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HomeMy WebLinkAbout040-1252-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building DivisiGA INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 463320 0 GENERAL INFORMATION 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: Davis, Craig & Jane I Troy, Town of 040- 1252 -80 -000 CST BM Elev: Insp. BM Elev: BM D Ition: Section/Town /Range /Map No: dv C) /(111 �T�'G�'� C�'1i+�K. 19.28.19.1329 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATIO N� S HI FS ELEV. Septic t / ' A �� IOD6 t- � Benchmark,(' , { A _ J 10 9 Dosing tXi.+.� uv Y/ Alt. BM R t , f � .---- 77jt� or Aeration r Bldg. Sewer <;7C 0 / ! �0 •g 2, II Holding St/Ht 6 v ! 0 r s /�. pi s• �? TANK SETBACK INFORMATION St/Ht p"lat !0•S 13 TANK TO P/ WELL j�L Ven t to Air Intake ROAD Dt Inlet Septi • d f 6 r0 p t Bottom D q " ~ . d j� / � • �0 � r ng > , , Head er /Man. 3 + GG Z Aeration Dist. Pipe Holding Bot. Syste ' Z . W 4 tjn Final Grade v PUMP /SIPHON INFORMATION aP 5aJ_A -*K41 .b Manufacturer Demand St Cover � !.�' •t rn / oS 7 � 1 � i Model Number 4 3W / Z �o5 - _ /V TDH Lift Friction Loss System He d TDH Ft I 1-�l I Forcemain Length / Dist. t ' ell I �Q A , SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Tr es PIT DI NSIONS No. Of Pits Inside Dia. Liquid 04th DIMENSIONS � '�• S SETBACK SYSTEM TO P/L BLD WELL LAKE /STREA LEACHIN Manufactur y ITr yS INFORMATION U Ty Of System: / UNIT OR '�� � l � H ✓ Model Number DISTRIBUTION SYSTEM Header /M anifold FDi x Hole Size x Hole Spacing V�to ntak e A e(s) Length Dia ngth Dia Spacin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade System Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Cente O Bed/Trench Edges Topsoil n Yes No Yes � � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /C/ /v Inspection 42: Location: 291 St. Andrew's Drive H WI 54016 (NW 1/4 NW 1/4 19 T28N R19W) Troy Village 2nd Addition Lot 78Parcel No: 19.28.19.1329 1.) Alt BM Description = 364)"', `7 SRZwr+� Q• �t�lN /�'t( - u J 1 00 ` / E2�� 2.) Bldg sewer length = / 2 oZ amount of cover = ♦ C_ � - f , 7 q L.� �. 3 Plan revision Required? /or,a No �{ Use other side for additional ti on. / C/ Date 4 Insepctor's S /ST?rt N�Or SBD -6710 (R.3197) j �-�`.�r "U ► V' �n� +�• �t� " ���"� `�^. �' f Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 5' N visconsin Ma on, WI Sanity y Permit Number (to be fillenn by Co.) Department of Commerce 08) 26 - 3151..�� Sanitary Permit A 1 ti state Ian I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal r tion provide may be used for secondary purposes Privacy Law, sl 1) T. CROIX COUN �?rojec Address (if different than mailing a ddress) I. Application Information - Please Print All Information s rC(,C� LJYI �L Property Owner's Na me Parcel # Lot y 7 Block # (_rat -+ Jane Davks (tea- l a 5 a - - OnO -/3 9> Property O er's M ailing Address Property Location / j l o ()txj o4G ` ' "' /" f y,,Section / / /q City, State I Zip Code Phone Number �" IaKe- land to °J �5v(f — 3 (circle one) 11. Type of Building (check all that apply) T OtA N; R_dE 111 or 2 Family Dwelling - Number of Bedrooms ' ' Subdivisiion Name CSM Number ❑ Public /Commercial - Describe Use Tr 1rlllo - g Zro Add thrx ❑ State Owned - Describe Use ❑City_ ❑Village �downship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. El Permit Renewal Permit Revision El Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 3 3 , 2 IV. Type of POWTS System: (Check all that apply) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable sot < 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 VLeaching Chamber Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: �! Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) Svstem 1Wevat ion b VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic eP44ek ag-Taek 00e D 600 �ei err � - - -- AeFeb Lc( CQ �7�V. Dosing Chamber 7 fO 7s0 ( + VII. Responsibility Statement- 1, the und igned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na the (Print) P robe s Si gnatur MPkMPR8 Numbe, Business Phone Number ?ttUt_ C.T Sfelner aaS S l '7! - Z/ZS- SSW` Plumber's Addre ss (Street, City, State, Zip Code) N $o 3a - f. _1Qt� Falls, 10-T 5L10Z_Z_ VIII. unt /De artment Use Onl pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I mg Ag t Signatur o Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial 1D (Q V J IX. Conditions of Oproval /Reasons for Disapproval t � Attoc complete plans (to the County only) for the system on paper not less thad 81/2 x I1 inches in size i SBD -6398 (R. 01/03) 1'UHP CHAHRY11 CROSS SFCTI011 Atli) SPECIFICATIONS Vent Cap Neatht:r Proof ( Approved Locking Junction Box Manhole Cover 4" C.I.- --- 12" Min Vent Pipe ' Final 4" Min Grade ' 18 " Min Conduit ' 18" Min X11 Approved Inlet Joints w/ C.I. Pipe Extend inl: 4pproved 3' Onto Joint wJ �.I. Pipe { Solid L x t e n d i n g I' �; A Ground i, I ` Onto iolid _ ,bAIarm ;round On B+- - -' i C •P ump Off - Concrete Block p SPrCTPICATIONS TANK PUMP {anufacturer: Wei SQ✓ Manufacturer: 6ekl v rank Material: Hovel NUt11Lur: j J 7 Z ,nnk Size: Callona Switch' Typo : Ic/oArI- Total Dynamic Ilead: Ft. CAPACITIES Pump Diachari;e Rate: yD GPM Total Daily Effluent: � Gallons 1 " or ' 0`1 Callons Number of Doses Per Dray — or Z 7,D 37 l + Gallons Dose Volume:' �/� Gallons :C� { 4�" or _ / 021 .69 Gallons 140 tea 1. See pump curve for or _ �2 3(o Gallons additionnl performance 'otal Tank information. :opacity Required Gnllona 2. Pump and alarm are to be inathIled on ueparat circuit ALARH J au per ILIIR 16. 17 NAC. innurncturer: I-e C / fodel Number ;w1 t ch Type. � page of HEAD CAPACITY CURVE CIO MODEL 152/153 w LJ w =� 50 153 12 40 152 0 Q w 30 < 8 z 0 - 20 Q 0 4 0 20 40 60 80 100 GALLONS LITERS 0 80 60 240 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATI • Timed dosing panels available Safety and Buildings Division County I v i 201 W. Washington Ave., P.O. Box 7162 J'-7 sconsin Madison, WI 53707 - . 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (�8) 266 -3151 .f 3 3zD Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information de may be used for secondary purposes Privacy Law, s15.04(1) ) Project Address (if different than mailing address) I. Application Information - Please Print All Information Z I nert w.S �� Property Owner's Na me Parcel N Lot!! Block M Cra 1 -k carte -jav IS Oq0 -1d 5a - �0- 000 t. 132 Property Ow is M ailing Address t Property Location 1 I oq Q u n o o Ve. • 1\1 JVA - S4, /YW 'A,Section i9 City, State , / Zip Code ?honS Nf rater/ 1j'_ l�i l&lun d, m t S S 3 �y circle > II. Type of Building (check all that apply) J T Z b N; RE a ZC)NING UFRC;E Subdivision Name CSM Number X 1 or 2 Family Dwelling - Number of Bedrooms �j j (J El Public /Commercial - Describe Use 60 , U/ ` /Q 7 e � ��� ❑ State Owned - Describe Use ❑City ❑Village XTownship of TA?( ' III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. XNew System ❑ Replacement System ❑ 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 . Type of POWTS System: (Check all that apply) p DI F PLL C k - StJ 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 I - Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 7 7 0 - 6eaching Chamber Drip Line ❑ Gravel -less Pipe ❑ Other (explain) {� V. Dispersal/Treatment Area Inf r Design Flow (gpd) Design oil Vca R ate(gpdsf) Dispersal A a e Dispersal Area Proposed (sf) stem Elevation t �DO0 Q D l I p . VI. Tank Info Cap ity in Total Number cturer I Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks ' Septic or holding Tank Aa0hio Imilimenl Un N• Dos C.ha hP..-.-- --._.. VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) PI is Si gnatu a MP/ S 11.�roe Business Phone Number 'PAOL 2, J. S�tetner Z z 5 �15� �1S -4� S Plumber's Addre ss (Street, City, State, Zip Code) Id 9Z 3c) 9y5 Y- Qi ycr Fa ll s, Aj S�oZZ_ VIII. County/Department Use Onl 14 Approved El Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Signatur (No Stamps) Surcharge Fee) ❑ Owner iven Rea , for Denial - IX. Conditions Approv 1/ 4 SYSTEM OWNER; 1 Septic tank, effluent filter and dispersal cell must all be serviced J maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. 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) ' I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page i of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Envir o n m e ntal BY Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north aqovr; locatiQn and distance to nearest road. parcel LD.# APPLICANT INFORMATION' Tease print all - info�lmation. � Personal information you provide may bg'us9d of secondaq purposes (Priva9%Law, s. 15.04 (1) (m)). ieWed Date . I Property Owner =} Property Location Continental Development ' : " n s Govt. Lot - NW 1/4 NW 1/4 S 19 T 28 NA 19 W Property Owners Mailing Address ; Lot # Block # Subd. Name or CSM# 12301 Central Avenue , Suite 234T "DQ IX i 78 - Troy Village 2Nd Addition City State Z' q' e�_um!* ,/ G1 City E] Village L7 Town Nearest Road Minneapolis • I Troy St. Andrews Drive Z New Construction Use: residential / Nd r of bedrooms 4 jAddition to existing building ❑ Replacement [� Public do c6mmercial describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpdfftz 8 trench, gpd/W Absorption area required 857 bed, ftz 750 trench, ft' Maximum design loading rate .7 bed, gpolW .8 tr ench, gpdhV Recommended infiltration surface elevation(s) By Designer ft (as referred to site plan benchmar Additional design / site consideration Final grade to be compliant with code Parent material Loess Over Glacial Outwash Flood plain elevation, if applicable ft F S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system f ®S ❑ u ® S ❑ u ® S ❑ u ® sou ❑ S ®u I El ® U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fP Boring# in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bpi Trench 1 1 0 -9 10yr3/4 - sl 2msbk mvfr cw 2f .5 .6 2 9 -55 7.5yr5/6 - 1 2mgr mvfr cw if 5 .6 Ground 3 55 -100 7.5yr6/4 - s osg ml - - .7 .8 elev 99.77 ft Depth to 9z. limiting factor >100" Remarks: 2 1 0 -24 10yr3/2 - sit 2msbk mfr cw 2f .5 .6 2 24 -64 10yr4/4 sil 2msbk mfr cw 1 f .5 .6 Ground 3 64 -120 7.5yr6/4 - s osg ml - - .7 .8 elev 97.85 ft Depth to limiting . S factor 120 H n 3 ntains several small pockets f is 7 5 5/6 orizo co eral o Remarks. t�oc ( w' ) CST Name (Please Print) &9 -" Telephone No. Thomas C. Nelson �' 715 -246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, Wl 54017 2/2/98 MO2605 19 PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT E::Kj Page 2 of 3 PARCEL I.D.# Environmental By Desi gn o � Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ;Trench 3 1 0 -9 10yr3/4 - st 2msbk mvfr ow 2f .5 .6 2 9 -24 10yr5 /6 - Ifs 2mgr mvfr cw if .5 .6 Ground elev 3 24 -100 7.5yr6/4 - s* osg ml - - .7 .8 98.87 ft Depth to limiting factor >100 Remarks: * Horizon 3 comais several small pockets of Is (7 5vr4/6) 1 0 -22 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6 2 22 -60 10yr4 /4 - sil 2msbk mfr cw if .5 .6 Ground elev 3 60 -130 7.5yr6/4 - s osg ml - - .7 .8 96.84 ft Depth to 92 limiting factor S-S 68 q p �7, I p. FP' I 4 I Remarks: Horizon 3 contains several small pockets of Is (7.5g4/6) 5 1 0 -64 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6 2 64 IOyr4/4 �� sil 2msbk mfr cw if .5 .6 e ev nd 3 102 -117 7.Syr4/4 - is 2mgr mvfr cw - . ' �b Cu 96.46 ft 4 117 -155 7.5yr4/4 - cs osg ml cw - .7 .8 Depth to 5 155 - 170 7.5yr6/4 - s osg mI - - .7 .8 limiting factor >170" Remarks: Ground elev Depth to limiting factor Remarks: . BY DESIGN 1432 120 STREET, NEW RICHMOND, WISCONSIN 715- 246 -2454 PROJECT NAME TROY VILLAGE 2nd ADDITION DESCRIPTION: NE%, NWT /, SECTION 19 „T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT: 78 SUBDIVISION: TROY VILLAGE 2 ADDITION 65 V�H 2_ 1 t sc Ar.F 1 ” =40' Tom Nelson BM i SWcorner post:ground surface elev. 100' cstmo2605 BM 2 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Ct Sttn -e Q y I `3 Septic Tank Capacity 16 00 gal ❑ NA Permit # 3 ZO Septic Tank Manufacturer Wet S fr- ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2a be 1 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ©o ❑ NA Number of Public Facility Units A Pump Tank Capacity a l ❑ NA Estimated flow (average) 4/37() 4 1,0 gal /day Pump Tank Manufacturer �` ❑ NA Design flow (peak), (Estimated x 1.5) 66 gal /day Pump Manufacturer ❑ NA Soil Application Rate Q • gal /day /ftz Pump Model �` ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ----- ❑ NA Fats, Oil & Grease (FOG) :_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Ot er: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 3° +d 0 1 FF US Biochemical Oxygen Demand (BOD,) 530 mg /L 4In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: q Other: ❑ NA Other: W NA *Values typical for domestic wastewater and septic tank effluent. Other: A MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) 5 ('c At least once every: ,�year(s) s (Maximum 3 years) ❑ NA Pump out contents of tank(s) 1v O N e When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ye ar (Maximum 3 years) ❑ NA Clean effluent filter A - / ©p At least once every: EF m ont h (s 0 NA Inspect pump, pump controls & alarm At least once every: f yet ❑ NA ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ 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. GMW (4/01) Page of START UP AND OPERATION 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 cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER l/ X� Name 1 n.4✓ �u rvc �j � Z AI C Name P / tip,/ 1 k _ A C Phone ! Z 5' 5"/J sly Phone ek L 3 � !7/�f SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name D Yf Dli n n Name C&'w — 2� 9 N N Phone ' — /0 2 q Phone 41 &L q(O 5 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. 01/21/05 . RI 10:32 FAX 715 386 4686 Z001 ST. CROIX COUNTY SEPTIC TANK MAtNT 4ANCE AGI M) VIE NT AND OWNERSHIP CERTiFICA'GON I±ORVI Own"uyer V a ► ,Y� r� W �► e � J! �... — .� - _ ___ Mailing Address �t I OC1 L`� Xo t j� L �+ �e /Ccc� c� . !�'1 ry 5 Property Address Z I .5+ . eve ► e -- (Verification required from Planning Department for mew c onstnmction.) City/State Parcel Ydentification Numbcrr 0q0- C � LEGAL DESCRIP'JrION 32 Property Location �'l. , ,� _ % , Sec. T ,N R W, 'own of T t2 0 Subdivision 7�K o V l -t S e c v w d A-aV t - (7 , Lot # _ 0 CertMed Survey MOP # . Volume _ - Page # Warranty Deed # 'T7 3 © , volwne ` 2 Page # !. Spec house yes no rot lines id endfi able yes no SYSTEM NLAIIVTEiA1riC_E Imptriper use and tpatl8tnanee of your septic system could n salt in its pmts lture failure to handle wastes. Proper maw consists ofpwq mg out the septic tank every three years or sooner, if ne erred 'Dy a licensed pumper. What you put into the eyetero can affect the "n of the septic tank ss a treatment stake in the waste disposal system, Owner maintenance t+egxn timilities ate specified in § Gomm 83.52(1) and in Chapter 12 - St. Croix County Sar itary Ordinanm mw ply agrees to sa6mit to St Croix County Zoj ring Departittea k a ce lification form, signed by ft owner and by* master plumber, jomuolman plumber, t'estricted plumber or a lie rased pumper vv xifyb mg that (1) the on - site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if ne m m y), the septic tank is less than 1/3 full of sludge• . "°'"t r---d *e Above r gL± ruts Rnd : name to _-M- intaa e. the private sewage disposal system with the standards set forth, herein; as set by the Department of Commerce emu. the Departruen t of T allual Resources, State of V1600nsin. Certification stating ftt your septic system has been maintained must be completed a id ret umed to the St. Croix County Zoning Department 30 days of tbo throe expiration date. Ol; P ANT DATE OWNER CERTMCATION Uwe certify that 0 temettts on this form are true to time boa t of mylour kno wledge. Uwe am/ara the owner(S) of the pre by f a deed recorded in Register of Deeds Offic M / Z O SIGNA OF APPLICANT DATE Aay information that is misrepresented may result in the san itW7 permit berm g re%oked by the Zoning Department. Include with this application a stamped wan=ty deed from the Register of Deeds Off .cc at d a copy of the certified survey map if reference is made in the wFranty deed. it CERT oF NORTH FOR: ALEXANDER & ASSOCIATES PROPERTY DESCRIPTI01 LOT 78, TROY VILLAGE SECOND ADDITION, ST. C I INCH = 30 FEET 891.8 1 . I O 0 O . O Q o` *9' poured walls, lookout* PROPOSED ELEVATIONS: k GARAGE FLOOR =896-8 TOP OF BLOCK =897Z LOWEST FLOOR =998.5 N O TOP OF FOOTING =098-Z O LEGEND l 0` M M • Denotes Iron Monument Foun 1 ` CO 892. Denotes Proposed Elevation. ��� X1011.2 Denotes Existing Elevation. � O 1 Denotes Direction of Drainage. N Z ® Denotes Wood Hub /Metal spik at specified offset. N � O � 41 -' Drainage Swale � f I hereby certify that this survey, plan ;,2$ or report was prepared by me or under 8 8A my direct supervision and that I am a duly Registered Land Surveyor under Z� the laws of the State of ti 0 ! ? t 80N8, INC. LAND GulRv m"a O E ILLER D DANIEL W B RM 918C LEXINGTON AVE. NO 11 CIRCLE PINES, MN 135135014 Date: Reg No. TEL, (763) 186 -6556 FAX (163) 186 -6007 ` STATAAR OF W AA& FOL 2 -62000 - 7 4 3 4 QD 9 KATHLEEN H. NALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. WI This Deed, made between K'¢ LLC, a Wisconsin Limited Liability RECEIVED FOR RECORD Company Grantor, 10/13/2003 09:45AM and Craig M. Davis and Yeabela Jane Davis Grantee. WARRANTY DEED EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 419.70 COPY FEE: Lot 78, Troy Village Second Addition. St. Croix County, Wisconsin. CC FEE: PAGES: 1 Recording Area ?dame and Return fddiess K . 6) 5/R_.- d 040- 1252 -80-000 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 this V day of October _ ' 2003 K'g LLC * * Sy: Kri tins land, ember * * By Mic J. ermain Member AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF } } ss. authenticated this _ day of N H T Personally came before me this day of October 2003 the above named N rAR K g , LLC, a Wis consin Limit Liability Compa * by Kris tina Ogland and Michael Germain, its members TITLE: MEMBER STATE BAR ---- --- 0 I k (If not, j C to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats. #.- SAO instrument and acknowledged the same. •......,,... ___ ___mot _ MS INSTRUMENT WAS DRAFTED BY 1 — - - - - -- Kristi O land, Attorn a t Law * �O r Pet/ 304 Locust Street Hudson WI 54016 Notary Public, State of V.� : S t.�✓� — My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of sons signing in an capacity must be or printed below their signature. INFO -PRO 800 l� g g Y P tY tYP� Pn g ( )6 55 -2021 www.infoproforms.cwm STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000 I Its t S SE E 79 T2 46775 S.F. il 1.074 ACRES * :RES 335.23' t X?" E S.F. $ 1.448 ACRES - N 83'00' 0 .. -.- � - ♦ A 9Q + 0 ACRES t ....,.. Zp, t9 p - -.- 2►" 7--Y+ 1 , ..., 111. 1 84.19' vv 90' DkJR't CD,,-J. 84* Cl S 07 58.07' .. . -""""-t79.37, , 45947 S.F. ;. gyp pp „ E 224. 1. 055 ACRES N 88`Q0 ` pp" W 0 3 i 8. 00' .___ _ > a -c �I h J } ii 4 o � 4 CLI p -i J �i Q. r4 3 Q0 CO p � � a -w ti V � 3 3 � 0 c L v y II _ N is 1� N r, t t ; V+ s u L Je l QD �. a a H � 0. u V � 3 3 V P. d •,n v 11 P e. 1 i f V pp v 7;Z- 04 C ID n n V)' 0 ct q 4 d 3 � � 3 O co (� V