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HomeMy WebLinkAbout020-1025-30-000 (3) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600374 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 DENNIS & LINDA GILLENWATERS TOWN OF HUDSON 020-1025-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: o0,(JO J 92~ -7T; 15.29.19.110A2 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER (I CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~ lU~ ~ ~ OD Alt. BNB t Aera Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent A' Intake ROAD Dt Inle Septic Dt Bottom Dosing / 7 Header/Man. t Aeration e. ~o ~ •3~f 9 3 Holding Bot. System ~ ~ D• PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover UJr GPM Model Number TDH Lift Fn'ctfati Loss System Head TDH Ft T 10.93 Force DAi4-- 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 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: _ INFORMATION CHAMBER OR 1J~i t~ Type Of System: ,.A, t ;:~Lj I I _ UNIT Model Nu e DISTRIBUTION SYSTEM j~ Wot~s_ Header/Manifold (t Distribution x Hole Size x Hole Spacing Ve to Air Intake Length Dia Pipe(s) Length Dia Spacing __TX 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 ~ E Yes No I_ Yes' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 962 BAKKEN RD ~[tiCQ O in CfJtJLC~ 1.) Alt BM Description GtIAL (0V4.1 S 2.) Bldg sewer length = ^ -amount of cover Plan revision Required? Yes A _t - A&Aj- No Use other side for additional information. 6LA~✓' - O SBD-6710 (R.3/97) Date Insepctor' Sign ture Cert. No `~,urw+ indt:ttlry Servim Division Cry 1400 1, WwhinOon Ave ST CKO tx P.O. Floc 7162 5wutwy Petmit Number (so be Btled m by Ca) Marlis= WI 53707-7162 o% Cv~37 Trum umber Sanitar)', Permit Application s " In anpordmve with SPS 383 2t(?). Wix GF1dn? ;Cade, SAM i.ssion of this form to"approlniwe govarn waftl unit A 1 `J2~ is raptm pna to t sadciarp rniit Now: Applkww fvrraf for stataawadd P©WTS tie u bmitttd to Addrors (if diMx t don mat'3at' S add=) the ' of and PtokaimW Savic. Plrr=v inf~tion you p vvide m4 be users fix wcondary ~-702-- L j~ j•~ " /G Dwvo" In the fnM l ava s 13. 1 m Sots IaEanoation - rkme Tfiat An IsfenMetior Y Property Owner's Name Panel lam- C,tJ,Q15 K, LiNz-R A. aitLEk1 5 ozo- 10015-- .30-000 Prnp«ty O%mces Meiling Address Propcoy 1.ombon I `I . l i I 1 96Z Govt, W City, Stem zip Code Phone Number ~5 y,. A)& seam HubS om tt~ l l .~fa14 t 5-.38 6 $2- 66 c f~- E T -;!!q N; R IL Type of RuMlsg (cbwk all that apply) ca f or 2 Famity Dwelling - Number of Bedroom 1 z Subdivision Nacre f ~ 4 Aloctc 0 PubiiclCacvmercw - Dewibe use ❑ City of 0 State Ovmd - Dmnbe U. CSM Number 0 village of J 7 T7 F?~ , z 17 KTowtt of -luD l~ Ili. Type etP"=it: (Cbeek arty are x ar lime A. tCompiete fire 8 if sue) A. 0 Naw Systextt gReptar emend Syme e D Trearmaknialder; Tank Rtpla ems o* O pow k&edifeatiwt m syz9tatn (exl~iam) B. 0 Pena it Rtxxwst 0 Permit Revision 0 Cls-r of Plumber 0 Ptrvtit Trttigibr to New List Previous Permit Number abd Dale us" ire Expimtian O*Tv" Z17- IV t f . T of POW TS 5 C'beek all dwt tVoo.~ Ire•Cxotrtxi 0 Fmesswrimd Ira-Cx+o M 0 At Caude 0 MouM y 24 in. of su9sbk sal 0 Mound < 24 ar. of sod L1 13oitting Ttttdt 0 Other MW-1-1 C«nPmul (COW) 0 Pras' a t7evwc (~a~) ~ Y. Area Isfar tt: ' A Design Flaw Wd) Design Sat ApO..dica Diapasai Aeon Required (sf) IJispassl Area 1?ropaacd t Sys arvabon /Ws &4L 54, 190qz in + VT. Task Info Capadty in Toad # of Maw(t~a4UM Galforrs tlallms Unab J s t~ Now Tanks Tadw xtfsciectt Vat. stsft meat- ; nac sasaouro ter NtrtaW*- +ef tie POWYS 4.- w the Plumber's Name (Pr* a MPti4iM Number Busir> M Phone Number KEITH -AKIA16,5 ~ zzyo37 7t 5- 5',3'-2$ Plumber's A&hm (street, City, strixt, Zip code) ` 10 F. 6tt1 PPGkMf 51-. (,A wI 5747Z-7 VIII t Ilse laweirtg SigwEaaa ed 0 ved perrmitFee j Dal, Reastxt for Detuiei S ~ / Z~i for ~ Q Mc ti#hper:'•!ui CON ncat A PAZ -AS tts per awtgfMent plan p. o ddM by Nltt.nixi: Z All ee4w* imic k irenerws mwt art: maiM.irt'd ~ t e (i tel. (A -A r o as per PXicxsWs coot! I ~.Minancm Aawk to ew pim Liam fry M rysi m oad **6o* a tka Comoro 0* on papaw a" kr rays to : t t koin it air SBD-6398 (R. €38t14) PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet CwWotwit Man" Dot RWNWIQW. Version 2.0, SBD-4 Q75-P (N.01/01, R. 10/12) Pg 1 of 4 Index $ Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Gross-Section & Plan View Pg 4 of 4 Management Plan Attachments: osures: FILTER r;e":115 PO TS Application for Review 5Pge-6, Soil Evaluation Report & Site Ma 1 Fs rc f ,c ~s Project Name / Description Owner Name(s): DEsJ is R. _Llk)txA A n ot1~ AJ u1~r 2 Phone: ?t6' = zs a _ Owner Address: q z,6 6A K.KiEJ ~D.T H u Zip: 54C )LO Project Address: t ~aMt^~ Govt. Lot: ~;:5r 1 /4 of t) t~ 114, Section 15 , T --,7-9 N-R I E Q or W9 Township: 44 ttL C)A) County: St`. cp,01)c b2D- ions- - - Project Parcel ID Designer lnfvnnation Designer Name: /U` E\/ Phone: 4- 1-7-75- Designer Address: 2s y 9 I F 646 A THOR'-s ef. R,VK~a talc Zip: .61 sSD c t~Je 5 t ttYi © L~ ftSOk . Ls tyt This sp dh~ ~ stamp. License Number: 1 0 'j ` Remarks: 4, ' H R o ~C aRT ~ 1ii38 A~. lttV~R p W1 Signature: d Date: _ ' l6a z,Die Dopy. Plot Plan f.--- Fi t®PER7Y t~WNER• ~Nrs V, DIVtm ,;ccE.v 1' - 40 FT. ("rept where noted) Legal Description. L 0 7 r. r Z1 1 L.a c~ T Scams ~~;+fy t - ~~6t Trr 5eC t 1 a~ , raw e LA) r y Ij 5T. c 90 Tti wtsca►J~~N. North Pm J M~t4tE LGO.0r Q e, r 4tkr~, 'o Site ocatim ~ 7G1iE0A1 ~U. r ~j DA Cc, t L.L&t W er=o aspic Tank(s) Hrnuirciur~: IN-GROUND GRAVITY DISPERSAL AREA Unto Elevation Trenches with QuIck4 Standard-W Chambers Sw,ic Tanis) WUU9 t i5mPrM> 3-ft Trench (down-blzlrig credit) ad od oW pki Eaw«r ..AI)12 o YEE - r asa.,r carm SOR.COVER way w..b TYPfCAL TRENCH CROSS SECTION VIEW 3ir t»~----- (No Scale) Pwvfde trrktirrksrt 3 ft Syswm Efien don R -paa*M bob em karxims. (vp") Cukk4 sbugmt W T9%,lao ► wj End cap (snow k cadw of Inlet J o at pipe catsadfor► on 1 vfaw.} TYPICAL '['BENCH buw P (No LAN tale 4f _ _ _ _ _ . , , _ _ - ' JA ffip3.00 tom ~fj i• J - - - - .r , a ♦ ~~a y~r~l ~ `vim Imo" (rr+~~ 8fsr ard-W Ctwnber W ft*04 p INSTALL. PER TRENC# ~ IOW by kdbamr $room NIc-1 n k+Mtipuauknt b habudoas. 0.&M SWW Q 24 f# 99 ldtarrtbir = 3 ' e + Pairs of end raps Q 6 fP EMAtpeir- ft' p EisA ppr u,,c t . v Required irtitraiion Arm= msmuwn Mel xxt x trwmtres = Proposed Total EISA = W _1 &A h l 1 5-Ot D 3 MRi` o -::7 4W gpd 0,7 Lj~ -&4Z. 20 ~-ks* 7 35 Mw. ukWtTS OR PAGE 4 Of 4 In-ground Gravity Management Plan 1,MPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and nlairtenance pursuant to requirecnMerits of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), WiM Admin. Code, this system shall be cortsklwW a humor health hazard if M rr ttairred in accordance with this approved management plan. Furthermore, adl kupection and maintenance attivides shall be perforated by a registlt ed PCWffTS Mabttairwr in accordance with SPS 3e3.52 (3), Vfto, Admin. Code. Maxilnnum D#Herj Am oeer~ft„Urrtits: Design Flow = q_`gpd; GM 5 220 mgC; TSS S 150 rngC; F0G 5 30 nvC IML290M Checklist INSPECT EVERY 3 YEARS o type of use o age of stern o nuisance factors (i.e. odors, user complaints, offa) o mechanical malfunction (i. e., pumps, vahres, switches, flows, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatrnent tank(s) and any distribution appurtenan*s) (i.e_, distrbAion / drop boxes) o neglect or improper use (k a., exc ng design cqmicifies, prohibited ettivi6ies, e(c.) o event of po nding in distribution call prior to closing o dosing Irregularities - if applicable (i.e., pump re-cycling, float switch sings, etc.) o electrical c omptxtent8 - if apple able (i.e., wiring, connections. switches. controls. tuners, alarms, etc.) o distribution lateral or taikrxai orifice plugging (measure lam distal ptessum - compare to design specif"tcabon) o surface diadtarge of effluent or sewage back-up into structure served MaInte-nance Checklbt MAINTAIN EVERY 3 YEARS (or when necessary) o §Nik, and dcsse tank4st shall be pumped by awed septage servicing operator licensed under s. 281.48 Wis. Sta#a. when the volurne of solids in the bwtMe) exceeds ona4hlyd (113) the liquid voltune of the tarnios) or as required by local ordnance. Disposal of contents shall be pursuant to NR 113. Ww., Admin. Code. o EMILIA shall be inspected every 3 yeam and shall be cleaned wtwn necessary to remove any accumulated solids according to manufacturer's specif> s. A servicing period w N always be greater than 12 mo tths. System maintenance rwports shall be submitted to the proper local government unit In accordance with SPS 383.55 Wisc. Admin. Coale. Report any component fWlune or malfunction to: Name of lndivkkjW or compw y: Alci~Aa 1~ Sl✓pf iC 2\1 a-A 9L Lt CA 4' Phone: -7/5- 2 0 - L3 37 Lodei government unit 5f . C t2ot _0_ u (~Ml~\ y t 1,'~EU wp Phone: 7 r -5_ 3 M - IVQ Local government unit address: EAw3u1 . \ w)-1- Zip: w ~ Any defective part of this system shall be repaired, replaced, or removed pursuant to WS 383.51 (1), Vftc. Admin. Code. Repair or replacement of failed or malfunctioning components shad comply with SPS 383, Vftc Admin_ Code, No product farms or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, VAm Admin. Cods. Cotlbinmmy Plan In the event that any faded treatment component of this POWTiS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review a sppmvalL A failed imVujnd dispersal component may be abandc>ged and replaced by a code-canptyrtg dispersal. in a pre-determined of suitable Wis, System AbandOnfrifffl-t !f use of this POWTS is discontinued, 4 shad be abarwlont In accordance with SPS 383.33, Micro. Admit, Code, i r3 a F `C+ SA i t ) - r~t~M 1! F k Yl..t - ~ -liA~~e~6i:.'FfF~ Y tv. :3f.f X., _,._`a. ..C..~ ~K`•. The CQuick4 Plus Standard Chamber offers maximum strength through its two center structural columns. This chamber can be installed in a 36-inch-wide trench. Like the original line of Quick4 chambers, it lafors advanced contouring (:apability with its contour Swivel G,onnection"* which permits turns "rp to lb--fegrees, right or left. It is also available in four-foot lengths to provide optimal installation flexibility. ~ttltetcly~ X1138 ~fvtt~~kt i ~kxait~6sas" The +)uick4 Plus All-in-Gne 12 L'ndc ap, and tf)e Quick4 PerisMpe Two center structural columns offer increased stability and superior strength are available with this chamber, Advanced contouring connections Latching mechanism allows for quick installation providing iru ceased flexibility in system configurations. Four-foot chamber lengths are easy to handle and install 1 Supports wheel loads of 16,000 lbs/axle with 12" of cover fY ji ,i?, i)i1t~~iT 1<ftrl'1I ` ! ~ i size Clu€clk4 Plus All-in-Ona i2 Endeap Quick4 P1tm ,VIII -i€ -Ono Pewignopo 34"W x 53"L. x 12"H Benefits: "left. (864 mm x 1346 mm x 305 rrun) May be used at the end of charnber Allows for raised invert Installations row for an inletioutlet or can be 180° directional inletting Effective e installed mid-trench 48" (1 218 mm) 12" raised invert is ideal for serial Mid-trench connection feature allows applications Lauver Wght construction of chamber rows with 8" (203 mm) center feed, as an aftemative to insetting at the ends of chamber rows Storage Capacity Center-feed connection allows for 47 gat (178 Q easy installation of serial distribution systems CPxt'rfied by the intematiorual Pipe connection options include Association of Plumbing O.G'' !15 mm), 5.3" 1135 mm), sides, ends or top and Mechanical 8.0" (203 mrr►}, 12.7" (323 loin) Officials (OAP O) E ri APPROVED in