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HomeMy WebLinkAbout657104 030-2141-00-010Wisconsin 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 Vicki & Gregory Patten TOWN OF SAINT JOSEPH CST BM Elev: Insp. BM Elev: BM Description: S. yD -5-1 5,1(44 uaerQ csv )och. Buti TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Intake ROAD Septic VVen;ttoAir Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufa er Demand GPM Model Number TDH Lift on Loss System Head TD Ft Forcemai Length Dia. is to w SOI,ORPTION SYSTEM If:?) &i\A� 6zx /-fY2t ,-& ELEVATION DATA County: St. Croix Sanitary Permit No: SAN-2024-036 State Plan ID No: Parcel Tax No: 030-2141-00-010 Section/Town/Range/Map No: 36.30.19.2060 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet jC St/Ht Outlet �.E�b Dt Inlet Dt Bottom Header/Man. Dist. Pipe � VJH'S �•`� 4y'nl� Bot. System fr�q S 6q 93' 81� Final Grade St Cover » 9q,6o Jai `f _n =PWTRENCj DIM IONS Width Length r �O No. Of rihes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION Type Of System: a 3 D / t ( y ( CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold t� Length Dia Distribution Pipe(s) L t a Spac' - x Hole Size x Hole Spacing Vent to Air Intake 7 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Over xx Depth ofxxSeeded/Sodded xx Mulched Bed/Trench Center TBedprench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ggl?d�2� Inspection #2: Location: 1273 84TH ST 1.) Alt BM Description 2.) Bldg sewer length = fi ��sD 1 �QA-e Wn�LS �lP.nTedL . - amount of cover Plan revision Required? ❑Yes X No LY7,," Use other,�id for additional information. .1L1A2� Date Insepctor'sSignature Cert.No. SBD-6710 (R.3 ) 4te �� B"t-S , Industry scmocs Dwiston County 4822 Madison Yards way l=? S� Nwnber (m be H&B in 1,y tom) Madison, Wl 53705 Madison, M 53707 7162 10 15 7 I ti q 1 Application Stale Transaction Number In accordance TAM SPS 383 21(2)_ Wis, two Code, sobmis6mm of this harm Yl dw apprapnate gavemmenW twit is required prior bo obtaining, a sanitary permit. Note Appiibcatinm rornts for stmtcovvra:d l'(3Arfs am submitted to the 3)cPamneat of Safety and Pmfi nsk mal 5arvioes_ Parsra al information }-nu provulc uray he Lewd for secondary Pnajet;t Address (if difCeremt than ttmiling addresl Putpas m in acconlanae with the Priyn Law. s. 15A I(1Xmv Suss aMA42- L AppBmtiioa Laformattiou Pkmw Print AN Ldoraadsn Property O%mer's Name u� Parch # �k; a a c -� i 1-o�..a r, Name f� � Pnapc ty t o dion l �._ Lot 5 F— V� }I., Scr uaa City, State j L� fyl U U � � � l Phone Number T � N R � E or W 11. Type of IItrildirig (check all that apply) Lot # SuhdivisinnAame El or2FamilyDwelIing—tdumber oMcdmoms � � hc1C0mnteteial — Uwe Use of rllage of fate Owned — Describe Use �,� (�/ � ) U CSM Nvnif= 11L TSppe of POWrS Permit (Check ekbter "New" or "Replacement" and other applicahie on Lane A. Check one box on Nme S. Complete line C if ap came.) A. Stem System 6_(� _. Otb Moto fecanan to Existing System (ram) 'bortal Prdrcalmew Unit (explain) g aoldiag Tank �Grrnmd +IFGiatts ❑MONA Individual Site Ui sign Pou. Type (explain) C- ❑ lteae M D3efcrrc ©Rcvj i. ar Pltmbts L_1' m"f- to New 0" � Previous Prmmit Number and Date Issued Fxptratran 57P Zlh l z!/(o/200� 1V. Dot armament Area and T mk tnfrwmathm. 2 Destm ':1d) � Soil Appl-wom Rabe(gpd►sFIM r Dispersal Area Required (st) � ! 3 f]ispasal Area PrmPased (� 0 ( S 60 �`` b Cayacity in TOW # of manuti xttrrr Tank rnfnzrrmfm Gallons Gallats. Units New Tanya Eu dM Tanks 0v rn as S an ix. C7 R. 1�+.1 l F h Sr*c or Holes lint / C 1 � Cltamlrtr 0 ❑ V. Respow%My 5f*t-MW 1 the maderiftned,awe r-p-ksi� fitri I Utiara of the POWTS shown o m the attar p1rns. Plumber's Nave (Print) s Si hfP1MPRS dsttmber Ph000c rN 1 Plu-k—' Address mxw, City, Staff 4p VL ConotyADeptartaitmt Use [lady %Approved Permit Fee Date issood Ismang Agent Sigsafnte Conditions af pprzD 3) �%i a I C.9.•�J�ili�cl! SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell aoQ� cQ -(� ue,{i �� �e �X-c +W KJ-4.6 must be serviced I maintainers as per management plan provided 6y plumber. 0 l �� 2. All setback requirements must be maintained 6e5� as per applicable code i ordinances. nzaresa m oamgrcar r tar tic sjstese - Wdy ■ rqmr . -�x 3. shm SBU-6348 (L 31) Ue ^7 See A n7Mz- S �,4 'C tm . Ti ot M14P LOCKfloN I T73 Lof" i0 3,K b 3 S-;,,pituvi 1: a0W4 Q Wt 5 y �XISI i I�bj) 063 gytE ,. =i7.L R r • r PER a a 3 sar 4 �� Phea Ti ot M14P LOCKfloN : I T73 Lof" i0 3,K b 3 S-;,,pituvrn aoW o' aw 5 y �XISI i I�bj) as tj1 flu Q W-v 063 gytE ,. Run— q-o, g .. .�■�_ io�r�'�"'��oo�#�lps�i.■'�q, �ur"�Q�iCt�'�ea. =s�� - _ 0 -. PI,3 afll IN -GROUND DOSED -GRAVITY DISPERSAL AREA Stepped Elevation Trenches With Guick4 Standard-W Chambers 3-ft Trench (dawn -sizing credit) m1n,12, SOIL COVER i�pl�'y TYPICAL TRENCH 12" CROSS SECTION VIEW mblench lrt, de l (No Scam) (ly 0aly . r Highest Trench Provide minimum 3 ft Lowest Trench (as applicable) separation between trenches. System Elevations J , ft; ft; ft, ft QuIcM Standard-W wl End Cap (Show location of Infet / outlet pipe connection on plan view.) (typle'd) -----��-------ter--- Observation Rpe (typical) Install per manuiaeftjmea f instrunllons. TYPICAL TRENCH PLAN VIEW {NO Scale} JA = 3.0 ft (typical) (typical) Qylck4. Standard-W Chamber INSTALL PER TRENCH, {typiga.0 f m(d ay Inflitraiw' Sy n a, Inc,) r� Qulck4 Std- mber wtnetallpurwantba manufaotutar'a Metn,atfat,o. p 10trIb 6tlo n. -Mieth od; branched manifold t r to qr .�'�`'S x rkrAll Yr .._ �•�.+. •,w y '}' •t' ,Yh •-� d II� �I � � '� •� .•1Al.r', i,t•I' . ''` 1 d�{+f� F ` �„•ti'�'rMS rtrr `: J'F I,++ r •' i i4sfl ,I Y^+i . rr I ' : .���`'' , , .p. y t: �' rrk'r.ir• ail �,. �-•---Try-.. f M•'' -0 RECEIVE[ jCOD c. 1323 + WbMak Da<tark"d i 2UQ5EV �RT Pap 1 d 3 eion d DiriSeiely and .� aNin 2 86, IKs Adm. Tom sa,m�c Aftoch oompiele ale pion- IX t� Plen must County iroMda dope, but not Med St Cron pemeR smote or end MM. loselion ape b merest mod. Meet" print ail kwon Batton. R rew 'In In roupooe xey ~ and for aa.nwvo�. t ear h. x �s a t�► au. (Gc.,.,,,1. I Z�0 S Ply Ownef Proprly Loc.Uon Grand Propectiog, LP Govt. Ld SE 114 NW19 S 36 T 30 N R 19 W Properly Owneh WOW Address Lot • Blocks 1 Subd Nama a CSllalt 712 Rivard Streeet, Snits 300 10 Nataie's Ridge Cry Stab Zip Code Phone Number _ J City Town Nersot Rood Somerset I WI 54025 715-247-59M SLJoseph I 80Th SG 16 New Cm*udion ties: id Ra -11 Hal / Number of' 1 co c c 3 Code dwW design flow nabs 450 GPD j Raplecamwt J Pubk or c niam el • Deeaibe: Penn nreI I ' Outwash F%in Fkmd per , ifoppIcable no Gbrural eanemrrts andoscommacKlofter Area is suitable fora converMkmW system with a 0.7 gpdhiqt rating. Possible wpdon elevation for Area , is 94AW. S"m is 2%. Borrig r J sane 16 Pit Ground Surface elev. 99.28 IL Deice by bnitmV hcW 97+ in. Sol AWcAw Reds 1 kxboon Depar Domi or t Calor Re" Des *jm Te fte struciue Consislenos 8oundsy Rocis apyr RS1 1 0-12 10yt'm none ell 21'abk mfr as 2m,2f .0 .8 2 12-19 1&pW4 none si 2fsbk ndr ow. ,f,,vr .8 .8 3 19-32 10yr4/4 none Sid 2msbk ntfr ow ivt .4 .6 4 32 77 10yr5/4 none grcos OSg ml ce —7 1.6 5 1 77-98 1 10yrM none ms Osg I mi -- — .7 1.8 eeeurw aorrigs J Borft f I /a 16 Pit Ground Suhcs oW. 1 98.05 ft Doo1h to bilira radar, 98+ in. �A—M—* dion Rate -- NEW"—. MM ��Tqos--M =m==== ==ME]' EIMMW 92 = e0o <3D mgrl. and TW <.,3u nWL CST Nome (Pleas P" Sbnd m CST Number Thomas J. Schmitt 227429 Address Tam SdvW Dale Evolu tion Conduded Tdophone Number 1595 72nd SL, Nov RWvnorrd Vk9 54M7 12A W4 715.247 2941 PnaparlY Owner Grand PropaEies, tP Pwad m # Pape 2 d 3 oI moot*'-, oo��000m ■ oo��0000�i Page 3 of 3 Conducted t*- Conducted For: Schmitt Soil Testing, Inc. Name: Thomas L Sclmt, CST 227429 Ad&w&- 1595 72nd St. arty, Ste, Z.O.- New MA motA WL 540I7 Phone: 715-247 2941 Subd.Name: Lot No.: Legal Dion: Township of Bench Mark EL 100.W Top of U2" rebar Alternate Bench Mark EL ?q 4.1 " Top of l%2" rehaz Contour Line EL__&4 Scale I" — "" " Grand Properties, LP 712 Rivard Strut Somerset, WI.54025 Nstalies Ridge 1� SF U41W114 S36 T30N R19W St. Joseph, St Coix County a Ttns soil repot was done to f MH a zonkV requirement. A preliminary plot map was used, no drainage eeaements or driveway bmbom were estadished at the time this soil and sibs vvaivation vm conducted. d CO/X//ri o�►� L�� dry � f `-'110 ' 77 , w,V IW# - rP •ab ��� � d CO/X//ri o�►� L�� dry � f `-'110 ' 77 , w,V IW# - rP •ab ��� � q `1 ...,....... I I(pill, 06 1� I iotJOS JOE JOE till FDA 1 laix till till I I iI Pis i� I t!llln�eusner , 1 6 �` r ' ..;------rl � NJ ! tllClC�l0l�4�" till, oll ST- CROIX COS ZDNIN� o ICg R `�LI �TTyICAT LON STATEMMuT `["Iom OF AN EgIST'M 'SEPTIC TANK This i.s t t 3 have i the '� I ` inspect the septic tam Preseatj See _ 1 nJ reside, located a t T - o _M, P� �r� S mow_ r UPon !,,pectio,, I certify that I he baffles to be in good condition, a it v-e foumd the tan Last -time Aced � ,� i t appears to be _ function1mg pro F Did flow bjactk act from ab8637ption syeteM? Yes Nra� �p to s�3Ume ox- l�gth of tine : { if no, skip .Capacit�: - gallons ufa P�efa$i t'oncrete Steed (if knc .) � � e�- - -� Age of TcMk {if know.) {Sigma l -� M 12L � VVW . {wame}Please Psi entle -Other4 E'oxIII to t i�NR �3 • ' Iioensed Pl {s - i45 - o6 r Wi 3cQnHjj. Statutes) psi nistratIve cbdej Ply (applying for Saruta� pe_t) Ce�t%fi Catipnx In accePting the above stater , ceatifY t the tank, aax, exist, ng S tic tank i is of to I -best of ter kaawl �tio sutler baffle), ��R 83, ir�i.8_ _ � cePt ��r �-lI 'off tv p fiction v�g Name 1'' 1 4� l� Y�'� pg jr Signat M'JMPRs_ and .ly. or 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)j. Permit Holder's Name: City Village X Township Grand Properties LP, do Mike Germain I St. Joseph, Town of CST BM Elev: Insp. BM Elev: BM Description: 9 7, 9 /3 - 3 C—ST- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , CAPACITY Septic D� Po lob 5ZS Aeration Holding TANK SETBACK INFORMATION TANK TO P/L 5o✓ WELL BLDG. Vent to Air Intake ROAD Septic ✓ 1T 7 5z; .._— Dosing Aeration Holding",­—­—, PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss Syste ad Ft Forcemain I Dist. to Well SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 515211 0 State Plan ID No: Parcel Tax No: 030-2141-00-010 Section/Town/Range/Map No: 36.30.19.2060 STATION BS HI FS ELEV. Benchmark S•9 03 Alt. BM F• j" Ge �, 15 G?7. % y. ('i Bldg. Sewer 7. Z St/Ht Inlet G 1 7:5 St/Ht Outlet Dt Inlet Dt Bottom Header/Man. 9. qY• Dist. Pipe Bot. System 3 •. Final Grade St Covey— BED/TRENCH Width j Length f„ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside D_ Liquid Depth DIMENSIONS 3 4 E 5 7 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBEROR Manufacturer: INFORMATION UNIT Type Of System: r /t pN,✓ Z6 6 �1> t f#- , /^ Model Number: ^ 6_ 4+ DISTRIBUTION SYSTEM 5e0 A. / 4 J-I fo = 32- W-„ d-,.,J( Header/Manifold Distribution x Hole Size x Hole Spacing Vent to� Intake Length Dia Pipes) _ \_ Length Dia Spacing �. zw SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only E"&r qtvl�_J _ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center �(� Bed/Trench Edges Topsoil \ Lis E No Yes [E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /— Location: 1273 84th Street New Richmond, WI 54017 (SE 1/4 NW 1/4 36 T30N R19W) Natalie's Ridge Lot 10 1.) Alt BM Description 2.) Bldg sewer length = 3 3 - amount of cover = Plan revision Required? El Yes VNo Z 2� Use other side for additional information. Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 36.30.19.2060 Cert. No. commerce.wl.gov afejKandBuildingsDivision 2� n Ave., P.O. Box 7162 County S ' iscons 53707-7162 Sanita�� it Numbero be filled in by Co.) t)epart "rit of Gbmnwr9ce State Transaction Number Sanitary Permit Appl'cafiep f A- ernmental In accordance with s. Comm. fining(2), nit ry p Code, submission of is fo a is required to obtaining a sanitary permit. Note: A plica n fo ����ii'']]''QQ r A Project Address (if different than trailing address) unit prior submitted to the Department of Commerce. Personal information y u provide may be use second ry T� / ��� O � u ses in accordance with the PrivacyLaw, s. 15.04 1 m Stats. I. A lication Inform tion - Ple int All Inf, ion Parcel # , Property Owner's Name raga ING OFFICE Property Location Property Owner's Mailing Address Govt. Lot T l 2 cT >rCr .% 11 G1 % � %L C3 Zip Code Phone Number 3 s'E '/,'/,, Section �o City, State (circle one) j T sL5r N; R� --EOv Lot # II. Type of Building (check all that apply) Subdivision Name 91 or 2 Family Dwelling — Number of Bedrooms %a,iL 3 K: ' joy ! Bl ❑ Public/Commercial—Describe Use 6� �L m. L ❑ City of CSM Number ❑ State Owned — Describe Use ❑ Village of LWTown of s�'Jcsse�/s U`rbi� GGI.�S W �' ���.o►w.ao�' ,Z III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ❑Other Modification to Existing System (explain) A. RNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only —"� List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ permit Transfer to New OwnBefore Expiration IV. T e of POWTS S stem/Com onentJDevice: Check ell that a 1 ❑ At ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil XNon-Pressurized In -Ground El Pressurized In -Ground -Grade ❑ Pretreatment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dis ersallTrest ent Area Information: Design Flow (gpd) Design Soil Application Rate( sf) iC ispersal Area Required (sfj Dispersal Area Pro d (s 5/ � System Elevation / g �/< <i6 e/ ��C� < � V VI. Tank Info Capacity in Total # of Gallons Gallons Units Manufac rer c w o New Tanks Existing Tanks 5 Z'S a ril d a U � w C7 0, Septic or Holding Tank Dosing Chatnber J Q e VII. Responsibility Statement- I, the undersigned, sssmne responsibiiity for Installation of the POW s ow RS Numbers � Business Phone Number Plumber's Name (Print) Plumber's Signature n« l Plumber's Address (Street, City, State, Zip Code) VII Coon /De artment Use Only Permit Fee Data Issucd Issuing Ag ignature pproved ❑=>an $ /J76. � �2. �� L61 ❑Reason for Denial IX. Conditi EUMMERgasons for Disapproval 31 } f� 1. c tank, effluent filter and Septic dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback tequirements must be maintained ttac coma e e p ans or a system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 02/09) Valid thru 02/11 J zK G <� /�✓I.Oy'%nLL /,V /C �� Id Ze- l =ya . JY/1 / /l%� v 0 ,z �3k 6•i' Tr .ev c � e S O�� �wJc,y` �y��o re►! SF. C90[x NO. -r? 7/6� S"I"ATE SANITARY PERMIT F-1 47's 8�� 1 l .515211 2ne6 X OWNER 1f ta-i � (:296 V PkT'TEi( . c mn DO ul.mggE T� -22.2 7o 4 TOWN OF ..9K6Pt{ SEC �P 9 7fl , IVIVY CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. / -M"kpm, AUTHORIZED ISSUING OFFICER DATE -1/j/W2.j THIS PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE i POST VISIBLE FROM THE ' • , FRONTING • DURING CONSTRUCTION SBD-06499 (R11/20)