HomeMy WebLinkAbout018-2019-36-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Building Division St. Croix
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) 600389
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] State Plan ID No:
Permit Holder's Name: 1289242
John Aaby City Village Township Parcel Tax No:
TOWN OF HAMMOND 018-2019-36-000
CST BM Elev: Insp. BM Elev: BM Description:
s PU „/I~ Section/Town/Range/Map No:
TANK INFORMATION 29.29.17.1236
ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
R. 5
Septic -,F,, t • S
' ~
Dosing Benchmark
I e; ova- z .o POO
,,mob O Sad (06c) 9Z Alt. BM
y4era~iefl
Bldg. Sewer
d3.83
Holding St/Ht Inlet Z.9Z/
'Z /A Z. 83
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WEELL BLDG. Vent t A=take
6 2. (o
S ROAD Dt Inlet
Septic 26 1 / Z Dt Bottom f ~r
Dosing Header/Man.
Aeration
` Dist. Pipe
Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
Model Number GPM 0~- ,ei- COJ I ~d S. 7s
~k
c7Z. Gs
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well -77 e- /6,g 19
/64-751p,
ys
SOIL ABSORPTION SYSTEM / g$
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits
DIMENSIONS \ Inside Dia. Liquid Depth
SETBACK SYSTEM TO P/L BLDG ELL LAKE/STREAM LEACHING Manufacturer-
INFORMATION f
Type Of System: 1 CHAMBER OR
,
mber:
DISTRIBUTION SYSTEM Header/Manifold FDise(s) tribution x Hole Size
x Hole Spacing Length Dia gth Dia Spacing f
SOIL COVER x Pressure Systems Only ff" ystems Only
Depth Over Depth Over Bed/Trench Center BedlTrench Ed9 es Seeded/Sodded xx Mulched
L4
E] Yes E] No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:
Inspection #2:
Location: 736 163RD ST A3 ~-7
6J~~Oj el, G God ¢I~p w~5~e<,-~5
1.) Alt Description = 11464- 5ov l o
2.) Bldg g sewer length = 2 0 / ti d-Q
- amount of cover Q
- / 0 "1. cda 712.1 O (Jr'4k, Lil GSQ.1-
Plan revision Required? ❑ Yes o
3 -7 -Lf
Use other side for additional informat>
Date
SBD-6710 (R.3/97) Insep or's Signa a Cert. No.
County
c.t-4 741 ED Safety and Buildings Division Coup St. Croix
' 0 i 111 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
` SP' Madison, WI 53707-7162
2, 11 -1 &U, 666 3'9~
Sanit . e It A ] 1 State Transaction Number
` PP 1289242
In accordance-wit 'St' .383; 1{2} Wis Adrif o e, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms ubmitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may he used for secondary
u ses in accordance with the Privacy Law, s. 15.04(1)(m), Stats.
1. Application Infor - Please Print All Information 736 163rd St
Property Owner's Nam Parcel #
John Aab 018-2019-36-000
Property Owner's Mailing Address Property Location - q, !j q
1830 32nd Ave. Govt. Lot
City, State Zip Code Phone Number
NE $W Section 29
Baldwin W. 54002 T 29 N, R 17(oirelEoone
II. Type of Building (check all that apply) L
1 or 2 Family Dwelling - Number of Bedrooms _ 36 Subdivision Name
Block # Rolling Hills Farm
❑ Public/Commercial - Describe Use
- ❑ City of
❑ State Owned - Describe Use tt CSM Number ❑ Village of
9' G 1 T I C C t fi Town of
III. ype of Permit: (Check only one box on line C mplet line B if applicable) d
27
Q- ex,
A. In New System
❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS S stem/Com onent/Device: Check all that apply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain)A
V. Dispersal/Treatment Area Information:
Design Flow ( 94) 1 Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
1800 (90 .4/1.0 900/4500 936/4504 100.1 EX. Sa-~ n c
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units n o v
New Existing Tanks
0
Z.6 a v rn s C7 a
Septic or Holding Tank ,,,maws J
Wieser X
Dosing Chamber
Z6,061 Wieser x
VII. Responsibility Statement- 1, the undersigned, assn a respons' ility stallation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plu 's ignature ) MP/MPRS Number Business Phone Number
Keith Knudtson 648443 651-470-1737
Plumbers Address (Street, City, State, Zip Code)
927 150th St. Roberts Wi. 54023
VIII. un /De artment Use Only
Approved Disapprove Permit Fee Date slued Issuing A t Signature
O even Reason for Denial
IX. Condilrlli~ ~easons for,Disapproval
3~ _ ~e S ce , L
t: hNr,+e;A rs+Xlilw 00
ai>i r.+u>st r~A SE § r~,t ~nta`, r t o r
>rts'p~t i»lNr:~yernen! phn ~uritiert trv ~lu,nbe;. f ✓ / X1.5 ~^'ot i/1, fCJl.. ✓~let..
2 Ateelbsekttl irerns must i,e r ~t,ntz.it:E. ~~'l ~ar.1--
M t~lf lIR CUP.R / o.ftliR21t1rF.3 V /l
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 z 11 inches in size
,q)
SBD-6398 (R. 11/11) G ✓V~0 P s b
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927 150TH ST, C': ' 7 rRS
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CONXRACTiNt ,
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ROBERTL, t'.,i
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~~wrnKTeDIVISION OF INDUSTRY SERVICES
y3 r~~~ Plumbing Product Review
Go , I y P.O. Box 7302
i s Madison, Wisconsin 53701-2658
v P $ TTY: Contact Through Relay
G~
Q~qo e~~ Governor Scott Walker Laura Gutierrez, Secretary
~ssiors~+~•
May 10, 2018
HOOT SYSTEMS, LLC
RON SUCHECKI
2885 HWY 14E
LAKE CHARLES LA 70607
Re: Description: SEWAGE TREATMENT APPARATUS
Manufacturer: HOOT SYSTEMS, LLC
Product Name: (trans id 3097849) H-SERIES HOOT
Model Number(s): H-500-A (MAX. DWF 600 GPD)
Product File No: 20180134
The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance
with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin
Statutes.
The Department hereby issues an appro based on the Wisconsin Statutes and the Wisconsin Administrative
Code. This approval is valid until the d of May 2023.
This approval supersedes the approval issued on March 12, 2013 under product file number 20120398.
This approval is contingent upon compliance with the following stipulation(s):
• This tank must be designed to withstand the pressures to which it will be subjected.
• The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the
department's stamp of approval. The plans and specifications must be open to inspection by an authorized
representative of the department.
• This product may not receive backwash discharge from a water softener. Water softener backwash
discharge must be discharged in another method acceptable to chs. SPS 382 and 383 (formerly Comm 82
and 83), Wis. Admin. Code.
• The maximum daily wastewater flow, which may discharge through this product, is 600 gallons per day.
• When this product receives wastewater from dwellings, it will produce an effluent quality with a maximum
monthly average value for BOD5 of less than or equal to 30 mg/L, TSS of less than or equal to 30 mg/L TSS
and F.O.G. of less than 30 mg/L and fecal coliform of less than or equal to 10,000 cfu/100ml.
• Plan review for the installation of this product must be obtained from the department in accordance with SPS
382.20 (1) of the Wis. Adm. Code.
• This product must have installed a department-approved effluent filter capable of filtering particles of 1/8
inch in size or larger.
SBD-10564-E (N.10/97) File Ref: 18013403.DOC
Hoot Systems LLC
May 10, 2018
Page 2 of 2
Product File No.: 20180134
Table 1 Maintenance Inspection, Pumping Requirements
PRODUCT/ Models H-500 600 gal/day)
Initial/Startup Inspection/ Maintenance 2-yr. service agreement w/manufacturer
Ongoing Pumping Cycle And/Or Requirements 2-yr. pumping (trash tank only), unless more restrictive
by local or state regulation; for aeration chamber, see
inspection results
Back-Wash Cycle N/A
Effluent Performance Levels NSF-40 Class I
BOD5 Credit For Downsizing Distribution Area YES
Fecal Credit For Reduction Of Vertical Separation YES
Additional Comments none
• These tanks shall be fitted with locking manhole covers in accordance with s. SPS 384.25 (7) (h) Wis. 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 installation, that conform to s. SPS 384.25 (8).
• The tank is not recommended to be installed where saturated soil or seasonal high ground water tables are
indicated between the bottom of the tank and the ground surface.
• BEDDING: 3-inches of compacted bedding shall be provided. The bedding material shall be dry, sandy
loam material, or coarser < Y diameter in the largest dimension.
• BACKFILLING: must be compacted at 6-inch intervals. Backfill material shall be free-flowing soil or gravel
4 inches in diameter in the largest dimension.
The department is in no way endorsing this product or any advertising and is not responsible for any situation which
may result from its use.
Sincerely,
en W. Schlueter
Plumbing Product Reviewer
Department of Safety and Professional Services
Division of Industry Services
Bureau of Technical Services
(608) 267-1401 Phone
(608) 267-9723 Fax
glen.schlueter@wi.gov E-mail
500 GPD GRAVITY DISCHARGE SYSTEM
H-500 A
106
zonx 68.5"
At
Water
C65.5" Line
74.5"
te"
28.5" At 68.5" At
Water Line Water Line
3„ Water Level
69.0" 205 Gallons
57.0"
52"
400 Gallons 715 Gallons
2.229' Avg. Length VVV ~`v
5.600' Avg. Width
4.333' Depth ~ n n
Rev. 02
9/24/02
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KNUDTSnN PLUMvliv0 i
CCt TRACTIN,,31, LL. .
927150TH ST.648"7MPRS
ROBERTS, WI 54023-6526
CELL 651-470-1737
POWTS INSPECTION AGREEMENT
The oorred opwation of the below ec;ulpment htiy influences the life of the wastewater system. Periodic
inspections Will help extend the We of the system and prevent the need for costly repairs. This agreement authorizes
access to your POWTS equiprnsrd by a trained and authorized Petersen technician during daylight hours to provide
regtlar IMPOCUM and routine mairiteriance to help assure the equipment is worldrg properly.
r
It is hereby agreed by and between Purchaser and h 4 -~W 1 Kf Provider) that in
consideration of the payments provided for hereirl, Service provide the of awed
rOPresentahm to perform penodre inspections of the equipment described below_ Service Provider will prepare a written
report after each inspection and provide a copy of the report to the Purchaser. This report will contain gun8ridations
for any operation and manintenarm deemed appropriate by the inspector.
This agreement does not assure any responsibilities or obligations thud are normally the responsibilities of Purchaser
and does not extend to cover any costs that may be associated wilh any recommericlatiom made under this agreement.
In no evert shall Service Provider be responsible for any special or consequential damages, inclrdng but not killed to,
loss of tittle, ir>tuy to person or property or incidental economic loss due to equipment fare or for any other reason
whah oover_ Service Provider may supply additional services, pants or him only after autho ikon by Purchaser.
This agreement shall remain in force for a period of yam, begire tg _ 2t) and
will automatically renew each year thereafter for one yew unless canceled by either party with at least SQ days written
nom. This agreement may be candled by the Purchaser only if replaced by a service agreement with an authorized
service Provider for the equipment listed below. Service Provider may delay or cancel f itrr s inspections if payment
becomes at least 15 days past due.
Periodic 6uspectiors: The Pub agrees to pay Service Provider 3
per inspection for font (4)
Inspections for the first two years at six month intervals and one (1) inspection each year therms Payment for the first
two years of Inspections is due at the tine of instalkation; additional payments are due upon inspection. additiOrhal
testing or services required by Purchaser will be bird based on time and material
Date
Service Provider CONTi Si `m
Phone x2715±-, E ,
Address City
Zip State .
-
Equipnvent Covered Under This reerrrent
Oeso*tkm Model Na Serial No. Install Date Locellorh If different from System
Owner
Owner.
DOW
MOM
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III I
II IIIII~IIII IIIII~IIIII~III I II~
8 5 0 9 6 2 4
Tx:4431224
Document Number Document Title
1063759
St. Croix County BETH PABST
REGISTER OF DEEDS
AEROBIC TREATMENT UNIT (ATU) ST. CROIX CO., WI
SERVICING AGREEMENT RECEIVED FOR RECORD
04/19/2018 02:28 PM
EXEMPT
State Plan Transaction Number - /289 Z`fZ {
j REC FEE 30.00
z /C~OM,,,~ -1,r PAGES: 1
A
j -
v
Name - (Owner) Typed or printed
Being duly sworn, states, under oath, that: E
3 !
l 1. He/she is the owner/part owner of the following parcel of land !
located in St. Croix County, Wisconsin, recor ed in Volume, Page,
Document Number /45y788 dated '7,&a/-' 7 , St. Croix County
Register of Deeds Office: Recording Area
~
A parcel of land located in the Ne r/n of the Jr" 'A of Section 2-, T Z") NAME AND RETURN ADDRESS
j N - R W, Town of f~a...m...dl , St. Croix County,
w~ S`10o Z
Wisconsin, being duly described as follows (include lot no. and t3, j A,,,j
subdivision/CSM or detailed legal description :
Le!' 3!0 a~l'n ~fi7~5 ~i o/8-Za/ 9 - 3(v- a00
Agreement Date: g 8 Parcel Identification Number (PIN)
y 0.
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,
a we agree to do the following:
E
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 property 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 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 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.
y
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.
S
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.
e 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 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
~ef 4j `lr is installed.
by reference to the property where the Aerobic Treat
Owner(s) Name(s) - Please Print bscribed and sworn to before me on this date:
Notarized Owner's Signature(s) =-A pVBL`G dory P c
CaplKhrimental Unit Official Name, Title - Please Prld~~~rfr11 Its>>1 My Commission Efx~pire 2 y 9
t~4/O 0/7
Govemm al Unit Offici Ign Drafted by:
/rsonal ' rmation you provide may be used for secondary purposes [Privacy aw s. 15.04(1 m)]
A.
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE"
This information must be completed by submitter document title. name & return address. and P/N (rf required). Other information such as the
granting clauses, legal description, etc. may be placed on this last page of the document or may be placed on additional pages of the
St. Q o►ttyb1MR3Y68 Rao* doub lpage adds one page to your document and $2.00 to the recording free. Wisconsin Statutes, 59.43.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer John Aaby
MailingAddres 1830 32nd Ave B ldwin Wi,
Property Address 736 163rd St.
(Verification required from Planni g Zoning Department for new construction.)
City/State Hammond Wi. Parcel Identification Number 18-2019-36-000
LEGAL DESCRIPTION
Property Location NE I/4 , SW 1/4 , Sec. 29 , T 29 N R 17 W, Town of Hammon d
Subdivision Plat: Rolling Hills Farm , Lot #
Certified Survey Map Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house DyesEbo Lot lines identifiable Dyes[:]no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1 /3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department withi 0 days of the three year expiration date.
I/we certify that all statements on is form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a arranty deed recorded in Register of Deeds Office.
Number of bedrooms -
K /tfltb
GNAT OF APPLICANT (S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application 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.
(REV. 04/12)
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Safety and Buildings
4003 N KINNEY COULEE RD
commerce.wi.gov LA CROSSE WI 54601-1831
TDD (608) 264-8777
isconsin www.commerce.wi.gov/sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
i
August 04, 2006
CUST ID No. 222774 ATTN: POWTS Inspector
HENRY F GROTE ZONING OFFICE
CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA
E4366 353RD AVE 1101 CARMICHAEL RD
MENOMONIE WI 54751 HUDSON WI 54016
CONDITIONAL APPROVAL Identification Numbers
PLAN APPROVAL EXPIRES: 08/04/2008
Transaction ID No. 1289242
SITE: Site ID No. 715495
Rolling Hills Farm Please refer to both identification numbers,
Town of Hammond above, in all corres ondence with the agency.
St Croix County
NE1/4, SW1/4, S29, T29N, R17W
Lot: 38,
FOR: ` t ~ K..
Description: Twelve Bedroom (Three Homes) Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 1086165
Maintenance required; 1,800 GPD Flow rate; 31 in Soil minimum depth to limiting factor from original grade;
System: Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01),
Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.01/0 ; Aerobic Treatment Un , Biofifer
The submittal described above has been reviewed for conformance with applicable Wisconsin ms ative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
component manuals listed above.
• The dose from the pump tank is to be field calibrated at time of construction as specified in the plan.
• All subsequent connections to the pump tank are to have a pretreatment unit installed upstream that produces
highly treated effluent that meets the requirements of. BOD less than or equal to 30 mg/1; TSS less than or
equal to 30 mg/l; and fecal colifotm with a geometric mean less than or equal to 104 cfu/100 intl.
• The FAST unit must be installed in accordance with the manufacture's printed instruction and system sizing
criteria found in Comm 83, Wis. Adm. Code. If there is a conflict between the manufacturer's instructions and
the plan approval, the plan approval and code requirements will take precedence.
• A maintenance and monitoring contract for the FAST unit is required for as long as the unit is in service.
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and
dispersal are prohibited.
HENRY F GROTE Page 2 8/4!2006
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area. chs. NR 811 & 812c
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the POWTS 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. Stat
• Comm 83.22(7) 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:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 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 die component(s)
utilized in the POWTS.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction/instal lation/operation.
In granting this approval the Division of Safety & Buildings 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 to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 225.00
Refund Amt $ 50.00
Charles L Bratz
POWTS Reviewer 11 , Integrated Services WiSMART code: 7633
(608)789-7893, 7:45 am- 4:30 pm Monday - Friday
charlie.bratz@wisconsin.gov
cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544
Rolling Hills Farm Mound
Additional Information regarding Transaction # 1289242
Construction Materials and Techniques
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manuals:
Mound, SBD-10691-P (01 /01)
Pressure Distribution, SBD-10706-P (01/01)
Location: NE '/4, SW '/4, Sec. 29, T 28 N, R 17 W
Town: Hammond
County: St. Croix
Date: August 4, 2006
Owner: Rolling Hills of Hammond, LLC
Address: 400 Second St.
Hudson, WI 54016
Designer: H ry Gro GIF'o~ g _
Signature:
Q .
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-'>T OF COMt,;FACE
License: WI D- 1 9-007 f-1i1,'D j 1 ~G\\,''~TEYAk $ C~
Attachments: SBD-10577 - Plan Approval Application
SBD-8330 w/ potential subdivision area details, see previous application
Page l: cover'
Ia. overview'
2: design criteria & calculations s'Epc
rg
3: plot plan j-_
3a: potential future plot plans
4: system cross section
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
8: system management
page 1 of 8
08/03/2006 09:32 FAX 715 233 0398 Certified Soil Testing Lag Commerce 1J004
f i !I .
/ / / / {Scale: 1 " = 40'1
'
Potential future W 975-1425 BIO
tank locations w/ 0.75 FAST
° ATU units 4
POTENTIAL FUTURE
OT 3 "1
1,782 FT.v
~z~gza.2
POTENTIAL FUTURE
p 0
.
ooa~ Pi , 781 SQ. F top
\ is ors w/0 79' 142 1057.50
/ POTENTIAL FUTURE Potential futwe lot lines
OT Potential future 4" service
1 42"
SQ. I , to pump tank' > - below
grade to top of pipe
(Jf ..04=100 ~ .
J I.
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Overview
This system design is intended to be of sufficient size to be capable of handling an increased
wastewater load in the future. The intent here is to comply with the St. Croix County Code of
Ordinances, Land Use and Development, Chapter 12, Sanitary, Enacted July 1, 2005.
Specifically, Section 12.4.A.3.c. (Common Systems, General, Submittal Requirements), requires
state approval from the Wisconsin Department of Commerce for an onsite disposal system.
A pending Conservation Development, Rolling Hills Farm, is proposed in the area around the
current designed system. If final plat approval is granted, the Rolling Hills Farm development
will have 77 lots serviced by a proposed 22 adsorption/dispersal components located on common
ground. This design is intended to serve as proof of concept and be a model design in essential
components and features for future system designs. Appropriate easements and maintenance
language are required by the ordinance prior to preliminary and final approval.
The dashed lines on the plot plan for this design indicate potential future lot lines. Immediately
adjacent to and upslope from the dashed lines are two, addi ' al otential future 1 s.
Conceptual I, each future lot is r ' cted to accommodate four bedroom reside e Each
residence will have a combination tank with a septic/trash tank compartment ahead of an aerobic
treatment compartment. "Thus, highly treated effluent could potentially be created in estimated
flow of 1200 gallons per day or design flow to 1800 gallons per day. Conceptually again, this
effluent will flow downslope to a dosing/pump tank located upslope from the
adsorption/dispersal component mound system.
This system is designed with surge capacity and timed dosing of the mound component. Surge
capacity is approximately 989 gallons represented by the pump tank volume between the timer
off float and the alarm float. The surge volume is about 82 percent of the estimated daily flow
assuming potential future loads. Timed dosing is designed to spread the full potential future
design load of 1800 gallons per day over 24 hours in 16 separate dosing events. With minimal
drain-back of 4.45 gallons, a dose of 117 gallons translates to an effective dose of 112.5 gallons
into the mound component. At a calculated total dynamic head of 17.55 feet the Zoeller 152
pump is estimated to yield 48.4 gallons per minute which indicates a timer on setting of 2.4
minutes or 144 seconds. Since sixteen doses per day are anticipated at full design load, the timer
off setting should be 87.6 minutes. Careful measurement of pump tank liquid level drop is
required to field calibrate these estimates and assure a 117 gallon timed dose. The liquid level
drop should be 2.36 inches per dose.
It can be noted that the 112.5 gallon delivered dose is slightly greater than five times the lateral
volume and will provide 5.3 doses per day for a one residence load at full initial design load.
Page 1 a of 9
08/03/2006 09:31 FAX 715 233 0398 Certified Soil Testing LaX Commerce 11002
Design Criteria & Calculations ` v 0-w 6 Z g g L ~Z.
Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L
Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L
Fecal Coliform > 10,000 cfu/100 mL
Treated Residential Wastewater Contaminant Load: 30 mg/L < BOD5
Septic tank + "highly-treated" effluent 30 mg/L < TSS
Fecal Coliform < 10,000 cfu/100 mL
4- Bedrooms x 100 ganedroom/day x 1.5 60-0 gallons/day hydraulic load, current ,
Z Bedrooms x 100 gal/bedroom/day x 1.5 l n , potential future
In situ designed loading rate o q- gallons/sq, ft. per day
Depth to estimated high ground water in.
Depth to bedrock It in.
Cross slope at systenj 4 , o % G w< < w~
Force main length 2 5~ ft, of in, o g
Manifold/header length 4 ft. of 1 `/z. in.
Drain-back 45~ gallons
Lateral length @ S--4. ft, of in.
Lateral elevation O ft. @ bottom of lateral
Lateral hole size in, in, Z S~ . ft.) Spacing
2, b holes/lateral holes total
Lateral volume Z, t ~ 4 gallons
Total lateral discharge rate 47Z, t, 4- gallons/minute @ ft. head
Network pressure compensation losses S ft,
Elevation difference ft. Friction loss q
Filter head loss ft' @ gallonslminute
ft.
Total dynamic head ft. Pump 4.4 gpm @ 2 ft. of head
Manufacturer o e_<<aX Model 4 5
Dose volume Z- gallons
Lift tank gallons
Pump tank filter loo - A -L
Septic tank gallons, 1 current + 2 potential future
Septic tank effluent filter t=t t o-v
1 current + 2 potential future
ATU o o S c~,~ F (~c i , 1 current + 2 potential future
Measurement pump timer enabled on-off 3 in.
Dose pump timer on setting C44 2 ~ min,; field verify dose @ gallons
Dose pump timer off setting between doses l~ min.
Height alarm from tank bottom 0 in.
Reserve capacity Z 3 5 gallons
spc¢s.CACS
Page Z of
i
08/03/2006 09:32 FAX 715 233 0398 Certified Soil Testing 4 La% Commerce Z003
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is
PUMP CHAMBER CROSS SECTION Page of 4
Min. Z Vcric Pipe with cap
2 tCr from door, window aMs Wr 1 g Q L 4 Z
J, r- ent Gap
or fresh air Intake V
Weather Proof
{ .Junction DOX ^ppraved k4king mariv c y
i oover w/ wzrn 9 itibei
12' MIN
i I1
Final
I Grade l O i, O !
l11 I 11 a 4' MIt~
i i la' MIN
Conduit ~ @ '
Approved 11 I s.: ~~Q Provide I
i f ^pprOYCed
Joirsz ^ Alrtighc 5e21
Joints
I t 1
1 t 1l
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1 O Pump 3 On 4
ELEV. fz ELEY, fC
41 ! ConcretC 131ock
11 3'G 4 G d¢ 'PG G d 9
v" 3' approvCd bcdd[ng rnaurial under bank 4-p 4r
SPECIFICATIONS
Note: Pump and alarm are on separate Number of Doses: 4 Per Day
circuits as per Wis. Adm. Code Gallons Per Day of Doses: ttzs Gallons
Volume of Backflow: 4 4K Gallons
Tank Manufacturer: Ly s Total Dose Volume: Gallons
Tank Size: ~-j S • µ Gallons
Alarm Manufacturer: c, L'ta~ Capacities: A 25.E inches or12l" Gallons
Model Number: t ° W w B 1 inches or '9 40,g Gallons
C 3 inches or ~kz Gallons
Pump Manufacturer: 7_o.aA« D inches or 0rlI Gallons
Model Number: kt2- Total........ s4' inches or2b}°eg Gallons
Minimum Discharge Rate: 1i4,--4- GPM
Vertical Difference Between Pump Off and Distribution Pipe b Ft.
Minimum Required Supply Pressure: r
xS Ft. of Force Main x Friction Factor/100 Ft + a Ft~ 43 ~~r»
Total Dynamic Head = k;. Ft.
I
Internal Pump Tank Dimensions: LengthWA,.~ Width ':~3P2 Depth to inlet S~
PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW
MODEL 151/152/153 PER MINUTE
14 45 153 EFFLUENT AND DEWATERING
z +o MODEL 151 j 152 153
S to 35 152 Feel Meters Gal. Liters Gal. Liters Gal. Liters
sz 30 I 5 1.5 50 189 69 21, 77 29,
10 3.0 45 170 61 231 70 265
e 26 151 15 4.6 38 141 53 201 61 231
20 6"1 28 110 44 167 52 197
20
25 7.6 16 61 34 129 42 159
t5 _ 30 9.1 - 23 87 33 125
1 35 10.7 - - - 22 85
+ i0 40 12.2 - - - 11 42
2.1 1 Shut-off Head: 30 h. (9.1 m) 38 fl. (11.6m) 44 R (13.4m)
5
i I
s:.oo
0 I ,
10 20 30 40 50 50 70 e0 90 too
GALLONS
LITERS
0 40 80 120 160 200 240 260 320 360
FLOW PER MINUTE e14509A Model 151 Models 152 / 153
CONSULT FACTORY FOR 7/32
SPECIAL APPLICATIONS 3-- 7 4
< 5/8 , 27/.2 _ i 5,
• Timed dosing panels available. 3 7/e
• Electrical alternators, for duplex systems, are available and
supplied with an alarm. - -
• Variable level control switches are available for controlling ® 3 7/6 i
single phase systems. t
• Double piggyback variable level float switches are available
for variable level long and short cycle controls.
• Sealed Qwik-Box available for outdoor installations. See
FM1420. T I
• Over 130°F. (54°C.) special quotation required. ,
u
1r,1 1---- III
i
i
II 11/16 _
i i
15111 ,W 53 Series
15111 153 MODELS Control Selection 4 3/6
Model ' Volts-Ph Mode Am Ds SIm •ex Du bx
N151 115 1 Non 6.0 1 2 or 3
8N 151 115 1 Auto 6.0 Included 7 2 or 3 -
E151 230 1 Non 3.2 1 2 or 3
BE151 T11 Auto 32 Included 2 a 3 151 v 2w+
N152 1 Non 115 1 2 or3
BN152 115 1 Auto _ 8.5 Included 200
r E 152 230 1 Non 4.3 1 2 or 3
BE 152 230 1 Auto 4.3 Included 2 or 3
N153 115 1 Non 10.5 1 2 or 3
•iN153 115 1 Auto 10.5 Included 2 or 3
E153 230 1 Non 5.3 1 2or3 SELECTION GUIDE
BE153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback varable level tlcat
switch. Refer to FMO477.
A CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pas.
e ,n;tallauon of controis, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 0225 used as a control activator, specity dupiez i 3:
ucanseo emctrician. All electrical and saiely codes should be followed including the most
1-'611 National Electric Cade (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
- MAIL TO: P.O. BOX 16347
!jr Loosvide, KY 40256.0347 Manufacturers of,
4n`!' SNIP T0: 3649 Cane Run Road r~
Loufsvdfe, KY 40211-1961 QLW11Y PUAIP6 S~vCE /9,19 ✓
(502) 778-2731. 1(800) 928-PUMP
httpJ/wwwzoeiler.com FAX(502)774-3624
0 Copyright 2003 Zoeller Co. All rights reserved. p g
System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If
problems develop with the adsorption system or any other system components, the installing plumber or the St. Croix County Zoning
Office, 715-386-4680, should be contacted for assistance.
General
Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which
flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of
contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to
settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as
water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type
of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health.
1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure
adherence to contaminant load design criteria.
2. Install water-saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5. Garbage disposals are not recommended; if you must have one, use it sparingly
6. No paper products other than tissue should go into the system.
7. No chemicals should go into the system.
8. Avoid surge flows of water; try to spread laundry throughout the week.
9. Aerobic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans.
10. If septic, treatment or dose tanks are no longer used, they must be properly abandoned.
11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and
heavy mulching may be required to maintain a functional system at start-up.
12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the
upslope natural grade; this will minimize the possibility of the system trapping surface run-off, final settled slope should
be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system.
Maintenance
1. The septic tank must be inspected every three years by a properly licensed person.
2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids
volume equals one third of the tank volume.
3. When the septic tank is pumped, any solids in the bottom of the dose tank and aerobic treatment tank must be pumped, and the
filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning;
initial inspections of the septic compartment filter should be made every 6 months until a minimum time sequence is determined.
4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. This system has an aerobic treatment tank which must be inspected every six months according to specifications and contract.
6. The aerobic treatment system has a blower which runs continuously; if blower operation has stopped a licensed plumber should be
notified for service as soon as possible.
7. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the
pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows
reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than
one or two days should pass before any necessary repairs can be made.
8. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system.
9. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
10. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
11. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system
area.
12. warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or
insufficient oxygen.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
and/or installation of additional treatment components or repair/replacement of the adsorption system may be necessary.
Page 8 of 8
' I
STEEL'S SOIL SERVICE 3of3
David J. Steel Rolling Hills Of Hammond LLC 994200 th St.
CST-POWTSM Nd1/4,SWL/4,S29,128N,Rl7W Baldwin. WI 54002
Lic. #248956 Town of Hammond, St Croix Co. Direct 715-760-0347
Rolling Hills Farm Lot 38 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 N
I" = 40'
=Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
Alt Benchmark Ele. 100.00 ft
0 Top of 3/4" pvc pipe
= Borings
Boring Elevations
BI = 100.40 ft
B2 = 100.40 ft
B3 - 96.20 ft
B4 - o.oo ft
i
c_4- 33 i
X
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i
Wisconsin SOIL EVALUATION REPORT #1878
Department of Commerce in accordance with Comm 85, Wis. Adm. C Page 1 of 3
Division of Safety and Buildings Steel's Soil Service
Attach complete site plan on paper not Less than 8% x 11 inches in 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.
Please print all information. -
Rev
Personal information you provide may be u s. 15.04 (1) (m)). Date
Property Owner FVoperty Location
Rolling Hills Of Hammond LLC. 006 vt. Lot na NE1/4, SW1/4, S29, T29N, R17W
Property Owner's Mailing Address L # Block # Subd. Name or CSM#
400 2nd st COUNTY 36 na Rolling Hills Farm 36- 3
City State Zip ode one Number City ❑ Village X Town Nearest Road
Hudson WI 54 5-386-0230 Hammond 160Th St
New Construction Use: ® Residential / Number of bedrooms ! 4 Code derived design flow rate 600 GPD
❑ Replacement 11 Public or commercial - Describe: na
Parent material Silty sediment and undeliying reddish sandy loam till Flood plain elevation, if applicable na ft.
General comments Mound design, system elevation 101.16ft based on contour line elevation 99.75ft. Minimum of 17 inches
and recommendations: of ASTM C33 mound sand.
F-1 Boring # Boring
Ph Ground surface elev. 99.85 ft. Depth to limiting factor 19 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Et1#1 `EfW
1 0-10 10yr3/1 none sil 2msbk mfr C5 if .6 .8
2 10-19 10yr4/4 none sid 2msbk mfr Cs na .4 .6
3 19-48 10yr4/4 C2d 7.5W5/6 sl/sd om mfr na na .0 .0
F2 ] Boring # Boring
Pit Ground surface elev. 98.85 ft. Depth to limiting factor 19 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. `Etrf1 `Ef*2
1 0-12 10yr3/1 none sil 2msbk mfr C5 if .6_ .8
2 12-19 10yr4/4 none sid 2msbk mfr 9W na .4 .6
3 19-29 10yr4/4 c1d 7.5yr5/6 sid 2msbk mfr 9W na .4 .6
4 29-48 10yr6/6 C2d 7.5yr5/6 ls/sl om na na na 2 L A
i
Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 S30 mg/L and TSS <30 mg/1-
CST Name (Please Print) Signature: - CST Number
David J. Steel 248956
Address Steel's Soil Service Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, W154002 6/12/2006 715-760-0347
SBD-8330 (3LO7M)
STEEL'S SOIL SERVICE 3 of 3
David J.. Steel Rolling Hills Of Hammond LLC 994200 th St.
CST-POWTSM NEI/4,SW1/4,S29,T28N,R17W Baldwin, Wl 54002
Lie. #248956 Town of Hammond, St Croix Co. Direct 715-760-0347
Rolling Hills Farm Lot 36 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 N
1" = 40' I
= Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100.15 ft
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
BI = 99.85 ft
B2 = 99.85 ft -C4
B3 = 98.05 ft
B4 = 0.00
~~N
CDrner
1
N5
aJ J~ ~
V
G~,
keeena and Building Division Commerce PRIVATE SEWAGE SYSTEM County
• afety and Building Division
.s St. Croix
INSPECTION REPORT!- Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 499134 Q
4J
Personal information You provide may be used for secondary purposes [Privacy taw, s.15.04 (1 xm)].
Permit Holder's Name: City Village X Township Parcel Tax Nosh/ d _ _
Rollin Hills of Hammond LLC Hammond, Town of V Q
CST BM Ek Insp. BM Bev: BM Description: Section/Town/Range/Map No.
~ats.~ f3l GAT
TANK INFORMATION ELEVATION DATA Z -
TYPE MANUFACTURER 5 CAPACITY STATION BS H[ FS ELEV.
Septic Iq Benchmark
t~~SE¢. ~S" y: ~ /ail •~d eats . Y
Dosing .s Alt. BM
Aeration
0 • --X Bldg. Sewer
k-
Holding Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet .1S • 40
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic t i
fi o?oZ Dt Bottom a + 25 26
. $ SfSI
Dosing Z' 13:5 g q ! / Header/Man.
Aeration Zb (O
Dist. Pipe
Holding
Bot. System
-7 (W
PUMP/.SIPHON INFORMATION Final Grade
Manufacturer f9tA.!_.DS ImNand St S°
Ver L+".. M&nh
y~V ss • y
Model Number
W ~p ~•!Z. ft ~ow~'ouT 5. ~ ~f
TDH ift Friction Loss System Head TDH Ft
lb. l(P
.4j -7
Forcemain 1 Length ! Dia. it Dist. to Well i
L. rs. 5 • 3
216 Z 1,35
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r longth • No. PIT DIMENSIONS No. Of Pits Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type/Of ystem: i
/L>O r UNIT Model Number:
t 1 OJ 3~/ 1141,
DISTRIBUTION SYSTEM r d D D • w. 9.bz
Head.r/m'a((n"d D(
Length 7 Dia Z r! Prpe(s) 4 1 / x Hole Size x Hole Spacing „ t to Air Intake 1
L- 0 S ~ Dia Spacing 'ZZ ~S
G e.~ w
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulled
lBedrrrench Center BedrTrench Edges \ Topsoil I Yes
No wYes ®No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Z ko 1 coon #2:
Location: pg 163rd Stmt Hammond, WI 54015 (NW 114 SE 114 29 T29N I 111,1111111P), oiling Hills of Ha Ord Lot 38 Parcel No: . .445 ~n s
1.) Aft BM Description = 2 r /v tc~S ~ ~ .5~ b A-
~OT
2.) Bidg sewer length = D C` r`5 j 1-
- amount of cover = $ p~-, ~"O •J C W-C plow ov
dtl~
Plan revision Required? ® Yes ® No
Use other side for additional information.
SBD-6710 (R.3197) Date Insepctor s Signature Cart No.