HomeMy WebLinkAbout006-1008-95-100 (2)Continence
PRIVATEAll SEWAGE SYSTEM
Comb St.CrOR
yre.c.meoe.a idiumnINSPECTION
REPORT
SalPi xe.
SAN-201 S101
GENERAL INFORMATION
(ATTACH TO PERMIT(
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TOWN OF CYLON
006-1008-95-100
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TANK INFORMATION
I ELEVATION DATA
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PUMP/SIPHON INFORMATION
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MI lnf, tl you pounds )nay Ee used M Mail durymes
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Si. CROIX COIIHlY 6MERNMEMCE\TER
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> Native vegetation surrounding the building
project.
> Top soil piled for use in final grade.
> Over 100 feet to any property lines.
> 22.5 acres
> Not to scale
N
T
N
iRRO, ^ Driveway
> Native vegetation surrounding the building
project.
> Top soil plied for use In final grade.
> Over 100 feet to any property lines.
> 22.5 acres
> Not to scale
N
PRIVATE ONSITE WASTE INSPECTION
RANDY BATES
E9260 9301 AVE, COLFAX, W154930
DATE: 5-1-19
PROPERTY OWNER: MATT STEFFEN
ADDRESS: 2284 CTY RD H DEER PARK WI
X IN MY OPINION, THE POWI'S SYSTEM ON THE DATE. OF MY
INSPECTION WAS IN GOOD WORKING ORDER.
_ IN MY OPINION, THE POWTS SYSTEM ON THE DATE OF MY
INSPECTION WAS NOT IN WORKING ORDER
LAST DATE THE POWTS SYSTEM TANK WAS PUMPED:
COMMENTS:
THERE WILL BE MANHOLE RISER RINGS AND LOCKDOWN COVERS
ADDED AT THE TIME OF EXCAVATION TO BRING THE SYSTEM INTO
CODE COMPLIANCE.
POINTS SYSTEM MAINTENANCE INFORMATION. HAVE TANK PUMPED
EVERY 3 YEARS, CLEAN EFFLUANT FILTER ONCE A YEAR, AND FOR
FURTHER INFORMATION CONTACT YOUR COUNTY TONING OFFICE.
DISCLOSURE: THIS INSPECTION IS NOT A GUARANTEE OF ANY KIND OF
FUTURE PERFORMANCE BUT A PROFESSIONAL OPINION. USAGE OF
POWTS SYSTEM CAN CHANGE WITH DIFFERENT OWNERS. THIS IS NOT
A WARRANTY OF ANY KIND OF THIS POWTS SYSTEM.I DISCLAIM ANY
AND ALL LIABILITY FOR ANY LOSS CAUSED BY RELIANCE OF THIS
CERTIFICATE. PAST PROBLEMS (IF ANY) SHOULD BE DISCLOSED BY
THE SELLER.
RANDY BATES MP#230966-&J � DATE
ST. CROIX COUNTY
SPB CTANKM�CEAGRE - .
ND
�/,,/�� ''11� OR^.ZE1R1SPMMIP CF1LTfFICATfON FORM
Own T7v IOAAM w 5PeYt-eti
ProrTy Address 228'{ G.L.y � X
fv¢Iec®mnmmmm Plmmvg&ZodaBnep¢mmtfsnw eoemo. ov.)
rv�deoo- Pemel ldmtln:atlonNmber AOh^ /COS—$$-/CZJ
LEGAL DESCRIPTION
P,npercylu Oi 156r.,Sec.�' .T 3l NR
Ce ed Survey Map# Volume Peged
Waa ty Deed 9Ya58'/ (befcre2M)Vomme— Paps
sps houseer¢'Pno Lotlmes ltlq[Sable'. r¢ om
SYSTEM MALVT2N-4 CEANTIO{ TR CERTIFICATION
;�oe¢mem>Gm:ro�aofY� e�assrnm wmo-mrobmm ar--�` rim-mnmmeoema r.�¢
evuL ¢emnSS ofP®➢s4 as the seapotsk Ivey chrsyeas¢roous, Enotled, vPeilevse3PmP¢. Wh&Yonpmwm
tloe ry. cw effin ffiad:SSPSfr Veptic) and a wam 12- lvda wme Ws➢osilrvsem. Uwn meiNmma
sspms3lLtix tt specdadm 65PS 363'-]/,l) ®tl iv Chat Id -S trou CowmSmkary
iye PmP 'owner^$e'su.wmCNS Gou Cam±' Plammg& Zoomg Dryv'aea' a we m1�siPetl'or the
mtlb3axsv➢b®h¢,Jo�meymm PI®b¢.+emctei Piumi¢walicevsW=d veN}(Ia (i)Oem-me
ar¢mm�srn�hmgoc¢epe�sanmltim ®mnv maT (a)ena �asnn smg Cdeeceaar7, rbe�Oemeth
I.ss4m Va fr➢of swge.
iMe, rbe md¢aipar n=ve.wtl Le obove rquvemmis entl agrtew mam6m tlepma[eswage tli sp ryarcm u'6b*e
smadaz3s sx forte, bey wse by AD-PSe A dPmJxsio JS i¢s and ID-, Deam Lo`Namzl Anouu;
Srse ofRuwu¢ Ccd5ca]oa r� mmyom sRtc ryrs[^m }as Y.smawvmedmuC be cemPl¢ed and reemeib We St Lro¢
Gmry Plmviu4 £ IDem4 DfiarDnm[ wlfain 30 3eyz i f7e frrxYm eTiAm ice.
N„e mdfy[bm ac atavmmn mA4 �rs me mummebm ormlebge YWeamlme aeo (s)of�e
prop¢ry de.�¢iaad eaove, bym ofDbe&
.imss ofa J.v..d¢deNrccwdedRegste o.Dee3i O8ce.
N=�b�s Of/b/«tube» 3
SIGNA1'URE OF APPLICANT(DATE
"'AVY mrvwuon lbv is mi.: -medmar reso5: m bt saubar p➢ bemgYvIk by the Pmmtin4@Zo®gllepa%"hTeot r..
[ml'wao Nv eppul m I u di wmm'Y deN from me Reg orDeas 03ce mtl a cosy oftbe c Sd sw-vry caps
rer¢enre cmade meew yd==
( V. 04Y)
dll
Wwn�AY 1 2019 Irc 8I
S[. Croix County e0eU9 S
ffiz
Affidavit for a single POWTS — eur
se icing Two Structures via Private Interceptor Main Brea or Deco
II N# ag-& ST.[NOIX Co., we
a
Name —(Owner) Typed or printed RECEIVED
w/so/2019 cad vN
being duly sworn, states, under oelA, that: EXEnm x
III is me owner/wawner of the following persel of had lmaed'mST Croix CO" FEE 2.00
c lywiwonsm.ONcRmvolume — .Page — uoenmem Number PAGES
y9eP;
SN1 Sr Cruix Cwmy Rw*vcufoeeas OlAtt.
'I 7%, Aaarh,
TownImacel
of
lard latend in due SE Y. Of the $�'/. o($ediony"wOcmV1W, �8Q —' i
ruwo or Cy�y � SLCwix Cmmty, Wachner IN ng duly aexnbWssKrJr ry%
far Qnideaf Iutmm�c'adsabel,sum JCSm ordeuned legal aacripronA
TGa. e.jv' /dot R-. a G fG.- E.d1' /0/6 a-.
6a"Od; j E.e- z poss. 'w°lom-e./,o08- 9s—/ro
mavm)
ynmrte..f the show desulbed perfect I acknowledgea9 that a create Orrsice Wmam, Trentmem System (POWTS) serane me
y reel,.. iarsstl for beduorms)who ,d,,ip wbrewmer Row of_ galmns/eay(DWr is NOW M lsa Rd rommom Az
powna pnhetlrwm) Ammimum0f mcapntsampamiaed,lfthenumbv or...Name exceeds the nummum for FDA TS
deae r me system win be unaysixa to accommodate meamed waarewmer flaws anNar ernuminam loam, and mey be earn« to
prom rtfaarc anary atru re 2'1LTwhe assauaz^awelung bats Men netted to me POWrS... Pmele marombor
ainewer@IMS) n ompbmmwllh SPSSgz30nzt I cadenced! that customs, oonbla btfomrnba Mll be made to my path,
mrcend m p rummgthupmpNy in the mmm.
DIRdthis30_aayor 269tq
atV �
AUTKENFIC'ATION
-------(Year)
mr)
TITLE: MEMBER STATE BMI W ISCONSIN
(Ifrat,
AUNorissa by it 90606. Wis. states.)
THIS INSTRUMENT WAS DRAFTED BY
s+. 6G G. �b Ze ,:,7 51a9 -
(SiMYma may be aaNemicaed or acknowledged. Both ate
amsummary _I
ACKNOWLEDGMENT
SIAltiOrW 9CONSIN )
SL cede cmmw ) ) �
Pe ally aameb Nrc me Nisyaay of
Ne ana.e mined
b� s
me known to he the
ew
persoms)who ex area me Nrropmg msmmm aand
mwwwleage Nene.
ac Llb Ccann 1M0912 Togo I of
Parcel #: 006-1008-95-100
oanorzm p 0330 PM
E t OF
Alt. Painful # 0431.1664C
0W-TOWN OF CYLON
CwreM %
ST. CROIX COUNTY. WISCONSIN
Opinion Da4 Historical Date Map% Silent Aree
Appllcari Percent
PNmMTyme Maf Units
00 0
Tax Address
Ownerlsl: 0=6mrenl Owner, C - Carol COOunar
MATTHEW STEFFEN
0- STEFFEN, MATTHEW
2284 CTY RD H
DEER PARK WI SW W
Property Atltlmalael:
- Primary
' 2284 CTY RD H
Districts: SO = School SP - Special
Type Gime Deaciption
SC 0119 SCH GIST OF AMERY
So 8020 UPPER WILLOW REHAB DIST
Notes:
SP 1700 RITE
Legal Descriptor:
430
Pascal HIsRo%co
Da
am
Voldaege
MIT
cs
1190
Plat: Tract: .•W1mioN
-NIA-NOT AVAILABLE 04-31N 16W
type
BWD
SD
WE
WE
2019 SUMMARY sill#:
Far Marroat value:
Assessed WNN:
0
Valuations:
East changed: E513112015
Description
Class
Acres
Land
Improve
Tonal Stott Reason
RESIDENTIAL
G1
641*
45 cW
50,800
958M NO
UNDEVELOPED
G5
18000
11200
0
11200 NO
Trials for 2019:
General propeM
224W
56,203
50.800
107 OW
Woodland
0W3
0
0
Topic far 2010
General Prc eW
22 KW
562W
50,800
1070.1T
Woo land
0000
0
0
LoMry Credit claim count I Cetlmca6an Date: o9N5Y10a5 aah M13
Specials:
Lear Special code Category Amount
Special Assessments Special C6a ge Delinquent chirp
Tore coo O.Eo O.00
Mj
»x, mDu E`Tiaxo.. " o .x opx.GIN .,. xam uE�.E.�..,
70
IN
. at�..x
....,..
I J
NOTIF I MIT FOP 'All
IF F
LF
MaN
6
i.00M• l tP
9T 91
s oxo
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of Enennoo:
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IN IN,.MrN IF
IMMUMp
IQY777 •.1
OWNERA�� agggrrTONISHIP 0gzN) m4Tp-a/[u
. DRBSB Pik 4z/J. � ST. CSOIg COUNTY. WISCONSIN,
/J,,n ,41&� LJr rob-/wP- ico
SUBDIVISION LOT LET SIZE
PLAN VIEW
gENCKK1Ng: (Permanent reference paanq crlhe: B`!A^ •� ¢wL�
El ..t ion of vertical mfec/Cn v n.t: /O� ,�ntt°slope at site
SEPTIC SANE'. Xanufecovice[_a �uygWM1goitl Co Vac i[
Nmhvr f rfngv on cover LP NN hole co eeVv
Tank Inlet Elevation m4 Out bo ES ea[
POIO' CHANGEManufacturer
///�l.v//� J� Numler of gallonsto
--
Mvnufecoucec /--toAlTZ CCC44g 111 [[[
Nuadec f Hotpump ewe[ n. cycle Ilom:
iientfon line. it on. Nice ump head:
gel lon per miwuJ]'Yq{�_, hoiYON....
pwa _.nave, of pump
Type nofewarning [4...... i,�N✓ J'.U' fcru fi%/r
BOLDING TASK. Hamlett ... r a Duet" of gallons_
Eleevation of o,,VoI, Duet
BBBPAC6 if PITvBIZC�g device i pin Net mete
r feet liquid tl pi ...page pit in �CPe-eleve[Son
bottom of seepaAe�n feet.
/ �SeePAGR BED SIZE: number of lines �d 4ugtN_f%lE tle depth'
SEEPAGE TRENCH dt length �saH
PERCONATION 0.gT8
INSPECTOR
-DATED PLUMBER 0 1 TT.II
LICENSE NUMEER