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Home My WebLink About018-2019-54-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law. s 15 04 t tgml) Permd Hdder's Name City Village Township Jeff Husby CBrJ Builders TOWN OF HAMMOND CST BM Elev linsp BM Elev IBM Description: TANK INFORMATION ELEVATION nATA TUR Holding TANK SETBACK INFORMATION TANK TO PIL WELL BLDG. vent to Au Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Loss JVIL At35UKV I IUN SYSTEM DI Bottom ELEV BEDlTRENCH DIMENSIONS Width Length No Of Trenches PIT DIMENSIONS No Of Pits Inside De Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING UNIT Manufacturer. Type a System. Model Number HeaderWanrfold joistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe( Pipe(51 Length Do Dia Spacing Depth Over Depth Over xx Depth of xx Seeded.'Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil _ Yes No _ _Yes No UUMMtN 1 5: (Include code discrepencies. persons present, etc.) Inspection #1: Location: 1619 75TH AVE 1.) Alt BM Description 21 Bldg sewer length = - amount of cover = Plan revision Required? - Yes No Use other side for additional information. SBD-6710 (R.3197) Date Insepctor's Signature Inspection #2: 1- Cori No. 2. \� 4= `O •,- Industry Services Division 4822 Madison County -- Si.Croix 9�t022 lei, 1\8 SEQ Yards Way Madison, Wjj3705 Sanitary PermiittNuu(mbber(to befillledinbyCo.) GtOtx e°encpMe t P.O.[3o.�j162 Madison• W' 07-11111116AFirp) v gJ'TJ��1 C/ �° ry Permit Application State Transaction Number In accordance with SVS 393.21(2), Wis. Adm. Code, submission of this form to the aprivow g alp unit 072001438-C is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POW'I'S submitted to Pmject Address (if different than ling address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary Purposes in accordance with the Privacy law, s. 15 04(1 x m ), Slats. 1619 75th Ave 1. Application Information — Pease Print All Information Property O%Tw's Name Parcel N Jeff Husby C&J Builders 018-2019-54-000 Property Owner's Mailing Address Property Location 316 Kamloops Place Gov, I,ot fiw svf •Section 7 . City Stale River Falls, Wi. 154022 Zip Code Phone Number 715-222-9731 T 2.1 N R W 11. Type of Building (check all that apply) I.ot M 1 or 2 Family Dwelling - Num fBedrooms ^ z h�-F�yed/ Subdivision Name Rolling OPubite/commercial - Dk. be a (Se... Block Hills Farm �C ity of u illage of Tate (Tweed - Describe Use CSM Number Ofown of Hammond Ill. Type of POV TS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete Bee C A. ✓ cw S stem ' �Ceplacement System Hher Modification to Gxisti System (explain) Pretreatment Unit (explain) ngY ( P ) ( M ) U 00 Dfolding Tank ❑In-('.murd Q4t-Grade rAdditional7,tcD Mound idual xign Other Type (explain) (conventional) > 24 C. ❑ Renewal Before []Revision hange of Plumber -01 Transfer to New (Tuner .ist Previous Permit Number and Date ed ' xPi�'pn 624935 8/19/20 -_ IV. DispersaVrreatment Area and Tank Information: C L A k2.. Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System lilevation Existing Capacity in Total H of Manufacturer Tank Information Gallons Gallons Units G o $ u Nea Iunits fxisims 'fanla S U in m h Seim, ce tlddmg 1.& 4(xl/921 1 wiser/Hoot ✓ Dounit Chamber Q IEJ V. Raponibility statement- 1. the oadersi8aed, auaase respomibdity for'ndanews of tie POWTS sbowa on the atUcbed plans. Plumber's Name (Print) PluK MP/MPRS Number Business Phone Number Keith Knudtson I 43 651-470-1737 Plumber's Address (Street, City, State. Zip Code) 927 150th St. Roberts Wi. 54023 Coanty/Department Ilse Only ...��tV1. p,l Approved ❑ I) Permit Fee Nate Issued Issue AgerLL .Signature Rc for S q l� �� L-ap� en Ik-nial .2� ZZ Conditions f Approv A-�-� STEM O c et+e�uoc �� ^ 9� Z f Zp MIN Septic tank, effluent filter and isper m cell must t serviced / maintained \ � � (a _ _ _ _ t%fs s per management plan provided by plumbet J l^('�`-'°'^'> II setback requirements must be main;aine t ��s� (,, _ 14A, t�7 Cede. s per applicable code/ordinancao. l"`+" ) r o S,,t, \ ' Atbch b comp a plans for the sy4emand submit to the ('ouoa2�ry only, oo paper not tbuo 5 1 a 6 v_ v"D�r_yv._TQ11ry ` .oil)!v__l._I _"!'C-.`.^mot G0p*4 75TH AVENUE 4 PROPOSED 10' DRIVEWAY 1I' I Lp N ILO i O ni GARAGE N 15.5 N SCALE: 1 INCH = 40 FEET 0 40 80 VERTICAL CONTROLD(iT�Ug�I: NAVD1989 G' ,,—J'841 Lde - -q PROPERTY ADDRESS: 1619 75TH AVENUE HAMM , WI S4015 It NORTH --(-/yam®J7P/o/•s� O lL� fr ----- ; 1&0 Ij HOUSE a 1 46.0 �d0 to I co ui N I LOT 54 N ",701 Sa FT. I o I I I 10'I MINIMUM BUILDING SETBACKS: FRONT 35 FEET SIDE 10 FEET REAR 10 FEET DIMENSIONS ARE SHOWN FROM LOT LINE TO EXTERIOR FOUNDATION WALL LEGEND FOUND IRON PIPE PER PLAT OR AS NOTED N WOOD HUB SET AT 10' OFFSET OR ON BUILDING LINE EXTENSION T.O.H. TOP OF HUB ELEVATION T.O.P. TOP OF IRON PIPE ELEVATION — — — — — — UTILITY & DRAINAGE EASEMENT — — — — DRAINAGE EASEMENT ALL EXTERIOR BUILDING CORNERS MARKED WITH PIN FLAGS FIELD WORK COMPLETED: nos e Tire y3 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE li Project Name: C&J Lot 54 Owner's Name: C&J Builders Owner's Address: 316 Kampools Place River Falls Wi. 54022 Legal Description: SE 1 /4 NW 1 /4 S 29 T 29 R 17 W Township. Hammond County: St.Croix Subdivision Name: Rolling Hills Farm Lot Number. 54 Parcel ID Number 018-2019-54-000 II, Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Keith Knudtson License Number. 651-470-1737 Date: 09/09/2022 Phone Number (651) 470-1737 Signature Designed pursuant to fhe In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 SCALE: 1 INCH = 40 FEET 0 40 BO VERTICAL CONTROL Di%TU : NAVD IM G' ,.-J-.6 k .1 4d a -s PROPERTY ADDRESS: 1619 7STH AVENUE HAMMyr, WI54015 75TH AVENUE ��e- - Aoig Ji'-e"3" N PROPOSED 10' DRIVEWAY 11.9' 12.0 z2.0; N GARAGE 155 N ® P/b/•sa I/- I! 15.0 I; HOUSE a � N N 46.0 I d,� 160 to I to h Lo a I LOT 54 21,781$a FT. I I 0 I I I I 10'I MINIMUM BUILDING SETBACKS: FRONT 35 FEET SIDE 10 FEET REAR 10 FEET DIMENSIONS ARE SHOWN FROM LOT LINE TO EXTERIOR FOUNDATION WALL LEGEND FOUND IRON PIPE PER PLAT OR AS NOTED ® WOOD HUB SET AT 10' OFFSET OR ON BUILDING LINE EXTENSION T.O.H. TOP OF HUB ELEVATION T_O.P. TOP OF IRON PIPE ELEVATION — — — — — — UTILITY & DRAINAGE EASEMENT — — — — DRAINAGE EASEMENT ALL EXTERIOR BUILDING CORNERS MARKED WITH PIN FLAGS FIELD WORK COMPLETED: r T ram;. AML"ATIOk V .— [A] 0 A� M"ATION .REMr. e H.EVAl V+w RECEIVED SEP 2 12022 ST. CROIX COUNTY CDD R�KaMT t AT*4 V wr.�e M w 40. 14 Al RECEIVED SEP 2 12022 ST. CROIX COUNTY CDD 4 � � Enos i i qk� 6 9 ram" w m rr wau rw I�QlGA71011 MAN 1P11 a ."` A2 - - - --- -- ---- -- - -- - - - - i i � ,,�'-•� fV p:=A was gzi1 ew w9 .sse nwa +•u v �u ao �-- 9 b❑ RECEIVED SEP 2 12022 ST. CROIX COUNTY CDD I I I I I I I I I GPM �i , oe� wit, pFi�O aEV1EW 75TH AVENUE fV T fV PROPOSED 1O m 10' ORNEWAY � Y- L1.9' s 1 z.0 N zz.o N 1 Z 0 H GARAGE 15.5 h HOUSE N ---46.0 I I I o i I LOT 54 11,781 SQ. FT. I I 0 I � I I I I io• � �85.23' SEP 2 12022 SCALE: 1 INCH = 40 FEET 0 40 CDD VERTICAL CONTROL DATUM: NAVD 1988 PROPERTY ADDRESS: 1619 75TH AVENUE HAMMOND, WI 54015 NORTH MINIMUM BUILDING SETBACKS: FRONT 35 FEET SIDE 10 FEET REAR 10 FEET DIMENSIONS ARE SHOWN FROM LOT LINE TO EXTERIOR FOUNDATION WALL LEGEND FOUND IRON PIPE PER PLAT OR AS NOTED N WOOD HUB SET AT 10' OFFSET OR ON BUILDING LINE EXTENSION T.O.H. TOP OF HUB ELEVATION T.O.P. TOP OF IRON PIPE ELEVATION — — — — — — UTILITY & DRAINAGE EASEMENT 0 b uj DRAINAGE EASEMENT to N ALL EXTERIOR BUILDING CORNERS MARKED WITH PIN FLAGS FIELD WORK COMPLETED: I, Douglas J. Zahler, Wisconsin Professional Land Surveyor, hereby certify that this Stake -out Plan was prepared by me or under my direct supervision and is correct to the best of my knowledge and belief. -"DOUGLAS J. ZAHLER * n S-214e - 9106122 Q LL_ V) r J 2 € N O a! Qf Z w J _J O € =)It c m c C � U0 3 1 OF E3 E 3 aE3 E3 C&OBULDERS tv- p I I 1 Ming (._ _ 4 d I 1 II 1 II I CW BUILDERS a � vEw aawrc■mmtr-�rrxb uw+u�n nw.v •�:.. "•� +:..,..�. � ■ -- ---- -- ------ - - i R 9 i i &j BUILDERS ' i ♦n...a. wrtm.e�w � i Newuawonowr.u�u. ,ounwmwnn.� �_.b••T. :•��,•• i I . w kit * W-V Contractor Guidelines for ATU Septic Homes The septic system for this home will depend on the proper functioning of the Aerobic Treatment Unit (ATILT), which is designod to treat and degrade solids prior to discharge into the shared septic system. As oonttraetorNadder, please observe the foLlowimg eonstimcdon guidelines: • As part of design and construction, arrange for water from sump pumps to go to an external discharge. Backwash Gem water soitmers should also be discharged attanaUy, as doing so will extend the li'fiee of the septic system. Note: Regulations prohibit fim ace eondmtate Gem being discharged externally. • Garbage disposals am recommended. • Avoid allowing any uncut construction materials such as plastic, rubber, cigarette filters, bandages, rags, cloth and towels to eatQ the system. Likewise, prevent construction chemicals and toxins such as paint and paint thinners, solvents, ctc., from catering the system. • Contact Knudtsoa Plumbing and Contracting prior to siting house grade in order to confirm that adequate fall wiU exist to allow gravity flow bctwom the house, the ATU and the shared septic line (which may be as shallow as 42 inches). hrco=1 siting may rquire an additional pumping statim and incur significantly, higher costs. • Tha ATU maotilaetraer does not rawmxnd tank installation in frozen grand, and it will be dace only at the coetractorlbu kkr's request and risk. Installation under these conditions will liidy also incur added ooats related to requiremmu such as snow removal, frost ripping etc. toOets. Catmost the MnMm du&k winter coDshLctK+n m cause tM tank and o mpOnents to AM= said fat. as there is no bacterial action at this stage to_Seacratc heat Use a salt stump to treat this water prior to aoI ing dram lines. Contact Knudtson Ptuzobing and Contracting for a description. Bu7dets failing to observe this precaution may be liable for system repair and/or replaoemeat due to freezing. Whenever possible, keep interior water lines turned off during winter until the time of occupancy. • Tanks must be pumped prior to homunwncr occupancy. For questions regarding these construction guidelirims call: Knudtson Plumbing and Contracting 651470-1737 I have mviewod and understand the above guiddinea: LA J S 5L.f Ij Rolling Hills Lot 0 private On -Site Waste Treatment System (POWTS) Inspection Agreement The correct operation of the equipment noted below stenlflcantly Influences the pie of the wastewater system. Periodic Inspections will help extend the life of the system and prevent the need for costly repairs. The agreement authorizes access to your POWTS equipment by a trained and authorized technician, during daylight hours, to provide regular Inspections and routine maintenance to help assure the equipment is woridng properly. It is hereby agreed by and between Purchaser and Knudtson Plumbing and Contracting that In ednsideration of the payments provided for herein, Knudtson Plumbing and Contracting will provide the services of a factory -trained representative to perform periodic Inspections of the equipment described below. Knudtson Plumbing and Contractin will prepare a written report after each inspection and provide a copy of the report to the Purchaser. This report will contain recommendations for any operation and maintenance deemed appropriate by the Inspector. This agreement does not assume any responsibilities for obiigatlons that are normally the responsibilities of Purchaser and does not extend to cover any costs that may be associate with any recommendations made under this agreement. In no event shell Knudtson Plumbft and Contracting be responsible for any special or consequential damages, Including but not limited to loss of time, Injury to person or property or Incidental economic loss due to equipment failure or for any other reason whatsoever. Knudtson Plumbing and Contracting may supply additional services, parts or labor only after authorization by Purchaser. This agreement shall remain In force for a period of _I -Years, beginning _May 2020_ and will automatically renew each year thereafter for one year unless canceled by either Party with at least 30 days written notice. This agreement may be canceled by the Purchaser only H replaced by a service agreement with an authorized service provider for the equipment listed below. Knudtson Plumbing and Contracting may delay or cancel future Inspections If payment becomes at least 15 days past due. Periodic Inspections: Association agrees to pay Knudtson Plumbing and Contracting $_M.00 per each houses annual Inspection. Any additional testing or services required will be billed on time and material amounts. Equipment Covered Under This Agreeniertt DeKdpdon -- Model No. Serial No. Install Date ATU'S Hoot or Micro -Fast L — Knudtson Plumbing and Contracting Sign 927 15& St., Roberts, WI 54023 651-470-1737 hownk Date: Signature: RoilingHills HhNne Association Inc. Print Name: Y4�4 1, Lo=tlgin N different fmm system owner Date: I -d 6—1v--;-..2 Street 31 K I --- — — Phone: 715- )L q 7 3 l a^ a:ara P & --- -- + --- City, State & 1 ZIP FaxI R� ✓L/ F411) IA) L S `101� Email: fo �41��s�y �lJ C oir r�ns�. n6� oh 4, 0 Go 4" CAS - n m 74}" II 4" CAS -,fir / 41A" i 40" 1!4-- POLYLOK 12" ACCESS LID (TYP) =Z SET RISER (TYP) N TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 000 GPD GRA%DlrXWGE SYSTEM H-600 A TANK SPECIFICATIONS DIMENSIONS: WALL:- 3" BOTTOM: 3" COVER: 4" MANHOLE: 12" & 24" I.D. PLASTIC RISER HEIGHT: 70" O.D. LENGTH 108" O.D. WIDTH: 74 1/2" O.D. BELOW INLET: 57" O.D. LIQUID LEVEL: 51" WEIGHT: 11,135 LBS. INLET AND OUTLET: 4" CAST -A -SEAL (CAS) BOOT OR EQUAL COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN y9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE Z< � v g F DRAWINGS SUBMITTED tO FOR APPROVAL = APPROVED BY: SNWT NO. APPROVAL DATE: 1 PRODUCTS NEEDED BY: 1 Cr Cro(X 010 00 H-Series Gravity Treatment System Green Choice Applications: Single and Multi -Family Dwellings, light commercial, Churches, and other similar Residential strength uses Performance: 98% Reduction CBODs 99% Reduction TSS 9996 Conversion of Ammonia (NH3) Fecal <1,000 w/o disinfection Range of Sites: 500, 600,750 & 1000 GPD High performance, low cost, energy efficient treatment system The H-Series Gravity Treatment System provides high performance at a price comparable to most entry level ATU's producing effluent of less than 3 mg/L on CBODs and 2 mg/L on TSS, it far exceeds the secondary standards of 25 mg/L on CBODs and 30 mg/L on TSS With these results, many locations allow reductions in disposal areas between 25 and 40%. Because the H-Serles completely transforms ammonia into nitrate, it is best suited for applications with rich organic soil content, surface plant growth and depth to groundwater to prevent nitrogen pollution of the water table. Slmpfle instafUatlon, reiiable performance, low coat of ownership This level of performance is enhanced by its simple installation, energy efficient performance and low cost long term maintenance and ownership. The systems components are assembled at controlled manufacturing facilities, rather than In the field, to ensure reliable performance with local support. Energy effiicient, environmental protection Made of locally available and manufactured concrete, the H-Series features an energy efficient linear compressor that uses less power than an average light bulb. its polyethylene daffier hopper is made of recycled ml1k )ugs. Choose Hoot, and you make a sensible, decision to prntprt the environment as you protect our most precious resource, our water. Drainfieid and Vertical Separation Reductions With gravity flow discharge, the H-Series allows you to choose your disposal application from conventional lateral Bees, leeching chambers, other alternative dra"eid materials. In some areas direct discharge is an option as well. Reductions of vertical separations to groundwater and impermeable layers such as rock range from 1 to 2 feet Make the green choice for wastewater treatment your wastewater system is the most expensive and important appliance you will ever purchase. Don't settle for just any system protect your family and the environment with a Hoot H-Series System. Wiesen Concrete Products Inc 14kOo-3ZS494S6 www.wleserconcrete.com Homeowner Guidelines for homes equipped with Aerobic Treatment Units The septic system for your home depends on the proper functioning of the Aerobic Treatment Unit (ATU), which is designed to treat and degrade solids prior to discharge into the shared septic system. To avoid breakdowns and costly repairs, please observe the following guidelines: • Avoid allowing any inert materials such as plastic, rubber, scouring pads, dental floss, cigarette filters, bandages, hair, mop strings, lint, rigs, cloth and towels to enter the system. These materials can build up in the tank, resulting in system malfunction, clogging and premature pump failure. • Do not flush or drain chemicals and toxins into the system, as they kill the microbes necessary for treatment. These include paint and paint thinners, solvents, drain cleaners, automotive fluids, fuels, pesticides, herbicides, fertilizers, metals, disinfectants and sanitizers. • Paper products including disposable diapers, paper towels, baby wipes, facial tissues and moist toilet paper are not designed to dissolve in your on -site treatment systems. Neither will excessive amounts of toilet tissue decompose. • Limit garbage disposal use to food waste that cannot be scooped and thrown in the trash. Do not put animal fats and bones, grease, coffee grounds, citrus and melon rinds, corn cobs, egg shells, etc. down the sink. Also avoid putting spoiled dairy products and yeasts from baking into the system. • Do not put medicinal materials, automatic disinfection tablets and similar items into the system. Also, septic tank additives generally do more harm than good. • If possible, spread laundry practices out over several days, rather than one "wash day," so the ATU can more efficiently process the water as it enters the system. Liquid detergents are recommended over powder; fabric softener sheets are preferred over liquid softeners. Use bleach sparingly, at half the recommended rate. • Clear water waste from dehumidifiers, HVAC units, gutters, whole house treatment systems and sump pumps can increase the flow to both your on -site system and the shared system, leading to shorter life. Both clear water and backwash from water softener regeneration should be discharged to an alternate outlet. Talk to your contractor. Do not disconnect power from the unit! Your ATU is equipped with an alarm that will notify you of a malfunction. If the alarm does sound, for diagnostics, service and repair call: Knudtson Plumbing and Contracting 651470-1737 t�►l9R�t�� iiONf�f.�lgrlrllf j j F P"M LA MWI RE No" WIOW" .adop"SPs3ezXXVM13Bd. r�leiei�s 4 Cad9L T * gXKQ it b# sm�I t Mir - Tmseppuvwsw*wftts%v*mqdtn l% mamwstd�t ►gaMMrr3111WL Tills apQravHi � � � 1h�NI1$�@ � ' - - � •,'• • • . m►c�,�r�e�ae��e �+e�'�,r�d+K+�ateriu�Ira�A�. :�:: ,. �mtlr+vPgk�ata�t��taR tna bi.��s r�+e of lie QepnbPam Ylrn nataare�t�:atlt _ _ imAtf.es�'.VwflrrvufMIN � �p��plggdlB ��rha.��d� r AP w Mao Ph'd�E�� 111i11'i�EO S �� kuh ih �IE6 dt FMIMElonswum — __. I. _.� qrp- ii 20 fm dv� lla� 1fe 1�9d Mkt l0el�s rn�ribei�sre ih aoCeldcis �IMI 5P9�. • "tl1Mr� �1t�s'd4� Red'rYsrr+1�0 #n�f �9 Yis� Oar 1a4 i� ao+�aan � s ��.?,5 (�. - f'(��3RIIEtlI�0�4fl�i�bBf'Y81fif8A�#'�� . N�IaAa1 ilYlN4en �t bin �otlks leplt ae� �s �rNi�Ae1�. BMW tfe�n►�.err�t��1�'iet��M91!!�� . Bettie traiiipndled ott4ieli 1 m+�Nl M 0 4' Fromm s�Ip,1�e�rtn,die�nierJn�fe�lelltiti�tlelllrli Tt�e� �1 n�Me�eoterelfi� tiiil is riogq *Wopdwow mee►+e�uEtu�nilr�. - . STr CRO IUNTY SANITARY SYSTEM O1 OWNERSHIP/ADDRESS FORM o�c�e 212021Use y Created /2021 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 PropeM Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Jeff Husby Mailing Address 316 Kamloops Place City/State/Zip River Falls, WI, 54022 Phone Number (reauired)715-222-9731 Email Address (required)leffhusby@comcast.net Parcel Identification Number O 18 - Z o f (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location _i WY4 , St4'/4 , Sec. � T J? N R I I-W, Town of .h0A� Subdivision Plat: (Z.o U-A N G li:{1U4 Ftr1(LN^ Lot # . Certified Survey Map # Volume Page # Warranty Deed # I j%1402, (before 2006)Volume . Page # Number of bedrooms 5 Spec house ■ yes 0 no Lot lines identifiable ■ yes 0 no New Property Address (StaTf Initials) OFFICE USE ONLY �sl�"14ye (Verification of new address required from Community 9 0 22 (Date) Department fdr new constriction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center cdd@sccwi.cgov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.sccwi, aov St. Croix County AEROBIC TREATMENT UNIT (ATU) SERVICING AGREEMENT [State Permit Number - C & J Builders, Inc. Name —(Owner) Typed or printed He/she is the legal owner of the following parcel of land located in St. Croix County, Wisconsin, with their deed or document of ownership interest recorded as Document Number 1144762 St. Croix Register of Deeds Office. This Property is described as follows (include lot no. and subdivision/CSM or detailed legal description): Lot 64, Plat of Rolling Hills Farm in the Town of Hammond, St. Croix County, Wisconsin. OR: U See attached deed copy for legal descriptions Agreement Date: 9/12/2022 IIIIqI11:UJI [III IIII Tx:5120951 1158578 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09/12/2022 10:10 AM EXEMPT u: REC FEE 30.00 PAGES: 1 JGFF__"vSiY - l G KAnLc7OP9 Pi./1cs_ Jve.c F^IL51 w= 54{sa;k 018-2019-54-000 As an inducement to the county to issue a sanitary permit for a POWTS equipped with m Aerobic Treatment Unit on the above -described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of SPS 383, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System) technology. If the owner fails to have the POWTS and ATU properly serviced in response to orders issued by the governmental unit or the Department of Safety and Professional Services (DSPS) to prevmt or abate a human health hazard as described in s. 254.59, Stats., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 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 m required by the manufacturer and the Department, including, but not limited to: the blower, electrical controls, and 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 m described in s. 254.59, Stats, 4. The owner recognizes that the county, DSPS, or POWTS 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 completion of each inspection, maintenance or servicing event in a manner specified by the department or designated agent within 10 business 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 POWTS certifies that the aerobic treatment unit no longer serves the property. 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 properly. 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 in a manner that will permit the existence of the agreement to be determined by reference to the property where the Aerobic Treatment Unit is installed. - Please Print I Subscribed and swom to before me on this date: .JE FFt;P_Y 1f.�5 ,'� AA or t, Gw� Notarized Owner's Signature(s) No ublic". as Governmental Unit Official Name, Title - Please Print My Commission Expires Community Development Department 'gi_o a.3 •••• i Cove mental Unit Official Si atum Drafted by: * ERso Personal information you provide may be used fo secondary purposes [Privacy Law s. 15.04 u NRQ'ATr%Q"F R01 QR' _ t-r—� i Sanitary Site Plan I - 1 or. Roiling Hilis Farm Residentia� 389 47'59'W E Propen 0%sners Association LLC 84.91' Roily q 11ULs Farm Outlot 2 Lots 52- 4 Part of the SWI-A I t F N& •e1s Sec 29 T29N-R17W ,,,,o,e-a Town of Hammond - St Croix Counts' -WELL DWF - gpd -o .• v,- H r ! 4' s A( R Kati • P,z 80q r LOT LOT LOT 51 52 50 ! 21,781 So. 21.781 SO 21781 SC FT F T FT I ! an ,Fr 81 73 ! i 05 Be ' E 160 52' per. T 0 OUTLOT�[ 42 '1 ACRES BW 359 SO F- 8V-._EV.. 75TH AVENUE 1 G76 C9 tFYI ta•0 WE I -�""" 1•ropp{tp EW I DWF 630gud I &M 9Pd J i V `. ^f..Gl H-aCC A' �- k we >. 0 : soot- I +C .314:; y� Sx«er n \� --� h LOT \ '� 34 3 21 781 SO n FT a•Stn 4C3%Cu - A6IT C-333s PYC C _ "vey vxe • vv .•_ .- 85 X 21,781 SO FT I t!... a-923 �'opxoc Wesel Cc�:-re 81 Sty V h'.a125C V R w C _F I. �1.••�r N S 7r,*& S" 1CO F.-at OWF 0' 180C grs. A CC - • 125 sa h -FIR • 141 a acts ]2 54 Proposwo D!1Flex 2- SC- 40 PVC F.M's Typcal of caci lo! H, ix1 a• Scat 40 PVC Bldg. Sewer 4' Scn 40 PVC or Aire D 3O3.4 PVC C invoyenco Pipe •x t Wooer an o r'-0. - • T+ eC 1 82 w p•. U N I t \. tt Ind2egs U1v Ihrvw Ca 0 1 v e� h Z Ir LOT 55 LOT g8 as co 2',781 SO I I 1.7 FT21.79' .0 SO S5 C--?U F- I?M n A�Jd� N a r 1 / Dwplex Dos& Tank Q-aa 075-;O ' lop ohnle! pipe w I D69.00 Srr !s ar. OpCn Slope PMooeed /' x 1i1' Mora D"nW Ce1' OGa'ed Wong To 1077 3C x-IO.i w,e Syslw+E�v "07800 PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION Rolling Hills Farm Owners As,socialion I OWN OF HAMMOND C', %1,11, 1 IJA I HY TANK INFORMATION ELEVATION DATA I TANK SETBACK INFORMATION nr E < 4- I ANW, I , I P L I i I PUMP/SIPHON INFORMATION -Z Mar.,' t I r, 1. t icpp SOIL ABSORPTION SYSTEM DED1`1111 NCH A'-Il 1. " DIMENSIONS SETBACK 0. WFORMAT 00 11, 6 -o v,a Z7-17lou' DISTRIBUTION SYSTEM kjAo<,r, .1 St. Croix 624935 018-2019-79-000 29 29 17 12791 "I 0 i9l 'qf 4 S IFs I � I 1iIv7-/-qj tjjr4 fwes- 7 6 JqU. 33 aII.LF?l 107Z -t.- I, or, I f, 6�o w7i 6.0z to-7 III,! S-ystwyl 76 7 09 jcrn. IF-11 DIMENSIONS N. , "I,, 11�1, 1.1 I -,-K1 ACHIN"?MNF uvf 0 7 u Sp� AnIL OVER a Venwuuw Svelwms rk.l. ee U..,nd Irk Aff.41!Zwada Swtems OnIv Y, Oc /7 t.1 COMMENTS: j or 92 Location 1. f, A. 4 of I fir VL4 t-vi k, jv-� mn,,j 7- -`; Plaii iev Nmin 14":t.ireV 1,--, 5(Jqll, 111111f %.I-- VY WWI-' I • 3M #*V euaf� C/*&Y 6) 14y, a0ft couNnr NO. 645416 STA7UE SAN TARP PERMIT . 3 ; �'" °"T"TTi'�'"r PREVIOU�NO2+"KsiT/ JL W J \ JQ�1 OWNER PLUMBE TOWN OF SEC,T_ AND/OR LOT N LIM, '� KY16M IN IC.# (048'4�3 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 maybe renewed for a specified period. (d) Changed regulations will not Impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations In force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of 6ZA& SUBDIVISION the permit, please contact the county authority. k ` O ZED ISSUING OFFICER — DATE d2l(2bZZ S UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)