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008-1049-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 584704 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 Township Parcel Tax No: Daniel & Trish Moniken TOWN OF EAU GALLE 008-1049-50-000 CST BM Elev: Insp. B E~ev: IBM Description: S~ Section/Town/Range/Map No: E~[~J 17.28.16.250B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4 ~ Benchmark / 5• • e~ /65 , o lots Dosing Ow~so S 8 Alt. BMr C 7• 5 97• nding Bldg. Sewer St/Ht Inlet \ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic '7 Jld c_ / 1 - Dt Bottom /4.7 qn.35 Dosing -7 J41 _74Z' 33 / ✓ Header/Man. ~-bZ Ad t' [HIding ration Dist. Pipe OZ Bot. System OOO • o ESL Final Grade O z PUMP/SIPHON INFORMATION "i Manufacturer L/I N% GPMand St Cove 7-15 9~ Model Number QrN 53 _ TDH Lift ~~Q Friction 0L0 System Heap TDH, " Forcemaiin• Length / Dia. /t Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trencig PIT DIMENSIONS No. Of P g _Inside Da,__. Liquid Depth DIMENSIONS / ` /e~,~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture INFORMATION CHAMBER OR .V+IV {~`~7A/' Type Of System: {O yZs UNIT Model NAnber: Q DISTRIBUTION SYSTEM Arj~ ZZ JS Header/Manifold O) Distribution x Hole Size x Hole Spacing Veto Air In e Pipe(s) 1_~.._ LDia LDia_ Spacing`. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over i Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center. 4.14f Bed/Trench Edges Topsoil L] No '-_~;4 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2269 CTY RD N MdF- Gaaw 1.) Alt BM Description = 2.) Bldg sewer length = oCJ~~ IJSr~ - amount of cover = 1 d~ Plan revision Required? Yes ❑ No 1 3 Use other side for additionafin~f r~nation. 1 Agnatu, ctCert. No. L4 Date Insep SBD-6710 (R.3/97) .~4 l~ Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer j1t/,'e.65 e C M inimum Pump Performance Required Tank Model Number GPM Ft TDH Total Tank Capacity Max. Bury Depth Total Dynamic Head (TDH) - Feet Pump Manufacturer s Elevation Head (a Pump Model Number (3 ki 5 3 Distal Pressure I A)A Alarm Manufacturer Network Pressure Loss Alarm Model Number Force Main Pressure Loss 0 ,(B 5b Switch Type Total Manhole Min. 4" Above Grade - Vv ith Locking Device Vent Min. 12" Weather-proof Above Grade Weather-proof With Cap Junction Box - - - - Finished Grade - - Depth of Cover 3 Ft Disconnect Means Y Y S > > S i } S S > > } > > > } S { }i { {Y< < }i}i i i>t Yti >i < i Yi>i Y{ { {Y T >t i> Yt } < {Y Outlet inlet Switch Settings and Reserve Capacity ' Tank Volume = GPI - - I I ' ; ;:J Dimension Inches Volume Gal. A (reserve) A /a" (alarm) B 2 I B Veep J (dose) CI 3 Hole i Off Elev. C (dead) DI 9 17-6c> Ft Total 3 ` > D Y t Ft Y J Bottom of Tank Elev. s; S S t 5{{ K K S{ K K S C S S{ S t 4{ S<< t t t{ S f{{{{{ i K{;{ C>( S 5 t 5 { S{ SSK KY<}i GENERAL INISTALLATION: The dose tank is bedde~ and/bank filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05lgj Page of PUMP PERFORMANCE CURVE w PUMP PERFORMANCE CURVE PUMP PERFORMANCE CURVE SUMP / EFFLUENT MODELS E LL EFFLUENT MODELS 14 3/8•,1/2°83/4°SOLIDPASSING CAPACITY 3/8", 1/2" & 314" SOLIDS PASSING CAPACITY 11 42 53/55 13 MODEL 48 57159 72 I 76 98 131/139 140/4140 151 152 153 4 191 I j Feet I Meters j Gal Liters I Gal. Liters ' Gal. 1 Liters 1 Gal. I Liters Gal. Liters Gal. Liters Gal. I Liters Gal. - Liters Gal. Lite's _ Gal. Liters 13 1S 2B 110 43 163 38 144 50 169 72 273 j 93 352 86 326 1 0 10 3.1 22 83 1 34 129 50 189 6.. 261 17 29f 3 12 30 114 40 151 61 231 79 299 i 80 303 45 170 61 231 10 265 15 4.6 10 38 19 72 14 53 30 114 45 170 64 242 73 1 276 - 38 144 53 201 61 231 zc I I 20 fi.1 - _ _ _ _ _ 64 25 95 36 1 36 66 250 25 0 44 167 52 197 3 16s 25 7.E - _ _ _ _ n a16s~ 8 ! 30 59 223 1 16 1 61 1 34 129 42 159 40 12.2 - - I 49 185 - - 23 87 1 33 125 - 3 50 15.2 28 106 - - - 11 42 60 18.3 - _ _ _ 1 - - - - - - - - - 1 - - - - - - 32 10 70 1n - - - 3oJ 90 27.4 I - - - - - - i I i - i - ' - 100 30.' I _ _ I I I 95- I I I IU a b _ _ I I 2 - - - _ _ _ 120 I 3fi.6 - _ _ - I - I j 1 1 I - I - - es Shut-0H Head 18 ft.15.aml 1o Zo fi., 5.9m, - t r - - ! 18 R.(5Sm! 25 ft.(1.6mI 23 ft.(7.Om 1 26 ft (7 9ml ~ 50 fl.115.2m1 I 30 ft.(9.1 m1 I 36 ft.111.13 m1 I 44 1.113.4m1 80 2 165 4165 75 ozz ~ ~ ~ ~ I 63 70 16114161 16314163 16514165 18514185 186/4186 18814188 189/4189 191 47631 Gay.. Users Gal. Users 65 - ua.. UI rs Gal. Liters Gai. Li1ers 2 Ga Liters Ca.. Liters Liters 100 37_ 6' 231 61 23 - - SB 220 145 549 14 S4 I 45 170 6' 35L 81 231 61 23 - - 58 220 1 140 530 140 1 530 I 45 17C i ifii 189 BS 322 6C 227 ! 61 23 56 220 138 507 73` 51+ 45 170 4161 4789 75 299 5 223 60 22 - _ 55 - 5B 220 12,8 484 1 13' 1 496 45 170 21 70 265 Si 6 59 222 _ III _ j SE 220 722 462 125 473 45 50 4141 62 235 G 200 98 220 85 .s22 58 t7p 7NJ 1410 116 434 120 454 45 1 707C 220 1188 46 170 46 772 S5 E 20 70 I 285 56 I . 220 i 1. 4188 104 394 109 413 45 1 45 I I 20 I 76 I 33 125 50 iB 51 9 58 220 I 90 34. 97 36, 45 170 1 5 39 148 ,2. 513 22D I 71 269 I BS 322 45 i 170 1~ 87 I 9 34 I - - I . 52 197 ' 2 4 i7 1 193 1 569 1 152 ' 261 : 455 - _ 0 31 I`- I 15.; 1 45 170 26 106 le, I _ _ 4 17C 35 1 1 _ - 31 - 117 8 34 I 729 I 45 ;70 151 1- I - 1 6 BO r I B4 I 40 151 30 _ _ _ _ _ _ _ 4 15 1 185 - - - 30 114 4185 - I _ _ 20 25 6 I 1 1 - 0 38 56 rt. 17. f I 66 ft (2C 1 1 89 tt. 26.4m 6- 20 96 I ( ) 73 f1f22.3mi 714 ft(34.rm1 91 fL(27 7m1 110 it.(33.5m) 137 ft l41 1m .8m! I 1 009922 1 I 2 j ® CAUTION Model 185/4185 should not be subjected to as I 53 76 137 I less than 30 feet TDH. 51 0 .59 139 NOTE: For Pump Performance on Model 112, Industrial column GALLONS 1o 20 io 40 50 60 70 ap so top lk 120 19D 14 150 explosion proof pump, see FM0219. UTERS 80 16C 240 320 400 480 560 FLOW PER MINUTE S EWAG E/\t~VID MODEL 211 264 286 25 268 270/4270 282/4282 264/42& 292/4292 29314293 29414294 295!4295 DEWATER`I1NG 24 70 - 1 2C- 1 I - 65 s. 17 en - ~ i I ~olRn s„ I m s I zt en zs 1s n,,o 1E_ 60 w 009904.~m 55 U i 16 I I ! i I a0 z I I I 1 1 I > I ,4- I I I X293 1 _ I I o ao I I 1 7 i I I I 1 I I I PUMP PERFORMANCE I I CURVE I 1 e=I I 1 I I I I 1 I 30 SEWAGE MODELS I I I 1 25 I I I 1 I I I ' II I ~ ~ i 2 SOLIDS PASSING CAPACITY 6~ 20 266,1 zs282 270 4-1 1 I 1y c I I I I I I I 1 z I I 7 I i 1 I 5 I I i I. 21 ; 264 292 . I I ~ 184 12841 295 A CAUTION Model I I : 293/4293 should not be I I C 1 I I 110 20 30 410 50 610 70 80 90 100 110 120 13C 140 150 160 17C 180 19G 9 03 subjected to less than 15 feet TDH. GALLONS zoc zio „ ~_e LITERS _ 0 80 160 240 320 40C 480 560 640 720 800 FLOW PER MINUTE © Copyright 2003 Zoeller Co. All rights reserved. 6 M-M/ooaid-M 3~U 99V9-5Z~-008 0 \ 7nod-1SOd :31VO 00/00/00 :31V0 09LK LM '>100a N301VW Ol AMH sn 9LL2M z iyf1NbW OIld3S :anod-3ad 3~VOS dOM :.19 NMV2J0 31300!100 B3531M bH-009/00Z[d]M V) 0 w ~-j w m J ~n ~ H Q J z F ° D co O cr J Z) w w w vO a r 0 a ° Of z Opp ~a w d m 0 CY F o p N Q o U v W0 _J Gi a d V CO o Z H (n 0! O O H Q W U Z a W p < mm 0m z Q zz F \ mm H O> W , J o Q Q J U J J N U 11 J O O < a > U O Q a °C) mvwi JW W W o(D z d 0< U a z p U a a o N J I wp~j c0~ (/Wjp ~v Y ¢ a (D 00 04 V) z 00Ll- ~°OOd1- 5o ~ m~<mwLLJ cn r~ic. ° QUd ~ Q 14 \U ~O~ _ir> H I Q ~NQ W) C14 , p l=F z~ Y~ LlJ Nr)(De J>°0 WQU LJ - Z cwi)wU U~ z0 U) (o N r: z C) U) LLJ ciiM0 fi ~0 ~0m OaY °OW Q W mOF- U) W p0 00 a- x Li -1 H>LL, 0 ZOZ F- ZU Q Z N~ Q p 0 za_W O 000 z V) m~2J ~m° QsrC~ Q-i0 Q z V NLLI F- F- LLI J Q Z Z j J J p Q Z Z J Q OQ U F-I W F U N I Q ~ F- U) w p C) z D d > o a a II l =o III a w F II II I I Ia Li II If CY 11 II I I _ I ,I N All II I~ > I I > V) IEI iI I~ 0 I I o ji ° ¢ II „9F w I N w w I Io I w J I h - W 1 I I) 11 1 119 ° I p II Q II W 11 ~ `N a 1 II I I ~ o W U U- H 0 J Z Q Z m ao~a Of a „96 sv „F5 N Y z Q H RECCIVE® Safety and Buildings Division County r S _ 201 W. Washington Ave., P.O_ BOX 7162 Sanitary Permit Number (to be tilled in by Co.) P S MAC 2 2016 Madison, W 153707-7162 f~//` zS 4?ti \ .S ~jl ~ t ^ ?7 V N Y I 76 XMMUNIT';N T?4Wmit Application State Transaction Number In accordance with SPS 383.21(2).. Wis. Adm. Code. submission of this form to the appropriate governmental unit is required prior to obtaining a santary permit. Note: Application forms for state-Dried POIi"TS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Sere ies. Personal information you provide mac be used for secondary purposes in accordance tcith time Privacy Lan-, s. 15.04(1 )(m). Stats. 1. Application Information - Please Print All Inform• 77-617 T A,, JV Property Owner's Name Parcel = ))AN) - PUS t KE Ob 5- l O4 a- .~O- coo Property Omyner's flailing Address Property Location 6 Z 5& 2) Govt. Lot City. State Zip Code Phone Number Section 17 -4- 540C-2 /5-71,,V-Oz13 T zS (circle one R F of II. Type of Building (check all that apple) Lot 7.1 or ? Famil DA%elling - Number of Bedrooms Subdim ision -Name ❑ Public Commercial - Describe Use 6k LOOMIS Block= ❑ CiI) of 60 ~d•A.. CSM Number Village of ❑ ❑ State Otcned -Describe Use Z Z 7 - X Tomm it of u (i~7 t III. Type of Permit: (Check only on oc on line A. Complete line B if applicable) 064- a. Nety System ❑ Replacement System ❑ Treatment Holding Tank Replacement Onh ❑ Other Modification to Existing System (explain) B. ❑ Permit Renev,a) ❑ Permit Recision ❑ C hange of Plumber I[] Perr it Transfer to Nety List Previous Permit Number and Date Issued Before Expiration Otmner Q IV. Type of PO«'TS System/Com onent/Device: Check all that a IN on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Nlound - 24 in. of suitable soil ❑ :Mound 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)__ ❑ Pretreatment Device (explain)__ 64 V. Dis ersal/Treat ent Area Information: 0A /04 Lb 84-0,0~-` I Design Flory (gpd) Design Soil Application Rate(gpd Dispersal Area Required (st) Disper Area Proposed (sf) Svstenr Elccatiort l~ CID 0.7 X7~ i /OD. OCR ` ~C? i X'1. Tank Info Capacity in I otal of Manufacturer Gallons Gallons units Sexy Tank> L - " - Exisnng Tanks ~ . r V M /ak szs - r s Septic r Holdutg lank ZSo ) Dosing Chamber 1 V11. Responsibility Statement- I. the undersigned, assume responsibility for installation of the PON\ TS shoscn on the attached plans. Plumber's Name (Print) Plum er's Simon. re MP MFRS Number Business Phone Number C_AkL Z5 ~Y,;p ~0~ 9`t Plumber's Address (Street. City. State. ZjpLCode) 2 L"' Q~05 10 fig( `VC- fik {~s lt~T '4 -2 VIII. unty/De artmeut Use Onh pproxed mroced PermittFFee~ Date sued / Issuing . t s2nature S ~v V 1 I1. Conditio - easons for Disappr al n ~ 1. Septic tank, eiflt;-nt filter and 3 ~C,yJ~tr~Q.tM e~ dispemai cell must all be -s , iarrec I ' alW management an :ded by plumber. 2. 114. etbajck requiremen s mutit be<ma intd eed as per appkabla rode I crdinaftoas. Attach to complete plans for the system and submit to the County only on paper not less than 8 D2 . I I inches in size SBD-0398 (R. I I I I) it .Plotpun _ Page f ~►tD # party Owner MO regal Desc*dOll wI I » = Oft d~ -rt 1~ 5 , n, f where n~ T28 ~f+ RIlo h► ~ ~~,,j OF eRDt X Co v~ n = s Backhoe pit -ACRCs No V) 7s' 'f 168 LIO ~ToQ of P N°~ oo ~d 00 j 70- 3i,n1u oo~s~ o E too. uAPO / GRv ~R~L s`'.'~tr o PKoPos~ w w~ !y0M~ '~.5'DlsTr~ ~l~ Site s Location: C.T, ff, -N y - ~S F S~~ PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10/12) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: TANK- sf`eGS POWTS Application for Review iL-TEK'_ 5,FL2L Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): rE~L J TKIsi-I A),10 KZA' Phone: 71~ -'7 ~ - Qzl3 Owner Address: zzz eTri: 13 S B-ALam&i c , wa Zip: _~f/ Project Address: 0-7-H. A) Govt. Lot: AtA_ AM 1 /4 of ~JE 1 /4, Section 17 T 29 N-RAE ❑ or W Township: EA.u LAt1ir=~- County: 57 cPt Project Parcel ID ors- I CLN-5G---O(e Designer Information Designer Name: /V14-"4 T ~1u P~ Phone: %f5 --q2-t,- 177- Designer Address: 2-ggq-1 Kin;<<, r'~Tt►t4P5 ~`7 . A; (~2~ Zip: 5gg3o E-mail: ~'1~((iS`~~t'%SiG~1'Cu~locK: ~cnn ``o~~~~~~tniiurn.►r~~~j,, License Number: I - OC,7 SCON t .,•.Jeel~ o St4 %u lti~ I•'VSi ~9t-1~T10,'l, "rRemarks: Sel~s AKA C(Ktu'~ -h r TS LL Signature: 4 c Date: original sigh ature required one h submitted copy. ' .Plot Plan Pagea►oo Property Owner DA.v L T~ sit II /i o~~ j e,.al Damr4Wojs TZS~t RIi~ W To F where mte4 ~u eaa~x ne~..m~ D = Barckhoe pit zo ~.Fs A North V LID pol l , A~oiCobt. ~ C Litt X8.600 To FsT f- 3/ lAl gOD=' l AD-so I)VIE oµn?© TC14JL ° P~i'ns AIE w k' A IZTAN } s hJoo~/~.SNI -VI -S;Wrrt Site Location: a. -Al -30 ~-S n # 4Vr-~ IN-GROUND GRAVITY DISPERSAL AREA Septic Tank(s) Manufacturer. 'A - Stepped Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) Septic Tank(s) Volume(sy gal _ gal gal gal Effluent Filter Manufacturer. SOIL COVER aC-mac min. 12' Ity*A Effluent Filter Model t?" min. "ncn TYPICAL TRENCH depth CROSS SECTION VIEW (ty*) _ (No Scale) I_ Provide minimum 3 ft (ty~) separation between trenches. Highest Trench n Lowest Trench (as applicable) System Elevations= 10 ft; ft; ft; ft; ft Quick4 Standard-W wl End Cap obsenratlun Pipe TYPICAL TRENCH (typical) (Stow location of inlet / outlet pipe connection on plan view.) (t O-* Install per manufacturer's PLAN VIEW Z rr "S-Wr- (No Scale) A = 3.0 ft B= 9D ft m (typical) Quick4 Standard-W Chamber CA (typical) PER TRENCH(typical) -n (mfd by Infiltrator Systems. Inc.) -n ~J Quick4 Std-W @ 2 Instal pursuant to manufacturers ttstructbns. 0 ftzEISA/ct - yy ft` + Z Pairs of end cap 6 ft' EISAI = f Z ft' Z X 7, 1 d t'~ 40 =Proposed EISA per trench= ft' Required Infiltration Area= ft Distribution Method: x Z trenches = Proposed Total EISA = ft ~Qk:4 V/ 7x `696, i PAGE 4 OF 4 In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = ~ gpd; BODS 220 mgL"; TSS 150 mgL"; FOG 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. c Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. I System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Phone: Local government unit: S7 C QW( CCuXjTj Zc_~) NG, Phone: Its 3~ ~ - ~f b Local government unit address: -M Lk D 5 Uk) UZI ZIP: Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384. Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. 0 W-OMWV GIL4 99t8-5Zc-008 31v0 OSLtiS IM 'MOON N3o1VN1 Ot ANH Sf1 9lL£M ldnNdW mas w -'aflod-1 -Ava 00/00/00 30 9d8~ -anod-321 .0-j-.* /t 3WOS d0M 'A8 W7W- 31 aMf-05Z1d1M 3: 13131M A 0 w w ~a ~W y as _j TE ~j~/ r w ow F- W g am'. O 1~- Q Q F- Z ce m Q z m Q' C9 d' V H Q El >o a a ° Q z 04 2 ►Q- 3LL F= c d o~ ~dU a c~ ( Zo Q aoo o to ~j wN 0 z 0f5 o " d Op= _ = Vf ~j = N~ &tn Y a a O Li _ \\o d.mo ~j mwtn d°o aFU- o a? ~o ZQ Lo N C) ~ I Q ~ Q OJ a N \Ne NN N: l~a .0 Z R _ 5 2 LLJ r N~ ~ZJ.. BZIL' U ZF--~ U-) WU 0W F~ of 9&OF=~ ..~0= OVY ° OW a F ? o mF xX DU ~K~'ZO"o°~c' °z= caF zd Y Z3mcpi~i~$mzl ~dt9 d$o a i Z° pQ C> o w F- Q c z z < W0 j a F U H U I Q W ~ N 1 Q 1 F- `a ? .6£ o 7, Ir 1 I i aco) w svo i+ N L do i ~m v o a .9£ a w o N a U \ svo t9 .5dn \ 0 F- N J v z 0038 ~ U) Y 2 1`- • • Filters PL-525 EFFLUENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm ,"4. J Accepts PVC (gallons per day) making it one of accessibility extension handle the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 9/16" Rated for over removed for cleaning, the ball will filtration slots 90,000 GPD float up and temporarily shut off the system so the effluent won't leave the tank. No other fr1Mr on Owl the market can make that claim! Accepts 4- & 6" SCHD. 40 Pipe PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional' alarm, the owner will be notified by an alarm when the filter needs ' Gas deflector servicing. Servicing should be done by a certified septic tank Automatic shut-off pumper or installer. ball riven filter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6' outlet pipe. If the tank. Make sure all solids fall filter is not centered under the bads into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. Technical Specifications PL-525 EFFLUENT FILTER 8178ALLCFE4( - ~ 'FMWTEXIEgT1019 t4E 11.57 DAET9181WEXMITS 8.10 4' 9(}11088' 9CH b - 1888 sm F a- 3102 - , - PL-O FI TER HOUSING 111,34 PART NO. -30142-525 MATERIAL: HOUTLETWSMG M MALL -HDPE P 4. SOOVEMOMSROATSgTCH - -rB _ 1829 - EJ1Dz3iSTSCH/0 _ 1884 / ~ FgiHANllEEXIEIIiIpi - ~'11 _ 824 -mcnArms -A - SOMETE) MIM 884 _ 84L PUSH ROD c r ,o f 1 4 lk. II f{. j I~ e 7.09 qpz 1 04 1882 X244 Ji r jI f Y t atci~ 1 - POLYLOK PL-0 FILTER OARTRK)GE PART NO. - 30141.525 - MATERJAL -POLYPROPYLENE p Technical Specifications PL-525 EFFLUENT FILTER 0 t@ B&L GECK - E70FPT56'%D-W FO $ur EXflm 1157 *4z . \ 4 V^ f OUTLET MINGE)O R75 ` IMH 40 & 6' SCH 4C / &10 ~~~Y yr I ~ ~ tai I 5.23 1i1 I j II PL-523 FILTER HOUSING 4a34 PART NO. • 31DI42-525 t MATERIAL d ° HOUSING-POLYPROPYLENE OUTLET BUSHING -PVC ~ G5BALL -HDPE LL~~ i SO.7ETE7QEP7SFLOATSWTCH 1029 t OP. HAkt' SCH 10 } ► l j 10.04 FOP. HAW EXIENTIOIr SWOFU16'SLOTS J tflq'„' 624 d11~ ~_b, Tom.- 50. 92 SOCKETEXCWM E04 SkLRWROD CPENNG aPEr 2171 -41 1i0? 3244 I a I~~ ~ 41, mpl POLYI:OKPL-525Fa.TERCAftTRtDGE ' PART NO. - 30141-525 M1 y = ZT~ MATERIAL-POLYPROPYLENE - J Ica F,~ _ w Ja m_ea t ` s w .y. 5,•,• ~ a _~tt- aim 1: i t l - ~ ~ ws (l Y X51. ~00 Y.. n a - j 1 The Quick48 Standard Chamber fits in a 36" wide trench and is ideal for curved or straight systems. It features the patent-pending Contour Swivel Connection- which permits turns up to 15°, right or left. The MultiPort- endcap allows multiple piping options and eliminates pipe fittings. The chamber's four-foot length provides optimal installation flexibility. J " • Advanced contouring connections swivel up to 15°, right or left ~?t • Latching mechanism allows for quick installation • Four-foot chambers are easy to handle and install X11 y • The Quick4 Standard Chamber supports wheel loads of 16,000 Ibs/axle with only 12" of cover • Certified by the International Association 1A f , of Plumbing and Mechanical Officials (IAPMO) &r • Tear-out seals on inlet ports provide a tight fit to the pipe - 4 • Eight molded-in inlets/outlets allow - - for maximum piping flexibility _ `Y _ _ r • Eliminates pipe fittings • Fits on either end of the Ouick4 Standard Chamber - - , - 15- APPROVEDin f - Quick4 Standard Chamber 34" (EFFECTIV VE LENGTH) MultiPort EndCap r I - _ -y Sa• - FRONT VIEW SIDE VIEW TOP VIEW Typical Trench View INFILTRATOR WATER TECHNOLOGIES STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber. endcap and other accessory manufactured by Infiltrator (-Units`). when installed and operated in a leachfield of an onsite septic system in NATIVE BACKFILL TOPSOIL accordance with lnfittrator s instructions, is warranted to the original purchaser 14older) 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 COVER BY` applicable lavr, the warranty period will begin upon the date that installation of the septic system DESIGN commences. To exercise as warranty rights. Holder must notify Infiltrator in writing at its Corporate t = Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator 12- t2. will supply replacement Units for Units determined by Infiltrator to be covered by this Limited F INVERT Warranty. Infiiltrator's liability specifically excludes the cost of removal and/or installation C i of the Units. ~ 34- SPACING PER COD 34^ lb) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (at ARE EXCLUSIVE. i W Woe TREWHI THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS. INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shah 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. Size 34"W x 53"L x 12"H including loss of production and profits, labor and materials, overhead costs, or other losses or (864 mm x 1346 mm x 305 mm) expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident. misuse. Effective Length 48" (1219 mm) 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 nlnimutn ground covers LDUVBt Height 8" (203 mm) set forth in the installation instructions: the placement of improper materials into the system containing the Units: failure of the Units or the septic system due to improper siting or improper Storage Capacity 43 gal (163 L) sizing. excessive water usage. improper grease disposal. or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fads to Comply Invert Height 8" (203 mm) 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 third party resulting from installation or shipment, or from any product liability claims of Hoder 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 Infiltrators installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other titan the original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of 4 Business Park Road states and counties have different warranty requirements. Arhv purchaser of Units should contact P.O. Bo. 768 Infiltrators Old Saybrook. CT 06175 Corporate Headquarters in Ofd Saybrook, Connecticut, prior to such purchase. to ld Sa brook. • Fax 860-577-7001 obtain a copy of the applicable warranty. and should carefully read that warranty prior to the 860-577-7000 O 1-800,-221-4436 purchase of Units. www.infittratorwater.com 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: 5,839,831 Canadian Patents: 1.329.959: 2003.564 Other patents pending, Infiltrator, Epual'eer. Ouick4, and SidekVirKw are registered tradern rks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. infiltrator Water Technologies is a registered trademark in Mexico. Contour, MicroLeaching. Poly-ruff. ChamberSpacer. MuftFW. PosiLock. OuickCut. OuickPtay. Snapl.ock and Sb-dK tLOCk are tradernarks of Infiltrator Water Technologies, PolyLok is a trademark of Polyl-ok, Inc. TUF-TITE is a registered trademark of TUF-TITE, INC. Ultra-Rib is a trademark of IPEX Inc. t-~ 2013 Infiltrator Water Technologies, LLC. An rights reserved. Printed in U.S.A- 0250813 Quick4 Standard Chamber `t I C I + i f it I ~ i } ~ ~ I t 48„ (EFFECTIVE LENGTH) MultiPort EndCap FRONT VIEW SIDE VIEW TOP VIEW Typical Trench View INFILTRATOR WATER TECHNOLOGIES STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, endcap and other accesso y manufactured by Infiltrator ff-Unitsi. whey: installed and operated in a leachneid of an onsite septic system in NATIVE BACKFILL TOP;pIL accordance with infiltrators instructions. is warranted to the original purchaser (`Holder) against defective materials and workmanship for one yea from the date that the septic permit is issued for f the septic system containing the Units: provided. however. that if a septic permit is not required by COVER BY` applicable aw, the wartanhr pe toil will begin upon, the date that installation of the septic system DESIGN commences. To exermse its warranty rights. Holder must notify Infiltrator in raiting at its Corporate } Headquarters in Old Saybrook. Connecticut within fifteen i15i days of the alleged defect. infiltrator } f will supply replacement Units for Units determined by Infiltrator to be covered by this Limited 12" 12 7 8' INVERT Warranty- Infiltrators liability specifically excludes the cost a removal andior installation E ib the Units. 34- SPACING PER COD ,T 3.t• ibl THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH jai ARE EXCLUSIVE. i3o-WnEraEHGN; THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS. INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE lcl This Limited Warranty shall be void if any mart 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. Size 34"W x 53"L X 12TH including loss of production and profits. labor and materials, overhead costs, or other losses or (864 mm x 1346 mm x 305 mm) expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wee and tea. alteration. accident misuse. Effective Length 48" (1219 mm) abuse or neglect of the Units: the Units beirw subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the minimum around covers Louver Height 8» (203 mm) set forth in the installation instructions: the placement of improper materials into the system containinc the Units: failure of the Urns or the septic system due to improper siting or improper Storage Capacity 43 gal (163 L) sizing. excessive water usage. improper grease disposa. or improper operation: or any other event not caused by Infiltrator. This Limited Warranty shall be void F the Holder fails to comoly Invert Height 8" (203 mm) with all cr the terms set forth it trtis Limited Warranty. Further. In no event shat infiltrator be responsive for any loss or damage to the Holder. the Units. or any third party resulting from installation or shipment, or trom 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 Infiltrators installation instructions. Id; No representative of infiltrator has the authority to change or extend this Limited Warranty. _ No warranty applies to any part, other than the original Holder. The above represents the Standard Limited Warranty offered by infiltrator. A limited num'be^ of 4 Business Park Road states and counties nave different warranty requirements. Any purchaser of Units shouic contact P.G. Box 768 Infiltrator 's Old Saybrook. CT 06478 in Corporate Headquarters in Old Saybrook. Connecticut. prior to such purchase. tc 860,57. -7000 • tax 860-57--7ool obtain a copy of the applicable warranty. and should carefully read that wa-ranh, prior to the 1-800-221-4436 purchase of Units. . www.infiltratorwater.com 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.'78: 5,839.84-t Canadian Patents: 1.329959: 2.00-1.56+ Other patents pending. infiltrator. Equaleer. Ouick4. and Sioewiria r are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrate Water Technologies is a registered trdemanc in Mexico, Contour. lAcroLeaching. Polyluff. CnamberSpecer. Multi%n. PosiLoc-k. Ciu ciiCUL OuickPlay. SnapLock and StraigrtLock are trademarks of Infarato - Water Techrologies PolvLok is a trademark of Polyl-ok. Inc. TUF-TITS is a registered trademark of TUF-1TTE. INC. Ultra Rib is a trademark of IPEX Inc. Q.; 2013 infiltrator Water Technologies. LLC. All rights reserved. Panted in U.SA. 025 0a13 CST-aid-~a3 Wisconsin Department of Safety and Professional Services 3 ~ U L47 Division of Industry Services SOIL EVALUATION REPORT Page 1 of in accordance with SPS 383, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM). direction and Parcel I. $ 1049 - 50 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s 15 04 (1) (m)) 3 ,71 /h Property Owner Property Location RICKEY R. & DONNA A LEE (Buyer: Dan %foniken) Govt. Lot NW 1/4 114 117/T 28 N R 16 E (or) Property Owners Mailing Address Lot # Block # Subd. Name CSM# 2378 20th Avenue City State Zip Code Phone Number ity Village ■ Town Nearest Road Baldwin, WI 54002 ( ) C.T.H. N New Construction Usea Residential / Number of bedrooms ' OR 4 Code derived design flow rate 450 OR 600 GPD Replacement ❑ Public or commercial - Describe: Parent material sandy outwash Flood Plain elevation if applicable ft. General comments Conventional in-ground trenches 0.7 loading rate ' and recommendations: l ` To be desisned after house is staked. ~a FT] (A- Boring # El Boring n Pit Ground surface elev. 108.75 ft. Depth to limiting factor >84 in. Soil Applicatio ate 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 1 0-10 7.5YR2.5,1 I 2fsbk mvfr cs 3vf-co 0.6 0.8 2 10-24 7.5YR15 2 1 21 fsbk mvfr Cs 2vt=co 0.6 0.8 3 24-31 IOYR3,6 1 1 f msbk mfr cs 2vf-co 0.4 0.7 4 32-48 7.5YR4%4 srl , Is Oso dl cs 2vf-m 0.7 1-6 5 48-54 10YR4 4 grly Is Osg dl cs lvf-m 0.7 1.6 6 54-84 1OYR4,4 Is Osg dl Ivf-f 0.7 1.6 I F21 Boring # Boring 10025 97 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 1 0-7 7.5YR2.5'2 1 2fsbk inN-fr Cs 3%,f-co 0.6 0.8 2 7-26 7.5YR424 sl 2fsbk mfr cs 2) f-co 0.6 1.0 3 26-36 7.5YR44 scl Om mti cs lvt=co 0.0 0.0 4 36-56 7.5YR4 4 cobrs Osg d1 cs lN•f-m 0.7 1.6 5 56-92 7.5YR3r4 s Osg dl - 0.7 1.6 .kA 4A ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD. < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa CST Number MARY JO HITPPERT Hollister's Soil Test ins&Desian -L 224832 Address Date Evaluation taKducted Telephone Number 28497 Kine Arthurs Court, Danbury. X VI 54830 02 - 17 - 2016 715-426-1775 SBD-£s 330 (RO7 13) Property Owner LEL. Rickev K Donna Parcel ID # OOH 1049 - 50 000 Page of 3 - E Boring # ❑ Boring • pit Ground surface elev. 100.(5 ft. Depth to limiting factor >90 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 1 0-12 till - 1 17-22 7.5YR3%2 1 1f-msbk mvfr cs 2vf-m 0.4 0.7 3 22-27 7.5YR4 4 s Osg dl cs Ivt=m 0.7 1.6 4 27-90 10YR6 4 s Osg dl 1%f-f 0.7 1.6 horizon 4 has layers of cos: cobs ❑ Boring # HBoring 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 Boring ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil EPD ion Ra te Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODF > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD_ < 30 mg/L and TSS < 30 mg1L ti3U-s v;r,Ri,_ I;. Plot Plan Page a of-:; Property Owner fiNci 5a)Q : bAA) Mopjjx.E4 I"= 4o ft. Legal Description A) Lq d 1O- F tiP`/4, sEC ,17, (except where notea7 Tas ~J, R160) ?okx} OF CA A LLG,._~S r eua~ x ca u ~ ~ 0 = Backhoe pit WLSc`in~~~n) ZCJ ~~€5 North 101. 75 ;-~oQ ~Fyou X800' 70 EA-557- P/~ h \ 44 IN90Ds J ~ 33I3 Op ~ IoO.hS' ~►ra SEE ~'Q, op ~ I]S S?IKP- sovE goo. poSeD 55 ft P~ &fzvkA ,j II ~ I i ` 'rSOUTO ply ? I Site Location: XF-sn- 30 -M 4vG. - M im -v.. _ S r A d r -•e, i ~ a r -As:2 a;': 2 ~'Vt6=c SE -SE ~r FdA 9 8 - A,,': : 2 r- S ApD2 Vo-:_2 N r r' y ~ t R 2 - -112 S'am`j N -N E -NE 17 , .opt Ht,F1 N_i -t 0 100 200 • _ Jl~I~tIMER: h5 map is nct guar W b. current or complete tl I _ conduvonsalRy, are the resp -bdlj tM 5 f i1 Cc_-19-2010 01 59 PM St C-C'x County Purr/Zcn -,g 715-386-4686 1;1 ST. CRON COUNTY SITTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Oamet'/&lyer _ ~ C'~-~l ~ ~Yl sV~r ,t,~,S~ t k'-Zh Mailing Address _Le)~k h '--L~~ Property Address (Verification required rj'0117 PIAnn g &Z oning Depnrtrticnt foritCW coABGUCtion,) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location f~'(4 Sec. J-~_, T,. N R-&, W, Town of F-fiU e,, I/ Subdivision Plat: ,L.ot# CertIfled Survey Map Volume page # Warranty Deed # (before 2007)Volunie pAge # Spec house yes Ito Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CE ITIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists ofpuntping 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 arc specified in QCotttm. 83.52(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 cr a licensed pumper veritytng that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary). the septic lnnk is legs than A iitll ot'sludge. I/wc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sot 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 36 days of the three year expiration date. I/we certify that all statements /Wrranty form are true to the best of my/our knowledge. f/we am/are the owner(s) of the property described above, by virtue of a deed recorded in Register of Deeds Office. Num r of bedrooms SIGNATURE APPLICANTS} 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)