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040-1186-90-003
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579040 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Abair, Pat & Debbie Troy, Town of 040-1186-90-003 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No: ftI, ✓ 5 12 p i As ecfi o n 36.28.19.791 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 103.2 Dosing e dl~trt 3,99 Alt. M 110 Aeration Bldg. Sewer rvt IC -r Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom p. I !r CGfDO 0 O Dosing ~ Hepd4 Aeration Dist. Pipe T T7 ~7 9. $ ! 3. Fs 3 Holding Bot. System 9• .9,7 PUMP/SIPHON INFORMATION Final Grade 7 Manufacturer Demand St Cover GPM /I V Model Number ~ TDH Lift/ Friction Loss System ad TDH / 2 l0 . 2n b 1 -1 & Forcemain Length C) Dia. -2-I Dist. to Well u o SOIL ABSORPTION SYSTEM .~j y 5 t DIMENSIONS Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia/ Liquid Dep DIMENSIONS SETBACK SYSTEM TO P L BLDG WELL LAKE/STREAM LEACHING Manufacturer: y INFORMATION CHAMBER OR nfi'Hrattr~ Type of System: l UNIT Model Number: N~9\MbN1~1 121 2b PP~oK, IZo3H-~o DISTRIBUTION SYSTEM ' INKS-, Header mfol Distribution x Hole Size x Hole Spacing Vent to Air Intake 0X Pipe(s) / Length Length is S, 1 cing ~IGU SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Bed Depth Over xx Depth of jxx seeded/Sodded xx Mulch;7,s Bed renc Center Bed/Trench Edges / Topsoil /f ;/Yes ®No rm-, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 72 West Wood Ridge Dr River Falls, WI 54022 (SW 1/4 1/4 36 T29NR19W) Oak Ridge `nLo~t 39 v1 Parcel No: 36.28.19.791 ,,Acres Ir Gt / (7 hQ✓f vV~l ~l 1.) Alt BM Description (ltd" 1 I p 4'I7Z 4 073 ► V ' Y vQOGt 2.) Bldg sewer length ✓Olt s o P f~0 n 1- ~~t r J'V 73 1 S 1 ~1 6 a cl~r~/ava~ - amount of cover = J~ J 60 50 , Q tyt 51~ S ~te / '7 Plan revision Required? Fol Yes No d E~ Use other side for additional informati n. / - Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) PLOT PLAN N Project Name: Abair Replacement Septic System Legal Description: SW114, NW1/4, S36, T29N, R19W P.I.D: 038-1186-90-003 Subdivision Name: Oak Ridge Acres Lot 39 SCALE: V'= 40' Township: TROY Parcel Size: 0.459 County: ST. CROIX System Elevation: T1=93.00' Existing 50.00' Infiltrator 0-40 Trench Slope: 1% to the south T2=93.00' Existing 43.75' Infiltrator Q-40 Trench BM1 Elevation: 100.00 To of Electrical Ped T3=93.00' Existing 43.75' Infiltrator Q-40 Trench BM2 Elevation: 101.63 To of Phone Ped T4=93.00' Existing 43.75' Infiltrator Q-40 Trench Backhoe Pits: T5=93.00 Proposed 45.00' EZ Flow Trench T6=93.00 Proposed 45.00' EZ Flow Trench NOTE: See page 14 for a complete plot of the parcel. T7=93.00 Proposed 45.00' EZ Flow Trench T8=93.00 Proposed 45.00' EZ Flow Trench ^ ~p 4 inch Sch 40 -ASTM D2665 u 00 4 inch 3034 -ASTM D3034 J-)~ ` LOT 3 t 6L' G Z ~ ~ Q/L• } WE LL. ' i `•i~ S_ J Ty G r3 3 - I+O~tS c O T-L G k(of P, %,V 5T /PC A-lEJt1 UA . i IhJe'o0 %Qi3 I ;0 1 pp- I i=Y rJc~ I Lm1 wFtu Page 2 v~tRxxargyr RECEIVED, County Industry Services Division St. Croix a/ ; 4 SP y 1400 E Washington Ave U U L 2 9 7t~~ry 1 6 P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) G. . Madison, WI 7- 62 ST cRaix COUNTY :p S 7cI 0 4/ O anitary Permit Application _ State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit N is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1 (m , Stats. Se ~~rl n 1. Application Information - Please Print All Information Property Owner's Name Parcel # Abair, Patrick JI De-f-- 040-1186-90-003 Property Owner's Mailing Address Property Location G 72 West Woodridge Drive l Govt. Lot City, State Zip Code Phone Number SW 1/4, NW 1/4, Section 36 River Falls, WI 54022 circle one) T28N R19Eor(n II. Type of Building (check all that apply) i Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Oak Ridge Acres ❑ Public/Commercial - Describe Use u` Block # ❑ State Owned - Describe Use ❑ City of CSM Number ❑ Village of a ® Town of Troy III. Type of Permit: Check on one box on line A. Complete line B if applicable) 26 AA-- K A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number d Da Issued Before Expiration Plumber Owner 3,Z ~ 6 IV. Type of POWTS System/Component/Device: (Check all that apply) Non-Press11r1'7ed Tn-Cao nd ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: 457 2 Z:~'IA r< Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed System Elevation 450 Rate(gpdsf) 900 900 93.00' 0.5 VI. Tank Info Capacity in % Gallons Total # of Manuf turer U °J Gallons Units w ❑ & New Tanks Existing Tanks w Z4, I a U in w Septic or Holding Tank 1000 1000 1 Wieser Concrete ® ❑ ❑ ❑ ❑ Dosing Chamber 600 1 Wieser Concrete ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. ness Phone Number Plumber's Name (Print) Plumber' afar MP/MPRS Number T715-760-0486 John Schmitt 7n/ 223760 Plumber's Address (Street, City, State, Zip Code) 616 150th Ave. Somerset, WI 54025 VII I,oC ount epartment Use Only Approved approved ' Permit Fee Date slued Issuing ent Signature r@ eiV"n Reason for Denial $ ? 3Q IX. Condil easons for Disapproval 'etfl%10hJ filter arld` . dais omal celimust all be SiMces maintained per management plan provided by.plumber.. 2. AA ssft Ck r ir`lementsmustb&ttai~tail d. as WAIMi c c& / aiii4il li Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R03/14) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Abair 3 Bedroom Replacement Septic System Owners Name: Patrick Abair Owner's Address 72 West Woodridge Drive River Falls, WI 54022 Legal Description: SW1/4, NW1/4, S36, T29N, R19W Township Troy County: St. Croix Subdivision Name: Oak Ridge Acres Lot Number: 39 Block Number Parcel I.D. Number 038-1186-90-003 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic & Dose Tank Specifications Page 4 Effluent Filter Information Page 5 Dose Tank Cross Section Page 6 & 7 Pump Information & Curve Page 8 System Sizing & Cross Section Page 9 EZ Flow Information Page 10 INFILTRATOR Chamber Specs Page 11 & 12 Management and contingency plan Page 13 Septic Tank Maintenance Agreement Page 14 Existing Tank Certification Page 15 Warranty Deed Page 16 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 7/29/2015 Phone Number: 715-760-0486 Signature: In- round Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Abair Replacement Septic System Legal Description: SWIM, NW1/4, S36, T29N, R19W PAD: 038-1186-90-003 Subdivision Name: Oak Ridge Acres Lot 39 SCALE: V= 40' Township: TROY Parcel Size: 0.459 County: ST. CROIX System Elevation: T1=93.00' Existing 50.00' Infiltrator Q-40 Trench Slope: 1% to the south T2=93.00' Existing 43.75' Infiltrator Q-40 Trench A BM1 Elevation: 100.00 To of Electrical Pod T3=93.00' Existing 43.75' Infiltrator Q-40 Trench A BM2 Elevation: 10:1: To of Phone Ped T4=93.00' Existing 43.75' Infiltrator 0-40 Trench Backhoe Pits: T5=93.00 Proposed 45.00' EZ Flow Trench T6=93.00 Proposed 45.00' EZ Flow Trench NOTE: See page 14 for a complete plot of the parcel. T7=93.00 Proposed 45.00' EZ Flow Trench T8=93.00 Proposed 45.00' EZ Flow Trench 4 inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 LOT 3 `t3 WCLi- L B2 +I lL I T 151 ^ % wr LL rs_ n83 T-L I+O~►S r f/ovo~Gc+a A~26c pR,%VtwAq 5T/PC W ZA 11GL A-lfl0 j~aoc Stu - Z 8>tit ~ FE tJo:- LoT wtu Page 2 are-009/000 IM :31IJ 9 S1b 8 -S Z ~ -008 Z \ :dnOd-1SOd :31V0 00/00/00 :3140 09Lb9 IM `N0021 N301VW OL JMH Sfl 9lL£M ivnN` V4 Olld3S w O :Hnod-32ld „0-,L=„b L 3lVOS dOM M NMV2l0 3139UUDU 1313'M w \ ?JN-009/00OLdIM N 0 ui ~ J w N Z J U cL D 0 co 0 C7 J O' FY v ¢ w 0- U) wm w LA CL 0 OO w F= am ° w a m o Q W (n U w LLI O a a a V) 00 LU p a m° :"c zz a w ¢ H0 o a zJ= Q U mj z 3 LL o¢ `n -J LL a 0 Q a ° °mN wow 0~ z 0~ ° Q a Vi a_ Q U O° J JQ L,°N a0 t0 ? En O w Y Cfl /Lw♦ -Q c; C, w~ mwcn r N co ° ¢ v al z 0 a N ) ~U ¢ t it U1-JW C) WQQ Lj~Q ~ OD W P V) d\ z V Q LJJ c0LO x W>d' U Z l (n W U °0 O cn ciiM0~~,,l00QY OOW Q w mFw a. LLI U ~J~jzUZ°~5U zUQ ZOO U ° Z W X ~xLLJ Y a00aww wv_ ¢*c~ Q*0 cD av,0 7 Z3mUm2mJS ° Z U 0W 7 L W p z z O OQ Q w I w 0 c~ w 6£ a > 0 z 1I % f~ II i D II - Il I ~ ~ 11 II I N ~I II I U 3-1 Li Uj V) o I I > II I > II ° 1I J J 0 II „9£ U L f X a o I I Q ~ I h „s ,<8b f LLI III Q II I ~ II ~ ~N r~ Il I I I o ==~h I I --JJ W U U D W z J Q uZb w 4~3?J a „b8 sv „95 Y z a Page 3 • A100'", A300w, A600'w-12 Series Filters Tv The intct al for s`rixxig septic tarries i5 sot by state anJ lxaE code. Throughout the United States tt►.-re r.s a wi:le difercricc I opinion on wttat this interval should be. but most regulatory agen strgg~st two to free years, The label' filter, w ctt does nc increase the ftcquency d servicing for the tank, should be clearedcLsfi itte septa tarn is norrnally inspected and ptmped l lowevef out fitet is vftally scif-cleaning. The continued action cf the anaerobic organisms on the label fief causes Lodged particles to disintegrate and fallto tip t-worn d ev tarn. f )cam fi ter ccda s a Smart: t_,- alarm, you Mil be notif M by an alarm otien the filter needs sFri'x6g. To serniiee the Piker *Settridng at'I,r mtel l'IttY should Qrlr e be done b r"J cortifrd sixtic tank pugw ormso iii STEPt d 111e STEP STEP septic tank Rer-tcvc the tank awes w rnty pt l the filter and Nrrq the tank if hale and side dm m-~cessary to p event any cartridge out at the V)Ids fr^ra esc g to case. he *Va wtcr he W& is removed. STEP STEP tnscrt the firer cartrk* track W is hawing the canndp over the - in a case making we the ,a<.c =s coat tg rinse off t?te cartridge flier cart%* is pr rty wt" water, bnav careful to rinse aiigrk_ and c at Sept gc ;r final back *to tank. hserted in. the case. Replace the septic tw* cow, Nvctes: • If }e=1 live a Fitered Ursa i- kloM Fifer. be see and sqaf ciw die amt Cq_rtng beC+re reoadng the Fitter. ."Jr 9-t Ml I;A'?~ _.:'..t;t;-'I '7IC .r fh-f„5.3'a..3T.i'.SY. ktL3t kYr ~.2y LC-;T'=~i >1:~ Call for :a free ZABEL ZONE' • 1-800-221-5742 -Or Order online: www.zabeizone.com Page * " aX SEPTIC TANK DETAIL / TWO COMPARTMENT WITH PUMP Page-of Owner's Name: Patrick Abair Outlet Elevation ft 91.01 ft Inlet Elevation Finished Manholes w / locking devices and warning label Grade c <---23"Min-> 51■®®t br®®ma00 0 8 0 a a I A (D C Manhole or Inspection _ Opening v 4" stable & Baffle t-I weep hole approved piping 4" stable & Effluent approved piping Filter zr" --------------reserve-(a-)- A alarm on W..---v-- sep ?ration b pump on dose volume (c) pump off dead (d) s Bedding Under Sank INTERNAL DIMENSIONS OF TANK Dimensions Inches Gallons Length in a 18 301.7 Width in b 2 33.5 Liquid Depth 36 in c 5 83.8 d 11 183.4 NOTE: Pump and alarm are to be installed on Total 36 603.4 separate circuits. Tank Manufacturer Wieser Concrete Pump Manufacturer Zoeller Tank Model WLP1000/600-MR Pump Model 53 Tank Capacity 1000/600 gal Alarm Manufacturer Unknown Tank Volume 16.76 gal / in Alarm Model Unknown Filter Manufacturer Zabel Filter Model A-100 DOSE VOLUME CALCULATIONS TOTAL DYNAMIC HEAD CALCULATIONS Design Flow (DWF) 450 gal / day Min Network Supply NA ft Number of Doses 5 / day Passive Vertical Lift 6.81 ft Max. Dose Volume 90 gal ele(H)ader/D.Boxelev. -Pump intake Drain Back 3.1 gal Friction Loss 36' x 0.927 100=0.33ft (Forcemain Length x Friction Design Dose Volume 93.1 gal Loss Factor)/100 Total Dynamic Head 7.8 ft Min Discharge Rate 20 gpm Plumber/Designer Signature: License Date: Page 5 SECTION: 2.20.010 Q&Zl Y/736ag SivcE /~9, 9„ FMOa93 r 0311 Product information resented ® Supersedes p -O ® 0810 here reflects catintia,s at All" time of publication. Consult factory regarding discrepan- cies or inconsistencies. MAIL T0: P.O. BOX 16347 • Louisville, KY 40256-0347 visit our web site: SHIP TO: 3649 Cane Run Road • Louisville, KY 40211-1961 www.zoellercom (502) 778-2731. 1(800) 928-PUMP • FAX (502) 774-3624 COMPARE THESE FEATURES 53 - 57 Cast Iron Series • Non-Clogging vortex impeller • Float operated, submersible (NEMA 6) 2-pole mechanical 55 - 59 Bronze Series switch & variable level long cycle systems available • UL Listed 3-wire cord plug; 9 ft. standard for automatic, 15 ft. standard for nonautomatic (For Pump Prefix Identification see News & Views 0052) • Corrosion resistant powder coated epoxy finish • No sheet metal parts to rust or corrode "MIGHTY-MATE" Stainless steel screws, switch arm, guard and handle • No screens to clog ;YM • Watertight neoprene "0" ring between motor and pump U SUBMERSIBLE PUMP FOR housing ®L DEWATERING ~R • Solid buoyant polypropylene float Tested to UL (SUMP) • Motor - 60 Hz, 1550 RPM, oil-filled, hermetically sealed, Standard Uv78. OR automatic reset thermal overload protected EFFLUENT (SEPTIC TANK SYSTEMS) • Upper and lower sleeve bearings running in bath of oil • Entire unit pressure tested after assembly PASSES'/z' SOLIDS tt • Carbon and ceramic shaft seal C US (Tested to and 1'/z' NPT DISCHARGE i----.. • Maximum temperature for effluent or csazz.z,o8 Standards) dewatering-130°F (54°C) AUTOMATIC • Passes %2" inch spherical solids MODEL • 1%" NPT Discharge. • On point-7%4" • Off point-3" • Major width-10 3/32" • Height-101/16" SPECIAL MODEL FEATURES: MODEL 53 MODEL 55 Cast iron switch case, motor & Bronze switch case, motor & pump housing pump housing Engineered thermoplastic base Engineered thermoplastic base VORTEX TYPE • Engineered, glass-filled, plastic • Engineered, glass-filled, plastic IMPELLER impeller with metal insert impeller with metal insert Stainless steel guard & handle Stainless steel guard & handle Bearing - lower & upper oil fed Bearing - lower & upper oil fed castiron bronze MODEL 57 MODEL 59 All cast iron construction All bronze construction Stainless steel guard & handle Stainless steel guard & handle Bearing - lower & upper oil fed Bearing - lower & upper oil fed cast iron bronze Cast iron impeller Bronze impeller ALL MODELS ARE COMPLETELY SUBMERSIBLE POWDER BN MODEL HERMETICALLY SEALED COATED TOUGH- Watertight - dust tight. Permanently oiled bearings. VARIABLE LEVEL CONTROL MODELS AVAILABLE • Automatic or Nonautomatic SYSTEMS AVAILABLE "53-57"-.3HP,115Vor230V "55 - 59" - .3 HP, 115V or 230V Note: The sizing of effluent systems normally requires variable level BE53BE57 & BN531BN57 available packaged float(s) controls and properly sized basins to achieve required with Piggyback Variable Level Float Switch pumping cycles or dosing timers with nonautomatic pumps. 0 Copyright 2011 Zoeller Co. All rights reserved. Page 6 TOTAL DYNAMIC HEAD/FLOW U- PUMP PERFO CE CURVE PER MINUTE MODEL 5/57159 EFFLUENTAND DEWATERING 20- 1 MODEL 53/55/57/59 W 6 Feet Meters Gal. Liters L) 5 1.5 43 163 g 15 10 3.0 34 129 z - 4 15 4.6 19 72 a 10 Shut-off Head: 19.25 ft.(5.9m) 0 f- 009597 2 37/8 63116 5 4 515 112 -1-11 112 NPT 37$ 10 20 30 40 50 GALLONS OOI' LITERS 1 7- 4 0 80 160 FLOW PER MINUTE i i CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level float switches available • Variable level long cycle systems available • Available with special cord lengths of 15', 25', 35', (50'230V only) 101116 • Alarm systems available • Duplex systems available i 3 3132 SELECTION GUIDE SK858 1. Integral float operated mechanical switch, no external control required. 2. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FMO477. 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. 4. See FM0712 for correct model of Electrical Alternator. 5. Variable level control switch 10-0225 used as a control activator, with "Easy assembly" Electrical Alternator (3) or (4) float system. (pUmnot included.) & discharge pie Single Seal Control Selection U n s Model Volts Phase Mode Amps Simplex Duplex CSA UL M53/55 & M57159 115 1 Auto 9.7 1 - Y Y R@-/5-5&--N5-7/-59- 115 Non 9.7 2 3 or 4 & 5 Y Y * BN53 115 1 Auto 9.7 * - Y Y * BN57 115 1 Auto 9.7 - N Y =T& 230 1 Auto a.a - Y Y OPTIONAL PUMP STAND P/N 10-2421 D57/59 230 1 Auto 4.8 1 - Y Y Reduces potential clogging by debris E53/55 & E57/59 230 1 Non 4.8 2 3 -or 4 & 5 Y Y Replaces rocks or bricks under the pump * Single piggyback switch included. • Made of durable, noncorrosive ABS ° `"`rno" • Raises pump 2" off bottom of basin All installation of controls, protection devices and wiring should be done a qualified Provides the ability to raise intake by adding sections of 1 W licensed electrician. All electrical and safety codes should be followed including the most recent National Electrical Code (NEC) and the Occupational Safety and Health or 2" PVC piping Act (OSHA). • Attaches securely to pump For information on additional Zoeller products refer to catalog on Piggyback Vadabie Level * Accommodates sump, dewatering and effluent applications FloatSwitches, FM0477; ElectricaiAltemator, FM0466; MechanicalAltemator, FM0495; Sump/ NOTE: Make sure float is free from obstruction. Sewage Basins, FMO487; and Single Phase Simplex Pump Control/Alarm Systems, FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2011 Zoeller Co. All rights reserved. Page 7 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Patrick Abair Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 System Sizing EISA Rating per Foot of EZ Flow 5 ft2 Soil Application Rate 0.5 gpd/ftz 450.0 gpd Design Flow _ 0.5 Soil Application Rate _ ~ EISA = 180.0 Feet of EZ Flow F4 trenches 45 feet long each 4 No. of Cells 4.5 Per Cell 3 ft Cell Width 18 Total No of 1203H 45 ft Cell Length 225 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Typical Cross Section Finished Grade 98 ft Observation Pipe with approved cap or vent , Soil Backfill 36 inch Geotextile Fabric 12 inch O MO bo C:JS tted andAnchored servation Pipe with Cap 93.00 ft Infiltrative Surface >36 inch >3 eet 89.35 ft ••r■a■a■■■■■■aaaa■■■■aaaaa■aa■■a■R■Ra■■■■■■■■■a■■■a■■■aa■■■■..■■ Plumber/Designer Signature: License MPRS 223760 Date: July 27, 2015 Page 8 Installation Instructions for iftEZ OZU1" EZflow Systems in Wisconsin flbyFILTRATOR Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the ite smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, • should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dies and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positioned upward and is • EZflow Bundles : in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric : der before backfilling. • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered. that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 1203H-GEO down along the sides of the product to a point at least six inches from the bottom of product. - - Geotextile Barrier Material 4. When installed in a trench, the trench should be dug to a width of 36 inches. This not only saves labor in excava- 12" tion, but also provides better load-bearing capacity after backfilling is complete. 36" • Page 9 The QuickC Standard Chamber The Quick4 Standard Chamber e B B s ,z- ~L mil ME ]HIM a~ r ~ M EM E112 1211 "M (EFFECTIVE LENGTH) MultiPort End Cap i \ 34" FRONT VIEW SIDE VIEW TOP VIEW Quick4 • • Chamber Specifications Size (W x L x H) ........34" x 53" x 12" (86 cm x 135 cm x 31 em) Louver Height .............8" (20 cm) Effective Length .................................48" (122 cm) Invert Height 8" (20 cm) INFILTRAT2R SYSTEMS. INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, end cap and other accessory manufactured by Infiltrator ('Units"), when installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions, is warranted to the Original purchaser ('Holder") against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; { a 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 y 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 4 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 N F 1 LT R AT O R 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 does not 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 a any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident. 6 Business Park Road - PO. Box 768 misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic Or other conditions which are not permitted by the installation instructions; failure to maintain the minimum ground covers set forth in the installation instructions; the placement of improper materials into the Old Saybrook, CT 06475 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 any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to 860-577-7000 - FAX 860-577-7001 comply with all of the 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 third party resulting from installation or shipment, or from any product liability claims of Holder a any third party. For A ~f~f1 - A A this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other 1-8~a22-fC applicable laws; and Infiltrators installation instructions. 36 (d) No representative of Infiltrator has the authority to change a 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 Infiltrate 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. For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1-800-221-4436. 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 v Canadian Patents 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4 and SideWinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. s a registered trademark in Mexico. ChamberSpacer, Contour, Contour Swivel Connection, Microleaching, MultiPOrt, PolyTuff, POSILOCk, QuickCut, QuickPlay SnapLock and StraightLock are trademarks of Infiltrator Systems Inc. © 2006 Infiltrator Systems Inc. Printed in U.S.A. Pa9Q290908WA-1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Patrick Abair Tank Manufacturer: Wieser Concrete NA Permit # E septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA Number of Bedrooms: 3 rr Septic E" Dose Holding Volume:_600_ al Number of Public Facility Units: r7o A Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft Design (peak) Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.5_ al/da /ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Zabel NA Fats, Oils & Grease (FOG) s30 mg/L Effluent Filter Model: A-100 Biochemical Oxygen Demand (BOD5) s220mg/L NA Pump Manufacturer: Zoeller NA Total Suspended Solids (TSS) 5150mg/L Pump Model: 53 High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L ry` NA Mechanical Aeration Peat Filter ✓NA Total Suspended Solids (TSS) 5150mg/LDisinfection f"` Wetland Petreated Effluent Monthly average r Sand/Gravel Filter Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L NA W In-Ground (gravity) In-Ground (pressure) NA Fecal Coliform (geometric mean) 5104cfu/100ml At-Grade Mound Maximum Effluent Particle Size: % in dia. NA Drip-Line r Other: Other: Other: IV' NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activate month(s) Inspect condition of tank(s) At least once every: 3 ry year(s) (Maximum 3 years NA month(s) Inspect dispersal cell(s) At least once eve : 1.1 year(s) (Maximum 3 years) NA month(s) Clean effluent filter At least once every: 1.1 )f year(s) NA month( Inspect pump, pump controls & alarm At least once every: 1.1 t✓' year(s) NA month(s At least once every: year(s) NA Use T5 - T8 for 5 years then alternate f month(s) NA with T1 - T4 Annually or as indicated At least once eve tLL year(s) mon s b ondin F year(s) 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 Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third 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 Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment 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 30 days of completion of any service event. (Rev.2/05) Page 11 Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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) discharge; 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, pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Name: St. Croix County Zoning Phone: Phone: 715-386-4680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. Page. 125) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Patrick Abair Mailing Address 72 West Woodridge Drive Property Address s a me (Verification required from Planning & Zoning Department for new construction.) City/State River Falls, WI Parcel Identification Number 040-1 186-90-003 LEGAL DESCRIPTION Property Location SW '/4 , NW '/a , Sec_ 36 , T 28 N R 19 W, Town of Troy Subdivision Plat: Oak Ridge Acres Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume Page # Spec house ❑yesOno Lot lines identifiable E]yes[]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 §SPS. 383.52(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 Safety And Professional Services 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 s form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w rann deed recorded in Register of Deeds Office. Number of bedrooms 3 o. 7 /Z/is- SIGNA OF A PL A T(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. 04/12) Page 13 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 72 West Woodridge Drive located at: SW 1/4, NW 1/4, Section 36 , Town 28 N, Range 19 W, Town of Troy , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 7/1/2015 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000/600 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser Concrete Age of Tank (if known): 11 years Permit number (if known) 453120 (12A "AIV rtll John Schmitt (Lffl ensed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 7/29/2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 14 , 0'+ v .0-. 20. , . i 1 r.~ i 110,11- F f f -im I I 04, r 4, RECaSO 1744 wisconsinDeparhrtWof NOV 2 ALUATION REPORT Page 1 of 3 Division of Safety and Buil t~gs in acc5, Wis. Adm. Code A.C.E. Sol & Site Evaluations S County Attach complete site plan on nol~' C i on must St Croix include, but not limited to: ction and percent slope, scale a dmremsions, oath arrow, ato nearest road. Parcel I.D. 040-1186-90-003 Pkew pr** an kwornwlra L By Datp Personal htametim you panda may be used for a wtclery purposes (RWWY Lew, s. 15.04 (1) (m)1. f) 71243 /0 Property Owner Property Location .2 Pat & Debbie Abair Govt. Lot SW 1/4 IWV19 S 36 T `N R 19 W Property Owner's Malurg Address Lot # Block # Subd. Name or CSN 1324 Fpster St 39 Plat Of Oak Ridge City State Zip Code Phone Number I City _j Village 11 Town Nearest Road River Fats WI 54022 715-425-1764 Troy West Woodridge Dr. e New Construction Use: ✓J Residential / Number of bedrooms _ 3 Code denved design flow rate 450 GPD I Replacement J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommandaWns: Instal three trenches at elev. 93.00' using 30 leaching chambers. Boring # JBoring a- _l Pit Ground surface elev. 97.70 R. Depth to limiting factor >108" in. Sod Application Bale Horizon Depth Dominant Color Redox Description Texture Structure Casistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Etf#1 'EfW2 1 0-14 10yr32 none sit 2fsbk mvfr gs 2f n,1 c 0.5 0.8 , 2 14-30 10yr4/3 none sit 211sbk mfr cs 2f,1mc 0.5 0.8 tp 3 30-42 10yr514 none ail 2msbk ds cw lfmc 0.5 0.8 4 42-53 10yr514 none Ifs 2msbk ds 9W tfm 0.5 0.9 S 5 53-108 10yr6/4 none sftft Oeg2msbk duds - 1vf,f, 0.5 0.9 s H#5 oonsisis of an unsorted mix of Osg s, Osg is, &2msbk Its. Loading rate refelc s most resRdW condition found within horizon. 92• i, Boring # J~ rf Pit Ground Surface elev. 98.43 ft. Depth to limiting factor >109" in, soil Application Rate Horizon Depth Dommani Color Redac Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 '042 1 0-10 10yr32 none sil 2fsbk mvfr gs 2fm,lc 0.5 0.8 2 10-31 10yr4/3 none ell 2fsbk mfr cs 2f,1 me 0.5 0.8 3 3146 10yr5/4 none sill 2msbk ds cW lfmc 0.5 0.8 b 4 46-96 10yr514 none ft 2msbk ds 9W 1fm 0.5 0.9 S 5 96-109 10yr6/4 none / sftft Osg2msbk duds - 1vf,f 0.5 0.9 ~s.tb nt•~b 1 Weathered ihne one fragments observed in 1-194. o an unsorted mix of Osg s, Osg Is, & 2msbk Ifs. Loading note rehicts meet restrictive condition found within horizon. Effluent #1 = BOD s> 30 < 220 mg/L and SS >30 < 150 * E 02 = BOD <_30 mg/L and TSS <-0 mg1L CST Name (Please Print) Signature: CST Number James K. Thompson S_ 3602 Address A.C.E. Sol & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, W1 "M 11/72003 715-248-7767 Property Owner Pat & Debbie Abair Parcel ID # 040-1186-90-003 Page 2 of 3 F3 ]Boring # .j Boring jo Pit Ground Surface elev. 98.12 ft. Depth to limiting factor > 105" in. Sod Application Re- Horizon Depth DormrerrtCoior Redox Description Texture Stricture Consistence Boundary Roots QPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'EA#1 •EtT#2 1 0-17 10yr312 none SO 2fsbk mvfr gs 2fm,1 c 0.5 0.8 (P 2 17-32 10yr4/3 none SO 2fsbk mfr ca 2f,1me 0.5 0.8 3 32-47 10yr514 none sil 2msbk ds cw 1fmc 0.5 0.8 4 47-84 10yr5/4 none ft 2msbk ds 9w Urn 0.5 0.9 (5 84-105 10yr6/4 none sAsAFs Osg2msbk duds - 1vf,f 0.5 0.9 s (off Htf.9 consists of an unsorted mix of 089 s, 0sg OK 21 W& ifs. Loading rate refekxs most restrictive c orKwon found within horizon. ❑ Boring f I Boring ft. Depth to limiting factor in. Pit Ground Surface elev. n9 Sal Application Rai Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots QPDff in. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Efr#1 "002 Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Hoozon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDAF in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 'Eff#2 Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS <3o mg/L and TSS <_0 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. ■ So./ ¢t~a/ua x.'0.7 ~ ♦ ~'ler/a~ron i /70 ~i o~ v )K /1G s/e,De 9B3r'a.f ~g v ♦ b~c:Id;n~ safe e ti~° 3 0 6000d,P-d80- Drive ■ ~o ,.c.- 0 I 1067577- s 9zsa' JO 1-Z rwh T'ao o~ eIee.. ped. d., 7' oi' ~e1e ~or~c 5s"m d e4= 1424. do.' i0 Flea- /O/. 3' fCj. ~ OF.3 2014 Property Record I St Croix County, WI Assessed values not finalized until after Board of Review. Property information is valid as of JUL 29 2015 10.25PM . OWNER CO-OWNER(S) PATRICK G & DEBRA J ABAIR 72 W WOODRIDGE DR RIVER FALLS, WI 54022 FORMER OWNERS PROPERTY INFORMATION PROPERTY DESCRIPTION Parcel ID: 040-1186-90-003 Alternate ID: 36.28.19.791 SEC 36 T28N R19W LOT 39 OAK RIDGE ACRES : School Districts: Property Address: 72 W WOODRIDGE DR SCH DIST RIVER FALLS Other Districts: Municipality: TOWN OF TROY CHIP VALLEY VOTECH Section Town Ranae Qtr Qtr Section Qtr Section DEED INFORMATION Lot: Volume Page Document # Block. 2433 X26 74 390 Plat Name: OAK RIDGE ACRES Plat History: LAND VALUATION (2016) OAK RIDGE ACRES Valuation Date: 20091109 20 NOT AVAILABLE Code Acres Land Value Improvements Total G 1 .459 40,000 192,500 232,500 TAX INFORMATION .459 40,000 192,500 232,500 Total Acres: 0.459 Net Tax Before: 3,204.15 Assessment Ratio: 1.0770 Lottery Credit: 10776 MITI Rate 0.013781366 First Dollar Credit: 63.68 Fair Market Value: 215,800.00 Net Tax After: 3,032.71 Amt. Due Amt. Paid Balance Tax 3,140.47 3,140.47 .00 INSTALLMENTS Special Assmnt .00 .00 .00 Special Chrg .00 .00 .00 B110- End Date Amount Delinquent Chrg .00 .00 .00 1 01/31/15 1,462.48 Private Forest .00 .00 .00 2 07/31/15 1,570.23 Woodland Tax .00 .00 .00 Managed Forest .00 .00 .00 Prop. Tax Interest .00 .00 Spec. Tax Interest .00 .00 Prop. Tax Penalty .00 .00 Spec. Tax Penalty .00 .00 Other Charges .00 .00 .00 TOTAL 3,140.47 3,140.47 .00 Over-Payment .00 PAYMENT HISTORY (POSTED PAYMENTS) General Special Date Receipt # Source Type Amount Tax Status Assess. Status Interest Penalty Total 12/01/14 0 C L 1'07.76 N .00 .00 107.76 01/27/15 31077 C T 1,462.48 P N .00 .00 1,462.48 07/23/15 48696 C T 1,570.23 N N .00 .00 1,570.23 c yO 3-00 d L1 M 0 7 CD p. '30 H. lD r X i 111 I 1 N O O CA Q p A `C iV • CD M 7 N y N 00 CD 0) p r~]/11 N0 (D 00 0. 3 3. t i o .i c v I o o 3 > > c l ow c 0 co A v to z D fD co D W 3 o - to `o z N N n r co) a O o O o c N rT m ~Oro z OOOOi z v_ w o C°2) 0 co C4 ca < Q v v o - M H :3 m o = eD = CD D) N N ~ 0 N C' M z c z :3 0 1 1 n 1 '~O a O O fll CD M ° y CL 0 v, (1) N 0 c c 20 A w a 5 CID w o -4 CO) Q 3 o A Z Q c L* n CD A z O CD v~ a O o' C ~ a W M N QwI < a m z CD ;a o° 3 zZ co z P I w i 0 a CD D c z CL m' c 3 o a I ~ ca z i I d ' CL a X. CD I a j j m I ~ ON N 3 o_ ?i < aro w I cn o W ti b L VENT CAP S- 1YGAIncn rnvvr JUNCTION BOX, 80X. APPROVED LOCKING 4" C.I. VENT PIPE MANHOLE COVER AND WARNING LABEL > 23' FROM DOOR 12" MIN. 1 WINDOW OR FRESH GRADE I GRADE AIR INTAKE 4" MIN , 'd's ELEV.--- + i::.// R IBM MIN... r se-' CaNOUIT IB" MIN. . ELEVATION PROVIDE I R+--, • AIRTIGHT SEAL APPROVED JOINTS A 1 III a, WITH C.I. PIPE ALARM * EXTENDING 3' • APPROVED 'JOINT WITH C.I. PIPE ONTO SOLID, SOIL g I ON EXTENDING 3' I 1 ONTO SOLID SOIL C PUMP ELEV. FT. .~a OFF 0 a C" •iCRETE BLOCK TANK BEDDING ELEV. jr, TANK MANUFACTURER HAS SUCH APPROVAL * RISER EXIT PERMITTED ONLY DOSE TANK a MANUFACTURER L0.A.%L~ NUMBER OF DOSES PER DAY :-L TANK SIZE (GAL) w "/ooo / Gov DOSE VOLUME -T'-- INCLUDING BACKFLOW l ~o G MANUFACTURER CAPACITIES MODEL NUMBER B ~INCHES OR 8 GAL SWITCH TYPE PMANUFACTURER Z599g-t D lo ail/ NOTE* Pump and alarm are to be MODEL NUMBER SWITCH TYPE installed on separate.circuits. MINIMUM DISCHAR RATE Afft GPM VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION .PIPE6%17 FEET •-f MINIMOM NETWORK SUPPLY PRESSURE Al A- FEET ~I FT 100 FT s~ FEET OF FORCE MAIN X o FRICTION FACTOR = .7 oZ FEET TOTAL DYNAMIC HEAD _ co .4 FEET TANK SPECS: EACH 1 INCH OF DEPTH EQUALS / ~GAL INTERNAL DIMENSIONS OF TANK:- LENGTH Al 4, WIDTH 8 y LIQUID DEPTH PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS d V FEMME9 x-n~ aaaaa ^ ~ 1 1 1 1 1 ~ N x 1 1 1 1 I 1 i i i i I R R a tx w IF l i i l ro E i i i gg 0 ' In ~as "a3 J:mz r a $ x 1 ~ a s a n i i i i t i i~ o v / i i l i l i f i f o I. o, R i i i i i i i i i i i d `r° ° M MM c s a B R R a 7 R ' I I a R O 1 I 1 1 1 1 1 I 1 F. i 1 Go o V 1 I 1 1 1 I I 1 1 , 1 ~~iiYY ~ ~ I I 1 , , I 1 , 1 I 1 , R O O N ~ I 1 I 1 1 1 1 1 1 1 1 1 6 rn $ 11yy 1 I I I 1 , 1 I 1 1 1 L~ O U 'U ^ b ~ ~ l l l l l l l l l l l l um.. p '0 a i i ;j! z d s R= i i i .t+ ~x N 9 v~ am r Z n mp owl MI R I 1 1 1 I 1 I i I I 1 1 1 $ Q e qq 1 I 1 1 1 1 1 1 1 1 1 I 1 0 Lo 0) , N ^ 1 1 1 1 , 1 1 I 1 1 1 1 1 v - - - - - - - - - - - - - Q In IA r A m i 1 1 I 1 1 I 1 1 1 I I 1 9 + LLI 1 1 1 1 1 1 1 1 1 1 1 1 _ w of 1 1 1 1 1 1 1 1 1 1 I ~ 1 ~ n U j I 1 1 1 1 1 1 1 1 1 I 1 1 Id Om < co N N ifl 1 1 1 1 1 I 1 I I 1 I I I H U t4i n N 1 1 1 1 1 1 1 1 1 1 I 1 1 c g W Z N ~ ~ 1 1 , 1 I I 1 1 , 1 1 I 1 F g N N 1 I 1 I 1 1 I 1 1 1 I 1 1 6 - J N o w Q h b 1 1 1 1 1 1 1 I 1 I 1 I I 0 8 }}U.' 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JAN. 20D4 800-325-8456 ME:t14_MODO OD-MR I I Monica Lucht Subject: #453120 Nechville/Abair Location: T of Troy, Lot 39, Oak Ridge Acres Start: Mon 8/9/2004 9:00 AM End: Mon 8/9/2004 10:00 AM Recurrence: (none) 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453120 0 GENERAL INFORMATION (AT FIiCH Tt PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Abair, Pat & Debbie Troy Township 040-1186-90-003 CST BM Elev: Insp. BM Elev: BM Descriptio n Section/Town/Range/Map No: I d Jl le 3 A~~ m P onJ~- 36. 1 791 l TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ld ` Benchmark Z,41 /61,61 Dosing lD~ Alt. B G t~ 4.-7q ec, Aeration 2 Bldg. Sewer l2 --s9 W. / S Holding SUHt Inlet !3 03 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic -3& -750 r / 1 Dt Bottom J~ 07, / a Dosing / / 1 -7 1 Header/Man. /a OS 93. 9/ Aeration Dist. Pipe , /a. a5 173.-77 Holding Bot. System _ 11.16 `7Z . 9L PUMP/SIPHON INFORMATION Final Grade (o SZ ~1 7 Se Manufacturer Demand St Cove w..411 GPM ~6 pl, C Model Number n TDH Lif$ Al Friction(.ILoss System Head TDH Ft I -1 5-7 Forc (main Length Dia.Z if Dist. to Well 7 50 / C, I SOIL ABSORPTION SYSTEM BED/TRENCH Width 4 / Lengt No. Of Tenches PIT DIMENSIONS N Of Pits Inside Di Liquid Depth DIMENSIONS -3 J lJb~7J 46(Z \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STR AM LEACHING Manufacturer: n . r INFORMATION CHAMBER OR ✓ , [ 6 Type Of System: / 7 / ' I UNIT ~~i N Model Number: DISTRIBUTION SYSTEM (o T Header/Manifold Distribution 14 to Z x Hole "S,~e x Hole Spacing Vent to it Intake Zt Pipe(s) I '1 Length t7 Dia 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 xx Mu hed Bed/Trench Center ('1 Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:___/ Location: 72 West Wood Ridge Dr U+own (SW 1/4 NW 1/4 36 T29N R19W) Oak Ridge Acres Lot 39 Parcel No: 36.29.19.791 1.) Alt BM Description = LIT 1-11 A 2.) Bldg sewer length = - amount of cover Plan revision Required? Yes No Use other side for additions inf mabon. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Satiety and Buildings Division Court Y N201 W. Washir,3r)6v,6 Pisconsin Madison, 7WEIVE Sanit ry Permit Number (to be tilled in by Co.) (60315 3 2 C~ Department of Commerce an LD. Number Sanitary Permit ApplieatAPR 1 5 200 State Pl In accord with Comm 83.21, Wis. Adm. Code, personal informaprovide may be used for secondary purposes Privacy Law, s15.04 1)(m)S CROIX COUNT Proje t Address (if different than mailing address) d D 1. Application Information - Please Print All Information 772' W J J W,,Q( YT; Property Owner's Name Parcel # Lo; # 3 Bfock4, Pa-f f AF-i ~ O 4G - //86 - 40 - em 3 Property Owner's Mailing Address Property Location ,--Al 3 Al c S~ - CO I& A Section City, State Zip Code Phone Number p p 7 T O 7~S- 76Y r7`o (circle one) Rr Pi6t 7* I fS w, SS' 2 T N; R/P E oQ II. Type of Building (check all that apply) 1/// JL6 S rw~ 2 Subdivision Name CSM Num er ,,.r 2 Family Dwelling - Number of Bedrooms J / / ❑ Public/Commercial - Describe Use Y,3 O -F 0Q k pfr C/ ❑ State Owned - Describe Use 29 P, lDoe []City -[]Village P ownship of re Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) ❑ Treannent/Holdin Tank Replacement Only ❑ Other Modification to Existing System A' New System ❑ Replacement System g List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. e of POWTS System: Check all that apply) on -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ 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 aching Chamber ❑ Drip Line ❑ Gravekless Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation qSo 91,00 90/' F ,s p3- pD VI. Tank Info Capacity in Total Number / Manufacturer Site Steel Fiber Plastic tructed Glass te Cons Gallons Gallons of Units WI 4-(pp 4C:,,re New Existing Tanks Tanks Septic or Holding Tank f All, Aerobic Treatment Unit Dosing Chamber AT L VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumbers Address (Street, City, State, Zip Code) g,!~ 7 11w /P S ~o6r-mss GU. S5~o~3 VIII. Cr ount /De artm nt Use Only Appoved El Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui g Agent Si Surcharge Fee) gnature (Nn Stamps) ❑ Owner Given Reason S .2 5) for Denial IX. Conditions of Approval/Reasons for Disapproval rat n nn SYSTEM OWNER. 3~ ~;+a w aCIC S . 1 Septic tank, effluent filter and dispersal cell must alt be serviced / main in as per management plan provided by plUFnber. 2. All setback requirements must be maintained as per appkcable code/ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 x I I inches in size SBD-6398 (R. 01/03) f Pa,t 4 j~ (S Cc)r S`,f 0 ow~r / ~ vel- z ) e F y Ts~,~ 7 8 I P/~ hF-l- 4-=NFL( P06 Frts (,)1- Syo23 71S"-7~i9- 33Z2- q 7, 70 3 ~ ,4 3.7s~OL ILI e' 3 3 4$ ~3 6 Gls~ R. agf W o y ~7.~0 Cot, f6t t 4 14 k- ll~t off F- t' F RI-VF-v (s . U)-T To o Fv Towws~ ;,o 711 96z dab F~~ s w~ S ~a23 7~S 733Z2- t~ ` clr~ c g 7, 70 y1 *V; ~ oL q ca P#-IAA- c 00 3' 3 ,3 t t0~- k_y3 ~8 97-2-0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner AP i- A Septic Tank Capacity al E3 NA Permit # q53 120 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 00 ❑ NA Number of Public Facility Units NA Pump Tank Capacity al A Estimated flow (average) Q al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer NA Soil Application Rate O. al/da /ftz Pump Model 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 (BODs) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Diss rsal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) 530 mg/L 71n-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 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 every: ❑ month (s) ((Maximum 3 years) [3 NA ❑ 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: 13 year( 1(s) (Maximum 3 years ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA lp~year(s) .3 Inspect pump, pump controls & alarm At least once every: ❑ month(s) A ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ yearls) 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 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 (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) Page of 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 replace ent 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 C-Vj1,LF- Name h C Lip. Phone 33;22- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ©/V(5 ~j'~ l G ShVc~ Name .CFo~ K 607N Ncrk Phone" 3 Phone 3 - ~i1G Q~ This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(dM(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. ST CROI K COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND. OWNERSHIP CERTIFICATION FORM Owner/Buyer Am f+ beg bb 1'e /d a,; t Mailing Address 0,2 Y FysY-e i- Property Address ~ c s lido c v (Verification required from Planning Department for new construction)- City/State /~wu A-97 5"Y07"L-Parcel Identification Number D d b - 1196 - g6 - ®O3 • }it) EGAL DESCRIPTION aa~~ _ O~ Property Location S W V4, %4, Sec. _36 T q N-R IF Town of Subdivision ) ©n R d e- r e. Lot # 3~. Certified Survey Map # . Volume j age # Warranty Deed # Volume ;z 4133 , Page # o Spec house ❑ yes ®no Lot lines identifiable 1" yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failurz to handle nwtes. 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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 Zoning Office within 30 of the three year expiration date. da t2t atzu-4 - If/ -La 0 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of ro rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. t~ 00 SIGNATURE OF AP LICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed {1 U 2 4 3 3 P 6 2 6 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co.. WI Document Number RECEIVED FOR RECORD This Deed, made between Rolling Hills Development 10113/2003 08.OOAM Inc., a Wisconsin corporation, Grantor, and Patrick G. Abair WARRANTY DEED - EXEMPT # and Debra J. Abair husband and wife as survivorship marital roperty, Grantees. REC FEE: 11.00 Grantor, for a valuable consideration, conveys to COPYSFEEFEE: : Los' 00 Grantees, the following described real estate in St. Croix CC FEE: PAGES: I County, State of Wisconsin (the "Property"): Lot 39, ak Ridge Acres, to the Town of Troy. Recording Area Name and Return Address N, 4~00-ir A 2y Fdskc S} Q~ ue#- F= L(L5, wa. WoZZ 40-1186-90-003 (Parcel Identification Number) This is not homestead property. f G~ ' 96\ ( 30 :9 28~~ 27 '26 n . V~o ,gag 784 783 82 781 780 3co ~79 565 Nt, 8 5 c. a m IV. 00.00' 100.00' 100.00' 100.00' P9 ,~6 3 a~ 786 - 35 ~a~e` 65 s 1^ 68 ss ` 787 roux( \ 3(O 78 8 r. J ~ elo7oo)1I C ~ ~~g ~ ~ !5 920 1s1\ 817'818 ....51 J .820 821 822 6 81~` 4Z ( z/ 789 ' -m Ay ►1 ~ sa: 37 -7 61 90 814 ~SQ 7/l5sli 33 60 1 1 4JO / 3 38,c ~s~ / 813 24 5666 9 Me 40 9 3 0 3 59 200.00 1 o 812 ~Kcl ~aOj Jc ; 41 200.00' S8(L^rFJt/IT(. -4 r V 794 811 I~1r/ 14 lV - VV 1/4~. E z; wp/l31/Sol s/► ! 42 0 p lyI ~ 41; w g s°:µ 57 810 795 uu01351 1&5 43 °o t<1 56 -4 %5566A 796 0 809 44 0 55 :c- 797 0 808, 2 nlv~if ! ° v 45 0 54 0 807 co I 0 8' ° v4 YJw` 1 46 0 53 (D I 799 0 806 0 4 ° 52 47 800 0 805 48 49 100.00' 100.00' r~ ° 50 51 0 o 801 802 gp4 100.00' 100.00' 803 - _ - W V4 COR _ _ = COUNTY ' SEC- 36 r~ .r---- ALUATION REPORT page 1 of 3 REClio 1744 Wisconsin Department of Con 2 Division of Safety and Buildingjonnot N oin acc85, Wis. Adm. Code A.C.E. Sal & Site Evaluations County Attach complete site plan i lan must St. Crob( include, but not limited toction and percent slope, scale or di, orth snow, ato nearest road. Parcel I.D. 040-1186-90-003 Please print a ll information. iewed By Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Pat & Debbie Abair Govt. Lot SW 19 NW 19 S 36 T 4V R 19 W Property Owner's Mailing Address Lot # -[-Biock # Subd. Name or CSM# 1324 Fpster St. 39 Plat Of Oak Ridge City State Zip Code Phone Number J City village Town Nearest Road River Falls WI 54022 715-425-1764 Troy West Woodridge Dr. _f✓ New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD f Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install three trenches at elev. 93.00' using 30 leaching chambers. ❑ Boling # Borings ~ Pit Ground Surface elev. 97.70 It. Depth to limiting factor >108" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence tBoundEalry Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-14 10yr312 none sil 2fsbk mvfr 2fm,1c 0.5 0.8 2 14-30 1Oyr4/3 none sil 2fsbk mfr 2f,1mc 0.5 0.8 3 30-42 10yr5/4 none sil 2msbk ds cW 1fmc 0.5 0.8 4 42-53 1Oyr5/4 none Ifs 2msbk ds 9W tfm 0.5 0.9 S 5 53-108 1Oyr6/4 none sAsAfs Osg2msbk dVds - 1vf,f 0.5 0.9 H#5 consists of an unsorted mix of Osg s, Osg Is, & 2msbk Ifs. Loading rate refelcts most restrictive condition found within horizon. 56• 92. a Boring # - Boring N Pit Ground Surface elev. 98.43 ft. Depth to limiting factor >109" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 1Oyr32 none sil 2fsbk mvfr gs 2fm,1c 0.5 0.8 2 10-31 10yr4/3 none sil 2fsbk mfr cs 2f,1 me 0.5 0.8 3 31-46 10yr514 none sil 2msbk ds cw 1fmc 0.5 0.8 4 46-96 1Oyr5/4 none Ifs 2msbk ds 9W 1fm 0.5 0.9 S 5 96-109 1Oyr6/4 none sAsft Osg2msbk dVds - 1vf,f 0.5 0.9 , 5- Weathered limestone fragments observed in H#4. consists of an unsorted mix of Osg s, Osg Is, & 2msbk Ifs. Loading rate refelcts most restrictive condition found within horizon. ' Effluent #1 = BOD s> 30 < 220 tng/L and SS >30 < 150 L ' Efft nt #2 = BOD < 30 mg/L and TSS <-X mg1L CST Name (Please Print) Signature: CST Number James K. Thompson k~~ - 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11/72003 715-248-7767 Property Owner Pat & Debbie Abair Parcel ID # 040-1186-90-003 Page 2 of 3 3 ] Boring # Boring Pit Ground Surface elev. 98.12 ft. Depth to limiting factor > 105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 1 0-17 1Oyr3/2 none sil 2fsbk mvfr 9s 2fm,1c 0.5 0.8 (P 2 17-32 1Oyr4/3 none sil 2fsbk mfr cs 20mc 0.5 0.8 3 32-47 1Oyr5/4 none sil 2msbk ds cw 1fmc 0.5 0.8 4 47-84 1Oyr5/4 none Ifs 2msbk ds 9w 1fm 0.5 0.9 5 84-105 1Oyr6/4 none sAs/Iffs Osg/2msbk duds - 1vf,f 0.5 0.9 s H#5 consists of an unsorted mix of Osg s, Osg Is, & 2msbVc Ifs. Loading rate refelcts most restrictive condition found within horizon. ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 ❑ Ong # I 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 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 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. ■ So./ eda/ua.'o.~ 71 i N c; 70' 1 u\ ~I MM z ■ o 3S'Qf ti !1g S/o~oe 99 J~g ~ b~c; Id;n~ 5;fe B 3 c,d o cc~o~,~ d8e 9B. sue" Delve- C007 E041-- i I s 9? sz~' 99 i o rw W e nn (D4 e lee- . p td . I6 . d,,~ To o to /e ~ioyic /oi ssupm L e4- = ioo.Gd,' ,o .Flee! = • 3 P, 3oF3 1744 IL ,ALUATION REPORT „ Wi~onsin Department of Com NOV Page 1 of 3 A.C.E. Soil & Site Evaluations Division of Safety and BuildingiZ h Co m 85, Wis. Adm. Code CjfT Attach complete site plan in s' . Plan must County St Crobc include, tut not limited to: (BM direction and percent slope, scale or dimemsions, n, nce to nearest road. Parcel I. D. 040-1186-90-003 Please print all information. By Dat% Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). D~X3/0 Property Owner Property Location Pat & Debbie Abair SW 1 /4 NW 19 S 36 T: y~ R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1324 Fpster St. 39 Plat Of Oak Ridge City State Zip Code Phone Number ity ~ Village M Town Nearest Road River Falls WI 54022 715-425-1764 Troy West Woodridge Dr. New Construction Use: 101 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement I Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install three trenches at elev. 93.00' using 30 leaching chambers. M Bing # I Boring Pit Ground Surface elev. 97.70 ft. Depth to limiting factor > 108" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-14 1Oyr32 none sil 2fsbk mvfr gs 2fm,1c 0.5 0.8 , 2 14-30 1 Oyr4/3 none sil 2fsbk mfr cs 2f,1 me 0.5 0.8 3 30-42 1Oyr5/4 none sil 2msbk ds cw 1fmc 0.5 0.8 4 42-53 1Oyr5/4 none Ifs 2msbk ds 9W 1fm 0.5 0.9 S 5 53-108 10yr6/4 none sAsft Osg2msbk duds - lvf,f 0.5 0.9 s aE- 3•~ A2 H#5 consists of an unsorted mix of Osg s, Osg Is, & 2"k Its. Loading rate refelcts most restrictive condition found within horizon. . 2 ]Boring # Boring N Pit Ground Surface elev. 98.43 ft- Depth to limiting factor >109" 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. 'Ef1#1 'Eff#2 1 0-10 10yr32 none sil 2fsbk mvfr gs 2fm,1c 0.5 0.8 2 10-31 1Oyr4/3 none sit 2fsbk mfr cs 2f,1mc 0.5 0.8 3 31-46 1Oyr5/4 none sil 2msbk ds cW 1fmc 0.5 0.8 4 46-96 10yr5/4 none ft 2msbk ds 9W 1fm 0.5 0.9 S 5 96-109 1Oyr6/4 none sAsft Osg2msbk duds - 1vf,f 0.5 0.9 S ~S.(6 nl•Ih Weathered limestone fragments observed in H#4. consists of an unsorted mix of Osg s, Osg Is, & 2msbk Ifs. Loading rate refelcts most restrictive condition found within horizon. ' Effluent #1 = BOD as 30 < 220 mg/L and SS >30 < 150 L ' Ent #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson _ 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11172003 715-248-7767 Property Owner Pat & Debbie Abair Parcel ID # 040-1186-90-003 Page 2 of 3 ' Boring F$ Boring # Pit Ground Surface elev. 98.12 ft. Depth to limiting factor > 105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 1Oyr3/2 none sil 2fsbk mvfr gs 2fm,1c 0.5 0.8 , 2 17-32 1Oyr4/3 none SO 2fsbk mfr cs 2f,1mc 0.5 0.8 3 32-47 1Oyr5/4 none sil 2msbk ds cw 1fmc 0.5 0.8 , 4 47-84 1Oyr5/4 none Ifs 2msbk ds 9w 1fm 0.5 0.9 5 84-105 1Oyr6/4 none sAsAfs Osg/2msbk duds - 1vf,f 0.5 0.9 S (o~ ~ H#5 consists of an unsorted mix of Osg s, Osg Is, & 2msbk Its. Loading rate refelcts most restrictive condition found within horizon. ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2 ❑ Ong # _j 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/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD5 <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. 5oi/ et/a/aa 6'o~ 5ca/e: / ='s/Oi N Grp 10/7yV ti . X.1 I o c, /1~ S/e~2 96~5'~czf , b+c;id;n~ vte 01 3 O sty ■ Con 60 v- ~ri t1G of ~ s z sa' 98 or ¢ne ti ar rep a exec. ped. 16. At. To vi-" izl Ass um 677-rev- = loo.eo' ,o . Elev= ioi 63' P , 3 ors