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Parcel #: 040 - 1122 -30 -000 12/22/2005 03:43 PM
PAGE 1 OF 1
Alt. Parcel #: 32.28.19.507 040 - TOWN OF TROY
Current X; ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
GARY J MOELTER O - MOELTER, GARY J
444 CTY RD M
RIVER FALLS WI 54022
Districts: SC = School SP = Special P operty Addre�ss(es' ' = Primary
Type Dist # Description ' W1131 CTY RD M
SC 4893 SCH D OF RIVER FALLS P dGtile�o
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 32 T28N R19W 40 AC SE SW Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
32- 28N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
01/03/2000 616409 1481/252 TD
07/23/1997 1002/517 QC
2005 SUMMARY Bill M Fair Market Value: Assessed with:
102999 Use Value Assessment
Valuations Last Changed: 09/06/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.000 7,100 7,100 NO
UNDEVELOPED G5 2.000 100 100 NO
OTHER G7 1.000 10,000 1 125,600 NO
01,5p � 13� --5,
Totals for 2005:
General Property 40.000 17,200 115,600 132,800
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 17,200 53,200 70,400
Woodland 0.000 0 0
Lottery Credit Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 040- 1122 -70 -000 12/22/2005 03:46 PM
PAGE 1OF1
Alt. Parcel M 32.28.19.510A 040 - TOWN OF TROY
Current X',, ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
JOHN J & GEORGINE FAM TR MOELTER O - MOELTER, JOHN J & GEORGINE FAM TR
W11311 CTY RD M
RIVER FALLS WI 54022 -4737
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 35.467 Plat: N/A -NOT AVAILABLE
SEC 32 T28N R19W SW SE EXCEPT C.S.M. Block/Condo Bldg:
7/2064
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
32- 28N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
07/23/1997 1002/517 QC
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
103003 Use Value Assessment
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 33.467 5,200 0 5,200 NO
UNDEVELOPED G5 2.000 100 0 100 NO
Totals for 2005:
General Property 35.467 5,300 0 5,300
Woodland 0.000 0 0
Totals for 2004:
General Property 35.467 5,300 0 5,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
,d Building Division
INSPECTION REPORT Sanitary Permit No:
• 487968 0
NERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
.'sonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
, ermit Holder's Name: City Village X Township Parcel Tax No:
Mo elter, Gary Troy, Town of 040 - 1122 -30 -000
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range/Map No:
)3.
? " f
At
32.28.19.507
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic /v Benchmark / y_
Dosing 66 Alt. f Q e da r l
�y'T G
Aeration Bldg. Seher � � / `� 0� • , /
Holding St/Ht Inlet S„jj -I/ •�fC)
St/Ht Outlet i^
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic f fj Y�Ca ►�NJ /� Dt Bottom
Dosing �� ! / Hen.
Aeration Dist. Pipe
Holding Bot. System •� q 7
Final Grade / Z
PUMP /SIPHON INFORMATION �— � 3 I o
Manufacturer / Demand St Cover
GP / / . /
o � 0
Model Number pe - / /�7
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. 2 r/ Dist. to W , r7._ / fj
SOIL ABSORPTION SYSTEM / 4
BED /TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 02 f.4 /„( /'
SETBACK SYSTEM TO I P/L JBLDG WELL LAKE /STREAM Manu r: AIW
IN Type System: > / � � �b R Model Num ber:
L_ I DIS RIBUTION SYSTEM 1Z 61�49 W1 oq 4
Header anifold Distribution x Hole Size I x ole Spacing Vent to Air Intake
2 / Pipe(s) Length Dia I Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center 1 9
/Trench Topsoil Edges To o
g p I =; i Yes n No Yes 11 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:� /Q/ 6 Inspection #2:
Location: 442 Coun Roayd,�M h ver Falls,, // WI 54022 (SE 1/4 SW 1/4 32 T28N R1 9W) 40 acres Lot f � � P j arcel No: 32.28.19.507
.{
1.) Alt BM DescriptionlJ "' , � } J l �N,II- I U+OtINQ��� �6T^S 1 i1na�� S0 I'
2.) Bldg sewer length = 75" ` HV J
- amount of cover = 4� /1_4�(- ��i t �
CYyi /D e GC� kc
Plan revision Required? ]Yes
1 1 06 b
Use other side for additional information. v' - - -- --
Date Insepctor's ig ture Cert. No.
SBD -6710 (R.3/97)
Safety and Buildin County
201 W, Wash' ton Ave. P.O.�B�
cdns�n I M C2017C
a lso WI 53 7 - 7162 tary ermit Number (to be filled in
Department of Commerce
(608) 266- 51 n . g 9Gj
to Pi n 1, D. Number
Sanitary Permit Application .5T_ CROIX cOU
In accord with Comm 83.21, Wis. Adm. Code, personal infornittion y provid�ONING OFFI T
may be used for secondary purposes Privacy Law, s15.04(1)( EProject ddress (if different than mailin g address)
I. Application Information - Please Print All Information ¢
q � M
Property Owner's Na me f Parcel a Lot N Block #
® AG��t2 D ( 1 2- - Z - - '30 0 a0
Property Owner's ' M ailing Address Property Location
GO ',k,Section
City tate / Zip Code Phone Number ,/o Q
7G 7 Zs— qi"O T �U N: R�B on e)
- 7
TI. Type of Building (check all that apply) Qr �5 0!, ,'
f Subdivision Name SM Number
i or. 2 Family Dwelling - Number of Bedrooms O C.
❑ Public /Commercial - Describe Use '�✓� 11
❑ State Owned - Describe Use U,4 C6.5 W �X, ' 1`7 + t 1 - 6 ❑City_OVillage VrTownship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
JK New System O Replacement System ❑ Treamlent/Holding Tank Replacement Only C1 Other Modification to Existing System
B, ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. TZpe of POWTS System; (Check all that appl t t 4iTm h
® Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil G At - Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) ,/
V. Dispersal/Treatment Area Information:
Des' n Flow (gpd) Design Soil AP lication Rate(gpdsf) Dispersal Area Required (s Dispersal Area Proposed System Elevation 99
66 ✓ ,/ / a �2 97,6
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Wiber lactic
Gallons Gallons of Units Concrete Constructed Glass
New Existing /n � Tanks -Tanks 'y
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assuule res onsibility for installation of the POWTS shown on the attached plans.
PI ber's Na me (Print) Plumber' Si gnature MP /MPRS Number Business Phone Number
�& i l�to,�J Z Z6 '�� 273
Z
Plumber's Addre ss (Street, City, State, Zip de)
"'e- ( A 4- /�- o /
VIII ount /Department Use Onl
pproved O D' pproved Sanitary Permit Fee (includes Groundwater Dn17ed Issuin gent Signature o St Surcharge Fee) ❑ 0 Reason o enial ob �
TX. Conditions of Approval /Reasons for Disapproval
SYSTEM OWNER: 3�
1. Septic tank, effluent filer and V O C�
dispersal cell must all be services ! ntafntaktsd
as per management plan proNded by plumber.
2. AN setback requirements must be maintained Yv\ Jb �--
as Pa► SAACSI le code / ordinances. J
v
Attach completo plans (to the County only) For the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
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6. 3. Es 409
DOCUMENT No. KATHLEEN H. WALSH
TRUSTEE'S DE REGISTER OF DEEDS
ST. CROIX CO., WI
Vill 1481P 525 RECEIVED FOR RECORD
01 -03 -2000 4:30 PM
Gary J. Moelter, Co- Trustee and Brian J. Moelter, Co- Trustee of John J.
Moelter and Georgine L. Moelter Family Trust for a valuable TRUSTEES DEED
consideration conveys without warranty to Gary J. Moelter Grantee, the EXEMPT V
following described real estate in St. Croix county, State of CERT COPY FEE:
Wisconsin: COPY FEE:
TRANSFER FEE: 165.00
RECORDING FEES 10.00
SEkt sw4 of Section 32, Township 24 North, Range 19 west. MRS: 1
. . . . . . . . . . . . . . . . . . . . . .
NAME AND RETURN ADDRESS
Rodll, Beskar, Boles & Krueger, S.C.
219 North Main Street
PO Box 138
River Falls, WI 54022
61 112a -- 30 - no0
Parcel Identification Number (PIN)
Dated this ZZ' h V day of December, 1999.
JOHN J. MOELTER AND GEORGINE L. MOELTER FAMILY TRUST
m. 1 1 . -- (SEAL) (SEAL)
Gary J. Moelter, co- Trustee Bri n M el er, Co- Trustee
AfTIHENTSCATION AC2C"OiWI,EDGt9,NT
Signature(s) - STATE Cr WISCONSIN )
�p ) 99.
Tf ORG FT COUNTY )
authenticated this day of 19_ Personally came before me this 22ND day of December, 1999
the above named Gary J. Moelter, Cc- Trustee and Brian J.
Moelte o- Trustee of he John J. Moel Georgine L.
Moe er ily Tr me known to a who
exe the f e instrument a , e same_
TITLE: MEMBER STATE BAR OF WISCONSIN ....
(If not '44w
authorized by 5706.06, Wis. State.)
TBIB INSTRUMENT WAS DRAFT&D BY: Notary Public
My commission is permanent. (If no� e:
Stuart J. Krueger
Rodli, Beskar, Boles & Krueger, S.C. .a�ap�►'� —)
P.O. Box 138
River Falls, WI 54022
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer : 4d& C�— 5-
Mailing Address C1 Al LS Gam/ _��Yez
Property Address T z CC9
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number O' 2 2 3o 4 I
LEGAL DESCRIPTION
Property Location �' /a , �]�/ '/4, Sec., T Z g N R_j'? W, Town of
Subdivision �— _ , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (z � , Volume l 't 1 Page # 2
Spec house yes Lot lines identifiable no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and b a master lumber, journeyman lumber, restricted lumber or a licensed pumper verifying that
Y p � J Y P � p P P �g 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.
I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
JO 0 1 WAS
I NATURE OF APPLICANTS) 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 SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS
PER COMM 84.25 CODE CHANGES 2/1/2004
Access Opening, not top of cover, Access Opening, not top of coyer,
must eldend to a point no greater must extend at least
than 6" Below Finished Grade 4" Above finished ' Gf ade . j
Cover with Wi Afi-1 eX V &Md :
(typical) 5'10
Locking Device �N b�'84x APP Finished Grade
i
Min. 23"
30 Access Opening
1 M 15 UL Min. 23" Access Opening
Oulet Effluent Filter y Lv /TH if "o% S'E
Union jQ,2oYEA /P� ,3 Pr.
Inlet Baffle
eel
i
Pu p
3
d Twa Compa
r�"ment SepticlPump Tank C ,/,, k v al e � . on vide W& AIT)
r� SPECIFICATIONS
TANK MFR: G7� DOSES PER DAY:
TANK SIZE: SEPTIC GAL. DOSE VOLUME: Z GAL.
DOSE 9 GAL. (INCLUDES FLOWBACK & <20% OF DWF)
ALARM MFR: CAPACITIES: A = INCHES= i GAL.
MODEL # � , Z GAL.
Switch type: B = — 2 — INCHES =
PUMP MFR: vu C = _ INCHES = l Z GAL.
MODEL M . r 11 _
SWITCH TYPE: D = INCHES = Z 3. & GAL.
REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e)
VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) Z FT.
MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + FT.
A FT. OF FORCEMAIN x 3,30 FT. /100 FT. FRICTION FACTOR ...... _ + 4A FT.
TOTAL DYNAMIC HEAD (TDH) _� , t, FT.
INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH
MP/MPRS SIGNATURE: LICENSE NUMBER: /X 2 Z6 % / 7
i
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner G Septic Tank Capacity Z>7b al 13 NA
Permit # Septic Tank Manufacturer 13 NA
DESIGN PARAMETERS Effluent Filter Manufacturer "Z L ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) g al/day Pump Tank Manufacturer 46*7C ❑ NA
Design flow (peak), (Estimated x 1.5) �d gal/day Pump Manufacturer �,� Lp ❑ NA
Soil Application Rate is al /da /ft2 Pump Model 1 0 C-r- ❑ NA
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:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD,) 530 mg /L X 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 Y in dia. ❑ NA Other: ❑ NA - 7 Other: ❑ NA Other: ❑ 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 eve ❑ month(s) (Maximum 3 ears) ❑ NA
p �'� 10 year(s)
y
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
IN year(s)
❑ month(s) ❑ NA
Clean effluent filter At least once every: ® year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
M year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
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 cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to 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)
Page '?, of Z
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 chemicals
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 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 reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name ����}� Name
Phone W Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name Cl'P ti
Phone Phone '71' ? 9 1 010
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
[RGOULDS PUMPS Submersible
Effluent Pump
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SPECIFICATIONS MOTOR FEATURES
Pump — General; General: ■ Corrosion resistant
• Discharge: 1'h" NPT • Single phase construction.
• Temperature: 104 °F (40 0 q • 60 Hertz ■ Cast iron body .
maximum, continuous when a 115 and 230 volts 0 Thermoplastic impeller and
fully submerged. • Built-in thermal overload pro- cover,
• Solids handling: 'h" tecaon with automatic reset ■ Upper sleeve and lower
maximum sphere. • Class B insulation. heavy duty ball bearing
APPLICATIONS ' Automatic models Include a • Oil -filled design, construction.
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
• Effluent/Dosing Systems PE31 Pump: • 115 volts operation.
e e
Low Pressure Pipe Systems Mawmum capacity: 53 GPM Shaded pale design ■All ratings are within the
• Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor.
.. • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■Quick disconnect power
Dewatering • Maximum capacity: 61 GPM a 115 and 230 molts 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
• Maximum capacity: 70 GPM • .50 HP, 3400 RPM p lug .
• Maximum head: 37' TDH • 115 and 230 volts p unit is heavy duty,
• PSC design ptable and compact.
METERS FEET g ■ Mechanical seal is carbon,
40 i I • I �— _,�, ceramic, BUNA and stainless
Pip ( - I MODELS: PE31, PE41, PE51 steel.
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INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY
(a) The structural integrity of each chamber, and plate, wedge and other accessory manufactured by Infiltrator ( "Units"), when installed and operated
In a leschfield of an onslte septic system in accordance with Infiltrator's instructions, Is warranted to the original purchaser ("Helder") 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. Q
(b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SYSTEMS INC
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 does
not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of Environmental Onsite
Wastewater Sol
production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically
excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of
the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the 6 Business Park
Road • P.O. Box 768
minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing 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 Old Saybrook, CT 06475
any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limned
Warrant 860 - 577 -7000 • FAX 860 - 577 -7001
Further, in no avant shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or ship- Q �f �f
ment, or from any product liability claims of Holder a any third party. For this Limited Warranty to appN• the Units must be installed in accordance V 00 -22 - 4436
with all site conditions required by state and local codes; all other applicable laws; and Infilti ator's installation instructions.
(d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the origi-
nal Holier.
The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of slates and counties have different warranty require-
ments. 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.
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 and SideWinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc.
is a registered trademark in Mexico. Contour, Contour Swivel Connection, MicroLeaching, PolyTuff, SnapLock, Chamber PosiLock, QuickCut, QuickPlay RECYCLED PAPER
and Quick4 are trademarks of Infiltrator Systems Inc. Q 2003 Infiltrator Systems Inc. Printed in U.S.A. Q011203HP -0
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Wisconsin Department o TION REPORT Page 1 of
3
Division of Safety and Bu cordance s. Adm. Code Coun ty ST. CROIX
Attach complete site pl "8 g/2 x 1 inches in size. Plan must
include, but riot limited point (BM), direction and Parcel I.D. (PENDING)
percent slope, scale or dimensions, R n and distance to clearest road.
Please print all information. Reviewed Date
Personal information you provide may be used for secondary Purposes (Privacy Law, s. 15.04(1) (m)). 46 /
Property Owner Property Location ❑
•
GARY WELTER Govt. Lot - -- SE 1/4 SW 1/4 S T 28 N R 19 E (or) W
Property Owners Mailing Address Lot # Block # Subd. Name or
444 C.T.H. M - — CSM Pen
Oily State Zip Code Phone Number tty � Village E]Town\,____Negmd Road
River Falls, WI 1 54022 ( 715 425 9448 C.T.H. M
Q New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replaoement Pubic or commercial - Describe:
Parent material outwash Flood Plain 7elm' }� General comments Conventional In- ground trenches =�purnping required
and recommendations:
To be designed by Roger Nelson
o Bonng # o Boring
ctor 6U
Pit Ground surface elev. 98.71 ft. Depth to limiting fa
ID in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
1 0 -8 10YR2 /1 — I 2f -mabk mvfr as 2vf -m 0.6 0.8
2 8-16 10YR2/2 — sil 2fabk mfr cw lvf-m 0.6 0.8
3 16-26 10YR3 /4 - sil 2fabk mfr as lvf -m 0.6 0.8
4 26 -31 10YR3/6 — sl 2f -mabk dsh cw lvf-m 0.6 1.0
5 31 -60 10YR3/6 — is lmsbk mvfr -- lvf-m 0.7 1.6
Horizons 4 & 5 have some gr.
2 Boring # Boring 96.71 52
❑ ✓
El Pit Ground surface elev. ft. Depth to limiting factor lo.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture &r u t ue Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2
1 0 -12 10YR2 /1 — 1 3f -mabk mfr ai 2vf-m 0.6 0.8
2 12 -18 10YR2/2 — sil 2fabk mfr cw 2vf-m 0.6 0.8
3 18 -27 10YR3 /4 — sil 2fabk mfr cw lvf-m 0.6 0.8
4 27-33 10YR3 /4 - A 2fabk dsh cw lvf-m 0.6 1.0
5 3342 10YR3/6 — is I fsbk mvfr cw lvf-m 0.7 1.6
6 42 -52 7.5YR4/4 - sl Ifa mfr aw lvf-m 0.4 0.7
7 52 -56 7.5YR4/4 f2f 75 YR 6 Om fr — — 0.2 0.6
"
Effluent 01 ■ SOD > 30 220 nV& 130 50 MA 6k 02 ■ BOD 130 mgll and TSS < 30 mg/L
CST Name (Please Print) CST Number
Mary 7o Hollister 224832
Address th Evaluation Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 09-27-05 (715) 426 - 1775
Property Owner MOELTER, Gary Parcel ID # (P ending) p age 2 of 3
1-71 Boring # Q Pit Ground surface elev. 99.46 ft. Depth to limiting factor 55 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 I *Eff#2
1 0 -12 10YR2 /1 -- I 2f-ma&sbk mfr ai 2vf-m 0.6 0.8
2 12 -16 10YR3 /4 — sil 2fabk mfr cw lvf-m 0.6 0.8
3 16 -24 10YR3/4 -- sl 2f -msbk mvfr as Ivf-m 0.6 1.0
4 24 -56 10YR3 /6 -- Is lmsbk mvfr — lvf-f 0.7 1.6
Horizons 3 & 4 have some gr;
Horizon 4 has some pockets of sl.
Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD7ft?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I *Eff#2
❑ Boring # H Boring Pit Ground surface elev. ft. Depth to limiting factor in.
Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
In. Mur"ll Qu. Sz. Cont. Color Gr. Sz. Sh. *Efll11 *Eff#2
* Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30:5 150 mg/L " Effluent #2 = 13013 :5 30 mg1L 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.
SM- 8330Test(R.07 /00)
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Parcel #: 040 - 1122 -30 -000 11/02/2005 10:50 AM
PAGE 1 OF 1
Alt. Parcel #: 32.28.19.507 040 - TOWN OF TROY
Current X; ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
GARY J MOELTER O - MOELTER, GARY J
444 CTY RD M
RIVER FALLS WI 54022 -4737
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * W1131 CTY RD M
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 32 T28N R1 9W 40 AC SE SW Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
32- 28N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
01/0312000 616409 1481/252 TD
07/23/1997 1002/517 QC
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 09/06/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.000 7,100 0 7,100 NO
UNDEVELOPED G5 2.000 100 0 100 NO
OTHER G7 1.000 10,000 115,600 125,600 NO
Totals for 2005:
General Property 40.000 17,200 115,600 132,800
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 17,200 53,200 70,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00