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HomeMy WebLinkAbout008-1013-60-100 (2)St. Croix C®u~~ty Planning and Zoning Detail Sanitary lnfortnation Tuesday, November I_i, 2007 at 8: 04:21 ,4M /'age 1 of 1 Computer #: 008-1013-60-100 Sub/Plat: metes & bounds Section: 5 Parcel #: 05.28.16.680 Lot: TN/RNG: T28N R16W Municipality: Eau Galle, Town of CSM: 114'{14: SE 1/4 NE 1/4 Owner: Moulton, Jon 2290 55th A venue Baldwin, WI 54002 State Permit: Issued: 04/23/2001 POWTS Dispersal: Mound Permit: Reconnection County Permit: 9 Installed: 04/23/2001 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Issuerilnspectar As Built Piurnber Kevin Grabau No Helgeson, Bennie Not determined No Other Requirements Additional Notes Money Owed not inspected -permit entered into database in $0.00 2006. Replacing existing mobile home with a constructed 3 BR house. Owner: Moulton, Jon 2290 55th Avenue Baldwin, WI 54002 State Permit: 175650 Issued: 08/21/1992 POWTS Dispersal: Mound Permit: New County Permit: 0 Installed: 08/27/1992 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA rtes issuer/inspector As Built Not determined Unknown Jim Thompson ~ Yes t Scheduled Pump Date Pumped 8/21 / 1996 5/31 /2003 5/31 /2006 10/31 /2006 10/31 /2009 Plumber Other Requirements Additional Notes Money Owed Helgeson, Bennie Connie Juen issued permit -not on list. 100o gal. $0.00 septic to 750 gal. dose tank to 6' x 62.5' mound. Filed with 2001 reconnection permit /* Wisconsin Drrpartment of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Droision , INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Lawxs.15.04{(1)(m)]. ~b~~~deJ~~me: ^ City ^ `~~@I~I~~I~"T'8~vvnshl CST BMElev.:- Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM ELEVATION DATA c°untSt. Croix Sanitdgy Permit No.: State Plan ID No.: Pa rce L7AY,Np ~ 13 -10-000 STATION BS HI FS ELEV. Benchmark Bldg. Sewer St / Ht Inlet St/ Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System i Grade BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth IMEN I N DIM N 1 N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu acturer: SETBACK INFORMATION Type O CHAMBER Mo a Num er: System: OR UNIT DKTRIgUT1~N 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 ^ Ye No No /COMMENTS: (Include code discrepancies, persons present, etc.) Location: 2290 55th Avenue, Baldwin, WI 54002 (SE 1/4 NW 1/4 5 T28N R16W) - 05281665 1.) Alt BM Description = 2.) Bldg sewer length -amount of cover = 3.) contour = Plan revision required? ^ Yes ^ No Use other side for additional information. _ SBD-6710 (R.3/97) Date Inspector's Signature Cert. No Parcel #: 008-1013-60-100 11/13/2007 os:oo AIVt PAGE 1 OF 1 Alt. Parcel #: 05.28.16.680 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - MOULTON, JON T JON T MOULTON 2290 55TH AVE BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 2290 55TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 16.000 Plat: N/A-NOT AVAILABLE SEC 5 T28N R16W PT SE NE THE S1/2 OF THE Block/Condo Bldg: ' ' SE NE EXC THE S 327 OF THEE 535 OF SD S1/2 SE NE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 05-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1099/219 QC 07/23/ 1997 992/254 W D 07/23/ 1997 964/465 W D 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment ~/alUat1011S: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 24,800 92,900 117,700 NO AGRICULTURAL G4 13.500 1,800 0 1,800 NO UNDEVELOPED G5 0.500 50 0 50 NO Totals for 2007: General Property 16.000 26,650 92,900 119,550 Woodland 0.000 0 0 Totals for 2006: General Property 16.000 26,650 92,900 119,550 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/1712001 Batch #: 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Srt. Croix County Planning and Zoning 29 2006 4 03 49 PM , at : : Tuesday, August Detail Sanitary Information Page 1 of 1 Computer #: 008-1013-60-100 Sub/Plat: metes & bounds Section: 5 Parcel #: 05.28.16.680 Lot: TN/RNG: T28N R16W Municipality: Eau Galle, Town of CSM: 1/41/4: SE 1/4 NE 1/4 Owner: Moulton, Jon 2290 55th Avenue Baldwin, WI 54002 State Permit: 175650 Issued: 08/21/1992 POWTS Dispersal: Mound Permit: New County Permit: 0 Installed: 08/27/1992 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined Yes Helgeson, Bennie file missing in 1992. Info from notecard -file folder $0.00 Jim Thompson Signed Off: Yes was placed in 2001 reconnection, which hadn't been entered in the database. Will return to archives Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 8/21 /1996 5/31 /2003 5/31 /2006 8/27/1995 Owner: Moulton, Jon 2290 55th Avenue Baldwin, WI 54002 State Permit: Issued: 04/23/2001 POWTS Dispersal: Mound Permit: Reconnection County Permit: 9 Installed: 04/2312001 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Kevin Grabau No Helgeson, Bennie not inspected $0.00 Not determined Signed Off: No Parcel #: 008-1013-10-025 11/13/2007 os:oo AM PAGE 1 OF 1 Alt. Parcel #: 5.28.16.65A 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/12/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - MOULTON, JON T JON T MOULTON 2290 55TH AVE BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 5 T28N R16W PT NE NE EXC N 35.01 AC BlocklCondo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-28N-16W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 04/12/2004 759303 2546/133 WD 04/12/2004 759303 1546/167 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment ValUatlOtlS: Last Changed: 08/04/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.500 300 0 300 NO UNDEVELOPED G5 1.490 700 0 700 NO AGRICULTURAL FOREST G5M 1.000 700 0 700 NO Totals for 2007: General Property 4.990 1,700 0 1,700 Woodland 0.000 0 0 Totals for 2006: General Property 4.990 1,700 0 1,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 /* 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 secontlary purposes [Privacy Law~s.15.04 (1)(m)]. rmi Holder's Name: ^ City ^ la a of: ~ou~ton, Jon ~a~ Cga~~°e"~ownshi CST BM Elev.: Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemai n Length Dia. H Dist. To weu SOIL ABSORPTION SYSTEM ELEVATION DATA count~t. Croix Sanitajy~~~t,No.: Statem Plan ID NUUo.: Pa rce 0 ~~N~ 013-10-000 STATION BS HI FS ELEV. Benchmark Bldg. Sewer St / Ht Inlet St/ Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Final Grade BED /TRENCH width Length No. Of Trenches PIT No. of Pits Inside Dia. Liquid Depth Di I N D! EN [ N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mo a Num er: System: OR UNIT nISTRIBt1TI~N 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 [] Ye No .Yes No /COMMENTS: (Include code discrepancies, persons present, etc.) Location: 2290 55th Avenue, Baldwin, WI 54002 (SE 1/4 NW 1/4 5 T28N R16W) - 05281665 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = 3.) contour = Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No .~ U~~U2%U1 IIUN 12:35 )4aT 715 35d ~d8d ST CR,T LO ZU?'~ING W_1001 ' County Sanitary Permit Application a~r.cROU000UNnrwlscoNSllr ' In dt~cOrtl vafn 15.04 St. Crolx County Sanitary Ordinance zONING OPFIGP Personal informatbn yo., p~vvide may be used for seavndB+rY Pu+'Po~ 3r. GROIx GpUNTY GOVERNMENT CENTER _„_ _~ tPrlvacy Law. 5. 15.04(1)(m)j 7101 Carmlthael Road 1~' " .T~f~ Hudson, WI 5401b-7710 ~ J (715)3811-~t680 Fax 715 38Cr4686 Attach tdn to farts for the system on paper notJes& 1/2 x 11 inches in t;NiE. County Sanitary Permit # ^ Check If isvlsl6f~to~p s Pi r DDO ~ - ~1 I. A Ilcatton Information -Please print all Information ~ C : tton: Property Owner Name ~,,~, •~ ~'" i SE 114 114, Sec 5 j ~.~ JON MOULTON I~~,' . ~ ~ ~~ r g N, R 16 Property Owner's Mailing Address - t ~~~ ,;~iGi~ ~ umber 81odr Number 2290 55TH AVENUE ``~ ~'~'• CouNTY /A ~ N/A ___ City, State Zip Code ~ Phon NG~Bc, f bdfvlsion Name tx C~ Number n ~~ / _ ~ `~ ~ GC~' N/ ( (J J `~ BALDWIN WI 54022 1< 715 6 -4 1 A I pe o Building: (oheok one) ^ :Ity ^ Village own of ~ t or 2 Ramity Dwelling - No. of Bedrooms: 3 EAU GALLE Public/Commercial (describe use): G' 3tate•vwned Nearest Road Check boa on line 8 if ttpplica o) e of Permit: (Check ~ line A II T . . yp yy Parcel Tax Number(s) , 1.p Repafr . Cj Reconnection 3. Non•ptumbing 4. ^Rejuvenetion Aj part of 008-1013- Sanitation Parmlt Number Date issued B) C,Y statusanlta Permit was reviousl issued 175650 08-21-1992 N. Type of POINT System: (Ghedc all that apply) ,J • ~ (~ • ~ Non~ressurized In-ground (~ Mound ^ Sand Filter ^ Corotruoted Wedand G Presaurized In-ground ^ Hdding Tank ^ SinglQ Pass ^ C1rip Linn At reds ^ AemblC Treatment Unit ^ ReClfcWatlnA ^ Other V. Ols ereallTreatment Area Inforrttation: 1. Design Flow (gpd) 2, Dispersal Arta 3.Oiapersal Area 4. Soil Application Rate 6, peroolatbn Rate 6. System Elevation 7. Fin o Required Proposed (Gals.lday/sq.ft) (Min~rtch) Elevation 450 375 375 .6 95.3 97.57 an n 61'mdt On p n ons ~ o of Manuftittul'6r Prehib Sits Con- t t d Steel Filer lass Plastic New Existing Gallons Tanks Concrete s rut e g Tanks Tanks 1000 1000 1 MIDWESTERN PRE ASm X ^ O ~ 0 750 750 1 IDWESTERN PREC STS ^ ^ ^ ^ VII. Responslbllity StIItement I, tho undoraignod, asium0 r0iponslbillty for repalrlreconnenction/rejuvenation/in5t811aflen of non-plumbing for the POWTS shown on the attached plans. A license is not re iced for terraiift re dir or the Installation of non-plumb) sanitation t ttam• Plumbers Name (print) Plumb Signature (no a s): MPMIPRS No. euslness Phone Number ENNIE HELGESON 220292 715 772-3278 Plumber's Address (Street, Glty, State, Zlp Codel W1229 770TH AVENUE, SPRING VALLEY WI 4767 Vltl. County Uae Only Diaepprwed Sanirary Permit Fee Date Issued ,4®ent Sgnat~ra (NO stamps) uing iss ~, Approvetl Owner Given Initial Adverbs ~ ~- r1p ~ - ~ 20 / ~ ~(„ .. • (J~'~M Vt DatcrminaUon 5 - ~ 0 Z . ~ IX. Conditlane of Approvel/Reesons for DiSttppfovaL• ~~ ~ n ~c, n _ n ~ ~ r.S S too " L ~ ~, o'lA~/' ~.~o~ - kS ~g~" r,~1QJ ©~ t: y , a _.~ , n, L ~x~ S~~Hj ~w ~.~.~~r .. o 3g~~. v3o ;F. _. y 1 I~ ~. ~ ~. Cx~S ~~~ ~ T ,\ ~Y ~ ~ c S r ~ ~r c~ r--> ~ CL K 1~5 Sc,.~ ~ ~rn~~ - ~~. ~~ ~ o~ /ti ~, I ~~.Czl~ ~ - `~y r y( 7 ~ ~ ~ Li ~-/' V C , ,_~ . e,~ AS BUILT SANITARY SYSTEM REPORT OWNER I©.~ ,/V~T,~ ~ '~~ „~. TOWNSHIP ~ ~, . ~, ~ ~l~_. SECTION~T c,~ ~ N-R~~~ ADDRESS_ `~£~ ,~ ~`~~ C~Tr-c ~ ~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~~C~ s ~ s ~ ~ f, ~G `e ram"I G S /l ~G~. INDICATE NORTH ARROW r.~ _.. BENC~B~ARK:Elevation and description:_L~d, oo '1-x,0 ~,-~ (~~ X~~~ Drs 5~~ Alternate benchmark SEPTIC TANR:Manufacturer: ~~~..+~$~-~e~ Liquid Cap. l®O y ~ecuc~ Rings used: ~ Manhole cover elev: ~®.0~ Final grade elev: ~' Tank inlet elev.:_~g .0 ~ Tank outlet elev.:1,~ ~ . ~7 ~ No. of feet from nearest road:Front , Side ~ Rear Ft. '~~'~ ~ From nearest prop. line:Front , Side `~ Rear Ft. Y Dc~ ~ ., No. of feet from: Well ~ ~e Building:. /~~ (Include this information in the above plot plan) (2 reference dimensions to septic. tank) SEE REVERSE SIDE i • ~.. i ~ PUMP CHANBER pp ,~ Manufacturer: . d( ~ ~~~h ~-L"- Li uid Ca acit O G~ r,.,,11. Z t Y ~ Pump Mode1:W '~3''~Pump/Siphon Manufact.: Pump Size `yio ~~ Elevation of inlet:~Bottom of tank elevation ~ y_ D 2 G i $ ~ ~~ ,~ Pump on elev.: DS Pump off elev.: ~y w Gallons/cycle: 2aS Alarm: Man.: 7.~, ~~Q~~~o Switch Type: ~Gl~~ Location ~L~ Distance from nearest prop. line: Front, Side ~Rear_Ft. Yc~•~ Q w ~-l , Distance from: Well (~ Building.. a V SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: ~ Sam-/ re ~r Width:...(~_Length ~~ a- Number of Lines: ~ Area Built //~~• ~`~ Exist. Grade Elev.~~/, 3~o Proposed Final Grade Elev. ~ ~. Fill depth to top of pipe: ~6 No. feet from nearest prop. line:Front , Side ~ Rear Ft.~ ~ No, feet from well: 0 No. feet from building~~ ~~ l HOLDING TANK Manufacturer• Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No, feet from nearest prop. line:Front Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR:_ ~ , ,:-._ 7-ti ~.,,,_y ,~o~. DATE : ~ "~~- 1 =~- PLUMBER ON JOB : ~ ~- e ~' c s J--" LICENSE NUMBER: ~~/ :S"-- 6/90:cj ~ ~ ~ C_~- d ~ ~ ~, ~~ ~--~ T n I ~ 0 -t-. 0 ~p ~T r r ~. i~ I~ . i ~_~ ~, ~, ~~ :~ ' 'i ~, ~ .; f , . , ;~ ~, ~ ~~" ~~ "-~ %`~ ~ v ' ~-~ `z ~ ~ T. T ~ ~ z. a~ ~ ~ ~ - p n = ~° ~-, t o c.~ - ~ ~ ~ d ~. . '' ~ s ` .. . ~ ~ ~, r U1 (~ ~ ro ~ ~~ ~~ i~_ v n ~~ R ~,F ~- r `~~ J ~ F uJ s LOCATION: EAU GALLE 5.28.16.65 SE NW 55TH AVE. Wisconsin Department of Industry, PRI~IATf' SELVAGE SYSTEM Labor and Hu,~an Relations INSPECTION REPORT Safely as~d Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village [~TOwn of: MOULTON, JON EAU GALLE CST BM Elev.: Insp. BM Elevy.~ BM Description: ,. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic E',S`~..~_f°°n~ /' CQ~S S~ Dosing ~~ '~ ~~ A Holding TANK SETBACK INFORMATION ~-" TANK TO P/ L WELL BLDG. Vent to Airlntake ROAD Septic ~~a0' ~ ~~- ~ ~~ NA Dosing >~~' ~~ ~ NA Aerati NA Holding PUMP /~+jliBiiOiLINFORMATION Manufacturer ~ D~e)mand Model Number ~ ~~~~ ~? r GPM TDH Lift ~~ Lriction~ ~~ Systema ~ TDH ,7 t Forcemain Length ~ Dia. H~~~ Dist. To Well ELEVATION DATA County: ST. CROIX Sanitary Permit No.: 175650 State Plan ID No.: Parcel Tax No.: 008-1013-10-000 A9"LUU:iUy~27~Q~ STATION BS HI FS ELEV. Benchmark ~' ~ ~ Bldg. Sewer St / FjMf Inlet /3 ~ ~~' (~ ~ St/I~f Outlet ~3,Sd ~?~~U~ Dt Inlet 3.S ~ ~ , (~G ` Dt Bottom , /~ Z ~ Header /Man. Dist. Pipe Bot. System Final Grade ~,o ~'S,7~~ / /~ ~ 4.OZ~ SOIL ABSORPTION SYSTEM L ~~,` DISTRIBUTION SYSTEM ~, - 'r' 1 ~~ ~9' BED /TRENCH width Length No. Of Trenches PIT o. Of Pits Inside Dia. Liquid Depth DIME 1 N DIME 1 N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING anufacturer: SETBACK INFORMATION Type O ~i/`y~ ` O ~ CHAMBER OR UNtT Moe m er: System: f~ 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 discre ancies, ersons resent, etc.) l f~ j"~~ -~ ~.~93 ~~~'~z ~~'.~'. (~fJ~?~`' W~?Q~%UCl.~~,~F-~~'~C-- `f''n"~P ~L'_ds~«`..'~ ~Gt!N,Q~/GG-f fiGt-.G~-'~ . - ~_~ - Plan revision required? ^ Yes ~~ Use other side for additional information. ~ ?~a SBD-6710 (R 05/91) Date Inspecto s Signature Cert. No. CAI~IITeRV DFRMIT OPPI 1[_OTIAN =~~HR . In accord with ILHR 83.05, Wis. Adm. Code .~..M,..a.,..,..,~..e,. COUNTY ' STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~~ ~~~/~ 8f~ x 11 inches in size. ^ a io eviousapplication -See reverse Side for InStrUCtIOf1S for Completing thlS applicatlOn. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. 592-40630 PROPERTY OWNER PROPERTY LOCATION JON MOULTON SE '/a NW %a, S 5 T 28 , N, R 16 ~(~r~ W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 303 OLE STREET CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER V WI 54028 715 698-2422 II. TYPE OF BUILDING: (Check one CITY ~ NEAREST ROAD ) ^ State Owned ^ VILLAGE EAU GALLS 55TH AVENUE . ^ Public ®1 or 2 Fam. Dwelling-# of bedrooms-3 PA TAXN M ER 111. BUILDING USE: (If building type is public, check all that apply) pART OF 008-1013-10 1 ^ ApUCondo 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ RestaurantlBar/Dining 4 ^ ChurchlSchool S ^ Mobiie 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. ®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 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 3 95 . 450 375 375 .6 Feet .5 7 Feet VII. TANK CAPACITY in allons Total # of Name ' M f t Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks urer s anu ac oncret glass App Tanks Tanks strutted Se tic Tank or Holdin Tank 100 1000 1 MIDWESTERN PRECA T Lift Pum TanWSi hon Chamber 75 750 1 M VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps MP/MPRSW No.: Business Phone Number: BENNIE HELGESON 3215 715 772-3278 Plumber's Address (Street, City, State, Zip Code): W 1229 770TH AVENUE, SPRING VALLEY, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater Surcharge Fee) a e ssue I ing Agent Sig a (No Stamps) Approved ^ Owner Given Initial Adverse D termination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber I~lSTRUCTI41-~~ 1. A sanitary permmit is valid for two (2) years. 2 1Gour sanitary;permit rr2ay be renewed before the expiration date, and at the t me of renewal any new criteria in the Wiscor=sin Administrative Code will be applicable. 3. All revisions to this petn'tit 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 th,e 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: 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 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 alt information requested in #1-7. VII. Tank information. 1=ill 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 al/ 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'r~ 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 470 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 mr,nitoring groundwater, ground- water r,ontar~ainatiur, investigations and establishment of standards. SBD-6358 ~R.11/£S8j ' APPLICATION FOR SANITARY PERMIT STC- 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 `,[ate rii'/l~ ~~~i ~ / %l/~i~~i~l Location of Property ~ '~ ~ ~lI_il~ ~, Section ~ , T a?~ N-R~ W sTownship ~Cy ~ ~Ci~~~ Mailing Address ~ ~®3 bl -~- ~`"~--' . Address of Site ~~~'~/~ Subdivision Name. Lot Number `"" Previous Owner of property ~~ ,~1n' ~~Q/) Total Size of''-Parcel ~~ Cy~~ -~ Date. Parcel was 'Created ~ ~l9 _ 9d Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _~, No Volume' and Page Number -~ 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PRUP~k7y O~uNrR C~'R7T t=i Cb 7 ICN T (wel cen~i,sy ~ha~ a,2Z d~atemev~.ta an ~hi~s Sanm atce ~lr.ue ~a ~h.e bead as my (oun) fznaw.2edge; ~h.a~ I (we) am (anel ~l~.e awneh.(d) os the pnopenty deac~ci,.bed ~.n ~'hi,b ,i.nbanmcLti.an Sawn, by v.vrtue os a wa~vca~y deed neconded ~,n ~h.e Oss~.ce os the Caur-~y Reg-i,b~en os ~eeda cus Dacumev~t Na. ~/Q ~ S ; and ~h.at I (GJe) pnedewtCy own ~h.e pnapad ed d.cte San ~h.e ~ ewage cLi,d j~o~ d y~~em (cn I (we) have ab~cu.ned an eaaemer~t, ~a nun w.~th the above desc~u.bed pnapen~y, San the car~~c.ucti.on as dai.d ~,: dy.~~em, ,and ~h.e dame had been du.~y neconded ~.n ~d~.e OSS-i.ce as ~h.e Cauv~ty Reg.c,a~en os Veeda, as VacumerLt Na. ~~ "~ y0S ) S ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE:'SLGNED DATE SIGNED ,. r DOCUMENT No. STATE BAR OF WISCONSIN FORM 1 -' S9H2 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED - - - ~ R.-.... ~ - - • - - REGISTER'S OFl•lCE This Deed, made between .---;Dale F. Moulton, a/k/a $T.CROIXCO.,WI~r Dale Moulton and Virginia R. Moulton, a/k/a RBC~dEO[ --- --------------------------------------- ,._ QBCAfC~ -.Virginia._Moulton,_._Yiusband___and._wife and each -------- - ------------------------- ---- __in___their__own-..right,. __ __ _ _ _-_•-•-•., Grantor, AUG 201 aeon T Moulton and Bonnie M Moulton, husband M ---------- ---------- -and. wife.-as•••1oint--tenants with right__of survivo shi~ 0:40 A. .-•as---Wiscon_sin--Marita_1_-Property_,_________________________ ro -------•-----------------------------------•-----------------------------•---------------•--------• Grantee, V Witnesseth, That the said Grantor, for a valuable consideration...... Re9isterofDeeds -------_-Ten---Thousand-.and--no/100 Dollars --- ---------------------------------------------------- --- - - - RETURN TO conveys to Grantee the following described real estate in .__ St ._•_CrOlX ~E~.~-~~yz~,.:,~ ~'~~`~ rJiC.-~ County, State of Wisconsin: ~ (dW/n~ !n/-Z ~~L East One-half of Southwest Quarter of Northeast Quarter ( E 1/2 of SW 1/4 of Tax Parcel No:._..____.__________________________ NE 1/4) and South Half of Southeast Quarter of Northeast Quarter ( S 1/2 of SE 1/4 of NE 1/4) of Section 5, Township 28, Range 16, EXCEPT South 327 feet of East 535 feet of said S 1/2 of SE 1/4 of NE 1/4. Grant~es_ agree to erect and maintain any and all line fences deemed necessary between land purchased by Grantees and land owned by Grantors lying contiguous thereto. j.. ', ~ :.~F ~ ~3o.e~ This _____..____~.~._.AO.~___ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; a~le_-F._. Moulton__and_. Virgina..R.__Moulton_________________________________________________________________ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this ---------1•--r----•--...----•------•-----•----- day of --------------- -- -U-~--•------•-•--•---••--•-----------.._., 19---92• CIZXc ~ -•---•-----•-•----(SEAL) (/.~•Civl~i~ZGd~f~~0--~-t_{~,QYI•_.__..._..-•--(SEAL) *Dale F. Moulton Virginia R. Moulton ----•--------•-----••----•------•-----------------•--------•------.._ (SEAL) r ----------••-•------------------••---•--•------••--•---••----•-•---- (SEAL) AUTHENTICATION Signature(s) --_Af---Dale_.-F_•---MAl1lt,an___a17.d_-- Vi 'nia R. Moulton hent' a ~~~ a ° ~1 "- ------ ------ - --- -- --- 19----9 2 *----------Rob~ert__R___ Gavic-------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ---------------------------------------------•-------------- authorized by § 706.06, Wis. Stats.) ACKNOWLEDGMENT STATE OF WISCONSIN i $g. ------------------------------------- - County. Personally came before me this ................day of --------------------•------------------..., 18------._ the above named to me known to be the person .__._.....__ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ROBERT R_. GAVIC -----------------------------------------------------------------•-------------- Attorney -at Law * ------------------------------------------------------------------------------ --- rn V~3:-le WI---54-767------------------- -- --....County, Wis. B-p g--- 3i-r-- - Notary Public ---------------•----------•--------• (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 19....__...) -Names of persona signing in any capacity should be typed or printed below their signatures. WARRANTY DPED STATE RAR OF WISCONSIN ~'/isconsin Leeal Rlank Co. Inc. f STC- 105 SEPTIC TANK MAINTENANCE ACREEMGNT St. Croix County owNER/suYrR ~Oh 1'llou ~~bh £ ~J~hli° ~I~DU ~71~ ROUTE/BOX NUMBER CITY/STATE l.I,~-~ a+~h YW~ 'l. [P .5'L/Opal PROPERTY LOCATION: ~~'-t, ~lt~ iy, Section S T ~g N, R~__W, Town of ~Q+i ~OCP~I'e , St. Croix County, Subdivision Fire Number Lut number _ Improper use and maintenance .of your septic system could result in its premature failure to handle wastes. Proper maintenance cun- siats of pumping out the septic tank every three years or sooner, if needed, by a l.lcensed septic tank pumper. What you pUt into the system can affect the function of the septic tank us a tre~~t- ment stage in the waste disposal system. St. Croix County residents m_~ a maximum of 60X of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant fur f a failing system, St. Croix County the requirement tl+at .systems properly The property owner agrees to submit to St. Croix County 7.oning a certification form, signed by t}~e owner and by a master plumber, ,journeyman plumber, .restricted plumi~er or a licensed pumper veri- fying t}+at (1) the on-tiite wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification Eorm will be sent approximately 30 days prior to three year expiration. I/WE, the undersiKned, have read the above requirements and a};rec to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and. returned to the St. Croix County %uning Of f.iyce within 30 days of the three year expiration date. SIGNED _ "gj~ '(Ylc+~S° U A'I' E ~`ao ~-- - --- St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2235- or 715-425-8363 Sign, date and return to above address. '„ ~~LHf-1 SOIL AND SITE EVALUATION REPORT " ' y ~ f-7 in accord with ILItFi p3.05, Wis. Adm. Codo .Ili ,1M .IMr.AI1RM Attach complote silo plan on papor not less than l; 1/2 x 11 inclios io size. Plan must include, but not limited to vertical and horizontal roloronce point (BM), direction and % of slopo, scale or dimensioned, north arrow, and location and distance to noarost road, APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~t C~a ( ~ iCELI.D. x ~ar-t- o F 00 ~ REVIEWED BY FROPERTY(7/VNER II 1 PROPE~TYLOCATION ~© v~ ~ ~ ul~ `t"o ~,~ ~ GOVT: LOT s'E ua tU ~ va,s ~' T ~ ,N,R ~ (~ E PROPERTY C1/YNER'S MAILING ADOR SS M,~ LOT r< BLOC N SUED. NAME OR CSM x GI 1 Y 51 A E ZIP CODE PHONE NUMBER ^CITY ^VILLAGE Ql`OWN NEAREST ROAD ~~,~o ~;II.~ ~~ ~sy cog n~s~ ~~u~~v~~ r„~. ~~i~~_ ~~ ~ ~,;`~ (EJ'New Construction Use (c~j~Residential / Number of bedrooms 3 j (Replacement ( ] Public or commeraal describe Code derived daily Bow LSD gpd Recommended design bading rate , S bed, gpd/ft2~trench, gpoltt~ Absorption area required ~ 7 S" bed, tt2 Z trench, f12 Maximum design loading rate . ~ lied, gpd/tl2 . ~ trertch, gpolft2 Recommended infiltration surface elevation(s) 95 3 8o1-Fe,,,.. o~ t3e~l tt (as referred to site plan bertcttmark) Additional design /site considerations M. ~. l' S v~c~ y,.rc~..e r c . ~~ ~_d~~m ~ ~ c e~ Parent material G1~ r, ~,( T,'t ( Fbod plain elevation, it applicable /V/(- h $ =Suitable for system CONVENTIONAL MOUND INGROUNDPRESSURE AT~RADE SYSTEM IN FILL WOLOING TAN U =Unsuitable tors stem •O S^ U O S ^ U ^ S ^ U .~' O S O U ^ S O U ^ S ^ U :* +^ SOIL DESCRIPTLON REPORT Boring # ~~ 3;~ c~.:~a Ground e~• Depth to limiting . tact u ~~ ~~~ Boring # ~x:~~~.~ ~'i ~ ~s az ~:~p ~~ :wY~'"•.':. . x•sii~:S Ground elev. q~•~S N. Oepih to liriting factor ~~ F +I.~,.u: Horizo Depth Dominant Color Nbfbes~ °' ~ Texture ~ Structure ~~~ Roots G P D/t1 in. Munsell '' Qu. Sz. Cont. Cobr Gr. Sz. Sh. 7 Bed Tre (~ 3 ~ r lJ~-} 3u .. S . (e - 4g I ~ ~ t u~ ~ ~ yK~ l p .~ ..., ~- ~a s I ~ s~l~ w~~ . S . ~ Remark s:~ t ! cQ C~~(JoSrt-YS tt~ Wit` 1( ~yR~ r ih 3r~. i ~t~4-i so•-~ r ~- ICS ~.~ ~. ~I ~ ~ ~~-~ ~~ a~f ,s- .t _ ~~ _ ~ ~ _ •- -- Remarks: , CST Name:-Please Print ~r ft_~ a Address: ~ ~ ~ ou- ¢ I -sue.! v~ r ` C • Signature',. ~ r~ /~ ~. C 'Phone: -•-~=-~ .Oats: ~Ot-/Zoo CST Numbor: ~ -3C~9~! 7 SOIL DESCRIPTION REPORT Boring >E is' 0 ! kcs::k£iYx:~xi:Q Ground elev. ~~tt. Depth to limiting laclor ~ ~s~ F{.G.u Boring # ~»:, ~n , ~4>~ ~a '- Ground elev. C~~(t. Depth to limiting taclor U lq ~s~- {t{ b u Boring # :A~>:34: Ground elev., h. Depth to limiting factor Boring ft v.xx.:o;:a:• ~~'i::::::.. ~.;~ <:' E iii r~ r: ; .; ...::.,.., Ground elev. ft. Depth to limiting factor Fiorizo Ueplh in. Oorninant Colon Munsell p, Mottles Du. Sz. Cont. Color Textu re Structure Gr. Sz. SIB. Cons'stence Bo~rrlary Roots ~ GPU 1 Bed Tra ~... C ff .S i 1 ~ ~M ~ l0 ~ -37 O ~ ~ 3 ~ c v s~ -~ , 5' . ~ ~..4 Remarks : ~ i r v_ ~ ~ i~ ~ ~ a~ S ~.~ °~ - L~ 5 V F S b A Remark s: v ~~>~~ ~ ~ ~G~ ~- r^ /', v G~' ~I ,/ ~`'~ ~C~le eE ~'"-" Remark s: `n ~ ~~ Je ~~ .j Remarks: :~` j .' ~ ~-~ ~~ ~ ~ ~ A ~ ~ 3 c W ii O` G -J l.~ Fcnee v~ a a 1 r ~. ~,, r~ (~ -~ 7 5 ~~ O i G' ~ ~ ~~~ ~ ~ >> ~ ~ --i' ~ F ~ r `. ~ b ~ 4 y C ~ G i ~ -~, ~' ~~~ ~ o0 U? 5 ~ cc ~ • 0 ~ ~ ~,.. ~"' p G ~ '!~ s ~ ~ ~~ ~ v b ~ ~ c 7i'- ~ ,~ ~ u~ ~ ~ ~ `~ ,~~- g ,- w ~_ f T^ )' i• ~' . ~ ~ Z~ ^' ~~ ~^' ~ ~ o a- b ~ ~ ^_~ s ~ ~~ ~~ ~ `~° h~ C fi` n ~ t; r ro r^ r ' v 1 'r ' V ~,~ J ~,,~ ~~~ ~~~4®630 ~ ~~' ry F~ ~ ~~ r AUG 14 t yy1 J - ~ ~ l ~, SAFr-.TY & DLDGS. DIV. ~ 0 - ~ ; o V, I ~ ~ ~T C\ . r ,, r ~ i t I ~ 7~ ' ~' ~-. t 1 A ., t, 1 „t ~._.._..__ _._...-t------'-.. _.C _ __ _ .. y,..._. ~~, ~ r5 PRIVATE 8EW1~ ~~ ~' ~'~: ~ Condjt~onally p `,` VE pro AP ~.. .~» ..R. ' '~: ~ `~ .~ , ~ ~ SEE CO OpdCE '~ ... ~ r ,l Q ~~ (~ ~ ~. /~ i ^ n. i Oi y '. ~ J I ",~ ~ 3 r~co ~ p. '' ' ~r ~ T ~ s \ ~ ~3'~a ~ ~ m• B i ~ ~ ~ _ - 4 O~ 5 s ~ ~^~ ~1a \ u ^° ~~.~m r. ~ U1 ~ ~ ~ ~~ ~ ~ ,~- ' ~ Page Of /.C( rW 1. _ G ~-c,? Cross Section Of A Mound lJsing A Trench For The Absorption Area Sr~er~ H GI~~ . Medium Sand Fill ~1 ~ 3 E PRIVATE SEWA ,.,T_r~~bA#~ui~~l~Y Aggregate, (mil (y~p'9~?' . C6vered With ynthetic Fabric ~~ A ~. QF NiDUSTRY~ LABOR i 1NIMAlIU~ ~ p11tlslON O ~AFETY }1N~ 01 // ,. sEE 1 D ~. opsoil ~~,s 9S. `-Plowed Layer D ~ Ft. E I ~ ~ Ft. r, ~ Ft. F r/ ~ Ft. N /. S Ft. Plan View Of ;4ound Using A Trench For The Absorption Area ~ Distribution Pipe Permanent Markers Force Main i Observation Pipe A o-----------------L-~-----------------• \ Trench Of ~" - 2=" Aggregate I ~~ ~ L A ~c '~t. g ~C~=, ~ Ft. I J~ ~ 1.5~ Ft. J ~ ~ ~ Ft. g -~- K l: C.S~ Ft. W .J~~,(~ Ft. L ~ ~ . (e~F't . License Signed: ~/ )~-_-,-,..>.~. ~/~~------Plumber: ~3~%/.5 Date: ~7-~~ -y'Y ~~ _ ~~~~- ~D~ rG~. '1-Z4-~ L pcr rJC.~,T ~''O _. a-?V` (~:PE ' '. Y,~." ~u I -c`~'•• `~ ~ I AT t=U'J Or. E!~ CN Lh'T'L~LI.L Q 1"FUI.E.S LU'•-tiT/~ O,J ~T~ JN O` + _.Q1.pE F'~Up F1R~ ~"OUF~L'/ SPA;:~~ . ' +, pVG .~--r-p2CE N H 11.1 Pl-l~CE= UcS'S 11.0\. tJEx.'1' ~b t-~'L~J CJiP -'D\SI.R-\9uT]OlJ:1~tPE .1:1'~youT_-_. PRIVATE SE1NAaE $YS'fEM Conditionally VED RO PP s A TtON ~~ OtV1S10N OF SAFETY AND BUS ING 1 S NCE SEE COR P ~~ L FT. x -~-'^'. Y ~ ~-~. _~1N._ `~ .~~.._ ~oF 1~UtES/T~1 P~ IUV. E.I.V. OF 1j,-~'4.lt~S ~~ PT: ~~ sr FRS'] T~ w17N Sc~ cc-~~]~U G HDL.~S ~T ~g ~1 ]J~U~~I.S .- LPcST ti~~-E •TD ~~ 1JEX1' 7D T~FE E~JD C1t-P- _ _ ...._..._ .--- (/~~ ~• / PUI'',P CHA.I^.B.R CROSS SEC'!C:.1 ANG ~PECIFICA'rl0'l~ VEUT CAP 4"C.I. VEVT PIPC FJ~. ~ 25~ F20M GOOR. WINCOW OR FRESH AIR INTAKE I8"/"~IN. j~ I-.JLET APPROVED JOIIJ7 W~C.2. Pf PE EXTE)\101NG 3' OUTO SOLID SOIL ELEV. ~~• ~ FT. WEATHERPROOF JUAICTIOA.1 BOX 12"MIU. I' I GRADE I I GOIJDUIT ~'-'- . ~ APPROVED LOCKII;G MANHOLE COVER ~~Jo~r~v„ •V ~ \\~; AG,E SYSTE ~' pq{VATE S>E~N PROVIDE I ~ Conditionc~Tl`3'IGHT SEAL A ~ j VE I ~o ~~ ~pj10N8 a ^ ~ MAN ~ I ~• ~ ~BTpY~ L,AgOR ~ N BU N g ~gKIN pp SAFET'f AND ~ 'I I SSE P NCE PUMP v-J CORK ~ D C0IJCRE7E bLOGK 4" MIIJ. I ~. ~ 18" N'I IJ. ICI III III I III ALARM ~'I . ' !J OAJ I OFF ~~ APPROVED JC'~' W~C.I. PIPE EXTEUDI-JG 3 ONTO SOLID SC RISER EXIT .3"" /..se~r~•n PERMITTED OIJLy IF TAIJK MAUUFAC~UR>iR HAS SUCH APPROVAL /~` GGi; ' SPEGIFI~GATIOf~1S DOSE Al V~ ~ " ~ ~ '~ '~ ~ TAIJKS MArvUFAtTURER: 1 1 ~r i1 ~~~ r= C PER DAy IJUMBER OF DOSES: '- ~- ~ TAIJK SIZE: _ ;I .~C~ GALLOAIS DOSE VOLUME 1 _ / ~r '~~ i4LARN1 MAIJUFACTURER: - ~- GA1.LOf: ~•~_ ~l 1 ,~~, tit".i-h S INCLUDIAJG 6ACl~iIOW: ° Pc. /'t~ MODEL -.IUM6ER: ~~~ ~"`~~~-~ CAPACITIES: A- ~h IAICNESOR ~• C~\ GALLOU SWITCH TyP[:. v~cci~- ~ I -~ g. ~ INCHES OR _~ ~ GALLC'_; ~• PUMP MAIJUFAGTURER: _ ~ ~ ~ (Y~`l~-) C,a~~ IAlLHES OR ~_ GAI.LCL • MODEL AJUMOER: '~ ~ ! ~ Ds ~C, INCHES OR~~ GALLON. t SWITCH TYPE: ~J> 1 ,,,L.I-~- !"!~v-c~~v,-~ ~•-~t~~~~ 1J07E: PUHP AUO ALARM AR[ TO DE MI1J-M s ~ INSTAlLEO OU SEPARATE CIRCUITS uM DISCHARGE RATE GPM VERTICAL DIFFEREUCE ~STWEEU PUMP OFF AUD OISTRIBUTIOAI PIPE.. ~ FEET •}- 1"11f~tiMUM AIETWORK SUPPLY PRESSURT,E/. 2.5 FEET -f- L-.:lL FEET OF t•ORCE MJ111J X ''S F/pp PLFRICTIOU FAC70R. ~~ y~ FEET' TOTAL OyUAMIC HEAD = ? ~" '6 FEET IUTERA)AL DIMEIJSIO-JL OF TAIJK: LE1.IC~TH ~" .~ ;WIDTH - `~ ~ •~LIQU10 DEPTH r ~_ ~ _ _ _ ' SIGIJE D: ~ r ~ ' ~ ~.~~~• ~ - LICENSE 1JUM8ER: - ~~~ S PATE: ~-L~ - 1 Z