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HomeMy WebLinkAbout026-1306-00-073 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597481 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: TODD MAREK TOWN OF RICHMOND 026-1306-00-025 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No l'7'` if- u ev 18.30.18.1632 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. 0-- a Septic ~I Benchmark •3 t~,~ /60-ce Bes ng .L '3► Alt. B A F CV R 1 J ?U.76 q Bldg. Sewer Holding St/Ht Inlet • TANK SETBACK INFORMATION St/Ht Outlet tJ oZ. aO TANK TO P/L WELL BLDG. Vent to A Intake ROAD Dt- y_ f____- t Dt Bottom Septic 75 I Lf Dosing Header/Man. IU,1 O Aeratio Dist. Pipe Lo'` Q Hol Bot. System IL I nO.u Final Grade PUMP/SIPHON INFORMATION Manufacturer _ Demand &tl!~Vv-er~ _35 IM - T PM Model Num r TDH Lift i tion oss Syste H TDH Ft Forcemailif L IDia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Le C) i No. Of Trenches PIT DIMENSIONS No. Of P Inside Di Liquid D th DIMENSIONS U SETBACK SYSTEM TO P/L~k) BLDG WELL LAKE/STREAM LEACHING Manufacturer: I INFORMATION T e Of System. I t CHA LINER OR Model Number DISTRIBUTION SYSTEM IL, Header/Manifold Distribution x Hole ize Ix Hole Sp cing V,enj to it Intake 1t 1~ *4 ) Length Dia Lengt Length Dia SpacingA__ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulc ed Depth Over Depth Over ` IXX Depth of od T Bed/Trench Center Bep rench Edges Topsoil xx Seeded/S \ Yes No Yes :N]. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2 Location: 1512 96TH ST 1.) Alt BM Description = `-'1` S !!1^' i~ C / 2.) Bldg sewer length= - amount of cover Plan revision Required? ❑ Yes [ No Use other side for additional information. Date Insepctdrs ha re Cert. No. SBD-6710 (R.3/97) tatty 5'f 9FpNCn~nr jC t' f a3 Safeand Buildings Division 201 W. WasFlington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 2 RECEIVE) a T$ $ Madisor~Vl 53707-7162 p SEP ® 5 zw p~'3StON TZA G3 State Transaction Number 3 OMM Appllca,s gxq L U~/V2 In accordance with SPS 383.21(2), Wis. Adm. de, fission of this form to the approy._ project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS ate _ the Departm6ht of Safety and Professional Servics. Personal information you provide may be used for seco„~_ / L purposes in accordance with the Privac Law, s. 15.04 1 m ,.Stats. ~j 1. Application Information -Please Print All / ma Property Owner's Name Parcel # l y _ _ ©/t L) Z oz ' L ~ Property Owner's Mailing Address Property Location A 2 y 3' Govt. Lot City, State Zip Code Phone Number Section (circle one) f~V l C~i~zP/~~.~ ~J Ti~ N; REor~ II. Type of Building (check all that apply) Lot # Subdivision Name or 2 Family Dwelling - Number of Bedrooms],, Block# ` L tis e ttJlLLCi~/ 11 1 4 ❑ Public/Commercial - Describe Use s ❑ City of CSM Number El Village of El State Owned -Describe Use - Town of IL, /✓py ✓0 LA-1 AA6.,C5 in. Type of Permit: (Check only one box n line A. Complete line B if applicable) New System ❑ Replacement System 11 Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) A List Previous Permit Number and Date Issued B. ❑ Permit Renewal Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soils Wad ❑ Holding Tank ❑ er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gp f) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 0 I l VI. Tank Info Capacity in Total # of Manufacturer Gallons Units o vl 7, Gallons U ~ New Tanks Existing Tanks Y , a U N ~7D w Septic or Holding Tank Dosing Chamber 09(l - $ d d VII. ResponsibilityStatement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' ame (Print) Plumber's Signature MP/NfigmNumber Business Phone Number Z Zk> 7~s Z73 S'Yf~ Plumber's Address (Street, City, State, Zip Code)' rJ L W it { L. • Gji/ VI oun epartment Use Only Pennit Fee Da Issue Issuing at Signatur Approved pprove $ 66 9 I I 4- 41 en Reason for Denial IX. CondivewpmKoweasons for Disapproval 3` n 'Q p (tea /~L~i.aJ 1. .Sepik tar!h'S 64A~61i: Inter t•fti /J tai. cell trust all be sr-eicss ! r,i~.~nts^et' ~ ~ as per :)'lanagement plan pi o tided by plumber. 2. W se%W* PBG MgClertYS4~ Y must. be r-,tairttrire4 , ! ~G✓L . as per efflk4 bie coda / crdinanow. Attacb to complete plans for the system and sub to the n only on paper not lest than 8 L z l ch U e 1 9' • SBD-6398 (R 11/11) PL 0 C~ T Air v iN ~ L~ a uv 0b Pg of Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Project Name and System Type: C o.Q Vt t Location: Street Address Legal D/ecription Township/County Design Criteria (Check one): R Holding Tank Component Manual: In-Ground Soil Absorption Component Manual: ❑ SBD-10571-P (6/11/1999) 1% SBD-10567-P (R. 6/1999) ❑ SBD-10855-P (3/2007) Version 2 ❑ SBD-10705-P (N. 01/2001) Version 2 Contents: Page 1:~ L Page 2:~~}~ Page 3: --/-AAV K Page 4: Page 5: ~U,14 F° Page 6: !y5' ¢L~;qv, Page 7: Page 8: /I/~Q-1t1, co, ths~ 14e- d Page 9: Cc .V_1V ' AYE Attachments: 41 A(,,4,4- i,,, A ,U `~~'t~ ~•y~ / i Plumber/Designer: 1~6 ~/rO71_ /y eA11 Signed: h " Credential Number: Z Date: I r PL 0 PL A IV 4~y ,P yZ ~ T 4 -for ~L vi 0 d 9D z Combination Sep•t-ic, Tank and PUMP CHAMBER CRO55 SECTION PJ0 SPECIFICATIO~JS UCk1T CAP WCATHCK PKOOf UtJ1JCTI0u SOX I- c. I. VENT PIPC lPPROV,EO C OCK1f.IG 5 jQ' FROM COO&, wPRr~I G ~A 6~L. './INDow OR FRCSH CouDUtr u~sP o>J tP~ A. R IuTAK~ c J w ! rYttz~ s tip` rrF I 1111.1. I 6" ua. L~C~ 11JLC T PROVIDE I - AIRTIGHT SEA L 1 , - I I APPKOYED .101iJT: APPROVCD Jo A 11JT Zt~$;L Ft~ I I I W/C.T. ~IPF~~"~ W / c.a:_ Pin I:, Tank construction I III ALARM shall comply with I I! TLHR 1,3.15 and 33.20 ° I I O Q C ! 1 PUMP OFF 0 CORICRETE ~ 1 -BLOCK , ~✓UJ V -X- RISER FXIT PEKP 17CD OlJLy IF TAUK MAIJUFAGTURC-R HAS SUCH APPROVAL 3BEQOI APPNG SCPI-IC F 5PECIFICATIO!JS DOSE LylS CcCC Tr. 11 KS MA>•1UFACTURJ: R.: AJUmf3CA OF DOSCS: PER D,~,~ TA1JK SIZE: GALLOk1S DOSC VOLUME ALARM r1A1JUFACT URCR: ~S C EO S 1T-~-n~ IR1CLUp11UG 6ACKftOW: GAtLOt~S r101DCL ►JUM6CR: I QL Hw CXPACITiCS: A=3 23WC815 OK GALL0115 SWITCH T.~PC: C L~°~ 8 = ItJCHCS~pK _L1iT GrLLOUS Pump MAk1U1FACTI] KCR: _ C r _IIICHES OR /ZILZi~ALLOU5 MODEL }JUM6ER: y 7 1' D=LIAiLHES CK UXLL0u5 SWITCH TYPE: uoTC: PUMP ARID ALARM ARE TO DL MUMUM D15CMARGE RATE r~ GPM INSTALLED QIJ SEFARATC CIRCUITS VCKTICAL pIFFEKEfJCE DETWECU PUMP OFF Au0..D15TRIBUTIOQ PIPE..- 71") hEET + I-SIk11MUhl lJETWC)RK SUPPL~ PR`~E~~SSURE , , , , , , , , C) FEET + ~ FEET OF FORCE Ij~ j Xr%oofLFKlcTlo>J FACTOR--~ FEET . TO7AL. 0tlQAMlC HEAD FEET As per.nanufacturer~ gal/in. a 3H "mm c t M4 r }y~Jj 7 C N N O O m m 15 .vl . C ° E' •C~ L C'p y.r e{A~1 2S a !4 13 c m n °i $ r aSi ~'~~Q 6te E. Q C Y= CS m C R 4 fA Q L.l ey'y}p9 1 y W ~ ~ g~ W a ~ Y <f~~~ a ~ to ~~klkt~ o E W r vffivc= d0 tirx~y 's~ ~ %ke H E L7 O C r O G° m y7Lk~. .;a ezz 1 bo e~ L O) ; m o m Y "9 O t~ m m'~ O m O. w m m F-FVrJi n« c Few t.'c. m. It lm 36 ~m6E mmmac~ v;cm o SmaE m~~~a ° W _ L N a°0. m 12 E w c' W O y C> -O fc W W p C N y c W M Y O O d W V t~ m ap pP N fq Oft m 0 CL C C~ r W ~.C C 0 N y W Of Q 01 eN rr ° Cm 5 m oL~ o ° ~ m E W l1 ~y@ n F.. 'Q' m 0 Y E m y c ai 3 ~to .w~ H 4 c o E W a c F r c p `m m LL C V y ~A ~t m~ O~ ~t ~ ' CCDcr pE mm~mm y~M-E71af LLJ 0 Ja N '6 J! K 6 - lV +~"-sN ~qp gg D~~ii pp G ~}fie U 5 e+~~e my~tt~iE ~5 r= E V M ~a Aug 0~8 ~5 w 4:~ N e ~;~Re zvu. O iF N a J2 O rz .,a it m R~ °8 EE~ . aFrE ~ Yy~~.tr;, erav u~ E Eli ~ ~,F+ .,,moxsm;wmrnrs _ c ~ r") >~"i r ~°yr ~ r'y yYr Fr'S ;r ~ ~r~ it § r ~ Ut ~ fr7>o4 ~'R tir s j >s c' r, irlr E d ' S $ 6f a ~ i ~,,~rr{~7~~,y,--~t`) I~ r~~ ~ pb ;~r; ivd•3vL .~r'iy,. ~ f ~ i'igr APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 HGOULDS PUMPS Submersible Effluent Pump PE WENT ►uM/ v~ SPECIFICATIONS MOTOR FEATURES Pump -General; General: ■ Corrosion resistant • Discharge: 114" NPT • Single phase construction. • Temperature: 104°F (400C) • 60 HertZ ■ Cast iron body, maximum, continuous when • 115 and 230 volts n Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover, • Solids handling: Ih" tection with automatic reset. ■ Upper sleeve and lower maximum sphere, • Class s insulation. heavy duty ball bearing • Automatic models Include a • Oil-filled design, construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor Is permanently Specially designed for the • Manual models available. shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor: service life. • Mound Systems perfomlance chart or curve. .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. l~ • Heavy Duty 5ump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts cord, 20' standard length, • Maximum head: 291 TDH • PSC design heavy duty 16/3 Sim with 115 or 230 volt grounding PE51 Pump; PE51 Motor: plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 115 and 230 volts portable and compact, • P5C design ■ Mechanical seal is carbon, METERS FEET 40 - ceramic, BUNA and stainless QE5i I I j I I MODEI : PE31, PEA1, PESt steel. 35 ' r I i I j i I ' HP:.33, .40, .50 ■ Stainless steel fasteners, 10ryr- I I' I I j 2GPM 30 ' , ' AGENCY LISTINGS 41 "I I 1 FT I U I I I a i l I a i l , ~ I I ~~0 C Us c zo ! I I ! a - j i i Tested to UL 778 and : I l i I I I I I I I i i CSA222108 Standards 5 15 I j -f- I- ' By Canadian Standards A65ociatlon File #L 36549 10 „L I i I I I I ' i ; : Goulds Pumps is ISO 9601 Regisrercd 0 _L . I I I i 00 10~ 20 30 40 50 50 70 GPM 80 O 5 10 15 m37 Goulds Pumps ® 2004 TIT Water Technology. Inc. CAPACrTY Effective June, '°°4 ITT Industries 9YE37/41 or 2 Family Dwelling In ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow (DWF) # of bedrooms x 150 gal/day/bedroom = i gal/day ' Design Loading Rate (DLR) or Soil Application Rate L~ gpd/ftZ (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area = DWF Jo 00 gal/day _ DLR 7 gpd/ftZ fttZ # Chambers = Required Distribution cell area Ol` ftZ ftZ/ unit EISA = / 3 Chambers Chamber Manufacturer and Model: %'4.y6 -4 AA- ki, I< 4 -I-'L a S Actual Distribution cell area = Required cell area yk)D ftZ + ftZ/ unit EISA End Cap Pair = ZftZ Cross-Section 'In-ground Soil Absorption System (2-cell 4" Schedule 40 PVC 112 f - vent pipe with Vent cap inches minimum jf2 ches minimum L / Z 76, L~ T 30 inches Soil Cover Trench 1 Sys- tern Elevation 1 Linch Chamber Height ' ft ft Trench 2 System Elevation a ft ft Trench Separation Leaching Chamber Width >3 ft to limiting factor Plan View In-ground Soil Absorption System (2-cell): Trench 1 Modify ft header/ design as ft Leaching Chambers 14 0 needed. Trench 2 4 inch Header (y Sch.3e" 3 l w ft with end camps Draw O for a Vent and for Observation Pfpe abo They will be located ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. w Quic 4 plus Standard Chamber Side and End Views j 48„ e (EFFECTIVE LENGTH) 12„ a 34" --~1 `s ,y;_i ~~4 PlUs All-in-One 12 ncap Front, Side and Ld Views 11.2" 13" 8" INVERT ~ 8" INSERT 5.3" INVERT + - 33" --~1 a Quick4 Plus All-in-One Periscope r, OUICK4 PLUS 'r ALA IN-ONE I ERISCOPC~ (360-SWIVEL ) 12.7" INVERT OUICK4PLUS ALL-IN-ONE 12 J - AJ ENOCAP . 5„ s. Quick4 Plus Standard Chamber Specifications Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cm) invert Height 0,6", 5,3", 8.0", 127" - - 5 cm, 8.4 cm, 18.5 cm, 22.6 cm) i (1. l 48" (122 cm) Effectjve Length ' INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator ( "Units"), when installed and i operated in a leachfield of an onsile septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder")i against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; g provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the ;j septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered ) by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS. INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part or the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR S does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages,; including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. r-I c . Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse N or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure t0 maintain the minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing 6 Business Park Road • P.O. Box 768 - the Units: failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, r or improper operation; of any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475 c terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860.577.7000 • FAX 860.577.7001 s third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions. 800.221.4436 r: (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the www.infiltratorsystems.com original Holder. d t The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, 10 obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units z v 'ir7 a~ t 4 s, r ~@, B ftY J ~ to ae t r ai9 dr - hba Y It S~ r r:9~i S ,a 3 r:~ t ~ xd S4E, r` ) n. n .,mw ~~fu w.e+amxew~"ww,~'x eie gtf ~'~k`t 1Ar d~_t ~qE .u ~x 7r~s emu, n~, S r w ~,n . ~ ~ a Z~ wa+e~i~fisT'§r'w s,i~utrdx«~.uerursc«~.ofai~wsi °s~an..on,...m.-.+++~+* w .•,n.•'~••,m••ua,.<eu ,M.:~A U S. Patents; 4,759,661; 5,017,041, 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716.163; 5,588,778; 5,839,844 Canadian Patents. 1,329,959; 2,004,564 Other patents pending. Infiltrator. Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. PLUS0510101SI-2 is a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc. © 2009 Infiltrator Systems Inc. Printed in U.S.A. POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS ` Owner Septic Tank Capacity -/Zoo al ❑ NA Permit # Septic Tank Manufacturer Uj IC-.i; ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units )V NA Pump Tank Capacity _ 000 al ❑ NA Estimated flow (average) ~460 -gal/day Pump Tank Manufacturer Lo ❑ NA Design flow (peak), (Estimated x 1,5) (000 gal/day Pump Manufacturer 0 u L D ❑ NA Soil Application Rate al/da /fts Pump Model f7 j{/ ❑ NA S}andard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODa) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD6) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: p NA r "Values typical for domestic wastewater and septic tank effluent, Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 p ear( )(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ® mont j(s) (Maximum 3 years) ❑ NA year( Clean effluent filter At least once every: ® ear() (s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA 3 IB ear(s) Flush laterals and ressure test At least once every: 1@ ear(s) Other: ❑ month(s) ❑ NA At least once every: ❑ ear(s) Other: ❑ NA MAINTENANCE 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. 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 to check for any back up or ponding of effluent on the ground surface. The dispersal dill(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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) it START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or oth c ical; that may impede the treatment process and/or 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 restage 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 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 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed., 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 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 that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring 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 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 recbn"structed 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 BASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON )"ROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Q 6 fZ CL 50A1 Name Phone S- Z 7:3 _ 7 T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name :rD(.{ivSo/,J 5-,,V Ni4-,f+'o-✓ Name S~ Old IX Zd^~/ ~4~r~~ogU Phone Z 7_3 Phone 3 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. { j LOT 24 1 M ct, o AREA To Tip . ° 1.911 ACRES I AREA 83,233 SO. FT. A n z y r 293.98' LB0- l+ I OU03T~ 7~5' 1 N 698.95' 404.97' 268.1p o P ~£NT i 1, eR LOT W ~O LOT 2255 AREA TO THREAD I 149,952 SO. FT. AREA TO OFi 1.5t ACRE / LBO-932-C ^ X6.' 58016'1 S74• 28, ~ EASEMENT 551.33 LOT 38 -348.57 AREA TO THREAD OF RIVER TABLE -r LOT 26 IK 2.4t ACRES / BEARING DIST. m AREA TO OHM ca' j Tl NJ8V6 41 E J19.60' m 1 j SO-s3o 72 N8251:T0-W 64.04' ~-E SEE SKEET 3 L TJ N38276'41 E 262.40' ti ci 24 f T4 N074J'45'W 208.42' T5 N8076.16'W 1.T 83' m y wisr- X 70 / 76 N767109'W 179,88' Z ns SR tS~ 4 77 N237946'W 60.66' o ~ /'O~G~ S y '47g, TB N827552E 149.85' ~r^ m ! ZAHLEp 1* LOT 37 79 N1270 59 E 144.94' Q y * 11 5-2145 f T70 N1270'59 E 20.19' 1 f{UDSO f T71 N7170 59 E 97.6J' -y V l T72 N85:37'02'W 179.78' a ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM j~ Owner/Buyer Mailing Address v Fex Z PropertyAddress 1512, ana k".. (Verification required from Planning & Zoning Department for construction.) City/State &16J Parcel Identification Number L~ Z 130t LEGAL DESCRIPTION Property Location '/4 , Sec. , T N RZW, Town of 'A96f Subdivision 9!/ Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house (W no Lot lines identifiable 4!g) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on 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 warran deed recorded in Register of Deeds Office. Number of bedrooms 4~ ' 0 SIGIWOZE LICANT(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. 08/05) un9ayy wiuMeus 18 uAeca soe~en .nom eNU~t ~ :;.y.:.,Y...e. u~m' tiee e,•ero:.owc SLOL~S':3'Jtld PIS PIIU*OYd[4 F• I LL 1-Q S ~a o ~z o~~ o 43 3.~~QpO a off. n~ n r X Z o Z Z Q Z W L N_ MOM N 71 `o o IM.Avo ,wa be. .'."~°:'.A.--a.....~.~..r~ weafN +uu7S r(B ~IeaO .wi..rr++.wnmmNws •plY~~i'tpeeU lWgl+N waspingad*"eyNeb w-rsw.+wwa plinsoudE4 3JNd °'•.`,.,..ao. ,iNV1110diII "OH AM :6021 SgOS ~itr91 ti>•InM im" a401 ~~~g~b~ I*{ ~ ~~1 Ia Er ia~ II 1. a~ ml z aaa c O Q 1;F Q Z ~e a ~ x X ._y. - 0 ON - ,4 A A-A I § H a a~ b a~ww-.ne~v m- F ~ 11 r r m ti ~ ? k a i . ~ .ro ::.,...^`a;;.~.,P.ao: 'R~ eale4Rm6 .wroyaaw S40L99dL' :3DVd 1NY1lJOdWt eewAAisj :dvmmog UM ■»sWW H3ww QUOl 43 <oQ Z 4 LL y s 3 Z it W Q ,o,se d xN ,a-.a r K r r °W Z ~ ~ ~ • r mn s 9 ~ 51 e m $X ; B t • ~ 4 ,ta ,a,~, ,or,c r - 4 N 4 .r,s , W 8t h' b 4 ~ s c 9 a 4 - .w o. 9+ w 0 - n ~ ,rs .o-a .u•,c .o-a n ~ t~~ fic 61a ~x yp .rx A,is y .§7 #1524 livisco sin SOIL EVALUATION REPORT Department of Commerce in accordance with Comm 85, Wis. Adm. Code ~j 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 must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 25 Please print all information. Revie d By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 9 Property Owner RECEIVED roperty Location Sienna Corporation ovt. Lot 4 SE1/4, S18, T30N, R18W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 4940 Viking Drive Suite 608 p 2 6 2006 25 The Glens Of Willow River City State lp Code Phone Number City Village t-^11 Town Nearest Road Minneapolis MN 54355T CROIX COUNTY - Richmond 95Th St. New Construction Use: ` Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement L- Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0_gpd/ sgft rating. Possible system elevation for Area 1 is (step trenches) high trench 94.50', low trench 93.50'. $ y 7 a Boring # Boring 'Pit Ground surface elev. 98.10 ft. Depth to limiting factor 102+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10yr3/3 none grsl 2fsbk mfr as 2vf .6 1.0 2 10-22 10yr5/6 none grs Osg ml gw lvf .7 1.6 3 22-39 10yr5/4 none grlos Osg ml as .7 1.6 4 39-102 10yr6/4 none s Osg ml .7 1.6 i 13 ❑ Boring # Boring T/ I Pit Ground surface elev. 94.70 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-11 10yr3/2 none sl 2fsbk/1mpl mfr as 2f .6 1.0 2 11-26 10yr4/4 none scl 3msbk mfr gw 1vf .4 .6 3 26-33 10yr4/4 none sl 2msbk mfr gs 1vf .6 1.0 4 33-62 10yr5/6 none grcos Osg ml cs .7 1.6 5 62-115 10yr6/4 none s 05g ml .7 1.6 - - 'TO-Li b ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/20/2006 715-247-2941 SBD-8330 (R.07/00) Property Owner Sienna Corporation Parcel ID # 25 Page _ 2 -of 3 T ~ Boring # II_ Boring Pit Ground surface elev. 95.25 ft. Depth to limiting factor 112+ 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 10yr3/3 none grsl 2fsbk mfr as 2vf .6 1.0 2 10-17 7.5yr4/4 none scl 2fsbk mfr gw lvf .4 .6 3 17-25 7.5yr4/6 none grs 2msbk mvfr gw lvf .7 1.6 4 25-39 10yr5/4 none grcos Osg ml cs .7 1.6 5 39-112 10yr5/6 none grs Osg ml .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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I ❑ Boring # Boring i 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 = 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 (R.07/00) Schmitt Soil Testing, Inc. Page of • Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Sienna Corporation Thomas J. Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608 1.595 72nd St. City, State, Zip: Minneapolis, MN 55435 New Richmond, WE 54017 Phone: 715-247-2941 Subd.Name: The Glens of Willow River Signature: li= Lot No.: Legal Description: Sz,) 1/4 SE1/4 S18 T30N R18W Date: Backhoe pit Township, County: Richmond, St. Croix Bench Mark El. 100.00' Top of 2" pvc pipe A Alternate Bench Mark El. 2~~ Top of Slope= Contour Line El. Contour Line Length Scale 1 40' 9014 857 Ak J ' This Soil and Site Evaluation was completed to tulfi) I requirement. It may or may not be in a location stable for you use.