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Home My WebLink About002-1024-50-000 1 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Glenn /v/CT/C e lj'~ ADDRESS Crx 0 YI u7b D07 i ~y . SUBDIVISION / CSM# LOT # SECTION 12- T,2? N-R , W, Town of ri ! A ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM rG~e c_° C.~ ~'I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /Ua l 1~~ ~Q --f-re /yz 04/~~e r ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING,TANK INFORMATION Manufacturer: Liquid Capacity: 4700 Setback from: Well /le House 35 Other Pump: Manufacturer Model a //Aize Float separation Gallons/cycle: ;?Z3 Alarm Location Farm / anC SOIL ABSORPTION SYSTEM Width:Length Number of trenches Distance & Direction to nearest prop. line: 300-x- Sd« / ~ Setback from: well: 190 House 145' Other ELEVATIONS Building Sewer ST Inlet ST outlet PC inlet PC bottom- Pump Off Header/Manifold 94'55 Bottom of system Existing Grade '71,33 Final grade 93-05 DATE OF INSTALLATIIOO~N : 7_29-9141 / PLUMBER ON JOB: O /t G ~U ~fSO LICENSE NUMBER: I 1~ ~~z 9 INSPECTOR: V , A nm~?Sor\, 3/93:jt BOLDT'S PLUMBING & HEATING, INC. 820 MAIN STREET BALDWIN, WISCONSIN 54002 (715) 684-3378 FAX (715) 684-3144 N N Z- t 1 i i ` 4, i ~ ~I l 1 00 0 W 0 • ~oO O l N f° _J I ° I r'p~'i ~ artn t l c {rySW,NE,SECpA i y~ StWAG~~J TN D) County: L'aborand Human Relations INSPECTION REPORT Safety and Buildings Division ST_ CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's 19 467 Name: ❑ City ❑ Village [Town of: State Plan ID No.:eSS WElev-:' Insp. BM Elev.: BM Description: n Parcel Tax No.: ~GfJ.CAL ) TANK INFORMATION ELEVATION DATA A9300129 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic s 040 Benchmark , o /Gig , Cd Dosing Aerati Bldg. Sewer ~rlt/ Hol St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet n l TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >-50 + 8a 3s ~ ✓ * NA Dt Bottom ?ta; - Dosing ,5()/ y5 NA Header/ Man. Aeratio NA Dist. Pipe S " S•L/~ In9 Bot. System Z 9S_~a PUMP tWiINFORMATION Final Grade Manufacturer Demand Model Number wf n 3 1142) GPM TDH Lift Iq6, Fnction/, 5 System„ 50 TDH Ft Loss e o~ Forcemain Length (QS Dia..' Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width LengtOl / / / No. Of Tfenches PI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS T ? DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING nufactur SETBACK INFORMATION Type O r,2_> r CHAMBER odel Number: System:✓net_C4 > Af OR LIDISTRIBUTION SYSTEM r / Manifold Distribution Pipe(s), x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length G` Dia. lam, Spacing J f4' /G SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 11 / t7 xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center ~ep Bed/ Trench Edges - a Topsoil R-ytn-p No B-*@r ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 14 , 111 ~J LOCATION: $ALDWIN SW,NE,SEC.12 T29-R16 (CTY RD D) I . Plan revision required? ❑ Yes ~o d Use other side for additional information. D / SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No. ADDITIONAL COMMENTS AND SKETCH ! SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION t~a~'1~711R In accord with ILHR 83.05, Wis. Adm. Code CouN c ! STATE SAV IA ER -Attach complete plans (to the county copy only) for the system, on paper not less than UJ1I1I ~10 [vJ 8% x 11 inches in size. Lcheck if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S 93 " O 15~ PROPERTY OWNER PROPERTY LOCATION lc e.r ✓ _5 c Y4 /1le~C__'/4, S /Z T , N, R 14 H (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # i> _ CITY, STA ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~I 6?e n, c~ad(_ S QO 715 11. TYPE OF BUIL ING: (Check one) ~ - 7z 13 CITY : e NEAREST ROAD ❑ State Owned 0 VILLAGE : :R 1,0/ ~r"_ ❑ Public X 1 or 2 Fam. Dwelling- # of bedrooms -3 PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) L?o 7 e 1OZ.e _ 30 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise:, Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. rvi 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 Z 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.) PROPO°E (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Q pELEVATION ~JD / r,/ Z7 !~13 Feet 713 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank poo 1000 (Jee -K S Ej Lift Pump Tank/Si hon Chamber Oo goo VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): 0 Plumber's Signature: (No Stam s) MP/MPRSW Nor: Business Phone Number: ~✓.c~s-o G1 33 7 Plumber's Address (Street, City, State, Zip Code): LTZ <~D GYlt.cf ~~v~ C~(/rl s`/Q~~~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signatur (No Stamps) r Approved ❑ Owner Given Initial Surcharge Fee) dvers Determination 1 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber w INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) . 9'3 - D 15G 61/Cnn /4,1,9 %e; PAGE -3 CF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 'i'~C.I. VEAIT PIPE WEATHER PKOOF APPROVED LOCKING JUUCTIOU BOX MANHOLE COVER - 25' FROM DOOR, WIMDOW OR FRESH 12"MIU. AIR INTAKE GRADE 'i" MIU. I ~ COWDUIT 18"MIAs. ::E • ~1 INLET PROVIDE T AIRTIGHT SEAL I III ~ / I ( I \v/ APPROVED JOIAIT A I III APPROVED JOMTS W/C.I. PIPE I I I ( W/C.I. PIPE EXTENDIUG 3' I (I ALARM EXTEUDIMG 3' OWTO SOLID SOIL d ( II ONTO SOLID SOIL I ( I I om . c i ~ 9• so I ELEV. FT. PUMP OFF r D CONCRETE 15LOCK RISER EXIT PERMITTED OIJLH IF TAUK MAMUFACTURE.R HAS SUCH APPROVAL SEPTIC f SPECIFfCATIOUS DOSE. TAUKS MANUFACTURER: NUMBER OF DOSES: PER DAy TAWK SIZE: GALLOUS DOSE VOLUME ALARM MAUUFACTURER: SCI Z-l2C-tr'o IMCLUDIMG BACKFLOW: 2Z3'5L pGALLONS MODEL NUMBER: .14-Y CAPACITIES: A = I9,871uCHES OR -~38 * 1d GALLONS SWITCH TYPE: C r Curs/ B = 13,13 2 1MCHES OR 31*49I-GALL0US PUMP MANUFACTURER: - i 044 C 1MLHE5 ORZZ3•y7GALL0US MODEL IJUMBER: 3Sg DINCHES0RZO`{' GALLOAJ$ SWITCH TYPE: -144Cr e- MOTE: PUMP AMD ALARM ARE TO BE MIAIIMUM DISCHARGE RATE 29,09 GPM ~~INSTALLED OU SEPARATE CIRCUITS VERTICAL DIFFEREIJCE BETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. ,36 FEET + MIIJIMUM METWORK SUPPLY P~R.EESS/SURT,E/" . . . . " , . . 2.5 FEET X55 FEET OF FORCE MAIN X ~~t1_F/ppFRlCTl01J FACTOR. 2'~g FEET TOTAL OtWAMIC HEAD = Z?'Z3 FEET IUTERNAL. DIMEWS10NZ OF TAIJK: LENGTH 7 ;WIDTH 7 ;LIQUID DEPTH y7 SIGNED: ~0-~- LICLOSE NUMBER: MP 66 Z 9 DATE: $_/6 G'le r~,r. a /C Submersible Effluent Performance curves S73-0/56 Pumps METERS FEET GV/ S/ DY'COP y 90 MODEL 3885 25 SIZE 3/4" Solids WE15H 70 = 20 WE10H J -WE07H 15 50 WEOSH 40 10 WE03M 30 20 5 10 0 0 0 10 20 130 40 50 60 70 80 90 100 110 120 GPM L i 1 0 10 20 30 m'/h CAPACITY [qGWLDS PUMPS. INC. SBECA FALLS PEW YOM 13148 METERS FEET 120 MODEL 3885 /4" Solids 35 110 LE15HHH- SIZE 3 100 30 90 I 25 80 I i +PIN Q 70 = 20 J H 60 0 WE05HH 15 50 40 10 30 5 20 Ilk 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 i i 0 10 20 30 m3/h CAPACITY 01985 Goulds Pumps, Inc. Effective July. 1985 C3885 bILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~3y~ 8'/z x 11 inches in size. Chen if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S 93 - 0154 / PROPERTY OWNER PROPERTY LOC TION 1; /Iak f / ` _5;0'/a _ '/a, S T e , N, R f ® (or) W PROPERTY ~~ER'S MAI ING ADDRESS LOT # BLOCK #A/ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER !r G,~ t),' 5y~l 7/5 7(5-72J3 II. TYPE OF BUILD NG: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE i S : TOWN t ❑ Public J' 1 or 2 Fam. Dwelling-# of bedrooms OAKUP-L TA NUMBER( III. BUILDING USE: (If building type is public, check all that apply) //n I 1 ❑ ApUCondo v v 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. jrnVI New 2. ❑ Replacement 3.E1 Replacement of 4.0 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 0 Mound 30 El Specify Type 41 ❑ Holding Tank 12 El 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 375 -3 7~ K, J Feet 9 7_3 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber Fa OD I Vlll. 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: Plumber's Address (Street, City, State, Zip Code): C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (Includes Groundwater Date Issued Issuing LAentsig tur (No S mps) IXWApp oved ❑ Owner Given Initial X,T,h/ Surcharge Fee) r Adverse Determination~U" X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this systeom. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water rnains'water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (8.11/88) Cross Section Of A Mound Using A Trench For The Absorption Area Medium Sand Fill ° F 6" Topsoil 3 E D Trench Of -'2" - 2~" Aggregate, Plowed Layer 6" Below Pipe, Cover With D /-O Ft. Straw, Marsh Hay nthetic Fabric PG~,S E Ft. G /-o Ft. g Z~~ F • 75 Ft. H ~ Ft. 00 C 0 ~0 G ng A Trench For The Absorption Area OtiQ~~ GG~P Force Main Distribution Pipe Permanent Markers IT,",fl'Observation Pipe o - A' 6 W C' B - K \ Trench Of - 22" Aggregate I r ; L A Ft. I >1`6t . K /O Ft. W B Ft. J 7.8 Ft. L Ft. S93-01561• License Signed: ` Plumber: 1VP 66L9 Date: 6 Z-~3 . z a~ y Distribution Pipe Detail For Two Lateral Network Holes Located On Bottom Are Equally Spaced PVC Force Main End Cap ~ `f X X PVC Distribution Pipe P P X * Last Hole Should Be Next To End Cap T P Ft. Hole Diameter Inch X Inches Lateral Diameter Inch(es) Y.Y? Inches Force Main Diameter Z Inches # Of Holes/Pipe Invert Elevation Of Laterals 95.8 Ft. Signed: License Number: W20 ~~Z9 Date: 6-Z-93 Coo , . ~ao4 a" ~N~ S93 015 61 ~ s s~ o aF ~ oFp~~M owe Q ''r" &NCE ~Ra~gP SEE w ! e~ . ,r ,j ; t ~i i lj PAGE" 3 (;F PUMP CHAMBER CROSS SECTIOM AkID SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25~ FROM DOOR, IU. WINDOW OR FRESH 12."m AIR IMTAKE GRADE ( y"~11U ( 18" /~fiN. COWDUIT INLET Gy~ PROVIDE I Gv GHT SE I III APPROVED JOINTS APPROVED / W/C 1. PIPEJOINT A y~ ( III W/C.I. PIPE EXTENDING 3' V ~~0~ . I i I ALARM EXTENDING SOIL ONTO SOLID SOIL B OQ' i I) ELEV. FT E~ PUMP OFF SIP CONCRETE BLOCK RISER EXIT PERMITTED OWL! IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC az SPEGIFItATIOAIS DOSE / ) ~(J TANKS MANUFACTURER: ItAee_ WtABER OF DOSES: PER DAy TAWK SIZE: GALLOWS DOSE VOLUME ALARM MANUFACTURER: IMCLUDING BACKFLOW: 3~~L GALLONS MODEL MUMbER: A ' 9 CAPACITIES: A=Z/'0-7 INCHES OR 35 -6 GALLONS SWITCH TYPE' r- 44 y B= ~Z~ INCHES 6R-34 "Al GALLOAIS PUMP MANUFACTURER: gold/o/ C=1113 INCHES OR2o'3,05 GALLO►JS MODEL NUMBER: mf-'Sj D- IZ INCHES OR2_QY_-2.6_GALLONS SWITCH TYPE: Aercar / MOTE: PUMP AND ALARM ARE TO BE MIIJIMUM DISCHARGE RATE 2o'-O'l GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEELI PUMP OFF AND DISTRIBUTION PIPE.. _._L-_ FEET + MIIJIMUM WETWORK SUPPLY PRESSURE✓ . . . . . 2.5 FEET 9 3 0 + -3o FEET OF FORCE MAIN X 'S F/oortFRICTION FACTOR.. FEET 61 TOTAL Ot JAMIC HEAD FEET ILITERWAL DIMEIJS10MG OF TAWK.: LENGTH ;WIDTH J;LIQUID DEPTH 7 SIGNED: LICEMSE HUMBER" Ap `"44?9 DATE: .Performance ` Submersible Effluent Curves Pumps ~ o f METERS FEET 9° MODEL 3885 25 eo SIZE 3/a" Solids wE15H Q 70 u=~ 20 WE,0I J -WE-07H 50 15 WE05H 40 10 30 WE03M WE03L 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 1 1 0 10 20 30 M3/h CAPACITY [QGOULDS PUMPS. INC. SEWCA FALLS NEW YM 13148 METERS FEET 120 MODEL 3885 35 SIZE 3/a" Solids 110 WE15HH 100 30 90 25 80 Q 70 Z 20 J Fa- 60 0 50 WE05HH 15 40 10 30 2Q 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 1 1 1 0 10 20 30 m3/h y CAPACITY 01985 Goulds Pumps, Inc. S93 ° 0 1 Effective July, 1985 C3885 r t SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 BOLDTS PLUMBING & HEATING DALE E HUDSON 820 MAIN STREET BLADWIN WI 54002 RE: Plan Number: S93-01561 Date Approved: June 8, 1993 Gallons Per Day: 450 Date Received: June 7, 1993 Project Name: MALCEIN, GLENN Location: SW,NE,12,29,16W Town of BALDWIN County: ST CROIX Fees Received (Priority Review): 360.00 The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW MOUND SBD-8817 i R. 01/911 I SAFETY & BUILDINGS DIVISION I 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations BOLDTS PLUMBING & HEATING Page 2 Inquiries concerning this approval may be made by calling (608) 266-2889. Sinc ely, P ER E. PAG Section of Private Sewage Division of Safety and Buildings PPP013/0009n/15 cc: -Private Sewage Consultant -County _UW-SSWMP -Plumbing Consultant Owner Plumber Environmental Health SBD-8817 1 R. 011911 s r w ~I ~ ~ ~ .„~u '~>r I L. "v tAL_U a t lulu hr-lut-f t D I L H R in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but f 1 not limited to vertical and horizontal reference point (84. drection and % of slope, scale or PARCELI.D. I dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION VT. LOT S l td 1/4 N4114,S / T ,2 9 AR e (or) W PROPERTYOWNER:'s MAILING ADDRESS LOT~A BOCK # SUED. NAME OR CSM S AIA CITY, STATE , / ZIP CODE PHONE NUMBER []CITY []VILLAGE 2TOWN NEAREST ROAD G'/ r%rwaco* C• sVO/3 (75)5 -7Z J3 a/d.. et . 17 pQ New Construction Use •pQ Residential ! Number of bedrooms 3 j ] Replacement ( ] Public or commercial describe Code derived daily flow 4150 gpd Recommended design loading rate _ZV bed, 9pd/ft2 trench, gt Absorption area required 3 75 bed, f123 7S trench, ft2 Maximum design loading rate bed, gpo4t2 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable /VA n S - Suitable for system oOhNEN "t. MoUNO WROUNDPRESSURE ATIGRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable I s tem ❑ S H U MS ❑ U ❑ S Off, ❑ S (9U ❑ S ®U ❑ S W U SOIL DESCRIPTION REPORT Boring # Horizon, Depth Dominant Color Mottles Texture Structure Consistence Barbary Roots GPD/ft in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed Trend- ° -g /oYR 5' `f /lone- Si/ 2 P1 5-A k n2 r CS .2 M • S Non e Si l 7 2 ,n n .nc w m NP • 2 Ground 3/ -ZL -T5'YR'Y q /Vo h e S[ m~s- C W 2 •.2 m 5 elev. 9_e' Y n. 26-3-Y 5,YR Z//,/- n e S/ 2 m SA K m ?Cr C w / v~ ' Depth to 5Ye y to limiting /10 Y9 s S Z m - .3 , y factor Remarks: Boring # Alone s•'/ Sk CS 2>n ~ f, _ y`- l3 iaYR 5~ /Uo n C s l 2 1>7W, C W 2 Z7 3 /3-29 s"YR y e S~ s rn -rr C cJ 2 AC - ~ • ~i Ground - elev. `-f 2-L39 S YR' Y 1 .1 /0 Y~ S L S~ 2 m S ~ ~►'J ~v C W J VT • 5 i - ~ 9~ n. Depth to - - - - limiting factor„ 9 - I Remarks: CST Name:-Please Print Phone: Address- 3z b "n. Sf• 130%~w.',•. , , 55~oOZ Signature: Dale: CST Number: Boring # Horizo Depth Dominant Color Mottles Structure ~iPpllt~ Texture Consistence in;:.. - Munselt ' Qu. Sz. Cont. Color Gr. Sz. Sh.?' Roots 8(!d :Try /0 YR /0YR //Y o~G si 2rnsk /nv-,rr Cw Zm Ground / -36 5Y~ Ile. /VOne 5/ s C W 7~vf • 5 •r!v elev. 91,L n. Depth to limiting >facla 3G Remarks: Boring # 13 I Ground elev. fL Depth to limiting y • factor Remarks: Boring # Ground elev. ft. Depth to smiting factor Remarks: Boring # Ground elev. fL Depth to limiting - factor -r Remarks: STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER !xxw C? a r,. ROUTE/BOX NUMBER ~fy 7~D ! FIRE.NO. CITY/STATE/ 1^~,>c70c~/1,/y r~> ZIP PROPERTY LOCATION: 1/4 /`r 1/4, Section , TN, R W, Town of Ca/~~~> St. Croix County, Subdivision Lot No. 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 a LICENSED SEPTIC TANK PUkPER. 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 $3000 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address `r APPLICATION FOR SANITARY PERMIT 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 ~ Location of property -L Cf~ 1/9 1/9, Section T G L N-R W Township ~GI/ -v-0 Hailing address cA" , -P 'Address of site t" Subdivision name A Lot number /Y Previous owner of property ~/C7611^ Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes _N0 Volume 712" and Page Number -599 as recorded with the Register of Deeds. ---------2------- 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 Hap shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. yO~yl -~3 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorlded in the Office of the County Register of Deeds, as Document No. Signature of Owner Signature of Co-Owner (If Applicable) 'Date of Signature Date of Signature . oc o, 13001 0L C STATE BAR OF WISCONSIN-FORM I I , • DOCUMENT NO. XV PAG_ wARR RRAR.TI GEED • THIS SPACE RESERVED FOR RECORDING DATA REGISTERS OFFICE THIS DEED, made between Joan M. Iverson and ST. CROIX CO., WIS. Jean Ann Mentink Recd. for Record this 19th Grantor day of August A,M 19-D5 and Glen W Malcein f 1:45 P 0ma 'i Grantee, N 1 Wi t n e s s e t h, That the said Grantor, for a valuable consideration li RETUR TO Q conveys to Granite the following described real estate in St. Croix Menomonie Farmers Credit Unio d County, State of Wisconsin: Box 126 k Baldwin WI 54002 _z SE 4 of the NE 4 and the NE 4 of the NE J'i and the SW 4 of the NE A that lays East of R.R. R/W Sec. 12, T29N, R 16W. Tax Key No. - I NS v FEE This is homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And ' 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 15th - --day of 19 85 _ ~U YFIt ~?iti/ (SEAL) ~`~'t - (SEAL) Joan M. Iverson - Jean Ann Mentink (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE. OF WISCONSIN 1 19.- i ss. Pierce County. Personally came before me, this 14th day of • August, 1985 _ the above named Joan M. TITLE: MEMBER STATE BAR OF WISCONSIN Iverson and Jean Ann Mentink (if nit. - - j: authorized by J 706.06, Wis. Stats.) !i n This instrument was drafted by ` - - B. J. Hammarback to me known to be the lier1'4n 14 *xecuted the fore- it goin instrument andl -Wn •edged*6awsame. 4j Shirley D. F u r u l•/ ~i (Signatures may be authenticated or acknowledged, Both - P1erCe n~, r County, Wis. I' are not necessary.) Notary I ublic_- My CornlniFsion is permanent. (lf iiot, state expiration date: 6/2°-- 19 86 •Nxmes of pcrsuns ;igning in any capurlt9 must be typed ur printed bel,,w Ilwi: si,;n:.lura•:. WARRANTY DEED-STATE SAR OF WISCONSIN. FORA NO 1-141' • ' vc 71$ 404234 SHERIFF'S DEED ON FORECLOSURE 1 WHEREAS, pursuant to a judgment of foreclosure and sale` 2 rendered in the Circuit Court of St. Croix County, Wisconsin, 3 on March 13, 1935 in an action between 4 Glen Mal::ein, 5 Plaintiff, REGISTERS OFFICE ST. CROIX CO., W I 6 °S' Recd. for Record this 112th John Kapusta, day of August A.D. 1985 United States of America, t ~A& g State of Wisconsin, Montgomery Ward & Co., LT 9 Sears Roebuck & Co., 8"M« of Dome Baldwin Motors, Inc., 10 Defendants. it 12 Deed exempt: 77.25(10) Wis. Stats. 13 and, after due advertisement, the mortgaged premises hereinafter 14 described were sold on July 23, 1985, to Glen W. Malcein, the 15 best bidder, for the sum of Sixty Thousand Eight Hundred Four 16 and 93100 ($60,804.93) Dollars, receipt of which is hereby 17 acknowledged, conveys to Glen W. Malcein, the following 18 tract of land in St. Croix County, Wisconsin: 19 Part of the Southeast Quarter of the Northeast Quarter (SE-1 of NE4) of Section Twelve (12), Township' 20 Twe.nty-Trine North (T29N), Range Sixteen West (R16W), Town of Baldwin, County of St. Croix, State of 21 Wisconsin, described as follows: Lot One (1) of Certified Survey Maps filed March 24, 1980, in 22 Volume 4, Page 928, Document No. 363352- ~ 1985• 23 Dated this / 1¢~ day of u _ 5 24 LuVerne Burke, Sheriff 25 St. Cl- ix County, Wisconsin 26 STATE OF WISCONSIN) SS. ST. CROIX COUNTY ) 27 Or the day of v aST, 1985, before me came 28 LuVerne J. Burke, known to be he individual and officer described in, and who executed the above conveyance, and 29 acknowledged that he executed the same as such sheriff, fcyx the uses and purposes therein set f rth. ~7 E{ 30 31 Notary Public, St. Croix C-4u r Q y 32 Wisconsin Q~ a F o My commission -2-1 ST This instrument was THOMAS A. drafted by: McCORMACK Thomas A. McCormack ATTORNEY AT LAW SALDWIN,Wi 990 Hi 1 Lcrest Street 54002 Baldwin, W1 54002 Tel. (715) 684-2644 (715) 684-2644 y-v a/ceY\ No. e CtY. llj~d, D G G'e n woo U ZA) GV N 83 z% 9# 9O v y s, e e /Z ~~d✓~ BZ O 30 70,rode. , SZ ~ ~D B -M, 70' z~ bl - 9y y4, yon aM. BZ - 9.3, 5 a3.9y.~ S Tr~- T, Sec. /2 Z?R ~ a ~ ~ sw/y NE/y C~ -1 Q~ ' r4tNYl By r l~ 0/7 /1P G~Z9 n CS-rm 3y/3 S ale /''=yo' G-2-93 cty•~•