HomeMy WebLinkAbout026-1306-00-056 r
PAIVP
commerce.vvi•gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
s e o n s n Madison, W I 5 3 70 7 -7 1 62 Sanitary Pe t Number (to be filled in by Co.)
1 of Conumrce 5 ' � n `
State Transaction Number
Sanitary Permit Application
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are roject Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you 997 /S Y TN !Ut /E_
p urposes in accordance with the Privacy Law, s. 15.04(1 m Slats.
1. Application Information - Please Print A rmati s3e,9
Property Owner's Name ' Parcel #
Mary 19 Zola
Property Owner's Mailing Address ST. CROIX COUNTY Property Location /
a PLANNING & ZONING OFFICE Govt. Lot
City, State Zip Code Phone Numbe, _ y. y., Section
_ circle one
T -70 N; R E oUWW
If. Type of Building (ch k all that a Lot
t or 2 Famity Dwelling- Number-of drooms Suhdrvrston Name
C3 41!!, Public/Commercial - Describe Use GEC ❑ City of
❑State Owned - Describe Use
CSM Number ❑ Village of
1K Town of ZZ�a.,AlJ
Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ® New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain)
B. C1 Permit Renewal ❑Permit Revision 11 Change Previous Permit Number and Date Issued Change of Plumber ❑Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Comp onent/Device: Check all that apply)
® Non - Pressurized !n- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rat pdsf) Dispersal Area Required (sf)j Dispersal Area Proposed (s System Elevation A r
.S" O
Vt. Tank Info Capacity in Total # of Manufacturer y
Gallons Gallons Units � U •_
New Tanks Existing Tanks a 2
a U in �, rn w C7 a
Septic or Holding Tank _
00
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number
Plumber' Address (Street, City, State, Zip Code)
V1II. County/Department Use Onl
�k<pproved ov Permit Fee Dat o
Issuin gent Sign e
caner rven Reason o al $ " / 7 5. a '' /
IX. Conditions of Approval/Reasons for Disapproval / / - t /_
SYSTEM OWNER: 31)& / e11e�0/ 0 Ifi IIIJ s*teo
1. Septic tank, effluent fitter and t
dispersal cell must all be servk:es / malntained H J,'� -�, 4-�,; ✓ � e wtael �' f
as per management plan provided by plumber.
2. AM setback requirements must be maintained
the system and submit to the County only on paper not less than g 1l2 x 11 inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
_ ................
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NVVr1h SOIL EVALUATION REPORT — _ #1540
1 Department of Commerce in accordance with Comm 85, Wis. Adm. Code " ° p 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, and location and distance to nearest road. Parcel I.D.
56
Please print all information. Revie# By Date
Personal information you provide may be used for seconds , s. 15.04 (1) (m)).
foKoa�
Properly Owner roperty Location
Sienna Corporation vt. Lot NE1 /4, 1/4, S18, T30N, R18W
Property Owner's Mailing Address S EP 2 6 2006 L t # Block # Subd. Name or CSM#
4940 Viking Drive Suite 608 1 56 The Glens Of Willow River
City State Zi Code " I�9YTY City ❑ Village ❑ Town Nearest Road
Minneapolis MN 5 35 Richmond 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 ft.
General comments
and recommendations: Area is suitable for a conventional system with a_0.7 pd/ sgft rating. Possible system elevation for Are
1 is (step trenches) high trench 96.0', low trench'9 �� f- le4w
F-1-1 Boring # ❑ Boring /j
® Pit Ground surface elev. 96.70 ft. Depth to limiting factor 96+ in. Soil Application Rate 7
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efl#2
1 0 -8 10yr3 /3 none grsl 2fsbk mfr as 2m,2f .6 1.0
2 8 -96 10yr6 /4 none cos Osg ml ---- .7 1.6
I
9 Jl
2] Boring # ❑ Boring
® Pit Ground surface elev. 96.7 ft. Depth to limiting factor 100+ 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 0-7 10yr3 /3 none sl 2fsbk mfr as 2vf .6 1.0
2 7 -14 10yr4 /4 none sl 2msbk mfr cs if .6 1.0
3 14 -34 10yr4 /6 crone grls icsbk mvfr Cs - - -- .7 1.6
4 3476 10yr5 /6 none vgrs Osg ml as --- -- .7 1.6
5 76 -100 10yr6 /4 none s Osg ml -- - - - -- .7 1.6
1
Z
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD mg /L and TSS <_30 mg/L
CST Name (Please Print) Signature: ..y /7 /� CST Number
Thomas J. Schmitt -�� `''" ` `' * ,/l � 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond, WI 54017 9121/2006 715- 247 -2941
SBD -8330 (R.07/00)
Property Owner Sienna Corporation Parcel ID # 56 Page 2 of 3
[ 3 ] Boring # ❑ Boring
® Pit Ground surface elev. 99.86 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 -8 10yr3 /1 none sl 2fsbk mfr as 2m,2f .6 1.0
2 8 -26 10yr4/3 none sil 2msbk mfr a 2vf .6 .8
3 26 -34 10yr5 /6 none grin Osg ml gw ivf .7 1.6
4 34-96 10yr6/4 none grcos Osg ml - - -- - --- -- .7 1.6
Z l l
�.3 i
F-1 Boring # F-1 Boring Uv
❑ 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/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef#2
F-1 Boring # F Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eft#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 (8.07)00) SdMrMrX $08 Taring I
Page -3 of ..�
Conducted by: Conducted For:
Schmitt Soil Testing Inc. Name: Sienna Corporation
Thomas I Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608
1.595 72nd St. City, State, Zip: Minneapolis, MN 55435
New Richmond, WI. 54017
Phone: 715 - 2 -2941 Subd.Name: The Glens of Willow River
Signature: _ ®� /L��� ^-'� Lot No.: S7
Date: / ..?/ i Q i � Legal Description: /YE 1/4 SETA S18 T30N R18W
Backhoe pit Township, County: Richmond, St. Croix
A Bench Mark El. 100.00' Top of 2" pvc pipe
A Alternate Bench Mark El. 8901 ` Top of / " 14. / X
Slope = J'X Contour Line El. Contour Line Length *W
Scale 1" = 40'
U
y1 �
p�
C�
P h 76
This Soil and Site EMation was completed to fulfill a zoning requirement. it may or may not be in a location suitable for you use.
' a
PREP
CWOIATaNR' cQVI4TY PLAT OF: THE GLENS OF WILLOW RIVER
MW VYWO oIAK
MINA IIX 65135
SURVEYORT #8.38475 LOCATED IN THE NEt /4 OF 741E SEI /4, THE NWI /4 OF THE
A � REGISTITL•S OFFICE SEI /4, PART OF THE SNl /4 OF THE SEI /4, PART OF THE
s • N LAID RRSETSIO, na ST. CROIX CO. SE1 /4 OF THE SEI /4 OF SECTION 18, AND PART OF THE Kill IB Ngsm, w 6 TREE7 e ",,� jR • u
1� � p.iu OF THE NEI /4 OF SECTION 19, ALL IN T30N, R18W, TORN OF
�.amY RICHMOND, ST. CROIX COUNTY, WISCONSIN.
I UNPLA�®
r -,EST M4 rouE R POOR [Am 1 a VOL Q P'G 2919
IS, gcnaN 16 N8O'0 T28•E 2611,TC DONdtIOx SErnON IA
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LOT 7 11 `` 4\ Rao errtlrsTV I.B I I
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I.e ACRES L OTC au ei Ill 1.Z0 421 I r LOT R DdN U.aNwr- - I I�
\ ` 73.2M SQ R. 73.04 S0. rt. 64216 B0. R. 7i IAN ACRfS tEC G.Sf LNT
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LOT 8 1 SNt ,�,BO s / _ _ _ . _ _ x - 24 Sa4w• _ _ uele yy
LOT 56
1.747 ACRES
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»9 ACRES LOT 54 ,8 1.522 AMU 1 L '----
1.550 `0. 1 1 � 1\ 7"us S r. astso -SSSA 67.M Sm FT. >r eeleao�saxis.e
j 1 LOT 47 .LOT 51 weAwYaE GmR.'A•r I ( ' is
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LOT 49
1
I.101 ACRES
wleo-ax0 1� 1 I 1� 444 F N ` , /'� / , 1 LOT 59
o5l 34,
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/ .�. LBo-Sol u' sT A RS S`l _11'
_awl >1.sA•
LOT 86 / �« 1 B Bw.o u, cweA r Ra �S
r, y \ / vT 1'' • r AREA ro THREAD or AILq \ •a•Amc!• A2B I
LSS AEA . L db� Oj avER.vws I I q
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LOT 6
\ \ .\ / 31 A I I uo-au.o yet AREA ro MREAO / / $ ' 1 A 4V ' •SP: -P'� LID
LOT 42 \ 1 \ / I !' OF RER
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LOT 68
AREA TMRM
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/ ,4 e ACRES p n.2
LOT 41 w. /S c! /�\ �M N > ;l1 = wao :. / I KE
lY �yA/ gG•/ GSELLNT -
"I LOT 69
Q l�f 7( N SEF fASESNNr I IP
^ h j �It• /: �,{� - GSF!(XE �?.4( / N rABIE Y• rM I 8 y
�.�1PP y J MEA TO TNEAD ] i
M Is i I i $
e 0.0
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F ��``. 4, LOT TO IIR
�$$p. `` ,�` • 'lrA/ N . \ tJEA lD
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AAxx BDlax YATR D ts'``.4°.� q„ !y�`,� \ Lu ACRES I•
LEGEND NWE.vfi6.0 MAIN BALER EUFVATON ` � • "'• '4' jr Igp.pN,O i �( 1
SHAD Awra6uu muNn LoNl:sr Bu1DNO aPDexa -THE
SE.- -HER .-T 180 -219.0
LOKET StNDOB CR 000T EYYATON. °
FgINMD 3�a•
m gM1ElER MQ! IFBM YE oRuEHz OEIEANIID 0 (a) OB2ERVATON ` `` 4 I A`
RMIEtER PW AYE
AS IIE/EA[!1 ®ro NAV.o (ee) ` ?A 1411 N06•E2 -1
• fOIMID 2 R11ipE `� N OD:. °A
IEN,00t uN[ ,l ., `►� 118.02' f 12.82• 1
• AY p ETER S wE "Mill EMINENT - EN SCRS TIE SEE NOTES A - Q
P N L"No OSTROM Nis YNE MO ME
® FDIRO eao NAL _- -. - . - _ IElAB MHOR. SEE DoNamv�I, py _EMCwD1r SHEET 3 FOR LAND � N
RECORDED AS DOLYYM 6 r.rr Eel
:rt 1 - i r R AL4'1N1 ar I6• REB USE REQUIREMENTS.
LOR 1 P IIMFAR FOOT will d10NIJ1Y RON WAVER YMN AS
DEIFRYMED BY S f N LAND SRKTN0. $ s P I §
BET 1' wmm GAYCIER 6Y TE RPANIM W V SN RS RYB011 ARE RIe.ECT ro A 1 Nom SIRIICTARS a LOri 61
O AS A R
Y
S
13] V PR YNEAR FORT_ 16-FOOT 6UEDINO griACN Row TIE oIIDRMY wax . - RE SlAB'CDT m YULnP1E u.0. (LORE6T eu1DN0 \I kr I
YMN T SHE 11B1DM RIKL ON MOST LOri n6s YIBAIX )) T RE6116CTON5 oV01aRC uPaN T F WIS
YES WHIN TOE CMSMVA71M AREA AND Ill NOT ARECT PIARY01 W THE ST ULNA E M EACH LOT. M ,` \ sauari
ul EA5 g �O•, -. CO & N
_.. _.. -.. _ 0101T UNE TE LOCATION K MY BIRDN0. O
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MR,EIR D] 011 IDLE 3L 34 ] N. M. It MD e0. AN
OF gINNAOE PATT0IME AND A 15l A D y y,NLFR
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AND FLEW 1DCA OF TE !e -fODT BUSDNO ffilBY1t OF {LOOP NATM fY BE AM Nil I I I U
76' 0.N.EY. SEIBAtlf SIWID SE CONDUCTED BY M ST. Ml COUNTY 241400 ......... tOd ROADIMY SEIBMa[ IA1E C 011 111E DEPT. O HAMM MORRS BEFORE 61RtD01 BALL BE RES 0CNSN
E m DETERNNNo I
BU4gN0 m M LOT. QII E/R` • CNRE EIEVAl10N AND APPROPNAE S 3 R iO
(DRES4 cHaRam 910YR1)
-� PROPOED oRKNAr
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LOT 2 SJCN EA s £MENT -- E ct
t C
1.634 ACRES S££ EASEMENT
71,191 SQ. FT. TABLE "S" FOR t?
DIMENSIONS
S89'35'40 W
98. 83 t o
,. -�2• N89'35'4Q'E
OIL
ML 7F
C3 ,/ - ' Slam EASEMENT - v i i Ulf
ell SEE EASEMENT 1
TABLE S FOR I Z
DIMENSIONS
im
LOT 55 t
1.747 ACRES
x 76,111 SQ. FT. t
LBO-943.5 ( 33' 33'
54 ' L 55
ACRES en x 1.522 ACRES
w n 66,277 SQ. FT. / N
S0. FT. 00 LBO -943.5 � /
940.0 m, cl
a
g,
,,.. DRAINAGE EASEMENT ' ^? Fr I �
Nx3r— •— ° — SEE EASEMENT
TABLE "H" FOR
189.98" 776.12'
207.95" 3 i 127.59'
44&.47 30 TRAIL 938.5' �` ''
`18'48'E 916.86' -- - EASEMENT CA t c�
LA
-... fib
Z
to
LOT 51
1.933 ACAS �� ~•
84,209 SO. FT.
L80 941.0 't I ny Inn n
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of A
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner NA Tank Manufacturer: ❑
L,/��Sb2 f�
Permit # ® Septic ❑ Dose ❑ Holding Volume: (gill)
DESIGN PARAMETERS Tank Manaaidurer: ❑ NA
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: ❑ NA Vertical Distance Tank Bottoms) to Service Pad: (ft)
Estimated (average) Fkw : ? may) Horizontal Distance Tank(s) to Service Pad: (fU
Specific servicing mechanics must be provided I vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): (gauday) I horizontal is >150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: (pwaylne) Effluent Filter Manufacturer o00K-y,4 ❑ NA
Standard ( Domestic) InfluentlEffluent Monthly average Effluent Filter Model:
Fats, Oil & Grease (FOG) s30 moll. Pump Manufacturer:
Biochemical Oxygen Demand (BODs) a20 mg1L 10 NA ❑ NA
Totem SuspwKW Solids (TSS) x150 mgA. Pump Model:
High Strength Influent/Effluent Monthly average Pretresbtent Unit
>3p mpt
(BOD5) >220 mg1t. ❑ NA anical Aeration ❑ Post Filter ❑ NA
(TSS ) >150 not ❑ Dbwecion ❑ Wetland
Preheated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other:
(BODs) t3O mgA. Soil Absorption System
(TSS) SW awt ❑ NA
Fecal CoBtorm eometric mean s10` ® in-Ground (gray) ❑ M- Ground (Prmw) ❑ NA
Maximum Effluent Particle Size 16 in dia. p NA ❑ At - G rade ❑ Mound
O Drip -urns ❑ other
Other: ® NA Other. ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) ® When combined sludge and scum equals one -third (%) of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) At least once every: Wows) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
® y"Ks)
Clean effluent filter At least once every: O ) s) ❑ NA
4? AAFArng?j Al-2 Inspect pump, PUMP controls & alarm At least once every: ❑ Yews)
® NA
Flush laterals and pressure test At least once every. ❑ s) ® NA
Omer: At least once every: month(s) ® NA
❑ year(
Omer: ® NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications.
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scrim and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system shah 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 atrttiority.
When the combined accumulation of sludge and sherd in any treatment tank equals one -third (%) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shag be provided to the kxel regulatory authority within 30 days of completion of any service event.
GMW -005 (02105)
Page --2— of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatinent tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impedes the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an
overload that may result in the bac or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
or POYVTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when sod conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the
area within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the pefamanoe and prolong the life of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides,
meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safe) Y compliance abandoned in corn lance with s. Comm 83.33, Wisconsin sin
Administrative Code:
• Ali piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• of b a Service tor .
The contents of al tondos and pits shall be removed and ProPeriY disposed Y �p>� n9 (pumper)
• 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
If the POWTS fails and cannot be repaired the following measures have been, or must be taken to Pr ovide a code compliant
replacement system:
® A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot Ones 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 to
effect at the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil. limitations. If the sod absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort
The i replacement �. failure of the POWTS a soil and site evaluation
❑ e s to has not been evaluated to i a suitable replaoem Upon i
must be performed to locate a suitable replacement area. If no replacement area is available a holding flank 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 biamat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
r it 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
NameZappa Brothers,Inc(Gary Zappa) Name Tri— County (Ben Morgan)
Phone (71 5) 386 - 2850 Phone (7 15) 386
SEPTAGE SERVICING OPERATOR LOCAL REGULATORY AUTHORITY
NameTri— County (Ben Morgan) Name St. CroixCounty Zoning Office
Phone ( 71 5) 386-2130 Phone (71 5) 386 -4680
This document was drafted by the staffs of the Green take, Marquette and Waushera County POWTS regulatory agencies in cornptiance with sections
Comm 83.22(2)(b)(1)(d)&M and 83-640),(2) & (3), Wain Administrative Code.
r
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of —
FILE INFORIMATM M SYSTEM SPEClflCATIONS
Owner .,� Tank Manufacturer: i rF& t- ,ivC/de'Tc D NA
Permit # ® Septic ❑ Dose ❑ Holding Volume: Wal)
DESRW P Tank Man►iaduner: ❑ NA
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose D Holding Volume: (gaq
Number of Public Facility Units: ❑ NA Vertical Distance Tank Bottom(s) to Service Pad: (fU
Estimated (average) Flow: (gaudery) Horizontal Distance Tank(s) to Service Pad: 00 5 feet or
Design (peak) Flow = (estimated x 1.5): (Oay) horizontal 50feet. Specific Instructions to rovided l
� on back.
In Situ Soil Application Rate. wmayfft Effluent Filter Manufacturer: /oars oK D NA
Standard (Domestic) IMuerWWuent Monthly average Effluent Fitter Model:
Fats, Oil & Grease (FOG) s30 mgrL Pump Manufacturer.
Biochemical Oxygen Demand (801%) 420 mgrL 10 NA ❑ NA
Torah Suspended songs (rsS) x150 rn91L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 awL Manufacturer
(BO� X 20 we& ❑ NA ❑ Mechanical Aeration [3 Peat Filter (3 NA
Preheated Effluent Monthly average p Weilan
Sand/Gravel Filter ❑ Other:
(BODs) S30 mgr- Soil Absorption System
(TSS) 930 ffaL O NA 10 "round (gravity) [3 in-Ground (pressure) [3 NA
Fecal Colifocm eometric mean 91(` ❑ At -Grade ❑ Mound
Maximum Effluent Particle Size 16 in dia. D NA ❑ Drip -Line ❑ other.
Other. IO NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) ® When combined sludge and scum equals one -bird (%) of tank volume
❑ When the high water alarm is activated
Inspect condition of tanks) At least once every: s) s) (Maximum 3 years) ❑ NA
Inspect dispersal Calks) At least once every: D months) (Maximum 3 years) ❑ NA
® yeAt(s)
Clean effluent filter At least once every: ® mont ❑ NA
�VwArOACIO 101-2 D Y Ws)
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
® NA
Flush laterals and pressure test At least once every: D ) s) ® NA
s
Other: month(
s) least t once every : IM NA
❑
year(s)
Other:
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shad be made by an individual carrying one of the following Icenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank i hardware ide an cracks or leaks,
tan s to ide an miss or broken ,
insp ections must induce a visual i of the k) try y ng fY Y
pectr nspecti
f sludge and scum and a check for an balk or effluent on the ground surface. The soil
measure the volume o combined udge y up por►olng of e
absorption system shad 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 fading condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one -third (%) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including tit not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 512 months, shall be perfomhed by a certified POWTS Maintainer.
A service report shad be provided to the local regulatory authority within 30 days of completion of any service event.
GWV -005 (02105)
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
��
Owner/Buyer , IU -"';IC
Mailin Address l C � ,�i .S � e &,'" '
g �
Property Address 9 6 ) h A Vt . Pie.At"/ W
(Verification required from Planning & Z 'ng Department for new construction.)
Cit y /State N tvJ 9 i41.Wl AyA.- W� Parcel Identification Number d 26 —/ 306 — 00 — 05
,
LEGAL DESCRIPTION
Property Location A ) 1 5 1 14, s t /a , Sec. , T - 38 ) MR—!&—W, Town of ?, i GA k+ -t on cL
Subdivision O4 Wi llow gJ' ✓c," ,Lot#
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house G) no Lot lines identifiable 7 Se no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal 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.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards 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 Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 3
C
SIGN RE OF APkICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
f
�� - . 1 111111 hill 1 111 IIIII IIII 11111 Ills Illlll 1111 1111
* 9 1 9 0 3
901590
DOCUMENT NO. SHERIFF'S DEED ON FORECLOSURE BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
WHEREAS, pursuant to a Judgment of Foreclosure rendered in the 08/06/2009 10:45AM
Circuit Court of St. Croix County, Wisconsin, on May 12, 2009, in an SHERIFFS DEED
action between: EXEMPT t 14
REC FEE: 15.00
FIRST NATIONAL COMMUNITY BANK f/k/a PAGES: 3
FIRST NATIONAL BANK OF NEW RICHMOND
Plaintiff,
VS. CASE NO.09CV107
CODE NO. 30404
SIENNA CORPORATION
BRUCE G. NIMMER REVOCABLE TRUST
VILLAGE BANK
S & N LAND SURVEYING, INC RECORDING INFORMATION '
..................... . ......................................................
.
Defendants. NAME AND RETURN ADDRESS
Bakke Norman, S.C.
P.O. Box 280
Menomonie, WI 54751
See attached
(Parcel Identification Numbers)
and, after due advertisement, the subject premise hereinafter described was sold on July 14, 2009,
to First National Community Bank, for the sum of $1,675,000.00.
And, WHEREAS, First National Community Bank is now entitled to a conveyance
according to law,
NOW, THEREFORE, the undersigned conveys to First National Community Bank, the
following tract of land in St. Croix County, Wisconsin:
Lots 1 through 13, inclusive; Lots 15 through 70, inclusive; and
Outlots 1 and 2, Plat of The Glens of Willow River, Town of
Richmond, St. Croix County, Wisconsin.
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