HomeMy WebLinkAboutSAN-2017-302 034-1037-30-075"A 91wa°t7 -30a
ST. CROIX COUNTY WISCONSIN
County Sanitary Permit Application PLANNING &ZONING DEPARTMENT
In accord with Chapert 12 St. Croix County Sanitary Ordinance ST. CROIX COUNTY GOVERNMENT CENTER
♦nal intonnation you provide may be used for secondary purposes
t 10t Carmichael Road
(Privacy Law. S. 15.04(1)(m)j Hudson, WI 54016-7710
(715)386-4680 Fax (715)386-4686
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A ach complete plans for th EN %2 x 11��
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� - Location:
1. Applicat' mation - Please Print all Information
Property wrier Name S(rJ 1(4 .5l.J t4, Sec
N, R /S 41 (o
p rJE ARD C� Lot Number Block Number
Property Owner's Mailing Address ` 3
,1 Sr Subdivision Name or GSM Number
City, State Zip Code Phone Nurner
78154
�1LE'n/GJooO C.rr �-r S p�;ltage [�TOWri of
II Type of Building: (check one) r�
I i or 2 Family Dwelling No. of Bedrooms: pt£ w�NEO SPA/al F/E60
❑ Pubhc/Commercial (describe use): Nearest Road
❑ State-owned 9iS W 90 r� Sr. 30
II. Type of Permit: (Check only one box on line Check box e it app ow
) parcel Tax Numbers) /& .7c/ I) ? S
•
1_❑ Repair
2. Reconnection EINon it bi C] Rejuvenation 03 y- �0 3 7- O - 6 7S�
A) .it o.
Date Issued _
Permit Number
B) y79Y8 /
State Sanitary Permit was previously issu
IV. Type of POWT System: (Check all that apply) Mound 5 24 in. suitable soil ❑ Mound A+O
❑ Non -pressurized In -ground � Mound ? 24 in. suitable soil ❑
❑ Peat Filter ❑ Drip Line
❑ Sand Filter El Constructed Wetland ❑ Holding Tank ❑ Other
❑ Single Pass
❑ Pressurized in -ground ❑ At -grade ❑ Aerobic Treatment Unit ❑Recirculating
V. Dispersal/Treatment Area Information
1. Design Flow (gpd) 2 Dispersal Area 3. Dispersalq Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation Elevation 7 Final Grade
(Min.Cmch)
Required Proposed (Gals.lday/sq.ft.)
Manufacturer Prefab Site Con- Steel Fiber- Plastic
VI. Tank Information Capaicty in Gallons Total # of Concrete strutted glass
New Existing Gallons Tanks
Tanks Tanks ❑ ❑
doe �.e /Loe 1 l✓/E6Ea Lo�lcaeri 2r ❑ ❑ ❑
,0,Ny,A00 A.JK a
f� ❑
VII. Responsibility Statement
I. nctionlrejuvenationiinstallalion of non -plumbing for the POWTS shown on the atta
the undersigned, assume responsibility for repair;reconneched plans.
license is not required for terralift repair or the installation of non -plumbing sanitation system. MP/ No. Business Phone Number
Plumber's Name (print) Plumber' i nature o to p Y 3 3 IV
Plumber's Address (Street, City State, Code) uQA.1D �✓ 1-
/l G a? 8 �r r
VIll. County Use Only Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps)
Disapproved
❑ Approved Owner Given Initial Adverse
Determination
IX. Conditions of Approval/Reasons for Disapproval:
Rev. 8/05
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Privete On5i to Wast ew atC��' T rea ment SySterl-i
Index and 'I hde. Pao,--
ProjectNaine: S �EdE / c 1i,fA4 so,✓ -- SNE�ArNc6a�
Owner's Name:
" " -
-Owner's Address:
1 / 55 ,1 90 rL1 Sr.
G7LENWQeO (:fl r W
715yyr- osS'G
Legal Description:
.54./ S J4
Vlunicipaliiy:
T_awn, Vie. C4y01 SP��rcFi��o
County:
Subdivision Name:
7,? -
Lot Number. _
_ 31ork Number:
Parcel I.D. N cmber:
0,3 S/- /a - 30 - a 74-
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Page 9
Name of Designer: �% a •� t�cE License Nianber:
�,r Date: 9-//- ao/7
S;g�aiule_
Deigned
suant to the Following pOW-TS Component Manual and o 81-95:
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4" CAST -A -SEAL
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FILTER OR BAFFLE
TOP VIEW
T INLET _ OUTLET
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W320—MR
TANK SPECIFICATIONS —
DIMENSIONS:
WALL: 3"
BOTTOM: 3"
COVER: 4"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 58" O.D.
LENGTH: 50" O.D.
WIDTH: 50" O.D.
BELOW INLET: 46 1 /2" O.D.
LIQUID LEVEL: 43"
WEIGHT: 3,880 LBS.
4" CAST -A -SEAL INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
GASKET, CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 8.0 GAL/IN
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
LOADING DESIGN: 8' 0" UNSATURATED SOIL
TANK CAN BE USED AS:
SEPTIC/ HOLDING/ PUMP OR SIPHON
COVER: MIX DESIGN #8 NO FIBER)
TANK: MIX DESIGN #10 STRUCTURAL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
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SHEET NO.
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Waste -Mate
Considered one ofAmerica's most popular sewage ejectors,
this robust family of pumps is known for reliability,
durability and performance. These pumps are industry -
proven, built of cast iron with stainless steel hardware.
The integral, preset snap- action float switch is engineered
for one million mechanical starts. The heat -dissipating
cast iron body with powder coated epoxy finish provides
maximum pumping performance under the most extreme
conditions. With a cool run design, the hermetically sealed,
oil -filled motor and non -clogging vortex impeller add LIP
to a long-lasting, trouble -free product.
APPLICATIONS:
Residential and light commercial sewage and dewaterina
• New construction
• Wastewater,, lift stations
S
SPECIFICATIONS:
• 2" NPT discharge (3" male thread available)
• 4/10 HP through 1 HP
• Available in automatic or nonautomatic
• 2" (50 mm) spherical solids capacity with vortex
thermoplastic impeller (cast iron available)
Models 266, 267 & 268 available in 3 phase voltages
For more information, see Technical Data Sheets
FM2788, FM2789, FM2790
For complete product
information, visit:
cn
l- w PUMP PERFORMANCE CURVE
MODEL 264/266/267/268/270
30
$1 25
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= 6 20
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GALLONS
wwwzoeller.com LITERS 0 100 200 300 400 500
FLOW PER MINUTE ,tZf ;-
(V All rights reserved. ZOELLER PUMP CO. 1 502-778-2731 1 800-928-7867 1 www.zoetier.com ' I
V 2� 5 v F 2 2y STATE BAR OF WISCONSIN FORM I -2000
!� i ,y I WARRANTY DEED
Document Number
Tjhitq Deed, Dade betoWebP Theodore E . Bergum and
S!%irl!i y' A7 Bercrum, husband and wife
Grantor,
and Stephen D. Richardson, a single person
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of
Wisconsin (the "Property") (if more space is needed, please attach addendum):
Part of the West One-half (Wlt) of the Northwest
Quarter (NW'n) of the Southwest Quarter (SW14) and
Part of the West One-half (FPi) of the Southwest
Quarter (SW4) of the Southwest Quarter (SW'i) of
Section Sixteen (16), Township Twenty-nine (29)
North, Range Fifteen (15) West, TOWN OF SPRINGFIELD,
St. Croix County, Wisconsin described as follows:
Lot Three (3) of Certified Survey Map filed October
26, 2004, in Vol. 19, Page 4867, Doc. No. 778156.
74Ba-7
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO.. WI
RECEIVED FOR RECORD
03/03/2005 10:00AN
WARRANTY DEED
EXEMPT #
REC FEE: 11.00
TRANS FEE: 132.00
COPY FEE:
CC FEE:
PAGES: 1
Recording Area
Name and Return Address
Stephen D. Richardson
206 Wisconsin Street N., #103
Hudson, WI 54016
034-1037-60-000 (pt)
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and roadways of record.
Dated this c $74 day of 2 005
* *Theodore E. Bed
*
AUTHENTICATION
Signature(s)
authenticated this day of
,E}V�L a_A , 7-,
* Shirley ergtim
ACKNOWLEDGMENT
STATE OF WISCONSIN )
ss.
't GtO County.
Personally came before me they of
ShirleyA. Ber
TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife
(If not, to me�goin�
be the person i e ctylled
authorized by §706.06, Wis. Stats.) the for dhe•sh
THIS INSTRUMENT WAS DRAFTED BY ,
* 1 L,2S
Michael H. Forecki, Attorney Not Wu �WWWR H
Eau Claire Wisconsin Y . rE '> tfln12CUWt, state expiration date:
(Signatures may be authenticated or acknowlcd ed. Both are not necessary.)^r
Names of persons signing in any capacity must be typed or printed below their signature.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000
Attorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1. Eau Claire W1 54701-7928
Phone: (715) 835-3029 Fax: (715) 835-4112 Marge Stafford T4399185 ZFX
Produced with ZipForm— by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383-9805 www.zioform.com
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-PRELIMINARY DRAWINGS ONLY . NOT FOR CONSTRUCTION USE*
SCALE IS 1/2 AS SHOWN IF PRINTED ON IIX17 PAPER
FRONT ELEVATION
SCALE:I w=vo.
NOTE.
UNLESS OTHERWISE NOTED
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