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HomeMy WebLinkAbout020-1439-42-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 589709 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: Adam Gamble TOWN OF HUDSON 020-1439-42-000 CST BM Elev: Insp. BM Elev: BM Description: L I~tl7 ISection[Town/Range/Map No: 514 Ira. ~ih I' I $y S,7 25.29.19.2768 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S ` Benchmark w't SE y' 1Z~o 9 pp.Q ilav.oo Dosing C d N2 h v 3~ rid v Alt. BM Aeration Bldg. Sewer F/; 31) (wf Holding SUHt Inlet I SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 71 Dt Bottom ~ j?• S ~ Dosing Header/Man. p e 0 is l loo. o Aeration Dist. Pipe Holding Bot. System -f' ft: PUMP/SIPHON INFORMATION Final Grade CibL S g lO Manufacturer Demand St Cover j'j QGt L (~S GPM ~ l Model Number 2y/ f ye TDH Lift-7 /_c Friction Loss System Head TDH Ft l IN Z G ! / Forcemain Length t Dia. Dist. to Well ~e SOIL ABSORPTION SYSTEM BEDITRENCH Width J Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR )L 2~ -/7,e Type Of System: i / UNIT Model Number: e) IV I ic-4, /1' Il Al/ ? S: u c 5ZN DISTRIBUTION SYSTEM Header/Manifold Distribution Ix Hole Size Tx Hole Spacing Vent to Air Intake Pipe(s) Length Dia % Length Dia Spacing _ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Over Depth of xx Seeded/Sodded hed Depth Over TBed/ Bed/Trench Center rench Edges i- 7 ` Topsoil I 11 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Q'~0 -~~j C • Inspection #2: Location: 901 HIGHLANDER TRL -4v~~ /j `~✓'I,vt$( ,,~/o~~."~' 1.) Alt Description = ~~un-~flol. Z~ r Yom'" e rrvs/~_L`(>o ~ r `r /rC /~f ` -r Lv~si +e 2.) Bldg g sewer length= - amount of cover = tD~1 ~ » ss I,,; Plan revision Required? ❑ Yes Y, No L3L( Use other side for additional information. G to z,-,: ~Z 1 ~L~l - _ _LJ BD-6710 (R.3/97) Date Insepctor's Signature Cert. No. S c r i County VE1 v ED Safety and Buildings Division 201 W. Washington Ave., Box 7162 Sanitary Permit Number (to be filled in by Co.) r K CEA ~pSt JUN ry2t~}Madison, llVl 537 16 O~'~S10NA~~ST.CRVIX COUNTY `COMMU tate Transaction Number MJ 6rmit Application in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a ganitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary y purposes in accordance with the Privacy Law, s. 15.04 1 in ,.Stats. -l D1 f~,~ -tJl~~~?L ~2AiL 1. Application Information - Please Print All Info n Property Owner's Name I Parcel # 0 6,14( Property Owner's Mailing Address Property Locations RC, o 19~7L G~~(,f~/~/r~- ~i G,,ovrrt. Lot 2 p City, State Zip Code Phone Number Iye~ 1/4, - r/., Section -5 . 6V ( one) T N; R circleE or& n. Type of Building (check all that apply) Lot # Subdivision Name ,11 or 2 Family Dwelling - Number of Bedrooms 6 / - ❑ Public/Commercial - Describe Use 60- l ❑ City of CSM Number ❑ Village of ❑ State Owned - Describe Use ~r}-Town of OlC C,e LLgo t.64 I Zl *-ZZ 5 III. Type of Permit: (Check only one x on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit. Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration - Owner ~+akvj, IV. Type of POWTS S stem/Com onent/Device: Check all that a I V1 r%4CW0L# &'P- LO'S Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersa!JTreatni4at Area Information: stem Elevation Design Flow (gpd) esign Soil Application Rate( f) Dispersal Area Required (so Dispersal Area Predio 6) 9q Al o • ~ brit VI. Tank Info Capacity in Total # of Manufacturer Ql0 Gallons Gallons Units c ° D 2 d d U New Tanks Existing Tanks o a U in y u; 0 a Septic or Holding Tank Dosing Chamber "MJ(~ t t ! (fl VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) / Plumber's Signature MP/i!tr Xr5 Number Business Phone Number 71-5-27-3 W1v Plumber's ddress (Street, City, State, Zip Code) VIII. Couny[Department Use Only Approvedp Permit Fee Date Issued Issuing ht Signatur iven Reason o I's Denial f v ✓ ' DL Condig)(eisTR&I 81fi teasons for Disapproval 1. Septir ta~~rk, e;flucnt filte* and V In CQi~ ~ t~ ~CS ~ ~ duper .,i cell must all be seivicas ! niaint~ tL~ed /1 •e HS per mpnagement plan provided by plumber. 7 *115 4- b 2 JR~i~~tluirernenls must.~ie ~atMeirs`erJ (n~ IS par 8PPIC" coda / ordinancas. ju•t u ek caJ 1p060 C._Z. 44~ a M A Attach to complete plans for the system and submit to the County ont n paper not less than 8 to z 11 inches in size SBD-6398 (R 11/11) I{ ~ ' elk ti ti &I 6- J c z ,I,A L~ J 9 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: C Legal Description:? d(,~ Township: County: Subdivision Name: (Iti9 yo Lot Number: Z Parcel ID Number: Page 1 Index and title pa Air Page 2 Plot Plan Page 3 System Sizing & Cross-Section R'J Page 4 Filter Specs Z C h+ A4-,")jMC Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat / Attachments: Soil Test & House Plans 6 Designer/Plumber: f p f / -)65L fO f/ _ License Number: Z 7 Date: Phone Number X73 j/ KYV' Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01), Page 1 I - Ov 0~ P o cY P✓c fYft (j N 6 or 2- Family Dwelling In-ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow (DWF) _ # of bedrooms x 150 gal/day/bedroom = gal/day Design Loading Rate (DLR) or Soil Application Rate = gpd/ft2 (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area= DWF gal/day + DLR _ =-7 gpd/ftz ftz. # Chambers = Required Distribution cell area 2 ft2 _ Z-y ft2/ unit EISA = Chambers Chamber Manufacturer and Model: ua C Actual Distribution cell area = Required cell area C; ft2 + ft2/ unit EISA End Cap Pair ft2 V X76 , Lk Cross-Section In-ground Soil Absorption System (2-cell): 4" Schedule 40 PVC vent pipe with vent cap 112 inches minimum 12 inches minimum / ivy inches Soil Cover Trench 1 Sys- - tem FlPvation inch Chamber Height - ft 2 _g o3ftTrench 2 System Elevation J ft ft Trench Separation Leaching Chamber Width ft to limiting factor Plan View In-ground Soil Absorption System (2-cell): Trench 1 ft Modify header/ design as ft Leaching Chambers 0 needed. Trench 2 4 inch Header ~ Sch.-~>v ~r ft with end camps Draw O for a Vent and 40 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. i - r m o c 4n3F ~~OO x-4 Hs CD T. 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"Values typical for domestic wastewater and septic tank effluent. Other: ! ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 p ear( )(s) (Maximum 3 years) 1i NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ® year(sj(s) (Maximum 3 years) ❑ NA ❑ Clean effluent filter At least once every; ® month(s) ear(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 3 east )(s) El NA Flush lateralg and pressure test At least once every: ❑ month(s) ❑ NA 123 ear(s) Other: ❑ month(s) ❑ NA At least once every: ❑ ear(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal ell(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 (Y3) 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 effluent filters, mechanical or pressurized components,. pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) r- J;) 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 icak that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected 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 cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent: To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of,any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; 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 falls 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. I.f 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 O L (2 L S 4A/ Name - 4!!~ Phone Phone '715-- 773 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name To 11NSon/ 5^4evi4-A+e0'✓ Name _ S-~Cd1dIX Z40) i Phone 7~5 Z 7 j "S Phone _ 71.5'~39kV4,80 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)1L(1) and 83.114(11, (2) 11 (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND x OWNERSHIP CERTIFICATION FORM Owner/Buyer q A-yyl Mailing Address Z 75 4 /tj.A 5--~- (_6 /a Y u N14 (2- 12 ~ IIJ 4-( QP~ Property Addres A,0 L (Verification req ' ed from Planning & Zoning Department for new %nstruction.) City/State gUt~~OAJ, Lc~ ( Parcel Identification Number LEGAL DESCRIPTION Property Location %a JU '/a ,Sec. , 25-T Z~N R1-7 W, Town of 4~y&fbl (2 /0 5 , Lot # T~ Subdivision JA )Pi 9 P Certified Survey Map # , Volume , Page # Warranty Deed # ZL 7_LZZ Volume , Page # Spec house yes (9 Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed* recorded in Register of Deeds Office. Number o bedrooms y SIGNATURE OF APPLICANT(S DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. REV. 08/05) ( APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 HGOULDS PUMPS Submersible Effluent Pump MODEL PE 41YINT Pump ai SPECIFICATIONS MOTOR FEATURES Pump - General; General: ■ Corrosion resistant • Discharge: 114" NPT • Single phase construction. • Temperature: 104OF (400C) • 60 Hera ■ Cast iron body, maximum, continuous when a 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover, • Solids handling: Yr" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class 8 insuladon. heavy duty ball bearing APPLICATIONS a Automatic models include a • Oil-filled design. construction. float switch. • High strength carbon steel ■ Motor Is permanently Specially designed for the a Manual models available. shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor: service life. • Mound Systems performance chart or curve, • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • Low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the ( • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. • Heavy Duty Sump/ PE41 Pump: • .40 HP 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM a 115 and 230 volts cord, 20' standard length, • Maximum head: 29' TDH • PSC design i heavy duty or 2 0 vo/grSJTW outhigh PE51 Pump: PE51 Motor: plug. Maximum capacity: 70 GPM .50 HP, 3400 RPM ■ Complete unit is heavy duty, Maximum head: 37 TDH 115 and 230 volts portable and compact. METERS FEET • PSC design ■ Mechanical seal is carbon, 40 r. ceramic, BUNA and stainless PE51 + ! - I I MoOis[s: PE31, Pf41, vest Steel. 35 I r I ( I HR .33, .40, .50 ■ Stainless steel fasteners, 30 •?E4-1 ` 2 GPM .1 j i ' i I I I • AGENCY LISTINGS F I , I , T ZS Y I j I I~ f l I' l i r i l I. ~ks j I I: i.. _ I I I C Q 20 t l i I, f i I- i c I"I F ; ! I : 1- -I I f 1 i Tested to UL 778 and I I I i ' CSA 222108 Standards By o I ! - radian standards &s9da6on j I 1 I. I i I I File #1R36549 10 T" 1 I ~ ! ~ 1 ~ ~ i i i ! I ' Goulds Pumps is ISO 9001 Registered 5 ! , 1 0 0 i l^j I ~0 10 20 i11 I •r I ..i..l I C I 30 40 50 60 70 GPM 80 0 $ 10 15 m3/h Goulds Pumps ® 2004 HT Water Technology, CAPACITY Effective June, ]004 "W/41 ITT Industries Combination Se?Gic-'.Tank and MS, PUMP CHAMBER CRO55 SECTIOM MI`JD SPECIFICATIO NET CAP WCATHER PiZ00F JUIJCTIOIJ 00X C. I. VCAIT PIPC APPROVED LOCKILIG J~A, JKLE COVER tvCR{ 2IO' FROM DOOR, 2 wARNI>J4 <_p,6EL. ,111JDOW OR FRESH co>J~u,r ~+~sP~11orJ PIPE ASR IIJTAKE Z 1, IsK MIhJ. LOOT I I i., PROVIDE IMLET AIRTIGHT SEAL I III eq~~~ I I I APPROYED J01111 APPROVED OF- ZPt r-tFu.~ I I I W/C.I. P1PE09 P° W/C.T- pip[ OR Tank construction I I I ALARM shall comply with ~I II ILHR 133.15 and 33.20 a i • I I o~J c I 1 I PUMP OFF 0 CoQCRCTC g BLOCK 3" APPfc~ RISER EXIT PEKMITFED OULti IF TAIJK MAIJUFACTURI~-R HAS SUCH APPROVAL g pplNG SEPTIC f DOSE W 1 5 coQjCCc~ iJUMBER OF D05CS: PER DAB TA1JK$ MA>aUF,iCTURCR.: TA1JK 51ZE: ZO(~ GALL0 S DOSE VOLUME ALARM t'lA>JUFACT UR.ER: IWCL-UD1KIG 6ACKFLOW:_L1_t! GALLONS MODEL 1JUM6ER: L OL Nw CAPACITIES: A= 2~ IIJCHES OR GALLOLI5 SWITCH T7PZ: 4 8= Z IIJCHES,OR ~ ~~c7G~LLOUS PUMP MAIJUFACTURCR: ~Te1it'tr0 C=_.ZWCHE5 OR L(_~L-~ - LLOU5 MODEL IJUM5ER.', 0= iAiCHE5 OK i 2- 4 bXLLOIJS SWITCH TYPE: DOTE: PUMP AMD ALARM ARE TO 1~L M1IJIMUM D15CHARGE RATE GPM 1N5TALLEO 0!J SEPARATC CIRCUITS YEKTICAL DIFFEKEMCE DETWCEIJ PUMP OFF AU0..0I5TR16UT101J PIPE.. A-) FEET -t- MIUIMUX IJETWORK SUPPLY PRESSURE FEET + ~ FEET OF FORCE ru11J X Lg~FYOFxFRICTlOU FACTOR-. FEET TOTAL OtIWAMIC. HEAQ FEET As per-manufacturer ~ T gal/in. a Y ® w,; 6 A ~u Standard Chamber Side and vwz 48" (EFFECTIVE LENGTH) - 34", -1 i# 11.2" 13" 8" INV+ ERT ~ 8" INERT 5.3" INVERT ti 33" - a a 1 QUICK4 PLUS ALL-IN-ONE PERISCOPE (360-SWIVEL ) a 12.7" INVERT QUICK4 PLUS ENDC -ONE 12 ENDC AP ffff~ fff~~ ~~_lll i ~ Quick4 Plus Standard Chamber Specifications I Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cm) Invert Height 0.6", 5.3", 8.0", 12.7" (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm) Effective Length 48" (122 cm) INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator ( 'Units"), when installed and operated in a leachfield of an onslte septic system in accordance with Infiltrator's instructions. is warranted to the original purchaser ("Holder") from the date that the septic c permit is issued for the septic system containing the Units; against defectie j and workmanship year for one r~ v materials provided, however. that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septc system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator 's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE, THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limmted Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limped Warranty I N F IL.T R AT O R does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and materials, overhead costs, or other losses or 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, abuse or neglect of the Units, the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the minimum ground covers set forth in the installation instructions, the placement of improper materials into the system containing 6 Business Park Road • P. 0. Box 768 he Units, failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, d or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475 d terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860.577.7000 • FAX 860.577.7001 - third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply the Units must be installed in accordance with all site conditions required by state and local codes, all other applicable laws; and Infiltrator's j installation instructions. 800.221.4436 (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the www.infiltratorsystems.com original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units, rnvmomkmuuramw8`am.m~aek.,.nrm~.<,+.a...,mx a_.. aw ,omw.,..m.,,.fl. x .~rowaw__ U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017, 5,401,116, 5,401,459; 5,511,903; 5,716.163, 5,588,778, 5,839,844 Canadian Patents. 1,329,959: 2.004 564 Other patents pending. - inhltrator, Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. .s a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc. © 2009 Infiltrator Systems Inc. Printed in U.S.A. PLUS0510101SI-2 sum lot 4 ' # COI 0 IW N ~ * 14 o :~a•e~~-- •,r- I iiiiij~ If 0001, f 04 I oe ♦ * g 1 C4 •eg Wisconsin Department of of and Professional Services o I ' 0116 ' Divisio Er " -7 SOIL EVALUATION REPORT Page 1 of 3 JUN 0 9 2016 in accordance with SPS 383, Wis. Adm. Code County ST. CROIX 4n rIoU1~bF$aper not less than 8 1/2 x 11 inches in size. Plan must Mili~id horizontal reference point (BM), direction and Parcel I.D. ~0 - 1439 - 42 - (100 e, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi d by Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). (e / / Property Owner Property Location ~~V// ELI M. & ELAINE DAVIDSON NATALE Govt. Lot NE 1/4 NE 1/4 25 T 29 N R 19 E (or) Property Owner's Mailing Address Lot # Block # Subd. Name r CSM# P.O. Boa 610 42 Indigo Ponds City State Zip Code Phone Number ity Village own Nearest Road Monroe, WI 53566 ( ) Highlander Trail New Construction UseE] Residential ! Number of bedrooms 3 Code derived design flow rate 450 GPD FlReplacement El Public or commercial - Describe: Parent material sandy ounvash Flood Plain elevation if applicable NA ft. General comments and recommendations: Conventional In-ground trenches 0.7 loading rate Property Address: 901 Highlander Trail Boring # ❑ Boring n Pit Ground surface elev. 103.50 ft. Depth to limiting factor 95 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 0-10 7.5YR2.51/1 I 2fa&sbk im-fr cs 3Nf--co 0.6 0.8 2 10-14 7.5YR3'3 I If--msbk nivfr cs 2xf--co 0.4 0.6 3 14-44 7.5YR311 1 4 sl llr mfr cs 2xf--f 0.2 0.7 4 44-80 7.5YR3/4 s Osg ml cs 0.7 1.6 5 80-95 7.5YR4,/3 s Osg rl 0.7 1.6 sore gr bem eeu horizons 1 &2 I Horizon 4 has some pockets of co, L1, 2 Borin # Boring 100 F 9 F-1 105.10 Pit Ground surface elev. ft. Depth 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 0-9 7.5YR2.5/1 1 2fa&sbk im-ft cs 3N-f--co 0.6 0.8 2 9-24 7.5YR313 sl I f-rsbk tnvfr cs 2X-f-co 0.4 0.7 3 24-50 7.5YR3;'4 sl Or rfi cs 0.2 0.7 h f-tn 4 50-100 7JYR4'3 s Osg 1111 0.7 1.6 1 4q S .Z * Effluent #1 = BOD > 30 < 220 mg/L and SS >3 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number MARY JO HUPPERT Hollister's Soil Testing&Design 224832 Address Date Evaluation Conducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 06 - 02 - 2016 715-426-1775 SBD-8330 (R0713) ATALE, Eli & Elaine 020 - 1439 - 42 - O00 2 Property Owner Parcel ID # Page of ❑ Boring # 11 ring 101.50 110 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 0-9 7.5YR2.5A 1 2fsbk mvfr cs 3N-f--co 0.6 0.8 2 9-71 7.5YR3/3 1 I f--msbk mN-fir cs 2xf--co 0.4 0.7 3 21-44 7.5YR3/4 sl Om mf`i as 1N-f-m 0.2 0.6 4 44-79 7.5YR3i4 s Osg ml cs 0.7 1.6 5 79-110 T5YR41/3 Cos Os- 111] 0.7 1.6 Horizon 4 has some gr 20-25% Boring # U Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. F] Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-8330 t R01 1 ? ) Plot Plan Page 0- of, Property owner~~~ iv ► bso-------~ NATAL97 1» = 4o ft Legal Description Lei- y~~y --m.Dtc PoNt)-s, (except where noted) fu L VF fitfG X)[;/4, SEe. 25, - 2gV, -Rig kt - ajA) OF = Backhoe pit ~~1/ flLs},~J 7-l L North LQ l 4. l ~ .b~ Site Location: a, f 0.~ t~ tv ~ ~ a a "t r t pry, .k~M k 'a 1E k rd w " r . yu- TM'w r~ a~ ~ 1 cam:' ~ 4a e ' i 6 'a 4 4 V 1284 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. QZG - '+oU Please print all information. Reviewe y Date Personal information you provide rpay be used for secondary purposes (Privacy aw, s. 15.04 (1) (m)). b Property Location Property Owner AY I t3' '200-1 ROSAMJI, L.L..C Govt. Lot na NE 1/4 NE 19 S 25 T 29 N R 19 W Property Owner's Mailing Addres 5T 0i JP,T';~ Lot # Block # Subd. Name or CSM# 2141 City Rd. C Tic 42 na Indigo Ponds City State Zip Code Phone Number City Village ✓ Town Nearest Road New Richmond WI 54017 715-248-7071 Hudson Highlander Trail ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 -GPD Replacement Public or commercial - Describe:na Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: system elevation 104.45 ft, trenches spaced and depth to code 5.75 below grade ❑ Boring # Boring ✓ Pit Ground Surface elev. 110.20 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-6 10yr3/4 none sil 2msbk mfr cs 2f .5 .8 2 6-26 7.5yr4/4 none scl 2msbk mfr cs if .4 .6 3 26-120 7.5yr4/6 none cos osg ml na na .7 1.6 COS <35% coarse fragments = 36" & >35% - <60% = 60" below system ❑ Boring # Boring ✓ Pit Ground Surface elev. 100.70 ft. Depth to limiting factor _ 130 _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-10 10yr2/1 none sil 2msbk mfr cs 1 c .5 .8 2 10-58 7.5yr4/4 none scl 2msbk mfr gw 1 c .4 .6 3 58-130 7.5yr4/6 none cos osg mvfr na na .7 1.6 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) `Signature: CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 5/1/2003 715-246-5085 Property Owner ROSAMJI, L.L.C Parcel ID # pending Page _ 2 of 3 [-3 ] Boring # Boring ✓ Pit Ground Surface elev. 98.40 ft. Depth to limiting factor 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-19 10yr2/1 none sil 2msbk mfr gw 1C .5 .8 2 19-58 7.5yr4/4 none SCI 2msbk mfr gw if .4 .6 3 58-130 7.5yr4/4 none cos osg mvfr na na .7 1.6 ❑ Boring # Boring - - Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft' _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWTSM ROSAMJI, L.L.C. New Richmond,Wl 54017 Lic. #248956 NE1/4,NE1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 42 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this 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 Ele. I OO.OOFt Top of 1/2" pvc pipe • = Alt Benchmark Ele. 99.5OFt Top of 1/2" pvc pipe C 1 = Borings Boring Elevations B 1 = 110.20Ft B2 = 100.70Ft B3 = 98.4OFt B4 = OO.OOFt r 1C~' /og, 22,1-rl ~'ti a ov 70~ ~.3 r&~a. or3 25 R 87129 S, F. 1✓~ 29, (2.000 AC.) to sB► `a , /(1.539 AC. N. B. P A )i fO \ t ~ , . f to ~ ~ri ~ ~ ~ , ~ ''/~J\!{ ~ ~ 49 188.13 • ` " 503,02' ,L -~40 1ho 26 102593 S.F.f ` ` ? f / (2.355 - ` ! r~. r \ o _ r _ O , i v` (1.023 AC. N B P. A k, x A <1 / 87776 S.F. 1 (2.266 AC.) (1.635 At. '34 7 3.06' a~. ll 5.10 .P.A.} cq p `N r IA. ` ~ \ ~y X ~w~ .-mil O!`f~~~~~} %,:%Y,f~• •.i \1.66' 27' .\:X,x \ 4_-~ 1 ! 109074 F. r; \(2.504 Vr 87180 S.F.`19 0.062 AC. N.B.P,A.) "(2.001 AC.) \ AC. N.B.P. A.) 389.21 97p , A W- y -28 . ` \V. 87.537 SF }50' (2.010 AC.) (1.087 AC. N.B.P.A.) \ } i C11. 109800 S.F. ..t~~ 41941 C7 'x: . `(2.521 AC.) 59.57 .143.73, O LIJ (1.473 AC. N.B.P.A. \42 Q tr) A J1 ~ / O \ .~ti:. a-~ ice _ . - - ~ ` ~o etc •Z s~ o`Li _ a '.'1