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HomeMy WebLinkAbout040-1072-10-100 (3) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600381 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: -7 Shirley O'Malley TOWN OF TROY 040-1072-10-100 CST BM Elev: Insp. BM Elev: BM Descrip' n: Section/Town/Range/Map No: 9 CF, , 2 t GST 18.28.19.275A-10 TANK INFORMATION ELEVATION DATA TY STATION BS HI FS ELEV. TYPE MANUFACTUREt/CAPACI W Septic Benchmark 6q 4- 'j '7 -rA 9' JQ~ Alt. Bjt(1,\ Aeration Bldg. Sewer ` ~r O Holding St/Ht Inlet G - 65 V ~ St/Ht Outlet TANK SETBACK INFORMATION {p I v TANK TO P P/L WELL BLDG. J~nt Air Intake ROAD Dt Inlet Septic a c ~ Dt Bottom v Dosing Header/Man. 91, 6 Aeration Dist. Pipe Holding Bot. System 7 5 9 7- D r . Final Grade g 7 01 oo PUMP/SIPHON INFORMATION a' 7 W Manufacturer Demand St C r -3 ~7. L Model Number GPM /Q S TDH Lift Friction Loss ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTIO SYSTEM BED/TRENCH Width Length No. Of Trent. PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~7 ~f I~e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manu r INFORMATION Type Of System: CHAMBER OR 1 ( UNIT ModejAuml~erj 10 30 135 70 7J Cyf„% C s DISTRIBUTION SYSTEM 71 Z = SD Header/Manifoll Distribution Hole Size Spacing Ven to Air t e Pipe(s) Va V L Length Dia Length Dia Spacing Ix x Hole 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 I Bed/Trench Edges Topsoil C7 Yes No Yes 7~:]No COMMENTS: (Include code discrepencies, persons present, etc.) Inspec .on #1: t Inspectio # Location: 355 DEER VALLEY DR U ~~a O 1.) Alt BM Description = r 1 4 41- 66 2.) Bldg sewer length = - amount of cover = f (M ✓ C L 4-4 6_ 4f7, 6 V-- Plan revision Required? LJ Yes No - L Use other side for additional information. ~4-11-% _1 L Date Insep is Signatu Cert. No. 4 I SBD-6710 (R.3/97) ~-4C, ~,,~o , Inds S+ervim Divisicm Cagy 4 3-'oa~s+ve P.O. Box 7162 Sanitary Permit Number (to be filled in by Co-) MAY O 1 201$ Madisact, wI3370?-~~~ S St. CR PPSoft Number r 't A Iicaxion of this frxm to ttk spproprime goverssmental uvitt is required #rtiar io obtaining a sanitary permit Note: Applicabm forma lar ma"mcd POWn am Sant ttai to Project Address (if different t6on moo tiro Deysst meet of Sefdy and Przd wux al Services. Paw al inf nmirtiar you peovide may be Lmd for secondary ~L iL74f n accxxdm=whit the Priam, Ls v s. 15.04(1 m State L a Information - Please Print Ail Ia ■ Property O ww's Name Parcel S /0- /m 1 ,AA- A, 040-16-7j- Property Omer's ilasg Address Property Location y 7 SA-Ic, :3.'55 DCF-9 VA u-T,- Dtv W-&~ Govt. Lo city, State Zip Coda Phase Nwrsbar 5e A0 Secoon } _ UDS ' yO11a T ZB N; R r£.E) IL Terre of Bunging (dwck Ali Hurt :ppty) Lot N 2 or 2 Family Dvmlling - Number of Balms r Subdivision Name aC~Me Block # 0 Pubs ic/Commercud - Describe Use 0 city of 0 Owned - Describe Use G ~f e CSM Number 0 Village of _ -My ~V cy ~4 J ~~c~/ ~Tovmof RL Type of Peter (Cberk only bel of lift A. Cempk4e list B if appfiCSWe) A. ❑ New System ep4-nx rt System 0 Treatmentlfloldmg Tame Replaeemeng Orgy 0 Other Modificabon to F.x b "8 SY (expJaim) B. ❑ Permit Ratewal ❑ Permit Itevtsitxr © Cmw of Number 0 Permit TramAr lo New List Previous P Number and Da fssUed Before Expiration Owner I Z S ?Q' 9G' IV. T 4 POWTS Cllr &all t8w Y Non-l'rae--d M-0--id 0 Pt-sissad Irv-Grourxt 0 At-Grade © Morssi > 24 in. of witaW 3Cn1 Q Mourd <24 in. of mutable sal 0 Balding Tcidc tkiser Dtsperss! Coret¢or tt (eatpEsip) 0 PrOrenot=t Device (explain) tArea la6ermatier• t?esigm Flow (gpd) Design Sol} Application ICI Mee ite}uirod {sl} Dwer3al Arcs Proposed sf} 3yntaa Etevatiort low 6}.(~ /,aod i;~f¢t•`{~ ~'~,dO~ Vl. Teak Info Capacity is TOW t of Gaikvm Gallons harts New Taws T I E U ° V ~n vi 'w C7 yw~ > V ] L Rts ibal ty Stat enagat- 1, tic smdc assarre twr Ia"alledlee of tie POWfS sieves an tic effacing as. Plutrbee's Nam (Friel) Plumber's Srgnsaae TAP/ lPRS Number Buiness Phone Number n ETT M~1114°5 z~~1fl37 7~ _ 5?~f- z~sb P'lumber's Addim (Street, City, State, Zip cock} IOS GHI60z: /-4 .ST: C'fkt~ t,cLT '~l7z7 vH ot.stf 4xviartament use o,s Apprwai 0 Permit Fee Data Sign Llure ive>; Rcavo-on for Dtrria} S ~ ' IX. Ceeditiess of mm" far Distap}r.r nl N.~.X r mxs~- is A- P ALA- r I " b ~ "*wM iw VrVieft pi- for v\ t>~ T srd w Nis Cwrry wed an Pat awe {es 21S in i I I LriNa IN der SBD-6398 (R 08l14) Plot Plan a4 Page Hof y Property Owner tfr .k - o~ legal Description vi P"'; 236r {except where noted} _to0 rk T s/ aF- Thy r6'/, sic'. Ig zgj Lt = pit rztr W, '-rOWd yF 7KV~ s ap.orx yFouN-ry w~ swats, / North 355 t~ ~R ~IA-LIE~y aRi V~ ~cR r 7 \i ~tcx x - L 0 P-Z r N ~ ~ /,i1rG ' - Cv ve- INDICATE NORTH ARROW 2-vo SL-(4 PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Mawa► D"M Remrem"., Version 2.0, SBC3-10706-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 Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: osures: Fug POWTS lication for Review Soil Evaluation Report & Site Ma i t ~S ' ~V a 6-,;Vn Project Nam I Description Owner Name(s): 5H I P, Nt. 6M-+ LLV~y Phone: - Owner Address: 35~' p UA-U-aDk, j4ub_sOal Zip: Project Address: { .ar Govt. lot: SE 114 of, 1/4, Section i Ys' , T ZI N-RAE F-1 or WM Township: _ Ki County: C"P Project Parcei is M __©q0 / ©7z. -1-- / 0 0 Designer Information Designer Name: AIA&v - ti eer. Phone: 7)5 - 4t'~ --7z~_ Designer Address: 2 j f 9 7 K1Ng AKTHypa s e4-,,a&pLkr-Z, w-T Zip: E-Iti~if; ~ t D ~ (i S ic~ 5tti/1 ~-t f 00 . ~ Oiyt This 5 stamp. . Ucense Number. 1$5 - vD 7 f Remarks: . MAnYj0 HUPPaftT Man FALLS, • W1 - ,Q r~~~/NM11Jd~H~ Signature. Date. „~f -r29 7~ l e*ch copy. Plot Plan t> Page 2-o Y f Property Owner Ak. a`ffiA+-q 4flft Leal description Lsr esfv\ v~ 0,~; 239 (kept where noted) 11 0- z Z-0e lPW tJ TN8 5EA OF 1Hb AJS /'4, 65Z'. /9 I'ZiIJ, BvA"e pit I -nWd IMF rKt) 4 -9- 0 eoUAj4T w~ srvNorth 355 IDEA V.414ey DM V 5 e r Qp, ~w~F Y 4~ctt r2_ i&A& K ~ "fix r '4"' ,Pa p~ root- To P-Z j f4 EJC1461tJ AYx, x sy t- &AA t1~8A • i~~ poix, ~~vtyj' <'-w ve- INDICATE NORTH ARROW KLey M. QNAA ALLE/ PAGE 3 OF 4 o ~ z • a e0 N ZZ La Q~ q W elf ~ ~ ~ ~ M I, lf; -30 d t o 3 c~ W w v ut o PAGE 4 OF 4 In-ground Gravity Management Plan 1MP2ff W-. The owner of this "round gravity system shall be responsible for its perpewa l opera on and maintenance pursuant to requirements of SPS 382-384, Wisc. Agin. Code. Purstiatnt to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human heakh hazard it not rnaintaine+d in aaowdanr a with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a regh tared POWT73 Yakdalner in accordance with SPS 383.52 (3), Wsc. Admin. Cade. mum= 12b2m, &H 22130MUMM. Design Flow = fo~ ~ gpd; Bf3Ds 5 220 nvul.*; TOSS 160 mgt:'; F00:6 30 moo Irmo-090" Cihecici>;st INSPECT EVERY 3 Yl".AM d type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o ffwx;tw malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, br+eeks, 4:om~n, etc) o solids yoke* in anaerobic treatment tank(s) and any distribution atppurtenam*(s) (i.e., distribution / drop brnres) o negkd or improper use (i.e., exc eeding design capacities, prohdAed activities, etc.) c extent of poxting in distribution oel prior to dosing o dosiN irregula a - if applicable (i.e., pump re-cycling, flint sw t h settings, etc.) o - if applicable (i.e., wiring, Conn coons, switches, controls, tuners, alarms, etc.) o digtribrtbm lateral or tattered onfi ce plugging (measure lateral distal pressure - compare to desilp specification) o surface cfisdune of,effluert or sevmge bac*-up into structure served Maintelriowst Cltecktlltt MAINTAIN EVERY 3 YEARS for when necessary) o and dm strafl be pumped by a certified septoas servicing operator licensed under s. 281.48 Wis. $tat& when the volurrm of so#de in the toniqu.) *xCeeft otlert~~rt (113) the liquid voknvw of the tank(s) or as required by local ordinarme. D*m d of contents shall be pursuer to NR 113, Wisc. Adrnin. Code. o EWhj*rtt fl§jds_l shall be inspected every 3 years and shall be cleaned when rm es to remove any accumulated solids according to marwfsduWs speeftations. A ssNlCf V period will alwatys be greater than 12 months. System maintenance report's shall be submitted to the proper total goverruyw+tt unit In at cords rem with SPS 383.611 W4sc. Admin. Code. Report any component failure or malkmetion to.- Name of individual or company: ADy txdep ~rC Tju mf AiIaV,,5 Phone: 7l5 - 7D3`-Q3 7 Local goverrrrrwtti unit lVrMthNtt V 1tPnrl.. Phone: 1 ' Local ZIP: goverrsrtexrt unit addrasa: U,t'15~.1~! T Any dtrl0clive part of this system std be rte, or r+ernoved pursuant to SPS 383.51 (1), Vftc. Admin. Code. Repair or r~epia ent of failed or maltunebQning components shad comply with SPS 383, Wisc. Admin. Code. No product for chwnn cW or physieati restoration of the POWTS may be used unless q oved by the department in accordance with SPS 384, is-,. Admin. Code. C Plan to the event that arty failed treatment component of this PQWTS canna be repaired, it shell be replaced pursuetnt to a plan submitted to the appropriate agency for review and approval. A faded fn-ground dispersal component may be abandoned and replaced by a code-oomp►13r v del component in a pre-dat+ermined area of suitable soils. System Abe If use of this PQWTS is discontinued, it s#•sati be abandormd in aCCOr too with SPS 383.33, Wisc. Admin. Code. The lifetime filter __5r 01 ;A nut-I! T`,:?,fct t lter',thcr-0ffe -n,, f'Afa: te~1"n:eeijefi' El?Ef 0!t.'.tirefkEt.;3tQd')`_';)9Wt flP~;"Yb)o:CE ti'fflte~ !-r a a6'q ';,thfs f',tes4 l tet f-F NK 6 Awl 9A b q W gc,i.a( The MA *a Wp dr'-:a M WOW dot r5-i,? Ih? :3• :f.do? ~iY3c+l.; ~'I ft' Ik3t n~na-ntl?l3- . e. 1d23'} C,C, ~ F'c~e eDSp !+=rn.:~i tiw t+4,!r giC~O"- Of St~iC~ Cfe¢Q:.v ~e'Cu~? s.~vrr~ , t .cat°S.'°+3fW .77; tT"@ f5 L~~cO ~ CNi~cCL I .t 8[ U it JIt i;:3E, d~(dt~£ iCk"~z~f Ji~:di dt'~ ~~~tfT!?a~ dp5 R~.atES t`tE:;;tiCf'8'2 naAM Mk dorA(P'snAn,dway AmAw-gar'Jkayef~C,*S?ff1-,- iOJ(r~i;Ct[ thEPPG SY~d.3'eas;,nrie Ct,'t' 'l0 t C6T"Lf0 S>'~ _.i'IY Single-Piece Filter Case 4a j_ ui im r J2i'C} Q U is 4 S s.rglf ."ere WE WW p5vties 10N !G f-C 7.~ r?F , le rkYe OSR cmtv-, 71 PLIe.. C1 at d ,O.D1m W ecmt too, iMc'!' , r imp, Heavy-Duty Outlet -ua.,~-~:; ty o~.;tlst nffiar~ a~:6cx~al gsse s r-oa,{~ r, to E exta _.,p urt fneextxMN Ndd Avp %Ig Mt t1wil S ,P;ort as v: dl -s edsy'115t0at'n ar J c ; I~ rg set Fhe Only Septic Tank Filter You'll Ever Need Yage s ot ~ Fili Thi! hor soli dez frec Pat mos f ltr des bec reducing risk of the filter cartridge floating out of the case. -tttp.//Iifetimefilterlic.com/septic-tank-filter.php 12/5/2016 47tlick The r: Plus INFILTRATOR Standard Charnbel The Quick4 Plus Standard Chamber offers maximum strength through j its two center structural columns. _ This chamber can be lnstalled in a 36-inch-wide trench. Like the i ' original line of Quick4 chambers, it offer; advanced contouring r capability with its Contour Swivel Connection- which permits turns up to 15-degrees, right or left. It is also available in four-foot lengths to provide optimal installation flexibility. ' i luick4 Plus Standard Chamber Benefits: The Quick4 Plus All-in-One 12 Endcap, and the Quick4 Periscope Two center structural columns offer increased stability and superior strength are available with this chamber, Advanced contouring connections providing increased flexibility in Latching mechanists allows for quick installation system configurations. Four-foot chamber lengths are easy to handle and install Supports wheel loads of 16,000 Ibs/axle with 12" of cover i i M/laxinium Strength Size Quick4 Pius All-in-One 12 Endcap Qulek4 Plus All-in-One Periscope 34"W x 53"L x 12"H Benefits: Benefits: (864 mm x 1346 mm x 305 mm) May be used at the end of chamber Allows for raised invert installations Etfective length row for an inlet/cutlet or can be 180° directional inletting 48" (1219 mm) installed mid-trench 12" raised invert is ideal for serial Mid-trench connection feature allows applications Louver Height construction of chamber rows with 8" (203 mm) center feed, as an alternative to inletting at the ends of chamber rows Storage Capacity Center-feed connection allows for 47 gal (178 L) easy installation of serial distribution systems inuert Height Certifxwd by the Intemational 0.6" (15 mm), 5.3" (135 mm), Pipe connection options include Association of Plumbing 8.0" (203 mm), 12.7" (323 mm) sides, ends or top and Mechanical` Officials (IAPA40) f} APPROVED in