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HomeMy WebLinkAbout036-1078-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) State Plan ID No: 592140 GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] NA . Permit Holder's Name: Village Township Parcel Tax No: Riverside Trailer Park Bill Block T77 TOWN OF STANTON 036-1078-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 31.31.17.487F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS IF-LEV. A Benchmark IV Lop %J Bldg. Sewer it Holding ky)tSej ilil -20C/C/hi1 A SUHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Dt Bottom Header/Man. ion Dist. Pipe Holding / 1 y~~V l 4-jjJ~Q ' Bot. System _eF V pM `A S Final Grade PUMP/SIPH ON Manufac Gema St Cover Y el Number T Lift Friction Loss System Ft Forcem Length Dist. to Well Vl SOIL ABS N SYSTEM BED/T CH Width Length No. Of Trenches NSIONS No. Of Pits Inside Dia. L elAh DI NSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM Manufacturer: 114FQRMATION CHAMBER OR Type Of System: UNIT Model Numbe . DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) IYLI Len Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons pre t etc.) Inspection #1: Inspection #2: dr/ j Location: 1442 CTY RD K u! eatie ~ ~ ~~ti lot ks 60 1.) Alt BM Description 1 dA~n ~ ~ &71 2.) Bldg sewer length hc) = ZZ- 2 ` b J amount of cove =)/P- L°~~r <<, " 5 Z' $ y2" D't y' &F Z" c e AU-4-- ~k -~eaM I S Plan revision Required? ❑ Yes No 1h 2_/ _ xl Q Use other side for additional information. / U Ly lide ~ - 12~~ Date %ooTnsepctor's Signature Cert. No. SBD-6710 (R.3/97) A' /7 0 7q-.,2 Z o 7S a a ~ KNUDTSnN PLUMBING F~ CONTRACTING- , I_LC Cam; ° .r F` << 927150TH ST. 646447MPRS ROBERTS, WI 54023-8526 CELL 651-470-1737 Zap ~ 9P 9P ho G 4 G+ I r ~ - 1 1---__.3&.:1 - 1Q - - _ t W7 #331 lltr I J0 II i Lzyo, (~j ~a s) M 1 -Z SD C4--) n-4 LLB 010 U9 -Z 1-7 ,CIO 4 A NJ -XH C~l tit ~ ~ Q' Z 1 County Safety and Buildings Division St-Groix b! 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ¢ Sps 1jl Madison, WI 53p7-7162 $T. CV CO VELNOp ENT a 1 j~ 1041 ItAly v Sanitary Permit Applicaticl i. oo I 'Al, State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate ~-V '7o✓Pl A)k ~ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS arc suo- ~ Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Information - Please Print formation .4~1442 County Rd. K Property- Owner's Name Parcel # Riverside Trailer Park Bill Block 036-1078-90-000 Property Owner's Mailing Address Property Location 3 {,'3 1'1 '111 369 East Kellogg Blvd. Govt. Lot _ City, State Zip Code Phone Number SE SW 31 section 55101 (circle one) T 31 N; R 17 _EorQ H. Type of Building (check all that apply) Lot # ❑ I or 2 Family Dwelling - Number of Bedrooms Subdivision Name Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number El Village of E7 Town of Stanton III. Type of Permit: (Check only one box on line A. Complete line B if applicable) At, A. ❑ New System ❑ Replacement System ®TreatmentJlIolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that a 1 ❑ Non-PressurizMithe, d ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Dispersal Component (explain) ❑ Pretreatment Device (explain)__ V. Dis ersalfTreatment Area Information: Design Flow ( pd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. T k n O Capacity in Total # of Manufacturer Gallons Gallons Units ` o v Rf V U ti New Tanks Existing Tanks o /LTIJ~ o. U v~ ~ v~ W C7 a. Septic or Holding Tank 2000 2000 1 Wieser X Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume.responsib• 'ty for - s Jti'on of the P TS shown on the attached plans. Plumber's Name (Print) Plum s gnttture MP/MPRS Number Business Phone Number Keith Knudtson - 648443 651 470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts Wi. 54023 V M. Coun /De artment Use On proved Permit Fee Date I ued Issuing Signature O en Reason r Denial /a 1!v IX. Conditi s of Approval/Reasons for approval 6(h) 'flikeov.- 41 ~OL 4a,60.ja" a6 /ko4..: e~bkl 2 t~ "&-coL6 1' osS - Lb, a t ' Attach to complete plans for the system and submit to the County only on paper not less than 8 ,2 x 11 inches in size e.A... Cal s t~. a~ aJ #4 Sill)-6398 (R- 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Riverside Trailer Park Owner's Name: BillBlock Owner's Address: 369 East Kellogg Blvd St. Paul Mn. 55101 Legal Description: SE 1/4 SW 1/4 S 31 T 31N R 17 W Township: Stanton County: St. Croix Subdivision Name: Lot Number: Parcel ID Number: 036-1078-90-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Sect~~ Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan D ` Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Keith Knudtson License Number: 648443 Date: 09/29/2016 Phone Number (651) 470-1737 Signature /101 Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 / A'67W4-9-12 5 '5'? Ire / ~dI/d~ Gam/ S pCc~~ l~ 1716 KNUDTsnN PLUMBING t4 O` C©I►TFeAC'PEN G, LLC (,if J j v Z6CSf~~.~ 927150TH ST. 648447MPRS ROBERTS, WI 54023-8526 CELL 651-470-1737 & 9P 9P ~~c~~ c e4 By,, orb ! 7 xF, XT, 14 -Z M-a0°uw :31U 95-V8-9Z~-008 0 \ :6nOd-1SOd 31V0 00/00/00 =31V0 OSLtiS lM 'NO021 N301VYV Ot lMH S(1 9LL£M 3dnNdW OIld3S w o :H nOd-3Nd „0-,L=„ti L 31VOS dOM l8 NMV2lO 31380000 13531m W4_000ZdW W W of J N Q H Q m ° C.) mO °o W J zo 00 ir ci U Q (n z = N LA d z O a a m ° O o w OJ V) LLI m to Q o ° U W _J Q Q tr W F-- ° p > w v z (n w W OP C9 O U Z ~C co ¢ w LLI Q mvi 0 < Z a wm < ~v 3: LLI W H p o o z I z 1-- 00 In W Om o ¢ JU J ¢ ° M mJ z > 5 3: LL O Q H CC t0 G Q H a NO ^ m J W W C.7 Z N d O U a d 0 z:) °o I O Li O N n 0 \ vN y a ¢ M p p p = ^ OD Q L~ cV s J H fn C7 ..i Y U OD z ° a U ¢ o ' Q O LL_. U~ 0 o d o ~oa!t LLI m w w 0 U dQ `ta`d O~_JL~--> ~ L F-V) a Lr) -OD Jd w O ZZ Y~ Q CJ, W cWnMz ..2~rnzwm°F 1 0zN rr- =v D~ wN z¢o 0 0 Lr°~~ = =oQ oow Q w Qwa M F °o in F- F! Z -J F- o oawW ~o Q:r a~° c~oQ av Mo Y Z Z3m UM2J~iM=j ° Z Z U ~W.. 0 1i Q J J O Q _j Y >Z N I- ° Z Z M OJ = u r U H W ~ a D o a z ~I w Or I V) W II I W I J II Q II I I (V (n M II o II I r U II W II 3 I LLJ II II > „s£ I 5 a II II a I w II N II ~ I W I , I II II 9 4£ Q o II II I I ui II `Yl II III f o cli a: U Q z W Q J ~ Z W 40321 a t~ "96 sv ,ACS z a RECEIVED SEP, 07 2016 ST. CROIX COUNTY COMMUNITY D SEPTIC or HOLDING TANK SE MNG CONTRACT Contract Date This contract is made between the Tank Owner(s) Name(s) and Pumper s Name We acknowledge the installation of (a) septic/holding tank(s) on the following property: (Provide legal description): I II 1. The owner agrees to file a copy of this contract with the local governmental unit (St. Croix County Plain nlg ck Zoning Department) to docuiiient onalil iciifi ilec by a G rti ed scptage servicing opc;rator as required in Comm 83.52(1)(c)2. Wis. Adm. Code and the approved Component Manual. i 2. The owner agrees to have the septic/holding tank(s) serviced by the undersigned pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose ^f o r~icii g the access road or drive so that the pumper can septic holding tank(s). The owner agrees service the septi hQl~;n„ `ti, , the pumping equipment. The owner further agrees to pay the w., farges incurred in servicing the septic/holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit (St. Croix County) a report for the servicing of the septic/holding tank(s) on a monthly basis. The pumper further agrees to include the following in the monthly report: a. The name and address of the person responsible for servicing the septic/holding tank; b. The name of the owner of the septic/holding tank; c. The location of the property on which the septic/holding tank is installed; d. The sanitary permit number issued for the septic/holding tank (if known); e. The dates on which the septic/holding tank was serviced; f. The volume in gallons of the contents pwnped from the septic/holding tank for each servicing; g. The disposal sites to which the contents from the septic/holding tank were delivered. ~ i 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract; the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature s) Subscribed and sworn to me on this date: Today's Date P umper's Name (Pant) Pumper's S ~ture Notar MARY I j LOCK C 'S ~lc~ i Pumper's Regist ati n umber n u / I l I i HOLDING TANK SPECIFICATIONS 4 Number of bedrooms Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 2000.0 Proposed holding tank capacity (gal) Wieser Tank Manufacturer WLP2000 Tank model number Alarm manufacturer Complete alarm manufacturer's na Alarm model number Complete alarm model number. Tank Dimensions and Data Tank Anchor Calculations X for round tank 19430 Ibs Weight of tank and cover 41.0 Liquid depth below inlet invert (in) 1.50 Safety factor 8.0 Maximum depth of soil cover (ft) 25768 Ibs Weight of anchor required 53.0 Height (in) Outside 24.6 in Soil cover req. for anchor or 164.0 Length (in) Dimensions 6.4 yd3 Concrete counter weight 96.0 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished vent cap junction warning label grade box > - 4" min. 12" min. ~ 24 in. Manhole and vent locations conduit vent pipe 18"Imin. W building sewer service 12.0 In. ' inlet blind plug alarm on Note: All tank joints, to seal and joints between tank outlet openings and piping are Electrical as per 29.0 in. sealed watertight. All NEC 300 pipe and vent materials and Comm 16 comply with Comm 84. 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Transaction Number: Page 2 of 4