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HomeMy WebLinkAbout026-1127-16-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No- GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 600348 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 Construction Inc. TOWN OF RICHMOND 026-1127-16-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: (,v Lo~-czmj 25.30.18.826 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t CAPACITY STATION BS HI FS ELEV. Septic Benchmark 15 OL* Li Jl~ Alt. BM Aeration Bldg. Sewer 133 15.60 Holding St/Ht Inlet ~jry SU t TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. a to Air Intake ROAD Dt nlet Septic Dt Bottom Dosing Header/ an. _ 8 y WWI r Aeration Dis . ipe ~.3 qb-9,r Holding Bot. System 7 d ow. -~t" PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM I I Model Number -Lail TDH Li Friction Loss System Head TD Ft Dist. to Well Forcemain Len th 1 Dia. 0 I L& - C SOIL ABSORPTION SYSTEM BED/TRENCH Width / Lengt I No. Of Trenches PIT IMEN S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK ISYSTE TO P/L (x! BLDG WELL LA ST M LEACHING Manufacturer: INFORMATION CHAMBER OR ~ I ~:7 I PAL= Type Of System: ~I 1 UNIT Model Number:oL, (a DISTRIBUTION SYSTEM F Header/Manifold Distribution - ix Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length l / Dia I Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ' Depth Over xx Depth of xx Seeded/Sodded r Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: ~l1 Y Location: 1326 141 ST ST t,. 1.) Alt BM Description = 2.) Bldg sewer length = X1'2 1 - amount of cover Plan revision Required? ❑ Yes ❑ No ~ Use other side for additional information. L71~ JIA SBD-6710 (R.3197) Date Insepctor's ignature Cert. No. County Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 1- a i V/ Madison, WI 53707-7162 6663 ~'g o~sins"` State Transaction Number Sanitary Permit A}~plic o . MME In accordance vvitit SPS 383 21(2 4~is.:Adm:; Code, s omission of this fn 'a to Pro ect Address (if different than mailing address) is required prior to obtaining; a, satntat'!,p=itr1NMC: Application forms for 1 the Departracht of Safety and'Pr6fessionaTSeivTes`-Personal inforr, ~n _,a for secondary / mar purposes in accordance with the Privacy Law, s. 15.04(1 m ,.Stats.' ` /✓z(o ,iq 1. Application Information - Please Print.All Information Parcel # Property Owner's ame C'1, Z //7- 7 ( a 0.0 Property Owner's M ' mg Address Property Location Kc Ild 171 Govt." Loot City, StalItge,`j / Zip Code Phone Number h/ /1a 1t~ y,, j' UJ '/a, Section e on 3 7 7/Z Ya T 41- N; (circlF ore LV5 II. Type of Building (check all that apply) Lot # Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms 10: el,4 of Block # l L ❑ Public/Commercial - Describe Use ❑ City of CSM Number ❑ Village of ❑ St to Owned -Describe Use own of 7 r 41 9 /V~` ~L % Z cNa,olc(a III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) A. )iLNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous 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 apply Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil G 5 ❑ Holding Tank_ 0 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. is ersaVTreat ent Area Information: Design Flow (gpd) Design Soil Application Rate( f) Dispersal Area Required (sf) Dispersal Area Proposed (s Syst~l Lion 4++I VI. Tank Info Capacity in Total # of Manufacturer ~ o ~ ~ Gallons Units Gallons U cd U Qj (n U v~ c0 o New Tanks Existing Tanks ° iTo Septic or Holding Tank p Z G r Z~~} C Dosing Chamber 6.06) IllLJ J G L J,: 6_4 6- VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name Print Plumber's Signature 14 MP/Ie Number Business Phone Number lfb J C -7 "L j, Z / T' Plumber' Address (Street, City, State, Zip Code)' VIII. oun epartment Use Only_ Pemiit Fee Date Issued Issuin Agent Signatur Approved ❑ D' pprove $,q474. 60 ❑ wen Reason for Denial V.01 IX. Condi1M1W RReasons for.Disappr6val 1. $fpCi'i Ur k, tr4t&m ,11W erhi 3 4--m. hG~Q.,M•~- e' be i Iu Cell rtu;t e0 R1ti bei. n,Per:zw3gement plan pro riderf by plum a~ 4 e en. .4 m rst tx, r.^:$ittt: ir. _ E . 2. rectiwsc:^ 'AA ielbsrk oe per #fpkrb1s co&. 1: n larruj. Attach to complete plans for the system and submit to the County only n paper not less'than 8 In x 11 inches m size SBD-6398 (R 11/11) LO C L 41 J 9 0 , .Die I t1~ ~y \f 1 g~ L D ~L f "77/ IJ- AL iotl x LS V C~ l -IL co r, l CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address:7. r- (4-J H /14 o 6t) 0 R Legal Description; Township:t C 41 ,9/,74' County: C'P o /K Subdivision Name: ~rCi~~.N f/G~s Lot Number: Parcel ID Number: Z- Z 7- Page 1 Index and title -1A/ Page 2 Plot Plan IOCKAAP Page 3 System Sizing & Cross-Section / Z L f4 pwo`, 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: 1JCCyi,,'t/ License Number: Date: Phone Number 1-7 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 CL i~ l Z,O~ 9- i1 1- or 2- Family Dwelling In-ground Soil Absorption System (3-cell Conventional) Daily,Wastewater Flow (DWF) _ # of bedrooms x 150 gal/day/bedroom = gal/day Design Loading Rate (DLR) or Soil Application Rate = gpd/ftZ (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area = DWF m ✓ gal/day -qLR 6 C` C) gpd/ft2 _ d C) ftZ # Chambers = Required Distribution cell area -~~ft ..Z ftZ/ unit EISA `s Chambers Chamber Manufacturer and Model: / /J F/L A4,-1tL 5i tai C l--- AL S Actual Distribution cell area = Required cell area t Uri ftZ + 15-, 3 ftZ/ unit EISA End Cap Pair = Z/S ftZ Cross-Section In-ground Soil Absorption System (3-cell): 4" Schedule 40 PVC vent pipe with vent cap 12 inches minimum 12 inches minimum I I I 7ft T3 Final Grade (FG) ft T1 FG ,S; q ft T2 FG inches Soil Cover inch Chamber Height Trench 1 System Elevation Trench 2 System Elevation Trench 3 System Elevation ft 2. ?ft zeft Trench 3 inch to limiting factor Separation Plan View In-ground Soil Absorption System (3-cell): Trench 1 Modify ft IME_ header/ design as ft Leaching Chambers 0 needed. ` Trench 2 4 inch Header Sch. 3L~ Trench 3 _ ftwith end camps Draw Q 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. i ~k 3F- m m G ~ ~ ~ ~ ~ ~ r 4!ylti'~`,Tf 0 r •H, di Sk 1! y 9 ry~ C ~ O N ~5 t ° E m C C L c'O _ S t n a) It %~c o•_cm n4r. z8d~ ai 3 N L S LL m a Yf+.~ xn + 'tklkkk •C ; -c N O E N m 41C n-1.~, R C i M E 0 (D 0 6:5 It, m ,,Cc0 C ~F'~orJf «O C F4-t re m c' ra m d E m o co ° v a Z. § v rb c a o _ V ~6 _ L C rot G X m .O m Ti co 2 w c $ W ac c to 5 c o d o~°t - a c~ c Q e C m° C C O N .y , d ~`Y 1 48 N Q1 vim a~ cvm~mm~ ■prk G oO~E m° ~.mOC Es~ ! o m o 'b, o m c CD Co 0 0 C ° L > a m L E N g+ W Q Ecc rr=~'> E n H~ym~3o m y} d F5r! ~'L S k 33 Iy J u"t „ s 4 F* M al4 p1CS5 cEo co I Im m On R 4 2 k~~nvr` iu i r 3 S 4- k & is 0 01~ '1 ~T F ~d2Y~~.. ggg 2 E 3 17 S I J~1 1~ L^ C7 m { 9 T `a r t r~ u u ~ a a 5 3Y8 ~ E aE G ae ys E ~j 1i = v oil L \ a Ea 51 s fyl nS1 yr rnJ7fMR~h~ f'~~,trs~;'~~ $ b ~~}y,",>rxF t F n ) Y ri ff S t.4K'S< Rl :1~ t lY ~,ah .1 +F eS4 pa ¢ / + c r; POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity / Zo a al D NA Permit # Septic Tank Manufacturer (ij IESC- R ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer O NA Number of Bedrooms 0 NA Effluent Filter Model ❑ NA Number of Public Facility Units J$f NA Pump Tank Capacity Teo 0 al O NA Estimated flow (average) V60 -gal/day Pump Tank Manufacturer t.(O NA Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer L D ❑ NA Soil Application Rate gal/day/ft' Pump Model f7 O NA Sfandard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, 011 & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (SOD,) 5220 mg/L ❑ NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical. Oxygen Demand (BOD6) 530 mg/L O In-Ground (gravity) O In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L O NA 0 At-Grade 0 Mound Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: O NA Other: O NA Other: q NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 0 month(s) (Maximum 3 years) ❑ NA Gil year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 0 month )(s) (Maximum 3 years) 0 NA RI year(s Clean effluent filter At least once every: ❑ month(s) ❑ NA ® ear(s) Inspect pump, pump controls & alarm At least once everY r O month(s) .O NA 3 18 year(s) Flush lateral$ and pressure test At least once every 0 month(s) ❑ NA ear(s) Other: ❑ month(s) At least once every: ❑ ear(s) ❑ NA Other: O 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 dell(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) START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or 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; ',foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;. pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed., • The contents of all tanks and pits shall be removed and properly disposed of by' a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement.-area has been evaluated and may be utilized for the location of a replacement soil absorption system, The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation toestablish 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 recbristructed 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 © L 2 C' L 5 o V E Name Phone -7 1 S- z 7 3 7 T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 3-p µ^~Sa~ s~},vr fit fed Name S- Cd1d/X Zdr✓! j Phone 7I5 Z 73 -.5_5 1 ( Phone 715 3by /vto90 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. ' - Combination Segtrri.c~ Tank and / PUMP CHAMBER CROSS SECT10tJ ARJO SPECIFICATIONS l VEuT CA,P WCATHCK PKO F JuQC.TIC)Q box I. VCNT PIPE APPROV~,D LOCKIIJG P11 JKLE COVER wt 'IO fROM DOOR, t~-~AFt~IsJ~ LfNBEC II~1DOw OR FRESH rr. t tl-~nP 6u- ~ I `(HI,U. ~~j - - I ~ ~ I8' MI IJ. - - - ~ 1JLET PROVIDE I AIRTIGHT SEAL I III APPROYED J011JTS APPROV=D JOIAJT Ef'8~ Ft A I Ii C. T. P1PEo'ap) WfL.I- PIPE OR PV Tank construction I I I ALARM shall comply with II ILH~ x,3.15 and 33.20 a I I I o 1J c 'i I I PUMP OFF 0 COUCRETE BLOCK 3'APPSc~ RISER EXIT PGR>'117CD OIJLy IF TAQK MAJUFxCTLJREK HAS SUCH APPROVAL BEDDING SEPTIC F SPECIFICATIOKIS DOSE A I 15~t CoUCfT~ TnI.JK5 MA >,JUFA CTLIRCR.: 6JUMf3EA OF DOSES: PEi', DA -.'J TA),JK aAZC:/Z,e ) 1-'- 6 Al_L0AJ5 DOSE VOLUME ALARM ltA1JUFACTURER: SS SKIS ~1~ I1ICLUDIAIG BACKfLOW: L__._1 GALLONS f101DEL IJUM6ER: 101, Hw CAPACITIES: A= Z lk HESOR GALLONS z IIJICHES'OR G~LLOUS SWITCH T,PFZ: z r` zt LLO~JS PUMP l'\AiJUFACTLRKZC _ !SO L_LL C +S IUCHES OR MODEL. RJUM6EK: - ---rzr D=itLHES oR UALLOIJS 5WITCH TYPE: L~ uoTC: PUMP AUO ALAKIn ',RC TO DL MllllMUl1 D15CtiARGE RArE- C'FM INSTALLED OfJ SEPARATE CIRCUITS VERRTICAL. DIFFERENCE DETWCEIJ PUMP OFF AQ0..D15TRIEIJTI01J PIPE.. FEET -t- h11►JIMLJ KJETWORK SUPPLE Pl!RESSUKC~ , , , , , , , , , _ . O FEET + FEET OF FORCE 1''1AIM X .Lt_L1__F/IOpfLFRICTIOU FkCTOR_. FEET TOTAL. CyQAMIC HEAD = __/)rFEET As per.nanui'acturei gGl/in. a APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 HGOULDS PUMPS Submersible I t Effluent Pump PE ~'IUM Pump s~ SPECIFICATIONS MOTOR FEATURES Pump -General; General: s Corrosion resistant • discharge: 1'A" NPT • Single phase construction. • Temperature: 104°F (400q • 60 Hertz ■ Cast iron body, maximum, continuous when • 115 and 230 volts X Thermoplastic impeller and R fully submerged. • Built-in thermal overload pro- cover, • Solids handling: Yr" tenon with automatic reset. ■ Upper sleeve and lower maximum sphere, • Cass B Insulation. heavy duty ball bearing • Automatic models include a • oil-filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • 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 • EffluenUDosing 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 heavy duty 16/3 SJTW With PE51 Pump: PE51 Motor: 115 or 230 volt grounding plug • Maximum capacity: 70 GPM • .50 HP, 3400 RPM Complete 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 ? I i MODELS. P01, PE41, PESt steel, • ErSi I I HP..33..4o, zo ■ Stainless steel fasteners. GPM 30 .PE1AGENCY LISTINGS 10 %12 o l I t I i i , I. i Ck us zo I r ' Tested to UL 778 and C5A 222108 Standards 15 By Canadian Standards Association 10- i , 1, i. I r File #1838549 10 T ( i ( i I 4 , ' I Goulds Pumps Is ISO 9001 RegLuErcd c. t 5 ~ I I , ' I ' 6r I; ~i I i I I, I ~ ! 0 j 10 20 30 40 50 60 70 GPM 80 0 $ 10 15 rn3/h Goulds Pumps ® 2004 ITT Water Technology, Inr_ CAPACITY EHactrvJun•, z004 BYE31/41 ITT Industries f w ick4 Pius Standard Chamber Side and End Views 48" (EFFECTIVE LENGTH) I? 12" =s _ - - - - - 34" a is ail-irr-One'" uncap Front, Side and End Views i. 11:2„ )I 13" 8" INVERT 8" INVERT I 5.3" INVERT l E 33"~ 1,'A6,Jc-k4 9as All-in-One Periscope DUICK4 PLUS k"+ ALL-IN-ONE PERISCOPE ' (14-ONE SWIVEL ) OUICK4 PLUS 6 4 12.7" INVERT ALL-IN-ONE 72 ~ ENDCAP CAP Quick4 Plus Standard Chamber Specifications Size (W x L x H) 34" x 53 x 12" (86 cm x 135 cm x 31 cm) Invert Height 0.6", 5.3", 8.0", 12.7" Effective Length 48" (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm) 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 leachreld of an cnsite septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder") against detective 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 x by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This 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, t s? rp S 1 ri c. . 4 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' „ 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 k to intain 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, themaUnits, 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 it 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.infiItratorsystems.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. n~. y s~~~ ~ ~!`rr,~,`ytz;~ a"Fr ~#$7'~'E~~3 x~ y, ~t~ ~k rl ~`"`,'~y , •'tg r s I ,r y,;~ r A 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. i nfiltrator, Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. PLUS0510101SI-2 s a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc. © 2009 Infiltrator Systems Inc, Printed in U.S.A. W I I 1 0` ~F . ll i I 0 I 770 > S89'52'55"E 616.78' ^ I I - I I m w : 130.91' 309 ~p L4 i I 1~ 307.78 N 44 i W lQ •244.40' 4' I Lc) w -49','B 372.1' { I ('7 (V I ~ Drainage Easement I W ~ N ~ I 1 10 j LOT V 04 -TAL AREA U.) I TO 0 p I W .M Zf CV I z ~i jcd 91,979 S0. f O I I N Q 2.11 ACRES O I I i i / N~ $ F.F.E. 1006.6 s ; I O 1 O N89'52'55'V4 I ,4 (n ul I ►7 LOT 16 z ~ TOTAL AREA: \ I 110, 775 SO. FT. 254 ACRES I I MN. FF. E. 1006.0 1 i I r I ~ r 33.00' 1 I 321.00' t --N89'52'26"W 354.00'-----~` 4s 3 OMLOT 1. 'Z C 66' I TOTAL AREA: Ww Z` NCX 2 to. I I~ 2,394 SO. FT. OQ r 13 n na e PrC r^. n n~` ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address " C) C" Property Address 3 zt, (Verification required from Planning & Zoning Department for new c n ction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location Sec. , T 3N R W, Town of /V . Subdivision C f~ /vi b p 1~4 1L 4 , Lot # t6) Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house <:f-cl no Lot lines identifiable e 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warm deed recorded in Register of Deeds Office. Number of bedrooms ? ;~~4ATTJRf O AP ICANT(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. 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Please print all information. a ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). fU3 .12 Property Owner Property Location Govt. Lot 1/4 1/4 S25 T N R I 8--f (.r) _W 1qW -10 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City Village Town Nearest Road New Richmond WI. 54017 (715 )247-5721 Richmond 140th, S t. ( New Construction Use: ❑ Residential / Number of bedrooms - 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: _ Parent material glacial drift o Plain elevation if applicable na ft. General comments t ( / and recommendations: f QfR~ $B~NQ S~9 0 trenches 3.50` below grade, spaced to cod( 0. C O Wat- F1-1 Boring # Boring 96.10 _ _ ® Pit Ground surface elev. _ ft. Depth to limiting factor +85 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~\,t L 2msbk DsH cs if -R 4 55-85 7.5 4 6 none s as M-'7fr -7 1-2 ►c ~ $ 41 1 Boring # Boring - F2-] ❑X Pit Ground surface elev. 96.10 ft. Depth to limiting factor +85 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 4 45- 7 4 4 none 1 k mfr aw na -5 -9 5 55-85 7 5 r4 6 none ms os ml na na 7 1.2 1 Z y7 '444 1 ' Effluent #1 = BOD > 36:< 296pg/L'and TSS >30 < 150 mg! ' ffluent #2 = BO < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gar L. Steel 02298 Address Date valuation ond, ed Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 10-20-2000 715-246-6200 Property Owner g T C n-T_i -,pme t r Inc. Parcel ID # pending Page 2 of 3 Boring # E] Boring - 3 Ground surface elev. 95.20 ft. Depth to limiting factor +84 in. © Pit 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 3 38-60 7.5 4/4 none Sl 2msbk mfr fna 5 ❑ Boring 95.30 +86 ❑ Boring # 4 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 4 ❑ E Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 = 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 (RAM) Property Owner R j C- Devele Inc. Parcel ID # pending Page 2 of 3 Boring # ❑ Boring f _ I © Pit Ground surface elev. 95. 20 ft. Depth to limiting factor +84 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 3 38-60 7.5 4/4 none Sl 2msbk mfr CFW na 5 Boring # ❑ Boring 95.30 +86 4 D pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 5~~4/4 PQ Pe q1 2msbk ffEfr- --9W ---S Ogg 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. Munseli 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 = SODS < 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.6=) r r STEEL'S SOIL SERVICE Gard, L. Steel RJC Development, Inc. 1554 200th Ave. CSTM2298 NW4SW4 S25-t30N-R18w New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #16-Richmond Hills N 1"=40' B = of sw lot corner @ el. 100.00' i lt. BM = top of 1" pvc pipe @ el 97 55' 3z~~ Gary L. Steel 10-20-2000 Lr Steel a-20-2(}''Cl oo s I r~ D i> S89'52'55"E 616.78' 00 t 1 130.91' 309.00 tl.! 307.78' ~ _ , ~ , - N ; 244.40' i L,4 i tp + 'V i ~ W . 49..84; 372.38' . W oz i I r cv jIt) Drainage Easement t3 i I In ►n i LOT 17 L0 i ( O C'4 TAL AREA: TD (V ( z O i ad tit 91,979 SO. FT O i I Z z 2.11 ACRES F.F.E. 1006.0 O i ( O N89'52'55*wc LOT 16 TOTAL AREA/ 4~l 110, 775 SO.T.~ _ I 2.54*ACRES MIN. F.F.E. 100 .0. ' ` 33.00' 321.00' { f `'--I --N89'52'26"W 354.00'------''~ 4s /r I ; OMOT ~1. ( 66' I TOTAL AREA: W i `r ~'7~ t1, o` °s t 3 2, 394 SO. FT. oi~~ryr° Lpoo ( I 0.06 ACRES nu)) 133' I'~ LOT -2 ty~ . N`7`J, LO' rn