HomeMy WebLinkAbout040-1310-00-021 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
` 1 y (ATTACH TO PERMIT) 488155 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
DCCI Land Planners I Troy, Town of 040 - 1310 -00 -021
CST BM Elev: Insp. BM Elev: BM Descripti Section/Town/Range/Map No:
9{ 7Z - VA A-W P& (1� "(— 17.28.19.2008
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTU R CAPACITY STATION BS HI FS ELEV.
Septic Benchmark mar r . 13 417-61- Cr7 Z . 'b
Dosing AItBlf� we y 7.3-1
Bldg. Sewer D�*
H olding St /Ht In
5.771 TX Zz, U3 35
S t /Ht Outlet
TANK SETBACK INFORMATION \
TANK TO I P Vent to it Intake ROAD Dt Inlet `
d ye 1
S eptic 'S , ° 6.1 - 1 s / / o om 71, 3 `IloO .'7 Z.
osing IS T
p � E` n ea er an.
.f�
era Ion , Dist. P ipe
9 Ohs
o ing o . ys em l7 ' a�
F inal ra e
,
PUMP /SIPHON INFORMATION oc. r j \ 1 9 . 1 T - 4
anu ac urer eman Dd Sr p
GPM o Go.� <:— ��' Z AP
o e um er '
Zd e S 1 16 ��.o
is ion ass ys em ea
1-2 .0b q ,J , 0
141 7• 74 Z
Lircemain 1 1-engi n 06 ia.�„ a M211
�5 • 13-5 973.5
tl•b" Lerigin 01 1 Iencilers U, "'E:5 wbi0e Ula. [quic Uepw
DIMENSIONS i ` \ �
3 1 164 � 4'ewc�
INFORMATION CHAMBER OR 1
UNIT N01110M.
`
1 .9 1
(o4 ZC I* ?
„ Pipes) ` �. \ J r
Length Dia T Length Dia Spacing
x Pressure Systems Only xx Mound Or At - Grade Systems Only 7,iNo AA MU J
bl"LlI Of Bed/Trench Center I � BedlTrench Edges \ Topsoil 1 yes No Yes
\>
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 317 Meadow Ridge Court HLAson, WI 54016 (SW 1/4 SE 114 17 T28N R19W) Meadow Ridge of Troy Lot 21 Parcel No: 17.28.19.2008
1.) Alt BM Description = `vv"' Cc�,.; e
2.) Bldg sewer length = 3 0 1
- amount of cover = � if
Plan revision Required? Yes o Inse clots lure
Use other side for additional information.
Date I— — p
SBD -6710 (R.3/97)
N t
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ev�
x 22
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Safety and Buildings Division County
201 W. Wacagletr�fvt^"I'"Or"8ax 7162 d 1`
N Viscon s i n Madison, WI 53 - CEIV atnitar Permit Number (to be filled in by Co.)
(608) 266 151 $� /575
Department of Commerce
Sanitary Permit Application MAY 0 1 20 �ca Pin I.D. Number
In accord with Comm 83.21, Wis. Adm. Code; personal information yo provide
may be used for secondary purposes Privacy Law, s15.04(1)(m ST. CROIX COU ftJect ddress (If different than mailing address)
I. Application Information - Please Print All Information
Property Owner's Na me Parcel N Lot Block N
G r C rJ d NNE < t �JC o Vic ! o o 0 a z
Property Owner's M ailing Address Property Location
(7 C 5 'A, �e b4,Section
City, State � XI �,/ J Zlp Co [ d � e ' '`� Phone Number
/V &A. e, 1/✓19 v `,'� I / It (circleQne)
T N; R G E ore
II. Type of Building (check all that apply) t7i Q.
t�i.I or. 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number
❑ Public /Commercial - Describe Use �.✓�
❑ State owned - Describe Use 't" Z.(,p +' Z ❑City_ ❑Village O'ownship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System p y 8 P Y g Y
y ❑ Re S ❑ Treamhetit/I•Ioldin Tank Replacement Onl Other Modification to Existin S
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. TXpe of POWTS System: (Check all that appl
)L Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructcd Wetland ❑ Pressurized ,Iii -G Ground C1 Holding Tank C] Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
C1 }�I Recirculating Synthetic Media Filter Leachin Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (expl• in)
V. Dispersal/Treatment Area Information: w
Desi n Flow (gpd) Design Soil Application Rate(g sf) Dispersal Area Required (sf) Dispersal Area Prop d (stJ System Elevation
CAD , (To ✓ L ® �b
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic
Gallons Gallons of Units Concrete Construct Glass
New Existing
Tatrks Tanks
— Septic or Holding Tank
Aerobic Treatment Ur)it
V J'- -
Dosbtg Chamber
VII. Responsibility Statement - 1, the undersigned, assume rdspoluibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's Si gna re MP /MW Number Business Phone Number
b fm"4i llrZ 2,7Z
Plu ber s Addre ss (Street, City, State, Zip C e)
V I. Count /Depart nent Use Onl
Approved lsap Sanitary Permit Fee (includes Groundwater• 7 11 Issuin gent Sign tur o St ps)
Surcharge Fee) L ��' �
❑ caner Gi easorh enial - � IX. Conditions of Approval /Reasons for Disapproval n 8YiTHM O � effl -3) Go � L_ w „ _ 8apNc tank , eMturtt
filter and dispersal cell must all W servk:es / l„al121111 r A W gernertt plan provided by plumber. 2. AN setbw* requirements must be maintained
a ca / r code / ordrnartoss. � t ,'NtJ� �— be Attach complete lans (to tho County only) fm• the system on paper not less thou /2 x 11 Inches Li size
SBD -6398 (R. 01/03)
91314*0 MMY2
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Wisconsin DepartrrrerN of commerce IL EVALUATION REPORT Page 1 3
Division of �atety and Buildings
in a with 85, Wit. Actin. Code
Attach complete site plan on paper 81 County St. Croix
indude, but not limited to: vertical and h I r Pool Panel I.D. jPending
►% n:..;.. , .!e ..c d!c a ws'r .. ^.d ! ..rd di... ance to .. ,a
r►ease pnm: are'M*rM on- S E P 2 1 2005 .y. r V
rp
Personal information you provide may be used for secondary p (Privacy Law, s. 15.04 (1) (m)). ' 3 /
Property Owner ST. CRO 1c n El
DCCI Land Planners Inc ZONING S 1/4 SE /4 S 17 T 8 N R 19 E
Property Owner's Mailing Address Lot # Block # Subd. Name or
1505 NWY 65 { 71 { 1 Meadow Ridne OfTrov 1
City State Zip Code Phone Number []City []MIlage IDTown Nearest Road
New Richmond I WI 1 54017 East Cove Road
El New Construction UseEj Residential / Number of bedrooms 3 to 4 code derived design flow rate 450 to 600 GPD
n Repiace rrm t n Public or commercial - Describe:
I ParRnt matprw Loess over glacial till Fkxxt Plain Plavahnn if annlirahlP ,... ft I
General comments - and recommendations: j_ n
AwS 4 r A� - V ravEe - O ( 5 A
Lav%O"k
n Boring
LL j .. ro E] Pit Ground surface elev. 970.78 ft. Depth to limiting factor >110 ' in
Sail Rate
Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots GP
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. '1201 'Eff#2
1 0-6 10yr3/2 - sil 2msbk dsh as 2f .6 .8
{ 2 { 6 i 1 n,,,eie 1 - 1 sil 1 Imchk I dsh 1 cw 1 if 1 4 I 6 I
3 43 -110 7.5yr4/4 - Is Ogg dl _ _ ,7 1.6
E Boring S 0 Boring 979.29 >96 ✓
a Pit Ground surface elev. ft Depth to Vmiting factor in. Sod Application Rabe
Horizon Depth Dominant Redox Description Texture I SUucture Consistence Boundary Roots GPDM
I l it l u...o I o., s, r•.nnt r *k r I I Ar s, Sh I I 1 f FM1 t —F
1 0-10 10yr3/2 - is Osg dl as 2f .7 1.6
2 10-17 1 4/4 - is Osg dl cW if .7 1.6
3 17 -32 10yr4/4 - A lmsbk dsh cw _ .4 .6
32.06 -• , 06 7 1 6
.1. r.� - s v�y, di - -
• Effluent #1 = BOD_ > 30 < 220 natL and TSS >30 _< 150 mull_ ` Ef Iluent #2 = BOD_ < 30 and TSS _< 30 malL
r:RT Names rPbaap P"% Airmahirw MT NhrNw
Thomas C Nelson "" 227387
Address Date Evaluation CorKkx;bed Telephone Number
1432 120th Street, New Richmond, Wl 9/18/05 715 -246 -2454
Property Owner � DCC Land Planners Inc Parcel ID # Pending Page 2 of 3
ICJ Ong
3 1 � # E] Pit Ground surface elev. 972.89 ft. Depth to limiting factor 73 in.
Soil 401cation Rate
Horizon Depth I Dominant Colod Redox Description Texture Structure Consistence Boundary I Roots GPDM
{ in. { Munsell { Qu. Sz. Cont. Color ) { Gr. Sz. Sh. I I I I 'Eff#1 I 'Eff#2 I
1 0 -10 10yr3 /2 - sil 2msbk dsh as 2f .6 .8
2 10-34 l 4/4 - sil lmsbk dsh cW if .4 .6
3 34-57 7.5yr4/6 - s Osg dl cW - .7 1.6
57 -73 'r C —A /A - t A— at _ 2 6
5 73 -90 10yr4 /4 - scl 0m dh - - .0 .0
I I Boring #
U U Pit vrourxa sul"We erev. n sMur w mrmnxt UK= m. Soil Ajocation Rate
Horimn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •01#1 'Eff#2
F-1 Boring # � Ground surface elev. ft. Depth to limiting factor in.
Pit
Soil Application Rate
Ho izon Depth Dominant Redox Description Texture Structure Consistence Boundary I Roots GPD/fe
I I in. { Munsell I Qu. S z. Cont. Color I { Gr. Sz. Sh. I 1 1 1 'Eff#1 ( - Eff#2 )
* Fflh w* * = Rnn > In < rm rrrnll anri T RR >.3n < 1 511 mn Ffib writ in = Win < an rmn arvl TRc <'An n,nA
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 TCY 608- 2648777.
sso- 1133"caO.07m0)
DCCI LAND PLANNERS, INC. ® SOIL BORING X-_
Lot # 21 - MEADOW RIDGE OF TROY
SW 1/4 OF THE SE 1/4 OF SECTION 17, BENCHMARK owl
T28N, R1 9W, TOWN OF TROY, ST. —TOP OF CONDUIT
CRODC COUNTY, WISCONSIN. Q ALT BENCHMARK
—TOP OF CONDUIT
TOM NELSON CST - Lie. # 227387 N NOTE: THE CONTOURS IDENTIFIED �. •
ARE PRIOR TO CONSTRUCTION. 1 rr 2 % •
ENVIRONMENTAL BY DESIGN CONSTRUCTION GRADING WAS IN f°r"• �►�
1432 120TH ST. PROCESS DURING SOIL TESTING. •
NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED TO =�
h. # 715- 246 -2454 CONFIRM FINAL CONTOURS r r
P DURING INSTALLATION. wT
` gI • .
SCALE IN FEET 1' 40' .I •
100 0 100 LOT
� \ c
` I
1
2. 3
9
9
B
79.29
B
ZND 97 .78
v
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U4 /25 /ZUUef 12:19 FAI 715 24U 4948 DERRICK COMPANIES id1003/004
ST. CROIX COUNTY
SEPTIC TANK MA*`fENANCE AGREsR"NT
AND
OWNERSHII' CERTIFICATION FORM
Owncr/6uyer V e- t -x U�, PA t t� t►.lt�''fL S.
Mailing Address plo 6a - A 44 Sy , )SC -t AAO "Q W1
Property Address l Mrc AiJG W1 Lvc
(Verification required firom Plarmiag & Zonin Nparhnert for new construction.)
Gity /Seats O1s311 � '( Parcel Identification Number 0
Property Locatian y, , - 5 C V< , Sec. „U_, T 'd N R ) W, Town of 1 � �
Subdivision Q��.a./ p E t� lip Lot # 2 � .
Certified Survey Map # Volume . Page #
Warranty Deed At "`� '�3 �a �s�j 'Volume -! � , Pagc # G o �
Spec house yes no Lot liras idestifiab no
HAVrM NMCE AND QH= z p
Improper use and raintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consistQ ofpuniping out the septic tank every three yaa; or zoom, if needed, by a licensed pwnper. What you put into
0M system can 4 fect the !unction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
rexponerbilitiet are specified in $Comm. 83.52(1) and in Chapter t2 . St, Croix County 5aattary Ordbraaca.
The property nvnM ogees to submit to St. Croix County Planning dt Zoning Department a cartifkaaon fom signed by the
ovviw and by s master plumber, jo umeyea m phuabet, restricted pbnrbw or a licensed pwr per verifying that (1) dw on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), tiro septic tank is
less than 1/3 full of sludge.
I/we, the undersigned bave read the above zequirenscnts and agree to maintain the private sewage disposal system with the
standards sct forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
CWW-cadon stating that your septic system has been maintained mast be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year vq*ation date,
J/we 01t4 that all sleteMwts on this form are true to the best of mylour knowledge. 1/we amlim the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of buds Office.
Nutgtbe bedrooms
7/
`t / Q yes
� - Z'
SIG ATURE AF LICANT(S) DATE
'"'Any information that is tMisroprestate d may result in the samritttry permit being revoked by the Planning & Zoning Department.
Tnctude with this applicstion a recorded warranty deed from the Registet of Deeds Office and a copy of the certified survey trap if
refererm is made in the warranty deed.
(14$4. p8/OS)
uYr inr cuvo lc: LO me i to cao 4a4o uCxxl�ll l UffiYANIxa 10002/004
It 2 7 31 P
lutvttc,�al �. tr
1 ST. CROI o C t v
� . �:eo0rn oa., tr
RMIY6D FM RECORD
L9WrrZD WA RAM DT" 411/L4I21 GUNPM
Doauuxat No,
This Deed am& betwoen VALLEY LAND s t 1 N
CO111;I'ANY, a Mimcsots corporation, C and C�
DCCI LAND PLANNERS, INC., C=ntm PAGES s 3
Wunwsetb, Mmt the said Omuta conveys to
C?xmtoa earaian real ettstie in si. Crcix Camaty, State
of Wbwndn, legally dewnbed on Exhibit A lywwo
(the "prvperty"),
Togedaarx with all and aiugulat heaadituucats ZrMLlld
and appuil�cea dw =mw belonging. 7 - —
Tbik cortvoyaboa is Wi bath wwrroy,
wmpt Gra>aftr coveatasts sad r+apx esect the
amtor has not made, done, excaftd or Tax LD.a MOW-
sufrored any act or thing wbereby the above- •
descrUd praperty or any part *=of, DOW Or 0. •
ai any time bearealtor, shall or uay be
iitowfic& charged or aw=berod in any
wMer, a nd Creator win warraaat tide to dte
above-dewril ed property "Awst Ali P
alsiMMX.the mama fiw u at tbrcugb Ocw w as
IL result of any such amt or tbing, provided, however, that the conveyance lse- made sad 01e
a amrgy of Grantor is findw Wted by and aMaw to those rnsttar set fartb oss ExIdbit 8 baroty.
Dated this _,,,_ day of inwaay, 7005.
YALL19Y LAND COMPANY,
A Minim corporaw
gy f
ACWfOWUWGEMi:Nf
STATE 0
COUNTY OF
I'ervmolly arse before we this day of January, 2005, the above named Glary B. Vaticy, sa
President of Valley Load Company. Imneeota cwporadM having foil suttsority to rb so and
to tam Iotowss w be the pers�rs'Who iataeuted im foregoing inWUMat and wknovviodged the
ic, Sta�'oY
tree .
4�
COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS
PER COMM 84.25 CODE CHANGES 2/1/2004
Access Opening, not top of cover, Access Opening, not top of cover,
must extend to a point no greater must eidend at least
than 6" Below Finished Grade 4" Above Finished Gp ade . �
Coverwith dgA'M 6 � V t-jr r ��t�`' 10 ' r
PPr2ev� D CAS
l�t� --
Lockinq Device b� '84x Finished Grade
(typical) jZ ". 1�. /Ax tIr►'►
vi LbitJ6r
t
SEw& Min. Z3"
> 30 Pr Access Opening
o r2 G
1 p' � � Min. 23" Access Opening
Oulet Effluent Filter 1 Gc/ /n! if �'o✓� Sl.�'E
i Union 2oYF7) 1P6 3 Pr
Inlet Baffle i KM
p/t/`T7> SOL /D S`4 /L
i
Pu p
ra W- Udd in �9 un .e r w c0 'e nJ,< 2'• lower 0'a P, ed ex
3 ",mod ar
Two ComparFment Septic/PumpTank C 4 o * sl ;, � f A mn oxide
SPECIFICATIONS
TANK MFR: �� DOSES PER DAY:
TANK SIZE: SEPTIC �� GAL. DOSE VOLUME: Z 3 ► GAL.
DOSE GAL. INCLUDES FLOWBACK & <20% OF DWF)
ALARM MFR: a 4 - CAPACITIES: A = INCHES = GAL.
MODEL # IAJ 6 GAL.
Switch type: B = — 2 — INCHES = Z �
PUMP MFR: 0U-'1-1) ✓ C= 7 INCHES= Z GAL.
MODEL M O a 5� /
SWITCH TYPE: D = ib INCHES = (2 GAL.
REQUIRED DISCHARGE RATE [0GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e)
VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = 1 T.
MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + C> FT.
2-6 FT. OF FORCEMAIN x 2,58 FT. /100 FT. FRICTION FACTOR ...... _ + 6 FT.
TOTAL DYNAMIC HEAD (TDH) _ Z FT.
INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH
MP/MPRS SIGNATURE: LICENSE NUMBER: 2 7 61
APR -12 -2005 16:28 FERGUSON ENT HUDSON 715 366 6144 P.01
[gGOULDS PUMPS Submersible
►� � ���� Effluent Pump
P C ,IV&Ls ,.
PE
U44 niMP
•
SPECIFICATIONS MOTOR FEATURES
Pump - General; General: ■ Corrosion resistant
• Discharge: 1'h" NPT • Single phase construction.
• Temperature: 104 °F (40 °C) • 60 Hertz ■ Cast iron body.
maximum, continuous when • 115 and 230 volts a Thermoplastic impeller and
low fully submerged. • Built -In thermal overbad pro. cover,
• Solids handling: 'h' WIon with automatic reset. ■ Upper sleeve and lower
maximum sphere, • Class B insulation. heavy duty ball bearing
APPLICATIONS a Automatic models Include a • 011 filled design construction
float switch. • High strength carbon steel s Motor is permanently
Specially designed for the a Manual models available, shaft. lubricated for extended
following uses: • Pumping range: see PE31 Motor service life.
• Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous
• Effluent/Dosing Systems PE31 Pump: • 115 volts operation.
• Low Pressure Pipe Systems • Maximum capacity: 53 GPM a Shaded pole design ■ All ratings are within the
• Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor,
�.. • Heavy Duty Sump/ PE41 Pump: • .40 HP 3400 RPM ■ Quick disconnect power
Dewatering • Maximum capacity: 61 GPM ' 115 and 230 volts cord, 20' standard length,
• Maximum head: 29' TDH • PSC design i 15 o d 16 / SJ W with
PE51 Pump: PE51 Motor: plug.
Maximum capacity: 70 GPM .50 HP, 3400 RPM ■ Complete unit is heavy duty,
• M head: 37 TDH 115 and 230 volts portable and compact.
METERS FEET ✓ ' PSC design ■ Mechanical seal is carbon,
40 �-- ---,• +`�- ceramic, BUNA and stainless
PE51 I I I I MODELS: P631, PE41, PE51 steel.
■ Stainless steel fasteners.
10 , I i -1 2 GPM
30 •pF4 .1- . •I t I I I AGENCY LISTINGS
o 1 Fr i
1
X
c 20 Tested to UL 778 and
C5A 221108 Standards
15 - -� ' ' _t- I - By Canadian Sbndrds A6SOd ton
0 � • I 1 1 . i
File +rt1R3no
Goukh
o i { -». ,.L ` I t . : 1 _I PL.nPS 1: lso WM RegLawd.
II
10 0 40 51 60 70 GPM 80
0 5 i 15 rr► Goulds Pumps
® 3004 ITT Water Technolog APACITY
Effective Jun•, 2 004 �' i �
�E81/47 <& ITT Industries
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa L of L
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner G C A- ND Septic Tank Capacity gal ❑ NA
Permit # Septic Tank Manufacturer ��� j r ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 'Z, 6�L ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) g al/day Pump Tank Manufacturer (� ❑ NA
Design flow (peak), (Estimated x 1.5) 1 gal/day Pump Manufacturer L ❑ NA
Soil Application Rate If 4 4 al /da /ft2 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 ❑ In- 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 every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
9 year(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
® year(s)
Clean effluent filter At least once every: ❑ month(s) 0 ❑ NA
year(s)
Inspect um um controls & alarm At least once eve ❑ month(s) ❑ NA
p p p ump ev e r y: lB year(s)
Flush laterals and pressure test At least once every: .® yea�(s)(s) ❑ NA
Other: At least once eve ❑ month(s) ❑ NA
every: ❑ Y ear(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 (4101)
Page 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 lie 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 seated.,
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
I
POWTS INSTALLER POWTS MAINTAINER
Name L S pN Name
Phone S' Z 7 7 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name t✓RQ 2i�J/✓j
Phone Phone
This document was drafted In compliance with chapter Comm 83.22(2)(b)l1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
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(EFFECTIVE LENGTH)
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FRONT VIEW
INFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY
(a) The structural integrity of each chamber, and plate, wedge and other accessory manufactured by Infiltrate ('Units7, when installed and operated
in a leachfield of an onsfle septic system in scoorclence with Infiltrator's Instructions, is warranted to the original purchaser ('Holder') against detective
materials and workmanship for one year from the date that the septic permit is Issued (a the septic system containing the Units; provided, however,
that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences.
To exercise Its warranty rights, Holder must notify Infiltrator In writing at Its Corporate Headquarters In Old Saybrook, Connecticut within fifteen (15) •
days of the staged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this United Warrant'.
Infiltrata5 liability specifically excludes fine cost of removal and/or Installation of ft Units. O
(b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT m
TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. SYSTEMS INC
(c) This Limited Warranty shelf be voted if any part of We chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does
not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, Including loss of Environmental Onsite
Wastewater Solutions'
production and profits, labor and materials, overhead costs. or other bases or expenses Incurred by the Folder a any third party. Specifically
excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of
the Units; the Units being s ib(ected to vehicle traffic or other conditions which are not permitted by the Installation Instructions; failure to maintain the 6 Business Park
Road • P.O. Box 768
mnimum ground covens set forth In the installation Instructions; the placement of Improper materiels Into the system containing the Units; failure of Old Saybrook, CT 06475
the Units or the septic system due to Improper siting or improper Sizing, excessive water usage. Improper grease disposal, or improper operation: or
any other event not caused by Infiltrator. This "led Warranty shall be void! If the Holler fails to comply with all of the terms set forth In this Umited
warranty. 860- 577 -7000 •FAX 860 - 577 -7001
Further, In no event shall Infiltrator be responsible for any loss or damage to the Holder. the Units, or any third parry resulting from Installation or ship- $00 -221) -4436
meet, or from any product liability C a Calms of Holder or any Wnl party. F inns Limited Warranty to apply, the Units must be installed in accordance
with all site conditions required by state and Wei codes; all other applicable laws; and Infiltrator's Installation instructions.
(d) No representative of Infiltrator has the suit** to change or extend this United Warranty. No warranty applies to any party other than the 04-
nai Holder.
The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty require-
ments. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a
copy of the applicable warrant', and amid carefully read that warrant' 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, Microl-eaching, PolyTuff, Snapl-ock, ChamberSpacer, Posil-ock, QuickCut, QuickPlay RECYCLED PAPER
and Quick4 are trademarks of Infiltrator Systems Inc. ® 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0
Parcel #: 040 - 1310 -00 -021 05/0212006 08:07 AM
PAGE 1 OF 1
Alt. Parcel M 17.28.19.2008 040 - TOWN OF TROY
Current [* ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
10/20/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
DCCI LAND PLANNERS LLC O - DCCI LAND PLANNERS LLC
PO BOX 445
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist ist # Description 317 MEADOW RIDGE CT
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 0.000 Plat: 10 /085 - MEADOW RIDGE OF TROY LOTS 1 -31 040/0
SEC 17 T28N R19W PTS NW SE & SW SE Block/Condo Bldg: LOT 021
MEADOW RIDGE OF TROY ('05) LOT 21
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
17- 28N -19W NW SE
17- 28N -19W SE SE
Notes: Parcel History:
Date Doc # Vol /Page Type
li 10/20/2005 809848 10/085 PLAT
01/18/2005 785170 2732/370 EZ CON
01/1412005 785053 2731/551 WD
02/13/2004 754206 2509/328 WD
more...
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 02/21/2006
Description Class Acres Land Improve Total State Reason
Totals for 2006:
General Property 0.000 0 0 0
Woodland 0.000 0 0
I
Lottery Credit: c laim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Charges Delinquent Char
Special Assessments es p g q g
Total 0.00 0.00 0.00