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HomeMy WebLinkAbout008-1008-50-000St. Croix County .Planning and Zoning Detail Sanitary Information Tuesday!, Ja~urary 20, 2009 Rt 9:12:43 AM Page 1 of 1 Computer #: 008-1008-50-000 Sub/Plat: 40 acres Section: 3 Parcel #: 3.28.16.39 Lot: TN/RNG: T28N R16W Municipality: Eau Galle, Town of CSM: 1/4 1l4: SW 1/4 NW 1/4 Owner: Jensen, Arthur D. Trust 569 County Road BB Woodville, WI 54028 State Permit: 353331 Issued: 03/14/2000 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 05/03/2000 POWTS Detail: NA Bedrooms: 3 POWTS Pretreatment: NA €at7t~s Issuer/Inspector As Built Plumber Kevin Grabau >4/1/00 -Not Required Gille, Dennis Jon Sonnentag Yes P/4aintenance Scheduled Pump Date Pumped 5/3/2003 8/28/2004 8/28/2007 9/2612007 9/26/2010 WI Fund: No Other Requirements Additional Notes Manev Owed Tanks buried before inspection, changed from $0.00 Zoeller 98 to Zoeller 140 pump -see new curve OK and staff signed off on report i °.tion Notification 04/01 /2005 V ~ 'Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Jensen, Arthur I Eau Galle Township nsp. BM Elev.: IBM l ~~ I l D a TANK INFORMATION 2,S' TYPE MANUFACTURER CAPACITY Septic ~ 0 O d Dosing ~~ H91 g TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~ ~ ~ Z / Z~I NA Dosing ) S~/ N~ 3 i f~~/ NA eratlon Holdi PUMP /SIPHON INFORMATION Manufacturer ~~~ ~ Demand Model Number ~ Z~-.GPM TDH Lift 2 ~ Lrictionl 35 Syeterr>z ~ TDH ~ Ft Forcemain Length ~~~ Dia. HZ' I Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No.: 353331 State Plan ID No.: Parcel Tax No.: 008-1008-50-000 STATION BS HI FS ELEV. Benchmark ~,28 pc.~ ~ ~ , p Alt. BM X2.0 3 aS= Bldg. Sewer S q ~., p S / Ht Inlet (Q G~ Dt Bottom Z ~ Header /Man. Dist. Pipe ~' Z ~~0 • Z~ Bot. System '* 3"~ 9~ Final Grade St cover ~ -~ ~ y 9 ~3 -~' 3,(~ ro3, / vo S~ 3. (,~A ll BED /TRENCH Width; Length r No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N a EN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM L acturer: INFORMATION Type O ' ~ U ~ Z ~~ ~_ C ER Mo tuber: System: >~ O I R UNIT DISTRIBUTION SYSTEM C~•~•~-~' =~5.4'f S .f~ 5-~ Header J Manifold ( Distribution Pipe(s) ~ x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. Z r Length ~ Dia. Z // Spacing ~ (~ !r 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.) Ins ection #1. / / Inspection : ~ ~bo Location: 569 County Road BB, Wood 'Ile, WI 54028 (SW 1/4 NW 1/4 3 T28N R16W) - 3.28.16.39 ~'`- 1.) Alt BM Description = ~ O '~ ~*~a ~r'ny._ j ~ ~ /os ~ I ' ~ ~ ~ Sf 3 ~ ~~ ^ ~ ~ Z t 2.) Bldg sewer length = 2.3' ~ p ~~ ~~d' srwcr . ~, l~5"r ~e~oW Alf 31+1 -amount of cover = ~ 1 ~ $ ~ c~.g 1 /o~ s f /~ ~~ } w s rr / 3.) contour= CSC, ~ r.~" -t~L ~ ~ / Y at]ou~ Df ~o~'h,. `1.~ ko wP l~ a~ ~+ wa~ ~~ // k~~// _--~9a I~rG i>~ ~r~- ~~~~~ f1«OS rYl ~ u ~~ i ~ ~U,,,~p~ c U•P Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ~ ~~ ~ 1Visconsin Department of Commerce ~I it - ~Q SANITARY PERMIT APPLICATION In accord with Comm 83.05, Wis. Adm. Code Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on county than 81n x 11 inches in size. '4 ..~... ~.~ j l J ~ • `,rr~C ^•~` Y • See reverse side for instructions for completing this applicati n,.., ~, `' ~S~ Sanitary Permit Number ~, e ~~~~~ ~° 3s333I Personal information you provide may be used for secondary purposes ,~~ `~ t-~ `'~ ^ Gee if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. ~ - State P n LD. Number . I. APPLI ATION INFORMATI N -PLEASE PRINT ALL INF R ION ~9~68$ Prop y Ow r Name ~yq~ 4r L tY4, 5 , ~ ~~ T~ g' , N, R f~p E (Or)~ Property Owner's Mai ~ Address ~' dot Num fi - Block Number Cit , S a Zip Code Phone Number dL~s1o a`qi o M Number 11. TYPE F B ILDING: (check one) ^ State Owned ~ ^ Ity ^ Village ~ Nearest Road may- p Public 1 or 2 Famil Dwellin - No. of bedrooms Town OFL V q III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) n - ~ • ~ ~. 2 > 1 ^ Apartment /Condo O - /0 0 8'_ ~D ' Od4 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. ^ Replacement 3_ ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an --____System ________System_____________TankOnly_____--___-___ Existing System ^_______ Exlstln~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 r 42 ^ Pit Privy /~U" ~ ~ 43 ^ Vault Privy 13 ^ Seepage Pit r 'r r ~ 14^System-In-Fill ~~-, ~ 8 Xc.E11- ~~ VI. ABSORPTION SYS M INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade /`~® Re uired (sq. ft.) Proposed (sq. ft.) (Galslday/sq. ft.) (Min./inch) Elevation ' ~ ~ 9 - Y g. ,S Feet Feet ~ S 7 ~ Z VII. TANK INFORMATION Ca aclt In allOns TOtal # Of r Manufacturer s Name Prefab. Site l Fiber- Plastic Exper. N E i ti Gallons Tanks Concrete Stee glass App ew x n s strutted Tanks Tanks Septic Tank r Holding Tank /Qyp 00 ~ ^ ^ ^ ^ ^ ift Pum T /Siphon Chamber pp op ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewa m shown on the attached plans. Plumber's Name: (Print) Plu Signature: (No tamps) M PRSW .. Business Phone Number: Plumber's Address (Street, City, State, Zi Code): ~Z ~0~ ST in~e~ WS S yao/ IX. COUNTY / DEPARTMENT US ONLY Approved ^ Disapproved ^ Owner Given Initial S~gitary Permit Fee ~~ncludesGroundwater j' Surcharge Fee) ~ v ate SSU2 Issuing Agent Signature (No Stamps) q ~ b 32''S' ~ 3^~ ~~2 ~ Adverse Determination -`~ X. CONDITIONS OF A PROVAL /REASON FOR DISAPPROVAL: ' ~ ~ ~ ~ - ~.~ ~5 ~~ ao ~ S~c. ~ . ~--~~ e4 l~/tf - ~ ~ C~ SBD-63~ (R. 4199) DISTRIBUT16N: 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 inownership oC prlumber 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 vvhenever 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, 608-266-3151. To be complete and accurate;thi~ sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, 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 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale dr 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 1 15 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. } `, ~ ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary March 1, 2000 OUST ID No.221471 DENNIS J GILLE 372 140TH ST AMERY WI 54001 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/1/2002 ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Site ID: 187225 St. Croix County, Town of Baldwin SW1/4, NW1/4, S3, T28N, R16W Facility: Arthur Jensen Proposed Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 648797 Identification Numbers Transaction ID No. 296688 Site ID No. 187225 Please refer to both identification numbers, above, in all corres ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, / [~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-785-9348, Mon. -Fri. 7:15 AM to 4:00 PM j swim@commerce.state.wi.us DATE RECEIVED 02/17/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7633 MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project ARTHUR JENSEN Owner ARTHUR JENSEN Address 2203 55 AVE Legal Description SW NW S3 T28 NR 16 W Township EAU GALLE County ST CROlX Subdnrision Name Lot No. Parcel lD Number Plan Transaction Number Index and title sheet Mound calculations Mound drawings Pres. disk caics. and laterals TDH and pump tank drawing ~~ ~~ Page 1 ~j ~F~ ~~ Page 2 `~I , j ~G Page 3 ~A 6'~O ~j~ Page 4 ~TIOA O® r Page 5 S,_ ~~ ~~ Designer DE iS OILLE _ License Number 2214.71 Signature ~. Phone No. 288-6637 Date 2-13-00 Notice: Tampering with this file by unauthariaed persons is prohibited. Deliberate modification wilt result in disciplinary action under s. 145.10, Wis. Scats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. SBD-10462-E (R.05/98) Page 1 of MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flaw. In ch- oun ds Metric Residential or commercial? R (r or c) (y or n) L_J Replacement system? Creviced bedrocks"rte? n (y or n) Slope 6 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 27 in 68.6 cm In situ soil infiltration rate 0.5 gpd/frz 20.4 Lpd/m2 Contour line elevation 97.5 ft 29.72 m Use standard fill depths? x OR Design depth? ~in ~cm Place X in box to use standard depths (24 and A+4 ineiusivej OR specify design fill depth. Center or end manifold ~(c oral Hole diameter 0,25 in o.f25. o.~5s, o.~ae. os~9, n 7F tl ~R1 nt A i1?{ inrh nnN Lateral spacing 6.00 ft Use 0 lateral spacing for trenches. Estimated hole space 4.00 ft Not a final calculation. Number of laterals ~ Pump tank elevation 89 ft Outside bottom of tank. Forcemain length 65.0 ft Forcemain diameter 2.0 in i.5, 2, 3 or 4 inch only. 2.067 in Actual I.D. SYSTEM SOLUTIONS Inch unds Estimated daily flow 450 gpd Absorption cell Design load rate & area Linear loading rate (LLR) Design width (A) Cell length (B) Depth of cell (F) Sand filter Upslope fill depth (D) Downslope fill depth (E) Basal area required (gpd/infiltration rate) Supporting components Topsoil depth Subsoil depth at center Subsoil depth at cell wall End slope toe length (K) Up slope toe length (J) Down scope toe length (l) Total mound length (L) Total mound width (W) 1.2 9P~ 375.0 ft 9.57 gpd/ft 8.00 ft 47.0 ft 10.0 in 12.0 in 17.8 in 900.0 ftz 6.0 in 12.0 in 6.0 in 10.73 ft 7.20 ft 12.10 ft 68.48 ft 27.30 ft HOlE DIAMETER CONVERSIONS 118 =0.125 114=0.250 MetrIC 5/32 = 0.156 9/32 = 0.281 1703 Lpd 3116 = 0.188 5/1B = 0.313 7132 = 0.219 34.84 mz 118.7 Lpd/m 2.44 m 14.33 m 25.4 cm 30.5 cm 45.2 cm 83.61 m2 15.2 cm 30.5 cm 15.2 cm 3.27 m 2.19 m 3.69 m 20.87 m 8.32 m Project ARTHUR JENSEN Transaction Number: Page 2 ofi MOUND PuN vlEw 27.3 ft 8.32 m W I =down slope dimension J = up slope dimension K =end slope dimension ~>~ Wit) =absorption cell (AxB) =plowed area (Lx11V) MOUND GROSS SECTION A = $.00 ft 2.44 m B = 47A ft 14.33 m J= 7.20ft 2.19m I = 12.10 ft 3.69 m I< = 10.73 ft 3.27 m typ. obs. pipe (anchored seaxey) 6' (152 rren) D = 12.0 in 30.5 cm subsoil cap .lateral topsoil G H E = 17.8. in 45.2 cm 99.00 ft ___ __ F = 10.0 in 25.4. cm Invert -- ----- .. .:: ~ ::: -:::•. eleY 30.18 m :~ ~:~::~:;:~= F G = 12.0 in 30.5 cm 'n •. ASTM C33 H = 18.0 in 45.7 cm D Sand Fill i sYs~ 98.50 ft elev. 30.02 m 97.50 ft contour 29.72 m elev. ~ 696 --y slope D = upslope fill depth plowed layer E = downslope fill depth Note: Rbsorption cell media will consist F =absorption cell depth of aggregate and pipe with laterals G =subsoil + topsoil depth at cell wall centered across AxB media. The cell H =subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: ARTHUR JENSEN Transaction Number: Page 3 of ~ _ 6+8.46 ft 20.87 m PRESSURE DISTRIBUTiiDN Cl4LCULATIC?NS Absorption cell Inch ounds Metric Width {A) 8 ft 2.44 m Length {B) 47.0 ft 14.33 m Lateral specifications _. _ Number laterals 2 Hoies/iateral holes Lateral length (P) .fl0 fi 13.41 m Hole diameter in 6.35 mm Lat. dis. rate 13.8 gpm 0.88 Us Sys. dis. rate 27.96 gpm 1.76 Us Hole spacing (X) in 121.9 cm Lateral diameter Pipe diameter Design opGOns Design choice Designer must '?C" one choice from the options provided. Manifold diameter Designer must `x" Otte CholGe from the options provided. 1 in (25 mm} 1 1 /4 in (32 mm) X 1 112 in (40 mm} X 2 in (50 mm} X 3 in (75 mm} X Pine riiarr~fx nbcirn nNams Design choice 1 in (25 mm) 1 1/4 in (32 mm} _ x 1 112 in (40 mm) x 2 in (50 mm) x X 3 in (75 mm} x 4 in (100 mm} x dace X in red pox of chosen diameter. Place X in red box of chosen diameter Distribution system contains: 2 Lateral{s) LATERAL DIAGRAM -END CONNECTION Place correct lateral diagram ay clicking in one of the drawings at right and dragging the diagram into this area. Latat~s i~811t£t@d i3+.teet the /4 & B dNnension Last halt dried ntxt to end cap ~ ~iGaR P AH laterals are ada-etioai lE. yc--}~ Hd es dried vn t1+e lsottoan aF the lateral ~ equally spaced FG3rt`R tTU2lit cetit#s ~Jl3 t~P ~ Cios>t ti3 mall~ad 3t .aapJ pant. Laterals ~ iorae main of P1~G S8h 4ti ~ s permanant end marker [par G13MA9 Tahlt 8+F_3f7-5j Lateral length {P) Lateral spacing (S) Hole spacing {X) Manifold length Hole diameter Lateral diameter Forcemain diameter Project: ARTHUR JENSEN Transaction Number: ~ ands Metric 44.00 ft 13.41 m 6.00 ft 1.83 m 48 in 121.9 crrl 6.00 ft 1.83 m 0.250 in 6.4 mm 2.00 in ~ mm 2.00 in 50 mm Page 4 of TDH and Pump Tank Drawing Total Dynamic Head Opera#ional head Vertical lift Friction loss Total dynamic head Dose Volume Dose is > Lateral void volume Minimum dose Drain back Dose volume 2.5(3 ft 0.76 m 9.20 ft ,~~ lp0 2.80 m 0.88 ft\~ ,l 0.27 m 12.58 3.83 m 10 times lateral volume 15.3 gal 57.9 L 153.0 gal 579.2 L 11.3 gal 42.8 L 164.3 al 621.9 L disconnect !~~ levels Typical Pump Chamber Layout In comt~ination with state approved treattnel-+t tank. Tank construction as per Comm 83.20(3) WAC. approved manhole Dover with weather proof n , ~ g ~~ and Pocking device !~~ levels ~ l~r~ box -'~ ~„ vent WPe ~ ~ electric as per NEC 300 and Comm 16.28 WAC waY of pump chamber or combination tank J A ,~/ alarm on pump on 8 pump off elev Tank manufacturer Pump tank capacity Pump tank volume 89.8 ft G 27.4 m D 3 " f75 mml of beddins~ under tank Pump manufacturer ZOELLER Pump model number 98 Alarm manufacturer LEVELALARM Alarm model number DVL Project: ARTHUR JENSEN Transaction Number: c A 0 ~~ B m C E 'p D Are laterals the highest point in the system? Yes'7(" here. If no, what is the highest elevation downstream of pump? C~ Forcemain drain back to tank? ('k" one) x Yes No attemate F- outlet location 18" (46 cm) min. ~r approved ~ outlet joint Provide 1 /4" weep hok or anii- siphon device as necessary Grade levels -pump tank mard~ok = 4" (10 cm) minimum above finished grade - vent = 12" (30.5 cm) mirrimum above fupshed grade 89.0 ft Pump tank elevation 27.1 m bottom of tank Inches Gallons 21.0 315.7 2 30.0 11.0 164.3 6 90.0 Page 5 of S` w u~'Y s 3 7'.2 ~ /~t R I~ w _ _ T ~w' { v7I d,:.. ~ tis t~ 1~~ t j ' .. " ~•' /r"rf !J ~ P~ A'` ,sry f~~~s II~ ~.~v- f I G:1 ..~ .i 2Z~~/~! ~~,. Ufl / .i ~ y~ R. +~~- LEI ~ ryt`-~ ~ 1 1 ~ ~ ~ ~ I I f ~ ~s_ I I ! ~ f ;~~ ~ o :~~r /t~ I If l I I I ! ~ II .~.- ~.~ I ! I l' 9 1! fi II I I 1 f ~ i t ~ i __.__~__ e PUMP PERFORMANCE CURVE w W PUMP PERFORMANCE CURVE PUMP PERFORMANCE CURVE SUMP 1 EFFLUENT MODELS ~ ~ EFFLUENT MODELS 3(8",112" 8 314" SOLID PASSING CAPACITY 14 " " " 42 318 ,112 ~ 314 SOLIDS PASSING CAPACITY 13 4 t3 t9t MOD EL 4 8 53 57 /55 /59 7 2 7 6 9 8 137 1139 140/ 4140 15 1 152 15 Feet Meters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. 3 t2 5 1.5 29 110 43 163 38 144 50 189 72 273 93 352 86 326 50 189 69 261 77 10 3.1 22 83 34 129 30 114 40 151 61 231 79 299 80 303 45 170 61 231 70 12 15 4.6 10 38 19 72 14 53 30 114 45 170 64 242 73 276 38 144 53 201 61 3 t86 4186 20 25 6.1 7 6 - - -- - - 17 64 25 95 36 136 66 250 29 110 44 167 52 tt . - - - - - - 8 30 59 223 16 61 34 129 42 3 30 40 9.1 12 2 - - - - - -- - - - - - 49 185 23 87 33 t ~ 50 . 15.2 - _ -_ - - _ - _ _ _ _ 28 _ 106 _ _ - - - - - ~ 11 32 10 60 18.3 -- _ _ -- __ _ _ _ _ _ - _ - - _ _ _ 70 21.3 - - - - _ - - - - _ _ _ _ _ - to 80 24.4 - - - _ _ _ _ _ _ _ _ _ _ _ _ 3 90 27.4 - - _ _ _ _ _ _ _ _ _ _ _ _ _ 95 100 30.5 - _ _ _ _ -- _ -_ _ _ - - _ _ _ 110 33.5 - -- - _ _ _ _ _ -- - - - - - _ _ _ _ 2 90 120 3 6.6 _ _ - - - - - 130 3 9.6 - - - - - - - - - - - 2 95 Shu t-o ff H ead: 18 ft. 5.5 m 19.2 5 ft . 5 .9m 18 ft. 5.5m 25 ft. 7.6m 23 ft. 7.Om 26 ft. 7.9m 50 ft. 1 5.2m 30 ft. 9.1 m 38 ft. 1 1.6m 44 ft. 1 eo 2 469 5 z 75 0 22 70 0 466 1611 4161 16314163 16514165 18514185 186/4186 188/4188 189/4189 191 ~ 2 65 3 Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal 100 379 61 231 61 231 - 58 220 145 549 145 549 . 45 60 93 352 61 231 81 231 - - 58 220 140 530 140 530 45 t 4661 4689 85 322 60 227 61 231 - - 58 220 134 507 135 511 45 55 79 299 59 223 60 227 58 220 128 484 131 496 45 1 t 70 265 57 216 59 223 56 220 122 462 125 473 45 50 62 235 55 206 58 220 85 322 58 220 116 439 120 454 45 188 4t88 45 170 46 172 55 206 70 285 58 220 104 394 109 413 45 1 45 20 76 33 125 50 189 51 193 58 220 90 341 97 367 45 - - 15 57 39 148 32 121 58 220 71 269 85 322 45 12 40 - - - - 23 87 9 34 52 197 51 193 69 261 45 152 ' 153 - - - - 10 38 - - 45 170 26 106 51 193 45 35 - - - - - - - 31 117 2 8 34 129 45 t - - - - - - - - 16 80 - - 17 64 40 30 151 - - - - - - 4 15 - 30 469 _ - - - - - - - - - - - - 20 g 25 5 - - - - - - 10 56ft.(17.1m) 66ft.(20.1m) 89ft.(26.4m 73ft.(22.3m 114 fl. 34.7m) 91 ft.27.7m) 110 ft. 33.5m) 137ft.(4 6 20 1 0099228 4 1 2 A CAUTION Model 185/4185 should not be subjected a 7 5 3,5s 7s 137 to less than 30 feet TDH. 0 5 7,59 139 NOTE: For Pump Pertormance on Model 112, Industrial col- GA LLONS t o z o 3 0 ao s o e o 7 o e o 9 o to o tt o 1z o t3 o ta o 15 o umn ex losion roof um ,see FM0219. LIT ERS _ _ _ _ _ ~l IOU L4V s[u 4UU 46p 56p '~ ~ FLOW PER MINUTE 0099~A • FHB-29-00 ?UE 03:4T PM JH LAPSON HEAD CAPACITY CURVE MODAL "88" __ 6 U 13 y to 2 8o t60 FLOW PER MINIRE TOSAI OYNAM;Sr Id,tt)f f lOwr[R M,MUi~ t;fau F.tfY Ay09R wATeRlaa GAMCfrV HEAD UNItO1MIN fEEY M[TfRb GAb$ t.TRO 5 ,.62 74 491 rd 1 OS 61 ?91 ,s ._s9 s ,ta 20 810 TS 4S w 21' P,4X N0, ~' 115 386 3746 F-+-J //B•~ •- p i/ti . . ems( i ~ 1 ~ a •`,~ l = v' • i,~~ .~ r j%, ~! ~ •` ~, ~..~. . ~ ~L. i \~ A~ i t /~" ~ ~ t ~~ NI~1 , I i j I C •-T ;2 r.j ~_ I • i`i• ~ P• 03 ~4~ .~ ~)~8 A .t/lfl t _ f ._...f. ~ :t1/t 6 „ .._.._„1.. - f-N1102 CONSUI~T FAC70RY FOR SPECIAL APpt:tCA7tdNS • Electrical a{tdrnaters, for duplex systems, are available an8 Variable Seve! float stirl:ches are availablC for Controlling singt6 gupplied with an alarm. and tt-re® ~phese syster+.ts. • Ntechanical alternators, for duplex systemt3, are available with Dpubte piggybacK variable level float SwitCihes are available or without alarm switohes. for variabtz level long cycle controls. n~.__I~rJ ..u ..~... d..te _ Wslnhf QQ IAG . ~~ N.P. Allud:t 4s Salsas Control tlolts.t?t, Mode Am SimDlnl Sel son t)u sex MtiB t t5 t Auto 9,4 t or 1 8 7 -^ N9ts ~, 115 1 n or 21i 4 Rae t38 1 Autc e.7 1 or S 6 7 -` E98 290 ~ t Non 4.9 2 or 2 • 8 1 of 4 d, S SELECTIOtt•tiUIDE t, Integral Moat oporilad 2 pole nrechattttal iwilch, no external Control ro~!red. Z single pt94yhack rar{sbM level !toast awltcti or double p-OgY>~k vat ia41e luvot, float switch. Refer to fM0477, 3. McChankai alternator 10.0078 or 40-0076. /. Sse FM0772, fo!tornct n,odN or Elecv:as! AltEina(ur, E-Poll. 5 Contror sWltch '0-0225 ~eeA at: a conUOl gr.:ivator, tpCdly auplex (9) Cr (t) tbet ayatem• 8. pact t;) Hess ,t_patc, jurlcr!or. Mx, for wstettipht ccnntUion w' wfred•61 almpleX a. dupteR oparahor+, tG~0002_ ). Twp (2) hole J•PaK for watsitipht connection a splice CAUTION ' forlnforrnolbntnaad+lienalZ0e11orprodu~~rolertocaralopoeCo*~bieslbRSuner,fMt%f1:Piggyusr:+t All Imretlstton or CoM101s, pra.!<fion darice6 and M~ldnp ehWtlb W dons br 1 qualirkd YsrteWele.elSrvitches,FM0417;ElecuicBlMemalor,FM0406;fdachanimSAMwr+W4Dr,fM01i6;6ompf Ncemeddtelncian. AUerec>rulsnaiatetycodessho~ltleefolbwedlncludingthemosl SeWiyo 9as;ns, FM0487; and 6inplo P!Iase SlmpkxPump CawevAban Syelen's, fM0732. recent NltlonJ! E;nthk boat (MEth sn41h1 OCCUpN;oM1 Saf@ly and Routh Act (OSHA). RESERVE POWERED Q~SIGN >~or unusual cand~tions a reserve safety factor is engineered into the design of everyl•oe{(er pump. ~~ tlrtx. ro; P.o. sox t6Ju ~~~~~ Lnusvilb, KY 10?5E•OJ6r Manurx7wer6 0l. . ~ ~ SMP 10: J6Q9 Cage Run RoaO L Oj/fBYI)IP, KY 40?!}•1Q6t ~e„rrp~,c+,s SNC~ /,9~3 i / ~/YI~ ~~ (SOdJ IlB•Z1Jt • t ~e:GJ 9ZB•PuMP fax(sn; lre•362t .... ..... ..- Z9 ~~dd ldnt7~x~ ~ 71N1 ~~~1~ LE99-B9Z-StL Ei~LO 000Z/i0/E0 ~e~„alt~,',«`'~~,1'~n: ~~~'„~o:~~r, r:-A ~L71LY~1{[~~+5t7 E 3:VA3.UA~~O~}~ii~~i?~~ i'' ; ; . ~ . i.:.r i~: ;-l tea wnd Fttanan IiNt-taons Paq~ _ _ ~„oi tiiv>wtonoOSMsl31J.l~de~a - 3rtlt:.~[~l'!'~'i:~ll~.='AF!3~~1 W; I-rtr.~ ~'.r~lu . IItEloh oornplata Tito Pid'+ort prpor tqt ~ ~ ~ then 81/2 x 11 incha~ in site. Plan snug include, but • _ ST• C ~.t,~lX not Arnitsd to wUftield arrd he-3z~W nt~ aros point (Btv1), d;tacdan and ~ of slapo, sends er PAR L . A ~manstonse, noetn eeaow, and toeetbn diaianco to r»ar~st rand. ~ ' APFL3CANT I~I1s0llYATISIV-1atEy ~ SE O~iNT as t iuF~au-tinu __. R EVttEt}BY~'"_.__._._..pATI: 3}ROPt:itt'1'OWN3~4 = ! pAOPERTYl.0GA7lON "~-~ - t~R'TNts`L A>~ _ YI~,K.4 ~ •S'~St~, - - ~ ~ ,1< ~' ~tr4,s 3 T 2 ~ ~ :N,R i ~ E j:~tf !V PROPERTY O3Y~MEA'•~S~ G A?ORt~S T T '2,p t~ . i ~ ~aT ~ at'~K ~ ' cs igr~. NA~c r,~p, r,~ u , ~t .A ~ PHONElV1~4BER 8+~.t~w~n,,wt Scoot; t~}S)f~8y.zg16 t_LA OIM N~ARE _~~t~v ~!k~-L.C y"'t'~` ~gy ~ Nsw Cansfrtidast ~ 1~ 39osk1enne3l Number of btWtooms 3 [ ; Addition to e~dng Ouikli~ i 1 iii t ~ i~ublic a conanerdd describe Code derlred dairy ibnr y.SO spa ~ iiecomm:nded des n toad rate 2 ~ ~ ....:.~_._bed. gp~ trench, j~tdlR ~orptian asoa ! 3~ ~ per, }~1 ~`t S itttrtdt, ft~ Maxpntrtt dedgrt 3a~r~Q rata _,,,;,~ bed, lifer` _ 6 b'2nCtt, 9p~ O~#YgO.~::~ ~+.+.:rr:'.7.°~R.._ ~ii L'1 ~ C N i~w ,~{a~~A / c..M ..+ wi,n.e i I I `I t-._..-.i H .....rr--.. e w V V ,M MW ~~, ~irr•~~ Additional dsi~ra0 ~ Ccntlidere~tans f~Ut~ >•J/` f 1' X ~ ~ ~ ~C ''~i 3 h1,wd U M l`t ~~~ O F $ ~I'~ F f C4 t°d~lff[_.~la'~i:~"-.'~r9 CV~\Z ~,t~1.i:S'~1,0'~~,___~1tL ~_.....FiC+^v/7j1t~~SAP-l3Al4lt..'~F9~t~iB~ _' ^. ~ r A A ~py~~yy may.-}- ~ ~~,M.~ r~ ~ ~W{y~ I{ !! - 3lnata'q~o is ,. VVY~a~~~b A S D3I13 M~ 1.S~1I( ~'V N. AMMA~ Y/1 MrllNiM M,•'Jl~/V Vy~nLTMV ~G fit, v (,.! u D S 1~9 t: - <y~ /.l•. I. (! I~1'NrI~Vi~~ ~ 5 ti~ } .r% q,~ 'I~f' {' f, ~, WW ~y~, y-,.V. ~, ~y "3tlit t~E$CRIP?tC~i t?Z,~dti'r ot~dtg '' ~~ 4,~~1 fAPm~r z~r• 8ortnQ ii ~~ ~~N 9S.bn t• D ~~,. ' /'~~' S` ~'su~`~or+.' in. t laW [•4...A. . ! .'llll ia{:1 l' VN.~:~ 71'MJIIII~'.~ HAut19e33 'flu.S'cLont. Corot 1 ' 4xa~M t~5a• ~:.cJt~nd- tar ~c. ~ 1F,~~~ 1 Roote I ~r7 ~,' ' ~~. ~.~ . ~.__ - ~. ~ 1L~4ttz' 3 i ~ •----~•-' s i 1 •,`_s_''rs b~~..S~. "' , -- C~ .1 ° :~ ` ~• ' `) i ~ ^ ~ t, ~ O+-~• $ ~Ci. '~~'{ Q. ~ l 3 ~ 1t, ~ ~F 1Y st t _ gt l L`f`S lire wi J~h~ ~S ~.'~S~'~'L~ , t-1 L+~f"+` ( C-S ` `~° ~ - ~a ' "~ ~ t, ' L' i i i ~~.~s..__,.. ,,... a:~~ 3'~iA ~ ~ Phons: '_.._ Arthur ?~~, >~e~erter 715425-0165 ' .~, rer soil Testis Atsi n Strvice-P,0. Box 7t+ River ~!E?a11s,WI 54422 c~-tb n: 2s.7~ ZoGU c~Nt"'-b 220254 U'L'lC1JlUU 12' 12 ~,4C 1?1:>>4C37227 F{At.LE F1i~FF,D)rRS -~+-+ G`ii.LE ., ¢RapEt~t'vowt,~R ~'~.35~~,~ ..__ __. 4t+~~. ts~~c~~Pi'i~ N~f`nr~r PARCEL i.D. ~ RorlnQ r~ 3, ~raund elev, R,~ -1~ ft. t3eplh ~ Yt~€drlp ~~~ w ~r Q Ground elev. ft t)aptle b iimltinp feCtOf Boring # V (.t`dOUf~ ei~v. i31[bt{rl~ :¢] 02 Nari~on r;~~t` ~~ In. aomina~ntColor ~ Munselt Motlles t1u Sz C ns C l 7axiuro _•~•.. Structure ..'._.o...... Consioe _.~ Bv~rxlay Rooffi t3Pt)I!t' . . o o a tar. 5x. Sh. Bed ~ 2 8-~"~ ~p y' '~ h~( - s~y~1 Z~abk. ~u`~- cg - w 5 .b 3 "L1_~6 S yR ~/y ~.s~ slti !. 1 ^-sbk t~ - •s~ .5 -.~,..__ ~mtrka; _ Flernark#: 3orinp ~ 'pound ~v, tti )epth to itnilln~ ~, . ._ ~ ,_ __ .....~,..~...,,. ~ : ,....,.., .., ,.A..~....... ~. ........ i vt%Uti/wd 1L: t~ NHA 111~C915lCGY Ha~L.ls it ILfy~'!2S • • ~ r;i1.LF' l~U3 - i ~ ~ ~~ ~ ~ t~ i~aye a'~ n f ~ i >:.~..~. i i , I B ~.C~ i~ ,~:co -c~ .'8il..s ptk~, ~ . s `r°~Sov~ G~-,,-~::rv'a1A-~ts~~ . o p ~ a I ~} ~'cass~.- ~ aE q.Z- i~sr Zs • Ffzcsr~t w~oux~ . . ____. I _ ~.a s 6 .? txi uar cap, Sher ~k ~ ,~, c .~ ~ 1 o.:t N! e t s~ieg `r~s Mtr~! . ~ . b ~ N ~ C34 8,~ ~ OM14'~ ...~.... 4fl `! b°!6 is q , 9- ~ ew~t41 i~ _ . ~ ~ ~ h t v 3 i ' i I t • • . oo-tb iyr:ature OateSlgne '"'._..~"'. re ep nne No2T~~'"'S ~""' . ' wisconsln °epartment of Industry, SOIL AND SITE EVALUATION R E P O R T Labor and Human Relations Division of Safety & Buildngs in accord with ILHA 83.05 ws. Adm Code Page ~ of 3 ' couNTY Attach complete site plan on paper not less than 8112 x 1 t inches in size. Plan must include but ~ S7" • C~~ `x , not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' Oab' - )OC~B - 50 ' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R IEWEDBY DATE 3 - I -Z,a~o PROPERTY OWNERS = M ~L~ - PROPERTY LOCATION ~R-~C~-K~2 Rtin ~ S'~wS~v eevv~t~ S ~1 1!4 N~1/4,S 3 T ~ ~ ,N,R 16 E (or~ PROPERTY OWNER':S MAILING ADDRESS. LOT # BLOCK # SUBD. NAME OR CSM # ZZp 3 SS~Rt f~Vt` . - CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE (MOWN ' NEAREST ROAD L3~~DI.JIIU w I Su~oZ f~fs) 68Y_ Zq L 6 t`, t°~v 6~-L-C ~`T~-F° ~38~ ~ New Construction .Use [~ Residential ! Number of bedrooms 3 [ [Addition to existing building [ J Replacement [ ] Public or commeraal desaibe Code derived daily flow ~I.S IJ gpd Recommended design loading rate , 4 bed, gpd/ft2 - trench, gpd/ft2 Absorption area required 3~ S bed, ft2 3-t S trench, ft2 Ivlaxlmum desi loading rate • 5 bed, gpd/ft2 - b trench, gpd/ft2 Recommended infiltration surface elevation(s) of 8 • S 9a•S Co,.~r ft (as referred to site plan benchmark) Additional design /site considerations f"ti0V n.lp W / $' X ~1 ~ " l3t?D .. M 1 h1 lh? U ~i lZ 4 o t= S f1'Np Fy G 1. Parent material Lo E?SS aUL12 6~t~C~fre. Tt ~~ Flood plain elevation, if applicable l`- ~ ft S =Suitable for system U =Unsuitable fors stem CONVENTIONAL ^ S ICU MOUND ®S ^ U IN-GROUND PRESSURE ^ S l~ U AT-GRADE ^ S ®.U SYSTEM IN FlLL ^ S ®.U HOLDING TANK ^ S I$U SOIL DESCRIPTION REPORT Boring # :~:~~.3.-~.;~ 3t 3:_Y ~:~ [ ~:3 Ground elev. a'f~.0 ft Depth to limiting factor Boring # 2 Ground elev. 95.bft Depth to limiting f3o~ ~~~ T Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrxlary Roots GPD/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. g~ terxh O-~ 1~~,z 313 ~ si1 z~-sb~r_ u" ~ C5 ~ ~ . S ~~ z $-Zg ~0~.2~~y - 5,~~ Z~sb~C mv~- ~S - •s ~~ 3 Z°l-3 s ~ R ~l~ --~1. ~-t2S~g L ~ esUk ~.~, - • 4 . S I o --~ 10`i 2 3 L 3 -' sL 1 Z'FS h1z wf'Fh ~S ~~ - S . 6 2. $ 30. t0~\i ~~~ - SZ~ Z'QSb12 yn U~Ft- ~S •S -6 _. _~ ?~ ,;' ~.~ ~ ~:~:.~.. r.. (~• ~ i`~ ~J\ r Remarks: Name: Please Print Arthu gerer Soil Testi N V" ~ / L. We erer Phone: 715-425-01 ', ' '., ~ ~' & Design Service-P.O. Box 74 River.Falls,WI. 540 -' 7~` 0_ p0- t 6 Date: 2. -•~ - Z OG (~ CST Numbe 2 2 0 2 5 4 PROPERTY OWNER ~~SCrN SOIL DESCRIPTION REPORT PARCELLD.# OO$- f~$-SO Boring # ~ 3 :::x Ground elev. 4$-fit. Depth to limiting factor ~~ 4 Boring # ~44 }p ~)) Ground elev. f t. Depth to limiting factor Boring # .,v„<~.~ <r°•~ vx ~~4~ ><:; Ground elev. f t. Depth to limiting factor 3oring # 22 ~' around 31ev. f t. )epth to imiting actor 1 J Page ? of ` 3 De th Domi t C l Horizon p in. nan o or Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr S Sh Consistence Botxxiary Roots GPD/ft o- a 10'~ ii j l 3 - i t . z. . Z`P s b k w~ h CS 1 Bed • S Trench . 6 2 8-2'l 10 ti~ y /y si'1 Z'Fsbk YrtU`~- cg - ,5 .~ ~ 3 z - S y R ~/y ~ ,S'~I~. sly l 1 as ~k o~.~~ - •y ,S Remarks: • 1 E i j1 €• . ! ~. Remarks: E' i s i hemarKS: f1C111dIK5: _. _. '~ ~' - , ~ PLOT PL~ Page 3 of 3 'SCALE 1"= 4D ' ~~ A ~i -~~ h'1 ~4- - ~1.:~00 •~ ~ oiJ S PlY«, z .S ' -~oU~ GlZw~t~ _!_~-_~.t1DIR-~'1~~ . ~ .. 4 - - L3 _ -. C'Z- - _ _ ~T u.~3r Zs ~~wrZ wio~~ . __ WUV9~ ~b Q~ ~)~Z.L K 'l t y SQL k [~ .. _ .._ ~ ( _ ~ ~ _ _ / iN L -~l S ~= .~ ~l1 pY.1~T~' CQhy14~7fi~'T vR NI D `•l~~ 1 TICS q~~ N ~` 9, ~ ' ~ Ikn J / M O a ~Dv~ F• ~D S ' ~ M 8 N`z.. ~~ . S , r ~ ~1 $~. 14 3w-!~c Z n~ ~~'"~ti4- CtRB'~ 610 ~ 4 ~ ~ ../`~~ ~ ~-g9°- L Z oo-fib _ -- ~~// _ . _ __ _ zzozsy : . off, Z-1- 2000 (715 ) 4 .5-~1 h5 CST Signature Date Signed Telephone No. CST # S'I' CI~dI1~ COUNTY J SEPTIC ': 'ANK MAINTI?NANCE AGREEMENT AND OWr~ EIZSHIP CEit'I~II~ICATIQN ~C7RM Uwtler/Buyer ~,___ ~'~T ",~ /~A K L ~'~ \/~'.JS~.J lvlailing Address ~_., ~ ~ a ~ ~ S -F'v`~{-v~ (~c~.~c~.~y i ~ (.y t ,~~{~U'Z Propet~ty Address _ ~ ~~~ _ ,.~_ ~~~-~ _____ _ (Vezifiaattou rcqujrt:d frvu i iia ~ $ Dapartrncnt for new cortstntction)~ ___. City/St~ttc ;LEGAL,, bESCItIPTI4~T Parcel Identi£ictttian Number QO ~ - ~~©8 - S'~ - ~ ~, ~' I'raptrl~ty I,oG~.tiazav~/ _ ~/t, J~k/-- '/,, St ~c. ~, T~_..,~1-~lb._.t~V. Town of,~u tsg //-~ _ Subdivision lit # ~____.____w~.. . , _ ~ _~-__ .,w_ Certified Survey Map # _ 'Volume , Page # ~ ~' 13 1Varranty Aced # _,~__ ~ , ~, Volume ~o z z _T,_, Page # __, 7 D ~- Spec 1~ouse ~I yes {~ no ~ L.a lines identifiable L~ ye/sJ ^ no SYSTEM MAIl~ITEAIANCE ~ ~-C/1.¢~ P~cc~-C~~~~~ lmpropcr use and maintenanceof your sal pe system ld result in its prcmattue failuue to b~d1e waatos. Prapertoaaiz~rea~,,ce consists of pumping ont tho s~p4c tank every thz~ a yeat9 or saaaer, if atadod by a licensed pumper. What you put into the system ran affect tl~e function of the septic taulc as a trc~ tmeat stage ir, the waste d{spo~al systeRt. The propetYy oa+ner agrees to Su6z~it t~ SL Cr+~ix Zoniag Ltepartment a ccttit~catzan form, sipped by the nrvttcr and by a mastezplumbar, jotnaeymanpltambez, restrictedpl imber or a liccase~d~uxnpe7 verifying that(1) tl~e on-site wrstewaterdisposal system is jn proper operatzug eanditiw andJor (2) after in; ~ectinn aa~l pumping (if necessary), the selsrie tavk is less than 113 full of ¢iuAgE. IJwe, the undersigned have read the above rcctuirr~ harts and a,gxeo to t;iaintain, the private sewage disposal system with the standards set forth, herein, as set by the Department of Cain nee ansl the Llapart:nont of Natural Re&ottxces, Statn of WisQOUSin. CrtK~aation statittg tryst yqur septic synteut bas been maintainer { reust be complete<i and ratdrn~ed to the St. araik scurfy Zoui~g Office t~rithin 30 da s of the three year expiration date. __~_ ~ l gl ~jb~ SIGt~TATURI3 APPI,ICAI~7' IaATE OV~!NE:Et C:ERT.~k'~~ TA ION I (apt) ce~fy that all statomaats ou this ; -,rnr~, axe true to thn host of my (oux) lcuowledge. I (wc) am (are) the owner(s) of tiac property described above, by vim,e of a wamt zty deed zacardsa ttx Rtg;strr of Deeds l7ffice. CGNA ' F A.PQLICAIQ'T _r___ T)AT~ ,.+F.r.«.+ AAy 1IIfUrmation that is mis-represetlCCd tp ay result in the sanitary permit being revoked by the Zonimg Department. ++***• *' Inryude with ttds Applicati~~n~ a stamped wan•lttty doed from tEto 12egistcr of Deeds nff5rc a copy of the c~ rtified stuvey trap if refrreace is ,Wade so the wacre.uty deed aa,rw~o,....~ BOtal~IT N0. BTATE l1JU1 OF WISCONt~IIN -FORM 4 ~~1~ ~'Ot ~Z PA~E~~O wARRANTr ono TKI{ MAC[ RpEMED fp11 REOpRONiO DATA .Toeeph Albrightson and Dorothy Albrightson, husband R~~T~ ~~~ x e as o t tenants, Grantors, ~• ~~~ ~. M/li- ilac'd 1b. Reoord Mt Stt- doy of D°~K Q 19_80 ~s and „~,~» to drthur D. Jeasea and JoAnne a at gt 0 lpuband and ,rife, as point tenants, Grantees. wtnRw To the rotiorrino deacrlbed real sst:b in St. Croiz Cotu-ty, 8tatia of Wisoonakc - Wast Half of Northwest Quarter (W~ of NW;tj of Section Three (3), Township Twenty-eight (2t3) North, of Range Sixteen (16) Nest, St. Croi: Cntmty, Wisconsin, except Tax Key Na the foibwing: Cotaaencing at the Northwest corner of said Section Three (3); thence South 595.09 feet; thence East 50 feet to the paint of begin- ning; thence South 27.91 feet; thence West 17 feet; thence South 393.48 feet; thence Bast 276.41 feet; thence North 421.39 feet; thence West 259.41 feet to the point of be- ginning. This deed is given in fulfillment of a certain Land Contract between the above parties, fisted June I, 1977 and reccrded June 14, 1977 in Volume 555, page 471 is the office of the Register of Deeds for St. Croix County, Wisconsin, Docuaeent No. 340776. TRAN~S~ p V S.~Y=~ ThN is no t homeatesd property. pN (~ -ah Exosption to warrantNs: Said real estate is subject to highways, taunicipal and zoning ordinances, Snd recorded easetaenta for public utilities. pew tt~b 3rd ~, of December ~ t0 80 (SEAy ..,~~y . ''//Jose Albrightson ~1.~ ~ ~ ~ s ~o~~ ~ (SEAL] Dorothy Albrightson fs~-U AUTHENTiCATiON 8lpnatursa autherNlcated thls day of ,19 T1Tt.E; MEMBER STATE BAR OF WISCONSIN iN ~. .uet+orl:.d by !i 7oeoe, wls. stacs.~ This Natrument was drafted by ~ ' I ACKNOWLEDGEMENT 8TATE OF WISCONSIN ss. St. Crotz County Panonauy cam. baron me, this 3xd aar ~ Deceslbe7c ~ tE 80 , tM show named Joseph Albrightsoa and Dorothy ~bri,~tson, husband and wife, as joi+±t tenA.+ts, Harald D. 01son, Atty. ~~~ua„~„-,~. to me known. to be the Baldwin, WI 54002. , ~ ~ ~0....."...s~0 ; person ~ who executed the forepoin~ In- ;per" -~ ' •.. J ~ stru ackrww ~ffthe `, isipnafurp may be autherrtieatsd or sckno~irte~ed tl,~rsr~M ..: - - - +xi : _,, ~ ~• ~ -^ ~. Harold D. Olson ,~~~~~ M r ~,'., ~ h v' ~~.e :Notary PubUc __ County, W:•. NY^~Y ~^Y ui.~Y muM 0. ryp~d a prb~- tNtiir ~- ; Q f! . Prn i • '~' .. .. •~• My Commission is perm«r-nt. iiL.oofstats~leatJ~dals; .~ ~: WARRANTY DEED -STATE aAR ~ Y~ABCtNiE1N. FROM NO, t