HomeMy WebLinkAbout040-1267-60-000
VYsconsrn Depanrrwn of Ccmnwcr PRIVATE SEWAGE SYSTEM
Safety ar,c Bi ud ny n,os,or St. Croix
INSPECTION REPORT sanrury Perms No
GENERAL INFORMATION ,Al IACH TO PERMIT; 582070
State P an ID No,. '
Pr.,wral mforma',cn y.■I provide maf he iF~d for so=-dart' r,ur; uses [Pr.•azy taw. ; 'S .a; l:,m;j 2663448
Pe Tt Hnln,es Name C VNlage Io+vrshio ParcN'ax No
Chistopher & rm!: TOWN OF TROY 040-1267-60-000
BM ir.ovionon 111
"5' DM [Ie: l utn,Range:%daL NO
l Q pIPE @- CO QA~r
rU1 16.28.19.1458
TANK INFORMATION ELEVATION DATA
TYPE MANI!Fi1Cfl'R / II IY SW ON ~B g I =S LLLV
Scplic 0 D.
ot
Benchrt3rk
510 /z ol0 7 c,3 ~d7. I q 5
Dar, Sewer SPHt Inlet
- - - - _ - ~S$ Am •
TANK SETBACK INFORMATION ;I.pt Outer `
LANK TO Fr 7J=LL BI DG vent r r+..r rtske L?UAV Of IMeI
Septic
O t hr ~r or Dottrxr
c~51~, U q.9 q-x Z r
b , aderr M J&tl
herahcn I 2' ,rb~
Ulsl Pipe
Haldlrt~ / 164.~f'l Z•55 10b 9B
- - _ - ~ knnta, CyR1P., g 3.~ 109.53
PUMPISIPHON INFORMATION ~Ql Grace
Manufacture and - St Co.u e
odt:l Number n _ ~ ~ ~,r•
TDIf -I Frictor I oss Sysietr Head TOH ~^1JV7 Ft
3 ~ (a. 5 ail fov,2 ~ 2.~ B l o~. ~0
Forcemam Le pia- t. Dill to the
t ,
~pV
SOIL ABSORPTION SYSTEM } -7 + = Z l i
BEDY7RENCH %4ACI r Length No. 0' =s Hvr-. PIT DIMENSIONS FMS Prs Irs~e D•: Ligwe OEp j J
DIMENSIONS I t O 1 i
SETBACK SYSTEM IU P/L BLUG `.W1 I LAKE STRFAM LFACHING Man Jfac-ut
INFORMATION
TY`pue Of Sys!enr n,p CHAMBER OR r
1't U N U T' 2 7 I O~ t UNIT Medel h:irr.Car
ta,l IZI)3H- 16
11 t-1- D1& BUTION SYSTEM ptsT OF HDUSE
I11 der anflAd 1),I blbon
rr t rt r z In r $IZC n H•. tar Spacing ve^d h3,%n !r tan!
g:h-- LLZ- ` -engrh _ 4 J Jia 1 ' Spaa,iPVl~'I _ 4&4
SOIL COVER x Pressure Systonls Only Kx Mound Or At-Grade Systems Only Y Gr
~cvln D"t !s+
S I Cepth O•xr xx Deotn o' ` n Scsded-`odor= x Mr. ;ted
Zd trend, Center Rec.I •en;-h ECges ~.r opsc• VII
ti / ( tcs No s No
COMMENTS: ; iI code tlisrreFeracs• persons RrPSenl, e!c.; Insp trios IY l; 'S f irspettor 82.
Location: 562 CIfATTANODUA DR ` (rL`Ar 47'1 7 e m
t ►Art BM l~scrro ion = ~V M Cb~t~ ~1o Occe bt~5cG1 ~~a r►. S Gi_S G r` JUF~ l.~
21 Rldgsewer IenGth= t tN` 1 V MD `
- amowN of cover = NJk 1 nS .t.`lbn ~lpl Ina J..~ x+ 1>4e iCel"" ~1{ f
y e v 0\)" e L
"Ian se er sit f(m diti Yes No
Use I I f _ I ^
o(hther sine for a ddiio in ma6on.y/, IT/} I1 l(rJ,
U
SRC E?'O1R ;;9?} r pctor'r S?natn•r Ccn ho
o R E C E I V SDI saf ly and bu I[I n iwl 1 v
$ 2C1 .V. eJrsh'notnn Av O. x 7 2 i,Irlrar. Pen it \undul rlr h; SII::J ^I + ('o_I
pS Mariison, Ltil 037 -
7 1haly' Application
1'I r,ui: „tilth7'S i,?Ir_I I..'.1 t i' .te..•Iiw.,•nr. , .hlilr•rr•', Ih• u,n:., ~TL~~ ~L•~T/.~~1►~~• ~/i!✓~
••11' 1 "tr"7:n,.1 .loll _
IS r i_I .I I I I m I . !•I nla,; : `Inr t . a m r ,.prl :..t1 11 I I IM • ,r , , 1'- -1 FW I < aI, •ut,m t:,J P• Pry, i
L, , I it A, Ai,:,: ht u,ac,; nt t',cn nu I r.:}
nn: I r 1 1;c•, an.' Is ul .I,r c-' I'iI•,• tai ~ I , nn;n••n ,~v.l r•„ Id, n ,..,,.:,i to• d•r , i
ll.r',~i...II'.1~t, I,:. n.r t. till l7.'I'r.•.: I:' Ii't~il':11.,
r - -
1. Alic:rtinn Infunnatinn - I'll as Print .111 Infnrmahun
O YO • ZC? 6 O a r
• •Yr C'1: [ ~1l I',I , \ 1111!• - - - - -
t~ d s~dna ~ elf f~, j i
hr,.}••11l li„n.r; \tl r1, \dJrL••
f v
V - I S sF ii:.•n
11. 1y x of Huildin I f \ R
1 (dwrl, N all that apply
tnl Flm.l}f):,zll m tiur;l`;:.IIS:,::,w,nl_4( tiwll,..t.,:Nmc
Jkl
tJl~ Ca+ filu• G. - r
67
P6h11;:Y~:,ut nrrrr. l Ur.:n~i 1I,c (
6 r:It'.
Srsro llHn..l Ili •;nh: 11 t'ti\1 \nrnL. ~ - \ :I a~:.•1
4 k 70 - _ .y~& aye I„•., II
111. 1 ►pc u( Permit: (('Levi, onIN one box on line A. Complete line B if applicable)
_n \'v,. i,,,•c , Rral.r.:nxnl ~„Icm ; r;;unr:.,l II •hiim• i.n k R •pl-weru n Oni\ Ilh•° \1 wirli,all--r o' I' ,U6. S+,lvnt I.~pl.1r11
R• I ;:nrt R, r r.,•II 1 i nul R, ,,,u.n I S •,an,c .•I P;umt:r i nm I ra Itl:r t., ( is ?'i~, it a. 'rrmc \ nr l,rr .rx I1~1: I+,uc.( -
R.a•,I\pu..; Kew
- S~rZ070 _ w
It'. Ts Pc llf POliy I S 5> clear+Cnm ,unenl.'Uecice: all that apLh'1 -
'1 Nur I'n_;r,n~c,! In-[.:a•:nd I'~.•„ nt?:J In-[.rrauol •.I In.r.l. \'oUnd :4 to nl ^1nr.ltt~ 24 tit it+.vj": and
_ 1 I.. •f,tlll_ I erL~ , i (11 fi: r1i.,l. .d ? oral`<,r:al' r. }~1..~ it I,-, wAll will 1): u[i I . Itnl
V. Uispenal."hrea dent kma Information: - ~n~~ ' ~ -
J Rol l:cl' J :p. r. ,l Lr' I I I :y. IrcJ I I* I Ih+;wr.al \r: Pl-'r,`,:d rn 1 , :
6oo
!S' v
1 1. 1 •rnk Intl-it-T- - ,+aan r Al -T-
- /-1101 /1 Ilk 7 r.
~Oo ~
_ {ao i w es EC -
V_I1, Res runsihilih• Statement- I, the under+i;;ned, a..unn• n•yuirWhili» for installaliuo of Iln• PIM 1 S shnwn nn the altacheol plane.
Lp,urnh:I ,+r_ fPr.r1T I .nd., . ~ii'.nu i ~11'GI \,:rthrl I Itrs„:;+Ph,'rw \Utttllir
JJn~x I\rr:<I. (a). s'a'c lip, ,u•:r
-
~lll uunh;D11iarnnent 1 ce Unl. -Z~-5'
1rrr.•,cJ , P. I it Frr n.. +,.:..1 -
yo J 3 xI.X. 'Reasons Inr I)isappru, ,I
1. Sepba e;ftuarn ittla• and Q citspen-*1 cO 'nusl all IrjM2L
~..G r
fir,
sa per muagement plan pro oven W plumb*.
AN - 060l fllgWKT.Nf1t must be I7+WAr:Md
tq per
appMcabia nods 1 c+dins+loq.
%Ila.h to corn .41, Ian, for The a„ltm aad,ul.um u, Ihr• C'uunn nnh..ul pall,;) nA IR, thao N 17 , 11 Ineh-
tiR[~ (,:')>ti cll. I I I I
n='•!~, 'J.4P,F 4: L'i'ti
I
L-
J -iJN pp
S, -
:oa CUNT,-,!_ 1
- - - - - - - - - - - - -
VV!^SER T4'vK 3?tT' S~O~Jtti9~? f-_
51
.~_OV P.S ABOVE G tC?UNC: W*-F C :'tilh~5 7~_rC~N7
4N710: K.= - - - ---~c !
t TD~ U= (--7VPP :D4
,23
( GAKAG
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DIVISION OF INDUS I KY SERVICES
3824 CHEEKSICC- I N
D HOLNILN %VI 54°36-9466
.S p Contact Through Relay
,l s ^,ttp scs,++n yuwr:ro•grarnslindas,ry-services
tivvv Wisconsin gov
Scott Walker, Governor
Dave Ross. Secretary
~1a~ 3 1. _'0 I n
CI S1 11)
-`4 111 !'OIl'7a lrr`,,r.•rr.~•
PAVI, R h01-::III.I.R /ONING CIFPIC'I
COUN I RYM11I 131J'41 IN(i cC flf;•1 T'f\(; 1VC' S I ('R( )lX ( ( RIN 1'Y SPIA
"I WIS('(►NSI\ l)R 1 !01 C 1h\11C11AIf1, R1)
NI IN' R1( IRIO\1) %%'1 i4o)1? I It_It) ON ~k l 54016-7,708
(Y)VUITI0NAl, APPROVAL
PLAN APPl217V:%1. EXPIRES: Il;i3lIM18
SI FE:
flru•h. `lonr:d I'arlncrs I 1 IdentiCkation Nu nhe
Chattaroo«a 1) -
-"Transaction IU \o. 2-71193-1
"Ivan Of Troc time II) No. X2414'.0
5t (-rt>is
I'Ieasc refer to ho:)r idcnlificmion number.
5('a4.1 u 4,-S16. T?
SVd I I. Rti, It 1011' ^c+t •rdll rnm•;pnndc•tce L+ith the
a•_cnc~.
? we - -
Sut?diki,:un. (;lover tit:,t,or 5'' ;Addition I m y a
MR:
I)CAription' four Bedren:m fll'lom Nfound S\ item 4" a flop: REVISION
(Meet Type' POUTS Cumporenr 4•ldr,ual Rc~,'u;alcd (Yhject 11) No • 1585081
Revision. N1aintena;tCc required. b00 (iPI) flu,ti rate: ?-t in SOil rninimdn' depth to I.ntit-m• litctor from
on Final rradc. Scarnri.Y. l:/.rl,~++ Mound i`oirrpollcrt( ~1anu;tL It % 1'i- I'res,urc I) -UibUliun ('rmipnncrt
%laniml - V:r. 10, SBI)- i N.0 I! I. R. '0 'I: 1 ffluent filter
The submittal de>e:ibed aho%c ha; -cep rc~.c•~od I:,r c„nfOrmince LSuh al,p'icahl: \1'i<Coli;i•i 1<lmini,tralicc Co&:,
:md WISCOnSi:t SldlutC; 1111- uhMittal haS `•crn (ONL)1 I Ir:)NALLY APPRC)1'I D. i fR_a~-+ru~cii chants
hoc me an addcr!dt:m to the pl_an> tha~rcriuu;ly a ro%ed on 3 3 16 under Ir:mtiactinn 11) No. 2063448. 1 his
,),tail is to be constructed and locattd in accorlOanCC W:h rte enclo;cd apnrmed plans and t+ith am Ctnnponci r
rtr:nu,tlLs i referenced ahoy [ he u+srcr as defined in caap;er 10 LW ( ICI). Wi . onsin SI-two. i, rCSpurmil le for
compliance kith a'i code requirement..
CCPT~.
No person may et la`te in or %%or: at pltmiWno in the state Unless lirCn~!rd to do ;o hV [1•e I)epanmrnt cr s. 143.06, PROF
ES
CIVISION OF a r
Tie folltmirtr condition.; shall Iv tn.l curin constTUo.lioa of in5ma.1mior And prior to OCCUP3110 or we ,
Reminders
t
• A ianaarx permit must be ObU111ICtl li't+m the court.- ~chc llti,, project k loxdtcd in accordance wth the
rcyuirements of Sec. 145. 1 1), NN i;. Stalls. -
• Ins-,1w;or oaf the pri%a0.• . woite system installatiml is required. ,Arrangements fur in,pcction ;hall be made %%it)
the d,signated county ut icial to accoroianC.: with the pro%isions of Sec. 145.211t2)(dI, %Vis. Stats.
• ;1 state appw\Cd 01iient tiller is regUit :dl Mi!intenance nforrnat:on mutt he eiven tot c u,.n r ofthC tank
e.xplainimt that peric+diC cleani:rc• of -,he filter t; reyr:irrrl Access to the filler fur c1caninf; rnurl be provided
per SPS 3134 product approval eandition..
• 111 POW7 S Component pipitiv, material shall lie SPS 3R41, ~t is Adn-- C'oae cor.rplianl.
• the area within 15' do\•n.lo;pc of;hedtsper;al cull Thal renvtir UncilStunccd. tr:rllic. cw:rratio•' ur
soil compaction i-, pfohibin•d in HS area.
6h 1 III r'._
• .t L0j: li 11n' ,li1P-0% l pl:p'.S, n110~ it-Il:.l lul 1, anJ t!1_:> lCia X11.111 !-L ill!-am d;ll'I71g (orstn,,','t1n itnJ i+t)Cll to
m~1:000n hy_;!1n11t16i 1 repro<cn-ati\e, A+f the I}cpann•t,nr. 1\hich ai:n ill~_utle 'offal :n;i:i i lurs
(h~ ner Respun%ihilities
• I he current 01\ren ant' each ,lll)wgwril u"wr. dull fern ye a co, of 1)ls letter incitidl7g 1nstrUcllOtls re)lali:n;
10 prt+p,.r u,c and 11131nn:11:11'CC 01 the s!Sion! WnCr, shYl recel Y'. I copy of llic appioprlalc operat,on im'x1 ,%tn:enance Ina ILIA anti or o%%ner'~ manual for lh< POWTS
de;Cribed in -.his apprclral.
• I h: owner of a POA l S !:ha?' he I.Vwsi:lle fir craska, that the rperatiun and ntainlettance of the POW I s,
occur: in t:ccvrdWIL1: w its thlt eN1pkr and 1".1e approwd mana'_.n!ent plan undo- s Sl'ti 3N3.54(1).
• 4 ll'.e e\eal Wis;of : h;lvrion system or an, Of Cs COlllpl rent part, nlalfun lion; so to to cream a hcahll
Wait, the piopert\ o\\ner r.rllst follr\l -he ;ontiYCnt.\ plan as described in the uppru\ed plans.
• the llav-lcr is rta onsl`.~Ic for auflnli:t:n- .1 rlainten:lnce \erifieatior report acceptabic to :11: counts for
rlaiii,xil:ince Iraenlll, ?IIrp~1;t';. RCPOI i~ 511211 be scb•'llltcd ul il'Iel'vilf. approprime f07 the CUnlpOrlellt(.l) t:11117e'd
W the POU t ti
In _'r.il"ino! 1!115 applo'.al lhC I )1\ kikir l+l lndU-,lrl tiir% ii,: I:>Cr> CS the rl;;h1 it) roiilllr. Cllial_C~ VI addiltOns -shi idd
,:e n:itians ariyc n:IF.in.,- tht: r.t rcccss.tr\ h:n Code curlpli:n e--. As per stale scat,, 101 1'_(2I. nothing in tht; revle\\
.hall reli.cc the dodyrcl of the n spon;ihilii\ for design:n_ a safe iluildirg. structure, or componcio.
flicuiri:, Cuneei rillthi, correspondence nil he made to me a: the lelehhul le numho I"wd hem". or at the addre<s
on this Ielicllte.'.d.
-'1C abV\e lent :=ddress:c shall prov;d: a Copy of this !eater and the POW I > mar:,,e nrnt plan to the Owner and any
n117ers 1\ho are resronsihk for the insla!lihni, orwrmion or Inakenance of the PC VV f5.
enc. rc'v I c% Itryu rot? S RS.00
Z/ s- v- s---4---_~ Finis Amount Ib ill Ile ?n1.0iLCd.
Llwrarcl \1 ti\snn hen You RecCiyc• I hat lnvoicC.
p(11k f` Pian Rey 1c\ecr. !T%isiorl of lndvstn Servic:, Please 111CIade a Co, With Your
(6081', 89- 1892- Mon - Fri. 7:1 ~ and - -;:i;0 pnl Pa\ nlent 5u;lmMs.
Crry.s\\ 1 n a w 1;cortsill ,gu\ WiSh9AR l code. 7633
cc: Fd\% is A 1 a\ L.~ Was:etl atrr 5pccm l l (1111634 4R 1 . Mondn% - Friday R.00 am 10 E30 pm
Note: Effective January 1, 2012, ai' codes under the juri;dictaun of the DNvision 0` Lldusu} Services iforr cr;v
SafCl\ & BLI ldirlal \%ill h.C modified. Code rchNerce; wilt nreNes slarnlg with "('orrm' huyc been replaced with
tiP1 ' to ICa1_I'I!t' Ihi reloC lio!l o' th. Diyi,iun of lndLlStr\ Ser%ke> (!11111 the former l)epartinent o Coll merce 10
Ihr F)cpaItill eat of Sat- cty & Plo fissional ~rryiCC>. Addiliorall.,:. Al IS ( 4vincik 5413) codes have been renumbered
m W addirco,ed In a "311(r ndw. for hlrm robicuca the h'l omsin ( ollrtlcrClal RGildin`-, Code \\lll be addrC,Sed
by SPN ( hapt:r, 360 3156