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HomeMy WebLinkAbout040-1138-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600295 GENERAL INFORMATION 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 Township Parcel Tax No: Genevieve Rugo TOWN OF TROY 040-1138-50-000 CST BM Elev: Insp. BM Elev: BM Description: QQ Section/Town/Range/Map No: x m) 36.28.19.5628 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ? /60D Benchmark 6 Met I QJ Wit Al . BM ri 313 /66,37- Bldg. Sewer c 12 Holding St/Ht Inlet ILI/ TANK SETBACK INFORMATION St/Ht Outlet ~p. °f7• TANK TO P WELL BLDG. Air Intake ROAD PHTM"t U Septic I , ~ ~~rt ~ ~ ~•J ~ 1 / ~ 1 Dosing ' Header/Man. Aeration Dist. Pipe b • .5 -I 17,64 Holding Bot. System ~ yA7 PUMP/SIPHON INFORMATION Final Grade 97M Manufacturer Demand St Cover GPM l Model Number TDH Lift Friction Loss System Hea TDH Ft Forcemain Le Dist. to Well SOIL ABSORPTION YSTEM BED/TRENCH Width Length No. f % s PIT DIMEILSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS A r /L _ SETBACK SYSTEM TO V P/L BLDDG WELL LAKE/STRE M LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System. C UNIT Model Number: 5 Sts sh DISTRIBUTION SYSTEM Q S Header/Manifold Distribution ix Hole ze ix Hole Spacing Vent tQ Air ke Pip/~--. Length Dia i_eneg(tsh)__~!!!~ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Seeded/Sodded xx Mulched Depth Over Depth Over xx Depth of r Bed/Trench Ce nter Bed/Trench Edges Topsoil es ] No., U No 1' 2.. Q3 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 852 CTY RD MM 1.) Alt BM Description = k~~ 2. Bldg sewer length = 'r ~ ~T• -amount of cover = ~ / •~a~~ ~ { lr Plan revision Required? ❑ Yes o Z~26~ Use other side for additional informatl n. I__ /e SBD-6710 (R.3/97) Date 04 a Cert. No. f Industry Services Division County qy 1400 r Washington Ave 5T. C, Roll< as l i P.0 ox 7102 Sanitary PermitNumber(to befilled in by Co.) DEC 04 Psn I 53 7-7 CROIX COUNTY ~ Z . an itary Pet 1 EYGKWAM22JRG State Transaction Number ue ,,,.vu ul inis form to the aPProPriate&overnmental unit , vi~ is , s rcquirrW exi prior to with 51'6 obtaining a a (2),Wis. Adm. Code. sanitary Ix:nnit. Now. Aypliwtion lurms tar state-owned I'OW'I-S arc submitted to Project Address (if different than moiling address) j the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.(4 1 m , Stats. D~~G C,~f { AA M a tion parcel # 1. Application Information - Please Print V'i Property Owner's Name Property Owner's Mailing Address Property Location A4 AA Govt. Lot _ Iv City, State Zip Code Phone Number StNr f1 E Section 3 o (circle one) 1 Uut' _FA 1-1-<j '6410 Z z N; R ._j~ - Ii or61) I. 'T'ype of Building (check all that apply) Lot 9 Subdivision Name I or 2 Family Dwelling - Number of BerIr is l Block N ❑ City ❑ Public/Commercial - Describe Use QC2. CSM Number ❑ Village of ❑ State Owned -Describe Use~/-1/-- X Town of_ - l Tl. Type of Permit: (Check only one box online A. Complete line B if applicable) A. ❑ New System V_yReplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Numbe and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit-transfer to New z 7 Before Expiration Owner=/ - IV. I , yp~ofPOWI'SSystem/Colm onent/Device: Check alt that a 1 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. ofsuitable soil ❑ Mound <24 in. ofsuitable soil ❑ Holding rank 90 er Dispersal Component (explain) bD F/t rEK /ut i5 Pretreatment Device (explain) V. Dis rsAffmat ent Area Information: posed S stem Elevation Design Flow (gpd) DGSign Sail Application Rat st) Dispersal Area Required (sf) Dispersal Area Pro Y t 36 D yz~. l-f~ Y . 00 V1.'I' ank Info Ca pacity in Total 401, Manufacturer o o Gallons Gallons Units W u 7 H viw (7 0. few ranks Existing Tanks ot~.totAn+E% i 'D D v[l/G`~ . septic V11. Responsibility Statement- I, the undersigned, assume res nsibil' for installation of the POWT~~Mwt RS the attached plat Hess Phone Number Phimber`s Name (Print) Plumber's `igna re^' AA IKE 90D,-WAL-J)~ qzs--~~--60 Plumber's Address (Street, City, State, Zip Code) ' VIII ' nt JI)e >artment Use (hil permit Pee Date Is ucd_ / Issuing t Sig tore Approved Disapprove er Given Reason for vial It/~ el~~ I 1a. Condit* asons for Disapproval A 1. rSeptir tank, ETfllxn: tifto- imd u spel-: o cell rust all be sit=[c s ! n+~+n as per ;,ivr.3gement plan pro ricers by plumber. r 2. Alt t'tftxrK k rec> stet:^ens trox~t,t,Er r. a<rt~ ire-i tilt per t~pFllhtlbl2t fx>rf l ,.Milutn+,, n siy~ Attach to complete plans for the system ani submit t he Countt on paper not ~6 than z ll i ~ a /1 L1lrw.~. I O► . SBD-6398 (R. 08/14) Gea uei Gt1 P.~.- 2 ~~d"~s C2 f I Plot PIM Z *Y 40 LqdD"W • • Icy r,L tfc sup/ o~ rtar N'/u J _ I F -45 ~=o- 1 13IZqAj,, Tavel) or- My, Sr CROIX eo~4~- ~ ~ ~ = N ~w a~ prr• w~sco~s l~~ft7 (i t5-0- 00~~ f 5Z G.7. f{, AqM Non* A I J "'IT ~lz ~ s { i ~ o \ / ~5 ` G ti Do 0 7-0 f 0 X514 04 t / `b 61')) f1SP1ff1 L' - Yh , J_:..`1 j,. L ; 0"-> ~ ~ 9FeJ • fl~i~Fr 5~ .vj MM C 5~~ o .>>7 r:r. H. M y IN-GROUND SOIL ABSORPTION COMPONENT SUBMITTAL REPLACEMENT DRAIN FIELD FOR A 2 BEDROOM RESIDENCE Owner's Name Genevieve Rugo 867 CTH MM River Falls, WI 54022 Located in the 852 CTH MM SW %4 of the NE 1/4 of Section 36, T28N, R19W. TOWN OF TROY ST CROIX COUNTY Parcel # 050-1138-50-000 Previous Permit # 9-19137 1970 INDEX Page 1 Index & Title Page 2 Plot Plan Page 3 Dispersal area Cross-section & Plan view Page 4 Management Plan Enclosures Filter Specs Wieser Filter Canister Detail Ez-flow product approval Warrenty Deed Existing Septic tank Certification Prepared By Michael Rodewald 285 County Road SS River Falls WI, 54022 715-821-6229 MPRS 931384 br Design Pursuant to: IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR POWTS (VERSION 2.0) SBD-10705-P (N.01/01; R. 10/12) r 1" Oft P • ~ 4; (CL• /IV "L C sLA tlfz- 7"hd !l; E t~i~„ ~C, 3(0 ,zr~~i, j%W TL4v-tip OF 57 LRd1X L°OlL1Y ;r, ~ p7 I Nw ~~fv - 13~ Jb' 0C) f ~iZ 671-(, AAAJ ~ l r: i w-LIL dot o \ '1911 r 41, d1Lr'~ h' • ~ r~ }lSPtt ~ - Y~ - ~ ly, a i S l Ej.Y y /,0 e SW Locad ' Gi:kr MM q t ~,7 E iL,) Idel; Cc 13 X 5y-A-e.,-,el~/~• oo G~a~, ►3 A ,7 N. M iN r:r. H. in V& PAGE OF t i@v °c O t iH ti r a g E CL z N =o = r p y co !L W n c Rc O! v~ @ 11 C C ,ID Q V:,~ vi N U d 17 as y m Fn ace U) 0 ~Q 3U V p 3 ~A p G '0 L 1-4 ooro ~ u ¢ Q G -4 122 _ Q N N (D w 11 J 11 11 W I II ! E > If W V ! Q c U a~i { I; N c U! g W Z N c I II O n » 1- I I CO 'z3 J U E ~ ~ ~ ~ = I II I .N ~ ~ p c 3 _ d C` m 2 m C a~ y ( I O W W }c!3 d a ~Uo i I n IRS , M ~ ~ umi a I II I 11 a~ c2 U o p f I s O _ U I I G U ♦ ! I W -a a I I © t W C- N I I LL ~ o ~ I I I' ll l+l u u x 0 I Jay C a m a ! I u !~r ° - I I ly CD Ln (14 Q ro= ° I II I U Cd? CJ J ' - z (n y m Wa I ! m m o w E ! I cr- c c o ~ m~ mti4 N I I ~ L a- cc$ o u m 8 7. 11 zZ > m EDD rn = f I d O 417 r O W~~ ii ~W w ~ E W I II i a` ' cr) U 0 ~z~ I i z Z z ! II i - + ° CL CL " I 1 PAGE40F4 In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SIPS 382-384, Wisc. Admin. Code. 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. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BODS 220 mgL"'; TSS 150 mgL"'; FOGS 30 MgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tankls) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: /J ET_TP-jV_b0f.-F FXe. ,M 1/« KODF~Mihone: 715-4 7- 5 -(01116 Name of individual or company: Local government unit: SI' C KG IX L'C' G(~~7Y tile All uI; i tYr ~ Et1c~P~~ F hone: ? ~ 5 " 3~~ L~ 6 ~ 44 Local government unit address: Lt b ak) fir-- ZIR fc Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SIPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. S stem Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. I F I m z O MM i ~o Q f -13 A ~ cN,a i no m 1 r i pN ~ 1 ~sor~aso .T~! ~ O C~tt "ran O A man 74 n OMtlUMV1S < cn cu I! c ASMlIS1iV M-Id 'ON13QOM I o gmm-Uli -M ouiod onn ° ® u 0 m -4 K3 seumarr" yea i Z I cam, > OM 0 rouTmv mi`' n C ~e.~,uvnwa ~ of CD Cp w co co .p. c~ rn O N f.3 nu~rnlm"3" NA'n m ci+ w%ma mvuwujF&a C m at IINVJAVM. 0 11 iR Im jam m fil ~p m Z p In F rn ~ 0 - w r W l ~ ED IV ~JI -9 w m u u w O _ o cl, Ui V ~ C m 3!g rc- w ao ozz ('pE~,'EVI~ V ~ ~<C[C~U i 1 43j" D m~ N D D 0 0 m(n cn mfg m - D DDA mzD r- mz D LN 000 rnArD NOD N (n O 6.. M 37j" z m-i ( z r r _ O ~ I rTl 18° MIN. G r \ A r 0 0 Z cT 37° 2 ~ _ m 0 m D ' b AD N m (A A D n rnto z> Z V) D rn m n opm m~ W D D rn r-71 (J) m °D > r D yD r r Z cf) c- 0 cn DRAWN BY: SWT SCALE PRE-POUR: AIL ~ER ccOCRETC REV. ANISTER DET 4 Y G L POST-POUR: TIC MANUAL US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 JAN. 2010 800-325-8456 FILE: SW 13 ErRE:V i 'i 66VEVY Oe, kuem ' 43;" D (A m M "D mw rrn 0 0 V) (A OZD DMA r'mz DAN Nr- Z r=mD 00 " O~ O r 2 N M 37j" 2„ z m 6„ W z r rn D= mD O 18" MIN. < m < rr1 N m D r 0 O Z 37" I 21„ a = cn O m O m ~ Ln m n~ D D i n (n D _ Z U)I i r I N -I D I m ;a m D r DM Cf) t 0 Z D rn m Frln ~r 0 ;;D m C r7 f~l D D rn Crl 0 m > D r- z t- cl) L O Z~ I \(A FILTER CANISTER DETAIL DRAWN BY: SWT SCALE:3 4" = 1'-0 PRE-POUR: I REV- m POST-POUR: MIENER COtICAETE DATE: JANUARY 2010 DATE: Om z SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 o REV. JAN. 2010 800-325-8456 FILE; SIffET13 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer q ' at/ ~ ~1 e L/ d Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) ~j City/State .i Parcel Identification Number LEGAL DESCRIPTION Property Location dQ Sec. T -iL N R W, Town of ✓ C1 Subdivision Plat: Lot # Certified Survey Map # Volume Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yesOno Lot lines identifiable jWyes E] no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §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 fdrecorded the three year expiration date. I/we certify that all statements on this forue to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty din Register of Deeds Office. Numbe of bedrooms SIGNATURE OF APPLl 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) E SAFETY AND BUILDINGS DIVISION Plumbing Product Review o /I P.O. Box 2658 Y, 0 Madison, Wisconsin 53701-2658 1 S P j<I TTY: Contact Through Relay , ~G Scott Walker, Governor Dave Ross, Secretary October 11, 2013 INFILTRATOR SYSTEMS INC. GOVERNMENT AFFAIRS DEPARTMENT 4 BUSINESS PARK RD PO BOX 768 OLD SAYBROOK CT 06475 Re: Description: LEACHING SYSTEM, POLYSTYRENE AGGREGATE Manufacturer: INFILTRATOR SYSTEMS INC. Product Name: EZFLOW DRAINAGE SYSTEMS Model Number(s): EZ1203H (3-12" bundles with pipe in center bundle in 5 ft. or 10 ft. length). EZ1203HP (3-12" bundles with pipe in each bundle in 5 ft. or 10 ft. length). EZ1201 P (1-12" bundle with pipe in 5 ft. or 10 ft. lengths), EZ1201 A (1-12" bundle containing aggregate only). EZ0701 A (1-7" bundle containing polystyrene aggregate only in 5 ft. or 10 ft. lengths). EZ1203H-GEO (1-12" bundle with non-woven geotextile fabric installed at 180 degrees on the upper side of the bundle, pipe in 5 ft. or 10 ft. lengths). (EISA of EZ1203 H, EZ1203H-GEO or EZ1203HP in 5 ft. lengths = 25.0 sq. ftJproduct, EISA of EZ1203 H; EZ1203H-GEO; EZ1203HP in 10 ft. lengths = 50.0 sq. ft./product, Width = 36 inches, Height = 12 inches, Max. depth of bury = 8 ft.). Product File No: 20130145 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an alternate approval to s. SPS 383.44(4)(a)1.a.; 384.30(6)(k) based on the Wisconsin Statutes and the Wisconsin Administrative Code. This alternate approval is valid until the end of October 2018. This alternate approval supersedes the approval issued on 4/10/2012 under product file number 20120139. This alternate approval letter shall be incorporated with your previously approved plans and/or specifications I approved under product file number 20120139. This alternate approval is contingent upon compliance with the following stipulation(s): I • This product must be installed in accordance with the manufacturer's printed instructions, product approval, and plan approval. If there is a conflict between the manufacturer's instructions and the product approval and/or plan approval, the product approval and/or plan approval will take precedence. • When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding j block of the product approval letter, this product must receive wastewater having a BOD5 value less than or equal to 220 mg/L, a TSS value less than or equal to 150 mg/L and a FOG value less than or equal to 30 mg/L on a monthly average. • When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must be installed in individual excavations that create a } dispersal cell that is horizontally separated from other dispersal cells in other excavations by at least 3 feet. The t 3-foot measurement is measured between the closest outside edges of the product listed in the regarding block j of the product approval letter. 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Ilao uollnq!alslp a41 ua4M •swaisAs panoidde luawliedao jo sienueW lug uodwoo S1MOd PaAOadde ui paq!oads ale6aa66e ouols io aoeld ui silao lesieds!p w pallelsui aq Aew lonpoad s!41 •lonpoad a4i jo wolloq a4l wojl segou! g iseal le lu!od e of lonpoad aql to saps 941 buole uMop 6wpuaixe pup lonpoad aql to dol uo Allowip pallelsu! `apOO •wpd 's'M `(6) (9) OE'V8E SdS "s to sluawaa!nbei slaaw leql ougel al!lxaloe6 ane4 isnw lonpoad s!41 •I!os nl!sw to apej6 leu!6uo Molaq ao le Ilan lesieds!p a4i to dol a4l se4 4o!4M `welsAs lesiadsip a ui pallelsui aq isnw lonpoad sigl 'aallal 12Aoidde ionpoid a41 1o Moolq 6u!pie6ai a41 ul palels 6u!lej VS13 a41 uo paseq paz!s si le4l llao lesiads!p a ui pallelsut si lonpoad sl4i ua4M 9VLO£lOZ :oN al!d lonpoad E L OZ ` L L jegolo0 Z a6ed ON[ SW3ISAS 80iVHilldNl l INFILTRATOR SYSTEMS INC Page 3 October 11, 2013 Product File No: 20130145 • Otherwise as permitted in this Alternate Approval, the stipulations of the in-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (Version 2.0) October 2012, [SBD-10705-P (N. 01/01; R. 10/12)] apply. • A copy of the manufacturers' installation instructions shall be onsite and available at the time of installation. • A copy of this alternate approval shall be onsite and available at the time of installation. • Additional information is included as attachment(s) to this letter; see attachment A. In granting this alternate approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making necessary for code compliance. Nothing in this review shall relieve the manufacturer of the responsibility for designing a safe component into the built environment. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Glen A. Jones, M.S. POWTS Product Reviewer phone: (608) 267-5265 fax: (608) 267-9723 email: glen.jones@wi.gov E E 6 i i 3 I 1 I " .l G 1( T ETI AGGREGATE TECHNOLOGY INFILTRATOR r (F .1 ~Ir 4it '"^s. ,.k fit Y F y y~,l2 i ~ w t . . y , t ` I _ . 4 A,;': ~r t Z i ;ja i g' •vt } ~T" `,ar ...rte ,..t y k ' i ~ks,.r y s~ x r ! a' d r ! f ~,_.:iC . v.~ ~ . ' r:.:~-~ ""~....J~`.~_ _ ~"a~~i. . J . - ~.'S..1 j.~'y r ~ 5 "'.'.:w'# - . -r gu~•y I EZflow by Infiltrator is an environmentally friendly stone and pipe, replacement to traditional stone and pipe drainfields using Compared with an engineered geosynthetic aggregate modular design. benefits include: The EZflow system is designed to improve infiltration performance by eliminating the fines associated with Always clean and free of fines crushed stone, and reducing compaction and embedment Bundles are quick to install, saving costs on heavy associated with stone. Preassembled units include a 3" or machinery and labor 4" perforated pipe surrounded by aggregate and held in Modular construction allows configurations to match place with a durable high-strength netting. This product french dimensions for most system shapes and sizes comes in easy-to-contour 5' and 10' lengths and in Engineered for optimal storage and absorption efficiencies diameters of 7, 8, 9, 10, 12, 13, or 14 inches. Ability to contour along sloped sites and around trees or iandscaping Lightweight system is perfect for repairs and tight job sites r s~t;acight expanded' Easily nand-carried into position reducing time and labor c;o~isVUCticn offers s:ruciUrai irrtegrir; a+'+o eslsts compaction. Engineered 5' or 10' lengths with simple snap, internal couplers ;,v.~-cliannels increase vo c space Easier cleanup at the job site with the elimination of stone improved water row Manufactured from recycled materials rather than a mined natural resource • A wide variety of diameters and configurations to meet any installation professional's needs Approved in many jurisdictions with an increased efficiency rating, reducing drainfieid size Backed by the leader in the onsite wastewater industry GEOSYNTHETIC AGGREGATE EZ r,y INFILTRATOR TECHNOLOGY I PIP • = s y 1 : F jj.'Jy'f 3 R ...,,,y ` } x spa. 5, f i✓, s.✓ ~ r' b v~#e s # `Y Y ~~~•fi?~ - ~ fir J I~ ^ s - n . e* tA' ~,A_ 4i, ki % ; s"~'.~ x f 6' i ~ • ~y,t ~ r "~5 rf',A .M• t ~ n t -;~y ?~:..~t EZflow by Infiltrator is an environmentally friendly replacement to traditional stone and pipe drainfields using Compared with stone and an engineered geosynthetic aggregate modular design. benefits include: The EZflow system is designed to improve infiltration performance by eliminating the fines associated with Always clean and free of fines crushed stone, and reducing compaction and embedment • Bundles are quick to install, saving costs on heavy associated with stone. Preassembled units include a 3" or machinery and labor 4" perforated pipe surrounded by aggregate and held in Modular construction allows configurations to match place with a durable high-strength netting. This product trench dimensions for most system shapes and sizes comes in easy-to-contour 5' and 10' lengths and in Engineered for optimal storage and absorption eff ic~ diameters of 7, 8, 9, 10, 12, 13, or 14 inches. "5ility to contour along sloped sites and around trees ndscaping ghtweight system is perfect for repairs and tight fob s.` Ig, .u°~ Ig"` " t;a;zt : ` s-""y't Easily hand-carried into position reducing time and lab -nstructlon offers structural integrity and ~sists compaction. Engineered • 5' or 10' lengths with simple snap, internal couplers .:.w-channels increase void space • Easier cleanup at the job site with the elimination of stei eating improved water flow • Manufactured iti,e, ' u a, d natural resource • A wide variety c dl r ~rS el installation professionals needs • Approved in many jurisdictions with an increased efficiency: rating.. reducing drainfield size INFILTRATOR I I Bundle System Configurations: Available in 7", 8", 9", 10", 12", 13" and 14" diameter bundles. Notes: Other systems include 10" and 12" bed systems. Bed size will * sr. dictate the number of bundles, 2. System dimensions are dependent upon bundle diameter and 5-, configuration. ~l 3. LLP is for "Low Pressure Pipe" in which a pressurized distribution pipe is field installed within the corrugated pipe. Internal pipe and couplings meet the requirements of ASTM F405. Bundles are also available without geotextile between the netting and syn'hetic aggregr«te. a) y 771, INFILTRATOR WATER TECHNOLOGIES STANDARD LIMITED a u 20`:I CJ WARRANTY f CE,i 601F-GEO (a) The structural integrity of each EZftow by Infiltrator expanded polystyrene drainfield system and other accessories manufactured by EZftow 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 > t y materials and workmanship for one year from the date that the septic permit is issued for p the septic system containing the Units; provided, however, that if a septic permit is not w required by applicable law, the warranty period will begin upon the date that installation of q the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator ° r r in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) 1 ( days of the alleged defect. Infiltrator will supply replacement Units for Units determined by EZftow by Infiltrator to be covered by this Limited Warranty. EZftow by Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. 4 1, 1 4 (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. e~ THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING e ,r NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR N t ? t t w., PURPOSE i.:. (c) This Limited Warranty shall be void if any part of the EZftow system is manufactured q; by anyone other than EZftow by Infiltrator. The Limited Warranty does not extend to •I U incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third t °s party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions: failure to maintain the minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event Y'tx z'" not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply r 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 Y Y PAY resulting from installation or shipment, or from any product liability claims of Holder or any third C party. For this Limited Warranty to apply, the Units must be installed in accordance with all t r "V4 0 site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited k ' ` t + :l C Warranty. No warranty applies to any party other than the original Holder. IU The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. 7 4 Business Park Road P,U. Box 768 Old Saybrook, CT 06475 ! n AT' o...I PC 1-800-27100 • Fax 860-877.7001 R e 1•$00-221-4436 www.infiltratorwater.com U.S. Patents: 4,759,661; 5,017,041, 5,156,486; 5,336,017; 5,401,116,5.401,459; 5,511,903; 5,716.163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizes, Ouick4, and SideWinder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico. Contour, Mlerot-eaching, PolyTuff, CharnborSpacer. Mullif ort, PosiLock, QuickCut, QuickPlay, SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of Polyt.ok, Inc. TUF-TITS i. I rogiMsred trademark of TUF-TITE, INC. Ultra-Rib is a trademark of IPEX Inc. 2015 tnliltmior Wife, Technologies, LLC. All rights resorved. Pnntcd in U.S.A. EZ01 0315AG Contact Infiltrator Water Technologies' Department • 1-800-221-4436 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) P ~5~2- C-~4 h7,d located at: 51j 1/4, & 1/4, Section, Town 2 N, Range /W, Town of `f , 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 i '7 Did flow back occur from absorption system? Yes No-K (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /,-//e Construction: Prefab Concrete Steel Other Manufacturer (if known): Z,&1aes e,,-- &,t Poe eosk Age of Tank (if known): /!2 7o Permit n1mber (i know (arc sed Plumber Signature) rint Name) (Title) (License Number) MP/MPRS (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 Wisconsin Department of S sional Services S~ ra 61 I I UI Division of Industry Services ! soiL JGVW41MM18X304 Page l of 3 S 383, Wis. Adm. Code County ST. CROIX Attach complete site plan on g~~4I an 8 1/2 x 11 inches in size. Plan must include, but not limited to;- ~ and horizontal reference point (BM), direction and Parcel I.D. 040 - 1138 - 50 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date n Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z / Property Owner Property Location GENEVIEVE RUGO Govt. Lot SW 1/4 NE 1/4 S 36 T 8 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 867 C.T.H. MM City State Zip Code Phone Number ity E]Village L!jTown Nearest Road River Falls, WI 54022 ( ) C.T.H. MM El New Construction Use Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD n Replacement n Public or commercial - Describe: Parent material sandy outwash Flood Plain elevation if applicable _(9e0sernmgnts)- ft General comments Conventional In-ground trenches -47 loading rate. One trench 90 ft. using EZ Flow. and recommendations: 1% flood is 888.00 ft. from readings on the bridge. Using flood elevation, the BM is 904.13 ft. (16.13' higher) 1❑ Boring # u Boring M. Pit Ground surface elev. 101.20 ft. Depth to limiting factor >100 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 1 0-12 7.5YR2.5/2 A 2f-msbk ds cs 3vf-co 0.6 1.0 2 12-23 7.5YR3/3 sl 2fa&sbk ds cs 2vf-m 0.6 1.0 3 23-40 7.5YR3/4 sl 2fsbk dl cs lvf-m 0.6 1.0 4 40-50 7.5YR3/4 Is Os dl cs lvf-f 0.7 1.6 5 50-100 1 OYR5/4 s Osg dl 0.7 1.6 a Boring # Boring t/?/* 100. Q >98 pit Ground surfaceelev. 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 1 0-12 7.5YR2.5/2 sl Ifsbk dl 0.4 0.7 2 12-22 7.5YR2.5/3 Is Osg d) 0.7 1.6 3 22-38 7.5YR3/4 is Osg dl 0.7 1.6 4 38-98 1OYR5/4 s Osg dl 0.7 1.6 10%0 1 11 * Effluent #1 = BOD > 30:< 220 mg/L an TSS >30 _ 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig e CST Number MARY JO HUPPERT Hollister's Soil Testin &Desi n 224832 Address Date Ev ation C nducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 10 - 26, 2017 715-426-1775 SBD-8330 (R07/13) Property Owner RUGO, Genevieve Parcel ID # 040 - 1138 - 50 - 000 Page 2 of 3 [-3 Boring # r Boring g Pit Ground surface elev. 96.80 ft. Depth to limiting factor >84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 7.5YR2.5/2 S1 1 fsbk rnvfr 0.4 0.7 2 8-18 7.5YR2.5/3 is Os dl 0.7 1.6 3 18-84 10YR5/4 s Osg dl 0.7 1.6 Boring # ❑ Boring a 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 Boring E Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 * Effluent #1 = BODS > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-8330 (R07/13) platpim Ptw Lw ' jpdM 1GL. !A: t -HC- -,aA OF Thy 1L E U [~"~"'Z"~ ~C: 3lv °Z.r3,N ( N. 1LMn Aj Op S'T. 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