HomeMy WebLinkAbout004-1061-80-225 (2)
PRIVATE SEWAGE SYSTEM S-
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INSPECTION REPORT
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GENERAL INFORMATION 3acr _r,
-R.,nd gre'rral'.o~ "u pT n - ~ uneG T:- r .n0-i-r pw., v5~~ _aJ 15 Gd jirc},
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TANK INFORMATION ELEVATION DATA
656
I'e:ahar, 'uri ssvur , 11
(n- 94
::SUH' inlu; ~IOV •6~ 16,o) I:il:hC OUae7
TANK SETBACK INFORMATION I ~
14Nx'-- r„ ,r.. :en: hlr mac• ~G- ID: Irate'
7.5 '79
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~a S ' 7-9
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PUMP.tSIPHON INFORMATION
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SOIL ABSORPTION SYSTEM _
BhJ.':HEN.^-H .e..._t -mn[^,e, ~'il U;fdFN:I DN - ^-c1... raim 'r: _qm: Gr-~fr.
:;cTNA"P:. Icy!',_!(-_ LEACHING A4ruf:ra_rv:
~ INf-DRrdAIIJN f._ GHAFSHEF' ~
y- "err l1r SH I r `I UNIT OR W-".! %a.'".
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DISTRIBUTION SYSTEM
r•1:~~ e'rr _i[..m:n--- - ^¢,r.: i~l_SUenn: I`: er qr m- 'I`I- 1
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SOIL COVER x r u21 rms Only xx N,ound Or 4r ram S: tcmr. Onyp
R 06
IH•-d .u-. Nc
I
COMMENTS: inrl:¢IC Coe ol:•a=nenuc:,, pes _~ns c-.- =.r. eG.S ins1n::_aicar:~+ ~n__:-a~.r
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G° County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN
- In, accord with Cnapen 12 St. Croix Count) Sanitary Ordinance PLANNING & ZONING DEPARTMENT
Fer~tirlal M0111hatron you Provide may be use: for secondary purposes 57 . CROD( COUN'. Y GOVERNMENT CENTER
fPriva%Law. S. 1504f1)(m)) _ 1101 Carmichael Road
iudson, WI 54016-710
1C
'715)386468C Fax. 715)3864666
AttaC'}compiete Plans for the svs em or paper not Mss than E-1,2 x 11 inches in size.
.AUU)!~3" ennL ~ I ❑ ^ a]pflC~!i]n
1. Appli ation 10form ron - Please Prim all Information Location:
FfPPL•R)' Ow'}(er NaRrc /
2 7 /lI ~ 114 0114, Sec Z b
fA5 5- L~/L/~/l Z N, R SEid!
Property Owners IJ:alimg Address ..off Number Brook Number
: Hq, State Zip Code ?none Numer Sjbdivisnn Name „5 uniPer
.Aj w Spa z 71 7/ 9,5 2 3~es (/o -Z
P~ s' 2 ~s
II Type of Building: (check one) ~L i[)• E Vil,ape Z-Tovm
UK,, or 2 Family Dwclllpp -No 31 Bodronms.
❑ Pudli:J::ommercja! (des6Tibe use!:
❑ State-owned earest Road It. Il. Type of Perrnl[ (Cnecr ony one box on line k. Cheat box on line B H appBCaDle,i ~ z0 T
Parcel Tax hlum]egs` a •.~8. 15. 41S - 3d
1.❑ Repair Reconnection r Non-pl.mtbing .0Rciuvenai>un
A) oo'f-/obi- BD - z zs
Santta nn
B) I'X Permit N~m]er ^7 'Date Issued
State Sancary Penn'r, was Prevnusly issued 9 J Q l -,~j - Q
IV. Type of POWT System: (Check all that apply) _ - ~1 _ _
1~10~r1L.
C Non-pressurzeC In-ground htounc - 2t in. sintaok sue: IADund 5 24 in. suit3]ie s]G ❑ Mound A-0
C Sand Filter roeteCVtleti3tf~- C Peat Filter C Drip Line
C Pressunz°. ^ m-ground ❑ Hoidmg'ank ❑ Single Pass C Other
C At-grade C Aerobic. Treatment Una C Recirculating
V. Dispersal7reatmem Area Information,:
1 Design Firnv (gpdi Dispersal Area 3 Dispersal Area 4 Soi Appfi-abdn Rate 15. Percolation Rate 6. System Elevatior 7. --inal Grade
Required Proposed (Gals.idny:sq It .1 (thin hrich; Elevation
D 7so . 6 ` 7. 1/0(
N. Tank Information Capa=y ir Gallons Total S of Manutactdre~ Pretab She Con- Steel Fiber- ! Past
iC
New Ewsfing Gaiiors Tanvs Conxeie stvicec glass
`anks Tanks
G b7 ~ r . i ~ ❑ ❑ ❑ ❑
II. Responsibility Statement
! the undersipned. assume responsibility for rePair'reconnenction.he)uvenationfiinstahation of non-plumbing for the POWTS shown or, the attached plans. A
ii unse is not required ron terralifl reoety of the installation of non-plumbing sanitation system,
Plum 's Name (print; PmmbersS4anawre (nc eta s)- MP1149R5 No. Business Phone Nurnbe-
o ztom ~
- U ~C3rJ z zb z i
PIu be' Address (Street, Coy. State, Zn ooei
C_ c S c c~ 072.
VIII. County Use Only
- Sanitary Perme Fee Date Is Wed Issu _em Sign to s ps!
Approved Ovmur r" mina. A v . 00
`O Z ' ft
motion O
IX. Conditions of Approval/Reasons for Disapproval: / L
SYSTEM. OWNER: 3~ 7 S`C+^- %'S
1. Septic tark erflL%n ufle n•1
ulsp2 Crll nUSt ill be ! - 11__ _ iJ haw~„v y~ /
aS ref tar'ryrm Pn n •iU~ rNODF. 1
2. All aeRMr;k tecuMC^ens m'ut uc i-~ r-t. ii c
as per irp kcal o)d: i ; frf mire?.
Rev 8105
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SI'. CROLX COL-NTI ZONE\G OFFICE
CI(R I' FfCATIO-N STATEMENT
I'OR UTILIZ 1TI0\ OF E3ISI NG SEPTIC T:-\K(S)
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Tom I Cdr ?,'l. S?.. Crcux COIL-17d `,i-iS: r s
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-o iner,jmrt:Il°:'J:.: Oi CorCC. 34.`;, and it I1C:`i
Most -event e u~,pec:io_ or sett i~:- -Z J
_ack occ_r f-on1 ah orp::o71 ;',~st r.' No
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Wisconsin oepanrlw,e of commorct, PRIVATE SEWAGE SYSTEM County: St Croix
Safety and Building Oiv.wx• $anle~y Pd•nnt No e ; . INSPECTION REPORT 499230 0
GENERAL INFORMATION (ATTACH B.) PERMIT) L•:'In„ n.vd
Persona: inform non you Provide nay ne i,w'or semneafy nwpv es (P"vacy La+.', s' S.G1 i l,uWI.
Permit HOLdei s Name: City V ip;ule X `(,."ship b ref Tai, No
Wilman, James Cady, Town of
CST BM Elev, f Insp H4 Llov • BM OesrnPtion $naxln!(,.n;Range:Mep No.
OD•t7 aD.a w:l I~ 26.28.15.
TANK INFORMATION ELEVATION DATA
TYPE PAANUFACT/L~I[y;L~R Ft CAHA(:IfY STATION BS HI FS FLEV.
Septic Denchmark
(6562 3. n oi•I(o I~
Dosing lL 71. _13K,
,
Aeration RICO sr,.y .r
Holding SUHI I'IIBI
TANK SETBACK INFORMATION SUHI Outlet
TANK TO PR. WFIL BLDG. Vent to fU'lntako ROAD Dl Intel /
Septic. ~ (179 r Dl Bottom Jz• r
7C o0
Dosing L L v 7 , Header/Man. 2 ,.p
L 1J0 •SU
Aeration It's1 Pj" Z Z• •r(yr
q g pO X~>
Holding Bot System • 5'D r
99.90
nai Grade l rr 1
Cam
PUMP/SIPHON INFORMATION ~j .,;u tae a7~ IZ
Manufacturer _ Or Demand .:Coeur S r., ~•,,.L Q/.
~ M14E- (91,A_..T7- GPM S "T Ga l
q.1 .del Number 13i _ 1 Ut+✓ r S6 / Q . V `
o-y TDH it Friction Loss System Head 7DH / Ft
~sl ,(,s 6 •5v 1-41, •,1_
Fofcemain Ienrtmf D,a.2- a Dill tov"ll `
SOIL ABSORP IVON S (STEM /1 2 5
Ir^.:e1e 7n
BEDrfRENCH W oth y 1 Lerytn Vc OI Tww/ke PIT DIMENSIONS Nn (M.".
DIMENSIONS I_ If
~f
SETBACK SYSTCMTO P:L L13LDG WFt I_ 1 LAKFiSTREAM LLACHIN IaoutaGoru,
INFORMATION C/S ter. I - CHAMBEWIDRIQ
Yee Ys ( Z UNII I Number
DISTRIBUTION SYSTEM {o
HesAeoMandold it Distribution / u %Hole Sear !I z1Wlu SPecing Vent In Mlooke
~r U.e 2 D Pipers; -uL \ I r(Z sw 1 3.0 f/t 20 . GS
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Dulnh <1 o. Conch D'o, (;?:~Ih III %x 1ee[Ied•StXl lad Yx MWtlxN
Bewrrenchco,tor nrci lrercn Fdges lepton Yes Nn Yu, No
COMMENTS: (Include code dtscrepenaes, persons present, ulc.) Inspection 41 ~•,1'2k~ Irapeciion KZ
Location: 136 320th Street Unknown (NE 1/4 SL 114 26 TZBN P15W) NA Lot 4 CI) J-revQ Parcel No 26 28 15
1.) Ali BM Description
2.) Bldg sewer length = \ 7
- amount of cover - ,14- I w5I•Y. c4ot, ^
,k 3) rf Of
Plan revision Required? YeS No Use other side for additional informal oft. Nov. 0 T / w'"
C:uc '/f~ ~~.+.x:+a,53,gnalurc rsn No. J
SBD-6710 (In W97)