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HomeMy WebLinkAbout040-1281-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430271 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: Derrick Construction Inc. I Troy Township 040 - 1281 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: �p ( 9 . k( I (*Sr SW* I = hl.% 19.28.19.1590 TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR R CAPACITY STATION BS HI FS ELEV. A - (OD 'der Septic Benchmark � w ei S ez- Dosing Alt. BM ,3 lcb.oi Aeration Bldg. Sewer Holding St/Ht Inlet 03.33 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 ' >1 5 ' 22 ' Dt Bottom h Dosing Header /Man. Aeration Dist. Pipe Co Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover 2 • Model Nu er , "� 7 T . tion Loss System Head TD Ft Forceerrain Length Dia. Dist. to Well SOIL B RPTION SYSTEM (, t ti ND ENC Width Length ( No. Of T nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENS NS f7 �. ? SETBACK SYSTEM TO P/L — J BLDG ELL LAKE/STREAM LEACHING Manufactu?r. INFORMATION HAMBER OR G Type Of System: / LTW"� UNIT 11 31 y Model Nue.D DISTRIBUTION SYSTEM -► rlt, Header /Manifold Distribution x Hole ize Hole pacing nt to Air Intake Ve ` Length Dia Leng 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 D C f , No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: DC f, Inspection #2: 1 Location: 226 Muirfiel Trail Hudson, WI 54016 S(W 1/4 SW 1/4 19 T28N R19� 0� i th Lot 127 Par 1 No: 19.2 d9.159 1.) Alt BM Description 2.) Bldg sewer length = �` T ,, � � � ��E I . (2.2 S• I i f 11 = • Q t - amount of cover= l �T� �,sail.Q� t)2• tZ•3�c�o3� f I(, Sp =�O�� P '' 3 � �^" �!e� •�= cue.,. -� (w) 3. � Z .�o= ��� � 8 � � � . �j v= b'�S.�Z Use Yes side for additional information No �1 SBD - 6710 (R.3/97) e other Date Insepctor's Signature ert. o"� 1° Safety and BtriWWW D➢vi m County 203 W. W Ave. P.O. BOX 7082 Visco n4 n Mod6on, WI 53707 - 7082 Smitory P Number Oo lod filled in by Co.) t}ii3 artmettt of Commerce / 261 �S�d y D a r Sanitary Permit A li -a_Q_ ae � _ _._ Su Plan l o. to scoved with Gosues $311, phis. Ada. Ced4 any be rhea for aeaoadtey l Project Adahess (irdiR6tot tlpe oileg address) L Applieailoa Iofonottlo s - PMtse Plat AN I y 1►Lc i i I��le ' 1 i - o Property ms's Nam i Parod M Lot P lock tl U l Cr/ on Owner's Msftg Addmu °-- - -- Property Location of B*Ndla8 ( Lo V, S a / Section �! City. State Zip Code Phone Number Q W� S f ?lS oZ II. "Type cheat A that apply) T R L E w P i err 2 tmamrsty Dwelling - Number of Bodmoms / 5tr6divieon Name CStt xmnbar ® Pmt - Desuibe Use O SM.Oweed - D.*. Use —3 l.� -z� ❑Caih! (((erne of III. Type of PW=W. (Cheek only sere box on We A. Comoviete Mae B N applkafie) A' New System O RapMcemew rsym. ❑ T000tmenomming Tank Reaaoe .* Only O Odror metsfimi en to System a. ❑ Pew Reneeta O Permit Revision ❑ Cbsoge of O Permit Tmmfer w New Lat Pmvwm Perout Nranber sad Dote tented Before Expitalim Member Owner Iv TMW of POwTS • Cbmk aR that Nan - lVesweiaed t 4wood O Mowd > 2d m. of vWsble sat ❑ ldound < 24 is d•suutobie soil ❑ At4vode O Sargfe Pass Seed hbw ❑ Coasuna od wetland O Pross rued ln- Ground ❑ Hokhng Tack ❑ Par Fiker OACwbjQTvCMImeoIU8Ih ❑ R«irode ing Sand Pater ❑ ltfedia Faker O Cbw**r ❑ Oda ( . ) V. t Ans inF aattfioa• Daigo Flow f8>+d1 + So€i / � ts0 S s'0 , © o �� / VL T Info Capaehy in TaW Number she 'e Golloaa Galiaos of Units Cotes Communed Glen >� Towns Septic at Hoidias Tact Aerobic Ttartateat twit �— - Datias t�ra6a VII. Stateoaest t, at mar of at pow" aMwa as the attacb" plses. s Naar S' Bw"m Now Number c S� Plumber's Addoaa City, Strom, Zip Code) o i swat Use Approved O SanMey Permit Fee (irtclada tlratwdwater Sigewre Stamps) O Owner Givam Rearoa 6or Deiai Surge / < M Coate of ApprovaNtenow for Dhapprovg YP ED mac, n,-F z N om- � �o�� � ��►�- • Z-2- /1 catgirle Mrss t+a On Coady / few dw an eet low 6- furl: tl fades a dot SBIY -6398 (R. 08/02) C�� I , , I i �C Z - T 1 : -- , I I L - fi- 1 • I j ' I i 1 1 i , : ! I { f ' AE U 4 { £i 06 : Y i 1 f i : : A I ' 1 JA',7 : , : I ! -- , ! II( I I _ F lo h c�G �►�s`I��..��� ©r IZ N X14 s -O f u At a`? � ' ro � _ 1 a �q 0 -bd� �Pr Onto , _ _ t 3 �f _cam' .man 7 Cam-. -- �1 Poo 'A Oro 6 ,�T �� �/ 9'00 y�x l '� f __ _ _ _ _ _ _ -._ P '' '. �... •. Q a i r.� r w __ __ _ _ - i Wisconsin Department of Commerce SOIL EV�UATION REPORT 3 `Division of Safety and Buildings / . �I , Page of g - • in accordance wit{6 \ 1Vrti $S, ->Ni>; .'Atlrr ' ode l L County S-T C'm l X Attach complete site plan on paper not less than 8 112 1'hitT%he s in sib. Pn must,- `, include, but not limited to: vertical and horizontal refe q 'point n and .- '`', par I I.D. ��) �i>v 6 q . 2191 I'll f d percent slope, scale or dimensions, north arrow, an 16 on and 0 nearest rcad5 Q Q - 0- Please print all inforft"ontj �j � 7 Z�QO i Re ' by Date Personal information you provide may be used for second aryrpu ses (Privy )(15.04 (1) Property Owner F't? 1�) _ Lv �t'Pr(L5 S . �[ertyl:oda on ZOHIrwG Kj 1/4 S W 1/4 S W Property Owners Mailing Address \ 1 "`; ' ti Lot # Block # Subd. Name or CSM# vmffilllo� L$ d0 PfBZZD QT--?v S /V E City State Zip Code Phone Number ❑ City [)Village ® Town Nearest Road $l.t°�t/vE I"ti1V SS�l�9 (7b3)75? -568 - r1Z0Lf ft 2ur [� New Construction Use: R] Residential /Number of bedrooms �_ Code derived design flow rate {� 0 0 ;'' � GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material `t4 Z-1k3 OU t;TD CLPm tr , OV`SW H Flood Plain elevation if applicable General comments 1 1�TPtt� tj �� (� andrecom en atio of= ?1161-►- CAI *fCLZ!Z Slb��w�L2 L�'P�bF <°- fl►"1L LS Sw -i s 12- Boring # ❑Boring . 1 G1 �GL2 l✓��'6 4 r� -eo M I - � , ,6pn a as = 7s7/ - Gl[A�n,6gs� a pit Ground surface elev. 8a b ff. Depth to limiting factor >) 10 In. I Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 T 0.. ►nom 0-1-U ! L) , 7- .3 Z 1.3 -Z Z 1 bK �Z � L3 — S � 1 z-� -sbk r►�� -t.• cs - s - B 3 z -u8 luLtz s/6 — S l �esbJz �s — -1L _3 y U& =110 bS F 2 Boring # I❑ Boring .B �1 Pit Ground surface elev. C l ub. S g, Depth to limiting factor L 13 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 10 -frj- 3 t Z L t0 -ZZ Sit 1-�-Sbyt Z.Z -�6 ►�H1Z 31b — Si I Z,`fSb�Z Y4 Cg — • S _ S 1b`f2Ylf. - g s Effluent #1 = B06, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign re CST Number Arthur L. Wegerer 00�31 =lZ'7 - 220254 Address ode g e r e r Soil Testing & .Design Service Date Evaluation conduced Telephone Number 421 N. Hain St. River Falls, WI 54022 10_1,1-00 715 -425 -0165 s 1 ' Y Property Owner C00"i A 1 � @ 3 - COiz,R Parcel ID # _ �f��J h/ Page of 1 IZ7 Boring # ❑ Boring ® pit Ground surface elev. 8 q_ Q • Q ft. Depth to limiting factor > 1 j In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 i o - �� t ��-I rz z[ 2 — s i f 1 `F's b k. w►`F�- e-w 1U -�- • Z • a 2 SO 1 Z'sb k �, �l- es — • s • 8 Y 1002 V/t _ �s o s . Y ) . s • 9 Ci I F(f 12.7 Boring # ❑ Boring Pit Ground surface elev. `3 - ft. Depth to limiting factor > l t0 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 O -b o -�L ztz s lMsbk ri,�►. �g )��' z �3 2 8 - lo9 51L — s 1 )M Sb1Z oil cs 3 Zb - 1 t0 oy2- Y/6 _ f -s D sg M I — S F-1 Boring # ❑ Boring Ground surface elev. ❑ Pit . ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /1`1 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. saD•e330 (P -W00) PLOT PLAN Page 3 of 3 Scale 1'= S4' �N J �O %. VvI A SM�N. a •�t So Su ll Prti3l.0 pr%7jm RZ )AJ vnPrt- aoo i S98 � — .cfo0•o(3 STf�LL-'12 ` - - -- C :� -S fYT LET 5 6 b�� SQT Nol- m uR C-; 17!,�vL S�sr _L��v►Ync�s _ -► 1')MC L�� d t0 -ZI -0 715- 425 -0165 220254 uo -3t8 -ltd CST Signature Date Telephone No. CST No. Job NO. y V , I N'•"" -- NNN.NNYNW ■_, , ' , I I ` 1 ` \ , \ r ` \ \ IA- / N.NNNNN -40 _ LOT 4 . / 0 ) , - O.S.M. - _ VOL. 4 124 py + / t I . t , / , / ," PAGE 99 / I / B -406 B-40 , • / , , . 'i B -350 893. 1 5 / �p�O �• / / I ./ I \ r 8 -405 - - - - -- PT '68 +d7iO4 / G .n ► , t t . • � t t � I 894.6 /' ! , / _ - r / I� ! I� t gf ` LOT 3 I 1 _ 8 -349 T , /A;_... SAGE 993 k9 2. • t \� _/ )' / ) 911.1 rTl 1 I I ,21§ �/�15.0 -- - - - - - - - - - - - - - - - - - - - - - - o '1 B�O� \91 8 , , , l q � -► G , I� --4,04 B - 3 4 8 t \ \ �� � I i, ,/ / , I I a / t �� ° ) P 63 +54.09 B-46 O \ X� 90 � 9.3 400 i ' )) PT * 63 +0'p.q0 L / \ I O N \ / LOT 1 r , ■,. f 3 0 b-4 ,> _ O.S.M. / , I VOL. 6 i O PAGE 1627 B t347 ` � I� Ir • � � C' 91 .3 1 1 y / i , ' ' - \, / - t V \ \ < 1 - \ . - �- / ► 1 k *' , 891.4 V � l 1 EZ1203H rr .lr r r r r ► • !rf 24" j rri _� r ►rrl�' r r � ri► . i ..► 12 4.6251# ►► •rf v f ►v ►v ♦• .r♦ f ► 1 rr V ;� +; : .f�f v, t 18.84 ►r.rrr. fri ►rr..r r�yr ft�� ►vv ..f -- 24" 36" 12 -1/2" DTA. Void �' p ae}7 W A P"m at 57.4 %, O.D. Of4^ at & A ... Pryt'e � 4 .623 iAClr� Void votfayre per lim f : 1 14 • j _, ±+5� Sidtwall {2 SW wals) 12 EL S9 i liar /0 •t h •' 0.117 CD, A. Of acaft c y" =1`2.5 a Bottom }R L i Owt cvn,,.r'Unfler' I.io -� r l' T ow Seat laterfaee Area 2 . ©0 f 1 Ji25 ` R 0'0. Of O>f� cAndtr, a 12 1 f2io /@ ' 374 422 R' Vll,d ate O+ft+de "i+dm •1`, Pr elected Tr (( ( t 01 .57a ., 901 w taeh Area Sidew 12 1 ,l ow .01 +rourrrz a aPl "eight � m. ` t 8ortpm tren„nA 2.00 Sq. cylinders Ow 1 9ottom _ ` Ft. (l1a h + i2ia — f � - 7. / k '� = 3.00 S 36 in. 1 "� vplsrpe at �� f!_2l (t2is.ff�j 519+ 9•Ft. a , 16'Ot Y Oj Yet �+de b... car"e" { t/2 Of vlld vpi... bc r i Prplecterd T,,.,,, Area = S." ft '0.117+0.422 +0, 901 «0,213 � ;1Q.21 S: - U.IOgf ! �`a0n'Ps Per f2 � ! .763 X 7. 0. l og a d 7 63 eta fi � 6 r '� ` �a�A - ter x ra s- C) EPS 'aggregate Trench SYstem EZ 1203H R "g''induStrio j Group ndustri al 38060 P j 00kiOnd. TAT ° Rd. ! `t r WUL Ezt,2o,H+ -n f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address �® ( %x 44 C, , wla J,.LO, . W-r 544Z 11 Property Address "' (D �'M l r✓ L.-t, t �-. (Verification required from Planning Department for new construction) City/State Parcel Identification Number 4� O — / 2-g 1 " 9 O — O-0 LEGAL DESCRIPTION Property Location 5W %4; SW V., Sec. T N -R LVW, Town of Subdivision t LA►- A'C Lot # 2 Certified Survey Map # volume _ Page # Warranty Deed # (0 Volume ?,� Page # -� Spec house yes ❑ no Lot lines identifiable 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 wW by a masterplumlerjourneymanplgmber, restrictedphimberora 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, heyin, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating tha our s c system has be maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o 4hr iii on SjKNATbRE F APPLICANT DATE OWNER CERT IFICATION 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 rty es bed ve, a of a warranty deed recorded in Register of Deeds Office. g / -7 GNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed z POWT QVVNER'S MANUAL & MANAGEMENT PLAN °- of e SYs Tank Mowsect�m � i QS'e C5 ❑ NA 4 T Owner 0 � Q HoWV VOI. � V l� Permit # / ❑ I+IA Tank Manufacturer PARAMETERS D NA D Sql* D Dose D H vol. 9N Number of Bones ❑ NA ❑ NA Effluent Pillar Matwfacnw Z0. Number of Public Fadit (hits Effluent ~ Modal � Estirnated f flour O� DNA ..Pump manufacturer nrfacn [i ► fPOW flow . ( x 1.51 _ f+mnp Model _ ❑. NA Rate ral � Infiuent/Effk iant OualitY aveza" FNter ❑ Po st Fes► Fats, ON & Grease {FOG) S30 mgR l Aeration ❑ Wetland Biochemical oxygen Demand {BOOM 5220 MW' p Other: Total Suspend Solds �} 515o rteg!!. E3 0 Mound aveaverage Manufacture► ❑ NA Pretreated Effluent Quality mo dy Cam} ) Biochemical oxygen Dernand {BODO I (gravity) D (pied) Total � Sow f i'SS) 530 mglL D D At -Grade L7 Feral � Ig-OOn a Ac mean) Si0` ckdloor d D tritear Maximum Effluent Paetit s Size Y. in tea. O NA 103 DriP- 2"A tittw : Cl NA Elther• NA •t/alttes typical damt wastewater and a tares ° MpjNTENANCE SCtif39JO Swvke Sae+riae Event rreote (sa VAwdm= 3 ) 0 NA 1aispect condition of tank �` (Y,) nk s) At Mast once every: of ta volume (3 NA When combined sludge and slum equ� Pump out Contents Of tanks) ❑ Wben the hie water alarm Is activated [03 NA � � 3 yews) Irk dispersal cauNs) At least once every mfg} ❑ NA At lewt onw every: 1 S) Clean effluent filter D masrtta(s) Q NA inspect , pump' controw & alarm At iaaat once aunty: C3 ) per} DNA Flush lags and pressure test At feast once every: ❑ yeasts) ❑ (a) ❑ NA At least once every: ❑ NA of the foNo+aiie9 Ncerusas or certificetioras: lklAl Inspections o arks, IN this tells shoot be made by era � casrYare9 one S"t ga Setvickv Operator (pumper) Inspections of tanks an Restricted Sewer floWTS �% POWYS Ma .r: sae cracks or Master Plurnber: Master PltrnOw a of the taS k e identify a" n i 9 or broken hardware, eft► y Tank insptrctl ons mgt include a vista � tired sCtun acrd a for arn1 back up or of efflugnt on the �} leaks, measure the volume of combined sludge the effluent levels lo the observation Pipes Mad to deck - surface. The dispersal {$) surface. r yy want on the ground sur rnaY adicate a fa t9 co^dittare > The porw&M ponding of effluent en ttee I of the local �► �- requires the imrnediats notification one-third IY,) Or mare of the tank volume. tlw When the combined a atwn 01f a and scum in any t""nent tank equals soul desposed of in accordance wkh chapter NR 113 entire contents of the tank slue be removed h1► a Sapta9e � Operator Wisconsin Administfu6m Code- mechanical of Pressurized Cornponents, pretreatmer All Other services, iteclude+B but not timated to the servicing p e fitters. loll a certified POWYS Maintainer. units, and any servitsng at intervals of .512 months, shat! be Performed of aril s event. A service report tthaN be pry to the local reguiator!► auy w 10 days of completion GMW {2142 . Page �f START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products, solvents or other chemicals that may impede the treatment process and /or damage the soul dispersal ced(s). if high concentrations are detected have the contents of the tank(a) removed by a septage servicing operator prior to use. System start tin shall not occur when wd conditions arc frozen at the infittratrve surface. Ong extended power outages panne/► tank a may fill above normal highwater levels. When power is restored the excess wastewater will be dbdmgW to the dispersal cells! in one h pa dose and may overload them resulting in the baclW or surface discharge of effluent. To avoid this alteration have the contents of the pump tank renwved by a Septage Servicing Operator Prior to restoring power to On effluent pump or contact a PNnnber 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 soli absorption anew. Reduction or elimination of the following from the wasctewetw stneaau may improve the perforrnance and prolong the We of the POWTS: antibiotics; baby wipes; cigarette butts. curndorW WtWn swabs; degnaassns: denial floss; disinf fat; foundation drain imp pump) discharge; fruit and vegetable peelings gasoline, grease; herbicides; meet scraps; medications; oil; painting products; per; sanitary napkins Dora; and water softener brine. ABANDONMEIff When the POWTS falls and/or is permanently taken out of service the following steps shag be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Add Code: • AN piping to tanks and pits shell be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and property 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 soe, 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 replac ernent arm d mould be protected from disturbance and compaction and should not be infdtped upon by rid setbacks from WashM and p gxmmd stnictum, lot fines and wed. Failure to prowat the moscons t cues will result in the need for a new sal and site evaluation to establish a suitable replacement area. ReplaeRement system must comply with the rules in effect at that time. D A suitable replacement wee is not avaiable due to setback and/or sop limitations. Barring advances in POWTS technology a holding tank may be installed as a lest resort to rapes the faded POWTS. O The site has not been evacuated to identify a suit" replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable rephmment area. If no replacement area is available a hohli ng tank may be irnstalled as a last resort to replace the failed POWTS. E3 Mound and at -grade sort absorption systems may be reconstructed in place following removal of the bimnat at the infiltrative surface. Reconstructions of suds systems must comply with the rules in affect at that time. < <WARNWG> > SEPTIC. PUMP AND OTHER TREATN@R' TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENM A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CWAXIWTANCES. DEATH MAY RESULT. FESCUE OF A PERSON FROM THE FOR OF A TANK MAY BE DIFFMXILT OR IiI POSSMLE. ADDITIONAL COMMENTS POMtTS UWALLER POWTS MAMTAINEt Name C� W ils Name Phone7/S Phone _ SEPi'AGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S , �n ► Phone s 3 This document was drafted by the staffs of the Green Lake, Marquette and Wausham County Zoning and Sanitation apsirdas in comPUmc• with chapter Comm 83.22(2)(Wt1)(d) &(f) and 83.54(1). (2) & (3). Wisconsin AdrMlistrative Code. 1\1 vLl♦ VI'ILLL I I 4A • 11J JVV I VV'i JQI I JV GVVJ 1L • VJ r. W • I• 1J3 2 P S�5 KAT STATE OAR OF WISCONSIN FORM 2 - 1908 R 1i 11- ,P kDUDS WARRANTY DEED sr•$ Co. r kI 00"Mwlt teurnber RECRI VED YOR RECORD �6 This Drod, made between 9130 AN Tr k>ARRAt we a c>zs aA ots Con EXaD? 1 atuf rr pn Grantor, R8C F$ t QMDany. TRANS t COPY tea• 90 I T �Y FkE t GE9t Y PA . Grantee, G=nt0A for a valuable consideration conveys and warrants to Grantee the lbllowlnR described real agitate In St. Cr County, State of Wisconsin: 126, 127 Lot 128,129 of the Plat of T ! rie g Ar .Addition i Troy, t. Croix fi N111 64 Return AdE/ass : :_, : :: i n thQ Taym of Tro Croix County, ( Wiiirconairt. Derrick Construction. nany, In !I subject to Declaration: of Cove P.O. Box 445 ria>atta, and New Richmond, WI 54017 Restrictions for Troy vi2l,aQe, Conditions a recorded in vol. 1241, I li Page 286, as Doc. No. 554964, and the Declaration of Golf Course Covenants # ons and Ea Coetd ti �enente . Page 302, a, Doc. No, 559"9 040 - 1213180 - wo recorded its Vol. Vat 1241 04b =1281 APPearing in the office of the Register of Dees - Iak - 00 - = 040 -1282 for St. Croix Count y, Wisconsin, d P .� ' s, restrictions and • such other arcef identittcetiort Nun>!x� easement i reservations of record This �. property , or in use, and the "'Buyer" obligations contained in the chase Agreement for this lot. (is) (is not) I ,I 8xceptions to warmniles: �I Dated tuts 30th day of 2(302 (SEAL) i • curies S. cook, President 'Troy Ds'e"loptnent Carperat on {SEAL) • .i AUTHENTICATION ACKNOVILEDGMENT signacsue(s) Minnesota State of wif ccstsM. • Anoka authenticated this dsy o f pamonarpt came before me this dai of share t+e � es S. Ceok, lies dent ;! Trov D+veic} Coroc�rattion ! t TITLE: MEMBER STATE BAR OF WISCONSIN to {[f trot, ma known to be the person who executed the fora 8olne urthortned by $708.06, Wu. Stets,) instrument and 4cknowledRe the same. If ! w E j THIS iN ;TtltlMENt WAS DRAfTFD BY TROY DEVELOPMENT CORPORATION A . h o n _ - —A. PTO nfj j; Notary Pubtk, Ow•.wo+tetwJ�toka County, Mi Chkrlee 3• Cook, president My COMIU10A is permanent, (If not. state expiration dais: •I (5ignatursa may be authenticated or acknowledged. Both are not _ LknuterY �1 r nacmeryt) I N&ft% erM.ae ,laptoi( M any aAWky mute be 1ypW ar prow"r .6kW JhWagJMJU r, tJ tl t !' WARRANT' DBBD STATE Batt A If WISCO iN le FORM No P" A. JOR&O a 4 01Wlil WK"-M"0= r$M %4 �fiH� T 3`W -1%4 - - �n - - — � w,� h�RC _ _ ♦ � _ � , . .. . N - 43.790 S.F. 1 ` I SE 1/4 OF , 1 . ... -9a ....... I 1 .......... ............ ....... .......................... .... . LOT o , I c c ol I o; 1 Z2 N I _-� I I PAGE N K) - - 1.021 ACRES - UI I ^ 44,461 S.F. DOC. I � I � N 89 0 40' 20" W I co ~ v 335.03' N I o I U o 1 it ' ° `° 123 q I I o c0 1 V I I I I S 89 0 33' 26" o ` 1.028 ACRES I 1 , Z I - 44,774 S.F. - 24.04 W 3 - - - - - - - - - N 89 0 40' 20" W a� rn U 331.17' ►� o ^;' ^� rn ago 4n 1 U d ° . • �� p � ' r- N 89 0 55' 19' cO b 0° ' 37.27_' OUTL_OT_5 1.1 III °p �:;_� �t o o ACR , I Z N 1 o EXISTING 66 �F TROY VlL L A GE L 44,016 S.F. 1 PL OT TN VOL UME_ r - - 1 M S 89 0 55' 19 N 89 0 40' 20" W Iv I U 1 w 3 3 43.85' 330.26 1 ^ _ N 04� w 125 o o N V0z N' 1.012 ACRES 1 I M O o ° w O w - I 44,065 S.F. 0 o oo I • O O = f'AC z L - - - ��' �� La 0 N 89 W �' ON I• °' N N 2 J o ° 331.40' r J 1� N 0 0 L 126 tr C* N 1 1.027 ACRES VI I i 44,743 S.F. 0 I •I I i N 89 W I N W I n cr 334.37' 1 li L4 I N _ 4 , II I I 127 •- I I OUTLC 1.022 ACRES U I I I 23,974 44,532 S.F. w N 89 0 28' 54" W I3 325.00' M tT 'M O N 16 1 00 00ui n^\ 9 LO C14, 0 I I O � 1 �\ 12 ° ° 1.037 ACRES AA 45,173 S.F. Z N / / MO O� l I °� 129 `��� / /�^ Mz 0 N 1.036 ACRES / i / U O OUTL O T 9 w 45,130 S.F. )F_TRO Y VILLAGE / I o --x W O S 89 0 28' 14" E G -� I w Q5 lii Z 57.89_��.. POINT OF M BEGINNING 00 , E a C� ��'�� �S� ��� .62' O N 1 '(� O 89 0 28' 14" W 57.89' p �p�50 `'' \ m \ Z 3 5' 66.00' 1 210.3 3' N 89 0 28' 14" W 395.17' i — P L_AI N VI_EW — — — — — — N 8 9 40' 23" W 2506.91' 1 I DRIVE '.OT 1 I LOT 1 0 1 h CENTERUM ._.. -=-=. - --- —.. I — — — � I LOT 2 LOT .3 _ -