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Home My WebLink About020-1491-05-000 (2)cD(tir yrl Ciahj-l�:�l �d f -h �V=n SANITARY PERMIT APPLICATION Depylimntofcommerce In accord withlLHa83.05. OoZU�—� q9/= o,S-oda So": w lilga lDq 313G 201 W. Waehi oon Avenue P O Box 7302 Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the , on per notl county than 81/2 x 11 inches in size. F(FrtiflE • See reverse side for instructions for completing this a tion .� to San bry PermtNumber R Personal information you provide may be used for secondary purposes _- i W;` ` L (Privacy Law, 15.04 (1) (m)1. ' Ovfr � s 'Chet* i� m p� applirmmn *ate Plan I.D. Number s. S? apo* 7 I. APPUCATION INFORMATION - PLEASE PRI r ... = 3 / 573 71 Property Owner Name .V G k4o i �rtr S TZ9 , N, R E (olp Property Owners Mailing Address` L' Block Number C State ip Code P ne Number Soidwoen•Nsme or CSM Number z yr N : (check one) ❑ State Owned vitifage Nearest Road Public 1 or 2 FamilyDwelling- No. of bedrooms Town of u III. BUILDINGUSE: (If building type is public, check all that apply) Parcel TaxNumber(s) 1 ❑ Apartment/Condo O 2 ❑ Assembly Hall 6 ❑ Medical Facility / Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash S ❑ Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify " IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. j6 New 2_ ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ___5Ystein __ ____System TankOnlY _____-____ ExistincjSystem ___ ExistlnQSZrstem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 1 t ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 (*Seepage Trench 22 ❑ In -Ground Pressure if 42 ❑ Pit Privy 13 0 Seepage Pit 3:— 3X aA.S, 430VaultPrivy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp Area 13. Absorp-Area 4. Loading Rate S. Pert Rate 6. System f,lev. 7. Final Grade Elevation Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq-ft.) (MinJinch) p;r.O7 y 4t 9 d y Feet ?9'"!I!/ 64 V11. TANK NATION G in gall°ns C Total Gallons # of Tanks Manufacturer's Name Prefab- Concrete coo steel Fiber- Plastic Exper Apo New Existin strutted glaze - Tanks Tnk Septic Tank or Holding Tank 1 IrJ [10 ❑ ❑ ❑ ❑ 110 ❑ ❑ Left Pump Tank r Vil . RESPONSIBILITY ATE ENT 4!/ER n on the attached plain. Plumber's Name: (Prim) Plumber's Signature:(No Sta MPeMPRSW No.: Business Phone Number: Die �`1E,1 i d -_T treiet.�IX. INt C f DEPARTMENT USE ONLY ❑Disapproved So itaryPermit Fee fVdutloCraaAY.oer Dateftsued AgentSignature(so Stamps) ❑Approved []Owner Given Initial $air"kt liming Adverse Determination S CD 5-a—Ze00 X. CONDITIONS QFAPPROVAL_/REASONSS'�RIQ�y�dq,PPROVAL: ..b� .Raft, da c..cf>a ` i SOD- $398(Ft 11197) e15Tea11[ge: oriomlt*t Y.oK VTs: ShNry iMialnp Diweiw,gww,Ph,�bh. PROJECT DATA Page 2- of io This dosed conventional in -ground system will serve a proposed building which will contain a kitchen and dining hall serving 2 meals per day for a maximum of 400 Girl Scouts. There will also be a multi -purpose room with a maximum of 400 people per day. 6 employees are anticipated with a shower being provided for employee use. 14 floor drains are proposed. ANTICIPATED WASTEWATER Dining hall w/ kitchen and toilet- 800 meals X 11 gal = --- 8800 gpd Assembly hall- 400 people X 2 gpd =----------------------- 800 gpd 6 employees at 20 gpd =----------------------------------- 120 gpd 6 showers taken at 15 gpd =------------------------------- 90 gpd 14 floor drains at 50 gpd =------------------------------- 700 gpd TOTAL =---10510 gpd SEPTIC TANK 10510 + 750 = 11260 gal minimum capacity required. Two 6000 gallon tanks by Wieser Concrete Products will be installed in series to provide 12,000 gallon capacity. ABSORPTION AREA 10510 gpd - .8 loading rate = 13137.5 sq.ft. of absorption area required. Two equal system areas are required due to the system size with each being 75% of the total area required. 13137.5 X .75 = 9853.1 sq.ft. of absorption area required per cell. Each cell will receive alternate doses of at least 1315 gal.per dose. ( 10510 c 2 = 5255 gal - 4 doses per day = 1313.75 gal/dose) Each cell will contain 18 trenches each 3' by 112.511ong with 18 units of High Capacity Sidewinder leach chambers per trench. This will provide 10,125 sq.ft. of absorption area per cell. PROJECT DATA Page 3 of 10 GREASE INTERCEPTOR C= H+G+H C= ROOX3X6 C= 14400 47- C= 3600 Sal. minimum capacity required. A 4200 gallon tank by Wieser Concrete Products will be installed. PUMP CHAMBER A 2000 gallon Wieser Concrete Products tank with duplex alternating pumps will be installed. ' SC4r t4 �I`' VOi11 _�2C19.0 -ftT �d7 b1St\��L5Z1UlJ-21-. 11? .00 _ �� __ � � 9 �So'I1:F BoX>:5> - - C`tit'wK�Y1�5 �3 L C2LCL fl • i 81lCAtfiOrS _ \tLS' t1t.V S tlt. V 5 6' Llta.60 \le.m ao4.,5 tSX?..-15 Lo8.40 1u8.90 too -es loT•os 10,-29 le1.2p teb-35 106-35 WS,Sb - 1oS.S'o Iow65 104..ls toj.90 to a 40 10 2.4S 4 oe \Qt.10 tu2..lo I CLSAM LO1.25 4D • e0 loo.uo I 6t 4455 9.z-to 48-� 96 80 4i.SS 46.%O amoo gb.00 tti.S' - F" +t2u7F� DUf t1s+F1 C CI L Vila. CLLI NO , Z e.,o Schiff 7�} �z"n.o.� I W 4�v�T t�alhDPaovEA LISP. I o� �vtL�o3M�@t Z4`COVL�{2 T`1.P lC .L _� 102iT ciw/i$1t4AT�RitCt: wcTwQ. )k3 '\JL S C**m Pest CetL Mlf 3'»6t 1125 ' "AiG kl/1$ lunY9 OF 1{16* teAPACITY 51pLA+JlND@R- LZW--li c—"A•ade1LS_PE1L-TI_--..-- StrE Pu'CIJ vtk3J Fa2iRR0VeN Lsl-�1ftYs�o7�: F�gIJ 0 PUMP CHAMBER CROSS SELT10N ARID SPECIFICATIOWSPAGE °I OF VEUT CAP ti c.z. VEAIT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE 10'FROM DOOR, JUUCTIOW BOX COVER WITH WARNING LABEL I2•MIL1. WIUDOM OR FRESH I rF- AIR INTAKE I GRQDC i yr MILS. I IC MIU. COWDUIT-- ---- ` 1 • PROVIDE I — MILET AIRTIGHT SEAL I // I+ I III v APPROVED JOIN A Tank construction shall Comply I III APPROVED JOINTS with approvedT/ with ILHR 83.15 and ILHR 83.20 i ill pipe extending Mu— � ALARM '3 feet o n t o 0 1-.tall dbpltn aUnreating teattole •ith. tha •late I I e]et� beiq i eetptated into the. dnplen eoetmL s o l i d soil. rich will " atti.at.d in th. went of psp filar.. I I ON Both sides O f C •i"ica'w•.ly .•itehind tie "nainint vats Le I I desires w uc► gcie. tank. I �1 ECCV. B� 6, FT. PUMP-� --� OFF D COUCRETC DLOLit � �aT�-3"APPStWE RISER EXIT PCRMPIFED OWL1 IF TAUK MAUUFACTURE.R HAS SUCH APPROVAL _1 gEDp1NFt SPECIFICAT101L15 _L• DDSE COIJ C.CLti*.T6 TANK MAUUFACTURCR: TANK SIZE: Z-C�00 GALLOWS uoTf. FLIAPAUD1,LAILMAR9TOU ALARM MAUFACTURCR:S.S.�INSTALLED OW 5EPA0.ATI CIRCUITS MODEL WUMBER: 1Aiscov-6n.Depawner" of Industry, SOIL AND SITE EVALUATION REPORT laborjdlemen Releoons niueion of SNuty 6 Q ildnns Page Lofi - - n. awvw mm iu u. w.v.., •.u. rw.... w.... Attach complete site plan on paper not fese Man 8 1/2 x 11 inches in size. Plan must include, but L PARCEL I.D. i not limited to vertical and horizontal reference point (W, direction and % of slope, scale or dimen Toned, north arrow, and location and distance to near ad. O o EWED BY DATE APPLICANT INFORMATION -PLEASE PRIM PROPERTY OWNER -VFBTTY LOCATION ,W.LOTZ/gr dtt 1/I,6/3 T.If ,N,R El PROPERTY RS MAILING ADDRESS s • BLOCK s Sl1BD. NAME OR CSM • , . sT• ' !' '_"' 'AT CRY, STATE zIPC00E _ NIWB�M,... ❑VILLAGE OWN NFAfEST ROAD New Construction Use [ [ Resider" / rhgero(bedrtxxns (1 Addition W existing bulldog [ 1 mj/J Pudic or cortmefcipjl�ec�ib�71 /rAl Code derived daffy lbw gpd Recommended desW loading rate _�t1ed, 9P Wig . W 2 Ahsorptbn area required bed, 1!2 __ bench, Tt2 Ma)enum design loading rate = _bed, gpd/ft2 — Bench, gpW RBCOMWended:htilbaW Slal" eWabmh(S) 944ew ru zvr .c 1t (as telBrrtW to site plan bendmark) Addoional design i site mnsideradas SVsTEi rt — 'r ix7Z. n Ar/&S i v Parent material Rood plain elevation, if applicable ft $ _ Suitable for system CCNVENTIDNAL ❑U I MDIIND [IS $ W4GA ND PRFSSUftE S ❑U A -eMDE ❑U SYSTBA N FLL ❑U TAKK $ ❑U U=UrstlAdTlebt S U Ground e1w. ay�ztL D"m Irriting lac50t � 14C Depth to limiting tacbr SOIL DESCRIPTION REPORT Remarks: �I PROP13"01WHER iCcA4 5rrAmft —KAirff&-w SOIL DESCRIPTION REPORT PARCEI.I.D.8 61r42&— 6O Paget ol 3 Boring # u Ground aw. ZZLY It Depth 10 limilling tam Boring # C3 Boring 8 13 elev. -2mt DO* ID Intm factor > k? Boring # Ll Slay. 1jr- sell. Depth ID bydm lam > //V L Remarks* Remarks: Remarks: 5804330(ROW 1lSsom.cw Oep rtn tof lndmvy, SOIL AND SITE EVALUATION REPORT Pap 4Of 3 Lanes mid 1Mmien Relasom Zivision of Safely a Biildnas Attach complete site Plan on paper not less than 8 12 x 11 inches in size. Plan must include, but C jr P CEL I.D.1 rot limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. /&All REVIEWED BY DATE APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER PROPERTY LOCATION �' - GOVT. LOT 1l 114,S T2 ,N,R E PROPERTY OWNERS MAILING ADDRESS LOT a BLOCK i SUBD. NAAE OR GSM t _ I Si ZIP CODE PRONE NUMBER OCITY EMLLAGE OWN NEAREST ROAD kj New Construction Use j j Residential / Number of becirooms I 1 Addition to eidstitg building I 1 Replacement (/J Pudic or canntertial describe �: LiYvY6.t/ Cade derived dais' low gpd Recommended desgn badig rare _bed gPdW_. p _trench, gp012 AbSorp area required bed, R2 beach, S Marinun design Wrog role --__bed, gpollz--�t_4endl, %KW Recommended r& lifi oft w1lacBalevalion(s) ZZ IED E/r4. A (as releeed b Site plan bertdmerk) Additinaldesign Isleaudderallam S'ai.vts/ k1Tct�i/ v4cT8�L/A7.E Parent material Flood plain elevation, 'd applicable R S - Suitable for syslan cwvEwrmk'EIS S❑ U tdhbll ❑ aEGRouwn PRESSURE S U A71hWlDE ❑ S U SVSTBA tRLL ❑ S U IfOLDNG ❑ S u U= Unsuitable I* S U Ground eley. -z It. Depth ID limiting tam >9y Boring N Z elev. JY. 6 It Depth b limiting facbt z/01 SOIL DESCRIPTION REPORT Remarks: Remarks: Pmnwowwm drm 5t 7-- SOIL DESCRIPTION REPORT PARMLMI aage, Lot 3 GOW Slay. 2L.If t Depth ID tinting laft -12.r Boring # El Gmund dev. 472,57- ft. Depth to kniling tailor Boring # NEW u Gmtold eift V, 7 M Depth 10 finiting left > 4d Boring # 13 IMM. - Z�T fMe7AWA44C A&&W;rAWCl� mm�sm sew Rn rkc- /Oz -747,<A/C C Rehr PkMbW 0221180 28288 McKee Rd. Spooner, WI 5M1 (715) 635 9 A 77 rn '/ % 1 pµl 6-i r , .Kai 9a ' Sr,�t[E 6D' d wr BM, 7o/0 if ,vntL st ieao, OFRRY rAC!-, PL.OVrd. SIN, 7'v? o f /Pips[ * r �AJE !f sar Ft OCR, NiiMw+E 9L•s. Fc�sFv, ��rREe Q yytO�o�Fu lrFl- Sti►t=IN DwrbToV of PRIVATE SEWAGE SYSTEM INSPECTION REPORT AL INFORMATION (ATTACH TO PERMIT) -.al idorr WUM you police maY be used for Secondary Purposes IPmacy Law, a.15.0a (1)(171)), rk'-1: Holder's Name: ❑ City ❑ Village ❑ {own o Croix Gid Scout Hudson T wn hi MEG.: Insp. M Etev.: M Destnption' =..re V1A I-n.0 11x7.o Cat- taws 1 ..s s& lo.e' TANK INFORMATION Pt" °'E6ATION DATA TYPE MANUFACTURER CAPACITY Septic wu bdp8 Dosing / eis Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Vent to Airintake ROAD Septic > �t scar v NA Dosing �t�t >� �- NA Aer= >1 M r % 140 NA Holding PUMP / SIPHON INFORMATION SOIL ABSORPTION SYSTEM /1 Q ) , Q 1 County. St. Croix Sanitary Permit No.: 363895 State Plan ID No: r T9 - T.+Ncaeitt. • .1119 PTrcel Tax No.: 020-1016-60-000 IS. zY• LR , -IS ST TIO BS ELEV. Benc k - 0,1#0 tj Alt. BM Bldg. Sewer St/Ht Inlefd- 4[• or St / Ht Outlet 11.11 (V 1.2- t Ot Inlet (S,O Y?-V" Dt Bottom ji• 52-8ibr Header / Man. Dist- Pipe Bot. System Final Glade St cover 2.. Z?L Tt�• r 314Z"Il II.13 5r-4-z 1[• `/o 411,116 TREN Width r Len . Of T nches PIT No.OfPits Inside Via, Liquid Depth r t .m 6DIMENSIONS SYSTEM TO P/L I BLDG WELL I LAKE/STREAM LEACHING an arer: SrW SETBACK CHAMBER ype Me Number: INFORMATION System: C ing. > 90 >3t* >'30o I OR UNIT _ Length?—'%` Dw SOIL COVER a x Only all Mound Or At -Grade Systems Only Depth Over X' Depth Over xx Depth Of xx Seeded/Sodded I xx Mulched I Bed/Trench Center Bed/Trench Edges Topsoil ❑Yes ❑Yes ❑NV COMMENTS: (Include code discrepancies, persons present, etc.) Insnection#1:6310SPI h Iucation: 965 Alexander Road, Hudson, WI 54016 (NE 1/4 NE 1/4 13 T29N RI9W) - 13.29.19.73 1.) Alt BM Description = (a�4 2.) Bldg sewer length = -amount of cover = ur Plan revision required? ❑ Yes JK No J Us�elot ersi r dditionalinformatio A/ O!ILL �( d �1.c"�-3� L" j� J �a c _e's /) In S na re _ .fin Cen. No- SIt 10 R.39 t 1-�-� n•r„Y4 . i (�" ayK GtRo�lf arr_ �3c . C-¢.o(Y- C-ncz�`s S 06L 6.6,� CQi-r-0 . e- ?.S=z• %- ^41 - to jar (4) - 4-2 . * 0 , £-1wsTtt 51►tE-�T`cb% FtL 9,,1f1M.�.•�s / R�1�3 , 6 93.'131 9t.z;' 87. aa' BB.ag .57. a 1 96. 43 ss.w 3' VIL 310 !z•co st. cg. }ills ir.os, -jq.* W."/ }2.c4 ` i •aY. _ '11. oy' VIA, SR.3L IF. � c 4Z 92 • I 71• � = a9•a4' ?2.7s�: t-F -W !(.-SO = 7r 70' R •st � {af.Bb' i�� }f." D ST•Qe _ -f.P oG &;sb. 6.X►1•►4 = ql• •I.Y ,�µc = 9s•3o� ib.l�... A4 - ti.c = 5.3o = 9 30 f Project Nanr: L.wa ian: Maiden Rock. WI 1400-.'i26-6486 Portage, WI 14800.362-72M Fond du lac, WI 14M)0641-6M 6 WeWte• www.wieserconmete.eom n+lk,a L,oeC,6 SEPTIC 5-IST-_ 3"� l o..cC f 1� - OIAOT sC. 4,-Itt.lt gS F. ►w ¢ 0. is (_P. .A-Ico ) Slot Ts6*JC.FkE6. ,) L?%— 99.00` 4) IZ.'f3 = 8p 35` g3.I?- t2� !f. So s q(. 16' 13� 1Z.2} = 9b• 13, f3•s * Tp 90' Icf.% = fj•9'f )L.yt =.9B 1 li.o s �s.YO �3.90 4,.4. a"i., I t to. 4d = W.00' 12.4" _ g9.9Y li.so it-'to' Is• ys = 414. or 1`i• ST = �2• Ss' Computation, Bv: Dalc: chmked By Date: _ Shccc: Of: