HomeMy WebLinkAbout020-1022-80-100 (2)County
• PRIVATE SEWAGE SYSTEM $LCIOI%
s.nq.ma°ue gomen INSPECTION REPORT nPinn1 xc. 65b41
GENERAL INFORMATION (ATTACH TO PERMIT) aI<eloxe.
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Mark VDnberg TOWN OF HUDSON r ° 020-1022-80-100
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TANK INFORMATION V ELEVATION O
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MANUFACTURER
CAPACITY
STATION
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Inlet4TANK
SETBACK
INFORMATION
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System PLOT PLAN
PROJECT Mark Vorgew ADDRESS 753 Holden Lena Hill W154016
TAN 114 9E 114S 16 IT 29 AIR 18 W TOwN Hudson COUNTY ST.CROIX
SYSTEM ELEVATION 93.H926 4.5' below Trade 616/19 3
DATE BEDROOM
CONVENTIONAL ON CONVENTIONAL LIFT HOLDING TANK
MOUND _ SEPTIC TANK SIZE 1000 gallons LOT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD KATE 7 ABSORPTION AREA 651 p of chamber[ 32
116 BENCHMARK V.R.P. Rated tank Cover ASSUME ELEVATION HIE' Finer LIf¢Ome FIkS
❑BOREHOLE O WELL -H. R. P, same as Condiment
Scale = 1/4" = 10'
110
L Barge
B.M B2
N, 23'X66'Cells >3'specing
4%Slope
ExisdOg3 J
Bedroom 0' B-3
House
100,
l V
00' We]5'
ve V
Co Qulck45mndard
B-1 c ��
`Cover 2mmbe g Char wit
wim 20.0 H2 of Ares
121, 5.6ftA /pair of end caps AO piping shall be ASTIv1 SDR 30134, vnlhln
4' Long ode a[ Sys[em Eleva[ion l0' of umk, piping shall be ASTM P891
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 6/6/19
Owner Mark Vonberg
Location: Nair SE1/4 814 T29N, R19W 753 Heiden Lane Hudson
Manuals Used: In -ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Si 1
4-6, Mainlarce antl o gency Plan
]. Existing Septic form
Signature
License num 226900
System PLOT PLAN
PROJECTMark Vonbera ADDRESS 753 Holden Lane Hudson W154016
NW its 5E 1/45 14 /T 29 SIR 19 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 930/928 4.5 below olatlB 6/6/19 BEDROOM 3
IT,
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE ] ABSORPTION AREA 651 N of cbambers 32
, BENCHMARK VH.P. Septic tank cover ASSUME ELEVATION THAI Filter Lifetime Filter
❑BOREHOLE (DWELL •H.R.P. Sannilailithernisternark
Holden Lane Scale = 1/4" = 10'
110'
LaBarge
B.M * B-2
29' X bb' Cells>3' spacing
V Valve
4%Slope
Existing 3
Bedroom FB
House
00'
00, Well 75' Vents
Vent
>6.. Quick4 Standard B-1
'Cover leaching Chamber
with 20.0 fig of Area
Pipings TM
4' Wng
12" 5.bft^2/palr of and caps All hall be ASSDR 30134, within
��„ Grade at System Elevation 10'of tank, piping shall be ASTM F891
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
5.612 pair of end plates 9
Finish grade elevation
Typical Installation 97.5'
vent i Grade Ve"t
3 �30/34 Septic Tank 3
5' Long 1 5' p Ong 1"
3 Ora de at System Elevation Grade at Sysem"evation
Spacing 5
23%66' Cells
Same on other end Observation tubeNent
At end of cell
A
16 chambers per cell S
System elevations:
A_93.0'
B 92.6'
POINTS OWNER'S MANUAL S MANAGEMENT PLAN Proa—m_
ILE IXFgIMRTIVX
BYeTEXSPECIPICATIOXS
m^TM
Septic Tank CePorM
I
DNAPa�nttP
Septic Tank MenukcNrer
pNA
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EMueM Fllter Manufaclum
NA
NumM W EWxma
p NA
Effluent Filter Made
❑ NA
NumMrolPWtFetllXy llnlb
Pump Tank CappNy
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Eatimel Mass (Mandela)
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DNA
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MAYIIENANCE MSTRUCPONS
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Plomem', MasiM PWmber Readidea Seer. PDAVE InapMon POINS Noral Saudi$among OPoalor. Tank Frye smug
IncWea ceara visual lnamn of nk(¢) bmenary any Myeam or Eraken moll Monday any appeal or taka,measure Me Poorest of
`ambired eWdge and arum and to chat for any back up or po ing of o lU int On Me Moved surface. The diwp l Pull I be
Aaually mepeda0 to a Me aMuent hovels In tlw duervabon pipes and to cbxk far am pending of effluent on Me gmuM surfaces
�Ra normal o affluent on me gmuM aorfaw may Imicam a !gall mMlpon ad requires the moral m Maroon of the local
ralumory aalnndy.
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to [W[ al be mnmea M a Sepipe SaMang Operation ads disposed of In ecaNanw rods tlleplM MR tts, wamraln
ndmlrvglauw code.
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and any dng MlrMrvah of b12 morale,Steel ever Porfmmed by a oenifiea POWfS Melnuner.
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the / qq residence located at:
S�a, Section T4 N, R/) W, Town of
Upon inspection, i certif`pithth— that I have fcucd
the tank and baffles to be in good condition, and it appears to be
functioning properly.
_ast time serviced: ujr1MUA�
Did flow back oc cu f m absorption system?
Yes No (If no, skip next line)
Approximate volume or length of time: _ gallons minctes
Capacity: /060
Construction: Prefab Concrete Steel Other_
manufacturer: (If known):&/ e�
Age of nk (If known): ZOD 2--
nature;
y� s
(Title) h
(late
(Name) viea!e Pratt
(Licensze Numberzw)
Form to be completed by licensed plumber (s.143.06, Wisconsin
Statutes) Or Licensed Disposer (NR 113 Wisconsin Administrative
Coda)
_________________________________
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I Certify that the tank to th best of my knowledge will
conform to the quirementa of ILEA 83, Adm. Code (except for
inspection opening ver outlet baffle -�[ (�/�......tt
Name signat MP/MPRS z&00
AGREEMENT
OWNERSHIPMTIFICATIONFORM
PaccelWmtifiratiov Nwober dd-D //�o�'�d -/j�
LEGALD ISCRtPTION
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wmmdb a®awoImb¢,Jo®embmrtwSe LlauCmwtFl,,ow Oa]nmLDaPut®mamrvfiuEmoo trotO Ytbe
wMemtm disposal ey,I®;.m Y�PI^mh*.amtricmlpL bour, cmeedpump+rmlymg �tll)demtai¢
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kss Ibex 1!] fdlofaNdge.
emtivEa ¢n ®aW, Emegazxtb the ebareaaquv®m¢ud aped to mlepiutM prvak sewage dlepoml aystm wiW@e
Y Da1uaT<nto(Cu®ace avd the DepaammtafNaaval Aevoucq 5®¢o(Wiargmm.
Cettidutiw e¢dag dm[ yom eeaPhe ,ymm her bem wbmmed mutt be m�lekd and tNoml m roe 5[ troix comry Pls®iog &
Z®vg Depnmm<wehm 30 days o(@e 9vee mryireli®des.
llwe utEfyget Yl Nleavmgmdda wsw Wvbeat of my/ma Ymwkdgw l/w2 emM1aalhe mmp(a)Mme
pmpaSjdvaimi vkave, byavtre ofa tleMtaoNedm Regialu of0eefa06ce.
IS etlmo®�
SIGNATURELICANT(S) DATE
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+e6ma ®vmde w the wertmly deed
(AEV.Otg4)
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