HomeMy WebLinkAbout020-1418-90-000
Volsconsin Department of Comme•ce PRIVATE SEWAGE SYSTEM County St- Croix
Safety and Bio ding Division
INSPECTION REPORT Sanitary Permit No
582090
(ATTACH TO PERMIT)
GENERAL INFORMATION State P an ID No:
Personal information you provide may oe used fc• seconcary purposes (o•ivacy Law, s 15.04
'zemlit lclder's Name City Village -ownship Parcel Tax No:
Bane Corporation 7 TOWN OF HUDSON 020-1418-90-000
CST BM Elev: nsp BM Elev BM CescrAon: r- Section/Towr!Rarge,Mao No
/LSb 1 c pe 20.29.19.2657
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER S CAPACITY STATION BS HI FS ELEV.
Septic 6.5
2.6 xx j> Benchmark 5-65104-&5 /66
LV V Alt. BM
e t~/ ~r►1 3•7-5
Aeration Bldg. Sewer , Sej
Holding - SttHt Inlet , /S "1 •9
Q
TANK SETBACK INFORMATION SUHt Outlet ~~0 0 c 37
TANK TO PIL WELL BLDS. lcn Ar Intake ROAD Dt Inlet
4. 1
Septic Ct Bottom
Dosing _ Header;Man 97,3
Aeration Dist. Pipe 9(,
Holding Bat. System 9S iig r 9. v4 -
Final Grade
PUMPISIPHON INFORMATION 4'~f cm
Manufacturer PMrid St Cover 3 G
Model Number 1 O 01,
TUH rft Friction Loss System Head TDB Ft
Forcemain Le C st, to 'Afell
SOIL ABSORPTION SYSTEM
BEDITRENCH Width _ength ( No. Of Trer-hes PIT DIMENSIONS No Of P is Inside Dia Lrqui Depth
DIMENSIONS 3 7
SETBACK SYSTEM TO P(L ` BLDG WELL LAKE;STREAM LEACHING Ma,uf.;;lurer
INFORMATION CHAMBER OR
TypebS dueA ,'1(• ~ UNIT Mc I N.,'ibar: _X " /
-,j
011
DISTRIBUTION ` SYSTEM 4h 34Ael LO = 33 . enoL,
HeaderNanaoly it fist ibu ion ` Ix Hole Size x Holy. Spacing Vent to Inta
Length U a~ Length Dia spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Deptl• Over Uep:h Over xx Depth of x Seeded,'Scdded xx Mulched
Bed`Trench Center QG Bed7rench Edgr_s topsoil ~ ~s a No _ Yes No
COMMENTS: (Include code discrepencies, persons present. etc.) Inspection #1 Inspection #2-
Location: 858 DORYVIN RD W C
1.) Alt BM Description =
2.) Bldg sewer length = Z
amount of cover
7
Plan revision Required? Yes No ( I 1 1
Use other side for additional nformalion.
Date 41nsepctor's sign Cert No.
Industry Services Division Count<
1400 £ \ ashington Ave
s j, ~,<o/?C
SPS MAR 0 S l U l'o P.O. Box 7163 Sanitan Permit Number (to be filled in by Co.)
Madison. WI 53707-7162 LQ p
ST. C ROIX COUNTY ✓ u ZQ / 0
COMMUM it Application State Transaction NuInW
I In accordance with SPS 333-21(2k Wis. Adm. Code• submission of this form to the appropriate eoyernmental trait
is required prior to obtaining a sanitary permit. Note: Application forms for statr•oumed POW75 are submitted to Project Address (if different dram mailing address)
the Department of Safety grid Professional Services. Personal information you providt~ may be used rot secondary
muses in accordance with the Privacy Law. s. IS.Od(S I(ra), Seats. 11
1. A lication Information -_Please Print All In rma "on .0_J_,8 4AAJ d Q/.
Property OWP-Ur s frame Parcel a 1 rl . 19. 7 lC S 7
I Property Oswxr-s Ntaihng Address Property Location
P A/V ooa,6.< /✓/„I X.O. Gott Lot
- ih•, State W- Zip Code Phone Number
cmrcle one~,~
/ f w~ sow! r T N: R . 1 aL%
11. Type of Build % (check all that apply) I.rn 7
1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name
Block R THE ZvL ew/
❑ Public/Commcrcial - Describe Uac 7bf
be- t
--7❑ State Otmed - (kscribc Use u4 t CSM Number age of ~
4~ ~1 Gl~~ f.J ~~I~l rv0 M Town of /►/0440,1J
III. Type of Permit: Check only one box on line A. Complete line $ if applicable}
❑
CKNety System Replacement System C3 rreatntertdHoli ing Tani: Replacement Only ❑ Other Modification to Existing system (explain) ~
B. ❑ Pcrrrtit Renewal (F] Permit Revision List Previous Permit Number and Date Issued
❑ Change of Plumber ❑ Permit Transfer to Nea•
Before Expiration Owner
!V. I'vpc of POWTS System/Component/Device: (Check all that apply)
j Nun-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Oradc ❑ klormd > 24 in of suitable soil ❑ ivlormd 607 %4&
< 24 in. of suitable soil 3 - II
'J Holding Tank ❑ Otlrer Dispersal Component (explain) ❑ Pretreatment Device (explain) /
1'. Dix ersaUTrea entArea Information: p
I Design Flou (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (st) System F ation
VS6 7 G y3 a YR 9G. yI 9s 7
V1. Tank Info Capacity in Total g of Manufacturer 1
Gallons Gallons Units Lj o
New Turks Existing Tarts H F ' a - -
I T I - U -7 ;r. _
srpnca DOO /ado ES ex c'O.%"CA'rrdr
C Dosing Chamber i
V11. Responsibility Statement- 1, the undersgned, assume responsibility for installation of the PO%YTS sborvn on the attached plate.
Plumber's ;`lame (Pnni) Plumber's Sienat re MPi;vtIMS Number Business Phone Nunlbcr
1 _
~4. ✓ tLKE a3/3y6 7/.T 4► 7.2 -Sd66 i
Plumber"s Address (Street City, State. Zip Code)
N 6 F.? Sr, w r ds' ~u.e f„~,o WI Sy7.T6 ~
VIII. un /De artment Use On
Approved n,_Litsappwue Permit Fee Date Issued Issuin gent Signor
,.Re.. far ial
It. ConditVffiTiEl 04kA AihReasons for Disapproval
1. Septic tank, erflt~ent filter end Ya.
oisper-:si cOl must all r A!Ln , ~i
as par management plan provided by pluMber. Alih
Z A a~ regialmr.(.nts meat 0 maintiirfid `
as per #VFbcable rode ! wdinane".
.mach to complete plans for the system and submit to the Count, only on paper not less than S t4 x 11 inches in size
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PO1iUs~ OWNER'S MANUAL & MANAGEMENT PLAN Page
FILE INFORMATION SYSTEM -SPECIFICATIONS
Owner 164./r- Tank Manuracturer. A)/,5,rL ~LA.rrr d NA
Permit; Septic 0 Dose l] Holding Volume: / ~o (9a1)
DESIGN PARAMETERS Tank Manufacturer: ® NA
' Number of Bedrooms: - 3 _0 NA 0 Septic ETDose I] Holding Volume: (4a1) f
fr: i
Number of PLOfic Facility Units: ® NA Vertical Distance Tank Bottom(s) to Service Pad:
Estimated (average) Flow : ' 3ab (gauday) Kafizontal Djrtance Tank(s) W Service Pad: 80' (r; i
~,.1 Specific servicing mechanics must be provided it vertical rs 5 feat or 1
Design (peak) Flow = (esUrriiak x 1.5): ~f Isd (gaday) if horiZOntei is >150 feet. 5pet7fic it16tNctiorm to oe oravided on bee::. l
In Situ Soil Application Rate: f (gwdayrf?) went Filter Manufacturer ,des r NA
1 Standard (Domestic) IniluentE--r-luent Monthly average Effluent f=ilter Model: Gf -/D
Fall. Oil & Grease (FOG) r:30 mglL Pump fvtanufacturer: NA ,
Simhemicill Oxyger Demand (80Ds) s220 MIL 0 P A Pump Model:
Total Suspender; Solids (TS5) slrio mg/L
High Strength lydluent/Efffuent Monthly average Pretreatment'Jnit t
;FOG) >30 mgtC Manufacturer.
19 NA
(HOD.} >220 mg(L Q NA L( Mechanical Aeradan 0 Peat Filter f
l . 55) >150 m rL Welland
0 pislnfeclion
Pretreated Effluent Monthly average L~ SVrWGravel Filter p other
j (isoD,) 00 mgti Soil Absorption System
(TSS) s3o mg1L 0 NA ad In-Ground (gravity) 0 in-Ground (pressure) ] NA
Fecal Coliform (geometric mean) s10` 0 At-Grada M hound
t Other
Drta Line
%4a)dmurn Ent cent Particle Stza /a in dia. 0 NA
1- Other. G N:,
j Other ❑ NA r
MAINTENANCE SCHEDULE
Service Event Service Frequency
`
I V When combined sludge and scum equals one-third of tank volume
Punp out contents of tank(s) [3 Whan the high vlatar alarm is activated -fl
month(s) (Maximum 3 years) ra NA
Inspect condition of tank(s) At least once every: 3 g year(s) 1
month(s) (Maximum 3 years)
inspect dispersal ell(s) At feast once every: year(s) _
/3 .rmorwr(s) n NA
Clean effluent flier At least once ever.!: 0 year(s)
NA
t Inspect pump, pump controls & alarm At least once every: 0El month(s)
❑ month(s)
E laterals and pressure test At least once every:. 0 year(s)
month(s) 0
other. At least once e`: er5~ ❑ year(s)
0 NA
l ether.
MAIN ENANCE INSTRUCTIONS
fnspActions of tanks and soil absorption systems shall be Trade by an Individual tarrying ono of the follovAng licenses or cer++~atper)•
Master Plumber, Masler Plumber Resiricted Sevier, POWTS inspector, POVNlTS Maintainer or Septage Servicing Operator
Tank inspeEfions must include a visual inspection of the tank(s) to identify any missing Q broken uent ornethe identify any stcracks orieaso
measure the volume of combined sludge and scum and a check for any hack up or P ng of f effland to an th gr any aurfi c of effluent
absorption system shall be visually inspected to check the eftent levels in the observation pipes che&
on the ground surface. The ponding of effluent on the around surface may indicate a tatTing condition and rsqurnsS b•e immedieWi
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-ihird ('.J) or more of the lank volume, 60 entire
contents of " tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other sorvicas, including but not limited to the servicing of effluent idlers, mechanical or pressurizzed components, pretreatment units.
and any servicing at intervals of s12 months, shell be performed by a certified POINTS Maintainer.
F, service report S11211 be "vicien to ine iocm regulatory authority within 30 days of -orr;pletion of any service event
START UP AND OPERATION X98 Q!
For new construction, prior to use of the POWTS check treatment tank(s) for the pramence or painting products, solvents or other
chemicals or sediment that may impede the treatment process'and/or damagw the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal Nghvrater levels prior to startup or due to pump failures. Start up or restoration of power under thesF,
conditions is not. recommended, as the excess wastewater will badischarged to the soil absorption system in one large dose causing a-
overload that may result in the backup or surface discharge of sf uent And damage td the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing operator (pumper) prior to restoring power todhe pump or contact a Plun ber
or PDJVTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when sod conditions are frozen at the irdlltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the
area within 1$ feet down slope of any mound or at-grade soli absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the troatment
tanks and soil absorption system: acids, armblotics, baby wipes; -cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, dfsirtfectan~ 'rats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons,'and water softener brine discharge. -
ABANDONMENT
When the POWTS fads and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is properly
and safety abandoned in compliance with s. 5!!1383.33, Wisconsin Arlirdsfsative Code:
All piping to tanks, pits and other sail absorption systems shall be disconnected and the abandoned pipe openings se0led.
c The contents of all tanks and pits shalt be removed and properly disposed of by a Septage Servicing Operator (pumper).
o Auer pumping, all tanks and pits shall be excavated and removed or their cpvers removed and the void space filled %vith soil,
gravel or another inert solid material.
CONTINGENCY PLAN
;f the POYVTS fails and cannot be repaired the fallowing measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaciion and should not be infringed upon by required
setbacks from erazing and proposed sftcture, lot lines End wells. Failure to protect the replacement area will result in the need
for a nmv soil and site evaluation to establlsh a sutiabte replacement area. -Replacement systems must comply with the roles in
effect at the time of their permit issuance.
C A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot bs
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort
C The site has not been evaluated to identify a suitable replacement area. Upon faMure of the POWTS a soli and ante evaluation
must be perforated to locate a suitable replacement area. If no replacement arm is available a holding tank may be installed as a
last resort to replace the failed POWTS.
mound and, at-grade soil absorption systems may be reconstructed In place following removal of the biomak at the infi#rative
surface. Reconstructions of such systems must comply with the rules in effect at that time:
I ARNING
TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN P0186NOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS;
POWTS INSTALLER POWTS MAINTAINER.
Name pN EL / 3 ' Name -T „I 1 !,K£ i-LK
Phone yx_ 66 Phone 7/5' 67.7
SEPTAGE SERVICING OPERATOR (PUMP - wlX J LOCAL REGULATORY AUTHORITY
Name Name ~T O/X 2oNiiJ[ OLFicEr'
Phone _ Phone 7 lft -
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1137
Wisconsi n Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Bu ldings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service
Attach complete site plan on paper not less than 8Y, x 11 inches in sve Plan must County St. Croix
include but not limited to vertical and honzontal reference point (BM), direction and
percent slope scale or dimems ors, north arrow, and location and distance to nearest road Parcel I. D.
Please print all information.
y Date
F'r+~u•rd eilunnu!ion y::u prcdu may Cc u~cxJ la cci,~nda y pur~~s~-i°r~uuj Lsw, s 1~ D411) i n)j /e~ G
Property Owner Property Location
Sienna Corporation ccvt. Lot SW 1 /4 NE 19 S 20 T 79 N R 19 W
Property Owner's Mailing Address I of # Block #i Subd. Name or CSM#
4940 Viking Dr, Suite 608 ! 63 st9 The Glen
City E4, fn, state Zip Code- PhoJne Number City Village ✓ Town Nearest Road
MN 55435 4Sz-~3S-z~a~ Hudson Dorwin Rd.
New Construction Use ✓ R idealist 1 Number of bedrooms 1 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe
Parent material Pitted outwash Flood plain elevation, if applicable na
General comments
and recommendations System elevation 100.75ft, trenches spaced and depth to code 3 50ft below grade
Boring # . Boring
✓ Pit Ground Surface elev. 104.25 tt. Depth to limiting factor 96 in. Sod Application Rate
HouLun Depth Do runant Color Kedox Oescnphon Texture Structure Consistence Boundary Roots GPDIft'
'Eff#1 "Eff#2
1 0-10 10yr3/3 none sicl 2msbk mfr cs If 4 6
2 10-17 10yr4/4 none scl 2msbk mfr cs na .4 .6
3 17-102 7.5yr4/4 none cos osg mvfr na na C 7J 1.6
a u ~ l~C ~ ~ Sys ~ r >s . CC t e 40 C0-9--t-,-t S~2z t d
GG 1
FY-1 Boring # Borinq
le pit Ground Surface elev. 104.25 ft. Depth to limiting factor 102 in Sort Application Rate
Renton Depth Uo n:nant Gcior Redox Description ?endure Structure Consistence Boundary Roots GPUttt'
'Eff#1 'Eff#2
1 0-9 10yr313 none sil 2msbk mfr cs 1f .5 .8
2 9-22 10yr4/4 none sicl 2msbk mfr cs 1vf .4 .6
3 2-102 .•l 7.5yr4/6 none ms osg ml na na ~.7 1.2
" Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 1.50 mg1L ' Effluent #2 = BOD<- 30 mglL and TSS < 30 mg7L
CST Name (Please Print) Signature: CST Number
David J Steel T-- 248956
Address Steel Soil Service / Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 / 9/1212002 715-246-5085
Property Owner Sienna Corporation Parcel ID # pending
Page 2 of 3
[-3 ] Boring # Boring
Pit Ground Surface elev. 99.85 ft Depth to limiting factor 102 in. Soil Application Rate
Horizon Depth Dominant Color f2edox Desc,rptiuri TPxturr Structure ^nnsistence Baindary Roots Gpp!fl'
*Eff#1 *Eft#2
1 0-12 10yr3/3 none sil 2msbk mfr cs 1f 5 .8
2 12-102, 10yr4/6 none ms-j osg m! na na 7 ? 1 2
C_-
~o L~ Q v Gv ru~~ b~ Qom- T3 ~ S~S P~►. - -e, ~,t,~ e- 41
tit
❑ Boring # Boring t
Pit Ground Surface elev ft. Depth to limiting factor in Sp[dicatron Ra elel
Horizon Uepth Dorrirvinl Cobr Redcx Description Texture Structure Uunsstence Boundary R,;,Z GPDIft'
*Eff#1 *Eff#2
❑ Boring # Boring
Pit Ground Surface elev ft. Depth to limiting factor in
r Sod Application Ratc
Hnnzon Depth Dominant Color Rocox Description Texture Stricture Consistence Boundary Roots GPUIft'
*Eff#1 *Eff#2
" Effluent #1 = BOD 5' 30 < 220 rng/L and TSS >30 < 150 mgiL * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mgiL
I be Department of Conunerre is an equal opfxrrtuniv, ser% ice provider and employer. If you need assutanee to access services or
Page 3 of 3
_ STEEL'S SOIL SERVICE
David I. Steel _
CST-PO'~'TSM 1564 Cty Rd GG
Sienna Corporation New Richmond, M 54017
Lic. 4 248956 SW114,NT.1/4,S 20,T29,R19W
(715) 246-6200
Town offludson. St. Croix Co. (715) 246-5085
1he (ilm lot 63
This soil evaluation was conducted to satisfy a zoning rcilairement, it may or may not be suitable. for
your use. The location of the test may or may not be as shown as permanent lot lines were not
established at the time the soil test was conducted.
Legend
1" - 40'
♦ - Benchmark El. 100.00D
Top Of '/2"pvc pipe
• - Alt Benchmark El.100.25FI
fJ Top of'/' pvc pipe
o - Borings
Boring Elevations
131 =104.25Ft
B2 =104.251-t tir
B3 =99.85Ft
B4 =00.00Ft
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