HomeMy WebLinkAbout016-1053-50-075 (2)
'vtt sronsin Dep.=n^remr;•r_omr ere= PRIVATE SEWAGE SYSTEM St. Croix
Salely :ntJ Rw Ding ]rvrsron
INSPECTION REPORT Sw, lar'., N'
;AI EACH to PERMIM SAN-2018-032
GENERAL INFORMATION ;tale nan ID No
I'e'Sp^dl inbrman.n you p,.,d.. °nry hu a .nd lot secono5rf outpcses lPn'vacy s Iiu: i I',',n )j
Penult -161:et's %arne L;Gy '':'tllagr Tcv,nsh Rrrcel lax No.
Michael Draxler TOWN OF GLENWOOD 016-1053-50-075
RN rln:• 1 I'rsp. BM EIQ•a: 2M Dcs~ at on'. J.KIILIIiIpM^4iange Nap N.
W3 -059 24.30.15.374A-10
TANK INFORMATION ELEVATION DATA
I YPL I•AANIIFACIURER CAPACI IY ST~A/TION BS HI IS LLLV.
Septic Ems 1660 6enchr~l T4,(j J42 M3•
L:rsiRg L~ 1 (050 A~BN, Z
Aeration Bldg. Scmr
-nidntq SW It Inlet 41 JI 20.7
I'll-S5 21.3 /d3
St'Ht Outlet
TANK SETBACK INFORMATION l `n
Tit\KTO rl.'I V-,'F II BLUE. All trta., ROAD Dl Inlet
aF
nt Finite)
Sep C 1 47 0 1
Doslny I {cadculvla•1.
Aeration List pipc
I to dung Dot. System
PUMP/SIPHON INFORMATION rural Grade
GAar'rrlarlurer f:ertand 51 C::vcr
G~A4
V,,del NumDCt q ^
I D•• Lift Friclion I oss Systonl I lead TDII rt
Grfzmair. Iangth Ula. Dirt to t^loll
SOIL ABSORPTION SYSTEM
BEDIIRENCH A'_A" Ir-_d N:i. Ur Irencres PIT DIMENSIONS N. Of I'JS -a "9n Lrqutl Ueprn
DIMENSIONS
SETBACK SYSTFM TO NFL BLDG NvLLL LAKFISTRFAM LEACHING Lr~unlsuwet.
INFORMATION _ CHAMBER OR
ypr: O' Sy.^.Ir.•n jr;5<l d /q/ UNIT MadH AumLet
DISTRIBUTION SYSTEM Z5
Header bla-Ara..- Rn:vdnrlKm Aloe Size .I-o1e 3a5anp '•ren: tp A-f,maka
Pipclxj
L- our Isngll Uia__ _
SOIL COVER X Pressur 'systems Only xx Moun -Grade SysLam4 Only
Depth 0's'.t Leer, Ever - - - - xv 11,011.4 - - ';eedetl5oddrr. zx NNChed
3.-d:?u^eH r;;,.reei Bcd: T'cncn Edpcs -oVroJ Yez No ves No
l Act . c.t Inspection *I Inspection A2.
COMMENTS: (Include tale disaenencres. persons 30s~'
Location: 3221150TH AVM/ DI_.' Au Dlvl Description
2.;. Bldg sewer length - / Z3
- amount of cover - I f „ / ~Gl. 1 AU
marl 'Cv[sion Renuired'> Yes\11111 N. 16 ' I _ if I ..se olhra side for additional Wormalion lVA v
I: arc Inseptdrx- rgnalure Can No.
ar 1Y`♦E~VvtN:v 6 `l -Z6l$- Z
County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN
In acca•d Nil, Chaport I: St. Croix Cawdy sarlilary. or I'la"Co PLANNING & ZONING DEPARTMENT
` Persbral infonnatia•; yob provide may be fir y rfda`y Curptl~ Si. CROIX COUNTY GOVERNMEN- CENTER
[Pr vary Law. S. 15.1 i I',(m>1 :101 Carmichael Road
Hudson. WI 54016-7713
i7'5)386-4(180 Fax715)386-1686
Atlaih complete plans for the system an Daoer not ess !han R-1 ~'2 x '.hones in size.
Ccun:y Sanitary Permit y ❑ Che::k if revision le previous apploa: of 3 9~ 1 1 S 411
R-A1- 2-6['W- 63Z J er'n'c
1. Application Information • Please Mall Information Location:
Property Cvnor Name
I J iI+
4, Soo: -I
T N. R P' E'or) W
Prroerfir Cwrers Mailing Address I of Number Block Number
A
.ly, Slate Zip code. Phone Numer Subdivision Name or CSV Numbe•
t tf ~f T-) ~ - ~ L ~ '•/Y"1 /~~(-ICr'~ S C C~7
11 Type of Building: (check ne) ~k ❑C4y ❑Village ®Tovm of
1 or 2 Fa•nily Dwelling - No. of Bodro::ins
❑ ',rtdiaCnmmeroial ~;descricc rse;: ~J"~*- - i-kA f {
❑ S:alc-evened La Nearest Road
II. Type of Permit: (Check oily one hex or line A. Check o::x on line R if applicabloi I 't 1-%A'
Parcel Tax Numberls)
A) 1.0 Repair 2. ~ Reconre(:t or, 3.❑Nor"plumbing . ❑ Rejavenation
anitation
B) Permit Number - Daln IsSUeo
iY State Sanitary Pri,mlt was previously iSv ihd
IV. Type of POWT System: (Check all that apply)
❑ NonPressurized In-ground f , . ❑ Mound s 71 in. st,rable soil ❑ Mound A+0
❑ Sand =iltcr ❑ Contracted Wellanb ❑ Peat File, ❑ Drip Line
❑ Prvssaored In -ground ❑ Huldinq lank ❑ Sirgle Pass ❑ Other
❑ At-q•ede ❑ Aerobe treatment Jri' ❑ Reureulafrg
V. Dispersal Treatment ca Information:
1. Dosig•; FL:w !I;pd1 2. Dispersal Area 3. Dispersal Area 4. Soil Appl caller Rate 5. Percolation Rate 6. System Elevation 7. Final Grace
Required Proposed IGalti 'day+sq.'!'~ (hlin.AnGh) Elevatior
I. Tank Information Capa'ely in Gallons I otal V of Manufacturer Prelab Ste Con- Steel Fiber- PlasIi;;
Naw Exisrirg Gallons Tanks 1 Conacle slruded glass
Tanks lanks U IS-K.IXI.
t ❑ ❑ ❑ ❑
r ❑ ❑ ❑ ❑
VII. Responsibility Statement
1. the r.ncersigned. assume iesponsint ty for repair'reconrnenc:lion:ieluvenation4nstallation of non-olUmbinp for the POWTS shown on the attached pans. A
I cense is not'oquircd for lerrahfl repair or the i islallalion o' non plumbing sanitation system.
Ph,mber's Name ;lvirti Plumbs szHt na!,r~ s:amrsj: P:MPRS No. Business Phore Number
PLlmbei s Add•e; s !Streel, City , Slat", Zip coe)
i`81 J .-j} c_ J:" l i,i r l 'rwV ~l ~~r:_
Ili. County Use Only
D.a . o•.•ed Sacilary Permit =co Date I ued Issui• ;lent Signaler o st
Approved Owner ` . r ^uerse '7 3 2 r / g
eterminatior L z`_7
IX. Conditions t rovaliReasons for Disapproval: \
3.$TEN OWNER: f, ~~~a/~- ✓
reQ : ~f
1. :~M tank, edken: ;iec- :nd 3\1 ~ u
ohper:i~ cell must ell ce r...
to PK .Tlar3Denlen! pizn n•s ~etoh cri
2. A/ nafilrilt Ierf m..renR must uo
a par tpFkrbh co*i !.:M'~,iAiopit
Rev: R!OS
J B HYDRO LLC
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J B HYDRO LLC
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N13431490' STREET 7151 949-009~,
RIDEGELAND, WI rcr 1115;'. 949 ON'
I C47Ei 1 wAL 1bnydroCchibar;iwi.
Jack Bowfun h1P: I. .-d 19
March 14, 2018
RE: Mike Draxler Property
The existing septic-mound system meets all set backs and is in good
working order. No ponding or leakage is detected at site; snow
conditions are present at this time. Pumps and electrical systems for
septic are functioning properly at this time.
Sincerely,
r-
Jack A Bowman, Owner
JB Hydro, LLC
NI WJ7 41)," Street 719 4.4q DOW.
uWyeianC, 5a6 i
'1h 945 p0)3
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nNURS.PpDYS. o+els aeu°°os tau osaW4 N0113nHISNOD tl300A
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Wlsconpin Department of Commerce PRIVATE SEWAGE SYSTEM County
Safety and Bukkogs, Division
INSPECTION REPORT St Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Samtarype",, i No
Personal information mi provice may Ca used for secondary purposes (Privacy Law• s-15.04 (1)(m)l. 374987
p¢rmrl Holder's Name: []City ❑VJlage ['AownT tate PldnlDNo: QI(o -
)rmler, Mike Glenwood'Township y~4k; 3228! - (j 2
CST aM Llev . hDV BM EII v I ff
O Description: vane la+No
vD • D T ~.1 I ; 20) . / 37c/FI
TANK INFORMATION ELEVATION DATA /zJe
TYPE MANUFACTURER //11 CAPACITY STATION BS Ill FS ELEV.
Be l~hr~~k f7.1~ 01.25-)60 O r
Septic cEwe.. 4- t Prt~a (wo (So
Dosing 6? C*,.•. ~[-O - r~ " S•S o6 •4S
Aeration Bldg. Sewer h 04,
Holdi St/ fit inlet 8 rn $.(o~ )Og,sB
TANK SETBACK INFORMATION St/ Ht outlet
TANK 10 pit WELL BLDG. v'•"t"' ROAD of Inlet
Arz Inbrke
Septic >gDr )z` - NA Dl _
Dosing NA I leader / Man. Z_ rS j I o ' .27
Aeration NA Dist. Pipe Cp 2•(S II0.0 r
Holding Bot. System
2-,10714. Oct. CT
PUMP/ SIPHON INFORMATION Fi I r e 4'µm -AL
~V Manufacturer S ` Demand r-iT ~qC
Model Number WT B(,,t, `
f0 * s r j7-q2_ l(2.4z D r
TDH Lthcl.$ke _Friction j S steal Ijix
Forcemain Length (os' Did 2 is Dist Towel
SOIL ABSORPTION SYSTEM
BED/TRENCH width ten •m t O PIT No of Prts Innde Oa epth
DIMENSIONS
_.-_~o r5 Ck) DIMENSIONS' SETBACK
SYSTEM TO P/L BLDG WFtt tAKF/STREAM LEACHIN e<wru
INFORMATION type (ST - CH ER Mode Numh•~ -
System _ 1 C! + ~ 0 UNIT
DISTRIBUTION SYSTEM 4• Sac -51 _ Ys
Io1.~z-
l x Hulc Sne I x Hu~Syeung I VenIToAllntake
HeaderlM ,fold a Dytnbubon Pipetz) ~~,~rr,,{{,~ tL
ength 2 I ih'}bA.3 k"p~a (2 spacing 1." I I18 x`frSOIL COVER is Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Uver Depth Uvei ex Depth Of ar Seeded/Sodded ae Mulched
led/Trench Canter Bed/Trendiidges (lupsuda I I y_es l_7 No Q Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc Il~acitnn J71: /dn ins etign tl.^_: 09 /a4 [>p
Location: 3221 150th Avenue, Glenwood Cllr. W1 74013 (NW 1/4 NW 1'4 24130N Ii15W) 243015 -l.ol l
1.) Alt HM Description T~p~~orwjo~lref.. 3. 21 3•I z'/y "
2.) Bldg sewer length = 14. D r a
-amount of covcr = > 18 Set CNaf
3.I corauw ~~~)t1/ ( `t.OC( /0..4 ?i•LI 7t w - ~12.1~•/
Azt~ 'd Q- Fn c~•~se... ~iN1e.
- -
an revision requireill~ es INo
U o tlerslde oraddlilon mf
ation 109 L•F- W y~•G`
it
tS er ° a ~ . w -
SBU-6710 C71 tZ_ l8 uGbi ~ Cvxv )ft F,- AKAQ- 'Wk.kwfes. IntpcrtoC, Lgnature Cert No
Est
3221 /Sb JE. Sanitary Permit Application Safety & Buildings Division
. Ave
In accord with Comm 83.21. Wis. Adm. Code 201 W WeP0 Box 302
`-ISCOnSin Sec reverse side lot msiructions for completing this application Madison. WI 537(17-730'
Departmem tar Cnmmnrce Personal information you provide may he used for secondary purposes (Submit completed form to county if r
(Privacy Law. s. L.O4(I)Imll state owne.
Attach complete plans (to the count\ cn nnlst lot the system on paper not less than 8•I12 x I I inches in size.
Canty Slate Senn~d~Vemtii Number ❑ Cheek d ¢vamn toP. eppp4ation state Plan D ;7;bi, /
I- /j S.
Sl- Ro(
Yropeny owner N,... . 37
1. Application Information - Please Print all Information L_5,K1*~-82(
i,f ~'/c
/pit I ~O NRProperty Owners Mailing Address Blo k Number
4 1000 Con.State Zip Codc phonebtt -0iN M Number
lrui o r `'P 3
11 Type of Building: ( heck one) v/ k" _ as r-,-_ ❑Cny S O
O /O .S3 -97.
❑ 1 or 2 Family Dwelling. - No. of Bedrooms.. ❑ Vdlagfc'~ /(i- - 3_ Gwtj wreetf rK 1- 1.0
❑ Pubbciwited retal (describe use)
❑ $ulc4wncd
NearestRo ad 1 ti
III Type of Permit: (Check only one him on line A. Check box on line B if applicable) .3d/^
A) I. ).New System 2. ❑ Replacement 3 ❑ Replacement of 4 ❑ Addition to Parul Tax Number(s)
System I Tank Only F.xistine System D.K - - -
B) ~-1'ermrt Number Dam Issued
❑ A Sanitary Permit was previously issued
IV. Type of POV✓P System: ((:heck all that apply) X09 • bD
❑ Non-prnstirized In-ground A uund Sand Filter ❑ Constructed Wetland
❑ Pressurized In-ground ❑ Holding'fank ❑ Single Pass ❑ Drip Line
❑ At-grade t Aerobic Trcatm I Unit a r ❑ Ro imulaling ❑ Other:
pffispersal/Treatment Area Information: T
(gpd) 2. DispersalAreu 3 DisperArea 7 Soi! ApphtaaIcrcletiRue 6. System Elevation 7Firul (trade
Regmrcd Proposed Rate (Gals Idaylfl) in !i) Elevation
Capacity in Total a of lanufacturer Prefab Site Steel n Gallons Galksns 'Tanks Con- Con. glaze
New Existing crete strutted
Tanks Tanks
S ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
VII Responsibility Statement
1 @e undersi d, assume trs nsibility for installation of the POWIS shown n the attache! lens.
Plumbers Now (print) Ylumbe's SiIV um no sumps): PRS Nn. Business Phone Number
1, j le- S'- 20
um s Address (Street, City State, Zip
.~.5 CIO 8 ' r 1. I S
Vlll County,Deparlmenl Use Only
❑ fhsappruved Sanitary Permit Fee (Includes Groundwater Dare Issued Issuing Agent Stgrmm (No stamps)
10 Approved ❑ Owner Given Initial Adverse No charge Fee)
4-Zs-2100
Determination P' _S .CD
DC. Conditions of Approval /Reasons ~ -fyor~ Disapproval: WA" J:"
All so -c s n ub+ 6r_ Mtt_ ~ as )v, t-df~e
SBD•6398 (R. 07!00)