HomeMy WebLinkAbout008-1083-10-000
Jisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 600240
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: City Village Township Parcel Tax No: -7
Jeff & Jody Gilbertson TOWN OF EAU GALLE 008-1083-10-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
,ob &.1 ) G 29.28.16.441
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
15 //Z•4 ieo
lZ.y
Septic soda Benchmark /67, X66 LIJJ ~~a •
Dosing Alt. BM/' GD J 7. ,6y.89
1
Bldg. Sewer
F i°rr p I ak 5 z
Holding 3 'A114, St/Ht Inlet
-Z r
2 ~ St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet
Septic Dt Bottom G-7g
Dosing i /vl . /t'/1T kys Header/Man.
~ ~3s
Aeration Dist. Pipe
7• b[z /OS/ S
Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade
, X11'
''7-7A 7. ~ /OAI/
Manufacturer Demand St Coven'. ` O lZ' cf/ ' I 7-
GPM
Model Number / S 3 /6Z 5
TDH Lit Frictio2Lo4 System Head:5 TDI
. 71 6.
Forcemain Leng~th~ ► Dia.' ►1 Dist. to Well f
SOIL ABSORPTION SYSTEM N
BED/TRENCH Widthength ` No. O enc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Al 7 / /Z, 9`o J
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Typ ystem: /e5 /6 e
vvk-doy A)4 /I UNIT Model Number:
D
DISTRIBUTION SYSTEM
Header/Manifol Distribution Ix Hole Size ix Hole Spacing V o Air I ke
Pipe(s) , ✓
Length Dia Length ✓ C ~ Dia h Z6 Spacing Z' v
es Only
SOIL COVER x Pressure Systems Only xx Mound Or At- rade Syst m
Depth Over Depth Over 1XX Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No Yes No
I (O
COMMENTS: (Include code discrepencies, persons sent, etc.) Inspection #1: /6/Z 6/1 Inspection #2:
Location: No Address Available r,t4- 11
1.) Alt BM Description = 1'Y.- /oD' "v v'
2.) Bldg sewer length = /110 ~~K dF a~ ~a - amo
unt of cover iJJ~~ 4~t~:44c) /
1'.sf' QW(. :J~.3ule~t~d~C6 1'►'n~~~- VJ" 2 ►1 Co. a Xi i S L.c b"i'l
Plan revision Required? F] Yes /O Z7 f -7I y
Use other side for additional information. -
Date sepctor's Signatur Cert. No.
SBD-6710 (R.3/97)
County'
ECEI~/ p ED Safety and Buildings Division 5~ w a~ -a0~
201 W. Washington Ave., P.O. Box 7162 St. Croix
o
Madison, WI 53707-7162 Sanitary Permit Number (to he filled in by Co.)
ST. CROIX COUNTY w/ V Y Z Yo
VVMMUNny- 4%
99 ern M RV24A Y ~~9A28J State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, sot app,IPuaie governmental unit 12
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(l )(m), Stats. -XXX.222nd St.
1. A lication Informati lease Print All Information
Property Owner's Name Parcel # ID
Jeff & Jody Gilbertson 008-1083-NN-000
Property Owner's Mailing Address Property Location a ,13,j6. L qq
2341 Co. Rd. E Govt. Lot
City', State Zip Code Phone Number SE S W /4, section 29
(circle one)
Beldenville, WI 54003 (715) 273-3287 T 28 N; R 16 E or W
11 .1 of Building (check all that apply) 611L Lot #
l or 2 Family Dwelling- Number of Bedrooms ( j) Subdivision NaAa.2
e"J'fi+lt~ Block #
❑ Public/Commercial - Describe Use d~
Na ❑ City of
❑ State Owned - Describe Use L CSM Number ❑ Village of
'T 5 Na Town of Eau Galle
111. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
Move existing holding tank
11 List Previous Permit Number and Date Issued
B.
Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device- Check all that apply)
,
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade *Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable s
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Trey ent Area Information: Po1v1, PL-525 effluent filter
Design Plow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation
450 Gpd 0.4 gpd/sq. ft. 1,125.00 sq. ft. 2,999.04.00 sq. ft.
i'wr, `tee=e9htEe~lir t _1
V1. Tank Info Capacity in Total # of Manufacturer
c
Gallons Gallons Units
U V U V
New Tanks Existing Tanks
/ a U s N cn i C 4
Septic or I-Iolding Tank 1,000 Na 1,000 l v~ Wiese Concrete X
Dosing Chamber 650 Na 650 1 Triple
VII 1. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
Dale Hudson 220853 (715) 684-3378
]'lumber's Address (Street, City, State, Zip Code) ~Z~ 2-
820 Main St., Baldwin, Wl 54002
VI11. unt y/De artment Use Only
Approved Disapprove Permit F'ey 7b Dat ~a e sued Issuing nt Signatu opll_~~
$ (0 , c Zq l7
,iv enReason for 11
IX. CondlA; a N r Disapproval 3 ~1 rp~b
.ai. Cetl Rust all be .~r, is s ! r.+ nt~'r ec
aS per i men plan n.u tide 1 by plumbe., aA, , , I`
2. An at`+beck rtcl,iws imlr~t rJe Mart u:e•f
as per ippilcnbl,~ co6~ I .-.rdinaxsx.
Attach to complete plans for the system and submit to the County only on paper not less than 8 I12 X I I inches in size
S B D-6398 (R. IL/H)
4
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Gilbertson 3 bedroom residential mound € $ 2017
Owner's Name: Jeff & Jody Gilbertson,-'1 fit- r f7'
Owner's Address: 2341 Co. Rd. E
Beldenville, WI 54003
Site Address: xxx 222nd St., Baldwin, WI 54002
Legal Description: SE1/4 SW1/4, Sec. 29, T.28N., R.16W. CONDITIONALLY
APPROVED
Township: Eau Galle DEPT OF SAFETY AND
FF, .JFESSIONAL SERVICES
County: St. Croix Gi`.'i iuN IfvDU Y SERVICES
Subdivision Name: Na
S~ CO GNGLNCE
Lot Number: Na Block Number: Na
Parcel I.D. Number: 008-1083-70-000
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance specifications
Page 6 Management and contingency plan
Page 7 Pump curve and specifications
Page 8 Site Plan
Page 9 Attached Soil Evaluation Report
Designer: Dale Hudson License Number: 220853
Date: 05/04/17 Phone Number: (715) 684-3378
Signature:
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), 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-10706-P (N. 01/01, R. 10/12)
Version 7.0 (R. 11/12) Page 1 of 9
Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
(R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a
300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for
1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches.
450.00 Design Flow (gpd)
17.00 Site Slope
102.50 Contour Line Elevation (ft)
15.00 Depth to Limiting Factor (in)
0.40 In-situ Soil Application Rate (gpd/ft2)
Distribution Cell Information
112.50 Dispersal Cell Length Along Contour (ft) = 4.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate (gpd/ft2)
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point
in the distribution Y-~
Pressure Disribution Information network? Enter Y or N
(C or E) C Center or End Manifold
2.00 Lateral Spacing (ft) If N above, enter the elevation (ft)
4 Number of Laterals of the highest point.
0.125 Orifice Diameter (in)
2.00 Estimated Orifice Spacing (ft) = 4.02 ft2/orifice
2.00 Forcemain Diameter (in)
30.00 Forcemain Length (ft) Does the forcemain drain back? _ Y
95.00 Pump Tank Elevation (ft) Enter Y or N
6.50 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal)
X 8.75 Vertical Lift (ft) 70.79 5x Void Volume (gal)
I 1.29 Friction Loss (ft) 75.68 Minimum Dose Volume (gal)
l 0.00 In-line Filter Loss (ft) 46.14 System Demand (gpm)
16.54 Total Dynamic Head (ft)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. options choice in. dia. options choice
0.75 1.25 x x
1.00 1.50 x
1.25 x x 2.00 x
1.50 x 3.00
2.00 x
3.00 x
Gallons/Inch Calculator (optional)
Treatment Tank Information Total Tank Capacity (gal)
1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in)
Weiser Concrete Manufacturer gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
653.131 Dose Tank Capacity (gal) PolyLok~Filter Manufacturer
15.93 Dose Tank Volume (gal/in) PL-525 Filter Model Number
Weiser Concrete Manufacturer
Project: Gilbertson 3 bedroom residential mound Page 2 of 9
Mound Plan and Cross Section Views
T
1/10B J
Observation Pipe
K r r r f r r r r r r r r r r r f f r r r r ~r 1
r rr r r r rr rr rr r r r
r f d- r'( d e.i ,d C r dbr - J l r A
w
l t
B
I
L
Mound Component Dimensions
A 4.00 ft E 29.16 in H 1.00 ft K 11.58 ft
B 112.50 ft F 9.25 in z 22.66 ft L 135.67 ft
D 21.00 in G 0.50 ft J 6.00 ft W 32.66 ft
450.00 (ftz) Dispersal Cell Area 2999.04 (ftz) Basal Area Available
4.00 (gpd/ft) Linear Loading Rate 11.25 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 106.02 (ft) ►
• H
G1
I F 104.75 (ft) Lateral
Dispersal Cell atera
104.25 (ft)-► - Invert
Dispersal Celli...:
Elevation D::::::::::::i::
Q..
1,41
102.50 (ft) Contour Elevation
17.0 % Site Slope
Geotextile Fabric Cover
Shading Key o- Dispersal Cell See lateral details on
10 Topsoil Cap o ° 1.5 ft r.r r.= f r Page 4 for number, size,
C r r r r rrxf r r
Subsoil Cap N ._o r and spacing of laterals.
0 0 ASTM C33 Sand f° `4 ;k d r r r r Laterals are equally
.V r F
Tilled Layer r d Typical Lateral J spaced from the
2 E=
0.5 ft s r r f r P distribution cell's
Aggregate v o r r+..f J.s d,r;
centerline in the
distribution cell (AxB).
A ®r
Project: Gilbertson 3 bedroom residential mound Page 3 of 9
Center Connection Lateral Layout Diagram
_..-~F040V n`41 n tCdlhlCttOrE A4 N* or 410ff to marry iad OC 4nq pom(W drr# 4#n(1C Al
Turn-upvdhsttuatvear ,k-x- I<- x12 x;' +1 Laterals Morccernavi 5ch 40 PVC
cleanoutslutt pC SRS Table'd.3U £
Roles drilled c,n the bottorn, of 6* 1atelal.
Number of Laterals 4 Orifice Diameter 0.125 in
Lateral Diameter 1.25 in Orifice Spacing (X) 2.02 ft
Lateral Length (P) 55.55 ft Orifices per Lateral 28
Lateral Spacing (S) 2.00 ft Orifice Density 4.02 ft2/orifice
Lateral Flow Rate 11.53 gpm Manifold Length 2.00 ft
System Flow Rate 46.14 gpm Manifold Diameter 1.25 in
Total Dynamic Head 16.54 ft Forcemain Velocity 4.71 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and
SPS 316.300 WAC 4 in. min.
Disconnect -
Tank component is properly vented E Alternate outlet
location
Forcemain diameter
Weiser Concrete Manufacturer 2 in.
Capacity 653.13 Gallons T
Volume 15.93 gal/inch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 22.25 354.43
B 2.00 31.86 C Pump off elevation (ft)
C 4.75 75.68 96.00
D 12.00 191.16 D
Total 41.00 653.13
Dose tank elevation (ft)
3T'_ Bedding under tank. 95.00
Alarm Manuafacturer ~SJE Rhombus Note: Switches
Alarm Model Number SJE 1011421 J-~ containing mercury
may not be used in
Pump Manufacturer Goulds this system.
Pump Model Number 3871 EP05
Pump Must Deliver 46.14 g p m at 16.54 ft TDH
Project: Gilbertson 3 bedroom residential mound Page 4 of 9
Mound System Maintenance and Operation Specifications
Service Provider's Name Dale Hudson Phone (715) 684-3378
POWTS Regulator's Name _ St. Croix County Zoning Dept. Phone (715) 386-4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 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 450 ft2 Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once every 3 years
Effluent Filter Should inspect and clean at least once every 3 ears
Pump and Controls Test once every 3 years
Alarm Should test monthly
Pressure System Laterals should be flushed and pressure tested every 1.5 years
Mound Inspect for ponding and seepage once every 3 years
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 mound 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 mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
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
45 Degree Bends Same
Diameter as Lateral
Project: Gilbertson 3 bedroom residential mound Page 5 of 9
Mound System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its'
cornponent manuals [SBD-10691-P (N.01/01, R. 11/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual
Ver. 2.0 SBD-10706-P (N. 01/01, R. 10112)] 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.
detective, 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.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration Traffic (other than for
vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within
the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that
the mound be heavily mulched as protection from freezing.
Influent quality into the mound 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 BOl 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 end of each lateral, and it is recommended that each lateral
be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial
test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal
distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and
any levels above 6 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 mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and
dispersal media, and related piping, and replacing said 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.
Pretreatment Units
The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or
disinfection units are attached as separate documents and are considered part of the overall management plan for this system.
Project Page 6 of 9
GOULC75 PUMPS Submersible
Effluent Pump
. r
EP04
3871 EP05
k'Aar
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- M Bearings: Upper and 5 /c-
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
• Homes Available for automatic and thermoplastic design prov oes AGENCY LISTING
• Farms manual operation. Auto- superior strength and corrosion SP Canadian StandardsAssodation
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast ron
for efficient heat transfer, Goulds Pumps Is ISO 9001 Reglsnred.
• Dewatering assembled and preset at the
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
-,I,' maximum. U EP04 Impeller: Thermoplas- N Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1'/2" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
104'F (40'C) continuous
140'F (60'C) Intermittent. METERS FEET
• Fasteners: 300 series
stainless steel.
9 30 _ I -~-~-f-S GPM
• Capable of running
dry without damage to 8 L2 s r7
components. 25
7
a
Motor: _
• EP04 Single phase: 0.4 HP, 6 '0
115 or 230 V, 60 Hz, 1550 14. 'V"
RPM, built in overload withl-b,//. 0 s
automatic reset. 4
• EP05 Single phase: 0.5 HP, o EPOS
115 V or 230V, 60 Hz, 1550 - -
3 10' _
RPM, built in overload with EP04
automatic reset. 2
• Power cord: 10 foot 5
standard length, 16/3 1-
S1TOW with three prong
grounding plug. Optional 20 0 00 10 20 30 40 30 GPM
foot length, 16/3 S1TW with
tnree prong grounding plug
0 2 4 6 3 10 12 in /h
(standard on EP05). / ~c ~ e
d.
CAPACITY 0•'160-'1111114 ~rti%IiMGCm sf~ 1a
Goulds Pumps
~20ozGoulds Pumps I ITT Industries
Effective September, 2002
B3871 P~ 7 !/t /
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Great 1 orck Opportunities r; i .7
- 1, r:
953 total square feet of living area
'ISM
a? I¢
Width: 36-0" Depth: 42'-4"~-~_~,
b;+xw
2 bedrooms, 1 1/2 baths s
Crawl space foundation
Special fea ores _ f
Covered front and rear porches feature PORCH
35'-8 "z7.7
ceiling fans to keep you comfortable in f°
warmer weather
Two generous bedrooms, each with a - KITCHEN
walk-in closet, share a spacious bathroom 16'-6"x11-3~._
Adramatic vaulted ceiling crowns the
open family room and kitchen = L; BEDROOM 1
Price Code
A, FAMILY BEDROOM 2'
19' 7" x 14.2
15'-S" x 10'-0
PORCH 1i
35,-8, x
O Copyright by
designer/architect
137 T, nr~lar +11X,,1,11, 6i ;t thN kAalini-Ac RIAMillcy Xlnfeyiadc Des'l,- orvisit www.l~l~ i7~te ~
Pj3LYANW0X
ZD Inc, p
Innovations in Precast; Drainage Zabel" yy i -525 Effluent Filter
& 14'aStBUVafel Products A Givisien of Polylok Inc.
PL-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tank.
Features: 1/16" Filtration dots
• Rated for 10,000 GPD (gallons per day). Alarm swatch
525 linear feet of 1/16" filtration. ~1~,000 GPD; (Optional)
Accepts PAC
• Accepts 4" and 6" SCHD 40 pipe. Extension Handle
• Built in gas deflector.
• Automatic shut-off ball when filter is removed.
• Alarm accessibility. Nated for
10,000 C;111)
• Accepts PVC extension handle.
P1,-525 Installation:
Ideal for residential and commercial waste flows up to - 525 Linear It.
of 7./.16"
10,000 gallons per day (G PD). o o
Filtration f 1/16 Slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.
Accepts 4" & 6" r
3. Glue the filter housing to the 4" or 6" outlet pipe. If ScxD 40 pipe
the filter is not centered under the access opening use a
Polylok Fxtend & Lok or piece of pipe to center filter.'
4. Insert the PL 525 filter into its housing.
Certified to
5. Replace and secure the septic tank cover. I!Ff NSI Standard 46
PI,-525 Maintenance: "i
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
needs servicing. Servicing should be done by a certified Gas Deflector
septic tank pumper or installer. Automatic
Shut-Off Ball
1. Locate the outlet of the septic tank.
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL-525 cartridge out of the housing. y
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserted tulda"~ Smart[ Hier a Alarm t.xtc:rrd & t,ok71x
Polvlok /abet & hest filters accept Easily installs
7. Replace and secure septic tank cover. the sma, trtlterv switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 `Ibll Free: 877.765.9565 Fax: 203.284.8514 w-WAk,.polylok.com
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
C)WJ 1161 IIP (1104 FICA-1-10N FOI M
Owner/1$tttyer Jeff & Jody Gilbertson
klailing Address N6809 Co. Rd. J, Beldenville, WI 54003
Property Address XXX 2-,nd T., Baldwin, WI 54002
(veritIcc t' om Planning & Zoning Department for new construction.)
~ \V
(ity/State Parcel Identification Number 008-1083-70-000
LF AL DESCRII' m)N
SE SW 29 28 6 Eau Galle
Property Location 4, '/1. Sec. , 1 N R ___W J own of
Subdivision flan: Na . Lot #r Na
Certified Sur-vey Map # Na . Volume Na Page 4 Na
Warranty Deed # (before 2007)Volume . Page
Spec house Elves[Dro l.ot lines identifiable Elyes❑no
SYS' EIM MAINTENANCA] AND OWN.U:R CEIRTIF1C'ATION
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 atfect the function ofthe 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 I i 3 full of slud-e.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal s: stem with the
standards set forth. herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
`Mate of Wisconsin. Certification stating that VOUr septic system has been maintained must he completed arid returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
liwe certify that all statements on I/ tt rm are true to the best of trry%our knowledge. 1%tive anu'are the owner(s) ol'the
property described above, by virtue of a i rranty deer( recorded in Register of Deeds Office.
Number of bedrooms
1~v ~ I 4 ,24 17
0 ~ z
SICiNA i URF (~F APPLICANT(S) DA I I
*'"*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 Decds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04112)
~ T
RECEIVED
O ~ ' 2418
Wisconsin Dek6AAf2016 SOIL EVALUATION REPORT I of 3
C-Qp4wrel;Q~E 3PS 3bS A.C.E. Soil & Site Evaluations
~+n~ in accordance with Csaaaa-8~; Wis. Adm. Code
'tRQIA'Vi~Y~Yi+F # r
County
C,1~{ I{T~tiot less than 81/ x 11 inches in size. Pla St. Croix
include, but not limited to: vertical and horizontal reference point (BM), directio
percent slope, scale or dimemsions, north arrow, and location and distance t( Parcel
00 1083 0-000 ~
Please print all information.
Rev ed By t
Personal information you provide may be used for secondary purposes (Privacy Law, s.
4r.~, ( i-~u I I / ad-
Property Owner Property Location
Jeff & Jody Gilbertson Govt. Lot SE 1/4 SW 4 S 29 T 28 N R 16 W
Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM#
N6809 Co. Rd. J na na Na re,
City State Zip Code Phone Number City Village ✓ Town Nearest Road
Beldenville WI 54003 (715) 273-3287 Eau Galle 10Th Ave.
✓ New Constructior Use: ✓ Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD
Replacement Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable na
General commentE n Z5 fx iv
and recommendations: Soil conditions require mound POWTS with dispersal cell PI Ted on 102.40' contour. Recommended Infiltraive
surface elev. to be 104.15' at 21" above contour.
40ra_ Boring # Boring
Pit Ground Surface elev 98.16 ft. Depth to limiting factor 19" in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture StructurE Consistence Boundar Roots GPD/ft2
in. Color Qu. Sz" Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
1 0-3 10yr212 none I 2fgr mvfr as 2vffmc 0.6 0.8
2 3-19 1 Oyr3/3 none sil 1 msbk mvfr gw 2fmc 0.4 0.6
3 19-31 1Oyr4/4 f2d 7.5yr5/8 sl 1msbk dsh cw 1fmc 0.4 .07
4 31-40 7.5yr3/4 f2f 7.5yr4/6 sl 1 csbk mvfr cw 1 fm 0.4 0.7
m3p 7.5vr5/8
5 40-51 7.5yr4/4 & c2d IOvr6/2 sl Om mfi - - 0.2 0.3
❑ Boring # Boring
Pit Ground Surface elev 103.54 ft. Depth to limiting factor 40 in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture StructurE Consistence Boundar Roots GPD/ft°
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
1 0-3 1Oyr2/2 none I 2fgr mvfr as 2vf,f 0.6 0.8
2 3-17 1 Oyr3/3 none sl 1 msbk mvfr gw 2fmc 0.4 0.6
3 17-22 1Oyr4/4 none sl 1msbk mvfr cw 1fmc 0.4 .07
4 22-40 7.5yr3/4 none Is Osg ml cw 1fm 0.7 1.6
5 40-55 7.5yr4/4 f2d 7"5yr5/8 Ifs Osg ml - - 0.5 1.0
H#4 & 5 contain a high percentage of clay.
Effluent #1 = BOD s 30 < 220 mg/L nd TSS >30 < 150 mg > * Effluent #2 = BODS< 30 mg/L and TSS <30 mg,
CST Name (Please Print) Signature CST Number
36162 3a1bN
James K. Thompson ~ 5~-----
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 10/1412015 715-248-7767
rOperty Owner Jeff & Jody Gilbertson Parcel ID # 008-1083-70-000 Page 2 of 3
Boring # Boring
Pit Ground Surface elev 99.00 ft. Depth to limiting factor 15'' in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture StructurE Consistence Boundar Roots GPD/ft;
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
1 0-4 1Oyr2/2 none I 2fgr mvfr as 2vffmc 0.6 0.8
2 4-15 1 Oyr4/3 none sl 1 msbk mvfr gw 2fmc 0.4 0.6
3 15-28 1Oyr4/4 c2d7.5yr4/4 sl 1msbk mvfr cw 2fm1c 0.4 .07
4 28-42 7.5yr414 f2f 7.5yr4/6 Is Osg ml - 1fm 0.7 1.6
H#4 contains a high percentage of clay.
F-1 Boring # Boring
Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture StructurE Consistence Boundar Roots GPD/ft'
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
❑ Boring # Boring
Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture StructurE Consistence Boundar Roots GPD/ft'
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
* Effluent #1 = BOD 5> 30 <220 mg/L and TSS >30 < 150 mg Effluent #2 = BOD 5< 30 mg/L and TSS < 30 mg,
The Department of Commerce is an equal opporhmit}' 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'I'TY 608-264-8777.
SBD-8330 MO-00j A.C.E. Soil & Site Evaluations
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