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HomeMy WebLinkAbout026-1175-06-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 506307 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Miller Homes of Hudson, LLC I Richmond, Town of 026- 1175 -06 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: vc� �J >� GSA 30.30.18.1406 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 190 Benchmark /Z50 /t .103 166 5Z Alt. BM ;444 lok� S 7& ®F81�� G Aeration Q BI g. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ �` AJ041 Septic Dt Bottom Z7 _ /� / 7 W , Dosing Header /Man. Aeration Dist. Pipe 1 Z 160 • S� Holding Bot. System i� t5 y 9.5 a f PUMP /SIPHON INFORMATION Final Grade 7• Z �OS •� Manufacturer Demand St Cover • ,5 // 7 , ac? Model Num TDH 11-ift Friction Loss System Head TDH -Ft Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ? , Z Ir���, '" `- SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manufactur INFORMATION CHAMBER OR 3.� r: Typ Of System: � UNIT te6A J O Zz YL w A . 1 fl - Model Numb r: e DISTRIBUTION SYSTEM Zs 4-a3 = q(. Header"M nfold ,I I D istribution x Hole Size x Hole Spacing Vent to Air I take � Pipe(s) \ � C 777 ` ._ `.._ 1• Length Dia Length Uia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center .0 • C Bed/Trench Edges Topsoil N Yes [] No Yes IJ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 924 131st Ave New Richmond,, WI 54017 (SW 1/4 SW 1/4 30 T30N R1 8W) Willow River East Lot 6 Parcel No: 30.30.18.1406 1.) Alt BM Description= ��` �--6 �-� '`�S �^ �- 5 ° `^•• 2.) Bldg sewer length = Z7 - amount of cover = u t i Plan revision Required? Use other side for additional information `___ Yes No D / �i� ❑ S 7 � Date Insepctorognature Cen. No. SBD -6710 (R.3/97) I Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 15 - �O r ® iseonln Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 O Sanitary Permit Application s Ian I.D. Number rmation In accord with Comm 83.21, Wis. Adm. Code, personal info you provide A , may be used for secondary purposes Privacy Law, s I5.04(1)(m) Project Address (if different than mailing address) (.3 i s`i" 4q �-- I. Application Information - Please Print All Infor ion t R,�r. dal Property Owner's Name 0 1 Block # - P roperty Owner's Mailing Address Irorty Locatio I ®. &X M CO NT /.S ' /., Section ity,State Zip Code /!/ hone /Number y x E / o ILJ r0 - Z �to Q "C� ! gg� (circa A o N; R V o II. Type of Building (check all that apply) Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms ❑Public/Commercial - DescribeUse q ! W�NCU) d vtS� I ❑State Owned — Describe Use � ,g E sue p . 7 • 1 ❑City_ ❑Village Township of (Z;rLwe-, III. Type of Permit: (Check only one box on line A. Complete line B if applicable) _ p A. New System ❑ Replacement System ❑ TreatmentfHolding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal El Permit Revision El Change of El Permit Transfer to New List Previous Permit L aiZ Number and Date Issued Before Expiration Plumber Owner 6 �YJ �' 5 - 6 (Q ^' IV. Type of POWTS System: Check all that apply) � �3rt i ❑ Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil. . ❑ A; Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter l _ ❑l Recirculating Synthetic Media Filter 5 ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) '� t no t�Tt�,V" V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application R te(gpds0 Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Tan4 1nfoCapacity in Total Number Manufacturer Pre b Site Steel Fiber Plastic llons Gallons of Units Concrete Constructed Glass Existing e Tanks e Septic or Aerobic T Dosing Ch 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 M1i 1fYl a a �1 � Z ZS� 7�f 7Go -"�� ZS Plumber's Address (Street, City, State, Zip Code) VIII. County /De artment Use Onl pproved ❑ Sanitary Permit Fee (includes Groundwater Date Issued / Issuing ent Signa re (N Stamps Surcharge Fee) co O Given R n for Denial + IX. Conditions of Approval/Reasons or Disapproval 1 Q� l �au` A o SYSTEM OWNER: 1. Septic tank, iffluent finer and w ,�.� ow,a„�. Ao-ft a � `1 dispersal cell must all be services l mak>takad as per management plan provided by pklmbar. 2. All setback requirements must be rttWritained ss per appNcable wde 1 orb. Attach complete plans (to the County only) for the system on paper not leas than 91/2 x 11 inches in size SBD -6398 (R. 01/03) was V's A - Z - 7 - R E F V C mR %6Qrg S 7 sT e7 f 9 c, S �3, sio cr 36' �d �o T 3 a .h I 2 " 3 �,�' SZ � T� E �v c'� E S • �ca.�CO' �rG,� S-�u,l \ o ° SW`'S/SrJjq Sec. 36, T n Al 00 i07. T",�� o / %u i c b V ssu lzCc cle% _ �oZ, rG � E1e�' _ /��. 36 �d 3 a st , Ate.- 2053 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 026- 1175 -06 -000 Please print all information. Revie d By Date Personal information you provide may be u 15.04 (1) (m)). L I Property Owner roperty Location Miller Homes Of Hudson, LLC I �ovt. Lot SW 1/4 S 1/4 S 30 T 30 N R 18 W Property Owner's Mailing Address N 2 of # Block # Subd. Name or CSM# P.O. Box 10 1 6 Willow Rover East City State 4ip CoWFM&U;4U TY I City J Village 16 Town Nearest Road Hudson WI Richmond 924131 St Ave. 01 New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement I Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.7 g pd loading rate. Recommended trench elev. = 99.50'. Boring # I Boring 01 Pit Ground Surface elev. 106.91 ft. Depth to limiting factor > 136" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -16 10yr4 /3 none Is Osg ml as 2fmc 0.7 1.6 2 16 -24 10yr3/2 none sil 2fsbk mfr cw 2f,1mc 0.6 0.8 3 24 -38 10yr5/4 none sil 2fsbk dsh cw lfm 0.6 0.8 4 38-48 7.5yr4/6 m2d 7.5yr5/8 sil 1msbk dsh aw 1fm 0.4 0.6 5 48 -76 10yr4/6 none Ifs & gr 0 sg dl aw - 0.5 1.0 6 76 -136 10yr5/6 none s & gr 0 sg dl - - 0.7 1.6 a LHR Comm. 85.30(3)(a)2 applied to discount redox. features reported in H#4. 17A, ft Boring # J Bori > 104" 16 Pit Ground Surface elev. 103.91 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Shdure Consistence Boundary Roots GPDIfl: in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3 /2 none sl 2msbk mfr as 2f,1mc 0.6 1.0 2 8 -50 10yr4/6 none co Is & gi Osg dl cw 1vf,f 0.7 1.6 3 50-104 10yr5/4 none s Osg dl - - 0.7 1.6 I r 2 con ins approx. 60% coarse fragments. * Effluent #1 = BOD? 30 < 220 mg /L and T S >30 < 150 g/L Eftfuant #2 = BOD <30 mg/L and TSS < 30 mg/L CST Name (Please Print) nature: CST Number James K. Thompson / ` 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11/17/2006 715 -248 -7767 Property Owner Miller Homes Of Hudson, LLC Parcel ID # 026 - 1175 -06 -000 Page 2 of 3 • ] Boring # Boring Pit Ground Surface elev. 105.26 ft. Depth to limiting factor >115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *EtT#2 1 0 -9 1Oyr3/2 none sl 2msbk mfr as 2f,1mc 0.6 1.0 2 9 -24 1 Oyr4 /6 none Is Osg dl ew 1 vf,f 0.7 1.6 3 24 -115 1Oyr514 none s Osg dl - - 0.7 1.6 1 G q- F-1 Boring # Boring P8 Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots OR in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 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. S1313.8330 (R.07 /00) A.C.E. SoN & Ste Evaluabons � 5a, /e ✓a /c�a����:� • Lo Ca cd P oo. S y Sec, 30. 7 r 1 r i 1 7 qo ! i 14-1 clot 1 t � t t � t � Q ` cgencl, 70 /E o/AV i'e6ar. Assc4mzd c /eu = �dD• r-0." Fled' _ /o� 3e� 'o 1 Alt- . '77537 OWNERS COUNTY PLAT DAMO.ARLARAIL58ACX WILLOW RIVER EAST ­­AVENUE NEW RICNMOND, WI 6401] sia�a ,o" LOCATED IN PART OF THE SWt/4 OF THE SWIM OF SECTION 30 AND IN PART OF THE NW114 OF THE NW1/4 OF SURVEYOR SECTION 31, ALL IN T30N, I I TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN. N aa ED`MN C. FVAUM O NORTF&AND SURVEYING, INC. $ s 058AR '65' \PO. 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E OCw4mE«R+sREw.rmuv+w+: Aro saLEwvoN / - rws RAr. mcLFOESeur.s BOl uN�reo ro cA 4ws LOT] BuuXNO UroROesTwcena ]anaRe.RwN4 oA - / i�oTHAVE,WE��� z FaCAVAriNO pO RANBgOwury NxOW AREA90RBMNAGE TO LO '... -' FASFUEMS. WA4F'O dwNAf.EMCRE9.vurFe WNA'A'S.wNEB \ /, \\ Cu.VFArs, BflMS ORRRASfi SflWgs. / / / ® 131 ST I STREEf _ w IT—T11 .7 / \ LOT B n 11 s RE-EO \ SEC. 30 6 31, T30N, 91 8W Po T..E \ SCALE IN FEET V- 100' \ 101 0 100 2 00 SHEET 1 OF 2 SHEETS U. 2 7 2 6 P 2 5 4 ?8 -►.E!52 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number Document Name RECEIVED FOR RECORD 01/05/2005 01:00P?l WARRANTY DEED THIS DEED, made between David H. Railsback a /Wa David H. Railsback II and EXEMPT # Aria J. Railsback. husband and wife ( "Grantor," whether one or more), REC FEE: 11.00 and Miller Homes of Hudson, LLC, a Wisconsin Limited Liability Company TRANS FEE: 2115.00 ( "Grantee," whether one or more). CC COPY FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return address Lots 2, 3, 4, 6, 8, 10, 12, 19, 21 and 22, Plat of Willow River East in the Town of Richmond, St. Croix County, Wisconsin. 026 - 1088 -95 -000:026- 1091 -70 -000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated December 30, 2004 (SEAL) (SEAL) ■ * David H. Railsback (SEAL) (SEAL) * *Arla J. Railsba& AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback and Aria J. Railsback husband and wife STATE OF ) authenticated orl December 30 2004 _ ) ss. Pe l l COUNTY ) %ristina Ogland Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (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: Attorney Kristine Op-land Notary Public, State of Hudson W154016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 * Type name below signatures. INFO-PRO- Legal Forms 600 -655 -2021 www.infoproforms.com ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address j� d x Property Address Z / 7j , S� J (Verification required from Planning & Zoning Department for new construction.) CD / ?v City /State ( Vj Parcel Identification Number ep�� LEGAL DESCRIPTION Property Location J L JL) 1 /4 , 1 /a , Sec. , T 3 ' 0 N R r� , own of tZ. Subdivision QV; j) a ,,J ,Lot # Certified Survey Map # 779 3 - 7 5� , Volume J z , Page # � O Warranty Deed # Z S , Volume 2 6 , Page # Z s� Spec house 17e) no Lot lines identifiable yes 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 alreatment 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. Uwe, 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. Uwe 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 r- S NATURE OF APPLICANT(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) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa = I LE INFORMATION SYSTEM SPECIFICATIONS Owner a✓ t �� (,(,•;f( QYp,/ Septic Tank Capacity 2— Perm,t A ( _ Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer 7 r moer of Bedrooms ❑ NA Effluent Filter Model r umoer of Public Facility Units NA Pump Tank Capacity g a. Estimated flow (average) t—{ SO al /de Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) (0 p p g al/day Pump Manufacturer Sol Application Rate O. 7 gal/day/ft' Pump Model Standard Influent /Effluent Quality Monthly average • Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Blocnemical Oxygen Demand (B0 D,) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: i P e!reated Effluent Quality Monthly average Dispersal Cell(s) B ocnemical Oxygen Demand (BOD,) 530 mg /L In Ground (gravity) ❑ In Ground (pressur ze Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Yax,mum Effluent Particle Size Y in dia. ❑ NA Other: I ❑ NA Other: = .ales typical for domestic wastewater and septic tank effluent. rOter: — MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least -once eve ❑ montli (Maximum 3 ears) �' ear(s) y rump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume = , i rspect dispersal cell(s) At least once eve El rs month(s) (Maximum 3 ea; every: ❑ year(s) y — Clean effluent fitter At least once every: _ 2 ❑ month(s) fS year(s) — um ❑ month(s) nspect p ump, pump controls & alarm At least once every: ❑ year(s) F _sn laterals and pressure test At least once every: ❑ mo nth ❑ year(s) ) f Omer ❑ month(s) _ At least once every: ❑ year(s) 0 _ e , — MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or Geri t,_s _ Mlaster Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator nspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracKS cr measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the groune s..rrs,_ Tne eispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any perc of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition ano regc:res mmediate 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 contents of the tank shall be removed by a Septage Servicing Operator and dispo$ed of in accordance with chapter r F Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreat uni and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintalner. A sere ce report shall be provided to the local regulatory authority within 10 days of completion of any service event. to P AND OPERATION Page Z 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 cAll(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 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 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, T alua bulialle let it al rl�o_ b e ai a �f104 /181T�� �or2 N61 40\j 37R 0 II J ❑ 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 Name EE Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 5Name ( ZO�lxj . Phone one _J /S 3e(,0_ fo (� This document was drafted in compliance with Chapter Comm 83 .22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative>rode. ic*4 STANDARD CHAMBER -- -- 52" —� Quick4 Standard Chamber 48' —I (EFFECTIVE LENGTH) e - _ 1 „ _�® -tee _ —_ i - -— 34” SIDE VIEW SECTION VIEW MultiPort End Cap ,s„ -- �- - - - -- - -- — - -- 34 " - - - - -- SIDE VIEW TOP VIEW FRONT VIEW 4 v l Standard Cham * Nomi - fi dtions MultiPort End Cap Nominal Spodificat�ons' Size W x 52x1,12 "i Size `(W x L x 34 =x 16" x 12 Effective Length%t r 4 y. ? 48" k Invert Height ; h, 8 or 1.25 " Invert Height Oil a I NFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY la) The atr -tural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator I "Units'), when Installed and operated in a leachf6d of art ensl'e septic system In accordance with Infiltrator's instructions, is Warranted to the original purchaser ( "Holder") against de nstive -mlenals and workmanship for one year from the dale that the septic permit is Issued for the septic system containing the Units: provided, however. a sepias permit is net required by applicable law, the warranty period will begin upon the dale that installation of the septic system commence, . r a a "y ghts, Holder nx V notify Inf Itrator In writing at Its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (I S) - ' • - e aI egrd defe. t. Inhltralor w supply replacement Units for Units determined by Infiltrator to be covered by Ihls Limited Warranty. 'SCE l y ,pet (tally excludes the cost of removal and /or installation of the Units. O Iol WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT F -C f" 'JN'TS INCLUDING NO IMPLIED' WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. SY I This t d Ws rant snail be void if any part of the chamber system is manufactured by anyone other than flltrolor. The Limited Warranty dons '. exte '1 e rodee6ll consequecral spacial it indirect damages, Infiltrator shall not be liable for penalties o gndalcd damages, Including loss cf Environmental Onsite Wastewater Solutions` w)dtlrpon and profits, labor and materials, overhead costs, or other losses or expenses incurred by the, Holder or anv third party. Specifically f o - Lmrtod Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of e :alts the Units being subjected to vehicle traffic w other conditions which are not permitted by Inc install t'o hstrucnons fail ure to maintain the 6 Business Park Road " P.O. Box 768 r nd covers set forth in m nstallat'on'nstructions the placement of Improper materials into the system conking the Units' failure of e t ¢;. 0 :Dill. system due to I pop . <i(ing or improper sizing, excessive water usage improper gee t e disposal or nproper of e al o, n. Old Saybrook CT 06475 am the, no, caused by Infiltrator. This L—ted Warranty shall be void If the Holder fails to comply with all of the rerms set forth In thi l Dialled ,va—ch 860- 577 -7000 " FAX 860 - 577 -7001 runner, In no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from Installation or ship p����r� ����� —1. or from any product liability claims of Holder or any third party- For this Limited Warranty to apply, the Units must be installed in aorordanCe O L ."!' a1I ;rte ✓mdlnons required by state and local comes; all other applicable laws, and Infiltrators astallation Instnrctlons- d! No representative of Infiltrat r has the aulhorify to change or extend Ihls Limited Warranty No wananty applies f.> any party outer than the ong •al Holder. , - alri p —ems the Standard Ilmit vl Wall -ty offered by Infiltrator A limited number of states and rounti- have ditcreut warranty nxluire , 'r ­:s. Any ourchast' N Unlls Should contact lnfllfratol 5 Corporate Headquarters n Old Saybrook, Connocticul, Writ lr to such purchase, to Obtain a ropy of 'he applicable warranty . and should carefully read that warranty prior to the purchase of Unrta. Patents - 4, ,9.661; 5,017,041; 5.156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839.844 I,adian Paten t7: 1.329,959; 2,004,564 Other patents pending. irtr� Lqu llizer and SldeWfnder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark In France, Infiltrator Systems Inc. = a registered trademark in Mexico. Contour, Contour Swivel Connection, MicroLeaching, PolyTuff, SnapLock, ChamberSpacer, Posil-ock, QuickCut, QuickPlay RECYCLED PAPER od Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0 Z- ® © x 14,., Filters PL -525 EFFLUENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters -The PL -525 is rated for over 10,000 GPD Alarm tgallons per day) making it one of � -- Accepts PVC I1 the ccessibility e largest commercial filters in its extension hanair class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL -122, the new Polylok PIL has l an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16 removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't i eave the tank. No other filter on the market can make that claim! Accepts 4" & 6" SCHD. 40 Pipe PL -525 Maintenance: f The PL -525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom -- mended that the filter be cleaned every time the tank is pumped or ` at least every three years. If the I installed filter contains an optional alarm, the owner will be notified €, by an alarm when the filter needs �. l servicing. Servicing should be��— Gas deflecto done by a certified septic tank I Automatic snuff un pumper or installer. ball when Miter i 1. Locate the outlet of the u s Patent rvoN 6,015,488 is removea I j septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary, PL -52 Installation: 1. Locate the outlet of in& 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover z. 4. Pull PL -525 out of the housing, mercial waste flows up to pump tank if necessary 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to tank. Make sure all solids fall 4" or 6" outlet pipe. If tn, filter is not centerea ��n,;<< back into septic tank. access opening use a P 6 Insert the filter cartridge back Extend & Lok or piece of into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL -525 filter n;L completely inserted, its housing. 7 Replace septic tank cover. 5. Replace the septic rawN c YA11 __ tA5 . _,a, ls�ascyw�'mUa -S r • LCL_ - �' r 7.. LOT 2i /_ I "1 I l .KF. G LCrt e -AREA �d' P ;I rp _0T 1E \ 1 r r 'r r r 1 t nC�f3 ' r fi ' g .f� 1 ! Tr0 Ic' ` .,Y .'rr "iFCSTp U.CTr LOT ir " - o t!, - ` .. .. , n_ S� \ �. 25 _ t r p Li 7:h�1.' ! av• emu. *' v...•.v> �'.�9[" )�`.�/ !�' aT a 7T 1J LOCATION =N FLL.T Call Jim Henry & Associates fc a (800)221 -SOLD Information deemed reliable but no Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County• �C include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north brow, and I ���I �Od to nearest road. Please p t a1 &ED 1 =1 . y Date ,,p Personal information you provide may tfa for seewndsry WuP-es (Privacy s. 15.04 (4) (m)). [.O Property Owne� 1 2 003 Property Locapon 30 30 Q Govt, t of 1/4 1/4 S• T 3 d N R $ E( W Property thvrter's Mailing Address T . 'J I . i tot Block # S NI�a �" `^' M/f K, G OFFICE City j utate . Zip Cods, Phone Number ❑ City ❑ Vida T Nearest Road ' ,1J) New Construction Use. Residential / Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement Public orr commercial - Describe: Parent mateiial 0 c.J C�4�`� Flood Plana e4vation if applicable LI A _ ft. General comments and recommendetions: jp -3 F Going Borin # apit Gnwnd surface elev.1 R Depth do limiting factor in. Sod Appl ication Rate Horizon Depth Domirant Color Redox Description Texture Structure Consistence Boundary Roots G PDfif �j in. Mu used Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Efi#2 /- Z -,off ✓-S� ______ C� .�s � Zc� - � � 3 .2 ® so" # Boring Pit Ground surface elev�- 'Y ft. Depth to limes factor Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP!?Jfir in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '01#2 1 D l /® r 3 12 . 7n-i r S T Effluent #1 _ BOD > 30 220 mgtL and TSS >30 < 1 ' Etiluent #2 = BOD <_ 30 mgA- and TSS 130 mg1L CST c � -- ��� s " ` Date Evaluation Conducted Telephone Number Address Zk /ate) I Soil Test Plot Plan Project Name David Railsback Shaun Address 845 133rd Ave New Richmond Wi 54017 C #226900 Lot 6 Subdivision Date 12/12/02 SW /NW 1 /4SW /NW 1 /4S 30/31 T 30 N/R 18 W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 92.7/90.3 *HRpSame as Benchmark It. BM Top of Steel Fence Post @ 1 04.0 ' % Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Soil test was done to satisfy Zoning Requirement. 508' Property Line Alt. 70' 5 , B- 8% Slo e B -3 7 , 35' 05' Line Property 40' B -1 96' 94' 92'