HomeMy WebLinkAbout040-1276-90-000
)AIsconsln Departmert of Comm-rce PRIVATE SEWAGE SYSTEM Ccunty St. Croix
Satet•; and 3ui ding D ws on
INSPECTION REPORT Sanitary Perrit No:
574384 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plar ID No:
?ersor•al wfnnnatiori you provide may oe usec hr seu;ndary pr.rpcses :Privacy Law', s.15 D4 j1'}(m);.
Perm. Holder's Name City Village X TownsPip 7arcel Tax No.
DeFlorin. Jason & Lisa Troy, Town of 040-1276-90-000
CST BM Elev. nsp B 1 thv 5M D cri ion it, ( Section,1Tchr.1Rarge'Map No:
17.28.19.1541
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Z I S J` Benchmark -l /v)
Dosing 3' Alt. BN1
B on ewer
i I tf"T7 / 1 f 3.3 16.5
b Z. 8
Holding S 'Ht Inlet 13 7 yq
1/13-
SU'Ht Outlet
TANK SETBACK INFORMATION
TANK TO P+L WELL BLDG Vent to Air Intake ROAD Dt Inlet
Septic f r i Dt Bottom
Dos no Heade )Man.
r i
I ,
Ae,,atiori Dist. Pipe
Holding Bot. System l.~
Final Grade
PUMPISIPHON INFORMATION
Manufac'urer Demand St Cover rr af,~ / f 3. h 10 3.6
L GPM
Model Number 2 .I'7 ~Ol+
ISz V 1
TDH Lift Friction Loss System Head, ; TD H,, Ft J r, r
7
Forcema r Length r. Dia Dist. to Well ~
SOIL ABSORPTION SYSTEM
BEDITRENCH V,' d.h Longlt:_ No Of Trenches • L1 I PIT DIMENSIONS Nc ()f Pits nsice Dia _i uid Depth
DIMENSIONS h•. 7
SETBACK SYSTEP.9 TO . ) P1L BLDG WELL t-AKEiSTKE.AM LEACHING Manufacturer
INFORMATION ~l CHAMBER OR
Type f'gIem UNIT Modes Numbe`:
DISTIjIBUTION SYSTEM
Headetf Vanifold' Distr oution x Hole Size . x He a Spacing Ve rho take
I ipeis j A;,;
P
v
I er.7tn ca Lergtn 1 l DiG Span g i
a
SOIL COVER + x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Cver ~t Deptr Over xx Deptt of 7
Bed,1Trer-lr Center'Edges Topso l Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc } Inspection #1:1~ 1 31 Inspection
Location: 398 Eagle Bluff Couft Hudson, WI 54016 (NE 114 NE 1i4 17 T28N R19W) Ea I- BIUff Lo: 9 G- Parcel No: 17 29.19 15 1
1 1 Alt BM Descript.on = rI 4 Y i ~e e_~o- / by r (di i n sew'
2.) Bldg se'.ver length =j{ 3 54,E
Z_ I v~ i 5 S~ S fry
- amount cf cover -
7 a F c_ a-c,.- Uo1, F, Cl f f
Plan revision Required? Yes ~No
Use other side fo, additional information I Icy 1 ° - - It + 1
jnll
Date InsepctorspSrignaturre Cert . e lo'.
S8D-5710(.83,97) l ( 111 ~,v )-%,P_ l1V~tlY~l ~VYV~- n `P
PLOT PLAN
PROJECT Jason Deflorino ADDRESS 10876 Alberton Ct. Inver Grove Heiahts Mn 55077
NE 1,14 NE 1/4S 17 /T 28 N/ R 19 W TORN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 103.6' 8128/14 4
DATT, BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
k10UND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O ""ELL * H.R.P. Same as Benchmark
Scale = 1/4" = 10'
r~ Eaggle Bluff Ct.
All piping shall be SDR 30,134, within 10' L7
of tank, piping shall be Schedule 40.
3 Acre Lot
2;
Wel I is to as ,
meet al I YI
WDNR
setbacks
1 02.6' ,IQ~
0
B.M.
B
Grading is to be done to
divert run-off away
1 from system Pro 4
I Bedroom
~ House
10% Slope
Tank is to be properly
B-3 bedded and provided
Area 1 5' below with lockdown covers
system is to with approved
remain L
undisturbed ` warning labels
Property Line
o
B-2 ~
Huffcutt Combo Tank
100' 103'
101' 102'
i
f ~ `,,unty ~ f
G + ! VO Safety and Buildings Crvision r-,1~~ l wit N> o be fiIlcd m by Co.)
01 W. Vt,ashington Ave., P.O. Box 7,62 5
tS7rl 01~ I Madison. W! 53-IC'7-7162
st=T-~ri~ ~vo ~>cr
- Cermit Applis~at~~~n - _
I
Vital =11, Y- -Y
W tiaa maz mt;
:s him Code, su5rrission oI thts force to the appttgrtat~ g if dril audr ss;.
oblslntng a sanltan pan't' NMI APPicatioo focus for staff cwtted 1'4-'W S arc subu:itstd W Pr acct Acid ess crecr
s rcQtitrt~~ ~ siona Savnes. P enal utfortnatioc you provide tna} be ascd for scconda - 1 ~7 r
Safety and Profa ti
t:,c Department of
pctposcs lnaccOr witE tlx Pnr_a`l aw. s ::.G41; Nml Slats.
dancc
ppGestio_n tnf~urmation -_Ylease Print All Inform U0111 I yar eta
Ptuperty pwttc's T:arse ~ t ~ ~ ~ ~d C
cLst - Lt>`a~°° 15, l
Prnpcny Owner's Mas1u,9,'-Q1U S ;;,vt Lot,__T
1 I/ ip '-0 C Ph I J r Y~. SoUion
one Vtnubcr
7_ ) I / ~ uck ort ,
(:1tv. State n v_ ~t 1 J ~i / ' - n
om` " F E
r
E i (s'i'~~ Lo -
u Tvpe tof Building (checy all at apply) ~Subd visloo?~ame
f' arnily L?.yci:ing Nwnbe* of Redrocxns ~C~ f
•
city of
I _
_ A~bG~I:'~,mrnercix; Inc"'x Use
fL \clage of
CSM Number I n
i Stan Owaui - Dl--be l:jR / i wn of rJ -
VIII. T}pe of Permit: (Check only one box on line A. Complete Liue B tf applicable) (Ddx7 M°dificanon Li Existing SW13T' (cxp!air
j- A -r S tczti K laccmcnt cvstacL Tr.:wucvt~ll.~l:bng Taz~k RePle,xtncnt -)nl~
' - Lst Prcw•ious Pcrmr. Ntanber una riatc Lssucz
- Change of PL=bCr I J Parris ir.+asfcr o Ncw
LR. { Peat; Renetsal L Para1: Rrns,un Cr ~r
B3L-" xc F.xpi-a:1on~i
4i=
IV Tvpe of POW I S cm/`omponcndDrs'ice. Check all that a Iv1 _ Fj Moues 24 N. Asutt-abtc soil ~Ad =d % 24 in Cf.- :ble soil
Nno-pressttrircd lrt-Cauund r-1 P-61=1=4 !n-rirouad _ Atlltayc -
V Prot aut t --lcc i•cxplain! r
Raiding iaat :ice D~Pa 'm: once: lexplain)
matiun:I tiyswn Elcss r°°/
V. Dis rsaL7rea
dsf) Dispersal rca R4 7%d (sfi Utspc/sal .Asca Pro is
,yp ea soil appInfor d
Flo- r------~tic2aoajrau,sp
# of Menrifacttuer
ir.
Tuta ° - -
C '
~N'L Tank Info tYallons ~ , mt<
i rellolu n I° o a ~ I c y R+
i hies' Tet>jcti i E~rmns Ia:b ~ ' f {v{ t' , J n i r. i s ~
Septic. ar Ho:dinR ".'ant 'T
VII. Responsibility Statement- I tLc tudersigned, assamc risibility fur iastaFlation of rice PORT~M'" t6moc gibed I'hcnte Number / J
Plumber's Maroc ;Prim; i Plumbe,'s S• attire i % 7 6
C - -
City', State. LIJ t '7
P:tarnc~r's A,iracss lStr~~ P
Lautng . ; Sigtcattne 'I
VIII. ountvtDe artinent Use Only a -t Diu Issued1'/
ettrut Fce
o r 11
r gPP'ovu I~ S 10 5 °b 9 / ; J _
J ~.,yt.~ ywEi•. ke:a:n'. for ~tntal + ~d
i4ous for Disapproval Gp .4- paA-S
I`{ CondititDtiV l!! /_j J S nP~(a"t~
i 1. Septic tank, effluent filter and a,~L l I/
d+spetsal cell must all be services f maintained
as per management plan provided by plumber.
2. All setback requirements must W maintained
as amicable code I ordinances.
- for the nystcm sabaut tD the (;ounty ooiy M paper Dot lets tiyaD h t : s 1 i tatao ~a stu
Attath tt, to mpktc plans
S7L e3JS i -'.l :li
UIVISION OF INDUSTRY SERVICES
= 3824 N CREEKSIDE LA
`;•1` HOLMEN WI 54636
p Contact Through Relay
S vAvw dsps_wi_govlsbi
S
vvvvw.wisconsin.gov
Scott Walker, Governor
Dave Ross, Secretary
Scr.tL rmber 12, 2014
('I TST ID No. 226900 AMY: P0 F37S
SHAUN R BIRD "ZONING OFFl:
BIRD PLUMBING; INC ST CROIX Co?
14-2 120TH ST 1101 CAR.4101AF i_ P
NEW RICHMOND W1 541117 HUDSON WI 54(~ I '
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 0912x'2016 _ ldertifca.ion Nwn:)ers ;i
Transaction ID No. 2455759
SITE: Site ID No. 805917
Jason Delforin Please refer to both identification numbers,
t.'' ahoy , :n all C0=1, on:ien;::: ~%itll the agency.
98 Eagle Mutt
Town of Troy
St Croix Count-
N 1NF.l r4, S 17. T2 8N, R19\V
FOR:
Description: Mound / Four Bedroom, Sloping Site
Object Type: POW I S Component Manual Regulat,d Ohjc a ID No.: '.502:0.1
Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth io liuniting factor from original grade:
System: Mound Component N,Ianual Ver. 2.0, SBD -10691-P (N.0ti01, R. I0i12),
P-es;ure Distributic n Component Mani:al - Vcr. 2.0, SBD 10706-P (N.01,'01, R. 10, 12): Effluent Filter
The submittal cescrih,d ahme has been revic~,ved for conformance with applicab,e Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDfl IONALLY APPROVED, The owner, as defined in
chapter 101,01(10), Wisconsin Statutes, is responsible for compliance with all code requircrnents•
No person may engage in or work at plumbing in tile state unless licensed to do so ')v the Dens_rnic:nt per x.145.06.
stats.
The following conditions shall be rnet during consmietion or installation and prior to occupancy or use-
Reminders
• This system is to be construcied and located in accordance with the enclosed approved plans and with the CON
component manuals listed ahovc. AP'
DEPT OF
• Per manual cited ahovc, limited activities are allowed in the area 15 feet down slope of the component area. PROFESSII
Soil compaction, excavation, vehicular trattic and other similar activities that impact the treatment and DIVISION OF I!
dispersal are prohibited.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area. chs. NR 811 & 812e
SEE X01
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
r,giiirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of ttte POWTS installation is required. Arrangements for inspection shall be made with the desig ated
county official in accordance with the. provisions of Sec. 145.20(2)(d), -Vic. Stat
S1 MN P u]F.') Pale ? 9.11.' 14
• SPS 383.22(7) A copy of the a-xpr:_v,:: p'ans, specil:cat;ons ar.d this letter stall '?c on-site during construction
and open to inspe.tion by authorized rep-cser.tatives of the Denartment, ,~hich may include local-inspectors.
Owner Responsibilities:
• SPS 383.52 Responsihilities. -1 he oNvne: ofa POWTS shall be responsible for ensurinL=_ that the operation and
maintenance o`'the T'01V FS occurs in accordance with tills chapter and the apprm cc] manage-mert p'an urder s.
SPS 383.54(1).
• SPS 383.52(2) A POV TS tzar is riot maiatairjcd in accordance V, id) the approved trrana ernent plan or as
required under s. SPS 383.54(4) shall be considered a human health hazard.
• SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropria'.c for the component(s)
utilized ui the PONVfS.
..%II permits required by th~c ~t;ue or the local mau:c pa'i shall be obtairncd prior `o corruncncernent cf
construction/installation-'operation.
In granting, this approval the Division of Indusm Services reserve, the right to require changes or additions should
conditions arise making there necessary for code compl:anc ..Asper state slats 101.12(2), nothing in this revie.v
shall relieve the designer of the rc,ponsability 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 th
on !his letterhead.
The above left addressee shall provide a copy of this letter and the PORTS management plan to t he w n; r
and any others who are responsible for the installation, operation or maintenance of the POW'l S.
Sincerely' Fcc Required S 250.00 -
'phis A nuunt Will Be Invoiced.
When You Receive That Invoice,
c'_tarles L Bratz Please Include a Copy With Your
POWTS Reviewer 2 . Integrated Services Payment Submittal.
(608)789-7893 . 7:45 am - 4:30 pm Monday - Friday 'ti'ti'iSNTAR l' code: 76 ;
cf-arles.bratz'asviscon~in.<~~:rv
cc: Edti, n .A Taj lor. 4Vastc% ater Specialist, (7 1 6 3 1 3484 . Monday - I-rida,S.00 am I'o x:30 pri
S L'•_L~ K ~Lt'J Pi,: 2 9'1 ',"014
sans, spe :ificatiom anc this letter shall be on-cit:: u: i I construction
• SYS 383.23(7) A co y of he approve
and open to ins-oection by aut~orized rep;eser_,a6ve: o-"thc_Department. which ma-, L-Iclude la al in:;pc:ctars.
Owner Responsibilities:
• SPS 383.52 Rcspor.siniliui:,. The ovue_ of a POW'TS shill be responsible for ensuring that the operation and
maintenance of the T'OWTS occ.trs in accordance ,vith this chapter and the approved management plan under s.
SPS 383.54(1).
• SPS 383.52(2) A PO'XTS that is not maintain-..-" in accordance with the approved macja2ement plar_ or as
required under s_ SPS 383 54(4) shall be considered a human health hazard.
• SPS 383.55 The o\ATer is responsible far submitting a maintenance verification repo-t acceptable to the county
for maintenance trackinc, purposes. Reports shall be submitted at intervals appropriare -or the component(s)
utilized in the POWTS.~
All pe-mits required by the state or the local municipality shall be obtained prior to co:iu_iencement of
c onstrtr cti on/ insta ll ati on,'operati on.
In gTant-ing this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise malting them necessary for code compliance. As per state stats 101.12(2), nothing in this rCVi::W
shall , vc the designer of the responsibiiih for designi=rb a safe building, st-ucture, or component.
Inquiries concerning this correspondence may be made to me at the teie.. _
on this letterhead.
The above left addressee shall provide a copy of this letter and the 1'O% I > cincnt hi 11 ki t,IL 11L r
and any others who are responsible for the installation, operation or maintenance of the PONVI'S.
Sinee:ely, Fee Recuired $ 250.00(:
This Amount Will Be Invoiced.
When You Receive What Invoice,
Cha-les L Rratz J Please Include a Copy'With Your
POI' TS Reviewer 2 , Inte~--rated Servlucs Payment Submittal.
('608)789-7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: ?633
charles.bratz.'a'WisconsM. OV
cc: HL' in A i aylor G a;tew ter Spec a'is:, ('1 :~l 634-;484 , y'lc,ndal. - Iridav 8 OCi am To 4:30 rc_i
Cover Page RECEIVED
SEP 2 2014
Shaun Bird INDUSTRY SERVICEO"
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/ 27/14
Owner:Jason Delfaring
Location: NE1/4 NE1/4 S17 T28 N,R19W 398 Eagle Bluff Ct Troy
Manuals Used: Mound Component Manual Version 2.0 (01/31)
Pressure Distribution Manual Version 2.0 (01/31)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7-8. Maintance and Contig cy plan
9-11. Soil test
12. Filter Specifications a ross section 'TIONALLY
'ROVED
SAFE
' ANAL ~ AND
Shaun Bird SERVICES
Signature 4DUSrRySERVICFS
License number 226,0
RESPO NDE
PLOT PLAN
PROJECT Jason Deflorina ADDRESS 10876 Alberton Ct. Inver Grove Heiahts Mn 55077
NE 1/4 NE 1/4S 17 /T 28 'S/R 19 w TOWN Troy COUN'T'Y ST. CROIX
SVSTEM ELEVATION 103.6'
DATE 8/28/14 BEDROOM 4
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE. O WELL * H. R. P. Same as Benchmark
SScale = 1/4" = 10'
Eagle Bluff t.
All piping shall be SUR 30%34, within l0'
of tank, piping shall he Schedule 40.
? ",::re Lot
Well is t1:
meet al I
WDNR
setbacks
1 02.6'
B.M.*
B-
Gradirig is to be done to
divert run-off away
from system Pro 4
Bedroom
House
10% Slope
Tank is to be properly
B-3 bedded and provided
Area 15' below with Iockdown covers
system is to with approved
remain
undisturbed warning labels
Property Line
B- 2 Huffcutt Combo Tank
100* 103'
101' 102'