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018-1043-10-000
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W O O. m O O 06 It ll 0) d CD F- N d i a) ~ o c a m C a a 0 c E H H H co H H H _3 Co 0 0 0 a m 0 0 0 a • a a a o a a a a a ~ I~ I N F- M M M Fa U) J C~ ~ : m F- m 00i O OOi O0i ° Z Z r- r- r C,4 o cl c:) 0 o m y o 0 o m 3 rn a> CL o a, a z ~ o o d ¢ z u2 m 1 w m p Fal 0 3 m y c O o m O a) N N ° j co (O 0 0 17 0 0 F- C~ a°i c c U c c c a m N N p t N C 75 aE`i N c y 2 0 co w 1 , -1 -5 n rn rn C ° E O U-) N Z v O U) W E CC) U U Co O N O O _ 0 O a.. N a3 (6 t?S U O) 0 N N w O ~ I :E E r V ~ E a`r E d n m a d a CL y m y a w • a ~ c c E t A 0CT Omo Ono j STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER l ADDRESS Y 7T ~G~~ 1~%t Dot ~ SUBDIVISION / CSM# LOT SECTION, T N-R_L~_W, Town of A,1?a&,,rl d ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S~ I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- 1 ~y BENCHMARK: AV a /1 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION 4 i Manufacturer:V,~~,r7~Pt~,~, Liquid Capacity: 1 ~ ee,6 a i Setback from: Well ? House Other Pump: Manufacturer GIu hi Model f - Yhl Size 311" Float seperation Gallons/cycle:~L Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches d G~ lei eS S rC~/~ Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: .20 _ PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt ~IvQire~,°~ir~Nartrr~ 19.29.17 •PRIVA~~►EUSYEM • TT '~'P Y• County: Labor and Human Relation, INSPECTION REPORT Safety and Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 193445 Permit Holder's Name: ❑ City ❑ Village ❑XTown of: State Plan ID No.: HAMMOND ST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 018-1043-1 TANK INFORMATION ELEVATION DATA A930010 / Z~ TYPE MANUFACTURER CAPACITY STATION BS HI FS . Septic Benchmark Dosing t. cLA-V.d 4*1 Aer ~r~ . ~t ~rcA- Bld .Sewer Hold St Ht Inlet 1 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet rl Septic NA Dt Botto Dosing NA Header / Man. a Aeration NA Dist. Pipe Holding Bot. System, PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ' Model Number GPM TDH Lift Friction~,~ System Head Ft Forcemain Length Dia. 2 11 Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C/7 , DIMEN SYSTEM TO P / L BLDG WELL LAKE / STREAM L Manufacturer: SETBACK CHAMBER INFORMATION Type O /jam 2a ~7 ' 1 >So r OR U e Number: System: r~~ L{ DISTRIBUTION SYSTEM Header / Mani fold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 44s Dia. (k Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over ri xx Depth Of xx Seeded/ Sodded xx Mulched Bed/TsgItLLenter Bed/Ts~ges Topsoil es ❑ No es No COMMENTS: (Include code discrepancies, persons present, etc LOCATION: HAMMOND 19.29.17.299B,SW,SW,COUNTY RD ) cy 2 . Plan revision required? ❑ Yes ❑ No Use other side for additional information. y ` 1 SBD-6710(R 05/91)`.°v 4 Date .'-c.,,•}s Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t E~ i 1 , p 1 s .1 t E lei/ 4 ! ' . ?f ev, 1~ Re t t ~ p I ! f P 4 i S . Ax d"A a { g r t._~ 4 I r i L ~ tl L_... __..l._... Plan fev' ; 9- 7 9..? t 1 17 ~~rr f _r fry ! ~ f t ' f { t c^' JL ~ man~~'vld P~Pc. ~V .Q ~ 4 a IS }.r~. pv~ -i1F Las+ holc shovlk 6c, r%CX1 ~o CMA Cap y t i AV , ti 6 G ? +'r X15 1~ T ~ i s P a.. F i- i; Y ; ~ hole 1 n c►~ 06 4cr•. l el l a ~ n cl+ Cis) UEPARJ Mangy O \ \ t ~ I Per Pope UV 3a~i a~~93 q V 93 i Page - Of - Straw, Marsh Hay, Or ;Synthetic Covering Distribution Pipe Medium Sand H z G 6" Topsoil F t, 3 ; E Ra . . Slae 4 Bed Of 2 %Z Force Main Plowed g a t a Layer WI3elow Pik D Ft. ti k` E I . S Ft. Cra's6 S-Wcj'on Of. 4Mound System Using att. - ,.,4 for Tha,bsorption Area F #7q Ft. G Ft. Ft. H Ft. Signed: A B 4 -7 Ft. License Number: 3D3 K_ Ft. .93 3. L Ft. Date: J Ft. Alte, ate sition I Ft. I rce W Ft. Observation Pipe ' J B t< *"---7 Force Main W T Distribution Bed Of iM- 2'2 Pipe Aggregate Observation Pipe Permanent Markers `~t~C,t~Z S ~,CwtZ,6 • Plan View Of Mound Using A Bed For The Absorption Area PAGF GF PUMP CHAMBER CROSS SECT IOU AIVG SPECIFICATIOUS VENT CAP WEATHERPROOF APFROVED LOCKIAIG JUNCTION BOX MANHOLE COVER r -T 12"MIU. GRADE I MIN. I ~ I fU~T I ~ 8" / r11 AI. ' C,OIJDUIT 1Z v 18"MIN. ,fir='`'` IAILET ya`:,~r PROVIDE I 1 AIRTIGHT SEAL I III / t `t( 4 l III ALARM . ~".'-a a ~vlFr. I I OAl APPROVED JOINTS WITH I ELEV. FT. APPROVED PIPE 3' ONTO PUMP--~ OFF lab. D SOLID SOIL CONCRETE BLOCK RISER EXIT PERMIITED OIJL4 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPED FICATIOU DOSE TANKS MANUFACTURER: St WMBER OF DOSES: PER DAy TANK SIZE: -750 G LLONS DOSE VOLUME l I P IL~ INCLUDING BACKFLOW: GALL. ALARM MANUFACTURER. -Tar k~ MODEL NUMBER: CIA CAPACITIES: A= 1 INCHES OR _ GALL( SWITCH TYPE: s= INCHES OR /5 GALL( PUMP MANUFACTURER: C=INCHES OR 1td(0 GALL( MODEL NUMBER: Ds_ 0 INCHES OR I l y GALL, SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 3 INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF ARID DISTRIBUTION PIPE.. -//'0 FEET + MINIMUM NETWORK SUPPLY PRESSURE . 2.5 FEET + ! a" 0 FEET OF FORCE MAIN X J. 42 F loo irtFRICTIOU FACTOR. 196 FEET TOTAL OyNAMIC. HEAD 16,41 FEET INTERNAL DI WSIONC OF TANK: LEM&TH 17 11 ;WIDTH G~;LIQUID DEPTH ~I BIGUED: LICENSE NUMBER: DATE: / I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS • INDUSTRY, DIVISION 'LABOR AND P.O. BOX 7969 r HUMAN RELATIONS 1 PERCOLATION TESTS 115) MADISON, w1 53707 W HR 83.09(1) & Chapter 145) LOCATION: SECTION: HIP UNICIPA ITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: T / SIB/ N/Rl 7E (or COUNTY: t MA I G ADDRESS: ~?Coo G ire l t c USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR NS: A InN ST : Residence RJNew &Replace rjh se"te den, 1~ieM so~j RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: STEM-IN-FILLHOLDING TANK: REC MMENDE SYSTEM: (optional) os®u ©s❑u asou SYas u ❑sEd u If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-~ B- /I B- S W rNS1 Ac SQ 30`I thin lard Ahp/s B-7 ~O/ 'Bls~ Z-,-2y"~ sf'Iasi"~a'%~~'~e Eej7e B- pus PERCOLATION ESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 P PER INCH P_ J _)911 0 30 <IV P_ 1-W P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 00 SYSTEM ELEVATION 3 T Ne oueeo~. I A i s - - - - i I 3 I i , E i &J, i B3 E I i Are i i I ~ I [ I I F -64e e t -Tr I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (prln : TESTS WERE C MPL TED ON: was ~)Ocn , 93 ADORES CERTIFI-C ION N MBER: PHONE NUM~E~tional): CST TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separate* and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Peecolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fit - few, fine, faint 'c • - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. 701L HR SANITARY PERMIT APPLICATION cou In accord with ILHR 83.05, Wis. Adm. Code S~&` STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less thU510~ 8% x 11 inches in size. chec k f son revious app ca 'on -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S - ' y /0 1 PRO ARTY OWNER ?0,14 PROPERTY LOCATION / X. S t/4, S TQ~, N, R E (o W PROPERTY WNER'S MAILING ADDRESS LOT # BLOCK # CITY A ZIP C DE PHONENUMBER SUBDIVISION NAME OR CSM NUMBER V . 11. TYPE OF BUILDING: (Check one) F-1 State owned ❑ VILTML.AGE NEA ROAD ❑ Public R 1 or 2 Fam. Dwelling-# of bedrooms _3_ QRCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) Q~ fit7/~ 1 ❑ Apt/Condo 0 / le~q ~&Z_ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify ~ IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) L'y1-s" ' -711 A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. Recor nection of 5. ❑ Repair of an System System Tank Only Existing System fisting 6ys~~tem B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued C / 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 REO~IIRED q. ft.) PROP SE (sq. ft.) (717 /d/sq. ft.) (Min./inch) ^ P ELEV TION ~~j r, ® / v ` - Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic INFORMATION App Tanks Tanks structed Septic Tank or Holdin Tank I>rl S 11 1 El Lift Pump Tank/Si hon Chamber / i VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er ame (Print): IX ignature: (No S ps) rP/JFMMW o Business Phone Number: AI OJ l/ PI s ddress (Street, City, Stat Zip Cod IX. COUNTY/D M ENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Si mks) Approved ❑ Owner Given Initial 0 ,Surcharge Fee) Adverse Determination 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. n 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 applicabie. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a San tary Permi! Transfer/Renewal Form E3r) 6399) to be submitted to the ~,o!,nty pridrto installation. 5. Onsite se*age cystwns must be properly maintained. Th !':t tank(s) mint be p.urr,pwd Iicensed, 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, 608-26673815. , 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. 11. Type of building being served. Check only one and ~ompiete # 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, -econnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system, information. Provide al? information requested in #1-7. VII. Tank stforrnation. Fill in the capacity of ev,-=-,,, --~~ew and/or exi_<:,',Is list the total c,,: 11-- number of tanks and ;manufacturer'S Indicate pft> t:v or site, mind tank !'ri~itef ail. t L),'f?('iGtE 'ior all septic; Purrlp/siehon and holding tanks for ti_6 system. ChF 1 e ital approva ! nl!f it tanks received experin-,_-.:a ; product approval from Dll NFi Vlli Responsibility statement. installing plumber is to fill in name, 6 -is,4 number with ao?ro-pril!ta prefix (e.g. MP, etc.), address and phone number. Plumber must sign ion form. IX. CountyiDepartment Use Only. X. County/Department Use Oniy_ .r Comply- e- plans and not smaller than 6',,', n1--he rvo-z'm be submittrri 'o ths: county. The p. •n.i !I1CIUd . IE. . y plot p!dn, ':bawn tG 5c,. rt 1!.-s 'of hr.}'direr tank(s), septlG o ;'ier treatrne,it tanks f),Ji!t1 w'ata! " awSrwc'iter 5eflrlCe; streams and lakes, PUiTI , Or S;Pholi tanks; distribution boxes •;,~,n~ systems repia- c;rr!ent system areas; ano' !"Ie 1::rcatiol of tblo-i bu . ziy served; B) hic riz~-,n ta1 1e ..;xi,,n rt Terence i(w n'-i; C) cornp!ete specifications fo pur:ps and controls, dose voium- , t6evat o;, dirferences>: friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E),$oil test data on a 115 form; and F) all sizing information. - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 W+sc onsin Art 410 included the creation of surcharges (fees) for- ~ r~ilni i8r of reg€:late(' ~ es which _:an effect c -~undwater. 7 r e ii t ,.tc1d hr(' i-e 3a so;!cha r St:." ;f 6n to. Irt ! ;r(_ n vi,xt i". S. Ovate" c ootarTHr,a i(on i-vt _ ;:_jdt ons an(i estabtishri.,, "~ri:Sards. s. a SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations September 23, 1993 2226 Rose Street La Crosse WI 54603 WANG EXCAVATING W9672 770TH AVE RIVER FALLS WI 54022 RE: PLAN S93-41014 REVISION TO PLAN S93-40368 FEE RECEIVED: 50.00 O'CONNELL, GREG SW,SW,19,29,17W TOWN OF HAMMOND COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, ennis Sorenson Plan Reviewer Section of Private Sewage (608) 785-9336 i SBDd6423 (R. 0"1) Parcel 018-1042-70-000 02/19/2008 05:01 PM PAGE 1 OF 1 Alt. Parcel 19.29.17.296 018 - TOWN OF HAMMOND 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 0 - O'CONNELL, EMMETT L & JANET TRUST ENJMr.ET-T--L, & J TRUST O'CONNELL 1530 86TH AVE ROBERTS WI 5402 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1530 86TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 19 T29N R1 7W 40 AC SE NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1149/603 QC 2008 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.500 4,400 0 4,400 NO OTHER G7 2.500 29,000 166,700 195,700 NO Totals for 2008. . General Property 40.000 33,400 166,700 200,100 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 33,400 166,700 200,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 112 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER O'Lhht ADDRESS 7T SUBDIVISION CSM LOT # Arl SECTION.. / ~_T-/ N-R_ I ~_W, Town of jQl?[I ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - 100 ~ f P ° nth r r 3 6VYI ::g ~ L"','l /rr INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Jl BENCHMARK: C~/ tg Z /L ALTERNATE BM lp ~W 6Q~Lj/~~ SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION Manufacturer:k!"T Liquid Capacity: 1'j6 Setback from: Well 2:50 House Other Pump: Manufacturer Model# Size l3 Float seperation 3 Gallons/cycle: Alarm Location ':SOIL ABSORPTION SYSTEM Width: ( Length PD Number of trenches Distance & Direction to nearest prop. line: Setback from: well: >144) ' House Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 30 INSPECTOR: 3/93:jt R SANITARY PERMIT APPLICATION coNTY4 In accord with ILHR 83.05, Wis. Adm. Code =:Zak STATE SANITARY PERMIT # ~G/ -Attach complete plans (to the county copy only) for the system, on paper not less than I q 8% x 11 inches in size. ❑ Check if rJevi i n ~ vious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. S 1' 3y D 3 o69 PROPERTY OWNER t 9 PROPERTY LOCATION Jr-L'm C~ l? Z % .~L '/a, S T N, R E (o6 PROPERTY OW R'4g (LING ADDRESS LOT # BLOCK # 1 H Cl TATE Z!F ODES PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER El CITY NEARS ROAD 1- II. TYPE OF BUILDING: (Check one) State Owned VILLAGE ❑ Public X71 or 2 Fam. Dwelling of bedrooms PARCEL TA NUMBER (S) III. BUILDING USE: (If building type is public, check all that apply) 6 r1(,yGy 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 50 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. K 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 0 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 V~' / R EQUIREq (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./'rich) ELEVATION L? C D d Feet 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 Holding Tank Lift Pump Tank/Si hon Chamber / I c El . El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb Signature: (No Stamps) W Business Phone Number: c 4 fV Plumber's Ad ress (Street, City, late, Zip Code): / G' fir, IX. COUNTY/DEPARTMENT USE ONLY #Approved ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing Agent Signature (No Stamps) ❑ Owner Given Initial CM Surcharge Fee) Adverse Determination a (,J X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/86) 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. IL 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. I 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 pointg; 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) l STC-100 This application form is to be completed in full and signed by the oc-ner(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. propert Owner of y P e~~ L va~~~ Location of property~1/4 5k/l/4, Section , T~N-R_LLW Township a em i►l J Mailing address D~~ a Address of site 1 / O ,'acl ill u TT- PI)L-r- f S k S 5 4/c - subdivision name Lot no. Other homes on property? ves=No Previous owner of property d! )Ot- e" tl r Total size of parcel _11 3 11521 A Date parcel was created Are all corners and lot lines identifiable? _ L Yes No Is this property being developed 17 or (spec house)? Yes -jrNo Volume and Page Number as recorded. with the r of Deeds. Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available; would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the county Register of Deeds as Document No. ( 7361 and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described pr for operty, construction of said system, and the same hasbeen duly Nocor g 7 in . he office of County Register of deeds as Document ~j 6 4 617-n . A-12 -22P signs re of a~ p~licant -appl cant Date of signature Date of signature if, W Iwor» ~..f WUWAda %40y 10 Croix too! tit a. 04111: k r } ♦ s ri f v sl1 f bl11111111111101 be { hWeby YA!'r the M15 ins{t1ww11 10 111 2 , l : ,ns dexv~f Mill M~ r h" bash mw tmd comet tiny : Am me t 3 k4 r- !~rKa v DDCU~E•., SPECIAL T No. WARICANTN' t STATE OF UE: Lr'O Mu r. r, Rpe • WISCDN$IN ~ FO P.M 2 NYaD rJR RECORD'-40 DATA W3,Gp OL 100?PAriE 67 This denture, Made this.. ...al .2nd yy per' --c^ OFFICE A ~ _ i D., 19. d 'STLRJ a of between FFeder Home Loan Moct a COr i _ ~ ...ation ST - 9.-.•---....._Lx..._ - p° R') ~ Co., •i:r_e of the La-s of !h •U?l~t "'eta' ~°srao'f EVi Q'r zed and existing under aad by., ' pC~d T -Record e Stx74XJf cpS( IM1 , located aL_.__...... APR as nt .-r R ~i3EX R7 rry of the 4 MC1aedA1 Y1 ._-.rQ i n 1 a jo> rst part and •----e9ory O'Co tenants nnell and Luanne Moe, 9 _ - 815 4 1 9 A. bl parLf the second part. - - 1 o F j' -ter of Deeft That the said part), of the Grst part, for and in consideration of the szxm of__-__-. ~ 1 Dollar and other Valuable consideration to it paid by the said part leS--_ Of the Second part, the receipt whereof is hereby confessed z^1du1°t Tr uk-owledFd, has given, granted, bargained, sold, remised, released, aliened, conveyed and eao_ jl fie L, and by thcx presents does give, grant, barfZai the sz:d parL1eS n, sell. remise, alien, convey, and confirm unto I _ _ of the second part,.... thtlr - the County of- Stheirs and assigns forever, the follo,Irlg described real estate, situated in A Parcel of -J ad .....................1h............................. , and situated in the' he Southwest' State of Wisconsi we (~i of SW;) of Section 19, Township 29 North, QUarter of twe Southwest Quarter St_ Croix County/ Wisconsin, described Range 17 Westr Town of Ham*lorx3, line of the Southwest 1/4 of as follows: Beginrdng on the Southwest 1/4 of said Section 19 South East of the Southwest corner thereof; thence North at right angles Wit t said South line 249 feet; thence East parallel with said South line 180 feet; then- South 79 feet; thence East feet; thence south 170 feet to said South Parllel with said! uth line; thence We tsalon line 90 South line 270 feat to the point of beginning. n9 said bg EXEMPT (rF NECESSARY, CONTINUE DESCRIPTION ON REVEP-SE SIDE) Together •ith all and singula- the hereditaments and appurtenances thereunto bcfoang or estatr- right, title, i~tcrest, claim or demand whatsoever, of the said party of the first Part, tithther r in n llaw or any wiseequitya, either in possession or "Pea-tancy of, in ar' to the above bargained premises, and their hereditaments and appurte+-'nces. appertaining; and all the To have and to bold the said premises as above described with the hereditaments and A -aces, the second part, and to___.__..-_..-- their PPurt eAa-'krs, unto the said part les / heir! and assigns FOREVER- And the sad oJrle Loan Mort a e Co Federal H _ Party of the first - - - 9...~. - ration p.11, for itself and its successors, does covenant, grant, bargain and agree to and with the said partAe of the • seized of the - heirs and assigns, that at the time of the crlsealing and delivery of these presents it is well Premises ab" " described, as of a good, sure, perfect, absolute and indefeasible estate and neat the same are free and clear from all encumbrances wh.never,........----- of i nJaeritance in the law, in fee simple, - - an that the above bargained premises in the quiet and peaceable possession of the said rc, L7d x551 8n-% against all and every rY Person or persons lawfully cJaimin ParLl~._.""'""""-- of the second part, t1121L' g the whole or any part thereof, it will forever WARKANT and In Witness Whereof, the said Federal H PaztY of the first P- 'rt, ___...........Oifle roan MOrtgagt? ~r~OrdtlOn has caused these presents to its President, ands be signed by.... oanterstgned b ' Secretary, day of._.......__. Wisconsin, and its corporate seal to be hereuntor affi xed, this A. D.. 19...93 SIGNED a_YD SEALED IN PRESENCE OF Federal Home [.oars Mortgage Corporat(ua,... CoryQa'dtelt:---• - KaifiTeen D.--McGi =f s~- ~ e~ Assistant Treasurer 4Sv~er', _ l=tlUr'CEf2SiG\ED: STATE OF XXXMDDUM VIRG Assistant r*Wr Assistant eL Cnert county. Secretary' Srd Personally ca¢le before me, this... '1 ' - a of g3 Ass 1l~rasurer R -D. 19-- SeLWAe- F an 7~~4 gs1 fi~ n t' #iJ of the above nim-- Go porattl~!sV ltel n"own to be the persons who executed the Z -~HtadB D Presldetat and Secrrtzrr of said Corporati • . anstrumer: o.. ..t, and be sz:d Coc,oration s<uLfi on, and acknowledged that they executed the foregoing instrument as such Sectetaly by authority, as the de 43 of THIS INSTRUMENT WAS DRAFTED BY John E_ Schneider . - f ' ANDEP-SON & SCENTIDER NOT\RY SEAL J\Jofafy Public,.. l! 07/1 f , A - a~f r Ary commissiot. (csptrrs) fa ISecr ea 59.• ' 9 (I) of the l~'iscnsin c - - che nams :a taruto w - Cwj( R"' .A ; ~~JM oft the isco P ido that ill instruments to be recorded shall fine ,.ainl ,lJ O ,he s,~srr which dra(!&r ',e imtrun.cnt, a shall be .r; Section 19.11; similarly rejuun t:.ai :.hc a y pr ere; or O1xa,nnen then-; W lRR s~ r\' I)r•, , F t i. ty;rn::rr. n, stmr-l of the s•nn .-ho, or 1111- . nT ('-T-1.,;I.~.. ST.{'t'}.' I)4• i", SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County fi OWNER/BUYER Lr< c t'~ C.0 ii h 1-:; l~ Vet Gt 61 r° 1 CJ tf, "'ADDRESS: r- • - RE NO: /3-/0 LOCATION:! 1/4,~ 1/4, SEC._T~N-R_~7 W TOWN OF:_Aglyi gl) c Pid 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of P the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the 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 fu Y). 11 of 1-4. sludge and scum. Certification from will be sent approximately J0 days prior to three year expiration. f/WE, the undersigned have read the ab ove requirements and agree to maintain the private sewage disposal system-in accordance with the standards set forth, herein,, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: MOIL, DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 O.EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, 1 C DIVISION LABOR.AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: UZQ SHIP NICIPALITY LOT NO.: BLK. NO.: SUBDIVISION NAME: W 'i Sw' /A? "1101'- 111,111C2 E (off C UNTY• o OW ER YER'S NAME MI.~t , re e LIZI USE DATES OBSERVATIONS MADE NO. BEDR COMMERCIAL DESCRIPTION: ICI SCRIPT ONS: PER L TIO TESTS: Residence - ❑New RReplace 7o/931 RATING: S= Site suitable for system U= Site unsuitable for system MIS ENTI®AL: M©ND: ou IN-GROUND-PR,URE:rYSTEM-IN-FILCFHQL-F]DINGIFANK:IRECQMMEN ED SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the e tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- II II 11 i " ~ ~r Q 0 6-p" I va ~Btl sl' /6 - 30 ~n Is 0"-96"6;j B- nn I ^ g"lue- IrAU1? ' trae lcr B- d 6~j1 '5J +1 B~a~~ B(sil l~'~-18" /3nsi R11-3a„ 6ne- 3a 11,64"Ar, 9l, U FOIL Ckclod ' )l . rW O'lass; SiruoUrf- 38,E h/1 tl 0\/a''Sls%1 !a°-10"ISWRi ld''_aU rlis A~' a5~1o"bn B-3. ~V /5sb ont ;>60 -Gir. I n 9' ol?" ~a /M A16 t B- n 6--61, III, 6-12" nS' a-av// 67 B m4s-" s4 pe g`s od PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P_ " b 30 3 D 3v ~yk ? 3 P- P- P_ P_ PLOT P- PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION .OCR E Bm. /oo:o u~s7~n~ rNell Cas;n _ b art.? 0 xls'kwr ~>crsiri~ rfor CC' - E Xarr~e ~a C. - - - ~ to ~3 - - - n ~ktE - E bq ~o a ie CrV T'r ~T Yr I, the undersigned, hereby certify that the soil tests r ported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPL T D O 3 0 SAS V/ P ADDRE S: CERTIFICA O BER PHONE NUM u ,_F(o tignall: 7 U ~Y 1 R_ oat ~ CST S TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DI LHR-SB D-6395 (R. 10/83) -OVER - OII 11- -6395 To u"HE % IO 1 3 rtl I TO THE OW This soil test repo np ire ; r' a s y permit. The county or the Department may request verification of this sr ir-:uance. A complete set of p' -is for the private s.°>vage sy;`.°rn and a ,r~_)ropriate local a ority in otrder to € Tire < a nr to the start of +struc60ra. f ~ M6 I _ I _I I i I_ _J _ { .H '8 Yx~ I _CT L Vf.~. 0. ~.~~v U`I~GTf tl -Yc MI, MN r'V V;~~'~~ t E i i I ~ ~ ! a i A Y a FA k" daw,r 11 ' sQAU92 r E I__I-__.i I$~ o - t 66 MAST +&E AT~kz~ VK T w_: tzi (7 Y Va a 9 , . 4 Y , . f ( , . t Ain a _ 111 1 1 I f ~ r 1 , l 1 Page - Of _ Straw, Marsh Hay, Or a Q Synthetic Covering Distribution Pipe Medium Sand H G 6" Topsoil - -J E D t. 3 Bed Of - 2 %2 Force Main Plowed Aggregate Layer Below Pipe) D Ft. 1.17 L?EP li F `i r r ~r f ,v E -I:Sl Ft.1.24~ (1y.9' J °TCrI'~55e!aft !q: Of A Mound System Using f Ir1e~J ffx , r t. ' f , J I F ~7 l Ft.' Q ~~/D ~i 10D.t 4 z}.il fS } 1{.lJ y Bed For The Absorption Area G Ft. A Ft. H Ft. Signed: B q7 Ft. License Number: 3D31 K Ft.M%,aio;t Date: L FtM%~-,\ 6q.46- Ft. Alte to P ti on I Ft. F :~e ain W Ft. Observation Pipe ' F-j- A 7,Fc W 7rce Moin Oistribution Bed Of 22 2Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area INIM111151411 NEW 111 11 r^' I•'old P~p~ Man, V e b ~ ~.r Q A'S ~vG Las holt Shoulk 6c, hcxt ~o endl CAP S S_F i- t y i$_ 1 nc.l.e5 41 hole 410.. n C~i ~ 1A4cc,I d1a• 1vi C6(0) man-colck dIA. -2 1 nc.h (e3 ~orce t'1Qi n di46 V%oIZ per Pipe. . muer+ elcu.-X Ia+er-L) A, f PAGt GF PUMP CHAMBER CROSS SEC IOU AMD SPECIFICAnokiS J . VENT CAP o .18 S :7 j4 - WEATHERPROOF APPROVED LOCKIRIG JUNCTION BOX MANHOLE COVER . 12"MIU. GRADE I 18"MIN. , INLET;', #L t hA1RT?G,FiT SEALi ; I I '*N1, / 04 ALARM S WITH ELEV. FT• APPROVED PIPE 3 ONTO PUMP OFF SOLID SOIL CONCRETE BLOCK • RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPED FfCATIOM DOSE TANKS MANUFACTURER: IJUMBER OF DOSES: PER DAy TANK SIZE: - 750 G LLONS DOSE VOLUME ALARM MANUFACTURER' T~,tl ~lK (I. t P fL INCLUDING BACKFLOW: GALL MODEL NUMBER: ()A CAPACITIES:9* INCHES OR GALL( SWITCH TYPE: 14 B= I INCHES OR __.3.5 GALL( PUMP MANUFACTURER: vC I INCHES OR d~G GALL( MODEL NUMBER: ' D-.10-INCHES OR -L-L_-L GALL, SWITCH TYPE: - NOTE: PUMP AMD ALARM ARE TO BL MINIMUM DISCHARGE RATE737 . 11414 M ~INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET 17 ~ + MINIMUM NETWORK SUPPLY PRESSURTTE//... . . 2.5 FEET ♦ S~ FEET OF FORCE MAIN X L'42 F/ooFtFRICTION FACTOR. FEET TOTAL DYNAMIC. HEAD = 11 -71 FEET INTERNAL DI WSIOWG OF TANK: LENGTH , II ;WIDTH -;LIQUID DEPTH LI 51GuE0: uz., b, LICENSE NUMBER: 3031 DATE: