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016-1024-10-110 (2)
Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may be used for secondary Jerry Lyons SST BM Elev TANK INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) [Privacy Law, s 1504 (1)(m)j lZ TOWN OF GLENWOOD TYPE MANUFACTURER CAPACITY Septic / G%1rS1`'r trSAp� 1/�C L V00 Dosing Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer //� t%a Model Number 0 G�M q S W b- TDH q 8 Fric[ton Loss 1 System Head 3. ZS T t 3�.8 Forcemain Length Dia.Z ry Dist. to Well \ Daman u SOIL ABSORPTION SYSTEM ELEVATION DATA County St. Croix Sanitary Permit No 633963 State Plan ID No. Parcel Tax No 016-1024-10-110 Sect,onlTown/Range/Map No 11.30.15.187A-10 STATION BS HI FS LEV. Benchmark19 .26 j02-t !O Al BM it Bldg. Sewer xt. 1 SUHt Inlet ./ Gxt r SUHt Outlet Dt Inlet J Dt Bottom Header/Man. • Dist. Pipe r 9I Z Bot. System O anal Grade St Cover q o-v �vvr S 47. 3 Z 7 0r3 g ) g383, BED/TRENCH DIMENSIONS Width Length t J No-BYfienches / /q:L� �7 PR DIMENSIONS No. Of Pits Inside Dia. Liguid Depth SETBACK INFORMATION SYSTEM TO h Type O.f,tS.ystem YKOV,- P/L �7� 7,6' BLD/G >56 WELL 510o x LAKEISTREAM LEACHING CHAMBER OR UNIT Manufacturer H Model Number ' 73 DISTRIBUTION SYSTEM Header/Manifold �� Length Dia Distribution Pipe(s) 3R 4 2' - Length Z Dia Spacing x Hale Size x Hole Spaang I Vent to Air Intake V� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only FYr Plti .M t r Ciep[R9rrr`- 130,TTT}rur nter 1 u p,� '2 Depth Over Bed/Trench Edges �— xx Depth of xx Seeded/Sodded Topsail 1 1 r Yes No xx Mulched XYes n No COMMENTS: (Include code discrepancies, persons present, etc.) Location: 3150160TH AVE — COyI, 4Vr 1.) Alt BM Description = gp �-'py.n �p� 2) Bldg sewer length =x i 5� - amount of cover - Inspection W I / 21 Inspection #2. t�-Ou(� SIG , t`y. Soi! ylejkl R7�L1 Plan revision Required? ❑Yes i I}'No /i a 2) Use other side for additional informa0 n. _ SBD-6710 (R 3197) _ Date Insepctoes Signature Cert. No. s 4 ZD ,v Safety and Buildings Division County _ ST .CROIX 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) .s v� nc �l �,o,n°eloom ;ono ary Permit Appticati State Transaction Number _ In accordance with SPS 383.21(2), W is Adm. Code, submission of this form to the appropna e 1 unit is required prior to obtaining a sanitary permit. Note Application forms Cor state-owned PO WTS are submitted [o Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be aced for secondary Lurposes in accordance with the Privacy law, s. 15. 1 m , Slats. /•_ y , I. Application Information - Please Print AB Information Property Owner's Name Parcel # JOSEPH LYONS 016-1024-10-110 Property Owner's Mailing Address P�gpf ' Local o `r' 3U' S7,4 D 3150 160TH AVE • Govt. Lot SE 11 SW '/., Section '/., City, Suite Zip Code Phone Number GLENWOOD CITY 54013 T N, R 15 E o0W (circle one) 30 II. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrooms 2 l Subdivision Name Block # ❑ Public/Commereial- Describe Use ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number Zo1�2 X 8-2182 I�Toompf GLENWOOD III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A_ ❑ New System �Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (ezplain) B. El Perron Renewal court Rev isio ❑Change of Plumber ❑Permit Transfer to List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that apply) t, ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade 4blormal> 24 m, of suitable soil ❑ Mound <h4��in. of suitablespill. ❑ Holding Tank ❑ Other Dispersal Component (explain) GS}-Zi-1 Pretreatment Device (explai v V. Dispersal/Treatment Area Information: 7o Vim' Design Flow (gpd) Design Sod Applic on Rate(gpdsf) Dispersal Area R ffed (sf) Dispersal Ar posed (sf) System Elevation 300 .6 0, q 164 7-750 164 76 2 `{ 'F 5 VI. Tank Info Capacity in Gallons Total Gallons # of Units , Man S tuaaa��� tltr ✓f'1iC4,tt Cr o 'a ._ New Tanks Existing Tanks i U h v W U L Septic or Holding Tank X 11000 Dosing Chamber X 800 X VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si true MP/MPRS Number Business Phone Number PAUL R KOEHLER �� 225410 715-246-2660 Plumber's Address (Street, City, Suite, Zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI VIII. County/Department Use Only Approved ❑ Disapproved Permit Fee S 90. Date Issued Issuing Agent Si e ❑ Owner Given Reason for Denial IX. Conditions of Approval/Rea`so-is Tor isa roval 3 OWNER: I t G r> 1, NO/I,r Cpyt 'b✓r�. SYSTEM _ 1 CC�t�/�� ry� / 1. Septc tank, effluent filter and �D q r�U Kd a EGG C-+ilJ A.� 7 'ro r P's dispersal cell must be serncen/maintained as par management plan provided by plumber.. 2. MI aWDafek raqqremenn must oe mairttaited MNaIq ( ✓r0te,1 LKr i K Attach to complete plans for the s tent d b ri to Cou oly . papF�my4lJJess. �B i(1 x rt iPn�. inf; f / cfr� P.1�!�,1�� /O/VVAI-0 srsf4 it hfa;vtr�tnatn.ee SBD-6398 (R. 11/11) /l�py,pyfalL,/�.., 40 ,0/`ero{y / o% kgr-I �cl- YtIPQ ?YoaMu�l.rJ -� CIS Q�oS(d°PS Z �, 5: V do Z �,8 hit om �° �°I z win Qol SAC) FodoL eei Mtn ,21 -0 aj r,�a ? Q5 / ST. C R_ OIX Cn-1= � `TY tt llscw/u Sla Community Development Government Center 1101 Carmichael Road Hudson WI 54016 Telephone: 715-386-4680 Fax: 715-386-4686 www.sccwi.gov 11/4/2021 MEMO POWTS Onsite: November 11, 2021 Project Location: 016-1024-10-110, Town of Glenwood Project Address: 3150 1601" Ave To whom it may concern, St. Croix County Community Development staff conducted an onsite soils evaluation on November 4, 2021. A state sanitary permit was previously issued for a conventional system using Eljen dispersal components. Upon further evaluation, staff found massive silt loams with redoximorphic features at a depth of 24 inches in the proposed system area. Evaluation near pit #1 showed a weekly structured sandy loam with cobbles from 24 inches to 64 inches. Below 64 inches appeared to be weakly cemented sandstone with redoximorphic features. Due to these findings, the site is not suitable for a conventional system. A mound system will be required for this site. Respectfully, B�e�n.'*HHeettzzel Land Use and Conservation Specialist Ben Hetzel benjamin.hetzel@sccwi.gov (715) 386-4742 Ps November 18, 2021 CONDITIONAL APPROVAL DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54543-6462 Contact Through Relay h6pl/dsps.wi govlprogramsfndusey-seMces . is onsn 9w Tony Evem - Govemor Dawn Crim- Secretary PLAN APPROVAL EXPIRES: 2023-11-18 Plan Review: PWTS-112102963-C CONDITIONALLY APPROVED PAUL KOEHLER DEPP OF SAFETY AND PROFESSIONAL SERVICES 321 Wisconsin Drive DIVISION OF INDUSTRY SERVICES New Richmond WI 54017 N SITE: Joseph Lyons 3150 160" Avenue SEE CORRESPONDENCE St. Croix County Town of Glenwood SW Y. - SE Y4 - S11 — T30N — R15W FOR: Description: GSF Mound Component Manual — May 2018 2 Bedroom Eljen GSF Mound —300 GPD— Replacement - 24" 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 e 12" of sand shall be installed between the contour and the bottom of the GSF product. e Eljen requires the pressurized lateral to be sleeved in a 4 inch perforated pipe with the lateral orifices installed pointed upward with every 51' orifice pointed downward to drain the lateral. e Maximum volume of a single dose is 4 gallons/dose/unit for B43. Care must be taken to set the dose volume as approved in the plan design. If the minimum tether length of a single switch mechanical float does not allow the proper dose volume, two separate floats must be used. e Ensure the existing septic tank is watertight, structurally sound and baffles are in place. Any changes made to the tank must be approved by the manufacturer. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • The dispersal cell 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 dispersal cell site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • 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, CP.C'Pi /2GCcxyZGC�ti CeCe (Elizabeth) Rudnicki Wastewater Specialist/POWTS Plan Reviewer, Division of Industry Services (608)400-3186 GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Project Name: Joseph Lyons Owner's Name: Joseph Lyons CONDITIONALLY Owner's Address: 3150 160th Avenue APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES Glenwood Citv WI 54013 DIVISION OF INDUSTRY SERVICES Legal Description: Township: County: Subdivision Name: Lot Number. SW-SE-11-30-15W Glenwood St. Croix Parcel I.D. Number: 016-1024-10-110 Plan Transaction No.: Block Number: 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 Pace 9 Site Plan Page 10 Page 11 L "`(k-, SEE COKRESPONDENCE Designer. Paul Koehler License Number: 225410 Date: 11118/2021 Phone Number: 715-246-2660 Signature: Designed Pursuant to the GSF Mound Component Manual (N. 08/16), and SSWMP Publication 9.6 Design Pressure Distribution Networks for STSAS (01/81) GSF Mound Version 2.26 Page 1 of 11 w aa�s C6n IJur 1 r) -Q L � v vyV,V%v NT Qh1 i 'To polf YG `Oa Rrh -I- lob oifvc P ;4 a j Rio fl-t 3'q2 Slop . I 15°1D c o nto✓r (�u+h�o{+��Ms at 1pYl� b 3'��99GG Scr `y� s yq sit Tao 96w G I Ghwco^� " = Noft, !6 e•h, QVT- P GSF WI MOUND DESIGN PROGRAM DATA ENTRY Site Information R Residential or Commercial Design Number of Bedrooms (optional) 300 Design Flow (gpd) 15.0% Site Slope (%) 94.50 Installation Contour Line Elevation (ft) F-60TO—T-1 Contour Length Available (ft) 24 Depth to Limiting Factor (in) 0.6 In -Situ Soil Application Rate (gpd/ft2) EFF #2 Distribution Cell Information 643 Unit Used 4 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 41 = Dispersal Cell Length (ft) 2 0 Dispersal Cell Design Loading Rate (gpd/ft) 2 Influent Wastewater Quality Are the laterals the highest oint in the distribution high Pressure Distribution Information network? Enter Y or N E Center, End, No Manifold (Pump to Gravity), or Gravity (No Pump) 0 Lateral Spacing If N above, enter the elevation ft 1 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e g 0 25) 1.3 Estimated Orifice Spacing (ft) = 5.47 ft2/orifice 2 Forcemain Diameter (in) 1 i 160 Forcemain Length (ft) Does the Forcemain drain back? �Y Inside Pump Tank Elevation (ft) ,� 1 r 3 25 System Head (ft) x 1 3 26.10 Forcemain Drainback (gal) 32.08 Vertical Lift (ft) 31 46 5x Void Volume (gal) 1 42 Friction Loss (ft) 5756 Minimum Dose Volume (gal) 0 Add'I Fitting Friction Loss (ft) 19.66 System Demand (gpm) 36.75 Total Dynamic Head (ft) Lateral Diameter Selection in. diam. options choice 0.75 1.00 1.25 150 x 2.00 x x 3.00 x Se tic Tank Information 1 000Se tic Tank Capacity (gal) Custom Concrete Manufacturer Dose Tank Information 800.64 1 Dose Tank Capacity (gal) 22.241 Dose Tank Volume (gal/in) Custom Concrete Manufacturer Manifold Diameter Selection in. dia. options Ichoice 1 25 1 50 200 3.00 Gallons/Inch Calculator Total Tank Capacity (9e9 Total Working Liquid Depth (in) gal/in Effluent Filter Information Sim Tech Filter Manufacturer 140 Filter Model Number Project Joseph Lyons Page 2 of 11 GSF WI MOUND DESIGN PROGRAM GSF MOUND DRAWINGS Mound Plan View © IIy��II�II��j Mound Component Dimensions 10 14 D 42.00 n0ift G 50 ft J 3� ft W 22 955 ft 164.00 (ftz) Dispersal Cell Area 76409 (ftz) Basal Area Available 7.32 (gpd/ft) Linear Loading Rate 4.10 (ft) 1/10 B Obs Pipe Placement Finished Grade 97.08 (ft) 95.50 (ft) F Dispersal Cell Elevation Q 4 94.50 Contour Elevation Shading Key 1FF WATopsoil Cap 2 Subsoil Cap 3 ASTM C33 Sand 4 Tilled Layer 5 GSF Media & Cell Header /Footer SF G H 96.08 (ft) Lateral Invert Dispersal Cell ,tt� Elevation (ft) 15% Site Slope Typical Dispersal Cell 4) n See Page 5 a 2 ft Geotextile 0 a o Fabric -0 ra .� _ J ;p $ 0.5 ft L 1 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: Joseph Lyons Page 3 of 11 GSF WI MOUND DESIGN PROGRAM LATERAL AND DOSE TANK •=TurrHp wWl valve a deanout plug P �ZJ—X� Laterals & force main of PvC Sdt 40 1st anficebraced at Z Orrdws pant except every (per OOMMTable 84 30-5) IL 5th far one pants --Edge ofchstrihWan�I drainage Numbers of Laterals Lateral Diameter Lateral Length (P) Lateral End (Z) Lateral Spacing (S) Lateral Flow Rate System Flow Rate 1.00 Orifice Diameter 2.00 in Orifice Spacing (X) 3929 ft Orifices per Lateral 0.72 ft Orifice Density 0.00 ft Manifold Length 19.66 gpm Manifold Diameter 19.66 gpm Forcemain Velocity 38.57 Pump Off Height Dose Tank Information 0.19 in 1.33 ft 30.00 5.47 ft' 0.00 ft N/A in 2,01 ft) 12 in Loclung mverwM wamng Nadel and Icckng dense, and Electrical as per NEC 30C sealed watetight and Comm 1628 VAC 4m men Disconnect Alternate outlet location TaNc component is properly vented Forcemam diameter �,� 2 in Manufacturer gal/inch - Weep hole or ant-sphcn deuce B Pump offel IRi 64 D Dose tank elevation (R) Mm 3" Bedding undertank 63 Custom Concrete Capaa[y 800 64 Dimension Inches Gallons A 19 41 431.72 B 2.00 44.48 C 2.59 57.56 D 12.00 266.88 Total 36.00 800 64 Alarm Manufacturer SJE Rhombus Alarm Model Number PS PATROL Pump Manufacturer GOULDS Pump Model Number WE07 Pump Must Delivery 19.66 gpm at 36.75 ft TDH Project Joseph Lyons Page 4 of 11 GSF WI MOUND DESIGN PROGRAM DISTRIBUTION MEDIA GSF Distribution Cell Media Layout OCell Width (ft) OSidewall to Lateral (ft) 4 ft Wde B43 Component Legend f- _ ASTM C33 Sand/Mound Sand A42 or 643 Module Lateral Turn -up (contained in Turn -up Enclosure) Distribution Cell Plan View Layout -Typical 4 Cell Width - A (ft) F 41.00 Cell Length - B (ft) 10 B43 Modules Required per Row 10 B43 Total Modules Required End Connection Later Layout Diagram Drag appropriate drawing from left to space below. FORCE MNN 4FTWCE END COWECTICN ProjectJoseph Lyons Page 5 of 11 GSF WI MOUND DESIGN PROGRAM SYSTEM MAINTENANCE SPECIFICATIONS Mound System Maintenance and Operation Specifications Service Provider's Name Countryside Plumbing and Heating Phone 715-246-2660 POWTS Regulator's Name St Croix County Phone 715-386-4680 System Flow and Load Parameters Design Flow- Peak 300 gpd Maximum Influent Particle Size I/8 In Estimated Flow - Average 200 gpd Maximum BODS 30 nri Septic Tank CapacityL 1000gal Maximum TSS 30 mg/L Soil Absorption Component Size 164 ft' Maximum FOG 10 mg/L Maximum Fecal Cohform 10E4 cfu/100 mL Septic and Pump Tanl Effluent Rltei Pump and Control, Alarm Pressure Systerr Mounc Othei 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 flushed and pressure tested every 1.5 years Inspect for pending 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 Lien mound component manual 2. Dispersal cell media conforms to Eljen products approved for use with the Ellen Mound Component Manual approved August 2016. Ellen media is covered with the manufacturers geotextile fabric. B. All gravity and pressure piping materials conform the requirements in the state code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 1911'.F.'E= LATERAL ENDS AT LAST 4" ORIFICE V+ERE UARJABLE UENGTH CL EANCUT BEGINS — DISTRIBUTION LATERAL Lateral Turn -up Detail 6 - d' DIAlvt1'ER LAVW SPF;JNId_ER CW LATERAL CLEAN XFF PLUG Project: Joseph Lyons Page 6 of 11 GSF WI MOUND DESIGN PROGRAM MANAGEMENT AND CONTINGENCY PLAN 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 Ellen Mound Component manual August 2016 and SSWMP Publication 9 6 (01181)) 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 watertightness 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, Slats. 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 filler shall be cleaned as necessary to ensure proper operation The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from Its enclosure If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may Indicate surge flows or an Impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 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 tested to verify proper operation If an effluent filter is installed within the tank it shall be inspected and serviced as necessary Mound and Pressure Distribution System No trees or shrubs should be planted on the mound Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration Cold weather installations (October -February) dictate that the mound be heavily mulched as protection from freezing. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell Observation pipes within the dispersal cell shall be checked for effluent ponding, Fondling levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider Project. Joseph Lyons Page 7 of 11 Wastewater APPUCA"ON5 uses: Specifically designed for the following Schools, . Homes, Farms, Trailer Courts, Motels, Hospitals, Industry,Effluent Systems SPECIFICATIONS pump /a capabilities:'" maximum. • Solids handlingNPT • Discharge size.2' • Capacities: up to 140 GPM ds' up to 1211 feetTDH. SJTOW or STOW severe duty oil and water resistant power cords. three prong grounding . ,/I -1 HP models have NEMA plugs. • 1 units have bare lead cord ends. Yz HP and larger Three phase (60 Hzh provided in • Class 10 overload protection must be separately ordered starter unit. • rds all have bare lead cord ends- n9s STOW PpWer co O eration: Pump ded • Total hea er4a0 C) continuous, 140°F (60°C) intermittent. • Temp ° specific HP, 104°F l umbersreverse side for • See order has and RPM's available. voltage, P MOTORS h_ grade turbine oil for lubri- • Fully submerged in big cation and efficient heat transfer, models. • Class B insulation on h -1 models. . Class F insulation on 2 Single p s for maximum phase (60 Hz): starting torque tor • Capacitor start mo • Ruilt-in overload with automatic reset. METER`. 40 3`. . Designed for Continuous P with - are within the motor man e ated Font nuous Y n working limits, can f f p submerged. out damage when fully lower heavy duty ball bearing . Bearings: Upper and lower heavy rated, oil and water resis- construction. end provides secondary d • Power Cable: Severe duty acket dama9 tant. Epoxy seal on motor f outer j Option Standard cord is 20' • P moisture barrier in case to prevent oil wicking' al lengths are available. 9 a ainst contaml- . O_ring: Assures positive sealing "ants and oil leakage. AGENCY j_ISTINGS ��d CSA 22 2 100 Standards U 116 a ian Standards Assonation vile NLR38549 Tested to ous gy Canad c so GPM m3/hr PAGE POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE WFORMATION -T. 41 owner AtTiV LYONS Permit i DESIGN PARAMETERS Numbs of Bedrooms 2 ❑ NA Numbs of Public Facility Units 10 NA Estimated flow (average) 200 al/d ay Design flow (peek), (Estimated x 1.5) 300 al/de Sall Applicetlon Rate •s al/d /ft' Standard Influent/Effluent Quality Monthly average` Pate, Oil & Grease (FOG) 530 mg/L Blodtemical Oxygen Demand fBODsI 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODJ 530 ng/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Cogform Igoometric mean) 510' cfu/10oml Maximum Effluent Particle Size Ye in die. 0 NA Other. ❑ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page of -I- Septic: Tank Capacity 1000 al ❑ NA Septic Tank Manufacturer CUSTUM PRECA019A Effluent Filter Manufacturer SIMTECH 0 NA Effluent Filter Model ❑ NA Pump Tank Capacity 800 al 0 NA Pump Tank Manufacturer CUSTUM PRECAST NA Pump Manufacture GOULDS ❑ NA Pump More-d 0 NA Pretreatment Unit O NA ❑ Send/Gravel Filter ❑ Peet Filter ❑ Mechanical Aeration ❑ Wetland O Disinfection 190ther: FLCXt Dispersal Cells) 0 NA ❑ In -Ground (gravity) ❑ In-Gmund (preasudzed) ❑ At -Grade Mound ❑ Ddic-Une ❑ Other: Other. ❑ NA Other. ❑ NA Other, 0 NA Service Event Service Frequency Inspect condition of tanks) At least once every: 3 mon slOt ears) (MaxYnum 3years) ❑ NA Pump out contents of tanks) When combined Budge and scum equals one-third %) of tank volume ❑ NA Inspect dispersal collie) At least once every: 3 0 month(s) (Maximum 3 re) O( year(s) Yea 0 NA Clean effluent fike At least once every: Elmonth(s) 1 X year(s) 0 NA Inspect pump, pump controls & alarm At least once every: eons months) 3 y ❑ NA Flush laterals and pressure test At least once every: . 0 month(s AS NEEDED ❑ yearls) 0 NA Other. At lees[ once every: ❑ month(s) ❑ year(s) 0 NA Other ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shell be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Malmainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) 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 pending of effluent on the ground surface. The dispersal cellfs) shall be visually inspected to check the effluent levee in the observation pipes and to check for any pending of effluent on the ground surface. The printing of effluent on the ground surface may Indicate a falling 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 %l 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 filers, mechanical or pressurized components, pretreatment tmite, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Mekrtalne. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event Page ? of Z START UP AND OPERATION ' Fpr new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process and/or damage the dispersal colts). If high concentrations ere detected have the contents of the tsnk(at removed by a septage servicing operator prior to use. System start up shell 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 cellist In one large dose, overloading the cell(s) and miry 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 perk over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or et -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance end prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreesers; 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 end/or Is permanently taken out of service the fogowing 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 plping to tanks and pits shell be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pie shell be removed and property disposed of by a Saptage 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 add material, CONTINGENCY PLAN If the POWTS falls 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 utlgzed 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. Felture to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement eystems must comply with the rules in affect 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 lair resort to replace the felled POWTS. ❑ Mound and et -grade soil absorption systems may be reconstructed In place following removal of the biomd at the Infiltrative , surface. Reconstructions of such systems must comply with the rules in affect at that time. < <WARMNG> > 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 Nerna LAJUIN I RTOWE r'LUIw1611VV HIVU fy Photo 715-246-2660 JU Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name BERANDS Name s' , C 1 ZOdtO Phone 715- Phone —7/f— 3fW60- This document was drafted In compliance with ohapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(tl. (2) & (3), Wisconsin Admlydsosdve Code. Eljen GSF Geotextile Sand Filter PASSIVE ADVANCED TREATMENT TECHNOLOGY Independent 3id Party Testing Confirms Compliance with NSF Standard 40 Protocol Requires a Smaller Installation Area than Traditional Systems Pre -treats Effluent with a Patented Two -Stage Bio-Mato Process Reduced Site Impact Made from Recycled Materials Lightweight and Easy to Handle Only the Eljen GSF Geotextile Sand Filter Pretreats Effluent with a Patented Two -Stage Bio-Matt" Process When your installation requires more performance in less space, the Eljen GSF delivers. With Eljen's patented two -stage Bio-Matt'" pre-treatment process the GSF applies a better than secondary treated effluent to the soil, increasing the soil's acceptance rate. The result is superior treatment it the smallest area possible when compared to other onsite technologies. A ELJEN'S EXCLUSIVE FOLDED DESIGN PROVIDES THE MAXIMUM TREATMENT SURFACE AREA IN A MINIMUM OF SPACE • Porous Top of the Eljen GSF allows evapotranspiration and oxygen exchange for better effluent treatment. • Anti-Slltation Fabric keeps fines out of the Eljen GSF • Untreated Effluent • Blo-Matt Fabric • Cuspated Plastic Core provides separation between layers of Bio-Matt' fabric. Maintains structural integrity of modules & aids oxygen transfer. Increases treatment surface area & effluent storage capacity. • Filtered Effluent • Treated Effluent FLEXIBLE SITE INSTALLATION • Trench or Bed layouts • Level or Sloped sites • Mound or In -Ground installations • Equal or Serial Distribution elen CORPORATION Innovative Environmental Products and Solutions Since 1970 125 McKee Street, East Hartford, CT 06108 800-444-1359 • 860-610-0426 • Fax:860-610-0427 Email: info@eljen.com • Website: eljen.com Patented C2015EIIencorperatlon 1516A-04/15 TRENCH SYSTEM—Soalght or Curved MOUND SYSTEM Perforated Pipe distributes effluent to the Eljen GSF. Pipe is secured to the GSF Modules with preformed metal clamps. Primary Treatment Zone forms on Bio-Matt— fabric. Significant fabric provided for every W of soil interface. Secondary Treatment Zone forms at sand layer. Long term acceptance rate of this biomat layer is significantly increased as compared to conventional systems. Specified Sand Layer provides additional filtration Native Soil or Fill provides final filtration IN -GROUND TRENCH SYSTEM SLOPED SYSTEM —In -Ground or Mound BED SYSTEM ROME GSF sle� 9 Step 14 General Installation Guidelines for Eljen Geotextile Sand Filter Systems 1 Carelul.y lay oil lie system com;:_ ---'s aid eefine se•oacks f'om cells. property boundaries and land terms such as streams aid dramaao nays in accordance with state aid local regulations 2 Prepare the site according to. and follow ng all slate and local regulations Do not install a system on frozen ground, saturated ground, or wet sods that are smeared during excavation Keep heavy machinery o" clayey soils used for the GSF systcrn as well as down -slope Irom the system whe•e sod structure is rorcal to, aCsorpror arc drainage Of the treated e'flderil 3 F'iai Pie dwers�on o' ups cne storrw.ater Set Sol grades at 31. min mum to ensure trial s+.orrrwa•er cmmage is opened away Irom Ire GSF system area once the system is cony ere 4 Excavate the trench. Scarify the receiving layer to maxnvze the irtedace between the native sod and the ASTM C33 specified sand layer 5 Remove all organic so l and roots al disposal are fit; extension areas 6 V Ti mize ,,,along in the trench or bed pier to placement o' the ASTM C33 specified sand to mo e soil c.YnpaO ron. 7 Rased an the GSF approval in your slate, place the proper amount o' a specified ASTM C33 sand with less than 10 % passing a #100 sieve and less than 5 passing a 0200 sieve and with a Coefficient of Per- meabddy greater than 5 feet per day on the bottom o1 the excavated trench 8 A hand Lampe' is suffioerr to s'anize lie Bard belo'.v the GSF modules Set the elevation of ;he top of Plc ASTM C33 specified sand aid CiecK to mace sure i is level using a 2' x 4- board and a carpenter's level, a, a laser level before placing the GSF modules 9 Avoiding footprints, place GSF modules with PAINTED STRIPE FACING UP, end to end on the ASTM C33 specified sand layer in the bottom of the trench CAUTION. Spacer cores can have sharp edges 10 Provide dstrbuhon bnxls) or drop -coxes defend ng i' the s ter s level or sloped 11 Use 4SDR 35 non-perforared pine'rom the d s;ribuhon box to the perforated pipe that is installed above the GSF mcdjles Note per'oralen pale is any used move -he module, 12 Center 4" SDR 35 perforated distribution ppe lengthwise over modules with orifices at 5 00 and 7 00 Using termination raps, cap the dislal ('art end of each perforated disinbunoa wipe, or connect distribution lines at the d stall tar) end of the sy,lem witi non -perforated re pe if multiple level trenches are des --nee 13 Secure tie distrbut on pipe to GSF modules usino one Hen wire clamp per module. Push clamp erds st•a ght cover into up-fanng core tivcugn the fabric and n:c tie underlying ASTM C33 specified sand layer 14 Spread Ellen cover labrrc lengthwise over the pipe and drape over the sides of the GSF module rows Secure the fabric by placing several shovels of specked said on top of the modules, between and along the noes of the modules Avoid bl cknq holes in oerforated pipe by placing the cover fabric over the pipe prior to olacor; ill over the modules 15 Based on the GSF approval in your stale place the proper amount of the specified ASTM C33 sand along the sides and ends of modules m the trench 16 Complete backf ll usirg excess AST M C33 sand on lop of the modules then loam to 12" minimum over lie ent re GSF syslern Bac4ill should be. clean. porous aid devo d of large rocks Systems will, bacid II exceeding I S' as measured from the top of lie GSF module recuires vowing at the distal (far) end of lie Pench Do rot use wheeled equpment over system A I ght track machine may be used with caution avoiding crush,rg o, siifbig or pipe assemdly BacK'ill in d rect on of pednrated pipe 17 Final grading of the site shall be it accordance with stale and local regulations Set gratle Of system and upslope area to divert stc rmwater runoff Finish grade over the GSF system shall be at a W. minimum to prevent surface pending BacKfill matenal surface shall be stabilized by seeding or sodding to establ sh a good vegetative cover In prevent ems on For more information, please contact your local 00-4 4-13 9 Ellen: eyen1-84500-44-139 nfo"ellen.com www.eljen.coln CORPORATION Innovative Environmental Products and Solutions Since 1970 I lied Cerporaruin 1110 Patented urnau!ds •j 4 � H 7 Sz eL 8.31 V.W.--�J. DJ�Vol on $16Wr i P7'ic TANK 3pS�Id b 00 GALS y / J CuSToM PRe-C A,5 fl J.sd n, c. er W i s r 7�1_ /-s 9'37 R;b,�1 cRGnrtf �gLOITch P� M P ��► N K _ r, i Yi ¢ -. cio co G 97 9 6 Wastewater APPLICATIONS Specifically designed for the following uses: • Homes, Farms, Trailer Courts, Motels, Schools, Hospitals, Industry, Effluent Systems SPECIFICATIONS Pump • Solids handling capabilities: -%" maximum. • Discharge size: 2" NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104eF(40aC) continuous, 140aF(60•C)intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. MOTORS • Fully submerged in high-grade turbine oil for lubri- cation and efficient heat transfer. • Class B insulation on Y3 - Pk HP models. • Class F insulation on 2 HP models. Single phase (60 Hz): • Capacitor start motors for maximum starting torque. • Built-in overload with automatic reset. METERS FEET 40 r 1 35 30 25 u a 20 O S 15 r 10 5 10 • SJTOW or STOW severe duty oil and water resistant power cords. • Y3 - 1 HP models have NEMA three prong grounding plugs. • 11h HP and larger units have bare lead cord ends. Three phase (60 Hz): • Class 10 overload protection must be provided in separately ordered starter unit. • STOW power cords all have bare lead cord ends. • Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously with- out damage when fully submerged. • Bearings: Upper and lower heavy duty ball bearing construction. • Power Cable: Severe duty rated, oil and water resis- tant. Epoxy seal on motor end provides secondary moisture barrier in case of outerjacket damage and to prevent oil wicking. Standard cord is 20'. Option- al lengths are available. • O-ring: Assures positive sealing against contami- nants and oil leakage. AGENCY LISTINGS Tested to UL 778 and CSA 22.2108 Standards By Canadian Standards Association File OLR38549 u5 01 1 _I_. _1; _.1_. ...,J..L!_1.._..:._._._lL1_....J _ L..... 1_. 1..._._._.1 .1_.1._ :,_L_._.._1_._..i . 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM I I I I I I I I I I I I I I I m3lhr 0 5 10 _ 1s 20 25 30 35 CAPACITY PAGE 44 NLESS STEEL TYPE 347 WITH 0,062 HOLES 2382 17 61 18 1/4" NPT FOR PRESSURE /ALARM SWITCH (STF-101) 13.0� PART# STF-100A2 DATE; 09/22/06 MATERIAL, REV; A DRAWN BY; JASON MAY APPROVED BY; DESCRIPTION; FIELD ASSEMBLE PRESSURE FILTER ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address)3150 160TH AVE located at: SW 1/,, SE /4, Section 11 Town30 N, Rangers W, Town of GLENWOOD , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service SEPT 1 Did flow back occur from absorption system? Yes_ Nox (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete x Steel Other Manufacturer (if known): CUSTUM PRECAST Age of Tank (if known): 1981 Permit number (if known) 8102960 (Licensed Plumber Signature) MASTER PLUMBER (Title) SEPT 22ND 2021 (Date) PAUL R KOEHLER (Print Name) 225410 (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 i ,�� �.:' � File #: ST. CRo NT N, SANITARY SYSTEM office Use Only 40" ' OWNERSHIP/ADDRESS FORM Created 212021 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. fOWNER/BUYER INFORMATION��r z . Owner/Buyer JERRY LYONS Mailing Address 3150 160TH AVE City/State/zip GLENWOOD CITY Phone Number (required) N/A Email Address (required)N/A Parcel Identification Number 016-1024-10-110 (found on the property tax bill) NEW SYSTEM. LEGAL DESCRIPTION y. w Property Location SW y4 SE y,, Sec. 11 , T 30-N R15 W, Town of GLENWOOD Subdivision Plat: p Lot Certified Survey Map # 5 Z Z Volume a . Page # 2 I L3Z Warranty Deed # /d % ` iG 2--9/ (before 2006)Volume . Page # Number of bedrooms 2 Spec house O yes ■ no Lot lines identifiable ■ yes 0 no OFFICE USE ONLY - New Property Address%� 1 S r I ✓� (Verificati new address required from Community Development Department for new construction) (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.00v SEP 27 NZI Wis. D t. of Safety and Professional Divisio of Safetyiygd, {iWirty 6ST-2vLI- 3'8r Page of 3 ICommunityDevelopment< i accordancewnnbvsmo, vis. Nom. �.00e Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may be used for secondary purposes (Pnvacy Law, s. 15.04 (1) (m)) Coumy STCROIX Parma I.D. 016-1024-10-110 Rev' wed by Date /J / /0 �7 Property Owner JERRY LYONS Property Location Govt. Lot SW 114 SE1/4 S 11T 30N R 15E (or) W Property Owners Mailing Address 3150160THAVE Lot # Block # Subd. Name or CSW (Ifjm 9-Z192- City State Zip Code Phone Number GLENWOOD WI 54013 ( ) ity Village • own Nearest Road GLENWOOD CTY RD X New Construction Use[3Residential / Number of bedrooms 2 Code derived design flow rate GPD ElReplacement Public or commercial - Describe. Parent material 0+kx1 b S) + l �ll� Flood Plain elevation q applicable ft General comments I and recommendations: a Boring # Boni �98.75 68 . pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onststence urdary Roots GPD fl#1 R#2 A 0-9 10 YR 3/2 - - SIL 2MBK ML CW 2M .6 .8 B 9-24 7.5YR 5/3 =--- SICL BK MFR GW 1F .4 .6 C 24-68 7.5YR4/4 -------- S 0 M SG ML C L LtS. to r IA ,� y o u )d >�:ei 40, �m ►^4 r ✓1 V FT]Boring # ❑ Boning 100 72 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz, Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD IR ' ff#1 B#2 A 0-14 10 YR 3/2 ---------- SIL 2MBK ML GW 2M .6 .8 B 14-48 7.5YR5/4 ------- SICL 2MBK MFR CA IF .4 .6 C 48 72 7.5YR4/4 ------- - S 0 M SG / MLX5- COBBLE Effluent #1 = BOD > 30 < 220 mgfL and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 myL and I tRi < M ntg/L CST Name (Please Print) Signature CST Number PAUL R KOEHLER 225410 Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE NEW RICHMOND WI AQUG 18TH 2O21 715-246-2660 SBD-8330 (Rl1/11) 7 01 Property Owner JERRY LYONS 016-1024-10-110 2 Parcel ID # Page of a Boring# U Boring 92.00 65 Pit Ground surface elev. ft. Depth to limiting factor in. S l Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. nststenceBoundary Roots I • GPDIft ' ft#1 ff#2 A 0-12 10 YR 3/2 --------------- SIL 2MBK ML CW 2M .6 .8 B 12-48 7.5YR5/4 ------------------- SICL 2MBK MFR CA 1F .4 .6 C 48-65 10 YR 7/3 ___________________ S 0 F SG ML ❑ 1__I Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. • Effluent #1 = BOD , > 30 <220 mgfL and TSS >30 < ISO mglL • Effluent #2 = BOD s < 30 mglL and TSS < 30 mgfL 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. S8D-833(r.I(RI Ir III Property Owner JERRY LYONS 016-1024-10-1I0 P.r iin3 2 3 Boring # ❑ Boring 92.00 65 y QPit Ground surface elev. ft. Depth to limiting factor in. Soil Awlicaion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft ' ff#1 ft#2 A 0-12 10 YR 3/2 -----_—_____ SIL 2MBK ML CW 2M .6 .8 B 12-48 7.SYR5/4 -------------- SICL 2MBK MFR CA 1F .4 .6 C 48-65 10 YR 7/3 ----_---__-- F S 0 F SG MIL — --- .5 .7 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ADDlication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. sistence Boundary Roots GPD/ft ff#1 fRF2 1-1Boring # 8 Boring Pit Ground surface elev. ft. Depth to limiting factor in. �_� Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots �i sauon rate GPD/ft ' f1#1 ff#2 • Effluent #1 = BOD s > 30 < 220 mg/L and TSS >30 < 150 mgfL • Effluent #2 = BOD c < 30 mg& and TSS < 30 mg/L 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. sao-833ornt(al 1111) le 16 1t ..4 �Pa" �T �t OVNS R1h I TGFOAPVL Iba 2 for 0'7 V C, Ito P�{ a Igo 21OP IL°ID Sly t0'1�tn✓Y q% S� y4 sE It Tao P,6 SCAI I='soft, e.,..P r4cr vu ►1�— S . Cc.. Y, COUNTY NO. 633963 STATE SANITARY PERMIT 3 1 so 1100+1 A.vt Exfamrxur�r PREVIOUS NO. OWNER PLUMBER TOWN SEC AND/OR LOT THIS PERMIT • POS Gyo LIC.# ZZS yto BLOCK SUBDIVISION zc VK*. 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. in) 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. ISSUING OFFICER -DATE /0// 14LESS RENEWED AIN VIEW Z/ THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (Rl1/20) RLPORT OF INSPECTION - INDIVIDUAL SLWAGI SVSTIM C t Sans (a)(y I'vrrmc l 190 ,07 slate Svpt(vlax � N A M I-Town)hi.p�N�(J�� _St. Cnviz County I cat<r n ��j�Sect� on Lod Subdi vi.5 i.on - SI P"TIC "FAN Si;v�l` ,=r _gaUone Numbe.n ob compaa.tmente D(A t(r VIC(I Ream: Wet Bu.itd.iny 12% )tape Highwatea PUMPING CHAMBER Sr.•v i -! gaffonb Pump ManaAactunen _ __--Mode.(' Number VOIDING TANK Sizv gatton) Numbe4 o6 Compattment) Pumpers. _ Atanm Sy)tem 120 )tope — — Highwaten ABSORPTION SITE BCd inenclr ' Of6tanee A)iom: We_tt_ � — Buikciing_ 12% )tope Highwate4 — - ABSORPTION SITE DIMENSIONS Width a( t&eneh --- st Reyu<nvd anea Lvngth oh each tine_s _ {t Depth oh Mach beeow t.lty - iri Number o6- &ne)— -- Depth oA itoch oven ttl'v--- --%in Totat tength oh tine)_ j,T 6t Depth o6 ti.te betow gaade _ _in D,stanee between Seope v( trench <n. pvn 100 At - Irrtaf ab)ohption anea _ -- - 6t Type o6 Coven: Papers o )tnaw ; f' 1 1 U L MI •NS I ONS -" Nurribvn vA pits GnaveC anoand I, t� ye) oil td+de diameters ! •�/'/ t De,. pth betuw cnCcr - —rro Total ab)onption anva Avvn , Y PLB 6 7 State and County State Permit # X� 2 Permit Application County Permi # for Private Domestic Sewage Systems County 'DENOTES STATE APPROVAL REQUIRED p �� c Date Approval Received from State if Required State Plan ID. # E�—Cza.9�C� A. OWNER OF PROPERTY B. LOCATION: f `Ej Subdivision Name, Mailing Address: DNS GLeNGi/oo<�, 6/7`Y Section , T,Q N, R j,y E (or) W Lot# City nearest road, lake or landmark Blk# Village Township oLt°NWsua( Single family ✓ Duplex No. of Bedrooms *3 No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder Automatic Washer _YES NO Other (specify) YES —NO # of Bath E. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks `Holding tank capacity Total gallons No. of tanks New Installation ✓ Addition Replacement Prefab Concrete .y- `Poured in Place Steel Other (specify) 9'006FA4, PU/24 Q /A4,11C F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft. New�Addition _ Replacement 'Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width ,4 Depth Tile Depth X " No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Hzoro Distance from critical slope r. O 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the tCerttffled Soil ester, , /NAME i¢14JPm( L@� C.S.T. # .�eJ —Sri (0 and other information obtained (owner/builder). Plumberure PMPRSW# o �� Phone #pZ3S%q( 2Plumber's -. b• - - _ PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). I I I i i , i I < d.)\ I — %o%. /, ?. C+N '�e4"^lary D D ., t — —t County ST CROIX afety and Buildings Division Sanitary Permit Number (to be filled n by Co.) � ;( +�l 201 .Washington Ave., P.O. Box 7162 !t� SEP 27 HZj Madison, Wl 53707-7162 \ `s A ` W qt. Croix Coi nty 33� 4,3 i I e lication State Transaction Number - N accordance with SPS 383.21(2), W rs Adm. Code, submission of this form to dIe appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for stat"wned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies Personal information you provide may be used for secondary purposes m accordance with the PrivacyLaw, s 15.0 1 m , Slats. �� V I. Application Information — Please Print All Information Property Owner's Name I LYONS S� L Parcel # 016-1024-10-110 Property Owner's Mailing Address ray Local o lI. 5+7 �� WA— 1d 3150 160TH AVE • • Govt. Lot SW i A SE ti, section 11 City, State Zip Code Ph on umber GLEN WOOD TY 54013 (cveleone) 15 E or)kV IL Type of Building (c k all that apply) Lot .. Q I or 2 Family Dwelling - N her of Bedrooms 2 1 Block # V ❑ Public/Commercial - Describe Us /E1 ❑ State Owned- Describe Use CSM NumberX g_�1p.LNWOOD III. Type of Permit: (Check only one box o line A. Complete line B if applicable) A. ❑ New System Y )0 Replacement S stem ep y ❑ Treatment/Holding Tank Rcpla t Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision hange of Plumber ennit Transfer to New List Previous Permit Number and Date Issued Before Expiration IV. Type of POWTS S stem/Com nent/Device: Check that a Non -Pressurized N-Ground O*WA z I r ❑ At ❑ Mound >_ 24 in, of suitable sod ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) E*retreamaent Device (exp ) ELJEN , V. Dis ersaVTrea ent Area Information: K { /`l /tB V Design Flow ( ) Design Soil Apphcation 4gpdsf) spersal Area (sf) Di Area sed sf) System Bl vaton 300 .6 00 500 �Z� �j , b VI. Tank Info Capacity in Gallons Total Gallons no Units Manufacturer s,'ri1k�a Fr7,k >r ,y /fir � u k U New Tanks Existi Tanks S Septic or Holdmgrank 1000 1 CUS M PRECAST X Dosing Chamber X 800 1 CUST PRECAST X t VII. Responsibility Statement- 1, t undersigned, assume responsibility for installation of the S shown on the attached plans. Plumber's Name (Print) Plumb; s Signature MP/MPRS Number Business Phone Number PAUL R KOEHLER � /� �� 225410 715 246 2660 Plumber's Address (Street, City late, Zip Code) 321 WISCONSIN IVE NEW RICHMOND WI 54017 VIII. Coon /De rt nt Use only Approved ❑ sapproved Pe�mri�t Fee S ✓ !J • O O Date Issu�ed Z �% Issuing Agent Si ��- Owner Given Reason for Denial / IX. Conditlo of ApprovaVReasons Tor Disipproval '3 .fn SYSTEM OWNER- A yX vyyt o Z eev ill- J a1 I(kj� 1 t _ I. SePtic tank. efllue,d filter and A I E✓ty--1 k-t- Eli j M V sal'} M•���" 10 W dispersal cell must be serviced/na'nta ned Un / as per mansgement plan by prov!ded Plumber.- 2. All solbaCk ee uiremenis must be msmtained �j at,, ) J� y L l Qa/ l �` "W applicatle ffa6lF/ufdiflanhaR -+ kv$i �%� S / C) f b !L /'1� C- l.{A r 7�h d 1 J • kX i5 $� Ar$� back to romp plain for the system and submit to teo- the uut�uty ly o apei oot lese p r�r 7vieNchp ja siu it bo�O W b11) e- xr(I'ia�i4&Ae4ll >Meir'1K~Vix IZ" 1[Sav� tv/Ji4rt Oj-clex vni4S� ':�Iadt � ., CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: JERRY LYONS Owner's Name: Owner's Address: 3150 160TH AVE GLENWOOD CITY Legal Description: SWl/4 SE 1/4 S 11 T 30 R 15W , Township: GLENWOOD County: ST CROIX Subdivision Name: Lot Number. Parcel ID Number. Designer/Plumber. Date: Signature 016-1024-10-110 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Fitter Specs Page 5 Maintenance Information Page 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans PAUL R KOEHLER 09/22/2021 License Number: 225410 Phone Number (715) 246-2660 Designed pursuant to the In -Ground Soil Absorption Component Manual for POWiS Version 2.0 SBD-10705-P (N,01/01). Page 1 Project Name: Owner's Name: Legal Description: Township: County: Subdivision Name: Lot Number. Parcel ID Number: Date: CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Y LYONS ` 3150 160TH AVE GLENWOOD CITY \ z SE 1/4 S I I T 30 R 15W ST 016-1024-10-110 Page Index and title Pa 2 lot Plan ge 3 System SIZINK& Cross-S Page 4 Filter ecs Page 5 Maintenance In mat Page 6 Management P Page 7 St. Croix Cty Septic Tank ME Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans PAUL R KOEHLER License Number: 09/22/2021 Phone Number Form 225410 (715)246-2660 Signature --0--�i� d1i Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-107D5-P (N.01101). Page 1 yv� e OGN-- Can'}o�r �x65 I �sD�D�54� 041 42°' v L�r►r \ J j31� 1 �(Dpo�PVG 1 a am 'i ID{p C 1 P j{ 2 a�. P;{ �4 a s P . e�, a�tt 9% b 3 5'yet shy sIf Tab G IGgwop/ L Ss C-414- 1' =soft, rtNNrr ,ter Cln Eljen GSE System Wl Design Program Data Print 2 nd Zan Clem name 1"', won, Safe rather 315016put ave G ien worn City Dest(ner Paul N goehler famere, nue warYsMek edro sam, ns. hemmer N sa/ tebe, or dress nal mneuks laminator Haft, III. Tre onsurdanch,Mrt r..r eerh so,ua The ,them a moks, 66osM mn oneho M1antl comakfamorm, scre",m/ah4 avy,rume,. �lareaara�lafY ManlarA _ NWba�s'� � dalN Note <mt C3nirwrm 11 She CheraRerne, /�_r Onaem Rl bD'lotlo� Pa. gatM1r Total Number a Badrooms 2 _ DDF per Bedroom(Dally Carlini Flow per Bedroom) 150 8pt DIN Bahr Deagt Flow) - [yuh Pill 12 ap llirar tP r _ Ppptlotpn Rate, Q6 Plh' i 3.. b, _ .ere eaa�� 4 i:?' .. Re,ii Bayl N,a ION.µ,Gum, enq Unk 115M U,ual B13 9a3 unit lmlaB WId1A - 4 5 Fact a er Unk 16 _ 12 M u me M N' Mnlmum Numb Olen W Modules Required (ReOuPed Basal Pr - Square Foolage per Unn or&tlroomse(S for B43 or 6 for Ali whkh... h eater) lateral of Dien GSF Modu sea Must begreater then orequal inlmum Humber of Ellen 43F Module, 32 IT its RrymreO 13 DMnbufion Call Des en Number of DlrtdbuGon Cells/TsenNes lPra supportsup to4Trenahes or 1 Number 0 laterals Inside Cell linogram supports up p 2 A Distalbultan Call Wlhh(k let b red, Cell Width is gre than 10 it and needs to be reused) B B. Distribution CN14ng1R C. unteral to bt<ra SpaOnB lMuhlple III f,.ems) 400 n D.Itlenl to Edge Spatlng(Multiple lateral systems) Zoo k Units per Row(4 red, adhrt number of mrduln to make rows equal) 16 T.! Square Footprint _ _... s:B A. Width . B. Length 65 C. Late 4.00 Lateral Spacing 200 D. Lateral to Edge Spacing A A. Width B\ C. Late 400 Lateral Species nit) 2.00 D. Lateral to Edge MIN 12' OF CLEAN FILL 12' D C A Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer HILLSDALE PRECAST Tank Model Number Total Tank Capacity 800.00 Max. Bury Depth 8.00 Outlet Manhole Mle 4" Above Gm*OQVii Locking Devi Inlet Manhole < 6" Below Grade led Watertight -% .• — —r — Inlet Depth of Cover Ft Outlet -*—� In Switch ings and Reserve Capacity TagfVolume = GPI D' anion Inches Volume Gal. e) A 17 340.00 (alarm) B 2 40.00 (dose) C 10 200.00 (dead) D 10 200.00 Total 39 780.00 Pump Manufacturer GOULDS Pump Model Number WE05 HH Alarm Manufacturer SJ RHOMBUS Alarm Model Number PS PATROL Switch Type 7, I I 10; Manhole Min. 4" Above Graft outlet �h, WithMormted wiLocki9 ng Device Manhole Min. 4" Above Graft outlet �h, WithMormted wiLocki9 ng Device weatba-proof )unction Box 4-� Vent Min.12" Disconnect Above Grade Means With Vent cap B ,, > weep Hoolf e Off Elevation C Ft Bottom D Elevation .<...... �_ Ft GENERAL INSTALLATION: The septictdose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.2.8 WAC. 02105 LJ Page of ly-