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Home My WebLink About026-1306-00-021isin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix A Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) I 617816 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.1594 (1 )(m)]. fr11— Permit Holder's Name: City Village Township Parcel Tax No: Shaun Bird TOWN OF RICHMOND 026-1306-00-021 CST BM Elev Insp. BM Elev: BM Description f_. „ Sec ion own/Range/Map No> 18.30.18.1628 TANK INFORMATION ELEVATION DATA WE ■ ` r H�1 TANK SETBACK INFORMATION C I 11) S �- rI11 PUMP/SIPHON INFORMATION SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengtq ^ I No. Of Trenches DIMENSIONS lU//t �l/J L i DISTRIBUTION SYSTEM STATIONe _�1 ✓I�N' BS HI FS ELEV. Benc aark I �f Alt. BM Bldg. Sewer r I I0or 0 SVHt Inlet Ht Outlet � � Of Inlet Dt Bottom Header/Man. V// ' Dist. Pipe Bot. System / 7 TL Final Grade ^ r I 'D O St Cover CHAMBER OR UNIT Header/Manifold Distribution x Hole Size z Hole Spacing Vent to Air Intake —7 Piped - Length Dia Lengthy ---Spacing -- - _ OVIL %,V V CM x Pressure Svsfems only — U--el n, A._r—A- e.,..— n.,i,. Depth Over Bed/Trench Center 1� I Depth Over )1 8edlTrench Etlges I� rI xx Depth of Topsoil xx Seeded/Sodded xx Mutche0 Na COMMENTS: (Include code discrepencies, persons present, etc.) Location: 1529 95TH ST 1.) Alt BM Description = 1 t li`� low- 2.) Bldg sewer length = LYN - amount of cove�rr=ll JV�p� 1�4 V'1 toV-L Plan revision Required? [-7 Yes No Use other side for additional informati n. I SBD-6719 (R 3197) Date Inspection #1: Inspection #2: V.Ot'� �- �- 4160N. Ins ctors Signature ro.0 SafetySafetyand Buildings Divisionn(&2 201 W. WasNngtr;n Ave., P.O. Box 1620MadisonWI 53707-7162. �ryPami[N®bo(mbefl0edmbyCoJ1 2020 , kA. jr ink �,t. (_ro�x C Permit Appl. StaeTraimeloonNtmba Commn v in yi Code, mbmicdet of thism foro the ap imrt !1 �T is inquired pia to Sbammi a rofmi pemp. ies Appacadon forms for state-owned POWTS art submitad bj• the Deparimem of Safety and Professional Saoies_ Personal udormatloo you provide may be used for secondary Pmjecr Address Cd diBcrcm than marling address) pulpases in accordance with the Law, s. 15.041 m), Sum 1 Application Information - Please bintAli Information Property owner's N e pinedy Pmpaty Owoo's Mailing Add=Prolictry Location ,h Saltio, City, state Zip Code Phone Number —.. T�U N; R E W IL Type of HaOdirtg (cheek all that apply) LatA 2_Faraily Dwelling- Number of Bedrooms Z/ Subdivision Name ❑ PubBcAConaraetal - Describe Use V & - tv Blocky ❑ City of ❑Sam Owned -Describe Use ❑ VMage of CSMNumba 2 17 ST. CEZLS pa Ito J I& MANN&W °"aof III. Ch" only one ho on line A. Complete line B if applicable) d' System /g r /Ysr® ement S ❑TreatmmNHoldmg Tank RWlaeemeor Ony ❑Changeoolumber ❑PamitTansfom New ❑016cr AAodficatimmE�85)'fOm (otPlam) Iin Previom PamkNmnba and Doh Baued IL ❑Permi[Renewalltevisim Before Expiation Ow,ya L atem/Com neor/Deviex: Check all that Apply.) -Pressoiaed In -Oro ❑ Presaunzed In-Caound ❑ AlGnde ❑ Mound> 24 an. ofmiable soil ❑ Mound <24 in. of suitable w0 Holding Tank ❑ Otber Disposal Competent (e plain) ❑ Preircatment Device(explain) V. Dist nineatmeot Area Information: ITL� SloFlow (�1/ Des�o7 Apph' !t WRa cWASf) Disparml aired (st) D s (sf) System ovation 3 ✓ � .' 10 �� $ VL Tank Info Capacity in Total a of Manufacmc Gallom Galan; Units u New ides Fvi�eSaaks 6 H Syidc or Holding Tads Donbas taabs VII. RespomibiGty State t- 1, the anderaigaed, a rapondbility for imafladon of thePOVM sbw a the ataehd plaaa 's Name (PAT) fl ' Signanne WAVI RS Nmnb r Bmiutt Phorc Num Ji— Ptmtba's (Saes, City Salk Zip 5_ ti&-LIZ2) VML Comitty/iDepartmeat Use Onliv ❑1 Pe[mit Fec s 00 Date coed ^ w� Issuing. Si ❑ Gieaset ven RD„ipl l0 L (/ IX. Conditions of ApprovaUReasons for Disapproval OWNER; SVSIEM 1. Septic tank, effluenth �fi�lt�e�r�e�nd dispersal tell must d d 13y Plumbm. as per management P'a^ Provi i 2, A11 ,?tb3tk reQrlitement5 nW5t be msintained O ,l:fab:e (OdaiordmaMes. AL -_._—__—T_.—._.�.....�......�...�......�..,.....r wdr SBD-6398 (R_ I1/11) �`my'rYs1 Ma g �I FEB 21 20N '1 Wisconsin Department of Comm9rce SOIL EVALUATION REPORT Page of Division of Safety and Buildings 1 ; �ounci.�.�,,,d l} 5, Wis. Adm. Code Corr Counry, Attach complete site plan on pa n ass than 8 112 x 11 inches in size. Plan must irxdude, but not limited to: vertical and horizontal reterenterpoint (B direGion and Parcel.LD. percent slope, scale or dimensions, north arrow, and location and di ce t an roe l J a; a Please print all information. Re vi by Dat Personal information you provide may be for secondary purteaes (Priv Z rrooerty Ovmused er _ ProoerNLocation I IV f _ i14Govt. Lo,15((l 114,�114 S 6 T�V N R E ( ) W Property Owners Mail' Add re LoJ,# Block # Subd. Name or CSNW 'ir , , / /(/ State Zip Code Phone Number ❑ C /p/�llllage Neararesst-RRo4o / GG� F-I�/Y_ 6 /1 .I SelfJ/ i I ( ) �l�/i,GGt.Aw�r 1 ;ZjNr Construction UssiOlResidential I Number of bedroom Code derived design flow rate X-W GPD ❑ Replacement�� ❑��Publ��ir//pppr wmmercial - Describe: Parent material 1C""IL�� Flood Plain elevation if applicable W11A� ft. General comments and remmendationss: System Type_476l/�� System Elevation r 7 GG711 Ing fCr Pit Ground surface elev. /03.) -ft. Depth to limiting factor YfI4 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Sz Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDRF 'Eff#1 I •Eff#2 Boringiv Boring Pit Ground surface elel/25 ? ft. Depth to limiting factor M. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 •Eff#2 Effluent #1 = BOD- > 30 < 220 marL and TSS >30 < 150 mat ' Effluent #2 = BOO, < 30 mg1L and TSS < 30 nxyL CST Name (Please Print) Sign CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address - Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 a?o — zp 715-246-4516 Properly Owner Parcel ID # Page —of Boring # Boring pit Ground surlaceelev./V,� ft. Depth to IkN*V factor 4 At' 0. Sod Application R—ate� ®®� . Sz. Cont. Color Description ®®®®®®OMM ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Odor Texture SWckwe Gr. Sz. Sh. Consistence Boundary Roots GPDfff 'Etf#1 'Etf#2 E. ' Effluent #1 = BOD, > 30 < 220 mWL and TSS >30 1150 mg1L ' Elauent #2 = BODr < 30 mg& and TSS < 30 mprL 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. 5e68110(R6 ) ,CST�� FEB 21 2020 Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page _ of Attach complete site plan on paper ndtlass than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal referenoelpoint (B direion and percent slope, scale or dimensions, north arrow, and location and di catctare roa Please print all information. rn ftr l iMormsbon you rxovide may be used for secondary par" ( DOIIDIy, pl.p ,1 0� a Re7by Da Z 7 Property Owner S/� Property Location Govt. Lotf2( 1/44 114 S T N R E ( ) w Property Owners Mani Addre iZ �p L�# o Block # Subd. or CSM# State Zip Code Phone Number r� / ( 1/ ❑ fllage Nea st Ro New construction Use f 3lResidenfial / Number of bedroom Code derived design Bow rate yJJ _ GPD ❑Replacement�❑Publ/i/ror commerdal-Describe: Parent material f%�Yn Flood Plain elevation if applicable �✓ i� ft. General comments and recommendations: System Type IBGr,�(/ .r System Elevation 9�n iF (� Boring # ❑ Boring ® pit Ground surface elev. l a J ft. Depth to lim" factor )1,4 in. Soil Application Rate Horizon Depth In. Dominant Color Mfmsefl Redox Description Cu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence BourMary Roots I GPD/IF •Eft#1 I •EB#2 1 0- i2 3 L All 7E, Boring # Boring Pit Ground surface slev/2; L) ft. Depth to limiting factor kf. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff •Eft#1 I •Ef#12 0- 06L, -,e- �- Ds- Effluent #1 = BOD. > 30 < 220 mg4 and TSS >30 < 150 ngfL • Effluent #2 = BOD, < 30 mglL and TSS c 30 rtglL CST Name (Please Print) Sign CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address n Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 2p 715-246-4516 M Soil Test and System PLOT PLAN PROJEt-,T Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017 NW 1/4 SE 1/4S 18 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 99.0/98.8 4' below qrade 2/22/20 BEDROOM 3 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 "I BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION too, Filter Lifetime Filter ❑ BOREHOLE O WELL +H.R.P. same as benchmark Scale = 1 /4" = 1 0' Property Line 95th St. 2-3' x 66' cells with >3' spacing 60' B-2 70' M B.M.* Vents 01 Vent Pro 3 Bedroom House 13� 20' 2% Slope 5' B-1 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 >6,. Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6f A2/pair of end caps 4' Long 12 Grade at System Elevation Line SHry ;)oao -fay "' ^ IJ D f\� Services Division I1400 County C • U 11 tJ 1400 E Washington Ave E A P.O. Boxn/162 Sanitary Permit Number (to be filled in by Co.) JAN $8 2020 Madison 70762 t Crol Est rmit Appli• tion Slide Tra sacti Number CP In ecc l Y�SPShctk a , submission of this forsto the appropriate governmental wit Project Address (If different than mailing address) is requir ning a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety ad Professional Services. Personal information you provide may be used for smon purpoesm in accordance with the Privacy Law, a 15.04 1 , Stars. r r ` ..i L Application Information - Please P ' t All fo atioo Property Claimer's Fleece Parcel q `f — D Z � Property Owner's Mailing Address ��f) f Property Location - . t.�`a7 Govt. cat is. %y Section City, Star / I ZipC a Phone Number N, le ace T 3r7 N; R E or II. ype of Building (c eek all that lapin -� 1 Su 'vision Name L 2 Family Dwelling -Number of ` r B /L - t City of ❑ Public/Commercial - Describe Use — ti-x, G ►L ❑State Owned - Describe Use1 El Village of CSM Number i� 2 • aJ T Q°N"of 1[I. Type Check only one box on line A. Complete line B if appli A. System y ❑ Replacement System ep y ❑ TreetmentMolding T k R lac ly � ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Chmge of Plumber Upe fer to New ed List Previous Permit Number and Date IssugV Beforo Expiration caner ' 1 tem/Com onent/Device: Check that a I Non-P---d In -Ground ❑Pressurized ln-Grourrd ❑At -Grade Mound> 24 in ofsuitablesoil ❑Mound <2 ,n.ofsuitable soil ` �M. 10- o mg an r Dispersal Component let, I Pretreatment Mal" (explain) V. Dis rsalffreat nt Area Information: - r 'gn Flow (gpd) Design Soil Application Rat sf) Dis I Am Required (s Dispersal posed (sf) Syst Eleven) - VI. Took Info Capw in Total p of anufacturer G Gallons Units } ` - 04 esv Tanka dng T Septic or Holding Tank Dosing Chamber VIL Responsibility, Stale , the -jisigated, au responsibility for installation of the POWTS shown on the attached plain. PI 's Name (Print) Plumber' ature MP/MPRS Number Business Phone Num r �u�,.� 2 G /. Plumber's Address (Streit, City, State, Code) t y3 z- a o t, �/�-c� 2-1 VM.9Eqetj1Mepartmemt Use Only Approved Seppro Permit Fee Date ueed Issuing m Signature Z rvrn Reason for Denial / IX. Conditions of Approval/Reasons for Disapproval I V O SYSTEM OWNER: 1. Septic tank, effluent finer and j Ve dispersal cell must be serviced / maintained/ as per management plan provided by plumber. J4 eels NO Z. All Setback submit to the Counm only on paper not I than I �G a in s n ,rcnn m s1 as per applicable code/ordinances. \J\ J t d� j°`jy{ •L{J SBD-6398 K 08/14) A8t,) �Dti�Q OLanECS El S It Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 1 /26/20 Owner:Shaun Bird Location: SW1/4 SE 1/4 S18 T30 N,R18W 1529 95th St. Richmond Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and Co 'gency Plan 7. Filter Cross Sectio Siqnature _ License nuF fCe/#226900 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates Typical Installation Vent Grade �30/34 Septic Tank 5' Lone t 5' Grade at System Elevation Spacing 5' 5' To be >1' above grade Finish grade elevation 100' ,Vent t" at System Elevation 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A 96.0' B 95.9' System PLOT PLAN PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017 SW 1/4 SE 1/4S 18 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 96.0/95.9 4' below grade DATE 1/28/20 BEDROOM 3 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION too' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. Same as benchmark 260' Property Line Scale = 1 /4" = 10' Vent >6., Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ftA2/pair of end caps 4' Long 12 Grade at System Elevation 34" All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 95th St. Pro 3 Bedroom House 40' MN 2-3' X 66' cells with >3'spacing 1% Slope W911 1311 59'I 13' I B 3 I B.M. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of .f- FILE INFORMATION Owner SLC Permit # DESIGN PARAMETERS Number of Bedrooms 0 NA Number of Public Facility Units -JdNA j Estimated flow (average) <3aVda I Design flow (peak), (Estimated x 1.5) < f�1.� aVda Soil Application Rate aUda /RZ Standard InflueMlEffluent Quality Monthly average Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) Q20 mg/L ❑ NA Total Suspended Solids (fSS) .5150 mg/L !Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 53o mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 5104 cfu/100ml Maximum Effluent Particle Size Jk in dia. ❑ NA Other. )06 NA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM Septic Tank Capacity al ❑ NA Septic Tank Manufacturer ❑ NA Effluent Fitter Manufacturer t ❑ NA Effluent Filter Model 0 NA Pump Tank Capacity l NA Pump Tank Manufacturer NA Pump Manufacturer NA Pump Model Nq Pretreatment Unit NA ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Dispersal Cell(s) ❑ NA -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound LI Drip -Line ❑ Other: Other. ❑ NA Other: 0 NA Other. ❑ NA Service Event Service Frequency Inspect condition of tanks P () At least once eve every: ❑ month(s) s (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA hrspect dispersal cell(s) At least once every: 7 m�)s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) r ear(s) El NA nspect pump, pump controls & alarm At least once every: 0 year mons(s) I I NA ]:lush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) Other: At least once every: ❑ month(s) 0 yea(s) NA ]ther: ru? ) MAINTENANCE INSTRUCTIONS I 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 ;:ombined 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. Men the combined accumulation of sludge and scum in any tank equals one-third (%) or more of the tank volume, the entire contents of !:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Ail other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, 13nd 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 Rhin 10 days of completion of any service event. Page _ 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 thIt 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 hlghwater levels. When prover is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the ceil(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 Septa" Servicing Operator prior to restoring power to it* 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 w thin 15 feet dawn 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 PONY$' antibiotics; baby wipes; cigarette butts; condoms; rotton swabs: degreasers; dental floss, diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; pairing 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 propetly and safety abandoned in compliance with chapter Comm a3.33, 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 property 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 rep system: itable 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 requi6ed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in time nW for a new soil and site evaluation to establish a suitable replacemerrt area. Replacement systems must comply with the colas 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 soli absorption systems may be recanshuded in place following removal of the biomat at the eifihrative 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 O� A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS — POWTS INSTALLER it Name Phone S TN t = SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ` Name ! Phone Phone r1 -- [C- ��f =j��—� -m This document was drafted in oornpliarnx with chapter SOS 383.22(2)(b)(1)(d)&(f) and 393.54(1), (21 1(3). YJlsconsio Adminietraure Code. 20140048A �p .. BLiLLii f�(�,lv SECTION A -A 1921 Owner/Buyer ILo,. City/State !-M Eml a t 0):i twM" ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREIENIENT AND CERTIFICATION FORM Parcel Identification Number b a-b - j:?,Q (,— 00 -() i Property Location 4 % ,6 E t/. , Sm. , T 30 N RLLW, Town of Lot# 0�. Cerblfied Survey Map #y Volume . Page # Warranty Deed # I ` S C volume , Page # Spec house S no Lot linen identifiable� yw %�po SYSTEM MAIIVTENANCE AND OWNER CERTIFICATION improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mamAenance 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 m the waste disposal system. Owner maintenance responsibilities are specified in §Co>mm 83.52(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 roister plumber, journeyman plumber, restricted plt>mbm or a licensed pamper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pronging (if necessary), the septic tank is leas than Ira 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 Departmeat of Natural Resources, State of Wisconsin, Certification stating that your septic system has been maimatred must be completed and returned to the St Croix County Plamming & Zoning Department within 30 days of the three expiration date. Uwe certify that all stateareats w� are true to the lest of my/our lr owledgc. I/we am/are the owner(s) of the property described above, by virtue of a dud recorded in Register of Deeds Office. Number of b ms TURF OF APPLICANTS) DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Plammm & Zoning Department. s*s Inchide with this application a recorded warranty deed tiom the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed (REV. 08/0) n 2.260 ACRES 98.432 m 59g 57 335 IN N.n-34'19�E LOT 19 1.696 ACRES i + 73.878 SO. FT. I I � LOT 1 E 3 2.339 Ai �+ N81'4015 J s~ LO7 1.789 0 77,938 P Iz I 354.23' N89'21'3YE 741.31'- } EA SEW � ( ! L i f' I 1.8 80,4 { i LOT 22 P CA m� Z560 ACRES I 111.519SO. Ft `%sconsin SOIL EVALUATION REPORT j]' /I IF j' #1471 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8'%x 11 inches in size. Plan must County CfOoc include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Rev' 21 Personal information you provide may be u s- 15.n4 (1) (m)) AljA GI Property Owner roperty Location Sienna Corporation N. Lot 114, 1 /4, S18, T30N, R18W Property Owner's Mailing Address Lot# Block # Subd. Name or CSM# 4940 Viking Drive Suite 608 21 The Glens Of Willow River City State p CW C ❑ City El Village Z Town Nearest Road MinneapolisI MINI, Richmond I 95Th St. ® New Construction Use: ❑ Residential / Nunber of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Pudic or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na_ ft. General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/ sqft rating. Possible system elevation for Area 1 is 95.3'. Slope is 1 ---. Boring El Boring ® pit Ground surface elev. 99.95 ft. Depth to limiting factor 105+ in. Soil Application Rate Horizon I Depth in. I Dominant Color Murlsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM' •Eea1 •En12 1 0-11 10yr3/2 none sit 2fsbk mfr as 2m,2f .6 .8 2 11-23 10yr3/4 none su 2fsbk mfir gW 2vf .6 .8 3 23-34 10yr4/4 none sl 3fsbk mfr is lvf .6 1.0 4 34-57 10yr6/4 none s 099 ml as — .7 1.6 5 57-105 10yr5/4 I none grs I Osg ml — .7 1.6 goring # ❑ Boring ® pit Ground surface elev. 99.40 ft. Depth to limiting factor 102+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cord. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDyfF 'ERat •ErM 1 D-12 10yr3/2 none I 2fsbk mfr as 2ni .6 .8 2 12-18 10yr4/3 none I 2fsbk mfr gw 21111' .6 .8 3 18-29 10vr4/4 none sl 2rrisbk mfr cs ivF .6 1.0 4 29-102 10yr5/6 none s Osg mi. — — .7 1.6 ' tmluent #1 = BDDS> 30 < 220 mgfL and TSS >30 < 150 mg/L • Effluent #2 - BODS < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature* /f CST Number Thomas J. Schmitt 7 /�G. � 227429 Address Schmitt Sal Testing, Inc. rDate Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/1=006 715-247-2941 SBOW11330 MOM) Property Owner Sienna Corporation parcel ID # page 2 of 3 ri-IBoring # ❑ Boring ® Pa Ground surface elev. 99.0 fL Depth to limiting factor 104+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Coat Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fe 'EMM 'Ee#2 1 0-9 10vr3/2 node 1 2fsbk/lmpl mfr as 2m,lf .6 .8 2 9-17 10vr3/4 none sit 2fsbk mfr gw lvf .6 .8 3 17-27 10yr4/6 none sit 2msbk mfr 9W lvF .6 .8 4 27-32 10yr5/6 flow sl lmsbk n* CS .4 .7 5 32-104 10yr6/4 none S OSg ml — .7 1.6 u $o- ❑ Boring # Boring PR Ground surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/R' •Ea#1 •E= ❑ Boring # L] Boring [ ] pit Ground surface elev. it Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. !Consistence Boundary Roots GPDMe •E1f#1 •Etf#2 Effluent #1 = BCD5> 30 < 220 mg/L and TSS >30 < 150 mg1L ' Effluent #2 = BOD5 c 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. SBo8330 (aa7M) Schmitt Soli T estln9, Brc. • Page ,3 of 3 Conducted by: Conducted For: • Schmitt Soil Testing Inc. Name: Sienna Corporation Thomas J. Schmitt, CST 227429 Address: 07VO. 611 k,hy Qr,ve Su,'le 608 1595 72nd St. City, State, Zip: New Richmond, WI. 54017 Phone: 715-247-2941 Subd.Name: The Glens of Willow River Signature:-v+V.-� Lot No.: A / Legal Description: 5W 1/4 SEl/4 S18 T30N R18W Backhoe pit Township, County: Richmond, St. Croix ® Bench Mark El. 100.00' Top of 2" pvc pipe Q Alternate Bench Mark EL 0% J ' Top of �7 " Ale AAA SSE /.fi �0 6W ) Slope— /ate Contour Line El. IYW Contour Line Length AW Scale 1" = 40' tee lb 11 Gl�- -U a� This Soil and Site Evaluation was completed to fulfill a zoning requirement. It may or may not be in a location notable for you use.