HomeMy WebLinkAbout020-1077-20-010
isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
.afety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 597439
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:
LUCAS FERRILL TOWN OF HUDSON 020-1077-20-010
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
✓A 1 28.29.19.31OB-10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
/UG>O
Septic Benchmark
(.J ~ ~ 3ZttC~ 4,4$ ma-45 /o 0
Dosing ` ' 7 c7d Alt. BM GOtiJ~. ~j . ZZ ~dlS • Zb
W 3
Aeration Bldg. Sewer
N R. lh vrZs ~g.Z
Holding St/Ht Inlet
TANK SETBAC INFORMATION St/Ht Outlet /b q4' A.
TANK TO WE~L~ BLDG V o Air Intake ROAD Dt Inlet
ibcb c w; (r 14.32 9G -07
Septic t Dt Bottom
"M 71 m to Zy ( 1P
Dos' Header/Man. -7, *3
Aeration O sJ Dist. Pipe 7,'4:3 Will! 07-
CPIZS 4'7. Z
Holding Bot. System 1.44 3 S- %>z. O
ia. z 9 • z 1~
PUMP/SIPHON INFORMATION Final Grade mt y7
Manufacturer GP nand St Cover
~ a
-AILUA
Model Number 1605.3
TDH Lift Friction Loss System He TDH t
G01L o _/.61101
Forcemain Length / Dia+.~ I Dist. to Well /
Zz1 4 1Z6
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 94 Z. m
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuftur
INFORMATION CHAMBER OR ' ; c;
Type Of System i UNIT Model N~nber:
DISTRIBUTION SYSTEM tJe6+- koj% 3 4-Z,3
Header/Manifold Distribution x Hole Size x Hole Spacing Veny~o Air Int
Pipe(s) ~
Length Dia Length Dia Spacing
L
i 4a-
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded No xx Mulched No
Bed/Trench Center 70 Bed/Trench Edges Topsoil
` Yes Yes ❑
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 599 CTY RD UU Pit"? 66,.m~ CLto.,5 4- ~QtJGS a
1.) Alt BM Description
2.) Bldg sewer length = G
-amount of cover
Plan revision Required? Yes No
G y
Use other side for additional information.
Date Insepctor' Signat Cert. No.
SBD-6710 (R.3197)
{acv ry ~n t/ ~ ^ T Co" n
~~~`V)~D Safety and Buildings Division St,
201 W. Washington Ave_, P.U. Box 7162 Sanitary Permit Number (to be filled in by Co.)
Madison, Wl 53707-7162
c~
AUG 0 4 2011 A ~`I N-z f
mber
$T. ORO `'/+C State Tran u
In accorda50"Moa Cder, 4VVE1667524M eAent.1 unit TA
is required pnor to obtaining a sanitary permit, Note. iappucatton forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
u uses in accordance with the Priva Law, s. 15.04(12(m), Sims.
L Application Information - Please Print All Information
114
Property Owner's Name Parcel n
Property Owner's Mailing Address Properly LocatiWQ S. q..9. /b -
(k;~l ~ts~ Lot
City, State lj Zi Code ! Phone l-tmtber
Section
`~~/'l 1 r \r e~ (circle one)
IT. Type of Building (check all that apply) Lot Y T ~ r N, R E or vjG
❑ I or 2 Family Dwelling - Number of Bedrooms Subdivision Namc d
Block #
D /
Public/Commercial - Describe Use U l ~}+v _
• ~ ❑ City of
D State Owned - Describe Use CSM Number U Village of
1b)r Z f-7 yJ~ S INT-woof_ PLk
TH. 'T'ype of Permit: (Checjt en line A. Complete line B if applicable) -
❑ New System $4WI,7rS t yttem
Treatmsxn(Hoidina Tanis Replacement Only D Other Modification to Existing System (explain)
S D Permit Renewal ( L1 Permit Revision l7 Change of Plumber ❑ Permit Transfer to New List Pr eviaus Permit Number and Daze Lssued
I Before Expiration Owner
IV. *f-Fg KT,5 $ l
stem/Com onent/Device: Check all that apply)
tWAon Pressurized In-Ground 11 surized In-Ground D AI-Grade D Mound > 24 in. of suitable soil D Mound < 24 m. £ suitable soil
❑ Holding Tank l Other Dispersat Component (explain) D Pretreatment Device (explain)
V_ Dis ersal/Trea nt Area Information:
Dest Flow (gpd) Design Soil Application Rate(gpdsB Dispersal Area Requires! (st) Dispers ea Proposed S. Elevation ()0
9 L~
t V IL Tank Info Capacity in Total 4 of Manuf ewrer
Gallons Gallons Units /fbl ylok
i +J # ~zs-
New Tanks Eisting Tanks c o U ~ m
Septic or Holding Tank 16 `
Dosing Chamber ' -7 S L lll+ 1
V H. Responsibility Statement- L the undersigned, assume responsibility for installation of the PUWTS shown on the attached plans.
Plumber's Name nnt) is Si, re MP/MPILS Number Business Phone"
umber
Plumber' Address (Street, City . Stat Zip Code) r
Lod l b O wi
VH1. un /De art-ment L e Qnl
ppmved sapprove Permit Fee Date sued Issuing A Signature
en Reason for Denial
$ /5 17
IX. Condit easons for Disapproval G
a lei lt4 r A is
htd of b 2„ in
I 3s allfl:wMi s , . . COMPOI Aj-
Per fi " An prund (jcrPa i-Situ S o i l nod
2. All seR4e k~ ~s must bt Alsivr b-ed dur iM s ub-c oh'Aq rmt~2 bb
j ax per pppjWAjq ctxlr' / ; rd;,,r rn;::::: J J
Attach :n co-plctc plans for the sysrrrn and subtoit to the I
S13D-6398 (R_ 11111)
bA C A
mew
9
IJLP
_f-
I
t
ti
-,N i r-,- P~ - tst , 6 t
ti ~ w i 1
~ 4ZF 4 - ' s3~
I j~
F {SCE~G//
is
€ 11
t
I
R6IyidL-nt?al A'OplirAfion
MDE'X AND TITLE PACE
Project Name: ~ U ~ ICA
Owners Na
YlC':
Owner's
Q
Legal Description:
UWE-
Township, D S yA
County: _ S•_~ c kb_ik,
,Ubdivision Naryin,- S 4 (P T~ \pl~r~lp
Lot Number:
tP,,~rcol ID NurWye•r.
P~ ~ ~ _ ierc~~y•~.nd title S
Page 2 f'Irsl: flan
Pe.ge 3 1) Vell) Sizing & Cross-,s
Fare ! - rwns~ I
-,Sge 5 llr(airrten n'cP in,`.r~rrnaCi~a~
Pa'-an Li - h/~'BrrB~C1'e~Ti1~'17i F~7v 1 - I
pa-ge i St. C ~x G ,~zpti Tank iVaihtanaiTcw Forll
Page 8 Warrant Dead
9 CSM ar flat
At'ta h-Miz-, t4,~: Soil Tat & House Planar
DratE: c Q t°.~z • License Nwmber:
i'horc Ntarnber
aiGnP;ure
1JE.1irlned (.Iursuant ko the In-„r d Soli Abso 7.ian Conpo,:rnt rran~r, ! for u
i
or • pW7S ti/ersipn 2.0 SBD-.1070-4i.p (N.0-1 /D1}.
Page 7
bA C A ~ r z a l i t
Q 9~du
sf -Q
~}0 91.0
9.«o
Dn`'
i
ll'' ~X!' l i N
10
11
uS
c,h Tito ty ~ 4v
e ~ ~ .
5~,1 k
I CO 361'
~Hi Miry
I
1 ~`t
PVC vent ripe Final a 3recle
With Vert cc-p
t
Chamber
sR - ~ ~Y~tern ~Ira~tatian
< 1. GmC -q Trench
4" D is.
Vent, OF abseyvaV an Pipe Trench 2 Heaver
- _..._Trench 'ftil~n sari ` a And Mode! _ t t
tSA
Raiit?v s is Per chamber SoirF AppEica#tt}n P.affe
S~
4p q ft
-90 Design Shit Apprica#ion s ate EISA
facie of
Technical Specifications
PL-525 EFFLUENT FILTER (COiWMERCIAL)
01:I BPtL GiECK ~ 1
EXLEPTS6'SH04u
FOR W ET EXiENn,'A I 14.35
t.5)
OUR. ET 3USHING EXCEPTS
X11 S1,11 4066'Sol Jfi ' 3+0
i
4
11/ i 5.23 fC 41" {I
55-
~ I I
I • ~ I I I II
ie3
PL-525 FILTER HOUSING - 7/_1
4 PART NQ - 30142-525 MATERIAL- ~_l 3
HOUSING-POLYPROPYLENE p, I [
OUTLETBUSHING - PVC I di { i
b.5 BALL -HOPE r1
100CT EXCEPTS FLOAT SW TOf
EX PTS1'SOi4G
~~.FCRgAN%EE%TEN1101. 10,54
(n-{ 3>--SVGF trse SLOTS
{ - 6J1 - I
I S00*TEXGEPTS f 604 956
BALL PUSH ROD OPENING
I o
it
r.oe
I 2077
k it 0{ jol
1402 2244
I~~~II I , I
p I o ~i:
POLVLOK PL-525 FILTER CARTRIDGE
PART NO. - 30141-525
MATERIAL • POLYPROPYLENE
' Trlti9l-----
ST. CROLX COUNT
SEPTIC TANK MUNTTENANCE AGREEMENT
AND
OWNERSHM CERTFF'TCATTON DORM
O-wlier/Buyer
L.u~c_y s ~a izQ.c 1(
_Mailing Address
S C_a .
Prapcity Address
(Verification required from Planting & Zoning Department for new construction.)
City/State 01 ` Parcel 1denti zcation Number
LEGAL DESCRIPTION
Properly Location r/ , Sec." , T ' ;(I N %2 ` W, Town of Up-SO
j _
Subdivision Plat: C S 01 ~&(p I ° (Q
,.Lot#
Certified Survey Map r , Volume Page #
Warranty Deed l (be.ioz•e 2007)Voli zne Page #
Spec house Q yes t=i no Lot lines identifiable r yes ❑ no
SYSTEM MAINTENANCE RIND OWNTER CERTIRCATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. Vi'ltat you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are. specified in §Corani. 33.52(1) and in Chapter 12 - St- Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Z-.ordng Department a certification form, signed by the
ommer and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) ah:er inspection and pumping (if necessary), the septic tank is
less than 1/3 fall of sludge.
Vive, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standarcls set forth, herein, as set by the Department of Commerce and the Department of Nattual Resources, State of Wisconsin.
Certification stating thatyour sec system has be
septic been maintained must be completed and returned to the St. Croix County Planning &
Toning Department within 30 days of the three year expiration date.
I/we, certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue ofa warthty deed recorded in Register of Deeds Office.
r
Number . f bediroo
NA OF .APP.L.I ST(S)
DATE
I
""Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. **X
Include with this application a recorded warranty deed
from the Re 'st.er of Dec* reference is mad: in the warranty deed. ~ Office and a copy of the certified survey map if
E47. g
"
Ctti~~: r s ~ ~ » 13 M MA
Permit septa TaTik Maratk'r nktme "'S ! Q i' if 1:1 NA
~ 5lirr~; E~#ar~il a trer i M ISJA
F~ MA
flltarts{ &r a= t?Tar" s M NA 1=;r'lt~erR Mar Madot
aurnEaer a~ ufil'sY tryao- ii Eta Fj NA ~ s Pump i~tk capz;city P MA
r t
l rump Srw t `;i.[rar J e • c ;1 WA
Saw h K~l1i;~ (aVtlf2t1~} -~FI~{. ~ ~ _
t~ssin~n :inusr (peylt}, lH,s2imcvd ~ i.r) ~ ~Elts E~tttng S~ttBttu;.9~C~' ~,v,l~ ` ..r ~ M h►A
' M MA
Soil AoPff'a£t R, -.W t~slL ~~f'"" S Patrtp i4144$E
a r CYit~f1: E.fni
~r;~rznty D IAA
>ndsr+3 3,~.'Itneritt lueri` Jtrs3 ever8
~a~, C~E1 ~f ;~t~1 ~r3 ~tg(t, ~ G 5ettxE)~,vaf k'L'%4r q IIW €11?F i
~"x:~3 m r~ ID !t!A G t~sn'ti:2l >itcr G~
S;ctpnervrl~sl oxygon Den, z4 fRWat`
Srb r,
R 1Gi~ .w'y~~~ T3l1rr{salan
F tsuai St~=erdar, -SrAlds S , Q NA
C+arruNy avara s ; Dispersal rke!lt~1
uretreede1ritE}i~?' a r ,,f lrrraus'H ~t~t~t~3iedl
~(t~:haniaa! ~'~V~~ ~~rtann (.~~JF3~1 ~ Cre,-11, tS,Er~~G,..urid 1~`av.~yx
W5' ' gT R MA R Al-fir da Ci it!l~un~
iaFparesd StiEtis , ' = C.taprxl
t spa! Cccl`r~ t~nt8frc fttB j 1 1
1u8C~t Ar~Iwle'r"E~~ ! g in 6-fa. 1~ ltlH r, a Q Rk
u, ;~laKltr G 111A l;»hert E
)
Omar" ' Other; G! MA
~r&3t'tA a t' "lnt 't tank
~1 °s~k1 1€I t 5 4 E ~GE.v e; rp WNW, M NA
Nil
AT team arsYa 5Varit:sar3 fl MA
irismsat a4ndlOm a; 4arrkls3
il~tt7e~ ~a~~tn~ slttdg~ artrw ~surn e~ ~~irrs t~~~):d lark 01UM _
PUMP 014-1 tuantenta o; tatY4c(al t~1 ~ . ~ (1~~+~~ r ~rs~ 6 ~iA
F A:,- t3et ~sraee Every: ~ : ~~r sl
E^~Ae~°' di~~rsas r.211ta4 ~~ta M ~tl~
~1. _ .
At S~~a~. 11 ly.~ r3;~arye {nn 112M
rnnn r~ffiws"n- iEtar ri Ft ) M MA
A: jg;Nst enve WAN. ~ IM
c~nkrt~ls °e alar>s, - 1p~5~~~~cj ~2 RA
l7lePoc~ put s, PUMP
At IL% once a vary; 1W4 ~~i'u
N ~lugii ,-sErP_is a:d xeRpr-P Lee l F ifufiiwl~( D IU
g G3211~r. - ~ (~s% 1'aBSi; iiSA'~ ~ISr}{; ~E....1~r Ple1A i
t ensm (&K' e~rtlR*3 S
~~A#W
Arty of
E »'S~3s e ;?ta(E y ,r•ai3_ by an lrrd3 ~..Idu-! t~,?ff
inspsctterts ~sFniza and fir. ~'f o ctCn i~ ~r
iU'tpsrsr PlwrztYsai'. 4t~,e,nsr ° m~er Ra'*r'leue- 95`VYPX~ ~.qi' 1 r orbroW h , idart l~! F-M arat3k~ or
t t r 19 in slae arts > lralud a Vjsuai ua¢pat »iaN of the 4errkisl to id°h i any r"►s or .of aft.' Stt Fi*,i ~R graurld aGir see,
maaswrs »he v-'Awlmn Mf r*O i61no s:wd d sq.,, ss and to h l> far sn+I h rak t Ertl tOrok ior My 1ilMYdtn9
!za di°peCsF1 eitjal s~e:i i~e vi TV inagnaad m ahc-Q? !,fie r~lueM Eev~sls irf *4 rs Itv tt g s,rr t e+an snd Fat tIta9 the
p.e yU;IN 9ttr cat !"Cre peen ing 4f eftant on fha cgrouild a„rF;arg may MEN
ll .Md)aze F G$1fl&=&ttE7n crf tha E~ae! r i rti ~°lkhfar'rl1t.
~l han %he amMMned t ur.ra41 ftn tai sludge and ssurm 1r1 2111 %;mk rgkrtr an d ai~p~~}e, to ~ odsrlss ~rtrtth oh pttw NR 112,
er•~rialso ~p
cr~r~*~ec~ of t: tank Sher, iYe reisnved by a P aaa S
«&~lat3tCYE~TIC
Wilisamain .A.dminittrMenfa Cade,
All other ssrt~l, tg~irar~in~ ~ 1~i~`~s~ ms~n hs~shlail ~~~r~a~a~itbY ~ tit#t ~yt~~~n~rl~:
~units, and acty wvleinzg at
d~rs csi' ct~34i~l"S'r'F ~iA ~ •et.
cR~tnr !+k)n
ss ;>l , ;err =i:&ia r-_ wr a decfi ka uhe t cai rerl~faL'~'Y SAY rrtlnj snit»hm 713
rat 113W : n*Rst, iC liar t0 use e1` the Fags of_ =OMITS _
at
nay
Of ay Impede the xraatrnant rurness and/or amaga1Lntrentmerst tankcs) for '010 e dispersal cal {s}, high ~aneenr ti s 'PrOdL d hove Other
O the 1 -
hs cfierzt fceis
tank(s) ralYf0~rw by a eeWLage servlcfng operator -ar?or tc rise, ccrtxanxs
'Wstarr, sty tip shc^3i nut occur wrier, sail conditions ate frozen a, -,he Irtft mtIve surfaco.
uric po r?ar autcaed dump "menks may fill above normal hish""at~!r I!Wela. Iften prswsr is ra rratl tYra;sYtEt W tdV war wIll ha
discharged to The dispersa# calls} in Lnd may resu
cane large doss, overloading the calflsl It P.~t tits ;aac?~up or suri~~a..d~scFiargs of
s fluent. To avoid this, site lort stave alts contents of ties pump tar:k ramavaci by g Ss • gD S.Wi rArr9 Glgaxatcr Oar to tosser?rig
cower to the 8frriua-lit P=p cr 0011T= a r lUmber or POWTS Malnxalnar to assist L-1 rGstara n^rmal ?eVels w,rfthfn the atr~ t rrsanna£v rs
p .ens, paroling the pump controls
Dc nct drive cr park ualhiolas ove7 tanks and diavarsai calls. Do not drive cr perk oVer, or otherwiwE dirs-,z; b or ca . aa'"r the area
"within 15 feet down SInPe of any mound ar at grade soli absorption ar&2.
ryeducticn or alimF.netion of the F0gC1sNing frOM xhe WSSTevratAr st*zaam May infprove the l~8ridtrl17nl9sa
v~ITS; arftlblodcs; baby wipas; ctgerette butts, tendons, ootten awaf~ J Whs le of tl~
aril rtrellcrn
ndeticn drain (sump pump) wam, trait and w ~ J r dg~p-za; s; dst~~t floss; ~irgQars d:~ff~~w~,y~°
tri 'tti15.8 jJ8&# n s C
pia, rt ff praducP c E~ esciire, Cf?'?&e x'+ _ r
Se l~HSiii~?3~ui 3~rlrter°w ^8~pkinAl T«rn'•i+..n_ , end Nn _ zftszie fc >
1"hen the i?OWTS f=alls ar(Var is penranently Taken out of service , e :ailavwlrg stags slrall 6a t'sksr)"tr r,s;,rv °
ka n{ crr
Jrcperitrand safely 0artlnnfd In ccmp?lento writ? ahror,1r,7 53 VlisWcrMi,-: AdmirtistfJ
Ail piping tc tanks and p?rs shall bs disconnected anti the abandoned, p cs ops-ijings iL°,,
Ti;a acnts m, aE tarft anti pi=- shall be rerncvad and praparly dispcsc u of bti s semCga S_rvz _ p ~ =TW..
-Aft
L;4tar Zsl '~Z7:5 $i3Y~ pi~$rc:t 66 oXG«~Ic.e„ HP'S Fa
I c' Bar 3r2 rf , ; ved or ^ C r c' ` s rs
Sail,
Cw 6r 1178r S_ ?'lE 8r12I. b i 79 i'? and 1 Ra V C5.0 a4 T'i??Bd S if j12
u01. 7INGEN :7' PLAN
Ir the °GWT;= €aPla and carrnc- ."`~sfrad ' ^ ?
'ha M asu:as rs,: b=_-^
r Gpia-.Lmarnsnt Syst. m, i ` L: taken, ~ 3r~L'i~2Q 1 t~? C^ 1 l•'Etrlt
'!k A sui- bfe re,zlamment area has bean evaluated and may be utilized for tyre lorwdan of a re 1=:.amsnt. sill Bta • lnn
system. The €epfanerttant area should be protested fmM distwbarce end cornpac'tton dna sho,u!d Tint be 11ifringatl uptm by
required setbacks from aXrsting and prapesad strt!cture: fo?,• lines and 0115,ts, Failure to prmett t~s- raplacernent area Will
result m, tba read *'ar a new Moil and site evslletian I'D sst_abiish a sultsb-'a replacarnent area, Repla:arnenf sysram~ rrr st
cornet f With ith the rules in affact at tn;qt tuna.
G A suitable replazem, a area Is not avaliah)a .d°we to tatback and/or soil lin7?iattons. SaWlrg advances in PC IA 1
technology a holding tank may be instalfed as a iast resort to rapiace the Bled P1i W T S.
E, TNe site has r ct been evalt!-a-tad to Itlentlty a aukable repl#camenc area. Upon Velure cf the POVV-[S .a soil and sits
evaiuatinn must ba psrfarmM to locate s suftable rerlacemant area. Pr' no replacement area is Scraltabla hwYdtrig tank
may be installed as a feat resort to rapfacs the failed POW T g,
D mound and a',-grsde sell absorption sma;ms MPV he rer~anslructad in Plata faliowing removes of th-9 laftrm aT V 'z
inff?trative surf'acs, Reccnmruotions cl 3uah systems must corrpfy with that ruleg- In 6.1t`act e, that-time,
< VMANING>>
SEPM, PUMP AND 0 rMq TREATf4rzNT TANKS MAY CONTAIN LF.T- I fAL GASSES ANDICIR WSVPFet?'IL r 09• Smi, Do IVOT
P.'N ER A SEPTIC, PiT,V?F OR OTHER TREATIMEN, TAYAR UNDER ANY G?R0VTWS a 4,NTCS~ , RESIT;°. r<naG-U-= -IF A
ADD!7IONA€. COMMENTS
FOWTS lNSTAf,e.irlJt
iVame lib {l&'S IlAtl9l Alltllrl.
-Q S a Name
& Fhota~
rRPTt~SSRitL'1= t71rs (r?sIPP r
Nam=_
, zQAi REc?tSS &y tSREy .yrs"TFT1-l
r~}aa 'r j .7: ~ ~ llr8rif~ ~ .T , < i ; r a - f
T 9
17
""='tis nocumer;: -was drafted ir: aormcsane= tnrizl: a~r~ C . J `
r c~.Z aZ..22f,-.',Ibr;tilt3sx{; a d 83,a ITi, t & fs),. VVISransin
A~dmitr,setrattva Gt,de,