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HomeMy WebLinkAbout020-1269-50-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 605028 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: Eddy & Richard Burt TOWN OF HUDSON 020-1269-50-000 CST BM Elev: Insp. BM Elev: BM Description: ! Section/Town/Range/Map No: 7q~ CST 7 *p 21.29.19.1329 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI LFS ELEV. Septic Benchmark Z. 14 /b2 7 ~W Alt. BM r WS 14-15; Aeration Bldg. Sewer ~..'I J4, 14.' i~ -_7 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet ~f. 13 11, 3Z ent t Air Intake ~ TANK TO P WELL BLDG. ROAD Dt Inlet Septic Dt Bottom g f' , Z ( Header/Man. dU 110 • d~ ~Z• T Z Aeration 4 11 Dist. Pipe S Holding Bot. System / PUMP/SIPHON INFORMATION Final Grade -71 b s Manufacturer Demand St Cover 1 GPM C~CGe,~ G . ~Z i J J Model Number TDH Lift Friction Loss ead H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches +l~J PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Q ^7 e 7 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ,,,A Type f System: n UNIT Model Numbe 1Z_' 116b' A)Ar- 54-1 DISTRIBUTION SYSTEM 1.74' -3 Header/Manifold / Distribution ix Hole Size ix Hole Spacing Vent tp Air Int e Pipe(s) Length~_~Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only All Depth Over Depth Over xx Depth of 17odded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 11*_1 Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 500 PRAIRIE LN G ~ {►d 4L 4. (~r 1.) Alt BM Description = 6 (~e✓L jkj t(t) 45d 4a 2.) Bldg sewer length = - amount of cover = 16 S C v4- Plan revision Required? ❑ Yes lo r_ t -51 I Use other side for additional information. Date Ins ctor's S ture Cert. No. SBD-6710 (R.3/97) m IL my 14M E WMM*M Ave Camay i .►t~ 1 R p JUN d 4201$ PA Ti 62 ( be MW S-A" ~ ?"diroait, Vn "M--7162 -mintv N it Appika#ion Commum t [n 39313(2), Wa. Alhn Cade ~ rrfdas farm to B+e apprWfiv a Pc na"MMA Wit AJA is MgUMA print to obWlsnstg a Xulasy permit. NJatr AppiKubm Cams Ax gwwmmd POWCS we VAMOW to Adtkess (if d~rmtt tttavt dr Dmulmunt of Sdety aid huhmmW Savitxs Pawmw ' yon pun& my be aw for s Made ry 14 '~`0m) mbmem ~ in amom .0 Wd ft ftm UK s !S. I ou Sly. ~(1 f~~,'Ail2iE l f11~ L laftn atwe mmn lrfat An Prep" Owner's Name t # ~DDy C~ ~z~c.NaR~ ~utxt" ~ Dom-tom'-S~-ooo Property Owner's Mmh% Addt+ea Paoptsty Loestion 17-94 HWY, BS City, Stmt zip code PGo"L I'm ~1, ~c5l. 'h saw t.}uDst),AJ w= IL Type .d B4mdww (&Wk as tba,t atPply) tot t E A t ore c-emity Dwelling --Numba ~r 3 316 nut ivitianwane stud` g'S L>4~oiV~ 3' 0~1 ' ❑ pubiiolC*mrnat W - Describe Use ~ City of O State owned - Doteribo use CDA How O V-dhW of 2- ;s~ If 17f-17 5 T~ or- -J4 IA. Tyw of Permit (Cbwk aWy aaaa m Us* A. t aa*jmM sire H Kappgm6k) A ]-O;~-SYera syr,~m b r t~d;eg Tw* wp tx only t Modtfimu u to txmbhg sysu,a (cqdm) 8• O Pamir Rnvesow O po mil Ravisian O chaipp of Pkmtber O pe mit Tmn hr a Nm Leaf Are iom Pa mit stet bond Reficvc owner ' ZZ D IV. T OfPOWTS SYRUMCM !]MIA an If" aft 15 Q,iNotmrt t 24 im of et»tabfa rpa liotdiug Tact Od+a F3isFsa9s1 Caoepocsat (c:}~da6t) A N Pi v i)erricz { ) it Arm t Iahaa s daaz JA Dtsip Fbaw (grd) De~ga Bait Appticatim Dnpet~sl Am Rai Wmd (sn i~spd~sad Ana (sfj gY~ FJesaaioa ©-7 t',o~fL+ glv~ to/ VC Task Info Capsaty in rntsd s of Canons tmumm units tVew rails t Tarts SONG -LbWWv4jWt r ~ 4 CEO VIL Rmpaudbdift Sttwmrert- 1, tt s !!dttsit.et, arassair ter arras Ma" of at Powm su" e. etrs afdselwa s Phlmt+tr s Name (Print} s 3i~nsmre t+tm*a H UmM fta to Nina s Address (Sftdl city, Suk, Zip CO&) L'S NI 57 C ~ L GtiIZ- 7Z7 A ~t,pR,, ~ O Pbrmit Res S, UL c ar. , Ei vrcniRtr t~tvis'v'e1 ptf 'diSpets*m cell must A bstifcss rn; ant&'. g iawper q'sragement plan -olidedbvby plumbe . 2 All rel6it r~t,tts a►ituittxa nair:t:,ir.E~ m per ipplicnbia c4di 1 ixdinaricn. t[~ Y~ Ee~pp li1R Tr Ite r7M~ r M CAM! M a Yt <r4 sari t to x It t.dss is Sias SBD-6349 (R. 68!14) ~icop 7it#yttZLl~uRT `!(tfs.. SEC . -3/ T ADDRESS ~/Z~Z ~1tAI_y~ S sr. man coum, wismsm Sa-a ~t~e.l~-ems sra.~ fLi&skr(o SMIVISIO0 W LOT SIZE Spad EVERYTHINC WZTM 160 2'8&1 OF SYSTEM tss GUMS. J~Jd ~~eso .0 o tz / r, Ri-TJuAjK ~ r y f-~UAlN6 iF 3C t r r n< F ) t ,5 k i r ~i 1s 1 i t~ . 7~'TI~CNCItE- i P~ ZR,F. ARWW Elevation of vertical reference point: IX.© Proposed elope at site: 7 0 Sa., SEPTIC TANK: Manufacturer- (fit;Se.r Liquid Capacity: jo c p a~1 Numb*r of rings used. Tank menbple cover elevatiaa::a Sank Inlet Elevation:__. Tank Outlet Elevation: -7,30 Number of feet from nearest Road: Froat,o8ide, v-T, (D feet From nearest-property line Fraat,0Side,0R.,0 ~ S feet N atber of Ieet from: well budding: o (Include this infotaation of the wave plot Plea)( 2 reference diNm sione to septic tank) i In-Ground Gravity Plan PAGE 'It?F 4 Index Cover Sheet VWSIOn 0. SBO 7t 4i/t16~R. 1{142) Pg 1 of 4 index & Cover Suet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross ecton & Plan View Pg 4 of 4 Management Plan Attachments: FAcigggm: 3ntFi i rc ( st~cs POWr$ Applicat for Review Soil Evaluation Report & Sifie Ma ANK ~I~-r r2 t s Cs SGPT(c TA-U , aorEUM ON r-111 ' Mzf---> Proyo%A rime I Description l Owner Name<*): _Et)DY C. `4 R,CHAEQ hul-4 Phone: Owner Addnasa: N "35~ t~ u us tz~► zip: Prolet:# Address: _-5,0 a PR ir- t_ Ai t.„-,tkPsaN _ r .t Q0VL li•• ar li Vw• t 114 of N ti.J 114, SectiaKt 2- t T2-,j N-R I --f E or yyn ! Towmidw, -up.5W County; 57: C 9&X ProJeet Parcel ID __l?2 I - 54 - (9p a Designer Information Designer Name: _JV AF y u eettk7 Phone: ?)5 42L Design9rAddress: 214 4 7 Kw6 ATHukps Cf mp ye; e E-mail. OIt i s trJes gn r owlWIo . C-6m This SUMP- Lk4mme Number: ! ~--Kfi - oD 7 Remarks: . A1AAY j0''• HttPP !Frr Diego 1i44y►4"~t Signabire: Date: <r - - z off` y Par PL AAJ aia~'/C~tE l1JuRT `Nt1S.., sec. r T ADDRESS /ZBr ~Iu/Y.-3S ST. CItmx CouM, WISMSIN k ((v SMIVISIOh _Tw(.4-% L-t j-, . LOT gin 2,107 feel_ SWW EVERYTHM WIT= 108 FE$T Or STSTB"i qty!/ 3 6 I 36 r#,,.. ~ 6F Snep a~' i 1 F R t y f`F1~-at~At~ AlNG6 ILP7Ia•r Ai ~ ~ ~ 1 ~ _ SS, Itz i~ IP a~ ki t i ~7 ! ' r V I ! J' ~ a Ast j ~ ~ ls~ .3r:C 7b'7K£NeMeS ARROW Elevation of vertical reference point: 1,06.Q' Proposed slope at site: 7o Ss« MKPTIC TANK: Manufacturer: ,Se r Liquid Capacity: jflOC2 P I Number of rings used. 3- Task -bple cover elevation: -3 Tank Inlet Elevation. lift Task Outlet Elevation: _7,30 Number of feet from nearest Road: PYoot,0 934e0 Raar, (D /IS feet -Prom nearest rv f p [Jest. Pine Pro* Oside,QRaar & S feet butbsr or fee[ tram: Well building. _ 3r3~ (Include this information of the abew plet plax)( 2 reference Jin usione to septic tank) i ~.afly ~ ~~•f-c~r~ .3u~ (;~sT LOT) WAGE 3 OF 4 AL W r ` w IL fit . ;01 ~ Irv to Ll i i lie g cCr LU PAGE 4OF4 1n-ground Gravity Management Plan ~rt~tr: The owner of finis in-ground gravity system shat! be responsible for its perpetual operation and mahhhte uvwe punKWt to regUnments of SPS 362-384, W(8C, Admin. Code. PuraWd to SPS 383.52 (2), Wisc. Adtrdn. Code, ibis system shah be considered a human h xft huard ii not MOWAaifteti In accordance with tht upptmved management plan. Furtivurnors. all Inapeclion anti maintenance aclsv albeit be porforn-md by a registered P'OVtITS Malntalner in accordance with SPS 383.52 (31 Wisc. Admin. Code. Ma lhLualn l~+amsal Area QMWm Lam' Des{gn Flow gpd; WM 5 220 mgL"; TSS 5180 mgC; FOGS 30 m L-' Insa m Lion Clhecklis# INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user comptatiats, elm) o mechanical ma on (i.e.. pumps, valves, switches, floats, etc ) o material fatigue (i.e.. teaks, breaks, corrosion, etc.) o solids volume in arta+srobic treatment tea Ks) and any dist*Khon appurtenarw*s) (i.e., disiribuflwt ! drop boxes) a neglect or improper use (i.e., exceeding design capacities. prohibi{ed adAflties, etc.) o extent of porxft in distribution call prior to dosing o dosing Irregularities - If applicable (i.e., pump re-tyding, float switch settings, etc.) o okK*Jcaf components - if applicable (i.e., wiring, c onnectims, swktm, controlas., timers, atarrrhs, etc.) o distribution iarteraf or lateral orifice plugging (measure lateral distal pressure - compare to design specification) Q surface discharge of effluent or sewage be(*-up intro shuct are served Maintenance CI'h@Ck1st MAINTAIN EVERY 3 YEARS (or when necessary) o 612& Ko s shall be pumped by a certified septage servicing operator lensed under s. 281.48 Wis. Stets. wlwn the vvokarm of aphis In the to tKa) exc eeft ons4Mrd (i13) the NqLW volun a of the tanks) or as reclcrired by local oardhnance. Disposal of oortWft shy( be pursu& t to NR 113, Ww. Admin. Code. o gff#uant fitbr(s) shall be inspeded every 3 years and shall be dcsned wtien necessary to remove any arxxasrtulated solids according t D manufacturer's Mills. A servicing period will alw eye be Weder than 12 months. System rnalrderwaxe reports shall be subn tied to the pn*w lobel goverrhnrwht unit In accordance with SPS 883.55 Wisc. Adadn. Code. Report any couhponant!allure or nNOurrction to: Name of Individual or oomparry: A 60,A) t P C) SZf ric T.AJ.SJ iM ZY~ t~t►oc~e: `715- ~a3 - 337 LocaigovernmeMurk 5r CR.V(). COAkAt~W1jy DP_QEZDPMeA)-t- Phone: 72L- 3k 4fQ Local government unit address: NU ICON r yV.l- Zip: Arry defective part of this system shall be repaired, reptaoed. or removed pmt to SPS 383-510 } Wisc. Admin. Code. Repair or replacement of failed or malftmdJorIthg cOmpch►hertts Mali CWOY With SPS 383. Wisc. Admin. Code. No product for dternical or physicat rest+oratlan of the POWTS may be used unless approved by the dirt in accordance with SPS 384, Wisc. Admin. Cade. Conenssen--y Plan In the event that any felted treatment cOmporaemt Of fhhis POW! a serhnat be m*red, it shall be replaced pursuant to a plan submitted to the appropriate agency for mvlew en4 approval. A Wed "round dispersal oomportent may be abandoned and replaced by a coder-compl, nc3 dispersal component In as pre ele tmhined wee of stAWAe soil. $X*M CM if use Of ails PdWTS is discontinued, it shall be abandoned in ac cordiwice with SPS 383.33. Wias-- Admin. Cade. I N F N LT R ATO R4 The Quick4' Plus Standard Chamber The Quick4 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 I original line of Quick4 chambers, it offers advanced contouring capability with its Contour Swivel ConnectionTU which permits turns up to 15-degrees, right or left. It is also available in four-foot lengths to provide optimal installation flexibility. The Quick4 Plus All-in-One 12 Quick4 Pius Standard Chamber Benefits: 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 mechanism allows for quick installation system configurations. • Four-foot chamber lengths are easy to handle and install • Supports wheel loads of 16,000 lbslaxle with 12" of cover Maximum Strength i Ai Q II ,i Plus i d. I d Chamber, IIM Specifications size Quick4 Plus All-in-One 12 Endcap Quick4 Pius Alf-in-One Periscope 34"w x 53"L x 12"H Benefits: Benefits: (884 mm x 1346 mm x 305 mm)• May be used at the and of chamber • Allows for raised invert installations row for an Inlet/outlet or can be ~ t.engf#~ • 180° directional insetting 48" (1219 mm) installed mid-trench • Mid-trench connection feature allows ' 12" raised invert is ideal for serial rdrM applications construction of chamber rows with 8" (203 mm) center feed, as an alternative to - insetting at the ends of chamber rows Storage Capacity • Center-feed connection allows for 47 gal (178 Q easy installation of serial distribution systems awrt Heigh Certified by the International • Pipe connection options include (15 mm), 5.3' (135 mm), Association of Plumbing 8.0° (203 mm), 12.7' (323 mm) sides, ends or top and Mechanlod 1 officials PPM0} APPROVED in