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Home My WebLink About018-2019-78-000 (4).consm Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix afely and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 633967 GENERAL INFORMATION State Plan ID Nol Personal information you provide may be used for secondary purposesPrivacy Law, s.15 04 (1)(m)]-�- [Permit Holdefs Name City Village Township Parcel Tax No Rolling Hills Farm Owners Association I TOWN OF HAMMOND 018-2019-78-000 CST BM Elev Insp BM Flew BM Descn n' Secbon/TownlRange/Map No 167.10lo ivy l 29.29.17.1278 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing t �� `R 7� 1 Z 5�0 Aer H mg TANK SETBACK INFORMATION ®�----I- PUMP/SIPHON INFORMATION Manufacturer rE Demand yy Model Number TDH Lift i.,!') Fnct n o� \b System Head TDH Ft Forcemain Length I -- Iti5 Dia. ❑ Dist to Well SOIL ABSORPTION SYSTEM / , , I ELEVATION DATA STATION BS HI FS ELEV. Benchmark , � I0�o 1 U t1J to Alt BM Bldg. Sewer NIA SUHt Inlet Sf/Ht Outle t nlet 9.36- to32.io0 Dt Bottom 1-2. ozgry Header/Man. 34, f 103g 32 r Dist. Pipe B System .t{Z O L7e lap - St c/ err lb �vr Q --77e .L61p31,.-5 wn.iwte, $.. 3.zq 038 E REtICtT ENSIGNS Width y Length No PIT DIMENSIONS No. Of Pits Inside Dia epth SETBACK SYSTEM TO P/L LDG LAKE/STREAM LEACHING Ma cturer INFORMATION CHAMBER OR UNIT Type Of System (-\ZF / del Number t,M.Olc) DISTRIBUTION SYSTEM / Header/Manif Id \ tt `l1 %�tp Disinbution p () I L ( y/ x Hale ize fl r/_ 7(! ® x Hole Spacing / Vent to Av Intake Length Dia Length •� DmIL Spacing {' 31I,( 2 a. S SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched BedlTrench Center Beifrrench Edges Topsoil — J Yes No 'Yes 'L No III(IMENTS: p(I I code discrepencies, perrsons presant, etc) Inspection #�. �,v� 5 °I n�' ; I Inspection #�) 1/l l n: Noress vra�-`la�bl,[71�_wtQi (/Q.wC9tl�l�l�2E/i./nr'19te fAvGf� /.C) /. jelDP tea( il% 1.) Alt BM Description = u 2.) Bldg sewer length = /✓plir - ""ri of cover �0V ` ftidL Plan revision for add? _ io No �p 2/iz02- ,�,f� pte heic�e for additional info ion Fy ��_jf 4981bh6 1 �eN'-�IE!""ors Signature �tl�jPr.r,ta'l.Pl i�t�i over su�,os ( Cart No. N- Q County Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 St. Croix Sanitary Permit Number (to he filled in by Co ) "ct. '_ Madison, WI 63707-7162 &3396- SEP 302021 �r�' nP g1t Application State 'InansachonNumber In accordance with PS I , mission of f ul form tot a alip unit 072101727-C (3`83 is required pnor too U& ry permit Note Application turns for state-o%vned POWI Sue submitted to Project Address (if different than mailing address) the Department of Sa cry and Professional Servies Personal information you pmv ide may be used for secondary purposesin accordance with the Privacy Law, s 15 (4(I m), Stats . / ^ Al �'( 1. Application Information - Please Print All Information Property Owner's Name Parcel N Rolling Hills Farm Owners Association Inc. N Ex 018-2019-78-000 Property Owner's Mailing Address Property Location 3435 Labore Rd. Ste 150 Gryt Lot SW y, NW / Section 29 City, State Zip Code Phone Number Vadnais Heights, Mn. 55110 (circle one) N, R 17 Ii orQV - _- — 11. "type of Building (check all that apply) 12 Lot N Subdivision Name Rolling Hills Farm I or 2 Family Dwcllm Number of Bedrm s �3 LAs 1 &20 Block # c/Commercial - Use ❑ PubhDescribe ❑ City of ❑ State (honed - rescnbc. Use ❑ Village of CSM Number N lawn of Hammond III. Type of Permit: (Check only one box on line A. Complete line R if applicable) ® New Svstem ❑Replacement Svstem ❑ Treatment Holding Tani: Replacement Oniv ❑ Other Modification to Lxistmg S�Stem (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit "transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POW7:S S stem/Con nent/Device: Check all that apply) .� ❑ Non -Pressurized In -Ground ❑ Pressurieed In -Ground ❑ At -Grade )U Mound> 24 in of suitable sod ❑ Mound <24 in of suitable soil ❑Holding Tank ❑ Other Dispersal Component ai) Pretreatment Dev ice(evplam) CU 4"t�1Jr V. Dis rsallTrcatment Area Information, Design Flow (gpd) Design Sod Application K 1) I Dispersal Area Required (st) Dispersal Area Proposed (sf) System Flevatio ry f lP^ 1800 1.5 .6 11200 1200/3057 103 .50 p , VI. Tank Info Capacity in Total p of Manufacturer Gallons Gallons Units 2 Sim tex fifers c u u - VewTaziks _ Septic or Holding Tack nosingCha'rber 1250 1250 1 Wieser x V If. Responsibility Statement- 1, the aadenigned, ruitin-44-P pAilitivfo4astallation ol the POWTS shorn on the attached plans. Plumbers Name (Print) Plu ignat MPIMPRS Number Business Phone Number Keith Knudtson 64W36517470-1737 Plumbers Address (Street, Citv. State, Zip C . 927 150th St. Roberts,Wi. 54023 V I ll. CountyAllepartment Ilse Only XAPpmved ❑ Disapproved Permit Fee ,rt''!/s/ Dat'� Iss m Agent Signature ❑ mat IX. Conditions Approve alesl)isappreual Z` I _20 j SYSTEM OWNER. Septic tank, effluent flier and t t/'Y�`/$�t.TV'D�(l- GC+2 Uti- dispersal cell must be serne.•d /maintained �) A �l „- . n ,�„h pS A� 1~�� as AA as per management by �>�t plan proe .Jed plumber. w�� ! 26MSOAA as Per app l icaicab!I e cod e'•UIUIIICIIC�J' aplan for thes"le into eCoaot:o on paper not kss SirBia Ii�s¢ebk t tnFer"A47`� �o P s Qoaoua ice. N� 1043.48' DWF = \ N 600 gp c� L.80= E N 1040.40 yyF = Sanitary Site Plan - $ FN# 1624 For: Rolling Hills Farm o� WE , . 7a e� Residential Property Owners Ass. Fa FN# 162z r2- Outlot ]-in the SW114 akd NW114 I See. 29 T29NRl7W . a PN0' Town of Flammond - St. Croix County 1g� .1b I � 70.01' C38 N � C8 __l_r/ C7 6 N S88°19'02'NV 1 70.01' FN# 1121. ,vcu• Proposed Proposed BM ELEV FN# 1619 WELL DWF 1036.01 FN# 1617 p 600 GPD o •Proposed WELL P GpD ems, 6 0 LOT m 0 40 e0 Typical of each lot will be a 4" Sch. 40 PVC Bldg, Sewer DWF 78 N and the placement of a Hoot H-600A B&o./Septic 600 GPD m 21781 N G°phic Sc0. (Faal) N, so Fr n, SQ7� 1 mat - so rt. N LOT 1036.501 > 19 1037.00' LOT m m 1035.00' N 20 \ N 4" PVC Bldg, OUTLOT 1 \\` o er (Sch 40 Typi 21 B1 29.56 ACRES Open Fallow Field Site N so Fr. 60 N Proposed Hoot �00. 1,287.641 SQ. FT. w H-600ABio./Septic erP Proposed 8' x 150' Mound Dispersal Cell 16, 1042.62' 0� �^ located along the 1036.50' contour wta S.E. of 1037.501 g5. 1044.50' O 10 7.19' 3 1 6 \/1, FN# k LOT 16 LOT N ` 17 wo —1 m rfl 21,761 �\ sa Fr #2 1 Proposed 4" Sch, 40 PVC or Astm -D3034 HM Conveyance Pipe Typical I_ Mound to ° Proosed Wieser Concrete W1250-MR Dose Serve Lots Tank w/ Simtech STF 100 In -line Filters H.W.L. 1027.7 18,19 + 20 Proposed Two 2° Sch,40 PVC F.M. BM#1 = Top of Wooded Hub NW Corner of Easement #6 Con rol Pt. # 2010 Elev, = 103.7,66' BM#2 = Top of Wooded Hub NW Corner of Easement #6 Existing Sanitary System for Lots 15-17 Contro Pt. # 2009 Elev. = 1033.90, 2„81 so er 0 t i ;�tPAft1'AfF l T 0 /r/s ASP I S /V l nk . tita July 27, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES- 2023-07-27 Plan Review: PW'TS-072101727-C KEITH E STONER 23220 Woodcreck Rd Siren W 1 54872 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY VJI 54304-5211 Contact Through Relay http'Rdsps vri.gov/programshndustry-services ww.v.wlscons n.gov Tony Evers - Governor Dawn Crim - Secretary Condrhonally APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE SITE: Rolling Hills Farm Lots 18-20 Shared Sanitary System 1621 '-'lid �%c Town of HAMMOND St. Croix County Total Amount: $325.00 Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-p (N.01/01, R 10/12) Mound Component Manual— Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) Description: 1800 GPD (/2 Bedrooms — New Construction — Pretreatment) Maintenance Required The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.0 1(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06. stats The following conditions shall be met during construction or installation and prior to occupancy or use: • The department mop require meterin;; (r ntonitu61W, of the effluent trt1r11 thn Prr,duet to eN dluatc the of"I'TT ll wid ��m•� h ri,. 1,, �I'ti : �.; -441 U1Urnt ruJLt% I)a,artItc, • 1 salid maintenance'sen icinS Cunh-art 1, rcyuu�:d for t4a lit, n` the .}amll. \ C7p\ ufthe unnal nanalit_s nl c, ntta.t Milli " .0 h111IUCII nI the II Lll t P1I� I t„ n.tcm�r ,Tthe �anitai heruut hX the permit is-ume ❑cent • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. if it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleesbu,wisconsin.eov Cell: 608-516-6134 Index and Title Sheet Project Name: Rolling Hills Farm Shared Sanitary System for Lou 18-20 Property Owner: Rolling Hills Farm Residential Property Owners Ass. Address: 3435 Labore Rd. Vadnais Heights MN 55110 Legal Description: Part of the SW IA and NW I/4 Section 29T29N-R17W Township: Hammond County: St. Croix Subdivision Name: Rolling Hills Farm Out Lot 1 Comp. #/Parcel ID: 018-2019-78-000 CONTENTS Page: I Plan Narrative Page: 2 Plot Plan Page: 3 Mound Plan View and Cross Section Page:4 Lateral Layout Page: 5 Dose Chamber Cross -Section Page: 6 Pump Curve Page: 7 a I-b Duplex Pump Panel Specifications Contlmonally APPROVED DEPT, OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Lou: Sanitary System Serving Lots 18-20 Page: 8 Hoot Systems H-600A Tank Specs. and Hoot Service and inspection Form Page: 9 Management and Contingency Plan Attachments: Soil and Site Evaluation Reports, Sample ATU Servicing Agreement and Hoot Systems LLC Product Approval with maintenance requirements. Mound Component Manual Used = Version 2.0 SBD-10691-P (N.01/01R. 10/12) Pressure Distribution Component Manual Version 2.0 SBD-10706-P (N 01/01R. 10/12) Designer. Keith E. Stoner, Signature: "L)te'Z-6 2021 License # Designer 157-007 Phone # (715) 653-2324 Page 1 of 9 Plan Narrative The following shared sanitary system design discussion focuses on the proposed 12 Bedroom/ 1800 gallon per day sanitary system to serve Lots 18 thnr 209t the Rolling Hills Farm Subdivision. This plan complies with the St. Croix County Land Use and Development Ordinances. A "Conservation Development', Rolling Hills Farm is designed for 77 lots serviced by 22 dispersal components located on common ground. Appropriate casements and maintenance language were required prior to final approval. The St. Croix County subdivision ordinance requires that each buildable lot has a soil and site evaluation completed. For these 3 lots the mound dispersal area will be located just north of Sanitary Easement Area 6 lying westerly of Lot 20 within the common area known as Outlot 1. The soils in this area were tested to slide the proposed system north to create a greater separation from the natural drainage area that moves surface water down the slope near the south property line. A four bedroom maximum design flow has been established for each lot. The county will require a sanitary permit for each lot prior to construction for setting the septic/treatment components verifying the design flow for each lot. These lots will be required to set an aerobic treatment tank with built in trash capacity that will be connected to a 4" conveyance pipe that will gravity flow to a common duplex dose tank located at the southwest corner of Lot 20, that will alternately distribute the highly treated effluent to a common mound dispersal system consisting of a 8.0 ft. x 150 ft. mound dispersal cell. Sanitary Site Plan For: Rolling Hills Farm Residential Property Owners Ass. Outlot I in the SW114 andNW114 See. 29 T29N-RI7W Town of Hammond - St. Croix County 1043 48' i N LB.O= g ro 1040.4 VVF = N 600 gpd \ • VEL r .o�F� d (cL FN# 1622 `'a \ / N — — — — C7 __— S8801 s'o2 ^w Proposed Pro BM ELEV FN# 1619 ,WELL . DW 6W 9P \/ FN# 1626 WELL 1 a �E3aa0 e a�Ae2 Pa _ q/9 1624 N / �gA399M s / aa26 io. WE 1ag2 LOT tP 16 NW LOT N �N 17 cN < F 21 7 0IT , 1036,01 FN# 1617 600 GPD Proposec • veu 6 FGPD LOT c 40 80 Typical of each lot will be a 4" Sch. 40 PVC Bldg Sewer DWF 18 and the placement of a Hoot H-600A Bio./Septic 600 GPD m 2, 7.1 m 21,7.1 Graphic Sc°Y (FYYt) N SO R LOT A SO IT 1 mch - 80 It. 1036.50' � 19 In 1035.0( OUTLOT 1 29.56 ACRES Open Fallow Field Site 1,287,641 SQ. FT. 4 Proposed 6' x 150' Mound Dispersal Cell located along the 1036.50' contour w/a S.E. of 1037 50' n m \ 1037 00' rn LOT 4" PVC Bldg 20 Sewer (Sch. 40 Typicap zi rel N N so 5v rn Proposed Hoot 0 a H-600A Blo /Septic i GUBYAR➢ #2 Proposed 4" Sch 40 PVC Astm -D3034 gH'j Conveyance Pipe T Typical / Mound to °7Tarkw/SimtechSTF Pro Wieser Concrete W1250-MR Dose -/100 In -line Filters Serve Lots H.W.L. 1027.7 18,19 + 20 Proposed Two 2" Sch.40 PVC F.M. BM#1 —Top of Wooded Hub NW Corner of Easement #6 Cl Pt. # 2010 Eiev. = 103. 7.66' 2, 7e1 SO rT TOO- P BM#2 = Top of Wooded Hub NW Corner of Easement #6 Existing Sanitary System for Lots 15-17 Contro Pt. # 2009 Elev. = 1033.90' 49 . 9' P/L Page 3 of 9 Mound Plan View L Mound component Dimensions A ' E F y 1I1 KL MI41;',, D G I 5.43' W25.8 IL(Ih (ft sit ) Dispersal ( ell Area 3Q5'J l It Baal Area Available 1.00 I@Pd/o Linear Loading Rate 1 15.00 tt) I; 1) B Obs Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 040.00 -0 F Elm Dispersal 602 Shading Key 9 % Site Slope Topsoil Cap Subsoil Cap By AS 1'M C33 Sand ® Tilled Layer Aggregate Obsem ation Pipe to be constructed of 4" diam. Sch. 40 PVC pipe w/ water tight cap, a minimum 6" slot anchored with 3/8" rebar or a water closet collar. Fla G �n La 03x(ft) Lateral 1036.50' (ft) Contour F levation Detail of T}pical Dispersal Cell I A r - rxtile Fabric Cover Center Connection Duplex Manifold Lateral Layout Diagram t 75 fl. x I' P Note: F.M. attached to center of the manifold. S 5°i° --> I urn -up ') ball valve or dean 'm plug Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate 1 /2 Cell Flow Rate System Flow Rate total Dynamic Head U Duplex Force Main -' per F NI- 1 1 /2 74 25' 4.00 15.12 30.24 60.48 25 ft. Page 4 of 9 tt. F P Lateral, and force Main of Pyl Sch 40 per SPI able 384 30-� 9% F-.75 ft. .. x Holes equally spaced on bottom of lateral Note: Forceful coming into the center of cell, 1st hole approx. 1.05' from the manifolds maintaining the 2.75' hole spacing. Northwest manifold + F.M. feed north lit of cell and same for the southwest F.M. + manifold in. Orfice Diameter ft. Orifice Spacing (x) ft Orifices per Lateral gpm Orifice Density gpm Manifold Length gPm Manifold Diameter ft Forcemain Diameter and Length Lateral Turn -up Detail 5/32 or 0.156 in 2.75 ft. 28 10.71 112, on] 4.00 ft. 1.5 in. 106' per F.M. Finished Grade Threaded Cleanout Plug or Ball 6" to 8" diameter Laa"n Sprinkler Box Vahe � V Note: Lateral ends at last orifice where variable length to cleanout begins. / Long Sweep 90 or Iwo 45` Bends Same Diameter as Lateral Distribution Lateral Page 5 of 9 Duplex Pump DoseTank Component Cross Section Approved Manhole Covers W ith Warning Labels and Locking Device ' 4" Min. Above Final Grade Weather Proof Junction Box Electric per NEC 300 R SPS 4" Sch. 40 Vent 316 012 WAC - or = to 12" Above Final Grade Disconnect Note: SJE Rhombus Type 122Duplea Alternate Outlet Location (Demand Dose) W;Approved 4" Sleeve �! Top of inlet = - 1032.00 (Set by Installer) Simtech STF / Porce Main Diam. - 100 Filter —/ Weep Hole or Anti Siphon Device Note: Pump switch and alarm to be A Duplex Force Mains wired to separate circuits. B p 1029 _3 Pump Off F,lev. WLP1250_MR Gallon C Duplex Pumps Lank Mfr. Wiesert Concrete D Dose Tank Elev. ] 03850 Vertical Difference Between Pump Ott and Distribution Pipe = 8.6T Minimum Required Supply Pressure ...................................... _ = 4.55 106' FT. of Force Main x 226 Friction Factor; I OOFT.... = 2.40' Note: Maximum dose per Pressure Loss Through Filter ....._._.......... - 50' _�._, 1.12 cell 180 gallons. Fatal D) namic Head .................. 16.12' Min. dose per I r2 cell - 68.31 gals. Number of Doses...- 5.74 Per Day Gal. Per Dati! ttof Doses = 156.77Gal. (Duplex Volume of Backfloii ......._.............. ...................................... = 17.28 Gal. Pumps.4lternating Total Dose Volume..-_._...................._..................._......._...... 174.05 Gal. between 122 of cell) PumpPant. Ca acity 1-'53.16 p Gallons Dimensions Inches Gallons Pump Tank Volune 34.81 Gal/Inch �- 1 19 661.39 Note: Tank to have B 2 69.62 two outlets. Pumpr. Goulds Mfr. C _ 5 174.05 Note: Forcemains Pump Model EP05 D 10 348.10 assumed to be equal Minimum Discharge Rate = 30.24 GPM per pump in length. Alarm Mfr. S.J.E. Rhombus Total -- 36.00 1253.16 Alarm Model Tank Alert Bed Tank per SPS.383.45(5) Anchor Tank as necessary to negate buoyant forces per SPS 383.43(8)(g). Wastewater Page 6 of 9 METERS, FEET 10 F- Order HP Volts Amps Minimum Circuit Phase Float Switch Cord Discharg Minimum Minimum Minimum Maximum Shipping Number Breaker Style Length Connection On Level Off Level Basin Solids Weight Diameter Size Ibs.kg EP0411 4 115 12 I 20 1 PluSwitch No Switt ch 10 1 /` Manual Manual 15' /." 20/91 EP0411A Piggyback / W,de-Angle 10, 12" 6" 21 / 9.5 - EP0411F PlugtU No Swd 20' Manual Manual 20/91 EP0411 AC Piggyback/ Wide -Angle 20' 12" 6" 21 / 9 5 EP0412 230 610 No lSwnch 10, Manual Manual 20 / 9.1 EP0412F Plug/ No Switch 20' Manual Manual 20/9,1 EP0511 F 5 5 13 20 PS t No Switch 20 Manual Manual i 22 • 10 EP0511 AC Piggyback/ Wide -Angle 20' 12" 6• 231104 EP0512F 230 6 S 10 N Plug h 20 Manual Manual 22 / 10 Single phase, duplex alternating pump control with override. Page 7 a+b of 9 The Model 122 control panel is designed to alternately control two 120, 208, or 240 VAC single phase pumps in water and sewage installations- The alternating action equalizes pump wear In addition to the alternating pump control, this system provides override control should either pump fail If an alarm condition occurs, an alarm switch activates the audiolvisual alarm system. Common applications include pump chambers. sump pump basins, irrigation systems and lift stations 1. Enclosure measures 10 X 10 X 6 inches (25A X 25A X 15.24 cm) Choice of NEMA 1 (steel for indoor use), or NEMA 4X (ultraviolet stabilized thermoplastic with removable mounting feet for outdoor or indoor use) Note: Options selected may increase enclosure size and change component layout 2. Magnetic Motor Contactors control pumps by switching electrical lines 3. HOA Switches for manual pump control (mounted on circuit board). 4. Control Circuit Board provides pump control and alternation 5. Green pump Run Indicator Lights (mounted on circuit board) 6. Circuit Breakers (optional) provide pump disconnect and branch circuit protection 7. Ground Lugs 8. Float Status Indicator Lights (mounted on circuit board) 9. Control and Alarm Power Indicator Lights (mounted on circuit board) 10. Auxiliary Alarm Contact, form C (mounted on circuit board) NOTE: Schematic is located inside the panel on enclosure cover. STANDARD ALARM PACKAGE 11. Red Alarm Beacon provides 360' visual check of alarm condition. Note: NEMA 1 style utilizes a door mounted indicator in lieu of a beacon. 12. Alarm Horn provides audio warning of alarm condition (83 to 85 decibel rating). Note: NEMA 1 style utilizes an internally mounted buzzer in lieu of horn 13. Exterior Alarm TestlNormallSilence Switch allows horn and light to be tested and horn to be silenced in an alarm condition. Alarm automatically resets once alarm condition is cleared. 14. Horn Silence Relay (mounted on circuit board) NOTE: other options available. Ar Entire control system (panel and switches) is UL Listed to meet and/or exceed industry safety standards Ar Dual safety certification for the United States and Canada JW Standard package includes three 20' SJE SignalMaster' control switches ■ Complete with step-by-step installation instructions Five-year limited warranty SEE BACKSIDE FOR COMPLETE LISTING OF AVAILABLE OPTIONS. SEE PRICE BOOK FOR LIST PRICE. Model Shown 1221 W114X6A COus 11.1370 Rh us PO Box 1708, Detroit Lakes. MN 56502 1-888-DIAL-SJE • 1-218-847-1317 1-218-847-4617 Fax email customer. service@sjerhombus com www.sjerhombus.com 122 T FTTI C MODEL 122 ALARM PACKAGE = select options or no alarm package t = alarm package (includes test/normal/silence switch, fuse red light, & hom) ENCLOSURE RATING = Indoor, NEMA 1 (metal) E]OW = Weatherproof, NEMA 4X (engineered thermoplastic) ERSTARTING DEVICE 1 = magnetic motor contactor 12012081240V 9 = magnetic motor contactor 120V only PUMP FULL LOAD AMPS = 0-7 FLA 1 = 7-15 FLA 2 = 15-20 FLA 3 = 20-30 FLA PUMP DISCONNECTS = no pump disconnect 4 = circuit breaker 120V (select STARTING DEVICE option 9 above) 120/208/240V (select STARTING DEVICE option 1 above) FLOAT SWITCH APPLICATION H or L = pump down or pump up (select 17 option) X = no floats OPTIONS Llsradbe/ow ENCLOSURE UPSIZE - If you selected one or more of the * options, or two ** options, a one-time enclosure upsize fee would apply CODE OESCRIPTIaN Q to Red beacon only / no audio CODE DESCRIPTION (must select `0"for alarm package) Q** 10K Antl-condensation heater 0 1C Hom only I no visual Q 11C NEMA 1 alarm panel (must select "0'for alarm package) 11 D NEMA 4X alarm panel **3A Alarm flasher Q* 148 Main disconnect(rotary style mounted through door, non -Posed) # 38 Manual alarm reset (must select circuit breaker) * 4A Redundant off * 0 0-20 FLA (total of both pumps) (select Opton 4D if ffoats mduded) * 20-60 FLA (total of both pumps) Q 4B Red redundantoff Indicator 8 alarm Q 16A 10' cortl in lieu m20' (per flcat) (must select Option 4A also) 16B 15' cord in heu of 20' (per float) 4D Redundant off float Q 16C 30' cord in lieu of 20' (perfloat) (must selecr 4A optron) (select 17 option) 0 16D 40' cord in lieu of 20' (pertinat) * 5A Thermal cutout/heat sensor auto reset 17A SJE SignalMastery f pipe damp 0 (per float) (for pumps w/thermal switch leads) Q 17B SJE SlgnalMastera / externally weighted 0 (per float) * 5E Seal failure arcurt 8 red indicator (2 wire) Q 17C Sensor Float" / internally weighted ♦ (per float) m 6A Auxiliary alarm contad, torte C 0 17D Sensor Float' / externally weighted ♦ (per float) (included as standard) 0 17E Sensor Float' Mini! pipe clamp A (per float) Q * 8A Elapsed time meter Q 17F Sensor Floatr Mini I externally weighted ♦ (per float) Q * 8C Event (cycle) counter Q 17J Sensor Float^ / pipe damp A (per float) 0 * 9_A Pump overload Q 19B Lead lag selector switch specify amperage after number 9 followed by letter "A" 0 19F Fourth float to separate alarm function from lag Example 912A = 12 amp pump 19T TOA (Test/Off/Automatic) switches and pump run tights * Q 0-25 FLA through door mounted * 25-30 FI A 0 19U HOA (Hand/Off/Automabc) switches and pump run lights 10E Lockable latch - NEMA 4X through door mounted t0E Lockable latch - NEMA 1 Q 19X Door mounted pump run indicator * 1DF Lightning arrestor (select pump cuuut breaker) 0 Mechanically -activated ♦ Mercury -activated if addibmwi feRhw" are required, Celt the factory fora quote on an Engineered Custom control panel. n w ■�r�• r . ^r,MODEL 122F17] W 9 0 T Alarm Package Enclosure Rating Starting Device Pump Full Load Amps Pump Disconnect Float Switch Application Options: Auxiliary alarm contact, form C, Elapsed time meter, event (cycle) counter, SJE SigralMastee f pipe clamp 6A SAC 17A bSJF-Rhrrnbus 0k14 Page 8 of 9 4" CAS - a INLET 0 n u� Im 31 }" 744" "— Iill _ 41" 40" TOP VIEW SIDE VIEW 4" CAS POLYLOK 12" ACCESS LID (TYP) IZ SET RISER (TYP) OUTLET a TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS EK SCOM at'`. A!r ?, 4'^! 600 GPD GRAVITY DISCHARGE SYSTEM H-600 A H-600 A TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" s 0 w N s o COVER: 4" MANHOLE: 12" & 24" I.D. PLASTIC RISER HEIGHT: 70" O.D. o LENGTH 106" O.D. m op WIDTH: 74 1/2" O.D. BELOW INLET: 57" O.D. a LIQUID LEVEL: 51" W WEIGHT 11,135 LBS. n W INLET AND OUTLET: 4" CAST -A -SEAL (CAS) BOOT OR EQUAL �' Y C COVER: MIX DESIGN M8 (NO FIBER) C TANK: MIX DESIGN #9 (SMALL FIBER) z 00 � o CUSTOMIZED TANKS: `s N FOR CUSTOM TANKS CONTACT WIESER CONCRETE r-> W 2 m � O W�00 0 a � co ¢ o z Z m ¢ ¢ U o F o D_ DRAWINGS SUBMITTED tO w N FOR APPROVAL = APPROVED BY: SHEET NO APPROVAL DATE: PRODUCTS NEEDED BY: /OF 1 Page 8bof9 Hoot Service and Inspection Form This testing and reporting shall be completed, signed and dated after each inspection. One copy shall be retained by the maintenance company. The second copy is sent to the local permitting authority and the third copy is sent to the system owner along with an invoice for services by the maintenance company. 1 Actual Date of Visit- 2 System Inspection of Owner: Address: City, St., Zip: Inspected Items: Aerator .......... . ........ ........ . Aeration Plumbing ................ Air Filter ............................... Effluent Pump (if applicable)..... Chlorinator _.... OK System Light .................... Alarm.................................. D-Box ........ Operational Inoperative Not Applicable J l C1 I l J i J Air Filter must be cleaned each service visit Operation of effluent disposal system must be made each visit (if pumped). A system with greater than 70% Settleable Solids in the aeration chamber must be pumped to avoid solids leaving the tank for the drainfield. 3. Repairs to system (list all components replaced): 4. Tests Required and Results: Test BOD (Grab) TSS (Grab) Fecal Coliform Required Results Test Method Signature of Inspector: Installer 11 or WW Lic # Private Onsite Wastewater Treatment System Mound Management Plan Pursuant to SPS 383.54 Wis. Adm. Code each Private Onsite Wastewater Treatment Svstem (POWTS) Shall Include information and procedures for maintaining the system within the parameters of SPS 383 and 384, and the conditions of approN al by the department. agent, or governmental unit. The approved plans and permits for the system will be filed with the county zoning or health department. This management plan complies with SPS 381.54. Wis Adm. Code. the Mound Component Manual for Private Onsite Wastewater Treatment Systems (Version 2.0) SBD-10691-P (N.OI/01) R. 10/12 and the Pressure Distribution Component Manual (Version 2.0) SBD-10706-P (N 01-01) R. 10/12 Table 1: System Design Specifications SanitaryPermit Number Number of Bedrooms - - 12 Flow, (GPD) 1800 -Design Soil Absorption Component Size (sic. 11.) 1200 (Pretreated Effluent) Trash Tank Capacity Gal. Pump Chamber Capacity Gal. 400 gal. 1250 gallons _ _Type of Wastewater Pretreated Domestic _ Pre -Treatment Knit installed per structure HOOT SYSTEMS H-600 A Table 2: Soil Absorption Component— Limits of Reliable Operation - Septic Tank Component Soil Absorption Component Desien Flow -Peak (GPD) 600 per structure 1800 Max. Influent Particle size NA :51/8 Inch Maximum BOD 5 (mgrl) NA <_ 30 m /1 g Maximum TSS Imgil) - NA -- < 30me� 1 - Maximum FOG NA --- NA — Table 3: Maintenance Schedule Se tic Tani rtnspect and, or service once every 3 years Dose "tank In- Line Filter Should inspect once a year and clean every 3 vears Pump Chamber Inspect once every 3 years Soil Absor tion Component Plush laterals every 18 months. HOOT SYSTEMS II-600 A I Service every- 6 months for first 2 years. Then annually j there after per maintenance agreement. See attached_ Page 9of'9a.b`r c Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under sec. 281_48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks. Pumping Chambers, Grease Interceptors, Seepage Reds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alanns may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the nest service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Pump Chamber I he pump chamber also requires monitoring once even three years or the time of problem, complaint or failure. Inspection should include checking the dose rate, volume and frequency. Warning: The dose chamber may till due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have problems. In this situation, the pump chamber should be pumped by a licensed pumper before pump cycling begins or other measures shall be used to dose the component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. Note: A Simtech STF-100 effluent filter will be installed in the dose tank for each force main to provide the filtering of the effluent to the dispersal cell. Septic tank and Pump chamber risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of sery ice. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry to the tank Warning: No one should enter a septic or other treatment or holding tank for any reason w ithout being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank may he difficult or impossible. I ank abandonment shall be accordance with SPS 383.33, Wis Adm. Code when the tank is no longer used as a POWTS component. Page 9 of 9 a, b + c Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every 3 years. Lateral turn ups are provided at the ends of the laterals for the purpose of flushing the lines of any solids. Flushing these lines should be done every 18 months. 'The inspection shall include recording levels of ponding, if any. in the observation pipes, and visual inspection for any evidence of surface discharge from the component. On steeply sloping sites, areas of erosion should he identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should he avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporap, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cefl, which may lead to more intense, and earlier. clogging of the soil. Planting of deep rooted trees and shrubs directly over or within 10 feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the case of septic or dose tank component damage, measures shall he taken to repair or replace the tanks to there original operating condition. Problems with the pretreatment unit should be addressed to the POW 'fS Maintainer. Bi-annuall annual inspections should prevent any complete failure. Should failure of the distribution cell component happen; the system shall be inspected to determine the cause of -failure, effluent quality testing and wastewater flows. Steps taken to repair or replace the dispersal cell may involve the removal of a bio-mat which would require cleaning or replacement of the distribution network as well as replacing the aggregate system and clogged portions of the sand fill. Component Owners Contact List Keith Knudtson Plumber/ATU Maintainer St. Croix Countv Lon n (651) 470-1737 (715) 386-4680 Wieser Concrete Products _ Maiden Rock W1 (800) 336-3416 Septic Pumper Powers Sanitation (715) 249-5738 ROOT SYSTEMS LLC I1-600 A (888) 878-4668 Page 9 of9 a, b + c Wiscorm Department of Safety and Professional Services aynsionaindustry S SOIL EVALUATION REPORT in accordance with SPS 395, Wis. Adm. Code #3637 Page 1 of 3 Keith Stoner CST Attach complete site an on p paper not less than 8'f x 11 inches in size. Plan must County Croix include, but not limited to: vertical and horizontal reference point(BM), dirdirectionSt. and -- - - ----- -—_ _ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. please print gill intonnatlon. 018-2019-78-000 --- — -- -- - - Personal information you prwMe may he used for secondary f+urpases (Prnaq Law. s. / $.06 (t) (m)) Reviewed By Date Property Owner Property Location I'rt h - Sr YY- S t_''I I , t t� tiq r ; 4 R.H.F. Residential Property Owners Ass. -- - - Govt. Lot NEl/4, NW1/4, S29, T29N, R17W ropeny nets Mailirg Address 3435-Labore Rd, Ste 150 - - Lot # Block # Subd. Name or CSM# 18 - 20 Rolling Hills Farm Outlet 1 __ City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Vadnais Heights i MN 1 55110 1 Hammond I 75Th Ave ® New Construction Use: ® Residential / Number of bedrooms 1Code derived design flow rate 1800 GPD - ❑ Replacement ❑ Public or commercial - Describe: _ Parent material Loess_over Bedrock Re_sidium Flood plain elevation, if applicable NA_ ft. _ General comments Easement 6 for Lots 18,19 * 20 - Propose a 8 x 150' mound dispersal cell located along the 1036.50 contour with a system and recommendations: elevation = 1037.50'. Upsbpe mound contour staked onsite. ITI Boring # ❑ Boring - ® Pit Ground surface elev. 1035.1S ft. Depth to limiting factor >62 in. Soil Application Rate Horizon Depth �,, Dominant Color Redox Description 1 Texture Structure Consislenoce Boundary i Roots ;_ GPDMf i in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Ettst 'EXJ2 i JO-12 1 10YR3/2 ! - sit 2msbk t mvfr Cs 3f-m I 0.6 0.8 - -- -' - �- ---r 2 1 12-24 10YR3/4 ! I 2msbk mvfr 1 gs 2f m 0.6 0.8 - 3 / - _ 24-32 10YR4 3 2msbk mfr gs if-m 0.4 0.6 -a -- --- 4 32-46 10YR4/4 51 gsms11 If 0.6 10 - - - ---- -------T--------�_ - I 5 46-62 ! 10YR6/4+5J8 - Is 1 Osg ! col -1 0.7 1.6 �I- - -- -- - --- -1— - ----� - #5 -Bedrock Resldium Boring # ❑ Boring Ground Pit _ _ surface elev. 1034.2 ft. _ _ Soil Application Rate - _ - Depth [o Ymrtirg factor 34 in. Horizon Depth Dominant Color Redox Description Texture in. Munsell Structure i Gonsistenc Boundary Roots L - GPDHt�_ Ou. Sz. Cont. Color Gr. Sz. Sh. •Ettp1 •EM2 1_"-4-;- 0-13 10YR3/2 - t -- -- - sit_ : 2msbk mvfr c 3f-m l 0.6 ' 0.8 �mvfr -2f-m 2 13-24 10YR3/4 - I 2msbk gs{ 0.6 O S - -- - - --- - - 3 24-34 10YR4 3 i _ / - d 2msbk 1 mfr gs if-m 0.4 0.6 - - -- 4- 3447; 10YR4/4 c2d5YR5/8-d 2msbk mfr 1 gs if 0.4 0.6 --_ - -T -- --- 5 1 47-65 j 10YR6/4+5/8 f2d5YR5/8 Is 0 col - 0.7 1,6 ----- - - ----li __ #5 - Bedrock Re lr omen[ s i = nw5> su < 22u mg/L and TSS >30 < 150 mg/L ' Effl t # = BODs- 30 mg/L and TSS < 30 mg/L < CST Name (Please Print) Signature: CST Number Keith Stoner_ _- -- u _ 224059 Address Keith Stoner CST Date Eva loon Conducted Telephone Number 23220 Wood Creek Rd Siren, W 154872 6/17/2021 715-566-0900 Sao -"M(11 con 3) Property Owner R.H.F.RewlearoaiPropetty_---- Parcel IDIf 018-2019-78-ON Page 2 of-3 ❑ Bonng Boring R ® Pit Grouts surface elev. 3037.2?, (t. Depth to limiting factor - 60 in. Appication Rate hbr¢on Depth Dominant Color Redox Description Texture Structure bonsistencel Boundary Roots �- - G_PDift' in. Munsell Qu. Sz. Cont. Color i Gr. Sz. Sh. ' I _ Efllf1 •Etftt2 1 �' 0-10 30YR3/2 sil I 2msbk mvfr CS 31-m 0.6 j 0.8 2 10-18 10YR3 4 0.8 i— 1 2msbkmvfr� gs 2f-m 0 6 - -I - 18-26 � 10YR43 Imfr gs I 1 0.4--0.6 3- ssbk - - - - -- 4 q 26�8 7,SYR4/sl 2 f m2f 1 mvfr gs 0.6 1.0 -F -- -- 5 48-60 ; 7.5YR4/4 - sr fs OsgI ml gs if 0.5 1.0 _ , 6 60f8 T 10YR5/9 c2d5YR5 8 sci m mfr 0.0 0.0 I ' � I ❑ Boring Boring # ElPit Ground surface elev. __- _ ft. Depth to limiting factor in. - ----- Soil Application Rater Horizon Depth Dominant Colo Redox Description Texture Structure Consistence) Boundary Roots ! GPD/ tr in. Mansell Ou. Sz. Cont. Color Gr. Sz. Sh. -Effd'1 •Effi2 _ - i I i i --+--i. -_ - -- i -------T Bourg ❑ Boring A Pit Ground surface elev. _ - _ ft Depth to limiting factor in. Soil Appication Rate Horizon i Depth Dominant Color Redox Description Texture Structure Consistence in. Boundary Roots F GP_D_!h= Munsefl Qu. Sz. Cont. Color Gr- Sz. Sh. I 'EfNt1 •EffM2 I I i I � I I Effluent tit = Boos> 30 < 220 mgfL and TSS >30 < 150 mg�L Effluentrig = BODs < 30 mgfL and TSS < 30 mal Can-93Wrc ralnll,il KNU Sraer CST H.W.L. 1036.6 Soil Test Site Plan For: Rolling Hills Farm j Residential Properly Owners Ass. Outlot I in the SWI14 and NW114 Sec. 29 T29N-Rl7W Town ofHannnond - St. Croix County —__ S8W19'02" W o' tbU= y� r 104040bwr =\- N 600 gptl R4 1624 d WEL 36 FN* 1622 ,38 (CC7 _ LOT -' 17 FN# 1621 • _P,M FLEV ' FN# 1619 WELL' OUTLOT 1036 01 1 FN# 1617 Proposed:WELL `= ooGPo 29.56 ACRES rDwF — 1,287,641 SO, FT. I600GPD_I, It-- o Q eo `� 1 N -"' LOT Mound to 1036 50' S �` 19 Crapnm sccie (EeeU Serve Lots 1037, 00' N LOT m 1 �<n a eo n 18,19 + 20 1035.00' N 20 N _ 7 w n v, Open Fallow Field Site a Elevation Data B#1 = 1035.18' B#2 = 1034.23' B#3 = 1037.23' Grade a Proposed Dose Tank = 1036.98' ' = Backhoe Pit r H.W.L. 1027.7 i i n BM 1 5�o a BM#1 = Top of Wooded Hub NW Corner of Easement #6 Control Pt. # 2010 Elev, = 103.7 66' BM#2 = Top of Wooded Hub NW Corner of Easement #6 Contro Pt. # 2009 Elev, = 1033 90' LOT 18111.1 8"1.1 SU =T LOT N 16 Nw Nrn L N N� 1 Ne � Cn N O� 21191 to so rr Nw 1e 0 FT 91 q4 NE ,00 p3 Existing Sanitary System for Lots 15-17 4R4 6/17/21 SSttoone'r�CST# 224059 P/L AEROBIC TREATMENT UNIT (ATU) SERVICING AGREEMENT This agreement is made pursuant to SPS 383.21(2Hc) 0), Wis. Adm. Code Property Owner(s) (Attach copy of deed if necessary) Model: Sanitary Wastewater Aerobic Hoot Systems LLC Treatment Unit Hoot H-600 A Recording Area Return To St. Croix County Community Development Dept. As an inducement to the County of St. Croix to issue a sanitary pernut for a POWTS equipped with an aerobic treatment unit on the above described property, we agree to do the following: 1 The owner agrees to conform to all applicable requirements of Ch. SPS.3 83, Wis. Adm. Code mlating to aerobic treatment and the maintenance requirements for the proposed POWTS (Private Gristle Wastewater Treatment System) technology. 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 manufacturer and the department including, but not limited to: the blower, electrical controls, treatment unit operation and sludge depth. These inspections are to be scheduled every 6 months for the first two years of operation 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, Stars. 4. The owner recognizes that the county department or POWTS Maintainer may make periodic inspections of the components to complete performance monitoring of the not. 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 30 calendar days from the date of inspection, maintenance or servicing. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property is no longer served by the aerobic treatment uniL 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 heirs 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 by the Register of Deeds in a manner, which will permit the existence of the agreement to be determined by reference to the property when: the aerobic treatment unit is installed. (Use BLACK Ink Only) Ownet(s) Names(s) (Print) Notarized Owner(s) Signatum(s) Subscribed and sworn to before me on this date: Notary Public (Prim) Notary Public (Signature) My commission expires: Drafted By: Keith E Stoner 23220 Woad Creek PA Siren. Wf 54872 ��cnhieit,y�� DIVISION OF INDUSTRY SERVICES Plumbing Product Revew P.O. Box 7302 Madison, Wisconsin 53701-2658 i TTY: contact Through Relay t ers�,=5v Govemor Scott Walker Laura Gutierrez, Secretary May 10, 2018 HOOT SYSTEMS, LLC RON SUCHECKI 2885 HWY 14E MAKE CHARLES LA 70607 Re: Description: SEWAGE TREATMENT APPARATUS Manufacturer HOOT SYSTEMS, LLC Product Name: (trans id 3097849) H-SERIES HOOT Model Number(s): H-500-A (MAX. DWF 600 GPD) Product File No: 20180134 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of May 2023. This approval supersedes the approval issued on March 12, 2013 under product file number 20120398 This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department • This product may not receive backwash discharge from a water softener. Water softener backwash discharge must be discharged in another method acceptable to chs. SPS 382 and 383 (formerly Comm 82 and 83), Wis. Admin. Code. • The maximum daily wastewater flow, which may discharge through this product, is 600 gallons per day. • When this product receives wastewater from dwellings, it will produce an effluent quality with a maximum monthly average value for BOD5 of less than or equal to 30 mg/L, TSS of less than or equal to 30 mg/L TSS and F.O.G. of less than 30 mg/L and fecal coliform of less than or equal to 10,000 cfu/100ml. • Plan review for the installation of this product must be obtained from the department in accordance with SPS 382.20 (1) of the Wis. Adm. Code. • This product must have installed a department -approved effluent filter capable of filtering particles of 1/8 inch in size or larger. SBD-10564-E (N.10,V7) File Ref. 18013403.DOC ST. CRO NTY SANITARY SYSTEM File#: / nly OWNERSHIP/ADDRESS FORM �z�e0 7 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORM774 - `�L owner/Buyer Rolling Hills Farm owners assoc. OCT 01 Mailing Address 3435 Labore Rd. mmt. crox City/State/Zip Vadnais Heights Mn. 55110 eyes, Phone Number (required) 651-248-1664 Email Address (required) W-1-v-e-to 7 q!n Pi b t a �.o , �f. ^ .5 . c o t", Parcel Identification Number 018-2019-7 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW t/4 , NW 1/4 , Sec. 29 T 29 N R 17 W, Town of Hammond Subdivision Plat: Rolling Hills Farm Q.rt+ Survey p # q I Volume , Vlfmranty Deed #'il / f 3S� 1�_(before 2006)Volume Number of bedrooms 12 Lot # ) 21-2-0 Page At Page # Spec house N yes D no Lot lines identifiable ■ yes D no OFFICE USE ONLY New Property Address N/A - (Verification 'new address required from Community Development Department for new constnxtion) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center cdd@sccwl.aov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.sccwraov AJLD Wisconsin. of Safety and 77ozim L— O�'�'�� #13637 Division of SOilFVei IJAM lid REPORT ORIGINAL 0I Page 1 of 3 II I I 'n . accordance with SPS 385, Wis. Adm. Code L ST a�do� I — 939 Keith Stoner CST Attach mplete site plan on paper not le than 8Yz x 11 inches in size. Plan must County St. Croix include, not I' itr�ljpkvetbP.9t And ho ' tal reference point (BM), dnrection and Parcel I.D. percent {�eo®�fr�i9@91tfltlfh row, and location and distance to nearest road. 018-2019-78 000 Please prfnt aH information. R 13y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /C I Property Owner Property Location rr{vF Sc`fY- tk, I lU il4 - tJ y R.H.F. Residential Property Owners Ass. Govt. Lot + NE1/4, NW 1/4, S29, T29N, R17W Property Owners Mailing Address - Lot # Block It Subd. Name or CSM# 3435 Labore Rd, Ste 150 18 - 20 Rolling Hills Farm Outlet 1 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Vadnais Heights MN 1 55110 1 Hammond I 75Th Ave ® New Construction Use: ® Residential / Number of bedrooms 12 Code derived design flow rate 1800 GPD _ ❑ Replacement ❑ Public or commercial - Describe: Parent material Loess over Bedrock Residium _ Flood plain elevation, it applicable _ NA ft. General comments Easement 6 for Lots 18,19 +20 - Propose a 8 x 150' mound dispersal cel located along the 1036.50 contour with a system and recomme ations: elevafiDn =1037.50'. Upslope mound contour staked onsite. " l IJ:c 19A+�.CLStxQ ❑ Boring 1 -2t9 r ❑ Bo rig # ® Pit Ground surface elev. 1035.1$ ft. Depth to limiting factor >62 in. Soil Application Rate Horizon I Depth Dominant Color Redoz Description Texture Structure Consistence Boundary Roots GPD/W •En#1 •EM2 in. Munsell Ou. Sz Cont Color Gr. Sz. Sh. 1 0-12 10YR3/2 sit 2msbk mvfr C5 gs 3f-m 0.6 0.8 2 12-24 10YR3/4 I 2msbk mvfr 2f-m 0.6 0.8 3 24-32 10YR4/3 d 2msbk mfr gs if-m 0.4 0.6 4 32-46 10YR4/4 sl 2f-msbk mvfr gs if 0.6 1.0 5 46-62 10YR6/4+5/8 Is Osg ml 0.7 1.6 #5 - Bedrock Residium ❑ Baring Boring # ® Pit Ground surface elev. 1034.2; ft. Depth to limiting factor 34 n. Soil Application Rate Horizon Depth Dominant Color ledox Description Texture Structure Consists ry Roots GPD/ftx in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. _ - Etf#1 •EB82 1 0-13 10YR3/2 - sit 2msbk mvfr cs 3f-m 0.6 0.8 2 13-24 10YR3/4 I 2msbk mvfr gs 2f-m 0.6 0.8 3 2+34 10YR4/3 d t 2msbk mfr gs gs if-m 0.4 0.6 4 34-47 10YR4/4 c2d5YR5 8 d 2msbk mfr if 0.4 0.6 5 47 65 10YR6/4+5/8 f2d5YR5/8 Is Osg ml 0.7 1.6 - — - #5 Bedrock Residmm-- - Ltnuent #1 = BOD? 30 < 220 mgfL and TSS >30 < 150 mgnL ' Effl t = BOD5 s30 rng/L and TSS < 30 mg/L CST Name (Please Print) Signature: - CST Number Keith Stoner 224059 ro Address Keith Stoner CST Date Ev uabon Conducted Telephone Number 23220 Wood Creek Rd Siren, W 154872 6/17/2021 715-566-09M seo-uw kamnat Property owner R.H.F. Residential Property Parcel ID # 018-2019-78-000 page __?_of 3 Boring # ❑ Boring ® PH Ground Surface elev. 1037.23 ft. Depth to limiting factor 60 in. Soil AppYcation Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/RT 'Ee#1 -Ef Q 1 Ar�) 0-10 10YR3/2 sil 2msbk mvfr mvfr a gs 3f-m 2f-m 0.6 0.6 0.8 0.8 2 10-18 10YR3/4 I 2msbk 3 18-26 26-48 10YR4/3 d 2msbk mfr gs 2f 0.4 0.6 4 7.5YR4/4 s1 2f-msbk mvfr gs 2f 0.6 1.0 5 48-60 7.5YR4/4 sr fs Osg ml gs if 0.5 1.0 6 6D-68 10YR5/4 c2d5YR5/8 sd m mfr 0.0 0.0 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure I Gr. Sz. Sh. Consistence Boundary Roots GPD/f 2 'Ell#1 'Ee82 ❑ Boring Boring # ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell TRFeZdox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FP 'EM#1 'Eff#2 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L c /) 101 Effluent 92 = BODS 5 30 mg/L and TSS < 30 mg/L SBD,Vffi 4RWn I) KCMh Sbg Sr 0 40 80 Crpphm� 1 inch - 80 ft. / H.W.L. 1036.6 Soil Test Site Plan For: Rolling Hills Farm Residential Properly' Owners Ass. Outlot I in the SWI14 and NW1/4 Sec. 29 T29N-R17W Toxin of Hammond - St. Croix Count}' 8% -- _� -- o S88"9'02''W _-- -e LbU= 1040 40 yyF = N 60(!, tl .� FN# 7629 "B2 FL FN# 1622 /o. �2c P�e. �A02 # 1621. BM ELEV ' FN# 1619 . WELL DWF tl' 103601 FN# 1617 600 GPD OUTLOT 1 WELL F Proposed 6 0 GPD LOT 29.56 ACRES DwF 16 1,287,641 SQ. FT. 600 GPD m 21781 m z17W N N, so I LOT g 50 FT to N• Mound to 1036 50' Serve Lots 1037 00' N LOT N 16,19 t 20 035,00' N 20 u, 1F u v O21781 Open Fallow Field Site so Fr Elevation Data B#1 = 1035.18' B#2 = 1034.23' B#3 = 1037.23' Grade (& Proposed Dose Tank = 1036.98 ' = Backhoe Ph H.W.L. 1 9% 1 F. N AA BM R Nl BM#1 Top of Wooded Hub NW Corner of Easement #6 Control Pt. # 2010 Elev. = 103.7,66' BM#2 = Top of Wooded Hub NW Corner of Easement #6 Centro Pt. # 2009 Elev. = 1033.90' U A3� C16'L -' � g9��• 5 AAZg•`N ' 6 6g2 VEL LOT N 16 LOT N� . 17 wo '1,7.1 50 FT -" tJ wc0 oo o rr 0 rn A3 ,�pp Existing Sanitary System for Lots 15-17 P/L AQ 6111111 N CST# 224059 L 1 ItVF O�WNER[te oc xunxwF. Lw E.a.E ROLLING HILLS FARM xaoeox. vn e LOCATED IN E OF NWI/4 OF THE SWI/4, THE NEIµ OF THE SWIM, FART OF INE SWI/O OF THE CTH SWIµ, MOSE114 NTOFTHESW TOWN LIF SECTIOND. AND OM OF WE NE1/4 OF WE SURVEVOgx � � NW1µ OF SECTION 32,ALL IN T28N, RIiW, TOWN OF HAMMOND, ST. CROIX COUNT', WIBCONBIN. Hoxn:ur,oe Flsnl.'a.ixo. I r , LOTHEE91 �'� xw�,w• ., _ - wa.nw.wlPePa.r. ! ,E I— sEE eTI EoaaNre w ewaa e E I LoraD ♦rnrr CeNStrtnnO.wo ��C� [ably 1 LOT 99 BEE 6NEC _mn.ure5rm%axxu 1 1 xuoeora, vn was _._ $ IE 1 EL.. - r rmu,.w,,,. i' ' .� 1' 9fy . •y1 LOT LOi 1 • 1 ,1 J • \ 29 29 J Y I ODUTLOTT 2 )j d ,Ac- 9Ni F5 LOT�.24 i .n [� 16 i •' i 22 0 0.1� MAICN YNE SEE SHEET I \ \ LOT R 5 i _ S i Id:4 a i y 1CTv' A I I I i LOYI _ I I' ttVrl/Y6R �II ` LOCATION SKETCH -iE T29N, R1TW y� 22 0T \ n. '[\ x. 1LO 2T 2 tim r, PL ` �,I � 6MTSH YxE 6[E 6NER • OUROT 3 LOT �! ,a.¢nn ` - f�__r• \ LOT la EEc 6NFEr• IS x LOT"11p �[ r LOT 11T . Y LOTl 5S LOT IS OUTLCT I Il � :a fn 5 1 •: 1 �t r$is S1, en It 1 S Nb9sTaew ,u1.Tr- 3li 1 �� uFw fkac Pg,p,y IF . 0 1 tinrr,m, n.uw i • WY6.58'W b16.25 tr.tt. r,s: L'I. mt i i'1� LEOENO PRIMMVMLDINOSEOIACKUNE6 nx m. or TYPICAL �, o nu.¢¢ncw ¢ .-,_�_._.___ � �..��•'SiL4 / :n,rrnr'uror r.ues.�.rt,�iwe..r,�•w¢rntm � _1 •..� i T��. nw � .vw� urrz w:.:.uwuuva^. r.-mnurwum n � vma.n. • u, li 4 y!`NY. %i l� IS rn. m.er+rreuo slPnxwwirw xuuo.uo>.•eiunw uumex.xce nVAL: powNw.mEroNr.un_Em ��:wu am',urw.r, rr. �e.ra.s w:arr[w ^-war.^Nw M_,.�Ws w r rmwq+n 1r� 6¢, lletlf,m se, Ir'ew30wW�If6I1(Ij o]rp} -,e...._�.....,..-a...,.....�..e-.. .e.w:�w.�n. �•-•°-.�:a. w.,..`_" cM'wINYOYMv�//b�V��jl(�V[rZ➢�E'rtL s.,r. „s,..,.e,.,.rrwa¢w,+n�rrr.waw�rrvwtl rura BCA411N FEET 1'-10a �rynn��o! ,�—�.Ea 6N bOFb SNEET6 12 teAm"y'? t) ir-Nov, COUNTY NO. 633967 STATE SANITARY PERMIT POLLING OWNER nn-suAQ i PLUMBE ff" T TOWN OF -A ska SEC _9T N, AND/OR LO S PERMIT 19 # ILLS ,:#Rw% TIoN c.# 648YY3 NO. CHAPTER 145.1313 (2) NTSCONSIN 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. The sanitary permit is transferable. -story: 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 agthorlty. 4MMJ6- A�J� O ED ISSUING OFFICER - DATE EXPIRES 1 UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)