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453267 030-2071-30-000
St. CroCounty Planning and Zoning Wednesday, October 18, 2006 at 3:48:30 PM Detail Sanitary Information Page I of ! Computer #: 030-2071-30-000 Sub/Plat: metes & bounds Section: 36 Parcel #: 36.30.20.619B Lot: TNIRNG: T30N R20W Municipality: St. Joseph, Town of CSM: 114 114: NW 114 SW 1/4 Owner: Village Five, Inc. 221 125th Avenue Hudson, WI 54016 State Permit: �8804 Issued: 09/22/1977 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 294 Installed: 12/13/1977 POWTS Detail: Bed - Seepage Bedrooms: 0 WI Fund: POWTS Pretreatment: NA Notes Isster(Inspector As Built Plumber Other Requirements Additional Wiles Money Owed Harald Barber No Boldt, Everett �.h� T"ec� a-a-io permit numbers 18804 and 18805 - $0.00 Harold Barber Signed Off No „' duplicated in 1981 permits. This is original permit for restaurant and bar on corner of Hwy 35 and 125th Ave. ZAZ Dave Bylsma was inspector for this project. File with 2004 addition and upgrade to current code Owner. Seven -Twenty, Inc. 221 125th Avenue Hudson, WI 54016 State Permit: 453267 Issued: 06/03/2004 POWTS Dispersal: Other Dispersal Component Permit: Addition County Permit: 0 Installed: 07/27/2004 POWTS Detail: NA Bedrooms: 33 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As BmIl Plumber Other Reg u rcments Additional Notes Money Owed Not determined NA Nechville, Henry Grease Interceptor being added. Restaurant with $0.00 Ryan Yarrington Signed Off Yes 2-5000 gallon septic tanks + 1500 gallon siphon tank to existing bed dispersal area approx. installed 1980-84. No card on file for installation/permit in archives. Bob Ulbricht certified existing system, received Maintenance agreement signed by current owners . Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 6/30/2004 7/27/2007 WEST C� PART S T. J I OSEPH T29-30N-R.20--I9W 39 AABY PLUMBING HEATING & ELECTRIC, INC. Milwaukee Thermo -Flow Heating Master Plumber Electric Heat 8 Wiring CALL: 698-2407 WOODVILLE, WISCONSIN Bass Lake Cheese Factory FANCY WISCONSIN 4-H ACTIVITIES CHEESES Mail Orders Sent Anywhere Camping Judging Phone: 612 - 439-9494 or Community Service Music 715 - 247-5586 or Conservation Recreation 715 - 549-6617 Demonstrations Safety Valley View Trail Somerset, Wisconsin 54025 Drama Speaking Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Seven -Twenty, Inc. I St. Joseph Township ST BM Elev: tnsp. BM Elev: BM De ►1k`yr\i`p}ti,on. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing 3 on Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air intake ROAD Septic 73 1 �7 4 r� �� r �h I [� 07 Dosing Aeration Holding —� PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Nu r TDH Lift System He TDH Ft Forcerrlain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 453267 0 State Plan ID No: Parcel Tax No: 030-2071-30-000 SectionlTownlRangeli No: 36.30.20.619B STATION BS HI FS Ell Bench rk ;tl 5.z Ji /d � Alt. BM Bldg. Sewer $ u � 7 . Z, St1Ht Inlet 71 L� StIHt Outlet <T f 3 -/ � 7 Dt Inlet Dt Bottom Header/Man Dist. Pi e Bot. S stem Final Gra St Cover G�'1-1 °11-.2 '2' BEDITREl Length No. O hes P IM17�p ENSION5 No. Of Pi#s ns Ia. Liqui eath DIMENSIONS _— SETBACK SYSTEM TO PIL BLDG WELL LAKE/STREAM LEACHING Manufacturer' --- INFORMATION CHAMBER OR UNIT Type O ystem: i C / 7 ��} Model Numb DISTRIBUTION SYSTEM 1 Hea lManifold IlDistributioiz Pipes) x HakZze x H oNkpacing Vent to Air Intake Length Lenglh Dia Spacing``- `.ld SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over ver De th Over--- xx th of xx Se ed/Sodded Iched Bed Trench Cen Bed,'Trench Edg Topsoil 1XX Yes No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ( I X 0 Inspection #2: / 1 Location: 221 125th Ave. @ Hwy 35 north Hudson, WI 54016 (NW 114 S 1/4 36 T30N R20W) metes Z Lot Parcel No: 36.30.20.619B � : 1� /OG 1.) Alt BM Description = �to� -<7 2.) Bldg sewer length = SCE r v. 11 - amount of cover = 3(,rtJ ✓ lu' ���� I L J Plan revision Required. ; Yes L: No -7 Use other side for additional informati n. :� % r SBD-6710 (R.3197) Date ]nsepclor, Signatur Cert. No. St. Croix County Zoning Thursday, June 03, 2004 at 10:58.23 AM Detail Sanitary Information Page I of I Computer #: 030-2071-30-000 Sub/Plat: metes & bounds Section: 36 Parcel #: 36.30.20.619B Lot: TNIRNG: T30N R20W Municipality: St. Joseph Township CSM: 114 1I4: NW 114 SW 114 Owner: Seven -Twenty, Inc. 221 125th Ave. @ Hwy 35 north Hudson, WI 54016 State Permit: 453267 Issued: 06/03/2004 POWTS Dispersal: Other Dispersal Component Permit: Addition County Permit: 0 Installed: POWTS Detail: NA Bedrooms: 33 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Nechville, Henry Grease Interceptor being added. Restaurant with $0.00 Signed Off: No 2-5000 gallon septic tanks + 1500 gallon siphon tank to existing bed dispersal area approx. installed 1980-84. No card on file for installation/permit in archives. Bob Ulbricht certified existing systern Safety and Buildings Division *isconsin 201 W. Washington Ave., P.O. Box 7162 Madison, WI '53707 - 7W Department of Commerce /r- r� Sanitary Permit Application In accord with Comm 83.21. Wis. Adm. Code, pers—I information you provide MR bo used for second ses Privac I. Application Information - r * "-'-• All *-.r..fln'j , property Owner's Name kztr.& 40' .- 7 rr. e W -y rr,` . P►2 v A. r4% Ccy ' �-cz � !� � d 17 lq__ VLF I } % PRO PE12 �� L(.G Property owner z n.,„,a ., — — City, State Zip Code Phone Number Its-s�q-��ss q'a :(-7 If. Type or nuitding (check all that apply) III 2 Family bwelling - Number of Bedrooms � A t� Pnhlic/Commercial - Describe Use C r ❑ State Owned III. Type of rmit! (C-deck on A. I _ New 2 ❑ Rerhrerr County '5T' Gr2 o r Site Address Sanitary Permit Number `/S3 Z G 7 ❑ Check if Revision State Plan I.D. NumbergG3 / . -3-1 Parcel Number / 030 - -I-o 70- - �20 -� IIPriioperty I.oeation YN l W14:STZO N.R--,t 4 Lot Number Block Numher Subdivision Name CSM ❑City— ❑Villsgq on line A (numbering scheme for internal use). Completr 3 ❑ Replacement of b Addition to For County use B • ❑ Check if Sanitary ermil previously Issued permit No IV. Type of Permit: (Check all that apply)(numbering scheme Is for in(ern2i use) 44 ❑ Non -Pressurized N-Ground 20 Mound 47 ❑Sand Filter 22 ❑ Pressutized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating V. Dis Mnl/Trentt lent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Recptired Proposed Rate(Gals./Days/Sq.Ft.) i Vul. Galloon v Existing dts Tanks or Flotding Tank Chamber 4onsibility Statement- I, 's Name (Print) Al 0ci rrr`G'� I Add ess (Street, City. State. Gallons of Tanks lsr1U /uS S, h --I I;z & I _ the undersigned, awinie Plumber's Signature AN ❑ Disapproved ' ❑ Owner Given Initial Adverse 0 e Road n B if appllc. lie) ����,� S0 ❑ onstrucled Wetland 51 ❑ Drip Line 30DOtherffQ!/ Percolation Rate I System Elevatlon Final Grade (Min./Inch) Elevation Prefab Site Steel Fibcr plastic Concrete Constructed Glass for butallalion of the POWTS shown on the attached MP/MPRS Number R��•t�--s phone Number. - -7In— 3 3-;Z! Z Sanitary Permit Fee (includes Groundwater Surcharge Fee) -/ ? � Dale Issued 6Y/2 / . IX, Conditions of Approval/Reasons for Disap rOva1 v r _ YSTEM OWNER: JL Septic tank, effluen I and dispersal cell must all be serviced / maintained as per management plan provided by plumber. itained as per applicable code ' .pb'"r (tcounty only) for thesystein on paper not less than etn ill Inch h alz� a ^^ ^��L✓� r_` SBD-6398is�-!h� sii,,. �.1/ ►'r/c (R.. QS/Ql) v y Stamps) Owner/Buyer ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM -5e-V6/J -Tr vt/y, 7y I /JC Mailing Address 2-Z! /)-�— /-6 US" Property Address <�A_ e7 (Verification required from Planning Department for new construction) City/State L L(±- Parcel Identification Number 0 O - _ q- 0 36 -moo -?-6 LEGAL DESCRIPTION Property Location'/., <wf '/,, Sec. L , T 3L N-R W, Town of 5 ► Subdivision ,Lot # M E710S 5/ ��1iid aS Pae # Certified Survey Map # , Volume g, Warranty Deed # 4 3 -7c/ 2 , Volume / , Page # / LA-r,l D �la � �,� o� Spec house ❑ yes L"no Lot lines identifiable EY yes ❑ no SYSTEM MAINTENANCE 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 wane disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, j oumeyman 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o �OF a iration date. I Z � v% S NATURE APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am {are) the owners) of the propgrty describe above, by virtue of a warranty deed recorded in Register of Deeds Office. / 2%1 ) GNATURE M APPLICANT DATE ****** Any information that is mis-representedmay result in the sanitary permit being revoked by the Zoning Department. ** Include with this supplication: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Srntembear 14, 1977 StevensInc. 11117 Coulee �n.',, f urlson, wI 54016 Gentlemen: Re: Mite C1ua - village Five Corp., (xmer Sewage Disposal HW 1 /4, 5`4 1 /4, Section 36, T30?30 R2GW To%mship of St. Joseph, Wiscionsin St. Croix Crirnty Plan Identific<aticn tin. 77-04006 Examination of pl uril. i n g p 1 erns Oki sr ex i f i iL a t i ons for the above -rant 1 oned project 11as been coaplotad. In accord �al th Chanter 1 -, °li sccrosIn �tatute3s, and Chapter ii 6-2, 1,115consin IV,iiinistrative Code, the plumbing pines and specifications are approve contin..;+nt upon compliance with 4:e stipulations inuic.-� ed can the plans and Elie fod lowing code 5-- ;t ix ns— Please review your code for the requi ref,ients a` each code section neater:. iR li 42.20 (2) (b) 1. Percolation and soil baring tests, Distribution and depth. 2, ii 62.11-1 (4) (d) 5. 'inlet and outlet piping and joints. 3. ii 62.-:U Dosing or pumping chamber. Sizing„ constructicm and pumping oquiFx•,,ent. 4. ti 6.'..1,() (r) (,) 3. e.apage beds. Distribution line spacing and headers. 5. The archltcet, professional engineer, reglstereca dosigner, owner or plumbing contractor shall keep at the construction site one set of plans bo aring the stamp of approval of the department. 6. in the event installation of the plumbing inprovements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work any commence. Y ',tevens Enmine"rr, Inc. pann 1 September 14, 1977 In -�rantlnq this Annrovai, the Olvision of health does not hold itself ila�l�* for any dofmts in Plans or specifications, plan omisslaos, examin.-ation overslRht, construction or any damage that ray result in nr after Installation and reserves the right to order changes or additions s hnu l d cond i t i ores arise mark i ng this necessary. This approval is based on Chapter H 62, Wisconsin Administrative Codes, requirerlents. it shall he necessary to obtain and fulfill the permit requirer-gents of the city, vilinge, township or county In which this Installation Is to be constructed. Failure to obtain local permits will autexlatieally void this acceptance. Rw► order of Wnh L. Andreand, Ph.O., Administrator, Division of Health, S incerely, .1.�,r�es �. �ae•nent r;cainf Ji S:JPTskk Inc. cc: `,r. Encert L-crthold, DPS - District 6, Eau Claire --A'r. ';~,rold C. Barber,, Zoning A&inlstreator 11111arc:. Five. Corp. "r. Roy K. Clary, R.S., thief, Sr.ction of Hotels and Restaurants ' pep teethe r 14 , 1977 Mr. Harald Stack Routes 2 n i e±nwood City, WI 54013 Dear Mr. Stacks Rat Holding tank - 2001 gallons Harold Stack, residence IN 1/40 HE 1/4, Section 3, T304, Rli )!! Trn.rn of Glenuood, Wisconsin St. Croix County 1 <sn Identification !;o. 77-04352 Lxanination of olumbinq plans and specifications for the above -mentioned project has been completed. in accorri with Chapter 145, 141scnnsin Statutes, and Chapter i, 62, Wisconsin Administrative Cade, the plurabinc7 plans and specifications are approved contingent upon compliance Ath the stipulations Indicated on th(! plans and the follo%gln,r code sections. Please review your code for thu requirements of each code section noted. 1. Our review of the holding tank plan has not been evaluated for structural stability, only for compllance to design requirerients of Chapter )1 62 of the Wisconsin Adninistrative Code. 2. The hold;nq tank shall be maintained and the contents disposed of as required Bander Section N 62.20 (7), !41sconsin Administrative Cede. 3. H 62.04 (4) (b). Building sewers. Depth. 4. H 62.20 (9) (b) 6. Holding tanks. Vents. f. The architect, professional rfineer, registered designer, owner or plum-binq contractor shall keep at the construction site one set of plans hearinn the stamp of approval of the department. 6. In the event installation of the plumbing improvements or system has not commenced within two years from this date:, this approval shall become void and new application shall be made for approval of these plans before work may cony nce. Hr. Harold Stack Page Z September 14, 1977 In granting this approval, the Division of Health does not hold Itself liable for Any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after Installation and reserves the right to order changes or additions should conditions arise mkinq this necessary. T'ils approval is based on Chapter H 62, Wisconsin Administrative Code, requirements. It shall be necessary to obtain and fulfill the permit requireients of the city, village, township or county in which this install,mtion Is to be constructed. Failure to obtain local permits will automatically void this acceptance. By order of Ralph L. Andreano, Ph.3., Administrator, Division of Health. Sincerely, J, es A. Sa rjen t Chief JAS: P(S: skk enc. cc: °"r. Erbert 3erthold, OPS - District 6. Eau Claire jMr. Harold C. T)rber, Zoning Administrator t"r. Yayne Lorenz State of VVisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES S*Ptm**r 9, 1977 Mr. Harold Stack, Route 2 Plan I fit.--f1. ra. Gletulrood City, W1 54013 ' w Dear Sir: a Re • 11a=1d Stack - Residence Holding Sank ,40 4-iil ; 53 T30N IMP, Town of Glenwood, U1 - S DIVISION OF HEALTH MAIL ADDRESS: P. 0. BOY 309 MADISON, WISCONSIN 53701 IN REPLY PLEASE REFER TO: SEC-10!`4 OF P- NIaII.G AND FIRE FR 07EC TION SYSTEI,.5 No. 7704352 This is to acknowledge receipt of your plans and specifications for the above - indicated project. When referring to this plan in the future, it will be absolutely necessary to utilize the plan identification number assigned to the project. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section H 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review ?, r �� t C/" Gam{ %CP fir' Fee required is Fee received is $ II Plan accepted for review. Fee is being returned because of II Overpayment II Underpayment. Providing one of the two catagories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance, No fee has been remitted. Plana submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance. E] Additional information required. See attached Plb. 100, The permit to start construction will not be issued until 30 days after requested information is received and accepted. QPlans being returned. See attached Plb. 100. Sincerely, � Z A. Sorg Chief JAS:fjs State ofr Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES August 24, 1977 Stevow saximefrs. Inc. 1407 coul'se NNW 1tttdsov, W 54016 Dear Sir: Plan I i0 ofil E i f-ic'a t ioq �.` , . � Re: 41te Club -- Fillagw rims • , Owner Sewage Disposal WA SWk Safi ' 30Y Ri1Wo, Tamohip of St. Jesefti, St. Croix CamutT DIVISION OF HEALTH MAIL ADDRESS: P. O. BOX 309 - ADISON, WISDON51w 53701 REPLY PLEASE REFER 70: SECTION OF PLUMBING E PROTE:[TION SYSTEMS This is to acknowledge receipt of your plans and specifications for the above - indicated project. When referring to this plan in the future it will be absolutel necessary to utilize the plan identification number assigned to the project. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section H 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review Fee required is $ Fee received is $ Plan accepted for review. Fee is being returned because of II overpayment Underpayment. Providing one of the two catagories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance. No fee has been remitted. Plans submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance. Additional information required. See attached Plb. 100. The permit to start construction will not be issued until 30 days after requested information is received and accepted. 11 Plans being returned. See attached Plb. 100. Sincerely, Zes A. Sarg Chief JAS:fjs Plb 100a 2/77 Department of Health & Social Services • Divis!on offHealta Section of Plumbing and Fire Protection Systems 6C8-266-3815 Re: In reply refer to Plan ID # 6 o The plans indicated above have been given a prelinu.nary review and tho following da.t;.,l its ('1 Lhc 1' missing or needs clarification. Please submit the additional information as Indicated and checked below. Upon receipt of this additional data, plan review will be continued. I. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or starlped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. II. Alternate Sewage Disposal Syste_3 (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 COPY). []Cross section of mound. 0 Pipe lateral layout. ❑ Plan view of alternate. III. Private Sewage Disposal Systems Ground slope with 2' contours Ln entire area of soil absorption system extending 25' on all sides. W Elevation of permanent reference point (benchmark) . ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lc-1 size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank 'f site constructed or tank manufacturer if precast. Construction detail and cross --section of soil absorption system. ❑ Soil boring and percolation test on EH 115 completed by certified soil tester (1 copy). Complete data relative tc anticipated use of bldg. Q 3 copies of PLB 60 enclosed. Deed restriction required (.i copy). IV. Holding tanks ❑ Profile of holding tank. LI Holding tank agreement signed by owner and local unit of Government (sample enclosed). ❑ Reason for :installing holding tank soil test or statemnt from county (1 copy). V. Lift Pumps ❑ Calculations for total li't pump discharge, 'read and gallons pumped per cycle. ElSize, length & depth of force ? sir_ ❑Detail & model of pLm.p or a.utor�.tic siphons including size, pump curves, drawdown and average flow rate GPY1. ❑ Cross section of lift pump tank showing p',.r,; (s) or siphon (s). VI. Water Supply, Distribution & Serr_ce Ll Sizing calculations. E On/off pressure of -0 if private water supply or static pressure at source if public supply. ❑ Gallons per minute Of punT.and size cf pressure tank. Size of pipe, length of run and materials used. VIl. Systems In rill Vil-,- mist be placed _prior to plan si_b scion) Q Total area filled ;Fill to extend LCf 'tieyor_d edge of trench before side slope begin). 0 Depth and type of fill. Copy of onsite report by county or disr.ict plumbing supervisor. O Length of brie fill has been in place . -over D.L ION . -- `— H1aV73 O Z Za3dY6 �a-�e a3.Lb'32i1nn bo �e� Hsabw 3dld A83d ,.fie NIW o . ,R :RlVA\3S 3.1bA►Ztd oaco#•�•w 700 NHo^ -- Nd-16 lO7d— `c'32ia 1rr�W3'Jd'1d32i �� // •-- af'm�� �O i ---� � — — � UUU li � I �►I l i / r I ( I L-1 LJ L� i 96 1 ,q b / ,h6 r N-4-L it xaew +i�n3e 10 �dlliwans Nrd Hi Q311IWSI1S 39 Ol ION - THM U 7dl,ldS I. PIb. 90A Interpretation Number 122 January 27,1978 WISCONSIN DEPARTMENT OF HEALTH E SOCIAL SERVICES Division of Health Section of Plumbing & Fire Protection Systems APPEAL — INTERPRETATION REPLY This reply is being submitted for an ❑ Appeal C interpretation Code section or sections in question 145.135 Wisconsin Statutes Name of owner or building Address City or Town County Plumbing Contractor Address Architect Address Engineer Address Other County Code Administrafors Address On November 16, 1977, Chapter 168, Laws of 1977, relating to sanitary permits was published and became effective as Section 145.135, Wisconsin Statutes. Please clarify the meaning of this law. SECTION 1. 145.135 of the statutes is created to read: 145.135 Sanitary permits. (1) VALIDITY. In this section, "sanitary permit" means a permit issued by the department or any county, city, village or town for the installation of a private domestic sewage treatment and disposal system. No person may install a private domestic sewage treatment and disposal system unless the owner of the property on which the private domestic sewage treatment and disposal system is to be installed holds a valid sanitary permit. A sanitary permit is valid for 2 years from the date of issue and renewable for similar periods thereafter. A county, city, village or town may not charge more than one fee for a sanitary permit or the renewal of a sanitary permit in any 12-month period. A sanitary permit shall remain valid to the end of the established period, notwithstanding any change in the state plumbing code or in any county, city, village or town sanitary ordinance during that period. A sanitary permit may be transferred from the holder to a subsequent owner of the land, except that the subsequent owner must obtain a new copy of the sanitary permit from the issuing agent. The results of any percolation test or other test relating to the disposal of liquid domestic wastes into the soil shall be retained by the county, city, village or town where the property is located. The county, city, village or town shall make the test results available to an applicant for a sanitary permit and shall accept the test results as the basis for a sanitary permit application unless the soil at the test site is altered to the extent that a new soil test is necessary. (2) NOTICE. A sanitary permit shall include a notice displayed conspicuously and separately on the permit form, to inform the permit holder that: (a) The purpose of the sanitary permit is to allow installation of the private domestic sewage treatment and disposal system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. t - r QUESTION What is the permit life under this law? ANSWER A sanitary permit is valid for 2 years from the date of issue. Section 145.135, Wisconsin Statutes, requires that all sanitary permit ordinances include a 2 year permit life. Any ordinance previously written requiring a shorter or longer permit life shall be revised to conform with the new law. The permit life shall be uniform throughout the state. QUESTION #2 If the Administrative Codes are changed, how will this affect a sanitary permit already issued? ANSWER A sanitary permit is valid for a 2 year period, regardless of any change in the Wisconsin Administrative Code. If the Code is revised prior to the expiration of the permit, the permit will be unaffected until the expiration date. If a sanitary permit is renewed after a Wisconsin Administrative Code revision, the renewal shall conform to the revised Code. QUESTION #3 The law states that only one fee may be charged for a sanitary permit or the renewal of a sanitary permit in any 12 month period. How does this affect a sanitary permit renewal? ANSWER. A permit renewal fee may only be charged once every 12 months. However, the permit may only be renewed for 2 year periods. When a system is not installed during the first 2 year period, the permit may be renewed and another permit fee charged. QUESTION #4 The law states that the sanitary permit is transferable. Please explain. ANSWER When a permit has been issued to an owner who later sells the property to another individual, the buyer must take the owner's permit to the issuing agent who will transfer the permit by completing a transfer form in the new owner's name. (This form will be sent to all issuing agents in the near future.) All conditions described on the first permit shall be transferred to the new owner. Can a transfer fee be charged? QUESTION #5 ANSWER The statute, as written, does not prohibit charging a fee for transferring a permit. QUESTION #6 The law states "the county, city, village or town shall make soil test results available to an applicant for a sanitary permit and shall accept the test results as the basis for a sanitary permit application unless the soil at the test site is altered to the extent that a new soil test is necessary." Does this mean the counties cannot question soil test results? ANSWER This does not mean that the county does not have the right to question and require further tests conducted on the property in question. It only means that the county, etc., must take the information and then act upon it. If the sanitary permit issuing agency questions the accuracy of the soil test results they may ask that the tests be reconducted or additional information be supplied. P 1 b. 90A Interpretation Number 122 January 27,1978 WISCONSIN DEPARTMENT OF HEALTH r; SOCIAL SERVICES Division of Health Section of Plumbing E. Fire Protection Systems APPEAL — INTERPRETATION REPLY This reply is being submitted for an 0 Appeal I Interpretation Code section or sections in question 145.135 Wisconsin Statutes Name of owner or building Address City or Town County Plumbing Contractor Address Architect Address Engineer Address Other County Code Administrators Address On November 16, 1977, Chapter 168, Laws of 1977, relating to sanitary permits was published and became effective as Section 145.135, Wisconsin Statutes. Please clarify the meaning of this law. SECTION I. 145.135 of the statutes is created to read: 145.135 Sanitary permits. (I) VALIDITY. In this section, "sanitary permit" means a permit issued by the department or any county, city, village or town for the installation of :, private domestic sewage treatment and disposal system. No person may install a private domestic sew age treatment and disposal system unless the owner of the property on which the private domestic sewage treatment and disposal system is to be installed holds a valid sanitary permit. A sanitary permit is valid for 2 years from the date of issue and renewable for similar periods thereafter. A county, city, village or town may not charge more than one fee for a sanitary permit or the renewal of a sanitary permit in any 12-month period. A sanitary permit shall remain valid to the end of the established period, notwithstanding any change in the state plumbing code or in any county, city, village or town sanitary ordinance during that period. A sanitary permit may be transferred from the holder to a subsequent owner of the land, except that the subsequent owner must obtain a new copy of the sanitary permit from the issuing agent. The results of any percolation test or other test relating to the disposal of liquid domestic wastes into the soil shall be retained by the county, city, village or town where the property is located. The county, city, village or town shall make the test results available to an applicant fora sanitary permit and shall accept the test results as the basis for a sanitary permit application unless the soil at the test site is altered to the extent that a new soil test is necessary. (2) NOTICE. A sanitary permit shall include a notice displayed conspicuously and separately on the permit form, to inform the permit holder that: (a) The purpose of the sanitary permit is to allow installation of the private domestic sewage treatment and disposal system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. QUESTION #1 What is the permit life under this law? ANSWER A sanitary permit is valid for 2 years from the date of issue. Section 145.135, Wisconsin Statutes, requires that all sanitary permit ordinances include a 2 year permit life. Any ordinance previously written requiring a shorter or longer permit life shall be revised to conform with the new law. The permit life shall be uniform throughout the state. QUESTION #2 If the Administrative Codes are changed, how will this affect a sanitary permit already issued? ANSWER A sanitary permit is valid for a 2 year period, regardless of any change in the Wisconsin Administrative Code. If the Code is revised prior to the expiration of the permit, the permit will be unaffected until the expiration date. If a sanitary permit is renewed after a Wisconsin Administrative Code revision, the renewal shall conform to the revised Code. QUESTION #3 The law states that only one fee may be charged for a sanitary permit or the renewal of a sanitary permit in any 12 month period. How does this affect a sanitary permit renewal? ANSWER A permit renewal fee may only be charged once every 12 months. However, the permit may only be renewed for 2 year periods. When a system is not installed during the first 2 year period, the permit may be renewed and another permit fee charged. QUESTION #4 The law states that the sanitary permit is transferable. Please explain. ANSWER When a permit has been issued to an owner who later sells the property to another individual, the buyer must take the owner's permit to the issuing agent who will transfer the permit by completing a transfer form in the new owner's name. (This form will be sent to all issuing agents in the near future.) All conditions described on the first permit shall be transferred to the new owner. Can a transfer fee be charged? UESTION #5 ANSWER The statute, as written, does not prohibit charging a fee for transferring a permit. QUESTION #6 The law states "the county, city, village or town shall make soil test results available to an applicant for a sanitary permit and shall accept the test results as the basis for a sanitary permit application unless the soil at the test site is altered to the extent that a new soil test is necessary." Does this mean the counties cannot question soil test results? ANSWER This does not mean that the county does not have the right to question and require further tests conducted on the property in question. It only means that the county, etc., must take the information and then act upon it. If the sanitary permit issuing agency questions the accuracy of the soil test results they may ask that the tests be reconducted or additional information be supplied. r Stale of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES 1� DIVISION OF HEALTH September 14, 1977 MAIL ADDRESS P.O. Box Log MADISON, wISCONSIN 53%2 STREET ADDRESS: 1 WEST WILSON STREET MADISON, 11%2 IN REPLY PLEASE REFER TO: iI SEA —ION DF PLI.'M. BPN ', AND FIRE PROTECTION SYSTE%15 Stevens Engineers, Inc. 1407 Coulee Road Plan Identification No. 77-04006 Hudson, WI 54016 Gentlemen: Re: Nite Club - Village Five Corp., owner Sewage Disposal M4 1/4, SW 1/4, Section 36, T30N, R20W Township of St. Joseph, Wisconsin St. Croix County Examination of plumbing plans and specifications for the above -mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes, and•Chapter H 62, Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans and the following code sections. Please review your code for the requirements of each code section noted. 1. H 62.20 (2) (b) 1. Percolation and soil boring tests. Distribution and depth. 2. H 62.20 (4) (d) 5. Inlet and outlet piping and joints. 3. H 62.20 (5) (c). Dosing or pumping chamber. Sizing, construction and pumping equipment. 4. H 62.20 (5) (g) 3. Seepage beds. Distribution line spacing and headers. 5. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. 6. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. Stevens Engineers, Inc. Page 2 September 14, 1977 In granting this approval, the Division of Health does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order chances or additions should conditions arise making this necessary. This approval is based on Chapter H 62, Wisconsin Administrative Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will automatically void this acceptance. By order of Ralph L. Andreano, Ph.D., Administrator, Division of Health. Sincerely, t►G• Jam s A. Sargent Chief JAS:JP:skk enc. cc: Mr. Erbert Berthold, DPS - District 6, Eau Claire Mr. Harold C. Barber, Zoning Administrator Village Five Corp. Mr. Roy K. Clary, R.S., Chief, Section of Hotels and Restaurants Pih. " 60 KECE1VIEf-' 3/7j PROJECT DETA!L I),%TA SHEET AUU � � )�%� NA,"IE OF BUSINESS LOCATION �� � -, j� � ley �i _._. �'�i � _ �i � Ul `� I r' ^-- S r eTO Sw, !' /•! --- - — � � _ .,7 I �� �. L � 1 street or hi gh,,,ay city or to;insh'i p county LEGAL DESCr !PT!ON _�}C �__ i 1 �' !^v Ic,� O'W`'!ER '' _L;`_!1_ � !`/ t'r ;�<�� Mailing address _l'�'+' 7. ARCHITECT OR ENGIt,EER T 'w'��'1 �'!l� -�, �• 1 � _ Address PLUMBER -_ Address _ ZIP I. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: v Er,lsting building New building Addition If addition to existing building attach detailed memo for each. ( } Drive in restaurant ......... Car spaces ( ) Restaurant .................. Seating ca a !ty (10 sq. ft./person) U p c ( ) Dining hall ................. Per meal served Toilet waste Yes No ( ) NOtel ( ) Hotel ( ) Cottages .. Number of units: 2 persons/unit �J 4 persons/unit TOTAL NUMBER OF UNITS ( ) Churches .................... Number of persons Kitchen 1'es Flo ,` Ear or cocktai I' lounge ...... Seating capacity (10 sq. ft./person) ri —�- ( ) Nursing or rest home ........ Number of beds \, ( ) t'obi1e home park ............ NLIMber of units - dependent (camper trailer) - nondependent (mobile home) \ �- ( ) Re-2il store .. Number of employees _ ( Number of customers TO sq. ft./person) Service station ............. Number of cars served (daily) �i ( ) School Number of classrooms Meals served Yes No Showers pro0 ded Yes No � ( ) Factory or office building .. Number cf ^ersons (total all shifts ( ) Apartments ..... Nummbe- of he;drooTs { Other Speci Fy __-------------- f 2. Indicate whether or not the following facilities are connected: ��Food waste grinder Yes Fl _Y_ o � _ p i shwashe r Yes No X- Automatic clothes crasher es NO Automatic Automatic potato peeler- Yes / Other (Spec! fyi ---__ —_------__-- !-10 _ 3. Fill in the appropriate information for the v-ollowingas indicated: Septic tank capacity planned Percolation test r4rc ;ts - ATTACH P:- L! `„_. _`FST A`D 5-)!L FE"2f.- S,EE1 Sr I! f+ i L• ��� f f i '.� -7- COPIPLG'r i I DE r�'�1r�CJ i F C)s ,` _i 0-o'l.J' M 'Secpage trench bottom area planned wi dth l inco reel. d P t h Seepage bed area planned /! f,!(• �—dth f? -- — _ i if I— t inear fect f Seepage pit planned outsirc diameter depth below inlet depth 4. See approved plan for specifications and dcta is. Signatur1of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION P. 0. Box 309, Madison, Wisconsin 53701 Approved: Addre/s: S I✓r"�� ��'✓C/�`� �u� Date: TF' I S AnP;0i-AL IS C,�SED ON STATE PLUMBI t:G S ,fir,l 40L'E REC!JIr1EF ENTS AND DOES NOT EXEMPT THE _ P-IS;AL.L!, ION FRM CM, VILLAGE, —.'.SHIP OR COUNITY PERPt l T REQU I REMIEN T S AND SHM-L BE IF I?EVISED MTHOUT THE VRITIEN APPROVAL ! OF THE DIVISION OF HEEALTH. DEPARTMENTAL USE ONLY RECEIVED AU G 2 3 1977 Verific�!ion ,.:.rL kj ......... State of Wisconsin � DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH September 14, 1977 MAIL- ADDRESSrP 0 aox MADISON, WISCONSIN 53701 STREET ADDRE551 WFST WILSON STREET MADISON, W!SCONSIN 53702 IN REPLY PLEASE REFER TO: SECTION OF PEUVBINI AND FIRE PROTECTION SYSTEMS Stevens Engineers, Inc. 1407 Coulee Road Plan Identification No. 77-04006 Hudson, WI 54016 Gentlemen: Re: Nite Club - Village Five Corp., owner Sewage Disposal N!J 1 /4, SW 1 /4, Section 36, T30N, R2011 Township of St. Joseph, Wisconsin St. Croix County Examination of plumbing plans and specifications for the above -mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes, and Chapter H 62, Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans and the following code sections. Please review your code for the requirements of each code section noted. 1. H 62.20 (2) (b) 1. Percolation and soil boring tests. Distribution and depth. 2. H 62.20 (4) (d) 5. Inlet and outlet piping and joints. 3. H 62.20 (5) (c). Dosing or pumping chamber. Sizing, construction and pumping equipment. 4. H 62.20 (5) (g) 3. Seepage beds. Distribution line spacing and headers. 5. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. 6. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. r Stevens Engineers, Inc. Page 2 September 14, 1977 In granting this approval, the Division of Health does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order chances or additions should conditions arise making this necessary. This approval is based on Chapter H 62, Uisconsin Administrative Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will automatically void this acceptance. By order of Ralph L. Andreano, Ph.D., Administrator, Division of Health. Sincerely, Jam s A. Sargent Chief JAS:JP:skk enc. cc: fir. Erbert Berthold, DPS - District 6, Eau Claire 11r. Harold C. Barber, Zoning Administrator Village Five Corp. Mr. Roy IC. Clary, R.S., Chief, Section of Hotels and Restaurants PIb. '` Gv- 3/70 PROJECT DETAIL DATA SHi LT UU-IVED AUG 23 1977 NAME OF F,1J5I t1E-.SS PLUMP'N"—' cP:r-rir)%' 1111 - \ "v, `t' 7 �' � 1.1j 1 � F.�To S �. C- � d I J� I.0 AT I Ott ---- J� —HNt1'_ street or h i gh�;ay city or to,msh'i p county LEGAL DESCRIPTION —P C* 1"-- � OF -5 VV I/ - � CL` -j� -T 30 IV f� 2 C V V 1 _i- 0W1ER —�.' i L r-�1 mot: - f LAC --P Ma i 1 i ng address ARCHITECT OR UG I NFER �f`1 t'` /` /✓`Address PLUt1BER --� -,--- Address 71 P z I P 1. Check appropriate building usages) 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 Iij Res tauran t Seating cipacity (lo 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 _ L Number of customers T10 sq. ft./person) { ) Service station ............. Number cf cars served (daily) ti ( ) School Number of class roocs Meals served Yes � No ( ) Factory or office building .. Number of persons (total all shifts ( ) Apartments .... ... Nllr?Jer of hcdrooms _ ( Other ..... Specify __------------------ -- 2. Indicate whether or not the following facilities are connected: f�Food waste grinder Yes __ No _� _ D i sh%tasher Yes _ No K Automatic clothes %•rasher Yes _ No Automatic potato peeler Yes Other . . . (Specify) 'L -`- NO 3. Fill in the appropriate information for the --ollowinq as indicated: �1 4 If- 2D 5 ; .� {� �-t � /�� U t! I !� -6 -S- C U �r- Septic tank capacity planned. ' it f ercoiation test results - f,, TAC14 n1-RCOt,AT !:'I 'FaT AND COIL nORI'?;S nrnnn,- S:,t-r- C0.µPl_F ,E l ' - \ SIDE r l f Seepage -trench bottom area fslannecl �_-- ---_ width linear feet Seepage bed area planned/� f ( !•:i th ---=� ___ r linear feet e'cpth ;t, T Seepage pit planned _ out, i 'c ci i '-)meter depth below inlet —_ depth 4. See approved plan for specifications and detaiis. Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTIOFI P. 0. Box 309, Madison, Wisconsin 53701 Approved: -- -- AdJr ss: 5 / ��Jy > L�"✓C ' S�✓�� f Date: .•�� L� j � l I �ti� U L' LTHIS APPROVAL IS BASED ON STATE PLUMBING I i� s� ' S- fjn I �� CHIDE R: U I REMENTS AND DOES NOT EXEMPT THE "� INSTALLATION FRO11 CITY, VILLAGE, TOWNSHIP OR COUNTY PERMIT REQUIREMEHTS AND SHALL BE VOID IF REVISED WITHOUT THE VRITTEN APPROVAL CF THE DIVISION Of HEALTH. DEPARTMENTAL USE ONLY D and rer or'!cd uncn by t he c,:tian of i and tUPE ! , 'J;t °tr o ron ' ificr?s f. :{' i I 6.?w--REANO, Ph.D. Administrator Verification RECEIVED AU G 2 3 1977 PLIJ"RIN, r; CPe-'tIr)".I 7 0 i G �E S�7TCtp —1. THIS tPOWF SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # A . -3 0—D �a NEt� wiEs� hSE 12-� Dry �YiS7iuG /z0 . f i O Z core OH"o I'A"i% !I P10,0p05 S A Isrl'�(r i-----�o1 - --- - —, �z limp(fir JA)T I �X�ST/�tJC� � ��� 1 lo0� p,�i,Vf%&�v jR -D E5Vi i oD �X•4�ri.v�D � / G•L� I\ � a o 7- C.J"t C jlk-- 2812 10th Ave. • Spring Valley, VWI 54767 715-772-3442 Reg. Designers of Engineering Systems Private Sewage Consultants PROJECT INDEX PLAN in ft f�Pi zb- o y Ct.0 tea/ �Tw�Vtq � MC,. DATE -0�� OWNER lL/ / lr a• . 4/ Fy_ Tti� PHONE 7/s' S�y CvZ SS ADDRESS ZZ/ la If- 57T. H Ut?sOA` Gc1lS . SgOl Co LEGAL DESCRIPTION lf/W/y, szv,'/ sloe , 36p TZD 4��30 Q TOWN OF s�' ., o SEPI SSE G(20l JL COUNTY CSTM N61-- LOCAL AUTHORITY/ SUPERVISION Sf' Cle6l)( 6'7-/• I46— O \ PROJECT DESCRIPTION: '' _ 7ti e �E A) % iV tt> o wN�6P S o 'BAR. UTAX� 6vU e /IFS / .. Gv /S4 �71 �.v�S z'e cc NFU- CADS c� J S 7- .4%c�tD of 'i�CR i's7-1SL�T7'c •� itl D 1,5 / N UqX / /NSp eC-fr0N ot- Alf fit �S � tZ�Z coPZFcp,W`o /,• t U - ? /00 'X /00 t A4 7V S1to Nb OF C5FFt-0E,0 i . SE-0 �ppE>r� Die` i S 7� 7'4 Ltd • /. S . Wu S 7-/R!f-, -M OF Ilktie-60 6-RE*Se7 1104-� c&)) k)2 ,,,,,,anrrarrurr„ rpq„ , ROB £RT W. �♦ ULERIDHT 1 D1160 sin ram, l� HUDSON, w1 , SIGN SEE CORRESFONDENCE Pg.l. Sizing Specs for Exterior Grease Interceptor Tank. Pg. 2 Plot Plan of Prperty and Existing System. Pg.3. Cross Section Specs of Approved Wieser Concrete Co. Tank Pg. 4. Dept. Product Approval Specs Re: Grease Int. Tank I GREASE INTERCEPTOR TANK SIZING SPECS The Valley House Rest. per owners testiment seats and serves approximately 50-60 seats/customers per operating day (9 hours serving time). They possess a dishwasher system but no food grinder "garbag disposal". The grease interceptor tank shall be oversized for an average seating of 100 patrons. PROPOSED: To install a 1200 gallon Wieser Concrete Products precast code compliant tank. PER COMM. 82.34(5)2.b. C= S x H xA C= 100 seats x 9 hrs. x 1.0 factor + 900 gals. minimum. POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # Fait 6 ipetsE /oi S' Pl . / 0 f y — L w� \, 1 1 5L G ff*E Za , !S'64tl�- SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # A .36-D y6 _�7_ color 6dN10 /1;4v7T S coo gems F�c� S&rT i C %it A;t S or fwt E� P of AT "!5td6rl p"G nT � WS P���5 .11' �1e Zoe I Soe �� I Ew WEE � kS� N A le 1 i PI0�Q�5 SOFA i s n �� i - - ---io o - -- - GO.1z VA)Go�e�a I Ibb l! Ri G�5 DI ' Ga-vpi rio,v a Zof q __- 60)— Ul c 0 0 0 0 o 0, �oON°' ��oa ;,+,Spy vtol s i ik 104" a TOP VIEW %! iF V T SCALE: 1 /4" = 1' �IN6' lm 4-vrl�ra.5 cl r SIDE VIEW SCALE: 1/4" = 1' W1250 GREASE INTERCEPTOR TANK SPECIFICATIONS DIMENSIONS: WALL: 2-1/2" 1 iJIS PO T SYSTEM SHALL BOTTOM: 3" INCORPOR TE PER COMM. MANHOLE^ 24" I.D. 83.44(2)c A PROPER ZABEL HEIGHT:72" O.D. FILTER MODEL # LENGTH: 104" O.D. 1A J WIDTH: 86" O.D. BELOW INLET: 53" O.D. LIQUID LEVEL: 47" *7-- WEIGHT: 8,300 LBS, INLET AND OUTLET: 1 4" BORE WITH STOP FOR QUIK—TITS, FERNCO GASKET, CAST —A —SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLES: -Z7 / AS SHOWN (( LIQUID CAPACITY• • LOADING DESIGN: 8' 0" UNSATURATED SOIL CUSTOMIZED TANKS: TANKS CAN BE CUSTOMIZED CONTACT WIESER CONCRETE ROOM Emmgmm W3716 US HWY 10, MAIDEN ROCK, WI 54750 800-325-8456 MODEL W1250—MR GREASE INTERCEPTOR JANUARY. 2001 nip. w,osr -- A 2525 P 609 STATE BAR OF WISCONSIN FORM 11 - 19H2 LAND CONTRACT Individual and Corporate {rO 9E USED FOR AtTRANSACTIONS WHERE OVER DOCUMENT NO. $ 25 co01S FINANCED :- AND IN OTHER NON -CONSUMER CT ATRANSACTIONS) Contract, by and between Seven Twenty, Inc., a Minnesota, corporation (-Vendor', whether one or more) and Valley House Properties o__ fHudson, _ LLC. a Wisconsin limited liability company. __ __ ('Purchaser' whether one or more). Vendor sells and agrees to convey to Purchaser. upon the prompt and full performance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), in __ St. Croix County. State of Wisconsin: SEE ATTACHED %q -7SlSU7021Ql KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/12/2004 09:45AN LAND CONTRACT EXEMPT # REC FEE • 19.00 TRANS FEE: 405.00 COPY FEE: CC FEE: PAGES: 5 .., •-.c :.bra LP - NAME AND RETURN ADDRESS 6iLp`. Sh ena Peterson q 4,Sy 7 5 rP3 e l 1 221 125th Avenue Nw y fo Huds WT 54016 ' leea- , s 030-'�Za17 1-.3a-oc�o -© 3a-a0-70- 80 This is not homestead property. (is) (is not) Purchaser agrees to purchase the Property and to pay to Vendor at 4005 P H EASANT_-R_I, DG E N E . 3 LA N E , MN 55449__ _ the sum of $ 135 , ODO . 00 in the foLcwing manner: (a) $ 0 at the execution of this Contract: and (b) the balance of s_._..__. 1 35 , 000. 00 together with interest from date hereof on the balance outstanding from time ro time at the rate of 7 5 percent per annum until paid in full, as follows: pursuant to the terms of that certain promissory note, a copy of which Is attached hereto as Exhibit A Provided, however, the entire outstanding balance shall be paid in full on or before the 15TH __ day of _ MAY, 2004 (the maturity date). Following any default in payment, interest shall accrue at the rate of! • 5 % per annum on the entire amount in default (which shall include, without limitation. delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor. Vendor agrees to apply payments to these obligations when due. Such amouns received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law_ Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after _the —date here_, 61e�fiYS7i�14K�t �lk�3@l1�c�C*Sds� In the event of any prepayment. this contract shall not be treated as in default with respect to payment so long as the unpaid balance of - principal, and tnterest (and in surh case accruing interest from month to month shall be treated as unpaid principal) Is less than the amount that said indebtedness would have been had the monthly payments been made as ftrst specified above. provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation. the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: SEE ATTACHED Purchaser agrees to pay the cult of future title evidence- It title evidence is in the form of an abstract, it shall be retained oy Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on the.__date heregf Crams 0- 0— STATE BAR OF WISCONSIN WISCOnain L99W Blank Co.. Ire. LAND CONTRACT - Individ—t and Corporate Form No. 11 - 1982 Mnwaukee, w's- LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SAINT JOSEPH COMPUTER NUMBER 030-2071-30-000 Parcel Number 36.30.20.619B OWNER NAME: First SEVEN -TWENTY INC Last VALLEY HOUSE PROPERTY ADDRESS: Hse # 112 PD --Street Name-- Type SD Apartment 221 125TH AVE SECTION 36 TOWN 30N RANGE 20W '/4160 '/440 Line Description Line Description TOTAL ACREAGE 7.000 PLAT LOT BLK 01 SEC 36 T30N R20W THAT PART 15 02 OF NW SW LYING NLY OF HWY 35 16 03 ASSESS WITH P616B 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit DOCUMENTNO. 4 - _ WARRANTY DEiED 1;STATE BAR OF WISCONSIN FORT( 2-19M — aooK 81� -a �l +_......_.Y.i11aq(t...K.1Ye..... TAV..,............................................................ -: ---- - -*'*"-------------------------*----------- -------------------------------*----------•- f............................................................................... conveys and warrants to ...................... .Il�.r.i._....-_...... .....a. Mirneaota-.Corpora.t.ion........................ .......................... r............................................................................................. -----------------•----------..............------------...------........----.....----............._..._......--- T"la SPACa RLa{RY[O Ma MCCCR"INp DATA i I REGISTER'S OFFICE STT. CROIX CO., DWI JUN 11988 4 ::155& ^''��M�� Regii3ty of Mods RETU*" To ....................................................................................... ......... .... ........... the following described real state in ......St. Cro1x County, State of Wisconsin: Tax Parcel No: .............................. II That certain parcel of land located in NWT of SW anu SW, of NK4 of Section 36-30-20, more fully described as follows: Commencing at the W4 corner of said Section 36, thence go due E (assumed bearing) along the E/W; line of said Suction 36 a distance of 243.30 feet to the Point of Beginning of ! the parcel tc be heroin described; thence N45000'00"E a distance of 64.85 feet along Lice: S right of way of a Town Road; thence due E along said right of tray a uis-a:-:e of 650.00 feet; thence along said right of way S76000'00"E a distance of 243.01 feet; thence along the E/W� line due E I,! a distance of 117.61 feet; thence S01000'11"W a distance of 457.76 feet to the Nly right of way of S.T.h. "35"; thence Nly and Wly along said right of way on a curve concave Sally having a radius of 2010.0E feet and whose chord bears N53042'52"W a distance of 881.36 feet to the E/W; line; j thence due W a distance of 307.04 feet along said E/W" line to the Point of Beginning. Together with the rights appurtenant to the above described 4' parcel in all highways or other rights -of -way previously or in the future vacated. Together with and subject to all highways, easements, or rights of way of record. 7UNS"'Ll, his is _ -, ' ' ... homestead property. (is) (is not) FEFj Exception to warranties: Subject to easements, reservations and restrictions of record. Dated this ..._....3..r............................. day of ..........Al. ...................................19.. X... AGE FIVE Inc. �� y�—' Q._ .. -... ----(SEAL) by �OHN TROLL, Jr., President _. Attested .to... -.. ..-... -- - .(SEAL) �lCG�GL/cam Gig.,. �/�_�� E (SEAL) b�% . JUDITH A.' TROLL, Secretary AUTHBNT*CATION ACKNOWLEDGMENT Signature(s) ----------------- ----- ------ --------------- ........................................ .......•• ........................... authenticated this -------- day of -------------- -......... ._, 19...... -----------------------------------.._------...------------------------------- 0-------------- ------------------------------------ - - TITLE: MEMBER STATE BAR OF WISCONSIN (If not. -. ------- ---------------------------------------------- authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED UY ............. TEPHEN- J... DC.�IL.AP----------- - F;uuson Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) STATE OF WISCONSIN S--- t. Cr- -o- ix I ss. - -- ---- --- --------------County. _ Personally came before me this ......5- ..__day of , ..!4 ................1 19._r'2. the above named _J01111 .axa. --- Jr.,...anu._,I.Ud1th__A._...T.roll, P r-e $ident_..and.- Secre.tary_,_-.r_esp-pc.tive ly, .Qf...VJ,laSe..�.y -Inc. - • - `-�''-- -- ----------•---------------------- ------- ------ to me known to be the person .S...... who q�cufpd `kie forego nst men, nd acknow [he s�Ele. Y _ _I � � m STEPhEN_J.' -UNLAP- i.� ' Notary Public....St....,C-roix___..Qbunt{(-Ais. Sty Commission is permanent. �i f/ f gt/�Iiyp/�1t� l f�tfdo � �i--------- ---- ------------------ ---- -- ----- •Namur r yerx sianina in am capacity n',,Id b, typr.t o. phi,[ d b-low th-ir sizn—re+. HG+ W W C.a.prlr® STATE BAR OF WISCONSIN FORM No. 2 — 1482 Stock No. 13002 STANDARD TANKS AT MAIDF.U-ROCK - SPOONER 800-325-8456 WI ONSIN INLET 3 YEAR DIMENSIONS LIQUID CAPA I Y MODEL !1 STYLE EXP.E FILE NO./N SEPTIC/HOLDING TANKS WLP750-MR Septic or Holding 20000645 February-03 42 359 84 20.28 WLP1000-MR Septic or Holding 20000646 February-03 42 480 104 x 86 27.83 W 1200-MR Septic or Holding 20010031 June-01 43 575 118 x 73 31.16 W1250-MR Septic or Holding 20000647 February-03 53 603 104 x 86 26.81 W 1565-MR Septic or Holding 20000648 February-03 57 750 109 1/2 x 93 30.69 WLP1645-MR Septic or Holding 20000657 May-03 42 789 150 x 84 45.78 W 1665-MR Septic or Holding 20000659 May-03 57 797 114 7/8 x 93 32.65 WLP2000-MR Septic or Holding 20010032 July-03 43 958 175 x 84 52.63 W2000-MR Septic or Holding 20000755 February-04 53 966 151 x 86 42.92 W2500-MR Septic or Holding 20000649 February-03 57 1208 159 1/2 x 93 49.46 WLP2500' Septic or Holding 20001001 September-05 41 1197 183 1/4 x 101 1/4 69A4 W3000-MR Septic or Holding 20000654 March-03 57 1440 186 x 93 58.94 W LP3000' Septic or Holding 20000995 February-06 48 1437 184 x 102 69.77 DRYWELL TANKS W 1300 Drywell N/A N/A 55 Round 84 N/A W2600 Drywell N/A N/A 115 Round 84 N/A COMBINATION TANKS _ W1000/500-MR Septic, Septic/Pump 20000653 March-03 57 719" 109 1/2 x 93 19.61 (Septic) or Septic/Siphon 479 9.84 (Pump) W i o00/600-MR Septic, Septic/Pump 20000652 February-03 57 768 114 7/8 x 93 19.61 (Septic) or Septic/Siphon 479 11.82 (Pump) WLP1000/600-MR Septic, Septic/Pump 20000656 February-03 42 770 150x84 27.88 (Septic) or Septic/Siphon 481 16.76(Pump) W1000/650-MR Septic, Septic/Pump 20010036 August•01 43 788 146 x 84 26.32 (Septic) or Se tic/SI hon 479 17.00(Pump) W 12501750-MR Septic, Septic/Pump 20000655 May-03 53 986 155 x 86 27.66 (Septic) or Septic/Siphon 623 16.12 (Pump) _ W1280/800-MR Septic, Septic/Pump 20010035 June-03 43 984 175 x 84 33.44 (Septic) or Septic/Siphon 609 20.60 (Pump) WLP1500/900' Septic, Septic/Pump 20000998 September-05 41 1150 718 183 1/4 x 101 1/4 41.67 (Septic) 25.00 (Pump) WLP1600/1100' or Septic/Siphon Septic, Septic/Pump 20000999 September-05 48 1389 184 x 102 41.86 (Septic) or Septic/Siphon 862 25.58 (Pump) _ GREASE INTERCEPTORS _ W1250-MR Grease Interceptor 20000647 February-03 53 N/A 104 x 86 26.81 W1565-MR Grease Interceptor 20000648 February-03 57 N/A 109 1/2 x 93 30.69 W 1665-MR Grease Interceptor 20000659 May-03 57 N/A 114 7/8 x 93 32.65 W2000-MR Grease Interceptor 20000755 February-04 53 N/A 151x86 42.92 W2500-MR Grease Interceptor 20000649 February-03 57 N/A 159 1/2 x 93 49.46 W3000-MR Grease Interceptor 20000654 March-03 57 N/A 166 x93 58.94 WLP3000' Grease Interceptor 20000995 February-06 48 N/A 184 x 102 69.77 'See the large tank section for drawings of mese low profile tanxS. STANDARD TANKS AT MAIDEN ROCK - SPOONER 800-325-8456 MODEL # STYLE I WI CONSIN I EXP. DATE INLET 3 YEAR I DIMENSIONS I LIQUID UPACITY FILE NO, IN HE P SEPTIC/HOLDING TANKS WLP750-MR Septic or Holding 20000645 February-03 42 359 84 20.28 WLP1000-MR Septic or Holding 20000646 February-03 42 480 104 x 86 27.83 W 1200-MR Septic or Holding 20010031 June-01 43 575 118 x 73 31.16 W 1250-MR Septic or Holding 20000647 February-03 53 603 104 x 86 26.81 W 1565-MR Septic or Holding 20000648 February-03 57 750 109 1/2 x 93 30.69 WLP1645-MR Septic or Holding 20000657 May-03 42 789 150 x 84 45.78 W 1665-MR Septic or Holding 20000659 May-03 57 797 114 7/8 x 93 32.65 WLP2000-MR Septic or Holding 20010032 July-03 43 958 175 x 84 52.63 W2000-MR Septic or Holding 20000755 February-04 53 966 151 x 86 42.92 W2500-MR Septic or Holding 20000649 February-03 57 1208 159 1/2 x 93 49.46 WLP2500' Septic or Holding 20001001 September-05 41 1197 183 1/4 x 101 1/4 69.44 W 3000-MR Septic or Holding 20000654 March-03 57 1440 186 x 93 58.94 W LP3000' Septic or Holding 20000995 February-06 48 1437 1 184 x 102 69.77 DRYWELL TANKS W1300 Drywell N/A N/A 55 Round 84 N/A W2600 Drywell N/A N/A 115 Round 84 N/A COMBINATION TANKS W1000/500-MR Septic, Septic/Pump 20000653 March•03 57 719** 109 112 x 93 19.61 (Septic) or Septic/Siphon 479 9.84 (Pump) W 1000/600-MR Septic, Septic/Pump 20000652 February-03 57 768 114 7/8 x 93 19.61 (Septic) or Septic/Siphon 479 11.82 (Pump) wLPt 000/600-MR Septic, Septic/Pump 20000656 February-03 42 770 150 x 84 27.88 (Septic) or Septic/Siphon 481 16.76(Pump) W 1000/650•MR Septic, Septic/Pump 20010036 August-01 43 788 146 x 84 26.32 (Septic) _ or Septic/Siphon 479 17.00(Pump) W t 250/750-MR Septic, Septic/Pump 20000655 May-03 53 986 155 x 86 27.66 (Septic) or Septic/Siphon 623 16,12 (Pump) W1280/800•MR Septic, Septic/Pump 20010035 June-03 43 984 175 x 84 33.44 (Septic) or Septic/Siphon 609 20.60 (Pump) WLP1500/900 Septic, Septic/Pump 20000998 September-05 41 1150 183 1/4 x 101 1/4 41.67 (Septic) or Septic/Siphon 718 25.00 (Pump) WLP1800/1100' Septic, Septic/Pump 20000999 September-05 48 1389 184 x 102 41.86 (Septic) or Septic/Siphon 862 25.58(PUMP) GREASE INTERCEPTORS W1250-MR Grease Interceptor 20000647 February-03 53 _ N/A 104 x 86 26.81 W1565-MR Grease Interceptor 20000648 February-03 57 N/A 109 1/2 x 93 30.69 W 1665-MR Grease Interceptor 20000659 May-03 57 N/A 114 7/8 x 93 32,65 W2000-MR Grease Interceptor 20000755 February-04 53 N/A 151 x 86 42.92 W2500-MR Grease Interceptor 20000649 February-03 57 N/A 159 1/2 x 93 49.46 W3000-MR Grease Interceptor 20000654 March-03 57 N/A 186 x 93 58.94 W LP3000' Grease Interceptor 1 20000995 1 February-06 48 N/A 184,102 69.77 -toee the large tank section for arawings or rnese low prone tanks. , tcommercemi.gov isconsin Department of Commerce April 23, 2004 CUST ID No.226375 ROBERT W ULBRICHT ULBRICHT & ASSOCIATES CO 2812 IOTH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/23/2006 SITE: Valleyhouse Restaurant 221 125TH St Town of Saint Joseph, 54016 St Croix County Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.commerce.state.wims/sb www.wisconsin.gov ATTIC• Plumbing Inspector MUNICIPAL CLERK TOWN OF SAINT JOSEPH 1337 COUNTY RD V HUDSON WI 54016-6712 FOR: EXTERIOR GREASE INTERCEPTOR Object Type: Plumbing System Regulated Object ID No.: 954844 Plan Type: Addition Jim Doyle, Governor Cory L. Nettles, Secretary Identification Numbers Transaction ID No. 993171 Site ID No. 682420 Please refer to both identification numbers, above, in all correspondence with the agency. The submittal described above has been review ed 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: A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction%installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. mcerely, Fee Rcquirea S 70.00 Fee Received $ 70.00 ` Balance Due $ 0.00 Daniel L Kraft Plbg , Integrated Services WiSMART code: 7657 (608)266-8075 , Monday-friday 7:00 AM-3:45 pm dkraftea commerce. state. wi.us cc: James E Wehinger Sr, Plumbing Consultant, (608) 339-7430, Paul Belisee & Sheena Peterson, Valley House Restaurant r - A REPORT OF IP1SPECTIO'_I--17DIJIDiJAL SEi1AGE DISPOSAL SYSTEI4 Sanitary Permit State Septic 771E TOWNSHIP St. Croix County OrDTTI% TAITTI Size __A110 gallons. 'lumber of Compartments Distance From: '?ell tj ft. 12% or greater slope fI. Building_ _ft. Wetlands ft 17ighwater ft. DISPOSAL SYS =:1 Tile Field or Seepage Pit(s) Distance From: iaell �� ft. 12% or treater slope _a`fi Duildin i10ft. Wetlands f: r FIr•.Ln IUFi hwater _ft. Total length of lines _14)�qft. dumber o: lines. Length of each line 1 0 e_ft. Distance between lines 40 ft. Width of the trench IU tft. Total absorption area 1155 6 sq. ft. Depth of rock below tile a in. Depth of rock over tile Z in. Cover over rock, Depth of the below grade 4JU _in. Slope of trench _in ner 100 ft. Depth to Bedrock _ft. Dept!' to ,-round water ,> � ft. 'lumber of pits Outside di, Met ft. Depth below inlet ft. Gravel around pit: y� "--ono. Total absorption area sq. ft. Square feet of seepage trench bottom area required ,quars feet of seepage nit area required Inspected by: �f�,S�uIA Title: — Approved Date �2 — 197'i, Rejected Date 197 kd$ lot PLB67 State and County State Permit Permit Application County Permit #, for Private Domestic Sewage Systems County C� 'DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: j B. LOCATION': Section T_1/ N, Rr! E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village 41 /—,— TYPE OF OCCUPANCY: 'Commercial X 'Industrial 'Other (specify) 'Vaffnce Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder_ YES NO # of Bathrooms --�, Automatic Washer _YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks. ---, D 'Holding tank capacit I Total gallons No. of tanks New Installation Addition_ Replacement_ Prefab Concrete `Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 11 2) 3)/Total Absorb Area / O �� sq. ft. New_ Addition Replacement 'Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No, of Tenches z Seepage Bed: Length/Width �' Depth Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Tester, `1 NAME !� =C, � C.S.T. # Wit: / and other information obtained from (owner/builder). Plumber's Signat a MP/MPRSW# 4 Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). Do Not Write in Spa c elow - FOR DEPARTMENT USE ON Y //11 Date of Application Fees Paid: State %�� County' (J Date c? s �' 7 7 %Issuin A Permit Issued ( ate) _ 7� g gent Name d y/✓ Inspection Yes No Valid# Date Rec'd aunty (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 oink copy) 4. plumber (canary copy) Revised Date 6 1 /7 PLB67 State and County State Permit # L Permit Application County Permit # for Private Domestic Sewage Systems County e5t C,Qa� X *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: ra FF v e✓ Gog p- �/��Sda, w;s . B. LOCATION: IVW % %, Section , T O N, R_ 6 (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial*Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES _;;A\ NO Food Waste Grinder Automatic Washer YES NO Other (specify) YES ONO # of E. SEPTIC TANK CAPACITY 00 Total gallons No. of tanks -77ayo .2.S�O PL- o`�OoO *Holding tank capacity Total gallons No. of tanks New Installation X_Addition _ Replacement Prefab Concrete is *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) a. 2) _/_ 3) Total Absorb Area //,4DO sq. ft. New X Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width —��De th Tile Depth No. of Trenches _ Seepage Bed: Length /Q,FWidth /D G Depth I y�`1 No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified S it Tester, NAME _de 4 o L C.S.T. # �,j —,$��� and other information obtained from &J (owner/builder). �J Plumber's Signatur MP/MPRSW# /'Y1 �`��� Phone # 65 7d Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 77o l-© o '77- Do Not Write in Sp BeloW - FOR DEPARTMENT USE ONLY Date of Application r Fees Paid: State' County ,..x �(� Date Permit Issued/R408ted- (date) '— i Issuing Agent Name t - Inspection Yes�No Valid# Date Rec'd j,,,,,,,,;;uLnty(Whi a copy3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 copy) 4. plumber (canary copy) Revised Date 6/1/ EH 115 (11-74) WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH„ BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOI L BORINGS AND PERCOLATION TESTS LOCATION: _%, —'/., Section _, T—N, R — E (or) W, Township or Municipality Lot No. , Block No. County Subdivision Name Owner's Name: Mailing Arlrlress: TYPE OF OCCUPANCY: Residence No. of Bedrooms EFFLUENT DISPOSAL SYSTEM: NEW ADDITION — DATES OBSERVATIONS MADE: SOIL BORINGS SOIL MAP SHEET S01 L TYPE PERCOLATION TESTS Other REPLACEMENT RCOLATION TESTS — TEST NUM- BER DEPTH INCHES CHARACTER OF SOIL THICKNESS IN INCHES HOURS SINCE HOLE 1STWETTED WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL INMINUTES DROP IN WATER LEVEL, INCHES RATE MIN/IN PERIOD 1 PERIOD 2 PERIOD 3 P— P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, I E NUMBER INCHES (DEPTH TO BEDROCK IF OBSERC1v� OBSERVED ESTIMATED HIGHEST i pFF B PLANVIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give reference point. Indicate slope. tN 1 4+1 1 1 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 location of test holes are correct to the best of my knowledge and belief. Name (print) Signature Certification No. 'ame of installer if known - Local Authority ap� a yw 'c ti'y v H fy DJ -� 7 _ TT � T S .x. CIO r —' E — -- - c - ---- 3 E--- - >+ -sVTJ 77 77A, �f JigWf;� 3�ISN( HLlrl�. Qt7 �J�H7S �Q1S�J( j.� �21�h"7) r_,IN J _ FA-C �F LAMP - -- At 1= � J \ x • ' Mrs^C� �ee> �5 IN WELL L LA :�, 7 E. 1;_: DE A,1,4 tc Tii q X,jll A�10k LD <I \j f--,'4' rAq Ill V:LOI^) 71 4-1, p \1 tc,) E. jt,- 14 A f0 E. P, PjSH 7AJh_ NO '7CALE A ?AP - -EL N 7RE WIN j S C.3 S I rj 4� C_ -Z j r-j- 17 ; -,—' , ,, '; 1.1 e `VAP_JES- F—L 6-1 E. 4 :_ F4 4— To F—L. IL k 1 PJ71 'Ij Lit 1E.3 I t-JIpc J `)LID 12 'n-tk, H E.A R_ ----------------- 6LY C0 10_ IL -LI1 kl CR J1 AL >C)4&-b 4 P\j c C. Z, H a C. 0 Z-o cc c, A L -LS00 AtQK \A/ i as E lz�cf P) -OL, b L Wi, N, E4JAL --D C —A I Jk 6 4'' G 0 4 C) r,a (j WjlfPIPE SIZE "JI-TH INSIblE PLI)mbi(JI-v, NO I`,A SLr, MIA 71 1131, ,J 1�,_ : IG A T Al I F--'- F_ 1, L JVUU, A-, MAtJ- J j, F_ I k