HomeMy WebLinkAbout026-1141-01-000 (2)
I
PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT Sanitary ennn No
GENERAL INFORMATION iATTACH TO PERMIT; dale Ilan Ib N. 607087
crspnal mt11nnabu` a prnvcC Play De _d 1" xcnntlJry purooseS lPn oaoy .ax c 15 TI< f I I',-T;J
F:^n 1 Holbc's Naela City b Doc 70wnslnp Pan:d T:n An
Jeremy Jensen TOWN OF RICHMOND 026-1141-01-000
bN Lle'+ Ins: 31,1 Flc. Ilk, Dcwtollon / jvp or-cwnlKanpe heap fl.
/ ii a,, 33.30.18.1005
TANK INFORMATION ELEVATION DATA
IYPF MAW AC L.IRFK f:.APACiTY SIAIION BS HI FS 61FV'
Septic E 1600 Gencnnlad: S t / /
Z I n A- J alt. sha
n-bRSG
Aeration Bldc. 2icvcI laldnln St'" It lnlc:
imllw
TANK SETBACK INFORMATION
LANK T.'t JP'L LVr-. , Gfx3. ien!, A•m~ke ROAD Dt lnlc: \ \
(iep;i;. 6I /ZT / ' Lll oohur,
J
Dnwi) q'edL•f: plan
S(.9 91, a•(
loldlny - Rol. Syslem q
9•~t I`r0~
PUMP/SIPHON INFORMATION Final Grade 161.
I''lanuta:;lure: Demaw '.over
GPN, Z.4 /df.9 03. /o
Mudel Nunn
7DH Li rnchon l osr'. Svslem lloac TCI- rt
OfGCmai Lelylh r1a G- s P:al - - - -
SOIL ABSOR M
BEDTRrNCH Aidlh 1 I enpn Nc Cn Ire ^e+ PIT DIMENSIONS INC ~ l' Pr., I-ola _ DUO Gep[r
DIMENSIONS 42 3
SETBACK SYSTFId TO V ~j B_ -Y-1 ylrl- , LiiKL: -RLAIvl LEAC14INf Ida avlsaurr f
INFORMATION CHAMBER OR r r YY.tirr~. n
pe I Svs'cm J1.~ 11 f /
I ( UNIT IA::c.• NumGt•!' . 1 i ~i - t~
~~1111 11 /
J y
DISTRIBUTION SYSTEM Zp 5ed4l, /S 4"0 u~
rcaccrWamtale C+a;ub..Lc- Ildc Scc r Hcle ❑ Plc p Vcn tc Art I~ I,
Pip": f
11
'f Uexs,Z- 3
Ira:Ftr_~y~ LIa Inn9'n _ Ca a~q~
SOIL COVER X Pressure Systorns Only xx Mound Or At-Grade Systems Only
Uz D[';veJzaV r; ve xr ]e.:olh of eT ;vd<tr.. xr 1.f.:; o'
&~u T encn center F,.y^rvnc- cp ` 110:X, `
es r.s n,
COMMENTS: i19Clutlc• code dlscrelrnCles. persons prasent Mr. I Insoechon $1 Inspeullon N2.
Location: :;>;r. 11GTH ST
' i AI: RM Descript:or - ~jOsflil. 1 1 + I!/VIII
2.) Bloc sewn naxlln = EY~d V a~JL (,I~.SF 0.;l ~.P~f
amoani of cover = t t
Plan revision Repmred? Yes xNr, ! q (0qJ4i1 • -5
Use olhel slue to- anditinnal mfomalloc. I
Date - - - Inscyte(s Ipnalure N,
SBD-ti7iG (R.3:9lI
I
Safely and Buildings Division 5T GRO 1)(
e 201 W. Washington Ave., P.O. Box 7162 Sm,ilwy I'cnnit Nunlhcr uo hr I111cA in by C'ol
~OSPS fi n 2' Madison. WI 53707-7162
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- 1 - 6670$7
Sanitary Permit Appwcativ State I ransacllon Nlllllber
III T soulancr wllh 9l'1 7% ?li?I. \V I. AAn, C' ,J,. auhna"I'm A 1111, Juno k. lhr Plopnn c ~.m cmmenial Lit / - l
I, lequrtcd pnur w ohlauliq_ a..mw.u, penny, Nair' 1pph,alwn ii-nn, 1,,r *lale-osvne(i ff )q'IS me submitted h, Pm)ecl Addlrss Iif dificrenl than nclilmn,, address)
LnDup unman III ]ales :aid I I le I ;:d S n I Per'.'a d inlinnlalion yua pruv Ide n,a% he used thr wcoadat -
puq u..: m a'""Idmlcc wish Ih I'm wN I.aa 15 4I I tom I. Sim\ 4~ 1710' I /l ~ 47
1. Application Information Please Print All Info alion LP D (P
Proprm' 1)scnar's Nana - - Parcel p
--I'nryxrtel N,n,r, Nlaihng:WJlcss 14opcn, Loeahon
17,18 11(* Y1` 3TQ.6 t 7
( its. Sieie /q)(.-ode Phouc Numhrr Sw 33
PEW (L~C.MIMtrML~ (~JS 5 -7 Ir ,IIeI
T 30 N. 1( I ;,rp
II f)pr of Building (check all that apply) 1,n r
1 or ] I-ari ly Ihvellin_e Nmnher of edr.. 01 Subdi, isam Name
X~nIt M~A__ I: - Dtj R ESCAZPE
- Public.(' onancraial - IX-scribc(fie 1 ~(lrvM
-
❑ Stale UscneJ Ihsaihr Ike (SNI Number
6 : 6} Ct«6 L 1 zz423 s /005
111. Type of Permit: (Check one~ ooebta
on line A. Complete line B ifapplicable)
l New Sysla Kepla 'ancl Syslen~ fn~:n m; nl/l loldme 1,011, Rci laccmcm Onls I I Olhrr %b,dihcahnn to I`\Islow System Iexplah0
li. ❑ Pcunil Rcae%Nal L Pcllllll Rce i'LOn Llnl Pwsuxls Prnuil Nmid Pale IK>uu
h:mgr of Plunilcl I'ennn ITm,slcr to Nrw qf, (y
Rclnm Pspinnion (lswcr ~ZQfoFB - Z7;)17 0
IV. Type of I'UN IS Syslem7Com ponenUDevice: (Chrck all that liPP1y) (r~✓(G1L4 $f'4►~A¢D 2 RfAM.] 22. i<ItiCY~~~a(~ 11]
N ,n-I'rcv.ulnied IN (nounJ I'rewiri/ l In (hound AI-Uradr I I Mound ' 1 in. mfmtahlc soil L Mowed -'d In It .ullahle soil
Wilrt l:nl e1 .:J Unupouall icsp!:un1 _ Prowatmeni 1),-N I, c treplam i- Y/&jdw ~
V. Dispersall ret[menl Area Information: -
11t mull , I rp.1 IA...rn s ,il Applicuhon KuleY FP( I - i- Dislx:rsal Ara, ILCymrLd i ll X01 r el [ rvJN sed lsl') Syslcw i Ic a wn
ySo . S l00 qao °l~3.6 lqz.~,
51. bank Info Capacity ul I tai ',,I V:Inul::cencr
Gallons
Vcw Tanks _ I "'Ing'tanks
S,:pu. nl l Ioldmc Tank
~ /eos / WEE!
III,' 11. ResponsibiliR Statement- 1, the uncirmipned. assume responsibility fur inslallalion ofthe 1'0\\ I'S shown on the attached plans.
Plumt¢r s dune I nwI I'Inmb,-C, Signauur - - MI':N11'I(S Number Bl ,Imns Phone Number
M ICE w_ A ~'fkE4L Ni►~/,1 ti '114 T7 3 718 768 • Slr_
_ 5
I'lunlh<r v 1ddr, s ISUrrI L ih, Stale. Lip l ..de I ~y - 3/ S
i 1016 185=N AuC+J,E 'DAUSAYk LAk.G wl 5'9,g►o
\ III ( uun_tv'Departmenl I.se Only - -
\4l ,ul - I'cnnil I ;c Daly I"aid L.wn,. rani signs it .
nu,R I n!ullknlal
L11? A
IX. Con li rrrr /R( (s In, for Disapproval `
1. Sep1!^ afrk, er n.cn ,I~tc :ni 3 1W„~, g~Z-
u'S~a/ cell -(r t dl[ ~ s It, A,
is Pa ~7wr3gemen! nPI Ell S ~ - ice't bv t, ii 41 f - 1~ rs _ J~ 7 t~r c^^^ v ea ,ice ,
2 A9 ae(tn+'k tecl.il~^xn, m'r.;tla: ~-e:nt r NV V~•`^" / /.l a,
\Iwrh to rnmplna plans for Ihe>,.Ien, and .ubmll to (hr ( In nh onh on paper non to, than N 1 a 11 Md.11.11 I'll
SBD-(,398 (R. I I r I I I
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sc so SYSTEM PAGE 2 OF
SOIL EVALUATION
ao tzo
SITE MAP ---1L PLOT PLAN
?RUJEC- VAfotF: J - ees ~:rt =1 rn;; -~5Z) Gac
Attach cesinr 9nv; c;alnula0ans for commercial plans
PRJ,IEC:1 ACCRES?. 1 G ~G l V J: r ~1 -lip=_ Maturia: + ASTM Standartl (I abler 384 30-3 8 394.30-5:
J~ N San Lary Sever _
BY t;ymuet 9N Eknl uo
G _ -o,oe Ma
'ttaa Jescnpaon k, y~ C.. .
mvu-:nc wnn o. IA-010RTANT:
Siaoc We'I Sv.md fIl a(:{:6r.:,mei: orawirg nc Show ground elevation willours at suitable Intervals.
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PAGE 1 OF 4
ln-Grcur Gravity Plan
Index & Cover Sheet
Component PAanual Design References:
Version 2.0, SBD-10705-P (N.01.101, R. 1.0,112)
Pg I of 4. Index Cover Sheet
Pg 2 of 4 P{ct P'an
Pg 3 of 4 Dispersal Area Cross-Section & Plar. View
Pg 4 of 4 %/Ianag.ernent Plan
d%ctachrnents: E-n: 9o_su_res:
Pvb"/TS App!'caticn for Review
Sci! E•ra!uoti_;n Report & Site ?dap -
Project Name / Description
e(s}: _ y TEAr75etJ Phone:
I7-18 -l_I(/r'! ~1zFti ~ !lrethcv** ~p 5YOJ7-
..'e-: Address:
r i
- 5•.1 , 33 3D__ra _ Vic{
rye: 1.TH 6a, F!-.one.: -p$ 5/1 4(_
..'.cress: fo/tj__llKrt. V BALSAf% ~k~WL__ Zip: 54AJC::;> -
go -IMA, t. cv,"
C.HF Ck F.t:2 n5 /:r. „JCrr l~ OMN:<,([ ..9 API U: IXL4L .
❑ SOIL EVALUATION Scale: 1"=60' SYSTEM PAGE 2 OF 90 SITE MAP ° ~J- ,2e PLOT PLAN
45~ naD
PROJEC I NAMF: _ DI-SIGN TWIN
u n gne! 15'
-
- Attach design flow, calculations forcommercial plans
1II
PROJECT rlDt112r:[:[ ~ 2 C~ l a 1o V't f Pipe Material t AS I M1I Standard iTaMes 3EN.;SO-3 8 384.30.5)
r' N San tary Su-N, /
db!Symod. 4 Bbl Emvauun
y Icma lAan_ _
3W Dcsi'npnon is Ji~, JP~ f'S _ -
rwl:~~e no+r q IMPORTANT'
..Dot Gradient 1%) well Symhd (if aoolicatle; 0 d11.A11,; a'. vr~~w Show ground elevation contours at suitable intervals
c:A I ested ARa: ri tie auv'cPrne Lw. - - -
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DIVERTER AND BACKWATER VALVES
Diverter Valve
Here's the simplest, strongest, aria most ecoromicai diveher va%ve ever inventea fo, septic tank leach fields. !t is made
a tough molded plastic. that will not shatter, bend, rust or corrooe. It is lighter in weight, easier to nandie and less
expensive ;o ship.
Functional
T ie ewe-ter valve stem flow may be controiled to ind vidual or cn,tltiple fields pup to thee) in any combination. With a
a-ree-way valve stem, flow may be averted to any two outlets. To allow flow through all outlets, the valve stom may be
r,icvea !tom the assembly.
Easy To Install
::^onect 4" dlastic sewer and drain pipe to inlets ono outlets on the fair way distribution box. {Unwanted outlets may be
~ealao by ~ratalling caps). The Diverter shield which houses the aiverer stern may be cut to desired length.
fi'JS Pkg. Wt. Ea, Product
Part Na. Dexription Color Oty. ;Ibs.1 Clots
Pvc 575P 4' °,rC D.ver;er Var.'e V h:e 4 9 50 35Py
1 ASS 575 4' At3S D ver•c• Va''ve u'a?k 4 7 50 35A9
r C'.CSEC 1 2 3
i ,
E~2 0Ev.)
J TANK TANK TANK
y~ n 5 n
•!AP! rC L >s:•s
" TANK TANK
'Ni51Ent T:~r\t
Gravity Backwater Valve
T,c NDS Gravity flow Backviater Valve is ciesigneo to erotect low areas or basements from the backf,ow of :vaF!r; f: ❑rn
street severs. it is available 'n 2'. 3 4 and 6' sizes °VC ~~aterial. l; is a cost effecti:re and a cliernically rassta I
alternative to cast iron valves.
Backwater Valve
T ne quick action tlapoo, allover unrestucted uni-drect!onal Tow. [lastomer.c casket in the flapper ensL'eS a "'alert grit
seal. Flapper can be easy rernovec and replaced it reck. •ed.
1 treaded access cap is designed for hate tignlening. Access cap neoprene gasKet provides a positive seal- Valve -t.d
outlets fit 2', 3", 4", or 6' DWV pipe and may be aoacted to 2' . 3", 4'. or 6" sewer and main pipe with NDS DWV :c
Sower & Drain Adapters.
L ghkweignt. easy to instal!. Horizontal installation required, witn arrows en top of the valve F.ub poirimn in tree c,rectier
cf the flow of water Access riser with
rover offers a simple, economical C~ IItem Number A 8 C Riser Height Riser aid.
assess to trio valve for inspection and 275P 275 2.15 5 c' 3 53 a
^.aintenance- The riser may be cut to t 275P`' 2.16
k 375P 375 35' T56 6.';; u
:'',.e desired length.
375PN 3758 3.5' 7.56 6.r3 -
i - 475P,475 4.47 ...9 7r8 fi
41bM 41SR 4.47 '.1 P. N C 6 7oP, 615 5.50
13
2 Nor A' a %ic o ,,c -n~i A u~ c s ..;F N o p::: v r. a oh y N H S
For customer service, please send your fax to: 1-800-726-1998 or call 1-800-726-1994.
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\OR rH -SOUl'H 114
ST. CROIX COLNTY
SEPTIC TANK NIA1NTI,'NANCF. AGRF:I;IvIGN'I'
AND
OWNERSHIP CERTIFICATION FORM
Owner'liuvcr /er-e 1Y -T
Mailing Address Z=_~b _I SI_ - _1V W_ 2f G - - - - -
hnwnc~r7J 2
Property :\ddr4~ 1_1-18 I b 51 _ _ -
(Verification required Iron) Planning & Zoning Department for new construction.)
City/State 1`4l= W I~e (1 hf2 parcel Identification Number Qom-
r l1-_~41~000
LEGAL DESCRIPTION
Property Location 5C Sea :~O , T 30 N R W. Town ol'_<<l (~rICL?o-rll~
Subdivision Plat:. LIUL_ 13on& s e
Certified Survey Map # J 22
D Volume 2.747_ _,Page it 17(!
Warranty Deed # 7 3 Z I q (c>
- (belbre 2007)Volunle Z,3 3y , fags k
J 5.s (0
SpechouseI yes Nno I,ollines idcntiliahle vcsi m,
SYSTI?M MAINTENANCE AND OWNER C'FRTIFICATION
Improper use and ntaimc•nancc of your septic system could! esu It in its premature failure to handle wastes. Proper
maintenance consists of puntpme out the septic lank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic lank as a treauncnt stage in the waste disposal s)stent. owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 of the St. Croix Gnmty Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planninv & Zoning Depamnent a certification firm, signed by the
owner and by a master plumber, joumcyntan plumber, restricted plumber or a licensed pumper verifying, that (1) the mrsite
wastewater disposal system is in proper operating, condition and or (2) aflcr inspection and pumping (if necessary), the septic tank is
less than II I full of sludge.
Ir'we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth. herein, as set by the Department of Safcty And Professional Services and the Department of Natural Resources.
Stale of Wisconsin. Certification stating that your seplic system has been maintained must be completed and returned to lie St. Croix
County Planning & Zoning Department within 30 days of the three year expu:uion date.
hwe certify that all sLntemcnts on this out are true to the. best of my lour know ledp v Iwa atniare the owner(s) of the
property described above, by virtue of it Warr ty decd recorded in Register of Deeds Office.
Number-of-hed room;
pare
"'.Any information that is utisreprescroted may result in the sanitary permit being revoked by the Planning Zoning Department
Include with this application a recorded warranty decd front the. Register of Deeds Office and a copy of the certified survey map if
refereslce is made in the wamniN deed.
(REV. 04/121
r,sn Dopy""'d'I M cummerce PRIVATE SEWAGE SYSTEM county St. Croix
y and Building Minion Sanitary Parma No:
INSPECTION REPORT 420688
°_NERAL INFORMATION (ATTACH TO PERMIT) Slate Plan ID No:
usoruil Informauun you provide may be used for secondary purposes [Privacy Low, 3 15.04 (t)(m)I.
ermil Hader 's Nam: City V llage X Townstp Parcel Tax No.
P.C. Collova Builders. Inc. Richmond Towns h1 026-1141-01.000
CST SM Eluv. Insp. BM Elev: BM Desr/ipoon: Sectlon/TOwNRange'Map No.
/06 , 0 p , _ Bh! 33.30.18.1005
TANK INFORMATION ELEVATION DAT
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic /L90-0 Benchmark
y.a , ioo.o
Dosing Alt. BM Isla,
L~OF^ f/ • _ /
Aeration Bldg. Sewer
S sr~' 0.0
Holding SUHI Inlet 51 251 "fY.
0
TANK SETBACK INFORMATION SuHt Outlet S ?
TANK TO P/L WEI L BLDG. Vent to Air Intake ROAD Of Inlet
Septic > 2S~ r ~-7/ - 01 Bottom f•~
Dosing ea er/Man. 4 ma
t.t
Aerdbon isl. Pipe I -
2 .7
Holding ` Boi. System 9 13.rf
(r5
PUMP/SIPHON INFORMATION Final Grade
.G
Manufacture, Demand St Cover
Model Number _
rDH Llfl .nn Loss System Head TD Ft
Forceniair. Length Dia. 1st. to WW1
SOIL ABSORPTION SYSTEM
BEDITRENCH eddtn~ I Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Do. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P1L5 BLDG WELL E/ TREA LEACHMON Manu _
INFORMATION Ty(p'9,.O~f S~y~st~em Q r ~f~ CHAMBER /O . /
W xw`Ci74Y S~ , l O U J V Model Number: s4 d- 4
DISTRIBUTION SYSTEM W'*JT M S s~
1 MeadarManaad Dislrvjution x 110Ie sue x Hole Spac Air Intake
U' Pes' 9~F'
Length ~ 7 50'
~Ca Lenengih_Na Spacing- 2L
SOIL COVER < 1 x Pressure Systems Only xx Mound Or At-Grade Systems Only d 'i`ds
Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched
Bedn'rench Center L 9 jjj0,1,,./ BodrTrench Edges Topsoil -
J . 1 y Yes i." No :cj Yea '9; No
COMMENTS: (Include code discrepancies, persons present, etc.) inspection #1:1///S/03- inspection #2:_/
Ta
Location: 1218 116th St New Richmond, WI 54017 (SW 114 SE 1/4 33 T30N R~18W)) Duck Pond Escape Lot 1 Parcel ,N/o,:, 3f33..330.~18.10~055 - I'
1.) All BM Description =._DD'/)UHT Of S/2/A~Cf SyS4Gy' ?Z' f Ldi~"- ~-►t~ ,/(T
2.) Bldg sewer length = '31 r ~ ~,.t,(~/ µ fyS,V e-/J c,.1`a(G (q. k/ e«n,/(/ ~u`t
amount of cover
l -
Plan revision Required? Yes ✓ No Data hsu .
Use other side for additional information. ~ ~
pctor';: .gnahuo Cen. No
SBDb7t0 (R.3~'97}
LRECEIVED
014 '11~ R
APR I 20033
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Wboansin DWNWwd of Camnave S0147~v"l R PORT Pop
inawowrdwm cou*
Aamch cw*kto Wb On on pww not ins fhm a 112 x I I incim in obw Pbn "Vid
k~ he rot - N lim varfoal O'd ho - lidwei p*t(B"~dkOclOnMnd Pawd LD..
PWC&tdo".ocWowdknwnkmnorlha~.Ndiocmmnwd lonamraMmed.
p""O pnw ON k*mmtbm
F -Wb*nvAftOpwV I mWbevndbr pwp~ O"Amy L~. c ISM (1) 0,41~ /-0 3
Promayomw F We V Uxs§on
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seoanlRdw'i
Soil t and System PLOT PLAN
PRO)FCT P.C. Collova Bldrs. Inc. 1 RESS P.O. Box 489 Somerset Wi 54025
SW v4 SE 1/4s 33 iT 30 NI W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/11/03 BEDROOM 3
CONVENTIONAL XXK IN-GROUND P SSURF. CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE.
1
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 If of chambe 30
BENCHMARK V.R.P. Top of 2" PVC Pipe ASSUME ELEVATION loo' Filter Zabel A-100
❑ BOREHOLE O WELL •H.R.P. Same as Benchmark
487' Property Line SYSTEM ELEVATION 93.0/92.8 6' Below Grade
Vent
202' P.L >6" Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long I 1 >
Grade at System Elevation
Plans Designed Using
Conventional Powts
Manual Version 2.0
Setback from pond was ✓ 6f \I
measured from highest b
observed water elevation
Pro 3
Bedroom °
House2-3' X 94'
f '
Cells with >3' Pond -d 1%SLope 50' VB-2 not enough slope
to establish
Vecontours
95,
inage easement 15' B M
515' Property Line
i S Fz~ cp`' C yti ?