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HomeMy WebLinkAbout002-1023-60-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597434 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: T City Village Township Parcel Tax No: Glenn & Joan Malcein TOWN OF BALDWIN 002-1023-60-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 11.29.16.166 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Tot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No Yes L7 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2566 CTY RD E 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? L I Yes No ~Ce ~ Use other side for additional information. _ i _ t L " Date Insepctor's Signature SBD-6710 (R.3/97) T - l~ t 1 c- E r v CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. Scale: 1" = 30' SYSTEM SOIL EVALUATION PAGE 2 OF SITE MAP I 30 45 so PLOT PLAN PROJECT NAME: DESIGN FLOW: 450 GPD 7.52 Glenn 1Aa Attach design flow calculations for commercial plans. 2566 County E / Baldwin , St. Croix county Pipe Material / ASTM Standard (Tables 384.303 & 384.30-5) PROJECT ADDRESc S: 3034 N Sanitary Sewer: 4 / Force Main: 2" / SCh 40 BM Symbol BM Elevation 100 BM Descnptlon: Grade of flagged Stakes Indicate north by IMPORTANT: Slope Gradient (W 2 Well Symbol (rf applicable;: Q drawing an Show ground elevation contours at suitable intervals. at Tested Area: on the appr to ne. PL -7 soo g!5 3 OF LL ' I ~onn~ I l ~ I t -7 cc RoPiE yh 9Wk --Ts5, 4-t,5 l 1 c°t. K29QE277CNATA 6~ S St. Croix $f}rV-dal~ Ivlaalson, w 1 D-) /V/ - 7162 Sanitary Permit Number (to be filled in by Co.) t of Co r (608) 266-3151 -1 Li 4-- MWIM 501 ei*Application State Plan LD Number ~#dbrd with Comm 83.2 1, Wis. Adm. Code, personal information you provide 03 _ ,•t ~ay~ed for secondary purposes Privacy Law, sl 5.04(1)(m) Project Address (if different than mailing address) L 4+ ~l~rmation - Please Print All Information 566 County Road* rty v 's Name Parcel 4 Lot ' Glenn UalceinM ~a~- Ib~ -40- ooo. Property Owner's Mailing Address Property Location 11, 2di A 1058 County Road D SW , SE yq Section 11 City, State Zip Code Phone Number Woodville, WI 54028 715-505-1446 T 29 N R 16 (circle one) 11. Type of Building (check all that apply) ✓ 3 Subdivision Name CSM Number 1 or 2 Family Dwelling- Number of Bedrooms % Public/Commercial - Describe Use nja 04V A~_ ❑ State Owned- Describe Use 1 []City []Village 01-ownship of Baldwin 111. Type of Permit: (Check only one Complete line B if applicable) A. ❑ New System Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision 11 Change of ❑ Pennit'Fransfer to New List Previous Permit Number and Date Issued I Before Expiration Plumber Owner J IV. Type of POWTS S stem: ❑ Non -Pressurized In-Ground Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At-Grade El anc~trir41❑ Constructed Wetland ❑ Pressurize , ._.p uul n c ❑ Peat Filter 13 Aerobic Treatment Unit 11 Recirculating San! , er ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application ate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed System Elevation 450 , is 7 - , `J lie -7 V .Tank Info Capacity in Total Number anufacturer efa Ei Steel Fiber Plastic Gallons Gallons of Units oncrete Constructed Glass Ne, Tlanks Existing ng ~ 6 efia ~r~ Tan !L(J Septic or Holding Tank X 1 000 1 e_ser X Aerobic Treatment Unit Dosing Chamber X-~ Lewis Bjork X VI 1. Responsibility , ateme4-Jl the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print)PTt ber's Signature MP/MPRS Number Business Phone Number Lewis Bjork 253976 715-231-7375 Plumber's Address (Street, City.. State, ode) + E7818 County Road E, Menomonie, WI, 54751 VI[[. County/ eartment Use Only wed is Sanitary Per t Fee (includes Groundwater D to Issue Issuing As g ture No tamps) VIM Surcharge TI ~ ~iv~cneason for IX. Conditions of Approval/Reasons for Disapproval SYSTEM CWNER: /;I L Ae4 f W ' 1. Septic tank, effluent filter and OW dispersal cell must an provided J maintained W15- PAA -rQ as per management t plan by plumber. CAGt GY 2. All setback requirements must be maintained 16S.1 as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) °rE~r DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD %o n 9~. HAYWARD WI 54843-6462 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~ES'Sf01`i BLS Scott Walker, Governor Laura Guti6rrez, Secretary July 07, 2017 CUST ID No. 253976 ATTN: POWTS Inspector LEWIS C BJORK ZONING OFFICE LEWIS BJORK LLC ST CROIX COUNTY SPIA E7818 COUNTY ROAD E 1101 CARMICHAEL RD MENOMONIE WI 54751-6637 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/07/2019 Identification Numbers Transaction ID No. 2966399 SITE: Site ID No. 839809 Glenn Malcein Please refer to both identification numbers, 2566 CTH E above, in all correspondence with the agency. Town of Baldwin St Croix County SW1/4, SEI/4, S11, T29N, R16W FOR: Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1714715 Maintenance required; Replacement system; 450 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); 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: CONDITI Key Item(s) APPR DEPT OF S • In the event this soil absorption system or any of its component parts malfunctions so as to create a health PROFESSION hazard, the property owner must follow the contingency plan as described in the approved plans. In addi ~p, tbeON U owner must insure that the operation, maintenance and monitoring duties as described in section VIII of VV J mound component manual are complied with. A copy of this information must be given to the owner upon - completion of the project. 7 • See corrections in red on the plan. The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of SPS 383, Wis. Adm. Code. If it does not conform a state approved tank must be installed. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. LEWIS C WORK Page 2 7/7/2017 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384. 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. Sincerely, Fee Required $ 250.00 'This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat. shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm LENVIS C BJORK Page 2 TT201, • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 584. 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. Sincerely, Flee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer, Division of Industry Services WiSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. p at_shandorf@wi sconsin. gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01/01, R. 10112) Pg 1 of 6 Index & Cover Page ` Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross-Section & Plan View UN 2 6 Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Attachments: Enclosures: Pump Curve POWTS Application for Review Effluent filter/ instructions /alarm Soil Evaluation Report & Site Map tank approval letter /existing tanks letter safety nets / plastic manhole Project Name / Description Glenn Malcein Owner Name(s): Glenn Malcein Phone: 715 _505 _1446 Owner Address: 1058 County D Woodville, WI Zip: 54028 Project Address: 2566 County E Baldwin,WI Govt. Lot: SW 1 /4 of SE 1 /4, Section 11 T 29 N-R 16 E ❑ or W Township: Baldwin County: St-Croix Project Parcel ID Designer Information Designer Name: Lewis Bjork Phone: 715 231 _7375 Designer Address: E7818 County E Zip: et. E-mail: lewisbjork@yahoo.com This space-ETKAXWproval s anv . License Number: 253976 L SERVICES a_I..4tY SERVICES Remarks: JNDEN Signature: Date: 6-20-2017 Original signature required on each submitted copy. SE JLj T - R AI i S+- Cr04 CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. o SOIL EVALUATION Scale: 1" 30 a5 so SYSTEM PAGE 2 OF 30 SITE MAP PLOT PLAN PROJECT NAME: 7 52 DESIGN FLOW: 450 GPD Glenn Vial ; ~,tNtc~i Attach design flow calculations for commercial plans. PROJECT ADDRESS: 2566 County E / Baldwin , St. Croix county Pipe Material / ASTM Standard (Tables 384.3033 8 384.30-5) N Sanitary Sewer: 4" / 3034 BM Symbol: BM Elevation: 100 FT 2" sch 40 Force Main: / BM Description: Grade of flagged Stakes Slope Gradient(%) Indicate north by IMPORTANT: 2 Well Symbol (if applicable): 0 drawing an w Show ground elevation contours at suitable intervals. of Tested Area: on the appr te• ne. ~ C,.N 7' t r f R / t h r 0E LL 1 E PAGE 3 OF 6 w w w o j v o No 0 0 c ti _ r r U U U) ^ u u u u 111 0 W O C w c c U) Z U 0 0 (n Cn f u 1~ 76 O Q o I I I I Y .2 a) \ J Z Lo w I I I j CL I cu v I I I cn \ I-I-o I I W III II Q . I ~aa I w J J \ I I°a~ I U W ai W ~ I I I r) CY) J V) +f ~_I I U C~ I I 00 w - I m I a~ z o > O ~ N II I I I I ~ o VJ Jf~-w I I I ~ z o II II '?o cn I I m c as I I I I ~o $ O 0 w a' 0 1: w o I I ~ o c 10 0 (D I I I I c a~ y z c~ II II ~ 3 I ~c m I I I s I I T II ~ m I I I I _ L 3 to w I l a rn I I I I m I I O) o W Lo ~3 r L0) o - I I I I I r-- o \ o~^I o o v I I II v r- w 0 (.0 ~ ~~QI I I I o O ~ olf rn N G \ U > cnUv I I I I O~ II w cL E > > co ma I L E a \ Cnw I I I I 0 ui 45 Z' o E \ I I C/) C7aoZ I I I m z I it II to °~oL I I°I I o Q a II II m z jl II m cn cn cc N y C 2 N E ' I 1 O Cl)i o N L-- in a O o E o ~ o cr) O N I °z PAGE 4OF6 00 U- p Z U °v Y O Cfl N N Q W 0 L) p co Y v r N M N C z O Z Cl) a io r p 0 IL 0 v~ O a a 11 a 11 u Z co Z oo~ N w W U o i QU a? ro o: W N j C L,2 m ❑ o Z a o m co =0' w ma UHJ Z a U a L o L cD a 0 Cl) ° a n cnn (3) ¢ c x Z U en .0 p = - LLI z a o yC:) v E ~ v U f; = o o O J O U O z ~ ❑ 0 < El 0 N _U) U^ U^ N m Z 'o- _ Xa c y x U ~ v oa w _ a co a ~v U ~E X X o UJ . cM ) ani C) c cc a W u) _ .a n o ''n J r co p m 11 00 Y (D T- y /••1 X CU L) = X v CL co 0) ~a cc (M L.L V Via, J'a a c+ry ~ Cl) a ~ J 2- CEII t6 O U) d a~/ = .O.1 U ~ u c a? ~ a~ w z U) o J w ` o c W z y O U O N d _ N v d _ z m / vii O / w _O O L -O VOj C ~ U -1 O 0- 0 E f9~ Q m o cU) 0> .0 W W cm m W > O LU cc L " / cv N W L L) LL f) _ ~ •Q a Z~ Z Oz F H L a J ^ LLI - / W o L coo co c/ co F- o m 3 m a rLn V- 0 Ca >.o 0 3 0 a~ = 'Q `U U o io n D 0 X W a> -C -p O - a (U o o W O U a 0- 'Q O m N O O L > Cl) O' > N O i O O m y y~ a w c Z a0 _°O O T L .4 O J O tC U c- 'a U o o Fes- `o Q U N m m io LL, N H L) r Q 0 V L m .Q 3 PAGE 5OF6 SEPTIC / PUMP TANK SPECIFICATIONS 4"0 Vent Pipe (No Scale) > 10 ft from Building Electrical must comply with 12" Min. or 2.0 ft above BPS 316 and NEC 300 Established Flood Elevation Weatherproof Extend manhole riser as necessary. (typical) Junction Box Approved Approved Locking Manhole IMPORTANT: Vent Cap With Warning Label Attached (typical) Anchor tank(s) as necessary conduit pursuant to SPS 383.43(8)(g) 4" Min. or 2.0 ft above Established Flood Elevation (typical) Airtight Seal Finished Grade 4 Quick Disconnect I J fP~ 18" Min. CAPACITIES @ /in7 e (typical) Depth (in) Volume (gal) - A 20.26 382 'k Weep \ --Approved Joints with Hole Approved Pipe 3 ft onto B 2.0 37.7 A Solid Ground (typical) [C] 4.88 92 L D 10 188.5 B ~ oar PUMP-OFF = *Pump Tank Liquid Level = 37.14 in j Pump _oft ELEVATION 90.83 ft ° INSIDE BOTTOM Force Main Diameter = ~2 in ! ~nlock ELEVATION = 90 ft B Force Main Length 150 ft 3" Approved Bedding Material Beneath Tank = 1~ ft Force Main Void Volume = 24.47 gal Vertical Head + Min. Supply Head = 3.25 ft [C] Total Dose Volume TDV = 92 gal/dose = L (5X total lateral void volume a TDV < 0.2X design flow) + FM Friction Loss 2.27 ft + (force main drainback volume) + Fitting Loss* _ .98 ft *(min. supply head x 0.3) MIN. PUMP DISCHARGE RATE = 26.21 gpm = TOTAL DYNAMIC HEAD - 17.73 ft PUMP TANK: SEPTIC TANK(S): Volume = 700 gal Total Volume = 1000 gal Manufacturer: Lewis Bjork Manufacturer(s): Wieser Pump Manufacturer: Zoehler Install approved effluent filter at the septic tank outlet Pump Model: 152 (See attached pump curve.) immediately upstream of the pump tank inlet. Controls/Alarm Manufacturer: SPI Filter Manufacturer: Orenco Controls/Alarm Model: Observer 500 Filter Model: FT-0822-14B Float switches containing mercury are prohibited PAGE 6OF6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operatina Limits: Design Flow = 450 gpd; BOD5 220 mgL"'; TSS 150 mgL"; FOG 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re-cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. o Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Lewis Bjork LLC Phone: 715-231-7375 Local government unit: St . Croix County Zoning Phone: 715-386-4804 Local government unit address: 800 Carmichael Street , Hudson zip: 54740 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re-constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. a.3,uc,o•'ou.var i myjmb IBAA%Tr..f 4 ov x SbJ rIAZ .0) - DUALL'U (V l%) H'1"1'1',://1D1~i.tlLM:AYAH!<.All.l Ul1/K'!'Y/'1'Wl.~/ir3:1LS ti3.lil1 U) • u U PUMP PERFORMANCE CURVE u MODEL 151'152/153 50 -14 45 153 12 40 35 uu 10 152 U 30 Q Z> - 151 © 25 0 6 20 15 4 10 2 5- 0 10 20 3 G 40 50 60 70 80 90 10GALLONS , LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 014508 I OF 1 i/27/2016 10:47 AN Existing Septic Tank Inspection Sheet Size .1000 Sizing Method 04 'r•s 2,017 Material ~roe-rjz Z - Zoo Baffels CI00ej Visible Cracks O Septic Level Stain Indication 4-k es rv% We at Lewis Bjork, LLC take responsibility of the existing tank to meet the requirements of this system change Signature Date Lewis Bjork Z's 3PC ~Di'to~ - x'93! i ; ALARM aE S t 5@ptfC,Prodocts Z= "Observer 500" Series Indoor/Outdoor Alarm Fe ces & Bmefts • NEMA 4x Thermoplastic Enclosure • Large Alarm Condition Indicating Light • Audible Horn rated 85db @ 10' • Alarm Test-Normal-Silence switch • Automatic Alarm Reset six w- • Supplied w/Cord Grip for Float Switch Installation Q • Includes 15' Mechanical Alarm Float & mounting tie strap • 6' Power Cord with 115 volt plug` • Suitable for Indoor or Outdoor Use • Two Year Limited Warranty • Available in both High Water & Low Level Alarm versions Dimensions 4-1 3L7 REF 3 aos t 7-1 641 C4 POWER aM ~T) V (SIDE) T-gL 122 PM IMM 1 7 *Note: Consult the factory for other available options. Septic Products, Inc. 1378 Twp Rd Ashland, Ohio 44805 Ph: (419)282-5933 Fax: (419)282-5943 y~~vEpARTArO~ DIVISION OF INDUSTRY SERVICES PO BOX 7302 I MADISON WI 53707-7302 3 i S ^ K Contact Through Relay yP.S y http://dsps.wi.gov/programs/industry-services u~ www.wisconsin.gov r L_ r ~OSSIONAL' Scott Walker, Governor Laura Guti6rrez, Secretary May 19, 2017 Identification Numbers Transaction ID No. 2944957 Site ID No. Please refer to both identification numbers, above, in all correspondence with the agency. OUST ID No. 253976 LEWIS C BJORK LEWIS WORK LLC E7818 COUNTY ROAD E MENOMONIE WI 54751-6637 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/31/2022 Re: Description: SEWAGE TANKS, CONCRETE Manufacturer: LEWIS BJORK, LLC Product Name: (tyrans id 2944957) SEPTIC, PUMP OR HOLDING (TANK AND ADAPTOR) Model Number(s): LB700, LB1150 (700 AND 1150 gals.) [LB700 BASE TANK; LB1150 CONSISTING OF 3 SECTIONS WITH THE 450- GAL. ADAPTOR AS THE MID-SECTION] [38 IN. L.L., 18.85 GAL/IN.; 96 IN. MAX. DEPTH OF BURY, 335 OR 551 GPD WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; TANK DIMENSIONS = 66 IN. L X 36 IN. W X 54 IN. H; ADAPTOR DIMENSIONS = 66 IN. L X 36 IN. W X 24 IN. H] Product File No: 20170151 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of May 2022. This approval supersedes the approval issued on 6/28/2012 under product file number 20120193. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • All manhole covers terminating at or above grade must have effective locking devices. • When this product receives wastewater from dwellings, it will produce an effluent quality with a maximum monthly average value for BOD5 of less than or equal to 30 mg/L, TSS of less than or equal to 30 mg/L TSS and F.O.G. of less than 30 mg/L. TUF TITE SAFE7Y Tuf Tite Riser System Safety Lid in 6" Tall Riser 4 screws included with each Safety Lid Access hole allows pump-out without removal Concrete Lid with handle. Use the Safety Pan on- Safety Lid Top and Bottom View crete lid. tlx For safety the lid can be filled with concrete. Our'Concrete Keepers'lock the concrete into the lid. 24"-RISL-FLAT-SL is made (close-up view) with 2 sets of screw holes for proper alignment in 6" tall and 12" tall risers. ( 24x12 Available in 4 diameters. 24x6 12" 12-RISL-FLAT SL 38 16" 16-RISL-FLAT-SL 30 Safety Lids sit on Riser Ledges 20" 20-RISL-FLAT-SL 20 with matching screw holes 24" 24-RISL-FLAT SL 17 49 12-RISL-FLAT SL in 16-RISL-FLAT SL in 20-RISL-FLAT-SL in 24-RISL-FLAT SL in 12-RIS-GREEN 16-RIS-GREEN 20-RIS-GREEN 2412-RIS-GREEN I I TUFaTITE' Biottibe", fflueW f ors ftorporated 11-OW-348-9843 Installation, 0 a n and Maintenance Instructions Model and Ail Base inlet Models U.S. Patent lam: / 4439323 installation, Instructions: The Biotube Effluent Filter is suspended in the septic tank by the 4° outlet pipe. The filter is composed of a vault body that will be fixed to the discharge pipe and a removable cartridge that consists of the Biotube fitter cartridge and the extendible handle. 1. Test-fit the effluent filter on the 4" out- let pipe without gluing. Make sure that it fits plumb. Any existing outlet tee will have to be removed. 2. Ensure sufficient clearance for trouble- free servicing of filter cartridge. Install assembly near the tank wall to reduce any stresses that may be caused by maintenance. Sufficient room between the access port and filter should be provided for easy removal of solids from the tank. The cartridge will need to be removed ~ Z- and cleaned while the tank's solids content is being pumped-out w NIN-Fr-FrM-1 Rev. 13, ©12/02 Pagel of 4 EnstaWation lnwucfions (continued) 3. Once the filter has been fitted properly, apply primer and PVC cement to the outside of the outlet pipe and the filter's 4" outlet Use a multipurpose cement if the outlet pipe is ABS. Do not use primer on ABS. Optional: Stainless steel set screws maybe used instead of glue. 4. Slide the effluent fitter onto the 4" pipe and plumb vertically.` 5. Hold the fitter in position until the adhe- sive has time to set (approximately 20 seconds). `art r. 6. Extend the handle of the cartridge to an 1 elevation above the top of the tank for easy access. Use 3/4" schedule 40 PVC for extension. F Either use the stainless: steel set screws or glue the extensions in place. NIN-FT FTM-t Rev. 13, © IZ62 Page 2 of 4 Inspection/Maintenance RMII Date installed: Model tank: Size: Model of filter: Single/double compartment: Date Cleaned? inspected yes no Notes: ImpotUnt Nannies and Lumbers System service provider: Phone: System installer: Phone: Septic tank pumper: Phone: Electrician: Phone: Designer: Phone: NIN-FT-FT-t Rev. 22 7104 Page 4 of 4 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer Glenn Malcein Mailing Addre s 1058 County Road D Property Ad ss 2566 County Road E (Verification required from Planning & ning Department for new construction.) City/State Woodville, Wl Parcel Identification Number 002-1023-60-000 LEGAL DESCRIPTION Property Location SW SE '/4 , Sec. 11 T 29 N R 16 W, Town of Baldwin Subdivision Plat: c~ , Lot # Certified Survey Map # Volume Page # Warranty Deed #1Qlklgi (before 2007)Volume (50 V Page 4 Spec house Elyes❑no Lot lines identifiable ❑yes❑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 Departn t within 30 days of the three year expiration date. I/we certify that all state ents on this form are true to the best of my/our knowledge. 1/we am/are the owner(s) of the property described above, by vir e of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE 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) RECEIVED JUL 19 2017 K29QE277CNATA Wisconsin Department of Commer v nLlJ/-k l lUlN KthORT Page I of 3 Division of SafeOrfa8,►. POU" ;,OMMUNITY DEVELOPMccordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. DU2~ Vh~2 /o b " percent slope, scale or dimensions, north arrow, and location and distance to nearest road. J Please print all information. Re ed by Date ~J Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z / 1 / 17/ Property Owner Property Location If r Glenn Malcein Govt. Lot SW 1/4 SE 1/4 S I I T 29 N R 16 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# • 1058 County Road D - - 2566 county E Part of > 100 acres city State Zip Code Phone Number ity ®Village ■ Town Nearest Road Woodville, WI 54028 ( 7~ 5-505-1446 County E Baldwin El New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD B Replacement Public or commercial - Describe: NA Parent material Loess over till Flood Plain elevation if applicable 14 ft. General comments Install 6'x 90' rock mound cell , with up-slope edge sand fill , 1.75' on the 99.9' contour , use .6 basil loading and recommendations: F _BI Boring # 11 Boring El Pit Ground surface elev. 99.5 ft. Depth to limiting factor I6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-4 10yr3/3 sl 2fgr mvfr gs 2f .6 1.0 2 4-6 10 r3/2 sl 2fsbk mvfr cs if .6 1.0 3 6-12 7.5yr5/4 sil 2fsbk mvfr gs if .6 .8 4 12-16 5yr4/6 grscl 0 - - - •6 5 16-20 5yr4/6 fIf10yr6/2 scl 0 - - - - F 17 2 B Boring # Boring 100 22 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 10yr3/3 sl 2fgr mvfr gs 2f .6 1.0 2 4-8 10 r3/2 sl 2fsbk mvfr cs 2f .6 1.0 3 8-12 7.5yr5/4 sil 2fsbk mvfr gs if .6 .8 4 12-22 5yr4/6 grscl 0 .6 5 22-36 5yr4/6 fIftoyr6/2 scl 0 - " Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 / E uent 2 = B D, < 30 mg/L and TSS < 30 mg/L CST Number CST Name (Please Print) Sin aWre Lewis Bork 253976 Address Date Evaluation Conducted Telephone Number E7818 County E Menomonie WI 54751 5-236-2017 715-231-7375 I Property Owner Malcein Parcel ID # Page 2 of 3 B3 Boring # Boring ® 100 21 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-5 IOyr3/3 - sl 2fgr mvfr gs 2f .6 1.0 2 5-8 10 r3/2 - sl 2fsbk mvfr cs 2f .6 1.0 3 8-11 7.5yr5/4 - sil 2fsbk mvfr gs if 6 .8 4 11-21 5yr4/6 - grscl 0 - - - .6 5 21-30 5yr4/6 fIf10yr6/2 scl 0 - - - - Boring ❑ 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # Boring Fm~ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 I * Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Tcst (8.07/00) r S~ T079 - R ! A! li CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. XS OIL EVALUATION Scale: 1" = 30' EISYSTEM PAGE 2 OF SITE MAP 0 30 45 60 PLOT PLAN PROJECT NAME: 52 DESIGN FLOW: 450 GPD Glenn Mal U."q ~,►Nk'~'i ~r-~ Attach design flow calculations for commercial plans. PROJECT ADDRESS: 2566 County E/ Baldwin , St. Croix County Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) BM Symbol: BM Elevation: 100 FT N Sanitary Sewer: 4" 3034 Force Main: 2" / sch 40 BM Description: Grade of flagged Stakes Slope Gradient Indicate north by IMPORTANT: of Tested Area: 2 Well Symbol (If applicable): drawing an w Show ground elevation contours at suitable intervals. on the appr te~ rte/ - FF' r 1 4 x ~ DELL Igo 3 ~2 m q`~,° RDA)E