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Home My WebLink About026-1149-25-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563819 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin Homes LLC, aka Oeverin Pro ertie Richmond, Town of 026-1149-25-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ( G's-r 36.30.18.1125 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER %S CAPACITY STATION BS HI FS ELEV. Septic ~C G 41 /Z g6 712 n CA Benchmark Q /O /dn Dosing Alt. p, -7 -3 / Bldg. Sewer /ar 95• Holding St/Ht Inlet 7Y.5 St/Ht Outlet TANK SETBACK INFORMATION \ TANK TO P/L t WELL BLDG. en Air Intake ROAD Dt Inlet Septic Dt Bottom 01 9a d / S 1G. V Dosing a 4j A-- 26 / Header/Man. Aeration Dist. Pipe 41,,5 J Holding Bot. System At. -7 Final Grade PUMP/SIPHON INFORMATION 3 • !J A) Z Manufacturer SGlu GP Demand St Cover (0-7 9C71- 3 Model Number Z7 5.3 iao,7 TDH Liftr/ Friction Los System HL ad TDy Forcemain Lengt}, / Dia., ,I Dist. to Wen SOIL ABSORPTION SYSTEM ~V BEDITRENCH Width Length No. O zp PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /Z 166 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR TYPej~f.~ ~temG /J~C~L UNIT Model Number: DISTRIBUTION SYSTEM o f Header/Manifold Distribution i/ x Hole Size x Hole Spacing / Ven Air Inta Pipe(s) cep S Length Dia\ Length / D Dia Z Spacing 3 Z v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center I~ Bed/Trench Edges Topsoil es No Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:F/L- Inspection #2: Location: 1268 142nd Street New Richmond, WI 54017 (SW 1/4 NW 1/4 36 T30N R1 8W) Torey Pines II Lot 2 Parcel No: 36.30.18.1125 r 1.) Alt BM Description = F: ',l ~b 0,e. CL a ~y Z a jz,-!, C11., r 2.) Bldg sewer length = Zd4 d ~r0 Js ~ - amount of cover = t) f' n n P Plan revision Required? ❑ Yes No Z Use other side for additional informa ion. SBD-6710 R.3/97 Date Insepctor s S nature Cert. No. PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 114 NW 1/4S 36 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 101.0' BEDROOM 4 CONVENTIONAL AT-GRADE XX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as benchmark - - - - - Property-Li-ne _ _ B.h'1.* Scale = 1 / 4" = 10' 99.5' Area 15' below system is 101.0' to remain undisturbed B_3 101.5' El B-1 8% Slope Pro 4 Bed roo m Ho use H uffc utt Combo Tank Grading is to be done B-2 to divert run-off away from system We l I is to meet al l WDNR setbacks Tank is to be properly bedded and provided with I oc kdow n cove rs with approved warning labels 490' Property Line 142nd St. County cam( a Industry Services Division ~Y_ r ` > -1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) a 4D S rf P.O. Box 7162 S Madison, WI 53707-7162 `w (O State'rransaction Number Sanitary Permit Application 3~~ In accordance with SPS 383.21(2). Wis. Ac CdK1 ssion of this form to the appropriate governmental unit required prior to obtaining a rani rr N ation forms for state-owned POWTS are submitted to Project Address (if different than mailing address) is the Department of Safety and Pr ss al ersona information you provide may be used her secondary 6 ur uses in accordance with th w, s. I " m), Stats. 1. Application Infor,natio le mf Ali I ----rs Parcel # Property Owner's Name f - i1T__ lJle ~n_ $1 Property Location I I Property Owner's Mailing Addr UI` 3 r el G~vt. Loot _ - - Zip Code Phone Ntnnl~if CR_ ~9 ~.i.~ Section City, State l / ^ Ircle on~ N; I F'ol !I. Type of Building (checN all that app] Lot --arne or2 Family Dwelling-NurnberofBedroo s h® _~-1-- - ❑ Public/Connnercial - Descri'ne Use o_k CA _ ❑City _ - C~(Number- ❑ Village of ❑ State Owned - Describe Use n of_ 111, Typ o1'Permit: (Check only one hex on line A. Complete line B ifapplicable) - - - A. New System Replacement System El Treatment/floldiag'1'anlc Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number tmd Date Issued ber ❑ P B. El Permit Renewal Permit Revision Change of Plum pwnerermit1 rausfer to New - Before Expiration IV. T of YOWTS S stem/Compllnent(Device: (Check all that apply) _ - il ❑ Non-Pressurized In-Ground [I Pressurized In-Ground t-Grade F] Mound > 24 in, of suitable so Mound < 24 in. of suitable soil ❑ ❑ Pretreannent Device (cxplain)____ ❑ Holding Tank ❑ Other Dispersal Component (explain) _ _ - V. Dis ersal/Treat ent Area Information: Dis c sal Area Proposed ) System Elevation Design Flow (gpd) Desigr Soi Application Rate pdst) Dispersal Area Required (sf) P Capacity in Total # of `Manufacturer v VI. Tank Ini'o a " u Gallons Gallons Units 2 p U n n r Newl-anks Existing Tanks o QC4 _ Septic or Holding Tank _ _ - - Dosing Chamber 76~ ils. V11. Responsibility Staterrient- 1, the undersigned, assn espousibility for installation Of the POINTS shown on the N. nbetached p3iusmess Phone Number Plum N me (Print) Plttmbe nature - 71b of .00~C Plumber's ddress (Street, City, State, Zip Code) 1 _-/Zq 54 V111 Count /De r•artmene Use Only Permit Fee Date Iss ed Issu,ng ent Signature, Approved ❑ / - to ex7 ❑ ne en Reaso vial $ - p - ~e asons for, Disapproval 3 La~cx j c.n5 ~ Pr IX. ConditM ,ti 1; ffii4pti0•.tank, effluent filter and a dispersal cell must afl beservices t matnta rod pe I 'A- J d `d1.E Y~ as per management plan provided by plumber' n ~b A e Z, AN It requirements. must be maintained ® a ,l, r 1 - per Code t ordinances. t Attach to complete plans-for the system and submit to the County only w? Pei .0, less tl112 rx~ 1°et~e SBD-6398 (80313) DIVISION OF INDUSTRY SERVICES epA1~T1 PO BOX 7162 o$ 9 MADISON WI 53707-7162 ti D Contact Through Relay 3 ! S K www.dsps.wi.gov/sb/ R S w www.wisconsin.gov G ~~Oss~oNScott Walker, Governor Dave Ross, Secretary June 25, 2013 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/25/2015 Transaction ID No. 2260390 Site ID No. 792056 SITE: Please refer to both identification numbers, Oevering Homes above, in all correspondence with the agency. 1268 142ND St Town of Richmond St Croix County SWIA, NW1/4, S36, T30N, R18W Lot: 25, Subdivision: Toy Pines II FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1434149 Maintenance required; 600 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter 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: This system is to be constructed and installed in accordance with the approved plans and with publication SBD- 10854-P (N. 03/07). • Distribution cell aggregate material shall meet the requirements of SPS 3 84.3 0(6)(i) & (k), Wis. Adm. Code. Distance from discharge orifice to end of distribution cell shall be > 6 inches but not > 2 feet in accordance with ND SBD-10706-P (N 01/01, R. 10/12) Table 2. COD • The pressure network is to be constructed in accordance with publication SBD-10706-P (N 01/01, R. 10/12) DEPT OAPP F entitled "Pressure Distribution Component Manual for Private Onsite Sewage Systems" and based on pipe sizing EPT F methods contained in Small Scale Waste Management Project publication 9.6 entitled "Design of Pressure PROFESSIO Distribution Networks for Septic Tank - Soil Absorption Systems." DIVISION OF 1N A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of~ SEE R construction/installation/operation. SHAUN R BIRD Page 2 6/25/2013 y In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. 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 responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Sally Sh aker Please Include a Copy With Your Engineering Consultant, Integrated Services Payment Submittal. Monday - Friday 7:45 am - 4:30 pm WiSMART code: 7633 sally.shumaker@wisconsin.gov cc: Edwin A Taylor, Waterwater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. I' '0 4q 1 SHAUN R BIRD Page 2 6/25/2013 In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. 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 responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, - - - Please Include a Copy With Your - - Sally Sh aker - - Engineering Consultant, Integrated Services Payment Submittal. Monday - Friday 7:45 am - 4:30 pm WiSMART code: 7633 sally.shumaker@wisconsin.gov cc: Edwin A Taylor, Waterwater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Charles L Bratz, POWTS Reviewer II, (608) 789-7893, 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. t ({~/\\j] ~Ct V 4A 0 Tq7 J 14 01, Le 0 RECEIVED f JUN 12 2013 ~~CE Cover Page RV/ Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/6/13 Owner: Oevering Homes Location:SW1/4 NWV/66 T30 N,R18W 1268 142nd St. Richmond System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications 'ZONALLY Shaun Bird ZOVED ~y AFETYAND Signature JAL SERVICES License number 226 USTRY&ERY= NDENCE ~ r t nt ,.l i` MGM '31 „K ;77 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NW 1/4S 36 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 101.0' 4 BEDROOM CONVENTIONAL AT-GRADE XX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. 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R R w•R R R R-'L L- ' ~ I .0 II %Slope = 1'lowe fClean aggregate basal ~,lrea :ti.. %z to 2 % in. dia. 0 - 4 in. sch. 40 pvc observation ripe i .,ateral with 2" 'T'opsoil CUP agl ;rega:te over pipe Ueotextile - Observation Pipe - G Fabric With Can r ryrR} r j Ft Lateral In-C rt F y-y+y•R•yy. ~ C r•J+r•l•r•r. r•r:r.r r r r•r r R 'Vi R-R•R•R•R•'L+R +R R•R•ti•R■R■R 1, 'L■R•R l'op . r r r r•r•r•r-J r•r.r r r-r r J•r J r r- Sol I Cap .I ii t R y'~'L.'L S•R.R ■■R.y. ~,■y.~•Y. ~,R R R R R•R . ~ i } r■r■r• YrrrYf•d+■r li ! J■r'1,J';,r J M r~r■J r r■r r, Ii _ R 1l R R R•R+R•R R 4+ •R 'P TJI -.rr ,r r+r-J•r•r•r•, •J ~ r' ■ M.,!!r5~!4•■.■ •y, R~!~ l t Contour L'L L R y-R 1 t r•r r r J r•J , „...1 LdLti 4rR.'L■R.R.RrR■R R• r J r~r,~r J r•r• ' r r r r•l-J•J r•r• J A. _ I) - ? l'lopred Surface~4 .y L Slope Direction GENERAL [NIST ALLATIONr The at-grade area is staked out along the desigli contour. Existing vegetation is movved and raked off the site. ':fhe basal area J., x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed it-the soi i. is wet enough at the plow depth to form a /4 inch soil wire when a sample is rolled between this pall-::Is of the hands. The A. a 13 area is covered by cleat aggregate deposited overhead by a backhoe. Special cart musi be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at--grade is seeded and mulched to promote vegetative growth, limit erosion and protect from li'eezinEg. T-te observation pipes are perforated in the lower 6 inches and secured in place. 03/05 lgi Page____ of Pressure Lateral Layout One Lateral - End Manifold .4 Threaded Cleanout Lateral Turn-up --00. Plug Force Main X L - Long Sweep 90 Bend Pres3ure System Construction Distribution Network S ecifications Lateral Diameter+ Z In. Laterals aj-e, constructed of Schedule 40 PVC OrificeDian-Leter_ In. pipe. orifices are drilled perpendicular to X (orifice Spaciri j , In. the pipe with a sharp drill bit and face down. L Lateral L. Ft. Lateral turn-ups terminate with a threaded Force Main Diameter Z In. cleanout plug and are enclosed in a 6-8 inch Force Main Len th Ft, diameter lawn sprinkler valve box accessible from finished grade. • • • • • • • • • • • • • • • • • • Grade • 6-8 Inch Lawn Sprinkler Valve Box 03/05 lgj Page of ;Septic;-Dc tSe fank. Cross Section An Pump.Performance Specifications I ank Manufacturer C i Putm) manufacture --r-0 1'rml7 Model Ntu►ber Tank Model ~ !7 f _ K Total Tank (,pack y Iraxtt 1Vltmufe'turrox A.la m Model Nimber Total yriarnic Read ('.['DH),- 11 eel k titer Matxufi!n,tur~ .l' I!X t'rltc t 1Vladel 1!I~urnloer Elevw,,!on Head - !a liitital Pressure Network Loss inimr.an Purr p )et'formanae RegtYir'ecl ~ ['otxt f 1 1, C al'CNl l l.! L_.~ _R T DH Outlet 1.Vlanh(de Mim V' Above (xrade With Manhole Min. 4" Above t;r'rtuie; f.:acslCinl; 1:)e~im. Inlet 1Vlarthole < 6" Below Grade, Sealed W atertiaht; ~ I Secia ily mounted With Locking Device Weather-proof Junctiou Box ■ y♦ ,ya{y Grade Finished ~ mmw I-" YYm 0.6. YYY. L.rt ~ r®Y ' Vent. Ain. 12" , Discomnect Albove Grade _ Wlaaois a With lent Cap Y'f •~+'e`Y1~.TTi~t"Y Ya"f- -.-r.~.r.~ir .-rw-.-.Yl-rr+rr►'r•r Y Y Y Y Y Y Y Y i Y I Y Y ♦ I; L Y Y Y Y`•`~ •,•Ir: Y' _ +Y . J• J Y•V•V•V `aF aYV~a~J~ 'E VY~~.-•!f1~.Y tY gib, Y,/ Y, Ylfr +i.ia~rl 1 r r I Y 4VY`Y YV1~Y,~, Y.•k~Y.M,Y 1 Y Y YI• IIrf1111Y1~i11M~1 ' v Y~ Outlet Filter Ifilet blet Bale it Y> • r7 !'4witch 'I'ett"ii s + Reserve capoucity IWO Weep l nrtk Valrxrruc / : i.?itnen11011; lrrches 'Volume Gal l1 `IY R . c~ w- re,gervtc) A. ~ J ~ r J Off rle' don (dose) `C; f3ot D • tam (dead) 13levation Ili V ~ - Iry Vy, ~.;Y rota) •Yi _y-l...f s~G'~4-L~L'Tl'.~il r4 _L_i!'t..Y~ti~1~i'fz_T.{'lia y_IT..}.-r.rY..r~Y.z.tl t-y-l-Y ~t s . .c'fY~CT"i"T'CTi'Y". T`TY"LJ • a 1 • . 1>.Y s•V~,1 ,a,Y~a ly yiy y.. I J a V a a! a V Iy 1 I i 1 i V•+~I J l 1 L ) : p 1 3 1 1~1 1 la l Y r 1 . > } F Y } Y > . . Val •Y •1 116 IaY'r"4 "I•Y `f'Y i+ 1 Y'F Y•Y Y'I• ' •I' ' 1 1" ~•J'a I JFd 1 d V,Y Y a 6! L d l I d; i1,lY+ a J Y Y Y L 1 V J 1•y / Y I I J 1 Y 1 I~IrY,I'1 f''1`1'J `Y'1'Y`V'('Yy ly+,l'V•a•1, Y•I• ~ +r Y.L: Y Imo.: ~,y,Jsy,~~IL.I,.,} , • ;:.t ~1.i1,LY~l. • ,.y.,y.t..YJ..tV1.41_.L4.L, .,Y_ .1.,y..p..Y-k ,A. Y Y_Lk.A.1_L.l.l YJ Y GENERAL IN,"I irMA-A-TTliON: 'l'ire septic/dose tank is bedded and back filled ill accordance With the, manufacturer's p cduct approval specifications, Maximum depth of bit y as spociflod by the InimuNcturer nmy not be exceeded withcat t for approval. hluihole covers exposed to grade have an en®cstive locking device (padlcocic) installed. Piping at the intet and outlet is of approved material, connected to the tank with Watertight tiitings, and laid on stable soil l q3 prevent settling or sagging- The force main is sjee vecl with 4" Sch. 40 PVC to bridge the tank uxcayation aim-.1 the sleeve is scaled watertight. Electrical service, comph m with NBC; 300 and Comm 16.24, 0110 1,.~ paw A. . aW ► ew. SEIV-400 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids Flow - Liters/Minute CoIrwstruricti'ion 0 50 100 •150 200 250 300 C.wiC r 35 --a-: 4 3U 1U epoxy-coated cast iron IVfGtcr HoaSOW EPOO-0gatdci cast iron' ~ 9 Impe ler Material Thermoplastic I-lasto mer 25 - - s ' Irrtlie f~tM1 fpe - Non-efgg,- 20 i 6 w Uplut t Epoxy-watec1 Cast iron v 45 ~ 5 06,f r'Ggrci JTW 10 - - 4 y Moc t, v 6cal Shaft Nitrile with carbon and 3 SBaJ GE rarpl( fac e5 s 1 FasJelers Stafn6bs stool 0 , Shari 0 Steel L0 U 40 60 00 F~w- Gallons/Minute S ruigs Uppel;sinfored.clseve andAgN6r'ail gearing; I .lT L_ _ c.iur u.is• SEhl-40-AF SEIV•-4U Specifications &MU SENT 40 50921 4!1(2. 115 1 1/2" FNPY 9/920 80 70 60 45 25 32 14 20 26,5 1750 04 "1 171 j~F'1 j 9I£!aR 8fi'a 70 ,.a6 1~7~ A'a/nM r+q I SEEN 40 AF 5091213 4110 1 15 11/2' FNPI J/920 50 k ~ 80 70 60 45 25 32 14 20 27.5 1150 ~:S N 40=/A . ~ ~ /Sll)"' , ~,t 1k. 1 1 2^ !FW4 9[ 20 f84 gyp 60 Franklin Electric 400 East Spring Street, Bluffton, IN 46714 Tel; 260.824.2900 • fax: Z60.8Z4.2909 Form: 996199 7-17 www.franklin-efectric.corn POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM t0'PECIFICATIONS Owner, ~ Septic Tar k Capacity CJ NA Septic Bark IVlartufacturer Z f _ iJ NA ]ESIGN PARAMETERS Effluent Filter Manufacttirc1r- -1 NA Number of Bedroomu El NH Effluent F I (er Model 0 NA Number of Public Faaality nits - - j6-NA Pump Turd; Capacity -ry ❑ NA Estimated flow (average) y(T4' al/da Pump Tank Manufacturer ❑ NA I Design flow (peak), (Estimated x 1-5) gal/da~ Pump Man,afacturer El NA Soil Application Rate - a{/da /ftZ_ Purrtp Mrirkol CI NA Standard Influent/Effluent C: uality - - Monthly averagew PretreatmE3 it Unit r-A Fats, Oil 8 Grease (FOG) 530 mg/L El Sand/G-~avel Filter 11 Peat Filter Biochemical Oxygen Ili inand (BOD5) 5220 mg/L 0 NA n Mechanir:al Aeration L::1 Wetland Total Suspended Solids (TSS) :5150 mg/L_ ❑ Disinfection 0 Other,. Preheated Effluent Quality Monthly average Dispersal C,all(s) 1-1 NA Biochemical Oxygen Demand {130176) 5301 mg/L ❑ In-Gromid (gravity) L.1 In-Ground (pressurized) Total Suspender{ Solids (TSS) 530 mg/L ><NA At-Giado El Mound Fecal Coliform (geometric moan) x104 cfu/100ml 0 Drip-Ling EJ Other: Other Effluent Particle aize 4 in dia, C7 NA 0 NA Other:.NH Other: ❑ NH *Values typical for domestic wtd:tewater and septic tank effluent. Other - - ~ 0 NA !MAINTENANCE SCHEDULE Service Event Syrir{ce Frequency - !inspect condition of tank(s) At least once eve Mont (s} ry' ears (Maximum 3 years) Ll NA !pump out contents of tank(s) When combined sludge and scum a luals one-third (fa) of tank volume LJ NA - !inspect dispersal cell(s) At least once every; L] month(s) iiyear(s) (Maximum :f years) CJ NA 'Cl Clean effluent filter At least once every; / lr ear(s)s) 1:1 NA Cl month(s) Inspect pump, pump control:; & alarm At least once every: j7~gear(s) L] NA Hush laterals and month(s) pressure ierst At least once every; . AS-year(s) L~ NA At least once every, Cl month(s) _ CJ O NA - - - - year(s) - 0 NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dinaersai cells shall be made by an individual carrying one -f the following licenses or certifications: Master (Plumber; Master Plumber Rustricbed Sewer; POWTS Inspector; POWTS Maintainer; Septaga Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identity any cracks or leaks, measure the volume of !combined sludge and scum and to check for any bank up or ponding of effluent on tha 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 giround surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. IA/hen the combined accumulation of sludge and scum in any tank equals one-third (Xi or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of n accordance with chapter NR 113, Wisconsin Administrative Code. 10,11 other, services, including but not limited to the servicing of effluent filters, rnechanimi i or pressurized components, pretreatment units, and any servicing at intervals of 51 7 months, shall be performed by a certified POWTS A,aintalner. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction,, pri ar to use of the POWTS check treatment tank(s) for the prersence of painting products or other chemicals th.,lt may impede the treatment process and/or damage the dispersal cell(s). If high ooimentrations are detected have the contents of thia, tank(s) removed by a seplage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pornp tanks may fill above normal highwater ieveis. When power is restored the excess wastewater will ble discharged to the dispersal cell (s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenit. To avoid this situation have the contents of the pump tank removed by a Septaago Servicing Operator prior to restoring power to the 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 within 15 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 the POWi.13: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dentO floss; diapers; disinfectants; fat: foundation drawn (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products-, pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following step€• shall be taken to insure that the systern is propel-ly and safely abandoned in compliance with chapter Comm 133.33, Wisconsin Administrative Code: • All piping to tanik:e and pits shall be disconnected and the abandoned pipe openings sealed, • The contents of all tanks and pits shall be removed and property disposed ct by a Septage Servicing Operator. r After pumping, adl tanks and pits shall be excavated and removed or thelr 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 compliilint replacement system: Cl A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacemerrl area should be protected from disturbance and compa3tion and should not be infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure: in protect the replacement area will result in the nEled for a new soil and site evaluation to establish a suitable replacement area. ieplacement systems must comply with the ruiesl in effect at that time. C1 A suitable repla,:,ement area is not available due to setback and/or soil limitations. Ban•Ing 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 POWl•S a soil and site evaluaiiion must be perforrnasd 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 soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface, Recon: tructions of such systems must comply with the rules in effect at that tirrre. <<WARNING>> SEPTIC, PUMP AND 01'1•IER 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 O1 A PERSON FROM THE IN'T'ERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS.. POWTS INSTALLER POWTS MA114TAINER a Name si^,-~.t.`• r~~ ~ _ ` '~..~-1~. Phone 14-rl SEPTAGE SERVICING Oil ERATOR JPUMPER) LOCAL REGULATORY AUTHORITY Name Name ` Phone 1. ? - Phone w - This document was drafted In c;ompllanc:e with chapter SPS 383.22(2)(b)(1)(d)&(t) and 38154(1) (2) & (3), Wisconsin Administrative Code. p r . ~ e FILTI~, R CARTRIDGE 't LA r ~ goon" ,p` Ir Installation '_^rrp I Ur y flt' th theace filter e: ed Hse! onto the eon tut the nutitak Pipe to tancen k ter through nder MUS opening. if not, then either insert ehsmare F , the outlet crr' solvent weld ure it is PiFie. (914 a) additional pipe onto the o oe the uttilet While the casrn is still rl fitted M of 'Y.-inrh pipe needenl tcn brat:o ile fi optional ~r to the reek end W;, slipple!mehtr~l .ide su nlpe, rneastcr'e thre length Ol'pteed to pprlrt. If side .,u ll if [rtilizing the step four Apart rnnthod is plot utilized, Far ittstatlatiarrs litalzirrg the optional ' APPlenrerctal side su solvent weld the st utilized, proceed t to o st etep , pipe onto the filter case- if side support method is not Solvent weld Cathid I:he filter ca,e otrto the outlet i the ca-,;e. 9e into the r_ascr Pr'pssing down until tills flit". lorkslhrtarthf1 brfittarn of If a I/R, switch is utilized, insert into Clockwise y0- a 1 the flterand lack oy turning Maintenance 1., The effluent lifter s •,auld be 5er'VICed. rieaned every Iirrle the sepdr tanf< Is 1- Open the outlett acc.:ss olr,°n[rry to inspect l:i", tank and filter; 3. Pump the septic tall"- r_ornpletely, making sum to rernckve sfuc[ge layer on the bottom of the tank and net just the sr um and fh er:ffluent. olItutl 4• leet the pipe, effluent IPull has beerr lowered belu{~O th firmly pull up an e invert ar' the the filter handlt t o die ove cartridge fYorl Lhp sludge the Shde the. Cartridge III) and o ut of t:he rase f Fi. U a VRS switch cnhil[:ctc d tU hit alarm is e~ cleaning, r:.. should he removed bj- turning t-ounterclockwisc?9Uhand cleaned with water only, 7. While holding rile cartridte an Its side (large f.et strrfar:e facing :r down) over the - r.. • dcc-.,; opening, rinse off the cartridge with water 11 only, making sure all :;ePtarfe material I. r , rinsclrl track into the tank. ' r;. If VRS switch is utiltZLCI, rephace 6 y rnsertin turning clockwise 9r)-, 9 info biter and '`t~^•. 9. Insert the filter cartridge bacl( into the the filter lacks into the 6ot3arrz case, lyr^-xsiag down until it °r'Xr or the case.; W. Replace and r • " r.r,ure the acres alrenfn9 on the tank,. . ~.1:1 WWW.bearonsitae.(.-(l, ►x11 ti' 7' - uft lL~"E1 3'r (653-4583) 12 ST. CROIX COUNTY SEPTIC TANK MAINTFNANC",E AGRE EMENT AND OWNERSHIP CERTIFICATION FORM Owner/.Buyer et?_ L ~ - a k,4 Mailing Address / `f ___Pt,,.z~_D_. ~•Gn __t7r~~ cc~~._ - Pro erty Address (Verification required from Planning & Zoning Department fhr riew construction.) City/State :Parcel :ldenti.fication Number. ®_~~~_t~b - LEGAL DESCRIPTION Property Location '/a ,Sec. ~la I' -~l7 N .l w, Town of ` Subdivision r__-- certifted Survey Map ff V alurrt+. - - - - Page # - l7 Page # - Warranty Deed # - Volume ;spec house es no l,ot iir►es identifiable yes no SYSTEM MAINTEN ACE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper ►naintenance consists of'purrgping out the septic tank every three years or sooner, if ueec ted, by a licensed pumper. What you put into the system can affect the 'function of the septic tank as a treatment stage in (lie waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 St. t,-crix county Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification forth, 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 tlran 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, a~ 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 31) clays of the three year expiration date. 1/we certify that all statements on this form are true to the best of my/our lmowledge. 1/we am/are the owner(s) of the property described above, by virtue of a warranty deed re • rded in legister of Deeds Cffiee. Number of bedrooms -DATA: - - ~IGNA'l,1J1~1~ OF A3'PLT.CANT'(S) ***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. 08/0-) DOCUMENTNO. STATE BAR OF WISCONSIN FORM 1-2003 8 1 5 1 1 2 4 WARRANTY DEED Tx : 4123014 977683 BETH PABST THIS DEED, made between Mark A. Miller and Lori L. Miller husband and REGISTER OF DEEDS wife ("Grantor" whether one or more) conveys and warrants to Oevering Homes ST. CROIX CO., WI LLC, a Wisconsin limited liability company ("Grantee", whether one or more), the following described real estate in ST. CROIX County, State of Wisconsin: 04/29/2013 3:58 PM EXEMPT#: NA Lo 25, lat of Torey Pines II in the Town of Richmond, St. Croix County, REC FEE: 30.00 Wi sin. TRANS FEE: 120.00 PAGES: 1 RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parcel No: 026-1149-25-000 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 26th day of April, 2013. Mark A. Miller I -YOU Lor L. Miller,` AUTHENTICATION DGMEN7C•~, V+ ACKNOWLE rJ R ga r+t' u; s Signatures authenticated this day of STATE OF WISCONSIN' 1 20 *s` `w r COUNTY OF ST CROIX sa' " TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Personally came before me this 26th day of April, 2013, the above named Mark A. Miller and Lori L. Miller, husband and wife to authorized by § 706.06, Wis. Stats.) me known to be the person(s) who executed the foregoing instrun nt and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Oranzo J. Oevering/Oevering Homes LLC Notary Public County, Wis. 1314207/ OJO My Commission is permanent. (Signatures may be authenticated or acknowledged. Both are If not, state expiration date: 5~Z2/~Q not necessary.) WA Ii APTY DEED Form No. 1-2003 LOT 20 22M ACFES (98OW 80. Fr.) ri NW51ZCE400.4 I LM as 2. S 08.091 $a Fr.) N W512E E- AT Lcyr 24 r .ter ' w w +j )C = E~ qq _ F 0 ~ ~k~lf Ta mi s q 22 O ni 5 MPH 1461 El I Ell JIM j J E=EJ ELD cj da Nil f rrl;' i+I .Y1 ~~r I I+rlr~rirl! " I I I;~ II 1 ±I i- r x n I ~ ,rl s 3 i 3s>~ 3 E p s ~ 9 a = 43 to ~ Tp 1 J J 30 pie aw qz k I - I I i 1 a ~ I I [F I t I I a.~ ccpp ~ I e.3uw ~runurlu,v mi,wurc xw 1':1 YS I I a~rnwu ux~rww I I H I L inavn nrx na7we _ i i i £ I I I I I I I I _ I I eesusneenw uoovn I F I I I I I I I 1 b I I I I c I I - A ~ I E I I p g I I I F y I I b I I I I P Y~ I I 1 I I I I p I I I I I I 1 ~ I I 1 9 I I 1 I 1 1 x I I I ! 1.__.I I I I F J _ Lq> I 1 II I I I I F 1 1 OII I~'1 I I ~fi I I II I':I II i I II I I I I I 1 II 1 I I'~I A I f II 1 I I I - 3 I I II 1~ 1 1 1 ~ 1- 1 I I p G I I I I a rr I' I I f I I II I . fl I j jl~O 1 I.. j I Ioo.e~nl sassnu,,s.w I 1 ~ I I 1 I i I I II i I I ~ II 1 II ®1 1 I I II I I - I 11 , ~ I a l I 11 B I I I II ~~I L- rnsm,m•,xmaxm a a IOU lip. 4 'q ~3 d g N a o3z@ ja E W § 0 ] rn i Q r i ITEM - - - - r ` I qQqQ ,~J }I p~ Z 3 W W G6, LG, I Z~ I ~ ~ m I i E1o M~.„,aY1,aa~YaYr I I I I I I I I I I I I r~ n . 1 n ~ e e , I n - 'v ^ I I I 9~ e,Yxea erm rendanaa[a , _ ° I I g~ ~ I Yam„rma3~~[., , - t ! / P! ~ e a R g 1 a { a e I ~ ~ I I ~ : I _ ~ i ~ x N O O ? I 33~' I t 5 R[ I - I I e w a e, T I u.Y am 12 g n.a a§61 - _ - - . _ - y ..g II ~-I3 - _ - 7 ~ Id F~ al 711, 3~Y,[Mw. R I i I p ~ i ail ~ 1 ~ Y ~ W I I ~ - I I ~ S~ d I I _ I - I I ~I~ r- a b q8l 20 p I r.. ..e t~[ .P 1f~1 ¢~~24G2 z n o25~ B F'Eu 00 ppg % F r gv -A j W ~ f.. n~ [[Y ~ ~tt~Q'j #tl Li'j pp9g W Y YP k ~ f~N ~x k gY ' u tl~ ~ g @ g Tq (a a 9 0 X80 o 7e~ 4 4 47~ tl; YBYs a flip 9 9 €9 LNL~ IN r zz; 3 8 ~N hgb~: h ;5 ' ~ bMb6 s~ m tl I ~ abbNe 1 l 1 vlwm a x ¢ cs e~ ~;s Wisconsin Department of Commerce SOIL EVALUA7klN, REPORT Page of 3 Division of Safety and Buildings C. in accordance with Comm 85, Wis. Adm. Code'b Attach complete site plan on paper not less than 8 1,~x hes in size. P(~Wi , include, but not limited to: vertical and horiz to fel~ nt (B M), direction anV, Parcel I.D. percent slope, scale or dimensions, nortFt~w d distance tp nearest roa~~ ' S ~ODv yy Please p inf anon. » QVH Re ewed by Personal information you provide may be fo econdary purposes (Privacy Law, s. 15.04 (1) (m)). L7LI Property Owner Property Location ee:.7 P_ Govt. Lot -5L<-) 114/J td14 S 3 T 30 N R E (or Property Owner's Mailing Add ss Lot # Block # Subd. Name or CSM# /4133 ~Pr wv ® ! Su.l "?,5- r ' Oily State Zip Code Phone Number ❑ City ❑ Viill 5~To Nearest Roa New Construction Use Residential / Number of bedrooms Code derived design flow rate 6 11Z~ GPD [3Replacement ublic or commercial - Describe: Parent material Flood Plain el fation if i ble ft. General comments and recommendations: Q t System Type /7 7 System Elevation F 1-1 4 Boring # E] Boring / Pit Ground surface elev. 5 ft. Depth to limiting factor- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff##11 'Eff#2 3 Boring # E] Boring Pit Ground surface elevAL/)~ S 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 vz Z y- 7 S G 3 - o - mss- /-4 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nam (Please Print) - - CST Number Bird Plumbing, Inc. Shaun Bird 226900 -le Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5 715-246-4516 Property Owner _ Parcel ID # Page of F,3_1 Boring # a Boring 00 ~l pit Ground surface elev. 44,- 19 ft. Depth to limiting factor r~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 e-12- 10L,1-31-'3-- s/ Mk- C-1- /'d - ? s C a i 59c- 70 ~s E 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth 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 = BODS > 30 1220 mg/L and TSS >30:E 150 mg/_ ` Effluent #2 = BODS < 30 mg/_ and TSS 130 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 (R.W00) 1 1 Property pwrrer _ _ _ Parcel 0 # Page of ~r Boring # El Borin,.l , pit Groundsuriac:eelev.,jJ,_~- ti. Depth to limiting to trx in. YSuil Application Rate htorizon Depth Dominant Ccslor - Redox Description 'rexture Structure C or,sistence Boundary Roots GPD/fft ` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 't "1=fffi2 u ✓ W 70 J-~-' el- 70 Boring ~LJ 8orrut r-~ Gn~t,rrrd surface -.ft. Depth to limiting fe,c for irr. l_.~ pit Boil A~liration Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Routs GPDfff in. Mc•I"sell Qu. Sz. Cont. Color Gr. Sz. Sh. "ElT#1 ` °F1111:Z Boring Boring # ft. Depth to limiting ia: tor irk Ci Pit _ Soil Awlication Rate Horizon 'lepth t fomir•alnl Cola Redox Description - Texture Structure ::Insistence Boundary Roots ~GPD/fP-~- in. mmsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1- `t=if/K2 - it 5:j < Effluent #1 = 1 ],C)DS 5 30:r 220 m9tL and TSS >30 150 rrmgA- ° ENflulal W 2= C300 30 mglL and 1"SS 30 rrrglL The Department of C rmmerce is all equal opportunity service provider and eruployn r, if you need assistance to access services or need material in an alternate format, please contact the department at 60 3-266-31 1 or TTY 608-264-8777. suo-esm lx.rraq Soil Test Plot Plan f1 Project Name Oevering Homes Shaun B' Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 #226900 C Lot 25 Subdivision Tory Pines II Date 6/6/13 S W 1/4 N W 1/4S 36 T 30 N/R18 W Township Richmond F-I Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 101.0' *HRPSame as Benchmark Property Line B M Scale = 1/4" = 10' 99.5' 101.5' 8% Slope g _ 3 Scale is 1" = 40' ~ B-1 unless otherwise noted B-2 490' Property Line 142nd St. LOT 26 (2.3 ACR S) 8V47'3,r-'E 330.00'_ 29T 490 LOT 25 j_•- / j.OT X12.3 ACRES n 1 \ (2.3 ACRES) $ 2,12 APAEjg ► I V I / Gil ACREr 297 I I 1 LOT 24 i ~,/MIN FFE 2ACRES i I = 1011.00 ( (2.0 ACRES) \ > / CN; I L1 3 418, ACF 'WS (1.4 ACRES) ?lot 'STORM WATER 2.0 ACES RETENTION AREA )2.0 ACRS) H.W.L. ----1009.0 X 317' 340' /005*81 1 1 FFE 08. 00"'j-, ~,,LOT,22 CA) '(1.4 ACRES) 9t x % / / 2.;3 Rlk g / 1000.94 / 1. A ES / ' i_ / "ORIGINAL 1666 Wisconsin Department of Commerce SOIL EVALUATION REPORT Pag I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 'VE Cert ied Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must t. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Cou y '.0 t percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pa I t•DSj CI ` 2 S -F7 Please print all Information. NTY ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). OF fCE I ~i 0 lOZ Property Owner Property Location Ames Investment, LLC Govt. Lot NW 1/4 NW 1/4 S 36 T 30 18 W Property Owner's Mailing Addre$ Lot # Block # Subd. Name or CSM# 34 Peninsula Rd 10 Tory P' es J1r City State Zip Code Phone Number J City A Village ~J Town Nearest R ad Dellwood MN 55110 715-386-2007 Richmond 142Nd St. 16 New Construction Use: ra Residential / Number of bedrooms 4 Code derived design flow rate 00 GPD _.-A Replacement Public or commercial - Describe: Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install 6'x 100' rock ell mound on 96.4 contour as upslope edge of rock w/ 0.5' sand fill Vill: a Boring # Boring /f Pit Ground Surface elev. 96.0 ft. Depth to limiting factor min. oil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-11 10YR 3/2 - sil 2 f sbk mvfr cs 1f/m .5 .8 2 11-29 10YR 4/4 - sicl 2 m sbk mfr cs 1m .4 .6 3 29-36 7.5YR 4/4 - sl 1 m sbk mfr gs if .4 , .6 4 36-56 7.5YR 4/4 - Is 1 m sbk mvfr cs 1M .7 1.2 5 56-66 5YR 4/4 f2d 7.5YR 5/3 scl 0 m mfr - - 0 0 i T-T Boring # Boring .46 Pit Ground Surface elev. 97.0 ft. Depth to limiting factor min. 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 0-7 10YR 3/2 - sil 2 f sbk mvfr cs 1f/m .5 .8 2 7-38 7.5YR 4/4 - sl 1 m sbk mfr cs 1 m .4 .6 3 38-62 7.5YR 4/4 f2d 7.5YR 5/8,5/3 Is 1 m sbk mfr - - 7 1.2 soils are suitable for an at-grade system; available length (shed proposed in future west of B-1) leads to recommendation for mound; horizon 2 ha some inclusions Is; horizon 3 has occasional inclusions 5YR 414 scl Effluent #1 = BODS> 30 < 220 mg/L and TS >30 < 150 mg/L ffl e 2 =GODS < 30 mg/L and TSS < 30 mgL CST Name (Please Print) Si n ure: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, Wl 54751 11/1612002 715-233-0398 Property Owner Ames Investment, LLC Parcel ID # Page 2 of 3 3 ] Boring # J Boring Pit Ground Surface elev. 94.9 ft. Depth to limiting factor 45 in. Soil Application Rate F 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 0-9 10YR 3/2 _ sil 2 f sbk mvfr cs 1 f/m 5 .8 2 9-16 10YR 4/4 _ sicl 2 m sbk mfr cs j 1M .4 .6 I 3 16-45 7.5YR 4/4 _ sl 1 m sbk mfr cw 1 m .4 .6 4 45-58 5YR 4/4 f2d 7.5YR 5/3 scl 0 m mfr - - 0 t-0 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I i I I I F-1 Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 1 Roots = in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I I I 1-7 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 (R 07/00) Certified Soil Testing 1Rhsronsin Ddpartment of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings X in accordance with Comm 85, Wis. Adm. Code County . Cr Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must 14 include, but not limited to: vertical and horizontal reference point (BM); direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. D 2 ~o l - Z please print all information. evi by Date Pamonal inracmation you provide may be used fbr secondary purposes; (Privacy Law. s. 15.04 (1) (m)). Property Owner Affrs _ Property Locati(nVe Govt. Lot 1/4AJLJ 1/4 S J, T 50 N R E (or & Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# _ City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road IJN I (~~5 )3~20~~ ~t o 1416 Ej New Construction Use: E] Residential I Number of bedrooms`3 ~k- Code derived design tlowlrate GPD ❑ Replacement ❑ Public or commercial - Describe: i Parent material Flood Plain elevation If apptica rtr~ ~4 ft. -1 LUU4 General comments ~s~~n ~~e;✓, f~~ c, U aAbql nd recommendations: ~E d ` rw ~ ~ o.,,t vvc t3 3 1 ah e m 70 F-11 ❑ Boring I Boring #IjUYi't~ a(eQS' Pit Ground surface.elevl00, 30 ft Depth to limiting factor in. Soi plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo Z In. Munsell Du. Sz. Cont. Color Gr. Sz. Sti. •Eff#1 •Eff#2 0-I4 10 3(Z - "NI 2xr, - 14 - ID Si c l 2msJok nor C-5 X310-4 IL id ' ~rn3bk mfr cs _ y (o 4 I -4 lb~4r C2P~.5 r 4IcD i 3 t4l a Boring #❑~tt Boring 4 ~t Pit Ground surface elev. ! 9' 70 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 t a-CZ l0 r312 . _ _ ~►1 Zrf bk m eS 2 2- I I LEI _ S~cI Zm k C5" - W (o y I~ s. ~i Z,msbk~ S . , 3 33-,Yp ~1 -7o ID to - 5 0< - - y CD • _ - < Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 - BODS _ 30 mg1L and TSS < _ 30 mglL CST Name (Please Print) gnature CST Number A 253t Address Date Evaluation Conducted Telephone Number ? l--.t god S-I. Som _ e I i _5yo25 0 C~15)7-g7-g0-08 Property Owner t nye-s (n-,\ics+ (len+, LLc Parcel ID # Page 'of Boring # ❑ Boring 40. 3a Depth to limiting factor 9 in. a Pit Ground surface elev. ft Soil Application Rate Horizon Depth Dorninant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Con. Color Gr Sz Sh. 'Eifel - •Eff#2 O-I Z tb 312. ~5 i 1 2-(r)abk mfr c 5 I v T 5.$ 2 1Z- l0 Zm ML C5 - y ~ 3 3n Ica ry) S[(-/ 2msbk m c, - - IT- ~f. C2 P -1-5 r ( b 5d 3mSbk yam-,; - _ LI Ca a Boring # ❑ Boring ❑ PIl Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth • Dominant Color . Redox Description..... Texture .-Structure Consistence Boundary Roots GPD/flz In. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F] Boring # ❑ Boring ^ ❑ Pif • Ground surface elev. fL Depth to limiting factor in. Sal 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 - • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < ISO mg/L • Effluent #2 = GODS < 30 mg/4 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 formal, please contact the department at 608-266-3151 or TTY 608-264-8777. sao;sw MUM) . t PAGE OF NAME nN a- S LOT# Z 5 LEGAL DESCRIPTION SJ %'V- i4 .S 'V T Zn N.R. E(or) SCALE: 1"= L~ D - i BM I ELEVATION /a0_ b BM 1 DESCRIPTION 6 VC- A - t- N BM 2 ELEVATION ~g yo BM 2 DESCRIPTION y o `rP~_ -sec. ,j SYSTEM ELEVATION f0% U O ALTERNATE ELEVATION iy /W CONTOUR ELEVATION X •elt~• L . At, SIG TURE ~~J DATE 7-12-02-