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HomeMy WebLinkAbout020-1327-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 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: o h 076- 32V w CST BM Elev: -771 BM Description: Section/Town/Range/Map No: m-#--l 2g. m. l -7 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3, la~.a Fr~~.: 3.v I0 Dosing IV L/ / ~ Alt. BM Aeration llrafi Bldg. Sewer ~ [A/vISTMo P11-0 L7 CAN Holding ' ` f QV SUHt Inlet AIJ TANK SETBACK INFORMATION St/ Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom j~ Dosing Bader 1/0 .0 Mq. Aera tion Dist. Pipe j.b Holding ystem jrb Final Grade /a. PUMP/SIPHON INFORMATION Manufacturer PMand St Cover .n~t r, (S Model Num TDH Lift Friction Loss ead TDH Ft 7 For main Length Dist. to we ,J SOIL TION SYSTEM BED/TRENCH Width ) Len th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di. Liquid Dept DIMENSIONS 3 0 ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. /116 INFORMATION Ty e Of a stem: CHAMBER OR 'M~ -41 JD ~ ljo ✓ UNIT Model Num / _ DISTRIBUTIONoSYSTEM WV~ J I'll-FAkel Manifold Distribution x Hole Size spee+ned--+► Vent to Ai{ Il Ile Length 10 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 M I Bed Trench Center Bed Trench Edges / Z. Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: , e p 1 S C n l~ -f- Yl e 1.) Alt BM Description = `~p U C XIS 11n~ Se L ~Y}e~~ Ii h ~Q C V\oj nS 2.) Bldg sewer length = ` W all S SNP! a ~Q~~ A 1/t - amount of cover VOW G~ `UL,~(~ P y 1~ Ql Plan revision Required? E] Yes ~(No In ,n ~i1" ~V Use other side for additional information. 4rt- Date Lq'tep or's Signature Cert. No. SBD-6710 (R.3/97) btt,o J - NOTICE: r NO'T`ICE: Please provide the following: • A plan view sketch showing everything within 104 feet of the system. • Two horizontal reference points to center of septic tank- manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 4` ~ ~ f ' \ r j / ~T IL i A.I h 4 7, - tr rNDICATE NORTH ARITZOW yc SA -1 - i ~4i .pct Y[~Y Li~+~R~7[ (=1 I~ Bax7162 Ave RECEIVE D L _ Madison, WI 53707--7162 Sanitary Permit Number Otn be Bed in by Co_) S t7ft(PI i$ Application Stale TransactionNra~r In arsCewgth 2~~ of ibis farm io tl~. is required prise. to trait the Depwtmem. of y sum Sezvi€ 's ft'sonal fr foa stwo-owned POWTS acre akmiu'd to Project Address if dim tlrart address) with the I you provide may be wad to, --]"Y i° aw s I5_ 134 11 2 m Stu 1• t1w III ti II - PIIease PpeIIt Isfot rna0on / lb Property Ova's Name &f,510 I Pared # Pro iy tk er=s Marling Ad> (j 7 ° 3L? _ Y Location Propert 7 6r('-c5iW Diztv'G city', Sufi r eon GIA Lot f"F IL Type of It (e beck all tint apply) i Lot # T O`-d` N; R 17 Eor w I or 2 Family Duel ling - Nsuaber of Badn©omns l ) I btdKUv1smn Name ® Publicfi orrtnreTCiat- a v BlDek # 5T. CRUX ❑ City of ® State O",a d- tlse CSM(Number r Q vfflagc tw F t7 t?s r Towaoft4 aL IIL Type of Pewrait: (Cheek onIIy of 6soXos Complete Idae B i f A ) New System t System Q T lding Tattls Orly ❑ Other 14FodiCratian to F.mntg System (,Mlam) B. 0 Permit R ❑ Perrnit Revs on L3 Change of Plumber T~:': i t Tram tsr Negv i~ Prcvkxo Permit umber d Date Issed Belt Expirrttian I IV.' of POWIN, that apply) PresmKized Noe y ?ts`- ® In firswrrd Q At-€iracte ❑ > 24 in. Gf-habk si ❑ M m d <24 in, ofsuiiable Sod 11sI$ding Tank ® Dispersal ("xPlai-) D Devi- ( _ V. 3s t An* Is Design (gpd) Dtmp Sail Applicatkm L3 O Required {sf} ( System Elevation VL Tank Info Capacity in Total # of Mwutfiwb er Gallons Gallons Units rim Taulm i~c; " ti~3v l' u v un E5 F4 s IBC( lti~trf<.S, VE' St"Mmt- I, the tit tistgeresE, of the POW FS sbmm an the attse$a9 places. I']ssarcber's Hume (Prism) s Si S Busitm PErotre Nmber K EITH Plumber. (sr ,City; StW, zipc ) VII Cons t {T-C OWN µ Approved D Permit Fee Due}Issared Issuing Sigoatiue err for Decrial $ Gk 5 D IK. CoII 1 ;,l ip ark, et' xw, lllte11. i ;d CiIS}!Bh<:~i cel r:1uSt illl tLW t -.j 12? 4ALce 8S POr 1afIA"!tnent plan Pro Tided by plumber. 2. Al (t~4lret:atnw "-t i,w maintc inf-I as par *Ffixlbla C4)de / crdiruln,91. Awac6 w for t6c 83%*= SW ' to the Comfy mly an MW not bw th= a w z t t iaffiea is aiae SE 3-78 k-r~ tla/L 4) PAGE 1 O 4 In-Ground Gravity Plan Index Cover Sheet Com m t Mane Design Refem noes: Version 2.0, SBD-10705-P (N.01/01, R. 10/12) 1-91 of 4 index & Cover Sheet Pg 2 of 4 Plot Plan P 3 of dispersal Area Cross-Section & Plan thew ` a n Q, e me ?fit !a Attachments: Encl uses: POIOVTS Application for Review ec Soil Evaluation Report & Site Map Project Name i Description O~rner Nary: I~ 1 Phone: Owner Address: -Ito ~Rbsr ~ Irv f 4 b _o .n Zip: Project Addre : Govt Lot: - ' C 1 /4 of - 5z 1/4, Section 2~1 , T 7-q N-R i`1 E F] or w2fl Township: r_)=c ,U County: &P-6, IN Project Parcel iD 7r; - ? tt C t: Designer Information signer Name: AAL\/ -I -HUeft'ZT Phone: ?15 T Designer Address: Zgt-ig7 K;A1s Al'-mat`s ~ Mp,~~; U-):r Zip: 5113"M E-mail. t (t s~rd~sc~ ot:~ f no%` a adv~ .M3 Sg izse Stamp License Number. Ik,5q--Do -1 ~7 at 4 Remarks: JO Ll4e RAt4r♦ A Signature: X Date: 0 i0R0_SkM2 "e re &ed on std conv. j N' r NOTICE.* Please provide the following: A plan view sketch showing everything within 100 feet of the system. ffi Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. PI VIEW r, JAI ltJ J~`/ - t ~ ~ f f`~ Jf 4Y ~ j gr. INDICATE NORTH ARROW ~ x r sTf Sep* T-A*uMxft1w- R4 UND GRAVITY DISPERSAL, AREA i ` ~K s Uniforrrt Elevation ' Trenches with Qu1c t4 S ardard-W Chambers . Trench (dovai-sizing ' credit) sT'x go V MWA t Uadaftsae MkLir sMez ova TYPICAL TRENCH separatim sa CROSS ECTM VIEW (W SWIL Provide mi *n m 3 0 system Efev~ it - betiaam trenches. (typical) :tea Starmlard-W w/ Fjw cap 4 (Show of i I an plan viewer-) TYPICAL TRENCH - PLAN VIEW (No Scaie) = Lt ft M {rypi~) ~ StarsdardW Chamber CA) INSTALL ' €6 Ct$: ft 0 (mod by - a c) 1 4 St& W § 20 fe EMAkhwnbar _ tram wrsvrd b itsbndom A iAftraBon Area = t_ , C>n pbh2xdJon Mentor Tdial EIS, :"Y'C' }--`l.- ~l'(iU ulili'v\ t PAGE 4 01F 4 in-ground rcavity Management Play IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wssc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. ulmum a ai yea O e nn Di li' : Design Flow = (f 0 gpd; BOD5 220 mgL-"; TSS 150 mgL-'; FOG 5 30 mgL-, l;ms ec n chap iist i SPEEC T ;VERY 3 YEARS o type of use o age of system o nuisance factors (i.e- C}da s°, user complain€s, etc-) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) 0 solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i. a., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i-e_, pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back.-up into structure se, ved Maintenance CheckiM MAINTAi;. _.-VER4 ,Y S ; i ( er n s a ~ . o Septic and dose fankfss shall be pump by a certified septage servicing operator lice =r~ a ~ ;--b F ~ b ;.4u ~ wis. Slats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance- Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o EEqucr~t shall be inspected every 3 years and shall be cleansed when nac ry to remove any accumulated solids according to manufacturer's specifications- A servicing period will always be greater than 12 months- System , . a5iY5" ec a5€L rutpor n wW~w~B Laa s€.Sbmitiad to t45e pr+Ct'pe iocal government. unit in accordance vvWi SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction too Name of individual or company: ANJI A IU~$t=P)C' P mw'~ i fi t .14a A T1 r d Phone: n twat government unit: . d- C,Pty ,'hi i k.i_~ Phone: Local government unit address: }S Q T -zip: Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWfS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Pia In the evert that any fails #restrn~_n. cornporient of this POWTS cannot to repair e%!, it shall be replaced pursuFunt to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. Sys em Aband9nment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code- _ ° " 'J ._q,. .......~4~ ~ _r<va v..... as .u s va t ♦liar ca Home Our Filter A The lifetime filter The best just got better! The lifetime filter is the most efficient, low maintenance effluent filter on the market, rated 3500 GPD. 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The chamber's four-foot length provides optimal installation. flexibility. • Advanced contouring connections swivel up to 15°, right or {eft • Latching mechanism allows for quick installation • Four-foot chambers are easy to handle and install • The Quick4 Standard Chamber supports wheel loads of ~ ~ •~'f+ ~ ~ t> ~ 16,000 lbslaxle with only 12" of cover 3ar • Certified by the International Association 1APM9 of Plumbing and Mechanical Officials (IAPMO) - Tear-out seals on inlet ports provide a tight fit to the pipe • Eight molded-in inlets/outlets allow 1 4 for maximum piping flexibility _ • Eliminates pipe fittings - • Fits on either end of the Quick4 Standard Chamber ~I APPROVED in