh - - 2 .6
* Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 0 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Thomas C Nelson 1 ' ` 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 9/18/05 715- 246 -2454
Property Owner DCCI Land Planners Inc Parcel ID # Pending Page 2 of 3
Boring
[- 3 Boring # Q Pit Ground surface elev. 965.81 it Depth to limiting factor X90 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texturs Structure Consistence Boundary Roots GPDlfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
1 04 10yr3/2 - sil 2msbk dsh as 2f .6 .8
2 7 -24 1 4/4 - sil Imsbk dsh cw if 4 .6
3 24-40 10yr4 /4 - is Osg dl cam' - .7 1.6
4 5yr4/4 - sl Om dh - - .2 .6
F-1 Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2
F 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. '001
'
Effluent #1 = BOD > 30:5 220 mg/L and TSS >30:5 150 mg/L ' EfBuenl #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.
SBD- 9330Test (R07/00)
OCCI LAND PLANNERS, INC. ' ® SOIL BORING •
G •
Lot # 19 - MEADOW RIDGE OF tROY
E i OF THE SE 1/4 OF SECTION 17, BENCHMARK
/4 i •
T28N, R1 9W, TOWN OF TROY, ST. —TOP OF CONDUIT , ,�
CRODC COUNTY, WISCONSIN. ALT BENCHMARK ± + •
—TOP OF CONDUIT — --�
TOM NELSON CST - Lie. # 227387 -N NOTE. THE CONTOURS IDENTIFIED • •
ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION.
, •
CONSTRUCTION GRADING WAS IN ►•r,
1432 120TH ST. PROCESS DURING SOIL TESTING.
NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED TO s ,•rn •
ph. # 715- 246 -2464 CONFIRM FINAL CONTOURS •
DURING INSTALLATION. o•+�a
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SCALE iN FM 1' 4O' •
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1 100 D 100
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61.55
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09/26/2000 10:40 7152473038 BELISLE EXCAVATING I PACE 01
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
O NER H1P CERTIFICATION FORM
f ' C � n
Owner/Buyer
l _
Mailing Address��'
# 1
Property Address
Tr
(Verification required from Planning Depattmen for new construction)
City /State z o - A> Parcel Identification Number
GAL DESCRIPTION C c k Property Location � '/4, 7� '/,, Sec. T - W, Town of rd
Subdivision Ma 0 Lot q
Certified Survey Map t{ , Volume , Page #
Warranty Deed N ��? Vb Voruncc . Page p
Spec house d yes no Lot lines identifiable yes ❑ no
SYSTEM MAINTENANCE.
improper use and maintenance of) our septic system could result in its premature failure to handle wastes. Proper maintenancc
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 Ruction 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, testricrc(l plumhcr or a licensed pamper verifying that (1) the on -site wastewater disposal system
rs in proper operating condition andior t2) after rn speoicin and pumping (if necessary), the septic tank is less than 113 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage dispoaat system with the standards
set forth, herein, its set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cen tfiCa"Un
stating that your septic system his been must be cnmpicled and returned to the St ( County Zoning Office within 10
days the three year c ration date.
6 d)-io 6
S GN F APPLICANT DATE
A
OWNER CERTIFICATION
I (we) terrify that all statements on thus form are ttuc to the best of my (our) knowtcdgc t (we) am (are) the owncr(s) of
the 91V perty described sho by venue of a � deed recorded in Register of Deeds Office.
SI NATURE O APPLICANT DATE
••• « «" Any information that is mts tcprescntcd 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 decd
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 2 of
FILE INFORMATION _ SYSTEM SPECIFICATIONS
Owner � Septic Tank Capacity ga l ❑ NA
Permit # Septic Tank Manufacturer — S ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms
-1 ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units IYNA Pump Tank Capacity al ONA
Estimated flow (average) gal/day Pump Tank Manufacturer J21-NA
Design flow (peak), (Estimated x 1.5) - gal /day Pump Manufacturer _,9 NA
Soil Application Rate gal/day/ft' Pump Model M NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 4!�,.NA
Fats, Oil & Grease (FOG) :_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD :_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD :_30 mg /L 0 In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) :_30 mg /L I 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 every: '7 ❑ month(s) (Maximum 3 years) ❑ NA
5 13'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: 7 ❑ month(s) (Maximum 3 years) ❑ NA
Jff year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
_FZ year(s)
Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ year(s) �
Flush laterals and pressure test At least once every: ❑ month(s) aNA
❑ year(s)
Other: At least once ever ❑ month(s) NA
y' ❑ year(s)
� Other:
❑ 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.
START UP AND OPERATION Page ' of
For new 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 cell(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 ca of be repaired the �ingmeasu been, or mu t be taken, to v' e a ode com liant
�'n P replace ent system: Gl7ak
VA suitable replacement area has been 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
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone 5 — Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f► and 83.5411), (2) & (3), Wisconsin Administrative Code.
i
$6840
KATHLEEN H. WALSH
Document Number WARRANTYDEED • REGISTER OF DEEDS
ST. CROIX CO.. NI
THIS DEED made between DCCI Land Planners Inc., a Wisconsin RECEIVED FOR RECORD
Corporation ( "Grantor") and Philip C. Warner and Kristi K. Warner, 06/06/2006 10:45A?i
husband and wife, as survivorship marital property, ( "Grantee "),
WARRANTY DEED
W ITNESSETH, that the said Grantor, for valuable consideration EXEMPT #
conveys to Grantee the following described real estate in St. Croix County REC FEE: 11.08
State of Wisconsin: TRANS FEE: 312.60
COPY FEE:
RecDrd Area C F EW
Name and ReW
Lot Nineteen (19), Plat of Meadow Ridge of Troy, In the Township of � 10 00 13 St
Troy, St. Croix County, Wisconsin BOX 1 0
Balsam Lake, Wt 54810 -0010
Part of- 040 - flt;9 -95 -000 ;
040 - 1070 -10- 000;040- 1070 -20 -000;
040- 1069 -80 -000
This is not Homestead Property.
Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC, Divine LLC, or Dreamstructures,
Inc. will be the builder of the home to be constructed on this lot
Dated this = day of)—&y, 2006.
DQQLLa nnem. Inc 1
orporayNtme
u c
k den
hael R. ravens Secretary
STATE OF WISCONSIN
ST. CROIX COUNTY
Personally came before me this 23rd day of May, 2006, Ronald L. Derrick, President, and Michael R. Stevens,
Secretary of the above named Corporation, to me known to a persons who executed the foregoing instrument
and tome known to be such President and Secretary of — ;!! Sr , n, an i dg ad that they executed the
foregoing instrument as such officers as the deed of said rporation, b Its a y PAMELA J. RUTI EDGE
NoWy
THIS INSTRUMENT WAS DRAFTED BY amela . Rutl n
DCCI Land Planners, Inc.
PO Box 445 Notary Public SL ix Coun Wi onsin.
New Richmond, WI 54017 My Commission Expires: July 27, 008.
Iofi
Parcel #: 040 - 1310 -00 -019 06/19/2006 05:03 PM
PAGE 1 OF 1
Alt. Parcel M 17.28.19.2006 040 - TOWN OF TROY
f Current Al ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
10/20/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - DCCI LAND PLANNERS LLC
DCCI LAND PLANNERS LLC
PO BOX 445
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 477 MEADOW RIDGE TRL
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 0.000 Plat: 10 /085 - MEADOW RIDGE OF TROY LOTS 1 -31 040/0
SEC 17 T28N R1 9W PTS NE SE & NW SE Block/Condo Bldg: LOT 019
MEADOW RIDGE OF TROY ('05) LOT 19
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
17- 28N -19W NE SE
17- 28N -19W NW SE
Notes: Parcel History:
Date Doc # Vol /Page Type
10/20/2005 809848 10/085 PLAT
01/18/2005 785170 2732/370 EZ CON
01/14/2005 785053 2731/551 WD
02/13/2004 754206 2509/328 WD
more...
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 02/2112006
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 M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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