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HomeMy WebLinkAbout042-1075-60-000(2) . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 1 l/` 2 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: 042-1075-60-000 Schlon-Tick Holdings LLC, Container storage Warren, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 1 S, I L6 `aJ A ~ 27.29.18.4278 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV. Septic Z• J^ Benchmark Z• g q y9 q SI 52J~. o u--C.J Dosing 56 Alt. BM Ca.M~a 6 a Z Bldg. S er $ 97 q•Z , o F---,' AA , ~d a k. SZS ' Holding Inlet Al W a (JC~C J l~ St/Ht Outlet TANK SETBACK INFORMATION TANK TO e'P~ ` WELL BLDG. ent Air Intake ROAD Dt Inlet W Dt Bottom Septic f y ~•g Dosing Header/Man. Lj S 927 C' 1.0- cl7 wt~_ A4 -7 Aeration Dist. Pipe w Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer -Z. ~ I DePnand ~ St Cover Z~S c~5 S Model Number 66 TDH Lift~, c~ I Friction L s s System Head TDH~ 3 Forcemain n LengthVb / Dia., j / Dist. to Well SOIL ABSORPTION SYSTEM ✓ BEDITRENCH Width Leng~ No. Of Trenches - IT D MENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t5 Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION Type Of System: UNIT Model Number: Le 00.-P. ~ a DISTRIBUTION SYSTEM Header/Manifold Distribution x H e Size x Hole S cps ing Ver7tEo Air Int e Pipe(s) ' W / Length Dia Length Dia ing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth f xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil es 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 742 130th Stre Roberts,ry 1 54023 (NE 1/4 SE 1/4 27 T29N R18W)N' Lot 1 Parcel No: 27.29.18.427B 1.) Alt BM Description = 2.) Bldg sewer length = /5 154- a l~c( G, IUA d' - amount of cover = Plan revision Required? Fol Yes No V ~v Use other side for additional information. Date Insepctor's ignature Cert. No. SBD-6710 (R.3/97) County `.w Safety and Buildings Divisiot C lbx 201 W. Washington Ave., P.O. Box Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707 62 S IP sR~ 5 ~ X2-1 z ;z C'Q X01 "gate Transaction Number Sanitary Permit Application ~ $ In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate ga,"mentaiunit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are ~nitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for somridary purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats. /}a 1. Application Information - Please Print All Information 1 Property Owner's Name Parcel # G - -A- a- l6~ - toy ' b Property Owner's Mailing Address Property Location 7 "a kQ~ rz~ , Govt. Lot I C t City, State Zip Code Phone Number t c, 1VVZ~- y,, y;, Section ` t7 sSlat cucle one V I~ ~Y I xx c . ~~l\v T ~ N; R -Ir E or II. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name / Block # Public/Commercial -Describe Use Sb ✓ ❑ City of CSM Number / T ❑ Village of ❑ State Owned - Describe Use V Vo ( Z a / ~7'own of VU A9-R&N~ III. Type of Permit: (Check only one box on line A. Co plete line B if a licable) I A' ❑ New System ❑ Replacement System reatmen olding Tank Renla mPnt~ 1a, El Other Modification to Existing System (explain) B. Permit Renewal e>Ttttt Revision El Change of Plumber List Previous Permit Number and Date Issued ❑ lz ❑ Permit Transfer to New Before Expiration Owner IV. Type ofPOWTS System/Component/Device: Check all that a 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed ( System Elevation -A0.6 14c~) ~S %7, 33 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks Pa~ lat~ a U o d M n V n w5 w Septic or Holding Tank Dosing Chamber UJ`) v VII. Responsibility Statement- I, the unde igned, ass me resp • ility fo install do he Fi1OW shown on the attached plans. Plumber's Name (Print) Plumber's ignature MP/MPRS Number Business Phone Number ~ffs M ~ c aa-► -1(5- a- S, Plumber's Address (Street, City, State, Zip CMIEL001 q~ Z i ~N~g ST K5-~-`-T- U ~~Z V~/1~~ ~1 VIII oun /De artment Use Only Approved sapprove Permit Fee Date ssue Issuing nt Signature tven Reason o ettial /D 2 IX. Cond' ' easons for Disapproval I. S6PWft*AM*fVWa,nd 3) dispersal Celtm * ail be serV M I maintairted w~a God e . as per msrngemeM plan provided by`plu,r. / t rHritie~ift mt* be ITli~irittg ¢ 1A 54,4- le, Attach to complete plans for the system and submit 4 the County onl paper not less tha 8 y2~ 11 inches i e j SBD-6398 (R. 11/11) 10 069-000kM :3-1Id 99-v8-5Z2-008 OIOZ •N`df 43SIn38 o \ Z ~ OSLtiS IM 'N08 N3O1VW Ol tMH Sn 9LL£M :8n0d-1SOd :31VO OLOZ k8vnNVr :31V0 -IdnNdw 0ud3S X38 31303~~~~'m w =o :8nOd-38d „0L l :3lV0S 3WS :AA NMV8O 10g I03-059/00OId-M V) \ Ld w v Z N o O W~ U H W ^ W U Q U~ N W ~L z D F a p J Z oU W a a. M 0: Na ' ~m O O N p 0 a W ~y Q LL. 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N ® o~¢ H 'R:3- Z W Zoo Jo 0=p - Z w~ W M CL Cn = H W O N J wOlf W co pQomJ fy aLL. ~ZEE Zw¢ N W J M L?2 ~ H ~a~=O co u o 0 0 0 0 0 III c U C LQ U _ r 1 N O N E E N 07 U N U O O 1f') O N N u O V U m (h N CO CO O ~ ,emu u I /All E I_ U O N WARMW O V U O L6 1 OIJmINYAR I DD co CAi c6 U ~ N ti O W O u U Q cn U ~ NEW N m U Q N 10 p~~~1!IIII~~O IY III!I+URIV~~ IIII J III Q~ N ~ N AIR M p iy CG fn C/) ov Z O \ ti 2 rn~ O 2 04 CMG LL W C O u CO LU a¢ ~O x cu'> LU LL ~ W Y a° ~~-9 W O CO LO LO U J IM CO of I J CV 0 LQL L? O `U- aoLu~ i' J J W Y 0:5 LL ti O J Z ~ C~ J J \ >F-WOQ Q a a 0 V 0 00 ~.rAATag~ DIVISION OF INDUSTRY SERVICES s?. Tom 10541N RANCH ROAD u~ P HAYWARD WI 54843 3 f ©S g Contact Through Relay P www.dsps.wi.gov/sb/ S www.wisconsin.gov Scott Walker, Governor A~OSSIONPtiS~~ Dave Ross, Secretary September 10, 2013 CUST ID No. 227548 ATTN.- POWTS Inspector TIMOTHY H MITTLESTADT ZONING OFFICE BOWMAN PLUMBING ST CROIX COUNTY SPIA 2819 KNAPP ST 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/10/2015 Identification Numbers Transaction ID No. 2301689 SITE: Site ID No. 794740 ECI LLC - Schlon Tick Holding LLC Please refer to both identification numbers, 130TH St above, in all correspondence with the agency. Town of Warren St Croix County NEIA, SE1/4, S27, T29N, R18W FOR: CONDiTIO Description: Septic tank replacement APPRO Object Type: POWTS Component Manual Regulated Object ID No.: 1446143 DEPT OF $A Maintenance required; Effluent Filter, Miscellaneous Review PROFESSIONA The submittal described above has been reviewed for conformance with applicable Wisconsin Administrativ65IpN OF 1NDU and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. SEE GORRE No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in the "In-Ground Soil Absorption Manual System" are complied with. A copy of this information must be given to the owner upon completion of the project. • This approval is for the replacement of a septic tank only. The existing septic tank that is being replaced must be properly abandoned. The proposed septic tank shall be connected to an existing dispersal cell that is code compliant or was code compliant at the time of installation and currently functioning properly. • The septic tank that is to remain must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of SPS 383, Wis. Adm. Code. If it does not conform a state approved tank must be installed. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. TIMOTHY H MITTLESTADT Page 2 9/10/2013 , In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 80.00 Fee Received $ 80.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer , t grated Services WiSMART code: 7633!. (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Michael J Myers , Northland Plumbing Inc Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Page 1 of 4 i SYSTEMS I N C Environinemal onsito Wastow, tear Snluti6rs°, Leaching Chamber Design Spreadsheet Project Name: ECI LLC-Schlon Tick Holding LLC~,®~ Owner's Name AUG 19 2013 Owners Address 7012 6th St N INDU' ° `Y SEIRVK"C St. Paul,MN 55107 NE W SE 1/4 Sec 27 T 29 N, R 18 W,,, Legal Description 1/4, Township Warren County Saint Croix Subdivision Lot# -41 SALLY ParcelID# 042-1075-60-000 pND SER~rc~ Table of Contents pg- 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Plan PON E 4 Plot Map 5 LJF-r S TA7/o~( total # of pages: 4 Designer Name: /-UW v License z 275 Date: /2 13 Ph. Signature: Design Methods Used "IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWAT R TREATMENT SYSTEMS" (Version 1 0) SBD-10705-P (R.6/99) N :1 Infiltrator and the Infiltrator logo are trademarks of Infiltrator Systems, Inc. 91'STEM~S~INC " Spreadsheet provided under license to Infiltator Systems, Inc by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Zoeller Pump Company Page 1 of 2 3 ~ a 1*rc~z'1tce8 5dnrct'r eace of Mind is Our Top Priority`~ Our Product# Pump Sizing support: Where tv Buy About Us Lucy-In PRODUCT 98 i a§£rPTZ 60 Hz i _ Product specificatinns HP ACS€.Tr: C d 230 -Ar €"ed €l czal Data t1 'sE i 4'.t ~ . LLBN . AMPS h., ~ Ll 7, ~ ~ j~~. a'si:, , y x.>i;6;9s IYRL:7St°9 A0, ~ G'€at 1) F-1- B PIN, TS SOLIDS HANDLING 1/211 17, '3•' n, f-.,c)hf;:"`rs3i CORD E,>,wp CMi ~5 (J CORD TYPE 413 3 ~ 3 { 7 f14; i CAP {~.it5 r.. PUMP HOUSING BASE, i I T4 w. C a'k € i 0,77 KVV' .317 A, GE 22r, AW>S 0PCf2A'TST N (',U. CCI ~ic3C?t (,-;'."?q"1;,41: AUTOO, .r KNTS .2.'.i,..,, r .r i9 €i $ . CORD I'l CORD TYPE http://www.zoellerpumps.com/ProductDisplay.aspx?Productld=92 08/16/2013 County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN ~~r1 ' Gpv 0 In accord with Chapert 12 St. Croix County Sanitar ~lin a PLANNING & ZONING DEPARTMENT Pconal information you provide may be used for second9 o ST. CROIX COUNTY GOVERNMENT CENTER of [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road 14, Vk. Hudson, WI 54016-7710 (715)386-4680 Fax (715)386 4686 ttach complete plans for the system on paper not less than 8-1/2 X"q inches in size. t~ ty Sanitar lFermit # ❑ Check if revision to previous application 0 17 Z 1. A plication Informs 'mn se Print all Information Location: --AV7 J_ Property Owner Name ~a 1/4 114, Sec V N, R E (or) Property Owner's Mailing Address Tttf ',do t rSubdivision ber Block Number -7012 -ru ba. City, State Zip Code Phone Numer Name or C M Number 1~' I ~ Z~ I lv II Type of Building: (thee o e)ORE amity ❑ Village JOTo* of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: V Public/Commercial (describe use): com ❑ State-owned Bare160 ad r-~ it. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 7YZ P arcel T Number(s) A) 111.0 Repair 12. Reconnection 3.❑Non-plumbing 4. ❑ Rejuvenation D~Z 1 12F75. 66 ~ C~ Sanitation ! fPv B) Permit Numbe Date Issued state sanitary Permit was previous issued lV. POWT Sy stem: (Check all tha apply) pressurized In-ground Mound Y~:2 i11 s uitable soil ❑ Mound 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter C Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Idin k ❑ Single Pass ❑ Other ❑ At-grade ❑ Ae is Treatment Unit ❑ Recirculating Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. ispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Req ' d ff~~ Pr ed (Gals./day/sq.ft.) (Min./inch) Elevation 00 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks 1040 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11. Responsibility Statement 1, the undersigned, assume responsibility for repa /reconnenctio rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair inst tion of non-pl bing sanit ion systOn. Plumber's Name (print) lumber ignatu to MP/MPR No. Business Phone Number r. 75 / 0 TJ M r? op- r ~ r AN I /Z lumber's Address (Street, City, Sta ip Code) VIII. County Use Only Dis Sanitary Permit Fee Date Issued Issui gent Signatu o sta s) X Approved Owner Given I I Adverse 2Zs , CD 8 113 L De IX. Conditions of Approval/Reasons for Disapproval: SYSTEM OWNER 3) $eptic tank, effluent lifter and dispersal cetl must all be services / m In Ined **.per management plan provided by plumber. wk reltuirement; roust.bemaintained 0 W*" dodi 1 ordinuliors