HomeMy WebLinkAbout161-1094-40-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 600239
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
DOUG & ROXANNE SUNDET VILLAGE OF NORTH HUDSON 161-1094-40-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
Ca ! ~ e iDo•&ti 12.29.20.747
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic di Benchmark
C- k ~ s-f ~ ~ C9 S C
Dosing Alt. BM
~f !-E2r ~Ls t ~t l t' x115i'A L(. Sp I C)
Ftera Bldg. Sewer X ` f
SUHt Inlet
TANK SETBACK INFORMATION St/Ht outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic D B o 4 - /
Dosing Header/Man.
Aeration Dist. Pipe
Holding - - Bot. System g. 1 I T - O F-
Final Grade
PUMP/SIPHON INFORMATION 5.3 /W jb
Manufacturer Tv Demand St Cover GPM f~
Model Number /
~J mar o •~d 1 av.
TDH Lift, Friction Loss System Head TDH Ft _
Forcemain Le. g Dia. Dist. to weu
SOIL ABSORPTION SYSTEM
BED/TRENCH Width It.,t Length qt9` No. Of Trenches PIT DIMENSIONS No. Of.Pts) Insi e Liquid De
DIMENSIONS t l~
~u 1 f
SETBACK SYSTEM TO P/L BLDG WELL LAKE/S AM LEACHING Manufacturer
INFORMATION CHAMBER OR L `tom
Type OSystem 0 ~ UNIT Model Number: n~
J t_t S>~-Q flC
DISTRIBUTION SYSTEM i- tvn '1~! Header/Manifold Distribution x Hole Size x Hole Spacing to Air Intake
t It Pipe(s) E/UAS
LDia Length r Dia i 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/
3 , 6 1 Bed/Trench Center BedlTrench Edges j Topsoil j Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 278 STATION CIR N ~~t8~ex t ~t t :-_66_ ee
1.) Alt BM Description= 6X_Ub56
2.) Bldg sewer length = U &bs-
- amount of cover = (i kf &~(-t
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information-
Date Insepctor's Sign Cert. No.
SBD-6710 (R.3/97)
Safety a -dui6ings Division
t ?G1 W. L'85hinciton Ave., P,O, Sox 7162 Ssatra ntr a.,tr(tnt
OCT 1 ~ 2017 ~ Madi "VVI :70 71" 1
r T
a3~
I way nm CROLXCOUNTy i /1) 1
ar33-n3^ i¢a C} ' y1t g ptl +Cfy '«iPo t
'earM APPIll
• j h r -
v3 9cco 13iwc i. SP S 21i 2 Ac4 r C L, sb au., io n c llu, fc rt ~ it :
ac r~~ls~ccl peer ..e..>i,t.i rcar ~.ati.~-u erg F'O" a S Yro_ircr 4<ldre- fit ttii.c:l-.i
D'~Vartmcw o ti n ,'r ' Sc e_. } t s-i? t ~~tn,1 W", p.c., d n ".1l. .antCi it.C
---1 t Ill 1. j
;
~l. ~ # Itc:rira ai 3nfn m ation Ptc a't- Print XH Information
a- ..1 1, rate ( t- u ..11 l".; ` C'
i'~o 1t tti c t~csaw ~ ~ ~ a ,
Sarin Ad8,'.~~ I
t7
y ~ i ~t > t tt.ii
l
t
t 4 .mot I
11. Type of Builcdasl (claccR all that .appl)} P.c t ~
a i S ban a m \snc
=,r' ~~Elfi'= ~.r~etlss. 'vun €~ro; €ttc3rt,,,rnF 14r r
- UHaicC ~::zr tiaI L~sct~bc C's~ # -r t
' r
n't} r i Vi agreeteal'
t t - ~
e- Di s G ~,I'
1I1. TN pe of Permit: (t' c-a 8. onk one ox sari lane X. Complete line if i sn;ai c-ahie)
f sii_. ;_j 0t.._7.~~u:i€.._.__
i_}12CC1nit~V..
'C 'I .....t~:,:<, .:.ir ...i
i s
:a,,;... ..~\iw i f
'j gel I
IV d aF o POW T,", v~tena C cs a an~zcaat 13€a €cr fC hack. t€t that ~ t-~;c , (t. 4 z,i <f.:St t,rAt_z.,,..a7 f....o-aE3 iradc L~' Nloat,k _ t... us' ..,t.,,t,tC
,,t., .._..•;e <..ns _ . Cs.
r. !
I
~TKra l4...f•r Q~f
C O' °nest: , ..t. ?am 7 t ( la `.1 fe ,i. IDU:IC~
LAAA . [lls ersaLs"d reataaae3tt,kre<a l f~rcaa tictn; Iti.
i7c r Fr r ; rdI L~ t 5< iS - pflic"Iti -i (,CC Ai_-.i ll opo;ccl (s4'1 S. ~.k.+4. : crtic
rr <
11 0 C> cf.
ti 4 I
V). i;wk Info', . n+~ uu,u3'ia tu:e
t
x,xt T
} dl. Y~i i~±il-9 (}9l!s}bt tS `['4' SFi1 tC'372 C'nt' din the Ek fl CfiCP'ai g7 Qd. 3titi1171l t' i"f <JS is %.>ib'}lis f.t i'![S EA:d lLi fit➢3t !.`if Qhe' PO~~ I S hCk6l5"i't
051 fi14' 13 §t:t Ct3i d (lid i74_ }
7'? ZLS~
KeITO -7
i
~Idl C off n: I~ t-f atit rt V w Onk
Ll 3 SY ..lam a / ` ( .,c -
IN. Con'!Niui_=rf ~g nro~'.Et § .:cos 5 for Di appitnnl
SYSTEM OWNER:
1. Septic tank, effluent filter and
dispersal cel! must be serviced /maintained
- - - _ _.a
tic-fit
as per n .
2. All setb c~ `:q irements must be maintained
as per appiicable code/ordinances.
In-Ground Gravity Plan PAGE 1 OF 4
Index & Cover Sheet
GGomporwnt anus DasTn
Version 2.0, SBO-10705-P . i fol, R. i0f12j
3,s
'~a '2 lit l
' Ian
of Dispersal Area Cross-section & Plan View
of Management Plan
Attachments: car g JEnc ~~Ap I ca vi
YVi P C i in ®r RR~
r r 4 t,, ,w t w r: 1 Soil Evaluation Report bite Map
,Ftt`; G-(' f t•`_ tip} t; i 1 D~ GI'D
Project Name I
y-^ in
Ater Name(s): u _ ,JUAi, , t Phone: 71! -31~ 4-__
(Winer Addrm:
t~~vE 1 i C ~~t1 I t ~4 e L l 'v'
zip:
Project Address:
Govt. Lot.,
t
county:
Designer Information
Designer Name:
'?J5 447-L- r ~e,.ST/'irm& - F -2cw f f,F"',1 c 1 r I~ _ _ s? - phone: f ( P,
plotpim Page 1;_7 of
PhWerly Owner
` 1Z r° rt /Z-20V M UJLLA es NC'j*6fl+ N IAy Se, ,S c a tX 1 `q)$Alb
C C~ t new LAi ` Pv y X
icy O
u v )Oe-P e
' ~1r~CJc x E tit
'r ~l
imE
39
"nr sue- F 1 -
INDI NORTR ARROW
Ar 5.1,
SEMCMARK; Describe the vertical reference point used
1,Pcrc+ ,r a ~G4SA++~q°
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK! Manufacturer: W /GYj td{ Liquid Capacity: s: S WK
Number of rings 19
used: _t Tangy maniYOle cover elevation:
1C7<✓, ~
~'t Tank Inlet Elevation, r
t, . .g Tank Outlet Elevation: •06
Number of feet from nearest Road; Front side 10
0 Rear - feet
_ Z, From nearest property line Front Sides
f arear,~feat
PAGE 3OF4
z~--
LP
L
s -~~CD
0 C_3
a E i U~Z t
Y ffi m s
o 2
CL 0
m cn ° a_s Q °
w
s m m m o
Z - ' C: m
mom: z E
LU a - c o
~t c i, gq m a
Cf)
> s ~ W
$ kot y . L7
(D EL
0 CL
}
ca Q
- m co
r`
-j 0
t st3 vs
Q.
CD
CA.
C ¢s
CO W CL
uj } }
} 4-
0
~ v
C-)
ai> CL
to -p
f
1
Cl)
Ul
}
v Q
as a
Z (D
LLJ CL
g~Y s crscFL } c u
w
€L
t co
} Q
} s co ,
y
Q
PAGE 4 OF
In-ground Gravity Management Plan
The o ner of this in-grew gravity v1sta n small responsible for its perpetual operation and maintenance pursuant to
* uirernen €sf 332-3 s drrsin. e. Pursuant to SPS 333.52 (2), Wisc. Admin. Code, this system shaft
be- considered a human health herd if not maintained in accordance with this approved management plan.
Furthermore, all inspection and intenan a vi' es shall performed by a registered POWTS Maintainer in
accordance- with SPS 333.52 (3), Ws. Admin. Code.
Maximurn is r al Area rr lr :
Design Flo : L; < gpd; 1 0 s S 220 rngL'a; 7 :5 L`; FOG :5 30 L71
,MLxection - Checklist INSPECT EVERY
3 YEARS
o type of use
ag"e of system
c nuisance factors (i, e. odors, user oomplaints, etc )
c mechanical malfunction (i.e_, pumps, valves, switches, flues, etc.)
material fatigue (i.e,, leaks, breaks, -confusion, etc.)
solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution 1 drop boxes)
nsci=ect or i proper use, (i.e., exceeding design czpactties, prohibit ad aciiv~jes, etc.)
exte 't of p rdia g in distribulJon cetl prier to closing
dosing i egulatities - if applicable (i.e., pump re-cycling, float switch settings, etc.)
electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, elamts, etc.)
distributon lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
surface discharge of effluent or sew ge back-up into structure served
f i ;l .en e Checklist MAINTAIN YEARS EVERY 3 (sir when necessary)
{ e tlo as d done tarsk( } shall be purer by a certified septage servicing operator licensed sander s. 28148 Wis.
Stat& h the vole of solids in the tank(s) exceeds o tlyd (1/3) the liquid volume of the tank(s) or
Us required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
: flue
aat Ater s) shall inspected every 3 years and shall be cleaned h necessary to remove any
i..iua °J._f?s acrcord#na _ FY'tari Ll: c3`c,cuf n ,^.a3'1t a,?--r.' a
: :,f? r.,i":~°$ will zxx1~~~'n f~ t} E' G°i"e,,!_~4rT t h ~":i'3 1!
` P Y T3scwiZ, `~Sixi&£'o ropL"n'LS allzal Le subnnii, to till proper l€.P•a""..ar i fgoven i.meal unti tin accordance w4h
SPS 383.66 rsc. drain, Code. Report any component failure or malfunction to:
Name of individual or parry: tir\LL';' ~ y P : ~t.f--_703 ~ )'6 J
Local gear rn tt unit T. _C t-ci C, i Phone:
_-?f ~ c3
Local cement unit address; zip:
Any ctefs`tive part of this systems shall be repairers, replaced, or removed pursuant to SE'S 383.51 (1), Wisc. Admin.
Cade. Repair or replacement of failecl or malfunctioning components sh li comply with SE'S 383, Wisc. Admin. Coda.
Floproduct for chemical or physical restoration of the pO S may used unless approved by the department in
accordance with SPS 384, sc. Admin. Cole.
Contingency Pian
In the event that any failed treatment component of this PO S cannot be repaired, it shall be replaced pursuant to
e pier subrnid~t# to th ~apprupriate agency for rev" vv and approval. A tailed in-ground dispersal component may be
abandon and :pla d by a a' „onpiyin<g dispersal component in a preAetarzrrined area of suitable sails.
If use o this PO S is discontinued, it shall abandon in accordance with SP 383.33. Wiisc, Admin. Code_
- -
y / dA t
H ~
~j
Jt
jd 4 G .Y ee,
'k
4 i
1 <
e
fx,
Quick44- Standard Chamber fits in a 36" wide trench
-1> is ideai for curved or straight systems. It features the
,"~utnnt- endi
ng Contour Sv~ilpef Connection- which perrnits
ns up to 15', right or left. The MuitiPort- endcap a,Pows
rr,uitipie piping options and eliminates pipe `itting_ The
}
a,riber's fc ur-foo' engfl3 provides o tirtial instaiiadon
'i~ ve 7 ~ ~ k
o 1°'et 'M1° f_ +
7kh
Adv~7ced contouring connections swivel up to 15`, ~
.
right or left
Latching mechanism allows for quick installation
amour-foot chambers are easy to handle and instal;
r
i'a QuisM Standard Chamber supports wheel [cads of
16,000 ibs/ xle vith only 12° of cover
d
I-ertified by the int'ernationai AssocC ati a A,r -
' _ n mss,, e . F f "
of
re pip~~~ -
J k d i-
Qht moiue c i-in i€ilets/out;e,s al!mv
for manimur ; piping, flexibility
Eliminates pipe fituns
i, its cn, ~lther enu of tyle Ci';ambe:
APP"
si: