Loading...
HomeMy WebLinkAbout040-1169-80-000 � n ■ o ' ■ 0 c @ E ! .§ ; ■ J % 7! 2 . e ] f # / _ x z e z 0 t= ® w 2 / [ m } ( ( 2 \ » } K) 9 - CO \ \ cu @ A EL / / § Z � C& , c § E E 2; m 7\ 2 a§% c ° ` ~( E E C § E � g . � 2 ..® E / § ± ¢ 3 C co CD / \ _ 8 2 % \ � ® 0) � / \ § 0 ou n r co N) to ;r ■ o c M T T $ f. 2 \ m ' \ k k \ 2 -2 ■ ■ ■ C § Q\ m e o v 3 k k � § 2 ; 2 . D / z 0 g § § [ § / } c _ C ° ( \ k / w ° e . « c — . / CL G) 0 \ ou M co E § z § e \ 2 2 ® \ } - § — � \ -n 0 % / � , � ) . � \ � : ¥ � R / . 2 \ o o * § / � f \ S E . 7 O N O n N O 3 n C . � p D) CD CD CD 0f N lo t n n C iU m O O O D a �' N Ra A 7 p_ O CCD 0 QV1 y '� ONO w7 Q O p to Q - 1 N M +(� c W N CD W 7 0 O O Q @ 7 N O Cn j O O 0 0 0 0 C 0 O CD (D O d O C7 O w O �° cn o 3 N N N N y W O p of m Q ° v n v > z D �p A m a > a 0 N a A `� „ W 2 W c o ° o o W N Q (� 0 t',.: O N 7 -� Z O N 7r (� O i .. 0 CA O A W N W � N N W N CO m N N 70c O 0 0� 3O". C lr a_ c �o v ° z a O O O A O O O °.:• A O N � O * * * C - 0 * * * 0 -• 3 l_Mrf O 0 O c N N N a Q c fn W fA m O O K CCDD CD N N - 0 N M. Vj rn rn Sr _a m m Q° m m _ m T c 'm _ CD o m m c 1 , 3 -N 3 -A 'o_ m A z 0 zg zcnz Q c D � � n D CD :3 ^� 0 N N O N l►r rn o o ro CD �. m cD 'U c S `� CD CD w iD n a m a a 3 5 3 5 _ a o cn = CD o 4 Z o N co c X = a a A Z o _, cn W CD a W CD CL 3 c 3 � m - 0" c) N) 0 3 r. y y Z CD '00I A w pl i W N n O 0 Q CD O y Q . 6 7 a C a N CD a C G _ G �a � o' CD CD @ j (D N O T y (� CD N _ O N C 0 a S — 3 D) 0 — 7 a Z a 0 z a ? — m o B o y 0 N O CO > _. CT V ^^ a 0 cn 0. N j O K O. Z cc 7 0 N fi 0 O m Q N 0 CD 0 fi Z CD 0 Er 3 77 N Iv O M O CD O _ A CD CD o w p o p .p ° CD ° CD i 0 Parcel #: 040 - 1169 -80 -000 06/15/2007 11:45 AM PAGE IOF1 Alt. Parcel #: 36.28.20.646C 040 - TOWN OF TROY Current X 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 - TWIN FARMS RANCH LLC TWIN FARMS RANCH LLC 114 BLACK BASS RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 114 BLACK BASS RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.800 Plat: N/A -NOT AVAILABLE SEC 36 T28N R20W 2.8A IN GL 1 COM NE COR Block/Condo Bldg: GL 1, TH S 50 FT, W 400 FT, S 24 DEG W 325 FT, S 10 DEG E 890 FT,S 31 DEG E Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 280.6 FT TO POB: S 76 DEG W 431.7 FT TO 36- 28N -20W SHORE, S 13 DEG E 50 FT, S 6 DEG W 200 FT, N 76 DEG E 250 FT,TH N 70 DEG E 318 more Notes: Parcel History: Date Doc # Vol /Page Type 08/22/2006 832699 WD 07/23/1997 713/11 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/2112004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.800 379,500 268,200 647,700 NO Totals for 2007: General Property 2.800 379,500 268,200 647,700 Woodland 0.000 0 0 Totals for 2006: General Property 2.800 379,500 268,200 647,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 210 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 Wisconsin Department of Health and Social Services Plb. #67 370 Division of Health SEPTIC TANK PERMIT APPLICATION T` FE or USE BLACK INK ZS" A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) T ^ � B. LOCATION OF PROPERTY W�-RE SYSTEM WILL BE CONSTRUCTED ALTEREL OR EXTENDED COUNTY Check One: 7 CITY VILLAGE LOCAL DESCRIPTION TOWNSHIP �. ,, c 0. IS LOCAL PERMIT REQUIRED FOR THIS WORK? /1 YES NO PERMIT NUMBER A D. SEPTIC I TANK CAPACITY e� U Gallons NEW INSTALLATION /ti REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One: One or Two Family Residence / Commercial Industrial other Specify) Number of Persons to be Accommodated "J Number of Bedrooms .'7 F. APPLIANCES ETC: Food Waste Grinder YES NO Automatic Clothes Washer X YES NO Dishwasher YES NO Automatic Potato Peeler YES= NO Other (Specify) G. MASTLR PLUMBER MAKING INSTALLATION Name: %�fi /ti 0. tC E) Address= A �/ /C'L "/, / f.��LL 5 License Number: HP Signature of Applicant: r 1 cl - - �':2 J/l NIP RSW Address: X/ H. (To be Completed by Issuing Agent) Date of Application All Fee Paid Permit Issued (date.) 7 / 2 �?l: Permit Number n 7 Agent (Name) %?:/�� °�� �. /i Fors Town, Village, City, County, etc. (Specify) :cte: The application cannot be considered for filing until all of the above questions are answered and the fee paid, Agents wil" forward application, the fee of �I.00 ror each septic tanx and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED _ ACCEPTED BY 1` ,� RETURNED (Initials) z (Date) S porr .) FEE RECEIVED VALID. No. 3 PERMIT N0* es or No REVIEWED BY APPROVED DATE (Initials) Yes or No COMPLETE OTHER SIDE SEPTIC TANK PERMIT NO. , "RZP0RT ON SOIL PtRC0LATI0N TEST A N D S O I L B O R I N G S TO DIVISION OF HEALTH - PLUMBING SECTI6N P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P t R C 0 L A T I 0 N T r S T Test Depth Character of Soil Hours Water Test Time Drop i n or Level Inches Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall 1st Wetted OverniSht in Minutes Last Period Last Period Period One Inch Example P - 0 36 Tog Soil 10 Cla 26 25 Yes or No 30 1/ 1 2 _ . Y2 60 et RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B O R I N G S- Minimum 36 Below Pro osed Abso .-ion S stem Boring Total Depth Depth to Ground slater Depth to Bedrock Number Inches Observed I Estimated Observedl Estimated Character of Soil with Thickness in Inches Example B - 0 72 it 72 Black Top Soil 12" CIM i8l't Sand 18 Gravel 24 1! '1 / •� _1Jj1< 4 �p RF=RD DATA FROM MINIMUM OF 3 BORE HOLES PE OF OCCUPANCY& RESIDENCEt Number of Bedrooms , OTHER (Specify) Number of Persons D WASTE GRINDER& Yes No X Dishwashert Yes No X Automatic Clothes Washert Yes No E FFLUENT DISPOSAL SYSTEM: NEW ` EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Diameter_ Liquid Depth I, the undersigned, hereby certify that the percolation testa reported on this form were made by me or under my super- vision in acoord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAMM /��1/� 0 [% ✓3n TITLE Type or Print REGISTRATION NO. or MASTER PLUMBER LICENSE NO. ADDRESS DATE 'I Z E- �TG SIGNATURE i er Z - rq V ;y '76 67— 3 V a C z, �. 36, zW. 2�0 �v� ` x 3 3 3 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420423 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Persoi;al information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township r37`7 o: McIntyre, Janine & Thomas Troy Township 040 - 1169 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: 4 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic u w Benchmark ur 3 S �os� I •'� Dosing V Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet `, • qS. 3�_ f TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �/ ^ / a f Dt Bottom Dosing IO (J Header /Man. Aeration Dist. Pipe (o Holding Bot. System ✓" PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number , q IJ41. ti TDH Lift Fn ' Loss System Head TDH Ft �L / Forcemain Length DI Dist. to SOIL ABSORPTION SYSTEM SR�U RENCHJ Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIO 3 �y SETBACK SYSTEM TO � P/L BLDG WELL me t, LAKE /STREAM LEACHING Manuf c �er: _ r , I - INFORMATION Type Of System: CHAMBER OR t �+ t ~r5 A a 1 / UNIT Model Number: p, I S ZD SOS DISTRIBUTION SYSTEM -Eo No, f L Header /Manifold Distribution kHole Size x Hole Spacing Vent to Air Intake Length is Length Dia Spacing 1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over TBed/ Over xx Depth of Seeded /Sodded xx xx Mulched D Bd/Trench er Center rench Edges Topsoil IN Yes [] No � Yes ! No COMMENTS: (Incl de code discrepencieA, persons ptlz nt, et ) nspection # :�/ l y Inspection #2: -- ' 0 rirp¢ad River Falls, W S t(.- V,�,C�, Z lack Ba Ro�54022 (S 1/4 SW 1/4 Location: 114 36 T28N R20WLN& Lo : ��• 1.) Alt BM Description = /j 2.) Bldg sewer length= wy Csn.en¢,p� . I ; " amount C L � �+ i - amount of cover = f `13 S3 � ,o• �►s' tl•trz 3 �w -LS � ,S wl �laD to f t L(s) = g3 's2 Plan revision Required? i] Yes No 'I) t S Use other side for additional information. t"" I SBD -6710 (R.3/97) � S D te� Insepctor s Signature Cert. No. � s Sanitary Permit Application safety dt Buildings Divisio 201 W. Washington Ave In accord with Comm 83.21, Wis. Adm. Code PO Box 730 See reverse side for instructions for completing this application Madison, WI 53707 -730 ��SCO/fS/D Personal information you provide may be used for secondary purposes Submit completed form to county if nc oepartment of Commerce (Privacy Law, s. 15.04(lxm)] Q -30 —D t.— J vQc) state owned. Attach complete plans (to the county copy only) for the system, on paper not less than 8-12 x 1 l inches in size. County 0 Check if revision to previous application State Platt I. D. Nrariber L Application Information - Please Print all Information°= Owner rata Property t.ocatiott 3 ' /1t�tl19VE i+ri /jl SEP 2 6 2002 t: ! N : . 1/ 1/4,5 T �PN> E(or Owls � ddress 8 N ST. CR01�; COUP' (` 11 /t�. - = Ff =lcE Code i me or M N City, P • / 7 /.r ) Y - o IL Type of Bui g: (check one) City El 1 or 2 Family Dwelling- No. of Bedrooms: 3 O V' e ❑ Public/Commercial (describe rise):_ Z,,e�L � /� � own of 4<1 - - b ir6� 0-6oO s- O state -owned 5'0 : _ ' = /. : >,P -7 M $ G k Nearest Road IT s C III. Type of Permit: (Check a box on line A. Check box on line B if applicable) A) 1. New eptacement 3. Replacement of 4. 5. 6. Addition to System System Tank Only Existing Systetr B) Permit Number Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ®'�lon- pressurized In- and ❑ Mound - ❑ Sand Filter O Constructed Wetland ud ( - O Holding Tank ❑ Single Pass . O Drip Line O At -grade - ❑ Aerobic Treatment Unit O Recirculating ❑ Other. V. DispersaUTreatment Area Information: 1. gn ow 2. Dispersal Area Dispose► Area 4. Soil Applicatiat 5. Percolation Rau 6. System evasion T. mat Graft Required Proposed Rau (Gals./dayAq. L) 04inlnch) Nl .1 GEl6 Elevation 5 - . 7 9 o . r' VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel F ba- Plastic Information Gallo Gallons Tanks Con- Con- glass New xisting crete strums Tanks Tanks v vir o�� ❑ ❑ [3 ❑ [03 VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS wn on the attached plans. 1 s Name (print) Plum s signature (no stem MRlMP No. Bum Phone Addtas (Stra% City, State, ZiP z Z zr IX. CountyMepartment Use Only Disapproved Sanitary Permit Fee (Includes Groundwater ing t Si atatups) roved ❑ Owner Given Initial Adverse Stucimp Fee) � o � Determination v I C loons of Approval easons for Disapp al: ,�,, (/YI. Corn m . JP3.3 3 Z f y a cAarnQtit/ iT Vill romdltl� al el ✓h a'}` ' Q* UO ' HOP PIOV44� ee Fogerty Piwnbbg #221180 r 28288 Md(on:de Rd. c ms d. --- Spooner, WI 54801 (715) 635 -9609 (4& ro rice) . Q ,dAr► =hm, Tip iF i2" �% �►�' 40.1 s 4 40'r� t I-L ter, `�•9 Y 3 6Auyr• ©= / ,op 6V. - prrz 7 A eftwD erFR. ®� ' Ap " WOE scrsTE�. O sN1�T /x` & AMb p, ST 7rgc Z4kMSf Vr- P4*4 AAOO L/ 3 slNt3 SyS7'F. ,3 eEtts �/5� • G -3 • .� — —� ._... b'��T comps F �'� S19.v0 APES• Z �6/ 6l� 5 DRy w zLC ,vEEO Tv m. o g –yv7, Fogerty Plumb ft #221180 28288 Md(er R dL cs --- Spoo 5) 35 -96092 i rArr LxWE (41 Z-4 rte) 4#s = � fie, � f �I /i'��rT `IQ• � doytswAG- = At Nr�L 8 4' - ?S-, F/4cwt XA 4,fA7 OF o = sf/cfT /�W Bai lrb �, rT y-qc Lih1/A St�pr�� 3 st�c� Sys7� = 3 e,CcZs • G 3 _ • at -Z � ' — S LA P d j L�L STA�I� w PLC Alrcb TV � v 7 .7B y0 v O g II II 11 o ' `• . CD CD �.. ( JQ r rs CD CD IQ Z. r� co Ge j ti •s CD ' \ Cl u �y N n f c O p N n O .�.• L *CD �C n = 00 O CD A 03 00 OD <p 1T C 1 to 0;0 W 1-+ q II •� II II II I� 3 �� ,,. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of .3 Division of Safety and Buildings in accordance with Comm 85. Ms. Adm. Code minty Attach complete site plan on paper not less than a 1!2 x 11 inches in size. Plan must indude, but not flmited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope. scale or dimensions, north arrow. and location and distance to nearest road. -70 -,�O Please print all information. by Date Pemaw hoonnawn you pride may be used for secanday turposm 0 Law. s. 1&04(111 Properly Owner Property Location NNE GovL Lot ,$&/ 111 114 . S %0 N R E (o& p Adds Lot # Block # Subd. Nam e or CSM# City state Zip code PhPhone Number ❑ Ctty ❑ Vintage ©'l' own Nearest Road L4 (Y t 1 A 4vw o ❑ New Construction Use: ❑ Residential I Number of bedrooms 3 Code derived design flow rate 'VT GPC 'Replacement ❑ Public or commercial - Describe: Parent material Flood Ptain elevation if applicable L 2 General comment �Gy V^ 42* L3GE fit' t J)w n, � and naoorrrraendations: V.T 75 �'G 3 c LS' Ar = L� W 6 # Ground surface elev. 1 ft. Depth to IGniting faclor 2 ha. F71 -fit Sod Application Rob Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munson Qu. Sz. Cont. Color Gr. Sz- Sh. - Eff#1 'Eff#2 cS .2 - _ — L e g-42 . S-. L >k e F t P 7 S- ll?L ❑ 8orrag a # ❑ pit Ground surface elev. R Depth to flmi ing fatty in. S p( 401catko Rate Horizon Depth Oominarat Color Redox Description Texture Structure Consistence Boundary Roots GP01W in. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. T *011M *01112 Z 3Z 3 /S Se 7 C-L c c c : Ilia A ' t - EfBuent.42 = SOD, 130 mg/L and TSS < 30 ff*I ' - s SST Name 04ease Prim) � .2a //X00 6r Date Evaluation Conducted Telephone Number r-SiQQ CS T Number Addr3s Fogerty Plumbing & Perk Test* g 4 $ p L 7i,� L3S ,�a�r a2s s / Property Owner. Parcel ID # 7O' Page -— of •3 i -� I # [� Pit Ground surface elev. _ �� ft. Depth to limiting odor 7 / n, S ol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDdff n. Munsell Qu. Sz. Cont. color Gr. Sz Sh. *M1 'Etf#2 3 _ r — L /e if _ ._ Z- JOS -j AV4 Boring # ❑ Boring th to smiling factor in• Pit Ground surface elev. ff. �P Sol lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bourndary Roots GPDIff n. Musses Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 "ER#2 9 # ❑9 in. Pit Ground surface elev. ft• Depth to 9 factor Sol Rate Horizon Depth Dominant Color Redox Description Texture SMX* a Consistence Boundary Roots GPDff n. Musses Qu. Sz. Corti. color Gr. Sz. Sh. 'Etf#1 '811#2 • Effluent #1 = BOD, > 30 _< 220 mglL and TSS >30 150 mg/L " Effluent #2 =. BOD, = 30 MWI and TSS 130 mglL 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 6082601 fj or I- VY 608- 264 -8777. seo•� »o ta.waol _ v Fogerty Plumbing #221180 28288 McKenzie Rd. 10v. Spooner, WI 54801 Q15) 635 - 9609 LrAlr- TOE► Ae X.4 /e ll/y/ =/31N, �P Of /2� fJIC'T /!d•D� ~ ps.rr 9� 9 X = Boi�rvG (= / Oop xw, -2?Trc T,}A* wr-4L ) f A O/ojcyo'o£c/r X-3 Q m o Apt I e 1 �o —Yo 7, i j ' { I , i I I I I i I , I , _ I , , j i i i , i , : ' I : i I Ocr. 27 02 09:54a FOGERTY PLUMBING 171563552BG P.2 _ a _ � POWTS OWNER'S MANUAL & MANAGEMENT PLAN Paco of ATION SYSTEM SPECMAInGUS Owner r Septic Tank Capacity al ❑ NA Permit P Septic "rank Manufacturer O NA pESIGN PARAMETERS Effluent Filter Manufacturer G ❑ NA Number of Bedrooms 3 0 NA Effluent Filter Model d 0 NA Number of Public Facility Units XNA Pump Tank Capacity aI I'J NA Estimated flow (average) galldff Pump Tank Manufacturer C1 NA Design flow (peak), ( Estimated .5) x 1 gallday Pump Manufacturer Q NA Soil Application Rate .7 gat/day/ft' Pump Model i7iMA Standard Influent/Effkue ' tlafiiy Monthly average' Pretroatment Unit ❑ NA Fats. Oil A Grease (FOGI 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (600 5220 mg /L 0 NA O Mechanical Aeration 0 Weiland Total Suspended Solids ITSS) 5150 mg /L ❑ Disinfection 0 Other: Retreated Effluent Quality Monthly average Dispersal Cell(M El NA Biochemical Oxygen Demand (BOD 530 mg /L )q In- Ground (gravity) Cl In -Ground (pressurized) Total Suspended Solids (TSS) *00 mg /L ❑ NA Cl At -Grade ❑ Mound Fecal Coliforrm (geometric moon) 510' cfu /100ml O Drip -Line ❑ Other: Maximum Effluent Particle Size X in dia• ❑ NA Other. p NA Other: ❑ NA Other. ❑ NA Other: [I NA 'vahass typical for doe vc wastwatrr and septic tan loo MAINTENANCE SCH L.F Service E Service Frequeno:y Inspect condition of tanklsl AT least once every: ❑ rnanth(s) (Masrmum 3 years) E3 NA g ear(sl Pump out contents of tank(s) When combined sludge and scum equals one -third IY of tank volume. O NA ❑ monthls) (Maximum 3 yearal -O NA Inspect dispersal Collis) At coast once every: ja yearts) ❑ mcnthlsl ❑ NA Clean effluent filter S � At least once every: ' Z year(sl month(s) • ir"A Inspect pump, pump Controls & alarm At least once every: 0 year(s) ' ❑ month(sl NA Flush• laterals and pressure tast At least once every: ❑ yaw(s) dther IJ At least once every: O ye y9 r arls) rjNA s) Older: j jNA MAINTENANCE INSTRUG11ONS inspections of tanks and dispersal tolls shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sower; POWTS Inspector; POWTS Maintainer, Septago Servicing Operator. Tank inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or looks. 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 cells) shall be visually inspected to chock the effluent levels in the observation pipes and to check for any pending 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, pretreatmerii units, and any servicing at intervals of S12 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; Oct 27 02 09:54a FOGERTY PLUMBING 17156355286 p.3 Page L'of 2 ` NFft' UP AND OPERATION' For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell($). It high concentraytions 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 *oil 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 cells) 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 Septago 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 tolls. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grado 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 writer 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 $3.33. 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 Soptage 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 provido a code compliant replacement system: ❑ A suitable roplacement 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. 13 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. O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Roconstructions 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. #121180 — - - --- ----� 28M McKe fiNia Sooner- WI SM1 POVIrrS INSTALLER POWTS MAINTAINER (715) 635 -9609 A Name (ii--v Warne Phone S'.. -- 3b Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHOVd Y Name Name Phone Phone -Ifs-- This document was dratted in compliance with chapter Comm 83.22(2)(b)(1)(d)Jk(f) and 63.6401. (2) & (3), wiSDonsirt Administrative Code. Sep 14 02 12:52p Tom McIntyre 1 715 425 2421 p.2 s Sep 12 02 09:1ep Tom Mclntaro. i 715 425 24E P•2 ST, MOIX COnWrV ZONING OFFICE CMIFICATI WMTREM Foil uTILIZAT=ON OF AN E)aSTINre SEPTIC TAM This is to certify that I have inspected the setetia taW: Prese¢tL so V residence located at: �'. Section 2,_• _ _�� x_?f2_Wi TOM of �f O upon inspection, Z Certify that I have fotaxl the tank and haff to be in good caondition, and it app ?sass to be rnrctioning Properly. 7 Last time serviced: Did float back occur from absorption :yetis? j_ Yes y (rf no, skip next line) Approximate volume or length of time= 7 0 gallonm j RA- nimutas Capacity: 16 Const %wti.on; Prefab ConCZWte_ Steel Other xanufa cturer: (If known) s ? / ,,, Age of Tank (If known) : —J "� �""�/ ����� , ; w� `s�-�a- lI75 V— �r� ( gam ) ( ) R ease prlbt (Side (License Number Date Forst to be completed by licensed plumber (s.2-45-06, W iaoonsin Statutes) or Licensed Disposer (m 113 wisaonsin Acaaiaistrative. Coda) --, ..--- •------------- r._.-- -._- -- — — — — -- plumber (applying for sanitary perait) CertificatiM In accepting the above statement regarding existing septic tank condition, I certify that the tank to the beat of ]o:cwledge will confor to the raga is of IUM 83. Wis. Ada 11 (except for i on op" ov ovtlat baffl •r S ignature yp�'APits 11 1M Ila - . — TO x a 'IT 1.M q 698ZHMUT 5t -16 eta 11091LO 23 02 09:14p FO PLUMBS 1715635528E p-? ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT vl OWNERSHIP CERTIFICATION FORM Owner4km ?s tW.Z'it/r V Aoi Mailing Address fly j k e f a /MKS Ab ,Cnr z wz Property Address Sg+/ E 4A0 P , A& (Verification required from Planning Department for new construction) y -�Z� t -To -mod City /State Parcel Identification Number LEGAL DESCRI Property Location fW ,, S4d ' /,, Sec. Town of 7 Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume 71 3 - ,Page # I/ Spec house 0 yes LYno Lot lines identifiable &'?res 0 no SYSTRM MAI Improper use and maintenauceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, resuictedplumber 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 113 full of sludge. Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office: within 3) days —of the thrr..e a - •- S S NkTR ZZMANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described attoved by virtue of a warranty deed recorded in Register of Deeds Office. ` • (( / /1�\ f 1 AJ�iL SI ATtJRE OF PPLI DATE " "•' Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. •'• "' " Inci:jde with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified sw-vey map if reference is made in the warranty deed Sep 14 02 12:52p Tom McIntyre 1 715 425 2421 p.3 S & N LAND SURVEYING HUDSON, Wi. 386 -2007 NAME First Federal of LaCrosse ADDRESS 201 South Second St. Hudson, Wi. 54016 DESCRIPTION Part of Government Lot "I" Section 36, T28N, R20W, Town of Troy, St. Croix County, Wi. Thomas & Janine McIntyre PLAT DRAWING This is not.a complete Land Survey o 4.51.0% sf S' 76 - - j 1 511 %P r 'mot garage . 5 � V ol 50.0' house o Lake ST. Croix cabin �x s06 ° -49 w �1t. ` 200.0' 15� %16 _15'E . OQ Sigkl! N '➢ 8'1'ATa lfdf Olf AI1f1702t3111 lrl R l..1lM tMla a si rA rut asawrms sr�w, r'�. •tea q . L- :1 . r 3 .H '��� �" , a e r ii d C" At .i.r Y ; WWA K " " mere brewers 1W for X V"tbos aa21 ` - 2 %k ,:.r6x «Lis �rlfe and 3n ftahr o .�...r;...: 2 f1`.CllaX C'�1f nth' r see& tar iG�ao�i x y`'3•.� ��.l+rG...w « « M ...Z» c ...r .«.�.«w. .fA� . •r.•.�Np..y � � �� ' -; ..sin.:.. �.. »..... ♦ w , v � . �y.I�. .w. s .«. +l1Ml....* ......+.� - .:� � ��� .:, t �_ �,` ..J..}�iyatr. w« r .....+ .! a +. y .r al.r...+ rM «.......,. '•. ar..nt t y, ..a... +».+,. ...«... •.a.. .wren... +r.• .. # ` 4i { tilsn®t8. Th" the Sam G"Sur, hr J Y a 1ah"k NftAiWs*§W ..:r, ?tr. .!=. a............ «.... Ad ............................ .... to lirast" as tollawiss dwarihed real Stole Y . 8tah od �► parcel of land containing, 2.8 le rss located tn' Government Lot I t Section 36, Township 23 + 3Aiihth, Range 20 West, Tours of Troy,' further described as ;foilowes from the Northeast corner of said Government Lot, gds Peen i der ' oAtt distance of 50.0, 'L t; thence West parallel with the hforth linei of said Goa%+rament ;1 a distance of 400.0 feet; thence South 24930' West a distance of 325.0 feet; thence,l1, TBouth 10 Mat a distance of 890.0 feet; theme South 31 last ' a distance of 280.6 'feat to POW OF BEGINNING for parcel.. to be conveyed herein; thence.South 71015 West a ` distsnce of 431.7 feet to an iron pipe stake on the.shore of Lakrl'St. Croixt thence South ;.13x45' Bast a distance of 50.0 feet to "an iron pipe stake an the shore of Lake St. Csoisi thence South 6 West a distance of 200.0 fast to an Iron pipe stake an the shore of ' St. Croix; o hence North 76 East 250.0 feet; thence North 70°13. 1"i 313.0r feet; 1 �thsncs North 31 15' West a distance of 214.4 feet to the Pona OF BEGI wire, including an t [land between meander • line and Lake St. Croix and also an: easement tpr an access rood to ';the above described parcel North and Bast to connect with the present town road as aov ; ,opened and traveled. The above parcel being subject to an easement for as access 'toad o f sand across the Bast SO feet as naw opened and traveled. pThia deed is given is performance of a land contract recorded August 22, 1975, ii, the Office of the Register of Deeds for St. Croix County, in Volume 527, Page 405, as ;_Document #328796. Ft — i t W i 4 Thin is A0 . ' homestead 00 UKM Together whit sit and singular the imvdiPuaembs and appurtewtnm thereaato Ddor oag; And :....Iela,lt4T .]i... �ltotbgrS. NaQml_ Weptberg ................. worrsnts that the title is good, indefeasible in fee simple and free and clear of encnmhrancS e: i awl will warrant and defend the same. ' Doted this ............ .... ... day of ............. December . ....... ..... , ii. . cw Ix c o UNTY AA PLANNING &.. ZONING �3irceuY,A' .�qY ^'.tmA�'&�..s sw .a Y.0 G T,�ti 4'#l�a.fXJ:G4Yk(6R4n: eaw?rmMNMX cF%iC�.s'da V: ?tM'�.?frinitWd4 ?�+c?3Fn v.'A,?:es.'axe�@'.v;.tX MI .a9r::.Y ,w.r- .TYi3T.t�.n - +K!C:'nY+SY:YM'm. ?. FAx M EMO DATE: - Vu--Y I 24 T ( P TO: NIf,4L1 \f AN F & SS &?Nj Code Administrati FAX NUMBER: Q 715- 386 - 4680 ' �. p 3 9. &o Landlnformati e, FROM: <�Vtfo GeAS 4 A Planning FAx NUMBER 715 - 386 -4686 715-386 74 Re roperty PHONE NUMBER: �/S-� 3%+ q d 77 `` - 386 -4677 Re ing NUMBER OF PAGES, INCLUDING COVER SHEET: .c 71 -- 6 -4675 RE: mc l - r Wye-c- �QaP�ieTj ST. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD HUDSON, W1 54016 715386 - 4686 FAX PZ @C0. SAINT- CR0IX.WI.US WWW.00.SAINT- CR0IX.WI.US