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HomeMy WebLinkAbout040-1118-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567203 0 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: Engler, Peter Troy, Town of 040-1118-60-000 CST BM Elev: Insp. BM Elev: BM Description: SectionlTown/Range/Map No: l , /3 1 A l t_ Q rvl-\ 31.28.19.482D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r CAPACITY STATION BS HI FS E V. 3.5 /D Z . S S. 1 Septic 135 6 Benchmark Z 75 T "S ~y 9 l nngin 3 Alt. BM It Z , llp / / 7,3 Aspatien d I d ~L ~Z~ Bldg. Sewer 1 Holding St/Ht Inlet 1 _ TANK SETBACK INFORMATION St/Ht Outlet 5-. Z Z -t-7, -f TANK TO P/L WELL BLDG. ent t Air Intake ROAD ZU-Wfet rl J.. E4ad- >`e t' 31 J 6r -72 ~ a - Bottom F G .S~ i~ Q"ir_ 162- $ 7 166 / Header/Man. F .4-7 7 7. Aeration Dist. Pipe 4-7 7 7. 41 Holding Bot. System 5. 3 L. . Z;9 PUMP/SIPHON INFORMATION Final Grade Z, 3 ( Te-7.'5 Manufacturer Demand St Cover GPM Model Numbe T Lift Friction Loss Syste ad JTFt Forcemaln Dist. to Well 7. az 53. (7 SOIL ABSORPTION SYSTEM ~C~ 9, OD ~j3, BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 197 ,riv, et _ SETBACK SYSTEM TO G P/L BLDG WELL x LAKE/STREAM LEACHING Manufacturer, J INFORMATION CHAMBER OR lA ~'l ►Ya~er1 Type Of System: / UNIT Go 0%.. ✓e rUO-r~Q 1~ 8/ 16n fit/ ~hlt Model umber: DISTRIBUTION SYSTEMS-- Ivs zdf tZ1~~-6b HeaderlManif Ids L 1 Distribution x Hole Siz~ x Hole Spacing Vent to Air Intake 7'` Length Dia / 1L ngth~_ Dia~ Spacing ` D ~0 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 1xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center zG~ Bed/Trench Edges Topsoil es 0 No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 363 Page Lane River Falls, WI 54022 (SW 1/4 NE 1/4 31 T28N R19W) NA Lot 2 Parcel No: 31.28.19.482D 1.) Alt BM Description = t". l 4-c.- - t 2.) Bldg sewer length = /~5 4-11 - amount of cover = L'~~( J Plan revision Required? Yes No Use other side for additional informatio _ Date 41s,nsepctor's gnature Cert. No. SBD-6710 (R.3/97) sa •Q. 5 ~ / tom, ewsf:- 339 ;eSe 4~ncr S;T i ~ra~esa.cltr-9ft5~r'Ci+tC. ~rt~~~ca„rs~~;~tt Pe~u'tF/i~fit E a~~prQc ccFfla4~ f ~,'tt~/ Rv4- s ~J/. St<o z2 1 97.° ~ lewee, iao.m' moo. IMP 9ko ySp' 9S~.U~ D-sw%;t/1 l~Scc.31, ?mil; ' /c.+..! i ' • :t , , I + A.bP.ud ,Q l9~: T. o,/ >roy, ~-4~X~° 40 -CCU ~"_js(acydecA~,\ 19q ~a-y' --y1`1 { !n9S rccrt5 1_ -lam , r 1~ 1 i ~l je L►e j i I _ y3.o' Al~Topa{c,~ceokn 9 #.ra e E1G~ r l l r! 1 /e nc~sctyoc fr,'••+ ~c!`o•~md d r~ I i l~ ~ ~ 9crrdsn. ~f+crt = y1.GS' + I r i l, U r Pie ,Poyot,.~c j ~ ~ ~ i E,r<5s<!~d;~.sQ/eeNat I 1 ~ r ,~"/tS?H13~3s~e~'f'IuentlrHt ~ r r r 1 t elm: =,,"'d.crJ' 1 r l pdol d«X.f Buz Gor~rr + i t Gvt.~btr3 jag e- 6-d.-la . t t t tLe \ s 83 93. o' + County Safety and Buildings Division St. Croix $ S * 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, Wl 53707-7162 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appro ovemmental unit Na is required prior to obtaining a sanitary permit. Note: Application forms for state-owned I'O submitted to Project Address (if different than mailing address) % the Department of Safety and Professional Services. Personal information you provide may be I secondary purposes in accordance with the Privacy Law, s. 15.04 1 m Slats. Y P~l Same 04 / P-,, f I. Application Information - Please Print All Information ✓ l-c► Property Owner's Name / ST CR <Q 1 Parcel # Peter & Elizabeth Engler 040-1118-60-000 Property Owner's Mailing Address Property Location 363 Page Lane Govt. Lot City, State Zip Code Phone Number _SW Section 31 (circle one) River Falls, WI 54022 (715)425-8009 T 28 N; R 19 E or W II. Ty of Building (check all that apply) Lot # Z 2 Family Dwelling - Number of Bedroc c Subdivision Name 1G.ta. ~ Block # CSM Vol. 1 P .181 ❑ Public/Commercial - Describe Use Na , ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of ZD Z1~ 2~ 329663 W-Town of Hudson ~,tir•- e.tl:, w III. Type of Permit: (Check on one box on line A. Complete line B if applicable) A- ❑ New System lacement System ❑ TreatmentlHoldin Tank R lacement Only 0 Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ ?ther Dispersal Component ❑ Pretreatment Device (explain) V. Dis rsaUTreat at Area Informati : 60 Infiltrator "Q-4 Pl "Standard c bens & 6 endcaps, Po L k PL- 25 effluent filter Design Flow (gpd) Design Soil Application BispersatArea Required (sf) Dispersal Area Proposed (sf) System Elevation 600 Gpd 0.5 Gpd/Sq. Ft. 1,200.00 sq. ft. 1,230.60 Sq. Ft. 86.50' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units I New Tanks Existing Tanks ~ .2 C7 i1 A X Septic or Holding Tank 1,350 1,350 1 Wieser Concrete X Dosing Chain filter canister Na 1 Wieser Concrete X VII. Responsibility Statement- I, the u ersigned, assn responsibility for installation f the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ignature MP/MPRS Number Business Phone Number James K. Thompson ` - MFRS 30021 (7,15) 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIII. un /De rtment Use Only Approved Disapprove / Permit Fee Date I sued Issuing t Signature eReason\for Denial $ 7/1 I IX. Conditl T l teasons for Disapproval 1. beptic tank, effltsintfitter and dispersal eell,must all be servIces / maintained as per management plan provided by plumber. 2 All s4a4li raquvemertts must be maintained as psr *plie" code f ordhatuM. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 z t I inches in size SBD-6398 (R 11/11) Conventional POWTS Index & Tilte Sheet Project Name: Engler 4 bedroom Replacement Conventional POWTS Owners Name: Peter & Elizabeth Ender Owner's adress: 363 Page Lane, River Falls, WI 54022 Site address: Same Project Location: Subdivision: Lot 2, CSM Vol. 1, Pg. 181 Legal Description: SWl/4 NEI/4, Sec. 31, T.28N., R. 19W., Tn. of Troy, St. Croix Co., WI. Parcel ID 040-1118-60-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Septic/Filter Tank Cross Section Page 7 Filter Specifications Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of existing septic tank Page 11 Waranty Deed Attachments: Soil Evaluaiton Report Mater lumber ResM ted Service: James K. Thompson, DSPS Credential #30021 Signature: Date: C,.2 13 7 -W Page 1 Of 11 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01101) ~ / 5oleda/uaf,'onro,~ ~ws 1. 3 Se.~. br= >Q#" 339 ¢St Cunct S.7 FoT J_ox ,'1-SZS 3/"~ AL" ~ ltc~r,b ~'1{er Kidd &S -tJ/. SS10.22 97° W. to ~ower~~ iaa.rpr Y~~ ; 9yo ` yya' q~ U+ ~ 3cc.L'~~tIJFJ'4; Sec. 3l, ~?mil; + t ~ r Irfw; T. o{ Troy, .5~- ~X Coo ~ rt✓cf i ~s ' ~}oPesrd SbrY deuc'1'1 I1' ~t-1 ! -1 tot r^~ 5 GiJ ~cu~5 ,1 t f rr J 1 , e 1 e < ` i ll / / _ 93.0 ! : 7'oFa{ r a~rxk., ! 1 /a nc~carc+t fry •n ov o~rd am a CX5617 r 1 ! / rs 61 156-, t t/ r l r ~ ?64 J ao - 86 7-5 ~ , 9©.a Cun#c.cf exl:54-4 We ~ ~ ~ ood o l r t ' T w ~t 3: cc1 [~p✓AC/ e Imo: = JYd.t+c)' ~ ! ~ Pool dtck' t ~ t t 8 t ~ !er! . /3' i t t 1 +5 sdf3` 8 el.aV t+ 11 90.76' (3ll- 4 r ~ 1 ~ 1 ~ 1 .t.o ~ g3 ENGLER DISPERSAL CELL SIZING CALCULATIONS 1. (4 bedrooms)(100 gallons estimated flowxl.5 design factor) = 600.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.5 gpd/sq. ft. 3. Absorption area required: 1,200.00 sq. ft 4. Absorption area as proposed: 1,230.60 % ft. (60charpbers total) Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Pius" end cap = 5.10 sq.ft. EISA 1,200.00 sq. ft. - (6 endcaps)(5.10) =1,169.40 sq. ft. 1,169.40 sq. ft./20.00 = 58.47 chambers required Number of trenches: 3 @ 20 chambers per trench Trench width: 2.83' Trench length: 82.00' Trench spacing: 9.00' on center Total system area w/ 9' center spacing: 21.00'x 86.00' Pg. 3 of 11 Soil Absorption System Cross Section 9 ft g?. 90' 9z.?tS ft 4° Schedule 40 Final Grade PVC Vent Pipe With Vent Cap 67~50 ft Leaching Chamber '66,50 ft System Elevation ,2. R3 ft ~v ft (o ft Soil Absorption System Plan View ft z. e3 ft ~o ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model P/ts.s EISA Rating Z0.0 sq ft per chamber Soil Application Rate 0.50 gpd/sq ft gpd Design Flow 0.6' Soil Application Rate + P-0.6 EISA = 60 Chambers 3 rows of chambers each. Page 5~ of Conventional Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code Genera The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at (715) 386-4680. Scotic Tank Septic tank servicing mechanics comply with SPS 383.54(lxe). Septic tank to be located within 150' of service pad, with bottom of tank to be 515' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new cell to old Drainfield at 3 year anniversary of new system installation. Old drainfield to be utilized for a 1 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter. Coutineena Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg. 5 of 11 432„ D m~ nn m~ N D D o 0 m N N m ~(A D m Z D N m Z D_Aln rZ rM> pn rn~r Dr D f- NN 6„ NO© 372 2° n m w z rn D = -1 D m_ o Z " ~D c 0 \ 18° MIN. 1 r mm m N m D ~ r ~ 37 J f 22„ e N n I I ~ m x o :r m n A D ~ D D Z N _ N' N M to a m A rl D r m~7O ZD O r- m > - F- M r= ,7 V ~ 0 O m m D D Dz O -i z T FILTER CANISTER DETAIL SCALE:3/4" = I' REV NC. os: \ WIESER COIICAETE DRAWN BY:SWT J o SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W1 54750 DATE: JANUARY 2008 REV. JAN. 2008 800-325-8456 FILE: SHEET 13 ~'9 G of Filters PL-525 EFFL DENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm Accepts PVC (gallons per day) making it one of accessibility the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over 10,000 GPD float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on JJ the market can make that claim! Accepts 4" & 6° R~- SCHD. 40 Pipe PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm the owner will be notified by an alarm when the filter needs servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ball when filter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL 525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. i P9 - 7W l~ n s~ Sal CROIX COUNTY So? 1975 ~ d` a oG'r wco N"~k a4 dd 3 2 9 6 3 3 CERT~N3ED SURVEY MAP E z^ ti Part of the SW 1/4 of the NE 1/4 of Section 31, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin DOUGLAS PAbS Q,. y ,v9o'oa'oo"c 626,oy N € zz -r a wB. 30 0 MO' I f 3 Sca It : ?.QO N 3.68 A c.<~ m 24 ` i t. 1" 200 OTrue ry~// 2 r~6?0 h o 0 ti 5;00 A, 0 W o 3-7 V N B9°17'25 w ¢47.06 C gO" so• e h ? 3.71 Acr<s C. S. Yol. 1, Py l65 M ' NB!14.0,oerE 833.03 S89•F400"YY 4"t/•/0 4 o • Indicates 2411 long iron pipe stake weighingi.13 #/ft. N fi 2 S' GOrndr S 81, T2s N, R l9 YV Desorlptiot i That certain parcel of land located in the SW 1/4 of thNE 1/4 of Section 31, T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin, more fully described as follows: Commencing at the south 1/4 corner of said Sedtion 31, thence go N 000 26t 05" W along the North/South 1/4 line of said Section 31 a distance of 2633.14 feet; thence N 890 441 00" E a distance of 833.03 feet to the Point of Beginning of the parcel to be herein described; thence N 000 001 00" E a distance of 240.15 feet; thence N 890 171 25" W a distance of 447.06 feet; thence N 250 021 25" E a distane of 620.38 feet; thence N 900 001 0011 E a distance of 626.06 feet; thence S 001 001 14" W a distance of 810.81 feet; thence S 890 441 00" W a distance of 441.10 feet to the Point of Beginning, together with roadway easements acrmss that parcel described in Certified Surveys Vol. 1, Page 165, St. Croix County, Wisconsin, and together with and subject to roadway easements and utility easement as shown above. State of Wisconsin) County of Pierce It James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Douglas Page, I have surveyed and divided lands shown hereon and N that the map and description shown hereon #re a true V entation (~Q and description of the lands as divided., and that- all the provisions of Chapter 236.34 of the Wisconsin Std viding, mapping and describing said lands. NDJ Certified Survey Mapsi ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Peter & Elizabeth Engler Mailing Address 363 Page Lane, River Falls, WI 54022 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 040-1118-60-000 LEGAL DESCRIPTION Property Location SW 1/. , NE 1/. , Sec. 1 , T 2$ N R 19 W, Town of Troy Subdivision Plat. Na Lot # 2 Certified Survey Map # 329663 Volume 1 , Page # 181 Warranty Deed # 946620 (before 2007)Volume , Page # Spec house C1yesCtlno Lot lines identifiable Dyes[]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 this fem are true to the best of my/our knowledge. I/we am/am the owner(s) of the property d above, by virtue of a r deed recorded in Register of Deeds Office. Num a rooms 4 SIGNATfJRE O PLICANT(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) 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) 363 Page Lane, River Falls, Wl 54022 located at: Sw '/4, NE '/a, Section 31 , 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 June 24, 2013 Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,350 gallon Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser concrete ge Tank (if 77!!: known): 35 years, installed 6/13/78 Permit umb3 James K. Thompson icensed Plumber Signature) (Print Name) MPRS MPRS #30021 (Title) (License Number) MP/MPRS August 27, 2013 (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 pl~ STATE BAR "oi- ~Nsw-FORM 1 - ` DOCUMENT NO. 57:3 WARKANTV OEM • - _ Q v THIS, SPAC$ ttESORVEO FOR AECDROINIG QATA :,t • ! _ DQ.U914 C Pageand Park 1.S;rearet REGiSTERS OILEJQE THIS DEED. -made betoeen Page, husband and wjXe ? Rec'd. for R,:tord I lat. 1. - - - ao daY of June A. D. 1,928 and Peter 3 E Ent=_ler and Ela~abzth 'Eng. er, husband t« A .and wi fe - as ioialt tenants . _ ga • ill VYit.o.sese.t.h, That the said Grantor for a valuable t:onsidaratioa ~11Z-htY___ ( t Register at Dalrd, five Thousand. and No/1M + L~;B cos veys to Cwsatee the following described real as Cate in St.. Croix Cotwar. are TO - - State of -Wisconsin: - - TheA certain parcel of. land described as Lot 2 an Cert:L.£.i" TTi Co SaiviTlgs_a)td ipan S,.L vey Hap recorded in Volume 1, page 181, of Certi ff'i_ed _ Survey' Maps -together with roadway. easements._.across-tba4 Tax Key. X_ This is 118tt_Iton;esteaaproperty. parcel described in Volume 1 of Certified Survey Maps, page 165 and together Fd?th road7vray easements and llt llity easements shown in Volume l o C'erti-fled Survey Maps, Verge 181. FEE Together with all and singular the hereditemente and appttrtenane~+s thereunto belonging or in aoy moist appertaining: And _TP~j° C- Page and Mar -r Marea_*-et y:jOZe ,_husband and a'1 FG warrants that the title is food. indefeasible in fee simple and free and. clear of encumbrances except Subject to roadway easements and utility easements as shomi on Certified Survey '.d3Ds_ and=will warrant and defend the same. - Executed at Elver Falls, i`)7_scons3l] this - day of.- 19. 7$ SIGNED AND SEALED IN PRESENCE OF LSEAL) t Douel s C. Fame (SEAL) ~ - - (SEAL) i. - (SEAL) Signatures of DOuimlas C. Page and Marv Naraaret authenticated this _ ' - 3/ day of _ 1! aX Title: Member Slate Bar of Wisconsin or Other Prri.y Authorized under Sec. 706.16 viz. STATE OF WISCONSIN Pierce ag_ County. i- Personally came before me, this , 31sT - day of May 19_ZS_ , f the above named Douglas C. and. Mary Margaret Page i, to me known to be the person s who executed the foregoing instrument and acknowl dged the same. This instrument was drafted by - _Jane ,A' Ce-trr cka Ralph E. .Senn, Attorney g:} eY•ee county. Wis. j2~ 5t. Box 135 Notary_Pgbli~ x River-Falls, Wis. 54022 Iy ' The use of witnesses is optional. My C•q•nrryE9 ~ioEx-i .(1;3 June 7. 198:~. Numes of persons signing in anycapacity should be typed or printed below their aignatvre l.~/ - KCtA C-7 j+ WARRANTY DEED-STATE BEAR OF WISCONSIN. FORM NO. ] - 1071 ' - - f' 2339 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,A~ dm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than A x 11 irlCtles in size. must` include, but not limited to: vertical and Pal ' rice point (BM), d rid/~I St. Croix &I WIP percent slope, scale or dhqfts.~ Enfamwatron. ocation and distan:cem, road. ~O Parcel I.D 040-1 18-60-000 1s' R ev ' By Date Personal h*M1ation y for secondary purposes (Privacy l.aw,'s,'(.,4 (1) (m)). ' By 01113 Property Owner Proocation Peter & Elizabeth Engler Govt. Lot SW /4 NE /4 S 31 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. N e or CSM# 363 Page Lane 2 na CSM Vol. 1, Pg. 181 City State Zip Code Phone Number _J City _f Village 16 Town Nearest Road River Falls WI 54022 (715) 425-8009 Troy Page Lane New Construction Use: 11 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ,J Public or commercial - Describe:NA Parent material Glacial Outwash Flood plain elevation, if applicable NA General comments and recommendations: Sfte suitable for conventional POWTS dispersal cell with 0.5 gpd/sq.ft./day loading rate. Recommended infiltrative surface elevation = 86.50'. Existing dispersal cell = 86.70' 1 '1 1 Boring # J Boring a Pit Ground Surface elev. 90.17 ft. Depth to limiting factor >107" in, Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PDHt° in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 1Oyr3/2 none sill 2fsbk ds cs 2fm,1c 0.6 0.8 2 12-29 1Oyr4/4 none grsl 1fsbk mvfr Cw 2vf1fm 0.4 0.7 3 29-47 1Oyr4/4 none gr Is Osg dl Cw lvf,f 0.7 1.6 4 47-107 10yr4/6 none gr s Osg ml - - 0.7 1.6 rl Horizons #2, 3 4 contain approx. 20 .40% vel, stone by volume. Boring # J Boring Pit Ground Surface elev. 91.31 ft. Depth to limiting factor >110" in. Soll Application Rate Horizon Depth DorninaM Cola Redox Description Texture Structure Consistence Boundary Roots GPD in. Mureell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 ff#2 1 0-15 1Oyr3/2 none sil 2fsbk ds cs 2vf,fm 0.6 0.8 2 15-40 1 Oyr4/4 none gr sl 2msbk ds Ci 1 vf,f 0.6 1.0 3 40-54 7.5yr4/6 none gr Is Osg ml Cw 1vf,f 0.5 1.0 4 54110 1 Oyr4/6 none gr s Osg ml - - 0.5 1.0 J Horizons #2, 3 4 contain approx. 20 - 4 gravel, bble stone by volume. 10yr4/ tong ing of Horizon #2 sl material observed extending vertically (o 70". H on loading tes adjusted to reflect more restrictive permiability of sl inclusions. * Effluent #1 = BOO 5> 30 < 220 mg/L an TSS >30 < 1 mg/L nt #2 = BOD < 30 mg/L and TSS S30 mg/L CST Name (Please Print) -15ignatuW. CST Number James K. Thompson -01 s 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 7!25/2013 715-248-7767 Property Owner Peter & Elizabeth Engler Parcel ID # 040-1118-60-000 Page 2 of 3 3] Boring # Boring Pit Ground Surface elev. 92.46 ft. Depth to limiting factor >115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 1 0-12 1Oyr3/2 none sil 2fsbk ds Cs 2vffm 0.6 0.8_ 2 12-32 1Oyr4/4 none gr sl 2msbk ds 9w 1vf,f 0.6 1.0 3 32-52 7.5yr4/6 none gr Is Osg ml cw 1 vf,f 0.7 1.6 ,4 52-115 1 Oyr4/6 none gr s Osg ml - - 0.7 1.6 ut ti I Oyr6/2 Om sit inclusion observed at south west comer f soil pit 39 - 63" exhibiting redox. features caused by soil tension saturation and are not indicative of ground water saturation. H#2, 3 & 4 contain approx. 20% coarse fragments. F41 Boring # J Boring 16 Pit Ground Surface elev. 90.86 ft. Depth to limiting factor >95" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD/fe in. Munsell Ou. Sz. Cod. Color Gr. Sz. Sh. *Eff#1 *002 1 0-8 1Oyr3/3 none al fill 2fgr ds can 2frrt1c 0.0 0.0 2 8-23 1 Oyr3/1 none sit 2fsbk ds cs 2fm,1 c 0.6 0.8 3 23-39 10yr4/4 none gr sl 2fsbk dsh cw 1vf,fm 0.6 1.0 4 39-95 1Oyr4/6 none gr s/is/sl Osg/2csbk dUdsh - 1vf,fm 0.6 1.0 ►1 Horizon #4 consists of an unsorted rrrbdure of s, Is & sl. Loamy sand has a h h clay content. Horizons #2, 3 & 4 contain approx. 40% gravel & cobbles. Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting fader in. Sol 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 = SOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 mg/l. and TSS <_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (807/00) A.C.E. SON & SrM EvakklWM O , 3 39 34,3 970 _ _ moo, quo Aoz z, C.Srn do ~P /8/ !o wer~ ioo.cn' . ` i r 9ko ~ qSp~ 9~f,U ` Q -Sty-'✓~/IEf''f, Sec. 3/, ; /e✓~/ I ; r Ir ,P, /9~; T. O~Tioy, St. a;-o i n F" sbrydccc''1 ♦i~f-~ f•~-., 6ein9S•GY~~1Cl@S 930 l : To~oo{c.~wol~n q,!'n' z EX~; r I , ~ , . , /4nds~C M uro~xJ I ~I l i l r r~ 9ardon Elm -9.2.GS' rPi~danc ~ ; ~ r ii ~ / / ' ~ I /$X~ -5 ~f~~►t a(tv~ -8670 90 0, X36' / ~ ood ; -i o I r Ir ~ \ c-~d,5 a ,'rr,ardu,.rd l ~ P~`~ ~ve~s, f}ssu.>,rd l l ' ( l~. ,B. : Tro of l~cvd elegy; =l~o.[io• 1 I ! I Poo/de c.,!!'..-E s,u) ~acr 9a16' (i z `qi.o' 1 ► ~ ► 83 3 cq4 AS BUILT SANITARY SYSTEM REPORT 0W13ER - .d l _ , TOWNSHIP rft6__Ck SEC. T N, R~ _1W F.O. ADDRES ST. VA CO , WISCONSIN SUBDIVISION L , LOT ►A LOT SIZE • ~M PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a® ~j,; r` fit T SEPTIC TANK(S) MFGR. C7r,e,~ 0 E STEEL NO. of rings on cover Depth DRY WELL__ TRENCHES NO. of width 'length area BED no. of lines widthr length area =1rLv-~ ep h to top of pipe AGGREGATE PERK RATE AREA REQUIRED AREA AS BUILT Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. IIS~L+COR y r-- DATED 9 PLUMBER ON JOB ~ W LICENSE NUMBER r r REPORT OF INSP~CTI01N--INDIVIDUAL SETRAGE DISPOSAL SYSTEM Sanitary Permitl~`11 State Septic -~3 TOWNSHIP St. Croix CdUnty S 77IC TXTK Size gallons. "umber of Compartments Distance From: J•Jell ?6T ft. 12 0 or greater slope /A f~ ell- Building / S ft. Wetlands rt T,ighwater ft. DISPOSAL SYSTEM __Z _Tile Field or Seepa;le Pit(s) 5 ~l Distance From: Well ~j ft. 121% or greater slope ~f Building,; 60 ft. Wetlands 91 ft S / IFLD water VA f t . 18 h A raj( Total length of lines -4-ft. Number of lines 3 Length of l i :hnc 4p..~ ft. Width of the trench ft. Total absorption area 14~ sq. ft. Depth of rock beloca7 the ~in. Depth of rock over tile Z in. Cover over rocl 5(/J pa„~'" of ,-.1' - 3 6 trench* ' iiin ner 100 f L. Depth to Bedrock ft. Depth to ground water ~ft. PITS "lumber of snits ffi: diameter ft. Depth below inlet ft. Gravel ar _yes no. Total absorption area sq. ft. Square feet of seepage trench bottom area required Square feet of s ..e ni a e re luireL Tnspecte Approved Date 197_ Date 197 '~P• ~opted F~ State and County State Permit # PLB67 Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: Og~~76e .3 B. LOCATION: c7W '/4 Off Section T 28 N, R ft 01 W ot# City _ Subdivision Name, nearest road, lake or landmark Blk# Village Township rwmy C. TYPE OF OCCUP79IVCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms ! No. of Persons ? D. TYPE OF APPLIANCES: Dishwasher ✓YES NO Food Waste Grinder i/YES_NO # of Bathrooms- Automatic Washer ✓ YES NO Other (specify) E. SEPTIC TANK CAPACITY /37s Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement- Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUE T DISPOSAL SYSTEM: Percolation Rate 1) 2) 3► Total Absorb Area t90 sq. ft. New V Addition Replacement *Fill System ~lG2S l°C✓) Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 0'Width Depth $oe Tile Depth -,76'z No. of Lines -3 Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land ~.°~®S. LC Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, / NAME A044% C.S.T. # /.34G and other information obtained from Oll f/.f (ewwner/builder). Plumber's Signature P/MPRSW# Phone #7l~-3~G ^3(~Z3 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). e~VO SCA'L ~ ~ GULL' Lols~ l/o~/ Ll.~~'wot,riv) ZZ9 zsar N J' s~ J 70 N 3zs' `9 SZS' ~0 ' 41V7 Do Not Write in Space Below OR DEPARTMENT USE ONLY 8 Date of Application L Fees P id: State Le, 0 0 C un ~ Date Permit Issued/F3e}eeted (date) 6, -cV- f Issuing Agent Name Inspection Yes-:-kNo Valid* Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 Plb 67 State and County State Permit # Permit Application County Permit fQr Private Domestic Sewage Systems County *DENOTES STATE= APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: OGIIIT P t~C 3 2~!/ ! /%~1t1~ all. B. LOCATION: S 141 % /%'/a, Section 1 , TZI N, R~ ( ) W Lot# Z- City Subdivision Name, nearest road, lake or landmark Blk# Village Township Ti~O C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms S No. of Persons Z D. TYPE OF APPLIANCE Dishwasher ✓ YES NO Food Waste Grinder _YES_NO # of Bathrooms Automatic Washer VYES NO Other (specify) E. SEPTIC TANK CAPACITY r3 Total gallons No. of tanks / *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) /Total Absorb Area /1J,00 sq. ft. New V"' Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 60" Width /,Pe Depth -eye"_ Tile Depth At No. of Lines 3 Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land ~29a SE Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME ~f/~~L ~'j/~=NJO.✓ C.S.T. # /3 l6 and other information obtained from Gr (~e4builder). Plumber's Signature MP/MPRSW# '~'M3 Phone # 7~f ' 3623 PLAN VIEW: Provide sketch be w of system (include direction of slope and all distances in accord with H62.20, including well). C,vosC4LG~ G!/EL't LGl_~-TO~✓ Gliv~ivGLr/N 1 _Zo Z r- 2 2, i Y ' -r S f { i E ' e ` I 2 3 ~ E 1 I ! sk-A F i $b' ko; c i f i i [ 3 T ~ E , t E ` 06 3 X15 i t t a... _ _ _ f E E i e t : 3 1 s- { t e E t i F ~ s r Do Not Write in Space Below FOR DEPARTMENT USE ONLY O d Date of Application / Fees P id: State Cou t ✓ Dat D ~h Permit Issued/Rd (date) Issuing Agent Name i, Inspection Yes_~_No Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. 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ST CROIRECOR SURVEYOR'S D OCr,` r r,~11FS 9 1g~5 0 R~O/rrOr CiNNF I ,y Sl, of l Croak 1VSCO^roe,^fY, 329633 CERT3YIED SURVEY MAP x Part of the SW 1/4 of the NE 1/4 of Section 31, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin DOUGLAS PAGE N 90°00'00" 626.0,6 N g 227. Ire 3 96.30 - Eosamant ~ s" AP 3 SGa) 61600 4 \ ~ 3.68 Acr¢~ O 1 - 200' l0 2 o Q7 0 True ?.0 ti o 0 S.U~ Acres 00 a W ~ o0 0 s 0 89017'25" W ¢47.06 3 -7 0 h 60 30• O 9i9 mss, E s¢m¢n~ 41 Z 3.7 1 A c i~¢ s 9 ct~ C. S. Yol. lJ P9165 y N A/ B' ° 4.4'06 -,C 833.03 .5 89°44.00-W /0 60' PO. B. o . Indicates 24" long iron pipe stake weighing1.13 #/ft. N o m o ~ ~ N S ?/4 Corm2r 5 31, T2sN, R19ri Description: That certain parcel of land located in the SW 1/4 of thNE 1/4 of Section 31, T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin, more fully described as follows: Commencing at the south 1/4 corner of said Sedtion 31, thence go N 000 26' 05" W along the North/South 1/4 line of said Section 31 a distance of 2633.14 feet; thence N 890 44r 00" E a distance of 833.03 feet to the Point of Beginning of the parcel to be herein described; thence N 000 00' 00" E a distance of 240.15 feet; thence N 890 17' 25" W a distance of 447.06 feet; thence N 250 021 25" E a distance of 620.38 feet; thence N 900 00' 00" E a distance of 626.06 feet; thence S 000 00, 14" W a distance of 810.81 feet; thence S 890 44' 00" W a distance of 441.10 feet to the Point of Beginning, together with roadway easements acrdass that parcel described in Certified Surveys Vol. 1, Page 165, St. Croix County, Wisconsin, and together with and subject to roadway easements and utility easement as shown above. State of Wisconsin) County of Pierce ) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Douglas Page, I have surveyed and divided t lands shown hereon and that the map and description shown hereon Ore a true t representation r and description of the lands as divided; and that.' d with all the provisions of Chapter 236.34 of the Wisconsin Std g, dividing, mapping and describing said lands. Vb1. 1 Page 181, J l Certified Survey Maps Regi9't 1 ~c ~egor