HomeMy WebLinkAbout004-1047-20-000
w scors n Deoairneot c'Cc--etce PRIVATE SEWAGE SYSTEM Cc,,nr; St. Croix
Safety 3n9 Djile nu U rsior
INSPECTION REPORT San tar; l No
606926
GENERAL INFORMATION (ATTACH TO PERMIT)
state Plan If, N.r.
~e-50na in`Grmaf on y_ nrOV dP. may t, used (af SP.fOrf.art.p.apd°e' IPr oG,.y :3w, 5 tb 9. b;m;; 3163005
Pefm t -;oldrf's Ii. City V~ la5c oxml.ip Farc¢I Tax NJ
Tl Nolvold TOWN OF CADY 004-1047-20-000
CS-3M Rev' I 1,5o Rfd Flpv fir"I Jes';'F;nCr uevtO ✓sn: "l-ne T'I'P NZ
/i YM, t W 20.28.15.321 B
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION HS HI FS II-V
Septl;; BerclTrark
Dosing 766 Alt HP,1 pQ ~G-5
Aw~ re., ; n Htdg Se'ne' IU' 9f ! He He'ding SVHI In et
TANK SETBACK INFORMATION St HI Cutlet
/.3 •S
TANK TO ~ 1" :N., LL RI DG Vert to AF I-Oke ROAD Ut n et 3 L o ,
Seprc / y l 15U I i - _ D! Hol,o'r 4• J 840.7
Dosrg /t{/ 15(0 ZO-2, 2-6 -7 Header;o.9an S, (o5 QZ.95
Aeralicr D'st. P Fite 13
O •7 `'I Z -
Hcldng - Bot System pI 3 q.•,~L
' 75
PUMPfSIPHON INFORMATION F ral Gadc I 7'65 r3.
Manufaaafer Demand St Coe' /
7ad(m GPM ('o le 93 °
Irtodel N,rrbe, 8 I~f 1 , ).5 Z ~~r /0.
o,n, o.~ 3 91 • ~
I DH 1 if, Ff.c1.1o'1 Los, Systcm Hoad TDH
a ' ~ 3 ' ~i
Fctcernaln Length Dla f Di,- to b';ell / L
SOIL ABSORPTION SYSTEM J
BED!TRFNCII Niiotr _ en~tr %0`p s PIT DIMENSIONS No D• PCs Insico Dro Lialrv: Depth.
DIMENSIONS '75 ~
SETBACK SYSTl TO lJ I III WELL LAKE:STRI LEACHING ta1;t"u,'J 5'!.'er
INFORMATION CHAMBER OR
E J ~ ~ / / L r,tc7e N..n,eer
~
lyV Iwo Ill 1 ;W UNIT
Ill
DISTRIBUTION SYSTEM Ill
IfeadCO."'do': Ulstnaptm'i xHOeSi:' IF kHnte Span ng b' IOAr ake
s F pcisr /yT / 7 . g./ IM_
Lergfr Dla • Lcngl'i r l: e__ Sp,'.:.ng J ~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a-
Dcot- OVCI 1ep'h C^:er rx De. otn n' xr sp¢deG Sac Berl rx H-IChed
HeI Tfennh Cer:e' Ew.;Tr-.uc Ed,cs Icpsinl Ves Ve Yps No
COMMENTS: :lnciuoe code discrepenc.es , persons mesent, eet►c~-vil,.y`11spection#I Inspection d2
Location: 2882 20TH AVE P. /1 ~IA~ f nI / L'i u
Alt BM Descnpbon = uwy1' SQ~c P I d w d f`
2 l Hldg sewer length = /70 O '1. 1 , (1 afa
amount nt of cceer = c
, Q (Jdl~(
Plan revision Recuned? Yes X
No
Use othe• side for addilt-rat informalion. I 1 - L
Cate Irsepcr.". Sig-a:vc Ce7 No
SRC h'17 iR,<?'.
S S6N-doi8 -339
-I CountN
Safety an¢Buil ings Division St. Croix
0 201 W. Was gton Ave.. P 0. Box 7162 Samtan Permit Nu:nt c no he filled in by Co
' t SP h• dison. WI 53707-7162
_ Sl:nc Tmmacimn Number
Sanitary Permit Application VKm K 3163005
In accordance w8h SPS 383.2112; \k I, Adm Me subn., >i,n 111, , futm w the appiornate g.. emmen:al unit _
o,reyumld prim to obtaimne a>1 oix% ut NoIC.:lpphtahcn !bnn> for st~tc-<nsned PMT rue submNai to Project 4W:a> nt ntTvent th;:n marlins address)
the Ilcpnrman of Salciv anJ 1'rolev.u:.ai Scn ics Pcmonll inlbrautovr sou pro,ide nmy be used for srcor•.Jan
u: o>r> in accordance wrlh me Vrt%acv I av, s 1 ~ O140 It m), Snits.
1. Application Inform - Please Print All Information - 2882 20th Ave.
Pro'neny Owner's N.m:e / _ Parcel e
Trygve Nor M. ! 004-1047-20-000
Property f)wnei Mri i•ic :ldJnss N:uperly L,raaon z a
27744 Denmark Ave.
_ _ _ 6oef lit _
( n\ State Ap ( ,dc P .-one Nmolx' SW SE _ ' i Sectwn 21)
3-301-1764 rime oneL
Northfield, MN 55057 V"
T 28 N. R 15 E or W
11. Type of Building (check all That apple) - - - - - - - - - -
Inr2lannl}Uwdl:nv- Nun+twr of ltedrocrt Suhsi>ion None
r-I 3
Block ,Y Ad 6
Publiu'Commercial - Uc,cnlx 1. se
._1 cIIN of
CSM Num ber U N'illuge of
i $ts[c Ow:ad - Iksibr U>r f \
Xim,nn( Cady
6 X Ab Ali
Ill. Type of Permit: (Check only one U^ n line :1. C'ompletc line B if applicable)
L Nc.y System Replacement System "freatmenOR)Idinc ',sink Replacement ink ❑ (A her Modification to Existing System (explat nl
R. ❑ Permit Renc.ral L Permit RCillmn 7 (CI Inge of PlumFrt ❑ Permit I ransfer to New Lt,l Pte, ious Permit Number and flare Issued
Urtorc I!spiranon (hvncr
I IV. FN De of P0N'TS Svxtcm/C'.om onent/Device: heck all t . 1j2 - _ r
Nun-Pressunmd In-Ground ] Prea.u vcJ In Ctound LI At.( -adc XNloumd>24 sit ofsunahlcso:l lound-=24 in orwitabic sod
Holding turd: L (kbcr Unix ic,l ('omlvmcnt ie,pbonl _ _ _ circa me vice (cxplaln) _
V. Dispersal/ Ir ment Area Information:
lkmgn F:.... tg I Dc,:gn Sod Al•phcaGon Raoe Jsl) Uispmul Area Keyuired Is1, Usircrsal :Nrea Prnpnud S}'smm IJrvubon/
450 6 1SC7 ~u~~i.`lo 92.3ft
I. Tank Info Capaalp in oral 40+ Mmwfudwcr
Gallons Callon, thins t o g
Sew Tmii:s _....tsist... lank, c = 2
V D ~C~GO ~ L v u+ r LL :i _
c: p[c ar Ho!aatg Twil:
X 11.5(7 i .a0 _ X
Dosink C?ianser
V IL Responsibility Statement- 1, the uodereianc sxumc re. MINlih for in alintion of the PO%\TS,huwn on the attached plans.
]'lumber', Name tPrint) PI iSSi • NIP MPKS Nundxr Biuincss Phone Nambcr
Lewis Bjork 253976 715-231-7375
P:umbcr's Address tSnecl ( m. Node. Yip CodeI
E7818 County Road E. Menomonie. WI. 54751
11 ounh!Dc artment I se Only
-
P, no lcc M Line Issued / Issum _cnt Sipnu re
\pr a: I Ur:y' n Rasnn fix De ml
• I.K. Condi4Y&TJPAA1111fKfAteasons for Disapproval
1. Seep , lark, e Yil(n: Air'. n Il
Oplk'f:':v Cell C.' dll De_ Jr y_ ll;-e( 44*6 L 1 f 1
.is per marayemen! pl,n ^ o met W Nlumhe- a r`Z-~ ~r
2. AN t1i #t k rKu" -ens must w 17 r, rt, it f i
wpernppiicnWitw iI:rtfnnrtt. pp~
Mach to complete prone her the spmm and mbmto the On.h only ppr~ 7I4ss0nm a i l l inahe,in star
r GJ7//`f /
SBD-6398 (R. I I~ I I I
~UK NUk :E A+FlX;Ab.t. 9RLOT a AS Ar-LICA&L
SOIL EVALUATION Scale dimension OSYSTEM PAGE 2 OF 6
SITE MAP Treatment dispersal cell PLAN
PROJECT NAME:
I OE513N F! OW. 450 GPU
t ve Norvolo theme scale 1"
rr~~~] &51A rys = 30' Attach oesvgr Sow calwletions for commercial plans.
PROJEC' ADDRESS. 2882 20th ave Spnng Valley PIPe Material : ASTM Standaro l-able_c 384.3.1-3 8 384X3 S>
N L Ir 4- sch 40PVC
/
8M mCd. + Bld Elevaanr.. _ 100 r SenMy Sewer.
sY - N 1
Fo Ma- 2" sch 40 PVC
8N Oeec4{rtun: eteValiOn lop Of Wafer well ca_
Slone Grd.9lent;%I IrjL:.-. nc.mry
IX T591e64ne. B well "wW(M aF4eeuk; IMPORTANT:
O ar°N11o^^On~"' Show grounC elemoor contours at sul•.alaa intervals.
oc :ne upv^.Ne LLe.
~ U
' S~ k IIS ' ~ e. as OSPS _ --T 43n~L T~,~r
L~ ~~7 4 r~ ~~pl`t 5 r S ~ G
D 1
j, to
5d` k~3:
Ig rne~.
r 11S
F' Im SEFfr~ I ZZS,~~ r
G :~rrr-14 wets Ora/ pNV I Awn; . ~ r`
Zn1$r1 r i y *fr-
ton a ry/:~t
r~
0 3"3n_ 48" 131atJ ~pN ti LA .
_ -
6-1 A4vt, W 'L
e
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I l'" ZS-3976
1 1
'41"t: 7.
vl - - 2C
`lr~a i?!rYr;~ DIVISION OF INDUSTRY SERVICES
10541 N RANCH RD
D HAYWARD WI 54843-6462
S Contact rl:rOLC Relay
:i
1 P S fttpi~csps',v. yov~proyramsrlneusiry-services
vvrv •,v sconsin.yov
Scott Walker, Governor
Laura Gutierrez, Secretary
October 02, 201 S
COST ID No. 25 39;•6 .4 17 A. POff I'S Inspector
LEWIS C WORK ZONING OFFICE
LFWIS WORK LLC ST C ROIX C'OCNTY SPIA
8-818 CTY RD L I 101 CAKMICI[ALL KU
NILNOMONIL \k1 51751-663' HUDSON WI 54016--7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: IW02r2020 Identification Numbers
'T'ransaction ID No. 3163005
SITE: Site IU No. 551119
17vwr Norvold Please refer to butt identification numbers,
2883 201'I I Ave above. in all correspondence with the agency.
Town of ('adv
SI Croix Counh
S\4'1:4, Ski 4, S.'0, I)8N. K15
FOR:
Obiect'I'Nile: POW IS Component Manual Regulalcd Object ID No.: 1798548
Maintenance required; Replacement system; 450 GPI) I low rate; System(s): Mound Component Manual - Ver. 2.0,
SBD -10691-14 (N.01!01. R. 10!12), Pressure Distribution ('ontponent Manual - Ver. 2.0, SBD-10'06-13 (N.01 01, R.
10 2): Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. I he submittal has been CONDIIIONALLY APPKOVLD. 'this system is to be constructed
and located in accordance with the enclosed approved plans and with arty component manual(s) referenced above.
I lie owner, as delined in chapter 101.01( I0), Wisconsin Statutes, is responsible for compliance with all code
requirements.
A copy of the approved plans, specifications and this letter shall be on-situ 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
Co, ND
consnvcti("n~ instal latter!operation.
In cramine this approval the Division of Industry Services reserves the right to require changes or add itim slttµld F SAFELY AN
conditions arise slaking them necessary fix code compliance. As per state stats 101.12(2). nothing in this Of U
shall relieve the dcsiuncr of the responsibilitq for designing a safe building, structure, or component. DIVISION OF I
` r
Inquiries concerning this cot'respondence max be made to me at the telephone number listed below, of at the address
on this letterhead.
I he above left addressee shall provide a copy of this letter and the POWTS management plan to the ~wner and aI C
others who are responsible Tor the installation, operation or maintenance ofthe POWTS. t
Since reh, Fee Required S 250.)0 EE C
Is,
This Amount 1k ill Be invoiced.
When You Keccivc That Invoice,
kVwrtl-A Taylor Please Include a Cop} With Your
Wasteva-atcr Specialist , Division of Industry Services Payment Submittal.
(715)6;1-3481 , Mon-Iti, 8:00 a.m. - 4:30 p.m. WiSMAR'l code: %633
cdwin.tayl onit.wi.gov
PAGE 1 OF 6
Mound Plan
Index & Cover Sheet 2 o zo~8
Component Manual Design References: SL
Version 2.0, SBD-10691-P (N.01101, R. 10/12) & Version 2.0, SBD-10706-P (N.01/0~,,,R. 10A129~_
nl(111~
Pg 1 of 6 Index & Cover Page
Pg 2 of 6 Plot Plan
Pg 3 of 6 Mound Cross-Section & Plan View
Pg 4 of 6 Distribution Network Specifications
Pg 5 of 6 Pump Tank Specifications
Pg 6 of 6 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Tank Alert / Tuf-Tice Riser cut sheet Soil Evaluation Report & Site Map
Tank approval / Biotube cut sheet
Effluent Maintenance instructions
Project Name / Description
(65-2018) Trygve Norvold
Owner Name(s): Trygve Norvold _ Phone: 763 _301 _1764
Owner Address: 2882 20th ave Spring Valley WI Zip:
Project Address: same
Govt. Lot: SW 1/4 of SE 1/4, Section 20 T 28 N-R 15 -_E ❑ or W❑✓
Township: Cady County: St. Croix
Project Parcel ID 004-1047-20-000
Designer Information ALLY
Designer Name: Lewis Bjork Phone: 71~5. "231Sr_WMS
Designer Address: E7818 County E , Menomonie WI Zip: ~ 4tf-
E-mail: lewisbjork@yahoo.com
License Number: 253976
Remarks: _':)r'JNDENCE
i'
Signature: --J Date: 9-11-2018
Onginal signature required on each submitted copy.
W r 1 { .J+ Loot uv
i,HECX BOX AS APPLCA&F Ec
SOIL EVALUATION X AS APgTEM ICABIE.
Scale dimension O PAGE 2 OF 6
- SYS
SITE MAP - - LOT PLAN
PROJECT NAME: Treatment dispersal cell
theme scale 1" DESIGNFtow aso GPD
T ve Norvow = 30'
ry9 Attach Oesagn flow celwtetions for commercial plans.
PROJECT ADDRESS. 2882 20th ave Spring Valley E Pipe Materiel i ASTM Standard (Tablas 384.30.3 6 384.305)
- N E Sannary Sewer. 4" 1 sch 40PVC
BM symbol. end ElevMbn. 100 FT 2" sch 40 PVC
BM Dexnplfai, elevation top of wafer well cap rww Men
Slope Gradient (°F) Well mDa applicable): dmwkvronn ey IMPORTANT:
of Tested Ares: 8 (11 O nwbp w~' Show ground elevation cnniours at suitable Intervals.
an vie •oproonle
350 ~rty`S Lr
1,3
703 -3c)l i j -
, ~ Gam g~.3
v ryS, s,G l~x~ ~r e J NY-
3y TRll~~nss (a
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2/
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SC t k I z S ' i ~ 3. as asps - -T (3 nrJt- s
71
'x 30
,f3Fd pp
G ~ X
T
Sr i` = 30
IgI~ M1` qe~
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r Cps ~225.4~
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2-0f" AFL, SttEVis(~ 7-26 2013
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PAGE 5 OF 6
SEPTIC / PUMP TANK SPECIFICATIONS
4"0 Vent Pipe. (No Scale)
>1o n r•°•
Build..q ElocMtal must comply otln
12" Min e• 2.0 it above SPS 318 and NEC 3(b
Fslaolls^ed Flood Elevation WvaltvrnxnM Extend nai&ole user as. necessary,
f!yartl} Ju'xNun Be.
Approved Approved Locking Manhoie
IMPORTANT: Von[ Cap aUh Warning Label AltaOred
(ypiwl)
Anchor tank(s) as necessary .--a,.-nua q^ Flo. a 2Aft acme
pursuant to SPS 383.43(8)(9) Estebllst-od Flood ❑evnoon
(ypiwl}
Airtghl SCUT
Finisned Grade
Ouic+Dswmrnn
a. 18, 0,11n.
CAPACITIES @ 18.85 galfin r uv"I`Ap
Depth (in) Volume (gal)
A 19.41 365.84
Weep ~ADprovotl Jarts •Mlh
Hole Appr -ed Pipo 311 onto
B 2.0 37.10 A Solid G,ound S
[C] 3.73 70.26 ~3
-Alarm
D 12 226.20 B _ to-or
I t~l PUMP-OFF
*Pump Tank Liquid Level = 37.14 in -ur ELEVATION = 83.8 ft
INSIDE BOTTOM
Force Main Diameter = 2 in rn lock
I B* ELEVATION = 82.8 ft
Force Main Length = 45 ft 3' Appv od Bonding Malone' Bo•xealn lava
___JVerticaI Head = 9 ft
Force Main Void Volume = 734 gal
+ Min. Supply Head = 2.5 It
[C] Total Dose Volume TDV = 70.26 gal/dose
+ FM Friction Loss = 62 ft
L (SX total lateral void volume 1 DV < 0.2X design flrnv)
+ (force, main drainback volume) + Fitting Loss" = 1.2 ft
`(n•%n. supply head x 0.3)
MIN. PUMP DISCHARGE RATE = 24.9 gpm = TOTAL DYNAMIC HEAD = 12.87 ft
PUMP TANK: SEPTIC TANK(S):
Volume = 700 gal Total Volume = 1150 gal
Manufacturer: Lewis Bork LLC Manufacturer(s): Lewis Bjork LLC
Pump Manufacturer: Zoehler
Install approved effluent filter at the septic tank outlet
Pump Model: 152 immediately upstream of the pump tank inlet.
Controls/Alarm Manufacturer: SJERombus Filter Manufacturer: Orenco -Bio-tube
Controls/Alarm Model: AB
Filter Model: FT-0822-14B
Float switches containing mercury are prohibited.
r
PAGE 6 OF 6
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; BODE 5 220 mgL"; TSS 150 mgL-'; FOG 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
age of system
nuisance factors (re odors, user complaints. etc.)
mechanical malfunction (i.e. pumps, valves, switches, floats. etc.)
material fatigue (i e , leaks. breaks. corrosion, etc.)
solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution ! drop boxes)
neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
c extent of ponding in distribution cell prior to dosing
dosing irregularities (i.e., pump re-cycling, float switch settings, etc-)
C electrical components (i.e.. wiring, connections, switches, controls, timers, alarms, etc.)
f; 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 (1t3) 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.
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 & Family Septic Service Phone: 715-231-7375
Local government unit: St. Croix County Zoning Phone: 715-386-4680
Local government unit address: 1101 Carmicheal Rd , Hudson , WI ZIP 54016-7708
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.
..?>Spi\elei-SC Mlp, `\vcw✓ocllerpumps.cootcon tent Iit enanu-QCrrvesSE D.151 I5...
SF.D.Ij I li3_ I>3.ewzl,ipe JPL(j Image 1>91
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u- PUMP PERFORMANCE CURVE
~
MODEL 151/152/153
50
14 45 153
12 40-
35
= 10 r52
30
8 25 J
0 6 20-
15
4
10
2
5--
0
10 20 30 40 50 60 70 80 90 100
GALLONS
LITERS 0 40 80 120 160 200 240 280 320 360
FLOW PER MINUTE
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-,~jnk AI a t AB
`'moor N arm System ;r,.::u vese` Ba :ery ~ac,Function
The Tank Alert AB indoor alarm system monitors
_
ievel conditions in lift pump chambers sump pump bas
holding tanks sewage agricultural. c1ters and other v:a
applications
ct
;c..:'r, ~1E'dln~All9
"he sleek design of the alam' features a use, friendly
pad with colored LED indicators for easy v sual dei:.
tion. The a!arm horn and red LED indicator activate f, a
high water alarm condition. once the condition. is c!ea
t`;e alarm automatica!'y resets, The green LED lrdica:_
' 20V primary power t0 the ala'rr !-primary power fails
a arm continues to vrerk cue to ,,at,ery oackup,
i
Features
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r!
tcir~atr a'a,n-reset ,
oattery back:,
Lc~ i u i:a`c:: c U1
d alarm LIVED
2•ec
;teen power C;-.
Installation Diagram
, arrn test svitcr.
orn si ence sv:!:c
F_xtemal terminal i~IOCk fc easy .09::nsta
^ciudes 15 SJE SignalU..aster control svvl'ch * , st
~.iternative ioat models for h.gh and ic:v .eve! a!arr
Op°ionall auxiliary co-facts !or- :emote devices
--Model Description
LLL(2gLL?L!
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S!crfi01' L, c; }-^or r ~d8 342-5753 Phone 218-847-1317
Tuf-Tite Riser Svstem
_ F,ser Lids - RourCea or Flat 1jrh Yolded-ir, gasket
t e r 120" and 24' diameters. Green
Concrete Lid - mth handle Use the Safe„ Par to
'as' :ojr a',ir zorcrete hos.
JCl~I
Safety Lid - Pala!e ised m place of concrete lid
F 2C" b 2»' Peer Fars Greer only
safety Pan Safety Pan T'1 a~ ailao:.e for '6", 20
=4" P:serS Green ort,+
Tall Riser - For septic tanks. Stackable in 6"
~ -rner:s krai!aole In 12°, 16' 20' and 24^
-ers. Greer or
~ -;k, ~ Tall Riser - r:or septic tank;- `tackable it 12"
.,:,•,,t
,.~:-:~•p~~ i -mers kvailaole mi tb' 2 X and 24"
eters Green cr''r
k Adapter Ring - Fcr mcirtmg riser or lid -o
DIVISION OF INDUSTRY SERVICES
PO BOX 7302
MADISON LNI 53707-7302
S Contact Through Relay
P htlp:ifdsps.W.govfprograrnsrindustiy-services
wvAv wisconsin.gov
Scott Walker, Governor
L aura Cul,&rcz, Secretary
May 19, 2017 Identification Numbers
Transaction ID No 2944957
Site I D No.
Please refer to both identification numbers,
above in ail oorrespondence vvi th the agency. -
CUST ID No. 253976
LEWISC BJORK
LEWISBJORK LLC
E7818 COUNTY ROAD E
MENOMONIE WI 54751-6637
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES 05/31/2022
Re: Description- SEWAGE TANKS, CONCRETE
Manufacturer- LEWIS BJORK, LLC
Product Name: (tyrans id 2944957) SEPTIC, PUMP OR HOLDING (TANK AND ADAPTOR)
Model Number(s): LB700, LB1150 (700 AND 1150 gals.)
[LB700 BASE TANK: L61150 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 361N, 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):
E] This tank must be designed to withstand the pressures to which it will be subjected.
LJ 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.
I
❑ 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 IF O.G of less than 30 mg/L.
iIlSpenJQC." S ` 0r%efflue+1. hmpirg rf
c They have tl 1- area of a full-vice fll i In r. Srndu
- nr.)rt 5eptir ri di-4ulw 4 I lkrlas Nast lat r ftlupnt
at ed an the ::I 40 a Ty-* 3034 u,:_t uIPP 0- a
7, tank f hzV Alth a nttPr cal tf"c C huugng.
'X,LePVCItal upttagatoverflowp..1.- ;,°valtalna
--rxb trtvent e!fluEml ffr-n- f~:. i5N1Q !N.
_I-nlrn; r0fiv -i:c• tl'+'1nWlFfi'
~tmvidl c!
:q nm:)Ilals i.. -N, Sta-dol(I
--liv nj or 1175- l h;-~-nv1)filtix nv~h~.; ::g7c
voot constn
.v plate .di.-GP
-lw,r:- :.nc+to,N6Zlava:Mann ic, Sheet >
rrh i cal Data Sheet >
I
I
I
Maintenance Instructions .T.
-aoo•a~e•aera
4" Biotube' Effluent Filter
How to Clean Your Effluent Filter
To ensure your effluent filter is functioning properly, it should be inspected every year. Under normal conditions, your
effluent filter will function for several years before cleaning is necessary. The filter should be cleaned when it becomes
clogged enough to restrict normal flows out of the septic tank. At a minimum, the filter should be cleaned whenever the tank
is pumped.
Most people prefer to have a septic tank service provider take care of filter maintenance and cleaning. You can find a
septic tank service provider in the Yellow Pages, under 'Septic Tanks & Systems.' Or you can contact your county health
department for a list.
If you wish to inspect and/or clean your effluent filter yourself, be sure to dress properly. Wear full-length pants and shirt,
shoes, gloves, and goggles or glasses. Then follow these instructions:
1. Remove the access lid to your septic tank byunscrew-~y
14,
ing the stainless steel lid bolts with hex head wrench
provided If your ltd is above ground, it will be easy to
find. If it is buried below ground, find the marker U,at t~..
indicates its location.
2. Remove the filter cartridge by grasping the tee handle 6 1,17
and lifting it out of its housing (see photo 11. t t
3. Spray the cartridge tubes with a hose to remove any '
material sticking to them (see photo 2). Ensure the three
orifices in the optional flow modulation plate inside the pr • n
filter are clear of any debris. Make sure the rinse water
Photo 1. Ro L _I. _ b+ug! ~ lrmg it out of us
runs back into the tank, but do not allow solids material housing,
to fall into the open finer housing.
4. Firmly place the cartridge back into the housing.
5. Some effluent filters come with an alarm that activates
when the filter needs cleaning. If you have an alarm,
check to make sure it is working by lifting the float
with a stick. An audible horn should sound. The alarm
G
panel is normally mounted on the side of the house or
in the garage. ;I `fix Y "
r i ti JJJ~r r~~' ,
Note: If your effluent filter doesn't have an alarm system 4 fF '
and you would like one, call your local septic system'
installer. ;::.r'A.•;v,i.,
Photo Z Spray the cartridge foDas with a hose.
6. Record die date that you inspected and/or cleaned
your filter on the form that follows. If you checked the
alarm or made any other observations about the tank
or system, include that information under "Notes.'
7. Attach access lid by placing it on the riser, matching
the openings in the lid with the bolt catches. Insert lid
bolts into catches and tighten with hex head wrench NIN-StIFF-1
provided. Rev. a 7r04
Pepe 3 of 4
Inspection/Maintenance Form
Date installed: Model tank: Size:
Model of filter.__ Single/double compartment:
Date Cleaned?
inspected yes no Notes:
Important Names and Numbers
System service provider: Phone:
System installer: Phone:
Septic tank oumper: Phone:
Electrician: Phone:
Designer: Phone:
M71-FUM
Rev. 21, 7,.01
Pegs 4 614
- J
ST. CROIX COUNTY
SEI''fIC 1ANK MAINTENANCE AGREEMENT
%ND
OWNERSHIP CERTIFICATION FORM
Owner/Buver Trygve Norvold
Mailing Address 27744 Denmark Ave.
Property Address 2882 20th Ave.
(Verification required front Planning & Zoning Department fur new cunsnvclion.)
City/state Spring Valley, WI Parcel Identification Number 004-1047-30-000
LEGAL DESCRIPTION
Property Location SW ;.r. SE n14. Set.. 20 -1'28 N R15 W. Town of Wady
Subdivision Plat: Lot K
Certified Survey Map H Volume Page P
Warranty Deed # (before 2007)Volume Page
Spec house❑yesdm Lot lines idcntifiablc Gycs❑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 lank every three years or sooner, if needed. by a licensed pumper, Nhat 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 specilied in §SPS. 383.52(l) 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 0 ) the on-site
wastewater disposal system is in proper operating condition ancLor t_') after inspection and pumping (if necessary). the septic tank is
less than U3 full ol'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 Resourees,
State of Wisconsin. Certification stating that your septic system has been maintained must he completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
1. we certify that all statements on this form are true to the best of rnyiour knowledge. liw•e amarc the owner(s) of the
property described above, I e of a wranty deed recorded in Register of Deeds Office.
Number of bedroom
IGNA fURI: OF APPLICANT(S) DA E
*"Any information that is misrepresented may result in the sanilan- permit being revoked by lbe Planning & Zoning Deparlmcnt.
Include with this application a recorded warranty decd from the Register ol'Deeds Office and a copy of the certilied survey map f
reference is made in the warranty deed.
(R f: V. 04.12)
CSri ao19 _ as
' 4:~ V4PTP'R O Pa
_ S 2 7 18
Wisconsin Department of Comm♦3i~T OIL EVAMATION 9e of
Division of Safety and 8 Idings
in auxrtlancqlt Comm 85, Wis. Aden Code
County St. Croix
Attach complete site pl oppgWndf leasthan S 12 x 11 inchesm size. Plan must
include, but not limited tbrveRical and horizontal reference point (BMI, direction and Parcel 10 . 004-1047.20.000
percentsbpe, scab or dimensions. north arrow, end location and distance to nearest road.
Please print all Wormation. Rev by Date
Personal Information you ovrde mxy be aged for "eonduy purposes (Pavacy Law, s 15 04 (1) (m)I. ~d
Property Owner Property Location
11
(65-18)'Frygve Norvold Govt. Lot SR' 1/4 -E 1!4 2 T 28 N R 15 E (or) W
Property Owners Mailing Address Loth BbdcN Subd Na or CSW
2882 20th ave - - Part of 5 acre parcel
city State Zip Code hone umber ity Village a Town Nearest Road
Spring Valley WI 1 54729 1( 7)5-967.2062 1 20th ave
❑ New Construction UseQ Residential! Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or oommerual - Describe: _ X A
Parent material Loess ca over till _ Flood Plain elevation it applicable
General comments Install a 6.43" s 70' mound cell with I" astm 33 mound sand on the design contour ( 91.3') , average slope across
and recommendations: mound basil area 8%, use .8 loading after 12" mound sand .
ORiC~
Boring
P t Boring N Ground surface a ev, _ 9103 ft. Depth to limiting lector 26 in.
❑a Pit if Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots , GDnr
in. Munsell Qu. Sz Cont. Color Gr, Sz. Sh. 'EBSt 'Efft/2
IA 0.4 I0yr313 None obsorved sl 2fgr mvfr gs 2(r2m 6 1.0
2A 4-8 10 r3/2 Non•oburved sl 2fsbk mvfr es 2f.2m 6 1.0
313t 8-13 IOyr514 Noneobservcd sin 2fsbk imfr is 2f m .6 •8
4C 13-18 Syrtr6 None oln-+ed rscl 2msbk mvfr gs Iflm .4 .6
5C 18-36 5%016 Dft Us ro'' grsel 0 mvfr gs - - -
P2 Boring N ❑ Boring 91.3 31
S pit Ground surface elev. _ ft Depth to limmifing factor- in To4 Application Rata
Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD4
in. Munsell Qu. Sz, Cont. Color Gr. Sz. SR 'EfWi 'Ef1Q
IA 0-4 10yr3/3 None Otircd sl 2fgr mvfr gs 2f2m .6 1.0
2A 4-11 1 .rI2 Nwxobservcd sl 2fsbk mvdr cs 2f/2m •6 1.0
3Bt 11-27 IOyr5/4 Nom Observed sin 2msbk mvfr gs 2f/2m .6 .8
4C 27-31 5yr-li Noneobxrved grscl 2mshk mvfr gs 2m A .6
5C 31-46 5yr416 1'lfuyn6'i set 0 mvfr gs
Effluent K1 = BOO, > 30 < 220 mgyL and TSS >30 --"IL Elf m M2 - B D < 30 and TSS < 30 rg!t.
CST Name (Please Print) _ lure -A CST Number
Lewis Rork 253916
Address Date Eva anion Conducted Telephone Number
117818 County E Menomonie Wl 54751 7.26-2013 715-231-7375
'
Page ~of- 3
Property Owner_ \orv°Id Parcel ID 004-1047-20-000
P3 Boring # ❑ Poring 89.3 26
Ground surface elev. ft. Depth to Umoing factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAY
in. Munsell Du. Sz. Cont Cola( Gr. Sz. Sh. 'EftM1 'EMIQ
IA 0.5 I03,r3.''3 None Observc'd sl 21gr mvl} gc 202m .6 1.0
2A 5-9 10 r312 None Observed A 2fsbk mutt cs 2f2m 6 1,0
3Bt 9-26 IOvr5)4 None Observed sit 21sbk mvfr 8s 2f.m .6 .8
4C 26-36 5y r4!6 11nOvr62 grscl
5C 36-48 5yr4l6 fl f1Ovr62 sel - - - - '
Boring a H 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 GPDRt'
In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh, 'EfffMt 'Eff#2
Boring k Boring -
F-1 E Pit Ground surface elev. ft. Depth to limiting factor in
Sod A liaiton Rate
Boundary Roofs GPDfIF
Horizon Depth Dominant Color Redox Description Texture Structure Consistence
in. Mansell Du. Sz, Cont. Color Gr. Sz. Sh. "Effiil 'EM12
I
Effluent 01 = BOD, > 30 < 220 mg& and TSS >30 < 150 mgrL ' Effluent /2 = BOD, < 30 mryL and TSS < 30 mg&
I he Department of Commerce is an equal opportunity service provider and employer. Ifyou :iced assistance to access serviecs or
need material in an altemate formal, please contact the department at 608.266-3151 or VrY 608.264-8777.
SDD.Pa:91N 11< n: coi
r
i
CHECK BOAS API- C WL5. XLOT O% AS APRICA9.E.
Scale dimension r~°F
SOIL EVALUATION O SYSTEM
SITE MAP PLAN
PROJECT NAME: Treatment dispersal cell DESIGN FLOW 450 cpo
Q~ Y5)A Trygve Norvold theme scale 1" = 30' Attach design flow calculeions for commercial plans.
t\v PROJECT ADDRESS: 2852 20th aye Spring Valley Pipe Material %AS'M Standard (-ablos 384.30.3 8 384,345)
_ _ E Son" Sever 4" 1 sch 40PVC
\\J\\((((YY) BM Symbol. ~j BM Eleveeon. _ 100 FT Fo.w Men. 2.. f sch 40 PVC
BM D.- vjm elevation top of water well cap S
IMPORTANT:
IMkm by
Slope Gradlert (4:1 5 well Syrbalsappuable) Q dr na en arrow Show grourxf elevation contours of suitable intarvsls.
of TesbO Alea'. on 2e sppelvlb Ilm
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O y 933 \\~/ZS tcx'
Sb' x TLS , \ ao osPs 617r ftct-
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