HomeMy WebLinkAbout018-2019-73-000Wisconsin 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 (Pnvacy Law s 15 04 r-
Permit Holder's Name City Village Tornsnip
C&J Builders Inc TOWN OF HAMMOND
CST BM Elev lInsp BM Elev I BM Description
TANK INFORMATION
TYPE
MANUFACTURER ;1
CAPACITY
Sepik
M
e
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG
Vent to Air Intake
ROAD
Septic
l
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Loss
SOIL ABSORPTION SYSTEM
ELEVATION DATA
STATION
BS
HI
FS
ELEV
Benchmark
S$42.
tc '�-
Alt BM
gS.S
Bld Sewer
l
Sl Inlet
St/Ht Outlet
DI Inlet
Dt Bottom
Headet-Wan
Dist Pipe
Bot System
Final Grade
St Cover
C r
9 �S77
.0
BEDITRENCH
DIMENSIONS
Width
Length
No Of Trenches
PIT DIMENSIONS
No Of Pits
Inside Did
Liquid Depth
SETBACK
INFORMATION
SYSTENVO,PIL
BLD
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer
Type Of Syste
Motlel Number
UIJ I KICU I IUN SYS I LM
Header/Mandold
Distribution
x Hole Size
x Hole Spacing
nt to A
Veir Intake
Pipe
Length Dia
Lengths)
Die Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
v Mulched
BedFTrench Center
Bed/Trench Edges
To
-1
Yes - No
❑ Yes I No
COMMENTS: (Include code discrepencies, persons present. etc)
Location: 743 165TH ST
1 1 Alt BM Description =- `1� (CV-�
2 ) Bldg sewer length = Lf Q
- amount of cover =
J
Inspection #1. Inspection #2
roO"tMOIN MOuAda►vo� )0+at i
Plan revision Re ulretlo Yes � No
Use other side for additional information�
88D-6710 (R 3l97) Date I. pc 's Signature CarrNo
<7yu —do A i— <)Sd
County �
I Safety and Buildings Division
St.Croix
2021
201 W Washington Ave., P.O. Box 7162
Sanitary Perron Number (m be filled m by Co I
MAR 3 0
Madison, W1 53707-7162
� �' ao
ham,3
rolz Co�ncy
r tv
APPIUevll•
State Transaction Number
-Com
eI'I'II1t
In accordance with SPS 383 21(2), W is Adm Code, submission of this form to the appropnate g vemmental unit
011900012-C mound
Proleet Address (if different than mauling address)
is required prior to obtaining a sanhary permit Note Application forms for stateowned POINTS are submitted to
the Department of Safely and Professional Servnes Personal information you provide may be used for secondary
purposesmaccurdancewth the Privacy Law, s 15 (W(I Nm), Suus.
743 165th St.
I. A lieation Information - Pka a: Print All Information
Property Owner's Name -
Parcel q
C & J Builders Inc.
018-2019-73-000
Property (Tuner's Mailing Address
Property Location
316 Kamloops Place
Govt Lot
SE / SW y, Section 29
City, State
!rip Code Phone
Number
River Falls,Wi.
54022 715-222-9731
(circle(r�p}
T 29 N, R�E.1
11. Type of Building (check a0 that apply) Lot
a
Subdivision Name
BI I or 2 Family Dwelling - Number 4 73
(Bedrooms
A 4 Q'ar hilu-1) Block
Rolling Hills Farm
a
❑ Pubhc/Commerenal - Describe Use
❑ City of
❑ State Owned - Describe Use CSM
❑ Village of _
Number
$J Town of Hammond
III. Type of Permit: (Check only one boa on line A. Complete line B if applicable)
A
New System
y
❑Replacement System
❑ Treatment/Holding Tank Replacement Only
❑Other Modification to Exnstmg System (explain)
B.
❑ Permit Renews]
❑ Perron Revision
❑ Change of Plumber
ElPermitTransfer to New
Owner
List Previous Perini( Number and Dale 1.
5/%yZvjq
Before Expiration
607100
IV. Type of POWTS S stetn/CounnenVIE) ice: Check all that a
❑ Non -Pressurized In -Ground ❑ Pressun,ed In -Ground ❑ At -Grade Mound> 24 in of suiniblS jpAj ❑ Mound <24 in o
soil
❑ Holding Tank ❑ Other Dispersal Component (explam) _ J0Pretreatment Device a lam) Hoot/600
V. Dispenaliffmatment Arcs lallmi mation:
Design Flow (gpd)
Design Sod Application Rae(gpdst)
Do, .1 Area Required (sf)
Dispersal Area Proposed (at)
System Elevation
3000 1
Existing
VI. Tank Info
Capacity in
Gallons
Total
Gallons
M of
Unts
Manufacturer
m
'
2
r9
New Turks
Fisting Talcs
a V
rim
Sepue or Folding Task
400/921
1
Hoot/Weser
x
Dosing chamber
2000
Wieser
X
VII. Responsibility Statement- 1, the undersigned, ass a rea sibdi fay Installation of the POINTS s►owe on the attacked plans.
Plumber's Name (Print)
PI
MP/MPRS Number
Business Phone Number
Keith Knudtson
648443
651-470-1737
Plumber's Address (Street, Crty, State, - Code
927 150th St. Roberts,Wi. 54023
VM. Coun /De rtment Use Only
Approved
X❑
❑ Dn
Permit Fee
iIO
Date Issued^^
Issnin Agent Sngres
'
en Ream r Denial
WZ
- w ce—
STEM OWNER: �Tw"
I Septic tank, effluent filter and TFtv�+t�� E� Z) tzvL
1
dispersal cell must be serviced / maintained
lplummber,
management plan provided byyplumber.
as per
All setback requirements must be maintained
as per applicable code/ol>tMndt+sewgetr M.ae 111mr the system and abA-amecoaaryonly WL aor teas m.c'a�naeuaa
SBD-6398 (R. ll/11) 1�'t5{p�,�y.�tlC,i(A, iyyiV�Y��r�-�, �i
6t'-PuS3 i�l��
4_3- v o
Q ✓�
514
165TH
STREET
L _ 106� '*
N
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H
pa
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to �Sn0M
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LEGEND
• FOUND IRON PIPE PER PUT OR AS NOTED
711 WOOD HUB SET AT ID'OFFSET OR
ON BUILDING UNEE1 ,,S,,N
T.O.N. TOP OF H U B ELEVATION
T.O.D. TOP OF IRON BAR ELEVATION
- - - - - UD LUT 3 DRAINAGE EASEMENT
-' - - - DRAINAGE EASEMENT
ALL EXTERIOR BUILDING CORNERS
MARKED WITH FIN FLAGS
FIELD WORK COMPLETED: 3/9/21
0
in v 0
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p
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IbPaJI:+TSON
CONTRACTING, LL,
927150TH ST. 643447NIri 6
ROBERTS. WI 54023-K25
CELL 651.470-1737
�ncCOPY
16.5TH
STREET
S
i
L'hL err ��
N
w
V
LEGEND
• FOUND IRON PIPE PER PLAT OR AS NOTED
0 WOOD HUB SET AT 10'OfFSET OR
ON BUILDING LINE EMENSN)N
LO. H. TOP OF HUB ELEVATION
T.O.B. TOP Of IRON BAR ELEVATION
- - - -- - UTIIDT B DRAINAGE EASEMENT
- ---
DRAINAGEEASEMENT
ALL EXTERIOR BUILDING CORNERS
MARKED WITH PIN FLAGS
FIELDWORK COMPLETED: 3/9/21
-42
1
91of 04
Ldfi 73
KNJuTSON
CONTRACTING, lL::
327150THST.648447rv1?i S
ROBERTS, WI 84023.8526
CELL 651.470-1737
t
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LAWN, RUUY Al
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LOT 72
9178100 . PT.
L,6.Or1080.00
OT 73
L.B.O.- 09000 a
1 pp'1,7O8 8Q rT. R
zeg�L.8.0.-1090,00
OT 767ee so.Pl"'
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'LOT 7
1 21,781 a0. I VI
�1,�•� t L,8,O,•1080.00
!� w•pp� RV
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LOT 7721,70,80 I '
L.B.O,e1080,01
TE 107.6
\ \
\ 8 "
WELL AND
ALL WELIJ
DISTANCE
SHOWN 0
INSTALLEI
SEPTIC TA
FURTHER
AFTER A Y
ON ADJ01
SYSTEM 8
FROM AN'
ALL LOT <
AOCESSI
OUTLOT 11
LOCATED
TO THEIR
INSTALLA
RELATED
Prlwte On,Site Waste TrgWigM Sptern (POWTS) lnspection Apeernent
The homed operation of the equipment noted below signlhcarntly inquarxa the We of tine was ewaber systern.
Periodic haspecdote wia help ndend the gfe of the systern and prevent the need for costly repo The agreement
autlwdzee myour POW S equipment by a trained and auf wiaM tedrnican, durigdayeahtrtto
Prns ovide regular inapedioarid routine
aintunanoeto help astrre qui the epnmwo t b rking papacy.y.
It is hereby agreed by and between Purchaser and "udtw n PlU nbkigand CpWnsciFg that In consideration of the
P3Vnerrts Providad for herein, Krwdtson Plumbing and Contractingwill Plow Me the sans of a facary-trakhed
repnhsenrative to Perform Periodic kapedkm of the eWfpment dewed below. Kmdraon PknMrRg and
Conbadahg will Prepare a wdlbm report after each mspeWon and Provide a copy of the report w the Purduser.
This report will mrxaln recommendatdns for any operation and maintenance deemed appropriate by the
inspechor
Th6 agreertKnt does not assume any responsibilities for obligations that are normally the respartlhilifies of
Purcraser and does note t d to rover any oasts that may be asso®te with my recommendations made under
thk agreement In no event shall Knudeson Plumbing and C tractkig be raspmtdble for any speoal or
mreequnhtlal damages, including but not limited to bs of time, mray tar person or property or kpJdental
emnamic loss due to equipment failure or for any other reason whatsoever. Knudtson plumbing and Cnntmeing
may supply additional services, parts or labor only after authoriedon by Pm b,,,r.
This agreement shag remain m fume for a period of_1_years, beginning May_ 202C and will
autumatitally renew each year thereafter for one year unless canceled by ertiver party wiM at hart 3o days written
notice. Tlds agreement tray he canceled by the Purchaser only if seplaad by a sesrive agreement with an
authorized service Provider for the equipment asted below. Knucitson Plumbing and Contracting may delay or
carpel future khspeWons if payment becomes at least IS days past due
Periodic Inspections: Association agrees to pay Knudtson Plumbing and Comoe og$_2oo.0o par each
house's annual Inspection. Airy additional testing or serNss squired will be billed on time and material amounts
EQLIIDnWR fevered tinder This Agn aamertt
Desotipt m Model fed. Serial N0. Oe""— Dare Lmt nt iFdHfistlR
Knudtrgs Plumbing and Contracting
927150v' St, Roberts, Wl 54023
651-470-1737
a
SWaltae-
Dale_ n --
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State & ZIP
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Contractor Guidelines for ATU Septic Homes
The septic system for this home will depend on the proper functioning of the Aerobic Treatment
Unit (ATU), which is designed to treat and degrade solids prior to discharge into the shared
septic system. As contractor, please observe the following construction guidelines:
• As part of design and construction, arrange for any clear water, including that from
condensate litres, sump pumps, etc. to go to an external discharge. Backwash from water
softeners should also be discharged externally.
• Garbage disposals are not recommended.
• Avoid allowing any inert construction materials such as plastic, rubber, cigarette fitters,
bandages, rags, cloth and towels to enter the system. Likewise, prevent construction
chemicals and toxins such as paint and paint thinners, solvents, etc., from entering the
system.
• The ATU manufacturer does not recommend tank installation in frozen ground, and it
will be done only at the contractor's request and risk. Installation under these conditions
will likely also incur added costs related to requirements such as snow removal, frost
ripping, etc.
• Ftneze warniap• Do not allow water from furnace condensate lines or other source&
includin¢ sinks and toilets. to go into the system during winter construction, as this can
cause the tank and componeocts to freeze and fail, Unlike traditional septic tanks, AN
tanks are shallow with vertical walls, plus there is no bacterial action at this stage to
generate heat Contactors failing to observe these precautions may be Gable for system
repair and/or replacement due to fiwzing. Whenever possible, keep interior water lines
turned off during winter until the time of occupancy.
• If the system has been used dining construction at other times of the year, the tank must
be pumped prior to homeowner occupancy.
For questions regarding these contortion guidelines, call:
Knudtson Plumbing and Contracting
651-470.1737
I have reviewed and understand the above guidelines:
3 -�5 = zz z-I
Contractor
7-21
Rolling Hills Lot #
5Z,
010
Green Choice Applications:
Single and Mufti -Family
Dwellings, light commercial,
Churches, and other similar
Residential strength uses.
Performance:
98% Reduction CBODs
99% Reduction TSS
99% Conversion of Ammonia (NH3)
Feca! <1 Mn^
Range of Sizes:
500, 600,750 & 1000 GPD
High performance, low cost energy efficient treatment system
he H-Series Gravity Treatment System provides high performance at a price comparable to most entry level ATU's.
Producing effluent of less than 3 mg/L on CBODs and 2 mg/L on TSS, it far exceeds the secondary standards of 25 mg/L on
CBODs and 30 mg/L on TSS. with these results, many locations allow reductions in disposal areas between 25 and 40%.
Because the H-Series completely transforms ammonia into nitrate, it is best suited for applications with rich organic soil
content, surface plant growth and depth to groundwater to prevent nitrogen pollution of the water table.
Simple installation, reliable performance, low cost of ownership
This level of performance is enhanced by its simple installation, energy efficient performance and low cost long term
maintenance and ownership. The systems components are assembled at controlled manufacturing facilities, rather than in
the field to ensure reliable performance with local support
Energy efficient environmental protection
Made of locally available and manufactured concrete, the H-Series features an energy efficient linear compressor that
use less power than an average light bulb. Its polyethylene clarifier hopper is made of recycled milkjugs. Choose Hoot,
and you make a sensible, decision to protect the environment as you protect our most precious resource, our water.
Drainfield and Vertical Separation Reductions
With gravity flow discharge, the H-Series allows you to choose your disposal application from conventional lateral fines,
leeching chambers, other alternative drainfield materials. In some areas direct discharge is an option as well. Reductions
of vertical separations to groundwater and impermeable layers such as rock range from 1 to 2 feet
Make the green choice for wastewater treatment
Your wastewater system is the most expensive and important appliance you will ever purchase Don't settle for just any
system. Protect your family and the environment with a Hoot H-Series System.
Wieser Concrete Products Inc. 1-8O0-32548436 www.wieserconorete.com
a
co
4" CAS
knell
4" CAS
POLYLOK 12" ACCESS LID (TYP)
EZ SET RISER (TYP)
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM 11 .7 REQUIREMENTS
600 GPD ORAVI"UDIO QHARGE SYSTEM
H-600 A
TANK SPECIFICATIONS
DIMENSIONS:
WALL.. 3"
BOTTOM: 3"
COVER: 4"
MANHOLE: 12" & 24" I.D. PLASTIC RISER
HEIGHT: 70' O.D.
LENGTH 108" O.D.
m $
WIDTH: 74 1/2" O.D.
BELOW INLET: 57" O,D.
LIQUID LEVEL: 81"
Lu
WEIGHT: 11,138 LBS,
INLET AND OUTLET:
■
4" CAST -A -SEAL (CAS) BOOT OR EQUAL
COVER: MIX DESIGN 0 (NO FIBER)
TANK: MIX DESIGN f
l9 (SMALL FIB R)
P5
CUSTOMIZED TANKS:
FOR CUBTOMI�TANKS CONTACT WIESER CONCRETE
o_
Td'
U
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
SHEET
APPROVAL DATE:
1
PRODUCTS NEEDED BY:
,OF
S-. CRo uN ry SANITARY SYSTEM Elle#`
O/ C Use Only
OWNERSHIPIADDRESS FORM I c—red2awl
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.
Owner/Buyer _
Mailing Address
City/State/Zip
Phone Number I
Email Address to
Parcel Identification Number
(found on the property tax bill)
OWNER/BUYER INFORMATION
Pq
L
Z
— �3,CIA D
NEW SYSTEM: LEGAL DESCRIPTION
Property LocationAir—,,
pir-- , ,.51 'h , Sec 2-7 T{ JN R_ ZW, Town of —NGi W tM 0
Subdivision Plat K o If!�ft � �{'M Lot # 73.
Certified Survey Map # QQ _ Volume_ Page #
Warranty Deed # — I �D 6 zD (before 2006)Volume Page #
Number of bedrooms q Spec house dyes D no Lot lines identltlable).yes O no
OF E USE ONLLYY
New gpgrty Address
(�
} t 3
'
1(0 J -/ l �/i
(VeriTratiof new
dons reyu,red from Community nrvebpment Department for new conzrucnon)
Iz
LI
(Stall lmnals)
(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
r
Community Development Department - Land Use Division
715-3864680 St Croix County Government Center 715-245-4250 Fax
cdd(msccwcoov 1101 Carmichael Road, Hudson, WI 54016 www scowl oov
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address
City/State 16l.h q4, Parcel Identification Number / �'— �� �}' 2 -3
LEGAL DESCRIPTION
Property Location 5jt- n/. ,S'LO %a , Sec. p,,'I,2? N R1W, Town of J!L—e Z
Subdivision
Certified Survey Map k
Warranty Deed p
Volume , Page #
(before 2007)Volume Page H
Spec hops A-C] a Let lhws identifiabi-X-11rm
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Lot i! _U.
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed parapet. What you put into
the system can affect the function, of the septic bird as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 393 S2(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Lining Department a cer ification form, signed by the
owner and by a masts plumber, joumeynan phmbe, Tesmded plumber or a licensed pumper verifying that (1) the on -site
wasleuater disposal system is in proper operating axalitim a l/or (2) after inspection and pumping (ifnecessary), the septic tank is
less than 113 full .(.sludge.
Uwe, the undersigned have read the above requirements and agree to maintain are private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department ofNatmd Resources,
State of wiscomin. Centificadmi stating that your septic syste o has been majecumcd must be completed and returned to the SL Croix
Coady Planning & Zoning Department within 30 days ofthe tlr year expiration date.
Itwc certify that all statements an this form are hue to the best of my/our knowledge. Uwe am/arethe owners) of the
property described above, by virtue of a warranty deal recorded in Register of Deeds Office
-
Number of bedrooms /
U RIGNATUItE OF APPLICANT(S)
/ zY/ Z.)
DATE
***Any infatuation that is misrepresented may result in the sanitary pemut being revoked by the Planning & Zoning Department. "r
Include with this application a retarded warranty deed from dw Kegister of Deeds Office and a copy ofdre certified survey mop if
reference is made in are warranty deed.
(REV. W12)
IMPORTANT
NOTE.
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St. Croix County
AFRO BIC TREATMENT UNIT (ATU)
SERVICING AGREEMENT
State Plan Transaction Number - PWTS-01 1900012-C
C 8t 3 Builders, Inc
Name — (Owner) Typed or printed
He/she is the legal owner of the following parcel of land located in St. Croix County,
Wisconsin. with their deed or document of ownership interest recorded as Document
Number 1116820 St. Croix Register of Deeds Office.
This Property is described as follows (include lot no. and subdivision/CSM or detailed
legal description):
LOT 73 of Rolling Hills Farm plat, in the Town of Hammond,
St. Croix County, Wl.
OR.
See attached deed copy for legal descriptions
77 iuiiiii�iii
Tx:4665387
1127395
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
04/08/2021 01:29 PM
EXEMPT ft:
REC FEE 30.00
PAGES: 1
RECEIVE^
APR 0 8 20;
ST.. CRIM COUNT
ling Anna
� NDj2E:Tl;j ABDjtf -rMG
KAM-00P9 fLRtf RJvcit FA tt5
Agreement Date: 4/8/2021 Parcel Identification Number (PM)
As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Acrobic "1 reatment Unit on the above -described property, we
agree to do the following:
1. Owner agrees to conform to all applicable requirements of SPS 383, Wis Adm Code relating to Aerobic Treatment Units (ATU) and the
maintenance requirements for the proposed POW'I'S (Private Onsite Wastewater Treatment System) technology. If the owner fails to have the
POWTS and At U properly serviced in response to orders Issued by the govemmental unit or the Department of Safety and Professional Services
(DSPS) to prevent or abate a human health hazard as described in s 254.59, Stats , the governmental unit (Town) may enter upon the property
and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment
for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats.
2 The owner agrees to maintain a contract with a licensed POWTS maintainer for the life of the system The POWTS maintainer will perform
periodic inspections and maintenance as required by the manufacturer and the Department, including, but not limited to. the blower, electrical
controls, and treatment unit operation and sludge depth These inspections are to be scheduled every 6 months for the first two years of operation
and yearly thereafter.
3 The owner agrees to contact the POW S maintainer Immediately upon any malfunction of the treatment unit and to maintain the unit so as to not
create a human health hazard as described in s. 254.59, Static.
4. The owner recognizes that the county, DSPS, or POWTS maintainer may make periodic inspections of the components to complete performance
monitoring ofthe unit
5. "1'he owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection, maintenance or
servicing event in a manner specified by the department or designated agent within 10 business days from the date of inspection, maintenance or
servicing.
6 This agreement will remain in effect only until the county once responsible for the regulation of POINTS certifies that the aerobic treatment unit
no longer serves the property In addition, this agreement may be cancelled by executing and recording said certification with reference to this
agreement in such manner which will permit the existence of the certification to be determined by reference to the property.
7_ This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to
the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement jly�,"ermined by
rrrr
reference to the property where the Aerobic Treatment Unit is installed eN %S TA 4
r G--'_
Owner(s) Name(s) - Please Print
Subscribed and swom to before me on this dyer -14
e CO: fJL
z erFr-y r {,busby-2
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Notarized Owners Signalurc(s)
Notary Oubhe • �r
///�
Govco,mental Unit Official Name, Title - Please Print
y Commission Expires
Community Development Department
GovemOfficial Signature
Drafted by
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Community Development Department
Personal information you provide may be used for secondary purposes [Privacy Law s. I5.04(1)(m)]
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1310.OT X
DRAIN FIELD LOT GROUP MASTER DRAIN FIELD MAP 2018
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WisconsinDepartmentofCo erce ���^ /`
Safety and Building Division (\ JYf6III iv -Cv-
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IVATESEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORM TION2)ir' j(,ef�rl�75
(ATTACH TO PERMIT)
Personal information you orovid myt be used.for econddhuro s
v Law. s.15.04 (1)(ni
County: St. Croix
Semi Permit No:
607100
Slate Plan ID No:
011900012-Ci
Permit Holder's Name
City Village Township
Parcel Tax No
Voran Desoto LLC
I TOWN OF HAMMOND
018-2019-75-000
CST BM Elev
Insp. BM Elev
BM Description:
Sec6onrrown/Range/Map No:
ro
_
I l &S1
29.29.17.1275
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
wil— lZ if TT
geo/9z/
Dosing
. ";5
r
Aeration
t
Fleld+rnt
Stu
T
TANK SETBACK INFORMATION ,
TANKTO
P/L
WELL
BLDG.
Vent to Alr Intake
ROAD
R-0-IF
2Sxf-
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
6
Q
ELEVATION DATA•Z.-7 /p2,'7 /di
STATION
BS
OHI Z, qj
FS
oOV.
Benchmark
z . s8
Iaz.�
ll
ion
It. BM
05
�4
Bldg. Sewer
:11
r
g8
St/Ht Inlet
q 22-
SVHt Outlet
Dt Inlet
IZ Q
v
7#,
Dt Bottom
•
�G r
-7/, Z3
Head fMa71
2 o'L
(?0/,d
Dist. Pipe
3. nP_
1 �. �i%i
Bot. System
a
Final Grade
St Cover
Sa .es
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r
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Cf311.'rcv�
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13.53
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•
TA63
9,48
A&-i
SOIL ABSORPTION SYSTEM
-) ' $ Z • /d.$S //a�
BED/TRENCH Wdth r
DIMENSIONS
Length `^�' Nc Of ReMrM
1
L.� V
PITDIMENSIONS No Of Inside 1) Liquid De
/
212 ' _ /
1
SETBACK
SYSTEM TO
P/L
BLDG
WELL
LAKEISTREAM
LEACHING
Manufacturer.
INFORMATION
OR
CHA UNIT
Type O
S m:
9I. 7
W vt
N
1
N
^-
NI('
Model ni
DISTR}BUTION SYSTEM
f-5 )
to ;..& jYiak c.,OP = 12,Z)=
Head r enfold
�tr
Distribution
Pipe(s) 04
V
x Hole Size G ry
7 2
x Hole Spacin
r
�% yI
ant Air Intake
Length Dia
Length 1 1 MaL Spacing
J
`' /
rv,
SOIL COVER
x Pressure Systems Only
xx Mound Or At -Grade Systems Only
L
f.�flkV
(i44/
Depth Over
Bed/Trench Center^ q
Depth Over
Bed/Trench Edges>'�r
xx Depth \of
Topsoil 1 I'i tI
xx Seeded/Sodded
Yes
No
xx ulche
XYes 0 No
COD EIS 6 (I de cod d �epeflci persons present, etc.) Inspection #1
/'f��✓�f'S B.�QXi Y/4f�' � S
Location: 73� 165TH ST
�14)1.) Alt BM Description I7.w�kae- rZSe_" r
2.) Bldg sewer length = Z-T [7
- amount of cover= T
�o o't' � I''^ `,F %�iY SY}M�t - f'►r' 1-°T � S
Plan revision Required? Yes X No j-/ q /
A ( OZ O
A Xt Other sid for additional inf m tion.
H) �F kz Cti ytr,� 5T- Zat Inset
a flick
t Ct-'J i Q�%91 �Zo2ospection #2: (QI II
0 Inspection
V141m:Of lNw�Vf�I-
6NSQt1nON
Npc t Aktt,L Mal
rs Signature Cert. No.
A L-rl3u. "k&ue . _�2 ,a te pg S cb.0
(A10- &ed )
'. IX COUNTY
OWNER
NO. 631300
E SANI�ARY PERMIT
n1ftF-NCFfM S`r� \
PRE N(.40*ft.(r-'
Go� �I
a..ta
IA1
PLUMBER rN %MS
TOWN OF AMlM010
SEC _, T N9
AND/OR LOT
o ILLS Rw`
�LtM. UT
THIS PERMIT EXPIRES ll
LIC. # $ V3
(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 maybe renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit
(e) Renewal of the sanitary permit will be based on regulations
in force at the time renewal is sought, and that changed
regulations may impede renewal.
(t) The sanitary permit is transferable.
IIistory: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
SUBDIVISION Note: If you wish to renew the permit, or transfer ownership of
c
the permit, please contact the county authority.
ISSUING OFFICER - DATE
UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R. 10/11)