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HomeMy WebLinkAbout020-1055-20-000 County: St. CfOIX Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division Sanitary Permit No: INSPECTION REPORT 600222 GENERAL INFORMATION (ATTACH TO PERMIT) 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: ZANE & TRACY jOHNSON TOWN OF HUDSON 020-1055-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Jown/Range/Map No: 21.29.19.203A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Alt. BM Dosing 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 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 CLEACHIR OR Manufacturer: INFORMATION Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 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 Yes E No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 526 CTY RD A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes -L-1, No I Use other side for additional information. Date Insepctor's Signature Cert. No SBD-6710 (R.3/97) / Safety and Buildings Division county St, C f_ 01 209 W. Washington Ave_, P.O. Box 7162 San~~~'~~® Madison, W1 53707-7962 daTS Permit Number (to be filled in by Co.) 21 Perzzzit A State Transaction Number ed pp -''r ~rnit Lthr%Depzrtment cordace wAW (73e submiss W60B8W i~itarY permit Vote: B Q H Yfo ]to oject Address (if different than mailing address) of Safety and Professional Servies. Personal information you provide may I ~ in accordance with the Privacy Law, S. 15.04(1 (m), Stats. a►Y r y~ L A .pp. ication Information - Please .Print All Information ` N Property Owner's Name Parcel n A'~ K lA c Ns c} (521Sa~%tS 5$ - Za - ~SDZ~ Prope Owners Mai ' a Address #rtY'Q Property Location City, Stn Gov[. Lot Zip Code Phone Number 1 1Nl ~lbS d 1~) 1v~vi ~1 ~\1/ lJ ~ '/4, ~ %s Section ~I (circle ) IZ Type of Building (check all that apply) Lot Y T N, R one F_ or W DI or 2 Family Dwelling- Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use Block. I .4- Z ~ ❑ City of I 1,- State Owned - l l ~ls CSM Number El 3 Villa`oe of ~~rc, XTown of flu pl uN III. Type of Permit. (Check only one boa on line A. Complete line B if applicable) A. I 17!*- System 4 Q Replacement system Treatment Uoldueg Tank Replacement only ❑ Other Modification to Existing System (explain) R ❑ Permit Renewal J ❑ Permit Revision D Change of Plumber 0 Permit Transfer to New List Previous Permit Number and Date Issued i Before Expiration Owner ~•.'r ~Tvm „ F V. of P YPe S stem/Coat onent/Device: Check all that apply) ~f I 19Non-Pressurized In-Ground ❑ Pressurized ln-Ground D At-Grade ❑ Motmd 24 in- of suitable soil ❑ Mound < 24 in_ of suitable sort ❑ 1. o utg Tank O er Dispersal Component (explain ❑ Pretreatment Dev{ce {e>lain) //vim V. Dis rsal/Trea sot Area Information: Design flow (gpd) Design Soil Ap eatitrn Rate( tisf) Dispersal Area Required (st) Dispersal Area Proposed ( System Flev t n 00 ~~Q~ ~~dv I®o.~7 t~iul~~ 1, fo .7s Tank Info Capacity in Total 4 Of Manufacturer Gallons Gallons Units i O V ~ Nctv Tanta .a-Sting Tanl¢ W • V'~ L o y a~i ~ 5 c~a ~ Septic or Holding Tank p. i;5 in ts, F5 ' d Vur D osing Chamber ` Se' VII. Respoltsibility Statement- I, tike undersign me responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl her' igna e MP/MP Number Bu loess Phone Number Plumber' Address (Street ity. State_ Zi Code) pw S ants WiVUL OVER /De artment U Only pproved it Fee Date is ed Issuing t Signature O ven Reason for enial $ ( v ~d /7 / IX. Cond Disapproval azts per::5n t ellem all be r /ide by umbee Q o✓r per i~iacayme n! plan pro ncl by Nlwnbr. II 2. 'AD selbsrk regL iremenl°s a u%it tta r:,a ntzk.e1'l j n W WkumWt code / cMiruvics,t. Arlach to cnmplctc plans for nc~ system and submit to the Conn[y only on paper not toss than 8 in_ x 1 t att:Les is sirr SBD-6398 (R_ 11/1.1) lz Ac-, *r a - 5() PcI A 4 ys~i rlk v ~o,'sb~ Icy}. 15 - ~R 4 r .1 t 1 iic j CONVEENTIONAL ON(~ipO--ENT DESIGN Residential Ajrniicatirar, INDEX AND TITLE PACE Project Name: ?AIVR 4 ZANS''A j-- OwnEf'$ to N?fYtP: \ 1 I I4drlres;' Legal Description: Township - bSLI County: SAdivision Name- Lot Nunrrber; Pwi:! I M tMurriter. Page 1 Irriir end title Pie Plot Plan Page 3 a ~~n r Sizin & Cross-S) fign j _ Parse, 4 FItar Sows Phi:: 5 ll'4ain'ten~ncP infr~rm.~iix~ • . _ - Pa_o•P cl _ Jia ri•ar :r'~ipl'4ail`i t~ic^, n ~ Page i SL Crcyix G ~e~ticTank Myine. t rt~rtc a F page 8 --`_`-"~----.c~r~r _ Warrant neeai csM, ar Plat A 'iLh•f'Yti2V'tkt8: Scr'r! T aVt se pT;4a ~s DP. siilner~P'iLlP1'v~YF?r; Lit?~n~ ~lramber. Date: c} o~ ~ ~ ~ ~ plianto Number Signature CiesiQned pursuant kn the I rr uny Soli f1bs~;~!ien i;ompe,~ent •Lfanu, ! ;n,- cOVV? S Version 2.0 SDD- f age Y I I zAti~Za~ ~s 78 4,-&&4-pM 5(l P-cl A n1 lo 1., S b s 19a. y ~ ~ s~ bbl SPA; ~i _ rs a 41,~'~ ~o b pp- 60, i Soil Absor Pvc vent Pipe ~ f+ina vie W101 Va;f1 Cap I j~ 10) a 7 Chamber f I L i u i-1S -3 syarm Elevation fS MFR A ksum on gm Flan ~ffaw i.Omehln Ven► OF abse nation Pipe Trench 2 Header ILL Trench zi Maflulbakie4'r An Model EfSA Rating 'Iq u ae;- cha4Ythe; Soil-APPltcation Rate ° I , Soil Application #'.ai'e f c3tiVS Q _ 042MhIFS efth. Page of • oti~~:rar N d- 2a~ uh N S jv p - i sr~f, s aP a S~1z. $4 C itA Permit z~eptia ai k» aA p ) eyel~ A YYtr2 -3i'Mz r of Sett ~~a~3 0 i iA t:~uent Fitter Madat V'1 NA n~~rt~ ~ Number of FutllG r¢Qi~ unlv-~ I G NA Puma Tpnk Ca;mzlty Hl HA 1"_•-nk iw mfizMrar NA Pump L^O ~e' co ~u (avara} lid :.5} NA gn :into (pe #cl, x lr~ t NA, Ap~ri:4 tan P arD *~tl NA S~r~dard i~~1ire7it-~;iue~; mss?fir 4lartht~r ssvars~"' a i P°~~t~eail'n~'."i: L4rlit: oil & straw t>" al :530 i~1g/i G £tldl rAUal R ter F~tu 111taF a S, icraharrrir~ l CS ~gat~ erten t3 l ;1 m 1'_ 0 NA. t Q tN nim, Awn iaHai 3 arwa~ scild!t (i S3 l ct7 F~ T3t frr,a iati C] NA " m ~ ~ tale^er~at ~elH3f G r a. ===j r C~Li~1rYt; Nlldtttlltu 2V@Pg a = ~Sittt &:fi F »ir ,.i tai lr~ d tSund 1r& in !n-Gr ~ . i; In^G,~und iprevi~~ S 4' n glf 51=henicel O"W"', D=7, and fmmtl C.l Ax^~?ads t.~ I~1~att~ i crta.~apar csd PeilBs i z ~S ~tp; °~lA 3 1 iW tsr Z" L =iLii'ta l a met curs;ett t t asMt rig mart) NA 1- tsar; i~axilusrGt'at~tirle si in ~tca, is ;u~ . ! Nk , Theft % Q~lr2f: I l 1~1~ T- - - - 113 7 E~~ ~ MAJ 0 ~1, NA CttttBP: t~r~'•~V4~Si ~lT~ ESp~`ti~ `.5:tie °-.c`~tsa~ _ - *vatusu kcal ins Gist StiflfilII MNA 801m N.- i tnsps c n+ i css rrk(sf A;. tea5x an:aa swaril eerts When ct rnti-"1Ad Shdg'e a~ acwt'r cs~ tank vr~is~ms p NA ti?t~l ryes 4 t.ssrataM of tarrkiai k 110 ° r O 0 NA lt~spawc diarsat nalita} At i^psk nraA avsrsr; asw sl M NA A4la5st rst,>`e a;rary~ Ci~aan tyt'tiLSa;ti iikt#r _ G3 avt~t'Y SPA 1r14~1Q 51GS iiS7 lJt1?{D Wt3$t'dlR.. tcZ:751 Fi (&'3t once ;ava' iigftA elverv, . < PtL"3i'i la<°8rrts 3ii4~ r;Sra&$~T:D ~G Atimo once azhar. - ` ia>=s° i;sA~ atysr}t; ~ 14A l „ ~11ar: " i Mi4RSltAfr•'~~tt' I,,.fjuz1rY an, Of *0 WtWl Tank « malt as ,.,<act: fey an in t 1 G3:~f' Tank inap5G$16?its of tsR. ?y and 0-9W, iUctst5r t~iiarnrsat : tt~e, ar Pjzieratrteueuaexi~F:Fdi iatcrr~ (3~R3`€ a ari h-vdwm, iat r~ra~t~a tar tsir. srsi>e it sns must iratm{ut' $ vls-tsai jmL1pSecaw is thm aft(g.1 to lt3g+TF'tlt? any r:1iss#t 1ra~2k rays ar i t a h k r ~upestxdit~g r:aamim the v~t~ of t~taYS' weed zWdva fief aec~ ar d to ch l~ far any ~lte dfspsrgel a~ellis•) shs i be VTSatily im. f e l> art o 1 ~e~ 110 l~arfaaas t~a~tt~ss:1 ra gip a<crj ti ~n and rac~ttirs~ the ~i $irti~Ciw an tfta ~U~~ 9Lii'f`~8 "hrat'at11• 'lCf2YYied.jals r r'- iliipatian 01 the 1a3cw m2da'"t ru Rmt mm of zank VOIL When the awmmned S=;rlwatlon 0 sludge a anb S racing Op~ i~ardrsp~ d} ~ in ~ s~ce ~n~th pYe p~xac {~1R5113e crarrra~s cry ~s gar-:?r short iae rem by Peke Mrisammin Adminialnerve Cade, tint tre:~n7rsrri~ All other 1, irtcfta ~m M, 't rim itxiM 2 rttctn~ s s;'iall~a ~erfiot'rn~3 by ~ a~~ ad tfY~r~.f'~~i;~ 3rt~►'ta~'n~6i~i•`t~: . units, and arty Seruitti k8 at seY~t}ca r& wt i sii8t iY' Ar~vided t3te idcai risvilatm mAlInri.y ItIffttwin 7Q drams d awnIXia~f It tit ffrN' ~ ~aVmt. A anj+w tsla~f START UP AN~t~ A U M D [t tCrt, prfar zr~ use of the VJTS check Yres°rtterst ta"tk{si for the Pregsneq cif page o h that may falpede the trsatmant process and/or damsge th3 dispersal cell(e), If !'Sigh coneen ~atlsM ~ ~sw~ hays ,he ~nxsnTs of the tank(s) removed by a septage servicing operator prior zo use, Syntarr; rtcr up sha:i not occur wher; soil cond tare are frozen ai the inttitra;.lve surfaco. During pnv`}ar outi~gas pump aeniGa may fill above r:orrrsal highwat$r IYvaig. VI power is rewzred discharged to The nisI cell(s) in one Iarge dose, overloading the catt(e) End may resuIt Z T118 yes kamm ru wa;arwIll be affluant. To avoid 411(5 9W,-4lon 1t8ve the contants of the puma tank rernovad by a Ss • oe W Ic0 or ar Frio r9s gs of power to the effluent paz+7ap or aontaot a Plumber or POINTS MalmElner to assist in n nu2gy o*4a~jnga he pwnp controls to ntrols rtg restore ncrrnes` levels SAffthfn 4he pump lank. ut11p %p Lkc not drive or perk vwYlolas ovI Tanks and dismirsaI cells. Do not drove or park over, or otherwise disturb or rarttlssa , tha :a:sa within 15 feet down slope of any mound or ai grade soil absorption area. Redtfcticsn or ei"rrni.7a*.ion of the following from, The vitastev q C• ..a polar S'r88rn , PD,~JT~. a~ibiay,es• #ao. ~ ay irnprova'd1e . _ u^ , ~ n the Ipsa; ciaerette butts; condoms, co e oWBIa dan`.l flo~rj *ffo sss; ; dl sdf~apa rsrrets; GIlongiiY#f?II 8f7ta_ ez in of r the fa,.da#ion tIrstn pornp pump) dsgrseaers cI$ ~9 mil waTCSr fruit and vegat.bl9 peslfngs; sasctlna; ar82se• ~r r . e fat'. painting " _ > talcs !nedreiri { , aasticides; sanitary napkine, Tampans, and water softener brie cCss; m scrsps, naecllC2t~ans~ alt; Ait,;'AIi,TrD£3MMEf x Whan the z=OWT8 fails and/or Is Pe,, .anently taken out of service the fpllowing steps &hall 6a ulrI tw tn3vrv whet the svstem to prosody and safsfy Abaft io„ -ed in campliznca ;rtrM char Comm -53-S3, Wis=nsin Adminlst ive pda: $ Air piping to irks and pl-,s ;hall oral disconnected and the abandoned p os o ~~ings lett, T t e 0=mars cf P tanks and tits sha be removed and prapariv d1ap rf of by a 3erst Sgrsrfci rW t#rsr o ATtsr a~ spf'c~; a'tt yanks a d flit shell bat axcavate4, and =arnoved or '.sir acvarb- F soil, grays( ar another r"ner; solid metarIel. erf d and the void spsr7e rifled snrftia (~ON7"INCUNCY FLAN If the POW T S fella are vannct he repsirad the; fcll=1IIvit,g marasures nsve been, or mti-sT be takers, to provide a curie =-m- pliant r iacarrsEnt sJStan; i A su€table reptaca_Pnant area has been evaluated and may be utilized for the Inaaxfen of a r8 l7- systgrn. The repfaserrert area shculti he protested from disturbance ant! comp3ctian elr,$ should 7to# e~YlMng ~ pompt on nflay required satbauka from &.xT9t?Sag and prcloosed µtruotara. ipt lilies and vre114, FRIl ure to prrytgI4't t-bg ranfacernem, area Will result ir, t e nerd for a new saii and site evsjustlon m establish a sultaa:a replacarnant area, 3aplaaarrs~t s~~sterns mrsat comply walls the ruins in a"Hect at flip, fime- Ct A suitable replaoemant arse Is not available eus to set;beok and/or soil 11511tR50M. garrIng advances in POINTS taahr:ology a holdlnsr Tank may be installed as a last resort to replace the f0ad Pow-Tat © The sita has not Caen evaluated to Identify a auiTable replacamerrt area. upon ;jure of the p71>t1'l'a a soil ataa eita eve.uatlrrn MUST ba par,,nnMed to II a aultable replacement arm f: nor placement arch is eSraligfsla a -ha dlnp tank may be installed as a last rasorr to replace the tiled POWTS. ~1 Mound and et-grade sell absorption &Ys#es"ns rriay he :scanst-Ur.+ Cl in plav2 ftsligwtlrS ,ettsoual of tFte bfi~n€5t at The inI surface, Reconstructions of sucth syatarns must comply with Tien mites In aftact at that-time, <WARTI > SEPTIC, PUMP AND D'8IM1:1 TREA-Ttyl NT 1 AN-KS MAY CONTAIN U~-I GASS681 NDI.O )WER A BEPM, PUMP OR OTHER TREATMENT TA-MR t IDM ANY GFRCI3IVlSiF+hIG'~ DEAT4 PA. V 312S$1t,T.~~M$OU'm O A PERSON FROM THE INTERM11 aF A TANX AMAY 3E Dr.-Z+CUI,T OR IMpOSSISL, r DDIiIONA€.G' IRIfMERITS %'OWTR INSTXLER t~lane PD'i~TS Ik1Afl9Atl~i)r~l S t trn, rv, Name Fhans -60-7 PErbrie SEPTA IE S"EIR-7301NG 'DP: PA'?ZR &rPr_ Wc-%t €Vams LOCAL Atstrx; o;rr~ r Mama i Ptrane