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HomeMy WebLinkAbout018-2019-68-000 . Croi X, Y,~~seersir :)ep_h., un•, Cl Co^-ercc PRIVATE SEWAGE SYSTEM co-urt, - St safety a,m lirr e,-g Civisiuu Sa-itar~ Perini! No INSPECTION REPORT 605169 GENERAL INFORMATION (ATTACH 10PERMI1) State plan ID No. 1357947 Pcicoral i'forrnahonG,, pros de r••aY ce usetl b, scrrnc.ir: pr.rposes IVrr:aty Lz'.e, sr5 (A fl;Imj) Permi:llacer; Na•-c Ci:y Vtl age Io,-sh p Pa-ceI Tax No. David Werner and Darla Peterson TOWN OF HAMMOND 018 2019 68-000 CS-B" rie• Irso. -151F7.1 . is6A Cesaiat on ~q ( Serlar:TVxn Rar.crM2 . u P✓ IILta✓~ol a co') 29.29.17.1268 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,.nlS CAPACITY STATION BS HI FS ELEV. JJ t L O ~2 Sep' c L./ e5C-~ ©0..Y f y~ Ci 7 J Benchmark p . Dosing All 8tv1 ~7 T Bldg. Sewer . 7.2 -c7J , O$ Aeration Holding f Stint In'et . 7-7 3 (,03 svH:ou:et 7•`E g3,S3 TANK SETBACK INFORMATION FV WELL BLDG. Air like. ROAD Dt InO ~ J A Dt Bottom Header: fwt~~an t 'K-- 9 • ` Onrteo Dis'1Pipe - Bot. System e 5 1 Finai Grade t` PUMPISIPHON INFORMATION 5DHL re. Uemand St Cover - GPIv1 Ey mber X' ' , i f~ •~5 6 03 F'r;horLoss System Heao TUIILength Dia oist. •lw^ t--- SOIL ABSORPTION SYSTEM PIT DIhLENSIONS Nn O Inside Uia LigdW O~Pth BED:TRENCH Lcn I' No 01 Trenches sJon . DIMENSIONS SETBACK SYSTFM TO V1L BLDG YELL LAKF:STREMA LEACHING `darilacldrer CHAMBER OR INFORMATION Tyre Of Sy£em / UNIT btrce' Nl,°'he'. DISTRIBUTION SYSTEM He:_der'K.a°rt0'p GiSCiC..tio•. Ix Ilo.n Size x H'~e Spar r6 `r'u"1 :c 0.ir Make P ua:a '_cngtn_ Da__. _enyp, Da SPac rg ' SOIL COVER X Pressure Systems Only x Mo d Or At-Grade Systems Only ax .,lukhed CeoP' Over Unat- Uvc' t x.' SeecudlSudtlcc Yes Np ISetllLencP ltienfe' God: re 1oh E7dcs Tr~soil Yer. N, : COMMENTS: pnUUde code discregencies persgrs present, etc. Inspection A'1 Impact or #2 Location: 1641 75TH AVE E z GD ✓ GtA W~ SG(uw s 1 ! At BM Desviption 2.:. Bldg sower ang:h = ZL'• - amount cf cover = /Q to -1 Plan rev son Requiredn Yves o ' I 2L) -7 Use otnef side for addlUOral in`ormation. - o e- - Insco^ is sign. a Cart No SBJ-:?'r R 3';T1 r r 11"Arv c~ I 1 0? FS Courts Safety and Buildings Division ST.Croix ( 201 W. Washington Ave. -P-0 Box 7162 Sal l.'uy Permit Number (to be filled in by Co) ~,s~ Itip Q6 Z~~B Madison Wl 53707-7162 - ~ Stale'I ruisaelmn Vuml+cl nita y F'crTrlit Applic !35 7c1 y~ In a d.n•.:c ++oh WS 181 lIIJ 1 l1 n. Adm. Colic. sul+miscl to o l tl i> l i,ll to it. ro nlaI uwt r+ywnd (nlul 1. ohralinng a ,.t1116rI+ rc n Note mu0.d to Pmtw Adihm% (If ddTercnl tlwn milling addica%) lh III., brcn: ,I S-.d 9•, au 1 Pr I+ssa+md SI I I Ii.....1 minmralino <wI prmnde may be owd fm scvun(II pugxx ,~'uun-c++n l11 f..Plcv l.uw+ I SI)411)(m 1. Swls (yam I. Application Information - I'lease Print A lrmation Ate - I'rnpem (halo'. Nan!, I",tree d David Werner and Darla Peterson la-201 9-6 -000_ / Properly Owner's Nlailillr, address propem I ocaurm l C1. J.' 7r ~r~ti N 7929 588th St. (rnt I'll - / 1 (liv Smlc Tpl .xlc f-IiI Number NE SW -I,. Ssoon 28 +iraic oncl Menomonie Wt. 54.751 612-964-5378 r 29 N. It Fine If. I %pc of Building (check all that appl)) Lot a 4 Suixhvlslon Nanlc 11 ur Iamd+Dxaclhng Munlxr o!licdnmms ~f 6k HlockN Rolling Hills Y~t/M Ipubho'Commo l Ikxrltm Iac VsI HCity if l ('SN Vnmlx~r H Vdlagcol '.~SlI.-o.ocd I)+•s+ow Ilse 1- 411 L1 folio of _ Hammond Ill. l'ype of Permit.: (('heck only one on line A. Complete line It if applicable) Nac Syslrm ❑ Repl:+cemenl S+.tem 1, I'rx.nmeno7 l,ddutg I:mk Rcplacunent Only ❑ (aher M„ ddlcation In Fxlsnr+g System (explain) I r t Ploclous 1'crmil Number arxl Date Issued R. F1 1'aunou II +v:J t]14.nnu IL u:,.;, U<-Ivurre ul'Plumt•er ❑Penn. -Ioc ler w Neu Bcfxo I.xF it lion (Amlcr IVY of fi IS Sy stclulComponent/DI ice: (Check all Thal a_ pply) U Nlm l'rv~wnzed I- Gr.xmd Fl Prc+s:In.ed Ill cowl ❑ :V-Oraak I-1 Mound r4 hr. of scalable w ll © Mourxl =olluAlbll (cxp:un) ❑Ilddnry,Tmlk ❑Other Uigwr.al l\•mlxmcnl Icxplam) ❑ Pictcatmcnl Il MM."" N'- DispersuUi reatment Area information: De,lgn I9nw ly,p+l)~ ~mn S...I applmabon R:nd YFxlsl) Urspers I Anu Rcywlcd (sn Uispcrsal Amu Ropoxd (sn Syslcm I lel-liun I~ /Il installed %T Tank Info ('slxl uy nI 'Total a of M:mufiwlurtY u c 6.11"n, Gatlin, Unit, Nev. Inik+ Ib-.uug Im.ki - c u~ u ~ 8 m septic HI..g link ATU Hoot 600 •,s _ X_ Ikauclh+mMr - Y 11. Responsili llry' Statement- 1, the ondemigurd• a un respio siluIi r idsullaoon the 114)N% \ xho 'o 0o Ihr Wlxbed plans Plnmlw1 s Nam (Prot) Plumly ~l ~os+I MPiMI'RS Numhcr liormcss pica. NuolsI, / _ / w Keith Knudtson 6415443 651-470-1737 - L~ plurnh+r - \d,l ISircct,('ay Sete,/Ip C'•.dc1 927 150th St. Roberts Wt. 54023 '(r4wjt- _ NIII 'oun h • .r-hRa /Ue arlnwnt lase Unh - I'anull¢ Dale -sued 6,im Agent Stlowol Appr, l Lwm`i< L..:,a,rl lLr 1... al yoo. O~ J~ J(/ 1\. Condit ) carnup rnr J)isapprnvsl 5\ , nv ~t - A t 1 ark eTltxrr. I t n 1 J (~M~7 Ciw dspet iarCell nl, -UM ap be is s 1.: M 1 1 ~1 as per ,~ar 3yeme.e pie +iae7 r~ rl Doe: Q~. ) n 2 All uttxx)c recur.cens moat t:~ - rr l e c o as per sKilorbl, c of t : rd ;aaN tr, x OtQ V I . %lulb 1 .,Owl plain ror /bc sy+tem end svbmil m Ihr ('only lady uo paprr I kts Ilea % v: r 11 Iacbo in +Irr Slil) 6 :ex (R. I V 1 I 1 y~~ _F f;JL of ~G G E / ! 1 1 'I I I ll ~ ~ti LtJ C'I II i I I I I I I II 1 it jp 1 ~6~ _ 1 it I r U C~ o / y> 7e T~7 c~ ROC3 EFTS. IVI 599?3L.S::r; CELL 651:T0-I i:;/ 00 a l \ \ AIR 1;.► 1 \ \ bol 41 \ \ ! \ ! I j Icy I 0 \ \Y\ 11 I w I \ \ II _ -1080- Wastewater Services POWTS INSPECTION AGREEMENT The coned uperadon d to Dabw egiip aft wig - iAuanues the ile of to awalowdar sySAM, Purbdc aspelos wi Delp adeid the No of the syslwn ad prevat the need for Coolly % The a Wee est atlvaes ekes b your P(WrM eth¢et by a bayed and =Amfb ed Poloaan ledaidnh drag drA t hoes to ptonu>e togta iepaebus and rmdm reaidaearvoe io help a.svac the equomat s waking prepcdV . bmre~afoo agneed ~payn atbetween p dedtor hem f Novider l pwolde the s of Ddoxy 4n*w l nerve b perfmw pabde ispec§Dm d the egcepnrrt deacobed Dafow- Service PaN def wi Memo a sorrel report aver ew h napecion and prattle a copy of to report b bve PuclUND" The upat V uerlaih r caveeldfims for a y ophratmh and moiienatce domed a pnipivle by de sepedoc Tee agmnot does ml amono any tespaerbifes ar obfgabots that nee hohnaay Me tepoffalAbss of Purchaser ad does hrt aced b runs any cotta Owe may be assodoled wit? ary hncounihrJdadots made sdrryhs sgeomenL in no eves[ shat Salvos pt "aw be hesparhwjb for any sperm - ammogeor ad usages. idurrg but not iced tq bss d f;m, qsy b pe(san m ptapeity a khddatut ecorhohhtc bas dB b epipssd tadue a iv athy abhor armors vletsoesha- Service plwider uuraw supply addMonal smvices, pals or lebm arty alai aloirallm by PuPchaw./ Th-s agteeesr - stet hme ih n force lar a period at yes. begwwn -&(r~ 20 / D sd wi a l omebray mncw each year toedbr for are yew utess carded by eiter perly wih at least 30 dwo awMen nowt 'this elreaw ut o ey be uSCt~ed byte Parlhaear sty I hrpieed ill a sahiot a9 , scar an slhmiaad service panda for the equipmart Cdhrl below. Survie Pnsilof fRof delay OF CWHX i futmh ispeciots t peyhrrst beconhes at least 15 days past doe. FeeioAe YapeeSo.s The Pu rctas r [pees tapay Service Presider $_q~-- pa is perfon for fur (4) :specious f= the ist bw yeas of sa nwrd h:6arvata end arse (1), riparian each yea tar seaftw Payment for 4m first ono yes d iapocfas is dale at On ie of ihstadfa[ atdiod psymsMa we flue upah ispadlm Any additooht laabhig arsavioas heQiad by Pmdm or vi be hied based an fee and awberval arurta / / Dole Serviioe Rovifm Sf_[ - pla+e -AC76.sri, LLC Address mar nani S! E+7a'c~ C- Slide Equipmeft COvwrad Ua1dK TMs armPban Model Ma. Serial its. bahr Daft ~ r ~°ahNmm Spelem F 7- --F~420± ♦~M!f: aw fw.. va LtJe~~~l NOW J ~ ah,.! Fat ehiaca.aR B~! _ I ST. CROIX COUNTY SEPTIC TANK MAR4TENVANCE AGRFJ%* f AND OWNERSHIP CERTIFICATION FORM OwoedEoyer David Wemer and Darla Peterson Mailing Address N7929 588th St. Menomonie Wi.54751 Property Address (V aifcaioa regened bom Plammog & Long Dcpcrmear lot aces coostrac non) cilyf%tate Hammond Parcel I&Wtification Number 018-2019-68-000 LEGAL DFSCRIMON Property Location NE SW sec 28 'T 29 N R 17W, Town of Hammond S.W.isiatt Plat Roiling Hills ILEA # 68 Carffwd Surrey Map N Volurrw Page A Waivaaty Deed M (before 2U07)Volurne Page k Spec bourn OY-0- Lotliaes ielmtifable0yeow SYSTF.'M MAINTENANCE AND OWNER CERTIFICATION Improper use amd maataoace of yoer septic system could result u as premaue failure to kaoalle wastes Pn ruutle cots o(pnmpiag oat the septic tank every tbrcc years or sooner. if needed, by a licensed peeper. What you pt two the system can affect the fumcums of the septic tank as a Beaumont sine is the waste disposal system_ Owow mio4aaoce responsbildies are specified m §SPS. 33352(1) and in CMpeer 12 - St_ Croix County Swritary Ordinance- The puperty owns agrees to submit W SL Quvi County PWwmg A Zo wng Departmast a certirkabon 6rm, v% wed by the uwra asd Ay a umler phnaber, Nurutym>o phssba, restricted pI I m a lic®ed pnW= vaifywg 16a (I) Ike am-side wastewater rbSQosa sy9em is is ptoper Des msditim eadtor afk7 impecaon and pumping (if army). the sgare tank m lest than 1/3 full of sludge Owe, the m lwAped have rod The above regwr mem and agree b mmieta® the Pena! seway;e dtposal sysita with the stiederds so Furth, baeir. as set by the Deparaaent of Safety And Professional Services mad the Department of Natural Resourcez Sucre of W isoeasm. Catifc tios sattag that your scgbc system has been maisamed most be completed mod reaaaod to the St. Croix Coeaty Planning 3 Zonin3 Dcyamcr ' 30 days dust three year Ii - dine. live certify thus an sat®mt this rum are true so We best of my!oer knowled.^e Uwe am'am the ewe r(s) of the property described above, by virtue of warranty dccd rz dud m Revjster of 13,& Office, `Ywfi* of bgdrooiiw; _ - p SIGNATURE PPLICANT(S) DATE "'Any uformah n ma is moreptamded may result is the sanitary puma been revoked by the Plasm & Zonimg Depaeem_ lachrde wdk thn apple auras a recorded warramy, deed from the RegWa of Deeds (Aliim and a copy of the catdied survey asp if reference is made in the wwrmny dmd (RSV. wIZ> waconsl97epenl.aml aCannxOrce PRIVATE SEWAGE SYSTEM Cuudy St. Croix Lary east rl.Aling DrvlSion INSPECTION REPORT SnniLnry PearetNo OIL- GENERAL INFORMATION (ATTACH TO PERMIT) slate Plan ID No Prvxnnal n(pmlalioo you Mo a maybe uw:d Inr xeGOndary puroosas (V,ivlrry t.aw. s 15 oa (1)(m1) f PrumiUbldw's Narre: City d0 X 7oemehp Parcel Tax No Rollin Hills of Hammond LLC ViilaHammond, Town of L C•T Tit n CST BM Eloy Insp. BI.1 Lie-, BI.1 Doscriplion Secho,7O 'RanpaMtap N ieo . reS e) - I CST 29.291 TANK INFORMATION ELEVATION DATA TYPE MANUFACIURLR CAPACITY STATION BS Hi FS ELEV. 5% It /oL,9S ieo• v5 Septic Benchmark /L12S L.5 Ip7.15 iito .ceS nosing q Q / Alt. BM Aerate Z (E . _ L- Bldg. Sevier S• s~~[ Axaa~V (p / Holding (~U SU Ilnlet~ ~05• / (,v Y SVF U tie: TANK SETBACK INFORMATION 7 3 Ti $.13 TANK TO P& WELL BLDG. Will 5u 9r Irene. ROAD Ot Inlet vr` ` (03 •3S pliC / x j5 DtBottom 13Z Jaoo 10 57.0} Dosing 113 11 7S LAI' HeaderfMan. k 53 V n 5 / / 3L r )o ! 10 ONAZ DrsL Pipe 9 /Q/ • (oS Holding Bot. System SS ro(.e5 PUMPISIPHON INFORMATION ` inalGrade / 3.9 o2.~S Manufacturer 1 _I Demand s i c ovcr Cf• 67 ~Ox~ ~ T~ f,PM yC ? J Model Number W r$S •1 a •Q - 15 TnH Li tdclg I oss System He I D ! FI G b 7 Z Oa b ~y 57, a-S Rxeum;an Ler th / Dia. DA Iowan ~ - . 3 4.3 T~ 63.38 SOIL ABSORPTION SYSTEM C a /St. fn BED/TRENCH Vlldm Length x No OI `turn. PIT DIMENSIONS No. Of Poo lollop Go L'xprxl Urxllh DIMENSIONS ~Q /z p SETBACK SYSTFM TO P.9 BLDG WEL I. I AKE?STREAM I CHING Manuladi emr INFORMATION Ty VIS"te 9d! N 74i 7/d0! N~4 al R M Abdel Number a9L DISTRIBUTION SYSTEM on!~ Lai. (o$ 4.6 MLD- C14-, 11 I.IwAaeni1y10 y Jixa tatbn b I I* Hot Svc q xYdo Spacma V Air n v I.anglh~Da ~r 5 Length 58 • 5 pia v SpaG^d__ SOIL COVER x Pressure Systems Only xx Mound Or At-Grado Systems only Depth Over Uxxtlh Ovor xx Depth a xx smalerl'Soddetl xx Muk. o BosTieech r-Me, /l / nmYrrtvr:b rdo- \ Topsoil I fl ~Y~eSS K No 'X Yex rr Nn COMMENTS: gndude cone discrepancies, persons present, etc.) Inspection a1: I /A.Ilnapecdon a2:_ / ~U Location: 1636 7581 Averf we Harmnund ll 15 CIE 114'Sy! 1!a 2B T 29N RliVry Rolling Hills Farm I of 65 F\I`S Parcel No: 2929.17. 1.) Alt BM Descnplion - wa'/K_• 6✓ 4A( Sr 1 ~ Aiak_ 40 DT P/ G; 2. ) Bldg se"r length = 05 -amount of cover= ' LO~ `7 22.TZ 83.'73 /Ylosi FoL N a. b gam. Plan revision Required? Yes No I 4 l 1 11 I (O lisp other Sete for additional information, _L_ ' Dale In x Sigia m Ced No SHU-6710 (R.(Y971 1 7~ IS I _ s .r o ~ IU 111 1 d N J 1 ~ 8 J o t l s- ' tl C , -3 ~ h ~ w n t t 1 r i CR 1 / t~ ~ ~ ~y 1 J N J c. - f ~ C d r t ~ i ~ 3 y( a Jl J( D 1 I+ nn ♦ j i W ~ y f ~ p AG iJ -r ~ 9 i S 20-g ~9 CI-j -~i 3 ~ 33, ~ ~s s 1 i o 5 a ; cI 14 c ar~ 'r 'd ~ .9~ ~ Z ~ 0 y r Sately and Buildings commerce.wt. v 4007 N KINNEY COULEE RD LA CROSSE WI 54601.1831 TDD 9 (608) 264.8777 'scons'n wvw.wisconsrn.gov l~ Department of Commerce Jim Doyle, Govamor Mary P. Burke, Secretary February 09, 2007 CUST ID No. 222774 A71M.- POW7S 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 P Numbers i PLAN APPROVAL F.XPIRFS: 0 2/0 912 0 0 9 identification Transaction ID No. 1357947 SITE: Site ID No. 721805 _ Rolling Hills Farm Please refer to both identification numbers, 16M Street above, in all correspondence with the a cue . Town of Hammond ' St Croix County NE 1/4, SWIM, S29, T29N, R 17W Lot: 65, Subdivision: Rolling Hills Farm FOR: Description: Residential Mound System / New construction / multiple homes - approved for 12 bedrooms total Object Typr.: POWI'S Component Manual Regulated Object 11) No.: 1114594 Maintenance required; 2,400 GPD Flow rate; 23 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2. 0, S8D-10706-P IN.01/0l), Acrohic pretreatment unit Tiro submittal described above has been reviewed for conformance with applicablo Wisconsin Administrative 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, scats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the component manuals referenced above. . The 0.75 Biomicrobics pretreatment unit must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. . Comm 83.21(2)(c)4. The application for a sanitary permit shall be accompanied with documentation that the master plumber or master plumber restricted service who is to be responsible for the installation or modification of the POWTS, has completed approved training on the proposed POWTS technology or method. i e Comm 83.21f21fc)5. Any maintenance requirements that the pretreatment unit requires at an interval of 12 months or less must be recorded with the deed for the property. A cony of the document must be presented to the county beforethe ocrtnit can be issued in accordance with the rcauiremcnts of Sec 145.135 and 145.19 Wis. Stats. • 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. RO.W.T.S. Conditionally ENEEMNimm ® V T Y - .V DEJ T I ?i 'I S ' S i ' S Q I I <S7 a, , v • mss: - fi ~v • I ~ Y ~~~~.f ~ f - h i s p y. f 7 s 1 t i sf ` ~l 1}i 343 l ~ Q cs.'iL7 ~i H~~ a J` it W n o v / t% j i 1 ~ I i '3 stF~t i~z .3 I Q ! o - - w a lyg a ~ ~ 4 ~ t Y~-74 t _ Y r l - = - Y~ : I $~ci~E~iif~F m t rr ~ I uf`tf£t ta•t~ ~ttdi~tl