HomeMy WebLinkAbout026-1165-19-000 I
Wisconsin Department of Commerce County:
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
569529 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 026-1165-19-000
CST BM Elev: Insp.BM Elev: BM Description: ,fin Section/Town/Range/Map No:
1 Y ' 6epr 22.30.18.1285
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER Ps .&J-' CAPACITY STATION BS HI FS ELEV.
Septic r^ s /Z.Sin Benchmark 7-73 /0-.' CC)
L L4, -' �(�l.J Alt. BM P��'� S1 L 7.92. 5,r •4
Aeration Bldg.Sewer
Holding St/Ht Inlet
C1. 31 W. 3
TANK SETBACK INFORMATION St/Ht Outlet 7,$ °l7. 9
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
l.a,✓s� s+�a
Septic / Dt Bottom 1
y
d LIL 50
Dosing Header/Man. Z 'T"7 • 5
Aeration Dist. Pipe
97. 5
Holding Bot.System
PUMP/SIPHON INFORMATION Final Grade •o
(v /O 1.`7
Manufacturer GPM Demand St Coves` 4 3 �G/• ,/
Model Number (� 7
TDH Lift Friction Loss System TDH Ft
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No.Of Trenches PIT DINt€NSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 17 4L 3 t✓`G
SETBACK SYSTEM TO P/L IBLDG WELL / LAKE/STREAM LEACHING Manufacturer: I —
INFORMATION CHAMBER OR T✓� �. �'`�4 t��r\
Type Of System:
35 UNIT Model N ber:
5_{ ��"
DISTRIBUTION Y TEM S zQ X3.- fd�5
Header/ ifo S Distribution Tol
e Size x Hole Spacing Vent tglAir Intake,
Length Dia_ Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/ dded xx Mulched
Bed/Trench Center ? Bed/Trench Edges Topsoil s No Yes No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / /
Location: 1424 129th Street New Richmond,WI 54017(NW 1/4 SE 1/4 22 T30NGR18W) Lundy Meadows Lot 1 Parcel No: 22.30.18.1285
1.)Alt BM Description= ��S�V° S
it
2.)Bldg sewer length= Z4
-amount of cover= /
_ ------ ----,"1 1 -"4
Plan revision Required? El Yes No rte,
Use other side for additional information. I f _
SBD-6710(R.3/97) Date Insepctor's Sig ture Cert.No.
11J11111111111111111111111111
8255774
Document Number Document Title Tx:4209059
St. Croix Count 1001402
County BETH PABST
anc Affidavit
REGISTER OF DEEDS
Occupancy Y ST. CROIX CO., WI
ok� RECEIVED FOR RECORD
\ L1._� 09/10/2014`12:16 PM
EXEMPT #:
Name — (O ner) Typed or printed REC FEE: 30.00
being duly sworn , states, under oath, that: PAGES: 1
He/she is the owner/part owner of the following parcel of land located in St.
Croix County, Wisconsin, reco ded in Volume Page
Document Number St. Croix County Register of Deeds Office: Recording Area
A parcel of land located in the '><of the�L%of Section LL, T j]N Name and Return Address
—R a W, Town of R.-,&uv r nd , St. Croix County, Wisconsin, being duly
described as follows(include lot no. and subdivision/CSM or detailed legalO n ��
description):
Parcel Identification Number(PIN)
As owner of the above described property, I acknowledge that the private onsite wastewater treatment system
(POWTS)'serving this residence is sized for a bedroom home or a design flow ofjQ gpd. The design flow is
calculated by assuming ISO gpd for 2 individuals per bedroom. There are currently_0_occupants living in this
residence; a maximum of 6 occupants are permitted based on the design wastewater flow. Therefore the POWTS
serving this residence is code compliant at this time. However, I understand that if there are intentions to exceed the
number of permitted occupants, the POWTS may be subject to premature failure and/or will need to be modified to
accommodate the increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this
information available to any future parties interested in purchasing this property.
l bah
D day ofy�Xber- bI`A_
LJ
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
)ss.
St.Croix County. ) -v"
authenticated this day of Personally came before me this 10 day of _
)-c"`t the above named
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be-the person(s)who executed the foregoing
(If not, instrument and acknowledge the same.
authorized by§706.06,Wis.Stats.)
P S IN DRAFTED BY: ;•t'
,S
Notary Public,State of Wisconsin ,_
(Signatures may be authenticated or acknowledged. Both are not My Commi sio is permanent. If not,state eV WO aate
necessary.) Date: t "
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE"
This information must be completed by submitter: document title.name&return address and PIN(if required). Other information such as the granting
clauses,legal description,etc.maybe placed on this first page of the document or maybe placed on additional pages of the document.Note: Use of this
cover page adds one page to your document and$2.00 to the recording fee. Wisconsin Statutes,59.43.
i
County
Safety and Buildings Division C 2.0 (J
201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.)
Madison,WI 53707-7162
anitary Permit Application State Transaction Number
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 AddresF(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide®y a used for secondary #IJ12Ll,/ 12 J R ,
purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. !j _
I. Application Information-Please Print All Infarmatian
Property Owner's Name I ?� Parcel#
A'�t�K MAR 1� �l/ Zb - 116 - od0
Property Location
Property Owner's Mailing Address A./MVN/RQ/X C (/
D p 0 Z Z g �O
.I? EV t ovt.
City,State Zip Code Phone Number J~ G
1'/: Z-�1/t Section Z
/U 6W 1Z1C9M0 N D W( S 01 -7 71 3 7 - Z r T ON; R
(circle E 0(9
IT.Type of Building(check all that apply) Lot# ,
Subdivision Name
41 or 2 Family Dwelling-Number of Bedrooms
�� Block# � �� MFr�Ow
❑Public/Commercial-Describe Use "�7V�G --�
El city of
CSM Number ❑ Village of
❑State Owned-Describe Use
�. t?Town of jet e-#~A✓10
3 6� C �- ��- za �
III.Type of Permit: (Check only one box on line A. Complete line B if applicable) Via.tQ�
A.
$lNew System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain)
B•
El Permit Renewal ❑Permit Revision El Change of Plumber
❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
I _6& -,C4 C
IV.Type of POWTS System/Component/Device: Check all that a 1 S ,� of
-Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil
❑ Holding Tank Other Dispersal Component(explain) ❑Pretreatment Device(explain)
V.Dispersal/Treatment Area Information:
Design Flow(gpd) esip Soil Application Rate(gpdsf) Dispersal Area R7zoo uired(sf) Dispersal Area Pro osed(sf) yytem Elevation
�,6 (� e� - _ 200 r 77
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units U y Y
New Tanks Existing anks d o w 2
c, a
g &V Z4 rJx'�C. �l�l/ U in
Septic or Holding Tank �7 v.,p — (z L—j 61- �t�►�
Dosing Chamber Q V v o j I 15 '
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 MP44DW Number Business Phone Number
/C D C�-X- /l5 u-G�D A/ 2 269 9 7 7/,57-, ,? 73- YKKK
Plumber's Xddress(Street,City,State,Zip Code)
ELL ,el 4,0o-7� ,� c-- w ( o
VIII.Coun /De artment Use Only
Approved Permit Fee Date Issued Issuing ent Signature
rven Reason for Denial
q75. 3
IX.Condi ' easons for Disapproval
�I�s�t � l��y�ld�-f pe,;el.� � — 'Th
1. 5eptic tank,effluent flRer and` � (;tA-a„ '0A
dispersal cell=must all be services/maintained
as per management plan provided by plumber.
2. Ad k-,qu ements must be meiMain6d ��
n.pair apple code/ordrtllttc / 1 ` °' - � leltt✓� Go dt t`� r i
Attach to complete plans for the system and submit to tit Coun niy aper not less than in z�in es in size �0
a.ti i-'.
SBD-6398(R 11/11)
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: D
Owner's Name: --�Q AfA-k 6 r�
Owner's Address: ,0d X Z Z S
AJ C--_-(,J rs-I C- �iYlO �/� L.��l _5 T V 17
Legal Description: i2
Township:
County: C V-0 X
Subdivision Name: L i / �5I"a Li
Lot Number:
Parcel ID Number: DZb — Z I — 0 0C?
Page 1 Index and title
Page Z Plot Plan
Page 3! System Sizing & Cross-Section I '�f}AI k C12Df s—S��'
Page 4: Specs ` Z p(AM P C u f2 v Er
Page 5' Maintenance Information
Page 6' Management Plan
Page 71 St. Croix Cty Septic Tank Maintenance Form
Page 8. Warranty Deed
Page 91 CSM or Plat
Attachments: Soil Test& House Plans
Designer/Plumber: Ir&0 License Number: 2 Z 6 f 9
Date: 3—/ 7—/ y Phone Number
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01101).
Page 1
00
D 2
FA^
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6�
q J
�v 6-^.VA
�k
3 0�°
ull ul u
P(PC
i
Soil Absorption System Cross Section
ft
� ft
4"Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ft
Leaching
Chamber 7 tt
— ft ftft Syste Elevation
Soil Absorption System Plan View
SO ft
ft {
I _
ft Leaching Trench 1
Chambers
4°Dia.
Vent Or Observation Pipe Trench 2 Header
Trench 3
Leachin Chamber S ecifications
p p
Manufacturer And Model I A-)1�1 L{-2 A2 10(.l e lz
EISA Rating—ZD—sq ft per chamber Soil Application Rate
6 b . li �9pd/sq ft
gpd Design Fiow� I/ ZqV Soil Application Rate + -100 EISA=_4(�LQ Chambers
3 rows of--Z—O—chambers each.
Page
0
9 f �
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• to ��L=j 261 71 9-MAMM Fit
00/160 � rigs
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 fin Is
of filtration.
A100-12Tm Series
i. 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 A100-12 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%.
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.
I F32"Filtration
Available lengths 20", 28"& 36"
A600-12TM 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 SmartFIlter®Alarm switch to alert the owner
of required maintenance.
1/64"Filtration
Available lengths 20", 28"& 36" For further technical information:
www.zabelzone.com
050103-244
POWTS OWNER'S MANUAL &'MANAGEME
NT PLAN
SYSTEM SPECIFICATIONS,
FILE INFORMATION p N
Owner �(� Septic Tank Capacity D al 1A A-k
Permit �
Septic Tank Manufacturer ��� ❑ N
Effluent Filter Manufacturer Z e- ❑ N,
DESIGN PARAMETERS ❑ N.
Number of Bedrooms ❑ NA Effluent Filter Model (�
Number of Public Facility Units
13 NA Pump Tank Capacity Q U al O N.
Estimated flow (average) gal/day
Pump Tank Manufacturer eb ycr,PN,
Design flow Ipeak), (.Estimated x 1.5) al/da
Pump Manufacturer o ❑ Ni
Soil Application Rate re `' al/da /ft
s Pump Model ❑ Ni
Monthly average*
Pretreatment Unit ❑ N<
Standard Influent/Efflueht Quality y
Fats, 011 &.Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 5220 mg/L ❑NA ❑ Mechanical.Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality
Monthly average FE3 11(s) ❑ NA
Biochemical Oxygen Demand (BODE) 530 mg/L (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑NA ❑ Mound
Fecal Coliform (geometric mean) 510'cfu/100ml ❑ Other:
Maximum Effluent Part icle Size Ys in dia, ❑NA
Other: ❑ NA
Other. ❑ NA Other: ❑ NA
❑ NA
Other:'
'values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: 33 p ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one
(Y,) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: .3 ® ea� �sj(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
® earls)
Inspect pump, pump controls & alarm At least once every: 3 H year(s)
❑ NA
Flush laterals and pressure test At least once eve ❑ month(s)year(s)
❑ NA
p every: +7 '®. earls)
Other: ❑ month(s) ❑ NA
At least once every: ❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
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 cqn the ground surface.
The dispersal coll(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 thservicing•of effluent filters, mechanical or pressurized components,.pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
START UP AND OPERATION
For new construction, prior to use of the PO o damesekthe dispersal call(s). If high rconcentra concentrations e detected have hthe content
that may impede the treatment process and/or g
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 f�ogadinat the levels. When power
and may resiult restored
backupcor su acts discharge'l o
discharged to the dispersal cell(s) in one large dose, 9
I ffluent; To avoid this situation have the contents of the pump-tank removed by a Septage Servicing Operator prior to restorins
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t(
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 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 e�s;l disinfectants; fat;
f tE
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss,
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 Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.,
•. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing-Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures'have been, or must be taken, to provide a code compliant
replacement system:-__
❑ A suitable.replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and•proposed structure, lot lines and wells. -Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
• A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed In place following removal of the b(omat 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.
M r
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name ;'p Lc f2 C(r SOS Name
Phone S — Z 7 3 — SFIj Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name -Z6,4 U f a v S'A-,✓i It 44 N Name 5-� C�o >e ,/ZD
Phone 2 7 3 Sgt( Phone Yj �'$ fo 16
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1). (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 4 D D 114 0 V'EK
Mailing Address f/' , 13 0 g Z Z 9 JU elt) At cb(44a l D w�
Property Address �212 Z
(Verification required from Planning&Zoning Department for ne c nstruction.)
City/State � I,[LH Mo n1 D Parcel Identification Number 0 z �, -- � 1 6�— Z I — � ° 0
LEGAL DESCRIPTION
Property Location Nv� 'A, 5 G '/4 , Sec. ZZ, T _5D N R_Lj W, Town of C I-�A4_a V,0
Subdivision Plat: (,(A) Q � 144 i'A-Pd �cJ S , Lot#�.
Certified Survey Map # , Volume , Page#
Warranty Deed # ? _Z / (before 2007)Volume , Page#
Spec house Oyes❑no Lot lines identifiable X'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 §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 'n thi 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
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ***
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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)
03/16/2014 20:37 FA% �1- f 001
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,
Effective Length "••"••"••. ".•"• "•••. 48"'(122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22_6 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 end
operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions,is warranted to the original purchaser("Holder")
f r the septic stem containing the Units;
issued o
i permit Is ssu
workmanship for one year from the date that the septic p p Y ,
against defective materials and wo p y
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 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
(c)This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR
does not extend to incidental,consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, inc.
including loss of production and profits,labor and materials,overhead costs,or other losses or expenses incurred by the Holder or any third party. systems
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
r 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• 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
S 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 W W W.I nflitrat0l Sy9te mS.COm
9 original Holder. " k
`s. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty
1 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.
U.S.Patents:4,759661`;5,017,041;5,156.488;5V 336,017;5,401,116.5.401,459,5,511,903;5,716,163,5,588,778;5,839,8
44
n e d
Canadian Patents:1,329,959:2,004,564 Other pate is p g
Infiltrator,Equalizer,Quick4 and Ouick4 Plus are registered trademarks of Infiltrator Systems Inc.Infiltrator is a registered trademark in France.Infiltrator Systems Inc. PLUS0510101SI-2
is a registered trademark in Mexico.Contour Swivel Connection is a trademark of Infiltrator Systems Inc.0 2009 Infiltrator Systems Inc.Printed in U.S.A.
' •. Combination Sep4c:•Tank and
PUMP CHAMBER CR055 SECTION ANQ SP(;CIFICATIONS A
�s//� VEUT CAP. f WE=ATHEK Fj Oor
G(� JUWCTIDQ 60X
ti"C.I. VEIJT PIPC APPROVED LOCKIMC,
—IO' FROM Door., . NA)JHOLE COYER. t-JIV
:111JOOW OR FRCSH � wAttIJII.JG L.A.6EC..
"S?Q: l01J Piet; ALR WTAKI � S coulSUlr
PROVIDE
INLET
AIRTIGHT 5EAL,
� I III I
III APPROVED JOT
APPROVED JOIIJT ZpSgtR, Ptl A W
W/C.I- PIPEOR Tank construction I III I W/C.I. P1PE�E�
shall comply with I II ALARM
ILHR 1;3 . 15 and 33.20 a Ij i I
_ I
PUMP ''j
OFF
0 COLICKETE
�Z 7 BLOCK
3"AP PR,-
RISER EXIT PERMITTED OQLy IF TAWK MAJJUFACTLJRER HAS SUCH APPROVAL SEOOtNG
SEPTIC E SPECIFICATIOUS
DOSE
TA kJ KS MAtJUFACTURCR.: W` C2JL� NUMBER OF DOSES: PER DAB
TAMK SIZE zoo GA,LLO-JS 005C VOLUME f
ALARM t�AWUFACTURECR: IIQCLUDIMCo 5AGK�^f7LOW: / � � � GALLON5
MODEL uUMBER: LOL Hw CAPACITIES: Aa ` OCHESOR ._L.—`LGAlL0u5
SWITCH TVC: ��� 8= Z IuCHES OR ����[�� G(�LLOU$
PUMP MAJJUFACTURCR: -,S// �QuL.� C=�IUCHES OR _._L�_Zi,ALL0U5
MODEL NUMBER: Tf' D AXHE5 OR (Z31 .6ALLONz
SWITCH TYPE: 9,d f ►JOTt : PUKP AUp,1LARJ•1 ARE TO t5L
MIWIMUM -DISCHARGE 'RATE GPM INSTALLED ON 5EPARATE CIRCUITS
VERTICAL DIFFEKEIJCE; DETWE:EIJ PUMP OFF AWD..D15TRIBUTION PIPE I-
+ MIUIMUM NETWORK SUPPLY PRESSURE , ; , , , . , , , FCET
+ FEET OF FORCE VAIN X T 'F O fLFKICTIOIJ FACTOR.. FEET
TOTAL OtI WAMIC HEAD = l?' / FEET
s per manufacturer • gal/in.
1. i .
APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01
6
HGOULDS PUMPS Submersible Z
Effluent Pump
PE
14WENT I11MP
SPECIFICATIONS MOTOR FEATURES
Pump—General, General: s Corrosion resistant
• Discharge: 1'A"NPT • Single phase construction.
• Temperature: 104°F(40°C • 60 Hertz ■Cast iron body
maximum,continuous when • 115 and 230 volts s Thermoplastic impeller and
fully submerged. • Built-In thermal overload pro- cover,
• Solids handling:1h" tection with automatic reset t 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 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 • Shaded pole design ■All ratings are within the
• Basement Draining • Maximum head:25'TDH PE41 Motor working limits of the motor.
.40 HP,3400 RPM ■Quick disconnect power
�_..•
Heavy Duty Sump/ PE41 Pump: cord,20'standard length,
Dewatering • Maximum capacity:61 GPM • 115 and 230 volts heavy duty 16/3 d men with
• Maximum head:29'TDH • PSC design i 15 or duty volt grounding
PE51 Pump; PE51 Motor. plug.
• Maximum capacty: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 t ceramic,BUNA and stainless
PE51 MODELS:PE31,PE41,PE51 steel.
35 _ I ! j I ! I I . HR.31.40,so ■Staldless steel fasteners.
I
.
10 , 2 GPM
30 •PE4 i e I AGENCY LISTINGS
! .7, t I 1 F
2s Co Uj
, ; i t
U. I I I : tl
a C US
c 20 Tested to UL 778 and
ti
CSA 22.2108 Standards
I"" I- t BY CaWmn Standards Association
File#tB9aso
l I I j :I 11 i I I ' Goulds Pmps is ISO 9001 RegisterecL
I ! I � � � Ili •I � ij `I -- � i ' .j � � i' i• i
5
�. oil ` f ' i '�i � ..�. .,• ill ^il � j ' '
0 0 10 20 30 40 50 60. 70 GPM So
0 5 10 15 m3/h Goulds Pumps
®ZOOa Ilr Water Technology,inc CAPACITY
Effective lune,.7W4
BP01/41
` T
ITT Industries
I
Wisconsin Department of commerce SOIL EVALUATION REPORT Page k of 3
Division of Safety and Buildings
in accordance with Comm 85,Wis. Adm. Code County .
Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road.
�eviewed Date
Ple ase print all information. Z
Personal information you provide may be used for secondary purposes(Privacy Law,s-15.1M(1)(m)).
Property Owner Property Location
.5 T'C//��! .lCz/ GC. y! Govt.Lot 1 114 S T N R.ZS E(o W
Property Owner's Mai' Address 1. _ �f Lot Block# Name or M#
tate ZP Code Phone Number City ❑Village r Nearest Road
rNew Construction us Residential/Number of bedroom Code derived design flow rate_ � GPD
❑Replacement Public or pmercl aI-Describe: ------- --- -- --
Parent material �� "' Flood Plain elevation applicable z, ft.
General tms �� �W /��.L�t��`✓ �� ��
and recommendations:
Boring#
Boring o
/}
Pit Ground surface eley! � v ft• Depth to limiting factor_in. Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#t -Eff#2
3 .A'Z
Boiling# Boring �
®
Pit Ground surface elev. r ft. Depth to limiting facto)in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2
�' IU 3 5 CS am
2 - rDkj 5 — c I� ry, w it
cel
c
11
it
•Effluent#1 =BOD >30<220 mg/-and TSS>30<150 mg/L 'Effluent#2=BOD _<30 mg/L and TSS<30 mgIL
CST Name(Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 — ��__ O 715-246-4516
. l U
Property Owner_ Parcel ID# Page of
F3-1 Boring# ❑ Boring
Ground surface elev. ' Depth to limiting factor in. Soil Application Rate
Pit '
E<
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIf'Eff#1 'Eff#2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh.
ID {
FS O5 ; '
tl
Boring
❑ # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. —9;ii—Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF
in. Munsell Qu.Sz. Cont.Color
Gr.Sz.Sh. 'Eff#1 •01142
❑ Boring
Boring# Ground surface elev. ft. Depth to limiting factor in.
F-I
❑ Pit M*Effff#I *Efff#2 Application ate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots
in. Munsell Qu.Sz. Cont.Color
Gr.Sz.Sh.
I
•Effluent#1 =BOD,>30<220 mglL and TSS>30<150 mgA. 'Effluent#2=BOD,<_30 mgA-and TSS<_30 mglL
The Department of Commerce is an equal opportunity service tprovider and
e mpl yer. if
6you need TTY ance to access
.services or
need material in an alternate format, please
SBO4330(8.6=)
Soil Test Plot Plan
Project Name William Stock/Steve Dalton Shaun Bir
Address 1748 112th St. I /
New Richmond Wi 54017 CSTM #226900
Lot 19 Subdivision Lundy Meadows Date 8/11/03
N 1/2 SE 1/4S 22 T 30 N/R18 W Township Richmond
❑ Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 97.0/96.9 *HRPSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2'
Scale is 1" = 40'
unless otherwise
noted
Please note: Installer must
verify all lot lines and setbacks
before installation.
B-2
Please Note:Tested area
may not be suitable for
c desired building area.
Check system location
4 90' before excavating.
o., B-3
N
5' Tested area has<1%
Slope and thus no
contours
30'
B-1
130'
Alt. B.
B.M. 225' Property Line
20'
51 .5 r
Pi
`` -
� � s
N
LOT19 ,
73.252 sq. ft.• s
ocmS
wa •a
�oq L
.x9904:
1111111111111111111111
1 1 111111
State Bar of Wisconsin Form 1-2003 8 0x?4053436 9
WARRANTY DEED
960901-
Document Number Document Name BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
08/01/2012 12:48 PM
THIS DEED,made between William B.Stock EXEMPT#• NA
("Grantor,"whether one or more), REC FEE: 30.00
and Todd Marek
TRANS FEE: 351.00
("Grantee,"whether one-or more).
PAGES: 1
Grantor,for a valuable consideration,conveys to Grantee the following described real
estate, together with the rents,profits, fixtures and other appurtenant interests, in St. Recording Area
Croix County,State of Wisconsin("Property")(if more space is needed,please attach
addendum): yy� ' Name and Return Address
Lots 9,14,15,1 19 hand 31,Lundy Meadows,
I Lot 13,Whitetail ea s KRISTINA OGLAND
ESTREEN & OGLAND
This is not homestead property. 304 Locust Hudson, WI 54016
026-1165-09-000:026-1165-14-000:026-1165-15-
000:026-1165-16-000:026-1165-19-000:026-165-21-
000.026-1 165-23-000:026-1165-31-000:026-1160-
13-000
Parcel Identification Number(PIN)
Grantor warrants that the title to the Property is good,indefeasible in fee simple and free
and clear of encumbrances except:easements,restrictions and reservations,if any,of record.
Dated g q—j
(SEAL)By: �4 V (SEAL)
* *William B.Stock
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)William B.Stock I _ i
authenticated on d _Zffl Z— STATE OF )
)ss.
COUNTY )
*Kristin O land
TITLE:MEMBEA STATE BAR OF WISCONSIN Personally came before me on ,
(If not, the above-named
authorized by Wis.Stat. §706.06) to me known to be the person(s) who executed the foregoing
THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the same.
Kristina Oaland.Estreen&Oiland *
304 Locust Street Hudson W154016 Notary Public,State of
My Commission(is permanent)(expires:_
1
(Signatures may be authenticated or acknowledged. Both are not necessary.)
iNOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO.1-2003
f *Type name below signatures. INFO-PROTM Legal Forms 600-655-2021 www.infoproforms.com
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