HomeMy WebLinkAbout002-1023-60-000 (3)
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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 Nov-)
i
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] y
Permit Holder's Name: City Village Township Parcel Tax No:
Glenn & Joan Malcein TOWN OF BALDWIN 002-1023-60-000
CST BM Elev: Insp. BM Elev: JBM ~ cription: Section/Town/Range/Map No:
11.29.16.166
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
01
Septic Benchmark
✓~/I' % t
Dosing , Alt. BM
Aeration I Bldg. Sewer
ktolding ' St/Ht Inlet
' St/Ht Outlet `
TANK SETBACK INFORMATION J11 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom I
Dosing l Header/Man.
Aeration Dist. Pipe
Holding Bot. System r
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.., C)f 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:
J.
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake
I Pipe(s) / ~ ~ - ` /
Length Dia J Length 1 `J 'J Dia Spacing• r `
SOIL OVER 1 x Pressure Systems Only xx Mound Or At-Grade Systems Only -r-
Depth Over Depth Over xx Depth of xx Seeded/Sodded Az Mulched
Bed/Trench Center i Bed/Trench Edges Topsoil PT `Yes E] No t~, Yes No
~
"
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 2566 CTY RD E
1.) Alt BM Description ~a~
2.) Bldg sewer length = 6vwu !I~ /r' CJ
amount of cover = V S4 c` o PO )D C /o/ow. 0/o
3
Plan revision Required? ]Yes No
L
I A
Use other side for additional information.
Inse ctor's Signature Cert. t. No.
Date P
SBD-6710 (R.3/97) re
i i
2 Oc
CH=CK 30X AS APP'JCABLE. PAGE
CHECK BOX AS APPLICABLE-:. SYSTEM OF
SOIL EVALUATION scale: 1" = 30' ~J
° 30 45 60 PLOT PLAN
r SITE MAP
DESIGN FLOW: 450 GPD
PROJECT NAME: ~N~c55 7.5Z
~a Attach design flow calculations for commercial plans.
Glenn
Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5)
PROJECT ADDRESc S: 2566 County E / Baldwin , St. Croix county N Sanitary Sewec_ 4 3034
100 FT 2" sch 40
BM Symbol: BM Elevation Force Main:~-
BM Description: Grade of flagged Stakes IMPORTANT:
Indicate north by
Slope Gradient Well Symbol (if applicable): drawing an show ground elevation contours at suitable intervals,
of Tested Area: 2 on the appr- e•
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A S-, In U s PRESSURE FILTER INSTALLATION & SERVICE INSTRUCTIONS
Ft~L~ER
1455 Lexamar Drive Toll Free 888-999-3290 Office 231-582-1020
Boyne City, Ml 49712 Fax 231-582-7324 Email salcsui gaar-simtech,cum Web www.gak-sinrtech.com
INSTALLATION:
When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe Thread. Pumps with
a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be
added to the inlet end of the filter (end opposite of the cap) to the desired height and a 2" union will need to be added to the
outlet end (the end closest to the cap & on the side of the filter). Always install the filters in a position where they can be
easily serviced. "Always use caution when starting threads to avoid cross threading". Plumb force main into the 2" sch 80
PVC union. **We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring
or sealing surface**. For best performance, if a check valve is installed it should only be after the outlet of the filter.
SERVICE:
Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend
inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we
recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service
interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for
any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted
properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic
tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks (600
micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendations.
If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need
for service. If system is equipped with a "pump on light" that stays on longer than normal, this also may indicate a need to
service filter.
To service filter screen, unscrew the 4" cap. Pull filter screen from canister and wash out thoroughly in appropriate
location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be
washed later at the shop. Note that in cold conditions the filter cap may be difficult to remove. Keep the filter in a warm area
or pour warm water over the cap before removing. Once the filter is installed in the tank it maintains a stable temperature
and removing the cap will not be a problem.
If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm
Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion.
NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through
the filter.
SERVICE ALARM SWITCH
The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on
SIM/TECH FILTER systems, remove 1/4" plug from base of filter chamber and connect tube fitting. Next, run the tube up into
the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap
provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water
alarm.
Pressure adjustment is made by removing the end plug, and inserting the 7/32 allen. Clockwise increases pressure. One
turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable
within it's range (3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed
the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alarm
switch is working correctly.
****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and
installation. Made of PVC plastic.
WARRANTY
All products are warranted against defects in material and workmanship for a period of two years from the date of purchase.
In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material, freight or
expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair or
replacement of the part. All warranties are void if the product has been improperly modified, applied or installed, subjected to
misuse or abuse. Except as stated herein, there are no warranties expressed or implied, including the warranty of
merchantability or warranty of fitness for a specific purpose. EFFECTIVE September 13, 2005
K29QE277CNATA County
164 St. Croix 5f}rV-dais
ivlaaison.. w I /v / - / 162 Sanitary Permit Number (to be filled in by Co.)
t of Co r (608) 266-3151 -I Li ~Ll
60. State Plan I.D Number
ei0fOR" Application ~10~03~
"with Comm 83.21, Wis. Adm. Code, personal information you provide
gayoed for secondary purposes Privacy Law, s I5.04(1)(m) Project Address (if different than mailing address)
1. 4,4• ~l~ mation - Please Print All Information 566 County Road* P
rty s Name Parcel 4 L-14 - ni-Is A
Glenn 7vlalcein`~ 602 _ 1023, 4o_ 000
Property Owner's Mailing Address Property Location It, aq
1058 County Road D SW SE
City, State a. /a, Section 11
Zip Code Phone Number
Woodville, WI 54028 715-505-1446 29 16 (circle one)
11. Type of Building (check all that apply) h N; R r
1 or2 Family Dwelling - Number of Bedrooms 3 Subdivision Name CSM Number
J~
Public/Commercial - Describe Use / la &
~
❑ State Owned- Describe Use V ;K7' DCity DVillage Utbwnship of Baldwin
ill. Type of Permit: (Check only one A 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 ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner I_rn
I Q0P 4 0/- 4.~7
IV. Type of POWTS S stem: JIM(/ UJ
❑ Non-Pressurized In-Ground Mound> 24 in. of suitable soil Mound <24 in. of suitable soil 11 At-Grade 04
e~s~San 4H ❑
Constructed Wetland ❑ Pressurize ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sancf Fi er ❑
I
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(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed System Elevation
450 -7 SI 7 '1 S C S
V . Tank Info Capacity in Total Number anufacturer t~~ efa Si Steel Fiber Plastic
Gallons Gallons of Units oncrete Constructed Glass
New Existing r., Okefi A
'I ((J (V~►
Septic or Flolding Tank Tanks Tanks
X 1 000 1 eser X
Aerobic Treatment Unit
Dosing Chamber
X Lewis Bjork X
VII. Responsibility (.temet~- I the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name
Plmber's Signature 1 MP/MPRS Number Business Phone Number
Lewis Bjork (Print) u J
(
253976 715-231-7375
l-~t
Plumber's Address (Street, City, State, ode)+
E7818 County Road E, Menomonie, WI, 54751
VI11. County/Department Use Only
wed is Sanitary Per t Fee (includes Groundwater D to Issuef 7
~ Issuing A Signature No .tamps)
y7yrl . DO Of
even Reason for Surchargel /
/
Ia. Conditions of Approval/Reasons for Disapproval /1 (MC,/1)%?7s
Vule
SYSTEM OWNER: ,n 'Of~
1, Septic tank, effluent filter and ale
dispersal cell must .be serviced 1 maintained ~U
as per management plan prtwiaed by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in size
SBD-6398 (R. 01/03)
DIVISION OF INDUSTRY SERVICES
10541 N RANCH RD
7T \ HAYWARD WI 54843-6462
Contact Through Relay
http://dsps.wi.gov/programs/industry-services
vat mac"' www.wisconsin.gov
Scott Walker, Governor
Laura Gutierrez, 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 aoencv.
Town of Baldwin
St Croix County
SW1/4, SEI/4, S11, T29N, R16W'
FOR:
Description: Mound, 3 bedroom re~idetic
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 add~~eION U
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of15
mound component manual are complied with. A. copy of this information must be given to the owner upon -
completion of the project.
• See corrections in red on the plan. ~ a
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
LEWIS C BJORK Pate 2 T72017
• 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/instal lati on/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.
p at. shand orf@wi s c onsin. g ov
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. 10/12)
Pg 1 of 6 Index & Cover Page
Pg 2 of 6 Plot Plan r
Pg 3 of 6 Mound Cross-Section & Plan View 6
Pg 4 of 6 Distribution Network Specifications LlS1~Y SE~`I~'`
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,Wl
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: 54 5
E-mail: lewisbjork@yahoo.com This spacc
253976 SERVICES
License Number: e'~Y SERVICES
Remarks:
NDEN
c~~{ ~c` - CSC,
Signature: Date: 6-20-2017
Original signature required on each submitted copy.
x ~
Q SE. 11 T - R t t Al i S~. G04
'AW r\j
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE.
0
SOIL EVALUATION Scale: T' 30 a5 so SYSTEM PAGE 2 OF
30 SITE MAP PLOT PLAN
PROJECT NAME:` Force Main: DESIGN FLOW: 450 GPD
Glenn Vial;^ ry Attach designflow calculations for commercial plans.
PROJECT ADDRESS: 2566 County E / Baldwin , St. Croix county aterial / ASTM Standard (Tables 384.30-3 & 384.30-5)
anitary Sewer: 4° / 3034
BM Symbol: BM Elevation: 100 FT 2" SCh 40
/
BM Description: Grade of flagged Stakes
Slope Gradient Indicate north by IMPORTANT:
2 Well Symbol (If applicable): Q drawing an w Show ground elevation contours at suitable intervals.
of Tested Area: on the appr to ne.
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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 SPS 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
II (typical)
Anchor tank(s) as necessary Conduit
pursuant to SPS 383.43(8)(g) Esta4" Min. or blished Flood .0 Elevation
(typical)
Airtight Seal
Finished Grade
Quick Disconnect
18" Min.
CAPACITIES @ alfin s ° (ypic~
Depth (in) Volume (gal) 4
A 20.26 382
Weep \ "--Approved Joints with
Hole Approved Pipe 3 ft onto
B 2.0 37.7 A Solid Ground
(typical)
[C] 4.88 92
L -Alarm
D 10 188.5 B On
[c] PUMP-OFF
* 37.14 + Pump ~_Off a ELEVATION = 90.83 ft
Pump Tank Liquid Level = in
Force Main Diameter = 2~in Conete INSIDE BOTTOM
ELEVATION = 90 ft
Force Main Length = 150 ft 3" Approved Bedding Material Beneath Tank
V rtical Head = 11.23 ft
Force Main Void Volume = 24.47 gal r
6y*- ~a 'ft:'Supply Head = 'eft
[C] Total Dose Volume TDV = 92 gal/dos
+ FM Friction Loss = 2.27 ft
L (5X total lateral void volume ! TDV < 0.2X design flow) V1
+ (force main drainback volume) ~J + 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: (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 Operating Limits:
Design Flow = 450 gpd; BOD5 220 mgL"'; TSS 150 mgL"; FOG 30 mgU1
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.
1
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f/)
• W PUMP PERFORMANCE CURVE
L
MODEL 151/152/153
50
14 45 153
12 40
r~ 35
< ~ 1~5 /I
s 10
v 30
o $ 25 151
-20-
15
4-
10-
2-
5-
10 20 3 40 50 60 70 80 90 100
GALLONS
LITERS 0 40 80 120 160 200 240 280 320 360
FLOW PER MINUTE 034508
I OF 1 5/27/2016 10:17 AM
Existing Septic Tank Inspection Sheet
Size CCD
Sizing Method T A d 4 :r7l$ F -10 -2017
Material n,~c t^c.~ ~j _ Zoo
Baffels ~0OJ
Visible Cracks 0
Septic Level Stain Indication
7-5~9d
We at Lewis Bjork, LLC take responsibility of the existing tank to meet the requirements
of this system change
Signature Date
Lewis Bjork
Pie 41 Z;3PIC
Z91y- - 931 -V
ALARM SYSTEMS
- l l
Septic Products sw-
"O server 500" Series Indoor/Outdoor Alarm
Features & Benefits
• NEMA 4z Thermoplastic Enclosure
• Large Alarm Condition Indicating Light
• Audible Born rated 85db @ 10'
• Alarm Test-Normal-Silence switch
• Automatic Alarm Reset 4308
• Supplied w/Cord Grip for Float Switch
Installation o
• Includes 15' Mechanical Alarm Float
& mounting tie strap w~
• 6' Power Cord with 115 volt plug Animm risr
• Suitable for Indoor or Outdoor Use
• Two Year Limited Warranty
• Available in both high Water &
Low Level Alarm versions
Dimensions
4j
3
mew
aoo
grass ssr
72 '04
(FROIM POWO CORD {SIflE~
IM PLUG HIM
*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
yEyARTA DIVISION OF INDUSTRY SERVICES
ytit' . roe PO BOX 7302
U°2 I P MADISON WI 53707-7302
j Ds , Contact Through Relay
http://dsps.wi.gov/programs/industry-services
y~`pS
www.wisconsin.gov
r
~~Ossio 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.
CUST ID No. 253976
LEWIS C BJORK
LEWIS BJORK LLC
E7818 COUNTY ROAD E
MENOMONIE WI 54751-6637
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/31/2022
Re: Description: SEWAGE TANKS, CONCRETE
Manufacturer: LEWIS SJORK, 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 GAUIN.; 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.
i
I
.,~~TU T T
F I E
SAFE7Y L~08
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 to cast
your own con- Safety Lid Top and Bottom View
crete lid.
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
20" 20-RISL-FLAT SL 20 Safety Lids sit on Riser Ledges
with matching screw holes
24" 24-RISL-FLAT-SL 17
12-RISL-FLAT-SL in 16-RISL-FLAT- SL L in
S 20-RISL-FLAT SL in 24-RISL-FLAT-SL in
12-RIS-GREEN 16-RIS-GREEN 20-RIS-GREEN 24x12-RIS-GREEN
I
JUPTITE"
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 002-1 023-60-000
LEGAL DESCRIPTION
Property Location SW SE ''A , Sec. 11 , T 29 N R 16 W, Town of Baldwin
Subdivision Plat: , Lot #
Certified Survey Map # +6 91 ~~6t45, Volume Page #
Warranty Deed #~Q~ 4 Q j'~ (before 2007)Volume 150b Page #
Spec house ❑yes0no 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 fDepart t within 30 days of the three year expiration date.
I/we certify that all on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, ba warranty deed recorded in Register of Deeds Office.
Number of bedrooms l a 3/i 7
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 A
JUL 19 2017 K29QE277CNATA
Wisconsin Department of Commer vnwH I IVIN KtPORT Page I of 3
Division of SafefMria®QkifclP06
JoMMU j N (IMLQPMacordance 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. 002_-)023-(Po percent slope, scale or dimensions, north arrow, and location
and distance to nearest road. VlJ
Please print all information. Re ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7 Zy V-7
Property Owner Property Location
Glenn Malcein Govt. Lot SW 1/4 SE 1/4 S I I T 29 N R 16 E( r)®
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 LlseE] Residential / Number of bedrooms 3 Code derived design flow rate 450
GPD
El Replacement Public or commercial - Describe: NA
Parent material Loess over till Flood Plain elevation if applicable NA 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:
B 1 Boring # 11 Boring
1.7 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 flfloyr6/2 scl 0 - - - - -
B2 Boring # ® Boring 100 22
M 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 .6
5 22-36 5yr4/6 fIfIOyr6/2 scl 0 - -
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30:< 150 E uent 2 = DS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Si n CST Number
Lewis Bork 253976
Address Date Evaluation Conducted Telephone Number
E7818 County E Menomonie WI 54751 5-236-2017 715-231-7375
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 10yr3/3 - 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 - - 45, .6
5 21-30 5yr4/6 flf10yr6/2 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/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2
❑ 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
I
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 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-83301 cM (R.07/00)
SE 11TAN1 - R AI 1 S+. Croft c..a
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE.
SOIL EVALUATION o Scale: 130 30 45 60 ❑ SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: 52 DESIGN FLOW: 450 GPD
Glenn Vial
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): 0 drawing an w Show ground elevation contours at suitable intervals.
on the appr tee ne,
VE "I
A tiatr
77 S-Oc>
0Et ~ ~
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