Loading...
HomeMy WebLinkAbout018-2019-49-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. CfOIX Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 633894 State Plan ID No Personal information you provide may be used for secondary purposes (Privacy Law, s 15 04 (1 )(m)I Permit Holder's Name C&J Builders Inc City Village Township 1 Parcel Tax No TOWN OF HAMMOND 018-2019-49-000 rrJ TANK INFORMATION Z-11 ,r� 7 S cr l ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration •�i H Holding TANK SETBACK INFORMATION (o1.Vrc Sr,.. I TANK TO P/L' 1 /T WELL BLDG 'dent to Air Intake ROAD Septic p >zo Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia Dist to'.Me'.i SOIL ABSORPTION SYSTFM STATION HIS HI FS ELEV. Benchmark �L l oq3 Io85. AID ,l to 3.0� P?iQ .7 Bldg Sewer St/Ht Inlet 6'3 IoB-7•LI Slii Outlet l0$7, 2 /,' Dt Bottom Header/Man Dist Pipe Bat System Final Grade St Cover f n G v t r 3. 010 )0?0. 7 BED/TRENCH Width Long No Of Trenches PIT DIMENSIONS No Of Pits Inside Dia Ligwd Depth DIMENSIONS r� / SETBACK SYSTEM T O BLDG WELL LAKEISTREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type 0 System Model Number O UNIT i I KItSU I IUN JYJ I CM Header'Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipets) Length Dia Length Dia Spacng JUIL Cull x Preccu ro Bveenme in.n. .. n... r_—. - m....,...... n Depth Over Depth Over xx Depth of zx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes f J No Yes COMMENTS: (Include code discrepencies, persons present. etc ) Inspection #1 Inspection #2 Location: 160975TH AVE 'No 6v4- 1 ) Alt BM Description =Tr% (py,<i 2.) Bldg sewer length = ZG - amount of cover =7 / 8 .' Plan revision Required? LJ Yes No I O �7 I Use other side for additional information. / fi SBD-6710 (R 3/97) Date 9 _1 )_1 asepct s Si nature Cart No -�Arv-tidal_ ;�R1 Safety and Buildings Division County St. Croix , Sanitary Permit Number (to be fined in by Co ) 2021 201 W. Washington Ave., P.O. Box 7162 . ; �_�= A AEG 16 Madison, Wl 537 7-7 2 u2 Applieati State Transaction Number Co t' rmit In accordance with S (2), Wis. Adm Code, submission of this form to the appropriate governmental unit 081901572-C Project Address (if different than mailing address) is required prior to obtaining a sanitary permit Note Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Senses Personal information you provide mm, be used for secondary purposesinaccordancemiththePnsacvLaw,s I5 I m), Stats 1609 75th Ave 1. Application Information - Please Print All Information Property Owner's Name parcel 4 C & J Builders Inc. 018-2019-49-000 Property Owner's Mailing Address Property Location 316 Kamloops Place Goof Lot 1A, SW y,, Section 29 City, State Zip Code Phone Number River Falls, Wi. e) T 29 N, R17 (circle oreXV IL Type of Building (check all that apply) ✓ Lot p SubdnisionName KIIor2FamilyDwellmg-Numbero Bedrooms�4�,���� 49 �1ems) Block# Rolling Hills Farm ElPublic/Commercial - Describe Use ❑ City of El State Owned -Describe Use CSM ❑ Vdlageof Number CK Town of Hammond IR. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement System ❑ Trea[mentlHoldin g Tank Replacement Only El Omer Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Lest Previous Permit Number and Date Issued MSUAM Before Expiration Owner 615462 VaiCi q%ei'� IV. Type of POWTS S stem/Coin onent/Device: Check all that apply) ❑ NonPresumed In -Ground ❑ Presswued In-Gmtmd ❑ At -Grade ❑ Mound > 24 in of suitable sod ❑ Mound <24 in of suitable sod ❑ Holding Lank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) Hoot 600 / Wieser V. Dispe mIrFreatment Area Information: Design Flow (gpd) Design Sod Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System elevation Existing VI, Tank Info Capacty in Total N of Manufacturer Gallons Gallons Units y - u 2 New Tanks Existing Tanks u,i Septic or Holding Tank 400/921 1 Hoot 600 / Wieser x Dosing Clamber Vi. Responsibility Statement- I, the undersigned, assum misonsi ' ity for insta tion of the PVWTS shown on the attached plans. Plumber's Name (Pont) Plumb ignature MP/MPRS Number Business Phone Number Keith Knudtson _ 8443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) " 927 150th St. Roberts,Wi. 54023 VER. County/fIleparnment Use Only yq Approved Disap ❑ rov SPerm4t F/in �j(}a/lc Issued Issuin Agent Sig [ ❑ yen n for Rnial IX. Conditions Appro VRes,eesier-Pisepprural?�S �S �^ 1 v� S,T rJ� 7 SYSTEM OWN 1. Septic tank, effluent filler and -t (��L -plS Vui it 6,BvltteC-4- -�o-bko dispersal cell must be serviced ! maintained as per management plan provided by plumber. 5 2. All setback requirements must be maintainede::�c:, TIk CAA_ asper ap hcaoiecoo ei IBtlh" Ieplansforthesyshmindsubmittothe County odjon pernoiI thaw aril' ches sae i s lien ins Wv�t.M7tQ.1^j),.ull� -r,kb -tKUV-'-Xt-1(5-wb Plot �,� Z at 91 Ao05 Ie- / 3v y15q �qu qo' n m M J—IAAI L1� CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: C&J lot 49 Owner's Name: C & J Builders Owners Address: 316 Kamloops Place Legal Description: Township. County: Subdivision Name: Lot Number. River Falls S29T29R17W Hammond St. Croix Rolling Hills 49 Parcel ID Number: 018-2019-49-000 Designer/Plumber. Date: Signature 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 B Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Keith Knudtson License Number: 648443 08/15/2021 Phone Number (651)470-1737 Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 7S- 109 c) L e u 5 e y b � do �kO4 30 � d a� �L d�a��tin GC � � _ ._� • I - � � ..__. a � � uvl d`Joo11 uivw Z On - 3U3 E N A2 ®�sf't I vat[on m ❑®® m ® —- a �3,Sear �lev Ion 1 � � m 0 C2)Rlq�t Elavetlon Al DWF of 1800 gala. /1.60 BAR = 1125 sq. ft. /811. - 141 ft. Lots 4"1 B 01 L-49 SM01 -Top of W00ded H Elw,-1084.29 .1 0 JB e3 75th Ave. M ELE nnn0•"rnmu nn� nnr 1076.0 QouY/-a VV Jul.•7 86.5 89.09' 88.89 84.91' 85.26' a lm m1 f FN# 1609 �FN# 1611 I FN# 1613 I LO 49 LOT LOT 21,781 SQ. N $O 51 CY � FT. W 21,781 SQ. W 21,781 SQ. LOT LOT a �' 0 • WELL • WELL — 52 0Fr. 53 y DWF = fN • WELL DWF = S 600 gpd DWF = 600 gpd 21,781 SQ, 21,781 SQ. FT, ,b 4" Bch. 40 PVC Bldg. Sewer 4' Sch. 40 PVC 4" Sch. 4o PVC Bldg. Sewer Bldg. Bawer ID N L-49 Hoo(H Hoot H-800 810/8900 Hoot H,600 BI0�e Bio/SepBo e0.26' 1091WOpdm 61.73 ea.ee' 85.26' BM#2 -Tap of wooded Hu 0 --. PtN 2029 "" 1— dw..1060.10Nr NOElm - 10%. 12' N81 SB #1 L ,0 7N8roa-43-EIeO.62' e1097.93' RyaPro sed S.d x 141'Mound Die real Cell Ek. -1 Po Pe 1084.72' Elw. - 109o.ea located along the 1082.22 contour w/a Outlet a 1080.72' Reeer 4' Sch. 40 PVC or Astm D3034 PVC Conveyance Pipe. System Elev. of J83.22' 10% Proposed Duplex 2" Bch. 40 PVC F.M.'s I e2 L-50 Rollin f- 1063.22' Proposed Wieser Concrete 9 WLP1250-MR w/ Duplex Pumps 0' ,B-501082.221 w/ Slmtech STF-10O Filters aE23287 BM ELEV. MCA 1080.22' SW • WELL 1075.68 O (n �Q.ii,� Mound Site Is an Open Grass Slope Township 600 gpd Hoot H µ 4TF Typical of each lot will be 4" Bch. 40 PVC Bldg. Sewer Blo/Septic OUTLOT 2 Pipe Malarial per ASTM Standard (Tables 384.303 & 384.30-5) 8 42.71 ACRES Insulate Building Sewer per BPS 382.30(11)(c) and Provide frost protection l Grade =1073.84' HOC 1,860,359 SO. FT. 4' FT. 4"Sch.4o PVC Tap Of pipe = tos7.5a' 9�Oti a W 0 co m 4" CAS - n e r N 31 J" 41" 106" 74j" IHI II 4" CAS iIu � -.fir III — III POLYLOK 12" ACCESS LID (TYP) IIII _ BL 40" I �Z SET RISER (TYP) TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 600 GPD GRAVITY DISCHARGE SYSTEM H-600 A H-600 A TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" 13 L, .o COVER: 4" 8 MANHOLE: 12" & 24" I.D. PLASTIC RISER HEIGHT: 70" O.D. r 8 LENGTH 106" 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 COVER: MIX DESIGN #8 (NO FIBER) Ln ® i 00 TANK: MIX DESIGN #9 (SMALL FIBER) pii o I = CUSTOMIZED TANKS: N FOR CUSTOM TANKS CONTACT WESER CONCRETE r") W� I Who 00 N m Ln 0 d J Cod Q O a o a v F 8 DRAWINGS SUBMITTED N FOR APPROVAL = APPROVED BY: SNOT NO. APPROVAL DATE: PRODUCTS NEEDED BY: /OF 1 CrOIX k H-Series Gravity Treatment System a) a) c..emww onslm NSFIYMSI MaNbrNg SlabaN 9O 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) Fecal <, 00010 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 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 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 mflkjugs. 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 Private On -Site Waste Treatment System (POWTS) Inspection Agreement The correct operation of the equipment noted below significantly influences the life of the wastewater system. Periodic inspections will help extend the life of the system an prevent the need for costly repairs The agreement authorizes access to your POWTS equipment by a trained and authorized technician, during daylight hours tc provide regular Inspections and routine maintenance to help anure the equipment is working properly It rs hereby agreed by and between Pur,hd>er and r nudtson Plumb rig and cuntrading that in consrderatwo of the payments provided for herein Knudtson Plumbing and Contracting will provide Lire services of a factory trained representatne to perform periodic Inspection, of the cqulll ac,bed below " nudtson Plumbing and Contracting will prepare a wrCten , eii af,c eod, m Ii ,, , .rid prom 1., e ropy of the repo-t to ire Purchase Th,> repot will contmn re_ommendatrons to any of Cran,.rr din: red nter anec deemed apornfl by the inspector I his agreement does not assume any responvbrhu, fir oolrgabons 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 Plum6mg and (ontra,t.ng be responsible for any sper,al or consequential damages, Including but not I meted to loss of rune, "'jury to person or property or inadental econumic loss due to equipment failure or for any other reason whatsoever. Knudtson PS.mbing and Contrarung may supply additional services, parts or labor only after authonzaPcn by Purchaser. This agreement shall remain in force for a penod of_3__- years, beginning_May ,020 and wilr automatically renew each year thereafter for one year unll , an,, ed'by either party w4h at least 40, days wntten notice This agreemen* may be car ceied by the Purchaser only rf,tcla,,d by a serm­ agreemen' wltu an author l.eJ sery ce Provid.r `a "he equipment let ed be I 11 I, lit. I r.I air, and =c ntrda rig icily tielao rr ,.ancel future nsoealons if pe am-nt o ej tics at 1, yr ; , ,ry, pus- d..e ,nod, lnrpe trans -,.social n ag, .,e: to -.a, n. d'. In Lin 11 i,, and contracun-S "h .ninon rr.,yecl;on A. f add,[,,,n ri testin, cr c-r.i. _ r - .wrce a. it be L„ lr or •lore rind ,t. ,,ai a! .its _Equipment Covered Under This Agreement Description Model No. Serial No. Install Date Location if different from system owner ATII'S Hoot or Micro -Fan Knudtson Plumbing and Contracting Sivir , -__ i)atc_ 927150p1'St„ Roberts, WI 54023 " 651-470-1737 System O'ey(y� t�1t .F Slgnatue \y1�( - - - - Ual- - Print g IPlls HcM\courors _ ss�Clahon Inc - PnntName�e,� L�(',W�110_ 'A P „t11r s �.- ��,� Z zz-973 I y, State & ZI (/C y/b z:v fdx l�er �q[� S iEmail I `"b#"\ r.F.ES IA I ;+I .irq- Ir.::rr. F r',.._ -6 a :Ifr oil . ip'All 1 jUTIM r!� err .- r :,r.e _`",. .:_ �-- - .:.- f ..:f ,- r f �• r" 'v .o.. ' .: rr, - v r r� • - w+: r' R:•c- t:i'• - n i"ce `:r a --qi.• .: .: :: ? aAd�,ta.�t� �mgA..abic��pS��t9.90�t i vd�,Lbffib Itmlt#� ftAlft� *11WP 3ft,V(I) AfHte Wi L Ada Code. a 7fi�pi�d1�"fiSel ��� �Idttftsi9Fit► "W. ..._.. ;;f� 6 2020 s W.:2MM134 • 8 WW shad be MW WO k;rw m anhule.imuers iriiamMmm vft S. .6 AA)O, (Sotit�. Tlie1'�311(t�lrei`fl��i�a[i�ts�8vasivl�T�t��.�d td be �tsidt�daPr�lut,�ng c�vlee . + 'i'tzese iantss s��l v�Ygln� ie�€Lp, Thai are vts�il� a�l"ii�slallp�oW ih�t tpni�m � s b't� �4.25 {�, ' RIQ k is nef Yec ed hr tre Teti �6rfrete saiur t(sull nt i �5 1 i strtRbW awe e� Mlo-Od (fin tho bVWm Dfthe tank and ft gtdm4 t ftW- • N 4Ctith of shah be The bedding YaMaM snaH he cirp, san* low fivWW, at WrWO% Wormw in the last • �A3-IA(�: hlust5e t�si ��s �finoft it�Rt21& illnla<e}3m1 b@ �in9 still ur gravel s A ipahas &t diameter in ills ietg�t ditttarlsix►. The ddjAMMM ffi in noway endm-sitig #hi, prraduot mr any adveWift m ifi npt aspmSi sit+r4q) Whis�l mail reeu��il da ewe. Sincerely, . PimnbbV PMdORWWW Depar6flt�6'f>`�antl s�rt�5�tatil Division Gt= Buteautlf7�tist>i�i�n , (608) 47-140 Phntit OUR) 26Y ffm MW glen"sohhtai,g© mail File #. ST CRRQJ- s I)NTY SANITARY SYSTEM oleIf. :eonfy �' OWNERSHIP/ADDRESS FORM c.e t.d212on Community Development Depacment m.11 util¢e the Info,mation to p'ovioe the prope-ty owner wit information regarding operation and niairtera Ice of vow or rnnlacemont sans tmy system' Th s information will be pl,VIdec as part cf cur o lgolno eff,rs to protect p.,bl c heath, your well, groundwater, surtace water, property value, orw L ,I I c, cos Once aporo,ed 'his comple'eJ form --Id edLrat, onal information wd! be se-t to vcr cy ema OWNER/BUYER INFORMATION C �', ' u �i _ Owner/3uyer � �\ 'eis nL`, Mai'inc Address 3/4�..�,`QQ S 4h1 a Gfy/StafefLlp Jf,iV(--, Phone Number ,reyv�rrd7C /(p/3�_.— ��j Final Address pequrec)_ Parcelldennfcation Number _Y� Ibund on IIrioPer[y ra, r l, NEW SYSTEM: LEGAL DESCRIPTION Property 1,cation _ I'I, L., , Sec r . ' VJ _CVoI et Subdivision Plat Ktl�jl Certified Survey Map # __. _ _ _ _ _ _ _ _ _ _.. Volume Doge Warranty Deed # _ _� J 'before 2006iVolume ,Page a Number of bedrooms Spec houseA yes O no Lor lines idenfihablA yes ❑ no OFFUSE ONLY New Property.4Jdn �� � ��� � AlAll _ :� This form moat be sobrnitterl ov,th ail Palate Oesire 'P/§tet Ireotment System (POV✓TS) apPhcations New System: rncfudv :.,th rlvs !nrm , "»cord Jr.": 'ion me Aegste� a' DaeuS I; it e cer, d:ed SurveJ n'op d ��r n. o-, , moor '.I 0P .,I, , Co ,rnurn-y Deve oomcet Dep2nment .end Use Dineen )ic zar,-nGfln stCIO, CcGo�c rrier. Curter a,, ;udC�sccd. cpv "''DI Canmchael (toad. Hudson W �40'6 amn s: cw rav Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Davison INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m)) Permit Holders Name I Cih Village Township ROLLING HILLS FARM OWNERS A% NFORMATION TYPE MANUFACTURE CAPACITY Septic Dosing W!Z$.�r 57f+ unn 1 I 1 Z�d Aeration 171TJ `r TANK SETBACK INFORMATION TANK TO P WELL BLDG VentoAlrintake ROAD Septic Dosing t tj /'/ I kV n Aeration Holding PUMP/SIPHON INFORMATION P(r T )%)AA._ C�.etZ Manufacturer Demand Oulds GPM OT, .++ Model Number aq TDH LifI;j Friction Syst Head TDH2 Ft 4 Forcenlain Length Di 11 Dist to Well 9•s ti I` oun" St. Croix I No, )INN OF HAMMOND j I 018-20194$O( SecaonJTowNRsngerMap Na 57 29.29.17.19 ELEVATION nikTAW7 IS 1D1_ 31 t^&r, . 4L STATION BS Lv HI to FS ELEV. r a Benchmark �o D87�. ` (OS`f•2d AIL BM al w Bldg. Sewer . 71 StfHt Inlet SUM Outlet Dt Inlet lo. to Tit s Dt Bottom (3.Zat 1o71w 5 Header/Man 3,4L 3.4G Dist Pipe 3 eG , E p 6 10 W 1l Bot. System F;nal Grade I W,U La lz e:� ow wK4 —6 Par St coy V 3.9 s{ togs. '4 a S 14 f, o 042.20 $ttit 3.6z �DB�. u E MENSIONS Width f Le' 4, i No Of Aenoha PIT DIMENSIONS No Of Pns msbe Du LiguM DeDtn fF I T u SETBACK SYSTEM TO Pill. SLOG IWELL LAKE/STREAM LEACHIll IManuflictufff: INFORMATION Type Of System �GtL4lr� 5 / N/A IV/A CHAMBER 011 -tlN1T el Number - 1 a7 F.Y 1:1I:1111 [a7: ■.Y't.Y 1 �!, �La•775�1�J7/!rl�lF�•Ji!• Headerndlild I f rt f Distribution It t t / V • G r P e(s) 2 l Hole Size ff f3z x Hole Spacing L7/ ! end As Intake Lengtn�_ Dui_ Length �• Du t Spacing ;l" SOIL COVER ' v<, i ddsssure Svatwm: Only xx Mound Or At -Grads Svatems OnN iy I- 41h n . Lo Qp R r QBap Cenhl Depth Over BedfTrench Edges> 2 f� xs Depth of Topswl —,;:>+-2T a SeededlSodded xs uched tpoaL 1 ® 1 N Yes Q No Yes ® No 4R COMMENTS: (include code discrepencies, persons present, etc) � Lxallon: 1811 78TH AVE L Inspection Y1 �y('�1 / 1;6w ha � v Inspection M2: r�frj/j"p� MA P •� I G tJ(' e�' t`5 �.OVLtf a .rhw+r� {ie.✓"�r"k,� 1`K' 1.) Aft BM Description = wrA�rn V'elfb` )� I"' 2) Bldg sewer length = CO/vt s4 sa. - Stf W+f "` A amount of cover = ( diver-eu ® r.1$f <t i-r b"y t7JK oh "-Illh cam Plan revisionRequired? Yes onNo Use other sideefor additional information SBD-6710 (R 3197) Date Insepcors'Signature F�au( (I-0- oZ u S'AN,,�eiQ —.277 Buildings eBuiBuildingsnoirsia, County Stcroix Sanitary Permit Number (to be filled vi by Co.) 2019 1 W. Washington Ave.. P.O. Boot 7162 Madison. 537 -7162 AUG 27 / `7/ / _ `- � Applicati State Trs.oclim Number 081901572-C In secordamce wth SPS 393.21(2). Wm Adm. core. sobousswn or aus farm to the apPropri.r goveiuoettd unit project Address (ifdiffertM chair msdmg address) n required pw to obtaining o sanitary permit Note Applieshon forms for stabowad POVM arc submnmd m the Ikpartmcrr of Safety and Professions) Servies Personal information you provide may be used frrsocordary vi with the Privacy Lw, s. 15 W ib m , Ss. �L01�f�'� �1�� d / /IrI" 7 i� is f&S ///IIII�������'a�ar L A tiiar laforimishoa -Please Print AD InforvandoB Property Owrer's Name Parcel a % I / Rolling Hills Farm Owners Association Inc 018-2019-11111111-000 Property Owner's Mailing Ackkes; Pr p" l.«ation ei q, a9.1 7 . sQft- 3435 Labors Rd.STE 150 Go" W y,, SW y,. Ski 29 Croy, State zip Code Pbors Number Vadnais Heights Mn T 29 N. R 11 (e Eor�P ole Gros) n. Type of Building (cbak all that apply) Subdmoson Name ❑ 1 or 2 Faintly Dwelling - Number of 12 l 3. Block Rolling Hills Farm N ❑ P blic Commereial Describe Use - ,c+� ❑ Croy of ❑ State Owned - Describe Use CSM 8 X /�i/ l'leral ❑ V these of (a Town ofHammond -- Number m. j0wAMWqnktCNwk only one boa on I®e A. Complete Due B if appicabk) - )Q New system ❑ Replacement System ❑ Trestro mill loldug Tads Replacement Ody ❑ Other Mociificabou to Emitting System (aeplam) B. ❑ Permit Remewal ❑ Permit Rcvmion ❑ Ch w. of %amber ❑ Permit Tma for w New laal Previous Permit Number and Dale Issued Before Expcmion Owner IV. Type of POWTS S as UDevite: Clock all Hat a ❑ Nor,ncarmil lo-('rtad ❑ Pesoa and In-Giviad ❑ At -Grade )❑ Mmund> 20 m. of eiitabk and ❑ Mad < 2/ as of suitsible soil ❑floldgTad[ Dltper.d Comp—(cptao)__--- _ _ ❑Pcwcssmcm Dews(eiplam) _ 1 V. Area Ldor1111a . Deign Flow Design Soil Appl' Rre(gpdsf) Dtepxrsal Area (d) Diaperal Are System F]evatim 1800 1.6 l 1083.22 VL Tank Info Capacity an Tow N of Monu(aetmer alloro Gallons Una Sim Tec Fitters ua Y R $to 5 Nee Tsnb Fsutiq 7anb 6 Cl N Vl t.. Sips or Hddwa Task °oi a gybe 1250 1250 VViBser Corterete R Vn. Responsibility Stateseeat- L tks a&,dped, arse na s aMwa r1a tbs staid" pia. Pbambe's Nauc (Prim) % igi - MPIWM Number Business Phme Number Keith Knudtson 648443 e51i70-1732 %unber'a Add. (SW ck City, Stale, Zip C:odc) 927 150th St Roberts Wi 54023 VULessamly/Deparlakrist Use Obly Approval permit I. s °D Dmc % Les Svpm1 'arm 456 s y ! Rerotr for Denial nLCmH rarniapprovar \ 51r rAnQ (e J. aA. pleb tvy, t ulr.prr..� sell rnuat all be s a_k s _''rg (,44w. - c so pr awagemen' d•--n yc riam W ybbTtoe.. (f,i�'i I� C Y,-C�� ewJ/ ••,: �" 2. A�afflief,i(fa�lybr';mn.511eai1Wl'i:J:i.d f: So per a;;a onblg cadn / crd:raaeee. .Urea r esagirre pm rr it a gstsai and wkasM r He C�/y aaly sa PYer W d tW a in s 11 19 SBIM398 (R. I1/11) DWF of 1800 pan /1.90 9AR - 1189 aq 9 79G - 14l 11. LM ep 91 \ ea.,-,aPdaenn.erw 0 e T1P,npoeetl 9.D a 141' Mount xepene Y IocWtl elorp 93.n oonloU, W/a ehnm FJw. of 10m.27 BM ELEV ' 1075.68 -WILL tl 800 gpd N 4_400 W PfC --�"75111 Ave. --- - --. — - --6M ELEV---- 75TH AVENUE' RAO'A7'r(VW A01 DR- 1076.09 89.08' 88.89 84, ' 85,226' 85,23' TFNNJ6N ��NO1911 fFN_ 41,13 I t LOT $ 49 g LOT LOT 21,7e1sQ. 50 51 FT 21,7815Q. 217 g° LOT LOT LOI •vcu DWFa FT, WELL DWF_ ,�`_ i 52T 53 54 55 800 6� °WF— WO9pd N -IMM WO9pd 21.781 SQ. FT 21,781 SQ. 21,781 SQ. 21,781 SQ rem.pPw gap. e.a. red,. an Pvc 4"9 10M eav a..., FT• FT. FT. old, e.a.r yx » ,. 1Md Nano Nao H B"Wk eORaWa faP=.Pec a W20 'a010°'""" Geer 85.26' 85.23' 85.20' Ne7vr4rc lm,er ass. -,Ann " -I�"m N89°51'10"E 560.24' 1094 71' n �. losses x Oudd- 1090.72' "•"" 4' 800. 40 PYC 0r M,m D 0091 PVC Cornay,ucp plea. P,olMsrtl DUpnx 2" 9cfi. 40 PVC F,M Y I n932z' Propoiie W.Conenn Rolling Hills Farm Residential Property WLMM"M "J Dapn. ^sap Owners Association INC. 9" • "109737' r/94Mach 97-Im Flom Outlot 2 I (M01Y SW1/4 of Sec 29 T29N-RI7W �q Mowd SIM n w Open Grew fops Township of Hammond - St. Croix County OUTLOT 2 PIp MMatlM M ASTM 9WdD wd (7eblw 9e%. 9] s 9e4 GD9) < 42.71 ACRES IMUW- M"V 8a par BPS 9r2 "11)(.) and MMl orG0e1 p,onalkn par 1m9 M.4.91e1,Ha DMrG- .toner OC 1,500,35990. FT. ,Oe1 a' '9no \ __ _ Pepa201G L�l C# BeArom 4X. Mc�couNTv STAT OWNER PLUMBERTIPAVW7#31F TOWN OSEC�AND/OR L (020 ge x) NO. 633894 AY PERMIT Ave. PR Ti V7"LJS' N(��ISAZ0+ LIC.# 6 3 CHAPTER 145.135 (2) WISCONSIN STATUTES TO (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 LA { ' 1 , *k SUBDIVISION the permit, please contact the county authority. ` w ISSUING 2 AIN1 A��♦ORI$ED ISSUING OFFICER -DATE PERMIT EXPIRES ! hA' l? UNLESS RENEWED BEFORE THA DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)