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Home My WebLink About040-1189-30-000L Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 6�714J GENERAL INFORMATION (ATTACH TO PERMIT) state Plan ID No: Personal information you provide may be used far secondary purposes [Privacy Law, s.15.04 (1 )(m)] Permit HoIder's Name: City Village Township Parcel Tax No: Robert & Cynthia Zaborowski TOWN OF TROY 040-1189-30-000 CST BM Elev: Insp- BM Elev: BM Description: SectionlTown;Ftange,'Map No: 36.28.19.834 TANK INFORMATION EL TION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aerat'oyu Holdit - TANK SETBACK INFORMATION PUMPISIPHON INFORMATION Manufacturer Zeuaarid GPM Model Numb TDH Lift rictio s System Head TDH Ft Far ain Length ❑ia- ell SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark z Q dZ.fa t1r7+0 Alt. BM Bldg- Sewer St/HtInlet St}Ht Cutlet Dt Inlet Dt Bottom Header/Man. C tr•L9'f' Dist. Pipe - 92 re -4 1 toS' Bot. System Final Grime C- 3.aq W- sr 5t Cover CWARL�rr Z AVIX �VP.0 �i .q6 Ccan��56e,r ec.� 6.z1 9S_$ai dxi 5�- S L-3�' N Width Length No. Trenches PIT DIIItlEN510N5 Na. Of Pits Inside Dia. Liquid Depth DIMENSIONS i 5� r � 1 SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manufacturer - INFORMATION CHAMBER OR " � AV— Type Of System: }—r{�ewSt` ' 1z, �� j UNIT Model Num� DISTRIBUTION SYSTEM Head r. h9ani of Id I n � z ,,6 q Length_ ❑ia Distri6uti- Pipe(s) Length ❑ia Spacing_ x Hole Size x Hole Spacing Vent to Air Intake b SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over Depth Over xx Depth of xx Seededi5odded Center BedlTrench Edges Topsoil _Yes _ No ImMulched COMMENTS: (Include code discrepencies, persons present, etc.) Inspection 41: 6%-jI_ f Location: 66 E WOODRIDGE DR 1-] Alt BM Description = 2.}Bldg sewer length = - amount of cover - 7 Plan revision Required? [ Yes X No S ' Use other side for additional information.i 58t7-8716 {R.3i97} Pate nsepctor's Signature Inspection 92: r� QM47- J qR 3 Cert- No- 0 ST. CROIX COUNTY ZONING OFFICE CERTLFICATION STATEKENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) 'Certify 9 A G,a�ard S >' This is to rtify that I have inspected he existing septic and/or dose tank presently serving the following residence: Or O J (�`� - 3C9 _ Oe)o (Street address) r located at: '/4, '/4, Section Town _N, Range-)V—W, Town of , St, Croix County Wisconsin, Upon inspection, I 4rtify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service t3�'1 Did flow back occur from absorption system? Yes (if no, skip next line,) Approximate volume or length of time: Tank Capacity: 1 ❑ Construction: Pref b Concrete C Manufacturer (if known): Age of Tank,(if known):. Permi't numb er (if known) (Licensed Plumber Sign re) 61 oiler (Title) (Date) - No-4— gallons minutes Steel Other S W ( rint blame) (LicenseNu b er) MP Forum- to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.061 Wisconsin. Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 me�[Eu p Industry Services Division County SAN-2024-077 ` 1400 E Washington Ave Sanitary Pcrmi[ Number (w be tilled in by Co.) APR 4 9 2624 P.a_ Rox 7162 Madison, wl 53707-7162 ermit Application 0allitiryIn State TransastanNurnbcr accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate guventmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PONN7S are submitted to the Department ❑f Satety and Professional Sen-ices. Personal information you pro,idc my be used for secondary purposcr in accordance with the Nvacv Law, s. 15,04(I)(rn), Stats. 1. Applica(Ion Inforroatlan — Please PrinI All Information Propertyrrf% Naamme� Parcel�4 Property Owner's Mailing Addr5as Property location tiUVl, i-U[ E. ./4 u7 r City, State j Zip Code Phone Number T�N; Rone circle nr25 £ 4 lI. Type of Building (check all that apply) Lot Subeimision stone 1 or 2 Family Dwelling — Number of Bedroams. [ Block ❑ Public/Commercial — Describe Use ❑ City of CSM State Qamcd —Describe ❑ Use ❑ Village of Number C Town of �rJE] J 11I. Type of Permit: (Check only one box on fine A. Complete Iine 8 if applicable) A. ❑ New System Reptacemcnt System ❑ 3-rratmendHnlding Tank RLtlacement Only ❑ Other Moditicatinn to Existing 5ysteru [explain) 13- ❑ Pernait Renewal ❑ Permit Revision ❑ Change of Plumber ❑ PermIL Transfer to New I.rst Previous Permit Number and Date Issued Before Expiration Owner 1V. Type of POW N Sys le rn/C orn9nettCID evice: Cheek all that apply) Von -Pressurized In -Ground ❑ Pressurized In-Cn•ound ❑ At�iradc ❑ yfuund ' Z4 in. nF suitable soil ❑ Mound 24 in- of ad ahle soil holding Tank ❑ Other Dispersal Component (explain) ❑ Prctreatmeot De ricc (explain) V. Dispersal/Treatment Area Information: 3 }( $Y Dcsi Flow igpd] Design Soil Application Ratc(g f) Dispersal Area Required ibfl Dispersal Area Proposed isf) System Elevation ,t� ..1 x.1 1 j � • � Y �,�'l G� � , VI."tank Info Capacity in Total a of Alanufacturer Gallon Gallons Units } � ` xi a Tanks-xis[in -anks zttit)Stew a cc .0 v. p a Holding Tank 6bL �1 L 7 Dosing Chauibci VII. Responsibility Statement- 1, the under aigosd, assume respondbilitl• fur instatlitdon of the POWTS shown on the attached plans. .Plumber's Name fPrintl Plu gnaarre MP P Business Phone Number ivl%, Plumher's Addrtcs (Street, City, S e, Zip Code) f� }r ■ r Countyftartinent Use Only tV7III. l Approved Permit Fcc Date Issued luting Agent Signature q IX. Conditions v Approv _ jre.�i�ie�� _[ L� SYSTEM OWNER: ACr F i z e.us'4 S Wk. �L] 1. Sepbo k, effluentsllsr and dispersal cell at pp fi D� Lk mstrr �4 �ft ��C must be semoed 1 maintained as per f' management plan provided by Number 2-All setback requirements must be maintained as per applk*0 code 1 ordinances attach to rntuplEte ptaav for the system and submlr to the Couotr aoh on paper nor kss than $ 1.1 x It lachcs io stir 4/1 S13D-6398 (R. 08114) p NO 3SOMOOOM a d zA w o r S W .0 .d oz F- Qj 73 II. w II uj a 'Ell A ce / OJ vs L, LLL tin % �� 4-J '" f y t p LL � LL E I 3 a 1 1 LL 1 % -N.Cl3 o �ac \ � O� 6 r o � C ►� d V N l Lo LN IS CL a- J _3e Ln OL Ln �� can 7•� l � ." � r 1 v Ln + CD 0 to �: I M. to OJ \, ' 1 / - Lna E ❑ I eA . C �- L Q1 - mN ui LL chrp IL: tni Ro Z7 17 a _ uzr cxaw a=nmm 1 SAN-2024-077; S! ar of Wi%cDnein Form i — 1982 !I WARRANTY DEED ; DOCUMENT NO. �� VOL 1134rvE 429 Matthew B Dusek a s3.n 1e 'LAUG li RoberC A._%sarowski andCr�thia R. II:3Q A.;.iconveys and warrants to Zaborowsk husbandan3wi£eas rvi�roF:lY�ipmalcita prcper it _ {[�� r •+•Yli'J SPACE A ERVEC FOR RECORDING DATA II, . `•�4_ �••^•-Y�• -• - -_ �f •-,---.••- [! NAME ANO AlwTtJVIN AODFtESS the following described real e5tate in St. Croix County. State of Wisconsim � 5Y (Parcet Identification Numberp IL 1; See attached sheet for legal description. P f' �E f{ i, i� This iS horncxtaad property. (is) >fi—) Exception to warrareti:s: easements, and rights of way of record, it any. Lfatcd this—„-.�______-:;" I -- day of (SEAL) `"' ---- (SEAL) Matthew B . Dusek (SEAL) AUTHENTICATION authenticatcd this ._. day of 1 9_ TITLE: MEMBE12 STATE BAR OF WISCONSIN (Hnot. authorir-cd by §706.11a. Wis. Scats.) 7 PAk.5 INSTRUMENT WAS ❑Fl AF7 ED 13Y ACKNOWLEDGMENT 1 STATE OF WISCONSIN � r SS. ii I.' Pcr5unally came before me thi% _ day of !' 19thelthnve nnmcd so me known to be who executed the fa(egoirt[ *a t ,1Fdgc the same. Joseph D. Soles Attorn-y ac_ Law -� River Falls, WT. 54022 (715) 425--7281 NDtarq [tiign.nturer mac• be authenticated (+r acknowledged. $cMh arc nut My cc, _. 4. -v . W % R R t%Tl [1F: F'.i7 ST•kTF $.tit L7f WISCIDNSF.'V F'O R%, rr.- Z — 19A2 - c-f-- -- County. Wis f,'not, State expiratil7n datC: iSGu _ Vh%cons— Leila! 61.ank C, I+•r M-1-Auk., W+c 5AN-2024-077 Lot Eighty -One (81), Oak Ridge Acres, to the Town of Tray except part of Lot 81 of Oak Ridge Acres in the Tow -reship of Troy, S t . Croix County, Wisconsin, more fully described as follv�;N Commencing at the Northwest corner of said Lot 81, the P07NT OF BEGINNING, of the parcel to be herein described, thence N89058' 43 "E 249.1,1' (recorded as S89"53'E 249.731) on r-he North line of said Lot 81, to the Northeast corner of said Lot 81; thence S85032'5911W 229 . G1' ; thence N48"46' 00 "W 26. 88' on the West line of said Lot 81, to the POINT OF BEGINNING, containing 2,208 square feet, being subject to easements of record. (For purposes of this description all bearings are referenced to the West line of Lot 80 of Oak Ridge a-i..., Tz:.- r c f '• rcy re de RR uvl o007, 00"E. . ) . ■';l4 ,L Ci7 .1,sx ti.aac err•.... .ram ._.x � And part of the Southeast 1/4 of the Northwest 1/4 and the Southwest 1/4 of the Northwest 1/4 of Section 36, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin, more fully described as follows. Commencing at the Southwest corner of Lot $1 of Oak Ridge Acres in the Token of Troy, St. Croix County, Wisconsin, the POINT OF BEGINNING, of the parcel to he herein described; thence N89"53' 00"W 21.051, thence N49001' 25f�w 155 .25' ; thence N85°32' 59"E 20 .32' ; thence S48'46' Ott"E 156 . 91' on the West line of said Lot 81, to the POINT OF BEGINNING, containing 2,208 square feet, being subject to easements of record. (For purposes of this description all bearings are referenced to the West litre of Lot~ 80 of Oak Ridge Acres in the gown of 'Troy, recorded at N00007'00"E.) p NO 3SOMOOOM a d zA w o r S W .0 .d oz F- Qj 73 II. w II � � �y n Lo 0 a 'Ell Auj / OJ rn L' 1LL tin f ] i �� "' 4-J 1 f G p 'LL %41 � 1L E I . and 3 a n Cl3 � C ►� d V N IL Lo N IS-Ln l AP CL O o IS7 .� ti`•I d f]}r'T3 4 m LL G m 9 tir -4) a- J _3e Ln I . ', m PA. B r 1 a a•ChLn P CD o � 0 cu cu 45 un v tt ❑ I i to C L Q1 - ALIz mN trj tL � rp13 I� i r Z7 17 ab cxa w a = uz rn as M SAN-2024-077 Wilconiin Department of Professional Services Divisior> of }ndustry Se Moat v�?f1 rl SOIL EVALUATION REPORT NiAK 20 In accordance with SPS 385. Wis. Adm. Code Countv Attach cc e�■'�$��s a a er of le than 8 112 x 11 inches in size. Plan must include. ST Croix �r�rAI but not Ii C � �rF Terence point (BM), direction and percent slope. Parcel I D scale or dimensions. nort arr Sion and distance to nearest road. 040-1189-30.000 Please print all information. Rev i wed by Date Personal information you rovide ma Eze used for seconda u oses Privac Law, s 15 04m Property Owner Property Location Bob Zaborowski Govt. LotSW ''A NW I. S 36 T 28 N R 19 NJ Property Address F Lot # Block # Subd. Name or CSM# 60 E Woodridge DR 81 9 Oak Ridge Acres I City State Zip Code Phone Number ❑ City ❑ Village ❑■ Town Nearesi Road River Falls WI 154022 (612) 919-0302 _ I Troy E Woodridge DR ❑ New Construction Use M❑ Residential/Number of bedrooms 3 Code derived design Plow rate 450 GPD ❑M Replacement ❑ Public or commercial - Describe: Parent material Loess over sandy and gravelly outwash (Pillat sil) Floodplain elevation if applicable NA R General comments and recommendations suppiementary bonny to verify swl wrrditinns a'reservP. cysiam area :der.iif, ed by Arthur Wegerer an. 5 28'94 LF 08 .00seriattor extei"[; Recornmenn in -ground "evrventional" lr@nthes e31 94 ,^,L'system elev wrm C 7gpdfi2 max laaLipp g rate 17 Boring # ❑ Boring ■❑ Pit Ground surface elev 99.30 ft Depth to limiting factor 't08 in Soil Application Rate Honzon Depth In Dominant Color Munsell Redox Description Qu. Az Cont. Color Texture Structure Gr Sz. Sh Consistence Boundary Roots GPD1Ft2 'Eff#1 'Eff#2 1 0-8 7.5YR 2.511 - I 3mgr mfr gs 3m-vf 0.6 0.8 2 8-20 7.5YR 2.512 - s11 2mabk 2mabk mfr ds 2m-vf 0.6 0.8 3 20-32 7.5YR 313 - SII-sicl mfi gs 1f-vf 0.4 0.6 4 32-38 7.5YR 414 - sl 2f-msbk mvfr gw 0.6 1.0 5 38-50 7.5Y R416 - cos Qsg ml cw 0.7a 1.68 6 (5% rock) 50-108 ' 7.5YR 514 - s Osg mi - 0.7a 1.6a 63r+�/174 Boring # ❑ Baring ■❑ Pit Ground surface elev 100.00 ft Depth to limiting factor '108 In Snil AnnEir.Minn Rata Horizon Depth In. Dominarll Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPDIFt� 'frfP#1 'Eff#2 1 0-13 7.5YR 2.511 1 3mgr mfr gs 3m-vf 0.6 0.8 2 13-29 7.5YR 2.511 - sil 2msbk mfr ds 2m-vf 0.6 0.8 3 29-41 7.5YR 5.212 - sil 2mabk mfr gs 2m-vf 0.6 0.8 4 41-52 1OYR 414 - sil 2fabk mfr gs if-vf 0.6 18 5 (5% rock) 52-58 10YR 414 12d 7.5YR 5.'8 B 10YS &1 sil l fabk ds gs 1 f-vf 0.4c 0.6 6 58-68 7.5YR 416 - Is-s Osg ml cw - 0.7a 1.6a 7 68-108 7.5YR 514 - s osg m1 - 0.7a 1.6a ' E=ttluent FI = HUD. > JU s 220 rr CST Name (Please Print) Ryan Bechei (Advanced Environmental LLC. ) Address W11932 560TH AVE. Prescott. WI 54021 2-Is and I SS a 30 is 150 m IL ' Effluent 02 = BOD. 5 30 m IL and TSS 5 30 Signature CST Number 5A4 1330832 Date Evaluation Conducted Telephone Number 03M7124 (651) 327-0074 SSO-8330 (R04115) o as ]!)oraaoann 3 WJ j Q a t 4 Lu rE F b � I � r L 4--o f �L I l 0 o� 0 0 0 ^Q) W t J QW u CL Lf) N C.J w n fA o � �� _ U) OD fm U m L.l�1 LU •r, C) Quo tn 0 0 9 ao o Ln o Qi CY) o zt CDz? rn n m w o a m a 2t m L L 0) 0 Ln Ln Ln o (u Q) =cncnmm WisconsmOepartrnentoflndus", SOIL AND SITE EVALUATION REPORT SAN-202AeO?7 of 3 LAHor and Hurnan Relations n ..� M C.fwv A R,.fA. r, r_a GQUNTY S-r- CP_-c] t?C Attach complete site plan on paper not less than B 112 x 11 inches in site. Plan must include, but PARCEL l.D A O 41 6- 1 1 8 `3 - 3 O not limited to vertical and horizontal ref ere nce point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road REVIEWED BY DATE. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: L7�J1V1� �_. 4 Z3t—nA t` . PROPERTY LOCATION GBIFE44• S�:_ 1/4 N)W 1/4.S 8 N,A ��[ E(vr�D PROPERTY OWNER'S MAILING ADDRESS LOT y BLOCK t SUBD. NAME OR QSYd t! CITY, STATE ZIP CODE PHONE NUWER [-)CITY ❑VILLAGE ®TOWN NEAREST ROAD C2lut<n2 FttC3 �l St4uzz �7l5yyZS. q5_t1 Y�t77`� k"%VtAbGG DR• t. [4 New Construetion Use lK Residential / Number of bedrooms j ] AddiaQn to e)asting building j ] Repiacement ] ] Public or oomrnercial describe Cade derived da4 flow ASo gpd Recommended design loading rate 0 • bed, gpolit2 o- g trench, gpdtft2 Absorption area required 6 qZ Rom, ftZ S 163 trench, ft2 Maxirnum design loading rate a .1 teed, gw? d • % trench, gpcw Recommended infilbation surface elevations) °l 5 . -f R (as re#ened t4 site planbertdtmark) Additional design I site considerations tS �_%E Q WM 1'b tk) lE'it 1 Ph Gt~ 3 Parent material S L 1 - _UQ49� sINA.p _Flood plain elevation, if applicable VZ, A . ft =Suitable for system U = Unsuitable tzars stem ® S ❑ U WXJ?40 '75 ® S ❑ U w cAaut�n PRESsuRE ®5 ❑ U Ar�w+oE IRS ❑ U SYSTEM IN Flu ❑ 5 ®U HOIDW TAW ❑ 5 e u Boring # '": Ground elev. Sao-5 tt- Depth to limiting tactor 7 cl1) Ground elev. co -a ft Depth ID limiting fam of 7q SOIL DESCRIPTION REPORT Horizons Depth in. DominarltColor Munsell hAot}fes Qu- Sz- Copt Color Texture Structure Gr- Sz. Sh. Cormistance 8dzby Roots GPD/ft Bed tench 1 Z �"►-37 iu�t tz 3�y w -- s l 1 Z'E' s bk till `��. Cam-. - 0�5 u6 _)-.Stir- V4 s ❑ sg rr, l c5 — p•� n S SB-q ❑ `'t CZ Yly h) j - fa.-f ' o.S Remarks. or• ; : a •S Z 0❑ 1CL 31y Z f 5bk � 4Z-Y8 'tag-t[t 31� — 5 � 1 Cabk �t V`�>r• �S - o.t[ 0.5 q$_g oYit Vly S o 55 �,, 1 - o.� `o.t TT' Remarks: ;ST Name: --Please Print Arthur L. W e R e r e r Phone: 715 - 4 2 5- 016 5 _ _- Vembrer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 ,signature �n Date. CST Number: ►,n ,�' �Y � �y_ io0 5�. Z6`�� - - M00576 PROPERTY OWNER �uS�k _- SOIL DESCRIPTION REPORT SAN-20 07L of PARCEL I.D. ��D' I��R_- 3❑ - Boring # ra Ground elev. koa.a ft- depth to limiting factor 7 Cs y" Boring # DA Ground elev. ion • D ft. Depth to limiting f R ,� Boring # 0', Ground elev. 1ck."L ft. Depth to limiting factor ? C)S" Boring # r� �"— I Ground elev. f t. Depth to limiting factor Depth Horizon; in Dominant Color Munsell Mottles Ou- Sz. Cont Coior Texture Structure Gr. Sz. Sh. Consistence Roots GPI /ft Bed w& 1 o-7LL %n-ikz Z Y, dw - .s o.6• Z z6_�C to�cf� 3fy S t � �-`� sbk �� cw �.s �• � 3 �f Lb�tlL 3IL — S C3bk MU'� C5 a.y ti.5 I Remarks. 'An �� - u•5 n.6 Z zz-qo Vk*34 SZ 3 uo_so csbk irru �v o,Ulu.s 313 11 l b+~t rL LO S D 99 h, _ ().'7 a, 8 Remarks: � �-Z3 1D'•tLi' Z l Z S } 1 Z.w� 5 1�k �h `�r ��, � l7- S +�- L� Z Z3-u) toYiz!y Cw - u So %-� m'vi- c 5 SI-CIS I D ye- (r/y - S ❑ s� 4� 1 _ a. ;a. S Remarks: Remarks: SBD-aria{R asrez} PLOT PLAN SAN-2024-077 Page 3 of 3 SCALE 1"- -3O ' i NLT�� L �n 8.3 1 yp• ZOp' Pt.OIEF Lor c-osc L> ev 'P•1� lap, oR[4-li$9-3� `p8 A fib$ �v.y.lDD 4 M00576 715 4�5 - .S.,Y_ CST Signature ~� Date SignedTelephone No. C5 SAN-2024-077 Burney Map far Patricia A. Selfiori-Rossing 4101000 PARCEL AREAS a;ndic;tea I,, x 24" iron pipe weighing 1.13 lbs. Iin./ft. sat. ■ Indicates 2" iron pip* found. Indicates If' iron i a found, �• ►.r9s so.rr. � P P B • P, sae Sn. rr. C - ►90 Se. ►"r. ❑ - P, ror sn. rr, y �M+ l 2910 ■ ■ 1 LOT 79 4L Buss LOT eG N!s /9•S3'!' Poo. 00'1 n N w� 1 o' L� BO \ 8 al BELFIORI - ROSSING x 0` = \ Sw CON., 1 N►9•90'43"F L a r ev z 5a�•Js's9"w s {9.$V FEN CF P4RCEL C oct 61, C a i 81 .►a .` a R," Fps Fox ❑USEK O' 4 +J� Sir CON. LOTC State of Wisconsin) County of Pierce) o a a F. y O .e h O s' W O " s j ► 0 w � rq: N y I } w 4 • 4 ti y It 1 Is Laurence W. Murphy, Registered Land Surveyor, do hereby certify that I have surveyed the above described and mapped property accarding to oFficisi retards and th4t this map and description are true end correct to the beet of my kno"Isdge and baiief. OATI ••fs-•t I :CALK ► " • sc' oRAvvN L WM I LCKATM i As -SO • 13 JOi NO. MOO • a a t -� LAURENCE W. URPHY REGISTERED LAMA SURVEYOR RIVER FALLS, W IS. 54022 SHEET 1 OF 2 e4\sG0IV U m: W R y� i 1713 ' Z ER FALLS ., 4+ L: • . SAN-2024-077 Wisconsin Department of Safety and ProfesslonaI Services Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, ST Croix but not t6mited to: vertical and horizontal reference paint {BIDE}, direction and percent slope, Parcel I.D. scale or dinvensions, north arrow, and location and distance to nearest road. 040-1189-30-000 Please print aii information. Revbewed by Date Personal information you pmvide may be used for secondary prurposes Privacy Law, s. 15.04 1 m . Property Owner Property Location: Bois Zaborowski Govt. Lot SW '/, NW r/ S 36 T 28 N R 19 W Property Address Lot # Black # Subd. Name or CSPA# 60 E Woodridge DR 81 Oak Ridge Acres City State Zip Code Phone Number ❑ City ❑ Vipage 0 Town Nearest Road River Fails J1NI 154022 16129190302 � � Troy E Woodridge DR ! [] New Constructbon Use: Residential! N u m ber of bed room s 3 Code derived design flow rate 450 GPO ® Replacement ❑ Public or commercial - Describe. Parent material Loess over sandy and gravelly outwash (Pillot sit) Ftaadplain elevation if applicable NA ft. General comments an recommendatlona: supp6Ernentary borings to verify sail conditions ad reserve System area identified by Ardiur Wcgarcr on 512&94. LF = >10s" lobseveation exterl Re Gorrrnend in -ground "conventional" tnenchvs at 94.1111 syfAem eleV. with 0.7gpd/V max. loasding rare. El Boring # ❑ paring ® Pit Ground surface elev. 99.30 ft. Depth to limiting factor '108 in. Soil Annlicatunn Rate Horizon j Depth I In. Dominant Color Munsell Redox Description Qu. Az. Cont- Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 ,Eff#1 •Eff#2 1 0-8 7.5YR 2.511 - I 3mgr mfr gs 3m-vf 0.6 0.8 2 8-20 7.5YR 2.W2 - sil 2mabk mfr ds 2m-vf 0.6 0.8 3 20-32 7.5YR 313 - sil-sicl 2mabk mfi gs 1f-rrf 0.4 0.6 4 32-38 7.5YR 414 - sl 2f-msbk mvfr goo - 0.6 1.0 5 38-50 7.5Y R416 - cos Osg ml cw - 0.7a 1.6a 6 (5% rock) 50-108 7.5YR 5/4 - s Osg ml - - 0,7a 1.fia ❑ Boring # ❑ Boring ® Pit Ground surface elev. 100.00 ft. Depth to limiting factor '148 in. SrnlAnnfdrat6nn Rafe Horizon Depth In, Llaminard Color MunseII Redox Description Cru. Az. Cont. Color Texture Stnictuire Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 't=ff#1 �Eff#2 1 0-13 7.5YR 2.511 - t 3mgr mfr gs 3m-vf 0.6 0.8 2 13-29 7.5YR 2.511 - sil 2msbk mfr ds 2m-vf 0.6 0.8 3 2941 7.5YR 5.212 - sal 2mabk mfr gs 2m-v# 0.6 0.8 4 41-52 10YR 414 - sil 2fabk mfr gs 1f-vf 0.6 0.8 5 (5% rock) 52-58 10YR 414 f2d 7.5YR 618 & 10YR 611 sit lfabk da gs If-vf 0.4c 0.6 6 58-68 7.5YR 4Pfi - Is-S Osg ml cW - 0.7a 1.68 7 68-108 7.5YR 514 - s Osg ml - - 0.7a 1.6a ' Effluent #1 = BUD- > 30 5 220 malL and TSS > 30 5 1bO moll- . Ettiuent #"1 = 80D. 5 3{1 mall- and I SS 5 30 ma1L CST Name (Please Print) Signature CST Number Ryan Bechel {Advanced Environmental LLC.} 1330832 Address Date Evaluation Conducted Telephone Number W11932 560TH AVE, Prescott, WI 54021 OW07124 6513270074 ativ-es33u (KU4/1o) Page 7 5AN-2024-077 44 ADVANCED ENV I PON MENTAL Property owner/Client: Bob ?-aborowski PIN: 040-1189-30-000 Site Address: 60 E Woodridge DR, River Falls, WI 54022 County: ST Croix INDEX Pg. 2 SITE PLAN Pg, 3 SOIL DISPERSAL COMPONENT Pg. 4 FILTER MAINTENANCE Pg. 5 MANAGEMENT PLAN Pg 6 MANAGEMENT PLAN Pg. T SOIL TEST Pg. 8 SO I L TEST Pg. 9 SOIL TEST Pg. 10 SOIL TEST Pg. 11 SOIL TEST Pg. 12 SOIL TEST Pgs 1318 AS -BUILT EXCERPT DESIGN PARAMETERS FLOW Wastewater Type: Residential Estimated Wastewater Flow: 300 gpd Design Flow: 450 gpd SOIL & SITE EVALUATION.- POWTS Type: Nan -pressurized Conventional Limiting Condition Depth: 108" Maximum System Depth: 72" Contour Elevation: 100.00' Limiting Condition Etev: 91.00` Land Slope: 2% # Bedrooms (residential): 3 # Occupants (per capita flow): -- Public Facility Flow: NA Treatment Level: Effluent 1 Code Required Separation: 36" Soil Texture: LS In situ Soil Application Rate: 0.6 Dispersal Cell Loading Rate: NA POINTS DESIGNED PURSUANT TO: in -Ground Soil Absorption Component Manual (Version 2.1) Comments: _ __ ;Replacement system for 3 bedroom home. No home business. (3) 55' Ell=low 1203-H trenches with parallel gravity distribution. Fltter basket with effluent flIter to be added after septic tank .■►►►"C0tj'►►,., ioutlet. Divert valve to be installed to allow existing bed system to be used as a backup drain fietd a -► ^ J lithe--- the future. ------ ---------------- = RYIIF! SIGNED: 3/18/2024 ADVANCED ENWRONMENTAL LLC W11932 560TH AVE, PRESCOTT, W! 54021 (651) 327.0074 13ECFfia. DZ253-7 PRESCOTT w wt E •f `•f �E5 t G N �`.t��' ti J y DW¢ V) E 4 U] M Ln !n v= a Ln — W a to D Ufa C 6] C 0 U 0 nl.. 'dtl 9D01V000M 3 V OR Y � ¢ a � b C fV uj o aJL. c c� cj 3 e$ iK cn \ mi aD� V I + ,- + �r r+ n cn Q r44 Q C Ln T6 V ' tr m L ui N cu 0 C) o -c: 'v s e o 0 d m � � N Q Ln Q � rn� °' 22 2� E N 0 �o 22 V I 'C ....................•CN U. Q N ,. € rL- 4-4 Ot ca o a v 12 w + ar = 0 Q !a ,n en ca f r a' E CL — a cy � CA Q 1 1 1 IN'n 00 aw - . F N Lu Wit il M I it ii i = 3, G y E Ln 1 ! I LA i t Ln i uu LU I.— p LW W :k...� � ❑� I 1 I k k H �! i� �� L q f p � 4 Z -...�..�. Inc. Arnnvsriar+F Preca.r. t]rmnage �.: Tahel" d Wa#em'slcr A+oduch � ■ Qiw&m m Pa" M�, INSTALLATION INSTRUCTIONS Step 1: (A) Locate the outlet of the septic tank. (S} Remove tank cover and pump tank if necessary. NSFIAN31 Starrdwd 46 MAINTENANCE INSTRUCTIONS Step i : Locate the outlet of the septic tank. DO NOT s USE RUBBER GLOVES WHEN CLEANING FILTER INSTALLATION INSTRUCTIONS PL-1221PL-5251PL-625 FILTER Centel filter with opening 0 i C7 ofx wLn J � LLD 2 Additional pipe or Qolylok Extend & Lok' for centering. Step 2: (A) Before installation, place the filter housing on to the outlet pipe (13) Make sure that the housing is positioned so the filter can be removed from the tank for maintenance and service. Step 2: (A) Remove Lank cover and pump if necessary. (B) Pull the filter out of the housing. (C) Hose off the filter over the septic tank. Make sure all solids fail hack into the septic tank. Step 3: (A) Glue the filter housing on the outlet pipe. (B) Insert the filter cartridge in the housing, making sure the filter cartridge is properly aligned and completely inserted in the housing. Step 3: (A) Insert the filter cartridge back into the the housing making sure the filter is property aiighed and completely inserted. (B) Replace septic tank cover Polylok, Inc. 3 Fairfield Blvd, Walhngtord, CT 06492 Toll Free: 877.765.9565 Fax: 203.264.8514 www.polylok.16age 4 MANAGEMENT PLAN SAN-2024-077 The owner of this Private Onsite Wastewater Treatment System (PCWTS) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. This management plan identifies operation and maintenance activities necessary to ensure long-term system performance. Tasks that should be performed by the homeowner are identified. Professional management tasks shall be performed by a registered PffiVTS Maintaloer in accordance with SPS 383.52 (3), Wisc. Admin. Code, however, it is the homeowner's responsibility to ensure all tasks get accomplished in a timely manner. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. ■ Keep this Management Plan with your Septic System Owner's Guide. ■ Keep copies of all pumping records, maintenance activities and repair invoices with this document. ■ Review this plan with your POWTS Maintainer at each visit; discuss any changes in product use, activities, or water -use, MANAGEMENT FREQUENCY DeWe Parameters system Spedficaflons Number of Bedrooms . 3 Septic Tank Manufacturer Design Flow (gpd) 450 Septic Tank Capacity (gallons) #N/A Soil Loading Rate (gpd/ft2) 0.6 Effluent Filter Manufacturer Standard Effluent Quality Effluent i Effluent Filter Model Biological oxygen Demand (SOD) 220 m9/1 Pump Tank Manufacturer Total Suspended Solids (TSS) 150 mgjl Pump Tank Capacity (gallons) Fats, Calls, Greases (FOG) 30 m8/i Pump Manufacturer Per installer Treated Effluent Quality Pump Model Per Installer _ Biological Oxygen Demand (BOD) - mg// Dispersal Cell Type Non -pressurized Total Suspended Solids (TSS) - mg/I Conventional Fats, Oils, Greases (FOG) - }) Pretreatment Unit Description NA Max Effluent Particle Sire (in) 1/8 -- - - - Homeowner Management Tasks Check (listen, look) for leaks in toilets and dripping faucets. Repair leaks promptiy. Regularly check for wet or spongy soil around your soil treatment area. Contact service provider if issues arise. Control burrowing animals (gophers, groundhogs, etc.) Keep bikes, vehicles, snowmobiles and other traffic off treatment area. Alarms - Contact your service professional if any alarm signals. Lint Filter - check for lint buildup and clean when necessary. if you do not have one, add one after washing machine. Caps - Make sure that all caps and iids are intact and in place. inspect for damaged caps often. Fix or replace damaged caps. system replacement aim,, Professional Management Tasks Effluent Screen - Check and clean per recommendations. Liquid levels - Check sludge/scum/effluent levels in ail system tanks. Recommend if tanks) should be pumped. Pump all compartments every 3E months at a minimum. Inspect tank inlet and outlet baffles (if applicable) Check drainfleld effluent levels (if applicable) Verify pump and alarm system functions (if applicable) inspect wiring for corrosion and function (If applicable) Clean drainfreld laterals (If applicable) Check event counter/elapsed time meter and evaluate water usage rate compared to system design flow. Check dissolved oxygen and effluent temperature in tank. Check for surfacing of effluent or othersigns of problems. Verify inspection pipes are capped and intact. Provide homeowner with fist of management resents and any action to be taken. system site from Vwfflc, vompsacUon, eta (if applicable) PiOWT3 REGULATOR: ST Cmbr Av n0,Toning Ot9 W ADDRESS .UOI CatmlchaalRD, Suftae I", Hudmn, W154fl,15 PHONE: t715) 3854taB+Ci Page 5 SAN-2024-077 START-UP & OPERATION For new construction: Prior to system operation, check septic/pump tanks for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cells. If high concentrations are detected, have the contents of the tank removed by a licensed septic professional prior to use. System start-up shall not occur when solIs are frozen at the infiltrative surface. During rower outagm. Pump tanks may fill above normal high water levels for system utilizing pumps. When power is restored, the excess wastewater will be discharged to the dispersal cell in one large dose potentially resulting in overloading of the cells. Backup or surface discharge of effluent may also result. To avoid this situation, it Is highly recommended to have the contents of the pump tank removed by a ficensed septic professional or have a septic professional manually dose the system to return the pump tank to normal operating [eve Is prior to restoring power, Do not drive or park vehicles over any septic system components. Do not drive, park over, or otherwise d➢sturb or compact the area within 15 feet downslope of any mound or at grade system or secondary septic system site. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an appropriately licensed individual or business. 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 backup or pond ing of effluent on the ground surface. Access openings used for service and assessment shall be sealed watertight upon completion of service activities. Any unsoundZdefggliv nin h be replaced immediately. 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. Pond ing of effluent on the ground surface may Indicate a failing condition that requires immediate attention by a licensed septic professional. Tanks must be pumped when sludge accumulation is within 12 inches of the bottom of the outlet baffle, or whenever the scum layer is within 3 inches of the bottom of the outlet baffle. In no case shall total sludge and scum volume occupy greater than 25% of the tank liquid capacity. The effluent filter shall be cleaned as necessary to ensure proper operation. The filter should not be removed unless provisions are made to retain solids in the tank that may slough off the filter during removal. if the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm and should be evaluated by a licensed septic professional. Pre-treatment components shall be maintained and serviced by a licensed septic professional according to the manufacturer's recommendations. CON77NGENCYPL4NS If the septic tank, or any of tt's components, become defect#ve the tank or component shall be immediately repaired or replaced according to the original system design specifications. If a dosing tank, pump, pump controls, alarms, or related wiring becomes defective, they shall be immediately repaired or replaced with components of equal performance. If the soil treatment co ponent fails to accept westewrater or discharges wastewater to the ground surface, it shall be repaired or replaced by, increasing basal area (if toe leakage occurs), rebuilding the component at the secondary system site (if identified), or removing and replacing biologically clogged absorption and dispersal media and associated piping. If repairs or rebuilding is not possible, a new soil and site evaluation must be performed to locate a suitable replacement area if one has not already been identified. If no replacement area is available, a holding tank may be installed as a last resort replacement POWTS. ABANDONMENT If the septic system fails and/or is permanently taken out of service, the system shall be abandoned according to SPS 382-384, Wisc. Admin. Code abandonment regulations- Requirements include: - All piping to tanks shall be disconnected and abandoned pips openings sealed. - The contents of all tanks shall be removed and disposed of by a licensed septic professional. - Tanks shall be crushed & filled, or removed. - A septic system abandonment notification shall be submitted to the appropriate local governmental unit. WARNINGII SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC TANK, PUMP TANK, OR OTHER TREATMENT COMPONENT UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ALWAYS CONSULT A LICENSED SEPTIC PROFESSIONAL BEFORE DOING ANY WORK. Page 6 s STC - 104 AS BUILT SANITARY SYSTEM REPO OWNER ADDRESS ([)C'-� F'4c1f w/ FT* ? t �12 S-i Crir.�lY. Cd;�,:HiY L�FFICZ: SUBDIVISION 69i+3 LOT SECTION__3 T N-R-LW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF rr7- 30 1 L L C'�+5A- 4l o '-5� L L- INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. R C EIv ED JUL 2 s �99� BENCHMARK: Csf Z n1 ,? I r r-ed V (Pen' CO-4 Cps ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION Manufacturer:_ Liquid Capacity: r Setback from: Well House Other Model# Size Float seper Gallons/cycle: A 1 a rm Loma... SOIL ABSORPTION SYSTEM Width: Length Nu r Distance & Direction to nearest prop. line: r Setback from: well: A�T House Z 6 other L� ELEVATIONSS 7° Building Sewer { 7 ST Inlet: C Z 3 ST outlet . PC �.�e PC bo�Km-- Pump O f f >[ Header/Manifold�Bottom of system ,5!t Existing Grade �� Z Final gradeft +' b f VA HATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 7,9 INSPECTOR: 3/93:jt TANK INFORMATION TYPE MANUFACTURER CAPACITY Septi c Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO PI L WELL BLDG, Ar Air Intake ROAD Septic yo + �/ .�, �� 7 {�- NA Dosi ng NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Model Number TDH I Lift Friction Loss Forcemain Length Demand GPM TDH Ft Dia. I Dist. To Well SOIL ABSORPTION SYSTEM Wisconsin Departmentof Inc'ustry, Labor and � uman Relations Saffety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) PegClL�i} er s ift, ❑ ity ❑ a Village Town : llllii!! nR r CST BM Elev.: Insp. BM Uev.: BM Description: J FI FVATION DATA County: ST . CROIX Sanitary Permit No-: State Plan No.: Parcel Tax No.: STATION BS HI FS ELEV. Benchmark /p q.06 160, Bldg- Sewer Q 6 9 7 7 St/Ht Inlet 4,76 17, St/ Ht Outlet 71 q C16 Dt Inlet Dt Bottom Header/Man. 7! 6 (�, y Dist- Pipe �, 7U CJ 4, 3 W Bot. System Final Grade (�,�(� z' CO- RED/TRENCH Width Length No Of Trenches 1 PIT No- Of Pits Inside Dia-Liquid Depth DIMENSIONS .2 y 07 l 100, DIM N I N SYSTEM TO P I L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION CHAMBER OR UNIT Type O I L� �J �� r 1,4 Mode !Number: system: 42 DISTRIBUTION SYSTEM Header! Manifold Distribution Pipe(s) x Hole size x Hale Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over I xx Depth Of xx Seeded/Sodded xx Mulched Bed /Trench Center Bed IT Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc-) LOCATION:{Troy.36.28.19W, SE, NW, Lot 81, Woadridge Drive L Plan revision required? ❑ Yes ❑ No 7 Use other side for additional information., ' I ) ; E y (0 5BD-5710(R 05/91) Date Inspector's Signature Cert No. 9 \6 V w ° L 0 o m c rA o y d - a U a, � c, m a d d '; •� �' 3 ,, n C'•G � ° � y w N d 3 d y °n n '�' m u7 � e ❑n ° d R - °: v� a� a u 04 n w yam•, �' O« CC 6+ h ol U o. r° F F � F 4; U CC ea � i� �' "• y � � D"Q Q la n z 3 0 I. H O a