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HomeMy WebLinkAbout040-1193-30-000 Parcel #: 040 - 1193 -30 -000 01/05/2010 03:30 PM PAGE 1 OF 1 Alt. Parcel M 24.28.20.869 040 - TOWN OF TROY Current [X 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 O - MORIS, WILLIAM E & LYNN R WILLIAM E & LYNN R MORIS 210 PLAINVIEW DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 210 PLAINVIEW DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.100 Plat: 04- 012 - CROIXRIDGE 040 -75 SEC 24 T28N R20W PLAT OF CROIXRIDGE LOT Block/Condo Bldg: LOT 23 23 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 24- 28N -20W Notes: Parcel History: Date Doc # Vol /Page Type 01/03/2008 866597 QC 10/26/2001 660262 1747/228 TI 12/19/1978 354039 587/38 WD 2009 SUMMARY Bill M Fair Market Value: Assessed with: 33899 365,000 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.190 66,900 291,300 358,200 NO 10 Totals for 2009: General Property 1.190 66,900 291,300 358,200 Woodland 0.000 0 0 Totals for 2008: General Property 1.100 72,600 283,200 355,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506370 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: Moris, William I Troy, Town of 040 - 1193 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: ,� , /J o Section/Town /Range /Map No: I -[) /tsU b ✓ '� _ 4_u� 1 24.28.20.869 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ,� / .?&t Benchmark ') LS L <Ud ` 0 Dosing I Alt. BM T k � O Aeration Bldg. Sewer Holding ' I � SUHt Inlet / G St/Ht Outle / �� SGT G 3, SS TANK SETBACK INFORMATION / 03. - 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD D)�tlet �(� 3 p y V Septic _ .nn/ Dt Bottom 5 5` p , , Header /Man. fp I,� I,o w • SS /01,-7 Aeration D ALE e ` Holding Bot. System L •I I Final Grade PUMP /SIPHON INFORMATION �✓la�',t_ �- 5 ' Manufacturer Demand A Cover GPM �, /O 2,- Model Number 3¢ TDH Lift Friction Loss, System He d TDH Ft a3 �•c�5 � ,A - 7,(,; , Y Forcemain Length Dia. Dist. to Well 2� SOI ABSORPTION SYSTEM ce_u BED /TRENCH W idth I Le h + No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P /Lc BLD WE LAKE /STREA LEACHIN Manufa s INFORMATION CHAMBER OR f�' Typ Of System: �/ ` I , UNIT Model Nu my DISTRIBUTION SYSTEM Header/Man if Icy I Distribution , x Hole Size x Hole Spacing ent Intake QI T D Pipe(s) Length V Dia Length Dia pacing � SOIL COVER x Pressu Systems Only xx Mound Or At - Grade Systems OnlyJ , � ir ` Depth Over Depth Over xx Depth of I x Seeded /Sodded xx Mulched Bed /Trench Center L! r�— Bed /Trench Edges Topsoil / Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 10 / ZP 1 ©�-� Inspection #2: Location: 210 Plainview Drive River Falls, WI 54022 (SE 1/4 SW 1/4 24 T28N R20W) Croix Ridge Lot 23 Parcel No: 24.28.20.869 1.) Alt BM Description = _5'o�.d_y 2.) Bldg sewer length= C(!v 7� 1 7LyU� - amount of cover = Plan revision Required? ; Yes Z No r� IU Use other side for additional information. D ate Insepctor s Sig ture Cert. No. SBD -6710 (R.3/97) D commerce .Wl.gOV Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix i sco n s i n Madison, Wl 53707 -7162 Sanitary Permit Number (to be filled in by Co.) [!apartment of Commerce j a (,t-7 —7 6 Sanitary Permit Application Na Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m Stats. I. Application Information — Please Print All Information 210 Plainview Drive Property Owner's Name R E C E I VE p Parcel # William E. Moris 040 - 1193 -30 -000 Property Owner's Mailing Address OCT 1 1 2007 operty Location 210 P lainview Dri ve Govt. Lot City, State Zip t-;0 0e eNumber SW ' /e, SE ' /s, Section 24 Hudson, WI 54016 Pho 5 386 -5788 T 28 N; R 20 w II. T e of Building (check all that apply) L ot # or 2 Family Dwelling— Number of Bedrooms 4 23 Subdivision Name c S -� n1 Block# El Public /Commercial — Describe Use Na ❑city of 0 State Owned — Describe Use CSM Number ❑ Village of Croix Ridge 0 Town of Troy III. Type of Permit: (Check onl a 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. ❑ Permit Renewal 11 Permit Revision 0 Change of Plumber 0 Permit Transfer to New q List Previous Permit Number and Date Issued Before Expiration Owner � � Z 7 / IV. a of POWTS System/Component/Device: Check all that appl k�v -614e Non - Pressurized In- Ground 0 Pressurized In- Ground 0 At -Grade 0 Mound > 24 in. of suitable soil ❑ Mound < 24 in. ❑ Holding Tank ❑ Other Dispersal Component (explain) 0 treatment Device (expla' PolyLok PL -525 effluent filter V. DispersaVrreatment Area Information: Three distribution trenches proposed with 20 chambers per trench. 60 Infiltrator "Q-4 W" chambers @ 20.0 s .ft EISA / chamber + 3 pair end caps 5.8 EISA = 1,217.40 sq. ft. Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation J/ 600 gpd 0.5 in -situ soil 1,200.00 sq. ft. 1,217.40 sq. ft. 99.50', 97.75', 96.00' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tacks � & U inU 0 4 P, Septic or Holding Tank _.j 1,2@ 1 A mmm X ---266L / 1 Weeks Concrete X Dosing Climber 800 800 Weeks Concrete X VII. Responsibility Statement- I, the und I prsigned, ass 94e responsibility for!qAtallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb s Sign I MP/MPRS Number Business Phone Number James K. Thompson 130021 715 248 -7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 -5413 VIIL fAuny Use Onl pproved El Disapproved 7 Permit Fee Date Issued Is mg Agent Si tune $ Pv l 0) U ❑ Owner Given Reason for Denial UL Conditions of A pproval/Reasons for Disapproval ' SYSTEM OWNER: �� / Y 3 ?/!. �Yh �Lt� ,? t Septic tank, effluent filter and �l�x . - (' "" � , J a /Y �K6 dispersal cell must all be serviced / maintained as per management plan provided by plumber. Q � 2. All setback requirements must be maintained CO S/ 4 20 44 as per applicable aW*0rdj pW%*q*ps for the system and submit to the County only n p r 1 tha 8 trz x 11 inches in Actin R �7� �� Or!Q.Q- e.��"� SBD -6398 (R. 01/07) Valid thru 01/09 �C�-[ �t Gt/f L �Xi 5 ��,x• � ra�/e e /e uJ,Y /, cer� E' /f2or','3�rvP•, lJ la?-' oFC/'OVI Sec. 2�{ T. 29if,, w "D., b N O O o � Q v5 � slo • r / EX /S�n4 � i L1 j i well , & ree. ,Qssu.m `�' elegy =1vo.VV' s � �a Fk S Ein�/ -b a'op t J S Cmti, y 6 e 2 (0 l 1�eSeclu -r.2.. K ��'lfcs �n;s E Po /yLat' EX, p po �o se-d we -c's C,7,V . PL tw. s ioo. LP �(' f> s lawn ✓afclL f� be 1 S 6a - /4(1,e LYi't�i� c3 o� t fx ecs Orr le le d a ;n a /off /1CCrrI� 6 : ex �. , e �e�itc/ i ss"6 /e• � �'in.+crs � D d `f i4.s.Tr� 3303V d E ee = /oS.SS,' frc&s eF{lu /awn A /L . 8� c lk rnC Ole of S o!l fir: �n board AF�r'r°X' COS 1 � .� Cell. SyY - kN -•' c ud<a lei grade o e = 980 0 0. 60 Bill Moris Pump Chamber Calculations 1. Force Main: Diameter 2" Length * 1.32f L Flow rate minute Friction loss 'x3. 30 1/100ft.) 2. Total dynamic head: Min. supply pressure 0.00' Vertical lift 6.25' elev. @ off float = 94.5', high elevation at forcemain invert = 100.25') Friction loss 1.32 ✓ Total dynamic head = 7.57' 3. Pump selection: Manufacturer: Zoeller Model number: BN 53 Pump will discharge 38.0 gpm @ 7,57' TDH 4. Dose chamber: Manufacturer & capacity: Weeks Concrete 800 gal., 37.00" 21.76 1. /inch (805 12 ag l actual) Sizing calculations and float settings: A) One day holding capacity: 19.00" = 413.44 sal. B) Alarm setting: 2.00" = 43.52 sal. C) Dose volume + flow back: 4.00" = 87.04 gal. Max. dose = (450.00 gal.)(20 Design flow) + (6.52 gal. flow back @ 40) = 96.52 gal. D) Reserve storage: 12.00" = 261.12 W. TOTAL: 37.W'= 805.12 gal, Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ---1'► Comm 16.28 WAC 4 in. min. Disconnect - r Tank component is properly vented E-- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacity 805.12 Gallons Volume 21.76 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.00 413.44 C B 2.00 43.52 P ume off elevation (ft) C _ 4.00 87.04 -t 94.50 D 12.00 261.12 D Total 37.00 805.12 Dose elevation (ft) 3" Bedding un er tank. 93.50 Alarm Manuafacturer SJRhom Alarm Model Number SJE10 11421 - _- -., -�� Pump Manufacturer Zoeller Pump Model Number BN53 Pump Must Deliver I 85.20 gpm at 9.12 ft TDH AF ex�3�' Gc�cvde,, P /a� oFCrO /an stidy5ca7J'y Sec. A T. Z01r,, e. Tr 4 N `0 1 1 4 V 1 i EW616'n��// J a pdcmt e. t K it Cun ;s /0 Al EXi' (rUpostcl �Jea�'S �UnC . 6 ; l� i /BO' � saPb'c F1ca � de a bo reCanaccAcd rs;M vo- fdc bt e. 5 lawn �O � 4k fr ecs of o�! dra,n{ e /�1 r {canheGL� �_ /aweJ� S� D e (/ gR' iaru/ `fi4.S.T,kt 3035/ Sr �Irwsrs e lU en of S,'ol! fir, m board ��� s A°� . It A a S. G'i' nna H 0{ /o ca &m, of be %sa�r 3 e %v1 0 0 �orean 200.60 i l TOTAL DYNAMIC HEAD /FLOW U- PUMP PERFOW CURVE PER MINUTE MODEL ' J55/57/59 EFFLUENT AND DEWATERING s 20 MODEL 53/55/57/59 = Feet Meters Gal. Liters L) 15 5 1.5 43 163 } 4 10 3.0 34 129 0 a 10 15 1 4.6 19 1 72 0 2 Ta7' 7 Shut -off Head: 19.25 ft.(5.9m) 5 3718 63/16 4 518 1 12 .11112 NPT 0 -tin T 10 20 30 140 50 3 7/8 GALLONS 38 LITERS 0 80 160 + FLOW PER MINUTE 4 CONSULT FACTORY i I FOR SPECIAL APPLICATIONS I I Variable level float switches available. Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35' and 50'. i • Alarm systems available. 101/16 Duplex systems available. i i 33/32 SKS58 Single Seal Control selection Listings SELECTION GUIDE I Model Volts Phase Mods Arrip, simpl Duplex C8A UL 1. Integral float operated mechanical switch, no external control required. 453155 & M57/59 115 1 Auto 9.7 1 - -- Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53155 & N57f59 115 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FM0477. BN53 115 1 Auto 9.7 Y Y 3. Mechanical aflernator'M -Pak' 10 -0072 or 10-0075. • B57 115 1 Auto 9 .7 - -- N Y B 230 1 Auto 4 4.8 Y Y 4. See FM0712 for correct model of Electrical Alternator. f ' • - �D53/55 & D5769 230 1 Auto 4.8 1 -- Y Y 5. Variable level control switch 10-0225 used as a control activator, with Electrical E53/55 & E57/59 230 1 Non 4.8 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system. Single piggyback switch included. ♦ CAU71 For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches,FMO477; All installation of controls, protection devices and wiring should be done by a qualified Dec" Alternator, FM0486; MechanicalAlternator, FM0495, SunplSewage Basins, FMO487; and Single Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump Conlrol/Alarm Systems, FM0732. most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P0. BOX 16347 Louisville. KY 4025&0341 Manufacturers of.. � SHIP T0: 3849 Cane Run Road O ® Itsrlts -VVVo Louisville, KY 4 02 11-1 961 �quTl a Z.11 SNCE ISNY PL/MP LO (502) 778 FAX(502) 7624 8003 PUMP httpJAvww.zoeltercom ® Copyright 2004 Zoeller Co. All rights reserved. 2092 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach con County plate site plan on paper not less than 8%: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and percent slope, scale or dimensions, north arrow, and location and dis @tone st ro � Parcel I. r 0 40 -11 -30 -000 Please print all information. Revie d By Date Personal information you provide may be used s. 15.04 (1) (m)). 7 07 Property Owner Property Location William E. Morns Govt. Lot SW 19 SE /4 S 24 T 28 N R 20 W Property Owner's Mailing Address SEP 2 0 L Lot # Block # Subd. Name or CSM# 210 Plainview Dr. 23 Croix Ridge City Stat Zip ode one City _J Village a Town Nearest Road Hudson W Troy Plainview Dr. 1 New Construction Use: 601 Residential / Number of bedrooms 1 4 Code derived design flow rate 600 GPD ✓J Replacement I Public or commercial - Describe: Parent material Glacial Outwash Flood �� plain el n, if applicable Na General comments J ac.� JLt�aJ: eva + rr [3tk`aTr1^t ;5 V and recommendations: Site suitable for conventional dispersal cell at . gpd loa ng rate. Recommended installing 60 Q-4 chambers in 3 trenches at levations of 99.50', .75', & 96.00'. Boring # J Boring V1 Pit Ground Surface elev. 103.47 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - Eff#2 1 0 -10 10yr3/4 none sit 2fcr mvfr cs 2fmc 0.6 0.8 2 10 -22 7.5yr4/3 none sl 2msbk dsh cs 2fmc 0.6 1.0 3 22 -32 7.5yr4/6 none Is 0 sg ml cw 2vf1 fm 0.7 1.6 4 32 -38 10yr4/6 none s 0 sg dl aw 1fm 0.7 1.6 5 38-47 10yr5/4 none Ifs 0 sg dl aw - 0.5 1.0 6 47 -66 10yr5/4 none s 0 sg dl aw - 0.7 1.6 7 66 -96 10yr5/4 none Ifs 0 sg dl - - 0.5 1.0 M 0 Boring # Boring Pit Ground Surface elev. 103.23 ft. Depth to limiting factor > in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PDIW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-10 10yr3/3 none sit 2fcr mvfr cs 2fmc 0.6 0.8 2 10 -19 7.5yr4/6 none sicl 2msbk dsh a 2fmc 0.4 0.6 3 19 -25 7.5yr4/6 none sit 2msbk ml cw 2vf1fm 0.6 0.8 4 25-33 7.5yr4/6 none Is 0 sg dl aw 1fm 0.7 1.6 5 33 -63 10yr4/6 none s 0 sg dl aw - 0.5 1.0 6 63 -95 10yr5 /4 none Ifs 0 sg dl - - 0.5 1.0 Effluent #1 = BOD 5 > 30 < 220 mg/L nd TSS >30 < 1 mg/L fBuent #2 = BOD < 30 mg /L and TSS <30 mg/L CST Name (Please Print) Signatu CST Number James K. Thompson = 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osce , WI 54020 9/11/2007 715 - 248 -7767 Property Owner William E. Moris Parcel ID # 040- 1193 - 30-000 Page 2 of 3 3] Boring # Boring M' Pit Ground Surface elev. 100.15 ft. Depth to limiting factor >92" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/4 none sil 2fcr mvfr cs 2fmc 0.6 0.8 2 8 -18 7.5yr4/3 none SO 2msbk dsh cs 2fmc 0.6 1.0 3 18 -31 7.5yr4/6 none Is 0 sg ml cw 2vf1fm 0.7 1.6 4 31-44 10yr4/6 none s 0 sg dl aw - 0.7 1.6 5 44 -53 10yr5/4 none fs 0 sg dl aw - 0.5 1.0 6 53 -92 10yr5/4 none s 0 sg dl aw - 0.7 1.6 — I I I 1 - i T 4 ] F Boring # Boring 0 Pit Ground Surface elev. 98.58 ft. Depth to limiting factor >76" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -20 10yr3/2 none sil 2fsbk mvfr gs 2fmc 0.6 0.8 2 20-28 10yr4/4 none sil 2fsbk mvfr as 2fm,1c 0.6 0.8 3 28-50 10yr4/4 none sil 2msbk mvfr gw 1fm 0.6 0.8 4 50-76 10yr5/4 none sil 1csbk ds - 1f 0.4 0.6 F-51 Boring # Boring Y" Pit Ground Surface elev. 100.61 ft. Depth to limiting factor >$9" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0 -19 mixed none mixed fill Na Na aw Na Na Na 2 19 -34 10yr3/6 none Ifs 0 sg ml cs -. 3 34-67 10yr5/4 none fs 0 sg ml cw - 0, 1. 4 67 -89 10yr6/4 none fs 0s9 ml - - ' %7 . 1 Soil evaluation completed to determine treatment capacity of soil and suitability of continued use of existing hydraulically failed dispersal cell. * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (it.07/00) A.C.E. Soil & Site Evaketlons 6")"V'AI7r�InCe- g`�92 GtJ,7 /,'Arri E: l�oi'YS P�v�•, tlV P /atr of'Cro S�yySwry Sec. 24t, T. 22i(,, e, zo cJ. Tn. op Tray, 56 . Cro;x Cm., Czi. 3 , � r ' 1 �rca vI i r /I EYlsf; I,a �� I � pj 3 1 r / g Ak �' p EXi' /aw8„Q, * /00•x' ,�••� stp62, Skr"s awn of tie1td c F oil E�<ss A &in o � © /ACJn E I'na r o ca�.c+� of { be low giayle � � c� . � � a•d�n Poo/ �. 3 o43 Dose Conventional POWTS Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with In- Ground Soil Absorption Component Manual SBD- 10705 -P (NO1 /On. All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October- February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to Jim Thompson, the master plumber in charge of the system installation or your county zoning inspector. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND 1 OWNERSHIP CERTIFICATION FORM Owner /lam KJ� ��iq�► -� /Y�oriS Mailing Address Z-/0 Property Address -5a-me- '/ (Verification required from Planning & Zoning Department for new construction.) City /State Feu --dse, )/. Parcel Identification Number LEGAL DESCRIPTION Property Location S GJ '/a , .56 - 1 14, Sec. _Z / , T 2-6 N R 10 W, Town of TO Z Subdivision c / /,"0/92 Lot # Certified Survey Map # Volume , Page # Warranty Deed # 66 02 6 2 Volume /75/7 , Page # �Z Spec house -*a no Lot lines identifiable es 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 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 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 of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE 6 ** *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 map if reference is made in the warranty deed. (REV. 08/05) ST. CROIX COUNTY ZONING OFFICE C CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the • /eOr/ZS residence located at: .5 1-0 '/4, SE '/4, Section -- 2(/ , Town 7-8 N, Range o W, Town of S , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service l %o Did flow back occur from absorption system? Yes t-" No (if no, skip next line.) Approximate volume or length of time: gallons >64_ minutes Capacity: . / ?DU, Construction: Prefab Concrete k"� Steel Other Manufacturer (if known): (� ✓,�9,� Age of Tank (if known): /q�q icensed Plumber Signature) (Print Name) (Title) (License Number) W /MPRS 0 '7 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) VOA .1747PAGE229 DOCUMENT No 9 587 VTATR POONA* `b TWO a-Act affsanvac. low W—o"'"d wwrw This Deed, made betwee ...... ........................... REGISTERS OFFICE . ............................ . .......................................................... . ..................... ST. CROIX Co., WI& .................................... . ...................................... ..................................... Recd- for Record this Iqt _h .......... . .......................................................... Granter do y Of—JAlas.—A.D. 1978 an& .... Kill- :am-E-- MOr-i-s-And-IftrY--Ann-14orls,--husb�a" Y . ----------- axid-.wife IA- .,-.as.-Joint--teTtaats ............ ............ ...................................... VZ . ............................................................................................. .................. ...................... . .......................... . ..... ----------------------- Gruntav6 WlWeSfieth. That the Said Gr"tor. for a T&IIIAble Cong ..... .......................................................................................... . ...... eorTeys to Grantee the following described real estate In ... St---Croix- . - - - �­ft - ro Gaylord, Bye � & RoA Ccunty. State of Wisconsin: Attorneys at Law 113 East Elm Street Lot 23 of CROURIDGE Addition located in the WIver Faft,- Wisconsin 54022 Southwest Quarter Of Section 24, T28N, R20W, Tax Ke N . ...................................... Town of Troy: Subject to easements, restrictions, reservations and SFER covenants of record. $7W. FEE Acceptance of this deed shall be indicated by its recording with the Reister g of Deeds and shall automatically and irrevocably make the Grantees, their successors and assigns a member of a non-profit, non stock 0 -ation as CROrXRIDM HMEOWNERS ASSOCIATION and entitle them to the b privileges Of said associati is an on and bind them to the terms, conditions and obligations of said association. This ------- not. .............. homestead property. (is) (in not) Together with an and aln&-W'Lr the h*r*dItAJWVub' and Appurtenances And.- ---- Aljex_S___KDs& .............. th*reanto belot4rfne; warrants, that the tft:& Is good, Indefeasibl --- G_Y;W_ simple and fr a nd ----------------- and will warrant and defend the sam Dated thi .......... Uth ----------------- - - - -------- day of ------------- -------- Ile r --- - -- - ---- - ------- ......... Is 78 -------------------------------------------------- ---------------- (SEAL) A .. • ... - - ---------------- - -------- (SISAL) --- -- ------ ---- --- --- - -- ... Alex-S—icosa ....... ....... . ..... . .. ------ - -------------------------------------- -- --- ------ (8ZAL) -- - A -------------------- ---------------- --- ( ---------------­-- - ---------- ----------- ----- -------------- - ------­---------------- - ---------- - - - - - ------------------- - AUT A0J1N0WLRDGWAMT Signatures Authenticated this ................. . ............... . .......... . .. ....... . day of STATE OF WISCONSIN --- — - ------------------- - — - — --- — -------- — ------- — - — ---- — ------------- — ------ - — ---------- County. [7—s-ty 0 1 - --------­-- — ----------- ---- — ---------------------------- --- y TITLE: MEMBER 8TATZ BAR OF WISCONSIN 197V SAS W ------- * -- ---------------- �` r --------- - --------------------- - --- --------------------------------- lot ---- ----- ...... . .......... . .. ---------- ----------------------------------- - ---------- T"is Iftormumm"r w^* CMA►TED ST t kno so TO 1 06�,Owu to bee person .... ....... . natrung oir �� ......... ----------------------------------------- f Instrument and ackwhowl ISOM? ...... ............................................................................... ---- Os. J� .... osa eged. %tb ............ , - -• -- ....................... ire not necearary.) Slenstures may be Authenticated or acknowld Notary Public ..St. My Coin I Sion Per .................................... Coun Wise (it not, sate expiration .- _m aation date r ............................... -*r'lag #a any "p ` &­14 be trawl W Vrl.t'd Miow their WAAAAWTV Danu w wj= W —[. I.Ar "Its) 109.89 6 5.00 134 00 - / S8 1.90 N 89 W i x'39 _ 309.89 � R �V 6 --r -- i 309.89 — � 9 N 89 109.89 200.00 0 — 0 , ti� I 2 w w N co N O N 1 , w i O N; 1.76A�RES O N n ° o f cli 3 a 22 - N o S z 1.19 ACRES o N ;.28 ACRES o z z 200.00' 278.50 150.96' N 89° 57' 31 " 1295.12' NORTH LINE OF THE NW 1/4 OF SECTION 25 UNPLATTED LAN05 OWNED BY ROBERT FULTON ................ LEGEND G COUNTY SECTION CORNER MONUMENT, 2 "X36 "IRON PIPE WITH CAP O 2" X 30" IRON PIPE , WEIGHING 3.65 LBS. /LINEAL FOOT. ALL 'OTHER LOT CORNERS STAKED WITH I''X 24" IRON PIPE WEIGHING 1.68 LBS. /LINEAL FOOT, NOTE ALL DISTANCES, LENGTHS, WIDTHS ARE MEASURED TO THE NEAREST HUNDREDTH OF A FOOT; ANGULAR MEASUREMENTS HAVE BEEN MADE TO THE NEAREST TWENTY SECONDS AND COMPUTED TO THE VALUES SHOWN. ALL BEARINGS SHOWN ARE TRUE BEARINGS AND ARE REFERENCED TO GRID BEARINGS. SCALE IN FEET 100 200 300 400 THIS INSTRUMENT i 0 0 1 E 0 Co1 m a v 11 M n I c U) x z 0 03 N 0 N O o =r :3 CD 23 00 0) C.0 (D C4 CD 00 CL 0, (D CD 3 0 (5 C c > F� 2). CD (a CD U) a co CD c 3 CL 0 , 0 — Q CD M, 1 CL I (0 to 0 r CA CD 0 c to CC) CD T O o o N 57 03 Orq (A 0) (A � 0 T a x a) cr CD U) ;o CL CD ri :3 CL Z 0 z CD z > (D 0 0 0 ZT 1:3 CD a X cn CD C: N (D z CD c6 -4 CA 0 a ;3 p Z M z 0 0 U) m m 4� co CX) z 0 ee cn N z CD 00 > > :3 CL Er 0 Cr N CD a) z a-a 0 CL 'a W 71 O CD (D 1 3. 1 0 0 m k-4 CD ti < w 0 kj O CL ti Parcel #: 040 - 1193 -30 -000 12/14/2005 11:17 AM PAGE 1 OF 1 Alt. Parcel #: 24.28.20.869 040 - TOWN OF TROY Current X'i ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - MORIS, WILLIAM E WILLIAM E MORIS 210 PLAINVIEW DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description ` 210 PLAINVIEW DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.100 Plat: 0234 - CROIXRIDGE SEC 24 T28N R20W PLAT OF CROIXRIDGE LOT Block/Condo Bldg: LOT 23 23 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 24- 28N -20W Notes: Parcel History: Date Doc # Vol /Page Type 10/26/2001 660262 1747/228 TI 354039 587/38 2005 SUMMARY Bill M Fair Market Value: Assessed with: 103556 369,700 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.100 72,600 283,200 355,800 NO Totals for 2005: General Property 1.100 72,600 283,200 355,800 Woodland 0.000 0 0 Totals for 2004: General Property 1.100 72,600 283,200 355,800 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 • AS BUILT SANITARY SYSTEM REPORT ' wR Il e kc is , TOWNS r . SEC. 2 T N R W J. ADDRt! A a j A 1 , ST. CROIX COUNTY, WISCONSIN. 3DIVISION Ck p LOT LOT SIZE PLAN VIEW Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET I , � E i — r Indicate Nc,nth Antow TIC TANK(S) MFGR. S ca.te t _�_ Q, (S �' �' '� CO2ICRETE� STEEL �� NO. of rings on cover Depth_ DRY WELL `_NCHES NO. of -. width length area -� no. of line width -4 length area depth to top of pipe 1911 7,EGATE 4a: ASj4 e h 1 I/2 it QOc` f1 •:.s.: RATE / AREA REQUIRED AREA AS BUILT ;claimer: The inspection of this system by St. Croix County does not imply complete :.r•Dliance with State Administrative Codes. There are other areas that it is not possible ..,inspect at this point of construction. St. Croix County assumes no liability for :tem operation. However, if failure is noted the County will make every effort to . cause,of failure. 7' -ASES AND OILS SHOLrLD NOT BE DISPOSED THROUGH THIS SYSTEM. `INSPECTOR DATED PLU; iBER ON JOB LICENSE NUMBER Af - Z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itany Penm.i State SPp,t.ic NAM X -�� Township S$. Cno.ix County Locatio�as� s� Section SEPTIC TANK I Size gattonz. Number o6 CompantmentA j Di,6tance Fnom: Wet � fit. 12% on greaten ztope 6t Bu.itd.ing it. Wettands Highwaten ' -- "' fit, f.. DISPOSAL SYSTEM Distance Fnom: W �� � St. 12% on greaten stope it. Bu.i.td.ing ► w it. Wettands F t, • H.ighwaten it. FIELD DIMENSIONS: Wi dth o the ch r it. Depth o6 no ck b et ow t ite . Length o6 each tine it. Depth o6 rock oven tite .i n. Number o6 tines Depth ob t.ite below grad f L in. Totat .Length o$ tines it. Stope of trench Z in pen 100 it. x r, Distance between ti nes � s t. Depth to bedhock 5t. Totat ab.s onbt,ion area 4t Depth to gnoundwaten fit. Requ.ined area t Type ob Coven- Pape on Straw v Numb en o6 pits Gnave.0 around p.it.s yea no Outside d.iameten 6t D.epth bel .i nlet _bt. 2 Totat ab.sonbt.io a ea it A Area tequijLed it • INSPECTED B TLE APPROVED ,DATE 197 . REJECTED ,DATE 197_ i EK 115 s WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVIC DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEA t P.O. BOX 309 �9 MADISON, WISCONSIN 53701 �; g REPORT ON SOIL BORINGS AND PERCOLATION TES, LOCATION: cL(C ' /4,�/4, Section N, R. / (orTownship or Municipality ti Lot No. ,23- Block No. �Y'a /'1l �/'�a Ge- County ' rdi X ~ Subdivision Name Owner's Name: ` ( Mailing Address: 6- N,gA"9 /9Lole, 0 / S !ad TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS Jlo PERCOLATION TESTS� / -r SOIL MAP SHEET �� SOIL TYPE _2X � "���a S ��T� Cd^�a eX, PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P_ /,/D / o P- A14 a o © Y y _3 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B _ l 9(" A/0IJ e- 7 p� � 7 7`s. /3 "�S / g le M e Si y�rr Fa e .S. Alw e_ 6' r �. �� S5' C ®2 �'" /Ii e / s " r,',ire S. B _ ,3 cl( / r' ' Q w1� _ f <_ G /,21, SL .2 M e ,S-;� " r"/Ale S / n / . �r� K S -5 p�" ,k,,�r� 7��„ rr Ts „ r, S - ��'r Mods fir' U " /CLOA./ 7 w ', S rt 1 / i. CdS 6L /,xr e =� PLAN VIEW (Locate P ercolationtests soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indiqo to nym}ey of square feet of absorption area needed for building type and occupancy. ���`'' - QUA A' f 4 D`.A 7ev 14t e,4 Fi,- Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. SyS 4--% tiF-- lee V,* e.". •e,at I L o c �� `s s e a pv a2 Z _ v — 1 r G3 cSr � e, .e yr N Q _r °jam lb e O r M O _ 2 C j`' AtS O I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) f LIV ° e'v -f Certification No. Address o Name of installer if known COPY A — LOCAL AUTHORITY CST Signature � J r � r • � f •� ie irk � f State Permit # PLB-67 State and County Permit Application County Perm' for Private Domestic Sewage Systems County l TG� *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 5'16 (ram o-e,(& d. -e. 4 1 r • 0 eq B. LOCATION: Section T2 N, R E (or) W Lot# 23 City Subdivision Name, nearest road, lake or landmark Blk # Village Township F-r C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) n Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY otal gallons No. of tanks —L HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLU_EfyT DISPOSAL SYSTEM: Percolation Rate — Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: !X 9,S Width�Ll— _ Dept h Tile depth (top � No. of Line 3 Seepage Pit: Inside diam� ter Liquid Depth No. of Seepage Pits Percent slope of land ,�L° - -n 22' �n - Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than pre o wner: SGtyy�G I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Teter, NAME e �Vl C T eeSeA) C.S.T. # 7 / and other information obtained from I 0/Z ( owner /builder). Plumber's Signature 2 MP /MP SW# Phone # 3840 — v Plumber's Address ru to c' . ("' PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. I fs' ; MO - .�...a... � .__.. y E . L � � 3 AA� £ 9 E / G.� � 7 F � � E .. _ . i..... Sew ►� S. E € c t 3 3 € b r. . i a.«.... .....m . E E I E 3 3 e � a P E 1 3 i E � E E _.., .._. A. m_..r E Do Not Write in Spac Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State I C nt / C� Date p P � 4�- // Y Permit Issued /Rtjec= (date) Issuing Agent Name 4_ Inspection Yes -YNo State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78