HomeMy WebLinkAbout026-1306-00-057
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
600365
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:
Oevering Homes Investments TOWN OF RICHMOND 026-1306-00-057
CST BM Elev: Insp. BM Elev: BM Description: c 1.- Section/Town/Range/Map No:
10010 18.30.18.1664
TANK INFORMATION ELEVATION DATA
1~.
TYPE MANUFACTUR PACITY STATION BS HI FS ELEV.
L: ito
Septic V~k o Ov Benchmark •O 145• /ham L)
In Alt. BM IIJV
n Bldg. Sewer
_108.07.4 tar. Z
Holding 14ta r~ 47*L S Ht Inlet 5- p~Y t 57
TANK SETBACK INFORMATION C CU nS I S t Outlet f9, I~B. S
TANK TO WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header/ n. TT
Aera n Dist. Pipe
Holding Bot. System
JR. .o G.
PUMP/SIPHON INFORMATION Final Grade q.0 I&t • L)
Manufacturer Dem d St Cover • I
RMV
/ 2 $ toil's
G
Mo Number
T H Lift Friction Loss d TDH Ft
For ain Length Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width IMI O. Of Tre~Ches PIT DIMENSIONS No. 0 its In deAi~ Liquid Depstl
DIMENSIONS `
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STR LEACHING Manufacturer: ,
INFORMATION Ty Of System: CHAMBER OR Model 170,r: C PV
6 4AC z
DISTRIBUTION SYSTEM 57$ kid
Header/ Distribution x Hole Size Ix Hole Spacing Vent to Air e
` Pipe(s) Length J
Dia Length Dia Spacing We5F
SOIL COVER Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over a2~ ~ pth Over Z xx Dept h of xx Seeded/Sodded xx Mulched
Bed/Trench Center ed/Trench Edges
t Yes FRI No
110 1- e - G1 Sol 1A,.
im 1111 r.10ji 17114 10"
COMMENTS: (Inc
lude de discrepencies, persons p s , etc.) Inspection #1: Inspection #2: AP Location: 998 152ND AVE N p ~It~l nod I/% @IatLlKta~- ~6W~j IW! I f %~Vp~,►/
1.) Alt BM Description = I+ ~,feL IIIS~Ct•~.. p•dd m~ P
2.) Bldg sewer length (,.FICA e GKsm w 54aka / e 1y1Spt~ / ~~If~
amount f 1 .
- of cover = IP
~ if Clow #4 All,
Plan revision Required? 0 Yes No
3
Use other side for additional information. u' b Plff SBD-671 0 (R.3/97) Date Ins ctor's Signature Cert. No.
D County c.
D
f rQ" Safety and Buildings Division -
' , g 2 2 'tO~a 01 Vy.. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
SUN lades ~rvl 07- 62 .
Croix county ent V LmA 3 (,oS
St UN 10 1$= Transadi N bet
Co emit Application
in accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than .-address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
puposes in accordance with the Privar-Y Law, s. 15.04(1 m , Stats. f
_L AA lication Information - Please Print All Information Parcel
Property Owner's Name
e ref ynJ~~w ^
Property Owner`s Mailing Ad - 0 V- Ps7
'3
F2Famfly ZigCode y PhoneNumber1/e, " _'1., 'on
6. lc
T3 d N; R E W
ilding (check all that apply Lot
Subdivision Name r
Dwelling-Number of Bc droo ~i
GO Block
❑ Public)Commercial -Describe Use ` J'Ar ❑ City of
CSM Number ❑ rllage of
❑ State Owned - Describe Use
z CgAt~ t,) 44 (g e- Ac ~ef ~S Town of
III. Type of Permit: (Check only on box on line A. Complete line B if applicable)
A. ystem ❑ Replacement System ❑ Treat menUHolding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Isiumber and Date issued
B. ❑ Permit Ren t Revision Change of Plumber ❑ Permit Transfer to New 1~
Before Exp- Owner
IV T of POWTS a om onentlDevice: Check all that apply)
so Q
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 m. of suitable soil ❑ Mound < 24 in. su' It
❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain)
V. Dis rsaVrrea ent Area Information:
i Flow (gpd) Design q-o7,Application dsf) Dis rsalAtea Required (s DIS Proposed (s S r Elevaji,ort
41 _q BUJ
0
Tank Info Capacity in Total # of Manufacmuer
Gallons Gallons Units am j
New Tanks Existing Tanks 2 a m m
fi. I I I rn m y iz. C
Septic or Holding Tank
Dosing Chamber
VII, Responsibility Statemen the undersigned, responsibility for installation of the POWTS shown on the attached plans.
MP RS N bet Business Phone N
Pl 's Name (Print) ,•e /J~
i
Plum Address (Street, City, State, p Code
VIII. C n e artment Use Onl
proved Permit Fee Date sued Issuin- . ent Si
APP= ~ $ 9a , OD G Z5 / S
v Rea son' for Denial
IX Couditill pproval AeJ
1 ♦ ' l ' I
be
all
~.*rt cell must
lN' t ll I d-1.ttd
as per „lar.syemenS plan p,o,ided by plumber. I
pK mpatlbls W& / c(tlinanc83. t ti~ f M~7~'t~M
Attach to complete plans for the system and submit to the County only on,paper not less u 8 m@ x 11 inches in size
s C`
4\
f 4
SBD-6398 (R. 11!11) L~(~ ~ ` 11. ~ ~ (o
V
I
System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New R ichmond Wi 54017
NE 1/4 SE 1/4S 18 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 98.0/99.0 3.5' below grade 4/18/18 BEDROOM 3
DATE
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Grade at drainage easement stake ASSUME ELEVATION 100' Filter Lifetime Filter
BOREHOLE r~ WELL *H.R.P. same as benchmark
215' Property Line
C'....I.. -4 /nn -4 ni
Jl:cilC = 1/,L+ = l u
2-3' X 66' cells with >3' spacing
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
Vents
Replacement Area to be original soil test
290'
Property Line
ST
40' B-3
30'
Vents
10' Pro 3
51 Bedroom
5 , House
B-1
B.M.* -2
12% Slope
Drainage Easement
ent
r 100th st.
Staked by surveyor J'Long
Quick4 Standard
Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
t +f "
4 Q/ 3 4 „ Grade at Sys
tem Elevation
152nd ave
too
~U -
N 2 2 2018
WiisconsinDepartment of omme Ju S IL EVALUATION REPORT Page of
Division of Safety and Buil 'ngs St Croi unty t
omm 85, Wis. Adm. Code
J ^ti
ConIVIII. ~g County
Attach complete site plan ` r not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. , 6~) r ` z)-
Please print all information. Review y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Loi,7e Govt. Lot r' 1 /4 1 /4 S T ON R/3 E( r)
Property Owner's Mail' Address Lot # Block # Subd. Name or M# r
City State Zip Code Phone Number ❑ City ❑ VI a Nearest Ro
t~ `f G ( ) tC
-7
ew Construction Us esidential / Number of bedrooms Code derived design flow rate ouN> GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable
General comments ~ ~ -
and recornmendations:
System Type System Elevation (0o C/~
F-P Boring # i-Pit Bonng yGround surface elev~- ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
4,
Boring # ❑ Boring 1
igPit Ground surface elev. ~ ft. Depth to limiting factor- in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
i
0 -01
I~
Effluent #1 = BOD. > 30 < 220 mg/L and T S,4>30 ---:150 ' Effluent #2 = BOD. < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date E aluatio Conducted Telephone Number
1432 120th St, New Richmond, WI 54017 * 715-246-4516
Property Owner _ Parcel ID # Page of
FS1 Boring # ❑ Boring
EL pit Ground surface elev.[ 0 , . > ft. Depth to limiting factor in• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. j*Eff#1 'Eff#2
~y~ - C~` U -"3
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
El Boring # F] Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
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/_ ' Effluent #2 = BOD3 < 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 (8.6/00)
Property Owner _ Parcel ID # Page of
Boring #❑t7tt Boring
E ~
EL pit Ground surface elev. ~0 S > ft_ Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
6, ~j
10,
fA(
r - ~101
Boring
-Boring #
F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgR_ ` Effluent #2 = BODS < 30 mg,& and TSS < 30 mg1L
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.
580.8330 (RAW )
System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New R ichmond Wi 54017
NE. 1/4 SE 1/4S 18 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 98.0/99.0 3.5' below grade 4/18/18 BEDROOM 3
DATE
CONVENTIONAL )00( CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Grade at drainage easement stake ASSUME ELEVATION 100' Filter Lifetime Filter
D BOREHOLE O WELL *H.R.P. same as benchmark
215' Property Line
Scale = 1/4" = 10'
2-3' X 66' cells with >3' spacing
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
Vents
Replacement Area to be original soil test
290'
Property Line
ST
40' B-3
30'
Vents
10' Pro 3
5) Bedroom
B-1 5 , House
B.M.* -2
12% Slope
Drainage Easement
Staked by su Vent
100th st.
ALo Quick4 Standard
Leaching Chamber
with 20.0 ft2 of Area
2" 5.6ft^2/pa ir of end caps
34" Grade at System Elevation
152nd ave
Countyt
Safety and Buildings Division ; }L
# 8 yr' ' ;.i 201 W. Washington Ave., P.O. Box 7162 Sanitary Permrt Number to be filled in by Co.)
r 3_S - N Madison, WI 53707-7162
d4v t y
Sanitary Permit Application stateTransaetionNumber ,k-~T`VT~- In accordance with SPS 38121(2), Wis. Adta Code, submission of this form to the appropriate governmental unit
is required priQ~~tq taiang a sanitary permit, Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) AA.
the Dcpartiny»ofSalety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Pnv Law, s. 15.04"1 m , Stats.
L Application Information - Please Print All Information
Property Owner's Name q ~ eel
Property Owner's Mailing Address Property Location ' a
7 _ 7 ft rv
L 7Z,
God {Lori , j
City, Stare r ip Code Phone Number ZEE
tion
(
e o
H. Type of Building (check all that apply
or 2 Family Dwelling-Number of Bedroo J Subdivision Name
O 6/
❑ Public/Commercial -Describe Use
❑ City of
❑ State Owned - Describe Use CSM N ber Village of
4-1 0! ~A 7wn of ,~L 1'Z'1 3n
III. Type of Permit: (Check only one bozo line A. Complete line B if app ab }
A. ,
System ❑ Replacement System ❑ Treaiment/Holding Tank R ent Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision Ch ge of Plum ermit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner 1,` r
IV. T ofPOWTS S stem/Com onent/Device: Ch al 1
Pressurized In-Ground ❑ Pressurized In-Ground de ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil G
❑ o g Tank Other Dispersal Component (explain) ❑ Pretreatrnent Device (explain) \ 7
V. Dis rsaVrrea ent Area Information:
Design Flow (gpd) Design Soil Application R7 dsf Dispersal Area Required (sf) Dispersal Pro osed (s
f) System Elev
/i
"1 7
171
VL Tank Info Capacity in Total # of Manufacturer
Gallons
Gallons Units a o
New Tanks E~png Tanks .m v J v
C C m y
U v)
Septic or Holding Tank i f
I
Dosing Chamber
VII Responsibility Statem - I the undersigned, asg me esponsibility for installation of the POWT S shown on the attached plans.
Plumber's Name (Print) J Plumbers gnature MP/MPRS Number Business Phone N er
Plumber's Address (Street City; State, Zip,,de)
/
-County/Department Use Oniv _
p ❑ Permit Fee Date sued Issuing ent at
proved
MS'S . a~ l g
❑ ❑ tven Reason for Denial
1X. Condtti oas or Djsapproval
i7
i'tMi t
~ J'•~ QC~~~C.l ro v0[~.+ Q
' firs per,r ct+tl d1l 2L
as per inw.3gernent plan pro Tided by pitunbe:.
Z. Al mfkwk rec,>r m.,errs mlist 1-=s r f<a.EC L /
as per ~limbl4 c nee / :.rdinar1 m,, ~ p
V
Attach to complete plans for the system and submit fire Corot} nip on paper not less than R In z l l inches in site
SBD-6398 (R. 11/11)
System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New R ichmond Wi 54017
NE 1/4 SE 1/4S 18 /T 30 N/R 18 w TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 94.1/94.0 4' below grade DATE 4/18/18 BEDROOM 3
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL -H.R.P. same as benchmark
215' Property Line
Scale = 1/4 " = 10' B-1 111 8
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
62'
Vents 0% Slope
2-3' X 66' cells with >3' spacing B-3 60'
J
54'
B.M.*
B 2 111'
20'
STO
25'
Pro 3
Bedroom Vent
House 100th st.
>6„ Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Long 12 31'
C ; Grade at System Elevation
152nd ave
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 4/18/18
Owner:Oevering Homes
Location: NE1/4 SE1/4 S 18 T30N,R18W 998 152nd Ave Richmond
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross SectAn
4-6. Maintanance and 1 n ingency Plan
7. Filter Cross Section
Signature-
License numb r #2JZ6900
t
System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New R ichmond Wi 54017
NE 1/4 SE 1/4S 18 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
r SYSTEM ELEVATION 94.1/94.0 4' below grade DATE 4/18/18 BEDROOM 3
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
1000 gallons LIFT TANK SIZE DOSE TANK SIZE
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
215' Property Line
Scale = 1/4" = 10 B-1 111 81
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
2'
0% Slope
Vents
2-3' X 66' cells with >3' spacing B-3 60'
54'
B.M.*
lll'
B-2
20'
STO
25'
Pro 3
Bedroom Len House 100th st.
>6„ ick4 Standard
of Cover aching Chamber
h 20.0 ft2 of Area
ft^2/pair of end caps
4' Lon31'
34" Grade at System Elevation
152nd ave
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
5.6ft^2 pair of end plates
Finish grade elevation
Typical Installation 98.1'
Vent A CI Vent
3' 4„ 3'
A~30/34 Septic Tank
5' Long 115 5' S' Long 1 Grade at System Elevation
36" Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A-94.0'
B-94. 1'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity al ❑ NA
t. E ,
Permit # Septic Tank Manufacturer L6, ❑ NA
3ESIGN PARAMETERS Effluent Filter Manufacturer C ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model (j ❑ NA
i Number of Public Facility Units _ -O- Pump Tank Capacity al NA
I Estimated flow (average) Tj aUda Pump Tank Manufacturer NA
i Design flow (peak), (Estimated x 1.5) avda Pump Manufacturer NA
Soil Application Rate al/da a Pump Model NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) 120 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <_150 mg/L _ ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L KNA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) <104 cfu/100ml ❑ Drip-Line ❑ Other:
(Maximum Effluent Particle Size in dia. ❑ NA Other. ❑ NA
(Other. A Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent Other: ❑ NA
IAINTENANCE SCHEDULE
Service Event Service Frequency
linspect condition of tank(s) At least once every: month(s) (Maximum 3 years) ❑ NA
ear(s)
ray-
(.Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA
Unspect dispersal cell(s) At least once every: ❑
month(s) , ear(s) (Maximum 3 years) 13 NA
ALy
Clean effluent filter At least once every: ❑ month{s} l / ❑ NA
ear(s)
I nspect pump, pump controls & alarm At least once every: r-1 month(s) C3 El NA
year{s}
:lush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
ether. At least once every: ❑ month(s)
❑ NA
❑ year(s)
'
ether. 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
iinclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
cembined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
'The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
I-egulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
INII other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
land 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.
page of
for the presence of painting products or other chemicals th*{t
START UP AND OPERATION
For new constriction, prior to use of the POWTS check t)wment tank(s) are detected have the contents of thO
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations
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.
tanks may fill above normal highwater levels. When power is restored the excess to vheftill ll ble
i
During power outages pump dose, overloading the cell(s) and may result in the backup or surface discharge
discharged the dispersal cep(s) in one forge m tank removed by a Septage Servicing Operator prior to restoring power to the
To avoid this s situation have the contents of the pu p rating the pump controls to restore normal levels
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually ope
within the pump tank. disturb or compact, the area within
Do not drive or park Vehicles ~ or at~and spe absorption area not drive or park over, or otherwise
J5 feet down slope of any -grade soil OWf :
Reduction or elimination of the following from the wastewater stream may improve the perfortnance and disLt prolong rolong s; the f life of of the thet Pdrain
antibiotics, baby wipes; cigarette butts; -condoms; cotton swabs; degreasers; dental floss; diapers:
water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; med•~catiorts; oil; painting prod
(sump pump)
pesticides; sanitary napkins; tampons; and water softener brute.
ABANDONMENT shall be taken to insure that the system is propefilY
When the POWTS fails and/or is permanently taken out of service the following steps
and safety abandoned in compliance with chapter Comm 53.33, 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 property 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 code cortpCnt
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a
replacement system: soil absorption sYsteim•
/ - suitable replacement area has been evaluated and may be utilized for the locatid of a replacement
not infringed upon by r ysteled
The replacement area should be protected from disturbance and compactionan should t area will result in the need
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replace comply with the a e;I in
for a new soil and site evaluation to establish a suitable replacement area. Refit systems must
effect at that time. in POWTS tectxrnalogN a
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances holding tank may W 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 fast resort to replace the failed POWTS. removal of the biomat at the infiltrative
❑ Mound and at-grade soil absorption systems may be reconstructed in place following
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO O
RCUM TANCES. DEATH MAY RESULT. RESCUE O~ A
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANW UNDER
R CI
DIFFICULT O IMPOSSIBLE.
PERSON FROM THE INTERIOR OF A TANK MAY BE ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
~x Name
Name
n Phone
Phone
SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORITY
Al 1 l
Name
r.. EgE~
Phone -
This document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f) and 383.54(1), (2) & (3), Wisconsin AdminWradve Code.
'}T
t P I , i
f { ais i~il
Lam"' (1II, ~ i
I I ;~Ig3;il
i
I Af
/ _ f~jI~
I
i ~ a !
p O
J
I
11 I ~ I
I
r.
S ~ F S
~ ~ I ~~y 4 ~ Q
W
I
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND -
OWNERSHIP CERTIFICATioN FORM
Owner/Buyer D2vC~ _ -
Mailing Address
Property Address
C n-
erification required from pl
a►ming & Zoning Departrne t
City/State r new construction-)
Parcel Identification Number' j
LEGAL DESCRIPTION
Property Location t V4, Sec. Subdivision T N R Town of
Certified Survey Map # - - Lot #_i
---Volume Page #
'VVarranty Deed # C
Volume , Page #
Spec house yes no Lot
Lot lines identabl yes no S LOUCM- MAINTENANCE AND 0"114 CERTIFICATION
Improper ruse and maintenance of your s
maintenance consists of eptic system could result in its re
the system can Pin out the septic tank ever y P mature failure to ha
affect the functe s y three ears or sooner, if needed, b a w"tes licensed e handle r Proper
responsibilities are ion of the in septic tank as a treatment stage in the waste disposal system Owner What You §Comm. 83.52 1 Y Put into
( )and in Chapter 12- St. Croix maintenance
The property owner agrees to submit to St. Croix County county Sanitary Ordinance.
owner and by a master plumber, jourme ry plag & Zoning Department
wastewater disposal system is in u an Plumber' restricted plumber or a licensed pumper vei mper ver a certification fo
less Proper l signed by the
than 113 full of sludge. condition and/or (2) after inspection and pumping (it'necessary the septic tank is
I/we, the undersigned have read the above
standards set forth, here requirements and agree to maintain Stating that u set thsum arhneat of Commerce and the 1me t the private sewage disposal system with
the
g that our septic y has been maintaineedDepartment of Natural Resources, State of Wisconsin.
Zoning DePartrnent within 30 days of the three Year expiration must be completed and re
Y xpiration date. turned to the St. Croix County Planning &
I/we certify that all statements oil S form deed are true to recorded the in best of Register m of /our Deeds Office.
Property described above, by virtue irtue of a Y knowledge, Uwe am/are the owner(s) of the
arrarriy
plumber of bedrooms
TGNA OF APPLICA T(S) J-1
'Any information DATE
IncludY rmation that is misrepresented may result in the sanitary permit being revoked by the Planning & 'Lorin De
Partrrrent-
e with this application a recorded warranty g
re#erence is made in the warranty deed, tY deed from the Register of Deeds Office and a copy of the certified surve
Y map if
(.REV. 08/os)
1.510 ACRES ( $
I 65,789 SQ. FT.: I
Ri
241.989 N84b9'49-W 456,84' I o + m
214'88 I EASEMENT
LOT 58 TABLE '1'
1.538 ACRES I REARING
I~ 66.998 SQ. F7 0 /i N6479 23
LBO-955.0 I 12 N647923
LO -"--Z, I I 14 N6479'23'
1.41 ACRES
15 N307526'
881 SQ. FT.
N 80
L80-955.0 ml 116 A(58:50'09
i•
7 N58:50'09
m N
18 S107649'
/-0b HWE- A6 DRAINAGE' EASEMENT I m 19 N08 56'30
~l 949.0 - S££ EASEMENT /10 N0856'30
1% TABLE7" FOR P'
5,89 N6fy DIMENSIONS I
Z I~
o 4
141
sicN EAR EV r
C44 TABLE "S" FOR i but
LOT 68 ' 2'S~ ro I DIMENSIONS C
AREA TO THREAD
OF RIVER C50
2.Ot ACRES
AREA TO OHIMA o N89'04'40'~L
1.8t ACRES o, 17.22
s~
LBO (SEE NOTEX /
^w~ SIGN EASEMENT -
SEE EASEMENT I
~ LOT 69
h
AREA TO 7HREAD -TABLE "S" FOR I i p
DIMENSIONS p I
OF FUVER I 1
7 4 & ♦MCC n 1 ` ' C
ar
- g o o~ 3.a~<~;~ E p s z
e~lo O S w-§~ Sy€~h I = a F -
C\j
s's 5 m O
to oo Q
~ I I I 1 I I Z
R~ ~7R J ~
ppp oy
T ~m
-
•I
A g I,I qq i I
~ab Gb 11• I Y~ ~ 1
1 I co I
1 I ~ Yp ~ ~
II I
______I Ig 1
~ I I I 1 1
I I I I I I
I i i ~ ~ ~ _ e
I I ~o~e, s3cp,wwme a, I I I I
I I
I II ~ x i::I~.-_ 3~ I
I I$ I 1 % I I
I I I I I
I I I i t I I
I i ~ I
I ~ I i I -
I - _ ~ - I I
1 I _ I 1____l ~ 1 I 1
< I I 1____l I J 1
I I T____i I ➢
~ I I I L______J I I 11
I I~ - I I I
_ I it I~ 1 I i
- I IX I~ I I I~ I
5 I II I I
R 3~y I 1' I' I I I~ I
~a I I Ij I 1 I I
I I ~ 11~ I C I 1 I
I I
I j II I I i I _
y€ ~ I I I I I 11
FF ii I I I I
R~ ~ I I~ 1, I 1 1
i I 1 1 I I
I II I I
t I
y i ; I I a ..t 1 1 I
e F n
I I II I -
A I I I I I~ 1
A INTO i. 1
1 _J_ _____J
io'o.r.,nam~uoo~ jl I
I 1 II t.. I
I I it ~I I
1 II I I
I I ~j Se , I
1 I II ~'.1
I I I 4. 1
I I i I I
I I I ~ I
- - - - - - - - - - - -
.ms.n o ~SBP
mA ~`~z a
Jig
8 8
Ab rn
i s> o
€ 71,~
0
s, w sRY ~ € J Q3g4~°a~ c
hat lum I, Tom
MIN 1
I
-
~ I I
I I
I
~ I I ~ I
i I
I I i I _
I I I R I
I _
tomsn S~~I
I
^ I fe ' w cJ+o I 4 I e
1 - ® 4 3! i _ t~~ ~ _ p
I I
I ~ < t
- _-__W y ~ 9 N O O _ I -
I G
a 4
__-till-
- i ~ < I ~ gg g I tlYw
~ ~ ar<.aP PUinrn p I
i i A 4~ i SSE? -
1 1 % I I - - - - - -
i +f 218 i wrvb Pa<vrvn i
I I _
sl I SPA"
I I
I pp 1
C
I
_ - _ - - - l I ~ a I I
_ - - _ _ - - - - - _ _ - _ _
I
I I ~ _
I I u I
I
LtdW a Pr IM 63l1aA'16 r1°[
, P3wM3v pe'rbB V~
9 I rain rn+aaPwe
9 ~ y 5 4":3¢dm '~C
I I ! ~4 b° 4 ~qqyy
s4~ S~ I I 4P s4° ~ =f C3
88
z
#1496
`Wisconsin SOIL EVALUATION REPORT
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.D.
57
Please print all information. Revi d By Date
Personal information you provide may be us fors Privacy Law, s. 15.04 (1) (m)).
Property Owner roperty Location
Sienna Corporation ovt. Lot NEII A SE1/4, S18, T30N, R18W
Property Owner's Mailing Address 2006 of # Block # Subd. Name or CSM#
4940 Viking Drive Suite 608 57 The Glens 'Willow River
City State
Zip C 6 dpr `I City Village Town Nearest Road
Lzzz
Minneapolis MN 5543 - Richmond 100Th St.
New Construction Use. Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement _J 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. Possible system elevation for Area
1 is 94.5'.
Boring # - Boring
F-11 Pit Ground surface elev. 98.08 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
1 0-12 10yr3/2 none I 2fsbk mfr as 2f,2vf .6 .8
2 12-25 10yr4/4 none sl 2fsbk mfr cs 1vf .6 1.0
3 25-40 7.5yr5/6 none grlcos Osg ml cs .7 1.6
4 40-115 10yr6/4 none s Osg ml .7 1.6
ttl
Boring # ! Boring
y Pit Ground surface elev. _ 98.08 ft. Depth to limiting fa or 115+ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2
1 0-11 10yr3/2 none sl 2fsbk mfr as 2f,ivf .6 1.0
2 11-17 10yr4/6 none scl 3fsbk mfr Cs 1vf .4 .6
3 17-23 7.5yr4/6 none sl 2fsbk mfr cs 1vf .6 1.0
4 23-30 7.5yr5/6 none s Osg ml cs .7 1.6
5 30-37 7.5yr4/6 none grlcos Osg ml cs .7 1.6
6 37-115 10yr6/4 I none a s Osg ml .7 1.6
tl~i ~,C~
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 =BUDS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: r r CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing, Inc. r Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond, WI 54017 9/17/2006 715-247-2941
SBD-8330 (R.07/00)
Property Owner Sienna Corporation Parcel ID # 57 Page 2 of 3
❑ Boring # Boring
Pit Ground surface elev. - 98.15 ft. Depth to limiting factor 117+ 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 10yr3/2 none I 2fsbk mfr as 2f lvf .6 .8
2 10-16 10yr4/4 none A 3fsbk mfr gw 1vf .6 .8
3 16-22 10yr4/4 none sl 3msbk mfr cs ivf .6 1.0
4 22-32 7.5yr5/6 none grlcos lcsbk mvfr cs .7 1.6
5 32-39 10yr5/6 none s Osg ml as .7 1.6
6 39-117 10yr6/4 none s Osg ml .7 1.6
F-1 Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # - ! Boring
pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = 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.
1
• Page _3 of -3
Conducted by: Conducted For:
>~chmitt 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: 7155--247-2941 Subd.Name: The Glens of Willow River
Signature: trot No.:~
Date. Legal Description: 5Z7114 SE 1/4 S18 T30N R18W
WA Backhoe pit Township, County: Richmond, St. Croix
. Bench Mark El. 100.00' Top of 2" pvc pipe
Alternate Bench Mark El. A?, 6, J Top of
Slope= 0 6~j) Contour Line El. Contour Line Length /VW _
Scale 1" = 40' y'pN~
id,
I U
~r
MIL
~G~ 1 FjM
Fir t~ nn ~
~z 31
This Soil and Site Evaluation was completed to lalfill a zoning requirement. It may or may not in a location suitable for you use.