HomeMy WebLinkAbout022-1063-60-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER . f. I ` it
ADDRESS oZ Q3 V
Y{L,44 lis Imo, s,f 0-2
SUBDIVISION / CSM# LOT
SECTION__, T -?8 N-R W, Town of
1wiv~1►,w'c
ST CROI?C C61'U" T"Y, WISCONSIN
PLAN VIEW
S'HOW EVERYTING WITHIN 100 FEET OF SYSTEM
Pd WS e-
0
1
i
'M, D WAX
4
ds
INDICATE NORTH ARROW
Provide setback and elevation information on reverse Of this form.
Provi"de"2 dimensions to center of septic tank -manholecover.
BENCHMARK: e-
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Cap city: /0o0 + Od
Setback from: Well House lZ Other
Pump: Manufacturer Zo~l~c. Model#J_ Size
Float seperation Gallons/cycle: Z3 D
Alarm Location haurr•✓'~
.SOIL ABSORPTION SYSTEM
Width: L9 Length 94 Number of trenches
i
Distance & Direction to nearest prop. line:_ 1,5 W~5 IL
Setback from: well: )oo t House 60 Other
ELEVATIONS
~ ooa~✓'
Building Sewer l 00.o-z- ST Inlet; q?, j ST outlet 7
PC inlet g s 7 z PC bottom Qp o 7- q6- 6 S_
Pump Off 91, g Z- Q8. 28
Header/Manifold_ gq, 7 2 Bottom of system
Existing Grade 15,01 Final grade ol, Z f
DATE OF INSTALLATION: ?_13 PLUMBER ON JOB: _
LICENSE NUMBER:
INSPECTOR:
Cty
3/93:jt
• r
~Kcon•<<h Department of Industry, PRIVATE SEWAGE SYSTEM County:
Lat>ora~hdHuman Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) sanitary 6Per 8614
Permit Holder's Name: ❑ Cit~yy ❑ Villa n Town o : State Plan ID No.:
FULLER, JOHN KINNICKI~N C
CST BM Elev.: Insp. BM Elev.. BM Description: Parcel Tax No.:
-0 ' y
TANK INFORMATION I/ C/ ELEVATION DATA A9600315
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Soo) Benchmark
Dosing /1100 a. J ~ lv0 ~ 00
Aeration Bldg. Sewer
Holding St/ Ht Inlet l`~"LNU~ a"
G~tNa~ s
9 ff.
TANK SETBACK INFORMATION St/ Ht Outlet 3_2 9.9-(g.
TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet C , 771
Septic '16, '75' 16 "15 NA Dt Bottom
Dosing r~ NA Header/Man. y, Z-
Aeration NA Dist. Pipe xr q 17,
Holding Bot. System 1"
11,0"
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number 61 11? 4 GPM
TDH Lift '11 Friction System ~s~ TDH Ft
Forcemain Length Dia. o Dist. To Well c;
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION ' / DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type of CHAMBER Model Number:
System: &A, a gp' > v OR UNIT
DISTRIBUTION SYSTEM
H*aderlManifold Distribution Pipe(s) x Hole size x Hole Spacing Vent To Air Intake
Length Dia- aLength 7--- Dia. Spacing IN "
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of yy xx Seeded/ 9~ xx Mulched
Bed / Trench Center I Bed / Trench Edges Topsoil b 'I [Yes E] No [3 Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: KINNICKINNIC.22.28.18W, NW, NW, NORTH RIVER ROAD
9 /r-710 - G/
Plan revision required? ❑ Yes dNo
Use other side for additional information.
SBD-6710 (R 05/91) Date kr(spector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
~ R SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PER
• -Attach complete plans (to the county copy only) for the system, on paper not less than Wrvii8% x 11 inches in size. ❑ Checo previou application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY WNER PROPERTY LOCATION
n -e'` 1J 1,,% )0 I•c/'/a, S T,;2 P', N, R I j% (or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
t 5j `T'o,, ti w ( W fi- )v 9-
CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
e 51
-7 I Is w i Q '9 P/ 0-
II. TYPE OF BUILDING: Check one CITY NEARES ROAD
( ) State Owned VILLAGE
tvew
❑ Public LRA or 2 Fam. Dwelling-# of bedrooms S~ PAR CE TAX L UM
III. BUILDING USE: (If building type is public, check all that apply) 6 a a ®l~ O
1 ❑ Apt/Condo
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 90 Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. .Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit _ Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 K Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
130 Seepage Pit Pressure 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 75 U 4 6.9 8 Feet / Oj. 2 3 Feet
VII. TANK CAPACITY Site
in gallons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holdin Tank )Apo Z C k A-d I 7F -77 Q
Lift Pump Tank/Si hon Chamber N;00 Igoe wee. A,., 21 1 L1 0 F-1 F-I F1
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 Signature: (No Stamps) MP/M o.: Business Phone Number: 39? ig
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue Issuing Agent Signatu ps)
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
L ' l
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the firs 2 of re:'"Er/ .I any new
criteria in the Wisconsin Administrative code will be applicable.
3. All revisions to thi:3 permit must be approved by the permit issuing authority,
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Rer?,:%wal For -i ( 63,9) ro be
submitted fo the county prior to installation.
5- Or+site sewage systems roust be properly maintained. The t tir ta k.. s) m ,_-J ?~e pc.:; a "{c. ,used
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your !oc: I cote Eidrrinistraterr or the
State of Wisconsin, Safety & 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 parcei tax n,mber(si of
where the system is to be installed.
Il. Type of building being served. Check only one and complete of bedrooms 1 or 2 FarTHIV Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank: replacement, taconnection, or
repair.
V. Type of system. ChE'ck appropriate box depending on system type.
VI. Absorpti nn system information. Provide all information requeste,' in '
VII Tank nfor!nation. Fill in the capacity of every r:ew andlor c c ,arrk.. t, tal g:~ iw rurrbc: - of
tanks and r; anufacturer's name. indicate prefab or site consoucted and tan,. ai ;.erial ce 11o, all
septrc, pU ip/siphon and hoiding tanks for this system. Check oNptr rimenta, .:)i;-rva ;),.I j i' ank r;;ceived
exper;m,~r-'al product app, oval from DILHR.
VIII Responsibiiity statement lrrsta linrl plumber is to 'ih in name, license nurnb;? w-h .te preP,( (e_g•
MP, etc.), address and phone number. Plumber must sign application fort-TI.
IX. County/ Department Use Only.
X. County/i)epartrnent Use Only.
Complete plans and specifications no' smaller than 81/2 x 11 inc.f,e. nr,.~'r t co,r:-!. The
plans must include +:he following' piot plan, draw, to scale h + e rica'ic , of
hoiding tank(s), septic. tank(s) or other treatment tanks; buildir.r iiie, :o- ; eater e:ervice;
streams and lakes; pump or siphon tanks: distribution boxes, .o 4., y• terns, f. i c :orner : system
areas; and the location of the building servpell, B horizontal a ;'trc a „lee 3', - n °(!f s :
C) complete specifications for pumps and controls; dose volume, eievat;on difte ence•: f` ~,)n loss; pump
performance curve; pump model and pump manufacturer; D) cross section of that soil .bsorotion 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 ncluded the creation of surcharges (fees) for ;srr;:`?~ r
regulated pract i,es whic~- ran effect g-oundwater.
Th,? monies ;cllected thTtug!, e:;e surcharges are used r r ,
war;er contamination inver-tigafions and establishment of stanejardia
SBD-6398 (R.11/88)
,
1 1
SAFETY & BUILDINGS DIVISION
s
State of Wisconsin
Department of Industry, Labor and Human Relations
" r 2,,ISW 201 East Washington Avenue
P. 0. Box 7969
Madison WI 53707
ULBRICHT & ASSOCIATES
ROBERT ULBRICHT
655 O'NEILL ROAD
HUDSON WI 54016
RE: PLAN S94-03544 FEE RECEIVED: 200.00
FULLER, WILLIAM & ~
NW,NW,22,28,18W V
TOWN OF KINNICKINNIC 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 ILHR 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 ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
Tit Tait submitt41 approval wi,,ll expire two years from the approval dat*,~ 0i
a Rs pormit is obtained, plan approval t4i11: expire on 4ay tho
r r -t expires.1- 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.
nc ely,
n th Stiemke
Plan Reviewer
Section of Private Sewage
(608) 266-8230 7:00 to 3:45 Mon. thu Fri
SHD-6423 (R. 0"1)
UL'BRICHT & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX
DILHR Plan I.D. # s94-03544 Date Sept. 2, 1994
Owner Amy Fuller Trust. c/o Wm. Fuller,
Trustee Phone 715-425- 5848
Address 298 Hwy. 65, River Falls, Wis. 54022
Legal Description site address: 293 N.River Rd. River Falls,Wis. 54022.
Part of 140 Acres. NW 1/4,NW 1/4, S22, T28N, R18W
Town of Kinnickinnic County St. Croix
C.S.T. Robert Ulbricht, CSTM2482 Installer
Local Authority/ Supervision
St. Croix County Zoning Dept.
PROJECT DESCRIPTION
An existing farmhouse with 6 relatively
small bedrooms has a failing drywell type system.
Estimated daily wasteflow for 6 bedrooms: 900
gals. per day.
Soils in the top 12 to 20 inches are well
structured and permiable (.5 GPD/ft2) but seasonally
saturated at 32". Soil consistentcy below this ranges
from massive (tills) to extremely firm. A very long
narrow mound system is proposed using 12" sand fill.
Pg.l PLOT PLAN VIEWS
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS CIfj
Pg.3 PIPE LATERAL LAYOUT ,
Pg.4 DOSING CHAMBER CROSS SECTION t
Pg.5 PUMP PERFORMANCE SPECS ♦j
OTC,
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. 'CF2O55 SECTION OF MouoD ^ wi rrk aeo
OED 9) F % r0
7.y R55Qc5ATE-
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cr TktCkaFSS Pip
s ys rEM
OF T'°P Soi L
~ I EvA 1-io,~
U )J FOR M To E ,u 11 N k, 9 8.9 8 '
Msv. .
RATIO
PIo w E o T' o P S o
Ni
u FoRM
4 % SLOPE FORCE eirWAT100 UAJMR
97.98'
I, 1.3 FT. lmvF-Rr OF 1 1/4" ]ATERMS 99.48'
F . 80 FT' Top 0 F R ock 99.80'
G 1 _ n FT•
H 1.5 FT. TOP of a_jZjL IATERAIS 99.60_'
PLA N VIEW OF MoujiD wi rti 'BED
FvRcE MAiN A 8.0 FT.
I - I 4 94 Fr
K 10 FT
114 Fr
W - f
a I T 13 F r
w T.
a ~
w 29 r
'E SEW p,G'E SY STS
Bap OF ley
To 1 r „ r'nnditi° na ~
f 3 -5 2 2.
Wisconsin Department of Industry, SOIL AND SITE E V A L T Page of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 8 A. Co
Or 'WO
COUNTS
Attach complete site plan on paper not less than 81/2 x 11 inches in Ian tri~st-ihttircte, but
not limited to vertical and horizontal reference point (BM), direction a °..'Of slgpe, scale pr, CEL I.D. #
dimensioned, north arrow, and location and distance to nearest road..; .
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VIEWED BY DATE
PROPERTY OWNER: /1114y roll" 'C--S747~- C/o T,pvsj~~ PROPER OCATI-
4
.,GOVT. LOT IVA {t%4 %vw1/4,S 22 T Z N,R le E (00
PROPERTY OWNERS MAILING ADDRESS LOT BLOCK ~ S BD. NAME OR CSM #
29 oo ,y4, l S t~hoe T of / D ,4 C_ f,4 c°M
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ROWN NEAREST ROAD
Syoz 2 ( -71S) yz,s
[ ] New Construction Use (residential / Number of bedrooms [ ]Addition to existing building
(qlieplaeement [ ] Public or commercial describe
Code derived daily flow 96-0 gpd Recommended design loading rate S bed, gpd/ft2 - ~ trench, gpd1ft2
Absorption area required 7-5-0 bed, ft2 7S0 trench, 11:2 Maximum design loading rate _,5- bed, gpd/ft2 ' ~ trench, gpolft2
Recommended infiltration surface elevation(s) 5--e_2 . 3 9?, ff ' ft (as referred to site plan benchmark)
Additional design / site considerations 51,7z- Sr, ~Q/~ Dv c~/ 'Fv,p -910PA."o T y0r - S i/Srf'~
Parent material5/fo6os 4.5 -5 T' PE" Flood plain elevation, if applicable ft
/Z 7- i-;~eS v N
S - Suitable for system CONVENTIONA MMOUy~ IN-GROUND PR URE AT-GRADE SYSTEM IN FlL_ H0 S NG TANK
U = Unsuitable fors stem ❑ S Id~l7 LyS 1:1 U El S ❑ S ~ ❑ S o t-
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft
9 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bed rertdt
x l ~-iz /o ye 212, 777--z 56,E S
/ 2
z
L 1- z 0 /0 ye 315~ Z f 56~ G~S~ ~ S ~f S
Ground 3 V-36 100e y ee- - .Si y 7 cS6,E' d v` G'k~ ~f S
elev.
~Z ft. y l 53 /o yle 7/l~ s y;~e' s~~ s~ o ~ss~~ c cv K N
Depth to 3'3 -7D 7, 2 PX s/g G~ 56i(' ~n.e f r N
limiting
factor
sss
Remarks: 71 70 C5' 7V,4-) le Af
Boring #
z/Z 'S
. ~
2 z y 2,6 /o Ye 5-11. 2 f S,6A- SSA oqs .2
, s
S,11 21,w e4e ~Li L'Gci , S ,
Ground 3 3Z /D Q#
I
elev. S3 7 S ye ~G S/ 0, ,~.cs~'v a w - ,v N 14 Depth to
limiting
fact , ,
F
55S - L ~ESTO-~-
Remarks: /4 T ,.5.~ "
Am y
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 3
PARCELI.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxl3y Roots GPD/ft
in. Munsell Qu- Sz. Cont. Color Gr. Sz. Sh. Bed tertd~
3 0-1,2- is Y,44, L s,/ z" 777 s s z , s
Ground j 6 -35 7,S 24,- 5k q w S G
el0 ft. s G3 ~s ye nV
7. 5 ` 2 f' 51r G / 2 4- a Z, N N
Depth to
limiting
Fdctor~./
5~5
Remarks: T ,3 Gi:~FS7`avE" Env cfl v-0'7-i'0zD
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
i3
Ground `
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring # T
13
Ground
elev.
ft.
Depth to
limiting
factor
f. b ~ ~ W N ~ rn
fly
141
c
0
c
M
ti
y
o db
17 AA °
w_
n
J
.e ~
1
~ M 1
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
i) St. Croix County
OWNER/BUYER J U h n. I'~ e
MAILING ADDRESS 116, '70, k
PROPERTY ADDRESS c~ 3 iii c ✓ r e,- L 1
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE E.-Its U r 5 4~ t3
PROPERTY LOCATION Y0 A) 1/4, -nL4/ 1/4, Section, T_?N-R 18 W
TOWN OF ► w wt4 y~ ST. CROIX COUNTY, WI
SUBDIVISION w kr- LOT NUMBER 11/ /'1'-
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: -Gl'
DATE: - l
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 7t j W f k,lor r
Location of property V uj 1/4 YU 1w' 1/4, Section , T j e N-R_8 _W
Township Mailing address 115
Address of site
Subdivision name y,, r*~ Lot no. Iy
Other homes on property? Yes No
Previous owner of property
Total size of property /4o _
Total size of parcel ) 4 p 9C-
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes ✓ No
Volume J109 and Page Number 9 4A 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. r,~S 0f z-- , and that I (we) presently
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 office of the County Register of Deeds as Document No.
ignature of Applicant Co-Applicant
&4' 17- /C/ Z6
Dat of Signature Date of Signature
"11SCONSIN REAL ESTATE TRANSFER RETURN - CONFIDENTIAL s a,,,,i~ :d1,-;{„;,,, u• ci>, T,,, Do Is "irh h,cumcnt(s) to b nronfed.
i7 U, 'S
t
15. Kind cf property o r „nary use
2. Address - New address if property transferred was primary residence Land only a. ❑ Residential
• :Iesilie Amy Fuller X~ Land and buildings Single family/condominium
❑ Other (explain) ❑ Multi-family - / units
17. Estimated land area and type ❑ Timeshare unit
3. Grantor is ❑ Individual ❑ Partnership ❑ Corporation) Other a. Lot size x b.❑ Commercial i
usirms use
II. GRANTEE: b. TOTAL ACRES c.❑ Manufacturing buslnessuse
4. Name John W. Fuller c. MFL / FC / WTL acres dl.[ r Agricultural
5. Address 1151 Town Hall ar. iT a d. Ft. of water frontage Adjoining land within 3 miles? ❑ Yes ❑ No
River Falls, WI 54022 VI. TRANSFER e.❑Other (explain)
18. Type of transfer: ❑ Sale ❑ Gift ❑ Exchange Other (explain)
- eaunst carder a will
6. Grantor /grantee related: ❑ None ❑ Corp/Shareholder/Subsidiary ❑ Partnership 19. Ownership interest transterred: ❑ Full ❑ Partial (explain)
_
❑ Financial g Family or Other; explain be 4u`= s L ' 1ofp ^ uti T
20. Does the grantor retain any of the following rights?❑ Life estate ❑ Easement
7. Send tax bill to Name and address 21. ❑ Deed in satisfaction of original land contract? Dated?
John W. Ft2ller 22. Points (prepaid interest) paid by`seller $ _
1151 Town Hall nri ve River falls, 54022 23. Value of personal property transferred but excluded from (25) $
III. ENERGY S. Is this property subject to the Rental Weatherization Standards, ILHR67? 24. Value of property exempt from local property tax included on (25) $
❑ Yes 0 No Exclusion code W-31f W-11, explain VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION
IV. PROPERTY TRANSFERRED
9. ❑ City ❑ Village M. Town i;i;~r,zeki.zric 25. Total value of REAL ESTATE transferred $ 124, 3t7R
County St- Croix 26. Transfer fee due (line 25 times .003) $ -O•-
10. Street address 27. TRANSFER EXEMPTION NUMBER, sec. 77.25 11
11. Tax parcel number
12. Lot parcel
Blk. no.(s) 28. Grantee's financing obtained from a. F-] Seller
Plat name If box a or b is checked, b. ❑ Assumed existing financing
complete Part Vlll -
c. ❑ Financial institution /Other 3rd party
13. Section 22 Township 28N Range 18W Financing Terms d. 0 No financing involved
14. Legal Description metes and bounds: (attach 4 copies if necessary)
WEST HALF OF THE N01-,rHWEST QUARTER (W112 OF W14 1/4)1 NORTHEAST QtTAPTER OF THE
NORTHWEST QUARTER (VE 1/4 OF NW 1/4) AND WEST HALF OF THE SOUTH&aST QUARTER
OF THE NORTHWEST QUARTER (W. 1/2 OF SE 114 OF NW 1/4), ALL IN SECTION TWEN^.'Y TWO
(22), TOWNSHIP TWENTY EIGHT (29) NORTH, FLANGE EIGHTEEN (18) WEST.
St. Croix County, Wisronsin.
VIII. FINANCING TERMS (FOR SELLER/ASSUMED FINANCED TRANSACTIONS ONLY)
29. Total down payment $ (Line 29 = Line 25 minus Lines 30a, b and c excluding payments for personal property)
30. Amount of mortgage/land 31. Interest 32. Principal and interest 33. Frequency 34. Length of 35. Date of any lump sum 36. Amount of lump
-47' " contract at purchase rate (stated) paid per payment of pymts contract (balloon) payments sum
a. $ % $ - $
,a -
b. $ $ - - $
c. $ % $ $
37. If the dollar amount paid per payment (32) is scheduled to change (not as a result of a change in the interest rate), fill in the line letter from above
Enter the date of change- - and the amount it will change to $
IX. CERTIFICATION We declare under penalty of law, that this return has been examined by us and to the best of our knowledge and belief it is true, correct and complete.
Grantor or agent Date Grantor's telephone number
SIGN 715)425-r3848
HERE Grantee or agent
A Date Grantee's telephone number
( 715) 425-9365
Print name and address of grantor's agent Agent's telephone number
Document number Vol./Jac. Page/Im. Date recorded Date and kind of conveyance Coiv. code
5:'501. i0b 144 1i 10/ Y5 1 3C /'94 PER. REP. DF:±1~ 1 2 3 4
FOR Parcel number
ASSESSOR'S Assmt. year 19 _ ❑ Field Sales number
L County _ _ ❑
USE Parcel classification I Tax dist Use
ONLY RES COM MFG AGR S/W FOR T Assmt. dist. _ _ ❑ Reject
1 2 3 4 5 6
Wisconsin Department of Revenue
oc-ann,a.-3.ne, . . . . . . . . . . . PAnPFRTV omipUFR:C rnov
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 5-1982 THIS SPACE RESERVED FOR RECORDING DATA
PERSONAL REPRESENTATIVE'S DEED
REGISTER'S T. C O X COOFFIC WE
S S01.2 von 1 08~a,E244 S
Recd for Record
F. William Fuller
JAN 1 0 1995
as Personal Representative of the estate of at 9: 30 AM
Amy Fuller, a/k/a Jessie Amy Fuller
("Decedent"), RegiaterofDeeds
for a valuable consideration conveys, without warranty, to
_
John W. Fuller, a married man with sole management and'
.__control of .-the subject property.
Grantee, RETURN TO
the following described real estate in St. Croix .---_County,
State of Wisconsin (hereinafter called the "Property")
Tax Parcel No:
WEST HALF OF THE NORTHWEST QUARTER (W 1/2 OF NW 1/4); NORTHEAST QUARTER OF THE
NORTHWEST QUARTER (NE 1/4 OF NW 1/4) AND THE WEST HALF OF THE SOUTHEAST QUARTER
OF THE NORTHWEST QUARTER (W.71/2 OF SE 1/4 OF NW 1/4), ALL IN SECTION TWENTY TWO
(22), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST.
St. Croix County, Wisconsin.
PEA
kx ' APT
Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which
the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the
Personal Representative has since acquired.
Dated this 3001............................... day of ----December 19_-94__.
~J
(SEAL) ww-
SI =1: ! (SEAL)
• F. William Fuller
Personal Representative Personal Representative
AUTHENTICATION ACKNOWLEDGMENT
' of F. Willi-am Fuller. STATE OF WISCONSIN
ss.
is r.. 4ee
A n,.. . i Count Y.
PUMP C11A1111FR CROSS SECTION AND SPECIFICATIONS
Vent Cap
Neathtr Proof Approved Locking
Junction Box Manhole Cover
4" C.I. 12" Min
Vent Pipe ;
Final 4" Min
Grade '
18" Min
Condui t
18" Min
1 -
Approved
Inlet Joints w/
C.I. Pipe
/
App ov e d Extending;
3, Onto
Joint w/ Solid
C.I. Pipe
Extending; i ~ A Ground
3 Onto Alarm
Solid
Ground B
i C
.Pump
O f f -
Concrete Block D
SPECTFICATIONS
TANK • PUMP
Manufacturer: We ek.5 Manufacturer: S
Tank Material:_ C>:1itcre+e Mod e1 Hu Mb Cr: y0
Tank Size: 710 Gallons Switch' Tyro DE
Total Dynamic Head: Ft.
CAPACITIFS Pump Discharg;c Race: 32- GPM
Total Daily Effluent_ 47S6 Gallons
A or - 340 Gallons Numher of Doves: Per Day
B . " or _ 3G Gallons Dose Volume:' ~yy Gallons
or _ /yy Gallons Notes: 1. See pump curve for
D 'nMll or ~,[lo Gallons additional performance
Total Tank information.
Capacity Required f- Cnllona 2. Pump and alarm are to be
inatnlled on acparat! circuit
ALARM au per IL11R 16.19 NAC.
linnuf ncturer: Arw,
Model ?lumber
Switch Type.
page of
J
ME40 PERFORMANCE
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40
12
35
10 ,
~ 30 N
W
W
_Z 25 8
Z
W 20 g D
_ W
Fa- 15
p 4 H
10 0
5 2
0 0 10 20 30 40 50 60 70 80 90 100 0
CAPA ITY GALLONS PER MINUTE
23833A275
r.
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS pAcE of j
VENT CAP
4"C.I. VENT PIPE fr 7 WEATHER PROOF APPROVED LOCKING
JUNCTION BOX MAMHOLE COVER
25 FROM DOOR, to/ 4ftA)AA)61 AISE/
WINDOW OR FRESH 12"MIU. I
AIR INTAKE
l per GRADE
I 4° MIN.
41,
r
99.0 COUDUIT 4.0'' PROVIDE I
INLET AIRTIGHT SEAL I III
I III
9 APPO' ROVED JOINT A Ny,196 `C I I i ( APPROVED JOIWTS
W/C.I. PIPE I "I ~,~('~nM I I I V/IC.I. PIPE
EXTENDING 3' 0 ` [ I I I ALARM EXTEIJDIWG 3'
0IJT0 SOLID SOH B 90.0 ATE SEWAGE SyS ONTO SOLID SOIL
60" (5 .0' ditiotl I I ow
C CQn
ELEV. 91- 4 FT s'I
D 1.41
'(AN K ~~Dp1 ~ ~ of °~ssoF (evA ri0)j 14
RISER EXIT PERMITTED DULY IF NIEHAS SUCH APPROVAL
'v
SEPTIC E SPEC I CATI K S
DOSE Weeks Concrete Prod. IJUMBER OF DOSES: 4 PER DAy
TAIJKS MANUFACTURER:
TANK SIZE: 1200 GALLONS DOSE VOLUME
ALA•.A MANUFACTURER: Ley el Alarm 0,0 INCLUDING BAGKFLOW: 230 GALLONS
MODEL HUMBER: D.V.L. CAPACITIES: A= 30 IMCRES OR 600 GALLOWS
SWITCH TYPE: Mercury Float 5= _ 2 IMCHES OR 40- GALLONS
PUMP MANUFACTURER: Zoeller Co_ C= 11.5 IMCHES OR -23.0 GALLONS
MODEL NUMBER: 98 1/2HP 115V D= 16-9 INCHES OR 330 GALLONS
SWITCH T9PE:Pigg-yback Mercury Float MOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE 40 GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET --rAA9k- TPECS •
~
+ MINIMUM NETWORK SUPPLY PRESSURE 2s.5 FEET -CAGGL, I a~ ✓E pit,,
r.
rn
W HEAD CAPACITY CURVE 3 7/8-- 6 1/4
MODEL "9,8"
30 5/8 I
8 I..
25 9
3 5/8
= 6 0 m
U } -
O
15 - 4 3/16
s -
to
1 1/2-11 1/2 NPT
2-
5
I
0 1
U.S. GALLONS ~ 10 20 30 40 SO 60 70 80
LITERS 80 160 240
0 FLOW PER MINUTE
z
TOTAL DYNAMIC HEADIFLOW PER 1,9ir,UTE
EFFLUENT AND DEWATERING
CAPACi'i'Y 12
HEAD UNITS/MIN
FEET METERS GALS LiRS
5 1.52 72 ^':3
10 3.05 61 81 ?.31
15 4.57 45 1/0
20 6.10 25 95 3 5/16
Lock Valve
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, to. duplex systems, are available and 9 Mercury float switches are available for controlling single and,
supplied with an alarm. three phase systems.
p Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for
:without alarm switches. variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard all models - Weight 39 lbs. - ;s H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float
98 Series Control Selection switch. Refer to FM0477.
Model Volts-Ph Mode Am; Simplex Duplex
3. Mechanical alternator 10-0072 or 10-0075. '
M98 115 1 Auto 1 9.0 , 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak".
N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float swatch 10-0225 used as a control activator, specify
D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system.
6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim•
-E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex or duplex operation, 10-0102.
7. Two (2) hole "J-Pak", for watertight connection or splice.
For information on additional Zoeller roducts refer to catal CAUTION
p og on Combination Starter, FM0514; All installation of controls, protection dev:oes r r If wiring should be done by a quail-
Piggyback Mercury Switches, FMD477; Electrical Alternator, FMO486; Mechanical Alternator, lied licensed electrician. All electrical and ra:oty codes should be followed Includ-
FMO495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and Simplex Control Box, Ing the most recent National Electric Colo 4NEC) and tbs Occupational Safety and
FM0732. Health Act (OSHA).
RESERVE POWEFR:ED DESIGN
For unusual conditions a reserve safety factor is nplneered into the design of every Zoeller pump.