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018-1010-30-000
i Departmentof Commerce PRIVATE SEWAGE SYSTEM d Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ermit Holder's Name: City Village X Township Dahlstrom, Don Hammond Townshi ST BM Elev: Insp. BM Elev: BM Description: /O 1 l~ ~/ ANK INFORMATION LEVATION DATA„ TYPE MANUFACTURER CAPACITY Septic „tom-2~t, /o2c~ pro Dosing ~/~ _ W Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ven o Air Intake ROAD Septic ~ ~ ~~~ ~ / ~/ Dosing a~ / 0 ~` ~ Aeration Holding - PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number ~O S (~ S TDH Lif~ , ~ Friction Los System Head TD ~ Q t 1 Forcemain Le t ~ Dia ~, Dist. to Well /~ s. ,~ SOIL ABSORPTION SYSTEM t°..P+ ~ o County: $t. CrOiX Sanitary Permit No: 420355 0 State Plan ID No: Parcel Tax No: 018-1010-30-000 TI ~/ BS ~+2 HI FS ELEV. ~ , Benchmark 9 ~o • S /G~. /Dw " Alt. BM ~'i~ ~"" Bld Sewer ~~ 's~ - St/Ht Inlet S72 ~Il- 33 SUHt Outlet ~- ~~ Dt Inlet / ~~ Dt Bottom O ~~ ,~~ Header/Mangy . D 9'~p_ z, Dist. Pipe D ~ p / ~ D Jfr~ ~~. ZQ Bot. System • S ~r 9 y<j -~ 7s 7 Final Grade ~ S~• ~~• , `~' St over y.a8' ~. ~ ~: 5 ~/S = v t BEDITRENCH Width / Lengt ~ No. Of Tr nches l PIT DIMENSI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ h ~~' Q_ `y~- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING Manufacturer: INFORMATION C OR Type stem: , f ~ / IT Model Number: ~~ ~~ DISTRIBUTION SYSTEM 4~f ~~~ />-'h~_ r~~n~ ~ d r~~ ~ Header nif t~9 Distribution f / x Hole Size ! x Hole Spacing /~ Vent to Air Intake + Z ~ Pipe(s) 7+ 3 / ~$h ~ Z 2~ ~tJ / Length Dia Length Dia Spacing + 7 SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Over Depth Over xx Depth of xx Seeded/Sodded Bed ench Center ~ fi ! ~ Q JT° .- Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes [~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ ~ ~~' Inspection #2:~/ l // O~^ Location: 1118 170th Street Ham~m~o~n/d~, WI 54015 (SE 1/4 SE 1/4 5 T29N R17W) NA Lot ~ L ~ Parcel No: 05.29.17.80 1.) Alt BM Description ~~ ~ GC~E'.~ ~''~ti"~'` S, 2.) Bldg sewer length = ~ i J - amount of cover = 3.) Contour = g'~S . ~~--, Plan revision Required? ~j Yes o Use other side for additional information. ~ ~~ v ~ ___~ ~.(%litiv~--' ~ ~ S --~ SBD-6710 (R.3/97) Date Insepctor's nature Cert. No. Q ~~. C/ ~Gh xx Mulched _ Safety and Buildings Division C~tY ~ ,. CaA ~ ~ ~ . 201 W. Washington Ave., P.O. Box 7162 - ~ r~S~o~~j~ Madison, WI 53707 - 7162 Site Address ~ ; . ~ De artm~nt of Commerce '~ • cd ~ ~ 6(~ ~ ~ ~ l ~~ '"~ Sanitary Permit Application Sanitarryy Pyr~t uz ~ ) .~ In accord with Comm 8331. Wis. Adm. Code. personal information you provide ^ p~k if Revision ma be used for seco ses Priv Law s15. 1 m I. Application Information -Please Print All Information Sate Plan I.D. Number of Tir+wts . t1D.~ Property is N ~ Parcel Number ~.- ~ ~ ~' C1A-~ `- S o f1. a Property Owner's Mailing Add Property LocatiCon /~ ~ ~ COUNTY ~ ;i ,G 5i; S T / N, R( •~ Cby, sere Zip Code PtfdFFIC Lot Number Block Number -`-- ~~ ~~G~ ~,' 111 _ J ~j~~ ~ S (/ Subdivision Name ~ CSM Number 1_. II. Type of Building (check all that apply) ^Ciry 1 or 2 Family Dwelling -Number of Bedrooms ^Village ^ Public/Comet - scribe Use _ o~mp ~ - __ - ~ ~S ' ~ Nearest Road ~ ^State Owned III. Type of Permit: (Check one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ^ New 2 ~ Replacement System 3 ^ Replacement of 6 ^ Addition to" For County use.. .~ S stem Tank Onl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued ' I V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) _.~ e.Q 44 ^ Non -Pressurized In-Ground 21~Mound 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Ptrssttrized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' ersaUTreatment Area Informati on: Design Flow (gpd) Dispersal Area Required Dispersal Area Proposed Soil Application Rate(Gals./Days/Sq~.FE.): Percolation Rate (Min.Mch) ystem Elevation Final Grade Elevation ~,od ~o~~ X03 q~ 9~~s' ~ ~~ , , ~, 'rank Imo Capacity in Gallons .Total Gallons Number of Tanks Manufacturer .Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Existing Tanks Tanks Septic or Holding Tank _ ~` oD ° ~' Dosing Chamber 1 VII. Responsibility Statement- I, the un ed, assume responsibility for a POWTS shown on the attached plans. Pl is Name (Print) Pl r ignature ~ /MI'RS Numbe / Business Phone Number ~~~~-9 s~' a .~ ~ ~ Plumber's Address (Street, City, te, Zip Code) ~ ~ ~~ rU~~ ~~~ ~ : ~ o~~ VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued h S Issuing Age Signature o Stamps) arge ) urc ^ Owner Given Initial Adverse . ~~~- 1~ ~ ~ GG ~ Determination ~ IS. Conditi o Approval/Reasons f Disappro ~ PN~y W141~ ~ ~. 4~t ~ ~ ~ I ~/~C~ , ~~ ~ ~ ~ ~n ,, ~ ~ - s Qu ~~ . ... s - ), sr rLU'r rLaty '. Scale 1 "= y 0 ' 'Page 3 of ~ pact - 43 ~~u~T Ptto~. Lth,~ r\ S r"i ~-.~• p1~~, ~-Orv`tpv2 ~. qS.p ~ ~~ ~oYN*~ ot- e ~o nor cor-1 t~~e ~\ \ \ t~ °tS.S ~ ~' ti ~ ° -Z ~ is 1v R.~3 ~ p ~° ~.~ ~~ 1 S' 0~ 5 a " ~,.v ~~ ~ ~ IN F- v` r~ i ~ . 60" ~u~ v,.~o~2 ~~w L orgy ~ °ID' of y,v Rv~ --~tw . ~LZ4C,~u~t O - .. .. _ _ --~__ `L'z__10U-:D _-_QN--=`t-tmP i o~~rr~°~1- w/ - -----~ ~ ~L -t`i~D---= SST sL~t E r a~ ~~ Zo o~ U"PvC ~~ ~ ~_. ~ct._I.U~,~-- , Fti.~talt Gtr-hDE - .~- - ... g"QuC s~~ O ~2~ oR 6" 9~.ow V ®JT Do ®~chi~ F¢o8T al'P'M '1"PVC wYF° A -J`~l ~~A PILL: ~lS`T~ rv 6 1'`f C-~'ri:S-_1`0 CLL ~I"Fvc s~,.`o~uc s~*+c-art. ~3L ~~-tvDUw~ FMS P '~I~'>u ovT ~°-~L.49 St~'T~ora ~ ~-0~E NOTES: ~i 1. Elevations shown are ex' fisting ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be 12uo /$On allon ca acit manufa g p y ctured by L..~ l ~a ~ Cu~C~~; w z / ~1-1 0o PAZ ~ d Ft l~R . . 4 . $ench mark 5 : S~ ,R~3Dy~ ~3. Divert surface water around, system to prevent ponding at the uphill side. ~ a ~scons~n Department of Commerce June 12, 2002 ~vnally -C3VED OF COMMERCE ~'~~~'~ 3PONDEN CUST [D No.267341 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL E?:P[RES: 06!12/7,004 SITE: Don & Gail Dahlstrom 1118 170TH St Town of Hammond, 54015 St Croix County SE1/4, SEl/4, S5, T29N, Rl7W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 854713 Identification Numbers Transaction ID No. 755499 Site ID No. 645659 Please refer to both identification numbers, above, in all cones ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (8.6/99). Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. RECi~~v~® JUN 1 7 ST. CROIX COUNTY ZOPJING OFFICE Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: {608) 264-8777 www. com me rce. state.wi. u s/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary A7TN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARM[CHAEL RD HUDSON WI 54016 ARTHUR L WEGERER Page 2 6/12/02 Owner Responsiblities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construct ion/instal lat ion/operat ion. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats !01.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~(a~_ ~~~~~/~I Charles L Bratz POWTS Reviewer ll ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G lansky ,Wastewater Specialist, (7l5) 726-2544 TITLE SHEET Page ~ of ~ FOUND SYSTEM FOR A ~ BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component t4anual SBD-1057 P and the Pressure Distribution Manual SBD-10573-P c cz. b ! qq~ C ~~. ~ 14 g ~ LOCATED IN THE S ~ 1 /4 OF THE S ~ 1 /4 OF SECTION S , T Zq N, R ~7 6d, TOWzd OF _ ~yn~ Y~ 1L1~ ST- L°_,\2.~ lX COUNTY, WISCONSIN. INDEX PAGE 1 of 7 PAGE 2 Of 7 PAGE 3 of 7 PAGE 4 of 7 PAGE 5 of 7 PAGE 6 of 7 PAGE 7 of 7 ~UL~ r ~~ TITLE SHEET SYSTEPi I°iAiQAGEMENT PLAid PLOT PLAN PLAN VIEW-CROSS SECTION DISTRIBUTION PIPE LAYOUT PUI.IPING CHAP~IBER CROSS SECTION PU1~iP PERFORi•1ANCE CURVE PREPARED FOR MAY 3 0 2002 __~1_t~ _ti~o `~-- sr1ZNt~- SA~ETY & BLDGS D~V, 1`~~"`~0~'~ , w~ S~o~7 PREPARED RY wEGEE~ER SL7 S L - TEST S NG AhtD . . DES = G~V SERV = ~E P.O. Box 74 421 I•d.~fain St. River Falls, jdI 54022 Phone 715-425-0165 Fax 715-425-6864 .a,M... .,.~~ qk:~ • s ~,r 14, . ~ ` X L r?Tr^Ja t ° WEU[HF'.'N o-u~s w ._ eits~orrrr 3 ---~ v ,.~ r, ..+° ,f~~a'U ~C7A'~~/ S . Zg ^Z JOB N0 :• C~Z -J3Z Mound System Management Plan page Z of 7 Pursuant to Comm 83.54, Wis. Adm. Code - Septic Tank - The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least-once every 3 years by inspection. 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 continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank; If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S tem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG. -Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure testis performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occun'ed and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General - This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)] arid local or state rules pertaining to system maintenance and maintenance reporting. -. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole 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 a tank or component. Continoencv 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. If the dosing tank, pump,. pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at -1 is - 3 $- b _ L1 (~ ~p S I . CtZ.eI~X - The system installer at ~ L S - ~ ZS - C14S8. lvf~ G The tank manufacturer at ~0 = 3ZS_ ~~s6 ltiJICSS~2 The effluent filter manufacturer at ~L10 - Z,Z~_ S'1 t[2 Zpct3~;t. The pump manufacturer at -- - ~j3p- g'Z,~-- 4~~g_ GOU - L.OS - PLOT PLAN • Scale 1 "= y p ' p~ C ~, - 43 s'r~~N• ~ ti ~ B.Z ~~ ~ `~ ~ . ~~ ~~ \ ~ a~° a P a3 '~ 1 S' C~ s ~ . ~~, ~, z ~c YVC C~~ _ 1 __ _~_ ~- coy-: o' -o~ _ .~~---~ -, .. o ~ w~L lD ---_- c~ ~ F~v~sK p p~S~-A'~~Eu-~,,~ N O~G ~ S~cCw P1~~, g 'nZ~S Page 3 of ~ --, ~o DoT corp. ~~T ' y i otiZ ~\Sh~R~3 ~\uu~ I ~ -'-~ ~ U ~,0~2 ~1tlu L 0'R U1 r / 4 a~ ~~ -z~ . ~ c``~-"PI7J 4v''f wl t'iZOST s~~ F r ZO OF 4~PVC ~2.~U__~-- ' ~~ Q ~1 ~ 0 ~, -- ~T." o1Z 6" 9tZDw ~ I V ®JT QR.®~e'R4n .. ~-II.oBT pETP'M ~I"PVC W`tF° H-J~l 19~ PcLi... ~1.S`hk6 `t'~1~vn:S-~O u"Pve au~~p,Ne s~C~ 13L .~PY~DUivN'~ F}-S C?lz1Z ~I?F, . NOTES: 1. Elevations shown are existing groun elevations unless otherwise noted. 2. Install 4" observation pipes with a~proved caps. ( Z required). 3. Septic tank to be lzuo /$oo gallon capacity manufactured by 4 . $ench mark 5 : S~ 1~-r3oy~ 5. Divert surface water around, system to prevent ponding at the uphill side. Page ~ Or" 7 Approved S:mthetic Coverzng~ ASTi~i C33 ' Medium Sand Topsoil ~1 ~ > ~~ . 3 istributian Fipe F 'o Slope Distribution Cell of ~ Force Main Z" to 2z" Aggregate From Pump CROSS SECTION OF A t~i"OUND SYSTEM Linear Loading Rates-gs GPD/Iu'~ FT Design Loading Rate=p,l~SGPD/SQ FT --A~-tar-A,ete- Pos i ti an of Force Main • L ~t ~-- -- - E -- - - A ~-1--~__-_ X68---- --------- e q t. ~ Ft. I 1 L Ft. J S Ft. ' K~F~. L $3 Ft . w 2 S Ft. ~ -Observation Pipe -----------=-- -----~-.--o G ~.E?ev. ~1~.5 Flowed Layer D o•S Ft. E O.g(, Ft. F 0 - ~ Ft. G 0 •S Ft. 11 l- 0 Ft. w - -- ~---_-_ ----_i ------~_.~- L-~- ` r ~-- - -- ~~ $~ ;~ . Distribution ~ ~ ~ „ ~~~ Pipe Cell of z to 2 z ~ aggregate Observation Pipe (hachbr securely) - f _ . . _ -- - _ ..------- . ' ' ~ PLAN VIE?~ OF A MOUND SYSTEM _ _ Distribution Pipe Layout Page S of ~ Place the holes at the bottom of the distribution pipes • at equal spacing. Remove all burrs from ti7e pipe and holes. Extend the end of each lateral up with the use of long turn or 4S° fitting to a point within six . 2nches of the final grade. Terminate the ends of the laterals with a valve,: threaded cap or .threaded plug. Provide access from final grade for the valve, threaded cap or threaded plus. ' l -=.,cc~.ss Box- ~'~-t P 1 cry L. Z,~s S _s'~'~-~0 N PVC F~jC Lateral - Manifold ~~ C Lateral x x x x xI2 xfZ x x z x 'Lateral Length - Lateral Length - p Distribution Line !~L'PrN V ~~ __-- p ti _ " ~- -- o__ ~ r~c~s,~ox - -~ ---0 . ~a P 3 3 Ft. ~ ~ Hole Diameter ~~ $ Inch ~-- S 3 Ft, ~ ~ Lateral ) ~ Inches) X Z ~ Inches Manifold " Z• Inches ' - Force Main " Z Inches ~ of holes/pipe 1~ ~ ~• Invert Elevation of.Lateralsg6-d Ft. llx0 •~ll = x•47 K 6 . X11.8 Z GPM ', .. _ ~ ~. ~ = Combination Sept~c~.Tank and PLf•MP CHAMBER CRO55 SECTION AAJO SPECIFICATIOIUS ' PAGE ~ OF ~ • • --,. - -VEU7 CAP ~ WE:ATHER PROOF ' JUUCTIOIJ 9~X . ti C.I.1/EIJT PIPC ~ APPROVED LOCKIIaG ~ lO' FROM OOOR. Mll3JHOLE COYER tvi'tH :JIAIDOW OR FRESH ~ tti'AR.tJ13,1G LI~gEL-• _ •w t~~~~~~p ~ ALK lAlT~tKE t ~ cor~cutT r~ I ' -- i ' FI Iv 1Slf© 6`,nw • .~ o~ fj ~ I ~ Y~ MU.1. I `- - ~' G ~~ ~ ` I 18' /ylI IJ. 18'I'41A1. ~.; ---------- ~~ _.. _ ~ ail U.1LET ~" PROVIDE I ---- AIRTIGHT SEAL I I ~ ~ R • ~ :", ,, v BA~~C I I I APProved z~~ ~`-~ _. a I i l ~ APProved joint w/ (~_`gpc~ ! I ICI ALARM PVCnt w/ PVC pipe ~ -I II Pipe a I I I I ou c ~I I ~L E,~~ .63 F T I ~ I PUMP --~ --~ oFF D CO-JCRETE . ~~„V, $1.t5~1 ~' '% BLOCK ~- RISER EXIT PERMITTED C)IJLy IF TA-JK MA1rUFACTURER HAS SULH APPROVAL~3NAp~F~ 6Ep0 i iV ie SEPTIC F ~ S P E C I F I CATI Ot~l S DOSE I~, TA-.7~C5 MAi`IUFACTURLR: w~"~ ~Z ~UX-~~~ j ~ ~ ~~g Z UU ~ ~ Ob TA J 1 EK OF DOSES: ' PER DAB . I . K SIZE ; GALLp1.i5 DCSE VOLUME r ALAR1+1 !'RAUUFACTURGR: _ S J ,~~`r;Z~ S`~S (• 1~S IA~CLUDIIJG 6ACKFLD W: _ ~ ~~3•'i _, GALLON: MODEL IJUMSER: ~ ~ ` ~ CAPAC ITIES: A c I ~ IUCHCS OR L ~ - 3 GALLOsJs SWITCH T~PC: _ ~ ~Z--Gv~"( 8= Z I-~CHES'OR ~4'S G(~LLOUS HUMP !'tAIJUFACTURCA: yuU<-fig C= 6 WLHES OR 133'~f GALL01.15 MDDEL 1.1UMHER: ~~O:S D= 1 ~ Z Zt. ~ I~iCHES O SWITCH TYPE: ~ L`'~tJR-~'/ R GALLOAlS b~6 - -JOTE: PUMP A1JD ALARM ARE TO 6L MIJJIMUP'1 DtStKAROE RATE L1~"~Z GPl„~ INSTALLED O A1 SEPARATE CIRCUITS VERTICAL DIFFEfCENCF DETWCEU PUMP OFf AUO..DISTRIBUTIO-J PIPE.. ~' 1~ FEET ~-~~ ~- MIt,1lMUM AIETWORK SUPPLY PRESSURE ~ ~ ~ ~. S~ FCET -i- 1 ~ FEET OF FORCE MAIIJ X 3'S~ F j FRICTlOtJ FAC70R p_ S ~ppt~ .. FEET TOTAL Dy1JAMIC HE:AO = t-S ~?I FEET As per rianufacturer Z.Z. Z,~ gal/in. Liquid depth 36~' . -. Goulds i~E~ °~ Submersible Effluent Pump ~ r~ u 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duly sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/4" maximum. -~ • Capacities: up to 55 GPM. J/ ; • Total heads: up to 24 feet. ~' • Discharge size: l'/~"NPT. • Mechanical seal: carbon- _ rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C)_ intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3~4" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'r~' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power card: l 0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS FEET 10~ a~ 3 8 2~ o ~ a w s U 6 2~ > 5 C 1! J 4 F 0 3 1( 2 o~ 00 i~ cv ov 4u 5U GPM ~ ~ ~ ~ ~ 0 2 4 6 8 10 12 m~/h CAPACrrY • Fuily submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermo- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Association (CSA listed model numbers end in "F' or "AC".) i I ! ~ ~ ~_ ~' ~ '1 , ~ ~~~ sGPM: E ~~xsFr , ~.~: i -- -- j ~ r ~ - ' -- ~ --- ~ ~ 1 l ~S' ~ _ ~ i i ~~. j .__I I j ~ i t ~ ~ -- ~ P05) ' , j i - i ~~ ~lI.S2j ~ ~ ~ ~ I I ®1995 Goulds Pumps, Inc. Effective May, 1995 Wisconsin Departrnent of Iridustry LAbor and Human Relations ~ssion of 8atery b Buil~rgs SOIL AND SITE EVALUATION REPORT in accord with ILHR 83.05_ Wis. Adm Cnria Page ~ of 3 ' COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ~ S~' C'~ 1x not limited to vertical and horizontal reference point (BM), direction and °f° of slope scale or PARCEL I.D. ~ , dimensioned, north arrow, and location and distance to nearest road. ' O 1 8 - 1 O1 ~ - 30 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWN ~ ~' l L- ~ ~~' ~- S~ 1Z-41`J1 PROPEATYLOCATION -EOtFr.-4w3T S ~ 1/4 S C 1/4,S S T Z. ~ ,N,R 1~ E {a W PROPERTY OWN 11 l a 1`10 1't}- ST. LOT ~ BLOCKS SUED. NAME OR CSM;! _ , . CITY, STATE ZIP CODE PHONE NUMBER 1`~ftl'~11"1 Cl~, ~ 1 S ~ p t s (~ lS~ ~~ 6 - 53g p QCITY QVILLAGE ®fOWN ' NEAREST ROAD ~~ ` " ' M 01t1~~ ~ p T7}- S T . (}New Construction Use bcj Residential / Number of bedrooms 3 (] Addition to existing building bQ Replacement [ j Public or commeraal desaibe Cade derived dairy flower S~ gpd Recommended design loading rate • ~ bed, gpolft2 - trench, gpd/ft2 Absorption area required 3"1 S bed, ft2 315 trench, ft2 Maximum design loading rate ~ 5 bed, gpd/ft2 • ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) p1, b• C ft (as referred to site plan benchmark) Additional design /site consideraticns ~'~ GU1,I~ ~Jlz3 `x ~ ~~' ti3m , W1 lr~}HUM ~ Z " -` r ~ ~ J F~P..1~ T-~ LL , Parent material ` L.o ~S.S ~ OVfl'i_ T r ~~ Flood plain elevation, if applicable N A ft S =Suitable for system CONVENTIONAL U =Unsuitable fors stem ~ ^ S ~1 U MOUND ~ S ^ U IN-GROUND PRESSURE AT-GRADE SYSTEM IN FlLL HOLDWG TANK ^ S ~u , ^ S ~ u ( . D S fxlU I D S [B'U SOIL DESCRtPTInN RFCnRT Boring # z~` Ground elev. ~5.~ ft Depth to limiting factor 4 O'' Boring # ~~ ~~ Z zY~~ Ground elev. q~~ n Depth to limiting factor 3 S '' Horizon Depth in ~DominantColor Munsell ( Mottles Du Sz C t C l I Texture I Structure h I Consistence I ectr>c~ry I Roots GPD/ft . . . on or o Gr. Sz. S . Bed Trendt o -9 10 `-t jZ.- 313 "-. S t ` - n Z T,Sb ~ I'11.`~r CS • S ~ ~ Z g-ii to ~~ ~L~ - sL t Z>7, sbk ~T~ cS - • s -~ 3 Zzr~ -~s~2~1~ - L l~sblz Mfr c~ - -y •S y ~.0-SS . 5 ~.R 3l y '~ ~ S `l2 S 1v s`1 ow, rn~,, _ rvp . Z Rem~rlre• ~ -9 t ~ `L IZ 313 ~ S i, I Z'F5b 1z `Nl'Cl~ CS - ` . S • 6 Z q ZS to `-t R- ~!~ -- s 1 ~ Zen s bk vn`~t- es - . 5 ., b 3 ?~' 3s ~.S ~~ ~!y - L 1 csb~. Y~t't~ cs _ ~ 4 .S u/ 3S-6S S kR.-~~y `P l'~jyR ~t3 Sc) Ova Vr,`~~' _ NP ~ -Z Remarks: ;STName:-Please Print Phone: Arthur L. We~erer 715-425-0165 ress: egerer Soil Testing & Design Service-P.O. Box 74 River.Falls,WI. 54022 ~' signature: ~` „_//ytL ~ ~~ Date: r r •CSTNumber. C ~, iJG °~-1. ~,,.` ~t9-Z.lp ~ -Z~~~1 220254 1Ar~sconsin Department or Industry, SOIL `AND SITE EVALUATION REPORT Pa e ~ of 3 labor and Human Relators g - Divislo! of Safety & Buil~ngs ;,, ~rnnrr~ with 11 4JR a9 !1G urn e.i.., ~..a~ ' COUNTY Attach complete site plan on paper not less than 81/2 x 11 i 'ze. Plan must include but Ste' C'~ ~X , not limited to vertical and horizontal reference point (B it •d`~ g °o, ~ slope, scale or dimensioned, north arrow, and location and distan tovp, road:'` , ' ~ ` PARCEL t.D. # O 18 - 101 ~ ~ 30 ' y - ~ APPLICANT INFORMATION-PLEASE PR ~'~k•1:L I ~ ~AT ON ;.y-;~, R IEWED BY GATE _ r a-fb- PROPERTY OWNER: `` ";~ PRO TY LOCATION G f~--l L D t~}-~,,, S~Zgy~ t•~~ -i ~ (~ ~ -60~' S ~ 1!4 S E 1/4,S S T Z ~ ,N,R 1-j E ( w PROPERTY OWNER':S MAILING ADDRESS • ,,.,.._a S7 CRC51X ` LOZ~r BLOCK # SUBD. NAME OR CSM # 10 ~} sr. - CO0 111 a 1 ,~~. ;, - . CITY, STATE ZIP CODE Q' aFFIGE ; 4 b 1~fTMw1 Oti-~D 53R 0 LtiJ I S ~Eo l S `~ ~• ~, ,' []VILLAGE ®fOWN ' ' NEAREST ROAD - ` Sfi' ; _ ~ ., M Q ~}- ~ p , [ j New Construction Use (uj Residential ! Number o 3 [ J Addition to existing building bQ Replacement [ ] Public or commeraal desaibe Code derived daily flow u s D gpd Recommended design loading rate • ~ bed, gpd/ft2 - trench, gpd/ft2 Absorption area required 3~1S bed, ft2 ~~15 trench, ft2 Max<mum desi n loading rate • S bed, gpd/ft2 ^ ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~l. 6- O qS o ~~ ft (as referred to site plan benchmark) Additional design / site wnsiderations MOV1.~ ~Jlg'x ~(-~' 3~ . 1"~1 inJ1 >Li U1~1 ~ Z ~ Oi= SAS ~'i c~ , Parent material ' ,....0 ~~S ~ OV ~Z T t ~~ Flood plain elevation, if applicable N A ft S = Suitable for System U = Unsuitable for s stem CONVENTIONAL ^ S $[ U MOUND ~'S ^ U IN-GROUND PRESSURE O S ~U AT-GRADE O S ~u SYSTEM IN FlLL - [] S f~U HOLDING TANK ^ S ~'U SOIL DESCRIPTION REPORT Boring # k~*:wh~~~:Y ~:., >--> I Ground elev. qs.~o fL Depth to limiting factor Boring # Z Ground elev. °t~3 ft Depth to limiting fa3 rs h -~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerxh 0-9 lo`-lR- 3l 3 - Si 1 Z-~Sblz w~`~}.• cS - • s • b Z q-zz to `'!2 ~Ly - st t Zv,1 sbk ~~~ CS - • S -b 3 zz~~ ~s~2~~~ - L l~sb~ r~fl- ~~ - •y ,s ~l ,SS . 5~R 3Jy 'PI.S`-t2sLV scl ova m~'-r' - 1uP€ •Z. Remarks: O 9 t ~ `L lZ 313 s L ~ 2,`FSb ~'L W1~Ir CS - . S ~ • 6 Z 4 Z8 to `-tCzYlyr - sl ~ Z~~n Sbk wl`Ft- es -- ~ 5 .~ 3 Z8 3s ~.s ~tZ Orly - L l ~.sbk. ~/Vl~i- cs _ ~ ~! •5 4 3 s-6 S S A 12.. ~l y ~! ~-tR.~B s c l o~ vh `F,' - t~., P`- Z Remarks: Name:-Please Print Arthur gerer Soil Testin ature: ~~ ~ ~~ I;. We erer Phone: 715-425-0165 ' & Design Service-P.O. Box 74 River.Falls,WI 54022 ~' . Date: CST Number: Y~~~,„~,,` ~9-21p ~ -Z~~-~1 22025tF PROPERTYOWNER~Pn-1C_..STRE1w1 SOIL DESCRIPTION REPORT PARCEL I.D.# O 1 c~- 100 - 30 Boring # <:::: r~<; € ~` Ground elev. f t. ~' Depth to limiting factor 3oring # ~.~~ _.. around elev. rt. )e th to P imiting actor _ . Page?- of 3 Horizon Depth in. Dominant Color Munsell Mottles Qu Sz Cont Color Texture Structure Consistence Bouxiary Roots GPD/ft ~ o- 8 1,~ `11Z- 3/ 3 . . . s j Gr. Sz. Sh. Z `FSU ~C w1 `~ c-S - Bed Trench ~ s ,s •6 3 ~s-~8 ~•s~i2 y~Y ~ ~ 1 csbk ~,~{'~. cs - , y .s 3$-SZ S `1R ~/y ~~ S`~1R S~~ SC ~ ~~ h7 `~ i - >uP - Z I nernarres: 7 l 7 1 Remarks: i i E i s. Remarks: ;.. rsemar-cs: _ . , • ~~ ~ PLOT PLAN SCALE 1"= 4~p ' ~ ~~~ ~r~.,ce. - '~"~'nZ~T"~P~T~z`it-/ Llr~E \ ~~ ~ ~ cu~.rtp~a. ez . g S _ o ~ --L. ~i ` ~ a- ~ a 3o'T'rp~+.~ pF B~ q '"-3 , jj bo NOT COW ~2. ~~,p, Z 69 , ,~~, i ~ o~Z D1S1v~L3 ~.~LS _ g.3 ,, ~ TtfilS ~~~- ~J TR~~T -L~ ~ \ ~ 2 o ~ ~~ S~I ~ ~So ': OF _ w~*ti-C_ _~--Lj _ . Page 3 of 3 ~~ ~~ ~O vcuu~ _ ~I _I ~; . Q' r- i 'fl12-tUE _ v~NT 1. X1.2"Cl'4'sc~,- ~~~~ C~ ~ --~2 ~> ~~ Z202.S'~ _(715 ) 425-n~i hs CST Signature Date Signed Telephone No. CST # . ST CROiX COUlYTY SEPTIC TANK MAINT~NANCe AGRLeMeNT AND O WNERSI{[t' ~-'R'L'LF[CATION FORM ~q t 1 Owncr/[3uycr _ [.N ~. / C 7~/`~ ~~ Malting Address Property Address ~~ l l l ~ (Vccificatioa rcgaicr~d from P ~ ~ v~ l~aniog Dcputauat for new coastcticdioaj CSttylStatc . ~ Paroci Idcutiftcation Numbs _ ~~~ I~ jD ' DD~j ~~A.L p~C~'1'XON Propafy Location S~ s, S ~ Y<, Scc. ~, T~N~~'~W, Tower of Subdivision ~ - Lot # - - ~ertifiod Sarvtry Map # Volumc _____ ~- . - ~ Pagc # Waa~a~y Doed # b ~~ ~~ 9, P - Volumc ~~ ~e #. SPo~.~Oaso D yes ~ no Lot Iiwes i~faotifiabic Ya ~. no ~atp mb~omtto St C~acD~~~. s~odb9~rc~ov~xudhy: isiapoopaccpar~ ~ Por:TxasodPm~oP~Q~t(Y3dyeo~n~snoei~sGca~o6adi~sispsa~ C~ imp°un°°n'RadpmmC,f~.~sc~kss~mu3~ndtofe. ~~'~R.~x~tiq'~beot'oeaad~D ~'$`~~Qieshmdstds ~3~saLatbaea~be S'ta~Ge of Wisooas~a.. Ucdi~r,~ipa ezpia6~oadatc, o~rcmmodto tha S't~CtoocCOUmtYZoaiag~O~oc~ai8iut 30 ~--- ~'~'l ~~~ S'IG~~B OF APPLICANT / ~ D DATE ot~rt.~c~r~.Txox . I ~~) ~ •lI ttata~ota oa this fomt arc tcac to dx bcst ofmY (oca) Japavv&~„ I (wie) serf (arc) the owncx(s} of ~ Proi aboao, by victnc of a 'a"~Y bad tuoocdod in iLcgista of Doody Off„ Si(~,T(~$ OFAPPCtCANT _ ~/ 0 ~ DATE st«sss ~ ~~mt that is mis~~y t~ in t6c saaibry pumit ticiag acvolood by the Zoaiag Dcpsttmcat.'•"" " iadndc Mth this Win: a , flood tin the Roux of Doody oiGoc . a copy of the oatiicod cuuvcy trop if ~dcrcaAC is madc is the wacraaty dcod .t. imp°°pec`aac"ods~b~~7~~oa~ldi~s ooaascs ofpimppmag serf ec ~. P~i~sC'f~tobwdbc~'s.Psopcranambcaznx aasff+oct~re,5m~cft6e~a~oa ~aifnoododbys~asodpau~ :y~,~~~~ - sd~c~nd~e~staLsy~as. .. - /o ° ~~ cccc • ~ ~oi'126~ PacE2~6 JVU~4~ STATE 3AR OF WISCONSIN FORM £ - 1y82 QUIT CLAIM DEED DOCUh1ENT NO. REai$TER'$ OFFICE Donald G. Dahlstrom, a single person $T, CROIX CO,, WI R~a'4 !t-- Mcerti - - - - - OCT 0 8 1991 quu-r:alms w Gail Nordstr3nd Dahlstrom, 1:40 P~ Re s/p el ONd~ the foiloµ~ng descnbed real estate m S[. Ctoix County; State of Wisconsin The Southeast Quarter of the Southeast Quarter (SE 1/4 of SE i/4) of Section Five (5), Township` I~.renty- yine (29) ,Uorth, Range Seventeen {17} West. THIS SPACE RESERVED FOR RECORGNG DATA NAME ANO FETURN ADDRESS Gall N, Dahl:;troct 1118 170th Street Hammond WI 54015 018-1010-30 PAF'_El iOENTIFICAiIUN NUMBER oZ D Q°~11q This is homestead property. (ts) lis not) Dated this ~=/ C~_ day of / (SEAL) -- (c~~L) AUTHENTICATION Signature(s) _ ~__ authenticated this day of ~ _, 19_ TITLE: MEMBER ST~1iE BAR OF WISCONSIN (1f nut, _ authorized by §706.06, Wis. Stars.) THIS INSTRUMENT WAS GRAFTED BY Cwbert F. Wall Hu son W (Signatures may be authenticated or acknowledged. Both are not necessary.) 19~~ •/ ~ l 1 t ~- /,/ /,, ~~ ~`\`~y'f~B~l {D Ar~~~i~~sL~~.~-~ (SEAL) it . Donald. C. Dahlstrom (SEAL) !I ;~ ACKNOWLEDGMENT ~~ State of Wisconsin, ~ ;' ss St. Croix County. i:; Personalty came before the [his ~f t day c+f lJc~a ~'a^ , 1997 ,the above nat.-d ~I Donald C. Dahlstrom ' I me known to be the person who executed the foregoing tn~rum;;t~, ~ppitllgy){~,~dge',he same. i a ;~' ~~. N7zc~ry Ptibl =. ~ l: y' =~t Caunt r - !t~compti on rs pe ap~tt?(If not, s[.