HomeMy WebLinkAbout018-1086-47-000Wisconsin Department of Commerce
Safety and BuilciEng 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: City Village X Township
Peterson, Chris Hammond Town
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic -
Dosing ~~ / _
-O ~ S~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L
~.5 WELL
T BLDG. V~to Air Intake ROAD
Septic ~ ~ (~ i i ~ (~, 'f-~'~S - Pr /
Dosing ~ ~
3a
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Number ~~ ~~ I
TDH Lift Friction Loss System Head TDH Ft
~j,~ll ~7 .~ 2,•
Forcemain Length t Dia. t ~ Dist. to Well
SOIL ABSORPTION SYSTEM
`'"""`Y' St. Croix
Sanitary Permit No: 408210 0
State Plan I Na
Parcel Tax No(,:
I 018-1086-47-000
~z n ~ba>r
ELEVATION DATA
STATION
~s~ 7 ~ BS
, z3 HI
ao. FS ELEV.
S a
Ber}p~arkL _J O -1'S ~~
Alt. BM
o
0 3
99•
Bld .Sewer ,.-O
~ , ~S , / r~
d"
SUHt Inlet s,~ 9 , .
St/Ht O tlet
0.
Dt Inlet
Dt Both, . ZS ~- l , 3~ ~'• s~ o, ~ ~
d fv
Dist. Pipe
•O
qtly- 23
Bot. System i/` ~ ~
Y'
s ~
Final Grade C i ~l~ _ _
Jr7v rye f
/ ,
St Cover ~ L3 ~ •
~-~,~1 ~ ~l 9 5-
BED/TRENCH
DIMENSIONS Width ~ Length ~ No. Tenches PIT IMENS NS No. Of Pits Inside Dia. Liquid Depth
SETBACK SYSTEM TO • P/L BLDG WEL ' ( LAKE/STREAM L NG Manufacturer:
INFORMATION CHA ER OR
T e O stem:
yp ~~
,>/"J`1 ff~C~ 1 ~~ ~ D Model Number.
DISTRIBUTION SYSTEM
Header/Manifol Distributio
n x Hole Size x Hole Spacing
~
Len th ~ Dia '
~ [f
Len th Dia S acin
SOIL COVER
x Pressure Systems Onlv xx Mound Or At-Grade Systems Only " ~(~ '~~~ CdL-u'
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ~ed/Trench Edges Topsoil H Yes No Yes No
COMMENTS: (Include code discrepancies, persons present, etc.) ~ -Inspection #1: / / O Y Inspection #2:~/ 'O /t~a'~
' So/~ OKTa ~ ~~~~'~-o o~-sevvR~ky
Location: 882 161st S-t~reet Ha/~mmond, WI 54015 (NW 1/4 NW 1/4 20 T29N R17W) Hamm/o~nd Oa s 47 arce No: I2 29.17.667 ~; 7E S
1.) Alt BM Description = f ~ p Gr ~ ~ ~0~ ~`'"~ .~r ]~o ~;~~,~/ v]0.~' d"i Y C'~S ~ f/ 5~~10 ..~-y.-.~5
2.) Bldg sewer length = l O ~ ~.~- -I•n..., o_ vpZ,~Q~, Q,K,F(S ~t~w~(~. U~n'ti''t ~ T~r'~-c -~Sd i ~ ~p//'ed -- C~,.1-c
-amount of cover=~ - ~.~.(.~,~-~~..{a /~~Sc~-•-~-~orope~" ~rtG<.d2d C$~ l`n1Sc/t~,~(.ecl.
3.) Contour = ! ~ .~ ~~ `0$1
Plan revision Required? , ~: Yes No ~' ! ~ It1~ ~ ~(G` U QI 4
L~YH-'.. .- - `
Use other side for additional information. (!~
Date Insepctor's ignature Cert. o.
SBD-6710 (R.3/97) _
Vent t Air Inta
- ~', I
~ ~1
,'~
d~
~,n ~.
P~,SL~~`i
~~
' Safety and Buildings Division
201 W. Washington Ave.. P.O. Box 7162 Co'rnty `
~ ,
~
~
^~~~~S,n Madison, WI 53707 - 7162 Site Address ~ _
r
Oe artment of Commerce - ~3 -D t 5' X0.6 S 1 '
~ a b
Sanitary Permit Application satin Permit Nnmber
~$21 D
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ CheckSf Revision
ma be used for seco ses Pri Law, s15. 1 m
Application Information -Please Print All Information ~
I state Plan I.D. Number
.
._.-- ~ °re ~r~. l~.
~~~ ,,,,,
Property Owner's Name Parcel Number
~ ~ ~ ~~
property Owner's Mailing Address , ` ~ ~ 2QQ
JAN
~ Property Location
~
0 N t,~l if d1 ~'4: S OT N. R f E
City, State Zip Code Pho~N~{sih~ ~~~
OFF t Num r Block Number ~ / /_
IO!(/
~;1'~JG
ZO Subdivision Name CSM Numq~r
/v
/~- ~5 / S-d y~ `S~o
Sw' / fib u~ Cr~~
II. Type of Building (check all that apply) ~ a,.s ~/ 5 ~'
~,,.Q. ,~•.~s . ^City
~
J"~' or 2 Family Dwelling -Number of Bedrooms ^Village
rib
e Use
sc
D
e
^ Pubiic/Commerc ownsbip
^ _
-'
_
-
'
^ State Owned ~ ~ Q S. O `` t t l t t ~ Neatest R ~f
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
~
1 New
2 ^ Replacetnettt System
3 ^ Replacemertt of
6 ^ Addition to
' For County use
stem Tank Onl stem
Exis
Permit Number Date Issued
B. ^ Check if Sartitary Petttut Previously Issued
IV. Type of Permit: {Check all that apply)(numbering scheme is for internal use) ~- ~eQ.
44 ^ Non -Pressutized In-Ground 21~Mound 47 ^ Sand Filter 50 ^ Consttucted Wetland
22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass S1 ^ Drip Line
45 ^ At-Gtade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other
V. D' ersaUTreatment Area Information:
Design Flow, (gpd) Dispersal Area Dispersal Area
Soil Application Percolation Rate System Elevation Final Grade
Required proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Eeevation
~
SO ySO a
~ ~ _' ~.~ s
VI. Tank Info Capacity m Total Number Manufacturer Ptefab Site Steel Fiber Plastic
Concrete Constructed Glass
Gallons Gallons of Tanks
wew satins
Tanks Tanks
~
Septic or HoMiag Tank D~ .~.. O~
Dosing Chamber s"D ~" ~ ~
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's N e (Print) Plum s Si lure /~/~~/ RS Number B~/ujsine~s/sj~Phone Number ~//~
!/'d ~~ ~ ! // r ~' ~ I
Plumber's A Tess (Street, ~ State, Ztp )
a ~-vt ~ ~~ .~--
VIII. Cotmt /De artment Use Onl
Sanitary Permit Fee (includes Grottndwater
Date Issued
Issuing Agent Signature (No Stamps)
Approved ^ Disapproved Surcharge Fee)
^ Owner Given Initial Adverse ~~~ ~ / o~ ~~
Determination
~ ~/~ C _ I ,~,, ~p
IXt C~ond9tions of Apal;Reas1o four-Dn appr v ~ ,~ n ~~ S t~~D~B~n, • c~^~- `~ ~~~ "" -- "
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~ CID.n,~ (e'~'~tMA i ~ Swr
105
.
A /n~ ^ /,/~~1
t3't!`~ $t9't^^R~
ne 1 ~_ ..~i_ `~:. .n _ ,..~ li fnQ~.YO PabOln 1...,{f1~I ~.iIOC.
Attach rnmplete plans (to the County od ) ror the em
SB ` . ~/Ol)
SPe u` c `mss .
s 8112:11 inches la size ~~a,^.p- _ _,
I
3
• D 7 /1m D 7 ]1 U
Scale 1 "= 50 '
Page 3 of 7
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NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required).
3. Septic tank to be ~O~p /C~So gallon capacity manufactured by
1." l ~''S LR.. ~~v C~{~ k/ / l~-- Lflob Zf~ ~Z.. ~i ~7"~-'S?
4. $ench marks = ~~ ~3oV
~~. Divert surface water around, system to prevent ponding at the uphill side.
~ ~
~scons~n
Department of Commerce
June 04, 2002
CUST ID No.267341
ARTHUR L WEGERER
WEGERER SOIL TESTING & DESIGN SERVICE
PO BOX 74
RIVER FALLS WI .54022
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/04/2004
RECErvE~
.! U N i 0 2002
ST. Cf~C~ X f'rC~lD~I'fY
SON I ~J ~ ~L~AF;~ilc~
A7TN: POW7S Inspector
Safety and Buildings
4003 N KINNEY COULEE RD
t.A CROSSE WI 54601-1831
TDD #: (608) 264-8777
www.commerce.state.wi. us/sb
www.wisconsin.gov
Scott McCallum, Governor
Philip Edw. Albert, Secretary
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARM[CHAEL RD
HUDSON WI 54016
SITE:
Chris & Aimee Peterson
161ST St
Town of Hammond
St Croix County
N W 1/4, N W 1 /4, S20, T29N, R 17 W
FOR:
Description: Proposed Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 853961
Identification Numbers
Transaction [D No. 754396
Site [D No. 645433
Please refer to both identification numbers,
above, in all comes ndence 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 Conditions:
• 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
(R 6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems"
SBD-10573-P (R 6/99).
• 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. Slats.
• Comm 83.22(7) - A copy of the approved plans, specifications and this letter shalt be on-site during
construction and open to inspection by authorized representatives of the Department, which may include local
inspectors.
Owner Responsibilities:
• Comm 83.52(i)(a) -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).
C ndrt oT S'
Q~ pally
PRn1/rr
ARTHUR L WEGERER Page 2 6/4/02
Owner Responsibilities Continued:
• 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.
• The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to
the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
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 slats 101.12(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,
Gerard M. Swim
POWTS Plan Reviewer -Integrated Services
(608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm
j swim@commerce.state. wi.us
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
WiSMART code: 7633
TITLE SHEET
i~OUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
This plan has been prepared in accordance with t
Manual SBD-1057 P and the Pressure Distribution
LOCATED Ii~1 THE ~~~^•~ 1/4 OF THE Nw 1/4 OF SECTION
T 0 [did 0 F ~-1~ Wi pt~JD ST . C°~2,Ej u(
L.vT `lam ot= l~-w~w~o-vD _o~1-mss:
INDEX
RECEIVE
Page ~ of 1
he Mound Component
P~Ianual SBD-10573-P
~' ice. b 14 q
~ ,T Z9 N,R l7 W,
_ COUNTY, WISCOPdSIN.
PAGE l of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEI41 NIAIdAGEi~ENT PLAid
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIE[d-CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUI•IPING CHATIBER CROSS SECTION
PAGE 7 of 7 PUriP PERFORI.IANCE CURVE
PREPARED FOR
MAC' 2 81002 C`~k\Z,`S Y~~_ Pr1w1~ P~1Z.Sorv
SAFETY ~ BLDGS DIIJ. _ ~~~-° ~~-~ , '~N SS ~Z~ __
PREPARED BY
WEGEE~ER SL3 ~ L .TESTING
AND . .
DES = Gil SEF2V S CE
P.0. Box 74 421 Id.~iain St.
River Falls, [dI 54022
Phone 715-425-0165
Fax 715-425-6864
DIVISIgNQF DF CD1yMERCE
AFFr AND BUItDiNGS
SEA ~'pRRES '
~EiVCE
~i~!C i~~~~~ ,~
~•f` tit
.`
AkT!+JN, ~ •~
WEuEHEa
0.915
fiLSWOHTw
t~w ~°~5!a~+~'
(~ • •.M~~ .(~
JOB N0: C7Z-LZ(~
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 System
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 GODS, 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 test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked far 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)J grid 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.
Contingency 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 wilt 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 LS-3 ~ 6- 6~d ST• d! tz.~1.~C •
The sgstem installer at ~, ~, S . Z(~_ (~~Lq'S U7-r3 q-2D
The tank manufacturer at ~~~ =3ZS~ ~~56 ~.Jl~T$'~`(~
The effluent filter manufacturer at - 800- Z-Z,J- S-7~ Z 7-Pr-3~z
The pump manufacturer at -- ` G 30 - S ZO- ~~' 6oUl..DS
PLOT PLAN
• Scale 1 "= SO '
Page 3 of ~
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NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required).
3. Septic tank to be t0op /(~S~ gallon capacity manufactured by
Lv ~ ~S ts2 G~ Cl2.~Tt/ w ~ /~-- L £rUb Zt~3 ~L. ~i ~7~-'3?
4. $ench marks = S~ ~pU
5. Divert surface water around, system to prevent ponding at the uphill side.
• Pane `l o; ~
Approved Synthetic Covering
AST~I C33
Medium. Sand
Topsoil
-_1 ~ ~ E
,, 3
i i ~
I
Slope
Distribution Cell of
2" to 2Z" Aggregate
istribution Fipe
G
F Elev. ~S S
E~D _ •
e
Farce Main
From Pump
CROSS SECTION OF A MOUVD SYSTEM
Linear Loading Rate=~•~ GPD/IN FT
Design Loading Rate=o;33GPD/SQ FT
"'~-a«+-~t-c Position
of
Force Main
.. L
A ~ Ft.
B -1S Ft.
I 1 Z Ft.
J 5 Ft.
K ~ Ft.
L °1 ~ Ft.
,,i ~3 Ft.
Flowed
Layer
D o-S Ft.
E O.fl ~Ft.
F o. ~ Ft.
G ~-S Ft.
E•; l.u Ft.
. ~ ~ -Observation Pipe
__ 6 , ~ K-
~-- ----------- ---•~ ~•QcCtss
C~-'~-•--------------------- --------------- ------- + 3oX
A i ~~6 L ~ -t
w ~`~_ ~__ - ---_--- ------------- ~ ~
-- -'~---
Distribution ~•-Cell of %" :~~
z to 22
I Pipe ~ a;gregate
Observation Pipe
(lUi'i~o= securely) ,
PLAN VIETrl OF A MOUYD SYSTEI4
Distribution Pipe Layout
Place the holes at the bottom of the distribution pipes
at~equal spacing. Remove aII burrs from the pipe and holes.
Extend the ead of each laxe.2i up with file ~e of IoIIg tun or 4f° ft~L.n~ to apoint within slx •
inches of the final e~ade. Terminate the ends of the late.-zIs with a valve :threaded c~ or
. threaded ~Ius. Provide ac:.~s from final ode for the valve; threaded caD or thresde~ plus.
FVC F~~~ PVC
Laterl- ~ Manrtold ~ Laterl
P Lt?~1~ V \ ~.,~
P -~+
O-- _
h t`,"J 1'r-.`.
~-- --
PzQe ~ of ~
;7CC. r~s 5~}S
- -O
- --a
P 37_ Ft.
S 3 Ft.
X ~_ Inchps
. .
• Hot a Diameter 1~Y~ Inch - ---
Lateral ~ 1 InchEes)
Manifold Z- Inches
Force Main " - 2 Inches -
~of holes/pipe t~ `
Invert Elevation of.Laterals q 6-o Ft.
~-
. .. _. - Combination Sept~.c~_Tank alid •
• , • PLI-MP CHAMBER CiZ055 SECTIOIJ ARID SPECIFICATIOIJS ' PAGE G OF ~.
_ --,.
. -VEUT CAP ~' WEATHER PROOF
• .lU1JCTIOU 90X .
'i'C.Z. VE1JT PIPE ~ APPROVED LOCKIt.1G
~ IQ' FROM OOOR, Mtt1JHOLE COVER tvl'fM
~ItAJDOW OR FRESH ~ t'"P`R'~t~G Lp''gEL-•
1tJ8PL~T10r`1 (PIPE CGJpUtT -.
• `~!H'ttZTlslti- zA-p ~ ~K t1JT11KE t ~
.. .. _. ~ ~
' Ft iii tg~ , ~, q C t ~ I Y Mp.l.
G O
R•~s•~ E
18'ltli`I. ~ ~ _____
,..
•.
11JLET L" PROVIDE ~ - _
..,
. •~;~ ~AtRTiGHT SEAL ~ I~~ ~
. , I \vl
8~~~~
APProved z~c8~t u~~ _. A ~ 1~ ( APProved
joint w/ ~~_~~~ ~ ~~I joint w/
PDC iD ALARx PVC ipe
e
P P _
I
° ~ r~
c ~ i ou
•i t
LLEY.~~,D~ FY - i
PUMP -~ __J
,~ OFI'
a
COUCRETE
~~, p p ~~ BLOCK
ti:
RISER EXIT PERMITTED OIJLy IF TAt.lK MA1rUFACTURIT.R HAS SUCH APPiLOVAL 3"ADPRoy!<p
• ~B.EDD t tv4
SEPTIC F - SPECIFICATIONS -
DOSE
TI,-,IKS MAfJUFACTURCR: )NL~EIZ ~~JC-Q~,T~ UL'MBEA OF DOSES: y • S
PER DAB
TAJJK SIZC: ~~OU ~6SO GALLO-.1S DOSE VOLUME z •
ALARYI MAUUFACTUR!`R; _S• S- ~~1 Z-O S~'IS1~}"2S I~CLU0tA1G 6AGKrlOW: 102- (,AUtONS
MODEL 1JUM8ER: ~O~ I-~W CAPACITIES: A= I~ IAlCHES OR 30
~~lJ~~ GALLOsJ g
WITCH TyPC: 8 = _ /Z IIJCHES'OR ~ G~LLOt,15
PUMP MAt,JUFACTURCR: 6UV~-pS C= b wtHES OR ~'0 ~- GAL<.OIIS
MODEL IJUMHER: - ~-~U~
0 ~ ~~" ~~H~rELS OR b ~ GALLOIJS
SWITCH TYPE: ~~L°~Lf tJOTE: PU11P AUD ALARM ARE TO bC
M31J1MUM DISCHARGE RATE 31. l(, GPM INSTAlLEO OA~JjSEPARAT~ CIRCUITS
VERTICAL DtFFEREiJCE DETWCEU PUMP OFF A-JD..DISTRIBUTIOIJ PIPE.. ~'~~ FEET " ~~ I
-}- MtElIMUM AIETWORK SUPPLY PRESSURE , ~ • SO FEET ~S.O x 1. 3,
'~- 1 S FEET OF FORCE MAIIJ X ~• yOI F~o Fr.FRiC71OU FACTOR.. ~" 3I FEET - ~
TOTAL Dy1JAMIC HEAD = ~-?•'~~_ FEET
As per manufacturer gal/in. Liquid depth •
Goulds
Submersible
Effluent Pump
MODEL
3871 EP04
EP05
APPLICATIONS
Specifically designed for the
following uses:
• Effluent systems
• Homes
• Farms
• Heavy duty sump
• Water transfer
• Dewatering
SPECIFICATIONS
Pump: EP04
• Solids handling capability:
3/4"maximum.
;.-~ • Capacities: up to 55 GPM.
• Total heads: up to 24 feet.
• Discharge size: 1'/i"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/"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.
\1
• 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 cord: l0 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 II FEET
101-
s l- 31
0
a
w
x
U
a
z
0
J
0
0~
s
2:
s 2c
5
1',
4
3 1(
2
1
• Fully 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-
plastic enclosed 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
SA• Canadian Standards Association
(CSA listed model numbers
end in "F" or "AC".)
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31.1(, ~ EP04 .-
~
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00
1 U 'LU 3U
40 50 GPM
0 2 4 6 8 ~ 10 12 m~/h
CAPACrfY
®1995 Goulds Pumps, Inc. Effective May. 1995
w • ~~
~ 3
Wisconsin Department of industry,
Labor and Human Relations
Division of Safety and Buildings
SOIL AND
in accordance
Attach complete site plan on paper not less than 8 1/2 x 11 inches i(M1 sC
include, but not limited to: vertical and horizontal reference point (E}AA},
percent slope, scale or dimensions, north arrow, and location and tjista
~.
SITE EygL~~TION
fyVit~'s: ILH~R 83.Q9',
Plan r~flsi-- ~ L L
action and
j tonearest rp~dt,~~9
~,i ~~F~~`Yti
APPLICANT INFORMATION - ,Please print all inform~tiofa. ZOA'1NG OFFICE.
Personal intormatbn you provide maybe used for secondary purposes (Privacy L~q sr 1b:9't (t) (m)). „
Property Owner ~ (~ N R ~ eo ~ ~~ o ~ d C~ r P rtb
V b SfJ 11•~J (3r4 ii l Ip ~1 t_ot #
Property Owner's Mailing Address ST >~~S,r Lu0
332. M i uN~5oT~4 '1
City State Zip Code Phone Number ~ City
ST• PnuL I Mme. I SSIo I (~S! ~z~z •5555
V
Page / of Z
:ount~ ST• L~o~•~
'arcel .D. # O ~ •
- ai •/a •so•aa
tevt e,~ h„ Date
~~'R~ ~vt ~ Iz11s~~9
1/4 /Uitrll/4,S ~f~ T.Z ~ ,N,R ~ 7 ~ (or) W
Subd. Name or CSM#
I ~~MMOND O/'¢•~f
Nearest Road ; w
[] Village . own , q,~,,iQ ! Gv b
[. iesidential I Number of bedrooms 3 Addition to existing building
[+~'fJew Construction Use:
^ Replacement ^ Public or commercial -Describe:
~0 Recommended design loading rate ~ bed, gpd/fiz_~ trench, gpd/ft2
Code derived daily flow 9Pd ? d/ft2 ' .7 trench, gpd/ft~
Absorption area required ~~bed, ft2 17f trench, ft2 Maximum design loading rate bed, gp
Recommended infiltration surface elevation(s) Su ~ ft (as referred to site plan benchmark)
Additional design/site ~nsiderations N/~ ft
~D EtS D ~~ ~FNSF T~ /~f Flood plain elevation, if applicable
Parent material
In-Ground Pressu AT-Grade System in Fill Holding T
Conventional Moun¢ ~ S
S = Suitable for sys Y m ^ S ~ ~~/ ~ U ~ S (] S ^ S
U Unsuitable fors stem L'
BOfing # Horizon Depth Dominant Color
in. Munseil
`
~
~
•i /0 Z
yR /3
~. ,o y~. 3
Ground 3 /~ ~
v~
Depth to
limiting
factor
m.
Remarks:
Boring # /
2„ Q, •
~"
•~ ~ ~ 2
Ground
elev.
Depth to
limiting
factor
~ ~ r~
SOIL DESCRIPTION REPORT'~~''~
_
Mottles
Qu. Sz. Cont. Color Texture Structure i,
Sz. Sh.
Gr.
l
~.
s~ ~ k
i. s h
- `~s ~uf
Mid ~ LFS ~Uf
MO S
~If T fSG fug
/oy1e 4~Z w~~~
Consistence Boundary Roots gad ,Trench
ds~. Cs - .s ~ .~
d ~- ~s -- .~;,s
... . s
s a ~'
G~ ~
_-- Qd ~
_ N ; N
,
CST Name (Please Print) R~Q~,R1" 7~~~R1ctiT signature
gate
~~s• 38G ~~~~ ~ s
CST Number
zaf.375
Remarks:
_ ,.~..
*.
UH Q I ~Q G ~~~ SOIL DESCRIPTION REPORT
PROPERTY OWNER ~, ~ ~ c^ S (~ g ~ .
T ~AMMo~~ ..7
GD ` ~~
PARCEL I.D.#
BOrirlg # Horizon Mottles Texture Structure
Depth Dominant Color Qu Sz. Cont. Color Gr. Sz. St
Munsell
i
n. ~ ~ f s/!~
3 ~ ~~3 /oYR y/ ZfS
2 .z io y~ 3 _._..
Ground
elev. 3 ~0 Z.~
.~~ f Ma f 5L !f
q~tt. ~o y/? ~r/Z '
Depth to
limiting
factor
~/ ~_in.
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
' in.
Remarks:
Horizon Depth Dominant Color
in. Munsell
Mottles
Qu. Sz. Cont. Color
Page ~ of
Structure Consistence Boundary I Roots Berl `
Texture Gr. Sz. Sh.
s
~•
_ p~ 3 of3
Ulbricht 8 Associates
Privat® Sewage Consultants
655 O'Neil Rd.
+,-+u~!:}on, Wis. 54018
cs Taz4375
~ /~~= 2C7
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Jun 17 02 05:56p Justin Mtlson
Y
715-796-5350 p•2
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
pWNlrtZSHIP C1:lZTIFICATION FOt~dvl
Owner/Buyer
Mailing Address ~ ~~I
Property Address
CitylState
i 6 ! s~' S'~. ~N,i,.-,end ~~ ~ ..~ o l S~
{Venticatioa required from. Plataing flePatUriant for new
LEGAL DESCRIPTION
Property Location .~ '~
Subdivision ~'wi $^°
Certified Survey Map #
W=treaty Deed # .~
Spec hvusc D yes L~ no
~7 ~I~ ' (GSd , ~7 • o00
Parcal idastufication Nuatber
~/r /'r., sec. 20 . T? ~. N-tt ! ~ w, Town of G M w~,.,.1
4~ l~s .Lot #
_~, Voltume _ "~~~ .Page #
~p.~p~, .Volume ~ ~ Pago # _ ~~~.
Lot lines idcnlifiable t~ yes D no
CYCT~i'M MAINTENANCE
izttpcoper ttsa and Hof Yo~>~ tysrem wttldtesult it<its ptcu,awrafailute to handle wastes. Propel mainteaancc
consists of ptamping out the septic tazttc ovary tBrac Years or sooner, if Hooded by +e iieeased pumper. What you Pat into the system
caa atTect the fuaction of ttte uptic tatati as a treatment stage in the waste disposal syatenL
~e pcoparty-oe~ner agrcas to submit to 5t. Crnfx Zoning Dcpar~cnt a ~ertificatioa form. siga~ed by ti>a ov+aa and bT a
ttiuterphamber, joumcymaapluuiber, tt:stzittedplamberoza iicaasedPumpavardy~°g tht4t(1) fire on•site urasttwaterdislwsa! system
is in pmper operating eooditiott at>,d/or {2) after iuspecaion and ptteaping (~ ncc~es~T}, We septic tanlt it less they 113 fall of slnd$e.
Uwe. the twdctsigncd have read the above tequirecnents and agree to maiaraia the ptivare sewage disposal sysrerrt wilt the standards
Sat fottlt, hereftr, as set by rLe Dcper®cot of Coaarrarce and rbe Depactxaeat of Natural Rssou:cas, Satt of W isroasln_ Certification
sutiog that your septic aysum has been tnaititaiaed muse be cnatpkmd and rettuaed to the St. (~oix County Zoning 01ftC°'a"tk+ia 30
days thtnts r expiratim date_
..~_ ~ / ~ ,
SIGNA'RJttE OF APPLlCAM' DATE
Q~VNER CEIt'C7kTCA,Ti(~N Y ( } $ we am a a
I (we) fy thst all statements on this form arc t~tie to the best of m our knowlad s. I ( } (r }the owtter(s} csf
the ptoparty d c 'bad above, by vittite of a warranty deed recorded to Register of Deeds QfTcc,
r
ATilRE APPI,ICAM' QATE
.....
•••••• Any iafarmatioa thrt is mis•reptesoated tray result is the sanitary pcnttit bang revoked by ~ Zoning Qepamnent. '
•• laelude with this tppiierttioa: a stamped watianry decd from the Register o, i~ceds offiec
a copy of ifie certified survey e7ap if refctcnee is tttadt in ttte wamary deed
rJ'i~llldflti~7{3 "1102111: W02i~
~,~ i.hi65:g0 Zt302 bi 'unf 09L59bZS[L ~ 'ON Xt1j
.«
~~ ~sas-~ s7s
6 8 1 6 5 2
STATE BAR OF WISCONSIN FORM 2. 1998 1{ATHLEEH H. MALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO. , 1iI
Document Number
This Deed, made between Hammond Land, LLC, a Minnesota RECEIVED FOR RECORD
Limited Liability Company ___ 06-13-2002 10:00 Ad
WARANNTY DEED
EXFlIPT t
Grantor, and Christopher M. Peterson attd Aimee L. Petetson, husbwd
REC FEE'
and wife ------- ~` ~~- ~~g"~-' 11.00
TRARS FEE: 68
90
.
COPY FEE:
CERT COPY FEE:
PAG
ES: 1
Grantee.
Grantor, for a valuable consideration, conveys and warrants to
Grantee the following described real estate in St. Croix
County, State of Wisconsin:
Recordin Area
Name and Return Addrces
Lot Hammond Oaks Subdivision,Town of Hammond, St. Croix County,
Wisconsin
Olg-1086-07-000
parcel Identifuarien Number (YIN)
This ~ not homestead property.
(is) (is not)
Exceptions to warranties: Subject to notes, easements,restrictions,cavenants and rights of way of record, if arty,
including but rat limited to those for dtainage,water retemion,ponding,and or utilities as may be shown on the plat of
Hammond Oaks Subdivision recorded in Vol. 8 of Plats, page 2, St. Croix County, Wisconsin.
The warranties of this deed, either expressed or implied are limited by the grantor to the
grantee, or anyone in the chain of title, to the consideration expressed herein, that being the sum of $22,900.00.
Dated this 6th day of June 2002
Hammond Land, LLC
AUTHENTICATION
Signature(s)
authenticated this _ day of
TITLE: MEMBER STATE BAR OF WISCONSIN
(I f not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Paul A. Baillon, Attorney at Law
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
« by ~.c!1~ (,~ r President
. Austin 3. Ballbn
ACKNOWLEDGMENT
STATE OF WISCONSIN )
ss.
Ramsey County. )
Personally came before me this 6th day of
June , 2002 the above named
Austin J. Baillon
to me known to be the person(s) who executed the foregoing
instrument and acknowled the same.
~A..136 H
"Paul A. Baillon PAUL. A. BAILLON
~_ ~
Notary PnbhC, State O ~ ~ Situ ~ I ~+~^a 35"~:. ExPIFES 131-1W5
My Commission is peILaot~St€1ti„4,~p~j}QO,,,~„e.
January 31 2005 .)
'Names of persons signingvm any capacity should be typed or printed below their signatures
srwre luR or w uconslN
WARRANTY DEED POItM Ne. 3 - 199a
INFOAMA710N PAOFASS[ONALS COMPANY FOND DU LAC, WI a00455-2021
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