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HomeMy WebLinkAbout020-1448-32-000 (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 (1)(m)]. Permit Holder's Name: RYAN & HEIDI BULLIS City Village Township TOWN OF HUDSON CST BM Elev: Insp. BM Elev: �i � BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing I Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing i Aeration PUMP/SIPHON INFORMATION Manufacturer Demand I GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length r ia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: SAN-2020-100 State Plan ID No: Parcel Tax No: 020-1448-32-000 Section/Town/Range/Map No: 32.29.19.2865 Bo BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � SETBACK SYSTEM TO I P/L BLDG WELL LA E/S RE 'M LEACHING Man actu er: INFORMATION M CH BER R UNIT Typ Of System: t; del Numb r: DISTRIBUTION SYSTEM Header/Manifold yy11 Distribution x Hole Size x Hole Spacing Ven to Air Intake � Pip T Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Bed/Trench Center � IJ�'7 Depth Over Bed/Trench Edqes � �- xx Depth of Tepsoil-�____s� xx Seeded/Sodded Y.e o xx I ed �i Yes 0 No i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 645 COBBLESTONE CT COv%c.4l-t rpm` 1.) Alt BM Description = 2.) Bldg sewer length = Fat >A - amount of cover = 7) !BO." 30\ Plan revision Required? � Yes XNo 67 21 Z Use other side for additional information. Date SBD-6710 (R.3/97) Inspection #2: Iy.U� Ih W1'Y�� Cert. I I N - :Zozo -100 my Sanitary Permit Application ST. CROIX COUNTY WISCONSIN with Chapert 12 St. Croix County Sanitary Ordinance �� PLANNING & ZONING DEPARTMENT Personal info ation you provide may be used for secondary p ose ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m 2U2� 1101 Carmichael Road ���Z 2 8 Hudson, WI 54016-7710 A"1 " (715)386-4680 Fax(715)386-4686 Cnorkitach co plete plans for the system on paper not less than 8-1/2 x 11 inches in size. Commun PP9rdy(80A w1nit # ❑ Check,if revision to previous application I. Application Information- Please Print all Information Location: Property Owner Name I r ' �E9 � � � U � � 1/4 S�'1.�1/4, ( �l `Sec T QC % N, R 91 E & 1 (or) Property Owner's Mailing Address Lot Number Block Number Ads i q So C v3�a TO Q � C 7d 3 z 1. rr , City, State Zip Code Phone Numer Subdivision Name or CSM Number f�v so►v VV/J S'y V4I0D i)tZ �o I�NT 15 II T e of Building: (check one) 1 or 2 Family Dwelling No. Bedroorryt;(,D \kLL4ll L4 i ity El Village ❑Town of - of ❑ Public/Commercial (describe use): �/ r )� A U ol,% ❑ State-owned Ned re t Road y— C 0 X1EJ, v IJ 6 C II. Type of Permit: (Check only one box online A. Check box on I7^ all pblic e ID 1 Parcel Tax Numbers) 2� b A) 1190 Repair 2AReconnection 3.❑Non-plumbing 4. ❑Rejuvenation (t B _ 3 Z_O© I Li Sanitation B) Permit Number I Ad State Sanitary Permit was issued 911 11 Date Issued I Zs Zol previously IV. Type of POWT System: (Check all that apply) l+ , 21. tq ,ZZ05 El Non -pressurized In -ground ,K Mound z 24 in. suitable soil ❑ Mounds 24 in. suitable soil ❑ Mound A+0 i7 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolati n Rate 6. System Elevation 7. Final Grade Required, PronnQPd (Gals./day/sq.ft.) (Min./inch) �-y�;.9 �..f� Elevation If. I. D .aI Vi. Tank Information Capaicty inlGallons Total # of Manufacturer Prefab Steel Fiber- Plastic Gallons Tanks / : % Concreteed glass New Existing Tanks Tanks Ufs ESitoon- VII. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non -plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non,pludiddribing sanitation system. Plumber's Name (print PJt�rtb is natur o sta ps): M o. Busin ss Phone Number Plumb s A ress (Street, City, State, Zip Code) � P�i, ' {�E�SE1 Vill, County Use Only ❑ Disapproved Sanitary Permit Fee Date Issued Issui g Age4tignat re (No stamps) Approved pp lVvn a-IuifiaLAdvP� er �(� J 'U%/�. `'- �"� Deter ation . IX. Conditions of Approval/Reasons for Disapproval: 3 ) /', � /� I I S` � � Vt �I'`""' V e -r '.� `� Je SYSTEtvt GW"�lER: n NNtt / 1. Septic efflue+41 filter a o�1/irairtalll� ' \/ ►/ �� �] (� i #.A! re dupersa! r.ell lumber. �C L I - tri ` �J rant a!an provided by p: enict._ ,Jr. per managerr All setback rett, i errents rnust be maintained 1 ' 2, as per appllc0abic fd�� Rev: 8/05 Holdings z'ank: Size: Gallons Manhole Cover: Q Replace ❑ Locking Device Cl Warning Lak+el Alarm �'unationale D Y 0 N ][nfiltration: ❑ Y � N DOBing Tank: Sipe: �(' Gallons Manhole Covex_ D Replace ❑ Lacking Device © Warning x.abal Alarm Funotionrsl: �� Y ❑ N Pump Functional: ,0\Y p N Infiltration: ❑ Y ❑ N get Total Area: �� ��� Pending Depth: in. syeten� Dopth selaw Grade: �Z in. vent/Obsezvat.ion rii.pe Functional: Y ❑ N Seepage or Surface DisChaxge: ❑ Y p9'.N, ar�tentiai Replacement Area Available: �Y ❑ �i Corrunsnta and Recommppendations A/ ` �� q,,1' L -.. 11'x,o.(nn,dl � inn V C A � /'19A l-t } [ll4 /')Yli N' i %� �! � � W v �� Certification and DisGlsS,mer 1 c:GrL11y 1.l►dL Ll�a aL-u•ao i fo atiot� is truc asld aorract to tho beet of my knowledge ae observed on ,--3$'F Operatio�181 aspects and observations reported ar b ed on the oonditione noted, at the time of inopoCtiOn_ 'rh3.fl inspe tion dope not i n any way guarantee or Wuarantee the continued ot>eratiori of �he system de�cri;�ed herein. ir�a Biytwtuz9 5 0 cnica �ctf� xha nNrtiro �nn,� 967.f,�Ab9LL TS�60 £Z0�/Lti/S0 \,. ' � x .� s -� .�L n.�' � ],rs �. � rn ��a��G��C?Z1 Rr-�po�"t Sa, ckground Information owne�c' a 1Vame: ��J►=41'JJ, }-�EI � �(JCj,.�S county: gT Cf2,� � _ Address: CDC �JI tt.:�.�� NG-- � x� pr Q �-I U�S�Iy City r Grste: TTIi��� � �� � Legal : iJEs � S'�✓� �� 29' � $�� -- � 21p Ct�de: � Parcel I.D. No.: �(`� ��y8'^ �-�(q Previous owner's Name(s): ��i� �Y ❑ N �X ❑ N QYN p x N Building Currently Occupipri? Typo of occup©ncy: �. Permit Tnformat�on Available? Date of Tnetallation: owner Interview i3aClc-ups? ❑ Y N Freeze-�tpa? ❑ y Si.ow DrainagQP C1 Y N Foul ddara? p y Date of Laet Septic Tan)c 3erV'iCing: other Comments: to • Bee�,aye� N OthaX? Owner's 3igz:ature: lJBte: Orieite zY1g action Typo of 1?rivate Sewage syarem: ❑ Bciow tirade ❑ AL -grade �;(, Mound ❑ Dpeed q Pressure ❑ Gravity 0 Bed I7 Trench � ❑ rit ❑ Bolding Tank ❑ Privy ❑ Other Taant�nent Tank Sotback Compliance: � WeXl ,� Building Lot 7Gina j®(, Pvol �� Surface Water � Other Doni.ng'Tank SetbaC3� c:omplianCe: � Wel]. � Building � Lot Line pool � Surface Wit®r ❑ Othez RA.^ti s�kback Compliance: � Weil '� Building � LOt Lina '� Poo1 j� Surface GPater CI other Explain Other(s): Component Condition Treatment Tanks Size: �� Qdd Gal�,one Baffles: —'functional p Need Replsoement Manhoi� COvart Q Replace ❑ Locking Device D Warning babel ' znfiltration: (� X 0 N 0 Cf? /7 fA 7ClHJ uHa r,tiTnim »nna 4n7.��Rn4 T� TG :FA F. LA7. /1 T. /GA C53 C r a . F N/ ^. 3 0 3=0 n� 91 O O o9/L t -1Z x O I XZ-Z I -t9 @ Joi I SZM'd 0 J M �- Ui v N O) z o m ---- N m = m �7 N O � r = 0 l9 V K _ i -��N� t o p= 3 0 N O N = U tO O U Q F- N CZ x Q O UU Ow 07 U OW 3m (V - m v m r I©2016 Copyright lain's Drawing Room, LLC 2,413 sq. ft. Lower Level � 2,542 sq. ft. Main Level LOT 1397 sq. ft. Upper Level LAYOUT 6,552 sq. ft. Total RYA/Y & pEIDI P�ULLf #16-111 � lain's Drawing Room0 RES�DEfQT19L• C:612.718.9B25 0:651.653.1241 DESIGN i &Daarriv� iaingiainsdrawingroom.ram 'r' O O N ©2020 Copyright lain's Drawing Room, LLC 2- 117/8" LVL TOP @ 8'- I 1 /8'1 �l 111 (lll /8" CEILING NEIGI-1T 3 r 194sq.ff. ,/'torage � FLOOR �� �: � lain's Drawing Room•« 2O6 s�. ff. �atn � bar � � RY�►/Y & � E I D I PS U L L f € n I RFs�DFrmac C: fi12.716.9825 6: 651.653.1241 400 sq. ft. Total DFSKiV &DRAFFM iainNiainsdrawingroom.com