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Home My WebLink About016-1045-60-000 LQ ► i`sT~Q pram l ~~y, 20.30.15 .pM0RTV WA4?%%T M County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 149237 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: 5 ev.: nsp. BM E ev.: BM Description: Parcel Tax No.: 1~ /L, G~ aS 016-1045-60-000 TANK INFORMATION ELEVATION DATA A9300364 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 00 Septic t; - Benchmark Dosing Aeration- Bldg. Sewer t1- - - Holding,._ St/Inlet TANK SETBACK INFORMATION St/ )4f Outlet TANK TO P/ L WELL BLDG. Aiir intake ROAD Dt Inlet Septic >~73 ' NA Dt Bottom Dosing 171 NA 4etCcWf / Man. Aeratio Dist. Pipe 6 Holding Bot. System PUMP /f tnNFORMATION Final Grade - Manufacturer - Demand x Model Number GPM TDH Lift Ul Lricti ; System TDH `~Ft Forcemain Length Dia.e " Dist. To Well ^ ~Q SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ / Length i No. Of Tr riches PI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~i DIMENSI N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI Manufacturer SETBACK INFORMATION Type O CHAMBER el Number: System: OR UNIT DISTRIBUTION SYSTEM kF7 M nifold I Distribution Pi e(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length 64 Dia. Spacing I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over f rs Depth Over „ xx Depth Of xx Seeded/ Sodded xx Mulched Bed /-T;eae#a Center Bed/ Tfefleh+dges - , Topsoil CO R-eVs- ❑ No [ es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: GLENWOOD 20.30.15.328B,NE,SE,290TH ST. Plan revision required? ❑ Yes EJ N-6 Use other side for additional information. r SBD-6710 (R 05/91) Date Inspector's Signature Cert. No SANITARYPERMIT APPLICATION COUNTY. I DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. 1:1 Chock if revision t&pre ious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION /a,S T N,R r)W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER l II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( ❑ State Owned ❑ VILLAGE ❑ Public ❑ 1 or 2 Fam. Dwelling4 of bedrooms' AR EL TAX NUMBER(U) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. El Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 H Mound 30 El Specify Type 41 El Holding Tank 12 El Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed ! Septic Tank or Holdin Tank El I El LJ Lift Pump Tank/Si hon Chamber El El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: lumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) - y ® Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber 1 1 1 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 GALE SMITH Owner: JAMES GOOSEN 3228 HWY 170 1436 290TH ST GLENWOOD CITY WI 54013 GLENWOOD CITY WI 54013 I RE: Plan Number: S91-40926 Date Approved: October 28, 1991 Gallons Per Day: 600 Date Received: October 21, 1991 Project Name: GOOSEN, JAMES Location: NE,SE,20,30,15W RESIDENCE Town of GLENWOOD County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 785-9348. S11D 6423 (K. 01/811 I SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Industry, Labor and Human Relations GALE SMITH Page 2 Sincerely, GERARD M. S IM Section of Private Sewage Division of Safety and Buildings PPP039/0009n/42 cc: JAMES GOOSEN X Private Sewage Consultant ISUD 6123iR.011811 Page ~ Of ~ i S row, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoil ..l l p E u $ . % Slope Bed Of 2"- 2 (Force Main Plowed Aggregate From Pump Loyer D X2'0 i Cross Section Of A Mound System Using E ~C-F A Bed For The Absorption Area F G _//O A Ft. H S i-gned B 7 Ft. - License Number: /W P ~O I i ~ Ft. Z J Ft. Date: KFt. L Ft. Ft. W3 1,0 Observation Pipe---,,, It` ~ Force Main W ° - From Pump Distribution Bed Of 2 - 2 1 Pipe . Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page o? Of Perforated Pipe Detoil 0 End View )Perforoled End Cop) \t PVC Pipe 1 oe ct ~►°Q SS°° Holes Locoted On Bottom, Are Equally Spoced F0 -1~. fvlpiN P Q D,stributi ✓ Pi Lost Hole Should Be Next To End Cap End Cep Distribution Pipe Layout P ` Ft. S -7-n X 16. Inches Y ZJ"' Inches Signed: Hole Diameter _ Inch Lateral Inches; License Number: 6 J~ O Manifold Inches Date:. Force Main Inches # of holes/pipe 2 Z 13 Invert Elevation of Lateral sf7,54(Ft. -116- PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS ' VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR, I2"MIU. WINDOW OR FRESH AIR INTAKE GRADE I I ~ `4° MIN. l-- ~ 16"MILL. COIJDUIT 18"MIN, 11~ INLET PROVIDE I AIRTIGHT SEAL I I 1 ~ ~ I II v APPROVED JOINT A I I I APPROVED JO W/C.I. PIPE I III W/C.I. PIPE EXTENDING 3' I II ALARM EXTENDING ONTO SOLID SOIL B I II ONTO SOLID I 1 ON c i ELEV. FT. PUMP-~ -_j y OFF • D CONCRETE BLOCK RISER EXIT PEKMI-ITED.ONLY IF TANK MAIJUFACTURER HAS SUCH APPROVAL SEPTIC SPECIFICATIONS DOSE 80~~ SAL TANKS MAAIUFACTURER: ~ P /1 S NUMBER OF DOSES: PER OAJ TANK SIZE: ODD GALLOMS DOSE VOLUME ALARM MAWUFACTURER: SST F~ c7`~o INCLUDING BAGKFLOW: GALLON MODEL WUM6CR: /D/ /l40 CAPACITIES: A= INCHES OR y.~ 9 GALLOk SWITCH TYPE: mQ/Q /C G( B INCHES OR -3 4{ GALLO► r PUMP MAMUFACTURCR: _ ~y~oe l '49 C = /,0 p INCHES OR /170 GALL01. MODEL NUMBER: D= INCHES OR /3.2 GALLOI. SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE -RATE i GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AIJD DISTRIBUTION PIPE.. XO FEET + MINIMUM NETWORK SUPPLY PRESSURE.. . 2.5 FEET + FEET OF FORCE MAIN X ~'b F ooFEFRICTION FACTOR..! FEET TOTAL. D'UIJAMIC HEAD = f0, % FEET I INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH 27/ ;LIQUID DEPTH -!~Z/ SIGNED: w ~ LICENSE NUMBER: ~R S-1ye DATE: . f'.~~e y dr !MlElEl ~ 811DRETE RT. 2 (Hwy. 10) MAIDEN ROCK, WI 54750. 715-647-2311 • FAX 715-647-5181 . t t ~ P % . .........E £ i ~o V i : t i l