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Home My WebLink About026-1306-00-014 Wisconsin sin Department of Commerce Co,anty PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division Sanitary Permit No. INSPECTION REPORT Sanitary 0 GENERAL INFORMATION (ATTACH TO PERMIT) state Plan I� ^ No A Peraonai information you provide may be used for secondary purposes [Privacy Law, s.15.04 t1 )(m)}. Permit Holder's Name: City ViPa(;e X Township Parcel Tax No: Q� Q4 -� Q Sienna Corp. Richmond, T own of CST BM Elev: � Insp. BM Elev: r BM Description �— —� Section /Town /Range /Map No 9.3• V 3 9t? CST ALT. Bw l 18.30.1 8•.2*5 -- TANK INFORMATION ELEV DA TA TYPE M NUFACTUREK) `) CAPACITY — ��- STATION BS HI FS ELEV. Septic 1..+ (,/ -� fienchrnark I #4 3. `�3. 7 Dosing At. BM Aeration Bldg. Sewer r O q, /• Holding ISt /Ht Inlet BS 9 9U j St/i-It Outlet nD TANK SETBACK INFORMATION CIO. TANK TO P/L WELL BLDG. Vent to Air Intake ROF.D� �C)tlnlet I _ Septic 41 I �) 1'L-t Bottom Dosing -� Loader /Man. �•��- 0 .0/ I , Aeration t t io. System • 3 ¢p holding � Final Grade ��O /Z•G ry� PUMP /S PHON INFOR _ O Manufacture Demand i I St Cover 2 ' _ 2 �3 tt �t� GPM 1 J _ T J Model Number - --� i TDH Lift Fric ss System Head T DH Fi Forcemain ILer Ibi a. Dist. to Nell SOIL ABSORIDTION SYSTEM BEDITRENCH Width Length No Of Trenches TT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 D z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING tvlanufact er _ 7/ INFORMATION r - -- I CHAMBER OR X10 T e Of System: ` oZ UNIT Model Number 5- , 0, DISTRIBUTION SYSTE V fold Distribution < Hula Size. x Hole Spacing Vent to Air Inta e Header / Mani Lengr) �: Dia 111 J Leng -- Di a_ -- -- : > pacin Length SOIL COVER x Pressure Systems Only XX Mou Or At -Gra Systems O nly Depth Over Uepth Over x>: DF:pth of xx Seeded /Sodded xx Mulched Bed,/Trench Center Bed.!Trench Edges Topsoil yYes N Yes No CO MENTS e d code di rep ci person present, etc.) Inspection #1:_fAt S/ v""fv Inspection #2:_, -- . Location. 1549 95th StreP Unkn I�(-�NW,�, 1/4 SE 1/4 18 T30N R1 8W) The Glans of Willow River Lot 14 Parcel No: 18.30.18.275 1.) Alt BM Description = s' Y�`�r►W°"`- cq-� t 2.) Bldg sewer lengtn - amount of cover = -{ �SK� coxQr 3) d . WA;t uw4v\,.. a-*- ; &A,4 Plan revision Required'? Yes ><No ( 1 0 ) 5 7 24S0 Use other side for additional information. ��' r / Date ncep;;;cr's ignatzre Cen_ No. SBD -6710 (8.3/97) Safety and Buildings Division County N 201 W. Washington Ave., P.O. Box 7162 �, C iseons i n Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 t Z / 7 Department of Commerce Stat an I Number Sanitary Permit Application �, In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy w, s Project Address (if different than mailing ad re s� ! 1. Application Information Please Print All nfor o Property Owner's Name JL Parcel q Lot # lock q C 9 AE Property Owner's Mailing Address Property Location G r= WW - /., _TA6F %., Section City, State Zip Code Phone Number �` ✓ � Z „� ircle o L S SS ✓ S T N; RAE o I. Type of Building (check Al that apply) bk 4,3 � 5vbrtA Su bdivision Name CSM N r ® I or 2 Family Dwelling - Number of Bedrooms 3 /2 J SF Pl CO.-- 0 Public/Commercial - Describe Use 640k4o0% J tid'�.: [` Z L, ' ❑State Owned - DescribeUse Z p�f,�' Ce1l� t,• g 1 - 1 Gt,w ❑Ctty_ ❑Village ®Township of R %L/ll7On/ 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 2 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System ❑ Chan List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑Permit Revision Change of ❑Permit Transfer to New Before Expiration Plumber Owner t nn IV. Type of POWTS System: Check all that appl i N — Pressurize In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber FPIastic Gallons Gallons of Units Concrete Constructed Glass New Existing - Tanks Tanks Septic or Holding Tank / ib 1060 1,000 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P s Signature M PRS umber Business Phone Number Plumber's Address (Street, City, State, Zip Code) e Vill. County/Department Use Onl rbApproved ❑ tsapprov \ - Sanitary Permit Fee includes Groundwater Date Issu d Issuii AAat C eoMerD Surcharge Fee) M �D Z� ��p O iven R enial t � v IX. Conditions of Approval /Reasons for Disapproval /� SYSTEM OWNER: 3) (ON q i ,nc D 1. Septic tank, effluent fitter and dispersal cell must all be servitses / maintained 0_1� as per management plan provided by plumber. 2. All setback requirements must be maintained , ` \ /� •, /� D as per applicable code / ordinances. 'T J I�Jt (�1u e11e✓�o�.�- ° Attach complete plans (to the County only) for the system on paper not less than 81/2 x I I inches in size > SBD -6398 (R. 01/03) f"f ✓G UF rt 11✓S )oeC71o1l' 1 01 1 ges o �2 3' 3, sly L or s ysTe.A-1 Et 89. a Atr 811 a� �. PRb�vc.D G/F /00 c S `'` Fi�rek 3 Jeo �¢ / � � l </\ '� pp s / e i J C v 9y q� / S /EJYNA C 0/?P q? Yo !1/ Klly -- D12, 5'611 t 6CL6 S�'C (lAGLE y U /��v 7X- !YIBLS /VIN, -57 6 5" 30M &kst -7 j ; I . 9 61'7 ro l i�Ar -3' _ -31 - — - - -- �+ g Pa ' �t ; Q t 8 _ 3 JEO T bcis �- _ Y p 40 -- - -- Ni / g T _ W i � 5)EANA Cokp, y9jYo', U! KING Dj2,_ sulrt 6o8 S& u,4ct & y illew 7 _ I -- __ _ _ ___ - - -- - -- __ - -- __ _ _ __ - _ _ _- 4' NVIsconsin SOIL EVALUATION REPOR - -� . A #1479 Department of Commerce in accordance with Comm 85, Wis. Adm. Codes.. — Page 1 of 4 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D 14 ' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev By Date Personal information you provide may be u for s. 15.04 (1) (m)). Property Owner roperty Location Sienna Corporation I nr lovt. Lot NW1 /4, E1/4, S18, T30N, R18W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 4940 Viking Drive Suite 608 14 The Glens Of Willow River City State ip Code Phone u City [f Village ❑ Town Nearest Road Minneapolis MN 5R3 5 Richmond I 95Th St. ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe 450 Parent material Outwash Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable for a conventional system with a 0.5 gpd/ sgft rating. Possible system elevation for Area 1 is 89.0'. FTI Boring # ❑ Boring Pit Ground surface elev. 92.11 ft. Depth to limiting factor 96+ 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 0-20 10yr3 /1 none I 2fsbk mf gw 2m,lf .6 .8 2 20 -39 10yr3 /4 none sil 2msbk mfr gw 1vf .6 .8 3 39-45 10yr4/4 none sl 2msbk mfr gw -- .6 1.0 4 45 -96 10yr5/6 none Is lcsbk mfr - --- - - - - -- .2 .6 45 -96" has 6" bands of 10yr3 /4 sl Om rate of .2_6 F Boring # Boring Pit Ground surface elev. 96.81 ft. Depth to limiting factor 109+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10yr3 /2 none sl 2fsbk mfr as 1m,lvf .6 1.0 2 10 -22 10y4/3 none scl 3fsbk mfr gw 1vf .4 .6 3 22 -34 10yr4 /4 none sl 2msbk mfr gw 1vf .6 1.0 4 34-48 10yr6 /4 none fs Osg ml as - -- .4 .6 5 48-109 10yr6 /4 none fs Osg ml - --- - - -- .5 1.0 34-48" has 1 1/2" bands of 7.5yr5/4 Ifs Om will restrict vertical movement, rate of .4, .6 " Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD a 30 mg /L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/13/2006 715- 247 -2941 SBD -8330 (807/00) Property Owner Sienna Corporation Parcel ID # 14 Page 2 of 4 ' I J I Boring # � Boring aaa --- --- " Z Pit Ground surface elev. 96.96 ft. Depth to limiting factor 110+ 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. *Ef1#1 *Eff#2 1 0 -10 10yr3/2 none I 2fsbk mfr as 2m,2f .6 .8 2 10 -26 10y4/4 none scl 3fsbk mfr gw ivf .4 .6 3 26-34 10yr4 /6 none sl 2msbk mfr gw 1vf .6 1.0 4 34 -57 10yr5/6 none fs Osg ml as ---- -- .4 .6 5 57 -110 10yr6 /4 none fs Osg ml - -- - - - -- .5 1.0 34-57" has 2 1/2" bands of 7.5yr5/4 Ifs Om will restrict vertical movement, rate of .4, .6 F41 Boring # Boring Z Pit Ground surface elev. 101.06 ft. Depth to limiting factor 110+ 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 0-9 10yr3/4 none sl 2fsbk mfr as 2m,2f .6 1.0 2 9 -20 10y4/6 none grsl 2msbk mfr gw 2vf .6 1.0 3 20 -56 10yr6/4 none fs icsbk mvfr as - - ---- .4 .6 4 56 -96 10yr6 /4 none fs Osg ml as ----- .5 1.0 5 96-110 10yr5 /6 none grs OSg ml - - -- -- .7 1.6 20-56" has 1" bands of 7.5yr5/4 Ifs Om will restrict vertical movement, rate of .4, .6 T Boring # Boring ® Pit Ground surface elev. 92.61 ft. Depth to limiting factor 124+ 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 /1 none sl 2mgr mfr as 2vf .6 1.0 2 10 -16 10y3/4 none sl 2fsbk mfr gw 1vf .6 1.0 3 16 -25 10yr4 /4 none scl 2msbk mfr gw ivf .4 .6 4 25-32 10yr4 /6 none sl 2msbk mfr Cs - - -- .6 1.0 5 32-65 10yr6/4 none s Osg ml as - - -- .7 1.6 6 65 -71 7.5yr4/6 none cbls Osg ml Cs - -- .7 1.6 7 71 -124 10yr6/4 none s Osg ml - - -- - - - -- 7 1.6 /-/,?, 32 _ � 7 33 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <_150 mg/L * Effluent #2 = BOD < 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 (R07/00) SdWn rd Soil Testing, im. Properly Owner Sienna Corporation Parcel ID # 14 Page 3 of 4 Boring # ❑ Boring N Pit Ground surface elev. 94.58 ft. Depth to limiting factor 130+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Etf#2 1 0 -10 10yr3 /1 none sl 2fsbk mfr as 2vf .6 1.0 2 10 -18 10y3/4 none sil 2msbk mfr gw ivf .6 .8 3 18-24 10yr4 /4 none sid 3msbk mfr gw - - -- .4 .6 4 24 -28 10yr4/6 none sl 2msbk mfr cs - - - - -- .6 1.0 5 28 -37 10yr5 /6 none Is Osg ml gw - - -- .7 1.6 6 37 -130 10yr6 /4 none s Osg ml - - -- -- .7 1.6 M Boring # ❑ Boring ® Pit Ground surface elev. 92.41 ft. Depth to limiting factor 120+ 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. *Ef1#1 *Eff#2 1 0 -10 10yr3 /1 none sl 2fsbk mfr as lvf .6 1.0 1 4 09" 2 10 -23 10y3/4 none sid 2fsbk mfr gw ivf .4 .6 3 23 -29 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0 4 29 -35 10yr5 /6 none Is lcsbk mfr gw - - - - -- .7 1.6 5 35 -64 10yr6 /4 none cbs Osg ml a - - - - -- .7 1.6 6 64 -80 7.5yr5/6 none cbfs Osg ml cs - - - -- .5 1.0 7 80 -120 10yr6 /4 none s Osg ml - -- - - - -- 7 1.6 �U,9) — g9 F-1 El Boring 71 Boring # El 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfW * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD < 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 (8.07100) SchnM SOY TOOM Inc. Page 7 of Conde cted by: Conducted For: Schmitt Soil Testing Inc. Name: Sienna Corporation Thomas J. Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608 1595 72nd St. City, State, Zip: Minneapolis, MN 55435 New Richmond, Wl. 54017 Phone: 715-247-2941 Subd.Name• The Glens of Willow River signature �7 Lot No.: Date: / _/ Legal Description: IVY 1/4 SE1 /4 S18 T30N R18W ® Backhoe pit Township, County: Richmond, St. Croix Mark El. 100.00' To of 2" vc i _ ® Bench p e p pipe A L Alternate Bench Mark El. q 3 . ? 6 Top of / + � 514 --y Slope = Contour Line El. A14 Contour Line Length /V u ,f-k P- .�, c,r✓e S ; l Scale 1" = 40'� �� a� 2' 41 yl 14r / 3q� V, 07 yl VP ,fat 13 dti i This Soil a d Site Evaluation was completed to fulfill a zoning requirement. It may or may not be in 9for NVIscons SOIL EVALUATION REPORT -- #1479 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% 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, location and distance to nearest road. Parcel I.D. /14 Please print all info atioRECEIVE Rev' By Dat Personal information you provide may be used for ry purposes (Privacy Law 15.04 1) (m)). /a ,� !7 Property Owner perty I 11cation Sienna Corporation . EP 2 6 2 9. Lot W1/4, E1/4, S18, T30N, R18W Property Owner's Mailing Address ST. CROIX CO (j # Block # Subd. Narnef or CSM# 4940 Viking Drive Suite 608 Y 14 The Glens Of Willow River City State Zip Code Phone Num r ❑ Village E Town Nearest Road Minneapolis MN 55435 1 Richmond I 95Th St. ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe 450 Parent material Outwash Flood plain elevation, if applicable na fl. General comments 6k- and recommendations: Area is suitable for a conventional system with a 0.5 9W sqft rating. Install system 5.75' below grade. F-11 Boring # [] Boring ® Pit Ground surface elev. 92.11 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *EfF#2 1 0 -20 10yr3 /1 none I 2fsbk mf gw 2m,lf .6 .8 2 20 -39 10yr3 /4 none sil 2msbk mfr gw 1vf .6 .8 3 39-45 10yr4 /4 none sl 2msbk mfr gw - - - -- .6 1.0 4 45 -96 10yr5/6 none Is lcsbk mfr - -- - ----- .2 .6 'k 1` 45 -96" has 6" bands of 10yr3 sl Om rate of .2, .6 Boring # Boring ❑ Pit Ground surface elev. 96.81 ft. Depth to limiting factor 109+ 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 sl 2fsbk mfr as lm,lvf .6 1.0 2 10 -22 10y4/3 none sd 3fsbk mfr gw 1vf .4 .6 3 22 -34 10yr4 /4 none sl 2msbk mfr gw 1vf .6 1.0 4 34-48 10yr6/4 none fs Osg ml as - -- .4 .6 5 48 -109 10yr6 /4 none ft Osg ml --- ---- .5 1.0 34-48" has 1 1/2" bands of 7.5yr5/4 Ifs Om will restrict vertical movement, rate of .4, .6 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD s30 mg /L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt �� 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/13/2006 715 247 - 2941 SBD -8330 (8.07/00) Property Owner Sienna Corporation Parcel ID # 14 Page 2 of 3 Fil Boring # [I Boring ® Pit Ground surface elev. 96.96 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none I 2fsbk mfr as 2m,2f .6 .8 2 10-26 10y4/4 none sd 3fsbk mfr gw 1vf .4 .6 3 26 -34 10yr4/6 none sl 2msbk mfr gw lvf .6 1.0 4 34 -57 10yr5 /6 none fs Osg ml as - - -- .4 .6 5 57 -110 10yr6 /4 none fs Osg ml -- -- .5 1.0 34 -57" has 2 1/2" bands of 7jyr5 /4 Ifs Om will restrict vertical movement, rate of .4, .6 -T- F�] Boring # El Boring j u Pit Ground surface elev. 101.06 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3 /4 none sl 2fsbk mfr as 2m,2f .6 1.0 2 9 -20 10y4/6 none grsl 2msbk mfr gw 2vf .6 1.0 3 20 -56 10yr6 /4 none fs 1csbk mvfr as - - -- .4 .6 4 56 -96 10yr6/4 none fs Osg ml as - -- .5 1.0 5 96 -110 10yr5 /6 none grs Osg ml - - -- - - - - -- .7 1.6 20 -56" has 1" bands of 7.5yr5/4 Ifs Om will restrict vertical movement, rate of .4, .6 n* l:�6 T F-1 Boring # Boring 0 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ` Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L " Effluent #2 = BOD < 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) SchnW SoN Tesum, Im. Page 3 of .7 r Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Sienna Corporation Thomas J. Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608 1595 72nd St. City, State, Zip: Minneapolis, MN 55435 New Richmond, Wl. 54017 Phone: 715 - 2 -2941 Subd.Name: The Glens of Willow River Signature: \r,� e+�� Lot No.: �y G Date: / i /y i Q 6 Legal Description: / 1/4 SE1 /4 S18 T30N R18W ® Backhoe pit Township, County: Richmond, St. Croix ® Bench Mark El. 100.00' Top of 2" pvc pipe DAlternate Bench Mark El. l q3. 95 Top of / 51eP Caf, ev 'APL Ovlt /—'/ ""e, Slope = Contour Line El. 111A Contour Line Length N. Scale 1" = 40' d, r' 4 Qr -v,.,J y L;Nr � 95 +k r 9 'e ' /3 ` 8q l / pig 6j q6 C r t This Soil and Site Evaluation was compldt ` to fulfill a zoning requirement. it may or may not be in a location suitable fo you use. cu ci CC C x U S op / O C C OU CA CD ` i Q `> O N r o x•• .. z Vm ; W IV eq w o C) OOD OD to 1-1v C4 0% (n aloft mor la W (i o f OO J�1 • x LO , x CD w 6 o n ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L N/YA r-19 Mailing Address �9 �_, d Llf 1, / S�.! /TE xo Property Address t h p (Verification required from Planning Department for new construction) City/State 11 600 -1 HMo/v Imo Parcel Identification Number 0.2('0 -/d S - -coo 'v LEGAL DESCRIPTION J'L Property Location SW— %,, sc '/4, Sec. T,3,Q_N -R _16 W, Town of �i'chY/ 'a vZ0 Subdivision L& C = L Ems of GU // t�� /�i' _ . Lot # . . Certified Survey Map # , Volume , Page # Warranty Deed # ?3 5;0 if y . Volume , Page # - Spec house ffyes ❑ no Lot lines identifiable Eyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. i The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrplumber, joumeymanplumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. a Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards y set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da f the three year expiration date. lD /l7 /O!o TI, RE OF PLICANT JAMES �usGH, ,QC��/T D Aft SI EN /V,4 C-o RPo RAT/ , /J OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the DroPerty described abo by virtue of a warranty deed recorded in Register of Deeds Office. //7/6 . 0 Dt "I'B * * * * ** Any information that is mis- represented max result in the sanitary permit being revoked by thcpZoning Department. * * * * ** *• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r . t E POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner e C Septic Tank Capacity app al ❑ NA Permit # Septic Tank Manufacturer l�ee,�.5 11 NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units MYNA Pump Tank Capacity al 13�NA Estimated flow (average) � b al /day Pump Tank Manufacturer ,A Design flow (peak), (Estimated x 1.5) ��jb gal /day Pump Manufacturer ;'NA Soil Application Rate . 5 gal/day/ft' Pump Model -A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit AAA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 8�� e., ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Ac., 3 Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: Other: 11 NA ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever onth(s) y' ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ?� ❑ onth(s) (Maximum 3 ears) ❑ NA ar(s) y Clean effluent filter At least once every: months) ❑ NA ❑ year(s) Inspect um p ❑ month(s) p pump, pump controls &alarm At least once every: ❑ year(s) N' Flush laterals and pressure test At least once every: ❑ month(s) gN'A ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 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 regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals (if 'S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant repl;7 nt system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER E me S�, ;{� Name ne 7 16 _ st�5 _ 6 s Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 4 o � Phone Phone _ ( — (o This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411►, (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS . Owner ,� c� CoC Septic Tank Capacity 600 ga l ❑ NA Permit # Septic Tank Manufacturer Oeek.5 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer $F10 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units RNA Pump Tank Capacity gal 1!KNq Estimated flow (average) b al /day Pump Tank ManufacturerA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ;E"q Soil Application Rate . al /day /ft2 Pump Modelq Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ;*"A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) �� uSP� ❑ NA Biochemical Oxygen Demand (BOD _ <30 mg /L Ground (gravity) ❑ In- Ground (pressurized)) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Ac' ( to Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ onth(s) (Maximum 3 years) ❑ NA jKy ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑ onth(s) (Maximum 3 years) ❑ NA ar(s) Clean effluent filter At least once every: month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) r ,/, A ❑ year(s) �� Flush laterals and pressure test At least once every: ❑ month(s) <NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 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 regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) 83508 KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 1 -2003 ST. CROIX CO.. WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 09/21/2006 03:15PH WARRANTY DEED EXEMPT # THIS DEED, made between Basels' Dairy Farm, Inc. a/k/a Basel Dairy Farms, Inc. a/k/a Basel's Dairy Farm, Inc., a/k/a Basel Dairy Farm, Inc., a Wisconsin REC FEE: 13.00 Corporation ( "Grantor," whether one or more), TRANS FEE: 5700.00 COPY FEE: and Sienna Corporation, a Minnesota Corporation CC FEE: PAGES: 2 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): Sienna Corporation See attached Addendum. `f G H 0 V l K k'115 h I'r 0 e Sa t, --c ( 2 L ! fY1d1 SSY3S` See attached Addendum. Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, highways, utility rights, reservations and restrictions of record. Dated — ! 4 ; — Bas s' Dairy Farm, Inc. P AUSEAL (SEAL) By: Gloria Basel, President (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gloria Basel STATE OF WISCONSIN ) authenticated on ) ss. ST. CROIX COUNTY ) * — Thomas R. Schumacher Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Gloria Basel (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Thomas R. Schumacher Notary Public, State of Wisconsin Bakke Norman, S.C. - Baldwin, WI 54002 My Commission (is permanent) (expires: ) (Signatures may be authenticated or admowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. • File No.: 10052 EXHIBIT A PARCEL A: The SE 1 /4 of Section 18, Township 30 North, Range 18 West EXCEPT the following described parcels: Commencing at a point 650 feet South of the Northeast corner of the SE 1/ of the SE 1 /4 of said Section 18; thence West 266 feet; thence South at right angles to the Easterly Bank of the Willow River; thence Southeasterly along said Easterly Bank of the Willow River to the point where said Easterly Bank of the Willow River intersects the South line of the SE 1 /4 of the SE 1 /4 of said Section 18; thence East along the South line of said SE 1/ of SE 1 /4, to the Southeast corner of said SE 1 /4 of SE 1 /4; thence North on the East line of said SE 1 /4 of SE 1 /4 to the Point of Beginning; AND EXCEPT all that part of the S 1 /2 of the SE 1 /4 lying South of the Willow River. AND ALSO EXCEPT Lot 1 of Certified Survey Map in Vol. 4 of Certified Survey Maps, Page 1111, Doc. No. 373623, filed on September 29, 1981 All in St. Croix County, Wisconsin. PARCEL B: That portion of the NW 1 /4 of the NE 1 /4 lying West of the Willow River, Section 19, Township 30 North, Range 18 West, EXCEPT the following described parcels: That portion of Lot 1 of Certified Survey Map recorded in Vol. 4 of Certified Survey Maps, Page 986, Doc. No. 366472 filed on September 22, 1980, being a part of said NW 1 /4 of NE 1 /4 Section 19, Township 30 North, Range 18 West; AND EXCEPT all that part of the NW 1 /4 of the NE 1 /4 lying directly South of the above described Certified Survey Map. All in St. Croix County, Wisconsin Tax ID #: 026 - 1053 - 50-000 2of2