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030-2058-90-100
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ZONNG September 16, 2008 B &L Liquor Attn: Albert Severson 136314 th Street Houlton, WI 54082 Re: Property located in Section 27, T30N, R20W, Town of St. Joseph, parcel # Code Administration 27.30.20.5678 -10, computer # 030 - 2058 -90 -100, further described as 1369 Main 715- 386 -4680 Street, Houlton. Land Information Dear Mr. Severson: Planning 715- 386 -4674 After review of the six effluent sampling events collected for the B &L Bar it is Real Property determined that the average influent quality discharged into the Private Onsite 715- 386 -4677 Wastewater Treatment System ( POWTS) exceeds Wisconsin Department of Recycling Commerce Comm 83.44(2) monthly averages for Biological Oxygen Demand 715 - 386 -4675 (BOD). Average effluent quality results of 340 mg /I BOD are above the allowable levels for POWTS treatment and dispersal components consisting in part of in situ soils (results table enclosed). Based on observations from similar systems it is likely that alcohol waste being dumped down the drain is the source of the high BOD levels. Therefore you are required to work with a licensed plumber /designer to do one of two things: try to minimize alcohol waste to the system and resample, or install an Aerobic Treatment Unit (ATU) to bring the BOD levels within Comm 83.44 averages by January 1, 2009. If the January 1, 2009 deadline is not met, fines and /or forfeitures of not less than $100.00 nor more than $500 per day, everyday the violation exists, may be assessed to resolve this matter. Sincerely, 4� Ryan Yarrin ton Zoning Technician Cc: Jim Thompson, Plumber Leroy Jansky, Department of Commerce (f Enclosure ST. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD HUDSON, W1 54016 715 - 386 -4686 FAX RF� AN �G� cOU o8 Nr R E SAMPLE ID WEEK DAY DATE REPORT # RESULTS (Mg/L) B.O.D. T.S.S. Ph F.O.G. B &L 01.05.09.08 Friday 5/9/08 7:30 AM 8010799 386.00 47.00 7.30 3.00 B &L 02.05.15.08 Thursday 5/15/08 11:00 AM 8011622 350.00 34.00 7.10 2.00 B &L 03.05.23.08 Friday 5/23/08 7:30 AM 8012212 254.00 33.00 7.20 4.00 B &L 04.05.28.08 Wednesday 5/28/08 7:00 AM 8012440 324.00 44.00 7.20 3.00 B &L 05.06.02.08 Monday 6/2/08 7:00 AM 8012835 423.00 66.00 7.20 1.00 B &L 06.06.06.08 Friday 6/6/08 7:00 AM 8013519 305.00 59.00 7.00 4.00 Average: 340.33 47.17 7.17 2.83 M 190 1 4. A lla J I44 if l3l>og 716 _ 50 5— 65 f9 R �CF/ . x ST CRo 0001? u 11 A � �/N /kco .' , p G O FF O SAMPLE ID WEEK DAY DATE REPORT # RESULTS (Mg/L) B.O.D. T.S.S. Ph F.O.G. B &L 01.05.09.08 Friday 5/9/08 7:30 AM 8010799 386.00 47.00 7.30 3.00 B &L 02.05.15.08 Thursday 5/15/08 11:00 AM 8011622 350.00 34.00 7.10 2.00 B &L 03.05.23.08 Friday 5/23/08 7:30 AM 8012212 254.00 33.00 7.20 4.00 B &L 04.05.28.08 Wednesday 5/28/08 7:00 AM 8012440 324.00 44.00 7.20 3.00 B &L 05.06.02.08 Monday 6/2/08 7:00 AM 8012835 423.00 66.00 7.20 1.00 B &L 06.06.06.08 Friday 6/6/08 7:00 AM 8013519 305.00 59.00 7.00 4.00 Average: 340.33 47.17 7.17 2.83 I G. C 3 G'-.: 2, N a ~ p w 0 G o n C I O O C C O N N N N V N Wto E L _2 = O CO ' N 4 - - eF 0 CO 3 m N > N 3 m co h P LO in c N N m° N rn c v O O �pcdo E ai Eo m yc ma o L F- m C 3 0 C Z U ` Y O z O m U. c M° Q N m U. C m E O 01 N O V O O. U v ono- m a� o I I o I I w o 0 3 ¢ iii z a w N Z O !+ O a m N��-z am I I O z a c c d Z c o c to F - m o E c' E c N c: CO 0 CO N Zn U N y • d p N _ CL O § a CL O O z 5 z O z w z j N c O LO x o m E z E m c � E � � E c _ .. R M .. ag 0 IL CL cn CL N d x in co co C O d E o G a E a j ° v H IN- FF-- 3 o F F _ @ LO 0 0 0 a m a� 0 0 0 a N •ry m S a a a 3 0. a s ►i a ! o °_ I� y y — N 0 O N O N O O N n n O J V S N N} m- Z �l z 1- N z tE a) E M CO o o E m oo Coo m a m c x v y o C w o rn v °—' ¢ n CO m 0 v °—' ¢ z cit CD a p c m C ° O H C «O W C V 00 a C N G C 0) M c- C (6 f0 C o° O O D U O 75 N J m m N Ci N °v = E E r J M o O _ (O y m m U O) O O 0 m m • �'' co N U) fn O Z N d (n m V N Z 0 x x V � E d I E d 3 di a l'' as L: a T • ce CL d .� a E i c c c r� r A 0 a 0 N V 0 m V m \ m j i : \ 0 �S\ \ 2§ / «U ¥ \C� \ 77] $ a OD ) 2Lq )§ ! k k00 2k r§ ) k \§[ U. a�53 k 5 =cc E 2322 ) n « / 5 « \ ix �j § w \ \ - J z % / z a m \ z :!t 2 § z § 0 _ « b \ � p 2 5 (\kj - .� :� §m # � \ ¥ & / / Q ( \ z \ z § \} « 0 It ) k CD \( \a)\ 1k m �I § o a = e E � \ >\ ƒ / m § § § - t % a a a ; § j \ 5 Q q : / / a ) ee ; E { § © 2 ) A2 3 S \ E �§ � <» 3� k 4) ( # z z 2 © �\ V) U) 2 \ / ' CO o ;m ) §« k G e [ 9 § £ \ § \ 2 \ g g G (I , e n o § 2 G\ 2[= 7 m f o 2 /] a& . f / @ k \ Oa § 3 § > ± J ± § f G §/ _> o z}ƒ w k/ J ' k C — / " a / j a 0 k ) r Parcel #: 030 - 2058 -90 -100 09/16/2008 10:19 AM PA 1 O F 1 Alt. Parcel #: 27.30.20.567B -10 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/19/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - SEVERSON, ALBERT A ALBERT A SEVERSON 1363 14TH ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.220 Plat: 4705 -CSM 18 -4705 030 -04 SEC 27 T30N R20W LOTS 14,15 & PT LOT 13 Block/Condo Bldg: LOT 01 & 16 BLK 7 NKA LOT 1 CSM 18 -4705 (1.22 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 27- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 05/04/2004 761595 2564/508 QC 02/19/2004 754646 18/4705 CSM 02/19/2004 754646 18/4705 CSM 12/23/2003 749907 2479/521 q mor .. 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 1.220 79,900 469,500 549,400 NO Totals for 2008: General Property 1.220 79,900 469,500 549,400 Woodland 0.000 0 0 Totals for 2007: General Property 1.220 79,900 469,500 549,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wilconsn Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix .°.lwety,:nd Building Division INSPECTION REPORT Sanitary Permit No: 506295 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: Severson, Albert St. Joseph, Town of 030 - 2058 -90 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CV5(& d Z 13 kh y 27.30.20.567810 TANK INFORMATION UELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / L r te- Benchmark Aeration Bldg. Sewer Holding St/Ht Inlet Ht Outlet TANK SETBACK INFORMATION tS�1 �•t40 /�`/ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD nlet ,47- -L U1NF'N T Septic I om Dosing Header /Man. a 9s 6 Aeration Dist. Pipe Holding Bot>� m 9Z, p PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM ►�,h Model Number / a TDH Lift Friction Lo System d TDH Ft Forcemain Te ffi Dia. Dist. to Well JI 3 SOIL ABSORPTION SYSTEM -' /V t / BED /TRENCH Width ength No. Of Wren hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS i� SETBACK SYSTEM TO � P /LS BLD W LAKE /STREAM ACHI G Manufacture INFORMATION CHAMBER 75 Typ Of System: Model Number: r. DISTRIBUTION SYSTEM Header/Ma Distribution Vent to s , x Hole Size x Hole Spacing In take VVI Lt X ` p �� t4.0 Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over r Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed[Trench Center f . Bed/Trench Edges Topsoil r 9 p Yes �— No LJ Yes COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / 0 / 1 3/ 6- Inspection #2: / / Location: 1369 Hwy 35 N Houlton, WI 54082 (NW 1/4 NE 1/4 27 T30N R20W) Village of Houlton Lot 1 Parcel No: 27.30.20.567B10 1.) Alt BM Description 2.) Bldg sewer length = C " -' yz - amount of cover = Plan revision Required? ❑Yes No Use other side for additional information. SBD -6710 (R.3/97) Date t Insepctors nature Cert. No. or) commerce.Wi,gov Safety and Buildings Division County C �� M 201 W. Washingt 16 cx s eo n s n Madison, Sanitary Permit Number (to be filled in by Co.) Department of Commerce - 66- a S anitary Permit App1ica State Transaction Number In accordance with s. Comm. 83.21(2 Wis. Adm. Code, submission of this form to the appropriate governmental 1' unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different thanmailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ( l u ses in accordance with the Privacy Law, s. 15.04(1 m , Slats. ,,�3// l 1 1. Application Information - Please Print All Inforntati /`i Oa -170AJ �r Property O er's Name l` Parcel # '1L 13 d C Lr Qv� '� 013 - 01fe- Yo - /Do Property Owner's Mailing Ad ress Property Location 3G 3 C 4! �� S _ s&�3 v QT rpr)IX City, State Zip Code hone Number NTY Govt. Lot / 5 W 14, Section o� U 1�4 I I !\ V (circle one) Ii. Type of Building (check all that apply) V V Lot # T N; R u E or w ❑ 1 or 2 Family Dwelling - Number of Bedrooms !�'/ / t7 Subdivision Name �,� y� Block # 7 tv / '� .Public /Commercial - Describe Use 6 X8 9 ❑ of r �e� B v L LrquetS�an -r✓ El State Owned - Describe Use CSM Number Village of V -2 6 Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only •O"Ot er Modification to E isti Syste ( lain) A 4 I J kAbro Ph 0W Cain B• ❑Permit Renewal ❑Permit Revision El Change of Plumber El Permit Transfer to New !_ P Permit Number and Issued Issued Before Expiration Owner / 7 7 r" IV. Type of POWTS System /Component/Device: Check all that appl Won- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound _> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil c � ❑ Holding Tank ❑ Other Dispersal Component (explain) retreatment Device (explain) V. Dis ersal/I reatment Area Information: /�" oc N esign Flow (gpd) Design Soil A lication Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation - -' - 37, 1 15U,7 a.s� )(G f;rS Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U New Tanks Existing Tanks c W 0 a U rn m rn w 0 n. Septic or Holding Tank f a UU (1 a q t 0 J Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu is Si re MP /MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) b7 u >r V11I. ount /De artment Use Onl pproved ❑ Disapproved Permit Fee Da a Issued suing Ag Signatur ❑ Owner Given Reason for Denial lo Z.� s of Approval/Reasons for Disapproval SY ��wLPt. V � ; elStic tank, effluent filter and ti � �� /_,) , d ispersal cell must all be serviced / maintained S 107 s per management plan provided by plumber. /ST7NL7" � 7 2. II setback requirements must be maintained Z A 1.14— as ac r to complete plans for the syste t and submit the C roty only on paper not less than s v x I inches in size SBD -6398 (R. 01/07) Valid thru 01/09 4 �7✓ / e ✓a/ua��^i : P �� � �" � . /oca.•Eed�or S� 3 7 56a,7 do.---d zp�/fratu,- GJtb.n l. .5bwe -, e- e'ed.. 3s S'M %►, inu,►� 1 o t /, do P /B • �l70S S cJyf! /I�y�! Sec. 27 7730/1. u�• Tn. of 56.1aSe��, 56. Cro;X G., Z1. , Al. 030- ,Z0 CS-90 -rQ u e i • o J b K n , N v1 H h ti /lo c ogre al - a 6(e s/olae ` F tll.rOC,u�� SyS�cr�, sl'c4. � h v p �• We / %f ors Q � � n �`t OiniA EX�sE;n� u)az� {iace �`,► \ �°� S ,c b h n /o•� :ne � esca/ eke 1 � / Pro w s caner Po/yl4XP� /OzseWI& EXisfih4 Out V* ¢, /Ec�a� out /tom. 14w as". T,°O l,�c<or Sfpre f °�• V } ' 5.ro..4 C6,—r all I/c�F{e�c -� Grrlcre,'� t reade.- S. T. w�0/Qaep Fr- 08;,z 6,4 in { /Aa ,6 ✓e 3u.r•Face r scd azspsesa- ccl/ PFF /uur / �m e W ' !nf /tia - ve Swf&ce b O N � PAGc� Z. U C EC OR RESPON E � /� oPo s•e �/ /ou S EE + Ilo�7 r Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 's c o n s' www.wisconsin.gov www.commerce.wi.gov/sb/ Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary August 02, 2007 CUST ID No. 222904 ATTN. POWTS Inspector JAMES W BOUMEESTER ZONING OFFICE BOUMEESTER & SONS EXCAVATING INC ST CROIX COUNTY SPIA 1070 HWY 35 N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/02/2009 Identification Numbers Transaction ID No. 1425110 SITE: Site ID No. 728525 B & L Liquor Please refer to both identification numbers, State Road 35 above, in alt correspondence with the agenc Town of Hudson St Croix County SW1 /4, NE1/4, S27, T30N, R20W FOR: Description: Non - pressurized In- ground POWTS / System expansion / Commercial Object Type: POWTS Component Manual Regulated Object ID No.: 1144810 Maintenance required; Replacement system; 963 GPD Flow rate; 124 in Soil minimum depth to limiting factor from original grade; System(s): In- ground POWTS Component Manual, SBD- 10705 -P (N.01 101) 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - 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 inspec s' Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. S A �C1111�1 DEPARTNIENT OF COMMERCE r - JAMES W BOUMEESTER Page 2 8/2/2007 Owner Responsibilities Continued: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. Note: TestinE of effluent quality for this POWTS shall be conducted per the attached management Alan; see page 6 of 7 of the plan for specific instructions. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 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 $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART, code: 7633' jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. REFCEIVED JUL 2 7 2007 SAFETY BUIL IC N NN - RESIDENTIAL CONVENTIONAL POWTS DESIGN Cocktail Lounge INDEX AND TITLE SHEET Project: Existing B & L Liquor Store oc L ge expansio Contact: Albert A. Severson Address: 1363 14thStreet Houlton, WI 54082 Site Address: 1369 State Road 35, Houlton, WI 54082 Legal Description: SW1 /4NE1/4, Sec. 27, T30N, R20W. Tn of St. Joseph, St. Croix County, WI. Subdivision: Lot 1, CSM Vo. 18, Pg. 4705 —1.22 acres Parcel ID Number: 030 - 2058 -90 -100 Plan Transaction Number. Unassigned Index and title sheet Pape 1 System design calculations Page 2 & 3 Site Plan Page 4 System Cross section Page 5 System Management Plan Pape 6 Attached soil evaluation report page 7 Designer: Boum ter License Number: 222904 n Signature: Phone No.: (715) 386 -9020 Date: d d SEE GGRRE pONDENCE System Design Calculations JOB DESCRIPTION: Existing B &L Liquor store currently serviced by oversized conventional POWTS. Owner proposes to remodel an interior portion of the building into a cocktail lounge. Proposal is to account for oversized septic tank capacity of existing system and apply towards increased demand created by lounge expansion. Additional square footage will be added to the existing dispersal cell that will fully account for wastewater flow generated by the lounge. Resulting dispersal cell will exceed sizing requirements of combined wastewater flow generated from both facilities. Sizing criteria based on owner statements of current wastewater generated by liquor store and anticipated wastewater load to be generated by lounge: l iquor Store.- Two (2) employees all shifts, 2 floor drains, 3,500 sq. ft. retail space. Total daily wastewater flow: = 236 rnd (2 employees, all shifts) (13 gal. /employee) = 26.00 gpd (2 floor drains) (25gal. /drain) = 50.00 gpd (3,5000sgft(70%) / 30sQ. ft-4 atmn )(l gal / atm = R1 67 god Total daily estimated wastewater flow = 157.67 gpd Total daily design wastewater flow = (157.67x1.5 conversion factor) = 2 5 5gDd (,otin Two (2) employees all shifts, 2 floor drains, 1,020 sq, ft. patron area. Total design wastewater flow: = Rns 50 Cmd (2 employees, all shifts) (13 gal. /employee) = 26.00 gpd (2 floor drains) (25gal. /drain) = 50.00 gpd (1,02 ft �4 gal/ afro - 40800 Total daily estimated wastewater flow = 484.00 gpd Total daily design wastewater flow = (484.00x1.5 conversion factor) = 726 00 god Combined daily design wastewater flow - Liquor Store: 236.50 gpd Lounge: 726 -0 o d Total daily design wastewater flow: 962.50 gpd EXISTING DISPERSAL CELL CRITERIA: I. Daily design wastewater flow �gpd `�2. Existing grade elevation: 92 -50' 3. Depth to limiting factor: > 1 MY' (elev. = 88.67') �-4. Existing system elev.: 92.5.0' (84" below grade) 5. Infiltrative capacity of soil at or within 36" of system elevation = 0.7 gDd ft 6. Absorption area required 338 4___3 sq ft 236.90 Gpd design flow / 0.7 Gpd = 338.43 sq. ft. required Standard Infiltrator E.I.S.A. per chamber = 31.10 sq.ft. 338.43 sq.ft. / 31.10 = 10.89 chambers required ,,-7. Existing absorption area installed: 68420 sq ft F i S A (22 chambersx31.10 sq. ft per chamber) = 684?0 sn ft F-1-vi-A, Number of trenches: 2 n 1 1 Standard Infilhm units each = 22 chambers total Trench width (A): 2.83' Trench length (B): 6R_75' Trench spacing: 5.00' 8. Excess dispersal cell square footage 345.77 sa. 684.20 sq.ft. installed - 338.43 sq.ft. required = 3 45.77 sq.ft. excess capacity Pg. 2 of 7 PROPOSED DISPERSAL CELL SIZING TO ACCOMMODATE LOUNGE: 1. Daily design wastewater flow: 726.00 gpd 2. Existing grade elevation: 99.50' 3. Depth to limiting factor: > " (elev. = 88.67') 4. Existing system elev.: 92.50' (84" below grade) 5. Infiltrative capacity of soil at or within 36" of system elevation = 6-7 /sa ft 6. Absorption area required: 977.1 Ssq t 726.00 Gpd design flow / 0.7 Gpd = 1,150.72 sq. ft, required Standard Infiltrator E.I.S.A. per chamber = 3 L I0 sq.ft. 1,150.72 sq.ft. / 3 1. 10 = 37.00 chambers required 7. Proposed absorption area to be installed: 1,15()_70 sg ft F.1 S A (37 chambersx31.10 sq. ft per chamber) = 1,150_ 70 sjl. F_I_S A Number of trenches: 4 = 37 chamhers tn al Trench width (A): _283' Trench length (B): --50-00', 50-00'. 6? 5', Rr 6R 75' Trench spacing: 3-00 SEPTIC TANK CAPACITY SIZING- 1. Combined Design Wastewater Flow = 962.50 Gpd 962.50 gpd/ 75 gpd = 12.83 gpd person equivalency 2. Minimum required capacity: 1,860.48 Gallons (962.50) + (11.61 x 2* x 12.83) + (46.77 x 12.83) = 1,860.48 *(Requires a two year maintenance cycle) (962.50x2.088 "magic number") = 2,009.70 gallon capacity required on 3 year maintenance cycle. 3. Existing septic tank Manufacturer & capacity: Huffeutt n gal. 4. Proposed septic tank Manufacturer & capacity: Weeks Concrete S_T,, 1 Ono gal _ to he connected in series, Existing Orenco FT -0822 -14RA effluent filter installed at outlet of existing Huffcutt septic tank Proposed PolyLok PL -625 effluent filter to be installed at outlet of proposed Weeks septic tank CONTINGENCY PLANS FOR DISPERSAL CELL RFPI ACFMF.NT Insufficient area is available to install replacement dispersal cell when hydraulic failure of existing cell occurs. Four (4) contingencies (dependant on available technologies and code requirements at time of system failure) may be possible to allow system replacement and/or rejuvenation. 1. Expose and remove existing Infiltrator chambers. Excavate and remove contaminated soil from beneath chambers. Reinstall chambers at greater depth (approx. 12 "deeper). 2. Expose and remove existing Infiltrator chambers. Excavate and remove contaminated soil from beneath chambers, place ASTM C -33 sand fill in excavation to restore original system elevation, and reinstall chambers. 3. Install aeration unit to pre-treat effluent and restore dispersal area permeability. 4. Convert existing septic tanks to use as holding tanks. F.FFLIIFNT MONITORING Effluent quality will be monitored to verify compliance with Comm. 83.44(2)(a). If needed, an aeration pretreatment component will be added to the system with pretreated effluent distributed through the dispersal component by pressure distribution. Pg. 3 of 7 ♦ Stti ,7 era de e � .5ai/ ei/a/ccatli'cYi P, . /ocafedor sfn.( - o. QQ 06 IiAf �Strn -e, /309 Sta 6e Pd 35 l / ^I r/; !B P� . 4705 s �r� �eXII S (C, 27, 'r 30/1 , Tn °F 56 •�T°Ser 56 . Cro;x �+., ,J /. , 4- 0 30 •�Zos8 -90 -/L ,F h H o 13 a w lu /Co �,opre c. a 6/e Sle oe F c#joini/� � , proPc✓b'cs awe > 1*0 frr.>., ac;5�vcr5uP CTS. n 13 E�ti Ski 0 6,Yi sLh�e eJc� nce ���.►�° �°� ° S k ed ,cab' by /.�.�s' � E /eday �a.L /off /ine ProPesla/cvee,f's eonere e CC': Toeof / o ff al— /I /,oCOae� 5l�odL �++�W' (y�ner o f,OroPcr6y. po /yLoXp - (a:LSe /u „/,y os': - r"o o f /.8 a,,- 6,re f��• EXisL cve/f --s-e ' c. /Eceat 9S. � EXiSE % .erg S.T. i� 11 t S.T. Or4xo F o&u iy6R `�1 %n�/ at�i' ✓P �urFatQ 9 A. S e dd;spKSarc // o Bxsb g �,r�br' C /ca�d�E<,E• � /�oPo �/ /oun SEE CORRESPON E NCE Pd&E z- 1 �a( M 1 = I II a� FlP I y 145 --1 01 �p �40,44 LA to f i 5 I In- Ground Dispersal Cell Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General 584-1070S_P &J -01/O 0 The In- Ground septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual ). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. No individual should ever enter a septic tank or pump tank as dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes 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 shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every year by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of the annual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Dispersal Cell and Pressure Distribution System The dispersal cell shall be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) on the dispersal cell is not recommended. The pressure distribution system is provided with a flushing point at the end of each lateral. Each lateral should be flushed of accumulated solids at least once every 12 months. A pressure test should be performed with the results compared to the initial test taken at the time of system installation to determine if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Testine effluent quality The sewage effluent generated at this site may exceed the high strength effluent concentration levels as established by the Wisc. Dep't. of Commerce. Influent quality entering the mound dispersal component of the POWTS may not exceed 220mg/L BODs, 150 MG/L TSS, and 30 mg/L FOG. Periodic testing of effluent concentration will begin 45 days after the system is placed in service and will continue at 4 — 6 day intervals for a period of 30 days with 6 samples being collected within that period. If concentration levels exceed Dep't. of Commerce standards, an aeration pretreatment component will be installed. Effluent quality will be assessed as described earlier. Results of testing will be submitted to the County Zoning Dep't, with a copy forwarded to the Dep't of Commerce approving agent. Influent flow may not exceed maximum design flow specified in the system design and sanitary permit. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the aeration unit, dosing tank, pump, pump controls, alarm or related wiring become defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. if the dispersal cell component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be replaced with a code compliant dispersal cell located immediately adjacent to the failed cell. A diversion valve will be installed to allow future re -use of the failed cell. Questions on the operation or maintenance of the system should be directed to the installing plumber or your County Zoning Inspector. Pg. 6 Of 7 1908 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8Y� x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel LD. - 0 ° z0 — J!p percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. tie LdBy Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location B & L Liquor Govt. Lot SW 1/4 NE 1/4 S 2 T 30 N R 20 W Property Owner's Mailing Addrem Lot # Block # Subd. Name or CSM# 1369 State Road 35 City State Zip Code Phone Number City Village id Town Nearest Road Saint Joseph WI 1 54082 715 - 549 - 6589 St.Joseph I State Road 35 New Construction Use: Residential / Number of bedrooms Code derived design flow rate 455 GPD ✓! Replacement ✓! Public or commercial - Describe liquor sales Parent material loess over outwash Flood plain elevation, if applicable NA General comments and recommendations: install deep trench system w/ 0.7 gpd /sq ft loading @ system elevation of 92.5 F Boring # Boring ✓J Pit Ground Surface elev. 99.9 ft. Depth to limiting factor > 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 1 0 - 10YR 3/2 - 1 2 f sbk ds gs 1f /m .5 2 6 -12 10YR 3/2 1 2 m sbk ds gw 1 m 5 �. 3 12 -25 10YR 4/4 sl 1 m sbk dh cs 1 m .4 .6 4 25 -34 7.5YR 4/4 sil 2 m sbk dh gs 1m .5 .8 f 5 34 -69 10YR 4/4 sil 2 m sbk dh cs 1m .5 .9 • � 6 69 -98 10YR 3/4 - s 0 sg dl cs 1 —1 7 98 -130 10YR 3/4 - s 0 sg ml 7 1.2 Boring # 4A Boring ;g Pit Ground Surface elev. 99.5 ft. Depth to limiting factor > 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -4 10YR 3/2 1 2 f sbk ds gs 1f /m .5 2 4 - 12 10YR 3/2 - 1 2 m sbk ds cs 1 m .5 3 12 -36 10YR 4/4 - sl 1 m sbk dh gs 1 nn y o ` 4 6 4 36 -70 10YR 4/4 - sil 2 m sbk dh gs lm .5 .8 5 7 -96 10YR 3/4 - s 0 sg dl gs if .7 1.2 6 96 -130 7.5YR 3/4 - L- 0 sg ml .7 1.2 occasional gy si coats on peds below 12" in both B -1 & B -2 ` Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mgC CST Name (Please Print) Sign to e: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 10/7/2003 715 - 233 -0398 Property Owner B & L Liquor Parcel ID # Page 2 ctif 3 a Boring # y.i Boring i! Pit Ground Surface elev. 99.5 ft. Depth to limiting factor > 124 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 -5 7.5YR 3/2 _ I 2 m gr mvfr gs 1f /m .5 2 5 -11 7.5YR 3/2 2 f sbk mvfr CS 1 m .5 • b 71 3 11 -25 7.5YR 4/3 - 1 sbk mvfr gs if .4 .6 4 1 25 -61 10YR 4/4 sil 2 m sbk mvfr cs 1m .5 .8 5 r61-124 7.5YR 3/3 _ s 0 sg - .7 1.2 i occasional gy si coats on peds below 11 "; all sand horizons, all pits, have occasional gr /cob /st w/ very occasional LS st ❑ Boring # ...'a Boring .J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 i I � I i I I Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L 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 608 - 266 -31 S 1 or TTY 608 - 264 -8777. SBD -8330 (R OWN) Certified Soil TeStbng 14 ID z� w 09.s� CA" o- ,, . S ♦.� t �.. o �...', r ,,,� l O F caY - per,, lO `mil � + �� 1 rya c2 se4 o� �`�' I—Aj � CI 3 3 ��y O �( Cz r1 VZ � d G �• 1 w L VOL 18 PAGE 4705 KATRLEER H. MWL STF — REGISTER OF DEEDS ST. CROIX CO * L MI RECEIVED FOR K ECORD CERTIFIED SURVEY MAP 02/19/2004 10:45AM CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW 114 OF THE NE 1/4 OF REC FEE: 15.00 SECTION 27, T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COPY FEE: COUNTY, WISCONSIN, BEING LOTS 14, 15, PART OF LOTS 13 PAGES: 3 AND 16 OF BLOCK 7 OF THE PLAT OF HOULTON, i r - cc N z N1/4 COR DOT #55 -35- 3892 -2004 z ° SEC. 27 NW COR, OF NE COR. p U BLOCK 7 — — — — — — — — — — — — — SEC. 27 �-- S89 °38'38 "E 2656.69' 32.90' � 2623.79 J V Af� - _ S89 °38'38 'EE NORTH LINE OF THE NE 1/4 OF SEC. 27 S89 0 38 1 38 "E w Z ca ° - - - - - -- -- --- S8 ° 38'38'E200.00- - - - - -- �= 50.00' �' = 0 W 150.00' — -_ — — - _ — NORTH LINE — �O4 OF LOT 13 VOL. 115. PG. 4242 SURVEYOR: PROPERTY CORNER COULD NOT BE I W THOMAS, M. HEALY r . Z SET AT TIME OF SURVEY, IRONS I [� w S & N LAND SURVEYING, INC. SET ON LINE AS SHOWN M z 2920 ENLOE STREET SOUTH LINE OF THE a O HUDSON. WI 5401 NORTH 40' OF LOT 16 S C) Z ` s o�\ I 2o.ss' S89 ° 38'38" E 150.00' z ���0 PREPARE OR: ALBERT SYVERSON I 1 , ALBERT 110.19 1363 14TH STREET VARIABLE WI TH� y ' HOULTON. WI 54082 19.25' 1 30.75 I I \ — I b� wl EXISTING IVN I Cj1 CO NI THO of QI c �I �� H 546 -a �( :\ BUILDING I � g �I pI UOSON. Q CIO I I wt O I co I E•. —+ X1 ©I `i O �• C ' M 9 I I UR �:/V I 8 •< �cc"�ch,,, o / � I CAUTION- HIGHWAY SETBACK v n 9 [M Y U I RESTRICTIONS PROHIBIT — I N� F� C Q a v IMPROVEMENTS. o z� O z Q � Z vi '9 17 S 0 . I T T ��\� ••..— J _L�Q� �� h ••••••••••••• SOUTH LINE 151.58' 48.42 OF BLOCK 7 l N89 0 38'38" W 200.00' AREA INCLUDING R -O -W: S SW CORNER 1.22 ACRES OF BLOCK 7 \ -wISION CORNER LINE 53,224 SO FT. EDGE i c� M TRAVELED WAYS �o u owe \ AREA EXCLUDING R -O -W 0.99 ACRES 43 109 SO. FT. EXCLUDING RAV LEGEND SCALE IN FEET 1 = 50' FOUND ALUMINUM COUNTY SECTION Zia CORNER MONUMENT 50 O 50 • FOUND 1' OUTSIDE DIAMETER IRON PIPE SET 1" OUTSIDE DIAMETER BY 18" LONG IRON THIS INSTRUMENT DRAFTED BY: WES ANDERSON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT JOB NO. 232 -004 DATE: 9/24/2003 REVISED:2/16 /04 SHEET 1 OF 3 SHEETS Vol 18 Page 4705 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner SYSTEM SPECIFICATIONS 1 � � A & f s Septic Tank Capacity (j(� Permit #� / - - -- a l ❑ NA Septic Tank Manufacture t 1 S ❑ NA Effluent DESIGN PARAMETERS ----- - - - - -- Filter Manufacturer PV, 1, -,, ' ❑ NA Number of Bedrooms /NA Effluent Filter Model �o d s 11 NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ftA Estimated flow (average) al /da Pump Tank Manufacturer _ NA Design flow (peak), (Estimated x 1.51 a 4 �-7 gal /day Pump Manufacturer -B,NA Soil Application Rate g al/day/ft' Pump Model Standard Influent /Effluent Qualit * NA Y Monthly average Pretreatment Unit 'B-NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Pretreated Effluent Quality 11 Other: Y Monthly average :D ispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODO 530 mg /L _ Ground (gravity) 10:1 In Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At- Fecal Coliform (geometric mean) 510" cfu /100m1 ❑Mound ❑ Drip -Line ❑Other: Maximum Effluent Particle Size Y, in dia. ❑ NA other: Other: ❑ NA ❑ NA Other: - ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) Q A year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ Montilla) a� p (Maximum 3 years) 13 NA ear s Clean effluent 11 nt filter At Eleastonce e every: r/ 12 months) / �P ❑ year(s) ❑ NA Inspect pump, pump controls & alarm At every: ❑ month(s) ❑ year(s) NNA Flush laterals and pressure test At least once every: p month(s) � N A Other: At least once every: ❑ month(s) o ar• ❑ — yearls) �NA 7 / ' (�2�" �t ZNVA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank Inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septa a Servicing g Operator and disposed on accordance Wisconsin Administrative Code. f i ordance with chapter NR 113, All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal celils). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. 'To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with : soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 'f7 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 compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area 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 biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at thattimet hr+a ^` < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOTE ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF X PERSON FROM THE INTERIOR OF A TANK MAY..BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name J` rn m Name Phone 21 5 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name PAYlrt -Q Name �,X�' \7C �Oln aN }1N I f Phone l -�, 5- 1 o D 5 Phone p� ^ This document was drafted in compliance with chapter Comm 83.22(2)(b)11)Id) &If) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address / 02�_ Property Address (Verification required from Planning & Aning Department for new construction.) City /State Parcel Identification Number 030- ap5S- LEGAL DESCRIPTION Property Location, '/4 , f 1 /4 , Sec. :: ,1 , T N R,: W, Town of - ,�S T4 Subdivision rYE0. 0 pL4-T/ S11) 8 / 1( 1 51 6^j , Lot # 40 T /3 E Lor,(4 0 13lic4 7 Wt I #- JZ_ Certified Survey Map # , Volume , Page # OS Warranty Deed # ��, 0' I S , Volume ,Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning' Department within 30 days of the three year expiration date. Uwe 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. Number edrooms . , nq _ G TUBE OF APPLICANT(S) DATE ** *Any info n that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 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 l3 (- U i wott St m residence located at: S W Y. Q F, y" Sec. T N, R a b W, Town of ST �� n� St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No J (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: r &UL I-I Construction: Prefab Concrete �_ Steel Other Manufacturer (if known) : 1�„�f�ru► Age of Tank (if known) : V \ r f3 btitP(1 U�f� (Signat re) (Name) Please Print ma (L s �)70 - (Title) (License Number) (b I t) ! (J-1 - (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . ' Name � `y Vy \`n - ts�o Signature 6t, MP /MPRS 11 a 1 U 2 5 6 4 P 5 0 8 STATE BAR OF WISCONSIN FORM 3- 1998 7 E. 1 S 9 s QUIT CLAIM DEED KATHLEEN H. NALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between B & L Liquor Store, RECEIVED FOR RECORD _Inc , a corporation under the laws of 05/04/2004 12:00PN Minnesota QUIT CLAIM DEED Grantor, EXEMPT t 15 and Albert A. Severson REC FEE: 11.00 TRANS FEE: COPY FEE: Grantee. CC FEE: Grantor quit claims to Grantee the following described real estate in PAGES: 1 St. Croix County, State of Wisconsin: Recording Area Lot 13 except the East 82 feet thereof Name and Return Address Lot 16 except the North 583�j feet thereof; Albert A. Severson and all of lots 14 and 15, Block "7 ", 267 Fillmore Avenue original Plat of Village of Houlton, St. Paul, MN 55107 St. Croix County, Wisconsin 030- 2058 -90 -000 030- 2059 -10 -000 030 - 2059 -20 -_ 000 Parcel Identitication Number (PIN) This is not homestead property. (is) (is not) �I � 1� ti 'I ii Together with all appurtenant rights, title and interests" Dated this S fL. day of February 2004 (SEAL) B & L uor , Inc . (SEAL �1 A ert. ver (SEAL) It s Chief cec tive Offic (SEAL) A` ii AUTHENTICATION ACKNOWLEDGMENT i Signature (s) ! State ofXM"Minnesot ss. Ramsey County. authenticated this day of Personally came before me this day of Februar 2004 q bey Alb ert eve }1e &lef — I I • ut vs. Off cer l'B & - L_ Liquor -- Store, Inc., a corporation under the law s ; TITLE: MEMBER STATE BAR OF WISCONSIN of Minnesota to (If not, me known to erson who executed the foregoing i authorized by §706.06, Wis. Stats.) instrument an ackno d the same. F THIS INSTRUMENT WAS DRAFTED BY ,. Seamus R_ Mahoney, Attorney Ro d W. Ylital0 Payne Avenue Notary Public, f W onsin St. Paul , MN 55101 My commission is permanent. (If not, sta a expiration date: (Signatures may be authenticated or acknowledged. Both are not Jarl"ary 31 2 0 0.5 ) necessary.) • Names of persons signing in any capacity must be typed or printed below Moir signature. " STATE BAR OF WISCONSIN wisconsin t_epd Blank Co.. Inc. QUIT CLAIM DEED FORM No. 3 - 1998 Milwaukee. wis. I . 4 6 FF IlDQ , a _& a A „ — 6 20 "`" A VOL 18 PAGE 4705 KATHLEEN H. WALSH d REGISTER OF DEEDS .r,;x ST. CROIX CO. WI u RECEIVED FOR hECORD 02/ 19/200 _. 4 10: _ 4 5A __ _r. .., I1 CERT r. _ IFIE .�L MAP CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW 1/4 OF THE NE 1/4 OF REC FEE: 15.00 SECTION 27, T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COPY FEE: COUNTY, WISCONSIN, BEING LOTS 14, 15, PART OF LOTS 13 PAGES: 3 AND 16 OF BLOCK 7 OF THE PLAT OF HOULTON. m: SE . 27 NW COR. OF DOT #55 -35- 3892 -2004 NE COR. OZ 0 c SEC. 27 p BLOCK 7 589 0 38'38 "E 2656.69' SEC' 27 32.90' _ — 2623.79' — — _& v 0 S89 °38'38 g w ` ¢ o NORTH LINE OF THE NE 1/4 OF SEC. 27 S$9 ° 38'38 "E LL z r - - - ca ------ - - -S89 °3938 "E 200.00' - - - - -- - J O w 150.00' - -- -- �ULLw NORTH LINE Z O M low � OF LOT 13 NW COR. CSM � Z VOL. 15, PG. 4242 m Z ¢ � r------ - - - - -- 00 SURVEYOR: sn PROPERTY CORNER COULD NOT BE _W m SET AT TIME OF SURVEY, IRONS THOMAS, M. HEALY \ g SET ON LINE AS SHOWN M Z S 8 N LAND SURVEYING, INC. w � y I J r 2920 ENLOE STREET �\ SOUTH LINE OF THE c6 C - O HUDSON, WI 54016 Z I NORTH 40' OF LOT 16 C -J co d P� I 20.56' S89 0 38'38" E 150.00' Z _ _ g �� p PREPARED FOR: y ALBERT SYVERSON '4 1363 14TH STREET 19.25 130.7 5' HOULTON, WI 54082 VARIABLE WI T" f 0 3 t ui 11 I EXISTING I N I I Go I m .., I Y I O I N� dI THO I S c ' \ ' �� I �I n ° I I H a �I ;� BUILDING I QI c �I I o 01 = 1 c� I GP o I UDSON. -A I dl O I Wt � I C _P O CAUTfON- HIGHWAY SETBACK -p G,�^pm q N RESTRICTIONS PROHIBIT I m N�o c`3 v IMPROVEMENTS. 0 2 I 0 - ' p if 0 19 — \ � •• t " """'•+ SOUTH LINE T61.58' 48.42' OF BLOCK 7 SW CORNER N89 0 38'38" 200'00' AREA INCLUDING R -O -W: OF BLOCK 7 \ -- VISION CORNER LINE 1.22 ACRES EDGE OF `�' ��l u � 1 53.224 SO. FT. TRAVELED WAY J.v. \ Yom— CO (p AREA EXCLUDING R -0.W l 20' 0.99 ACRES 43.109 SO. FT. EXCLUDING R/W SCALE IN FEET I" 50' v LEGEND FOUND ALUMINUM COUNTY SECTION CORNER MONUMENT 50 O 50 • FOUND V OUTSIDE DIAMETER IRON PIPE • CI SET 1" OUTSIDE DIAMETER BY 18" LONG IRON THIS INSTRUMENT DRAFTED BY: WES ANDERSON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT JOB NO. 232 -004 DATE: 9/24/2003 REVISED:2/16 /04 SHEET i OF 3 SHEETS O Vol 18 Page 4705 , C) N O 0 fn O 19 9 0 d o ;, f o d f c lu o m (D (D (D m v T '�° CD w CD CD I C/) m x g, CO C ro 0 . 7 3 < c o fN °� °� c n 0 go ` w go Q F s r r a) W 5 r CD o� O N y SJ N Vi C N N N C •O W r'S ° a a Q o ° ? C> w 0 c � cn m m c (A o w m O o o e-r !��►1{ 3 N CD to N O O O lr N N C n 4 , Z N �^ Z ( D - F D a Z" a c — co CD A A O N N N N O C 6 O O M T T '0 7 T T 7 K PM z 0 0 0 O O O - c to �n rn 0) v to to to 0) o w N O 'O 3 to W D7 O T c o v is v 0 o x (D O M N 2 CD N (D y = Co ''. V (D CL i D1 _ ' O O) N ( p H (WT A 0 m 3 m m o c 7 CD O N O p Z Q r N o Z . o D m o O D < CD 7 �1 ° ° (y O CAD O's CD CD CD O CD w O • lt CD N CD C C N C N w x d d CD i n 3 0 7 1 3 Z CD S (p CD f fl .,.1 .a -1 Ch A v N a cl A z N .. O 7 C (D < p v C C 3 Z 'A :U 3 3 z N m ° y N y CZD A W p� O N U1 U1 � Q CD N a 7 S 2 CD 'm 3(Q m O °a — a m m — 3 o m Z a �-0 Z a ' O n U 3 O N N C CD pp Q 3 d N O CD N y O D) 0 (n ° to y 3,2 0 0 ) CD �n a ?.tea D o o _ (n w o Ut p N 0 7C• O cn � T CO ' CD p p p V O O S A CO W N CD A 0� J Ee 0 ffl 0 ti ti O a �', O *- � ' ti Ww,onc n Dapaertment of Commerce , PRIVATE SEWAGE SYSTEM County: St. Croix Safety an?! [s'uilding Division — INSPECTION REPORT Sanitary Permit No: 430651 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)I. Permit Holder's Name: City Village X Township Parcel Tax No: B & L Liq I St. Joseph Township 030- 2059 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: r! O Section/Town /Range /Map No: �b (7 j i'_0 G r� 27.30.20.570A TANK INFORMATION EL V TION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. U Septic Benchmark I vw Brn / t6 0 Dosing Alt. BM 6 Aeration Bldg. Sew Y - 7 , s Holding St/Ht Inl t &J- G,. TANK SETBACK INFORMATION ©r l n �+�Fr Fi 10 St/Ht Outlet g g,� 9,5' 6 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S� o 2 _ Dt Bottom Dosing 7 Header /Man. Aeration Dist- ID" Holding Bot. System • 11.65 a - � PUMP /SIPHON INFORMATION - T 5 Final Grade Manufacturer Demand St Cover � GPM Model Number r TDH Lift Fri st m Head TDH Ft I Forcemain Length Dia. Dist. 19 W SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMEN No. - Li uid Depth DIMENSIONS 4 l SETBACK SYSTEM TO O � P ✓ /L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: r»n , n � UNIT r— ` 3 "J }� Model Nu be R SYSTEM Koh Si (Za il `ham Header fold ` Distribution x Hole Size x Hole Spacing ent to Air Intak O Gr— S / �J Pipe s Length Dia T Le gth SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of lxx Seeded /Sodded Bed/Trench Center Bed/Trench Edges To b�j �•b� �J Y °e "s Yes COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / C //(/ Location: 1369 Hwy 35 Houlton, WI 54082 (Unknown 27 T30N R20W) Village Plat of Houlton Lot 16 Parcel No 97 30 20 1 570 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = f ''11Gt1 P` VIA C6 dvvn pti+' 6" tog_ fy Yes 3v' - Use other de for information. No i c � q o � SBD -6710 R.3/97 Date In epctor's Signature Cert. No. Safety and Buildings Division County T �4 � - 201 W. Washingto ve., Sari permit Number (to be filled in by Co.) Nvisconsin Madison, W 53 E(VE (608) 66 -3131 51 30 6 Department of Commerce JAN 0 g State lam I-D.Number 9 = T S. /Q.#) Sanit Permit Applicati n 4 200 In accord with Comm 83.21, Wis. Adm. Code, personal informati you provide may be used for secondary purposes Privacy law, slS. lxm) ST. CROIX COUNT'(if dI$erent �° mailing address) ZONING SO4 1. Application Information - Please Print All Information 13 d } lb 1 t 1t+ 1 P el H w�C !, Bloc n Pruperty Owner's Name (r ) 7 p y Location 13 Property owner's Mail Address CP �© J 4L Zip Section rz� � 00 9— Ciry, State !L Zip Code Phone Number �r- � 41 J'7 L7 T I D Ni R E oe�) 4 �� �rJ 11. Type of uilding (check all that apply) Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms u X Public/Commercial- Describe Use wnship of _ V �2 K _ ❑City_ ❑Village o ❑ S[a[e Owned - Describe Use ICI 111. Type of Permit: (Check only box on line Complete li�ppll,.Ible) A. O New System Aheplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System list Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Rev Isirn ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that appl - C *.,F Non - Pressurized In- Ground ❑ Mound ? 24 in. of suitable s it ]MoaTzTf m: o swta At- a Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculadlig Synthetic Media Filter ❑ Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑Other lain) V. Dis ersal F cut nt Area Information: (n pew ( S stem Elevation Design Flow (gpd) Design Soil Applicatiar Rate(gpdsf) Dispe� �ea Required s Dispersal Pro ed s� Y V1. Tank Info Capacity Total Number Manufacturer Concrete Consttructed Steel Fiber Plastic Gallons Gallons of Units New Existing Tanks Tanks scene ... HW,t; T...4 HOC /GOD / Aerobic Tsstmcn Unit I DwinK Chambcr VII. Responsibillty Statement - 4 the under swum ns1bW for installation of the POWTS shown on the attached lens. MP/MPRS Number. Business Phone Number Plumber's Name (Print) PI Si gnat z&W o h/Z v95��o J Plumber's Address (Street, City, State, Zi C S"eo9 7 V Vill. County/ e artment Use Onl Sanitary permit Fee (includes Groundwater Date Issued Is uin gent Signature ( Stamps) Approved ❑ Disapproved Surcharge Fee) �� �. ` El Owner a Reason for Denial r IX. Conditions of Approval/ UReasons for Disapproval SYSTEM OWNER: G ? 2S- t � 1 Septic tank, effluent filter and _. dispersal cell must all be serviced / maintained }�- as per management plan provided by plumber.s'� 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plant (to the County only) for the system on paper not less than air! x 11 locb In size ( SBD -6398 (R. 01/03) / at ,, G04k L A 1� baeltl.toe �o; L. r�ovtt7t 1V o sea sel O�Ao--s o well r I � e I I T3l 4,t 1�4 ;�• C . �.^ ►a -U. -O- p*4 I �' Q d c J-AA L i Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 visconsin www.commerc .wis ons Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 27, 2003 CUST ID No. 139462 ATTN: POWTS Inspector TODD L SINZ ZONING OFFICE T L SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 -5520 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/27/2005 Identification Numbers Transaction ID No. 934860 SITE• Site ID No. 667341 B &1 Liquor Please refer to both identification numbers, 1369 State Road 35 above, in all correspondence with the agency. Town of Saint Joseph, 54082 St Croix County SW1 /4, NE1 /4, 527, T30N, R20W FOR: Description: Commercial (Retail/ Liquor Store) Non - pressurized In- ground System Object Type: POWT System Regulated Object ID No.: 927576 The submittal described above has been reviewed for confomlance 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: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "In- ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10705 -P (N.01 /01). • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan Condilfio A ��� approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take DEPARTMENT OF precedence. B�Ii�WN OFAAFTEI�, • The plumbing for this project discharges to a private sewage system. The approval covers only SEE CORRESP domestic /sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes. - y -- • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat TODD L SINZ Page 2 10/27/03 • Comm 83.22(7) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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, stricture, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 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 $ 175.00 17 Fee Received $ 175.00 ;✓ s_, Balance Due $ 0.00 Charles L Bratz / POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Henry F Grote, Certified Soil Testing I .� 15 2p03 B & L Liquor - Conventional System - spF Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manual: In- ground Absorption (v. 2.0) — SBD- 10705 -P Location: SW 1 /4, NE 1 /4, Sec. 27, T 30 N, R 20 W Town: St. Joseph County: St. Croix Date: October 28, 2003 Owner: B & L Liquor Address: 1369 State Road 35 St. Joseph, WI 54082 Plumber: Todd Sinz Signature: License # MP 139462 Attachments: 6748 Plan Approval Application SBD -8330 Page 1: cover 'n�lly 2: design criteria and sizing 1 ED 3: plot plan COytM cc 4: plan view /system cross section `otciN 5: maintenance JN EN Page 1 of 5 A Design Criteria Wastewater Contaminant Load: 30 mg/L < BOD < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Estimated design load = �s S� gallons /day hydraulic load Design Calculations In situ designed loading rate d • t. gallons /sq. ft. per day Depth to estimated high ground water > 1 3 L'> in. Depth to bedrock ' 3 in. Cross slope at system % System Elevation 't Z. a Final Grade Elevation ctct•5 + Septic tank ' 4-11 gallons Effluent filter c) V o F e SY it. 1 4. %1 t o Estimated Daily Load 6 FTE: 6 x 13 = 78 gallons /day 2 floor drains: 2 x 25 = 50 it 7500 sq ft retail: 7500 x 0.7/30 = 175 it Load = 303 gallons /day Design flow: 1.5 x 303 = 455 gallons /day Septic Tank Sizing Minimum sizing for 3 year service frequency is 950 gallons; use Huffcutt 1000 gallon tank. Adsorption Cell Sizing In sands @ 0.7 gpd/sq ft: 455 gpd/0.7 gpd/sq ft = 650 sq ft minimum Use Infiltrator, Standard leaching chambers @ 31.1 EISA; minimum required number of chambers is 21; use 22 shells, two runs of 11 shells each; 684.2 sq ft total for a loading rate of 0.665 gpd/sq ft. Specs.calcs.gravity Page Z Of 13 (� a t \ w Z t l csZ�1n X1,12., z QA4, c9 lo Q�3N��wo.o� a��-v o•. ;•� n S1-i,�Z, do ^w1 \O�- c�Y -•+2.. � �• • ��/1_ S�1`:"' ���j� t� ba�lc�oe yo ( a+dLQN Y�ov� f I \�o X83 se� -`o� o�'i \�•-i 1` � �f dke I� r I �l jk,.� owl V ¢— l U d G�l�w L1 k I� 11� �I mMi � K �b�`�� 1 QR.1 ♦ 4,- 11� v �'1 w �.o -� ire+•. S 9.4 . �L PQ L qz.S- -� • 1 o.bV� O O S . 10.1 O O =•st' is g •'t'Z' ' � O C7 io s a.�, � a 1= o� �-�•. �� l S J System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T. L. Sinz Plumbing, 715-235-2644, or the St. Croix County Zoning Office should be contacted at 715- 386 -4680 for their assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start -up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. Periodic observation pipe inspections should be made by the owner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 4. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 5. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 6. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 7. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 8. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 9. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for non -high strength wastewater systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 5 of 5 1908 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and _ b . Zp _ 3 J�o Z — 36' , Roq percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. a� - o - C - -c-lon Please print all information. tp* 4ewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ' Property Owner Property Location B & L Liquor Govt. Lot SW 1/4 NE 19 S 27 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1369 State Road 35 City State Zip Code Phone Number City Lj Village jo Town Nearest Road Saint Joseph WI 1 54082 1 715 - 549 - 6589 St.Joseph I State Road 35 New Construction Use: Residential / Number of bedrooms Code derived design flow rate 455 GPD Replacement Public or commercial - Describe liquor sales Parent material loess over outwash Flood plain elevation, if applicable NA General comments and recommendations: install deep trench system w/ 0.7 gpd /sq ft loading @ system elevation of 92.5 a Boring # Boring f Pit Ground Surface elev. 99.9 ft. Depth to limiting factor > 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10YR 3/2 - 1 2 f sbk ds gs 1f /m .5 2 6 -12 10YR 3/2 - 1 2 m sbk ds gw 1m .5 . 3 12 -25 10YR 4/4 - sl 1 m sbk dh Cs lm .4 .6 4 25 -34 7.5YR 4/4 - sil 2 m sbk dh gs 1m .5 .8 f 5 34 -69 10YR 4/4 - sit 2 m sbk dh Cs 1 m .5 .9 �+�% - - `2 j 6 69 -98 10YR 3/4 s 0 sg dl cs .7 1.2 7 98 -130 10YR 3/4 - s 0 sg ml - - 7 1.2 Boring # Boring 16 Pit Ground Surface elev. 99.5 ft. Depth to limiting factor > 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -4 10YR 3/2 - 1 2 f sbk ds gs 1f /m .5 2 4 -12 10YR 3/2 - 1 2 m sbk ds Cs 1m .5 i 3 12 -36 10YR 4/4 - sl 1 m sbk dh gs 1 m .4 .6 4 36 -70 10YR 4/4 sil 2 m sbk dh gs 1 m .5 .8 5 7 -96 10YR 3/4 - s 0 sg dl gs if .7 1.2 6 96 -130 7.5YR 3/4 - s 0 sg ml - - 7 1.2 occasional gy si coats on peds below 12" in both B -1 & B -2 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mgL CST Name (Please Print) Sign to e: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 10/7/2003 715- 233 -0398 Property Owner B & L Liquor Parcel ID # Page 2 of 3 31 Boring # Boring jid Pit Ground Surface elev. 99.5 ft. Depth to limiting factor > 124 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -5 7.5YR 3/2 - 1 2 m gr mvfr gs 1f /m .5 •�y 2 5 -11 7.5YR 3/2 - A 71 2 f sbk mvfr cs 1 m .5 b 3 11 -25 7.5YR 4/3 - 1 m sbk mvfr gs if .4 .6 -�( 4 25 -61 10YR 4/4 - sil 2 m sbk mvfr CS 1M .5 .8 5 61 -124 7.5YR 3/3 - s 0 sg - - .7 1.2 occasional gy si coats on peds below 11 "; all sand horizons, all pits, have occasional gr /cob /st w/ very occasional LS st F-1 Boring # Wei Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # _jI Boring 1 Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ` Effluent #2 = BOD <_ 30 mg /L 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 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Certified SaITesOng .k o\r - \�lo� v „ Sw- ~l�- 2� -3ro- za w IV Lwo o .-1 NA 1b e �1 nn S 4,� t ti O ..n'. M W I � O� G.IY'NQ„4 }O r•L (` ltie.l� G1 `l 3 -ri„"R o"- 2 S �Jra 1 oK �fJt � d Z a !!ZI .4-,z B & L Liquor — Sizing Estimated Daily Load 6 FTE @ 13 gpd = 6 x 13 = 78 gallons /day 2 floor drains @ 25 = 2 x 25 = 50 " " 7500 sq ft retail = 7500/30 x 0.7 = 175 " " Estimated Daily Load = 303 gallons /day Design Flow = 1.5 x 303 = 455 gallons /day Septic Tank Sizing Minimum sizing for 3 year service frequency = 950 gallons Drain field Sizing At 0.7 gpd/sq ft = 455/0.7 = 650 sq ft minimum Page 4 of 4 04/05,*04 NON 14.15 F 715235819 CEDAR F BUILDING SYS 0003 .11/10/2003 10 :01 FAX 7189352402 - T L SINZ PLUMBING INC fao0i IST CROIX COUNTY SB?nC TANK MAIN TZNANCE A $$Nrsw AND OWNERSM CMTagCATION FO RM pwncr/Huyer �� // Meiling Address /c3 6 9 , 3 A/060 Propotty Address 136 9 .-ILI Y '35 r [W �'Yo (VesiCt[;A oO0 required fr Pls=tUg DaParastont for new CoeatrnGtto City/State Parcel Identificadon Number 5.ae- d Pr op ctt5' ` /. S 3b N-W. Tawu of CvT. t 6t et Subdivision Certilled Survey Map # volume 1_'t���A Wa >'ntnty Dead # � 'l . Volume S house O yes ❑ no Let lines idontifiAble ❑ Yu II0 W Iatit MAIAt'I�NAN2 lsxtptoper use aad tasit your $Wie Imam could result io its ptetrs Mm "urn to Eiaut'!Ie mac'. FPS °sa''ate°"°°` eoasists a(V=PW out the septic u mk C"'T tbl" }OM or 6900e:4 if ssededby a 1 asdputn ?ar. R►'hat you put taco the system caa meet the f edon of the acpdt tank as s exoamacot dSc in the waste disposal Otcta. . CDs ptVparty oa'Rcr agte4s to sybmit to St. CSm x Zoning JAopattmemia �ostioA f or est. sigaod by tho owner sad by a Grp {�, Jar,[• j, t, �eyM= plwmb rr, ZejztctadpI =boomGesrnsadp ['ocifyiuBtbat(i) the os- s;tawostr:woterdisposnisystem is it pmper vpc tnt ng ro a ditio>7 and/or fi) after 3aspeedon tad pumping (if acersaasy), &e taaptfe lank i tens cirri 1/3 N11 of sludge. I/a< the wj rr*ed have toad the above seguisumcu% and 4sma to mains the privale smige 41spostl system with the standards SAC foeth, liars' set � by the Dop;i�testt of Comm�tce ttad thv e�u�cat of Nattrsa! Resetatcet, 9tatc of WiaanasQ d R ctatm 5960 syuem leas bean viedmust bs completed mad to the SL C1c ix ea=ry Zoaing lfiw dAy= eW cr Pira a date, r DATE TG A A PLICAATL' v i t WU sCb N orl this fo arc true to the bast of my (G") Laowledt;e. I (we) sm (em) th6 aV1�eR�) GC the r , above, by a of A wit decd recorded is Registsr of Dtc& C Ma+. 1 a r 0 DATE SICI .� F Ap LICA .... •. , may inl scion that is ally- tept"=Nd ratty result tit the s2weary pe ttsut bcbmr, mvekod by the Zoaltsg DepartweaL •• Include wftb thi appllcttloat tb �cr d ccA � now�=do in tbg tga=ty d0wd c M of 01/05/04 MON 14:14 FAX 7152359190 CEDAR FALLS BUILDING SYS C�o02 . .12/30/03 TUE 14:21 FAX 715. 388 ; 687 REGISTER OF DEEDS 10002 479P •S20 -T.-i, 6 5 UnR all WISCONSIN 1 ]. — ) 901 KAY H VALLSH WAAAAMTY aL"CD R Z$'[8R O DEtDO W. cROZx ., wx DoQUMENT NO. _� :=a>: s' »aarrerersa:.��• :r:. :_...� RzctSYED FOR RECORD t ]SIiN 7{► LN A JL►WLLY. s it = L 4 1?tEl+S�en 12/2312003 18s00AK WARRANTY DEED ! eCnve .a and warr>ents to $ Core Iri F 2 . _ > �/S � 576. Q►6 y a I'Sist:a��[4l:.IE at7lCnvs�Gloes �..— �C F't6� L PAGES: 1 Tutu vpw44 h¢itgvtD pall NLQo"Wo "'TA .. seTiJaeraccsna6fJ ttx sapvsrv.• e.s:r�r_ N/.h1E Aft r1ETYgr nQORE ll[e rallo -4ng dexcHbeA real estate in 4 • xoiz _, ,, Counly, S[a[e or wvconsilt: Lot 13 'UXCEPT she SaOe 02 feet t:hareof; Lot 16 «�' 4#3 EXCEPT Chas North 58'1,/Z fvta chsreof and All'cg Lote in + "' '"� " X4 rd 15, nX®c2E "7r', 4siginal 1`!F► ai Y311ago 02 0:30 ...�..,'S 6.T.Qr Houluon, 9t. Cxeolx'Cous+ty, VLocone1m. - 'nncebtoti 1 111"1 S1.11) • via — ao59 - to - roo� • � o3o= a05s -2o• =000 �f�� b36 2-0s - � -55 104 l b I6 '_ 11110 itamcs[esd property. • Ua) k pan - ' (+�areptlon w wrr�ntles: • bawdrhis Z9tth' day of Janu Ar a (SEAU _ CSEAL) Etilt�katni.n A .Ieevg�,1. S G «AU (5 AUTHENTICATION . AGKNOWL6DCrM1L'NT ' Slsrutmra(s) • � - state tat. �� ��. - eau aulhentleate4 this -1fl v[ day of t0 ptuenttly a t.hba day c Itie 4vve Mrne iftnigun;. }1 at l, a 9�Y.�_ a peYaon.. - url_C. MEMDKR5TATg OAK OP WIMZONSiN _. (1r not, 104%aNp. i, f aulryolircd.Sy,R7o6,of. Wb, ,stets.) `` K / p � ' w Q r ,�Ifrir g � S�q!'+ Irt Int pa�'P�O ' who cY lad the tnrcgv►n THIS INSTW3 WAO OA^FTCP eY r S. a 4 L viquor Stores Ine. r• �, Z67 rpe 71Itnors A- et SE„ " vl+iR (5lgnrUrrs IMay be iHTh d t'nlleared or ■cnovTledged. D.111 are no[ ��.� Op 8 Isl•t!e frttlfa r"` t rea�l•al[pr, d.lc s =• Lr - T.7at3'f�4�$ .AR"IM�rr..s .�Gl l l LYarai+n ^ -i ST1.iaR• -�aCZT .: 'd .r• ii37`•. ...- •1T•• f ••T. ... •'T'Ir.r ' r+.w.► of persons >Aa+ M aaF aal'�'7 abu11 by gprA ar Rtrafd bd,.+ rhe[r p�.�.y. - .. . _ . . %VAIMANTV bxrir ETgTG BAN Or WlKC! tmwm �+++.•Fw la wPAV . . it = �(D m w m z z O A CO 2 2 z N _A co (n N O -4 0 Sk7 3 C O Ro CU N C7 O G� J p co (;• fl. 7 `� N 0 (T r d d b w N r :, I N O ON IP N C1 7 C1 C C 7' C11 N UO O c Q n 0 CD CCDD n O! O O A7 O o a o w o w ° D o p1 w n z D m Q z D m ct. D 14 a w rCl o N a w T co cn Go cn 3 c T o p S C I o 0 Q w 0 S 3 _ o c lo t L --^„ OW A � v 0 CD p O 7 0 (D CD 7 n r to CD (n A A< O N N< CO O G 3 .. EE CA M O O O O N O O O N o r Vl fA fo O N N N rn t7 O O m r3. "0 O O co 7 a m m o D ^' m CL c m 7 C'p m � .. S to 7 ` O d 7 z N z z z m o z O D o D °�� O d - V m o to CD m p rn CD _� v, c � v y _. CD CD w m X, n m n a 3 0 � 3 � z m s co m c6 �_ - N 0 7 d o 7 o P z m w 3 CA C = M _ n N 7 7 A z 0 0 d a O 7 O N 7 m W m O < J (D a a 3 z ° o c z No 3 3 m g C4 'aa o A CD ^ ^O D 3 m D rnrn� ° CD CO o v, �� a m ° o O N N C 3 co N C 3 om z a ? m o z a o - o C O C N CD 7 C CD d' co Q 3 w (b o WCA N O D� O o� 3 on =r y A CD 7 QD d T �1 n A cnWO n N -n pn W O TCD N V O O =r ^ A N ::3 !Yq O d+ O Fn O � O Q 0 cl 5 REPORT OF INSP7CTION--- INDIVUAL S31AGE- DISPOSAL SYST34 PRM -'kRY TRMMENT consists of Septic Tank% Other (Describe) SEPTIC TANK: Distance from: Well 9 ft., Lot Line ft. Buildi.ng__iLft. High watermark ft. 12% or greater slope ft. Wetland ft. Cistern ft. No. compartment Liquid capacity 0+� gal. EFFLUENT DISPOSAL SYSTM consists of Tile field. Seepage pit (s). Seepage-Tit or Tle Field Distance from: Well ft. BuildingLift. ' Lot Line ft. ftstern ft. High Watermark of water course ft. Slope 127. or greater Wetland ft. Total length of tile lines ft. Number of lines Length of each li.neM .,ft. Distance between ft. Width of trench in. Total effective absorption area of trench bottom Sr. ft. Depth of filter material below tile in. Depth of filter material over tile in. Cover over filter material Depth of tile finished grade in. Slope of trench bottom in. per 100 ft. Depth of bedrock ft. Depth to ground water ft. Number of Pits Outside diameter L_ft. Depth below inlet .S'_ ft. Lining material Gravel around pit: X No. Total sbsorption area so. ft. Square feet of seepage trench bottom area required Square feet of seepage pit area required Inspected by: (��� / �,/✓ Title: GC u Approved ` , Dat Rejected Date ,19 l �/ County, Town of i Owner Sanitary Permit No. Property Address Q/ Septic Tank Permit No. Z-1 Subdivision PI; #67 7/71 Wisconsin Department of Health and Social Senwioes Division of Health SEPTIC TANK PERMIT APPLICATION TYPE OR USE BLACK INK - PLEASE PRINT A, OWNER OF PROPERTY Name Address (Street, City, Zip Code) B, LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY �- Check Ones CITY _ HI VI E LEGAL DESCRIPTION TOWNSP (Block, Lot, Sao.) C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES No _PERMIT NUMBER D. SEPTIC TANK CAPACITY r GALLONS NEW INSTALLATION z' REPLACEMENT ADDITION MATERIALSs PREFAB CONCRETE POURED IN PLACE STEEL OTHER� NUMBER OF TANKS TO BE INSTALLED: E,. TYPE OF OCCUPANCY Check Ones One or Two Family Residence Commercial Industrial Other (Speoify) Number of persons to be Accommodated Number of Bedrooms F. APPLICANCES, ETC= Food Waste Grinder YES NO Automatic Clother Washer YES NO Dishwasher YES NO Automatic Potato Peeler _YES NO OTHER (specify) YES NO G. MASTER PLUMBER MAKING,INSTALLATION y , Names Address: / T— i SIGNATURE O$ APPLICANTS License Numbers MP ADDRESS s . ' ' _ ._ __._.__. MP RSW r' H. (TO BE COMPLETED BY ISSUING AGENT) Date of Application - Fee Paid Permit Issued (date) : Permit Number 1 r Agent (name --^' Fors GM, village, oity oounntys' *to. specify) NOTES The Application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.00 for each septic tank and the third copy of the permit (canary) to the Divisions of Health „ Cheoks and money orders should be made payable to the Division of Health. COMPLETE OTHER SIDE i NAMES , COMM SEPTIC TANK PE`kIIT NUMBER# REPORT ON SOIL PERCOLATION TEST AND SOIL BORINGS TO DIVISION OF HEALTH — PLUMBING SECTION P.O.BOX 309, Madison, Wis. 53701 H 62 Wis. Administravive Cod Pursuant to .20, , e PERCOLATION TEST TEST DEPTH CHARACTER OF SOIL HOURS WATER TEST TIME DROP IN WATER LEVEL INCHES MINUTES NUMBER INCHES THICKNESS IN INCHES SINCE HOLE IN HOLE INTERVAL SECOND TO REXT TO JMT TO FALL 1st WETTED OVERNIGHT IN MINUTES LAST PERIOD LAST PERIOD PERIOD ONE INCH EXAMPLE P - 0 36" TOP SOIL 10" CLAY 26» 25 YES OR NO 30 4 60 1 2 3 RECORD DATA FROM PW.M M OF 3 TEST HOLES COMPUTE SIZE OF ABSORPTION AREA IN ACCORD WITH H 62.20 WIS., ADMINISTRATION CODE. S O I L B 0 R I N G S- MINIMUM 36 BELOW PROPOSED ABSORPTION SYSTEM BORING TOTAL DEPTH DEPTH TO GROUND WATER DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED OBSERVED ESTIMATED CHARACTER OF SOIL WITH THICKNESS IN INCHES EXAMPLE B- 0 Z2,11 Z2 BLAC TOP SOIL n J LAY 18 SM 18" GRAVE 24 1 2 3 RECORD DATA .= MINIMUM TYPE OF OCCUPANCY: RESIDENCE: NUMBER OF BEDROOMS OTHER (SPECIFY) NUMBER OF PERSONS FOOD WASTE GRINDER: YES NO DISHWASHER: YES NO AUTOMATIC CLOTHES WASHER: YE5 NO EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT TILE SIZE NO. LIN. FEET TRENCH WIDTH DEPTH NUMBER OF LINES SEEPAGE BED: LENGTH WIDTT � DEPTH TILE SIZE NO. LINES SEEPAGE PITS INSIDE DIAMETER LIQUID DEPTH I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (3 ), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my laiowledge and belief. NAME - y TITLE TYPE rOR RIN REGISTRATION NO. ER PLUNDER LICENSE NO. ADDRESS'.. DATE SIGNATURE DO NOT WRITE IN SPACr BELOW + MR DEPAR U E ONLY DATE RECEIVED ACCEPTED BY RETURNED FEE RECEIVED VALID NO. PERMIT N0, REVIEWED BY APPROVED DATE INITIALS YES OR NO PIb."' # 60 3f7D PROJECT DETAIL DATA SHEET NAME OF BUSINESS LO C ATION '__l___ _t �tt street or highway city or township county S sT J•s�'P� LEGAL DESCR I P U19 ` _' - . ii� „ (j /�' -.C�. L(�_�__- - -- - -- OWNER _ff L11 CrJE't Mailing address L4 Z- _ .Ltic! Z I P57y > ARCHITECT OR ENGINEER Address _ ZIP PLUMBER Address Z I P 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant ......... Car spaces ( ) Restaurant ................. Seating capacity (10 sq. ft. /person) ( ) Dining hall ................. Per meal served Toilet waste Yes No ( ) Motel ( ) Hotel ( ) Cottages .. Number of units: 2 persons /unit 4 persons /unit TOTAL NUMBER OF UNITS ( ) Churches .................... Number of persons Kitchen Yes No ( ) Bar or cocktail lounge Seating capacity (10 sq. ft. /person) ( ) Nursing or rest home ........ Number of beds ( ) Mobile home park ............ Number of units - dependent (camper trailer) - nondependent (mobile home) () Retail store ................ Number of employees Number of customers Tl0 sq. ft. /person) Z l� ( ) Service station ............. Number of cars served (daily) ( ) School ...................... Number of classrooms Meals served Yes No _ Showers provided Yes No ( ) Factory or office building .. Number of persons (total all shifts ( ) Apartments .................. Number of bedrooms ( ) Other ....................... Specify 2. Indicate whether or not the following facilities are connected: Food waste grinder Yes _ No Dishwasher Yes No _ Automatic clothes washer .Yes No Automatic potato peeler Yes Other . . . (Specify) No 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned A 060 Percolation test results - AT TACH PERC OLATION TEST AND SOIL BO RINGS REPORT S COMPL OTHE SIDE I Seepage trench bottom area planned width linear feet depth Seepage bed area planned width linear feet r depth Seepage pit planned 4 0 Alr diameter depth below inlet s I depth 4. See approved plan for specifications and details. i Signatilre of person completing form: STATE DIVISION OF HEALTH, PLUMPING SECTION P. 0. Box 309, Bison, W s n 53 A ppr ove d: cam' �`�^' L F ��./ 1� � • � �� � � �g19 Address: C�o l�, � e Date: AU A ( / t O Z I T H I S APPROVAL IS BASED ON STATE PLUMBING / CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: +/ _ _ .Z INSTALLATION FROM CITY, VILLAGE, TOWNSHIP OR COUNTY REGULATIONS OR PERMIT REQUIRE - MENTS AND SHALL BE VOID IF REVISED WITHOUT THE WRITTEN APPROVAL OF THE DIVISION OF HEALTH. DEPARTMENTAL USE ONLY THIS APPR SHALL NBTVOID EA NOT INS RSI FROM THE DATE OF APPROVAL i -cA p t V: W t 4 7 -3 7 mn 7 , t M Im Az f� W A p"P I% - V , 7� -4 IW� qf- K AM z 4l� , % -04 VA � ve- T low 4 , ?T, 4". i-,,, jw -9 1� vv;-; if4rq- F - W FpTzeM jX 1 Z 4 1k. '03" 4 Aq 5 � 34.1 CD W7 m A Am IA S, F � ;. ��a *`y•s.�"i,w�" g, �' ` , ' ' ,-�wy t `. �s � e t �F 5�.����� 4.d t h yy qd �� * y. A .+t �M•rF. k ���`'3 r����y k /�w. y J ' 3 .fi .• fi TY , r •'b'tl �R ��" x? ld' U yy .y[a., :' x rorz' .YC - E� ' ' A- Kk t P . n, ',: T gyt.�l,� ' � f L yA' rR,. � �- P • '.�#,� sy - f; y' � G _ . L A 'y .A .6TF_ ��y a. S � � , ?, zf•• � �.µ'k , 3� ��r:' Y � 9x. 4 ;•��'rY i}'..+ ���1" , � {} • �# µ`y� rd. Ji�Q" i J h., k #t ��. '.' yyy t. .X1:. lam• /A �� "T. `tl• �iwa �.n•IS+ 9 .:'�.xt '!: e8 � � 'a �, � , � t " � y ''� p . 'iG le ,��}'�" , '. iF '- � -.'Y :.. �•� v , n � � � /9 i 3 � ��` 3 xr : 5 r F R sp ^^ 11 d q • '� a:�` t i � c•J � t'J ��i a .ik� '' w t t` � r7 r a9;:- f p���� i Et '� y-y . _. -�,�* � x TA � ��F�+�" ' ` ' it .°' 9n�i�' L. ..� a .�' . '� ' R � ! � - ,� � '�,x "l= t> ..t e� t �E' �� x , d k. ♦ s, 4 'act '11P+�t r'� FA TrV r "��• ��, � y �} 'M `t i � �r � ,C .. 'i:T�'s '' j ' � ` �� , ���.r y_ ..y � x�ilF 'xO- �, #F.sl6se: �� .: a r � x,# ' _ uT •..s"'ty r .. L R . :: IF #,F Xr rt wc�FC: ,w.,N .s ham.:' 9x? -'o a+ y y•' S r ; 4' - tlx 4 ;g�w�� Al f ; e.' j r, f . ;r� ti> � "..s . ,� ct` -- •�- „�'!w� ��'�.S 2 . A' . N 3: a ic; : � S`1�;. . v. Plb #67/ 7/71 Wisconsin Department of Health and Social Services Division of Health ' SEPTIC TANK PERMIT APPLICATION TYPE OR USE BLACK INK — PLEASE PRINT A„ OWNER OF PROPERTY Name Address (Str�e«et City, Zip Code) B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY s ;X- Check Ones CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP f (Block, Lot, Sao.) C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? f No PERMIT NUMBER D. SEPTIC TANK CAPACIT G ALLONS NEW INSTALLATION REPLACCvM ADDITION MATERIALSs PREFAB CONCRETE . POURED IN PLACE STEEL OTHER NUMBER OF TANKS TO BE INSTALLED: ! E. TYPE OF OCCUPANCY Check Ones One or Two Family Residence XCommercial Industrial Other (Specify) Number of persons to be Accommodated_. L Number of Bedrooms__ F. APPLICANCES, ETCs Food Waste Grinder YES NO Automatic Clother Washer -.- YES --- 00 Dishwasher YES t o Automatic Potato Peeler YES E NO OTHER (specify) YES 'ZO G, MASTER PLUMBER MAKING INSTALLATION ` q * . <1 _^ Names 4.t f Ad `''� � "9 ° tee �'�{ '*� «4�` � F � `,r; dress s � ' 7 2 ro PU 1e e, SIGNATURE OF APPLICANTt t License Numb �r, r MP RSW ADDRESS: - - �� „��. H. (TO BE COMPLETED BY ISSUING AGENT) Date of Application Fee Paid Permit Issued (date) Permit Number Agent (name) Fors town, village, city, county, ato. (specify) NOTES The Application cannot be considered for filing until all of the above questions are annered and the fee paid. Agents will forward application, the fee of $1.00 for each septic tank and the third oopy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. COMPLETE OTHER SIDE � J NAME s « CQtwy l SEPTIC TANK PERMIT NUMBERt REPORT ON SOIL PERCOLATION TEST AND SOIL BORINGS TO DIVISION OF HEALTH — PLUMBING SECTION P.O.BOX 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis, Administravive Code PERCOLATION TEST TEST DEPTH CHARACTER OF SOIL HOURS WATER TEST TIME DROP IN WATER LEVEL INCHES MINUTES NUMBER INCHES THICKNESS IN INCHES SINCE HOLE IN HOLE INTERVAL SECOND TO EXT TO LAST TO FALL 1st WETTED OVERNIGHT IN MINUTES LAST PERIOD LAST PERIOD PERIOD ONE INCH EXAMPLE P — 0 36" 0 I " CLAY 26" 25 YES OR NO 30 60 M 1 i X � .1 ff l ,. +fqJ 60 RECORD DATA FROM MINIPE OF 3 TE HOLES COMPUTE SIZE OF ABSORPTION AREA IN ACCORD WITH H 62.20 WIS„ ADMINISTRATION CODE. S O I L B 0 R I N G S- MINIMUM 36" BELOW PROPOSED ABSORPTION SYSTEM BORING TOTAL DEPTH DEPTH TO GROUND WATER DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED OBSERVED ESTIMATED CHARACTER OF SOIL WITH THICKNESS IN INCHES EXAMPLE B - Q ae 7 n BLACK TOP SOI4 " CLAY 18 SAM 18" GRAVEL 24 of RECORD DATA FRO MIND�IM 0F_3 TYPE OF OCCUPANCYt p RESIDENCEt NUMBER OF BEDROOMS / OTHERS (SPECIFY) NUMBER OF PERSONS I FOOD WASTE GRINDER: YES NO DISMASHER: YES NOX AUTOMATIC CLOTHES WASHERS YES I I EFFLUENT DISPOSAL SYSTEMS NEW ^ EXTENSION ADDITION REPLACEMENT TILE SIZE NO. LIN. FEET TRENCH WIDTH DEPTH NUMBER OF LINES SEEPAGE BEDS LENGTH WIDTH DEPTH TILE SIZE N0, LINES SEEPAGE PITS INSIDE DIAMETER ' LfQUID DEPTH .-0 _.4 I, the undersigned, hereby certify that the percolation tests reported on this form were made by tae or under my super - vision in accord with the procedures and method specified in Chapter H 62.20 (3 ), Wisconsin Administrative Code, and that the dVa recorded and location of test holes are correct to the best of my knowledge and.ttelief. ?FJ NAME t r' TITLE ' PE or PRINT REGISTRATION NO. OR MASTER PLUMBER LICENSE N0. ADDRESS % . f �` apt DATE SIGNATURE . ' " rD WRITE IN SPACE FOR DEPARTMENT US QNLY hl DATE RECEIVED ACCEPTED BY RETURNED FEE RECEIVED VALID N0, PERMIT N0, REVIEWED BY APPROVED DATE INITIALS YES OR NO 0 cn 0 0(a 0 C '9 0 21 0 c °f 3 t� ID co • v n a I v `D as ro a� 2 2 w Z N W cn m Z o o Cl) cn r < �� • N N C O (O S?o j. 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