HomeMy WebLinkAbout032-2172-04-000 (3)
erisco-sn DQDa^menl of CDmme'oQ PRIVATE SEWAGE SYSTEM CD`''h
Safety' and B~ 10-g Division St. Croix
INSPECTION REPORT sa°.IalyPe•mrtNo
GENERAL INFORMATION (ATTACH TO PFRIO T) SAN-2018-275
7a le Plan ID No'
Pe'SOllal Informal on you FrC'JICe IIIUy LQ ~sQC 'O' S1'CCrda'y DUrDC5e4 IV hVaCy LaW, S 15.a< i' ilm)I
Fcnn.t HC'def•s Name
Kris Kopp coy vl ago rouIsnD Parcel Tax No
TOWN OF SOMERSET 032-2172-04-000
JSI BDa E P. I-so 6M E ce BM Deser Dion. o,.Cto Tuc,o Renge;l'ap Ne
18.30.19.1444
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
SDpnc 1..~
i1 ~ eencnmark
Dosing All BM
Aeration
I l Bldg Sevier
~.2 107 i
No Ding ~ , S H; InI t
TANK SETBACK INFORMATION svrltouuet
TANK TC P:;. WELL BLDG. 'ell to A, o-take ROAD U7 inlet
Sectic D: Dot:o-r
i
Ucsirc headef.Man
Aeration Dist. Ppe
Holding
Bot. Systen'PUMPISIPHON INFORMATION Final Grade
fA3%faCll.ref Demand St Cover
GPM
Model Number
TDH Lift Friction Loss Syste•r Head TDH Ft
Fcrcemain Lere:n Dia. List to'vVel
SOIL ABSORPTION SYSTEM
BEDiTRENCH 4vld1.1 Lengtr No 0• Ire"chex PIT DIMENSIONS No C1 Pits 'isiCeUla Lirux;D,0,
DIMENSIONS
SETBACK SYSTEM TO P+L BLDG V.Fl LAKE:STRFAM IEACHING IJar utacturer
INFORMATION
fypQ Of SiStenl. CHAIdBER OR
UNIT P,todel Number.
DISTRIBUTION SYSTEM
HeacenManilplu D~s!n DUbo° I Hole S?e x Ho'Q SDacir•g Von: ti A r Ir l.; v.e
? pets!
'_engl• _ Dia_ Leng'r f?rJ Spa ping-
SOIL COVER x Pressure Systems Only'--- xx Mound Or At-Grade Systems Only
DEFIn Over Depth Cver xx Deoth of xa Seeoea; SOICe, I
:eQtTre,) ur nte' e", Trench E +x .I iIChetl
dges IFpsoil Yes No Yet _ ND
COMMENTS: (droll --ode disc'openc es. oersons p•esentnt. ex ; Inspection p1 Inspedion al
Location: 141 '53RD AVE _PW~?gb, "U c-1(1'x;1 9a tll to /1 IOU
I ) Alt BM Description = (/\S (.0wl •,twe "All ~/~~I1 ~ b~ wli, p
I' IL~ rI x1 O
2 ) Bldg sewer *09t, = I~ r 1 r^^~`wt' ,`~T 1 S l t-a`CL
- amount of cover = t (\C (1p
If i W P
Plan ~ison Required? Yes III'' No
Use other side lot addi:'ora' informati n. _ l I'All
<t'
J
Date -
6].,:.."0 il? 3 r5'1 ViiC1>f $ignJLre Cut 140
5~+~ aoIg- 975
~ps9 County Sanitary Permit Application
ST. CROIX COUNTY WISCONSIN
~ coo kyA In accord with Chap ,:l 1 ^ SL Crorx reunlr 7yulary lydrnanr•c SL CPLANNINGOL1N
Y DEPARTMJh
HOIX 8 2ONINGCC)
LR! ENT
y Parsonal ,nlnnnahon you provide may he u' c:l^^,rti• Gr rndary pbywses G!LNT CFVI6R
(prvd:y I a'm. S. 1504(1 Ir
$ k ^ tar n41)l Rua-
- WggGn. 'v`!I 54015 77'0
i.1- 3864680 Fast/15i388317.416
Attach complete plans [or the system on ran.. : SS an 11 ircl. In 517l'
Comity Sanitary Psnnut X LJ Chnek i' rc.n sign Npre •iJUS a(~Ngc_rL::n
I^
t r Z
Application Information- Please Print all formation
Propcry :ieT,r !J:ar x. Location:
/ d (F
1 4. Se,..
1 I N. ry R Li cW
Properly OW110 i !Aailng Address
I of Number Block u r
ity, Sla;a _ Co Phcnu N'111.
t/iJ r JO ~ i Subdiv'sio:r Name or CSkI ,Number -
A r
II T c of Building: (check one)
v
F ?Far uy D I'nJ r ::ar, ~ CIC- lxiry ❑ Vllldy 1 of
m.
❑ h
St-itnOnntl sled
Il .>I lv- --w~M
II. T
A[ wAj ype of Permit: iChack We! • n c box o
n lire A- Check Mx oil line R u appl.naaci J ,
RO ❑ RJ palCnl lax NJm er!si
pair 'tecunnoclirm NJmplumburq . ❑RJju•:enat oil
San lal. on
Oermu Nu vl:er Dale Issned ! / [
Stale Sanitary Permit was provioc'.3, sF.". J r _
-ol-f 'O.V`rTSYsle>n~ deck all that apply)
:on pressur the inground L. W!vu•rda It, LitUble I UMuund nlmir ~:,I
❑ hlcund A.0
Sand 1- 11" FJ !.c!rstruc0.a Vfellan9
❑ Pres:tur zc+n In gm!mJ n Peat Lillur I,] Drip Lou
U C HnCLny Tank V Smyle Pass Li Iher
At-qrade ❑ A•,r-Aw Treatment Uni! II HeCiroWalinq
V. Dispersal: Treatment a Information:'/' r
L I lion Few' igpdi 2. Ui. r _r of Aran 3. J.rpCrsai Area 4. y i Applicut nn Rai:, S P-111POn P11. G. System Llcvalion Final Gmde.
Rcg ur.., proprgcd iCiul..,.::: a;nt.o. ILI Oita. rinch
'C OC - LletvallOn
I. Tank Information udpaicty in Gavu'vi 1clal P M Man
ufnGlr.rer :h Con. S1Jal FbCr- Viastic rel4b tJCw Enrstny GaF:: re. lams C011cwi Jna+;le sbucled
glass
Tanks tanks ,
?J
❑ F] O ❑
n n n o ❑
II. Responsibility Statement
L ;he undersigned asti.InJ respnr 'Rniiry'or rFfar:r -nan luvnrncnat crv'n I.
livene -s not rcoen 1 allalim, GI nan-phrrnbin0 rnr ;he POVJTS shown on the attaentrJ plans A
W hg lonu;ut repair or Ih• ms1- of 1101:10
n-plurrbinJ . rr it..lion system.
Plr. Lv r c Name r r 1 Plambe n' uu'J (n
rr[(pp ~ ..reps): A!RRS No. Ryl;incag phone Nr bCr
PIumINS s Addrts isle et. Cly. SIa1o q del - '-n- / ' ~ r
VIII. County Use Only
°:ced Sanitary Permit Fee U-tr t„
App.oyr., ~c- I>aainq Cpl Siynatu• r. ui
<i,vr•Crn . AdvarsC
IX. Conditions of Approval: Reasons Ior Disapproval:
SYSTEM OWNER: -JV
1, t itp(ic tack, eRIG6n: life- Old
dlspec:a~ cell sus; al' be s^_' ICis 'nt4,i ec
as per aw:ayemen'. plzn pIG ~oenbv plumber.
2 Ail 11EAlG'If IaSt,lrxxrus mast be rsutt: e~f
as W rpiio" c4W /:rdira76aT.
I j -
. pt
` L r
1 1
.
ni - _ ~)DID
~ c CcY, _
i
Wiscenyin Department of Cw nlerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety arc 8olding Dvision
INSPECTION REPORT Sawtnry Permit No'
578928 0
GENERAL INFORMATION (ATTACH LO PERMIT) State Plan ID No
Personal mfOrma6or ycc p'ovide may he used for secondary purposes (Privacy law, 5.15.0.1 !r;i m;J I
Pem`s HOdees Name. City Village X Township Pafoe Tax No
Kopp, Kris Somerset. Town of 032-2172-04-000
CST SM Flee ,sp. BM Elev: BM Desupl.on Sectwnftaw RargeA p No
ST _ 18.30.19.1444
TANK INFORMATION 11
N ELEVATION DATA
TYPE MANUFAC URER \ ! CAPACITY STATION BS HI FS ~E/LEV-
Septic Benchmarx
' t All. BM Nk'( U 169• -z <
Acnahon Bldg.Sevrer IC'.7
Ti; trig . , - st„t,nlet
StR1DOutlel
TANK SETBACK INFORMATION 15.~
TANK TO P,11- WELL BLDG. / to Air In lake
(1f Inlet Septic `-j ]ROAD)
DL-8 R Header/man. I0-2
eA-r lton Dist. Pipe I U 7.
He In9 Bot System N I r. t ~<r,ll.r t_a
PUMPISIPHON INFORMATION Final Grade
Manufacturer--- ChM d St Cover I rj7 4 C C7 - f
Model Number /f n .fir r
Lj.Z, ~ l +
TDH LiM, Friction Loss System
H - TDH Fl ^i(J
_ pG'/I '(C YJ
Forcemain Stn Dia----- -DS! to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Wdln I Lengtn ~y l NO O7 ttcr;,nes PIT DIMENSIONS No 01 Pits Insloe Da. bqud Oeptn
DIMENSIONS
SETBACK SYSTEM TO `f Pt WELL LAKEiSTREAM LEACHING Manvhctder. I
INFORMATION ~~BLDG CHAMBER OR nTJ I~GJ
Ty O(System. i 'A f UNIT Mooel Number
DISTRIBUTION SYSTEM )
Heade,,Manllold 1 nOr Wien K Hole Sae x tick Snna'g Vent to Nr (make
e(s)
it ength. I I pip Dia Lergih _ Da Spaang - v o
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Q(1 ii
Deptn Over I I Depm Over Ix" Dean of xx Seeded:SCdded _ xx Mulchec
BcU•Tronur Cen!er 1 ~ ILI BaCTrencn Edges Topsoil Yes = No 1*1 Yes
- No
COMMENTS: (Include code discrepencies, persons present, etc) IIspecbon AI Inspection Y2:_I_r
Location: 348153(d Ave Somerset. W: 54025 (NW 1:4 SE 114 18 T30N AT 9W) St. Croix National Southern Estates Lot Parcel No: 18.30.19 1444
a u
i.)Art BM Description=-~iIItn' ltl'(r TU~ i f(`•;,, ,a',6;1 4'T, ICL.~\ ✓l
2.) Bldg sewer length - (.)(4 I /
amount ofcover = (UP1l jjb F )fG~<<!~
NM. Gn all Y/~I Q ~I(~
Plan revisicin Q
Use other side for addi additional informati `r. o ti I
Dare Inup.]txs Sig afure CeM1. No
SBD-6710 (R 3187)