HomeMy WebLinkAbout026-1306-00-007 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
567295 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)J.
Permit Holder's Name: City Village X Township Parcel Tax No:
Wrich, JoAnn M. I Richmond, Town of 026-1306-00-007
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No:
16 1, Gs-r 18.30.18.1614
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV.
Septic W1 ems' '�r Z•5 1 Z C T Benchmark
n J C Alt. BM �7
Pb T a F �e 3 .a /63. z
Aeration Z Bldg.Sewer
�.S /aZ . 7
Holding St/Ht Inlet
3.8(o a2 .3
St/Ht Outlet
TANK SETBACK INFORMATION /�Z •O
TANK TO P/ WELL BLDG. Vent to r Intake ROAD Dt Inlet
Soy S s
Septic Dt Bottom
p 3 9 B� l`f 93 _
Dosing Header/Man.
Aeration Dist. Pipe 99 yZ
Holding Bot.System Q 9$ ,
(7
PUMP/SIPHON INFORMATION Final Grade 5'z.4 . 161 , /9
Manufacturer Demand St Cover, 1�� r Z �� O
Model Number , \
TDH Lift Friction Lo System Head TDH Ft
Forcemain Le Dia. st.to Well
SOIL AB STEM
BED/TRENCH Width Lengthl I I No.Of Trenches PIT DIMSUZIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO ,V P/L JBLDG WELL LEACHING Manufacturer: ' ^
INFORMATION CHAMBER OR ^�/
Type Of System: 93 1C� UNIT Model Number* 44 S
ON�CH Or J �`
DISTRIBUTION SYSTEM 1-7 4-1-7 4- f ewe 3 ,1b
Header/Manifold 1 Distribution x Hole Siz x Hole Sp cina g Vent t Air Int e
t /`-�,C, Pipe(s) � � \\_ �Lr 14 Length Dia Length Dia Spacing N-_
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth o xx Seeded/ odded xx Mul
Bed/Trench Center 9 , , Bed/Trench Edges �� Topsoil Yes [] No es No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 1550 97th Street New Richmon 54017(NW 1/PE 1 18 ) GI ns of Willow River'06 Lot 7 Parcel No: 18.30.18.1614
1.)Alt BM Description= /Q a
2.)Bldg sewer length= /� p Pad
-amount of cover= ` �.
/8 6 w ellu GccQ of
Plan revision Required? E] Yes No
Use other side for additional information.
SBD-6710(R.3/97) Date Insepctor's S' nature Cert.N t
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c Safety and Buildings Division
I' ,.;'X,a,;`„ 201 W.Washington Ave. P.O. Box 7162 "� —R�
b i' 62 Sanitary Permit Number(to be filled in by Co.)•
N.: 116;,: Madison, WI 53707-7162
v
*zrox•av 5(a 2 I 1
Sanitary Permit A: him Slate'Transa tion Number
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of'this e governmental unit ..._/4
is required prior to obtaining a sanitary permit. Note:Application'fbrn)s far st ted POWTS are submitted to Project A f different than m''li g address)
the Department of Safely and Professional Set-vies. Personal inforl5iatio ou provide may be used for secondary
u inset in accordance with the Privacy Law,s. I5.04(I)(m),Stets. __ i rrq�
I. A o olication Information—Please Print All information -. _—� --_ 1 ��"�� %
Property Owner's Name LL "dam Parcel#! — — — —` '"1
ANN p` cYa�-� i0G -66 '
Property Owner's Mailing Address — Property Location (. I 6/4 LI)
City,State C°rr- /tJ Govt_Lot
Zip Code _Phortrtber
pl- /� , 04:4,00, /�, '/M1, Section �
N e �e d p(� y V (circle one)
I.I.'lf. pe of Building(check all that apply) Lot# — -.—" T 3 V N; R_..1 D_ L or W
1 or 2 Family Dwelling:.N�j'�`ber of Bedrooms / �/ Subdivision Name -3 e� `7ft 71i1u v 1 Li
Block# - - t R
❑Public/Commercial-Describe Use task i Tye 1'eN S �+ u Rive
�-,r. -��/e('s em, ------ ❑ City of —--- —..._—._.
❑State Owned-Describe Use CSM Number ❑ Village of__ ___
Town of F t.L�i1M-�j,►�_ �`
III.Type of Permit: (Check only one box on line A. Complete line B if applicable) - "--- --__.- -_-i
A. �" ❑Replacement System H Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain)
B. ❑ Permit Renewal ❑Permit.Revision [1 Change of Plumber ❑Permit Transfer to New List Pseviou.PP mtit Number and Date Issued
�__ Before Expiration Owner /
I IV.'I' le of POWTS System/Component/Device: (Check all that apply) _
Naon-Pressurized In-Ground ❑Pressurized In-Ground ❑ At-Grade
e_L❑Mound=2 i s.of suite 1 soil Mound<24 in.of suitable soil '
❑ Holding Tank ❑Other Dispersal Component(explain jT� 1 1 "`d*ro ✓ C14 611Zreatment Device(explain).
V.Dispersal/Treatment Area Information: .
�Design Flow d -- -- - --�I -f" 11 t�� = , -__ _- _..._—�
g (gpd) Design Soil Application Rate(gpdsl) Dispersal Area Required(si) Dispersal Area Propqsed(s System Elevation
� b b_ o.to .1 l 6k) C9 )0 60 ,' ,44
VI.Tank Info Capacity in Total #of Manufacturer / .��— - —
Gallons Gallons Units °'
— — VI/ Iy 1 o L.-671- 1, °
New Tanks Existing Tanks ry U 4
cii Fri rn i) *a, 3 (fir
Septic or Holding Tank— — [— —__-n•
Dosing Chamber �.�..--.—_ _ ).►76 �`— .—__567"�)1r1ti —_—.— —_—. °- —
VII. Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. —'
Plumber's Name(Print) Pin tier's Sin a ( MP/MPRS Number Business Phone Number
Plumber's Address(Street,City,State,Zip Code) `— — I D. 4"Y 715—/ i r 9")`o
V.I. Count /1De:e artment .Ise Only
Approved ❑ Disapproved
Permit Fee ; Date ss ed Isst' g Agent Sit •attire — --——"�-
,__ ❑Owner Given Reason for Denial $ / l • �I �/13 G�!Z ,� �it�, �
IX.Conditions of Approval/Reasons for Disapproval 4 ----
SYSTEM OWNER: p �ha i 11.41.,n14.'` 66�4 %`/td-
,"" � ,,
1.Septic tank,effluent filter and r''ry-� fN �OKITS
dispersal cell must be serviced/maintained Q �� �oT �dl'��
as per management plan provided by plumber. 29/ • 0 70�/ >d S5/$�{�yt--yhttq h ZB �N��
2.All setback requirements mu ��---
st be maintainer] .. ♦ /, . r ,i
as—per applicable c plans for the system and submit-o a ionn o Iv on paper not let ,/1 in a 11 inc es in size .y
ardiltil .p y —
pada- , 1/F5i4 wlel MZtt d SGvndf 9.- 6,9 5./
SFI7-6398(R. 11/11) .U "�f)A1 62'
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: bir,)
Owner's Name:
Owner's Address: C
r3
. •.L■•
Legal Description: ik) S E 1)k) S Vo'
Township. IQ-PU
County: Th. C
X U1><
Subdivision Name: C.rep 0 c Rwe-K
Lot Number
Parcel tip Number: 0) ' 130G- ' 067
page 1 Index.and title .
Page 2 Plot Plan
Page 3 _ System Sizira& Cr9sis-SeVOin
Page 4 Fitter Space__
Page 5 Maintename. information
Page 6 Maniejernent Plan
Page. 7 St. Croix Cty Septic Tank Mattel:lame Form
Page 8 Warranty Deed
Page 9 CS/VI or Plet
.
AtteettMetts: Soil Test& Haute Plans
Designer/Plumber: License Number: 4
-----
Date: Phone NUMber __ILS_,-1(6L)190)6
Signature
Dos clri ad pursuant to the -Ground So ii Absorption Component Marlon,for POWYS Version 2.0 6,31:3D-10705-P(NI.01/01).
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Design Flow 4- , Soil Application Rate ,- 0 EISA = 1 0 Chambers
0 IOM'S of 13 __ chambers each. I fop i 1,
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I W1250-MR DRAWN BY: +E SCALE: e2 PRE-POUR:11111ESER COACHETE REV.
§ § SEPTIC MANUAL DATE: JANUARY 2010 k . POST-POUR:
W3716 US HWY 10 MAIDEN ROCK, WI 54750
2 REVISED JAN. 201 0 800-325-8456 FILE: m250-■
PL,-525 Effluent Fitter- Effiumt Filters : Po lvlok sac,
Page 1 of
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posook,Inc Is pfoessrt ts,a t i d its rynv commercial filter to its existing fins of quality■effluerit 11,,F,Xtttr.tinti&Letlerm
The t'4..-525 is rated for over 10,000 GPO(Gallons Par Day)malting it
lergest commercial filIers. in its il,i4ss,h hes litia linear feet of 1/18"f'fitration,stots. Like the L.r.slagra Ok MISrer QIPVerS
Polyfok PL-122,the new Polylok pl,-an MS en aulornatic shut or hall ineltallea with ever,y '
..94 ...,:00,4; ' 1•••• •• for • th L.. li wilt II t ,•t 1, 1 ii. if Difitl'ilartIon e45300,ArIc
fir,Whon the1ilter 1$removecl ror ciaaning, . e pa wil oa.i,ip ana emporat ty shut o
I!..'(:;,5),.‘o'0 trIvil"
the sYstIm SP the effluent wo n't IeSve The tOk, l'iln orkir filter on the mviret can make that ACcle$6011eS
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Nava,aaelna, Pomp
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°Mitring InforrOtiOn 0 Reqtlafit e Chiote ta Reload Practu .ett
Nicargo'!$'
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Sanitary Tam
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Rated for 10,000 GPO(Gallons Per Day)
0 528 linter feel of Mr filtration
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" Robar Sp,,*„.c.:,,s,,,T• At Amepts 4"and 6 SCHD,
Enlar 40 pipe for details
. Handles and ROMiVitti
41 eott in Qa.,$Nflog4v •
0 Automatic shi.tfroff hall when filter is removed ,.
• At Alarm acoessiblifty
, Signs
0 Aceepta PVC;eXtertSien handle
, 1 LandOspa i Drain-age
The PL-525 Effluent Fliter should operate affir.71tntly for several yem unOer nerrn/11 1 ROMS&CitalttOS. .
conditions before requiring cleaning. ft is reoommanded that the filter be cleaned every
time the tank is pumped or at least every three years.If the Metalled filter oontaths an i Ftwo$0044.1,1%
optfonal relertn,the owner will he notified by An Alarm when the filta.needs aervioing,
.ServIcIng should be done by a certified septic tank pumper or Ineteller, CCitlaltrelle Aocessorlas
lItlaintomnc* instrutions: ' Pr4aaree Miners
•
i 0,4141^Crontrol Protkied
1 Loose the outlet of the septic;tank.
2, 'Remove tank over end pump tank if necessary. I liab4. <and CIVILI
41$0 plumbing whet,filte.r is rernovox-,I,
1 Atan44041110$1
4• Pull PL-152 out of the housing,
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5. Hose off flay over the septic tank.Wks aura all solids fall kaoc into septic.onk, Rekar asfolt and IrD 0;
6. Insert th e fitter cartridge hack into the nousinp. makIn9 aura the filter ia proi:56.1rly ----.....---------,-„,
oligrisd enl,#11114111%4)/Fnu'llA4).
lOsearativs Landsospe
7. Reptace septio;tank cover.Pl...-525 Installation:1410$1 for residential anal oommernfai --------"."'""”'"—
waste flows up to 10,000 Gallons Per Day PPE)).
1 Technioal Speark,‘,,atic4
, Installation Instructions: •
FivatifId Proo#404
1. Locate the otitfe.t of the septib tank. I Pomp,Filk)r and$un
F2141t:er A2lairi larne 1 a n
2. Remove tank cover and pump tank if necessary 'I riRisPe
,
0, Glue the niter housing to ths 4"or 6"outtet pipe, tith,s fiNg '" .43 roared„mg,
tha afamea.fl oPeritn9 mall a Pcqrirlk Exi4311.^.a Loki.or pion'er oL'sf i'pliptemto or:Inter-ft-lie-rt. S.rnrn1F1 WA r Tro Control
4. !mart the Pl..-528 fitter into its housing
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`Wisconsin SOIL EVALUATION REPORT #1493
Department of Commerce in accordance with Comm Wis m. a Page 1 of 3
Division of Safety and Buildings Schmitt Soil Testing,Inc.
Attach complete site plan on paper not less than 8%x 11 inches in size. Plan mus County,,., St.Croix
include,but not limited to:vertical and horizontal reference point(BM),direction an
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.
7
Please print all information. Rev' / / Da*Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I /6/!/(0
Property Owner RECEt
VEID Property Location /
Sienna Corporation Govt Lot NW /4,SE1/4, S18,T3ON,R18W
Property Owner's Mailing Address Lot I Block# Subd.Name or CSM#
4940 Viking Drive Suite 608 SEP 2 6 2006 7 The Glens Of Willow River
City State Zip Code Phone Number - City L Village ❑ Town Nearest Road
ST.CROIX COUNTY
Minneapolis I MN 1 55435 I Richmond I 95Th St.
C New Construction Use: ® Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement ❑ Public or commercial-Describe:
Parent material Outwash over weathered Flood plain elevation,if applicable na ft.
General comments
and recommendations: Area is suitable for a conventional system with a 0.6 gpd/sqft rating. Install system 33"below grade
going with contours.
1 Boring it ❑ Boring
❑ Pit Ground surface elev. 98.50 ft. Depth to limiting factor 33 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 0-10 10yr3/2 none $1 2fsbk mfr as 2m,2f .6 1.0
)o� 2 10-19 10yr4/4 none sd 3msbk mfr gw 1vf .4 .6
3 19-27 7.5yr4/4 none grsl 2msbk mfr gw lvf .6 1.0
4 27-33 7.5yr4/6 none grls Osg ml es ---- .7 1.6
5 33-66 2.5y7/3 c2d 10yr6/8
10yr7/2 vfs Osg ml as --- 4 .6
6 66-75 2.5y6/6 c2d 10yr6/8
10yr7/2 grvfs lcsbk mvfi as ----- 0.0 0.0
7 75-80 2.5y7/3 c2d 10yr6/8 Om mfvi ---- ----- 0.0 0.0
10yr7/1
2 Boring# ❑ Boring
❑ Pit Ground surface elev. 101.18 ft. Depth to limiting factor 79 'I 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 10yr3/1 none I 2fsbk mfr as 2f,lvf .6 .8
2 11-19 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0
3 19-27 10yr4/6 none Is lcsbk mvfr gw lvf .7 1.6
4 27-79 10yr5/6 none s Osg ml as ---- .7 1.6
5 79-82 2.5y7/3 c2d 10yr6/8 Osg ml ---- ----- 4 .6
10yr7/1
55 1
*Effluent#1 =BOD5>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: l CST Number
Thomas J.Schmitt ...X1.-.-,/ 1.L�r"' 227429
Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond,WI 54017 9/14/2006 715-247-2941
SB0-8330(R.07/00)
,
Property Owner Sienna Corporation Parcel ID# 7 Page 2 of 3
3 Boring# ./❑ Boring
❑ pit Ground surface elev. 100.8 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 0-9 10yr3/1 none sl 2msbk mfr as 2m,2f .6 1.0
2 9-17 10yr4/4 none sl 2msbk mfr gw if .6 1.0
3 17-22 10yr4/6 none Icos 0sg ml gw ---- .7 1.6
4 22-69 10yr5/6 none grs Osg ml as ---- .7 1.6
5 69-80 2.5y7/3 C2d 7/1 vfs Osg ml --- .4 .6
r - .
a H
31r (1q
4 Boring# ❑ Boring
Ground surface elev. 100.23 ft. Depth to limiting factor 70 in.
� Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
P ry
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. "Eff#1 'EMT
1 0-12 10yr3/1 none sl 2fsbk mfr gw 1m,2f .6 1.0
2 12-17 10yr4/4 none sd 3msbk mfr gw lvf .4 .6
3 17-28 10yr4/6 none sl 2msbk mfr gw 1vf .6 1.0
4 28-37 10yr5/4 none Icos lcsbk mvfr gw 1vf .7 1.6
5 37-70 10yr5/6 none grcos Osg ml as --- .7 1.6
6 70-80 2.5y7/3
c2d
1 0vr7/1 107/6/8 Osg ml --- .4 .6
_ " 1;_ ---
❑ Boring
5 Boring 33
g#
❑ Pit Groun surface elev. 99.73 ft. Depth to limiting factor 70 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 0-12 10yr3/1 none I 2msbk mfr as lm,2f .6 .8
2 12-22 10yr4/3 none sil 2msbk mfr gw 2vf .6 .8
3 22-31 10yr4/4 none sl 2msbk mfr cs lvf .6 1.0
4 31-55 10yr5/4 none grcos Osg ml gw .7 1.6
5 55-70 10yr5/6 none s Osg ml as ---- .7 1.6
6 70-80 2.5y7/3 c2d 107/6/8 ml ---- --- .4 .6
17/1,
C
33' 'b
*Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD 5<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(5.07/00) Schmitt Soli Testing,Inc.
iL
Property Owner Sienna Corporation Parcel ID# 7 Page 3 of 3
• 6 Boring# ❑ Boring
pit Ground surface elev. 99.85 ft. Depth to limiting factor 70 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
1 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. "Eff#1 "Eff#2
1 0-12 10yr3/1 none I 2fsbk mfr as lm,2f .6 .8
2 12-20 10yr4/4 none sid 2msbk mfr gw 2vf .4 .6
3 20-25 10y r4/6 r4 6 none sl 2msbk mfr cs lvf .6 1.0
4 25-70 10yr5/4 none grcos Osg ml as .7 1.6
---a
5 70-84 2.5y7/3 �+$ vfs Osg ml ---- .4 .6
1 I. Q ii I kin
(:::::::1;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/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 "Eff#2
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/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
*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(R07100) Schmitt Sal Testing,Inc.
+� Page 4/ of 4/
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, WI. 54017
Phone: 715-247-2941 Subd.Name: The Glens of Willow River
Signature: / U Lot No.: 7
Date: ? I /`/ i 494 Legal Description: ,-zaj 1/4 SE1/4 S18 T3ON R18W
NA Backhoe pit Township, County: Richmond, St. Croix
A Bench Mark El. 100.00' Top of 2" pvc pipe
A Alternate Bench Mark El. /c7.2.S/9' Top of .2"/''C / '/e1-
Slope= o?g Contour Line El. /16.' Contour Line Length///4
11c4 57571-e04 5—/e�u,�/ah r Z-15 .1/ 7"ie,rc.�iep et-1- syj e%J m,
3" 6-e/cn__7 yluc/.e ,,&c&//e/ 70
Scale 1" = 40' C e ti r c+—/ a. O 6 7/67/f(2 cscAle.
/VOY/ 474-,. -
QQd
0 0 ..
31
,(4.0,1P6
Ate/1 6u-1 de'
POP I t S
54 t a4 70
a‘ 15--/
62'
33�
c r �y
/ (4! VD 1'' 3
6� 1
. /VU ,
La I 'Th
67 13 /6C ec/
1 ! / P # /ads 7
Cane EL. 4'y63` 40 d/ /E'er P4°
This Soil and Site Evaluation was completed to fiilfill a zoning requirement.It may or may not be in a location suitable for you use.
Nov-11 2010 10 45 AM S. Croix Cminty Plan/Zoni.)g 715-126-46P6 1/2
IL IRPORMATIOp POINTS OWNEFir$ MANUAL & MANAORMENT AN Raga of
FE i
SPIIKIPI*A A t
QIG , 847010 Tank Capaety
Permit dt —„.„ ),E a 1 CI NA
: $eptlo Tank Manufeeturer bJ11St X
II , _Eff1411M
r M
FitteendentUrer so
DORI ,.,4,^ ■AttiVrt.$ M NA
Nurrther of Redroome C:1 NA Effluent Fitter Model
n NA
Number of Publlo FacillitY Unitt F.Zi NA , Pump Tonk Copeolty -----
1 Setimeted flow(averarae)
........„ 31 jaw . PleoP Taok Menufenturor
Design Sow (peak), (Estimated x 1,5) 0 gelfle2 Pumb Manufooturer *
Soil Appitt■Pftlari FlattR s
!awvit , Pump Model %* MA
stoneler4 laugntigffloont cmautv Monthly avoreRso ' Pretreefm-----ent Unit ----"— NA
Fate, OH 64 Graeae IFOCII 1;$0 Im01/I-, Ll $end/Grevel FRter ri Pen Filter
BiOnilarriO01 Onrl Demand (SODA) X2.20 rpm/L. in NA ' Cl Meobentael Aartdot 0 Wotland
Tote Suspended Sonde (TSS) 150 M(01- CI VR10004011 CI Other;
, —
Pretroated Effluent Qty Monthly average 1 Olspareal CAHN) CI NA
Sloahominel Oxygen Demand (BODO 450 negil, hle-eround (PravkYli 1 In.Orourld tprassurIzed)
Total,3uspeodad Bolide {TU) f42O M2/1, )4 NA ' i CI Are,Oratle 0 Mound
Fetal Colifonn(pornetria mean) •A 4 ofurlOOm1 0 Drip.I.,lho r,:l OtIlsr:
NA
Mexlmurn Effluent PartIole S!zo 4 4 in■lna, fl NA ' "
Other; 'nth y
1 NA --6" 0 NA
• other: C NA
*vatue .typroal for cloniastio wsstswatof And tar/tin fel*efffuerm
NIAINTIM'4'•'-• 14-311, '
Sayvias,Evant
Iriaiz..,oorritittkiri a/tarkiej At ingot ono%) ry,
ak/a " -V ct fltiliodmat 2 yams) ri NA
When=retitled sludge end&SIMI saulais onatithird (%)of tank volurrla 1:1 NA
Pump prat name=of tanklal
impact dispereal oell(e) At leen one every: D ,,,,, ,, ,, (Nreadmum 3 years) CI NA
.,. I von 4ti4 ci NA
Cleo 6 ffiusnt'filter At legal;Vine ovfliV
--------------- -----------' ci mom* ' ,
0 NA
InsPoal:FarrIP, pump oontrols 84 Worm At leapt onraa every: CI ititir - _
Fluah leterere end preasure feet At at once kopery:r, 0% , IN NA
Othon Teem ons every
At
---
0than IN NA
MAINTSNANDE INSITIVOTIONS
!nspdatiOns cir tarrita one Otepereei man shall be ros00 try an Inevidual aarr'tit one a the f1lovV1P4 Iteeneee tlr rtirtiftNirtiOrtg:
MaCtar Pilarlbar MagtaT Plumber Raatrloted 5fawan powra impottm po\Arrs Maintattor; tlottga Stiolming aptfrator. Tenrk
inspeotione altrat inClUria fi VISVal irMarttion of the,rarilcisi to identify any rolse9ng or broken hardwana„identify any areake or leaks,
maaaloa tils voima r antntlinfpd stwoge and sours anti 1: check for any baoR up or pontlIng of;0'1'1w:wit On the Mrrmartri surface,
Ito dispersal OW shall be visually inapsated to chook the effluent[wale In the Oservation Pip rai th Ohelltk for arty pending
of effluent on tile ground melee% 'The pondIng of 4//lwerit no 1:110 grood surfaoa may Indicate a faillorli oondltion and requires the
irornatilna flatifitiation ed tila 10Ofii ragleattly nuthoritYn
Yaen the oomind enournultion of slur and eaum in any tank equals orKettilrd (V or MOM Of tiliii tt*141)40110, the entire
aontents of the tank shell bo rammed by a septetle samoing Operetor and dieppead of ln Iinorltiarios with tihaptet MR I'M,
krVisconsin Administfariva codAr,
All other services,Inoluding but not limited to the servicing of effluent flitera, Meellenlbal Or preestarleeN cornoonsnta,proveatmsn't
units, arid arty aarvidirigi st Intarvala of II 2=nth% shell be perforMed by a 00100 POWTSARtritenOr-
A ytearvkla report shat he proved to the tatiai romufatory authority within 1 0&flys of Mr Tort of law ua Writ.
taMA?t4/01)
Nov-11-2010 10 45 AM St. Croix County Plan/Zoning 715-386-4626 2/2
START LIP AND OPERATION Page of
For new construction,prior to use of the POWTS cheek treatment tanks)for the presence of painting products or other ohemloals
that may impede the treatment process andlor damage the dispersal cell(s). If high concentrations are detected have the contents:
of the tank(s)removed by a septeige serv1r;Eng operator prior to use.
System start up ahaii not occur when soil conditions ere frozen at the infiltrative surface.
During power outages pump tones may fill above normal highweter levels. When power le restored the elsaap wastewater will be
discharged to the dispersal cells) in one large dose, overloading the mills) end may result In the bedkup or&Thin diechsrga of
effluent, To avoid this altuation have the contents of the pump tank removed by a Septage Servitting iperastor prior to metering
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually:operating the pump of ntrois to
restore normal levels within The pump tank.
Do not drive or park vehicles over tartlet and dispersal cells, Do not drive or park over, or otherwise disturb or compeer, the area
within 15 feet down slope of any mound or at:grade sell absorption area,
Reduction or elimination of the following from the wastewater stream may improve the perforrnenae and prolong the life of the
POWTS; antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; dispute dielefe ante; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meet eesreps; medications; oil;
painting products;pesticides;sanitary napkins;tampons; and water softener brine,
ABANDONMENT
When the POWTS fells and/or is permanently taken out of service the fonowing steps ehef be taken to insure that the system la
properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Mode:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings seaied,
e The contents of all tanks and pits shall be removed end property disposed of by a Septette Servieing Operator.
• After pumping, all tanks and pits shell be excavated and removed or their covers removed and the void space filled with
sail, gravel or another inert solid material.
CONTINI ENOY PLAN
if the POWTS fella and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated end may be utilised for the louden of a repiseertrerst sell absarptlon
system. The replacement area ehou d be protected from disturbance end arcmpattien and should not be infringed upon by
required setbacks frosts,seisting and proposed structure, lot Rtes and welis, Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a eultebie replacement area Replacemeflt smelts must
comply with the rules In afFect at that time.
D A suitable replacement area Is not available due to setback and/or soil limitations. Earring advances in POWT'S
technology a holding tank may be installed es a last resort to replace the felled POWTS.
0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and alte
evaluation must be performed to locate a suitable replacement area, if no replacement area is avetieb)s) a holding tank
may be installed se a last resort to replace the failed POWTS,
D Mound and at•grede soil absorption systems may be reconstructed In place following removal of the biomat at the
infiltrative surface, Reoonstruetione of such systems must comply with the rules In effect at that time,
«eWARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AMOR INSUFFiCIENT D 'Y'SSSI!, 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 commis
POisVTS INSTALLER POINTS MAiNTAI
Mir k Yin t • t 11221 -111111111111111M11
Phone Phone
SEPTAt3E SERI.iCii Gs OP ;A'T0K(PUMPER)
°'
P 1 ) _COAL err: .
Na
me i oY(. M
Phone ' 1)- ►, b,5 Phone J r�
• I 1 -�� • � �
This document wee dratted in compliance with ohepter`Comm 88.22(2)(hillittil(fi and 55.54(11,IR)&(3),Wisconsin Administrative Code,
2013-12-04 13:36 BOARDS TO DOORS 7152460111 >> 7153779620 P 1/1
ST.CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 6J,z.r c IA
Mailing Address Pc� �O 7 Z N's-.r' gi +•'a'e wy P10/7
Property Address 5S0 7 5 reRg Fyw /CI t fi.woeJ o 0.0_ fat 7
(Verification required from Planning&Zoning Department for new construction.)
City/State 1..1(w R;cAbs,,rn wy Parcel Identification Number Z.4 - I OG - C —d 0 7
LE„GDESCRWWTION
Property Location N L) 1/4 ,SS 1 1/q,Sec.( T 3 0 N R ) S W,Town of g)c-1-4M41, i]
Subdivision 4Lit1f a 1 tit[ c-44-Ad g,,t ,,. r�
Lot# 6 .
Certified Survey Map# , Volume
—._- ,Page#
Warranty Deed# �� Volume
... ,.:. ,Page# •
Spec house no Lot lines identifiable yes no
YS T NANCE AN OWNS CE TI CA ON
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.
Uwe,the undersigned have read the above requirements and agree to maintain the
standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,Statelof Wise nsin.lee
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.
Uwe certify that all statements on this form are flue in the best of my/our knowledge. Uwe am/are the owner(s)of the
property described above,by virtue of a warranty deed recorded in Register of Deeds Office.
Number o bedrooms
SIGNAT 'L OF APPLICANT(S)
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Departm
ant *y
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey ma if
reference is made in the warranty decd.
p
(REV.88/03)
I I
11111
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-2003
8
WARRANTY DEED TX:4165380
990063
BETH PABST
THIS DEED, made between One Corporation,a Wisconsin corporation, as REGISTER OF DEEDS
to an undivided 52.106% interest and from First National Community Bank, ST. CROIX CO., WI
a national banking corporation,as to an undivided 47.894% interest 12/06/2013 11:47 AM
("Grantor"whether one or more)conveys and warrants to JoAnn M.Wrich,a EXEMPT#• NA
single woman("Grantee",whether one or more),the following described real
estate in ST CROIX County, State of Wisconsin: REC FEE: 30.00
TRANS FEE: 75.00
Lot 7, Plat of Glens of Willow River in the Town of Richmond,St.Croix PAGES: 1
County,Wisconsin.
RETURN TO _ _—_ _
First National Community Bank
PO Box 89
New Richmond, WI 54017
Tax Parcel No: 026-1306-00-007
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 Z' day of December,2013.
On• Corporation,a Wisconsin corporation
1..D4..-1—,A
ohn D. Soderberg,Pres'.
First National Community Bank
.-
By: .e Green,Vice President
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of , STATE OF WISCONSIN
20_
COUNTY OF ST CROIX ss.
*
TITLE:MEMBER STATE BAR OF WISCONSIN nn
Personally came before me this Z day of December,2013,the
(If not, above named One Corporation,a Wisconsin corporation,by
authorized by§706.06,Wis. Stats.) John D.Soderberg,and First National Community Bank,Joe
Green,to me known to be the person(s)who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY t 1/-ITh" .
Robert L.Loberg/Loberg Law Office * 1,111141717 ttttttt-
Notary .11•lic ,11/ County. 't,MAN,t 10i�i
My C. mission is permanent. (If n ;state eepiFagi i date:is
(Signatures may be authenticated or acknowledged. Both are �,/� 9//y ) *:
not necessary.) r * • *
r. a
9•• VBLAG
. '�2�r
WARRANTY DEED /�FO• St^-eNeo.1-2003
1 of 1 ���4rFnntµtNxx,
Parcel #: 026-1306-00-007 12/13/2013 03:06 PM
PAGE 1 OF
Alt. Parcel#: 18.30.18.1614 026-TOWN OF RICHMOND
Current X ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units
11/16/2006 00 0
Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner
0-ONE CORPORATION
ONE CORPORATION C- 1ST NATIONAL COMMUNITY BANK
1ST NATIONAL COMMUNITY BANK
109 E 2ND ST
NEW RICHMOND WI 54017
Property Address(es): *=Primary
*1550 97TH ST
Districts: SC=School SP=Special
Type Dist# Description
SC 3962 SCH DIST NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST Notes:
SP 1700 WITC
Legal Description: Acres: 1.504
SEC 18 T3ON R18W PT NW SE(THE)GLENS OF
WILLOW RIVER(06) LOT 7(1.504AC) Parcel History:
Date Doc# Vol/Page Type
12/22/2011 947756 WD
03/16/2010 913232 AMEND COV
08/06/2009 901590 SD
11/16/2006 838975 PLAT
more...
Plat: *=Primary Tract: (S-T-R 40%160v.) Block/Condo Bldg:
* 11-015-GLENS OF WILLOW RIVER 026-06 18-30N-18W NW SE LOT 007
2013 SUMMARY Bill#: Fair Market Value: Assessed with:
251967 16,500
Valuations: Last Changed: 09/27/2011
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.504 17,100 0 17,100 NO
Totals for 2013:
General Property 1.504 17,100 0 17,100
Woodland 0.000 0 0
Totals for 2012:
General Property 1.504 17,100 0 17,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch#:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00