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HomeMy WebLinkAbout026-1165-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569530 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: I 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 I Richmond, Town of 026-1165-23-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: Bran I �f's-` 22.30.18.1289 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ;.� S CAPACITY STATION BS HI FS ELEV Septic ,^ Benchmark D G✓% e�e, 3lo �. �d•31 16 ,31 i�6 Alt.BM rI Aeration Bldg.Sewer v . /oz. o r Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 9 I /-d! TANK TO 41,2-VA" L WELL BLDG. Vent Air Intake ROAD Dt Inlet N.. Septic Dt Bottom 5/ r^ ' /Q� Dosing N!� Header/Man. Aeration Dist. Pipe /D.7 9Y•3 Holding Bot. System //.71 //.97 98• 6iE Final Grade ' PUMP/SIPHON INFORMATION Manufacturer Demand St Cover�� GPM tr- .•l J w.`. 5. j 'L' Model Nu TDH ift Friction Loss System TDH Ft Forcemain Length Dia. Dist.to well SOIL ABSORPTION SYSTEM BEDITRENCH Width LengLtL No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth 3J DIMENSIONS 3 I!e �� �- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: Q 1/t UNIT / �l/r'r Model Numb r: Cep, �o.� J9 Numb s/Q DISTRIBUTION SYSTEM Z6.4.Z-0 :&b 5 Header M ifglId/ '` Distribution x Hole Size x Hole Spacing Vent to Air Intake J( L' Pipe(s) �_ \_ )44. ,Jell Length Dia 4 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth o x Seeded/Sodded jxx Mulched Bed/Trench Center , Bed/Trench Edges ` Topsoil es No _e_s 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1429 129th Street NgFw-�Ri�chmond,WI 54017(NW 1/4 SE 1/4 22 T30N R1 8W) Lundy Meadows Lot 23 Parcel No: 22.30.18.1289 PrI 1.)Alt BM Description= / J Ga JG`—J ��. Ca'� (�✓( S�t?UJ S 2.)Bldg sewer length= Z,9 -amount of cover= r n O Plan revision Required? N Yes Nos (p J Use other side for additional information. L_!�! _ SBD-6710(R.3/97) Date Insepctor r ignatur Cert.No. �Lo f j CA-IJ ( 11 =� qD ' Z - + P lot,D �� 2 3�► .�... L L f 9y® a N V V ev/ P County Safety and Buildings Division C 2n l 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 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 be used for secondary /� /z purposes in accordance with the Privacy Law,s.15.04 1 m Stats. I. Application Information-Please Print All In for n e D �� Parce l# 13 Property Owner's Name 3 �r{ r Al2�K ,c, •; Z(� 5 "7—'9 Property Owner's Mailing Address /JM ,qO Property Location D gt? Z2 COV Govt Lot z z City,State Zip Code PPhhoneeNumber Op 1U� %, Section,�ry 5 -7 d�✓ -3/ z- T .7 N, R�_lEore(J d.Type of Building(check all that apply) Lot# Subdivision Name 41 or 2 Family Dwelling-Number of Bedrooms �j Block# 1.u AJ-0 Y if 4y ❑Public/Commercial-Describe Use ❑ City of CSM Number ❑Village of ❑State Owned-Describe Use 0 Town of Wg W 2b +• 6 C elm II.Type of Permit: (Check ofinly one boa on line A. Complete line B if applicable) a 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 ❑Permit Revision ❑Change of Plumber El Permit Transfer to New Before Expiration - Owner IV.Type of POWTS System/Component/Device: Check all that apply) $-Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound 2:24 in.of suitable soil ❑Mound<24 in.of suitable soil�lU!rj dlolwt ❑ Holding Tank Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersaVFreat ent Area Information: Design Flow(gpd) Design Soil Application te(gpds Dispersal Area Required(sf) Dispersal Area Proposed(s0 System Elevation /40 0,S I zoo J 2L � � 1191 9g,5 VI.Tank Info Capacity in Total #of Manufacturer V Gallons Gallons Units u N = New Tanks Existing Tanks Septic or Holding Tank (-z Le— Dosing Chamber t7 v �- o v 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 MPAARW Number Business Phone Number k 'AJg; 0, / 2 2 6 V 715'- Z73. WLY Plumber's Address(Street,City,State,Zip Code) -C—r L 5/,)0?,Z- -� c-F W ( o VI .County/De artment Use Only Approved ❑Dis Permit Fee Date Issued / Issuing ent Signatur ❑ er Reason for Denial $ j hO IX.CondttlQlLt ' easons for Disapproval 3) /) ` )/� mil l' JICq.. O 1.''Septic tank,effluent filter find' t ` dispersal cell must all be services/maintained 1 y - �� as per management plant provided by piut(lbet. ')) //�� 11 `` rr 2.:+411 satt It t+equ$r nerft dust bCmaintaitibd 4) fl b t tZa.(�5 i�c y 1 i-�, s NO le,(a v.� ZOn as 06&f tirdittiws Attach to complete plans for the system and submit n,,e County aly a paper than i z 11 inches}n size Ab 6rz P4-Z SBD-6398(R I1/11) C.�'std 60, 0 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: - ®P;b ImM-ge(� Owner's Name: Q /v6 A-k G k Owner's Address: 1,0, Legal Description: r )W, 5 Z 2 3(' )2 ( g Township: 144/V!, County: Subdivision Name: (�(�( /lJt� �' 4fC�-L0DW 5 Lot Number: Z 7j Parcel ID Number. QZ�, (I(05 / ~d 6 0 Page 1 Index and title Page Z Plot Plan �� ��,v(c c([;ats•rj�C Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5;; Maintenance Information Page 6' Management Plan Page 71 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test& House Plans Designer/Plumber: k© mL /U�&,wV License Number: AV Date: 3-- 7 /�! Phone Number Signature Designed pursuant to the In-Ground Soil Absorption t✓omponent Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 PLO f P LA-nJ I I ✓ qp , - % 3 L + 13 I..Ul ND y M �kDo v�y J p 5� ,0 �� 2301 ON ri y° N � v v� P i Soil Absorption System Cross Section /0 ,57 ft lo If( y 4"Schedule 40 Final e PVC Vent Pipe With Vent Cap Leaching f p d Chamber ft ` --�—ft ' ft System Elevation ft Soil Absorption System Plan View 50 ft I ft Leaching Trench 1 Chambers 4°Dia. Vent Or Observation Pipe Trench 2 Header Trench 3 Leaching Chamber Specifications FZEISARating urer And Model I/y r-/L4-Y? A-4-D/L 0-%-t G �--� sq ft per chamber Soil Appli cation Rate iJ d/s ft 9p q w J.Z0 Soil Application Rate r'� EISA= Chambers 3 rows of Z1V chambers each. Page of wane 0 1112 1=974 ._ fi iti A 100130, V600 ' 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 100-12"m 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 either 4" or 6" SCH 40 pipe. The A100 -12 Series is also outlet hub that accepts P P .: popular in many areas for residential use du e to its high quality effluent and Large e capacity. Independent research has shown the A100-12 de creases TSS by 50-90% and CBODS by 20-40%. f�1'1 I/76"Filtration Available lengths 20". 28"& 36" A300-12T 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. 40k1/32"FlWadon Available lengths 20", 28"& 36" A600-12T M 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. 1/S4"Filtration Available lengths 20" 28"& 36" For further technical information: www.zabelzone.com 050,03.244 POWTS OWNER'S MANUAL &'MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS. Owner Alz Septic Tank Capacity Q _a, ,, Permit Septic Tank Manufacturer �i/t�y 01----------- Effluent Filter Manufacturer Z A,97�L ❑ f DESIGN PARAMETERS Number of Bedrooms ❑ NA Effluent Filter Model /O c? O t Number of Public Facility Units ❑NA Pump Tank Capacity Too 31 O h Estimated flow (average) v� al/da Pump Tank Manufacturer rt�/l yca � Design flow (peak), (Estimated x 1.5) d(� gal/day Pump Manufacturer ❑ N Soil Application Rata al/da /ft� Pump Model O N Standard Influent/Effluant Quality Monthly average• Pretreatment Unit N. Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel'Flter ❑ 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 Ft- Fecal lls) l7 NI Biochemical Oxygen Demand (BODs) 530 mg/L in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑NA ❑ Mound Collform (geometric mean) 510`cfu/100m1 ❑ Other: Maximum Effluent Particle Size Y in dia. ❑NA Other: O NA other: ❑ NA Other: ❑ NA "values typical for domestic wastewater and septic tank effluent. Other•. O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank every: � ear earls) At least once eve ❑year(s) (Maximum 3 years) O NA � Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume O NA Inspect dispersal call(s) At(past once eve ❑ mohth(s) (Maximum 3 years) O NA P rye 3 ® ear($) Clean effluent filter At least once every: 13 month(s) ® earls) .0 NA Inspect pump, pump controls & alarm At least once every: 0 rnonth(s) O NA 3 9 year(s) Flush laterals and pressure test At least once eve ❑ m Year(s) ) O NA P every: � V. earls) Other: At least once every: ❑ month(s) O NA ❑ ear(s) Other: .. • ❑ NA MAINTENANCE INSTRUCTIONS 4^ 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 qn the ground surface. The dispersal,e011(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 falling 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 th servlcing-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. OMW (4/01) START UP AND OPERATION For now construction, prior to use of the POWTS check tie die areal call(s), If high rconcentra tons Z other c are detected havethecontent that may impede the treatment process and/or damage the p 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)liege iwtat the cells)and may rest It in thedbackupcor surface discharge al o discharged to the dispersal collie) in one large dose, overloading effluent. To avoid this situation have the contents of the pump-tank removed by a Septage Servicing Operator prior to restoring power to the affluent 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 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 diapers; disinfectants;t life of fate POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; 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 easures have been, or must be taken, to provide a coda compliant If the POWTS falls and cannot be repaired the following m replacement system: 0 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 now soil and site evaluation to-establish a suitable replacement area. Replacement systems-must comply with the rules in effect at that time. 0 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. 0 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. 0. 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. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 0 Lc 2 C(r S/�;p,/V Name Phone S _ 7- 7 3 7 T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 7W A j s o v SA-1tA'awe ti Name Phone 273 Sf ,ff, Phone This document was drafted in compliance with chaptot 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 41-0 D P 'M Mailing Address e.0 ' e g Z7 9 N eW (C 41a ai D kol S'a/ Property Address ! 4 z� 1 2� e P -- (Verification required from Planning&Zoning Department for new constructs n. City/State tA E Lk) A,[C U 1W nl D Parcel Identification Number. d Z b— I(1 S -3 l —0 4b LEGAL DESCRIPTION Property Location /y 0' S E 1/4 , Sec. z- �N R�W, Town.of /2 G M B �,/0� Subdivision Plat: Ltd A11K f��d t�J S , Lot# Certified Survey Map # , Volume , Page# Warranty Deed # � 6 ® / o (before 2007)Volume , Page# Spec house Ayes 0 no Lot lines identifiable)<yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION i 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 Plannin &Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a 7*ty deed recorded in Register of Deeds Office. Number of bedrooms " "`OC 9)CN� .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) 1-46ry }N OW '.�� T 'f' �.• ' u Y .• O N.. 'SIR j, ► [g1 IL e N S � t h w 1 IrTr ,lv'h► vb it Ml \ Joe, S j67�•a1 � v "•� •''�ty \ 111\/ / / .ltd` Fes, Y� ,`�'•�• �"i ��f N�w 8 + / r N t g M'� Zt/t• ! ! /! ��.9. �9+' �� * �•' +trr•RK.,y., I..�� � � FS � a . 64 c4 NNry .vj.ZA as � a ,, ••�y, �.. ! j s `n i s I. ti I OD '1•� " � T :1 b L,, •h •ct��r� $� •i7S,ZRMS LyRY Se kt)4e lb Vol, 9� d .,i 2 •apt ''. �^ nY i ��i 'S� E te. — S .i- � Ai n N \ 'Q� ♦ / x i�i w !y Ur.,,.. / � b � h.. dh r 5� w a •� I \ 4 ``` \�—+1�i � 11 .�'•�'^•-./ 1� � �`v�r`.�� � �,l'Ti , Zi0 01 xyd 09:0Z r1oz F: Alk t Quil Plus Standard Chamber Side and End Views j 48" t (EFFECTIVE LENGTH) 4 Fay Fj r I` 34" n Quick4 Plus All-in-One 12 Encap Front, Side and End Views I 13" 8"INVERT 8"INVi ERT I5.3"INVERT A- � -18 ----�I '- 18.2" 33" Quick4 Plus All-in-One Periscope 5 OUICK4 PLUS ALL-INANE I EL )COP (3W SW yyq, A " F 6" G QUICK4 PLUS ; 12.7"INVERT ALL-IN-ONE 12 e ENDCAP Quick4 Plus Standard Chamber Specifications l _....... ------ 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" Effective Length .................................................... 48" (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22,6 cm) ------ ---- —-- l 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 leachlield 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 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, f Connecticut within fifteen(15)days of the alleged defect.Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered y by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. ' "r (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, 5.t e(Tl S 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. S y Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear,alteration,accident,misuse,abuse a or neglect of the Units;the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions;failure 10 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 'i 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 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 II (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 nflitratOrSyste mS.COm original Holder. !` u 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. Arvfx z xPi' 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 Quick4 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 Combination SepGic;Tank and Q PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS --� - ��jj IVCUT CAP WEATHER P)ZOOf JUIJC.TIOW 90X V° ti'C.I. VEIJT PIPC APPROVED LOCKIIJG jQ' FROM DOOR, MANHOLE COYER wIV 2 wARr.�I�J4 LABEL . �r�BP�.}101J PIPE �IIJOOW OR FRCSH S ALP IIJTAKE ccupu�r ,,/ •w I rYttz�l a tt9"�rr'P � r I 18.1'lIIJ. ���` ' • �•� PROVIDE I ---- IMLET •, � AIRTIGHT SEAL, I I A• I I�I APPROYED J0147 APPROVED JOIMT 21'SH�L. Ft� I II W/C.T. PIPE�Pu W/C.I. PIPCOR Tank construction shall comply with I II ALARM TLHB ()'3 . 15 and 33.20 C I I 0M _ I PUMP --j OFF 0 COIJCRETE $ZZ 6LOCK RISER EXIT PERMITTED OIJLV IF TAQK MAIJUFACTURER HAS SUCH APPROVAL AD IL DO I?qG SEPTIC F SPECIFICATIOUS DOSE TA►JKS MA>.JUFACTURER.: W I'I CQJCIZ,p_ IJUMBER OF DOSES: PEF. DA'y TALIK SIZE:- � ZDV GA•LLO-QS DOSE VOLUME Z� ALARM /'tAWUFACTURGR: S�S,�-L�L"T}LO 5�� 11� INCLUDIIJG 5ACKfI.0W: r GALLONS MODEL IJUMBCR: JOL Hw C ACITIES: A_ �39 CHCS OR� IIJCHES OR GALLous SWITCH TyPr. 8= z HUMP !IAJUFACTURCR:_ -S D _q/_Z GlLL0U5 C:_C IuCHES OR 1—Y-1-IL�i,ALL0U5 MODEL .IUMBER: _ PC /_ iMCHES 09 i2 3' .5ALLOMS SWITCH TYPE: nQ IJOTE: PUMP AMD ALARM ARE TO OL MINIMUM DISCHARGE RArE_. OPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEIJ PUMP OFF AU0.0ISTRI5UTI0Q PIPE.. z FEET t MIIJIMUM NETWORK SUPPLY PRESSURE D FEET . . . . . . . . . . FEET OF FORCE MINX FTC /100 fEFRICTI0IJ FACTOR------L' FEET • TC►TAL IMAMIC. HEAD - FEET As per • manuf ac turer gal/in. APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 RGOULDS PUMPS Submersible Effluent Pump PE WLYW PUMP ate•-_ SPECIFICATIONS MOTOR FEATURES Pump—General; General; t 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 E Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover, • Solids handling:1h- tection with automatic reset is Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing APPLICATIONS ' Automatic models include a • Oil-filled design, construction. float switch. • High strength carbon steel ■Motor is permanently Spedally 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 • Shaded pale design ■All ratings are within the • Basement Draining • Maximum head:25'TDH PE41 Motor working limits of the motor. ��_.. • Heavy Duty Sump/ PE41 Pump: I • .40 HP,3400 RPM ■Quick disconnect power Dewatering • Maximum capacity:61 GPM • 115 and 230 volts heavy duty 16/3 rd length,th • Maximum head:29'TDH • PSC design or duty volt grounding PE51 Pump: PE51 Motor: plug • Maximum capacity:70 GPM • .50 HP,3400 RPM ■Complete unit is heavy• Maximum head:37'TDH • 115 and 230 volts p duty, • PSC design portable and compact. METERS FEET g ■Mechanical seal is carbon, 40 ceramic,BUNA and stainless PE51 I f I I "I r MODELS:K31,Pf41•PE5t steel. 35 I i I 1 I HP..33,.aa,sa ■Starless steel fasteners. cP is r i Pe I I - 2 M I I I I AGENCY LISTINGS 30 ' 4 I + ' .j i 1 FT Q LIE. I ! � r I• I• , I I ' z 25 �ck®us f 20 ...I -�j a I I - ! - I ; I Tested to UL 778 and ' I i ! I: r I-I I ; j j' I CSA 222108 Standards E- 15 By Cana"Standards Assodadon .I I ( I I I u ! r I File#LR39Say 10 -;,.,� I I ...�.� 4 I �. 4, Goulds Pumps is ISO 9001 Reglstwed i i � I � I I i I � I r •I � Y I 5 " I I I -� � , I - i I � � i I• � : II. r ,• , OL O 0 10 20 130 140 50, 60. 70 GPM 80 0 5 i0 15 m3/h Goulds Pumps Ef 2004 ITT Water Technology,InC CAPACITY (�.T Effective June,.1004 ITT Industries �E31/41 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page�L 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 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. pe rcent slope, e,scale or dimensions,north arrow,and location and distance to nearest road. Z Please print all information. R ewed Date Personal information you provide ma eused.fRrjami9dary purposes(Privacy Law,s.15.04(1)(m)). / v Property Owner Property Location / l r' 's•���.�. .5 T6 C//�-�, �� 'JC�i GC. ^/ Govt.Lot 1/ 1/4 S T N R E(o W Property Owners Mai' Address Lot# Block# Subd. Name or M# l /�% �'" p2 "' dL�2 e ci City tate Code Phone Number ❑City ❑Village rT Nearest Road New Construction U se Residential/Number of bedroom Code derived design flow rated GPD ❑Replacement Public or merclal-Describe: _------- ------ -- -- Parent material 42Z Flood Plain elevation if pplicable �C� ft. General comments and recommendations: >���o L cs�Ti��� �''✓ �v� 9� O jJ IDBoring -� Boring# P S it Ground surface elev. /� �` ft. Depth to limiting factor_ lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 d" /� L L S ® Ong# Boring /� pit Ground surface elev /// ft. Depth to limiting factor 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 k LY •Effluent#1 =BOD >30<220 mg/L and TSS>30 1150 mg/I- 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L 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 — j�w Q 715-246-4516 r Property Owner_ Parcel ID# Page of F3_1 Boring# ❑ Boring Pit Ground surface elev.4e, 2ft. Depth to limiting factor in. Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 L, m S , 2. 307 LO ,Sl L o w � 1( I I ❑ Boring# E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 ❑ Boring# Boring Ground surface elev. ft. Depth to limiting factor in• ❑ Pit Soil ADDlication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots •E GPD Eff#2 in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. Effluent#1 =BOD;>30<220 nxyL and TSS>30 1150 mgA. 'Effluent#2=BOD,<30 mg&and TSS<_30 m91L 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. SOO.9330(R.rwuo) Soil Test Plot Pla Project Name William Stock/Steve Dalton LBird Address 1748 112th St. New Richmond Wi 54017 sTM #226900 Lot 23 Subdivision Lundy Meadows Date 8/11/03 N 1/2 SE 1/4S 22 T 30 N/R18 W Township Richmond F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 100.2/99.8 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.2' Alt. B.M. 239' Property Line 158' Property Line B.M. 100' 5' -1 Scale is 1" = 40' 55' unless otherwise noted 8% Slope Please note: Installer must _ verify all lot lines and setbacks before installation. 30' Please Note: Tested area 0' may not be suitable for B-2 desired building area. 103' Check system location before excavating. 104' 0 105' 0 0 N N lb A. • - �N. 2394 D5 x24 sq. ff. % LOT23 ON) L07 - • N 71. 452 ., o State Bar of Wisconsin Form 1-2003 8 0x74053436 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): Name and Return Address I Lots 9,14,15,16,19,2 ,23 ad 31,Lundy Meadows, KRISTINA OGLAND Lot 13,Whitetail Mea s 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-I 165-16-000;026-1165-19-000;026-165-21- 000;026-1165-23-000;026-1165-3 1-000;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 'p-4 -->a I7,&1?i' (SEAL)By: �� (SEAL) * *William B.Stock (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT �. Signature(s)William B.Stock I i authenticated on d STATE OF ) )ss. COUNTY ) *Kristina O land TITLE:MEMBE 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 instrument and acknowledged the same. DRAFTED BY: Kristina 021and,Estreen&021 and * 304 Locust Street,Hudson,WI 54016 Notary Public,State of My Commission(is permanent)(expires:_ (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED m 2003 STATE BAR OF WISCONSIN FORM NO.1-2003 I • Type name below signatures. INFO-PROT"Legal Forms 600-655-2021 www.infoproforms.com 1 of 1