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HomeMy WebLinkAbout020-1099-30-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600223 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: JOHN HART TOWN OF HUDSON 020-1099-30-000 CST BM Elev: Ins . BM Elev: BM Descri tion: Section/Town/Range/Map No: P P 33.29.19.399C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH 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 Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM I Header/Manifold Distribution ix Hole Size ix Hole Spacing Vent to Air Intake Pipe(s) 11-ength_ Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of ]77~ddecl xx Mulched I El Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 652 BRADHURST DR 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = I i Plan revision Required? ❑ Yes ❑ No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) YOV Q- 01 7 - ervtc DiDivision County 1 7 Washington Ave f . C/ C'l P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 5 2011 WWI 5*11-W Cozo ZZ3 ST. CR State Transaction Numbei ~011~ DEVEL l1yrnitp ~Gl w th SPS 383.21{2j, Wis. Adm. Cie, submFSSion ofthis form to lire agpra riafe vern& unit is required prior to men ts$staining a sanitary perntit hlote~ Application forms for statc owned POWTS are submitted to Project Address (if different than mailing address) the i)cpartment of Safety and Professional Services. Personal inftttation you prat ide may be used f secondary Iiincaatii)n lucewith the Priv Latvy s. I S.Q4 t or 1. #ion uforrzrati tt , Sfaton i* Br Af/(5~ o - P lea t All Itrgo turn ` Property Ovaier's Name K Pagel 9 ' p' rf } , rt 1 r -3~`-- b,cC Property C+u=ner's Mail C o ing Address r- Property Location ~~"jj gq- J'I Govt. Lot City, Stale Zip Cade 3'hor Number - section ` :~r 1 =aC t Ii. TY o#" Building (check all th t apply) (Lot 4 E o W I cr? Fa oily Dwelling- Nurnierof133edreKj # Sutdiv7sion Name ~ i 'lack © Public.lC ornmercial - Describe Use ❑ City of State Owied - Doscribc U., CSEvf Number ❑ Village of ~`l~/[•~.~~ It (f ~Toevnof H (,{s,;{i~ r LIJ Ill. Type of Permit: (Check only ofhe iron on line A. Complete litre B ifapplicalale~ A. Q New System Repl t System 0 Treatment/ folding Tank Replacement only Q Other Modification to Existing System (explain) Q Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit 'f List Previous Permit Number and Date Issued Before Expiration ransfer to New Owner yuc Ib'. `I' • of $'f3VTS S ste£nlCotn nent/Device: Check all that s l } " Non-Pressurized to-Ground Q l'ressurizcd L=t-Gtcatnd 0 At-Grade (I Mound > 24 in_ of suitable sail 0 Mound <2f it . of itabfc soil © Hoidit Tao CYther mvels2l Component (explain) ~~lO~ 0 Pr, eatment Device (explain) V. Dig, irsa°LrIl estsoa at:irca, lasffiartt£ation: Design Plow-(gpd) Design Soil Application Rate( Dispersal Area Required Dispersal Area pro s System El i 7_ Tank Info City in Total # of Manufat:tur Gallons Gallons Units New Tarts l .a ~ ° u CxrSlrAg Tani w R U SCptrC . 7 L' r Z G j i j? Dosing -01.b. Vll. Responsibility Statement- i, the undersigned, asscnum r risibility for installation of the PaiV7S shown on the attached plans. Plumber's Name (Print) Plcunbcf's SiViature, z number Business Phone Number ' tl~l «l jj_ ¢ 9 Plumber's A dress (Street City. State, zip Code} "4 L r l j ,j I f ! Ca `3_ f' 3r / 5 ~`tt ~~vi i 1. ✓ . - i t- ?`lt_ VtII .Dort rtment Use BJttly Apptcr'ezl ❑ ro4, Permit Fee~j Date I ued issuing m Signature, - c~w iv-1 geasont Denal g/ ~6 AD /7; LX Condit", ypp ark; Eer rovssl tltsNerecs,i cell must an b_ g_st-a" ! to r, *a per m aragert►ent plan pro Tided by plu,nber. 2 All tllelbwk reC,WV9riftnig mtrst,t a r:,artt,.lr.eri i n per Wknbla c4& / c:rd'rnant s3. ~ttrsta:a eoen~#e;.e ~ far rtxc systc:a sne3 suhs~t to #tm: Cczm b c a jrs§xer aai loos ty~ a IR x t £ r~£~ey, ssz atz¢ SBD-6398 (x. 0$1f4) t 41- pE{.'~ l/7 ( SGT/ f~OJKG~ c.~ 6ca /,l: l .J 4 /7,7 C t r 6 I f`j ~ ~ ~ fff r t lj~ cy .L PAGE 1 OF 4 ` f a Index & Cover Sheet Component Manual Design References: 'tiersion 2.0, 6D-107 _P (N,01/01, R. 10112) Index Cover Sheet P Fiat Plea 4 Dispersal Area Cross-Section & Plan View M=fr Aanag meat l infiltrator Specs O TApplication for Review Previous Sanitary PerrnitlInspection Report Seri EvalUation Report Site Map Septic Tank Agreement Warranty Deed : ce g a t t Description I Owner € me s': J(~` N . ea T Phone: 715 _ 531 311 Owner Address: 52 Brad urst Cdr.; Hudson, 1,11 t 4016 Project Address: te') _ Govt. NA NE 33 29 164 of 114, Section 1 1 L~L Township: Hudson county: t. Croix Project Parcel ID : 020- 1099 - 3 - 000 Designer Information Designer Name: M2ry Jo Huppert Phone: 71 _ 426 _ 1775 Designer Address., 2 A 7 King Arthur's Court, nbUry, IVVI q-nail: oiiisterdesi n outlook co License Number: Remarks: HUi t, i% . z Tank & filter to k'`°'i qa be inspected. Signature: 10 2 OriginaE gnatum required an ja"h submitted copy, ~ arm t , .r Y b ye$. 1617 /0 car-54 . 4-- a; irr tree. Ass awe e /,e,/, 1,eAo. 4o, to l i J P AGE 3 OF 4 Lu ` (r 7 v ro {J 3 U co < < 0 > c RS s c c C 'sue E c ( r CS Q i o U? ill u 4 7 5 q v ai T X Uf r°a D ` (P1 T ° J " L W z V 3i ry .2 1-41 R Q cl) i r (f} tail' III LLJ -l z l U gg t ~ j £ tc? i 2 v ,i F } f c v. if ro' IT Lu 2 Q:f CY Si Ii [8 N } L 1 c v U LLJ Z V c~ ~ u e3 M ry C: LU t 1°- a C Cr} e a + ,t LIJ wl U3 { i r' --_j PAGE 4 OF 4 In-ground Gravity Management Plan l IP ~OR A : The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to rec;uirements of SPS 382-3841, 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. r urthermore, ail inspection and maintenance activities shall be performed by a registered PO a Maintainer in axordance with SPS 383.52 (3), Wisc. Admin. Code- Maximum Ms ersai Area m~~rrglts: Design Flow = 500 g pd; BODs<220rri T 5150 gL"a; FO 5 30 mg'~" f s action hecklls I SPECT EVER' 3 YEAR ~ type of use o age of system nuisance factors (i.e. hors. user complaints, etc,) mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e_ Teaks, breaks, corrosion, etc.) solids volume in anaerobic treat ent tank(s) and any distribution appurtenarce;s) (i.e., distribution ! drop boxes) o neglect or improper a (i.e., exceeding design capacities, prohibited activities, etc.} c extent of ponding in distribution cell prior to dosing closing irregularities - if applicable (i e,, pump re-cycling, float switch settings, etc.) electrical components - if applicable (i.e", wiring, connections, switches, controls, tuners, alarms, etc-) o, distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare ter design specifications) u surface discharge of effluent or sewage back-up into structure served ai tenance hecklisf INIAINTAIN EVERY 3 YEARS ( r when nocessaty) cr eotic and dose tank{s she!! be pumped %y a certified .eptage servicing operator licensed under s. 281,48''is. Stats. when the volume oaf solids ire the tam(s) exceeds one-third (113) the liquid volume ref the tank(s) or as required by lcc@! ordinan , Disposal of constants shall be pursuant to NR 113, Wisc. Admin. Code. * giRgga fitter s} shall be inspected even years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period trill always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 lisc. Admin. Cade. Report any component failure or malfunction to: N ame of individual or company: Advanced Septic In tall tion Phone: 715-703-8337 Local government unit: t.~ roi Communit Dev io mi_nt _ Phors: ~ 715-386-488{ _ Local government unit address: dson, ) _ 54016 - zip: Any defective par€ of this system shall be repaired, replaced, or rerroved pursuant to SPS 333.51 (1), ),disc. Adnnin. Code. Repair or replacement of tailed or malfunctioning components shall comply with PS 383, Wisc. Admin. Code" too product for chernical or physical restoration of then POWTS may be Used unless approved by tine depa;-tirnent in accordance w ith SPS 3 D isc. Admin. Code. cntlrmenc ten In the event that any failed cr'satrrls~ni cctimporicnt of tl" s PC ,,T c nnot be repo rrC , ij shall be r£"p,aced pursuant it: a plan submitted to the appropriate agency for revietiw and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal cornponent in a pre-determined area of suitable soils. yyste A andonmem if use of this °C W-1 S is discontinue it sh l6 be ail sridon•ud 1!1 2 CGtdc4' Le CI? rvP` J,;31I `W£ ~.:3. SC,. AAdmin. i. ri; n °z* v T ° >r ' v ~IM The Cuick4~ Standard Chamber fits in a 36" wide trench hi and is ideal for curved or straight systems. It features the - patent-pending Contour Swivel Connection- 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 optimal installation flexibility, r • Advanced contouring connections swivel up to 15', rt 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 IG,000 Ibslaxle with oniv 12" of cover Certified by the International Association ~ ~ ~ ~ of Plumbing and Mechanical Officiois (IAPMO) ` • Tear-out seals on inlet ports provide a tight fit to the pipe ° Eight molded-in inletsloutlefs allow _ for maximum piping flexibility Eliminates pipe fittings Fits on either end of the Quick4 Standard Chamber APPROVED in