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HomeMy WebLinkAbout030-2083-30-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600216 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: BOB & CHARISSA CURRAN TOWN OF SAINT JOSEPH 030-2083-30-000 CST BM Elev: Insp. BM Elev: Description: Section/Town/Range/Map No: `00 BM A/~ ( G~j 36.30.20.706 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 163 & 160 Alt. BM ~p ASC.Asm Ca b Bldg. Sewer F') D4k. 6 Holding '!5rz L St/Ht Inlet J TANK SETBACK INFORMATION St/Ht Outlet c/ 7, a TANK TO WWELL BLDG. Ve it I take ROAD Dt Inlet - ~f iotoo > ~Co 57 Z~ Dt Bottom t l 9G T DF7 Header/Man. , Z ~ '7* 63 Aeration Dist. Pipe Holding Bot. System 7T? ys~ Z eC? PUMP/SIPHON INFORMATION Final Grade -Ci Manufacturer DeP Rand St Cover f~ C 4:7 G 13- 3 (c ~ Culp o Model Number JO~ TDH Lift Friction Loss System Head TDH Ft 1/eALJe., O (.Z "1(0. •7 Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS V ~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactu ern, INFORMATION Type OSystem CHAMBER OR F-( V'"J S i r171i UNIT Modber: nrJ~ 8~ 33 DISTRIBUTION SYSTEM We54- ("7 +-1 c3 d- Header/Manifokj► Distribution x Hole Size x Hole Spacing Ve~o Air I e n)ay Pipe(s) Length--6- Dia _ Length Di~ 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 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 237 RED PINE TccR 1.) Alt BM Description= G~~ LS~t✓~ 9 (/vJ Q~ / 2.) Bldg sewer length = - amount of cover = I~ Plan revision Required? ❑ Yes to ' O D Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signal re Cert. No. {~pw woe ~ ' s Ci Co4-i n //~~ii.~~++G 1rr Safety~acid Buildings Division V VE D 201 W. Washington Ave_, P.O. Box 7162 Sant Number (to be filled in by Co.) Madison, Wi 53707-7162 oc 2u X615 2 ! (o ST. CROiXt Perm2 TCOTTZG8Lm20n,r W State Transaction jqLTIber h' accorib}8(~? de submission of this torm to neltrtal emit is required prior to obtaining a sanitary permit Note. ALona lication forms for state-owned POWTS are submitted to Projeet Address (if different than mailing address) the Department of Safety and Professional Servies. Pnformation you provide may be used for secondary r u uses in accordance wilt the Piiv Law, s. 15.04Scats. C~\ L Application Information -Please Print All ation Z3 ^T Propert y Owqer's Name 1 lam. 1a.~ l Parcel n YZ ~lp ass ~ C,~~n~~ (0 3() a - Property Owner's Mailing Address C' l tea( Property T City, rate Location , . , 0 I Govt Lot Zip Code Phone Number ~ r _ ` v,, s IN /s Section ~ ~L! circle one) IL Type of Building (check all that apply) Lot Y T N; 12 a o circle W 1 or 2 Family Dwelling - Number of Bedrooms O 3 Subdivision Name c~ t a wo. Block # ► ~ "b d ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village Of 2 U s eA %_,j ' *r7 Town of In. Type of Permit (Check only one bo on line A. Complete line B if applicable) A. ❑ New System lacement S P ystem ❑ TreatmcntlHofding Tank Replacement Only ❑ Other Modification to Existing System (explain) B ❑ Permit Renewal 11 Permit Revision ❑ Change of Plumber ❑ P" it Transfer to New List Previous Permit Number and Daze Issued Before Expiration Owner 355 -70 W -7 1 q IV. of POWTS --stem/Component/Device: Cheek all that a I 56Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grads ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in_ o£su' ble so ❑ Holding Tank ❑ Other Dispersal Component (explain) • , w' ❑ PmM:atinern Device (explain) V. Dis rsal/Trea ent Area Information: j Design Flow (gpd) Design Soil Application S ~ dsf} Dispersal Area Squired (sf) Dispersal Arca Proposed S evatron VL Tank Info Capacity in ,viarr d of Manufacm Gallons Galion Units VZ~~I 0 °~~\rl cbNi)1 ~rl a tj ca• ° N Tantts Faison€ Tanlcs 1 \ +K/ \ W 1fih ~~~1t ~„Irl" StA~ a°t.. a' ? a°ri a ~ R f J a. t v~ r„ n rz c7 O, Septic or Holding Tani; (uc~ 1 1~3e~ Dosing Chamber VII- Responsibility Statement- L the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) 1 r`s ature MP/MPILS Number Business Phone Number M uUm '71 ~ 160-61 Plumber's Address (Strcet, City. State. Zip Cod.) i'fIJ[. un /De a nt Use t}ni Approved sappy Permit Fee Date sued Issuin bent Signature cn Reason for 'a1 $ ~ $ 5 , ~ ` ~ 7 IX. Condit sons for Disapproval 1. '*.Sr ptis tark; effk&nt direr vhd dinper::ai cell must all be sttcjs!~cmta r c ilia per iMaragerrient plan provided by plumber. 2. Ai.S*fair* mgw,fte smps mwtbe, t:'klirdoried i! per rXkrU9 wdrs / crdinamm. Attach to cnmpictc plans for the system and submit to the Coam nnl t7 Ynntaher not Ecu Hran A ir_ x ] t incLes is svc SBD-6398 (R_ 11/11) - OP h~~ rs p" COMA~j "owl r 1i i - ~ i i ~ II l ; CC NV,E-:N,TI0N,AL COMPONENT DESIGN Re yidentar1 Applic~sficr, INDEX AND 7•I•! LE PACE Praiect Name: V C Icf ~l S s q -C rcK 1 i.; Owner's s Addr:6s-s: 3 •"1 Leclal D'eSr_ription: S 1 S , S f ( aT V p Town-ship County: I ~K ubr,'ivision Name rke it) U d W f Lot Number: !'r~rcrl IF) Nurr,kyF.r. 3 ~ 3` ~V 0 o V Page 2 ~F'Itai: Pin Pege 3 _ ~',nti SiLi~ c Cross-~Ciicsn Pare FiftT scs- Page 5 Il~air5t~nan'cP Inf~rmati~ti Paop ,farr~;:eme~~t Pion Pare i St. Croix C c Tank Page Warra•nly Deecl P p 9 CSM. ar Plat A hrtt t!~s: Soil TaV & House Pl~~;s Dp 5 g1jer1pItrr°,w pr: D.;,tf, 14 ~ Lic i7 e iWtarr,ber, S.i1LillciUrC Lu-signed Wursuant to the L; 3 and Soli Absar5t,0n Compe,:ent ivfvnu Pt7V+TS /e 1 rsion i. Sg[~..107n~.P ~W.O-1/D1). a f age 7 i 78a 3 W f i Ax 711 ~l (ti1u r IJ~'r~ C~ b ~L U 0 b - \0 l u~, Dc of ~ ~~S(~ Bar roes n 4" Sullcdttle .gip Pw, vent Pipe i Tin-21 e 1 With Vs-'It Cap ~ ti 6ysles~tl ~l~uat(b~t $oil T" f.Rdsi..Pi5.9tio,", .v~'i~y.-'7p ~{j~ ~.[+{Si '8 'kF•xel i t-nch I a f ~ c",f?c1tTi~Er~ Veldt OF abse ltgfiran Pip, ~F~t4C;3 2 Neatt~f fie ~s And IUiesdai ~ ~ Ac EISA Rating : U . oers. chamber Soi6 Application Rate ~ ~ qPd Design i=tQw ~ 1 qPd/sq It Soil Applica#ion sate' Page - of Technical Specifications PL-525-.EFFLUENT FILTER M10F I ) SIT BALL DIECK EXFPTST9040 FCRMETEXTENTION i1.57 I' 1135 I ' I i. OfTfi ET 9USFtlNG EXCEPTS : SCH a&a. SCH SG ! 310 I zj~ PL-0 FILTER HOUSING 15 34 PART NO. - 3014M25 MATERIAL HOUSING- POLYPROPYLENE OIJTLETBUSHING -PVC 6.5BALL-HDPE i` Li A F-- SOWT EXCEPTS FLOAT SWTGt EXCcPi51•SCH 40 y j } 'I 'iF~ In~& F;It;141:tItF E%IEl1nOh _ _ ; . i t 54, L ere ; 520F 1A.6, SLOTS 6241 `J ti I ~-3Jr- 956 ` - SO~TE7lE S61 . c 'yFF¢§ BALL PUSH R00 r- OPENING i i i IJ =I ~ I 'I r o~E~xlc I J71 ! ? 1 ~ I I + y ~l ~O( it jOi y ( II i i ! ~ 1902 nu i li 11. 1 1r I j ?7 'i io ~j joi POLYLOKPL-525 FILTER CARTRIDGE 1 ! i} PART NO. 30141-525 MATERIAL-POLYPROPYLENE i I I (j ) j 1 i tz IMF T - POW S OWRIER"S MANUAL & ANAGIMENT KAN Peps ,.,.,._.0 FHA MEMATIOT S't'k'iiii. P 3 1 ettia~t ar L, 11 n `1 N aop2c Tank I V O O ~a4 Q WA Permit epti4 ask MaAtdr p r P 1t~ NA a;xlttza^; Rtar MFAdAz pF Lu G NA Number of . c!r~ a„ Number of 1"c 43Y e'eaiL~+} a^It~ t G i~tlt s Fnnp i nrtk apaR1~ gI NA I lr ;af d .4rsr NA I=e.~ ff w (averap} rump TRnr 1 3 lid bgn :iovx (peF-,,#c}, Sttlrl rl i.~} ' 1l)d ~tlattu`~ C NA. a P~arrp Nf~~i NA, Soil ~r lrrn PMT afiJ ~f Ns atfindard 3tF1ira7ii~l t ,ut n: ~7~rs?t~, Monthiy ssv£rs~~ 6 prat eeiri13*i: L4riit ~p Gi( Crete t Lk2 OO .-n 0 «Qint/ova! ;tsr G1 Psi > Ii ar -gA ` 8ic>t namir t O-xVpn DRrrt=d (RLv-%, mRfl- G nta G tNs rt t ~r c ~ t s ~'Icc7 .•~t.., h" L3Safi'I'P&~it7t7 1='i ~r~:~r~ i atai ~ sr dad citrus { i , , $ a r~ispar~$1 ailta} G NA rread u1:rr~ t ittit~ t~ltatr l~ty averarlo a ©Irrratutd tierecrrll qtr-ahenicl~f ~~~~art ~LtrneAc G5-Wkl ~ 1 A ~ G A~^~i:'ada i~ Id1~st•:nd Q rn N p tai ~s andsd Sol 'S E.t-% I -Q . gpL ~ - f t ~1sY,s a t3rip-~3nt~ E? at C~1"r l2xr tpzma€aia rte 3 f szi Z vi i t sp a t C3~t'tr: Maacimum lust, zar'4tc1e Size ( Y, in Q NH G f~ G >1iA t,wher: Mar t3~her: G NA ' M'~tttes ice- dxtc3s'~c _ . •rca.• Sraz~ Gib j~tisr t ys~ } M NA R+. iea condt~n a= tarrktsi i 'rG arsaa swan;~~ Sat'~53_ 9 j-am ) :a W it yrai ma 0 NA ,4iiO t~~a i~thert cesres~inatl s1~ar~~a ~r►d ;aum- sVsrs 4., r-u?T;Ty qt.r< r: tar a of tatYkta} G rlt Rid (1 ttat q rs} fl NA RS teaa-T nflaa sverya 3 : a~ztsl tnapac+: di6wp*rsa; Halite} rs I } M NA 3 at iesst 0t1c* a;tarys • . ate !sf. Crean al l i slit fili sr a i ) qRA lrlapACt pusx_a_ p*arnp constrcris ~4 awm R. taaxt cn ar ars?= i a~t1 i At, is se onr. elfary, 0-, Ei~.¢3i; taterFta arw p~ss?~r~ :eat ~lA G t Y~ ~ c32i5ar: 1 p"t itn ~i1-'a F\18 N., NA ll by ana d It¢ ft~A~ivV:lt!►;;t tt'xreraam r~r , P^ti~E 4Gt~ inapaotions rst rtkc and d~ ~ aha w~ ,,.:ada by an ire rvictu~r . q;41r wo -Opm- 'dxr. Tank ntcastar t~t~arntlai: t a,bsr R-i ber Ramrlate-d S5-,Wax,1 PIOWTI S 31"w"a or traken •Sw1w." tt 1 ate craQlcs cr teai r lnspjv=r Orts -mum i clud'a s u}sfsai papa wc!9 ia.` one mrtkfs} to i ni~ an-it rnfssing get tZa tsre~ art ~'[A around ScrrPaaa, rneaa{era tha u;ft rsE tnrafx7btn>#d s wdvs a^d e6 and trs hsc< far any 17aok ofG! or gmft to h l~ ~,~r ~ prsrrdir TIla dtsparsai elt(s} s -till i e visuOv h heated Te ch-W "x'18 ~°;lue~ levels in uh4 OWr Ti as sf:tuant era the graund surfncs, `(`Ytt pancirig zp$ aft jasnt ❑r: thn groutid $'+eavs may Indim a FiDL,15 wt,M and raquiras the imtn eMats rtr~tidt~attesn o; ~ha tacsl r-tlaltflr a!1thorrty, IMMk ibe volLma tank entire Man The cwt&n-ed s herrk,,aL1 grad b :Mudge a and Ha a eijjg Ot~ar~csP and d sp ~}ef or i-xrm of In amards~s w1th 1-aW NR 113a Gar,~~ of ~&~a<;k srr be: ~ rerr+c~ Y ~ gMis=nala AAm1rnlwmewa Cade, aElaaiIY1B17fi All ~~sr sm1m,Vl~rit4 i~~arva~ 1tiiW man ft, Eel affluent performed IhSP ~ a#t wino t~'~r~C~"CS I~h~ ~t~rt~si"tp'p''t~: Ar urin, and any ~r B at A snrAc,s rapas shalt be prpAded to 2ha innai cspula pry aig'orrft/ VAFWt in 10 clwva d cn 4 W1 &I "WTSa mt. a~w t~ttalf START EJP AND OPEpAnorg Fags - of rear new acnseruc~ten, prFnr TO use Of the Pt3Vsl'i`S check treatment dank i ia Presence of that may ,rnA6ae tne.treafrrtsnti prods aril/or datriage tns dasp>~.~sal catl~sl. if high *roneep:~attens Aj; ~s* W hove ;17e dcintenTs of the tankW removed by a septago tarvlr lag operatar prior to use, Systam star. up shag not cocur wirer, sail aoridMans zra frozen at the infiltraTtva surface. During po,rrar outages pump Tonics mLry fill abova normal highwat4:r (Yvets, when power is raatored tita sYka- M W"tav Oar will bs discharged to The casimmA call(s) in aria Tema dose, averfasding the call(s) vnd may result Lei the liac . effluent, 70 avoid thls sttua-ftn have the contems of "he Pump tank retrieved by a Sa. rw Cpl cr fP or 9u larfa~a d~ to ~c~aror of pawner to the effluent p=p or oantant a Plumber or POWTS MaInz-.lnar to assist i<? s fo gr; =p Ccrt2rial nlralLrt restcra rict7naal levels with(rt The Pump tank. ~ P~ittg the %=p S to ra Do not drive or park ve :folas over tanks and dlsisersai calls. Do not drva or park over; or otherwise disturb or compao;r the :eras within 15 feet down slops of any mound or at grad6 loll absorption area. Redaction or errminetion c'f the f"ollowilag from the w stewrater =earn may ttMprova POikli5: aritiblatIcs; baby wlpea,' ci-aerette butts, candams; notcn swabs, da seser~ p~~ loss; j aril rsrdlQf?wff $ sn "the foundation drain (sump pump) water, fruit and vagetobie pesiln a n soling" -crease; "ie:b c am raw. mps; daFYef~l~t~rt5; fat'. palming products, pes•,I4fdes; sanitary Napkins, tampons; and water s-n~sner prlne. Imo tn~iicz~onsT all, A5ANDCNiMEN11 When, u:a FOWTS fails aanVetr Is pest anaiatfy taksr. nut of service the fallowing stapS sheill Ufa Uken--Yo in3vr: that the system praperiv End saf31y db ibned in compliance w h cha r Comm ES23. vllisanns* Admini ive octl$: * Ail piping xo tanks and pf„s shall bs dieconnected and the abandoned pros oparnings sealed. w The centams of r, ants and pits sna be removed aLnd ~ F cl ~p-ry ,sfsmwd a,.9 by 8 3ees+ege Segv:cng Ckps, mar, ~ * After all talks and pllM &i;E l be axcavatez -.nd :ramoved or .l-,air covers raaty: dt and the vo.,d spa sail, gravel or mother fnart salid matarlel, 0a filieGi with CON T ING91VCY FLAN If the PC?WTS €alls and cannoT be re;*fnad the follawin-c measures fisve been, or M. rap.acarnsnt system. tel rg, to provide a cue c^rnp#rant A suitable re, lacamant area has been evaluated and may be utilized for the lau't(cag of = re t~, system. The replanement area 5hcetIct be protested frzim disturbarce and campectjan end should 6t be hirknga upem by y required setiaaclts frorn 3x>attng and przpnsad struot'a e: io. Miles artd wa;' s, Rvffuta to 06th the raplacernerit area will result it tote tro=d for a navS sail and site evsluatlan m sstablisn a suitable ;eplar-amnit area. Rspla-n- went s'?stams must cornpht vu.th the rules in er;act at that t4na_ Q A suitable repiame men; area Is not avabble dus to setback and/or sail limitEdong. Earrlnr advannes in POWTS tachnolagy a h aldIrg Tank may be installed as a last resort to replace the famed POW T S. Ct The site has no-, basn evaluated to Identt#y a suitable replacement area. upon tai:ure of tie Pr3w .S a sail and site eva,ua,tirn must ba performed to locate s suitable replacement area. If no replacement area is avellabla a hcrding tank may be installers as a lest resort wo rapfacs the felled POWTS. 0 Mound and a grs„e sail rbsorption Systems clay he reconstructed in plme milawtng rarnoval of the bltrMa St tf a fnfiitrmt ve sun frica, R3onns trxa:ians of such svatams must comply with also ,rulasq in dffact at tha'ttims. < ,tWfiRN1NG> > SEPTIC, PUMP AND OT~91 TR ATflll N7. TANKS MAY =Pti TA'IN LE'd'I3AL GA5 WTER A SEPTIC, PUMP OR OTHER TIVA:TMENT TATAR UNDER ANY ~R0VA4S. £sEA , P. V.AV~ QX~~'~N" QQ ~QT PSRSO.Ar iRQM THE TI!'I'EPIOR Q:u A TANX AMA`" 3E D,r IZCLILT rip- IItt POSSI: LE. ~A~ 3~SH3fl T . R~S~ CP A A0131-11WAL COMM8NTS FOWTS INSTALLER Name t I'Q'{IU'1"S It4tiVT'A. t o rh cu rti~Y Name Fh.n~ f `1 ' j ly phonn SEP'i'.AilS E~ .G1ti&G ~+py ~ r. Qt ~P Ili1fPEk3 it AL ?Z_-is•; AUTHOM'FY ry iVeme p ~ ~ I P dowu;tt _ , iMaG `raft ed is ea rn Fan c-_ W ',t hans =c.Izpnr G !118~.2~{2 icifii?ul3i~ a 3a. 1 -fir 1, 1$} 8 {3jr Utatsctinsin Acimiriarrative Coda.