HomeMy WebLinkAbout004-1072-30-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER 77 t O
• i
ADDRESS Z,S' L 4)A) SUBDIVISION / CSM# LOT #
SECTION_~TZ_V_N-RI~_W, Town of rO
ST. CROIX COUNTp, IS.CNSI d i-NiF11
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Lt'
l/
C^ ~ u
t
E 0
y INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
! v S~oci; • ~t ~~--t-,, - h r ~i/pit 1
BENCHMARK:
ALTERNATE BM: •1
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer. Liquid Capacity:
Setback from: Well House ~S Other
Pump: Manufacturer C Model#-3,915S-_ Size
Float seperation /Gallons/cycle: /y7
Alarm Location Z61-
1~]
/trGx ..:SOIL ABSORPTION SYSTEM
Width: _~t C, r Length fD~~ Number of trenches ~•~S g~
Distance & Direction to ne1rjest prop. line: g/
w~
Setback from: well: House/ Other
ELEVATIONS
Building Sewer'/r ST Inlet: f D ST outlet C~
PC inlet _JZ PC bottomT~ S Pump Off
Header/Manifold Bottom of system y 5
Existing Grade ~r Final grade !K7, g3
/-~c
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER; INSPECTOR:
3/93:jt
LOSTfdI(3rtGADMinaDti,y28.15.479 PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar mit
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
X
M!HQMA 9 14 F, r4QUERRM -I% MIT
E•I v.: sp, BM Description. Parcel Tax No.:
o',5 Co/~~ it
-
TANK INFORMATION ELEVATION DATA A9300201 S - .4W S
TYPE MANUFACTURER/ CAPACITY STATION BS HI FS ELEV.
Septic li C r,. ~ry~~J d Benchmark
Dosing ed,
Aeratio Bldg. Sewer
Holding St/*I Inlet /a
TANK SETBACK INFORMATION
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air intake
Septic NA Dt Bottom
Dosing NA tleadw / Man.
Aeratio NA Dist. Pipe /A. of
Holding Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand 7-w<r ~,v3 9
Model Number W GPM
TDH Lift <jl Friction Systems TD 9~ Ft
Loss Forcemain Length Dia. FDist. To Well'
SOIL ABSORPTION SYSTEM
BED/TRENCH Widt~y r Lengt~ j / No. Of Trenches PIT Inside Dia. Liquid Depth
DIMENSIONS }O f DI EN I N
acturer~.,.----
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING
SETBACK CHAMBER
INFORMATION Type Of fi O.r J , Moe Number:
System: yy~ /did OR UNIT
DISTRIBUTION SYSTEM
hYww111111s/ 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
Aed /Trench Center 2"/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: CADY 30.28.15.479
8 c
may/ • vim, ~ ~ .
R - Plan revision rejuired? ❑ Yes p,
Use other side for additional information. /o? GYo G~-~
SBO-6710 (R 05/91) Date Inspector's Signatu Cert. No.
+ ali-k-1 af 4 ~~Ivd j /
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
E
f
IL.HR SANITARY PERMIT APPLICATION COUNTY
s In accord with ILHR 83.05, Wis. Adm. Code ST. CROIX
STATE IT#
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% X 11 inches in size. Ch revis o previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S93-40706
PROPERTY OWNER PROPERTY LOCATION
THOMAS GENZ NW Y4 SE %4, S30 T 28 , N, R 15 E (or X@
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
150 NN` N/A N/A
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
SPRING VALLEY W 54767 715 72-4460 N/A
) TY : NEAREST ROAD
II. TYPE OF BUILDING: Check one Cl
( ❑ State owned O VILLAGE
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms 4. A NUMBER(S) CO RD NN
Ill. BUILDING USE: (If building type is public, check all that apply) 004-1072-80
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line-A. Check line B if applicable)
A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 El Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
130 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
600 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
00 Feet 7 Feet
VII. TANK CAPACITY Site
INFORMATION in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
New isti Gallons Tanks Concrete strutted glass App'
Tanks Tanks
Septic Tank or Holding Tank 120 1200 1 WIESER CONCRET
Lift Pump Tank/Si hon Chamber, 7 750 1 IE SER CONCRET
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):
W1229 770TH AVENUE, SPRING VALLEY, WI 54767
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A gnatu tamps)
❑ Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTkICTIONS r
r
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 tie permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (S6D 6399) to be
submitted to the county prior to installation.
5. Onsite ;=.ewaAie systems must be properly maintai led. The sepli tank(s) must be purrF d z y ,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.
ll. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
111. 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. A.bsorpt!^c system information. Provide all information requested in #1
, u i?c cr of
VII. Tarr, in the capacity of every new and/or existing tank, list t:.e total
all
,nlis as?; a~u` +_tr2r's name. Indicate prefab or site constructed anc l'an'k. nrateri ii v~? !u for
sepr s , l > E, 's ptE and holding tanks for this system. Check experim:• ::Approval ur f a,-,, s received
approval frc;m DILHR.
V1" Sftn "'ii'"flT~r "tWo4r-r`t. !nstalllr g plumber is to fill in name; :Ice-'!se rRl.l't?I?E' with a +r r • ,rB;!ky !prefix (e.g.
P' P. r1..'; : 1: s! a ld pftfine nur. !)er. Plumber must sign application farm.
IX. 'County:`?lepartm nt Use Only.
X. 'Countyi'!~`°K;:?.'<rt r!el,t Use Only.
Compif-i:e ; 'a3 >Pecifications not smaller than 8'/2 x 11 inches mi!~zt he sL,bm i r ' tl,- co, inty The
panc r t.e following: A) plot plan, drawn to scale or with c C! ' i if f i?ion of
hol~ing T11. tank(s) Or other treatment tartkS,=1ild rid ,.er service;
streamY rf. i3kes7 p :mks or siphc,n tanks; distribution Dazes; 441+ absorr,,,. - syite!r't r e!!r ?rat system
areas a ; the `vacation of the building served- 3) horizontal and vertical _l r atior -
C) complete spec:`ications for pumps and controls; dose volume; elevatlor, difference::.: 'r oss; pump
perform.ll carve; pump model and pump manufacturer; D) cross secilon of the soi! abscrf::ion 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 pr icli ;es whicf- ear,, effect groundwater.
t .
The ,;onies coin °cir f t> r ,:.gh hese s! rcha fes c. f'
wcit6r t;ontar;Air+ation ir1vPs?gat?.e~nS.and E*Stai✓•lSflnnr`r',%..:)? Rr,•5:3?':'i',
SBD-6398 (R.11/88)
--A SOIL AND SITE E 1Q PORT
R D I L H R in accord with 1 .05, Wis. Adm. o
~ • :fIWM,11,I
\U1 ..\Ml.•.IMMIM1\ARM COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 i rn siz ~ mut~i~nclude, ~t
not limited to vertical and horizontal reference point (BM), dir a~f s~o~, scale or PARCEL I.D. A
dimensioned, north arrow, and location and distance to near d. \ G~~y GGc~
REVIEWED BY
APPLICANT INFORMATION-PLEASE PRINT ALL INF T DATE
101
G lvv\ l h C~vv. J o S/ S
PROP/ERTY (7WNER PROPti
~20iz't S ~e~r 8 1/4 SE 1/4,S~0 T a N,R I E (ar 1y
PROPERTY 0NNER'$ MAILI ADDRE S OCK N SUED. NAME OR CSM N
Isv C~~ lJ
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ILLA E 9FMW NEAREST ROAD
-7-7,~ - c~ G r. /-l' I W O'
( New Construction Use ( Residential /Number of bedrooms
j ) Replacement ( ) Public or commercial describe
Code derived daily flow /6'0 gpd Recommended design loading rate . 5 bed, gpo$ , 6 trench, gpde
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate . S bed, gpd/tt2 • 6 trench, gpd/ft2
Recommended infiltration surface elevation(s) 9S = It (as referred to site plan benchmark)
Additional design / site considerations
Parent material ~uer Flood plain elevation, if applicable &I ft
S = Suitable for system OONVENTIONAL MoU MROUNDPRE RE AT-GRADE SYSTEM IN F7&J, HOLDING TTA~N,
U = Unsuitable fors stem ❑ S C+-YU In ❑ U [I S l I-] S C1 S [BTU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color MoWes Texture Structure Consistence Ba tiary Roots GPD/ft
in. Qu. Sz. Cont Color Gr. Sz. Sh.
y~~~x Munsell Bed Tre
"-V C
f"<"s -IS I~= y 5i sit ~~~rs t a s~k Y~tv~r c,J 5
I CO
Ground 3 it
- <%y s t 1... Y\ -S tom. ~r r can , ~o
elev. t -7, 9 NV, 5 I Sb~ I
~
I~
~
Ilmttingo i
factor
~j rou~~Q uo. r a. l 3(
Remarks: UNt• `~.Z't 3 dl ` O ~o ` RZ 0)1\
Boring #
__/0 vet I s~~ W, d o s- j
SJ C Q woo S r I S U 3 ~r- a o
n s h'L~c t c a .S
Ground `3 U -
Ground r v k S J
elev. 1 ~ 1 F
j.S ft. t« C C~ y y 5 a w.s b , S~ I ~o
Depth to -
limiting
la lot it
_
Remarks: Vtr` 3 7. S k aid 1l~~lQ ~ZCbc,\j tti aJ `CT(art Zoy~
CST Name:-Please Print Phone: 77-2
Address: \
Signature: Date: CST Number.
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G'
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Stt. Bed Orer
i b-? t 0 C
-7-0 CA Lj
Ground 1-130
elev.
Depth to
limiting
f Ct~t
Remark's:
Boring #
x4J-11
Ai
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
>>y>y '^MYA:YTK:4
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Nix
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
I I i I 1 ~ li
I'; 1OT il~ e C a !
- FI<o T-A rF j ~Cn - - -
I ~ I II
I
i
-II
I !
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, p
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I I
ry•'?~ qo s
' I ' I i I ~ I I
it ! I i l I ~ I f ~
L G
150.6
P, M 1 5.12 Q. 106. c
j~ ~Ce 1 R~..
' I II X1,1 ~Q iPo lj,> etr i o>~,e ~5~ I I i I t --t-- -
I~L'~ I I I I ! i I
II I
I
II ~ 0.I -11 140
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• •w°•~ SOIL (in EVA ON REPORT
~'DILHR
R 03 O5dm. Code
~ COUNTY Attach complete site plan on paper not less U,ggss %s ie. Plan usl include, but not limited to vertical and horizontal reference andof §lo ale
or PARCEL I.D. x
dimensioned, north arrow, and location and dirod,APPLICANT INFORMATION-PLEASEPRRM REVtEWEOBY GATE
v \vV~nw aor~ S /S
PROPERTYONNER `P PERTYLOCATION r
/ hp`yi 5 ~evr C GOVT. LOT PW 1/4 SE 1/4,S,30 T a N.R I E (aC
PROPERTY (7NNER'$ MAILING ADDRE S LOT N BLOCK N SUED. NAME OR CSM x
Is c~ C ~u /U
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VIL GE NEAREST ROAD
v ('115) - V C r rf' " ~tJlu„
( ew Construction Use ( Residential / Number of bedrooms
L I Replacement ( I Public or commercial describe
Code derived daily flow /<50 gpd Recommended design loading rate .5 bed, gpd/it2 .6 trench, gpd/112
Absorption area required bed, 112 trench, fit Maximum design loading rate bed, gpolft2 • b trench, gpd/fl?
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design I site considerations
Parent material S, f ~ n vej- Flood plain elevation, if applicable N,4 it
S = Suitable for system CONVENTIONAL MOLIbIQ MROUNDPRE RE AT-GRADE SYSTEM IN Flyr HO SNC~ TAN
U = Unsuitable fors stem O S Ro In ❑ U O S 0-1:1 1 S C~' J~ ❑ S 916 SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bocnciary Roots GPD/ft
In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed Me
~ s l sbk Irk l w
a
C)\/
5/3 SE1= TZemnc~5 s a S~tiC Yrl J 3 r U)
ltw i~ - l5 ION
. S u 1 _2 (CO
Ground 3 1S-3b ~y 51 3w, s~~c r. r n
elev.
t ~ s i I 3 s~lc, C t
91ssrt: y 30- L , -f Y Ile,
Depth to - c 3 S~k i,~
limiting
la•~clO rr
(j 1ro~hK LO J, r a F 3(',
Remarks: Of 3~ S \]P,: Sr 1 0 5~ Lo` c
Boring # (
g k s F;: c. V d fa
v p '1~- srC }~Qr~~k S , ~k U . 5~
Ground 3 ~-ya - Y ~ • t ~ s ~ ~ w. sbk ' S
elev.
Depth to - -
lirniling
ta~tor r r _
tr0clnoei LO
Remarks: Utr 3 7.5 'Ss ~)J,6 -izpf
CST Name:-Please Print Phone:
Address: ~o ( hr \i 4 U OL' 12
Signature: ~ at ~ ~ , 3n Numbor. -
SOIL DESCRIPTION REPORT
Boring # lJorizo Depth Dominant Color Mottles Structure G 't3'It' .M
in. Munsell Texture Consistence f3ourir~ry Roots
Ou. Sz. Cont. Color Gr. Sz. Sh• E3ad Tror
v:::2~r•."•'~y~•".~ ~ / I l V ~ ~ ~ ~ ~ ICI
Ground - y- ' -
elev.
C
Depth to
limiting
factor
Clor ~t •
Remarks: '
Boring #
Ground
elev.
IL
Depth to
limiting
factor -
s
Remarks:
Boring #
v:';wn;s;''Ys
Ground
elev.
ft.
Depth to
limiting
factor
7-
Remarks:
Boring #
•dt,
Li~:w+..rrr:T}}:.r
Ground
elev.
fl.
Depth to
limiting
factor
Remarks:
M N A e - -
~ qo
(tJ ~ C s~
a i ~ / q0 s
I
Ro
5 ke ~ ry R bb
h ~ ~ Po er
s 0.I ^y
s
I J
,
5 c, :Rol I
a
Nip o,~ cL Q cQ -
'I
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,t E leo.
83
I
I
J gy~
1 o3.0o
loo. 06 r/
i.n JJSV ~~u;er axle#3S %B( g~
i"Drc~ Aa,,. S
1
r~nc 6ti S.~ p~<
lvj
~~T
p'sl i , < t v
k
~``•"~u ~ x c ~e~O ~ Sh a~~ 1 1`~`
s
W d~j to
t't ~ h i U Nc~k R u~ • e
cc,-v,x f G rn S.,~Q
J
L l 'jjS l nLtli S +C' IGl Z--
Page _ Of
r3 4 0 7 0
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
Topsoil H__` JG
- F S
E
3
n
b
% Slope.
Bed Of --2"- 2 Force Main \\",Plowed
Aggregate From Pump Layer
D Ft.
E f,b Ft.
Cross Section Of A Mound System Using
Ft.
90
A Bed For The Absorption Area F I
G 1 Ft.
A Ft. H Ft.
Signed:
13a'2 d Ft.
License Number:/"- K LQ
p5-Ft.
Date: `1 - L 101.3 Ft.
j~Ft.
Alternate Position T 1_3_ Ft.
of
Force Main W a.? r Ft.
Observation Pipe
- -
I
i
A
----------------------•I Force Main
W °
w,tp,GE Distribution Bed Of 2- 2
Pty alt Pipe Aggregate
bservation Pipe Permanent Markers
, f~ ~~y1(1l1S
P X40. Mound Using A Bed For The Absorption Area
Perforated Pipe Oetoll
0
End View
-End Cap )Perforated
y+ PVC Pipe
1 Ob~c• •
Permanent End Markers
~s
Holes Located on Bottom
are Equally Spaced
e
per-
PVC Force -Main
4 From Pump
ISO
Q PVC
ENo
CA Monl►oid Pipe
l y~Pvc.
6ielrlDullon..•
nn Pipe
Lost Hole Sh I(6r1
NexfAq;Xop
~3 stribution Pipe Layout
a 2 2 ~
~ A O P 3.a_
Dom'~~3 sad S R
L~
S
x
Y
Signed: Hole Diameter Inch
License Number: Lateral " Inch (es)
Date: 1 LC> - j Manifold " Inches
Force Main Inches
ff '1 S!' i t~tf<rtkitS
I~t' a C~ I ~ t'ro~'~ ~_e z cvn~h SGcCCPccQr~i q li-t'o ~ts 4'f
f J~ / r ~c 6 e /1) o f ''oN ~t' C cc~r~ .
4 S 74
~V\r ~~p d yn .c l'tGn 2 . tom/
Page -()fS-4 0 ` O 6
M COMBINATION SEPTIC TANK/PUMP CHAMBER
No Scale) 4" CI Vent Pipe with Approved Cap, +25,
Approved Locking Manhole Cover From Buildings
With Warning Label Attached
Weatherproof Approved
Warning Label Junction Box Vent Cap
12 Minimum
Final Grade 6" Minimum 4" Minimum
6" Maximum Quick
4 11 C.I. Disconnect
18;" Minimum Insp. Pipe---
soAGE
1/4" Weep
i0 r, Hole
es
Approved Joint ►
w/C. I . Pipe
g so too
A
Extending 3 ~s~~• Alarm
of sR B Approved Join'.
Onto Solid S ' ot~se On 6; w/C. I . Pipe
;pO : C Extending 3'
7. 00 Off Onto Solid So,
D
Conc. Block
3" of Beddinq Under Tank-/
Note: Pump and Alarm Are On Separate Circuits Number of Doses: 'y Per Day 150
Gallons Per Day/# o-FDoses: 2Ls'~C Gallons
r Volume of Backflow:....... +_j_Gallons
Tank Manufacturer: ers Total Dose Volume:........=gallons
Tank Size-Septic/Pump: 1_-,0o a 1 ons i 7G. 2-4
Alarm Manufacturer: S
Model Number: Capacities: A ~S' inches or o ,D Gallons
Switch Type: + B inches or, Gallons
Pump Manufacturer: C =ll + Cinches or GallonsfT1.43
Model Number:," ~,'ps' T)- cJ" + or Gal 1 ons 145,11
Minimum Discharge ate: Total _ 4/7 inches or 7 -:~.c.> Gallons -GPM Vertical Difference Between Pump Off and Distribution Pipe: j.2jeet
Minimum Required Supply Pressure: Feet
bf2 Feet of Force Main x3 ,7 b Friction Factor/100Feet: + eet
;)"-Inch Diameter Force Main
Total Dynamic Head:...=C ,5 Feet
Internal Tank Dimensions: Length` Width Liquid Depth
Si gnaturos,, License Number ~~/S Date '7 -Z& - i
~~c;.~-ate _~--~~e/~
. ~ r ~s~~~ ,tf t Via; to r tr'~tk t t _"X +
„ 70
1 / i 10 ~ 1
I
\ t
04
b
E>*4z x; ~y t r a
7,; J
- TANKSPECIFICATIONS
CAPACITY: 1200/750 GALLONS
INLET AND OUTLET x
CONCRETE STRENGTH:'5000 P f it F 4 BORE WITH,0" FOR TYSEAL OR
REINFORCEMENT: ERNCO GASKETS' Yy
COVER: #4 REBARr ~x;' Y 4~ INLET AND OUTLET BAFFLES:.. .
TANK: .6 x 6/10 GA WIRE PJI
rf ,b.¢ P VtC *MEETS~fVI D.f L .AND
DIMENSIONS
,~rt~ MN M'P~C A:~S~PECIFICATIONS
WALL: 2z LENGTH 5 r~
4 ~IQUICAPACITY
BOTTOM: 3". WIDTH 11; Y 86"< > r 25.40 GAL/INCH (SEPTIC)
COVER: 5" BELOW INLET 53" ~ r AL/1NC'~r PUMP
HEIGHT: 66" MANHOLE 24'7 I D s' f WEIGHT.'14, 795 POUNDS
MODEL WCT 1950 moolESER 1200/750 Combination Tank CODCRETE
Rt. 2 (Hy 10) Maiden Rock, WI 54750•(715)647-2311
r 1
c
Performance Submersible Effluent
Curves Pump~;
METERS FEET S" 3 4 0 7 0 c)
90
25 80 MODEL 3885
4 Ids
0 WE15H
W 70 +1 + +
Z 20 WE10H
H 60
WE07H
15 50
WE05H
40
10 30 WE03M
20 WE03L r
5 11
10
0 00
10 20 30 40 50 60 70 80 90 100 110 120 GPM
L I
0 10 20 30 m°/h
CAPACITY
[gGOULDS PUMPS. INC.
METERS FEET SB`E{A FAILS NEW YOM 13148
120 MODEL 3885
35 110 WE15HH SIZE 3/4n Solids
30 100
90
25 80
Q 70
S 20
J
H 60
0
50 !WE05HH
15
40
10 30
20
10
0 0 t-H+
10 20 30
1 40 50 60 70 80 90 100 110 120 GPM
I I I
0 10
20 30 ml/h
CAPACITY
01985 Goulds Pumps, Inc.
Effective July, •1985
ST C- 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/ UYER \Ab~nn~S
ROUTE/BOX NUMBER p \t\ V\, Fire Number ~le p
CITY/STATE li ZIP PROPERTY LOCATION: Sections T Z N, R
Town of 16 r- , St. Croix County,
Subdivision Lot number
Improper use and maintenance.of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a l.censed septic tank pumper. What you pdt into
the system can affect_ the function of the septic tank as a treat-
ment•stage,in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their 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 veri-
fying that (1) the on-site 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 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 Depart-
ment of Natural Resources. Certification form must be ;in3 4rpleted p le
and returned to the St. Croix Co 0 day
unty ,onin9 0 f.i,ce wit 0 ;
~ti
of the three year expiration date.
SIGNED ~y-
1) ATE .
L--
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-4,25-8363
Sign, date and return to above address.
P'
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 VV0 V^ 'o,
E IL, section 7 , TN-R~W
V, 3
.Location. of Property
Township r U `4
Mailing Address ~a
Address of Site S \AN
.Subdivision Name.
Lot. Nu ber
Previous' Owner of property c~ A 6
Total. Size- of parcel L v
.Date Parcel was' Created \-Z-- p z- p
'ire all corners and lot lines identifiable? Yes X 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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
T (We) eelLti.by that atZ dtatement6 on th-U bonm one true to the but o.b my (oun)
knowledge; that I (we) am (aAe) the- ownen(d) ob the pnopenty deac ibed in this
.in6oAmat.ion bosun, by vihtue ob a wajrAanty deed nec_onded in the Obb.iee ob the
County Reg.isten ob Veedda6 Document No. 5 43~ ; and that I (We) pneaentZy
own the pnopoded date bon the aewage didpod dy.6tem (on 1 (we)- have obtained an
ea.6 ement, to nun -with the above da ot,ibed pkopWil, bon the eondtnuction 06 said
d yatcm, and the same had n duty'neconded in the 046ice o6 the County Regi6ten. o6
Deedh;, a6 ument Na ) .
SIG URE OF WN SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
DOCUMENT NO. STATE BAA'OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA
f WARRANTY DEED
463487 Net 884PAG0P`48REGISTER'S
OFFICE
Gordon M Emerson and ST.
This Deed, made between CRO~X CO., W~
ii Jeanne B. Emerson, husband and--wife and_:each:_n their Recd for Record
awn right.------------------------------
at u 2 1990
_ Grantor,
and-__-___Thomas H. Genz and Scherry L. Genz, husband and ~ 1100 A.M
wife as_joint tenants with right of survivorship, as
Wisconsin-Marital ro t -
---p ---~_Y~-- - - - ReglsterofDeeds
Grantee,
Witnesseth, That the said Grantor, for a valuable consideration------
! Twenty-nine__Thousand__Five Hundred- Dollars ($2/9~+~,.500)-------
StoiX RETURN TO
conveys to Grantee the following described real estate in ___•__Cr
County, State of Wisconsin :
The South Half of Southwest Quarter;
! Northwest Quarter of Southeast Quarter;
I{ Tax Parcel No-
and par o Southwest Quarter of Southeast Quarter
described as follows Co mencing at the northwest !
corner of said SWa of SE4, thence South A rods; thence
northeasterly to a point A rods southeast of place of beginning,
thence West 1~ rods to place of beginning, all property being
in Section 30, Town 28, Range 15.
it
This Deed is given in, consumation of that certain Land Contract between the
parties dated December 2, 1970 , recorded December 4, 1970 in Vol. 467 at
! pages 327-328, Document No. 303123.
ii
f 'fi.LA
To I/17/
j
EXEMPT
This 1S-_nQt------- homestead property.
(is) (is not)
(i Together with all and singular the hereditaments and appurtenances thereunto belonging;
And-------Gordon- _F~rson- and- Jeanne- B. _ Elmerson
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
i~
and will warrant and defend the same.
DI this 22---------------------- day of AL1gl1St------------------------------------ 19----90
-_1' rIckt,"10V
------(SEAL) ---.--(SEAL)
Gordon- - M. Emer--son * ~I
it ?arc l ----------(SEAL) - -------------------------(SEAL)
--------Jeanne B. Emerson
~i
i AUTHENTICATION ACKNOWLEDGMENT
e1G rdon._M-__Emersan__and--------- STATE OF WISCONSIN l
Son ss.
-
------County.
lf_ St_________- 19____90 Personall came before me this _______________day of 11
------------------119 the above named
* Robert R. Gavic
i;
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not- Il
i! authorized by § 706.06, Wis. Stats.)
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
!I THIS INSTRUMENT WAS DRAFTED BY
ROBERT R. GAVIC -
Attorney at law
__----County, Wis.
~s
S1r`Ong`-'FIa11ey ;--in}I--547-67 Notary Public
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (Tf not, state expiration
are not necessary.)
date. 19--------•)
.Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. inc.
FORM No. A - 1982 Milwaukee is
DOCUMENT NO. I STATE BAR OF WISCONSIN FORM 3 - 1982 THIS SPACE RESERVED FOR RECORDING DATA
QUIT CLAIM DEED
I
Scherry L. Weeks, f/k/a
Scherry- L. Genz, a single person
quit-claims to ---.Thomas••Ii.t__GeDZ-,•••-~A$~~_.j?~x;;QXI---•------•.-.--••.-------
the following described real estate in 3-t-- ..C.r.OiX County, "m
State of Wisconsin: RETURN TO Douglas R. Zilz
P.0 Box 359
ll---Huds-on-..-WI--5.4OL6---..--.-..
Tax Parcel No:
The South one-half of the Southwest Quarter and the Northwest Quarter of
I! the Southeast Quarter and Part of the Southwest Quarter of the Southeast
Quarter d rie cs rie cs bed as follows: Commencing at the Northwest corner of said
Southwest Quarter of the Southeast Quarter, thence South 12 rods, thence
Northeasterly to a point lk rods East of the place of beginning, thence
West lk rods to the place of beginning, and the North 2 rods of the
Northeast Quarter of the Southeast Quarter, all being in Section 30 AND
that part of the North 2 rods of the Northwest Quarter of the Southwest
Quarter lying West of the road in Section 29. All in T2814-1115W. AND
The North one-half of the Southwest Quarter except the South 1 rod thereof
Section 30-T2811-1115W.
I
This deed is given in conformity with a judgment of divorce between the parties
I dated October 17, 1991.
I
I.
I
I
homestead property.
This ..-._.-_..1-..........
(is) (ixxi'Dk) '
Dated this c;,? - day of 19...
' gr- (SEAL) L. _Wee s, f/k/a
Scherry__ L . enz
(SEAL) (SEAL)
* .
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ..OT...... n" L'.WS4. STATE OF WISCONSIN
i
ss.
-----•---•-•-----r••----•----~:_
County.
authenticated this .~.~ay of. u.Ait.-I....... 19.Z- Personally came before me this ................day of
19........ the above named
t-~
Gyv~.~+~ KuC-U-
E: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Zilz and Estreen
P.O. Box 359
Hudson; ---Wi---- 5.401-(r-----------------•-------------------------- Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
date: 19.-------•)
'Names of persons signing in any capacity should be typed or printed below their signatures.
_ _ STATR BAR OF WISCONSIN
HGMdlerCarlpelryM FORM No. 3 1982 StOCIC NO. ~30~~