HomeMy WebLinkAbout020-1162-70-000 (2)
16's ons,n Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix
safety and ItLtdna Di vs on
INSPECTION REPORT sancay Per.-1 No
I
SAN-2018-348
GENERAL INFORMATION (ATTACH TO PERMIT) Sta:e Play ID No
Persc~a nfn'ma:ic, you pmnec may 6e '.see for secerns^J pu•Peses' P l-vacy Las, S.'5 C4 I I'iml]
Pe'ml: Ilc'de- s Nd-a Gtv Village Teur's'rilt Pa,sel Tax No.
Greg Bauer TOWN OF HUDSON 020-1162-70-000
^ST BFd Ple, nisF. 81.1 Elev 3R' Descfirl On SeC70n:TOan: Ranaer'dap No
166 .9Z L 29.29.19.934
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION HS HI FS ELEV
Sep: c ` Berchmark
~f; 6h a weC /O
Dos ng Alt BM
t Z 417-
Aerator Bldg. Se'A•er
EtieL
Hold ra St-HI Inet
r
TANK SETBACK INFORMATION SO 11 Outlet
TANK TO tL WELL BLDG. Vent A r Irlake ROAD DI In el
r-
Sept c -33 7z 33 cf3 I - Dt Holtorn
Dosng Heedertufatr
rte fl,ri p G /3, Lb ioa . to
Aeration Dist Pipe
Holding Bot. System
Final Glade
PUMPISIPHON INFORMATION
Nlarufeclure: Delman- S: Cover
GPM
Mc-el Niumber
TDH LA Friction Loss System Head TDH Ft
Forcemain Lenglh a D st to sVe
SOIL ABSORPTION SYSTEM
BED,-TRENCH '6-17 Lerglh No f Tr . he: PIT DIM NSIONS No. O' Pds Inswe rh3 Licuic Dep:h
DIMENSIONS Iy L~ Q ` 1
SETBACK SYSTEM TO D P:l. BLDG WELL / LAKES IREAM HAMBERG Mn^~u'aC:u'er
INFORMATION CLEACHI OR
Type I5ystem. UNIT
V I•I~VY~Q \ `
DISTRIBUTION SYSTEM
I lcada+6 a-JU J Distrio.n- x f.c e Sae. Ix Aclu SPas~°p `Jeoj-to iyr ln:_aglt-
P PefS', F/_ xX
LcralP Iha _ Lon II'~~ -_-?R
SOIL COVER x Pressure Systems Only xx Mouh2f6r At-Grade ems Only
CcPR' Orr DU Ltd Over ex Cep1F cf xx SeededSoJcec xx ldul&ed
Bed:TTerch Center Bed:Tren6h Fags - 'opt- - -
- Yes ;No Ye: No
COMMENTS: (Include cede c' screpencies. persons present. etc.i Inspect on pt Irsceccor p2.
Location: 7270REENBRIAR RD r I CC 1 (r'~'~~ L~`'^ ~U Q
= T~ Co hGfQ~FQ~. C-rO~, U1
1 ; All HM Descn: lion .l-
2 ; Bldg sewer length = t1 ce' G
.anoint of cover= xtI i ' 1 C0 Gil ~+2f 5 Q?
Plan revision Reymred9 Yes Xlo ' 1 t r Q - S°
Use other side for addmona information. ` v
Date InsepCC's Si a:ve Cen No
SBD 6713I11 3W',
.r~~ •f.~ r
t .11' .+,Q y Sanitary Permit Appticatfor ST. CROIX COUNTY WISCONSIN
it a.:t r~ >,i 7. 15.04 St Croix G;urty Sanitary Urd nar -e ZONING OFFICE
~ y ~t,6 1 ~CKjy'r~l mfan~uon you provide n~:y be used for se „Onagf/ .,..rposcs { OT CROIX COUNTY ;;O\4RNMCN I CE!i'::R
' iip1r W (Prvarr'.aw. b. 15-04rjft
.4r 1 - I 1101 Carralchael Road
gf i - Hinson. Val 54016-7710
._,-_„--M. _ ~T !~_-a If 1izc. 64480 Fax (71>j336<6i;ti
hP~t~trrlpletr ;.:rs for the :.y sleet rxr -f1E t a: b 1 x 1 i in-che5 in n -i2a ~
r.r S 6 ]fy Perm, i; ❑ Ct•r:rk %revrsie^ to _viocs rliGd:.on t f
r -7 icy -22L4f
4ppiicafian Information - PlOase Print aH In`o r eio Location:
• r y Oardr Nam
lp. L l
-T .:.tY'Ov.e:s)1 ne, nd J. e•'c wtIN JNcmbe-
h 7a7 Cy11~~~! 6A-E d K 21)
i y. Slate carp CodL !1~ hire P r nr Sd : ;sun Nwr.e it C !J Nut ber
r~(cc.c7Son! w+ ~Svo1lc c r-flan-~z+~~LF c.~Kt:~y l+t~[
s..m
F,. Tvntif f urfdlnc cheek ono} amity ❑vr lagc _!'nv n
y o[ i r I:' Lv e Ilan) No. e:l Redroorr>_
fdes(rco use.'. ffl~
Nuarosl
~n..r.~eo.~oo.~ C~P.CEN B211~t'. PD
_ Y - e cf ° retie C:r•-eu uay ire box a.r I ne A Chr:ck box cn ine B ;r apFtcal!e)
Parcel Tax N'ul bcr(s}
rj 1.~rtepar f' Revunne.-riot 3.LNon-(iumb;ny :.QHeju°:enation - ~ J ~ ~ f llu -?u q. `:moo 83wa'un A1, -d
Perch Nu^15c' iDate Iss A!:: I
!i I 'Sd Sea's :>anilery Prnnit wae, prc'.iously i5ucd :7 - jr
1iC rOP7T SYsK'n' reek all thatapply)
1, it crr.,surze Ir y;OU^sl ~~jC'~
6'.ound ? Sa^c Fihet Cl Constn; -ed ri ueUene
r n•_o~ r-;p<;.. r. t=, i!oldirg Tans -,l Single?ass Q Dap Ura p
r - + G ,m",)'. rua'JnUn: U:.i: ~_I RCr.a'C.:I2aI W_ t-1 :,•htr
p e. rp :
7. cnimm t A n Infornia ion..
-:.41 F< t.~rC "a xna•A'e3 CSrl-rsa t 4. LI 1'in Ralf fete('. -aC.ot n..t-; 'ti System Ee.allcr
{-Final C-r
PhD ,r2u;ui,e1 ~rcE.sed G 1_•..a.isrl it ,Mn -nchf i ~Elc'.aficr.
1 t. rankle fnfofn:atiun Ca~ar ty r1 C i,orc; -iota S of D. anufad.cer 'r -.fhb Si c Ccr. ; Sloe? Ksbor- ' Pia Gc
fiev s,a•IUrs lark* Concrue SI ifL
arks far k, I
^r G. ey cce,sibility S'ta:ernent
c e r a.silned a er c, e .p,,r ii'h (cr n.pa r e J ne t en j ina uri ryla!Ir.Gnn O' ^Or pl rbiry for ae PO:^: fS s':o:•;n c''hc zltorn. d p:.+n::. F.
1 - r_e b nu r Q,,irdc f:-.: rr-• h reaan or 1`e n IaI2 .on of non Lluriti•1 do lati Jn system, k
or .1,"s 1 rn- ;pn t ~k u e. s Srg: a:.,re (o ran,p5)._-- M, t t?RJ N- o. ~3usiri ?.:ant.NU n .
lL.u~fc~.HEC+IVyLLt^ ~a v ~ wkJL- fro ; L 7`('i 3 2?
r IuTGU res :Stn-t, cif; St 1 E Li:':
Jlit. tawny Us', Only
f
rl'.5. r v l'. i..CLA: y' t°efrlil Fc : I )tiIP Ic 1 Issuifl "°ryC ~.t airy lalL ' ~r'.? E t r §
S rP(1
LCI:.:•d
C"Arne (71;; V1-
lb ~1Y t: onn: e.onslIof AppravaPRe"Om; for Disap;:roval: f I
4z 1001
rUµiY 4ir ( bet ".1 ~py~rc. n W.
r lkra a ~ ~ I
Form -STC-(04
AS I:UILT SANITARY SYSTEM REPORT
OWNERTOWNSFIP SEC. ~Q - RI
ADDRESS ST. CRO-X 00'J~lY, WISCONSIN
SUBDIVISION LOT C- LOT SIZE
?LAN VIEW
Biscances and 2imensionr. to meet requirements of bLH2 R?
SHOW EVERYTHING WITIIIN 100 FEET OF S.nTEM
/+eus,c
J ! it
I t t~
~•vr ":r-k
rf
+
I
INJrcATE NORTH ARROW
BENCHK4RK: De.^.cribe tae vertieul reference point LPed
Elevation of veri lea: reference ;C'int; Proposed slope at nice: _
SEPTIC TANK: Mar.ufactcrer:~'~+s L?quLd Capacity: ~fp?~
Nunber of rin6gs us,J:
Tani maaho:c cover elevation: F
:~1~~_
Tank Inlet E:evatioc:-/iX~ Tank Out:cc Elevation:
Nurber of feet from nearest Rwnd: Prent,O Side,O Rear, l2y /
Frog nearest property -'Inc Fror,[,O Side,~Rear,O ,-.•.c•t
Number of feet -role: ws- bu'12Ing: VV
(include chin in-, ormat ton of th~ a'oeve ;ant plan)( _ reference dimensions to cept It tank,
ST. CROLX COUNTY
S:-!P'7 !C AGRE. ivENT
OCo'S'RS LP CER iiFI A71O N F0It':4
,i 77 l~t4.f-~tlg2; nt( r~~,~- 1-~~dccnl l.~ 1- S'-ic fLp
Ps,pern, A33rass
=DC 333 required otc i'iaLninc K =Dune Dtpanment for nt+w cv~: srua:ion.l
r
70
TLEGAL DEESCRT-PTION
1~-'1!1:~`~' 1 \ n I q TV, Town o ~IJIo Jam/
Certified Sun eF )lap;;
'Warranrc Decd r
Spe aoue y> _ r, t Imes tee nail: E :I _ n^
5 STEY \LAL\TENA\CE -A-M) )'W-rIk-ER CER'ILFIC:aTION
L=lpr:9;,e: `L""•: n= S;°ri itl':Sn:. ,:Ir i:"n!i: - .;~2:~ ~ALLf C....~' L' ; 5 j?; =1rtaTU*C .~:CC[' t LL:L: F"v.. - _"Dp::
]IlGA', ~37..e CAtSLQ$Of -,ur 11' :J°-':2.1li' vtn t';-_ a.. Or :4JUL0i. 12 L°e] a:iJCP.3C=pl'MM ,1li j'D_rSI
tLe ~m ::zn aut:.t ,`ut:ioL o; tie. optic :ani a< a eatn',2nt rtz_- ¢ ur F"-ce c;,:.,_ st2a ✓u:, maintcran:2
7. • S. <rnt}' Sar Crur" cc.
er,
respo faai ts'se sr,2:ifi_d is ,:nC ;Si.= 7 u)d s a a: n-
-ie ,t_, n::~or r °cs to sl nit t S_ C7-- iC11137v ?'a-mic:_ G Zo yc D2nar non: a c 7ca~ion fay simti b.'tat
ov,,Der arid Sv a =a:me- plume,:, ion~ey 3r ab_:, :e. uic d 717i7.;e or z li::tn td a'rtne- vt- i::; tha: i;7j the on-site
WiS:eF'8e: spUsa7 57, L 113 D70pe7 ]Y„^. a:ln_' :AL:SIOIl an: Or l-t aIPS an and n_TnRi7`.~ i nFJ:.Y^S=Z':. the 52:,7: :aLk is
1e~i Li" _ ` I1tJ i!: S7ll~t.
1'wz, _ie dtrsi td havt read tie alx.ve ,re?uir_•mmis and a--- tr main:au: LL' sewage disposal sysusm ui:t the
-ht _ ",t,anmen. o-: Sa:. pn Prefcssi,na] Scn:cts and 3e Dt anm :
=)dar~ se: fx,hor as set fr. _
Sta: e' a c~ Rrsource .
5-a -,!z :}iat V.I-= scp5:. vsttm :c ie2r a.Lr.:ain::c ni-zZ compltc:.d anj : et.t:tisd t. tut _~`t rniz
trp :a:n dat
C,mm~ i'la .n g on:ne ?tr a~ 2nt iL iL dz;'s o: ht tree Year
:`we c.°rd that LL saran-=n o7, hes::, my~o'~ im:±u•L•3ec. We an a7. the owne, j of :ht
runt v dcsaiued a:-,nve, b\' t"i-ue of a F"`. aL dt9::9aJrntd IL f: t' siw of D ds ~C
\umt r oS' vctroums
~IG\~zTUPiO= CSt DATE
`•`L ~y iyorm=on ILK L Mi.= :eseLttd may :en:h W the. >ari:2 .:aei-g -evoy cd t•. the ?:ar..n;n_
1=1'xie dLIS e rtcordtd wa=ncry d---d i= zu die - _i:t. of Dce1 Ofkt- and a : ony of the :;.sr_5e= cm,e} map s
refwen::t s ma:ie iL tit wa_-za v d=_
(REV. 041-1)
j a - - - - - Form - S T C - 106
AS F:UILT SANITARY SYSTEM REPORT
OWNER-~/r T
TOWNSHIP _ tlgal
SEC, a~?t-R~ W
ADDRESS _ ST. CROIX COUNTY, WISCONSIN
_ Za" 4p-s
SUBDIVISION ~y LOT LOT SIZE
PLAN VIEW
Distances and dimensions to test requirementu of ILHR 83
I
SHOW EVERYTHING WITHIN 100 FEET OF SYSTN_Y
Ne:ae
1 as ~ 1
I
i
~h 44
INDICATE NORTH ARROW
n
BENCHMARK: Describe the vertical reference point, used 4f,/u t- i C!'
Elevation of vertical reference point: -160-,2--- Proposed slope at Nita:
SEPTIC TANK: Manufacturer:
Liquid Capacity:
Number of rings used: _ Tank nanhole cover elevation:
Tank Inlet Elevation: //!2/ - Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side 0 Rear, J m, feet
From nearest property tine From r, Sid'! Rear,
o feet.
Number of feet from: well V/e building: i
-7
Qnclode this informs[ion of GF.e above p'_ot plan)( 2 reference dimensions to septic tank)
DEPARTMENT OF INDUSTRY. INSPECTION REPORT FOR SAFFTV 6 BUILDINGS
DIVISION
LABOR a HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS
BUREAU OF PLUMBING
P.O. BOX 7969
M%yPISON, W 153707
SWst,n1k,629,T29N-R19W MCONVENTIONAL OALTERNATIVE aN. LON Mw
DI.NrI'•Ml
Town of Hudson L Holding Tank ❑ In-Ground Pressure 17 Mound
Lot 5 Country Hill
NAME OF IEMMIT OLO[p ADMIfa Oc IERMIT XOLOf N INEPECTIDN DATE
Ardis Brandt R.R. Hudson, WI 54016 0- 87
at, IT ELEV.. C3TRE1 IT ELIV
NCX YARN IM1Urrwl rNnF.n peml MEL"OE IF DIEIEafMT FROM FUN
Nvrrr of llur'br 57(7 . CeumY. - nwv rmr r
Calvin Powers Jr. St. Croix 92551
SEPTIC TANK/HOLDING TANK:
MANUfACTURER LIO.ocAPACIrV TANK IN-111 FLEVQQ IANKOUT L E T F L EV.. IROVIDED IppvlllED OVER
/v /•2y ~~0.9L ❑YES ONO ❑YES ONO
NUMBER OF' "DAp "oIE^TV tit NDMD VENT
e[pDING V(NT DIA. VENT MATI ALAIN LINE AIN MIFt
FAREST M
IFEET
OYES UNO ❑YES CIN NEAREST
DOSING CHAMBER:
FGAFLONS 4C TLWEA 110UIDCAPACIIV PUMP NDpI Pb WSII•MM INOVIDEO OVtN
VES ONO CIND EYES ONO
PEif CV LE: AI AL FEET RrIjIfil NUMBROF ^oILOINU vpFRENCE t TWEEN ❑YES NO NEAREP ONAND OF F)
SOILABSORPTIONSYSTEM. Check inesoil moisturest Ehedepth Dl plowing LfN<.ro D•ANt iul MA NrAI An~NANNmf.
`FORCE
or excavation. (11 sl can ue rolled into a wire, construction Mall cease until MAIN
the se l is dry rnnugh to continue.)
'ONVENTIONAL SYSTEM: .NUID
wmE
No" - LENrT -11'0 msvr r ~ AuNC GLT-'- ..A Drnn
/TRENCH BEDENSIONS `.L InFOr- 0 M ^'A• PIT
DIMENSIONS / Z 7 ~T " L A w
9ILI,
YLL ILL O! 11- 01 R PPPF I Rf 5 I ME~FTF A.EIA_ VO TR l1MBER OF BUILOM4 N SH
eElnwrlJES o y r rXWER f vljNL• E vENO IT"' FEET FROM ` S
L/ / Z 7 Z~f NEAREST-__
MOUND SYSTEM:
Mpundsite plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA
meets the criteria for medium sand. TIONS MEASURED.
❑YES DNO - nua I 5 IVAIIEWWI-I I
IE xTJNI _ eENMAAI NI MAnN
MILC E s
OYES CJNO ❑YES ONO
or,AUvERTAFVCH:etD --DU ~nov[N tiiFLCF'6FR- DEer+oc rorsoi i%nn SEEOfa u-°Heu
CINLEfl LI%if$
7
DYES LNO ❑VE _ ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM: II LW" 117 HA rv V a
nttH. LEN4 H OOF LAIEflAI EPACING GRAVEL DFITI BILMV IIIF
BEDITRENCH 1Rl NCXEs
DIMENSIONS
MANIFOLD U NANI OLO DrIn hlf A Ir r fRIAL MTI OISIN tali rfr- DISUIIOUIrTI}'i PI NA VUAL MANKIND
f1 EV ELEV 0.A ELEV 1015 UTA
ELEVATION AND
ORMATION RREEILV IAIVfrv NATERiAI VERINAL LI R [ NUL Ip A11ROVfD
DISTRIBUTION r•JIr SVE OLE PACING HEED
INf r.Aws C YES To NO OYES ONO Nu
COMMENTS: FR wl I I a sERVATIDN wEI LS. NUMBER OF uhnivoltlTT WELT B11nDI
FEET FROM I
❑YES 'C1N0 ❑YES ENO NEAREST--1L__
Nr nZ k1
r 112
z~
2
~I.13
~.n`t~ t If 3
Sketch System on li i in county file for audit.
Reverse Side.
sR.NAruaE ~
Zoning Administrator
DILHR SBO 6710 (R. 01182)