HomeMy WebLinkAbout040-1249-80-000 I
n N O !, 3 T n r_
°c f
,00 d h.
`°
��', (D
�.
fD v m
n
(n 3 7. z v, z o ca 0
C1 (O Q. rt � y W OD D�j C Q
N� j C N 1
OD - W (D m �- 0 (D A O
N N N CL 3 Q 3 N
o o m W O
N OD A 3 CD C a O N O 25 6 ^�'r
f�/1 f W O Q
p
w ? N C p
OD CA) CL N
CD
�_ _
N N p "^ f N C
Z i�3
0 0
O 0
O O yr �:' n r N
ti m o? '' 3 0 ca
° 000' �•
0I3 ODg
y ° °
SN
p o K ZD o
o
O „ w
N m =r N
N .
C) 0 O N o N
OI Q
=r N
0 a
w
CD
w � N
o
N Z <D
A z
CL''',i
fD ID 1 < N fO
OD
CL N Z
O ! Z
O CD
N A <
I A f
I
D
°- I
a �
0
T
w c
o z a
z
co o
I
I 'I
i
I
I �
A
l � �
A
O
CD J,
C
p Q ti V
O a a
O CL ti
( PL� Fswe,,
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.o4 (1)(m)]. 38383
Permit Holder's Name: ❑ City []Village ❑ TRwn of: State Plan ID No.:
de and Eric I Troy Townshi
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
6D I b 1 (50 .0 1 r 1 N-� a', j v\ , � e 2 C ST � * # - 1 ?49- 190-000
TANk INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ��` 2_1:�0 Benchmark o o U , 3 .03r
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St /Ht Inlet 05 •�:3Z
TANK SETBACK INFORMATION St/ Ht Outlet 2 v , t:+
TANKTO P/L WELL BLDG. Ventto
Air Intake ROAD Dt Inlet
Septic ,5 o' 3 / —� NA Dt Bottom
Dosing NA Header /Man.
dD
Aeration NA Dist. Piped
Holding Bot. System
PU / SIPHON INFORMATION Final Grade --,,
Ma facturer Demand t cover 6, 3q • D 3
Model er GPM
TDH Lift Friction System DH Ft
F cemain Length Dia. I f Dist. To Well
OIL AB ORPTION SYSTEM
ENCH Width Le ng h Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
A \ DIMENSION
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manu er.
SETBACK CHAMBER
INFORMATION TypeO r , Mo d I Number:
System: Cov v, p [- OR UNIT
DISTRIBUTION SYSTEM
Header / Mani ol I Distribution Pi s) x Hole Size x le Spacing Vent To Air Intake
Length Dia. Length 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 ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: e1 /ZI / cal Inspection #2: — f--f -
Location: 273 Toon Court, Hudson, W1 54 1 (W 1/2 NW 1/4 19 T28N R19W) - 1928191300 Troy Village -Lot 58
1.) Alt BM Description = Ulbe. S 7, CAM> 1
2.) Bldg sewer length=
- amount of cover
Plan revision required? ❑ Yes 9 No
a
Use other side for additional information. . DS 2ec
SBD -6710 (R.3197) Date Inspector's Signature Cert. No.
Safety & Buildings Division
a-� 3 t2ooN C Sanitary Permit Application 201 W. Washington Ave.
In accord with Comm 83.2 1, Wis. Adm.,,C c PO Box 7302
�� , /
w See reverse side for instructions for compl tin '�h�lyft/ Madison, WI 53707 -7302
nsi u provide may be e condary purEio county if not
p lion o form to co
�J �► information Y 't completed f
x Personal Y P Submr p tY
O°pticrment;oE.:Cammeree (Privacy Law, s. 15.0 1 3Ol i :30 ll p C ✓ state owned.
Attach co m Ietc plans to the count co only) for th s s m, on t s than 8- 1 inches in size.
County State San Permit Number ❑ Chec i(fc 'Sion to previqus app 9A S c an 1. D. Number
ca io
.A lication Information - Plcase Print all Information n:
Location
Property Owner Name / UJ
. E r t L 4, SOT ,N, W
V Block Number
Property Owner's Mailing Address f r i - , \ ,v.yti t Number
Zi Code Phone Number Subdivision Name or CSM Number
City, State P e,
11W � I 01
❑ City
Il. Type of Building: (Aieck one) ❑ Village
9 1 or 2 Family Dwelling - No. of Bedrooms : JS Town of
Public /Commercial (describe use):_
❑ State -Owned
Nearest Road a-
Parcel TaxNumber(s)
6 t o R
III. T e of Permit: Check only one box on line A. Check box on line B if applicable)
9. O
A Existing S steo
m
) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition t
System System Tank Only Date Issued
B)
ber
❑ A Sanitary Permit was p reviously issued Permit Num
OWT System: Check all that apply) ° — t
N. Type ss P r ( ❑ Sand Filter ❑ Constructed Wetland
�1„Non- pressurized In- ground ❑Mound
• Pressurized In-ground , V ❑ Holding Tank ❑ Single Pass ❑ Drip Line
• At-grade 3 X 1n6. Z ❑ Aerobic Tre
a ent Unit ❑ Recirculating ❑ Other:
V. Dis crsal/Treatment Area Information: CA9
1. Design Flow Dispersal Area 3. Dispersal Area 4. S 'Application 5. Percolation Rate 6. System Elevation Elcvat n radc
Required Proposed Rate (Gafslday /sq. ft.) (MinJ ch)
� �' 8 r 3,_
8 37 t `� 10
Capacity I
Ca
Total # of Con- Con - glass
Manufacturer Prefab Site Steel Fiber- Plastic
VII, '
' � ank P tY in
Information Gallons Gallons Tanks
crcte structed
New Existing
Tanks Tanks ❑ ❑ ❑ ❑ e
❑. ❑ ❑ ❑
VIII. Responsibility Statement
1, the undersigned, assume res orisibility for installation of the POWTS shown on the attached plans. Business Phone Number
Plumber's Narn tint) P umber's Si a (no stamps): MP/IviPRS N °• ��3J
a�os37 1 »s - ay -
Plumbees Address (Street, City, State, Zip Codc)
IX."County /Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signature (No stamps)
I�Approved ❑ Owner Given Initial Adverse Su Fee)
Determination Q arge Q 6D Z
X. .Qnditions o �A�prov /Reasons for Disapproval: s s� Pecs �Qt - 6 —".k M,1,- soy � �aQ
�.
�.,LA.Wj re CA
is •�e+' `� - P�.�.es'w, r•c. � t�9+tiC�• �•a.e �°�'' S u.� rw� � {�. � e� ct
Co� 5 wc,�. oo ao�► �b6�1S 1
k
c
i I rl L6 E I I N I 8
,
,
i II � I``
,
I � I
_
I
f
537 `
t I ,
3 , I
ZE
t i
I
, (
1
;
:
1 i i
� I r!
j
r
1
Es�ijke'
� I
I v i I
i
22
E ,
1
I � !
f L 1
6 i
, I
, y
,
E �
_l L_
,
,
I I i I o
— }—
C I i I f
I ' '
' I I
c I
,
,
I E
; r
_
i :
,
• I _ .
I
s
I
:
t ! f
i
i � t
1
I
I
;
s
l�
I �
f
,
i
I
i I j
I ;
' I
I
, I
• I I ' ' � f i . i � i
'
;
i 3 I I
I
I
i 1
;
,
._. L
1
,
I I
; I
,
I
I
I i I
+ q i
• 1
i
I i I
:
i
r
i I
I �
I I
I i i I
;
I
I
,
;
:
I
I
4 r
i
i
I
i
I
M�s4r�tisin Department of Industry SOIL AND SITE EVALUATION REPORT Page _ j of - _ 3 labor and Human Relanons
Giais?on of Cafety a B uildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 i r e. Plan must include, but ST. oco 1
not limited to vertical and horizontal reference point (B I� I n °/ l ope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance�� � a . �./
APPLICANT INFORMATION- PLEASE PRIW(,p f. INF ION ' - FVV EWED BY DATE
PROPERTY OWNER: " rj PR , P TY LOCATION E 1 1
50V+A1 &KZAeA 4 r ft/Vk �5 R M M sn W yLtila,S 1 9 T 2? N,R 19
PROPERTY OWNER':S MAILING ADDRESS `' C�?Oi . LOT. BLOCK # SUBD. NAME OR CSM #
2.bO c. F coin 5'a
CITY, STATE ZIP CODE P UM`/C ❑VILLAGE J�fOWN NEAREST ROAD
} 40'sd' l u�12 Ib 0 -ZD - r C.T. +I, F
�Q New Construction Use 94 Residential / Number of [ j Addition to existing building
I Replacement [ j Public or commercial describe
Code derived daily flow (600 gpd Recommended design loading rate n. 4 4 ed, gpd/ft trench, gpd/tt
Absorption area required 1500 bed, ft I zba trench, ft WWmum design loading rate 0.4 bed, gpolft D•� trench, gpd1tt
Recommended infiltration surface elevation(s) TO 8E DE EVM WED Sy s re� d to site plan benchmark)
Additional design / site considerations --
Parent material Flood plain elevation, if applicable AlA ft
S - Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U =Unsuitable for s S❑ 50 S ❑ U 0 S ❑ U S❑ U ❑ S U ❑ S )� U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trtartcft
I 0-13 Io YK 7 4z — S 1 Cs - 0.7 A .T
Z 13 3Z 10 — S� t '4r Q —'
Ground 3 �Z- g t.5 .5 — 1 rinS�iK a •y 4. Y
elev.
$Q ft.
Depth to
limiting
factor
2
Remarks: 14040A 1 10 500% GKA ;_LftZDA) 2 44ASS0ME S,IWD G RAVEL- M OZAI 13 ?A T Zmj
Boring # '
10=2Z:- 0 •' s I Z CS 0.4 o. —
4"� Z 2z- 2. S 3 10 I 1 rn sb rY\ C — 0 . • `�
Ground 3 -B3 2 z5 a I rv. V O. •`�
elev.
! -I ft
Depth to
limiting
fac tor
�
7
Remarks: 14A e1_ I104J /4 Td 2
T Name: — Please P 'nt Phone: Cr3
Add ress: t1
Sign Date: & . M1K. 27, 197 CST Number:
6 Ajp1l. ?b ) LIcI l o MO37O7
" PROPEkN6WNEA SOIL DESCRIPTION REPORT Page 2- ut =_M��� . Sofctil D
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure �� Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
- 0 - 4z _ 0 m
- I0Y — s I rn r — 0.7 0
Ground 19 - 34. 2.5 X1 K 2.'5 M V wJ — . 4 .�
elev.
8lft 3L-8 7.5 vR -3/4 s O r 0 s. a mi — -- 8,7
Depth to
limiting
fac tor
Remarks: 800-1724* 1 tZ "%J F- WMZ- QKAVEW HOKJZOM 'S }+AS slung 0 0CXa - M OF SA0Z (SI -06t-
Boring #
t 0 -IS I o yk z s r, 050 rn I - - 7 0.8
v
W-47- 7
Ground
elev. q l c 4 z-g , -' S (� m I p. La
&La ft.
Depth to
limiting `E4. . fac
-- T
Remarks: 44t6ZWO Z ttTS "10
Boring #
) 0 2 /z. — is I m sb K s _ 0 7 0.
j,. 2} Z _ - 2q to z — sl 1 msb r �s — o. o.
Ground
3 4- 1 _ ) mSbK M- s - �
elev. Lq 14 S I I ms X ry
gf,�q ft.
Depth to
limiting 3 Z
factor /
Remarks: 2 t4A
Boring # �A T fip Z m 9
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD49330(R.05/92)
PLOT PLAy Page 3 or 3
r
Property Owner �GI�MMLLE Leg z - YO
`
Legal Description )17T 5 8 "TKO3 " = ® # 1 5PiKf- IN S 511:E ()F
g�L- g7' PINE - rnim - FLA ":N 0
'11J LOCATED IA) - rrf: r=& 524, 376 ✓ a 4Z sell-LE IN SV4 S1orof
T28 A 26W 4 W S19, T 27 Al K IIN W - E - rRjWF - — F- L-A&
rt0 W N 0 F 'h2D y, .ST, CIe01 X c.o U Anv, W r ,
= soil boring w /backhof
540 MOS FbK Cof-KECT
LDT UAja j*AJ
S[3� 2
L $
Wr Lo
57 s8
I� QA� L am.81;
L 84,b•1 S69.0 �
a LOT
a4�s s
t5L s ue, yy
SC.o PE '
D
I8473
IL Bbb,S �L 8L$.0�
-T-Rood M0 3-70-7 CST
M o 370'7
COU T Date V, Zb
,QEv ",WR z - 7, /997
�o uiioE vri�iry
Wisconsin.'Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of -
Labor and Human Relations
Division of Tifety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
' COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (B % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distanc O t io' d. ll 040- 1249 -80
APPLICANT INFORMATION- PLEASE P L I ORMA*TiOO RE IEWED BY DATE
PROPERTY OWNER: ' PERTY LOCATION
cc; f LOT 1/4 1/4,S 19 T 28
Co ntinental Dev. �KP4, ; NW NCR 19 (or) W
PROPERTY OWNER':S MAILING ADDRESS �'s', T BLOCK# SUBD. NAME OR CSM #
12301 Central Ave. NE. 9 4te �3 T �RplX na Troy Village
CITY, STATE ZIP CODE PHONE NUM cat ITY ❑VILLAGE [9OWN NEAREST ROAD
Blaine, MN. 55434 Troy Troon Court
[x] New Construction Use [ A Residential / NumbeQ1 b6d rdorng 4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft •8 trench, gpd/ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft
Recommended infiltration surface elevation(s) 87.55 ft (as referred to site plan benchmark)
Additional design / site considerations trenches %pace to code 4/00' below surface grade
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem 1 L3 ❑ U LAS ❑ U [3S ❑ U :K] S ❑ U 9] S ❑ U ❑ S 7 U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
..................
.................
1
................. 2 26 -44 7.5 r 3/4 none sl 2m r mvfr qw if .5 .6
Ground 3 44 -84 7.5 r 4 4
elev.
8 4.35 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0 -24 10 r 3
aw
2
Ground 3 47 -84 7.5 r 4/6 none ms oscf my na na .7 .8
elev.
8 4.55 ft.
Depth to
limiting
+�4t
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. AvV New Ri mo I 54017
Signature: Date: CST Number: m02298
��° 8 -14 -97
PROPERTYOWNER Continental Dev. SOIL DESCRIPTION REPORT Page 2 of
PARCEL I.D. # 040- 1249 -80
Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft
Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
1 0 -12 10 r 4/3 none sl 2m r mvfr cs lm .5 .6
3
2 12 -22 7.5 r 4/4 none scl 2m r mvfr 9w if .4 .5
Ground 3 22 -84 7.5 r 4/6 none ms oscr ml na na .7 .8
elev.
97. ft.
Depth to
limiting
V or
Remarks:
Boring #
1 -12 10yr 4 none S1 2m r mvfr Ow 2m .5 .6
<.. >:: 4 < 2 12 -25 7.5 r 4/4 none is os mvfr 9w if .7 .8
Ground 3 25 -84 7.5 r 4/6 none ms osct ml na na .7 .8
91 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0 -12 10yr 4 none sl 2m r mvfr 2m .5 .6
2 12 -24 7.5 r 4/4 none sl 2 r mvfr lm .5 .6
Ground 3 24 -84 7.5 r 4/6 none cos osq ml na na .7 .8
elev.
9 1.15 ft.
Depth to
limiting
fa t
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Continental Dev. Corp.' New Richmond, Wt 54017
MPRSW 3254 N 4NW4 S19- T28N -R19W 15 246$200
town of Troy
lot #58 -Troy Village
N
1 =40'
BM.= top of mid -lot survey stake C el. 100'
Alt. Bm.= nail in Norway Pine tree C el. 91.45'
mss.
1 / ) 0
60 0 A S5 �
�—
Gary L. Steel
8 -14 -97
01
_0 Xzt=
XKZOS z CD
n, CX.
a co 0
CL
T
01
5� X 0 r
0 N
(F) CD -0 0 co �- C �I c.
=r =r
- C
& -3 (D
c D = O r @
t
D (0— CD , co
=r
(a. — c: ........
U —
0- - 0 CD :
c 0 0
CD
0
c
0 0 CD
0 2:
0 (C)
(D
C*)
-ft ::r �F Q- cND '�
Q' =3
CD -4
(n cr 0 0
CD 0 :3 -,
x :3 E Z f 1) ..........
CA)
2
m z-
(0
c C 0
Invert I V—
(D
0
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number $3 38
Number of Bedrooms
Design Flow - Peak (gpd) CrD
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal)
Soil Absorption Component Size (ft2) qS-8 2 -�
Type of Wastewater Do
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) � 5
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank -
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the se and outlet filter shall be assessed at least
once every 3 years by inspection. T outlet filte shall be cleaned as necessary to ensur
proper operati The filter cartridges a removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole 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 one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ETA(, G bQ ca P•+z -�
Mailing Address _ :- y 5 A 5 N - t a- r a, 5 5 - � W 0 A I ay.rk W, VV5 , C A Q I 1 ( �
Property Address a `7 3 T r o o -Y\ C,-Ac
(Verification required from Planning Department for new construeti o,
City /State AMIOS ", \ Parcel Identification Number 0+a -t2-4`1- %,O
LEGAL DESCRIPTION
Property Location %, 1 /,, Sec., 1WIC - Town of ��
Subdivision __ '`�! � F Lot # r 7 'b
Certified Survey Map # . Volume . Page #
Warranty Deed # (0'L QD 9 S Volume C31;;;' , Page #
Spec house ❑ yes Xno Lot lines identifiable Xyes ❑ 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
masterplumber, journeymanpltjmber, restrictedplumber or a licensedpumper 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 Zoning Office within 30
days of the three year expiration date.
f ,, t /Z
SIGNATURE OF APPLIC 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 owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
.�. e wr- rz / /%1 /
SIGNATURE OF APPLI ANT 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
� � r
iWpw 495 'a
STATE BAR OF WISCONSIN FORM 2. 19"9 ts28$SS
uocumeatNamaer WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Ricky L. Zurn and Ckarlane M. Urn, 6ECEN D FOR AEC=
busband and wife
16 -16 -2001 1040 AN
YARRANTY No
Grantor, and Eric Odegard, Sr. and Lynn Odegard, husband and wife CE I
RT FEEL
—e
COPY FE-:
TRANSFER FEE: 209.70
RECOItDIN6 FEE: 10.00
Grantee. "Nos t
Grantor, rot a valuabie consideration, conveys to Grantee the
following described real estate in SL Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
RecoMatg Area
Nam and Resum Address —�
Lot SS Plat of Troy Village in the Town of Troy, St. Croix County, 920 g a
1 l
1910 D A Drive
Wisconsin. Woodbury, MN SS125
040-124940
Parosl ldemification Number(PIN)
Thb Is out homestead FmPwty.
1W (is not;.
Exceptions tc warranties: Easements, restrictions and rights of way of record irany,
Dated this 14 day of Au gust 2000
• c . Zurn
• • ne M. 2aam
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WIMIP N !III )
) ss.
Washington County )
authenticated this day of Personalty came before mot this 140t day of
August , 2000 the above named
Ricky L. Zara and Ciadece M. Zaan, husband arW self t
TITLE: MEMBER STATL' BAR OF WISCONSIN
to me known to be the pare sr (e)- who.veooWtod- lhe.Cewgoiwg. .,
(If not. Instrument and ackno. lad d KELLY L. ZIMMER
authorized by 1 706.06, Wis. State.)
THIS INSTRUMENT WAS DRAFTED BY •` t t r l • ; �". , r/ 1 ! rj
0 61 9 0 Da Estraen Notary Pubine, Static of i
°'acs, Hadmos, W 54916 My Commission is permanent. (If net, suue expiration date:
(Signatures may be authentituN or acknowledged. Bath are not necaaey,)
• Names of persons sipiag in any capacity met be typed or printed bobw &ir Aviators, mso poor. Ffteo 000 emwa. Pone as tao,Yn
STATE 8A,1R OFV4XOI4N14
WARRANTY DEED FORM No. I -J!"t
I • d zGGO -GG6 SIG jewInS e i t44uR3 dSE =Z I 0o *I oaa
N, 1 �a / 9Jl io
o I / � A p C ° S r uo . $ n- �' 3 ��. Al i,s'Yy. W
co
w Vl W OMA 01 �g ._♦ N - • OI io
° aS
Q A W1� qN / V1 N '� O^ V '4`l !E• O
�I ^ Nc.� ,s •f ."s ' O ^ n N N ^ z
'OL s'tt .. pp00. �, H N 10
OI I po ^ �c om 1 3 .,00.00.` 0 S z '00�.! !f \J
V Y aN N N a a � y '•(L Yd' ,
= I e H , Oo ., E -CO M « 8^ ZO o sir d S 1 9!J a
07'00 0 0 I J
aD h^ ily OlM
n l z E s i. o , �A 00
g 07' °°« `mrr�sr VI h hy^ p #
265. ` N •s� 1 a0.
U V '� w W sj ,6 't9L 1 a r
8 g l Z'96 �i 10 I M i N o o - 'o
3 ..00.00.90 s C4
3 VI c0!n 00'99 In
_ z 3 4 N — Ip
- 8
os Alf °90,09 <l z a
W to r 1 J r�r. <!, 8 F8 8. }I SM3 NV '1S L
120 p = , 3..00.00.005 N� N 3 i I 00
.tog t Vl n t I I n rn o
0
a I H r '
2 D
M O
O I a
W 3 N «OO.00.ZOS I �
iv t iv8 I _ }
N ~ c+�m �� N q t0 I F' I .cq0 (n.
O I N OQM Z
•o to J c
VI gy Om y� 'B 0 W W
8 W I rFSy�,s r v� 1 �' �.�' � $ $ ��'
�f1 �.
h is .} . V) a '-L.1 v Z y h
�9 Z ' C4 bl
0 vS Sz 1 I I ^- 10 tun) .. \
0 - N In 1 1
«9g . 9 0.01 yy �ca�m \ N I 44'ry '
W W
♦ 41 - - �-
♦ 5 2�� s 1 ^ o• 8 m 3I
ui
zI
< 3 3 .,o0 00 so S
VI N '�
TL
WI n v o M «0000.09 N I , w`� W
` H Ica 'Or N , N
W z .. w
1 ♦` I r !� 3 I OJ �<
Z
1 ♦ �i F M ,.Ot ,t£.00 N 411. OI ,► ►. i l' n
N 1 ♦ 40 I N N I nn
o ♦ z n (4 N Sr
` of 1 1 \\ !�'�- �. N rf
alac3l \ \ 17
♦ 12l�103
♦ ^ N \,\ N ,
♦ io N \ 0
a ^ O X11 n
OD
\\ � � Ir0 t .► 1
_ C4
1 1
I < st g AVM)Ibvd W L
i p e I 17 � ♦ , :
z� n z ,+�^' olt i SQNb� � '� ►• ( I 6 •'� + n
1 �� IN I , p3� g ♦ �;c� W W W 3 z V
IWW,I ZpaJ ^i ' ^ 1 I dNn $ I �`'` B g Q S o tO g "
W a _ J�I6lQ ; O I $wryNTO
N
1 6 Z ` _S I W M 1 y z m vl
g ON Ida � o s I —���� U. II 1
�^ J
x t- N a 3 6L N SUM H3IHM 'M6ty 'N9Z1 -i ltJ 1 01
Q _ f b 6L N01133S 3NI1 N01103S WL HIMS -ILWH Q J 1
NNW bi 6 3H1 bl 0331SIMay SSNWM 003v1SSY
z U
U 0 • I D o I oN 1
1