Loading...
HomeMy WebLinkAbout018-2019-66-000Wisconsin 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 [Privacy Law. s 15 04 (1)(m)i Inc :p BM Elev 5?. o TANK INFORMATION TOWN OF HAM TYPE MANUFACTURER CAPACITY Septic � ,Jres�i LOWL � ✓i rDa Dosing Aeration 0 0 Holding TANK SETBACK NT ORMATION ( O\M rL 5.— —J TANK TO I P/L IVVVFLL BLDG Vent to Air Intake ROAD Septic 3 0` 3) ' 3' 3 r' Dosing Aeration Holding PUMP/SIPHON INFORMATION l 10 5UIL A85UKPTION SYSTEM I. i i It St. Croix I Tax No J DATA S.. Pry n ' i 018-2019-66-000 .29.17.1266 Li 917 Z9 (e STATION (�J t' FS ELEV, Benchmark 57.63 Alt 8M I YI Bldg Sewer y. 3 7q. 33 Sti Inlet St/Ht Outlet 6.q8 77.15 Sit linjet cr L;Kt- ra.z 4 73.37 Of Bottom r Header/Man Dist Plpe Bot System Final Grade St Cover C 0 y.« 3,0 60. 6 3 IEDtTRENOH DIMENSIONS Wdth Length 1 •`1f'- Nc Of Trenches PIT DIMENSIONS No Of Pits Inside Do LiQmd Depth SETBACK INFORMATION ISYSTEM TO P/L BLDG WELL LAKE TREA LEAC NG CHAMBE OR UNIT Manufactu Type Of Sy tem 1 V VIl/ M INumber UIJ I hi I IVIV ST51 t:NT Header/Manifold Distr tion x Hole Size x Hale Spacing Vent to Air Intake pe 1 LengthDia 1 n ) I Da- Spacing 5UIL L L)V LK %Pressure Svinams Only xx Mound Or At.(' rada.Rvstenic Only Depth Over Depth Over xx Depth of xx SeedediSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsal Yes r.., No _ Yes No COMMENTS: (Include code discrepencies, persons present, etc) Inspection #1 Inspection #2 Location: 164075TH AVE I 1_ Z..F 60 11 Alt BM Description = i h 1{ r �NL•� /J �1.. 2 ) Bldg sewer length - amount of cover 1' Plan revision Rfor ad tl� [ 1 Yes yNO Zin=i Use other side for additional mformaho 7 I � J SBD-6710(R 3/97) Date ' Sg ure Cart No �1V-stirI - /0 y /— County St. Croix Safety and Buildings Division Sanitary Perms Number (to be filled in by Co �a -. 4J 201 W. Washington Ave., P O. Box 7162 :.) � © .t\ � .. - 11 Madison, WI 53707-7162 (v 333 25 3 2021 �, Sanitary P it Applies State Transaction Number In accordance with SPS 383 nl(2} W.H, submission of this form to the approprr I unit 1357947 Protect Address (if different than mmhng address) is required prior teobt0mriga sanitary permit Note Application forms for sfrwwlWGliI POWTS are submitted to the Department of Safety and Professional Servies Personal information you provide m ry�Rllifwa,4condary purposes in accordance with the Privacy Law, s 15 I m , Stats 1640 75th Ave I. Application Information - please Print All Information Property Owner's Name Parcel # C 8t J Builders Inc. 018-2019-66-000 Property Owner's Malting Address Property Location 316 Kamloops Place Govt Lot NE /, SW �, Section 29 City, State lip Code Phone Numher River Falls, V1fi. 154015 2/S—,2;7 29 (eireleone T N, R1�EorX D. Type of Building (check all that apply) Lot a Subdivision Name I or 2 Family Dwelling- N umber of Bedrooms 4 66 ` eBlock Rolling Hills Farm a Publre/Commercial- Describe Use' S __ ❑ City of ❑ State Owned - Describe Use CSM - - - ❑ Village of _ X Townor Hammond Number — III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New stem S y ❑Replacement System ❑ TreatmenUFloldmg Tank Replacement Only ❑ Other Modification to Ewstnng System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 499296 2/26/07 IV. Type of POWTS System/Component/Device: Check a0 that apply) ❑ Non -Pressured In-Grourd ❑ Pressured In-Grouad ❑ At -Grade Mound 224 in of suitable sod ❑ Mom < 24 in of suitable so ❑ Holding Tank ❑ Other Dispersal Component (explam) _ _. _ Pretreatment D.,ce (explain) Hoot 600 / Wieser - V. DispersaVrinciatment Area Information: Design Flow (gpd) Design Sod Application Rale(gpdsf) Dnspetsd Area Required (sO Dispersal Arco Proposed (sf) System Elevation Exsiting VI. Tank into Capacity in Total N of Manufacturer o Cmllons Gullonis Umts m u V New Tavks Fxisnvg Tanks � o �; � 8i $' ffi i� Scp is cr Holding Tank 400/921 1 Hoot 600 / Wieser 1 DningCha°ber 4200 1 Wieser 1 VQ. Responsibility Statement- 1, the undersigned, resume yespom e1XVTS shown on the attached plans. Plumber's Name (Print) Plum S MP/MPRS Number Business Phone Number Keith Knudtson 648443 651-470-1737 Plumber's Address (Street, City, State. Zip 927 150th St. Roberts,Wi. 54023 VrrrIE. County/Department Use Only Ip Approved ❑ Dn ro Permit Fee Date Issued Issuin Agent Signature ven Reason or Demd trriaclinaMtww IX. Conditions Approv 1 3\ A- & � 19� / n YSTEM OWNE /) tank, effluent filter and eQ Septic dispersal cell must be serviced /maintained �� plan prcvided by plumber.n}y�,.Q�(J as per management must be maintained All setback regr,rernents as per aPPI'catlia Corl l:rt4YtlfrENHrCIHpkte plans For the system suit sib-' a Comfy only on paper not lessmunn Mx ll m itrs msne V ,5-1 , ��- ^,,.,,;,.�a 5k �� �/krtt ttatitG2 SBD-6398 B- 1 vu) l f��an rw �" V _ V d � - ----- ---- ---- o' / r ca � kC4cA- CC) Mn q� / `c o T 6 6 F/ pY y 21,781 SO.14co / 6 I � .cn-1 -1 -- 54.0------�-r_� : / ,II HOUS �•- /4 m 27.8• i 1 .Y — 5 /� p j r __ _ �7ANll N 1 I / / -'--I i't ' VT 1 1 1� t ^ N i / 1 i ^ o 1 b.0 272 1 - 205 N r \ \ PROPOSED ^ DRIVEWAY \ \ \ fV 1323p' 1086 —t co \ T � A Vt E N U E (�CjCppY �G / fV 76 LOT 66 21,781 SQ. FT. 1cft in 1 5 / 54-0 / u! HOUSfi- J m 1 b Ila GARAGE Lq v I il:b t o N I i 20-5 q 16-0 27.8'— �- -- ------ .>z \ - - PROPOSED 99 l DRIVEWAY �1084 i�=132.30' co \ A Vt E N U Pirate On -Site Waste Treatment System (POWiS) htspection Agreement The correct operation of the equonent noted below vpdflmtly influences the We of the wastewatersystem Peiodc inspections will help extend the frfe of the systern and prevent the need for costly repairs. The ali eernent authorizes access to your POWTS egWpnern by a trained and authwiad tedhodery during daylight hour; to provide regular inspections and routine maintenance to help assure the equipment k wptlrrg properly. it is hereby agreed by and between Purchaser and Knudtson Plumbing and Cpmactingthet In consideration of the payments proMded for herein, Khwdtxon Plumbing and Contracting will provide the services of a fecturybabwd representative to perfonm periodic Mupemp¢ of the eq ipmaht described below. Knudtson Phunlig and Contracting will prepare a written report after each Inspection and provide a copy of the report to the Purchaser. This report will contain recommendations fo airy o+eatim and maintenance deemed appropriate by the Inspector This agreement does not assume cony respmnibilities for obligations that are normally to resporhdMTRes of Purchaser and doe not extend to cover my costs that may be associate with arty recommendatiprs made under this agreement In no event shall Knudson Plumbing and Camrar$w be responsible for any spetlel Or consequential dr.agm, including but not limited to loss of time, injury to person or property or incidental economic loos due to equipment fagae or for any other reason whatsoever. Knrdtsm Plumbing and Contracting may supply additional services, parts or labor ody after autorbation by Purchaser. This agreement shag remain in face for a period of_1_ years, beennhhg _May_ 2020_ and will automabcak renew each year dareafbw for one year unless canceled by eider party with at least 30 days written Mike. This aerrement may be canceled by the Purchaser o h, If replaced by a service agreement with an authorized service provider for the equipment gated below. Knudkon %pnblrgl and Contracting may delay or carrel future inspections if payment becomes at least f5 days pas due. _ Periodic bspectiohc Avocation agrees to grey Knudtsat Plumbing and CantrMicg $_200.00 per each hose's annual irspecton. Any additional testing ox services required will be bleed on time and material anohans. EMM MYMA Covered Udder This Meemme6 Desaiption Model Igo. I Serial No. I Instal Da4e laoaimn H dlfermt ftm srstern Owner AT VS Hoot or Micro -Fast: Kmtdtson Plumbing and Contracting 92715& St., Roberts, WI 54023 651-470-1737 sigrmture_ Date. I Rolbng Hgk 7p _ z 7 Print Na \L err%iJ f Z 2 Z— 7] j street% S City1%, State &f 7. /ati (IS l.�r 22— Email:' ¢� File x: SH CRc> uryry SANITARY SYSTEM orylpeu:eoxry �® OWNERSHIP/ADDRESS FORM' Community Development Department will r ilite 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 INFORMATION Owner/Buyer?(�7u,reih-le }- c- ne- MallingAddreG e-w P-�� d City/State/Zip�e^ Phone Numbered) Email Address Lk Parcel Identification Number (found on the property tax will) NEW SYSTEM: LEGAL DESCRIPTION Property Locahorul I- �'�'/.. Sec�/�r�Q1� T�? / N R-W. I own of Subdivision Plate_/ r _a [- Lot If yam. Certified Survey Map x _, Volume Page #_ Warranty peed At _ (before 2006)Volume - Page x Number of bedrooms _ Spec house yes 0 no Lot lines identifiabl('4 yes 0 no New Pro rty d ss I `ram 0 �� • "'� - (V N rns reWveo M1o�^, Comm�niry ae+elopmen�cepvtment for new cwrsovctionl (5 Hln�eaKl Ia1te1 ne« This form most be submitted with ail Private Onsite Wafer Treatment System (POWTS) oppi"onons New system include wdh thu form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey nap if reference is modern the wirranry deed Community Development Department - and use Divls'on 715-386-4680 St, Cron County Government Center 7t5-245-4250 Fax ,ddf5,rv,1 no, 11 o1 Carmichael Road, Hudson, Wit 54016 00 _ PR Mill 00 ._________________ ________________________________ i ------------------------ a FRONT ELEVATION ❑ B m o rn w/� 00 Fr � p � a a LEFt ELEuii VATION y RIGNT ELEVATION �f wu, 0.4101Y BY ® fY—lfl�El cev Ma"a m m m ry--- ufnnu® +axon po vau r n REAR ELEVATION AFL «.u� ..,o Al IMPORTANT N�, 41 q 5� a -a C 6 <i �a `4' 9 W U 5 g w¢ OIk" By I �s II sms mrt aaom I I M ]A3 plNCiiC •'c�:l'f �Vi�l:3'i' a MAGLCR O�RM y �� I J f A I I ' F 1 uuu � fo' p•v a' •-ip' x-o w y I a i P i a ro.w I I eeocoar q I x,o. I b eeoE,�Roao, • I I O a I I I I I I I I I t I i I ,• c I IMPORTANT NOTE. -5 tip .r oe 'o e I .� wm�w® eaeerrvr I' II I b a !� A �..e: • n i VI/ � y3 � I I D 3 � T in 6� k I 9 F thov ane Dart a yam ail mo FOUNDATION PLAN Max r. Nm PA Elf A2 I I• . IN \ ! I I I 51 _SWALE . wsLcm � uw EoeMH / 1 1f 77. C 'SIDE // (.�%/ % I fit ! fl 1 i 1. ado / / 1 eB.73 , s Boma! SWALE ! e w/ *I SIDE SLOPES 1rr'. ocanf: ez / /�ice_— osrwroE /� // If �" / / /f� /J I i \ I TRAIL 71.72 / 7M 9 37 / ir6i.o p I I ( 1 / / mJr i1 / H.P./� , I q4.e 90 ---- zw n.a k I 1 I dt4o 1 / / / / _ — 1 icw *OF 1&A ar AT om — .� 62 -Alt, \ 9 �Q1 K()wT AT gIliAt1 .41 — — J / 16� I I �\ 1 / / P. I 1 I 1 / ,/ I 1 I I I � 1 _ 1 I i 1 ( co C I I 1 I 1 1 \ \ \ \ \ \ \ \ I 1 I / / �/ ,7 I ,� I- WE f I 1 1 ,. \ , \ \. \ i i I 1 / / 7. // �� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Property Address 02� City/State ' Parcel IdoatiSwtim Number e-) G" -lr/P -Oar LEGAL DFSCRIMON Property Location _A Y >`� Y. , /sec. L T 2JN RW, Town a �t� of ids U4 vu Subdivision Plat:_ L-th 1 is 61M _ . Lot M�W- Certified Survey Map f/ 1 '7 l [ Volume_. Page is Warranty Deal p l �C- T {O (before 2W'nVolome —Page R' Spechaac9k,eot, La lines idmtifiehiep(mom Impoprf tree and tmintoaoce ofyatf Septic "Am could MIME in is pnevatu a failure to hanrdlc wastes- P.opee t®matma mosm of ptaasping at the septic tmk every thee yeas or sooner, if needed, by a licensed pace. What you put into the System over affect the function of We septic tads as a tirJrmera stage in the was0e dispod syslom. Ovuer minrcmncc trsprmtbilhla ere W-cified in §SPS. 393S2(1) and in Chq ter 12 - SL Croix County Sanitary Ordiu o The psgerty owe agrm to srnbnet b SL Ceoia County PWKuw & Zoning Deparontm a ratification form, signal by the ovmer ad by a ous0e 1>lumber.joarneynetan diotbe, restricted pkenhe Or a linseed pmpc verifying that (1) the oo-ate wastewater disposal syst® is in Proper opeatioE condition araVor (2) after inspection and Pumping (tfrccssary), the septic took is Ir$ than 1/3 fill ofshadiic- U/ the undersigned have red die shove o quirtmenm ad epee tc nainuin the private sewage dmpmal syaem with the suodads Set faith. herein. as ict by the Depntarrnt ofSafey And Prof®oral Service and the DVErataN of Natural Resources, State of Wwomlm f.ertifEatiat stating than your septic sysaean has beer naiWlned naW be mtnpkxd and reteii to the St. Croix Cony Planing & Zoning Departintat within 30 days of the thee year expiration rote. Vane certify that all eatemenss on this form me hm to the beit of my/ow knowledge- Uwe arJae the ownrr(s) of Sete property described abum by vine of a waurty dad recorded in Regiwr of Deeds Office. Number of bedroom / - KI MATURE OF APPLICANT(S) DATE —any Infanatioa that is roisrepeetted may reuo in due seniury peruat bung rceokcd by the Plannieg & timing DcyawmL v Include vnth this aPPhcatinn a rtmded warranty deed (ions err Register of Uceds Ofii a and a copy ofthe certified survey map if reference is nn& in the warriuty rod. (RRV, W2) ri 4' CAS TANKS ARE MANUFACTURED TO MEET DR EX( ASTM C-1227 4" CAS POLYLOK 12" ACCESS LID (TYP) °Z SET RISER (TYP) B00GPO ORAVI'() ISVAROESYSTEM 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. WIDTH: 74 1 2" O.D. BELOW INLET: 57" O.D. LIQUID LEVEL: 51" WEIGHT: 11,135 LES. INLET AND OUTLET: 4" CAST —A —SEAL (CAS) BOOT OR EQUAL COVER: MIX DESIGNAS (NO FIBER TANK: MIX DESIGN j�e (SMALL FIB R) CUSTOMIZED TANKS: FOR CUSTOM}TANKS CONTACT WIESER CONCRETE DRAWINGS SUP'" FOR AP' APPROVED APPROV' W 3 Y 0 LJ H-Series Gravity Treatment System Green Choice Applications: Single and Multi -Family Dwellings, light commercial, Churches, and other similar Residential strength uses Performance: 99% Reduction CBODs 9996 Reduction TSS 99%Conversion of Ammonia (NH3) Fecal <110KOO We d:si`ect-;-- . Range of Sizes: 500, 600, 750 & 1000 GPD High performance, low cost, energy effkkmt treatment system The H-Series GravityTreatment 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 4M 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 uses less power than an average light bulb. Its polyethylene clarifier hopper is made of recycled milk jugs Choose Foot, 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 lines, leeching chambers, other alterative 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 bw- 14MO-3255456 www.wi St. Croix County AEROBIC TREATMENT UNIT (ATU) SERVICING AGREEMENT State Plan Transaction Number - 1357947 C & J 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 1127532 St. Croix Register of Deeds Office. This Property is described as follows (include lot no. and subdivision/CSM or detailed legal description): LOT 66 of Rolling Hills Farm plat, in the Town of Hammond, St. Croix County, W1 iuiiiiiiiiii8 6 Tx:46696111 1128246 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/21/2021 09:36 AM EXEMPT #e REC FEE 30.00 PAGES: 1 OR: A wu P� r a See attached deed copy for legal descriptions �e$� t.J= S 018-2019-66-000 Agreement Date: _4/21/2021 Parcel Identification Number (PIN) As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Aerobic Treatment Unit on the above -described property, we agree to do the following: L 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 POWTS (Private Onsite Wastewater Treatment System) technology. If the owner fails to have the POWTS and ATU property serviced in response to orders issued by the governmental unit or the Department of Safety and Professional Services (DSPS) to prevent or abate a human health hazard as described in s. 254.59, Slats.. 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 rcndcmd. The charges will be assessed as prescrihed by s 66 0703, Slats 2 The owner agrees to maintain a contract with a licensed POWTS maintainer for the life of the system The POWTS mamtamer 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 mspecbons are to be scheduled every 6 months for the first two years of operation and yearly thereafter. 3 The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit sit as to not create a human health hazard as described in s. 254 59, Stats. 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. The 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 la business days from the date of inspection, maintenance or servicing- 6. This agreement will remain in effect only until the county office responsible for the regulation of PO WTS 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 he 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 to be determined by reference to the propenv where the Aerobic Treatment Unit is installed Owner(s) Name(s) - Please Print Subscribed and swom to before me on this date: J EFF t'ey S Hv9b� (�l�i% cif` l �°02 Not^arize,d Owners Signatures) Notary- Pu ,✓ Governmental Unit Official Name, Title - Please Print My Commission Expires = yr *; Community Development Department Oa-a6-�oa��4 PElERSoN .�� Govcmme 1 Uni=Off cial Si Comm by �y RYMp Community Development Department .,A ' Personal information you provide may be used for secondary purposes [Privacy Law s. 15.04(1)(m)] S mrnerce.wl.gov Safety and E jo , 1 201 'h' '.Veilango A, ti;consln Madison, I5' llepartnsent of Gommatr;a Sanitary Permit Applicati n (n eccordance ..r h s Comm Ad 21(2). 1% rs. Min Code, suhm,asinn of thts form the. nn rzno•m,i Vum w olaamma e s +.eery ycI ,, Nor, .4pph:anon wrni I'm sulrmvtl m u,c Lkn:am.anr of Comme¢e wn you Grm, Name �qIL Type of Building (check all that apply) L YJ or2 Famoy Dwelling-Numherof Bedinnms i 5k � Po6hc/Comnternal Des"'. Use smn..---- Counq L �I..R•I)wnCd-JeS�r(K t1 •,C _ __ ____ __ _ � �/L(.{/ is h--IZb o J S43SaCo 1------ � Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) 1 (�,f.ew S+stem � RCplarment$ysum cTie,imeNtBoldmg Twk Replacement Only B i �� Peimn Rencua! ❑Yermn Ret isles 'i H;tow Ennutwn IL y9 9 z Sra: Tiaosactmr dumb Nr,T,ciy Location I / Gorr Lol__ `J (IZh-S,I qq (�tmlr 0. gg T N; R /%_E.20 Subissawn Nara ❑ village of __-_ r� -4 li --------- ❑ tkna Sf,Ki ticaucn la Esotmy' SYs:ent 1Cxplai� Change ui`PlvrY%beif) Permit Trmfes to Tew I Gs: Pre, w¢s Perms Ntunbef and Date Issued i I Ua ner ItTl' IJ Xun-Pressunzed In -Gouts ❑ Pressor ¢<d In-0mund ❑ ❑ Itoldtnf lank I` Other D,sPeml C'omPonent (explmn) } I'\10 m>v Iof Fwmblc soJ ❑ Mrrun;l<Nmar smu—---__---1 __ L' Pm;,emmenl Desme les plaml .Q_t� a- u,nan t low Igpol L)es,gn Sod Appltimo atd Lvls ❑uposel 9rea uveC (si D+speisa-kea Pro ed is ISystem E!evanon 9'I. Tank Info of Nr•. Tanks_ M ta..pvxr 541,X s ` sa^nr o, nnleug rnik - Csc' ✓ i Dosing a+a,nn. x i /Zv• 0_ t' yL _�/J: __ -_ .?rJ, /sry .— \'11. Res OnObdity Statement- 1. the undersigned, aesaare respoosihilin for lastAlatioa of the POWTS nn on the attacbed plans_ -Plo—mhe-'-s�,1'emePow) --i P.ua+tv"s sgn,turc-_—------�_^ d PRti Numbeiii Business Phone Nu,bc, i Plsmbe%s Addrcas (Snen,Crty, State. 7.ry Codz) I — — yprosnl i Pemutfee I Dater ued 1 756. "6. b<D + Z �� wn reen Reason for enial Z O i IX. CondijjgA f'Appro al,,Reasons for Disapproval 3\ J� �' 1. Septic tank, effluent otter and Jl S 1 1 dispersal call must all `-_as per manapemerd plan provided by plum _-- AN t re2utremerlta_ f till r1 t sa pb �PPf8161M'�2ar r, tin-ai - - E) v J 4--1 t"p I ek1�1wta vFE d-a Co SBU-n193 fR 0!'U7)\1ehd ChM 01/09 RS/t 5� �LrLi e foJ;trL.e Tu (r Scpol L tea^+` -+vim) G %%10 � lad, ocX'd" s'a9 i w �;plc., w 9�S-\4tS �3, uIilPRL -�et� q o, Mai 6�oy. �b �1,8' 3" Puc aoA, / � C�:T Qh ly't�K Rad[,y n..^ t0 Sco..l� i�o�... Q��.. A/�n.: �. • i'T P\J. MQA (0.04", So�loy iea.o 5T �Le� o 4-5 lso.O \lol,q \\0 t 0 w 7 (W I1J Rolling Hills Farm Mound Common System Design for Lot 65 (and future lots 66, 67, and 68) Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: co 0 Z 9 N oLodion: z y a t'j 'A - Dag Owner: Address: Designer: Signature License: Attachments: Page 1: cover Ia. overview 2: design criteria & calculations 3: plot plan 4: system cross section 5: planview, lateral detail 6: pump tank exit detail 7: pump curve 8: system management Mound, SBD-10691-P (01/01) Pressure Distribution, SBD-10706-P (01/01) NE '/., S W '/., Sec. 29, T 29 N, R 17 W Town: Hammond County: St. Croix January 11, 2007 Rolling Hills of Hammond, LLC 400 Second St. Hudson, WI 54016 Hey Grote r( WI D-1 SBD-10577 - Plan Approval Application SBD-8330 Engineers final grading plan, 1" = 80' Redrawn plot plan, I" = 60' Uuim §pFETY AND BUILDINGS I�i1gIDN of SEE CORR ONDENCE page 1 of 8