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HomeMy WebLinkAbout026-1153-02-000 Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division , INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 569525 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: 026-1153-02-000 Marek Construction, c/o Todd Marek Richmond, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: l Aim, Cs ( 19.30.18.1140 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER .`r'f CAPACITY STATION BS HI FS ELEV. Septic 'r-% Z. a Benchmark /ZSd .3 M6-3 /dd ~:1 e5d-- VT Alt. BM ,(e i~ep •73 9~. 17 Aeration Bldg. Sewer 0 • 9 Holding St/Ht Inlet 9 ! . TANK SETBACK INFORMATION '§t/Ht Outlet `1 !0, TANK TO p P WELL BLDG. a to Air Intake ROAD Dt Inlet \ 4- SbJ),k, Septic °/b / 9z Zt 47 , Dt Bottom Dosing Header/Man. j Z• 4 913. 4 Aeration Dist. Pipe IZ• 9S . 41 13-1 °13. Z Holding Bot. System 13.5 9L .3 Final Grade PUMP/SIPHON INFORMATION ; l_ s; A 2- 9- ( " '111'7, 7 Manufacturer GP Hand St Cover LQ J 4A, 7. T Model Numbe TDH Lift Friction Loss I System Head H Ft Force main Length ist. to Well i SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. FLuid Depth DIMENSIONS 3 GO Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur Al INFORMATION CHAMBER OR _X Al / 4-r.' Type Of System: Q.._ UNIT , Sd~~ JI :r7 3 f 9`J NV J Model umber DISTRIBUTION SYSTEM / Je Z Z k Z y /~l S Header/Manifold f Distribution x Hole Size x Hole Spacing Vent to Air ntake c / Pipe(s) ~ \ ~ ~af c LengthDia A _ Length Dia Spacing C.~ 4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1489 94th Street New Richmond, WI 54017 (NE 1/4 NW 1/4 19 T30N R1 8W) Glen View Lot 2 Parcel No: 19.30.18.1140 1.) Alt BM Description ez. G~ ~ec~d 1 S 2.) Bldg sewer length = 36 / - amount of cover 14G t1 nn S~- f 6(~"py~ ✓Y►p Q G1~o•e f - ^0 4o~ Plan revision Required? Efl Yes No S Use other side for additional information._ , _ T✓ SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No. i PLO 4- ~L,41V rC~ ~ Le - Z -ci G FN v/ e-- V/ t 6D SOD VIC" to, JY# In fi 6 5o' r /y% County i2v t x e. Safety and Buildings Division C 0 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) VIT-1 Madison, WI 53707-7162 s~s K 5C~ 5z 5 State Transaction Number Sanitary Permit Application in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to th prep ' ` governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-o 'm submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide mayY u oses in accordance with the Privacy Law, s. 15. 1 m , Stats. -~t 1. Application Information -Please Print All In rm n ST Parcel # Property Owner's Name 0 S -O Z- D o p A'P2 LLI / y MMUNI ~k COI Z (0 Property Owner's Mailing Address Property Location © 0 OpM-N g T l/ J ZZ g Govt Lot /I City, State Zip Code Phone Number- Sectionl T 4 I Y / ~j circle one 715--37 - Z Iz/ T3 Q N; R Eo &W I~I6i9mo 14 b .S 01 -7 II. Type of Building (check all that apply) Lot # Z~ Subdivision Name 44 1 or 2 Family Dwelling-Number of Bedroo Block # -9 L t? -l V ❑ Public/Commercial - Describe Use ❑ City of CSM Number El Village of 1) State Owned -Describe Use ~ Town of /C f G~M D 1✓ A Z p cent ~ w z ► t- zz III. Type of Permit: (Check on one box on line A. Complete line B if applicable) Zow A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner L/t 9; d-r~F 0': Y IV. Type of POWTS S stem/Com onent/Device: Check all that apply) e r 54-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. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate (gp Dispersal Area Required (sp [1Dispersal VI. Tank Info Area Proposed (sf) S stem Elevation Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks d Existing Tanks ° =1 7.` ~~Ov a U~ ~n ti vi u t7 a Septic or Holding Tank Z L1"~ Z C-O (Le- ~~rV- Dosing Chamber ©v e 0 ( 1 >C 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 MPR+~'W Number Business Phone Number ke )kjC- C5aL/ 2 2 9 7 7i6/KV Plumber's Address (Street, City, State, Zip Code) -CLt; 5&0 0-/Z-.t c-(- cv t o VIII. Coun /De artment Use Only Approved Di Pemtit Fee Date Issued Issuin ent Sign e ❑ El Reason for Denial $ 3 9 IX. Condi easons for Disapproval `pt'i~'tank,lfHtisnt filter and' ) dispersal cell must all be services / maintained W , P- Vha4 as per management plan provided by plumber. 2. At sel6ack requirerrtents;1luut bo,;maintalpbd as per appUeable code 1 otdl11at1t 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: --D 9i b 11441?-E K Owner's Name: A-k r~ ~~x Z S Owner's Address: Z ti CucJ ►2t 4!o -2 /J 64/ '{e;/7 Legal Description: AJ UU Township: tK f L 1)4,4 r✓ Q County: C DLO ) Subdivision Name: L E N V/ C w Lot Number: Z Parcel ID Number: 2 - r (GJ 3. D `c -00 U Page 1! Index and title Page 2 Plot Plan ( f A~(~ cuLoss - s ~c Page 3 System Sizing & Cross-Section c vLc 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 Attachrraents: Soil Test & House Plans Designer/Plumber: /Ulg-7 p /1/_ License Number: 2 Z 6 r19 Date: Phone Number /s~ Z ?3~fCfC Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 PLO L,4 rv l - D Le Z J L ~N ofL:L411 Q~P „p~P kbP'Iv f60 LL Cori f Vx 5DI coo 03 y+ ,cIoil Absorption System Cross' Section q~ ft Fina- Grade 4" Schedule 40 PVC Vent Pipe With Vent. Cap ft ft Chamber ` System Elevation ft ft :soil Absorption System Plan View $ 88 ft ft { I S ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header 1Leachina Chamber Specifications . 12 UIcK Pius Manufacturer A60 Model 1iU RIAR4-(ate EISA Rating 219 sq fit per chamber Soil Application Rate gpd/sq ft f~ gpd Design Flow* Soil Application Rate + . Z ~ EISA Chambers ZI 2!rows of 2Z. chambers each. i i I Page of 64COUTIMM 267 M.., A 1~ 12" 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. l A 100-12T M Series The A100-12 is the commercial filter chosen by more engineers and installed in Y 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-CaseT"" 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% A and CBODS by 20-40%. .41 116"Filtration Available lengths 2028 & 36 .43 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. I 2"Filtration Available lengths 20", 28" & 36" A600-12"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. 1/64"Fiitration Available lengths 20"'28" & 36" For further technical information: www.zabeizone.com 050103-2" - POWTS OWNER'S MANUAL & 'MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS. Capacity 12,60 al O i Owner • Seanufacturer O i Permit AAeK Sej.n CAL ❑ i• EffManufacturer Z 4 DESIGN PARAMETERS ❑ r Number of Bedrooms ❑ NA EfflModel 10 0 Number of Public Faculty Units O NA Puapacity o o Estimated flow (average) al/da Pumanufacturer et yckPh Design flow (peak), (Estimated x 1.5) al/da Pumcturer G.Li~ O N Soil Application Rate a al/da ft= PumO N Standard Influent/Effluant Quality Monthly average• Pretreatment Unit O N Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel'Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD&) 5220 mg/L ❑ NA ❑ Mechanical. Aeration ❑ Wetland Total Suspended Solids (TSS) 5160 mg/L ❑ Disinfection E3 Other: Pretreated Effluent Quality Monthly aJ13 •Dispersal Cell(s) ❑ Nf Biochemical Oxygen Demand (BODE) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-Grade ❑ Mound Fecal Collform (geometric mean) 510' cfu/1O Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. Other: ❑ NA Other: Other: 0 NA "Values typical for domastic wastewater and septic tank effluent. Other:' ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 years) ❑ NA ~ 3 ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA Inspect dispersal call(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ® ear(s) Clean effluent filter At least once every; month(s) earls) ❑ NA Insect pump, pump controls & alarm At least once eve 0 month(s) ❑ NA P rye 3 ear(s) Flush laterals and pressure test At least once every: ❑ month(s) p NA ial. ear(s) Other: At least once every: ❑ month(s) ❑ NA ❑ ear(s) Other: . ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any. cracks or leaks, measure the volume of combined sludge and scum and to check for. any back up or ponding of effluent (?n the ground surface. The dispersal'c:Oll(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 th servicing-of effluent filters, mechanical or pressurized components,.pre;reatment 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) 6 .or emical products START UP AND OPERATION nce of oth For now construction, prior to use of the POWTS chock treatment tank for If h prey ncentra tons late de ectad have theccontenf 'i that may impede the treatment process and/or dpriordtopuseat cell(s) of the tank(s) removed by a septage servicing operator System start up shall not occur when soil conditions are frozen at the infiltrative surface. ess During power outages pump tanks may fill above normal hlghwater levels. When power re sIs ein ored tbackup he a cos su acted ter wiiill o ! effluent. To avoid this situation have th discharged to the dispersal cell(s) In one large dose, overloading the c removed by a Septage Servicing Operator prior to r estorin the contents of the pump -tank ~ power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls u restore normal levels within the pump tank. Do not drive or park veh)clea 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 of the j dental floss; diapers; disinfectants; fat; i 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; sanitary 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 • ~r Comm 83.33, with chapter properly and safely abandoned in compliance Wisconsin Administrative Code: ~ A I • II P1Pin9 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:- 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. O 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. soil absorption systems may, be reconstructed In place' following removal of the biomat at the Mound and at 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 2 CL~ Sow Name Phone S- 7-73 ' 7 T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 76df--,J.1o v sA-s✓i A 4- 0 v Name 574- C Quo ! >C Zd Phone 273 SS(, f v Phone 7/S .~S ~c T 6 This document was drafted In compliance with chaptef Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Coda. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer `D D P 114 A& E/z Mailing Address Z7 9 J) eWd''~ Property Address (Verification required from Planning & Zoning Department for new cons ction.) City/State k A,(LN M o n10 Parcel Identification Number © Z - 1193 - 0 Z - o o 0 LEGAL DESCRIPTION Property Location ' 4 N VV '/4 , Sec. _~L, T N R~W, Town of A)40 Subdivision Plat: L Lot # C, Certified Survey Map # , Volume , Page # Warranty Deed # :z + (before 2007)Volume , Page # Spec house ityes ❑ no Lot lines identifiable W yes ❑ 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(l) 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 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 warranty deed recorded in Register of Deeds Office. Number of bedrooms ~~A. R)(~ 1171 -1K 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) Ach ® a Quick4 Plus Standard Chamber Side and End Views i 48" f (EFFECTIVE LENGTH) k W AN r~ . 2! Ir< FAQ ! II 34" A a.~tla app 1 y z° "sa,, " -k4 Plus A!!-in-One 12uncap Front, Side and End Views I i 11.2" r T 13" 8" INVERT 8" INERT 5.3" INVERT n uick4 Plus All-in-One Periscope OUICK4 PLUS 3 ALW14-0NE ERISCOP6-- SWIVEL d j 12.7" INVERT OUICK4 PLUS I ' ALL-IN-ONE 12 DCAP EN E -~I 5" ham-- I~ 9" Y s Quick4 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 leachfield 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, 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, TO TH s LIMI TED INCLUDING NODIMPREMEDIES IN SUPARAGRAPH (a) AE LIIED WA RANGES OF MERCHANT AB LI(TYLORI FITNESS OR A PARTICULAR PURPOSES WITH RESPECT TO THE UNITS, (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 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, Old Saybrook, CT 06475 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 arms 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 ti 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 #I (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 t 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: 4,759,661; 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. PLUS051010ISI-2 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. Combinatio.n SePC-ic--,Tank and PL1-MP CHAMBER CROSS SECTIOIJ AND SPECIFICATIONS ,a •-VCWT CAP WEATHER Pjt00F ~/J A /6K JU►JCTIOW 5OX ,/V~ H'C.I. VEIJT PIPC APPROVED LOCKIMC, jQ' FROM Oo01t, 1MAWHOLE COVER wt"M ' yvARrJjwco ~8EL. -'AWDOW OR FRESH Co>JDUtT ~NsPo~ IpE A>K INTAKE S w / rYtCLZI s ttl- zrr P r j ~ b~l~ , • ~ i I Y~ MI1J. II ~ MW.~,IOOT I I ' 1 - . 18' /ill lJ. ~.e 'PROVIOE I WLET AIRTIGHT SEAL I II I BA A. I I~I APPROYED J0141 APPROVCD JOIIJT nIF-. ~ll.~'~ I II W/ C. T. PIPE~Pu W/C.I-PIPCOR Tank construction I I shall comply with ALARM ILHR ()'3.15 and 33.20 I II I I om C I I 1 PUMP OFF R O CONCRETE ~J 5LOCK RISER F-YIT PERMITTED OQLV IF TANK MAWLIFACTURCR HAS SUCH APPROVAL 3 SEPTIC r SPECIFICATIOUS DOS E TAW KS "Z5 EZ C~ Cl~'}->r KS MANUFACTURCR.: 1JUMISCR OF DOSES: PER DAB TANK 51ZC ZDV 0A.LLO-IJS D05E VOLUME l~,L ALARM MANUFACTURCR: S•S,~-L r1ZO 3LjM-el_2 IIJCLUDINC6 OACKFI.OW:-L ! GALLONS MODCL IJUMBER: 10L Nw CAPACITIES: Ac -Z3„ CHCS OR CALLOUS SWITCH T~Pt: - ' 456.0,44 8= Z IQCHES OR _Wf-Z OI LLOU5 PUMP MAQUFACTURCK: S 0 C=l.. IUCHESOR ~T LLOUS MODEL f\IUMBER: WCHES OR f 2 3, b0ALLWJS SWITCH TYPE: r~ F NOTE: PUMP AND ALARM ARE TO OL MIWMU/'1'DISCHARGE RATE CP/A INSTALLED pfJ SEPARATE CIRCUITS VERTICAL DIFFEKENCE DETWCEU PUMP OFF AU0.015TRIBUTIOIJ PIPE.. --~-LL. .EET t MIIMIM1UM NETWORK 5UPPLV PRESSURE FEET + J y FEET OF FORCE MAIM X 3. F oftFKICTIOU FACTOR.. ' 7 FEET TCrrAL MAMIC HEAD = z FEET As per manufacturer gal./in. APR-12-2005 16:28 FERGUSON ENT HUDSON '715 386 6144 P.01 HGOULDS PUMPS Submersible Effluent Pump PE "IftT Pump SPECIFICATIONS MOTOR FEATURES Pump - General; General: s Corrosion resistant • Discharge: 1'h" NPT • Single phase construction. Temperature: 1040F 400• 60 Hertz ■ Cast iron body. maximum, ontlnuous when • 115 and 230 volts IN Thermoplastic impeller c and fully submerged. • Built-in thermal overload pro- cover. • Solids handling:'/" 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 ■ 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 • Shaded pole design ■ wAll orking limits o within motor. • Basement Dralning Maximum head: 25 TDH PE41 Motor. disconnect power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick length, Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts cord, di heavy duty 16/3 standard d Saw len len with • Maximum head: 29' TDH • PSC design 115 or 230 volt grounding 1PE51 Pump: PE51 Motor 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. •PSC design METERS FEET ■ Mechanical seal is carbon, 40 ceramic, BUNA and stainless PE51, j 1 I I I MODELS: K31, reap, Pcsr steel. HP, .33, .40, so ■ Stainless steel fasteners. 35 1 o I, I + 2 GPM l ` i I AGENCY LISTINGS 30 --PE4- 1 FT Jill W Zs el a I i ~ji. , 20 Tested to UL 778 and { ! i I I - I I j j I j CSA 222108 Standards 15 -l- I- By Canadian Standards &Wjadon ~O_ t l I i I File #LR38S49 ' I ',10 { I-....L Goulds Pumps is iso 9001 Registered 0 0 U. U'Lil 0 16 20 30 40 50 60. 70 GPM 80 0 5 10 15 m3/h Goulds Pumps Ef 200a ITT Water Technology, Inc CAPACr1Y Eff•ctivJune, 2W4 BYE31/41 ITT Industries Isconsin Department of Commerce SOIL EVALUATION REPORT Page-, of 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 ° ` t D include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, anp`tec4on and distance to nearest road. Please print all inf4rmat Revi ed by Date Personal information you provide may be used for sew dary purposes (Pnvacylaw i..A 5.04 (if (m)). Z 0 S~ Property Owner ; Property, Location I Govt. Lot ~ LAA S T3 N R E (o w Props Owner's Mailing Address Lot # = Block # Subd. Name or M# City tats Zip Code PJae Number - ❑Ity ❑ village To Nearest Road 0 1 ls Z New Construction Use: Residential / Number of bedrooms 31,1 Code derived design flow rate" GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Chi tst~t/Zv Flood Plain elevation if applicable ft. General comments ~ P- 7 S e r u:~ Boling # ❑ Boring Cb&- nd c'° E 2 °o E a ja Pit Ground surface elev. `v ft. Depth to limiting factor in. r*Eff#l il lica'on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#2 2- - m~ 6k 1 z 3 - (JS NOS -7 Q Boring # Boring Pit Ground surface elev. v 3 ft. Depth to limiting factor 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 ;'Otlye z C .2 m 5 S- Z .3 2 1 rIYU Qs ML na Ili-- 1.7 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 r 2- Property Owner _ Parcel ID # Page of [37-] Boring # ❑ Boring 54 Pit Ground surface elev. V)_~/! ft. Depth to limiting factor Ze~in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ? 'Eff#1 'Eff#2 'Iz a 31, 73-11 F-I Boring # ❑ 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 # 11 E) Pit Boring Ground surface elev. ft. Depth to limiting factor in. Sal 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#1 'Eff#2 Effluent #1 = BOD5 > 30 1220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mgA- and TSS 130 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6N0> • Soil Test Plot Plan Project Name Lakes and Hill Development Shaun Bir Address P.O. Box 10598 White Bear Lake Mn 55110 CSTM 26900 Lot 2 Subdivision Glen View Date 7/18/03 1 /4 N W 1 /4S 19 T 30 N/R18 W Township Richmond B ' g Q Well PL Property Line County ST. CROIX BM VRP Assume Elevation 100 ft. Top of 1/2" Pipe _ s- ystem Elevation 95.5/94.5 *HRpSame as Benchmark Alt. 7B~j Top of 1/2" Pipe @ 103.9' 440' Property Line ~t. * M. 200' 265' 101' Scale is 1" = 40' 99' unless otherwise 50' noted 97' - so' Please note: survey was not completed at time of testing, B-3 B setbacks from lot lines may change. Installer must verify 50, 10.7 Slope all lot lines and setbacks before installation. B-1 Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. /2014 20:51 FAX fj013 • 1 ~ U N P L A?r D LANDS No0.00,10"W 530.65 40*00.i 0ME ' 605 tn" U- S00.00.1-ep- 604.43 256.16' NOa'DQ 226.51' _ 1,.- - - - - - - _ 164.4' _ ~ 1 ,I 1 in I '1 - i M go r All 1 w~ t V~ O Q ~ lie_ Ln t ~~I t opt Mkx N 1 n ~ ~ v Gl 1 33i 33. 6 ~supu'so"w paa.7 m S00'00 26 E 256.20' 1 .44 :Iv -00 1 g00m0'00"w C*, II Illlllllliililllllllllllll III 8005750 State Bar of Wisconsin Form 1-2003 Tx:4004507 WARRANTY DEED 921581 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Hillvale Development Limited Liability Partnership RECEIVED FOR RECORD ("Grantor," whether one or more), 08/27/2010 4:00 PM anTodd Marek a married Berso EXEMPT N/A n REC FEE: 30.00 ("Grantee," whether one or more). TRANS FEE: 102.00 PAGES: 1 Grabtor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Hudson, W154016 Lo 2 12, and 33, Plat of G1enView in the Town of Richmond, St. Croix County, File # 2805832 Wionsin 026-1153-02-000;026-1153-12-000;026-1153-33-000 Parcel Identification Number (PIN) i This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Ea ements, restrictions and rights-of-way of record, if any. Dad August 27, 2010 Hillvale Devel ent Limited Liability Partnership (SEAL) ~ SEAL) * * Richar S. Nelson, Partner (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Sig ature(s) STATE OF WISCONSIN ) SAIDG14 K. ) au enticated on ss. _A St. Croix COUNTY ) STATE OF 'V~17!.";C~_`N13JN * Personally came before me on August 27, 2010 , T6LE: MEMBER STATE BAR OF WISCONSIN the above-named Richard S. Nelson, Partner of Hillvale Development Limited Liability Partnership (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrumen d ac}crtowledged &MG T S I NSTRUMENT DRAFTED BY: Attorney Doug Berg Notary Public tate of Wisconsin-/ 1200 Hosford Street Suite 201 Hudson WI 54016 My Commission (is permanent) (expires: R 3 13 ) (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. W TY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 ' T e name below signatures. loll