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HomeMy WebLinkAbout018-1083-15-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division r) INSPECTION REPORT Sanitary Permit No: SAN-2020-1 32 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: /_ a' Personal information you provide may he used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 6 QL Permit Holder's Name: City Village Township Parcel Tax No: Jim Berilacqua I TOWN OF HAMMOND 018-1083-15-000 CST BM Elev: Insp. M Elev: BM Description: Section/Town/RangelMap No: �f.40 D-r ioAlofli 16.29.17.587 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Xy \ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing X� I n Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number max' I S t yr\ -r' 3-7 TDH Lit-6 7 Frictjo n,LL System Head TDF t / Forcemain Len t t Dia'2 tt Dist. to Well>t0ON SOIL ABSORPTION SYSTEM e t 7, 5 t —7 ELEVATION DA .7 1112 • 7 STATION BS N.3 HI FS ELEV. Benchmark tp Olot Alt. BM)iCr iCv �.� . Bldg. Sewer cy,s SUHt Inlet SVHt Outlet t X\ \` A; Dt Inlet Dt Bottom Header/Man. A (.I R Z g. Dist. Pipe Bot. System All h 61 .3 Y7.8 Final Grade - . 2• /ou. Q a lHC ' 3.3 yq • rZ �IOUS !�2- S Vv. cTS BED/TRENCH DIMENSIONS Width t Length , ([/�G, No. Of Tr hes PR DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ._!L SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer.— INFORMATION CHAMBER OR UNIT L 1+7+ V-k Typ Of System: U�1 7Z' (�/ t Model Numh L'Iows COON �W DISTRIBUTION SYSTEM COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over BedlTrench Center ^- Z I Depth Over Bed/Trench Edges > / t l xx Depth of Topsoil xx Seeded/Sodded xx Mulched Yes ®No `. COMMENTS: (Include code discrepencies, persons present, etc.) �—`y-�In-s'pection #1: Inspection #2: Location: 173096TH {rAVEE' �xII -- "-^r` 0J.30J x v • /, 1.) Alt BM Description = it l �( (IV-,(- --V'eVt�j 00 fit) 4-� 2.) Bldg sewer length = Ext - amount of cover=t/M�l / L'4' Ui""_J AA Plan revision Required? ❑M Yes AL No Use other side for additional information. �✓ I _�____ _� �� Date Insepcto s Signature Cert. No. Ste' O 20 -13 7- SY 1. �,. " Safety and Buildings Divis'ani Ctntmy � - Smhmy PamitNomber (m be filled m by Co.) s c 201 W Washin9ton Ave.; P.O. Bex 7162 ^ MAY 26 2020 • Madison, WI 53707-7162St •� �� Z (7nal x Count. lU Ter enN®ber Comma it Application 1` In accordance with SPS 3931112), Wis. Ada Code, submission of this form to 00 apprsprtae gdvemmeaw unit Pmjeet Address (if different than mail address) a mquled prior m obUming a sanitary pemit Note: Appl(oatim form for state-owned POWTS are submitted to the Department of Safety and Professional Servies. Personal information you provide may be used hrr secondary immoses in accordance with the Pri Law s. 15.04(1 m Suds. L ApplUcartion Information - Please Print All Information iA Property Dwae's Name I N parw d �- 19 — 8 ��~ a` , 6 evi r4-c t C Property Owner's Mailing Address Property Location F y,, v,� g�oco¢qL17 CitY, Stater Zip Code Phone Number .. \J L' Lot Y 11 of Building (check all that apply) Family Dwelling-NumberofBcdmoms �� Sub/4 ivnaon�`ame Block{ / /' ❑ PublclCommercial-Describe Use ❑ city of ❑State Owned -Describe Use CSM Cl of ' Number IiI. Type of Permit (Chet Only one box on line A. Complete Use B if applicable) A. system - System ❑ TmtmeoUHoldmgTaak Replacement Only ❑ OdrerModi icatimto Exisciog Sys (=,plain) B- ❑Permit Renewal ❑PetmaRevision ❑ Change of Plumber ❑ Permit Transfer m Nea L previous Permit Number dI1ac Tssued Betme Expiration Der 50f9o3 z� ofPOWTSS stem/Com nent(Device: Check all that apply) la-Grormd ❑ Pressunged In -Ground ❑ At -Grade > rade ❑ Mcd24 in. of suitable soil ClMound <24 is of suitable will ❑ Holding Tack ❑ Otber Dispersal Corrp®ent explain) ❑ Prareamnent Devi ( lam) V. DispeniaVrmtment Arm Informatio Dead Flow (gpd) Design Sob lieebm failefipciso D" persal Area Required ( Dispersal Ares (SOS a . VL Tank lmfo Capacity in Gallons Total Gallons # of Units Mamufaamer Ncw ranker Fsieoag T.aks _ A—t�er SS �e rn i=c F s�r„erB°wens T'°k /LT' / Dosing Chmba 16,30 VII. Responsibility Statement- XIbe wdersigaed, a posafbaity for installation of the P6wTS shown on the attached peas Plmmber' Name (Rim) Pl ' MP/I.1PRS Number Businms Phwe N Av Phmber's Pddrcss (Street, City, � Zip41-Z` - Jl,/e�� s& VIIL Co /De rhnent use only ,Approved 1 ❑ Di Permr Pee Dote Issued 41'th. Issu' g Agent Si a-'Cw— ❑os 9ven Reav Denial DL Conditions of Approval/Reasims for Disapproval \ � �i _ 3 °t- TEMOWNER: v9�tliZ2 t P Qtvt4(�ar / be / ptic tank, effluent Alter and t�dl4ce persal cell must serviced malntalned s per management plan provided by plumber. b*- tr?de 5 2. A requirementsor Ia. aysoem sera " error Cowry a Fanjet ksg tiro a ra 11 aria as per applicable code/ordinances. t/l is �.yt fb rQ SBD-6399(R 11111) j System PLOT PLAN PROJECT Jim Berilaccua ADDRESS 1730 96th Ave Hammond Wi 54015 SE 1/4 NW 1/4S 16 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 97.3/97.2 3' below grade 5/22/20 BEDROOM 3 DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE DING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1150 # of EZ-Flows23 ,'� NCHMARK V.R.P. Top Of foundation ASSUME ELEVATIO 104.55' filter Lifetime Filter ❑ BOREHOLE O WELL "H.R.P. same as benchmark Property W&I 20' , . COPY Huffcutt combo tank Bullrun Valve ��` 96th ave 11M 0% Slope 40' 2-3' X 115' cells with >3' spacing C Existing 3 Bedroom Well System may have a additional boring done to lower cells into better soils Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/22/20 Owner:Jim Berilacqua Location: SE1/4 NW1/4 S 16 T29 N,R 17W 1730 96th Ave Hammond Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. EZ- Flows Cross Section 4-6. Maintance andlppntigency Plan 7. Existing Septic Tank Form Signature' License number #226900 System PLOT PLAN PROJECT Jim Berilacoua ADDRESS 1730 96th Ave Hammond Wi 54015 SE 1/4 NW 1/4S 16 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 97.3/97.2 3' below grade 5/22/20 BEDROOM 3 DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1150 # of EZ-Flows23 NCHMARK V.R.P. Top of foundation ASSUME ELEVATIO 104.55' ilter Lifetime Filter ❑ BOREHOLE (DWELL *H.R.P. Same as benchmark Property FM Huffcutt combo tank Bulhun Valve 75; 25' f B-3 40' 0% Slope 0' 2-3' X 115' cells with >3'spacing Ci-i' ) Existing 3 Bedroom .f Well 80' j System may have a additional boring done to lower cells into ents better soils 96th ave Cross Section of a Two Cell EZ Flow In -Ground Dispersal Component Design Flow a Loading Rate L = Required dispersal area i%2 S sq Ft 1_/ Required dispersal area (f ti7 + 50 (EISA) = 1 e. i number Qf units) Geotextile fabric to meet Comm 84.30(6)(g) Wis. Adm. Code (/ Minimum of 12" of cover over top of cell Two observation/vent pipes to be provided per cell Not to scale Cell #1 0 ? System Elevation::/ �, J Ft Final Grade: J�y,t Cell #2 System Elevation: �y, /fit Final Gradw/9 � 1 Zf Ft ST. CROIX COUN'1"Y SEPTIC TANK MAINTENANCE AGREFM),tN7' AND OWNERSHIP CERTHWATIONFORM Owner/Buyer �— — _..._ I "r-- --� t Mailing Address ��% 3 l Property Address (Verification required from Planning & 7uning Department for new construction.) City/State_Y _ -- Paree) Identification NuriberQt3 _I0_ 1 �7 LEGAL DESCRIPTION )1 / I Property Locatio� S« N It / W, Town of Subdivision Z ,_lf------ -----,�_....- --- Lot#. Certified Survey Map # Volume _--_ _- Page # Volume---,— —Page# Spec house yes t:Y ----.. • - Lot lino- identifiable ce) SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its prmlahure f alum to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, ii needed, by a licensed pumper. when 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 §Comm 83.52(1) and hr Clspter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planing & Zen mg Department it cot tification fork, 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. 1/we, the undersigned hove read the above reyuireurents and agree to maintain fire private sewage disposal system with the standards set forth, herein, as act by the Department of Commerce and the Department of Natural Rusomves, Stars of Wisconsin. Certification stating that your septic system has been uraiatained mast be completes I and returned to lire St. Cleix County Planning & Zoning Department within 30 days of the three year expimlion date. I/we certify that all statements on this Fenn are true to the best of my/ola knowledge. I/we an/are the owuer(s) of the properly described above, by virtue ooff�a warranty deed recorded in Register of Deals Office. Number of bedrooms 5 1.2// 2U DATR ***Any information that is misrepresented my result in the sanitary permit being m:voked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Registe of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed, (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __of_ FILE INFORMATION Owner " 1 r r _•l' i (t� �. Permit # --V DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA i Number of Public Facility Units Estimated flow (average) i 3c�altda I Design flow (peak), (Estimated = 1.5) i allda Soil Application Rate ailda tfe Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 53o mg/L Biochemical Oxygen Demand (SOD,) 920 mg/L 0 NA Total Suspended Solids JSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) _<30 mg/L NA Fecal Coldbrm (geometric mean) s104 cFW100m1 !Maximum Effluent Particle Size )§ in dia. ❑ NA Other. A 'Values typical for domestic wastewater and septic tank e9luenL MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al El NA Septic Tank Manufacturer f ❑ NA Effluent Filter Manufacturer AU JL ❑ NA Effluent Fitter Model —ZrZ J ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer ❑ NA Pump Manufacturer ❑ NA Pump Model ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Peat Filter CI Mechanical Aeration ❑ Wetland ❑ Disinfection 0 Other. Dispersal Cell(s) 13 NA round (gravity) 0 In -Ground (pressurized) ❑ At -Grade owlvlound Drip -Line ❑ Other. Other. 0 NA Other: El NA Other. ❑ NA Service Event Service Frequency (Inspect condition of tank(s) At least once every: ❑ mott S(s) (Maximum 3 years) ❑ NA !!Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 O month(s) (Maximum 3 years) RI-Warls) O NA Clean effluent filter At least once every: o�js)Vryea ❑ NA ! nspect pump, pump controls & alarm At least once every: 3 Q morrths(s)Oyear( ❑ NH -lush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) they. ether. At least once every: (] year(s) 0 NA ❑N�A.) MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Vaster Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of cembined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be Asually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third ('Yj) or more of the tank volume, the entire contents of Ibe tank shad be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. IOJI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority .vithin 10 days of completion of any service event. Page _ of — START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thtlt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank($) reproved by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of afluenl. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park yehkks over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWf$' antibiotics baby Wipes: cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers: disinfectants: fat: foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propel ly and safety abandoned in compliance with chapter Comm a3.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void spaoe fitted with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption "eon. The replacement area should be protected from dishubance and compaction and should not be infringed upon by requiried setbacks from existing and proposed structure, lot lines and wells. Failure to prated the replacement area will result in the rme{ed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulet in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area a available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. POWTS INSTALLER POWTS MAINTAINER Name �. Name (2v Phone ;: _ �' Phone J �� ; _ ^ , `60 SEPTAGE SERMNG OPERATOR UMPE LOCAL REGULATORY AUTHORITY Phone i'/�!_ ! ( Phone ` This document was d. in eomplance with chapter SPS 383.22(2)(b)(f)(n)S(f) and 383..54(1), (2) 8 (3). Wisconsin P.dmInW,86we COAa ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to cert44 that I have inspected the septic tank presently serving the IN" ,--I c C,-/ residence located at: Section , T_aN, R_4ZW, Town of . Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur f om absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes r,apacity:/m,,--�% Construction: Prefab Concrete Steel, Other _ Manufacturer: (If known):/ 1< Age of //n'14' (If known).: (S (Title) S -.2 Z-.20 Date (Name) Please print 2Z69'( (License Number) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to he best of my knowledge will conform to the require ents of ILHR 8 , Wis. Adm. Code (except for inspection opening ov outlet baff Name ��[c✓ ` •tom SignMP/MPRS ZZF,rCh� 5 9M ET , r - / LOT 17 3. 12 ACRES / �,. �� ,.•�tgP 135,768 S0. FT. W / fJ 4 �^ 584.30, 243. 0p, ro�O .OT 16 Ar v �V� a 2.07 ACRES LOT 14 y Q y'� 90, O75 SO. FT. 3 8' 2.01 ACRES a 87, 745 SO. FT. a � M i. SE t@.QCK trf M A r.3/' NBOe-r �sp3. 00, 26Z4.- r3.33 loo 623. 00, w LOT 7 2 SET9gCK ' ............ C20V Sbi t Wlsconsln DeparbTnt of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Canty '} Attach kxxrylete site Dian on paper not less than 81/2 x 11 inches insize. Plan must Include. but not rureted to: vertical and horizontal reference point (BM), direction and Parcel ID. percent slope. scale or dimensiorrs, north anow, and location and distance to nearest road. Please print r j=by Personalinforrrabon you providemey be used15D4(1)(m)). Property Owner Location Page I of Date F7-e,O rN cT ,ScrN JUN 0 Goy. Lot Sc va,tid va s/!o T z y N R Property7OwnsT s Railing Address not Block # Subtl�./Name or GSM# );Z30- Y / l�, ./J,. _ S7. CROIX COUNTY /s At S,�n f T TT IO �l�"�� t City State Lp Code ❑ City n Village r@ Town Nearest Roo 1(4( ;Sq615 i (711)7(<o'l/Z/oI hMMond �� p New Construction Use: Residential / Number or bedrooms 3 Y Code arrived design now rate rsoi � oar ❑ Replacernent ❑ Public or mrvnercial - Describe: Parent material %'. // Flood Plain elevation if applicable ti//i N ���aaSy `-' e/tu• 9� so an. tions: Boring # ❑ Bo ng IF GPD I L:] Pit v,w„u wuak:c ccr. rv-•l.. .1. 1 — Soil Application Role Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz Cont Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDM 'EBIN I •Eff#2 a-/ 6 — S 7+ti+�L G� /i S 3, L yf .- Zmsbe - -jv� 29.v cos. 34 �r / I9 ElBoding M 1n �G tp Pit uwu,.muuryiaw., Sod Application Rote Horizon Depth in. Domnant Odor MtnseH Redox Description Ou. Sz Cant Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/flr 'I = 'Eff#2 / /r,4- 1,5 G 3 - ` /G — SG z 21. V AT. Effluent #1 = BOO, > 30 < 220 ng/L and TSS >30 < 150 rngfL ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 nWL Address � Date Evalkrabonmm on Conducted Telepne wuoer S�. Samt�f+-/, [.//. s't'or� ptv'ny D� 3-o h rl$o i Parcel 1D # Paw —.ta3 .. MMM ® AWMAMMM=M = �- E ® �®aWRMM ©50r� ®MM�MMM� ■ gibm-.:. M MM Effluent #1 = BOO, > 30 < 220 myL and TSS >30 < 150 mg/L • EflAienl #2 = BOD, < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 58DElN la.),oq PAGE 3 OF 3 SCALE:I"= yo BM I ELEVATION /00•6 BM I DESCRIPTION e,C 1:oji c BM 2 ELEVATION p7,So BM 2 DESCRIPTION(yo�*1%vG SYSTEM ELEVATION f;l, to SYSTEM TYPE / o n rrn �irnw CONTOUR ELEVATION - - Q6 C 91,Lk_ .-. Safely and Buildings Division County SM Aisconsin 201 W. Washington Ave., P.O. Boa 7162 , Site Address 9 6 4% A , Wl 53707 - 7162 of Commerce 1 l UQ, —Department Sanitary Permit Application San" Puma Numb" y O LI g o 3 to accord With Comm 83.21. Wis. Adm. Code, penmsl mforma6om you provide D Check if Revision Z mly he used for Privacy taw a15. i m I. Application Information - Plme Print All Information Sao Plan LD. Number ProperrIty Owmr's Name Parcel Number hArr Ja�'("60 0ft—ICE3 -IS-MC31-+ Property Owner's Willing Address Property Location Il30 46+-h Avc SE 'AMWIA;SJ6 Taq NRI1 City, Sate zip Code Phu Number Lot Number' S Block Number H Amrnor'A wS 5 40 /S Subdivision Name CalNumber s eA ANC N� of BuIlding (check all that appty) . orb rillII. 2 Faon7y Dwelling - Number of Bedrooms D Pubbacommemial - Describe U ❑ Sue Owned Road S (6+j 7 I11. t: Occla only one no: oo Bore a for Inteln.i use piste nne B tr apptinble) A' I New 2 D 1tcoacemmr' gem 3 D Replaameu of 6 D Additimm to For Cmonry use Tank Od B. d samary Petmir Previ udy hmtd Pert Number tioN4o3 Date iaaued �b 13 a0oz ry of Permit: (Check all that apply)(uumbering scheme 6 for internal roe) 44 Non-Preeemaed Non-Gramd 2111 Mound 47 D Send Filter 50 D Cotuouclod Wetland 22 D Presaurrsed In -Ground 41 ❑ HoMimg Tank 48 D Single Pus 51 ❑ Drip Line 45 D At -Grade 46 D Aerobic Treatment unit 49 D Recucahoog 30 ❑ Omer V. Area Information: Desip Flow (UKQ Dispersal Area Dupersal Area Soff Application Percolation Ram Symm Mevatlon Final Grade Rapaad Proposed Rate(GW./Days/S9.R) (Mm.MrL) Elevation 'DSO Li 100.3 VI. Tads Info Capacity in Total Number Manufacturer Prefab site Steel Fiber Plastic Glum Galbns of Tads Comcrae Constructed Glue :-k Tami=o N U O-C_L�tt- lot'o ] 000 O re 1-C. X Dw* CMmba (00 � ce.sw VII. Responsibility Statement- I, the for installed. of the POWIB abe" on the ntfarLed Plumber's Name (Prat) 'SS' WINIPILS Number Busime s Phone Number Toeid 51Nz (344 bZ �r a3s a6ti�( Plumber's Addms (smecc City. Sao. t 5604 �OS4 Av e, ft is WT -76 / VD /De tlhe only Approved D Disapproved Sanitary Permit Pee (indudes Groundwater Surcharge Fee) Dar I.msed tearing Agem Signature (No Stamps) ❑ Owner Given Ito"Adverse� I n D Determination •� .0 IX. Conditions of Approval/R for Disappr aiQ .rrw`4. IUa�au Se•Q Pe (w�}J^."Y_^0� .4dQoS�RI�«A.�cRL''J3ttr Anarh mpine plor eon the Carary only) err the "ores ea ppr r Its, team 8107 a 11 hrbu to au cnnA1GR M 05/01) -G%A rvOw ^ •9nc /Z90 h bl a73- awl ry" ln 1� MMn Wt►TIiiRPROUF .iilNR10N LOCKIMO COVER 8[� V4iirifW� .ABFL. LUK w�co"rtcr�l !plo _s. /Ye46o SOIL240 %.D.TuBD3 , M4 swc NlpTI I � ca L � 4 o 3'o C¢T =Wrib ^ �AFFLE3 wTo NEGTIOMS `� "y '�.� `yQ �i • \w0 � ON ^ G�ND 4z' r.lf� coA/ctcra . _w iwo CK SEPTIC t . SiP��'LAT��„ css DOSE TAN,.S MANUFACTUILCR: .`�-��r LwmbCR OF OOSCS: PER DAe TANK 512C: lsV� VOA SAL.LOWS -.DOSC VOLUME ALARM MAAWFACruR[4: $d Nrk4k-v— IWCLUOIWf. 6ACKFLOW: 96,y GALLONS -�03 POOCL WWYrOERl -\!1 CAPACITICS: Am � WCNC5OR ..� WLLOCS SWITCH TtIFC: as L INExE500. *tck-q WLL045 SUMP ^AUUFACTURCR: IS/e mn i/,lc ' 1 ""co OR g6AU•Ou5 MOOCL WUMDCKI SiLEP .30 O. �+' IMI; HU OR !!R 40ALLONt SWITCH TUM, VA"..`v b'\\. N09E; PUMP AND ALARM ARC TO DL MIWIMUM OISCNARGC RAT :3 G►M IN5TALLC0 OW 3EPA5kATC GIRCL.Ti /CRTICAL OIFFEKCWCE OETWECU PUP► OFF AND DISTt10UTIOW PIPC.. —7 FCET t MU�l��IMUM WCTWORA SUPPLY PKCLSURT,E� ... .. . FEET + _-1I—FEET OF FORCE MAIN X LLC F/po,EFRICTIOUFACToR..Llf� £CET U = TOTAL 0`JWAMIC NCAO s 276 FECT JT EItNAL OIME UiIOWt Of TAUX. LEWC.TH \%g 7W-OTN ��• ;LIQ UUIO DEPTH 4z.. 1q,ti 6 w Zd W610:60 S00Z EZ 'FQW 86CO E£Z Sit : 'ON XUJ UNUS31 Ii OS 03IdI12930 : W063 Pump runs but delivers only small amount of water. 1. Pump maybe air locked. Start and stop several times by plugging and unplugging cord. Check vent hole in pump case for plugging. 2. Pump head may be too high. Pump cannot deliver water over 24' vertical lift. Horizontal distance does not affect pumping, except loss due to friction through discharge pipe. 3. Inlet in pump base may be clogged. Remove pump and clean out openings. 4. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. 5. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. Fuse blows or circuit breaker trips when pump starts. 1. Inlet in pump base may be clogged. Remove pump and clean out openings. 2. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. 3. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. 4. Fuse size or circuit breaker is too small. 5. Defective motor stator: return to Authorized HYDROMATIC Service Center for verification. n Motor runs for short time then stops. Then after short period starts again. Indicates tripping overload caused by symptom shown. 1. Inlet in pump base may be clogged. Remove pump and clean out openings. 2. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. 12 3. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. 4. Defective motor stator: return to Authorized HYDROMATIC Service Center. SHEF30 Performance Curve ,SEEM IMME ON 0 Wisconsin Department of Commence Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may to used for secondary purposes [Privacy Law, s.15 04 (1)(m)). Permit Holdees Name: City Village X TownsNp Johnson, Larry L. Hammond Township CST BM Eley: Insp+. B—M Elev: BMppD�es�c_dolian: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER Dosing y� ECAPACITYSeptic Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL Vent 0 Air Intake ROAD Septic �- l Z 1 1551 QQBLDG. W r Dosing LI I,l Aeration Holding PUMP/SIPHON INFORMATION Manufacturer L rrrAM � GPM_ Model Number 5 Lef 430 11ka!" TDH tp r Fdctio Loss System Head System Head TDH Ft TDH FlLoss Farce n Lengt 1 ` p Dia. Disc to Well � 2v J RAII ORRI•IRPTinN SVRTFM Ilr•1 1 _ N _ L _ /.L__ i STATION BS I HI FS ELEV. Benchmark 1 `F8 Icy OD-6 Alt. BM �&q )Ocf•s-vr Bldg. Sewer q-20 r SUHI Inlet I0. 0 !3• �S r SVHt Outlet Dt Inlet Dl Bottom Header/Man. Dist. Pipe J Bot System •1 O �•d0 Final Grade I t_ r�� St -Cover NC DIMENS NS Width r 3I Length ( 11'a-mg aF.. No. Of Trenches Z PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth SETBACK SYSTEM TO P/L 9LDG IWELL LAKE/STREAM LEACHING Manufaa rr,,�� INFORMATION CHAMBER OR UNIT •IL-. Type Of System: 5 y I r b 1 I J M [Number: ! I` a, U1 LYa91:11..rUpf.Y•AYad rf. Heade nifold Dislrituli n x Nole S¢e x Hale Spacing Vent to Ak Intake y Pipets) r Long( X*' Dia Length Dia Spacing SOIL COVER x Pressure RvNems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xz Seeded/Sodded xx Mulched BedRrenth Center Bed/french Edges Topsoil �', Yes No ,, R' Yes �]� No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1; C..a O���npZ Inspection #2 --f=/=� ��B at k 1uitlall17 0 �yy. /wflH�montl, WI 54015 (SE 1l4 NW 1/418 T29N R17 y Pheasan Hills Lot J�i511 P�cel No: 16. .17 5 7L 1.) Alt BM Desscccnpticnn = ) 0.UwA� - W+•r •Wtyla../1 pwle�� 2.) Bldg sewer length = r�y--•✓[G'Lfl k �' r✓ - amount of rover = n_ V+� 3) 0�+.,wr�ciwe,ta6lve...�S .,. � (�-�i �olt..•c��as. rs �, Plan revision Required? Y q No Use older sitle for adtliliona orma[ion. I _ ly`-��d t Dater.. ��,��w���5gr"� - - Insepdofs Signature ! /�.0 rt.No. SBO-6710(R.3/97) A a &&L l ,s - i- L.l _ LJI _-A t4l rA ./.nirr L ' r e yMy, N v 12D� I* 0414