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026-1306-00-029
St. Croix Wisconsin Department ofCommercA PRIVATE SEWAGE SYSTEM County: Safety and Building Division INSPECTION REPORT Sanitary Permit No: 03 (ATTACH TO PERMIT) State Plan ID No~ GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. City Village X Township Parcel Tax No: Permit Holder's Name: Richmond, Town of 026-1306-00-029 Rousar, Jamie A. & Jamie P. CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ~FJ yy\ 19.30.18.1636 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r CAPACITY STATION BS HI FS ELEV. Septic Benchmark /I• I d ~6~ G ~8 _ g IAJI` e Dosing Alt. ✓wj L O F~ 1 C~ J C> wa -V r„t_b,,, Q / b lG ~~i~ Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Ai Intake ROAD Dt Inlet /hoc Septic Dt Bottom f/ C,~~ ~ 7 ~ 3 Le Dosing / / / / Header/Man. 7•!sl ~ ~ ,y/ Sy 750 -7 371a / . z Aeration Dist. Pipe Holding Bot. System rf /D i 00.5 Final Grade g J~ • 1 PUMP/SIPHON INFORMATION Manufacturer J)e UT' Demand St Cover t C Jt~- CJ GPM Model Number ft~ Z„[ TDH Li , $q Frictio~o73 System 72, JT Forcemain Length Dia. Dist. to well ~7 SQ / SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS b Z ' f ~-13 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:f INFORMATION CHAMBER OR -3_:-^A& 1 UNIT Model Number Type Of System: 77 7 : ova 3 166 '_7 /66 Gp rt..>t v~r 0 ~ DISTRIBUTION SYSTEM ZZ+!Z Z = J S Header/Manifo! J~ IDistribut'Lon Hole Size x Hole Spacing Vrto.Air Intake Pipe(s\ ) Length 5 Dia_ Length Dia Spacing 4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only CLA. Depth Over Depth Over xx Depth Qf xx Seeded/Sodded xx M hed Bed/Trench Center Bed/Trench Edges ` Topsoil ` Yes No Les No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 963 150th Ave NNew ichmond, WI 54017 (NW 114 NE 1/4 19 T30N R18 ) Glens of Willow River'06/Lot 29 Parcel No: 19.30.18.1636 1.) Alt BM Description = ' t I)« ~ ~ 5 ho s 2.) Bldg sewer length = 3 - amount of cover - Plan revision Required? ®Yes No - - - Use other side for additional information. Date Insepctor's ignatur Cert. No. SBD-6710 (R.3/97) A WOO- 2- 75 BAL-sUk CT. .rAv. 3 - ►1t3 N[~J~s v-.a. jX01 7 SubdaName: TIC (Am Rhmr - F 31? TURN R18W p~ I!X: Try r`:~'^" ilrltarie i. ~G jtip of J' J~ at i Ag t e4oA cx ~fo w ~ Vej cgo~o o.a) C4 ntour one F1. ,ov.4L Co T f t Cr g r ~i 40 -rw X x~ 1 M t o 1 map tic t I I i l l If't' ~ 1~, I _ f 1 j. into M- III 1 t ~ p P- d' l ID ~ix%p y 3 we0-- ~ X Py n ~ r County Safety and Buildings Division f Q $ Ik 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in Ify Co.) P S Madison, WI 53707-7162 Sanita it Application State Transaction ber In accordance with SPS 383.21(2), e, s lssion of this form to the appropriate govern rrll is required prior to obtaining a sani No .Application forms for state-owned POWT} ,are submitt roject Address (if different than mailing address) the Department of Safety and Pr si Se . s. Personal information you pr " e be 4Wjd*r seconds ' purposes in accordance with the L s. 15.04 1 m Stats. "```"'''"CCCCCC~~~i''' 'Pop AV e- a 171 1. A lication Information ease Print All Information S . N a WT 5,q Property Owner's Name Parcel # Gi. *j c- 1 t 1!~ K4 z-c.-- t tS c, ~ ~o - / 3 Q l;G - Chi 2 y Property Owner's Mailing Address Property Location 1,11-3 . C'-r Govt. Lott City, State Zip Code Phone Number , / Section 0 S' ircle one) yet - T3 o N; REolf~ II. Type of Building (check all that apply or 2 Family Dwelling -Number of Bedroo ' Subdivision Name l*---- I Ol6 616 1-4~ Au- CCletu of 41 !lo w ❑ Public/Commercial - Describe Use ~ ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of n l- C t,.> L7i ~'~i Z t -1~t Z Town of R I Z4 -eden~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ew System ❑ Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) 2` B. ❑ Permit Renewal aPermit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date ss d Before Expiration Owner-~ IV. Type of POWTS System/Component/Device: Check all that apply) n w / 'S X Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soir- ❑ Holding Tank Other ispersal Component (explain) ❑ Pretreatment Device (explain) - V. Dis ersal/rreat 1 nt Area Information: adG~ D w (gpd) Desiggnn SoiApplication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Prop ed (sf) System levao n j '1. C* V w O5j. 4 r I 41 QF~ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units S o ~2 New Tanks Existing Tanks / r o Y Ry G✓ a /lL~ a U in y vm w 5 w Septic or Holding Tank / f'Ba V' f Q Dosing Chamber ? VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum " ' MP/MPRS Number Business Phone Number r+v G ~ "715--S-qq -5a Plumber's Address (Street, City, State, Zip Code) 3 " C Z 7 `7Vd VIII. Coun /D artment Use Only Approved 1:~isappro~ ve Permit Fee Date I ued Issuing A e Signature $ gs , to S i3 Owner Given Reason for De ti a, IX. Conditiftowweasons for Disapproval eptlc tank, effltlsnt finer end e ev a)(i' o &16 LJ dispersal cell,must all be services / malntained V a:#" r management plan provided by plumber, 3., M ~ 1gt*ements must be maintaiged 'Tun Attach to complete plans for the system and su it to the C untyonly paper not less t 81/2x111 inchesLin size t i V T ci~,-' d y fi rG [/OCR f SBD-6398 (R. 11/11) 12-1-5 3ALM4-k CT. f;ity CtatoZia: jai f:Ati` w i 540 1 7 •rs SuMfName: 11W Gim of W. it, Iqw Rive- T $1Y T30N R1$W ToA nshi". '.M T-tv, Vt ^evc:.. _ t~%7taric ri. cv.5 -Fop of ~Gae f As t Gvo d~.e ovrrgs' (stiVv Ce9it mrA.) COntour Line EL *VdL A t 41V -or." All It t l ! I IIIT r ~se•.,g+~t~' ~ 11 ~ ! too \ a 6 10 A j "I Amt S~tbatu cross section J v, Final Grade C Schedule 40 PVC Vwd { Cap 0, a0 ft LOOOilng hamb• J/ff/. C sysr Elevation -It ft It Sod Absowdon- InM Plan ft 1 i Trench Lead,ving n vent Or Observation Pipe Chambers C Dia. Trench 2 Header Manufacturer And Modeler (,>4t1c' K 'i EISA Rating ;Z70 sq It per chamber Soil Application Rabe gpd/Oq It _ gpd Design Flow + C, Soil Application Rate + ?d EISA Chambers 2 rows of Zz. chambers each. pap ~5 Of q Paae O t` SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS u" CI VENT PIPE 12" MIN. ABOVE GRADE F, WEATHERPROOF ? 2S' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COV W1 PAD LOC K FINISHED GRADE WARNING LAB 7-- ==-4" HIM. 18" XAt r A IJ%SCarmoct INLET • WATER TIGHT SEALS GAS- ' ~ l TIGHT + vAPPROVED FILTER A SEAL, , JOINTS WITH APPROVED LYL04 5x~ -f--- LM APPROVED PIP PIPE 3' - _ i N 3' ONTO ONTO SOLID SOLID SOIL SO I s. C PUMP OFF ELEV. g1Ao FT_ OFF' D `t- W -cv "sly 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS J _ SEPTIC / DOSE TANK MANUFACTURER : W) j sy< NUMBER DOSES PER Y : Q 30 'L'ANK SIZES: SEPTIC I7~0 GAL_ DOSE VOLUME INCLUDING 14 DOSE (}Q a P_ GAL. FLOWB -779 GAL. ALARM MANUFACTURER: -S5E R{dMF30 S CAPACITIES: = 2P. -6 I CHES = LMA Gf MODEL NUMBER: 'Ant- - h - 8 2 ItfCHES G6 Y8 = = SWITCH TYPE: PUMP MANUFACTURER: ~V 'Q C = NCHES = ?7 Gl MODEL NUMBER: SWITCH TYPE: OVtJFR$i E'A t.,., INCHES = ?ZZ.Y-0 Gt .SP-5 cc'a--- REQUIRED DISCHARGE RATE LA GPM PUMP ~ ALARM wrR NG AS PER a 1 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE _9 FEET + MINIMUM NETWORK SUPPLY PRESSURE - - - - - - - - - - - - - FEET + a f EET FORCEHArm x FT/100 FT- FRICTION FACTOR EET 1 / / TOTAL DYNAMIC HEAD il--Fr E ET INTERNAL/jDIMENSIONS OF PUMP TANK: LENGTH 14# ; - WIDTH, DIAMETER gj. i-^` LIQUID - 3~ ffrPTH 77.E i - t3: i-Lowe- _jA` Pb:r, DC- 00 raQULDS PUMPS Submersible Effluent Pump PE *Wan nor GOONS Moral fl"dIT111185 ftw _ Gertat . IN Corrosion resists • WdtaW 1%, NPT phase wr atumn. • Tem"ahm I Off OM ' CO MU ■ Cast kon body. marorrmm, aorrtmuous vrhen ` 11 S and 230 voles ■ TherrnopW* anpet ww f* wbmrp& ( • Btit- *&ffaal oaload pw Mw. Icy • solds Wnft: 1~ %ft wt a Yw sli! m noftm sphere. ' Class B kwilaitim h" duty hA bearing - Automatic models kKkWe a ' 044OW desigm aorrstntdtiom AM%"TOM float AVk& • High sberqtfi carbon steel ■ Momr is penman w* Spda#y designed for the • Manual models awar'lable. shad. Ntbd®ted for a anded A n*g rage: see PE31 Motor: w hike gfe. . MMM system perfomwo chart or anus. • 3314P, 3000 RPM ■ IbvAwed for a mfix ors Lo capoW. 53 GPM a 115 Shabd Pole des* ■ =ore widin the • Basement Draining • Aiimftum head: 25' TDH PE41 Motor: of the now. • Duty Sumps PE41 - .4014P, 3400 RPM fa QW& dimmmm ~ Dawatering • Mmdmmm capadtr. 61 GPM • 11 S and 230 vo0s h 20' standard length • Matdrnum head: 2W TDH • PSC design heat duty 16x3 StTW rWwk th 115 Or230 voitgrottttft PE51 Pump: PB1 Mot of pkig- Mmftum capadty: 70 GPM , SO aHP, nd ~ ~ a Ccamptele unit is ha" duo, Maximum head: 3? TDH I 15 METERS t ' PSC desgn ■ MKhaWW seal IS wbat a0 ceramic. BONA and ste less T . * - 110DELi PE31. ~B41. PfSt~ steel. . w:.%. ,q, M ! • Stainless new fasteners. 3s , 10, 2 c +M i-s- AGEM usnme 3 _ 1 FT V co UOS Tedw fo UL778 aNd 20 CSA 222108 9tanderds ~'r ii-'`' titltlissHnl/cktS090d1 peotmnld. 10 5•. _ t q. -T 0 0 0 L.4. -174, j 10 20 = , 30 50 .1360 70 C'PM 80 0 5 10 15 m3lh t t ' Rsconsin SOIL EVALUATION REPORT #1528 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings chmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), dined n and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distan o Barest road. 29 Please print all information. Rev' By Date Personal information you provide may be used for secondary pu Law, s. 15. 1) (m)). /p o D D Property Owner rty L lion Sienna Corporation 6 ovt. ILQII NW1/4, E1/4, S19, T30N, R18W Property Owner's Mailing Address S~ # Subd. Name or CSM# 4940 Viking Drive Suite 608 p~ 2 The Glens Of Willow River City State Zip Code P ne Nurse City ❑ Village ❑ Town Nearest Road Minneapolis MN 554351 A00- Richmond 95Th St. ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public 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 .7 gpd/_sgft rating. Possible system elevation for Area 1 is (step trenches) high trench 98.49, low trench 97.49. g f 7,5 _j Q 5 ❑ Boring 04r- ❑ Boring # ® Pit Ground surface elev. 105.04 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/3 none sl 2fsbk mfr gs 2vf .6 1.0 2 11-30 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0 3 30-35 10yr4/4 none grsl 2msbk mfr Cs 1vf .6 1.0 4 35-60 10yr6/4 none s Osg ml Cs .7 1.6 5 60-90 7.5yr5/6 none grcos Osg ml Cs .7 1.6 6 90-100 10yr6/4 none ,4 , s Osg ml .7 1.6 a Boring # ❑ Boring ® Pit Ground surface elev. 105.04 ft. Depth to limiting factor 69 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 1 0-15 10yr3/3 none sl 2fsbk mfr gs 2vf .6 1.0 2 15-33 10yr4/4 none sl 2msbk mfr Cs lvf .6 1.0 3 33-45 7.5yr4/6 none grsl icsbk mfr Cs 1vf 7 1.6 4 45-60 10yr6/4 none s Osg ml Cs .7 1.6 5 60-69 10yr4/6 none sl 2msbk mfr as .6 1.0 6 69-84 10yr4/6 m2d 7.5yr6/8 sil lmsbk mfr L---- .4c 6 7.5 r6 1 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt ~ .v IKL~ 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/20/2006 715-247-2941 SBD-8330 (8.07/00) T Property Owner Sienna Corporation Parcel ID # 29 Page 2 of 3 3 ] Boring # U Boring ® P8 Ground surface elev. 100.30 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture tructure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color G . Sz. Sh. 'Eff#1 •Eff#2 1 0-10 10yr3/2 none sl 2msbk mfr as 2f .6 1.0 2 10-18 10yr4/6 none sd 2fsbk mfr 9w 2v1F .4 .6 3 18-27 10yr4/4 none sl 2msbk mvfr gw .6 1.0 4 27-36 10yr4/6 none Is lcsbk mvfr as .7 1.6 5 36-100 10yr6/4 none s Osg ml .7 1.6 ~g F4] I Boring # Boring ® Pit Ground surface elev. 102.10 ft. Depth to limiting factor $2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Efr#2 1 0-10 10yr3/3 none sl 2fsbk mfr cs 2vf .6 1.0 2 10-24 10yr4/4 none sl 2msbk mfr 9W lvf .6 1.0 3 24-36 7.5yr5/6 none Is icsbk mvfr gw .7 1.6 4 36-82 10yr6/4 none s Osg ml as .7 1.6 5 82-90 10yr4/6 m2d 7.5yr6/8 sil imsbk mfr .4c 7.5 r6 2 6 i F-sl M Boring # ❑ Boring Pit Ground surface elev. 102.0 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfW 1 0-10 10yr3/3 none sl 2fsbk mfr as 2m,if .6 1.0 2 10-19 10yr4/4 none sd 2fsbk mfr 9w 1vF .4 .6 3 19-29 10yr4/6 none sl 2msbk mfr gw .6 1.0 4 29-42 7.5yr5/6 none s Osg ml gs .7 1.6 5 42-86 10yr6/4 none s Osg ml gs .7 1.6 6 86-100 7.5yr5/6 none grcos Osg ml .7 1.6 .fig .'•I Z► 43 z * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <_150 mg/L " Effluent #2 = BOD5 < 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. SBD-8330 (8.07/00) SdWM SOB Tes", Im Page 2 of ~ Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Sienna Corporation Thomas J. Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608 1595 72nd St. City, State, Zip: Minneapolis, MN 55435 New Richmond, Wl. 54017 Phone: 715-247-2941 Subd.Name: The Glens of Willow River Signature: Lot No.: / Date: Legal Description: /VI 114 A114 S l9 T30N R18 W Backhoe pit Township, County: Richmond, St. Croix A, Bench Mark El. 100.00' Top of 2" pvc pipe d Alternate Bench Mark El. 5f' 9s. Top of $>4 / l Slope= _ 0 Contour Line El. /1//4- Contour Line Length /!.M r Scale 1" = 40' f x x k ~ ~ 1 ~ l~ ~ k ( ~t~'~ , a r Qr~ a9 Dr~,kay.~ y t, ~6 qa~ 2-6 l lr~z Xk ~ xk ~ ~ X x y93~ This Soil and Site Evaluation was completed to fulfill a zoning requirement. It may or may not be in a location suitable for you use. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of I Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 026 - 1306 - 00 - 029 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 1:1 El JAMIE & JAMIE ROUSAR Govt. Lot NW 1/4 NE 1/4 S 19 T 30 N R 18 Property Owner's Mailing Address Lot # Block # Subd. Name or CSW 1213 Balsam Ct. 29 The Glens of Willow River city State Zip Code Phone Number ity []village E]Town Nearest Road New Richmond, WI 54017 ( 715 ) 781 - 5605 Richmond 150th Avenue E] New Construction User Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable ft. General comments 8 pits were elevated to relocate system at a lower elevation so pumping would not be required. Pits varied in depth and recommendations. to limiting factors. No pits passed for an inground conventional system. IU Pt L qk5 1 ~ uz ❑ Boring # ❑ Boring © pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 "Eff#2 Boring # Boring ❑ D Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 *Eff#2 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 1150 mg/L Effluent #2 = BOD 30 mg/L and TSS 30 mg1L CST Name (Please Print) S' CST Number Mary Jo Hu ert Hollister's Soil Testing &Design) 224832 Address a Eval ti ucted Telephone Number W9875 690th Avenue, River Falls, WI 54022 05 - 13 - 13 (715) 426 - 1775 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 1 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 026 - 1306 - 00 - 029 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location JAMIE & JAMIE ROUSAR Govt. Lot NW 114 NE 1/4 S 19 T 30 N R 18 E(or)W ❑)W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1213 Balsam Ct. 29 The Glens of Willow River City State Zip Code Phone Number ity []Village ■ Town Nearest Road New Richmond, WI 54017 ( 715 ) 781 -5605 150th Avenue E] New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable NA ft. General comments 8 pits were elevated to relocate system at a lower elevation so pumping would not be required. Pits varied in depth and recommendations: to limiting factors. No pits passed for an inground conventional system. QF-t(o N !kl_ TEST~ f R ©N L4 - R(v ut ❑ Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 i ' E Boring # Boring o Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Efr#1 `Eff#2 * Effluent #1= BOD > 30:5 220 mg1L and TSS >30:5 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 5 30 mglL CST Name (Please Print) S' CST Number Mary Jo Hu rt Hollister's Soil Testing & Design) 224832 Address Date Evaluatio C ucted Telephone Number W9875 690th Avenue, River Falls, WI 54022 05 - 13 - 13 (715) 426 - 1775 County Safety and BuiligingsDivision CYC ?C C-~ g S~ I t° e w 201 W. Washington Ave., P.m. Box 7162 Sanitary Permit Number (to be filled m by Co.) t ` pS! Madison, WI 53707-7112 State Transaction Number a hn t Application in accordance with SPS ~4' is. Adm. Code, submission of this form to the appropriate governmental unit 1_ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) /~2 the Department of Safety and Professional Servies. Personal information you provide maybeed for secondary u ses in accordance with the Privacy Law, s. 15.04 1 m , Stats. lD J 6 G ~t V~ 1. Application Information - Please Print All Information Property Owner's Name Parcel # aw"t~ I ~SG,/ -li- (zt,it- 17 -Q- ccSI'vo 0~~ - 1 C G - C'na °I Property Owner's Mailing Address Property Location tali (ate Cr- City, State Zip Code Phone Num^b~erp - yg N 1A Section a! / r W t d ' S~C Gl J~ (circle Eoor L 1~i C~~-tc I.t.u~ 5-V©! -7- 7 2/ 5 T JCJ N; R II. Type of Building (check all that apply) or 2 Family Dwelling - Number of Bedroo Subdivision Name L/,.. Pleas. ol 4l.Afiriuj 1Z. 6k a,S ❑ Public/Commercial - Describe Use ❑ City of tio~~ P 4 ❑ State Owned - Describe Use CSM Number ❑ Village of / Z Town of R; Clrinv.+..v' 2z III. Type of Permit: (Check my one box on line A. Complete line B if applicable) A. XNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) s~ B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner -IV. Type of POWTS System/Component/Device: Check all that apply) c~a f' l XNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pre atment Device (explain) V. Dis ersal/Treatm t Area Information: Design Flow (gpd i; Design Soil Application Rat gpdsf) Dispersal Area Required (sf) Dispers ea Proposed (sf) S stem Elevation C)C VI. Tank Info Capac in Total # of Manufacturer r- Gallons Gallons Units Z c New Tanks Existing Tanks / /CI a U on CIO w C7 P. Septic or Holding Tank 051(7 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' MP/MPRS Number Business Phone Number 17/5 spy - s Plumber's Address (Street, City, State, Zip Code) 3:D`$' CGS ~c~tltti ws Soar VII oun /De artment Use Onl Approved Permit Fee Date Issued Issuing t Signature $~f`75~~r 3iyri3 O iven Re for Denial IX. Conditoft'PEIMOMdtlfteasons for Disapproval 3 "°IU--,r r,~t@r anri c disoer 71U I . ~F ^e5 if rnaintain as per rT ; "t c ro., 5, :iu her. 2. All setback requn~ntei,o 71us br red e~~ ~ . b~~oty C ~c as hcable code / ordinances. / Attach to complete plans for the system and submit to the County only o paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. I1/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: JAMIE & JAMIE ROUSAR Owner's Name: (same) Owner's Address: 1213 Balsam Ct. New Richmond, WI 54017 Legal Description: NW 1/4, NE 1/4, S19, T30N, R18W Township: Richmond County: St. Croix Subdivision Name: The Glens of Willow River Lot Number: 29 Parcel ID Number: co, 130tb-- C!?° Z9 Page 1 Index and title Page 2 Plot Plan Old", Page 3 System Sizing & Cross-Section Page 4 Filter Specs ~ S r Page 5 Maintenance Information n Page 6 Management Plan ° A Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Mary Jo Huppert License Number: 1859-007 Date: 02/19/2013 Phone Number (715) 426-1775 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBDA 0705-P (N.01/01). Page 1 alty. Ste. FVV TA :ii hih Cfflm~c✓. u .~v n,aWwmuc UeaGa iwarx .Gx. a . r?- Tap Of ew eww a wOpw=Contour Line .El., NIA- C'nntnrsr T.;_„_P °=4 w n. A 01 Ang r~ 1 1 lilt 1s # " I`II nIaE# 111_ '1R' n I DAI Lim Gqj I P, ~ X AT- i $oil Absorai`ion ISM Cross section FkW Grade C Schedule 40 PVC Vent Pipe g With Vent Cap Leaching Chamber System Eldon 41 Soil absorndw SWARM Plan View ft It i Leaching Trench 1 Vent Or Observation Pipe Chambers Me. Trench 2 Healer Leachi g C hK Sneciflcaifot~ Manufacturer And Model_ EISA Rating sq It per chamber Soil Application Rate gpd/04 It -ty gpd Design Flow + 0~ Soil Application Rate + ~W EISA = 145 Chambers 2 rows of 2?- chambers each. } page ~5 of q p'-S .~S MIE ~7RlLt 1 E Z W Q CL J W Oda via U' uox L N ~ _ ~ LL. W o~ U-~9~ L a U- co llt U v wM ~w T N Z ° z SO .1 0 W 0 0 0 N(6 (0 z oaa Q V- V- Iv- zQ(D(D( o C/) U- U- LL z ww:r-J J U Y) :T z da°~ J (j) LL ~ O ~ ~ io m r- a. 29 U. 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Cl) lm T m m N o CY, m O D U) ti O vZi ° cn Cn m C z =i 0~ W C') Cl N N IV Ch C7 W N WA O r M C -ml Cn D 2 C") C') O m V O° V IJ ~ n m n LLA N I oxrap i V C"Im W h1 w CO _ A A o c 3 N ;Z rQ O G N 4 N IV w C: N-1 6V17O III u 0 © 0 0 0 II _0 _ r Cn M --I Iv z cn 9-1 0= cam cn C 0 o; .tom _ m --A z cn 0 co G) cNr,cn c I z =0 O ~o r- c rnz~ nm O m c 0 Po co -m r c CC7 rn= j9; -0 Ill =m mrn Z m ° m _ m z O Z v, V O - O O O C.7'i O N CA> C W O W W ~ O G.7'1 N 0 jai F9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN of t=11.o FORMATION SYSTEM SPECMATIONG Owner Septic Tank Capacity ySG~ Q NA Permit p Septic Tank Manufacturer ❑ NA DESIGN PARAM s Effluent Filter Manufacturer 190 J _y O NA Number of Bedrooms D NA Effluent Fitter Model 5 Z5 p NA Number of Public Facility Unite NA Pump Tank Capeeity W NA Estimated flow (average) ~►C~ al/day Pump Tank Manufacturer yA Design flow (peak), (Estimated x 1.61 4,60 al/da Pump Manufacturer )a NA Soil Application Rate 0, ai/d /W Pump Model PCNA Standard Influent/Isffluent Quality Monthly average" Pretreatment Unit NA Fate, 011 A Grease (FOG) S30 mg/L 0 Send/Gravel Filter 0 Peat Filter Sioohemical Oxygen Demand (SODg) x220 mg/L q NA 17 Mechanical Aeration 0 wetland Total Suspended Solids (TSS) 9150 mg/L 13 Disinfection 13 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (800e1 530 mall )11~In-Ground (gravity) Cl In-Ground Ipressurked) Total Suspended Solids (TSS) S30 mg/L 0 NA 0 At Grade 0 Mound Fecal Coliform (geometric mean) S10` cfu/100m1 0 Ddp-Line O Other. Maximum Effluent Particle She I(` in dle. 0 NA Other; 0 NA Other. 0 Other: D NA *Values typical for domestic wutewatar and septic tank effluent. Other. 0 NA MAINTENANCE SCHEDULE Service Event Sarvitst Frequency Inspect condition of tank(s) At least once every: month(s) (Maximum S Yom) DNA esr 9) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume 0 NA Inspect dispersal oeli(s) At least once every: 7j C7 a (Maximum $ years) 0 NA a eerie Clean effluent fiter At least once every: 0 month(a) f O NA ear(s) Inspect pump, pump controls & alarm At least once every: 0 month(s) %®'NA Q ear(s) Flush laterals and pressure test At least once every: D month(s) )d NA D ser(e) Others At least once every: p months! Other: 1 13 yaw(s) as NA a NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shell be made by an Indivldusl carrying one of the following licensee or cartificadorm Master Plumber; Master Plumber Restricted Sawar; 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 oracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(a) shell be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Yd or more of the tank volume, the entire contents of the tank shall be removed by a Saptage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or preesurixed components, pretreatment units. and any servicing at intervals of s12 months, shell be performed by a oertifled POWTS Maintainer. A Service report shall be provided to the local regui)itory authority within 10 days of completion of any 3ervko event. START UP AND OPERATION Page of -1 For new construction, prior to use of the POWTS check treatment tank(s) for the prowas of painting products or other ahemlvata that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankfai removed by a saptage servicing operator prior to use. System start up shall not occur when coil conditions are frozen at the Inflltrative surface. During power outages pump tanks may Rif above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal call(s) In one large dose, overloading the call(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the oontents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntalner to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 16 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of are POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental fkhee; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease, herbWodes; meet scrape. medications; oil; painting products; peatickies; sanltary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following atape shall Ise taken to Insure that the system is properly and aefely abandoned in compliance with chapter Comm 83.33. Wisconsin Administrative Code: e All plping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pfta shall be removed and properly disposed of by a Septsge Servicing Operator. a After pumping, all tanks and pits shall be excavated and removed or their oovers removed and the void speoe filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code comppent replacement system; A suitable replacement area has been evaluated and may be utilized for the location of a replaoement soil absorption / system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Pure to protect the replacement area will result in the need for a new sell and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 13 A suitable replacement area Is not available due to setback and/or soli limkotlons. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 13 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soli and dte ,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. 13 Mound and "red* soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. t <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFMNT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 11f'rOk Name lx, Phone 7/.5- al phone -7/5 -544 J - 5-.2 l3 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name d Name JTT, C, RD(> ('0(,l/ rTY ZG~V "6, Pqu WaA- 'AA phone .Y 15 ' 5- Phone 7 ) 5 - 3 (v ~f/v C~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ,,,SAM i E SAM iE RpLI-S fl Mailing Address i L 13 $ALSlkAk t_' Tl . ,,J- W R c C--#t A& G ti Zi t,J.:t- :5qD/7 Property Address q( ' 3 1 SO -fh AV ON ik (Verification required from Planning & Zoning Department for new construction.) City/State [K- y Parcel Identification Number QZ~' l 3dEr-D~l~-d?2~i LEGAL DESCRIPTION Property Location NV4 '/4 , AAA '/a , Sec. III , T 3 (1, N R ff W, Town of T-Zi CNM UN4--"J, Subdivision Plat: -rtAV &L9- N5 OF W I LUO 140 eK , Lot # '-Z~_. Certified Survey Map # , Volume , Page # Warranty Deed # _q Y `4 > 1~ (before 2007)Volume .241Z0 Page # 410-5- Spec house ❑ yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning 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 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w ty deed recorded in Register of Deeds Office. N ber of bedrooms C-~ 3-1 /L SIGNATURE OF APPLICANT(S) DATE * *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/0 j2 `l . II INII Iillll II illilll II II I 8137161 DOCUMENTNO. STATE BAR OF WISCONSIN FORM 1-2003 Tx: 4110892 WARRANTY DEED 974436 BETH PABST THIS DEED, made between One Corporation, a Wisconsin corporation REGISTER OF DEEDS ("Grantor" whether one or more) conveys and warrants to Jamie A. Rousar and ST. CROIX CO., WI Jamie P,_$L2us's husband and wife ("Grantee", whether one of moree; tTie 03/05/2013 1:30 PM to~owing descriibed real estate in ST CROIX County, State of Wisconsin: EXEMPT#: NA REC FEE: 30.00 TRANS FEE: 75.00 PAGES: 1 of 29, lens of Willow River in the Town of Richmond, St. Croix County, sin. RETURN TO St. Croix County Abstract & Title Co. lne. 219 S. Knowles Avenue New Richmond, WI 54017 j Tax Parcel No: 026-1306-00-029 This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2013 real estate taxes. Dated this 28th day of February, 2013. - One Corporation, a Wisconsin corporation QL B o Sode erg, Owne AUTHENTICATION ACI(NOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20_ ss. COUNTY OF ST CROIX TITLE: MEMBER STATE BAR $CONS Personally came before me this 28th day of February, 2013, the (If not, above named One Corporation, a Wisconsin corporation by authorized by § 706.06, Wi$ Stafs.J~7 Z i• U ; - - John oderberg, its Owner to me known to be the person(s) who = exec ed the fore 0111 ins ent and acknowledge ga the same. P U~ 02 THIS INSTRUMENT WAS'~~~C Vv; '''~~ur~aruus•►`~ Robert L. Loberg / Loberg Law Office MA V114L Notary Public St Croix County, Wis. 1313381 ! atp I& .Art My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are ) ~1-l I f not necessary.) U "Names of persons signing in any capacity should be typed or printed below tbeir signatures. WARRANTY DEED Form No. 1-2003 1 of 1 L 0 7L 2-7 YREPAR80 FOI 90w COUNTY PAT h THE GLENS OF WILLOW RIVER X- L OF. SURYLTORr LOCATED IN THE NE1/4 OF TEM 1161/4• THE Nt1/4 OF TM Dawns a Lffxa, S61/4. PART OF THE 511/4 OF THE 561/4. PART OF THE Q~C xwq 1161/4 OF 711611 961/4 OF S6CflON /8. AND PART THE N11/4 R M1p°0N' r , OF THE N61/4 S6C1'N1N LB. ALL M T90N, 8181, TORN OF y~ t tO[M Sr. cno01 CWIHi T. 115CO1W17. ZAMM6xT N - a 1• ca : C SEE SHEET 1 TAB6B-o• L LOT 28 a w~r~ z- >~iror T~ ~ I of a ara~ rv~ Q JINAt j u aainwr ss ,r• IJ , rJ WtILT K Y9 1!`3 1 G NrmAT JxrS 9 W IIIIJI]M N4,' '>rT."',. axxNr1w• 911111E N i6Ei rrer LOT 26 , > j r h]r LOT 211 r'a wr ytfr• 1 mv y hC rs,~yT SEE SHEET 1 LOT37 i~~-SSSS i alq. L\ `S i L60OID LOT 7? 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YO Bata / r sai sow,WK D]wmI r R- ~ ~g / ~QNrfL ~ - xc-pfo awl ,xm DLwnxl ir' z --zaTa--1- -'f g7i hfafy, r fi : ~ 'x0""s.O r m wm~0'0ox w aatr°r"aox anQ"~aoL _ .ti I I ~ LL wara,'c ]fL»' " I g•t _ i:'rx]r _ ocvaoms oLmawao w av: asmlwna 1>a ~ 1 I S } 7a. A f , a wrNDlom to A.L1e0 Lr0 1 e lwa..~ K ' ,$j I 1 F uvw 1'LOT 34 or ( j, <"S uc rreur L 1 - LOT 211 -'~--'i V 1 , 1 I , LaL xsR r} ~ r ~S ~x~iQe'~a S~ I i SSee rxo-aa: ~ / ~ f y+4x~ 1„ql~ ! f'i f>rII oD° p m'e'n s i e w'o'o v~w.tnu - !"1 1 1 xea~i~'w Q.sae~s.w ac ' LOT OS S mrNxr I,xr Gm !Intl s wx vfw r,wL LaeA1~i°iwas ~ --_--__a i i i a'. a iue.w.Ox4[M14!{eQO,'xot xo'r~ ~,OtN1pw"viis~xw s I '1 f ~ieuele n x yL me Darn ]Nx~a Dare 7~ ~ / "rVL~~ ' f i 7 MmKie a ~ KsQiRf xOat I I. ' ufun ramrlL~Mac 5= f I INp LOT 112 1 S frxf]f e]exae ",rU ~ l~s' a• 1 , ` fmw ifsar rrx , 1 I IJPW.a - If YTAB S~ a 1 'a / got pgE`tS}~X ~~a 4r `rbe AI ` , j t ur ff 'i>~ t~r wl W -MK 47 /aTfy,/ . s rt,; r ui M N ',sf Lei ur LOT 20y' .p/ • - ; 'f ° rnr rer !!1111 Q mw'm Ixo.ffaa !or / ~ ~ wrcw AL- Qwl A 'r, ar loi WF aUK] O p 'A' xw.gxe -R ' ~ Nr f M / f ~ i f • IOt i+ tli Tic T six ' v o'wr xsN ev/ rsrs ~ , ♦ F-- rw m MMLUIMDUNNU. » rfi v I IrIL s wDl a ~uawr su ao fxrnam uml y fgltp rr d QI,IfaC M arxtaxw ? K ~ ~ 1., % ~ Nixpm Mrpt arnlf¢ n0 !Ol AODW ' fWl fax Mf ML lq R IQf trflm tD sllxaas Is'xt K Illl,r q QG A RA~x~pQKx{MyMf/!~Q{OyL gyp~p~pL _ " slt~l~ 9LVa KRIe M asIBYMtW ~xOM1 wT N ~ f. frxaxrc QDNxD1 >Mf rrrxrwa; NA MMMNLL >h i NaIC Q GIN rML6 frxx an Ms MN 4 sssier m zgiL n.,'rBr~. x` OPriY !M WNxf V GMl. xNQ Mla xmxAlpW y , t,1 ~ • y- aaaM 'i °caxr arras aNNW MwT Qx~YQ10 IDXtt MAIL 6 IM fx0l.Oxs OI/]a6 AaR1r Ta 1Cr 0Im - ~ f sscefL ax,ofN rwxr,rrxav a aoc x~L M,.a,/ flKA sar/s xK n. Aaa iarR Lerxro otmq ' NApll 94 w M !DI AairK. j~t °J sl}"` !s* o r C ar fmrrDN flM>Im xr nw,r IINA .rf MQ ,ft,-e1 we doMm" 4943M SIPIAM SHEET 2 OF 4 SHEETS FLOODPLAIU BOUNDARY ~r Wisconsin Department of Safety and Professional Services: Homepage Page 1 of 1 Customer Details Name MARK E BROWN Contact Info HOULTON,WI 54082 Specific contact information is not available for this customer. Credentials listed for BROWN, MARK E The continuing education information displayed here may not be accurate due to reporting, entry, or web retrieval errors. It is a credential holder's responsibility to keep track of their continuing education credits. i I • Black=Approved. The credential is currently valid and is not ready for renewal. • Blue=Renewal Application Sent. A renewal application has been sent to the credential holder. This does not guarantee that the credential is currently valid. • Red=Expired or Other. The Credential has expired, the application is pending or the record has been locked. The credential holder should contact the credential unit if they wish to reinstate the credential. Credential CE Hours CE Needed Type [Expiration Needed J1 By Master Plumber 03/31/15 23 71 12/30/14 http://apps2.commerce.wi.gov/SB_Credential/SB_CredentialList?cust_id=224656&j_capt... 3/13/2013 t r yP i • f 1- y, f'3 .EZ 7 ct 9 A. t7 , rt} twf t kt: yS ,N r ' -101"isconsin SOIL EVALUATION REPORT #1528 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings chmitt Soil Testing, Inc. County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direc£ nand percent slope, scale or dimensions, north arrow, and location and distan o earest road. Parcel I.D. 29 Please print all information. ~0 Rev' By Date Personal information you provide may be used for secondary pu Law, s. 15. 1) (m)). ~p o D Property Owner rty L lion Sienna Corporation 6 ovt. t NW1/4, 41/4, S19, T30N, R18W Property Owner's Mailing Address CJ~ # Subd. Name or CSM# 4940 Viking Drive Suite 608 ( 2 The Glens Of Willow River city State Zip Code P ""K Nrxe City ❑ Village ®Town Nearest Road Minneapolis MN 55435 Richmond 95Th St. ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public 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 .7 gpd/_sgft rating. Possible system elevation for Area 1 is (step trenches) high trench 98.49, low trench 97.40'. 7,5 _j 5 Boring # ❑ Boring J-at- ® Pit Ground surface elev. 105.04 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/3 none sl 2fsbk mfr gs 2vf .6 1.0 2 11-30 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0 3 30-35 10yr4/4 none grsl 2msbk mfr Cs lvf .6 1.0 4 35-60 10yr6/4 none s Osg ml Cs .7 1.6 5 60-90 7.5yr5/6 none grCOS Osg ml Cs .7 1.6 6 90-100 10yr6/4 none s Osg ml .7 1.6 2] Boring # F-1 Boring ® Pit Ground surface elev. 105.04 ft. Depth to limiting factor 69 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 10yr3/3 none sl 2fsbk mfr gs 2vf .6 1.0 2 15-33 10yr4/4 none sl 2msbk mfr Cs 1vf .6 1.0 3 33-45 7.5yr4/6 none grsl lcsbk mfr Cs 1vf .7 1.6 4 45-60 10yr6/4 none s Osg ml Cs .7 1.6 5 60-69 10yr4/6 none sl 2msbk mfr as .6 1.0 6 69-84 10yr4/6 m2d 7.5yr6/8 sil lmsbk mfr .4c .6 7.5 r6 1 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/20/2006 715-247-2941 SBD-8330 (8.07/00) Property Owner Sienna Corporation Parcel ID # 29 Page 2 of 3 3] Boring # E] Boring ® pit Ground surface elev. 100.30 ft. Depth to limiting factor 100+ in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sl 2msbk mfr as 2f .6 1.0 2 10-18 10yr4/6 none SCI 2fsbk mfr 9w 2vf .4 .6 3 18-27 10yr4/4 none sl 2msbk mvfr gw .6 1.0 4 27-36 10yr4/6 none Is icsbk mvfr as .7 1.6 5 36-100 10yr6/4 none s Osg ml .7 1.6 t --I - ~l 70 a Boring # El Boring Pit Ground surface elev. 102.10 ft. Depth to limiting factor 82 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 none sl 2fsbk mfr cs 2vf .6 1.0 2 10-24 10yr4/4 none sl 2msbk mfr gw ivf .6 1.0 3 24-36 7.5yr5/6 none Is icsbk mvfr gw .7 1.6 4 36-82 10yr6/4 none s Osg ml as .7 1.6 5 82-90 10yr4/6 m2d 7.5yr6/8 A imsbk mfr - 4c 7.5r62 .6 -4- 44-4" ,y F-sl Boring # F] Boring Pit Ground surface elev. 102.0 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 none sl 2fsbk mfr as 2m,if .6 1.0 2 10-19 10yr4/4 none sd 2fsbk mfr gw 1vf .4 .6 3 19-29 10yr4/6 none sl 2msbk mfr gw .6 1.0 4 29-42 7.5yr5/6 none s Osg ml gs .7 1.6 5 42-86 10yr6/4 none s Osg ml gs .7 1.6 6 86-100 7.5yr5/6 none / grcos Osg ml .7 1.6 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD5 < 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. SBD-8330 (8.07/00) Sd W tt SOB Teghv 1M. a Page -7 of Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Sienna Corporation Thomas J. Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608 1595 72nd St. City, State, Zip: Minneapolis, MN 55435 New Richmond, Wl. 54017 Phone: 715-247-2941 Subd.Name: The Glens of Willow River Signature: I.i,-t.B~"'~' Lot No.: Date: ~_r ?©r d Legal Description: NIJ114IVN/4 S17 T30N RI 8W Backhoe pit Township, County: Richmond, St. Croix Bench Mark El. 100.00' Top of 2" pvc pipe - d Alternate Bench Mark El. `5~ f3s Top of l Slope= Contour Line El. /1/.151- Contour Line Length 41,4 ysr , , s/ yy 3 Scale 1 40' /0D 03 Dr~.~kQy~ y &a' ~r x " x x This Soil and Site Evaluation was completed to fulfill a zoning requirement. It may or may not be in a location suitable for you use.