HomeMy WebLinkAbout042-1067-91-000
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Building Division St. Croix
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) 579079
Personal information you provide may be used for secondary purposes [Privacy Law, S. 15.04 (1)(m)]. State Plan ID No: 2567000
Permit Holder's Name: City Village , Township Parcel Tax No:
Zack Gillis . TOWN OF WARREN 042-1067-91-000
CST BM Elev: Insp. BM Elev: IBM Description: y~ Section/Town/Range/Map No:
CST 6'"I 24.29.18.381 B
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
wI~SE>~ L.~. r6ao 1,25 101. IOO.C~
Dosing
Alt. BM
Aeration t S Bldg. Sewer
Holding ` lol•oy 76 ~3•yy
St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet fz 6t(
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic :175' 17,4 Dt Bottom
Dosing y W k U, Header/Man.
Aeration Dist. Pipe
101.6q 11,32 ~G • 7Z
Holding
Bot. System
161.0q s:ay ~G•do
PUMP/SIPHON INFORMATION Final Grade ay L
Manufacturer /~r• 3'~
/ UAL Demand St Cover
, lo~.a~i
6 GPM 1.Ir8 9410
Model Number YP6~ 3'5~ t
5Z
lot.2S
TDH Lift Friction Loss System Head TDH Ft
. DZ ~•fJ , S' ly.~L
Forcemain Length t Dia. Dist. to well ,
~ b
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 40 r 8,~r
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION
Type Of System: CHAMBER OR
>
1-. 7•t~ ` r 7sr ~fA UNIT Model Number:
DISTRIBUTION SYSTEM
[eader/Manifitionn x Hole Size x Hole Spacing r Vent to Air Intake
ength Dia Length Z Dia Z Spacing /g`~ x.75
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over p
Depth over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ~ Bed/TrenchE ges > / or Topsoil
(p C J X Yes 0 No 0 Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I b I I Inspection #2:
Location: 1480 CTY RD TT
I J_
1.) Alt BM Description = 4e'k Pety 014t/ e / ~Y C [ f K/~r
2.) Bldg sewer length a h '~J yrq vU rr
-amount of cover = tt
Plan revision Required? ~ Yes 04 No
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
fIre and Building isio County St. Croix
201 W-Washington Ave., P. 71 Sanitary Permit Number (to be filled in by Co.)
° ffiP1 AUG 3 7 20,15 Madison, WI 53 -716
sr. Cao~x 07 57 967 7
- IoM o
Sanitary e Q~ication sta 25670100 Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to ject ss (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ~1w~~.
u ses in accordance with the Privacy Law, s. 15.04 1 m Stats. yrvv tro. Rd TT
L Application Info - Please Print All Information
Property Owner's Nam / Parce „ 011_41
Zack Gillis
Property Owner's Mailing Address Property Location 6 q z - /&07 - 204 Canyon Pass Govt. Lot
City, State Zip Code Phone Number SE /4,SE, Y4, section 24 _
Hudson Wi. 54016 T9_N; RI_IEore6 3$7
U. Type of Building (check all that apply) Q oA Lot #
Q(I or 2 Family Dwelling - Number of Bedroom 3 Subdivision Name
rm__Block # •1^
El Public/Commercial - Describe Use
❑ City of
❑ State Owned - Describe Use / CSM Number Vol 70 ❑ Village of
61*TJ4 4- (;rte. >P 61 *1613 SE" of Warren
III. Type of Permit: (Check only one boa online A. complete line B if ap licable) x
A. Q(New System ❑ Replacement System 11 Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner /
IV. Type of POWTS S stem/Com onent/Device: Check all that apply) 4 id AN-A69
❑ Non-Pressurized In-Ground ❑ Pressurized in-Ground 19 At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersaUTre went Area Information/
Design Flow (gpd) Design Soil Application te(gpdsf) Dis rsal Area Required (s Dispersal Area. Propo SO System Elevation
450 60 T 50 756 96.0
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units 525 Poly lok U y
New Tanks Existing Tanks o v
U in m rn w C7 ri+
Septic or Holding Tank 1000 1000 Wieser X
Dosing Chamber 600 1_ I combo x son 1 VII. Responsibility Statement- I, the undersigned, u e res i ' instal f the POWTS shown on the
attached plans.
Plumber's Name (Print) 1 Si MP/MPRS Number Business Phone Number
Keith Knudtson 648443 651-470-1737
Plumber's Address (Street, City, State, Zip Cod
927 150th St. Roberts Wi. 54023
VIII. County/Department Use On
V-10101- I
Approved Isapprov Permit Fee Date ssued Issuin ent Signatur
rven Reason for Denial $ ~ J .
IX. Condi*gjReasons for Disapproval 3 4're_
1, Septic'tank, effluent ~itef ilnd . GO (nr~n+► ! '
Aisfttrsal cell must all 1 I\ G~i-t~E" w I M
ss per m r%gement plan provided by plumber,
2- Ajjj0Q~"-AWW#MWft "t M.1f, ~1 0l~ s dY.ti. ~a tob►.~dl aA
Attach to complete plans for the system and submit to the County o on paper not less than 81/2 x 11 inches in size
SBD-6398 (R. 11/11)
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In,
WWI
pErxRTMFN~ DIVISION OF INDUSTRY SERVICES
PO BOX 78
y~~ I D 9n SCHOFIELD WI 54476
3 s K www.wisconsin.gov
9~0 P S.
A Scott Walker, Governor
~0 SIONAtiS~ Dave Ross, Secretary
July 06, 2015
CUST ID No. 648443 ATTN. POWTS Inspector
ZONING OFFICE
KEITH E KNUDTSON ST CROIX COUNTY SPIA
927 150TH ST 1101 CARMICHAEL RD
ROBERTS WI 54023 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 07/06/2017 Identification Numbers
Transaction ID No. 2567000
SITE: Site ID No. 814392
Gillis Farms Inc Please refer to both identification numbers,
1486 Co Rd T above, in all correspondence with the agency.
Town of Warren, St Croix County
SE 1/4, SE1A, S24, T29N, R18W
FOR:
Object Type: POWTS Component Manual Regulated Object ID No.: 1543787
Maintenance required; Replacement system; 450 GPD Flow rate; System(s): At-grade Component Manual, Version
2.0, SBD-10854-P (N.03/07, R. 1/12); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and installed in accordance with the approved plans and with publication SBD-
10854-P(N. 03/07).
• The pressure network is to be constructed in accordance with publication SBD-10706-P (N 01/01, R. 10/12)
entitled "Pressure Distribution Component Manual for Private Onsite Sewage Systems" and based on pipe sizing
methods contained in Small Scale Waste Management Project publication 9.6 entitled "Design of Pressure
Distribution Networks for Septic Tank - Soil Absorbtion Systems."
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. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 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 and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
KEITH E KNUDTSON Page 2 7/6/2015
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
;6'1 When You Receive That Invoice,
ew A Jan n Please Include a Copy With Your
POWTS Lead, ivision of Industry Services Payment Submittal.
(715) 340-0407 WiSMART code: 7633
amen@wisconsin.gov
matthewjanzen@wisconsin.gov
R
JUN 7 2 15i5
";-Ti SERVIr-.
RESIDENTIAL AT-GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
Project Gillis Farms Inc. Replacement Sanitary System
Owner Zack Gillis
Address 1486 County Rd. T Roberts WI 54837
Real Property Address: Same
Legal Description SE1/4-SE1/4 Sec. 24 T29N-R18W=TT~NAI.I.Y
Township Warren County St. Croix CQ (~D
Y SERVICE
Subdivision Name Lot No ES
C
Parcel ID Number 042-1067-95-000 r'
1
Plan Transaction Number . -SPONDEN~E
C~%izt`-
Index sheet Page 1
Calculations Page 2
At-grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump curve & specifications Page 7
Plot Plan Page 8
Designer Keith Knudtso License Number MPR#648443
Signature Phone Number
Date 06/14/15
Designed pursuant to:
At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07), and both
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and
Pressure Distribution Component Manual Ver. 2.0 SBD-107MP (N. 01/01) (ft,iga)
Version 7.0 (03/12) Page 1 of 8
PRESSURIZED AT-GRADE DESIGN
At-grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
300.0 Estimated wastewater flow (gpd)
450.0 Design wastewater flow (gpd)
6.50 % Site slope
96.00 Contour elev. below lateral (ft)
45.00 Depth to limiting factor (in)
0.6011 n-situ soil application rate (gpd/ft^2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
9.00 Linear loading rate gpd/ft
9.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
84.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) a Center or end lateral connection
1 Number of laterals
0.125 Orifice diameter (in) e.g. 0.25
Not a renal
calculation 1.75 Estimated orifice spacing (ft)
2.00 Forcemain diameter (in)
2.02 Forcemain flow velocity (ft/sec)
50.00 Forcemain length (ft) y or n Does forcemain drain back?
85.42 Pump tank elevation (ft) y or n Are laterals at highest point?
6.5 System head (ft) x 1.3 NA
10.08 Vertical lift (ft) 8.2 Forcemain drainback (gal)
0.45 Friction loss (ft) 37.5 5x Lateral void volume (gal)
0.00 In-line Filter Loss (ft) 45.7 Minimum dose volume (gal)
EE17.03 Total dynamic head (ft) 19.8 System demand (gpm)
Lateral Diameter Selection Gallonslinch Calculator (optional)
Pipe diameter Design options Design choice Total Tank Capacity (gal)
Designer 1 in Total Working Liquid Depth (in)
must select 1.25 in Gal/in (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
3 in x 1000 Se tic tank capacity (gal)
Wieser Concrete Manufacturer
Effluent Filter Information Dose Tank Information
Pol -Lok ] Filter manufacturer 603.4 Dose tank capacity (gal)
PL-526 Filter model number 16.8 Dose tank volume (gaVin)
Wieser Concrete Manufacturer
Project: Gillis Farms Inc. Replacement Sanitary System
Transaction Number: Page 2 of 8
AT-GRADE PLAN VIEW
1/6 B Observation pipes (2 typical) A 9.00 ft
D 1 B 84.00 ft
~t-----~ 1/6 B 14.00 ft
C 11.00 ft
r
W C D 5.00 ft
E 2.00 ft
L 94.00 ft
D B W 21.00 ft
A x B 750.00 ft^2
L
T T
Cap
17-17 -,-71 = Total aggregate cell A x B Typical
in obs. tthe tower 6°, and
= Plowed area L x W anchored securely.
-1
6°
AT-GRADE CROSS SECTION
Svnthetic fabric cover
97.79 ft Finished grade
Lateral elevation
invertelev. 96.50 ft '
Observation pipe
at aggregate toe
E
6.5 % Slope
Surface contour 96.00 ft C A
and system
elevation D
= 12 in. topsoil and subsoil
over aggregate and tapered to toes. Plowed layer
below L x W
= 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: Gillis Farms Inc. Replacement Sanitary System
Transaction Number: Page 3 of 8
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - End Connection
P
Last hole drilled next to end cap IE X Laterals & force maM of PVC Sch 40
Hales driflod on the bottom of the lateral per SPS T** 3$4.30-6
equally spaced • = Turn-up%Wbsllvolveorclesnoutplug
Lateral Specifications
0.125 Orifice diameter (in) End Lateral connection point
X 1.74 Orifice spacing (ft) 1 Number laterals
48 Orificesllateral P 81.78 Lateral length (ft)
19.8 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
19.8 Sys. discharge rate (gpm) 50.00 Forcemain Length (ft)
17.03 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather-proof waming label and locking device
junction box
Final grade disconnect 4'
Tank component is Alternate
properly vented outlet
^location 18" min.
Electrical as per NEC 300 and I~ Approved
SPS 316.300 WAC outlet
Tank full joint
c Inches Gallons JA Provide 1/4"
A 19.2 322.5 weep hole or
Alarm on antisiphon
m B 2.0 33.6
E C 2.7 45.7 Pump on B device.
C Note: A double float switch will
o D 1201 .2016 .86.42 ft required to set dose at 2.7" or -4 i Totals 35.9 603.4 --i
Pump off 45.70 gallons.
D
3" Bedding under tank 85.42 ft
Goulds Pump manufacturer SJE Rhombus Alarm manufacturer
EP04 Pump model number Tank Alert 1 Alarm model number
Project: Gillis Farms Inc. Replacement Sanitary System
Transaction Number: Page 4 of 8
At-grade System Maintenance and Operation Specifications
Service Provider's Name Powers Sanitation Phone 715-246-5738
POWTS Regulator's Name Lt. Croix County Zoning Phone 715-386-4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 118 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 750.0 ft2 Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service FmQuencv
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test monthly
Pressure System Laterals should be flushed and pressure tested eve 1.5 ears
Mound Ins ect for ondin and seepage once eve 3 ears
Other
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 at-grade component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07).
Lateral Turn-up Detail
Finished
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
- Long Sweep 90 or Two
96.50 ft - 45 Degree Bends Same
Diameter as Lateral
Project: Gillis Farms Inc. Replacement Sanitary System
Transaction Number: Page 5 of 8
At-grade System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SBD-10854-P (N. 03/07), SSWMP Pub. 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N. 01/01)]
and 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 SPS 383.33, 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.
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.
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.
At-sarade and Pressure Distribution System
No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade 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 at-grade 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 at-
grade be heavily mulched as protection from freezing.
Influent quality into the at-grade system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. 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 and 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 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.
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(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at-grade 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 renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Gillis Farms Inc. Replacement Sa Transaction Number: Page 6 of 8
Page 7 of 8
MGOULDS PUMPS Submersible
Effluent Pump
EP04
3871 EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- i Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses: heat transfer, ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• Farms manual operation. Auto- Canadian siandardslls~Odation
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "C" or "F".)
factory. strength, and durability.
SPECIFICATIONS ■MotorCoverThermoplastic GoAdsRnpsis1S09f)01mom-ed.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
maximum, ■ EP04 Impeller: Thermoplas- ~ power Cable: Severe duty
• Capacities: up to 60 GPM, tic Semi-open design with rated ail and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 11/2" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
104°F (40cC) continuous
1401F (60°C) intermittent. METERS FEET
10
• Fasteners: 300 series
stainless steel,
a 30 s GPM
• Capable of running
dry without damage to 2s rr
components. 25
o
Motor: _
• EP04 Single phase: 0.4 HP, " e 20
115 or 230 V, 60 Hz, 1550
RPM, built in overload with s is:
automatic reset. 4-
• EP05 Single phase: 0.5 HP, c EPOS
115 V or 230V, 60 Hz, 1550 3 10
RPM, built in overload with ! automatic reset. z
EPaa
• Power cord: 10 foot s
standard length, 16/3 1
SJTOW with three prong
grounding plug. Optional 20 ° °0 10 20 3o ao so cPM
foot length, 16/3 S1TW with
three prong grounding plug ,
o Z q a 10 12 m3/h
(standard on EP05),
CAPACITY
Goulds Pumps
E 2001 Goulds Pumps ITT Industries
Effective May, 2001
83871
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I
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer Zack Gillis
Mailing Address 204 Canyon pass Hudson Wi. 54016
Property Address 1 W Co. Rd. TT $ /4Z
P-1~1
(Verification required from Planning & Zoning Department for ne onstruction.)
City/State Roberts Wi. 54023 parcel Identification Number 04 -1067 -bfk-000
LEGAL DESCRIPTION -1
Property Location SE 1/4 , SE 1/4 , Sec. 24 , T 29 N R 18 W, Town of Warren
Subdivision Plat: , Lot #
Certified Survey Map # 413 Z~ , Volume Z , Page # Z..~ .
Warranty Deed # b 14 7 " l (before 2007)Volume , Page #
Spec house 13yesEho Lot lines identifiable Elyes[]no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statemeyarran this form ar e true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue ty deed recorded in Register of Deeds Office.
N er of bed 0 3
'4~4a "7
IG ATU OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
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Parcel 042-1067-91-000 09/10/2015 09:52 AM
PAGE 1 OF 1
Alt. Parcel 24.29.18.3818 042 - TOWN OF WARREN
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
06/05/2015 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
ZACHARY THOMAS GILLIS O - GILLIS, ZACHARY THOMAS
1486 CTY RD TT
ROBERTS WI 54023
Property Address(es): Primary
Districts: SC =School SP =Special 1480 CTY RD TT
Type Dist # Description
SC 2422 SCH D ST CROIX CENTRAL
SP 1700 WITC Notes:
NEW FOR 2016. CSM CREATED NEW LOT LEFT 2
REMAINDERS.
Legal Description: Acres: 2.660
SEC 24 T29N R18W PRT SE SE & SW SE BEING
CSM 27-6123 LOT 1 Parcel History:
Date Doc # Vol/Page Type
07/01/2015 1014764 WD
06/05/2015 1013278 27/6123 CSM
01/13/2009 886582
Plat: * = Primary Tract: (S-T-R 40'% 160%GL) Block/Condo Bldg:
6123-CSM 27-6123 042-2015 24-29N-18W LOT 1
2016 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/17/2015
Description Class Acres Land Improve Total State Reason
Totals for 2016:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin department of Safety and Professional Services +I 7q"%
Division of Indust"RECEIVED SOIL REPORT L #1306
461+ 2~31 Page 1 of 3
SEP 0 4 6.i in accordance with SPS 385, Wis. Adm. Code Keith E. Stoner
Attach compp_lete itg RI~~99, RR~~~~r~~ not less than 8% x 11 inches in size. Plan must County
include, b~riotQiftt6z~~llfand horizontal reference point (BM), direction and St. Croix
perce" N'Q@ ti> j90M arrow, and location and distance to nearest road. Parcel
042-1 -9
Please print all information. Rev,606 By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Zack Gillis/Gillis Farms Inc. Govt. Lot SE1/4, S/1/44/24, T29N, R18W
Property Owner's Mailing Address Lot # Block # Subd. Name CSM#
1486 County Rd. TT
City State Zip Code Phone Number
City ❑ Village ®Town Nearest Road
Roberts WI 54837 Warren Same
❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Sandy Loam Till Flood plain elevation, if applicable Na ft_
General comments Propose a 9 ft. x 84 ft. At-Grade Mound kcated along the 96.00' Contour w/a System elevtion of 96.00 ft. Contour staked onsite.
and recommendations:
❑ Boring
1 Boring # ❑ Pit Ground surface elev. 94.97 ft. Depth to limiting factor 45 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-8 10YR2/1 I 2f-msbk mvfr Cs 3f-co 0.6 0.8
2 8-19 10YR3/3 I 2msbk mvfr gs 3f-co 0.6 0.8
3 19-27 10YR4/3 1 2msbk mvfr gs 2f-co 0.6 0.8
4 27-38 7.5YR4/4 scl 2msbk mfr gs 2f-w 0.4 0.6
5 38-45 5YR4/4 sl lmsbk-m mfr gs if-co 0.2 0.6
6 45-60 5YR4/4 f2d 5YR5/8 sl m mfr gs 0.4 0.7
7 60-70 2.5Y 714 c2d 5YR5/8 Is/sl Osg-lmsbk 0.4 0.7
,,,L JJJJ I Boring # ❑ Boring
l ® Pit Ground surface elev. 95.00 ft. Depth to limiting factor 48 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-8 10YR2/1 I 2f-msbk mvfr Cs 3f-co 0.6 0.8
2 8-20 10YR3/3 I 2msbk mvfr gs 3f-co 0.6 0.8
3 20-38 7.5YR4/4 scl 2fsbk mvfr gs 2f-co 0.4 0.6
4 38-48 5YR4/6 sl lfsbk mfr gs 2f-co 0.4 0.7
5 48-65 5YR4/6 c2d 5YR5/8 sl m mfr gs lf-co 0.2 0.6
6 64-75 2.5Y 7/4 m2d 5YR5/8 Is/sl Osg-lmsbk mvfr - 0.4 0.7
Lowest horizon of each boring contained fragments of limestone approx. 20%.
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * ffluent #2:= BODS <30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
Keith E. Stoner 224059
Address Keith E. Stoner Date Evaluation Conducted Telephone Number
23220 Wood Creek rd. Siren, W154872 5/1512015 715-653-2324
SBD-8330 (R07/13)
Property Owner Zack Gillis/Gillis Farms Inc. Parcel ID # 042-1067-95-000 Page 2 of 3
F31EBoring
Boring # ® Pit Ground surface elev. 96.47 ft. Depth to limiting factor 60 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2
1 0-9 10YR2/1 I 2f-msbk mvfr 6 2f-co 0.6 0.8
2 9-17 10YR3/3 I 2msbk mvfr gs 2f-co 0.6 0.8
3 17-26 10YR4/3 d 2msbk mfr gs 2f-co 0.4 0.6
4 26-41 7.5YR4/4 sl lmsbk mvfr gs 1f-co 0.4 0.7
5 41-60 5YR4/4 SI m mfr gs if 0.2 0.6
6 60-71 MY 7/4 c2d 5YR5/8 Is/sl 0sg-imsbk mvfr 0.4 0.7
Lowest horizon of each boring contained fragments of limestone approx. 20%.
❑ Boring
a Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
i
i
II
i
❑ Boring
F-I Boring # El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *EfW
~Y za S
* Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L
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