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018-2019-79-000 (12)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT l UIIly. St. Croix Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 641935 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. 032200443-C Permit Holders Name: Rolling Hills Residential Owner Associa city Village Township I TOWN OF HAMMOND 1 Parcel Tax No: 018-2019-79-000 CST BM Elev: [Insp. BM Elev: IBM Description TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Model Numbe Ft I Forcemain SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SI/Ht Outlet DtInlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDrrRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Da. Liquid Depth SETBACK INFORMATION SYSTEM TO I P/L BLDG WELL LAKEISTREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: Model Number: UIJ 1 Klt%U I IUN A-TS I EM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil O Yes D No Q Yes Q No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection 42: Location: No Address Available 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑Yes ] No � - Use other side for additional information. I— _ SBD-6710 (R.3/97) Date Insepctors Signature Cart. No. 41AlN -,-)a tea. 10 !' Industry Services Division County - pp t+ 4822 Madison Yards Way Madison. WI 53705 St. Croix Sanitary/ Number (to be filled in by Co.) (: ' j,} U P.O. _Permit Madi WI 53707-7 jot62VV San,+ qyt A pllca+1()n 'Y'e lto State Transaction Number In accordance with SPS 38 211�b, , u mission of thils form the approprla mental unit 032200443-C is required prior to obtainin dry permit. Note: Application forms for staleo=ZeS are submitted to Projml Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary Mound-9 purposes to accordance with the Privacy taw, s. 15.04(l)(m), Stats. NA L Application Information - Please Print All Information Property Owner's Name Parcel # Rolling Hills Residentail Owner Assc. LLC 018-2019-79-000 Property Owner's Mailing Address PrZop�rty ' Location �� q 3435 Labore Rd. Ste 150 Gnat. Lot City, State Zip Code Phone Number Vadnais Heights AA 55110 N v.,SW ,a, motion 29 T 29 N R 17 E or W 11. Type of Building (check all that apply) Lot # V } a al or2 Family Dwelling- Numberof Bedrooms 16 29-32 Z Subdivision Name Block# Rolling Hills Farm ablic/Commercial - Describe Use ❑City of fate Owned -Describe Use illage of -- CSM Number FIZITO..f Hammond 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i applicable.) A. ❑New System y p y �e lacement System ❑Other Modification to Existing System (explain) g y ( p -) RAdditional Pretreatment Unit (explain) Hoot 600 B' []HoldingTank ❑In -Ground LF't-Grade OMound Individual Site Design Other Type (explain) (conventional) C. Renewal Before Revision barge of Plumber ofransfer to New Owner List Previous Permit Number Date Issued is �' Expiration • XZGt�' ou � I IV. DispersaltTreatment Area and Tank Information: Design Flow (gpd) Design Soil Apphcatio te(gpd/s0 Dispersal Area Required sf) Dispersal Area Pro (s f) System Elevation 2400 1.0 / 1.5 X15 1600/4878 �$oe 1600/4878 1097.00 Tank Information Capacity in Gallons Total Gallons # of Units Man urer c, i5 0,9 Y l Flut� o y y h v V a New Tanks Existing Tanks 2 fS au Septic or Holding Tank 2 sim tec sf100 fitters DosingClumbcr 1250 1250 1 Wieser 17 Q V. Responsibility Statement- 1, the undersigned, assume respopoilft foginstallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum r' Sign a MPlMPRS Number Business Phone Number Keith Knudtson 648443 651-470-1738 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts Wi. 54023 VI. County/Department Use Only Approved ❑ Disapproved Permit Fee S Date ss yrZZ Issuing Agent S ❑ Owner Given for G t9 t7 Reason Denial , —zz2tzL� Conditions of Approea /Reasons for Di ov I( Co ttid I 0A , %jq - S Q rovedpt t'- q - ..., 1 t'K 1 1 11r . LL! SYSTEPA OWNER: )� i ✓l /� /' _ / I -r'-h 'T'N tS �[�' N.rT . 1. Septic tank, effluent filter and dispersal cell must►1);}arvired/mairdained r:t� by plumbs[ L01t�µ�yr. ✓ `d V L 0 as per management plan provided 2. All setback regOirement► mull be 11141ydalined J r r,j It per nop kale coda/ordinances. 4. Attach to complete plad{for the system and so it to the County only on paper not less than 8 1/2s I I inches in size SBD-6398 (R. 03/21) ! \ „1 _ L/ Ao ",0 March 17, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-3-17 Plan Review: PWTS- 032200443-C Keith Stoner 23220 Woodcreek Rd Siren, WI SITE: Rolling Hills Farms Mound #9 723 163`11 St lots 29-32 Hammond Township St Croix County N Y SW Y. S29 T29N R17W FOR: Description: 16 bedroom-2400 GPD — 22" to limiting factor- Effluent Filter - Maintenance required. Pretreatment- Hoot DIVISION OF INDUSTRY SERVICES 10511 N RANCH RD HAYWARD WI 5454341462 Contact Through Relay h11p:/AftM.vn goWprop,~ndu.uy-wvm. www.wbeonanpov Tony Ewxa - Governor Dawn Crlm - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Mound Component Manual — Ver. 2.0, SBD- 10691-P (N.01/01, R 10/12) 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 POWTS 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 POWTS. 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. Sincerely, Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)813-9111 Joshua.rowlev@wisconsin.gov Index and Title Sheet Project Name: Rolling Hills Farm Mound #9 for Lots 29-32 Property Owner: Rolling Hills Farm Residential Property Owners Association LLC. Address: C/O of Tyme Properties Conditionally 3435 Lahore Rd. STE.150 APPROVED Vadnais Heights MN 55110 DEPT. OF SAFETY AND PROFESSIONAL Legal Description: Part of the N 1/2 of the SW '/. SERVICES Section 29T29N-R17W DIVISION OF INDUSTRY SERVICES Township: Hammond County: St. Croix Subdivision Name: Rolling Hills Farm Outlot 2 Comp. #/Parcel 1D: 018-2019-79-000 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 i Lots: Sanitary System Serving Lots 29-32 SEE CORRESPONDENCE 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 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.0001 R. 10/12) Pressure Distribution Component Manual Version 2.0 SBD-10706-P (N 01/01R. 10/12) Designer: 1 Signature: License # Designer 157-007 3-1 1-22 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 29 thru 32 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 31, 32 and 33 with a verification boring completed. The sanitary system for Lots 29-32 is located within the common area known as Outlot 2. 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 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 east end of Lot 32 in Outlot 2, 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 31 equals 100.00' or—1094.50' the BM for Lot 32 equals 100.00' or approximately 1098.10' and the BM for Lot 33 equals 100.00' or 1094.00' using NAVD 88 Datum. A surveyor was hired to locate the existing irons and staked the septic easement areas 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. For this mound dispersal system we relocated the mound dispersal cell from the original designated easement area to and area upslope of the lots to be served so we would not have to go under 163rd St. We used Control PT.#4020 the Top of a #6 Rebar with an elevation of 1093.92' 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 pit labeled KS#1 was dug to verify the soil conditions and tied into the benchmark along with contours within the proposed system area. OUTLOT 2 Page 2 of 9 s T. LOT SS 21,M SQ FF. z MATED TO M PUBUC )T 3 781 FT. 42-71 ACRES 1 r9B0 = 80. FT. New Mooed9 tarlata 29-32 Flopmed V x 2W Moond D gmnnl Can btaWd tdcog tie 1096.00' ccotcar a/a ft m E m. of 1097.001 U LOT 84 q odn KB m m laic. 'i 0.8fadHLt.ct 33 15 M.-10W.00 ITx Prupaea Wiese Cleow 47IP1230.4R DsT=kW!3W9lei81P-I008M0WPl 5M7L D.tYail K,032 LOT 33 PL 0 AM Toplms� 10w. -lOM.70 Imm sa FT. litw.-1019.S1 k/1 LZ@ 7� pi PL#4037Tepbm q _ ��� m ti Bad100n1 Hm aw. -1opm ®sa. TypkW0 H4M A tortAS PmpS& 40d Two 2" Sah40PVCFNr BbBrpkeTart P1.#4mTap31.1 of L low. -1002AW 4 SR ' 0 4'BrdO. ■ B/QL70 0 ■ !r1 L>11 2 12 <� LOT 31 i� ■ML31 VIM sa Fr. 4' rm `BMa 727 4BR Pipe Pc#4=Tapb>e FbatF4000A IN oft L21 9>Q* eto-b.a0oT.1k �+ PL#4019Teprem LOT 30 m M tta FL Hlw.-Ierca 4 8R 4 9dp 8~ »7u Ar FtootFt-8tpA �tlla tbppa TW* LOT 2B PNN723 48R zl.M T-T. PL#4mTopba 2g ZS HIM.-ImAr M � All P9mkdacook=wIRS I*b394343 and SPS TAb 3d430-S AL ma - Top et tot iron rw 40zu TOPIM ASSUNM ZLZV.- 1M92" CCINN BM--10Rtr N 128.19' TO THE PUBLIC a — � s�r_PURPoses — 40 so - so ft Lu 0 Q 0 I SOUTH UNE t Mound Plan View L Mound component Dimensions A 8.0E 24.4 B 200. F D G 6n 1600 tft. sq.) Ihspersat Cell Area 12.00 QpcYft) LinearLoading Rafe Page 3 of 9 H 12" K L 1242UNI-8- W 4878.0 (tt•) Basal Area AvaiWc (ft) 1/10 B Obs. PipePiacement Mound Cross Section View Aggregate Dispersal Area Finished Grade 1098.90' _ C. Fl 77ro t DispersalCell .� Elevation 0i44 WA Xf tl Shading Key ® Topsoil Cap ® Subsoil Cap l ASTM C33 Sand ® Tilled Layer ® Aggregate 6 % Site Slope Observation Pipe to be constructed of 4" diam. pipe w/ water tight cap, a minimum 6" slot anchored with 3/8" rebar or a water closet collar. Detail of Typical Dispersal Cell o- A G1 114 tmff-097.5(R) Lateral Contour Elevation wile Fabric Cover .08 ft.,, Duplex Forcemains to the Center of the Dispersal Area w/ End Manifolds Lateral Layout Diagram P Note: F.M. attached to S center of the manifold. Turn -up w/ball valve or dean out ping 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 KI Duplex Force Main I2 per F.M. 2 98.75 4.00 21.60 43.20 86.40 21.00 Lateral Turn -up Detail Finished Grade 6" to 8" diameter Lawn Sprinkler Sox .25 ft. in- ft. ft. SPm gpm gpm ft. Page 4 of 9 P - 31. Laterals and force Main of PVC Sch. 40 per SPS Table 394.30-5 6% r X Holes equally spaced on bottom of lateral Note: Forcemains coming into the center of the dispersal area, 1st 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 Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Diameter and Length 5/32 or 0.156 in. ft. 2.50 40 10.00 ft'/ orif 4.00 ft. 2.00 in. 2"/ 60' per F.M. Threaded Ceeanout Plug or Ball Valve f Note: Lateral ends at last orifice where variable length to cleanout begins. Long Sweep 90 or Two 45° Bends Same Diameter as Lateral Lateral Page 5 of 9 Duplex Pump DoseTank Component Cross Section Approved Manhole Covers With Warning Labels and Locking Device / 4" Min. Above Final Grade \ Weather Proof Junction Box Electric per NEC 300 &SPS 4" Sch. 40 Vent 316.012 WAC > or = to 12" Above Final Grade n y Note: SJE Rhombus Type 122 Duplex (Demand Dose) Top of inlet = Appmx.11086.85' Note: Pump switch and alarm to be I A wired to separate circuits. WLP1250-MR I C Tank Mfr. Wiesert Concrete — Alternate Outlet Location W/Approved 4" Sleeve Force Main Diam. = 2" " .Weep Hole or Anti Siphon Device Duplex Force Mains Pump Off Elev. 1084,02' Duplex Pumps D �1083,35' Dose Tank Elev. Vertical Difference Between Pump Off and Distribution Pipe = 13.49' Per 112 Minimum Required Supply Pressure ...................................... = 4.55 of cell 60' FT. of Force Main x .57 Friction Factor/ I OOFT.... _ _2.47' per dose Note: Maximum dose per Pressure Loss Through Filter .................... _ .50' F.M. assumed to be F.M. or 1 /2 cell equals 240 gals. Total Dynamic Head .................... = 21.00' near equal in length. Min. dose per cell = 160.96 gals. Number of Doses ...= 6.02 Per Day Volume of Backflow ............................ Total Dose Volume .............................. Gal. Per Day/ #of Doses - 199.08Gal. (Duplex ........................................ = 9.78 Gal. PumpsAltemating .........I............................. — 208.86Gal. between cell halves) Pump Tank Capacity 1253.16 Gallons Dimensions Inches Gallons Pump Tank Volune 34;81 GaUnch A 20 696.20 B 2 69.62 Pump Mfr. Goulds C 6 208.86 Pump Model WE-05H D 8 278.48 Minimum Discharge Rate = 43.20 GPM per pump Alarm Mfr. S.J.E. Rhombus Alarm Model Tank Alert 1 Total= 36 1253.16 Bed Tank per SPS. 383.45(5) kt4 Anchor Tank ar► neeelleary, to negate buoyant forces per SPS 383.43(8xg). Wastewater METERS FEET 40 130 120 35 110 30 100 t 90 u=1 25 80 u 1 20 70 G60 15 50 40 10 30 5 20 10 0 0 Page 6a of 9 . ml� MENEM MEE goal mmimb".. -No 1s_ON --mmou won_ 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM I 1 I I 1___.. L .. -1— 1 1 1 1 1 1 1 1 0 5 10 15 20 25 30 35 m3/hr CAPACITY COMPONENTS "m I•e. DesalPtlon 1 Impellw 7 Casmy 3 Mechanical Seal 4 Motor Shah 5 Motor 6 Ball Bearings 7 Power Cable a Cas,ng O-Hrng 7 5 I 1 2 !mp' I 6 4 3 PA(a Wastewater Page 6 of 9 PERFORMANCE RATINGS .gall ms ri,.e1 Ordor No. WE-03L WE-03M WE-0514 WE•07H WE-70H WE -ISM WE05HH WEISHH WE-20H HP / ? A I 1i i 'i 2 RPM 1750 '75C 3500 3500 3500 3500 3500 3500 3500 5 86 - - - - - - - - 10 70 63 78 94 58 95 - 15 52 52 70 90 103 128 53 93 138 20 , 27 35 10 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 S7 82 103 35 8o 126 40 - - - 45 74 95 30 77 121 45 - 35 64 86 25 14 116 = 50 25 53 71 - 70 110 r 55 - 40 67 66 103 60 - 30 56 63 96 61 - - - 20 45 - 58 89 70 _ - 35 55 81 IS - - - - - 25 - 51 74 AO - _ _ - - _ 47 66 90 37 49 100 28 30 DIMENSIONS (AII -j.mcvsvons are in mches Do no-, use for constvcnon purposes �— 11Y4"— ROTATION I� 5�. 8'f," 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 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 altemating pump control, this system provides override control should either pump fail. If an alarm condition occurs, an alarm switch activates the audiotvisual alarm system. Common applications include pump chambers, sump pump basins, imgabon systems and lift stations. 1. Enclosure measures 10 X 10 X 6 inches (25.4 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 Circult Board provides pump control and aftemation. 5. Green pump Run Indicator Lights (mounted on circuit board). 6- Circuit Breakers (optional) provide pump disconnect and branch circuit protection. 7. Ground Lugs S. 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 Hom provides audio warning of alarm condition (83 to 85 decibel rating). Note: NEMA 1 style utilizes an internally mounted buzzer in lieu of hom. 13. Exterior Alarm TestlNormal(Sitence Switch allows hom and light to be tested and hom to be silenced in an alarm condition. Alarm automatically resets once alarm condition is cleared. 14. Hom Silence Relay (mounted on circuit board). NOTE: other options available. Entire control system (panel and switches) is UL Listed to meet and/or exceed industry safety standards jff Dual safety certification for the United States and Canada AV Standard package includes three 20r SJE SignalMaster® control switches Ar Complete with step-by-step installation instructions Ar Five-year limited warranty SEE BACKSIDE FOR COMPLETE LISTING OF AVAILABLE OPTIONS. SEE PRICE BOOK FOR LIST PRICE. Model Shown 1221W114X6A ReAuse PO Box 1708. Detroit lakes, MN 56502 1-888-DIAL-SJE • 1-218-847-1317 1-218-847-4617 Fax email: customer.servioe@sjerhombus.com WWW.SlerhombUS-Corn 122 C MODEL 122 ALARM PACKAGE Eal= select options or no alarm package T T 1 alarm package (ilcltrdes test/normaNsilence switch, fuse, red light, & horn) pENCLOSURE RATING J = Indoor, NEMA 1 (metal) W = Weatherproof, NEMA 4X (engineered thermoplastic) ARTING DEVICE I EM1 =magnetic motor contactor 120/206/240V 9 = magnetic motor contactor 120V only 'PUMP FULL LOAD AMPS = 0-7 FLA ff 1 = 7-15 FLA 2 = 15-20 FLA 3 = 20-30 FLA PllMP DISCONNECTS 0 = no pump disconnect 4 = circuit breaker 12CV (select STARTING DEVICE option 9 above) 12012081240V (select STARTING DEVICE option 1 __�LOAT SYNTCH APPLICATION H or L =pump down or pump up (select 17 option) X = no floats OPTIONS LlstedbNow above) ENCLOSURE UPS17E - If you selected one or more of the * options, or two ** options, a one -lime enclosure upsize fee would apply. 00DE otscarrraN 1A Red beacon only I no audio �7 (must select V' for alarm package) < Q 1C Hom only I no visual r (must sated -0-for alarm package) Q ** 3A Alarm flasher * 3B Manual alarm reset *4A Redundant off Q (select Option 4D if floats included) 4B Red redundant off indicator is alarm (must sale& Option 4A also) 0 40 Redundant o8 float (must Select 4A option) (select 17 option) Q * SA Thermal autoultheat sensor auto reset (for pumps wlthennal switch Zeds) * 5E Seat failure circuit & rod indicator (2 wire) 6A Auxiliary alarm contact, form C �,.,/ (rrckrded as standard) cz * 8A Elapsed titre meter 6C Event (cycle) counter # 9_A Pump overload specify amperage after number 9 followed by letter "A.. Example: 912A= 12 amp pump. * 0-25 FLA # 25-30 FLA 10E Lockable latch - NEMA 4X 10E Lockable latch - NEMA f cdoE DEscwvnoN ** 1OK Anti -condensation heater 11C NEMA 1 alarm panel 11D NEMA JIX alarm panel Q* 148 Main disconne-ct (rotary style, mounted through door, non4useM (must select arcn/t breaker) * 0-20 FLA (total of froth pumps) * R 20-60 FLA (total of both pumps) 116A 1D' cord in lieu of 20' (per fbet) 16B 15' card in lieu of 26' (pertloat) 16C 30' cord in lieu of 20' (per float) 0 6D 40' cord in lieu of 20' (per float) [17A WE SignalMester• 1 pipe damp 0 (per float) Q 179 SIE SignalMaster' I externally weighted 0 (perfloat) [� 17C Sensor Floet° I internally weighted • (per float) Q 17D Sensor Float° I externally weighted ♦ (per Reap [] 17E Sensor Float' Mini I pipe damp A (perfloat) Q 17F Sensor Float° Mint 1 externally weighted ♦ (per float) Q 17J Sensor Floe? I pipe damp A (per Root) 0 19B Lead leg selector witch Q 19F Fourth float to separate alarm function from lag Q 19T TOA (Test101flAutomstic) switches and pump run lights through door mounted Q 19U HOA (HandfOff/Automatic) switches and pump run lights through door mounted Q 19X Door mounted pump run Indicator - 4 r r� e6- n -+'Y .. E'7a# _:5`r_ix.......'4 w'fi' au . r,M,4A ;�OHmrLc MODEL 122� W T T T Alarm Package Enclosure Rating starting Device Pump Full Load Amps Pump Disconnect Float SwNch Appihcatlon Options: Auxiliary alarm contact, form C, Elapsed time meter, even: (cycle) counter, WE SignetMaster' f pipe clamp 6A BAC 17A Page 8 of 9 106' 31}' 74}" -ram 7 r 4' CAS ai IHI a Q �II Itll l rJ1L I 41' _ 7 a. 40' 4' CAS �I POLYLOK 12" ACCESS LID (TYP) r1 SET RISER (TYP) TAWS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 6W GPD GRAVITY SYSTEM �SCCHARGE 0 H-600 A TANK SPECIFICATIONS DIMENSIONS: <> Ellc WALL: 3' WALL- BOTTOM: 3' COVER: 4' $ MANHOLE If B 24' I.D. PLASTIC RISER HEIGHT: 70" O.D. r $ LENGTH 106' O.D. g WIDTH:74 1/2' O.D. � BELOW INLET: 57' O.D.o o LIQUID LEVEL: 51' WW WEIGHT: 11.135 LBS. r N W INLET AND OUTLET: 4' CAST -A -SEAL (CAS) BOOT OR EQUAL COVER: MIX DESIGN j8 (NO FIBER) C e V 00 TANK MIX DESIGN /9 (SMALL FIBER) CRUST OR ED TANKS:'CUSTOM i cj � TAWS CONTACT WIESER CONCRETE M W� W OD m 3 0 m U DRAWINGS SUBMITTED F $ N FOR APPROVAL = APPROVED By' SHEET NO. APPROVAL DATE: PRODUCTS NEEDED BY: 1 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.01101) 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 Sanitary Permit Number Number of Bedrooms 16 Design Flow GPD 2400 Soil Absorption Component Size (sq. ft.) 1600(Pretreated Effluent) Trash Tank Capacity Gal. 400 gal. Pump Chamber Capacity Gal. 1250 gallons Type of Wastewater Pretreated Domestic Pre -Treatment Unit installed per structure HOOT SYSTEMS H-600 A 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 51/8 Inch Maximum BOD 5 (mg/1) NA <_ 30 mg/l Maximum TSS (mg/1) NA <_ 30mg/ 1 Maximum FOG NA NA Table 3: Maintenance Schedule Septic Tank Inspect 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 + 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 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 113 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. Pump 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. Warning: 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-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 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 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 c:omponent'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 freezing. 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. Contingency 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. Bi-annual/ 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 Cotmty Zoning 715 386-4680 Wieser Concrete Products Maiden Rock Wl (800) 336-3416 Septic Pumper Powers Sanitation 715 249-5738 HOOT SYSTEMS LLC I H-600 A 888 8784668 Page 9 of 9 a, b + c AEROBIC TREATMENT UNIT (ATU) SERVICING AGREEMENT This agreement is made pursuant to SPS 383.21(2)(e) (5), Wis. Adm. Code Agreement Date 018-2019-79-000 Property Owner(s) Legal Description of Property (Attach copy of deed if necessary) POW -IS Equipment Description: I Manufacturer Sanitary Wastewater Aerobk I Hoot Systems LLC Treatment Unit I Hoot t"00 A I Recording Area 1 Return To St. Croiu County Community DMIk paratt 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 following: L The owner agrees to conform to all applicable requirements of Ch. SPS.3 83, Wis. Adm. Code relating to aerobic treatment and the maintenance requirements for the proposed POWTS (Private Onsite 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. 3. The owner recognizes that the county department or POWTS Maintainer may make periodic inspections of the components to complete performance monitoring of the unit. S. 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 onsitc wastewater treatment systems certifies that the property is no longer served by the aerobic treatment unit. 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. wfiich will permit the existence of the agreement to be determined by reference to the property where the aerobic treatment unit is installed. IJ Owners) Names(s) (Print) Notarized Owner(s) Signature(s) Subscribed and sworn to before me on this dart: Notary Public (Print) Notary Public (Signature) My commission expires: Drafted By: Keith G J7oner LJIZU +rooa t.reex Ka..3nren, ffr Jung DIVOW bF WDL411V 81 AME-13 P.O. Bft 7= M khrirotinitis5M1-2ese M- came Through Relay mar Seae We4ar Loom GWOO a, t VOWY May 10, 2018 HOOT SYSTEMS, LLC RON SUCHECKI 2886 HWY 14E LAKE:GHARLES LA 708W Re: Description. SEWAGE TREATMENT APPARATUS Manufacturer: HOOT SYSTEMSs LLG Product Name: (trans id,3007-54G)VI-SEIRIES.HOOT Model Numbers}; H-500-A (MAX. ;DWF SW 0PD) Product File No: 20180134 Tile speclticallons andfor plans for this plumbing product have bWT*VW#9d mW determkW to be in =pPOWI ae_ witb:chapters SPS 382 through 384, Wisconsin Adminishokive Ctrtle,, WW'ChVIP tJ 145 and 160, WWOQt*iri Stabilln The Department hereby Issues an approval based on the Wisconsin Statutes and the Vftoonsin ire Code. This approval is valid until the end of May 2023. This approval supersedes the approval issued on March 12, 2013 uraier product fide number 20120398. This approval is contngent upon compliance with the follovaing stipui tn(s): • This tank must be designed to withstand the pressures to which it will be su"oted. The manufacturer must keep at the manufacturing plant set of plans and speafloationsbearing the departments stamp of approval. The plans and spedflcations must be open to Inspection by an awed representative of the department. This product may not receive backvmsh discharge from a water softener, Walter axthww bacW&Mh discharge must be discharged in another method acceptable to chs. SPS 382,and.383 (frarraarly 82 and 83� Wis: A&M. Code. The maximum daily wastewater flow, which may diachargstll#VV hWs ptsoduct to SWIpftin Pwd VVt t this PnNh ct receives wastswrater front diviA t ei it90 produce art effluent ganilWrwltl a maxims m matey ever w values for BOD5 of less of equal �f 3El 60rk„. TSSVf less.#rarrh Or°le"—* 'W and-F.D.G. of peas than 30 nVi-,and fatted oolIform td ie.We" or aWd to Adm Plan rw Aew for the installation of this product rru►st be obtai nsd tiie dapaglfrteritirt 40401d111116 with SPS 30220 (1)of &e Wis. Adm. Cade TW product roust halve ktallad a department -approved e#8um-4t filter capable of dlerlrtt}`pertides 4118 h.ih in we or h1hW. s�ilispa� lra.l6fexl Fnsta��t�lerd"eiddE Hoot 8ysWns LLG May 1.0, 2018 Page 2-of 2 Product File NQ.: 20IM34 Is 1 PRODUCT/ _ H-t'iElO few_ Initial/ Ins Mein 2 ; 00 Ongoing Pumping CY+ale AndtOr Rwowmrft pYlrosler>�fM ,�.., �'�si1YMr,sii f.JOWPOOMMUft Book -Wash Cycle N/A Effluent Performance Levi . NSF-40 Class I BODS Credit For Downsizing DistributioftArm-, YES Fecal Credit For Reduction Of Vertkal S Additional Corturrerns none • These tanks shall be Mad with locking manhole cowers in scoordance with & SPS 384.25 (7)'(hj Wta. Adm. Code. The manhole cover must be secured to the riser using screws which are not standard or Philips head to be considered an effective locking device. • These tanks shall bear warning labels, that are visible after instathOn, #* QWOW rks a: SPS W25 (l). The tank Is not recommended to be installed where saturated sWargeaWNI hlgWOOW4vmWWbW ire indicated between the bottom of the tank and the ground surface. • BEDDING: 3-Inches of compacted bedding shall be provided. The bedding naterial shait bury, OWW loans materiel, or coareer s % diameter in the tersest dknenskm. • BACWILUNG nUWtbe oomp8d $d 8d4"Wh 6+ttervais, 13 }Nkrrx> sJ9M�ilfltitN �[swi s 4 inches In diamderin the largest dknenslan.. The department is in no way endoraft this product tar ehy advar" UO Is riot OdM" blip q*rOW s(hn®tiM-which tndjl result from its use. DNiWw of trirlltrstry Services Bureau of Teohnk* Services (608) 267-1401 Phone (608) 287-4723 Fax glen.schhreterCwi.gov E-mail WNW GPD GRAVITY DISCHMOE SYSTEM I-I,MA '140 2.2W Avg. Length 5AOO' Awo. Wklth CUT Depth Rev. 02 .ow 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 Aerator................................... C 0 Aeration Plumbing ................. C J Air Filter ................................. C 0 0 Effluent Pump (if applicable)....... -i C Chlorinator ............................. ) 0 0 OK System Light .................... fl 0 Alarm ..................................... C! ] 0 D-Box .............................. C C 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: Signature of Inspector: Required Results Test Method C a Installer II or VIIW Lic #. OUTLOT 2 EASEMENT EXHIBIT FOR: TYME PROPERTIES LOT U PROPOSED EASEMENTS LOCATED WITHIN LOTS 29 THROUGH 32 AND LOTS 34 & 35 OF ROLLING HILLS FARM, TOM OF HAMMOND, ST. CROIX COUNTY, TASCONSIN. LOT 60 LOT 61 'o f "�T`•�N7.�..� fN� La1" LOT 36 �S XWTHIM f m FOUND SURVEY MARK KAL IN PAWWW. PROPOSED EAMDIENT OESCRUMION& Proposed Easo marts. No PwS%Awe to to opmew out in otter docurnw,tS located wftil Late 21 w,reu9h 32 ad Lola 34 d 35 or Rumv HMs Farm Town at itarnma,4 St. Duly county. a Womsw arms maw prtkm riy described w Idoew ' Lot 29; Ths oatriy lwntr-Aw (25) Mt of Let 22 of 000i,9 Me farm T~ of Momrnad, WL Craw Crmwty. IltwarPL Let M The .wtorly twenty-M (25) tact of j Lnt 3D of Rclaq Mee Frm. Town of HanGnsnd. SL Crow OrrtA WYawek,. LOT 52 ? ? 84 LOT 63 LOT 64 IfZ -y ►� n 13113 OUTLOT 2 0< LOT 35 r� OOTLOT 2 fwA mar) L,A 31: The northaty tan (10) feet owed Ms eostrty twety-five (25) fan d Ld 31 d Rw►q tl�. farm,, Town of Honw,cnd. SL Crok County, WaaffA L \� S� Lot 32: Ter wutlrrly farm (tO) ten of Lot >Z of among .� MYY fm m of arTaItwlartl, SL Crate County. aYaonGk Let 3e: llw easterly Moon (15) +wet of Lot 34 of RAW Hark Farm, Town of Hrmnr,d, SL 6do Oarnlyt 11111=i,. tat J& TM na11v1y Ages, (13) Yet of Lot 35 of RafM9 HMG Farm, \ _,d 1p Tam of we St. Crek Card), NBCWA-L lr- J. {Y HS BPDONBIVA ` 8 f.�G1�AB� oUT1.OT 1 1 • sett ama' Gsr V /a Votes GOaGON r ewe Al GpOtL pby mrw%w As aAa, )d (Sir _ SOMA" WINWATC L &Mary L Oak Tanww Land Saw^ LLC, a Frafaadw,d Lo-d arwyr to the DYlls eA Dwar% do hreby *W" that p,arayrlt Is a vowed frfi 3W sco~. Foyrt) Ma'ariw of Tp- PnPallw. 1 how aGrwtad ad firearm Ma lamb as shawl an the dwl.d m+ ohltlm Y s tr,w and croft reprwr,tdkn d ttr odd rewy cwwkctw m May 1, 2020. 1 ow" list .1 rsler,cwe a. — w the moramento awe b. Pled w Mew, a, the map ati the eubbe ber,dery lbws are —octly dwlprt� ear d,aarn on the map to then boot of my Iwomr.. earn ow end bol d. 1 owt* "ot 1 haw aar.pBad mn the predderte of Oglr A-E 7 of the dbcaro n A*AnWbaOre Cod- TM Pure— al thb Eoear,Ont E,d,ibR Is to 9rGp)daaay dgkt the Fraposed oowrnents v dlaeWd •s,O (m a Plwiou ly Md Map d Survey) and Is to be wed eo m mdmDlt In my subsequent docusw,LL No manurnrsa wen Not AMAKACI EXHIBIT A Z� e. r,.�.--------- 7WO ME --b SURVEYOR'S N01M __ _ 'i 1, ",mG . or wrMMed No pat of this w vw we stobw7delt is made eomme 0 9 the erddrwar of undrwou d OF amimd aonSUara, m tot er fadNw Nat may nhcl the ws r ,Ynlcp,nar,t of tris property atlw fife, a At Is dwar on t!i mop. Y, praAdl Vft bwday UNwy m aUGNW haw, h made M estG% r d,are 4Mwtm,eafl �HKs r t% Of my ,9 an the Ift whnM pohm nobdtM a Potent awned ~ "m west Is Now on V,w map- Arm r ee r !�i FSm FR(06 11g'J9i'# "a9a n µT1+ January 1, 2022 RE: Service Provider/Installer Certification Wisconsin Hoot Systems Hoot Systems, LLC (Service Provider/Installer) Keith Knudtson 927 150th 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, OAWA Aaron Yonts Regional Manager Hoot Systems, LLC. March 17, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-3-17 Plan Review: PWTS- 032200443-C Keith Stoner 23220 Woodcreek Rd Siren, WI SITE: Rolling Hills Farms Mound #9 723 163` l St lots 29-32 Hammond Township St Croix County N Y2 SW Y, S29 T29N R17W FOR: Description: 16 bedroom-2400 GPD — 22" to limiting factor- Effluent Filter - Maintenance required. Pretreatment- Hoot DIVISION OF INDUSTRY SERVICES 10611 N RANCH RD HAYWARD WI 54613-6462 Collect TWW" Relay Atlp:1ft". vn.poWproprWr&Wuetry-aarvleee www wletonon pov Tony Even - tiovarnor Own Crim - 6eoretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Mee SEE CORRESPONDENCE Mound Component Manual — Ver. 2.0, SBD- 10691-P (N.01/01, R 10/12) 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 POWTS 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 POWTS. 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. Sincerely, Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)813-9111 Joshua.rowlev@wisconsin.eov ST. Cfzo NTY SANITARY SYSTEM File#: tu:;, ,,,,.;f„ office use only OWNERSHIP/ADDRESS FORM aeawzawt 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. OWNERIBUYER INFORMATION Owner/Buyer Rolling Hills Farm owners assoc. Mailing Address 3435 Labore Rd. City/State/Zip Vadnais Heights Mn. 55110 Phone Number (required) 651-248-1664 Email Address (required) 37'A- r9-d'l0 Parcel Identification Number 018-2019-78-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW '/a , NW '/4 , Sec. 29 , T 29 N R 17 W, Town of Hammond Subdivision Plat Rolling Hills Farm Lot # Certified Survey Map # Volume . Page # Warranty Deed # (before 2006)Volume . Page # Number of bedrooms 12 Spec house ■ yes 0 no Lot lines identifiable ■ yes 0 no New Property Address (Staff Initials) OFFICE USE ONLY (Verification of new address required from Community Development Department for new construction.) (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 715-245-4250 Fax cdd@sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwLgov U Visoonsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code #1920 Page 1 of 3 Steel's Soil Service Attach complete site plan on paper not less than 8'/ x 11 inches in size. 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. _3 1,roCZ) Please print all informatic, (� Personal information you provide may be used for �u3ds (Priva Law, S. 15.04 (1) (m)). Revi B Date ' Property Owner Property Location Rolling Hills Of Hammond LLC. okZOp6 Govt. Lot na NE1/4, SW1/4, S29, T29N, R17W Property Owner's Mailing Address ,� ZY of # Block # Subd. Name or CSM# 400 2nd st COON 31 I na Rolling Hills Farm ,21- 3U-3 I-3Z City State Cods(. one Nu City Village � Town Nearest Road Hudson WI 016-386-0230 Hammond 160Th St New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement El Public or commercial - Describe: na Parent material Silty sediment and underlying reddish sandy loam till Flood plain elevation, if applicable na ft. General comments Mound design, system elevation 104.30ft based on contour line elevation 103.70ft. Minimum of 6 inches and recommendations: of ASTM C33 mound sand. Boring # ::1 ring © Ph Ground surface elev. 105.70 ft. Depth to limiting factor 36 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/W 'Etf#1 I 'E1102 1 0-17 10yr3/2 none sit 2msbk mfr gw 1vf .6 .8 2 17-36 10yrr4/4 none Sid 2msbk mfr gw na .4 .6 3 36-50 7.5yr4/4 cld 7.5yr5/6 scl om mfr gw na .0 .0 4 50-65 5yr4/4 c2d 7.5yr5/6 scl om na na na .0 .0 2 ❑ Baring # Boring Ground surface elev. 105.70 ft. Depth to limiting factor 96 in. Soil Pit P 9 Application Rafe Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 'Eff#1 I •Eff#2 1 0-9 10yr3/2 none I 2msbk mfr cs 2f .6 .8 2 9-14 10yrr4/4 none Sid 2msbk mfr cs na .4 .6 3 14-20 5yr4/4 none grsl om na gw na .2 .6 4 20-78 7.5yr4/4 none sl om na cs na .2 .6 5 78-96 10yr6/6 none ms 099 ml na na .7 1.6 ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign reCST 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 5B"JJu txuiniuf Property Owner Rolling Hills Of Hammond LLC. Parcel ID # Pending Page 2 of 3 Boring # Boring PR Ground surface elev. 101.00 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz 'Eff#1 'Eff#2 1 0-12 10yr3/2 none I 2msbk mfr is if .6 .8 2 12-34 10yr4/4 none sicl 2msbk mfr a lvf .4 .6 3 34-74 5yr4/6 none grsd 2msbk mfr gw na .4 .6 4 74-96 5yr4/6 none grsl imsbk mfr na na .4 .7 Boring Boring # Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Texture Qu. Sz. Cont. Color Structure Consistence Gr. Sz. Sh. Boundary Roots GPD/W 'Eif#1 'Eff#2 ❑ Boring # C Boring C pit Ground surface elev. ft, Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Texture Qu. Sz. Cont. Color Structure IConsistence Gr. Sz. Sh. Boundary Roots GPD/ft' 'Eff#1 'Eff#2 ' Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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. SBD-8330 (ROA00) Steel's Soil Service 3of3 STEEL'S SOIL SERVICE David J. Steel Rolling Hills Of Hammond LLC 994 200t' St. CST-POWTSM NEI/4,SW1/4,S29,T28N,R17W Baldwin, W154002 Lic. #248956 Town of Hammond, St Croix Co. Direct 715-760-0347 Rolling Hills Farm Lot 31 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. 99.50 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1 = 105.70 ft B2 = 105.70 ft B3 = 101.00 ft B4 = 0.00 ft � isconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPOR in accordance with Comm 85, Wis. Adm. Code #1921 Page 1 of 3 Steel's Soil Service Attach complete site Ian on paper not less than 8'% x 11 inches in size. Plan must P P P P 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. O/ Please print all informatio Revi Date Personal information you provide may be used fo Qposes nvacy Law, s. 15.04 (1) (m)). Property Owner Rin Property Location Rolling Hills Of Hammond VLC. Govt. Lot na NE1/4, SW1/4, S29, T29N, R17W PropertyOwner's Mailing Addre Lot # Block # Subd. Name or CSM# '�� (f 32 na Rolling Hills Farm a1--60-3L�'Z City St to Zi%s %*O%A City [-]Village - Town Nearest Road Hudson 54016 5-386-0230 Hammond 160Th St New Construction Use: K' Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement FJ Public or commercial - Describe: na Parent material Silty sediment and underlying reddish sandy loam till Flood plain elevation, if applicable na ft. General comments Mound design, system elevation 100.85ft based on contour line elevation 99.70ft. Minimum of 14 inches and recommendations: of ASTM C33 mound sand. Boring # Boring Pi( Ground surface elev. 100.10 ft. Depth to limiting factor 80 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' Etf#1 -Eff#2 1 0-11 10yr3/2 none sit 2msbk mfr cs lvf .6 .8 2 11-32 1Oyr4/4 none sid 2msbk mfr gw if .4 .6 3 32-80 7.5yr4/4 none sl/IS om na gw na .2 .6 4 80-96 7.5yr4/4 c2d 7.5yr5/6 sl om na na na .2 .6 Boring # ] Boring Pit Ground surface elev. 100.10 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon ' Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' 'Efffl 'Eff#2 1 0-9 10yr3/2 none sit 2msbk mfr cs 1vf .6 .8 2 9-17 10yrr4/4 none Sid 2msbk mfr gw na .4 .6 3 17-26 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 26-39 10yr4/4 f2d 7.5yr5/6 scl om na gw na .7 1.6 5 39-68 5yr4/4 c2d 7.5yr5/6 scl om na na na .0 .0 ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 <30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number David I Steel 248956 Address Steel's Soil Service Dale Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 6/12/2006 715-760-0347 SBD-8330 (R.07JOD) Property owner Rolling Hills Of Hammond LLC. Parcel ID # Pending Page 2 of 3 Boring # Boring ® Ph Ground surface elev. 97.20 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft= 'Eff#t 'Eff#2 1 0-10 10yr3/2 none sil 2msbk mfr cs if .6 .8 2 10-22 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 22-31 5yr4/4 cld 7.5yr5/6 sl 2msbk mfr gw na .6 1.0 4 31-55 5yr4/4 c2d 7.5yr5/6 sl om na na na .2 .6 ❑ Boring # E] Boring n pit Ground surface elev. ft. Depth to limiting factor 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/ft2 EtT#1 'Eff#2 i 1-1Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' 'Eff#1 'Eff#2 ' 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. SBD-8330 (R.07/00) Steel's Soil Service STEEL'S SOIL SERVICE 3of3 David J. Steel Rolling Hills Of Hammond LLC 994 200' St. CST-POWTSM NE1/4,SW1/4,S29,T28N,R17W Baldwin, WI 54002 Lic. #248956 Town of Hammond, St Croix Co. Direct 715-760-0347 Rolling Hills Farm Lot 32 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. Top of 3/4" pvc pipe = Alt Benchmark Ele. Top of 3/4" pvc pipe = Borings 100.00 ft 100.05 ft Boring Elevations B1 = 100.10 ft B2 = 100.10 ft B3 = 97.20 ft B4 = 0.00 It �x? ?�a 5k6 4 WisconWh Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code #1922 Page 1 of 3 Steel's Soil Service Attach complete site plan on paper not less than 8'/ x 11 inches in size. 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 locati distance to nearest road. parcel I.D. 33 �� ��Please \nd print all inRevie Date Personal information you provide may be et� purposevacy Law, s. 15.04 (1) (m)). 9 Q Property Owner 6 Property Location Rolling Hills Of Hammond L C. cj Govt. Lot na NE1/4, SWi/4, S29, T29N, R17W Property Owner's Mailing Addres COVN Lot # Block # Subd. Name or CSM# 3 3 400 2nd at 0�7� 33 na Rolling Hills Farm City Stat Zip e P umber City ❑ Village Town Neared Road Hudson WI 5 715-386-0230 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, if applicable na ft. General comments Mound design, system elevation 100.25ft based on contour line elevation 99.65ft. Minimum of 6 inches of and recommendations: ASTM C33 mound sand. Boring # Boring Pit Ground surface elev. 99.65 ft. Depth to limiting factor 71 in. Soil Application Rafe Horizon Depth in. Dominant Color Munsell Redox Description Cu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' •ER#1 •Eff#2 1 0-10 10yr3/2 none sil 2msbk mfr cs Svf .6 .8 2 10-29 10yrr4/4 none sl 2msbk mfr gw if .4 .6 3 29-43 10yr4/4 none sl om mfr gw na .6 1.0 4 43-71 10yr6/6 none Is osg ml cs na .7 1.6 5 71-96 10yr6/6 c2d 7.5yr5/6 Is osg mvfr na na .7 1.6 Fi-IBoring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Texture Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM2 •Eff#1 •Eff#2 1 0-9 10yr3/2 none sil 2msbk mfr cs 1Vf .6 .8 2 9-17 10yr4/4 none scl 2msbk mfr gw ivf .4 .6 3 17-28 10yr4/4 none sl 2msbk mfr gw na .6 1.0 4 28-60 10yr4/4 cld 7.5yr5/6 sl om na gw na .2 .6 5 60-79 10yr6/6 c2d 7.5yr5/6 Is osg mvfr gw na .7 1.6 6 79-86 5yr6/6 c2d 7.5yr5/6 scl om na na na .0 .0 ' Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L ana I SS < Ju mgrL CST Name (Please Print) nature: CST Number David J Steel c 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 6/12/2006 715-760-0347 SBD-8330 at 07M) Property owner Rolling Hills Of Hammond LLC. Parcel ID # Pending Page 2 of 3 Boring # Boring Pit Ground surface elev. 97.05 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth in. Dominant Color Munsel) Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots I GPD/ft' -Eff#1 -EfHt2 1 0-10 10yr3/1 none sil 2msbk mfr cs lvf .6 .8 2 10-22 10yr4/4 none scl 2msbk mfr gw Ivf .4 .6 3 22-32 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 4 32-48 5yr4/4 cld 7.5yr5/6 scl om na a na .0 .0 5 48-84 7.5y4/6 none ms osg ml gw na .7 1.6 6 84-86 5yr4/4 c2d 7.5yr5/6 scl om na na na .0 .0 ❑ Boring # ] Boring Pit Ground surface elev. -ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsel) Redox Description Texture Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/W 'Eff#1 'Eff#2 ❑ Boring# ❑ Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Redox Description Munsell Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' `En#1 •Eff#2 ' 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 M 608-264-8777. SBD-8330 OLOW00) Sted's Soil Service STEEL'S SOIL SERVICE 3of3 David J. Steel Rolling Hills Of Hammond LLC 994 200`h St. CST-POWTSM NEl/4,SW1/4,S29,T28N,R17W Baldwin, WI 54002 Lic. #248956 Town of Hammond, St Croix Co. Direct 715-760-0347 Rolling Hills Farm Lot 33 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. IQ( H 4/J,NWT 02 N K-0 Legend 1"=40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.05 ft Top of 3/4" pvc pipe ❑ = Borings �I Y Boring Elevations B 1 = 99.65 ft B2 = 99.65 ft B3 = 97.05 ft B4= 0.00ft B 1 �z' f" clq'6�rk- o6 4 Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT in accordance with SPS 385, Wis, Adm. Code #1377 Page 1 of I Keith E. Stoner Attach completeCounty site plan on paper not less than 8� x 11 inches in size. Plan must St. Croy include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Percent sbpe, scale or dimensions, north arrow, and location and distance to nearest road. Please print all infomratron. 018-2019-79-WO-Date- Personal information you provide may be used for secondary purposes (Privacy law. S. 15.04 (1) (m))- Reviewed By Property Owner Property Location Rollirtg Hills Farm Property Owners Ass. Govt. Lot N1/2 1/4, SW114, S29, T29N, R17W Lot # Block # j Subd. Name or CSM# Properly Owner's Owner's Madiing Address C/O Tyme Properties 335 Labore Rd. STE. 150 Ourtlot 2 City State Zip Code Phone Number City Village ® Town Nearest Road Vadnais Heights MN 1 55110 • Hammond 163Rd. New Construction Use: Residential / Number of bedrooms 16 Code derived design flow rate 2400 GPO Replacement ❑ Pubic or commercial - Describe: _ Parent material Sitty n sedimetve or sandyloam till _ sedimentaver _ -.-- _. -. _. Flood plain elevation, if applicable nor ft. General comments Verification boring for the proposed mound dispersl area for Lots 2932 Using sal tests for Lots 31-33. and recommendations: # C] Boring Pit Ground 1093.8 ® surface nlev. ft. Depth to limiting factor 28 in. Soil Application Rate kiDALOq - Derstinerll EitltriMMl� �A HIHEdIsi 1 0-7 10YR2/2 SI 2msbk mvfr a 3f-m 0.6 1.0 2 17-11 10YR3/3 sl 2msbk mvfr gs 3f-m 11-22 30YR4/3 sl 2msbk mvfr gs 2f-m 22-28 10YR5/6 sl imsbk mfr gs 2f-m 28-32 10YR4/6 c2d 5YR5/8 Is Dsg col gs IF-m 32-39 10YR5/4 c2d 5YR5/8 Sid 2msbk mfr gs if 0.6 1.0 3 0.6 1.0 4 0.4 0.7 5 0.7 1.6 6 0.4 0.6 See the Sanitary Plot Plan for the txxing location. - Effluent rxt = BM5> 30 c 220 mglL an > < 150 mg/L Effluent #2 = BOD5 30 mgrL and TSS <_30 mg1L CST Name (Please Print) CST Number Keith E. Stoner 224059 Address Keith E Stoner Date Evaluation Conducted Telephone Number 23220 Wood Greyrd. Siren, WI 54872 11/42021 71"53-2324 SB683300 0LI3i (P 8cdrosy. 601AA *WV% AtOWIJ 15t . C COUNTY NO. 641935 STATE SANITARY PERMIT Jo Addmss T S WAL PRAV NO. kolPl/�5 OWNER PLUMBER TOWN OF ov%LIC.# g Wy SEC Z" ' 9T ZA! N9 RaE1) AND/OR LOT ov�l-L4, it BLOCK W0'lo1WFZ4ArZA �. POS 01 SUBDIVISION 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 wW not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER - DATE NLESS RENEWED AIN VIEW ZZ THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1/20)