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HomeMy WebLinkAbout020-1464-14-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 578955 Ile 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: Webster, William Hudson, Town of 020-1464-14-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: OO.C) J CST UM J4& / 11.29.19.2957 TANK INFORMATION I ELEVATION DATA TYPE MANUFACTURER PACITY STATION BS HI FS ELEV. Septic 1 I Benchmark 1 )o3+1 DaeinT- V Q lJ r pp 019, IL Alt. BM~ 3,ZiJ 62 Aeration Bldg. Sewer Holding '5.01 9-7- -7Z StNltlnlet / w.-'5 9'01 TANK SETB CK INFORMATION St/W Outlet ~01 I I0 TANK TO P/ WELL BLDG. Vent to Air Intake ROAD D r„i°+ Septic y N q s S~er~ ~ Ibb} D!`B"m Dosing Head r/Man. Aeration Dist. Pipe Lj ~ q. 8 93.Iz Holding Bot. System 9• ~A0 H. J3 PUMP/SIPHON INFORMATION Final Grade `3.1 48'~ 9q• Manufacturer emand St Cover GPM A, fla- -3 -Z8 19. b2- Model Number TDH Lift Friction s System Head T DH Ft Forcemain ngth Dto Well SOIL ABSORPTION SYSTEM Z Z I- L Z BEDITRENCH Width } Length o r I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Dept DIMENSIONS It /lJ\ / SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: /J INFORMATION CHAMBER OR N n L7r*o T e Of $yst m: 5 ► 1 24j A- UNIT Model Numb d -y- S 1`~`►, `~I v f►IL S/ ✓ D IBUTION SYSTEM ea er anifold Distribution x Hole Size x Hole Spaci~ Vent to Air Intake (s) JC~ y) Pipe ,~j~ Leragth. Dia Len th Dia Spacing tl V~ SOIL COVER ~ x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Seeded/Sodded F -Mulched Bed/Trench Center Gt } I Bed/Trench Edges Topsoil xx / " / IaYes 0 No 5k es No COMMENTS: (Inclu a code discrepencies, persons present, etc.) Inspection #1: l l JJJ Inspection #2: Location: 755 Mound View Rid Hudson, WI 54016 (SE 1/4 NW 1/4 11 T29N R19W) Mound View Estates II Lot 14 Parcel No: 11.29.19.2957 1.) Alt BM Description J = C ` Wv s Hex sc#'tws -*Ned nori- ti5in«d 6D Msp*k 2.) Bldg sewer length = } hd~S ` - amount of cover vsed on Ntart / (JQpau*Le + A*VA ~ 91, Plan revision Required? Fm~ Yes yNo 2 ^t Use other side for additional informati I / SBD-6710 (R.3/97) Date pctors Signature Cert. o. County -EIVED of an ildings Division 54 C ~O 11 Poll hin Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) G~ b D P ~J Madison, WI 53707-7162 ~a 5 7f 1755 IX COUNTY State Transaction Number anitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats. ~b av~B v! I. Application Information - Please Print All Inf atinn / Property Owner's Name / I Parcel # ft,(, t prm wtr-,A '9 el C V6 V 41 OOG Property Owner's Mailing Address Property Location / C ! i2 I /MI6 Govt Lot ► J City, Skate ` Zip Code Phone Number A)Section _ w/ 1 ✓ ~~~j Z 6 ~o _ 8 ~s9 l [ (circle one) f Z 83' g T Z N; R E or II. Type of Building (check all that apply) Lot # Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms L lock # Public/Commercial - Describe Use 11 City of a CSM Number ❑ Village of El State Owned -Describe Use I- `Town of 11a,05 O 2- N'5~- CAL Li L~"46 III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) 2-6 Jr A. [~-New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. 11 Permit, Renewal El Permit Revision El Change of Plumber El Permit Transfer to New / [ Before Expiration Owner A- ~1, C2-T~ Q I V W. T e of POWTS S stem/Cornonent/Device: Check all that apply) " XNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ^l0!5 ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ant Area Information: DesE~o Flow Design Soil Application Rate(gpdsfJ Dispersal Area Required (sf) Dispersal Area Prop System F&ation Z, D t S v VI. Tank Info Capacity in Total # of Manufacturer Y Gallons Gallons Units u t j New Tanks Existing Tanks / c w s ,(,1 Ze, ►~QX- ~P/~ a U v~ rn w t7 a Septic or Holding Tank / Z p W I ~f v Dosing Chamber 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 MP,4 PI'Number Business Phone Number ,4 2z~ Y r Plumber' Ad ess (Street, City, State, Zip Code) ALL 4AV/12 4 o , VIIIoun /De artment Use Only Approved Permit Feeeej Date Issued Issuing nt Signature Ivan Reason for Denial $ ~7 IX. Condi5it8T6i *WReasons for Disapproval I.' Septic tank, effluent filter and dispersal cefl must all be serVlces I maintained as per management plan provided by plumber. ~ ~q's!cK lequiremenla P~ust l>e tpauntslhed, as per applcabls code / ordinances. 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) L o ~ Bm / ~o® f'1SG P1~E ®'~/~'12 -foP Pv~ ~iPE 9'8,/0 U36 LL 0 (L"` ~t C< b y X25 0 L~ r i LL : t c 6....► - 40 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: CaN y l~r.✓~~ Owner's Name: (/Z/_ /nr--n Owner's Address: Z/ ~76 j~ o y D /N/ Iti l f~1>/ Legal Description: i(J 5 l4 Township: ~f p J County: Subdivision Name: VIEW 64*1_41_4~ Lot Number: Parcel ID Number: 02Q D~f Page 1' Index and title 4- Page 2Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5Maintenance Information Page 6 Management Plan Page 7' St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat p Attachments: Soil Test & House Plans Dew/Plumber: /Lpq~. License Number: Date: -/g-15- Phone Number Signature Afl- Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Pc4/v/ -5c At, Z/O i -/Vo for- plc yip ®'Bn~ 2 P~~ "emE 99,10 UJ6 Lt 0 ~Ou sE g5t o y'f tz5 1~u `L X 1 L L. I- or 2- Family Dwelling In-ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow (DWF) _ # of bedrooms x 150 gal/day/bedroom = ~L gal/day Design Loading Rate (DLR) or Soil Application Rate = j ~7 gpd/ft2 -(per SPS Table 383.44-1, 2, or 3) Required Distribution cell area = DWF _ gal/day + DLR l gpd/ft2 2 1 # Chambers = Required Distribution cell area ef-5 19 ft2 + ft2/ unit EISA = hambers Chamber Manufacturer and Model: -M 614 L4g k -k~ b~ I.L /C ~C 7 eteS Actual Distribution cell area = Required cell area g6~ ft2 + / ft2/ unit EISA End Cap Pair = 74, 1 ft2 Cross-Section .In-ground Soil Absorption System (2-cell): 4" Schedule 40 PVC vent pipe with vent cap ~r inches minimum 12 inches minimum 12 LL ,l 9'g o ~JV inches Soil Cover Trench 1 Sys- tem Elevation inch Chamber Height -21-,-6ft G I ft Trench 2 System Elevation ___~CL~ft ft Trench Separation Leaching Chamber Width '73 ft to limiting factor Plan View In-ground Soil Absorption System (2-cell): Trench 1 Modify ft header/ design as ft Leaching Chambers 0 needed. Trench 2 4 inch Header Sch.,40 ftwith end camps Draw O for a Vent and for Observation Pipe above. They will be located ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. Page of Al ~12 industry.1 In 2000 abelalters made have the been filtering best even series The original ZABEL® Disc nm lteer in the 1959. The wastewater longer than a a y f better by introducing a complete redesign of the original with more great features and finer levels of filtration. A100-12TM Series The A100-12 is the commercial filter chosen market. more The reliable performance and more localities than any other filter on the ma flow rates from 3000-6000 gpd allow this filter to be utilized in almost every application. The new ZABEL Versa-CaseT11 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 many areas f residentiuse due to its al the A100-11 quality 2 decreses TSS by 5090% capacity. Independent research and CBOD by 20-40%. vis"Hltradon 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 al reduce FOG ite as much as wastewater Osys A300-12 is also used for ons a finer level of TSS removal, such as Laundromats and dog kennels. As with all ZABEL Filters extra filter y. cartridges are available to speed service time and allow offsite cleaning of the used cartridge. 01~ 1/32"Hltration 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. 164"Filtration For further technical information: Available lengths 20 28" & 36" 111LM" Pjft or INOMMOMW .zabe/zone.com www 050103.244 POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS + Owner L.~ It Septic Tank Capacity I 201 u al ❑ NA ❑ NA Permit # Septic Tank Manufacturer W fESC_ (Z Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS p NA Number of Bedrooms 41 ❑ NA Effluent Filter Model ~I NA Pump Tank Capacity al ❑ NA Number of Public Facility Units , Estimated flow (average) 440 al/da Pump Tank Manufacturer Lo (2 ❑ NA ❑ NA Design flow (peak(, (Estimated x 1.5) bpo gal/day Pump Manufacturer Model ❑ NA Soil Application Rate al/da /fts Pump ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD$) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: ❑ NA Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BODE) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Total Suspended Solids (TSS) ❑ Other: Fecal Coliform (geometric mean) 510° cfu/100m1 ❑ Drip-Line Other: ❑ NA Maximum Effluent Particle Size Ya in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *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: p ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: ® year(s) Li month(s) ❑ NA Clean effluent filter At least once every: ®year(s) O month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 13 year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: year(s) 11 month(s) ❑ NA Other: At least once every: ❑ ear(s) ❑ NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of. combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface, The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined shall be sludge and scum in any tank equals one-third tNRe113, by a S ptage Servicing Operator and disposed)ofrin more of the tank volume, accordance with chapter contents of f the the tank Wisconsin Administrative Code. All other services, including but not limited to the servicing-of effluent filters, mechanical or pressurized components,. pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or othe emicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents A of the tank(s) removed by a septage servicing operator prior to use. System.start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent: To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers;' dental floss; diapers; disinfectants; fat; 4-:Joundatlon 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 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. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER E Name No q 2 C-(„ $o-1J Name Phone S Z 7 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name :ro µ.v j o !^J 5- ,v i fh k v Name 6& 1 x Z cd I f Phone 7I~ - Z 73 - 5_5 Phone _ 7/s~3$6~~`~80 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 BILL -e- SA 9z6 W,5-- Mailing Address an/6 Property Address -'ff U AV U W (Verification required from Planning & Zoning Department r ew construction.) City/State # P '/D bd Parcel Identification Number d Z D - 1 b - f -Dtfo LEGAL DESCRIPTION Property Location f 1/4, N 1/4 , Sec. j , T ZI N R~W, Town of Ala®s'o ".0 Subdivision 4 DL,AJd 'UIL- w 654-A -Aj!5-~ 5 , Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # Volume , Page # Spec house yes Lot lines identifiable 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 §Comm. 83.52(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. Uwe, 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 Commerce 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 fo a 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 eed 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. 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. 08/05) 996862 BETH PABST REGISTER OF DEEDS State Bar of Wisconsin Forth 1-2003 ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD 06/06/2014 08:40 AM Document Number Document Name EXEMPT # N/A REC FEE: 30.00 THIS DEED, made between Matthew J. Kosse and Melissa M. Kosse, husband and TRANS FEE: 210.00 wife PAGES: 2 ("Grantor," whether one or more), "The above recording information and William C. Webster aka William Webster, a single person and Jamie K. Dea verifies that this document has aka Jamie Dea, a single person, as joint tenants been electronically recorded ("Grantee," whether one or more). & returned to the submitter Grantor, 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): Land Title, Inc. See attached Exhibit A 2200 West County Road C, Suite 2205 Roseville, MN 55113 LT File No. 503708 020-1464-14-000 Parcel Identification Number (PIN) 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: Easements, Restrictions and Covenants of record, if any. Dated May 1" 2014 (SEAL ' r (SEAL) * Math w J. Kosse Melissa M. Kosse (SEAL) (SEAL) AUTHENTICATION 000M,11"",~ ACKNOWLEDGMENT Signature(s) 't!! - y STATE OF Wisconsin ) 6TA& , 7T ) ss. authenticated on = i St. Croix COUNTY ) 4+,ry4rpp ItMSo,Personally came before me on May ls` 2014 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Matthew J. Kosse and Melissa M. Kosse, (If not, husband and wife authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing in trument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Merile J. Bune Larry Mountain, Attorney, Land Title, Inc., 2200 West Notary Public, State of Wisconsin County Road C, Suite 2205, Roseville MN 55113 My Commission (is permanent) (expires: 10/17/2017 ) (Sig)iatures 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 © 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 TmeCuatoixounst`y'962 Page 1 of 2 LT File No. 503708 EXHIBIT A Lot 14, Plat of Mound View Estates 11 in the Town of Hudson, St. Croix County, Wisconsin I 1 I i I I I St. Croix County 996862 Page 2 of 2 far P dig oil ? Z p+ gill "k, I ` z O m°O O A q Q. 4% It as ors i t S IMAM -0= IQ t v E lU 1 l as t ~~x~~a$ boa 1 t ~ ' ; ~W~p t ~ ! a -1 _ 1 i i ' xf l to f~ 1 ! O ~a$ i •t~a~$ ~ ! ~ / i ~ ~ j ~ i t t + ! i' P jig 1 + ( ~Rot 1 1 1 $ $ 114 of i a ! -oar' Am t~ 1 g i p $s ■ ,so z~ opt.; 4 I Pilo t / ~ ~ a J 39 cis t i / Vie, ~y - 10 $y ~?3 8mova4~aa~3=~'voa$7■'~a CQ RUM fill Id :rg "HIM 114104 lie IDEAL ng mink 10 13-1114 aaan as IMUS g~ 1 a / ax Sig 441 :9aa _73 W-P 1i ~ _ E ~ n ~ A ilt a r' 5211, 41 z 84" r m N -I 3" I I / 1 I I I ~ / Is c/) s 5.. 3r 444" I ' 0 0 ~~O I N < < m m I ~ mz~ I I I ~ II ~ ~ 39" a z O c N Fl D m m z c c cn Ti O c ZN rn m X ° D z o = z z v D 0 'o -i D Z > !2 C ~ - m z O Zz N D >gz Z DOZ ° D G~~D grco~rSK0CD* m~ m Z ZrT O oco 0 O-Z mpm-mm>oo>- ~ C m m co vr.. ° cr~ -i v 5 0'n0 U) 0 =C0jJ~==m8r7z r D moo mDO -{O~ =-~0x~ N -i n m S N L/) -M-I> \ C rm z DOS j L/) F:1 I F <~a,cnm~'w\ , m O zo m S 0r -a- m nDm Comm °NN m IV x N r o D z Co Dm L4 mm~ ~N or~o0\ ~N n cP m m z N r~*1 m ? cnm I m r(Ao m 0 m O G~ -i < C OD D D 07 0) : -P, ° O 0 \ 0 m c O Mmr- I r N O w D D O 9 Oz z 0 0 mom (n co O O v v (n z c N ra0 D m0 o D m O ~ cn \ =rZ r- --j 0 C7 M c W z >24k O W O D O C) o p~ 1 z N D D Z O mf r r -I m f7 v m 0 Fl ° z O p z X S o m cn N D 0 O A~ O mr A m z ;0 r ° m Z c 0 < m X m cn z m m z N r m \ O = WLP1250-MR lulESER SCALE:1 4" REV NO. DATE: CORCRETE DRAWN BY:SWT n -4 Z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK. N1 54750 DATE: JANUARY 2008 REV. JAN. 2008 800-325-8456 FILE: WLP1250-MR A tag T. Quick4 `Pius Standard Chamber Side and End Views is 48" e (EFFECTIVE LENGTH) 12" lid sue. '------34"~ Qui(*4 Plus All-in-One 12 Encap Front, Side and End Views 11.2" 13" 8" INVERT 8" INVERT 5.3" INVERT ~--18.2 33 Quick4 Plus All-in-One Periscope t CUICK4 PLUS 460-S PERISCOPE-, ALL-IN-ONE oulcK4 PLUS 5" ENDC P 12.7„ INVERT 12 Quick4 Plus Standard ;Chamber Specifications__ Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cmj Invert Height` 0.6", 5.3", 8.0", 12.7" (1 ,5 cm, 8.4 cm, 18.5 cm, 22.6 cm) I r Effective Length 48" (122 cm) - INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, and 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 detective 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 Say septic system commences. To exercise its warranty rights, Holder must notify replacement its at Its Units poste Hea byu rters in ll be cob a ed for f Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply pby this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. RANTY ARE THERE EXC (a) ARE DIES WARRANTIE TOTT E UNIITSD NCLUD NG ODIMPL ED WA RANB ES OF MERCHANTABILI YLORI F TNESS FOR A PARR ICTHER ULAR PUR POSES WITH RESPECT INFILTRATOR® (c) This Limited Warranty shall be void if any part of the chamber system Is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, stems 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. Sy 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 P.O. Box 768 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 • a .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 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 800 221 ,4436 installation instructions. 1 (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 s " .p_ yc 0, 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 Quic1<4 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. A W;,^.onsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page of _ in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 112x 11 inches in size. Plan must County ~.V include, but not limited.to: vertical and horizontal reference point (3M), direction and Parcel I D percent slope, scale or dimensions, north arrow, and iocation and distance to nearest road. % 7 G [f j~ ~(J s+7) Please print all Infora:atfon. Reviewed b Date Personal inrormar n you provide ma be usod for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2oa Property Owner Property Location Govt Lot 114y(,,j 114 S j( T Z N R E (or)O Property Owner's Mailing Address A PR : 3 o O, Lot # Block # Subd. Name or CSM# 0 C L ~A oUrd U lC'115 ~54Qk5 l City 1 State Zi Cod T C UQ`3e~ f ❑ City ❑ Village ES Town. Nearest Road Wir Z ING FFICE Mound U(e New Construction Use: ~J Residential I Number of bedrooms 3 Code derived design flow rate _ys0 (Z Q _ GPD [General Replacement Public or commercial - Describe: arent material D U 1 i a Flood Plain elevation if applicable ---_,Z-/ comments ere v, and recommendations: S S~ F T1 Boring # ❑ Boring Pit Ground surface elev. 9 0 ft. Depth to limiting factor _ in, ' Soil A lication Rate Horizon Depth Dominant. Color Redox Description Texture Strucura Consistence Boundary Roots GPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 l D 2' Io ~ i si' ( 2rr, mfr ~S I 5 8 9iL1 2mS - J 3~s-I IBS ~ _ ~ r c s . s mt - /.2 Boring # Boring tQ' Pit Ground surface elev. Y/ o_ ft. Depth to limiting factor 1 3 / in. Horizon Depth Dominant Color Redox Descr~t n Texture Structure Consistence Boundary Roots Soil A G D ion Rate in. MunseiI Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z 2n- 'C'- Cr -Q3 LIO-59 (O. 5 F 7. 2rlrZ5 ry4r c- 4 -13► t y c) m Effluent #1 = BODE > 30 c 220 mg/L and TSS >30 < 150 mg1L ' EEfiiuent #2 = BOD < 30 mg/Land TSS < 30 mg/L CST Name (Please Print) Signature CST N~umberq Address G 2a`73 C0) Date Evaluation Conducted Telephone Number 21\3 ?_S` 1/5-71.e0-027 { SOIL EVALUATION REPORT Page _L of - W;-a.onsin Department of Commerce Division of Safety and Buildings County in accordance with Comm 85, Wis. Adm. Code . ~ 1 0 Attach complete site plan on paper not less than 8 1/2x 11 inches in size. Plan must ~ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. `7 J percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date Please print all Inforntatlon. Reviewed b ate Personal informaC n you provide me be used for secondary purposes1Privacy Law, s. 15.04 (1) (m)). Property Location Property Owner I' • Govt Lot SE_ 114(/ r,v 114 S It T Z N R E (or)o Property Owners Mailing Address APR .3/2004 Lot# Block# Subd. Name CI IeSM# C. 1 MC~U~ v UJ S AC'S < \ 'Ker% El City ❑ Village (Town Nearest Road City State 7~ Cod%) q CAA6 ? ING OFFICE Noor)d U e Code derived design flow rate GPD IY5 New Construction Use: Residential / Number of bedrooms ❑ Replacement ❑ Public or commercial - Describe: ft U a S!n Flood Plain elevation if applicable Parent material General comments rt,p /h e(,e t/, ~Z• ~U and recommendations: Ej Boring ❑ Boring # surface elev. O ft. Depth to limiting factor in. Soil A lication Rate 9~ Pit Ground - Texture Horizon Depth Dominant Color Redox Description Structure Consistence Boundary Roots GPD/ff` •Eff#1 'Eff#2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 1 p -2 to ► _ S~ l 2m rr r ~S I v-~ 5 8 2 2- 3~ l - i c 1 2 t~-~5 r c S `-t ~P 3-i►g It It Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sod A Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Con:. Color Gr. Sz. Sh. 1 ~ t b-20 t0 l - Z ZO- ICS L-10-59 t0 ~ 5 F I `l . ~ S. 2,~r-~S *~r° c-yv R. -13► t ~I O rY~ 7 2 11 ~ t( p • Effluent #1 = BOD > 30 < 220 ntg/L and TS < 150 "VL ent #2 = BOD < 30 mg/L and TSS < 30 mg/L T Name (Please Print) Signature CST Number i 2-533401 Address 2-533401 Date Evaluation Conducted Telephone Number 2 ~3 ~ ~ _ Sc~~,~r5e~- L~ ► -a ~ pis-7c~onoz?~.~~„ . i. 4 Property Owner i _ r_------- Parcel ID # Page of-- Boring # ❑ Boring a FS1 Pit Ground surface elev.? D- ft. Depth to limiting factor !~1 ✓ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? , in. Munsell Qu. Sz. Cont Cok)r Gr. Sz. Sh. 'Eff#1 'Eff#2 l D 10 r_3 5; ( Z C S 1 v4 -5 3 J~ I Q ` i`5 F ! p cl 2- m C rv - . L-1 10 rylb S Os n-~ I - 7 t . 2 ❑ Boring # ❑ Boring ❑ pit Ground.surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # Boring ❑ Pit Ground surface elev. 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 ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD, < 30 mg/L and TSS < 30 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. SB D-8330 (R.07/00) PAGE_OF 3 NAME: 6<.;-e y- LOT#Al LEGAL DESCRIPTION:.SE I,U,,u1/4,S 1LTZffN,R, IgE(ar~J SCALE: I"= wm l ELEVATION: 100. BM I DESCRIPTION: 4r - ~~12- e fi )12 BM 2 ELEVATION: O e BM 2 DESCRIPTIONJon o J 1"00c. e `r SYSTEM ELEVATION: f~Z • (U 4 SYSTEM TYPE: ('d(}v~ r+v,~a~ ;r 00 b Q" t slam - 0 ;w"L SIGNATURE: 155r DATE: l -Q ~IZ