HomeMy WebLinkAbout018-2019-78-000 (5)Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM
--- ' ZA. UrOIX
Safety and Building Division
INSPECTION REPORT
sanitary Permit No:
641934
GENERAL INFORMATION
(ATTACH TO PERMIT)
State Plan ID No:
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]
032200444-C
Permit Holders Name:
City Village Township
Parcel Tax No.
Rolling Hills Farm Residential Property
TOWN OF HAMMOND
018-2019-%8-000
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
a
Ajiinlior'
Holding
TANK SETBACK INFORMATION�„ky�
TANK TO PIL; WELL BLDG.I ant to a ke R
Dosing 1 1�.5' 1%2;1 1160' 1 1 1
PUMPISIPHON INFORMATION
t
Cnll Al2Cr%DDT1nN SVSTFM
FI FVATInN nATA
STATION
S
HI
FS
'�ELEV.
Benchmark
` /_A
! p 4
(ag, O
Alt. BM
BI g. ewer
. 75
055.
SUHt Outlet
Inlet
Dt Bottom
q
Header/Man.
/
Dist. Pipe
all
Bot. System
Final Grade
,i er
9.85
O(o 3
��
�u
_L
o69•S
—15
6 -
bn7
BEDrTRENCH
DIMENSIONS
Width t
Length ,
0
No. Of es P
PR DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
SETBACK
INFORMATK)N
SYSTEM TO
jPiL
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer.
T OI Syste
7 (
I
7 I�
Model Number.
nICT[i10rITIrIaJ CVCTFaa
Header/Manifold t
P sMgution t !
x Hole Size
x Hole Spa d t Vent to Air Intake
Length I l� Dia Spacing
Length Dia
h .
cnu d7"UFw - C--- M1 vv ununrlnr A/lra A -% t tams onw . Yv v a , i ry11/J r
Depth Over JA N I
L
Depth Over -
xx Depth of -�}
Topsoil %//'
yoc Seeded/Sodded xx Mulched
'Yes
Bed7Tr Center (I
Bed(Trench Edges
Yes j No DA No
COMMENTS: (Include code discrepancies, persons present, etc.) Ipection #1 J� l� �/Inspecbon it2:
Location: No Address Available •. C(/► /�yr////jry/ r� C�-
1.) Alt BM Description
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? L] Yes No I
Use other side for additional information. U Il
Date nsepctoes Signature Cert. No.
SBD-6710 (R.3l97)
r
0
-I co 24•
(v \��vL�U Industry Services Division County
Ulm 4822 Madison Yards Way St. Croix
i• _r o1J 2022 Madison WI53705
Sanitary,� = APR P.O. Box 7162SanitaryPermit Numpber (to be filled inby Co )
CoontY Madison WI 53707-7162 J (3
Com Mv ermit Application State Transaction Number
In accordance wi 383.21(2). Wis. Adm. Code, submission of this -form to t p$or
it 032200444-C
is required prior to obtaining a sanitary permit. Note: Application forms for stale rlted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide mZ dary u .1
purposes m accordance with the Privacy Law. s 15 (M(l )f m). Stals. Mound fF 1
1. Application Information - Please Print All Information
Property (Tuner's Name Parcel N
Rolling Hills Farm Residential Property Owners Assc. LLC 018-2019-78-000
Property (Tuner's Mailing Address Property Location
3435 Labore Rd, Ste 150 • Za i -7. 1 Z 7 6
Vadnais Heights Mn.
155110
E , sw , metro„ 29
It. Type of Building (check all that apply)
Lot a �\
O }
1.29 N R 17 E or W
OI or 2 Family Dwelling -Number ofBsdroonns 16
U IJ
1-4 l
Subdivision Name
�tiblle/Commercial - Describe Use
Blockk
Rolling Hills Farm
'ity of
late Owned -Describe Use
CSM Number
illage of
yu-
( lownof Harnmorld
Ill. Type of POWTS Permit: (Cheek either "New" or "Replacement" and other applicable on line A. Check one box on lime B. Complete line C i
applicable.)
A
,ew System
✓
t--�
1
ateplacenlent System
❑(hher Modification to I-xist ng System (explain)
❑Additional Pretreatment Unit (explain)
�J
Hoot 600
B'
laoldingTank
[]In -Ground
LJ�t-Grade
OMound
Individual5ne(7esign
OtherType(ex (explain)
p
(conventional)
C.
El Renewal Before
Revision
'Flange of Plumber
E3ransfer to New ()wrier
ist Previous Permit N and QWc Issui� ri
Expiration
ZPD`
G
�
/•� /
C
= IN �•,
J
IV.
Dia rsavi'matmeat Area and Task 1 fo
lion:
Design Flow (gpd)
Design Soil Applicatitxi st)
Dispersal Area Rtxluir
Dispersal Area Propo st)
System Elevation
2400
1.0 / 1.5 0. g
1600 / 3628 3�
1600 13628
1070.50
Capacity m
Total
N of
Manufacturer
Tank Information
Gallons
Gallons
Units
`- l
?
0
o $
V
u
New Tanks
I:zislin Tanks
p
Z
i7`� I
I
�t
perp++
E
'
t o_DC
S U
i0
Septic or I lolding Tank
2 Sim Tee FS 100 filters
ED
I =1
F-W;111
Dosing Chamber
1250
1250
1
Weser
ILK11=1=1
V. KeapematDtllty 6tatement- I. the wadersiRaed, assume respegfbillty for ipaillsdoer or the POWTS shown oa the altached plans.
Plumber's Name (Print) Plu s Signal MpIMPRS Number Business Phone Number
Keith Knudtson '164B443 651-470-1737
Plumber's Address (Street. City.stair, zip Cock)
927 150th St. Roberts Wi. 54023
lyApprovtxl ❑ Disapproved Her//role fee Isswn=ure
❑ (Tuner Given Reason for Denial S tO�S• 0L)
Conditions of AppmvaUReasons for Disapptnvol _
SYSTEM OWNER ?, (e) VK UL)v\ r- D1 of eol l 1
1. septic tank, effluent filter and
dispersal Ctlf must be serviced/mairdarned r r t IS f 1�t'
as per management plan provided by Plumber. r 1 11 tt t I h )L S 7Lt YC rel Vf�
2. All setback requirements rnYst be maintained ~ h 11 Ora 1 ./��I n / /
as per applicable code/ordinancea. Avc 1 n C74cG�_ W l�t. �� r5 �ft^►a (r �L
/ J Attach to complete plum r the sysleto and w mil t the ('Dung' Daly pa r eel "thin 8 Irl a I 1 inche, is srte
(e Y'14,4 q !/r`oor, S 5 o-i3 1- A�-� � ve aP1 4ero6;e -*ta -
SBI 148 (R. 03/21) f1
f'c� '�o�
March 17, 2022
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2024-3-17
Plan Review: PWTS- 032200444-C
Keith Stoner
23220 Woodcreek Rd
Siren, WI
SITE:
Rolling Hills Farms Mound #1
723 163rd St lots 1-4
Hammond Township
St Croix County
E Y: SW Y. S29 T29N R17W
FOR:
DIVISION Of INDUSTRY SERVICES
10541 N RANCH RD
HAYWARD WI 54&3416t
Cwftd TtMLQh RNsy
MW Aftm W 9oWPMW2 &#ff4U l y-@Wy oss
www w0cor"M pov
Tory lows - Oewrww
OC►Mn - NorNro
Conditionally
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
4 .7"Wr. ' V"A1y
SEE CORRESPONDENCE
Description: 16 bedroom-24D0 GPD — 40" to Mound Component Manual — Ver. 2.0, SBO-
limiting factor- Effluent Filter- Maintenance 10691-P (N.Ol/Ol, R 10/12)
required. Pretreatment- Hoot Pressure Distribution Component Manual — Ver.
2.0, SBD-10706-P (N.01/01, R. 10/12)
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 101.01(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:
Reminders
• The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short
and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed.
Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the
Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes,
to avoid compaction.
• Components and soil removed from an existing drain field shall be properly disposed of so that
there is no risk to public or environmental health.
• A sanitary permit must be obtained from the county where this project is located in accordance with
the requirements of Sec. 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be
made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis.
Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of
the tank explaining that periodic cleaning of the filter is required.
• 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.
Owner Responsibilities
The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also
receive a copy of the appropriate operation and maintenance manual(s) and be responsible for
ensuring that POINTS is operated and maintained in accordance with this chapter and the approved
management plan under s. 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.
The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POINTS.
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 POINTS management plan to the
owner and any others who are responsible for the installation, operation or maintenance of the POINTS.
Sincerely,
Joshua Rowley
POWTS Plan Reviewer, Division of Industry Services
(715)813-9111
Joshua.rowlev@wisconsin.rtov
Index and Title Sheet
Project Name: Rolling Hills Farm Mound #1 for Lots 1-4
Property Owner: Rolling Hills Farm Residential Property Owners Association LLC.
Address: C/O of Tyme Properties
3435 Lahore Rd. STE.150
Vadnais Heights MN 55110
Legal Description: Part of the E 1 /2 of the SW %.
Section 291'29N-R17W
Township: Hammond County: St. Croix
Subdivision Name: Rolling Hills Farm Outlot 1
Comp. #/Parcel ID: 018-2019-78-M
CONTENTS
Page: 1 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+B Duplex Pump Panel Specifications
Lots: Sanitary System Serving Lots 14
Conditionally
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
SEE CORRESPONDENCE
Page: 8 Hoot Systems H-600A Tank Specs. and Hoot Service and Inspection Forth
Page: 9 Management and Contingency Plan
Attachments: Soil and Site Evaluation Report, Soil Verification Borings,
Sample ATU Servicing Agreement, Hoot Systems LLC Product Approval with maintenance
requirements and Hoot Systems LLC Installer Certification.
Mound Component Manual Used = Version 2.0 SBD-10691-P (N.01/01 R. 10/12)
Pressure Distribution Component Manual Version 2.0 SSD-10706-P (N 01/01R. 10/12)
Designer.
Signature:
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 16 Bedroom
2400 gallon per day sanitary system to serve Lots 1 thru 4 of 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 easements 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 4 lots the mound dispersal area will be located within the tested
areas for Lots 4 and I 1 with verification borings completed. The sanitary system for Lots 1-4 is
located within the common area known as Outlot 1.
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. Thcse lots will required to set an aerobic treatment tank
with a 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], that will alternately
distribute the highly treated effluent to a common mound dispersal system consisting of a 8.0 ft.
x 200 ft- mound dispersal cell.
The soil tests completed by David Steel are provided. The BM for the soil test for Lot 11 equals
100.00' or--1069.30 and the BM for Lot 4 equals I00.00' or approximately 1071.25' using
NAVD 88 Datum. A surveyor was hired to locate the existing irons and staked the septic
easement area as the agricultural fields within the subdivision had continued to be cropped and
some of the irons and T-posts marking the lot corners had been disturbed as it has been 15 years
since the original soil tests had been completed.
We used the top of a nail set in a wooden hub at Control PT.#5025 with an elevation of 1068.07'
ft. as our benchmark for the sanitary systems construction along with other available control
points with known elevations. For this dispersal area site the existing lot irons were verified with
elevations as documented. Soil verification pits labeled KS#1 — KS#3 were dug to verify the soil
conditions and tied into the benchmark along with contours within the system area.
Mound Plan View
Observation Pipe .'
Page 3 of 9
�r•.� r-s!!r•,�r-Lr=s!r=<ti!r�y!:=Lr=.r�:.�r��r=.fir•,
INN
�r��r.
ri
L
Mound component Dimensions
A 8.lx E l .? H 12" KP
17
D " G 6" 1 5. W�
®Msq.) Dupetsai tell Ara 6 g (fl.-) Basal Ara Availabk
(W") LineartA"ng Kttk 120 l(ft)I/IOBOb%.PipcPIwcment
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade _ 0
107 . 01) IF
Dispersal —t
4
Cell
Elevation
Shading Key
® Topsoil Cap
® Subsoil Cap
ASTM C33 Sand
® Tilled Layer
® Aggregate
G
71 A {ft)
Lateral
N1069.50'(ft) Contour Elevation
6 % Site Slope
Observation Pipe to be constructed of 4" diam.
pipe w/ water tight cap, a minimum 6" slot
anchored with 3/8" rehar or a water closet collar_
Detail of
Typical Dispersal Cell
xtile fabric
Cover
Duplex Forcemains to the Center of the
Dispersal Area w/ End Manifolds
Lateral Layout Diagram
A8 fl.+ 4.33
P
Note: F.M. attached to
S center of the manifold.
----J�
Turn -up WWI valve or clean
w 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
x
Duplex Force Main
2 per F.M. 1
2
98.75
4.00
21.60
43.20
86.40
23.98
Lateral Turn -up Detail
Finished Grade
6" to 8" diamcter Lawn Sprinkler Box
.25 ft.
in.
ft.
8.
gpm
9pm
gpm
ft.
P
laterals and foicc Main of PVC Sch 40
per CPS Table 394.30-5
Page 4 of 9
4'1.08fL+
r
X Holes equally spaced on
bottom of lateral
Note- Forcemains coming into the center of the
dispersal area, 1 st hole approx. 1.25' from the
manifolds with the hole spacing between the
manifolds of — 2.83ft. North manifold + North F.M.
feeds the north 1/2 of cell and the South manifold +
South F.M. feeds the south 1/2 of cell.
Orfice Diameter
Orifice Spacing (X)
Orifices per Uteral
Orifice Density
Manifold Length
Manifold Diameter
Forcemain Diameter
and Length
5/32 or 0.156
in,
2.50
ft.
40
10.00
fl''
orn
4.00
R.
2.00
in.
3"/ 522' per F.M.
Threaded Cleanout Plug or Ball
Valve I
Note: Lateral ends at last orifice where variable
length to cleanout begins.
Long Sweep 90 or Two 45' Bends Same
Diameter as Lateral
Distribution Lateral
bT ,,
LOT
L�
LOT
>d
L
11
LOT a
r'
age 2
rb
1O
Y
21.781
e..m
LOT S
21.7l1
80. FT.
WELL
w n
SO. FT.
rn,
nn
w\ .erg26
•P .ucfo
iM
r�•IIH['
q¢
LOT 4
yA
xr rfa•e
�y\\1f
IYwY1.W)1.. 11
Q
��.1 � w
T Y»
•�i.w. . - iM �p
rIJ00 ra.
zlp
yy
LOT
��
raorvr •
�
"'
ct.r n .
/wL1.
Ciln.Jp3,
Ty.+bas io+o w
•1�1 L�./r
r
1�
biRS 7ga.a11'$b Nnllr
P' •ooao�
r� rLOTZ
a <
i
Aw• DMN R'C far,Np qpa
Rqd f'.Il fr flrrµyft
H.JH R R.
frr n •
milli
l
WE
.ram
AV
aMbib,/I.JO T1Wq lllWgldllyvrl A.e
S
p N•I• ` ✓
Aland Siµ• 1 Fr 14
AT
"VZV
sw,—
o..frl aHro
LOT 1
plop aG flyby J'Sd Nrrw Alw..
'r•'
Ylt•
n.a. H.mw"
Truf r ir. a
fy.
?r yI
11r M0 �'Y� • W
MY.Ye Aw
n�
QQpp pQ
H\7\\TEaYa° a06187
Ipp_'�'t_'
fin
,t
1 ngvad Vim f'mea Mll ll]0.Nllla Ta
uwn.cn ny.rra wnC•
SO
N.1 41 •�o.01¢Ibq. ad SY+s•SIF14s
tr �µr wiw Aa o>.,. r\r \y,+,r+h•
NI k3
bJ1
iaxo OUTLOT 1
k
rwaw
29 SE ACRES
7R
bi,f 1,287,641 SO. FT.
w �--
r.y..ILl.noa
.�
ek ION.Je mror •/• S,r rindl
All POOF drll m.frsb5'S T" t 3
�1�TydlYbrrr.YR•IQS
,.
rd SM T" 3M.10.J
ANOfOCs...
II WI r.� - [TLL rair
/180a7------
61'
Page 5 of 9
Duplex Pump DoseTank Component Cross Section
Approved Manhole Covers With Waming Labels
and Locking Device / 4" Min. Above Final Grade
\ Weather Proof Junction Box
\` Electric per NEC 300 &SPS
4" Sch. 40 Vent 316.012 W AC
> or —to 12"
Above Final Grade ri
F___J�_ffirAlternate
Note: SJE Rhombus Type 122 Iluplex Outlet Location
(Demand Dace) /Approved 4" Sleeve
Top of inlet = Approx.' 1057.80' 111 1 1 1 Forge Main Diam. - _ 3" "
Weep Hole or Anti Siphon Device
Note: Pump switch and alarm to be A Duplex Force Mains
wired to separate circuits.
B Pump Off Elev. 1055_04'
WLP1250-MR C Duplex Pumps
Tank Mfr. Wiesert Concrete D
Dose Tank Elev. 10543T
Vertical Difference Between Pump Off and Distribution Pipe = .15.96 Per 112
Minimum Required Supply Pressure ...................................... = 4.55 of cell
522' FT. of Force Main x .57 Friction Factor/10017T.... = 2.97' per dose
Note: Maximum dose per Pressure Loss Through Filter .................... _ •50' F.M. assumed to be
F.M. or 112 cell equals 240 gals. Total Dynamic Head .................... = 23.98' near equal in length.
Min. dose per cell - 160.96 gals.
Number of Doses .. - 6.37 Per Day Gal. Per Day/ kof Doses = 191.34Ga1. (Duplex
Volume of Backilow.................................................................... = 191.57 Gal. PumpsAlternating
Total Dose Volume..................................................................... - 3S2.91 Gal. between cell
halves)
Pump Tank Capacity 1253.16 Gallons Dimensions Inches Gallons
Pump Tank Volune 34.81 Gal/Inch A 15 522.15
B 2 69.62
Pump Mfr. Goulds C I F 382.91
Pump Model _ WE-05H D 8 278.48
Minimum Discharge Rate - 43.20 GPM per pump
Alarm Mfr. S.J.E. Rhombus Total- 36 1253.16
Alarm Model Tank Alert t
Bed Tank per SPS. 383.45(5)
Aeahur Tank u twe@vAry to negate buoyant forces per SPS 3113.43(8xy).
Wastewsw
Page ae of g
METIM FEET
40 130
ERIES: WE
35 120'-- } -- i r - t j } IZE:'/. SWDS
110,
RPM: 3500 a
30 100 ` - -' 5 GPM
i 1 r TLSFT
90'
25[ 80.
20 70 -- -- i
ao
- ^� f-
is s0--
1 I
40 1 +
t0 30 - - — - - - -- - -
5
20 - - -
10 �- - -
0 L
00 10 20 30 40 0 60 0 80 90 100- 110 120 130 140 750 160 GPM
00 I-1_—L - L_ 1 _L-1--�_ I 1 I I
S 10 15 20 25 30 53 nl3/h►
CAPACITY
COMPONENTS
- -llngan
1el Seal
MMO:(w
Shah,•,
, rqs
C:abk
O-Ring
II
S
1
2
6
4
3
PAGF 3
Wastewater
Page 6 of 9
PERFORMANCE RATINGS 9 ieon, p, n CH
OrdwHo.
WE413L
WE-03M
WE-05H
VIE-07H
WE•10H
WE•/5H
WEOSHH
WEISHH
WE-20H
RPM
1750
1750
1rM
3500
3500
3500
3500
35W
3500
ti
86
-
10
%D
63
78
94
58
95
-
15
52
52
70
90
103
128
53
93
138
20
27
35
60
83
98
123
49
90
136
25
5
15
48
76
94
117
45
87
133
30
-
-
35
67
88
110
40
83
130
35
22
57
82
'03
35
80
126
40
-
-
45
74
9S
30
77
121
45
-
35
64
86
25
74
116
=
50
-
25
53
77
-
70
110
55
-
40
67
66
103
60
30
56
63
96
65
-
20
45
58
89
70
35
55
81
15
-
-
-
25
-
51
14
80
-
47
66
90
-
-
-
-
37
49
100 -
28
30
DIMENSIONS
(All Alme�s ons arc In mchea Dn not use for constrirnnn purposes.)
I49 111h,_
ROTATION 5Y
8Z'
KICK -BACK
PAGE 5
Single phase, duplex alternating pump control with override.
Page 7 a+b of 9
The Model 122 control panel is designed to allemately 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 audiovisual alarm system. Common
applications include pump chambers, sump pump basins, irrigation systems and lift stations.
1. Enclosuro measures 10 X 10 X 6 inches (25.4 X 25.4 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. Magnate 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.
ti. Green pump Run Indicator Lights (mounted on circuit board).
S. Circuit Breakers (optional) provide pump disconnect and branch circuit
7. Ground Lups
S. Float Stalin Indicator LION (mounted on circuit board).
8. Control and Alarm Power indicator Lights (mounted on cirwit board)
10. Auxiliary Alarm Contain forth C (mounted on circuit board)
NOTE. Schertmtic is located inside the panel on enclosure cover.
STANDAW ALMI M MCKAGE
11. Red Alarm Beacon provides 360' visual check of alarm condition.
Nola: NEMA 1 style utilizes a door mounted kxlk:ator in lieu of a beacon.
12. Alarm Mom provides audio waning of alarm condition (83 to 85 decibel
rating) -
Note. NEMA 1 style utilizes an internally mounted buzzer in lieu of hom.
13. Exterior Alarm TestlNormallSilence Switch allows hom and light to be tested
and horn to be silenoed in an alarm condition. Alarm automatically resets once
alarm condition is cleared.
14. Horn Slone* Relay (mounted on circuit board).
NOTE: other options avaiLable-
AF
Entire control system (panel and switches) is UL Listed to meet andlor
exceed industry safety standards
AF Dual safety cerffication for the United States and Canada
Standard package includes three 20' SJE SignalMasten• control
switches
AF Complete with step-by-step installation instructions
Five-year limited warranty
SEE BACKSIDE FOR COMPLETE USTINIG OF AVAILABLE OPTIONS.
SEE PRICE BOOK FOR UST PRICE.
Model Shown 1221W114X"
9 @ U
IJO
RflS US'
PO Box 1708, Detroit Lakes, MN 56502
1-88&DIALSJE • 1-218-847-1317
1-218-847-4617 Fax
email: c ushxner.service®siertwmbus.com
NrN'Mr•fJlf�•C�
12z i F)
MODEL 122
4U MMPACKAGE
5A(_] 0 = se(oct options or no alarm package
2 alarm peCkege (nCMrlea te5t/normaYsilerwe witch, fuse, red light, 8 horn)
ENCLOSUREED
RAi ails � I
= Indoor. NEMA 1 (metal)
W = Weatherproof, NEMA 4X (engineered tlfartfloplastic)
_ ; DEVICE I mag i
= msgrletic motor contacSor 12020824W
9 = magnetic motor contactor 12W only
PUMP FULL LOAD AMPS
= 0-77 FLA
1
1 = 7-15 FLA
2 - 15-20 FLA
3 = 20-30 FLA
PUMP DISCONNECTS
0 = no pump disconnect
4 - crmil breaker 120V (soled STARTING DEVICE option 9 above)
120/208240V (select STARTING DEVICE option 1 above)
�T Pump H APPLICATION
H or L =pump down or Pump W (select 17 option)
X - nio floats
OPTIONS trr.aa.I
BA 804C
�- r
Not
�vy,vo,"
ENCLOSURE UPSIZE - N you selected one or more orthe * options, or two ** options,
a one-time endosum upsets fee would a".
l
CODE DEscmmoa
Q to Red beacon only / no audio
(must soled 10- for Rom packs")
0 1C Horn only / no vwal
(must select ro' Ax atom package)
*# 3A Alarm flusher
* 38 ManuN alarm reset
*4A ReWrhdem cif
NOW Option 40 if Doers included)
0 4B Red redo dent off u*Wslor a alarm
laws( sebof Option 4A also)
[� 4D Redundern off Now
(must s4fed 4A option) (soled 17 a~)
* SA Thermal arOdrNreet ser»or auto an
(hor Pumpa wAhakmel swrich leads)
# SE Seal frhre circuit a red indicator (2 w a)
0A Auxiliary alarm contact fom C
(shallded as standard)
rzn * 5A MapaW time meter
* 8C Event (cycle) counter
er 9_A Karp ov.rkud
span y amperage alter number 9lbsowed by *W('A-
Example: 912A=12amp, pump.
* 0-25 FLA
�*L—j 25-30 FLA
10E L.odrabie With - NEMA 4X
/DE Lnckal" lath - NEW 1
* 10F L*htwV amwlor (select purry doled treslrer)
vJ-Imr tea_
MODEL 122 1 W 9 0 4
Alarm Packnip R Enclosure ating
BUW" Device
Pump Fug Load Amps
Pump Disconnect
Float Swroh Application
Options: Auzitiary eleven, contact, form C,
Elapsed M* mWw, event loads) cou itsr,
SA slgnawastse f pipe damp
8
18A
168
18c
160
17A
ITS
17C
17D
17E
17F
17J
198
19F
19T
IOU
lox
Ariti-oDndeneelion heater
NEMA / alarm panel
NEW 4X alarm panel
Main disconnect (rotary a", rnokmrod through door rmn-1tiseci)
(must soled circuit breaker)
0.20 FLA (total of both pump")
20-60 FLA (Total of both pwanpa)
1 D' Dad in lieu of 20' (pN aDaf)
15 dad in how or 2W (per fos)
30' oord in You of 20' (per Rout)
4io' cad in feu of 20' (per fbat)
SJE Sgndktwm* I pipe damp • (per soap
WE SuprhalsA~ i euMnlsfy weighted 0 6w ibap
Sensor Floor IntemYy weighted ♦ (per Boat)
Sensor Fluor) wftmsly wepMed A (Par NOW)
Sensor FloW Mini /pipe clump ♦ (Dar aesr)
Sensor Floel` ►fsw / sidemeYy weighted A (per abal)
Sensor FkwO f pipe damp A (purr foal)
Lead lag selector "with
Fourth float to separate alarm Lkrrim from log
TOA (Test/Off/Automatic) wwhhes and pump run lgtds
through door mounted
HOA (HanoM MAurtdnaEc) swathes and pump inn lights
f wet* door monied
Door mounted Pump run indicalor
• MadhudGky-eCWatsd A Menarry-activated
d S& Rtmmnhn OW14
Page 8 of 9
4' CAS
i)
n�
Fr — =1lFr
;I IN! — b r 4' CAS
POLYLOK 12' ACCESS LID (TYP)
`Z SET RISER (TIP)
SIlE VIEWoE
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REWREMCNIS
NO GPD GRAVIII' d9CNARGE SYSTEM
H-6H60000A A
TANK SPECIFICATIONS SPECIFICATIONS
DIMENSIONS:
WALL. J'
BOTTOM: 5'
COVER: 4'
MANHOLE: 12' & 24' 1.0. PLASTIC RISER
HEIGHT: 70' O.D.
LENGTH $W D.D.
YADTH: 74 1/2- O.D.
BELOW INLET: 57' O.D.
LIQUID LEVEL: 51'
NE3GHT: 11.135 LBS.
INLET AND OUTLET:
4• CAST -A -SEAL (CAS) BOOT OR EQUAL
COVER: MIX DESIGN #8 (NO FlTP]t)
TANK: MO( OE" /B (SMAu Flm)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT MESER CONCIMTE
FOR APPROVAL
APPROVED BY:
APPRONAI DATE:
PRODUCTS NEEDED BY:
10—7,
W
f;
Y 00
:N
n
O
_ N
9 -�
Page 8 b of 9
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:
Operational
Inoperative
Not Applicable
Aeration Plumbing .................
[]
G
Air Filter .................................
0
0
Effluent Pump (if applicable).......
[]
n
a
Chlorinator .............................
C]
0
OK System Light ....................
0
Alarm.....................................
0
0
D-Box ................. . ..........
L7
7
0
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
5.Comments:
Required Results Test Method
n
C
l 1
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
System (POWTS) Shall Include information and procedures for maintaining the system
within the parameters of SPS 383 and 384, and the conditions of approval 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 383.54, Wis Adm. Code, the Mound
Component Manual for Private Onsite Wastewater Treatment Systems (Version 2.0)
SBD-10691-P (N.01/01) R. 10/12 and the Pressure Distribution Component Manual
(Version 2.0) SBD-10706-P (N 01-01) R. 10112
Table l : System Design Specifications
Sanitary Permit Number
_
Number of Bedrooms
16
_Rcsip Flow (GPD)
2400
Soil Absorption Com neat Size . ft.
1600 Pretreated Effluent
Trash Tank Capacity Gal.
400 W.
Pump Chamber Capacity Gal.
1250 gallons
T of Wastewater
Pretreated Domestic
HOOT SYSTEMS H-600 A
Pre -Treatment Unit installed r structure
Table 2: Soil Absorption Component — Limits of Reliable Operation
Septic Tank Component
Soil Absorption Component
Design Flow -Peak GPD)
600 per structure
1800
Max. Influent Particle size
. NA
s 1/8 Inch
Maximum BOD 5 (mg/1)
NA
<— 30 mg/1
Maximum TSS (m )
NA
s 30m I
Maximum FOG
NA
NA
Table 3: Maintenance Schedule
Septic Tank
Ins ect and/or service once every 3 years
Dose Tank In- Line Filter
Should inspect once a year and clean every 3 years
Pump Chamber
Inspect once every 3 years
Soil Absorption Component
Flush laterals every 18 months.
HOOT SYSTEMS H-600 A
_
Service every 6 months for first 2 years. Then annually
there after per maintenance agreement. See attached.
Page 9 of 9 a, b T c
Septic]
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 N R 113,
Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors,
Seepage Beds, 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 alarms
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 next service needs to be performed to maintain less
than maximum scum and sludge accumulation in the tank.
Pomp Chamber
The pump chamber also requires monitoring once every three years or the time of problem,
complaint or failure. Inspection should include checking the dose rate, volume and frequency.
Waning: The dose chamber may fill 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-loll 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 service. 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 without
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 be difficult or impossible.
Tank abandonment shall be accordance with SPS 38333, Wis Adm. Code when the tank is no
longer used as a POWTS component.
Page 9 of 9 a, b + c
Soil Absorption Component
Tbc 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 be 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 be avoided particularly during
winter months. The compaction or removal of snow cover over the component may lead to
hydraulic failure by frizzing. This type of failure is usually temporary, 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 cell, 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.
ContUmencv Plan
In the case of septic or dose tank component damage, measures shall be taken to repair or replace
the tanks to there original operating condition. Problems with the pretreatment unit should be
addressed to the POWTS Maintainer. Biannual/ 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
651 470-1737
St. Croix County Zonis
715 386-4680
Wieser Concrete Products
Maiden Rock WI
(800) 336-3416
Septic Pumper
Powers Sanitation
715) 249-5738
HOOT SYSTEMS LLC
11-600 A
888 878-4668
Page 9 of 9 a, b + c
AEROBIC TREATMENT UNIT (ATU)
SERVICING AGRF,EMENT
[his agreement is made purarant to SPS 383,21(2)(c) (5), Wis. Aden lode
Agreement Date Parcel Number
018-20M78- MO
Legal Description of Property
(Attach copy of doed if necessary)
POWTS Fquipment Descriptimn, Manufacturer anal Model:
Sanitary Wastewater Aerobic Hoot Systems LLC
Treatment Unit Hoot H-W A Recording Arm
Return To St. CTMX County Cbmmurity Develrrpment Dept.
As an inducement to the County of St. Croix to issue a sanitary permit for a POWTS equipped with an aerobic treatment unit on the above
described property, we agree to do the ibllowing:
1 The owner agrees to conform to all applicable requirements of Ch. SPS.3 93, Wis. Adm. Code relating to aerobic trcannent and the
maintenance requirements far the proposed POWI*S (Private Onsite Wastewater Treatment System) technology.
2. The owner agrees to maintain a o ntract with a licensed PO WT3 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 aid to maintain the unit sn as
to not create a human health hazard as described in s. 254.59, Stars.
4. The owner recognizes that the county department or POW US Maintainer may make periodic inspections of the components to complete
performance monitoring of the unit.
5. the owner or the owner's agent agrees to report to the department or designated agent at the complexion ol'cach 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. Ibis agreement will remain in effect only until the county office responsible for the regulation of private unite wastewater treatment
systems certifies that the property is no longer served by the aerobic treatment unit. In addition, this agreement my 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.
r This agreement shall be binding upon the owner, the heirs orlhe owner, and assignces 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 where the aerobic treatment unit is installed.
Use t3LACK Ink On
(hvrne(s) Names(s) (Print) Notarized Ownerls) Signatures) Subscribed and sworn to before me on this date:
Notary Public (Prime)
Notary Public (Swientre)
My commission expires:
!]rafted ey: Keith & Stoner 23220 Wood Creek Rd. Siren, W/ 54872
DIWOM OF INCKJMy 8ERVICF.B
Puivift l Pwisw
P.O. em 73M
t eau WMarisihtr870 -n"
Try: Contact Through Ragry
Governor Scae WWkw Laura Oudwrec, Sacmtary
May 10, 2018
HOOT SYSTEMS, LLC
RON SUCHECKI
2886 HWY 14E
LAKE CHARLES LA 70807
Re- Description: SEWAGE TREATMENT APPARATUS
Mw dachxar: HOOT SYSTEMS, LLC
Product Name: (bans id 3097849) HSERtES HOOT
Model Numbers) HWO-A (MAX. DWF 600 GPD)
Product File No: 20180134
The specifications and/or plans for this plumbing product have been reviewed and delarmbled to be in compliance
%dh chapters BPS 382 through 384, Wieoo wh Adn*Wt Me Code, and Chapters 145 and 1W. Wisconsin
Statutes
The Departmenl hereby issues an approval based on the Wisconsin Slaiutes and the Wwoonotn Ade*jWrS&*
Code. This approval is valid until the end of May 2023.
This approval supersedes the approval Issued on March 12, 2013 under product Ale rximber 20120398.
This approval Is contingent upon compliance with the following stipuiation(s):
This lank must be designed to withstand the pressures to which It will be subjected.
• The manufacturer must keep at the manufacturing plant a sell of plans and specifications bearing the
department's stamp ofapprovat. The plans and sDeCIACatbns must be open to inspection by an outlorized
rspresSPIWIVe of the deportment.
• Thts product may not receive baclMiosh dWdiarge from s water softener. Water SORW sr bo*Wstsh
dlsot w" must be d wharged in another method acceptable to chs. SPS 382 and 383 gwrrierly Cam 82
and 83), Wls. Admin. Code.
• The maximum daily wastewater flour, which may discharge through able product, is 800 gallons per day.
• When 11111111 product receives wastewater from dwellings, A call produce an &fluent quakty with a mardmum
monthly ayetapa value for DOW of less tttpn or equal to 30 ffWL TSS of Was. than or upsol to 30 m9fl TSB
and F.O.G. of lass tltan 30 mt1/L and fecal oDftnin of lon than or equsf to 10,000 chW10QmL
• Pion review for the installation of this product must be obtained from tl0 dqp w#r wht in aaooWalwo wits WS
382.20 (1) of the Wra. Adm. Code.
• This product must have installed a department -approved effluent filter capable of f8tarkv particles of lie
Inch in size or larger.
6e0-IW84-E (tl.1047) FAR FW.. ISM34011)OC
Hoot Syslems LLC
May 10, 2018
Page 2 of 2
Product File No.: 20t80134
Tahis 1 WiManaftna rnarwlion Mm ninn RoenAnar wOR
PRODUCT/
InMaYSWWp IggRomg MajnhKgMo
2- . 4i fYkM
Ongdng Pumping Cycle AnWOr Rwlukamerrts
OFNW=uriblt seer ►aeaktti.
ery load at Saes for amps d wv*w.I"
Back-Waeft CydA
NIA
Eft"t Performsim Lave
NSF-40 Cbm f
SOD6 For DowneWng Distribution Am
I YES
Fecal Credit For Reduction Of Vw t:al
'YES
Addttlonal Conerrords
I none
• These tanks shall be tined with locking manhole covers in accordance with v. WS 384.25 (7) (h) Va. Adm.
Code. The manhole cover must be secured to the riser using screws which we not standard or PhAips head
to be considered an effective locking device.
• These tanks shall bear warning labels, that are visible after installation, that conform to s. SPS 384.25 (8).
• The tank Is not recommended to be installed where setkaad soil or seasonal high ground water tables are
Indkxded between the bottom of the tank and the ground surface.
• BEODING: 34nches of oompacted beddhV shall be provided. The bedding matenet shall be dry, sandy
kun material, or coarser s Ai diameter in the largest dimension.
• SACKRWNG: must be cornpaclod at s 6-lowh iMarvais. BadSO malarial she$ be free -flowing sal or gravel
s 4 inches to alien Mw in the largest dirtre wbn.
The department is in no way endorsing this product or any advertising and is not responsible for any situation which
may result from its us*.
X
W. Schlueter
Plumbing Product Reviewer
Department of So" and Professional Services
Division of k ttustry Services
Bureau of Tachnioal Ser Aoes
(608) 207-1401 Phone
(e08) 2e7-OM Fax
glen.sdttwhvCjW.gov E-mall
500 GPO GRAVITY DISCHARGE SYSTEM
H-500 A
!r ,oar
I
O
74.s-
22M Avg Length
a.eoo' Avg WAM
4 333' Depth
Rev. 02
66.F
N
WAbr
January 1, 2022
RE: Service Provider/installer Certification
Wisconsin Hoot Systems
Hoot Systems, LLC
(Service Provider/installer)
Keith Knudtson
927 1501 Street
Roberts, WI 54023
This letter is to serve as your official certification as a "Hoot Certified Service Provider/Installer"
for its Advanced Treatment Units. Keith Knudtson has been listed as an approved
service provider/Installer on our listing for the state of Wisconsin.
They have successfully completed onsite training on multiple sites and engaged in trouble shooting
methods and solutions. Service Technicians have been trained to service and inspect the functionality of
our products along with proper installation guidelines. As a "Hoot Service Provider/Installer" we have
agreed to continually educate Keith Knudtson on all aspects of our product line.
Respectfully Submitted,
Ckkd-A+#z;-
Aaron Yonts
Regional Manager
Hoot Systems, LLC.
ST. Ctzo NTY SANITARY SYSTEM �#t
i'., o//tce use only
Olum OWNERSHIP/ADDRESS FORM creowzrmt
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 INFORMATION
Owner/Buyer Rolling Hills Farm owners assoc.
Mailing Address
City/State/Zip
3435 Labore Rd.
Vadnais Heights Mn. 55110
Phone Number (required) 651-248-1664
Email Address (required) 37-1-0-ily rw,� �7i1'� /h_)$'�-e,5 , c d
Parcel Identification Number 018-2019-A8 00 1
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location SW y4 NW 1/4 , Sec. 29 T 29 N R 1 W, Town of Hammond
Subdivision Plat: Rolling Hills Farm d of #
Certified Survey Map # . Volume . Page
/�#
Warranty Deed # -1 13 01 (before 2006)Volume . Page #
Number of bedrooms 12 Spec house ■ yes O no Lot lines identifiable ■ yes O no
OFFICE USE ONLY
New Property Address
N A
(Verification of new address required from community Development Department for new construction.)
q/ I ,ZZ
(Staff Initials) (Date)
This form must be submitted with all Private Onsite Water Treatment System (POINTS) 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 715-245-4250 Fax
cdd(&sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi oov
Vvisco1 sin SOIL EVALUATION REPORT #1928
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Steel's Soil Service
Attach complete site plan on paper not less than 8%, x 11 inches in We. Plan must County
St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D Old—(i.�(.1) I U_6/
R t
Please p R Daft
to
Personal information you provide may be sed 4pprivacy Law, s 15.04 (1) (m)).
Property Owner Property Location
Rolling Hills Of Hammond LLC. JUL 19 2006 Govt. Lot na SE1/4, SW114, S29, T291% R17W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
400 2nd st ST. CROIX COUNTY 4 na Rolling Hills Farm
City Sta City Village Town Nearest Road
Hudson WI 1 54016 1 715-386-0230 Hammond 160Th St
New Construction Use: , Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe: na
Parent material Silty sediment and underlying reddish sandy loam till Flood plain elevation, it applicable na _ fl.
General comments Conventional system, system elevation 96.70fl. Trenches spaced and depth to code�a� 3.00R below,
and recommendations: grade. �// 7)
i Boring # Boring
Pit Ground surface elev. 99.10 ft. Depth to limiting factor 72 in. Soil Application Rate
Horizon
Depth Dominant Color Redox Description
in. Munsell Qu. Sz. Cont. Color
Texture
Structure Consistence
Gr. Sz. Sh.
Boundary
Roots
GPD/f 2
•Eff#1
•ER#2
1
0-9
10yr3/2
none
sil
2msbk
mfr
cis
lvf
.6
.8
2
9-16
10yrr4/4
none
sid
2msbk mfr
CS
Svf
Svf
na
.4
.6
.7
.6
1.0
1.6
3
16-25
10yr4/4
none
SI
2msbk mfr
cis
4
25-35
7.5yr4/4
none #
9rcos
os9 mvfr Cs
osg ml a
osg mvfr C5
5
35-62
10yr4/4
none
' ms
na
.7
1.6
6
62-72
__L5ycV4
none
graos
na
7
1.6
7
72-80 10yr5/6
C2d 7.5yr5/6
sill
om na na
na
.0
.2
2] Boring # Boring
Pit Ground surface elev. 99.70 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon
Depth Dominant Color
in. Munsell
Redox Description
Qu. Sz. Cont. Color
Texture Structure Consisten Boundary
Gr. Sz. Sh.
Roots GPDM
'E"i 'Eft#2
1
0-10
10yr3/2
none
sil
2msbk mfr cis
if
1vf
.6
.6
.8
1.0
2
10-20
10yr4/4
none
sl
2msbk
mfr Cs
3
20-38
7.5yr4/4
none
Is
osg
mvfr cs
lvf
.7
1.6
4
38-96
10yr6/6
none
Is
osg
ml
na
na
.7
1.6
' Effluent #1 = BOO 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 ri lL and TSS <30 mg/L
CST Name (Please Print) /^tune: 7 CST Number
David J. Steel �� `� 248956
Address Steel's Soil Service Date Evaluation Conducted Telephone Number
994 200th St Baldwin, WI 54002 6/12/2006 715-760-0347
S#D4330(R.07/00)
Property owner Rolling Hills Of Hammond LLC. Parcel ID # Pending
Page 2 of 3
❑ Boring # Boring
o
PitBGround surface elev. 98.90 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon
Depth Dominant Color
in. Munsell
Redox Description
Qu. Sz. Cont. Color
Texture I
Structure Consistence Boundary
Gr. Sz. Sh.
Roots
GPD/ft'
'E4«1
'Elf#2
1
0-16 10yr3/2 none
sil 2msbk mfr Cs
lvf
6
B
2
16-26
10yr4/4
none
sid 2msbk
mfr
Cs
1vf
.4
.6
3
26-60
7.5yr4/4
none
sl
2msbk
mfr
Cs
na
.6
1.0
4
60-96
10yr618
none
grcos
osg
mi
Cs
na
.7
1.6
5 96
10yr5/4
c2d 7.5yr5/6
A
om
na
na
na
.0
•2
❑ Boring # Boring
Pit Ground surface elev. ff. Depth to limiting factor in. oil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture Structure Consistence
Gr. Sz. Sh.
Boundary
Roots
GPDAP
•EfM1
'0111112
❑ Boring # Boring f
Pit Ground surface elev. _ ft. Depth to limiting actor in. Soil Application Rate
Horizon Depth Dominant Color
in Munsell
Redox Description
Ou. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence Boundary
Roots
GPD/ft'
*01101
'Elt#2
Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BODs -S 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
saw370 (R 07/00) Sted's Sol Servlae
STEEL'S SOIL SERVICE
David J. Steel Rolling Hills Of Hammond LLC 994 200'h St.
CST-POWTSM SEl/4,SWl/4,S29,T28N,R17W
Baldwin, W154002
Lic. #248956 Town of Hammond, St Croix Co.
Direct 715-760-0347
Rolling Hills Farm Lot 4
Fax 715-684-3449
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
The location of this test may or may not be as shown, as permanent lot lines were not established at the
time the soil test was conducted.
Legend
1" = 40'
♦ = Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 99.95 ft
❑ Top of 3/4" pvc pipe
= Borings
s�
Boring Elevations
CCtt U`
B 1 = 99.10 ft
B2 = 99.70 R
3of3
� Cornol-
n r
N S �' #1933 Wiscons n SOIL EVALUATION REPORT page 3 of 3
Department of Commerce in accordance with Comm 85, Wis. Adm, Code
Division of Safety and Buildin9 s Steers Soil Service
Attach complete site plan on paper not less than 8%: County x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Paroel I.D.
Please priqLAH intonnation,
ate
Personal information you provide may be for ikE�H�iR3i�vaury , s 15.0411) (m)}. Re %� D�/ -?/h/
Rolling Hills Of Hammond LLC. JUL 19 2006 Govt. Lot na SE1/4, SW1/4, S29, T29N, R17W
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
400 2nd st ST. CR_OIX COUNTY 11 na Rolling Hills Farm ll—)2--13
City State jZip Code Phone Number City Village , Town Nearest Road
Hudson WI 1 54016 715-386-0230 Hammond I 160Th St
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe: na
Parent material Silty_sediment and underlying reddish sandy loam till Flood plain elevation, if applicable na ft.
General comments At Grade or Mound Design. System Elevation for At Grade 100.45ft for Mound 100.45ft based on contour
and recommendations: line elevation 99.95ft. Minimuum 6 inches ASTM C-33 mound sand.
Boring # Boring
_ ' pd Ground surface elev. 100.15 ft. Depth to limiting factor 50 in. Soil AWfication Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consisten
Boundary
Roots
GPD/R'
•E}Kt
•E11#2
1
0-18
10yr3/1
none
sil
2msbk
mfr
Cs
if
.6
.8
2
18-30
10yr4/4
none
sid
2msbk
mfr
cs
ivf
.4
.6
3
30-50
10yr4/4
none
sl
om
na
CS
na
.2
•6
4
50-60
10yr6/8
cid 7.5yr5/6
IS/Sil
om
na
CS
na
.0 .2
5 60-72
10yr5/4
c2d 7.5yr5/6
Sil
om
na
na
na
.0
2
ITI Boring # Boring
PitGround surface elev. 100.15 ft. Depth to limiting factor 45 in. Soil Application Rate
Horizon Depth
in
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consisten
Boundary
Roots
GPD/ft'
•Elm
'EM2
1 0-13
10yr3/1
none
Sil
2msbk
mfr
a
if
.6
.8
2
13-24
10yr4/4
none
Sid
2msbk
mfr
CS
ivf
.4
.6
3
24-45
7.5yr4/4
none
sl
om
na
gw
na
2
6
4
45-60
10yr6/8
c2d 7.5yr5/6
IS/Sil
om
na
na
na
0
2
tftluent 01 = 9rJU > 3U < ZZU mg/L and! 1 bb >3U < IOU mg/L Emuenc xc = DVUS
CST Name (Please Print) Sign CST Number
David J. Steel _ 248956
Address Steel's Soil Service Date Evaluation Conducted Telephone Number
994 2001h St. Baldwin, WI 54002 6/12/2006 715-760-0347
Property Owner Rolling Hills Of Hammond LLC. _ Parcel ID # Pending Page 2 ,of 3
]Boring # Boring
Pit Ground surface elev. 99.85 ft. Depth to limiting factor 62 in, Soil Application Rate
Horizon Depth Dominant Color
in Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence Boundary Roots
GPD/fl'
*01111
-Ef►#2
1
0-10 10yr3/1
none
Sil
2msbk
mfr Cs 1Vf
.6
.8
2
10-24
10yr4/4
none
Sid
2msbk
mfr
gw lvf
.4
,6
3
24-62
7.5yr4/4
none
sl
om
na
is
na
2
.6
4
62-70
10yr5/4
C2d 7.5yr5/6
SO
om
na
na
na
.0
.2
❑ Boring # Boring
pn Ground surface elev. _ fl. Depth to limiting factor in. cation Rate
Horizon
Depth
in.
Dominant Color Redox Description
Munsell Qu. Sz. Cant. Color
Texture
Structure Consistence
Gr. Sz. Sh.
Boundary
RootsPD/ft'
"'E"
" TIM'
Boring # Boring —
Pit Ground surface elev_ ft. Depth to limiting factor in. Soil Application Rate
Horizon
Depth Dominant Color Redox Description Texture Structure Consistence Boundary
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
Roots
GPD/ft'
'E11#1
'Efts2
Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <-150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
sawa�o MOWN need sa suvtoe
r
STEEL'S SOIL SERVICE
David J. Steel Rolling Hills Of Hammond LLC 994 200'h St.
CST-POWTSM SE 1/4,SW 1/4,S29,T28N,R I 7W Baldwin, WI54002
Lic. #248956 Town of Hammond, St Croix Co. Direct 715-760-0347
Rolling Hills Farm Lot 11 Fax 715-684-3449
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
The location of this test may or may not be as shown, as permanent lot lines were not established at the
time the soil test was conducted.
�O
a`
0 1
5�
j
Legend
1" = 40'
♦ = Benchmark Ele. 100.00 ft
Top of 3/4"
pvc pipe
• = Alt Benchmark Ele. 100.25 ft
❑ Top of 3/4"
pvc pipe
= Borings
Boring Elevations
B1 =
100.15 ft
B2 =
100.15 ft
B3 =
99.85 it
B4 =
0.00 ft
loo.6,F`
3 of 3
Wrscbmn De~ of Safety and PraessionA Ser"m
Dnhsan of lydustry, SWvloes SOIL EVALUATION REPORT
in accordance with SPS 385. Wis. Adm. Code
#1376
Page 1 of 2
Keith E. Stoner
Ads& complete sits plan on paper not leas than 8% x t t inches in sae. Plan must
include, but not limited to vertical and horizontal reference point (BM). dkection and
county St. Crobc
—
Parcel I.D.
perosnt slope, scab or dimensions, north arrow. and location and distance to nearest road.
018 201&78 000
Please Print am wort�laf7fan.
Reviewed ley Date
Personal uiomhasan ym prowle may be used to asoondry purposes (PrrmW Law. a. 15.04 (1) (m))
Property Owner
Rolling Hills Farm Property Owrws Ass.
property Location
Gout. Lot Ern 1/4, SW1/4, S29, T28N, R17W _
J
Propety Owre�s Maiip Acid
Lots �Olodc s { Subd. NMne or CSM/
C/O Tytrre Properties 335 Labore Rd. STE. 150 _
Outbt 1
City Stab Zp Code Phone Number
City ❑ Vi" ® Town Nearest Roth
Vadnais Heights ION i 55110
Hammond 1 72 Nd Ave.
R New Construction Use: ® Residential / Number of bedrooms _ 16 Code derived design flow rate _ 2400 _GPD
n Repiawnew ❑ pubic or commertxal - Descnbe._
Parent material §!! rLSEdment !A Sa !4 L08L08m THI i_ Flood plain elevation. N applicable _Na _ n
General commanb Soil Verification Bortngs for the construction of a 6 x 200 it. Mound Dspersa( CO.
and recommendations
go" a ❑ ��
® Pd Growl surface Ow 1070.0 fL Depth to limrtwhg factor >40 in. SolRslb
tloifaop
Color
Fardotr
Twi:
8hlrhMe �ItlriitAlp
tq..
qu, ii? Gdfor
&, Dtr.
1 0-10 10YR2/2 �{ so
2 10YR4/3� I sit
2msbk IL�mvtr
2msbk �nr# r
a 3f-m 0.6 0.8
4S 3fin 0.6 0.8
3+16-T26iQYR4J4 Slt
46-40 10YR4/4 sl�
2rr�k�0.6
lfabk mil
0.8
— 2f 0.4 l 0.7
the boring location
See Sertifety Site Pbnfw
Borifv
Ground surface elev- 1069.0 R. Depth to limrting hoot >43 b. gotl Appigtlort RsOe
"own
090y
K
rP]R��
y+am�.' :..1._
VY%
1
0-10 1mrR2/2 so zmsbk fin* CS 3f-m 0.6_0.8
2
3
10-19 10YR4J3 sit nwfr gs 3f-m 0.6 0.8
t:2msbk
19-31 19MV _. 2 ---� }—gs 0.8
h�—
4
31.4.3 10YR414 I A lfablr fnfi 2f 0.4 0.7
I
See Sanitary Site trlardor the baring location
- Efnuent e1 c BODE 30 < 220 nhglL and TSS >30 < 150 mgul #2 - Boos 190 mgrL are Tub <_au mgrL
CST Name (Plena Print) Signature CST Number
Keith E. Stouter �y} �— 224059 _
Address Kalb E_ Stoner ^— Da EN vmk**n Concluded Telephone Number
23220 Wood Creak rd. Siren, Wl 1 72 11/5/2021 715-653-2324
SeD-Wa tit" ll
Pmp"OwnW F2! tg_Hi1s Farm Parcel ID N 018-2019-78-000 _ Pape 2_of 2 _
3
❑ 8«mD
Bori s opt Ground surface elev. 1069.7 ft.
Depth to 6nbV fkW �>48 in. i nppMcation Rate
M.
OU, end dlebZ'.i9oidh
;, f . X
1 0-9 10YR2/2
2 9-16 10YR4/3
so
01
2mSbk mvfr cs 3f-M 0.6 0.8
2msbk rrrvfr gs 3f-m 0.6 0.8
3 16-23 10YR4/4
I
si
2msbk mfr gs 2f 0.6 0.8
4 23-35 10YR4/4
5 3520YR4/6
si
1s
lfabk rtfi gs if 0.4 0.7
099 rrfl — 0.7 1.6
See S"arf Sroe P wft
ttte bor" IO MM
❑ Bo"
m PN Ground suf m else. __ A_
Depth to I nuft factor _ m. 1 Appticabon Rate
t#,Ofkm �:
. ..- Cf
�I
�'` n Ground surface efay. R. Depsoft th w — m• App�41i0rt
iM;bIl10R #lawtlrrwari7or wdaR 1�.atY►rdrfl a
Effluent •1 = BOO, > 30 < 220 mgA and TSS >30 < 150 mglL
ffluent O2 = SM,, - 30 mplL and TSS <30 mpR
Sil"I rea (R 07l13) VAWh E. Sbs
SUcro; couNn
I 1P &d r--60 VW
(0mokcW movvxj
NO, 641934
STATE SANITARY PERMIT
No Address
DJW6�� L PkVJ0b5Nw00'-
OWNER
Igo 1114443�ft
OW 04
PLUMBER
TOWN OF
SEC 2 I ,
/OR LOT
941 Is r=ACVL'P% I
THIS PERMIT EXPIRES
POS
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.
(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: 1971 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 1 aZZ
vLESS RENEWED BE O THAT DATE
AIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (RI 1/20)