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HomeMy WebLinkAbout040-1306-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561046 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: Waters Edge Construction Inc., James L. Krue Troy, Town of 040-1306-23-000 CST BM Elev: Insp. BM Elev: BM Description: / Section/Town/Range/Map No 6 6S T- 08.28.19.1850 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -y-,,` s f Benchmark e 1 /oL /1216 14 -1-0 s; Dosing i Alt. BM A"at= _j Bldg. Sewer 11,7 93r Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION \ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 3 I S~ Z 1~ _ Dt Bottom Dosing ! 33 Header/Man. 7. '34 9-7-75 Aeration Dist. Pipe 7,3 7~ R 7 Holding Bot. System A PUMP/SIPHON INFORMATION Final Grade 16- -7:i~' 7 Manufacturer GP and St Cover I Ga t.`.__ 5' I Q Model Number 15/ ' TDH Lift Friction Loss System Head TDH Ft 1. 7- 5 a . A- <?.g Forcemain Lengtty6 Dia.Z I I Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Lengt No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z - &A Gk" 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR ,~,~','I +r____ Type Of Syslzli UNIT Mode~Number O^c~ -7 /rd AV e DISTRIBUTION SYSTEM (o L3 Z Header/Manifold J/ Distribution` Ix Hole Size Ix Hole Spacing Venyip Air Intake Length Dia Length ` Dia Spacing` ` ,r/ )v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C~ Depth Over Depth Over 1XX Depth f xx Seeded/Sodded r ulched Bed/Trench Center -3 Bed/Trench Edges Topsoil I "I L Yes No _ es [ No J COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / Location: 439 Jordyn Lane ^Hudti~scon~, WI 54016 (SE 1/4 NE 1/4 8 T2288N R1 9W) Sunset View Lot 23 Parcel No: 08.28 19.1850 1.) Alt BM Description 2.) Bldg sewer length = 2 n - amount of cover Plan revision Required? ❑ Yes *No s c~ J ! / s Use other side for additional information. Date J tnsepctors sign re Cert. No. SBD-6710 (R.3/97) I Jul 24 2013 06:09AM HP PaxPelke Plbg & W0 Inc 7156725267 page 2 I _ . i 0 I ! tht ` L t~ ~ - - rr , 1 - 1 w ~ Lt, I ` E R`• b 'r i C k 1 tIN^ n Ln m kZ ~ i ~ ~ K 40 J ~u`C st a PP 14. k Sit t' Ist k~ 0 4V4(.3 r ,r County t+rj'°t Industry Services Division _!5~j-, LQD/X .f 0 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) S P P.O. Box 7162 - Madison, WI 53707-7162 i C) L4 ~ 6"',tf. State Transaction Number Sanitary Permit Application In accordance with SPS 38312 Wis. Adm. Code, submission of this form to the appropri ernmental unit is required prior to obtaini ry permit. Note: Application forms for state-owned PO a itted to Project Addre (if different than mailing address) the Department o a amp sional Servies. Personal information you provide may be use -r r PUT es in ac c e Prijaey Law, s. 15.04(1 m ,Stars. 1~~~~i r! 1. A li o orma ' - Please Print All Information `J l Property 's N Parcel # E2 CO.JSr a Tia,✓ sr CRO 1' Property Owner's Mailing Address Property Location 400 , SO !~r wlri- 130 Govt. Lot ` • , v) City, State Zip Code Phone Number 1 8 E Section 45- 7G0 -070 y (circle on II. Type of Build g (check all that apply) Lot # T ~8 N; R /9 E o ~I or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use ❑"9bf ❑ State Owned - Describe Use CSM Number 8 Village of Town of !//2Gy Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ❑ Replacemen S stem ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ),List Previous Permit Number and Date Issued B. ❑ Permit Renewal Permit Revision Change of Plumber ❑ Permit Transfer to New r / Before Expiration Owner , l GJ V6 -3 IV. Type of POWTS S stem/Com oven evice: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 2,4 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ~ T, 1~ t ❑ Pretreatment Device (ex lain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose (sf) System Elevation yso 7 / C y3 G Y9. z 9sa f Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units { 7. a U N New Tanks Existing Tanks 0 ~ T 1! r t i 0. U0 05 j; [n LZ C7 ra Septic orklaWis%Zwk p00 Qyo /E.fEit C-dnJG~, Dosing Chamber GDO - et Goo I' I VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print Plumbe ' ign re MP/A~ PM Number Business Phone Number aN.tJ 6lti'~' 07~3/35~t: 7/S c7.T-S,?1G Plumber's Address (Street, City, State, Zip Code) Ge? 98 Sr 1A.1Y ,?S ~Gl,44Y G.J T S-Y726 .Al V111. oun /1)e artment Use Onl pproved ❑ Disapproved Permit Fee Datels ued uing Age Signatrre ` ar „ n ❑ Owner Given Reasonfor Denial -5 IX. Conditions of Approval/Reasons for Disapproval r 3n..tij"~- L' ''Lt -'t " a u L j Attach to complete plans for the system and submit to the County only on paper not less than 8 IR x I t inches in size SRD-6399 (R0313) Jul 24 2013 O&OG)AM HP PaxPelke Plbg 8 WD :nc 715672+267 page 2 M T IN ~ o tea I - n i~ a1° R 06 o o L -t i' a'~ / y 1~ N A n to ~ U IL m ~nz~ - ti f 6. ox 7 Private Onsite Wastewater Treatment System Index and Title Page Project Name: Gr/ArEasEOlE Ga.~l'sta~rr~.✓ - LQoa.,n /owes A116+"Id Owner's Name: Owner's Address: yo o S ~5Eeo-w .r ~u~ rE /30 .~Gly~fo~ ~1 sYD/G Tis 7~0 - 0705 Legal Description: /VET,?8~ / 9 l./ Municipality: Town, Vie, Gity of A.0? County: Subdivision Name: JU.✓.SET ~EuE1oPiYE.J r Lot Number: 0l3 Block Number: Parcel I.D. Number: Page i ~,vDEx tt ;;IrZE IVA er r Paget ~Lo3' ~1A.✓ sJ//loss- .~Ec7-~e.✓ /LA•y ~EIJ Page 3 .SEnPj'~G ,✓K /~u ry Z,%Imm L'•toss-Sic r~o.J Page 4 f'y~o ~E.[Fo.Cry/.•~o-oeat a e Page 5 i~owTs ocJ•✓t'z's f1•l.-.4 1, /yAwlA6E~E.Nr i".4 Page 6 Page 7 ~/t T~2 ~A/~+lTEwIA.dGE ~,rJfc Page 8 Page 9 j- jr~pyr,,~ r • Soy` ~d~Ot uy r~e.✓ ~EPo.i T Name of Designer: J o /EL License Number: lW - a-U I SY4 Signature: - Date: .)r .5 loop Designed Pursuant to the Following POWTS Component Manual and Comm 81-85: In Ground Soil Absorption Component Manual for POWTS (Ver. 2 2.0) SBD-10705-P (N. 01/01) Page -30f 7 SEPTIC TANK &'PUMP CHAMBER CROSS SECTION'AND SPECIFICATIONS ..c 541. yo. 4" CI. VENT PIPE 12" MIN. ABOVE GRADE 9 WEATHERPROOF /pt FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS y ~~toul W/ PADLOCK E /,v~swa►Q ~,~,~p f WARNING LABEL G b< ArPer - MIN. 18" IN. INLET I: t' . WATER TIGHT SEALS s r GAS- TIGHTi -A SEAL i APPROVED JOINTS WITH APPROVED ALM APPROVED PIPE 3' ONTO 4ttTO SOLID C ' ON SOLID SOIL SOIL' PUMP OFF ELEV. 8C. S FT. t OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC./ DOSE' TANK MANUFACTURER: ~jESE.c ~o,✓G~I~rE NUMBER DOSES PER DAY: S. TANK SIZES: SEPTIC fooo GAL. DOSE VOLUME INCLUDING 87.,5 9 r DOSE Goo GAL.. FLOWBACK: .GAL. ALARM MANUFACTURER: T. E" ~~s/or~,6as CAPACITIES: A a -g.2,0 INCHES = _ 33L GAL. MODEL NUMBER: SWITCH TYPE: B - INCHES = 33 6 _GAL. PtTMP MANUFACTURER: ZOELGE'2 ~„icil C = S,S INCHES = GAL. MODEL NUMBER: 457 SWITCH TYPE: Ec~iydicRL D = 8.5' INCHES " 1w 9 GAL. REQUIRED DISCHARGE RATE o?p GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC ,VERTICAL•DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 9.S FEET MINIMUM NETWORK SUPPLY PRESSURE . . . . . . - FEET + jo FEET FORCEMAIN `X /.o FT/100 FT. FRICTION FACTOR*. FEET TiDTAL DYNAMIC HEAD = ~~rm INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S3 WIDTH I8,~ ; DIAMETER - LIQUID DEPTY 24 A. ya,, 7 TOTAL DYNAMIC HEAD/FLOW LL PUMP PERFORMANCE CURVE PER MINUTE MODEL 151/152/153 EFFLUENT AND DEWATERING 14 45 153 MODEL 151 152 153 12 40 Feet Meters Gal. Liters Gal. Liters Gal. Liters 0 35 1.5 50 189 69 261 77 291 5 = 10 152 30 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 0 8 2 t5, 20 6.1 29 110 44 167 52 197 25 7.6 16 61 34 129 42 159 g 20 30 9.1 - - 23 87 33 125 35 10.7 - - - - 22 85 15 4 40 12.2 - - - - 11 42 ' 10 Shut-off Head: 30 ft. (9.1m) 38 ft. (11.6m) 44 ft. (13.4m) 014508B 2 5 9 Model 151 Models 152 / 153 10 20 30 40 50 80 70 80 90 100 GALLONS s 7132 67132 LITERS 0 40 80 120 160 200 240 280 320 360 3718 ' 4 518 3 718 4 518 FLOW PER MINLITE_ 014508A i CONSULT FACTORY FOR a _ 37/8 3+~ SPECIAL APPLICATIONS o i 3718 0 3718 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and f I supplied with an alarm. • Variable level control switches are available for controlling single phase systems. I • Double piggyback variable level float switches are available i for variable level long and short cycle controls. I - 12118 I • Sealed Qwik-Box available for outdoor installations. See 1116 -,I - ---I FM1420. Jill • Over 130°F (54°C) special quotation required. 415116 151/1521153 Series SK2444 SK2064 15111521153 MODELS Control Selection Model VOlts•Ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2 or 3 8N151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 " N152 115 1 Non 8.5 1 2or3 Easy assembly" BN152 115 1 Auto 8.5 Included 2 or 3 (pump 8 discharge pipe not included.) E152 230 1 Non 4.3 1 2 or3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 L2or BN153 115 1 Auto 10.5 Included E153 230 1 Non 5.3 1 BE153 230 1 Au to 5.3 Included 3 SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level OPTIONAL PUMP STAND PIN 10-2213 float switch. Refer to FM0477. Reduces potential clogging by debris. 2. See FM0712 for correct model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. • Made of durable, noncorrosive ABS. 3. Variable level control switch 10-0743 used as a control activator, specify duplex Raises pump 2" off bottom of basin. (3) or (4) float system. Provides the ability to raise intake by adding sections of 11/2" or 2" PVC piping. A CAUTION Attaches securely to pump. All installation of controls, protection devices and wiring should be done by a qualified • Accommodates sump, dewatering and effluent applications. licensed electrician. All electrical and safety codes should be followed including the most recent National Electrical Code (NEC) and the Occupational Safety and Health NOTE: Make sure float is free from obstruction. Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2008 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 5,f 7 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: [I NA I"ER S 4W 4 Z- CO,✓Srezez owl L✓/ESEa eo,✓carrE Permit # - / M Septic El Dose ❑ Holding Volume: 14,0,0 (gal) DESIGN PARAMETERS Tank Manufacturer: L,//ESER Co..,ca,rrd- ❑ NA Number of Bedrooms: 3 ❑ NA ❑ Septic D4 Dose ❑ Holding Volume: Goo (gal) Number of Public Facility Units: 5MA Vertical Distance Tank Bottom(s) to Service Pad: /p (ft) Estimated (average) Flow : ~p p (gal/day) Horizontal Distance Tank(s) to Service Pad: yo (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow= (estimated x 1.5): J o (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal/day/fe) Effluent Filter Manufacturer: ~ES ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: GF-/o j Fats, Oil & Grease (FOG) <_30_m9/L Pump Manufacturer: Z oEL L ESC Biochemical Oxygen Demand (BODE) x220 mg/L ❑ NA ❑ NA Total Suspended Solids (TSS) -150 mg/L Pump Model: /.s/ High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (GODS) 220 mg/L ❑ NA ❑ Mechanical Aeration El Peat Filter NA (TSS) > 150 mg/L El Sisinfection ❑ Pretreated Effluent Monthly average e wetland Y 9 ❑ Sand/Gravel Filter ❑ Other: (BODE) s30 mg/L Soil Absorption System (TSS) !530 mg/L ❑ NA Fecal Coliform (geometric mean) !510, OIn-Ground (gravity) ❑ In-Ground (pressure) ❑ NA 1 ❑ At-Grade ❑ Mound Maximum Effluent Particle Size /s in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: ❑ NA Ot her: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) lirWhen combined sludge and scum equals one-third of tank volume 19 When the high water alarm is activated Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 Years) ❑ NA ,3 ®year(s) Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA S ER year(s) Clean effluent filter At least once every: 9 month(s) [I NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA .3 19 e Yar(s) Flush laterals and pressure test At least once every: - CI month(s) 2F NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) 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 <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) Page Co of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be:discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK j~ SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY ' RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER, Name Name o EI,~E E[KE Lu~~i„~t Phone 671 _ ` Phone S G S LG SEPTAGE SERVICING OPERATOR PUMPER -G/.✓~C.rrca✓.✓ LOCAL REGULATORY AUTHORITY Name Name y-~ ~jto/X zo.✓iat D fFied, Phone Phone ~S' 8 - O r ~~,,..ff sy m = O ^l y.1 rf ro ro 0 O p+. n ra o m O ` ; o v {j~ M ~ ?ill d SD n S m < Q. ( hid N3Nrog 'r'om J ~ ro ` n CD z 0 4 1D M~~1 Bd °ipmmmo+m TN o g o C E ~ 3 =r ID N = ro ro ti ro W l 3.; ~ d to Q. d d N T T r~ N ~ O 7 ro x= O ,O ro O. 3 m ty < c r. ro n 9D -3 Il tf N U 7c 5 m m 3 ro = d O N _ ^ n L d 7C' d F- I' O 0 I. I O to O 7 ro ~ ~ ; t a 3 ro s o M~+ til. ' n ti tD p s 1 T? = 4 a m r N =r f m a = ro o m w a ~ ~cD f.. ro I N O O. w 0_ 1E 52 O c N C O Q ==_alb t o._ro-D-° N 0 m A d n ~ ,LS RL d ro g =r - _ r d N l Y ~T•o~~ n~aa = d ro 9 7 N o 3 3- .0.. N (SD d 0 S d A 53 2, CL ro c -1 ( mam n g =h ~ F... !D CD Z 3w 'T G T ao 3 c ate.{ tD m~mO C C Nm Z 3 " i.a rl. o O Lot (D < ro m m c ID =r r+ c< ^3 d ~lA C ~ C a d d O ~o > >ry o w d N Td ro® W 7C Q ;na 5 Inv~QT IDS E; f-D r 0 :3 So to o 0, p C m n = xm mm ~~c m m a s ,a ro m v+ - 1J N j d N O' {A S m Q QC d C Q N N _ Y = m - X+ a n v a m m Q 'II r+ l~ ,c m m -r ro m O o pl .r Court wed'. ks' ~Je® Safety and Buildings Division Sy ZlOlx 6) S 201 W_ Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, Wl 53707-7162 S >yi 3 S~t 'emit Application State nNumbw In accordance with SPS 383. 1(2); VPis: Adm Code, submission of this form to the approp ' ntal unit LJ/A is requited prior to obtaining a sanitary permit Note: Application forms for state-owned mitted to Project dress (if different m/ailing ad~) ,b ~AJ the minvses Department of Safety and Professional Servies. Personal information you provide may nary / G3 ~Z ras-, ' v in accordance withthe Pri Law, s. 15.04(1 xm), Stars. 7 / I. APP111cation Information -Please Print All Information Property Owner's Name Pan x-1 # fEas rauc rr-.aa D ~6 -i30( , - Z 3-6CD Property Owner's Mailing Address La o Property Location v DO SE~av4 v13 Ya"7C z-h WT Govt. Lot City, State Zip Code Phone Number yS y4, Section $ u SonJ ~l SS'o/6 /S 760 - 6 76 y (cirelV . Type of Builifing (check all that apply) - Lot # 'r a8 N; R / 9 )c 0 II o ~Ior2Family Dwallmg-]!?.0/'f]B77 .3 . 013 Subdiivvisi onName cif ` Block# S&.~-<s' ❑ Pubi' cal - J -of ❑ State Owned - Describe Use B I'1" V CSM Number 'Viitagevf Town of ~rw y III. Type of Permit: (Check only one box online A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Lgsr~d Before Expiration Owner IV. T of POWTS stem/Com nt/Device: Check all that apply) XNon-Pressurized ln-Gtound ❑ Pressurized In-Ground ❑ At-Grade ❑ M and J> 224 In. Of suit2lbip soils Moond < 24 iv. of suitabl soft , n ❑ Holding Tank ❑ other Dispersal component (explain) Gf C~%"'U ni'D1 e 7 t7 f/ V. Dis reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation / 3Y3 9S 0 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanta Existing Tanks 1 Cd L7 r 1 ;2 septic- DOa - Don / E~2 ~a~✓~.eETE DasingCliam6er W11P -/a,9 A44- VII. Responsibility Statement 1, the aadersigaed, mane responsr"bi ity for installation of the POW TS shown on the attached pleas. Plumber's Nance (Print) Plumber's Si MP/i"1Z4 Number Business Phone Number - P~ I , 7,7 --5;,2Z 4 Plumber's Address (Street, City, State, Zip Code) 6a? 0S 'Sr. wY. ~u eAti o I Sy7~~ C rtment Ilse Only as Approved 13 Disapproved Permit Fee Date ing Agent Si $ 5- ° l Zo13 ~i~ ion Denial , SYS1 Reason for D-1 CoQ 4 (i►lgiffo Mter Disapproval A /e0 C n dispersal cell must be serviced / maintained C[ 7 - ' as per management plan provided by plumber. 2. All setback requirements must be main ained - as per applicable code/ordinances. Attach to complete plans for the systrm asd submit to the Coanry oaty an paper not than 8 rn I ' m SBD-6398 (R. 11/11) Private Onsite Wastewater Treatment System Index and Title Page Project Name: ~.4tERS"./,r CoAfsrfwc riot - 3-est. /✓Geau✓o ~owTS Owner's Name: //~rEitsED~E ~.~sric~c rro,✓ Owner's Address: moo S ,sEGo.~O .Sr. , ~ui r~ 130 . 7/s' 7~D - 07a y . ~.J Legal Description: SZ_1,9 Municipality: Town, V e, aty of ~ita Y County: ewo/x Subdivision Name: .Su.~sE r ~Et✓ ,~D uE~o~i'r~,v Lot Number: o ?g Block Number, Parcel LD. Number. Page 1 Ave X V/-reZ- .S/yE,r 7- Page 2 ~~or ~LAw~ ~✓,~~Rots- .SEc rio.✓ f'jXd 4)1, Page 3 .S~E~Tic f' A~✓K .S~~EGiFi~Ario.✓ s Page q 10,94o;T.f atl.✓Ex s 10ow-a4t f /yA✓A6Er1E~ r Pt Page-5 Page 6 tic TE~e 101-4iw rE.✓A.WC! ~,✓fo Page 7 Page 8 rrf~iyyE.~rs ~oic ~dAl uo rio.✓ ~E/jaa f Page 9 Name of Designer: ,%-o oga A,'t xE' License Number: Signature: Date: 41- /o - ?o 13 Designed Pursuant to the Following POwTS Component Manual and Comm 81-85: In-Ground Soil Absorotion Component Manual for POwTS (Ver 2 0) SBD-10705 P (N. 01/01) ~O IrN o ~ a a ca n Z t~ a V tom` c 1 a = h GO o a~' moo o b L^ WU C c w C tA, w t i nr \ Q T L e p a t 'v O l~ ' D z D m 61" D 86" z C 42- 0 ~ z r O ^N -1 O 00, i m --i UP 41" I N~~ m ~ 4" CAS / P \ m 0 En m 3° 36- 4" D I II cn ca m m UP 38 _n x 0 r O 4" CAS \m x / N v C C ~ m O NE 3 O z c: ° 39" rj 0<0 n D Z D g:y> -Nt n a) r- D O m D I A _n ~ cn m Imo m r5,. x~ n x D Z O m n ~n o z Z O o 75 z D Fri Fn ~1-4 X~ mz z*7ZC 47 nc~ p~z nuz ~mpz M>O Oy0 Z c° °x ~m °Fcq °m ~mD ~n° ;K0 Svc p i2~ o tZ/1 w-4 my Cam cn r-IZ D m00 mDp -gyp.. zc-i =ai F A z Dro- 4 Nzr c: rj) o' rnA^ Fa- --nc)" t-3 OXrn En ~ ~ z r° D O -u Fn > -4 D D ,-ml ~p ,-l m N M 0 D 9) alk v D v D G C Z Co. D N cn Vl I p O s -gym?_ r s o~ m u n V X in ZN t*1m O A'rp V in Pima) --I V) m> i m rCA p° 0 n0- 20 D < z °m FA to cn zz _ O w (n o p D N v O o C) r v m z]a O n O Z ~m D mDm mO o ~m~ va Ws { 1 Wt D A P3 H Z 0CD O D `p°p° =rz r00 Wrnn D Z D ~ m O z :9 ;:1 ° Z D ° sD y .~v ° G7 o +1 ~p -Ni C°J 0 -n 4 O Z O D D v r Om °oA Z v 0 rvi c) 'D p 0 (A D m m zo O oN En o 0 o c/) FD H Z ° M O ° Z `n r m \ m MY1000-MR 0 m ~~~~~~~E ~A BY: SME SCALE RE-POUR: °m+ SEPTIC MANUAL MIENER REV. I \ Z W3716 US HWY 10 MAIDEN ROCK, NA 54750 DATE: JANUARY 2010 DATE:. POST-POUR: c ° REVISED JAN. 2010 800-325-8456 FILE: VMWO-W I~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of C/o FILE INFORMATION SYSTEM SPECIFICATIONS Owner y- QSEOL oNS3-i>?u o,J Septic Tank Capacity ~10 gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA L✓ESE.e c'~0.d4. DESIGN PARAMETERS Effluent Filter Manufacturer S j- ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A4__ A41 0 NA Number of Public Facility Units $3 NA Pump Tank Capacity gal NA Estimated flow (average) `?06 gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) ysl~ gal/day Pump Manufacturer P\NA Soil Application Rate .7 gal/day/ft2 Pump Model ❑ A Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) _<30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Qualityt Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODj 530 mg/L Xln-Ground (gravity), ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :5104 cfu/1 OOml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ JNA Other: ❑ NA Other: ❑ 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: ,3 ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA ❑ Inspect dispersal cell(s) At least once every: month(s) ,3 year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 13 month(s) ❑ NA ❑ year(s) ❑ month(s) Inspect pump, pump controls & alarm At least once every: ❑ year(s) NA Flush laterals and pressure test At least once every: ❑ month(s) X NA 13 year(s) Other: ❑ month(s) At least once every: ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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. Page J of !o START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps;'medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 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 Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS 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. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name 4iYiJ ~GKE Phone 1 Phone 1j ~-12-,52-641 SEPTAGE SERVICING OPERATOR (PUMPER) - oaJ..~ LOCAL REGULATORY AUTHORITY Name Name ~~oiX o o .~t cE Phone Phone 7/; 38G- 3116,0 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 777 r-,7 rM (D A (D m N CL 10 f/1 e•f Q m c0 m 0 F7 hrt F ~ © i p ~ 3 a N - a of Dni ~r e~T ro n, (D 4 k o n a S:~ [3 0( f.► . C~ cn O @ < ro (D ' F~ Q w ro m 'r - O a3 mmmdm G y ~ c s !!i ttir w ro n c °i ~ am a "~,m ID ir ma, w CLV' 0 3 an3 ui = (DaN 0 03 'm a~ ro= S (n n C= N° OD W ID SD ig CLM 'D -0 m CL r Iwf C Sr O_ N n ° N• N <c S p - S~ S ro w _ =(D nw S3 O N9 a^ N C -a m -am O (D m '.P A O O G)'a v w _ O 0-3 rD i =-a w N Q m O 7• VY ro ro= n m D .n. N 'O D( T BCD m w 3 w o- m = c 3~ s3 D am rn 3 :~s-r' / I 3' p: ~ ;y ~ f~D Z v3 3 UF a, 3 = m o o ~ m ID n 'R 0 C N v 03num.~ to r+ =r ID 3 o°°< S ID °m.°^.° n m rD ~ m m (o S n 1Q m o n rDm cA "m N •a ~ i W X- CL M o o- . a -:E5 % W _ a,2 u 0 0. =r 3wos 3 ~ ~(n~ m m ~(o C rD =r n (D a O ?r F F w r~ ~ ~ C NpO o A N Z ro N lu F.r • Ei* . SL 0, ; = fD a' to m~~ ° a. z (D h K >;-o~ 0 rD o ° m3o° T % Z tir n v.0 ro m 't O fit' 'I` tQ 0 I ~D to to Wisconsin Departmen of Co~erL"~~r~GD SOIL EVALUATION REPORT Division of safety and uildinggss Page of ® 9,in2rdan with Comm 85, Wis. Adm. Code Attach complete site an on Pape not les 1/2 11 inches in size. Plan must County S l C~j) include, but not limited to: veqlfat A refere ce point (BM), direction and percent slope, scale or ime i ~(!N t114pt~ n location and distance to nearest road. Parcel I.D. ease print all information. Revi wed by "Date Personal information you provide may be used for secondary purposes (Privacy Law, s, 15.04 (1) (m)). 242), Property Owner Property Location -GM _ ~ S E 'Pfn/1~ 3 L ~~v ~C171'i? N1 Jr S(_ 1/4.{J4_-- 1/4. S T Z 8 N R E~ Property Owner's Mailing Address Lo "3 block # Subd. Name or CSM# P o. Sox 3 3 - SI~~vS~T v1Qj 7~ City State Zip Code Phone Number ❑ City ❑ Village Q Town Nearest Road t3At1 lRlc ~vI 5cl $!0 (1I S )y$S.33S 1-ZO` New Construction Use: ® Residential / Number of bedrooms 3 _ 1. Code derived design flow rate S D - U U(7 GPD ❑ Replacement ❑ Public or commercial - Describe: I Parent material G L~el 1 (1j,~ j lti~ Flood Plain elevation if applicable ~1 ft. General comments and recommendations: ±v X18 r~ x 5 D i Boring # ❑ Boring ap qb F"' ® Pit Ground surface elev. cA Z ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 j SL-L 0 3 6 vugR- 3l 6 - 2m sbk N/), Ile C'-,~ - • S i a I i Boring Boring # ❑ , ® Pit Ground surface elev. c-~ CL 2 ft. Depth to limiting factor > 3 in. Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 I rJ- ~Z 10` L ~2 31 Z - St ( Z~s b M Lw Z,-P- S S- 3 - ~oYQYA - S rJS I - ~.Z Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L . CST Name (Please Print) 'gnature CST Number Arthur L ' -Wegerer 2-3 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Main St. River Falls, (7I 54022 )Z_ ~C~_~3 715-425-0165 a Property Owner ` De~j N~ (Parcel ID #~'1~ 1 /V G Page of j a Boring # ❑ Boring ® Pit Ground surface elev. c y • y ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color . Redox Description Texture Structure Consistence Boundary Roots GPD/fl' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 0-~1 16-1 R31 z 2-- S's c m`~- ~w z'~ ,s ,g (e Z ~~~g ~0`~2316 - s 1 1 Z►tirsbtc wt ~ ~s - ~s 3 3 ay ~o~ R Yh3 _ s c) sCt z Boring # ❑ Boring F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Soil Application Rate ry Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring At ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil ApGIpiD/~ Rate In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODE < 30 mg/L and TSS < 30 mg/L Tlie Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6/00) PLOT PLAN Page 3 of • Scale l'=S0'< Lu i z2 F~M44 Z r s - 0-7 0,n ~0r Sp V) clCt 9 °1 10 p LN)~ Z3 s~i'~Eia g.3 Fv~ Irv t~r4-~ A7 ILbT- ii FL~Oo_p`!"A 1R4V 1~►t~E LIST.~1`'iZ._ LsC_10n•~Utv -7 t) PVCPLP(~- w/LPrrf+. 1Z,1G_U3 715-425-0165 220254 03-Z1 S _ Z3 CST Signature Date Telephone No. CST No. Job NO. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P~ tr-5 E710V Mailing Address 3~ ~e c, O t-i,, A f C.J r S r w'~`. Property Address (Verification required from Planning & Zoning Department for new construction.) City/State 14^ W Parcel Identification Number V ~l t 3y .2 0 a~ 1 _-U LEGAL DESCRIPTION Property Location '-)G7 'l4 , Of °I/ ,Sec. T fN R Town of ~f Subdivision SJAS~e-+ j ce C') , Lot # 2~3 Certified Survey Map # , Volume Page Warranty Deed # (l7 Ll J J , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Deparment a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 13 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. a I/we certify that all statements on this form are true to the best of myfour knowledge. Fwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of roo of e S - w 1~ s 1. ~t,•t j f ft'e -17 C72~ ffURE IG A 4 A~PPLLII C (S) DATE ny information that is nusrrepresented =mayr)ult in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/05) Parcel 040-1306-23-000 04/17/2013 01:55 PM PAGE 1 OF 1 Alt. Parcel M 08.28.19.1850 040 - TOWN OF TROY Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 06/17/2004 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - B & L LAND DEVELOPMENT INC B & L LAND DEVELOPMENT INC 7925 ARNOLDTOWN RD LOUISVILLE KY 40214-4501 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 439 JORDYN LN SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 1.190 Plat: 10-009-SUNSET VIEW DEVELOPMENT 040-04 1/37 SEC 8 T28N R19W PT SE NE BEING SUNSET Block/Condo Bldg: LOT 23 VIEW DEVELOPMENT ('04) LOT 23 (1.190AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-28N-19W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 06/17/2004 766198 10/09 PLAT 2013 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.190 62,500 0 62,500 NO Totals for 2013: General Property 1.190 62,500 0 62,500 Woodland 0.000 0 0 Totals for 2012: General Property 1.190 62,500 0 62,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 04/12/2013 13:26 FAX 17153867664 RIVER VALLEY ABSTRACT ® 001/001 1 i sll11 IIf! Ill.likl it `tak K:Ir ul' \6'e:C1hr:m 1vrm, l "00- 11145514? WAIt1;AMIT1)E:Cp lu ix..411rris r)+•.n1a,r!.l'n.a.c, t,.,..,,r:..,..,r.,t s 976433 -y BETH PABST fHt~gP:EU-nlmlcbalwccn (fti„j~j;InJD_rv~l••n,enl REGISTER OF DEEDS - •C L.. r.~ttC.,„r 1~'i s~;nrac.o • 1:uq~rerati~l~_..,__. ST- CROIX CO. WI Y,f"(if1et41N. 'tit' Ib.f rare nr more). 04108/2013 4:01 PM .1'Wttzz£tl>:c-~u~~zlCstctita.lrts.`. - i Ida 1'111 - - - - EXEMPT: NA - ---r (;r:lnttr; t+! ha telr a~ rtgrrtl. REC FEE: 30.00 :144. 00 Lir'dnti6', 11,f i% a'a luabh: Cqr(+111cfalllni, T R A NS CtV ryt)'t R• (iri1111Ct I{ll' ~nll fl ht•In~ d•:'q'ril)C~ il'ill r PAGFEEES: 1 cSlerl:_ lut~C lllil t.q~ Illt Ic,11}. Imr(1:Y. 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