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Parcel M 24.31.18.408A3 038 - TOWN OF STAR PRAIRIE Current X 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 O - ZEHM, DELL R DELL R ZEHM C - NEW RICHMOND AIRPORT #64 NEW RICHMOND AIRPORT #64 2060 HWY 65 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 5.540 Plat: N/A-NOT AVAILABLE SEC 24 T31 N R1 8W 5.68A SE NE BEING LOT 3 Block/Condo Bldg: CSM 4/992 EXC PT/HWY PROJ 8936-06-21 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 06/19/2003 726606 2282/350 TD 04/02/2001 641815 1611/386 QC 07/23/1997 1165/511 WD 07/23/1997 793/352 more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 175506 1,077,300 Valuations: Last Changed: 06/27/2006 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 5.540 49,700 902,400 952,100 NO 02 Totals for 2006: General Property 5.540 49,700 902,400 952,100 Woodland 0.000 0 0 Totals for 2005: General Property 5.540 49,700 893,400 943,100 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 C 0 N (D n WI rt O (D \ / 3 G> ' -00 F3 g 0 C N' G► 0 rr 3 (O O O N N QN Y/ CL _ O a ca 7 N N ED O SW S C m@ @ (D N - -00 O o 7 q N. I(D D- .O. o Z CFJ rn s rn N (n 4 z C° rn rn - 12 PG 33f2 41411 i(37' ,es, :1 t]IX7 ~rp_ s h CSV V A 12 PG 3274 A -A CD -4 t ,y X1 OD 00 cc) S P O OD CD A 11 r (`~F i gi h`Ml ~ I CS ST. k- ROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 - (715) 386-4680 FAX (715) 386-4686 July 30, 2001 File Ref: 16-01 Dell Zehm St. Croix Harley Davidson 2060 STH 65N New Richmond, WI 54017 Re: Board of Adjustment Decision Dear Mr. Zehm: The St. Croix County Board of Adjustment has reviewed your request for a special exception request to expand your business and has approved your request with conditions. The enclosed document is the formal decision regarding your application. Should you have any questions or concerns, please do not hesitate in contacting me. Since y, Steve Fisher Zoning Director dz Enclosure cc: Clerk - Town of Star Prairie w/enclosure Kellison Co. w/ enclosure FINDINGS, CONCLUSIONS, AND DECISION OF THE ZONING BOARD OF ADJUSTMENT ST. CROIX COUNTY, WISCONSIN Case: 16-01 Complete Application Received: March 8, 2001 Hearing Notice Publication: Weeks of May 7 and 14, 2001 Hearing Date: May 24, 2001 FINDINGS OF FACT AND CONCLUSIONS OF LAW Having heard all the testimony, considered the entire record herein, and conducted an on-site inspection, the Board finds the following facts: 1. The applicant is Dell Zehm, who is the owner of St. Croix Harley Davidson at 2060 STH 65 N. New Richmond, WI 54017. 2. The applicant filed with the Zoning Office an application for a special exception to expand his existing business in the Commercial District pursuant to Section 17.18(1). 3. The property is located in the SE '/4 of the NE '/4 of Section 24, T31 N-R1 8W,Town of Star Prairie, St. Croix County, Wisconsin. 4. The Town of Star Prairie supports the applicant's request. 5. The Board of Adjustment found that this special exception application conl-orms with the requirements for granting a special exception under Section 17.18(1). DECISION On the basis of the above Findings of Fact, Conclusions of Law, and the record herein, the Board approved the applicant's request for a special exception for an expansion to an existing commercial business based on the following findings: 1. The plans for the project were designed by a professional engineer. 2. The request complies with the standards of the ordinance. 3. The plans have been approved by the Land and Water Conservation Department. 4. The Town of Star Prairie has recommended approval of the request. 5. There have been no complaints in the past on this business. 6. There were no objections to the request. 7. The spirit and intent of the ordinance will be met. With the following conditions: 1. This special exception allows St. Croix Harley Davidson to expand its current facility to include a repair and service department. 2. The applicant shall continue to comply with the terms of the previous special exception decision dated June 16, 1997. 3. The applicant shall provide the County with a screening plan for the west property line, to include staggered pine seedlings, if such a plan is allowed due to the proximity to the airport. Planting/screening plans to be approved by the County and planted within one year of this Decision. Applicant is to speak with airport officials to find out the regulations regarding this issue, and notify the Zoning Office if there is a problem. 4. Outdoor storage is not permitted. 5. Any proposed lighting is to be illuminated downward to eliminate light pollution onto neighboring properties. 6. The applicant must provide the Zoning Office with an as-built that is signed and sealed by a professional registered engineer, verifying that the storm water management pond was constructed as designed and approved by the St. Croix County Land and Water Conservation Department. 7. The storm water management pond must be constructed, seeded, and mulched per approved plan by July 15, 2001. 8. The applicant shall receive approval for the building plans from the Wisconsin Department of Commerce. Applicant shall submit a copy of the state approved building plans to the Zoning Office prior to commencing construction. 9. The applicant shall provide a hard surface (asphalt/concrete) on all interior-driving areas within six months of the completion of the project. 10. One (1) sign is allowed with total signage area not to exceed 100 square feet. This sign must be located a minimum of 10 feet from all property lines. Any other signage must be approved by the Zoning Department and must strictly adhere to the St. Croix County Signage Ordinance. 11. Applicant to maintain a minimum of one parking space for each two employees and one parking space for each 200 square feet of retail ground floor area plus at least one additional parking space for each 500 square feet of upper floor area. (Note: 37 parking stalls are required by ordinance and the applicant will have 85 parking stalls when the project is completed.) 12. The applicant shall allow free and unlimited access to the project site at any reasonable time to any Zoning Office employee who is overseeing the project construction, operation, or maintenance. 13. The applicant shall secure all necessary town approvals, including compliance with any building code issues. 14. The Zoning Office is to be notified at the start and the finish of the project. 15. The applicant shall have one (1) year from the issuance of the Special Exception permit to act on the Special Exception permit. Failure to commence business operation in this period shall result in the expiration of this Special Exception permit. If the Special Exception permit expires, the applicant will be required to secure a new Special Exception permit before commencing the business operation. 16. Any minor changes (or additions) in expansion of the project, including the facility plan, signage, lighting, grading, and parking, shall require review and approval by the Zoning Director. Any major change and/or addition to the originally approved plan will go through the Special Exception approval process, where applicable, as stated in the ordinance. 17. Accepting this decision means that the applicant has read, understands, and agrees to all conditions of this decision. The following vote was taken to approve: Peterson, yes; King, yes; Rose, yes; Chairperson Speer, yes. Motion carried. 2 APPEAL RIGHTS Any person aggrieved by this decision may file an appeal in St. Croix County circuit court within 30 days after the filing date shown below, pursuant to sec. 59.694(10), Wisconsin Statutes. St. Croix County assumes no responsibility for action taken in reliance on this decision prior to the expiration of the appeal period. St. Croix County does not certify that the identity of all persons legally entitled to notice of the Board of Adjustment proceedings, which resulted in this decision, was provided to the County. If an appeal is taken of this decision, it is the responsibility of the appellant to submit at his/her expense a transcript of the Board of Adjustment proceedings to the circuit court, which is available from Northwestern Court Reporters, Hudson, Wisconsin. It is the responsibility of the Board of Adjustment to submit its record (file) of this matter to the circuit court. ZONING BOARD OF ADJUSTMENT Sig mod: Chairp on Attest Dated: 07/30/01 Zoning Director Filed: 07/30/01 3 1 ~ J Wisconsin Department of Commerce SQlL VALUATION REPORT Page of tl4 Won of Safety and Buildings C iniaccordance ¢ hf ~5, Wis. Adm. Code County Attach complete site plan on paper not le s than 8 1/2 x ~1 imps irra~~ i~ Piatimu> t include, but not limited to: vertical and ho Q4tal refeFerxk p'bint'IBM), dir§ctl percent slope, scale or dimensions, north itow, and local," t~ T;r{ilttance to~tea~ t road. Parcel ! 0 ✓ 3 ~ _ / j7 r ` D ~ Please print jgfofrrfatJdi?UN FFt(k Reviewed by Date Persons] information you provide may be used for iee6od". pUrposes (Privacy Low, s. 1V04 (1) (m)). Property Owner i Property Location Govt. Lot j~ 1!4 /::j l4 Sc2Y T N R VE {oOQ Property Owner's Mailing Address , Lot # Block # Subd. Name or CSN)# Y State Zip ode e Number ❑ City ❑ Village 'Ej Town Nearest Road W 17 1 ~2j-k2-X/i "09' S f f w ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate f GPD Replacement ,Public or mmeraa) -Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: 1 Boring # ❑ Boring ® Pit Ground surface eievXS ft. Depth to limiting factor/"0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 /V1 10. (y '!0> . z. P-1Barir~p # ❑ one 2 ❑ Pit Ground surface elev. ~11 ft, Depth to limiting factor/ / . in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRF In. Munsell tau. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 Effluent #1 = BOD > 30 1220 nVL and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) a676d Address Date Evaluation Conducted Telephone Number ova 81 /9 z A/ l - syal7 7,, =aY6-yr~ Property Owner - Parcel ID # Page of aBoring # ❑ Ground surface elev. ' ft. Depth to limiting factor in. Sal Application Rate pit ~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. MunseN Qu. $z. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 12-7 C J r ( S r, V 11 Z El Boring # ❑ BOf'~ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth . Dominant Color . Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Bor(ng F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. • Soil plication Rale Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff In. Muxtseli Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 '01102 Eff uaint #1 = BWO > 30 5 220 mg A- and TSS >30 < 150 mgit- ' Effluent #2 = BODS _ 30 rng/L and TSS < 30 mg/L The Department of Cotntnerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. aeo.aaao ttt.aroo) coil Test Plot Plan')/ Project Name Dell Zehm Sha i d Address 2060 State Highway 65 New Richmond Wi 54017 CO M #226900 Lot Subdivision Date 412101 SE 1 /4 NE 1/4S 24 T 31 N/R18 W Township Star Prairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 90.6 *HRP Same as Benchmark Alt. BM Base of Siding @a 99.2' Highway 65 Description of Building and future Buildings: ' Existing Existing 50 Shop/Retail Shop/Retail Retail Store Area: Store Store 7200 ft^2 and B-3 Alt. 6000 ft^2 B.M. ?'3 Employees: 25' ~ M49 9<30 all shifts Floor Drains: 3 total 0' 15Total GPD: Pro Addition Future Pro 1160 5' B-2 Shop/Retail Store 96' Slope 18' X 80' ainfield 0' JU 25' B-1 5' Vent 95' 0 99y % Ob'L5C 3„l5,titi,00S I ~ \ f, a6 x: I 1 9 i 9 - a 1 32'-0" ``74'-10" 51'-9 IIA6 ' - I X m7 I N .-cy I 9.0 I~D ` I (TYP.) : ) I N n N 1 1' N / - m JI r~ f 9y I ~ i \\:N czt ~f OX I IOX I p i1 I \ 0 \ J 1 I _ ~1I ~i t II \ J-_ I i r ~ It (t~ X C I ~ N / I ~1 J N ~ ~ ~ ~ tl e ~y ~ ! 1~ ! X N I// m - 3 D ~ ~ 1 to ~ b 6 r ' ~ I ~ 8•_0° 1 90,-0.. 60'•0" 5'1'-91 I i , Z EXIST x * C I oQ n \ ~w I N ~ / ~ ^-S Y" II I ~ r i I IFT .....1 ,1 l S.T.H. "651, tabbies' x NOT TO BE USED R~ FOR CONSTRUCTION s > ST- CROIX HA ADDITION SITE PLANS >a NEW RICHMOND, WISCONSIN I.-" DRAUN BY: STEVE OTTO REVISION vs 11 11 11 11 ~ 04 _ s KELLISON COMPANY JAMIE ANDER50N~x~ 11300 HUDSON BLVD. N. SUITE 200 OAKDALE , MN 55125 CHECKED BY: KEvIN ST. CROIX COUNTY WISCONSIN - _ ti ZONING OFFICE I p N p M N■ O A NNNN6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 June 16, 1997 File Ref: 39-97 Dell R. and Corrine R. Zehm 764 240th Street Osceola, WI 54020 Re: Board of Adjustment Decision Dear Mr. and Mrs. Zehm: The St. Croix County Board of Adjustment has reviewed your application for a special exception request for a commercial district permit and has approved your application. The enclosed document is the formal decision regarding your application. Should you have any questions or concerns, please do not hesitate in contacting me. Very truly yours, ~)7' 'k ~ David Dacquisto Zoning Director dl Enclosure CC: Ruth A. Johnson, Clerk - Town of Star Prairie Kellison Company FINDINGS, CONCLUSIONS, AND DECISION OF THE ZONING BOARD OF ADJUSTMENT ST. CROIX COUNTY, WISCONSIN Case: 39-97 Complete Application Received: May 1, 1997 Hearing Notice Publication: Weeks of May 5 and May 12, 1997 Hearing Date: May 22, 1997 FINDINGS OF FACT AND CONCLUSIONS OF LAW Having heard all the testimony, considered the entire record herein, and conducted an on-site inspection, the Board finds the following facts: 1. The applicant is Kellison Company whose address is 3880 Laverne Ave. N., Lake Elmo, Minnesota 55042. 2. The applicant on May 1, 1997, filed with the Zoning Office an application for a special exception request for a commercial district permit. 3. Dell R. and Corrine R. Zehm are the owners of the property which is the subject of the application and is located in the SE1/4 of the NE 1/4, Section 24, T31, R18 in the Town of Star Prairie, St. Croix County, Wisconsin. 4. The subject property is presently used for retail/ service 5. Special Exception request is for a commercial district permit under Section 17.18(1)(a). A special exception is required where there is any commercial district permit. 6. The following exhibits were presented: Exhibit 1: Town of Star Prairie letter stating no objections to request Exhibit 2: Copy of deed to property Exhibit 3: Plans for expansion with revision date of 4/24/97 Exhibit 4: Letter from steel soil service on existing soil system. 7. Dell Zehm, owner, and Peter Vanasse, applicant, being duly sworn, explained that Harley Davidson is a growing company and they are asking all dealers to expand. Harley Davidson is requiring that Zehm have a 14,000 square foot building, including a 7200 square foot showroom. Vanasse explained that setbacks are no problem as they are not building any closer to the road. The existing parking lot is paved and they will pave the new parking lot according to county standards. They will be sending the county a copy of the state approved plans. They are also looking into the septic system to see if it is adequate. 8. Under Section 17.18(1)(a) an application may be made for a special exception for a commercial district. 9. The Board of Adjustment finds that this special exception application conforms with the requirements for granting a special exception under 17.18(1)(a). DECISION On the basis of the above Findings of Fact, Conclusions of Law, and the record herein, the Board approved the applicant's request for a special exception for a commercial district permit and has been approved on the following vote: N. Golz Yes J. Neumann Yes A. Jensen Yes T. Filipiak Yes Chairman Bradley Yes with the following conditions: 1) State plans to be submitted to the Zoning office before start of project. 2) Parking area to be paved. 3) Septic system to be upgraded as necessary 4) Zoning Office to be notified at start and completion of project. APPEAL RIGHTS Any person aggrieved by this decision may file an appeal in St. Croix County circuit court within 30 days after the filing date shown below, pursuant to sec. 59.694(10), Wisconsin Statutes. St. Croix County assumes no responsibility for action taken in reliance on this decision prior to the expiration of the appeal period. St. Croix County does not certify that the identity of all persons 2 legally entitled to notice of the Board of Adjustment proceedings which resulted in this decision was provided to the County. If an appeal is taken of this decision, it is the responsibility of the appellant to submit at his/her expense a transcript of the Board of Adjustment proceedings to the circuit court, which is available from Northwestern Court Reporters, Hudson, Wisconsin. It is the responsibility of the Board of Adjustment to submit its record (file) of this matter to the circuit court. ZONING BOARD OF ADJUSTMENT Signed lj~ Ch rperson Attest Da-441,~ Z'orii?lg Administrator Dated: 06/16/97 Filed: 06/16/97 i 3 d 3r 7 cr.'. AS BUILT SANITARY SYSTEM REPORT OWNER E J~, r/~ ~ isL~ TOWNSHIP SEC,2/T jN-RgW ADDRESS, ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LO SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 RHO yI EVERYTHING WITHIN 100 FEET OF SYSTEM is I di a e o th Arrow i - i SCAL BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: Liquid Capacity: ;r.~ SEPTIC TANK: Manufacturer: rte', ~c r,A L/.~~. Number of rings on cover Tank manhole cover elevation Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle- gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower bran name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of'manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits feet diameter feet liquid dept seepage pit inlet pipe-elevation bottom of seepage pit e evation feet. 11 SEEPAGE BED SIZE: number of lines width _1 jigth,~ the depth SEEPAGE TRENCH: width length PERCOLATION RATE=- AREA REQUIRED ARE AS BUILT L. A INSPECTOR DATED d ~ZPLUMBER 0 JOB ; T~ ' LICENSE NUMBER __1 . RI 1 01 1N`;Vl CI ION INUI VI ON AI ';I (V AGI SVS I I M S~IViI la)I11 I'r~Irnl f Srrlrl~ SvI)IIr, j'r~ ,Ai511~~~~ TuwrlAIt il~ CnI~~ r Couv1ll I )1 Scc.t~un 1_u1 N Sit bdty fn 1 I'I It' IANK 1 > yaYYane Nllmbeif oO corn1)atitrnerlt,5 f of c OIUIn: wcee Z 120 eov 114.gitwa teh IMI'IN(: CIIAM81 R Pump Manu6actun-en Mudek Nurnbv~I 11)1NG IANK ~I 'c yaXYonA Numbers o6 CorrlpaAtmevn-t6 f ' t l r n l ' At aif m if A tvm fI two O1„rn: woee 6a edt, ny_ - 12~ Ato1rc Hi911waten VI ION S11I h;cd ~11 vkIc(1 t(Irl c li It ril tooYY Ru-i edi nq - t2 n v 114 ghwa tc )1 111)N ':III OIMI NS IONS UI It t11 ( f 1vncif f (S t Rv(I it plc l ait vit ~ I r Icvi ylIf vach Yini> - # Dvptll u~ hoch bvkuw tiYv 1v1 r- i NIIrn1)r.'I P<IN vA Depth a ~j hOCI2 ouch 1 i Yv v1 ) lu(~IY Ivn11th it Y(Yleh vP rtll 0 6v Yuw cln14dc ~1 tvr k. l~Inrv fit)twvvn YinvA SYupt I~~ tnencll.- in. 1,I„I 100 ! 1t11)v CuvvI1: I'al.rvh uh AI~Iaw I I 111 MI N'. 10 N ti C's Nnrril~I~)I Ir~ 1)ctA GnavcY 14 Yld CSI to 11vA OIIt's (I' diamct(,n - ~t 0 ept(1 1)cCow irlYvt (~I Ir.1rll' lhAriZ1).t<orl a I v a ~t A~IC~I Icyui I ht C kJ I'1'ROVI U =t VA II ' 1915 I II C I I U DATI 19K 'I AtioN I OK) RI -It CTION 2 =115 cs~t~t,Q.~,p State and County State Permit # PLB-67 Permit Application County Permit # Z/ County for Private Domestic Sewage Systems STATE APPROVAL REQUIRED *DENOTES ~ -1 ~ L 6 State Plan I.D Date Approval Received from State if Required o . # 0 C) A. OWNER OF PROPERTY Mailing Address: .1, T _34 N, R ollit) (o r) W L o t # - C i ty B. LOCATION: Section Subdivision Name, nearest road, lake or landmark Blk# Village 9 Township C. TYPE OF OCCUPANCY: *Commercial:::~ *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms -No. of Persons D. SEPTIC TANK CAPACITY 00 -Total gallons No. of tanks 1_Q HOLDING TANK CAPACITY -Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel - Fiberglass Other (specify) New Installation - A - Replacement Lift Pump Tank or Siphon Chamber-Total gallons Prefab concrete Poured-i n-Place- Other (Specify)- E . EFFLUENT DISPOSAL SYSTEM: Percolation Rate -Total Absorb ea__Lfk~sq. ft. Ar New. ;K Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. -Width- Depth-Tile clepthi_(typ) No. of Trenches- Seepage BecIL-VELength 77 ~F_Wiclth 41 Depth VO Tile depth (top)__Q(JZ_No. of Lines__3 Seepage Pit:-Inside diameter Liquid Depth-No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private 0 Joint El Community El Municipal 0 Owners name as I isted on E H 115 if other than present owner: 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 Soil Te5ter, NAME u. C. S. T. # 5.E:-5;J1_and other information obtained from (owner/builder). C, Plumber's Signature MP/MPRSW# Phone #Iky~ - , Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. J Do Not Write in Space Belo FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application 4 175 Fpes Paid: State County ~ate f Permit Issued/Rejected (da tL) 4,1 4r Issuing Agent Name Inspection Yes L,~~No State Valid# Date Ree'd 1. county (white '~copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, W1 53701 2. state (pink copS 4. plumber (canary copy) Revised Date 7/1/78 EH 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:'/4,AL-%, Section~--2-'i/-,TaN,R,dt (or) W, Township or Municipality AL&L!: Lot No. , Block No. County _ Subdivision Name Owner's/Buyers Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Be ooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW -1~-REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS - 77 PERCOLATION TESTS /9 -49 SOIL MAP SHEET NAME OF SOIL MAP UNIT 4- PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- J P- " if t I t 1 P- P_ P_ ip- i SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 7 t - - 1 to ALSY 2Z - B- B - ~ - - B- B- S B- - - S PLAN VIEW (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 horizontal and vertical reference points. Indicate slope. . £ t 5 e ~ N ~ E z 3 t /p . . _ 1 g \ 3 { I m m., ~ 13u•1~Js~°~ Vim. • E a 3 ~n I, the undersigend, 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) Certification No. - Address Name of installer if known " Copy A -Local Authority CST Signature k 81-00595 t G, Z;~`~~6+t ~ S, ,,rC r, f .~OJoD ~•''lit - ~s.Yahrc~'s v x C o o o a R l -slei 7-0 r,4 -at-7; s o7 x / a OS 'itlrJT u r© ;Fe ~b x , 03 sxs, C10 V- 7' Ac< ~Gv ,t~G 8~t Q C t • 74 MAN ° sa4 °,~G~ RACE IVF[1 o~QP G~~~~p MAR V41981 - V cv ZONING Yr- OFFICE AN J r.J , -2-244 LIZ CZ r d ~ y w 'gin o . by 4 i i c W_9 A ' ° Q M ~Y Plb 100a 102/78. of Wisconsin Detach And Return Upper State Portion ~ DI V ISON OF HEALTH Portion Of I 1 This C 1 orm With SECTION OF PLUMBING Correspondence AND FIRE PROTECTION SYSTEMS Any Return MAIL ADDRESS: P.O. BOX 309 J MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the plan review fee required is $ ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. ❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance. ❑ Plans being returned. ❑ Additional information required. SEE BELOW. 1. 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 stamped in accord with Section H 62.25(2) (a) Wisconsin Administrative Code. ❑ Affidavit enclosed. 11. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. 111. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot 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 if 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 certifiedsoil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tan`(<g---., 7J Profile of holding [aok. _1 Holding tank agreement signed by avvner and local unit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. Cress section of I+It pump tar+k showing pump(s) or siphon(s). V1. Systems In Fill (Fill ;nust be placed' Prior to plan submission) lJ Total area filled (fill to extend 20' beyond edge of trench before side slope begin). I_ Depth and type of fill. Copy of onsite report by county or district plumbing supervisor. U,-iigth of t r%e fill has heen in place. r Department of Industry, Labor & Human Relations Division of Safety & Bldgs. State of V1' 1SCOIISIII Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 Tel. 608-266-3815 INALL CORRESPONDENCE REFER TO PLAN { IDENTIFICATION NO. NAME OF PROJECT TYPE OF APPROVAL STREET AND NO. CITY OR TOWN COJdY STATE ZIP h~'\'~ r 'Ott OWNER ( ►~'R Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. n accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. 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. 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. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, James Sargent-Bureau Director PLANS REVIEWED BY: DATE: cc: DPS-OWS Owner DI LHR Local PI Plumber H & R (2) County Mfg. Rep. Bur. of Health Fac. & Services DI L H R SBD-6099 (N. 06/80) Rec. & Env. Services Plb. # 681 "0 0595 1 /78 PROJECT DETAIL DATA SHEET IA►~ ~49 NAME OF BUSINESS Li,vN lG SECT6OPd. LEGAL DESCRIPTION ~it-~-7CIlF1S OWNER K I= 491111 MAILING ADDRESS 4 4 c~,• ,r/i»c+,.a 74 1 ZIP S~, 7 ARCHITECT, ENGINEER, ADDRESS PLUMBER OR DESIGNER TELEPHONE NUMBER -o2zl /K 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building Addition Apartments and condominiums . . . . Number of bedrooms Assembly hall . Seating capacity ( ) Bar . . . . . . . . . . . . . . . . Seating capacity # of meals served ( ) Bowling alley . . . . . . . . . . . Number of lanes ( ) With bar ( ) Campground and camping resorts . . . Number of sewered sites Number of unsewered sites Total number of sites ( ) Camps . . . . . . . . . . . . . . . ( ) Day use only Number of persons ( ) Day and night Number of persons ( ) Catchbas i n . . . . . . . . . . . . . Number 6 J7 ( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of perso ~61' ( ) With kitchen Number of p s ( ) Dance hall . . . . . . . . . . . . . Number of persons AT? ( ) Dining hall . . . . . . . . . . . . Number of meals served daily ( ) Dog kennels . . . . . . . . . . . . Number of enclosures ( ) Drive-in restaurant . . . . . . . . Inside seating capacity Car-service Number of car spaces ;y ( ) Dump station . . . . . . . . . . . . Number of dump stations Employees ( total of all shifts) . . Number of employees ( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ( ) Mobile home parks . . . . . . . . . Number of sites ( ) Nursing homes . . . . . . . . . . . Number of beds ( ) Parks . . . . . . . . . . . . . . . Number of persons ( ) Toilets ( ) Showers ( ) Restaurant . . . . . . . . . . . Seating capacity ( ) Dishwasher and/or disposal? ( ) 24-Hour service bQ Retail store . . . . . . . . . . . . Total number of customers ( ) Schools . Number of classrooms Meals ( ) Showers ( ) Self service laundry . . . . . . . . Total number of machines ( ) Service station . . . . . . . . . . Number of cars served daily ( ) Swimming pool bathhouse . . . . . . Number of persons ( ) OTHER . . . (Specify) . . . . . . . COMPLETE OTHER SIDE 2. Indicate whether the following facilities are present. Floor drain yes no Number of drains Food waste grinder yes no Dishwasher yes no _ x Automatic clothes washer yes no Number of clothes washers 3. Septic tank capacity Holding tank capacity Septic or holding tank manufacturer T-'J4 f~ 4. SEEPAGE TRENCHES: total square feet width of trenches length of trenches depth number of trenches SEEPAGE BEDS: total square feet width length of bed 7, depth SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit Sigrrature of person")omple ing,form: FOR DEPARTMENTAL USE ONLY Address Z i p - Telephone Number Date - tro N Rte` RANU~jN t Ya8 _ INanS AN T M ~ y SION 4~ ~ NG~ SSE CaA~~Q~~ REPORT ON INSPECTION OF SANITARY PERMIT # 9V71 (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Time of Inspection ame, AaUr-ess,)Llcense NO. o ns a ing,Plumbe CL of Al~i (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodwaY? YES NO FloodPlain? YES NO DILHR-SBD-6095 N.05/80 Signature of Inspector: EH 115 Rev. 94 W, • REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION :41,t_'/4, Section's TN,R t (or) W, Township or Municipality Lot No. , Block No. County Subdivision Name Owner's/Buyers Name: Mailing Address: & '416"1 , TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEWX_REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS Q! S: - 20 PERCOLATION TESTS -,2<_- AC SOIL MAP SHEET_ ja NAME OF SOIL MAP UNIT .54n* 44-2 PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- / '7 r f 1 _3 r Jul 7 o(o P- I , P-, P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 1 B_ B- 94 IL 06 /1 Z,3 B- r &S4" g~u B- B- 7 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan t fie 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 horizontal and vertical reference points. Indicate slope. \ 4 A- IN, t dIGC~ari~,anots bldC. \ N I X \ JZ I I, the undersigend, 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 ho a are correct to the best of my knowledge and belief. I Name (print) Aza Certification No. Address Name of installer if known Copy A - Local Authority CST Signature