HomeMy WebLinkAbout026-1306-00-023
4Jrsconsir Depanrnenl of Commerce Cr'1n
PRIVATE SEWAGE SYSTEM St. Croix
Safety anc nu Ial. ng Division
INSPECTION REPORT San mrv Pe•ma No
6003$2
GENERAL INFORMATION (A I I ACH TO PERMIT) state Plan ID Nu
Pri is nfc•mation you Pic vide may b.- use-1 for secondary puror.ses' Drv.acy la v: . y t5 C,Ii I;imil
l l de, s Name City Village 1cw-);ha Parcel Tax No.
Harvey Halvorsen & Ruth Hilfiker TOWN OF RICHMOND 026-1306-00-023
CST RM Elov Insp BM Elev B!.! Desr.vpt IV Sei own.Rangiii No.
g 7z 13 ivil t --s- 18.30.18.1630
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE L CAPACITY STATION RS III FS ELEV.
Septic I Benchmark O q1 /61
. 72
Upem, Alt BM
Fit a tofz 5 s 1•'Ni Ca 7.b7 X9.95
Aeration Bldg Sewer
Holding Sll Inlet gr ~3
Stil Outlet J
TANK SETBACK INFORMATION 9. a8 93 S1/
TANK TO RL bVELL BLDG. entlo rWill ROAD Dt net
1
Septic 75! D1 l
Dosing Heade0i ♦A c~ 72 iO
Aeration Dist. Pipe 16.3
9L 3
Holding Bet. System 9/• 3
3 !
PUMP/SIPHON INFORMATION Final Grade 1 ?0 C 7
Manufacturer Dernan❑ St Cov
GPM 5,~.~e.~ Z • b"7 99. 9
rutodel Num'-•
TDH Lift I'l I oss :i•:51 TDH Ft
Forcemain Length 1) a C s'.t to %rk l
SOIL ABSORPTION SYSTEM
BEDITRFNC14 Wdtri Ln.-911 Nc 01 wigs PITDIMENSIONS Nn O`Pts Vl1e:l Liy_id Or-ath
DIMENSIONS
SETBACK SYSILM TO Y/ P1 F-•BLDGI WELI. LAKE.STREAM LEACHING P.i::n.~tacturer.
INFORMATION CHAMBER OR / a4ff~
Typ//e U~f Syslcm UNIT Motlel~tl(noer J~
(/O n 6 f
DISTRIBUTION SYSTEM / 4L-16 --3Z ✓S
Headertl'lanifcd~. rif lil;A,r x'lolc Ere xIIWO Sp3nirg b'enl lo~~u lnrase~
PI n,
Len,tn D a- f I eng,r - :n.: spacmg~-
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Di Ovoi Dentr O'er xx Denrh r.. -:x 'k,0,1 ;odcec x.: Pahl _neC
F!er.:Trenco ('.erlel 7 V Uc~J+lornrh I 11 Tc osnil ~YEq W
N^
COMMENTS: ;Include code disc(eper les, persons present etc.) Inspector N1 j( Inspection fa.
Location: 152096TH ST CZ1 vJlJ~ Gha.~...3 ~''qf L=-a ~s 1n' a
1 ) Alt BM Description = Sy d+ QA+ 5 ~.I PJJ e ^ ~r
2-) Bldg server length = 30
V
-amount of cover= -7/1
Plan revision ReQUged7 I Yes No IXLXX't~
Use other side for additional infsrmahon. - - - -
Date I",epetor2' Cell No.
SOD 67 10 ;RS!0?i
~ IOU-
D - -
„,I = Industry Services Division 1400 E Washington Ave
Sannan Psmil Number (W he filled in by C'r.l
0S pO Box 7162
MAY 1 ?3t$ Madison. WI 07 16
Ps 1a~38Z
Sanrta> ;'pact it ,lpplicatton Stale f on Smnbty
la eortlontt with SPS 393 2](2). \t i 1dru. C :d 111aw lon w this loan lu the aPPnoryinte :,ovemm ntal unit
:-s rcquircd pnur to onLuning a sannan per mrt. Note. 1PPlitanu1tor,ns lln stat..n,ned P(]\Y I S :ve wbinntcd to
~S+.c~Y ,\ddcesc (if rb Ocrcnl th.,n nwiling addr...'the I)ptnmcol of Sato, and Prof <su onal Ser, re,, P rnotntl inlonn:d!on you provide i a
n) I%- used fur sceonrlan q llY. f,
per'o vin rrorJana,rith tile pli, a,1'I~a%%. 1.04I N in). Slats V
L_A~y6cahonInfttrmation Please Print All Information
.."rop n Owner.<Nam i) Pu I'
I rop Tfv t.ocau .u
I -uprt\p,~y,e(s \(ading.\Ad[ess
»t n» _
e
Ci+COde Phone >und'° - / ~ .o^eVi I~.1
Cih 1t ! /
11 Type (If Building (check all that flppl)')
I or 2 Pamil, Uwcllinc \onlbo If Hadroyot»s Subdivision Name / V
B!orF.~
; public conuntt:ial - Dcacribe i'vc _
Cil, of
❑State 0,tied -Dcnaihc t. sc_-_. ❑Village of i7
1 (S%I \u[nber
I I 1 \pc of Pcrmn: (Check onN r c box on line A Cum tkl ,te line B if ap \ ] New Scstent ❑ i(eplacumem S.1,1cm E] '!tamtenl: linlding •fnr,k Rcplacem,nl Only ❑ Other
1lodih cation to Existing System (explain)
Ime II. Permit Itn Nod El Pernnt Re, 'isi or! ❑Civa of 0, I 11''r Tr:msler to Ne,v Lim I+reeiou.c Permil umFeruu! Data Ismed
E] H•lura Ecpmpon ~ HII nbcr _ I Owner
i' T\pc --POWTS S}st,.ta/C om~u_n(JDc%ice: (C•hcck all that apply)
Non I'wssunn unJ ❑ S'rcccun>•J lu-(rrotmd ❑ .\t-Cimdc ❑ Mound as in of mailable wil ❑ Mound ? 1 in. t1loitablc,oil
ilo mg tank ❑ Olirer Uisp. "l Component (explain) ❑ l rore:m» nl M%i m (explain)
Ili V. U!spci saUTn'atme Area Information:
U:. !nn I Ww (ppd) Uc !gt S>A Apph.a.i`oyn /t Ui<pasal Veu R yuiral (st) Uispenal \rca Propos<J (+p S)etam l:Ie,:nion
(
-1)
Vl.Tflnl:Inf(o t Cp,rncm I o
-7 - mllons l'uib ~ • '
I : I ..P, t I:,nihm_ I`.nkx C 1 O I~ 525 cl f : i -
Septic or tk lding'1:ink O _ ` ( E n ❑ ❑ r,.
r:),o,ng Chamber - _.1__. - ❑ ❑ ❑
VII. Rcspo Ibilih_• YaCeme t L the undersigned, aaumt rrrpoasibi , fn indafL•uiuP r~ of the P01\TS aho»n writhe attached plum. _
!'dumb i'ant<(I n f-it -I-PIumM1ar r.nuy jv NIP \IPItS \urnt+.r ~~B!nincsslhare Vnmlxr
-CV
Plumlxr s Ad res (Sli tit. City. Stales L Code)
\ ment Use Onh' -r- - - -
ksurng enl sir'naltnr
P ! I „mint Fee T )JIQ .>w 7%
II Un~-p!rtR,.,.,-.-R,, Denied 1 OJ_~ I 5 ~1.~
I c;tsp 1\. ConJt X
^ will m AV fat Uts:!pp ru,'aI QD (a" Ale y ci~- 4z
4 VWVI 4MR Milt 41 kZ%An .'jt)fi Wft;C1L.
flrpr MW.IQNnM plan plo+idaA Irv NpLnbe:.
2 AM til4l A ntiiw .wm mumil tN rctarxr"•!
\uJl•. miJL!~nc, rire:. ,..t ,.~a ~vt1n r. Ll, I _-d.~~pul.
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owners Name:
Owner's Address: i 7•r
Legal Description:
Township:
County `
Subdivision Name:
Lot Number.
Parcel ID Number
Page 1 V Index and title
Page 2 Plot Plan _
Page 3 System S¢jnj-& CrossSection
Page 4 Filter Specs -
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Qeed
Page g _ GSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber r 1` License Number. _ _L
Date: Phone Number
Signature
uesiyed pumua to ow In.cmutd Sal Hbss"ption Component Manual For POWTS version 2.0 SUD-10705-P (N.oLo,).
Page 1
T
I +ff `v
I V
li I
i
yll r'a
I
G'
3
I
Soil Absorption System Cross Section
ft
y
4' Schedule 40 Final Grade
PVC Vend Pipe
With Vent Cap
Leaching 0,
Cham bar
_ft
System Elevation
ftft
Soil Absorption system Plan View
ft
- = ft ~1I~Il~11~I[➢~~1~I111~1I~~ll~1III1~11T~7~77I,~fiLLW~ll1ll
n Vent Or Observation Pipe t eachmg Trench 1 ~ -
czc) s~ias : Chambers _
~L►11I1~[II~!11T~1~jl~ I~I~L ~
4 Dia.
Cmnch 2 Header
- - - - - Leaching Chamber ification~s
- - - - -
,
Manufacturer Arid Model 1
EISA Rating ! sq ft per chamber
Soil Application Kate ! 9Pd/sQ ft
is ~ gpd Design Flow
Soil Application Rate EISA
Chambers
- - 2 rows of -chambers each.
i -
Page of
_ PL-525 EFFLUENT FILTER t
-.,..,ter=t__ - _ _e-. ..u•:a'Y .~-4::... _L~ _
Polylok, Inc is pleased to add its r~~---- i
new commercial filter to its existing
line of quality effluent filters. The
PL-525 is rated for over 10,000 GPD Alarm
(gallons per day? making it one of accessibility " A`ceptsPVe
the largest commercial filters in its extension handle t
class. It has 525 linear feet of 1,116"
fiftr-ation slots. Like the Polylok +r 1.
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed 525 fnearfeet
with every filter. When the filter is ' of tlt6' s
removed for cleaning, the ball will filtration slots Rated for over
w
10,000 GPD
k
, :41"12
float up and temporarily shut off (
the system so the effluent won't
leave the tank. Ato other faker on { 3
the market can make that claim! ;~R 6°
SCHD. aoPipe 'L-525 Wnicanance:
The PL-525 effluent Filter should
operate afficiandy for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the fifter be cleaned ` F
every time the tank is pumped or
at least every three years. If the 3 1
installed filter contains an optional
alarm, the owner will be notified 3
by an alarm when the filter needs - i
Gas deflector
servicing. Servicing should be
done by a certified septic tank ? r j
_ Automatic shutoff ;
pumper or installer. bag when filar I
1. Locate the outlet of the U. S. NW t No* 6,e1S.488 i is removed i
septic tank. c SO LM
2. *Remove tank cover and pump
tank it necessary. l3L 52 hn sta)(atloY`_ 1. Locate the outlet of the
3. Do not use plumbing when septic tank.
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
tank. Make sure all solids fall 4 or 6' outlet pipe. If the
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-625 filter into
completely inserted. its housing.
7. Replace septic tank covet. 1- S. Replace the septic tank cover.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMA4 ON SYSTEM SPECIFICATIONS
O :ter t; lo nk f.Sanaf:: toter ' ! I I NA
Peir[A w C' Seo1i:; D Dose D H:t'ding Volume _ iuaq
DESIGN PARAMETERS lark DAanu`acturer NA
Norther of Bedrooms- f ] 1.1 ❑ Septic El Dosc ❑ Holding Volume: (gall
Non1 ocr of Pubic Facility Units: pj N.
Vertical Distance Tang BoGOm(s) to Service Pad: (t!i
Estimated (er2ge) Flovr 113, 17ontai D'stance Tank(s) to Service Pad* ifn
~~,„L, (gal:day)
on .'fic serviar< mechan cs must be rcvided if vertical is =15 fect r
I: nsign (peak) Flo•s - (esihn ited x 1.5): / (7al daY1 it hori<ontal is>15u feet. speedo insuucti9nto be prooedod on bL:x.
In Situ Sol Ap dicalion Rate: (!gal d~~, n'; G-fluent Filter Manufacture :
' ❑ NA
Standard (Domestic) InfluceYd-ffluent Monthly averag^ I tf aunt Filter fJodeh L~ "7
Fail- O'1 R 6rra5o (FOGI -:33 rtg/l PUI`10 fVlanufaCfure':
Olerhelrlcal OX-igen Demand BOJ,) 220 nl ❑ Nit NA
Total gospdrdcd Solids (I SS) <150 mOrL Pcmp Model: -
6'igh Strength InfluerUEGluenl Nlonthly average Pretreatment Unit
(FOG) >30 mg:i- %larUfaclurer
(RODO :•220 r Cl_ Q NA O NA
(TSS) x1.50 mya ❑ Mochatical AcraLon ❑ Peat Filter -
1 Disirfartior ❑ 1•VaP.arri
Pretreated Effluent Mon:hly averag" (j Sand:Graae1 rilfer ❑ Other:
i30D,J -:33 mOFl- Sur Absorpticii System!
(TSSj =30 irgIL , .I Nil
Focal Conform (peometric mean) e'1W YJ In-Grcurd (gravity) D In-Gromid (mcssare) ❑ NA
- _ Id -Grade [-I t.louec
klaximum Fftlacnt Pall cle Size dia_ I I NA Linc 1 Otlrr.
Other.- 1 1 N'• Other: I I NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
_ 'u"Jhcr!x~nt',in-:nai.d3cnr~Csc:jm':goalsnn~.-Ii!-,l icf'nn<volr.mr.
P;:rrp out unlents of tankf=y
❑'.°;hen the high +,vatnr a.anT is aCtrvatrc
Inspect corditcn of ta-k~s) At yeas: once every J 1,x in N)
(Maximum 3 years) ❑ NA
b'I y lr,d)
Inspect dispe sal cell(s) AC least once every'
J❑K y"'r" 1vaasl i's( (Maximum 3 years) E3 N,"+
rncnth(s}
(lcan cffiurnt filter At :cast once every : I I NA
~ Yaaris)
Ir spect puma, p::mp controls & alas . Af least once every ❑ r"octlgs) D 9 NA
_ yc=rs7
-
n rth(sj
F u - r late•als and aressure test Al leasl ono, every El _0 NA
D yea f ,1 - _
Cillr y, l„~.r un - r„iY(❑ronll:i'+j
OL art
MAINTENANCE INSTRUCTIONS
I:spec. ors cf tanks and soil ahsorpt!., s'y5ten ; Sh 11' 1: 1. r1--1 by ar d= -'U71 eamr inJ cn-: e` -.,r,u;i is :r :ns nr crtrhI1":1 ons:
Frlas:er Plumber. 1:lastor Piumbe- Rcstrictac' Se„e:, f'O'vVIS I•splttarr P0'1%.18 i~7ai-;a:no• cr Septace Sera.cing Ooc;r<ator (pumper)_
Tank insrnrtinns'Alsl ir•dUde d visual Inspect :on of the tank(s) to identify any missing cr Lro.<en hardovare, identity any cracks or leaks,
rr.easure t,,e volume of cnnr bined sludge and se~rn ;:no a c"ck tar any back up or pcndirg of rfflucnt on the around surer,'. fhe soil
absorption system steal be Visua:ly Inspected to check the effluent levels in the obser•vai'on f; pen and to for any pondinq of effluent
on We ground surtace. T^e pocding of effluent on the ground surface may incicate a fading cord "or and rccIJ cs the :rrmMiate
notirlcalion of the.ocal rogu:atcry authority.
When the combirled accurrUladon of sl~dye and scum in any treatr7ent tank equals one-third (i) or more of the tank vo'ume. the entire
contents cf the tank snail be ren-. )ved by a Sephigr. Serv,cirg Operator (pumper) and disposed of in axorcance with chapter NH 113,
4V sccnsin Awninistrawe Code.
All other services. incudi•tg bl.l rot limited tc the servicing of rift: :ten[ filters, nic&anbal or p•ess;:670d cemporenis, pretreatment units:
and any sc-•,icing at intervals cf 12 !ncn:hs: shall he nerfnrmed by a certified PO':°.rTS Nlaintainer.
A scrvicr report shall be provided to fhe lo::a. rego'<dory a~lhcri:y r;iGi n jC cayS of cor,lp:etien of any service event.
W VV-a05(0&ue)
Page START UP AND OPERATION
For nc:; ccm;tructioc, pii:! to use of the POb^JIS check treatment lark(s) for the presence of paint..ng products, solvents or other
chertcals or sedimort flat crag impede the treatment p,noess andlor damage the soil abserption system. If ^igh concerdra:ions are
detected have tho cortents o` Lie tack(s) romoved by a Septaye: Se.vic:i:tg Operator (puM,per) prior to use.
Pump tanks may fill above normal higrivaiter levels prior to starWp or due to pump failures. Start up or restoration of power urder these
conditions is not moornmended, as the excess wasteeazter will be discharged to the soil absorption system in ore lwye dose caus.rg an
overload that may result in the backup or surfaco dscharge o' e'Oueal and damage to the system. To avoid this situation have the
contents of the pmr.p tank re'novad by a Septace Senrciny Opeiato•' ,pumper) prior to restoring power to the pump or cionlact a Pl,imber
or P(YVJ I-S Mainlainer to assist in manually operating the pomp cortrols until norm:, ctfluent :evc'1s are restored.-;ith:n the ptryp mnk.
Sys`em start up shall not occur ::hen soil wrdi;ats are frozen at the infitrative surf::rec.
Do not drive or park veNc9ns over tacks or the soil absorption system. Do rot crive or park over, or mitritivse disturb or compact, the
area w thin 15 feet dcv;n slope of W1 mottled or at-grade soil absorpton area.
Reductien or elimination of the folio:v:rll from t'e wastedrater stream tray improve the perforwarce and nrCong the fife of'he treatment
tanks and soil absorption system. acieis. Zntioioti:-,s haLy Wipes, cigarette bolts, Condoms. col:or. s :abs, degreasers, dental floss.
diapers. disinfec tarts, fats, foundaton drain (sump pump) discharge, fruit and veocl2.li e peelings, gasoline, greases. herb-.tides. meat
scraps. rnedicaCon& oils, pa!ctino procucls, pesticides, sanitary napkins. solvents U-mpons, and water softener bane discharge
ABANDONMENT
N cn the PU',^J I S `ails and~'ur is permanently taken cut of service the fo lo+wng steps shall be taken to insure that the system is properly
arm sa ,ly abandoned in compliance .with s. Comrt 133.33,104sconsin Acrtinistrttve Code:
• All piping to larks, pits and ether sci; absorption systems shall be disconnected and the abandorcd pipe openings sealed.
• 1 he contents of 21 tanks and pia shall be removed and properly disposed of by a Septage Scrvirng Operator (pumper).
• Artcr pumping, all lacks and pits shad be excavated anc removed or -,heir coders removed and the void space filled with soil,
grave: or anther inert so'id material.
CONTINGENCY PLAN
If Inc 110'".NTS fails and cannet be repaired the foloming mrasurcos have been, or must be taken, to provide a code compliant
replacement system:
A sitablo ropirmtimorl area has been eva:uatcd and may be a:i'ized for tire location of a replacemert soli absorption system.
The rep:ncemen: area sho ild be protected Eom disturbance a'd compaafon and should not be infringed upon by rge:uim-d
setbacks Tarn existing and propcscd sfructwe, :cl lines and %velis. ra'.ure to protect the replacement area will result in the nned
for a new soil and s:'te evaluation to estat:fsh a suitable replacement area. Replacement systems must comply with the rules in
effect at lne time of the r permit' ssuance.
❑ A scilab~e replacement areas not avafable due to sciback :aid.*or soi hrritalions. It the soil absomtion system cannot be
rehab litnted ano barring ad•va-oes in P0''N18 technology, a holui•xl tank way be installed as a last resort.
❑ Tire is to has net oc-en evaluated tp'dert:y a suitable. roplacement area. Upon: failure of the POWTS a soil and site evaluation
must be pcrformcd to locale a suitable replacement area. If to r'eplacemort area is available a huldicy rank stay be installed as a
last resort to roplaco the faired PO%NTS.
I I CJ.ound and at-;lade sail )hror-rcil sys:en•s may I:n recorsfmctcd in place tollo+mrg rerrnvel of the biomat at t^:c infiltrative
surface. Reoonsr.rrtions o= suet': systems Must carte }y w'-h thn rules :e eFec' el'nat first .
WARNING
~i TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
yIr 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 INSTALLER POWTS MAINTAINER
earth' / , a Nan
I'lix re - ~ ; Ph^n^
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
N;rne n me , , -
- ti
Phorr. I store
in dec.rman, :.a_. dial>_:: L> 11 . ctn+f of '.ra J':_cr Lane. kdarCuclt•', aid'*.A'nr. rare. (.nerdy F'OdlIS te7u-InrY r-der .ins. in r.nmrlom..e vi.l. suer:ors
(;t:,- rr 8522(2' r,-_1 ills .r resin Aw-nnr.-I:-rr: r Ce9c.
F':ae 1-C_ of _
START UP AND OPERATION
Ue•: ;:o. uu action. Nnor tc U-~ ct t•`c 11CW"I •r:,ntn cnt for th...r p`oducts, s:);~vents or other
cten:.-cals of sedirnent I'nat way in•.,cae t-:e :roatiront proxss andior camage trin sm mn orptixl syme-m If high conce^,tnations are
cetected .wve the conlen!s of Cne tam(s) rem:rid by a Septage Srrndng C}pe <tlor {ocmper, prior tc use
Perin tanks may fill above normal highm~ale: levels price fc sarlup or due to pump .`alures. Start cp or restoration of paver ur:der these
;;❑ndrio::s is net renommenced as the excess 4dastsw-ter wi'I be discha,aed to the soil absim-on system in one largo dose causing an
: roac V:a: may result in the I or surface discharge of eff..rent and damage to ;he system To avoid this situation have the
c::mten!s of the pump tahk removed by a septage servicing Ope .:or Ibcmoert prior tc resto•mg I to the pump o- comas a Plumber
or i 6le'.1I feiantamor to assist in manually o:,e•ating the pump contro:s ;:nti~ norms. effluent levels are restorec u,thin tai:: mjrlp tank.
SC
VAern sta L up shall not xcu-wher soi: conditions are ro%en a: t-e infltrative surface.
Du not drive or park vehides cve- to-iks or thn soil ahsnrption systeT Da no- drvc or park over, or otherwise disturb or compaa, the
sera evith:n 15 rent dorm slope o` any mound or al-grade s;;il absorption a-ea.
I ndnct on or riiminabon of the to'lo'.vino I '.he wesleddater slie=m way improve Cie berfocnance and prcicnc the li`e of the treatment
.anks and soi alsorption system: acids, artioiotic baud v:ipes acareIte b-t:S, condcros, cotton sv+abs, deg-easars, dental floss,
N .pc-s' dumirrnc:ants, fats, inundation Grain 'sump p ar:pi dscnarya, fr-i: and vegetable oeelinas gasoline. greases herbicides, new.
scans. rled:catiors. oils pain-nc products: pesticides, sanitary napkrs, solvents. tampons. and v.'ater softeno- bone cischarge.
ABANDONMENT
VA:en the S fails andio- IF, nermanentiv taken oj't o` service me fol.ow•icn s-cps shall be taker to Insure that the svs:em is properiv
anJ safely aba:iconeJ in compiianxmdth s. Comm I K Vdisconsie Aciministrahve Ccde:
• Ali pip nc to taints, pits and other soil absorption systrms sha'.I be disc-in-acted anr: the abandoned pipe openings scaled.
• The co'L'enls of all tanks and pits shall ae removed and pronely dispose:: of by a Septage Servicing Operator (pumoer).
• After nurai-c, all tanks and p1iR shall oe exavale~ and rnlovac o' I:nei• covars rnmovec and the void space: fiDed with scil,
grave or aroCie: ice:: solid material.
CONTINGENCY PLAN
if lne PO:v.TS fails anj c:annot be renairec the foaa'wi•nc measures have no. r, or must be taken, to provide a :awe compli-nt
replacement system'
f~( A suitable repiaoerrect area ras Deen evaluated and may be u!i izad for the localio- of a replacement snit absc a on systal.
The •cpla::rmni-t a-ea sho,id be pratectec frog; distu!bacca a°d cornDaction and shoud ^ot be infn•iaed ~.;pon by reeui•ed
setbacks from ex:sLng and a-oprscd s*::oturc. lot G-cos Inc Web,. + aflwc to protect Inc rep:a::ement area enll resuL- :r. the 'ac-
far a riwe soil and sl`a evaluation to estanlish r, saitahlo •.nr:<:,^.eT^.nt area. Replan-ment syste'ns must comply apt- the rul.nr in
cf` rot it thn fame of their oermit issua'ue.
A. sutable replacement area is ic- a•va.la:ile.. due to set nice, and.-or snit imitations. I' the soil absorption system cannot b:-:
rerbilila:ed and barring advances it POV:' 15 tec'nnoaooy, a hoidIna tame may be a:stallea as a last resort.
F-1 The site has riot been evaluated to identify, a s.ritable replarx:me-t area. Upon fa!lwe of the 1'O',Ar-S a soil and site eva
must be perornrod tc Innate a sul:able reDlaoement wea. If no replaceri area is available a holding tank may be Installed _
as't resort to roplacc the failed PM%-TS.
❑ Mound and at-grade soi: acsorpUan sy> °ms may be reconstructed 1- place fc; owing removal o` the oiomat at the mPi m,C
surace. aeoonstr.r;t!ors o` s..^n sy':;:rms must :;cr-ip y t° n:b^ in cPtr.- nt ` -t tins.
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 IN rERIOR OF ATANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POINTS MAINTAINER
SEPTAGE SERVICING OPERATOR (PUMPER! LOCAL REGULATORY AUTHORITY
i
Name
!'hone P ~c - : ~ .
Sir
Tai:. 9c ~uvr1 wc> d'aflrr. t i.. _!.fa .,f ~ d: esn nA., L:rm,i ..:..ra r.:u I.ar i:uurl:' Pr?:'. , reap. h°~ aa;:n .i~..: t .:nn{ai r r>: aitn s=h a::--.
'nrr 4;t t i ';tttli&If1 an 64(!j I 1 S • r. l-V',emir 1 t d
ST. CROIX COL~'TY
SED"sTC TAII K- vLADNMEINTANCE AGREEMEiv'T
AND
OWNTI RSHIP CERMCA77ON FORM
Owner-.Buyer L7A' m x
Ma.4d&ess /`f ZL %liyto-a`l nL~ZCf' ILL k6l,'140 ND 14, S~/o(
PTQz ry ,kdt=s 4) -"161 r_ -
(Verincaxion required frmn pran=g Zoning Departmmt ft new construction.)
City/Stale ,T_ J- Parcel Identification Number
LEGAL DESCRg
Properly Location '/4 , _ i/< , Sec. , 'I N R L w Town of 1C. , a tin
Subdivision Plat: a ,i ;'r/ Lot #
-
Certified Survey Map Volume. Pagz
W RXTW i<'y Deed # (before 2007)Volume ..page `g
Spec home Dyes Ono Lotihuid=t6"Aywj3no
SYSTEM MALNTE~*ANCE AND OWNER CERTIR`IC.elTFON
improper use and maintenance of your septic .system could result in is premature Failure to bandle wastes. F oper
maintenance consists of pumping ous: the septic tank every tbrce years or sooner, if needed, by a licensed pumper. Wbat you pre into
Zile system can affect the Amcdon o£rho septic tank as a treatment stags: in tre waste disposals; stem Owner maintenance
responsibilities are spaded in §SPS. 38352(1) and in Chap[er 12 - St Croix County Sm>itary 4rdiaan=.
i be propsrty owner agrees to submit to St Qoix CrnmyP1Wz0' ¢ & Zoniae Department a c rafteadon form, siwed'oy the
owner and by a master plumber, journeyman phmaber, restricted plumber or a licensed pumper verifying that (1) the an-sire
wastswater disposal system is in proper operating condition an&or (2) after inspection and pumping (rfuaeessay), the septic tank is
less tban 113 full of sludge.
Jwc, the,,m&=wed have read the above requirements and agree to mi*tr=n the private sewage disposal system with the
standards sec ir^di, hmeba as sex by =e Depart of Sat* And Pro =i*Gal Serl= and the Depattm= afNalwal Resources
Sate of V,%L ; Certdicmw S=ag etas your septic system bas been mainotmed must be completed and returned to the st Croix
Coamy Planning & Zoning Dgmlmecr whbin ---0 days of flee ahsee Yew eznirarion dare.
1/we cera£y the all statement; on this form are true to the best of my/our lmowled9e 1/we am/are the owner(s) of the
?rope,-ty described above, by virtue of a warranty deed recorded in Register of Deeds pinta.
Number of bedrooms 7
Sr OF APPL_CAll i (S ~JATE
asy itifoimation that is misrepressmed may result in the samirmy permit balms revoked by the Piamn=g & Zoning Depmtment.
Include was this application a recorded warranty deed from the Register of Deeds office and a copy of the cwMBed sttrvay map if
reierenoe is made in the wanam y deed.
17REV. 04M)
N 'a \ 2.188 ACRES
95,328 SO.
FT- Leo-951.5
LOT 17 ` N1 z°"
1.840 ACRES
80,163 SO. FT. \ 6561 h
Leo-961.2 \ ~e \ 1 r
N1j3419E 5199, \ \ N182851 E LOT 45
1.598 ACRES 1^'
\ v \ 69,607 SO. FT. z z 1
LOT 18 Leo-951.5 1 1
i
2.260 ,43ACRES \ \`A OR AGE /
988,432 S0. FT.
20, pMENT
\ m SASE
8. ~3 ~T 65
, .s
N11.341
LOT 44
Y►. `
e~ LOT R19 E 66420 SQ F
1.696 ACRES \ L60-939.0
733,,87 878 S0. Ff.
211'3 3g All
~ N14
e~
u: 379.24 ~'Z5'y 1~~ \
5 \ , , L(
.OT 21 µ51.401 E
339 ACRES \ 1.5
65,1
,909 SO. FT. w .5
~1 1 i 1
L
1.789 OT 20 ACRES ,
77,935 SO. FT. 1
,1 ~ I;N 1
,1.~ N i1 , 1
,
1
-..-387.08-..- ,1 1.72
23' 741.31'- +-u-- . - - . ' ,
354. N89 21'33'E
010' (RAIL ANC unL ,TY
EASEMENT I t
LOT 23 I 2i
1.847 ACRES
LC
80, ,442 S0. FT. AREA TO TI
1.71
LOT 22 " AREA
2.560 ACRES ^ I f- 1LBi
111,519 SO. FT. n i W
b 5843153E 396.84 272.
F I
N n
V. h I LC
I n ~ $ AREA TO T
g LOT 24 ^ ACRES N 1 X1.6:
1.911 ao
833,,23 233 S0. FT. r 1.4
LB
293.98' 33' 133' I
7!
100'37" I I 268.13
E 69495' 404.97'
Parcel 026-1306-00-023 Vale as of 02uOV2018 03:011111
Alt. Parcel ITUWN OF RICHMOND
SI CFtOIXCOUNTY.
V-, SCONSIN
Owner and Mailing Address: Llrl~KEE ner(s):
1.ARVEY I. I4ALVORSEN R, I tU I • I I
tU i i' L HILFIKFR - -
1,143 TATv LACK PL Physical Property
Nl-'VV HICHNICND VJI 5:017 Address(es):
Districts: 520 96TH ST
Dista Description Parcel History:
Sf-j
2
I LIST NEW rtlrf Ifv'C.ND Dal Doc a Vcl,'Paye Type
o 'o LVI G 1 ~t 1,9E _ L'.D
',0 l1Ff v t's:+ILLOvuREH,1Hl)IS-i _ 0% 32L.-, ti _ VJD
1:-"'-'2 (11 1 I I -6 - Vv
Legal Description: Acres: 1.84: 03i16+~01!)-Hii:'?? AP, -
AMEND COV
- -
^Fl±e 130N R 13':^J PT SVJ SL; THE1 GLENS Oi
CVJ RlvEl i fVrl I O__ 23 i1.84:'A: ~
Plat ~L Tract {S-T-R 4u6, 1605'+OLI BlockrCondo Bldg
• • 1-C15-GLENS OI WILLOV^* PIV-H C%G-OC LOTS ' ;T It,-30V 8'Vy SSE : O P 023
2017 Valuations: +91urs I ast Changed on
0927+20-1
Class and Description - Acres Lund Improvement Total
-
_ I_r34: 20,200.00: 0.00; 20,209))
Totals for 2017
G n rat I i perCy 1.847 2-0.2()0.00, 0.00 7 ^-OO.CC
'vv>cnl.vi 0.(1:1:1 0.00' .1,00 O.iKI
Totals for 2016
Gr.._ oral PrJJrrry a4; -0 00.00 0 ('0 _ 20 2m) Cc
J.00:) 6-.Col 0.00
2017 Taxes Bill a Bair Market Value: Assessment Ratio:
46C1J11 24,5C0.co _ 0.8240
And Due Aml Paid Balance Installments
Net Tax ?4.1. C 1 !2.35 172.35 Fnd Dale Total
Special Assessments J C.iiC OAO
_-r)V31r"101; 172.35
Special Charges C.OC 0.tla 0:00 1- -
2 C7l31:2018 17235
Delinquent Charges 0.C0 0.09 O.UO
Private Forest Crop :Uli) C.00 (1.(10 Net Mill Hale 0.01706402(1
P!oodland Tax '.X' C.00 0.00
Managed Forts! Land C.i1C O.CO 0„ )J Cross Tax 391.91
Prop Tax interest 0.00 0.00 School Credit 4!,2:
Spec Tax Interest 0.190 0.00 Total 544.70
Prep Tax Penalty C.00 0.00 First Dollar Credl; 0,00
i_t Chii'nti
Spec lax Penalty ().0(1 0.00 1 Lottery Credit 0.0!)
Other Charges O.CC 0.00 0.01) Net Tax ,'114,'0
TOTAL 3,1 4,70 :72.3:1 1 x7.35
+11fere8! Cit!C,i+a!QCi for G2''"'P!;7:;
;Posted - -
Payment Pa*'*Tj1 ;-:~i
Dale Receipt,", Type Amount Note
U1+19;20IN L11'B3I I 1 1 a;' ih ~ l1i;LV6RSEfd C,C 0546 GI_
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`visco sin SOIL EVALUATION REPORT - - #1475
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings - - -Scfirnih Soil Testing, Inc.
County Attach complete site plan on paper not less than 8% x 11 inches in sae Plan must SL Croix
include. but not limited b' 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.
Please print all information. ~ 23
Rey wed Ey,; - Dale /
Persona: information you provide nruy be used f ur srs Privacy Law, s. 15.00 (1) (m)). /
Property Owner Pr arty 1 ovation
Sienna Corporation Go Lot S 1/4, SE1/4, S18, T30N, R18W
Property Owner's Mailing Address C F Lot Block # Subd. Name or CSM#
4940 Viking Drive Suite. 608 3 ~ The Glens Of Willow River
City State Zip ode T N,hfynq(JV!!!J)~r~ City Village Town Nearest Road
Minneapolis MN 5 Richmond 95Th St.
New Construction Use Residential/ Number of bedrooms 3 Code denied 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 gpdt sgft rating. Possible system elevation for Area
1 is 93 0'
Boring # Boring
Pit Ground surface elev. 98.72 ft Depth to limiting factor 110+ in Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure !Consistence Boundary Roots GPDift'
In Munsell Qu. Sz Cont. Color Gr. Sz. Sh •Eff#1 •Eff#2
1 0-12 10yr3/1 iron I 2mgr mfr as 2m,2f .6 .8
2 12-24 10yr4/4 none sit 3msbk mfr gw 2vf .6 .8
3 24-36 10yr4/6 none sl 2msbk mfr gw I lvf .6 1.0
4 36-48 1Dyr6/6 none sl 2msbk mfr Cs .6 1.0
l
5 48-60 10yr5/G none Is lmsbk mvfr gw .7 1.6-
6 1 60-87 10yr5/4 none cbs OS9 ml 1 as .7 1.6
7 87-110 „ 1Oyr5/6 none s „ Osg ml .7 1.6
_ - _ )
2 Boring /Boring ~ uq.~
Pit Ground surface elev. 98.49 ft- Depth to limiting factor 110f u' So,I Application Rate
Horizon Depth Dominant Color Redox Description I Texture Structure Consistence Boundary Roots _ GPD/ft'
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. ~Ef #l •Fff#2
1 0-11 10yr3/2 none I lmpi mfr as 2m,2f .4 .6
2 11-29 10yr4/4 none sit 3msbk mfr gw lvf .6 .8
3 2943 lWr5/6 none I sl i 2msbk mfr gW 1vf .6 1.0
4 43-52 10yr6/6 none sI lmsbk mfr Cs 1vf .4 .7
5 52 90 10yr5/4 I none cbs Osg ml I as - 7
none N I J 16
6 90-110 10yr6/4 s Osg ml .6
1.
Effluent #1 = BOD,,> 30 220 mg!L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg!L and TSS < 30 mgt
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 9/13!2006 715-247-2941
Propeity, (Tuner Sienna Corporation Parcel ID # 23 Page 2 of 3
Boring # Boring -
Pit Ground surface elev. 97.07 ft- Depth to limiting factor 110+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistencel Boundary Roots GPDrft' _
Munsell Qa Sz. Cont- Color Gr. Sz. Sh 'EfM'1 •E##2
in.
1 012 10yr3/2 none sl 2mgr mvfr as 2vf .6 1.0
2 12-28 I 10yr4/4 none scl 3msbk mfr gw lvf 4 .6
3 29-44 1Oyr4/6 none sl 2msbk mfr gw .6 I 1.0
4 - 4476 10yr5/4 _ none grcos Osg ml as .7 1.6
5 76-110
10yr6/4 none o s - Osg ml .7 1.6
~ N
❑ Boring # Boring
PA Ground surface elev, fl. Depth to binding factor in. ,Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfN
in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t •Ef#r2
❑ Boring # Boring
Pit Ground surface elev g. Depth to limiting factor - in jSoil Application Rate
Horizon Depth Dominant Color Redox Descrip!ion Texture Structure iConsistence' Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. [ftsi •E##2
I I
-III}- - - - •
E!Ouent #I = BOD,> 30 < 220 mq,L and -SS -30 %50 ma+L ' Effuent = BUD < 30 mgrs and TSS < 30 mg,L
The Department of Commerce is an equal upporlunity.wr% ice provider and employer. 11'yuu need assistance to access services or
nced material in an alternate Ibmurt, please conlact the depannient at 603-266-3151 or 'I I Y 608-264-87".
vsu-xv u: ,ow'i rm~,m soi i c;c
Page _ of `3
C0Hdne0.:d LIN: t'onductcd For:
Schmitt Soil Testing Inc. Name: 'Sienna Corporation
Thomas .1. Schmitt, CST 227429 Address: A-,v
1595 72nd SI. City, State. /if): ,h r i s / ~S y1'S'
:
New Richmond. 11'f. 54017
Phone: 715-247-2941 / Sulxl.Name: The (ileac of Willow River
Cnmaimc. _~Zl`"-<<a~ -7'
Lot Teo.:
Legal Description: 5!-v_I'4SF.l:4Sl8 'I'30NK18W
Backhoe pit Township, Counly: Richmond, St. Croix
AA. Bench Mark BI. I00.00' "l'op oft" pvc pipe
Alternate Bench Mark F.I. `,I1 y Top of 1 ' 1"'t L /',r'r'-
slope Contour Line 1:1. /df Contour Line Length Scale 1 " - 40'
r
i
1
F P~caJ
II ~~t/} I I
i i~.7 ~ ' ~r GIs I
Std" X'O
II
5-2,
ar
W, coil Nod Hite I Aun'.....:•...., wplr'ul t Ilia➢.n>n uu taµmoueu. It m:» rn me) Il a I,, in a I,n.,lion sn tlah.e Il - y:m i.,,.