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HomeMy WebLinkAbout018-1010-30-200 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law. s 15.04 (1)(m)] Permit Holder's Name: GAIL DAHLSTROM City Village Township TOWN OF HAMMOND TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CfOIX Sanitary Permit No'. 642247 State Plan ID No. Parcel Tax No. 018-1010-30-200 Section/Town/Range/Map No. 05.29.17.80E STATION BS HI FS ELEV. Benchmark Alt BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bol. System Final Grade St Cover BEDlTRENCH DIMENSIONS Width Length No, Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE STREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: Model Number: Ura r rct DU I tvry J T J 1 1 Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipets) Length Dia Length Dia Spacing JWiL V V V Gr[ x Pressure Svafems Ori rr I nr At-r:rmdu Qxia+ .. n.d.. Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil '—] Yes [-] No 1xx :] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Location: No Address Available 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3197) Date Inspection #1: Insepctors Signature Inspection #2: Cert. No. RE-CEfVED Industry Services Division 4822 Madison Yards Way County ST. CROIX Madison, W 153705 Sanitary Permit Number (to be filled in by Co.) �= DEC 0 9 2021 P.O. Box 7162 Madison, WI53707-7162 sTSwftVPPeMit Application StatcTransaction Number NA In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this fort to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 xm). Slats. j pZ 110TH AVENUE �O 7 f. Application information - Please Print All Information Property Owner's Name Parcel # GAIL DAHLSTROM 018 - 1010 - 30 - 200 Property Owner's Mailing Address Property Location 1118 170TH STREET NA Govt. Lot City, State 7 ip Code Phone Number HAMMOND, WI 54015 651 - 503 - 6699 sE ,, sE ,, SeC1iOn os T 29 N R 17 E or W IL Type of Building (check all that apply) Lot # fa/ Ior2Family Dwelling - Number ofBedrooms /� �+ 3 5 `fo r s4wr0. 2 Subdivision Name NA Block # O'ublidCommercial - Describe Use � NA ❑City of r--I,, t estate Owned - Describe Use u illage of CSM Number V 28; PG 6357 OTown of HAMMOND III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A' ✓ ew System `/ Replacement System ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B. Holdin Tank g ri In -Ground t-Grade Mound Individual Site [ksi ✓Other T ype (explai (conventional) GMAT C. ❑Renewal Before Revision 'hange of Plumber ❑Transfer to New Owner List Previous Permit Num er ate slued Fxpiration f IV. Dis ersaVrrreatmerit Area and Tank Informati n: Design Flow (gpd) Design Soil Application Rate(gpd/s ispersal Area Req it (sf) Dispersal Area Pro ed (sf) System Elevation 450 0.6 225 227.5 9'f, /-7 Capacity in Total .. Manufacturer Tank Information Gallons Gallons Units o a� New Tanks Existing Tanks - e��'r� �` a = — p a. U in H v: ia. U 4 I rM Septic or l lolding Tank 1000 1000 1 WIESER (COMBO) ✓ Dosing Chamber 650 650 Q a V. Responsibility Statement- I, the undersigned, assume respons ility forogstallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb S' a c MP/MPRS Number Business Phone Number MICHAEL RODEWALD 931384 715-425-6200 Plumber's Address (Street, City, State, Zip Code) 285 C.T.H. SS, RIVER FALLS, WI 54022 VI. County/Department Use Only Approved ❑ Permit Fee D to Issued Is pin V gent Signature r Given Re for Denial $ �� I.; zQ Z.Z Conditions o Approv rov 3 \ Ue n STEM OWNE I rXj.]P,ny�,,-.(�, �, / Septic tank, effluent filter and J �'-"� 1 1 �� 2 , dispersalcell must be serviced / maintained ) St'� 3 a fr ,Q„ , �'� oze Z / s per management plan provided by plumber. S) w� 4 II setback requirements must be maintained ! G""` , I Z�2 �Z,a;L l U 1 i 4 5R } s per applicable code/ordinances. tth f. 290 t� Attagy to co 1<M �S• r thr s atem nd% brit to In Co an anly Von not res3.auda to s I 1 Iacaes size •� t r Sa r / w y�.t s..iA'n��V"��/`I'tC) �L!'•',- Q YM. t N , NA Id. YVt SBD-6398 (R. 03/21) Dt)fl -OA_ P�I� "t" tvL b&M 1F`I5- Plot Plan PROPER7V OWNER: 6A(L 1>QAL! rROnn LWI DesaOtbn: LOT 2, csM Vz8 -?C- 6 35'i; SE' OF -mt Szh. Bs,,2ga R_TvwN oF NAMMOND� sf cl?.aiX 10 COL41VT4 WltbeDMUM- 018010-3O- ZEV copy ^�rvROUNp SUR�flCE Lt" WOOi]8N F6 Sf— �jlo,7't i page ofy: 2" =- 40 Ff. (exaeptwhwe noted) a = bmmm pit Zt. 56f AZR� North G i w 1 4 N$W WIEW jowl&50 TANK. W1 puMP flLTM I . \ >I� of 1�� 40 p sto^ --COPY Indust Industry Services Division County 4822 Madison Yards Way ST. CROIX Sanitary Permit Number (to be filled in by Co.) I;I ""Sp 2�2 Madison, WI 53705 C Q'p P.O. Box 7162 Madison, WI �7-7 State e Transaction Number 5. �t it Application In accordance ith�(31i8 is. Adm. Code, submission of this form to the app Hate governmental unit NA is required prio ammg a sanitary permit. Note: Application forms for state-owned POINTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 110TH AVENUE 1.A lication Information - Please Print ill Information Property Owner's Name Parcel q GAIL DAHLSTROM 018 - 1010 - 200 Property Owner's Mailing Address Property Location 1118 170TH STREET Govt. Lot NA City, State Zip Code Phone Number HAMMOND, WI 54015 651 - 3 - 6699 sE , I on 05 T 29 N E or W 11. Type of Bui g (check all that apply) Lot tt a] or 2 Family Dwe - Number of Bedrooms 3 , S division Nam OPublic/Commercial - Des a Use NA Block N ❑ of _ NA ❑Slate Owned - Describe Use CS umber Vit e 28; PG 6357 can HAM ND Ill. Type of POWTS Permit: (Check eit "New" or "Replacem t" and other applicable n eck b on a B. Complete line Cif a licable. A. ✓Neve System ZReplacement Syste ather Me cation to Existing System (expi } Additional rcatment Unit (explain) • B' ❑Ifolding "rank []In -Ground t-Gr —7hu dividu i ign Other Type (explain) (conventional) GMAT C. ❑ Renewal Before Revision of Plumber sfer t caner ist P r ermit Number and Date Issued Expiration I 7. IV. Dispersal/Treatment Area and Tank Informatio Design Flow (gpd) Design Snit Application Rate(gpd/s0 Dispersal a Required (sQ Dispersa Area ed (sf) System Elevation 450 0.6 2 22 Capacity in 'Ibtal of Manufac er Tank Information Gallons Gallons - S New Tanks Exista, mils ���„ U U in b in ii V CL Septic or llolding'rank 1000 1000 1 WIESER (COMBO) ✓ Dosing Chamber 650 650 Q V. Responsibility Statement- 1, the underlined, assume responsibility for stallation of the P TS shown on the attached plans. Plumber's :Name (Print) Piuma e MP/MPRS Number Business Phone Number MICHAEL RODEWAL 31384 715-425-6200 Plumber's Address (Street, City, State, Zip de) 285 C.T.H. SS, RIVE FALLS, WI 54022 VI. CountyfDepartment Use OnIff ❑ Approved El Disapproved Fee Date Issued Issuing Agent Signau yPermit ❑ Owner Given lion for Denial Conditions of ApprovaVReaso for Disapproval •••- . - -• •"..,.� Hymen, euu auumn in uic s.oumy only on paper not less man it is s 1 i mcnes in sae SBD-6398 (R. 03121) GeoMat IN GROUND AND DOSING DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Owner Info Project Name: GAIL DAHLSTROM Owner's Name: (SAME) Owner's Address: 1118 170TH STREET HAMMOND, WI 54015 Property Info Property Address: 110TH AVENUE Legal Description: Township Subdivision Name: Lot Number. Parcel I.D. Number: Plan Transaction No.: Index Pages SE SE S 5 HAMMOND NA T 29 N County: ST. CROIX 2 Block Number: NA 018 - 1010 - 30 - 200 R 17 W CSM#: NA Page 1 Index and title Page 9 Plot plan Page 2 Data entry 1��e to pvAlp C.Awr �{ `P`" Page 3 GeoMat dist. cell drawings & calculations � e 11 Soil test Page 4 Lateral and cell cross section �a e tz- Soil test Page 5 Management & contingency �e 13 Soil test Page 6 Maintenance & specifications � � I y Aerial Page 7 Tank cross sections Page 8 Distribution media MARY JO HUPPERT License Number: 1859-007 Date: 12/06/21 _ Phone Number: 715-426-1775 Signature: Designer Stamp: _ State of Wisconsin Approval Stamp: PP : P 5... TZ :: .fa+ - "-.� • ¢ - ---� y: Designed Pursuant to the '•,,- GeoMat In Ground Component Manual Ver. June 26, 2018 Version ,.� Page 1 of 14 In Ground and Dosing Distribution Component Design Design Worksheet Site Information R Residential or Commercial Design ISD Required? 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 2.00 Site Slope (%) 94.17 Prop. System Elevation (ft) 40.00 Depth to Limiting Factor (in) A In-situ Soil Application Rate (gpd/ft2) Contour of original grade at downslope side of cell(ft) Installation Contour (ft) Enter value on Cross section Tab Limiting Factor Elevation (ft) Depth Below Grade Distribution Cell Information 3.25 Cell Width (ft) 0 Number of Cells 2.00 Dispersal Cell Design Loading Rate (gpd/ft2) 21 Influent Wastewater Quality (1 or 2) E Center or End Manifold, Dist. Box or Drop Box 1 Number of Laterals System dosed 0.00 Lateral Spacing (ft) 20.55 Forcemain Drainback (gal) Does the forcemain drain back?l Y 0.50 Forcemain Filter Loss (ft) 2.00 Forcemain Diameter (in) 126.00 Forcemain Length (ft) 90.00 Inside Pump Tank Elevation (ft) 3.50 System Head (ft) x 1.3 6.27 Vertical Lift (ft) 0.00 Friction Loss (ft) 10.27 Total Dynamic Head (ft) Designer must enter friction loss and system demand (gpm) 65.55 Minimum Dose Volume (gal) 25.00 System Demand (gpm) �ltt:11. C'1Z1'14'11- iLil1 ]iII1C S:'o Treatment Tank Information Effluent Filter Information 1000.001 Septic Tank Ca acit al) Pol lok Inc./Zabel Filter Manufacturer Wieser Concrete Manufacturer 3014-525-1/16-10,000 GPD Filter Model Number Dose Tank Information Gallons/Inch Calculator (optional) 650.00 Dose Tank Capacity (gal) J Total Tank Capacity (gal) 17.001 Dose Tank Volume al/in) Total Working Liquid Depth (in) Wieser Concrete Products, Inc. IManufacturer gal/in (enter result in cell DoseTankVolume) Project: GAIL DAHLSTROM Page 2 of 14 I - (CCAR (ae(ammtt V U O On ISM-410 O'O � O-O- 00�3�'O O 0000 1 3.75 K 1 S1 0.00 ft ft ft A 3.25 B 70 L 72 W 10.75 Basal Area Calculation GPD Loading Rate 450 0.6 gal/sq ft/day Totall 750 ft2 Number of Cells 1 1 Cell Lengthi 70.00 Min. Cell Length 69.2 Cell Spacing 0.00 ft Basal Area Required 750 ft` ft Basal Area Proposed 752.5 ft ft ft GeoMat Dis ersal Cell Basal Area Calculation GPD Loading Rate 450 2.00 gal/sq ft/day Totall 225 ft2 Pronosedl 227.5 ft2 ft Lineal Feet of GeoMat Required 69.2 ft Lineal Feet of GeoMat Proposed 70 ft NOTE: Min S dimension = 1' System Elevation 94 Limiting Factor 91.67 Separation 2.33 t t t 2' Min Directions: Play with cell length to get desired cell spacing, length and width. Remember system SHOULD be longer than it is wide. It must also Satisfy basal loading rate and GeoMat cell loading rate. Project: GAIL DAHLSTROM Page 3 of 14 End Connection Lateral Layout Diagram Hole spacing is every 12", 1/2" hole at 4 &8 O'clock, starting 4 O'clock 6" from end and 6 O'clock Holes at 12" from end. Lateral Spacing O.OD ft Pipe Diameter F---2 o-ol in Distribution Cell Cross Finished Gra e Lead End MA a -0.17 ft 2 in Fab6c IX Top of geomat to be at or below original grade cbclpoont IfIffitrid" surfike 40ir 11511111FIVation Pip Project: GAIL DAHLSTROM Page 4 of 14 Contour Geomat Sloping site Cross Section View Minimum 12" cover over pipe %.59 �2--]°h slope elevation Minimum inshu 95.25 95�331pmd eomat elevation Min system elev 94.17 12" aMust be lower than System elev 94.17 Downslope elevatbn —111�1�� --,* L 4.— Undisturbed soil Limiting factor inch F4o�Limiting factor elev 92.17 IAfIdM 11 1Q75 Width Changes by increasing "I" in Drawing & Calos Tab Recheck cross section after making changes to Width Notes/ Maintenance Requirements MANAGEMENT PLAN This private onsite wastewater (POWTS) has been designed, and is to be installed and maintained in accordance with SPS 383, Wis. Admin. Code, the in -Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0 SPS- 10705-P (N.01/01). GeoMat in ground Component manual Version 1. 1. This POWTS has been designed to accommodate a maximum daily flow of 450 Ions of wastewater per day. The quality of influent discharge into the POWTS treatment or dispersal component shall be equal to or less than all of the following. A monthly average of 30 mg/L fats, oil and grease A monthly average of 220 mg/L BOD5 A monthly average of 150 mg/L TSS Wastewater shall not discharge to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140Tables 1 & 2 at a point of standards application, except as provided in DSPS 383.03 (4), Wis Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. 3. Defects or malfunctions identified during maintenance described above shall be repaired in conformance with SPS383 Wis. Admin. Code, and the pertaining county Private Sewage Systems Ordinance. The user's manual, provided to the owner of the POWTS includes the names and telephone numbers of the properly licensed individuals to contact for such repairs. 5. No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Dept. of Commerce in accordance with SPS. 384, Wis. Admin. Code. 6. If the POWTS is replaced, or its use discontinued, it shall be abandoned in accordance with SPS 383.33, Wis. Admin. Code. NOTES Two Effluent Filters to be installed where possible 1 to be installed in ST, and or 1 in pump tank in order to insure particle size less than or equal to 1/8". Filters should be cleaned once in spring, and once in fall. Also, strainers in sinks in the building shall be maintained, so that solids and fats are minimized to flow into system. A minimum of 2 observation pipes per cell shall be installed. These pipes shall be located approximately at the end of each cell. The plumber, or county shall see to it that a copy of these plans including this page, maintenance folder, and maintenance agreement is given to the homeowner. This system may contain a dose chamber. If a pump, float, electrical outage causes the dose tank to fill, the homeowner should see to it that the effluent level in the tank is brought down gradually and not all dosed to the system at once. One large dose could cause damage. Contact a pumper or your installer if this problem occurs. The homeowner is responsible for formulating a water conservation plan that will ensure the system is rarely overloaded. I.E. spread laundry out over time, not 6 loads in 2 hours, while everybody showers, and uses the toilet, ETC. CONTINGENCY PLAN FOR COMPONENT FAILURE A. Septic Tank. Any structural failure resulting in cracks or leaks in the tank must be corrected by replacement of the septic tank component. Leaks in the joints between manhole risers or covers shall be repaired by replacing faulty seals with approved materials to make joints water -tight. B. Outlet Filter. The outlet filter shall be replaced or repaired when it is either no longer capable of preventing the discharge of particles larger than 1/8 inch or when it has become permanently degraded by clogging so as to interfere with the design flow out of the septic tank. C. Dosing chamber and pump. The dosing chamber shall be replaced if any structural failure Is found. Leaks in joints between manhole risers or covers shall be repaired by replacing faulty seals with approved materials to make joints water -tight. The pump and controls shall be replaced when they are no longer capable of functioning according to the design plan. D. Pressure Distribution Piping. Partial dogging of the distribution network may result in unduly long dosing cycles. The ends of the distribution laterals may be exposed and the threaded end caps removed. The piping can be disconnected on the outlet end of the pump. The distribution piping may then be back flushed to cleanse any accumulated matter from the piping. It is recommended that the dosing chamber then be pumped by a licensed plumber. E. Soil Absorption Cell. The discharge of sewage or wastewater to the ground surface is strictly prohibited due to the human health hazard created by the effluent. All failures created by surface discharge shall immediately be reported to the appropriate county. The pump shall then be immediately disconnected to prevent further discharge to the ground surface via the soil absorption cell. The existing septic tank and dosing chamber shall be used as a temporary holding tank until the necessary repairs to the soil absorption cell can be achieved. The replacement shall be initiated only after any necessary plan approvals have been obtained from the appropriate plan review authority and the required sanitary permit is obtained from the county. Project: GAIL DAHLSTROM Page 5 of 14 Service Provider's Name DARRELL'S SEPTIC SERVICE Phone 715 425-1025 POWTS Regulator's Name St Croix County SPIA - Zoning Office Phone (715) 386-4680 System Flow and Load Parameters Design Flow- Peak 450 gpd Maximum Influent Particle SizeMcfu/100 in Estimated Flow - Average 300 gpd Maximum BOD5mg/L Septic Tank Capacity 1000 gal Maximum TSSmg/L Soil Absorption Component Size 227.5 ft2 Maximum FOGmg/L Type of Wastewater Domestic Maximum Fecal Coliform mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System In Ground Service Frequency Inspect and/or service once every 3 years Inspect and clean as necessary at least once every 3 years Test once every 3 years Should test periodical) Laterals should be flushed and pressure tested every 3 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the GeoMat In Ground Component Manual Ver. March 20, 2017. 2. Dispersal cell media conforms to GeoMat products approved for use with the GeoMat In Ground Component Manual Ver. March 20, 2017. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Scarification of basal area is accomplished with a rake or other tool. 5. All disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail 6-8" Diameter Oggv)!! ncp-'( N ld-QUV°8 Threaded Cleanout �°000Flnlshed o0000 Lawn Sprinkler 000000 0 0 000000< °o°o°o° Plugor Ball Valve 0000000°c Grade ��p°°o°o° Box i R OR °n�'n n n n n ° Lateral Ends at Last Orifice Where Long Sweep 90 or Two ""—�45 Degree Bends Same Diameter as Lateral Distribution Lateral I Lateral Cleanout 94 Feet Project: GAIL DAHLSTROM Page 6 of 14 Clean out Pipe Locking cover with warning label, locking device and water tight seal Electrical box as per NEC 300 and SPS 316.29 WAC r Wires From Electric source Boss stop and water tight gasket High water alami ump On Float 4 Pump Olt Float Dimension Inches Gallons A 24.38 414.45 B 2.00 34.00 C 3.86 65.55 D 8.00 136.00 Total 38.24 650.00 4" Vented Cover Optional ball v ve to control speo of effluent beini dosed ForCemaln diameter 4• ASTM 303 pipe to 2 In. oncew f in onto solid ground Weep Yok or Mt Fumco siphon dvlke 3 Pump I F=I 4- Pump off elevation (11) l 90.67 Block Dose tank elevation (ft) ~— 90.00 Wieser Concrete Products, Inc. Capacity 650.00 Volume 17.00 Filter Manufacturer ISim / Tech Filter Filter Model Number ISTIF 100 1/16 Alarm Manufacturer JSJE Rhombus Alarm Model Number JAB TANK ALERT Pump Manufacturer JZoeller Company Pump Model Number JBN 53 Pump Must Deliver 25.00 gpm at 11.49 ft TDH Note: Switches containing mercury may not be used in this system. gal/inch Project: GAIL DAHLSTROM Page 7 of 14 GeoMat Distribution Cell Media Layout; 3.25 Cell Width (ft) 2.63 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements O Distribution Pipe GeoMat is covered with approved geolextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 3.25 Cell Width -A (ft) 70.00 Cell Length - B (ft) End Connection Lateral Layout Diagram Finished tirade ►V Y V V Ifpip `=:„'i• ` Fabric _ _ rMr GEO MAT 1 1 I I 2�/1SZM 93 I t l l r l f l Instrative' Surface 13A"C_IV9-S�IL See details on page 4 for number, size. and spacing of laterals. Project: GAIL DAHLSTROM Page 8 of 14 Plot Plan pve -� of y PROPERTYOWNER: 6AIL 1---)WLSTFbNM r— 40FT. {except where noted) Lesmtsrr 2, Csq, VZ4-�G 635i, SE�Iy o -► /�. a a pn sicl os� i2ga� R17VJ TowN o Hs�un�onlD� sT CRaIX 2J. -SLf A� Counl7 WtSCOM.:504. 018- 100- 30- ZEV North 0 ?pofmD , 6 r9 u� )07.169 3D�OF4A61A&Wif e NEW %ovie C 1000/-50 TAML W/PuMI ffwmR _ F z •00 ti y 9s �$,h6rZowaa suaF�tcE �Zyb' ri -71' o s � Site ! ation: I -- Lfam. E,, A 05 � T i,3�k c VE. x Sn� P& E T 1/0 r AVC 07/Y8/P007 16:09 FAX 715 273 6864. . P . C . LAND NG1fI; , VLI /2 iJJ1 iV. W w`w HEAD CAPACITY CURVE "�- -�-- 6u III1LL + "53-551f SERIES r n� 1 �-- us GALLONS LITERS, p UNITS/MIN ""T r"' s cat erns 5 1.52 43 10 10 3.05 34 120 15 457 19 72 19 5.87 0 0 1 1 9`y4 1U 20 g 0 40 50 1, 00 1GO FLOW PER MINUTE FRICTION CHART FOR PVC SCHEDULE 40 PIPE (Flow Ceetlleie7,l c_tcnl ibw Goa , h• r •4- . r 2 ti' r r O V 4t. V K V N, V I(, V It1 V N. a t,2a ,714 a 1.72 1.1a f,N, .536 1e 2.16- 5.7a Ise W4 1S 3.l2 3.7a 2.3r Lf4 I.I .616 4.27 awl 3.16 Z.06 l,il• lA4 1.34 i 25 5.77 9.74 7.W 4,4i !J0 I.Zr. .765 30 a44 13,a 4.7i 1.2> 2A> tJlt 3.01• .759 1-30 364 3s .7sl 10.2 S7 8.40 3.31 2A! ] ,0 11 t .346 40 20,6 10.7 3.03 ,re 2E 1.20 1,74 4S 9-47 2D.a •7,09 i3.3 4,30I ,444 1.65• ,9a2 ts3. 2a 1�6 t>s so S.74 9.62 42,72 .ses 2a0 .O3a 1.51 .747 6.70 0.11E 3.f7 3A4 1.23 1.76 .330 7,C• 11.6 4,09 3,•7 1.Sf 2.0!' .41 660 1+, E.W '� tiy1 - Io.7 5.47 ] 72 3.1 ,75t tsD 6.61 S.rE 3.7a L34 1>s >.Ix1 9.roe 14,•� Laf _ _� •.G1 6.03 5.0• 7.7> 225 _. 6.467 Z.04 337 275 6.93 4.13 7.34 4.67 - --- _ 400 Y lt�•1T4 -+aw•1 . G.\G• Y•lV[, 1 G.I n, y-Lv4 A f IINM,t S+A - 11 h N PT .!%4�j-fit jj!ti� Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT pap 4 of 4 in accordance with SPS 383, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 018 - 1010 - 30 - 200 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed by Data Please print all information. Personal inforrnatiwr you provide may be used for secondary purposes (Privacy Law, s- 15.04 (1) (m)). Property Owner Property Location GAIL DAHLSTROM Govt Lot ---- SE 114 SE 1/4 S 05 T 29 N R 17 E (or) W Property Owners Mailing Address Lot # Block # Subd. Name or GSM# V 2$ pa, 1*357 1118 170TH SSTREET 2 — i city Stale Zip Code Phone Number ity [:]Vllage EjTown Nearest Road HAMMOND, WI 1 54015 ( 651 ) 503 - 6699 I IOTH AVENUE New Construction Usee Residential / Number of bedrooms 3 Code derived design flow rate 450 GPO Replacement ❑ Public or commercial - Describe: Parent material SANDY LOAM TILL Flood Plain elevation if applicable NA ft General comments PRETREATMENT GEOMAT IN -GROUND -- 1.0 Fr. ASTM C-33 SAND — 0.8 LOADING RATE and recommendations: NEW TEST REQUIRED — DRIVEWAY GOING THRU 1ST TEST. mapped: JsB 0 Bores # o Boring40 El ft. Pit Ground surface elev. 95.75 Depth to limiting factor in. Soil Aoolication Rate Horizon Depth in. Dominant Color Munsell Redox Desmption Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots I GPD/ff 'Eff#1 -Efl#2 1 0-10 10YR3/2 — sil 2fsbk&gr mfr cs 2vf-f 0.6 0.8 2 10-24 1OYR4/4 _ sit 3fabk mfr cw lvf-m 0.6 0.8 3 24-40 7.5YR3l4 sl 2f-mabk mvfr as Ivf--f 0.6 1.0 4 4046 7.5YR3/4 fIf7.5YR4/6 sl Om mfr 0.2 0.6 some gr 2 Boringill U Boring 94.75 42 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz- Cont Color Texture Structure Gr. Sz- Sh. Consistence Boundary Roots GPDRf' 'Eff#1 I -Ef #2 1 0-10 10YR3/2 — sit 2f-msbk&gr mfr cs 2vf-f 0.6 0.8 2 10-16 10YR4/4 — sit 2f-mabk mfr cs I vf-m 0.6 0.8 3 16-42 7.5YR3/4 — s1 2f-mabk mvfr as Ivf-f 0.6 1.0 4 42-50 7.5YR3/4 1711f7.5YR4/6 sl 0m mrfr — - 0.2 0.6 some gr. - Effluent 91 = BOD > 30 < 220 mg/L and TSS >30 < 150 nx (L Effluent #2 = BOD, !i 30 mWL and TSS < 30 mgfL CST Name (Please Print) CST NumberS' MARY JO HUPPERT (Hollister's Soil Testing & Design) 224832 Address Date Evaluation ached Telephone Number 28497 KING ARTHUR'S CT., DANBURY, WI 54830 11 - 11, 2021 715 - 426 - 1775 Jt11tbS.f V kKV // 1 �J DA}iLSTROM, Gail 018 - 1010 - 30 - 200 Page 2 of Property Owner _ Parcel ID # Boring # Baring 94.95 42 ' Pit Ground surfaceelev. ft. Depth to limiting factor In. il lication RateHorzon Depth Dominant Colo RedoxDescripton Texture Structure Consistence Boundary RootsEGPDHfEff#2 r in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. sit 2f-ma&sbk mfr cs 2vf-f 0.6 0.8 1 0-9 IOYR3/2 Ivf--m 0.6 0.8 2 9-20 10YR4/4 sit 2f-mabk mfr cs 3 20-42 7.5YR3/4 sl 2f-mabk mvfr as lvf-f 0.6 1.0 4 42-49 7.5YR3/4 fl f 7.5YR4/6 sl 0m mfr 0.2 0.6 some gr./few cobs. Boring # ❑ Boring n pit Ground surface elev- ft. Depth to limiting factor in Soil Application Rate Horizon Depth n. Dominant Color Munsell Redox Description Cu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff Eff#1 Eff#2 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting (actor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 j -Eff#2 ` Effluent #1 = WU5 > 3() < Z20 mgt. and T66 >30 < 1 W mcy'L SOD4330 (ROr/13) ERluci n 02 - 6O1D. , 30 ry9t and TSS _ 3O'rng/L I '. SCC ArcGIS Web Map Or -- _- t oQoS D k � f r y s l 1 4" :010 1:2,257 101812018,8:23:11PM D D.Dz 0.04 O.OTmi site Address Points IntertnedialeContours Public ROW Lot i ,T� - - <all other values, Private Riphtof-Way Lundell Commas Elmnr ent 0 0.03 0.06 0.12 IndezCoMours <all doer values, - INDEX La and Unds General Gorman Ekmenl St. Cl.,. co,wy �.N• Ila.•ebPmenl scc coo INDEX -""- INDEX DEPRESSION Ou"ot Tax Parcels MDEX DEPRESSION INTERMEDIATE Unit INTERMEDIATE DEPRESSION Park Web AppBukle,Imkc SI C,o C ,v, O,,,,. „..y Devebprr n I S,. C,. C.1, ComavMy DevabP—t I SCC C' 146" I m TOP VIEW 4" VENT �n 4" INLET[: — _ — _ _ _ _ 7 4" OUTLET �4V 3" PUMP PAD a WLP10&,0 650-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 54 1/2" O.D. LENGTH: 146" O.D. WIDTH: 84" O.D. BELOW INLET: 43" O.D. LIQUID LEVEL: 3B" WEIGHT: BOTTOM 14.940 LBS. INLET AND OUTLET: 4" CAST —A —SEAL BOOT OR EQUAL GASKET, CAST —A —SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 26.032 0 GA LN �SEPTI) ) 1LA LOADING DESIGN: 8' 0" UNSATURATED SOIL MN TANKS: WILL HAVE ONE VENT OVER OUTLET AND WALL HAVE TWO VENTS IN COVER OVER INLET TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON OR SEPTIC/SIPHION r� SIDE VIEW_ CUSTOMIZED TANKS: TANKS CAN BE CUSTOMIZED CONTACT WIESER CONCRETE TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 0 OF File #: ST. � C uNTY SANITARY SYSTEM office use only + OWNERSHIP/ADDRESS FORM Created 2/2021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. Owner/Buyer OWNER/BUYER INFORMATION GAIL DAHLSTROM Mailing Address 1118 170TH STREET City/State/Zip HAMMOND, WI 54015 Phone Number (required) 651 - 503 - 6699 Email Address (required) 940 Parcel Identification Number 018 - 1010 - 30 - 200 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SE ,�4 SE 1/4 , Sec. 05 , T 29 N R 117 W, Town of HAMMOND Subdivision Plat: NA Lot # 2 Certified Survey Map # I o `f R7 Volume 28 Page # 6357 Warranty Deed # S (9 (before 2006)Volume Page # Number of bedrooms 3 Spec house 0 yes ■ no Lot lines identifiable ■ yes 0 no OFFICE USE ONLY New Property Address / 6? 1 7 / ILA ZYY A VLET (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mop if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, W! 54016 www.sccwi.aov A, I arr- n I 37" 7725 'k n u 10 -'sk !07v St. Croix County Accessory Structure Affidavit-C r- IV =`J 64-i/ Al. PAUSAiu'.l. DEC 2 7 2021 Name — (Owner) Typed or printed ST. CROIX Cot He/she is the legal owner of the following parcel of land located in St. Croix County, Wisconsin, with their deed or document of ownership interest recorded as Document Number 566 6 % St. Croix County Register of Deeds Office. Recoi This property is described as follows (include lot no. and subdivision/CSM or detailed legal description): Parse Sa %y r SE%y See 9 `7w9AI 9 /?"J bl 28 -6357 46f- 2 OR ❑ See attached deed copy for legal description 11111111:811,1111!�e 1145697 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12/22/2021 10:15 AM EXEMPT *: REC FEE 30.00 PAGES: `4 IR 11 Mddnss �9a�sil y,�t,.re•t�k�S'Jo/S As owner of the above described property, I acknowledge that the Private Onsite Wastewater Treatment System (POWTS) serves an accessory building on this lot and is sized for a future (3) bedroom home, or a design flow of ,ftgpd. This accessory building may not be used as a residence on this parcel. I also acknowledge that I will disclose this information and stipulation to any future parties interested in purchasing this property. Dated Vss day of * &AIL_ 7_2A-FlZs-_r194)AA AUTHENTICATION Signature(s) authenticated this _day of * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY: St. Croix County Community Development (Signatures may be authenticated or acknowledged. Both are not necessary.) * ACKNOWLEDGMENT STATE OF WISCONSIN l )ss. St. Croix County. ) Personally came before me this day of the above named 1+ to me known to be the petson(s) who executed the foregoing instrument and acknowledge the same' KATHLEEN J. OSTLUND Notary Public g Wlsconsi Notary Public, Slate of Wisconsin My Corn is on is ermanent. If not, state expiration date: Date: _ _ __ St. Croix County 1145697 Pagel -of-4- Wisconsin Department of. nd Pro easy onet Services D �!3— Division of Ind�t(l., �, 1 J SOIL REPORT 1SU� �_<' kr-., "� nnQQ tOZ` 1 in accordance with SPS 383, Wis. Adm. Code County Attach�"lei6Osite plan on paps{ not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical nd horizontal reference point (BM), direction and Parcel I.D. 'percent north arrow, andlocaticnand distanceto nearestroad. Vcfm �"s" j*lease print all information. vowed by ersonal infcrm nion you provide may lie used for secondary purposes (Privacy Law, s. 15.04 (1) (in)). Page 1 of 4 ST. CROIX 018- 1010-30-200 Property Owner Property Location 1:1 El GAIL DAHLSTROM Govt. Lot ---- SE 114 SE 1/4 S 05 T 29 N R 17 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I Pa., io 557 1118 170TH SSTREET 2 -- V Z$ , City State Zip Code Phone Number ity nVillage • own Nearest Road HAMMOND, WI 1 54015 ( 651 ) 503 - 6699 HAMMOND I 1 OTH AVENUE Q New Construction User Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement D Public or commercial - Describe: Parent material SANDY LOAM TILL Flood Plain elevation if applicable NA ft. General comments PRETREATMENT GEO TIN- ROUND -- 1.0 FT. L4S1_M C-33 SANIa -- 0.8 LOADING RA"'I and recommendations: (�(� t9v�S iGk� waEt�w7�' Lap a 8�, •+, w„ NEW TEST REQUIRED -- DRIV AY GOING THR I ST TIAT. r&b,. (Z u 1 X) mapped: JsB � I a Boring # © Boring Q Pit Ground surfaceelev. 95.75 ft. Depth to limiting factor 40 Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff -Eff#1 •Eff#2 1 0-10 10YR3/2 sil 2fsbk&gr mfr es 2vf-f 0.6 0.8 2 10-24 1OYR4/4 - sil 3fabk mfr cW ivf--m 0.6 0.8 3 24-40 7.5YR3/4 sl 2f-mabk mvfr as ivf-f 0.6 1.0 4 40-46 7.5YR3/4 fIf7.5YRai6 sl Om mfr 0•2 0.6 some gr 9 �.o 2 Boring # U Boring 94.75 42 Pit Ground surface elev. ft. Depth to limiting factor --�in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots .wun, ,yam GPDN 'Eff#1 'Eff#2 1 0-10 IOYR3/2 sil 2f-msbk&gr mfr CS 2vf-f 0.6 0.8 2 10-16 IOYR4/4 sil 2f-mabk mfr Cs lvf-m 0.6 0.8 3 16-42 7.5YR3/4 s) 2f-mabk mvfr as 1 of-f 0.6 1.0 q 42-50 7.5YR3/4 n LLiUA4. sl 01m mfr - - 0.2 0.6 some gr. # j Guruart *I - oVu I JV Z "U nrtyL dI1U I JJ /JV � 1W mgrL - tmuent wz = Cuu < Ju m91L ano t55 < 30 rT192 CST Name (Please Print) CST Number S VARY JO HUPPERT (Hollister's Soil Testing & Design) L224932 Address Date EvaluationCl5nducted Telephone Number 28497 KING ARTHUR'S CT., DANBURY, WI 54830 11 - 11, 2021 715 - 426 - 1775 SBD-8330(RO7/13) Property Owner DAHLSTROM, Gail Parcel ID # Boring 3 Boring # r i Grnnn l mlrfnra alav 94.95 ft 018 - 1010 - 30 - 200 Page 3 of 4 Depth to limiting factor 42 in. cal a �J rnann aim Horizon Depth n. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Efi#1 'Eff#2 1 0-9 10YR3/2 -- siI 2f-ma&sbk mfr cs 2vf-f 0.6 0.8 2 9-20 10YR4/4 -- sil 2f-mabk mfr cs Ivf-m 0.6 0.8 3 20-42 7.5YR3/4 sl 2f-mabk mvfr as I of--f 0.6 1.0 4 42 7.5YR3i4 flf 7.5YR4/6 sl Om mfr 0.2 0.6 some gr./few cobs. Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Crol Arvllirafinn RaM Qu. Sz. Cont. Color ❑ Boring # H Boring Pit Ground surface elev. R. Depth to limiting factor in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Owl PWPIIt GPDff Uurl Rate *Eff#1 'Effp2 ' Effluent #1 = BOOS > 30 < 220 mg/L and T 55 >30 < 130 m9rL Sob-9330 ptom 31 ' Effluent #2 - BOD5 2 30 mg/L and TOO = 30hng(L Plot Plan p4p 3 of Y i PROPERTYOVMER: 6AIL LDkiALSTROIA 1"= 40Ff. / (except Where noted) tWi Description: Lxt f 2, CsM V 2 8 — *PG 10,6f '%e .SE �/ 4 r = 'itt� �y. Ci == b Kume Rrt SEC, 85t i241J R_ 17W TOWA) OF HAMAAW-D ST g-RDIX 2J, 1,57of XRE5 CouNTYi WI!S aw,-W4- Ot$-:lot0- SO- ztO ��E.Rotwp SURF�ICE If o St'— %,'79' Sitec North G y � O � N� P '0 blse t Stt�D � GI e NEW WIESER JOW/(e50 TANIL WjPuMr (O-V;R F ,p0 ft�t Q) a 9Z6Ar'S No a�4s cobo- SCC ArcGIS Web Map 54 1002018. 8:23 11 PM P%H ROW Lol Pv MIM4-W.Y L�N�CM.LW IMIICAtaWn INDEX Ld s UNN General Common Fw..k NotX INDEX DEPRESSION Oulm Tax F`arclb 111EKDEPRESSION IWERMEOIATE U.k INTE EOIATE DEPRESSION psA 1-2,257 0 0,02 0.04 0.07 n 0 ow OM 0.12 M,V..Cd dm ,De.am�wl.S=CDD i VxUulw�i+'M St Q., C., C.T-.ky tIt tl4 c 5W cc i2eck 6SAre W t" +;A&+"ee) 0/X courvrr NO. 642247 STAT SANI R PERMIT c 169a ilo Are OWNER PLUMBER�i TOWN OF� SEC r ,T! AND/OR LOT PREVIO i BLOCK I/ SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b), The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contarjthe county authority. ' JhOIFIZED ISSUING OFFICER -DATE 731&7.2. THIS PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROY THE ROAD FRONTING THE LO G 4]NSTRU CTIQN SBD-06499 (Rl1/20) � � �'�� ,