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CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE _J PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3 'P )P'nKoom rye, /oo5p ► se~}i c. p o J~ "a00 "I Fu'., p / Tz c~,A m berg 3 FoR<e w 1ax5a f3e,r~ S 3v Y INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 3 ly" Stee.) Elevation of vertical reference point: 00, Proposed slope at site: J I_ SEPTIC TANK: Manufacturer: W~~ S Liquid Capacity: ~d00 ` Number of rings used: Tank manhole cover elevation: 0~ 43 N. r;15. Tank Inlet Elevation: Tank Outlet Elevation: 8R31 Number of feet from nearest Road: Front,O Side,O Rear, O oyetz Soo feet From nearest property line : Front,OSide 10Rear, 0 CVKK QdU' feet Number of feet from: well OL-, building: -~a / (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE Osr DER I 11 Liquid Capacity: Uvo Aanufacturer: Wei s 1 ' Np Pump Model: Pump/Siphon Manufacturer: -a LL r Pump Size p Elevation of inlet: 8 11 Bottom of tank elevation: U I'/ Pump off switch elevation: U 5. 0 ( Gallons per cycle: Alarm Manufacturer: ~e U Alarm Switch Type: w{~ Number of feet from nearest property line: Front, O Side, O Rear, Ft• a0~ Number of feet from well: S I Number of feet from building: I' QII (Include distances on plot plan). 51,4t, 0006 Rep0-1~K SOIL ABSORPTION SYSTEM s~ Bed: j Trench: Len&the-d' - Number of Lines: a Area Built: Width:---La- V Fill depth to top of pipe: OVQK line: Front, O Side, O Rear,O It . Q Number of feet from nearest property Number of feet from well: Number of feet from building: T~ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: _ Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Cry pacity : Number of rings used: Elevation -F bottom of tank: Elevation of inlet: O Side, O Rear, 0Ft. Number of feet from nearest property line: Front, Number of feet from well: Number of fef,t from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated Plumber on Job: : 2 License Number: _ 3 T~ 7 3/84:mJ . DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: Ni`T-; , :11'1 , Sec. 19, T29-Pelt/ CONVENTIONAL El ALTERATIVE .signed) Town of Tlarren ~j ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 14 , TV 12 Jqy()(j -9 AME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION A : [ f C T, T 95702 - BENCH MARK (Permanent reference point ESCRIBE IF DI NT 1 P REF. PT. V.: ST REF. PT. ELI AL, 6, 9L 91, 3,; 1 Name of Plumber: /MPRSW No.:! County: Sanitary Permit Number: P' Jim Boum,eester 3404 St. IS 1:i5~? s0 SEPTIC TANK/ MANUFACTURER: LIQUID CAPACITY: TANK INLET EL TANK OU WARNING LABEL LOCKING COVEER/~ PROVIDED: PROVIDED: 13.`pl S C7 LP 8~• 36 YES ❑ NO ❑ YES NO BEDDING: VEN IA.: MATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH C 'o. r/ V , ALARM: FEET FROM LINE: AIR INLET ❑ YES NO ❑ YES 1 N0 NEAREST > a CIJ o'er DOSING CHAMBER: ol K F, /&.s MANUFAC~TUyRE~R: BEDDING: LIQUID CAPACITY: PUMP MODEL: PU P/ /AN~UF~ACTURER: WARNING LABEL LOCKING COVER VIDED: Lie ❑ YES NO C C r PROVYES ❑ NO PD J OYES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDI G: VENT TO FRESH RENCE ~ BETW FEET FR PDIMP ON AND OFF EEN 3rrs YES ❑ NO NEAREST LIN 7 h AIR INLET: SOIL ABSORPTION SYSTEM. Check the so moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATE/IRIrYA)LAND MF)RKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN / 1 11 -~C~X ~Jv~ the soil is dry enough to continue P CONVENTIONAL SYSTE' EZ , at 9419.2 BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER IiVSIDE DIA.: # PITS: LIQUID / TRENCHES: / N~giERIAc- DEPTH: DIMENSIONS •x GRAVEL DEPTH JFILL EPTH DISTR. PIPE DISTR. PIPE D $IR. PIPE MATERIAL: N DISTR. NUMBER OF PROPERTY WELL: r BUILDING: VENT TO FRESH BELOW P G) A FEET F IPES: ABOV COVER: ELEV. INLET: ELEV. END: II// C; FS6,ne Ple. PIPES: LINE: i AIR INLET: e? 3 ~ V_ 9S /ISTWI a') 02 NEAREST ` 9/ MOUND SYSTEM: 6r.40' Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST-* ^ , _..•e...-. ,.4;~ ter? ~ZC.~;v'Q..d c GL~1F . Retain in county file for audit. Sketch System on Reverse Side. SIGNAT E: TIT SBD-6710 (R. 06/88) ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY , 15 - STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ESTATE /re 8'f x 11 inches in size. eck vision/toOplrevious application -See reverse side for instructions for completing this application. PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY f R PROPERTY LOCATION 1 C N1 (~?'/aNL) '/a, S I r] T 9, N, R E (or) W PROPERTY OWNER'S MAILING ADDRrS - LOT # BLOCK SS BKeC f ~k • &N- 65 708 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR SM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned C3 VILLLLAGE : NEAR ST ROAD 171 =N QF: 9 F, a ❑ Public R 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) /D ` (0-5 Qt - ~O 1 ❑ Apt/Condo `f 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ 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. N 'New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) A Sanitary Permit was previously issued. Permit ~ 7~6 t~ T (f' Date Issued 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 i T REQUIRED (sq. ft.) PROPOE D (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION / Feet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Holding Tank D Q O Q Lift Pump Tank/Si hon Chamber 'T O Q Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: -5i M- Bo ("Me o Plumber's Address_ (Street, City, State, Zi Code). QI l o uD56l~ 1•c IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater e Issued Issui Agent Signature (No Stamps) rVr Approved El Owner Given initial surcharge Fee) 9-4-- Q Adverse etermination / ` `0 C. 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. VIII. Responsibility statement. Installing plumber is to fili in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells, water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) tee- u a APPLICATION FOR SANITARY PERMIT k a c ?y 9'~ e 0 star t S T C - 100 This application form is to be completed in full and signed by the owner a) of the property being developed. Any inadequacies will only result in delays of the permit . issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property Section / T N-R~ W Township Mailing Address Address of Site ' G Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created _ /n19 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes ~ No Volume CD and Page Number _/,>61yas recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) cvLti.6y that aft 6tatement6 on this 6olrm ane t ue to the beat o6 my (om) knowledge; that I (we) am (are) the owner (.a) o6 the pnopeh ty de a eh i.bed in xh i a .in6oAmati,on 6onm, by vi tue o6 a waA a.nty deed Aeeonded in the 064.iee o6 the County Reg.i,a.ten o6 Deeda as Document No.-f- 8'6 j ; and that I (We) pneaentty own the pnopoe ed site bon the d ewage dia pod b yd em (on I (we) have obtained an eaaement, to nun with the above deacnibed ptopenty, bon the eon6tnuc ion o6 aaid .ayetem, and the .name has been duty recorded in the 046ice o6 the County Regiaten ob Deeda, as Document No'f-3 SIGNATURE OF OWNER SIGNATURE OF CO-OWNER ( APPLICABLE) - uG 4? DATE SIGNED DATE SIGNED 1 .lJ l l l..l l l 11U. :i I A I I~ ]JAR OF 1VI SCONSIN FORM 1-1882 TIIIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED I3 VOL i This Deed made between Paul Engstrom and I REGISTERS or-ma Lois M. npstrom, husband and wife as I 5T•iX Co., Yy~• oint tenants Rec'd, for Record this 30th day of June Grantor, and................... Reed O' nd._.._.___Will iam• Malley and. Karen••O'Malley., -B3 at 3:50 A.D. '19 ______________husband and wife,-•as o_int tenants, I • Grantee, l1 10018r Of Deed, Witnesseth, That the said Grantor, for a valuable consideration...... I _ conveys to Grantee the following described real estate in _S,-• Croi II RETURN TO County, State of Wisconsin: All of the NWT of the NWT, Section 19-29-18, lying II South of U.S. Highway 12 and the right-of-way of i ~ Tau Parcel No• the Chicago, St. Paul, Minneapolis & Omaha Railway ~ 1. Company as now located and established and that part of the NW's of the NWk of Section 19-29-18 lying South of U.S. Highway 12 and North of the right-of-way of the Chicago, St. Paul, Minneapolis & Omaha Railway Company as now located and established. The aforesaid right-of-way now being owned by the Chicago and North Western Transportation Company. $j6 Ao IILE i This 1s..}~8~) homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; An<1..... Paul.-Engstrom_and--L0A.-N.• Engs.t-rom- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements of record, if any, and mineral right reservation of record. and will warrant and defend the same. Dated this . day of June 19..83_.. (SEAL) ~~••=•6'' _-_--(SEAL) ' PAUL ENGSTROM, a/k/a PAUL H. ENGSTROM I.. ; (SEAL) « LOIS M. ENGSTR& ~ AUTHENTICATION ACKNOWLEDGMENT SignRture(s) Paul Engstrom and STATE OF WISCONSIN Lois M. Engstrom Be. authenticated this _x•Cl. ay of---------- June 19.83_ .......County. Personally came before me this ....day of ,.0._4:, 19........ the above named LOIS A. MURRAY TITLE: MEMBE$-STATE BAR OF WISCONSIN (If not, authorized by § ?OG.06, Wis. Stats.) - to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY HEYWOOD, CARI & MURRAY Hudson, Wisconsin 54016 pds Notnry Pnhlic ...,...,................................County, Wis. (Sil;nllturps cony be nuthentlented or neknowledti►ed. Moth My Commission is permanent. (It not, state expiration ire not necessary.) date: , 19......... ) Tames of persona signing in any capacity should he typed or printed below their signatures. 1 I 'ARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 - 1887 Wisconsin Leral Blank Co. Inc. Milwaukee. Wis. z . H • 9 ST C- 105 r 9 H SEPTIC-TANK MAINTENANCE AGREEMENT o St. Croix County z c7 9 H OWN,E /BUYER • ROUTE/BOX NUMBER ly AYt~Yi~ '44.* . Fire Number CITY/STATE ZIP ,rrtoP PROPERTY LOCATION:-!LW; WO It, Section Tf-g!? N, R_Zy W, Town of 1 4,2011M) St. Croix County, Subdivision Loi number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank.is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- 10 ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Off:Lce within 30 days of the three year expiration date. SIGNEDw PAV\ DATE `y St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. D~PARTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND P.O. BOX HUMAN RELATIONS PERCOLATION TESTS (115) MADISON W 53707 (H63.09(1) & Chapter 145.045) LOCATION : SECTION: rOWNSHIP/MttNtCtPAttrY: OT NO.: BLK. NO.: SUBDIVISION NAME: 1!,4 NIRIA W V1 1) '4 1/1 - I COUNTY- OWNER'S MAILING DR S USE • DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL D S R PTIO, ROFIL l DESCRIPTIONS: 1PERCOLATION TESTS: QIResidence .3 L~1New ❑Replace I /p/mss/~~ RATING: S= Site suitable for system U= Site unsuitable for system [CONVENTIONAL: MOUND: IN-GROUNDPRESSUR, : S STE -IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) 2S ❑U CAS ❑U CAS ❑U ❑ S Egg 2S ❑tl If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS IAI- X. BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIG HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) Wm e- s tlw ' C 67' tic0w/Ay>.e,41 ,x. B- Z 2 0 c 2 „ s yt G 2'artS w~lO~tS~ 'f~„ ..C. B -3 / O r C ' i I .3 n f,./ C S !!AIX "Pi 1' AIS kJ 3. V 5 '/r• tom. B- P2 ~q', 74 B- 9b 27 fl ' 5; 1 /./1 / / 3' s cs ci A 3 ;9h t f 0.0 02.,e , B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD p R PER INCH P. / S- P- P- 3 t 7 P- P. )►C SAP S 7 9 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. SYSTEM ELEVATION i I a I IN .57 i I I I T-1111 r-- I , I 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. ME (print : TESTS WERE COMPLETED ON: p O ADDR SS: CERT ICA ON NUMBER: PHONE NUMBER (optional): r .1 S CST SIGNATURE: Soo 13 u DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - L P. B.L. 67 PLOT AND CROSS SECTION PROJECT PLUMBER NAME bdril'itm O' A e. NAME J'irn n e LOCH I0 w L I C ENS E u DATE 31,17110 --T PLOT MAP a 9 D 0 gg' p ~ a o z (Y) d 13 .7o, Q = ( 00.0 FDF off' 31, Sfiee 1 f i pc 840 halt o = Pc2K ~ = pd ja ~ Qr,~i' lots , W e) l s ave ~~r~'1•~2 ~ f'1►A~ ~bO~t LfF~or~ St~lc St~~'-ct►"~ WL~ I S ~pR71ccK t 1~N SO FRESH AIR INLETS AND OBSERVATION PIPE CROSS SECTION - Approved Vent Cap 77 0-~ Minimum 12" Above 9~ ~(0 Final Grade 4- FI WA1 GRADC U a MAY ~ 4" Cast Iron Above Pipe y Vent Pipe To Final Grad Marsh Hay Or Synthetic Covering min. 2" Aggre e Over Pipe ~ Distributio 1► F- Tee Pipe / ~t Aggregate l Perforated Pipe Below 9W Beneath Pipe Coupling Terminating At Qa~p~,,^ & 1-Bottom of System L DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR WHUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. OX 7969 BUREAU OF PLUMBING MAIPSON, WI 53707 T~~T NW1:;,NW4,S19,T29N-R18W KXCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: Town of Warren (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound HWY 12 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: William O'Malley 11455 Breda Street, St. Paul, MN 55108 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF, PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: David B. Fogerty 3233 St. Croix 92546 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO BEDDING: VENT DIA.: VENT MAT(.: HIGH WA ER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE: AIR INLET OYES ONO OYES ONO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL BUILDING. VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR INLET. PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing LENGTH DAND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR. PIPE SPACING: COVER INSIDE DI A. #PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH IF ILL DEPTH JDIITR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PIPES. ABOVE COVER. ELEV. INLET. ELEV, END: PIPES. FEET FROM LINE: AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES O meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS DYES NO DYES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. ]SODDED SEEDED MULCHED CENTER: EDGES: DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL'. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.: DIA.: ELEV.: PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: INUMBER OF PROPERTY WELL: BUILDING FEET FROM LINE: DYES NO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE Zoning Administrator DILHR SBD 6710 (R. 01/82) t (3 13ILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code T i2(_) c y STAT SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than • 8'/ x 11 inches in size. STATE PLAN I.D. NUMBER -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. rF TITION R V ARIANCE ❑ YES NO PROPERTY OWNER PROPERTY LOCATION William O'Malley NW %NW %4, S 19 T29 , N, R 18 E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 1455 Breda St., CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, St. Paul, minn 55108 1(644 7164 M VILLAGE: Warren HY 12 Mr TOWN 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. © New b. E:1 Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ® Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. E1 Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ® Seepage Bed b. ❑ seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 1 624 24. 624 94.96 Feet U Private ❑ Joint ❑ Public VI. TANK CAPACITY Site INFORMATION in allons Total # of Prefab. Fiber- Exper. New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank __,000 _..1000 1 Weeks concrete X ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT 1- Li 0 I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stam s -MR/MPRSW No.: Business Phone Number: David B. Fogerty 3289 749- 3656 Plumber's Address (Street, City, State, Zip Coda)- Fogerty Name of Designer: H ts. Rd., Roberts, WI 54023 D. Fogerty VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # David B. Fo ert 3233 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: Fo ert H ts. Rd. Roberts WI 54023 749 3656 IX. COUNTY/DEPARTMENT USE ONLY F-1 Disapproved Sanitary Permit Fee FIA,4:~.,no water Date Issuing Agent Signature (No Stamps) 25 Approved ❑ Owner Given Initial ge Fee Adverse Dtermination Qz J ~ J - X. COMMENTS/REASONS FOR DISAPPROVAL: ~~e iJ, o Geed ey Dias /t /,e /,S D w Ak"') SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber r INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- roorns, etc.),_ depth of system, or.-type of system 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be subm-fitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. !f you have q.iestions concerning your private sewage syste;_?, c=ontact your local code ad Ill inistrator or the State of Wisconsin, Bureau of Plumbing, 608-266-38`5. To be complete and accurate this sanitary permit application must include. 1. Property owrer's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; il!. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repai r; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin-, V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more r~ commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public: debate. The groundwater bill Groundwater = included the creation of surcharges (fees) for a number of regulated practices which Wiscorh5in'S' can effect groundwater. The surcharne took effect on July 1, 1984. All of the water that buried treasure is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. U T!ie nonies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t .ate, groundwater contamination investigations and establishment cf standards. Ground,mater, il's worth protecting. HD-6398 (R.03/86) 0~ Q ale7 APPLICATION FOR SANITARY PERMIT a Ga~ f0'~r/l t,~! R~i~t S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Prop erty~{I Section 1 p , T_,~LN-R_Zf W `N Township Mailing Address / Address of Site A2" S Y6 a Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes - No Volume CD and Page Number ~ 1~51 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLO ING: A Warranty Deed which includes a Document number, volume and pa &e number, and the Seal of the Register of Deeds. In addition, a certified urvey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Ma shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION I (We) centi.by that ate statements on zhts bo&m cute tAue to the best ob my (ouA) knowledge; that 1 (we) am (ane) the owner(s) ob the pupenty desct bed in this inbonmat on bo&m, by vi tue ob a waAAanty deed neconded in the Obbice ob the County Regi6ten ob Deeds as Document ; and that 1 (We) ptesentty own the proposed site ban the sewage d"pas System (on I (we) have obtained an easement, to nun with the above desn bed pnopehty, ban the constAuction o6 said system, and the same has been duty neconded in the Obbice ab the County Reg.csten ob Deeds, as Document M*7 )s ; s_o ) . 0 SIGNATURE OF OWNER SIGNATURE OF CO-OWNER ( APPLICABLE) DATE SIGNED DATE SIGNED uvc.:UMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED I~ REGISTERS OFFICE This Deed made between --------Paul Engstrom and f C Lois M. Engstrom, husband and wife as II ~r'`7IX O., W _._-_---.---joint--tenants , Reed. for Record this 30th I Grantor, day Of Jae:t~.D. 19 and William- Reed O-Malley and Karen -0 .alleys._____•.... I At 3:50 P --83 _-------------husband and wife1 as aoint tenants,__...._ . • II _ ---.Grantee, ~i Reghter of D~M• Witnesseth, That the said Grantor, for a valuable consideration...--- l 1i conveys to Grantee the following described real estate in St,-• Cr__ix- 1i RETURN TO County, State of Wisconsin: All of the NW'4 of the NWT, Section 19-29-18, lying South of U.S. Highway 12 and the right-of-way of Tax Parcel No: j the Chicago, St. Paul, Minneapolis & Omaha Railway Company as now located and established and that part of the NWk of the NWT of Section 19-29-18 lying South of U.S. Highway 12 and North of the right-of-way of the Chicago, St. Paul, Minneapolis & Omaha Railway Company as now located and established. The aforesaid right-of-way now being owned by the Chicago and North Western Transportation Company. This homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And---------- Paul---EnSs-trom_and-Lois... Engs_t_ro ln _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements of record, if any, and mineral right reservation of record. and will warrant and defend the same. bated this day of ............June 19..83... (SEAL) ---A t,G1v (SEAL) * PAUL ENGSTROM, a/k/a PAUL H. ENGSTROM _ ---(SEAL)-n l F{-1.,.. -.?'~_'~~z- - 1 ---•----(SEAL) * * LOIS M. ENGSTROM AUTHENTICATION ACKNOWLEDGMENT Signature (s) Paul Engstrom and STATE OF WISCONSIN Lois M. Engstrom as. - ---County. authenticated this _X1___ say of---------- June 19.83. Personally came before me this ................day of r 19.....__. the above named * LOIS A. RR)k TITLE: MEMBER-STATE BAR OF WISCONSIN (If not authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ...HEYWOOD CARI & MURRAY Hudson, Wisconsin 54016 ' Notnry Pnhlic (Sil;nrltureq mny he nuthentienteil or acknowledged. Both My Commission is permanent state Wis. Ire not necessary.) . (If not, state expiration , date: 19......... ) Lames of persons signing in any capacity should be typed or printed below their signatures. i 'ARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 - 1982 Wisconsin Least Blank Co. Inc Milwaukee, Wis. AA H • z ' cn H Y STC - 105 r H SEPTIC-TANK MAINTENANCE AGREEMENT St. Croix County z t7 a OWN_E /BUYER • ROUTE/BOX NUMBER Fire Number CITY/STATE, ZIP J-3-10P PROPERTY LOCATION:4!(41 14, yUU)_14, Section, T,'?g_N, R/,;j~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 con- sists 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 treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. FA 0 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE `y St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. i ME[VT OF ON SOIL BORINGS AND SAFETY & BUILDINGS REPORT INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RE.L,otTIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: LOT NO.:BLK. NO.: SUBDIVISION NAME: y OWNSHIP/MHidtCtPLtYY: H- , ( )w MAILING ADDRES COUNTY: OWNER'S r A DATES OBSERVATIONS MADE USE PROFI L DE R PTIONS: R ATION TESTS: NO, BEDRMS : COMMERCIAL DESCRIPTION: LAN/ew El Replace /,(s Residence ~d D o RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:loptional) S ❑U CRS ❑U BS CJU EIS CCU CAS ❑U z' If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS S BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, LOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i c C ,w 6 B- 7' / J& 0 J .R S1 AA 7 h c t w~~. cob, s~ • 9 ~lSN w s• B- 2 B_ .3 fD ~ c p Si 1 ,?•3 ' h t/Z G s w , a' I1rS w ' 3.V1,e 5"/r. tel. G 7 i'/7n ~1 L u B_ 3 c ~ 7 6 B- 9b' 1.3' s cs w f 3 ' csw B_ PERCOLATION TESTS T DROP IN WATER LEVEL-INC ES RATE MINUTES EST DEPTH WATERIN HOLE TEST TIME P R PER INCH NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIODI PERI0D2 P- / 3 S_ P- P- 3 t, 7 P__ ~y s q S P- C 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. SYSTEM ELEVATION r' t t : r t t , s - T i 1 a 1 E S 1 3 3 t - 1. 4.~., t e j } j l U t I 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. ON: 4TEST STS WERE COMPLETED p O 6 ERT ICA ON NUMBER: PHONE NUMBER (optional): kADDRESS: int): 20, r SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - TRUCTIONS FOP COMPLETING FORM 115 - SBD - To be a r IT id accurate st Your report must include; 1. ! rnplei (-iptlon; ' r; t CIE -ly irhether this i; Bence or commercial pr 3ber of k or commercial use phoned; placem t o; c ~iitability ~s. A SITE IS SUITABLE FOR A HOLDING TAN11,' ONLY IF ALL C t S` ;TEMS ARE , OUT BASED ON SOIL CON )ITIONS; 6. the abbrevi here for writing profile ~iptions and compi ~ the plot plan; '=GIBLE 61-- _ 'fy ?ncating your test lo( ins. Drawing to preferred, A iy b S benchm~'k ,on reference point are clearly shcmo ! r~~ancr~t; >ropiiate (foxes to ch arnes, addresses, flood plain data,, xernp- 10, If Bch as flood plaiii, E t t} does r N.A. it sriate box; 1 Si t I place your curient ad+' I your r tifirL number; 12. 1 pies and distribute as ALL SOIL TESTS MUST F LED WITH THE LGG' HuRITY WITHIN 30 DAYS C OMPLETION. DEVIATIONS FOR CERTIFIED SOIL. TESTERS Soil Sep „n T r.~, Other Symbols 10'' BR - Bedre 10"} SS LS - L HGW H f ~?rr E3;t Is L Eli, [ , J; - f3p Gy - ~..ow"" ~.~ay Ct, Tf ..'quest r to plI b~~~ ~ 00 a A w ~ ~ ~ fill ~D N ~o O u r v o o w _ i d ° i i I I// ~ ~ vl z ~ J Vt 0 U~ n o eow PAGE OF • PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAMHOLE COVER 2g' FROM DOOR, WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I `I"MIN. 18" MIW. COUDUIT IQ 10"MIKI.\ IAIi..EI" PROVIDE I AIRTIGHT SEAL I III V I III APPROVED JOINT A I APPROVED .IOIWTS I W/C.I. PIPE I III W/C.2. PIPE EXTENDIM& 3' I II ALARM EXTENDIWG 3' OIJTO SOLID SC;;. 9 I II ONTO SOLID SOIL I I ow c I I PUMP- --J 1 M OFF D CONCRETE BLOCK RISER EXIT PERMUTED ONLY IF TAUX MANUFACTURER HAS SUCH APPROVAL SPECIFICATIONS SEPTIC AND DOS TANKS MANUFACTURER: ~Pr~lr ~ti~ NUMBER OF DOSES: PER DA4 TANK SIZE: ,G00 GALLOWS DOSE VOLUME ALARM MANUFACTURER: INCLU0!A!C ZAC.!,FLOW: GALLONS MODEL NUMBER: P/ y CAPACITIES: A=-(~IWCHES OR Vz GALLOWS SWITCH TtIPIE: c w~ B a L INCHES OR 3 GALLOWS PUMP MANUFACTURER: -2;t/4~ =/7 a. C IWLHES OR LSf^ GALLOWS MODEL NUMBER: --~3 D~ z INCHES OR GALLONS YS ~6s SWITCH TYPE: Moh~U NOTE: PUMP AMD ALARM ARE TO bE PUMP DISCHARCrE RATE ~.r GPM INSTALLED ON SEPARATE CIRCUITS . VERTICAL DIFFEKEMCE Bi9bWCEN PUMP OFF AMD DISTRIBUTIOM PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET ♦ FEET OF FORCE MAIN X O5~ F/ooFtFRICTIOM FACTOR.. FEET vc TOTAL DtJWAMIC HEAD i FEET INTERAIAL QIMEWSIOWG OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH q7 m7: 51GF00 LICEMSE NUMBER' 3z>S ~ DATE:4112.Vff 7 -117- HEAD CAPACITY CURVE Dpi W W IW 00 30 - _ TOTAL DYNAMIC HEADICAPACITY PER MINUTE EFFLUENT AND DEWATERING 95` SERIES 53-55-57-59 97 137.139 163 165 28 ' M ( L LTRS ~"AL LTRS 3~L LTRS GAL LTRS LTRS 90 5 1 52 43 163 _ '5 248 104 394 .;t 231 231 EFFLUENT AND DEWATERING 3.05 :1 129 s7 216 79 300 231 231 15- 4 57 19 72. <3 163 64 242 D 227 •:0 227 26 ♦ - - - °J ♦ SEWAGE AND DEWATERING 6.10 27 104 36 136 s9 223 227 ♦ 7.62 6 30 " 216 223 t1 ♦ 9,14 55 206 220 'J-- - - 24 - ♦ 3 1219 46 172 1206 \ °:0 15.24 Ul 192 33 125 191 75 1829 15 57 :3 161 22 7 0 21.34 30' 1 14 70 60 24 38 _ 14, 53 V MODEL MODEL Lock Valve 4.5 26 66 87 20 65 163 \ 165 TOTAL DYNAMIC HEADiCAPACITY PER MINUTE \ \ SEWAGE AND DEWATERING \ SERIES 267 268 282 284 293 18 p \ P* M GAL LTRS GAL LTRS GALL LTRS GAL LTRS LTRS \ \ 5 1,52 ':.'A{ 408 02.• 3j 86 13a 492 11 8 681 55 0 3.05 50 227 72] 273 95 360 S 598 \ - _ 16 A 1, 4 57 i0 76 .3 163 6. 238 E7288 r \ "0 6.10 - 8 30 3 125 - - J \ 25 7.62 - 14- \ 45 30 9.14 4 163 292 \ 5 10,67 60 227 \ ; 0 12.19 46. 174 \ 'S 13 72 28 106 - 12 -4 \ fj oG 15 24 - - - 12 45 \ MODEL Lock Valve 1- 21 26 35• 53 35 10 293 \ 1 30 ~I MODELS 8 2137 139 6 20 MODEL 284 15 4 DEL MODEL 82 10 68 \ 2 2 ELS~~ 5 53 5, MODEL ?MI ODEL 59 97 267 U.S.GALS. 10 20 30 40 50 60 70 80 90 100 110 120 30 140 150 160 170 180 190 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Mlilers Lane Manufacturers of P.O. Box 16347 7 Lucky 40216 ILOUIS778-2731 v 10 (502) QUAL/TY PUMPS ~NCF /939 8 r ~Y 1