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HomeMy WebLinkAbout030-1058-90-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592276 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Jeffrey & Alison Klinger TOWN OF SAINT JOSEPH 030-1058-90-100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: X00 8 9 to V 6- 23.30.19.203J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r •n.~lr Septic _ 2 Benchmark LJ,* S 7 JQS , e,ems(' I r~ SZ S Alt. BM~~r ! Ga o ~ a~ 3 0 d/ • SF/ Aeration ..v-.. Bldg. Sewer Holding St/Ht Inlet 1-7-4-7 cf 9,2~ TANK SETBACK INFORMATION St/Ht Outlet 7 'C3 C1 qn TANK TO P/L WELL BLDG. (vent t Air Intake ROAD Dt Inlet Septic AA- Dt Bottom e Dosing Header/Man. 9.111, 95 . q Aeration Dist. Pipe 9 g S S Holding r- Bot. System /C1 ` gs, r~ Final Grade PUMP/SIPHON INFORMATION F 74 x• 31 Manufacturer Demand St Cover .1 L -1.3 Dem N Model Number TDH Lift Friction Loss System Hear TDH Ft,- Forcemain Length Dia. Dist. to well _ / tf SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenched„ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z ~fe I~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR + INFORMATION -t ~4 UNIT Model Num TypeQJSystem 7,ft L7 IV A— -7100 DISTRIBUTION SYSTEM ZS >c-3 ° 75PLJ~ Header/Manifold Distribution Ix Hole Size re Spacing Vent tq Ait/ r,njake Pipe(s) t!`~- `S Length ~-(.J Dia Length 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 L No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1467 N BAY RD a +~hs r ~-O S dv~ 1.) Alt BM Description = d 5 ~y~ Gd • w 2.) Bldg sewer length = / v p~ -amount of cover = / ~ h LA_ `fZ 30 Al iJ l Plan revision Required? ❑ Yes No P J 1 Use other side for additional information. Date InsepctySinature Cert. No. SBD-6710 (R.3/97) f County "~Tfm Safety and Buildings Division .5f, CrZ G ' RECEIVED 201 W. Washington Ave., P.O. Box 7162 anitary Permit Number (to be filled in by Co.) 7Q Madison, WI 53707-7162 ON APR 112017 Ry I S' ~'u 1~ C 1 L ltt A~3pl1Cat10I1 u Slarp Transaction Number In accordance wX ) p~~~~~ .'~'~l~8bmission of this form tc is required prior to obtaining a sanitary permit. Note- Application forms for sta the Department of Safety and Professional Servies. Personal information you i Address (if different than mailing address) u nses in accordance with the Priva ~ Law, s. 25.04(1 (m), Stats. "'G" Tor secondary L Application Information - Please Print All Information Property Owners Name r Parcel # yt CA (0- 0-16 Property(O~w(ner s+Mailin~ Ad ress ~2 r~ V~ v l~/ 1 C~ 1 Property Location . . 3 C 3.S Cary, Stnte Zip Code Govt, Lot i Phone Ntmtber ~K ~ .i /•Y j Section ~o R j/1(circEone) IL Type of Building (check all that apply) Lot Lo" T U N; R For W I or 2 Family Dwelling Number of Bedrooms j _ Subdivision Name ❑ Public/Commercial - Describe Use r' n t ' ' lock Gi;' ' ❑ City of ❑ State Owned -Describe Use CS&4M Number ❑ Villagoe of Town of > l :~ZL i1J % f 2 ti?~ ~ 4 111. Type of Permit: (Check only om box on line A. Complete line B if applicable) ( C ew System ! D Replacement System D Treatment/Holding Tank Replacement Only D Other Modification to Existing System explain) g. ❑ Permit Renewal ( D Permit Revision ❑ Change of Plumber D Permit Transfer to New List Previous Permit Number and Daze Issued i Before Expiration Owner l IV. e of POWTS S stem/Coin • onent/Device: Check all that app Y) I C { Non-Pressurized in-Ground ❑ Pressurized In-Ground ❑ At-Grade D ivlound > 24 in- of suitable soil D Mound < 4 in. of suitable it D D Bolding Tank ❑ Other Dispersal Component (explain)❑ Pretreatment Device (explain) V Dispersal/Treatment Area Information I Desi Plow (gpd) Design Soil p 'cation Rate(gpdst) Dispersal Area Required (st) Dispersal ea Proposed (sf) S tJ yteem Elevation ~~ll COL "L ~S ~La 93 as- m~y.S-GS VL Tank Info Capacity in Total P of Manufacturer Gallons Gallons Units i Nm Tanks Existin Tanks U R w~liy/Di figs 4,; B h f Septic or Heldiug Tack l Y Leh a w v Dosing Chamber VII. Responsibility Statement- 1, the undersigned, a. Wine responsibility for installation of the POWTS shown on the attached plans. Plus Name (Print) Pin is ature 1 MP/MPRS Number Business Phone Number PI b 's dress (Street City. State, Zip Code) W,) J S ~ 9 cD J6~'-b ~ VIII. CountvlDe artme t Ilse On[ Tpmved a T3isaroved Permit i ee 'Date Issued Pp Issuing Aq t Signature D Owner Given Reason for Denial 49.6 OP I]X. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: ` 1. Septic tank, effluent filter and dispersal cell must be serviced / rr5aintainF'd / as per management plan pruvidad by pl,sn,;Leer. V' L-1)P 7D1 1 i 2. All setback requirements must be Maintained as per app lit7arilciet~ ta[ Ire system and submit to the Cnnnty Duty on paper not fen than 8 In : t I inches in Si" SBD-6398 (R_ 11/11) C C)P4I f l ? 1 Ji fr~(_ i i~i,)fl/(:PO-N ENI" DESIGN ~E;5IC1C`flt ~j3iJliC,r,Tfir)71 INDEX AND TITT,` PAGE Project Naive: ~ t Owner's iVarnP: OWI)O,r's Bpi, Legal Doscription: Township int y: CK ubdivjslon N7TY1(y Lot Number Go i' arcnl iC) i\furrtk~'Fr - S Q j ~ ! 00 Pago 1 i~~~'~z ~nct ~,rt►e Page 2 Page 3 Lsn7i w - i & Crt);a;5- sGtiGSfit ~ ` l~~~in't'~.n~•t1'c~ P'ago _ ~~'~~n ' nrrnt PTr7n P A,,.e 7 OF PlaL & i-ionwte C''frar;:s Ntam ,8r: q ;JeSupnerl laursuant t~ the f^- - , rnuntl Soli Itbso;mion i:on~ponent ~~~tan;,ra! .nr !='t~~Ul'S llrrsiari i.b 5f3D..90"IU•.5-~ rInGJ'r= i i 1 y i r/ 786 ,o yon Nam f a Sv 5bI F 63 3x- fro ti ~~"a~.1~ns $0 Abso F-1 4- 4.. ( PVC 'tent Pipe i~inai _68061 Glff4~ \/r~1i Cap ~ljam~e, J 1~ ~ syqp-m Elevation f-f ~3 _AV Soya fto► l tiid7Gr , i 1'^'nch f C_t LLL n ! jjR. Vent Or Obsel-vation Pik Tranrit 2 H ~Cf~t fill, i1 ns #rart~~Fer And Model FiSA €iatin, 4t sr~ Pes-Charnber Sod-Appfir.-hation Este 0 ~ d ~i _ Mott Design t tw, _ 9pd/sq ft . ~ Soil r'tpptiCeticsn Rate Page Technical Specifications PL-525 EFFLUENT FILTER (,Ai ) 61 r2" BALL CHECK EXCEPTS 6'SFID 4J RINLET EXEN fljN 435 157 9 J T.GH4a fl T4%S,NG Ex~PTS ~J : s o' SOM 4o a +u a : / --r r / s 27 1 --+-t 7392 r PL-525 FILTER HOUSING IB 34 11 ° ` PART NO -30142.525 !f M ATERI AL. HOUSING-POLYPROPYLENE OUTLET BUSHING - PVC 0.5 BALL - HDPE ---SOCKET EXCEPTS F'-OATSWa, -=-Y P11o.2s 'W E zG~PTS 1 ' SCH 40 as FOR H WDLE _XTEN fl ON i 6' SLOTS y\ S~ SdT OF ".6' SLOTS -647 SODETEXCEPTS 5.04 BALL PUSH Rte OPENING 1 .,c 'y ew: ~ ! ~ i I I ?.C9 Or'E~.:p10 'b:'9ii II 2C T ~ - - 902 22 ii POLYLOK PL-525 FILTER CARTRIDGE PARTNO - 30141-525 MATERIAL - POLYPROPYLENE Ill r-1L 1t~1"13 1U9A t P SPri ~5 , F'ty~"1 1Y ='P i C,tirr ~~e ~k~_ p ~l Sd N 1►ti Sapt3a Tank s aaPt~ 1 a S U ~aI Q NA Permit 4 Septlo 'dank Manufaax~crar Q NA a l~ iwe ZP#az Iwlan~tf ra Etrar v L~ Q NA 8 Number of Redrracrrts Q NA, mffluaa Fitter Made[ 17-1 NA N.utnfaer of PUNIC F8011'rky Eirtlta ! M NA ~urnn Tank ~apantty _0 . NA sz( fauu {avara? f rump Txmk V-11MOWt, Or TQA pur;tmanufacturer Sail Ap}511 r Cirti~ P,aCa Vii!° ~r a Frump timid tApntressmen: Unit: - • I Q Viand/gavel Piiler to Part Fliter Fata, oil & Grosse iFt3 i :Std MAIL F Slaaherniol Oxvgon Demand (BODrl ~~~t1 me/L Q NA G71t~awi~at7l~t Aeration i~ r!V'~CI~I~d 'i Q zl~rirl#`sts'tlcm 1 t tYtar TOW Susper;wad Salida M MS) , Q NA '~ratrea{,ad ~ Itten taut T-~ ! month1v atrar die 1 >\°sis~^er s! rya!!{a} . ID tn~c F, and {gravity} Q In,C3rawrwd {preaaurivedt G Rit?aht~rriir~ni xy an D=and tIR(DM .1 -A n t?r~ 1 Ax~Grade 0 i~aal~+nd G M911, Q NA ! Total Rtaapendsd 8011da E S } d Q prip~~Tt~e f h 5r, 6' _ x e, afifr rte { mefria Mari) A10 NA~ l7tti~17 r!>~ Sisa gin tiiao Q. NA Q NA Maximum i~ IwetG P~rti L that" ctti~ra'_ . r' 1~ P;iA ~___~-T•.,---~. Q NA rt i LOt e MOV t~flPtlftT'CSlii~l~~ S~~i1pD9~tw~ Sart~3arx rxarlt Q 'rs,;ttftt}' ` aeaD M NA ysarts ti~lrltr~srirrp ye Afi Ina" naaa~ran! J~ Cl NA lnapact annditlan of tank(g) `lUhen f-MMIlInAd sit,P, arm' aPtarrs er~>x~itg 0rr~a~h'irai f%) of t&tr Vo(u►ne _ °wrrtp ptir mantas of tank t IAA - At, lUST Once euetY' ar{sl IrPSpBrst d;spraal '811W ST Once OV91'Y' At least: ctl'tna naaryt # t ..gar a, l Clean Gif{Ltans filter Iii jt%ztrth( ) NA .,...-R.,..,--..,._.,r,.___..~--•-~-'---- tiw" ut5~l, ~f pump atan~trttit3 alar.P~ 1 At igar~t cnrag &VeYV: 1rt9F?acx pwtnuz P Gi r hj. I NA x Flush hers is and yaresat~r sear Aj: 9east anr~ a~raeN; r(, CstiSar; As. laest anza Btrary,, Q ` aarisr - - SSA 4SCE-- -11pn 'y 4 ins~ecxirans tt~r tanks and disper. IP'9 sl. Ell, be srarja Pay an 1nelvid al utrarryln Or.ja of t. 0 foil-o tm ~~`~~~5 p~oatifroa' ~a~ k M.ast;sr Plumber: Mavar Plumlaer Rnstria't$t' SgWPP; P''Okhl' in--IPO Y' E'~WTra MOMali on apn rr~ka or looks, inspen"Tona must include a v1suzi inspection at the tariie(s'1 'm idensliu any missIno or broken hordworn, Identify any of maaawra ho vali=B of nimbinlod siwdga• one naC lm And iz .^.heak. far snv hrattk rip ar pun4ng of aofrilaerlw on tilt groutld Ourfaae. Tha fluemuan;: aei r,. unli su f a rho ponelnqzof 01,1 n t nn flta ~ ou yd vx are may nriiaote a I.aiCfnC a~ tUtIon andaragtatres'the of affi an the he tte g rotan+iawt`ratas. tawrrrtc autihrari;;u. it'nmadla,e notif riatInn u'rr shs local rn tr llUhari the iad a r,.ta a,adltb sludge snag ®ga ise?vicisg Opnratori and ds ."dl 0 In amiwdarice vtr9 h OhaPW NR 113, rrJntants of f x; %ba~e tank Shall rxc eM 4 Wiscanain AArnlnlAxr;gvwA Cnde rv"~!E£iSrrl~flC 011 sftlwsn~ flOrs All bGlier aratia a, l arty x r~srvai aitvllts mrnthaas iail olnge pe formad 1;%] a carti a$ POWT iii m netts lprt~ertt"s: pr units, and any r 1 ~9 ai1 t7* y t1 8 a+ tt» RhY tPr,~a ra~tnrr sl & t7 rravid©d to tl?e lnrai repL,3a~:orY aUtihdrlxy tPiiCttin 10 ei r of C tWi qM"P WWI