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002-1068-40-000
Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may be used Jamie Benner PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) (Privacy Law, s 15.04 (1)(m)I ICST BM Elev IInOsIQ �� IBM Description M 2 TANK INFORMATION TYPE MANUFACTURER Rit-�S CAPACITY Septic C l�11eXr r J ii Dosing (bVAY�1 O 5 Poo 'rt r Ail d L� Jul J Holding TANK SETBACK INFORMATION /_rM.L-c L( nS TANK TO QIL WELL BLDG. Vent to Air Intake ROAD Septic , ' 2- S 7517 5 br Dosing J Aeration Holding PUMP/SIPHON INFORMATION Ms4 Deli t e, 16--6,5 Manufacturer // yy CCno(ds Deman GPM Model Number TDB 1-14 t 1 Frichon LosS o,sa System Hat, ITCH/J t Forcemam Length . Die. Z„ Dist.toWell 50� SOIL ABSORPTION SYSTEM 11 TOWN OF BALDWIN ELEVATION DATA STATION B� ID Z I 1 FS 4�EV , Benchmark 7, —( r (� p8 1 6S Alt-,! r i 7,E Bldg. Sewer SUM Inlet N" .1 p O SUHt Outlet Dt Inlet Dt Bottom Header/Man. / Dist Pipe y.z (ao.o9 Bot System 'Cl 1 , 3 S 11.30 1-71"o t)r 8.�� T17.36 St Cover, kc 8 xj iW`nl Pa Y% 0, -1 10- M 2.3 1f7).-1 � BI Sewcr 11.13 IN, Io 8? 4Z.2 T Z'4 F: 4 e N 114--, BED/TRENCH DIMENSIONS Width � / t 7� Lengt No QLX;ieneher la�(rht 1 PIT DIMENSIONS No. Of Pits In de Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO 0 f4 IP/LA.11BLDG IWELL LAKEISTREAM LEACHING CHAMBEROR UNIT Manufacturer �Zti Type Of stem. ] ,Ov �� —71 t >6-6 ` __ Model Number: q-2 DISTRIBUTION SYSTEM Header/Mandold Length Dia Distribution r Pipes)9` / 1 Length •7, • 7 Dia Spacing Hole Size 1 r ` -off p x Hole Spacing r .SS Ve'r/�/I1 to Air lntak,(�j� b�C V tC JT� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ,Pe? fl, i y+ t r Dd11RfOver— tgr, �7 V1# IDepth Over Bed/Trench Edges xx Depth of Topsoil y 1 � xx Seeded/Sodded Ves No xz Mulched K Yes [:] No t 2 COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1. Flow71K Z / 4K 4 Inspection #2: Location: 2444 HWY 12 ^'a J . rA f t �Je Lf r „„�['_ _ -1 d ,1tist-'atTC r L� rr " C 40 / Cy$ 1.) Alt BM Description = FIke- Cover Y� / Q,��.{,. '^"t>• 2.) Bldg sewer length= P/�Oa � -amount of cover=SC>= f Q 1 $r56 100r o Z f0.90 lbz, 5 Plan revision Required?[, Yes [XI No % t t ///JJJ �y�/�� Q '3 -f r 81j Use other side for additional information. Date Insepctofs Signature �L7� / L' 10 7 SBD-6710 (R 3/97) i J lAaj-i_1 r— ICC \7�/NZ �D Safety and Buildings Division ST CROIX ` IS�LS� V 201 W. Washin on Ave., P.O. Box 7162 Washington Sanitary PermitNurober (robe filled in by Co,) t l '= x' MAY 18 2021 Madison, wl 63707-7162 �;3375 51. �olz n Communll� eN it Applicatio - - -- State Transaction Number zloo927-L in accordance wr ._ t n. m e, submission of this form to the appmpriate governnmermml unit Projecl Address (if dilTermt than mailing address) is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professimd Servies. Personal information you provide may be used for secondary s� purposesin accordance with the Privacy law, s. 15. I nil, Sorts. 2444 HWY 12 WOODVILLE L Application Information- Please Print AB lnformatlon Property Owne's Name Paul # JAMIE BENNER 002-1068-40-000 Property Owner's Mailing Address Property Location 27'�'��` 11490 JULIANNE AVE N. Govt Lot SW SE :6, Section 27 City, Share Zip Code Pbone Number STILLWATER MN 155082 612-385-9131 T 29 N. R to (noclew� II. Type of Building (check all that apply) Lot # Subdivision Name Z 1 or 2 Family Dwelling - Number of Bedrooms _ Bock *1—� ❑ Public/Comm an ial - Describe Use D City Of • ❑ State Owned- Describe Use ❑ Village of )0TownerBALDWIN CSM Number lgXw'� ����� ZONE X Ill. Type of Permit: (Check only one box on line A. Complete live B if applicable) A' ❑ New System ® Replatameot System ❑ Treamtent/Hokliog Talc Replxeommt Only ❑ Otbabloddication so adamg System (arplaio) B. ❑Permit Renewal ❑ Pemdt Revision ❑ Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date toned Befor Expiration Owner IV. T e of POWTS S •stem/Com onent/Device: Check aH that a ea% Vat ❑ Non -Pressurized in -Grand ❑ Pressurized In-Gmuad ❑ At -Grade ❑ Mound > 24 in. of suitable it I Mound <24 in. of nimble soil ❑ Holding Tank ❑ Other Disperse] Compenart (ex ') ❑ Pr bnent Device (explain) V. Dies er iaVrreatment Area Information: Cbr AjqV,%d &1115 N t D -jr = Design Flow (gpd) Design Soil Application Rate(gpdst) Di cquired (sf) Dispersal yra Proposed(cl) Y Elevation 600 .8 388 75 D 388 / 13Z 3. a VI. Tank lode Capaciry in Gallons Total Galion # of Units ,p 'J Manufachuer 1#1,(G� 6-2` p 6� C.�m 11-r TITTc New Tanks Eektog Tanks It Septic or Holding Tank X 1200 1 WMESER Cm✓ti b D During Chamber X 800 1 WIESER X VD. Responsibility Statement- 1, the undersigned, assume responsiblEty, for installation of the POWTS shown an the attached plain. Plumber's Name (Print) I Plumber's imalmn , MP/MPRS Number Business Phone Number PAUL R KOEHLER �p��� 225410 715 246 2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI V 11. county/Department Use Only Approved ❑ Disagnoved rn� Permit Fa 5%7S a s Date Issued 5 l 2/ lamming Agent Signenue SYSTEM WIOE6tr Glvem Reason for Denial LKC0atitbdaFAA0pfail 4btax forDlwpproval3 s (Fiat' A6Ano�wa+t0 AS P/` (e rY 0+1� S / dispersal cell must be serviced / maintained , as per management plan provided by plum ' 1E':�.. Sfe% apPf�D✓q f /ef kr ct Cu+dt�IavtS I!n 2 All setback requirements must be maintaine e917+ i , f / [ as per applicable codeiordlnances. Attach m con kte lam for the tam }j°°d submit to the County oniv on piper nw Ins tbau d to e l l bwba le sim �f� G ftfyer PVWya A"Y'' nth fir) 5,)Piw+bt— 'fin rrsvr'Ditl-Vj4 * I1ta;m4tawf in4rm.,y t©t used 'f+ rl^ee1 r«rnirtVa. f p p,+o owrlar. G SBD-6398 (R. 11/111) / 1 ) /� 1)Z*' r13 •rl edlows -9%1- .Siflf� F4Mr�{/ u'G ���`• (o44d.7 Coda mv"'!'./ OCIk �drO 7NonT y-Or' cAf fmt/al f 4djl5 Z Fn !� QtA.X�)i1!5I �J / aCICOP �i L y.— so t q i } i ia< li �, lif 4 3cQm I e �tnner we 1�2 Rtrc c} Sn 06'1-l04S—Y0..6c Sw'/i s y`l S 2�T 19 K16 w B,M"Ma,.i- 1 I JPvt- = 1000,w qzp— Qa+r1,Ma�K2 2' PJC 9$ , 55 To p o-f P pa, Plt-I %is pl,fi j Su Qai,,16 3 53,3 C.OI'+b,q Une- 7�,Z6 S lope" `i 20 Ac res Plug � �►� ��er- �en� kS a) 13-7 4i' -�o .? *^ Y O 80 �4- Y( Y 6 r 4 k� I-iw y 1 L V�AMTNr May 14, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-5-14 Plan Review: PWTS- 052100927-C Paul Koehler 321 Wisconsin Dr New Richmond, WI SITE: Jamie Benner 2444 Hwy 12 Woodville Baldwin Township St Croix County SW X SE % S27-T29N—R16W FOR: DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54643-6462 CWVW Though Refry h J/daps. m.gov/pmgrems(industry-servicee nww.ramnein.gov Tony Evan- Governor Dews Crkn - /eereten Description:4 bedroom-600 GPD - GSF Mound Component Manual—(N.08/16), Replacement —17 " to limiting factor— Pressure Distribution Component Manual —Ver. Effluent Filter- Maintenance required 2.0, SBD-10706-P (N.01/01, R. 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Install the GSF products and distribution piping per instructions. If using pressure distribution, distribution pipe should be sleeved through the 4-inch corrugated pipe located in the GSF product. One out of every five orifices in each distribution pipe shall be installed at the 6 o'clock position so as to allow for thorough drainage of the distribution pipe following each dose. The remaining four orifices shall be installed in the 12 o' clock position. All pipes must drain after dosing. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stets. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Joshua Rowley Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)813-9111 • Install the GSF products and distribution piping per instructions. If using pressure distribution, distribution pipe should be sleeved through the 4-inch corrugated pipe located in the GSF product. One out of every five orifices in each distribution pipe shall be installed at the 6 o'clock position so as to allow for thorough drainage of the distribution pipe following each dose. The remaining four orifices shall be installed in the 12 o' clock position. All pipes must drain after dosing. A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stalls. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. A copy of the approved Plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Joshua Rowley Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)813-9111 Conditionally GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE APPROVED DEPT. OF SAFETY AND PROFESSIONAL Project Name: JAMIE BENNER S ERYIGES Owner's Name. DIVISION OF INDUSTRY SERVICES Owne's Address: 11490 JULIANNE AVE N. STILLWATER MN 55082 bitt CE Legal Description: SW 1/4 SE 1/4 S 27 T 29 R 16 W Township: BALDWIN County: ST CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number. 002-106840-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 GSF mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Designer. PAUL R KOEHLER License Number: 225410 Date: 4/20/2021 Phone Number. 715-246-2660 Signature: Designed Pursuant to the GSF Mound Component Manual IN. 08/16), and SSWMP Publication 9.6 Design Pressure Distribution Networks for STSAS (01/81) GSF Mound Version 1.0 Page 1 of 8 GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Site Information R Residential or Commercial Design 600 Design Flow (gpd) 4.0% Site Slope (%) 97.60 Installtion Contor Line Elevation (ft) 17 Depth to Limiting Factor (in) 0.8 In -Situ Soil Appliction Rate (gpd/ft2) ® Number of Bedrooms (optional) 140.00 Contour Length Available (ft) Distribution Cell Information Unit Used 4 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 97 = Dispersal Cell Length (ft) MA42 2.0 Dispersal Cell Design Loading Rate (gpd/112) 2 Influent Wastewater Qualfrty Are the laterals the highest poinyt in the distribution Pressure Distribution Information network? Enter Y or N Center. End or No Manifold (Pump to Gravity) 0 Lateral Spacing If N above, enter the elevation ft 1 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) Estimated Orifice Spacing (ft) = 10.21053 ft2/orifice Forcemain Diameter (in) � Forcemain Length (ft) Does the forcemain drain back? t J Inside Pump Tank Elevation (ft) 6.5 System Head i ft) x 1.3 13.76667 Vertical Lift (ft) 0.465409 Friction Loss (ft) 20.73208 Total Dynamic Head (ft) Lateral Diameter Selection in. diem. options choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Septic Tank Information 1200 Septic Tank Capacity (gal) WIESER Manufacturer Dose Tank Information 800 Dose Tank Capacity (gal) 22.24 Dose Tank Volume (gal/in) WIESER Manufacturer N .04935 Forcemain Drainback (gal) .28459 5x Void Volume (gal) .33394 Minimum Dose Volume (gal) .65317 System Demand (gpm) Manifold Diameter Slection in. dia. options choice 1.25 1.50 2.00 Ix 3.00 Gallons/inch Calculator Total Tank Capacity (gal) Total Working Liquid Depth (in) gaVin Effluent Filter Information POLY LOCK Filter Manufacter 525j Filter Model Number Project, JAMIE BENNER Page 2 of 8 4 we 1V? Parma cl �b oat-la68-Ya-oc Swr,�5Fyi 92"T1.9R16 W (o PJC loo, w Qaw1•^�grK12'PJC 9`d,b5 ``OpP;p� Pli-Ig65 pll} l RS U Qdr',�16 3 53,3 Como 9 l.i nc- I �, Ga slope- y 610 scq�e 1'- `lob, 2� RC res Plus I4w y I L i- GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Site Information R Residential or Commercial Design 600 Design Flow (gpd) 4.0%, Site Slope (%) 97.60 Installtlon Contor Line Elevation (ft) 17 Depth to Limiting Factor (in) 0.8 In -Situ Soil Appliction Rate (gpd/ft2) Distribution Cell Information A42 Unit Used q4 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 97 = Dispersal Cell Length (ft) 2.0 Dispersal Cell Design Loading Rate (gpd/ft2) 2 Influent Wastewater Quattity Are the laterals the highest point in the distribution [Y� Pressure Distribution Information network? Enter Y or N E Center, End or No Manifold (Pump to Gravity) 0 Lateral Spacing If N above, enter the elevation ft 1 Number of Laterals of the highest point. 0.125 Onifioe Diameter (in) (e.g. 0.25) ® Number of Bedrooms (optional) 140.00 Contour Length Available (ft) led Orifice Spacing (ft) = 10.21053 ft2/orifice rain Diameter (in) rain Length (ft) Does the forcemaln drain back? 0 Pump Tank Elevation (ft) 6.5 System Head (ft) x 1.3 13.76667 Vertical Lift (ft) 0.465409 Friction Loss (ft) 20.73208 Total Dynamic Head (ft) Lateral Diameter Selection in. diam. options choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Septic Tank Information 1200 Se tic Tank Capacity(gal) WIESER Manufacturer Dose Tank Information 800 Dose Tank Capacity (gal) 22241 Dose Tank Volume (gallin) WIESER IManufacturer 13.04935 Forcemain Dralnback (gal) 43.28459 5x Vold Volume (gal) 56.33394 Minimum Dose Volume (gal) 15.65317 System Demand (gpm) Manifold Diameter Slection in. dia. options Ichoice 1.25 1.50 2.00 X 3.00 Gallons/Inch Calculator Total Tank Capacity (gal) Total Working Liquid Depth (in) gaUn Effluent Filter Information POLY LOCK Filter Manufacter 525 Filter Model Number Project: JAMIE BENNER Page 2 of 8 Mound Plan View noun wmponem uimensions D 119.00 n G 20.50 ft J 7.14 ft W 120.78 f 388.00 (ft2) Dispersal Cell Area 1322.73 (ft ) Basal Area Available 6.19 (gpdtft) Linear Loading Rate 1 9.70 (ft) 1110 B Obs. Pipe Placement Finished Grade 99.18 (ft) Dispersal Cell Elevation Elevation 100.77 (ft) 4 A Site Slope 99.77 (ft) Lateral Invert Elevation Shading Key r Typical Dispersal Cell rfm 1 L11111Topsoil Cap $ a See Page 5 2 ; Subsoil Cap o a 2 ft Geotextile 3 ASTM C33 Sand Fabricto 4 : Tilled Layer 0 m 5 GSF Media m F L 1- _ `' S It o 0.5 ft A See details on page 4 for number, size and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: JAMIE BENNER Page 3 of 8 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below ! = Turn -up wt Valve a deanad plug —. _ Z-- .. ~- --X_Laterals 8 face main of PVC Son 40 1st onifica located at Z Ortilloss point up except e y (Per COMM Table 84.30-5) 5th are points down for drainage. Numbers of Laterals Lateral Diameter Lateral Length (P) Lateral End (Z) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Orifice Diameter in Orifice Spacing (X) ft Orifices per Lateral V15.65317 ft Orifice Density it Manifold Length gpm Manifold Diameter gpm Forcemain Velocity 94.35 Pump Off Height Dose Tank Information 9ac41rm as pa NEC 300 s1dOmm1&2BVVeC J Talkconparat is property Varied WIESER Manufacturer Capac' 8013 Gallons Volume 1 22.24 gaVinch I Dimension Inches Gallons A 19.4382219 432.3061 B 2 44.48 C 2.53300112 56.33394 D 12 266.88 Total 35.971223 800 LadWrg ows win wen Irg ktxi end kdft d%ke. and laded ed Vade Dzanad. I I l'acarolndma 2 in 1 _YAM hdeo- B at4alprm dNoe I i r Purp ofdesaaon (1) D �� - 86 Mr. 7 Bcddng on iv taia Alarm Manufacturer S3 ROMBUS Alarm Model Number PS PATROL Pump Manufacturer GOULDS Pump Model Number I epo4 Pump Must Delivery 15.65317 gpm at F20.73208 ft Dosetankeev MIA) lli� 85 TDH Project: JAMIE BENNER Page 4 of 8 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below P ♦ =Tum W w/bel valve or deenout plug Y X l.e4arals &race [rein of PVC San 40 lstorrifimloaWatZ Onfices point up e>wW every (per COMM Tade 80.3D-5). 5th one parts down for drainage. Numbers of Laterals Lateral Diameter Lateral Length (P) Lateral End (Z) Lateral Spacing (S) Lateral Flow Rate System Flow Rate 1 Orifice Diameter 1.5 in Orifice Spacing(X) 95.175 ft Orifices per Lateral 0.825 ft Orifice Density 0 ft Manifold Length 15.65317 gpm Manifold Diameter 15.65327 gpm Forcemain Velocity 94.35 Pump Off Height Dose Tank Information Ebcbicd as PQ and Omm fl Tadr mrP*Wt is praprrlywmted WIESER IManufacturer F.— Capacity Soo Gallons A Volume 22.24 gal/inch B Dimension Inches Gallons A 19A382219 432.3061 8 2 44.48 C 2.53300112 56.33394 D 12 266.88 Total 35.971223 800 Alarm Manufacturer Alarm Model Number Pump Manufacturer Pump Model Number Pump Must Delivery Project: JAMIE BENNER La C C O SJ ROMBUS PSPATROL GOULDS epo4 15.65317 gpm at 20.73208 ft 4ie mh Facardn darata 2 in a 'Moon (I) 86 DasalaYtde'MGan(* 8S TDH Page 4 of 8 GSF Distribution Cell Media Layout ®Cell Width (ft) Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Drag appropriate drawing to space below. 4 ft Wide ® ASTM C33 Sand/Mound Sand A42 or B43 Module __ - =i_ Lateral e, Turnup (contained in Turnup Enclosure) Distribtion Cell Pland View Layout -Typical 4 Cell Width - A (ft) 97.00 Cell Length - B (ft) 24 A42 Modules Required per Row 24 A42 Total Modules Required End Connection Later Layout Diagram Drag appropriate drawing from left to space below. Project: JAMIE BENNER Page 5 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Phone L--- J POYVTS Regulator's Name Phone System Flow and Load Parameters Design Flow - Peak 600 god Maximum Influent Particle Size 1/8 In Estimated Flow - Average 400 gpd Maximum BODS 30 mg/L Septic Tank Capacity 1200 gal Maximum TSS 30 mli Soil Absorption Component Size 388 ft' Maximum FOG 10 mg/L Maximum Fecal Coliform 10E4 cfu/100 mL Septic and Pu Efflue Pump and Pressure Service Frequency Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to the standards, have a watertight cap, and are secured in a as shown in the Eljen mound component manual. 2, Dispersal cell media conforms to Eljen products approved for use with the Eljen Moun Component Manual approved August 2016. Eljen media is covered with the manufacturers geotextile fabric. 3. All gravity and pressure piping materials conform the requirements in the state code. 4. Tillage of the basal area Is accomplised with a mold board or chisel plow. S. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turnup Detail 6 - 8" DIAMETER LAWN SPRINKLER RNISHEDGRADE — — — _ — LATERAL ENDS AT LAST 4" PERFORATED PIPE ORIFICE WHERE VARIABLE 4" END LENGTH CLEAJNOUT BEGINS CAPJi -- DISTRIBUTION LATERAL LATERAL CLEANOUT PLUG LONG SWEEP 90 OR /( TWO 45 DEGREE BENDS SAME DIAMETER AS LATERAL Project: JAMIE BENNER Page 6 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Phone POWTS Regulator's Name 1Phone System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400gpd Maximum BODS 30 mg/L SepticTankCapaclty 1200gal Maximum TSS1 30 1mg1L Soil Absorption Component Size 388 ft' Maximum FOG 1 10 mg/L Maximum Fecal Collform 30E4 cfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Frequency Inspect and/or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushedandpressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to the standards, have a watertight cap, and are secured in a as shown in the Ellen mound component manual. 2. Dispersal cell media conforms to Ellen products approved for use with the Ellen MounComponent Manual approved August 2016. Ellen media is covered with the manufacturers gectextilefabric. 3. All gravity and pressure piping materials conform the requirements in the state code. 4. Tillage of the basal area is accomplised with a mold board or chisel plow. S. 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 6 - 8" DIAMETER LAWN SPRINKLER FINISHEDGRADE— LATERAL ENDS AT LAST 4"PERFORATED ORIFICE WHERE VARIABLE LENGTH CLEANDLIT BEGINS —�-- DISTRIBL)TION LATERAL LONG SWEEP 90 OR T WD 46 DEGREE BENDS Project: JAMIE BENNER Page 6 of 8 Mound System Management Plan General This system shall be operated in accordance with SPS 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals Eljen Mound Component manual August 2016 and SSWMP Publication 9.6 (01/81)) 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 83.33, 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, defective, 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, State. 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. Intermittentfilter alamxs 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 113 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 tasted 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. 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 call. 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 falls 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Page 7 of 8 4 :�am e- �cnner Parc GI ZD Dot-10�8-Yo-pt SW ri5�L�1 S 1�T 1`) Ri6 uJ Ikpve a 160 w Q�.,�.Mq�Kz 2�pdc 98-55 Top of Pipes PIt I qG Pll}z SU Qa",.16 3 53,3 CO nib, t 1-1 Y1 o �0 4D scqi� 2O ac res Plu's 14ti ti I L- A _: f_C) — — - 33.02 183.9 cm] -- -� - -- 2071 [528 ] — � 4' (10.16 cm) BALL TRAVEL I_ 5.711 [14.7cm] A 6.5" (16.51cm) SEALED BALL -- MATERIAL - HOPE POLYLOK PL- 525 - 625 CUTAWAY HOUSING FILTER CARTRIDGE MATERIAL -POLYPROPYLENE MATERIAL - FILLED POLYPROPYLENE - BALL PUSH ROD SECTION A FACTORY INSTALLED -A MATERIAL- FILLED POLYPROPYLENE 4' AND 8" FACTORY - 'OPTIONAL BUSHING INTALLED PPE OUTLET (FOR 4' THIN WALL PIPE) MATERIAL - PVC PART NO. 30142- R OR OPTIONAL FLOAT SWITCH (FOR 110 MM. PIPE) PART NO.30142-FUR HGOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handing capability; lie MaDdmum. • Capacities: up to 60 GPM. :Total heads: up to31 led. Discharge size: 11/2'NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104OF Mat) continuous 14" (6000 intermittent • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. NOW. •EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, bulk In overload with automatic reset • EP05 Sinole AM: 0.5 HP, 115 V orlAV, 60 ft 1550 RPM, bulk in overload with automatic reset • Power cord: 10 W standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16(3 SJM with three prong grounding plug (standard on EP05). 0 2003 Goulds Pumps Effective July, 2003 B3971 • Fu grade in high for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models IrKlude Mechanical RM Switch assembled and preset at the UCtDry. FEATURES a EP04 Impeller. Thermoplas- tic semi -open design with pump out vanes for mechanical seal protection, METERS , FM 2 x V Submersible Effluent Pump 1=� EP04 & EP05 Series 0 EPOS Impeller Thermoplas. tic enclosed design for improved performance. a Casing and Base. Rugged thermoplastic design provides superior strength and corrosion resistance. 0 Motor Housing: Cast I= for effident heat transfer, strength, and durability. W MGM cow. Thermoplastic cover with Integral handle and float svvftch attachment points. 0 Power Cable: Severe duty rated oil and water resistant. � ncl low ==nng construction. AGENCY LISTING CMWNC- Am*bn Fk # LOW) Gaft Pop Is 50 9W Mosind --A. 5 GPM Z5 Fr 25 2G INS S4 'o In 20 30 40 so GPM CAPACHY 10 12 Goulds Pumps ITT Industries [QGOULDS PUMPS APPLICATIONS Spedii designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/: maximum. • Capacities: up to 60 GPM. �'1 • Total heads: up to 31 feet. • Discharge size: 11/2" NPT. • Mechanical seal: carbon- rotary/ceramk-stadonary. BUNA-N elastomers. • Temperature: 1041(400Q continuous 140OF (60`Q intermittent • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor. • EP04 Si!n�gle phase: 0.4 HP, 115 or 210 V, 60 Hz, 1550 RPM, built in overload with automatic reset • EP05 Single e: 0.5 HP, 115Vor23 V,60Hz,1550 RPM, built in overload with automatic reset • Power rod: 10 foot standard length,l6/3 SJTW with three prong grounding pug. Optional 20 foot length, 1613 S)TW with three prong grounding plug (standard on EP05), O 2003 Goukis Pumps Effective July, 2003 93871 • Fully submerged in high grade turb ne ofi for lubrication and efficient heattransfer. Available for automatic and manual operation. Auto- matic models include Medraninl Float Switch assembled and preset at the factory. FEATURES ■ EP04 knoler. Thermoplas- tic semi -open design with pump out vanes for mechanical seal protection. METERS , FF" Submersible Effluent Pump EP04 & EP05 Series ■ EP05 Impeller Thermoplas- tic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and r:orrosion resistance. ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ■ Motor Cover. Thermoplastic cover with integral handle and float switch attachment points. ■ Power Cable: Severe duty rated oil and water resistant. CAPACn'Y ■ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING Ca eft $UFA rds Awadrfon Re1rt1t3" GoLft P.AP It 50 WM Reyfoher 1 10 12 awh Goulds Pumps ITT Industries CAST -A -SEAL 0 w w 4• VENT I(I � T !1 • . f/1 a j• � n + I.I n� I RU O� 3• I 1 `� PUMP PAD SIDE VIEW WLP1200/800-MR TANK SPECIFICATIONS DIMENSIONS � o WALL Y BOTTOM: 3' COVER: 8' MANHOLE 24' I.D. PRECAST CONCRETE RISER < HEIGHT: 53' 51 LENGTH: IS-8' WDTH: 8'-o' BELOW INLET: 41' LIQUID LEVEL: 36' WEIGHT: BOTTOM /4,BOO LBS.221 COVER 8.170 LOS. INLET AND OUTLET:4' CAST -A -SEAL BOOT OR EQUAL GASKETINLET AND OUTLET BAFFLE AND FILTER: NISCONSIN. SEE DETAIL /10 (OTHER STATES SEE CHART) 1W LIQUID CAPACITY. 33.46 CAL/IN (SEPTIC) Q BE 22.24 GALIIN (PUMP) �{ LOADING DESIGN: 8'-0' UNSATURATED SOIL ® a TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON ' o COVER: MIX DESIGN /8 (NO FIBER) TANK: MIX DESIGN /8 (SMALL FIBER) LaN CUSTOMIZED TANKS: o FOR CUSTOM TANKS CONTACT WIESER CONCRETE I� X11 � RENEWED BY RENEW DATE F F HAWTNGC CI IRBAT=t:n FOR APPROVAL APPItWED BY: SHEET N0. APPRMAL DATE: PRODUCTS NEEDED BY: 1 - A A 6.5'(16.51crn) SEALED BALL MATERIAL - HOPE 4"(10.16 cm) BALL TRAVEL — 5.78 (14.7 cm I — PCILYLOK PL- 525 - 625 CUTAWAY 33.02 193.9 cm) I -- 20.71 [52.6cm1 FILTER CARTRIDGE MkTERIAL- POLYPROPYLENE MATERIAL - FILLED POLYPROPYLENE s BALL PUSH ROD FACTORY INSTALLED ECTION A -A MATERJAL - FILLED POLYPROPYLENE 4" AND 6- FACTORY OPTIONAL BUSHING INTALLED PIPE OUTLET (FOR 4- THIN WALL PIPE) MATERIAL - PVC PART NO. 30142-R OR OPTIONAL FLOAT SWITCH (FOR 110 MM. PIPE) PART NO. 30142-EUR POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of_L FILE INFORMATION Owner JAMIE BENNER Permit 0 - DESIGN PARAMETERS Number of Bedrooms 4 ❑ NA Number of Public Facility Units ❑ NA Estimated flow (average) 400 aI/d ay Design flow (peak), (Estimated x 1.5) 600 al/d ary Soil Application Rate •8 al/da /ft2 Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOGi 530 mg/L Biochemical Oxygen Demand IBOD,) s220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD,) 530 mg/L Total Suspended Solids (TSS) 530 mg/L 0 NA Fecal Conform (geometric mean) 510" cfu/100ml Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 1200 al 0 NA Septa; Tank Manufacturer WIESER ❑ NA Effluent Filter Manufacturer POLY LOCK 11 NA Effluent Filter Model 525 ❑ NA Pump Tank Capacity 800 al ❑ NA Pump Tank Manufacturer WIESER ❑ NA Pump Manufacturer GOULDS ❑ NA Pump Model EP04 ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Pest Filter ❑ Wetland O Other: ❑ NA Dispersal Collie) ❑ "round (gravity) ❑ At -Grade ❑ Drip Urve ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other. ❑ NA Other. ❑ NA Other. ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 rtandnfsl (Maximum 3 years) la er(el ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third %) of tank volume ❑ NA Inspect dispersal call(s) At least once every: 3 ❑ months) (Maximum 3 years) EXYearls) ❑ NA Clean effluent filter At least once every: 1 O month(s) Myear(s! Inspect pump, pump controls & alarm At least once every: 3 0month(s) X year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ maeriaIon1.SIAS NEEDED ❑ NA At least once every: monthls) ❑ year(s) Q( NA Other: D9 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank Inspections must include a visual inspection of the tank(sl to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface. The pondng of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page Z of 2 " For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tank(sl removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meet scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shag be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert sold material. CONTINGENCY PLAN If the POWTS fags and cannot be repaired the following measures have been, or.must be taken, to provide a Code complaint replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. S ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infilt ative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. COMMENTS POWTS INSTALLER Name COUNTRYSIDE PLUMBING AND H Phone 71 -2 - SEPTAGE SERVICING OPERATOR (PUMPER) Name BERENDS Phone 715 265-4623 TIP POWTS MAINTAINER G Narnel PAUL R KOEHLER Phone 715 246 2660 LOCAL REGULATORY AUTHDRITY Name ST.CeD ( - ZOKilrtl Phone '"] 1 S- 3 SCo- This document was drafted in compliance with chapter Comm 83.22(2)(b)(t)(d)&(fl and B3.54(t), (2) & (3), Wisconsin Administrative Code. Page Z of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products orother chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pas shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pas shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pas shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert sold material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. D44113ITEZ1 nP- A/6'VJ CON 51`19 Lhnan ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name COUNTRYSIDE PLUMBING AND H TIP Phone 715-24 - POWTS MAINTAINER G Name PAUL R KOEHLER Phone 715 246 2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name BERENDS -77 Phone 715 265-4623 Name IsT. Ckp I v z0%ilai Phone 1 3 w(O— (G 0 This document was dratted In compliance with chapter Comm 83.22(2)(b)(1)(d)&lfl and 83.54111, (2) & (3), Wisconsin Administrative Code. ST CRo NTY SANITARY SYSTEM Filece ly OWNERSHIP/ADDRESS FORM ��"d212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your Issued sanitary permit online, you can do so by using the Property Files Scanned weblink. Owner/Buyer JAMIE BENNER Mailing Address OWNER/BUYER INFORMATION 11490 JULIANNE AVE N. City/State/Zip STILLWATER MN 55082 Phone Number Email Address (i 612-385-9131 N/A Parcel Identification Number 002-1068-40-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW y, SE 114,Sec. 27 T 29 N R16 W, Town of BALDWIN Subdivision Plat: , Lot # Certified Survey Map # Volume Page # Warranty Deed # g8391 � (before 2006)Volume Page # Number of bedrooms 4 Spec house 0 yes O no Lot lines identifiable ■ yes O no r . `'t "( r IOJFFICE USE ONLY New Property Address � �I 2 't 4� 12 (VerificatioKof new address required fro Community Development Department for new construction.) 9 51 (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.aov L r' �Er C'� V D Wis. t.ofsa UATIONRtPORT Division tSafellrk Buildings County In ccordance with SPS 385, Wis. Adm Code t CrGI% e t County Attach mpletesa than 8 1/2 x 11 Inches in size. Plan must ildude, vertical and horizontal reference point (BM), directon and Parcel I.D. percent ope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Personal nformation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) _ / -, /, 31—O(Udi—/o?3 Page I of 3 ST CROIX 002-1068-40-000 1 1517-7/ Z/ JAIME BENNER Govt Lot SW 1/4 SE 1M S 27T 29N R 16E (or) u Property Owners Mailing Address tot # Block # Subd. Name or CSW 11490RTLLANNEAVEN I I GX•�+�-( n Y'rn!`j�� /' a(- Ya((r, City State ZIP Code Phone Number ity ❑Vilage a own Nearest Road STILLWATER I MN 1 55082 1 ( 61)-385-9131 240TH STREET New Construction UseQ Readential / Number of bedrooms 4 Code derived design flow rate 600 GIRD O Replacement Pubic or commercial - Describe: Parent material loamy drift over loamy till Flood Plain elevation K appicade ZON ft. General comments BORING 3 had water seepage to a level of 26" limiting factor is 17" for a mound system . build the mound out and recommendations: Lcnlr of elgins and hold it up to the top side and towards the east . 1❑ Boring # 11 Boring ❑. Pit Ground surface elev 96.5 ft. Depth to limiting factor 24 in Sall Application Rate Honzon Depth in. Dominant Color Munsel Redox Description Qu. Sz. Coat Color Texture Structure Gr. Sz. Sh. nsistence Boundary Roots GPD/R' tf#1 fW2 A 0-11 10 YR 3/2 -- -- - SIL 2 M OR MFR CA 2M .6 .8 B 11-24 I OYR 5/4 --- - ----- - SICL 2 M BK MVFI CA 2F .4 .6 C 24-48 10 YR 6/3 10 YR 518 MCP SOLID SICL 2 M BK MVFI ____ ____ .4 .6 2 Boring# Boring 98.45 Depth to limiting factor 32 Pit Ground surface ein, elev. it Soil 'cation Bate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft ' ff#1 1f#2 A 0-5 10 YR 3/2 ----- ---- SIL 2MGR MFRMCA2C .6 .8 B 5-28 10YR5/6 — -- — - SICL 3MABK MVFIIF .4 .6 BI 28-32 1 OYR 3/2 --•----------- S/GR OMSG MLIVF .7 1.6 C 32-55 10 YR 7/2 IOYR 5/6 MCP FS OFSG ML------ 5 LO (Please Print) - Signature r=mlAl IL N< -C U a,ry rTIWL aril Ioo a i 1 _ CST Number 321 WISCONSIN DRIVE NEW RICHMOND WI APRIL 20TH 2O21 715-246-2660 Property Owner JAMIE A BENNER Parcel ID# 002-106840-000 Page 2 of 3 Boring 9330 Boring # Vj Boph . Ground surface elev. ft.Depth to Inviting factor 17 in. Soo Application Rate Horizon Depth in. Dominant Color Munsel Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsis0woe Boundary Roots GPD/ t ' 11#1 02 A 0-9 10 YR 3/3 --------- SIL 2MBK MFR CA 2F .6 .8 B 9-17 10 YR 514 — -- SIL. 2MBK MFR CA 1 VF .6 .8 C 17-30 7.5 YR4/4 10 YR 5/6 CIF SCL 2MBK MFI CA — .4 .6 ❑ Boring # Boring Pit Ground surface elev. ft Depth to limiting factor in. Sail flcetion Rate Horizon Depth in. Dominant Color Munsel Redox Desciption Ou. Sz. Cont Color Texture Structure Gr. Sz. Sh. istence undary Roots GPD/ft 2 R#1 Boring ❑ Boring # Pit Ground surface elev. R Depth to limiting factor in. Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz Sh. Comustenoe undary Roots wn nc Uvr, rwre GPD/ft ' M tf#2 Effluent #1 = BOD , > 30 < 220 mgn- and TSS >30 < 150 mg2 ' Effluent #2 = BOD • < 30 ng1L and TSS < 30 mg2 The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266.3151 or TTY through Relay. SN"330TM rk I VI1) Property Owner JAMIE A BENNER ' Boring ParcellD# 002-106840-000 3 Bonn # g 0 pit Ground surface elev. 93.30 8 Depth to limiting factor 17 in. 2 3 Page _of_ c�a n.,,uf �he'� rtar„1 Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence undary Roots I GPD/R ' 01 102 A 0-9 10 YR 3/3 ---------- SIL 2MBK MFR CA 2F .6 .8 B 9-17 10 YR 5/4 SEL 2MBK MFR CA 1VF .6 .8 C 17-30 7.5 YR4/4 10 YR 516 CIF SCL 2MBK MFI CA -- •4 .6 1-1eorig # Boring Pit Ground surface elev. R Depth to limiting factor in. S it „cation Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh, nsislence Boundary Roots GPD/ft' fNi 111102 Boring ❑ Bonng # Ground surface elev. ft. Depth to limiting factor in. Pit Sail A.Ii.ton Rate Horizon Depth in. Dominant Color Munsell Redox Description Clu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence oundary Roots GPD/ft ' 0#1 02 Effluent 01 = SOD r> 30 1220 mg1L and TSS >30 < 150 mg/L ' Effluent #2 = BOD s < 30 mg1L and TSS < 30 mg1L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. ssoA)]orm(RI vu0 j 93,3 S. i- 0 4 IL 12 Gtnn4F r parc el Ws—Yo—o,�, SW/, SFLEI g17-�),IR16 W, I�pvt QlI,w ac.,l,MnrK2 2"Q�JC 98,55 Top of e;p,- Pit 19�,5 l�arn� 3 13,'3 II COnbo,r nc- $ lope y Cho C �0 ka cc scq�c 1'= `lob, ao ac rf-s Phu$ 2e f I ¢ ce "n -�-- S� • �-o � X couNTr NO. 633375 STATE SANITARY PERMIT zHyy 14wY /2 � P OWNER Ta.wt; C PLUMBER Pau TOWN OF aIer— LIC.# Z Z 6gjo SEC 2-7 ,T Z9 N, R (G E/61 AND/OR LOT BLOCK Cz THIS PERMIT EXPIRES POS SUBDIVISION ZoNE7 X CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may Impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ZED ISSUING OFFICER - DATE 7-4Z3 UNLESS RENEWED 514 AIN VIEW rw/ THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)