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Home My WebLink About018-2019-67-000La`i 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)] C & J Builders Inc 'ST SM Elev 03 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic W SLr' Dosing Aeration O _ DD Holding TANK SETBACK INFORMATION 1-i ✓ P'S SLre, . n., ) TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic 3 I f ' L �-c� Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number I TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia Dist to Well SOIL ABSORPTION SYSTEM I...,,-p,y St. Croix ELEVATION DA So o Tax No 018-2019-67-000 VRange.iMap No 29.29.17.1267 rest 4 1Zg6 STATION BS HI FS ELEV Benchmark Alt BM in LO If- Bldg Sewer D 4.18 s3 . 1 L,rs SUHt Inlet _s�.- II � SIZ 6 SUHt Outlet S. � gZ - SS se vJCr %G.Bi? Dt Bottom 1 Header/Man Dist Pipe Bot. System Final Grade C Li St Dor BE D/TRENOH Width engih No Of Trenches PIT DIMENSIONS No Of Pds Inside One Liquid Depth DIMENSIONS' SETBACK SYSTEM TO P/L BLDG WELL LAKE/ST EAM LEACHIN Ma facturer INFORMATION CHAMBER R UNIT Type Of System 1 odel Numbe DISTRIBUTION SYSTEM HeaderiManifold ID15thbrition x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing OUIL l.0 V CK x Pressures Svstemc Oniv x Mn nH nr At.rr.d. st Conk, Depth Over Depth Over xx Depth of xx Seeded,'Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil _ Yes ❑ No Yes j No COMMENTS: (Include code discrepencies. persons present, etc ) Inspection #1 Inspection #2 Location: 1644 75TH AVE 1.) Alt BM Description = I'n �Ca (6Vir .. 7�� t S 6H fJ �r✓ 2.) Bldg sewer length ='�� _ �1 .5� N'�(.Y, 4- - amount of cover 11 7,q 6 —COwtrvloN I,wu�� Stt �• (n/[�..I1f l/I1�j Plan revision Required? LI Yes No rn Use other side for additional tormahXI SBD-6710 (R 197) Dale Insepctor's Signature Cad No r� nn'l (1 CD / 1'aLyy afety and Buildings Division County St. Croix JUN O 201 - Washington Ave, P O. Box 7162 Sanitary Permit Number (to be filled in by Co. ) ;r1�:�Ry Madison, WI 53707-7162 Croix C moment F 0-7 U ermit Application State Transaction Number � � �, In accordance with SPS 383 21(2), Wis Arlin Code. submission of this form to em ovmenml unit is required prior to obtaining a sanitary permit NoteApplication forms for state-owned POWP a e%%tiaakted to Project Address (it different than mailing address) the Department of Safety and Professional Servies Personal information you provide may be used for secondary purposesin accordance with the Pen acy Law, s. 15 1 m), Stats 1644 75th Ave I. Application Information - Please Print All Information Property Owner's Name Parcel 4 C & J Builders Inc. —232Ntr� 018-2019-67-000 Property owner's Mailing Address Property Location 316 Kamloops Place Govt Lot Jf %>V y, �S 4'� % Section City, State Zip Code Phone Number River Falls, Wi. J/.S 2 ? Z' 9,3 r /(c; le one T�fL-C-�� N, R E II. Type of Building (check all that apply) Lot 4 I or 2 Family Dwelling - Number of Bedrooms 4 67 Subdivision Name serp� qu Rolling Hills Farm BlockN ❑Public/Commercial - Describe Use ❑city of El state owned -Describe Use El Village of CSM Number Town of Hammond III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement Svstem Treatmemt/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner :%f 9 (�� & /. (� IV. Type of POWTS S stemlCom onent/Device: Check all that apply) ❑ Non -Pressurized In -Ground ❑ pressurized In -Ground ❑ At -Grade P Mound> 24 inrwytabi.a�,..e'"-^•• of smtable sod ❑ Holding Tank ❑ Other Dispersal Component (explain) ] P etreatment De ice(expl 1 Hoot 6 00 V. Dis rsaVTreatm Area Information: Design F (gpd 'gn Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s0 System Elevation 1800 fisting VI. Yank Info Capacity in Iotal 4 of Manufacturer Gallons Gallons Units m o o New Taal Existing Tanks v SU b Vl x i Z3 F Septic or Holding Tank 400/921 1 Hoot 600/Wieser ATU X Posing Chamber VII. Responsibility Statement- 1, the undersigned, assarjot rmponsibD' f ' stall. fio a POWTS shmvu on the attached plans. Plumber's Name (Print) Plum - Signature MP/MPRS Number Business Phone Number Keith Knucltson 443 651-470-1737 Plumber's Address (Street, City, Swte, Zip Code) 927 150th St. Roberts,Wi. 54023 V III. CountyAllepartimcnit Use Only Approved ❑ Fee DateIssued IsswAgent Signature61ZL ��iPermit e_❑rDemalIX. Z Conditions pp1 s D I YSTEM OWNER. 3 lS 0. IC I ��de" T . Septic tank, effluent filter and dispersal cell must be serviced !maintained � f as per mt plan p anagemenrovided by plumber. Ou5 `n /n All setback requirements must be maintained S,T—/Hft7$ as per applicaole code+ocenaesiaeampete aes far the system )<md ubmit h'e ryopily on paper not lev tgaos 4V ioene tnoee rL,BD-6396 1) D� u IlSI2( �o swkP 51q�l ZoLI- j5q ��. Cpp, ,2at i (5-c-tA z5/.5 -Von/7 ( r jw� P,,' 1) /e6 k �y el- vs:f�"?, p 19„ /D �'? • 7K rfc1COPY CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Lot 67 Roiling Hills Owners Name. C 7 J Builders Owners Address: 316 Kamloops Place River Falls Wi. Legal Description: Township: Hammond County: St. Croix Subdivision Name: Rolling Hills Farm Lot Number: Parcel ID Number. 67 018-2019-67-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Keith Knudtson Date: 05/27/2021 License Number. Phone Number 648443 (651)470-1737 Signature Designed pursuant to the In -Ground Soil Absorption component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 J�q' /'IX�{ -77 77- '� J ewe, �w j� /l 6 u, , F e- ys`�ti P l,„ s a, W =\7= AZOZgRCni r �. + Nky if), 2018 tip .t! fi IFF I d k-s:i 14 - s'^_ ••.r c+Yl • .t _ iR [- : 5 •,!.} c ! a L :)• [ 1 3•_ ! fi r r. I ITR M f S,1 .111 7- r;5 he Dqmr:anent tex t €"an aWroW rased on the U _ Wn SWtes acid ft W=ansin Ad3ffaas6 bve Code_ This approval is va UA the Ow of may =3. r 1 t 's. e' S • r •sl .� Cs a 'r• 3 r' �� r "i.- - [ :. :�-Y'G-si �- . TMs tank must Be destined to **islwW the pWAftS la wtikh 4WD iia l9 "•�"f 1' I• :{y+ fl:[ i! : F l.K; f�6 ]I:1 •!• i i f rS�!'"! i G ]l. ! S:HxI ^•%]:�6 -� F" f r ! F K>ri'<•' • _ i -< is O:! '�f !: i �2- i.Y,"��+ Raw - 1' �1 .I:-i �• I'.' YY.a:'ar:2f rirl S 11 .! I` Z •liar([ i E: I[Y 1'0 'S M• `i' "=f ,:I ;r" - s:i .r "rl - sc-- _ _ c • M r • 1 - :i :_ i c. •F '1T t3. :1•- 3 s : '" � fir: � C.F - _ -r.,:y • i • S e!r.:.� i Pianre vtorttreinstaltatbpbfthispndudmustbaOb ii3»i'fMM ftdepart M ,-a1i) nf#mV& Ad», Gone. + iitiSptc�lS,tt3E.�tstiitiveir&a6t��iAg3ia�prt}vc��#►uerd'tifier�aa�sie�,f�si3i4i8 inch hl sio of iagw. I?o t S NZO •�� '.•:o r - 4al a _If:�- = -- v • ,v __ - fc1 :� rrorq •.: e - f K .l - 1.i .i-f' q n3ia: .i r. a - !n a.s s._ •N=. !x �;cf - .Im �O' -. •ir_'vs� a ri•..fl •: :rl:- %oi, 'o... 'e •'c i:9'e e.:ci r _ - Yr' r> ri i '- In•<. a,t •- - iryl91i .y .�: a F. ir::::; e.a.f i,z f r � : o :o a - t � _ n s nl <•ot� , .a ::' f'=!(��7 - di!- •I•I'`P[' f : flit' .�-n • 1•S.S^ • .ti e a we . ,t. ••'ca _ t1 a c a" a .;. 1 'x.ell ;r : a-.:• . -r :.z e z _ - 7h0dewt$inrAmyendwadi* Oft pfa&td or tip( — aWis.rMt-- kf WiNhm W. sawar PH8nkv1Q �ft -- r OMN01 ROLLING HILLS FARM LOGxT®N TR Of IIW\M p nle lW 1M. M N!\N OF M BW \K VM1OF THE E1MIM Q T11! rd�w\x.n, N BNIKARD PYRMTIIE Rl1M OF THE BM1M 11LLNYGIgN O. Y1O MIR OF TK ME\M OF TIIE gygyEypR NW1M OF BECIpN 9E. NL N T4EH. R1TM. TQYN OF XIWN Wes. M. CI10R CQIMIY. NMGOMIM. EE 1�TL �- IfGOID .�u�nr�p_H��,n�rcf_�!HM3Lr�x1! ��EREYmYf�xM I.1 -.. ti MIIIMYBIIIWWO E[1BKXUM!{ '�'Q_=•~��1 � W1b 1llQQR, "�`01R101E s ly 6 lDr lOT M ' — �ar I. LOT r-T / bem �. 1M 6 Wr ;ea �°"•ii '^ram ..r"' s� .. :/ -G .. .ter.. Mc @5 � '�. die• «morn'' • � � iP� loTa• � ,. Jqq'. , y '. s MUM Ali for ae i„'#-' 6x�' �f y }+r • ��f. = 78 ( �\ Eai WT ar _ ,O. (Q• �jT- laT \` \ �`'�� ; � �\\ 10 I • � e I for r ( / ..,�, �/ ' �'1 1 ' wr • / 1• 1 WTI ,. I.Qf�W10111Y<QMHTi � � � ,yF 1E . •fyLNR3f 1•-100 WTCX HNEQYgT• 1E 01® = � � 6.vlxdx•Hs1• L � IAS-n c r/roz // / 1 1`� 1 \I I I roe I I 11 j 1 \ ! o wwu/_LrMw � o a lr LVM3 tmimr / / ! ! / / / 1I mo rvnLs. E oii o / ! / i 1 I V 1 1 06 ,rQA __� 1 1 I �__�_; I I 1 YID/ 1. xQLlto <� /dHL / / / t 9 TL 00 s — Le ' _ r / I I ZcaL / 30MliL ,r----�i~ r�� T 7/ ze ( '�—I 1 r I I ! d+LddO •NIM 1!I s3d019 3w 1;� /M 13TOtS /1101108 .s ! xL VO%f/ 9/ 1 O / / I pV / 306 Y cm U.Ij t► J I /, // 4•._, I •v I 1 b _.. � _ � '_ Logy / � 1 NLd30 tan uci 1 ! ^ l J 53da" am t9 /M 3TMS 1101L06 A I I I t ! ,A.- 4" CAS 4" CAS POLYLOK 12" ACCESS LID (TYP) ..Z SET RISER (TYP) TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS /1 6000PDGRAVITj'8D1DS MGE SYSTEM H-600 A TANK SPECIFICATIONS DIMENSIONS: WALL:-- 3" BOTTOM: 3" < COVER: 4" MANHOLE: 12" & 24" I.D. PLASTIC RISER HEIGHT: 70" O.D. 8 LENGTH 108" O.D. m g WIDTH: 74 1/2" O.D. BELOW INLET: 57" O.D. i LIQUID LEVEL: 51" WEIGHT: 11,135 LBS. � W INLET AND OUTLET: # 4" CAST -A -SEAL (CAS) BOOT OR EQUAL Y COVER: MIX DESIGN (NO FIBER) TANK: MIX DESIGN FIBER) = 0 (SMALL Y 5 CUSTOMIZED TANKS: 39 FOR CUSTOMNTANKS CONTACT WIESER CONCRETE 0 a T DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEE APPROVAL DATE: 1 PRODUCTS NEEDED BY: _,OF ST. CROIX COUNTY SEPTIC TANK MAIN PENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Oumer/Buyer Mai ling Addr. Property Addi City/State 4404 Mart—_ Parcel Identification Number l>_L� 696 t.�! LEGAL DESCRIPTION Property Location _ % , % . Sec. __ 1 _ N R_W, Town of /1' Q W w o !it2' Subdivision Plat i(e I \'v�, I L�, _?-ll M _ , Lot # _- Certified Survey Map # -- Volume , Page # Warranty Deed # (07_42 (before 2007)Volume ' Page # Spec house 1415c.0m Lot linesidentifiable lyyes(]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your sepuc system could result in its premature failure to handle wastes. Proper marmenanee consists of pumping out the septic. Lnk every three years or soonei, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a imamceot stage in the waste disposal system Owner maintenance responsibilities are specified in §SPS- 383 520) and in Chaple, 12 - St. Croix County Sanitary Ordinance The property owner agrees to submit to tit. Croix CnnnCl Planning & Zoning Department a certification form, signed by the owner and by a master plumber,dourneyntan plumber, restricted plumber or a liceitsed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and'or ('_) after inspection and pumping (if accessary). the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above reywremen¢ and agree to mmntam the private sewage disposal system with the standards set forth, herem, as set by the Department of Safety And Professional Sc,,. and the Department of Natural Resources, State of Wisconsin. Certification stating that your .septic system has been maintained most be completed and rimmed to the St. Croix County Planning & Zoning Deparmem within 30 days of the three year expiration date Uwe certify that all statements on this loop ate true to the best of my"our knowledge Uwe am/arethe owners) of the property described above, by virtue of a warmtny der 1 recorded it Register of Deeds Office. Number of bedrooms q Tl RE OF APPLICANT(S)__ DATEDA E ***Any information that is misrepresented may rzsult in the sanitary pemut being revoked by the Planning & Zoning Department. •aa Include with this application a recorded warranty deed hem the Register of Deeds Office and a copy of the certified survey map if reference is made in the wa raory deed. (REV, 04112) Private On -Site Waste Treatment System (POWTS) Inspection Agreement The Correct operation of the equipment noted below signor can tly influences the life of the wastewater system Periodic inspections will help extend the Iife of the system and prevent the need for costly repairs the agreement authorizes access to your POWTS equipment by a trained and authorized technician, during daylight hours, is provide regular Inspections and routine maintenance to help assure the equipment is working properly. It c hereby agreed by and between Turdra,er and KnudGon Plumbing and Contracting that in consideration of the payments provided for herein Knudtson Plumbing and Contracting w,ll provide the services of a factory -trained representative to perform periodic inspections of the equipment described below Knudtsor Plumbing 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 for any operation and maintenance deemed appropriate by the Inspector This agreement dues not assume any responsibilities for obligations that are normally the responsibilities 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 Knudtson Plumbing and Contracting be responsible for any special or consequential damages, including but not limited to Ios 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 authorization by Purchaser. This agreement shall remain in force for a period of_1 years, beginning _Mav_ . 2020 and will automatually renew each year thereafter for one year ones, canceled by either party with at least 30 days written notice- ]his agreement maybe canceled by the Purchaser only If replaced by a service agreement with an dididt ed service provider for the-quipment listed below. Knudtson Plumbing and Contracting may delay or cancrl future in;pecbnns if puymen+ bcarmes at 1-ast 15 hays past due Periodic Inspections Association agrees to pay Knudtson clumping and Zontracting $_200 CO - per each house's annual inspection Any additional testing or services regwreo will be billed on time and material arml Equipment Covered Under This Agreement Description Model No. Serial No. Install Date Location if different _f_rom system owner 1 ATII'S [hoot or Micro -Fast i Knudtson Plumbing and Contract -rig Signed _ -r_ _- - . Date, 927 150" St , Roberts, WI 54023 " 651-4/0-1 /37 System Ow Signature Ruling ll ills Ho own Asso Iation'nc Tip � Print Name: - Street 3r�- t rty State & 7�r l .1 Cc - r-z. [45, Date 01/15r2020 Ph ne: �7is�Fax r yyt.((ff d— Email I ,)2.�c �tv.Sbu_C.�'kCwC+r ST CRO- LINTY SANITARY SYSTEM File#: OffiOWNERSHIP/ADDRESS FORM—A-2212— y C ommurnty Development Department call utilize this informaho, tr, prov,de the pn;perty owner with Information regarding Opeia6On and mainteri.-ante cr sour new or reolacernent sanitary system' This intormaton vdlll be provider' as part Of roil . inyi nnG wforts to protest public health, wur wed lroundwater, surface water, property va,u�s, end U-L,nty resour, i; Vnr� cpl:ru,cd this rrmqaetrd fern and eciucatona'': Information will be sent to you by eamil OWNER/BUYER INFORMATION Owner/Buyer 4,8 y;LL,,d �T1e . Mailing Address 31 tom C,ty/State/Ziprli_/- �tl Tom_- Phone Number (required;(��.�2.LZ ��,31 /� Email Address i refecri eafi Sl i4�--_ Parcel l dentificotion Number ifound on she aicv [v 1, bid', NEW SYSTEM: LEGAL DESCRIPTION Property Location _. Se ' IV Y'I 1 -v:n ci _ Subdivision Plat iZ ft. — As) J �iy1 - - - - -_- gut s % Certified Survey Map # _ - Volume P,,ge # Warranty Deed# _ _-rt"toie 20'J6N'olurn, _ _ _ _ Faye Numbe- of bedrooms spec houseAye:. 0 nO _ct lines idenbfiatde 0 yes 0 no Ne✓rvroperty Address1��,U—,OUSE ONLY _ , . si .,i,,,r .,r�.r�r".r i�, Srd;zl _- Thisform must be sobmitted vzt`1 oft ans It, !;n,rra "t"cr FS4ih I:rn!ir fore New System: Include 6% trh Oct. fmrn c rt. of clod ,: m„ a4, llslr pi n"i' Re., e' er a)De.;, rv;,, "nd „u; c! 6^".e: nf,eJ st,ev mop rf referenrc As:nod, ,, (he ves,, 1/,J. , I Co nma I t, Dr v, ,f'ic Il"PO'clAent '_end I Iy Urvlc o., 71`,-48e-4680 St. Go'a rcunr/ c-lleili Coma i lly7-, -42',11 Fay cdd a5cav go, 1101 Carrn,hae Ru„ d, I-lud+on vVl ;an 16 .xb cro a, ISO (i KEG ELEVATION DO�� ' ------------- FRONT ELEVATION m RIGHT ELEVATION 1e�.'. Ae 10 .10 s NMO ORAVN BY OEG W ai Dart. 0 m07 11fINVN®: of a ie �e� Al h, r. I� I j i y� �FOl1NDATION PLAN W u vT NQO07 IkVINO m zna per A2 IMPORTANT NOTE Kn "kill \ � cu�u I �a n. i,o . i uviep coon '�� I 9 ai 04 16 SIG � �S I I III 0 MA IY is ._. _.__—_ - • _—_ —_— NNWWN I �111� �1 � MAM LEVEL PLAN m m n rti ,..... o ."w .c. PAO A3 i 0iuu9�i8uhi0u0ih Tx:4585959 St. Croix County AEROBIC TREATMENT UNIT (ATU) SERVICING AGREEMENT State Plan Transaction Number - C & d Builders, Inc -- Name — (Owner) Typed or punted 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 1131626 St. Croix Register of Deeds Office. This Property is described as follows (include lot no. and subdivision/CSM or detailed legal description): LOT 67 of Rolling Hills Farm plat, in the Town of Hammond, St, Croix County, WI. OR: See attached deed ropy for legal descriptions Agreement Dale: _6/1412021 1132281 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06j14j2021 09:43 AM EXEMPT #: REC FEE 30.00 COPY FEE 2.00 PAGES: 1 LAIIN 15 2021 St. CroixCountymunity Development As an inducement to the county to issue a sanitary permit for a POWTS equipped wish an Aerobic Treatment Unit on the abov -described property, we agree To do the following: I. Owns agrees to conform To all applicable reouirementa of SPS 393, Wis. Adm. Code relating to Aerobic 'ruatme t Units (ATU) and the maintenance requirements for the proposed P01hi-I's (Private Oosite Wastewater Treatment System) technology If the owner fails to have the POWTS and ATU properly serviced in response to orders issued by the goverrunemid unit or the Department of Safety and Professional Services (DSPS) To prevent or abate a human hei hazard as described in s. 254.59, Stats., the governmental unit (fawn) may enter upon the property and service the tonk or cause to have the rank to be samcad and charge the owner by placing the charges on the tax bill as a special assessment for current servicesrendered The charges will w assessed as prescribed by s. 66.0703, Stets, 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 menufactuecr and the Department. including but not limited to: the blower, c:xtricel controls, and open meet unit operation and sludge depth. These inspection we to be scheduled every 6 months for the first two years of operation and yea ly thereafter. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the trot so as to not create a human heath hazard as described in s. 254.59, Stab. 4. The owner oxecip szes that the county, DSPS, or POWTS maintainer may make periodic hupecuons of the components to complete performance monitoring ofthcuiit 5. The owner or the ownei s agent agrees to report to the departr:ent 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 otlice responsible for the regulation of POW 'IS ecnities that the aerobic treatment unit no longer serves the property. In addition, this agteemem may he cancelled by executing and recording seal certification with reference to this agreement in such msnntt which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the own a, the hews of the owner, and assignees of the owner The owner shall submit this agreement m the Register of Directs, and the agreement shell be recorded in a manner that will permit the existence of the agmcment to be determined by reference to the property where the Aerobic Treatment Unit is installed- Owner(s) Name(d- Please Print Subscribed and swum to before me an this date: e)EfFitEy N V3 �, � (t-(. 0--Oa-4 Nowired Owner's Signeture(s) Public V Govemmenml Unit Official Name, Title- Please Print My Commission Expires lij . Cormmmity, Development Department Q-%—`Qto^"}p�j Is Gov earn nitofficial Signature funded by: O J _ Community Development Department ~bagYPO Personal Information you provide maybe used for secondary purposes jPrivacy law s i5.04(I)(m))I St Croix County 1132231 Page 1 of 1 a 1'a _AST. WEST 114 UNE SECTION 29 /319.14' MATCH LINE SEE SHEET 1 SSO°5048•E i 12.3 i N99°49'19'E 402.99 133.00 Saw t1 .77 1p 14 \ ,q ° � LOT 65 q ! .L LOT 67 1 LOT 68 21,792 SO. FT. ' vs�Tiy,q ��,� • ' , • M� i< nb .� ' LOT 60 , ,p4 _OT 66 21,791 SO. FT. to 1 N9 b - -� 1,791 SO. Ffi LOT / •, z,saaFr.,' LOT / 62 4 oe / 21,7e3 so. Fr� � 21,791 SO. FT. -�_ v91 41�61 o LN00''026 74.19, `�" N83°40'0411 �. SB2° 944 91y1K- --, B6_90' _ gM `re EL \ , 1092.g0 \ , , r " LOT l LOT ( t 63 64 I 21.792 SO. FTI R 21,791 SO. Fr. c C2 1 C i Wiscensu T7epariment of Commerce PRIVATE SEWAGE SYSTEM Safety and Fludding Division I INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m)] Perms Holder's Name City Village X Township Rolling Hills of Hammond LLC I Hammond. Town Of /bd . (05 6 — i TANK INFORMATION cS-r ELEVATION DATA TYPE MANUFACTURER CAPACITY ujteSeptic _ / N 2 S- Dosing ^ M__ to z �� Aeraho I G� TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic is Dosing � tW / 6 l 0� ' 7S ' 6� Ae ti n / LnF ' 1 / 31 i , 10 Qlti 5 (o Holding PUMP/SIPHON INFORMATION Manufacturer 6,1 n / Model Number W �1 TDH Lif( Friction Loss System Hea b Forcemain Length Dia. Dist to Well 7�0 3 SOIL ABSORPTION SYSTEM W U STATION BS S� 5 HI l06,55 FS ELEV ieo• VS Benchmark AIL BM GU.I:! • �� 7. 93 Bldg. Sewer �J. 1F (�• p � ! S• 9 fir✓ �f SU t Inlet Stl O tier Dt Inlet ^' oS 4v3 •3Z Dt Bottom yZ6o /5•y 57.a} Header/Man Dist. Pipe Bot System Final Grade St Cover jPr vl 67 (03 cZ - ,11 /._L.r / S /In I_-t4A0� 4�(J.t/riTrdlS BEO-rRENCH Width Length i No Of Trenc ._. PIT DIMENSIONS Na Of Pits v Inside Do Liquid Depth DIMENSIONS /� IZ0 Q ` SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM L CHING Manufacturer CHA R N TYPe Q(System i r/3 i �/� i xrl /�� Model Numhe, \ /dlQ�...U,i3"_1G-i/ 7/6d /V Y.1 Jla 1 MI13V I IVIN JTJ I CM WaJ'r Oy.. (•Oil•d.IMy` leaderlMamf9ld // Distribution C6 -�C i / x Hole Size �/ z/ x Hole Spacing Var t.J�A;'u-I�n/��im .ength_Do/5 ' _ Pepgth Sg' Dia /' �✓ Spacing_ V/p �� ' GU 4 JUIL UOVER x Pressure Svstamc Du.w x Mn—al nir Af-co—do c—r— n. 1" Dap1h Over Bed/Trench Center / / / Depth Over Ded/Trench Edges \ xx Depth of Topsoil I C1 xx Seeded/Sodded yes xx Mulched Yes No COMMENTS: (Include code discrepancies, persons present. etc.) Inspection #1: --1 , 2 /0'7 r�Q Inspection #2 _?/_ 7' 1 6— Avl '(''' � m JVI �15E 1/ •}pol� (N 1/4 29 T2N R17W) Rolling H� riLot 65 �,1 `S PUarce 29 29 r 6� 1 ) Alt'BM Descrriiption S'141S ''t.Q'�}'ly. b/ 7" d ` a2 2.) Bldg sewer length = -amount of cover= / �� t^� G5 ZZ.BZ. $3.73 /1�oed- a� dot rN•G..'� % b Plan revision Required? Yes No _ --� 1 j 6-7 - r- Use other side for additional information I SBD-,7'0 rR 3+97y Dale insTs Signa re Cer, No Overview This system design is intended to be of sufficient size to be capable of handling an increased wastewater load in the future. This plan complies with the St. Croix County Code of Ordinances, Land Use and Development, Chapter 12, Sanitary, Enacted July 1, 2005. Specifically, Section 12.4.A.3.c. (Common Systems, General, Submittal Requirements), requires state approval from the Wisconsin Department of Commerce for an onsite disposal system. A Conservation Development, Rolling Hills Farm, is designed for 77 lots serviced by a proposed 22 adsorption/dispersal components located on common ground. Appropriate easements and maintenagce lapguage are required by the ordinance prior to preliminary and final approval. This design fo ,J6 will -have conu�Qon pump tank and dispersal components to service an additional three lot, lots 66, 67, and 68. Lot 65 and eac future lot are projected to accommodate four bedroom residences. Each residence will have a combination tank with a septic/trash tank compartment ahead of an aerobic treatment compartment. Septic/trash compartment outlets will be equipped with filters equipped with filter alarms to facilitate proper maintenance. Thus, highly treated effluent could potentially be created in estimated flow of 1600 gallons per day or design flow to 2400 gallons per day. All this effluent will flow downslope to a dosing/pump tank located just west of lot 65. This system is designed with surge capacity and timed dosing of the mound component. Surge capacity is approximately 1983 gallons represented by the pump tank volume between the timer off liquid level and the alarm float. The surge volume is about 82.6 percent of the design daily flow assuming potential future loads. Timed dosing is designed to spread the full potential future design load of 2400 gallons per day over 24 hours in 21 separate dosing events. With drain -back of 283.2 gallons, a dose of 397.2 gallons translates to an effective dose of 114.0 gallons into the mound component. At a calculated total dynamic head of 58.3 feet the Goulds 3885-WE15H pump is estimated to yield 56.74 gallons per minute which indicates a timer on setting of 7.0 minutes or 420 seconds. Since twenty-one doses per day are anticipated at full design load, the timer off setting should be 61.6 minutes (3696 seconds). Careful measurement of pump tank liquid level drop is required to field calibrate these estimates and assure a 397.2 gallon timed dose including drain -back. The liquid level drop should be 6.7 inches per dose prior to drain - back. It can be noted that the 114 gallon delivered dose is slightly greater than five times the lateral volume and will provide 5.26 doses per day for a one residence load at full initial design load. The common effluent collection line must be constructed with schedule 40 PVC and installed in accord with Comm 82.30(11)(e). In particular the trench bottom must be over -excavated a minimum of three inches and the elevation of the pipe established at the pipe invert with at least three inches of clean sand. Pipe backfill shall be in accord with Comm 82.30(11)(e)2.a for the initial twelve inches. The collection pipe should be installed at a nominal depth of six feet below grade to facilitate gravity collection from future residences. The Comm 82.30(11)(e) installation requirements also apply to the system force main. Page 1 a of 8 ( Z/ aw &01 . C QO AC COUNTY STArvlf.', 6M4 SE �YF�e PRE t NO. 633804 Y PERMIT OWNER 4,T'RJU II.OE!S�C. PLUMBER TOWN OF N SEC- J 2 N AND/OR LOT ~i 4 S IS BLOCK wwww�W" OUS NO. NOMMENS aE CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (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. (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 thepermit, please contact the county authornity. SUBDIVISION ISSUING OFFICER - DATE UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R1 1/20)