HomeMy WebLinkAbout026-1306-00-058
V;:rrrcr. r. ]r.:a•rnc-!nf ::or TC-cc r=cu^ri St. Croix
PRIVATE SEWAGE SYSTEM
SaG#) and But drug Glvis or.
INSPECTION REPORT NB
GENERAL INFORMATION (A; IACH IO PFRMIT) 607063
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Oevering Homes LLC TOWN OF RICHMOND 026-1306-00-058
RV Fi,-, n5, 61.1 HE, By N:,
/00 18,30
TANK INFORMATION ELEVATION DATA
TYPF IAANJFA[:TURLR CAPACITY STATION RS HI FS E! EV
Senile 1, ! 1666 Rencnrtlark ,7.0 /Qy
G6dac}- AIt. GM
• 7
I Cep{ r; `
tA~ LA-
Acrahon Bldg Save. S, 1 9G
11010mq - SUHt Inlet (0. Z5
TANK SETBACK INFORMATION StrNt G tlet
("•5 RS.S
TANK TO P: VVEL.L GLLKi .enr. An InUke R )AD Dt Inlet
11- /
Ai%
. I d w I
Septic I
D Dt Bottom
O (osmp ^J ~eanerlf.-0an 6-7
Aeration r Dist. Pipe 95.3
Z
'loldmy Got. System 7' qy.
'7. Ir fly, 2-
Finat Grade
PUMP/SIPHON INFORMATION 3.1 n
Manufacture- Demand St Cover
G lhl M n, 7
Model Nm e.
1 DI I uclmn ! :rss. Svste• r. T Hi Lt
Forwaiam Lcnyll. Dia Irv 1c 1No
SOIL ABSORPTION SYSTEM
BEDITRENCH Ymtltr. longlh Nc CH Tyro^ce PIT DIM -N@ STUNS 'ac DI nstlc Ga. 4p, : ""th
DIMENSIONS
SETBACK SYSTL IA 10 P!I BLDG iL LL AKLrSTRLA LEACHING Manu'armm- (I !
INFORMATION _i Pc CI' System r CHAMBER ON I~'f p
Ce ~.u O ^,'Q UNIT M:.J Nmuber w
DISTRIBUTION SYSTEM ~~'vvv Al, 4. - Z
aea:lrr'N:rtr'r~d Disrouton r ~nae j to bole °:pac °g ven' Ac In' ke
P msi ~ ` ~o IC S
SOIL COVER x Pressure Systems only xx Mound Or At-Grade Systems Only O
7e alll (:.zr Depth Over 1,. , eptn of 10, ..eccedl SC a xx Mwcned
!c:P-leo::r ::e•1c • tt Bn9'rcn;h Ecpes xcos
T Nc Vcs Nc
COMMENTS: Ilnclud( code discrepencies, persons present. etc : Inspe::nun pt Inspection 42.
Location: n!)2 152ND AVE r•
1, Co u~ -
1.1 Al: GM Descnotion =
2.1 Bldg smwr Ienpth =
- amounl of cover =
?gar. revision Required? 'Yes ° 2~ 19i / T ,ft
Use other side for additional Information. C7 T I G J
Sd[»fIC iR.3r9?I raw irl-cto S'Plat ;:cif DL,
SAw-~~~i -06 3
Safety any Bwkii gs Dms'wn
r .0 $ I 20 JU. Wasnington Ave., P.D. Box 1-162 5aniarv permit N.I (to be fiCod w, by Co,
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Sanltar\, Pere}lt;f}fllcation mrcT:a2 Am -nNwnM
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App]ic atmn Information -~ndan,
I Applnoease Print All 1nformannn
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IL Type of Budding (check all that apply) R F
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S}strn L Repl-recut 5>stnr, T•cwmcnoH-ISm; Tardc fccplmxmrnr Cmlp L 1ARI MaSticauoo m Fxis[ing SysL~ (rxl!lam;
R L Y•rmt P., lieu ianr. ❑ Ct:+ngc of?wmhe: F1 Fro i n,s1a :u New Litt hrv [ous Perma Nwnbc and I)= .ssurd
act i scc ti',r. ih>nc _ A C`
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Respongbiliry $tateme 4 the dersixnrd, u rc ponslmlip for incullaliuo of thr PUwTS chowu ou rbe artactlcd plans
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SBD-6398 (A. 11it1) IJ 0 -
Soil Test and System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 114 SE Ii4S 18 rr 30 NIR 18 w'rowN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 97.0/96.7 4' below grade 5/9/19 BEDROOM 3
DA'Z'E
CONVENTIONAL XXX CONVENTIONAL LIFT 110I,DING TANK
MUl1NU SEPTIC 'T'ANK SIZE 1000 gallons LIFT 'T'ANK SIZE DOSE TANK SIZE.
HOLDING 'T'ANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCIINIARK V.R.P. base of surveyor stake ASSUNIE ELEN'A'fION loo' Filter Lifetime Filter
❑BOREHOLE O WELL •IL.R.P• same as benchmark
Scale = 1/4" = 10' Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Luny I 2
34' Grade at System Elevation
Pro 3
Bedroom
House
B-4
10'
70'
- 152nd Ave
S'
10' 10
Vents
2
B-1 70' 3 5'
5 B.M.*
25'
2-3' X 66' Cells with >3' spacing
20' All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
290'
075' Property Line
Drainage easement staked by surveyor
Property Line
OqS
I 1„.,, it 1
WisoorlunDepartment of Commerce SOIL EVALUATION REPORT Page of
Dmsion of Safety and Buildings
Mact,ArdarbaW.Crifiim85. Wis. Adm. Code Court ~r1r 7/~
Attach complete site plan on paper riot less than 8 112 x 11 inches in size. Plan most
ryV
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 mad. O Z- (a- go CO -05
Please print all information. Ravi by Date
ParferYLMorms lMn you orevide may be used for sxoneary purposes(prrvcy Law, s. 15.04(1;(m): . -5/-/
Property Owner Property Location /
Govt. Lot 2E- IN td4 T 27N R E(aW
Property Owner's Mailing Addrl e - Lot # Block # Subd. or CSAW y
i
City q State Zip Code Phone Number ❑ City ❑ Vil age Nearest Road
QcC~'IC f ) I
New Construction Use-GirBesidunbali I Number of bedrooms Code derived design flow rate G P D
❑ Replacement ~,I'Publ' or commercial - Describe
Parent material a,&0ce _ Flood Plain elevation if applicable q ft.
General eommams G/ -'~uc./~ Zer a x
and recommendations. 1
/ p~'
System Type G11J Ep r:tern Elevation ` /r (,`7
❑ng# O Boring
IL I.
pit Ground SUdaCe efev V n. Depth to limiting lector in
Soil Application Rate
Horizon Depth Dominant Color Redoz Descripton Texture Structure Consistence Boundary Rafts GPD,MP
In Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E##1 •Eft#2
-9 r r5-
/v
c/7
d i
~ rg
Boxing a BonFIV
a pit pit Ground surface etev 1_U1) Off Depth to limiting fads in
Soil Application Ratio
Horzon Depth Dominant Cov Redox Description Texture Structure Consistence Boundary Roots GPD."
in. Munsell Qu. Sz. Cont. Color Gr Sz Sh 'Eff#1 •Eff#2
0 3r' S L
Z a- L, s mi r~ Nf,~ '
Effluent #1 = BOO. > 30 < 220 myL and TSS >30 < 150 mglL ' Effluent #2 = SOD. < 30 mry4 and TSS < 30 my'L
CST Name (Please Print) Si CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Dare Fvawalimn C rimted Talaphono Number
1432 120th St, Need Richmond. WI 5401 < / 715-246-4516
Property Ovmer - Parcel ID # Page --01-
Boring _
FN Boring # ❑ Boring
L~t O.Pit Ground surface elevl oar h. Depth to limiting factor _y/-7L )im
Soil Apol icatdn Rate
Horizon Depth Dominant Cdor Redox Descnphon Texture Structure Consistence VlBwndary Roots Gf>O#f
in. Munsell Oil Sz Cont. Color Cr Sz Sh 'Eff#1 •Eff#2
n
C'8
Z - /I
fr
Bonng # ❑ Boring
F-1 ❑ pit Ground surfaceelev. fl. Depth to limiting factor in.
Soil licetion Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistonce Boundary Roots GPD/tf
in. Munsell Co. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 •Eff#2
1-1 ❑ Boring
Boring # Ground surface elev. _ ft. Depth to limiting factor in.
❑ Pit - Sail Application Rate
Honlzon •lepth Dominant Cola Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 'EB#1 'Eff#2
' Effluent #1 = BOD, > 30 < 220 mgJL and TSS >30 < 150 n qk • Effluent #2 = BOD, 130 nxy4 and TSS < 30 nVL
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 608264-8777.
SOV NM(xbmi
Property- Owner _ Parcel ID # - _ Page _ o'
Borng # f-1 Bonn; _
api, Ground surfaw ew&- ~ L It. Dept?, to hmbng factor in
Soil ^ hoauon Rate
Horizon Depth Dornmanl Odor Redox Des mion I Texture Structure (;onsrsterre Boundary Roots GPOl1f
in. MUn4eb Ou S: Con! Color _ G. Sz St. 'Eff#t 'Eff#2
i
r I
r
z~- Bang # . Bonng
111 pit Ground surface elev ~D 3, 0
ry. Depth to 6... pit Gmun sur!aoe elev ~ ry. Depth to limiting factor 13 X/ in.
Soil oL:abor. Rate
Honzon Depts. I Dornauanl Coior Redox Dus;xiption Texture Stru--tore consister - BoundaryI Roots GnDxf
I in. Munsell Ou. Sz. Cont. Color G. Sz. Sh. ! 'Eff#1 'Eff#2
f OS AN, JL~
i r
I _ r
b I
U' Boring # ❑ Boring
❑ pit Ground surface elov. ft. Depth to limiting factor in
Soil Application Rate
Horizon ')epth Dominant Color Redox De pbon. Texture ' Structure Consrslence Boundary Roots GPD4f
in. Munsell Ou. Sz. Cont. Ca1or Gr Sz. Sh. 'Eff#1 'Eff#2
I
i
i
I I
I
Effluent #1 = BOD, % 3C < 22C mg4 and TSS >30 < 150 mgt ' Effluent #2 = BOD, < 30 rng.4 and TSS < 30 mg4
Tne Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in ar alternate format, please contact thr department a! (SU--26f.-3! 51 or '[-I Y 608 264-8"'
Sep e)0 MAM
_ ~tru 06.3
~a1!%mn. j C r l
Safety an 4 il9in s Wvisiort
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tlw `kpar mcta •.f safen, and Ih k I ;J ~-n r P -n al Ir torn nun ono p:o. ioc ma• be used frx seumdsy
Lun rs+:n a•.ordan..c w-+thLbllna _L-L 1 II!
I AVDlitahoo Infonnatton -Plrasr Print All Information
l~~ Pala.?
1 operty Own I S )dmlmg 4ndr ro ) (J~1- I• mop,, y lu:ation I S. ,7v . l p• &45'
> > (~pLl r,l.%. ~YL~ j _ Gott lat /
Cav State :Q - ZqF !e .h':w Nlmtx S-eooo
Lei ~L/-,111 _J1L-/ 1-_- _ - Tj~.N; RF rd'
ll.'I'ypa of Building khcrk all that appls) Luc -
7 Sl1bdl V IOC NYTC.
ot 2 Family Dwcllicg idumba ,.f scion (J f r
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❑ Scam Owned - CksmM l:K - _ /
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llf. Type of Permit: (Check only one 1. on line k. Complete lime B if apphci-
A Ne 3ynem Cdq+lacm rn shlr. 1Tc:.^nca lafn^_-.a.kY I: :(mh .Ij~ Oln_Mevticati-nt.-s•avuY, S)" v,:espixm)
i - - - - I - -
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R. C Yctmi: Rcww'al ❑ Yamtl Hrs'itiuc :P!er.. 'I ^'•1n '.'a[e.tC. to Few
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caa] .ru, Kegal.ed S'l I
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r VI 1. Responsibility Slatem tLdu.d,7gn ed nr responubiliq for imaallaftun of the Y_ OH'fS shnwa on the aubchrd plans. -
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Vlil. Counrv,Depyr[ment 1'se Only
k'^-rtnit Fe: i A°te <suei Iss'In' r.t, ""'a Si_;wlme
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2. All li~ fKOW lertiS In" W iMn1.JI.E /AI ~ I r~
a PK apF7of~Fl taYSff;tAl~,Al16tL Tf QI~ ~b ~ (6stn
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SBDh;~hiR I1+IL
System PLOT PLAN
PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond 1N! 540'7
NE 1;4 SE 1!45 18 rr :30 N;R 18 At 'TOWN Richmond COtiNTY ST. CROIX
SYSTEM ELEVATION 93.0!92.9 5' below grade 4'14.19 BEDROOM 3
DATE
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC "TANK SIZE 1000 gallons LIFT TANK S[ZE DOSE TANK SIZE
HOLDING 7:ANK SIZE LOAD RATE .7 ABSORPTION AREA 651 y of charnbers 32
BENCHMARK A.It.l'. Top of 2" pipe
:ASSLmr: Ia.t:Y.ATION Iwr kilter Lifetime Filter
❑BOREIIOLE O WELL `H. R. p. same as benchmark
B-_ l l.s , Scale = 1/4" = 10'
122'
.,III Vents
B-3
66
V
B-1
I~_nd Avc
Bedroom
House
All piping shalt be ASl'M SDR 30+34, within 290'
10' of tank. piping shall be ASTM F891
Vent Property Line
W, Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
t i.6ft^2lpair of end caps
~ 4' Long 1_"
Grade at Svstem Elevation
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120Th St.
New Richmond Wi 54017
715-246-4516
Date: 4/14/19
Owner:Oevering Homes
Location: SE1/4 SE1/4 S18 T30N,R18W 992 152nd Ave Richmond
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintance and Contigency Plan
7. Filter Cross Section
Signature-` j - _
License number,9226900
System PLOT PLAN
PROJECT Oeverine Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 1/4 SE I /4S 18 1•I' 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 93.0/92.9 5' below grade 4/14/19 3
DATE BEDROOM _ CONVENTIONAL XXX C'ONVENT'IONAL 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 Filler
❑BOREHOLE O WI:[,[- *II•R.P. sameas benchmark
52' 57' B_2 I1 B.M.* Scale = 1/4" = 10'
122'
42' vents
2-3' X 66' Cells with >3' spacing
B-3
66'
B-I 20'
ST
30'
152nd Ave
Pro 3
Bedroom
House
All piping shall be ASTM SDR 30/34, Within 2q0
10' of tank, piping shall be ASTM F891 Vent Property Linc
ALo Quick4 Standard
Leaching Chamber
with 20.0 ft2 of Area
„ 5.6fI^2/pair of e nd caps
Grade at System Elevation
34"
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft'-1 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 98.U
Vent Grade Vent
3 X30/34 Septic Tank 3
5' Long 1 5' S Long t„
Grade at System Elevation
36" Grade at System Elevation
Spacing 5
2-T X 66' Cells
Same on other end Observation tube/Vent
At end of cell
A
16 chambers per cell B
System elevations:
A-93.0'
B 93.1'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - of
'ILE INFORMATION SYSTEM SPECIFICATIONS
Owner ( i P Septic TarK Capacity C NA
Permit # Septic I ank Manufacturer u NA
DESIGN PARAMETERS Effluent Filter Manufacturer J 0 NA
Number of Bedrooms O NA Effluent Filler Model 0 NA
Number of Public Facility Units LL NA Pump Tank Capacity al P NA
Estimated flow (average) -34Z) gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) ~~j1.~ gaUtla Pump Manufacturer NA
Soil Application Rate arida lftz Pump Model NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit NA
Fats, Oii & Grease (FOG) °c30 mgiL. 0 Sano/Grave! Filter 0 Peat Fitter
Biochemical Oxygen Demand (BOD,j 20 mgiL D NA 0 Mechanical Aeration O Wetland
Total Suspended Solids ('SS; <_150 mg1_ Disinfection D Other:
Pretreated Effluent Quality Monthly average Dispemal Cell(s) L NA
Biochemical Oxygen Demand (BODs) I s30 mgA. X-n-Ground (gravity) 0 In-Ground (pressurized)
i
I otal Suspended Solids (TSS) <:30 mgP_ - NA 0 At-Grade 0 Mound
Fecal Colifonn (geometric mean) X10" cfuil00m1 D Drip-Line 0 Other:
'Maximum Effluent Partite Size 41 in dia. 0 NA Other. - - u NA
other F! NA Other. NA
'Values typical for domestic wastewater and septic tank effluent Other. D NA
IAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of [ark(s) At least once ove-y: `CJ month(s) (Maximum 3 years) n NA
(Pump out contents of tank(s) Who. combined sludge and scum equals one-tnird (h) of tank volume Ll NA
Ins 0 month(s)
pest dispersal Dell(s) At east once evey: (Maximum 3 years) ❑ NA
J?-year(s)
G
lean effluent filter At least once every: month(s) ❑ NA
,)J-yearls)
moil nsped pump, pump controls & alarm i Al least once every: D mo C year(s)
=lush laterals and pressure test At least once every: D moral NA
0 yearks)--__--
Other D month(s)
At least once every : NA
D year(s)
ether - - - N.A.
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an nuividual canying one of the following licenses or certifications: Master
Plurnber; Master Plumber Restricted Sewer; POWTS'rspectur, POffT-S Maintainer; Septage Servicing Operator. Tank inspections m,rst
include a visual inspection of the tank(s) to identify any missing or broker hardware, identity any cracks or leaks, measure the volume of
~ximbined sludge and scum and to check for any back up or poncing of effluent on the ground surface. The dispersal cell(s) shall be
i✓isually inspected to check the effluent revels in the observation pip" and to check for any pending of effluent on the ground surface.
The pending of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
When the combined accumu'ation of sludge and scum in any tank equals one-third (!a) or more of the tank volume, the entire contents of
!.he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
4dministrative Code.
Ail other services, inducing but not limited to the servicing of effluent filters, mectianlcal or pressurized components, pretreatment units,
land any servicing at intervals of _12 montns, shall be Donorrned oy a certified POWTS Maintainer.
a service report shall be provided to the local regulatory autaoot; •wirhin 110 days of completion of any service event.
Page of
Lhrt
START UP AND OPERATION uct s other chemicals of the
For new construction, prior to use of the POWfS check treatment tank(s) for the presence of Painting Prod or may impede the treatment processarxf/or damage ~a to the dispersal
cell(s). If high conceritraWna are detected have the contents
tank(s) removed by a septage servicing opera
System start up shall not occur when soil conditions are frozen at the infittrafive surface will be
surface excess discharge wastewater effluent.
During power outages pump tanks may fill above normal highwater levels. When power is the restored backup the
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in Operator Prior to restodng Pr/•ef to the
To avoid this situation have the contents of the pump tank removed by a Septaga Servicing the pump connote to restore roomer laves
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating
within the pump tank. the area within
not drive or park over, or otherwise disturb or
Do not drive or park vehicles over tanks and dispersal calls. area.
15 feet down slope of any mound or -at-grade s& prolong t the life of the POWfB:
Reduction or elimination of the following from the wastewater stream may improve the performance disinfectants, and prolong foundation drain
antibiotics: baby wipes: cigarette buns; condoms; cotton swabs: degreasers; dental floss; dlspe 3; i s oil; painting p~
(sump pump) water, fruit and vegetable peelings: gasoline; grease: herbicides: meat scraps;
pesticides: sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propel Y
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe opernngs 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 shag be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN code compliant
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a
replacement system:
-.B suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by req
setbacks from existing and proposed structure, lot lines and welts. Failure to protect the replacement abaci will result in the neled
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the tutaii in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to reptace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site irevaluattpaz
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be a last resat to replace the failed POWTS.
in effect fo towi ti removal of the biomat at the infiltrative
❑ Mound and at-grade soil absorption systems may be reconstructed
surface. Reconstructions of such systems must comply <<WARNING>> with the rules SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN.
DO N
BE DIFFICULT O IMPOSSIBLE. MCI~SEANCES. DEATH MAY RESULT. RESCUE OF A
ENTER A SEPTIC, INTERIOR OTHER A TANK M REATMENT TANK UNDER ANY
PERSON FROM THE I
ADDITIONAL COMMENTS
POWTS INSTALLER POINTS MAINTAINER
Name Name AI.,{.
Phone
Phone - ~ <
I i
~.__..I
LOCAL REGULATORY ULgTORY AUTHORITY
SEPTAGE SERVICING OPERATOR UMPER
e
Nam
Phon FIName
- - / Phon
e e
Administrative Code.
This document was drafted in earpRance with chapter SPS 3e122(2)(b)(1)(d)b(t) and 383.54(t), (2) & (3), W^
ST. CROIX COUNTY
SEPTIC TANK MAINTENAACP AGREEMENT
AND
OWNERSHIP CERTI171CATION FORM
Owner/Bayer _61,Pvel1(,~y ~~G~'~- - _ - - -
Mailing Address /~!~(fL'~ L1P~_
Property Address
(Verification required from plartu ne %oni . 14--
tment r"or new constmenon } - - - -
City/State
Parcel Identification Nimrber
LEGAL DESCRIPTION - - - - 3GCO OS ~
Property Ltxatiou G 1
, - ~ - , sec. 8
- T --~6 _ N R l_ v W> 'I'owa' of ~C t «z<
of
Subdivision > .
-
Certified rSurvey Map # - - -,Lot # O
- - - - - Volume
-
- Page # - - - -
Warranty Deed #
- 1 - - - - , Volume Page
Spec house yes nn - - - -
Lot lines identifiabl y" no
SYSTEM MAINTENANCE AND OW SEK CERTIIICATION
Inipruper use and maintenance of,n
maintenance consiste of ansin
the syste n Y ur Sei'ti<: aysicrn could rrsulr in its prruuturr. failure to'rami'e wastes Trope
m can allect the ter tog oft the scion:; hank every three years ur suoucr, itnced;,
the septic tank as 4 by a licensed n r
es are siucified in G, a hcatment stage in the, waste. disposal h Per- What you put urtu
responsibilities nun. 83. i2(i) and in Chaptn, 12 - St. Croix County nyaty rd owner mgt¢tenauce
The property ownta agrees to submit to St. (rota Couut}• phtwring d: 'Lunar Dr, artrnent a tr'crtit7Cation Corn
owner and by a massy teem I's r, Proper journe.yrnain open plumber- n ced phrmbe or a licensed ptrmper verifying that (1) the ou-sue
wastewater disposal system is i¢ g P u signed by the
less thanli4lullofshrdge. upt.ralttrgConditiition antp'or(2)after
in
spe.etion and primping (if necessary); the septic tank is
"we- the uralersigued have read the above requhearenrs and agree to a,arntain the
starrdads set tbrlh, bcrem, as set b}• the))epurrn'ent of C'omrnerce and rho f)
Private
Cc Lficalion Stettin filet your se _ scwarte disposal
system with tb,-
/.truing f)epartni at within 30 days of the three year expiration date tied State of Wisconsin.
B ptie system be, been maintained must be con plered and retur to !hwt Croix ('.nun(), planning &
I/we certify that ati stalcrnculs on 's form arc her: to the best of ruvhnn* kuuwictlgc. 1/we aui/ate the nwrrer
Property described above, by viirua of a w ianty deed recorded m Rrgi; ler of Deeds Office.
(~O1 the
Number of bedrooms
[GNA'T'( OF' APPUCANT(S)
a++ DATF,
My intbrmation that is misrepresented rosy result in the sanitary pennit being revoked by the, planning 8, "Lotting f)cparruient. f
faclude with this application a recorded warranty deed fun) the Register of Uced
reference is made in the warranty deed, s Office and a copy of the ceitifieti survey map if
(REV. 00105)
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ewiSC0nsin SOIL EVALUATION REPORT - - _ #1497
Department of Commerce in accordance with Comm 85. Wis- Adm. Code Page 1 of - 3
Division of Safety and Ruildings Schmitt Soil Testing, Inc.
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County SL 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 /
58
Please print all information. Reviewed Bye Date
Personal inf0ittlabOe you prov'dU maY P;IU9Cd l ve. tae. s. 15.04 (1) (m)). J
Property Owner Property Location
Sienna Corporation Govt tot NE1 4, SE1/4, S18, T30N, R18W
Property Owners Mailing Address ~i 'c. I -o1 I1 Block # Subd Name or CSM#
4940 Viking Drive Suite 608 58 The Glens Of Willow River
City St a zip doAe r-^Iphom Number City Village Town Nearest Road
Minneapolis MN' 5 Richmond I 100Th St.
New Construction Use 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 tit
General comments
and recommendations: Area is suitable for a conventional system with a 0_7 gpol sgft rating. Possible system elevation for Area
1 is 94.10'.
Boring # Boring
Pit Ground surface elev 97.76 fl. Depth to limiting tailor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD.4v
m Munsell Ou. Sz. Cont. Cola Gr. Sz Sh. : 'EfF#I 'Eff#2
1 0-10 10yr3/1 none sl 2fsbk mfr as 2vf .6 1.0
I
2 10-19 10yr4/3 none scl 2fsbk mfr gw lvf .4 .6
3 19-32 10yr4/6 none qrls Lcsbk mvfr Cs I .7 1.6
4 32-115 10yr6/4 none s Osq ml I 7 1.6
Ao3
❑ Boring # Borinq
Pit Ground surface elev 98.81 fl. Depth to limiting factor 115+ in. Soil Application Rate
Henzon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD.412
In. Munsell Ou. S7 Cent Color Gr. Sz. Sh. •EB#l •Fff#2
1 0-12 1Dyr3/1 none sit 2fsbk rnfr as 2vf .6 .8
2 12-21 10yr4/4 none sid 3fsbk mfr gw Ivf .4 .6
3 21 31 lDyr4/4 none sl 2fsbk mfr cs lvf .6 1.0
4 31-115 10yr6/4 none s Osg ml .7 1.6
~ I t
5 1
Effluent #1 - BOD,.> 30 220 mg. ;L and TSS >30 < 150 mg!L ' FK ;ent 92 = BOD < 30 my'; and TSS < 30 mgL
CST Name (Please Print) Signature , CST Number
<,.; [ 227429
Thomas J. Schmitt
Address Schmitt Soil Testing, Inc Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond. WI 54017 9117/2006 715-247-2941
/1111111 lX nr..:
Propeny.Owner Sienna Corporation Parcel ID # 58 Page 2 of 3
❑ Boring # Boring
Pit Ground surface elev. 98.08 ft Depth to limiting factor 115 r in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD+ft'
in Munsell Qu. Sz Cont. Color Gr Sz. Sh. '["I •Etl#2
1 0-12 10yr3/1 none sit 3fsbk mvfr as 2vf I 6 8
it
2 12 22 10yr4/4 none I sid 3fsbk mfr gw 1vf .4 .6
3 22-32 10yr4/6 none sl 2fsbk mfr Cs lvf 6 1.0
4 32 38 10yr5/6 none, grcos Osg ml cs I 7 1.6
5 38-115 10yr6/4 none s Osg ml .1 1.6
❑ Boring # Boring
Pit Ground surface elev. R. Depth to limiting factor in Soil Application Rate
Horizon Depth Dominant Color Recox Description Texture Structure Consistence, Boundary Roots GPDAV
m. Munsell Qu. Sz. Cont. Color Gr Sz. Sh. 'Effa7 •EIfx2
i
❑ Boring # Boring -
Pit Ground surface elev. fl. Depth to limiting factor _ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f-
in. Munsell Qu. S2. Cont. Color Gr Sz Sh 'Eff#I •Eff#2
' Effluent #t = BOD,> 30 < 220 rngf. and TSS :30 < 150 mg!L ' Efflue'il 42 = B00-< 30 mg,!. an:: TSS 30 rig,.
the Department of Commerce is an equal opportunity service provider and employer, If you need assistance to access wnices or
nm-d material in an alternate 10MLal. plCavc contact the department at 608 266-7151 or I I Y 608-264-8--7.
viu-x a,,;a c: <xii 4nnrrt 4x1 I'MM Ire
Pate of
C`onductcd by: Conducted FOE
S_rlitlitl Soil Testing 111C. Name: Sienna Corporation
I homats J. Schmitt. CS "f 227429 ;address: 4940 Viking, Drive Suite 008
1595 72nd tit. City. State. Gip: Minneapolis. MN 55435
Ncw Richmond. WI. ?4017
Phone: 715-247-2941 Sub(I.Nanic: 1'11e Glens of Willoxw River
Lot No.: Legal Description: SC I%4SH1.14 S18 LION R1SW
Backhoe pit Township. Cuunty: Richmond. St. Croix
A Bench Ntai k 11 100 00' 'l op of T, pve pipe
Alternate Bench Mark H. YF tr' 1'op of
Slope- Contour Line H. rns C'onlour Line Length
5"`
Sca 40•
W
F
1~ F3 M~
II~ R
~ al pie
I,N
Lfx `15 7 < rsi
~ 135
I \
f Q Syr
i -
0OU
Ihis Wil buJ << LtislrcGc~, e:,u nv.ltnll 'd[„unm n±nruncn~o t.~ ur.<_~mm:nnMy~nalu4.Iliun 9utlLh k~~_ccu