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HomeMy WebLinkAbout008-1012-10-100 (2)wiscon entofcommerce PRIVATE SEWAGE SYSTEM Safetf g Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Peterson, Jake & Lindsa Eau Galle, Town of SST BM Elev Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER ~ S CAPACITY Septic i 6*J~v` ~x~ ~s1-~ to / Z (0 0 osin g ~ ; ~~r ~Ca,i~ ~ r /Do0 /~ Holding TANK SETBACK INFORMATION TANK TO t ~ P/L~ ~~-Nx7 WELL BLDG. Vent to Air Intake ROAD Septic b / 7d 8 --` Dosing ~ 7 l5 ~ i 15 Aeration Holding PUMP/SIPHON INFORMATION ,.~~/ Manufacturer Demand 2®Q.,~~ ~ GPM Model Number I ~~ ~ ' ?z. TDH Li~~• ZZ Friction Loss System Head ~ TDH~3 r , JJ Forcemain Length Dia. t ~ Dist. to well Z SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 515146 0 State Plan ID No: Parcel Tax No: 008-1012-10-100 Section/Town/Range/Map No: 04.28.16.63A10 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer ~~ / SUHt Inlet SbHt Outlet ~, O ~/ ~/ Dt Inlet 9z 9 , ~ DtBottom 2~.Z\ ~g.~ /Z~ J3 `t37.~f~ Header/Man. Dist. Pipe Bot. System /D~.b~ 3.3J /a5, 3 Final Grade St Cover BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS _, No. Of Pits ~-_ Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO ~ P L 1 B DG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: T Of S t ype em: ys UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Veit to Air Intake • U G Length Dia Length Dia Spacing 7 SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 2352 50th Avenue Woodville 154028 (SW 1/4 SE 1/4 4 T 8N R16W) NA Lot 1 1.) Alt BM Description = 1 r ~.~,Lj 2.) Bldg sewer length = ~~' ~` ~~~ ~ n -amount of cover = J ~ v ....~~~J1J1J1J1 C~ v~ ~/ t~.1 { Plan revision Re uired~ Yes No J Use other side for additional information. ~ _ _ _ SBD-6710 (R.3/97) Date Insep r' 2~17~ `f S57 t ~1;d-~,fl~ ~~~~~ ~-'t.c Inspection #2: / / Parcel No: 04.28.16.63A10 e ,.` s~~',`~... • o ~ .,.~-S se o~~.~J V '~[_ ~~3 Cert. No. trommeroe.wi.gov Safety and Buildings Division County - C~ D 201 W. Waslting~toe .Box 7162 ~ <, I x '~CO~ '~ ~+ ~ Madison, ~2 Sa~a~y Perniit Number (to be filled in by Co.) repartnterrt of Con unerce ~ ~ ~ S~ Sanitary Permit Application sou Tran~a ~N"meer h1 accoe+dance with s. comm. 83.21(2), Wis. Adm. code, submission aE this foam to the appropriate N goven~nedal unit is required prior to obtaitring a sanitary permit. Note: Al~lication forms for stagowned _ project A (if differed than mailing address) POWTS are submitted to the Delmrtmed of Commerce. Personal iufotmation you provide may be used for in accatdance with the Privac Law, s. 15.04 1 m ,State. I A ' ti I f i S((/-,ti..4~ . ca on n ormat on -Please Print All Information Property Owner's Name Parcel # 1~hC E!~/Zsor~ Do8-~d~Z..,o~/do 3~i Property Owner's Mailing Address Property Location 3 ~ ~ J~D % N U ~ PLANNING & ZONING OFFICi. Govt. Lot City, State ^y- Zip (C,od e~ Phone Number S W '~, s ~ ~, Section ` Z 8 II. Type of BtWding (check all that apply) ~ # T N; R ~(~ E or~~ ®1 or 2 Family Dwelling -Number of Bedrooms "'r ~ Subd~v~si°° Name Bloc$ ~ ^ PublictCommercial- Descr~e Use ~ of ^ Cr V . ~s P o y ^ State ~,~ _ ~~ Use CSM Number ^ Village of q /Q S ~ L/_ / ~ ~ Town of ~ Ei~Gt G ~GL E lII. Type of Permit: (C lack only one box on line A. Complete l ine B if applicable) A' ^ New System ^ Replacemed System ®, Treamnent/H T~lace~d Only ' ^ Other Modification to Existing System (explain ~ ''`-- B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Numbet and Date Issued Before Expiration Plumber owner ~ S3 3 ~ ~j 6 ~L/ ZOO ~~ IV. of POWTS S em/Com nent/Device: (Check all that a 1 ) ^ Non-Pressurized In-Crrow~d ^ Pressurized In-Grouttl ^ At-Grade Mound > 2A in. of imitable so aund < 24 in, of suitable soil 221 ^ Holding Tank ^ Other Dispersal Componed (explain ^ Pretreatmed Device exp V. rsaUTreatment Area Information: fl Design Flow (gpd) ~ DO Design So~7 Application Rate(gpdsf} "~ Dispersal Area (sf) Dispersal (sf) stem El ' ~ p ..~ D D ~O OD s o s - ©b VI. Tank Info Capacity in Total ~ of Matatfacwrer ~ Gallons Gallons Units ~ ~ Ntw Tanks $xisdng Taake ~i ~ ' i ~ G~ v i 1=. Septyc a fIoldo~g Tank ~ Z !~ d / Z 6 O / t~ S I nc9© iooo ~ , ~s~2 VII. Respomsibilit Statement- I, the mtdersiyted, a respeata36iltty for fmstai0atiat of the POWTS shown m the attached piisss. Ph~r's Name (Print) Plumber' tore MP/MPRS Number Business Phone Number ~ a ~~ ~c~rh l 1?' X23 7~(~ 7~S-~~~/~-6~rr Plumber's Address (Street, City, State, Zip Co d e) ~ / Co /De mew Use Onl Approved ^ Disapproved ^ Permit Fee $ ~ ~ • Date Issued 9 2 Z I Aged ignature ~ ~ owner Given Reason for Denial v o !t,~ -- ~ IX. Conditioffi of ApprovaUReasons for Disa pproval // / ,, ,/ ~ ~ ~ ~/ ~~ 5~-t1i~l ~~lJ~ ~/~~ Co~ ~ a~a~- ~-nJ a ~~~2c'~ s-c~ r~~ •~ •~ ~_•~+.. mw w.,wua .r uw ~..aemy anq as peya' ms ~ uvn a uc s 1a esnw m ®ze,~ / /'/ ~~soi ~ e /(1/Lc4~i'Or~ ~ ~ f ~~~ ,* Ni~ ~ ,(~'(~ : Scn/2: /': ~D' /off l,'C~Sr?/6P/s,~.y//h~ /off 5{-~a-if'e. Clu!`',/cY~z7' SC Sw mac. 5; 7n, ok' ~~ Z~ P!'Op05~ driV2u~4y gLbeol rim ~ ~a.r iG^~ /'es %~~cC. r-- I a~a~.~ YI ~o~o.~d ~.zG~~a,~ wecKs ~a„c~e.~c QF,~/kc•~E•~%~r Qro~oosCcl BaD 9.P. WGtxS COnCrt-'tC /~~P~,n 4cr - c% "~ rce r~aie ¢.X,~- ~i roue ,~~-~. s/°s~(.~IOP.~.c. Foncen'(a~n. To bt iikStc%~~ c d a S Doti 6Pr} eaz`~io4ive,,aa : J~' ~~ b ~~ Q° p~aPcs~e shed 8 0 i I ' ~ 5 opE I c I~ 6 3~ i t. ~I 1~ I _ ~, y 1 -a ~opl 1 's ~o~td ~a~ d Q f zG.l~9:r ~.u.P'3'w/G'x ice' d~s,ac~s4/ce/% ~u.r(yJ /a~C/~a.(. of I>s"x y9 3f~'w/ %y„o~~ F'c~s $,aaceda~ x•53,' b v d' . ^n ~ ~ o ~; N ' \ M /o~.z3' Z3, as 1ar~ ~ T o~F /o~~ SSumedLl• =Ic,YJc,D~ I ~ 250. oo' _ ~~~~ _ / ~p~ ode ~~ua-Q -~C~ ~a~~~ -~ S o~ 9 ~I - P~. partmentofCommerce PRIVATE~SEVUArE SYSTEM ~'^ `!dingy ' V ' INSPECTION REPORT GEiVE~'~cAL rtk<i=ORIIMATIC~I I+ (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Peterson, Jake & Lindsa Eau Galle Townshi CST BM Elev: ~ ~ •~~'~ Insp. ~I~: BM Description: ~~ i or~~' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~ r~ / Dosing ~' Aeration y, ~~~ J` Holding TANK SETBACK INFORMATION county: St. Croix Sanitary Permit No: 453306 0 State Plan ID No: Parcel Tax No: 008-1012-10-100 Section/Town/Range/Map No: 04.28.16.63A10 STATION BS Benchmark /1 ~~ / Alt. BMA, I o G~" ~u o-r. ~ Bldg. Sewer e St/Ht Inlet HI 'z .~ /g IFS ELEV. / ~, . a7 ~~ e~ ~~~~r7 ~'~ . S3 ~ - - / r7 ' ~ V J ~t~p St/Ht Outlet p 1 1~ .~ ~~ . Z ~- Dt Inlet ~ ~' y~ 9 ~6` ~ ~~ ii ~ , ~, Dt Bottom 8~. 7 yy 7Jb~ J ~~ ' l Heade n. _~ /~~/ ~ 9~.7i Dist. Pipe >, ~0(0• t ' ~~ '~ ~ , 7L Bot. Syste ~~' ~•~~ ~ ~ ~-,~ r Final Grade ~' / ~ ,-7 t ~t overr r`A n ~ ~ p 7~[-~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~ ~ t ~/~ / ~ r ~ ~ Dosing ~ r ~ ~ • ' ~~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~ ~ ~~ nd ®E GPM Model Number ~~~ / - TDH Lift ~ Friction Lossr Systempp Head TD Ft ~ ~~ J~ • ~ ~ v lo• ' Forcemain Len~ r Dia. ,~ N Dist. to Well~~ ~ SOIL ABSORPTION SYSTEM ~ lL ~r~ ,rso2 s-~ ~_ t ~ - ~o~. BED/TRENCH DIMENSIONS Width f Length 7 No. Of nches PIT DIMENSIONS No. Of Pit si a ia. Liqu' epth SETBACK SYSTEM TO P/L BLDG WELL LAKE/BYRE M LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of S stem: ~ ~ ~ r ~ ~ ~ /~ UNIT Model Nu er. U ~ I (~ DISTRIBUTION SYSTEM ,1 Header/Manifold ~ i i ,~~ Distribution Pipe(s) ~~ 1+ ~~~ f ~ ' x Hole Size ~ ~~ /~ x Hole Spacing ~' Vent to it Intake ~~ Length Dia Le Length Dia 1 Spacing ~ , ~ SOIL, COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv Depth Over ~ Bed(Trench Center ~ / ~ Depth Over Bed/Trench Edges xx Depth of /~, Topsoil `~ ' xx Seeded/So ded ~ xx Mulched N `~~ _ ~.v \ rV-~ ~> Yes ~j No o s L~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ 30 /~ \ ,~ Inspection #2: / / Location: 2352 50th Avenue Woodville, WI 54028 (SW 1/4 SE 1/4 4 T28N R16W) NA Lot 1 y ce No:~O^28.16.63A 1.) Alt BM Description = ~P °~ ~`~~ 1~3 ~,~'r^"~'~ 26~ IG~ 2.) Bldg sewer length = ~' ~ r ~ ~ ~ Ln i ~ ~,''~- r - amount of cover - '7 ~ ~~~ •~- eyv 3.) Contour = ~b ~ , ~'7 _ - ---- ------ --- - ------- - - r- - ,---- Plan revision Required? t'~ Yes No -~ 1 3~ ~ ~ ~ ~ ~J Use other side for additional information. ~__-__.L_~__-_`.__' I___.__ _. ___.___- __- __-_____- -_~ _ T SBD-6710 (R.3/97) Date Insepc is Sign a Cert. No. a Center Connection Lateral Layout Diagram Forca mai n connection via tee or Dross to mur6old at ang point P •=Turn-upw-brllrahroor ~-x-~~a12~a12~I clwanoutplug Holes driged om the bottom ~ the lateral. Laterals are identical s Laterals k force main of PYC Sch i0 par COMhA Table $4.3d-5 Number of Laterals Lateral Diameter Lateral Length (P} Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head 4 Orifice Diameter 1.50 in Orifice Spacing (X} 49.34 ft Orifices per Lateral 3.00 ft Orifice Density 8.24 gpm Manifold Length 32.95 gpm Manifold Diameter 32.40 ft Forcemain Velocity Dose Tank Information Electrical as per NEC 300 and -- Comm 16.28 WAC ~_ ~isconned Tank component is propery vented Weis@r Ca Ci 1000.00 Volume 21.50 Manufacturer Gallons gal/inch Dimension Inches Gallons A 27.43 589.71 13 2.00 43.00 C 6.18 132.94 D 10.90 234.35 Total 46.51 1000.00 A B C D Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number 140 Pump Must Deliver 32.95 gpm LocMng cover with roaming ~hel and k~cldng device and sealed Hratertight 4 in. min. E- AKernate otrtlet kx;ation Forcemain diameter ~ 2 in. Weep hole or artti- siphon devce ,. ~~r Tn~~~ri P~um off elevation (ft) 85.66 -~-~ bo~forh • Daee elevation ft ~ ~ ~ 7 ~ , 84.75 C at 32.40 ft TDH v"~~~~'u"~'~ C~~'~~' Project: McNamara Residence Page 4 of 9 ~ . ~~a~ ~,w s5tre-szF-oos eooz •NVr •n~a O aooa xavnrrir ova osttis rA '~aoa Ic~avn rol~-+ sn au~ l1/f1Ndi^I ~LLd3S ~ ~ .IMS ~.te rrNVaa ~~~,~~'~ ~ ~ o ~~va •orl n3a .I = .i I~ -leras 00014H3M ~ z W W U W ~ N O V I Q ~ ~ ~ N ~ ~ a W J `~' Z F- ~~ U ~ Z O 0 ~ ~ ~ ~ ~ ~ ~ - - ~ ~ o o ~ N O ~ .. WOE' C7 ~ \ V o W W Q ° ° Q '~ ~ ro ~ a ~ N ~ w O ~ a QWaW J ~ `°oooo mN a = O o o O r o 0~~~00 J J0~ 0 } R N T W Q Qe W~fDO N ~WiAd'Y 4WN ~ WW %f - JF d Q N Q ~ ~~ Wr ~ R d R N > W< ~ l- N mt W p.. W ~ < Q Q ~m YZ :~ O J \~~ n Z~ld--UF~U ~~N ham- y =U ~ ~ = Z Q F- W M J.. W--^' .. ONF- ~..0!-[] 1-F:O<W OB 0 Oz~ U s OOW Y J ZF-4 N W m a a HU y G W Z = J t='~~ O(~~ =2~0 G? _ pp <tl a a p~~ < Q ~ E"~J~ p ~ O W N OC f-. ~C 9 Z3mv~~om~33 3 o ZOQ Z V W ~ Q W F J O o Z ~ L~l ? ? 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