HomeMy WebLinkAbout030-2044-95-010
V/annns n Ueoartment of Commerce PRIVATE SEWAGE SYSTEM `"'Orly St. Croix
8ita:y antl Budd ng Dives on
INSPECTION REPORT 3srlarrPe'nnlNo
GENERAL INFORMATION (ATTACH 10 PERMIT) s.;te Planu: No 605197
Perso•al rlur-otCr' you prowde fray bu used rcr se.'=Cary purpuscs IP vacy l a w , 5 iS ee .-,grnJl
PC'fnll HolcerS \.I-e: City V lage Townshp Parce fax nC
Edward or Margaret Gilstrom TOWN OF SAINT JOSEPH 030-2044-95-010
CST SM h e: 1-sp Bro 1. 1e'':. BM Descr pnc- CCbOfu'I ovrt'r iiI,;u; Lrap NC.
/ oa Q ill 16b 26.30.20.506A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER OS CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
.n 7600 3.S 163• /CID
Dosing All BM
L 'A
+~bo G Sa 6wz, G $ 9 -
Ad* ,
Aeration B no Sewer
91 1 ill Q sz s z 9z . zii
Holding SL. 14! Inlet
~
TANK SETBACK INFORMATION Si Outlet
~
TANK TO i~ WELL BLDG. le'n- Airlrtake ROAD Dl Inlet
Septic Dt Bottom
I Za /6Z Z 7 - 1(.. ZI B 7.3 3
Dosing y f r Z7 e _ Header. titan 6 s
/ . g,
~0 1a ~5•
Aeration Dist. Pipe G
_ rs .~5 Z
Ho ding Bo! Syslcrr n
CS (t,.,J
PUMP/SIPHON INFORMATION F ral G adc (o- O ST
r
Idanufacturer Demand St Cover 7 t`
71 GP!1l a 4___ $ 9G 7
Mudel Number
53 3Z r 9 , cz 9~• si
TDH Lift F,ict on Loss System head TD
8,L 1• is 76, Z r If 3
FO'Cemar Lenctg ` 1 DR I: ,I
r I T
SOIL ABSORPTION SYSTEM
BED,TRENCII NJlr _ervat/n No. OL r'c~s PIT DIMENSIONS No. UI Rts I^sitle Ua. Liquid DCaln
DIMENSIONS 3 V 3 I n `I 1
SETBACK SYSTEM TO l OLOG VJELI LAKE.-'STREAM LEACHING Mari
INFORMATION CHAMBER OR EL +~/br✓~ if 11
o ISys:e° p UNIT MoJIll Numter.
DISTRIBUTION SYSTEM d-(. 4- ` /Tr
leaoanW/~amt0ltl~ )Z-~ D str buton x HOC S.zc x IICIC Spep"q oiar h e
V} Pipelsi u
Lengl'f Dia l entil - Ca spn_ aq
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Deofn O,er Depm Cvef r: I of u Seeded+ScdoCJ . lA,~h.nsd
Bed!Irench CCn:cr r IoTI ranch Edges Popsu Nn - x'cs NC
111
COMMENTS: (Include co u,-scinee~penciieeswp~ersons present, etc.) Inspection #1 f Inspection
Location: 1341 iSTH ST ~V~7" kd Srl_/1~~'Lw~-- t/
1.) All BM Description = / 1 Q~QS dl~ /O tT' ~fa,.rN Oar/
2.) Bldg sewer length = ~X.Aeudj
-amount or cover = 7 / O l1 1 JS I Ast/'~"++tV~, Jvi r l Plan revision Rect redo -J Yes No ~O (t T~ 7
Use other side for additional information. t f7
Sl iR 3 r^'1 Uato Irwp. is Sigr tie Cert '
VW-aul$•-d a
~pS MrNC.\t ~~♦S,t\f }r^J I Illlllo
1 r't J Industry Services Division tit (:r'c
1400 E Washington Ave
z ' ,o tianitan I'ennil Nunther no he IiIIcA in by t'u.l
P.U. Box 7162
Madison. WI 53707-7162
kh, sh a,°C ' E
a l97
73) 65
1 rn
> I I rmt,aetwn Number
1 Sakai-, sermit Application -1~
_
In accordanc5 w0kS tTi 1161. Wm. C ,dt uhmi a u t I lhl, flan h the +4`Pn i 1.
i. reyuircd pr hl tlnm a s Inmmm' pamm Note %I) pl Lead n 1, nr. VI w (C , sncJ I 't Al 11 atc 9lhnIle( to
the Dup' ,utinpn oISalyly ,lad Prate>an Ir cl \ddre„ tit dil Icran l1w iw dine addressi
nal Scn 1 e~ I..re•nal f.u man.m wp n..v:Ac m9s IN ussd iix a.onda I
p,.ln is la 3CC1'tda1cC %%11111 he PI iiaey 1 aw I.1 1, I t'nn. Non, I .a; I ° Sllee(
1. Application Informatio lease Print All Information
Plopclt, (Awcl'>. Nlalu t - - I ryf z
(ill 11' fn I .'+t.U'1' 1'Sl llgalel UtU {I~1-9j 6lll
a4.3o.a0.snc►t
I'mpenv (ASner Al:ulntg Address Pntpem' I oi:alwn
: 141 1' ' Street
GoXI Lot
C'rv. Slate Zip Qrdc Phone Number N" 4. SISection 26
1 loath. M'I tax,,, iclydc one)
IF iaN 7 R11)I(nr tl'
II. Tvpe of Building (check all that apply) ,it ❑ .I I link Dss lliag Aumtel of It,Jmom, Subdk.,iun Name
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❑ Slate ()caned - Des, nhe I to ❑ V;aa~c of
SNI Aunnxr
w ~0 ELF/aws Ej rnys'll oull'if St. Joseph
I11. A a of Permit: (Check o on line A. Complete line It if applicable)
\ ❑ Nnc S\,Ir ❑ I cph:cnmm Sys;c^- I reinnim:'I is,Iding bank itcnlaccmcnt Only ❑ I nlla liaf Siouan In l'.\nline S\AC111 is\plaill I
I
I _
I;• ❑ ilemtil Itntew:d ❑ Penun RC%l,ion ❑ l fl mec o. ❑ I onn I ramtcr to New List I'levmns Permit Number laid Datc I.,ued
Bdinc I\I.ilalion I Ilu,11K, Asirr ~
I - r 1WTS SvstentlClm onent:rDev ice. (Check all that apply I _
❑ Nun-PrcmunrcJ In-Unmod ❑ Pr:,anv 41n-(irnund ❑ %l-Grade ❑ %h-and r .I sunanic,oil ❑ Mound '-1 iu. it suitable soil
71 locum an' I hr Ui.pcr.:J t oil, win Rcyplaini ❑ Plcueaanint l)es i:i "pialIIs
F'. Dispersalrl'reatl ent_ Area Information:_ -
h• c n I w tr,p.l. as 1 n S.nl Appil. ea dispel,al Aura Requir .,I) DI 1SISal Arta I r Died I\tl S) lynt I.7as Ib n
.S ~ li'.n •p.:d`. 40p rn'p 1 I), 9d.1 U. stl'
VVV ~1.
A'I. 'Lank Info iapaap in
(canons
ldial k or s -
Gallon, Unit \1ank, ;offer c _
Pus :m;k. I-.ylanr'I:u1L. / ~N _ r G f ~ V
Sep@c or lloidn@Twli, 1Dhi1 ihllll i Rlcscrl o rrt•Ir ❑ ❑ ❑ i ❑ CI
Ue.nu• t_hanl1w. 6911 69it I el:e,er (b ILICIC F. O ❑ ❑ U_
It. Responsibility Statement- 1• Ihr undersigned- assume responsibility roe installation of (Ile VOM I'S shown nn the allas•hed plans.
!tnah.r Namc I I rind cant, A , I I - / \1': \I:'iiS \hnnhcr liusincss Phone Kumbel
"e-7M1-14x6
Plumber, \:1dw,, IStn:el CaN Stale, A Code: 616 150 Ayr. Somerset. WI Sd025
A'll itimWDe artment Gse Ori 4 41
\pplos cJ ❑ I1iv . . Puma -ee Dele Is it
Iczum gent Ggn:nure
CC)
. ntrv}}jj~~ n It avo° :Lr Ucnial # ~~S' Z~/ O f,
I\. CondA . ,at9fi;nS~lc1l,~(~- Disapproval
~p'1}[~~/ Y c
fli` Ve cell -1j t eh r>P , c ,le_ S 3) 6W 16
Asper taf-35erier pl 1 '1 is L/ 'IuinheJ. n_ ♦ ~1 t 1 -
2. AM aaT7ck recur P.n.s w- t Lt, rk II e 1 1~/(~r
all pat I'M d! u>d: , .Id
- \uarh hs rompiele pLlna G.r the .)acm and ohni t n. the ('lamp n.I, nn paper met Ir.. than Y 12 , I I ladi in I-
NRDdwB 100, 11:
SYSTEM PLOT PLAN
Design f low. 45o galloZ
Project Name: Gilstrom replacement septi _ N..-I>
- Attach design how ca,culafiocs for
Project Address. 134115th Strevt commemial plans.
Rfd1 Symbol . BM Elevation: 100.00' - Pipe Materials i ASTM Standard Scale: 1" = 60'
BIA Desaiphan: TWO 1 ? PVC Pipe Tables 3&.30-3 & 304.305 0 03 90 120
BM2 Symbat Q BM Flevation: 95.57' ao PVC: ASTM D96E5
dM Description' roo of doa sili 4" 30.4 °'V^ ASTM C9~;W _J - -
AS RJ JtiB`_~ 15-
Slope Gradient of Tested Area: ia:~, _ 5G, 4C Pv..
Well Symbol ~If aoplicablet
Notes. Nele9
33.51 Acre Parcel
1345 15th St
Well
PI, BM2~jr 3 Bedroom I Existing septic system to be
I House abandoned as per code
Driveway
Wieser WLP10001650-MR
8% p - - Septic.., Pump Tank
- -l -1
arag
A B2 60' 2" SCH 40 PVC \ i
BM1 Force Main
5 '
T1 3' 0' EZ Flow Trench EL = 94.50'
r I I
T2 3'x 0' EZ Flow Trench El. = 94.10'
T3 3'x 0' EZ Flow Trench El. = 93.50' Pole Bam
Buildinn
o r-'`-J 1 ,I rf
i Well Shop II
HoUSdi
Driveway 1
1341 15tH Street i
Property Line
Page
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Gilstrom 3 Bedroon Replacement Septic System
Owners Name: Margaret or Edward Gilstrom
Owner's Address 1345 15th Street
Houlton, WI 54082
Legal Description: NW1/4, SE1/4, s26, T30N, R20W
Township St. Joseph
County: St. Croix
Subdivision Name: NA
Lot Number: NA Block Number
Parcel I.D. Number 030-2044-95010
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic & Dose Tank Specifications
Page 4 Effluent Filter Information
Page 5 Dose Tank Cross Section
Page 6 Pump Specifications & Curve
Page 7 System Sizing & Cross Section
Page 8 EZ Flow Information
Page 9 Management and contingency plan
Page 10 Septic Tank Maintenance Agreement
Page 11 Warranty Deed
Page 12 CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 9/3/2018 Phone Number: 715-760-0486
Signature:
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P IN. 01/01)
SYSTEM PLOT PLAN
Project Name: Gilstrom replacement septi Design Flow: 450Aa
N
Attach design Flow calculations
for
Project Address: 1341 15m Stec commercial plans:
BMt Symbol . BM Elevation: 100.00' Pipe Materials I ASTM Standard Scale: 1" = 60'
BM Description Top of 1 j- PVC Pipe Tables 384.30-3 & 384.30-5 0 60 g0 120
SM2 Symbol: Q SM Elevation: 95.57 i 4' SCN 40 FVC ASTM D2865
RM Description: Top of door sill 4'',4934 PVC ASTId D3034 -
Slope Gradient of Tested Area: i8%) _ Z' SCH 40 PVC A61 M 01785 15
Well Symbol (if applicable)
Notes: Notes
33.51 Acre Parcel
i
1345 15th St o
f Well
BM2~3 Bedroom Existing septic system to be
House abandoned as per code
t-
Driveway
Wieser WLP 1 0001650-MR
8% r Septic/ Pump Tank
~ crag
P~A
B2 60'2" SCH 40 PVC
BM1 Force Main
T1 3'x 0' EZ Flow Trench El. = 94.50'
T2 3'x 0' EZ Flow Trench EI. = 94.10'
T3 3'x 0' EZ Flow Trench El. = 93.50' ` Pole ~I Bam
Building
a 1
Well Shop
Housi
m
U)
U) f
Driveway
1341 15th Street
I
i
Property Line
- - pie 2
wo;vmowr:3~le yc~R-SZ~-JOS
OUd3S
0903 W 'MJCt N3GiVri Cl AMH S^ T~0001d-M
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Page 3
ms in hra, Or. nJ9r Zabel
or 1. 11: 1 ao,i rN0.~y.~ni.
The PL.-525 12 liter 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 I'L-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.
q. 7zV - Alam, Swihrh
Rated for 10,000 GPD (gallons per day). D (Optional)
,000P
G
525 linear feet of 1,%lii' lilts lion. (10 <v_ Accepts V PVC
Extension I I:utdlc
Accepts 4" and 6" SCHD 40 pipe.
Built in gas deflector.
Automatic shut-off ball when filter is removed. W~t
bility. Rated for
In,(XK)GPD
Alarm accessi
Accepts PVC extension handle.
52o Linea
Ideal for residential and commercial waste flows up to r FI.
of lj 16"
10,000 gallons per day (GPD). Filtration Sloe
1. Locate the outlet of the septic lank.
2. Remove the tank cover and pump tank if necessary.
Acm &fi"~--"
3. Glue the filter housing to the 4" or 6" outlet pipe. If SCI ID no pipe
the filter is not centered under the access opening use it
l'olvlok Extend & Lok or piece of pipe to center filter.
4. Insert the PI: 525 filter into its housing. - Cpr tin rJ
5. Replace and s,rure the septic tank cover. riSPIAN SI St:mdad 46
1
The PL-525 Gf iluent 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 filler contains an optional alarm,
the owner will be notified by an alarm when the filter 41 C = -i Gas Deflector
needs servicing. S-rvicing should be done by a certified
septic lank pumper or instiller. - ' Automatic
Shul-Off Nall
1. Locale the Outlet Of the septic lank.
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed. 1
4. Pull PL-525 cartridge out of the housing.
~ 1
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. PolOok, Zibel br Best filter, accept Fasity installs
the Son.,rtFdter1D twitch and alarm. into existing lanky.
7. Replace and secure septic tank rover.
Polylok. Inc. :i Fairfield Blvd. Wallingford, CT (16392 Toll Frcc: 877.765,9565 Fax: 203.284.8514 www.polylok.cOln
Page 4
PAGE 5OF6
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Vert Rpc
>139 fmn,
Bulldlrg 6eztrcul •o.uA ~'^oN'Mlh
12" bfin. o• 1.0 tawm Sp> 316 and NEC 3,ki Fx10^.d rtanheu'se' as neassan•.
Esloollshed Fbod Elevation w'xather,, mo'
(M~ ra) Jurcbor Box
Approved Approved ltxkmy h9arhoo
IMPORTANT: Vont Cap vth'JJert',•y Label Attached
pypLap
Anchor tank(s) as necessary -Cordu;
pursuant to SPS 383.43(8)(9) 4" ?Ain. er 2 0It atavo
Fstab6shed F eked FHwaton
` ' (Iyplrali
]I[~„ _ ~Aidgld Seel
F'.ntr,ed G-aoa Qu.cH DI=_cor^,arl
1a" i.1ir.
CAPACITIES @ 17000~ galrin a w
Depth (in) Volume (gai)
A 19 323 I 'Keep Apu,oved Jalrla wih
tba Apptowx: P1eke J It W10
B 2 0 34 q So:d Gmund
(IYPiwll
[C] 5 85 0 . A law
p 12 204 n
] } PUMP-OFF
I"I Pu ,p
_ 6-on ELEVATION = 91.00 it
Pump Tank Liquid Level = 38 in
cnno~to 1•
Force Main Diameter ==min INSIDE BOTTOM
Block ELEVATION = 90.00 it
A' APFrovm! f1edd rg Idnlnnu Benae!h'a•'+
Force Main Length = ~0 it
Z • Vertical Head = 4.50 it
Force Main Void Volume 9.78 gal
+ Min. Supply Head =h ~
[C] Total Dose Volume (TDV) = 85 galldose
Imo` + FM Friction 2.0 Loss = 0 it
(5X total lateral void volume `DV 3.2X desion fklw)
(force main dfainhack volume) + Fitting LOSS` = it
° (min, supply head x 0.3)
MIN: PUMP DISCHARGE RATE =~~9Pmm l = TOTAL DYNAMIC HEAD = 75 it
PUMP TANK: SEPTIC TANK(S1:
Volurne = 650 gal Total Volume = 1000 gal
Manufacturer: Wieser Concrete Manufacturer(s): Wieser Concrete
-
Pump Manufacturer: Zoeller
Install a proved oved effluent filter at the septic tank outlet _
FII ',w immediately upstream of the um tank ni tet.
Pump Model: 53 1
+cee al'ur. red "O
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Polylok
ControlslAlarm Model: 10363613 Filter Model: 525
Float switches containing mercury are prohibited_
- - Page 5
PRODUCPSPF-CIFICATIONS `'''I' _
198 mm: 4-571' 14t7•NFT
H,d'd Povre, 3~' 0 1117 rem1
V. tag,. 115 (r 730 _
1
Phasa 1 Ph - 3-7 1
C Ha 60 Hz h 98 mm!
r
1550 . Id '•I
~ RPn1 -,~y
Type S•mdad pole + j 1
Insulation class 0 t 4' 1104 rd
A-8 9.71
Amen
Ope,allo, All...vatic or nunaulolnauc
Auto On;Off Points 7-V4' !18.4 cod i 3' i7.8 cm! I
Dischmge. Size -VZ NP' j r
Solids Handling 1711 2 mml sph"w"I solids I
a (wnA Length 9' 13 m} automatic, 1b' l5 mj nonaulornatic - - - t ^ - j
~ ter: I
` Crrd Ty Vo IJI. 1,sted.3 w?.!, yrnunded Vldy
a Ma. 114:111 19.75 15.9 ml
l.fax, Plrv. Rate 43 GPN41163
m.. olo m ing Ter•1P. 130 'F 154 `C'' 1 .1
10.116'
Coning 001 1,11'A 1258mmi-- 1
M.olo, Prnlnctior. Auto 105(1 lhennel ovcrl0:nl I I ' 4
Cop Cust iron or brdr•. m. : I r ' , I ~ \ I u_ 3=Y32`
ronzy
N me o• engineered iher^1uV.1Stlc
J
Cmecna.icai W.nd, l ronze IM mni
Q vd
119
LU ls n1amic
Qc Impellor Type Non-4%oyg:ng vortd>
G1mpall., Plastid cost iron or bro:ve
Hardware Stanlvn:a creel
Motor Snah AISI 1715 cold rolled Stec
Gnsket Neoprene w PUMP PERFORMANCE CURVE
NO IF. see,'alai a..mP:nI", 4hd,t f..r sp(rlli:: de,alh:, MODEL 53
0 20
i~
i
:J
t5
Z
z 4
O
10-
2-
5-
0
10 20 30 40 50
GALLON
SP n ICI Q; .
LITERS 0 80 160
FLOW PER MINUTE
A CAUTION At i-r.l I :"Ir P"11-11 no J"' ? 10 0-o d on d b1 (z ddie' i 'ersad nl.c r c ur. All elecmcal and safety codes ahaulJ Ua J
f. owed r d'no t,rt rre:,.vent Nat on. Etrt Incas Cod. WEC: and II' ()c W nnol I ty and l+.#10 Aa idSHAI-
7) Copyright 2017 Zoeller' Co. All rights reserved.
502-7782731 1 800-9207867 1 3649 Cane Hun Road I Louisville, KY 40211-1961 zocllerpumps.com
Page6
1
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PAGE 3 OF 5
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Page 7
Installation Instructions for AEZflowW
EZ//ova.' Systems in Wisconsin by INFILTRATOR
Wisconsin Department of Commerce. Safety and Buildings 5. 1 tie Abso•ption area (SF) necessary for a given site shall
Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and
product and detem med R to be in compliance with chapters the Permeability, for the site. If certain criteria is met, the
-omm 82 through 84, Wisconsin Aomin. Code, and Chapters EISA svirg can be used in Wisconsin, resulting in a 40%
'4',) and 160, Wisconsin Statutes. All sites must meet the Site smaller dramfield.
83911 Condi ions & Locations & Isolation distances as noted iu ;
local regulations. 6. Place EZflow buncle(sj in the EZflow configuration ap-
proved by system des.gn permit specified for the, particu-
The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing ppe
center bundle in 5' or 1.0' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any
with pip in each bundle in 5' or 10' lengths. additonal aggregate only buedies that may be required,
should be butted against the other aggregate-only bun-
A single pipe bundle contairs a four inch perforated pipe ,ur- dles and de not require any type of connection.
rounded by EPS aggregate and 's held together with poly-
ehtylrne netting. A single aggregate bundle contains aggregate : 7. 1 he lop of each GEO cylinder contains a filter fabric pre-
only and is held together with polyethylene rotting. manufacturec in between the netting and aggregate The
fabric is inserted to prevent soil intrusion. The installer
Materials and Equipment Needed shall make sure the the GEO is posili.oned upward and is
• EZflow Bundle- in contact with the fabric contained in the adjacent cylin-
• EZllcw Geotextile Fame der before backfilling.
• EZflow Internal Pioe Couplers
• Pipe for Header and Inlet 8. The FZflow Drainfielc Systems should be installed in a
• Dackroe/Excavalor level trench in all directions (both across and along the
trench bottom) and should follow the contour of the ground
Installation Instructions surface elevation (uniform depth), with all continuous
The instructions for installation of EZflow products are 9:ven adjoining 10 fool cylindrical bundles placed end to end,
below. This prodact must be installed in accordance with state with central bundle distribution pipe interconnected,
rules defined in chapters Comm 82 through 84, Wscons,n Ad- without any dams, stepdowns or other water stops.
ministratne Code, and Chapters 14b and 160. Wisconsin Stat-
utes, as well as the local health department's current desigr : 9. he. t•eoch top shall be. gnadec such that water will not
manual. pond. Backfll should be seeded or sodded immediately
after completion to reduce erosion.
1. After the local heafth department has determined sizing,
configuration, and Iayoot for the E79ow systems, stake 10. EZflow EPS bundles are flexible and can f in curved
or mark wdh paint the locatron of trenches and lines. Be trenches as may be necessary to avoid trees, boulders. or
careful to set correct tank, invert pipe, header tine or dis- other obstacles.
lr'balion box and trench bottom elevations oefore instal-
la-.ton of pipe bundles. I'..EPS aggregate is lighter tr,an water, therefore, it might
be expected that natural buoyancy forces would tend to
2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when
bundles in the trench(es). Remove any plastic bags in thr_ ponding occurs. Field experience has shown, however,
trench before system is covered that this is not a problem when systems have a minimum
of 6' of soil cover as recommended by manufacturer.
3. this product must have geotextle fabric that meets to
quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extendinc 1203H-GEO
down along the sides of the product to a point at least six
inches from the bottom of product. - - - _ Genrr•,rre
-:1 Garr yr Ma-Pnai
4. When installed in a trench, the trench should be dug to
a width of 36 inches. This not only saves labor in excava- ll y
lion but also provides better load-bearing capacity after
backfilling is complete.
Page 9
PAGE 4 OF 4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity 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 perfomled by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow - 450 gpd; BODE 5 220 mgL"; TSS 5150 mgL"; FOG S 30 mgL"
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
age of system
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.)
solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution I drop boxes)
c neglect or improper use (i.e., exceeding design capacities. prohibited activities, etc.)
n extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re-cycling. float switch settings, eta)
o electrical components - if applicable (i.e., wiring. connections, switches, controls, timers. alarms, etc.)
n 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.
Slats when the volume of solids in the tank(s) exceeds one-third (113) 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.
System maintenance reports shall be submitted to the proper local govemment unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
John Schmitt Phone: 715-760-0486
Name of individual or company
Local government unit: St. Croix County Community Developement Phone: 715-386-4680
Local government unit address: 1101 Carmichael Road, Hudson, WI ZIP: 54016
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. Admire 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 in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33. Wisc. Admin. Code.
Page 9
ST. CROIX COCNTY
SEPTIC TANK MAINTENANCE AGRELAIENT
AND
ONVNLRSHIP CERTIFICATION FORM
Owner-'Buyer Margaret or Edward Gilstrom
,%4ailint; Addres 1345 15th Street, Houlton, WI 5408
- - - -
Property Al dress 15th Street-
(Verification required from Planning & Zoning Department for new conslroction.)
Cit Houlton' WI Parcel Identification Number 030-2044-95-010-
LEGAL
LEGAL DESCRIPTION
Property Location NW ;v, SE . Sec. 26 '1 30 N R 20 W, Town of St. Joseph
- - _ - n-'n-- .
Lot .r 'v~
Subdivision Ylat:_ - -
Certified Survey Map # Volume Page A'
Warranty Deed - (before 2007)Volume Page _
Spec house 11yes[3io Lot lines identifiable Elyes[3no
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 die 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 sperilied in sSPS, 393.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to SL Croix County Planning & Zoning Department it certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber of it licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition andior (2) alter inspection and pumping (if necessary), the septic tank is
less than 13 full of sludge.
Ir'%ve, 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 Depainnent 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 fi. Zoning Department within N days of the three year expiration date.
Uwe certify that all ,mtcineuts on its form are true to the best of my.. our knowledge. I;we mNare the owner(s) of the
property described above, by virtue of a r arramy decd recorded in Register of Deeds Office.
Number of bedrooms 3 - _
DATE
SIGNATURE OF APPLICANT(S)
***Anv information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application it recorded warranty deed front the Register of Deeds Office and it copy of the certified survey inap if
reference is made in the warranty deed.
(REV. 04112)
Page 10
X3
D@partment of #1942
!s Safety art,-. 19 2018SOIt~ EVALUATION REPORT
~ I in accordance with Comm 85. Wis. Adm. Code page 1 of 4
_ Profe4ional Servi ea p +r Schrndl Sod 1 estinu. r:.
Attach complete site Ian on root fe5y^~` ier1F has in size. Plan must County
P p@Pe SL Croix
include but not limited twveAicaMnd'hionzontal reference polnWCWU,daWtM and - -
percent slope, scale or dimensions, north arrow, and location andy9lance to feare7s road. Parcel D.
.,/j7~ .Jp`Z I 911 _Part of. 0-2 -95-010
Please print all information. Revi By Date p
peasant ~nionnanon you prowde may w usw for secondary Purposes IPOVacy Law. s 15.04 (1) (m)) Z p S
Property Owner Property Location O
Gillstrorn, Margaret Govt. Lot NW7/4 E1! , S26, T30N, R20W
Property Owner's Mailing Address Lot # Block Subd. Nan or CSM#
1345 15th Street NA 33. S"/ A e Parcel
City Slate Lp Code Phone Number City Village Town Nearest Road
Houlton WI 54082 715-549-6467 SLJoseph 15Th Street
New Construction Use. Residential I Number of bedrooms 3 _ Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe- - Za+W-
Parent material _Outwash -(Chetek-Onamia Series.) - Flood plain elevation, if applicable NA - ft.
General comments Area is suitable for a conventional drainfield with a lilt pump. Rating is 0.5 gpolsgft. System elevation is i3 step trenches) High
and recommendations. 94.5': Middle 94.1'. Law 93.5'. Slope of area is 8%.
❑ Boring # Boring -
pd Ground surface elev _ 97,20 - fl. Depth to limiting factor 93+ in. Soil Application Rate;
Horizon Depth Dominant Color Redox Description Texture Structure, Consistence Boundary Roots GPDMJ _
in. Munsen Qu. Sz. Cont. Color Gr Sz Sh. •En#1 •Etf#z
1 0-7 10yr3/3 none sl 2mgr rI as 2vf 0.6 1.0
2 7-18 7.5yr4/6 none grsl 2msbk I mfr gw lm,lvf 0.6 1.0
3 18-32 7.5yr5/6 none cos Osq ml gw 0.7 1.6
4 32-89 30yr6/4 none s Osq not - 0.7 1.6
t
r I I ~II
7 41
b
W. i
Boring
2 Boring #
' pit Ground surface elev. 98.0 fl. Depth to limiting factor 96+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD:TP
in. Munsell Qu Sz. Conl Color Gr. Sz. Sh. 'Unit 'Ed#2
1 0-9 10yr3/3 none sr' 2mgr mvfr as 2f,1vf 0.6 1.0
2 9-18 10yr4/4 none sl 2msbk mfr gw Lf,lvf Ili 0.6 1.0
3 18-30 10yr4/6 none sl 2msbk mfr gw if 0.6 1.0
4 130-36 10yr5/6 i none sl lmsbk mfr i gw 0.4 0.7
5 36-58 10yr6/4 none s 05g 1r ml cs 0.7 1.6
6 58-96 10yr6/4 none Osg m`, 0.5 1.0
Effluent #1 = BODS> 30 < 220 mgrL and TSS >3 150 mgrL ' Effluent # = BOD, 30 mgrL and TSS 1L30 mgrL
CST Name (Please Print) Signature: j - CST Number
Thomas J. Schmitt 227429
Address Schmitt Sol testing, tic. Dale Evaluation Conducted Telephone Number
1595 72nd St. New Richmond. WI 54017 7/27/2018 715-760-1978
SNUSSW [a Ul0.q.
Property Owner Gillstronl,Margaret ParcelID# Part of: 030-2044-95-010 Page 2 of 4
boring
3 Boring # - Pit Ground surface elev. 96.30 ft. Depth to limiting factor 96+ In.
Soil Application Ra[eHorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDf#°
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'EH#1 •E11142
1 0-7 1Dyr3/3 none sl 2mgr mvfr as 2vf,2f 0.6 1.0
2 7-16 10yr4/4 none sl 2msbk mfr qv+ 2m,2f 0.6 1.0
3 16-26 10yr4/6 none girls Icsbk mvfr cs if 0.7 1.6
4 26-42 10yr5/6 none cos Osg ml cs 0.7 1.6
5 42-96 10yr-6/4 none s Osg I ml 0.7 1.6
I
Boring
F-1 Boring # pit Ground surface elev. Depth to limiting factor in. i
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure !Consistence Boundary Roots GPD#t'
in. ' Munsell 'Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ftt#1 •Eff#2
I
Boring
Boring # Pit Ground surface elev. - H. Depth to limiting factor In
- Sod Apphcabon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence, Boundary Roots GPDil t'
in. Mansell Qu. Sz Cont. Color I Gr. Sz. Sh. 'EMI •E##2
i
! I
' Effluent #1 = BOD > 30 < 220 mg.;L and TSS >30 < 150 mg. L ' Effluent #2 = SOD, < 30 mglL and TSS 30 mgil_
fhe Deparlmant ol'Conunerce i, an equal oppor unity sere ice provider atld employer- If you need assistance to access sere i,es or
need 111ulaY.d in all allcl'llnte Nil Iu<U, plca'e ennhrcl the dep:ulmm,l al hll%.?6h-:I51 w ll ti PII%-2h4-%"?-
~il'.;-v
Pape 3 o' 4
"nducted hv: Conducted for
Schmitt & Sons Excavating, Inc.- Name: Maruaret Cillsn»m
Thomas J. Schmitt CST 227429 Address: 1345 15th Suer
586 Valley View Trail City. State, Zip: Iloulton, WI 54082
Somerset, W 154025
Phone: 715_-760-1978 Subdivision NA 33.51 Acre Parcel
r-:,,
.ri~rd'UIP " Lot NO. : NA
Date Legal Description NW 114 SE 1.14 S26 -1'30N WOW
8 Backhoe Pit Township, County. St..loseph'1'ownship, St. Croix County
A Bench Mark 1 El. 100.00' Top of 1 112" PVC pipe
n Bench Mark 2 El. 95.57" Top of door sill on west facing house door
Slope= 8`70
Scale 1"= 40'
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