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012-1077-20-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] IuounrySt. Croix I 022200171-C Thomas & Rita Hawley I TOWN OF ERIN PRAIRIE1 012-1077-20-000 CST BM Elev Insp. BM Elev: BM Description: Section/TownMangelMap No: 36.30.17.558E TANK INFORMATION 7, NC TYPE MANLFA TURER CAPACITY Septic II1_G ,l Dosing Aeration Holding TANK SETBACK INFORMATION J , _) _ t / lA , •.A C PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Li Friction oss System He t Ft 1 Forcemain Le lh Dia. 11 to well \ r,sl, SOIL ABSORPTION SYSTEM ELEVATION DATA (,) g$ 9 1 . a . C�15" • iW : ` .II BED/TRENCH DIMENSIONS Width / Le ng No. Of es f tQ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO 0 1PILBLDG WELL LAKE/STREAM LEACHING Manufactu INFORMATION T Of Syst": ;7�. ✓ r CHAMBER OR uNIT Model Nu DISTRIBUTION SYSTEM Header/hAanifold Distribution x Hole Size x Hole S Vent to Air Intake ll-ength--9�- Pipes) 1 t1 ( I pII \ Dia Length Di Spacing D SOIL COVER x Pressure ysterns Only xx Mound Or At -Grade Systems Only Depth Ova Depth Over xx Depth of xz Seeded/Sod xx Mulched BedlTre Center `, Bed/Trench Edges TOP" f� Yes � No ;s Yes COMMENTS: (Include code discrepenciees, persons present, etc`.) Inspection #1: Inspection #2: Location: 1218 205TH ST *� yCA, �}'flcJ ae(�G� . —v"�ve Who i oI& 1.) Alt BM Description = �j'`(pJ{ Q�' J, 1�llt t ) � . I'�iN ti2-t/a7d-'f d''\ �Ju umf Y 2.)Bldg sewer length = 7LV [l 1�� 1" QWA'ry C1W R" mot'I,,Vj„Jt ! (lt -amount of cover = V _� j `�/{ lamkv Plan revision Required? EAJ Yes No �n Use rsideforadditionalinformat W '1 _ _ _ _ _ V�1 _ _I __t( SBD6770(R 3/97) Date des Signature Can. No. Industry Services Division County _ rt r�Q�L 4822 Madison Yards Way Madison, WI 53705 ST CROIX Sinitary Permit Number (to be filled in by Co.) 16 �, Fig 4c tti P.O. Box 7162 Madison 70 1 2 (� Z Z? -5 opt eat s St Permit Applicatio State Transaction Number zzZp61 C In acco w0A 321(2) Win. Adm. Code, submission of this forth to the ate governmental tout O is required p o obtaining s sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (f different than mailing address) the Department of Safety and Professional Services. Personal information you provide tray be used for secondary purposes in accordance with the Privacy Law, s. I5.04(I)(m), Stats. 1 s1 L tioalaformatioa-Putt hW An ermldeia Property Owner's Name Parcel M THOMAS AND RITA HAWLEY 012-1077-20-000 Property Owner's Mailing Address pygerty Ipcon 6 1218 205TH STREET w ' . b - `6 Govt. LA)t City, State Zip Code Phone Number BALDWIN WI 715-222-6694 sw 1/4, ,, Sewn 36 Il.3W:s+[BOU111[nt (check aU that oppty) Lot g T 30 N R 17 E or W ©l or 2 Family Dwelling - Number ofBedrooms 4 Subdivision Name Dublic/Cmmrwrcial - Describe Use Block M itv of aState Owed - Describe Use CSM Number illage of Z o ►�-¢, yin. ✓DTownof ERIN PRAIRE T)pe of POWTS Permit: (Check either "Nests" '' ' , a" . w Yee A..abecik lio has q ae Compliant cane C ff , ; A e w System Replaternent System LL E]M r Modification to Existing System (explain) dditiaul Pretreatment Unit (explain) B' a�lolding Tank [:]In -Ground Dot -Grade ❑✓ Mound Individual Site Design Other Type (explain) (conventional) C. Renewal Before ❑Revision Ficha)" c of PWmber laransfer to New Owner 't ist Previous Permit Number and Date issued S"'J L4C-�- = Zz t Expiration 6'43 vn; IV. rattneat Area and Tank lafonnsdi : Design Flow (gpd) Design Soil cation Rate(gpd/sf) Dispersal Area equired (sf) Dispersal Are posed (sf) 80os stem Elevation 8q, Z43 600 .6 Q B 328 7 328 ,) Tank Information Capacity in Gallons Total I Gallons q of Units Manu acwrer /�/C SZS a �+ U ,u New Tardy Existing Tasks 0 ..7 1 U = e ti a i� d Septic or Holding Tank X 1200 1 1 1 WIESER ✓ Dosing Chamber X 1 1 800 1 1 1 WIESER ✓ V. Rp ilfly Statetowt- 4 tlh! .;aoriillpwd, assoate responatbilty for installation of the POWTS shown on the attacYed plasm. Plumber's Name (Print) Plumber' Sign MP,MPRS Number Business Phone Number PAUL R KOEHLER 111-i 225410 715-246-2660 Plumber's Address (Street, City. State, Zip Code) _ 321 WISCONSIN DRIVE NEW RICHMOND WI VI. Canty artmeet Use Only Approved ❑Disapproved Permit Fee Dar Issssueedd is A nt Signamre ❑ Owner Given Reason for Denial $(p I J5. 00 Z `�f Z Conditions of Approval/Reasons for Disapproval �Q _ _/f h SYMMOWNER: 1. Septic tank effluent fitter and dispersal cell mvst be servicedlmaintaerW r J� as per management plan provided by ptutnbaa 2. As setback requir# nil nWt W mahAvi rtl A as par applicable woe/ordirw as, (o e L Attach to taaplete plans 4 be' Ines sadsubmit to the Cwaty ea paper sat its an a in s 11 in adze 1' r//(/vn _ {. vkvt lo!'bvf /&N S YS r`' !'L(etirV4i'tLtn�-er / SBD 6398 (R. 03/21) � � d � I 4, 0.t V MAGI LA A The exist. POWTS shall be found and properly abandoned per SPS 383.33, WAC Act T 93,8 h Y 4 , _0 s� Y, w LRK� P4 i so 11, o r►w5 4.j Kith ii ow L � }' su 3L T3DIJ $17W of roLc ,Fft Pr,;, coA+Owr ��ifi UG�IG��i1cLlF. Bast. 0-� Lgvji �1-- Pri 1 B�Ir 9 PI't 3 �3�$ $�Dpa. S°Xa s'CAit r February 10, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-02-10 Plan Review: PWTS-022200171-C PAUL R KOEHLER 321 Wisconsin Dr New Richmond WI 54017 SITE: Thomas and Rita Hawley 1218 205th Street Town Of Erin Prairie St. Croix County Total Amount: $250.00 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay httplldsps.wi.gov/programsfindustry-services www.wisconsln.gov Tony Evens - Governor Dawn Crim -Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DN SION OF 1 TRY SERVICES SEE CORRESPOND CE FOR: Description: Four Bedroom GSF Mound System 1 Sloping site ELJEN GSF Mound Component Manual — May 2018 Version, 600 GPD, 14" depth to limiting factor from original grade, Maintenance required, Effluent filter, Replacement Construction 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(1-0), 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 • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Ms. Stats. Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. 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 she 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. • 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. State. • 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. 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. 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. 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, POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: Katie. PetzelAwisconsin.gov Cell: 608-574-1189 X.- Project Name: Owners Name: Owners Address: Legal Description: Township GSF W I MOUND DESIGN PROGRAM INDEX AND TITLE PAGE THOMAS AND RITA HAWLEY 1218 2057H STREET BALDWIN WI 54002 SW 1/4 SE 114 SEC 36 T 30 R 17 W ERIN PRAIRE County: ST CROIX Subdivision Name: Lot Number. Block Number. Parcel I.D. Number. 012-1077-20-000 Plan Transaction No.: Page 1 Conditionally Page 2 APPROVED Page 3 DEPT. OF SAFETY AND PROFESSIONAL Page 4 Page 5 SERVICES DIVISION OF INWISTRY SERVICES Page 6 Page 7 Page 8 SEE CORRESPOND CE Index and tide Data entry GSF mound drawings Lateral and dose tank Distribution media System maintenance specifications Management and contingency plan Pump curve and specifications Designer. PAUL R KOEHLER License Number. 2254101 Date: 1/26/2022 Phone Number. 715-246-2660 Signature: ��/�=/�✓ Designed Pursuant to the GSF Mound Component Manual (N. 08116), and SSWMP Publication 9.6 Design Pressure Distribution Networks for STSAS (01/81) GSF Mound Version 1.0 Page 1 of 8 9 _ a CAST -A -SEAL I. �• 1�11 � �j m 1 � 1 li ;'I i Ali II FILTER OR I I I II I BAFFLE wI /-4' CAST -A -SEAL r%i � '•�CL �v I CU � � PUMP PAD SIDE 1aEW WLP1200/800-MR TANK SPECIFICATIONS DIMENSIONS: WALL• 3' BOTTOM: 3' COVER 6' MANHOLE: 24' I.D. PRECAST CONCRETE RISER HEIGHT: 53' LENGTH: 13'-8• WIDTH. 8'-O' BELOW INLET: 41' LIQUID LEVEL: 36' WEIGHT: BOTTOM 14,800 LBS. COVER 8,170 LBS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: W ISCONSN. SEE DETAIL f10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 33.46 GALAN (SEPTIC) 22.24 GAL/IN (PUMP) LOADING DESIGN: B'-O' UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN f6 (NO FIBER) TANK: MIX DESIGN /B (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE c yt } m � J 3s QQI 4II7 REVIEWED BY o U REVIEW DATE a DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: PRODUCTS NEEDED BY: � O POWTS OWNER'S MANUAL & MANAGEMENT PLAN . Ps" I of 2 Rl X INFORMATION Owner THOMAS AND RITA HAWLEY Permit i Number of Bedrooms 4 ❑ NA Number of Public Facility Units 9( NA Estimated flow leverage) 400gal/day Design flow (peak), (Estimated x 1.5) 600gal/day Sol Application Rate .8 aUd /w Standard Influant/Effluent Duality Monthly average* Fats, On & Grease fFOG) 530 mg/L Biochemical Oxygen Demand (BODd 5220 mg/L ❑ NA Total Suspended Sold* rTSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Conform (geometric mean) 51 W cfu/100ml Mmdmum Effluent Particle Size Ys in dia. ❑ NA Other ❑ NA *Values typical for domestic wastewater and septic tank effluent. s AMTFauewr_F sutmmfn F SYSTEM SPECIFICATIONS Septic Tank Capacity 1200 gal O NA Septic Tank Manufacturer WIESER ❑ NA Effluent Filter Manufacturer POLY LOCK ❑ NA Effluent Filter Model 525 ❑ NA Pump Tank Capacity 800 al ❑ NA Pump Tank Manufacturer Wieser ❑ NA Pip Manufwuw GOULDS ❑ NA Pump Model 'EPO4 ❑ NA Pratreatinmt Unh ❑ Sand/Qraval Filter ❑ Past Flier ❑ Mechanical Aeration ❑ Wadand ❑ Disinfection ❑ Other: ❑ NA Dispersal Call(s) ❑ in -Ground (gay) ❑ At -Grade ❑ Drip -Una ❑ NA ❑ in -Ground (pressurized) UK Mound ❑ Other: 0"M ❑ NA Dd'sn ❑ NA Otiwr. ❑ NA — — — Sarvlee Event Service Frequency Inspect condition of tanks) At least once every: 3 J00 = a) (Maidrnum 3 yeas) O NA Pump an contents of tank(s) When combined sludge and scum equals one-third (Ysl of tank volume ❑ NA Inspect dispersal call(s) At bast once every: 3 ❑morn (e) (Mcdmum 3 ysers) ❑ NA Clean aent filter fffu At least once every: 1 ❑ monin) ❑ NA Inspect pump, pump controls & alarm At least once every: 3 ❑ motih(sl Pq ❑ NA Flush laterals and pressure test At least once every: Q Ne) AS NEEDED ❑ NA 'sr st At leaonce every: p ear month(s) IRNA Other: ,Q 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(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 pondinp of effluent on the ground surface. The dispersal cellis) shag be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of affluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate notff)cetion of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third (Ys) 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. AD other services, including but not limited to the servicing cf 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 avant. STARTUP AND OPERATION Pepe Z of 7i ' 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 cellls), if high concentrations are detected have the contents of the tank(a) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infitretive surface. During power outages pump tanks may fin above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(a) in one large dose, overloading the ceg(sl 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 calls. Do not drive or park over, or otherwise disturb or compact, the area within 16 feet down elope of any mend or at -grade soil absorption area. Reduction or aOmination of the following from the wastewater stream may improve the performance and prolong the He of the PDWTS: 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; on, painting products; pesticides; sanitary napkins; tampons; and water softener brkM& ABANDONMENT When the POWTS fails and/or Is pemhanertly taken out of service'the following steps shag be taken to insure that_the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and phs shag 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 kwt 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 compilant 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 Ones and wells. Failure to protect the replacement area will result In the need for a new soli and site evaluation to establish a sultabfa replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area Is not avallabie due to setback and/or sob Omhatlons. Barring advances in POWTS technology a holding tank may be Installed as a lest resort to replace the failed POWTS. IN ❑ Mound and at -grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltretive 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. ADDITIONAL COMMENTS Name COUNTRYSIDE PLG AND HEATING Phone 1 715 246 2660 POVIRS MAINTAINER Name PAUL R KOEHLER Phone 715 246 2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORJTY Name Name Phone Phone —71 f — 36 (p— f'D b This downem was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54111, (2) & (31, Wwoonsin Admfilstratim Cods. We, Dept of Safety and Professional Services SOIL EVALUATION REPORT Division of Safety and Buildings In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches In sae. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Reviewed M Personal irdonnabon you prome may be used for secondary pulse■ (boy Law, a. 15.61 (1) (m)). Pop —L of 3 ST CRODC 012-1077-20-000 -•--� -""-- rrupenyLucauun ❑l THOMAS AND RITA L HAWLEY Gov. Lot SW 1µ SE1µ S 36T 30N R 17E (or} Property Owners Mailing Address Lot #Mock # I Subd. Nsrne or CSW 1218 205TH STREET City Stab Zip Code Phone Number owlage ■ own Nearest Road BALDWIN W1 1 54002 1 71�-222-6694 Q New Comrbucson UseO Residential f Number of bedrooms 4 Code derived design flow rats600 GPD Q Replacement ❑ Public or commercial - Descrbe: Parent material MAGNOR SILT LOAM Rood Plain elevation ff applicable ft Gerwral comments and remrrmwdations: u Boning U Boring # QPit Ground surface elev. 84.9 R Depth to uniting factor 18 in. Rate Horizon Depth Dominant Color Redox Description Texture Structure idenoe Boundary Root GPDIft = h. Munsell Qu. Sz Cont Color Gr. Sz Sh. "I A 0-8 10TR3/3 L 2MBK MFI GW 2F .6 .8 EB 848 --I0YR613 SIL 2 MSBK MFI aw IF .6 .8 C 1 18-26 1 7.5 YR 5/3 7.5 YR 5M C3D SIL 0M MVFI GW --- .0 .2 Bo 2 l3orirg # ring 88.6 14 0 Pit Ground surface elev. ft Depth to I niting factor In Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz Cont Color Texture Structure Gr. Sz Sit nsistence Boundary Roots GPD/R ' }yt1 A 0-8 10 YR 3/3 L 2 M S13K MFI GW 2F ,6 ,8 EM 8-14 10 YR 6/3 SIL 2 M SBK MFI GW 1F .6 .8 C 14-24 10 yR 6/3 75M 518 C3D SIL OM MVFI GW _ .0 .2 ------' --- - -••g.. .....,w-vv_,w „y� GlrYentfrG-ou/ �JV RIg/L am 100 � au"WL CST Name (Please Print) Signature CST Number PAUL R KOEHLER v„/�� 225410 Address Date Evaluation Concluded Telephone Number 321 WISCONSIN DRIVE NOV 17TH 2O21 715-246-2660 Property Owner THOMAS AND RITA HAWLY Parcel ID # Boring ❑ pitGround surface slay. 83.8 ft 012-1077-20-000 Depth to Bmntg factor 14 in. Pape 2 of 3 Sna AnWwmtinn Rarn Horizon Depth In. Dorninantcolor tdunsel Redox Description Qu. Sz Cont. Color Texture Structure Gr. Sz Sh. istsnce Boundary Roots GPD/ft t A 0-8 10 YR 3/3 - --- L 2 M SBR MFI GW 2F .6 .8 E/B 8-14 0 YR 6 SIL 2 M SBK MFI OW tF .6 .8 C 14-26 10 YR 6n 7.5 YR 518 C3D Sul OM WE GW — .0 s Boring • Boring Pit Ground surface elev. R Depth to Imling factor in Goa dX-.M. RaL Qu. Sz. Cent Color p,,,;,,w H Boring ���M Pn Ground surface slay. R Depth to limiting fecbr In. Sol Application Rate . Effluent N1 = SOD ! > 30 1220 mg/L and TSS >30 < 150 mg& ' Eflluerd a7 - BOO � < 30 rrV& and TSS < 30 r g& 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. saobwru(sunq 0 1 ,I -1-11ODS %5 ibis q'88 z �'d 6 �h8 Vd 00 x +� �LI y rtOCI ?E 7 rid 'YN rr& skw o / �'Oip-oL-LlAl-tl4 4Z leg b� // Mu �C, Wy 1 I I 1 I 1 I 1 Tc� I One I 1 OQJ fT�d�x1 �o-attiq 1 tip i ST. CR �� Nrv. SANITARY SYSTEM File #: l%ra'rrrnsn Office Use Only 10 OWNERSHIPIADDRESS FORM creaw W021 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 OWNER/BUYER INFORMATION THOMAS AND RITA HAWLEY Mailing Address 1218 205TH STREET City/State/Zip BALDWIN WWII >Q Phone Number (required) / / `-�� !� h -,/ply Email Address Parcel Identification Number 012107720000 (found on the property tax bill) ,NEW SYSTEM: LEGAL DESCRIPTION Property Location SW 1/4 , SE t/4 , sec. 36 J T 30 N R 17 W, Town of ERIN PRAIRIE Subdivision Plat: Certified Survey Map # Warranty Deed # _ I Volume . Page # 2006)Volume . Page # Lot # Number of bedrooms 4 Spec house O yes ■ no Lot lines identifiable ■ yes 0 no New Property Address rx is4y'\' (VerificaUaKof 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.aov Mound Plan View Mound Component Dimensions D 22.00 n G 0.50 ft J 17.61 fl W 27.3310 ft 328.00 (ft2) Dispersal Cell Area I 807.94 (e) Basal Area Available 14.63 (gpdMt) Linear Loading Rate 4.10 (ft) 1110 B Obs. Pipe Placement Finished Grade 91.02 (ft) �poll 6 H 90.02 (ft) Lateral Invert Cell 89A3 (III)--- Elevation Dispersal Cell ::::.•.. S 1 Elevation ••••••••••••• 3 !.::::•::::.•.....:.•::•::•::•::•::•:•::::•:::•::•:•:•:•:•::{ •:•:: :•:•: ' :•' X :•::•:87.60 Countour ..................... ................ Elevation . • • • • :::�� b-10 Site Slope Shading Key crzmn Topsoil Cap Subsoil Cap ASTM C33 Sand Tilled Layer Project: GSF Media Typical Dispersal Cal See Page b Geotextile Fabric —> F 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. THOMAS AND RITA HAW LEY Page 3 of 8 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below P Ttmm-W vAmA valve or deonait plug Z let onHioe lomw at Z =X== Ortllloes Point up aoaoept every 6th one pokes down for drairrpa Fcme main oonnectfon vie tee or cross to matfold at any point. Laterals &taros mein of PVC Bch 40 All laterals Identical w8h oMfloe equally spaced• (per COMM Table 84.366) Numbers of Laterals 2 Ortnce Diameter 0.175 in Lateral Diameter 15 in Orifice Spacing (X) 3.21 ft Lateral Length (P) 39.26 ft Orifices per Lateral 13 Lateral End (2) 0.74 ft Orifice Density 12.61538 ft'/ortfk Lateral Spacing (S) 4 ft Manifold Length 4 ft Lateral Flow Rate 5.355033 gpm Manifold Diameter 2 In System Flow Rate 1 10.71007 gpm Forcemain Velocity 1.093757 ft/sec 3852 Pump Off Height 12 in Dose Tank Information I Loddnpoar�wnn}0 d wd1.l*pdaJoe, and Elach 1aspa•NECJ00 aaredsalatldt do '16LIE NC unn —( 41n.mh ANt..part Is pnosiyve isd YJIESER Icapacity I800 Volume 1 22.24 Vlamrfacturer F— Sallons A pl/Inch B Dimension inches Gallons A 19.2818848 428.9291 B 2 44.48 C 2.68933827 59.91098 D 12 266.88 Total 35.971223 Boo MrL T BeddngudarleNc Alarm Manufacturer Sl ROMBUS Alarm Model Number I PS PATROL Pump Manufacturer GOULDS Pump Model Number 504 Pump Must Delivery 10.71007 gpm at 14.34912 ft Project: T HOMAS AND RtITA HAWLEY Fdow ain dendar 2 1n' Mp dfalvRam M 82.6 D=tv* WvMcn M 81.6 TDH Page 4 of 8 GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Site Information R Residential or Commercial Design 600 Design Flow (gpd) 5.0% Site Slope (%) 87.60 Installtion Cantor Line Elevation (ft) 14 Depth to Limiting Factor (in) D.8 InSku Soll Appiiction Rate (gpolftz) Distribution Cell Information B43 Unit Used 8 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 41 = Dispersal Cell Length (ft) 2.0 Dispersal Cell Design Loading Rate (gpd/ftz) 2 Influent Wastewater Oualtity Are the laterals the highest point In the distribution Ii Pressure Distribution Information network? Enter Y or N EE Center, End or No Manifold (Pump to Gravity) ®Number of Bedrooms (optional) 120.00 Contour Length Available (ft) Lateral Spacing Number of Laterals Orrtflce Diameter (in) (e.g. 0.25) Estimated Orifice Spacing (It) _ Forcemaln Diameter (in) Forcernaln Length (ft) Inside Pump Tank Elevation (ft) 6.5 System Head (ft) x 1.3 7.416667 Vertical Ufl (ft) 0.432451 Friction Loss (ft) 14. 44912 Total Dynamic Head (ft) Lateral Diameter Selection In. diem. options choice 0.75 1.00 x 1.25 x 1.50 x X 2.00 x 3.00 x Septic Tank Information 1200 Septic Tank Capacity (gal) WIESER IManufacturer Dose Tank Information 800 Dose Tank Capacity (gal) 22.241 Dose Tank Volume (gaUln) WIESER Manufacturer If N above, enter the elevation ft of the highest point. 12.81538 ft2/orifice Does the forcemain drain back? 0 24.48753 Forcernain Drainbac k (gal) 35.34335 5x Void Volume (gal) 59.81088 Minimum Dose Volume (gal) 10.71007 System Demand (gpm) Manifold Diameter Slection In. dia. options choice 1.25 1.50 2.00 X 3.00 Gallons/Inch Calculator 1200 Total Tank Capacity (gat) 38 Total Working Liquid Depth (in) 33.33333 gain Effluent Filter Information POLY LOCK Filter Manufacter 525 Fitter Model Number Project: THOMAS AND RITA HAWLEY Page 2 of 8 no Ce f1+o.+r B 7.L ssjOe I— 6l44dr:,... 9 17 83.8 a � � tRKY. 1 `= ya 1 1�1g �*r� St, l�� w�nw•� : 4 Pq cu.l TO a��-1o77-z�-caa T�pmwS ,.J su 36 Tao IJ R 17W S w ky e�' Yl,.L SC4 to A 10 Em Prq,rt. i 'a4va utaft Brit. A,+ Ow dt = IDD Pli 1 ft l PINY 2 4s,� Pit 3 931% slnpa 6 /0 S'Cwrs. r CYb 100 GSF Distribution Cell Media layout ! ®Cell Width (ft) Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Drag appropriate drawing to soace below. 8 it Wide ASTM C33 Sand/Mound Sand A42 or B43 Module Lateral Tumup (contained in Turnup Enclosure) Distribtion Cell Piand View Layout - Typical 8 Cell Width - A (ft) 41.00 Cell Length - B (ft) 10943 1 Modules Required per Row 20 B43 JTotal Modules Required End Connection Later Layout Diagram Drag appropriate drawing from left to space below. Project: THOMA5 AND RITA HAWLEY Page 5 of 8 Mound System Malntenence and Operation Specifications Service Provider's Name I Phone POWTS Regulator's Name COUNTRYSIDE PLUMBING AND HEATING Phone 715-246-2660 System Flow and Load Parameters Design Fbw - Peakgpd Maximum Influent Particle Size 1 In Estimated IF - Averagegpd Maximum BODS 30 mg/L Septic Tank Capacitygal Maximum TSS 30 mg/L Soil Absorption Component Size[]ft' Maximum FOG 10 mg/L Maximum Fecal Coliform 10E4 cis/100 mL Septic and Pump Tani Effluent Flltei Pump and Controb Alarrr Pressure System Mount Othe Service frequency Insped and/or service once every 3 years ShoWd Inspect and dean 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 pondng 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 Epen mound component manual. 2. Dispersal cell media conforms to Ellen products approved for use with the Ellen Mom Component Manual approved August 2016. Ellen 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 accomptised with a mold board or chisel plow. S. The mound structure and other disturbed areas will be seeded and mulched to prevent soli erosion and help reduce frost penetration. Lateral Turn -up Debll 8-8'DIAhfz 8 LAWN SPRINKLER TM SWEEP90 OR TYYO 45 OEr3REE EM3JDS SAME DIA ETEli AS LATERAL Protect THOMAS AND RITA HAWLEY Page 8 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 Egan Mound Component manual August 2016 and SSWMP Publication 9.6 (01/81)1 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 fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced If the alarm Is activated oontinuousty. Intermittent filter alarms may Indicate surge flows or an Impending continuous alarm. The septic tank shall have Its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, If such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify Pry 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 riot recommended since soil compaction may hinder aeration of the Infiltrative, surface within the mound and snow compaction In the winter will promote Bost 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. 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. Contingencv Plan If the septic tank or any of its components become defecttvve 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 components) 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 Page 7 of 8 [e. GOULDS PUMPS APPLICATIONS Specifically designed for the • Effluent systems • Homes • Farms Hea• yrduty sump • Dewatering SPECIFICATIONS • Solds handling capability: 11,r nmadmum. • Capacities: up to 60 GPM. ��• Total heads: up to 31 feet. • Disd►arge Site. I V NPT. • Mechanical seal: carly - rotaWaaramic4tatlonary. BeUmNpA-rNatellaaslomers. m. • 1046F OM continuous 140•F (60*0 intermittent. • Fasteners: 300 series stainless aw. • Capable of running dry without damage to components. Motor. • EP04 Si phase: 0.4 HP, t t 5 or V, 60 Hz.1550 RPM, butt in overload wth autbm5radc resetngke 03 • 115 V or 238V, 60 H2;11550 RPM, built in overload with automate reset. • Power cord:10 foot standard lerhgdh,1613 SJTW with three prong grounding foot length, plug. SJ1W wtth three prong grounding plug (standard on EP05). • FuUy submerged in high grade turbine al for lubrication and effident heat transfer. Available for automatic and manual operation. Auto- matic models include Medraniol Float Switch assembled and preset at the FEATURES ■ EP04 Impeller Thennopfas- tic semi -open design with pump out variesfor mecha" seal protection. FARM ,FE Submersible Effluent Pump EP04 & -E PO 5 Series nermoplas- tic�endoW"krr design for Improved perkrmanm Base: Rugged tthn"Llst erng �k design provides superior strength and corrosion resistance. ■ motor Housing: Cast Iron forAcient heat transfer, strength, and dur"ky. ■ Motor Cover: Thermoplastic cover with integral handle and Ow switch attachrnent pokTh. ■ Power Cell Severe duty rated oil and water resismrrt. ■ Bearigs: Upper and lower heavy dory ball bearing cmouction. AGENCY LISTING �Ohrira 9realri Asailoa lar � tJeaio 6ouYrti4 b 60Soat nr�awht INS tM�tirt t�fir�h�rornntataaahaas�rhtaa�r..�- ro ME a 2 4 6 8 cAPAcrnr 10 12 MVh 0 2003 Gourds PUMPS Wedi,e ",2003 B3871 j'J' ITT Industries Is CST-aoa (— q-7 � D27 2a21 i �D� Yft. Dept of Safe anECd Proto Mnal Services SOI EPORT Page of 3 Division of Safety ar�d Buildings , roix C'-'"''' ' ,p�dt+' 'danoewith SPS 385, Wit. Adm. Code Co nminty ST CROIX Attach complete sdVoIbm on paper not bas than 8 112 x 11 inches in size. Plan must include, but not imbed to: vertical and hortzontal reference point (BM), direction and Parcel I.D. 012-1077-20-M percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Reviewed by Data Personal irdormabon you Provide may be used for secondary purposes (Privacy Low, a. 15.04 (1) (m)). Property Owner Property Location THOMAS AND RITA L HAWLEY GovL Lot SW 1/4 SE 1/4 S 36T 30N R 17E (or) W❑ Property Owriers Mailing Address Lot ag Beck * Srbd. Name or CSW 1218 205TH STREET I I & nfy" City Stag Tip Code Phone Number ❑Vllage a own Nearest Road BALDWIN I WI 1 54002 1 ( 71)5-222-6694 ❑ New Construction Usela Residential / Number of bedrooms 4 Code derived design now rat GM I mall errient ❑Pudic or corrrnerrial -Describe: Parent ma*W MAGNOR SILT LOAM Flood Plain elevation if applicable General comments and recommendations: ft. l Borings ❑ Boring A -1- JD El Pit Ground surface elev. 84.9 ft. Depth 10 uniting facer 18 in. Sol Application Rate Hor¢on Depth Dominant Color Redox Description Texturo Structurece nsistenBoundary Roots in. Munsel Qu. Sz. Cont Color Gr. Sz. Sh. RitlM A 0-8 10 TR 3/3 ----- L 2MBK MFI GW 2F .6 .8 E/B 8-18 10 YR 6/3 --'--- SEL 2 MSBK MFI GW 1F .6 .8 C i 8-26 7.5 YR 5/3 7.5 YR 5/8 C3D SIL 0M MVFI GW — •0 1 Boring / U Boring A- .— � 88.6 14 0 Pit Ground surface elev. fL Depth to limiting factor in. I, e. , s •r . o.s. Horizon Depth in. Dominant Color Munsel Redox Desorption Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. nsislmoe Roots GPD/R ' A 0-8 10 YR 3/3 L 2 M SBK MFI GW 2F .6 .8 EB 8-14 10 YR 6/3 — — SIL 2 M SBK MFI GW IF .6 .8 C 14-24 10 YR 6/3 7.5YR 518 OD SIL OM VF MI GW .0 .2 Eftient 91 = BOD > 30 < ZZ0 mWL and 155 >30 < 150 mgrL - tmalerm Wz = nuu j au M0fL aria r %�Q 2 .>v nqL CST Name (Pleaee Print) Signaturo CST Number PAUL R KOEHLER v��l� 225410 Address Dab Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE NOV 17TH 2O21 715-246-2660 Z_ SBD4330 (RI t/l 1) Property Owner TH�OMAS AND RITA RAWLY Parcel ID 012-1077-20-000 Page 3 Boring# v Boring 4 �p Groundsuriaceelev. 83.8 fl Pit Depth to limiting factor 14 in. 2 3 Horizon Depth in. Dominant Color Munsel Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. bomistanoe undary Roots GPDlR fW fw A 0-8 10 YR 3/3 ---- — -- L 2 M SBK MFI GW 2F .6 .8 g/B 8-14 10 YR 6/3 — ------ SIL 2 M SBK MFI GW IF .6 .8 C 14-26 10 YR 6/3 7.5 YR 5/8 C3D SIL OM MWI GW _ .0 .2 1:1 H Boring # Boring Pit Ground surface elev. R Depth to limiting factor in. Redox Description Qu. Sz. Cont. Color Boring #a "`tiny Pit Ground surface elev. R Depth to uniting factor in. _ r .I. j...��. P.-All•'11- • Effluent #1 = BOD 5 > 30 < 220 mg& and TSS >30 < 150 mg& • Effluent #2 = BOD : < 30 mg1L and TSS < 30 nV& 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. SDD433OTM (aI Ill 1) 4,,wf- vm ►� 1W Boor too � oc K 1 �W11Y i = y0 a� I $ �o1rI- St. LIA PG tc�.l SO aiZ-1071- 2-0-oa6 S« 36T--io0 A17W �anc S w � #i Tk4- scr. � 6 qt r✓S / To Env Pro;rt. 86yc; ti` ctit aa.5c- d'i L.,6Pesi Ai Oe1,e = IDD Pli 1 ?�,9 Ply 2 gB,, Pit 3 $3/8 Slo pes 60/0 574 A?(t �CK• TNO. 642275 STATE SANITARY PERMIT /zI8 z05t1 � ERIRE L PREVIOUS NO, 1431Z5 OWNER 7 OWC.1 � )e.Ja &IJIr✓ PLUMBER TOWN OF. rip% SEC 3 9T 36 AND/OR LOT N9 THIS PERMIT EXPIRES LIC.# ZZ614/b R_L7-_EAW BLOCK SUBDIVISION 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 regWations in force on the date of approval. (c) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations wiR 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 UNLESS RENEWED Z,g/ Z Z ORE THAT DATE AIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1/20)