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HomeMy WebLinkAbout040-1082-90-275 _Iq Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556400 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)j. Permit Holder's Name: city Village X Township Parcel Tax No: Lawrence, Timothy & Linnaea Troy, Town of 040-1082-90-275 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No /Qd.6rJ 14 G~ 21.28.19.326C30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS H FS ELEV. Septic Benchmark g b • • OS 1Z 6^ 77 -0- Dosing Alt. B 1d RJ0 3/ 75a ~ l.4~, Z4' S Qz. 7-51 AemftV' Ili Bldg. Sewer Holding St/Ht Inlet Z ~ • ~ ' TANK SETBACK INFORMATION St/Ht Outlet TANK TO ^ P/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet Septic SC J67 Dt Bottom Dosing 7 6d / 7 Of Header/Man. 3 / & Aeration Dist. Pipe D icy C/, 5~ Holding Bot. System Al -7 /63 - Final Grade • O D~ PUMP/SIPHON INFORMATION Manufacturer Demand St 0019r. g GP ~ ~ ~ Co~J /d l,.$ Model Number M ~~.YYY TDH Lift Friction Los System He TDH 15-5 if at, ('y I 16Z Forcemain Lengt fia.Dist. to Well 16 0-7 SOIL ABSORPTION SYSTEM Q. G 16B , BED/TRENCH Width Length No. zlt nche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~C SETBACK SYSTEM TO `J P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of Syyyy~~~~¢¢m: y ~ ~ O ✓b^- UNIT Model Number: DISTRIBUTION SYSTEM ( J Header/Manifold/ Distribution x Hole Size C Ix Hole Spacing Vet it Inta Pipe(s) T J .~L Z Length Dia Z Length Dia 1► Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched Bed/Trench Center / q Bed/Trench Edges ` Topsoil L Yes No .I Yes 7 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: nspection #2: Location: 508 Rolling Meadow Drive River Falls, WI 54022 (S//W 1/4 NW 1/4 21 T28N R19W) NA Lot 09 Parcel No: 21.28.19.326C30 1.) Alt BM Description r.. (t, 60 JA.". eit- ~ A-!. 4-- 2.) Bldg sewer length = Ot.~~ a v`. r _ amount of cover 7 = d AL-~' G" j / ' .6 '41 a 9 9 36 F Plan revision Required? ❑ Yes No Use other side for additional information. __(7_~I lp Date Insepctor's ature Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Tim Lawrence ADDRESS 4524 Alabama Drive Columbus MS 39705 SW 1/4 NW 1/4S 21 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 103.8' .8' sand lift 4 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of spike in ground ASSUME ELEVATION 100' ❑ BOREHOLE O WELL * H. R. P . same as benchmark Scale = 1/4"= 10' Pro 4 Bedroom House Property Well is to meet Line L all DNR setbacks 1115' H uffc utt Combo Tank ~ a Grading is to be done to divert run-off away from system B.M B-2 Tank is to be properly bedded and provided with Iockdown covers with approved warning labels 10% Slope Driveway 106' 104' Area 15' below system is to 103'02200' 200' remain undisturbed B-3 35' 100' 493' Property Line 552' Property Line Rolling Meadow Drive commerce.Wl gave Satbly and Buildings Division county 201 W. Washington Ave., 1.O. Box 7162 Madreon, Wl 537(17-71 G2 SuniiuryGPorn,:e Nm,~tt~,r/(t^u liv nn.c+.~~ vy..:<,.~ ~sconslrl Department of Cosnmerea `✓~~_-l s 1~-__ _ A State Transaction Number ,N' INV Sanitary Permit Application ht accordance with s_ Conan. 83.21(2). Wis Adm. Code, submission of this form to the appropriate, go~ ernmu _2_ / 7 93 o ~ unit is required prior to obtaining a sanitary permit. Note: Appliualion farms for s :~e-(►wned POD"T -are Iect Address (if different than mailing address) s+rbmiaw to the Department or Commerce. Personal information you providAW,tk+ -sod for secondaiY urposes in accordance with the Privacy la(r.r, s. 15.04(I)(m), state 1. Application Information - Please Print All Informatio- _J_0 v 40 ` /YY Property Owner's Name Parcel 9 _ ?0 P.:operty ownet''s Maiiing A s ~t~~~ ^ ,ti Property Loculioit Govt. Lol ] City, State Zip Code _ Phone Number Section 1 IC OV6TIN 'trC ` r+✓t(/7n/rCo i' _ C l I N; IZ _,i W Ili. Type of Building (check all that apply) Lot /a - - v 1 SubdiAsior► Nalne 1 or 2 Family Dwelling - Nurnber of Bedrooms _ 4.b P, ~ aw -Block # C_ Public/Commercial-Describe Use ❑ City of._-----------_.--_-- rb (b0,-,CSM Number ~ 7t0 Z U Village of C State (honed - Describe Use -.-t "own u1 ~~c~ 4W 76 M. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ew system ❑ Replacentwit System ❑ Treatment/Holding "Tank Replacement Only Ll Other Modificaliou to Existing System (explain) List Previous Ft:nuit Number acid bate }issued S. ❑ Permit Renewal ❑ Permit Revision E-1 Change of Plumber 1) Permit Transfer to New / Before Expiration Owner - 6 I1' Tyra of POWTS 5vstem/Companent/Device: Check all that appW ❑ Non-Pressurized In-Ground ❑ Pressut ized In-Ground El At-Grade ound ? 24 in. ul'suitable soil ❑ Mound 24 in. of suitable soil ❑ i-lolling 'tank ❑ Other Dispersal Coro punent I'reireatmerlt Device Trea eat Area Information: Po `ed System litavati(m pd) Design Soil Application e(gp s Dispersal eu Dis ersal AArrJea r~,,k - a0aeity in Total • # of Manufacturer (lallons Gallons Units Nan Tacks - - Existing Tutiks w Taak V lI_ Iteslrontslbiiity Statement- X, the undersigned, assn possibility i'or instullation of the POWTS shown on the attached plans. Plumber' ature MP/MFRS Number Business Phone N ber, Plumber's Name (Feint) Z47 Plumber' 'Address (StrCCt, City, State, Zip C ode} ' ~ ~ I~, J VIM ount !De trtm ne use only--. - irt ent signature Permit Fee Date Issued Issug Approved U Z~J 'tom 12-1-7 / z liven Reason ]nr Will Condig+y V#,#VMVWReasons Tor Disapproval 3, / bra r ✓ I~c~ir 1. Septic tank, effluent filter and J !.arse!', dispersal cell must all -e services !maim 1i / t as per management plan provided by plumbe-L 2 AN selllack ro ui►efrlSf is IYlust be ►nalntamad as per apQNc" hole Attach to eampieie plans for the system and submit to the Co iY ouly uu paper uul fens t6 6 lrl x t 1 inches is We (otJ cBD-6398 (R. 02/09) Safety and Buildings 141 NW BARSTOW ST FL 4TH .00 o~ WAUKESHA WI 53188-3789 Contact Through Relay 3 www.dsps.wi.gov/sb/ www.wisconsin.gov °~s9joNpv~ Scott Walker, Governor Dave Ross, Secretary December 04, 2012 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/04/2014 Identification Numbers Transaction ID No. 2179306 SITE: Site ID No. 786442 Tim Lawrence Please refer to both identification numbers, 508 Rolling Meadows Dr above, in all correspondence with the Town of Troy agency. St Croix County SWl/4, NWI/4, S21, T28N, R19W Lot: 9, FOR: Description: Mound, 4 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1403954 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2. 0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/0 ) the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Syste s SBD-10706-P (N.01/01). jr The building sewer and distribution network piping shall be of material listed i 3 384.30-5, Wis. Adm. Code. 01a~ F~ In the event this soil absorption system or any of its component parts malfunctions so as to c~ health hazard, the property owner must follow the contingency plan as described in the approved plans. In ad on, the owner must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 12/4/2012 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Cover Page RECEIVED NOV292012 Shaun Bird SAFETY & BUILDINGS Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11/28/12 Owner: Tlm Lawrence Location:SW1/4 NW1A S21 T28 N,R19 W 508 Rolling Meadow Drive Troy System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specifications ross section Shaun Bird Signature`. License number 90W ~ ~CC , PLOT PLAN -PROJECT Tim Lawrence ADDRESS 4524 Alabama Drive Columbus MS 39705 SW 1/4 NW 1/4S 21 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 103.8' .8' sand lift BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of spike in ground ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark Scale = 1/4"= 10' pro 4 Bedroom House Property fell is to meet Line all DNR setbacks 1115, Huffcutt Combo Tank Grading is to be done to divert run-off away from system B.M.* B-2 J~ ❑ Tank is to be properly bedded B-1 and provided with Iockdown covers with approved warning labels 109 Slope 106* Driveway 104' Area 15' below system is to 02 200' remain undisturbed B-3 35' 100' 493' Property Line 552' Property Line Rolling Meadow Drive Section and Plan View Mound System Cross Dimension Feet ~i A II I/ B 7 J t i D a j a E A i # F ~.$Y r G W t ,Z a H t I 7 i t J S. v i! K L t K B Z Slope % L 1!:"' "1 = Topsoil = ASTM C-33 = Clean aggregate 0 = 4 in. sch. 40 pvc Ca Material sand fill ® '/Z to 2 '/z in. dia. observation pipe Geotextile H Fabric s • $ F _ Ft 'D E Plowed Surface ~2 Ft Contour Slope Direction __..y GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower b inches and secured in place with rebar or a closet flange. 10/071gj Page of Pressure Lateral Layout Two Laterals _ End Manifold 4 Threaded 4 Cleanout Lateral Ttirn-up Plug Manifold M X \ l L Long Force Main Sweep 90 Bend Distribution Networks ecifications Pressure System Construction Lateral Diameter Z In Manifold Diameter . In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 2- n. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Len th Ft. Lateral turn-ups terminate with a -threaded M Manifold Len th Ft. cleanout plug and are enclosed in a 6-8 inch In. diameter lawn sprinkler valve box accessible Force Main Diameter _ from finished grade. Force Main Len th _ Ft. Grade ;C7 6-9 Inch Lawn Sprinkler Valve Box page -of 03/05 lgj .t Septic-l)ose Wank. Cross Section And Pump Performance Specifications 'rank MaircuFat;tur Pump Manataturer, Tank Model Number -0 Pump Model Number Alom Mwnufaa 41e C Total Tank C pacitY .mss ~7_ - J"~ ' - - - 1Vlax+ Bury Depth _ _ A1am Model Number. _ f G- SWktOlk Typo -Al ef F.,f f4- Total Dynamic Y cad ('TDl-I) _ Feet Alter Mar►ufi►cturer ' Filter Model N'um'ber Elevation Head Distal pressure _ , 5 • J Network Loss _ _ Minimtun Pump Performaruae Reqwired'orae Main Loss GFMI TDH outlet Manhole N^ n. V Above Grade With Manhole Min+ 4" Above Grade Locking Device. Inlet Manhole Securely 1l~ouated With Locking Device < 6" Below +C~rrpde Sealed Watertight Weather-pWof Junction Hoc. 4- Finished Grade rw w wo mm em km Ire Ire If#* 1 Vent Min. 12" Diecannect Above Grade Means With "Vent Cap r 1 Y Y L,L 1 1 1 0 I I r Y Y L,1 L Y L~ t 1 /,Y r i L 1 1 1 i r? 1 1 x 1 Y r i} r/r/ i 1 I V i 1, V{, IYV + 1 +La Y1 1 1 L Y 1 1• I,Y + 1, 1 1 1/ 1 a 1/♦ Y Y r 1. 1. Y + VY+/ I r r / { 1+ L i l L Y Y Y Y Y L Y 1 1+! 1► 1 1, , {•1 , Y 1 r 1 ILL ~I;Y, ~ 11L1/ Y,i r IV . . , Outlet Filter Inlet 4-~~ Inlet Baffle ,,►1 o~iY r': Y 11 ,witch Settings and Reserve Capacity A" Weep Tank Volume GPI Hole I;Y B 1;1 -Dimsnsian, Inches Volume Gal. - 1> -..(reserve) A; . y4•r P4 (alarm) 2 off (dose) C~ - + >L t ~c M°'~.--► Bottom 1 . . (dead) D Sr~ Total D Flevatiion : 7 r 1 L Y tI, 1, L41,Y,r11,►,►, 411141' YI' 1 i+~" -1' ~"f't•'Y'►"t"f'Y"Y~t~S-!"►'T- TrY-c-rL^I-r 1,1 1 1 {,'Y /rl l• 11{111 I;r;L{L{LIT+1It i i/Y 1"Y /{/11/t4Y1i /1Y i > ►41i i1t,1,i ILi1r}/{f/1}. Yltrl lYllirrt4Y~►41VI~i4i+t1Y 4i4 Y{Y•t4k It YY {I+Y/14!{14111/1+L{ •1.141+r'r{Y {r1Y'r{Y+r4Y• r; IY++ 11.{1+ 1{a 11 a,{Ia+1,1141+{Ir a/rY11+11 i1111t II If x{1111411 }i411{<11 i{i111it11r111/+111{1 {till GENERAL INSTALLATION: The Septic/dose tank is bedded and back filled in accordance with the nnanufacturer's product approval epeoifitaations, Maximum depth of bury as speaiflod by the manufacturer may not be exceeded without pyior approval. Manhole covers exposed to grads, have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the lank with watertight fittings, and laid on stable soil to prevent saujing or lagging, The force main is sleeved with 4$1 Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Eleotrioul service complies with NEC 300 and Comm 16.28, 02105 U' page of V LaserJet 3100, 1 11b bbY Mdf MNY-a-vo a-uurm, «a« SH SER1E;n !,,SUMP/EFFLUENT PUMP 9 US ~19 cations 14 ~ MII raw ~ ! ias t ri► 11011 *am NOW r~wWIIBClflmvrIBr9 Wolf ftl Oll N AMtsNOa it IF !M IQ OW rw.l~ip 9D1a1d $ago 9UC9! Vo 115 914 in 10QB 70 64 55 41 $2 10.8 EP 84 911 r11,94x&9A M30 Uc, Wo M S!A 6.5 1000 76 Y 55 41 92 1&0 ~ 9a 8.f1 ~1i84~&9A lsl0arss 69986D bl Wii 1% W 18A 1000 70 64 66 41 at 11.9 V 27 9,11 ~ 1s&1.9.9A Cc go Is 4 12 12.1 {Jo~gauYDutyRMed-`Li11N (ilu3NheltwarieO~MnAA7mliriMdaoa9ilUtliwdWRRllba90A6tllypEler~Wltldn4Mpd>~MdrGlrt~hr1lf11t91WmP~' FLOW- L[TERSINCUR Ongtr ction o loco zoos aoao Motor Hausiq 16voxy UAW Cass Iran Tinpetler iVlaterisl Poly "arbolmOlle rs Irripeller' ~ Closed V'anis. . 'o YolUto AB5 Povvtr Card TW-A fSS W Mechimicul SW Seat ~ Nitrile with cerban and ao ceramic flans Faster Stainless kneel lu Shaft gtainle SoW _ za Hesri Upper Sleeve and Lower "I Bearings 'TITI -tilt 1111111111 o ao 40 . 60 so rLaW- GALWNSMINWE r may' op Pg,1FOR2aeMAZ"2E CUi2V_ E . L1tue Giant Fa Co. usv pt1 not tw3e• pidabomr C10.otK( 73167 rbaaa: 4415.i147.~l1 +Faa~ 4e9.ti8.lSSe S.mdb raslmaala~wiuu~titut~i~oe~gwu v(W.w. uttleadmatramp-CO10 0 FCTtn 496296 07103 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity /a S S' al ❑ NA Permit # Septic Tank Manufacturer Ila ❑ NA DESIGN PARAMETERS Effluent Filter Manufacti.Arer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ,141A Pump Tank Capacity 7 al ❑ NA Estimated flow (average) 5elOl 7 alMa pump 'rank Manufacturer ❑ NA Design flow (peak), (Estimated x 1,5) e5~ o0 gal/day Pump Manufacturer ❑ NA Soil Application Rate /0 al/da M2 Pump Model ❑ A Standard Influent/Effluent Quality Monthly average* Pretreatment Unit -AbLA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids_ (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L "IA ❑ At-Grade 'Mound 4 Fecal Coliform (geometric mean 590 _ ) du/100m1 ❑ Drip-I-me ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other ❑ NA Other. /~FfdA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every; monthls (Maximum 3 years) ❑ NA tl*earCs i Pump out contents of tank(s) When combined sludge and scum equals one-third (3~) of tank volume ❑ NA i Inspect dispersal cell(s) At least once every: yeafts+s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 411 - [3 month(s) ❑ NA ar(s Inspect pump, pump controls & alarm At least once every: ❑ months) ❑ NA `7f~year(s, Flush laterals and pressure test At least once every: ❑ onth(s) ❑ NA Aryear(s) Other: At least once every: ❑ monthis) ❑ NA Other: 13 ear(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servit ing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground si irface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. .1 Page r_____ of START UP AND OPERATION For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of +Ihe tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface, During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Onerstor prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 16 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POW'fS: 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 scrap, ; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water 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 83,33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septagee Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filed with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells, Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time, ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. `'The site has not been evaluated to identify a suitable replacement area, Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area, If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS, Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DfJaATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name r Phone Phone r ILE SEPTAGE SERVICING OPERATOR PU PER LOCAL REGULATORY AUTHORITY Name yl~ Name -Phone 1 Phone Thls document was drafted In compliance with chapter SPS 383.22(2)(b)(1)0*1) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Rr Ojv FILTER CARTRIDGE INSTRUCTIONS Installation STEP I pry lit the filter rare onto the and of the outlet pipe to ensure it is centered under the access, opening. It not, then either insert more tank through the outlet or pips into the solvent w e id (glue) additional f e pipe. ff p onto the outlet S:~Cw s While the case is still dry fitted on the outlet pipe, measure the length of '16-inch pipe needed to brace the filter to the tank and wall if utilizing the optlonal supplemental side support If side support method. Is not utilized, proceed to step four. &i` ~1 For installations utilizing the optional supplemental side support: solvent weld the %-inch pipe onto the filter case, if side support method is not utilized, proceed to step four. Solvent weld the fliter case onto the outlet pipe. I"rt the filter cartridge into the rase, pressing down until the filter locks Into the bottom of Zx P,y "I the case. ~gsl•4. If a AS switch Is utilized: insert into the filter, and lock by turtling clockwise 90°, ~µfly •M'• S •~y•ti•9', Maintenance L The effluent filter should be cleaned every time the septic tank Is serviced. 2. open the outlet access opening to inspect the tank and Illtel: 3, pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. a- Once the effluent level has been lowered below the invert of the outletpiPe, firma y pull up on the filter handle to dislodge the cartridge from the case. . 5. slide the cartridge up and out of the cast for cleaning, l 6. if a VAS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 90° and cleaned with water only. L 7. While holding the cartridge on Its side (large flat surface facing a down) over the access opening, rinse off the cartridge with water , only, making sure all septage material 1s rinsed back into the tank. r a. if VRS switch is utilized, replace by inserti tI` ng into filter and d turning clockwise 90°. 9. Insert the filter cartridge back into the rase, pressing down until the filter locks into the bottom of the case, 10. Replace and socure the access opening an the tank. i:• :n:w< : a~, •yc: ra,rt..a:d't<rc .-t,rr.;• , WWW.bearonAtexonll 877-MLFILTERS (653-4583) 2 --(Z- 7 7 EEO 9 7 2 VOL 19 PAGE 4857 KATHEEEN H. REGISTER OF DEEDS ST. CROIX CO. 11I RECEIVED FOR kECORD 10/13/2004 04:15PH CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP LOCATED IN THE SW 1/4 OF THE NW 1/4 OF SECTION 21, T28N, COPY FEE: R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, BEING PAGES: 3 ALL OF LOT 2. CERTIFIED SURVEY MAP, VOLUME 10, PAGE 2819, AND ALL OF LOT 5, CERTIFIED SURVEY MAP. VOLUME 14. PAGE 3893. i NW CORNER SECTION 21 T28N. R19W LOT 4 WES T RIDGE A CRES o g S 89.54' 42" E r`r- 48. ~j ©I - - -~N~ I - , y 50' L01 N ~ 50' 1..~ I I N 4~ 1 1 W N LI I I I N QI WI ~3~< Q v I SCALE IN FEET -I I N M) LOT 9 QI I I ~ I D O 75 150 300 OIL I N 81 ®2O IAN de A YL A O.1 W 50' ,4-_ _ - - - - 50' I 502 ROLLING MEADOW DRIVE RIVER FALLS, WISCONSIN 54022 Q4q aa; .,s ue, I L-ILJ -_j co 83 I LEGEND 03 OI 4+ S 89.54' 42" E' 493.17**- • I oNS W COUNTY SECTION CORNER m 247.64' c 136.00' 1p9.53' ' o o MONUMENT. ALUMINUM CAP Icy 245.53' 1°: r (UNLESS OTHERWISE _ o NOTED), FOUND. ~I~lo• ~ IY I 1 0 • 1 1/4" IRON PIPE, FOUND. V I QO I °o I ' 50' 50' 150' 68' N z _ _ J w I` N 0 1" IRON PIPE, FOUND. KIWI 1--- _ 1, $ O I at 1 1/4•• x 18" 1itoN 1`IC~I 50' I IN IM v I ' N cd o PIPE WEIGHING 1.68#/ Q I Q I AfOO 7 1 IGo G 13 I cla to LINEAR FOOT, SET. - in J o/ a 1 SYSTEM I~ r6 1 66' - - BUILDING SETBACK LINE. M •.LOT 7I IW N IVEM y m # (R-~ PREVIOUSLY RECORDED I INFORMATION. 1.-boo i I° LOT 8 1 N I - X EXISTING FENCE. 1 0 Z C.D 1 Ig 50' 50' - - c I 1 U SOIL BORINGS PERFORMED BY Z I MARY JO HOLLISTER ON I= c 40' SHARED z 6- I APRIL 5, 2004. X CD WELL I DRIVEWAY - to O_ m M to EASEMENT NOTE : ALL IRON PIPE (FOUND OR SET) ARE DIMENSIONED 9TE S 88°25' 17" W 57.75' N AS OUTSIDE D 1 METER . 24785' 25690 66.00 4725.11' 47 2' 88° 481 49" W 257. 6', 0=%r _ 19 _ _ w E i CORNER 96.5 EAST-WEST 1/ SECTI TION 21 W 1 /4 CORNER -N8-a'48-1491-1E 52 7' SECTION 21 EXISTM DRIVEWAY 1 SECTKJN -Ar T28N, R19W T28N, R 19 W~ (STEEL "SURVEY ROLLING MEADOW DRIVE AREAINCLUDING TOWN AREA EXCLUDING TOWN MARK" NAB) _ _ _ - - - LOT ROAD RIGHT-OF-WAY ROAD RIGHT-OF-WAY UNPL A T TED LAND 7 3.192 AC., 139,028 S.F. 3.000 AC.. 130.681 S.F. *NOTE: LOT 7 REQUIRES A FRONT SETBACK 8 3.209 AC., 139,793 S.F. 3.000 AC., 130,684 S.F. EXCEPTION TO DESIGN STANDARDS FROM 150' TO 100' g 8.001 AC., 348,521 S.F. 7.946 AC., 346,111 S.F. . THIS INSTRUMENT DRAFTED BY DANIEL P. KUGEL PAGE 1 OF 3 Vol 19 Page 4857 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 1 w Lt~►~ Lc,w r-eV, c-c- Owner/Buyer Mailing Address 5 a ?41(4b C1,mC j:)Y t V -2 b 1 Li vV1b 0 S M5 j~ Property Address 5012', Qot l t vl. YYl e-trja w j~f-, W o ~q (,),I S jo ( (Verification required from Planning Department for new construction.) City/State so Parcel Identification Number io :5 LEGAL DESCRIPTION Property Location 155 %4 , /,J w %4 , Sec. 0. ( . T a N R 19 W, Town of rro Subdivision (v A- Lot # Certified Survey Map # 7 -7-1 Volume Pag # q `j 5 -2. Warranty Deed # Volume Page # ~ Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE . . Improper use and maintenance of your septic system could result in its premature failure to handle waste. 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 ma' tenance 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 Zoning Department a certification form, signe by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site tewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is 1 s than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispos 1 system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Sta of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Departure 'thin days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the o er(s) of the pro describe abo e, by virtue of a warranty deed recorded in Register of Deeds Office % j IGN TURF O P 4 ! DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning artment. Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certifid survey map if reference is made in the warranty deed. 1 IllllIIIIIlI(II{Il { Il I II lli $ Tx:4078829 3 STATE BAR OF WISCONSIN FORM 1 - 2000 966302 WARRANTY DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Erik P Paulson and k1ary Paulson, ST. CROIX CO. WI 10/29/2012 3:28 PM hushand and wife, Grantor, and-fintothy R Lawrence and L.tnnaca I_ EXEMPT#• NA 111wTCnCe, husband and wife as survivorship marital property, Grantee. REC FEE: 30.00 TRANS FEE: 225.00 Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 2 described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A Recording Area 7 I Name and Return Address: i lile C)^ C 7# l~d3~ Together With all appurtenant rights, title and interests. 040-1.082-90-27i Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, easements and restrictions of record. Dated this 17th (lay of October, 2012. * Erik P Paulson Vk Pau .on * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST.CROIX COUNTY. ) ss. authenticated this 17th (lay of October, 2012 Personally came before me this 17th day of August, 2012 the above named Erik P Paulson and Mary Paulson, husband * and wife to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) *Jay P Penfield THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 817/20 16 ) Michael 11. Forecki. Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) =JAQ.,PENFIELD *Names of persons signing in airy capa city must be typed or printed below their signature sin 1 of 2 WARRANTY DEED STATE BAR OF WISCONSIN FORM Na 1-2000 EXHIBIT A Lot Nine (9) of Certified Survey Map in Volume Nineteen (19) of Certified Survey Maps, Page 4857, as Document Number 776972, field in St. Croix County Register of Deeds Office on October 13, 2004, Being Located in the Southwest Quarter of the Northwest Quarter (SW 1/4of NW 1/4) of Section Twenty One (21), Township Twenty Eight (28) North, Range Nineteen (19) West, Town of Troy Being All of Lot 2 of Certified Survey Map in Volume 10, Page 2819, as Document Number 521597, and All of Lot 5 of Certified Survey Map in Volume 14, Page 3893, as Document Number 626220, Formerly Being Part of Lot One (1) of Certified Survey Map in Volume Four (4), Page 1157, as Document Number 377181. Subject to shared driveway easement over Lot 9 as shown on said Certified Survey Map. Subject to Rolling Meadow Drive right of way. 2 of 2 T RECEIVE d WisoonsinDepartmentof Con APR 14 2004 SqL EVALUATION REPORT Page I of 3 Division of Safety and Build' ST. Cf" lt91 With C#mm 85, Wis. Adm. Code Z I I tc ~Y St. Croix Attach complete site plan txa.l.intlhes 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, northarrow, and location and distance to nearest road. Dot Please print all information. Reviewed by /9 1 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).~~ v ✓ ! I Property Owner Property Location 11 BRIAN & ANGIE SYLLA Govt. Lot SW 1/4 NW 114 S 21 T 28 N R 19 E (or) ❑W Property Owners Mailing Address Lot # Block # Subd. Name or CSNW p/ 502 Rolling Meadows Drive 67 1 - 41 / -7 0 b J City State Zip Code Phone Ntxnber ity rIvivage Nearest Road ~D River Falls, WI 54022 ( 715) 425 - 0113 Rolling MeaQOWS Dr. New Construction UseE] Residerffial / Number of bedrooms 4 Code derived design flow rate 600 GPD ® Replacement Pubic or commercial - Describe: Parent material till Flood Plain elevation if applicable MA ft. General comments Mound System 0.5 fL sand fill - 0.5 Loading Rate and recommendations: Boring Pit Ground surface elev. 99.27 ft. Depth to limiting factor 49 /in. Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Corti. Color Gr. Sz. Sh. "Eff#1 -Effi2 1 0-6 10YR2/2 - 1 3fgr mvfr ci 3vf-m 0.5 0.8 2 6-14 I0YR3/3 - sl 2fsbk mvfr ci 2vf m 0.5 0.9 3 14-33 10YR3/4 - Is 1 msbk mvfr cw 1 vf-m 0.7 1.2 4 33-49 10YR3/6 - fs 0s ml ab - 0.5 0.9 5 49-60 10YR3/6 flf 10YR4/6 fs m mvfr - - 0.4 0.6 (I Iorizons 1 > 2, & 3 have 10-20% gr; side of pit; Horizon 5 has some we bands of 10YR3/4 fs ) F2 Boring # Boring 107.25 37 Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E9#1 'Eii#2 1 0-11 10YR2/2 - I 3fgr mvfr ai 3vf-m 0.5 0.8 2 11-20 10YR3/4 - s sil 3f-mabk mfr cb 2vf-m 0.5 0.8 3 20-37 7.5YR3/4 - is lmabk mvfr cw lvf-f 0.7 1.2 4 37- - - till/lsbr (Some gr in all horizons; Horizon 4 has some pockets of s.) Effluent #1 = B00 > 30:< 220 mg& and TSS >30:5 150 mg1L ' F_fllu-rt #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number M Jo Hollister S 224832 Address - 11-j Date Evaluation Conducted Telephone Number W9875 690th Avenue River Falls WI 54022 04 - 05 - 04 (715) 426 - 1775 Property Owner BRIAN & ANGLE SYLLA Parcel ID # (Pending) Page 2 of 3 Boring ❑ Boring El Pit Ground surface elev. 100.20 ft. Depth to limiting factor 30 in. Son Application Rate Horizon Depth Dominant Color Redox Description Texture Strudnxe Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Conk Color Gr. Sz Sh. -Eff#1 -EM 1 0-9 10YR2/2 - 1 3fgr mvfr ai 3vf-m 0.5 0.8 2 9-15 7 5YR3/2 - sl 2f-msbk mvfr orb 2vf-m 0.5 0.9 3 15-30 10YR3/4 - sl 2f-mabk mvfr cb 2vf-m 0.5 0.9 4 30- - till/lsbr (Some gr in all horizons; few stones) ❑ Boring # rl Boring Pit Ground surface elev. ft. Depth ID W iting fador in. SoN Rate Horizon Depth Donixkirrt Color Redox Description Texture Structure Consistence Boundary Roofs GPDM in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. '011111 -Eff#2 F-1 Boring # Boring H Pit Ground surface elev. ft_ Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Strucdxe Consistence Boundary Roots GPDJIf in. Mu nsell Qu. Sz. Cont Color Gr. Sz. Sh. -Eff#1 -01#2 • Effluent #1 = BODs > 30 < 220 mg/L and TSS >30:5 150 mg& * Effluent #2 = BODs < 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-833fresi pe.07i00n PLOT" PLAN pAG~ 3 ~tY OWNS: S ttR '~RiItAT {J61~ i,~(.~N7: ! ~ ~ ~ ►yttFaCE ~I~ M P~kR+CEL LOCATED ~M~ - ,~PiKL GFl~ouND-d1 SS ~ TH s TNT w . oo T--% 4W #Z- oP0 C F/ff- ~&Wll R T 5 T W►5 0 qaD -50L LNG W/ PAMoe NO GOMM M "AGK t't MfM5 r ~Q' ~a GZ,O~ w O p 0 ti Q 3 O 0 o SEC. X Zs Da. 3 i r Parcel 040-1082-90-275 04/09/2008 12:46 PM PAGE 1 OF 1 Alt. Parcel 21.28.19.326C-30 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/13/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - PAULSON, ERIK P & MARY ERIK P & MARY PAULSON N8762 1025TH ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 508 ROLLING MEADOW DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 8.001 Plat: 4857-CSM 19-4857 040-04 SEC 21 T28N R1 9W PT SW NW FKA PT LOT 1 Block/Condo Bldg: LOT 09 OF CSM 4-1157 & FKA LOT 5 14-3893(12.208 AC) BEING CSM 19-4857 LOT 9 (8.001 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-28N-19W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 06/14/2005 797613 2822/265 WD 10/13/2004 776972 19/4857 CSM 07/23/1997 1101/266 WD 07/23/1997 1096/184 WD more... 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/23/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 8.001 108,000 0 108,000 NO Totals for 2008: General Property 8.001 108,000 0 108,000 Woodland 0.000 0 0 Totals for 2007: General Property 8.001 108,000 0 108,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00