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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ( j L~r_`LI~F
ADDRESSeS- fjf LIZ, 1 -7 q t' Ave-
IZ
SUBDIVISION / CSM# aez~ LOT #
SECTION____-~/ T - fX N-R1gW, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~?o d?G-
Ile ° ~ wkly
G ~
/ = S/O S cam/
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
. e
BENCHMARK: -
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING.TANK INFORMATION
xs ;v~ Yea
Manufacturer: Liquid Capacity:
o.si
Setback from: Well House ~Qother
Pump: Manufacturer-4-I,/,X- Modelf1k,1,_ziG4 Size
Float seperation ~Gallons/cycle:
Alarm Location
;SOIL ABSORPTION SYSTEM
Width: f_ Length S" Number of trenches ~
Distance & Direction to nearest prop. line: Setback from: well: 11 House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet 2,~,7:~/Z PC bottom q7,~5~ Pump Off
Header/Manifold Bottom of system QS~.
Existing Grade ^97/ Final grade ?Z,,l
DATE OF INSTALLATION: S -9F
PLUMBER ON JOB: -~I
LICENSE NUMBER:
INSPECTOR:
3/93:jt
L ~`r's i rt n i . 4.30.18 . YK1VXye ff V1 A-9 S %TEIOI 4TH County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) sanitary ermit o.:
JGENEPAI, INFORMATION
Permit Holder's Name: El City El Village a Town of: State Plan D No.:
Av,pptp rALVT T. F. CST r
BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
101).o r, ki
TANK INFORMATION ELEVATION DATA A9300062
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ) 5, 6t1ef 1,060 Benchmark
Dosing S \ v U
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet 1o,3 o 3
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet p 0, 5
a- / O y 3
Septic y, 3U' NA Dt Bottom 13,~3 8 9, o a_
Dosing NA Header / Man. S- 9 v C/-S
Aeration NA Dist. Pipe C, / 9q.3V
Holding Bot. System 7, y g3.5
PUMP/ SIPHON INFORMATION Final Grade 3 3 q 7.
Manufacturer Demand X35 4i,.S6
50 GPM 13,o~ ~ T,
Model Number 3 11,L
TDH Lift Friction Sysatem TDHFt
oss
Forcemain Length n5,,, Dia. 1" Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length 1 No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / ;2.1 S~/ / DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER / model Number:
System: 3 6 OR UNIT
DISTRIBUTION SYSTEM
Header/ Manifold Distribution Pipe(s) t x Hole Size x Hole Spacing Vent To Air Intake
Length ko r Dia. Length 5 Q Dia. r4 Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
A Depth Over Depth Over r xx Depth Of \1 xx Seeded odded xx Mulched
Bed / Trench Center 3 Q Bed / Trench Edges ' p'<x Topsoil ❑ Yes 'D No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) + e`7
LOCATION: RICHMOND 4.30.18.619,NW,SE, LOT 20, 174TH,
s ~.tt`a. u' r
Plan revision required? ❑ Yes El"No
l
Use other side for additional information. EEI-I)i
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
DILHR SANITARY PERMIT APPLICATION
COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STA SANITRY PERMIT #
Attach complete plans (to the county copy only) for the system, on paper not less than ❑ - ?8Wx 11 inches in size. C k Ironlo previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROP O NER PROPERTY LOCATION
Nm) '/a %,S T3 ,N,R E(or)W
PROP TY OWNER'S MAILIN ADDRESS LOT # BLOCK #
Cl 2a 294 Z
STAT ZIP CODE PHONE NUMBER SUB IVISION NAME O7,k:,e NUMBER
S II.
TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NE REST ROAD
❑ Public 501 or 2 Fam. Dwelling-# of bedrooms __~Z PARCEL TAX M )
Ill. BUILDING USE: (If building type is public, check all that apply) C~X- -/D
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 1o ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Off ice/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. El New 2. ~ Replacement 3.E1 Replacement of 4.0 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 9 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./' ch) ELEVATION
7 Feet Feet 197 VII. TANK CAPACITY Site
INFORMATION in ailons Total #of Manufacturer's Prefab. Fiber- Exper.
New istin Gallons Tanks Name oncrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank
Ej F]
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installatio of the onsite sewage system shown on the attached plans.
Plumber' Name (Print): Plumber' Si ture N ta' MP/MPRSW No.: Business Phone Number:
Plumber' ddress reet, City, State, Zip C a)•
IX. COU TY/DEPARTMENT USE ONLY
~ Disapproved nary Permit as (includes Groundwater a e Issued Issuing ant Sig ature (N tam
A roved El j (tea Surcharge Fee)
pp Owner Given Initial o U
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.
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.
Vlll. 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 o1 standards.
SBD-6398 (R.11/88)
STC -loo
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), thensa 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)...1/4 j _1/4, Section , T.f N-RA W
Township ~,121,-7AI19
Mailing address 2L 1'~;_ /iii Z
Address of site )
Subdivision name L/,4ar%jb~
- Lot no.
Other homes on property? ves-_No
Previous owner of property _ l r_-_'4", t _(J j . 1
Total size of parcel 5r_
Date parcel -was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes .,._,~No
Volume.~`-~-L_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 & 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 t e office of the County Register of
Deeds as Document Note , 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 property, for
the construction of said system, and the same has been duly
recorded in the office of County Register of deeds as Document
No.. .
Y J
Signature of applicant CO-applicant
n
Date of Signature Date of Signature
UU(,UMtNI NO. WARRANTY DEED-By Corporation
STATE OF WISCONSIN-FORM 2
2 9 6 3 4 2 THIS SPACE RESERVED FOR RECORDING DATA
THIS INDENTURE, Made this I 4M .........day of........ May R t G I u T E R S OFFICE
A. D., 19-_-0., between.VIEBROCK.-CONSTRUCT-T--1-QI.a----1NGa-+--_••------------------------------------ 87. COIk CO.. WIS.
Rec'd for Record this_21aJ~_
.....................•------........._..............------............-•----...........-•----.......--•--•----------_--•--------...........a Corporation
duly organized and existing under and by virtue of the laws of the State of Wisconsin, located day of-__ M?Y______A.D.19 69
at Q$1ZRP I_.* Wisconsin, party of the first part and at--- 1:00 ----P • M•
..Ca I-v i n-_.L,....Beebe -s-?.ng1 e..man
Reg stet f D ds
•
part.y of the second part, RETURN TO
W i t n e a s e t h, That the said party of the first part, for and in consideration
of the gumof..One--•ooi iar...nd__oth-gr...200.0...aB,d._xa.l.1akl.e...cQnst:der_atlo 11
..............................•.••••--......._...............•........••..................................to it paid by the said partY-......... of the second part, the receipt
whereof is hereby
confessed and acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents
does give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part..y ......of the second part,.._iil_Sheirs and assigns
forever, the following described real estate situated in the County of........ T.._.CERQ.(X ................and State of Wisconsin, to-wit:
LOT 20 of VIEBROCK'S RIVER VALLEY VIEW ADDITION of the Town of Richmond, located
in North Half of the Southeast Quarter of Section 4, Township 30, North of Range 18,
West, In St.Croix County, Wisconsin;
(IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE)
Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate
right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy
of, in and to the above bargained premises, and their hereditaments and appurtenances.
To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said partY......... of the
second part, and to..h i S heirs and assigns FOREVER.
And the said....... V 1 EB M.K. JONSTRllICT.I.Q40....I.1110..s
_
party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said parll_.......... of the
second part 11.iS .......................heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the
premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the
same are free and clear from all incumbrances whatever
and that the above bargained premises in the quiet and peaceable possession of the said part ...y...... of the second part,-__11.12heirs and assigns,
against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT AND DEFEND.
In Witness Whereof, the said V 1 EBROCK..B!!!$TEiliL"T.i.il-r• I.111G._t....-•------------
of the first art, has caused these resents to be si ned by Marv 1 n V i ebrock
party P P g its Presid ,
countersigned by---- LUVef'f1e._R_v-- -QU $ its Secretary, at....... Ostjea.l.a----------------•------
Wisconsin, and its corporate seal to be hereunto affixed, this I_4th-------- da of......... A. D., 19__(7Q ~v
SIGNE AND SEALED IN PRES NCE OF
t:L
V EBROCK, C S UST ON, INC.
o; C
Veh E..._~ol.t_.. arv n ebroc dmt -
C TE GNED:
(I Henry--- C 94 ey Lu erne R. Quist cretary
STATE OF WISCONSIN,
POLK County. ss•
Personally came before me, this.... l4th..... day of ......MAY A. D., 19...6.9.,
Marxln...J.M .Lehrack.................___........, President, and.-..._LUVerne R. QIJ I_St Secretary of the above
named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such ........................President
and.......! ................................Secretary of said Corporation, and acknowledged that they executed the foregoing instrument as such officers as the
deed of said Corporation, by its authority.
1 vah• E.- Do
L,eioTART
c <4- S UAL
This instrument drafted by - t' 1 : ? A
' Notary Public............ POS.......... .......................County, Wis.
Henry_.Ca.._~afcey,._At Of'LIgY:.._QSC1xQ;l'.`d -xi •r My Commission (Expires)
(Section 59.51 (1) of the Wisconsin Statues provides that all Instruments to be recorded shall have plainly printed or typewritten thereon the
names of the Qrantors, grantees, witnesses and notary).
WARRANTY DEED-STATE OF WISCONSIN, FORM NO. y C
7IOfIK 451 PA r ~ l 45' N.. C.. MILLER CO., MILWAUKEE
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADDRESS / FIRE NUMBER ? 7 _
CITY/STATE - ZIP_
PROPERTY LOCATION _1/4 , _51/4 , SECTION, W
TOWN OF , 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 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
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
system properly maintained.
The property owner agrees to submit to St. Croix Zoning a
certification 'form, signed by the owner and by a mater 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.
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 DNR.
Certification stating that your septic has been maintained must be
completed and returned to the St. Croix Co. Zoning officer within
30 days of the three year expiration date.
SIGNED:/ J
DATE : 1f ' 1 S
St. Croix co. Zoning Office
911 4th St.
Hudson, WI 54016
Wisconsin *Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L of
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED B DATE
PROP TY OWNER: PROPERTY LOCATION
y GOVT. LOT 1/4 1/4,S T N,R X (or
PROPERTY OWNER':S M (LING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
J
CITY, STAT ZIP CODE PHONE NUM ER CI VILLAGE DOWN NEAREST ROAD,/
( is
[ ] New Construction Use Residential / Number of bedrooms [ ] Addition to existing building
j(J Replacement [ ] Public or commercial describe
Code derived daily flow' r gpd Recommended design loading rate ed, gpd/ft2 , y trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate y bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation(s) ~Z ft (as referred to site plan benchmark)
Additional design / site considerations
X11T ~."L.9ti Flood plain elevation, if applicable JJ'Zg ft
Parent material pct 7 Al
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
6-7 11_)YZ _2 A) 119
/ -
'Aul all
Ground
elev. ft' -
Depth to
limiting
factor
Remarks:
Boring # /
Ground
elev. _
>L ft. -
Depth to
limiting
factor
~ f
Remarks:
CST Name:-Please Print J Phone:
Address:
Date: CST Number.
Signature:
Z~2 IL,'
PROPERTYOWNER ' = - SOIL DESCRIPTION REPORT Page..~of,
PARCEL I.D. #~~~~/i~ -
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Clu. Sz. Pont Color Gr. Sz. Sh. Bed Trench
04,
ZA,
/
? 14
Ground
elev.
9~Z ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
F{4
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor F-T
Remarks:
SBD-8330(8.05/92)
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2"OF I'16GRC6A'1R • • "~"MATM^ op. V OF STitAM
EL.EV, of:&ZFEIT.~T s."oP~i~ccacc^TC
74 •wr~~. •r~~.
OISTRIOUT10W Fort TO bC AT L;CAiT 1►JCHES 6tLOw ORIGIW~I• •.a~oe
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NIMUN VSPT.N•OF E-KA OT1ON FROM OR16WAL'6gt%Da w1L I. BE
-L~Z_ 11JCHEs
tvHl ' vm iEPT'N OF EACAVATION r'jkoM O~IGINAL. GRADE WILL. 5C INCHC S
3t r 1
S16UCO:
• •OAT C
PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VEIJT CAP /
'i"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
JUNCTION BOX MAIJHOLE COVER
? ?_5' FRAM DOOR,
WINDOW OK FRESH 12"MIU.
AIR INTAKE
GRADE
I
IB"MIN.
CONDUIT--
11~
PROVIDE I
iNLE T AIRTIGHT SEAL I I i I
I I I v
APPROVED JOINT A I III APPROVED JOINTS
W/C.I. PIPE I III W/C.I. PIPE
EXTENDING 3' ( I) ALARM EXTEWDING 3'
OMTO SOLID SOIL ( i I OWTO SOLID SOIL
B I
oN
c
PUMP
OFF
D
CONCRETE 5LOC4K
RISER EXIT PERMITTED OWLS IF TANK MANLWACTURER HAS SUGFi APPROVAL
SPECIFICATIOUS
EPT•IC AND I
IOSE TANKS MANUFACTURER: ~it/fir S IJUMBER OF DOSES: PER DA`d
TANK i,IZE : 12eq,~ 7LLOQS, DOSE VOLUME: ~l GALLONS
ALARM MANUFACTURER: A - CAPACITIES: A=-3--,- I►JCNES OR _t,'T/ GALLOWS
MODEL HUMBER: /~)l B=-2 INCKS OR -3'),/ GALLONS
.5WITCH TYPE: - C= R INCHES OR ~sG GALLONS
PUMP MAMUFACTLIKE R: D= -INCHES OR .lc.5.~IYGALLOWS
MODEL NUMBEFC. 6,1~ _?YJ< NOTE. PUMP AND ALARM ARE TO BE
:)WllC. H TyPE: INSTALLED ON SEPARATE CIRCUITS
PUMP DISCHARGE. RATED GPM
VERTICAL. DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION P PE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE - FEET
+ FEET OF FORCE MAIN X __,9j F/pp,,FRICTIOU. FACTOR.. -29 FEET
TOTAL 0'3UAMIC HEAD FEET
~i✓7.d'i~E,~GC'
H 'WIDTH 'LIQUID DEPTH
IIJTERNAL DIME 1ONS OF TAIJK: LEn1C~T ~
IJ
r
~O
SIGIJED: LICLUSE HUMBER: y s,r DATE:
b m c - . is- b e ff I
I E
Performance'
Curves
Pumps
METERS FEET
~a Z-
90
25 MODEL 3885
SIZE 3/4 Solids
WE15H -
70
Z 20 WE10H
4
1.- 60
0 WE07H
15 50
WE05H
~:!i~ . 4-
40
10
WE03M
30
WE03L
20
5
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
I I I I II
0 10 20 30 m3/h
CAPACITY
[gGOULDS PUMPS, INC.
SEPECA FALLS PEW YCM 13148
METERS FEET
120 MODEL 3885
35 110 WE15HH SIZE 3/4n Solids
30 100
90
25 80
70
2 N _ _f+_ + + T
Z 20
J
H 60
50 WE05HH
15
- L~$ -4-
40
10 30
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
01985 Goulds Pumps, Inc.
Effective July, 1985
C3885
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the L)4 /v"') /~~x°d residence located at:
A) 1/4f S4 1/4, Sec. T- LO N, R_,!2 W, Town of
Upon Inspection, I certify that I have found the
tank and baff'les''''to be in good condition, and it appears to be
functioning properly.
Last time serviced__ S= l
Did flow back occur from absorption system? Yes No(if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacurer (if known):
A7,of Ta k if own) ~
(Signa ure) (Name) Please Print
T uj S'0/
(Title) (License Number)
(Date)
Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to t e best of my knowledge will
conform to the requirements of ILHR-83 Wis. Adm. Code (except for
inspecti n o enin ,over outlet baffle).
Name Signature / L~~~//MP/MPRS
5/88
REPT131 RICHMOND ST. CROIX COUNTY ZONING PAGE 1
05/03/93 12:13 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/ 4/93 AREA: MJ
Activity: A9300062 5/ 4/93 Type: CONV93 Status: PENDING Constr:
Address: RICHMOND 4.30.18.619,NW,SE, LOT 20, 174TH
Parcel: 026-1110-10-000 Occ: Use:
Description: 193402
Applicant: BEEBE, CALVIN L & JEAN L Phone:
Owner: BEEBE, CALVIN L & JEAN L Phone:
Contractor: O'CONNELL, KIM A. Phone:
Inspection Request Information.....
Requestor: O'CONNELL, KIM Phone:
Req Time: 15:05 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION