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040-1272-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552343 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)]. Parcel Tax No: Permit Holder's Name: City Village X Township 040-1272-90-000 Allen, Jeffrey S. & Lisa Troy, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ty\ 17,28.19.1516 03.3' TANK INFORMATION EL~VO N D ATA TYPE MANUFACTURER CAPACITY • STATION BS HI FS ELEV. Septic Benchmark r $L, /61 , 2 f o3.3T ~ G 7 ,~j 'T7. Dosing AIM L4•"7 (.7 . S er Aeration Bldg r St/Ht Inlet Holding St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet -7 Septic ! Z Dosing Heade Man. ~D• 3 93 Aeration Dist. Pipe y.;?' $M Holding Bot. System Al 9Z. (419 6. Final Grade G~9 PUMP/SIPHON INFORMATION 1" 44 Manufacturer Demand St ver GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION YSTEM BED/TRENCH Width Length No. Of Trend~-~'~ yy~~ PIT DIMENSIONS No. Of Pits Inside Dia.Liquid Depth DIMENSIONS CE-ACHING SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacturer: _i `I t~ INFORMATION Typ Of System: I UNIT Model umfler: ~a~~..,,~-.'ate lI AJA- (~7 /Zts WL). 4 aa5~- DISTRIBUI"ION SYSTEM L+ZZ Hole S} x Hole Spacing VAir Intake Header/Manifold! Distribution x Pi pe(s Length 16 Dia Length) Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Depth Over Depth Over xx Dept of xx Seeded/Sodded Bed/Trench Center N Bed/Trench Edges Topsoil 'IS Yes UE No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: 7.2 P t r Location: 416 Lost Rock L e Hudson, WI 54016 (SW 1/4 SW 1/4 17 T28N R1 9W) Troy Wood Lot 40 Parcel No: 19.1516 v Ca J ~ ~ Ti S. -S~. S Pa ~cS1 l 1.) Alt BM Description is tie = 1 2.) Bldg sewer length = r~ ~t ,i boP[,., - amount of cover Plan revision Required? Fw~ Yes No Use other side for additional information. J / Insepcto Signat Cert. No. SBD-6710 (R.3/97) Date Col C Lgolt Safety and Buildings i ' ion ounty y ` o;T1 FFIG 201 W. Washington Ave., P.O. Box Cn(~l S Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) P rce S65 23 Y3 anitary Permit Application State Transact i nNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental AM M unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary cur poses in accordance with the Please Print s. 15.04(1 m , Stars. 1. Application information - -Please Print All inf lion Property Owner's Name Parcel # n a- L► s~ 1Q~ eN 4~U • 1~~a, Qv ~ Property Owner's Mailing Address Property Location City, State I V Ll L. Govt. Lot 1 , ` Zip Code Phone Number _ y s W y<, Section UbS O>\i W 1 S S 1 (circle one) • \ fil If. Type of Buildin T a b N; R E or W V g (check all that apply) Lo ❑ I or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use - ❑ City of,_ ❑ State Owned - Describe Use -7 CSM Nunmber ❑ Village of _ ~Townof_ Ruh z/ lb:w- ce-us L,-.j I [I. Type of Permit (Check only one box on tine A. Complete line B if applicable) A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• El Permit Renewal El Permit Revision 101 Change of Plumber List Previous Permit Number and Date Issued ❑ PetTrtit Transfer to New Before Expiration Owner[r./~~ IV. T e of POWTS S stem/Com onendDevice: Check all that a t l o►~Z Non-Pressurized In-Ground ❑ Pressurized In-Ground El At-Grade El Mound > 24 in. ofsua.ble soil ❑ Mound < 24 in. of suitable soil e. hj ❑ Holding Tank ❑ Other Dispersal Component (expi n) - Pretreatment Device (explain) V. Dis ersal/1 rea ent Area 6tformation: Design Flow (gpd) Design Soil Application Rat gpdsf) Dispersal Area Required (s Dispersal Area Prop ed (so System levation Goo s v 88 b m.`~ VI. Tank Info Capacity in total # of Manufacture Gallons e Gallons Units ~ ~ c v id u U ti New Tanks Existing Tanks ~-t~ A 1r-~ a~i via ri, wt5 a Septic or Holding Tank I TO WP, 1 YL Dosing Chamber L) f t~S-e►S--tic ~ V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu s Si re MP/MPRS Number Business Phone Number 5'k "-k y11(31\ ~ Haag vy b4 ION Plumber's Address (Street, City, State, Zip Code) ) b1 b ~W 39 K) JVol0 , V111. ount /De artment se only pproved isapprove Permit Fee Date is ed Issuing A e Signature $ G~ rGiven, Reason for Denial 3 IX. Condi tasot s for Disapproval 1;; ptk nk, efflt>lant fi or entl dispersal cell mast all be sentes I manlalw as per management plan provided by plulrmber: 2.. # scoack ftq*eme[ltc muM be:frlai as per --we cods / ordiiwice. Attach to complete plans for the system and submit to the County only on paper not less than R t/2 x I I inches in size SBD-6398 (R. 01/07) Valid thru 01/09 .A41neo P/o + 3 Q F r~x~ s ~N5 «bl~$oo Q~ cta4u 3u S' Fns u~ Q au O Ir b4U` !-p Cv'VCR G e G ~ -Toruc4 f 941 14 U~ J~~1~ I, qo, c~c ~3h i i i I i I I i CONVENTIONAL COMPONENT DESIGN Residerftiai Application INDEX ANID TITLE PAGE Project Name: T Owner's Name: Owner's Address: bS~~ Legal Oescription: 5 LJ \1 Township: County: Subdivision Name TOOL, Lot Number: b Parcel I'D Number: Page 1 In'd*x and title Page 2 _ Plot Flan P89e 3 S y stem Sizing & Cro on Page 4. Page 5 Malntanance Information Page 6 M_ana -meat F'ian Page 7 St. Groin Ctv,13aptic 'l'ank Mahtenan e Form Page 8 1Narran!y Deed Rage 9 _ -_C:S,M_or Plat - »Attochimants: Soil Test & House Mans Designer/P'hjmber: i v blr r ,~p f a 9 Liitia-nse, Number: Date: _ Phone Number 1: 3 tL -9 va o Signature Designed pursuant 4th Gr ound Soil Absorption Component Manual for r'7VUT'S Version 20 SF3D_10705,,.P rage 9 00 5 'P (;1~nn~tK Co4u , ~U~ al StetLTbN1 1e- 1~V Fhsl IiJ ~~IVf MbN~~~e CvuC~ o e 3x Pn y~g~116M u~ S~b►N~ l 1,7P1~ K~L1ti ~RP ~'V V L ~l 3. 1 3 9 wt ?1 1 * 8 6 3 6 1 8 1 State Bar of Wisconsin Form 1-2003 863618 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 11/06/2007 10:30AM THIS DEED, made between Aspen Development, Inc., a Minnesota Corporation WARRANTY DEED EXEMPT I ("Grantor," whether one or more), REC FEE: 11.00 and Jeffrey S. Allen and Lisa R. Allen A '~~:;FFE TRANS FEE: 1199.70 PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Na in dress needed, please attach addendum): Burnet Tit e 7550 France Ave. S. First Floor Lot 40, Plat of Troy Wood in the Town of Troy, St. Croix County, Wisconsin. Edina, MN 55435 ATTN: Pc,;l C'lc.ing Central 040-1272-90-000 Parcel Identification Number (PiN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated October .2007 Aspen Dev opment, Inc., innesota Corporation (SEAL) (SEAL) * * By: Michael C. eterson, Vice President (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. St. Croix COUNTY ) i racy t. Tumer * .4 1 NletaFy A Personally came before me on Octobe 2007 TITLE: MEMBER STA ` ISCONSIN the above-named Michael C. Peterson , ice President of Aspen Development, c. a Minnesota orpora ion (If not, tope known to be th son(s) who executed the foregoing authorized by Wis. Stat. § 706.06) i ack d the 1 THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg Notary Publ fate of Wisconsin 1200 HosfQord Street, Suite 201 Hudson, WI 54016 My Commi sion (is permanent) (expires: ~L 161 ) (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 C 2003 STATE BAR OF WISCONSIN FORM NO. I-2003 ' Type name below signatures. 1 of 1 Soil Absorption System Crass Section 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap Leaching _ Chamber V A5 Svstern Elevation ft ft ft oil b n System Pan View I-raac;h ing I Bench 1 Chambers n ~Ella. I ETr) Ar 12- Header Vent Or Observation Wipe Trench 3 Manufacturer And Model ~b~ 0>7 k~ E13A Rating sq ft per chamber Sail Application Rate. 9~dlsg ft o gpd Design i loco *1 _ Soil Application Rate . qS _(1_._.. t F--I aA = Chambers rows of o1~_ chambers each. Page of _ T,T a1~•ai~tx pap a "2 .,,~.1~'Y~~;¢i`eii~?`rhai'rii~:•~i.Yi,~' Pa1 Ialk i.,..:i .:............::.:....'.i.:;.,. Inc, s ralrfteltj ~I1rdp 11W?3Rltlrr(~ti?~ C1, (~T 064S2 2 q.1 oll F r~~, E4 r , ~t3••Tb5-f1~~~ s~xlVlok,+~crrr~,,, _ You ar` I'le FrrWtaG.£ petails U T E F F`L FILTER E N 4 i i Raising the bier in Mar toohnoi,a won n"14^625 Effluent. Fit tlPtel" Description ,a~11r11 F~1hl PlAylok, Ina,, is, pleased i;o 47dd tcs new cornmercl,ml f' fer to ft., c.,xistiny firm crf qm allry Kflafor+t rtd $a t.,c7icT^° ^ TU filters. The PL-525 is rated farover'I0,000 CPp (GAlttans Par Dsy~ maklnq it c)ne of thn ~ arg t commerdal filter, in its Clas , It hA U5 linear fr.•.et of 1116" fiitraonn slota. i_ilte the ROOM & Riser Qovam, Polylpk Pi_-122 thA nt7an, Pgfyjn PIS-b.25 haq art ~r,ttUS'nPdtic tihut off ball in tMllad tnrkth Avery ci ''il filter, b'utrn the filter is rp novr•-fit foi' de!0'rinq, the ball will flbat up Rind temp6rarily mijut ofF i l~istt'iYv~rtian anc 1 ~,,tl,l),ml~•, th6 ay4vtorn as the affluent won't In Ave the link, No otlvw itMr on 1'l1e nl trket ran make that M claim! 11 +~~~~rNi849 l^.-*vr•.-rornnmw~emr+,•«•.wnww a « nr InPrarrtl Non^ iif a, ft t?rrl in9 ral;ic'ar+ e~+~gtrest a traot~ !r9d M..,,. m,..•., _.___4 - P aalcltbatl Prrar'latvf~ l p systems n^.nv,errneun+.•mmm.«eanny,•.•.•. l •_~r.,.._...._.,.,,,., ! a'i`l S>slniftry Tees R Qp Rzted for•10,000 CIIL7 (GAllr.,ns Pear Clay) DeflactK9m Enlarge for dctau$ o AGx;o1nF.a~,fc e; of 11'15" fiftr~atinn P~ and 6' SCHD. 40 pipe r s 0 Built in Qe4 n0fladtnr AukomAtic sllit`rerf! b€~II whmn filtar is rramnvec! I ~ # erfrr rtl It Alarm accressbifity 0 Aaceptw PVC extr•;nsiari handle ! iu its 'Th,~ P'I_«•52a F•fllLren£ F"r1t~r .;hauJrV npRrnSrS ontly fray raraavor~al y I ~ Forms & Clamps . roP6 ldi9G~eP 11CItYr1w1k eonditfnn` iaefnra requiting in. ciAanrn it is efici tly foci that-A f M ~ « Nw««~1 q . kinita the t0n1; is pump191 or at Icsst 11-vary ifrrwe yFArs. thra InafRlielylfillCer t tatnlted eve 00011cll ;akarm, the nwner will be not M, M. by an afalval when tho filter, rlegd,~ Oervi&i 1J 8arvickn Ah1S an W!#yi a~# 1i 515hauld clone by a be rertffiieci $ept tank (runa~aar or In$ta►lOr. 11h, i~ ~ir1+t~+~ bra #r f Concrete Accsssorlas 1 t,oc Ate the 41.rtlet of the selai?rr, tsrnk, - X~f7tPf]) prorjugf Remca~r, tAnl< ccrvcar and pump tank iF necessary. E'4-0~Cp 3, Do llot r~9p plulvrftiiriq vvhe;n filtol, i5 r4-1M )Ved, Rl t r~ "1. Bull P1,525 aut of fir. Musing. 5. htc4e of `11te1° avar the septic, tank. MAke surA all Snlirlh fait erwii int'u S ~atiG trrik. Reber ftfvf~ 5. Insert tits fitter cfarfric9t~e Clans into the housinp slaking sure 11r~ l « Tm. w pligl rod hnG# r MPIO wsly imsartol. C tilt.. 4 pr'+~perly and &f R 7. Repkace 9ep(ir.,• tank cover. Pi_..525 InatrarlAdiran; r a«,,, _ . uvagte flours 14P to 10,000 raAcrlm Per I~,A kdc~>i( f0l, Msidendal an ccammPrrifAi ~~~~r~ifl~it~ ~~frd~ra~ lfa t R~ 1i a ~1~1 #r c sus: Tactanfra#'Sp r Of 1. t ryraFla ft nrrtiaf of thra ~eP4. tank. q `iKYf U 2 i~RtYrave tanit cr rrnr And }ate+ri r P1d171pr Fil ar Aq~( $I In tank i 3. Gill,* the fitter llnusinry, fo thra 4" ank ore ef. r r if k Fnraasr~ry,4" A, a `hA AnnASA Openin rash Pot tok Fxanri ri #Ad wndFr ( inaart the PI_,52 .o r y • 4. p 1+ II this filter is, not r.~rrrts , FUt r r1!ltArrrTM Panel an 'marS~ilk~a 1 RIB p (liter fnfo i`c,5 housing. nk 1r p^ AW n r '0 of pipe It.) pr:9nher" tllfQf. ( ~ntrC}f 1 f ~a1'//U; ir~it! ~ l~ Il G ~ t•.,....,m ..»..w••.•Am.,,,,.«.....~.,,,,,,m« r sir ,99 o i11r••tr r~,RnavPr ~icrl~~vnrlv,n; ~~G (S Al 67 tri 'a an A w oil Ci r-. rte. s 25 f~ t/~ ~ ~y,CL Lu pe' l ~6 0l•07, 'bI ~~~n Uc 1 n. 1010 9 ~ 12AM No, Obi I'. 2 { A A POR m r-3 ri° Kr-Y ~ ~ ~t1 m C!J 24 ~i~ Cm CCU G7 r4 . ti.a i tl u Oil. -IF ~efs r ~ 0. im i r ~L. gait County Pl an/Zaning 715-386-4686 1/r FILE I UAL & M,AN~,s~T PLAN Page,, at INFORMATION IOwner SYSTIM 41PNOIFI A7n Pr~rrnit ~@ N ~-t l A p S'aptla Tank Capacity b~D al QNA Saptla Tank Manufaaturar WQ) SR R 0 NA ESlt9lV PAFi,4ME7'llRS Effluent Filter Manufacturer Number of Redra+5naa 0 NA C3 NA Effluent Filter Modol M NA Number of Publio Feollity units NA Pump Tank Capacity estimated flow (average) Z1 U v U U gal ANA Design flow (peslt), (Estimated x 1,d) alPda Pump Tank Manufacturer late 1~`R Cl NA ~ al ds Pump Menufeaturer b cl 0 NA Sall Application Hate x Pump Model Al/day/9`t G V Cl NA Standard Influent/Effluent Quality Monthly average* pretreatment Unit Fats, Oil & Grease (FOG) K30 Mull. 0 NA 17 Sand/Gravel Filter b Peat Filter Biochemical Oxygen Demand (BOO,) X220 mg/L 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 6150 mg/l, 0 Disinfection Pretreated Effluent: Oluality Monthly averags Dispersal Celt(s) A Gather; Sicaheminal Oacygan Damand (3019) QS0 ma/l., O1 NA a bkInMGrpund (gravity) p In-Ground (pressurized) Total Suspended Solids (T 8S) 430 mg/i, C3 NA A At-Grade 0 Mound Focal Colifonn (geometric mean) ;gl04 cfu/1 OOm1 0 Drip-LIna A Other, Maximum Effluent Particle Size Yo in dta, q NA Gltnar: or or, ~ - 13 NA Y 13 NA Other. "Values typloal for domeatlc wastewater and aaptla tank affluent. Other ENA MAtNTENANC& SOHODULE Service Event Servlperregwenrr Inspect oond(tion of tank(sl At least once every„ naaartkft(hJ Cl ears) lMlsltimurn 3 years) C7 IAA Pump out eontants of tank(s) When combined elwclge end scum equals one»thtrd of tank vraluma 0 NA Inspect dispersal call(s) At least once every, a tnanth(a) .ears (lVtaatin111m 3lreers) A NA Clean affluent filter At least once site ry< . on III) NA Inspect pump, pump oantrole & glaarrn At least anon every -0 Marts (s) ❑ NA Flush laterals and ,pressure test At least once every: Cl month(s) " Qthgr, d aor(9' NA At least once every; C( Mona 1(s1 gzhera CJ ear s¢ NA NA MAiNTRNAN1;E INSTRUCTIONS inspections of tanks and dispersal calla shall be rnads by an Individual carrying one of the following lltaoneae or certifications. Neater Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS MaIntalner; aeptale Selv(atn:g Operator, Tank inspections crust include a visual inspection of the tank(s) to Identify any missing or broken hardware, Identify any creates or teaks, measure the volume of combined sludge and scum and to cheak for any hack rap or pending of effluent on the ground surface, The dispersal oellisi shall be visually Inspeoted to check the effluent levels In the obasivadan pfpsa and to aheck for any pending of affluent on the ground surface, The ponding of affluent an thca ground surface may Indicate a failing condition and requires the Immediate natlflcation of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals aans-third (N) or more of the tank volume, the entire contents of the tank shell be removed by a Septa,Se Servicing Operator and dlsppsed of in MCCO Bence with bhepter NIA 115, Wisconsin Administrative Code, All other services, Including but not JIMIted to the servicing of effluent filters, mechanical o.r pressurtted aompgnents, pretreatment units, and any S@rulcing at intervals of 512 months, shall b& performed by a certified POIWTS Mafntafnsr, A service report shall be provided to the laael rsgulatury autbority within i 0 days of Completion of any servioa event, QMW (4/01) Nov-11-2010 10:45 Ar^ St. Croix County Plan/Zoning 715-386-4686 2/2 Page -of START UP AND OPERATION products or other chemicals rccof the poVqTS check trentmem tank(s) for the presence of e~ andlcr damage the dispersal oeli(#l if high concantmtlonnsiaredetected have he contents For new aonstruotion, prior TO use that may impede the treatment p of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when sail conditions are frozen ar, the Infiltrative surface. may raftorad ower levels. watsr l above the discha power outagos II(s) in onellarge dose omal verload ng the cell(sandnmay re wit in he backuap or surfs e d pharpie of sit effluent, to the dispersal affluent, To avoid his sump or contact a Plumber or POWTS p Mtank alntainaroto assist in manually operating herpumptcontrols to power to the affluent p R restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal calla, Do not drive or park over, or otherwise disturb or compact, the arse within 15 feat down slope of any mound or at-grade soil absorption srea, the lifa~ of the Reduction or elimination of the fallowing from the wastewater stream may improve the performance and prolong POWTS: antibiotics; baby wipas; cigarette butts; condoms; cotton swabs; dagroasers; dental floss; diapers; d(sirrfaatarits; fat; foundation drain (sump pump) water; fruit and vagetabis peelings; gasoline; groans; harblcides; mast scraps; medleatlons, all; painting products; pesticides; sanitary napkins; tampons; and water softener brine, ABANDONMENT When the FOWTS falls and/or is permanently taken out of service the following steps shall 69 taken to insure that the ayetem Is properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Cods- • All piping to tanks and pits shalt be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a EQptaga 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 falls and cannot be repaired the following measures have been, or must be taken, to provide ai code compliant replacement system, A suitable replacement area has been evaluated and may be utilized for the to tlon of a replacement soil absorption ,system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by reuird result In the setbacks or a now existing and site evaluation ttoeestablish a suitable (repllaacement arsa, Replacement systems must comply with the rules in affect at that time. as l a last raso: to a replace the failed limitations. Barring advances in PgWTS 13 A suitable raplacernerit area is not installed available ,technology a holding tank may be 13 The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must bs performed to locate a suitable replacement area. If no replacement area is evallabie a holding tank may be installed as a last resort to replace the failed POWTS, Q Mound and at-grade soil absorption systems may be reconstructed In place following removal Of the blornat at the infiltrative aurfece, Racvnstruot)ons of such systems must comply with the rules In effect at that time, < C WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY OONTAINt LETHAL GASSES ANWOR lNIEWAFIDIANlT OXiiGEN. ISO NOT ONTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTAN~S1, DEATH MAY ~(I~3ULT. FIi;IgCUB OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMME TS POWTS INSTALLER POINTS MAiNTAINIENt E Name r►tom, bVtr. f{j f(L Name CUI Phone Phone SEPTAQE SFRWICING OPERATOR (PUMPER) i.AaAL REQ:ULATCfEr u .:.o, 7nt _V ATjj 'fl rzhQ`~' \f~ Name S-f . G"b' Zvi) N PPhone 1 S 3~s- y U Thfs document was drafted in AamplianCa with chapter Comm E83'212( )(b)11)(d)&(f) and 83.54(1), i21 (9J, bitlaconain AdmInlatratlVa Cede, i Nov-11-2010 10:45 AM St. Croix County Plan/Zoning 715-386-4636 2/2 Page -of START UP AND OPERATION rodwota cr other chemicals tha contents Por neW raometCUotion, prior to tree of the PCltA1TS check treetit~r~t tanks) for the presence of paslnt8ng p aati(el. if high concentrations are fie tad have that may impede the treatment praxes ref d/or palm prior use. of the tank(s) removed by a septage sB system stark up shall not occur when stil aandltians are Iroxen K the lnfiltrativs surface. During power outagae pump tanks may fill above normal htghwater lovals. When power In rastorad the excuse Wastewater VAII be lose, In the result may lM and trio over pump tankareimoved by a Septaga Sorvlraing Operator~priordtorestating or su discharged the dispersal coil(s) iota nee largentents of theloading effluent, To avoid tts limp o+n th power to the effluent pump or contact a Plumber or PpWTa 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 calls, Do not drive or park over, or otherwise disturb or compact, the Area within 1 5a lest down slope of any mound or at-grade ac)( absorption area, lwn the life o4 the Reduction or elimination of the fallowing from the wastewater stream may impro game pd rm lr on d arid aperreso a ~lfeoint tat; POWTS: antibiotics; baby wipasl cigarette butts; condoms,, octton swabs; ~ foundation drain (sump pump) wator;rfrut and vegetable peWater;s of nlin , gnri ass; *bliaides; most scraps; medications; oil,, painting products; pesticides; sanitary pi Tampons; ARANl ttNMENT $ ~Sr fmflWisconsin w"Ine stops Ads na"lll 69lta en to incurs that the system is When the POWTS falls and/pr Is permanently taken out of service the Cole, properly and safely abandoned In compliance with chapter Comm • All piping to tanks and pits shall be disconnected and the abandoned pipa openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a $eptage Servicing Operator, • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled wilt sail, grave) or another Inert solid material, CONTINGENCY PLAN If the POWTS fella and cannot be repaired the following measure& have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may ba utilized for the location of a replacement still stiaorptlcn system. The replacement area should be protected from disturbance and ccmpaoftn and should not be infringed upon by required setbacks from existing and Proposed structure, lot lines and walls, Failure to protea't the replacerntnt area will result in the need for a new soil and sits evsluatlon to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time, C~ A suitable replacement area is not available due to setback and/or sail ilmitwdons. Earring advances In POWTS technology s holding tank may be installed as a last resort to replace the failed POWTS, Ct The site has not been evaluated to identify a suitable replacement area. (Moon failure of the RCIWTS a soil and Bite evaluation moat be performed to locate a suitable . raAlaaernant area. If no replacement arse Is available a holding tank may be installed as a last resort to replace the railed POWTS, I Mound and st-grade soil absorption systems may he rscangructsd in piece 'Hawing removal of the biomia't at the "Iltretiwe surfaaa, Re00n=u0 1©ns of such eystams must comply with the rules In a'f'fect at that time, < <WARNING > > SEPTIC, PUMP ,r'l•ND OTHER TREATMENT TANKS MAY OONTAIN LETHAL BASSES ANIIJOA INGUFFIOWNT DXY09N. OD NIDT ANTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRC4IMI&TAN008. DPATH MA.Y RBq LT. FlEl~Ct11; 'OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT Oil Ill POSSIBLE. ADDITIONAL CQIIIIME TS POWTS INSTALLER Name bl~r-4 tJ %-M, Name Phone Phone 3 c' :1 IS -0 1EPTA11E SIzRVICING OPLRATOR tPUMpEffl LOCAL RECdiJLATCJfk A rY Name rzllk r E9J S Phone 1 S ~ ~ l C ~ 3 vb 99 ~a U This document was drafted In pcmplienoe with chapter Comm 88,22(2)(b)(i)(d)&(fl end 83,54(1),q ds (e), Wtaconsin AdrntnlsteatIva Code, ST, CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City/State A~ ok Parcel Identification Number dN u LEGAL DESCRIPTION Property LocationS~A '/4 , S U '/4 , Sec. 1-7 , T NR 19 W, Town of 13' 'G'xly Subdivision Txu ~ ` 00 a , Lot # V. Certified Survey Map # , Volume , Page # Warranty Deed # & 3 r 8 , Volume , Page # Spec house yes 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 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 113 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 a.ll statements on t Pis form are true to the vest of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w ra.nty deed recorded in Register of Deeds Office. Numr er of bedrooms SIGNATURE OF APPLICANT(S) DATE DATE ' ***Any inforxna.tion 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) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presentl serving the L.)Sb ~ ~lk~, Y ng residence located at: 56) W, Sec . N, RSL_- W, Town of ICU County, Wisconsin. Upon inspection, I certify that I have found the St. tankrand baffles to be in good condition, and 't- appears to be functioning pro er Last time serviced P ly. Did flow back occur from absorption system? Yes Nom -line. (if no, skip next Approximate volume or length of time: ,Capacity: gallons minutes Construction: Prefab Concrete Manufacturer (if known) : ^ 3------- steel Other Age of Tank (if known) : s~sex tv (Signature (Name)- Please Print (Title) M'V 95 0 (License 1 Number) . (Date) I' Form to be completed b licensed disposer (NR 113iWiscon Wisconsin Administrative 6 Code Wisconsin Statutes) or - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank co certify that the tank, to the best of my knowled a wi ndition,. requirements of ILHR 83, Wis. Adm. Cade g 11 conform to the outlet baffle). (except for inspection opening over Slvlr\ (name 1,64~e tS' II'C(~ Signature MP/MPRS 2285 Ab* Wisconsin art 1 merce SOIL EV F RT Page 1 of 3 Division of Buildings in ordance with Comm 85, Code A.C.E. Soil & Site Evaluations ~e=,~~~.r County Attach mplete }(t~n* paper the : x 11 inches in size. Plan must St. Croix include ut not I' ed to: v i rence point (BM), direction and parcel I.D. percent lope, ss algq and location and distance to nearest road. 040- 72-9 000 rint all information. Revie d By Date Person in you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Jeff & Lisa Allen Govt. Lot na SW 1/4 SW 1 S 17 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 416 Lost Rock Lane 40 na Troy Wood City State Zip Code Phone Number J City J Village J Town Nearest Road Hudson WI 54016 Troy Lost Rock Lane J New Construction Use: 6_ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD K1 R_ eplacement J Public or commercial - Describe: Parent material Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.7 gpd/sq.ft./day loading rate. Recommended system elevation to be 92.75.'.13, 5 54~ u Boring # I Boring ✓J Pit Ground Surface elev. 100.02 ft. Depth to limiting factor >127" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIit= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr2/1 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 10-23 10yr4/4 none sil 2fsbk mvfr cw 1vf,f 0.6 0.8 3 23-31 7.5yr4/4 none sl 1 msbk mfr gw 1 of 0.4 0.7 4 31-36 7.5yr4/6 none Is Osg ml cw - 0.7 1.6 5 36-58 10yr4/4 none s Osg ml aw - 0.7 1.6 6 58-68 10yr4/4 none Ifs/fs/s 1 csbk dsh aw - 0.5 1.0 7 68-127 10yr5/4 none s Osg dl - - 0.7 1.6 Z~ Boring # J Boring 12 ' 7 Pit Ground Surface elev. 100.46 ft. Depth t limiting factor >130 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/2 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 11-20 10yr4/4 none sil 2fsbk mvfr cw 1vf,f 0.6 0.8 3 20-27 7.5yr4/4 none sl 1 msbk mfr gw 1 of 0.4 0.7 4 27-33 7.5yr4/6 none Is Osg ml aw, - 0.7 1.6 5 33-60 10yr4/4 none s Osg ml aw - 0.7 1.6 6 60-72 10yr4/4 none Ifs/fs/s 1 csbk dsh aw - 0.5 1.0 7 72-130 10yr5/4 ne s / Osgl t dl - - 0.7 1.6 * Effluent #1 = BODS> 30 < 220 mg/L a d TSS >30 150 mg/L ~Z ~2 * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signat re: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, Wl 54020 4/4/2012 715-248-7767 • Property Owner Jeff & Lisa Allen Parcel ID # 040-1272-90-000 Page 2 of 3 3 ] Boring # Boring Pit Ground Surface elev. 99.97 ft. Depth to limiting factor >130" in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P Z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-18 1Oyr3/2 none sil 2fgr mvfr CS 2vf,f 0.6 0.8 2 18-32 10yr4/4 none sil 2fsbk mvfr Cw 1 vf,f 0.6 0.8 3 32-42 7.5yr4/4 none sl 1msbk mfr gw 1vf 0.4 0.7 4 42-55 7.5yr4/6 none Is Osg ml aw - 0.7 1.6 5 55-78 1 Oyr4/4 none Ifs/fs/s 1 csbk dsh aw - 0.5 1.0 6 78-130 10yr514 none / s Osg dL.., - - 42 3 6,7 I Borin F-1 Boring # g Pit Ground Surface elev. ft. Depth to limiting factor in. Sit 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 Boring # I Boring F-1_) 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 -S_30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) A.C.E. Soil & Site Evaluations a EIV36tn q~+aclc ~~a6G., A5ettk nt~4S {oc.nd fa be ~I/cd w/ nazi✓t Sa.d ~ GcL/e~ / = r eF• 0 yS,Ee.a.Aeuse, W&O N~ I•i .I Lawn ' eC iC,. (e 5 /c,~es I, is d Y 5cjq, C -6&,X man Ao/e ' byG~abo~v z^~~• ~ 3 dccec 7 = Bcn~li rrfarC~: tdocv,~ Or- S'-d' n . i4ssun+tol wc.►f 'sfn r---- elc~=~o3.34' EXi i K/Si~Q/!GG d J i r- ~ h a Lo St ~oc.~T.-r.'/ 0-,t de-Sac- pq , 3 0~'3 d Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 488036 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: A letree Builders Troy, Town of 040-1272-90-000 CST BM Elev: r Insp. BM Elev: I IBM Description: Section/Town/Range/Map No: W .O t30.c7 a-~ c cC► 6MA 17.28.19.1516 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic On q,, Benchmark 45gs r Dosing Alt. BM Aeration Bldg. Sewer 10 t Holding St/Ht Inlet f 13- !Z ?2- TANK SET CK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > S-0 1 18 / Dt Bottom '6 • l O 6 • IS! Dosing Z f Header/Man. U1 O 0 Aeration Dist. Pipe V 1 Holding Bot. System 36 (0. S ~ PUMP/SIPHON INFORMATION Final Grade 0 99 Manufacturer S S d St over 6 V C19. W' Model Number 1 16O. Lift •3~/ Friction Loss System Head TDH~ . bt Forcemain Length , Dia. Dist. to Well O I, \ n > SOIL ABSORPTION SYSTEM $ 5 W-WfRIENCH Width Length I No. Of Trenches P IM Liquid Depth DIM 3 O f Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactu INFORMATION CHAMBER OR xq~ Type Of System: ( 5_6 UNIT Model Nu er: v DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake e(s) Length Dia Len Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over FBdp Over xx Depth of xx Seeded/Sodded xx Mulched Dethrover Center rench Edges Topsoil ~',y~Y/es No ]Yes ~J] :N.] COMMENT/g:,,(Includq,codl~RCies, a ons pro y , etc.) Inspection #1 4_ Z4M1o Inspection #2: T7r Locatio7n^:~`74T6 Lost Rock Lane Hudson, WI 54016 (SW 11/'4IV 1/4 17 T28N R19W) Troy Wood Lot 40 Parcel No: 17.28.19.1516 1.) Alt BM Description = 5' , 2.) Bldg sewer length = 181 3 -amount of cover CAS Plan revision Required? ]Yes No - l Zvi Use other side for additional information. _ - - L Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) l~ Safety and Buildings Division County 1~S~~~S~i~ 201 W. Washington .Ave,, P.O. Box 7162 Yd Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co,) j Department of Commerce 60 - Z/3:$ b 3 Q II Sanitary Permit Appl at State Plan 1. D. Number In accord with Comm 83.21, Wis. Adm. Code, personal orma ' u ro d may be used for secondary purp Privacy La , s15.0~ r) 2QO Prgject Address (if different than mailing address) 1. Application Information - Please Print Alll,rmation ST. CROIX COUNT ~L. J n r ~r Property Owner's Na me ~ / lQ L K /-ci X Parrcceell # Lot # Block a Property Owner's M ailing Address Property Location j City, State ;;_2 ode Phone Number _ •_1A,Section %Z~ 7;14',-d (circle o II. Type of Building (check all that apply) k T N, R /9 E q i o ao ~J-M~ 0l or 2 Family Dwelling - Number of Bedrooms n/o 4:U4_- Subdivision Name CSM Number +I ❑ Public!('ommercial - Describe Use,` y~ _ _ i ❑ State Owned -Describe Use 16-City_❑Village e.fotwnsnship-of Zino i ~ _ I III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - / 27Z - 9 - t~Gt'U _ A, New System ' L1 Replacement System I J r reatmendmolding Tank Replacement Only ❑ Other Modification to Existing System B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumbet Owner IV. Type of POWTS System: (Check all that apply) (Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil L1 Mound < 24 in. of suitable soil At-Grade 11 Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ molding Tank ❑ Peat Fitter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ,W Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) 4 5 V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed ( f) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic ' Gallons Gallons of Units Concrete Constructed Glass New existing Tanks ~ Tanks f¢- Septic or Holding Tank ~O Aerobic Treatment Unit - Dosing Chamber ]7~ VII. Responsibility Statement- 1, the undersigned, assume responsibility for ` ynAullation of the POWTS shown on the attached plans. _ Plumber's Na me (Print) Phum-~ber's Si gnature// M PRS Number Business Phone Number /44-C!`LLl9/I ~'(•tLn7'hCv~~i' Or°~~ / 7O ~ls'✓QG ~l.7! Plumber's Addre ss (Street, City, State, Zip Code) / I L VIII- ounty/Department Use Only i Approved dye Sanitary Permit Fee (includes Groundwater Date ssue Issuin gent Signa re Surcharge Fee) tven Reaso r Denial ..X.U ~ ~ /z /9 ~5 IX. Conditions of Approval/Reasons for Disapproval r N11s< W00# 3) ~o, rvtit l- 5 o~v.e~' i'v►a tic ~ncSZ. t. l elft halt, WOUNd nor and / V dspo" CON must ON t1e_t t G,ovu eot.~J F~(`• as par menegameM plan provided by pkxnbsr. 2 AN sdx" requirements must be maintained as code f ordin antes. L 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) i ~ a .NNMWD M3T#YZ bns ~Mlt 1M1eu!►h ina~ x1ut8 ?fl„ 7~{r -.P':,:. ~ _ _<,a 116 ?Ytsm i•w..~ :r;.=~!►~€:r:~ t•atj~s•.,ip : •.~.j 1n!+~~~ne r, -~rG ct ~ ~,,ri-.. ~ ~i~ 7 i .'?r'.4f1't9R{.~t91 ?~Jb+'~7`!t "A S • N Y I, 3 •wAl 3 a 1358 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and parcel I.D. percent slope, scale or dimemsions, north arrow pnd location and distance to nearest road. Pending Please prit7t4044ormation. Reviewed By Date Personal information you provide m vsQA'(or secondpurposes (Privap s. 15.04 (1) (m)). Z / S Property Owner C.- 1f Property Location Humbird Land Corporation - Govt. Lot 1/4 SW 1/4 17 T 28 N R 19 W Property Owner's Mailing Addres ' : _t NI(y f Lot # Block # Subd. Name or CSM# 332 Minnesota Street, East t404 ST kC, x ' -y 40 n/a Troy Wood Subdivision city S~~e+'Zip Code PhUN-Rl'umber l City _J Village let Town Nearest Road F _j Saint Paul M ,~55, ~eV222-5555. Troy E Cove Rd / Lost Rock Lane 0 New Construction Use: e Res"rAial / Number a rooms 3 Code derived design flow rate 450 GIRD Replacement Public or commercial - Describe: Parent material outwash plains Flood plain elevation, if applicable n/a General comments and recommendations: Part of 1.5 acres. BM #1= 100.0'. BM #2= 99.05'. Recommend 96.45' system elevation. P23 from preliminary boring work done 5-5-00. 3 [P2-3] Boring # l Boring d Pit Ground Surface elev. 99.0 ft. Depth to limiting factor >75 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0-9 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 9-15 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 15-22 10yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 22-39 10yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 5 39-53 10yr5/6 none gr. s 0 sg ml cw - 0.7 1.2 6 53-75 10yr6/6 none , Is' s 1 msbk mvfr - - 0.7 1.2 ~~o ~ ►I .,JE" Qb 3 / Boring # Boring 3p .~v 3 r to 1/ Pit Ground Surface elev. 99.65 ft. Depth to limiting factor >75 ✓ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= *Eff#1 *Eff#2 1 0-10 7.5yr2/0 none sil 2msbk mvfr as 1f,1m 0.5 0.8 2 10-15 7.5yr3/2 none sil 2msbk mvfr cw 1f 0.5 0.8 3 15-22 10yr3/4 none sil 2msbk mvfr cw - 0.5 0.8 4 22-34 10yr4/6 none gr. sl 2msbk mfr cw - 0.5 0.9 5 34-43 10yr5/6 none gr. Is 1msbk mvfr cw - 0.7 1.2 43-55 10yr5/4 none gr. Is 1msbk mvfr cw - 0.7 1.2 ~c6 f 7 55-75 10yr5/6 none s 0 sg r% ml - - 0.7 1.2 I * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L 'A 1 'k'- -Effluent #2 = BOD5 < 30 mg/L and TSS <_~0 mg/L 2 CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450937th St., New Auburn, WI 54757 11/21/00 715-658-1344 1 i O Property Owner Humbird Land Corporation-_ _ Parcel ID # _._Pending _ _ J Page 2 of .3 F2 ] Boring # _I Boring 3 F - 5 a~o,~ar C✓ 6/ Pit Ground Surface elev. 97.95 ft. Depth to limiting factor ->75 in. Sal Application Rate - Horizon Depth Dominant Color Redox Description Texture Structure _ _ _ Consistence Boundary Roots ____GPDIft _ *Eff#1 'Eff#2 1 0-13 10yr2/2 none sil 2msbk mvfr as 1 f,1 m 0.5 0.8 2 13-18 10yr3/4 none sil 2msbk mvfr cw 1 f 0.5 0.8 3 18-27 10yr4/4 none sil 2msbk mfr cw - 0.5 0.8 4 27-36 10yr4/6 none gr. Is 1 msbk mvfr j cw - 0.7 1.2 5 36-46 10yr5/6 none gr. Is 1 msbk mfr cw - 0.7 1.2 6 46-62 10yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 7 62-75 10yr5/4 none s rr011sg ml - - 0.7 1.2 3 ] F 16 Boring # Boring 3 - gy, Pit Ground Surface elev. 98.65 ft. Depth to limiting factor >75 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots - GPD/ft'_ _ *Eff#1 *Eff#2 1 0-13 7.5yr2/0 none Sil 2msbk mvfr as 1 f,1 m 0.5 0.8 2 13-18 7.5yr3/2 none sil 2msbk mvfr cw if 0.5 0.8 3 18-25 10yr3/4 none sil 2msbk mvfr cw 1 f 0.5 0.8 4 25-40 10yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 5 40-64 10yr5/6 none gr. Is lmsbk mvfr cw - 0.7 1.2 6 64-75 10yr5/4 none s 0 sg ml - - 0.7 1.2 F-1 I Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor - in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ---SP__ *Eff#1 *Eff#2 I I ' Effluent #1 = BOD y> 30 < 220 mg/L and TSS >30 150 mg/L Effluent #2 =GODS <_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, Dlease contact the department at 608-266-3151 or TTY 608-264-8777. j Property Owner Humbird Land Corporation Parcel ID # Pending Page 2 of 3 Z Ong # _J Boring Pit Ground Surface elev. 97.95 ft. to limiting factor ✓ ~P >7 _ 5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRI *Eff#1 *Eff42 1 0-13 10yr2/2 none sil 2msbk mvfr as 1f,1m 0.5 0.8 2 13-18 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 [27-,36 27 10yr4/4 none sil 2msbk mfr cw - 0.5 0.8 4 10yr4/6 none gr. Is 1msbk mvfr cw - 0.7 1.2 5 36-46 10yr5/6 none gr. Is 1 msbk mfr cw - 0.7 1.2 6 46-62 10yr4/6 none Is 1msbk mvfr cw - 0.7 1.2 7 62-75 10yr5/4 none s 0 sg ml - - 0.7 1.2 3 ] Boring # J Boring 3 ✓ F td Pit Ground Surface elev. 98.65 ft. Depth to limiting factor >75 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -_-__SPDLfI.__ *Eff#1 *Eff#2 1 0-13 7.5yr2/0 none sil 2msbk mvfr as 1f,1m 0.5 0.8 2 13-18 7.5yr3/2 none sill 2msbk mvfr cw if 0.5 0.8 3 18-25 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 4 25-40 10yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 5 40-64 10yr5/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 6 64-75 10yr5/4 none s 0 sg ml - - 0.7 1.2 F-1 Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIf - *Eff#1 *Eff#2 ' Effluent #1= BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD5. 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. IL X ~e+ y R2 3 Ca,., f car Con-fcu ~ r Vi CL Q~3 O'j l 47L/00,0( -For c F 3/y" Tr,, f, f c Pf [ Markrr- T ~3 m #;z EL c7 9,0.5 QF 7 1 .rron fjJ Mgr~Ct/ N .S;1 o r i'v vi/ &C k 1~caG ee~f F A S" crc s ~o L~s~ Ko~k[~,re Pj C3pF 3 S1 . CROIX COUNTY SEPTIC TANK MAINTENTANCE AGREEMENT AND C>'UNERSHIP CERTIFICATION FORM Owner/Huy et ..Jzfz,Z~:" Mailing Address Ga'~ wd Property Address l~ kn s 7"- - _ (Verification required tiant ?lacuuug & .7,oning .f)vpartnlenr for new «oristtuctiotz. r_.- Citv!State Pai-eel Identification Ntunber LEGAL DESCRIPTION Property Location 'is 1.~ _ 't, .Sec 1Z T Off-NR /0 W, Town of c... . Subdivision Certified Survey Map Volume_ Warranty Deed # ~ 73 % ohlrrte page Spec house ycs n;. Lot lines Identifiable yes no SYST -M MMNTE'VANCE AND OWNER CERTIFICNIJON ltttptoper use and maintenance of you; septic system could result in its urrnwwa failure to handle wastes. Proper mairtenance consists of purnping out the septic tank every' three yzaii or sooner, if r_eeded, by a licenard purnpcr What you put into the system can affect the function of the septic tank as a treatment siage in the waste disposal system, Owner maintenance responsibilities are specified in §t°omm, !I3. S2(1) and hi C after 12 - St. C'reti t'vurr±y Stn fiery ordinance. The property owner agrees to subtnit to St ('roix County Nzruting & Zoning Department it certificatiozi firm, sigscd by the owner and by a master plumber, journeyman plumber, resmcted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and"Or (2) after inspect!on and pumping (if necessary), the septic tank i:. less than 1i3 full of sludge Fwe, the andrrsigued have read the above rcu.airctnents and agree to maintain the pr,vate sewage dis'posai system With the stanlard4 sst forth, herein, as set by the Department of Cwmncrce and the Dt parmettt of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retttrrted to the St. Croix County Planning K Zoning Departme.it within 30 days of the three year •:xpiration date. Iiwr certify that all statements or, this form air trcte to t1w best of my%our knowledge, liwe am/ure the owner;) of the property described above, ny virtue of a wars anty deed recorded in Register of Deeds Office. Number of bedr omens 'IGNATt~ E OF APPLICANT(S) DA TIE 'Am, srt.orniation. that is misrepresented may result in caniiary permit being revoked by tha Panning }tit Z,;ninp D;~pamtwnc '.zclude with they application a recorded warranty deed bore, th., Regutei of Dec< i1 Otfie and a copy of'the certified suivev n:ap i! rei'erence is made in the warranty deed, (REV. 08145) 7 7 3 7 6 4 U, 2 Q S 2 P O O KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co.. WI Document Number RECEIVED FOR RECORD This Deed, made between Day Farm Investors, LLC, a Minnesota Limited Liability Company 09/08/2004 01 :00PH WARRANTY DEED EXEIPT M Grantor, and Appletree Builders, Inc R TRANS FEE.- EG FEE.- 251070 COPY FEE: CC FEES _ PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recordin Area Name d Return dress Lot 40 Troy Wood, Town of Troy, St. Croix County, Wisconsin`, 040-1272-90-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements,restrictions,covenants and rights of way of record, if any, including but not limited to those for drninage,water retention,ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St. Croix County, Wisconsin.The warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to an amount not to exceed the consideration expressed herein, that being the sum of $83,900.00. Dated this 30th day of August 2004 Day Farm Investors, LLC by . DD President : . Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) )SS. Signature(s) Ramsey County Personally came before me this 30th day of authenticated this day of August 1 2004 the above named Austin J. Baillon TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (if not, instrument and acknowled a the same. authorized by § 706.06, Wis. Slats.) l--P~ ■ THIS INSTRUMENT WAS DRAFTED BY PO Paul A. Batson, Attorney at Law Paul A. Baillon ■I oN s i ai aaoa Notary Public, State of Wisco (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (If not, state expiration date: necessary.) January 31 2005 ) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE LIAR OF WISCONSIN FORM N0.2 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800-655-2021 s POWTS OWNER'S MANi t & MANAGEMENT PLAN page as FILE INFORMATION 8X? SPi:C114CATIM Owner 4ee-0,Wic Tank Capacity ,2 al Q NA Permit 13sp~Ic Tank Manufacturer ❑ NA DESIGIN PARAMETERS Iffluent Filter Manufacturer 13 NA Number of Bedrooms G NA 9,k" nt Filter Mode( e0 C~ NA Number of Pubic Facility Units, Q l Purlrp Tank Capacity al O NA Estimated flow (everatae) 4'~f # Pump Tank Manufacturer I_b r6,s er.- O NA -Zj Design flow (peak). 1Estimated x 1.5) 4 41 d ell Pump Manufacturer 0 NA Soil Application Rate al Pump Model 0 NA Standard Influent/Effluent Quality Monthly ayer'400 Pr eatment Unit DNA Fats, Oil & Grease (FOG) 00 mg/L Q # vdlGrave) Filter ❑ Peat Miter Biochemical Oxygen Demand 18005) 52.20 MOIL Q NA Q Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m@IL a Disinfection ❑ Other: Pretrested Effluent Quality Monthly average -61-1-04" Celt(s) ❑ NA Biochemical Oxygen Demand (80041 00 mgfl+ Q In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) $30 mg1l. Q NA Q At-Grade ❑ Mound Fecal Coliform lgeomertr)e mean) S10` 041100m1 Q Drip-Line ❑ Other: Maximum Effluent Particle Size Y$ in dig. 13 JNNAA 0 NA Other: Ia 0 NA CWW; 0 NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At Igait cno# every: 3 ear s month(*) IMexlmum 3 years) O NA Pump out contents of tank(s) Whom combined sludge and scum equals one-third IYai of tank volume ❑ NA Inspect dispersal cell(s) At least once every; earUt11s1 (gym 3 years) Ci NA Clean effluent filter At least once every; O e) ❑ NA Inspect pump, pump controls & alarm At least once aviary; p m er(a), DNA 'E3 month(s) ❑ NA Flush laterals and pressure test At least Once every: r- Q yeaNsl Other: At laser once every: ❑ year() p NA Other: 13 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an indlvklual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWT$ Inspector; POWTS Maintainer; Septage servicing operator, Tank inspections must include a visual Inspection of the tpnk(al tg idgntlfy any missing or broken hardware, identify any cracks or tasks, measure the volume of combined sludge and scum mod to check for snV back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the affluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluen 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 (Yg) or more of the tank volume, the entire contents of the tank shall be removed by a Septags 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 pffluelnt filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be perforlmed by a certified POWTS Maintainer. A service report shalt be provided to the local regulatory authority within 10 days of completbn of any service event. Page- of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment lank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage that disprsal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operiltilr prior td use: - - System start up shall not occur when soil conditions 4r* frp2 at the Infiltrative surface. During power outages pump tanks may f8i above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) M one large doaq, avorioadlno the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contento of the ponp 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 calls. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grads 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 vetlillatable poelings; gasoline; grease; herbicides: meet scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and we tor softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the fQgowing steps shalt be taken to insure that the system is properly and safely abandoned in compliance with chapter Comrp 83.33, Wisconsin Administrative Code: e AN piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e After pumping, all tanks and pits shall be excavated and reMoyad or their covers removed and the void space fitted with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS feats compliant and cannot be repaired the; following measures have been, or must be taken, to provide a code replacement system: O 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 diatulbpnoe and compaction and should not be infringed upon by required setbacks from existing and propopW structure, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evailoation to eatabiish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. 13 A suitable replacement area is not evatlabia due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be Installed int P last resort to replaos the failed POWTS. 13 T site Al~ e 0, 10, 1 W., s if, go rall holding tank 010 O Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomet at the infiltrative surface. Reconstructions of such sysfan'is must pompiy with the rules in effect at that time. < <WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANK4 MAY CONTAIN LMI AL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT , RESCUE 0 A ENTER A SEPTIC, PUMP OR OTHER TREATMENT YANK uNtt0ft RIMY O)IiCUMSTANCEB, DEATH MAY RESULT PERSON FROM THE INTERIOR OF A TANK MAY Ito 41!*10_ 41 on l ll~ IDLE. ADDITIONAL COMMENTS POWTS INSTALLER PO S MAINTANVER II, Name , 14'u ,r, o~e~y^ Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL EflULATORY AUTHORITY Name Name x Coo- L __n Phone Phone - 3 $ (o ` mil' This document was drafted in compliance with chapter Comm 13.22(2)(b)(1)(d)&(f) 94 83.5411). (2) 6 (31, Wisconsin Administrative Code. Page --ot START UP AND OPERATION For new construction, prior to use of the POWTS obp94 traatment;ankla) for the presence of painting products or other chemicals that may impede the treatment process and/or damage ihq dispersal selN*!. If high concentrations are detected have the contents of the tank(&; removed by a septage servicing oper(ltsrr rarlQC to +a9e: " ' System start up shall not occur when soil conditions." fr.pgen at the infiltrative surface, r a: 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 dosq' QyarioadIn~ the collie) and may result in the backup or surface discharge of effluent. To avoid this situation have the content$ Of the pu(np tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTl 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 calls. po not strive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-gran) soil absorption area. Reduction or elimination of the following from the wastsfwater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes, cigarette butts, co of . acs (tors svltabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and v9elaple pbai(nga; gasoline; grease; herbicides: meat scraps, medications; oil; painting products; pesticides; sanitary napkins; tsmptina; and watalr ssattetls¢r brine. ABANDONMENT the following steps shall be taken to insure that the system is When the POWTS fails and/or is permanently taken out of sgr. ice properly and safely abandoned In compliance with chgpter Gomm 30, Vidiliconsin Administrative Code: e AN piping to tanks and pits shall be disconr)sated and the. abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed end 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 measurea have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evalufited end may be utilized for the location of a replacement soil absorption system. The replacement area should be prOtes31ed from disturbance and compaction and should not be infringed upon by required setbacks from existing and propp* atructltre, lot lines ar!d wells. Failure to protect the replacement area will result in the need for a new soil and site evdlustlon to oaijt hsh a suitable replacement area. Replacement systems must comply with the rules In effect at that tNnq. ❑ A suitable replacement area Is not avallabiq due to asDtbook and/or soil limkations. Barring advances in POWTS technology a holding tank may be Installed stets last reoprt tp replace the failed POWTS. him Pn sits © The sit e tank C) Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such aysioms Moot aonlply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKd$ MAY CONTAIN JATHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENt TANK UNDi*I!t ANY OIEiCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY tPIIZIC~# (IPQ;BIBLE. ADDITIONAL COMMENTS POWTS INSTALLER pcWTS MAINTAINER Name Name Phone - .9' i~Norte SEPTAt3E SERVICING OPERATOR (PUMPER) C REGULATORY AUTHORITY Name Name -715 Phone Phone _ 3 $ (p - This docusnent was drafted in Compliance with chapter Comm #3.22(211 4(f) and 81KI), (2) 4 (3), Wisconsin Administrative Code. {y :NT PIPE MIN. 25, rRpM !?C(2a WS N:~OW p 13:~V G.IAD1~ i ~IEATi~~RAROQf FRESH AIR :NTAXE :UNCTION DQX A~FROtdcD F+`NISHE~ ~ WITH CONDUIT `"FOLE CoJ£R aRAI. W1 PAD LOC X i Lltl f • 4'LcT WAT=R I'Iati: SEA` f A7 GAS• } r`• TIGHT PpROVE~J . A SUL JOINTS WITh 'TPA 3' a r BALM APP VID PIPE INTO Sill ID I {--f•.- 440N j ~ 31 im 'OIL s 1 SOLID. SOIL C PUMP OFF ELEV , IT, RIM EXIT D MWITTED CN;.Y ' If TANK NANUFACT'. 3" APPROVED armobNG VtiDER TA?NIX HAS APPROVAL CON%0 EI'P PAD SPECIFI-C'AT:CN5 ""TIC i D03Z "ANX MAN',JFACTJRtR: j x-wr. h"-iM+3ER 40,w,ES PER DAY: l ,'•~~tl. S.. Iii SEF"'IC "'o GAL. iNC a~ZwNG 00 - GAL. ~ LARM MANUFACTURER, " MODEL WMaZRa CAr.gIZ:IFS1 A : -lNCXtS s ~aAL. SWYTCki TYPE: wmgpr _ INCHES ,•n,m„ NR mourACTVAJR ; .GA i Moat. mums v C INCHES • ~GA:,. SWITCH TYPE: ~ mew GAI, =RED A78C KARQE RA? aP: P'.'MP "AAM WIRING AS F I . r ""--CAL :)"'wnENCE BE. ~ Y~iY1R 26~Z3 MINIRVII NETWORK SUPPLY pRS:SSUREOFFYAHL S'p,!8tli:ON F7FE . • FEET' FORCEMAZN x FT1300 F; . FEET FR~~ TO?.~LIDYKAMXCAHZAIi 1'EET EN':' ''"UNAi. OIMI::e:ptiS 61.F +"•i~'~!P I►A!SK: E!tiGi;y , F FrEl W:ZTK 02 60 ' '`I9ER ; . kGOULDS PUMPS Submersible Effluent Pump EP04 3871 EP05 APPLICATIONS • fu6y submerged in high 0 Ei~06 Impeller 7hermopias ar Bearings: Upper and lower Specifically designed for the grade turbine nil for tie enelod design for heavy duty bail bearing lubrication and efficient WPM* performance. construction. following uses: heat transfer. • Effluent s stems M t,;a4i ;<nd Base: Rugged Y * Homes Available for automatic and design provides AGENCY LISTING Farms manual operation,,ul - supatlor >i#ttyngth and corrosion ~ saanduaJs Assod4on • Heavy duty sump matic models incite fn' • Water transfer Mechanical float 1Yiritco MI Moor Housing: Cast iron (C5A listed model numbers end * Dewatering assembled and presit at the br ifil6ent heat transfer, In "F" or "C".) fadoty. and durability. SPECIFICATIONS Motor Cove: Thermoplastic Goaids PvmF5 is lso 9001 N 0dmd. FEATURES "It; with 4egral handle and Solids handling capability: 5041 90111: l attachment points. maximum, 8 EP04 Impeller, Thermopla5- a Pgwaible: Severe duty Capacities: up to 60 GPM. tic Semi-open design with rated oil r C water resistant. • Total heads, up to 31 feet. pump out vanes far mechainical • Discharge size: I'!,- NPT, seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N eiastomers. • Temperature: 1040E (4OcC) continuous METERS FEET 1 40*F (60n intermittent. 10 r- - • Fasteners: 300 series stainless steel. f - • Capable of running e ,,.r-s t:r~, dry without damage to $ T 2s Fr components. W _ _ ' . _ T Motor: ic EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with s i automatic reset. 4 EPOS • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, 3- 101- built in overload with - E , automatic reset. i, • Power cord: 10 foot ( 5' t standard length, 1613 1 r ' . S1TOW with three prong grounding plug. Optional 20 cL 00 to 20 30 40 so GPM foot length, 16/3 SJTW with 1 three prong grounding plug 0 2 A 6 8 10 12 m~ih (standard on EPOS). u►eACi7Y Goulds Pumps ® 2000 Gouid$ NrnP$ ITT Industries Effective February, 2000 63871 ~ TM uiCk4 STANDARD CHAMBER 52" Quil Standard Chamber - 48" - --y! (EFFECTIVE LENGTH) 12" * i 1 8• ' ~ 11 - 34" SIDE VIEW SECTION VIEW MultiPort End Cap f1 ` 16•` r 12" f r 1 1 \ 34"- ; SIDE VIEW TOP VIEW FRONT VIEW ~tld"tar W x a $}r_` 1 !r. r r "quick4 Standard~Chamber Nominal Specifications r r , 'MultlPp End CaQNominal'Specifications ` Size(WxLxH} 34"x52'x12 Sizer(WxLxHj 34'x1 6"` z 12" Effective Length 48" Irivert Height 8" or 1.25" Invert Height 8• INFILTRATOR-$X5TEMS INC STANDARFl~ IMI )gip WARMNTY i'-1 Ih slru[tu al ugrity nr a' ch ch-tl- old plate, wedge z d .two stay n arndncrutod by I ill 'w ( Urdt:; I, wnat it talleth ar rip Oirtratxt i+ a Isa-t Geld n nn -A to snotic system in ac-ditnca with infiilrala s _t ucl u+ts, Is warrai to Ir. r urig~r rep txtrchaser t9latun) nq ,l dwitt r n',alW leis antl wnrkm:u ,hop for ate year frum IM dale Thal the sap&G parr r,il is `"-w for lho atTHlc. vyst--.+A itirg t e Uses; pmvidetl, hrw.wer, t 31 1 ;oplie pe nit s nM requ ltd by applreeble law, the ; t, pe I po tna date l 1' ,+.allatror o1 to. aeplif. yalMrt fOnenences. To P . se ifs Wa .aoty rights. Hoder most nottly Iof ialo t wafng at lU tea porale Head:! + ern in O. 1 uybmok Ca necticul w+thin ridledr 05) r ' . da of the allayed defect. InENralor will supply replaocme t Units is Ur 't determined try Infiltrator to I CtlteRad by t[$a United Wan a^ly. in+ll alor s rabildy spectu~aly eeoludea the Cost of removal wd/or installation of the Urals. O P TC HE tWrS,U WARRANT' ANU RSMEDIE , :NI SU!ipARAMERCH (a) ARE TY Oi FlTlq 1 i; FO ARE NCiCULAR WARRANTEES WRF RESPECT SYSTEMS I N C TU TYE UN(r;- IN::LUUING ND IMPl1ED WARRArJ[IE.S OF MERCHANTABILITY OH flTlul( ~ fCiR A PAlil'ICULAR Fal1RPOSE. p 17i s I.imlled Warwiv shall be Vold d any pad cf the rhamtla~ system r ruartt,lacanred ,y Tryons other Ih,ur i0linllor. 1he Linrrlsd Warranty does n t rytend to it t tdentel, constriquerdiel. special or a irect d-+mages. milli ate shah not ha i hlo lar f tailkl s or r4wialeo damagc5, including toes of Envtronmwifel 017811 WntgMtOr S U607s~Pe I cat In and ens II and malerrals, Ov neaa Cost or thor ~oeses ar exoens s imttrrerl Cy the riddor or any Ihil I paty. Speoili-i eve,l 11en fr :+m Lmluj W,wranly coverage am damage to the un Is du; to ordinary wear anti rear, alteration, accide it mist abuse or nuplsCf of p lit ll. 'IS the Unts ue ng -h~rterl to vehicle Imffio or Other aundlions whtk r, are tool permillnd try the installation tslrucfivw (&,it- to "lR 11rn the 6 Business Park Road " P I Box 768 r n:rnum grow d avers sal forth in the installation in ilructonei the PIa.:2mant of impmeer ma .ill is ,r io the system contalning the UrWS; fa~ture of Oi .t fha I Ills or Ill. septa syslOnti rite to improper eafrg or improper ,iarra, o~p3tieive water usage, inrpreper grease dlspoeal, Or Improw opera/]rl a ~d Saybrook, CT 08475 any oche, ew_nt nor Caused by Infiltrator, This limited Warranty ytall tte wid g the Holier ImIs to oamply with all of We terms set bah In this Limited Na`s'ty. 860-577-7000 • FAX 860-577-7001 Further, in no event shall Inlittralor be responsible fur airy lose or damage to [rte Holler, the Lmils, or any third party resulling from instellai or :trip- 500-221 ~A ,~~w meat, or from any praiuct kabllnv claims of Holder or arty this pang For [his Limited Warranty to apply the tkots moat be Installed In aworderwo v G `Mf v with all site conditions reyrtired by slate and kral codes; all other applicable laws; and Inliliralor's installation tnS1A.CtorLS. idl No relrm"~o tativa of InkXrator has the aut"PIV to change or ea!end this Lnniled Waaanty, No warranty applies Io Rory early other than the oriyt- nal Haider Tltr` above mpresents the Sta.tdanl Limited Warartly naertxl by kJdlrolor. A limitorl rwn+i of riat., and Cptatl- le. direreM w-e: teary regrme- " Mks Ally parGtasar of l.lrrils should c:nttacl InlRrabr's Cur,,orai. Heatl4uaners rn Ol1 S;rybra,k, Came fiiiut tsar to such pwnhvrsa, to obtain a ezgry o+ Ina applicabe warranty, aril slruuld carefully read that warranty prior to the purh+ase u: Urvis. U.S Patents: 4,759,661; 5.017,041; 5,156,486; 5,,36,017; 5,401,116; 5,4Gt,nu 1; 5,51 1,903; 5,716,16.; 5,588,778; 5839,844 Canadian Patents: 1,329,959; 2004,564 Other patenls pending. intiltl<ator, Equalizer and SideWindei are registered trademarks of Infiltrator Sys".ems Inc. Llfdlrltor is a legislated tradomork in France. Infiltrator Systems Inc, is a registered trademark in Mexico. Contour, Contour Sunvel ConnecLlort, Mrooltlaching, PolvTutl, SI°rdpl-ock, Charntierspacer, Posil-ock, QdickCut, QufCkPlay RECVCLEOPAPER ,:i -id Uuiek4 are trademarks of Infiltrator Systems Inc. 0 2003 Irfitrator Svr tarts Urc. 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