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Home My WebLink About026-1306-00-008 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 597456 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: ROBERT & CATHERINE WYMER TOWN OF RICHMOND 026-1306-00-008 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Gtr( 76 ftor t--e+ S 18.30.18.1615 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic l C-pit-r 1, ! ✓rC~ Benchmark toq, De's 1 Alt. BM Aeration Bldg. Sewer lot - Holding St/Ht Inlet 3.39 100-00 .171 TANK SETBACK INFORMATION St/Ht Outlet 39 fUa~~,~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration-, Dist. Pipe Holding J Bot. System PUMP/SIPHON INFORMATION Final Grade /UO J Manufacturer Demand St Co r s GPM Model Number TDH Lift Fri5j"n Loss- System Head T H Ft Forcerrvain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM' Q~, sit I BED/TRENCH Width Length t No. Of renches PIT DIMENSIONS No-,5, ~ _T Inside DA_ Tquid De-PIN DIMENSIONS \ SETBACK SYSTEM TO P/L BLDG WELL LA /ST M LEACHING Manufacturer:1~~ / INFORMATION Ty Of System: CHAMBER OR e UNIT Model Number DISTRIBUTION SYSTEM ! - ~~l~e•4►~S Header/Manifold Distribution Ix Hole Size x Hole Spacing Vent to Air Intake 0 Pipe(s) / _ / Length 161 Dia _ Length Dia / Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 7 ` Seeded/Sodded Mulch Beth Over Center Beth O Edges Topsoil I Yes CNo r J v Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1546 97TH ST / 1.) Alt BM Description J L-efCC~ 6v- 2.) Bldg sewer length = - amount of cover Plan revision Required? Yes [7 No fq~~+ Use other side for additional iinnformation I Date Insepctor's Cert. No. SBD-6710 (R.3/97) 1 County 7 Industry Services Division y ti D 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P.O. Box 7162 Madison, 37t) 71 '71T- q°fFSSIONaL~t)H . ' emit App] 31 SR5AAD57BPY StateTransactio her i accordance wi5383.21(2), Wis. Adm. Code, submission of thi )tT In is required prior to obtaining a sanitary permit. Note: Application forms for state-Owned POWtS are stdtm►itea w Pr ec Address (if different than mailin€ address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.040)(m), Slats. I. Application Information-PleasePrintAllInformation Parcel # Property Owner's Name Property Location , Property Owner's Mailing Address C f 5~ Govt Lot City, S Zip Code Phone Number /VN %s, Section (circle T N R / E ori II. Type of Building (check all that apply) Lot # Subdivision Name / i or 2 Family Dwelling - Number of BedrOOMS Ok- - ❑ Public/Commercial - Describe Use Block it ~ ❑ City of ❑ State Owned -Describe Use CS Number ❑ Village of Town of / -76 III. Type of Permit: (Check only de box online A. Complete tine B if applicable) A. New System ❑ Repiacernefff System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued B Plumber Owner ~a Q Before Expiration IV. Type of POWTS System/Component/Device: (Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound? 24 m, of suitable soil ❑ Mound < 24 im of suitable soi ❑ o mg Tank er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUfreatme Area Information: 1 • Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation d Rate(gpdst) - VI. Tank: Info Capacity in Gallons Total # of U~°- Y Manufacturer o a o ? r G U v i` C7 c New Tanks Existing Tanks Gallons Units C Septic or Holding Tank ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Reapo ibility Statement- 1, the undersigned, ass a respafisibil' instailAtt of the PORTS shown on the attached plans. umb r' are (P Plumb signature MPtMPRS Number Business Phone Number Plumber's A dress (Street, City, State, /Zip Code) T VIII. oun /Department Use Only Approved rsapprove Permit Fee Date I used Issuing nt Signature Otis tven Reason for ial S IX. Condii~eastIms for Disapproval M rk, ta. L,( 1i MID Mini 3 uispan:ai cell riust all be ti ic?ls' r, e'nt -err /1~ ) nsper ,inanagernent plan pro iiden by plumbe,% 2. All r~k recuitet-aanes must-bu i-x:nt it i,i as per tgiictUit code / c•rdinanot s. attach to complete plans for the system and submit to the Count only on paper not less than 8 r2 x 11 inches in size t - ,V . I 41 -ice"-__. _ ~ - _ v i i r i G ~ _ s T v t~ i f 1-_ rl ' G 1 i _ 4 Y"l 71 Soil Absorption System Cross Section tt f 4° Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching ~ Chamber / System Elevation ft ft Soil Absorption System Plan View ft ft ft Leaching Trench 1 Chambers 4° Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model EISA Rating _ sq ft per chamber Soil Application Rate r gpolsq ft gpd Design Flow 7_ Soil Application Rate 22 EISA Chambers 3 rows ofd chambers each. Page of <<' -(rill- REC Wis. Dept of Safety and Professional Services SOIL EVALU I'' SPORT Page of Division of Safety and Buildi , t, in accordance with SPS is. County Attach complete site ptiYri o r P x t 1' ,st - MI include, but not r~ ~&rence poi P► and parcel LD. percent slope, scale or dimensions, north arrow, and location ar ~P to nearest road, A Z'(1 _ - ; . Re vi by Date Please print all informatir 5 Personal information you provide may be used for secondary pu,, .'rivacy taw, s. 15.04 (1) (m)). ~u ya~t property, (Owner { Property Location . 1', 4 Govt. Lot 1/4~• 1/4 S " T ~ ? N R E (or Property Owner's Maiitg Address Lot # lock Subd. Name CSM# I City State ( Zip Code Phone Number City ❑ Village Town Nearest Road New Construction Use:I Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ public or commercial - Describe: :-Z 400 A Parent material Flood Plain elevation if applicable ft General comments and recommendations: jj j~7 d • Boring # ❑ Boring ® pit Ground surface elev. //-f,: 7_ ft. Depth to limiting factor_ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence oundary Roots GPD/ft s in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 . 02 _ !7 Xll ::14k Boring # ❑ Boring ® Pit Ground surface elev. _L ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure sistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. tf#1 if#2 .c. s».s hC cF 7 _ E t #1 = BOD > 30 < 220 mgA- and T ' Effluent #2 = BOD < 30 mg/L and TSS < 301`1`191 CST Nam (P a Pri Signatur CST Number ~ . Address - Date Evaluation Conducted Telephone Number / SBD-8330 (RI 1/11) i Property Owner x, ParceI ID # Page, of Boring Boring # 111 ~ Pet Ground surface elev. ft. Depth to limiting factors in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 01 * ff#2 r ' l AA Z/J r 1l I~ r ❑ Boring r Boring # ❑ Alt Ground surface elev. ft Depth to limiting factor in. Soil Appfication Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2 in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. ff# t 02 ❑ o Boring # ins Ground surface elev. ft Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ` ff#1 * 02 * Effluent #1 = BOD 5 > 30:5 220 rng/L and TSS >30 < 150 mg/L * Effluent #2 = SOD 3 < 30 mg/L and TSS 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. M-8330 M I/I l) Property Owner Pa`rcet ID # 3~ - Page of ~ Boring Boring pit Ground surface elev. fL Depth to 1im+tin3 fact°r-~--in. Sod Application Rate # Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPDfft Z in. MunseQ cu. Sz. Cont Color Gr. Sz. Sh. * ff#1 4 ff#2 q ~S r Al 4 sc 000, VF- li Boring # Q Boring ® pit Ground surface elev. ft Depth to limiting factor in. it Appfication Rate Horizon Depth Dominant Color Redox Description Texture structure nsistence Boundary, Roots GPDJft z in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. t3#1 * 02 Boring Boring # Ground surface elev. R Depth to limiting factor in. EJ ❑ pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots * ff#1 GPDJft ff#2 in. Munseil Qu. Sz Cant Color Gr. Sz. Sh. Effluent #i = BOD 5> 30 f 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = SOD a :5,30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SM-8334 (RI 1/1l) t\ .W C 4 tit G 74 P\ PT_Alk).T ~ J County `\r liL+ Industry Services Division p IRE 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) f r ,.t, P.O. Box 7162 ti I ' Madisor WI 53707-7162 S5 / # J ~AAr~Ef JIU\N4. it Applicai,, 55,4 " State Transacti umber yxy ~4 In accordance with SP (2), Wis. Adm. Code, submission of this form to the approp,._ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS a, -94' the Department of Safety and Professional Services. Personal information you provide may be used for secu._ ect Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. ~ 1. Application Informa ' n - Ple a Print All In mation 1,14 Property Olwner'. 1`)a,,,P a Parcel # Property Owner's Mailing Address,// Property Location'$, 5Q, i, $ , ) 6 15 1n S Govt. Lot City, S to Zip Code Phone Number At) '/4, --5~ '/4, Section 4Y (circle o ) 1 1 T S T, 36 N R/& E o>w' II. Type of Building (check all that apply) Lot # ❑ l or 2 Family Dwelling- Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use Block ❑ City of ❑ State Owned - Describe Use El Village of SM Number ~+Y1Ci,MYfJQ1~ I ~ ' ~ ~ r 0; t4, Ce-11-5 LJ /r Town of III. Type of Permit: (Check only a box on line A. Complete line B if ap i le) A. ~d New System ❑ Replacement System atment/Holikin eplacement Only ❑ Other Modification to Existing System (explain) B ❑ Permit Renewal ❑ Permit Revision han e of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration P r Owner IV. Type of POWTS System/Component/Device: (Ch that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At de ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil S ❑ Hol ing Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment eInformation: Design Flow (gpd) Soil Application Dispersal Area Required (sf) Dispersal Area Proposed /(,f) System Elevation (gpdsf) 6 -3 i % VI. Tank Info Capacity in Gallons Total # of fjM anufacturer Gallons Units ~4~ o a U v u C7 C New Tanks Existing Tanks de. Septic or Holding Tank El El 1:1 1:1 Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Respo sibility Statement- I, the undersigned, assume r sponsibi ' for installation of the POWTS shown on the attached plans. Plumb r' ame ( in Plumber's gn MP/MPRS Number Business Phone Number -2 Z Plumber's Address (Street, City, State, Zip Cod , l _7? Z, r ; VIII. unt /De artment Use Only Approved P Permit Fee Date Is uedIssuing A Signature iven Reason r Denial $ 5 S117-1117 IX. Condfe 1Rea'IR~ t odr Disapproval ~t>ai w~ mtut all e~'r~nica„~ !nt G.''rec' ) as; plan pra'sided by plt_nbe*. , ~rMls lrna3!fAetra>»MGine*I ~il Q.~ A--Otr 2. All' n P* 00* / C4M W1M- a Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R03/14) ,l V 4 t ll s i } o o CONVENTIONAL COMPONENT DESIGN Residential application INDEX AND TITLE PAGE Page index end Tlt1e Project Page;Ptat Bari Name: p g 3 Sy8tem Sfzrng & t rrasG S i t€on Owner's J, €~e 4 1=1tecs Name: C~~9E fa~%i' ER(3Yil3ntttt[9 W3 Owner's 6 I"' 'ag [J , a erneh Pan Address: rage dept{ T~nE Ilayntenace Pages t; . ~.SNE ar P!a# Atlacliment Stt€ Ts Legal Description: d~~r Subdivision: Lot # Town: County: Parcel ID#~- Designer/Plumber: ~v~,/_ License #,-22-11-21.3. Signature: D"ate:-- Comments Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 Index+Title 2/2/2012 O r -4-r o ~V e~~ 3 i 4 ~ 4 ,r Soil Absorption System Cross Section e- tt 4° Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching Chamber System Elevation Soil Absorption System Plan View J- 2-1 j1 _5 ft - €t Leaching Trench 9 Chambers 4° Dia. Trench 2 Header Vent Or Observation Pipe cs-~ ,~z„t35 Trench 3 Leaching Chamber Specifications Manufacturer And Model L~1/ _s~ia Iran EISA Rating ; sq ft per chamber Soil Application Rate gpolsq ft _ gpd Design Flow Soil Application Rate_ EISA = Chambers rows of chambers each. Page of ~ Q U J NOW RINSTRUPCOMONS 1NgT4LLA f ON INS (t1i tag 'M Z:,~T703 r 1 ~ T ~_t E t•c-J, itiV~j. .✓.[-•`e~~r' 1 ' J } f i - y~ ~z s I y t i` `z ' f 1 .a y z ~3 (Aeg „ihe outlet of the ~G tank {A) gBef2: Step& file jW M place the ( housing on the {R} Locate fifer houft an fo to ufiet pipe- Mwet ¢fge- } Remove tank cover and pump iant~ tf toha q i7e (B) ea tosure {H} Msed fm i; ner wssimY is pgs oned so'ifieVw can be hou*19 - sane the ON ; znzcnred f 3ni #ze iank far a is P y a gnsd and maintenance and seMb_- compieiieiy Rweried in the housin& MAINTENANCE INSTRUCt-fON-S '7--7' 17 4fl ""fir? ♦'3 L. i .,1- + i.' "~?t i . Stop 1: Step 2-. Step 3: ( F Locate the otttiet of ibe s°piic lank. {A} Remove tmk c and pump {A} #03n#0 1, ho ~13a back 11 11.11111'''' Elit;7; _ i'f musssary. 11 tD ft ff m tot s $2E ntLl'IS FtaY aF~ghed r c t;r~} ft}5) TISiS 111yG~1111C.rP~tI.J.,LL S. +J 4.~lfir~. _ssrbx and gjlr~~~(. aA~LLI,~~i~~p yY,°~'~ '~"'Y"~i ~p~~y~ ~'U1S_G1i~+V~{• (B) tank i rAv , ) ,fie l1 s7 t' i z1.J 4~-. t_: : '`°,'`...•`:.J? • sure all svffd l fag back ~ the niiF=~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _:L-of FILE INFORMATION SYSTEM SPECIFICATIONS Owner C,~,z;~ ~ ~,~,t'' Tank Manufacturer: ) 0 NA Permit# 0 Septic ❑ Dose ❑ Holding Volume:_$C (gal) DESIGN PARAMETERS Tank Manufacturer: 3 NA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: (~(-NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Design (peak) Flow = (estimated x 1.5): (gal/day) Specific servicing mechanics must be provided if vertical is >15 feet or if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal/day/ff) Effluent Filter Manufacturer: ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) s30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ~NA Total Suspended Solids (TSS) 5150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L NA J?f NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter Pretreated Effluent Monthly average e ❑ Disinfection ❑ Wetland Y 9 ❑ Sand/Gravel Filter ❑ Other: (BOD5) 5_30 mg/L Soil Absorption System (TSS) s30 mg/L C9 NA Fecal Coliform (geometric mean) 5_10° K(lin-Ground (gravity) ❑ In-Ground (pressure) ❑ NA Maximum Effluent Particle Size in dia. El NA ❑ At-Grade ❑ Mound ❑ Drip-Line ❑ Other. Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every' ❑ month(s) year(s) (Maximum 3 years) El NA Inspect dispersal cell(s) At least once every: ? month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) _,Q'NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) J&NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA El year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third (X) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) START UP AND OPERATION Page 4 • of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps s' and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Cc, • All piping to tanks, pits and other soil absorption systems shall be disconnecte • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). • After pumping, all tanks and pits shall be excavated and 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: 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 structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or sal limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INS LER POWTS MAINTAINER 1 LName Name ne Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name I ::::d Phone Phone = - This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY S.F.PTI~C TANK ~:AL~r'I`r~ AI~tCJ, A.G "r.. ' AND 0WNTERSFAF CERTiECATION FORM L:_gAr ess /,51 6 7 ze~ 7' \/7 ~/7/' o -5, ~ / l// (Verificedon regabzd from Planning & Zoning Deparnaim for new ccros'uvction.) Cite/State 4-b wo cam, of Parcel Identification Number D Zoo - Z3 Lo665 L C_ L DESCRIP .Proms Location x'14.. 7-NI R W, Towa of Subdivision Plat: - ~s Certified Survey Nap Volume _ Page -97'armaty Dead (before 2 )Volume _I't e Sow louse yes*no Lot khm id Jsl yw C.no EfSTEM MA MNANCE ADD OWNER GERTff ICATION improper use and maintenance of your septic system could reM't in its premature fi ilrue to handle wastes. Proper maintenance consists of pumping 011 the septic tank every three years or sooner, if needed, by a licewed pumper- What you put into the s3 stem can affect thm binction of the septic rack as a treatnimzt stage in tie waste ` s2l y onsfoilities are specified in §SPS. 383522 and in Chi ~'~m C~~ maintenance maintenance ~rP airier IZ - St Croix County Sanitary Ordinaucc. The property owner agrees to submit to St C~roix County Planning & Zoun g Department a ceniEc im f0m signed by the owner and by a master plumber, joumeyrmarr phunbea, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping Cif necessary), the septic tank is less thm I/3 Bull of sludge. I1we, IJ,,e undersigaed have read the above requirements and age to m utam the private sewage disposal system with the stand* ft,& hare}, as set by i&e Departmezit of Safigy And Prrafe l Sere es and The DepwUnent ofNa tral Res, State Of W u . CwUfi=(m sag th9a y= septic system leas beeai maniftmed _ must be completed and rimed to the St. Croix County P & ZMiA9 DeParlWent Within 30 da)v of the &w year cq dale. l/we T3' that au statements on this are true to the nest of my/our know ~ Uwe am/= the owner(s) of the nroge-ty described above; by titue of a w > deed recorded in Register of Deeds Office. -N tuber of bedrooms SIAM OF AI' -CA=SS). nor Any information that is may result in the sanitary permit beMg revoked by the Planning & Zanmg Departmem include -%,vh this application a recorded war3mirf deed from the Regismr of Deeds Office and a copy of the ceatfied survey mats If reference is made in the waawty deed. ~RRV. 64M) i 1 N S CJ wi 4ow ly►'Vrr' 1 a~ 9'E 2641.79'---- fz N00 2'z1"w 159.06 377,14 S00"52.210 20.1 • 20.11 _ 'a'---.-~ LOT 7 1.504 ACRES n 1M 85,524 SO. FT. ful tf) \ \ LOT 9 . Fr \SEE S 97TH , 952.5 STREET 1 A~ \ 4+} LOT 9 1.773 ACRES •77,219 SO. FT. _ LBO-955.9 . - W DRAINAGE EASEMENT SZ6,~ LOT 11 - S£E EASEMENT • 1j1.522 ACRES oti x MBLE F" FOR \ j 6,314 SO. FT. yb \ D/AIENSIONS r' y J4. Q LBO-955.9 HwE-947.5 958.3' \ / ti / 91 ~ LOT 10- 1.520 ACRES 20 fL k~ 66,206 SQ. FT. LBO-955.9 / lAcbb l~ LOT 47 cn i o kiA N / r #1492 ~wisconsi%n SOIL EVALUATION REPORT, , 1 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings - - Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8Y= x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. 8 Revie d By Date Personal information you provide may be used for~econdary purposes (Privacy Law, s. 15.04 (1) (m)). 2rj 6 Property Owner n O Prop rty Location Sienna Corporation Govt Lot _ NW1, SE /4, S18, T30N, R18W Property Owners Mailing Address Lot I Block # Subd. Name or CSM# 4940 Viking Drive Suite 608 ? _ The Glens Of Willow River City State Zip ode ff)o N~r~1~er City Village Town Nearest Road I~~IX -UUNTY Minneapolis MN 55 35 Richmond 95Th St. <I New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD j Replacement Public or commercial - Describe: Parent material Outwash - Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating for Area 1 with a system elevation of 97.70'. Area 2- 0.6 gpd/sqft rating, System elevation 97.20'. Boring #r J' Boring Pit Ground surface elev. 101.98 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color T Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10y3/2 none _ sil 2fsbk mfr as 2m,2f .6 .8 2 9-18 10yr4/6 none sil 2msbk mfr gw lvf .6 .8 3 18-27 10yr4/4 none sicl 3msbk mfr cs 1vf .4 .6 4 27-96 10yr5/4 none grcos Osg ml as .7 1.6 5 96-100 2.5y7/3 c2d 10yr6/8 vFs O 10yr7/2 r sg ml .4 .6 011 BF2113oring # Boring Pit Ground surface elev. 101.18 ft. Depth to limiting factor 79 in. - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/1 none _ I 2fsbk mfr as 2f,1vf .6 .8 2 11-19 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0 3 19-27 10yr4/6 _ none Is icsbk mvfr gw 1vf .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 10yr7/1 vfs Osg ml 4 .6 at ' 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: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. ---I Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/14/2006 715-247-2941 SBD-8330 (R.07/00) Property Owner Sienna Corporation Parcel ID # 8 Page 2 of 3 Fil 1 Boring # Boring 1 Pit Ground surface elev. 100.93 ft. Depth to limiting factor 84 _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sl 2mgr mfr as 2f,2vf .6 1.0 2 10-16 10yr4/4 none scl 3msbk mfr gw ivf .4 .6 3 16-20 10yr4/6 none sl 2msbk mvfr gw ivf .6 1.0 4 20-51 10yr6/4 none s Osg M1 Cs .7 1.6 5 51-72 10yr5/4 none grs Osg Ml Cs .7 1.6 6 72-84 10yr5/6 none grcos Osg ml as .7 1.6 7 84-91 2.5y7/3 c2d 10yr6/8 0 ml 4 6 10yr7/3 I g6 Boring u.1V sj~.710 Boring # Pit Ground surface elev.w._ 99. 5 _ 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 2fsbk mfr as 1m,2f .6 .8 2 12-20 10yr4/4 none Sid 2msbk mfr gw 2vf .4 .6 3 20-25 10yr4/6 none sl 2msbk mfr Cs lvf .6 1.0 4 25-70 10yr5/4 none grcos Osg ml as .7 1.6 5 70-84 2.5y7/3 c2d0y0yr6/s vfs Osg ml ,4 .6 1 ,r ❑ 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 I *Eff#2 T7- Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.07/00) Schmitt Soil Testing, Inc.