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HomeMy WebLinkAbout006-1076-80-000 St. Croix County Planning and Zonin Monday, February 14, 2005 at 3:38:03 PM Detail Sanitary Information Page I of I Computer #: 006 - 1076 -80 -000 Sub /Plat: metes & bounds Section: 33 Parcel #: 33.31.16.516A Lot: TN /RNG: T31NR16W Municipality: Cylon, Town of CSM: 1/4114: SW 1/4 SE 1/4 Owner: Conley, Jon 1816A 227th Street New Richmond, WI 54017 State Permit: 405171 Issued: 06/17/2002 POWTS Dispersal: Non - Pressurized In -ground Permit: New County Permit: 0 Installed: 07/15/2002 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Pam Quinn NA Smith, Gale original parcel number retired, have created new $0.00 Signed Off: Yes lot in CSM plus remainder in Village of Cylon Block 5 Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/15/2005 - — — — — — — — — — — — — — — — — — — — — — — — — — — — — Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division s INSPECTION REPORT Sanitary Permit No: 405171 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: Conley, Jon I C Ion Township 006- 1076 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: OU I no - 111 ee5h,6 dd on eaS -l-c6 r-- p ole barn TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark v � �,Q� /06 j htv¢s hw I d 3 103.( D • � Dosing 06 Alt. BM 5-r Aeration Bldg. Sewer 5. qcl Holding St/Ht Inlet �.0 q7•D TANK SETBACK INFORMATION St/Ht Outlet ° f <0.33 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �2 O / / Dt Bottom i Dosing He r /Man. 41 9.09 g5 O O Aeration Dist. Pip ! 5/ s 2 Holding Bot. System / 'T'3- T i - D Final Grade PUMP /SIPHON INFORMATION Z •� 9� • 3� Manufacturer Demand St Co 3 •� v 0 �•3 Model N e TDH Lift ion Loss System Head TDH t Forcerna+n' Length Dist. to Well SOIL ABSORPTION SYST BED/TRENCH Width / Len No. f Tren es PIT DIME IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I I SETBACK SYSTEM TO P/L DG WELL LAKE /STREAM LEACHING Ma aufac ct `rer. INFORMATION Type Of System: 4/ / CHA B O J''F f," S Y �9 V n 1 5 /t Model Number: DISTRIBUTION SYSTEM �( V _ 3 Yd Cl"k+� r /nifld Distributio / �( . x Hole Size x Hole Spacing Vent to r Intake IM I L H . e , ad t e gh Ma n Dia �� Length I ?// �� 4 ./r (�y�J Spacing SOIL COVER x ressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center q� J '! Bed/Trench Edges Topsoil � �#] Yes 'jj� No [ 1 Yes COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: '7 /_[,S/ O� Inspection #2: / / Location: 1816A 227th Street New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T31��A� 0-2�, Parcel No: 33.31.16.516A 1.) Alt BM Description = � d G��jy1"rs G(j Awn —C'IA d 2.) Bldg sewer length = Zg/ - amount of cover =� I M de �� s� �� 4v at l revis Plan Use other information. side for additional Yes lformation. No SBD -6710 (R.3/97) Date Insepctor Signature Cert. No. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 `�SCOnMr Personal information you provide may be used for secondary purposes Madison. WI 53707 -730'' Department of Commerce _ (Submit completed form to county if r (Privacy Law, s. 15.04(1)(m)] z ✓ 3 5 Z state ownee. Attach com lete plans (to the county copy only) for the system. on paper not less than 8 -1/2 x 1 I inches in size. County State Sanitary Permit Number ❑ C heck if on State Plan 1 Number 5T cge os I %MN I. Application Information - Please Print all Information Location: Property Owner Name JUN 1 3 2002 Property Location / T om Y lv 54� y1 /4 1 /4, S ? 2T 31,N. Property O Addr IX COUNTY Lot Number Block Number a ZONING OFHCE t � S — Phone Number Subdivision Name or CSM Number � � tate o /off II Type of Building: (check one) ,.., �5� ❑City ❑ I or 2 Family Dwelling –No. of Bedrooms: A Village ❑ Town of ❑ Public /Commercial (describe use): �� �/ 13 State-owned /j/ III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road A) 1. A New System 1 2. ❑ Replacement 3. El Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System " -- 80 - B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 'rob Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At- grade r 3�>tkle bic T at nt Unit ❑ Recirculating El Other: V Dispersal/Treatment Arek Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strueted Tanks Tanks ❑ L' ❑ ❑ ' e-Se- ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume res on ibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): Mpj&wmNo. Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu'ng Agent Signature (No stamps) 'Approved ❑ Owner Given Initial Adverse Surcharge Fee) 0 0 Determination 3 Z zS. — '200 IX. Conditions of Approval /Reasons for Disapproval: a" B.tt� e'arcex ) I �_ s� o�� _ _ d" SBD -6398 (R. 07/00) ■�±�� ■cam ■� ■■■■■■■■■■■■■■■���a ©� ■�■■ ■! ■#:!!�!��l�C■ : ■ze ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■r■■■■ ■■ ■ ■r■■■■■■■■■■■■■■■■■■■■■ ■ OMEN ■■ ■ ■a ■■■ mom E ! ■ ■©u one memo will ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■■miiiii ■iii ■r■ ■■■ ■■ ■■■ ■■■ ■■■■■■■ ■1■ RI:■■■■■■■■■■■■■■■ NNE mommmorlm 1� r ■� ■■ Mans ■ ■ ���� ■ ■ ■■ ■ ■ ■���� ■ ■ ■■ ■■■■■■ ■�i��! %����w1ii�Y ■1■ ■ ■ ■ ■■ ■ ■ ■ ■ ■�ri ■ ■ ■�► �l��! ■ ■ ■ ■AI ■Y ■ ■ ■ ■ ■■ ■■ ■■ERE■■■■■ "■ mom ■■■■ ■ ■■i 'u■■■■■■■■ ■r■■■ I ■1■frfl'/■■■■ ■■■■■■■■■■■■■■■ ■■■■■ 1 ■Y ■0 ■■■m ■■ ■ ■■■■■■■■■■■■■■■■■■YI ■A ■1■ ■R�•' ■ ■ / ■ ■■i� ■ ■ ■ ■ ■ ■ ■ ■■■■■YI ■Y ■■■ MEN mom ■ ■ ■/■ ■ ■ ■ ■ ■i / ■■ ■ ■ ■�■ ti■■■■ Z1m ■Gi■■ ■■■■■ ■ ■�_ ■ ■ ■I�■� ■r■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■ r■■■■■ ■■■ ■'■■■■■■ ■■■■■■■■■■■ ■ ■■■■■ ■■■ ■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ME ME ■■■ ■ ■CO■■■■■■■■■■■EPA! mlNM ■■■ ON ■■■a■■■■■■■■■■■■■■ 0 N ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■ ■r■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■ ■■�Y■■■■■ ■■■■■ ■■■■■■■■■■■■■■ ■■■ ■■■■■■■■■■■■■■■■■■■■■I�a ■■■■■■■ one ■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■:.�r - own ■■■■■ ■■■■■■E■■E■■EE ■■■■■■■■E ME RM ■ ■■■■■■ ■■■■ ■■���■■■■ ■■ M ■■■ ■E■ ■■■■■■■EIET., fi■■■■■■■■■■■■■■■ MEN ■■■■ ■ ■■■ ■---- EE ■E ■EE■ ■gym ■ ■ ■E■ MEM ■O ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■MMi ■IFS ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■M�■E�ii ■iii /■■■Yi■Yl■■■■■■■ ME ■ES■ ■■ ^ ■ii ■ /i' % ■ ■ ■ ■ ■YI ■Y ■1■ ■ ■ ■ ■■ ■ ■ ■ ■ ■Rr!' . ■ ■ ■�a l lm!- I!fi ■ ■ ■ ■!11 ■Y■■■■■■ M■ SOMME ■■■mmaro �1SE ■MYIEI ■1�l�I� ■ ■■ ■ MM ■EM NOME■■■ MEMME IMMUMMMEM ■ ■ ■ ■ ■ ■■■■■■ ■E■■ ■■■■■■YIIY■I or -Iff" ■E /EEi'EE ■ ■E■ ■ ■ ■ ■ ■■ YI■Y ■ ■E■ ■ ■ ■I�■ ■■■■■EiMEE ■■ ■MCI ■IY ■ ■ ■■ ZME ■ ■M MEOMMMEMEM_ E■MWWMM ■ ■MEE No OEM ■■ ■■ESE■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■■E ■■ ■■■■■ ■E■ ■ M■ ■'M■■ E■■ ■EE ■E■ ■E■■■ ■ ■E■EM ■E■ ■t ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■E ■ ■ ■ ■ ■ ■ ■EE■ ■■ ■E ■�i ■ ■ ■S ■ ■ ■ ■E ■ESE ■ ■ESE EEEE ■ ■ EEE Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited 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. I.D. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Property Owner /'+ � Property Location J� e, n cg ll Govt. Lot S k 1 /4s 1 /4 S T 3 N R I6 �►:, W Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road BLit /C ON � ~ . 5" D /`J ('� /.S'). o 9 f � G :2 ; Z .S f' CQ New Construction Use: Residential / Number of bedrooms _� C derived desw1ow rate C, '- O_ GPD ❑ Replacement ❑ Public or commercial - Describe: F __— Parent material 6;4A 0'/4/- ) Floo�Piaiii elevation s# applicable General comments 2001 and recommendations: 5XI A eM e 93 3 F - /] Boring # Boring ] pit Ground surface elev. f ��� ft. Depth to limiting fa in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 0-1 o r G- -/ M �� A- S � �' 3 23 -.2 e j o Al It 16 / VF iv aMAan Z -1- ql 1 .j s _ l Boring # Boring pp Q ® pit Ground surface elev. o' 1/ ft. Depth to limiting factor in. Soil Application Rafe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I •Eff#1 •Eff#2 d -/a v 3 a Alvr'R A S a m 3 21 43 /s G R m4- GS 1 47 Al M A-VT MAI A S , 6 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print Signa i CST Number Address / Date Evaluation Conducted Tele Number Property Owner Jo e � ay Parcel ID # � / �o - -" d B0 Page vz of _ F3 grins # ❑Boring 9a .� Pit Ground surface elev. ° o# ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 M "41 A4V 4 a /I A 15 - 0- - rgl e 31X G G 9M ,44 ,t M F Boring # ❑ Boring E] Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 150 mgA- ' Effluent #2 = BOD < 30 mgA. 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. SOD -8330 (8.6/00) � T I 3 o HI I - -- -- -- -- - -- - - i. - - -- - I i d 0- , - e v MY O!v ' S� N Ave - TF �- - -- Infiltrator SideWinder chambers provide more than twice the infiltrative capacity of stone and pipe systems. From the makers of Infiltrator chambers; And, the continuous louvers of the Infiltrator the products that revolutionized septic and stormwater SideWinder chamber wind fully around its sidewall, management, comes the Infiltrator SideWinder offering maximum infiltration (as shown in the chamber. Designed to replace old- fashioned stone circle inset to the left). and pipe leachfields, these high- strength polyolefin chambers fit in a typical three -foot -wide trench and Open chamber bottom boosts infiltration. are available in two sizes, Standard and High The Infiltrator SideWinder chamber also features a Capacity. The patent - pending Infiltrator SideWinder completely open chamber bottom which provides chambers sit directly on the trench bottom and latch over twice the effective downward infiltration of a together quickly, end to end, so installation takes less conventional system, where stone restricts the move - than half the time of a laborious stone and pipe job. ment of effluent into the soil. Leaching chambers are Infiltrator SideWinder chambers may be used for a tested and proven technology with over 500,000 any application that is suitable for stone and pipe. systems installed over the past 22 years. However, by offering greater infiltrative capacity The Infiltrator Sidewinder's sidewall and open - chamber per linear foot, these chamber systems can require chamber work together to provide a state -of- the -art as little as half the space of conventional systems, leaching system that is more than twice as efficient as depending on state and local regulations. a three -foot conventional installation. SideWinder sidewall. System efficiency. The Infiltrator SideWinder chamber features the pa ' SideWinder patented SideWinder sidewall. Standard Infiltrator SideWinder This unique design has 35% more leaching sidewall area 411 3 ft. Stone Pipe below the invert than the SideWinder Standard Infiltrator Chamber. sidewall 0 1.o t.a 2.1 The High Capacity Infiltrator SideWinder Chamber System is more than twice as efficient as a same- length stone and pipe system. Polyolefin construction. Infiltrator SideWinder chambers are molded of ■ PolyTuff, a proprietary blend of polyolefin plastic that includes recycled resins and is formulated for optimum strength and chemical resistance. It's impervious to wastewater constituents and is stabilized to resist ultraviolet rays. Infiltrator chambers are manufactured using an exclusive patented process to assure consistent high quality. AASHTO H -10 load rating. Infiltrator SideWinder chambers have been structurally tested by a registered professional engineer. The chambers are available with AASHTO ratings of H -10 (16,000 lb/axle with 12" of compacted cover). Nominal chamber anecifications. Standard High Capacity SideWinder SideWinder Size, W 4 x H 34" x 75" x 12' 34'x 75"x 16" Weight 29 lb 136 lb Storage 73 gal /9.8 ft 115 gal/ n i /'y Ff' t POWTS OWNER'S MANUAL 8L r1Ar1iJkUr. - tcrf' r..r... — FILE INFORMATION SYSTEM SPECIFICATIONS owner - Q" V,�-y Septic Tank Capacity B D b g al ❑ NA Permit # S - ( Septic Tank Manufacturer Gig g 13 NA DESIGN PARAMETERS Effluent Filter Manufacturer 7 � 13 NA Number of Bedrooms 3 ❑ NA. Effluent Filter Model ❑ w Number of Commercial Units �,NA Pump Tank Capacity gal ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA D� Design flow (peak), (Estimated X 1.5) gal /day Pump Manufacturer — ❑ NA Soil Application Rate gal/day/ft' Pump Mode! ❑ NA Monthly average* Pretreatment Unit ❑ NA influent/Effluent Quality ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil ez Grease (FOG) :530 mg/L ❑ Mechanical Aeration ❑ Wedand Biochemical Oxygen Demand (BODs) :220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) .5150 mg /L Manufacturer pretreated Effluent Quality ANA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :530 mg/L ❑ In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) _ :30 mg/L ❑ At -grade ❑Mound Fecal Collform (geometric mean) :510 cftr /100m[ 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size k inch diameter * Values typical for domestic (non - commercial) wastewater and septa( tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At least once every ❑ months 3 year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every ❑ months ¢I year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months year(s) Inspect pump, pump controls ez.alar m At least once every ❑ months ❑ year(s) 14 NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) I,WNA Other: At least once every ❑ months ❑ year(s) t& NA Other: At least once every ❑ months ❑ year(s) � NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an indivu WTS r aintainer f Septage Servicing Operator. Tank Inspect!( Plumber, Master Plumber Restricted Sewer, POWTS Inspector; PO f as must include a visual suludege a of the d scum and t ) che k any back u missing p or ponding of idend any cracks or leaks, me ure the ground surface. The dispersal volume of combined sde an cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent or 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 (Ys) 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 ch. NR 113, Wiscor Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, precreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintalner. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION presence of painting products or other cherr For new construction, prior t ll((). use of the POWTS check treatment tank(() . I f h concentrations are detected have the con that may impede the treatment process and/or damage the dispersal ce nr rka ranlr(sl rpmovp !sy ,% tentage servicing opera prior to use. . Page — or .— System start up shall not occur when soil conditions are frozen at the InflltratJve surface. During power outages pump tanks may fill above nornul hlghwate levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cot*) 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 restorinti power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore ncrmal levels within the pump trnk. 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 Wearn may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; coaoti swats; degreasers; dental floss; diapers; disinfectants; tat; foundation drain (sump pump) water; fruit and vegetable peelings; psopne; grease; herbidda; meat scraps; medications; oil; paintinr Products: oesticides: sanitary napkins: tamponsi ind water softener brine. ABANDONEMENT e the following When the POWTS fails and /or Is permanently taken out of strvic shall be taken to insure that the system is property and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Adminisuative 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 property dtsposod of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their cover's removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to prOv14e a coat compliant replacement system: `i. 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 urucwre, lot Ones and wells. Fallure 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 rnust comply with the rules In effect at that time. O A suitable replacement area is not available due to setback and /or soil Ilmlatlom. Barring advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS- 0 The site has not been evaluated to Identify a sulWbk 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 b available a holding tank may be Installed as a last resort to replace the failed POWTS. O Mound and at-grade soil absorption Mwrr s may be reconstructed In place following removal of the biomat at the Infilvative surface. Reconstructions of such systems must.colnply 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 TKE INTERIOR OF A TANK MAY RE DIFFICULT OR INIPMURI F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Na L Na me Phone 6S 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Apo' .Zd Phone fb ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /moo Mailing Address I (FIX Z� 0 Property Address /�/ e (Verification required from Planning Department for new construction) City/State 9i `i M a Nod Parcel I dentification Number gel LEGAL DESCRIPTION / / property Location ` /., '/4, Sec. 3� TN -R /O W, Town of C o Subdivision ✓ . Lot it Certified Survey Map # . Volume _ , Page # " Awn rra ty Deed ,; ? , , Volume Page # (a�� ec house ❑yes � no Lot lines identifiable 0 yes 11 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masWrplumber, journeyman plumber, mstrictedplumber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, 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 30 days three a thr ear a tion date. C � }( ,f� l07 /� �i X SIGN OF APPL 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 owners) of the property desc 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. x SIG- *s * * *« y ATURE OF APPLIC DATE An informat' n that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" « Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ti i� ao O �3 �.. d S:\"� OMA F s , r 1 ra y'► x.119 ap� 0 �nS�eeocr m Scknr T � , i qo CAP y lti 2ef Dop. 181 z, a '7 t 5t • U_ 1883P 277 -- 67793 KATHLEEN H. WALSH' REGISTER OF DEEDS "� ST. CROIX Co., WI RECEIVED FOR RECORD 05 - 02 -2002 1:20 PH IAJIT CLAIM DEED EXEMPT # REC FEE: 13.00 TRANS FEE: 8.70 COPY FEE: CERT COPY FEE: PAGES: 2 Rwoedie+d Area Name and Rebwa Addrou . j o, Cove op (�/�v i�,'c�lryrona/, l�J•' s'�oi7 • 06G- 1o�6 - �'0 ftmd IdmdSafi n N=&w M "THIS PAGE IS PART OF IRIS LEGAL DOCMUNT — DO NOT REMOW lbb b6 mad" aden aae U awohW by o*mkw. dmomw d& d IM ffrc oace coned a Pok w Ae VwAgS dmm. ked &MWM. w- may be pbmd M d6 JIrs p js if Ae decum 1f or awy be pfmad M eAdWmd posh AV dw Aftm ooee. M► Use d A& smear pjs ad& ens pjs to yaw docuo w d AM w As man ft ass• piseendn Sues. S9.S17. WMA 20" WeJ / /Utni ued k Mtw 4" -S r,;�o ! r*17 QUITCLAIM DEED THIS QUITCLAIM DEED, Executed this 1 st day of May,2002, by first party Joseph and Lorraine Gillen whose post office address is New Richmond, Wisconsin 54017 to second party, Jon F. Conley whose post office address is New Richmond, Wisconsin 54017. WITNESSETH, That the said first party, for good consideration and for the sum of $2883.00 paid by the said second party, the receipt whereof is hereby acknowledged, does hereby remise, release and quitclaim unto the said second party forever, all the right, title, interest and claim which the said first party has in and to the following described parcel of land, and improvements and appurtenances thereto in the County of St. Croix, State of Wisconsin, to wit: Legal Description of the eft. parcel located in the town of Cylon: SW '/4 , SE `/4 , Sec 33, T 31N, R 16 W. Town of Cylon, parcel 516A Computer # 006 - 1076 -80 Part of the Southwest Quarter of the Southeast quarter (SW %4 of SE '/4) of Section thirty-three (3 3) Township thirty-one (3 1) North Range Sixteen (16) West described as follows: Commencing 66 feet East of the SE corner of Block "5" of the Village of Cylon according to the recorded plot; thence East 150 feet; thence North 366 feet; thence West 129 feet; thence North 100 feet; thence East 229 feet; thence South 499 feet; thence West 100 feet; thence North 33 feet to the place of beginning. IN WITNESS WHEREOF, The said first party has signed and sealed these presents the day and year first above written. igned, sealed and delivere presence of: / i itn ss First Party Witness Second Party STATE OF } CO Y o I.�ISC�O� W A) 5'TU I` F} 1C On �QIU�. � 9 a 6 0 a before me, personally ppeeared personally known to m (or roved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the same in his/her /their authorized capacity(ies), and that by his/her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. . Signature � � � Affiant Known ✓ Unknown ID Produced (Seal) 1 oft STEPFIANIE A. DESW Notary pubr*State of WNW* E prr acs+ 0 1�3o.10054t24rz002 8:15 PM %4,0.150 7 PAGI 38 STATE BAR OF WISCONSIN FORM 2 - 1998 6r2�_ 0 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Joseph M. Gillen and Lorraine M. 05-02 -2000 9:30 AM Gillen, husband and wife, Grantor, and Jon Conley, Grantee. Grantor, for a valuable consideration, conveys and warrants to WARRANTY DEED Grantee the following described real estate in St. Croix County, State of EXEMPT N Wisconsin: CERT COPY FEE: COPY FEE: TRANSFER FEE: 22.50 RECORDING FEE: 10.00 PAGES: 1 RecordinR Area Name and Return Address G / REMINGTON LAW OFFICES P.O. BOX 177 NEW RICHMOND, WI 54017 715- 246 -3422 PIN:006- 1076 - 90-000 This is not homestead property. Part of the Southwest Quarter of the Southeast Quarter (SW1 /4 of SE1 /4) of Section Thirty -three (33), Township Thirty -one (31) North, Range Sixteen (16) West described as follows: Commencing 66 feet East of the Southeast corner of Block "5" of the Village of Cylon according to the recorded plat; thence North 366 feet; thence East 150 feet; thence South 366 feet; thence West 150 feet to the Place of Beginning. Exception to warranties: municipal and zoning ordinances, easements and restrictions of record. Dated this .Z? lay of April, 2000. N O S H M. G 11 LyL�� EN ' LORRAINE M. GILLON AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated this _ day of ST. CROIX COUNTY ) * Personally came before me this r i6.. ,.� ....... ..........i �..,...._. ncu..� 7777 .�.tJ.. _ ORDINANCE AMENDING CHAPTER 17 ST. CROIX COUNTY LAND USE ORDINANCE REZONING LAND FROM AGRICULTURE TO AG.-IkESEDENTIAL ORDINANCE NO. a a n a WHEREAS, the Statutes of the State of Wisconsin provide for a Planning and Development Committee to act in all matters pertaining to county planning and zoning; and WHEREAS, the St. Croix County Board has established the St. Croix County Planning, Zoning and Parks Committee; and WHEREAS, at the request of the County Board this Committee is to review petitions, hold public hearings, and present its recommendations for rezoning requests to the County Board for action; and WHEREAS, the St. Croix County Planning, Zoning and Parks Committee held a public hearing on the rezoning request of JOE GILLEN on January 9, 2002, in the St. Croix County Government Center in Hudson, Wisconsin; and WHEREAS, the St. Croix County Planning, Zoning and Parks Committee having considered all written information and verbal testimony presented at the hearing, and finding that the request meets the requirements of Wis. Statute 91.77, voted to approve a rezoning of the following described land: SEE ATTACHED Based on the following findings: 1. The parcel is in the rural planning area and is an appropriate use. 2. Access to the site is from a town road and an adjacent site. 3. Rezoning to sell to an adjoining landowner to add to an existing lot platted in the unincorporated area of Cylon and eventually build a home. 4. The parcel is too small for development but will be added to an adjoining parcel bringing that parcel into conformance with current regulations. 5. An onsite review by staff has determined that the building site will not impact the floodplain or shoreland. 6. There will be one -acre net buildable area on the combined site. 7. Best management practices, erosion and sediment control and stormwater management should be utilized to avoid impacts to the south fork of the Willow and the drainageway. An erosion control plan should be required. 8. The St. Croix County Natural Resource Management Plan Goals II, III and IV also encourages protection and preservation of surface waters and wetlands; fish and wildlife habitats; and agricultural land and soils to preserve ecological functions and recreational and scenic values and wildlife habitat. 9. Town of Cylon has reviewed the rezoning and recommends approval, stating that they have considered §91.77. THEREFORE, BE IT NOW ORDAINED by the St. Croix County Board of Supervisors, meeting in regular session, that the 1.15- acre parcel is now rezoned from Agriculture to Ag.- Residential. Dated this 1_15 'Ch day of _j , 2002. Legal Description Legal Description of the 100 x 499 ft. parcel located in the town of Cylon: SW 1 /4 , SE 1 /4 , Sec 33, T 3 N, R 16 W. Town of Cylon, parcel 516A Computer # 006 - 1076 -80 Part of the Southwest Quarter of the Southeast quarter (SW 1 /4 of SE 1 /4 ) of Section thirty -three (33) Township thirty-one (3 1) North Range Sixteen (16) West described as follows: Commencing 66 feet East of the SE corner of Black "5" of the Village of Cylon according to the recorded plot; thence East 150 feet; thence North 466 feet; thence East 150 feet; thence South 499 feet; thence West 150 feet; thence North 33 feet to the place of beginning. �( 1512PAGE 281 623564 KATHLEEN H. WALSH RGIR Jon FConfey ST. CROIX�CO., WWI PO Box 1175 1.435 Grove St RECEIVED FOR RECORD ^ t^� Cumberfand, WI 54829 05 -19 -2000 3:45 PM QUIT CLAIM DEED EXEMPT 0 CERT COPY FEE: COPY FEES TRANSFER FEE: 1.50 A298 - QUITCLAIM DEED RECORD FEE: 22 8298 -04 THIS QUITCLAIM DEED, Executed this day of , a , by first party, Grantor, ?? c:illen whose post office address is - :i chmond, Wi.seons.in to second party, Grantee, Ton F. Conley whose post office address is Rox 1175, Cumberland, ;Visconsin 54829 WITNESSETH, That the said first party, for good consideration and for the sum of Five 'Jundred Dollars($ 500. no ) paid by the said second party, the receipt whereof is hereby acknowledged, does hereby remise, release and quitclaim unto the said second party forever, all the right, title, interest and claim which the said first party has in and to the following described parcel of land, and improvements and appurtenances there- to in the County of St. Croix , State of :disconsin to wit: Part of the southwest Quarter of the `southeast Quarter (S':e1/4 of 1/4) of Section Thirty- (33), '"ownsliip Tliirty- olie(2I )T`Orth,P-a.n€;e_ � 16)';:est describ °d as follows: Commencing 66 feet i?a.st of the :;P; corner of '',lock 11 of the Village of Cylon according to the records plot; thence 3ast 150 feet; thence youth '55 feet; ttience Fast 15o feet; thence i:ort',, 33 feet to thle )lace of Iegrinn.ing. ABHF ___________ _________________ ______________ _____ _ ed 3 1 ______________ ______________________ (Revis _________ If your state requires 8 1 12" x 11" forms, cut off the bottom of this page at the dotted line. O E•Z Legal Forms Before you use this form, read it, fill in oil blanks, and nuke whatever changes are ne—ary to your particular 0 53926 1 2 1 0 1 0 1 ) 4 5 ouns,uuon. Consult a lawyer if you doubt the form's fitness for your purpose and use. E -Z L gal Forms and the reuilc make no representation or warranty, espreas or inWhed. with respect to the merchantability of this form for m iaended use or purWsc. THE ° NUGGET 28x48 1173 SQ. FT. BASEMENT READY FLOOR SYSTEM 44'-0 - 10' - 7' -10" 9' -7' F -9' L 00 ATH 2 KITCHEN BEDROOM O, q MAST BATH DINING aQ 0 - -- io N STAIRWELL MASTER LIVING ROOM BEDROOM pl /Den DUTCH MILLENNIUM MILLENNIUM PACKAGE: PERIMETER HEAT & 7/16" OSB WRAP PARTIAL DRYWALL, UPGRADED WALLBOARDS & TRIM T/O VINYL WINDOWS (54" NO GRIDS) WITH UPGRADED DRAPES 6 PANEL STEEL FRONT DOOR & EXTERIOR COACH LIGHT 9 LITE COTTAGE REAR DOOR WIRE SHELVING IN CLOSETS & UPGRADED TRIM T/O � UPGRADED COUNTERTOPS WITH BEVELED OAK EDGING BACKSPLASH —T /O KITCHEN & BEHIND BATH SINKS FLAT SQUARE OAK CABINET DOORS & HARDWOOD STILES 40 GALLON ELECTRIC WATER HEATER WATER SHUT OFF VALVES T/O 60" FIBERGLASS TUB /SHOWER WITH DRAPE UPGRADED DININGROOM LIGHT 2'x2' SKYLIGHT IN BOTH BATHS HOLIDAY HOMES 1863 HWY 53 WIRE /BRACE /SWITCH BOX LIVING ROOM CEILING DISHWASHER — POTSCRUBBER CHIPPEWA FALLS, WI 54729 VINYL PATIO DOOR 715 835 -0568 HOUSING HOTLINE 1- 800 - 657 -6805 515 A 3 i 3 15 ° o _ 93� 61.8 255 N LINE 194.5 515 C D "1 .10 C � � q i3 /,p 5 1 5 6 I q-44 qo& ago •— . 8"n 0 2 510 516C 437.5 142 42 183RD AVE. 50 7 621 s 620 s 7 6 qa 1 1 8 622 5 607 8 610 a 9 623 4 618 ° 4 606 1 9 611 516 B 10 617 3 605 1 %612 n s h M 2 I ` 2 604' ' 13 ° GIG or 615 I i 603 1 14 A� 150' /82ND _ A VE. _ _ //n 1 ` 7588 s& 87 i s ``596 7 597 2 1 °o 9x86 0 5� 95 8 598 . 516 A `585 4 594 9 599 ° I 3 58 n 3 593 1f 24 83 2% 9 2 11 � 0 I 1 �58c�� 1 591 1602} .} 6 6,)en4 ick l=r AVE. _ r 573 �81 15 572 e 5 5 �I resen+ 4 571 9 576 I 3 570 10� 7 l 2 569 11 �. 78 S D 1 L568j TRUNK NIV) :S 1 OR SEG ' "33' e - 0{ '�v1 �1I IQ