HomeMy WebLinkAbout040-1273-00-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division INSPECTION REPORT Sanitary Permit No: 592279
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Parcel Tax No:
Permit Holder's Name: City Village Township 040-1273-00-000
CRAIG & PATRICIA JOHNSON TOWN OF TROY
CST BM Elev: Insp. BMEl~ev~ BM Descripfi Section/Town/Range/Map No:
17.28.19.1517
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV.
hmark STATION
'S Benchmark M
Septic ( ~ • t
f
B0 Li- - Dosing I
Aeration Bldg. Sewer 6,•~~U
Holding_ St/Ht Inlet la. 3
TANK SETBACK INFORMATION
TANK TO ~P/h WELL BLDG. 7en o Air Intake FROA1
Dt Int Dt Bottom Septic f Dosing 0 U 1 t Header/Man
. to , i
v 1 7(~ 't CQ
Aer tion Dist. Pipe I _ U j5
Bot. System
Final Grade • 1001. •v
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover .~J ~3
GPM
Model Number O~ [p3 ~U•ja
TDH Li~•~ Friction Los System Head T4H_•~~ Ft
Forcemain Le~ th u t Dia. Dist. to Well ~
FY
SOIL ABSORPTION SYSTEM
D
PIT DIIV~NSIDZS No. f Pits Inside Dia. Liq
BED/TRENCH Width ~ Len h~l No. Of Trenches •/~\_/1
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER LEACHING Manufacturer:
INFORMATION TyOf S
yste Ltt t r UNIT Mo I Number:
DISTRIBUTION SYSTEM
Distribution x Hole x Hol spacing
Header/Manifold to Air Intake
~I
I Pipe(s)
Length Di Length Dia Spacing
O_i
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Yes No
Depth Over C Depth Over xx Depth of xx Seeded/Sodded
Bed/Trench Center ~I Bed Trench Edges - Topsoil Yes E No
11,101 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 420 LOST ROCK ~LN~(~
1.) Alt BM Description = ~t-, Gvk L~~~ S dU 0
2.) Bldg sewer length = a-~i I
- amount of cover
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information. O Insepctor~s Signa re Cert. No
Date
SBD-6710 (R.3/97)
County
GP,
Safety and Buildings Division I<-012(
8 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be 5lled in by Co.)
k APR 11 zu.` ( Madison, WI 53707-7162 512-
CROl7C COUNTY Z- 77
State Transaction Number
Sanitary Permit App
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of tl vu t
is required prior to obtaining a sanitary permit. Note: Application for, 20 Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal informa_-.. pruvioe m be used for second
purposes in accordance with the Privacy Law, s. 15.04 1 m ,,Stats. 2Q Stv 12~' is
L Application Information.- Pie Print AllIn formation #
Property Owner's Name Parcel
#
C. 0~ l J- ~rl -~~1 Jam' C' ,,~J ~ V Z 7 'UQ 0 ®"G
Property Owner's Mailing dress Property Location , 7~ cr S i 7
VZ. L /1~ j- 5 Govt. Lot
City, fate Zip Code Phone Number f~~y}, Section
' T r~ N, R / irclE oreC~
L fy f.U ( U Z 7 Z c
H. Type of Building (check all that apply) Lot #
Subdivision Name
1 or 2 Family Dwelling -Number of Bedroom
Block e-ej
R ❑ Public/Commercial - Describe Use ❑ City of
o,rse
CSM Number ❑ Village of
❑ State Owned -Describe Use
Town of -I-
Z w ;7- -2Z
III. Type of Permit: (Check only on box on line A. Complete line B if applicable) AA,
A t
.New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
` List Previous Permit Number and Date Issued
B. ❑ Permit Renewal Q Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
77 4 a X4 f'-qv 1-1
IV. T e ofPOWTS S stem/Com onent/Device: Check all that apply)
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. Dispersal/Ti ersal/Ti eat ent Area Information:
Design Flow (gpd Design Soil Application Rate(gpds Dispersal Are Required (sf) Dispersal Areea''Proposed (sf) System Elevation
C,{J~ a c~'~} l ~r Z l 0 ,
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units c °
New Tanks Existing Tanks 2 0 ;3
(I ~j J o
a. U rn h cn i L C7 G k/A 6
Septic or Holding Tank
Dosing Chamber C•U~U~ ~7C~ C CJ ".t L~
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Si afore MP/tr Number Business Phone Number
> /
Plumber's Address (Street, City, State, Zip Code)
.C__7 i._c_-
VIIIun epartment Use Only
proved Perm-it Fee jD~at Issssue Issuin gent Sign e
❑ ~O .ven Reason nial $ 1~ I l ! 17
IX. Condit vt easons for Disapproval
Eiflt eN
SGflt'Itite' 2fif 3 to, CQ.N,- C.i;1?Q.
iti*i l* Celt Must all tgA%jVj§! r~~~n -
as ayement plan pro,tided by planter.
r'ECc1+1Pet:'ie9fNE41t Wt;teC M.,nt,:ire'l
W PW flpFilictlbits Code / C.rdinanem
Attach to complete plans for the system and submit to the County only on paper not less than 8 m x 11 inches in size
S13D-6398 (R 11/11)
~.d L b
1
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: fi[AJy ~ A J
Owner's Address:
C7 5757 O 'J' LAJ I SSG L
Legal Description: S i.v S
Township:
County: S-f C` pLe) t Se
Subdivision Name: y Wciyp
Lot Number: ~Z/
Parcel ID Number: -7 -7 6)0 -,t! e)
Page 1 Index and title
Page 2
Plot Plan
Page 3 System Sizing &Cross-Section P~~ ~~2
Page 4 Filter Specs
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
Designer/Plumber: License Number:' z Z6 K? 7
Date: 7 Phone Number
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
PL A-`~
r~
oZ
vi
2
,r
1-d ~t
or 2 Family Dwelling In ground Soil Absorption System (2-cell Conventional)
Daily Wastewater Flow (DWF) ~ - of bedrooms x 150 gal/day/bed room = LLI-G-gal/day
Design Loading Rate (DLR) or Soil Application Rate = D gpd/ftZ (per SPS Table 383.44 11,, 2,oor 3)
Required Distribution cell area = DWF bL gal/day _ DLR gpd/ftZ ftZ
# Chambers = Required Distribution cell area ft2 = ft2/ unit EISA = Chambers
Chamber Manufacturer and Model: (/i F L f&4 •l7 /t- t x (k i L r T Id L- Lt _e-;
Actual Distribution cell area = Required cell area ftZ t ~G1 z ftZ/ unit EISA End Cap Pair = eei6l Zft2
Cross-Section tn-ground Soil Absorption System (2-cell):
4" Schedule 40 PVC
vent pipe with vent cap
f12 inches minimum 12 inches minimum
44L I
T
inches Soil Cover
Trench 1 Sys-
tem Elevation inch Chamber Height
ft ft Trench 2 System
L4 Elevation
ft ft
Trench Separation Leaching Chamber Width
7 1 ft to limiting factor
Plan View In-ground Soil Absorption System (2-cell):
Trench 1
Modify
ft header/
design as
ft Leaching Chambers ,14
needed.
Trench 2
4 inch Header
Sch.
Q ft with end camps
Draw O for a Vent and for Observati on 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 Septic Tank Capacity i Zo C.) gal ❑ Nf
Permit Septic Tank Manufacturer k1 f it Sr-R ❑ NI
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms NA Effluent Filter Model ❑ NP
Number-of Public Facility Units J>~i NA Pump Tank Capacity go 0 al ❑ NA
Estimated flow (average) ~QD al/da Pump Tank Manufacturer Lo jC= S6:~ (Z O NA
Design flow (peak), (Estimated x 1,5) 600 gal/day Pump Manufacturer 5 0 uLO ❑ NA
Soli Application Rate al/da /fts Pump Model P ❑ NA
Standard Influent; Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter GI Peat Filter
Biochemical Oxygen Demand (BOD.) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection O Other:
k Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical. Oxygen Demand (BOD6) S30 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y in dia, ❑ NA Other: O NA
Other: ❑ NA Other: p NA
"Values typical for domestic, wastewater and septic tank effluent, Other:' I ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 3 iJ month(s) (Maximum 3 years) 0 NA
D ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
® year(s)
Clean effluent filter At least once every: 13 month(s) ❑ NA
® ear(s)
Inspect pump, pump controls & alarm At least once every; rr 3 ❑ month(s) „11 NA
ear(s)
Flush laterals and pressure test At least once every: 3 ❑ month(s) ❑,dNA
ear(s)
Other: At least once every: ❑ month(s) ❑ Other: ❑ ear(s)
0 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-611(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 th- 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
y- 4l .
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 detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System.start up shall not ocauh 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 fails and/or is permanently taken out of service the following steps shall lie 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 In as a last resort to replace the failed POWTS.
❑ . Mound and at-grade soil absorption systems may be rec6nstructed In place following removal of the b)omat at the
infiltrative surface. Reconstructions-of such systems must comply with the rules in effect at that time.
< WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON tROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name O C-2 G i'_ S O~,V Name
Phone -715-- Z 7 3 l/! Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name T04NS6n! 5f}N(fhd'✓ I E Name _ f-~C/1dIX Zd
Phone 715-Z73-5_51( Phone 1/490
This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY /
SEP'l W TANK N4AINTENANCE AGREEMENT
AND
OWNI-1161 HP CERTIFICATION I`OItM
{)u ncrl{ uyer I~. l ~ ' la/l `'~C: f-)
Mailing Address - [Al
Property Address `t c e; t c C L 4 E 1~_. lC~) L 5 r:.
(Verification required front Planning & Zoning Department for new construction.)
1---"
Oty"State jvl~ ,~,tyf L Parcel Identification Number
LEGAL DESCRIPTION
Property • Location
. Sec. C iy IZ W,'Crnvn of
Subdivision Plat: Lot
Certified
Survey Map # Volume , Page 4
Warranty Deed # } ~ °Lq -a (before ?007)Voiume Pa~(c
Spec houseElvespo Lot lines idernitiablepyes(]no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and tnaintcnance of your septic system Could result in its prentaunre trilure 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 pit 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 §SPS. 3$3.52(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 ( I ) the on-site
wastewater disposal system is in proper operatim' condition and or (2) after inspection and puntpin,.- (if necessary), the septic tank is
less than 1,3 full of'sludge.
I'we, the tulduit';xd hay. ~ r ':ad the ;tbo%e rcyaircmcnts and Mlle to 111aintain tic pricatc sewacc disposal system ith the
standards set firth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
Slate of, Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. rot
t aunty Planning & Zoning Department within 30 days of the three year expiration date.
I we certify that all statements on t `s farm are uric to the best of nty: ttur knowlcd-c. I ~se amarc the owner(,) of the
property described above, by virtue of a wa •anty decd recorded in Register of Deeds (Rice.
Number of bedrooms !
S NATURE OI' APPLICANT(S) DATE
","'Ativ inlitrmation 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 ol'Deeds office and it copy of the certified sur\ e~ map if
reference is made in the warrants- deed.
(REV. 041112)
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PUMP CHAMBER CRO55 SECT1CW AMD SPECIFICATIOMS 1
yE1JT CAP. WEATHIF, PROOF
,1uQr-TIOQ DOX
ti`C I. VEIJT PIPC , APPROVED LOCKIQJ;
, fOA)JHOLE COVER wig
jjQ' (ROM -COOK
wARJJIIJ4 LP.BEL
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APPROVED JOINT AP?RCYED
PEP•
W1 C.1.PIPE0 R W~Z/ Tank construction I III
shall comply with I ALARM
TLHR ()3.15 and 83.20 a ( II
I o~J
C I I
em x I
_ PUKP
OFF
L~ CI~ CoQCRETE
~Z (J 6LOCK
RISER EXIT PER/SITfED OIJLy IF TAUK MAiJUFACTURER HAS SUCH APPROVAL ~I
SEPTIC F 5PECIFICATf0QS
DOSE
T~>JK MA3JUFACTURCR: UUMb[g OF DOSES: PER CJ:
TA~JK OfZC c~
; ✓,0 0GA.LL0I6J S DOSE VOLUME tL
ALARM MAWUFACTURCR: SS.~-L f1~O 3'-1.~( 15 INCLUDIUG 6ArKFLOWj: r + GALLONS
*=r-L IJUMBCR: ~Ol Hw CAPACITIES, A=_JIIJCHC5 OF, GALLONS
5wITCH TyPL: - ' -'01f 1 B = z IQCHES'OR ~7OI LLDIJ5
PUMP MAIJUFACTUREK: L" LP C=~^INCHES OR 7~11ALL0U5
MODEL fJUMDER: _ C_ q D=- INCHES OR ^ ~ 1-Ac ,LL01J5
SWITCH TYPE: + WTE: PUMP AMO ALARM ARE TO ~C
MIIJIMUM'D15CHARGE RATE CpM INJ TALLED OIJ 5EPARATC CIRCUITS
VEKTIC/,L DIFFEF JCC DETWCCIJ PUMP OFF AU0,.0I5TRIBUTIOU PIPE., Jai hEET
t MIIJIMUM MCI-WORK 5UPPLy PRESSURE FEET
I Ak FEET OF FORCE M IM X
Ioo rLFRICTIOU FACTOR.. FEET
TOTAL QyQAMIC HEAP
_ / ~ FEET _
As per.manufacturer
gal/in.
APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01
HGOULDS PUMPS Submersible
Effluent Pump
PE
4tVan PIMP
a•=-
SPECIFICATIONS MOTOR FEATURES
Pump - General; General: ■ Corrosion resistant
• Discharge: 1'/r" NPT • Single phase construction.
• Temperature: 104°F (400C) • 60 Hertz ■ Cast iron body,
maximum, continuous when a 115 and 230 volts ■ Thermoplastic impeller and
fully submerged. a Built-in thermal overbad pro- cover,
• Solids handling: r/r" tection with automatic reset. ■ Upper sleeve and lower
maximum sphere, • Class B insulation. 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 • 115 and 230 volts cord, 20' standard length,
• Maximum head: 29' TDH • PSC design 1heavy 15 or 230 v16/3 M oltgrounding
h
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 ceramic BUNA and stainless
PE 51 ! I MODELS: K31, Peal, Per steel.
r ( i I i I i I I I .I r HP:.33, .4o. zo
35 I I ■ Stainless steel fasteners,
T 1 i
I. M 1 1
30 ?E41` I' I • ' •i i t I I I AGENCY LISTINGS
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20 ' I I 1 .1 _ i _ I 1 I ' Tested to UL 778 and
i I i i I (I j CSA 222108 Standards
0 15 I -t- ~I • i I 0Y Canadian Stan&v& &SgdaGon
i I' i i I I I I -I _I File #LR38549
10 i f ; ,.L ! !
7 I A I i • i I i GoLdds Pumps is ISO 9001 Regiqercd
5
O i t I I i i I i t I. I I I I' r I
0 10 20 30 40 50 60 70 GPM 8-0
0 5 10 15 m3/h Goulds Pumps
® 2004 rTT Water Technolo CAPACrmY
Effective June,IZW4 ~Ln~. `~aT
BYE31/41 ITT Industries
r eN3~~- t ~ z~
W
f 04 Laick4 Plus Standard Chamber Side and End Views
l
48"
(EFFECTIVE LENGTH)
34
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d
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Quick4 Plus All-in-One Periscope
QUICK4 PLUS 8
ALL~N-ONE PERISCOPE
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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 5.3", 8.0", 12.7"
Effective Length .............r. 48" (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm)
a
INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY t
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 onsite septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder")
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 applicable law, the warranty period will begin upon the date that installation of the [I
septic 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
any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty
(c) This Limited Warranty shall be void if an I N F I LT R AT O R
does not extend to incidental, consequential, special.or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, c
including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. b
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
the Units. failure of the Units or the septic system due to improper siting or improper 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 fails to comply with all of the Old Saybrook, CT 06475
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
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.
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U S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844
Canadian Patents 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc.
is a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Ina 9 2009 Infiltrator Systems Inc. Printed in U.S.A. PLJS0510101SI-2
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1359
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service
Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County 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. nuin
Please print all information. Reviewed Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). GvvY( D~
Property Owner Property Location
Humbird Land Corporation Govt. Lot 1/4 SW 1/4 S 17 T 28 N R t9 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
C { 2 Minnesota Street, East 1404 41 I n Troy Wood Subdivision
Y State Zip Code Phone Number City Village ✓ Town Nearest Road
Saint Paul MN 55101 651-222-5555 Troy E Cove Rd / Lost Rock Lane
✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flaw rate 450 GPD
Replacement Public or commercial - Describe:
Parent material -outwash plains- Flood plain elevation, if applicable n/a
General comments
and recommendations: Part of 1.88 acres. BM #1= 100.0' BM #2= 104.0'. Recommend system elevation 100.1' between 102.6'
and 103.4' contours.
❑ Boring # Boring -
✓ Pit Ground Surface elev. - 100.93 ft. Depth to limiting factor >72 in Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft? -
*Eff#1 *Eff#2
1 0-11 7.5yr2/0 none sil 2msbk mvfr as 1f,1m 0.5 0.8
2 11-16 7.5yr3/2 - none X ~ sd 2msbk mvfr cw ~ 1f 0.5 0.8
I -
y-- - - - -
3 16-22 10yr4/4 none - - i sd 2msbk mvfr - cw 1f 0.5 0.8
4 22-33 10yr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.9
5 33-48 10yr5/6 none gr. Is
1 msbk mvfr cw - 0.7 1.2
t
4
6 48-72 10yr5/4 none s 0 sg ml - - 0.7 1.2
❑ Boring # Boring
✓ Pit Ground Surface elev. 103.4 ft. Depth to limiting factor >80--- in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G-P_D/ft? -
*Eff#1 *Eff#2
1 0-11 7.5yr2/0 none
y i
sil 2msbk mvfr
as 1f1m 0.5 0.8
~
- - -t sd 2msbk mvfr -
2 11-18 7.5 r3/2 none
cw 1 f 0.5 0.8
- - - - - y -
3 18-26 10Yr4/4 none sil 2msbk mvfr cvv 0.5 0.8
4 26-32 10yr4/6 none gr. sl 2msbk mvfr cvv - 0.5 0.9
5 32-46 10yr5/6 none gr. Is 1msbk mvfr i} cw - 0.7 1.2
6 46-80 10yr5/4 none s 0 sg ml - - 0.7 1.2
! _ _ - - ~ - - - - -III - - - _ - _ -
* Effluent #1 = BOD 5> 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
II, Tom Gustum 227618
Address Gustum Septic Service Date Evaluation Conducted Telephone Number
N13450 937th St., New Auburn, WI 54757 11/21/00 715-658-1344