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HomeMy WebLinkAbout018-2019-47-000 (2)Wisconsin 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 (11)(n­ 1)] Permit Holder's Name: City Village Township C&J Builders Inc Jeff Husby TOWN OF HAMMOND CST BM Elev-. Insp. BM Elev: BM Description: I I TANK INFORMATION I TYPE MANU CTURER CAPACITY Septic �• Ak �Q l 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 Demand GPM Model Number TDH ILift lFriction Loss System Head TDH Ft Forcemain I Length IDia. IDist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA COUnty St. Croix Saritary Permit No 645455 Sta!e Plan ID No Parcel Tax No 018-2019-47-000 Section/Town/Range/Map No- 29.29.17.1247 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer 01 St/Ht Inlet St/,Ht Outlet Dt Inlet Dt Bottom Header/Man Dist. Pipe Brit. System Final Grade St Cover %J I BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth I SETBACK INFORMATION SYS15M TO X P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacture�- Typej OVA V Model Number: U10 I KII t:5U I 1UN 0 T J I t:IVI Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 'DUIL UUVt:K x Pressure Svstems Only xx Mound Or At-(' rnrllp I;vqtpmc, Only Depth Over Depth Over xx Depth of xx Seededy'Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc,) Inspect 1 Inspection #2: tA).►- ��Ln Location: 742 161ST ST I j�,'�,� d5T yvotcmy .11, . �v I VA 1. Alt BM Description = tc+ 0A1 2.) Bldg sewer length =,- tt - amount of cover = V 1� Plan revision Required? Yes No Use other side for additional information. ' Date Insepctors Signature Cert. No. SBD-6710 (R.3/97) � —� Sf}}N' 2o2a- 30 Ire ECE Divisio #*Ls Divisid 01-inty St. Croix Sanitary Permit Number (to be filled in by Co.) W. Ave., P.Q. Box 162 Box 162 P S W SEP 9022 Madison f'� 7-7 16 2 -1 LJ SarfitPOOWe A Transaction Number In accordance with SPS 3 unience, u mission of this form o the appropriate go Frimental unit ----------------- Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note" Application forms for tate-owned POWTS are submitted to the Department of Safety and Professional Servies. Personal information y u provide may be used for secondary purposes in accordance with the PrivacyLaw, s. 15.04(1)(m), Seats. �`N 742 161st St. Hammond - I. Application Information - Please Print All Information A Property Owner's Name I ' (we Parcel # C&J Builders Inc. Jeff Husby Aq 018-2019-47-000 Property Owner's Mailing Address Property Location 316 Kamloops Place Govt. Lot A 4, SK�4 '/4, bJ 1/ Section City, State Zip Code Phone Number River Falls, Wi. 54022 715-222-9731 ff -Neolirc le one) T N-) R I ?E or W I 11. Type of Building (check all that apply) Lot # Subdivision Name I or 2 Family Dwelling - Number of Bedrooms 3 47 Block# Rolling Hills Farm El Public/Commercial - Describe Use ❑City Of ❑ State Owned - Describe Use CSM ❑ Village of Number Town of Hammond Ill. Type of Permit: (('heck only one box on line A. Complete line B if applicable) A. ( 0'- 11X New System El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. 0 Permit Renewal El Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 615461 6/9/2020=.i IV. Type of PONVTS System/Component/Dev ice: (Check all that applyl---. U Non -Pressurized In -Ground ❑ Pressurized In -Ground F] At -Grade Mound > 24 in. of suitable soil ❑ Mound < 24 ia,41ZL'e t soil � El Holding Tank D Other Dispersal Component (explain) Pretreatment Device (expla V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf,) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation Existing I VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks ,4cd P Cc: 13 0 ci U Septic or Holding Tank 400/921 Weser/ Hoot X Dosing Chamber I V111. Responsibility Statement- 1, the undersigned, assume respony.bilitv foeonstallation aft OWTS shown on the attached plans. VIP", Plumber's Name (Print) Plum e , Sigpatur MPIMPRS Number Business Phone Number Keith Knudtson 648443 651-470-17.017 P] Ll Ill her's Address (Street, City, State, Zip Code) 927 150th. Street Roberts,VVi. 54023 VII 1. (,ounty/ )epartment t Ise Only - AA proved p i ❑ D1 roved Permit Fee $ Date ssued Issuin gent Signature ❑ 0=�ven_�Re for Denial �Ll 0 ;,2 zz 2 IX. Conditions o"m)rP4/4h11`­Reaxa____ fwr I pproval A4Gyl V*K IL)OA; r ro ve SYSTEM OWNER: 1. Septic tank) effluent filter and dispersal cell must be serviced / maintained as per I - - V) 50 management plan pmm Qy*WVA4Wlk)r the Wfern and submit to the County only on paper not less than 8 1/2 x 11 inches in size 2, All setback requirements must be maintained r applicable code / ordinances. Ll S BD-6%0_(aR.'1 I � 11) 6;0) feuyc Us A� M � 1 S LS a� 9 J. 3 3 lov .-e /�!, " Lr.;al fl6 4 4wi 7yI'Z /4 / ir sT�.��t �Or vA 4/10 ✓6� �� [ 7 . #-rP/ ? �POW, o �oSti %Acn� CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name-. C&J Builders ATU Owner's Name: Jeff usby Owner's Address: 361 Kamloops Place River Falls, Wi. 54022 Legal Description: Township: Hammond County* St.Croix Subdivision Name: Rolling Hills Farm Lot Number: 47 Parcel ID Number- 018-2019-47-000 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 Gfit Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Keith Knudtson License Number: 648443 Date: 09/29/2022 Phone Number (651) 470-1737 Signature Designed pursuant to the Mpw In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 �v—G�-.di�2-ai0 4efe 00%� t' i7, ',77 r--Af o1N 0 "o " 7 A7 vy L�� oP 7L:�' tz- US EDGE BITUM�NC S T R G 1 6 1ST �------- #: SANITARY SYSTEM File ST CRONTY Office Use Only OWNERSHIP/ADDRESS FORM cmated212021 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. OWNER/BUYER INFORMATION Owner/Buyer —&4-S g!V ' 1 kX_S 1_T, rAC-.1 #31 G i'�R� L-Oo? 5 P L Mailing Address City/State/Zip K VG� r f� � � 5 f � � 5 "� o a� Phone Number (required). � � � ' _ � � �_3 , -- - - Email Address (required) J ��v Sbx Y����g�• n �� Parcel Identification Number (found on the property tax bill) NEW SYSTEM-- LEGAL DESCRIPTION Property Location 1/4 1/4 Sec. T ____N R W, Town of M on 01v� # ��'� 44-�L_!zT -1L Lot Subdivision Plat: Certified Survey Map # Volume Page Warranty Deed# 2006)Volume Page 4_ Number of bedrooms Spec house kes 0 no Lot lines identifiable �K yes E3 no ....................... OFFIC SE ONLY New Property Add Ojerifiration of new address required from Community ?,Z I niti'KF­' (Date) Department for n4 construction.) This form must be submitted with all Private Onsite Water Treatment System (PovvTS) 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 ,cddQsccwi.gov 1101 Carmichael Road, Hudson, W1 54016 wwwsc Contractor Guidelines for ATU Septic Homes The -pend on ft pnVa finctioning of the Aerobic Treatment Unit , sep& *Ystm for dlis home will de R& - to discharge into the shared septic systern. AS (ATIJI which is dcsigned to uw and degrade so] prior conUuctur/buildcr, plmse obsme the following emstruction guidelines: As part of dcsW and cmstruction, arrange for water'fi-om sump pumps to 90 to an discharge. Backwash from water softeners should also be discharged externally, as doing so will extend the life of the septic Mtem. Note- Re prohibit fimimc condmsatc from being discharged externally. 0 Garbage disposals are not recommended. Avoid allowing any inert conrumfion materials such as plastic, rubbff, ciPfeUc firms, ban&ges, • ragsewi cloth and towels to enter the system. Likewise, went cOnstructiO ,n chem'cals and tox'ns such as paint and paint thin=`S,, solvents, etc., from entcr'ng the *'fin - Contact. Knudtson. Plumbing and Cont me prior to Siting house grade in order to confirm that adequate fall will exist to allow grav" flow betwcen the hmwg the ATU and the shared septic jjjnc (whic h rnaLy beas shallow as 42 inches). keorrect siting may require an additional pumping station and incur significantly higher- costs. •"Ibc ATU manufacturer does not rccorninend tank installation in frozen ground., and it will be done only at the contmtor/builder"s request and risk. inwill sWiation under these conditions wi ed costs related requirements such as snow removal, ripping, etc likely also incur add a Frme WAM-99: water nsate fings or other stas i�acludi sinks and toilets, enterum �w�mtq�rco�n the ���LnLction can cause the tank and gipmqngnts to Use a salt sump to UVO freeze and c.;j as thm is no bacterial at flus stage to_gmeraxe neat thL-Is water prior to entering drain lines. Contact Knudtson Plumbing and Contracting for a dcsuiption. Buildcrs faiMg to observe this precaution may be liable for system repair and/or to fteezing. Whenever possible, kccp interior waWr tincs turned off during rephLeement due winter until the time of occupancy. 0 Tanks must be pumped prior to homeowner occupancy. For qucstions regarding these construction guidelines, call: Knudtson Plumbing and Contracting 651-470-1737 I have reviewed and understand the above guidelines: 7 Rolling Hills IA # X 5/ ;-0' 0 01, Date Priwte On -Site Waste Treatment System {POWTS►) Inspect -,on Agreement The correct operation of the equipment noted below significantly influences the life of the wastewater system - Periodic inspections will help extend the life of the system and prevent the need for COSOY 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 working properly. Knudtson Plumbing and contracting that in consideration of the It is hereby agreed by and between purchaser and and Contracting will provide the services of a factGry-tragned payments provided for herein, Knudtson Plumbing representative to perform periodic inspections of the equipment described below. Knudtson Plumbing and Contracting 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. sibiRies for obligations This agreement does not assume any respon that are normally the responsibilities of e with any recommendations made under Purchaser and does not extend to cover any costs that may be associate this agreement, in no event shall Knudtson Plumbing and Contracting he 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 addMonal services, parts or labor only after authorization by Purchaser. 20 and will This agreement shall remain in force for a period of —I-- years, beginning 20 — automatically renew each year thereafter for one year unless canceled by either party with at least 30 days written notice. This ag uireement may be canceled by the Purchaser only If replaced by a service agreement with an pment listed below. Knudtson Plumbing and Contracting may delay authorized service provider for the eqOr cancel future inspections if payment becomes at least 15 days past due. Periodic Inspections: Association agrees to pay Knudtson Plumbing and Contracting $_200.00 per each houses annual inspection. Any additional testing or services required will be billed on time and material amounts. Equipment Covered Under This Agreement _.__ _.�__, install Location if different Description Model No. Serial No, from sVstem owner M� ATUIS Hoot or Micro -Fast Date- Knudtson Plumbing and Contracting Sign 927 15& St_,, Roberts, W1 -54023 651-470-1737 system Date: 01/14/2020 Signature:.- Rolling Hills Homeowners Association Inc. Print Name: Phone: Street: City.. State & ZIP Fax: Email: | wwwhoots snexnsecomp mxUnwHoot OmY Pb" January l,ZO22 RE/ Service Provider/Installer Certification Wisconsin Hoot Systems Hoot Systems, LLC (Service Provide r/I nsta I ler) KeithKnudtson 927l5OmStreet Roberts,. WI 54023 This letter is to serve as your official certification as a "Hoot Certified Service Providen1nstaUer" 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 ourproductsa|ongvvithproperinstaUationguideUnes.Asa"HootSenviceProvider/|ns1a||er"vvehave agreed tocontinually educate Keith KnudLsononall aspects ofour product line. Respectfully Submitted, Aaron Yonts Regional Manager Af 'HOOT SYYST 106 600 GPD GRAM raWHARGESYSTEM 741l H-600 A' TANL5PE.C1F-1..Q A-T1 .......I I ... , _...... .. .,. DIMENSIONS:. 4 CAS man"* wwW^ is 4 CAS WALL,, 3" BOTTOM.# 3r. COVIM 4 MANHOLE! 12N 24" I.Ot PLAS-nC RISER �Olp POLYLOK 12" ACCESS LID (7YP) HEIGHT: O.D. LENGTH 108" U.D. 8 '')� WIDTH: 74 1 2" 0,,D, BELOW INLElo 57" 0,0, LIQUID LEVEL 81 41 40 WEIGHT; 11,135 LEIS, INLET AND OUTLET: La a 4" OAST -A-SEAS (CAS) 8007 OR EQUAL 0 COVER: MIX DESIGN #8 (NO FIBER) LO 10. TANKI, MIX DESIGN #0 (SMALL FIBER) m 00 CUSTOMIZED TANKS: FOR CUSTOM" TANKS CONTACT WEBER CONCRETE log nj 00 .QUTLET SIDE -�ZW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM 0-1227 RECAAREMENTS It lk 9 D RAING S Su -B--M--'i I EF FOR APPROVAL APPROVED BY: SHEET NO. - APPROVAL CAM, PRODUCTS NEEDED BY: OF V77 T ail • VYVy". %iliaraya IFUTZ b1WA HWDW1P0M' H�Ser*ies Gravitreact ent Syste Green Choice Applications: Single and Multi -Family Dwellings, light commercial, Churches, and other similar Residential strength uses. Performance: 98% Reduction CBODs 99036 Reduction TSS 99% Conversion of Ammonia (NH3) PIMt-711 Wlf) %A1 /I-% A; c; r%fpf-+; t-% m a J%'F WW'f %... %At —pal a 1 LOW$ I Range of Sizes: 500,600r 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 CBOD5 and 2 mg/L on TSS, it far exceeds the secondary standards of 25 mg/L on CBOD5and 30 mg/L on TSS. With these results, many locations allow reductions in disposal areas between 25 and 40%. Because the H-Series completely transforms ammonia into nitrate, it is best suited for applications with rich organic soil content, surface plant growth and depth to groundwater to prevent nitrogen pollution of the water table. Simple installation, reliable performance, low cost of ownership This level of performance is enhanced by its simple installation, energy efficient performance and low cost long term maintenance and ownership. The systems components are assembled at controlled manufacturing facilities, rather than in the field, to ensure reliable performance with local support. Energy efficient, environmental protection Made of locally available and manufactured concrete, the H-Series features an energy efficient linear compressor that uses less power than an average light bulb. Its polyethylene clarifier hopper is made of recycled milk jugs. Choose Hoot, and you make a sensible, decision to protect the environment as you protect our most precious resource, our water Drainfield and Vertical Separation Reductions With gravity flow discharge, the H-Series allows you to choose your disposal application from conventional lateral lines, leeching chambers, other alternative drainfieid 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-Serles System. yste Wieser Concrete Products Inc. 1-800-325-8456 www.wieserconcrete.com Homeowner Guidelines for homes equipped with Aerobic Treatment Units The septic system for your home depends on the proper functioning of the Aerobic Treatment Unit (ATU), which is designed to treat and degrade solids prior to discharge into the shared septic system. To avoid breakdowns and costly repairs, please observe the following guidelines: e Avoid allowing any inert materials such as plastic, rubber, scouring pads, dental floss., cigarette filters, bandages, hair, mop strings, lint, rags'. cloth and towels to enter the %-I system. These materials can build up in the tank, resulting in system malfunction, clogging and premature pump failure. 0 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 ATtJ is equipped with an alarm that Will notify you of a malfunction. If the alarm does sound, for diagnostics,, service and repair call: Knudtson Plumbing and Contracting 651-470-1737 ............ Tabb I mamwm_ w j APR 16 zon St. Croix County Oli�lR1�i11� VAWW \ Jla1e7� M�rta�+e u70w( n 0 ow own War awls nae�aEaet�c aot -ae�°°6ad�ry�'M'trc:rs l�rt�9a�wue�+aor�nnetpre �d�cptgrssFs 38z�YpNhBAd.�mA�l��a�4 aed 0¢aim o!i tld,�YY surrss.: �ssDe�R�f� tl�oir Mob ��9�9o16saoinABa - cme „r�rta�Raa�a.aes�t�' .� yg,s'�a�Le°n tk�aaiS 3e91�mar�krttM+an� �tdsevaamlkx�o�t�anitamp , 71:ciriatWle �y/�1dIh6 PMINE►'�o'�M C Wf 1�iY�Pk to • �epfd1i19 #Ml'tdOb ll� V�PNiNP��°�4aA � ryi�Rm6yMtt0YY�1�Y14 4dRa'.ApIfiF9i11lB6FYftftiff �g C1fATdimtbC�Yl.��i�d ffidlQeYNiA�� a liN IRWklpb.lMlid�S-���p����-��� lot 04" 4 � Y�Ne1tN��iUWDi1011Y#t���� �1�. �1167:11?blo"�-�- AqF,QO�so�.araa�a�h�aaf�eeetrsn�rwe�w�Aoa r p�0orit+s�1��1�it1lYWd�m1iA6leptlf�9dE14dloop—'M�IPP P�6s5Ne.ldx Oode. TNM�Nd4�EmnItMMeg���Y�� . ipd�mlY9ftlBl�t at IN& *he daww'Oft Document NUniber Document Title St. Croix County AEROBIC TREATMENT UNIT (ATU) SERVICING AGREEMENT ,State Permit Number - j 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 1150638 St. Croix Register of Deeds Office. This Property is described as follows (include lot no. and subdivision/CSM or detailed legal description): Lot 47, Plat of Rolling Hills Farm in the Town of Hammond, St. Croix County, Wisconsin. OR: E. See attached deed copy for legal descriptions Agreement Date: Doc :8919160 Tx: 5127178 1159925 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WX RECEIVED FOR RECORD 10/14/2022 09:04 AM EXEMPT REC FEE 30.00 PAGES: I Recording Area NAME AND RE -TURN ADDRESS PWIC(e—X5 XNC�v KAM1*-VP-4 PLAC--4—'c- Vc-r,., FA ) 1 -5 / L*J -T 5 Al & 0, a-k- 018-2019-47-000 1 Parcel Identification Number (PIN) As an inducement to the county 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: 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 prevent 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 issessmcnt 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 as 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 as 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 cvent 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 off -ice 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 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 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. NaNIC(S) - Please Ppint F Notarized Owner's Signature(s) Govemr-riental Unit Official Name, Title - Please Print Community Development Department Subscribed and sworn to before me on this date: LA Not ublic My Commission Expires ; *+, Governm ital Unit Official Signature Drafted by: JUM-A—. j Community Development Department PEUERSON Cj 11*14 *8"68E:) Personal inforinatio—ri you provide may be used for secondary purposes [Privacy Law s. 15.04(1) Olt _ *r&: St, Croix County 1159925 Page 1 of 1 It4Ul L CMWGH ct�+tw.r .t c• .+ �+ ArroW r.et• •..�.. r seer 96 O' Tt�aurw � 4 sa, KItcww. + I cN.+ ems, WAX- � Y . .. W tD 1�-a' i7 0 rkmbw e.eraa.l DAh ..z +4 10 . 1 bww iS 1� Y •fi .1 -- -- ,., - t � - `1 - D' 7,C' r..cw.r�pl ?r.:1"i3 ,ants» �. n-wrt» twn+n Main Floor Plan ... ti �..... L.�.. .._ �J 1191 eq. Fk RS u'C+E+1 'ri.✓CX. u..NFMr r1 +.4W" KL N Ci0 MC�Y.• 4Y ..LVIIIIYM W tlq.� •. A3 Tyµ. n EII I L ��9V1l�(011 j iCY a� µ 1 eft Elevation 2) fRicght Elevation_ 1 O 3-2 5 e i -y0' NOL LLI R� IVIihJ IOoo� . 1 / 1 \ ry Me r q _ _ warm ..a . I Walk -Out FouncU tlon rb.... .. yW Oq ti. W if ii li F► ` Fr' �r � Fr e � � �Fr�Fr��r.Fr.Ft ./.F.I.r./.+ Fr.Ft`fr;Ft 1.►. h, M. h, 1 Ft 4 fr , Ft 4 Fr . ,Fr-Ft.hr.Ft'Fr,Ft l 1, r/ e fir; }r, Fr; Fr. Fr; Fr '`Ft:Ft:hr-Fr�Fr�Fr ©C==0 'fit;}',F►.F � � i e it ® ❑ ❑ ❑ y ii El ii ll �i t FLeF4.�LeFL.F4 �eFLe�4eFL " V•FI'LV :: i s; e e, �i to m 1 E!! 9 a k NEW RIC)i4M AND SPLIT 15 y 3ARAGE fiicsi-a_ F,_ 8 1 . 7 CID Sanitary Site Plan §0,26 Cn Co For: Tym e P� erties, 4L C OP vo N87008143E 160.52' << Rodling Hills Farm'Wlot 2 S&/ of 9 46-48 Part of.the SWY4 C;? 0 Soo, 29 T29]V-R]7W 0 CO S, -00- 0 Town ofilommomd ;R St. Crobk- C1 0 30 so C 3 4 0,5540 SM ELEV. N 10 14-76 1510 (>aphlc "o (Feet) 1075.88 (P 42 1 in - Go ft. WELL DWF - 600 gpd Hoot H-000 1310/septic OUTLOT 2 42.71 ACRES Grade :: 1073.64- 00 FN0 744 LOT 481,860,359 SQ. FT. ,- \ %.." 0 4" Sch. 40 PVC Top of p1pe = 1067 64' -1 Top of W(x)d Hub 9 Proposed 8.0 x 141 Mound Dispersal Cell Flev. — 1061.6(Y 6 located along the 1064.28 contour w/a System Elev. of 1065.111 Wisconsin 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 (1)(m)] ,Co St. Croix Sanitary Permit No 615461 State Plan ID No Parcel Tax No 018-2019-46-000 1 Section/Town/Range/Map No 29.29.17.1246 Af '07 1 DL 03 -7 r% to to;? _2_Q Permit Holder's Name city Village Township Rollinq Hills Farm Owners Associatior-C TOWN OF HAMMOND CST BM Elev I Insp, BM E�ev BM Description I V10 wee TANK INFORMATION TYPE MANUFACTURE CAPACITY Septic Dosing Lh fl Aeration TANK SETBACK INFORMATION TANK TO P/L LAI VVE L L BLDG Vent to Air Intake ROAD Septic Dosine, Aeratic Holding � "� PUMPISIPHON INFORMATION Manufacturer Demand by G P M Model Number T H TDH Lt-. IT F Friction Loss System FLqJ-ad 1. iisil) 1 .6 6 1 _ Forcemain Len,th lia 6 Dist to Well I 4z 1 A. SOIL ABSORPTION SYSTEM ELEVATION DATA Co,)* STATION 15 B�� HI On FS ELEV. Benchmark 2, Alt. BM Bldg. Sewer ( C7 " 0% V rL kid St Ht Inlet St./Ht Outlet Dt Inlet Dt Bottom IT 4 Z.K /0�o. kill Header/Man .7 Z. Dist. Pipe z r-o17 Bot System Final Grade • S! C 4ve BEDITRENCH DIMENSIONS Width C9 Lenoth 1 L) ) es I Q X 1 71 PIT DIMENSIONS No Of Pits Inside Dia Liquid Ce,,t- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STRqNy ILEACONG \ Ma a Ma eV INFORMATION AM R OR IT Type Of Sys AA I AAeIC Nvrmer: Header,'Marifolic I Distrib0on 'N I "L " % Pi pe(s) 06-0 9 x Hci'e Size r x Hole Spacing Vent to Air Intake Pa4Kla Length D Dia Spacing Lengthim SOIL COVER & '0% . x Pressure Svstp-m,-q Oniv xx Mound Or At -Grade Svstems Oniv rer*. rt \.2 x4&ar- Q BedtTrrmcrtenter (�%.50001 ) Depth Over BealTrench Edges xx Depth of Topsoil xx SeedecUSlodded Yes j X No xx Mulched V Yes No 10. COMMENTS: ,include code discrepencies, persons presert. etc Inspection #1 'Z r 4j"r- I r section #2 2en 3 1�7 Location: 740 161 ST ST -P 7�j Llk 11 1% t L PAv j L� W�?t&&e 1 ) Alt BM ' Description 2.) Bldg sewer length ormp%/'J/ - amount of cover = V4 " Plan revision Required? Yes No Use other side for additional informa io k �a u e Cert.No Date Insep,ctor" 19 SBD-671 0 (R 3197) f (A (y • COUN STATE SA7I i C�a 645455 RMIT 0 i PREVIOUS NO. N I IV 0 W 0 KI PLUMBEW4" rjjk14At94-&i1C0# TOVVN OF SEC ZI? qT 9Lt-N9 R AND/OR LOT BLOi T EXPIRES 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 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. (i) 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/2bizz �qTNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1 /20) State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number I Document Name By THIS DEED, VoranDeSoto LLC,, A MlBnesOtS limited liability company ( hereinafter. "Grantor," whether one or more), convey and wanantto C & J Builders, Inc., a Wisconsin corporation ( hereinafter ""Grantec,13P whether one or more), the following described real estate in St. Cretz County, State of wisc()nsm-: Lot 471, Plat of Rolhng Hills Farm in the Town of Hammond, St. Croix County, Wisconsin. 1150638 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/25/2022 02:51 PM EXEMPT#: REC FEE 30.00 TRANS FEE 120.00 PAGES: I "The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Ana Name and Retum Address Exception to warranties: easements, restrictions and covenants of record; highway and St. Croix County Abs ftma & Title Co., Inc. street rights of way; and Municipal and zoning ordinances and agreements entered 575 N. Knowles Ave., Suite #B under them and ftuther except real estate taxes accruing in the year of this conveyance. New Richmond, W1 54017 018-2019-47-000 Pa=el Identi5cabm Number (PIN) J A M E S S M A 170"FE NOT omestead property. Notbry Public State of Minnesota MY COmmission Expires January 31, 2026 VoranDeSoto LLC, a Minnesota limited liability Dated sx) 7.. company *Paxd Schreier, President (S FAL) AUTHENTICATION Signature(q) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAIZTED BY: St. Croix County Abstract & Title Inc. Co. V �OkoyAshley Bonkoski at the direction of grantor. 22-S31637 ACKNOWLEDGMENT STATEOF M10141ESC>T-4k COUNTY FVA PASE ss. Personally came before me on I '14 the above -named VoranDeSoto LLC , a Minnesota limited UsbilfMcOmPany, Paul Schreier, President to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. JOY^%4F5 S 1A-AL40 tj IE- Noblic, State of Wiwa! IVU4 0"m My Commission (is permanent) (expires: —A (Sigmtures may be authenticated or &elk wiedged. Both are sol necessary.) NOTE: THIS IS A STANDARD FORML ANY MOD'FICATIONS TO THIS FORM SHOULD RE CLEARLY IDENTIFIED - WARRANTY DEED , 4D 2003 STATE BAR ®F WISCONSIN * Type name below signaftu�cs. FORM NO. 1-2003 St. Croix County 1150638 Page 1 of 1 -