Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
008-1017-10-000
Parcel #: 008 - 1017 -10 -000 01/11/2006 04:10 PM PAG 1 O 1 Alt. Parcel #: 6.28.16.86C 008 - TOWN OF EAU GALLE Current IX' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner % DORO INC O - WISCONSIN FOOD SERVICES LLC WISCONSIN FOOD SERVICES LLC 3112 GOLF RD EAU CLAIRE WI 54701 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 1.265 Plat: N/A -NOT AVAILABLE SEC 6 T28N R16W PT SW NW LOT 1 CSM VOL Block/Condo Bldg: 2/360 EXC THE N 20' OF SUCH PARCEL Tract(s): (Sec- Twn -Rng 401/4 1601/4) 06- 28N -16W Notes: Parcel History: Date Doc # Vol /Page Type 09/16/2004 774554 2657/596 WD 07/23/1997 1144/223 WD 07/23/1997 1144/222 WD 07/23/1997 904/571 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 138289 630,800 Valuations: Last Changed: 10/09/2000 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 1.265 133,600 310,200 443,800 NO Totals for 2005: General Property 1.265 133,600 310,200 443,800 Woodland 0.000 0 0 Totals for 2004: General Property 1.265 133,600 310,200 443,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 008 - 1017 -20 -000 01111/2006 04:10 PM PAG 1 OF 1 Alt. Parcel #: 6.28.16.86D 008 - TOWN OF EAU GALLE Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/16/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WISCONSIN FOOD SERVICES LLC, RETIRED RETIRED WISCONSIN FOOD SERVICES LLC Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 1.265 Plat: N/A -NOT AVAILABLE SEC 6 T28N R16W PT SW NW LOT 2 OF CSM Block/Condo Bldg: VOL 2/360 EXC THE N 20' OF SUCH (PARCEL WAS ADDED TO 008 - 1017 -20 -100 86E TO Tract(s): (Sec- Twn -Rng 40 114 160 1/4) CREATE 008 - 1017 -20 -025 86D -10) 06- 28N -16W Notes: Parcel History: Date Doc # Vol /Page Type 02/13/2004 754180 25091236 EZ -U 1144/223 WD 1144/222 929/394 more 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04 /04/2005 l i Description Class Acres Land Improve Total State Reason i I I I Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r Parcel #: 008 - 1017 -20 -025 0111112006 04:10 PM PAGE 1 OF 1 Alt. Parcel M 06.28.16.86D -10 008 - TOWN OF EAU GALLE Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area . Application # Permit # Permit Type 09/16/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner % DORO INC O - WISCONSIN FOOD SERVICES LLC WISCONSIN FOOD SERVICES LLC 3112 GOLF RD EAU CLAIRE WI 54701 Districts: SC = School SP = Special Property Address es * = Primary P P Y : ( ) Type Dist # Description SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 6 T28N R16W PT S 1/2 NW FRAC DESC AS Block/Condo Bldg: COMM SE COR LOT 2 CSM 2/360 -POB; TH S 87 DEG E 151.38'; TH N 288'; TH N 87 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 151.38; TH S 288' TO POB 1.209 AC & LOT 06- 28N -16W SW NW 2 CSM 2/360 EXC N 20' Notes: Parcel History: Date Doc # Vol /Page Type 09/16/2004 774554 2657/596 WD 10/13/1995 534965 1144/223 WD 10113/1995 534964 1144/222 WD 06/05/1991 470110 904/576 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 138290 57,700 Valuations: Last Changed: 08/04/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 2.050 40,600 0 40,600 NO Totals for 2005: General Property 2.050 40,600 0 40,600 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 Parcel #: 008 - 1017 -20 -100 01/11/2006 04:10 PM PAGE 1 OF 1 Alt. Parcel #: 06.28.16.86E 008 - TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09116/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner RETIRED WISCONSIN FOOD SERVICES LLC O - WISCONSIN FOOD SERVICES LLC, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 1.209 Plat: N/A -NOT AVAILABLE 9 p SEC 6 T28N R16W PT S 1/2 NW FRAC DESC AS Block/Condo Bldg: COMM SE COR LOT 2 CSM 2/360 -POB; TH S 87 DEG E 151.38'; TH N 288; TH N 87 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 151.38'; TH S 288' TO POB 1.209 AC 06- 28N -16W (PARCEL WAS ADDED TO 008 - 1017 -20 86D TO CREATE 008 - 1017 -20 -025 86D -10) Notes: Parcel History: Date Doc # Vol /Page Type 10/13/1995 534965 1144/223 WD 10/13/1995 534964 1144/222 WD 06/05/1991 470110 9041576 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/04/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 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 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER BPS / TOWNSHIP SECTION W Cu T L P N -R 1c, W ADDRESS ST. CROIX COUNTY, WISCONSIN 3tr SUBDIVISION /� LOT�T SIZE PLAN VIEW SHOW EV ERYTHING WITHIN 100 FEET OF SYSTEM 1 0 7 X44- i INDICATE NORTH ARROW SEE PLOT PG��IJ BENCHMARK:Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. 194 33 e,N6 -s 41,( ecuEeS 94060-t-�,O Tof� f Rings used: Manhole cover elev: / Final grade elev: tip¢ Tank inlet elev.: Tank outlet elev.: SEA ��d T /�L.�.✓ r No. of feet from nearest road: ron 2 9 5 S , From nearest prop. line:Front Side Rear Ft. No. of feet from: Well X 2 5 r Building: 90 (Include this information in the above plot plan) 2 reference dimensions to septic tank) SEE REVERSE SIDE 3` J ' t PUMP CHAMBER Manufacturer: Liquid Capacity: ( 2)- Pump Model: Pump /Siphon Manufact.: ZGE1Izw Pump Size /2- OP Elevation of inlet: 100, Bottom of tank elevation fy 70 on elev.: 97, 3y f 1037 7 40- "`0 Pump Pump off elev.. Gallons /cycle. oS Low Alarm: Man.: Switch Type: FlOA7 Location X ' Distance from nearest prop. line: Front Rear Distance from: Well �0,P0 Building Z /�'t e ���G� � 3� �� I(P6 SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: $Ep 13�D Width: /Z Length 1.2-0 Number of Lines: 7 Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No• feet from nearest prop, line:Front , Side Rear Ft. Q S2 No. feet from well: '�O No. feet from building HOLDING TANK,_ Manufacturer: Capacity:_ No. of rings used: Elevatio bot ank: Elevation of inlet: No. feet/ from nearest �Op- i ne:Front , Side , Rear Ft. No. feet fro ell , building , nearest road i Alarm Xafiufacturer: INSPECTOR: T T� o Al n SAN DATE: 1 PLUMBER ON JOB. LICENSE NUMBER: 6 /90:cj HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULORIGHT MIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ','.INN. INSTALLER & DESIGNER LIC. NO. 00663 Ail Wisconsin Department Industry, CO V!: : P Y Y PRIVATE SEWAGE SYSTEM �`�. Croix Labor and Human Relations INSPECTION REPORT Safety and Buildings Division Sanitary Permit No.: ) GE1IIERALlNFORMATlON ATTACH TO PERMIT Sw Nw 6 28 -16W Hwy 63 &55th Ave. 149087 Permit Holder's Name: ❑ City ❑ Village Town of: Stz9e $Ir Rf:8 Hardee's Food S stems I Eau Ga11e G -91 -00649 CST BM Elev.:66 Ar Insp. BM Elev.: BM Description: Parcel Tax No.: / rC NUJ da C� c,ri: 86 -E TANK INFORMATIO / L, ` ELEVATION DATA ,�Y. , ,6,r TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. `S Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand � ` �s Model Number GPM TDH Lift Friction System TDH Ft oss " ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) ?� 5J Y " l ot ) WC� \ / �: P.,.�_�.� C ,4.!/, ,"� +.'�_C , -`,. �ti-fl / �,,.., [ r✓%�^ /�,..4 -'t. Plan revision required? ❑ Yes ❑ No Q / Use other side for additional information. l ' A �-� SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. 40ILHR S ANITARY PERMIT APPLICATION - AWQ(L�c3V_ In accord with ILHR 83.05, Wis. Adm. Code 5 r 6ev f X , STATE SANITAR P R IT # -Attae h complete plans (to the county copy only) for the system, on paper not less than 1:1 / ?0 8% X 11 inches in size. Check if revision to pre ous application -See reverse side for instructions for completing this application. I S � LAS ��NF I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. � PROPERTY OWNER f f,tA DP 7�_—,tJ5 PROPERTY LOCATION �� p . AI a 6-4E2e - /P�'Si p E .v 5W '/4 A S T 21 , N, R `G E (o W PROPERTY OWNER'S MAILING ADDRESS M, WJ3 LOT # BLOCK # 3 /ice GoCF /ep. r?o�*rNv'6 CITY, STATE ZIP CODE PHONE NUMBER 7157 - SUBDIVISION NAME OR CSM NUMBER CITY NEAREST ROAD 11. TYPE OF BUILDING: (Check one) F State Owned VILLAGE :f47,,t TOW 4 V Public 1:11 or 2 Fam. Dwelling -# of bedrooms _ 4CEL TAX NUMBER(S) ,r� 6 t 2 g ` 1 �.O Ill. BUILDING USE: (If building type is public, check all that apply) (7� LZ tJ 1 ❑ Apt/Condo �{ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ElOutdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 K Restaurant/BaTtDITTh1g 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previousl issued. Permit # _ Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 $4 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 El seepage Trench 22 In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 2" 1. GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELE 7. FINAL GRADE 3180 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) /Z 5, '7 S ELEVATION 1 2 - (0 CC f;O �Q f . / 2 0 Z // Feet //S. L Feet VII. TANK CAPACITY Site in gallons Total ¢# of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdina Tank X C0111Gc Q Lift Pump Tank/Siphon Chamber r n r El 2 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: 3 3 0 ?�s Plumber's Address (Street, City, State, Zip Code S� 0 l it) C 1 L IX. COUNTY /DEPARTMENT USE ONLY Disapproved I S itary Permit Fee (includes Groundwater I Date Issued Issuin Agent Sign lure (No ps) Approved ❑ Owner Given initial !} 'n rcharge Fee) t rmin tin P' �k Gs X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. f 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsir Administrative Code will be applicable. 3 All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transter /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction foss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. I SBD -6398 (R.11/88) Sf ,y4, ('03 _ r Z w, n !LA4 T IZA1 I N r \m�cc� O v, i `c n oro 4� C � (/ o o g } g , A t T kil tj n7 i vv 2 cn ©� � i (�j o c v tb � h o ts ob N W o �1 m O O � i ► ° `si. C IO z � (}� W iJ N r,9 fl �` Jj ws� C-4 I N c� 1 -4, Al o CK. t t, 1 W CC's I c t , ;:r Tomttiy G. Thompson SAFETY & BUILDINGS DIVISION ' Governor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 ROBERT ULBRICHT Owner: HARDEE'S RESTAURANT 655 O'NEIL ROAD 3112 GOLF ROAD HUDSON WI 54016 EAU CLAIRE WI 54701 RE: Plan Number: S91 -00068 Date Approved: April 15, 1991 Gallons Per Day: 2,895 Date Received: April 8, 1991 Project Name: HARDEE'S RESTAURANT Location: SW,NW,6,28,16W EAU GALLE Town of EAU GALE County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50 -64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT HOLDING TANK SNU.6423 ia.07t9 i Tomnhy,G. Thoinpson SAFETY & BUILDINGS DIVISION Governor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations ROBERT ULBRICHT Page 2 Inquiries concerning this approval may be made by calling (608) 266 -2889. Since y, i E PA E Section of P ate Sewage Division of Safety and Buildings PPP013 /0009n/ 1 cc: HARDEE'S RESTAURANT _Private Sewage Consultant County _UW -SSWMP _Plumbing Consultant Owner Plumber Environmental Health HHD 64231 H. 07/801 r . Mate of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue April 11, 1991 P.O. Box 7969 Madison, Wisconsin 53707 HARDEE'S RESTAURANT 3112 GOLF ROAD 'F EAU CLAIRE WI 54701 Petition No, S91- 00068 -P Re: Hardee's - Restaurant Onsite Sewage System SW,NW,6,28,16W Town of Eau Galle, St. Croix County, WI The petition for a variance requested to sections ILHR 83,15 (5)(b) and 83.23 (1)(d) of the Wisconsin Administrative Code was considered on April 8, 1991. The petition has been conditionally approved. The condition being that an alarm system be incorporated into the duplex alternating controls which would be activated in the event of pump failure, simultaneously switching the remaining pump to dosing on each cycle. The rules require that there be a one -day holding capacity above the high water alarm switch in pump tanks and a mound system site shall have a minimum 24 inches of suitable natural soil. The variance requested was to use duplex alternating pumps in lieu of the one -day holding capacity in a dose tank and to install a replacement mound system on a site with 19 inches of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Si erely, Richard Meyer�Arc ec t Direc tor, Office of Divis n Codes and Application (608) 266 -3080 I RM:PEP:4636g cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls :r Thomas Nelson, Zoning Administrator - St. Croix County Robert Ul bri ch t, Plumber SBD -6828 (R. 70 /87) To vmy G. T7hompson SAFETY & BUILDINGS DIVISION Governor Gerald Whitburn it Secretary State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 ROBERT ULBRICHT Owner: HARDEE'S RESTAURANT 655 O'NEIL ROAD 3112 GOLF ROAD HUDSON WI 54016 EAU CLAIRE WI 54701 RE: Plan Number: S91 -00068 R Date Approved: May 6, 1991 Gallons Per Day: 2,895 Date Received: April 8, 1991 Project Name: HARDEE'S RESTAURANT Location: SW,NW,6,28,16W EAU GALLE Town of EAU GALE County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50 -64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT MOUND - REVISED MOUND I SBD -& 23 i H. UV901 Tomy G. TlPompson SAFETY & BUILDINGS DIVISION Governor Gerald Whithurn Secretary State of Wisconsin Department of Industry, Labor and Human Relations ROBERT UIBRICHT Page 2 Inquirie2vate approval may be made by calling (608) 266 -2889. Since el E E. Section Divi sion of Safety and Buildings PPP013 /0009n/ 2 cc: HARDEE'S RESTAURANT _Private Sewage Consultant County UW -SSWMP Plumbing Consultant Owner Plumber Environmental Health SHO-6 23 i R. 07/80) Tammy G. Thompson SAFETY & BUILDINGS DIVISION Governor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations GENERAL PLUMBING PLAN APPROVAL 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 HOMESITE SEPTIC PLUMBING Owner: HARDEE'S FOOD 655 O'NEIL ROAD 3112 GOLF ROAD HUDSON WI 54016 EAU CLAIRE WI 54701 RE: Plan Number G91 -00649 Date Approved: April 8, 1991 Date Received: April 8, 1991 Project Name: HARDEE'S Location: HIGHWAYS 63 & I94 Town of EAU GALLE County: ST CROIX Fees Received (Priority Review): 80.00 The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All items required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved. If construction has not commenced before the expiration date, new plan approval must be obtained. The Section of General Plumbing has reviewed these plans for plumbing code requirements only. This approval is for the following elements only: I - GREASE INTERCEPTOR NOTE: This approval includes installation of Grease Interceptor Only. Inquiries concerning this approval may be made by calling (608) 266 -8075. U reiy, tr DAN KRAFT 4 Section of General Plumbing Safety and Buildings Division PGP008 /0011w /14 cc: HARDEE'S FOOD _ KEN PERTZBORN _Environmental Health _ Local PI SBU- 6423(k.117MUr- Dept. of Agriculture ,_, Facilities Needs P.S. Consultant SAFETY & BUILDINGS DIVISION Tommy G. Thompson (governor t Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations February 5, 1991 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 i ROBERT ULBRICHT Owner: HARDEE'S RESTAURANT 655 O'NEIL ROAD 3112 GOLF ROAD HUDSON, WI 54016 EAU CLAIRE, WI 54701 RE: Plan Number S91 -00068 Project: HARDEE'S RESTAURANT County: ST CROIX EAU GALLE Location: SW,NW,6,28,16W Fee Received: 50.00 EAU GALE Date Received: 1/23/91 This letter is to acknowledge receipt of the Petition which you submitted to the Office of Division Codes and Application, Section of Private Sewage. We cannot however, process your submittal until we receive: - 1) PRIVATE SEWAGE CONSULTANT ONSITE - After a discussion with Sam Rockweiler, soil scientist, it was determined that prior to obtaining a variance approval a DILHR PSC must visit the site. This is standard procedure for systems over 3000 gal /day. Also, the presence of existing systems and filled areas would necessitate this action. Please contact LeRoy Jansky at (715)723 -2544 to arrange for an appointment. 2) SYSTEM CONFIGURATION - It is essential that the proposed system configuration be provided for this project. Please retain one copy of this letter for reference and return the other with the materials requested. Your Petition will be processed within 30 working days by the Section of Private Sewage following receipt of the requested items. Petitions or plans submitted to this office which require additional information will be held 90 working days for receipt of the information. If, after 90 days, response to this letter has not been received, your plans will be returned. If you find it necessary to contact us regarding your submittal, please call us at (608) 266 -2889 and refer to the plan number as shown above. SRO 6423, K. 071801 SAFETY & BUILDINGS DIVISION Tom''my G. Thompson _ Governor ' Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations ROBERT ULBRICHT Page 2 February 5, 1991 Since y, Gf PETER E. PAGE Section of Private Sewage Division of Safety and Buildings PPPO13 /0001n/ 4 COMP: 1 ELEM: cc: HAR E'S RESTAURANT _County _Plumbing Consultant _Local PI _Plumber _Environmental Health _Facilities Need Analysis Section _UW -SSWMP _Dept of Agriculture _Private Sewage Consultant I SNU-&LLS (N. 071901 9 S tate of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue Apri 1 'i 1 , 1991 P.O. Box 7969 Madison, Wisconsin 53707 HARDEE'S RESTAURANT 3112 GOLF ROAD EAU CLAIRE WI 54701 Petition No. 591- 00068 -P Re: Hardee's - Restaurant 0nsite Sewage System SW,NW,6,28,16W Town of Eau Galle, St. Croix County, WI The petition for a variance requested to sections ILHR 83.15 (5)(b) and 83.23 (1)(d) of the Wisconsin.Administrative Code was considered on April 8, 1991 . , The petition has been conditionally approved. The condition being that an alarm system be incorporated into the duplex alternating ` controls which would be activated in the event of purr!) failure, simultaneously switching the remaining pump to dosing on each cycle. The rules require that there be a one -day holding capacity above the high water alarm switch in pui:�rp tanks and a mound system site shall have a minimum 24 inches of suitable natural soil. The variance requested was to use duplex alternating pumps in lieu of the one -day holding capacity in a dose tank and to install a replacement mound system on a site with 19 inches of suitable natural soil. All of the data and statements submitted on behalf of 'the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Si erely , R chard lute er Archict A Director Office of lei vi s6n 991 APR ,2 Codes and Application cg 1 (608) 266 -3080 �o I �R GF RN: P+EP:4636g �' e 1` cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Adnninistrator St, Croix County Rober Ul bri ch t, Plumber SBD -6928 (R. 10187) Tomno G*&ompson SAFETY & BUILDINGS DIVISION Gftrernor .' Gerald Whitburn Secretary w - State of Wisconsin Department of Industry, Labor and Human Relations f PRIVATE SEWAGE PLAN APPR Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 ROBERT ULBRICHT Owner: HARDEE'S RESTAURANT 655 O'NEIL ROAD 3112 GOLF ROAD HUDSON WI 54016 EAU CLAIRE WI 54701 RE: Plan Number: S91 -000 Date Approved: April 15, 1991 Gallons Per Day: 2,895 Date Received: April 8, 1991 Project Name: HARDEE'S RESTAURANT Location: SW,NW,6,28,16W EAU GALLS Town of EAU GALE County: ST CROIX The plumbing plans and sper'f''1CM ons for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped `conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is 6ttained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements S' dt'° ortti ' �i11'Se;ctidh'�I +L?tR`82'Ffar gefie�ral 'plumbing or i#1 Chapters 50 -64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PETITION REPLACEMENT HOLDING TANK CO � FCFi�FO APR sr 19gj 2 OMn° o� f F �� CF _ ��.V� xx Tomypy CP hompson SAFETY & BUILDINGS DIVISION 01 verno Geral&Whithurn Secretary State of Wisconsin Department of Industry, Labor and Human Relations ROBERT ULBRICHT Page 2 Inquiries concerning this approval may be made by calling (608) 266 -2889. Sincer y, f Section of Px; vate Sewage Division of Safety and Buildings PPP013 /0009n/ 1 cc: HARDEE'S RESTAURANT _- Pri vate Sewage Consultant _County ___UW -SSWMP Plumbing Consultant Owner Nlumber Environmental Health ,.p . � SNU- iFrLBR.U?78U l ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITA Q , Owner i�l7F'S /4 , eS% Address to Cc 3 �c� City/State ( �'�` � .w CtJtS . 672y'-7 Legal Description:, Lot Block Subdivision/CSM /il Sec. T;f N -R !4 W, Town of 1 � IN # • z P • AG • �'G - �' SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: r',tS�ll2 � ' � Tank manufacturer G, `� - Size ST/PC / Setback from House Well P/L S d ( 7-) Pump manufacturer E116X Model /�2 ( z fI! - Z 2 O Vo e-� Alarm location o p�NE� (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: /tw p—r �2-) Type of system: Width Length Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS 7a� eF 4!�4efk -F140X- A T foS Description of benchmark Elevation • 7� Description of alternate benchmark 1 " - P a,t� Al,* - Go Elevation /O (F O oo 2 CQ Building Sewer ST/HT Inlet /B©- ST Outlet fd • 3d PC Inlet ld � •l PC Bottom Header/Manifold Top of ST/PC Manhole Cover LT Distribution Lines () () () Bottom of System( () () o f t Final Grade () () ( ) EPA( , l�t�tg Date of-instaHatien / / Permit number 3 - 7 4 , 5 State plan numbe 2-� Plumber's signature Z 2- C o 3 �� g License number Date 1 1 Inspector _ � � 17 S51 ` 4 - Complete plot plan .r ORIc NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. I • Show, alternate benchmark, if applicable. PLAN VIEW � Si'2� �S I INDICATE NORTH ARROW M I o V) I 'J N Lis � O � to C4 4, W 4� N l k 4 1 N o / h `C IL 1 / lK I� U- i� �� M t O 11� N •� �', O v. to h � a U ,% lr \ - Z I Q4 lu t� sj 4D LO ci ku + O 4j c C � cn W r o v- 3 i o lye C � � Lu cn (u �. oc o- o �� ice" �� I 2 C� tz r a' ej h e o c i Q J M N z3o¢ t� !u z' Szw W d w w r LAI C 9 IQ 0 o � oc Vl- � e 2v a !'roject Index Sheet Owner.. 114PDEC.S roOD SySTEtifS -1'•vc • % TO,.-3 I lOA.3G -E R � pRES, - q„ Address: 3 Go /F RD. '5 LC ClfI Gf>i5. r`'70/ Pkov 71s — eS5 /// Site Location �dri t 3 C5,4 pE.�nivG -. Sw i� �)W �/ Sic. �o, TZBA) IZIt w ��tZc GA //E T cv usti.� 5 T. G,po /'X cc u.0 Ty .Project' Descrip ±ion 14 ke/0 14, - , jrA T S j T /'C Sy STf iy /'S p�'Or OSEf� FOR A" A�t s T , fv , F?ti T ��tO ' s ,2'U�cE D.v�r , 4167 t . Ille ,BEST�4VR+4 T) • > Oi /S �4- s U�,� lirl'C-O Br 5 r. o R ai' x �v v., T Y z o.� /,� G- P r . 3 el 8 14 . G& v4A) s / s - �� ►c >, 1.3 T ?t VT FOR M ODi F I'CrtT /oN 14 PPk, 0U,t• L I Si z 1 rJ � J G� s p.<.�. �� Tfi,Q /E 1 2 - , �� tf R 8 IS 2S T E- �,r� /oyEE A// slfi,,CrS� X Zv 6m-X'-'S 45 X00 IpAf6v5; X SO S E•f e<- r l5 0 5 — 7T; X /S �WS E,f s6 T Z Z. S 0 O,vE D,P %vim- �.v GviclDOcJ COU.vTEi� .uivi�rdM o� &0 SEfiTS 4 3 �. S. I . T O 7 L TrA„� t D DKiZ/ �v.4sT '�locv = 3 I SO S 3200 GPs /o4 = tea <o�o 447e- 1, PRo pos Esc : z s eP ,1 X 0 s o , F -r-. r h.t'L r L, h} (Z fjz . 3 y C s) z " 4,ke" e� p R c r S x Irt X A- It/J/� L - w Z / A A L-TE R m hTj,3 i =( /S 0 '6 , 0) 0 x ( � ,'1 SEPt�rFTE CFFGUE.07' pU.K e Z f 3 14- 'v: , y P S .3 93o S ��s �v i„� lid of l Day �dl DIA)G- C /,v SE, S h P ,4 c r� 6 , % 4 S S�--e / oav f .,¢ � og's TD T.t L y/3 o S `,�� # - - S s - ���k - 15 s dwa Page 1. Plot Plan Views --- P c S G d Cross erection P� Q a e M ound E g ��` o � � ,E' ; �4GL Ex�STiu �,-• 7'�P �tT�•t�.c,7 �"�,vf'S Page Pipe Lateral Layout Page Dosing Chamber Cros `o �.•� Sl Ow,✓ S//�!/ /3E � d. $� ® E -c Nc 413,"odN&a pe,_ X7. 1— N •R :P-3,03 CZ) Page Pump Perform ,pe SMA4 Q -F iViiu CVtiVEN IOahL b�y4 /N`F'�ELpS l/ 11-1-5 $ 2 A (J- T HOMESITE SEPTIC PLU 655 O'NEIL RD., H , WIS. 54016 � a Eva'. Pi umber ROBE ULBRIGHT water/ Designer WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. t MINN. INSTALLER & DESIGNER LIC. NO. 006M Ce S91 00068 Date HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 OF ROBERT ULBRIGHT !10S. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Signature ^Tara. ;1`43TALLER & DESIGNER LIC. NO. 00663 O COPYRIGHTED 1991 MAY NOT BE DUPLICATED WITHOUT DESIGNERS PERMISSION i c W N- D p - -- w cn } y n u t 1 lb (�1 n C r a \ y rn m `► o° Ln \ w \ - I M nl b 0 fi 70 Z rn o o 'V o ° G 7U ci I n F z t m m� 70 ON 4 , L m r 0 'P I I M ' o >l) C s /DUX 5 TlU '! F I 1 0 I ° aNI of { •A��... N4 its I . D {vis {I a E op yi E CORRESP ENC L oss. v O w 6\ c O 0 1V Oz Ica V i N 3 I S�ooE �j L; alp • � N D � D � - P p , � U1 w o N S91- 00068 i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count SST . CROIX ' Safety end Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar3 0"V9.: Persottal information you provice may be used for secondary purposes (Privacy L*v, s.15.04 (1)(m)]. 1fArR0Hf80r'R919T -- AURANT /JON MUNGER [EAU [GA IME ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: I BM Description: Parcel 00 0 17 — 2 0 —100 loo.3 100- 0 v� lef v7 Tank TANK INFORMATION ELEVATION DATA 00050 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmar y 1 12-5 111.55 (00.3 Dosing flew " * Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. AirI to n take ROAD Dt Inlet irl l �fG 6 O� eptic q0 f NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer -Zr-,e- j Demand Model Number 2, Co q(' "GPM TDH Li z-' "q Friction I.4G. System TDH 3ll. Ft So ► Loss t mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Di;7 Liquid Depth DIMENSIONS DIMENSI SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION TypeOf CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed ! Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE 6.28.16,SW,NW 2106 55TH AVENUE P av%J ir-ep(a &gyme,,� S� w +n e f V - )b p o-i eiticl etVv t � �C 7a6c -,� iA54r4 v � usf l;n" jJ t/ 3 �8 Plan revlsi0n rc ulr ed ❑Yes 0 No 1 Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature ROWS 7_ - SANITARY PERMIT APPLICATION 01 E and Washin Ave. SI°° N*6cojis i m. P.O. Box 7969 Department of Commerce n accord with ILHR 83 O5, Wis. Ad Code Madison, WI 53707 -7%9 • Attach complete plans (to the county copy only) for the system, on paper not less County 5%r. than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary yP � P e er r mi � t Number The information you provide may be used by other government agency programs ❑ Chec if rissio�ntop/evious application IPrivacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION I F RMATI - PLEASE 981 ALL INF RMATI N &72 ? - 7 Property Owner Name f Propert Location WOO X"C . C b PARS , 5(,Uva ,(��j 1 /a, S �D T 29 N, R 1 6 E (or W Property Owner's Mailing Address � C Lot Number �- Block Number 31z U i&,v o City, State L Phone Number Subdivision Name or CSM Number � 1715 3 -Co o 2 - 2- o Q - z-3 11. TYPE OF BUILDING: (check one) E] State Owned o 't � Nearest Road El ge Villa ublic 0 1 or 2 Family Dwelling - No. of bedrooms wn of III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s ) 1 E] Apartment/ Condo — 1 1 -/ — a ) 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales / Repairs 11 Restaurant 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3 /� Replacement of 4_ E] Reconnection of 5. Repair of an - - - -- Y- S stem y S stem Tank Only Existing 5 stem Existln System stem ------------------------------------------- B) A Sanitary Permit was previously issued. Permit Number Date Issued ea T V. TYPE OF SYSTEM: (Check only one) i fab - Z 440!!� 4j !�l ?`ice' 4-5 pl -yk Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed e --� -� 211 &Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench �— 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit t � DV �9 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 14.5 1Z7. 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 3 ( D Required (sq. ft.) Prop ed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) ` 6 .o - Elevation ZCl �I �P 2 O /. Feet / ' Feet Cap city Site VII. TANK in g allo ns Total # of Prefab. Fiber- Exper. INFORMA ION New Existln Gallons Tanks Manufacturer's Name Concrete strutted Steel glass Plastic App I ROIACA'�"�"� � Tanks Tanks ES� Septic Tank or Holding Tank ' SGT 15'& �� ❑ ❑ ❑ 1:1 1:1 Lift Pump Tank /Siphon Chamber ts (4/ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signa ure: (No Stamps /MPRSW No.: Business Phone Number: Plumber A�r (Stree ity, St p Code): lid �� /915 • to � �'G W IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate issued Issuing Agent Signature (No Stamps) p A pp roved E] Owner Given Initial surcharge Fee) yip �� qg Adverse Determination Zoo R7 egi , X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: I I SOD -62198 (8.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Number I i INSTRUCTIONS 1- A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plum ber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly mSintained:`'The septic tank(s) must`be purrApedby a lir-ensed pumper whenever necessary, usually every 2 to 3 years. , & if you have questions concerning your onsite sewage system_ , contact your local code administrator,or the State of, Wisconsin, Safety and Buildings Division; 6G&266 -3151. i e , To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII: Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and -manufacturer's name, indicate prefab.or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. .County Mepartment,Use Only. Complete plans and specifications not smallerthan 8 112 x 11 inches must-be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference p9i9ts; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; 0 soli test data on-a°1.15 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE , 1983 Wisconsin Act 410 included the creation*of surcharges (fees) for a number of regulated practices which can effect groundwater- The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ' Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 71sconsin Tommy G. Thompson, Governor Department o f C William J. McCoshen, Secretary March 02, 1998 CUST ID No.259518 ULBRICHT & ASSOCIATES 655 O'NEIL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL Transaction ID No. 67297 APPROVAL EXPIRES: 03/02/2000 SITE: Site ID: 3169 ST CROIX County, Town of EAU GALLE SWIA, NW1 /4, S6, T28N, R16W HARDEE'S RESTURANT FOR: Description: PUMP TANK REPLACEMENT FOR MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 6673 Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code. This system is not reviewed for the code requirements set forth in chapter Comm 82 or in chapters Comm 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire in two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Since y, DATE RECEIVED 03/02/1998 r FEE REQUIRED $ 60.00 PETER E PAGEL, P S PLAN REVIEWER I1 FEE RECEIVED $ 60.00 Integrated Services - BALANCE DUE $ 0.00 (608)266 -2889, M - F, 0745 - 1630 HRS PEPAGEL @COMMERCE. STATE. WLUS i I BRICHT & ASSOCIATES CO. � :a 6 '72 9'7. 655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # 67297 Date March 2, 1998 Owner Hardee's Food Systems Inc. Phone 715 - 836 -6800 Ext.22 Address c/o Mr. Jon Munger, 3112 Golf Rd. Eau Claire,.Wis. 54701 Legal Description Tax Parcel # 06- 28- 16 -86 -E. SW1 /4, NW1 /4, Sec. 6, T28N, R16W. Town of Eau Galle County St. Croix C.S.T. R. Ulbricht CSTM2482 Installer R.'Ulbricht Local Authority/ Supervision St. Croix County Zoning PROJECT DESCRIPTION A Revision/ Emergency Repair, to an existing commercial mound system installed in 1991. Previous Plan Approvals: Private sewage S91 -00068 General Plumbing G91 -00649 SITUATION: The existing pump chamber collapsed and caved in on Sunday Feb.21, 1998.A new exact pump chamber (Heavy Duty model) with exact pumps and control settings, as previously approved, shall be re- cstructed. The plot plan attached is actually the AS -BUILT plan submitted to St. Croix County Zoning Dept. after completion /inspection. The exact pump chamber elevations and total lifts, are as they exist, and shall be exactly as they are to be reproduced in this repair /replacement of the dose tank. .T. The old dama cpd jber Shall be abandoned per Comm. codes. Oft too Of ,�� � NCB ,: ,,, � � .� ., • . Pg.l PLOT PLAN VIEWS co n, G - T4,a... SEE P 9 g.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS ( '� D':..HUt':C_J. Vii Pg . 3 PIPE LATERAL LAYOUT �.'1 d ~• •...,, ik;llr 4� Pg.4 DOSING CHAMBER CROSS SECTION �'� °�uS,I,G,„`\``�����`�� Pg.5 PUMP PERFORMANCE SPECS 10R This design for installation is based entirely on measurements, elevations, land-cape conditions (slopes etc.) and soil suitabilit 'I't�e accuracy of his specs, as re Y Provided by cm the CSTM. ported, shall remain the sole responsibility 9 Any use of this POWTS design by any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet /frozen soils) by any such parties or persons. *A- i l DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTf�Y, C DIVISION BOX 7 LABOR AND PERCOLATION TESTS (115) MADISON W 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP /�: OT NO.:BLK. NO.: SUBDIVISION NAME: s� 1 / Na 1 f (p /Tz? /R & E (or �>fu Get! /E /� Z PO/ - z P 5 3 � 0 COUNTY: MAILING ADDRESS: 5'f CQD/ �t1vL /Ui // vK QI.� { �c�, �( 3 Zl S. 6, 3 , 3rd 1 D Lo i , -j car S . USE 60 0 4 - 50 30 DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I TESTS: ❑Residence MUSIC S?ot'E /L El New Replace I S��pT 2 7 1.? O E D: Tr> ,CAE Gf/i4 -� E a �ESr rra2.t�,7 -- - ff�3�POE� s Goof sysrc�5 RATING: S= Site suitable for system U= Site un suitable for system ONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S DU ❑S ©U ❑S ©U ❑ CU © ❑U sz2Pc,f �� io,.� SSE o�4 3000 If any portion If Percolation Tests are NOT required DESIGN RATE: of the tested area is in the under s R 83.09 {5)Ib), indicate: �. Floodplain, indicate Floodplain elevation: 5?5U 611,4 5 1/4 PROFILE DESCRIPTIONS FE& T BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED E HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) • e3 ' 15 . �.�, y / o lc ' 8,u . 'P/ 7,V 0 r.-, B -1 CP.S /OD• 20 �� a - 5,- plat -Fy /v r f f �T I GCo ' � I, o �J.3a -SY ft-�•2 , � w� f• �.P. d�sT, B- oQ - car. H-Df5� I.S ' '�euse -DEO S u,� n� . 5 . b? 0,V . B- 14'0-5 , /, 0 ' o /,� - S ,-rot y (_a C & y 16,ir j . /o6. y X, /3.v, OAAt , /�Gfyy fre.y u.�N, 04 B- l� 2,� DEvs� fw.t S/ f.f.f• �K -ay ku *s . ?3' /6obe 7A4 -, D TA.V S ( f3h.- ( 5 AmAf 0,,> B- 3' 0/ 5 7 / 1 f3 'i3u. sv/3 ��d�crr�e S i 33'PFt,sE B - 3 6P. , (o�, S& '�it 210 �o�rP,4cr p a, - oR SS e"10 - 4,. f f PERCOLATION TESTS oR -g AJ 6*5 /, D / & &S-e 4ef1^' 1. D 73,t,u D &o } TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTE f NUMBER INCHES AFTER SWELLING INTERVAL -MIN. -PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- P- P- 6 k P- - 1'"7 O P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION. SEE FIL °r P L- A A) UE dZS S (j)E L7' k 7 t q 3 • } t ."�-- _ E Tl�i : € (1-'Oi ,° !'?''iI s f l 5 �,4AOy tiN of f I N ;TE ?/�i' 5 � 3a d �' } - 1 16 W _/ v,� IJ/�ki ,�NC,z �Q �f�lj• ..j/2 /`l�G�'i�r/i 10 } fi o il GS D �! 74j 5�� Tu oell 77 IWIM 51 _.. I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): ESITE SEPTfC___P TESTS WERE 655 O'NEIL RD., HUDSON, WIS. 54016 � 'f p T COMPLETED ON: p G ROBERT ULBRIGHT s" 2 - 0 ADDRESS: '11S MASTER PLI ERLTO. NO. - 330TW:RS CERTIFICATION NUMBER: PHONE NUMBER (optional): "INN. INSTALLER & GESIGNER LIC, NO. 00663 ZV p 'L ' CST SIGNATURE: JC � DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 10/83) — OVER — r INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system: S. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 1U') BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under 3 ") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well Is — Fine Sand Bldg — Building Is— Loamy Sand ? — Greater Than 'sl — Loamy Sand < — Less Than '1 — Loam Bn — Brown 'sit — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. Thesanitary permit must be obtained and posted prior to the start of any construction. �,q-r 2 D, E�MENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 MADISON O 53707 HUMAN RELATIONS ULHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHI OT NO.:BLK NO.: SUBDIVISIO N NAME: sou 1 /tio 1 / C. /T 2 e N/R 1(E �'�- 3 j cs Q5tiUPIJ6— COUNTY: MAILING Tc�a /1C �>9����s map s�sr. IG ADDRESS c /0 3 M �,� �-� , �e�s , S 3 11 z CroiF 12D, E,i - a- C bri0F wis. 5"�/7a / USE 7/S - F 3 5 DATES OBSERVATIONS MADE NO. BEDRMS.: C crT DESCRIPTION: STS: JlljPf% W/ ❑New Replace /i "15:1 ��/ /y/f/Q�L ZD • ZS C�Ipioy�E - s s RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) DS Du EIS ❑u DS ®u OS E1U I EIS EA 1 A/oo -4-sn If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: L GffSS Floodplain, indicate Floodplain elevation: tdr'�7E�i ? I_ �uy� PROFILE DESCRIPTIONS /01 ` GRosT BORING1 TOTAL DEPTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGR TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) o _ " 1,el y. 13N /o yR 4 /1 Gi z; - 9,A B- y 9C) to 7, Zp �-t 3 6 - /�' /3N /o �- sl 2 f r dX c w �, 6-,e ; r Z - y 8A . 7. s y,� SIC, B- m, W 6y Hors' f06,-S11 B- S� 3 d 1, Mb f C w 0 e - G ,, t o TS' ' `.O(' Gy �� io y�R fz S�'/ 2fSb�t s c B wt 9-2Z - � !l �i�/ /00 /0,F 5, 2 5 2 z /� r� F/� .w S h/� cc�i� - z7 jCj f• �2 `� /� fGt, a7 " -SS 7/co snt �sA�, .t s L . L A Ns ky f T 1 � o �PE '�,' c w ' s s' 7v' �.s r� C Al c�.; B co ► f' w 76 - o o VIR c S� rK �� gu, ; /D� - /LO " /D y/� FB- -- J — VE/z Y Mo /'s r /joPE �PEJEG D Si�CE NORMAL Lo f a O6 w% Ff�u vT 4�ovu� y PERCOLATION TESTS peoljfi/3c Scc,t// > c f -� �,�/u / /nj! } TEST DEPTH , WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES t NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 2 P - z 2 0 P_ 3 0 / �I , Z 2 c. P- P- P_ * KX 40 77'&V ,C V /N vt R ipr7fLL� // $ /9 T EA - a'E;; 4 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. �.► % fr s/�ti0 �i // U ,pP /L10!/•e1j� : / Z a SYSTEM ELEVATION. (where 9,� ovvp ��t••�ti�a. E 3 ; .7` e i , r I�- _ MA c i i I € ------ 4 - 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. HOMESITE SEP iG PLUMBING CO. NAME (print): 655 N EIL RD., HLJL)6U17 VVIS 540M ITESTS WERE COMPLETED ON: ROBERT ULBRIGHT 2-1 f f7 ADDRESS: 1116. MASSTIER I CERTIFICATIQN NUMBER: PHO NUMBER (optional): 1. 1 .INN. INSTALLER & DESIGNER ! ,C. NO. 00663 Z7 j � 2 �Ej_ CST SIGNATURE: CP DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR•SBD -6395 (R. 10/83) - OVER - 1 —, P INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under 3 ") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well is — Fine Sand Bldg — Building Is— Loamy Sand — Greater Than 's1 — Loamy Sand — Less Than '1 — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water ' Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction i1 N . PAF OF REPORT ON SOIL BORINGS AND j S A FETY &BUILDINGS IDUSTRY, e f DIVISION LABOR AND PERCOLATION TESTS (115) f 4' MADISON WI 3707 HUMAN REL,�A SONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP OT NO.:BLK. NO.: SUI VISION N AME: 3w '/ ' 1 /4 Ce /TV N/R XP E (o 1>7 k G,t// _. _ BD _ _ ., _ _ COUNTY: r MAi LING ADDR SS: e-10 Ted ST G, _O /X ,lflf�PL >� S }�bO SyS7`E�1f /� Ga /F �� E"�f%< �' bf�iPE' Gv�s USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMM R IAL DESCRIPTION: ( OFI LE DES CRIPTI O NS : PT I N PE '/ Zed E ❑Residence ;P'6: j Q � ❑New Replace Il C am( RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S ©U QSDU EIS13U DSQU OS ®U /9ovti ATE: IGN R If Percolation Tests are NOT required DES �^ If any portion of the tested area is in the under s. ILHR 83.09(5)Ib), indicate: GG�,S J Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ST HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /J ., v _ ,n 3 3 TT z s K, acs c B- ?'L /2-0-/7 24r `/' // /ote "r3 5/ Zan5611 L es cc, /o YX C 1 3 nN aG .>~ 4' cw 2 d- MO TS (13, - 6X B 36 _ - 72 " /G /,1 y X of AI h G /,f F 3 �fZ /3.v &c, n B- B- B- PERCOLATION TESTS TEST DEPTH _ WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATTER INCH ES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PE RIOD 1 PERIOD 2 P ERI P- P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION. E � � I _._ r L . k — E - I 1_-A 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: / �IL-.P f )G PU j j','&NG Ca. ADDRESS: RUKERT(11.hRI7NT CERTIFICATION NUMBER: PHON NUMBER (optional): 1P✓8ER LIC. (vr y� CST SIGNATURE:, r : �. r C J(,. 03663 /jw„r'J�,p� err 1 . DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR- SBO.6395 (R. 10183) – OVER – ` � s� INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 �► , r To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under 3 ") LS — Limestone 's — Sand HG W — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well fs — Fine Sand Bldg — Building Is— Loamy Sand — Greater Than 'sl — Loamy Sand — Less Than '1 — Loam Bn — Brown 'sil — Sift Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay III — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 1710 MU06 - E(2 , PPES . (Doles &.'C OWNER /BUYER �pOp S '. %'H�' � F •� t ROUTE /BOX NUMBER * 3 Fire Number CITY /STATE AfW G11116ee_ Ly / ZIP 6"/ ' 740 3 PROPERTY LOCATION: s� �, N� , Section , T Z d N, R I l W } �' � Town of �f�'u11' < <� , St. Croix County, Subdivision /' , Lot number Improper use and maintenance of your septic system could result its premature failure to handle wastes. Proper maintenance ton- sists of pumping out the septic tank every three years or soonor, if needed, by a licensed septic tank pumper. What you pyt into the system can affect the function of the septic tank as a treat- . � ••; ment stage in the waste disposal system. St. Croix.County residents m_._Y be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was n operatio i era prior p ti n p 1 r to July 1, 1978. St. Croix County accepted pled this ro ram in Aug ust of 1980 with the requirement that P 8 B , q owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a ,.. certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is In proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge sa scum. Certification form will be sent approximately 30 days prior to three year expiration. ' Z I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with- the standards set forth, herein, as set by the Wisconsin Depart- 00 went of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Off:,pe within 30 days. of the three year expiration date. 41'.'. SIGNED &A DATE St. Croix Count Zoni Office 7 - is ft=xVW4 -, 1 54 015 f-IVA 16'- 3 9 0 - 9�r3 Z _ 3 JO (- dS�� c~ . ' • 'f' Sign, date and return to above address. C-6VA;7Y ? SCP7 APPLICATION FOR SAHITARY PERMIT STC -100 This applicatlon form Is to be completed in full and signed by the omer(s) of the property being developed Any lnadoquacles will only result in delays of the patmit Issuance. -Should this development be Intended for resale by ownet /conttactot,(spec house), than a second form should be retained and cospleted when Us property is sold and submitted to this office with the 4ppcopci4te deed recording. --------------------- ------------------------ --wi--w--------•--- Omer of pcopecty HAADkW X�TQQD SYS Location of property sW 114 1 - Section -,� T J1 -RALV Towne h 1 p Mailing address 31/2- 6;v11 Address of alto _ `Iw�• 3 j X — h7 subdivision nae► �s� !!off- 2- • Lot nuwbst / 07'�s l j Z Previous owner of property Total ■ise of parcel _MeL. vote pateol Ws created _ AMiI Z 7 Ate all cornets and lot lines Identifiable? r - r .L •r 11 0 Is this property being developed tot resale (spar house)T�__,__Yes r _ M0 Volume and Page Number S?� as racotded with the Reglatet of Deeds. - - - - - - • - - - - - - - - - - - - - - - - .. - - - - r r • • - r w w w - r .p r • w w � r r r - r - - - - - -.. - w r r - -- ww - - r -- - • - -- • - • INCLUDE WITH THIS APPLICATION THS FOLLOWINCI A WAARAXTT DIND 'which Includes s DOCUNt"T NUMgZR, VOLU?1a AND PAOR NUMARR, and the 99A.L OF THt RRaISTRR Of DRRDS. In addition, a cattitled survey, if available, would be helpful so as to avoid delays of the reviewing ptocess. It the deed description refereneas to a Caitifled Survey Nap, the Cattifled Survey Map shall also be required, ------------------------------------------------------ 7 ------------------ PROPIRTY OWNER CERTIFICATION I(vel cattity that all statements on this form are true to the best of lay (out) knoviedgt; that I (we) any (ate) the ownet(s) of the Property described In thl■ Intotmation form, by vlttus of a warranty deed @corded In the office at the County Registet of Deeds as Document No. inlo M3 . - J and that I (we) presently own the proposed site for the sewage disposal system (at t (vs) have obtalned an essement, to run With the above described ptopetty, for the cons uctlon of said system, and the some has been duly recorded In the ottice of s y y R t C °a�t�sc of Deeds, as Document No. UV's 1!i n urs 4 # 9 ow sr V Blgnatuto of Co - owner (If Appilcable) 2� / Dote of Signatuta Date of Signature l_ f to a ss H,5 SIdL�• �• Q� 1 5"�6 t2E 09 ti ed V I VS '1so � �, s'��` g �� , FQ� Reid - 1� M� X01. P� Q A• ID . i . �baA Cif as m V i ds \ d U.... vtif p• ve W ,s \ Ro'n• ����, and �� Rc��`d� a xe Y' � a t► to'�e Y tca • De p ttnet \ i 4 Saga MK c0n`e S, X x t'i tce1 f ° Sec t Town f iX ' o Cr°. n al ^ West foil° vel a C ll a d s' a . lFr e late j° St .- tbw est a SlXte desct t joe ttl Su ty Y M P d Teal Igo Ra ng fu l 1Y a fled of th � It i m th . descr ibe a (21 of .Yt enc 3 Cet ti t pia g °'N ,tin OTte, half �2g� 11C sin ° 'rwo Count des` �ibe A di 1 5l. t nee state os v,,� °° Uth eight Wis of t'Ot Cl: tern g� 39 21 a el of leggi a So e ntY' ntYf n et St. e he e V L ot got o pa Lt ° wn Sy1l'p CtolXUtbeast eo 360 tc el t 0 0 th en of s O o ac cel fo t Galle, a t bev o i . 2' o t�[t o th 2 e a 8 Fast in ng 1• sai old• d $► encinq ed i'a 1WWI �G' hence on the co m 00 + of of reco cet a ,t C L eco T of 8 51. ed b eat BEG ' cOUtYt eao ements of t �ettif le . 0 ? 0'1 uttt CL ne F '1 e�pF °ve b ,ect to red to � Coun �e S to eas em e ing ttac C, tlae ' .0Q ect to also b to be a 6 0 of SL d 3 K bein u poses an d Patc i 1 s P age Leaa P scribe d in vO "A' above d t ecot de Tte utaP s>�LY Y Maps A •� 0 of rec .d Pt`'r`Tt: etio 9 1 testti , �9 is n °t � �'�, Thia *gK tis n°tl Easement S = � J, R na Dated thts b -can , A• De S ��F.�i•' ��aY yt N ". C � ��ti Ct���1`� County �`� � ' ea g$�TTGA��p13 CrOl�a`t c,%xke iorc ar AiS "r i r- nebban 19 ' Onala the atuTe(s) 3 ) 0 an pr V k 'cit ed day °i S d the a nte• red this t he P vile tOdttt'nt n ^� ATE 0 ,,• �' `._ . tiSEgB'6R Slats* n t. <xt n °t' atate 19 .l tltot ,F -efl e l' tbl inn t INSI Co rK as A �ZI -�A0 Rc�n�v,edk"e<o' -t d • �!►" ,. e .. - dot ,.�•., mast .t.la� z hi °o I � � II � � l• � J �� p v, VA IL i ) R w C 1 o O - -�- An s -\ j \' \\ I oI 1 w o �Q. ,j �-- CQ `--,o r� -j __.. �. ------ .. _ 41 O I • r i O J 'n C, •� I W 1� v 1 `�^ 1�j j �� t� f — cJ ! j I l+ 0 .� -? -- � � � o ti p- J ;s J G \� � I ! � , � � �• 3 � k •,,.�. N� Lr) --��i .\ z j • 3 J 3 1 3 41 L4J � C Lu to (\ -+� r 2 ° n cc t " C4. � U� k � `� � z _ I q 3 N �� : N ,1 o _ I . � v � � v Q- VN a a- vb � o � Lo - 2 44- o < oCho, v � iu W 2 a I� (A \3 J Q 4 W p W L V U- Z� v 0 0 �� 2 Fo P-- rY X o LL. P W W 0 . G ' t x Ch V 111 (4) � J N x %j � f �) w J 43 J a4 cY <� < O 3 IL i� u� ; •� W �-' 1L �- Qn I 11 Pl- t o •� � C� 2 v 0 J o � w � � 0 CY ' i aroo1 -Y iIarno 3Nc)lot) Glotl I ��z QrnQW l dd}-Z �r,rn�oll pion 1V1n1 S�Z Q ttinOvi mo, L OLD Q rnOj�.! ?S3ddn - P p -1-4 5 ThI ` c- yo►lyna - a 5 (8 o � n d oa „h �. � ► i cl S¢o Sl 31 VI Q-L - L c,-g)L/SQV y104cI9015 \ 1 IL 3 N b wd'�d 7 Scfc-"n aW Z1arrn� '� 2a ddn __.. ..------- ._.--- ___._...__._.__. Q�YOoN 30 /Y»1 A ( - Vl a ? S - z �. ocYnow ?3 48dh - 1� Sc-• � 9 IV 1..� �LV�3�� v �o ro►1� ���o� ..Z/ � o a.�� �d. �iS o Sa o y = – - -- , i - _ S 5 p cy Q cycl c n,, W � q d d n • - - -- – -- — 7L Szl o CT C n Q ;�, Z `� ) 1 21Sb/:4 ZWd —L — 9c''id -ten o� �.�13�{'c�i�S s C-oI LVA—q) 3 Vv 1 SA 5 plc .�Mn `7 Cl cl YL — S Nno o s �� S � 0 Z Cd- — 0 0 Ci o n V) i ,> 1 w�0 to N cn o c q o , � O p I L 34 W oL j i �- u O CL- o f -� — i w n_ Lv fl _ F Q J 0 41 i CL -� Q. iLi LU cu �-- i o Ln V o LL Li- ui LIL co CQ ui Lu v t Win, v ' - - -- ri > > x lL 2 £ o o 2 0 0 " 2 k t-n �o w d � CL o- LO ij i i `� N O 0 UJ CO N r� ''- LU o LU w gy p_ - � £f [L ae , to L o , -� Lo�- a- 3 CY UJ 09 ° J 2 C) '� �� a 111 PL Q '. W 2 W 0 a W O I L! .. T ui v �, H= A � A' L- o N 7D C - L - Q 0 - L 191919 1 c� E S g 9 S R 2 v A c n 9 R fi R a s- m a m c a H� 4 �s���$�:$ _; mss♦ i m 10 9 O m r 4 A A� T - Z. III S - R�RRSS °SRS h-+ O o O Z CO °' - o L I f c a c L O L 4 U O d co a? W k CL w — G 0 ? O me .� ... CO m` O . V O N Cl) 'D i ` U p 6 N a y ca y y Q N d a N L O C H C O x o d m '> E vy, 3 p M N t/1 C C , -, • �x W O • O ? a aa� poi oSE co U lo dV 2 O= a a ? c9 • U O O m M C, C d 0 j = L m _O C L O O a C U 3~ Q M r 4 • 4_ r tL Q 4 • N N �_ G �' U .�.r y m O a C r ` N 0 C V i H a= o c� y `� o f o an d N m o m o 3 m m y :3 U N E y N .c? • C a ° W e t0 m U m oft /1 L d c �l yip a� Q� y'm p , U a a -C a- a m •p U co R oi; r? Egmm'accEa` �+ w � ' d m ' E -� �•� as 1°aEyc`OY�1.a� - �oN'�� a o i o a� E ° ° c o.� o d. y E m �p n c - a c= r_ as o o a a t y v `o �� "• S 4 0 �, a a v o o I- U - J J J p 0 � D b � W � 0- "• $ 0 g f N W !�^ 0 mN $ a \ 0 pp N pppp ,� O m - W �Q o p^ 0 3 O n J EE W N W N C N O� 0.. o � s •$ R tu SWUM �^ i� e �i N p e :°• .f- .N- ao io f eV o OVHH OIWVNAa IV1O1 0 0 V WSW � 3 0 W W p 1 • 0 � � N �• w CL 1 o� am 3 0 r o M g J J f m cic W W t7 o� J4 o Q T - 1 s 'w o 1334 � a h u� i a e 2 N Sl1313W r n $. r A o m e f n o° u OV3H OIWVNAa IV1O1 I _ $ 7 C;l- GN � �l �' � y �► 1. n n � � T 't• �'' � � c ,� m m � � � y, �, Z " ro � 1 ml of me N c � d� F, m G m c �, o /7 e 1nM � Ln to o v, Ln O ti o `, VN d N F 70 r► 70 orn� m-S 70 0 1y u, o m q 70 z � O 0 0 SITF sys7 So " ILA 2 0 p 15 S /o�PS ry ! ATIOHS % r ST I ABO AN' H viAty 0 d v/ e:A DEPAVITM A� NO ltd � DiViS � T o O - ESP ENCE yl�` � I� E CORR a s Ln G) o W r> o r I U3 , Vi c m a l ivien I _ N = U� O 591-00068 Z of CROSS SE OF M oum D S — -U PPE R LOWER 5 y5 T EM c V S T STIo,.3 S Sy,' }kT 0VE T - Y?AiZ fA$RIC> 'D' P • " PPER MOU uL7 ZS O UPPER MvuU� 12 5.7 5 IOWE M OUE D � Q �,N� 8 % T LA 5IO 1 3.r „ of /z FnRC� F(EVATto �F (. S F r A 55 V E GATE MA W F-,( (, S TI,J G-- 5 QA DE , ZWDEQ rD6 FT uP�ER MoviuD 12 3. St3 (. U F r IOCO Moue jjq. h 'I -- PLAKI - o MOUX)D - U5WCs BED FOR !� ^i 0� U l � vU � � � r _ . T\/PICAL FOR UPPER l vc e o v �pp0 N pEP pC�� � ENC� � o Sre RD3h(E,JT To IftTe1kRf ° DS v --- - -/- - - - - - - _ O. '�� , (3 PVC k 12,75 -r- 655EQVATIO► L , ��/3, 5 FT L z sc) Fr pi PEs F:OFCE MA S91-00068 J S, o Fr 3 it P vc rcA. 40 �EacTrH -s = I S. 0 P 370 70T',6, L lit/ 3� O Fr UPPER Mou"' p low ER R ECEIVED-- M ouk) D 275 � Tore 2 3 - 7 Volp VOI . � PPE R M bVN� art - -- - MAY 6 'fit VO(D VOIUME IOW Mouxv 1 0 - 5 CIAi . of IMAL04"a y rn d N L - i l� N G O y L 0 b 7 70 ll1 � C- 70 G rn i fi rn a n d rn n - c V 0 1 - �, -° Z rn > fTl rh d r 7Y rn rri Z; X t 10 b °�) 70 m m oNS,,�� -n F N 70 --U R +� (� 4PFl�N1E�a� G , O���S S�� • x o � � b m n d x � � n O o � t m rn� z o _ m _ rJ r\ n s m cp ._, Lo 6\ (�a \ Ln 11 -= n pi -7 r r O 1 Z -� r cElvr II g -00068 c -� I> o Z Z c 3: 0 m 0 7 ` c N Z m W r i m o a -� rn _ 70 C C `T7 �i 3 Z F 2 C o L d d cn 3 3 Z _ G m _ a Uq — o m d nr 5 _ r- R nl � c _0 - �► - o n C) L LA - 4 Z 4-1 r►t 3 " m to • d b ll� � N S '' m � ra o E m ui c 7V 7 r Cs) iv . , p m - (A v cn t4 o� d n�� I S-- S _ A �' rn Z rn E V 0 o m o r Z � b � w > Q Ir3 V — N w � f �' cc L - m o c t ' N Z c rn cn m > ; p � C) Fri A, o d Z VN op � H Ul p U Sa c ' �Q �► U1 n rn O 0 o m 3� _ G a 7� O 4 . N > ni C o C -o Ul ECEIVED O O ..�.) i 1 1' / 0 Z i ----- --�_ 0/ '° G w4y 6 1991 - - -{ 13UR AU oP BUILD11 0 o / �iiATU 81f8T aSS -a N n o - - -- - - - -- C _ m 3 ^ o > IQ) -h n lD U'l m LH oo 7D C .n cn d �' G r V1 p L d c V 0 `4 rn Z - x a � Zh c C . o Ai T L (TI - i m m IC7 1 Y C70 � > G° i�1 0 � z S91-00068 1 TOTAL DYNAMIC HEAD c� w r > m p o w + m a METERS f/1 p y yy yN� pp s 0 H N O N O N O N S S O M N O N O FEET O mm W -� g ° � a ° m r O " m a ° r N c C $ g m c ° Fm m T m o m V G m g rn r o � e o I �4rn � o r a TOTAL DYNAMIC HEAD - r m m � IS i � � IS' N � METERS g — m C s N g H y a o a c ln' S N �" in o a S Yi g N g 8 o a FEET Ic 0 0 1 0 ` =''C uC �t g �- r ; _ O o p c o + r m r O ; i 3 m o oo_ ,,� I � � m - V g m c 8 °' 4 g �m N T 1 r fD W c 1 m m A 1 A C N .n» C �y y - —3(0 O M C Z a a m j y O 7 C O w* 3 d m N a »• - a! a iD 0 2 3 a D y N cl 3 CD `s m O(D W A <D N N A 7' O f 7 i ° . n N <> C g a m M C 3 m n n' 3 3 •'- - • m' °—' O m a 6 S 6 1 A N O _ w O fD y m (D m ^' C Z a A r 7 1 r. a b ' O r 'R om ° m f lD O "N d'a� 0 a m co R m ° < m c r • • • • • • • • • • pOj 0 0 3 N N 0 > m T r "' W .l > ;st ri W.wC n.3� O C 7C y H N !� ! O i� H 7 w F .mi a N W= C 0 1 N T CD 3 r 3 O m. n S C CD to 2 (D (A t m 7 O O' y ? O C CD Q w fD N = (D W N 1 00 0 Q N O � > N 0 CD PL m Z C 7 � �■ CL a m N `. v_ v m o n D w m 7 m c 7 - A ? m o c m cu aa rn mo & Z O o � N • 1 9 � I ♦/� � Wm �asx�xsa woo _� o M 16 N $ cn g �, rKCf;l4 - 3 a _ Z: s n SG s gU11.D% sxu OF TEAS a�yRypSER gY5 S91 eM