HomeMy WebLinkAbout018-2019-16-000Wisconsin Department of Commerce
Safety and Building Division
GENERAL INFORMATION
Personal information you provide may be used for secondary purposes
ings LLC
TANK INFORMATION SfIL o ^ R
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
[Privacy Law, s.15.04 (1)(m)]
II110617 l0[e]071,\ AU75LeP►Io
TYPE
MANUFA TURER �,�5
CAPACITY
Septic
,ram �Q
you 9Z1
Dosing
Aeration
o li
Holding
TANK SETBACK INFORMATION
TANKTO
P/L
W
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
.
(D / o f
3 , "']1 [
A.., 3 W
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
Lift
Friction Loss
System Head
TDH Ft
Forcemain
Length
Dia.
Dist. to well
SOIL ABSORPTION SYSTEM
(!Ovf-
'ATION DATA
STATION
BS
HI
FS
ELEV
Benchmark
q
O�•
(�� r 9Q
Alt. BM
n (ov-tr
7
r�7 23
Bid�Sae�
9.2
3 &y
St/Ht Inlet
2�
T5, 36
SUHt Outlet
LJ
�
(omASR Wf1
f
41ti
414
IY)
IZ.3
j'
f,063
/,0 62
Dt Bottom
Header/Man.
Dist Pipe
Bot. System
Final Grade
St er
,,
S
97. z3
BEDITRENCH
Width /
erigth
No. Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia
Liquid Depth
DIMENSIONS
— ,
I
SETBACK
SYSTEFFM�^T O1M
P/L
BLDG
WELL
LAKE/STREAM
LEACHING
Manufacturer
INFORMATION
CHAMBER OR
UNIT
Type Of S tam
Model Number
%o n
DISTRIBUTION SYSTEM
Header/Manifold
IlDistribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipets)
Length Dia
Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
xx Depth of
xz Seeded/Sodded
ra Mulched
BedfTrench Center
BedfTrench Edges
Topsoil
❑ Yes ❑ No
E Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1. Inspection #2.
Location: 1625 72ND AVE 1.) Alt BM Description = SN CO Vi
2.) Bldg sewer length = 3W
-amount of cover=7,�f10" 1_CY
Plan revision Required? _ Yes No
Use other side for additional informatio
SBD-6710 tR.3/97)
+T�JS[ IOCC(t'! OH sy�►lK� V ns f
on
-no wr li oK
P(,,�,, �r 1lteas,ared rk t c.c 11 aw lei- 4-o E�S-)--
/� Date Insepctofs S�gnra�ture/ , 1 Cart. No.
}(.iy1Ni� -#740r
SRN- Zo21- 2Y0
Ll
i, v _ _
and Buildings Division
County
St. Croix
JUL
�(�/Safety;
2 CU � � . Washington Ave., P.O. Box 7162
cum
Sanitary Permit Number (to be filled in by Cal
Madison, WI 537 16
Sang 1 pplication
to Transaction Number
In accordance with SPS 383 21(2), Wis Adm Code, submission of this form to the appropriate governmental unit
071901162-C
Project Address (if different than mauling address)
is required prior to obtaining a sanitary permit Now Application forms for state-owned POINTS are submitted to
the Department of Safety and Professional Servies Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s 15 04(1 m), Slats
1625 72nd Ave.
1. Application Information -Please Print All Information
Property Owner's Name
Parcel 4
W C Land Holdings LLc
018-2019-16-000
Property Owrier's Mailing Address
Property Location
626 Tremont Lane
Goer Lot
SE y, SW y, Section 29
City, State
Zip Code Phone
Number
River Falls, WI.
(circle one)
(circle
29 N, R 17 EorXV
D. Type of Building (check all that apply) Lot
a
111 or 2 Family Dwelling - Number Bedrooms 4 16
Subdivision Name
(as(+�r�i+(�s) BI«kit
Rolling Hills Farm
❑ Pubhe/Commercral - Describe Use
❑ City of
❑ State Owned - Describe Use CSM
❑ Village of
Number
N Town of Hammond
Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A
New S stem y
❑ Replacement System
El'I'reatment/Holdmg I ank Replacement Only
El Other Modification to Existing System (explain)
B.
❑ Permit Renewal
El Permit Ree lsion
El Change of Plumber
❑ Permit Transfer to New
Lust Previous Permit Number and Date Issued
Before Expiation
Owner
/�
61— �� L .
IV. Type of POWTS S stem/Com nent/Deviec: Check all that appl15- 1
❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in of suitable sod LJ Mound < 24 in of suitable sod
❑ Holding Tank ❑ Other Dispersal Component (explain) ® Pretreatment Device (explain) Hoot 600 / Weser ATU
V. Dis rsaVl'reatatent Area Information:
Design Flow (gpd)
sign Sod pphca ion Rate(gpdsf)
Dispersal Area Required (sf)
Dispersal Area Proposed (st)
Sys m Elevation
1800
Existin
V L Tank Info
Capacity in
Total
q of
Manufacturer
Gallons
Gallons
Units
SimTek 100
o v
_
New Tacks
Eusnas Tanis
v
L
L
Septic or Holding Tank
400/921
Hoot 600/Wieser ATU
x
Dosing Chamber
sD0
(tit / •e 5 Qr
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plum r' SigQat
MP/MPRS Number
Business Phone Number
Keith Knudtson
�t
648443
651-470-1737
Plumber's Address (Street, City, State, Zip Code) ,
927 150th St. Roberts,Wi. 54023
County/Department Use Only
�V/ill.
O Approved
❑ Disapproved
Permu Feee1-rD_ate
Issued
Issm Agent Srgrtature
❑
I
eason mal
Conditions ppmv t r^- NaPPE^ t A-tU c.c• t�d� - w-o Vap4s
YSTSTEM OWNER:
a
Septic tank, effluent filter and
dispersal cell must servicedbe _/ maintained�d roV?� Ma�tM
as per managementt plan provided by plumber. l 7mv
I
. All setback requirements must be maintained zr,
7�p asp rappl able �ceode/oPUPAir mpwieeatasPorthe mhmandsubmitbthe ComtyF
per olleaa 81 Iliec tosxe n
`(Zu5L�fl'fl l iallt w ! I Gs nine i� Ml^
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D'vw s _eaQ+�e,,�f Ter DeT6.1k Lam
c� .
✓- r%d3� �Rq�
G'evei, FL v.
To Qosc
72n_/ ;FOr"
/V-
4
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Lot 16 ATU
Owners Name:
W C LandHoldings
Owners Address:
626 Tremont Lane
Legal Description:
Township:
County:
Subdivision Name:
Lot Number.
Parcel ID Number
River Falls, Wi.
SE1/4SW1/4S29T29R17W
Hammond
St. Croix
Rolling Hills Farm
16
018-2019-16-000
Page 1
Page 2
Page 3
Page 4
Index and title
Plot Plan
System Sizing & Cross -Section
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: 07/ 10/2021
License Number: 648443
Phone Number (651) 470-1737
Signature
Designed pursuant to the In -Grand Soil AbscrpWn Component Manual for POWTS Version 2.0 SBA-10705-P (N.01/01).
Page 1
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• W.MNM .a ',=: Y iY. •:i(a"e bedding rl ec prmO4The bedding_sihA be dry, sandy
The dep*itr it in m wW endorsing IW pr4duet or any advefting and * riotrest s uati€Ln which
may result "r b ram.
4" CAS
TO MEET OR EXCEED ASTM C-1227
4" CAS
POLYLOK 12" ACCESS LID (TYP)
EZ SET RISER (TYP)
600 GPD ORAVr JHAROE SYSTEM
H-600 A'
TANK SPECIFICATIONS
DIMENSIONS:
WALL. r
BOTTOM: 3"
u
COVER! 4"
MANHOLE: 12" & 24" LID. PLASTIC RISER
HEIGHT: 70" O.D.
LENGTH10B" O.D.
A
D.
BEL W INLE1r 67� O,D,
lw
LIQUID LEVEL• 61"
WEIGHT: 11,135 LBS.
Lu
INLET AND OUTLET:
=
4" CAST -A -SEAL (CAS) BOOT OR EQUAL
Y
COVER: MIX DESIGN (NO ER
TANK: MIX DESIGN jD
(§MALLFlBML)
CUSTOMIZED TANKS:
FOR CUSTOM,�TANKS CONTACT WIESER CONCRETE
0
�QQ� a6
3
4
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY: S
APPROVAL DATE:
PRODUCTS NEEDED BY: 1HEET
-Ox
,.
H� •T
Y
www.hootsy$tems.com.
,00!aftdawt�
H-Series Gravity Treatment System
Green Choice Applications:
Single and Multi -Family
Dwellings, light commercial,
Churches, and other similar
Residential strength uses.
Performance:
98% Reduction CBODs
99% Reduction TSS
99% Conversion of Ammonia (NH3)
Feca! .
Range of Sizes:
500, 600,750 & 1000 GPD
High performance, low cost, energy efficient treatment system
The 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 tens
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 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 lines,
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 forjust any
system. Protect your family and the environment with a Hoot H-Series System.
Wieser Concrete Products Inc. 1-800-325-8456 www.wieserconcrete.com
Homeowner Guidelines for homes equipped with Aerobic Treatment Units
The septic system for your home depends 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. To avoid breakdowns and costly repairs, please observe the following guidelines:
• Avoid allowing any inert materials such as plastic, rubber, scouring pads, dental floss,
cigarette filters, bandages, hair, mop strings, lint, rags, cloth and towels to enter the
system. These materials can build up in the tank, resulting in system malfunction,
clogging and premature pump failure.
• Do not flush or drain chemicals and toxins into the system, as they kill the microbes
necessary for treatment. These include paint and paint thinners, solvents, drain cleaners,
automotive fluids, fuels, pesticides, herbicides, fertilizers, metals, disinfectants and
sanitizers.
• Paper products including disposable diapers, paper towels, baby wipes, facial tissues and
moist toilet paper are not designed to dissolve in your on -site treatment systems. Neither
will excessive amounts of toilet tissue decompose.
• Limit garbage disposal use to food waste that cannot be scooped and thrown in the trash.
Do not put animal fats and bones, grease, coffee grounds, citrus and melon rinds, corn
cobs, egg shells, etc. down the sink. Also avoid putting spoiled dairy products and yeasts
from baking into the system.
• Do not put medicinal materials, automatic disinfection tablets and similar items into the
system. Also, septic tank additives generally do more harm than good.
• If possible, spread laundry practices out over several days, rather than one "wash day," so
the ATU can more efficiently process the water as it enters the system. Liquid detergents
are recommended over powder; fabric softener sheets are preferred over liquid softeners.
Use bleach sparingly, at half the recommended rate.
• Clear water waste from dehumidifiers, HVAC units, gutters, whole house treatment
systems and sump pumps can increase the flow to both your on -site system and the
'shared system, leading to shorter life. Both clear water and backwash from water softener
regeneration should be discharged to an alternate outlet. Talk to your contractor.
Do not disconnect power from the unit!
Your ATU is equipped with an alarm that will notify you of a malfunction. If the alarm does
sound, for diagnostics, service and repair call:
Knudtson Plumbing and Contracting
651-470-1737
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Page 2 of9 H.W.L. 1036.6 NN
Sanitary Site Plan
For: Tyme Properties LLC
Lolling Hills Farm Outlot I
Part of the SE114 - SW114
Sec. 29 T29N-R17W
Hammond Tnsp. - St. Croix County
S88019'07W
BM ELEV
1036.01
A IIM -Top of Lot Iron SW Corner of Lot 16
,1, IIRP=Same
ASSUMIEDELEV.= 100
IiM # 2 -Top of Lot Iron SW Corner of Lot 17
1 Inv. "- 96.47'
OUTLOT 1
29.56 ACRES
1,287,641 SQ. FT.
I
01$ ad2pPS�P�v BM ELEVL
N 1040.40 <J62 e Jg�.\� gA`3'A 1 1047.02
m2/ °
72 7201' �0. (p 5
O
P FN# 1627 ��42 12�a \°PEE
VE
A LOT DWF = 600 gp (
)38 18 LOT
LOT N DWF
C 17 00 gp ztm 4" PVC
• N
DWFac*. (Son.,
rn 600 pd Exl
m g':� e'o ". �j -
$� .
• �°
T LOT
.P
s ,m
N 1 s
4"Sch. 40 or
N
LOT m si,m
Astm -D3034
19
cr3
4
LOT
20 sa �'. q
p3
10p'
r
m
2
NI
w
s,,m
90,M
Existing Wieser W2500•MR
Dose Tank
05aS
Top of Cover 96.90'
Existing Mound Cell
g6
in concave bowl
being replaced.
TransID# 1670635
Site# 735502
Maintain Well and Waterline Setbacks
Oo
per SPS 383.43(8)@
A
Proposed two 4' x 150' Mound Dispersal Cells
101.80, w/a
S.E. of 103.30'
Upslope cell located along the contour
Down slope cell located along the 101.30, contour
w/a S.E, of 102.80'
101.30'
P/L
100.50'
i
DA�( 8�2055Py53,1 0�
Exist g 4" PVC Private Main
w/Cleanouts near proposed
conveyance pipe intersectio
a 102.59
Mound to
Serve Lots
15, 16, 17
Open Field Site
Proposed Two 2" Sch.40 PVC F.M.
N89057'56' W
AV
St. Croix County
AEROBIC TREATMENT UNIT (ATU)
SERVICING AGREEMENT
rate Plan Transaction Number -
WC Land Holdings
Name —(Owner) Typed or printed
He/she is the legal owner of the following parcel of land located in St. Croix County,
Wisconsin, with thew deed or document of ownership interest recorded as Document
Number_1116823 St. Croix Register of Deeds Office
This Property is described as follows (include lot no. and subdivisioa'CSM or detailed
legal description)
Lot 16, Rolling Hills Farm, Town of Hammond, St Croix County, Wisconsin
OR
❑ See attached deed copy for legal descriptions
Agreement Date: _July 29, 2021
IlliIIIIIII!IIII
6 6 1 9 0 5 7
i,
Tx:4696796
1135729
6ETM PARST
REGISTER OF DEE95
ST. CROIX CO , WI
RECEIVED FOR RECORD
07/29/2021 10 19 AM
EXEMPT #:
REC FEE 3000
COPY FEE 2.Oo
PAGES:1
3 0 2021
"County
• Development
t Cm1' A\D AETI�RN/sDDjot,
LC � 4 r �rY
parcel
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, Wa Asian Code relating to Aerobic Treatment Units (ATU) and the
maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System) technology If the owner fads to have the
POWTS and ATU properly 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 m s 254 59, Son", the governmental unn (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, Staffs
2 The owner agrees to mmntam a contract with a licensed POWTS maintainer for the life of the system The POWTS mainumer will perform
periodic inspections and maintenance as required by the manufacturer and the Department including, but not lunrted 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 ofopermo r
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 so as to not
create a human health hazard as described in s 254 59, Stals
4 The owner recognizes that the county, DSPS, or POWTS mamtarner may make periodic inspections ofthe components to complete performance
monitoring of the 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 10 business days from the date of inspection, mantenance or
servicing
6 This agreement will remain in effect only until the county office responsible for the regulation of POWTS counties 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 hers 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 property where the Aerobic Treatment Unit is impelled,
Owner(s) Name(s) - Please Print
Subscribed and sworn to before me an this date.
-re re* P. is6ej0fto
Notarized Owner's Signature(s)
Not Pubhc -
Governmental Unit Official Name, Tine - Please Print
My in.. Expires ;.•••••••. •�•„; ��
Community Development Department
'OQ
D a - 06 - ;w a - y JULIE A.
Governmental nitOfficial Signature Drafted by IS I 1ptlrt%`J�11
Community Development Department
PJ=
„ARY
Personal information you provide may be used for secondary purposes (Privacy Law s 15 04(l)(m)]-'•'ow"
RECEIVED
JUL 3 0 2021
ST. CROIX COUNTY CDD
WL
bZz-
SCC ArcGIS Web Map
7/30I2021, 11:41:24 AM
1:1,128
0 0.01 0.01 0.02 mi
® DrainageEasement Lot and Units Park General Common Element Shoreland Overlay District , ` �
1�� ry�---r1y
, i —1
Public ROW Outlot Lot Tax Parcels 75 FT Building Setback 0 0.01 0.02 0.04 km
Unit Limited Common Element 300 FT River/Stream WDNR, SCC COD, SCC COD and SCC Higt y Dept, SCC COD, FEMA,
Web Appaudder for A GIS
SCC CDD I WONR, SCC COD I SCC CDD and SCC Hghway Dept I FEMA, SCC CDD I CDD and NPS I National Geospelal-Intelligence Agee. (NGA), Detla State Univealty; Ean I
vl�mrar, DeP.m^er+r cor-,ree. PRIVATE SEWAGE SYSTEM St. Croix
s.kq .^P MN^p prvmm�
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SC,* P:.1. a rx 815459
Ve x-..M�m Mon rc- car ee mry ee uua toy reranea'r N'om.a 1Pmr:.r lar, a 't :4 i' ..m
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SITU-6i99 (R. I I i I I l
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4501. C204KCOUNTY (d;5rr)ATU)
STATE SANITARY PERMIT
NO. 633855
PLU
TO'V
SEC
AND/OR LOT
PREVIO�JS N�/S S�T��R\
oil
BLOCK
INS SUBDIVISION
CHAPTER 145.13l12) 1`TSCONSIN 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 he renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(u) Renewal of the sanitary permit will be based on
regulations in forceat 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.
&&*04WW'AQTjffORVED ISSUING OFFICER - DATE %Z
S PERMIT EXPIRES UNLESS RENEWED BEFORE THAT/
DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)