HomeMy WebLinkAbout030-2131-27-000 Wisconsin Department ofICommerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
487942 0
GENERAL `INFORMATION (ATTACH TO PERMIT) 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: Village X Township Parcel Tax No:
City
Marquette & Lee Builders St. Joseph, Town of 030- 2131 -27 -000
CST BM Ele Insp. BM Elev: BM Description: Section/Town /Range /Map No:
'-VQ/l 23.30.20.1081
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
9' ZS 09 z S /crd
Septic � Benchmark
1
Dosing Alt. BM
Aeration l � J L / Bldg. Sewer�
Holding !`7 U St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION / �—
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic � � i i� 'q�, � � Dt Bottom
Dosing Header /Man.
/J A m-5 -6 `% -7
t
Aeration Dist. Pipe ' � 99. o
to. 7L. 19 . 7
SZ 9
Holding Bot. System 4 d
.1. q ?, a5
i2. S
Final Grade
PUMP /SIPHON INFORMATION 'k T A 102 - �/5
Manufacturer De and St Cover
o "(4 /
Model Number n (�Q UI V s't 3
TDH Lift Friction Los System ead TDH Ft
Forcemain Lengt h i Dia. t Dist. to well / J r-
SOIL ABSORPTION SYSTEM
BEDITRENCH Width I I Length No. Of Trenches I _ PIT DIMENSIONS No. Of its Inside Dia. Liquid Depth
DIMENSIONS �• �j 6 3 v,, .CA
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR Lv�► -i I Q'( 4L-
Typ Of S ` � b , Irk UNIT Model Number. 5J ir—
DISTRIBUTION SYSTEM /5 c�►t.(.� `yf S % �-�
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to A Intake
/ Pipe(s) \ 3! F'(a -�.
Length 5 Dia length \ Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only �' p✓
Depth Over Depth Over xx Depth of lyx Seeded /So d' d xx Mulched
BedrrrenchCenter t Bed/Trench Topsoil \ Yes i +'',I No Yes No
1r 5
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 121 d / � Ins ectiti�on #2:
Location: 1424 Thelen Farm Road Hudson, WI 5401 (SW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot Z S' Parcel No: 23.30.20.1081
- r.p o a GG.r F��. -:� E 7 Co ,)ep
1.) Alt BM Description = T
2.) Bldg sewer length = 3 6 f V
- amount of cover = ) 2 "cd h' NV-J fd
Plan revision Required? 'Yes No OS
Use other side for additional information. ___
Date In pctor's gnature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County C�
N 201 W. Washington Ave.,. P.O. Box 7162
►�' ��� Madison, WI 53707 — 7162 itary P 't Number to be filled in by Co.)
Department of Commerce (608)266 -3151 7 � Z
Sanitary Permit APP State Plan I.D. Number
In accord with Co 3.21, is. Adm. Code, personal i forma i>fe
may be us sec y (ftt j (' g
y ary ose vac La , sl5.0 Project Address if different than mailing address )
I. Application Information — Please Print All Information A (C` ell
Property Owner's Name Parcel # Lot Z 7 Block #
Props O er's Mailing Address Property Location
e ' / &A/ �� �'/., 566 Section 2 -3
City, S to I / ( Zip Code / 7 Phone Number
tJ 0 j /) 7 circle one)
11. Type of Building (check all .that apply) � T t/ N; R C. r
1 or 2 Family Dwelling — Number of Bedrooms c, Subdivision Name CSM Number
Public /Commercial — Describe Use
❑ State Owned — Describe Use ❑City ❑Village ❑Ibwnship of ( r
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A, ® New System ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑Permit Renewal ❑permit Revision 13 Change of ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that app
WNon — Pressurized 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 ❑
Synthetic Media Filter ��',p..�// ,
Recirculating yn ❑Leaching Chamber ❑ Dri Line ® gravel-less Pie ❑Other (expl �cotpx T SD
V. Dis ersal/Treatment Area Information: ' { 3 \
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation i —8 / / I 1
U0 67 Jr g siti� z s. 3
ank Info Capacity in Total Number Manufacturer Prefab Site Steel Fi er Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks I Tanks
Septic or Holding Tank
1
Aerobic Treatment Unit
Dosing Chamber _ p l / X
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
gnature MP Plumber's Si Number Business Phone Number
�JLc �,✓ z z6 Y9 z7 -W
Plum er's Address (Street, City, State, Zip Code)
-i' J
VIII. Coun /De artment Use Onl
K Approved ❑ Dis d Sanitary Permit Fee (i ludes Groundwater Date Issued Issuing Agent Signature o Stamps)
Surcharge Fee)
❑ en Reas for Denial B
IX. Conditions pprov at
SYSTEM NER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
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Wisconsin Department of Commerce n E TION REPORT Page I of 3
Division of Safety and Buildings
in accordance with Comm S. e
tip) t County ST. CROIX
Attach complete site plan on paper n less Sian $ (P Xa k Pats in ust
include, but not lim4ed' vertial Wisof►1i1 r noeVaW , direotio and Pared I.®, 030.2131.27.000
percent slope, scale or dimensions, no►t a row, and location and distance to nearest road.
Please print all informladon. Re ewes by Date
Personal intormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
❑ )W
MARQUETTE & LEE BUILDERS LLC G Lot --- SW 1/4 SE 1/4 S 23 T 30 N R 20 E(or)W
Property Owners Malting Address Lot Al I Block # Subd. Name or CSM#
1810 Crestview Drive 27 -- Settler's Glen
City State Zip Code Phone Number village IDTown Nearest Road
Hudson, WI 1 54016 ( ) Thelen Farm Trail
Q Construction Coruction User] Residential f Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Pub or commercial - Describe:
Parent material outwash Flood Plan elevation if applicable WA ft.
General comrTm As Conventional In- ground trenches -- 0.7 loading rate -- to be designed by Roger Nelson /
and recommendations:
r---- � •• - (ems f
Property Address: 1424 Tllelen Farm Trail C
F7] Boring # [] Boring
Q Pit Ground surface elev. 98.55 ft. Depth to limiting factor 101 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Str Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *01#2
1 0 -6 IOYR2 /2 — I 3f -msbk mvfr cb 3vf-co 0.6 0.8
2 6 -9 10YR2 /2 - I 2f-msbk mfr a i 2vf-co 0.6 0.8
3 9 -16 10YR4 /4 — sil 2fsbk mfr cs 2vf-co 0.6 0.8
4 16 -25 7.5YR4/4 sl 2fabk mvfr as 2Vf m 0.6 1.0
5 25 -64 IOYR4 /6 — cos Osg dl cs 2vf-m 0.7 1.6
6 64 -101 10YR4/3 - s Osg ml -- -- 0.7 1.6
(Some cobbles)
Boring Bar # a Pit Ground surface elev. 99.60 120
ft. Depth to limiting factor in.
Soil ikstion Rata
Horim Depth Dominant Color Redox Description Texture Stncttue Consistence Boundary Roots GPDHF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfF#1 *0102
1 0 -7 10YR2 /1 sl 3fa&sbk mvfr cs 3vf-co 0.6 1.0
2 7-16 10YR2 /2 — sl 2fa &sbk mvfr cs 2vf -co 0.6 1.0
3 16 -33 10YR4/4 — s&gr Osg dl cs 2vf-co 0.7 1.6
4 33 -72 10YR5 /4 — s Osg dl — - 0.7 1.6
5 72 -120 10YR6 /3 — s&gr Ogg dl -- -- 0.7 1.6
(Few cobbles & stones.)
*
Effluent #1 = BOD > 30 220 mg& and TSS >30 150 mgA_ " Effluent #2 = BOD < 3D mg& and TSS < 30 mg&
CST Name (Please Print) Signature �, CST Number
M Jo Hollister W � 224832
Address Date Evaluation Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 10-03-05 (715) 426 - 1775
Property Owner M a r quette & Lee Bui LLC Parcel ID # 030 - 2131 -27 -000 Page 2 of 3
IJ one
I Boring # 101.00 120
_ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A Rate
Horizon Depth Dominara Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 I *Eff#2
1 0 -5 IOYR3 /3 -- fsl 3f -msbk mvfr cs 3vf-co 0.4 0.7
2 5 -12 10YR3/3 — fsl 2f -msbk mvfr cs 2vf-co 0.4 0.7
3 12 -22 10YR4/3 -- fsl 2f -mabk mfr cs 2vf -co 0.4 0.7
4 22-44 7.5YR4/3 -- sl 2fabk dh aw 2vf -co 0.6 1.0
5 44 -60 10YR5 /4 -- s&gr Osg dl cw 2vf -m 0.7 1.6
6 60-96 OYR5/4 &4/6 -- s&gr OSg dl cw -- 0.7 1.6
7 96-120 10YR6/3 -- s&gr Ng dl — -- 0.7 1.6
F-1 Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in. Soft icaiiorr Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2
❑ �# 9 so
�u""I Pit Ground suftace env. it. Depth to Ilmlting factor In.
r*Efr#1 iRate
Horizon Depth Dominant Color Redox Description Texture Stnxlure Consistence Boundary Roots GPDfff in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh.
*Etf#2
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg& 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.
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
north arrow, and tcation and distance to nearest road.
percent slo scale or dimensions,
P i�� ,
Please print Reviewed by Date
Personal information you Provide may be used r secorld>lry�rtr!os@s (PAVy Law,. 15.04 (1) (m)).
Property Owner((1� ropetty Location
eo fr1 a e, �Cy(Ylt.` { r° ovt. Lot SI)J 114 SC- 1/4 S 23 T 3Q N R 20 E (ori)
Property Owner's Mailing Ad ss of # Block # Subd. Name or CSM#
(D I Z Ca t 1\ o;
2� A G /e
City State Zip Code urMir E] City ❑ Vill ge [� Town Nearest Road
N 2 (651 )43�i -2 4
New Construction Use: 0 Residential / Number of bedrooms 3 - �_ Code derived design flow rate U O O GPD
❑ Replacement ❑ Public or commercial - Describe: �I
Parent material 00 ( - W Cc 5 I' Flood Plain elevation if applicable �/ 14- n•
General comments S Y 2 M �' 6
and recommendations: 00 r e V 9 5- 3 0
i
Boring #
Fq ❑ Boring
Pit Ground surface elev. � ��, � ft. Depth to limiting factor 1 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
I S i) Zr Aal� n-�r c S (V y , S . g
b I0 r- I3
2 12 -�+2 SL. 2 S K mfr CS - F J -
3 72 -140 1() r yl to — CILY5 COS
Boring # ❑ Boring
�t
Pit Ground surface elev. R a I
S Application Depth to limiting factor 3 0 in. • Rate
❑
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. S z, Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
-12 10 .r3I3 I I Z my C S ) "X 'b 8
Z 12 -30 i 4��I — SL 2 �r •5 9
3 36-54 10 r- 3/ tp CZP1,5 X 'AhP SLI, Z k m
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
QZ(A s t Date Evaluation Conducted Telephone Number
Addre
�/3 r��� ✓� ��'t�er s Gc�/ s yUZ..s-
Property Owner ac, H(Yyto 5 Parcel ID #
❑
Fs
Boring #. Boring Page r - 2 of
I�
'' ' Pit Ground surface elev. q5; ft. Depth to limiting factor in.
Horizon &z. Sh. Soil Application Ra
Depth Dominant Color Redox Description Texture Structure Consistence Roots GPD/tt'
In. Mansell C1u. Sz. C.ont. Color Gr. 'EffN1 •EffN2
0 -12 1p r.313. -- rl
I 4 r (-1 Si_ 2rrs
3 3q -55 lb 1(o e2- "l .5 ; . y I(n L_ Z►�,Sbk — — Co
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rai
Horizon Depth Dominant Color Redox Description... Texture Structure Consistence Boundary Roofs GPD /fl=
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •EffN1 'EffN2
Boring # ❑ Boring
El PIC' Ground surface elev. R Depth to limiting factor in.
Soil Application Rata
Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /11
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'EffN2
Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent N2 = DOD < 30 m
_ g/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 ITY 608- 264 -8777.
SB61770(R07/00) r
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PAGE_a,_OF
NAME Cck r n c s 2 TOT #Z LEGAL DESCRIPTION Sw %St `a . S Z ZI T - z , , c N R Z ° E(or
SCALE: I"= yU I
BM I ELEVATION I(I�
BM I DESCRIPTION o i � I Cka r��! fry
BM 2 ELEVATION
BM 2 DESCRIPTION �vp a-� _ - -_ --
Se . Z 3
SYSTEM ELEVATION
SYSTEM TYPE IX of A c� — 't
CONTOUR ELEV TION
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SIGNATURE DATE �z —oZ
COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS
PER COMM 84.25 CODE CHANGES 2/1/2004
Access Opening, not top of cover, Access Opening, not top of cover,
must eidend to a point no greater must extend at least
than 6" Below Finished Grade 4" Above Finished G ade . / �
Coverwith WaA -n GUF' Y �
Lockin Device T Xl b ^J'64y TPPRA'� CA
(typual) Finished Grade
3un. u iA:) t
aEVV ETy .. .
Min. 23"
30 FT Access Opening
0
l pi Min. 23" Access Opening 2 H ^6 )rAeCE/hR /N
Ouha Effluent Filter j &0/77/
union 4,wR..oYEJP PIP6 3 PT.
Inlet Baffle
ON`s .SOS -/D S`O�C_
s
Pu p
1 0
3 ",Sand a ij raW- in e A W7 eeh-/er 2 •• Aluer Si an ed�ex
Tw C 4 o ms on f ide GUccl�t)
SPECIFICATIONS
TANK MFR: U11)t'S DOSES PER DAY:
TANK SIZE: SEPTIC GAL. DOSE VOLUME: / 7 `T / GAL.
DOSE VrO GAL. (INCLUDES FLOWBACK & <20% OF DWF)
ALARM MFR: CAPACITIES: A = Z INCHES = ilyl GAL.
MODEL #
Switch type: ��?? B = — 2 — INCHES = GAL.
PUMP MFR: COOU C n C = � INCHES = �r`l' Z GAL.
MODEL #: P 'f l
SWITCH TYPE: D = INCHES = GAL.
REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e)
VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ //0' FT.
MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + C FT.
A FT. OF FORCEMAIN x , / FT. /100 FT. FRICTION FACTOR ...... _ + ! 2. FT.
TOTAL DYNAMIC HEAD (TDH) FT.
INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH
MP/MPRS SIGNATURE: LICENSE NUMBER: ✓'� //"
APP -12 -2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01
[I GOULDS PUMPS
Submersible
Effluent Pump
PE
k kolw PUMP
SPECIFICATIONS MOTOR FEATURES
Pump — General; General: a Corrosion resistant
• Discharge: 1'r4" NPT • Single phase construction.
• Temperature: 104 °F (40 °C) • 60 Hertz ■ Cast iron body,
maximum, continuous when a 115 and 230 volts 0 Thermoplastic impeller and
fully submerged. • Built - in thermal overload pro cover,
• Solids handling: mh" tection with automatic reset ■ Upper sleeve and lower
maximum sphere. • Gass 8 insulation. heavy duty ball bearing
APPLICATIONS ' Automatic models include a • Oil- filled design. construction.
float switch. • High strength carbon steel ■ Motor is permanently
Specially designed for the • Manual models available. shaft, lubricated for extended
following uses: • Pumping range: see PE31 Motor. service life.
• Mound Systems performance chart or curve, • .33 HP, 3000 RPM ■ Powered for continuous
•
Effluent/Dosing Systems PE31 Pump: • 115 volts operation.
• Low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the
• Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor.
\_.. •Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power
Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts cord, 20' standard length,
• Maximum head: 29' TDH • PSC design 115 o 230 1 / 3 Sj w with
PE51 Pump; PE51 Motor. plug.
Maximum capadty:70 GPM � .50 HP, 3400 RPM ■Complete unit is heavy duty,
Maximum head: 37 1 TDH 115 and 230 volts portable and compact.
METERS FEET • PSC design ■ Mechanical seal is carbon,
40 _ ceramic, BU NA and stainless
PE51 ' I ! i I
I ( I I MODELS: PE31, Pf41, PE51 Steel,
35 I r ' I I I I I I I 'I ' HP .33, .ao, .so ■Stainless steel fasteners.
3 •�E4 �: , ! _l - !
i —► z GPM
1FT I .I l I i t ! I AGENCY LISTINGS
q + I.
,L ZS
U ' i i I I I I I i t I t I'' t l l I• Ek
Q 20
Tested to UL 778 and
j 1 i 1 i ; ; I I, I ; I j I j •' CSA 222108 Standards
15 ! ' —1- I- ' I BY Cefl SbndU& Assod ton
O II
j'' file KR311S49
1 0 i I I '' ..L I i I• f A I I. I'' i GoWd romp mps is ISO 9oom wgyLqerca.
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0 00 I I 10 I ; ;. I I..I
20 30 40 50 60 70 GPM 8o
0 5 10 15 m Goulds Pumps
® 2004 ITT Water Technology, Ine. CAPACITY
EffectivaJun•, a 00 ITT Industries
�E37/41
L U /C►'z S
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STANDARD CHAMBER
52"
Quick4 Standard Chamber 48"
(EFFECTIVE LENGTH)
6 in
12" 2 = s E L I 1
v ��
g " I =�N �
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ma _ in 1 mm — 11 � j
34" SIDE VIEW
SECTION VIEW
MultiPort End Cap
R
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16"
12"
34" SIDE VIEW TOP VIEW
FRONT VIEW
.� �� s,, ., ,• _ +tw°,r "+,x a :�� ' x' N� � �' . v' tt y 6 � '° " �" ".
✓� i� �� � � V ��� � � �hn x3n 7" `�wT N �xy:}'ti *'�f � '$� pt�
s��:�'' aN �'z,, .� riS � "•,�'.: � "�'� ^ "' ��Y,�
INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY
(a) The structural integrity of each chamber, and plate, wedge and other accessory manufactured by Infiltrator ( "Unks "), when installed and operated
in a leachfield of an onsfie septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ( "Holder") against defective
materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however,
that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences.
To exercise its warranty rights, Holler must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) . • .
days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty.
Infittrator's liability specifically excludes the cost of removal and/or installation of the Units. Q
(b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SYSTEMS INC
TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
(c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Umited Warranty does
not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of Environmental Onsite
Wastewater Solutions -
production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holler or any third party. Specifically
excluded from limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of
the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation Instructions; failure to maintain the 6 Business Park
Road • P.O. Box 768
minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing the Units; failure of Old Saybrook, CT 06475
the Units or the septic system due to improper slting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or
any o her event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited 860- 577 -7000 •FAX 860
- 577 -7001
Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third parry resulting from installation or ship- 800-221-4436
ment, or from any product liability claims of Holder or any third party. For this Umfted Warranty to apply, the Units must be Installed in accordance
with all site conditions required by state and local codes; all other applicable laws: and Infiltrator's installation instructions.
(d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the origi-
nal Holder.
The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty require-
ments. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a
copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units.
U.S. Patents: 4,759,661; 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
Canadian Patents: 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer and SideWinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc.
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and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner LL �YJ�f7c5 Septic Tank Capacity a l ❑ NA
Permit # Septic Tank Manufacturer �Gr ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer - 2_ ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity g a l ❑ NA
Estimated flow (average) g al/day Pump Tank Manufacturer Cpl 15irIeN ❑ NA
Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer C-'OftiL 13 ❑ NA
Soil Application Rate gal/day/ft' Pump Model P & V ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA
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) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L Ik In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometri mea n) 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: ❑ month(s) (Maximum 3 years) ❑ NA
y 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: ❑ month(s) (Maximum 3 years) ❑ NA
year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA Q year(s)
Inspect pump, pump controls &alarm At least once every: [3 month(s) ❑ NA
® year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: At least once every: p yearlsj(s) ❑ NA
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 512 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)
s
Page Z of
START UP AND OPERATION
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
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.
❑ 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
Name �d OJ Name
Phone -1 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name f c" J�
Phone Phone j
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer __ , /' i L-U.�" L Grp /1 �(.l /L pis LC C
Mailing Address ! iL b L>ett ur- My sO ^j W f 5- yo6
Property Address Hz q t- !l1 e � M iu y
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number 036--Lt 5 (- 2.7-- D
LEGAL DESCRIPTION
Property Location J(.J 1 /4 , J � ' /4 , Sec. — 23 , T 3N R <?D W, Town of ;'SOGc5?
Subdivision 5 �� 6� �� , Lot #.
Certified Survey Map # , Volume , Page #
Warranty Deed # _7� j j , Volume 7:5 0 , Page #
Spec house yes (J> Lot lines identifiable 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.
Uwe 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.
Num of be ooms
SIGNATURE 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)
76 I -B55
U 2 5 6 6 P 4 4 2 KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO.. YI
STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD
Document Number WARRANTY DEED 05/06/2009 03 :30PH
THIS DEED, made between St. Joseph Development Corporation, a WARRANTY DEED
Minnesota Corporation Grantor, and Marquette & Lee Builders, LLC EXE PT #
Grantee. REC FEE: 13.00
Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 271.20
described real estate in St. Croix County, State of Wisconsin (the COPY FEE:
CC FEE:
"Property "): PAGES-. 2
Recording Area
Name and Return Address:
Land Title Inc.
1900 Silver Lake Road Suite 200
New Brighton Mn 55112
-O '
Together with all appurtenant rights, title and interests.
Parcel IdentificationNumber(PI Dap 01 ,3 2 Q
This is not homestead property.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Dated this 18th day of March 2004.
* Kellei St. Martin, Vice President
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF MINNESOTA )
WASHINGTON COUNTY. ) ss.
authenticated this 18th day of March, 2004 Personally came before me this 18th day of March, 2004
the above named Kellei St. Martin, Vice President St. Joseph
* Development Corporation a Minnesota Corporation to me
TITLE: MEMBER STATE BAR OF WISCONSIN known to be the person(s) who executed the foregoing
(If not, instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.) t��
THIS INSTRUMENT WAS DRAFTED BY
Notary Public, State of Minnesota
My commission is permanent. (If not, state expiration date:
Greg Booth A ttorney 1 900 S ilver L ake R oad S uite 2 00 t S )
New Brighton Mn 55112
(Signatures may be authenticated or acknowledged. Both are not necessary.) ANNETTE D. THEM
*Names of persons sigming in any capacity must he typed or printed below their signature 1 0 1MY NOTARY PUBLIC -MINNSWA
Comm. Expbu Jw , 31,1006
Am
■
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000
U. 2566P `�y
File No.: 228684
EXHIBIT A
Lot 27, Settlers Glen located in the Town of St. Joseph, St. Croix County, Wisconsin
N
\ \ SE NT
o \ SE E
20' RECREATIONAL
TRAIL EASEMENT
\ s\y LOT 26
�y 2.
3.001 ACRES
130,707 SQ. FT.
L.B.O. =866.0 .•�, \
LOT 27
T.
\
. s � � •
HE 3.001 ACRE
130,709 SQ. FT. �"
N g /.
L.8.0.=902.0
25.93' p
)7'070E 358.72'
- TRAIL- - .. \
. % CONSERVATION
EASEMENT
LOT 28
3.001 ACRES
.OT 33 tip 1 30,711 SQ. Fl
)00 ACRES \ \ �o'j ' \ /� - DRAINAGE ���\ L.B.O. =902.0
,680 SO. FT. \ EASEMENT E
•------ •- -••• -- �,'�o a te' H.W.L. =900.0
881 '1331
2.57 py'\ may.
0 \ g�
cb Of
1 Vr S� ;
SEE SHEET A