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014-1016-40-001 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPnvacy Law. s 15 04 1 I)(m)j 7ermit Holder's Name C(ty `.tillage Township David and Megan Burlingame TOWN OF FOREST CST BM Elev Insp BM E v S escription ( Y t r UlY TANK INFORMATION ELEVATION DATA. TYPE MANUF TtJPEP CAPACITY Septi jq\, L� - Dosing com!o O�� - Aerat�on .w6leh, 11-0 0 *E * llop TANK SETBACK INFORMATION Lind �.C�I►n:...�- ✓ TANK TO PAL VVEI L. BLDG V tlnt In .-ir ntakZ ROACH Septic 7151 Dosing 5 3 G I Aeration Holding PUMP/SIPHON INFORMATION MI&.S County St. Croix Saritary Permit Nc 644715 State Plan IC Nr Parcel Tax No 014-1016-40-001 SectionlTownlRange/Vap do 7,31 .1 5.107A STATION BS HI FS 3•'l a. LEV •� hmafk Alt erg Bldg. Sevmf St/F°°It Inlet � � � 3 •� Stil-it Outlet Dt Inlet Dt Bottom I � • Header/Man I Dist pipe 1301 System •3 � • Final Grade r Cove7-*- ,SOIL ABSORPTION SYSTEM BF-DjTR€NCN 'IVidth Length I No Cf A DIMENSIONS g IS SETBACK SYSTEM TO P/L BLDG WELL If+tFC}RIIAATION Type Qf Systern 115'd DISTRIBUTION SYSTEM PVT DIMENS)ONS No Of P11s ilnside Oia ILiquid Depth LAKEISTREAf,v1 I LEACHING Manufacturer, CHAMBER OR UNIT IMcidel Number HeaderiMandold `% Distrwbutior� I x Hole /SiZe x Hole �pacr ` Pipes? % 1% J Length--k— Die Length Cara Spacing SOIL COVER x Pressute Systems only xx Mound Or At-GTade Systems Onl Depth Depth Over xx Depth of xx Seeded Sodded Beet �nchenter11*4 e�dlTre nch Edges 7 opsoll 7 Yes \0� ��' o COMMENTS: (Include code disorepencies, persons present. etc) Inspection #1 Location: 14 220TH AVE � I o`eu molly\ JO welt 1 ) Alt BM Description=���c'�r � %L �-- �J� 00y) 2 ver }Bldg seer length � �1 %amount of cover = Alks Plan revision Required? Yes I%. No 9 Use other side for additional information, Date epctor"s Signature S80-6710 (R 3/97) 'Dent to Air Intake `' " - xx Mulched No Yes No Inspecl+on #2 1-519 4e 10 Cert No if X�i J��j L�� Industry Services Division Coun r 4822 Madison Yards Way Sanitary Permi I Number (to be filled in by Co.) Madison, Wl 53705 P.O. Box 7162 Madison, TV 37 A 716?ff 15` st, LApplication State Transaction Number fnun In accordance 1 (2), Wis. Aden. ft. Cudc, submission of this fonn to nit z-Z0111 I — C*L P . tt�Aqdress (if different than mailing address) is rcguired prior to obtaining a sanitary permit. Note- Application fon-ns for state-owned PO S are submitted to the Department Safety Professional Services. Personal of and information you provide may be used for secondary purposes in accordance with the Privacy Law, 9. 15.04(1)(m), Stags. 7,ZjfJ4 a& 1. AppAcation Information,— Please Print All Information- Property (3wner's Name Parcel -A AA Ue" 1P LArt, 0_1q ID I � Properly Owner's Mailing Address Property Location Govt. Lot 1A) 1/4, Scction T N R _E oez City, State 5t Zip Code Phone Numbu �545031 IL, Type of Building eheck ill.that apply) Lot 0 Subdivision Name or 2 Family Dwelling - Number yf Bedrooms V 4 ublic/Commercial - Describe U Block N DR -:P OCity of .State Owned -- Describe Use —9CSM Number L_ I IV illagc of (z4D N E own of I Iffjype 'ofT , OWTS Permit: (Check"elthur "New" or "Replacement" Rnd other appheable on line A. Check one box on line B. Complete line C it app eef A, ;qew System []Replaceinent System 1:10thcr Modification to Existing System (cxplain) [:]Additional Pretreatment Unit (explain) B. []Eiolding Tank lit Ground t -Grade WMOU nd Individual Site Design Other Type (explain) (conventional) ElRenewal Before []Revision hange of Plumber F-Irransfer to New Owncr Lisi Previous Permit Number and Date Issued Expiration IV, DispersabTreatment Area and Tank Information: tm CAAL —,==to Design Fla"w (gpd) Design Soil Application Ra(e(gpd/sf) Dispersal �qliiircj ('SO Dispersal Are roposid (sf) System Flevati0/ .s C�D • WOU �cp qq, 5 Capacity in TOW #of Manufacturer - - - Tank Information Gallons Gallons Units New Tanks Exisling Tanks VV, U Septic or Holding Tonk DOSI rig Ch amber ej c -1 RIM Statement- I., the undersigned, assume r sibifity for installation of the Powrs3hown an the attached plans,. r in Plumber's Name (P ' t lumber s tu re MPAI 4PRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 41;vff j5q 1 Ll :2 V1. Count y/D partment Use 0idV Approved 0 Ved Permit Fee Date Issued Issuing Agent Signature S caner iven on ror Denial Conditions OCKFT-ONI/Reasons ffior ADVISm"Prra"I MP LA.*, 3)AU OWNER: eptic tank, effluent filter ITEM and ispersal cell must be sewted / rmaimlained S per management plan providtid by PlUmber. 4cr 11 setback requirements must be maritained s per applicable code/ordinances. re 1101I OU LUMPICAC PSENS JUF mc sysivill anu suUM14 lu Inc tuunty QF11y On paper Flut less 111ou 0 ji a a I 111LISTS 11 Ahs FA IL 0% r,"AOA� SBD-6398 (R. 03/21) • rWA,V Z�4Le4� System PLOT PLAN PROJECT Dave Burlinciame ADDRESS 1190 Main St. St. Paul Park Mn 55071 SW 1/4 SW 1�4S 7 /'r 3 1 N/R 15 W TOWN Forest courqTy ST. CROIX SYSTEM ]ELEVATION 99.5p 1.5' sand lift DATE 5/25/22 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL j.,urr HOLDING TANK MOUND SEPTIC TANK SIZE 1200 gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of Chambersnone BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVA"ION '100li'ilter Lifefime BOREHOLE (DW"FLL Il - R. P. same as benchmark' IM 8% Slope 0 Area 15' below system to B - 3 remain undisturbed Weiser Combo Tank Pro 4 Bedroom House B 1 96 .51 N 9 7.5 q8.5198.0' 1320' Property Line V2.1jis to meet all WDNR setbacks Grading is to be done to divert run-off away from system Scale - 1/4" 10' 01 4 0 80, f 1 220th Ave C -o -r June 6, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-6-6 Plan Review: PWTS - 062201111 -C Shaun Bird 1432 1201h St New Richmond, WI SITE: Burlingame 22 01h Ave Forest Township St Croix County SW Y4, SW Ns S7 T31N R15W FOR: DIVISION OF' MOUSTRY SERVICES 10641 N RANCH RD HAYWARD " 54U34462 COMW Thmugh Rft Twy Even Q*~nor Omm of &K retary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Description: 4 bedroom 600 GPD — 18 P1 to ound Component Manual — Ver. 2.1 (May limiting factor- Effluent Filter- Mainten�irce 2022 -) required. Pressure Distribution Component Manual — Ver. 2.1 (May 2022-27) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10),, Wisconsin Statutes,, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • The site shall be property prepared prior to plovAng. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. Ifnecessary, use only tracked equipment, during dry conditions, with minimal passes, tmavoid compaction. " Components and soil removed from anexisting drain field shall be properly disposed of so that there is no risk to public or environmental health. ° Asanitary permit must beobtained from the county where this project is located inaccordance with the requirements of Sec. 145.19, Wis. S,tats. ^ Inspection nfthe private sewage system installation \srequired. Arrangements for inspection shall be made with the designated county official |naccordance with the provisions �Sec. 145.20(2)(d), Wis. " Astate approved eff|ue[It f/Iter is required. M aintrnance information nmst he given to the owner of the tank explaining that periodic cleaning of the filter is required. open -to inspection by authorized representatives of the Department, which may -include local Owner Responsibilities The current owner? riiid each suhsecjUerit ovviior, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operafioi'i and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintc-mied in accordance with this chapter and the approved management plan under s.SPS 383.54(1).. in the event this soil absorpnon system or any of its component parts malfunctions snastocreate a hra|/hhazard, the property owvnermust follow the contingency plan asdescribed |nthe approved plans. The owner is responsible for submitting amaintenance verification report acceptable tothe county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the cornponent(s) utilized in the POWTS. |ngranting this approva I the Division of Industry Services reserves the right to require changes or additions should conditions drise making them necessary for code compliance. As per state stats 101.12(2), nothing iri this review shall relieve the designer of the responsibility for designing asafe building, structure, orcomponent. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are resAonyib|e for the installation, operation ormaintenance ofthe pOVVTS. Joshua Rowley POVVTSPlan Reviewer, Division ofIndustry Services (715)813-9111 a Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/24/22 Owner: Dave Budingame Location: SW1/4 SWIA S7 T 31 NoRl 5W 220th Ave Forest Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution 'Manual Version 2.0 (N.o1%01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Spedficabons and crow section 8-9. Maintance and oonti y plan Attachments: soil test 7r1C Shaun Bird Signature License number 226900 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Page 1 of 9 SEE CORRESPONDENCE System PLAT PLAN PROJECT Dave Budinaame ADDRESS 1190 Main St. St. Paul Park Mn 55071 ►w 114 SSW 114 s 7 /T 31 1' /R 15 w TOWN Forest COUNT' ST. CROIX SYSTEM ELEVATION 99 5' 1.5' sand lift DATE 5/25122 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING 'TANK. MOUND � SEPTIC TANK SIZE 1200 gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of Chem one BENCHMARK V.R.P. Top of 314" pipe ASSUME ELEVATION 10eFilter Lifetinie I30REIIOLE 0 WELL * H . R . P . same as benchmark 1 O' Property Line A�lell is to meet all WDNA setbacks 78.5' 0. V B.M. Grading is to be done to divert run-off sway from system Scale 1/4" 10' 1 40' 80, 220th Ave Cl o I I j A W Mound System Cross Section and Plan View 0 "'N'k: 11 dr'�'$f I I to %I, 1. 10 1. 1011, I'd,. 0, .0 , tk %O'kh% 1. r 4 F V lb . . . . . . em SIM IIIIIIIIIIIIIIIIIo "M i K T L T Dimen3iOn Feet A —if B 7:r D E F G 2r] H 1.7, V K L W j#-W Z S 12jLe Topsoil ASTM C-33 Clean aggregate 4 in. sch. 40 Pvc Cap Materilal J 4''. sand fill Y2to 2 1/2 in. dia. observation pipe --4:00 M WNW 7"VII %-% P W ; 7 61 VIP,* 0--WW-W Slope Direction 0 GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proc4ed if the soil is wet enough at the plow depth to form a 1/4 inch soil Wire whcn a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediskly after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less d= one foot thickness to minimim compaction of the plowed surface. After the topsoil cap is plawd, the entire mound is seeded and mulched to promote vegetative growth, limit crosion and protect from freezing. The observation pipes are slotted 'in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 1gj e`? Page '��Of Pressure Lateral Layout Two Laterals —End Manifold rorce main 9 Pressure System Construction tided trout 19 Ig Sweep 90 Bend Laterals are constrwted of Scbedule 40. PVC pipe. Orifices are drilled pc�iculsr to the pipe with a sharp drill bit and face down. Lateral turn- ups terminate, with a waded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler vaive box accessible from finished grade. 90009 0 rade 0 0 00 of 6�-8 Inch Lawn Sprinkler VaJVC Box Page of 03/05 lgj Septic -Dose 'dank Cross Section .And Pump Performance Specifications ]Fdtas Mmufh=Lis FUodW Numba AOV f t M�-- ii t C Mm &ZE 1l . m-7 jr( !31 P'I'M ENRON o.ac ,te 21VIE OEM. jr Above Gm& With iodcios Dsyioa. Lilaet Manhole < 6" Below (i*de 8esl�ai 'gitatactiy�►t inlet GMERAL INSTALLATION: no Unk I installed. Piptng xt the kM aW .ouft of VPWVW malarb laid on "le soil to pment ing or wing. 'fie f0m me excavation s We"* is sadW Wight. UiW mvic r i �r 1 i1 go, 11WE V,�� bedded god book fl11ed in with the � of b�► a� �pedlied by the �nvtso�wrr any not � rude im me el6ea&W-e fodsvioe ("Idlock) oonneobd to ie tsnit with woMee�t tin�tV yW L abvved witEr '4" Sch. 40 PVC to brid=e tre talc . eDmMies wft NEC 300 and Comm 16.2R. External Construction Pump Volute - Gray iron casting class 25 Pump Legs - Gray iron casting class 25 Powder coated casting Motor 0Il-filled and hermetical(y sealed Class 8 insulation rating Stainless steel rotor shaft Single-phase models are thermally protected 3-Phase models require overloads in control panel Impeller Semi -open design. Cast iron construction ❑ual Shaft Seals Upper unitized carbon ceramic and lower Viton"I double lip Fasteners 300 series stainless steel Power Cord 25' length standard. Quick -connect design allows easy field replacement. (35' available on single-phase,, 35' and 50'available on 3-phase) Level Control Wide-angle mechanical float sealed in a PVC housing. Float has a series plug for manual by --pass operation Water -stop seal in cord entry to eliminate water wicking into the pump Adjustable clamp provided for optional pipe mounting of the float Discharge 2" FNPT with 1-112" FNPT cast iron flange provided Maximum Fluid Temperature 1040F, 400C Continuous Duty 140DF, 60°C Intermittent CORD LENGTH WEIGHT M❑❑ELS HP VOLTS PHASE AMPS 01SCHARGE AUTOMATIC IN FEET IN LBS FL102M-2 1 208-230 1 12 1-112" & 2" No 25 71 FL102A-2 1 208-230 1 12 1-1/2" & 2" Yes 25 72 FL103M-2 1 208/230 3 9 1-112" & 2" No 25 71 FL104M-2 1 440---480 3 4.5 1-1/2" & 2" No 25 71 FL105M-2 1 575 3 3.3 1-112" & 2" No 25 71 NOTE: 3-phase models require a controt panel For automatic operation. See control panel literature for complete specifications on panels. 35' cord option available on single-phase models. 35' and 50' card options available on 3-phase models. Add "-T suffix or "-5" suffix to model number. Example: FL103M-3 for 35' cord, FL103M-5 for 50' cord. Performance Curve 60 Hz 3450 RPM Liters Per Minute 0 76 151 227 303 379 454 140 130 120 110 100 90 80 3 X 70 49 60 50 40 30 20 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130 US Gallons per Minute Specificatlor)» subject to chaiige without notice. Copyright © Liberty Pumps, Inc. 2023 All rights reserved. LLIT006769-R02/23 in n Y BAC K SWITCH 3PH POWER CORD 1 FL1 rrR luber P S J ef?ty UMP Submersible Effluent PUMP A Family and Employee Owned Company 5 �_Qdia �_ 1 hp 1-1/2" or 2" Discharge Flange mounted Features e 3/4" Solids handling a Heavy cast iron construction * Semi -open cast iron impeller * Stainless steel rotor shaft * Dual shaft seats 9 Single float, mercury -free level control * Additional mounting clamp provided for optional switch mounting to pipe * Fully adjustable pumping range a 2" FN PT threaded discharge with 1-112" FNPT flange provided e Quick -connect power cord - 25' length standard Available in automatic and manuat models POWDER COATED TOUGH" ,M YearUlarra nt SSPMTC IFIED CERo C us UIscharge w, NqV 1-1/2 or 2" 04/18/2012 16: 43 tlbd M lUbtJ rKr_rcxumv rumor 1 %0%00 W%.# ZocUer Pump Compamy Page I of I 16 —7 4 FTT OA-52M I 1.1921 JD I Coop boles~ Coos* and SwpwWww SECTION A -A POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of FILIONFORMATION Jillit 11141 lei V.1 17.1 �L= Number of ONA Nufftw of Commdal Urft- E261mm ftw (aMa'ape) / 6 (J Dell4filk ftN tppNiQ,Jill (wed X Sol Appkmgw Rate 1n&nrWE111md Quality Morift average* Fats. 01 & Grease (FOG) 00 nigAL Ekochen*sl Oxygen Dernaix! (BODJ s220 mg& ToW Suspended Solids (TSS) _<Isonoi 13fttn,mkW EAkienl Quality ;;P<NA Monthly amitge" ff% I d. —.J— — — it ---A owuw,w6JJJlJJJm Oxygen Deffwd (BODS) s30 mg/L Total Suspended Sollids (TSS) --qW mgAL Fecal Caken (geometric mean sl W c(u/1 00nV Maxbmjm Effkmnt Parkle Size 1 4 " diameter MMNTENMCE SCHEDULE SYSTEM SPEG11-1k;^1 lurJ14 ISepW Tank Capacity Jual DNA Sepdc Tank Manufacimw 0 NA I E ftent Filter Manufacturer 13 NA Eflkmnt Filter Model 0 NA uwTank Capacity P Pu [INA P ump Tank Manufacturer Pomp ZL-A�,L.> 13 NA Purnp Manubdurer .pump 13 NA Pump Model O)NA Pretreabnent Unk 0 Sanlr4f%W� FRw 0 Peat FIRw 13 Mechanical Aeration 0 WeUwW 0 Dkirdecdon 0 1100W. Manufacturer Dismi Cell(s) * Invound (gravity) 13 round (pressurtzed) * At -grade ound 13 CW4>4ne Vahns bvikal kw dorrwl (mn-wavinwcW4 wastewater end 2 to* @MuwlL Vskj" jV p, kw ptatrealed wvste"ter. Service Event Service Frequency Inspect condftion of lank(s) At kmW once every months, 04ears) (Maximum 3 yrs.) When icomblined sludge and scum equals one-third %) of tank volume P np out wntents of tank(s) !aspect ems) At least once every 13 rnonthij�!R year(s) (Max I mum 3 yrs.) Ckm effkwmt filliter At least once eviery /Af 0 mon hs Inspect pump, pump controls & alarm At least once every [3 morl -;Pofeaqs) 13 NA Flush laWmls and pressure test At least [ono`e evilaq 0 mwthVtrMr(s) 9Z� At least once every 0 months C1 yeaqs) NA At least once every 0 months 0 year(s) NA MAINTEW010E INSTRUCTIONS I ns-pimedilka-m- of Wft and dispersal calls shall be made by an lndWuW carrying one of the followkV U or ON Wk-a- Wil: Ma Plumber, Master Plumber Restrided Svmw, POWrS Inspachx; POWTS Mainhdrmw. SWtage So aing Opmtw. Tank inspections must kw*xle a v1suaJI -wdon of Ow tank(s) to Identify any 0,1 or ken hanMrm,, identify any cracks or Wall ffmasure On voluaw o(m t*wed sludge and scum and to, cho* for mW bw* up or ponding of of on the ground surface. The dispersa1l oWs) shall be visually inspected to dwKk the amusm 114"k In the observatkm pipes and to check for any poinding of efflusid on the ground surface. The pondkV of effluent on On groaW surface may ate a failing oondition and requires the knnr�eWjate rx0ration of the local regulatory auftft- When, the cxxnbkmd accumulation of sludge and scum in any tank equaLs one-third (n) or more of the tank volume, the enter Wintents of the tank sha 0 be removed by a Septag e Servidng Operator and disposed of in fiance Wth ch . N R 113, Wocortsin Administrative Code. ■ The swvicing of effluent filters, medignical or pnmoLfted POWTS oxnponents, pretreat9maint componelnbi„ SM any other maintenance or mondoring at mats of 12 nxxOs or.lil "I be perl'birmed by a certified POWTS, Maintallner. ' I A serviqg report shall be provided to the local regulat(xy audxxfty wkhln 10 days of complefim of any sennice event. START UP AND OPERATION For new owstruction, 1xior to use of the POVVTS Chock treatment tank(s) fcw the presence of painting products or other chernIcals, that may Impede the treatment process and/or darroge the dismal cell(s). If high concentrations are detected ha" the contents of the tank(s) removed by a septage servicing operator prior to use. START UP AND OPF-RATION KW�xu othe-NA". For now coaMmfon , prior to we of ON PMTS &0* ftMm6rvt tanks) for 'IM PM of p*WWg or r AC96 --tVWFW%i� I have ft of thO may Impe& to giantVaos"wWadatmoft d4o"Cel(s). tank(s) nmwvod by a mqAW sarAft qmraWr pW to use, Syswm stsd up shW1 r*1 ooew when mg condftz w fmzen at the lnfhVWhe surfaos. �' M to Duft povow out &W pwV tanks mW IM Wxqe normal higNmter lam. When power its restored *w ww--�ws Rik - Pft di to the dWpwW oall(a) in or* kwp dose, overk)adhg the call(s) and may re" in the ba&W or sudam Of efflu&* To avoid this smu"on hwe ft contents of ft pump tank removed by a Seplage Servicing Opar*W prW to low PMW to went pump or contaof * Plurnber or POWrE Maintalner to assist In manualty opera *lg the pump owtda to m4bm rm?"ffil hw*IS within the punip tat*. Do W ddw or paA vahk;Ws over Wks mW clispenW celis. Do not &" or park over, or oche ftlu(b or die am w4thin 15 6W down sbpe daM mund or at-grWe soil ab"*m area. and PIDIWg #A WO the POWTO, Redudbn or ommumn of ft follovAng *= the wasommter stmw ray Imp OW djapM; disinfedeft; fat* foundation drs$n Nos WWW"Wes " baby was; cjWrefto butts; candame; won ems; ice; ra; oil; pointing prod (sump pump) waW, fruit and vegetable peelings; gaWrw grea"; hm&Wdee; ftmt scraps; madit cato posNoWes; son#A" rmpkins; inpona,, and water wfteiw bdm. ASAND01MENT When the POWTS falls on0or is permwwritky token out of servics fell w4gi ai" shall be taken to Woure thall ft SYStem Is PmP60Y and safely abuidoned h complance with chapter Comm 83.33, Wlemnaln Adm0nistra9ve Code., • AA poN to W" " pft OW ba discWneded wW the abwWoned poe --- sealed. • The conterft of all tanks oW pfts "I be --- WW PMP" c9spo"d of by a 8~ SenWnq Operator. 0 Aftw pmVing, aid tanks aM pb shah be 1 and mnmed or their ors removed and the void space fined 04th 90110 a ... or arw*ar Wool solid materiel. CONnNGENCY PLAN If ft POWTS faft a#W carax* be do ".WROW"Ig ffwwaum have been, or must be token, to pmMe a code comol#W repbCWWt systam: A uAllable r I t area has b"n and may be ufted for Me krAMM of 4 iW18061TWA W" a - "Mepn. The rep, Owl it am shodd be *om diOurInnce wx! WW stwW not be Inifted upon by requl4d saterra am will rewlt In the n*W ftcM *om &)d**V jM sue, and wed. Fella to pmted Ow mot corn* wth to rtAes In for a now ev soil mM ate akmdon to estaNlah a *Abdft replawTwd Roo a at that time. 13 A sultable replawment area Is noi evalmNe due to m9back arid/or will lWn*Wkm. Donft advarices In POWTS te&WogV a Ing tank may be installed as a I meort to repis" the failed POWrS. The WW has not been evaluated to Iderft a sulWe repwment am*. upw twn of ft powre a ow xxi om evehmsm bo porforrmd to koetog a sultsbis rephimemeni am. If no reel cemW area le.90- hk haft I rk rnw be listalled as a IM mkd to rep roe the failed POWTS. IMP- MWW WW $HpMe &A Mm zy%Wft may be rewnWucAed in plow blowing removW of ft blomat at VW WINEW" --00 . R=nstnxAons of OuCh SYSSWU must cwMly with the nAes In ~ at OW lime. <4eWARN1N0*o-'* .A.d6.M SEPTICP PUMP AND OTHER TREATWNT TANKS MAY CONTAIN LETHIAL GAMES ANDIOR RMUFMONT OXYWK 00 M-01 BITER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. FAICUE 0 PERSON FROM THE INTERIOR OF A TANK TAAY BE DIFFICULT OR IMPOGGIBLE. ADDITIONAL COMMEM POWS INSTALLZR � if � m hot* LNaPISM SEPTA" --811"CI1NG OPERATOFLIPUMPER). NW" bWW7) - 0 W.. ......... Pf1cm POWTS "WAINER !LL Ulm. C16 jX401.1 Sri This dacwnw vm& ckaftd In ommolanco with ohop4or SPS 383.22(2)(bXi)(dA(f) and 383-54(t), (2) & (3), Wkmontln flum1wilwe" Dapsr *N of Coivrwce SOIL EVALUATION REPORT Pater � of ,. DM*lx of Bar i; W*MUVA m h Comm 95, Ms. Mm. Cc Usc h vloW W6 p6n on popw ,rsd kw Vw 8 ill x I i &rx*w in Wzs. Pan ft%* sol . W, Imo( �'1v� fin' lo: �r r k*ll and r► ww= p lot / OW), & and F' 1.0. IfIldve,leworclklm 6, ncOh, snvw, " lo� P%ir# merit stiff Informirttari. Rqwwww low by DOW Pose ifft"vjEpw%-W-I YOU pr ridWWy be "W br "wft6wy py,;om (PrivW t " t. 16,04 (1 Q%jj. s7 Pmpwty Locown N RL'Z�E (oj ILL T3/ 4 1 A, A.A_ stm I wown NW&*M RoW + y Aga 40 0-9 1A U • • s s * • i pillillilliq 41 w �..� � • a � • r. � i all � r."�. � F i i /i".. �, _ w r r [ V WAlpvy4mm P.-Alng". 1p Two=, A ION FA 2M FFA for .At pWAf .. 791 &; 4 r=;-.� 0 �. M'1 om / ��• w I fl-40, IF/all 'AU '�A _.F All AS Mal jr &VA W d� M" MOM * • a .)p 30 •! TU 30Dc 15 # SbO .1 ")A. and M CST game (Ploass Print) ture CT Nuffdw B4rd Piumbing, Inc. Shaun Bird 22000 1432 1 nth St, Now Rich nd, Wl Wl ,�, 715-246- 18 PanDw E0 1 Page - d------�. bid" M MUM rfl�r,�oWISH m in - F.M., �M�rrv��r.�m►,firA ON i'lim:1 rmm. 91 WA FA FAR I E wl" A... M M Iran Co 4 Win+ I all c-t!�-ern EMWft11 is WOO �3012 mg& &W TW>30,11 0 m9L * B%wt 02 a WDO 130 m &wWIMt30 nVL The arowng of Commerce is in equal opportunity service provider and employer. If you a"d s--slam" to amass sovices or raced material in an a1temte fomut, Plem contest the d rtmcnt at 608-2 i-3 151 or TTY 1 -2 -8 7 ? 7. Soil Test Plot Plan Project Name Dave Burlingame Shaun Address 1190 Main St. St. Paul Park Mn 55071 Lot - Subdivision ------ S W 1/4 S W 1/4S 7 T 31 N/R1 5 i ftdmimmwnw� n n Boring 0 Well PL Property Line L RM or VRP Assume Elevation 100 it. Date C64 #226900 5/24/22 Township Forest County T. CROIX Top of 3/4" pipe System Elevation 919.5' * H F1 pSame as Benchmark Parcel #: 014-1016-40-001 Valid as of 06/2812022 01:44 PM Alt. Parcel #: 07.31.15.107A Owner and Mailing Address: DAVID BURLINGAME MEGAN BURLINGAME 1190 MAIN ST SAINT PAUL PARK MN 55071 Districts: Dist# Description 1127 �S'CH"DF)T OF ('I FAR LAKE 0038 CLEAR LAKE FIRE DIST 1700 NORTHWOOD TECH 8020 jUPPER WILLOW REHAB DIST Abbreviated Acres: 0.000 Description: SEC 7 T31N R15W PT SW SW FRL EXC PRCL 21 T 011-1 AS IN 377/36 (HWY 63) EXC CSM 28- 6416 LOT I TOWN OF FOREST ST, CROIX COUNTY, WISCONSIN Co-Owner(s): BURLINGAME, MEGAN Physical Propeft Address(es): * 2614 220TH AVE Parcel History: Date Doc # Vol/Page Type 10/04/2021 11403§1 1 WD 10/29/2020 11 521E WD 11/15/2017 .105 1 -7 28/6416 CSIVI 10/04/2017 1055089 1/ 1 WD more.. . Plat Tract-(S-T-R 401A 16011/4GL) Block/Condo Bldg 1'07-31N-15W SW SW N/A -NOT AVAILABLE 2022 Valuations: Values Last Changed on 04/06/2021 Class and Description G4-AGRICULTURAL G5-UNDEVELOPED Acres Land Improvement Total 24.000 4300.00 0.001 4,300.00 27.981 26,100.00 0.00' 26,100.00 Totals for 2022 General Property._ 51.981 30P400.00 0.00 30,400.00 W 6 0—d fan d 0.000 0.00 0.00 0.00 Totals for 20,22 General Property 51.9811 30,400.00 0.00 30,400.00 .1.. - Woodl and 0.000 0.00 0.00 0.00 2022 Taxes Taxes have not yet been calculated. Key * - Primary SANITARY SYSTEM File #: ST. CRONTY Office Use Onfy �� �� OWNERSHIP/ADDRESS FORM Crwted212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, ground%%rater, surface water, property values, and county resources. Once approved, this completed form and edulcational information will be sent to you by email. OWNER BUYER INFORMATION Owner/Buyer DL'12�L VQ Mailing Address City/State/Zip 5t aQ(�PA N - ���� i Phone Number (required)Ll IL5 I Email Address (required) n.11P 1�>i AW-W %0' 6, EAIf'16 " co j 1W Parcel Identification Number �� � � � - - (�) (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location 1/4 1/4 , Sec. -.1 T "I� N R i W, Town of Subdivision Plat: Lot # Certified Survey Map # Volume Page # Warranty Deed # L4 6)3R� (before Volume Page # Number of bedrooms — (A- Spec house 0 yes no Lot lines identifiable yes 13 no New Property Address (StA initials-) OFFIJCE USE ONLY a(v /4 ZZO AVE. I- (Verificati n of new address required from Community 17 ;?AP 2z (Dat4 lopment Depi6ment for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mop if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cddP- sccwi.ciov, 1101 Carmichael Road, Hudson, W1 54016 wywsccwl4ao M 0 -C o O V � COUCH V Rec R 20' 34' Foos Pong Q UJ szi C=) u N LANAI 22.r7x 16-5 ..o Bedroom 11 -5'x 12' (138) Bedroom 2 1Vx 16' (176) r # PORCH i 14w7x" Bedroom 13'x 13' (169) utilityC) #� St �aKi 1! si 9 10IX 10, 77 [7 b Family Room fj 11'x 16' •� � s � 4 w 4! � w Bess ' Shelter-- PORCH 8# WIDE11.E!12' .r _ w +�. � a i � � • 4 • • �.--�� _ - ,�r..�s-.sue _.� ► -� �r � " '.' � .. w � w�., - T r Z ! ' s _ a 1r � +w • � 01, C) 0 0 Couch Rec R 20' 34' Foos Pong .4 i. 22-7x 1 6w5 I t 191191 , -1 15we99 v- "19111"01 .0, 11.51 x 12' (138) Bedroom(j) 11' x 16' (176) PORCH 14V7x" ri Bedroom 3 (i) 13'x 13' (169) fir_ � .� � �. utility Storage 10' x 10' Bass Shelter 11 .5'x 12V 22-7X 16-5 N., I AV LANAI All 4o-7X" MBA__- Home Theater 1 0-5x 1 1-4 14.5'x 24' DINING 16 -OX 11 &0 WIC M Tl STE 11 0,4x6,0.r ar. ,. wI 6-Ox 140 s 46 r � KrrCH � 13arox S�7 r Dr 1 FOYER FAMILYt shelf nk Z ANT 7x16 c"m I9-Ox 1%,0 f 6x6-4 UP TO BONUS� � � r Van STUDY RCH i - _ 1 - WqF l ; � i Truck It 9 �f� NEC rff� WED MAY 31q7 L EVALUATION REPCRT Page Sets aqc SJNdIrcs C 0 M95�'� t W =mpete she pqar or pape"iv. iess ftr, E 'I 'Ax d' irt,-.-Nn ir. 3ae Plar �njslf. , din lrduoe, W rxY, knttec tc"OnZ017tS, refemn �E "rn K:bon anc pefc4en,t scope, q�je or djmens�ons, nort$-. arro% anc- locabor ene. distanoe tcnea,, roac. Please prinf all inforMation. r-�� mto-mouor V,-X D-Ovfoe rr-&4 tx US41�.- fcm sa--onaQ7% pp'jrpo"s (Flnvacy Lau I I Courts, Fie evq#e*'-4 to 4 N R E o (W C) a VFW ti Govt. Lq:!;O(-1-5" Propwty CNr. ers 4 # Sjbc. Nwr* or CSN# hkakic Adwesms Lq go 47 State Z; C"CKW Mlnone Nj-lbw New Rcad I chy L7 CA� C) v"Wge Z12 L�� somboucfiy) esjoenta, N. '0'7 C,-xx ae-ived ayes 5ow rate Replaawrent LLI.A%d ie- -a - I Piam. ete-vabon if appocabie ft q XXY)Z f vsterr. Elevation ISvSIqr" Type Zya4 Ground surface e4ev&-��Ft Pit sw 50-1 Roots GP Ha� Depth C-01"y- Redox Dftcnpbcr Tedi Strxtre Consistercx ICW in. DoMunsef Ou. Sz- C-0ior Gr. Sz- Sh. *Eft 1 E ft2. AV A?� T ?* 1, -/x 1l' � 4C OM*. I � Lj Z22f: Bon-rV y tr p;t Groond suisce atev.� ft. Hartzon Depth Domirwt C-0ior ReK$ox Desanption. in. Murmel QU SL C01-0- cloia 0-/0-� - - S& F/ffA A AfA ..M I VJM, WMAU U W- BM. > 3() 5 220 rn2k and TSS >30:� 15G CST Name (Please Print) Bird Plumbing, Inc. Shaun Bird Address 1432 120th St, New Richmond. WI 5401 Dept, tC W*bN *a or Scation RAS "r e xtire Souctire Corisisten:oe &xindary Roots GPOM *E"l 'Effn Sz. SrL d I t-Allma wr Irstmda WIWI "lion 7 • Effluerd 92 = BOO. < X mq& and TSS:5 X mQk rature CST Number 226900 Date Evaluation G'onauctted Te4aphone Num"r 01 715-246-4516 lop- C-Ipc Property Owner - Parcel ID Page Of --------- 3 Bon ng # E Boring 15 Pit Ground surface ele,.T& Depth to brniting factor in. I SCIA ' Rate Horizon DepM Dominant Color Redox Descnp*)n Texbxe Stuck" Consistence Boundary I Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, 'A 401#1 *EfW A, ear jo El Borl Pit Ground surface elev, ft. Depth to limiting factor in. %I Applicabon Rate Hk)rizon Depth Dominant odor Re<Joy Description Texture Structure Consistence Bwndary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Elohng Ground sudacft. elev. El Pit Depth to *4*V factor in. sc* NV**9fl Rate FkWi" ."th Don-irwrrt Ro1ox Description • TextLre stuck" Cormstence Bourdwy Roots GPDM in. MLWWA, Qu. Sz- ConL CoW Gr. Sz. Sh. *Eff#1 *Eff#2 0 Effluent #1 = BODIS > 30 < 220 mg/L and TSS >30 < 150 mg& * Effluent #2 = BOD5.1 30 mgI and TSS < 30 ffVIL 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. W-23 M (RAW) Property Owner Bodng # Pamel ID # a Boting -2 ),7 fR pit Ground surfam elev L�p I ft Depth to WrMkv faclor in, Sol AA*_ k:l� Rate] n�ifi�O�I ��I�► Of�II' d�f�/Yi�7�1J��'I�� nIFA9f I Wma r F Ar r/A M WIA AAW M MM MM MM Bodng 0 Boring Depth to jff�fiNr f&:Wf pit Ground surface elev. ft. �,,-,-ter. JILLA. Redox Description Qu.,Sz. Cont. Color Suing # BoH ng pit Ground surface e�ev. ft. Depth to facbr in. * Eft" 91 w BODI > 301220 mg/L and TSS >30 < 150 "V& & Eft02 = 80D$ < 30 ffV& and TSS 5 30 ff9t The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access mvim or need material in an alternate fbrmat, please contact the department at 608-266-3151 or TTY 608-264-87 77. sea-Ij.w x6m) Soil Test Plot Plan d6 Project Name Dave Burlingame Shaun Address 11 QO Main qt "-.1 -1 St. Paul Park Mn 55071 Lot Subdivision S W 1/4 S W 1/4S 7 T 31 N/R1 5 W Boring 0 Well PL Property Line or VIP Assume Elevation 100 ft BM System Elevation 99-5 C�w #.1226900 Date 5/24/22 Township Forest County T. CROIX Top of 3/4 11 pipe *HRpSame as Benchmark Please take a look. It looks like there YOU need to be a new game planl If there is disagreement about the we and, the property owner can hire a Wetand Delineator and have the site evaluated. Thanks. ysteiii 'LOT PLAN PROjigcT Dave Burlingame A D i] R ES 5 11 go Main St. St. Paul Perk Min 55071 N 114 SW 1f4 7 IT 31 N1R 15 W rawrq Foxes# COUNTY ST. CROIX yrnm EUVATION 995 1.5' sand lift DATE 5 BEDROOM 4 +N`ZNTIONAL AT -GRADE CONVENTIONAL LIFT HOLDINGF TANK MOUND W SEPTIC TANK SIZE 1200 gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of Chambersnone BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 1001 Filter Lifetim 11BOREHOLE YELL * H. R.P sarne %1maifflailikk B- � 1320' Property Line Area 16' below system to B - 3 remain undisturbed Weiser Combo Tank Well is to meat all 1,R setbacks Pro 4 Bedroom x++. B -1 �\\� g6.5' 67.b' B.M. Grading Is to be done to divert run -oft away from system Scale = 1/4" = 10' 01 400 80, 2201h Ave r] OUJOH U mutis x AL *a$ umdS $ OAPON K 40 W * *)Q8 4 A oldoed as soloqd 'stuewnoop 'so6vssaw puy OP. H `wl'c k Id .-V-H ' SMZHA -)%-XlLuoo 1,1*,, " " PPA,'oA4-4Ilb CARISMD"CA] UAM30 dl311 U311W)"A 1111 uqwmiy1uj1l4j U-1 Wd Pw 1�NVNLA SM3-m In" lll()Il � I COUNTY NO* UFN ft% 0 14 k na 10-11 ?1 MA Ll 8 " S 11 FM TOWN OF SEC 5T N1 AND/OR LOT IS PERMIT EXPIRES A.A Lac.#?.24o0 445 BLOCK '1 � CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and ma N I i v r u n u wed fi) r ;k specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewaL (f) The sanitary permit Is transferable. RWory: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ZED ISSUING OFFICER —DATE UNLESS RENEWED BFFORE THAT DATE POSI IN Pl—.AIN VIEW SBD-06499 (R1 1/20)