Loading...
HomeMy WebLinkAbout020-1117-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St, Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597469 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: Lance & Sally Hermann 7 TOWN OF HUDSON 020-1117-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /p 66 6L4 19.29.19.494 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2~ ZIP /60 QOO*M Alt. BM 6tes, ( 7 99.5~I Aeration Bldg. Sewer ~4 644 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet '~•~P 9S- L~ TANK TO J,L{ WELL BLDG. Vent to it In, take ROAD Dt Inlet (~A ~{n, PrI~+\ 4 . Z 9S. off, Septic 141- Dt Bottom Dosing Header/Man. - y.4 93. g l Aeration Dist. Pipe 7 b Holding Bot. System 9 2. 8 N Final Grade PUMP/SIPHON INFORMATION 7.7 Manufacturer Demand St Cover 9q • S GPM C_v ( Tj_j 114 Model Numb - TDH ift Friction Loss System Head TDH Ft Forcemain th Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur INFORMATION CHAMBER OR 'T/\ ' Type Of System: Q UNIT Model N mber Co B V $7 DISTRIBUTION SYSTEM 17 +T7 = 3 is w 3 Header/ManifokV Distribution x Hole Si ix Hole Spacing vent Air I take 5 Pipe(s) ® - Length 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 es No, j ""S~ es D No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspe i n #2: M J `i ISa ~ rt'~ Location: 886 WILLOW RIDGE RD 6, 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover = 4~4 3 ^9 c~ Plan revision Required? ❑ Yes No Use other side for additional information. Date Insepctor' ignature Cert. No. SBD-6710 (R.3/97) ( r ✓ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the followipg reside ce: (Street address) Fee located at: 1/4, 1/4, Section , Town N, Range W, Town of- s~ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: a 0 u Construction: Prefab Concrete v"" Steel Other Manufacturer (if known): j,,:. j_s Age of Tank (if known): ? Permit,~number (if known) 4n (Licensed Plumber Signare) (Print Name) Ij/ lJ V V (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 I RECEIVED S P Aj ao (-7 -a e Industry Services Division County Yl~ 0 2017 1400 E Washington Ave ST. C P.O. Box 71 Sanitary Permit Number (to be filled in by Co.) G~ T. CROIX COUNTY Madison 537 -7 0Y,eWUtAffYDML0PME.K 111 11L 7 Sanitary Permit A.pplicatiq ,6 State Transaction Number In accordance with SPS 38321(2), Wis. Adm. Cate, submission of this fo c appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services.. Personal information you provide may be used for secondary 4_1~ ~ f purposes in accordance with the Privacy Law, s. 1 S.4 1 m , Slats. ` 1. Application Information - Please Print All Information O Property Owner's Name parcel # / Property Owner's Mailing Address Property Location ~ Q t3 4'~,r i Lit a) i br<; e 1- Govt. Lot City, State Zip Code Phone Number %4, Y44, Section f t 1 ~J~ -50 712 --zZCI Q(c T Z~ N; R ter _IEa IL Type of Building (c eck all that apply) Lot # Subdivision Name Ior2Family Dwelling -Number ofl3ectraom 3 /41 BEock# © Public/Commercial - Describe Use ❑ City of State Owned - Describe Use CSM Number Village of _ 1 L 4 ~ I -own of III. 'l'ype of Permit: (Check only one b on line A. Complete litre IB if applicable) P ©Treatment/Hotdusg Tank Replacement Only 0 Other Modification to Existing System (explain) A. New System Re laeemerlt System 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 l Nan-Pressurized In-Ground ❑ Pressurized in-Ground El At-Grade ❑ Mound?: 24 in, of suitable soil ❑ Mo < 24 in. of suitable soli ❑ Hording Tank er ispersal Component (explain) D Pretreatment Device (explain) V. Dis rsaltl'rea cut Area Information; Design Flow (gpd) Design Soil Application Rate( f) Dispersal Area Regmred (sf) Dispersal Area Pro (sf) System Elevation i co q3, VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units w v Y 2 NOW Tanks Pxisrutg Tzsks r ' o Septic or Hording Tank y (00 1 V VII. Responsibility Statement- I, the undersigned, assume responsibility for installation a h W'FS shown on the attached plans. Plumber's Name (Print) Wature_ P umber Business Phone Number r1t 7/.5- 71- Plumber's Address (Street, City, State, Zip Code) ^ VIII. Dort /De artment Use Only Approved isappra Permit Fee Date Is ued issuing t Signature _ 00 C0yyiae- bluer Reason vial S -ru / 17 IX. ConditSYjS easous for Disapproval ~ t . Seplt:, t w*, 6It1+: MW ttri 3~ ~o W 6e- e , 14 e u Sp2t a:u wll must all be s t plan p!o iiae i by piumbei. as per j"~A 2. AD must Uti utt t it e 4 f Ain as per itp~tl ft torla.= +ft~l kl,IrJ i. ~r ~..C.l ~y '-yQ~ 1l + • Attach to complete plane for tine system and sub tp the Coaaiy ssty on paper rat las trxan ra x l t inches in sirs / U SBD-6348 (R. 48/14) Plot Plan Page ,Z-Qf Prqperly Owner lm=4® L-gged n zT 1g. uj t Li. pj, ► Ripu--- t\ w kere new) fe pt .4 - -AAN' PATS N) AC9~Els i C,C c ~ r'iL'J 4 J Qb.oo ^ ,~,~u•~~r+ 1) 0 Site i m: i Lk r. t PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-R (N-01/0,11, R. 10112) of Index & Cover Shoot of Plot Flan of Dispersal Area Cross-Section Plan View of 4 Management Plan Attachments: Enclosures: Infiltrator Specs POWTS Application for Review Miter Specs Sail Evaluation Report & Site Map WARXAN i Ac..F-C-> Project Name l ascription Owner Name( s): LANCE O, ALL'S A. HER ANN Phone: 715 _X20 Owner Address: 886 Willow Ridge I, Hudson, Wl ZIP: 54016 Project Address: (same) Govt. rate OVA 1 /4 of 1/4, Section 19 T29 N-R 19 Er or W `township: Hudson County: St. Croix Project Parcel ID : 020 - 1117 - 70 -000 Designer Information Designer Name: Mary Jo Huppert Phone: 715. 426- 1775 Designer Address: 28407 King Arthur's Court, Danbury, W1 Zip: 54880 E-mail: hollisterdesign@outlook.com ~ t~~I~r=ryr~~~rfr~ . License urn ber: 1850-007 Remarks: MARY JO HUPP!7RT D 1859 RIVED FALLS,: ` V11 Signature: t b' L Z Sato "08 2 2007 0 iginal 'nature required a 0Y7 submitted copy. ' K14 plotpim Page. ?-Of I"-40 Backkoe pit l C) O It 1-7 °0v- cool 35 No k t / t v iv, ? kJ a 1 Y F S6Qtic Tank{s3 ~Y,xk IN-GROUND GRAVITY DISPERSAL BAR _ Uniform Elevation Trenches with Quick4 Standard---W Chambers septic santc{sI tia-rne(s): gal 3 -ft Trench (down-sizing credit) 9A -.-A gal went Fttter AAaned u FE yt~ EitWeM Fdier ! mom. tZ' tgFtcat} SOIL COVER tr TYPICAL TRENCH m ` CROSS SECTION VIEW ~a• _ {No Scale} Provide ttasnanum 3 it A ~r it separation between trenches- System Elevation = (typical) Quick4 Standard-W oo-.., tlm Mpa TYPICAL TRENCH w1 End Cap (Show location of inlet / outlet pipe c)ranectmn on plan view.} ft"r (typical) ~WWCXturelt PLAN VIEW (No Scale) son JA= t (tYp 7 Quick4 Standard-W Chamber CA) (40kali d INSTALL PER TRENCH: (re by kdMr" syn. k-) tm rat p,~t re MMWftWftN&S ket~ A Ouick4 SW-W @ 20 fig ElSisdt tarYi f = 7) w + Pans of end caps @ 6 fit EISAtpair= ft` J r~ / = Proposed E$SA per trench = ft- 'Required infiltration Area= Gst, < C 'fe p n Method: x trenches = Proposed Total EISA = Y n= • ~c 2 ,C, C,.°7 LPG ALA 7-, C~ Q~i I' JJ i a ' NiT_`~ jC 1U Z ` K P # It s . 3L-1 1n rrs 4 7 (,4tv rTS G ~I I ~I i J PAGE 4 OF 4 In-ground Gravity Management Plea IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SIBS 382-334, Wisc. Admin. Cade. 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 PO a Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Cape tincl Limits: Design Flaw = 456 d; B D5 5 220 gUl; TSS < 150 rrmgL-'; EGG S 30 mgL" Inspection 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.) solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution 1 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 applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) distribution lateral or lateral orifice plugging (n-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 Se2tic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the task(s) exceeds sane-third (1/3) the liquid volume of the tam(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code, o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. 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 SIBS 383.55 Wisc. Admin. Code. Deport any component failure or malfunction to: Name of individual or company: Advanced Septic Installation phone: 715-743-8337 Local government unit: St- Croix County Community Development F~hone: 715-386.4680 Local government unit address: _ Hudson, i Zip: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.54 (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 PCWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Continqencv Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shalt 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. System andonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SIBS 383.33, Wisc. Admin. Code. ' r f ` ~ ~ ~ ~ 4 yon` ~.5 3~,~ •~v' . j d i Y` T .r The Quick48 Standard Chamber fits in a 36" wide trench and is ideal for curved or straight systems. It features the ` patent-pending Contour Swivel Connection which permits -~-ro turns up to 15°, right or left. The MultiPort:.° endcap allows Book, multiple piping options and eliminates pipe fittings. The _ chamber's four-foot length provides optimal installation y - ja flexibility. bK, A, Advanced contouring connections swivel up to 15°,k right or left • Latching mechanism allows for quick installation • Four-foot chambers are easy to handle and install' • The Quick4 Standard Chamber supports wheel loads of 16,000 lbs/axle with only 12" of cover • Certified by the International Association of Plumbing and Mechanical Officials OAPMO) l N. Tear-out seals on inlet ports provide a tight fit to the pipe • Eight molded-in inlets/outlets allow y for maximum piping flexibility • y • Eliminates pipe fittings - Fits on either end of the Quick4 Standard Chamber APPROVED in QWCk4 Standard C ~u - f3~ --s - w v s 34° 48° i (EFFEGTIVE LENGTH) Mul EII p f J 1 'c~ FRONT VIEW SIDE VIEW TOP VIEW T View - WJ:U-'WATCfftWA71MTBCHNOLOSr=SSTPJWPJMLIWTWWAIUIAMW W The ^ W each chamber endcap, and by KAW-x rlh -l. and over-Ited to a teach6seld of an onsite sepbc system in NATIVE SA(3aW-L Tt3Psatt accordamz raittr kOhastor's astruainxs, is warranted to the arigarat pumbaser (-Hold r-l against defective materi wW workmianship lbr one year 5vm the date aha# ftm sap 6c perm is issued trrr the septic system caramning ' the Urd!r provided havrever, that I a sepW parnit is not required by applicaMe v, the g+asrarty periexl vrd taec rs upon the dite, Shat' v*tdabon of the SepIIc system CONER a tIEStGN k ~ in S- yWWL Cmacticut turbot Lin (15) days of the d detect. Max t ! vffl supplymptacement Chats for tiietsdelarmiried try lrttitratortO becovered bythis t.imkvJ tr _ it . e•' aavt37s Waeraxgy_ kffilbatDrZ SIP sprOfica(!y e9WkXwS the cost of rterrotat aedlare>on of Unib, M THE L tAthrET3 WARRANTY AND REIAGMES IN SUBPARAGRAPH (a) ARE EX(:LLtSiVE. s134CMIG PER COME the c s ey THERE ARE NO MER WARPAUM WITH RESPECT 74 THE WIS. tt• aUDI VG NO l LIE[) WARRANTIES CIE MERCHWABRAY OR RTM3GS tM A PARTICULAR PURSE - (c} This Lambed Warranty shall be vad if any part of the chamber systan is rsaru ued by anyow Whirr #$an YddUratur The UmO-d Warr my does vat adend to it _ owmequertiai specW or In irect darna-W& Infiltrator stns not be rite for or fiquKWed damages. size 34°W x 53"L x 12°H kx*xkng tom of producoun iaxi I. U&or and r akehraa cost-, «a6w wssm or (864 mm x 1346 x 305 rri n) expenses ulairried by the Halo orany turd party. speefficaiy, eat dart Lunited Wananty coverage are damage to tha Units cue to oadinary wear acid teat. alteration, accident. misuu 43° (1219 mm) abs turiex4ed of the Units: are Urob being std ha vehicle kaffic Or dtler ons ftCh are not peoatted by fltx instalatkwI hanichanT U&ue to masstain We mitw um ground coVars 8' (203 mm) set forth an am - Instfilbw instructions: the ptapan t of Inproper matMI& iAD the system GOrtamwig the tAW LA= W the Units or the septic system the to kapeoper wing orarpoper SWMge Capacity 43 gal 4163 L) use , a aropeativzc tar any everts not caused by k=jator Was La ted Warrardy Wall be void if ft Holder has W comply bran t 8" (203 MM) h A of the tam set hartlc in tFss - Fuedm in event sib katralor be resp=W* for any loam ordamage toga timer, the tkals. ar any #ad patty re%" hwn or -ban arty proud 5abdity dwas or airy tlsitd party- Far thKs tft aPW ft IItft nd be' in ww4um w1h al sb cwWfins sssitsred by s and local codtm aff other applicable lao= and tratraeor s aim imhucham (d) No repraserItatim or k0hator has, the a awnty to change or extend this L=IW Wamaray. - t''mraY aw~ to a"Y party other Shan the odginat Liddy t t B t Thor above r the Simard ti~fed Why offered by tntaaraw A lmiled mae3erof Batt rsa s 1-- dirt W=U* rB*wa Mt,- Ant p XdMW of thuds shad ",t. MA 4 PG. ad S.-rybroor. CT 06175 to s C.orpoaatt!. in ~ • Cars~n>t. tkiar m srxh prrd~ to e6D-s7r 70W - Fax 80.5 7-7W obtain a copy ca the appu-b;e 20-tyr, accord siaoaa d carefully coati that warranty pnorto the purchase of Units, ~eom 41$ t 1,759.6fi8: S.n47,nt4: 5.75~„titf~ 5.647:3.-101.49& 5.-f09.4sa:.5S47.~ 5.796.fS3; 5~68.77+~ 5.839.Bi7 Cam P ti.~99~ 2,0aa.56i O~serp~arSa P~B. r.r. 4krvdaA_ared are 00 Yrta~rT is a vied en Franoe. int~aeprVl*:amer Cext~ur, 6'Gi}rnA, t~asd~aye, Q1;~QA. ~1°'6are~st~e~trarierro6cintamaoo- zr~ arts ~ L4^atvT PWyt td a W trsc Tt tTTE is a W TtIfTtiE INC. i32ftl cd fiIE hrir Peibe3 Y~rar ' U-G.Aneigm sz d Rewd intisw. C25OW3 The Only septic rank Filter You'lI Ever Neal Page I ofA- Tile lifetime filter I'a o6 ter The lifetime filter is the most efficient, low maintenance effluent filter on the market, rated 3500 GPD. With nea filtering capacity of other filters, lifetime filter is the best value for your dollar. The unique plate design eliminat solids inside the cartridge virtually eliminating maintenance. Cleaning is made easy through the elimination of s between plates, mAing the time to clean and replace minimal. Our unique, durable construction and patented ultimate protection of the drain field. The lifetime filter is available in 1/8", .1/16",1/32° and 1/64° filtration size In addition, our distributors buying directly from the manufacturer allows them to get our product to the enc reasonable price, without compromising quality. Single-Piece Filter Case Made of high quality materials, this single-piece Filter case contains no glue or screws, providing I i ~I littp.-//lifetii-nefiltet-IIc.com/septic-tank-fiIter.php 17 The Only Septic Tank Filter You'll Ever Need Page 2 of,* s 0 - 7a i I Molded-in Support Nubs The filter has 2 bottom molded-in support hubs place. The additional side hub provides even mor of , •4 http://Iif'etimef lterlic.com/septic-tank-fjlted-.php Q i~~ iraA 11 ~ Z OC C5 . tr r LLI w ® Cl) a CL Cl) L Ind, F w _ cc e ® N r p 0 ■ f L ,rao _ ®NQ LA tt1 d U?Mt[} fci 20 t V~1 P"°1 ~ ~ ~ des w < t~ tsi tii LEI: coo s 150, < - S23 ~ui ~p) w 0 OW t :9 6L 0- M= a you X= CD CD w p I~i x i f LU cc ULI CL w Lim C l jig, 3- i x N ~a w E Cm ® cc cc 75 CL d oQ20 20 ocio Ln 00to ~MtC1 ® 00 co ~qL W aW U ~i ~0< ai E- u. 0 6a c) CI) O ca o p rvs x'2 CY) (a LL N f`- ~ N i4 F- 1 i r C\d Y CY) LO CN f i rrom: 08122/2017 09:25 #501 P.0011001 IC T AGREEMENT AND OVINMSHM '1` ON FORM - A . 44 c A~ Zoning Departumm for new conshut&MI city b C"Iffmd e ® (bcfm 007 e~ . , Pve Lot lines id Of i - to bMU& of Sato 1 12 -SL a ammswpiumbw hm am Y3 fen of shw9c 00"Um ( (If show, Um WA* 6. dwol-bed by vihrtkww of a ~r4drmd rmx*d in Aq*W qf Dag* Off k:w s~ t? .33 (OPAPPLICANT(S) Z2d-U-7- DA '"Any kkMackm owl's a if g Wv "A-2)