HomeMy WebLinkAbout026-1167-01-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
569526 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:
Marek Construction, c/o Todd Marek Richmond, Town of 026-1167-01-000
CST BM Elev: Insp.BM Elev: BM Description: n� SectioNTown/Range/Map No:
4 •( 27.30.18.1303 j
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER h 4 CAPACITY STATION BS HI FS ELEV.
Septic r... ?.S �Zc7� BenchmarkQ Al Po I a�. Za6,S k k Alt. J.A t/ �•
Aeration V Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet 7 ys
TANK TO P/L WELL BLDG. Vent r Iptake ROAD Dt Inlet
Septic fM II Ft Bottom
Dosing K� Header/Man. at•75 cy7, C
Aeration Dist. Pipe CT .7- q,7• 7�
Holding Bot.System �6•$ q 3 L
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
GPM "T
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width No.Of Trenches PIT DIME SIGNS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 Length 96 7, i feK `LjIib
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufactury___.n� `��
INFORMATION CHAMBER OR /� -�
Typ Of System:LL UNIT Mode�Iumb� 6-4- 3g 1 /�5
DISTRIBUTION SYSTEM d( Z Z4-Z, Z �S
Header/Manifold Distribution x Hole Size Ix Hole Spacing IVent o Air In ake
Pipe(4—. �` �� -�� �� 0
Length ' Dia Length Dia Spacing I & n
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over ` Depth Over xx D h of xx Seede Sodded xx M Iched
Bedrrrench Center V Bed/Trench Edges Topsoil
g � ` Yes � No s 0 No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 1397 126th St New Richmond,WI 54017(NW 1/4 NE 1/4 27 T30N R18W) Lundy's Preserve Lot 1 Parcel No: 27.30.18.1303
1.)Alt BM Description= ltj� C j, 4!:�aj-e, w /5-C-ce,,j
2.)Bldg sewer length= St{
-amount of cover= /!Plan revision Required? 0 Yes NXNo /k �� I �f /
Use other side for additional information. —i� L — - _ I `_�_r 7 C
Date Insepctor' gnature Cert.No.
SBD-6710(R.3/97)
PW � (,A-
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e°era County ,,
2b• , Safety and Buildings Division (Z-o l
J,p ,• A 201 W.Washington Ave., P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.)
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S. y� Madison,WI 53707-7162
s. � (a95Z(
olio'as State Transaction Number
Sanitary Permit Application
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s.15.04(1 m),Stats. 13 7 /Z(ate 5+•rte
1. Application Information-Please Print All Infor Parcel#
Property Owner's Name 3
A�.GLK OZb �-llb� - bl -o6d
Property Loca
Property Owner's Mailing Address Location Property
D Ro ZZ $ Govt.Lot C ,
City,State Zip Code Phone Number /� (`tJl� /V %, Section
715-- �j (circle one)
0/ 7 3- Z' Tt/ T�O N, R__Eo0
FI.Type of Building(check all that apply) Lot#
Subdivision Name
1 or 2 Family Dwelling-Number of Bedrooms L(�C9 P g_67,f 6 v
Block# JP
`��
❑Public/Commercial-Describe Use ❑ City of
CSM Number ❑Village of
❑State Owned-Describe Use
Town of Glf Al o.4j Q
Z `��- Gem Z L +
III.Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain)
List Previous Permit Number and Date Issued
B. El Permit Renewal 11 Permit Revision ❑ Change of Plumber ❑Permit Transfer to New
Before Expiration Owner t�'!�.-F rn� Q✓
IV.Type of POWTS System/Component/Device: Check all that apply)
S t7�J
54-Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable
❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain)
V.Dispersal/Treat t Area Information:
Design Flow(gpd) Design Soil Application Rate(gp f) Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation
5 $
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units r� ;? =
New Tanks Existing Tanks 1 L, ° .. = .2 n
a / a Cg H rn u C7 C.
Septic or Holding Tank t l"� -- (Z t}p L—j i t5 (t�►L
Dosing Chamber Soo v Q [ f yC
VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature NT44 B Number Business Phone Number
ko can ��G��ti/ 2 2L4'9' 7 71.5--- Z73' �
Plumber's Xddress(Street,City,State,Zip Code)
C. S44,)0??- 4- &k- cti t a
VIII.Coun /De artment Use Only
Approved ❑�' Pemtit Fee Date su Issuing ent Signature
en Reason for Denial
IX.Con dit#f§tJAtWeasons for Disapproval 3\ 2 J� / n _n,, Q !►Qr.J vv►¢,Oc✓ f�
1 "Septic tank,effluent filter and I /'A�P
dispersal cell must all be services/maintained W a In
as per management plan provided by plumber.
3. AN setlack jrquirements must be maintained
as per lli l ble cods i ordinancbts.
Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size
SBD-6398(R 11/11)
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: - 0 P 6 /,m-ac K
Owner's Name: Q Q NA-k C k
I
Owner's Address: 10
Legal Description: 7
Township: /Y14/V!'
County: C_fLO )
Subdivision Name: �u �✓��`S �/ZC-sou
Lot Number: 0
Parcel ID Number: ® Zlo- —000
Page T Index and title
Page 21 Plot Plan
Page 3i System Sizing & Cross-Section
Page 4: Filter Specs ) Z p V 6-
Page 5 Maintenance Information
Page 6i Management Plan
Page 7i St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 91 CSM or Plat
Attachments: Soil Test& House Plans
Designer/Plumber: Aq� BLS p License Number:
Date: �-` 7 /�:_ Phone Number
i
Signature
Designed pursuant to the In-Ground Soil Absorption omponent Manual for POWTS Version 2.0 SBD-10705-P(N.01/01).
Page 1
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8,oll Absorption System Cross'Section
ft
Final Grade
4"Schedule 40
PVC Vent Pipe ft
With Vent.Cap �_
Leaching
Chamber --.L
�— System Elevation
!Soil Absorption.System Plan View
8q ft
�ft
I
I ft Leaching Trench 1
Vent Or Observatictin Pipe Chambers
4°Dia.
Trench 2 Header
rLeaching Chamber Speelfications
Manufacturer Aod Model_f/U F/44A4-FvA- 12 EkI c PG u$
EISA Rating sq � per chamber Soil Application Rate y gpd/sq ft
Q gpd Design Flow* Soil Application Rate + . ® EISA= Chambers
21
2!rows of 2z chambers each.
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Rage of
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0 ## Series
The original ZABEL®Disc Dam Filter was patented in 1959. The 12"series filters have been filtering
wastewater longer than any filter in the wastewater industry. In 2000 Zabel made the best even
better by introducing a complete redesign of the original with more great features and finer levels
of filtration.
A 100-12TM Series
The A100-12 is the commercial filter chosen by more engineers and installed in
more localities than any other filter on the market. The reliable performance and
flow rates from 3000-6000 gpd allow this filter to be utilized in almost every
application. The new ZABEL Versa-Case' is available with built-in reducer and
outlet hub that accepts either 4" or 6" SCH 40 pipe. The Al00-12 Series is also
popular in many areas for residential use due to its high quality effluent and large
capacity. Independent research has shown the A100-12 decreases TSS by 50-90%
and CBODS by 20-40%.
1/1 S"Filtration
Available lengths 20", 28"& 36"
A300-12"m Series
Long heralded as the ultimate grease trap filter, the
A300-12 provides 1/32" filtration and has been shown
to reduce FOG by as much as 50-98%. The A300-12 is
also used for onsite wastewater systems which require
a finer level of TSS removal, such as Laundromats and
dog kennels. As with all ZABEL Filters extra filter
cartridges are available to speed service time and allow
offsite cleaning of the used cartridge.
732' Filtration
Available lengths 20" 28"& 36"
i
A600-12"" Series
The newest addition to the ZABEL Filter line incorporates the proven performance
of the disc dam design with the finest level of filtration available on the market.
The 1/64" filtration of the A600-12 provides optimal filtration levels for those
unique applications with very fine particulates and suspended solids. Every A600-
12 Series filter includes the exclusive SmartFllter"Alarm switch to alert the owner
of required maintenance.
I
164"Filtration
Available lengths 20",'28"& 36" For further technical information:
www.zabeizone.com
050103.244
POWTS OWNER'S MANUAL &'MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS.
Owner
��C Septic Tank Capacity o al of
Permit#
Septic Tank Manufacturer wtry ❑ f
Effluent Filter Manufacturer Z�} �L ❑ f
DESIGN PARAMETERS
EEstimated rooms
0 NA Et Filter Model ❑ t
lic Facility Units
0 NA Tank Capacit y d (� al 0(average) O 0 al/da Tank Manufacturer (11,1 i�S'c�2 +caf`
eak), (.Estimated x 1.5) d gal/day Pump Ma nufacturer a Gt,litA ❑ N
Soil Application Rate 01 gal/day/ft2 Pump Model P ❑ N
Month) average* Pretreatment Unit ❑ N.
Standard Influent/Efflueht Quality Y g
Fats, Oil &.Grease (FOG) 530 mg/L O Sand/Gravel Filter O Peat Filter
Biochemical Oxygen Demand (BODa) 5220 mg/L 0 NA ❑ Mechanical.Aeration iJ Wetland
Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(S) 0 NI
Biochemical Oxygen Demand (BODE) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L 0 NA ❑At-Grade 0 Mound
Fecal Coliform (geometric mean) 510'cfu/100ml O Drip-Line ❑ Other:
Maximum Effluent Particle Size Y In dia. 0 NA Other: ❑ NA
Other: 0 NA Other: 0 NA
'Values typical for domestic wastewater and septic tank effluent Other:' 0 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect c.ondlt!on of tanks) At least once every: 3 0 year(s)(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA
Inspect dis ers'al call(s) At(past once eve ❑ month(s) (Maximum 3 years) ❑ NA
P every: -3 0 year($)
Clean effluent filter At least once every: 13 O ear month(s) .0 NA
Inspect pump, pump controls &alarm At least once every: 0 mo'nth(s) NA
.3 El H year(s)
Flush laterals and ressure test At least once eve 13 month(s) 0 NA
P every: '®.year(s)
Other: At least once every: 0 on j(s) ❑ NA
Other: ❑ NA
MAINTENANCE INSTRUCTIONS 4'
Inspections of tanks and dispersal calls 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 qn the ground surface.
The dispersal'c011(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 tha 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 Qf in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to thenservicing•of effluent filters, mechanical or pressurized components,.pro;regtment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMw (4/01)
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment al nk(s))fo If the high prey concentrations is a detected have the content
that may impede the treatment process and/or operator d priordtopuse. '
of the tank(s) removed by a septage servicing
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highw,at the eels. and may exult restored the backup or surface discharge il o
discharged to the dispersal cell(s) in one large dose, overloading
effluent. To avoid this situation have the contents or POWTS Mank ane
moved
to t ass S Operator prior t o
In manually operating the pump controlsl v
power to the effluent pump or contact a Plumber
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 are;
within 15 feet down sl6pe 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 s; 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; sanitay napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Coda:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.,
•. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing-Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
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 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.
O . Mound and at-grade soil absorption systems may be reconstructed in place following removal of the btomat 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
PERS0f,1 FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name 0 & IZ N1 C—L,50/v Name
Phone S — Z 7 3 _ ( !/! Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name 7p Awl fa v .5@A-All AA-".-v Name 5 Z-0 r✓f-ti
Phone 2 7 3 5- Phone 7157
This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.64(1), (2) &(3), Wisconsin Administrative Code.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer "D F 174 HPZfK
Mailing Address 1 13 P tC Z'z /U �w (Gt�.v�v.✓D � Sf�r
Property Address f 2 72 ZCo
(Verification required from Planning&Zoning Department for ne onstruction.)
City/State k LA) Ia (GN A40 nl D Parcel Identification Number 6 Z b — / /67 - / _6 °o
LEGAL DESCRIPTION 77
Property Location Al '/t k�''/4 , Sec. Z �, T 7y N R ( 9 W, Town.of C 14- A6
Subdivision Plat: L u Af 0 l S �S �>� , Lot#�.
Certified Survey Map # , Volume , Page#
Warranty Deed # 75-14 (before 2007)Volume , Page#
Spec house14yes 0 no Lot lines identifiable X yes 0 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 §SPS. 383.52(1)and in Chapter 12- St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning&Zoning Department a certification form,signed by the
owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site
wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning&Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on form are true to the best of my/our knowledge. I/we am/are the owner(s)of the
property described above,by virtue of a w anty deed recorded in Register of Deeds Office.
Number of bedrooms
�S� 3)(N 'a � .3 1171 f l
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
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A Quick4 Plus Standard Chamber Side and End Views
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48"--
(EFFECTIVE LENGTH)
34"
!-1uick4 Plus All-in-One 12 Encap Front, Side and End Views
11.2"
13"
8"INVERT/ 8 N�T
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33"
Quick4 Plus All-in-One Periscope
QUICK4 PLUS
ALL-IN-ONE PERISCOPE
(360-SWIVEL
12.7" R QUICK4 PLUS
INVERT ALL-IN-ONE 12
ENDCAP
Quil Plus Standard Chamber Specifications
Size (W x L x H) ............. 34" x 53" x 12" (86 cm x 135 cm x 31 cm)
Invert Height ................. 0.6", 5.3", 8.0", 12.7"
(1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm) '
Effective Length ........................................................ 48" (122 cm)
INFILTRATOR SYSTEMS,INC.STANDARD LIMITED WARRANTY
a)The structural integrity of each chamber,end plate,wedge and other accessory manufactured by Infiltrator "Units"),when installed and
operated in a leachfiektI of an onsite septic system in accordance with Infiltrator's instructions,is warranted to the original purchaser("Holder")
against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units;
provided,however,that it 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 alleged defect.Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered
by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units.
(b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT
TO THE UNITS,INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE
This Limited Warranty shall be void it any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR®
I does not extend to incidental,consequential,special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages,
fincluding loss of production and profits,labor and materials,overhead costs,or other losses or expenses incurred by the Holder or any third party. systems inc.
0, Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear,alteration,accident,misuse,abuse
or neglect of the Units;the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions;failure
to maintain the minimum ground covers set forth in the installation instructions;the placement of improper materials into the system containing 6 Business Park Road • P.O. Box 768
the Units;failure of 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 Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475
terms set forth in this Limited Warranty,Further,in no event shall Infiltrator be responsible for any loss or damage to the Holder,the Units,or any 860.577.7000 o FAX 860.577.7001
third party resulting from installation or shipment,or from any product liability claims of Holder or any third party. For this Limited Warranty to
apply,the units must be installed in accordance with all site conditions required by state and local codes;all other applicable laws;and Infiltrator's
installation instructions. 800.221.4436
(d)No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the www.infiltratorsystems.com
original Holder.
The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty
requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook,Connecticut,prior to such purchase,
to obtain a copy of the applicable warranty,and should carefully read that warranty prior to the purchase of Units.
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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,Quick4 and Ouick4 Plus are registered trademarks of Infiltrator Systems Inc,Infiltrator is a registered trademark in France.Infiltrator Systems Inc.
is a registered trademark in Mexico Contour Swivel Connection is a trademark of Infiltrator Systems Inc.@ 2009 Infiltrator Systems Inc.Printed in U.S.A. PLUS0510101SI-2
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PLf-MP CHAMBER CRO55 SECTION AND SPECIFICATIONS
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_TO' FROM DOOR, . to WHOLE COVER wlV
wA4ttJItJG LP.6EL .
•,jjNOOw OR FRE5H C COW DUrr
PIPE ALP, WTAKI t S
tj
w!Yrt(ZZ1 s di'GrP �, r I
►-r PROVIDE I —"'-"-
IJLET ` "' •
.'� AIRTIGHT SEAL.
APPROYED J0141
APPROVED JollJT ZMEL. r-t
w/c.r- PIPCux Tank construction I III ALARM 1
shall comply with "I I
ILHR 83 . 15 and 33.20 6 I II
C
• I I oIJ
PUMP 1 —_J
• ` OFF
0
COQ KETE
OLOCK
RISER EXIT PERMITTED 01JLy IF TAWK MAIJUFACTURE:R HqS SUCH APPROVAL 31'AD
SODDING
SEPTIC r SPECIFICATIOfJS
005E lnN 1�5�TL CQQClZ�-�
TA�.IK MAUUFACTURE:R.: IJUMtSER OF DOSES: PER RAy
TAMK 51ZC: 'ZD GA.LLO-WS DOSE VOLUME
ALARM /'lAQIJFACTURCR: S�S.�-L�G7ZO SLI 'I� INCLUOIIJG 6ArXir1.0W: / / GALLON5
MODEL uUM6ER: Nw CAPACITIES: A= `--?18C50K _L'/04LOUs
•- 5WITCH TZIPr:_-' t /y
• 8= z• INCHES OR ��C[_��G�LLOI!$
PUMP MAMLIFACTURI<R S CeuL 7 IIJCHES OR '•z�.1LL0U5
MODEL MUM15ER: Q t p t ?��
INCHES OR -GAlLO1J5 .
SWITCH TYPE: rr f "OTC: PUMP AUO ALARM ARE TO 6L
MIMIMUM'DISCHARGE RATE 3b OPM INSTALLED ON SEPARATE CIRCUITS
YEKTICAL DIFFEKENCE DETWCELI PUMP OFF AU0.015TRI15UTIOIJ PIPE.. hEET
t MIMIMUM NETWORK SUPPLY PRESSURE . ; , , , . , , , FEET
+ , . FEET OF FORCE MAIN X 3 3 FYc tLFRICTIOU FACTOR.. ��' FEET
TOTAL DYNAMIC HEAP
--r•-�--= FEET
As per • manufacturer '
_ �_ . . gal/iris ,. ..
APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01
[4GOULDS PUMPS Submersible
Effluent Pump
PE
'MUM T PUMP
SPECIFICATIONS MOTOR FEATURES
u
Pmp—General; General; s Corrosion resistant
• Discharge: l'fi"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
fully submerged. • Built-in thermal overload pro- cover.
• Solids handling:rh" tection with automatic reset i Upper sleeve and lower
maximum sphere, • Class B insulation. heavy duty ball bearing
• Automatic models include a • Oil-filled design. construction.
APPLICATIONS float switch. • High strength carbon steel n Motor Is permanently
Specially designed for the • Manual models available, shaft. lubricated for extended
following uses: • Pumping range:see PE31 Motor service life.
• Mound Systems performance chart or curve, • .33 HP,3000.RPM ■Powered for continuous'
• Effluent/Dosing Systems PE31 Pump: • 115 volts operation.
• low Pressure Pipe Systems • Maximum capacity:53 GPM 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 heavy duty cord,20'standard length,16/3 SJTW
'cth
r.
• Maximum head:29'TDH • PSC design 115 or duty volt grounding
PE51 Pump: PE51 Moto plug
• Maximum Capacity:70 GPM • .50 HP,3400 RPM ■ .Complete unit is heavy duty,
• Maximum head:37'TDH • 115 and 230 volts portable and compact.
•
METERS FEET PSC design ■Mechanical seal is carbon,
40 ceramic,BUNA and stainless
pE51, j I ' ; I + I I j i
IMODEts:K31,rear.PE51 steel.
35 ■Stainless steel fasteners.
t •i
i
I I AGENCY LSTINGS 30 PE4 FT
o i t !• I f 1 • I'
Z 25 I •
C�ck
.r. I I �'.I I' I I I•
I us
20 i••I. ' "�j a I _ I I Tested to UL 778 and
CSA 222108 Standards
t 5 t ! I + By Canadian Standards&j9dadon
File#LR38S49
10 ^^-� I-;. L I l ^I I I ! ' Gourds Amps is Is0 9oo1 Registered
• I I• � j I l�
0 0ll 10 20 i ' III I ` I '
20 30 40 50 60. 70 GPM 80
0 5 10 1s m3/h Goulds Pumps
®2004 ITT water Technolo CAPACrrY
Effective June,2004 �•Inc
Bi'E3T�4, - ITT Industries
RECEIVED
Wisconsin Department of Commerce SOIL EVALUATION REPOR n1PX113 � age 1 2094
Division of Safety and Buildings -
in accordance with Comm 85,Wis. Adm. Code
County ONING OFFICE
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. Z -7,0/
percent slope,scale or dimensions,north arrow,and location and distance to nearest road.
Please print all information.
Re ' wed b Date
n
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). (/
Property Owner Property Location
Govt.Lot 1/4 1/4 S-�2T ^-W N R E(o W
Property Owner's ailing Address Lot# Block# Name or CSM#
S S ) r
city State Zip Code Phone Number El City ❑village wn Nearest R
XNewConstruction Use. Residential/Number of bedrooms Code derived design flow rate 00 GPD
❑Replacement L {] Public�orr commercial�-D scribe: ----- -- —
Parent material f nC-e®`��tX/ �-� Flood Plain elevation if applicable ✓� -- ft•
General comments
and recommendations: 3,1
�
1:1 Pit
� # �pit Ground surface elev. 1 "ft. Depth to limiting factor i Z'c> in. Soil_Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
-
12--q7- ,-. C
3 Y2-12 it S 10 s
fL
t( I
B oring# El ring Pit Ground surface elev.� ft. Depth to limiting factor in•F�q Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
2- b-� ow
IVI ,t
Effluent#1 =BOD >30<220 mg/L and TSS>30:E 150 mglL 'Effluent#2=BOD _<30 mg/L and TSS<30 mg/L
CST Name(Please Print) Signa CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Date Evaluation Conducted Telephone Number
Address 715-246-4516
1008 192nd Ave, New Richmond, WI 54017 -�
Y
c r
Property Owner Parcel ID# Page of
Boring
571 go"�# '"�_ 2�n
Pit Ground surface elev. oft. Depth to limiting factor ; ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 I *Eff#2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh.
,
❑
Boring# Boring
❑ pit Ground surface elev. ft. Depth to limiting factor i"• Soid4plication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
Boring# Boring Ground surface elev. ft. Depth to limiting factor in.
C1 Pit Soil Application Rate.
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
< and TSS<30
'Effluent#1=BOD;>30<220 mglt.and TSS>30<_150 mg/- 'Effluent#2-BODS_30 mg/L _ m9A-
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.
SBO4330 OtAul
• Soil Test Plot Plan
Project Name Environmental Holding L.L.P. Shaun ird
Address 706 19th St. S.
Hudson Wi 54016 C§�& #226900
Lot 1 Subdivision Lundy's Preserve Date 5/24/04
N 1/2 NE 1/4S 27 T 30 N/R 18 W
Township Richmond
Boring Q Well PL Property Line County ST. CROIX
IL BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe
System Elevation 93.5/93.3/93.1 *HRpSame as Benchmark
Alternate Benchmark Top of 1/2" pipe (LD 99.6'
i
Please note:Soil test
140th Ave was done to satisfy
county zoning
requirement. Soil
test may not be
suitable for owners
desired building
location.
Scale is 1" = 40'
unless otherwise
*B.M?o' B-1 100' B-2 noted
10' Alt. B.M.
30' 98'
50'
100' B-3
4% 97
Slope
Pro Town Road
R�� ��� '
JUN 01 2004
Lundy's Preserve Comments:
sr CKOIXCOON
Y y
ZONING OFFICE
The soils in this subdivision are quite variable and differ across the 80 acres. Some consist
of a clean outwash sand,other consist of glacial tills. In certain areas,the medium sands
have a very deep red color unlike I have seen in all of St. Croix county. The color does not
indicate high ground water because the color is so consistent. If you go through the red
sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam
Quinn from zoning,she commented that there could be a different chemical reaction with a
sands. I believe this is the case for the sands have a consistent size, and no mottles were
found above or below the sands. Sometimes bands were present, but were very slight,
and were mentioned to have the systems sized a little bigger in order to accommodate for
any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8,
and 9 have a extremely poor soil present not suitable for a mound system. The surveyor
and I discussed this condition, and the resulting tests were spaced as far away from this area
as possible. All the soils tests were done to the best of my ability and I hold no liability for
anomalies and other oddities that can be found on this site.
Shaun Bird
CSTM #226900
5/28/04
8 0Tx54037564 8
State Bar of Wisconsin Form 3-2003 9S1766
QUIT CLAIM DEED BETH PABST
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
03/02/2012 2:06 PM
EXEMPT*: NA
THIS DEED,made between Citizens State Bank REC FEE: 30.00
("Grantor,"whether one or more), TRANS FEE: 273.00
and_ Todd Marek Construction.Inc.
("Grantee,"whether one or more). PAGES: 1
Grantor quit claims AS-IS AND WITHOUT REPRESENTATION OF ANY KIND
to Grantee the following described real estate,together with the rents,profits,fixtures Recording Area
and other appurtenant interests,in St,Croix County,State of Wisconsin("Property")
(if more space is needed,please attach addendum): Name and Return Address
KRISTINA OGLAND
ESTREEN & OGLAND
Lo02,3,10,13,14 and 15,Lundy's Preserve in theTown of Richmond,St.Croix 304 Locust
Cou Wisconsin. Hudson, Wl 54016
026-1167-01-000;026-1167-02-000,026-
1167-03-000;026-1167-10-000:026-1167-
13-000;026-1167-14-000;026-1167-15-
000
Parcel Identification Number(PM)
a-a�- a.
Dated i Citizen=S :(SEAL) J (SEAL)
• *Thom s Van Pelt,President and CEO
(SEAL) (SEAL)
*
AUTHENTICATION ACKNOWLEDGMENT
Signatures)
STATE OF WISCONSIN )
authenticated on �� CA i )ss.
/ OI}L COUNTY )
' Personally came before me on Thomas Van Pelt oA (a-
TITLE:MEMBER STATE BAR OF WISCONSIN the above-named
(If not, to me known to be the person(s) who executed the fort' n
authorized by Wis.Stat.§706.06) instru ent and acknowledged the same._ Df���B. WILLERT
Notary Public
THIS INSTRUMENT DRAFTED BY: I �• �� f Wisconsin
i.
Kristina Oeland,Estreen&00and Notary Public,State of
304 Locust Street,Hudson,WI 54016 My Commission(k—peRRaaeetf)(expires: )-Q6'15 )
(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.
QUIT CLAIM DEED 0 2003 STATE BAR OF WISCONSIN FORM NO.3-2603
•Type name below signatures. INFO•PRO° Legal Forms 800655.2021 www.intoproronns.eom
1 of 1
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