HomeMy WebLinkAbout020-1416-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
~ INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
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
Glen Johnson Construction Hudson, Town of
CST BM Elev: Insp. BM Elev: BM Description:
j 6~ ~ S ~ - 3 cs~
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic Z ~_
~i e.4~e~. (Lt
/Z50
2u, ~- r ~
Aeration
Holding
TANK SETBACK INFORMATION
. en o it na e
ep is Z,7 i ~ ~' $' , S ~ 7 [.~ Z ~
osing
era ion
o Ing
PUMP/SIPHON INFORMATION
anu ac urer eman
GPM
o e um er
I rl ion oss ys em
rcem in I .
ELEVATION DATA
County: St. CroiX
Sanitary Permit No:
4H$OH7
State Plan ID No:
Parcel Tax No:
020-1416-10-000
Section/Town/Range/Map No:
20.29.19.2629
STATION BS HI FS ELEV.
Benchmark
~3. z_
1~~.~
ia~- S
Alt. BM
~; ~ ~.~,.. Go~.~.
6 , s5
iiy is
Bldg. ewer
Z •y5
nz, z 5
t/Ht net ~ ~~~~ 3
t t ut et
3.`7
»I
t net
0 om ~ ~
ea er an.
i~,7
~a
// • 55 d . !5
o . ys em T,
-r /l . (p
~ z.ss id3
!ez ./S
ina ra e
~~ ~ ~
~~
over
~~ 1 c
6. JS /
/~~~ ~~
.~VILAD.7VRr11VIV aTal>cm
DIMENSIONS ~ ~ ~p.~ ~C~
OO DD C~ ~ ~e~G~
' ~, "~- ~ ~_
INFORMATION CHAMBER OR '~~~`~ a~-»
Cd~J~~ O '~ / ~ Z 1 V~ f / " ~ UNIT O ~
UI.7 I RIDU 1 IVIV 7 T.71 CIYI
~k
2.~ T~ Z7. !a~ ~~r
! ~
Length l0 Dia_2 Pi e s
Length Dia~_ Spacing~_
~
\
~ 0~...! 'TTe
JVIL VV V CR X F'reSSUre')rSLemS Vrlly xx mouna yr hr~araue ~ys~Cma .,,•••y
Bed/Trench Center ~
Z • , I C BedlTrench Ed es
9 \ To soil
P \
Yes ~; ;'1, No ~~
Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /
Location: 422 Swift Circle Hu son, WI 54016 (NE 1/4 SW 1/4 20 T29N R19W) The Glen Lot 35
' `Alt BM Description = ~ `L` `^'~ 'r
-wer length = R . S !
inspeczlon ~~: ~ ~_
Parcel No: 20.29.19.2629
a tti.
'~.
i ~ _ -.______...._------
r _' ~~-_ Safety artd Buildings l~iv,
~aconsln 201 ~~ w~~ttlt~tan n-.~t;., p
Madison, WI 537U - 7
_ Department of Commerce X608} 265-315
.._~._,.
Sanitary Permit Appi~cation
In accord with Comm 63.21, Wts. Adm. Cade, persoru-l infortnatiun you pr')`+
' may be used far secondary purposes Privacy Lew, s15 (14(!)(nt)
I. Appllcatiott Information - T+lease Print All Inforrnatitut
Property Owner's Na me // ,,,,
~ ~ s. ~_~11~~1
f Property Uwner's M ailing Address /
City, Swte `'• -----
I. Type of I3ttilding (check al! that appiy)
or 2 Family I)wrllittg -Number irf Bcdre~:+ma _.
' ~ PublieiCommercial - Describt lJse
i ~.1 State Owned - Descrii~e Use ~..-------_
U~u~~~
Zip Lodz ~ ('hopo t~rttmt
~Y ~r~r~ s
`n.Q ~ ~ art _ L (.
1--~
~~ E y'' c_r_. ~ x ---
Sanitary Per it bee ate bt: rtieti in by ca ~
State Plan .ember
ST. COI COUNTY f- ~~
r^_ss (if differe marlin address}
~ y22 ~~~~ ~~~
Farce! ;a 01 ~ _~~~ .rot M ~Q _lJO Q block N
3 ~" ,~"
Property Location .~} ZlO 2 9
+_ __.
circle
Subdivision Neme ~~ CSi14 Number w i'
e~-y /
n t tC a ~t,J
_.._ _~_______.____.___r...`.-____.__.--- ~ ~Cityr! IVillag~ ~k'townsltip o~~~
IIT. Type of P It: (Check only one box on line A. Complete flue B if applicable) _ _ _ j
_.._ ~ New Syste i ~,~ kepl;tcement System ~ TreatrnpntrKolding'Tsnk F(,eplacernertt t)nly I C~ Other Modification to Existing System
l .. ` ..-,^. _^ ---r-._.. ~ List Previous Permit____..__ ._. -- - __.__..__
B. tt-i Pe~rmir Renewal (~u Permit R2visian ~..~ ihange of ~~~ Permit'~'ransfer to Nea Number arx9 Dare Issued
Be' fore Expiration ~ Plumber Uwrret
-~_.~L__- _. ~_. _._..__.._.... _ „
~....~r._i-._.___
~11'. Type of PQWTS~stem: (C'he_ck_a_II that appfy)~_~__ _____
I~Nin -Yr~ssurized let-l;rtwnd ;~'• Mound _~ 2q in. of suiutble spit ~ Mound < la ui- ~t' yuitabie soil ^ Ar•Gradr i~ Singte Pass Sand Filter
~ '~~ Cot+structed W~tlartd _~ Pressurized. in-Grouse! L Holding Tarp L~~ Peat Filter G ttt:r~bic 7'reattncnt Unit ~-.J Reeireutating Sattcl Filter
~ Recirculating Synthetic Media Filter eaching Chamber !..~ Drip line ` J Ccavcl-ions Pi ~-.~ _Utttar (expEain) _-~
.._ r.....~.4_ •-- -
~V, Dls real/Treatment Area_Informttlan. _ ~ - ~_ ~,(~ _,~`
Design Flow (gpd) Design Soil Application Rate pdsfj Dispi:rsai Area Required (st) Dispersal Area Ptotwsed (sfl 3 System Elevati;,n
-r-°------r--_.._...«
rl. "Cask info I Capacity in Iota Number '~ !vtarwfaeturer Prefab Sita Steel ,Fiber ;Plastic
_ Gallons ~ Gallons + of Units ~ t.ancrete Constructru ~ Glasc ~
New ~~ I t
~ Tanks ~ T'anks
___~_ - ,..~.-_ ~__....___ _.,..._. -,.._r.-._. _._.._--
~Septic or F!okling Tank ! e _
Aerobic Treatment Umt ~~ ,~ n n ! i ~ --•-*--_~ .__t._ _-,__I
uvsing c..rtatnoer ! _ rl~j0 ` U f
' ___ ._~ ;
VIl Res risibility SCatement- 1, the tindersl ed, assume
H„st:sber's Na me (Print) Plumber's Si gnansre
Plurnbt:r's Acldre ss (Street, City, State, Zip Cade)
t,
_-__
es~ r
EibilitY for ~t9tailatton ~
r
~~
tune tiumber
VI1.I. Dent /De artment L'se OuI,Y _
. nprovt~l i_J Disapproved Satusary Permit F (includes Groundwaur ~ Date Issued 1 ing Agen Sigtt tune ' .'v tamps?
' ~ Surchar a Pee O
__. 8 1 O ~ 1 / / t
_ _ ~ t~wner Given 12eason far Denial _.i.._ ~ s `-~ __~_~~. - _ ~~'(/j~1/I"
1;Y. ('ondt3' ~ pµrova fte:.tons trs Disapproval I / _ _ -- ~---
! SYSTEM OW NE ~.cC~ >"C (~l~/' QWhQ1f% Peter( ~~G
' n c, effluent ter and ~ G
~ dispersal cell must all be serviced /maintained
as er mana ement Ian rovided b lumber. //~~~" ~"~ ~, p ~
~ 2, All setback requirements must be maintained t~ ~ S-~vvc ~ ~"' ~_~~~~ :~ ~~
,/ ~ i
as per applicable code/ordinances. ~ ~/~ f~~jl,o ~ ~D-~r~,t~1~D S~1/~'t/r~ . ~_ ~~ ~
6V~AL~ W Yom' AttacV L.cumpl pi-env (tq the attty onGy for r;Yateep on Aer nut ~dt12 } 1( inch~~e
POYtr"f S shown on the attached
~~ Business Pl
~°~ s', Sd
~.
V'
~~~ ~~
~~~v'
~-~S~
~,vc
~g.Z7~
~P~~
~~r~"'~
~~~ r ~~ ~~~~~~~~
Br~~ r ",P row lsd~ ~
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7, 1094
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, W is. Adm. Code Steel Sal Service
County
Attach complete site plan on paper not less than B~ x 11 inches in size. Plan mast St. C roor
indude, but not limitedto: vertical and horizontal reference point (BM), direction and
penznt slope, scale or dimemsions, north am~w, and location and distance to nearest road. Parcel I.D.
.-_t _ pend'
Please print all irtfomta ' "'., ~ ~ ~' '.~ Reviewed By Date
Persons information you provide may be used for secondary rposes ~P"rniacy l aw, s. t5.04 (1) (m)). ~ ~ ~ _ ~ 3
3
Property Owner ~ _ t~ 5,, ~ r°~Locat n
Sienna Corporation ~'- '' n.'L`ot NE 114 SW 1/4 S 20 T 29 N R 19 W
Property Owner's Mailing Address I~ #, :. Bi k # 5ubd. Name or CSM#
4940 Viking Dr, Suite 608 355 _ tna The Gin
City State Zip Code Phone~l+lamb2l' °" ~C~ty ~~" • Village Town Nearest Road
E ollna MN 55435 95~-b3s"-z~~ Hudson Carmichael Rd.
~~ ~,3r
~~~
New Construction Use: /_ ;Residential / Numberof bedrooms 4 Code derived design fbw rate 600 GPD
Replacement Public or commercial -Describe:
Parent material Pitted outwash Flood plain elevation, if applicable na
General comments /~7~~
and recommendations: System elevation 101.69ft, trenches spaced and depth to cods 4 `166f1 below grade ~ ~-
a ~ ~r a z ~
'~ Boring # Boring
~, Pit Ground 5urtace elev. 105.85 ft. pith to limiting factor 110 in. Soil Application Rate
Horizon Depth Dominant Color Redoz Description Texture Structure Consistence Boundary Roots GPD/it2
'Eff#1 `Eff#2
1 0-10 10yr3/3 -none - sicl -2msbk mfr cs 1f .5 .8
2 10-24 7.5yr4/4 none is osg mvfr gw 1vf .7 1.2
3 24-110 7:5yr4/4 none cos osg mvfr na na ~ 1.6
.~~ r/
~,
~
~
~
~~ ~i
,~ r`
Boring # Boring
/'
110
Pit Ground Surtace elev. 105.85 ft. Depth.to limiting facts in. Sal Applicaton Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
'Eff#1 *Eff#2
1 0
J 10yt3/3 none s~ 2msbk mfr cs 1f
.5
.8
-
2 8-110 Z.5yr4/4 none cos osg mvfr /
~~
na na / .7 / 1.6
~~3 ~~, ~_ ~~~ ,~
/ ~~
~~
~,~ tt
`'
~~ u
~~.~_
- cmuenr ~~ = rsvu 5> su < uu mgrs and r S5 >3U < 150 mg/t_ * Effluent #2 = BODS< 30 mg/L and TSS <~0 mg/L
CST Name (Phse Print) Signature: CST Number
David J. Steel ~ 248956
Address Steel Sal Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 5401 9/5/2002 715-246-5085
Property Owner Sienna lorporation Parcel ID # P~~D9
Boring # --! Boring
(/~ Pit Ground Surface elev. 101.05 ft. Depth to limting factor
Horizon Depth Dominant Dolor Redox Descriotiort Texture Structure Consrstena
1 _0-18 10yr3/3
2 18-38, 7.5yr4/4
3 38-110 7.5yr4/4
7 ~~ 1r- ~~ ~~
~ ~r
~~
none sil 2msbk
none sicl, 2msbk
none cos osgw
.~-s'~`~
mfr
mfr
mvfr
~ ~~~~~
Boring # B~rng
Page 2 of 3
110 in. Soil Application Rate
~undanr Roots GPD/ft=
*Eff#1 *Eff#2
cs 1 c .5 .8
cs 1 f .4 .6
na na ~ 1.6
* Effluent #1 = BC7D X30 <"220 mg/L and TSS >30 < 150 mg/t_ * Effluent #2 = BODS < 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
^ Boring # Bonng
Pit Ground Surface elev. ft: Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox. Description Textun: Structure Consistence ..Boundary Roots GPD/tt'
*Eff#1 'Eff#2
Page 3 of 3
STEEL'S SOIL SERVICE
David J. Steel
CST-POWTSM
Lic. # 248956
Sienna Corporation
NE1/4,SW1/4,S 20,T29,R19W
Town of Hudson, St. Croix Co.
The Glen lot 35
1564 Cty Rd GG
New Richmond, WI 54017
(715) 246-6200
(715) 246-5085
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for
your use. The location of the test may or may not be as shown as permanent lot lines were not
established. at the time. the. soil test. was conducted. Legend
1" = 40'
~ =Benchmark EL 100,00Ft
Top of 1" steel pipe
. =Alt Benchmark E1.1141.SOFt
Top of'h" pvc pipe
a =Borings
Boring Elevations
B1 =105.$SFt
B2 =105.85Ft
B3 =lOl.OSFt
_ B4 =00.OOFt
,•.
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• ~ SEPTIC TANK ~ PUMP CHAMBEk CROSS SECTION AND SrECIPICATI0N5
' 4" CI VE?dT PIFE 12" MIN. ABOVE GRADE ~
? 25' FROM DOOR, WINDOW OR
FRESH AIR INTAKE -----.,
FINISHED GRADE
~+" C I RISER ---~
_.._._
18" IN. 6" MAX.
INLET I ~~ .~'
WATER TIGHT SEALS
APPROVED
'IPE 3 °
)HTO SOLID
TOIL PIJMP OFF ELEV . FT.
WEATHERPROOF
JUNCTION BOX APPROVED
WITH CONDUIT MANHOLE COVER
W / PADLOCK ~
-------WARNING LABEL
~, y~ ~ --4" MIN
l ~ ~,~
.•
.}
~~
~+
I'
GAS- ~ 1'
TIGHT ~ ~+APPROVED
A SEAL ' ~ JOIHTS WITH
--~-- ; BALM APPROVED PIPE
..~. i 3' OHIO
C { ~ ON SOLIO SOIL
--~-- OFF ~t6ti RISER EXIT
D PERMITTED ONLY
IF TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICAT?ONS
SEFTIC / DOSE
TANK MANUFACTURER: l,Jte.ge~ct
TANK SIZES: SEPTIC ~a`$'a GAL.
~~ DOSE ~O0 GAL.
ALARM M.ANUFACTL'RER : ~'4.v e.~AC~..~..
MODEL NUMBER: ~~.~/
SWITGH TYPE ~M~,,s
PUMP MANUFACTURER : ~~~,,)y~s
MODEL NUMBER : 'E P ~`4
SWITCH TYPE : ~ecz, ~,
REQUIRED DISCHARGE RATE ~ O GPM
NUMBER DOSES PER DAY:
DCSE VOLUME INCLUDING
FLOWBACK: 1S9 GAL.
CAPACITIES: A = as INCHES = 14I ~o a, GAL.
B = 2 INCHES = ~ ~ GAL.
C = ~3 INCHES ti ~_GAL.
D = ~ INCHES = ~ a.~p GAL.
PUMP ~ ALARM WIRING AS PER I LHR 16.23' WAC
VERTICA L DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE I~ FEET
+ MINIMUM NETWORK SUFPLY PRESSURE 2.S FEET
+ ~a FEET FORCEMAIN X a.~oFT/100 FT. FRICTION FACTOR !•5`7 FEET
TOTAL DYNAMIC HEAD = 13 ,S7FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH -- ; WIDTH ~- DIAMETER --
LIQUID ~~ ~8 ~~ ~1 Ga) . Pe-2 ~ ~i
SIGNED: ~/~C-.-- I. /'' LICE.NSi; NU2aBER: ~a ~ 9 9 n DATE:
1/88
~(~', GOULDS PUMPS
Submersible
Effluent Pump
~~
3v~ I E 05
APPLICATIONS
Specifically designed far the
following uses:
• Effluent systems
• Homes
• Faints
• Heavy duty sump
• Water transfer
• Dewatering
SPECIFICATIONS
• Solids handling capability:
3/," maximum.
• Capacities: up to b0 GPM.
• ToWt heads: up to 31 feet.
• Discharge site: 1'/~' NPT.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N eiastomers.
• Temperature:
104°F (40°C) continuous
140°F (60°C~ intermittent.
• fasteners: 300 series
stainless steel.
• Capable of running
dry without damage to
components.
Motor.
• EP04 Single phase: 0.4 HP,
115 or 230 V, 60 Ftz, t 550
RPM, built in overload with
automatic reset.
• EP05 Single phase: 0.5 NP,
115 V, 60 Ht, 1550 RPM,
built in overload with
automatic reset.
• Power cord: l0 foot
standard length, 16/3
SJTOW with three prong
grounding plug. Optionat 20
foot length, t 6/3 SJTW with
three prong grounding plug
(standard on EPOS).
®2000 Goulds Pumps
Effective February. 2000
83871
• Fully submerged fn high
grade turbine rill for
lubrication and efficient.
heat transfer.
Available for automatic and
manual operation. Auto-
math models inclf,de
Mechanical Float Switch
assembled and preset i~t the
factory.
FEATURE5
^ EP04 Impeller: Thermoplas-
tic Semi-open design whth
pump out vanes for mechanical
seal protection.
METERS FEET
to
9 3~
a
z
s
u 6 2
s
o ~ t
a 41-
0
~ 3
0
^ EPOS impeller. 7hermopfas-
ticenclosed design for
improved performance.
Caking and Base: Rugged
thQrmoplastic design provides
superior strspgth and corrosion
resistance,
^ Motor Nortsing: Cast iron
fvr gl:fldent heat transfer,
strett~t~, and durability.
t t~lOtor Lauer: Thermoplastic
coyer with~itttegral handle and
floarsw)tch attachment points.
w power Cable: Severe duty
rated ol) and water resistant.
^ 8earings: Upper and lower
heavy duty ball bearing
construction.
AGENCY LISTING
~• Canadian Standards Association
(CSA listed model numbers end
in "F" or "C".)
Goidds Pumps is Is0 9001 Registered.
_... t, , .
() 10 ~0 30 40 SO GPM
CAPACITY
Goulds Pumps
ITT Industries
~ 4 ..! ~ ,_
0 2 4 6 8 10 12 m~/h
k4~
Qu c
STANDARD CHAMBER
Quick4 Standard Chamber
SIDE VIEW
MultiPort End Cap
12"
~ ~
~ __L
34" SIDE VIEW
FRONT VIEW
INFILTRATOR SYSTEMS INC STANDARD LIMITED WARRANTY
(al The structural integnlY of each chamber, end plate, wedge and other accessory rturxrlaclrrpd by InliArel« ('Dills"1• wlx;n hslalled aid operated
in a leachfidd of an ensile septic system h accordance with hfiltret«'s kutruclions, Is warranted to ttw~ rxignal purchaser ('Fblderl against delectNe
materials and workmanship f« one year Irom the date That the septic permit h Issued 1« l1>e seplh system wnlahing the Units; prov'Kled. IaWeY«,
that if a septic permit is rat rewired by appraaWe law. the warranty period wI0 begin upon ttq data that ntstallalion of the
To exercise its warranty rights. Hader mull notify hfiltrat« in wahg at its Corporate seplx' system conxnences.
days of the al f-leadcT~arfcrs~di O5/ Saybrook, Corzuclz:ul wHwthipfrfleen 115)
leged detect. hfillret« wiA supply replacerrrent Unlls t« lMits determhed ty Infiarat« to be crr„~xed by this LArlllod Warranty.
Infgtrat«'s AabllAy specifxaly exchrdes the cost or removal and/or instanalan of the Units.
N) THE LIMITED WARRAN71' AND REMEDIES tN SVEIPARAGRAPH (a) ARE IXCLUSNE. 11;ERE- ARE NO O"IHER WARRANTIES WITH RESPECT
TO THE UNrrS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABIUN OR FRNESS FOR A PAR11Cl1LAR PURPOSE.
(c) This Umited Warranty shay be void n arty part of the chamber system Is manulactcrred bV ;xryrxu other Ilan InlAtrel«. The Umited Warranty does
not extend to Incidental, consequential, special « hdirecl damages. Infnlrat« Shan not be liahle I« penaltkxs « liquidated damages; including bss of
production and profits, labor and materials, overhead costs, « other bsses « expanses hcurred by the Hold« or any thlM party Specificaly
excNded Ir«n limited Warranty coverage are damage to the Units due to ordinary wear anclluar, alleralbn, acddenl, misuse, abuse « neglect of
the Units; the Units behg subjected to vehicle lretra «other corxfsions which are rat perrnilled by the ir~taAetlon hstrurlions; failure to malnlah the
mhlmum ground covers sot forth h the hstallatlon hslructlons; the placerttart of improper maleda4s into the system contahhg the Units; tenure of
the Units «ttu septic system due to knrxoper sNug «improper sizing, excessive water usage, improper gmase Disposal, «krroroper aperatbn; «
arty other event rat caused try Inftllret«. This Umiled Warranty snan be void if the Bolder lens to. comPN with all a the lama sal form M Inls Lhniled
Warraay.
Futtx~, h no event shaA hfillral« lu responsAlle 1« arty bss «damage to the Hadar, the Units, or any Ihln7 party resutlhg Irom hslaAalion «sMp-
rrxlrlt, «Irom arty product Lability Gams of Holder «arry Ihvd part'. F« INs Umited Warranty to apph•, lnp Urals must be instaned h accordartcs
with all site condltbns regtnred by stale and local codes; an otter aipplicable laws; and hfiltralat InslaAatbn h^,truclions.
(dl IJO representative of Infslral« has the auttanry to charge « extend Ihls Lilnitetl warranty. No warranty applies to ern Pent ahm true the odgl-
nal Holder.
The above represents the Standard Limited Warranty onered by hfYtrator. A Iimi1W rnxrrber or stales and counties lava Dilferenl warranty require-
ments. Arty purcluser of lJrrts sfaWd Coaact hfAtrat«'s Corporate Headquarters h Old Saylx«NC, G«vactkwt. prior to such purchase. to obtain a
coPY of the applicable warrant', and sh«rld carefuly read that warranty prior to llte prxclusa ul Units.
.,Quick4 Standard Chamber Nominal Specifications~~r Mu1tlPort~End Cap~fVommal SpeciNcatlons:. , , '~~ _~
t
Size. (Wx L'x H) °34` x 52"'x'12 ~ ~ ~~Size (W~z~~L`~x H) "~"` ~ '~ r `Y " ' `34" x 16' x``12'
Effective Length '48" ~ Jlivert Height 8" or 1.25"
invert Height g"
TOP VIEW
. ~ ~.
O
SYSTEMS INC
Environmental Onsite Wastewater Solutions'
6 Business Park Road • P.O. Box 768
Old Saybrook, CT 06475
860-577-7000 • FAX 860-577-7001
800-221-4436
U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,51'1,903; 5,716,163; 5,588,778; 5,639,844
Canadian Patents: 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer and Sidewinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc.
is a registered trademark in Mexico. Contour, Contour Swivel Connection, MicroLeachilTg, PolyTuH, SnapLock, ChamberSpacer, PosiLock, OuickCul, QuickPlay
and Ouick4 are trademarks of Infiltrator Systems Inc. ®2003 Inliltlalor Systems Inc. Printed in U.S.A.
RECYCLED PAPER
t]p1121),3HP-0
SECTION VIEW
POWTS 4WNE~'S IVIAi~UAl. & A~ANAGEMENT Pi.AN
FIi.E INEORMAI'ION ~-~ c~ ~..,-- 3 S
owner - r` _ - ,~~ ~ ~ _ ~1
DESIGN PARAMETERS
Number of bedrooms ~ p NA
Number of Public Facility Units p C~~
Estimated flow !average) elide
Design flow (peak}, (Estimated x 1.5} ~C~ d elide
Soil Application Rate ~ aNda Jft2
Standard influent/Effiuent Quality
Fats, Oil & Grease dFOG!`.
Biochemical Oxygen Demand {BOOB}
Total Suspended Solids (TSS) Monthly auaraga"
530 mgfi.
`.5220 m$/L ~ ~
5160 m~/L
Pretreated Ef#luent Quality
Biochemical Oxygen Demand iBODB}
Total Suspended Solids (TSS)
Fecal Colifonn (geometric mean! Monthly average
530 mq/i.
S30 mgEL
510° of~+/1QQrnl .
~ NA
Maximum Effluent Particle Size Ys in die, q NA
Other: Q NA '
*Vatues typical for domestic wastewater and septic tank effluerrt.
SYSTEM SPECIFICATIONS
Page ~ of ~/
Sepxio Tank Capacity 2 ~ al DNA
Septic Tank Manufacturer ~ ~ e ~, O NA
~ffloent Filter Manufacturer ~ ' ~ ~ O NA
Effluent. Filter Model ~~~' O NA
Pump Tank Capacity ~j'~J' al q NA
Pump Tank Manufacturer ~ B.S ~°~ O NA
Pump Manufacturer ~~,~/ O NA
Pump Model O NA
pretreatment Unit
Q ~it:~ndJGravel Filter
Q t~lechanical Aeration
~ pla}nfection
^ Peat Filter
^ Wetland
O Other: [] NA
Dispersal Calls}
q ln-Ground {gravity}
Q At*Gracie
` [a O lip-Line DNA
L! ln-Ground {pressurized)
O Mound
Q Other:
t7tt~at Ci NA
~tfwer; DNA
Qther: O NA
MAINTENANCE SCHEDULE
Service Event Service frequency
inspect conditiwn of tank{s} At IQa~t once every; 3 oar s! s (Maximum 3 years} DNA
Pump out contents of tank{s} When gombined eludes surd scum equals one-third tYa} of tank volume Q NA ,
inspect dispersal califs) At least onae every: ~ ear(~r}!s} {Maximum 3 years} DNA
Clean effluent fiker
At least Qnce every:
l ~ month(s)
,'~' ear{s}
O NA
inspect pump, :pump controls & alarm At least once eve
N~ ;,.__._ ^ month{s1
D .ear{s} p NA
Flush laterals and pressure test.
At least once every:
<-- ' O month{s}
^ year(s) ^ NA ~
Other.
At least Rnca every: =
--- O month{s}
^ ear(s) O NA ~,
Other: O NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made py an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer;- RbWTS inspector; P4WTS Mainiafneir; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank{>i? to idantjfy any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to aheck tar any back up or pending of effluent on the ground surface,
The dispersaE ce[i(s} shall be visually inspected to check the affluent levels in the observation pipes and to check for any pending
of effluent on the ground surface. The pending of effluent on the Around $t?rface may indicate a failing condition and requires the
immediate notification of the local regulatory authoCity.
When the combined accumulation of sludge and-scum in any tank equals one-third {Ys) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Cods.
Alf other services, including 'but not limited to the servicing of effluent filters, mechanical or pressurized gomponents, pretreatment
units, and any servicing at intervals of 512 months, shall be perforPned ~y m certified POWTS Maintainer.
A service report shah be provided to the Iocal regulatory asitllority within 1Q days of completion of any service event.
Page of
START UP AND OPERATION
For Haw construction, prior to use of the POWTS check trpfitrnent tankls) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell{s1, `If high concentrations are detected have. the contents
of the tanklsl removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are froxan at the infiltrative surface.
Quring power outages pump tanks may fill above normal highwatec levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To .avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWT$ Maintainer to assist in manually operating the pump controls tc
restore normal levels within the pump tank.
Do not drive or park vehicles aver 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-gretle soil absorption area.
Reduction or elimination of the following from the v~rastewater stream rraay improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; oo~doms; cotton sv~tapa; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain !sump pump! water; fruit and vegeteb{e peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tam~ans; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out 9f service the fallowing steps shall be taken to insure that the sYStem if
properly and safely abandoned in compliance with ahaptet Comm i33.~3, N(i$consin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned p'spe openings sealed.
~ The contents of ail tanks and pits shall 6e removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits ahail be excavated and. removed or their covers removed and the void space fiNed wit!
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 complian
replacement system:
1 b r tioi
~J
n/p °
A suitable replacement area has been evaluated and may be utilized for the location of a replacement sot a so p
system. The replacement area should be protected from dsturb~ncs and compaction and should not be infringed upon b•
required setbacks from existing and proposdd structure, lot dines and wells. Failure to protect the replacement area wi
result'in the Head for a new Soil and site evaluation to establish a suitable replacement area. Replacement systems mus
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 POWT
technology a holding tank may be instailecl as a last resort to replace the failed POWTS. '
. . , .., - --.L_~,~ __.,~.. - , ~__ ~_:~. - ,.f *hd, pOMrTS s ii a d sit
O Mound and at-grade soil absorption systems may be reconstructed in place following removal of-the biomat at th
infiltrative surface. Reconstruc#ions of such sysfams moat comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CQNTAIN RETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NO
ENTER"A SEPTIC, PUMP OR OTHER TREATMENT? i`ANIS l1NDSR ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF ,
PERSON FROM THE INTERIOR OF A TANK MAY sE pIFFICULt OI# IMPOSSIBLE.
ADDITIONAL COMMENTS .
POWTS INSTALLER PO S MAINTAINER
Noma `/r•4li~di "-, ~li~C 1r
Phone 7 l' - ~' ~• ..~'~+.~'
Name ,
Phone
SEPTAGE SERVICING OPERATOR IPUMPER) LOGAL REGULATORY AUTHORITY
Name Name
Phone Phone ,°
This document was drafted in compliance with chapter Gomm 83.ZZl2ltbl(91'(di&ifi and 83.54111, l21 ~ 131, Wisconsin Administrative Code.
rrcurl . x.nurwncrc rLUrusuvu
~~
this IVU. (1JJCiOJ1Gl ~P. YJJ CYJYJJ lYJ•JJru'I tc
IJ J~ . 4AiDi~A ~~llJlf i .~
SEPTIC TANi~ MAYNTLNANCE AGREEMENT
AI~7D
OWNFRSHfP CERTIFICATION FORM
OwnerBuyer, y ~1~1 ~` - _ (~~1Y~ Calm --~,nC~
Mailing Address -y `~'X ~'.~~I _,___~~. ~~-~~ V~ ~_l~
Property Adciress
~ ~LcJt F'T C'/2 C L-
(Verification requited fmm Planvng & Zoning Deparimcnt for new
City/State ~CQSi~I ~ ~..= Parcel Identification Number O Z6~/ __ f0_-~Gl~
Prapetty Location tJ£ '/. , 5~ '/. , Sec. ~ , T ~N R~W,'rown of }~u
Subdivision _.._ ~I ~D~ ~~ ..~ ., ~ ,Lot # ~5
cercittaa survey MAP ~ _ - .. ..... ~ .., Volurzse. ._....^...~ page #
Warranty Deed # 7 ~ ~ Lp ~ , Voltuna 2 `~ ~ ~-- _, Page #
Spot house yts
Lot lines identiRable ~ no
SYSTEM M~-YNTEIVI*+N~E AND~yV„jVER Cl~~'~,~~~rAT~,ON
Improper use and ttminteaance of your septic system could result in its nraaature failuro to haucilC wastaa. Propel
tnaintanance consists of pumping out the septic teak every three years or sooner, it ttetded, by a liceasod pumper, What you put imo
the system can affect the function of the septic tank as a treatment stage in the waste disposal sy3tCm Owtatr maintenance
responssbilitiea arc speeit7ed in $COalm. 83.52(1} an~1 in Chapter 22 - St Croix County Sanihuy Ordinance.
'I'hc prvpcrty uwntlr agcovs to subnut co St, Croix Gounty I~Iannitlg & 7ooutg I~epanment a e;ereifiaation form siYnert by the
owner and by a nsra;ser ph:nuber, jouravyman }~lun~bc+r, res:rictCd plumber or - iteonaed pumper verifying chat (I) the nn-Aire
wsxtewatcr dispoaa! system i3 in proper operating condition ancL'or (2) aRrr inspection and pumping (if neeossary), the septic tank is
lass than 1/3 fuEl of sludge,
Lwc, the underaigaed have read the about requirccneats and agree to maiatai» the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Daparaonent of Natural Roaourcq, State of Wiacoasia.
Cemficatioa stating that your aepdc a~tem hss been maintained must be completed and returned to the St. Croix C.'ouitty Planing &
Zoning Departmuent within 30 days of tht three year expiraatic~+~ date.
ilwe certify that all statesneniR nn this forni are trot tv the brut of soy/ear knowledge. Uwe ardare the owner(s) of the
property described above, by viritse of a warranty deed recorded in Register of Deeds Office,
Number of bedrooms ___~_~_
~ ~~ ~o
`.-_- S NATURE OF FLICANT(5} .. HATE
•i'Any information that is wisreprescntod may rcault in the sanitary pcnnit being revolsd by rite Planning dr X.oning Departtr-ent. "'
Include with this application a recorded warrarsry dyed 1"soret the Register of Uaeds Offsce and a copy of the certified sur~'ey n~mp if
rcferet~ce is made in tfic warranty deed.
t~v, od~as
Parcel #: 020-1416-10-000
02/23/2006 02:43 PM
PAGE 1 OF 1
• ri~~. • w•vv• • ~v.cv. ~ V.~v~v VLV - 1 VYYI`~ VI I IV VVVIY
Current ~ X~ ST. CROIX COUNTY, WISCONSIN
' Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner
O -GLEN JOHNSON CONSTRUCTION INC
GLEN JOHNSON CONSTRUCTION INC
2629 BURL OAK TRL
HUDSON WI 54016
Districts: SC =School SP =Special Property Address(es): * =Primary
Type Dist # Description * 422 SWIFT CIR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.007 Plat: 1983-GLEN, THE 02
SEC 20 T29N R19W NE SW SE NW LOT 35 BLK Block/Condo Bldg: 5 LOT 35
5 THE GLEN
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-29N-19W NE SW
Notes: Parcel History:
Date Doc # Vol/Page Type
01/16/2004 751971 2493/301 WD
01/15/2004 751638 2492/229 WD
12/21 /2001 666080 1797/613 W D
9(1(1 SI IMM~RY Bill #: Fair Market Value: Assessed with:
Valuations:
Description Class
RESIDENTIAL G1
Totals for 2005:
94284 92,400
Last Changed: 10/25/2005
Acres Land Improve Total State Reason
1.007 94,200 0 94,200 NO 05
General Property 1.007 94,200 0 94,200
Woodland 0.000 0 0
Totals for 2004:
General Property 1.007 52,800 0 52,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
U 2y92 P 229751638 ~`
WARRANTY DEED
This Deed
made between,
West Lake Builders, Inc.,
GRANTOR and
Glen Johnson Construction, Inc.,
GRANTEE
WITNESSETH, That the said Grantor(s), for a valuable
consideration conveys to Grantee(s) the following
described real estate in ST. CROIX COUNTY,
STATE OF WISCONSIN:
Lot 34, Block 4 and Lot 3S, Block 5, Plat of The Glen in the
Town of Hudson, St. Croix County, Wisconsin.
This is Alt homestead property
KATHLEEN H. 11ALSH
REGISTER OF DEEDS
ST. CROIX CO. , MI
RECEIVED FOR RECORD
01/15/2004 11:30AM
MARRAHTY DEED
EXEMPT f
REC FEE: 11.00
TRANS FEE: 597.00
COPY FE£:
CC FEE:
PAGES: 1
Name and Return Address
RV AT # 03A-11323
PIN #
020-1416-00-000
020-1416-10-000
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the property is good, indefeasible in fee simple and free
and clear of encumbrances except easements and restrictions of record.
1
Dated this day of January, 2004
seal )
~~~~ ~reK o ~' .
~iYE1i 4F,vy--
AUTHENTICATION
Signature(s)
(seal}
authenticated this day of
i tue: Member Jtate >3az of Wisconsin
This Instrument was drafted by:
River Valley Abstract
1200 Hosford Street #201
Hudson, WI 54016
Tracy L. Turner
Notary Public
State of Wisconsin
seal)
(seal)
ACKNOWLEDGMENT
STATE OF WISCONSIN
COUNTY OF ST. CROIX
Personally came before me this I, day
of January 2004 the above named
~~,~~ ~ir~,~~
to me known to be the person(s) who
executed the foregoing instrument and
ac owledg e
1
*. ~
Notary ic, State of Wisconsin
My com tssion expires: ('L1~-~
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