HomeMy WebLinkAbout022-1055-90-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER J/ m /gyp/re's T
ADDRESS /4 Z<D
SUBDIVISION / CSM#_ ~j / yI~CJ j LOT #
SECTION__Z±_T)y6_N-R__ZZ_W, Town of K/H~►ic~,44
ST. CROIX COUNTY, WISCONSIN
PLAN VIER
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t4,
U 7' 417 ~p. r 1'!G /bO ~t
-5 Ls
1 ~ ,t / Ub% oG 141"41
I t~
_ I
i
~
INDICATE NORTH ARROW
_J
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
~ r -
BENCHMARK: 6/6~ d ~C c _•1' ~jaas~ Slr f i_rT
ALTERNATE BM'
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: 11n_tP.- Liquid capacity: 14001•"E
Setback from: Well /,~D House 69' Other
Pump: Manufacturer I'LeVZ-"s Modelt Size T/d
Float seperation Gallons/cycle:
Alarm Location e11.1~
SOIL ABSORPTION SYSTEM
Width: 'S Length 161K Number of trenches /
Distance & Direction to nearest prop. line: 11-50
'r
Setback from: well: /AO't House 10o'r Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
-Existing Grade Final grade
DATE OF INSTALLATION: /J-- /7
PLUMBER ON JOB: ~r
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisc*;*M Departrpent of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Auman Relations INSPECTION REPORT ST. CROIX
Salety,and Buildings Division
` (ATTACH TO PERMIT) Sanitary Pe rm it No.:
GENERAL INFORMATION
P FOB l i +aJm ❑ City El Village X Town of: State Plan I 0.:
CST BM Elev.: Insp. BM Elev.: BM Description: 1~ Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic J 1 y Benchmark
Dosing
4,.
Aeration Bldg. Sewer
Holding St/Ht Inlet 13,17, X3.6 '
TANK SETBACK INFORMATION St/ Ht Outlet get 3 '
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header/Man.
Aeration NA Dist. Pipe
Holding Bot. System . 101, 7
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer ;x t- F.J Demand
Model Number /y1'E yU GPM
TDH Liftj/.5 ( Frictionl~, Systems~~ TDH/~,j Ft
Hea
Forcemain Length l~ Dia. , o Dist. To Well 'SUS
SOIL ABSORPTION SYSTEM
BED/TRENCH Width. Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ' D (1 DIMENSIONS Manufacturer.
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING
INFORMATION Type O CHAMBER Model Number:
System: /00' -/06 / G OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold 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 Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Kinnickinnic.19.28.18W, NE, SE, Lot 3, Quarry Road
1r ~ ; T
Plan revision required? ❑ Yes 0 No
Use other side for additional information. /J /7
SBD-6710(R 05/91) Date nspector'sSignature Cert No.
ADDITIONAL COMMENTS AND SKETCH w s
SANITARY PERMIT NUMBER: 5 ,
fy)
V;
SANITARY PERMIT APPLICATION
COUN
- In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% X 11 inches in size. Check if revision o previous application
-See reverse side for instructions for completing this application. ST!xE ~~IM3R
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. LO 3
PROPERTY QWNER PROPERTY LOCATION
v%, 4,rres F- t/4 5' '/4, S 1 T 218, N, R 18 (Or)(Z
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
!d rte`
CITY `TtA~TEr Z CODE~3 PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
J2, 115 (tt II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE N A ST ROAD f~ J
I5Z1 k c
❑ Public 3 1 or 2 Fam. Dwelling f# of bedrooms ~i ARCEL AX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo C~
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 in line A. Check line B if applicable)
A) 1.9 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 ❑ Mound 30 ® Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground /47- Gra-je 42 ❑ Pit Privy
13 ❑ 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
4 ~d 7$~ /0A ,5 Feet 4127, Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' ame (Print): Plumber's ignature: (No S ps) MP/MPR Business Phone Number:
a4 7y5 77z 3-;21
[fir
Plumber's ddress (Street, City, State, Zi Code):
9 Al_e 6ti, `-C.07-9 I,J/6
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved 1 Rary Permit Fee (Includes Groundwater Date Issue Issuing A nt Sig ature (No )
`qP/)
~J/Approved ❑ Owner Given Initial Surcharge Fee
X -coo
Adverse Determination
X. ONDITIONZS OFF APPPROVALIRAEAA~S77 FO ISAPP O L:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, 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 the 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 & 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.
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 in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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 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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
~ T Xe
` EC~iV~E'b
R
~~y p 5 1995
% DIV.
Jim Forrest - At-grade Syste ~LDGS
- sAFErv
595-40333
Location: NE 1/4, SE 1/4, Sec. 19, T 28 N, R 18 W
Town: Kinnickinnic
County: St. Croix
Date: May 8, 1995
S95_40333
Owner: Jim Forrest
Address: 403 Wasson Court, # 15
River Falls, WI 54022
Plumber: Roge Timm
Signature:
License # MPRS 3224
Attachments: 6748-Plan Approval Application
County on-site
115
SBD-5524 Application
SBD-5524 Onsite verification
page 1: cover
2: calculations
3: plot plan
4: plan view, system cross section
5: lateral detail
6: pump tank exit detail
7: pump curve
page 1 of 7
System Calculations
one family residence bedrooms
Loading rate n'6 gallons/sq ft per day
Depth to ground water in
Depth to bedrock 3 } b
in S95-40333
Cross slope %
Force main length ft of in
Manifold/header length ft of in
Drainback gallons
Lateral length @ ft of 'Z, in
Lateral elevation t Ot.%, ft (bottom of pipe)
Lateral hole size 'I`r in @ in ( s'O ft) spacing
holes/lateral, holes total
Lateral volume <<°•4' gallons
Total lateral discharge rate Z4-sue gpm @ ft head
Elevation difference ft
Friction loss ft @ Z~ gpm
Total dynamic head a 'C, S/ ft
Pump/si)9,on 10 gpm ft of head
Manufacturer Model #
Dose volume gallons
Lift/sfp~kon tank C.y`'°, gallons
Septic tank gallons
Measurement pump on & off in
Height alarm from tank bottom in
Reserve capacity 3~3 gallons
Z
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i3 IZ~i~ J
Observation Soil Cover
12 '
Well
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SEPTIC E SPECIFI'CATIOMS
DOSE ate.
TANKS MANUFACTURER: IJUMBER OF DOSES: ZPER DAy
TAWK SIZE: GALLOUS DOSE VOLUME g. co
ALARM AA64UFACTUXER: INCLUDING GACKFLOW: GALLONS
MODEL AIUMpER: CAPACITIES: A= WCHES OR 313'4' GALLONS
SWITCH TYPE, nn g c Z INCHES OR GALLOWS
PUMP MAWUFACTURER: C= 1i WCHES OR 1ok CrALLOUS
MODEL WUMBER: sw 3g Da INCHES OR \o-".6 GALLOMS
SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE
MIAIIMUM DISCHARGE RA Z~ GP/1~ INSTALLED OW 5EPARATE CIRCUITS
VERTICAL DIFFEREAICE BETWECU PUMP OFF AUD OISTRIOUTION PIPE.. FEET
♦ MIAJIMUM NETWORK SUPPLY PREtSURC . . . . . . . 2.5 FEET
♦ FEET OF FORCC MAIN X 1' k F/
Iooltt.FRIGTiON FACTOR. FEET
TOTAL DtfWAMIC. HEAD FEET
IAITERNAL DIMEAl5101Ji OF TAWK: LEAI&TH -;WIDTH 'LIQUID DEPTH
.;LIQUID DEPTH
4r
I
Performance Data
32
Pump Characteristics
Puns /Motor Unit Submersible
Manual Models SW25M1 SW33M1 LL 2a
Q 1/3 HP
Automatic Models SW25A1 SW33A1 W
x
Horsepower 1 /4 1 /3
is
Full Load Amps 8.0 10.0 > 1/4 HP
Motor Type Shaded Pole (4 pole) °
a
R.P.M. 1550 0 8
Phase 0 1
Voltage 115
Hertz 60 0 o to Zo 30 4W 0
3
CAPACITY-U.S. G. .
Operation Intermittent
Temperature 120" F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0
Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10
Discharge Size 1.1 /2" NPT
Solids Handling 1/2" Dimensional Data
Unit Weight 30 lbs. I. All dimensions in inches
Power Card 18/3, S1TW, 10' std. 3-1/2 5-7/8 2. Component dimensions may
i " I - (20' optional) 4-1/2 very ±l/8 inch
3. Nor fa construction purpose
1-1 2 NPT unless certified
3-1/2 DISCHARGE 4. Dimensionsand *his are
Materials of Construction approximate
S On/Off level adjustable
Handle Steel 6 We reserve the right to
3.1/2 make revnions to our
lubricating Oil Dielectric Oil I products and their
Motor Housing Cast Iron 3 sperilkowns without notice
Pump Casing Cost Iron I
Shaft Steel
Mechanical Seal Faces: Carbon/Cermaic s
Shaft Seal Seal Body: Anodized Steel
Spring: Stainless Steel • C .r 8
Below: BYna'N PUMP
10-1/8 ON
Impeller Thermoplastic 9-U2
upper Bearing Bronze Sleeve Bear' DISCHARGE
HEIGHT
Lower Bearing Row Bab Bear' -
3-1/2
Strainer/Base Plastic 3 PUMP
OFF
Fasteners Stainless Steel -
AURORA/MYDROMATIC Pumps, Inc. 1
840 BanaY Road Ashland Ohio 44805
419 289-3042
Wiq nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
r Labor And Humah Relations
t Divisionof Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 i in must include, but
not limited to vertical and horizontal reference point (B i o V scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance est road.
APPLICANT INFORMATION-PLEASE PRIN INFM r `V° REVIEWED BY DATE
PROPERTY OWNER: RO LOCATION
Jim Forrest 0 GO NE 1/4 SE 1/4,S 19 T 28 N,R 18 >"r) W
PROPERTY OWNER':S MAILING ADDRESS -N, W, LOT . BLOCK # SUBD. NAME OR CSM #
403 Wasson Court, 15
CITY, STATE ZIP CODE PHO E ❑VILLAGE )DOWN NEAREST ROAD
River Falls, WI 54022 (715) 4 Kinnickinnic Quarry road
4x] New Construction Use [a] Residential /Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2
Absorption area required goo bed, ft2 750 trench, ft2 Maximum design loading rate 5 bed, gpd/ft2_,6__trench, gpd/ft2
Recommended infiltration surface elevation(s) 101.0 It (as referred to site plan benchmark)
Additional design /site considerations install 104' x 9.5' at-grade rock unit (100' x 7.5' effective)
Parent material loamy/sandy ou wash Flood plain elevation, if applicable NA ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S EU U S ❑ U ❑ S O U Us ❑ U ❑ S )MU ❑ S 0U1
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-7 7.5YR 2.5/2 - sl 2 f sbk mvfr cs 1 f/m .5 .6
w?t'i 2 7-12 7.5YR 2.5/2 - sl 2 f-m sbk mfr cs if .5 .6
Ground 3 12-15 7.5YR 3/4 - sl 3 m sbk mfr cs if .5 .6
10ev 7 w/ tongues from horizon 2
ft. 4 15-29 7.5YR 3/4 - sl 3 m sbk mfr s if .5 .6
Depth to 5 29-40 7.5YR 4/6 - is 1 m sbk mvfr aw - .7 .8
limiting 6 40-53 7.5YR 3/4 f1d 7.5YR 613
sl 0 m - - - .3 .4
factoor1
5YR 5/8
w/ incl sions 10YR 6/4 & occasionally e hibiting a fine platy structure slack w ter drosite'
Remarks:
Boring #
1 0-5 7.5YR 2.5/2 - sl 2 f sbk mvfr cs if .5 .6
2 5-11 7.5YR 2.5/2 - sl 2 m sbk mfr as if .5 .6
3 11-25 7.5YR 3/4 - sl 3 m sbk mfr cs if .5 .6
elev. Ground 4 25-32 7.5YR 5/8 - is 0 sg ml gs Rterob 7 .8
10U.4 ft.
5 32-41 10YR 4/6 s 0 sg ml aw 7 .8
Depth to 7.5YR 6/3
limiting 6 4-64 7.5YR 3/4 f1d 5YR 5/8 sl 0 m 3 .4
factor
41" mott ing bec ming c2d below bout 52; occasiona inclus' ns 10YR 6/4 s; perched groundw ved 72"
Remarks:
CST Name:-Please Print Phone:
Henry F. Grote 715-665-2681
Address: Po Box 57, Knapp, WI 54749-0057
Signature: Date: CST Number:
4/24/95 3065
PROPERTY OWNER Jim Forrest SOIL DESCRIPTION REPORT ) Page _2
PARCEL I.D. #
1
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw&
1 0-4 7.5YR 2.5/2 - sl 2 f sbk mvfr cs if .5 .6
=4>:~2 4-10 7.5YR 2.5/2 - sl 2 m sbk mfr cs if .5 .6
Ground 3 10-16 7.5YR 3/4 - sl 3 m sbk mfr cs if .5 .6
elev. w/ tongues from horizon 2
100.6ft• 4 16-23 7.5YR 4/6 - sl 3 c sbk mfr s .5 .6
Depth to 5 23-36 7.5YR 4/6 - is 2 m-c sbk mvfr aw - .7 .8
limiting 6 36-44 7.5YR 4/6 - is 0 sg ml cs - .7 .8
f9c1Rr
w/ irr gular sl inclus ons & occasional 1 YR 6/4 s inclusions
7 44-53 7.5YR 3/4 If2f 7.5YR 5/3 sl m
as .3 .4-
Remarks: 5YR 5/8
Boring # occasionally exhibiting pl structure
8 53-76 10YR 5/4 - s 0 sg ml - - .7 .8
sr •
sl band @ 61-63; water 0 70"
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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ST. CROIX COUNTY
` WISCONSIN
ti
rorri ZONING OFFICE
r r r r
rprrll
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
_ (715) 386-4680
May 5, 1995
Mr. Jerry Swim
State of Wisconsin/DILHR
Safety & Buildings Division
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
RE: Jim Forrest
Plan I.D. No. S95-40333
Dear Jerry:
Enclosed is an Onsite Verification Report for Jim Forrest's
property located in the NE; of the SE', of Section 19, T28N-R18W,
Town of Kinnickinnic, St. Croix County, Wisconsin. If there is
anything else that you need, please do not hesitate in contacting
our office.
ry sincerely,
K. ompCS0571-
ames on
Assistant Zoning administrator
mz
Enclosure
r.. a K 4
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY 6 BUILDINGS DIVISION
ONSITE VERIFICATION REPORT
201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
1. Are the soil and landscape features accurately reported on the Soil Description
fore?
YES NO
If no, provide further description.
2. If for new construction, could he developr,,ent occur without an at-grade system?
YE S NO
IF ,yes, what other type of sewage disposal system could be used?
Q ,`4 6
3a. State the name of the installing plumber:
b. Has this installer received written directives or orders regarding previous
construction of at-grade or mound type systems?
YES NO
If yes proceed to 3d.
c. If tnis installer has not previously constructed at-grade or mound type
systems, have they attended a University of Wisconsin training session on at-grade
systems?
X YES N4
d. If -ie answer to 3b is yes, or if the answer to 3c is no, the installer must
incluae a written agreement to attend a preconstruction meeting with DILHR and
county staff, and receive onsite construction supervision by. DILHR and county
staff. Fees for this supervision will be charged in accord with s. Ind 69.11 (1),
Wisconsin Administrative Code. This supervision may also be required for
s uent installations.
unto Officia Sign ure at
^J re~i~ -T,c~.'~ 595 = 4!033.3
~o~at~ori and Owners Name
OI~NRSBD-5524 T OFT'~ir7/7,•C 1~%nrl,C, ~ ~ e/D;~' (fo;
4295K
• 00
9 FILED 0
S
NiA2 ? S '994 i l
JAMES O'CONNELL
Register o1 Deeds
51.4453 SL Croix Co., W)
CERTIFIED SURVEY MAP ro _
LOCATED IN THE NE 1/4 OF THE SE 1/4 AND THE SE 1/4 OF THE SEI/4 OF SECTION 19, T28N,
R18W, TOWN OFKINNICKINNIC, ST. CROIX CO., WI.
E 1/4 COR. SEC. 19
PREPARED FOR: COUNTY MONUMENT
DONALD AND MARGARET PAUSCH O.N FOUND).
of .
lu1
I°
CE R T is r• i ED SURVEY MAP
69 )
I
JOL. 9 Pv. 2690
NOTE: BEARINGS ARE REFERENCED 9A3 x-1001 ✓ QI
70 THE EAST LINE OF THE NE 1/4. ' I 1~•
(RECORD BEARING)
.p3 931
6\o0Q 891 i M~33 3'I a
III W
~ ^ I y
h
1 W 1 M I =
1 ~ 1 F-
O/ U.
N
I Q I to co
r, to
I OD 1 W Z.
L 0 T 2 "I ri) ? Q
10.60 ACRES 1 y r?I r
(461,625 SO.FT.) y
9.95 AC.EXC• ROAD R.O.W. ' I a
(433,563 SQ. FT.) 1 rl
W W
793.73' Z' N 8 6° 3 1 1 5 E 33.7 5 9.84 J'
CL•
BUILDING SETBACK ° z
I V)~
A PPROX. NORTH LINE
N 1
O
\ LOT 3 I to I APPROVED
0' a 10.60 ACRES ' W a
' Z N (461,630 SQ.FT.) 1 O '
W
W 01.416 A C. E X C. R.
692 SO.FO.)W. i al0 1• MARd 71
.Q
a ' o W I ST. CROiX COUNTY
2w 1001 Comprehensive Piarviir
0 0 3 331 Zoning and
Q:O
dO , 28.93' Parks Conuri fte
a-.1 1
aW 708.65' '
S 66 ° 31 ' 1 5'' W 7 3 7. 58 N: If not ~>acordetl
a I within 30 dais e
®0ee ~ ° ~g®J
p
UNPLATTED L.ANDS• I~ N 1 -ipPnovalse
o no-1 & void
•o Z
~ JR. y:::S RA.
w :+,t;-,;_~ e•• 0= SET 1 "X 24" IRON PIPE WEIGHING
S 1604 1.13 LBS. PER LINEAR FOOT. SE COR. SEC. 19.
SPRING VALLEY 1 ( C H I S LED I N
• 0 1 "IRON PIPE FOUND.
® bVIS. r m CONCRETE FOUND)
VOLUME 10 PAGE 2738
SCALE 1 200,
JAMES M. WEBER S-1804 0 100' 200 400
NELSEN- WEBER LAND SURVEYING
RIVER FALLS - MENOMONIE
DATED ~ fig. ~S,Igg~4
94-5 THIS INSTRUMENT DRAFTED BY J.W. SHEET OF 2
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER J , v►-+ ~o rres
MAILING ADDRESS
/02-4Q 4J-
PROPERTY ADDRESS
(loton of septic system) ease obtain from the Planning Dept.
CITY/STATE klwe*y rzi 16 lam/ i & 5 S16 Z ^Z
PROPERTY LOCATION 0&7 1/4, 5 1/4, Section I q , T N-R_ZS_W
TOWN OF A ic- ~ ih12.1 G ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP .5/ 'A s~, VOLUME PAGE LOT NUMBER -3
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 pSIGNED: i
DATE: / s-/ F 'j-
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 .TlMr~y-r~s
Location ofproperty 1/4 SC 1/4, Section /f ,T ?kN-R W
Township >1rLtc~;rir~i~, Mailing address
Address of site
Subdivision name no.
Other homes on property? Yes~No C s~ ✓a-P /0~. ~73~
Previous owner of property
Total size of property
Total size of parcel 10,66
Date parcel was created ft/ 91 1
Are all corners and lot lines identifiable? >C Yes No
Is this property being developed for (spec house) ? Yes __X No
Volume and Page Number as recorded with the Register
of Deeds
I14CLUDE WITH THIS APPLICATION THE FOLLOWING:
A JWARRANTY 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. 61yr 7 3- , 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.
Si na ure of Applicant Co-Applicant
/s b
Date of ignature Date of Signature
DOCUTAEN't No. I STATE BAR OF WISCONSIN FORM 1-1982' TNt/ ..ACS REesRVeO FOR RccosoiNO DATA ~j
WARRANTY DEED ( Ilk
U4872
JTe CRC DC CO., W1 i 4
This Dead, made between _Dgn&W.•J•r•_.Pauscrh•-$nd•........ rae'dfarFrcord
Margar.e.t..:..._.P.au.s.ch._-hus.band...and-wi.f.e...a nd APR 4 1994 tY
Rarriet..Ma.e..Ei}ruck...a/. kla..Harr.iat..M...Ii-ynck......
-al...tenant.s...ia..com ma Grantor, 8.30
and..... Jame s.. M.-Far res.t..and..Mary... Ja..Eorreat.,.............. } ,
...hus.band..-and..blif.e..as...surxivorshipL..marital
,
-propert.y property
, Grantee,
Witnesseth, That the said Grantor, for a valuable consideration......
conveys to Grantee the following described real estate in ..S.t.....CrQiX.......... A9~
County, State of Wisconsin: (~✓Pr ~/lt 4
Lot 3, Volume 10, Page 2738 of Certified -
Survey Map, as Doc. No. 514453, Register of TazParcel No
Deeds office, St. Croix County, Wisconsin,
being located in the NEk of the SEk and the
SEC of the SEk of Section 19, T28N, R18W,
Towu of Kinnickinnic.
I ~ -F
This is not homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And...._..Grantors
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions, and rights-of-way of record, if any,
and will warrant and defend same.
Dated this . f day of 199!±-...
. ................(SEAL) .........1~ • Mar aA...... C....P4Luggh
(SEAL)-. (SEAL)
Harriet Mae Eiynck.z..._
a/k/a Harriet M. Eiynck
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
St. Cro i x
County.
.
authenticated this day of 19...... Personally came before me this ...._31-A' "day of
gj;. h 19..9 the above named
onald-•J.-.P.4u.-r.. h......Margare.t._Q!..
Pausch, and Harriet Mae Eivnck
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not. 1:w .'_~.....rhl
authorized by 708.08, Wis. State.) to me known td 12d .Aiy~peESOn $ -=j, T=t who executed the
foregoing instrtWlt ..,Anl ckepodtebge the same.
THIS INSTRUMENT WAS DRAFTED BY - Q r •
C. L'...Gaylord, Attorney :
M.r Riye?r..Falla-,--_WI••-_.54022 Notary Public ._...eEiALAI County, Wis.
not, state expiration
(Signatures may he authenticated or acknowledged. Both My Commission is assent: t 9~
are not necessary.) date: Ayr l:f4..._t..--.• 19 ) k
.
-Name or persons eirnins in •ny upaeity should be typed or printed below their sirn•tures.
%va...tNTT nvrn RTAT1. RkR n► WlQr•r,YaTN Ri-k a.. I-
ME40 DIMENSIONAL DRAWING MW50 DIMENSIONAL DRAWING
"ON" ul
-
rJrnl _n n
E
_ O
c.1 14.76
E "OFF" V 6
E
6.25
C,~
0
2.06
1-1/2" NPT
• 38.1 mm)
Discharge
E J-6
r cn _ 9.04
01 cm ® ALL
a _
L 5.66 .-5,44
t (144mm)
11.68 11.42
(296.5mm)
ME40 PERFORMANCE MW50 PERFORMANCE
CAPACITY LITERS PER MINUTE
CAPACITY LITERS PER MINUTE 0 100 200 300 400 500
0 50 100 150 200 250 300 350 30 - 10
i I
40 12
35 8
10
N
F 30 R w 20 - W
w
W 8 F LL 6
IL 25 Z Z
Z -
Z 1Q 15 I--_~__ -
W 20 6 Q = J =
F F
J F Z 4 J
Q 15 J
F OF 10
O 4
F O
10 ~ I I
2
2 5 I
0
0 0 10 20 30 40 50 60 70 80 90 100 0 0
0 20 40 60 80 100 120 140
CAPACITY GALLONS PER MINUTE CAPACITY GALLONS PER MINUTE
23833A275 ~1
01
MYERS
LIMITED WARRANTY
F.E. MYERS warrants that its products are free from defects in material and workmanship for a
period of 12 months from the date of installation or 18 months from the date of manufacture, which-
ever occurs first.
During the warranty period, and subject to the conditions hereinafter set forth, F.E. MYERS will
repair or replace to the original user or consumer parts which prove defective due to defective mate-
rials or workmanship of MYERS. This remedy is exclusive and is the only remedy available to any
person with respect to such MYERS product. Contact your nearest authorized MYERS distributor or
MYERS for warranty service. At all times MYERS shall have and possess the sole right and option
to determine whether to repair or replace defective equipment, parts or components.
Start-up reports and electrical system schematics may be required to support warranty claims. This
warranty is effective only if MYERS supplied or authorized control panels are used.
LABOR, ETC. COSTS: MYERS shall IN NO EVENT be responsible or liable for the cost of field labor
or other charges incurred by any customer in removing and/or reaffixing any MYERS product, part or
component thereof.
THIS WARRANTY WILL NOT APPLY: (a) to defects or malfunctions resulting from failure to properly
install, operate or maintain the unit in accordance with printed instructions provided; (b) to failures
resulting from abuse, accident, or negligence; (c) to normal maintenance services and the parts
used in connection with such service; (d) to units which are not installed in accordance with appli-
cable codes, ordinances and good trade practices; or (e) if the unit is moved from its original instal-
lation locations, and (f) unit is used for purposes other than for what it was designed and manufac-
tured.
RETURN OR REPLACED COMPONENTS: Any item to be replaced under this Warranty must be
returned to MYERS at Ashland, Ohio, or such place as MYERS may designate, freight prepaid.
PRODUCT IMPROVEMENTS: MYERS reserves the right to change or improve its products or any
portions thereof without being obligated to provide such a change or improvement for units sold and/
or shipped prior to such change or improvement.
WARRANTY EXCLUSIONS: As to any specific MYERS product, after the expiration of the time
period of the warranty applicable thereto as set forth above. THERE WILL BE NO WARRANTIES,
INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PAR-
TICULAR PURPOSE.
Some states do not allow limitations on how long an implied warranty lasts, so the above limitation
may not apply to you. No warranties or representations at any time made by any representative of
MYERS shall vary or expand the provisions hereof.
LIABILITY LIMITATION: IN NO EVENT SHALL MYERS BE LIABLE OR RESPONSIBLE FOR CON-
SEQUENTIAL, INCIDENTAL OR SPECIAL DAMAGES RESULTING FROM OR RELATED IN ANY
MANNER TO ANY MYERS PRODUCT OR PARTS THEREOF.
Some states do not allow the exclusion or limitation of incidental or consequential damages, so the
above limitation or exclusion may not apply to you.
This Warranty gives you specific legal rights and you may also have other rights which vary from
state to state.
Direct all notices, etc. to: Warranty Service Department, F.E. Myers, 1101 Myers Parkway, Ashland,
Ohio 44805.
Myers*
F. E. Myers, 1101 Myers Parkway, Ashland, Ohio 44805-1969
419/289-1144, FAX: 419/289-6658, TLX: 948-7443
Printed in U.S.A. 6/95
23833A275