HomeMy WebLinkAbout022-1036-40-000
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
' Tabor anv4luman Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 289337
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
PHILLIPPS, ROBERT KINNICKINNIe
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
022-1036-40-000
TANK INFORMATION ELEVATION DATA A9700153 az
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic: c.1✓'' Benchmark
hosing S a°' 7569
Air Bldg. Sewer
Holding St/ Ht Inlet
T , SETBACK INFORMATION St/ Ht Outlet v'
Vent
TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet tr4
Ar
Septic
>/&u ?/leJ' /0 NA Dt Bottom
Dosing r ,2S I NA Header/Man.
Aera-tie"I NA Dist. Pipe
Holding Bot. System
PUMP/ SIP RMATION Final Grade
Manufacturer G _ Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss
F Head
orcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width-, Length No. Of T enches DPIT I E No. Of Pits Inside Dia uid Depth
DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACH anufacturer:
SETBACK CHA ER
INFORMATION Type O y Moe Number:
System: C"y\ky, _716Y >1(d OR" NIT
DISTRIBUTION SYSTEM
Header / Man' old i, Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length ~ Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sy Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Y No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: KINNICKINNIC 13.28.18.P202,NW,SW 339 SHERWOOD FOREST ROAD
Plan revision required? ❑ Yes P'NO - ?
Use other side for additional information.'
SBD-6710 (R 05191) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
1 r
a.
SANITARY PERMIT NUMBER:
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building water systems
201 E_ Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code 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 81/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
a V /
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
IPrivacy Law, s. 15.04 (1) (m)]. ('417115 State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Ow r Npmer J Property Location
ri~ ,l/',W`'n' Li I' / i'p S b~ 4 Y&j 1 /4, S T C2 R , N, E (or W
Property Owner's Mail dress Lot Number Block Number
3 evwaa r es 1,
y, State ~r Zip Code Ph e Number Subdivision Name or CSM Number
J/C 1, ? ( ,i~j 1 S
ll. TYPE F BUILDING: (check one) ❑ State Owned ❑ City r~,r ad G ~~s
❑ Public 1 or 2 Family Dwelling - No. of bedrooms ° Towwn ofIf1 t f L° o
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 13.3 9. / g. 9,0 / I?
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 online A.-Check box online B, if applicable)
A) 1. ❑ New 2. 1;.Z Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
-----System --------System Tank OnlyExisting 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 60 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank
127 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit fiv y a,~ powk P 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/da /sq. ft.) (Mi : i ch) 9'7A 1912, A> Elevation
d D add D~ P A*et Feet
VII. TANK Ca acit
in gallons Total # of Prefab. Site Fiber- plastic Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ El 0
Lift Pump Tank /Siphon Chamber ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage s s em shown on the attached plans.
P m er'sName:(Print) PI r'sSignature ( oStamps) MP RSWNo Business Phone umb r:
1pil 1a5- ff
Plumber's Address (Street, ity, te, Zi Code Q F t~
D s'y a
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps)
OApproved ❑ Owner Given Initial Surcharge t ee)
CTLyI~ ~
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
S80-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Sdfety & Buildings Divi ion, Owner, Plumber
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 systern, 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 must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material- Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill inflame, 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 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells, water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences,- friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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Wisconsin Department of Industry, SOIL AND S I ION REPORT Page \ of
Labor and Human Relations
I)Msiomof Safety & Buikfings in accor R 81.0 m. Code
b COUNTY
nno~nn
Attach complete site plan on paper not less than 81 inches i <3~Rkln mu de, but S`T" <'11M
not limited to vertical and horizontal reference point )?r dir and % of slope, r PARCEL I.D. #
dimensioned, north arrow, and location and distant to rear I?Xgd.r 1997 w O ZZ. - 3 - 4
APPLICANT INFORMATION-PLEASE PRINT Lk"I FOR REVIEWED BY DATE
PROPERTY OWNER: OCATION _
~Z-T 1 l,L P S N W 1/4 Sbv 1/4,S 13 T Z8 N,R L$ E ( W
PROPERTY OWNER'.S MAILING ADDRESS # BLOCK # SUBD. NAME OR CSM #
339 Sti~~►va,~ Foil Czb~ - - _
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DOWN NEAREST ROAD
2tu L ~t.S ~vl S~lozZ (BLS) L4 ZS_ stiisy E~~v►.~ `~h tt~►.~ ~C ao ;;Msr Rig
[ ] New Construction Use [A Residential /Number of bedrooms y [ ] Addition to existing buildatg
Replacement [ ] Public or commercial describe
Code derived daily flow oo gpd Recommended design loading rate - bed, gpCW - S trench, gVW
Absorption area required - bed, 1`12 trench, ft2 Maximum design loading rate - bed, gpd/ft2 S trench, gpd*
Recommended infiltration surface elevation(s) S p1m e- 3 ft (as referred to site plan benchmark)
Additional design / site considerations 'A bySEb "C1L ~ S - -H 'S' x 6 o t zK,G, 'n44 DAP WW' ~pwNSl SAE eD Gt-~
Parent material o s ov~M S"\,4 ov~wr} s Flood plain elevation, if applicable Iv . A, ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem 29S ❑ U ®S ❑ U OS ❑ U 10S ❑ U ❑ S ®U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft
in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed mr>ch
Z'FS~ 1^nv`Q7. oc.S - _ S
A<- ~o~tz-ylL{ G~s1 Zen Ab x voU->k cw - .5
_ S, s1 ~~sb1z- VK v~--
Ground 3 zt,-68 Sy(Z31 d- Gt^ m I -
elev.
q8.q ft
Depth to
limiting
factor
Remarks:
Boring #
.
0-9 t3 -t Z z lz s t 1 Z ~s~k w,-~H -s
rii
Z 2.~ ~o~ R Yl si 1 Z s~k m cfv ' s
WI U S
'~h _ •
3 L{-~ Z - S~1 R 31 6h S C
Ground
elev.
R9S
Depth to
limiting
factor
-Z 4
Remarks:
CST Name.-Please Print Phone:
Arthur L. We erer 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature-
w2 , . /~r`'L Date: CST Number M00576
-lt3
PROPERTY OWNER ~~t► ~.l P P S SOIL DESCRIPTION REPORT Page of
PARCELI.D. ~Z-Z - LO36 _~D
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trer
3 6_9 10- z/Z - Si ) z`E-Z~ w,'-~- rus
Ground ft- ~L - Gv a I t- 's b "o u `'I' - ~1 •5
elev.
Its-Z-1 ft.
Depth to
limiting
factor 6
~Y
Remarks:
Boring # _
o _ ~I tio\-t VL- 31z s 1 w, sbk m u ~k, , . S
Ground 3 3o~lb ~►-5 y RBI S- t Tz 3L 3 Q' ^ In v'~►..
elev. "Z
10 ~ ft. Uo~ B wt~S CJ 1
Depth to S U I L 3' - o_
Iimlting L S h1 G \ 1n Z t 1v
factor G Z
3o k
L
S~-L ti I N CO M a V t 1Z P(1 1"1
Remarks:
Boring #
13 L_JQ (ffR S v`, ~7- l l 13t_ ,,v X aO~v Se ~v
13-
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
13-
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
SCALE 1"= L4Cj
'
s ~iE1~.w o oD t=vR~s T R•u ~t-t5 ~ ° • l m i 'Co
2o~ T "I~-Lv0PS ~ovviV st
S-14
'L( Bb RBI ~u`+'tv~ 1 of -m-k- <FL . L8
C~he
'Cttuk.
G~2AVr.p ~ 7g s
/ zy - L-L loo : 0, Orv b~ Vri sit, 3 /y
bo' li~IPt• Pht PIPS W/LA
E-L -R
c.~ltvvt" EL. oSq. s.z eL sS - V,". 'one `coP
s b, 01= ~ Dl r!, cc~~2 Q03T,
~ q• S ~ F2N~
b0 •
5 to
Q.
(-Z (17
(715 ) 475-01 65 _ M00576
CST Signature Date Sign Telephone No. CST #
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
Labor and Human Relations
Division of Safety & BuikGngs in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
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. CJ Z-2 -
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION _
j3kEZ-r i;p~ NW 1/4 .Sbv 1/4,S Y3 T Z8 NR L$ E. ( W
PROPERTY OWNER`-.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
33 9 S vm-- ~Oob FoRes
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE 00WN NEAREST ROAD
2we'iL FAiULS, ul SgoZz, (-)W uzS-SZisy N-<,w6 v-%L Qijli .c mo ;;m5r tza
[ J New Construction Use [A Residential /Number of bedrooms y [ ] Additit n to existing building
(4 Replacement [ J Public or commercial describe
Code derived daily flow oo gpd Recommended design loading rate - bed, gVW " -S trerick gPdtft2
Absorption area required - bed, ft2 \1-0~3 trench, f12 Maximum design loading rate bed, gpd/(t2 -5 trench, gpolft2
Recommended infiltration surface elevation(s) S P1M E- -S It (as referred to site plan benchmark)
Additional design / site considerations y, b(sS'g-b `"tgK)ctms - ~N s' x 6 ci LD G , 'a4 DT& WT ~OwNS~AE Erb Ge-
Parent material t o s ovLR- S " q o~~wr~ s W Flood plain elevation, if applicable lv . Iq . ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN Flt HOLDING TANK
U = Unsuitable for stem ® S U ®S LI ®S U 54 S ❑ U S ®U S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Barry Roots Bed Trench
K 1 ~oti2 zLz - s~ z'~sl~ WhU~,.
x Z -z o~t R- l G~ s l Zwl S k wl U- >k cw - - 5
Ground 3 ?~,-68 Sy231 Gh m I -
elev.
CIE4 ft
Depth to
limiting
factor
Remarks: _
Boring #
_ o-`l 1,0~.~ zlZ ~ st 1 Z~-s~k mph a.
- • s
Z _ Z 2~L goy R- l S-1 Zr1 S ~k hi cu j
A s o s~ 4
3 Z _ S`i 2 31 Gl~ S C W1 U ~'h € 5
Ground
elev.
CH s ft
Depth to
limiting
factor
> 7Z4
Remarks:
TName:-Please Print Arthur L. We erer Phom.
715-425-0165
Addmss-
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
fie. 9-113 Date: y-Z 9-97 CSTNur M00576
PROPERTY OWNER
_ ~Lh~~PPS SOIL DESCRIPTION REPORT Page? of .3
PARCELI.D.e OZ-~ L~3(. -4D
Depth. Dominant Color Mottles Structure GPD/ft
Bring Horizon in "Munseli Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bourcl3ry Roots
Bed Trends
Z 9 Z~ t~`i'R.. sl Zm Selz rn `~'i- C►.`, - • 5 • ~
,Ground 3 Z6 ~.L Z'S yci Y! 6 _ ~s o ss -
fl-
,Gro ciP- ~L G a 1 0-3 b "VI U, - • S
Depth to,-.
limiting
factor 6 Y
I
i
Remarks:
Boring # _
o_ q Lo`ti ~z li s w► Sbk vn U 'F►- ~.k, . `l • S
y z. - , •S~ R alb : , - `~s o ~ ~ S - , s . b
Ground T?- in U 4,
-
elev. ; v
1. ft.
Depth to S v l L 3' o
limiting
factor lS `'t ►~10 l/v G kftz,
}Ju Z
Remarks:
Boring #
WIV S v~, tsl-L l3L ~vt r j S Aj FLA-P
P
[3.
Ground
elev. i
ft.
Depth to
limiting
factor
j
Remarks:
Boring #
Ground
elev..
ft.
77,
Depth to
limiting
factor
Remarks:
SBD-8330(R,05/92)
3
PLOT PLAN Page 3 of
SCALE 1"= L4 p '
CpVN `_~T M
SL -o -w . L-AAft
~o~~RT P~utA1~S ~ov.nv~
ntn moo. oZZ _ X036 - ~o - .
•4
0
x vE~.lr - ARY aKs1-(_ ? G ~2 t1"M7 EZ .
q BD R ~I a~`r tvw► of <'Z . L8 -
l'~pu8@ x k J Jl9NT - fl~`i.W~.LI- ~
GRAVn~ Ll 7$ S .
~1R$ 4
e o. ~n9 - LZ„ 100: O' 0N► 6" ti bit, 3 /y
a0 oo' ~~R• PvC PIPET w/~~Tt},
t1 ~i°t - s
C,pvR °i~l•o a.z Hoft. SS
S' o F 6 ~l i!. ca Q03T
qg.1,
0. S' Ft~~
s • /jj
bo
s !o ~
Q,
g.3
9~-113
(715 ) 4 .S-njfis _ 1400576
CST Signature Date Sign Telephone No.. CST
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 P rt Phl"PtI residence located at:
Section /3 , T-2~N, R/nW, Town of
f ~~~y1 i'0 Ay) I C 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 fr m absorption system?
_ Yes No (If no, skip next line)
Approximate volume or length of time: ® o gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacturer: (If known):
Age o Tank (If known):
')~elka S P 4244~
(Signature) (Name) Please print
(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
inspec ion opening over outlet baffl
I-V
Name b n Signature M /MPR 3~3 1
PAGE OF
' PUMP CHAMBER CROSS SECTIOW ARID SPECIFICATIOMS
VENT CAP
'1"C..I. VENT PIPE APPROVED LOCKIN
w WEATHER PROOF MANHOLE COVER W
JUNCTION BOX Wok r no"A ..et br.l
2: 25' FROM DOOR.
WIWDOW OR FRESH I
AIR INTAKE I
GRADE I y"MIN.
won
I
18"MIN.
COWDUIT
10"MIN.
PROVIDE
. INLET AIRTIGHT SEAL
-7 I I APPROVED JOINTS
APPROVED JOINT A I I ( W/C.I. PIPE
W/C.I. PIPE I I ( ALARM EXTENDING 3'
EXTENDING 3' I II ONTO SOLID SOIL
ONTO SOLID SOIL B I I
I ( ON
C i I
FT. PUMP--~
ELEV..__ OFF
r
0
CONCRETE BLOCK
0 3" APPNet
RISER EXIT PERMITTED Ly IF TANK MANUFACTURI;.R HAS SUCH APPROVAL 13¢pDIf•
SEPTIC E SPEGIFICATIOUS
DOSE vt4 W1°S C°Y'/~ 1p!'PC~kS NUMBER OF DOSES: PER DAU
TANK MANUFACTURCR:
TANK 51ZE: GALLOWS DOSE VOLUME J~
~o INCLUDING OACKFLOW: • O'-' GALLONS
AL_ ARM MANUFACTURER:
MODEL NUMBER: 1.4 CAPACITIES: A= 3F INCHES OR'_ GALLONS
SWITCH TYPE: g = 'r-pINCHES OR ~j•~ GALLONS
Gou 1~ C a -/P r IkiCHES OR Z1a5i)GALLONS
p_UMP MANUFACTURER: it 1e/' & MODEL NUMBER: Ds D•QINCHES OR ~ GALLONS
MOTE: PUMP AWD ALARM ARE TO BC /7.OOigi
SWITCH TYPE:
3 GPM INSTALLED ON SEPARATE CIRCUITS
~a
MtIJIMUM DISCHARGE RATE
VERTICAL DIFFERENCE bETWEEN PUMP OFF AND JDISTRIBUTION PIPE..3d3~ FEET
+ MINIMUM NETWORK SUPPLY PRESSURE ? 5 FEET
♦ dY EET OF FORCE MAIN X 0' r FYo fCFRICTION FACTOR..TFEET
TOTAL DtlWAM1C. HEAD = YT_& FEET ,
INTERNAL DIME.IJSIONS OF TANK: LEWGTH~.L;WIDTH*;LIQUID DEPTH
5IC714EO~. 2' A LICEWSE NUMBER: y f DATE:_r._.~:.:.
Bulletin CL21A
July 8, 1983
• For Homes GOULDS
• Farms '
• Trailer courts Model 3885
u.,► (Supersedes Model 3970)
• Motels -
• Schools • ' Submersible
• Hospitals Effluent Pumps
I7I11i.rM tin.
• Industry
• Effluent Systems Pump Specifications
Solids Handling Capability to Ye".
ti
anywhere effluent Discharge Size
or drainage must be ,'""k 2" NPT
„r Semi-Open Impeller
disposed of quickly,
3 vane de=lgn, threaded on shaft. Three phase
quietly and efficiently.:
units use -speller locknut to prevent accidental
back-off. Pump out vanes r ' ackside of impeller
for protection of mechanic. ?al.
Casing
_ Volute type for maximum efficiency.
Stainless Steel Fasteners
Heavy-Duty Solids Handling Series 300 stainless steel for corrosion
resistance.
Dependable Capability to 3/4" , • -Mechanical Seal
Ceramic vs. Carbon sealing faces. stainless steel
I) spring and Puna N elastomers.
;>ra _ Maslmurn Temperature
• ~ to i 160° F.
'h, 'h H.P. 60 Hz Capable of Running Dry
Single Phase 115, 230 Volt. without damage to components.
Motor Specifications
Motor Fully Submerged
1/2, V4, 1, 11h H.P. 60 HZ y in high grade turbino oil for permanent lubrica-
Sin le Phase 230 Volt. Three I lion of bearings and mechanical seal and
g efficient heat dissipation. Motor sealed from
'Phase 208-230,460 Volt. l environment by rugged cast iron enclosure.
"fJ Bearings
Heavy-duty all ball bearing construction.
Stainless Steel Shan
Series 300 stainless steel for corrosion
resistance. Threaded shaft.
Single Phase Units
All single phase units have built-in thermal
90 i e overload protection with automatic reset
Three Phasc Units
90 Overload protection in Starter unit 208:130 or
,a~ rw y r
1 ~t,1r 460 volts Threaded shall 60 Hz oirr;diun
~ Q ~r ~ ao
70 Power Cord
y~j g" " r ' , , te>~ r%` • Walm and oil resilt;uit Epoxy Seel on motor end
60 , 1•' arcs as a secondary moishne harper in case of
O f t y, a rY. .>Y, 1` ..a IS' ~iIT 4 •5 damage to witer jack0ing Corrosion rer,lslanl
W ll Y> ~ gland nut
150 ~ 6.' "l• •1 N f ` 1 ~ K .~r X A ~ .)fib
t? , r w Single Phase Units
i•• r+ rl i
40 11 P models equipped wilh L'• of 16 :1
SJTO with 3-prong grounding plug 1. 1 . H P
> N4 d> ) ' v rt " i w Is. 3 I models equipped with 15' of 14 ',1 ,.',TO power
O 30 cord
O 20 • t c.. i
SPECIFICATIONS ARE SUBJECT TO CHANGE
WITHOUT NOTICE.
10 R ~ ~ 'w
° 0 . 10 20 .30 40 50 60 70 90 90 100 110 120 rn GOU LDS PUMPS. INC.
GALLONS PER MINUTE U SEnECA FALLS NEW `M 13148
• r
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER w loi
MAILING ADDRESS 31/ ,A L P W 6o C~ GYes ~ ,
PROPERTY ADDRESS a'*"
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4, S~ 1/4, Section T a(20 N-R J4C > W
TOWN OF t[ h' 16 Loa I/I /C ST. CROIX COUNTY, WI
SUBDIVISION , LOT NUMBER
CERTIFIED SURVEY 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 expiration date.
SIGNED: W `
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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
Location of rope frty~l/45'/,J 1/4, Section ,QT o9t/ N-R ,R W
Township A c ~1 Mailing address
/ro Y G'S
Address of site
Subdivision name Lot no.
Other homes on property? Yes-No
Previous owner of property 6.6
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes ek No
Volume 'k)a ~ and Page Number 6 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
and that I (we) presently
Deeds as Document No. XIM
own the proposed site for the sewage disposal system or I (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 Q~ i~g/of the County Register of Deeds as Document No.
C~ .J
Signature of Applicant Co-Applicant
9 Date f icrnature nat-P nf q 1 rinatllYP
r . . DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 - 1M T"m m~ smc"Ev FOR RsCORDINe DATA
' WARRANTY DEED
44"M11
,rl., 1 ~8iA6(
This Deed, made between •-Leonard A...Phillipps .t"ym 0"01
-And..Lucile-.Philliggs....aka..Lucille..Phillippa....... sr. C-"x CO., WIL
_ %ea for R"wd Ms 20th
an . d.._....RC. er....L.... . .Phli . .].:t . .p...al1 ..d...............~QxR.......k1y. Ph Grantor, 1i.i3,Pps . _ac A.06 1? 85
husband and wife as ~oint tenants, , 11 6
12.30 P
_
Grantee,
Wltnesseth, That the said Grantor, for a valuable consideration......
conveys to Grantee the following described real eattte in .--.-..-St C?_'_oix____ RO ert L. PhilllDDS
County, state of Wisconsin: Route 12
- -
Nk of the SWk, Section 13, Township 28 North, Rimier Falls, Wl 54022 ,
Range 18 West, except part of NEk of SWk of Ta: Pw No:
Section 13-28-18 described as follows:
Commencing at Wk corner of said Section 13;
thence E on centerline of County Trunk Highway "J"; 1432.0 feet to
place of beginning; thence S 440.4 feet; thence E 264.0 feet; thence
N 440.0 feet; thence W 264.0 feet to place of beginning; also except
commencing at a point 5 rods E of the NW corner of NEk of SW34;
thence E 16 rods along the N line of said 40; thence S 10 rods on a
line parallel with the W line of said 40; thence W 16 rods on a line
parallel with the N line of said 40; thence N on a line parallel with
the W line of said 40 to the place of beginning, all in Section 13-28-18.
[This deed is in satisfaction of a land contract between the parties
recorded in Volume 514, page 538, as Document No. 323426.1
Grantors further relinquish the right to remove firewood reserved
in the above land contract.
This homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto beiomsing;
And--...Leonard__A. Phillipps_-and- Lucile..Phillipps.,.- aka Lucille.-Phillipps
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except municipal and
zoning ordinances, easements for public utilities, and building restric-
tions, if any,
and will warrant and defend the same.
Dated this _7_~A-------- day of
~Y-.. 1.( S
. AL)
Leonard A. Phillipps.-L
(SEAL) .........(SEAL)
Lucile Philli s-.
aka Lucille Phillipps
AUTHENTICATION ACKNOWLEDGMENT
Signature (a) STATE OF WISCONSIX
S+- sa. croor
--County.
authenticated this ...---..day of 19...... Personally came betem me this 1.7-11 day of
-DtccMkGr__--,_---, 19-40 the above named
..Leonard- A-.--- - - -Phill -ip-
-ps---and---------------•----
' ...Luc.il.IR.. Phi.llippz-,---aka.-Luc.il-le.--Phi l l ipp s
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, . ,
authorized by § 706.06, Wis. State.)
to me knpwn to t14g who executed the
foriinstr C' *ledge the me.
THIS VSTRUMENT WAS DRAFTED BY ~ 1! 1.~~
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