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HomeMy WebLinkAbout020-1491-13-000 F WisconSin,DeparWent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety%no` Buildir* Division INSPECTION REPORT Sanitary Permit No: 30216 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Girl ScoutCamp St. Croix Valley I Hudson Township 020. 1016 -60 -000 CST BM Elev: Imp. BM Elev: BM Description: hj. r-c 3 0 N So ;4 c S Section/Town /Range/Map No: Bra F4 1 0c) = p,GOr t3� vo• T °'(, Z Pvc. P` 13.29.19.73 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Jy')/� Bldg. Sewer /, Q Y.q eat ,{ ( YVL l S Y / 000 ,S -C�J�D !Gb ,1 ing b St/Ht - I " i_ .s# t 1 34 q - 4a TANK SETBACK INFORMATION 7 St/Ht Outle I .3 a QS - ,� TANK TO P/L WELL BLDG. Vent to Air Intake VROA o Dt Inlet �d Septic L" ( 2ov icy r --�. t Dt BUtCOrn a� bo4 > Zoo g - Dosing , Header /Man. t 1: �. ti 2s� roG pj 5 r< ding Bot. System T I- Eon+ Final Grade PUMP /SIPHON INFORMATION g ka, S i,_. 45 Manufacturer Demand St Cover Lja , l t S GPM Ta-vt >kk - Z_ Model Number 57— 15 « °� x ✓ / F_ PC) - I t F s � IA TDH Lii � Fric i n_ i oss System Head T H Ft Z �,. =t%+,_ , 44 �p9• i. Forcemain Length -3" Di . Dist. to Well to ; C". v I�� L�-3 SOIL SORPTION SYSTEM ti /• IMUG EENCH7 Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I � 1-3 Z�� t SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typ Of System: CHAMBER OR _T F onv. / --- yzao UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) —_._. . Length D Length Dia Spacing ` - SOIL COVER x Pr Systems Only xx and Or At - Grade Systems Only Depth Over Depth Ov xx Depth Tx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench L-dges Topsoil Yes 'ij T No E&I Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #11: / / 6 ' / 1S 3 Inspection #2: / / Location: 965 Alexander Road Hudson, WI 54016 (NE 1/4 NE 1/413 T29N R19W) NA Lot Parcel No: 13.29.19.7 1.) Alt BM Description b 5 N Z `S E/e V. 2.) Bldg sewer length = g �1 h Z_ 3 ,b 2_ 9 amount of cover = A 3) Grt�S� �'1`I-• in /.t7 �',.Gv�t.� I.J /'l S ^YO�ad/r� 1 L- 2-- 3.9 S Plan revision Required? Yes No Use other side for additional informati Date Insepctor's Signature Cart. No. SBD -6710 (R.3197) r; Moll 3 s s N f-s Top �� . �Yt� �L Z_ EaSr ? LtTA 8 3 � 0. I LOA, t i o. qq A l 1. So f.� 7 � .. ► -Y h ✓""� r- 3 W¢-T f r, 3 s Ll 1 /2-9 d p S1�S —f L� �ar 8,/ . G i � Boa t V MA , AW Safety and Buildings Division County ' 201 W. Washington Ave., P.O. Box 7162 X irsconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 0)266-3151 30((0 Sanitary Permit Application PAID State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you pro " 7 7 .Z D8 c .%. t 0 • i � may be used for secondary purposes Privacy Law, sl5.04(lxm) Project Address (if different than mailing address) I. Application Information - Please Print All Information - - Ah , 6 1 Property Owner's Na me Parcel Lot # Block # r1. s^ C ? Ivy.; •ZO— Property Owner's M ailing Address j Property Location 41 City, State Zip Code Phone Nummbii" " (circl e ) II. Type of Building (check all that apply) T N; R ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number OPublic/Conimrcial - Describe Use ❑ State Owned - Describe Use _-. ❑City ❑Village Rtownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A- U New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System i B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ,l'ir/ S IV. Type of POWTS : (Check an that apply) -'-- -A C IeNon Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil At Grade El Single Pass Sand Filter El Constructed Wetland ❑ Pressurized In- Ground 11 Holding Tank 11 Peat Filter 11 Aerobic Treatment Unit 11 Recirailati ilter $k ❑ Recirculating Synthetic Media Filter 11 Leaching Chamber 11 Drip Line 11 Gravel-less Pipe El other (explain) V. D' ent Area Information: =4 C Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area r�po��a (sf) System tan -3 A 9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Galtons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks -*stem S� Septic orRelcl a 2 5 1 40 — ✓ Dosing Chamber VII. Responsibility Statement I, the "tinder Ved, a. ' ility for installation of the POWTS shown on the attached plans. Plum beL Ogeriy ll mbing 1 Pl ber's Sim tgft'wWRS Number Business Phone Number F #221180 2 --e y.P Plum � State, Zip Code) Spanner, WI 54802 (71S) 635-9609 VIII, Ct t /De artment Use OW IK Approved 1 ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu' nt Signature (N Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial' Ft►• 2 IX. Conditions of ApprovaMeasons for Disapproval n 0 S • r Attach complete plans (to the County only) for the system on paper not less than 8t/2 x 11 inches in size a a r Cb H S I J il l I 3 N o C4 1 O f J CA r-r l� � � s � • l CJ r c f r � ' •� IV p s r x f ` N { AA r + ' o W � n A C �M O VVVVVV Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 Mir TDD #: (608) 264 -8777 �seonsin www ,nnnnn,•commerc .wis c ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary June 25, 2003 CUST ID No.224059 ATTN.• POWTS Inspector ZONING OFFICE KEITH E STONER ST CROIX COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/25/2005 Identification Numbers Transaction ID No. 877208 SITE: Site ID No. 178033 St. Croix Valley Girl Scout Camp Please refer to both identification numbers; Alexander Rd & 100TH Ave above, in all correspondence with the agency. Town of Hudson, 54016 St Croix County NE1/4, NEIA, S13, T29N, R19W Subdivision: Csm Vol 565, Pg 45 4344842 Facility: St Croix Valley Girl Scout Camp - Dorm & Cooking Facilitiesi, Hudson 54016 FOR: Description: Nonpressurized In- Ground 2400 gpd. Object Type: POWT System Regulated Object ID No.: 907933 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Component Manual, SBD- 10705 -P (N. 01101) ". • Comm 84.10, All materials used in this installation shall conform to the provisions of this chapter. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits col required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. 4, In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. �v Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. KEITH E STONER Page 2 6/25/03 The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 275.00 Fee Received $ 275.00 Balance Due $ 0.00 mac,•.- �.e -�u..- Thomas E Devereaux Plumbing / POWTS Reviewer II, Integrated Services VYiSMART, code 7633 (715)634-3026, 7:15 am - 4:00 pm Mon. - Fri. tevereaux@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Donald J Adsit Scout Girl Scout Council of St Croix Valley Fogerty Plumbing & Perk Testing, Inc. Index and Title Sheet Project Name: St. Croix Valley Girls Scout Camp Property Owner: Same Address: 400 South Roberts St. St. Paul MN 55107 Legal Description: Doc.# 344842 Vol. 565 Pg. 45 NEl /4 -NE1 /4 Sec. 13 T29N -R19W Township: Hudson County: St. Croix Subdivision Name: NA Lot: NA Comp. #/Parcel ID: 020 - 1016 -60 CONTENTS Page: 1 Index and Title Sheet Page: 2 Sizing Calculations Page: 3 Plot Plan Page: 4 Plan View �t i o It a Y Page: 5 Cross Section of Cell #1 and #2 ;' ` ` 1 E D ,4rcC" �F G p BW� Page: 6 Cross Section of Cell #3 and #4 Tv Page: 7 Pump Chamber Cross Section t�E Page: 8 Pump Curve Data Page: 9 Cross Sections of Septic, Grease Interceptor and Pump Chamber (a,b,c,) Page: 10 Management and Contingency Plans In- Ground Soil Absorption Component Manual Used = SBD- 10705 -P (N.01 /01) Designer: Keith E. oner License # 1575 -007 mm�n►uip Signature: ( •���ONS� *'o Phone # (715) 653 -2324 Date: 5/31/03 '* . • KEITH I° •• STONER c p -1575 a Fogerty Plumbing Siren, Wis. #221180 28288 McKenzie Rd. -bESIGI`�o�` ° Spooner, WI 54801 ���unununuun�"` (715) 635 -9609 J 2 of 10 Sizing Calculation for the St. Croix Valley Girl Scout Camp Dormitory with Cooking Facilities Camp Day/Night: 60 People 25 al. = 1500 al. P g g 4 Floor drains x 25 gal. = 100 gal. Total estimated daily flow = 1600 gal. 1600 gal. x 1.5 = 2400 gal. Design Wastewater Flow Note: Effluent quality to fall within domestic effluent guidelines. Propose a 1000 gal. Wieser Concrete Grease Interceptor Model W1000 -P or W- 1250 -MR Grease Interceptor Sizing: Per Comm 82.34(5 )(2)b C = MxGxH 2xP C = 180 0 x 9 C= 4860 = 810 Gallons 2x3 O N a b Poo ale 4hk g t ,r r x';rr Ir t 4 i n t er' a r IL ► a N ON s A �b ti 0 t0 3 3 4 4 —N W A ~ J te r" b J a it a ° 00 1 Q~ C CA A: ' �• w cia �ta b °D eo A, NJ In b ti N A Qs A c Did Not fA 0 2 0 2 Ah ca CA Ni Go .a. c IV m OQ _ .A. ••4 e• �L�tl� � "V • _ 02 •' � ., a e `..:. `. ._.. ` _ gin. • •.: t' \ 0 0 0 c co w c o r 1 H tic w T 4 o 1100 li 11 a oil ° • ` F� � � r rte •+ •:� �• II 16n C/1 wu cr �: F3 W I W n � R- `'gyp.: � "� ,� � � � _ • •( ♦ `\ % � � tea\ \ \ i (� ♦ \ \` N7. tai ♦ Y � b 8 Pg. 7of10 DoseTaank Component Cross Section Approved Manhole Covers With Warning Labels and Loclotng Device / 4" Min. Above Final Grade Weather Proof Junction Box Electric per NEC 300 & COWL 4" Scar. 40 Vent 1628 WAC >or -to 12" Above Final Grade Alternate Outlet Location W /Ap�oved 4" Sleeve I :: Inlet Force Main Diam. = 2 " Weep Hole or And Siphon Device Note: Pump switch and alarm to be A wired to separate circuits. 84.54 Wieser B Pump OfFlev. concrete C Tank Mfr. 2500 Gal. D rlt Dose Tank Elev. $ Vertical Difference Between pump Off and Distribution Pipe = 9.54 Mininanm Required Supply Premcrre ....... ............................... = NA 20 FT. of Farce Main x 3.30 Friction Factor/100FT.... _ Jg — Total Dynamic Head .................... = 10.20 Number of Do=_ = 5 Per Day Gal. Per Day/ #of Doses = 480 Gal. Volumeof Baclnow ..................................... ............................... = 3.26 Gal. Total Vohum .» ................................... ............................... = 41M W. Pump Tank CVacfty2507_67GalIons Dimensions Incas Gallons Pomp Tank Vohure GaVinch A 32.67 1606.4 B 2.00 - 01.3 - 7 Pump Mfr. Goulds C 9.83 Pump Model EPO-4 D ,5�{j " R 2 Minimum Dischsrge Rate = NA GPM j twyaa. 40 Alamo MR SJ. Electra' Tom= 51 2507.6 Alarm Model 101 -01H Bad Tank per CORM. 83.43(5) Anchor Tank as niecewary to nee buoyant forces per COMM. 83.43(8)(8). ( Pln • I r METERS FEET 10 MODEL: 3871 4 30 B 25 7 I 2 15 4 I EP05 'o f � 3 10 - 2 5 0 00 t0 20 30 40 50 a U.S.CPot 0 2 4 8 8 10 12 m1M CAPACITY Pump Specifications Features and Benefits ' /10 and 1 /2 HP • EPO4 impeller- semi -open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal.. Discharge size 1 NPT • EP05 impeller - enclosed design Solids: 1 /4" maximum for improved performance. Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides bearing construction. superior strength and corrosion Single phase: 115V resistance. Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer. strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and ` manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. e 57 —j" 0 44j" c 67" I 1 r D 51" m m 2j" 4" m ( N " 464" s 0 D z z o 0 0 C m v O 0 mZ G)PZ rW�r2�c�WgQ Z p � Rtp D ap - 1pfp"26DOO9z T > n mC MOC X � p g = - =i0.�r I� c o �� r-r � oom i — ill N '0 Ca D i� � �l N � � 1 Z,A __N rn ;;D .ZOI O O D (1) = O .... O x �i m N (n0 C7�v� --+ C N D-�I mN N 0 fri 0 p � Z O rn 1 p to 0 0 I O o u lJ cn > of m (� �. r rn� z �0 o Z N 0 D D Op 0 N V i2 O I n N O m O m rn CA m �"1 z Z n O tr a 71" 93" 0 54" a i r z a D 62* r 0 D 0 r m tTl 3 „ I N 1�7F - � Z r 57 " O = r z z g p O m m rn v --q --I z >o O n p Z 0 m p m m a 0 O y N O c�r-I �n Nm0 =C0�0 =z -�irZ cn r - -IZ n �z �,OO -1 � -,0'. � N Z (n �mc mz�.. rn N Tg z Dom" �z� �� � m W� y ..rn Z �, D '�' W V 0m D� - I D $ , • m i Nf - - 1 0 10 =N O W N N O .� D as - ►� to O P r' a c m o� O 0� N �rn+'i m 1 Ul CJ� (Ji '' O a O n /+' C� --i! V D r c f - I ' { C v -n D r s a N' O 01 ca N 00 t_JCJ tZ C rn > m D tm/! rn O 0 Np n O D 0) = �0 o O W e {—�� �D{{ D Z � O o 8 v M CC-n frl r .1 O z Z� 0 O z 01 b �� > z 1 U u u M n Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In -Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10705 -P (N.01/01). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms NA Design Flow - Peak d 2400 Estimated Flow - Average 1600 Se tic Tank Capacity al > or = to 5011.20 Pump Chamber Capacity al. 2500 Soil Absorption Component Sizes . ft. 4 3'x 173'Cells w/ Leaching Chambers Type of Wastewater I Domestic Table 2: Soil Absor Lion Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak d 5011.20 2400.00 Maximum Influent Particle Size in NA 1/8 Maximum BOD (mg/L NA 220 Maximum TSS (mg/L NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Pump Chamber Inspect and /or service once every 3 years Soil Absorption Component I inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Pump Chamber A pump chamber if part of the component package also requires monitoring once every three years or at the time of a problem, complaint or failure. Inspection should include checking the dose rate, volume and frequency. Warning: The dose chamber may fill due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have problems. In this situation, the pump chamber should be pumped by a licensed pumper before pump cycling begins or other measures shall be used to dose the component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. Septic tank and Pump chamber manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or glow the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. 2 Management Plan for a Septic Tank and Soil Absorption Component The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. The soil absorption component reserve area if one is provided should be kept free of any structural encroachments and left undisturbed. Contingency Plan A contingency plan for this site would be to excavate leaching chambers to determine component failure. Then remove clogging mat and replace with ASTM C -33 sand. Once this is completed, clean and replace leaching chambers and backfill. This may require and individual site design. An alternate area suitable for a mound system has also been identified. Component Owners Contact List - Fogerty Plumbing Dave Fogerty / Plumber 715 635 -9609 St. Croix Co. Zoning Office Steven Fisher 715 386 -4680 Wieser Concrete Products Maiden Rock WI 800 336 -3416 Zabel Filter Co. 800 221 -5742 Iri-County Sanitation 715 386 -0114 3 { Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 N*iscolnsin www.commercew issb www.wiscon isconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary June 25, 2003 CUST ID No.224059 ATTIC• Plumbing Inspector MUNICIPAL CLERK KEITH E STONER TOWN OF HUDSON 23220 WOOD CREEK RD 429 STAGELINE RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/25/2005 enti i on Numbers SITE: =1ransactionID No St. Croix Valley Girl Scout Camp S DNy 033 Alexander Rd & 100TH Ave Please refer to both identification numbers, Town of Hudson, 54016 above, in all correspondence with the agency St Croix County NE1 /4, NE1/4, 513, T29N, R19W Subdivision: Csm Vol 565, Pg 45 #344842 Facility: St Croix Valley Girl Scout Camp - Dorm & Cooking Facilitiesi, Hudson 54016 FOR: Descripi k . xterior Grease Interceptor 100 als. Objec ype: Sanitary Drain & Vent System Re lated Object ID No.: 907941 1 Gr The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • Comm 84.10 Materials used in the installation shall be in accord with this chapter. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. C Inquiries concerning orrespondence may be made to me at the telephone number listed below, or at the address on this let rhead. S' e Fee Required $ 70.00 L� Fee Received $ 70.00 v Thomas E Devereaux Balance Due $ 0.00 j Plumbing / POWTS Reviewer II , Integrated Services (715)634-3026, 7:15 am - 4:00 pm Mon. - Fri. tevereaux@commerce.state.wi.us WiSMART code: ,765? cc: Donald J Adsit Scout Girl Scout Council of St Croix Valley Donald D Hough, Plumbing Consultant II, (715) 634 -4804 Fogerty Plumbing & Perk Testing, Inc. Index and Title Sheet Project Name: St. Croix Valley Girls Scout Camp Property Owner: Same Address: 400 South Roberts St. St. Paul MN 55107 Legal Description: Doc.# 344842 Vol. 565 Pg. 45 NE 1/4-NE 1/4 Sec. 13 T29N -R 19W Township: Hudson County: St. Croix Subdivision Name: NA Lot: NA Comp. #/Parcel ID: 020 - 1016 -60 CONTENTS Page: 1 Index and Title Sheet Page: 2 Sizing Calculations Page: 3 Plot Plan Page: 4 Cross Section of Grease Interceptor and Manhole Cover and Lock Detail In- Ground Soil Absorption Component Manual Used = SBD- 10705 -P (N.01 /01) Designer: Keith E. Ston License # 1575 -007 Signature: Phone # (715) 653 -2324 Date: 5/31/03 COs� * �KEITH E. * ditL0 STON ER _ D -1575 Siren, r l� CE Wis. 2TI.DI NGS SG EN 7 Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 -9609 2 of 4 Sizing Calculation for the St. Croix Valley Girl Scout Camp Dormitory with Cooking Facilities Camp Day/Night: 60 People 25 gal. = 1500 gal. 4 Floor drains x 25 gal. = 100 gal. Total estimated daily flow = 1600 gal. 1600 gal. x 1.5 = 2400 gal. Design Wastewater Flow Note: Effluent quality to fall within domestic effluent guidelines. Propose a 1000 gal. Wieser Concrete Grease Interceptor Model W1000 -P or W- 1250 -MR Grease Interceptor Sizing: Per Comm 82.34(5)(2)b C = MxGxH 2xP C= 180 0 x 9 C= 4860 = 810 Gallons 2x3 0 oa A C R+ � O � by IS yob A bb � �oA Gk n Ak 1 57 - 2 0 44j" c 67" -i ° 51" j n 2j" 4" m j N i i N _ I Z NI + r = Rt --1 46j o m fi m O o D M y ;0 r��'IpmoZm 0 �? �C m z i p s 5 1, - rA A - 40 C m � � � rim n��i ODmZ =N - N - 0 rn '< ° Y O .pp N a Vl fil ' N T7 I (n �- N O16 O x. N i rn O rn0 O > ° � Z O rn 1 0 to a� ��� ,•, p l 0 O o N r D- �? m �.. CA O {� 0) A Z f_ p O D Z n >� D Op v J v o c Z � rn ©off° r 0-`' A r zr r 0 -� Z D X V 0>0 -"0 � > M D > X > M D m Z U) 0 > o Z � — > Zn 0 O K7K z r � Z IV z z y -4 m X W O > Z O o --i X C m r m N —i m Z MM4 �O V r -;u 0 Z Z ! . 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G.;W( x cour} Y ,� � -�cE- CRY swe Q Apia �P p C MAP - -) ^' Nearesti�oatl ity D WT OM 212 - p S`- L cPa ff Now Canstrudim Use: ❑ Restdenid 1 Nwdw of betiootns -- Code denied design lbw rde K w [t�'Pubk or camme dd - Dos=cdbe: T R Rood Plain devoWn if appic0 N pamt note" Deneral oamtents !N/fi �/1 rw►t ,�)eT �., , p . S9 �mNt�6rv`1' �ivl�L and mcooanerdaiotts �/, -! ,� &Aet/AAbT /5 )- ,g p• s` 9 ..._/ /1 60'ing M Ground st.taoe elan►. rte. -t_= � a � � �_ �2.fe -'m Sail Rabe pit T �Yae Cotttos BotndatY Ro°Rs GPDff Dominant Pm" Descriprion Sr- Sh. _ `EA31 't�2 in. Muni Au. SL Cont Cater -t 2, S � 7 2 L 3 ° d 6 jpec ❑ e P oepw w titti�tlg faces po G s f ? /.t in sw Ran L roundwaoe e bv. _ Texkae Sbucue Camps um BOUMWY R GPM Horizon 77 minant Redact Desaipion 'EW llAunsei flu. Sz. Cont. Cobr 4 - .k//z 4 �� �►- El > < and TSS >3D _< 150 nail. Bbm t #2 = BOO -< 3D mgiL end TSS � 3D mgiL Effimt 1i1= 80D 3D - 220 ngil. C5T Number & Past Taft Data Cot &OW Telephone Number Adtiess spoofter, w1 54801 .� Z° ° 3 Rw * Owner ST ',ZM m44 (a.�1`� S pa v roel m to_y_ l0 /2 Pegs 2 of J r3l Batltg 8 Pit G=M mbm dev. �'. tt Depth to 6nciirg tarjor tn. Sol Ampoom Rate t mtwn Depth DoniiiiantGolor Redox Descdpfmn Text" Stick" Consistence BourAwy bads GPOW in. Mu>sell Qu. Sz. Cont. Color GL Sz. Sh. 'E1 1 'E1M2 SL 2 — 2 3 22 -sp &S Acc / ► AlS pd Gmundsixtace R Dap1h1D IFL Soil Appkadw Rata Hormon Depth Dominant Cokw Redox Desc r%WM Tetuxe Studue Consistence Botcndaq► Roots GPDW Kt. Mussel Gu. Sz. Cont Color Q: Sz. Sh. 'Etf#1 'EAte2 . �� — cos G JrL , V 6 • t - 4 5� t QauKtsinetee+►. n D lactor 7 /22- in, sal Rate ftimn Depth Dominant Re" Descr"M TextGre S U*n Cas toe Bantlacy Boots GPM in. Mtxsa:I Qu. Sz. Coot Color Gr. Sr_ Sh *EM *M .S- �trrG .1 .7 2. 1 ' Effluent #1 = BOD, > 30 < 220 mg/L and •TSS >30.5 150 mgA- " Effluent #2 BBD, 5 30 nV& and TSS 530 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 3151 or 1W 608 -264 -8777. seo•uta R-60t ��� � ( ta q 5-0 -- > �tYOww �;. c ry' Y�rt� st�l t of -or 27 F Bwft Boift pi , Gror,na surface scan. 9I ,C It D t kno bdor ?.1L�— �- sa Ram Norimn Depth Dominard Radon Des n Texture Stn,aune Caere ewdwy Roots (ate in. Mumel Qu Sz. CoM Color Or. Sz. Sh. •EiF#1 fE1�2 z LS Sex mfr t E] F71 plt Grv�nd surtaoe ebv. it Deptlti eo r faclar JV/ in say _ Ram l Depth DominarN Textue Rooms GPM in. Muise! Qu 111;z_ C & Cdor Gr- Sz. Sh. •Ei I Ten 2 - -- L A�iF CS i •- 3 F,57- - Z f L . .� r .. /yt L� � (7f � crowd sufa� ate+►. �'� 8 . _ (t Depm a rm�ns Taaor � in• SON � V y� Florizar Dorninarrt Redorr Oesaiption Terre Structure Conenje ree ®oudary Roots t,(�Dri1F in. Wad au Sz CO AL cola Gr. Sz 5h TIM fEt�2 /_ S Zg 2 SL e- -3Z L s AV&05A cs • A • Effluent #1 = SOD > 30 220 mglL and TSS >30 < 150 mg/L • Effluent #2 =• SOD, 5 30 mgll and TSS 130 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 3111 or J- W 608 -261 -8777. - . seu- euo�e.sroo� M n yo C,cdrtX' rliM -C1 �Cr� P P—of� "� ❑ eomg 4• M t3aru>g (� pit Ground sutaos elev. � ft �rita>g factor %z in. Soo bate Mar Depth Dominant Redw Desa"on Tendon Sbucnse Consistence Boundary CaP E mot► OEM in. Muaseli Qu. Sz. Cant. Cater Gr. Sz. Sh. 1 3 LS Am 7 A AV 2 " El� Pit Gouncl suttee sie►• k Dspei >o rung faraor °1- sea AwMatim Rate Morimn Depth Dominant Red�t Description Tatlue SYudure Consistence eaundary Rooms GPDJIE in. Mum QM Sz. cant. color Gr. Sz. Sh. 'E1f87 'E(fN2 L1 S wings ❑ 9 Pit b Ong factor Sea Rate horizon Depth Domintrut CdM Redox Desaipkan Texture Sttxaae Consistence eounfty Roots GPDIIE n Munselt tlu. sz. Carl. color Gr. S7- Sh. •EW 'EiNF2 • Effluent #1 = SOD, > 30 220 mg/L and TSS >30:5 150 mg/L " Effluent #2 SOD 130 nKA and TSS <_ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 60995931h or V Y 608- 264 -8777. t sao43w(x.6M) t � D Fogerty PfwnbMa 94 qua a , ' A6 1 P sw oi - st3 28288 McKenzie Rd. q Spooner, WI 54801 t (715) 635 -9 , f. 6° I j / � �tlscE 1�A� � � f '. 4 I" = dm py Aor - V *10e AP- ED£� •--3 ,, ®rc Ir�IE, F4sct�D, it }} 3 . � d Lirraz ra MAD-, V ' d /t: ry 1 11 ` 1 r��� •yr � 9 ` l 3 wwr�' AwAir*v =44bm#rr-P. • 2 �+ 79' - iMIG T+P Sc/fG�, fi .lioti�vp 96 -� I R ��cyusry To � S y l , .x ss 4' o IB i 1 � j 4 � 1 On, / S.T. �— 31I � O 'Aft \ { X4 Sts • r \ / of " ^ h ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer--- C,r.w GQ .Mailing Address 4kq s. ,xaagg�zr s7- Property Address &,5 /�G�xx.� �� „�Y�.f" A6xl -)�� Agox- TO /g� (Verification required from Planningg Department for new construction) City/State Parcel Identification Number ,*2,V — IPI W led LEGAL DESCRIPTION � f��,E� fljd ]'Yfrs' 1i¢ACAr-:L Property Location .Ufa %, y/. l/ Sec. 13 , T -R f — W, Town of �,om•J Subdivision _ Lot #_ Certified Survey Map # , Volume — . Page # Warranty Deed # .7.2 ✓.93 Volume suer , Page # �!L Spec house ❑ yes NKno Lot lines identifiable ayes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof yomseptic system eouldresnit in its prem tm fadweto handle wastes. Proper maintenance consists of pumpiag out the septic tank every three years or sooner, if needed by a licensed pumper. What you pat into the system can affect the function of the septic tank as a treatment stage in the waste disposal system The property owner agrees to submit to St. Croix Zoning Department a certification fond, signed by the owner and by a master plumber, journeymanpirmnber, restricted phtniber or a he ensedpnmper verifying that (1) the em -site wastewaterdisposal system 1 ° 1 °P 8 oiiod Dion and/or (2) after ieRmli m and pamoping Cif necessary] the septic tank is Iess than 1/3 full of sludge. Uwe, 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 Commerce and the Department of Natural Rmotnrcxs, State of Wisconsin. Certification stating that your septic system has been maintained must be cmVle ed and returned to the SL Croix Cexnty Zoning Office within 30 days of the three year expirstim date, 2 4 11 03 SIGNATURE 6F APPLldkk& DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 7 /a�11 SIGNATURE 6F APPLIC DATE- Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department ** Include with this application: a stamped wamnty, deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed oVIT CLAIM DMIM DOCUMENT NO. STATtt OF Wjq=Nta1N - FORM 14 ROOK 510 rACE 216 T „ I[ fPAC[ e[atu Vk ! R[COIIDn•O OwTA I1 321533 is . This indenture, made by ..II1xl.St4t+t.. CoLnc l l ..ot .St.- Crai x 12EGICROIX OFFICE C _Yal].r�c,............_... .._. _' .�. .... ._.., sir. CROIX CO' Wli. I ' i s Corporation duly organized and existing under and by-virtue of y � v oofftwttbe d w State of , Reed tr RApprd m., innesOt�tt ntOf, Of. � l... Ww... 7. . . ItA ...G.aW.*...LIAW�A.►....... M[tgt �D . A day °t- hereby quit - claims to ..... Six .... iX_�Lala.�t.. G1.G�» .SCO�t1 t. C�tOp4 -1J3G. r �Le : -...i� .. ��. trSUI�. Il 1_. t112k.:. 1: �' jI>• A: E. �. 1:.. �C. Q.[ �0.[, tL. lAR ............._ ............................... �I i ... ........._........... grantee.........:.., of ..... .... ......_ .......... ............................... llitii of �' aced. xal u�akale _frrons�I�derexlnn..Dal.ler... 1..IIO.�...and...athac.. the following tract of land in .............. SL....Gralx..._ ....... _. coun – -- — ......................_._ I� – true Stateof Wisconsin: ................................................................ ......._...................._.. .._.._. I 1 0 " i " Scout c ouncil 47 W. 9th 8t. At, Pan Northwest Quarter (NW1 /4) and West Half of Northeast Quarter (WI/2 of NE1 /4) of Section Eighteen (18), Township Twenty-nine (29) North, of Range Eighteen (18) West, St. Croix County, Wisconsin, except that part of the West Half of Northeast Quarter (Wi /2 of NE 1 /4) North of the highway. Northeast Quarter of Southeast Quarter (NE1 /4SE1 /4); South One -half of Northeast Quarter (S1 /2NE1 /4), and that part of North One -half of Northeast Quarter (N1 /2NEl /4) south and east of the town road as presently located, all in Section Thirteen (13), Township Twenty-nine (29) North, Range Nineteen (19) West. 1. South Half (S 1/2) of South West Quarter (SW 1/4), Sec. 12; 2. North Half (N 1/2) of North East Quarter (NE 1 /4) of North West Quarter (NW 1/4), Section 13; 3. South East Quarter (SE 1/4) of North East Quarter (NE 1/4) of North West Quarter (NW 1/4), Section 13; 4. That Part of the North Half (N 1/2) of North East Quarter (NE 1/4), lying northwesterly of the Town Road, Section 13; 5. South East Quarter (SE1 /4) of North West Quarter (NW 1/4) of Sec. 13; ALL in Township 29 North, Range 19 West. a3,__ EXEWT In Witness Whereof the said grantor has caused these presents to be signed by ..... , Ar dIA ... KaX[ 11an ............. _.................. ........................ ............................... its President, and countersigned by ...... Alai19.. jayart ........................................................................ , its Secretary, at ...�..• ............................. ............................... Wisconsin, and its corporate seal to be hereunto affixed this _ ......... .. ................ ....IC1................ day of ....... . Apr1l ............................... A. D., 19...7 .. SIGNED SEALED N oF .. ra IAL... S. GaUT.. .1:.01,1KC.1.L._OF...ST....CRO1 X 1kLLEx - ft // _.._....... ........... � ,`%V ............................... aA- _ Prnideot lfarid Ardis Harrison Carol n Y � COUNTERSIGNED- .--•r'� � -- - �p . ... �;.. ..r. � ._ . Secre n_ a lZ Al ant I nya rt Verone Pratt STATE OF WISCONSIN, ss. Additional notarisation, s ►,u 1 ............................. 2633..................... County. . on back. ..... APtLI...... :,r Personally came before me, this _ ... .............. ......���e11. y � � ..........A1. iiiA.1 1YArt .......................... .. ` !l of the above named Corporation, to me known to be the personl< who a rued the foregoing instrument, and to }'! �.. 3 ,I" Ols N��B .K t a. � j M i )rl� �.%Vc) sa.aidxo uoisslwwoo AW egossauuiW 'Aluno0 Aaswed `oi [7esij qn AjeloN %liao 'uoileaodaoo pies 40 paap ayl se aao1440 yons se ivawnalsui 6uio6aaoj ayj painoaxa oyM uosaad aye aq ol uMOU>l aw ol 'uoij -ioo paweu anoge a41 30 luapisaad 'uosiaaeH slpay '�M 'liady Jo /yep sIyI aw asofaq aweo AIIeuosaad ( A3SWVd 30 A1Nnoo SS ( VIOS3NNIW 30 31VIS x S E w p, v F—; U u N; V O .� I