HomeMy WebLinkAbout020-1117-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 597371
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:
NEAL & KAREN JOHNSON TOWN OF HUDSON 020-1117-30-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
j y-_ } 19.29.19.490
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic (J'u-rr i > B nchmarl~ .1 7 Z / /01 Dosing ,z U,X ~n Alt. BM
Aeration f` Bldg. Sewer
Holding St/Ht Inlet f v
St/Ht Outlet /f
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
c J s
Septic Dt Bottom
Dosing Header/Man.--- - " - 5' 914 '?cS j
14,I )L 7t .
Aeration, f Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
GPM 'a.r r~
Model Number ;1
S
TDH Lift Friction Loss System Head TDH Ft
7u G~ VrJ ~3.0r
Forcemain Length Dia. Dist. to Well
j r
L
SOIL ABSORPTION SYSTEM
BED/TRENCH Width 734ngt1Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS z No.
SYSTEM TO l P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: -
INFORMATION CHAMBER OR 16C lci^z 7~i3/
Type Of System _ UNIT Model Number: ~l , f~ yt
~7r V J~_ r « / J 2 1-36, /1
DISTRIBUTION SYSTEM, /d /G s$ = 3i,
Header/Manifold ID istribution Ix Hole Size Ix Hole Spacing V nt to A Intake ~I
r Pipe(s)
Length Dia Length' Dia " Spacing _
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over wDepth of xx Seeded/Sodded xx Mulched
BedrTrench Center C-/ Bed/Trench Edges Topsoil \Yt-, I No Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
`7 try ~~v'- i at 1t> qtr 1Gr{ ct3Zll.
Location: 892 WILLOW RIDGE I 0
1.) Alt BM Description
2.) Bldg sewer length = "j/ t✓(A ~Q~
- amount of cover
Plan revision Required? Yes No I/
Use other side for additional information. >
SBD-6710 (R.3/97) Date Insepctor's,Signature Cert. No.
f
SM v j 7
` .~~y' lstry Services Div n County
t ~ \ \ t 1400 pMB,-
rn-owq an \ ; ~-jig J N 2017 5 6 Sanit:sy Permit Number (to be filled in by Co.)
t#Il 3,7162~j ~j
4~ ST. QOM uNly -23-7/ I Mrs
l pp i state Tt art~lioat Number
In weor&= with SPS 3832](2), Wis. Adm. Cade, submission of this form to the 'ate governmental unit _
is required prior to obtaining a sanitary pc"iL Note: Application forms for ued POWYS are submitted to Project Address (ifdiffa 'ttCt~ha~ wading addrgPSS)
secondary
tine Departmerd of Safety and Professional Services. Personal informatetxt you provide may be used for
in acenrdmice with the Privacv lzw. s. )5.04{1 (ml. Stab. -
I. A ' Information - Please Print All Info ti ou
Property Owrw's Name Parcel ~
,60
Property Oww's Mailing Address; Property L- ioo
f ,i,F,r { r t . t Govt. Lot
Cr?y, St--, 7IP Code Phone Number v. 'l. Srctic>n
vrv'
" T 'i N, R 6 ,W;
, Lat ~
II. Typx of Building (cheer all that apply)
AA or 2 Farniiy Ihfel ling - f Redrooms Subdivision Name
1
Lam. 13tas*: •
.J
Q Pn'btzcfCan""ercial - se - 0 City of
State Ummed - Describe Use CSivi ]dumber Q Village of
yr
t /(3 Nn Tovmof
III. Type of P ; (Check omly o a ota litre A. Complete line -B if We) Z-6 A.0
(A Q New System Re[rlacsmt~tt System Q Tre rrent/Holdnzg TaA Replacement Only Q Other M4odifxatiort to Existing System (explain)
t B. Q Fersnit iFcn~rycuaat Q Permit Revision n citange of pina,iscr Q Permit'fran fer to New List Previous Fermst Number and Date Issued
i3cftae G--gziratim Uatr
M Type of W I S Systcm/Corn
oar-wi 9evec Chzek all that or-,
fty)
l for Presseaired In G<eaexnl L'I Puma= in-fisrouud Q At-iir de Q Hour d > 24 in. of suitable soil Q Mound < 24too ]table soil ~J
Q Holding Tank ts]x t Com;ro tit (explain) _ Q Prct va went Device (explain) V. ant-ca a t Area Infortttatioa-
izsign Flow (gpd) Design Sail Application ~ Did issal Ares Requ:ired (sf) :Area Proposed (so Sys Et
VI. Tank Info Catty in Total # of tceures ,
Callum Gallons Units u c
New Tmtks E8 Tscs c M i
a ~ ran m rn tz. C~ CL
thug 1 ,Mr
VIP. Responsibility State tat- i, the rtsponsMffify for' tion of the POWYS t attacked pis.
Plumber's Name (Print) Plwnber's tgnaiz7X--- Numtser Busatatss Pltarte Number
".rNPP4 Plumber's Address (Street, City, State, Zip Cam) Vill.
an ! r t Use only
Approved As pProv Petzrtit Fee lYate /7 L'1116ng Agtstt gnature
s • G /3
l ; t easort for Denial
-w 3,
SP 406th f~ r
SO&
tiis{teEc;,t ceN r..ust all a ssetytt*1 r,,t ~nj ^g
as par r semen! plan provided by plumber, F G~ ✓
2 =444 C'+a trlrealenrtr±ra<x t ,e trta rwirml o
tm:L to cawpk* via= Ur Cite 03UM 20d $Mb=dt t o the City * y =paper smS kris 11- 9 14 x 11 is sic
Page z of
°aPpe-------
Owner
~,~14tf 1v 5D fJ T s! _ 40ft
deg Descripdor, L bT fs, c~ t ~ ~ moo- h (wept where noted)
:C, Jet, 7~~IrJ . tZ j9W '1 o -I'li 6.- f-, is USOfi~ ST Ct~~ i x o t~ 1~ T~,~ M = Back hoe pint
t
I
i
r
i l vry~t ~ ~
~ .r '-i?tom 4
FFc)
v r- r e.A tr-,
~lTD ~r e tr, ,,`_t~
1, JJ!! ,:'r{_-
~G
.bite Location:
I'd
J ~C wn
:
i
r
PAGE 1 CP 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10705-P (N.01/01, R. 10/12)
P Index & Cover Sheet
leg of 5 Plat Plan
Pg of Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg of Management Plan
Attachments: Enclosures.
Pump Curve _ POVVTS Application for Review
Filter Specs Soil Evaluation Report & Site Map
Tank Specs Warranty Deed
Infiltrator Specs i Septic Tank Agreement
Project Name I Description '
~I
Owner Name(s): NEAL S. & KAREN M. JOHNSON Phone: 715 _336 _31,601
Owner Address: 892 Willow Ridge 1, Hudson Zip: 54416
Project Address: (sarne)
Govt. Lot: NA 1/4 of 1/4, Section 19 T 29 N-R 19 E ❑cr w
Township- Hudson,, County: St. Croix
Project Parcel ID 420 - 1117 - 30 - 000
Designer Information
Designer Name: Mary Jo Huppert Phone: 715 _ 426 _ 1775
Designer Address: 28497 King Arthur's Ct., Danbury, Wl Zip: 54830
E-mail: hollisterdesign@outlook.com
License Number: 1859 - 007 z.
Remarks: _
X%
Signature: date 06 -CAS - 2017
Oric+raai signature regt,,irec er each sucmitte ca^y.
Plot phqk!,~ Page z o 6,
et~~
Legal .._..5 Ott ~f.~o n(
Description It=4(ft
L a~ ~s ~ L A DcW.1 (except where toted)
Vic, 14 T2~}r/. ,{9W 'Tow,u p f0 t sai sr c~alx CaKn17~! ttekhoepit
eqz North
Z~-, - G o;~
y
i
4
1.
Zt;
1. UJ 0
eA t~`..L
25
Site Location
H, W f
1 ( ti
I
1
= PAGE 3 OF 5
C) o
z~
~W 2
I-- > U p
z Q <C o c
w = ca ~-U) 0)
c
CU m
~ U) ITV E
> a Q x m
EL-
d V t A
O ~c p Cn
2 f7
0 i c a
Q ~ h
V
~ '1 Y G U)
(
d 1 j C: = V, _ - t C L11
It +Z
E a
C/) ( • _ Q to 19 r, O
rl) t '
I f`i r o r. fl
a HXLJ
of ry
y r? i~
21 N
L
Lywad¢ v 7' v
if a L 1~ x
CY) ( ? Q
Q i~ 4
4.-o LLI
D > co
(D LLJ I i
E -6 Lu °
5,... N O.. I U 4
u I
Q ~I w it
z
r
F
PAGE 4 OF 5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Vent Pipe
,10 11 from
Building Electrical must camPty with
12" chin, at 2.0 it above SPS 316 and NEC 300
Establzried Flood Elevation l Extend manhole riser 25 necessary.
WeaUlerproa,
(typirai) Junction Box
Approved Approved Locking Manhole
Vent Cap with ;Naming Label Attached
IMPORTANT: ~ (typical)
Anchor tank(s) as necessary - Ganduit
pursuant to SPS 383,43(8)(g) 4° Min. or 2.o Y above
Established Ficuad Elevation
ttyPi~ll
Airtight Sea] z
Finished Grade Gate Valve i
*Quick Disconnect
CAPACITIES e@D, galfin r 1 * "
Watertight Plug
Depth (in) Volume (gal)
42
in
' Min. Depth =
A
(aelow frosdine)
r'B 2.0 Watertight Gasket
t I i Alarm
' f On
I [Cl l PUMP-OFF
*Pump Tank Liquid Level = in I Pump ~_oft ELEVATION = -tee ft
Check tt
Valve E
D INSIDE BOTTOM
Force Main Diameter = 2 in Concrete
Block ELEVATION = 83,00 ft II
FC}rC8 Main Length 3" Approved Bedding Material Beneath Tana
L T 75:i'
Important: Bury farce main below frost line or insulate 63-1,
as necessary pursuant to SPS 382.30(11)to)= W.A.C. r2
[Q] Total Dose Volume (TDV) gal/dose
02X design flow -elf) DRAWBACK wil check valve] ~1 r CG
Vertical Lift ft
it
PUMP TANK: SEPTIC TANK(ak
Volume = f gal Total Volume = gal,
Manufacturer. Wieser
Manufacturer(s):
Pump Manufacturer: Zg ler
Install approved effluent filter at the septic tank outlet
Pump Model: 98 (See attached pump curve.) immediately upstream of the pump tank inlet.
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer. Simtech
Controls/Aalrm Model: AP Tank Alert A10v
Filter Model:
Float switches containing mercunyare prohibited.
w~ J V ~+~7sxa€~ ~a-gin 1 1 1 1 6
m co 'o
~3 R R R R R R R R 7i 7 n i i
~ a~ a~~ a~ I t t t t t t t{~ ~ - 3 ~
16
184
3 d 2 Y x a
o ,
M r i t i: 1 t t`
gg~zt~ { i i i I i i t t? ~~z$a2Ssqn i i{ i t I r =
W t
I M -I I I I I I t t co I
M M H at :d R 1 R i l i I t t I t' In c
00 r :d t t{ t i t t i t i t i o c
~ C
$ t t t t t t t t t t t t Q CItS
n F-
4
o
- 2
U n~ R R• i i i i i t i l i i i i i ~
~ e
Loo, 1 1 1 1 1 1 1 1 1 1 11 1 1 1a
' - - n 1 1 1 1 1 1 1 1 1 1 1
Q Lo j a 1 I 1 1 1 1 1 1 1 / 1 1 1
I W Ucc' 1 1 I 1 1 1 1 I 1 1 1 1 1 v S
o v.
I = ~ S ~ v~ t t t t t t t t i t t t t- R
a co
a r
Q c" 1 t { t t t t t { t t { t t
U
_ e
t" Z vni r a3 1 1 1 1 I 1 t t 1 1 1 1 1
> N N H
n J Q 1 1 1 1 1 1 1 I / 1 1 1 1 m -
U C5 d 1 1 1 1 1 1 1 1 1 1 1 1 1 _
0 a ~ .n~ S
Z N o
J \
I'd
04 M ~
N 'e
co s
M
R
R $
eR Z/V-
vi T-
n o
OY3N 71YfAU0 1V101
In-ground Dosed-Gravity Management Plan PptGEA;70F
IPORT'A$
The owner of this in-ground dosed-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), Wisc. 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 363.52 311 WtsQ. Admin#
lylaximurn D aersal Area t eratin Limits:
Design Flaw gpd; S®Cs_ , 220 rragL' Y, • T'SS :5 95 . FC)G5 3f9 rrtgL,
~ r~gL',, '
In§Rgetion Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
o neglect or improper use (i.e., 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 appii ble (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 served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seetic and dose tank{sD shall be pumpers by a certified septage servicing operator licensed under s. 2$1.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
ffiu t falters shall be inspected even 3 yea and shall be cleaned when necessary to remove any
accumulated sa!ids wording to manufacturer's specfications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company-
f Aa Phone:
Local govemment unit"` ' r I
r Ct % is t Phone. ~'/~.`."r_ ),lfs> 1 J~(e'?,~%`
Local govemment unit address: ZIP: t _
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the P®WTS may be used unless approved by the department in
accordance with SPS 381, Wisc. Admin. Code.
Continoeney Plar$
In the event that any failed treatment component of this Pt?WTS cannot be repaired, it shall be replaced pursuant 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.
Stern Abangonment
if use of this POWTS is discontinued, i2 shall be abandoned in accordance with SPS 333.33, Wisc. Admin. Code.
SHIPPING LIST HOLLISTER DESIGN
(1 EA.) 6" X 58" TOP SLAB W/ 27" OFFSET PROJECT: 999
(1 EA.) 44" FLAT TOP BARREL (1 EA) MANHOLE
(1 EA.) 42" W/ ATTACHED BASE
(1 EA.) 8QRS BOOT 048"
MANHOLES PRODUCED PER ASTM C-478
❑PIPE GASKET (BOOT) X27 4"
0-RINGS I
BUTYL RUBBER - - - - - - - - - -
❑ JOINT WRAP
I
❑ POUR INVERTS
NO INVERTS
❑ STEPS
❑ ADJUSTING RINGS
REVIEWED BY
REVIEW DATE
DRAWINGS SUBMITTED 6"
FOR APPROVAL APPROX. WT.
1,400 LBS. 58"
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY: Ill I
I- 27"
I
I I
I I
I 4„
I
I
44"
APPROX. WT. j
3,175 LBS. i 8
I I
1 I
I I
I I
I I
n n
I I
I I
64" i 64"
I I
42"
APPROX. WT. I I
4,825 LBS. I I
INCLUDING BASE
I I
I I
I I
I I
1 I I
"
PRE POUR s T 2°
WALL THICKNESS: 48„
REINFORCING:
POST POUR 66"
WALL THICKNESS:- - - HOLLISTER DESIGN SCALE: 1/2" = 1' REV NO. DATE:
\
m PROJECT: LOCATION: MIEBERCHCHETE DRAWN BY:SWT
V W3716 US HWY10. MAIDEN ROCK, WI 54750 DATE: 6/5/17
V WIESER JOB 800-325-8456 FILE: i\ohmd*Wm\ffMm10111"d*-mc*W tmilsVdk a* - mmpUelaiA*
II
;v J
C.'; `D ~ -
I o '
<1 (/O C? cum
cu
LS~ Z Q O
w ~
yf Q w D-
1
J
{ Q
C
MEN=,
t-- I, LD WW >
n
r- ~Cll?-~ z
CO O
LLJ
r-
I
w 3 u
- CK Q "w
{ <L Q Q' w
' ~ U I
LL-
CL Q {
CD
j ~ I { g ~ E 1
I
/~y~J
9 l, ~ I
l l
# 1
v ~rO
h
7 1
+1'kx ~k
' 1 tp h
53,
3&
'MI
f. ~ ~ r sx .zt- T
~ t $R } 3' ~P~~ eat S~ `d+:
The Quick4.S Standard Chamber fits in a 36" wide trench
and is ideal for curved or straight systems. It features the
patent-pending Contour Swivel Connection's which permits
turns up to 15°, right or left. The MultiPort- endcap allows _
multiple piping options and eliminates pipe fittings. The
chamber's four-foot length provides optirnal installation
flexibility,
L
• Advanced contouring connections swivel up to 15°,
right or left m
Latching mechanism allows for quick installation
• Four-foot chambers are easy to handle and install - ,
• The Quick4 Standard Chamber supports wheel loads of
k~wi
16,000 Ibs/axle with only 12of cover
• Certified by the International Association z =
I O
of Plumbing and Mechanical Officials (IAPMO)
p~
• Tear-out seals on inlet ports provide a tight fit to the pipe
. Eight molded-in inlets/outlets allow
for maximurn piping flexibility
• Eliminates pipe fittings
Fits cn either end of the Quick4 Standard Chanter
APPROVED in