HomeMy WebLinkAbout018-2019-74-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM IoD
Safety and Building Division
110' INSPECTION REPORT 14 ? O
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes Privacy Law. s.15.04 (1)(m)I
TANK INFORMATION --t— ELEVATION DATA
TYPE
MANUFACT ER f4rll.�
CAPACITY
Septic
^ Z ] f
Z
Dosing
A raliar
ltflo�IIIIJIJ
Holding
TANK SETBACK INFORMATION
TANK TO
L
WELL
BLDG.
Vent to Ar Intake
ROAD
Septic
, l(
�1
(D 3
3 J C t
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
Lift
Friction Loss
System Head
TDH Ft
Forcemain
Length
❑ia.
Dist to Well
SOIL ABSORPTION SYSTEM
County St. Croix
Sanitary Permit No
633326
State Plan ID No
Parcel Tax No.
018-2019-74-000
SectionlTown/Ranges No
29.29.17.1274
STATION
BS
HI
FS
ELEV
Benchmark
/7 63
71. Z
Ali BM
Zn (,ovc1r
-4i,j
^! .
Bldg. Sewer
? �`
J fr
SUHt Inlet
' D�
D�.
SSt/HHtt-Ouutlet
f
Dt Bottom
Header/Man.
Dist Pipe
Bot System
Final Grade
St Comer 01'.4
2•%{o
S.G
1
-yt%
��• Z
<ovt�
3
By-5(o
BED/TRENCH
DIMENSIONS
Width ✓
Y--�I
Le t¢ ///
I
No Of Trenches
PIT OIMENSIONS
No Of Pns
Inside DaLiquid
Depth
SETBACK
SYSTEM TO
!L
BLDG
WELL
LAKE/STREAM
LEACHING
Manufacturer
INFORMATION
CHAMBER OR
UNIT
Type Of Sy.IiIiuir. /n
!/`
Model Number
I176Y1:3 Li�l1N]���l�d,l
HeaderlManifold
Distnbution
x Hole Sae
x Hole Spacing
Vent to Air Intake
Pipets)
l�
n % 1zf
Length Dia
Length Dia Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
BedlTrench Center
Bed(rrench Edges
Topsoil
i Yes No
--
�] Yes '. No
COMMENTS: (Include code discrepencies, persons present, etc..)) Inspection #1. I IInspectionlL#2:
Location: 741 165TH ST 11�11 TA � L/ Oki' /�/// < Ca �. N+e'^ MO,,•� Ci. t �T�.!'�
1)AIt BMDescrip4on=-iM I.t.T LDIIL"� Ives �-+If �eJ. l iC {, �e(`IIVNt4- 69 -71
2.) Bldg sewer length = Z � •
- amount of cover = y `ji
Plan revision Required? ❑ Yes No�L/-✓�
Use other side for additional informal) I Z I
SBD-6710 (R 3/97) rK� —
Date Insepctoi's Signature Can No
r�
�
Iln)r�ii
�qlvv —aG a i — /(]
County
.e•
2021
Safety and Buildings Division
St. Croix
Sanitary Permit Number (to be filled in by Co I
APR 13
201 W. Washington Ave., P.O- Box 7162
Madison, WI 53707-7162
3 33 2-�(
\�' .. ,nun,ty Dro eloG;nent
Sanitary Pel Illit Application
State Transaction Number
In accordance with SPS 383 21(2), Wis Adm. Code, submission oflhis forml0'llrmap�p(ppk�te ova emmental unit
011900012-C mound
is required pnor to obtaining a sanitary permit Note Application forms for slate -owned POWWTSIl!'eaMnnled to
Project Address (d different than mailing address)
the Departinent of Safety and Professional Serwies Personal information you provide may be used for secondary
j
purposes in accordance with the Pnvacy Law, s 15 1 m , Stets.
741 165th St.
I. Application Information — Please Print All Information
Property Owner's Name
Parcel 4
GMTZ LLC
016-2019-7"00
Property Owner's Mailing Address
Property Location
316 Kamloops Place
I� Lot
/ SW y., Section 29
City, State
Zip Code Phone
Number
River Falls, WI.
54022 715-222-9731
T 29 N, R 17 E orX (circle one)
U. Type of Building (check all that apply) Lot
a
Subdivision Name
Rolling Hills Farm
Xi I or2 Family Dwelling-Numberr��eedrooms 4 74
Afi fwa` Q�ft"s HI«k
s
❑ Public/Commercial - Describe Use
�,
❑ City of
❑ State Owned - Describe Use CSM
❑ Village of
Number
RI Town of Hammond
III.
Type of Permit: (Check only one box on line A. Complete line B if applicable)
`y
New System
y
❑Replacement System
❑ Trea[ment/Ilolding Tank Replacemrnt Only
❑ Other Modification to Existing System (explain)
B.
❑ Permit Renewal
❑ Permit Revision
❑ Change of Pliimba
❑Permn Transfer to New
List Pre. ions Permit Num and Date (epyEd t a.r
Before Expiration
Dwt><r
607100 5/14/1
IV. Type of POWTS S stem/Com neot/Device: Check all that a .f
❑ Non-Pressanzed I. -Ground ❑ Pres,sao.d In -Ground ❑ Atdimde Mound > 24 in of suitable sod ❑ Mound 124 in ofsintable sod
❑ Holding Tank ❑ Other Dispersal Component (explain) _ _ _ l ® Pretreatment Ik. ice (explain) Hoot 600 i Wieser ATU
V. Dispersalifrireatment Area Information:
Design Flow (gpd)
Design Sod Application Rwc(gpdsf)
Dispersal Area Required (sf)
Dispersal Area Proposed (sQ
System Elevation
600x5
Existing
VI. Tank Info
Capacity in
Total
N of
Manufacuaer
Gallons
Gallons
Ilnrts
y
U
New Tanks
Existing Tanks
o
a. U
v, ,.
rn
a O
a
Senn or Holding Tank
400/921
Hoot 600 / Wieser
X
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume mspon ' ility f ' [nllation of th WTS shown ou the amebed plans.
Plumber's Name (Pnn1)
Plumber' Signet
MP/MPRS Number
Business Phone Namber
Keith Knudtson
8443
651-470-1737
Plumber's Address (Street, City, State, Zip Code)
927 150th St. Roberts,Wi. 54023
VIU. Coun /De artmeot Use Only
APPioved ❑ Disap
Permn bee
Date ssued
I in gent Signature
`
$
❑ ven R or Denid
/
IX. Conditions o Approv I '2\ t�
SYSTEM OWN ER'
filter 1 n¢+^
1. septictank, effluent and J Aw
diY1 rW0 2
dsperer sal cell must s /_d `
VICedpro
t n i by plumber.f M LOT- l
management plan provided by plumber. 1 �B
as per 7�'
2. All setback requirements must be maintained \r'O ID
as per appiica ec0 e etr plans for the system and saboot to the uoly only on paper or 1. tbana It inchm in
�) �iAas l8P hQ�4s tUr��e�rz
p�
S` 3>S 7R. sail) t�,00 34-K"*
44w�vc`
i
�b2z,-�� `LGs
L a-� %T
Z,= SL�e a. �ei,�zr�ns
�cIcopy
�e� N 8
l b%
Z- - 7,3
�✓ S� h l ��1�� �C$ �tyl� /
�f�1COPY
1
D
5-
L
�io f"(P o0
mob- f 73
/ ✓ 5�nrfcr�/ C75�yY /
,5
r.
77
Private On -Site Waste Treatment System (POWTS) Inspection Agreement
The correct operation of the equipment noted below significantly influences the rife of the wastewater system.
Periodic inspections will help extend the life of the system and prevem the need for costly repairs The agreement
authorizes access to your POWTS equipment by a trained and authorized technician, during daylight hours, to
provide regular inspections and routine maintenance to help assure the equipment is working properly.
It is hereby agreed by and between Purchaser and Knudtson Plumbing and Contracting that in coruiddation of the
payments provided for herein, Knudtson Plumbing and contracting will provide the services of a factory -trained
representative to perform periodic inspections of the equipment described below. Knudison Plumbing and
Contracting will prepare a written report after each inspection and provide copy of the report to the Purchaser.
This report will contain recommendations for any operation and maintenance deemed appropriate by the
inspector.
This agreement does not assume any responsibilities for obligations that are normally the rieg onsibil"hties of
Purchaser and does not extend to cover any costs that may be associate with any recommendations made under
this agreement. In no event shall Knudison Plumbing and Contracting be responsible for any special or
consequential damages, including but not limited to loss of time, injury to person or property or incidental
economic loss due to equipment failure or for any other reason whatsoever. Knudtson Plumbing and Contracting
may supply additional services, parts or labor only, after authortzmlun by Purchaser.
This agreement shag remain In force for a period of_I years. beginning_May. 2020 and will
automatically renew each year thereafter for one year unless canceled by either parry with at least 30 days written
notice. This agreement may be anceled by the Purchaser only if replaced by a service agreement with an
authorized service provider for the equipment listed below. Knucitson Plumbing and Contracting may delay or
cancel future inspections ff payment becomes at least 15 days past due.
Periodic Inspectlons: Association agrees to pay Knudtwn Plumbing and Contracting $_200.00 per each
house's annual Inspection. Any additional testing or services required will be billed on time and material amounts,
Equipment Covered Under This Agreement
Description
Model No.
Serial No.
Install Date
Location if dtifferem
from system owner
ATU'S Hoot or Micro-rast
Knucitson Plumbing and Contracting
92715& St., Roberts, WI 54023
G51-470-1737
system owner
Sign ate:_
Signature:
Date: I
Roiling Hills H
Prim Name:
orda ewners Assatinn In,A
)
r7
7-1
Pho e:
Street
is
mot! 0
-71 z-m TZ
State&ZIP nn��
f 'en ^Ms
J r Z.7i
Fax
Email:'f _
s
r
r
[
i
:p
:5
f
;
L
h
_
g3
�
�s
Y
fF
L
E
6
r: 1
EE
f.
d6
A
f
i19
?iE,6�vE-;';sr,,r:I,}ffGg f
G t
J BUILDERS
W
�9C is Ei s
jdEsfs r ° 9i;'2E���'e�`Pst
NEW RIGNMOND SPLIT
15
s� i
g
g
E
�nRaae RKLrr
s if:�i iSz
1�
4 1
e
A S
f
•O
o �
� N
IN
....... . . ..... .... ..........
LAI
El
IS)
Ali T-Al-PRix --- ---
---- --------
.... ... ..
rc
LJ
Voll"dal �nl.
A72
c. Grooc
D
[NSF NSF
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 <1,000 -1c ds:nfe .=
Range of Sizes:
500, 600,750 & 1000 GPD
High performance, low cost, energy efficient treatment system
The H-Series GravityTreatment System provides high performance at a price comparable to most entry level ATLrs.
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
C3ODs and 30 mg& on TSS. With these results, many locations allow reductions in disposal areas between 25 and 40%_
Bemuse the H-Series completely transforms ammonia into nitrate, it is best su"tted for applications with rich organic sod
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 mdkjugs Choose Hoot,
and you make a sensible, decision to protect the environment as you protect our most precious resource, ourwater.
Drainfield and Verdcal Separation Reductions
With gravity flow discharge, the H-Series allows you to choose your disposal application from conventional lateral lirmes,
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 rode 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. 1.8O0-325-"56 www.wiesercorKTete.com
C
f
09
A
m
Itl
31741"
4" CAS
v
7
11 I�al
:III -gill
fI`•;
.-fir;
� 41An
7J�_
41"
40"
TANKS ARE MANUFACTURED TO
ms
OR EXCEED ASTM
4" CAS
— POLYLOK 12" ACCESS UD (TYP)
4Z SET RISER (TYP)
REQUIREMENTS
600 GPD GRAV7&[SrRGE SYSTEM
H-600 A
TANK SPECIFICATIONS
DIMENSIONS:
WALL:. 3"
BOTTOM: 3"
F
COVER: 4"
MANHOLE: 12" & 24" I.D. PLASTIC RISER
R
HEIGHT: 70" O.D.
#
g
LENGTH 10aw C.D.
fo S
WIDTH: 74 1/z" O.D.
BELOW INLET: 67" O,D.
LIQUID LEVEL• 51"
3
WEIGHT: 11,135 LES,
INLET AND OUTLET:
L
4" CAST —A —SEAL (CAS) BOOT OR EQUAL
Y
COVER: MIX DESIGN/9 (NO FIBER)
TANK: MIX DESIGN
(SMALL FIBER)
Y
CUSTOMIZED TANKS:
FOR CUSTOM'NTANKS CONTACT WIESER CONCRETE
o
QQ� ZQ
tTi Q
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY: rSHEET NO,
APPROVAL DATE:
PRODUCTS NEEDED BY: OF�
ST CR NTY SANITARY SYSTEM File#--
OWNERSHIP/ADDRESS FORM C.N2offilf�1nty
Community Development Department will utilae 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 Addre
City/State/Zip
Phone Numb'
Email Address
Parcel Identification Number
(found on he property W bill)
OWNERIBUYER INFORMATION
NEW SYSTEM: LEGAL DESCRIPTION
Property Location NE 45w to , Sec.'! I 1 Z9 N RR W, Town of �AYNM E 1) �
Subdivision Plat lb ��rn � Ywh—rGy!`/V� Lot #N
Certified Survey Map # �`..��ppp 3 Volume Pagel+
Warranty Deed # -_ _. 09 ! Z / 1 (lopffore 2006)Volume Page #
Number of bedrooms Spec hous-Ayes O no Lot Imes identifiablepyes O no
New PmpMy Address_1_ USE ONLY Ive.�nrayo`%n-�of�'new��Vsz Jeg1m,ee tram community ombpment oepartrrem log ne. comvuclion.)
(s a Ily�lei �/
Thus form must be submitted with all Private Onsde Water Treatment System (POW7S) applications
New Systmx Include with this form a recorded womanly deed from the Register of Deeds ice and a ropy of the certified
survey mop if reference Is mode in the warranty deed
Community Development Department - Land Use Drvison
715386-4680 St. Goa County Co emment Center 715-245d250 Fa.
cddiascom aov 1101 Cannichael Read, Hudson, WI 54016 w.ow sccwcaov
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer__ (O / rl L 1_ (. L'.
Mailing Address 3 ( (i" /
Property Address % / u S 1 s_
(Verification required tram Planing & Zoning Dimmmmr for new cons slims.)
City/State q a Paroel Identification Number
LEGAL DESCRIPTION
Property Location_%, %. .See. I N R___W,'town of avb(rm f.)
Subdivision Plat: Ro 'i' _05 /—cif ✓Y� _ , Lot # �.
Certified Survey Map # (Y , Volume Page #
Warranty Deed 00 (before 2007)Volume , Page #
Spec house vesdm Lut Imes idcatifiabloyes0no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper sae and maintenance or your septic system could result in its premature failure to handle wastes. Props'
maintenance consists of pumping out the septic tank every three veers or sooner. if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) mid in (7napter 12 - SL Croix County Sanitary Ordinance
The property owner agrees to submit to St Ctmx County planning & Zoning Department a certification form signed by the
owner and by a masts plumber, Journeyman plumber, restricted plumber or a licensed pointer verifying that (1) the on -site
wanewattt disposal system is in proper operating corabtinn and/or (2) after inspstion and pumping (if cecessary), the septic tank is
I. than In full ofaludge.
Uwe, the undersigned have =it the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Departmrm of Safety And Professioal Services and the Department of Natural Resources,
State of Wisconsin Certification stating that your septic system Itas been maintained must be completed and retained to the St. Croix
County Planning & Zoning Department within 30 days of the dvcc year expiration date.
Uwe certify dial all statements on this form are me to the best of my/our knowledge. Uwe an✓are the owner(s) ofthe
property described above, by virtue of a wmrinty deed recorded in Register of Deeds Office.
Number of bedrooms
11 SIGNATURE OF APPLICANT(S) DATE
`"Any information that is misrepresented may result in the sanitary pemnit being revoked by the Planning & Zoning Department.
Include with this application a recorded wmrxnly deed Gran de 1(egnster of DoW3 Offce and a copy of the certified survey map if
reference is made in the warrarrty deed_
(REV. 04112)
1w.a.P.e-�is� t� ::
nne� 4r Lim
Wiisconsir, Depanni 0 Comrne-e
Safety and BuLmng Divisrcn PRIVATE SEWAGE SYST M (;) St. Cri
INSPECTION REPORT Sanitjry Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) e Pla- ID No 607100
Pe'sondl inso'n uion ycc oc, as may be used Is secondary purposes ;Pr.vacy Laws 1 t 34 Oj; m)j 01 1 900012-C
Permit Holde!s Name Crry Village Township Pa•cel Tax No
Voran Desoto LLC TOWN OF HAMMOND 018-2019-75-000
CST BM Ele+ Iri BM Elev BM rescnptoa Secucn.,Torvn:Range%tap Nd
ti �-�; 29.29.17.1275
TANK INFORMATION ELEVATION DATA • Z . •-7 /67 .% /pp
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
i
Y
Aeration
c
r
Hold,,n
t
TANK SETBACK INFORMATION Ir
TANKTO
PIL
WELL
BLDG
Ve^ttc Air Mahe
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
SOIL ABSORPTION SYSTEM
/
BED/TRENCH
DIMENSIONS
Width r
b'
Le,gih
�I7 1z ,�-f
c-
No O' f e,aFi
NV
PIT DIMENSIONS
/
No Or
Insice Dr
Liquid Oepr
SETBACK
INFORMATION
SYSTEM TO
S.1
Type O S tin I n
J
PIL
� ]
r
BLDG
%)
lUr-f
INELLx'
1. `
Iv
LAKEiSTREI
(s)
)V
LEACHING
CHAMBER OR
UNIT
Malufach,
pAodel tuber
DISTRIBUTION SYSTEM t-57)I i
Header tamfold
I
Dsbibuton
Rpe�;ss
)
x Hole Sze n
I�
x Hole Spaoin
Vem to Air Intake
Lergt-__
D a�
Le^gtn0_
Da L
SFac ng�
L• !
SOIL COVER x Pressure Systems Only
Depth Over nr Depth Over I
Bed,Tre^ch Cen:e-.•f q BedrTrench Eyges> 12-
COMMENTS: (Include code discrepencies persons present. etc)
Location: 739 165TH ST -
t I All BM Description = -
2 ) Bldg sewer length =
- amount of cover =
Plan revision Requmetlo Yes No
Use other side for add; oral information _
Date
�-e71- R 3/97.
STATION
BS
`fto
HI
102q
FS
ELEV
/i
Benchmark
2 S$
16Z .
—
/GL>
AI: BM
Bldg Sewer
SLIHt Inlet
«
St/Ht Outlet
DI Inlet
a
Dt Bottom
•
/G 1
-7/x z3
Head IPAa
3.oZ
q°i•c/L
Dist Pipe
nP-
(?n `/
`7
Bot Systeem'/
IZZJ�
18, /f 6
05
JJ� CGV-Ci
BL'•1
St Cover
83 -53
W,S
• ia,35 i/aa , .�
xx Mound Or At -Grade Systems Only - J C,"- (,11111 /c...e-
xx Deptr of J,rx Seetled%Sodded xxM ulcne
Topso I
1111 Yes NJ —yesq
Inspection #1 f. � � U 1-A Inspection #2
�th._> G tND Fodu4wtt�ol�
P
fYC�1M� o� �►1SPCrn�•
insenctors S cratdre
I_
Cer. No
�cr Lars }3-� `3f;1v - T j c�? ' 6r
St. Croix
Buildings Division
Ir -a 1 " i�
201 W. Washington Ave., P 0. Box 7162 1
S.,I, PcrmM1 Number po he filed m h, Cn 1
s `\ 's
1Madls 70 16
Z j
IN
6 7l DU
Sanitary l'Arm it Ap�/l ica Lon
Stine I r.un .In,n Nnmh r
m.x.ordvxo xtlhM1w491'-li+)AA., A dn, r.d,. ,uhn11»1„n ,1thr,Inn) h, the.Mpmprlate p,,.nun,nud unit
011900012-C
rcymreJ pn.v I., ohl.unwg mn.rn pcmul AppL..rhon Wnn+for,tin.-owtxd 14)WIJ x.+uhrmneJ 10
I'ngr.l.Add,,- 01 dillercni th.m madmgddre-)
the Ikpertmmnt of SAO, .md Prof ... io al Sin m, Pcr,on.d rNonn.oun ,nu pro. ide min Ix uccd fin ,..oml.v,
_
m r+es in auorSvxa „,Ih the I'm .x, 1. a„ + I S ptt l kml Stat,
C. _ �,
` �
1. Applkation Information k .nnl.Ullnformahon
Voran Desoto LLC
018-2019-75-000
I'mlxm fh,n.r , ktarhn, AdJn:-
Pr�J,n, I
3435 Labore Rd
c nt I
NE SW iii>>n.,o 29
c'm Vem
/1p Gde
1%,MNumber
Vadnais Heights Mn
55110
--
P9 rele
T N. R 17 1 urQ1
If.'1 ype of Building (check all that apple
TJ I .rc'_ hemrh U,,.Ibnp Sun,Mr,., fi<dn..r
75J
SuhJn unm Sam.
1 `
Is
Rolling Hills Farm
❑--
- p1ce''�
❑ t'n. of
/ `
❑State DwamJ Denulr llx
❑ t Jl.rpe of
t'\M N1)mher
� L,wn of Hammond
/ Ile✓
—-ZIZ.CI
Ill. I ype of Permit: (('heck onh one box on line A. Complete line
__.. .—_. _.
B if applicable)
�--- —
--"6 _
hstrm ❑ R. pla..mcm S,aem ❑ I n-., n,nul lolJme fink Rcpl. crri,tn 01], ❑ (hh.r NIMilkauen to fxtHmg S, +tem (exphno)
N. ❑ l4rmn Renewal ❑ P<mul R< mn ❑ ('h.mg. of Plumhr Lnt Prcv rain Pcnnn NumMr :u)J llute 1+.ued
❑1 rmn Tran,(r to Ncw r
it, L\pu Inn (ha, tM� J
IV. type of PUN Il lxrtem/( on�nenUllevur (( heak all that apph _ �a � %
❑ Non Rc.,unred In Ground ❑ Pre+w v.J In-('n unJ ❑ AI -Grade ] MotmJ _-'-0 m .A +mlabk vnl ❑ M11nunJ < mm'n7$�l4 ll_
❑ Iloldmg and ❑ utta7 Dnlxr,el t ony,..ncnt letp Lnnl 14ctrcatmcm ih, me (rzpl. Hoot 600 -�
\'. Du nalt"I relitillient Area Inforn tion:
Ik+rpn fl.,w tgl'J) Ik-,�gn S 1, r<au„rr R.n,(,,,fl Urg<ra1 Arc. cgmrcd 1,0 Uupar-il Arca Pro -d .0 S,vcm I k,amm /
�j �
600x5=3000 1'.01 0 1500 r�' 1700.32 98.58
\'1. 'rank Info c a1u.)n m N of Mannfactmcr -- --
GAI11 Gallen, Cnn. `? -
ILxi,unF
h,, r-r
}`TM" .e ti.arfnc lad:
400/921
Hoot 600
ATU
Hoot 600/ Wieser
x
Mnu4 ctanhn 2000 _ 2000 Wieser _ x
11. R=fponnibilih Statement- 1. the ..dersieaed...sume respuastbrRh fo msbllatieo ofth, POU li, shows o. the an.Aed plaav
PIumMCh'am<IPnnll Plumh.rTvnu - _\II'MPR\SumFcr 13uvm--++Phone Sumher --
Keith Knudtson - 64
� y' 8443
7
`
Plnmtxr'„1Jd,c., rltrar (n. a.n. np(.,I.t p
927 150th St. Roberts Wi. 54023 3&b1P1,1
-
% Ill. Counh/Deptirtment Ise Onh — }- -- 7
ppro. ed ❑ D -- i'.rmrt I ../7
' b `✓
)am I,+,wdjQ
Inur e<m Smmt
er Guar Rcewnh"ik... A /6
I\. ( onditswalzmAlfilitilimcni,on, fur Insapprinxl
1 Septic tark.cfle,n.ItRc'tn1 3� A--ru f AA... ;v,, d
J:res
_ `` � .. � �.1�
is per.inar3Semen' pltn i .. 'oe' L: �JJ Pfr �J�r� tt ' 4t+)Cl
lei—
2. AN a l t r.. .. `
tirkpK vc,to^ ,, tt� J
r
+a P�PppiicrbW'c .�� rl :,t„�
per c:St-� c..1-t-�
An.rh hr rompkk p6m cur the a,A. aad submit ar the ['oval) oils oa paper not ken ilia. a la a i 1 inehee in sire
SI1D-6399(R. Ilrl l) t
Q,f� t r- t4 f✓ r("
i A n
1
1'
1004",
Q �,L
1-pLq
OELINATED
I-WFILAN D
131 OAT
',i
k 8�
4
WETLAND LIMITS
APPROXIMATE ELEV/
.. \�paRr4Flr r
Januan 3, 2019
CONDI FIONAL APPROVAL
PLAN APPROVAI- EXPIRES:
1'Inu 14"I," r' '.. I. -I
KEITH E STONER
23220 Woodcreek Rd
Siren WI 54872
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL
GREEN BAY WI 54304-5211
Contact Through Relay
http Hdsps.W govlprogramsfiindustry-seances
vmw.vnsconsin.gov
Scott Walker, Governor
Laura Guti6na:, Secretary
SITE: Rolling Hills Farm Shared Sani Lots 73-77
I Nt: s 73;-74 , 165th �trrcl
Saint Croix Counts
Town of Hammond Pressure Distribution Manaul
Mound Component Manual — Ver. 2.0.
SEID-10691-P (N.01/01, R 1012)
Description: 3000 GNU (PretreatmentS}oundv —New Construction)
Maitenance Required
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes 1 he submittal has been C'ONDIITONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. I he owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the slate 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:
• I he department rums require matenn_ or nutmtnrow ofthe effluent trail' no, p:, Ja 1,, .valu.rtc 11u
,prrei:,,:, �i,`-,,.nfh n:., L �'� �- ; 7 r'tli�r rt yu-tl:r� P-c-m.ctc-•
1 tnlid munil enanee .en icut;; contract t,.I,urcG 6,i the hh° of 0, "'trm ial
�i vi,n ir. , .�oh rni.t h, .vb nin.d t tinh p,t„i t' 1Ce71— "t th:..0 ratan p,r;n:t In tltc psrnit
• Preserve dispenal area prior and during construction to avoid disturbance compaction and use of the site.
• With new construction; it is recommended not to activate the pump in the dose tank until the tanks are
pumped prior to homeowner occupancy.
• Wastewater generated from contractors cleaning of equipment and tools and!or left over construction
products shall not be discharged into the drains discharging to the private onsite wastewater treatment system
(POW "I'S). Waste generated shall be properly disposed of on -site or off site.
• Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to
present matting under the dispersal area. All loose organic material to be removed from mound area.
• Divert surface water from POWTS Area.
P4,c 1 of 1 t1
Plan Narrative
TTK ioil,mine, Aared sm=% ie- deism di cu,sior. 1elciLses tin bnA proi4,-Sd'tl }?e&vklm
t(',,I rali.,n rrr 3a% sutitar% �%nern t,+.eF%a Laa>'? ttuu'- ; the RoamL Hills 3 am
tin i%Ision Tht, p an atynp, ie; +%IIh the -0A Co;u:a Land I -e sid 1?e%cloprnent
thduii eCS. a'Corncrnalxm Lk%ek,rmem Rolfine H:11� Iarm i:dc,i ned I+ir-- lot xa%;ced
ha _'� .'tLF17V1 compN ricni, IoNaicd or.. comm,,7. gttvinti -\;Tn� pn. aie eminent ano
Rlalnlen8nee l3n u3Ye N% Tc Fal s)1 Fe a'. rnOr to final all rt�%a_t-
I he fit. Crux t Dunn subdi%i.ion ow -&,once re luires Thai each Nnldahk lot ha> a vil and site
c%aluatn.,o caxnlvcic,° for thc�c 4 lot, thedisper>al area ,.:ii he located on the tit d area
ploZ,,Nej l x, n ! a,' _ > w�li te�, R\i wlii 1. u.�d foiTilur -,3,nI .lJ% %>icYli de�lgn,
eie%aao;i dau U e N%cre uruhie :o iocaie th on__.nal BMtisat consl,tsd of s - P\Y pfpc
INmc%er %kc t\eTe ahle in re-e,taliltKh a rcNk n;R' lm3 .: or il. mean ,C3 lc %cl cle%Alwn of
1 108 74�' that the on_tna cngmeimnc compam had eciahli,lied )or I tit R\1 %%Yin an
elci ation of 100 00 i ..\ 1 eX% R\t on,i:tinr� of a i : " into pipe ua_, �-n and Telcrenccd as
)tNt_rxi fz
A it%ur beds ,ini rimmmunt de i_n Co%% h i hrc n c tabh hed for each lot. The count% will require
a tifnttaT% rvrmli tor each !.,t =--or la, L.mNmr ctioi i,n emn_ the sL"k treatment compom-nis
%-ceding the .hsim t' o,m for es 1, lol 1 ic,c !.u, u:li required lei et at; icrol is treatment Laid:
i.iih hunt in ir:th cafwai that %,dj he coon tied to a pn%ate main mierceptor that a%ill Yta%in
tlim w a conution duplex Jti,e tanl, k- aied near I of '?- that %till altemwwk di inhute the
hiYh3% treated clfluert to i common mows; O SPer&7s 1%11CM 8 fi_ y -'I '- jA fi
The lmnate main iniercepxu .%;ll h vnanxted o`A inch sch- 4i Pk C With cicwwut_s k%caiad
as.,n.• themutt F he u`p'r�s t:,rcc ruin. %%iil .on,i,t of ' .Bch.. Ail Y\ C and %%r3i h directional
tvrea[ and nlal%ta: L'rniCT if,; " \iraY:
(*669W&W)
O1X COUNTY
STAT�
OWNER MT-Z
PLUMBERKO" 4
TOWN OF NII
NO. 633326
ANIAY PERMIT
)6 741 AvE)
PREVIOjTSfW
"O_ ��
YI
Cs (VqT Y3
SEC-21 ,TIcN, R j$
AND/OR LOT BLOCK
P.o "JU& 141SUBDIVISION
(2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and may be renewed for a
specified period.
to) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History; 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note; If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
AUSO ED ISSUING OFFICER - DATE
PERMIT EXPIRESi UNLESS RENEWED BEFORE THAT hATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (RI1/20)
11
Q =s
� r I
' Q, I
Ile
_YP o.
,2 C
EACH PARCELS
SUBJECT TO ST
LAWS, RULES At
0 MINIMUM LOT SI
BEFORE PURCH
PARCEL OF LAN
a COUNTYZONIN(
R" TOWN BOARD F
I
I
I
I
1
I
I
I
I
I
I
I
I
YI
I
I
byl
W
I
I
I
i
I
I
I
I
I
I
I
I
I
I
J
WELL AND
ALL WELL)
DISTANCE
SHOWN O
INSTALLEI
SEPTIC TO
FURTHER
AFTER A Y
ON ADJOI
SYSTEM S
FROM AN`
ALL LOT (
ACCESS/
OLTLOT II
LOCATED
TO THEIR
INSTALLA
RELATED