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HomeMy WebLinkAbout030-2153-12-000 Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600246 GENERAL INFORMATION Slate 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 CITYWIDE DEVELOPMENT INC TOWN OF SAINT JOSEPH 030-2153-12-000 CST BM Elev: Insp. BM Elev: BM Description. Section/Town/Range/Map No: 20.30.19.3082 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER / S CAPACITY STATION BS HI FS ELEV. Septic C T:..- Benchmark zoo 7.4 i671 iaa Dosing Alt. BM 1~ I J' • ~ z ' Awmilims rhL, Bldg. Sewer /d•.g 9(, Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent to r Intake ROAD Dt Inlet Septic 64- Dt Bottom 1 S 75 a 92- Dosing 35 / Header/Man. C~ 5 Q I Aeration Dist. Pipe Cy I• Holding Bot. System /Q 97 4 4 El 30< Final Grade q PUMP/SIPHON INFORMATION -7 Manufacturer rr^^ Demand St Cover GPM L.O EJL+ 7•L I2Sd 3 Model Number 1G+ / 50 TDH LiftC Friction Los ~ System Head, TDH Ft Forcemain I i5 Length Dia. Dist. to W Well 1Zl SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Da. Liquid Depth DIMENSIONS -5 Z e~G ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur INFORMATION CHAMBER OR Type Of System: ZS 33 UNIT Mod Numb r: DISTRIBUTION SYSTEM ZZ.~-ZZ JS Header/Manifold 1 Distribution ix Hole Size ix Hole Spacing Vent .o Air ntake Pipe(s) Length Dia Length Dia ` Spacing ~e SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Q( Depth Over Depth Over TTO De pth of Seeded/So ded xx Mulched Bed/Trench Center ~ Bed/Trench Edges ~ psoil I No - Yes No s COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 477 149TH AVE `Z 1.) Alt BM Description = , V J 1 2.) Bldg sewer length = Z 5 - amount of cover = -7 a~ Plan revision Required? ❑ Yes 4 J /L l/f,/,~ y l ~ Use other side for additional information. 1 J IL ~l}•••f SBD-6710 (R.3/97) Date 1 nsepc 's Signatu Cert. No. -'3_ _ County Cho 1 ~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) IV D $ Madison, WI 53707-7162 'x A; r ;OMMUN DEVEL9 Perm State Transaction Number ;t a T07gXE ~-rY V N AHD _,,..,,mental unit in accordance with SPS 383.21(2), Wis. Adm. Code, subr. 1F is required prior to obtaining a sanitary permit. Note: App . _..,„wued POWTS are submitted to roject Address (if different than mailing address) the Departmeht of Safety and Professional Servies. Person,u tnrormation you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. / 7 1 / L Application Information - Please Print All Information Parcel # Property Owner's Name Property Locationa0 ~ 66 . o Y i Property Owner's Mailing Address 9C-7 ko,4p Govt. Lot City, State Zip Code Phone Number C /\1I Section O /J Z Sy3~ 7 Z Z TY6) N; R _L J--IE on' J~?1 - AA (curc II. Type of Building (check all that apply) L° l Subdivision Name or 2 Family Dwelling - Number of Bedrooms [Jill Block # P/ C) Jj E ❑ Public/Commercial - Describe Use ` ❑ City of CSM Number ❑ Village of ❑ Sta Owned -Describe Use Town of 57-~-- -~5e).~, 1H. Type `of Permit: (Check only on box on e A. Complete line B if a, plicable) New System ❑ Replacem ~ent System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) A. List Previous Permit Number and Date Issued B. ❑ Permit Renewal Q Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) tKNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil JS ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) J V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation & to e .7 S-5-9 3 C) e) , VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n E ° 0 U N New Tanks Existing Tanks it wU n v wC7 a Septic or Holding Tank err) 2 Dosing Chamber ~e v . ji; f-O j~ G C VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumbe 's Name (Print) Plumber's Signature MP/1~-Number Business Phone Number 7 715- -773 Plumber' ddress (Street, City, State, Zip Code) L tZ f-f4 W VIII. Coun epartment Use Only Permit Fee Date Issued Issuing ent Sign e XApproved ~ '~apnee+e $ 0 en Reason for Denial ?5 1b 1?_7 /7 IX. ConditN 1&~easons for Disapproval 2 r eon ~r 1" tank, e9tssh:lift lei` •7 dKPIa .so Celt must all be selic±s ±z ln~ ec' \ 1, /b 00 0~~~~ as per„ lar,ageme plan p!criaeti by plwnbe . J o R~4% l~ ~p 1 2 'AN At rect,imtlr ;erns mtr t be; za:rt, ir.E d 6j ob~ S r&4✓a ~ as Pa ~kMbl. C-nd / crdirsijt;;... 1 Attach to complete plans for the system and submit to the County only on paper not less than 8 1,12 it 11 inches in size SBD-6398 (R 11/11) L Q - - Z V V I f 8 7 I ~D i1p~ 5 4 x- CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: C j ~y CC~r©~ ~GO~,~c'~ti t Owner's Address: 105-4 4r0 s{ S Legal Description: A ARV AJ U'_ S Z tU 3e) /Z `7 w' Township: -f- S oScs~ County: 5f C°G =D/~ Subdivision Name:f Q,til ~1L_ Lot Number: Z Parcel ID Number: Page 1 Index and title pa,4'P eax VC Page 2 Plot Plan Page 3 System Sizing & Cross-Section f f ~~(1r< Page 4 Filter Specs ~Z 1,AJr(Lf(.40,A Page 5 AdW 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: x/11 z 1? 4 Date: rG -z 7 Phone Number 711 Z 7? ~~{k Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Lo+ ~f v ~ Z-~ s~ or 2 Family Dwelling In ground Soil Absorption S sy tem (2-cell Conventional _ ICJ Daily Wastewater Flow (DWF) _ # of bedrooms x 150 gal/day/bedroom ~ gal/day Design Loading Rate (DLR) or Soil Application Rate Bpd/ft2 (per SPS Table 383.44-1, 2, or 3) gPd/ft2 = ` ~ ft2 Required Distribution cell area =DWF gal/day DLR -7 + Q = # Chambers =Required Distribution cell area ft2 + ft2/ unit EISA Chambers Y Chamber Manufacturer and Model: t' L e tom` Z) u).,-, i, ~S QQ ft2 + L ft2/ unit EISA End Cap Pair = J ft2 Actual Distribution cell area =Required cell area Cross Section'in-ground Soil Absorption System (2-cell): 4" Schedule 40 PVC vent pipe with vent cap R 12 inches minimum 12 inches minimum inches Soil Cover Trench 1 Sys- J tem Elevation / Z- inch Chamber Height -3-7-ft a ft Trench 2 System Elevation ~ft ft Trench Separation Leaching Chamber Width >3ft to limiting factor t Plan View In-ground Soil Absorption System (2-cell): Trench 1 Modify ft header/ design as _ ft Leaching Chambers /4 0 needed. i~ - Trench 2 4 inch Header Sch. 2e) 3'~e L._ ft with end camps Draw O for a Vent and for Observation Pipe above. They will be located ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. Page of $fy~ ~ 8 H {n ff ,yr i S~ 1 Y 91 G ~ t 4,y,eFq x { ~ P o-t ~p ~t Z ~;rbi~ °X t ett'^ e Q 3 ~ a ° SWi ~ ~G Y ~ 033 P ~ sa = i Q ~ ' 33 > a s a ~ ~ fir E< Y rte. P 6 .°l ~b t~ to '1'[ai4 00 iF. 3 3. r sz}n•t6 `fit ~~~i/~`4'r~,r" h lop HS ~ ~ A - ~ ~StmaFJr~~w~ - a. 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POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity I Zo cy al ❑ NA Permit # Septic Tank Manufacturer W Iar SC_ R ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS ❑ NA Number of Bedrooms 11 NA Effluent Filter Model Number of Public Facility Units flf NA Pump Tank Capacity 4q_@L-0 00 0 al ❑ NA Estimated flow (average) ;40 1QO gal/day Pump Tank Manufacturer Lo rZ ❑ NA Design flow (peak), (Estimated x 1.5) t~F (000 gal/day Pump Manufacturer 0 U LO ❑ NA z Pump Model ❑ 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 ❑ Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Monthly average Dispersal Cell(s) ❑ NA Pretreated Effluent Quality Biochemical Oxygen Demand (BOD6) 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: Maximum Effluent Particle Size Ya in die. ❑ NA Other: dNA Other: ❑ NA Other: "Values typical for domestic wastewater and septic tank effluent. Other: ! i 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) 13 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; ❑ month(s) NA ` 3 ® ear(s) Flush laterals and pressure test At least once every: ❑ month(s) 13 NA V.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 c~0II(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 S12 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) bl START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products ftchemical., 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 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., 0 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 recbnstructed 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 BASSES 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 fZ C L S O Name Phone .S - Z 7 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Sp j4^'5o^J 5-Anji fitted-11 Name S-~ CdldlX Zd^~t Phone 7L5 Z 7 j _S O Phone 71- 5;"3 Od VrT ~gU 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. APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 HGOULDS PUMPS Submersible Effluent Pump PE .ginfia A NT Pump s~ SPECIFICATIONS MOTOR FEATURES Pump - General; General: ■ Corrosion resistant • Discharge: 1'A" NPT • Single phase construction. • Temperature: 104°F (400C) • 60 Hertz ■ Cast iron body, maximum, continuous when • 115 and 230 volts X Thermoplastic impeller and fully submerged. ' Built-In thermal overload pro- cover, - Solids handling- 112- tecdon with automatic reset t Upper sleeve and lower maximum sphere. • Class B Insulation. heavy duty ball bearing • Automatic models include a • 011-filled design. construction. APPLICATIONS float switch. • High strength carbon steel s Motor Is permanently Spedally 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 T 016/3 SJ W With volt grounding PE51 Pump: PE51 Motor: plug • Maximum capacity: 70 GPM • .50 HP, 3400 RPM Complete unit is hex • 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 ~~>'tr I I I I I. I MODELS: PE31, PE41, PeSr steel. 35 HP:.33-4o, .so ■ Stainless steel fasteners, 10 - i I I I. 2GPM I -I i I i l I I I AGENCY LISTINGS 30 E,41 1 FT 25 e( I _ I I i t I i I I.i i' u I i •i f l i 1 ~ t i I 20 G us o I I I ; _ r- 1 I Tested to UL 778 and I i ` I I I i_ l CSA 2221o8 Standards 15 By Canadian Standards Association FO i 1 I I I File #LR38549 •'10 Goulds Pumps Is ISO 9601 RagLUrod. 0 0 0 10~ 20 30- 40 50 60 70 GPM so 0 ' 10 15 m3/h Goulds Pumps ® 2044 ITT Water Technology, CAPACrTY Effective Juno, 2004 `~a T EE31/41 ITT Industries Combination Sep-tic. Tank and PUMP CHAM15ER CROSS SECTIOtJ A~1D SPECIFICATOIS ' - VEIJT CAP WEATHEK rf 00 jL QCTIOIJ BOX ti C.I. VC~1T PIPE ~IPPROV"D LOCKIIJG ? IO' F9 CM,, DOOR, MAIJftOLE COYER 1-V1"~ wAFN1 G LA4EL- -,l11JDOW OR FRESH co>J~u>r ~~s~ o~ P tPE AJK IUTAKE a w / rYttz-Tl s tt~" ~-rsF ~ I - i ~ ,L 18' /'1I1.1. I L _ _ J\ i- PROVIDE I IMLE T AIRTIGHT SEAL I III /f R I I I APPROYED JO11JT:- ~ APPROVED JOIKI Zf~E~L 'Pty I I I i W/C.T. PIPEaP'c w/c.T- PIYEO}ZPV Tank construction I II ALARM shall comply with I II ILAR I)'3.15 and 33.20 a I I I oN c ! I I Pu1-~P-~ OFF ~ COUCRETE lS~OCK 3 A P f'~N K15EK EXIT PER:' MCD OIJLy IF TA.IJK MAQUFACTLIR`F-R HAS SUCH P,PPFOVAL BEDOIN G SEPTIC F 5PEC.IFICATICtJS DOSE W,j CQ~ I ~ C ~ -rn>Jk~ MA>JUF~+CTURER://77 1JU/1BEA OF QOSCS: PER QA.~ TA}JK SIZE:)GALLOUS DOSE VOLUME ALARM lIAIJUFACTUR CR: j.~. C~~L~ S~5"~1~ IkICI--1-101W. OACKF1.OW: / r fZ GAL L ON; f'100CL 1JUM0CR: L ~~w CAPACITIES: A=-.? nACHLS OK CALLOUS SWITCH T.~PC: IIJ[HES'OR Cr[L G~LLOUS PUMP r~AlJL1FACTUKCR:. _ t L ~ c. 7 1QLHE5 OR zWLLOUS MODEL lJUMI~ER;~ If~ D=11~HE5OR ~Z'ALLOIJS 5WITCH TYPE:1JOTE: PUMP AUO ALARr~ HK6 TO dl MIUIMl11'~ DISCHARGE RATE -5- z. GPM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFEKEKICF DETWCEIJ PUMP OFF AIJO..DISTRIBUTIOIJ PIPE.. hEET t /'~IUIMUM fJETWORK SUPPLY PRESSURE , . , . . . FEET -f- FEET OF FORCE MIPJ A" F/0fT,FKICTIOIJ FACTOR-. FEET I O TOTAL. CtQAMIC HEAD = Z FEET As per.manufacture.r_ Zf.~t~ gal/in. A k o- iii '10 ri Quick4 Pius Standard Chamber Side and End Views 48" (EFFECTIVE LENGTH) 12" S =_---34" H j 1 DWs All-ir.-One 12 Encap Front, Side and End Views 11.2" 13" 8" INVERT 8" IN T 5.3" INVERT t _JJ . 33" 4 Picks Aii-in-(one Periscope OUICK4 PLUS" ALL-IN-ONE PERISCOPE (30 SWIVEL ) ij US 12.7" INVERT QUICK4 12 ENDC-ON 5„ 911 NDCAP Ifs Quick4 Plus Standard Chamber Specifications - --J 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 all each chamber, end plate, wedge and other accessory manufactured by Infiltrator "Units"), when installed and f' operated in a leachneld 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, is 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 9 (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 riot 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. s),,- r,I s I n C . Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse s or neglect of the Units: the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure Io maintain the minimum round covers set forth in the installation instructions; the placement of improper materials into the system containinl, he Units, failure of the Unfits or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal 6 Business Park Road • P.O. Box 768 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 e 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 II 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 4 installation instructions. $00,221 .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.i nfi Itratorsystems. 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. ~ ,3 Ix:'C'M ' s t•'.:v 5 do<,kf :h.zN s II ~ $ a 5 mI V ) a 4 of r vd rN T M7 r gw$~' at e I,'i a es 7417-. ~L "c( Ala I I Ll S Patents 4,759.661, 5,017,041; 5,156.488: 5,336,017; 5,401,116; 5,401,459; 5511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents 1,329,959; 2,004,564 Other patents pending. nfiitrator, 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 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND U7 OWNERSHIP CERTIFICATION FORM Owner/Buyer GlJ G' ~C` I~L d~F~v-r i ti c Mailing Address p ER 5 Property Address 7 (Verification required from Planning & Zoning Department for e construction.) City/State Parcel Identification Number C-3 z / S Z LEGAL DESCRIPTION Property Location AAd Sec. 2- f?, T _N R_ W, Town of t SO S ~'~t~ Subdivision r, l D `Z L , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 7 , Volume , Page # Spec house yes 4o 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 fn form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue pf a ty deed recorded in Register of Deeds Office. Number of bedrooms /_U__Izz lhl""x 2~1 SI T APP NT(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) t G Sl~ SFF l NOTE ON PG. x,32' 7.69. Mir 1 4! -C23 g2V6'~~•186.6 S a AVENUE ca _ '05•W 186.64 S,SJL 6 3 ~ 89 _41.66. N 'T LOT 13 8 N LOT 11 ..38' Q 07' Z 63' .95' :091, 27' g . ,49' ?mss LOT 12 ,82' 04' 0 41' N TOP OF 1' IRON PIPE HWE = 947. 11' m 6M ELEV.=939.2 ! LBO 950.5 g4 m DRAINA GE EASEMENT Vw 29 N e~ 3, LOT 14 m WEo 70' 21' •l 27' 38,'5.67' 58' S82-47003"E 71 ' 434.66' 48. 794' •f~~y LOT 10 1 LOT 15 1? w HWE : 935.2 LBO 937.21 € j 4 E - b W-Qi WauJ w°1 9 \\ll ilk d ~ 11~ti{ 1~'r 111 L W IN as ~ W I R1I " -Mli a ~ R N E sp ~ x Y I lilil l~ il 1" ii ' I g'7E v~ Ir,l c inn r~~~~'Gr~ If; it I~I II f~0 W ~~jj[~•~~-~ ~ ~ W Z `o Si'I tom it G'" I I Z J ~ g E "Rip k f' r U. 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I I r m Lill ~.l 1 ~ 'Wisconsin SOIL EVALUATION REPORT #1460 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 5 Division of Safety and Buildings Schmitt Soil Testing, Inc. 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 dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please p, j t 9- - 12 - CXX~ pp Revie By Date Personal information you provide may ffbl~cAaitlrt(Priva Law, s. 15.04 (1) (m)). ~z 8 Q Property Owner Property Location Golden Harvest Capital, LLC DEC 13 2006 Govt. Lot NW1/ NE1/4, S20, T301N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 14906 Blakeney Road ST. CROIX COUNTY 12 Pioneer Ridge City Stab Zip Code Ph City Village Town Nearest Road Eden Prairie MN 55347 (612)202-3234 St.Joseph 50Th St. 1 New Construction Use: I,-' j Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD __I Replacement _ Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable for a conventional system with a 0.7gpd/sqft rating. Possible system elevation for Area 1 is 97.0'. Slope is 0%. Boring # Boring Pit Ground surface elev. 103.45 ft. Depth to limiting factor 115+ in. Soit Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 1 0-5 10yr3/4 none sl 2fsbk mvfr as 2f .6 1.0 2 5-9 7.5yr4/6 none Is icsbk mvfr gw 2f .7 1.6 3 9-41 7.5yr5/4 none vgrls Osg ml Cs if .7 1.6 4 41-56 10yr5/4 none vgrs Osg ml cw .7 1.6 5 56-115 10yr6/4 none s Osg ml .7 1.6 ❑ Boring # r Boring Pit Ground surface elev. 103.35 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/3 none sil 2fsbk mvfr as 2f .6 .8 2 7-15 10yr5/3 none sil 2fsbk mvfr gw 2f .6 .8 3 15-32 10yr4/4 none sil 3msbk mfr gw if .6 .8 4 32-40 7.5yr4/4 none fsl Om mfi cs .2 .5 5 40-65 7.5yr5/4 none vcbcos Osg ml gw .7 1.6 6 65-112 10yr6/4 none t s , Osg ml .7 1.6 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 Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 7/27/2006 715-247-2941 SBD-8330 (R-07/00) L Property Owner Golden Harvest Capital, LLC Parcel ID # 12 Page 2 of 5 Fil 1 Boring # Boring Pit Ground surface elev. 102.3 ft. Depth to limiting factor 92+ 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 10yr3/3 none sil 2fsbk mvfr as 3f .6 .8 2 10-17 10yr5/3 none sil 2msbk mvfr gw if .6 .8 3 17-23 10yr4/4 none sl 2msbk mfr gw .6 1.0 4 23-42 7.5yr4/6 none Is 1csbk mvfr gw .7 1.6 5 42-60 7.5yr5/4 none Icos Osg ml cs .7 1.6 6 60-92 5yr4/4 none sicl lmsbk mfr .2 .3 4 Boring F'~]Boring # Pit Ground surface elev. 102.08 ft. Depth to limiting factor 106+ 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 0-7 10yr3/3 none sl 2fsbk mvfr as 2f .6 1.0 2 7-20 10yr4/4 none sil 3msbk mfr gw 2f .6 .8 3 20-38 10yr4/6 none sl 2fsbk mfr gw 1vf .6 1.0 4 38-53 10yr5/6 none s Osg ml cs .7 1.6 5 53-106 10yr6/4 none s Osg ml .7 1.6 7 . lu ❑ Boring # Boring Pit Ground surface elev. 102.75 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell TR--edox u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 1 0-10 10yr3/3 none sl 2fsbk mvfr as 2f .6 1.0 2 10-16 10yr4/6 none grsl 2msbk mfr gw if .6 1.0 3 16-32 10yr5/4 none sl 2msbk mfr gw if .6 1.0 4 32-56 5yr4/4 none sl lfsbk mfr gw .4 .7 5 56-82 10yr5/6 none Is 1csbk mvfr gs .7 1.6 6 82-86 10yr6/4 none vgrs Osg ml cs .7 1.6 7 86-110 10yr6/4 none s OT ml .7 1.6 1-7 ` Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L Effluent #2 = BODS < 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. SBD-8330 (R 07/00) Schmitt Soil Testing, Inc. Property Owner Golden Harvest Capital, LLC Parcel ID # 12 _ Page 3 of 5 FWI Boring # Boring Pit Ground surface elev. 102.7 ft. Depth to limiting factor 110+ 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 10yr3/3 none sl 2fsbk mfr as 2f .6 1.0 2 10-22 10yr4/4 none sil 2msbk mfr gw if .6 .8 3 22-34 10yr4/6 none sl 2msbk mfr gw .6 1.0 4 34-60 10yr5/6 none s Osg Ml CS .7 1.6 5 60-110 7.5yr5/6 none s Osg ml .7 1.6 IL Ibi F7 ]Boring # Boring 1 Pit Ground surface elev. 101.8 ft. Depth to limiting factor 25 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 0-7 10yr3/3 none sil 2fsbk mfr as 2f .6 .8 2 7-17 10yr5/6 none sil 2msbk mfr gw if .6 .8 3 17-25 10yr4/4 none sl 2msbk mfr gw .6 1.0 4 25-41 7.5yr4/4 cif 7.5yr5/6 sl lmsbk mfr a .4 .7 7.5yr6/2 5 41-75 5yr4/4 clf 5yr5/6 5yr5/2 sicl lfsbk mfi 2 3 Fi-1 Boring # Boring - Pit Ground surface elev. 96.30 ft. Depth to limiting factor 96+ 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 0-7 10yr3/3 none sl 2fsbk mvfr as 3f .6 1.0 2 7-16 10yr5/3 none sil 2fsbk mfr gs if .6 1.0 3 16-34 7.5yr5/6 none Ifs icsbk mvfr gs 1vf .5 1.0 4 34-57 10yr5/6 none s Osg Ml Cs .7 1.6 5 57-96 10yr6/4 none Ifs Osg ml .5 1.0 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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. SBD-8330 (R 07/00) Schmitt Soil Testing, Inc. Property Owner Golden Harvest Capital, LLC Parcel ID # 12 Page 4 of 5 Boring # - Boring 1 pit Ground surface elev. 96.55 ft. Depth to limiting factor 32 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 10yr3/3 none I 2fsbk mvfr as 3f .6 .8 2 10-14 10yr5/3 none I 2msbk mfr gw if .6 .8 3 14-20 10yr5/6 none sil 2fsbk mfr gw .6 .8 4 20-32 7.5yr5/4 none sl lmsbk mfr gw .4 .7 5 32-58 5yr4/4 clf 5yr5/6 5yr6 2 sid ifsbk mfr gw 2 3 6 58-80 5yr4/4 cif 5yr6/6 sicl lmsbk mfi cw 2 3 5yr6/2 7 80-90 10yr6/4 none Ifs Osg ml .5 1.0 ❑ 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/ft2 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 GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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 7TY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page .S of Zonducted by: Conducted For: Schmitt Soil Testing Inc. Name: Golden Harvest Capital, LLC Thomas J. Schmitt, CST 227429 Address: 1440 Arcade St. N 1595 72nd St. City, State, Zip: St. Paul, MN. 55106 New Richmond, WL 54017 Phone: 715-247-2941 Subd.Name: Pioneer Ridge S*Omww. 41 416 ~•Lot No.: ~,G Legal Description: IVIJ 1/4 NEl/4 S20 T30N R19W 1• Backhoe pit Township, County. St. Joseph, St. Croix A Bench Mark El. 100.00' Top of 2" pvc pipe, 0 Alternate Bench Mark EL /0.3.9 ~ " Top of 2" pvc pipe Slope= + Contour Line EL AM Contour Line Length M cv , { Scale I"= 40 , ~a r la ` . 6~ t r OjDt 71;9t This Sol and Erahnuion was oompieled to liM a zoning it mry or may not be is a loatim soiwbk for your w&