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HomeMy WebLinkAbout018-1068-70-000 0 pp C c o p prn of ao m 0. 0 o I r o ° a ~ N N N L O O O O 0 C O CD x 0. O N Y 7 C ~ N rp I N c Z o m -0 LL o L - C m o C p o Lo Q U ~ I 3 M Z y W E Z o Z y y (L co m 1- U) _ o I N C ~ O O Z d a U w r 2 N d N E E O u ~ o 0 N mv, '0 M C14 p y= o z z o N Z o N c ~ I d = N c 'm Y 0 oc"a` E CD cn (n (n ~ X333 I • a a a (y g -O (N N } F\ O y e -j n U ! Op rn M a `l M O p O Cl) LO O O 1~1y U m a I ~ N N v 1w ~ cD m pN C O ~ N N ~ C p C N N C O O C O O 0) CD 0) CD p^ H m O C C {1 m p r L.L E Y i7 N L W C s C Q w O^ O Ed LO C O O C O O N C14 C) E -C Q> N Y N tr') ED -0 CD 04 E 0) =3 W N U (n O co U • O M= O N Z U) r w a dt a a w iv £ 'u c Q 0 a n 0 v1 U AS BUILT SANITARY SYSTEM REPORT OWNER v'~,vGfs TOWNSHIP SECTION T N-RW ADDRESS ~x~ir.-.C ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT-,44r-c-LOT SIZE 24 o~-°4 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM +a - p D yiv ~ o 3 VY INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK : Manufacturer: ~2n. ` v c 4 7` Liquid cap. lefa U Rings used: 4Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road : Front_J-., Side , Rearj#_Ft. Z1d From nearest prop. line:Front , Side A~l , Rear Ft. 9 No. of feet from: Well IllG---4-- , Building: l d'elvl- (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER ll fit. s' e Y S ~`G~ ~J~ at~ Manufacturer: Liquid Capacity: 7 S Cam/ Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side, Rear_Ft. Distance from: Well /Jc.L Building /4 G~ sL SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side, Rear..Ft.~ No. feet from well: C ~ C11- No. feet from building i GGvt- HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE : ~G g 2-- PLUMBER ON JOB LICENSE NUMBER: aIQ 6/90:cj LOCATION: HAMMOND 31.29.17.471,SE,NE,31, Wis_ronsin Department of Industr~, PRIVATE SEWAGE SYSTEM County: Labor anrd„HumanRelations INSPECTION REPORT Safety a~.d Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 149285 Permit Holder's Name: ❑ City ❑ Village ]V Town of: State Plan ID No.: RICKFORD, FRANCIS & DOLORES HAMMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No. 7dG. P>e~ / 6'. _ai U!2 ~i~°r a 018106870000 TANK INFORMATION LEVATION A A9200129 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y /A 000 Benchmark o75 /00,0 Dosing t`! rlk 75`d Aeration Bldg. Sewer Holding St/Ht Inlet g,33 9q./7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet r~ Air Intake l0 7 ~.a 3 Septic >/pv/ x/00 >/c)o NA Dt Bottom SO 9~-© Dosing 9U ° y /00 t /v v > /a NA Header / Man. Aeration NA Dist. Pipe /03-(-3 Holding Bot. System y 50 l X3.0 PUMP/ SIPHON INFORMATION Final Grade Manufacturer ~o~1 ~e r Demand $T r1-7 f , g3 C? (o 7 ()8 Model Number 1;~ k' GPM TDH Lift Friction System a TDH/o, 5 Y Ft oss Head Forcemain Length a p ' Dia. a " Dist. To Well yT'1'-' SOIL ABSORPTION SYSTEM BED/TRENCH Width Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS W- DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type of CHAMBER Moe Number: o , System: /7)e.r;> low 7/~ > t`• OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length \9 Dia Length; =f Dia. ) 1i Spacing NC(? rr SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over ) I' xx Depth Of xx Seeded / Tudded Vulchecl Bed /Trench Center p Bed /Trench Edges ! Topsoil "0 ' es No Yes [a No COMMENTS: (Include code discrepancies, persons present, etc.) I •a Plan revision required? ❑ Yes ❑ No Use other side for additional information.U 140 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: `v s 4` - SANITARY PERMIT APPLICATION =OLHR In accord with ILHR 83.05, Wis. Adm. Code couNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El 4/q ~P~ 8% x 11 inches in size. C 4k ref ision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S PROPERTY OWNER PROPERTY LOCATION 621-4 4,/ cive~ '/a 0 t/4, S 31 T Z4, N, R 1 ? E (or)4V PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # R 12 04/0. e I CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER . Sh C y~ f OV a 4jCY a 5 II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ E:I CITTLYAGE : NEARS T ROAD A(I M ,N OA- ❑ Public Ell or 2 Fam. Dwelling-# of bedrooms 3 PAR AX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) Ql l D ~e r... 7 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. NU New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 PQ Mound 30 El Specify Type 41 [__1 Holding Tank 12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 9V 3-4 3 11 18r 43 Feet D. f Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank < < Ej F-1 Fj __FU_1 + [I Lift Pump Tank/Si hon Chamber, , 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) /MPRSW No.: Business Phone Number: f Plumber's Address (Street, City, State, Zip Code): /d D sv w -~!O IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Is 'ng Agent Sign o Stamps) t Surcharge Fee) Approved ❑ Owner Given Initial ti LIN Adverse Determination ~ `V I 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 maintaindd. The septic tank(s) must be pumped oy 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, ? econnection, 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 rite constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if ranks 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 81/2 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; (Jose 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-8398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 WEGERER SOIL TESTING AND DESIGN Owner: FRANCIS RICKFORD P.O. BOX 74 RT. 1 RIVER FALLS WI 54022 ROBERTS WI 54023 RE: Plan Number: S92-40130 Date Approved: March 25, 1992 Gallons Per Day: 450 Date Received: March 25, 1992 Project Name: RICKFORD, FRANCIS - PROPERTY Location: SE,NE,31,29,17W Town of HAMMOND County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW MOUND Inquiries concerning this approval may be made by c (608) 7PS- 48. Sincerely, f ERARD M. SWIM LO 2): Section of Private Sewage Division of Safety and Buildings s+ PPP039/0009n/21 cc: FRANCIS RICKFORD X Private Sewage Consultant SBD 8433 iR. ul/du 1 J Page 1 of MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATES IN THE SC 1/4 OF THEME: 1/4 OF SECTION ~1 T Z9 N, R 11 W, TOWN OF ~vthp)v0 , ST GS(SUC COUNTY, WISCONSIN. INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ~R.R~ c\ S lZ1 C~cFORS7 - R~~E12TS , \ .54023 PREPARED BY WEC- EIDER S~ I t_ TEST I p4 AND ~~losoo~op r3E5 _ era s~~rv I cE C01d F.O. BOX 74 421 N. MAIN ST. ~ `rj•'~•'ti RIVER FALLS. NI 54022 ARTHUR L. WEQFRER : a 715-4 {1155 40 ~LSW'oDDRrH. 4 1 W/ %wft1l 3-Z-3_9Z JOB NO. Q 1 ?A7 3 PLOT PLAN Page Z of ~o Scale 1"= 30' - ~ h i L 1' r~rBtiC~E GWur.,p . ~1-N w,aST S 10 b, eF L1 yX 6 'r Posr wi~.~ •`pASS wi7H aq-p~•rsecN rz Yv- ray N io ~ r r hR; c ~ti ll l -S ~-41(M)C. N Z~~Z O O J ONSITE SEWAGE SYS o na ~o ditio - I e 0 AV VED ~ h f pEPAR?MEN OF INDUSTRY, LABOR AND 1 0 R0M,,,t4 RELA NISION OF 2 ~ E v SEE COR I A D a ~ rl N Ne R kJej- ZD 6vz- Fn- LN'hgT So Sou`~ OF "Ouo+D R"t ~T I.ST ZS FtZl~V1 'T~s, NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( y required) 3. Install 4" observation pipes with approved caps. ( 2 required) 4. Septic tank to be ti~0 gallon capacity manufactured by w~ ~ S ~2 GL>fu erZ~'T~ ~t~D L5 c-T S 5. Bench Marker ppy L 6. Divert surface water around mound to.prevent•ponding at the uphill side. r Page 3Of 6 Approved Synthetic Covering Distribution Pipe Medium Sand H G Topsoil = F Elev I C) 0 - - 3 E D pNS11-E SEWAG b 6 / u Slope ~py}~L~60 4 Bed Of 2- 2 Force Main \"~Plowed V In IN -PRO Aggregate From Pump Layer air APB AND REtAT10NS D \.O Ft. DEPARTME F INDUSTRY, LABOR D B DINGS VISION OF ross Section Of A Mound System Using E I.4 Ft. SEE C0R A Bed For The Absorption Area F 0-8 Ft. G i - o Ft. A 6 Ft. H 1.5 Ft. Linear Loading Rate= I GPD/LN FT B 63 Ft. Design Loading Rate= o•y GPD/SQ FT I \Z- Ft. J -7 Ft. K 10. S Ft. Aitm=t4- Position l_ 84 Ft. of Force Main W Z S Ft. L 7- ! I - - U Observation Pipe 8 K 01 A I - - W Io ----------------------.I Distribution Bed Of 2 Pipe Pipe Aggregate Observation Pipe Permanent Markers ) (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page Of Perforated Pipe Detail 0 End View )Perforated End Cop. PVC Pipe Install permanent-marker ~o~ Soo at end of -each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe 4 )istri ution P1 Last Hole Should Be I Next To End Cap End Cap . P Z9.3Ft, Distribution Pipe Layout S 36 E •1N YSTEM ONSITE SEWAGE S X _G'j Inches conditionally y ~ y Inches slum 02111111111, in t; Hole Diameter )I4 Inch VANED AU Pno Lateral Inch(es) DEPARTMEN OF INDUSTRY, LABOR AND HUMAN RELATIONS lSION 01 F B GS Manifold Z' Inches Force Main " Z Inches SEE COR NQ CE # of holes/pipe Invert Elevation of Laterals Wa-SQ Ft. Place lst hole 3Z, if from center of manifold with succeeding holes at 6q4 intervals. Last hole to be next to the end cap. J • PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE OF E> VEIJT LAP 4"C.I. VEKIT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE 25' FROM DOOR, JUNCTIOAI 6OX COVER WITH WARNING LABEL WIUOOW OR FRESH IYMIU. AIR INTAKE I I GRADE I * I `I' MIN. Et. Lv 3 CONDUIT !9"MIN. ~i. M oN PROVIDE I IAILE T t.RjoTIGHT SEAL APPROVED JOIN T/ A stink ttov ED I IiI APPROVED JORITS R AN N RElAT10NS I *ALARM ftSOf BU c ~~CORM I I LLCV. q5•~ J fT. PUMP OFF ~ D cl%4,5lo COKICRETE BLOCK 3" APPRove RISER EXIT PERMITTED OAJL'j IF TAWK MAMUFACTURE:R HAS SUCH APPROVAL gEDD~NG SPECIFICATIOKJS DOSE _ TAWK MAMUFACTUSLER. WtEiSeR CD~QX4EM NUMBER OF DOSES: 3'8 PER OAy TANK SIZE: -ISO GALLOWS DOSE VOLUME 3 ALARM MANUFACTURCR' S•S ~-FC j SY57I:-_kiS IRICLUDING 6ACK►LOW: GALLONS MODEL WUMBER: ~w CAPACITIES: A- 15 WCHES OR `s GALLONS SWITCH TSPC: INCHES OR G~ LLOAiS PUMP MANUFACTURCIt. ZQ,tF "LQZ C>O"~P~w C= 6 IKICHES OR ~ZV• 3GALLOUS MODEL NUM6ER: q-T D= 1_ L4//ZIKICHES OR 2'9C'7 GALLONS SWITCH TYPE: 1-1 MOTE: PUMP AWD ALAfLm ARE TO 6E MINIMUM DISCHAMPE RATE z~•og GPM IN5TALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE OETWECIJ PUMP OFF AUD..OISTRIBUTIOU PIPE.. 7'~9 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . 2.50 FEET + 'LO FEET OF FORCE MAIN F oo FtFKICTIOKI FACTOR.. O' Z9 FEET TOTAL DtJUAMIL HEAD = ~~'S8 -FEET DIAMETER 4 IIJTERAIAL DIMLWSIOIJ~i OF TAIJK: LEW&TH ;WIDTH 7_s~r;LIQUID DEPTH - r-BOTTOM AREA - - 231= GAL/INCH AS PER MANUFACTURER = Zv :v S: GAL/INCH rn I- Jr UJ Fv LL HEAD/CAPACITY CURVE 41/ 6/ MODEL 97 4% 8 - 4% \1 25'- - 1112 - 11'h NPT W 6 20' - 43/16 m z 15' I ❑ 4 - - J Fa- 10~~ 44- 0 10' 2 ?g, % 5' I 0-1- L US 10 20 30 40 50 760 h GALLONS LITERS 0 80 160 240 1 10t1/1e FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PEA MINUTE EFFLUENT AND DEWATERING CAPACITY HEAD UNITS/MIN 35/16 FEET METERS GAL LTRS - 5 1.52 56 212 10 3.05 46 174 15 4.57 35 133 20 6.10 15 57 Lock Valve 23.75' CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available a Mercury float switches are available for controlling and supplied with an alarm. single and three phase systems. • Mechanical alternators, for duplex systems, are avail- • Double piggyback mercury float switches are available able with or without alarm switches. for variable level long cycle controls. SELECTION GUIUE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard All Models - Weight 33 lbs. -'/2 HP 2. Single piggyback wide angle mercury float switch or double piggyback mercury float switch. Refer to FM0477. 97 Series control SelecUon 3. Mechanical alternator 10-0072 or 10-0075. Model Volts-Ph Mode Amps Simplex Duplex 4 See FMO712 for correct model of Electrical Alternator, "E-Pak". M97 115 1 Auto 12.0 1 or l &7 - 5. Mercury sensor float switch 10-0225 used as a control activator, specify duplex (3) N97 115 1 Non 12.0 2 or 2 & 6 3 or 4 & 5 or (4) float system. D97 230 1 Auto 6.0 1 ort&7 - 6. Four (4)hole "J-Pak", junction box, for watertight connection or wired-in simplex or E97 230 1 Non 6.0 2 or 2 & 6 3 or 4 & 5 2 pump operation, 10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice, 10-0003. CAUTION For information on additional Zoeller products refer to catalog on Combination All installation of controls, protection devices and wiring should be done by a Starter, FM0514; Piggyback Mercury Float Switches, FM0477; Electrical Alternator, qualified licensed electrician. All electrical and safety codes should be followed FM-0466; Mechanical Alternator, FM0495; Alarm Package, FM0513; and Sump/- including the most recent National Electric Code (NEC) and the Occupational Sewage Basins, FM0467. Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 3280 Old Millers Lane Manufacturers of O OL ~~L~ ZZ7. 1(502) 0. Box 16347 • Louisville, Kentucky 40216 778-2731 • FAX (502) 774-3624 QUAL/TY PUMP.J INCE lf3y I N r O c $ c/~ to ~ r\ N .5 o o J o0 Q Q Q 2 1 ? v C rn o s ::3a%3: CP (A ol Ice In xc 4- to N O t g 1j > -o - a~ O~ O 10 V 2 W a _ • n1 0 CL E r.- o 0 CL 0 10 ~ .o v H a1 J a C/I ~/1 dl i o o ~2 m a CL C > 3 c i- m ° ".0 o J 1 47 r q CL O Q O 0' c O - a d C -.D O N a, 3 1 ,i c OWE a ° y a► Z • y I O N T (D D V1 c rn m aE E O C I y V E ar ' ar O V ~p 3 W kn to /r V a . "N ~ P Q 41 r4 0 1 L J o u N N N r (~l A P4 in #A V r- v r"~ N 1 a can W M c N r► p O D CD :2 0 41 'p D. X 0 3 u 1 v~ c D c m a~ V + I ' In1 in r ~ ¢C0 G N Q, Cl+ N Q O Q ~ u X0 2 ~ O v~ ~ -2 19 2- 0 4-) a Q 41 ~ Y N d O ~I (f~ 10 ~ ~_11 Q ' f' ~1 C 41 ` c ME y V ar n Q v < -D 0 16 C O Z 01 a. rn N O ` i7n J- 4J E lU o N KI a w 1 X1%0 0~ _ Q 0 Cc C I O ~ L31~ ~ ~ O rn° O 0 q 2 co r~ ~XC a ~w In^ 0 V 64 N C 4 \ O R _ N O cc 1 ~ ~ T~ N4 dC N V m nW! 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S S c 5 ; d 3 1 P Q Y N J 0 GO T C r t/1 ,n is E E O ~i( d GPI V E a,o "0 V ~Cl ~J V W N N~ Q (D -C jt~ N m O 41 N N N u, g z ; ~ o N ~ n t~ N N r r V W N O I 47 (71 0 >1 0 N a 14 x - $4 a I 0 W N q, d p, U) o 1 Q p ~ o a, `p . 0 (A 13 0 3 ao ~fl 41 N c t (A Vl V) C I co 0, Q ~ O j Q I a., / din r N Lt- ~-r~r 0 0 1-- ~a a~ :3 o _N .9 s .o nl da' W 0 0 O a N N W t -C ri 00 ox 2 0~ 6 N y- 07i v m z VI ~U- N C C C d1 4-) 0 0 W N N rrl ~ g ` Y 10 - N J:g w ;~o~ o(A 0 a o r A ~jl IV P~ o a -,LSaM '--i OQ oL ~l~vk! 1s „ S +tl,--;? ctl, c, K S?~ o I N t~ u -r .0 v O W C Z ®oa=~ o r" d CA s? E-+ oN M O '0 m F~ h a o a r J-- 4o W S~ 41 a o cn ay aou 1 I VM SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS: _91t4 •+e i, YQ-13 FIRE NO:_ (Q 63, LOCATION: Sr 1/4, SEC. S/_T .2 N_R_W TOWN OF: ST.•CROIX COUNTY SUBDIVISION:_~ia,~y~cs 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 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 full of sludge and scum. Certification from 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 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 I. DATE: St. Croix County Zoning Office 911 4th St. - Hudson, WI 54016 STC - loo This application form is to be completed in full and signed b the owner(s) of t)le property being developed, Any inadequacies will only result in delays of the development be intended for resale bytowissuance. ner/ ontr Chtord s his house), then a second form should be retained and completedtwhen the property is sold and submitted to this office with the appropriate deed recording. f Owner of prop I property Location of property,24-- 1/4 X1/41 Section 91 IF N-R W .Township (Mailing address Address of site Subdivision name Lot no.- Other homes on property? yes No Previous owner of property Total size of parcel Date parcel was created cte Are all corners and lot lines identifiable? Yes __.2S,_No Is this property being developed for (spec house)? Yes No Vvlume_G' end page Number of Deeds. a as recorded. with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: - - A WARIWITY DLLD which includes a DOCUMENT NURDER, VOLUME AND PAGP. NUMBE R & THE SEAL OF THE REGISTL:R OF DEEDS. certified surve In addition, a y, 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 ny (our) knowledge that I (we) am the property described in this information form by e virtue of rtue of a warranty deed recorded in the office of the count Re Deeds as Document No • 3~?a Y gister ly own the proposed site for the sewage/ disposal t system ) or preIse(ntly (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. Signature of ap~l''ant p Co-appl cant C Date of signature Date of signature - STATE BAR OF Nn800tI - ADAM WARR NTY 0~ VOL 634 PACE 429 TNIa MACE II~iE11VaD NO 011111110010" DATA 3 / 2991 REGISTERS OF19CE Irene Pabstg a widow ST. CROIX CO., WIS. Recd. for Record Ibb 25t day of A>J >,~tt A.D. 1981, amwe .W,,,sntato Francis R. R cklord and Dolores at 4:00 P M. IA. Bickford, husband and wile a..w. M Ipeeds ovum To th*110ftaikW dhorWad reed estate In St Croix county, stain of Wwoormn: Tax Key No. _ The East Half of the Northeast Quarter (E~ of NEC), Section Thirty- one (31), Township Twenty-nine (29) North, Range Seventeen (17) West and the East Half of the Southeast Quarter (E~ of SEC), Section Thirty (30), Township Twenty-nine (29) North, Range Seventeen (17) West, EXCEPT One and One-half (1~) acres in the Southeast corner as described in volume "85", page 597. This deed is executed for the purpose of fulfilling that certain land contract between the parties hereof dated July 26, 1971, rui:orded July 28, 1971, in Volume 474, page 235, ,is document no. x06041. FF,H This is homestead property. # n (IS) (is not) F"!~[ Exception to werranti": E 6 4 1 Datad this 24th day of August I I 2'(SEAL) Y SEAL • Irene Pabst (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGEMENT Signet res aut ated this 24th day of STATE OF WISCONSIN Au us , tg 81 j _ County Personally carne before me. thin day of . t Needham TITLE: MEMBER STATE BAR OF WISCONSIN the above named _ aMnoflas0~y.f7to8.o8,.ww'•sb1«I- Th' instrument was dratted by RLinstra, Van D k & Needham, S.C. Attorneys at Law - New Richmond, Wisconsin 54017 to me known to be the person who executed the foregoing In- strument and acknowledged the same. t (Signatures may be authenticated or acknowledged. Both are nut necessary.) - - - Notary public. County, Vi/is. 'Names W Uwlana e.pnnp .n ar cepeuty inset t"' typeU or pnn~eu .p•,w uin. r~.wr•, My Gurnrniss1o1'1 is permanent. (if n-,;; state expiration dale: 19 ) WANR::NTY UEEU - STATE eAH Ur WISCONSIN GRUM NU i 1977 a sTATE BAR OF WWOONGIN - FORM a •OOOIN~NT MO wAMAirrr 0W 9 THIS APACE aE111MEO Ir" "00fDt a DATA ~v voL 63 v E ~4 PA AN 3'72981 REGISTERS OF14CE _ ra to Pabst, a widow ST. CROIX CO., WIS. " Recd. for Record Ihb_25ft„ day of A_Tt A.D. 19al rranci& ford and Dolores at 4:00 P M, e:tttttrs~atwdetwranfseo M~ Si_~ckfor$s. ~,,.>~...A d wife ; agn" To gN bpptaNtp driapibed net smote in St, C ro x County, stab Of Wisconsin: Tax Key No. The East Half of the Northeast Quarter (E~ of NEC), Section 's'hirty- one (31), Township Twenty-nine (29) North, Range Seventeen (17) West and the East Half of the Southeast Quarter (E~ of SEA), Section Thirty (30), Township Twonty-nine (29) North, Range Seventeen (17) West, EXCEPT One and One-half (1~) acres in the Southeast corner as described in Volume "85", page 597. This deed is executed for the purpose of fulfilling that t2rtain land contract between the parties hereof dated July 26, 1971, recorded July 28, 1971, in Volume 474, page 235, as document no. 306041. FE5 This is homestead property. (is) (is not) F ~ Exception to wsrranpea: F 'A Datad this 24th day of AUgUat (SEAL) (SEAL) • Irene Pabst - - (SEAL) (SEAL) f / AUTHENTICATION ACKNOWLEDGEMENT Slgnot resaut Wed this 24th- day or STATE OF WISCONSIN Au us - t9 81 _ County. Personally came before me. this day of t Needham ly TITLE: MEMBER STATE BAR OF WISCONSIN the above named adttarlaN~y}30~.G6rWrsr-fr►srwl- TI,I- Instrument was drafted by Rc.instra, Van Dyk & Needham, S.C. Attorneys at Law New Richmond, Wisconsin 5 40 1 7 to me known to oe the person who executed the fornoing in- strument and acknowledged the carne. (Signatures may be Authenticated or acknowledged. Both are not necessary.) _ tJCitary pubs,(_, County, V`/is. 'NAmes ut ycJOM a yn r,~ w , -a1+, I,w>bO .Pxo ..l.« My Curnrnis~un ~s permanent (it n„I state expuaUOn dale: WARRANTY DEED - STATE BAH OF WISCONSIN, FROM NO ! 1971 I ST. CROIX COUNTY WISCONSIN r~ . ZONING OFFICE ST. CROIX COUNTY COURTHOUSE - 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Mar. 19, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To Whom It May Concern: An onsite investigation of the Francis Rickford property, located in the SE 1/4 of the NE 1/4 of Sec. 31, T29N-R17W, Town of Hammond, St. Croix County. This onsite revealed suitable soils at a depth of 38" requiring 12" of fill beneath the mound septic system. Should you have any questions, please feel free to contact this office. in erely, James K. Thompson Assistant Zoning Administrator cj