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Home My WebLink About018-2019-52-00014 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM 11ty. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 633895 Stale Plan ID No: Personal information you provide may be used for secondary purposes IPnvacy Law, s.15 04 (1)(m)I Permit Holder's Name City Village Township Parcel Tax No. C&J Builders TOWN OF HAMMOND 018-2019-52-000 CST BM Elev Insp BM Rev. DM Description / m4" 'go Section/Town/Range/Map No. 29.29.17.1252 /, c o� ,,r�s%) ot� cSr�r t 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY tic R ffoo T Dosing ` Ar(6S e7� ' L V` eraho 00 din TANK SETBACK INFORMATION TANK TO P1L WELL BLDG. Vent) to Air Intake ROAD Septic Dosing 11 l 331 / Aerati Holding PUMP/SIPHON INFORMATION Iss Manufacturer Demand O UL-65 GPM Model Number G f o 'tyJ' n TDH Lift bo Friction Lost System Head TD 2 agFt Forcemain Length 1 D1iiaa. rr Dist to well o0 SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. nchmadc It. BM Bldg. Sewer / .g� O ^�•10 v7O SUHt Inlet SUM Outlet iii Yo5l. 3/ Dt Inlet /5.62 057.191 Dt Bottom p.30 .73 H der/Man. Dist. Pipe Bot System nal Grade S Cover L7� .off D1" caw1 �l SL� /0.36 /063, S BED/TRENCH DIMENSIONS Width L th No. Of enches PIT DIMENSIONS No. Of Pits Inside Die, Liquid Depth SETBACK INFORMATIONAt4 SYSTEM TO Type Of System BLDG WELL LAKE/STREAM / LEACHING CHAMBER OR UNIT M cturer Mode 'rkltttuber:� DISTRIBUTION SYSTE 111� Header/Manifold Distnbunon x Hole Size x Hale Spacing Vent [o Air Intake Pipes Length Dia Length pacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center BedlTrench Edges To Yes ❑ No Yes No c C NTq:Includ code discrepencles, persons present, etc.) Inspection #1. /)(��-/'�pj! Inspection #2. " )Location: 11615� �j75TH VE 1.) Alt BM Description= /Kgnz• li+Z,2�1rj2(—? g` 2.) Bldg sewer length - Z I tt l �- r -amountofcover= ) -42. Plan revision Required? Yes XNo f I) Use other side for additional mformah n. 4 Zat/1 S D- 10 (R.3/97) DInse ors Signature Cert No 4)l �.o 9y, t�T ►,a S-4 c0�t�+e 4 d I of keR <AA1--)021- Q i ` & 4 v Safety and Buildings Division County l%✓'p f Sanitary Permit Number�(a be sued in by Co ) 01 W. Washington Ave., P 0. Box 7162 Madison, 53707-7162 St Croy County nt C J LJ Develop Permit AYt'11Ca State amt� In accordance with SPS 383 21(2), Wis Adm Code. submission of this form to the appropriate mad unit �Traannssarctiioon�Number `�^^^ [/ / is required prior to obtaining a sanitary permit Note Application forms for state-owned PGWTS s mmed to Project Address (t di erent than mating address) the Department of Safety and Professional Senses Personal information you provide may be u r secondary ses m accordance with the Privaev Law, s 15 04(1)(m ), Stats 1615 75th Ave I. Application Information - Please Print All Information Property Owner's Name Parcel 4 C&J Builders 018-2019-52-000 Property Owner's Mailing Address Property Location 09. zi�, 17. tZb z 316 Kamloops Place Govt Lot NW y, SW Section 29 City, State Zip Code Phone Number River Falls, W. 54015 (circle one) T 29 N. R 17 E o,)W H. Type of Building (check all that apply) Lot 4 ® 1 or2Famdv Dwelling-Nuinberol'ffedr ms 4 52 Subdivision Name Rolling Hills Farm Block # ❑ Public/Commercial - Describe Use ❑ City of El State Owned - Describe Use El Village of -_ CSM Number 2 ::1 KJ Tnw mf Hammond ID. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. I1 New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to ExistingSystem (explain) It. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued fiction: Expiration owner 617796 1/2/20 W. Type of POWTS S stem/Coin onent/Device: Check all that apply) ❑ Non -Pressurized In -Ground ❑ Pries. surized In -Ground ❑ At -Grade ❑ Mound> 24 m. of suitable sod ❑ Mound <24 in of suitable sod ❑ Holdup Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) Hoot 600 / Wieser V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Sod Application Rate(gpdsl) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Existing VI. Tank Info Capacity in Total f! of Manufacturer Gallons Gallons Units 2 Slfmft4sec filters. t s✓V' ° u '_' New Tanks Existing -I anks 1x„jt,.5 Septic or Holding Tank 400/921 1 Hoot 600 / Wieser ATU Dosing Comber VII. Responsibility Statement- I, the endrniFned, asse rnpomi 'lity for iesta ifon of the POTS shows on the attached plain. Plumber s•Name (Print) Plum tgnauue MP/MPRS Number Business Phone Number Keith Knudison 8443 651-470-1737 Plumber's Address (91111liet.City, State, Zip 927 150th St. Roberts,Wi. 54023 VIII. Coun arns ent Use Only Approved ❑ Disapproved Pe,rroIt Fee $ l D Issued Zy L [ssumg Agent St e ElOwner Given Reason for llemal Y }Dnrate IX.Cotsditions of. ApprovsVReas(rwforLj)isapproval 3 1� 1_ ,� p/blA J��/s µq rYt rfLWCL SYSTEM OWNER: 1. Septic tank, effluent filter and �N��`(,t,�, ffv Ot—p-clr", dispersal cell must be satyiced/meimair ad \ _ as per management plan pravided by plumber. T, �%� t g ,erN„1.� ISP a n ; All be / setback requirements myst maintained 11 it er i llteiite Wilaµrtdltl6MeiWs� S W 1rt! C con Attach to complete plant for the stun anll submit to qe County only on pater rat less thaa e('a x 11 iocha i'nor �1 YKovHd 6�v1 ov�-%ef- Strc�C�S �Uls SBD-6398(R. 11/I1) -lee Va,%, d- lL�t eel [�yrn%.w//1 D �i3307s- oaf' cSa Dose Tank Component Cross Section Approved Manhole Covets With Wamiag labels and Locking Device / 4" Mm. Above Final Grade \ Weather ProofJunction Box Electric pererNEC EC 303D0 & SPS. 4" Sch. 40 Vent / 316.012 WAC > or —to 12' t\� Above Final Grade 11 n y FIAU�te Out let location v u le Sleeveor Anti Siphon Device Note: Pump switch and alarm to be AWired to separate circuits. BffElev. /OS1j,-- C Tank Mfr. Wiener C--ao - % D Dose Tank Elev. Vertical Diffetcmce Bctween Pump Off and Distribution Pipe — Mimimttm Reqmhed Snpply Pressnm..__..__................._...... _ / ,e FT. of Force Main x/�1V Friction Faetodl00F1'....-�]�' Total Dynamic Head .................... -p'♦; Volume ofBaekflow_»..._........ _.......... _...... _._.»....._i1 Total Dose Volume .................... ... _.._..____:L2.,... ,ZrGal Pump Tank Capacity ',^_ Gallons Dimensions Inches Gallons Tank Volme Os"`"� Gal/tach A -j I / B /P 0. Pump Mfr-od . �r C —L[Y( (pq, Damp Model gj� D y �� MinimDischarge ffie ge R—_GPM —Y— Alarm Mfr. S_T�o G.,h,t,,, Total— Alarm Mod ,, ,(/pi„rt/ Bed Tank per SPS 383.45(5) Anchor Tank as nazssary to negate buoyant forces per SPS. 383.43(8)(g), RECEIVED NOV 2 2 2O21 ST. CROIX COUNTY COD [qGOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatenng SPECIFICATIONS • So6ds handling capabTdy: '/l naxhnom. Capacities: UP to 60 GPM. • Toth heads: up to 31 feet. • Discharge size: 14:' NPT. • Mechanical seal: carbori. rotary/ceramic-stauocary, BONA-N elastomers. • TempereWre: 1041F(409] continua,, 140°F (601 j irrtermident. • Fasteners: 300 series stainless steel. • Capable of nmrvog dry without damage to components 16o41-%71 hi' «Submersible of 'J�z Effluent Pump ERICH EP04 & EP05 Series • Fu" submerged In high grade turbi oil for lubrication and efficient heat transfer. Available for aummaticand manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ■ EP04 Impeller. Thmmplas- tc Seri .open design with PanP out vanes for mechanical seal protection. M Motor. = m�ee •1i54a 230V W 1550 RPM, built in overload with automatic reset • EPOS phase 0.5 NP, cart 115 V a230V, 60N; 1550 RPM, bait in overoad with automatic reset. ` ,1 • Power cord: 10 foot standard length, 16/3 S1TW with three prong grounding Plug. Optional 20 foot length, 1613 91 W with three Prong gmmldmg dug (standard on EP05). 0:033 G." n,,,es Efhcllre Ni,, Zoo, 83871 ■ EP05 Impeller. Themmplas- fic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ■ Motor Ilorrsing: Cast iron for efficient heat transfer, strength, and durabgmy. ■ Motor Cover. Thermoplastic cover with integral handle and float switch atradrmem points. ■ Power Cable: Severe duty rated oil and water resistant ■ Bearings: Uppn and lower Iwzvy duty ball bearing construction. AGENCY LISTING CI. CwAdw,,fandwds Rsmrlan. _ .File •VMS" reWr ft"b W"in R,&,,& - ��5)0 Got�Ids Pumps r � �& rrr Industries RECEIVED NOV 2 2 2021 ST. CROIX COUNTY CDD Yz� (CICOpy �e 5f�o✓��Coe 5�—. �2-LI rb51a.s3 ,a�� CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: C&J Lot 52 Owners Name: C&J Builders Owners Address: 316 Kamloops Place Legal Description: Township. River Falls ,Wi. 54015 NW1/4SW1/4S29T29R17 W Hammond County: St. Croix Subdivision Name Rolling Hills Farm Lot Number. 52 Parcel ID Number. 018-2019-52-000 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 Pfan 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: 08/15/2021 License Number: 648443 Phone Number (651) 470-1737 Signature Designed punnuant to the In -Ground Soil Absorptan Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 f/- 6 fz,:� ,ej Pr ��5��a✓.ef eo W/age. �L� rb�o.33 ,ago Sanitary Site Plun loprFRO11inggills flveIth-1111(1l Propert Owners Asslil-010t, Rollin,1, MIAs h'1n In f 4diliji t J ory 1,' 1•l Port 1!l flip r1WI14 Sol, 11.101 u! I1101to f'nd - Nif hNIX Chump LOT 50 21,781SO. FT. 1 so.52' OUTLOT 2 42.71 ACRES 1,860,35E SQ. FT. LOT 51 tPNe taro Propmed • WELI DWF = 600 gpd Hoot H-000 4" Bch. 40 sic septic PVC Bldg Sewer LOT 52 BM F.LEV.-- 75TH AVENUE- 1076.09 N tFNk 1517 Proposed • WEI. DWF = 600 gpd 4`8ch. 40 PVC Bldg. Sewer Hoot H-OX 81o18eptc LOT 53 tFNN 11119 Proposed . WELL DWF = 800 gpd Hoot H-B00 4'Sch. 40 Blo/8epec PVC fig. Sewer a LOT 54 N 21,781SO. 21,781 SO. 21,781 SQ. 21,781 SQ, FT, FT. FT. FT. 4" Sch. 40 PVC or Aetm D•3034 PVC Conveyance Pipe. 81,73' 85.86' 1092.16 65.26' os3.69 85.23' NW5111 WE 560.2,V 1079.00' Proposed Wieser Concrete B1� WLP1260-MR w/ Duplex Pumps w/S1mtech STF-lCOFllters 1 B3-1.54 DWF of 1800 gals, /1.50 - 1125 sq. R. /Bf1. - 141 fl. Lots 52.54 Proposed Duplex 2" Sch. 40 PVC F.M:s / Typical of each lot will be 4" Sch. 40 PVC Bk1g, Sewer 4" Sch. 40 PVC or Asfm D-3034 PVC Conveyance Pipe. Control Pt e2042 . Wooden Hub Elev. - 1077.49 1 B2-L54 1077 t Indicates the Drive C/L Page 2 of 9 '2.99' 11 owh� I Inch . 50 R. LOT 55 LOT L N as y 21,781 SQ. I FT. 21,781SO, FT. 86.29 1 86 B1•L55 Control Pl. #2032 oa Wooden Hub 2M Elev. rs 107391' Duplex Dose Tank Grade m1075,00' Top of inlet pipe = I D69.01y Site is an Open Slope Proposed V x 141' Mound Dispersal Cell located along the 1077.00' contour w/a B3•1-55 System Elev. of 1078.00' ,7 ST CRoJac -LINTY SANITARY SYSTEM File# Of oe Use Only �^ OWNERSHIP/ADDRESS FORM Creareel/zelr Community Development Department wdl utilize this information to provide the property owner witty information regarding operation and maintenance of ve•,a new or rep:ecement varntary system 1 his information will be provided as part of our onpomo e'toCs to protect public he, -h, yaur w61 groundwater, surface water, property values, and LOOM, Iesour- S Vnce app-o. ed ins cempleteo form and educational information v-ri he Sent to you Dy cmalk tr OWNER/BUYER INFORMATION T Owner/Buyer _C .J AL y-0QA Mailing Address O Oe aCe City/State/Zip _--9i C✓ f W]A — r.)1 Phone Number Email Address Parcel !dentrfcation Number (fouorl in t,e ..,,,.:r —_c2.� `---�/-.-_6 a NEW SYSTEM: LEGAL DESCRIPTION property Location tk _ r: r Se/c) _ vv -C .n c Subdivision Plat 111Li_KGil`$ryrs Certified Survey Map # 6 _ ___ deRrn� Warranty Deed 9 _� 3 7!�' _ _ (beto e 2006,Vc1.lme Number o` bedrooms _ Spec hcuseSes O no /a-w_✓N- O HP LOtIT 71 _.- Page Lo' Imes dentifiab e�0K'es ❑ ao gOFFICE USE ONLY Nev. Property Address (Se�RLia'y Cxte )his form must be Submirea mt,-+r all Prorate Cnsite f/ater Trectment System ;'f'ON.?5) ;rop(Ica'lons. New System: Irdcd n- .. Com�„n ;y Development Depamnent Laid use Jenson 715 186-4680 St Croix Co+"3y Go!emn•erI Center . S ?=S-'250 rax CddCmscaa wt ?Ol Carrmichae' P.oad. Nudsol. N5 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGRFEMFNT AND OWNERSHIP CERTIFICATION FORM \� OwnerBuyer A'�"�." �' Mailing Address Property Address City/State &14A LA�Panel Identification Number/Q— �7"%/`f' '--s� Ll^>CD LEGAL DESCRIPTION Property Location 'i; , Ya , Sec._, T _N R W, Town of gam,( Nil 0✓y Ny Subdivision Plat: QSO Lot # S Certified Survey Map # Volume , Page # Warranty Deed # ��,,,{{{ (before 200T)Volume , Page # Spec house ycn'esElo Lot bin,dentdiablDan SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could resuL m its premature failure to handle wastes Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed. by a licensed 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 respomsbdures are specified m $SPS 383 521 I) and in Chapter 12 - St. Croix Co..,,, Sanitary Ordurame. The properh owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber.joumeyrnan plumber. restricted plumber or a licensed pumper serif} Ina that (1) the on -site wastewater disposal system is in proper operating condition and/or t2) after mspechon and pumping (if n..r)'l, the septic tank is less than I /I full of sludge. f'we, the undersigned have read the above requirements and agree to maintain the prorate sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your sepue system has been maintained must be completed and retumed to the St. Croix County Planning & Zoning Department within Y) days of the three year expiration date 14e certify that all statements on this form doe true to the best of my our knowledge. I we aro are the ownens) of the property d suitxd above. by virtue of a warranty deed recorded in Register of Deeds Office Number of bedrooms y IGN TURE OF -APPLICANT(S) DATE "'"Any information that is misrepresented may result in the sanitary permit being resukcd by the Planning & Zoning Depamucto Include with this application a recorded wamnty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed (REV. 04/12) 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, com 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, RVAC 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 106" 31k" 741" o I ___ -71 4" CAS 11 4" CAS POLYLOK 12" ACCESS LID (TYP) h1---1�L�== --J 41" 40" 0 LO '.Z SET RISER (TYP) TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 600 GPD GRAVITYDI CHARGE SYSTEM A H-600 A TANK SPECIFICATIONS DIMENSIONS: WALL- 3" BOTTOM: 3" COVER: 4" MANHOLE: 12" h 24" I.D. PLASTIC RISER 8 HEIGHT: 70" O.D. 8 LENGTH 108" O.D. m g WIDTH: 74 1/2" O.D. BELOW INLET: 57" O.D. c LIQUID LEVEL: 51" W $ WEIGHT: 11,135 LBS. W INLET AND OUTLET: 4" CAST -A -SEAL (CAS) BOOT OR EQUAL t0 COVER: MIX DESIGN #8 (NO FIBER) ® � 00 TANK: MIX DESIGN K9 (SMALL FIBER) V I CUSTOMIZED TANKS: N FOR CUSTOM TANKS CONTACT WIESER CONCRETE M W� I 00 W �r 0 Q o O Q tD � 4 U o F DRAWINGS SNOUTED I N FOR APPROVAL = APPROVED BY: S14WT NO. APPROVAL DATE: 1 PRODUCTS NEEDED BY: FI c, CrODC H-Series Gravity Treatment System Green Choice Applications: Single and Multi -Family Dwellings, light commerdal, Churches, and other similar Residential strength uses. Performance: 98% Reduction CBODs 99% Reduction TSS 99% Conversion of Ammonia (NH3) Feca! ., nnn /o disinfection 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 CRON 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. S®rple 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)ugs. Choose Hoot, and you make a sensible, decision to protect the environment as you protect our most precious resource, our water. Draiinflield 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 1-800-32S-84S6 www.wleserconcrete.com i�eont+rraw lseartt�fe+t6�tieeetY�r '' e�::�• o-.rc , r. �. ♦ a . ♦ t7Ysp�1t Cott .a +'flwla�r►wroAad�sna�,�a�ek+�re��.$p9►d�• +r tAe�gbi9te4 eHet��t+a�t+�ian. I� Hr t� at ia�gnr. pq 16 ZRO Tha hmk* net mowmrm*d to balwWW *toe oaum1w §vo W DMSQr,* . high Sound w4Wtbk-s 4m (40-40tWoen VW bWWMof the t9rk wni ft orr t3siaii� mm WAWW, a aW.§er bWWWO mAuig shaft bel Sao orgmvet W. scbtuek P>laratL Deparbfttd Of saw aw I)M'8iM 4f ft(k4" SWAM& Phbhe (608) 267471'3 MW 3 S — S 1:171fJ AwOw � � r -_:,, v , n, w ,.,.,ql�"��• Sic_ .. e.aa� v Z _ � ww pt RI aaa: e.aee.� 4 __ _ 0 tle 3 it - Lit- C x _ o.p I - 6 9 v �d a A3 ier s __...Wu a Y m ZN E N --- e 4 Y {..., �.r--•- we w a MiwPin. a .r° 6 i na ® ED ❑ m Pit ® ® m - m-------- q i3�Retr EleveLlon 1 i❑ m . o0 t 0 N 3 ryryry��jjj O 1 E` _- Ieva lon 2 R19ht E[avatlor p 7mFzW .T J U CI All CEO❑ �q��7 O � ___ - � .._��." 0=0 000 00000 Al Private On -Site Waste Treatment System (PO`i Inspection Agreement The correct operation of the equipment noted helow'unit hcantly mflu ernes the IT be of the wastewater system Periodic inspections will help extend the the di rystem and prevent the need for costly repairs The agreement authorizes access to your POWTS equipment by a trained and 'authorized technician, during daylight hour, to provide regular Inspections and routine maintenance to help assure tire �gmpmerit is working properly It a hereby agreed by and between Pn ,ha$'i and Ki.u,tsnn Plumbing and f,lu rre trig that in consmcration of the payments promded fur I -I Kmutt... o V I urnbing I I Cot i ne wrr; or umcto thn+erv¢es of a tart or ynramr it representative to parfor rn Pcriodv 1.l spechirn, of thr eyvpn I ent in, uh-d berom + noirIt sor vininth m; and Contracting will prepare a I r eteu r epur t Al:,, of t 11,rLt,-'n,it 1, 1"To y't II, ter r r �h:.r,in base, This report will mrtam recomrnenoatmns ;or In, I ocrat'n cr: l Jeemei r.P, III Ie sc the nsperYnr This agreement does not a5511 me any responsrbr 1, hrn for oobgahons that all -lorma Ily tine resccrsi br rue- of P. rdo,,io and does not extend to cover any cost, that may be associate with any recommendd t l on: made under this agreement In no evnnt shall Knudtson Pl embmg and Coil rarbng he re-,nonsi ble for It 'IV In -of or consequential damages, including bet't'_t ;[retied I. hlSc If lire, col ,rr fir, nermn irr prnpertr c. n-,wntal econonec ions ddc to equipment faili_rc o- to, n VT a„r v. ar aye- ✓rnc,-on Pl,"Iol ; Ivii -. Lim tr,g may soppty aodolvnai scan"" parts or'dbr:r nil f after aothonzaLrn it, punha-er rhrs agreement shall remain in foie for a period o _l r_ r, begmnmy _mca _ -I_0__ ., .ill w automatically reneeach year thereafter for one year .In e,- rdn eld'ry etlher part, :,i!h at ha.t io days terGto notice- This agreemenr may be Cinceler, by the r„rrha,e- only if reelaseo o, a xorace afire<crnr I arty -n aath0 Izn,s -,r-e pr I,.Tde-'.-r du Ior„ P n, I r, t l 1, t_d a o ,. „L r'Lon 19L.rar n.tl r[r.r 111 T I� i-la, .Ir cancel Future i'_SFl or c f Pa Vine,: ceo: 1 n. _ =r Ind .t . .d, .a_t J,.I Pere loin: mpertl o n_ 4:,r_at,., -s I, r r, ,.ni ,.m I __ .1 --[- nL.:SC'idn(Lla.ri5:e:rlpn;,os-. itillo � Er _r-ice_ r, 11,_C "I it' IT. rn=an_, I...,d..1.11, Equipment Covered Under This Agreement Description Model No. Serial No install Date Location if different from system owner A-GS Hoot or.V"-o-Fart - - Knudtsor P;orr,omg end Ccntra,;,ng 927150" St ,Roberts, WI 54U24 651-470-1737 System Came Signal ur- p/ priding Hlac ep�ir,e ;-arya h�-„r„ Pt Nzne__4 CfT1l�r TLl[K-�i_ 0 �3t not 14, 1 � State & Zip y,weer Fa,1I' Wr stf�zz II._ L - $-s-7 I uz 7.71 r�< GUrvirim Vr'rm%oG ADVICE. 1277.16 DEDICATED TO THE PUBLIC N89°47'SVE 691.96 FOR STREET PURPOSES 8904769° 1. ' r� 86.67 — 89.01Y — 88.89' — 84.914 — 86, / N I \. LOT LOT t LOT LOT L 49 50 151 52 5 121,781 SQ. I21,781 SQ. I21,71 21,781 SQ. 21,781 SO. t Fr. FT. F '6'i Ss9� N870081430E 160.52' \ �� / \ oA�k\ 7 i , 232 9 ELEv 9,oA ` 1° X* < .OT 48� '�� q &dr7bo AAS. S4- . Croix COUNTY NO. 633895 STATE SANITARY PERMIT I05 75n Ave EiT�NSFPIPEtlfOL4S.tl0� OWNER G+ PLUMBER ilk i TOWN OF moto SEC Z9 ,T V? N9 AND/OR LOT 52 THIS PERMIT EXPIRES POD Cx 4 qeqy., Rom. BLOCK SUBDIVISION ISSUING OFFICER 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. (e) 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 the permit, please contact the county authority. -DATE 81Z Y T" iEWED VIEW THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20) '"... '' -. """ PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION +P I I AGH I [ 1 PI-IMU I ; Fnrrnr +rm.rah.,, n.• _... .. .._ -- � ...r :Ala Iawn-R. Rollinq Hills Farm Owners Assoclatlorb IfOWN OF H 1010o. 9l0 W ooj Pj Jo - TANK I ®�ii I■ II TANK SETBACK INFORMATION (IoC k TI. K'n �of t'•L / S Lair 'ZLI FLf1.. en'o-,.� na.. RDA[: 8 (J %too 7ro�' .t Holdinn i PUMPISIPHON INFORMATION Z 1, *9. - ' q'd' ' 30. a Manula�lure- // I _ �— C4^n.rl� MO.], r.� -.. FPoS�'Z 1 Funrnt IM _ -ryll r Ilia ,7��a SOIL ABSORPTION SYSTEM I I St Croix AMMOND]L;' 018-2019-79-0001 29 29 17 1279 DATA gip`} uCreNlom, 3. s i0� L7 io6o. oar f.b3 10S . 1+ to53. 1 katl.-rfAan f// . q 1—p1701� Sl oL^Ei 1o53 SMMENCN (1IME NSIONS :.P' •. i PT C'IMENSQNS '• r• a .'."._ SEIBACK MFORMAnON r I� "•'. .' _ .i. :.•t L COINQ Ck� 9e kbfk 1J l 1iV Yt� '7 ��..// 2-I1"AU� AGO DISTRIBUTION SYSTEM �_ � L � o-i g•h _ L. . y.n • , Caor SOIL COVER _ I 1 • E L- , p.... Soste nw Onh, .. Mound Or At -Grad. S..temS OnIY irf H N' N. I." 1�aYiw�tR3f{:e64`I /1 Kei:' I ICIe L I r._25 /+li: N }, I 66 COMMENTS ... .t.. :.a., ._ L,:;ot. ,a:.:..1>' i )4L.{ (6Jl' Lo[allon Na ;, l9ies5 Arn i,iLl ZZ 7 0 1 iV �t 31 r1 4 1Vv:e Plt %�Lt T : yU4: �2c, l G:O' �• � V t f � h 7 ) Bn6q ;Rwcl IunNlh= i .. ��+Uf1K'�-�S��o�s �iA� Ko �ri�+-t�S .Q4 J.'VG �114 ��7 "ft^t v�;� LJ t't_k41--; ves- r.. �V,(A Safety a a R.nlro,ngs Division St Croix 1 Is.f ' ?OI W WashiniLttwi Ave P 0 Box 116' i I ;I ;llj:i Madr#WI 53707 7162 ; � �S{tr sx• �7 7� ,4 �-tr ntt_ Pt- mit Awlic lul l 1 .w:r,tdarna 1 + 1 il, t I ti .. .. I t ,ri -' 091901$75-Ci lyn,rdpr, I I 1 , 5 nl r I ,-i tc 1 III, - I t r in lI i, J ti l l Plulhl 6,1'. .. tl 1'6 .0 N.-c sddlr'nl nw"min,rl 1\,1.ry nd 111 I 1,1-.1\ I. I, u. I ... I Sluev.11,o,.i.,..ralvamdlv'ew«Iln�- J"nfa.+cxmaa aJ-ax. ,wth flirt rn.+, Ln, I.41Inu.1 '•LH. f^� 75ttk I,4vc 1 %pphratitm Information - 1'Irax 1'nnt .III Inlnnaantm / i } P1r�('P.. tMac a^v 7•.:r.J Rolling Hills Farm Owners Association Inc . 018-2019-79-000 _y i4n,t rtv (h, n.r _ A6u Lo, 1A1n•+. Pr.,hlty i .+.I•e.n « � i , I�� 3435 Labore Rd.STE 150 1 rh N.q. lh. ,i.l. ,� `.nmhrr NW SW Sn n•e. 29 II Vadnals Heights Mn (�29" 11. T�pr of RmlOmx lchrck aR Ihat appil I tl . l do1,it ,lmr `. nnRal nl fS.-,I tifr �� Rolling Nils Farm i'Pubhca uimm�n ud lhvnlw lw _ Hammond 11f I fpr o It'hrrk unO unr Inn an bnr \ t rmplete liar li dapphraflkl Z�r, �t,,:. \..,<�� ItapL.. n•1\.. +.u, �I�h.. •.Atli .J,.. vt ky.l"rrt..wlHd. �tILa, 1L .m.at.mn.i a,d."\a 'emir:plaml H. � P... • k a ..... f', �, .. .. � _.. r...... ., .. '—� 1.� .., r. , .. h.ia.. n.1 I G . L::xd 4 Innl lipe at PI tN 1 \ h+lem f umpunenl7katcr (l herl rk nil that atA —_,`__ i 1, 4 I P[CM1LJ.dbI i .sand J I'.,,.. 'ad L, Ir. 1.0 ..\.,.6, r..rm 4., .I I .L, -,i U I,o "1 m •f nabm, ❑ +GH _ .. fllni. t,. 1 lh1 nxl 1 rl.9rra Int tu, rn,ltaa�tJanr rno-1 f144'„ •: �r 106e0v' _l8ia312400 1 \1. rank Oda T--FI I u_rr 2- Still flIt' ers ,_l. • , -Z . i 1250 I ) 11250 Wie ser eset x i 11 Resprnnfhlllh Statement- 1. Ili, en 1 r ,xonL a rrgx.nal 1 t la r«Iail 1 1 rM I n\\ 11.h..wn n Orr elbdlyd 1axo 't, ,a C>�t %'j• MFIR, -..1. j B7" '. V9. x.r 4:rmhc j tom' IS 470-1737 KeithKnudtson `>< �/ 648443 927 150th St Roberts Ws 54023 \ l C0111111)epartmenl M c.; T• / 1f I\ 1 iin#00vFR V.lWftrnv* Reavrnr for ni+apprl,a at 1 N ,I I Y c tl 11 I �. `;� C..-Or'1 � � i N4� . /�• 1�a�}1JW[�._ J) ��/ d15(, I 4 r I i US. t i,.1 I n al ' n ,❑1- r ��J1I . og yam a 1 u1n//(„^" litrni �•=Nj.Mp gtaII. Grlk•..,,r�•wl NAuar u.IL., seh uharypn .et h+IS.x kt]a li tr in V H I-6398 1 R 11 1 11