Loading...
HomeMy WebLinkAbout040-1113-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515207 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: Stock Estate, Lynn I Troy, Town of 040 - 1113 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: (� 1�1/I C _-5T j 30.28.19.466 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Z -73 162. 13 ab Septic 1, / `O Benchmark Alt. BM d Z r, 1 Pe !d �zs 7 5 1, Aeration Bldg. Sewer 5. - •7 i n. . Q 3 Holding St/Ht Inlet :T ✓ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet t94 Septic Dt Bottom Dosing Header/ n. I 131- & boar J �.93 7- $ Aeration Dist. Pipe '3 yto Holding Bot. System 7 2- /0.73 - !2- MAT t.oz 96 .71 Final Grade PUMP /SIPHON INFORMATION �' ��• �3 Manufacturer Demand St Cover 7 , 51 162 ' GPM �/�, d ' Model ber ' e I ? Z' , i /a/ . 57 TDH L' Friction Loss System Head I T DH Ft 2 / fa(� /62.15 /J ` r 5 Forcemain Le ng Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length 1 1-7 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di Liquid Depth DIMENSIONS 3 — Ae^Ct,0Z `— _1— SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: I '16 6-w UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold IDistribution x Hole Size x Hole Spacing Vent tot Z4 C Pipe � 7 s) \� `� L O e.Jelra ✓� �,� 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 N Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # #1: / / Inspection #2: / / Location: 165 Cty. Rd. F River Falls, W1 54022 (NW 1/4 NE 1/4 30 T28N R1 9W) 40 acres Lot Parcel No: 30.28.19.466 1.) Alt BM Description= 2.) Bldg sewer length = Z 0 C �el (3' F , �0 V -amount of cover = i f ro � � ��X Plan revision Required. Ll Yes No /D - - J/ / X Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors gnature Cert. No. PAID) commerce.wi.gov Safety and Buil ' I N 5 /!5 zo :Z Coun 201 W. Washington e., P. i sco n s i n Madison, WI 3707 -7162 Sanity Permit Number (to be filled in by Co.) Department of Commerce 4 9 Sanitary Permit Application State T a °ti °n NU` � In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the ppro riA v OFFICE unit is required prior to obtaining a sanitary permit. Note: Application forms for ec OIX COON dress (if different than mailing address) submitted to the Department of Commerce. Personal information you provide ma use for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. I. Application Information -Please Print All Information Property Owner's Name £� Parcel # A s G ?4A °///- 3-30 -N Property Owner's Mailing Address r Property Location / / I T l 4 F Govt. Lot C City, State Zip Code Phone mb Number 5 t:3 Y< 99: / <, Section 3 6 R � 6 c� t J��O 0 a. &57 � 1 ,2 , 3689- (circle one T a N; R Eo H. Type of Building (check all that apply) Lot # 1k 1 or 2 Family Dwelling - Number of Bed r oms 4 1 go+ Subdivision Name f Block # ❑ Public /Commercial - Describe Use ^— El city of ❑ State Owned - Describe Use �/ CSM Number El Village of v� 3 i',.Ji -- �� w f g� / O t Town of `I nn IF III. Type of Permit: (Check o ly one box on line A. Complete line B if applicable) A ' ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner J-A . IV. Type of POWTS System/Component/Device: Check all that a 1 0 G (S K Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound 124 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) / ' ,0C.) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate dsf) Dispersal Area Required (s Dispersal Area Proposed f) System Elevation r/- 4 2.8 4 0 . io /a 0n /0 72. 9z.o r3 , Qa.53' VI. Tank Info Capacity in Total # of Manufacturer Gallo Gallons Units -0 2 o $ 2 New Tanks Existing Tanks y c 0 a V rn y A w C7 a Septic or Holding Tank / SQ S 4, W �� Dosing Chamber S ;1 fir' VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWA shown on the attached plans. Plumber's Name (Print) / Plumb is Signature MP PR umber Business Phone Number E; 1- etu U/ ax X5 - -7f9 - P umber's Addre s (S eet, City, State, Zip Code) IF X47 N� (.� R w� ��o� VIIL /De artment Use Onl Approved Eli ti- Permit Fee Date I sued Issuing ture ent Signa ,� y75 Co 17- o5 ❑ iven Reason for Denial 1 IX. ConditjtjE4MW easonsforDisapproval 3) 01 cY n 1. Septic tank, effluent filter and / dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained at PK Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size -` SBD -6398 (R. 02/09) Valid thlu 02/11 Al /Vr AAA 7 9 � �. p •5cZ apt: -.�__ �, _.___..�.,._ _�__ _._ �� .1 r YA �l T-2 % /$ q u.rc K V C N A r�d ER S � c , ot f Ego c.AF s zy PER TR,� a NEO MAX E S r 7" 1 Q W E1- Lecopy 0 kv ��L a Al RRM� s �'R.. < r x4.39 #V► o. 141, T 91.9 — 7 0 �y a �� YA D E , e ss Paul. t�� 9 Al 9 c- y CHAn►OERS 1' �. ENo c.RPS 7y'FER 7'RscA1cH , ra,S3 �r�.o� 9o•s3�,- � �i asE sc. M f v y� Sir r�G 4 14 sap SEFf T"'�'NIS 9 � T I �� o��e � •-� {9G Lj wEL �a Lp L3 EL. L Fla�`N�pN.EU _ � 1 P. 38 l A. Introduction A.1. Project Description We the Innovative Power Systems, Inc. (IPS) is planning to construct a wind turbine at the residence located at 1041 65 Avenue in Roberts, Wisconsin. The general location of the project is depicted in Figure 1 in the Appendix. A.2. Purpose The purpose of this geotechnical is to provide subsurface soil and groundwater information to be used in the design and construction of the wind turbine foundation. A.3. Scope of Services Our scope of services for this project was originally submitted as a Proposal to you on June 22, 2009. J Tasks completed in accordance with our authorized scope of services included: ` staking the boring locations and coordinating the locating of underground utilities near the boring locations, ` conducting one penetration test boring to a depth of 40 feet, classifying the samples and preparing boring logs, transporting samples to our laboratory for visual classification and logging by a geotechnical engineer, submitting a geotechnical evaluation report containing logs of the borings and our analyses of the field tests. Our scope of services was performed under the terms of our June 15, 2006, General Conditions. I i CU 7�� 11 C9Sl- vWsoondn Departftwd of Convnerce SOIL EVALUATION REPORT P oivision orsarev and Buil ngs In accordance with Comm 85. VWs. Adm. Code Attach complete site plan on paper not tess than a w x 11 inches in sae. Plan kckx e. but not Grnfed to: vertical and horizontal reference tint (BM). Percent slope, stale or dlmenslons, north arrow. and location and distance to Please print all informatfon. by Date Persow rxomumon roe provrdb be used for "—dW prvoses MrWaor tow. s. 15 04 (1) (m)). 1 z b P YW 5�0ck C W ,ECEIVED 1/4 S T� N R V Owner s g Address C' Lot Block # Subd. Name or C" �u f- DEC 0 2009 A"T OF /6 0 �9�5' Stye ❑ ❑ wage Z) Town Nearest Road 4)1 S r(D2� C G ^ 4016S w ❑ New C.onstruction tise:)4 Residential / Number of bedrooms Code derived design How rate &Q D — 7 S O " GPD )Q RWleoernent ❑ Pubic or oommercial - Des«ibe• Parent mate" W" f>Rt Fr 40PA Rood Plain elevation N applic and teoa ndallons: SW A.), Are& j�_ Spot Tested suitable for & Cwwdonai inground system (P.O.W.T.S.) F py f Ground sufece elev.. R Depth to Hmiling radar in. Sol Applioallon Rate l im aon Dapm DonAlmdwor Redox Desaiption Texture Structure Consislence Boundary Rats GMff in. Munsell Cu. Sz. Coat. Color Gtr. Sz. Sh. •EM1 I •Eif#2 / 0 -/,0 /D ie (R G 1f5 S - q W 1/0 0-20 ( to 2 f 7 7.s 5 5G s s /o 5 M 1 wAt a o S4 6p HOD . Pa / / D Yx 3)F ,tom . ,, . 42$ o 80 " # i at P V'° Gourd suftw eie,. / R t"ih to Wdling factor y in .. sw Mplialfibn Rate Morison Depth W*wtC4m Redox Desc*dm Texture Strucbme Consistence Boundary Roots GPOII! In. Munsell am Sz. Cant. Color Gr. Sz- Sh. •Efi#1 `EM 21 12 • 5 ---- 5L Vf L 5hL f.K-f c I (00 s. 5 6, s4 C 5 / 6a • Ettlaerd iN = BM 30 < 220 mgH- and TSS X30 < 150 mg& E kwt #2 = BOD 130 nV L and TSS 130 nWL Csr Nunn (Please PdM 2tL �3I2 C tl Csrr� 2'i637Sr Address Dab Evaluation Conducted Telephone r.mber [ Mbricht & ASSOCiales Oc-1. t 2-oof 7 1S"• 77,2.39"-/ Private Scmage C 2612 10th Ave._ -- Spring `valley, Wl 54767 f i FM mmm - �l 0 VA 52=176201=4 m MON"I/ mm mm� A EM- mmmm mm mwm I ■ ' ._ ' �r m m " WIN, mmm m mampm W-1 FA MAAMNMMIMA� WAS sA92M : ' ®who " f ���mm� = =Biwa jdMW-!A � � %ice =�© mmm it MIM=MM ova mm� ■M®mV�MMMM mm� =► Mmmmm� ■ WEI 1 � ©© Y o w NO GL ALL NON-CONFORMING P�. TREATMENT TAN RpPERLY BE ABANDONED P PER COMM. 113.33 C! c4l � ate u /t ants C�s � o � 13 / z 3a' d l3 3 � co��u 1 SNG�� 0 P Ta h N � 1 ,� co 5f ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer s- ,y, °f, Z N N S5 � T Mailing Address !�/ Property Address — Gyit- (Verification required from Planning & Zoning Department for construction.) City /State ga_-. Parcel Identification Number LEGAL DESCRIPTION Property Location $(,off ' /4 , ' /4 , Sec. -30 T ;:?a N R__ &( Town of Q Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # tj y '7 (0 4 S (before 2007)Volume 8 `�° , Page # l 4 8 Spec house' -1 yes i -] no Lot lines identifiable Lyes i -i no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 frill of sludge. 1 /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 Planning & Zoning Department within 30 days of the three year expiration date. 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 o a warranty deed recorded in Register of Deeds Office. Num of be r s r SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey snap if reference is made in the warranty deed. (REV. 08/05) 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner / ;?5 - 0 g al ❑ NA eptic Tank Capacity Permit # Septic Tank Manufacturer NA DESIGN PARAM Effluent Filter Manufacturer f� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units EWA Pump Tank Capacity al Estimated flow (average) 40 & 4,0 O al /day Pump Tank Manufacturer 016A Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer A Soil Application Rate i (D al /day /ft2 Pump Model A Standard Influent /Effluent Quality Monthly average" Pretreatment Unit A Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average ;Z-Giound al Cell(s) �OZ6v ❑ NA Biochemical Oxygen Demand (BOD <_30 mg /L (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: ❑ 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: ❑ ear( ►(s) (Maximum 3 years) ❑ NA 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: ❑ r3onth(s) (Maximum 3 years) ❑ NA 0year(s) Clean effluent filter At least once every: onth(s) 11 (s) ❑ year(s) ❑ month(s) O IAA' Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s)� ❑ 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) i 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. ND ABA NMENT O 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 lace the failed POWTS. technology a holding tank may be installed as a last resort to replace 14 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 NameC Phone Phone �-- SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name , Name Phone �� = a 1-5 Phone 8� This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. w ,� ,• OQC'tlMENT N0 ,. THIS cg POR RRCOROING DATA ' DEED QUIT ii STATE BAR OF- WISCONSIN- FORM � sP116 REs -- Il)R� _ 4sgJ ... V PAS S L '� 1t Alvin C. Stock and Lynn F Stock, !! tenants; 1n common, !1 Reed for 1N! Record { Alvin G. Stock and T n F , n Sto��c, - -- - -- - - -- -- - - - - -- - --------------- - - - - -- - - -- - - -- MAY 0198 .:quit cla�ma to _ - u as ]olnt tenants---- ----- -------- ---- -- - - ---- -- - - j� Ot 3.30 P� m = - -- -- --- ---__- , ------- - --- -- -- I (� — i s -�f— -the• follosing described real- estate in St Cr 01 x --- County. l - - - State of Wisconsin: i RETURN TO �t Tax Parcel No- - -------- ------ ------ --- ! South One — half ($x) of the Nor theast Quarter (NE) and Southeast Quarter (SE o) of the Northwest (N %) of Section 30, T28N, R19w, less highway conveyance - -- described in Vol. 483 @;page 328, 1 Y l � This .__is_ not ..... homestead- property. _ ., I I • 1 (is) (is not) Dated this - - - •- ---- 8th--- - ---- - -- day of ------- - ----- - - g _$9 • --- -- -- -- -- - - - -(SEAL) --------------------- (SEAL) -�ar - -•- ----- { Alvin C.• ­Stock ` - , • - ---- -- - --- ---- • -- - - - _ --. - -• -- (SEAL) f L Stock AUTHENTIC - ATION ACKNOWLEDGMENT � Alvin C Stock and Signature(s) _. ------ ------ - ----- ------------------ STATE OF WISCONSIN ) Lynn took - ----- -- --- ----- -•----- ----- •-- ------County. - -- ------- !1 authe Cate s _gt y of }'_________ __ ___ 19_ 9_ Personally came before me this - _____day of ,I Ti -- - - -- --- --- ------ --° > 23 the shore named - --•--- - ---•-------- -- ------- S lex Kosa ------- --- --- -------- ------ ----- -- - - -- --------------------- r, t ----------------- ------ ------------- -- - - - - - - -- - -- --- --- r - --- ----- - --- ------ ---•- ------- --- - - -- -- ----- ----- -- ---- --- - -- - -- ----------------- TE: MEMBER STATE BAR OF WISCONSIN /w (If not, -------------------------------------------------------- ---- -- ---- - --- -- - -- --- --- ............. authorized by $ 706.06, Wis. Stats.) to me known to be the person -- _- ------- who executed the T oregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY -. ALEX S. KOSA - - -- •-•-- ---•- •- -- -- ----- -- - - ---- -------------------- Hudson, wl *---------- ------ -- ----- -- --- ---- --- --- - -- - - - -- ------ ---- ---- --••- •- •-- - - -- . -- ---- --- .................. — - Notary Public -•---- ------- ------ ------ ... County, Wis - i rt, r: roa v .ao �a n rs My Commission. is nermancnt. I If not, state expiration n rsx not n�nncFnrv.l QUrr CLAtM DEED aT,%T1•: IfAlt OF WIRC XSid: t5'strm -in t.•z¢wl ni.nk Co, 1 - , rnftm hl ilva., 4.•n R.a I lillll III IIIII IIIII IIIiI I IIII IIII 111111 IIII ���� Document Number J Document Title * 9 0 8 0 9 6 y St. Croix Countv 908096 SETH PABST Occupancy Affidavit for a single POWTS REGISTER OF DEEDS servicing Two Dwellings via DIMS ST. CROIX CO., WI 7y�cSk�✓ lrh� F-Vrn K4sMrF RECEIVED FOR RECORD 12/04/2009 09:10AN Name — (Owner Typed or printed AFFIDAVIT being duly sworn , states, under oath, that: EXEMPT f 1. He /she is the owner /co -owner of the following parcel of laa4 REC FEE: 11.00 located �in St. Croix County, Wisconsin, recoor ed in Volume p PAGES: 1 Page -E-�-9 Document Number 5 b 5t. Croix County Register of Deeds Office: . } Recording Area A parcel of land locatey� in the - f70!4 of the PA, of S on D , Name and Return dra: e �/ _ Den n I'S m b sus �e rte, Tn+s�ee, T N - R �_ � Town of St. Croix County, Wisconsin, being duly des 'bed as follows b F 6Y ZL (include lot number and subdivision/CSM or detailed legal (f description): Parcel Identification Number (PIN) As owner of the above described property, I acknowledge that a Private On -site Wastewater Treatment System ( POWTS) serving the primary residence is sized for -4 bedroom(s) with a design wastewater flow of 4p & gallons /day. (DWF calculation based on 150 gpd /b room @ 2 persons /bedroom). Two dwellings will be connected to the POWTS via Private Interceptor Main SeWer (DIMS) in compliance with Comm 82.30(12). A maximum of $ occupants are permitted. There are currently a total of_ occupants in these residences, therefore the POWTS can be considered code - compliant at this time. However, I understand that if the number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate any increased wastewater flows and/or contaminant loads and may be subject to premature failure. I also acknowl a that I will disclose this information to any patties interested in purchasing this p o in the fu ed this da o M AUTHE IM ACKNOWLEDGMENT Signature(s) � STATE OF WISCONSIN ) Us. DEKN 5 AK.:i E St. Croix County. ) authenticated this day of Personally carne before me this - day of q the above named TITLE: MEMBER STATE BAR OF WISCONSIN to me known (If not, to be the person(s) who executed the fore instrument and acknowledge the.sa' CIV authorized by 6 706.06, Wis. Stats.) THIS INSTRUMENT WAS DR FTF- BY 1 1 4w- f 4011 J ae�. �� u . Notary Public. State of ; (Signatures may be authenticated or acknowledged. My Commission is petmanen . loot;. Both are not necessary.) date: Date' "THIS PAGE IS PART OF THIS LEGAL DOCUMENT— DO NOT REMOVE" This tnformation must be completed by submtaer: document at/e. name & return addrem and EN pfrequiredl, Other information such as the granting clauses, legal demnotion, etc. may be placed on this firs page of the document or may be placed on additional pages of the document. && Use of this cover page adds one page to yaw document and 12.00 to the recardG,a fee. Wisconsin Statutes, 59.5 1 of 1 ru t , may o 4Z s� 4 M I S r "m law x E � b l 0 } ariR 0; -�' ' Lu a� wM r As E I n ". sib AA all "i e k 1 fill! �. � f,� TA oil rz 11 c I its A: k I 4 ll 4! g o - Q ,a ( x s d ' guy + * h c► °,� Tr Zf a � Parcel #: 040 - 1113 -30 -000 12/07/2009 11:51 AM PAGE 1 OF 1 Alt. Parcel #: 30.28.19.466 040 - TOWN OF TROY Current IX-1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner LYNN F STOCK O - STOCK, LYNN F 165 CTY RD F RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ° 165 CTY RD F SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 30 T28N RI 9W SW NE EZ -UT- 1499/354 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 10/02/2006 835740 TI 07/23/1997 840/198 2009 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason LTUR G4 35.000 3 AGRICULTURAL , 600 0 3,600 NO 00 UNDEVELOPED G5 1.000 100 0 100 NO AGRICULTURAL FOREST G5M 2.000 8,000 0 8,000 NO 05 OTHER G7 2.000 20,000 69,200 89,200 NO 10 Totals for 2009: General Property 40.000 31,700 69,200 100,900 Woodland 0.000 0 0 Totals for 2008: General Property 40.000 19,650 93,400 113,050 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00