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HomeMy WebLinkAbout020-1491-03-000Wisconsin 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 City Village Township Nunya Revocable Trust I TOWN OF HUDSON CST BM Elev Insp B� Elev BM Description _ IQ,, TANK INFORMATION TYPE MANUFAC URER I—Z CAPACITY Septic r(� 1 z5a Dosing �n ? z 75p Aal2tion- F;� r Z �1 Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7Zj �A Z� Dosing >z5 iljh Z� ' „� 30' Aeration Holding PUMPISIPHON INFORMATION �5 �- Manufacturer GI, b�r'`l✓ Dist to Well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI I FS ELEV Benchmark 8,5 tvs.s (oo Alt BM`` -- 1 nC, tD C -7 -S Bldg. Sewer SUHt Inlet 16,-7 97 Q !/ SUHt Outlet Dt Inlet Dt Bottom Header/Man Dist. Pipe ailk �tr `Irk fL v Z Bot System -T 1 9 , O m. I'll . S Final Grade St Cov 1 7,5 /o BEDrrRENCH DIMENSIONS Width , Length -� , 1 No Of Trenches —7 PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/ BLDGC_ WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacture rr• I r iyti-. Tf7 Ty e Of System/ `ONt/(.µ Y7D.y, 3Tj r 3 0 \ V �. Model Number J Ce DISTRIBUTION SYSTEM Header/Manifold f , Distribution x Hole Size x Hole Spacing Vent to Air Intake Ll Pipe(s) Length Dia Length Dia Spacing SOIL COVERlt � .. a x Pxnc cu.o s—r— n-h, Depth Over p Bed/Trench Center �I� t Depth Over P BedfTrench Edges 7 /2 xx Depth of p To xx Seeded/Sod dad Yes _ No xx Mulched _ Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2 Location: 871 CRANE HILL TRL 1.) Alt BM Description= 2)Bldg sewer length=`!J� �%VQ,� ox•� IVO� £h(� - amount of cover = Ll 2 o � y -�{j O G r o L �i I . t Plan revision Required? Yes X No %� I� 1 I / 5 f, Use other side for additional information. SBD-6710 (R 3197) Date __ _ Insepc is na Cart No Q x Lflrc? r� a MAR 2 9 QZl ty and Buildings Division Court jashin 201 gton Ave.,P 0Box 7162 ,��,� Sanimn• Pertnrc Number (m be filled in by Co) d,.Z 53707-7162 _Gnarl r, .,,i.. ir, ,:.nt Sanitary Permit Applicatio State Transaction Number In aecordtma Aft SPS 38321(2), Wis Adm Code, subnas,iou of this form to the appropriate g =1 is required prior to obtaining a sanitary petal Note ,ALppbcmon forms for state-owned PO WTS are submine, We Department of Safety and Profes nonal Seroies Personal informmion you provide may be used for secondary Pm)ect Address (d different than mailing address) i i. purposes m accordance wnW We Privacy Law, s. 15.04(I )(m) Spas. L Application InformAB Information - Please Print Information V //-7^� O !/ / PropertyOwner's Name Parcel k N� Property Owners Mailing dress Property Location (� JI I I lVl. Crovt }'Ot W �'J� y1 Section / 3 city, State ZipCodePhone Number �iv-CNlX- W 1 i--s �� Type Building T ! 9 N, R IE one —L ,,,III. of (check all that apply) / Lot # �Kjjm 2 Farm7y Dwelling -Number of Beevonu, Subdivision Name -3 }' Block Pubhc,Comrnercial— Describe Use �Cilyof_ — O State D0.iled - DPSQ1be t15L CSM Number Vdiaee of I al. Type of Permit (Check only one box on line A. Complete line B if applicable) `t System _Replacement Sysn7n [ Trearroent/Holdmg Tank Replacement 0o1v D Other Modification to enstme System (e piam) B. 13 Permit Revewzl enat Rev¢ D Change Of Pluirl '�' Permit Transfer m New Lin Previous Permit Nurober and Date Issued ELIOR LXp=on l I ()µ9Q IV. T ofPOWTS S stem/Com onent/Device: Check all that apply) J -Pressurmcd InGrnund C Pressurized In -Ground ❑ Al -Grade D Mouria > 24 m of s utablc soil :: !Hound 124 in of surtable soil 11 Holdwe Tank Other Dispersal Coinpwcut lam) ❑ Pretreatment Deuce (explain) V. Dis rea eat Area Information: l+jfi Design Flow• (gp Deny Soil Applicau e(gpdst) `J Dis ersal Alta R (sfl Dspersai Area pro (s S, ere ElevaW Q0 57 R, VL Tank Info Capacity To #of Mann Gallons hew =uLmug �In� II Um r ,, t lke— — .mks Tab _ ! �.V _ m v y C Sepoc ar Holawg 7aek 1 /).� '�, ✓!! —.-V - //11 VII. Responsibility Statemen We undersigned, An L respoasibility for installation of th 0O 11 $shown on the attached pleas Plumber's Name ) ` PI Siglaiure MP/MpRS Niimber Bnsmess Phone N ber Y� SXCL--�Ph®ber's Address (Street, Cry. State, Za ) 7- z S ✓ /i2i r //f%Sal % I ryy Approved I 0 Disapproved Permgtt Fee I Dale u / Issuing Agent tune • \ ElOwner Given Reason fa Denial 5 LJ Z IX. Conditions of ApprovaVReasons for Dfsappr/ /'r� ot�l a'n540/ I r ���-iyy,Vr �! f�s ft�r `f tRf✓) QI�(t SYSTEM OWNER' JJ LC T -� 1. Septic tank, effluent filter and 710 {H`e, Cr �W ✓� . dispersal cell must be serviced / maintaina/ as per management plan provided by plulq 2k lq(f� / G �4 M .J. ,pf.i,� ro . n ou <othark requirements must he maintain d ]"t M as per applicable CCA"nEkl He"iF'"�F"iss for teesystem sad submit to the County only ou paper antIcss Nana in r f1 inches io sue SBD-6398 (R 11/I1) r Soil Test and System PLOT PLAN PROJECT Nunva Rev Trust ADDRESS 1758 Asoen Ct. New Richmond Wi 54017 1/4 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 99.0/98.5 5' below cradle DATE3/28/21 BEDROOM 4 CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIz1,765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of power box ASSUME ELEVATION too' Filter Lifetime Filter ❑ BOREHOLE O WELL sH,R,P, same as benchmark Iul 102' B-1 40' _ -j 35' 90, lim 9% Slope Huffcutt Combo Tank 30' Crane Hill Trail cale = 1 /4" = 10' 104' Ang 5' 34" B-3 2-3' X 90' cells with >3' spacing Op h� ,ai o1 -1 VA J Quick4 Standard Leaching Chamber with 20.0 ft2 of Area \5.6ftA2/pair of end caps .LGrade at System Elevation Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 2/15/21 Owner:Josh Shores Location: 1/4 1/4 S 13 T29N,R 19W Lot 3 Crane Hills of Hudson Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross eOO 4-6. Maintance andy Plan 7. Filter Cross Secti Signature License numb 2 Soil Test and System PLOT PLAN PROJECT Nunva Rev Trust ADDRESS 1758 Asoen Ct. New Richmond Wi 54017 1/4 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 99.0/98.5 F below qrade 3/28/21 BEDROOM 4 DATE — CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 .ABSORPTION AREA 891 # of chambers 44 , BENCHMARK V.R.P. Top of power box ❑ BOREHOLE O WELL *H.R.P. same as benchmark M. s' 102' B-1 40' _ rl —35' ail B-2I L 40' 9% Slope Huffcutt 1 Combo Tank 30' Crane Hill Trail ASSUME ELEVATION 100' Filter Lifetime Filter cale = 1 /4" = 10 104' Vent >6' of Cover 5' 4' Long 12" 34" IF B-3 2-3' X 90' cells with >3' spacing COPY Pro 4 Bedroom House Quick4 Standard Leaching Chamber AL with 20.0 ft2 of Area \5.6ft^2/pair of end caps .-Grade at System Elevation Property Line �� All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates Typical Installation Vent A(I Grade A/30/34 Septic Tank m 5 Spac System elevations: A 99.0' B 98.5' 5' Grade at System Elevation 5' To be >1' above grade Finish grade elevation 104.0' Vent 1" at System Elevation 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A B 22 chambers per cell Fu- 54- 2,024-035- 0 - Safety and Buildings Dmsion 201 W.Washington Ave., P. O. Blau 7162 County / 1 CI a+Y Permit Number(to be filledinn by Co) FEBD 16 �OZ 7*-�Wre Madison, WI 53707-71 ZIA (23 I2 S2 "t-PermifApplication ITrens ,N®ber In a rdanw with SPS 383.21(2), Wis. Adm. Code, subme icm of this form to the apprepr ate governmental out Project Address (if different than mailing address) is required prior to obtaining a sanitary permit Note Application forms for smfe POWTS are submnred m . the Department of Safety and Professional Ser m Perswal mborma non you p vide maybe used fors ndary purposes m accordance with the Laws 15-04l1 m), Sets. �( CQ-(t'�E >-11 u" �Q �i L A 6cation Information- Please Print All Information Property Owner's Name Nun Panel # a rus'{r ozD — f-o -o©to` Property Owners Mwlmg Addrt Property Location ( l3 TJ /SV Gout Lot \r v, JLZE' Section Crty, State Zip Code I Phone Number _ le T Z N, E W # II. Type of Building (check all tho Ifpiy) (((�jjJ//J � 'ante w 2 Family Dwelling -Number of ASubdmsi i Block# C s IJ PubhcJCotnmercial - Desrnbe Use City of '❑State Owned-Desambe Use CSM Village of Number I own of ! III. Type of Permit (Check only one box on line. Complete line B' pplicable) A. System' ❑ Replacement S t/Holdmn Rep l Only J Other Modtficavon to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revm Chan of Plumber I 11/.urt Transfer to New Lest Previous Pcrmn Number and Dare Issued Before Expiration — TV. T of POW'1'S S stem/Com oent/Device: (Check all t a 'ao-Prrss¢iud m-Crrommd ❑ Pressmiud In -Ground ❑ At -Ciro& Mound > 24 m of suitable soil C Mound < 24 m. of stitable soil is ❑iioldmg Tank ❑Otber Dupetsal Component( lam) ❑ rnt Denw (explain) V. Dis rsaareatment Area Information: ;L X t D / Design Flow (gpd) Design Sol Appbcanoa pbea jteq ed (sfl paSpl�raPro (t) Systcn CUy S El G/ / t Cl[ GY/ r ✓r 5 SI . VL Tank Info Capacity m Total # of Manufa Gallons Gallons UnitsNew - 7aoks E . auks v - $epoc x Bolding Tack �> \' y 1kMsng mamba VII. Responsibility Stateme t- 1, undersigned, responsibility for mstallation of the PO sbowo on the attached plans. Plu 's Name (Print) t Plum ignaure /MPR$ NumberBmtsmess Phone Ntmn c Plumber's Admeff (Strew, C , State, Zip Code) VI1L Counity/Depayfineat Use On IR•cpx D Appm,M Pecmrt Fee S Date issued k m exit S� ❑ Reas wDevml S�S� �EJ2 LY. Cord" ors Approv ea9ens-ferBrsapPrnval 3) D��veu� STEM N€R: epti ank, effluent filter and is rsal cell must be serviced/ maintained 1 per management plan provided by plumber.\` r All c�thnrk n IrPmentiq must he maintained R C� in as pei appitca Cl' Code t S for tie s}s and busy em me Commry owy o. pepe;natlns^ mv�BNz�lt,ars�es�m�g}u '� SED-6398 (R 11/11) SJ t?1 u, . 6 Q — 4o Wyi& S 'Vl/1�1-11 1�i.CQ, e-'kt. . System PLOT PLAN PROJECT Josh Shores ADDRESS 1758 Asoen Ct. New Richmond Wi 54017 114 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 95.5/95.4 4.5' below grade 2/15/21 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE WELL *H.R.P. same as benchmark Scale = 1 /4" = 10' Road B-3 2-3' X 90' cells with >3' spacing Vents �N\\\\\ V 0% Slope 2-3' X 90' cells with >3' spacing _ 60' B-1 20' ST Pro 4 Bedroom Vent House >6 Quick4 Stan d of Cover Leaching Ch er with 20.0 ft2 of a 5.6ft^2/pair of end ps 4' Long 12 Grade at System El ation 34" D�t� a Seel # I. P�"'`1-f- All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1 above grade Finish grade elevation / Typical Installation 100 i Grade Qvent Septic Tank 5' Long t 5' 5' Long t 3 6" Gra e at System Elevation Fade at System Elevation Spacin 2-3' X 0' Cells Same on other d Observation tubeNent At end of cell A B 22 chambers per cell Septic -Dose Wank Cross Section And Pump Performance Specifications Tank Manufacturer Tank Model Number S 7 Total Tauilc Capacity i )- s S 7 6s Max. Bury Depth Q Filter Manufacturer Filter Model Number j Inlet Minimum Pump Performance Required 7-0 GPM. 07 Ft TDH Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight Switch Sctti ngs and Reserve Capacity Tank Volume= /')GPI Dimension. Inches Volume Gal. (reserve) A 6 , - (alarm) B 2 (dose) C . �� � 7 3 (dead) D iS3 Total Y 7 6� Total Dynamic Head (TDH) - Feet Elevation Head /lam Distal Pressure '— Network Loss Force Main Loss , R Z c r- NCR Total / Manhole Min. 4" Above Grade nr:a, r Disconnect Means lllllllllllillJ . 1, Elevation �—= Ft GENERAL INSTALLATION: The septic/dose tank is bedded and back filed in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective krckmg device (padlock) installed. Piping at the Wet and outlet is of approved material, connected to the tank with watertight Sttings, and laid on stable soil to prevent settling or sagging- The force main is sleeved with 4" Sch• 40 PVC to bridge the tank excavation and the sleeve is sealed watertight Electrical service complies with NEC 300 and Comm 16.28. 02105 U Page of X-