HomeMy WebLinkAbout032-2147-80-000 Nd County St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 506169 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: City Village X Township Parcel Tax No:
Meuissen, Glenn & Lisa I Somerset, Town of 032- 2147 -80 -000
CST BM Elev: Insp. BM Elev: BM Descr ion ^ 7 Section /Town /Range /Map No:
0 ,b 15.31.19.1289
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ! Benchmark
Dosing � Alt. BM J„ !- / / � -,/,_- 2
Aeration B21 a. a
Holding St/Ht Inlet
a
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WEL BLDG. Vent to it IntakeROAD Dt Inlet
Septic , �r f 4 4- Dt Bottom
Dosing n l Header /Man. 0 � �- 9 9f 23
Aeration l � Dist. Pipe - , 0. S
Holding Bot. Sys
3
PUMP /SIPHON INFORMATION eC /r0`� lG�i — ts+h�t �- 5 / / • Z3
Manufactu Demand St Cover
GPM L4 tl Qd
Model Number
TDH Lift Pion Loss m Head TDH Ft
Forcemain ength Dia. Dist. to Well
SOIL ABSORPTION SYSTEM Alt .ZD �" • (o ����
BED/TRE
S Width Length No. Of Trenc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIO NS n i!V SETBACK SYSTEM TO P/L BLDG WE ufa INFORMATION Type Of stem: -,5a r Q del Number:
1 �'
BUTION SYSTEM 3
Heade anifold Distribution x Hole Size x Hole Spacing V V Vent to Air Intake
/ Pipe(s) / / 1
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched
Bed/Trench Center �� Bed /Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: S Inspection #2:
Location: 2136 54th S tree t Somerset, WI 54 (NE 1/4 SW 1/4 15 T31 R1 9W) Oak Haven Lot 18 r " Parcel No: 15.31.19.1289
1.) Alt BM Description = / tr
2.) Bldg sewer length = Z'L►
- amount of cover =�
Plan revision Required? Yes o
Use other side for additional information. 4�P 1
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
r commet Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 S C p2O
i sco n s n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
I toepartment of Commerce 5 -'
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 rojectAdd ess (ifdiffe
submitted to the Department of Commerce. Personal information you provide may be used for secondary 7_
p urposes in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. F
1. Application Information — Please Print All Information
Property Owner's Name Parcel #
Property Mailing Address /� Property Location ! Z D
/ 7 suA S� / s I /� lft Lot —_ D
City, State Zip Code Phone Number y,, y., Section
�i/� (circle one
II. Type of Building (check all that apply) O L�t4 1K I or 2 Family Dwelling - Number of Bedrooms l E- - -CJ Subdi Name_
2 Block # l./AIr- H A Ve V
El Public /Commercial - Describe Use i 007 T -
❑City of
MAY U
❑ State Owned - Describe Use CSM Numb r ❑Village of
-I T, C UNTY b4 Town of 50 (5�f
I le 1- C-1�a � ('
111. Type of Permit: (Check only one box on the A. Co line B if applicable)
A.
ig New System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS S stem /Com onent/Device: Check all that appl
05 Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitable soil Cl Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information: ij 6f. P5
Design Flow , (g l pd) Design Soil Application R (gpdst) Dispersal Area Required (st) a rea ro ' Sys em Elevation ® 9 8
VI. Tank Info Capacity in Total # of Manufactur
y
Gallons Gallons Units 7 a 1 :3 6 L � /� � 2 U �
New Tanks Existing Tanks / t �7� t ( o
a U v) yr 'w 3 a
Septic or Holding Tank t r J �j t� 6 �� Jr
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 /*tMt" umber Business Phone Number
R n � a Z 4 6 yq 7 7 / S' 273
Plumber's Address (Street, City, State, Zip Code)
�LGSr�v'67� -,_E-F C^/ 1 ., �o
VIII. County /De artment Use Onl
Approved approve Permit Fee Date I sued Issuing nt Signature
r Given Reason for Denial
5� D 7
IX. Conditm-fiftwWweasons for Disapproval
1. Stptic tank, effluent fitter and
dispersal cell must all be services / maintained
a$ per management plan provided by plumber.
2. AN adback requirements must be maintained
pa tine t to complete pans or he system and submit to the County only on paper not less than 8 112 x 1 I inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
I
Plot Plan
Property oWner R«t^P -D ia+TZ K.JCM S C- U- F ft
1 " =40ft.
Legal Description tfr t, omc- vimsAl (except where noted)
mEYy oF- -ME 13 = Backhoe pit
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Site Locatio
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Legal Description for it, OMS, HA%KN (except where noted )
k�Yy o�,nie sw�/ sec. Us -rya, R ,4 W . [Z = Backhoe pit
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+ )Ni sconsin Department of Comrne OIL EVALUATION REPORT pa 1 Of 3
Division of Safety and Buildings a`-.'
in accordance with Comm 85, Wis. Adm. Code
— County ST. CROIX
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 032 - 2147 - 80 - 000
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Reviewed b Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). J
Property Owner RECEIVED erty Location tl 1:1 El
RICHARD DIED CH Go .Lot "'- 1!4 SW 1/4 S 15 T 31 N R 19 E (or) W
Property Owner's Mailing Address MAY 0 1 2007 Lo Block # Subd. Name or CS Oak Haven
10784 Thone Ro d 8 --
City State Zip Code Phon u COUNTY mber ity []Village ■ Town Nearest Road
M
Woodbury, N 55129 ( ) 54th Street
Q New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material sandstone outwash Flood Plain elevation if applicable
General comments Conventional In- ground trenches -- 0.7 loading rate
and recommendations:
❑ Boring # [) Boring
Ground surface elev. 100.96 ft. Depth to limiting factor 100 in.
Q Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2
1 0 -3 10YR3 /2 is 2fsbk mvfr cb 3vf -co 0.7 1.6
2 3 -17 10YR3 /6 Is If- -msbk mvfr cs 2vf -co 0.7 1.6
3 17 -33 7.5YR3/4 s Osg ml cs 2vf -m 0.7 1.6
4 33 -100 7.5YR4/4 -- s Osg ml ._ -- 0,7 1.6
I
t
f
� to
2 Boring # Boring 98.16 94
E] pit Ground su ce elev. ft. Depth to limiting factor in.
Soil lication 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 *Eff#2
1 0 -4 10YR3 /2 Is 2f -msbk mvfr cb 3vf -co 0.7 1.6
2 4 -32 10YR3 /6 Is If- -msbk mvfr cs 2vf -co 0.7 1.6
3 32 -94 10YR4 /4 - s Osg ml -- __ 0.7 1.6
* 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) Si CST Number
Mary Jo Hollister Hollister's Soil Testin & Desi n 224832
Address Date Evaluatikxl Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 04-30-07 (715) 426 - 1775
Property Owner DIEDRICH, Richard Parcel ID # 032 - 2147 - 80 -000 Page 2 of 3
Boring
3 Boring # ❑ o Ground surface elev. 93.81 ft Depth to limiting factor 90 in. Soil Application 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 'Eff#2
1 0 -4 10YR3/2 -- is 2fsbk mvfr cb 3vf -co 0.7 1.6
2 4 -30 10YR3/6 -- is if -msbk mvfr I CS 2vf -co 0.7 1.6
3 30 -90 7.5YR3/4 -- s Osg ml -- -- 0.7 1.6
❑ Boring # 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
a Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 I *Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD 130 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- 8330Tea (R.07 /00)
Plot Plan for Site and Soil Evaluation Page 3 of 3
Property owner - ri
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Legal Description uTi otv, HmsA; (except where noted)
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SHEET 1 OF 3 MEETS
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address ���1 �JIF ISE del U.
Property Address A ir.
(Verification required from Planning & Zoning Department for new construction.)
City /State lam. Parcel Identification Number tj 3 2
LEGAL DESCRIPTION
Property Location t�E 1 /4 , <SW 1 /4 , Sec. l r,..,- , T N R ,,A W, Town of Is
Subdivision Q-�y t-�\Jex 1 _ , Lot # l8
Certified Survey Map # _ , Volume , Page #
Warranty Deed # O 'T b 7i , Volume , Page #
Spec house yes ® Lot lines identifiable 49 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. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Nu ber of bedrooms Q3
W 0?
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)
* 8 4 9 4 6 2 1
State Bar of Wisconsin Form 2 - 2003 849462
WARRANTY DEED KATHLEEN H. WALSH
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
05/01/2007 10:30AM
THIS DEED, made between Richard Diedrich, a single person WARRANTY DEED
( "Grantor," whether one or more), EXEMPT I
and Glenn E. Mevissen and Lisa J. Mevissen, husband and wife REC FEE: 11.00
( "Grantee," whether one or more). TRANS FEE: 213.00
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 I
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is
needed, please attach addendum): Name and Return Address
Lot 18, Oak Haven, Town of Somerset, St. Croix County, Wisconsin.
'TV"C
Po Q rnr Nt
Sq o.)--c)
032- 2147 -80 -000
Parcel Identification Number (PIN)
This is not homestead property.
is not
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated April 25, 2007
(SEAL) (SEAL)
* *Richard Diedrich
(SEAL) (SEAL)
* *
THENTICA N ACNO It DG 11 Q U E W I E R Z B I N S K I
Signature(s) ' L - MINNESOTA
authenticated o O K STATE OF MINNESOTA $� iy "` ' a, zc,v
ss.
*
tP4.W1S�� COUNTY )
TITLE: MEMBER St5ktAR OF WISCONSIN Personally came before me on April 25, 2007 ,
(If not, the above -named Richard Diedrich, a single person
authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
Attorney David J. Estreen
304 Locust Street, Hudson, WI 54016 Notary Public, State of Minnesota
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 -PROTM Legal Forms 800 - 655 -2021 www.infoproforms.com
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 9'L���lf •� L (f� (/� !� f�N Septic Tank Capacity Z 40 d a l ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ,41Q a ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ❑ NA
Soil Application Rate y gal/day/ft' Pump Model ❑ 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 Ain- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA
�': - 3 9 ear(s) y
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
IN year(s)
Clean effluent filter At least once every: ❑ mo (s) )
® ye ❑ NA
Inspect pump, pump controls &alarm At least once every: 3 [3 month(s) ❑ NA B year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
'® year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components,. pretreatment
units, and any servicing at intervals of 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)
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 may replacement area has been evaluated and be utilized for the location of a replacement soil absorption
P Y
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 Q �L SO N Name
Phone S— Z 7 3 — T Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name 54 4-d oz Zp .'1(��
Phone Phone �/ y ' 46 go
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.
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INFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY
(a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator ( "Un tsl, whan Instated and operated
In a leachfield of an was septic system in accordance with Infiltrator's Instructions. Is warranted to the original purchaser ('Holden against detective
materiels and workmanship for one year from the date that fine septic permit is Issued for the septic system ocntalung the Units; provided, however,
that if a septic ptxmnit Is not requlmd by applicable law, the warranty pariod will begin upon the date that Installation of the septic system con"hences.
To exercise Its warranty rights, Holder must rosy 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 determi by Infiltrator to be covered by this Limited Warranty. / •
Infttrator'e lability speofcally excludes the cost of removal and/or Installation of the Units. O
R
THE LIMITED WARRANTY AND IN SUBPARAGRAPH (a) ARE IX THERE ARE OTHER WARRANTIES WfTH RESPECT
T SYSTEMS INC
TO THE UNITS, INCLUDING NO IMPLIED LIED WARRANTIES OF MERCHANTABILITY OR OR FITNESS FOR A PARTICULAR ICULAR PURPOSE.
(c) This Limited Warranty shat be void n ary part of the chamber system is manufactured by anyone otter than Infiltrator. The Limited Warranty does
not extend to inckl ntal, consequential, special or Indirect damages. Infiltrator stall not be liable for penaalea or liquidated damages, Including loss of Environmental Onsite
Wastewater Solutions"
production and profits, labor and materiels, overhead costa, or otter losses or expenses Incurred by the Fickler or any third perry. Specifically
excluded from Limited Warranty coverage are dama to t unite true to ordlra" wear aria tea alteration, accident, misuse, abuse or ne w 6 Business Park Road • P.O. Box 768
the Units; the Units being Subjected to vehicle traffic or other conditions which are not permitted by the Installation Instructions; failure to maintain the
minimum grand covers set forth In the Installation Instructions; the placement of Improper materials into to system containing the Units; "re Of Old Saybrook, CT 06475
the Units or the septic system due to Improper siting or lnproper siring, excessive water usage, krVxoper grease cbposal, or Improper operation; or
any other event rot caused by Infinratoc This United Warranty shat be void if the Holder fails to comply with all of the terra set forth In this Limited
Warranty . 860- 577 -7000 •FAX 860 - 577 -7001
Further, In no event anal Infiltrator be responsible for any loss or damage to the Honer, the Units, or any third party resulting from installation or ship- 800 -221 -4436
ment, or from any product Rabtity claims of Holler or any third parry. For INS Umaed Warranty to apply, the Units must be Installed in accordance
with all site conditions reWred by state and local codes; an other applicable laws; end Inflhbator's Installation Instructions.
(d) No representative of Infiftrator has the authority to change or extend this Limited Warranty. No warranty apples io any party other than the origi-
nal Holder.
The above represents the Standard Limited Warranty offered by Infiltrator. A fimited number of states end counties have different warranty require-
ments. Ary purchaser of Units should contact Infgbator's Corporate Headquarters In Old Saybrook, Comectiaut, 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 SldeWinder are registered trademarks of Infiltrator Systems Inc. Infiltrator Is a registered trademark in France. Infiltrator Systems Inc.
is a registered trademark in Mexico. Contour, Contour Swivel Connection, MicroLeacNng, PolyTuff, SnapLock, ChamberSpacer, PosiLock, QuickCut, QuickPlay RECrccEDPAPEn
and Quick4 are trademarks of Infiltrator Systems Inc. ® 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0
i
t
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
• county St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
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. 77 nm
Please print all information. Reviewe ' Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` ^^�/ ✓f 1/ //e .
Property Owner ti Property Location
r ''� Govt. Lot NE 1 /4 $W 1 /4 S 1 5 T 31 N R 19 for) W
Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM#
11160 190th Ave 18 na Oak Haven
City State Zip Code Phone Number ❑ city ❑ Village KI Town Nearest Road
Elk River MN 55330 (61 2) 441 -8888 Somerset 21 0th. Ave.
G1 New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 G D T
❑ Replacement ❑ Public or commercial - Describe:
Parent material outwa sh Flood Plain elevation if applicable pa „� ft}
General comments
and recommendations:
trenches @ el. 94.70', spaced to code 3.50' below grade a 2`001
t
Boring COUNTY %\
Ell Boring# 98 .80 +9Q d� *� zUN►NGOFFICE
® pit Ground surface elev. ft. Depth to limiting factor in.
Soil I' e
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary s/
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#2
1 1 4 4 none ls osg mvfr gw if 7 1.2
2 6 -90 7.5 r4/6 none ms os ml na na .7 1.2
# Boring t � Boring
F�2 Pit Ground surface elev. 97.70 ft. Depth to limiting factor +84 in. Soil licetion 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 'Eff#2
1 0 -8 10 r4 4 none is osq mvfr qw if .7 1.2
2 8 -84 7 5 r4 6 none ms osq ml na na .7 1.2
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L uent #2 = ND < 30 mg/L and TSS 5 30 mg/L
CST Name (Please Print) Signature • CST Number
Gary L. Steel X . 02298
Address Date L(valuatioli Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 6 -2 -2001 715- 246 -6200
Property Owner Gerald J. Sm ith Parcel ID# pending Page 2 of 3
3] Boring # f-1 Boring 95.20 110 pit Ground surface elev. ft. Depth to limiting factor +86 in.
Soil Application 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 "Eff#2
if 5 9
2 12 -867.5 r4 6 none ms Osq ml na na .7 1.2
F-1 Boring # El Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil A plication 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 j "Eff#2
Boring
❑ 1:1 Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit I Soil Application 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 "Eff#2
" Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L " Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.6/00)
STEEL'S SOIL SERVICE
Gary L. Steel Gerald J. Smith 1554 200th Ave.
CSTM NE4SW4 S15- T31N -R19W
New Richmond, WI 54017
MPRSW -3254 town of Somerset (715) 246 -6200
lot #18 -Oak Haven
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 11 =40'
BM.= top oft" pvc pipe @ el. 100.00'
Alt. BM,. =top of 1 "pvd pipe @ el. 97.60'
IS/ `
AI m (A
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c
Gary L. Steel
6 -2 -2001