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HomeMy WebLinkAbout026-1306-00-044 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (00 0-54176-5L GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No: do . 6 nmP_ A C TOWN OF RICHMOND 026-1^24-1-2-~110 CST BM Elev: Insp. BM Elev: BM Description: ~r Section/Town/Range/Map No `7$. 124 -g- 1 GS( 0.18. TANK INFORMATION ELEVATION DATA /V, Sip, Ar TYPE MANUFACTURER I~J CAPACITY STATION BS HI FS ELEV. f Septic , Al, / Z Benchmark % 5• 40,32- / V Alt. Aeration Bldg. Sewer , lit Holding St/Ht Inlet 9'S39 1113 TANK SETBACK INFORMATION St/Ht Outlet . 310 TANK TO P/L WELL BLDG. Vent to Air ntake ROAD Dt Inlet \ I~ Septic 404 / / / Dt Bottom \ Dosing _ Header/Man. , SS 7q -77 Aeration Dist. Pipe 7•0~ 94.77 ---f Holding Bot. System 4Q• 6 93' -74 PUMP/SIPHON INFORMATION Final Grade /•Z 99. i2- Manufacturer GPMand St Covert O 3' 161' / Model Number TDH Lift riction Loss Syste TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ) Length / No. Of Trencc , PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 9a 2 (f A r L.M SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture~cc ~/1 INFORMATION C CHAMBER OR A~ S 7 Type Of ^ System ^ 49 A UNIT Mod Num er: DISTRIBUTION SYSTEM WIN'C( of Header/Manifold /1 Distribution x Hole ize x Hole Spacing Ven to it In Pipe(s) jr Length~_ Dia AA Length D i a Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over jxxDepth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil A gs No Yes U No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1702 107TH ST_ GOJt.~~ 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = "V7 ffF~~ Plan revision Required? L] Yes No Use other side for additional information. 11 p Date Insepctor's nature Cert. No. SBD-6710 (R.3/97) o Caxxrrr~ County Industry Services Division, X. 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) ~S P.O. Box 7162 yy P S Madison, Wl 53707-7162 3 ~6j~*sro~a~5~ J s San Permit A pliation ransactionNumber Qi~ In accordance with SPS 383 1(2), IN1 AdribO&, ti ~ itlsm this form to the appr t it " /JA is required prior to obtaining sanitarq l D e on €orms for state o are submitted to Project Address (if different than mailing address) the Department of Safety and rc&S ices. Personal information yowrovide may be used for secondary purposes in accordance with rvacy Law, s. 15.040)(m), Slats. r' 1. Application Information - Please Print All I anon Prope vncrl s dame Parcel # Property Owner's Mailing Address Property Location Govt_ Lot City, State Zip Code Phone Number Section /'S (circle o ) _ G•r L T__ ~ N R E o / II. Type of Building (check all that apply) Lot # Subdivision Name i or 2 Family Dwelling -Number of Bedrooms ~ 4 ❑ Public/Commercial - Describe Use Block # aJ5 PIt 0 City of El ❑ State Owned - Describe Use ❑ Village of CSM Number 1♦J,t ( w Z Z ~'ZZ G Town of N III. Ty a of Permit: (Check o y one box on line A. Corn fete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Da Issued Before Expiration Plumber Owner IV. Type of POWTS System/Comp ent/Device: (Check all that apply) f Ed Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. o suitable soil 94 ❑ Hol mg Tani er ispersal Component (explain) [I Pretreatment Device (explain) V. Dispersal/Treat Area Information: 100, Design Flow (,gpd) / Design Soil Application Dispersal Area Required (sf) D=Area ed (sf) System Elevation Rate(gpdsf)VI. Tank Info Capacity in Gallons 2 Total # of Manufacturer U U f allons Units G c= C7 G New Tanis Existing Tanks 02000 i':! o e U cn Septic or Holding Tank - - 0 ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ VII. Respo ibility Statement- 1, the undersigned, assume responsibili for installation of the PONNTS shown on the attached plans. Plum r' ame min , i Plumber's Si MPlMPR3 Number Business Phone Number Plumber's Address (Street, City, S ate, Zip Code) s' ,L VIII. Count /De artment Use Only Approved d Pe rmit Fee Daate s Issui Agent Sign t=:v 'en Reason or ial S S •7 IX. ConditM1MReasoss for, Disapproval 3> ` p 1. eipti~. tank, a nt 111W 011 r upper :su cell J J A17t ig~ rxtsc an b2_s_ftl ` cgs ;,~t plan ,9 ,10 19 rJ' ` t ~yi$ per 'v l IOP.~1 l)`/ .7iU;71tml7. 2. /~1'~ req~~-s muut L•e na.r:t: it ii,! f tot I gdittnn.er. Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size r I \ i l fro 'Cor CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: Legal Description Township: County:" ,k Subdivision Name: 7~'r~ It'.l w'1 Lot Number Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat j Attachments: Soil Test & House Plans Designer/Plumber:i„ License Number. Date: Phone Number " J Signature Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-107 5-P (N.01/01}. Page 1 I~x ISI i I I lr~ I 40 - Pt~Ggtple3tff~pe i4ft - it .2 -1 a"bam iP f8t~ aft @ol-lw 71 -;t Venn Or o[~s°ssa F-17 Gees ©.1) y N n5 47 DIM f~ Header Tree3cS~ 2 ManUfa carer And Moide, gw, ~~A Ring ~e~t~ 1 7 gpd Dee,91, c:c ~tsv s of ~s each_ payer PL: 525 EFFLUENT FILTER C ' - Polylok, Inc is pleased to add its new commercial filter to its existing .4 line of quality effluent filters. The PL-525 is rated for over 10,600 GPD Alarm 'r----- Accepts PVC igallons per day' making it one of accessibility extension handle the largest commercial filters in its class. It has 525 linear feet of 1=15° filtration slots. Like the Polylok a PL 122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16° Rated for over removed for cleaning, the mall will filtration slots 10,040 GPD float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can mane that claim! Accepts 4° & 6" SCHD- 40 Pipe` PL-525 rOaiin -eRntaf"ncev The PL-625 Effluent Filter should operate efficiantiy for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs Gas deflector servicing. Servicing should be clone by a certified septic tank -i Automatic shut-off i pumper or installer, ball when filter is removed 1. Locate the outlet of the U.S. Patent Nop G.a1s,48a septic tank. 5,371,640 2. Remove tank cover and pump tank if necessary. t 52 l r~ 1. Locate the outlet of the " septic tank. 3. Do not use plumbing when filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6" outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into septic tank, access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. f of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION SYSTEM SPECIFICATIONS Owner ^ Tank Manufacturer: 5'E" ' ❑ NA h Permit # ® Septic ❑ Dose ❑ Holding Volume: (gat) DESIGN PARAMETERS Tank Manufacturer: El NA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: >M NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : (gauday) Horizontal Distance Tank(s) to Service Pad: (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): (gal/day) if horizontal is >150 feet. Spec inst;uctiops o be provided on back. In Situ Soil Application Rate: (gauday/fh) Effluent Filter Manufacturer- /1'e ~ c^k ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: S~ Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) s220 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: NA (BOD5) >220 mg/L ) NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other: (BOD5) <_30 mg/L Soil Absorption System (TSS) 5530 mg/L :n NA Fecal Coliform (geometric mean) 510` 14 In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA El At-Grade Effluent Particle Size in dia- ❑ NA El Drip-Line ❑ Mound ❑ Other. Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) O When combined sludge and scum equals one-third (3/,) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: [ moth(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 7 ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: Rmonth(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ 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 (3~) 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) Page / of START UP AND OPERATION 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 shall be taken to insure that the system is properly and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (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 cede 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 soil 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 INST R POWTS MAINTAINER Name i ✓ i Name Phone L~ , Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGU TORY AUTHORITY Name Name 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. ~ of START UP AND OPERATION Page 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 anti/or is nt?rm nnanty taken rn it of canhr o tho fnlimAinn ctonc chill ho taken to in that 11 le .....3...... ' _ r-........... 1, be u1l th ay 0MAII is pr Up=] iy and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (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 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 soil 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 INST R POWTS MAINTAINER LNa e Na me e Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGU TORY AUTHORITY Name Name 1 1 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. 0 A- CROIX COUNTY TIC TANX MALNM 'ANCE AC R€D&LNT ANT 0 'NI ERSHIP C`ERTIECA.TTON FORM O~xver - Mailing A.tdlzress C1~ S, 7 c, 7'ti (verification required fiMM PbMM&D4 & Zialng D own ft new oansnvc6m) City,stae /L 6,~ C, a~ Parcel Ide iification Number Z6 ~QT Propletg Locatiam IV) t, 1!d J % F Sec. R ~f W, gowm of Vo Subdivision Plat: Lot # Certified Survey Map n , Volume . Page Warranty R (b )Volume _ P ~ SPW b 0 yes40 Lot bits iderlii&k a y.) t.o SYS= ILALNTLhIAYEE AM OV R CERTIF`ICA~QN improper use and mamtenance of your septic system could result m its premaure failure to banft wastes. Proper mainterAnce consists of pumpitrg out the septic tank every three years or sooners if nesderi, by a licensed pumper. What you gut into the system can affect the won of the septic tank as a treaty wt std in the waste disposal s3am Owmea maim maace espousiE ies are sped ia ISPS.' 83M(1) and in Chapter 12 - St C ycix County Sm& v 4rclhran= The proptxty owe agrees to submit to St: Croix County Plate & Zartarg Dcparttttcnt a c an form. Biped by the owner and by a master plnnnber; journeyman phmnber, restricted plumber or a licensed pumper vm*ir,* that (1) the on-site wastewater disposal system is in prapex V atimg condition aaftr (2) of inspection and pumping (Ifnecessary), the septic tank is less then 1I3 fcdl of sludge. ilwe, the underd-pied have read the above requirements and agree to ma9rrrairs the prime sewage disposal system with the samax* = had,, hers, as setby the of Safes And hvh=aual ces ate file of HOmil Rte, State of W-==;M C=d5cx W staws tit yaw s ec .tom ift b must be c=pleted and rem to the St. Croix C=WY Ham= & Zt wjdfm 30 derys the &w yaw aprallm tom. lfwe catify brat all staoments on *jyfita are true to the best a; my/our knowledge. Uwe am/are tine owmer(s) of the property described above, by virtue of 7"' deed r= rdad is Register of Deeds C7ffice. Number of bedrooms ka"NTAItM, OF APPLI.CA-Mr(S), DATE ***.Any information that: is miszegresetcted may result in the sanrWY Per a being revoked by the Plm=g 8e zmwg Dep =ea Include, with this application a recorded warranty deed ;turn the Register of Deeds Of fice and a copy of the certified survey map if retereace is made in the watizM deed- t RF . 64M) µg~ 6 v d' / NgR cZi_+?as 1"1 H12 N08434"W 1J4.80• H29 501244JE 12083' H46 E ° i { 2 11 H13 N87'J3 07 E SS BJ' H30 52135'I4 'W 557.99' H47 2OT~\ N ~ U , H14 S1220101T 120.42 HJI S72U542W 72.75' H48 H15 5122001E 4&95' H32 S72J642-W 83 J9' H49 IT 17 \ ~`'s 8 0 \ 95.328 SQ. FT. H16 N73J521E 267.23' HJJ S72 36'42W 17354' H50 I ACRES LBO-951.5 N,jOyfi ~1 H17 N7JJ521 E 6365' H34 N822609'W 256.20' H51 S SQ. FT \ `~r \ 7.°A j3g 3T :11 u 1 961.2 6g61 `U rN1,7~ N + ~1 LOT 48 - LEGEND 3.419E 227.97 1 1 51 ~r 1 0 FOUND ALUMINI Nj8'28 E' N' 1 SECTION CORNS \ LOT 45oa i I± I7. 11 FOUND 314' X \ Z~ 1.598 ACRES iA 1+ u 1 ° i~1610 © DIAMETER IRON LOT 18 \ 'r \ 69.607 SQ. FT. z t 1 1 1 FOUND z- our. 2.260 ACRES LBO-951.5 '~a 1 1 H18 98,432 SO. FT. 1 N i 1T gAME7T0i IRON \ E sOE►R+ NCE i n u.IH'8 .1 SEE SHEET 2 • p E°TER IROi 6 57 E 598. 338.73' \ V \ 38T, =y Qa FOUND 600 NA N.1.T3419~ \ -~N'N73'sS o ~ LOT 49 SET 1-1/4- DU LON 430 LBSPEERR LOT LOT 19 °.r m 4~I \ \ v A ES a 1.696 ACRES \ `6' x 1.52 SO. FT. 01 I" OtJTSIDE 6 \ O iBT LONG IRON m 73,878 SQ. FT. L80-939.0 BM `1~ g5.28 \ 1.13 LEIS. PER 1 950.7' \x50 ''~y \ o_ \ 27132 E 36860 .°•t \ \ TRAIL EASEMEN' N74.381$ V. \ 7.y `rn 379.24 34.25\ DRAINAGE EASE] N81'4p 15 E •\'1 11 \ 75' O.H.W.M. SE LOT 43 w \i 1 \ 1.506 ACRES . . . . 100' ROADWAY' 10 65.812 SQ. FT. (UNLESS OTHER' m LOT 20 \ 1 LBO-937.0 1.789 ACRES I ; - ,a 8770' 1 LOT 50 --Il- PROPOSED DMV if. a 77,936 SQ. FT. t il' = i N 1 313.10' ,Ip0.8o \ o so o \ xxxx BENCH MARK ET _ ail N 1 NN 18 E a c?i\,N` V. \ \ HWE-958.0 HIGH WATER ED I \ \ \ LOT 42 \ \ • \ LBO-949.0 LOWEST BUILDIN 1 - - - • -387.09- . - - I TOTAL AREA \ \ LOWEST WINDOW N89'21'33'E 741.31--1 I ; :1.728 ACRES (7 SO. FT.) /p \ Y A S1 AREA TO OHWM MAIL A EASEMENT ND.UTLLITY••-.•^..-..li \ t ELEVATIONS DETERMINED BY I 1.7t ACRES k I \ AS REFERENCED TO N.A.V. 1-130-932.0 /.`k+09 hi \ I'Jr•\ MEANDER LINE LOT 23 1 I 275.21 379.1x-~~„~ \ CONSERVATION I I 1 \ 1.847 ACRES 1 38476 45 E 103.96• \ \ 80,442 S0. FT. I I LOT 41 498.39 *19.22I ' THE PROPERTY ~ \ - AND THE WiLLOV q ~n I n AREA TO THREAD OF MYER EASF l%TCO li i I I KI C99159~ SHs 91L ZI9'9 - E=Ncgu -19 Vv -LO- - :MIllJl(K3H o ~1 ok/ w~bv~i v a71n~ o ° wooZj 6ulm -ja S UpI o z v ~Ijl~lSV l.L (j ss' 175 i~ O ' ~ 4 P ~I i ; I O O ~~I I~~RI~.I;~t ~I i. 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CROIX COUNTY, WISCONSIN Owner and Mailing Address: Co-Owner(s): WILLOW RIVER OF ST CROIX LLC 1626 70TH ST Physical Property NEW RICHMOND WI 54017 Address(es): 1527 96TH ST Districts: Dist# Description Parcel History: 3962 SCH DIST NEW RICHMOND Date Doc# Vol/Page Type 1700 WITC 07/13/2015 1015278 / WD 8020 UPPER WILLOW REHAB DIST 12/22/2011 947756 / WD 03/16/2010 913232 / AMEND GOV Legal Description: Acres: 1.525 08/06/2009 ' 901590 / SD SEC 18 T30N R18W PT NW SE; (THE) GLENS OF more.,. WILLOW RIVER ('06) LOT 44 (1.525AC) Plat Tract (S-T-R 401/4 1 6 01/4 GL) Block/Condo Bldg * 11-015-GLENS OF WILLOW RIVER 026-06 LOTS 1/70 18-30N-18W SW SE LOT 044 2017 Valuations: Values Last Changed on 09/27/2011 Class and Description Acres Land Improvement Total G1-RESIDENTIAL 1.525, 17,300.00 0.00 17,300.00 Totals for 2017 General Property 1.525 17,300.00 0.00 17,300.00 Woodland 0.000 0.00 0.00 0.00 Totals for 2016 General Property 1.525 17,300.00 0.00 17,300.00 Woodland 0.000 0.00 0.00 0.00 2017 Taxes Bill # Fair Market Value: Assessment Ratio: 460211 21,000.00 0.8240 Amt Due Amt Paid Balance Installments Net Tax 295.21 295.21 0.00 End Date Total Special Assessments 0.00 0.00 0.00 1 01/31/2018 147.61 Special Charges 0.00 0.00 0.00 2 07/31/2018 147.60 Delinquent Charges 0.00 0.00 0.00 Private Forest Crop 0.00 0.00 0.00 Net Mill Rate 0.017064026 Woodland Tax 0.00 0.00 0.00 Managed Forest Land 0.00 0.00 0.00 Gross Tax 335.64 Prop Tax Interest 0.00 0.00 School Credit 40.43 Spec Tax Interest 0.00 0.00 Total 295.21 Prop Tax Penalty 0.00 0.00 First Dollar Credit 0.00 Spec Tax Penalty 0.00 0.00 Lottery Credit 0 Claims 0.00 Other Charges 0.00 0.00 0.00 Net Tax 295.21 TOTAL 295.21 295.21 0.00 Interest Calculated For 02101/2018 (Posted Payment Payments) Date Receipt # Type Amount Note 01/09/2018 24764 T 295.21 ST CROIX COUNTY ABSTRACT & TITLE CO INC CHK #60890 JA 01/29/2018 35036 T 0.00 WILLOW RIVER OF ST CROIX LLC CK#109 DA I `Wisconsin SOIL EVALUATION REPORT #1517 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 8'/2 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. . 44 Please print all information. Revie d By ~ Date Personal information you provide may b used (Pdva Law, s. 15.04 (1) (m)). /0/)z Property Owner Property Location Sienna Corporation --SEA Govt. Lot NW1/4, E1/4, S18, T30N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 4940 Viking Drive Suite 608 NTY 44 The Glens Of Willow River City Stat Zip Code Phone Number city Village F` Town Nearest Road Minneapolis MN 55435 Richmond 95Th St. New Construction Use: y 1 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 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/ s ft rating. Possible system elevation for Area 1 is 95.40'. _ a~ Boring # ! Boring Pit Ground surface elev. 98.92 _ ft. Depth to limiting factor 90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 'Eff#2 1 0-12 10yr3/3 none sl 2msbk mfr as 2m,2f .6 1.0 2 12-19 10yr4/4 none sl 2msbk mfr cw 2vf .6 1.0 3 19-27 7.5yr5/4 none gricos Osg ml gs 1vf .7 1.6 4 27-76 10yr5/6 none cos Osg ml cs .7 1.6 5 76-90 10yr6/4 none s Osg ml as .7 1.6 6 90+ weathered sandstone 2 Boring # Boring ~Z. Pit Ground surface elev. 101.02 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I'Eff#1 'Eff#2 1 0-12 10yr3/2 none 7 sil 2fsbk mfr as im,2vf .6 .8 2 12-23 7.5yr5/6 none sl 2msbk mfr gs 1vf .6 1.0 3 23-58 10yr5/6 none gricos Osg ml cs .7 1.6 4 58-115 10yr6/4 none s Osg ml .7 1.6 J ' Effluent #1 = BOD5> 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 9/19/2006 715-247-2941 SBD-8330 (R.07/00) Prope. ty Owner Sienna Corporation Parcel ID # 44 Page 2 of 3_ Fil Boring # Boring Pit Ground surface elev. 100.17 ft. Depth to limiting factor _ 115+ 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 0-8 10yr3/3 none I 2fsbk mfr as im,2vf .6 .8 2 8-22 10yr4/4 none sicl 2fsbk mfr cs 2vf .4 .6 3 22-30 10yr4/6 none grlcos icsbk mvfr cs ivf .7 1.6 4 30-64 10yr5/4 none grcos Osg ml cs .7 1.6 5 64-99 10yr6/4 none s Osg ml as .7 1.6 6 99-115 10yr5/4 none grcos Osg ml .7 1.6 jI Boring 5~.2 F-1 Boring # Pit Ground surface elev. - ft. Depth to limiting facto i 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 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page 3- of -7 Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Sienna Corporation Thomas J. Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608 1595 72nd St. City, State, Zip: Minneapolis, MN 55435 New Richmond, Wl. 54017 Phone: 715-247-2941 Subd.Name: The Glens of Willow River SignaIure: Lot No.: / Date: i Legal Description: Al 2 1/4 SEl/4 S18 T30N R18W Backhoe pit Township, County: Richmond, St. Croix Al Bench Mark El. 100.00' Top of 2" pvc pipe Alternate Bench Mark El. 9s-, 7 7 Top of Cd ze,vr/-41 a 7 ~ c~~~r<, ~ Slope= yS Contour Line El. A111 Contour Line Length A/;4 L-``sue"""~) I f qS X Scale ] 40' -tom/ / C~ I d.35 `'L 1j ~n,vt I7 i7 This Soil and Site Evaluation was completed to fulfill a zoning requirement. It may or may not be in a location suitable for you use.