HomeMy WebLinkAbout040-1278-10-000
PRIVATE SEWAGE SYSTEM courty St. Croix
'.Msconsin Dcpa•1•nenl nF Consrerce
Safety and Building Division Sanitary Permit No
INSPECTION REPORT 584711
State Plan ID No
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal in`c-riatir:•r ycu prov de may be used for secordary purposes [Privacy Law, s 15 C4 (1)im))
Perm t Holder's Name: City V age Township Parcel Tax No:
Karl 8r Stephanie Ulrich TOWN OF TROY 040-1278-10-000
CST RM F ev Insp. BM Cie,, SM Desrr of n Sect cnJownlRan9.w-o Nc
o/ 7zL la 2 16.28.19.1553
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURCR CAPACITY STAIION BS HI FS ELEV.
Septic ;e ~ Benchmark ?1~ L 9,~P .7
7 5 7
Alt. BM 4.17 17 a
tl~r ems- ~ t~
Aeration _ Bldg. Sewer 65 c~ dG r
Holding StlHt Inlet j ,IC e~..rG~Gn
SG'Ht Outlet U~iZJ ~`f~ 6
TANK SETBACK INFORMATION
I ANK TO P/L 1AELL BLDG ve Air Intake ROAD Dt Inlet `
Septic Dt Bottom
~ 5a N~ /a ao
Dosing HeaderiMan Z 9y5.
Aeratio Dist. Pipe 9qS ' f
9 y~~ 95
Holding - BeL System /0. Z. 9 . Gk
o. 7
hu~al Grade
PUMPISIPHON INFORMATION
Manufacturer Dem and St Cover111111, 61tI ~t~^f ~yyg ~g
Model Nu !
TDH Lift`, Friction Loss Syst ead TDH Ft
rorcemain Length Dia. Dist to wen
SOIL ABSORPTION SYSTEM
BEDITRENCH 'Xdtr Length No. Of -•encnes PIT DIMENSIONS No. Of Pits nside Di= liquidDept")
DIMENSIONS y'a Z -r( 11%r W 1"_~ 1-3 1 SETBACK SYSTFNI TO P!L BLDG 1 WFLL LAKE/STRFANt LEACHING Manufact er ~ / Ry~
INFORMATION CHAMBER OR .5 V.
Typ/e Of Syste r J 7-4 f UNIT f "o I4umber
1 Ails
DISTRIBUTION SYSTEM ,J 2Zi'ZZ
Header;Manifpld 11,~slntutfon x Hole S¢e rcle Spacing Vent to.Air Intake %
Length 4 D a Length Dia ;pacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of sx Seededl5odded T Mulched
Bed;Trerch Center Real, i re 1ch `=dges Tcpsoil "es No
COMMENTS: (Include code discrepencies. persons present, etc.) Inspection #1: Inspection #2:
Location: 395 CEDAR CT~ / • ~~y~"'` r `
1.) Alt BM Description =
2) Bldg sewer length = 26 Caje,.,b
- amount of cover = PC it
e n oJ(,~(,, Sa ~ l~ ref ~ ~o ~ Z 5
Plan revision Required? _ Yes Flo G~~ ' 1 I„]n 3 17~51
Use other side for additional information.
Lae nsepcto Slgnatur Cert. No.
SBD-6'1C (R 5+87i
-w~ - County
Safety and Buildings Division 51
REC D01 W. Washington Ave., P.D. Box 7162 Sanitary Permit Number (to be filled in by Co.)
EIV
=1S P r jam' Madison, Wl 53707-7162
r t s~ /
APR 0 ~ 70 5'64 7Y
L State Transaction Number
_a~ ~Wt r'~DDliC1t1
In a, ordarrcc with SPS S83.Z1(2), W':s. Adm. .o e, . '4gNti of this form to the a=ppropriate governmental unit ~
is required poor to o':rtainuip a sanitary permit Note: Application forms for state-owved POWTS are submitted to Project Address (if different than mailing address)
the Dcparunent of Sider', and Professional Scrvies. Persona information yoc provide may, be used for secondary,
purposes :n azccrdance wri the °rivacy Law s- 15,04(1)(m)• S
3 (7'} c6 n m <2 c+,
1. Application Information - Please Print All Information -
Propcrv, Oa~;rr's Name Parcel tl
An L r S t c rw t (,~11 C~ 1 ct~ Gr l Z 3 r a G) e) -C-~~
Propci'y Owner's Mailine Address Property Locution IQ, y8• tcl • 1553
$ 7.7 4 b i~'~1 DS Z Govt. Lot
city, state Zip Code Pbone Number /V t.lV Section
(circle on-)
- T N: REt
11. Type of Building (check all that apply) Lot
I cr 2 Family D.+clliug Nijinber of Bedrooms Z Subdivision Name
Block4 tk it F
?ublic.'Commcrcial - Dcscnbc Use ❑ City of
CSM Number ❑ Village of
❑ State Owned -Describe Use
IwJ Z ~ ~-Z'Z 5-Town of jz-o
III. Type of Permit: ((.heck only one oz on line A. Complete line B if applicable)
New Systcm 7 Replacement System ❑ Trea'aneuUHoiding Tank Replacement Onlv ❑ Other Modificatiou to Existing System (explain)
B Permit Renewal PerrtitRevision Change of Plumber C Pe:ruit Transfer to New List Previous Permit Number and Date Issued
❑
Before Expiration Owner
IV. Ty e of PU\VTS Svstemt_Com onentfDevice: Check all that apply)
Y-Aon-Pressurized ln-Ground ❑ Pressurized In-Ground At-Grade ❑ Mound > 24 in. of suitable soil ❑ J.-found < 24 iii. of suitole soil
_J Holding lank ❑ ULMn Dispersal Component (explain} ❑ Pretrearrnent Device (explum /
Dis ersaL'I'reat t Area Information:
r Ucsign blew (_;Td) Desirgt Soil Application Rate(gpds Dispersa: Area Required (sn Dispersal Area Proposed ( System Elevation
G~ ,J O ly-5;1.
V1. Tank Info Capacity in Total A of ! Manufa=er
Gallons Gallons Units
Ne. _inks Existing Tanks / v y D
W KM/l~s~IJ.S,i I`r1~ U v v, 5- F,
ap:rc ur Huldxg Ta ilc f 7 IG-~ C SZ { t~ J ` S
VII. Responsibility Statement- I, the mrdersigned, assume responsibility for installation of the POVITs shown on the attached plans.
Plamber's Name (Print) Plumber's Signature MY, idwnber Business Phone Number
Plunhe 's cress (,Street, Ciry, State, Zip Code),
VIII uunt0'Departmeat Use Only
Approved Permit QFee~ Date su J/ Issuin eat Siatu
O + rven Reason for Denial V z- / 4
I~. ConditSdf$ ~tabti~l~lifReasnns for Disap t '
1. Septicnk, eiRL* r, nlte, and proVal 6 a 3 t!~ JG
oisperr.Li cell must all be 5--tc,~s! rn~inta rec' tGIGC
cJ /~y~ It ! II • ryi
as per management plan provided by plumber. -51,5 -
2. An atlRpaclt regt,irer:'tertts must tie nairttFfried
POr WFlic No code / :rdinanrei.
Attach to complete plans for the system and su it to th ounty only on paper not less than 8 w- x 11 inches in size
x'11 i g~( y-G% 4rGc y~' ' ~!4'•! s
S3D-b X93 (F: 1 l!1 1 i
P~Of PLAN
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name.
Owner's Name: K A t C y ' f~ A ^i7 L l 7
Owner's Address: y L) -UD S ,e~ 4,
Legal Description: 1L u-', lei ccj 4-
Z
Township: + 6 y
County:
Subdivision Name:
Lot Number: Z I
Parcel ID Number t✓~ C 7 75~
Page 1 Index and title
Page 2 Plot Plan I( 4LL,ctc t( p4u j
Page 3 System Sizing & Cross-Section -~t0, [-7L.-
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 a ~A t <~jy Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Desigrer/Plumber C%~2 License Number:
Date: - - Phone Number /7/S~
Signature ~
' 2-7
Designed parsuant to the In-Ground Soil Absorption Component Manual for Fow7S Version 2.0 SBD-10705-P (N.01/01).
Page 1
F~O-i` PLAN.
PR01'~KfY 0t~1 K; L to L I H I CG~NI?; /'I = YO
L
MMI Z FEE BUFF 49,41 -?DP QFMIt-1 LArME X-r
1~T~t7 W t F W' FTtiE W/ t C 0UA1Y7 S fLrr~C
2 R W, Ow/J O F T.u S
1 COLAT\l DISC
OA) IAJ,
5 ..501L 13CW11% W/ ope
r~ u~ a Ta~~~
L~
T_ Al
f ,
pot"
day 6
X v
1- or 2- Family Dwelling In-ground Soil Absorption System (2-cell Conventional)_
Daily Wastewater Flow (DWF) _ # of bedrooms x 150 gal/day/bedroom = gal/da
Design Loading Rate (DLR) or Soil Application Rate = j, 7 gpd/ft2 (per SPS Table 383.444-1, 2, or 3)
Required Distribution cell area = DWF ~Ci C C" gal/day = DLR 7 gpd/ft` = IJ s ft2
# Chambers = Required Distribution cell area ft` _ ~ C ft2/ unit EISA = Chambers
Chamber Manufacturer and Model ( (t -0?A4-a~L C i%-« 1~ 19-L S
Actual Distribution cel! area = Required cell area ft` + ft-'/ unit EISA End Cap Pair = _-3_V,?-ft2
Cross-Section In-ground Soil Absorption System (2-cell),
4" Schedule 40 PVC
vent pipe with vent cap
12 inches minimum 12 inches minimum
LL\
T
I
LJ inches Soil Cover
1
Trench 1 Sys-
tem Elevation
Z inch Chamber Height
5-6 ft ~ ft Trench 2 System
v '1~ Elevation
ft 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
5 ft Leaching Chambers r 0 needed.
Trench 2
R
4 inch Header
I!
Sch.C 7
ft with end camps r
Draw Q fora 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
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POWTS OWNER'S MANUAL MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner t l_ r- -/-j { Septic Tank Capacity Z U al ❑ NA
Permit 1 Septic Tank Manufacturer 0i IIcSCC (Z ❑ NA
Effluent Filter Manufacturer ❑ NA
DESIGN P RAMETERS
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units J NA Pump Tank Capacity al ❑ NA
Estimated flow (average) 1160 allda Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) (oo0 gal/day Pump Manufacturer ❑ NA
Soil Application Rate al/da /ft2 Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOO.) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODa) 530 mg1L gin-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 510' cfu/10Om1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA
Other; ❑ NA Other: ❑ NA
'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
i
MAINTENANCE SCHEDULE
Sorvice Event Service Frequency
Inspect condition of tank(s) At least once every: p ear( I(s) (Maximum 3 years) O NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA
e ❑ month(s) (1'1laximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once evry
~ -3 ® year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
® ear(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
3 B year(s)
Flush laterals and ressure test At least once [3 month(s) 13 NA
P every: 123 year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ ear(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septago Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent qn the ground surface.
The dispersal 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 accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of off luent 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 (4101)
L. `I 1
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemical;
that may impede the treatment process and/or damage the dispersal cell(s), If high concentrations are dotected have the contents
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 call(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;
"..foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease, herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
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 biomat at the
Infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time.
< < WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name p fZ C L S o.^J Name
Phone *7 1 S - Z 7 3 - Z/! Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name 3O (-FNSonJ S,4 n/r Fitfro L Name /LCRC E Coun141 ?0,41 CoQdIX 2014 J
Phone 7/5 Z 73 Phone
This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.64(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEP I IC TANK '_%4AINTCNANC'F, AGREEMENT C7-
O'V~NERSHIP AND
CERTIFICATION MIMI
O„vnerrRuvet. Ulrich, Karl & Stephanie
N-1ailinb Address 877 Badlands Rd, Hudson, WI 54016
Properly Address 395 Cedar Ct
(Vcrilication required from Planrnin & Z r Departmentfor new construction.)
Cit\v,State Town of Troy Parcel Identification Number 040-12781-0000
LEGAL DESCRIPTION
NW NW 16 28 19 Troy
Property Location Sec. [ N R %k , I o„n of y
Subdivision Plat: Eagle BI uff Lot 4 21
Certified Survey Map # _ Volume - Pare #
NNarranty need # 1023269 (Attached) (before 2007)Volume Page #
Spec house ❑ye,Ono Lot lines identifiable Dyes❑no
SYSTEM MAIN ENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of puntpim, 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. Owncr maintenance
responsibilhics are specified in ASPS, 38-1.5-10) and in Chapter t2 - 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. journe) mail plumber. restricted plumber or a licensed pumper verifying that (1) the on-site
wastewatcr disposal system is in proper operating condition and,'or (2) after inspection and pumping (if necessary). the septic tank is
less than Ira full of slud-e.
1/we, the undcrsi(Ined have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of 1Visconsin, 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 ofthe three year expiration date.
I we certify that all statemenY-varratity his form are true to the best of mylour knowledge. 1/%rc aia!arc the owner(s) of the
property described above, by virtue odeed recorded in Register of Deeds Office.
Number of bedrooms 4
Karl Paul D . -tisigned tI Karl ?aul Ulrlch
DV: cn=Karl Paid Ulrich, 04 , 06/ 16
URE O'•' :►(41"Ph 'ANT(S' DATC
U JIGINI
l=kulrich moredirec .core,
r I a - U
c=~
***Any information that is rr.ISrcpr~ E~Ytfl ti i}9 i' 9 u1t Mffie sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Oflicc and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04112)
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Quick4 Plus Standard Chamber Side and End Views j i
48'
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Zuick4 Plus All-in,-One 12 Encap Front, Side and End Views
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33" -~1
Quick4 Plus All-in-One Periscope
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12.7' IN`lERT I ENALL- DCAor'e tz
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Quick4 Plus Standard. Chamber Specifications
# Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cm) Invert Height'.,.,....,..,..,.. 0.6 5.38.0", 12,7"
} Effil Length 48 (122 CM) (1,5 cm, 8,4 cm, 18.5 cm, 22.6 cm)_
INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY
e (a) The structual vilogrity of uach chamber, end plate, wedge and other accessory manufactured by Infdtralbr ( 'Units'), when installed and -
g cpained in a leachlield of ar orsile septic system in accordance with Infiltrator's Instructions, is warranted to the original purchaser ('Holder')
S against defective materals and woomansil for one year from the date that the sepl permit IS Ssued'•or Ind septic system containing the Units;
! prcv'ded. however. that if a septic permit is rot requirod by app; cable law, the warranty perloo will begin upon the date that Installation o' the _
S septic system commences To exorcise its warranty rlgrts, Ho der must notify InffirwDr In wr rng at Its Corporate Headquarters In Old Saybrook,
Cennart.cul wilhfn 1111.1 (15) days ct the alleged defect. 'nfilli'l wlll supply replacement Units for Units determined by ifiltrator to be covered r'
by Iris Lrm:$C Warranty. infiliril s liablllly specifically excludes the cost of removal and/or lasts ialion o' the Units. z~
(b)THE LIMITED W49RA\TY AND REMEDIES IN SURP.AR1,6RAPH (a) ARE xCLUSIVE. THERE ARE NO CTHER WARRAN`IE WITH RESPECT
TO THE UNITS, INCUtijl NO IMPLIED WAR9ANTIES CF MERCHANIABILI-Y OR FI-NESS FCR A PARTICl.LA9 aL)Fl E
FF (c) This Limited warranty ;mill ba void it any part of the chamber system is manutactired by anyone other lhar Infltralor. The Limite Oiaril INFILTRATOR =
C does not extend to incidental. consequenttil. special or ndli damages Infiltrator shad not be liable for per-allies cr I qudatee damages,
systems, ack:ding loss oI prpduction and props, labor and materials. overheat' costs, or other losses cr expenses insured by the r-olde• or any tr re party I
n C
Spacillcally excluced Irom Limited Warranty coverage are damage to the Units due to :xdinary weal aril tear. alteration, accident, misuse, abuse
or ni of tire Units. the Units bang subjected to veh Cie traffic or other cU<Witons wh Ch are not permiaed by the installation instructions; failure
to mainlair the min murr grourd covers set forth ir. t1ro inslallwion Instn cliors; the placement of improper materials into the &ystem containing 6 Business Part Road • P.U.
Box 758
the Units, fa:lure pf lha Un''.s or the septic systern d3.e lo improper sitirg or improper sizing, excessive wa'.ur usage, improper grease disposal,
or improper operatim. or any otter event not caused by Infiltrator. This Lirritec Warranty shell pe "d if the Huldur tails to comply with all of The Old Saybrook, CT 06475
terms sal lodh in Iris Limited Warianly. Fuilhe•, in no e,enl shalt Infiltrator be responsible for any loss or damage to the Holder, the Ur s, or any 860.577, 7 000 • FAX 8E0.577.7001
third party esu t ng Iran ras dlion or shipment, ci from a-)y product liapibry clalms of holder ui any tnird party. Fdr :his Limnos Warranty tc
apply. the Units must be installed in acbordance with u.l s :u conditions required by state end local cedes: all usher appticaoie laws: ane Infiltrator's
wslaeat'on nstructions. 800.221 .4436
(d) No reprosen:alive of Inlil:•alor has the authority to change or extend tnis Jmilod ~ioariranty. No warranty Bob ies to any party other than the www.infiltratorsystems.com
CGiginal Holder.
The above represents the Standard Limited Warranty offered by Infiltrator A limited rumbar of stales aril counties have different warranty
¢ requirements- Any purchaser of Units should contact Infillwor's Corporate - itadquarters in Old Si Connecticut, prior:o such purchase.
to obtain a copy of the app leable warranty, and snot, d carefully road that vdc ranty pr or td the l of Units
~'405' M, M1
U S Patents- 4.7t9,U61, 5.017.C41: 5 156,458 5,33E,01 7; 5 4C1,116, 5.401,459 5,:,l 1 903. 5,7-6,163: 5391-, 778; S,839 844
Canadian Paleots: 1,329,359, 2,CO4,564 Other palerns perdiny.
.•r,trator. -gjalizer, 0Lc•.4 and Cri Plus are regislured Iradarri of Ir'ifrwor Systows Inc. Ir Oltratcr is a ,egisterec trademark Ir Franca. Infiltrator Systems Inc.
a eg ste ed tradeTar'4. i-~ f oxi.n Contou• Swivel „onnacuon is a rademark o' Irf :•ator aysfems Inc. 0 2009 Infiltrator Systems Inc. Farted in U.S.A. Pl1JS051C10I51•2
VAsoonsin Department of Commerce SOIL EVALUATION REPORT Paga of _
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm- Code _
County 5 I , C rZ0 t?<
Attach complete site plan on paper not less Man 6 ti2 x 11 inches in size. flan must
include, but not limited to: veitical and l,nrizontal reference point (BM), dire:;tion and Parcel I.D.
percent slope, scale or dimensions, north avow, and location and distance to nearest road. Q a
Please print all information. Re wed b Date
Personal Information you provide may be used for secondary purnosm; (Privacy Law. s. 15.04 (1) (m)).
Property Owner Properly Location
C- 114 /J VJ 114 S 11, T 24~ N R I~ -><V) W
- ~ ~ K
Properly Owner's Mailing Address of Block # St Yi. Name or CSM#
1 Ob Zlf1C~l> ~LUFr' s _ _ l_ ✓ '7
1180 4 fit' EK.DE>rf~l ~1, !,)E ~U 1T
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Gity State Zip UU00 Phone Number L lty ❑ Village 1 Town Nearest Road
(~~►ti)>< Mil 55L1~t`~ (~b~)7s7-~5ti`d 7t20y TCA.~N~~IAt~L'EY R~•
I0 New Construction Use: Residential ! Number of bedrooms 'A Code derived design flow rate _ GPD
❑ Replacement ❑ Public or commercial - Describe: - -
Parent material ~;s~f r1~T ONE Flood Plain elevation if dpplica ft.
General comments TRtiC+1~S V~V'v /I,IV~~ ~jt
and recommendations: S~`>T~f11 ~lr~ ►p~ ~~f•.{ (1`" "fir"
MAI
w -d
rA-1 Boring # lJ Boring
VW Pit Ground surface elev. 19 - `ib, `I 0 ft Depth to limiting factor 100 in. Soil Appiicali-•t,
u Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1F
In. Mansell Ou. Sr. Cont. Color Gr. Sz. Sh. 'EfWl 'Eff12
-3 10 vp 7f t _ 'IS m b 3v~ (j, I, 2
Z -12 ~VR'~z - is z{s Y m~~ Gl~ 3, p,~ 1,2
3 .1ZJzl . 3 - O s rnl 0-V3 2f
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S 3)-)ap o 5/ - S O LA I - 0, z
o~n t✓ t_ ra t o _ z an15 -
r ga,14 y
❑ Borny d ~ ~ 7
r2 Boring ® Pit Ground surface elev. Q y 73_ tl Depth to I;miting factor _7 102 in. Soil A lialion Rate
Horizon Depth Dominant Color Redox Des 'Q Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
m ab 0
1 0-3 to ~1r>,211 '51l_i Z f
av-
z 3-10 1o-1IlZ212 bl 2 1 ab o.~ o,Q
3 to-2-1 I p4 121 - s OL 2m-f rZ
4 10y4J/6 -5 O C Zrn 0,-7 1rz
yo-1oz t a-4 q - s O " Oil - - 0.-7 z
(-~DWV'r, r,F' V1r L 1N F4UY2) zoAJ S 3-5)
Effluent #1 = BODE > 30 < 220 mg,L and TSS >30 < 150 m9I ' Eflluerc#2 = GODS < 30 rng.2 and TSS < 30 n-VL
CST Name (Please Print) °i ature CST Number
Nl A►N , N01S-t5T 1= L2~' z zt 18 3 z iv, Address Uale Evaluation Conducted Telephono Number
Wq`d75 ~10{1iJ~, R~U~f~lLS 10-5U-00 ~_"1 t~ )yZb-1~~5
LnT 2-1
n13 Property Owner (1~K CHA 1Zt-T--S cel ID ft Page z of ~
Baring # ❑ Boring CA Pit Ground surface elev. Depth to limiting factor 7 l fls in.
Soil Application Rate
Horizon Depth Dominant Color Redox Desc ' Texture Structure Consistence boundary Roofs GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2
0- lovP,z~ 3 ~a r LX 0 5 0'$
2 t-1-I2- 10\1V•-LI Z r I 1 Irrn, I 5 _ 0•y DA.
IZ-2'-i 10',2y 5~ 5 ' m 0,y 0.(A
4 Z5-3 t Oti `l 5 d~ CS Z 0 • `7 1. 2
S -10~ 10vR'~b - 5 LA I. Z
El Boring fl ❑ Boring
❑ Pit Ground surface elev. ft. Depin to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Elf41 'Eff#2
i I -
Boring
Boring # Ground surface elev. _ ft. Depth to limiting factor in.
❑ Pit
A o..licali:n Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff42
Effluent #1 = BODS > 30 < 220 m9`1. and TSS >30 < 150 rnyll- ' Effluent #2 = DOD, < 30 mgrL 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 609-264-8777.
SHD-9330 (RAVU)
PLOT PLAN
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Parcel 040-1278-10-000 04;091i2008 11:24 AM
PAGE 1 OF 1
Alt. Parcel 16.28.19.15.53 040 - TOIIVN OF TROY
Current X ST_ CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 C
Tax Address: Owner(s): 0 = Current Ow-ier, C - Current Ca-0.vner
0 - VAN NESS, ROBERT & KATHLEEN L
ROBERT & KATHLEEN L VAN NESS
1733 LAUREL AVE
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Pri» ary
Type Dist # Description " 395 CEDER CT
SC 2611 HUDSON
S° 1701) WITC
Legal Description: Acres: 2.169 Plat: 08-037-EAGLE BLUFF LOTS 1143 04G-01
SEC 17 T28N R19VV NE NE LOT 21 EAGLE BlocklCondo Bldg: LOT 21
BLJFF
Tract(s): (Sec-l-wn-Rng 40 1A 160 1 i4)
16-281\1-19VA.' NIA' NIA'
Notes: Parcel History:
Date Doc # Vol/Page Type
a V30i2C08 867975 'A'D
07,26i2006 83586 ^1D
10i23i2001 659807 1743.199 'AD
10i23i20Ci 1 659806 1743! 198 TD
2008 SUMMARY Bill Fair Market Value: Assessed with:
C
Valuations: Last Changed: 07/23/2004
Description Class Acres Land Improve Total State Reason
~iI=S DENTIAL 01 2.169 132,000 C 132,000 NO
Totals for 2008:
General Property ~.16 9 32,000 0 132,000
Woodland J.UUJ 0
Totals for 2007:
General Property 2.169 132.000 0 132,01--1-
Woodland U.(7GG 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total U.D' 0.03 0 00