Loading...
HomeMy WebLinkAbout042-1091-70-000 4 c -0 I o 0 v c c 2 Ct O r G x C c N c0 ~C a) o y ~ v ° E ~ I r L O c w I C R fl N ti n c c a O O L C Z O U ~ N m LL c r (D O u) C co Q) a) X E C13 ~ a I d' O ~ ~ ~ yr I r00 o LL L z C, d I C,4 ~ a co cn o O z ? a v ~ r O N w m z U) c o U) z (A F- r N N E -e o m E o ~ I N O IDI • ~l ° L a) O O ¢ ¢ O 2 Z Z N z I c yj £ j N (V 4) 4, d (u }i U) CL Q (D c, Ln C U O G G a a r- O O m E N w O V~ 0 Lo ~ F- F- O O N 0 0 0 d LL Z° s g a o o N o Lr) Lf) fn tq ~ U ~ rn rn } E ¢ co O 00 w O ~ O O n N 04 (D W ~j U) oo n O 0 0 O co N C QUj Q Q 0- 0) O In .O :7 N t. H CD N E E a) co I C r 00 c c- co M O O O o) a) 1- ~ F H o • ~V y O M> ICI Ll.. N O U CA O ce _ I Cs C a w CIO E r~ o t A 0 a O ian U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERi E 7 ~L~~f S9~ -d X769 ADDRESS SUBDIVISION / CSM# LOT # SECTION 3 T .Z 9 N-RAW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 71 17,,,;~ cat-JU.H-e !mv-d a I J 44 s=T G,s. INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: DLO G ~LiVG /5-A' ygE 4:Z~.0 ~ ALTERNATE BM: - G • S. , ~q a SEPTIC TANK / PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: GIJ,~S Liquid Capacity: /,.20a Setback from: Well 7 S-V House y G Other - Pump: Manufacturer 2o6LG~2 Model# IZI Size Float seperation Gallons/cycle: ->a 5 Alarm Location ~7sl~t- .SOIL ABSORPTION SYSTEM Width: Length /,6' Number of trenches Z Distance & Direction to nearest prop. line: 71 Setback from: well: 7_&70 House > 7r D i Other ELEVATIONS Building Sewer ST Inlet; 2 z ST outlet. 5/, , PC inlet ,FSPC bottom gD,92 Pump Off R,, 3i Header/Manifold Bottom of system- Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: ^ LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hufnan Relations ST. CROIX 'Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PI o.. FOGERTY, GLADYS X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: l J '61 " A9590267 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j~~ps ~y,e ZGd Benchmark Dosing C1)U C /1'~ 6).80 Aerat~ n Bldg. Sewer Holding St/ A Inlet g9, -33 TANK SETBACK INFORMATION St/¢+f Outlet /a' TANK TO P/ L WELL BLDG. Ve Air Intake ROAD Dt Inlet Septic >/GUS ~~Gd' ' NA Dt Bottom s 79 77' Dosing///w, NA bl"dell /Man. /w•~43 / Aerati NA Dist. Pipe Hol Bot. System PUMP/ INFORMATION Pm Final Grade Manufacturer e on Demand 0.5, o+ 6-, S, v c4 ~/(")ql /0.1/ , 90, 97 5 3~D Model Number 70 TDH Liftq.96 Friction ~Q~ System )TDH, t ' L H CC~-c, 3. 8 -:0 Forcemain Length/( Dia. a " Dist. To Well 7/(Z' w4~~ OIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT its Inside Dia. Liquid Depth DIMEN I N 7 DIMENSIONS ' SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING u acturer: INFORMATION TypeO CHAMBER Mod e y m er: i System: "-,,-.c_1 to Eo c, OR UNIT / Y DISTRIBUTION SYSTEM m ka;W /Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length &0 Dia. ~ Spacing ` 5 / 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 E] Yes C] No C] Yes El No CP".v COMMENTS: (Include code discrepancies, persons present, etc.) Mn^LOCATION: Warren.32.29.18W, SE, SE, 60th enue~/~erfo~ i ,<c /,00, V7, lc--C C~ /n~u~pW /1 Plan revisi n required? ❑ Yes ❑ No Use other side for additional information. g SBD; 6710 (R 05/91) Date Inspector's Signature Cert. No. y(/ ADDITIONAL COMMENTS AND SKETCH - SANITARY PERMIT NUMBER: p m~ SANITARY PERMIT APPLICATION Buereaau u oand s f of B uit didinWater S s g WateriSy Butems 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 8112 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 ❑ Check it revision to preus application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1 /4 114, S 32 T 29 , N, R /p E (or)9P _IF Property O ner's Mailin Addr s Lot Number Block Number 1 tE City, State Zip Code Phone Number Subdivision Name or CSM Number 11. TYPE OF -BUILDING: (check one) ❑ State Owned ❑ Cityy Nearest Road ❑ Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF w [LO /Sw~ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo O- © - p~ 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 on line B, if applicable) A) 1. ❑ New 2. 0 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 Number 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 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 411010 -90, 5`AD , 2- • 917,,Z Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank ,G f m ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 4"e I a~ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY ATEMENT I, the undersigned, assume responsibility for installation of the o to sewage system shown on the attached plans- Plumber's Name: (Print) Plum er's Signature: mps #PfMPRSW No.: Business Phone Number: r .4 1 ber's Address (Street, CTfy, State, p Code): 9)r : 43 IX. COUN Y / EPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Ag nt Si ature (No amps) Approved E] Owner Surcharge Fee) verse Initial er p~~G~ Addverse Determination CJC~ X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD-6398.(R. 015/94) 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 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 ma'intained'-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'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 Dwe"ling. 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 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. Corplete plans and specifications not smaller than 8 1/2 x 11 inches must be subriitted_to the cc unty. The plans must include the following: A) plot plan, drawn to scale or with complete dimension,, location of no',Jing tank(s), septic tank (s) or other treatment tanks; building sewers; wells; water mains/water ser: ce; strea-ns s,r,d lakes; pump or siphon tanks; distribution boxes, soil absorption systems; replacement system area,; and the to--at:othe building served; R) orizontal and vertical elevation reference points; C) complete speci fi-ations for pumps anc controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and ,.ump manUf_( !,rer D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and alI 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 rnonitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Industry, Labor and Human Relations August 15, 1995 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S95-02769 FEE RECEIVED: 180.00 FOGERTY, GLADYS SE,SE,32,29,18W TOWN OF WARREN 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. 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. Sinc rely, n th Stiemke Plan' Reviewer r ORIGINAL Section of Private Sewage (608) 266-8230 7:00 to 3:45 Mon. thu Fri SHDA-7987 (R. 10/84) AA . • r. l ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT IHDLX DILHR Plan I.D. # S95-02769 Date 8-15-1995 Owner Gladys Fogerty Phone 715-3318 Address 1092 60th Ave. Roberts, Wis. 54022 gal Description part of a 159.6' acre farm. Treatment system home located in the SE 1/4, SE 1/4, Sec. 32, T29N, R18W. Town of County - _-.--Warren._...___St.. Croix C.S.T. David Fogerty CSTM3233 Installer Local Authority/ Supervision St.- _roi x -Co ntv Zo na Dept PROJECT DESCRIPTION Replacement system. Failing existing system is overflowing, and appears to consist of two tanks (size & condition unknown) with a direct overflow pipe. Estimated daily potential wasteflow for this existing 4 bedroom home is 600 gals. Soils as described by evaluater are slowly permiable in the upper 12" (platey structure due to field compaction) with a soil loading rate of .3 GPD/ft2. A long narrow trench type mound system is proposed. Soils beneath the top 12" are seasonally saturated and extremely firm (sandy clay). A mound system using 12" sand fill is proposed. Existing septic tank will be exposed and Pg.l PLOT PLAN VIEWS inspected, certifying it is code compliant Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS and 1200 gal. in capacity; otherwise, Pg.3 PIPE LATERAL LAYOUT a new 1200 gal. approved precast septic tank shall Pg.4 DOSING CHAMBER CROSS SECTION be installed. Pg.5 PUMP PERFORMANCE SPECS 595-02"769 1111s design for installation is based entirely on measurements, elevations, landscape conditions (slopes etc.) and soil suitability provided by CSTM 3 23 3 The accuracy of his specs, as reported, shall remain the sole responsibility of the CSTM. ~lun rlllrrp~,6 1SC0 Any use of this POWTS design ty any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) .Q. w. a . shall not be construed as an assumption of responsibility by .LIMM the designer for the workmanship, construction, placement, min substitution or selection of any components not specified, or 8 H(IDZON, any assumptions by the plumt,er that any. unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet/frozen 44~~ """~~•~j4~~~` soils) by any such parties or persons. 9A~ SIGH 0 - z 0 tA O o 6` e `I Z SON ` , / ITV 4 cup • 95-02"7 69 , INS, was f' ce. - PR0PEPTy L,iNE -EA6r Synthetic Covering Medium Sand Distribution Pipe 4 do N o Q Topsoil _ e lip vp i faRM % Slope Trench of 2 Force Main Plowed % to Aggregate Layer Ju (Undisturbed. D 1,49 Ft. Soil E,.-/.- Pll Ft. 4 Cross Section O1z A Mound System Using F • fa Ft. Trenches For The Absorption Area G Ft. A V Ft. N-5 Ft. B Ft. 'Q L C Ft. O 4 K ~L Ft. L Ft. 7 p.. m- J 9 Ft. 2 I Ft. H F`' F W_ Ft. i J ' C pRlP ditto Observation Permanent sari µ ; pipes Markers t • f O < ST ~L ~ifif s J V 0~ ~~QUN qF,S X *H/~E,4DEp e16 Trench Of 2 ~ - 2 4,velfe/i 1Aj10 Y ~ Aggregate Dom' pry°~°° C) A 11 Mound Using Trenches For Absorption Area a vt v so;~ /V fd7X tTrvE c,j^f C / y • _ ~ooo Gw 595-02769 -3 Gio~f~=~ Zooo - sQ Fr L x 53 8 y l z joa g S4 fT VSTRIf3uT'IoA3 PIpE N Two.R._k L q .o.ur P R 0 \ P Co a F r \ R / Fr WcNES ~oCtcE MAirv ^ t~r. P Vc y IiucNEs o f VARi'AGLE 'Di srAa CL. TOTAL Vc9 I V o ivh E Gabs. 'I YZ/ H ote~ 'A,AYIETER INGHtS i ~h~E~/4~ n t 2 INcNES • MAMIFOLD A I wc.14ES S. P o .LLB ~14? , P E- 10VERT E Ll;VAT1Oo Coll ' e i= L. A TE IN-5 17 It. -7 Q pF s. ' ,V1S10~ s roc ,~A~l -DE TAi I-- Aru V e.AP pp? Fo R ATE p P P E C] • Rem ovE- hll 3)Rill BVR 5 l \ y R 595-02'769 1I6IES locA-reo OX3 BOTTOM EqV-A(ly SPACE L) , ViSTRiduTtoN *DlSchAi2CrE RATE' PoR eAch LATERil- P~R GAL/I~►~ti1. TOTAL 1`7. iSTRiBOTioO DiSCHAR&E* RATE r-OR Nt;twoR k 30"/2- ~,~~~MI'1V. a•~' MI'M1 MVAA PUMP CHAMBER CROSS SECTIOM AMD, SPECIFICATIOAIS PA JE- ~ of C` VEo'T r.AP 4"C.I. VENT PIP[ APPROVED LOCKING WEATHER PROOF JUNCTIOM BOX MANHOLE COVER 2S' FROM DOOR. IAM WINDOW OR FRESH 12"MIU. AIP INTAKE I ~/1AD~ ~~~~~iTION GRADE, I 4" MIN. IB" MIN. CONDUIT fle~U~n PROVIDE I - INLET AIRTIGHT SEAL I III n I III V E OI 5 V I III APPROVED JOINTS APPRO ROVED J N7 IN K I I( W/C.I. PIPE W/C.I. PIPE 'I fv I S EXTEMDIM& 3' ~0~1D ( I I ALARM EXTENDING ONTO SOLID SOIL L7 1 I II ONTO SOLID SOIL B q. ~/.Z) I I rn I I o4J c V I I go• ~a ELEV. FT. PUMP---- wig OFF TANk 'Etp01^' 6 I BLOCK cc lrvAfiod f 71.0 RISER EXIT PERMIirtD OUL9 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEGIFI•CATIQI IS DOSt ((jE~,(S a,v(,f-t 'Q WMBEa OF DOSES. PER DAH TANKS MAUUFACTURER: TAWK SIZE: /0 i - GALLONS DOSE VOLUME 25, ALARM MANUFACTURER: wyt-1 llf1 m ~ - INCLUDING SACKT~ 6W: ? ZS GALLONS MODEL MWASM V L CAPACITIES A= INCHES OR y~ GALLONS SWITCH TYPE: lg"ed/Q y Fla'' T- B =-2--IMC14ES OR GALLOUS PUMP MANUFACTURER: C=IAIC14 ES OR GALLONS MODEL NUMBER: AL / 111A D- ~Gf751NCHES OR 33 GALLONS SWITC4 TYPE: Pf6-6YBAvck- MSR'COPY IJOTC: PUMP AMD ALARM ARE TO BE MIMIMUM DISCHARGE RATE 3o GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF ANQ DISTRIBUTION PIPE.. FEET fiAooL S9PtC'S . + Ml"IMUM NETWORK SUPPLY PRES LIKE . . . . . . . . . . . 2.5 FEET EAC(A, O~ + FEET OF FORCE MAIN X ~ F/oo ".FRICTIOU FACTOR..' 3/ FEET TOTAL 09MAMIC. HEAD s 23 • 9/ FEET 9A. RbVN p 9T . INTtRMAL DIMEMSIONS OF TAUK: LEKIGTH ;WIDTH ;LIQUID DEPTH J A PRIVATE SLWAGE SYSTem • Co nditionalC~' APPRO LABOR V MAII RELA F iNDU3TRY. D BUl )14 DIVISION of SAF , SEE COB SF'ONDENCE Pe5 HEAD/ ,1S CAPACITY 34 32 105 CURVE 30 '95 - 20 i 90 26 H5 EFFLUENT 24 80 MODEL and Q 75 MODEL 189 22 70 185 19 DEWATER/NG 2 20 8S_ a 4 ~ > 1e 0 55 F 18 5o \MO DE L O 3 MODEL F' 14 45 1HH 12 40_ 35- 10 MODEL 30 137,139 MODEL 8 25 SEWAGE and 185 DEWATER/NG 8 20 MODEL + 15 ~kEL' 181 4 10 2 C MODEL a + 5 - 53, 55, 57, 59 0 GALLONS 10 20 30 40 50 eel 70 80.1 90 100 11o 24 LITERS 0 80 160 240 320 400 75 _ , 22 - FLOW PER MINUTE 70 - - r 20 e5. _ 1 C ,t ?0_ - MODEL Q 295 j S 55 1e V so ~i 14 45 MODEL j Z 294 L}' 12 40- Q 35 MODEL F- 10 293 Q 30 MODEL 284 i e 25 I MODEL e 20- 282 i 1s _ F 4 to ...__MODEL 2 287, 268 e 3280 Old Millers Lane j GALLO#" to 26 30 40 5o go I 7o so I HO 100110 120 130 140 ist 180 1~0 to 190 P.O. Box 16347 4 I t i Louisville, Kentucky 40216 L1T[M 8 HO 1M 2" 878 4108 480 s" $40 720 (502) 778-2731 FLOW 1'EII M"411 T -02'769 F11Gf1 F~tEID "161 ="163* ="1fa5*" "185"-"188"-"189" Series I iP) ('2 HP) (1 HP) (1 HP) (1 %2 HP) (2 HP) 0 Automatic or Non-Automatic. +O 9 t/2 H.P., 115V, 230V, 200-208V,1 Ph. or 3 Ph., r+ st o.- u•, 0.1 u,. c.. L", c.+ u1. G.- we 6.1 u.. 46OV, 3 Ph. + sz ss 10. 73, a+ :J+ ms sez M ser r ` %n m rn r.t ro. n+ 23+4a seo Is+ sr2 n 'Not Cae • 1 H.P., V/z H.P., 2 H.P., 230V, 200-208V, 1 Ph. 9 =$z jjz ~z sJr +a s.9 or 3 Ph., 460V, 3 Ph. R ~ az ]+0 s9 e73 MI 22' +Ja sls " seo 17 . z9n zee ss »3 +ze 4e4 aJ se" • Passes 3/4" solids (sphere). z4s ss zss se 2m 90 340 +2+ 4" +n 4e+ SC 1225 8 1+/z" NPT discharge standard. ~r . .e .z s; zne ~5 zs3 +so m ++4 u+ .B =+9 90 Jot +00 J19 85 32 • Float operated, submersible (NEMA 6) 2 pole +3. 2" 3e s +sJ '0 269 ro zes mechanical switch. ^n =418 s 28 too 54 jp4 z • Automatic reset thermal overload 43 e J= +40 3n en 79 protection, 1 Ph. only. ++0 3200 a W • Durable cast iron construction. sR es 13 91. • 2" or 3" flange available. • ♦ Canadian Standards 20 ft. UL listed neoprene cord and plug. listed Sp Assoc. Approval Available Non-Automatic k1ndni Pirnirrd WARNING: Model 185 should not be subjected to less thaA NOTE No UL listing Ior 200-208VII Ph, pumps. 30 feet TOK Mercury float switches are available r for non-automatic models. l Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ` • COUNTY Attach comRIete site plan on paper not leice 1 size. Plan must include, but not~imited to vertical and horizontal refe%of slope, scale or PARCEL I.D.# dimensioned, north arrow, and location rest ro APPLICANT I NFORMATION-PLEA ~RMA REVIEWED BY DATE tN PROPE ,Z R: J f j N o PROPERTY LOCATION ' GOVT. LOT 114 1/4,S T N R E o PROPER 0 ER':S I DDRE LOT # BLOCK # SUED. NAME OR CSM # O 1 e '-cwrnt~Of~ CI-j9;, S ATE zip CODE,," PHONE NUMB ❑CITY []VILLAGE [MOWN NEAREST RQ#D [ J New Construction Use[/] Residential/ Number of bedrooms [ J Addition to existing building [/J Replacement [ ] Public or commercial describe Code derived daily flow X00 gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface evatior " S - c It (as referred to site plan benchmark) Additional design / site considerations e Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S 0 U 4S ❑ U ❑ S O U ❑ S O U ❑ S P U ❑ S 4U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baaxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench MEMO 5 Ground elev. e ft. 2 /L-d( o - b' r/-r S Depth to limiting factor 21 qj y S i s - s - s- y 6 s< e- `6fe - - Remarks: - Boring # L -Z- o - S e ✓ . i. . 3 Ground elev. ft. -fit Depth to 3 Y2 2. - GS r _ . s limiting factor Remarks: - 0~• C ~a CST Name:-Please Print r Phone: 2~ zgg -_ewf Address: Signature: / 2F-,* Date: L 'LO CST Number: 747 rnvrcm r vrn.an av~r_ uCO%.nlr i IvII ncrvn PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boundary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench x .f 3 h S 6 ~s Ground elev. Q&2- ft. L . -3 7 S - _ [ v 3 Depth to limiting factor 3 -Z -5, - 6 s~ 6 e ~ r - .0 .7 Avr Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # h.: v k{i\ C•tiN.:.:v ..n.. Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) s ~ V g s - o\ tl a II \I+ h Ntj 3 tl \ o Hal a C a s yp ~ a M~ IN, , n >7 w STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix Co ty OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS/ (location of septic system) Please obtain from the Planning Dept. CITY/STATE "2 ,2,t ~?TJ . C. -ILL l0 13 PROPERTY LOCATION .5 1/4, .5E 1/4, Section , T~Z W TOWN OF lwGfZ121Z~,YJ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER I 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: DATE:' a - ~S 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 o Location of propertyS 1/4 S~ 1/4, Section _r.1_,T_,A_~_N-R/J0 W Township G/ ,e Mailing address 2 LV Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Ansn~ Total size of property ll~ Total size of parcel ' 1 Date parcel was created /y 7-,l Are all corners and lot lines identifiable? i.-' Yes No Is this property being developed for (spec house) ? Yes v No volume lD p Y and Page Number / ~O 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 the office of the County Register of Deeds as Document No. 117 , 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. Signat re of p icant Co-Applicant Date of Signature Date of ~ignature 5221'7 YOL 1008wE 167 • STAVE OF WISCONSIN, CIRCUIT COURT, St. Croix COUNTY -PROBATE- IN THE MATTER OF THE ESTATE OF , . t . FINAL CV3IX Cam., James J. Fogerty JUDGMENT OCT 6 1994 8:00r~! A., File No. 92 PR 106 ~$<-'t•'~"V"""`~ THE COURT FINDS THAT: 1. The petition for final settlement came on for hearing upon notice/waiver as provided by Ir v; notice has been published .or determination of the heirs of the decedent; the expenses of administration, funeral, last illness, and the claims against the estate have been paid; the Department of Revenue's Certificate Determining Inheritance Tax, if required, and Closing Certificate are on file showing no unpaid taxes; the decedent at the time of death owned personal property in joint tenancy and/or as survivorship marital property asset forth in the inventory on file, which interest terminated at death; distributions have been maae as shown in the account(s). 2. The decedent died testate on Sept. 5, 1992 Date 3. The following were the heirs of the decedent: Gladys J. Fogerty, surviving spouse and sole legatee of the will of deceased. 4. At the time of death, the decedent had the following real property interest: A. Description of Joint Tenancy Property and Name of Surviving Joint Tenant(s): None B. Description of Survivorship Marital Property: Name of Spouse: G l a d y s J Fogerty Miscellaneous farm property, including dairy stock and bulk tank. Real Property: E } of SE4 and SW4 of SE4, SEc. 32, T 29 N R 18 and that part of SEc. 32 T-29 N R 18 W described as the E } of NE 4 lying S of the Township Road which crosses said NE4 at an angle running NE and SW, approx. 42 acres. 5. The decedent at the time of death had a life estate in the following property: None PR-1425,3/86-(29A) FINAL JUDGMENT s. 863.27. Wisconsin Statutes Page 1 of FINAL JUDGIIliENT 6. The following property 9 P y remains for distribution: yQL98wtUQ `J Personal: Miscellanous farm property, including dairy stock and bulk tank. Real: The East Half (E}) of the Southeast Quarter (SE4) and the Southwest Quarter (SW4) of the Southeast Quarter (SE4), Section 32; Township 29 North, Range 18 West, AND That part of Section 32, Township 29 North, Range 18 West, described as the East half (E}) of the Northeast Quarter (NE4) lying South of the Township road which crosses said Northeast Quarter (NE4) at an angle running Northeast and Southwest, an acreage of approximately 42 acres. IT IS ADJUDGED THAT: The classification of asser- 3s shown in the inventory is approved. The payment of claims and debts and the accounts on file are approved. The fees of attorneys, personal representative, and guardian ad litem are approved. The distributions described in the account(s) are approved. The interest of the decedent as joint tenant in real and personal property terminated at death. The interest of the decedent in survivorship marital property vested in the surviving spouse at death. The life estate of the decedent in the real and personal property terminated at death. The property described in finding number 6 is assigned as follows: Gladys J. Fogerty, per last will and testament of James J. Fogerty. State of 'X[SCOnsln County of St Croy I twrpby cer fy that ihrr; rVc4 neM is a full, true and conrW copy ot~the or,, rat,on file and of rr co -Ij !n b`'m and nas "L)kvn comparisd t:,,r r1 Al;asl 9 -e P.egister in PrQC4jq_. BB~YY{ THE COURT: Tho Js 0' Brien CirowtJadge -N Circuit,,Court Commissioner Name .,Attorney Address (`ate 2-2 STate Bar of Wi #01007075 Page 2 of