HomeMy WebLinkAbout038-1191-60-000 Wi6 consin department of Commerce PRIVATE SEWAGE SYSTEM y'
Count
Safety a�d Buildings Division St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar�Pgrrp
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. / /
Permit Holder's Name: ❑ City ❑ Village T wn of: State Plan ID No.:
Kopp, Bernard Star Prairie Township
CST BM Elev_ Insp. BM Elev.: BM Description: Parcel Tax No.:
Co. O ' 1 V(- = CST 6 �- 038- 1191 -60 -000
TANK INFORMATION ELEVATION DATA l 3 , 41, ( Q S
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Z Benchmark In-0 `
Dosing Alt. BM 4 f.
Aeration Bldg. Sewer �j -(oS�f �`� " i3.s o.`f3 r
Holding St / Ht Inlet g 4 (p 2 l ,Q� 0,
TAN SETBACK INFORMATION St / Ht Outlet g- (� t 3.98 q o . G Z'
TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet
Septic N (l NA Dt Bottom
Dosing Z' 72 NA Header / Man.
Aeration N Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand St cover
Model Number GPM
TDH I Lift Friction M tem TDH Ft
L oss Forcemain Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM °�_o g�� 5�
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Mod Number:
System: OR KNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent 777
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over TBed th Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center /Trench Edges Topsoil ❑ Y s 1 ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1 . ( /off/ onlnsnectinn 0!
o £ I 3 d ° �1
`7 T ri •
A .. W A
X Z o w 7,
I O A a OD
N
1 CD 00 N �6 3 1 fD M m a tr
a w° tai
p ? N
CD
CD a °
I 3 O o jZ33 m I
cu � ;a rn °' I
o °o °Zii n o c
o g 3
v
CL °» !�1 •
CD '0 0
C Z
o tlf N N a I 0
0 Q T 0 0 =
K Of y
CL
N
I Q Z g Z
D =+ a
? !r
o
S _
mF 0 c N
m d w - a
w n� 3
Z
3 - i: 2 0
�ur< a Q
t9 4: 0
CD
7 N 7 CL Z _{
D 07 M z w w
�—' v W Z
as C ;0
0 0 3
d! Z
CL
s A
I
m Si
n
0
(D o'
c
Z a
< m N Z
N p<j C
3 fi
O A
I > j
=0
a l c
m m
o V
y N
D I A
A
° C1
V
° O a I .-
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
. I �
f
3
p
z
3 i
-
4
I
( It
it
I
� z
f � S
a� f
F o1 2- 4-
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructi leting this application PO Box 7302
i seonsin personal information you ,�.,dd �' u e' r secondary purposes Madison. WI 53707 -730^
Department of Commerce [pr' F (Submit completed form to county if r
state owner
Attach complete plans (to the count onl )k x0tem. a er not less than 8 -1/2 x 1 I inches in size.
County - State Sanitary Permit er nZARWYevision 0 ous application State Plan 1. D. Number
[f l_
I. Application Information - Please Print all In do 9 w $_ Location:
Property Owner Name S3 CRo1X Property Location
cr co�� ; . �'
/�l(il(1 /4 lG(1 /4,S T� ,N, or W
Property Owner's Mailing Address `. % Lot Number Block Number
City, State Zip Code umber Subdivision Name or CSM Number
(
I1 Type of Building: (check one) ❑ City
1 or 2 Family Dwelling— No. of Bedrooms: at P rr ?( ❑ Village
❑ Public /Commercial (describe use): jRTown of
❑ State - owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest oad
LA
A) 1. New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax mber(s)
System Tank Only Existing stem (9 _ 6 - a67�
B) Permit Number / 3. ? /, / 4�G Date Issued
r-1 A Sanitary Permit was previously issued
I,V. Type of POWT System: (Check all that apply)
Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V Dis ersaUTreatment Area Information: — 0
t. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final rade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) j Elevation
✓ 77�D '2 �/
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
I(Zo ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VII Responsibility Statement
I, the undersigned, assume res on ibility for installation of the POWTS sho n the attached plans.
Plumber's Name jp rin t Plumbe ' igna re (no s PRS No. Business Phone Number
P umbers Address (Street, e, City State, C , r
Q y ��
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 71ssumAgent Signature (No stamps)
VApproved ❑ Owner Given Initial Adverse Surcharge Fee),.
Determination �(� Q v 2
IX. Conditions of Approval /Reasons for Disapproval: \
/ m4 -,�, "J- 6uel( sdAr f-s ac r oc,- �� .`f3 - � Po P( ZJ /
2-� ��/f�r �U 6� M.Q.�h ptr Aa v�Gou�.tc..Gtoul`a�5.
SBD -6398 (R. 07/00)
Wiscc. depart of Industry SOIL AND SITE EVALUATION REPORT Page _1_ of _ 3
Labor z. uman Relations
,Dysiop Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 038- 1055 -20
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION EVIEW D BY _ DATE
�, t ua•8 I
PROPERTY OWNER: PROPERTY LOCATION
Greenwood ]Enterprises, Inc. GOVT. LOT NW 1/4 SW 1/4,S 13 T 31 N,R 18 k(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
1416 Third ST. 37 1 na NorthGAte
CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD
Hudson, WI. 54016 (715)386 -3674 Star Prairie I 214th Ave.
New Construction Use [x) Residential / Number of bedrooms 4 [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate _ .7 bed, gpd /ft .8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft2 - 8 trench, gpd /ft
Recommended infiltration surface elevation(s) 95.50 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem N S ❑ U N S ❑ U N S ❑ U ®S ❑ U ®S ❑ U Cl S [3U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-10 w if .5 i .6
2 -30 10yr 4/4 none sl 2m r mvfr Cfw if .5 .6
Ground 3 ml na na .7 .8
elev.
9 9.0 ft. * 2 k80 10 r 5/4 c2d7.5 r 5/6 sil Lens tm H-3 nonco i uou
Depth to
limiting
factor
+84 1�
ti
Remarks:
Boring #
1 0 -12 10 r 3 3 none 1 2msbk mfr if .5 .6
2 12 -24 10 r 4/4 none sicl lcsbk mfr w if .2 .3
•-
Ground 3 24 -84 7.5 r 4 none Cos osa ml na na I 7 .8
elev. {
9 9.5 ft.
Depth to
limiting
factor S
+84
Remarks: ST CRax
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 ZONING OFFICE
Address: 1554 200th. 4v New Richm nd WI 54017 ,
Signature: Date: 11 -3 -98 CST r >>n 2�
0
R ERTYOWNER Greenwood Enterpris SOIL DESCRIPTION REPORT ' 3`
P oP P Page
PARCEL I.D. # 038 - 1055 -20 F -
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
.................
..................
.................
3
1 0 - 12 10 r 3 3 none 1 2 mfr
2 12 - 10 r 4/4 none sicl lcsbk mfr qw if .2 .3
Ground *3 28 -32 10 r 5/4 c2d7.5 r 5/6 sil lcsbk mfi w na
elev.
9 9'1 ft. 4 32 -84 7.5 r 4/4 none 11 _ 6 0__S�
Depth to
limiting , L
.�
factor R �, 5 +84
I
Remarks: *non contiguous in Horizon
Boring #
1 0 -9
qw if
4 2 9 -29 10 r 4 4 none sicl lc .3
Ground 3 29 -84 7.5 r 4 4 on o osa M1 na na .7 .8
elev.
98.6 ft. —
Depth to --
limiting .- qS 3 1 . Z
factor
+84 q7
Remarks:
Boring #
1 0 -10 10 r 3/3 none 1 2 mfr 1 .5' .6
5 €`
2 10 -28 10 r 4/4 none sicl lcsbk mfr aw if .2 .3
Ground - • 7 •8
elev.
9 9.2 ft.
Depth to
limiting y
factor
+ 84 1, ioY y
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
I T
Remarks:
Il SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave.
CSTM2298 NW4SW4 S13- t31N -R18W New Richmond, WI 54017
MPRSW -3254 town of Star Prarie (715) 246 -6200
lot #37- NorthGate
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 " =40'
BM.= top of 1" pvc p ipe C el. 100
Alt. BM.= top of 1 pvc pipe C el. 99.10
�i
p
�' �a
c
4
Gary L. Steel
11 -3 -98
4 . MI a l o l I No_ 72,330 sq. ft.
N ° �`'cp 1.660 ac. w M —
Q SHOP Z C I / 3
53.00' 90,680 sq. ft. `',fl z
O� M E S89
L, I 2.082 ac. o '
r
M 3 i 90.93'
/S . N ° M I 26 6 �'
L� z 214 ~ a 1 ti'1 z N89 07
z 0 165.02' pp' D, ti6' 28
5.26' 146.82 an i ag. � �� X 40.93' 18.
z '3 / i
S89.07'26'E 421.28' 56�°�22 tia 0
- QUTLpT -- z9
403.08' 16.92,x_ so .-
- N89 °07'26'"W 420.00'
'0fj Z V
fti° °p �� o w 3 7 o SS,So
1 °4 ° o o 1.27
3_ 9 - ��C�� C) o ' ` 74,459 sq. ft. Z
�, 1.709 ac.
Q / 3�' N ��J , 99.0 - NO S'
� �
185.0(
66,555 sq. ft.
L, J�`5 o� 1.528 ac �P�co 3
qtr v
S �� /� °� °�j,0 O
CD
O\J/ _, o �P��, � )K When I
`�Q� / T°p a vt,1� °n � '� Z � lo �� O p�� 2� the en
1
39 07'26 "E 480.01' 76.00 S�2 sad sv
shop, c
420.00'
N89 °07' 26 "W positio,
r0. the plc
y - be reo
the no
S \ / LEGEND
96,918A. ft. �� 2 SECTION CORNER MONUMENT FOUND
2.225 ac. � p 2" X 36" ROUND IRON PIPE WEIGHING
�QP (0 �/ 3.65 LBS/FT. SET
2" IRON PIPE FOUND
S �` • 1" IRON PIPE FOUND
CIS
12' UTILITY EASEMENT PARALLEL WITH
LOT OR RIGHT -OF -WAY LINE
BUILDING SETBACK LINE -WIDTH SHOWN
J
PONDING OR.DRAINAGE EASEMENT LINE
ALT, OTHER CORNERS AR F. MONTTX,4P'KTTFn
3 �
LPO
»o � T6
1060
h
3
a
la3 � -ate
�S� yS.So
7 -20 -1995 1:45PM FROM P .1
.r te•�ra�+annwMn�wwmuF, SVII., AI Y *11 t CVALNA I IVn1 RICIOVR 1 r at
Isd+oi slid Ha+ien Rslsvem . N 1, _
v ""' Pf °ts° aMi "p in acrd with ILHR 133.05, Wis. Adm. Code
MOM
Attach oemoste site plan on paper not leeB then a I& x 11 inches in size. Plan must include, but FR Croix
not lirttitsd to vertical and horizorrtal reference point (111", drac n and % of slope, scale or . '.0. e .
dimensioned: north arrow, and tocallon and distance to nearest road. 055 -20
APPLICANT INFORMATION— PLEASE P1iINT ALL INFOI{MATIOfit D BY OATS
PROPERTY OWNER: PROPERTY LOCATION
_ cam. LOT W 1u sW 114,6 13 T 31 ,N,R 18 ft(a) IN PROPERTY OWNER'S MAILING ADDRESS LOT N BLOCK 9 3LiBD. NAME OR C,SM e
1416 T)tir4 ST. 37 na North0 to
CITY STATE NO CODE NUMBEEi 001TY OVILLAGE NFOWN NEAREST ROAD
Hiidsan . WI - 54016 (715) 386 -3674 Star Prairie 214th Ave.
FT New ConsRucdon Llse 0C.1 Residential / Number d bedrooms 4 [ j Addition b orrisArtp building
1 1 Repteoement [ ) Public or commercial describe
Cone derived daily now _fim 9pd Reeomr oxied design loodho rat . _ 7 bed, go* _,, hrich, pW
Absorption area reduire0 858 per, n2 7S0 trer�fi,lt Mamtum design badirtp rate T Gad. gp . • 8 itendt, gpd/h
Rawnt nonded. infilr'abon surlim.dw%ion(s) 95.50 It (as relanwl to 06 plan bertdlmark[
Adildonal deOp I stle consideraltors na
Parent ntliww o6twash Flood plain elevation, if applicable _ h
S = Suitable for' system CONVENTIOW AMMD 4GROUND PRESSURE AT-GRADE SYSTFM IN FEL HOLDM TANG
u =umvw* slant CI O u ® S Q e s Qu ®S 0U M S 0 a [3
.
SOIL DE3CRIPTION REPORT
Boring d Horizon Depth Dominant Color Wks Texture Structure CoaWlia" BmrdwY Rao% GPD/ft
in. Munsell Qu. Sz. Cont Cdw Or. Sz. Sh.
I3ed Itlfrh
_ 5
2 My
,.5 .6
G�mund _ 7 ncmg e1ev.
9 9.0 ft. * "
6 s"i Low tm Hn3 ri
Depth to
GttuGng .
fade
+84" �....
Remarks:
Boring d
1 0-12 10yr 3 ncme qw if .5 .6
2' 2 12 -24 10 4/4 t~t si 1 2 mfr :If . 2 .3
Ground 7 . 5 yx 4A nme A :7 .8
dev,
Depte
rxrtiNnq '
IBM
Remarks;
CST Name: -- Please hint L. Steel Phone: 715 - 246 -6200
Ad*m: 1554 200th. A &ew ch qd, 4017
Sigttrewe: Dam: 11 - - 913 CST Number M=98
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer " s
Mailing Address y t 7 y' -
Property Address 46W ,30
1
(Verification required from Planning Department for new construction)
City /State G Pa �°''�" '"� �-d.�a �= � l Identification Number
n — r)
LEGAL DESCRIPTION
Property Location of w y,, 5 t.✓ %., Sec. L3 T 3 1 N -R Town of Sy�,e,
Subdivision
Lot # 3 '7
Certified Survey Map # , Volume Page #
Warranty Deed # - &) P �� Volume 7 Page # •�
Spec house Byes p no Lot Iines identifiable yes ❑ no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensedpumper 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.
Uwe, 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 Commerce and the Department of Natural Resources State to of Wisconsin. Certification
stating that your
septic
expiration date. system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year
SIG CA OF APPLI
DATE
OWNER CERTIFICATION
I (we) certify that all statements on this 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 warranty deed recorded in Register of Deeds Office.
1
SIGNATURE OF ANT
DATE
««•« «• Any information that is mis-
represented may result is the sanitary perniit being revolted by the Zoning Department. «•••««
«• include with thin appiicstion: a
stamped warranty deed from the Register of Deeds office
a copy of the certified survey nap if reference is made in the warranty deed
I
1528 567 III
STATE BAR OF WISCONSIN FORM I - 1998
KATHLEEN H. WALSH
DaamurtNumber WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed made between Gremwood Enterprises Inc a Wisconsin RECEIVED FOR RECORD
cprmmt Grantor, and Bernard L Kopp and Shirley F Koyp husband
and wife as suryiyashjp mnriL progea Grantee. 07 - - 2000 10:00 AM
Grantor, for a valuable consideration, conveys to Grantee the following WARRANTY DEED
described real estate in St. Croix County, State of Wisconsin Crbe "Property"): EXEMPT N
CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 78.30
RECORDING FEE: 10.00
PAGES: 1
Recording Area
ame a torn Addrou
S &C Bank
P. 0. Box 128
New Richmond, WI 54017
039 - 1191-60
Parcel Identification Number (PIN)
This kM homestead property.
(N not)
Lot 37 of the Plat of NortbOate, recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin on May
20, 1999 in Volume 7 of Plats, at Page 46 as Document No. 603503.
i
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances
except easements, restrictions and reservations, if any, of record.
Dated this caee— day of
G �11
By:
* * E
ary t, iu
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) lames E. Rusch, its president STATE OF WISCONSIN )
) ss.
St. Croix County )
authenticato&lhjs _day of 000. Personally came before me this day of
QQQ the above named Mary R. Rusch. its
gay to me known to be the person(s) who executed the
foregoing instrument and acknowledge the same.
* Lois A. y
BER ST A BAR OF WISCONSIN
R
authorized by 1 706.06, Wis. Stab.) *
Notary Public, State of Wisconsin
THIS INSTRUMENT WAS DRAFTED BY My Commission is permanent. (If not, state expiration date:
Lois A. Murray, Zilz, Estreen & Ogland, LLP - )
304 Locust Street, Hudson, WI 54016
(Signatures may be authenticated or acknowledged. Both am not
necessary.)
.Names of peno,u signing in any capacity should be typed or printed below their signatures
WARRANTY DIED SrATE BAN Or WISCONSIN
rORM Nw 1'1"@
INFORMATION PROFESSIONALS COMPANY FOND OU LAC, W BOO.OW1071
ii
P7 ,. .................
. f 01:- 715 3812 SA1HD ,, GE -HRI E PAGE 02
1 003 C
t0 X2. j 1
- POINT OF BEGIN!` NG
71rl
�� C1 ' �o ° `� 9FON
� \:
+ oo f.•.
56 NA tool .
4E - ro E�6 K-r l � 1 ..� l�� r. -.��• \ �� 1
999 0
�G
s
-
,t •� ~ --�-" — 7 1. .� .._ a.a I
Z
r 1002.9
p i \ . \ S _
1103.92 1 �• ry ,f ,. .+ �,` / �,
Q _ f .�
i
j
0
/. 43
E AS, F NIEN7 :A:t. / �_ r'J i la E1
fn
no
Wi6consin bepartment of Commerce Y
Safety,Vd Buildings Division PRIVATE SEWAGE SYSTEM County Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,P,g�rSjt�lVo.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. S �/ yyyylUl
Permit Holder's Name: ❑ City ❑ Village T wn of: State Plan ID No.:
I
Kopp, Bernard Star Prairie Township
CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.:
1 OD 0 I DO. D ` l VC = C -T� 6KA* 038- 1191 -60 -000
TANK INFORMATION ELEVATION DATA l 3, 31. C8r t8(,,
TYPE MANUFACTURER I Y
T E CAPAC STATION BS HI FS ELEV. T S
Septic Lj LLIL Z Benchmark 0 q - 1 0. 0 r
Dosing Alt. BM I '
Aeration Bldg. Sewer -(oS-f C1 " t3-S o.`t!3 `
Holding St/Ht Inlet $ -� (p 2. " 13 .TZ q0. I � r
TAN SETBACK INFORMATION St /Ht Outlet g�( o -96 1 0.0 2,'
TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet 8.6s
Septic I J( NA Dt Bottom
Dosing Z Z� r NA Header/ Man.
Aeration N Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand St cover
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. Fi Dist.Towell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O mod Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
[D epth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
d /Trench Center Bed /Trench Edges Topsoil ❑ Y s ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1. (� /o(,! Ot�Inspection #2: 1 /
Location: 1309 214th Avenue, New Richmond, Wl 54017 (NW 1/4 SW 1/4 13 T3 IN RI 8W) - 133118986 Northgate -Lot
� 37
1.) Alt BM Description i� )
2.) Bldg sewer length=
- amount of cover
aC � t e.flati,,
Plan revision required? 920A E] No
Use other side for add itio formation. I M Ij
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH "
SANITARY PERMIT NUMBER:
� E
qq y} i
t
3
l
b
a
h.
E � ,
_.
E
3
N I
4
k..........- .., -,,.M �,.. �..,........a m. �.... R.,..r e.. mbY�.... � ...am.,t......_.. ,.�,e.a.d..«,....m� .. e....- ....im.e.�.....t._.. --... .�...� e,........�..m......,.