HomeMy WebLinkAbout026-1153-33-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CCOIX
Safety and Building Division
INSPECTION REPORT sanitary Permit No 592292
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)]
Permit Holder's Name: City Village Township Parcel Tax No:
TODD MAREK TOWN OF RICHMOND 026-1153-33-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
~74,~j 19.30.18.1171
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
i~
Septic Benchmark
99, i
Alt. BM
Dosing
Aeration n Bldg. Sewer P~
HiIdin St/Ht Inlet
StJHt_0utlet
TANK SETBACK INFORMATION ~
TANK TO P/Lr WELL BLDG. ent o Air Intake ROAD [?t Inlet
Septic Dt Bottom
5 Ail S d,
Dosing - Header/Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer ` Demand St Cov
~'n ycyr GPM N I Z / f
Model Number
TDH Life Friction Loses System Head TC)H) Ft
Forcemain Len th Dia. ;I Dist. to Well
i
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia: Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer,-.?--
INFORMATION CHAMBER OR
Type Of System: ! l.. ` f fYl~
UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution ix Hole.ize x Hole Spacing Vento Air Intake _
t Pipe(s) F 1
r
Length,- Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only L1t1~
d
Depth Over pp ) Depth Over ~ xx Depth off-- xx Seeded/Sodded xx u c e
Bed Trench Center hw Bed Trench Edges , Topsoil Yes Nc
n Yes No -
L_
i
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1478 92ND ST
1.) Alt BM Description
2.) Bldg sewer length = Jd
-amount of cover= y
Plan revision Required? ❑ Yes ❑ No 7 c~ V ~p
-
Use other side for additional information. T LA
Date Insepctor's Signatur Cert. No.
SBD-6710 (R.3/97)
County C,
m3°Safety and Buildings Division J a C
RE 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be tilled in by Co.)
Madison, WI 53707-7162
o p APR 2 2'11 ~cf ZZ~I Z
°s,ox"` N State Transaction Number
^pNtMUB►fi~ it Apphuw__
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropi, _ - project Address (if different than mailing address)
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are su~._
the Deparimeht of Safety and Professional Servies. Personal information you provide may be used for secondary
I z -
purposes in accordance with the Privac Law, s. 15.04 1 m ,.Stats ~
I. Application Information - Please Print All Informa oy parcel #
Property Owner's Name /
46) r.> f> ev
Property Owner's Mailing Address Property Location I G ?J~~ 1 1
rfo ® G , Z Govt. Lot I
Ci State Zip Code Phone Number Section
lCIls L} LK ~~Q 7 T 3o N; R~lEore6
II. Type of Building (check all that apply) of #
Subdivision Name
~1 or 2 Family Dwelling - Number of Bedrooms ~r A J Block # 9 L V
ak
❑ Public/Commercial -Describe Use ❑ City of
OC 4
CSM Number ❑ Village of
❑ State Owned -Describe Use A.-Town of l~ N0 ~'1 p
Z LL(Checkk tj Z°~' III. Type of Permit: only o e box on line A. Complete line B if applicable) Q
A. New System ❑ Replacement System ❑ Treatmeut/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previ us Permit Number and Date Issued
B. ❑ Permit Renewal _ ❑-Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that a 1
f 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) ❑ Pr treatment Device (explain) `
V. Dis ersal/Treat nt Area Information:
Design Flow (gpd) Design Soil Application Rate(gp f) Dispersal Area Require (sf) Dispersal Area Prop d (sf) System Elevation 39
/jY/f/ (IJ~ l o
VI. Tank Info Capacity in Total # of Manufacturer
C V
Gallons Gallons Units ~l'J{
New Tanks Existing Tanks f 2
'I, U
Septic or Holding, Tank ry - ZLy v r-- X'
Dosing Chamber C.- Q~ ~ e - ~L
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' lgnature d MP/2~Number Business Phone Number
~ 7/s - z 73 -
zoo,2~ - ? 7 ~7_ Z_, tlet
- A)e - ei
Plumber's Address (Street, City, State, Zip Code)
0& 6 c C> eZ4 H r
VI oun /De artment Use Only
Permit Fee Date sued Issuin gent Sign re
Approved $
0 tven Reason for Den (7 w /7
IX. CondiM"1ElA11YMWeasons for Disapproval
3> ~ ere
1. -SOA!', tank, effhxn: itlte- a5n 1 sc V
uisperr:ai cell must all best?;,. ic>s ! ro intr`reeq
&S per mar,3gement plan prc Jiae 1 by plumber.
2. `Aaiotgrk rKwMinerns Must,tn IrE&nt ir"E !
00 P*r Vrkrbll s cod? / ,:rdina11r 3.
Attach to complete plans for the system and submit to the County only on paper not less than 8 112 z 11 inches in size
SBD-6398 (R. 11/11)
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: "Q 212 /21 ~'Z C r
Owner's Address: Z-
- LA2 A(C.C~-/LL~~ t 7
Legal Description: A~ Al
L~~ S r Gf N' / tJ G~
Township: /2( e
County: S,4 C (Lo ne
Subdivision Name: 9 L6/J U I C W
Lot Number:_
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan C 10 CL,A& p
Page 3 System Sizing & Cross-Section t Z ~?v~cclz
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: (~OJL~n / j EL$ ,04/ icense Number: / P Z Z e f 9
Date: - Z -1 Phone Number 7/5 l 7, jf~fl
Signature j'
Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
Ct-O+
Nr
00
v hx
e-~
5 ~sj,6 ~
l U V4nj
or 2- Famil In-ground Soil Absorption System (2-cell Conventional
~ y Dwelling l
,
-
Daily Wastewater Flow (DWF) _ # of bedrooms x 150 gal/day/bedroom - _1~2_gal/day
Design Loading Rate (DLR) or Soil d/ftZ (Per SPS Table 383.44-1, 2, or 3)
- c Application Rate Bp
Required Distribution cell area = DWF (00t gal/day = DLR e gpd/ftZ = ftZ
# Chambers Required Distribution cell area iJ ftZ = ft2/ unit EISA = --D- Chambers
Chamber Manufacturer and Model: 62
Actual Distribution cell area = Required cell area ftZ t ftZ/ unit EISA End Cap Pair= < Z ftz
Cross-Section in-ground Soil Absorption System (2-cell):
4" Schedule 40 PVC
~f - vent pipe with vent cap
12 inches minimum 12 inches minimum
T_
inches Soil Cover
Trench 1 Sys-
tem Elevation ~;7- inch Chamber Height
✓t ~ft ell-oft Trench 2 System
Elevation
ft ft
Trench Separation Leaching Chamber Width
ft to limiting factor
Plan View In-ground Soil Absorption System (2-cell):
Trench 1
Modify
ft header/
design as
ft Leaching Chambers 0 needed.
Trench 2
4 inch Header
Sch-5t) .3
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.
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POWTS OWNER'S MANUAL MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity I Zc~ gal ❑ NA
Permit # Septic Tank Manufacturer l~7 fESZG12 ❑ NA
Effluent Filter Manufacturer 13 NA
DESIGN PARAMETERS
❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model
Number-of Public Facility Units J$f NA Pump Tank Capacity c~ ai ❑ NA
Pump Tank Manufacturer Lo jESC_ R ❑ NA
Estimated flow (average) 60 al/da
Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer 0 u L 0 ❑ NA
z Pump Model f7 j{/ ❑ NA
Soil Application Rate al/da /ft
Standard Influent/Effluent Quality Monthly average• Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (BOD.) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD.) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-Line ❑ Other:
Other; 13 NA
Maximum Effluent Particle Size Ya in die, ❑ NA
Other: ❑ NA Other: ❑ NA,
i
"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: ❑ month(s) (Maximum 3 years) ❑ NA
Gil 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: ❑ month(s) (Maximum 3 years) ❑ NA
® year(s)
Clean affluent filter At least once every: ❑ month(s) ❑ NA
® ear s)
~
Inspect pump, pump controls & alarm At least once every: ❑ month(s) 11 NA
3 N ear(s)
Flush laterals and test At least once everY ❑ month(s) ❑ NA
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; 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 eoll(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)
1.1
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 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;
~!;foundatfon 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 recbn'structed 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 -"ROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name p 2 L S DAl Name
Phone 5 - Z 7 3 4!!f Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name To 14^jSal~J s~} Ni fA+ev Name S`rl 6"IX Zdel
Phone 7~5 Z 7.3 " S $ Phone 7/y"3 86- V~g0
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
SEPTIC TANK MAINTENANCE AGREEMENT
AND 07
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address eO . gv h C.~{~ l ^jo W
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State V C A) Al •b Parcel Identification Number ( 115- - `3 3,
LEGAL DESCRIPTION
Property Location Lcl/4 ~'/4 , Sec. T v N R__L9 W, Town of ( C tf ti1a A/ ~
Subdivision L /J I E , Lot
Certified Survey Map # , Volume , Page #
Warranty Deed # l Z 15,11 , Volume , Page #
Spec house A7 no Lot lines identifiable es, 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.
I/we certify that all statements on thi orm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a wa my deed"recorded in Register of Deeds Office.
Number of bedrooms
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)
Combination SepG-jc~Tank and
Qp SPECIFICAT10MS ~V -
PLi-MP CHAMBER CROSS SECTICIQ A
WEATHE
VE1JT CAP r/- K Pjz F
JUIJCT101J 60X
ti"C.I. VEIJT PIPE APPROVED LOCKIMC,
OoOK, J."x4HOLE COVER
wARrJIUG LP,BEL
IQ ' FROM
, iQooW OR FRESH a Muir
~rJsP o>J P IpE ALu 11JTAKf S
j wlrllfL ittT- C_rrP > ; I Y'KIJJ.
11 6°MWC • ~ I
I+ ~KinW~, t~~ T I I
i - I I ~ 18/'l I Ll.
~.e PROVIDE I
I1.1LET
-'AIRTIGHT SEAL. I
I (II
APPROYED J014'
APPROVED JO WT ZP18EL. FLL ~t A I III W/C.T. f'IPE~P1
w/C.I. PIPCeR Tank construction I II ALARM
shall comply with 'i II
ILHR ()3.15 and 33.20 a I
I I oN
c 'I I
I
i
PUMP
~ OFF ~
D C0~ICRETC
BLOCK
RISER E=XIT PERMUTED OIJLy IF TAWK MAIJUFACTUR7-7 HAS SUCH APPROVAL gEppINC
SCPIIC r SPECIFICATIOUS
DOSE ~5EZ CZQ C~-~
T~i.1K MA►JUFACTURCR.: W 1 1JUMEiER OF DOSLS:~ .PER 0.y
TA1JK SIZE: C C GA.LLOQS DOSE VOLUME l~
/iLARM t'lAQUFACTUKCR: -Z S ~L LMO 34~ I11CLUDIIJG dACK({ OW; __~L_~ GAlLOFJ5
MODEL IJUMBER: LOL Nw C PACiTIES:
uCHCS oR GALLOUs
SWITCH TyPt:[~7:'~r
$ = z IIJCHES~OR V(, Z G~LLDUS
PUMP MAIJUFACTUREK: -IUCHE5 OR L_L 6.c_ZI;ALLOUS
V MODEL 1JUMDER: _ T 1 Dt__I(Z_IMCHES OR L2 ALLOIJS
\ SWITCH TYPE: Ft iJOTE: PUMP AFJO ALAR11 ARE TO ~L
'IN TALLEO ON 5EPARATC CIRCUITS
MIIJIMUPI'pISCHARGE RATE GPM
VERTICAL DIFFERENCE DETWCCIJ PUMP OFF A1,10.015TRINTIOIJ PIPE...~f--•. FEET
+ "'tWIMIJM I.IETWORK 5UPPLy PRESSURE FEET
i- FEET OF FORCE MAI1J X C F~ ET
loo rcFRICTIOU FACTO F. FE
.
.
TOTAL OyQAMIC HEAD FEET
As per,nanufacturer. gal/in.
APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01
HGOULDS PUMPS Submersible
Effluent Pump
PE
i .k
44ww PUMP
b~
SPECIFICATIONS MOTOR FEATURES
Pump - General; General: ■ Corrosion resLstant
• Discharge; 1'/V' NPT • Single phase construction.
• Temperature:104OF (4000 • 60 Hertz ■ Cast iron body,
maximum, continuous when a 115 and 230 volts N Thermoplastic impeller and
fully submerged. • Built-in thermal overload pro- cover,
• Solids handling: 1/j" tecdon with automatic reset. ■ Upper sleeve and lower
maximum sphere. • Class B Insulation. heavy duty ball bearing
APPLICATIONS • Automatic models Include a • 011-filled lled design. construction.
float switch. • High strength carbon steel ■ Motor is permanently
Spedally designed for the • Manual models available, shaft, lubricated for extended
following uses: • Pumping range: see PE31 Motor. setvlce 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/ PE4.1 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 heavy of 2 0 volt grounding
With 115 PE51 Pump: PE51 Motor: plug.
• Maximum capacity. 70 GPM • .50 HP, 3400 RPM Com Jete unit is heavy
• Maximum head: 37' TDH • 115 and 230 volts ■ portable and t is heavy duty,
METERS FEET • PSC design ■ Mechanical seal is carbon,
40 _ ceramic, BUNA and stainless
1 1 MODELS: P01, PE41, PE51 steel,
7 35 r ►fP .3s, .ao, so ■ Stainless steel fasteners.
10 E4 , , •I - a i Wnn
30 AGENCY LISTINGS
x 25 I- I i I I J I o
c Zo f I i I Tested to UL 778 and
i ( ( i I I I : ( I I CSA 222108 Standards
E- 15 1 By Canadian Standards Association
' I I j. I., I A I I , fik#uus g
10 Goulds Pumps IS ISO 9001 Registered
0 10' 20 30: 40 50 60 70 GPM 80
5 i0 15 m3/h Goulds Pumps
® 2004 ITT Water Technology, CAPACrrr
Effective June, 2004 Iru
~E_,~<, lTT Industries
t:
~j'~q m r a ~ y 5 ~
~ t ~ 'lW L~ ® + LIL1 ".a , .'k~ y p t r~ S fh ~d~.w du°y
,21
plus Standard Chamber Side and end Views ,
48"
(EFFECTIVE LENGTH)
a
_ 34"~
(1uick4 Plus All irk-One 12 Encap Front, Side and End Views
91.2„
s
1
13"
8" INERT 5.3" INVERT
8" INVERT
- 18.2" 33" -~I~ 9
(Ir.Ack4 Plus All-in-One Periscope
OUICK4 PLUS
ti ALL4N-ONE PERISCOPE
)
(360* SWIVEL
b
12.7" INVERT OUICK4 PLUS
ALL-IN-ONE 12
ENDC
ENDCAP
s
I
Quick4 Plus Standard Chamber Specifications
a
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"
i
(1.5 cm, 8.4 cm, 18.5 cm, 22,6 cm) I
Irl
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 M
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 _
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 s
(c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR
does not extend to incidental, consequential, special or indirect damages, Infiltrator shall not be liable for penalties or liquidated damages, r including loss of production
and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. L - I f I v-
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.O. 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 mis 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 S
3 -
(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
s 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 Inc. 0 2009 Infiltrator Systems Inc. Printed in U.S.A. PLUS0510101SI-2
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narek@hotmail.com
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Wisconsin Depart~ggfQcf~rr~ r rQN REPORT Page of
Division of Safety aF1d i1l9ngs
~ Ut4'i,Y in accordance with Comm 85, Wis. Adm. Code
CRpIX C~ ri~pp1,AEta County ~
✓ '
Attacht,m~g r{teYrtot'fess than 8 1/2 x 11 inches in size. Plan must
indude, ®M3trl to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6Uio7t 3 - 666
Please print all information. Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ::g:y Property Owner Property Location
ON R E (o W
I r, 1 zw r Govt. Lot Nis 1"X). T tip -X
Property Owner's Mailing Address Lot # Block # Subd. Na a CSM#
f C 1- j
2- 2-
City IR 1 State Zip Code Phone Number ❑ City ❑ Illage Wglvn Nprgst Ro
71 1
Nko'NewConstruchon Use~.d,Residential/ Number of bedrooms Code derived design flow rate C' GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent materials l/ f}t.17C Flood Plain elevation if applicable
General comments
andrecommendations:
System Type y "J t..L {5 System Elevation
MBoring #
O Poring Ground surface elev. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -E )X2
E
L1107
1
Boring # Boring f '
Pit Ground surface elev. 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
• Effluent #1 = BOO. > 30 < 220 nWL and TSS >30 < 1 ' Effluent #2 = BOD. < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Bird Plumbing, Inc. Shaun Bird ~226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 54017- 715-246-4516
i
Property Owner _ Parcel ID # Page of
Bori # ❑ Boring RL
n9 pit Ground surface elev. 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 `E
f - C
t7
1
F-1 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/ff
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ Pit
Soil Application Rate
Horizon 7epth 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 < 30 mg/- 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.
SBD-8330 (8.6/00)
Property Owner _ Boring Parcel ID # Page of
f ❑
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 •E
1-t 4c,
A &f
Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon ')epth 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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BODS < 30 mg/- 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.
SBD-8330 (8.6/00)
Soil Test Plot Plan
Project Name Todd Marek Shaw Bird
Address P.O.228
New Richmond Wi 54017 CSTM #226900
Lot 33 Subdivision Glen View Date 4/14/17
NE 1/4 N W 1/4S 19 T 30 N/R18 W
Township Richmond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation TBI *HRpSame as Benchmark
Scale is 1" = 40'
unless otherwise
noted
92nd St.
a~
a
0
a
94' Fill/cut soils to bedrock
95' 1 30' B-2
Of]
25 2% Slope
10'
10' B- 100, B-1
B.M.
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Wisconsin' Department of Commerce ALUATION REPORT Page 1 of 3 ,
a
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Q~ 3 _ ~
percent slope, scale or dimensions, north arrow, location and distance to nearest road.
Please print all i form~i~a E i V D Revieuy2 by / Date
Personal information you provide may be used for sec ndary purposes (Privacy Law, s. 15.04 ~1) (m)). G 4
Property Owner JUN 1 2 20 O Properly Location (7 m
Lakes and Hills Develop ent Govt. Ljbt NE 1/4 NW 1/4 S 9 T 30 N R 18 E (or) W
Property Owner's Mailing Address Cot # Block # Subd. Name or CSM#
PO Box 338
City State Zip Code Phone Number City RVillage ■ Town Nearest Road
Balsam Lake WI 54810 ( (6)51) 484-1818 92nd Street Richmond New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600
GPD
Replacement n Public or commercial - Describe:
ft.
Parent material Loess over outwash over bedrock Flood Plain elevation if applicable NA
General comments Mound System
and recommendations: ~Q'`~ eleJrt,~,OJ~S /I
Load Rate 0.4 w, f
uJ/ G5 Place system between borings 1 and 3 4
. p,~r.~^k- V v~,S r ~ ~ ~ ~ QaC~ ~.ocr~~-.ate rTleaSufe.cn ad'd'-. FT] R Boring # Boring
f
Pit Ground surface elev. 9 1 ft. Depth to limiting factor 25 in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
A 0-10 10YR 3/3 L 2mgr mfr as 2vf-f 0.6 0.8
2BC 10-25 10YR 4/4 LS 2csbk mfr gam' lvf 0.7 1.6
3R 25 10YR 5/6
E 2 Boring # Boring 9 26 ✓
En] Pit Ground surface elev. ft. Depth to limiting factor in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
A 0-9 10YR 3/3 L 2mgr mfr as 2vf-f 0.6 0.8
Bt 9-21 l OYR 4/4 CL 2csbk mfr cw lvf 0.4 0.6
2C 21-26 10YR 5/4 S Osg ml gw 0.7 1.6
3R 26 10YR 5/6
I
* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS 5 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Kathryn DesFor e Evergreen Soils b #254260
Address Date valuation Con ed Telephone Number
2705 Agnes Street Eau Claire, WI 54701 May 10th, 2006 (715)520-2693