Loading...
HomeMy WebLinkAbout040-1190-50-000 (2) County: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division Sanitary Permit No: INSPECTION REPORT 605023 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: Christopher & Kathleen Haroldson TOWN OF TROY 040-1190-50-000 CST BM Elev: Insp. BM Elev: BM Description: ' / Section/Town/Range/Map No: Qv4r M- 04.28.19.843 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic DOCK Benchmark (os ADD . (o / e-c~ BecMg Alt. M 455~~ C4 M, we,4- Aeration Bldg. Sewer < C) 1ZZ_ Holding St/Ht Inlet y a, St/Ht Outlet TANK SETBACK INFORMATION f TANK TO P/L WELL BLDG Lt t Ai r Intake ROAD Dt Inlet ~1 S • a ~L oec~ILN Septic Z-7 / pr R~rr~,~~; ( 6 16 rf 77 g Z I Header/Man. • 6.3 c~ Dist. Pipe Aeration Holding I Bot. System 5 Final Grade , / 3 ~ G • 3 S PUMP/SIFHON INFORMATION Manufacturer _ Demand St Cover1 7l GPM 141 6.74 5ct `o- Model Nu er v - J Cie. TDH Friction Loss System Hea TDH Ft S 6Ju- Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width f Length No. Of Z Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Qd~Gf~O~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION T Of System: n r/~ /6 3d 9a /J UNIT Model Number: yp wdr d✓~JGh~v DISTRIBUTION SYSTEM 2cIL Fca•F~ g ~b Header/Manifo~ Distribution x Hole Size x Hole Spacing Vent to Air take P Length Dia- -1 Length Dia a Spacing` SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 5 5 De th Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched P es No [ Bed/Trench Center ✓1 , 111-4 Bed/Trench EdgeS~ Topsoil ~ Yes C No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 538 FRANCES AVF , / V G ~ ~y ~G~ 1.) Alt BM Description 2.) Bldg sewer length r..5 v I f -amount of cover O jej 4-6 Plan revision Required? Yes ❑ No Use other side for additional information. Date sepc Sig re Cert. No. SBD-6710 (R.3/97) 4 w , 1 f. ~ a 4 r . , :Zek sy ` ~ • c ~ ~ ~ v~ " is a ~ ~ ~ a - .t . e f 4 P7~ v; gyp. ~f 1vn gyp a mm- s s a i ~ Y'x r~ „ k . d Ali 46- e ate. • 1•. f~?g ~~u TA" • t 41 ,P• Nom' - ;da ) , ~t~ ~ t ~ ~ 4 u I'~~ ~s ,ur ~ ~.~".d r `✓s} ~ xt' s' ~ 4r" `a ~''~nDV~~" eI~ L ~ T+' ` 4~ , t y r ~E ~ Mr '~i+. pse~ t i ~ ^ „r`v~!• an . . ,;«.,.f .i'~ r, 'F d~}A ,r,J sb,a f~ { "'-~~R' y y,~-s ' -07 , j.., r.Z I k s v 'f a .aM` ~ ' f•'~`' 4 ~ `fit ,C _ r a. * _ . ~ . . y 1 t a WIT . , w • 1 F • yY 5, f}~~~., 1 r r f , i _ .Ek t• l .1 4 41`."A.k.y~t`~~` L Y A 1 sal ~`i f I- - "~'i•^• ~ v._!' f ~ +1'a5V95i ~'J~,f, r I~ P ~ d k~~~>' V, ~ 5 $k, a" .I~~Y ~f . r _ a„ - /ya•- J i~ ~t i 6 t .~a aC } is ~t '~k+S ~ ~ p<, h ..~i•`~' - - - - `aA~ a t 4,`~,,~ N2 ~t }~Dlir ~ ~.`~'tT t..,+ r ~~~-ffi.. w i ~`e ik "r1 ~ , ~ _ , i ..k v"'"~'r , - ,Y t a 1~ ~L I *i,, k ~ h l a ~ r.. 7' ro > fi ar" e~.r'~ \ ; Y ; ~,f,?.-X" l r t °!°,i` h+~ ~~'m"i A Y" k~«r 4r `~t xp" St Cs~ci gu ° "~6pi h •L~ V~~~'*" ~ ~4~ v~ Y~ k i,~ r 1.3 =aft < ` 5 ~F F%, r,f'~'B~A~ ~ , .i• ..1"-~ r. ~ <t~" ,.,~t ~ y ~gj+. r~. j ~y r ~ a j fr ,Y,i' r m- 1 fi~ y~;••E fr+~-„t. o t. Rs ct .k -.eiS~t < - • yt. r t t y bkt "r Y ~r - +v/~7 5 a ",1 c MF+ ~ a ~ra4~~ , k., Yyx ,7t w ~y : ~ w. qtr: y ~ a rA Ar r 5 e..tc_r!'„~ p .~t~~0 4 a ~;ga,~ ,9r w~` ~,a ~„q~~,. ~a "~~Q'°~k,~}. " r Y.y~ ~ Irk a 4 ~ . sJ! -°i$~ ~ ~ 0 9t '~{1d 2* G 1 ° n T.ylmi f p a s ~~~'4~~ti~a"i+e a nl;~ .'3"• ,x ~ ,b'.. ti*"ke - w c r, 'R' 4 h r~Yh gy ~ a~• tw ' r~'xE!~ r •~"~~~`}~S ro~ r~ ro{,`•`J I~~i`t'r~~,•,s V~~ w -3`Q`• - ' ~ ,JA ,r .A `k ff~'•.- aJ t~¢~ y Y k ' \ ~ ~4•+ ~`p~ ""tea-,tC , _ r ILI l a/ -f 1 .r~ I m r " - r 1u ~.Y ~le~ h *r' 2 ~,,«K, ~•ro 1. 41 y lat IOW ...,N ,ailf ~ s 'x~ 5' " 1, S•~ .r :'SS Vii. .fry."y ~''r Y ) ~ . _.1~ ta+. ~ fdustty Servim DMsion calmly 5T c'<01 K 1400 E Washington Ave ` ■ ` 91~ P.O. Box 7162 Sanitary Permit Number (to be filled it by Co.) t Permit Applica ' sT70a in eCCOrds~i¢e 9321(2). Wis. Adm_ Cody sibmissaan of this farm tD ffie appropr s e Vvernmertal unit AJ)k is raquied ptiddi to obtast % a sanitary permit Note: Application Socmts far sue-owned P0VM are car ed to Project A~re:s (ifddlumt than reading address) the Deperwie ut of Satty and Pofc==W Sams Personal infamstion your pmvide inay be used far seamdety yJ/' r J?SUj ►~~a,/`C purposes in accordance with qte i Isw s. 15. 1 m Stets. i. LfirmIdDa- Please PrW AN Wwmafi.■ C S~lNtt~ 'z Property Owner's Name CHKI--)TWHVt D, K-A-rftcEEAf A,W~s~ rgo- a0~ 1900 Property own ces Alining Awma Property Location C q. I ci 53 S Frer4 U -A UE . Clout. Lot city, State Zip Code Phone Number NC y, 5~-- y, Seetim,/~'~ G(i~SON W~ 5`fQI~O TZ- _N. R ( 6~ E"LJ H. TyW of Building (tretk all Mat apply) r f Subdivision Nmae ~la2Family Dwelft-Nranberaf Bedroom^ =A~fv-~j 'fire-& VALLE Ut~V~ ❑ PubtieXonm+erciai - Dtscrbe Use El City of ❑ State Owned - Describe Use ~CSMM Number 0 Village of Z T lJ ~L lx.+.7 0 Town of T III. Type of Penal: (Check amly ow m Hoe A. Coatpkle Not B d appMaubie) O A. ❑ New system >(Replacaman Syste. ❑ TrestmentMoldmg Tank Replace meat Only D Other Modifiraeart to Etuanag Syshaz (crgrtam) B ❑ Permit P"zoW ❑ Permit Revision ❑ Change a plumber a Ffermit Tramfa to New list Pwvious Permit Number amid DWI Before Es "6011 Oven r , ! ! . . 1 03 fV. Type of POWs S C%e& all that Nat Presscrimd kr> Caotatd ❑ Prmtrriaed In cm+amd ❑ A. a © 4aund _ mmiffibk wil ❑ Mound < 24 in- of w>i i tk and Ito 0 Holding ~Desperral Con o., (tacplain Co X12 ' r -SM4 Dt vice (explain) V. Dfa Atrq Iwfart•atioa Dot Flow (pd) Design Sad Al*i9atim Dsptrtnal Arta lte>quircd (so Dispersal Ara Proposed System 17sv~on r 4110 0. (0 7-fo 11 0 ~3. SD Vf Taalc laic Capacity in Told tF a( Marrafacdrxr Culiurs Cwdimna Units g o ~ o ?rate Tads £ Tait U ° a l✓ ea IDS ~Z i» w o, w a AS /,C oca i Mi r VEL ftn Staler.eat- the onderigmed. ~aom rud -a.Sa. of tba POVwtS saw. user tttc aWebW plama Phm*WS Name (Print) 44FA IM Ntamber Bum=& Phone Number M JKE RODEWA L-a 93i 71-'~i--#2,tjF-Iz00 Phimba's Address (suety City, State, zip code) 2.455 C.-r.A. 5 U > A GAS usz ~FOLZr vuf. Sigrtrae _ pt3 Bit Fee Date VANA ❑'OwnerUivat Rein for tlial #'95 G14115 l,~"'ppatra' !~+-s°,~,t l a ec 4 w CYIl ' eUSi be a iir 5 r 7 rr Ill~' ?ts per ;~ara5ement plan p! ~ o ~oE 1 uV Nlumoe;. 2. A~ ts~~F~~~~°v-ems MI 3t Ue t It' f w per knbls ro& 1 AM & to' I - ohm for a.9Hs ai rt+Mit as the Cep .dy M P"W art 4s thaw a to a tt tarLes is d: 5BD-6398 (R. 08114) bra 1 r W rv ~ ~ ~ I f ~ 4sstti~tBD tbD c?D' 5 kk tom. Z i t ~ PAGE 1 OF S In-Ground Gravity Plan Index & Cover Sheet Component MWXW Deso Re ftnoss: %ftm m 2.0, SBD-10705-P (N.01101, R. 10112) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plat Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attarclxneits: E ures: Flt -tcg spFCs POWTS Application for Review s ~5 Soil Evaluation Report & Site Ez-OW SPECS WSA OA9 FILE fps P~aP 5~ I C 7 AC:;, Ebb o f c E W FILE) Project Name I Description owner mame(s): CNP-i,'5W W~b b, KAwLFM b:-MOLD OWner Address: 53:~ Fi;~An1ct s A vk,-, f-Fu ns on1 .Zip: Project Address: C_~ME) Govt Lot:.. - 114 of.5Z~ IM, Section_ q T 75 N-R )`1 E E]or W Township: -r 6V _ County: .5r. CKDi2~ . Project Parcel ID S: /Y f 190 - 50 096 Designer information Designs- Name:., ~ -flkePgiz-r Phone: 7)5 - 44, , Designer Address: 2t~y 9 y K ~ ~ ~ ~,zs C+_, ~~FiV t~►~ +.J~ ap: 5y &'S~ ~1k ....a:ilAfa E-frail: kin ~sl~r~lesian (a-,; t)Lk+IwK com _ nlU 5 ~ ~stamp. i.icerwe Number: 18541- op 7 Remarks: . NARY ,~ip ~ #OuAP e FAULL_&%, Rt ' Y1ll Signature: Date. ~y_zDl4 ~~r~ilad COM- OFL/ r 5~ T~3~ I~I9Gi! .fir 15 o~ w~ jDO.v ~o t7' Q 3 -roe OF pUtsr, c co,~,e(a 7pS~rU~~'$"" a55wMp /6Q. i ~ esf rte, 3 'IT A, R ~e~~~CfQ X 014 S Vila: - /i2 1 i ~ r-~ S rd s8~ j J Q ~ jba,p ~o i# 7' a 3 oP d~ f~r~srJ c co (or.~ Vwal 'gyp%oxv~ 8"'` 1455ttM$p !a8 40C elsf tkt t ! 4 j 6 t'RANC t scl~l~ , ,AVM U-r d L~ S~iU j CtfP-! S s PAGE 3 OFD aM U3 c 11/1133 as j_~ O J gE ~ ~ ~ Q a ~ E FV ~ J D A' O .SS zm Am: N 0:2 -le > $ u s,t~ r m v. ~ m IL ~ ~ ® T U CM, o g o-b E m co n C m Q a V u C T C lu T~ p ~N o -j b 0.0 ~ ~ z C Q O s• ii W Q 0 < U) 75 WO..p d a LLB _ ^ o I u I cc (A a o ( I o c.~ ao M ID U V l 1 ~f U E a _ • - • - ~ I I ~ ~ ~ a~+ W •N I I I LL = •v~ ' _ o I I fA 3 m ° " u x ❑ ~ ~ I ~ 1 I m uai u~ ~ V { ! w w wcw`` - p s I I Wt W-- Q L V O Q u ~ N W L` -;-7 m iC d a I- I af }'1 ~..i 3t e t df 7 0 LJ > yt `J soCL ~I C Z ~ ~ ~ v ~ = u ~ j ~ (D [ U II a 0 Lh W > W , E co LLP II 0 z ? i o U Z I 14 Z + a In-ground Gravity Management Plan PAGE 4 OF 4 RTAM: The owner of tm in-groerrd gravity sydern shag bs reeponwible far 8s pwpftW operation and mdramuff ce pursuant to regtlirel o* of sPS 382 384, W1w- A*ftin. COCIM %a=# to SPS 383.52 (2), W hw9 Admin. Cade, ibis systerr, shy be c onsiidered a htsmn health hazard it not ms'inb* ed in acoordw= %th this approved rnwaWmerit pion, Firthenrrorr3, all inspection and rru*ftnance actives shell be performed by a registered POWTS Mob ebw in arx:arc~ctee with SPS 383.52 (3k Wisc. Admin_ Cade. NNELMM RNIN"M Area Ooeradna Urr Design Flow AM gp* BM S 220 UV ; T33:5 hill nVO; FOG 530 RVO InsPersbiott CtrsdcYat MISPECT EVERY 3 YEARS o type of use o age of system o nuisance fackws (ie odors, user cam t", eft.) o rte Ical muf woon (La, punps, valves, swildm% flats, ek-) o notarial fatigue (ae.. teaks, breaks, corrosion, eft) o solids vdume in areembic wit tarWs) and any din appurbenamca(s) [r e., won ! drop boxes) o neglect or i nprow use (ie. exceeding design des. Fxotr~ed advities, etc.) o extent of panning in dr *RN on cal prior to dosing o dosfrg irregufarbes - if applicable (t-&-, p-wW m-cychn% fleet wAbcn seftnim etc.) o eWdrical eornponw is - if applicable (Le-, wiring, co m cdom sMlbdmm , canbnL% tellers, aMnn% oft) o deft button ialeral or l weA orifice pkrggirrg (measure lateral disfal p iesmire - compare to design spomcooon) o surface discharge d dtfue3nt or sewer beck-up into structure served YsfuI wmum Checklist MAiN'TAMI EVERY 3 YEARS (or when n y) O §MR§c and r shalt be PmPed by a cedww sq3tage mv" operator lensed trader s. 281.48 Wis. StM& when the v kmw of soida In Ow tack(s) ww"ds aw4hkd JIM tare Nquid vDkmw of dw mss) or as required by local ordinance. Desposal of contonte shah be pursuant to M 113. Ww- Admin. Code- • Effkrerd f3li"dud be Inspected *my 3 yous and shah be deaned who necessary w remoure arty accumulated sails aooon*q to marxfachrel'e~ speoilicavans. A ewvich period vA aiwwp be peau then 12 nxx hrx. nrpats shag be submNW to the propw NNW go-'a om et unit In aeeonjonce w0h SPS 383.66 Wee. Ad v&L Coda_ nReport any carcpocwrt tbit m or ardher bum tia: Name of MM dud or company: J v ~ 1 KL-- ROD'EW f1 LD Paella- 7 f 92) -1, Z Z9' Local govern meet unit: 5T Cl2nlX COMMLW )Ty C~VGcapnn ENT Rom 715-- 3F&-4W Local govemmeri unit address. _ Nu DSO ~ VJT- Zfl'.~lal j.1 Corte Repair p of tall i Wed be replaced, or mnxk ®d purserant In SPS 30&51 (1). Wien- Ad min. nmi 1uncho ing componwft shelf comply with WS 383, Wisc. Admit. Code. No product for dtemical or physical redw3bon of the POWTS may be used trdws approved by to depwknent in accordance with SM 354, Wisc. Admin. Code. In the event that any taped b eabrm" E compo w t of this POWTS cannot be ri d, it shall be replaced pursuant to a plan suWM tad to the app mpnate agency for review and app z rat- A *dad ire p+ai dispersal oorreponwd may be abandoned and Mpfe W by a node-con>nlym d component in a Pre4elennined area of sealabie sgls. System if use of d* POWTS is discontinued. it shag be abandoned in accordance with SPS 383.33. Wtsc„ Admin. Code.