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HomeMy WebLinkAbout040-1308-00-147 ',^,13etlnkm De:ahlvenl W Comma•cc PRIVATE SEWAGE SYSTEM Ca°nty St. Croix S:drt: and D.: ding Drewan INSPECTION REPORT Sanitary Perm I No. GENERAL INFORMATION (ATTACH TO PERMIT} State Plan IC No 600332 =ersona -format Jn yeu om': oo n'my t:e used v sncondaty p. fpeses IP•Yacy Law, s. 15.04 r'j(mjl 'Vflogc 'aenshiD Pa'ce'Iax NO'. William & Arletta Johnson TOWN OF TROY 040-1308-00-147 „T 3'A Ele: I-so. U`A Llev BNA D,oo;"Pllc^. Sect.on.Tvw,JRar:gewap No viz 24.28.20.1966 TANK INFORMATION ELEVATION DATA TYPE ).1A\UFA~;-URER CAPACITY STATION BS HI FS ELEV. Septic Berchmarx -l 1- 1 r Dosing Alt el. 75 ~~Ob !I o Aeratiwl Bldg. Sevocir I Io'nrng - - St-'Ht Inlet -1 5, TANK SETBACK INFORMATION SUHtOutlet LINK TO P:L,, *1,L:. 41 1.1(11 'vent :u Ai: I-Iakr. R AID Dt Inlet Septic I DI Pn8orlt Dosing IfeadcuWan. - 107`( 3 Aeral,on List Pjpc 110 ding Pot System I r.t 10 rjd" ""'b -inal Grade PUMP/SIPHON INFORMATION 1 Manufacturer Demand SI Cover \ crM ~ kc/ Model Numbe - - IDII Ldl LI n• Lc>s - System Head TDH H Forcemaln engtth _ Din:---____ Clst u'. SOIL ABSORPTION SYSTEM BEDfTRENCH 4id1h "'0th Nc Of Trc-c^es PIT DIMENSIONS Ne. Of Pus Inslee Dia. Liqula Dnpth DIMENSIONS 3' r y~'\ - - - SETBACK SYS IFNI TO P:L BLDG WELL ,AKEiS- EAN4 LEACHING Marafaclu,ct ti t+a "-t`>1) INFORMATION CHAMBER OR Type i 4 Syslen a i j UNIT IA"ol It, _ C?n P . U j' I DISTRIBUTION SYSTEM Headev mwdcl0 u6'buL0^ 11 -cle ::x s-1clc acing '':'epl Ic A• Make 11 Plpe.5: AJ :ea9 h_ n:, _ 1 ,n9'h play Spacing :y Ai a SOIL COVER It Pressure Systems Only xx Mound Or At-Grado Systems Only Deolh :''on U. +pe : "FTth cf *.x _.Indrtxyded _ - 1.1u c`cd 3etl'1'ench Center I,ac! Irruh n,::r: .c Yes no Yes Io COMMENTS: (include code dlscrepencles, persons present etc; Inspection #1. Inspection #2 Location: 302 LINDSAY RO 1 1 Alt BM Description = Y l.k? y (1^1t~ 4 J~ . a 2) Bldg Sevier length = - L( amount of cover = v Plan revision Rcquire0 Yes 7 No ~ Use other $loe for additional Information.- - '/~j OMe In se gnantrc Coe No SM6710:R 3:97) I, ?~Industry Set dices Division } 1 11 s Q $ 1400 E Washington Ave S nn u\ I cnnu \uullxl Uo he lilted in by Co 2P F O Box 7161 S F I- ' 5'1 $ C Madison, WI 51707- 61 SanitAry Permit' Appl1C3t1( 01S. ac Iran,acnon Nnmher Ina ram-c with SPS 4Y^. ii I R ,I Iln,sl n Of 1111, 16wit, • Q~ vemm n al will lx n pnn. l prior l In Imo • n n u i. r,lw V 1 Al pll. ltl n l 1,m- li- w/-3V M I \ are'llN llhd In u:e IApnrbnent of S.nll, a'd I r . uual ]cn u„ I "'.11 d mh nlah,:n A I -a 1113, he u.e i lot c"onJ:w~ 11~9w[:1JJrc>+i J'dnicrcnt than mailmL, addre%s) puL , m a'co: l m edh Qt l n,:c, i a+,, ~ I. 1,.t, l p;nn Stan. _ _ _L Application lnform_mion (lease Print All Information Pro n, Owner's \ am: C/) Nice! 1 ' Prole n, omier', l,lmbn, Wdn>. _ 11, p..'ly l ecal Xm /.`f. o~g • eZG. 19LY i Ci» Name+• ZipCodc Phone Number -Sill "~.10,. Sc2tion % ~ ibr<Iu"a i N R I'rtflt% B., Type of Building (check all that apply) Lot a _ I or " 1 anal, Dwchl c•.- Nu h • ul Dedronms _ f SubJnisral N'gne ❑Iuhll:iccnlm,r. id w,c,the( c_ BlockP ~~.~(_~~•~G/= _ ~o0 -V- If O/lnot ❑ Sruc I?wne:i - I7 s( _ _ ' ❑ Village ill Shl \:atthcr 2 p;~- (,e,115 w Z2.kZZ el~,..~det3 ® iU,,,l„t IILType of Permit: [Check male on bus on line A. Complete line it if applicable) ( m \c,, \\,I.'m ❑ Replzcclneol S,11em U : rc:nlnem.' Ilnlanr~. !auk e:?Iacelnad only ❑ Other Modification 101 mshny, System ie\plami It. ❑ :'ul alit Runcaa! P nni: Rus,,ion n Ch.u15c of ❑ I c:mil l wil,ki to Nca Leal P1cs i, Pant \umber:nd Di Is+ued Ik ,1,c lispu tti na I lund'I 1 tauel ll ! y~ IV. Type of POW I S System (wilt .onunt Dcdice: Wheck all that apply) J~/ Non Ptcs:uniui In t n.'u"'J ❑ ter.-Wld ❑ :\t-(addc ❑ Mound - S in .:it .unah1cc.:,I U Vonnd 24111.of,11ilabl,:oil J,! Ila mil tot nle:I 11 r.J(:':Igl a .ueyll:nul ❑1lroeuun nt Dul:eie\plnun CIA& Dispesd.-Trealme krea Information: _ Ual u I f icpJl l k 1 n \ 11 ,pl:li, uc:: Ili>pelsal Area Rcymred I,sl) Ulsl a al/Area Pi's t) Sys I'm I lo ..'al / (tat I J ~ ) ~ ~/c_~'• ~ -7/ _ ~ VI. Tank Info all'wr, in I lal lit V- Turks P.ainh le lent. Gall u, Unil f y - r a Sepliu it llulJing L:°., Jr ;'1-~'.- _ f'~.'• I_A- ❑ El 1:1 El 0X1,1ne, Chamher ❑ I 1 ❑ ❑ ❑ VII Hespa siblhts Statement L the undo. t ncd. arum, rr.ponslhitif for installation of the PON fS %l o»n on [he almched pl ans. Plans by. mile myl~ I hasher S~I6aurr MP A11 RS Numha H I ne Numher Plumh,r \eJ1u, Su ,1 ('n•:. SI.le /.p(l,Jul • c VI11 -ounl)i Depnr lmcm 1 a Only \.pr.:.eed r .wL,~~ ~ 1, in III C list :I sueQ,I I will.. Al Itii.•nulu¢ I\. Ccaldipylfc,T=~ W. 1Reaa oa Di.approval n 1,s{ ///111 ~ ~J~ ✓ ~ 1. •.B~pLi:lark, Eli Il~a• gM + ad~ oMpa : cell -+w.t an b1I Lt\iIML[[l%1nW2i so per jw 3Vmsw plan pm 40ed by Oumbe:. 2 Nnelblrpkrect.fear.^erttsltuMtwr.IlarAtrad so pw !pp'yplW+ MO.! I .T161LIIM7. NUrA la ennlplclc plan. Il,r Ihr ydrm mil .nlnnit is, 11u• lllllnty will) on paps sill tail )ban h v: , I I hlcAC. in .ire 51SD-6.19811 0; I4) 1 Or q-L~ i l CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Zkl. = Owners Name: Owners Address: f - - Legal Description: township: ' ` - County: - l Subdivision Name: Lot Number: " I Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 _ System Sizing & Cross-Section Page q Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page g _ CSM or Plat Attachments: Soil Test & House Plans License Number. Designer/Plumber: Phone Number Date: 5-- / - t Signature i Designed pursuant to 0w in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBn-10705-P (N.01101) Page . it I. J,f+JfJn~ i31'lfx of ~IH7 ? i W 1 I. - r - 4i1 a on Swatem Cross ~t ~ YI~cC~rade ' 4 sd~dul2ao i j ptlG Ve 4:0 I R4~ vani cap g, / E )¢ching Chamber r- s `eroaban S~,F f~Ei WOMMon vsfecrz ?an Irraw it >ifl ICI 'i )~~iutg Tech 9 21. ft Vent OrObsr,rauun Pipe I" Chambers T/I 114 _Z7 "e2der Trench 2 f--'- y?r fxiirr3 Ghamtrer Eft I Manufacturer And Nipde! 7 E)SA Rating _LL- so fr per chamber Sol) Application Rate _L~ g/pd,.s4 it _ sail Application Rate-- - c)SA= i _Ctatnbers L gpd Design Flou ?rowsof-:22- chambers each- - -_-j Page of PL-525 EFFLUENT FILTER ( Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD Alarm ~l < Accepts PVC tgalions per day) making it one of accessibility extension handle the largest commercial filters in its class. It has 525 linear feet of 1;16" gr4i , filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is filtratioof 1116" n slots Rated for over removed for cleaning, the ball will 4 10,0WGPD float up and temporarily shut off ,E the system so the effluent won't L= leave the tank. No other filter on =z the market can make that claim! Accepts 4" & C SCHD.40 Pipe PL-52'F_5 Cam-, • The PL-525 Effluent Filter should. Operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or (71trr at least every three years. If thenstalled filter contains an optional r, alarm, the owner will be notified by an alarm when the filter needs deflector servicing. Servicing should be 1<r Gas by a certified septic tankI { automatic shutoff pumper or installer. _ t ball when finer f is removed 1. Locate the outlet of the us. f oenr Noe sots,aaa septic tank s,ansao *MAO 2. Remove tank cover and pump - tank if necessary. Dt = J 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4 or 6" outlet pipe. If the tank. Ivlaka sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 5. Inscrt th - ~'r rtge bad: Extend & Lok or piece of pipe intothe sure to center filter. the fiite, ;s p. o! and 4. Insc~" D1-525 filter into completely inserted. its housing. , .elf r Papl? - 1.., --r C: POWTS OWNER'S MANUAL & MANAGEMENT PLAN =are ldf_ FILE INFORMA ON SYSTEM SPECIFICATIONS 'her , N - i Tank ❑ NA Pcrinit ii Vi Septic ! 1 Dose f I I IolCing Velum e: 1 ark Manufacturer -V) NA DESIGN PARAMETERS Number of Bedrooris: I I NA i 1 Septio I I Dose ❑ Holding Volume: (gap Number of Public Facility Ilni's Yj NA Veri.cal Distance. Tank Bottom(s) to Seance Pad: (fti Esfrrated average) I lo•w : i_!C, (gm day; Horizontal Distance Tank(s) to Service Pad: pev.lic srv ciny mechanlu dust bo pre ridod if vertical is >15 fe or Design (peak) F'o%v _ (estimated x 1.5): Z~,_.` (aa Lint) if h n rzdal - >150 fr-.f. Specific u,;hat:om; to Lo provided on h.u:k._- L) Stu Sea Aop1cation Ratc: (gal'dayat') Effluent ..=filter "Aar ufaclurer. Ll NA Standard (Dorlestic) In(laem.-'E fluent A-0onth y average Effoerlt Filler Prlodel: Pros Oil & Grezse (roG) '.3i) r!0 _ Pump Minutacturer: R.Onteallcal Oxygcn Oemand !L'OD..) 220 nyil- L I NA NA Total Susp.mt l Solids ( ISS) .--.15C rryl- Pump Model: I ligh Strer.gU111 uenuEff hunt Month.'y average Pretreatrnert Unit (F^Qi >3J rog+L D,1arufaciurev (uol)ed >220 Writ- bd NA ❑ Merhanitial ion Aeration ❑ Peat Filter ❑Uisir.fedicn ❑vVCt:and Prr:l,eatcd Effluent P.40TI11y average ❑ SandiGravel Filler El Other. (130D,) ::30 MNl_ Soil Absorptien System (TSS) <_30 rr.g;l_ NA Fecal Conform (aeomekic mean) s10' In Grcund (gravity) I I In Grcund (Pressure; 1 NA _ - A:-6raae ❑ Mouad McArt'.um EICue'A Panicle Sze A, (i1 dia ] NA i-', nr p-: five ❑ nta=-- Othei. 171 NA ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump ou- contents ortank(s, ,Jhen ccathined sludce a"iJ scot equals one th r d i cf :wik volume n Then t°e Ligh ,haler ala m , a :,J + eti Ir spe c: conditier o" tanks At - L) r~orth(s) ) least oncr. ever) _ (Maximum 3 years) LJ NA Inspect dispersal cell(s) Al least on,:e every: ❑'n"'ih;s) P1 yoar(s) (Maximum 3 years) El NA C'ean effluent filter At least once every. - - ~ j r'lonthis) ❑ NA _ _ ~I Yeor(e) _ Inspect pump, p.:mp controls 8 alarm At least orce every: H rrcn:h;s) -L N ❑ yoaf(si ' Flush laterals and pressure te.=.t Al (east once every nlardl rsi M NA other- (I or. rtht,7 A t least once ovcy: LJ - - - ?a -a NA r: s; 011or: ❑ Nip MAINTENANCE INSTRUCTIONS Inspections at 1^.ks and S.I ib,crptiur. -y,aerns r-h.II h^. mad. by 2n irdvv dual ca`ry •ic; cr:e o` the fclb:vi°,) licerse< J ^^'tdi.^ahr.n rulastel P:~r,iber, Plaster Ifi:mbcr Restricted SL=et' POWIS I-spec:'nr PO':VfB Ma'ntniner nr Septage Scrv.ing Oxra:cr (pr_mper). -rark inspectians !null riclude a visual mspontion of the lark(si to identify any missing o.. broken hardware, identify any cracks or leaks, measure the volairn of combined sludge and scurn and a check for any back up or ponding of effluent on the ground surface. The soil absorption sys'em shad be visualy inspected to check ttlo effluent levels m the obser:ason pipes 2nd to check for ar.y pondicg of effluent or the ground surface. the porring of effluent on the ground surfax may incicate a failing condition and requires the immediate notification of the local regulatory outhorih/. When life c:omt;:red accumulation of s'odge and scrum in any troatmcnt tank equals ore-third ('3) or more of the tank volume, the entire canrents cf Pie tank shall he remove:l by a Seplage Servicing Oprimior (pumper) arrl disposer) o' in accordance: with chapter NR 113, 1i,isconsin Administrative Code. All other servic r s, including but not fmaed to the, servcing of effi .cnt filers. meU dllica' or preMinzed cornporents, pretreatment tints, and any servicing at intervals of <'.12 months, shal' be parfoinied by a certified 1'0* I S Maintainer. A service report shall be provided to the Ic:^,nl regulatory aulhority within 30 Lays of cemplet:on of any service event. GfdlA' 005 (02;05) Pare of. START UP AND OPERATION For nee; constru:;tion, I:rlor to e ct ch:• f'^'o"JTS c`eck ire,:cient tank(rj fc the prr_.,::n.-e Of psi^fnry products, solvents or other chemicals or sediment that may impede the t,eatment F-omss andtor damage th.e soil abscrptior :system. If :•:igh concentra6cns are detected have the centers of If:e lack(s) removed by a Septage Servicing Operator (pun,per) prior to use Pull tarks may fill above nonral higntaater le:ols prior to starlcp or clue to pump failures. Start up or reslora:ion of poser ucder tneso conditions is not re:nnvnecded. as the excess waste•::ater wi be discharged to the soil absorption system in One large dose taus rg an overload that may ieUft in lho bac3:!p or surface discharge of effluent and damngn to the system. To avoid the situation have the contents of the p:rmp tank rernevec sg a ScptaC.r. Searciny Ol (pumper) p•ior lu restoring pu•Ner to the pump or contact a Plumber Or PO'VJTS f laintainer to assist in ma-pally epcnlfiny the pucrp contrOls until normal effluent levels are restored within file pump tank. System stall up sisal: not occur when soil cordtons are tr07en at the irAllrative surface. Do not drive or nark vehices over tanks or the sell absorpton system. Do not drive ur park over, or othenNrse disturb or compact, the area :within 15 fc-: dawn slope of ary mound or all grade soil absorption area Red,icticn cr el,r16alicii cf the fol.o,vrg frow the v:astevater strewn may improve the pcrfc Tr ircc and prolong the life of ;he treatment tans and so,l absolptiun system: acids, antiaiotics, baby wipes. cCarO'te butts, cnndorr s cot'or sv:al degreasers, dental foss, ciapcrs disin`ec:ants, falls, foundation drain (sump pump) discharge, fruit and vecetah'o pr..ilings gasoline, greases, herb cities, meal scraps, nolicatiocs. oi's pairting products, pesticides, sanitomy napkins, solvents t mpons and crater softener brine cischarge. ABANDONMENT vNt:en the POvvrB fai s and:or is pernannntty taken cat of semca the follnvvirg steps shall be taken to insure :hat the system is properly and safely :^handoneJ in temp iarl .vith s. Comm 83.33,11-Jisoonsin Adminishative Ccdo: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • 1 he contents of all tacks and pits shall be removed and properly disposed of by a Septage Servi crig Operator (pupil After pumping: all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, g,avnl or another i:*rt scud material. CONTINGENCY PLAN It ti--e. I10'%,VFS fails and cannot be repa'red the folcmirg measures l:ave been, ci :mist be taken, to provide a code compliant replacement system: A suitaLa replacement area has been eva:uatOd and may, be utlli/ed for the lewliun of a rep'arercent soil absorption system. Tie reoaoplrent area should be protected from distcrbn•rce acd compaction arJ should not be in0:n,yed upon by reeuired setbacks `nom existing and proposed sb'uctu-e, lot lines and wells. Fa lure to prclect the replacement area will resin in the need for a ncaw soil and site evaluation to establish a sultable replacemnnt area. Replacement systems must crimpy with the rules in ctfcct at the time of their ocrmit issuance 0 A suitab:e replacement area :s act avafable due to se'hack and:pr sot limitalioes. If the soil absorption system cannot be rehabilitated and bating advacces in PO'VV 18 technology, a. hold.-.q tank may be installed as a las' resort ❑ I he sae has not been evaluated 'u icenty a sui ahlc rr.•placoment area- Upoc failure of Coe PO'a'U S a soil and site evaluation must be perfo"M to locale a s0table replaocment area. If no replacement area is available a holdirg tank may be installed as a last rnsort to replace the fat led POV41 S. I l k1cund and at-;gad~' sO'I ahsorptien systems may ha mr.ors'ructed in place follovrg removal of the biornat at tFe infiaraGvo s.:i ace. Recorstr,:cf rims of such systems must ecmplp wth the rules in effect at :rat time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK f • 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: POWYS IN TAL _ POWTS MAINTAINER Fhore Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Pnon Phone 7hi5 don vi,we :,r deaf co Ill the . `as d a b.[cr Lakes Marquette and 'vVsans:lard Couuly l I S rc3u almy a;ln..ius i:i cumpl.an.' v:iY Se¢iors Comm 6322i/,,;l I„dj&;q .r a 0a.54(11. ,2i R I~!• :ia:.cnsin;,dminrst'ali:c Coile START UP AND OPERATION -rr ncm, mnsnsticn, pnor to use ff the for tn~ of I i mica prodncts, so!verts cr ather cnor is or sediment that may impede Ind treatment p-occss a-d+or damage the sail absurpiion system. If high concentatons are detect; have the contents of the tan:<(s) removed by a Seol Servicing Operator (pumper; :)no- to use. Pomp tanks may f.Il above norma highwator ievels pric• io s:arup or due to Dump failures. Start up or restoration of powe, antler these onditions s rot recommended, as the excess wastewater will no discharged to ti!e soil abscrpton system it one large dose olll an a've"IDad that may result in tnt. beckno or su'ac . discba-gc d effluent and damage to the system- To avoid this situation, have the !:onterds of tie purnp tank removed by a Sep:aq:: Serviciey ODe;alo ;pumper; prior to restoring paver to 'he. Dump or contact a Plumber or PON.?S PJaintainer to assist in manually cperaiin3lh.e pu:no co-troll unti normal otflcent ievels are restored with:r t^e pump tank. System sta t up shall not occur•arher soi: oocdlucns are frozen at fh:: ir5grtive surtace. Dc r0: drive o- Dark vehicles OVer tanks or tree soil absorption system Do not da re o: Dark Over, or otnel diSfun) Or 003)DaCt. 'P1e area V.?thllt ^E feet down slope Of a.-,V mound 0' -q:-tirade soil aosor"itlcn area. Redudicn or e:imina6on of the fl f-on the v,<sicnater st-gam nay improve the performance and prc'onc the life of the treatment ;arks and soi- absorption system: acids, antibictins, baby swipes, agarete butts, condoms, cotan swabs. degreases, dental floss, cnF,pers disinfectants, fats, foundaticr drair (camp pumpi d.scha^3c, fn:i: and vegetable peelings, gasol!ne, creases..nerbicides. mea: sermps, modications, oils panting products. pe;aeides, sanitr:y nDDSms, l tampons, anal wat , softener brine discharge. ABANDONMENT VJ: a:r t-~e to is and+or is pe-manertly taken act` r service the fol:owing steos wall be taken to insure that the system is prol and ;af . y abandoned in comp:iance wth s. Comm 83.:3, Vdlseonsin Administrative Cool • Al. pip:ny to tanks, pits and other soil absorption systems shall be d soornected and the abandoned pipe openings sealed. • -i he contents of all tanks arc pi-.s shall be removed and prooe::y disposed o° by a Septage Servicing Opeata (pumper), • After pumping, all tanks and pits shall be ex cao'ated anc removed Or their oovers removed and the void space filled w'itt soil, - gravel or anal inert solid namnal CONTINGENCY PLAN If the POVl fails and c:annct be repaired tf;e JbIlO^;;nc measures have beer, Or must be taker. to Drovide a code compliant -eplacaonont system jsl A su`tah,c rcplancmert ill has bong evaf,;ated and rray be utiCzed io the Ic:;aticn of a reDlaceirl soil absorption system. the renlacemen: area should be protected f-om octu-bance a:id compaction anc should not be infringed upon by required setbacks from existin3 and proposed stni-me, ot lines and •wel!s. Fai.lie to pro:ec: the replacement area will resctt in' me need for a neve soil and site evaluation to estaallsrf a suitable replacement area. Replaccrril systems roast comp.y with the rules in effect at the vale of their permit issuance. ❑ A suitable replacement area is not available due to sel and+o- soi' llmitebore. If the soil absorption system cannot be rehabili:attic and ba:nny advances in PO•,PoTS technology, a noel ig tank may be mmal,ec as a las: resdr_ The site has not been evaluated to ident.`y a suitable replacement area. Upon failure of the F)CAl rS a soil and site eveLiaticr must be perforrnec to Io:ate a s.:ilacle replacement area. If no replinnniont area 1s avai.able a fnldi:,g tank may be ristal ed as a :ast reso-t to replace the failed Po':^dTS :-j D4oune and a' grade soil aasj:Dticn sy&tems Way be recxsUUCted in place fn1irrv4ng removal of the biomat a: the mfiltratwe t;xface- Re;;,Jfstlu:.licvs of such s;dens crust comply sdt° the r.:Irs in e°tc^t nt -at tune. WARNING TREATMENT TANKS, PUMP TANKS. AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK ' 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. v' ADDITIONAL INSTRUCTIONS: POWTS IN T LE POWTS MAINTAINER Namc P`hT SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Phone 7l-?S ae::1ll1:fl WAS (:anal uy It ataf(s at *ac GW-11 _a UL'c.utlc ax L'da ~sha'a Cor,rh P 1=;u. ~.h . a.un:. u~ .:criplia ice fu 3.totem ST. CROIX COUNTY' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM n t r / Owner/Buyer 4L Mailing i) - / - Address ~ Property Address / 0 1 :v ctScc s~ u---:= - (Verification required from PI g & Zoning Department for new construction.) Parcel Identification Number City/State l.. ~ . LEGAL DESCRIPTION Property Location it+ Sec. T R~~- W, Town of , # ~L• ~1~ Lot Subdivision Plat: . , / i; Certified Survey Map # Volume Page # Warranty Deed # _ (before 2007)Volume Page # Spec house o yes no Lot lines identifiable )0 yes O no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. t you put into maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. 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 §SPS. 383.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 Safety And Professional Services 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. Uwe certify that all statements on this fo are true to the best of my/our knowledge. I/we amlare the owner(s) of the property described above, by virtue of y w deed recorded in Register of Deeds Office. Number of bedrooms SIGNAR" OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. '=s 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. (T1RV 011111) I ~ I I I a'. 1451 -1 I \ p ~ I \ \ I TROY ILLA 24 -I--- 144 / ~y \ J7% IRCY VILLAGE fA1-5E NE-SE NN-S \ / I ti ~\ye J THIRD ADDITION 14 \ ✓ / I / \ t.OG4 ACCRES\ ~°M wQigN I`'~~~ s+Hs \ F ISYI-° 8 N \43,725 S F. J 00, \ PLA MJI EW DRIVE 143 ` ,,N 1 _ \J Po• iy SCALE: 1" - 20( - - 147 / 8 1 1000 ACRE A \ 3.560 S.F. 142 1 Ali `1F - - V~7Z N NOTES: 1, ALL LINEAR MEASUREV 148\ W.CE TO THE NEAREST SHOWN. ~t 1.000 ACRE I\ 2. THE PARCELS SNWN C 141 Hs\43,560 S.F. AND I:AMC~HIP LAWS, A11NI4" LOT SIZE, A OR CEVE.CPINC ANY P OOH"~`\ / ZONING OFFICE kV T \ \ / y / 149% \ e~ 3. BUILDING SETBACKS ` \ / Z n •UINIIAA,I OF 75' FRC 7 1.OCACRE \ VVV -MI N IKIM Of 25' FRC / /~O/ v34 5 6O S.F. „ IF THE DISTANCE TO LOT A MI C - A. 25' ERG / \ \ A1INILW of 2s• Rc 1 50 w \ / o Z WITH OR RES IDEN 4. NO o I OR CHANGE THE I G I WATER A-40 1.000 ACRE v > V ♦ 1ES B IS NO 43,560 S.F. V/'moo I ALLTETERRING, FILLING. EASEAR WATER R N CULVERTS. , BEId.6, OR C:O /\JJC O' \ I ~N 5. ALL IRON PIPE (FOUN 6. LOTS 166-168 91ALL ^-,,~g ~ T .l S.^.'I. -'VALUAPON REPORT. Page - - a 5 NISCLn9n ,.eaattn`.nN o: Commem. Jtds'An of salary -no oullc rys n ,t ~artlarx'u w~ln Comm 25. '.Y e. Nan. '::Joe I AdaCh comD'.aln site Dun on oaW nd in,, in an e. '12 a 'I inches Plan? ust q I~ -Z f moluca. 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Parcel 24.28 040 `Ob`d~ 0 I Ir,)'; Current X ST CRC:X COUNIY, VJSCJNS1% Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 02:10;2004 00 0 Tax Address: - Owner(s): O - TRIBELLA PROPERTIES LLC TRIBELLA PROPERTIES LLC PO BOX 210 HUDSON WI 54018 - - Property Address(es): ' - Fri i iro - ' 302 LINDSAY RD Districts: SC = School SP = Special Type Dist # Description SC 4893 SCII DISI RIVER FALLS SP 0100 CHIP VALLEY VOTECH Notes: Legal Description: Acres: LOOM) SEC 19 T24N R19W PT SW NW , BEING I ROY - - VII I AGE 6TH (04) LOT 147 (1.000AC) Parcel History: Date Doc # Vol/Page Type 08;3012013 985155 108;3012013 985154 02;1012004 753934 09:100 AT Plat: of wa --Tract: ;s-T-R 4C'. n;av.i Block/Condo Bldg-. ' 09-100- I ROY VILLAGE 6TH AOON 146,1168 19-28N-19':V SVv N"N' LOT '.47 2013 SUMMARY Bill Fair Market Value: Assessed with: 236804 65,8(;C Valuations: Last Changed: 11;09;009 Description Class Acres Land Improve Total State Reason RESIDI`NIIAI 01 1.000 75,000 0 75NO Totals for 2013: General Property 1 000 . 5,000 0 lS,000 Woodland 0.000 0 C Totals for 2012: General Property 1.000 75.000 0 75.000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Balch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 O.CC t: r: