HomeMy WebLinkAbout026-1064-95-050 r
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
(ATTACH TO PERMIT) 592296
GENERAL INFORMATION 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 Township Parcel Tax No:
ZACH JOHNSTON TOWN OF RICHMOND 026-1064-95-050
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/6D ccv 21.30.18.327C-05
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ; t CAPACITY STATION BS HI FS ELEV.
~J
Septic 'ZI Benchmark 164-2,3
/dd
W Lei /
Alt. BM ( G v..`, . 9 16 Z• 3
too L"'t.
Aeration Bldg. Sewer 33 /46
Holding St/Ht Inlet d 9~ S g
St/Ht Outlet V
TANK SETBACK INFORMATION S G~ 9.3
TANK TO P WELL BLDG. Vent to Intake ROAD Dt Iniet
Septic )1!56 1 V Dt Bottom
Dosing Header/Man. ~(p~
77 9`5 5-6
Aeration sue,-~•-~~.~_. .o...~ Dist. Pipe Cj' • 7
93~
Holding Bot. System //,d 93
92 . 75
Final Grade
PUMP/SIPHON INFORMATION 7. b Z
Manufacturer Demand St Cover GPM r:1 2-9 ~6Z-.3
Model Number
e TDH Lift Friction Loss System Head TDH Ft
Forcemain Leng a-°°"°°"__ Dist. to Well
SOIL ABSORPTION YSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS : 7b ^7 IG ~G(_
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION Of S stem: / CHAMBER OR . l
T
ype O Y , _ a '75D t • I~~, ` UNIT Model N=
DISTRIBUTION SJIYNS_'TEM 1-7 I-7
Header/Manifold Distribution Ix Hole Size Ix Hole Spacing Vent to Air take
Pipe(s) G/
Length Length Dial- Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth over Depth Over xx Depth of xx Seeded/Sodded jxx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
a~ Yes C No ,des E No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1410 120TH ST _ l~
1.) Alt BM Description = `
2.) Bldg sewer length =
- amount of cover
Plan revision Required? Yes No 11 17 ~f/ 3 J
Use other side for additional information. 1
Date k1jnsep is Signatu Cert. No.
SBD-6710 (R.3197)
Land Use
1. C R O IX 'CQL U ~iTY Planning 8 Land Information
r Resource Management
Community Development Department
5/1/2017
Chana and Zach Johnston
1398 120th Street
New Richmond, WI 540017
RE: Conditional Approval: Land Use Permit, File# LUP-2017-013
Project Location: 21.30.18.327C-05
Project Address: 1410 120th Street
Chana and Zach Johnston,
Community Development staff have reviewed the Land Use Permit application for the construction
of a new Single Family Dwelling, driveway and Private Onsite Wastewater Treatment System
(POWYS) within the Shoreland Overlay District, Chapter 17.30. The request has been
conditionally approved based on the application submission and following findings.
• The proposed project meets all applicable setbacks. There is a blufFline and the
proposed house exceeds the 20-foot setback.
• According to FEMA Firm Map Panel No. 55109C0210E, a portion of the property is
mapped Zona A. The project as proposed is mapped out of the Floodplain.
• The amount of new and existing impervious surface is less than 15%, therefore
complaint with Shoreland Impervious Surface standards.
• Vegetation will not be disturbed within 35-feet inland of the pond.
• Erosion and Sediment control plans were submitted in an addendum on April 26, 2017;
this finding is conditioned below.
Based on these findings, approval of the Land Use Permit is subject to the following conditions:
1. A tracking pad shall be installed prior to any land disturbance or construction activities at
the entrance of the property. Wisconsin DNR Conservation Practice Standard 1057,
Stone Tracking Pad shall be followed; this standard is enclosed.
2. A flag shall be set 275-feet inland of the eastern property line, beginning the
measurement at the road right-of-way. This is to verify development will be out of the
mapped floodplain.
3. Erosion control logs shall be staked per plan around the proposed house and down slope
of the POWTS dispersal component Cdrainfield~.
4. A pre-construction inspection is required to verify erosion and sediment control has
been installed and the areas above have been flagged.
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686
www.sccwi,us/cdd www.facebook.com/Stcroixcountywi cdd(cDco.soint-croix.wi.us
2
Co+r~munity Development Department
5. St. Croix County reserves the right to require additional erosion and sediment control
measures to be installed if found necessary due to site-specific conditions.
6. Phosphorus fertilizer shall not be used to establish and/or maintain vegetation, unless a
soil test confirms phosphorus is needed.
7. Permanent vegetation shall be established once final grade is reached. A temporary
cover crop such as oats, winter wheat or rye shall be applied on all disturbed areas if
seeding cannot occur prior to September 111. Dorman seed and increased application
rate will be required after freeze up.
8. A post-construction inspection is required prior to removing erosion and sediment
control to determine the project site has reached a point of 70% perennial vegetative
cover.
9. It is the applicant's responsibility to secure any other required local, state or federal
permit(s) and approval(s) prior to land disturbance activity.
10. Failure to comply with the terms or conditions above may result in the revocation of this
permit by the Zoning Administrator according to Chapter 17.30(13).
This approval is subject to the conditions listed above; it does not allow for any additional
construction, structures, grading, paving, filling or clearing of vegetation beyond the limits of this
request. Your information will remain on file at the St. Croix County Community Development
Department suite. It is your responsibility to ensure compliance with any other local, state, or
federal permitting or regulations, including contacting the Town of Richmond and the Wisconsin
Department of Natural Resources to inquire if additional permissions are required.
This permit is valid for one year, with the possibility of up to two (2) six month extensions if the
applicant submits the appropriate permit extension fee and documentation to the Zoning
Administrator. A hard copy of the Land Use Permit placard should be submitted to the local
Building Inspector upon application for a building permit. The orange placard must be posted on
the job-site and visible from public view.
Please feel free to contact me with any questions or concerns. I am typically available Monday-
Friday from 8:00-5:00 PM. If you would like to schedule an inspection, please call the main office
so they can direct the next available staff member to accommodate your request as soon as
possible; (715) 386-4680.
Respectfully,
Sarah Droher
Land Use Technician II
EC: Town of Richmond
Chang i hnston23(aDhotmai1.com
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686
www.sccwi.us/cdd www.focebook.com/stcroixcountywi cdd@co.saint-croix.wi.us
3
('onimunity Development Department
kopssnwausauhomes.com
CC: File
Enclosure Standard 1057, Stone Tracking Pad
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686
www.sccwi.us/cdd www.focebook.com/Stcroixcountywi cddPco.saint-croix.wi.us
Stone Tracking Pad and Tire Washing
(1057)
Wisconsin Department of Natural Resources
Conservation Practice Standard
1. Definition
3. The aggregate shall be placed in a layer
A stabilized pad of stone aggregate or tire at least 12 inches thick. On sites with a
washing station located at any point where traffic high water table, or where saturated
will egress a construction site. conditions are expected during the life
of the practice, stone tracking pads shall
II. Purpose be underlain with a WisDOT Type R
geotextile fabric to prevent migration of
The purpose of this standard is to reduce off-site underlying soil into the stone.
sedimentation by eliminating the tracking of
sediment from construction sites. 4. The tracking pad shall be the full width
of the egress point. The tracking pad
III. Conditions Where Practice Applies shall be at a minimum 50 feet long.
Either a stone tracking pad or tire washing 5. Surface water must be prevented from
station shall be used at all points of construction passing through the tracking pad.
egress. This standard applies where construction Flows shall be diverted away from
traffic is likely to transport sediment off site. tracking pads or conveyed under and
around them by using a variety of
IV. Federal, State, and Local Laws practices, such as culverts, water bars',
or other similar practices.
Users of this standard shall be aware of
applicable federal, state, and local laws, rules, B. Tire washing: If conditions on the site are
regulations, or permit requirements governing such that the sediment is not removed from
the use and placement of this practice. This vehicle tires by the tracking pad, then tires
standard does not contain the text of federal, shall be washed utilizing pressurized water
state, or local laws. before entering a public road.
V. Criteria
L The washing station shall be located on-
This section establishes the minimum standards site in an area that is stabilized and
for design, installation and performance drains into suitable sediment trapping or
requirements. settling device.
A. Tracking Pad: 2. The wash rack shall consist of a heavy
grating over a lowered area. The rack
1. The tracking pad shall be installed prior shall be strong enough to support the
to any traffic leaving the site vehicles that will cross it.
2. The aggregate for tracking pads shall be C. Rocks lodged between the tires of dual
3 to 6 inch clear or washed stone. All wheel vehicles shall be removed prior to
material to be retained on a 3-inch leaving the construction site.
sieve.
Conservation Practice Standards are reviewed periodically and updated if needed. To obtain the current version of WDNR, WI
this standard, contact your local WDNR office or the Standards Oversight Council office in Madison, WI at (608) 833-1831 08/03
Words in the standard that are shown in italics are described in IX. Definitions. The words are italicized the first time they are used in the text.
REQUIRED TO BE SHOWN ON SCALE IN FEET WETLAND / i 0' 75' 150' _
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County
Fj RE~"!~~VIE~► Safety and Buildings Division
R 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.)
Sp g=1 Madi WI 707- 16
Ito
APR 13 2017 f V'
;s 1 State Transaction Nu,pber
~pNIMUN 11 r,Yr---- N pr-
mut
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govc,.....__
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)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
ucposes in accordance with the Privacy Law, s. 15.041)(rl Stats.
1. A lieation Information - Please Print All Information Parcel #
Property Owner's Name ITe) I ,Q / l / ,r p~
/ Property Location CR 1 0 0 . S a7
Govt. wner's Mailing Address ,
GoCvt. Lot L
tJf G/ Zip Code Phone Number J j- ya, Jr '/4, Section
City, State C rcle one)
T13 -`7a - G'l T J~ C> N; R E oa)
It. Type of Building (check all that apply) Lot # Subdivision Name
X1 or 2 Family Dwelling - Number of Bedrooms
, ~ Block #
El Public/Commercial -Describe Use _04 f ❑ City of
er/a~ El Village of A Ill"_
C' b'33
hov_se lays~S
❑ State Owned - Describe Use _ C> 1 7& 1/ l Town of /I~
d I•s-hlboh'on felts w 1-7+17 Chn Mbers
III. T (Check only one box on line A. Complete line B if applicable) I IT IF)
A. ❑ Treatment/Holdin Tank Replacement Only El Other Modification to Existing System (explain)
ew System ❑ Replacement System g
r'
List Previous Permit
❑ Change of Plumber ❑ Permit Transfer to New
B . Permit Renewal El Permit Revision Number and Date d
❑
Before Expiration Owner
e of POW I h S s Cous nent/Device: Check all that a l
Non-Pressurized In-Gro ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 iso /
❑ Pretreatment Device (explain)
Other Dispersal Cotnponent(explain)
V. Dis ersat/Tre ent Area Information: Dispersal rea Proposed (s System Elevation
Design Flow (gp Design Soil Applicatio ate(gpdsf) Dispersal Area Required (sf) s 0 ~j 3
Total # of Manufacturer y a
Vi. Tank Info Capacity in o v H
Gallons Gallons Units
~ w ^a a
i73 rig w C7 a
New Tanks Existing Tanks ~ j 9
Septic or Holding Tank hGL~ t ULIA) l L
Dosing Chamber
Bp ans.
VII. Responsibility Statement- 11 the undersigned, assume responsibility for installation of the POWT MP o n o Number attached
usiness Phone Number _APR
~rint> Plumber's a ~ .~~ir?~.~-7 7is•= ~H~~ ~y
Plttmbe ~A,•~dress (Siney~==ity, State, Zip Code)
VII . Coun [Department Use Out
Permit Fee Date sued Issuing Agent afore
roved Z~ 45 er Given Rea, r Denial ~ n .
IX. Conditions of Approval/Reasons for Disapproval 1V a u 01L 5lp CkS
SYSTG4 ~ t `Ater ~~1
01,
t c malntinec t 7 , roswn Con~f rol (eqvied dwnS iDPI
1. Septic tang
'
; , G ~ a i
CO
dispersal e „,t
as per managemsr0 t i .ao i „ilui~,cd
re uiren~ei)t , r ttiit
V, .
d or`tbe system and submit t the County on yon paper not less th• 73 Mx 11 inches in size
as per apP~d> O I n ,`n m9PCa oveG -~b Oe
~~6 p
SBD-6398 (I2. 11/L1) & f~ ~ •
%O NVENTIONAM COMPONENT DESIGN
esidentia, Appiicatior
INDEX AND TITLE PAGE
err -r: Nam
0w per's Name. A/ J-0 l//u
wrner's Address:
ownshic:
County:
S-mc,msion Name
_c`, Numce- .J
Parcel ";J Vr~ V
Page in-ex anc tit
Page 2 Pio` Plan
Dage 3 System Sizing & Cross-Sectior,
Page 4 ~iiter Smec
Page 5 Maintenance Infor^ atio
'age 6 Manaaement Pia-
Page S` Croix Cty Septic Tank IVa;n-e: anc=
Page *ar-anty Deed
Pag= CSIV. or Pia`
Attac'lmenrs./Sci 7es- & House P a''S
Des ane-iPiumde-. flf,_14/? L/ c„rt, /l ~~Y`4` ~s-'_icen.se Nu .De-.
Cate'
T Phone Nimne-
Soi Si~n3t~r-e
Ass., 6 53D-".
Pace
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ft ITITI T 1 ! i i f f (?7 t~?T,I 1 plll ljpTT'TM F OI'Tffff t*rrT Tm -in-rTT-r~
Leaching
Vent or Observation Pi
Chambers
TTTnTrr *T 7T- FTrjrT r rrT
. Frzr
~e_is~
f)ch 2 f ?i ccicr
Leachirsq Chamber Sc~ecifr~afac~~s
Manufacturer And Model
i ai ) ~ t itci ilt) E' coil ApOication Rate s C
gpolsq fit
9Pd ueicnt ,oar : y.
Soil Application Rate~fp l Chambers
I 2 rows of
7.~ chambers each.
Pace of
r ,~t ~3,-- ~ r
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OW WNER'S IMANUAL & MA €AGEMENTPLA rile " of
DILL INFORMATION SYSTEM SPECIFICATIONS
Owner
`T Septic Tank Capacity f f 12 NA
Permit # Septic Tank Manufacturer ~ gal
❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model El NA
Number of Public Facility Units .4t^ NA Pump Tank Capacity NA
gal
Estimated flow (average) gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) f J gal/day Pump Manufacturer k'NA
Soil Application Rate J gal/day/ft2 Pump Model 11Z NA
Standard influent/Effluent Quality Monthly average' Pretreatment unit NA
Fats, Oil & Grease (FOG) 530 mg.!- ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD,) 5220 mg/L J~% A ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Ceil(s) ❑ NA
Biochemical Oxygen Demand (BODS) ' <30 mg/L ln-Ground (gravity) ❑ in-Ground (pressurized)
Total Suspended Solids (TSS) _<30 mg/L ~ NA E At-Grade El Mound
Fecal Coliform (geometric mean) <10` cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size i in dia. ❑ NA Other: ❑ NA
Other: Other.
l E2 NA ❑ NA
'Values typical for domestic waste^Nater and septic tank effluent. Omer: :1t
r0AINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once ever = monthlsl
y' 6-2- Jyear(s) (Maximum 3 years) ❑
Pump out contents of tank(s) When combined sludge and scum equals one-third fY3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) 0 NA
- R year(s)
Clean effluent filter At least once every: l month(s) ❑ NA
❑ year(s)
inspect pump, pump controls & alarm At least once every: L month(s) X.NA
u year(s)
Flush laterais and pressure test At least once every: ❑ month(s)
G year(s) NA
u month(s) ')the: WA
{ At least once every:
^ year(s) ❑ W
Other:
i0AINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tani:
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent an the ground surface.
he dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage 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 pressurized components, pretreatment
units, and any servicing at intervals of <12 months; shall be performed by a certified POVVTS Maintainer.
A service report sha 'the !J a
START UP AND OPERATION ~'aye 7i of
=or new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
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 septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage 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 celis. I.o nor drive or hark 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
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (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 steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 63.33, Wisconsin Administrative Code:
o All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
r The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
® After pumping, all tanks and pits shall be excavated an removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant
replacement system:
G A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed s=-ruu*ure. !-,)t ';nes and wells, Pailure to orotec`_ the replacement area will
r;;sult in the need for a new soil and site
comply with the rules in effect at that tim..:.
Cl A suitable replacement area is not avai'
technology a holding tank may be installed as a.,L ",3 repia.u .r,e ;aueu P".is'v f
The sit@ site
aluati ~ a o ding ank
upl=e-ent area it, be i ea. e . Vf2p4418 rrEZL. 99D12- I1&_1V✓ at JS`re(JCTI0
Mound and at-grade 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.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name U r&r Name
Phone " 77;0 } G Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name ~-j- r~_u t
Phone Phone -7tS 3~~,_ ~~J
This document was drafted in compliance with chapter Comm 83.22j2)(b)(11)0&(f,~ and 83.54(1), (21 & ;3 , 'r'ilscons n 2dminisuative Caae.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer
t
Mailing Address cf`~ l.,t-C
Property Address
(Verification required from Planning & Zoning Department for new construction.)
47
City/State ,f~-c ~f
Ci~✓~~,,~,>~ Parcel Identification Number
LEGAL DESCRIPTION
Property Location j,1- 6 Sec. G~ , T ~ N R Town of Azcit_-V~r~~
Subdivision Plat: , Lot # .
Certified Survey Map # 7c' / Volume ,Page #~a
Warranty Deed # Ty(~Q (before 2007)Volume , Page #
Spec house ❑ yes &o Lot lines identifiableKyes ❑ 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 §SPS. 383.52(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 private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services 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.
Uwe certify that all statements on this form are true to 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 of bedrooms ~J'
4~zlL/~
SIGNATURE 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. 04/12)
Wisconsin Department of Safety and Professional Services
Division of industry Services
SOIL EVALUATION REPORT t?G 3
CI of
indance with Comm 85, Wis. Adm. Code
County St. Croix
Attach complete site plan $4gian 81/2 x 11 inches in size. Plan must ^Z
include, but not limited to: vertical and hori ontal reference point (BM), direction and Parcel I.D. .7
percent slope, scale o&TwQftpg4,(g l w, and location and distance to nearest road. , ■
'0MMIA1ITY P Revi d by
eas Vimation. D
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). at3 h7
Property Owner Property Location ❑
Brian Johnston Govt. Lot SE 1/4 S 1/4 S 1 /30 N R 18 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1398 120th St na na 4.33 acres pending
city State Zip Code Phone Number []City ❑ Village Town Nearest Road
New Richmond WI 54017 ( 61 2-685-2575 Richmond 120th St
0 New Construction Useo Residential / Number of bedrooms 4 Code derived design flow rate 450 GPD
11 Replacement FlPublic or commercial - Describe: na
Parent material outwash Flood Plain elevation if applicable na ft.
General comments Conventional System, system elevation 93,$0ft Trenchs spaced and depth to code 5ft below grade.
and recommendations:
t I
FT] Boring # 11 Boring 98.80 120
F-1 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
1 0-10 10yr 3/1 none sil 2msbk mfr cs 2f .6 .8
2 10-24 10yr 4/4 none sicl 2msbk mfr gw if .4 .6
3 24-120 7.5yr 4/6 none Cos osg ml na na 7 1.6
Boring # F] Boring 98.80 120
■ 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
1 0-12 10yr3/l none sil 2msbk mfr cs lc .6 .8
2 12-22 10yr4/4 none sicl 2msbk mfr gw if .4 .6
3 22-46 7.5yr4/4 none sl om mfr gw na .2 .6
4 46-120 7.5yr4/6 none cos osg ml na na .7 1.6
F-J
* Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) S;ign re CST Number
David J. Steel 248956
Address Date Evaluation Conducted Telephone Number
1h99150thRtNewRirhmnnrl Wt 54017 AMI /1niA I1 s-7d~n_nza7
a
Brian Johnston 2 3
Property Owner Parcel ID # Page of
a Boring # Boring 95.60 120
' 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
1 0-12 10yr3/1 none sil 2msbk mfr cs lc .6 .8
2 12-22 10yr4/4 none sicl 2msbk mfr gw 1 f .4 .6
3 22-46 7.5yr4/4 none sl om mfr gw na .2 .6
4 46-120 7.5yr4/6 none cos osg ml na na 7 1.6
❑ 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
❑
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/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
SBD-8330 (R07/13)
STEEL'S SOIL SERVICE 3 of 3
David J. Steel Brian Johnston 1699 150th St.
CST-POWTSM SE1/4,SE1/4,S21,T30N,R18W New Richmond, Wl 54017
Lic. #248956 Town of Richmond, St. Croix Co. Direct 715-760-0347
4.33 Acres Pending Fax 715-246-0318
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
The location of this test may or may not be as shown, as permanent lot lines were not established at the
time the soil test was conducted.
Legend N
1"=40'
n c ♦ = Benchmark Ele. 100.00 ft
' Top of 1" PVC Pipe
• = Alt Benchmark E] 100.00 ft
Top of 1 1/2 " PVC Pipe
0 = Borings
Boring Elevations
B1 = 98.80 ft
B2 = 98.80 ft
B3 = 95.60 ft
B4 = 0.00 ft /
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