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HomeMy WebLinkAbout010-1010-80-000 -0 (D Q c aa) C? 0 M o ro Q o rL ~ ro I p C N o I E E I ry o O- E a) ,q ~ T y a c 2 O i _ a '0 ro 2 Q Z C w C LL C EO O O N ~ E ¢ oN U ro M Q a, (o W E U) O Z O d v H u a m o o z zt a~i z d c o N F- I'. N z 2 c`o ~ I c I ro o ¢ ¢ O ~ Z Z ' N z y G~ 7 R E I N R y - d 06 M O w +4) ro O 0 0 (D o o N m L ro o cocIL 2 a_ co E 0 0 0 z° ti a (L a a g E n n o V) a N U aWi o) o) > **ANA a0i I'D > 1) CD E L ° y m N `fy v ¢ is (0 m N N y O O N N C ` O C C 2 C E O 00 ~i 'j U y O QA 0 0 O¢ O O O C y U- 0 0 1 O coo Y y C E N p ro o CD F c (D • 7, ° r> E 0 y ca E Z Lr O t W N O y Cn o C4 ~d V ~ 3 a m a • a a '2 m a A 0 d I' O N V S s STC - 104 AS BUILT SANITARY SYSTEM REPORT kED i r OWNER i/1/ JUN 1997 COUNry ADDRESS .2? ZOMIN OFFjCE Z ~ SUBDIVISION / CSM# LOT # SECTION L/ T~N-Rj~W, Town of /Vj~,Q/~Lo/ ST. CROIIXX7C`OUUNNTY, WISCONSIN PLAN VIEW L SHOW EVE NG WITHIN 100 FEET OF SYSTEM Dy N ry goo 16, ~ 17', A Ye' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of'septic tank manhole cover. BENCHMARK: ALTERNATE BM: SK / PUMP CHAMBER / IN) INFORMATION Manufacturer: Liquid Capacity: O ~1 Setback from: Well House 6 Other Pump: Manufacturer e'O GA Model#,EZo size O Float seperation S Gallons/cycle: z~' Alarm Location SOIL ABSORPTION SYSTEM / Width' Length Number of trenches Distance & Direction to nearest prop. line: Setback from: we11:~o 1 House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold , Bottom of system 9 , Existing Grade gar 3~ Final grade DATE OF INSTALLATION: / PLUMBER ON JOB: ~/,'ty`~ LICENSE NUMBER: INSPECTOR: / 3/93:jt ov x Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: S Labor andHuman ngs Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar289342 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: WITTMER, KEVIN EMERALD CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: Grp ~d17 S Q s 010-1010-80-000 TANK INFORMATION ELEVATION DATA A9700158 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , " , `c.r, 4e ee. l_ 4 Benpchmark x,15/' led, ed' Dosing Z,-) C S Y60aU', Cg1 x.~,, 8. M Aerati n Bldg. Sewer 3S' Holding - St/ Inlet i 7 TAN SETBACK INFORMATION StOutlet 7 7S- TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet i Air Intake Septic >50, d- NA Dt Bottom Dosing r NA Ups L/ Man. Aeratio NA Dist. Pipe Holding Bot. System P P / SIPHON INFORMATION Final Grade Manufacturer Demand ~,0~ S, 9 Model Number GPM TDH Lift Friction System §0' TDH Ft Forcemain Length ,M' Dia. a'r Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT No_ Of Pits Inside Dia. Liquid Depth DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA urer: SETBACK INFORMATION Type 0 CHAMBE Mo e e ~ System: d _ > SD OR UNI DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 1q Length Dia- Length Dia. ~ Spacing q SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tf%OWCenter Bed/ Tse Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EMERALD 4.30.16.66A, SE, SE 2392 },70TH AVP,NUE ~6, 97 6% PS/ ►Cf 11Q Q~'. `LP~GI(! 3 cc^/1°2(1'1 41 ` Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: Safety and Buildings Division ~'■~■■■7 SANITARY PERMIT APPLICATION Bureau of Building Water Systems In accord with ILHR 8105, Wis. Adm. Code 201 E. Washington Ave. P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs R [Privacy Law, s. 15.04 (1) (m)). El Check it revision to previous application State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION - e p Property Owner Name - Property Location e V ;A( 1 /4 S0 1/4, S T 30 , N, R astir) W Property Owner's Mailing Address Lot Number Block Number al"__ 70 t- v*,;' Cit y, State `a( / r Zip Code Phone Number Subdivision Name or CSM Number EM e RX 4v L2 Acr-o/2 II. TYPE OF BUILDING: (check one) ❑ State Owned City Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms ❑ villa a / Town OF A/( /•/l~el? f- ~70f kye Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Ole-" /ale - ?a 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ❑ New 2. Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. Repair of an .....System ........System Tank Onl ❑ _____________Y______________ Existing System -Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 IV Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 4~99 3 9'-f- 3 2,iK / a2 961 9.5- Feet Feet VII. TANK Capacity INFORMATION In gallons Total # of r Prefab. Site Fiber- Ex per. New Existing Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 4/--e da- s ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber O0 ! / ® ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Si u/ re: (fyp Stamps) MP/ IV 10 'No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 17 ~~e O~ Lli% Ol IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) IgApproved ❑ Owner Given Initial 1!6 Surcharge Fee) Adverse Determination 1,/"/, X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 7 7-V 17 SBD-639B (R. 015/94) DISTRIBUTION: Original to COUnly, One copy To: Safety a Buildings Division, Owner, Plumber i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application roust include: 1. Property owner's name and mailing address. Provide the' legal description and parcel tax number(s), of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI_ Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, numb=r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 10 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; well,,; water mainsAvater .erv,ce,, strearns ar,d lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas and the locatior )f the building served; B) horizontal and vertical elevation reference points, C) complete specifications for pumps ar~.7 controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump man,ifa, surer; D) cross section of the soil absorption system if required by the county, E) soil test data on a 115 'orm; and F) x.11 sizing information. - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the _ e /V A-) J' - residence located at 1 V., Sec. LJ TAD N, R W, Town of St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No line. (if no, skip next Approximate volume or length of time: gallons minutes Capacity: Construction: Pr fab Concrete Steel Other Manufacturer (if known) : f, Age of Tank (if known): (Signature) (Name) Please Print PG an4 Ze 8 M /0 (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature MP/PlIft 6 9/1 Lain Department Industry, SOIL AND SITE EVALUATION REPORT Labor and Human n Relations Page ~ of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 5 a /4? C9 /X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION _ g© REVIEWED BY DATE PROPERTY OWNER: EE 2 s' 1/4,S T2e N ,R ~6 A W) yy PROPERTY OWNER':S MAILING ADDRESS BLOCK # UBD. NAME 0 CSM # 7© f1 CITY, STATE ZIP CODEV1 /I /1i MOWN NEAREST ROAD h Ld o /f v~ [ ] New Construction Use [ ] Residen tial / Number of bedrooms Re placement [ ]Addition to existing building p [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gd/ft2 trench, gpd/ft2 Absorption area required bed, ft2S trench, ft2 Maximum design loading rate bed, ft2 Recommended infiltration surface elevation(s) Tench, gpd/ft2 ark) Additional design / site considerations ft (as referred to site plan benchmark) Parent material C~ It G, Flood plain elevation, if applicable /y h ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem OS IOU OS ❑U 0S 2U ❑S ®U OS oU ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont Color Texture Consistence BRoots GPD/ft Gr. Sz. Sh. Bed T / / Cam' to t a rend' Ground elev. - ~ N~ Depth to limiting fact/or Remarks: Boring # Ground d ,4 /V,4 elev. Depth to ` limiting ' fact ; 4- C-r Remarks: tIX CST Name:-Please Print ~A tt'l, ,Sml Phone: O CL/V L", Address: nNurmnberr:~, Signature: Date: a OWNER M j?SOIL DESCRIPTION REPORT Page of~-~ PROPERTY PARCEL IA GPD/ft Depth Dominant Color Mottles Texture Structure Consistence BRoots Bed Trench Boring # Horizon in Munsell Qu. Sz. Corn. Color Gr. Sz. Sh. 1V,4 1y,4 3 Ground elev. q~~ ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ~ti: Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 1 I , J I I : - - - - 04 41 o _ %~-I - - - - - - - H•_ /adn _ e i Q s~ j I - L~ , 9~. 8 t'o'o - --I I - - - o I ~ - H _ _ I i ~ i II I , , i I_ 1 - I I_ I i ~ i I ! I I !I ~ II i - --I _ I - FE --I-- - ~ _ j -I I ~ I I - - --I - I i ~--t - I-- - - L4 - - - ~ I I - 1 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce May 23, 1997 15837 USH 63 Route 8, Box 8072 Hayward WI 54843 SMITH PL GALE SMITH 3228 HWY 170 GLENWOOD CITY WI 54013 RE: PLAN 597-20306 FEE RECEIVED: 180.00 WHITTMER, KEVIN SE,SE,4,30,16W TOWN OF EMERALD COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, e oy . Jansky Wastew er Specialist S or Section of Private Sewa (715) 726-2544 Friday's 3133R/ 1 SBD-7997 (R.11/96) t - Ij i e D a 7 h v Pii c" _ r 9f Df- RT EN f 0 iN US RY LA' OR AN HU A RE -All N I 1 I I Jt4 - - I i _ j1 II 1 ~Jf j- PYNI 1411V v~ - __07 Page'L Of Straw, Marsh Hay, Or Synthetic Coverinq~ 3 Distribution Pipe Sand P'm G Topsoll tzoy~- E t~ D b ~ •Slope 2-e Bed Of 12--2 i (Force Main I'IoY.ed Aggregate From [lump Layer Cross Section Of A Mound System Using ~ A Bed For -Fhe Absorption Arco G A Signed: t . License Number: j--1Q Date: t .li~3o ~t~•Zrs. -~1 of v0110r1 'Ipc \Force Main F A W ° _ _ From Pump z-22 Distribution Bed Of M Pipe Aggregote Observation Pipe Permanent Markers S97-20306- Plan View Of Mound Using A Bed For The Absorption Areo Page- 3 of Perforated Pipe Detail / End View FoRA~~d Pve p/Ne ,PfR Q `s{ A Force rain PVC Holes located on bottom of force main are equally spaced S9'7-20306 End cap Last hole should be next to end cap Distributation pipe layout P F t R - Invert Elevation of Laterals ~yFt Inches y S - Inches S igned ` XInches N P 5? C" Y~Inches Licenses Dates _ J _ A~ 17~ Hole Diameter Inches Lateral " ~2 Inches Manifold " - Inches Force Main " 2 Inches # of holes/pipe a:Z 4 . of ~ PAGE PUMP CHAMBER CROSS SECTION AIIUO SPECIFICATIONS ' ' VEAIT CAP " 4"C.I. VENT PIPE ' WEATNER PROOF APPROVED LOCKIMG ZS' FROM DOOR, JUIICTIOU BOX 1 MANHOLE COVER WINDOW OR FRESH 12"MID. AIR IIJTAKE ~ GRADE 1 411, `i" MIIJ. I 18"MIJJ. COgJDUIT 18"MIN. IIU LE T PROVIDE I - AIRTIGHT SEAL' I i I APFROVED JOINT A /c.l. PI~C 1* I-,*, C.T. PIFE wAPPRCNED I I ~ WIC.. FE EXTEMDING 3' EXTENDIU', C►JTO SOLID SOIL - I II ALARM B I I ONTO SOLID 5)1 I Jj C i o u CLEV. ~ I I ' F T. - I pump-, F2 306 CONCRETE BLOCK "sA AVo/ RISER EXIT PERMITTED GULIJ IF TAAJK MANUFACTURER HAS SUCH APPROVAL ded UNaleR TA IVA' SEPTIC E SPECIFICATIOPIS DOSE TANKS MANUFACTURER: e~? /f s I,JUMBER OF DOSES: PER DA-4 TAMK SIZE: ife a GALLOUS DOSE VOLUME ALARM MANUFACTURER: 0 INCLUDING BACKFLOW: GALL Of S MODEL NUMBER: 0 CAPACITIES: A= 22 INCHES OR GALLOA; i SWITCH TYPE: Al ~'ga l 7 INCHES OR PUMP MANUFACTURER: _ GD y d C = S INCHES OR ZZO GALIOI:i MODEL NUMBER: - 'Floc D=- INCHES OR Ll GALLORIS SWITCH TYPE: -S~r iuce'Me D p E; PUMP AND ALARM ARE TO BE MirvIMUM DISCHARGE RATe 2 GpM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEAI PUMP OFF AIJO DISTRIBUTIONpIPE,../_ FEET + 141MIMUM NETWORK SUPPLU • PRESSURE FEET + 0 FEET OF FORCE MAIN X I' 6 F/IOOFLFRICTION FA0TOR.-,/,J& FEET ` TOTAL O`JIJAMIC HEAD FEET _ IAITERNAL DIMEWSIONS; OF TAUK: LENGTH- ----_~WIDTH ~ ;LIQUID DEPTH SIGNED: LICEWSE DUMBER. V1iESTE3UI IBC SUPPLY INC. e. 12 DUSTRIAL RD. Goulds Oil, Wl 54016 Submersible Effluent Pump EP04 3871 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. • Farms Motor: Available for automatic and tic cover with integral handle • Heavy duty sump • EP04 Single phase: 0.4 HP, manual operation. Automatic and float switch attachment • Water transfer 115 or 230 V, 60 Hz, 1550 models include Mechanical points. • Dewatering RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EP04 built in overload with construction. • Solids handling capability: automatic reset. ■ EP04 Impeller: Thermo- 3/4" maximum. • Power cord: 10 foot plastic Semi-open design AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for • Total heads: up to 24 feet, with three prong grounding mechanical seal protection. SP Canadian Standards Association • Discharge size: 1112" NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end ilisted model numbers rotary/ceramic-stationary, three prong grounding plug improved performance. end in "F"or "AC".) BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104" F (40"C) continuous superior strength and 140°F (600C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET, stainless steel. 10 . S_.. 2-0.3 O 6 • Capable of running dry without damage to 9 ! i + so I j t-4-50PM components. --I Pump: EP05 8--+ • Solids handling capability: c zsl ~2.5FT a maximum. a 7 - • Capacities: up to 60 GPM. _ • Total heads: up to 31 feet. s 201 • Discharge size: 1'/2" NPT. a - Z - • Mechanical seal: carbon- s j i rotary/ceramic-stationary, ° BUNA-N elastomers. 4 • Temperature: ° epos' 3 10 104'F(400C)continuous 1401(60°C) intermittent. 2 EP04 i _ i 0 00 10 1 20 30 - ..__40 50 GPM 0 2 4 8 8 10 12 mom CAPACITY 091995 Goulds Pumps. Inc. Effective May, 1995 B3871 • S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property JA/ If .1 Location of property 1/4 S~_)= 1/4, Section T 2aN-R_ZA~_W Township _Fje? ? p L aj Mailing address 7a rX '4 a/ ILI J" Address of site 3 G~ I.7 y$? Subdivision name Lot no. Other homes on property? ---,?(_Yes No Previous owner of property C1- y L~ i' f- A:, Total size of property 0 -7 A G - Total size of parcel 3 4 C Date parcel was created Are all corners and lot lines identifiable? Yes __,X No Is this property being developed for (spec house) ? Yes _ ,~_No Volume and Page Number 021 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No.q6' , and that I (we) own the proposed site for the sewage disposal system orr Ie(we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the of ice of the County Register of Deeds as Document No. x ZSignnatuurr' of Applicant Co-Applicant X S- :;g F-- Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BNWK ft V / /V MAILING ADDRESS 17 2 - A y e PROPERTY ADDRESS 3 a -7 Q vit, (location of septic system) Please obtain from the Planning Dept. CITY/STATE 'e!5Nf C~ 17.4 /o/ Lv / !gyp/a PROPERTY LOCATION ~ 1/4, _S 1/4, Section , T_,~? 0 N-R~W TOWN OF ~/VJ e /qA L o% ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME _ , PAGE , LOT NUMBER - 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year ex 'ration date. X SIGNED: X DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-198211 TNIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED 543698 - L _ ~~nr ? =78*1"'F 1470 Shirley M._Wittmer for l .1..IRLEY WITMR..-.. ~I MAY 14 199G Kevin L. Wittmer quit-claims to - - - the following described real estate in .............St Croix County, State of Wisconsin: RETURN TO ii 11,1 o4CLl.~V ~ it Tax Parcel No:.._....... belOW The North Half of the Southeast Quarter; the East 32 rods of the Southeast Quarter of the Southeast Quarter excepting therefrom a parcel of property located in Southeast Quarter of Southeast Quarter of Section 4_30-16, described as follows- . Commencing 12 rods West from the Southeast corner of said forty acres, thence West 20 rods, thence North 16 rods, thence East 20 rods, thence South 16 rods to the point of beginning. The West 2 rods of the East 34 rods of the Southeast Quarter of the Southeast Quarter of Section 4, said 2 rods to be used for road way purposes to the North Half of the Southeast Quarter of Section 4. This deed is given pursuant to a judgment of divorce granted in St. Croix County Circuit Court on May 14, 1996; Case No. 95 FA 284. *010-1010-80, 010-1010-90, 010-1010-40, 010-1010-50 F This -S............. homestead property. (is) (is not)) Dated this -------•----....1.../-------------------•-- day of _play , 19...96-, - --------.(SEAL) :5 r V1. ` _(SEAL) * SHIRLEY M. WITTMER •-------------•------•----(SEAL) ---.......(SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s)/~- _o(,,~_eSTATE OF WISCONSIN 1 ST. CROIX ( ss. 5 '?"6'p - - ...County." This deed is given pursuant to a judgment of divorce granted j in St. Croix County Circuit Court on May 14, 1996; Case No. 95 FA 284. *010-1010-80, 010-1010-90, 010-1010-40, 010-1010-50 i! F This ..........iS homestead property. (is) (is not)) Dated this /Y Ma 9 6 day of .........._...---x............................................... ~ 19--••--~-• ' ..(SEAL) (SEAL) SHIRLEY M. WITTMER • ................(SEAL) ........(SEAL) r AUTHENTICATION f~ ACKNOWLEDGMENT Signature(s) _1//•.._0 f ~ _ STATE OF WISCONSIN ST. CROIX SS. County. authenticated this -l...day of 19- Personally came before me this ...day of ay..•-••-----------•--...-, 19..96 the above named Shirlex M....Wittmer TI E: EMB STATE B OF WISCONSIN (If not, authorized by § 706.06, is. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY REMINGTON LAW OFFICES t T. Remin on New-_Richmond,___• I 54017 St. Croix Notary Public --..County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 19.---•--••) QUIT CLAIM DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 3 - 1982 Milwaukee. Wis.