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HomeMy WebLinkAbout032-1018-40-001 h O (a M d I O Q O 0 O~ a ~ ~ ` 'C T N N N O O N C O N N E N ErnM y.~ C you a N L U OI n ~N li 7 N (9 '8 l0 C cep a ac 'a -2 a N E ~-0 0 N mg o y N W2 j'OLLY Cw 'O C N 0 7 0 N L 9 O22 O y C o° o, L U T V > y a a~iu N ° a o € oIx N O N C y N" N C N m N CL O O C y J O w L .y.. 7 f6 v o 4) m z O u) -a a) L 0 0 0) zo C cm 5D LL U N d m N c0 N N N 3 O 0 U 0 O N N Q U v o °cao ELLS v o N I o CD c z y O o 14 p N O Z o caw a N co `c` n H cn v ~ II ~ N 1 c m c O z N O N y N w d Z c w N C O fq F- N E N 1 Lo 4) M ~a ~+J > c c w L (V w N N N N N •NN C L N w p T ►i o to a Q O as 0 cn a Z N £ Z Its 0 ci m - i 0 N a t .r J N 9 Cl) .N N. o G D a hhww N I c FN- H~ > I J E 000 m a. IL CL a co I in 0u moo ~l C9 z n rn o Q N N N N E 0 0 O N ~p CO 01 to O ''U N I Q Z cn m w > > o O L U) N y oo c j U w o v E 4) 0) O O a Fo- y N C U d oo a o o N N N N V O O O N,I m C S N C = N G m a~ v c o rn u o M O 0 ' O of M o 0 1 • o o U) LL o z N 2 z U)i C \ #k = lI v ~ ~ I N N co d ~t a L: a tt`1~v o m` 3 II! 3 0 0 ~1 A U(L 2 0 v)v Parcel 032-1018-40-000 08/01/2006 05:19 PM PAGE 1OF1 Alt. Parcel 7.31.19.91A 032 - TOWN OF SOMERSET Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BAPTIST CHURCH, TRUSTEES OF FOURTH TRUSTEES OF FOURTH BAPTIST CHURCH C - CHURCH CAMP LODGE CHURCH CAMP LODGE 900 FORESTVIEW LA PLYMOUTH MN 55441-5934 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 300 221 ST ST SC 4165 OSCEOLA SP 1700 WITC Legal Description: Acres: 31.960 Plat: N/A-NOT AVAILABLE SEC 7 T31 N R11 9W SE SE EXC PARCEL 91 B Block/Condo Bldg: CHURCH CAMP LODGE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-31 N-1 9W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 721/41 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/22/2003 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 1.960 7,800 0 7,800 NO OTHER X4 30.000 0 0 0 NO Totals for 2006: General Property 1.960 7,800 0 7,800 Woodland 0.000 0 0 Totals for 2005: General Property 1.960 7,800 0 7,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 NORTH S1 PART SOMERSET T 31 N. 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S. a~~ y ~a ii:iii:iiiiiE nita Tobin 4GS .TwP. • c~ Q 2 sar/ O •L/N SO a ® 7a~ ckf° d M¢P P I SE~E~S3 64 iQe✓ /97s~ BANK OF MOULTON MONTGOMERY WARD SOMERSET IRRIGATION CO. at Baldwin Save With Us - Help PUMPS AND PIPE FOR SAVE ENERGY - SHOP BY PHONE Build Your Community EFFICIENT HANDLING LARRY AND BARB ANDERSON MEMBER FDIC OF LIQUID MANURE PHONE: 247-3321 PHONE: 684-3291 PHONE: 247-3371 SOMERSET, WISCONSIN SOMERSET, WISCONSIN BALDWIN, WISCONSIN 54002 '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 nel)D.Number: ~tDlSft WIt'731_19W (If FS-tate sPlan Town o:E Someerset 71 CONVENTIONAL E] ALTERATIVE S9 -~>•0109 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Camp Cleara,~.ter I~;e 1, Somerset, `TI. 54025 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: le J. Myers 6219 St. Croix 119493 .Ly SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO ST No DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER PIT INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST 110- MOUND SYSTEM: 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 DYES ❑ 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: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND 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 PROOPERTY WELL: BUILDING FEET FROM ❑ YES ❑ NO ❑ YES ❑ NO NEAREST * Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06/88) Zoning Administrator Thanas C. Nelson DI~.HR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 9 F-3 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE & AN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. f0 7 PR ERTY OWNER PROPERTY LOCATION F C'/ (ice'/a '/a, S T--?/, N, R E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : NEAREST ROAD <6 ZJ A/ch r TAX NUMBER( ) ❑ Public ❑1 or 2 Fam. Dwelling-# of bedrooms - PARCEL 111. BUILDING USE: (If building type is public, check all that apply) 9 R- 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 El Hotel/Motel 9 El Office/Factory 13 El Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 Rr 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 f a '7 e 91C) a? 7, O Feet S Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks ~1 strutted Se tic Tank or Hold in Tank Z tyalj~ Lift Pump Tank/Si hon Chamber P%dz, 4 6o 2 1 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' Signature: (No Stamps) M MPRSW No.: Business Phone Number: ",g tr 6 i zs um is Address (Street, City, State, Zip Co IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue Issuing Agent Signature (No tamps) Surcharge Fee) Approved ❑ Owner Given Initial O 0 _ Adverse Determination 7 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 s 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 a// septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference 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) SANITARY PERMIT APPLICATION COU TY, DILHR In accord witl►ILHR 83.05, Wis. Adm. Code + r,.x -v STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for tit system, on paper not less than 41" Z~3 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE P,JFAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. / I PROPERTY OWNER ~ PROPERTY LOCATION , - } '/4 %4,S T N,R E(or)W` PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one ITM NEAREST ROAD El State Owned O. V CITY : - R L AX NUMBER( ) ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms , III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 El Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ❑ Replacement 3.E1 Replacement of 4.0 Reconnection of 5.E] 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 ❑ 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./inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Con- Steel Plastic Concrete structed glass App' Tanks Tanks Septic Tank or Holding Tank F1 Q F1 I Lift Pump Tank/Si hon Chamber 1 El VIII. 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: + f Plum is Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY Disapproved sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No/Stamps) ` -24 Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: T SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s 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 (SBE}6399) to be - - submitted to the county prior to installation. -5. Onsite sewage systems must be properly maintained. The septic tank(s) must bepumped by, a' licansed , - pumper whenever necessary, usually every 2 to 3 years. 6. If you ahave questions concerning your onsite swage Safety & Buildings bivisione6M266-3815~ contact your local code administrator or the State of To be complete and accurate this sanitary permit -application must include: =Y 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. 4 11. Type of building being~served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling'. 111; Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, _ot repair. V. _ Type of system. Check appropriate box depending on system type. Vl:, Absorption system information: Provide all information requested'Irr #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 approvai only if tanks received experimental product approval from DILHR. Viii. Responsibility statement: Installing plumber is to fill in name, license number with appropriate°prehx (e g. MP, etc.), address and phone number. Plumber must sign application form. e IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'f x 11 inches must be submitted to the county: The 3 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/wateriservice ' streams and lakes; pump or siphon tanks; distribution boxes; soilhabsorpt" systems; replacement-system areas; and the location of the building served; B) horizontal and vertical elevation reference points; =',a 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.pan 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) APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property 1/4 5 /4, Section Township f-Mailing address 130X IPe Address of site 5.~~►hs Subdivision name Lot number Previous owner of property Total size of parcel 7 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 2„ /and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION - - I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Sig tur of Owner ~~~£C2 Signature of Co-Owner (If Applicable) Date of Signature Date of Signature LA, f S 40 jF d GMRbVR, for aid iS o"WOVSkUl t CC the- } MR UMM FMM M MD/100 MAAid 03al, tht-AWAM'Y' # the revsipt of ahicb is beroby ditt 1 mpsia* 81x21, "Wcant and ow"I ' wtn tba f , . all ttgwa 4 rafts ter, psewls of . ! lyiaeg ale! bel font mat of min, Qsrcribsd as follows a ant part of come t Lot 1 and the Southeast 0MICter. . Sonthe"It tie d ' M pn,Jr * nshin 31 North, Range 19 west, lying South and hest at f i line. 1"inning at a point on the south line of said SE 1f8 x:1 4 ° "I" S50 f+set Muth 890 209 340 hest of the southeast corner Of SAW asaa . X we SOP 36' * 20" Mbet, 2050 foot more or less* to ;a paint on *be a yid %JWWWa ert Lot • 1, said point being am feet, soave or Leer Mrsts oorasr of said Lot 1. and there ending. , ARWICR farther -ooaveys aid quitclaims all right, title. ad interAot in . stssets,' eeeys, strips or gores abutting or adjoining mid lands. 'fief above described lands are being acquired for administration by the ~asary of the interior through the National Park Service. .;VISM W 10 R= M SAID, together with all the heredita t mod. rues tbtreitrto belonging or in anywise appertaining, to the. 6 ens' a forever. And the said COR for itself. -its suocessors ate] ~ t with the tWAM and its assigns that it is well and la y -of the lands and premises aforesaid, and has good right to sell and in the swiner and form aforesaid, and that the same are free from all ances, eft for existing easements for public roads and highways, pnblfc ` £i es, railroads and--pipelines. 111 M, wall warrant and defend GPAUM and its assigm in the quiet and poag1 legion of the above bargained and granted lands and presifts agaimet LauMfully claiming or to claim the whole cc any part thereof. `xv the GIMUft has caused its corporate name and seal th be' r+a,. Y ' 49f ix*d by- its duly authorised representatives the day and yew ohm 1I S C`f"[CE y. Fourth Baptist Church of Co., WV5, ' 16th =7/ag_,._1-.'.'7. les Pratt, Chal Of the 2rusteso ipan 2.30 P %4MIN a+ DOD& TyfiMd E. Og v e, Secre y of the asters f - ' ,yam Yisconsin a "~s# Y Cr St. 'Croix fln this 15th day of. October . 1985, before me, a Notary- Publ'ik. malty les Pratt-yi-ento me to be the Chairman of..:the- iWb mi l Z. Ogilvie f known to me to be the Secretary of the Trustees +ra& 0M.. ~ +OCKOWation described in and who executed the within instrument pursuant'; ~l► ~ 1awr# or a remol0tuion of its hoard of directors. I ft-VT r t Notary 6 c My emission Exprem t!rlna drof dad Eby, the National Pat le a Service . St . c ro iY ~1,iR ~ ~ w 'i7f is "a1;+itd esew * f rras .payment of State deed stamps E Or IA I" 17.25(21. R: Pegg Ekee taf One Page IOSA 'IIwr 1o STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 04-n'1/° 7_7S T ROUTE/BOX NUMBER FIRE NO. CITY/STATE ZIP`~D2 PROPERTY LOCATION: 1/4 5 1/4, Section 17T 3Y N, R ~Z_W, Town of i--0e 3 , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 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 form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department 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 1 DATE -X- St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDIN INDUSTRY, C DIVISIO LABOR AN P.O. BOX UMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 A H (H63.09(l) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: SSE '1011 /T3 N/R/9E (o ,So ET COUNTY: O ER'S M ILING ADDRESS: T of a L W* ArE S ,MSET .6ox10 0 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: IPER-C-OLATION TESTS: ❑Residence i/yN/r New ❑Replace I 7 /A! h U RATING: S= Site suitable for system U= Site unsuitable for system ONV NNTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) 0S ®U ❑S QU IS ❑U ®S ❑U ❑S A I AI- Q a -ma y F 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 BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES . HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) a 9qe f> 7 2 _ - S B-a 60 X6.8 v " a_',oei wG' or- 66- 1R Svcs B-7 10 -16 "V/ra&jj- h PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RI D 1 PERIOD 2 ~PE D3 PER INCH P- 13 oN P- c 1 3 o A4! 3 E 30 47 1 7/Z < 9r © / 3 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_ 78.6 q Z 6.26.3~'71S ~ 1 s 1801` 0jo o f tow m P~- /04 Po L r eAd 80 rs E r-LtV E ~ E lp 2z I ~ P3 - F E 3 i ~ w i e ~ / ~ r f 3 t I. [ I _~r-~ i i t ~ I I :t 148 fir 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. NA (print): TESTS WERE COMPLETED ON: A DRESS: CFRTIFI`NU BER: PHONE NUMBER(optionaq: C3T 30 C16 2 CS S NATURE: ` 10 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - N , I STRt 'IONS I _ COMPLETING FORM 115 - S D - 6395 a r: s. your rep elude: 1. I descrip 2. Th n must c ?then this is a residence or commerc S- M/k amber of F : or commercial use planned; 4. pla~ I; ra T, ; .>a A SITE IS SUITABLE FOR r _ } 3 TANK ONLY IF ALL OUT BASED SOIL GONDITIC f 0fil e- > 1ple plot plan; 11 1 rr test loc<" oR ferred. A ice point are Cl( t; ~Ir!S es, flood plr. r f-.n elevation) doc,s not apply, u6", t address -1 your certificaI as \LL SOIL TE BE " =I TH THE DAYS O LETION. I TIONS FOR -,-.ITIFIE- -_3S beds HG- r?, . "sl ~.l B n - ssil Bi SR - Sl'. Gy Y fff - CC R"~1. RTIIII r3"t d t p - , HWL _ BM - F VRP _ Point it t to r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS i03T R Y, DIVISION AND PERCOLATION TESTS (115P.O. BOX 7969 4 RELATIONS MADISON, WI 53707 (ILHR $3.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MUNICIPALI LOT NO.: BLK. NO. SUBDIVISION NAME: A, ii~ G S~'~a ` /T31 N/RAM ( S M IL NG ESS: DDR COUNTY: OWNER'S/BUYERS/ A2 ii~ 8x o So W S Z/ D rE T.-CJ of DATES OBSERVATIONS MADE USE PROFILEDESCRIPTI NS: PER OLATIONTESTS: V.i NO. BEDRMS:: COMMERCIAL DESCRIPTION: ref Q 14iNew ❑Replace S.•~ - S` a V ❑Residence S~L1NIT D RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND- _ CtIN-GROUND-PR ESSURE: SYSTEcM-I(N~FILLHOLDIIN~G(TA'N'K: RECOMMENDED SYSTEM: (optional) 20 E J lCJ' V J EIEIJ iC3,J Y [IJ C1J v' I ES If Percolation Tests are NOT required FDEIGN RATE: If any portion of the tested area is in the under s. ILHR 83.0911 indicate: I Floodplain indicate Floodplain elevation: . PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) W c~yaoT. B- D 3 4~S/E 3 ~,Ok,Q 9.3 6 ~e' 36- 6 /'l~,v~, h-6S,e~ r B- G -3 O'y''DYQ,v 9- a -do,a~f w~ B- 3 6 t / - 3 dii 1• c5- 3' 6 .S w ".~/oT B- L-7 7 a B- Ij B- 6 U_ l o~ ,51 .fPERCOLATION TESTS TEST NUMBER INCH S FTER SWELOL NG INTERVALnMIN. PERIOD 1 DROP IN W PE-00 2 EL-INCHES PER OD 3 RAPER INCH ES I o y / J P_ t3 3 P 30 i P- /1/ -130 2 O 314 IQ 9 P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION /00. 2 . -I F - - I 3 E EI a 22 /GI 03~qs_E of 7o le%. /QoPF a p 1$14 Yl~llp PO Z'F a_ . spa' TN P s500 - E t 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. NAM rint : TESTS WERE COMPLETED ON: I )L9 4Z,9 I(?t,9 R IAJ / C4 IV _5,_ 3 A R~~SS: C RTIFI TION NUMB R: PHONE NUMBER (optional): ~l S 61 *R 6S, 16 CS ATURE: e DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - II ST_ A ION COMPLETIN j im 115 1. ascripa r ast e`' th - t ter corn t, 3" M_. 4, is r b. Cot xes. A SI : IS LY IF ALL OTs-i E.. OUT 6 PLF ;vvn hrre ,v e °,crip-oc r 'r _ 'ie plot plan; 7, ra a= „irately locati' " t a tic. s+ preferred, A gar rtacal elevation ,,)k t are clearly shown, and arse permanent, eaoxes as to dates, names, ood plain data, percolation test exLnip- 1 h flood plain, elevation) does not :;oly, pla '4.A. in the appropriate box; YOU! Current address and your cat tiflr;atk 12. ;'lake legible r =s and distribute as required, ALL SOIL TESL r MUST BE FILED WITH THE LOCAL AL: _AC°` ITY WITHIN 30 BAYS OF COMPLETION. EVI TIONS FOR CE TI, ) L TL Sail Separates and Textures Other Sy- bols st - Stone graver 10") BR - cob Cobble (3 - 10") SS Sat- tot gr - Gravel (gander, 33") 'S - Lirea~si ~ ae s Sand 1-1'I High C,. S coarse Sand Percolation r. n Medium Sand /ell s Fine Sand v rtd l_oarza is -I vaara l - n Bn Br awn B 6y V T~.I -;,area S lay Loam t stills i oarn t j JL ..7c r sit; - Silty fit - ~c Clay cc - c pt peat nwl tt s4-r Eti1~uck d st p HWl soil _ meter BPS? ark VRP TO THE OWNE : This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A comp e set of plans for the private sevdac;e system and a perinit application must be submitted to the appr( e local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUST NDUSTRYY, , C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W1 3707 P.O. BOX 76 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.. BLK. NO.: SUBDIVISION NAME: 1/ /T N/R E (or) W COUNTY: . OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER IAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ❑ Residence ❑ New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUNccD: IN-GRO UNNcD-PRESSURE. S STEccM-IN-FILLHOLDIccNG TANK: RECOMMENDED SYSTEM: (optional) E [under Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER I or) 7- PER INCH P- P- P- P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points n P, d show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ✓ P V WT Ct 5 So_M eg5CT I,US- SYSTEM ELEVATION E 3 I F ~ 1 ~ E E ~ i i r 7 1 ~ _ 3 r - I, the undersigned, hereby certify that the soil ests reported is form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded d the tion of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: ADDRESS: S 3 - F CERTIFICATION NUMBER: PHONE NUMBER (optional): CST 36-6 12 /7 CS SI ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LHR-SBD-6395 (R. 02/82) - OVER - A INSTRUCT! NS FOR MPEETIN FORM 115 - SI ID - 6395 To be a complete and ~ soil to r r:!port mast inclydde: Ir 1. Complete legal descriptio 2. The use section must ciea indicate whether th e is a residence or commercial project; 3, M, %X11 number of h ems or commercial use planned; 4. Is _ 1-placemr . system; 5. --i'labilii.y a•_:_i,ig boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL 04 (STEMS ARE RULED OUT BASED ON SOIL CONDITIOW d, the abbr, i , is shown here for writing profile descri it c nl ; - g the plot plan; 7. 3' 1 a;~. -::tely locating y<" test locations. preferred. A I . ` ition point are clearly shown, d are permanent; nimes, resses, flood plain data, , era test exemp- aira, elr~~ ~tiar'roes not apply, ply-- ` A. m th< . -pvopi'iate box; our certification i `prate as i ALL SOIL TFu JT BE FILE[) VVITH THE 'ITHIN 30 DAYSC -?L"uTION. -VIA! T1 )IL TP Cthe ~ Z='rnbols L roc( L im t l Bn B1 B` - Gy - t x. Y sc,; ;y ( R sici - Sit Loy mot - y sic lay p = HVVL - Hii BM VRP P int fii rrtay request the private in r to i t' tp S 894 0 ' iMENTOF G t 14D SAFETY & BUILD+ - I7RY, DIVISION ANDS" ..`j P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (1LA~ r T!};^l+ ! !~!~^UrJlt I~ALI'r'f: l-Or NO~r! LK PIO.: SUBDIVISION NAME: COUNTY: E ~r7Rr]a)!V!I a -7r - sa F nr r l any ~ ~~r__ . . • - IND. ` Pi;o KCABEDnN '~iC€FiEiPTfU s: !`€FjZt L'nTi7~fi*ESrs: C]Rosiaertc. F7 RATING: S' Site suitabii for system Lite $it~ wr .ni+. f t I!J!i !(ILL ir)C[.• \'aF__._~..__ T t1W If FC:C1 rrvlE-NDED SYST EM:Ioption 11 ps [RU 2 610 If Percolation Tests are NOT►equired DESIGN RATE: It any rii,~n of the tested area is in the r under s,H63A8151(b), indkab: + Finn) ,12rrm, indicate Floodplain elevation: F (I71!-.. DESCiiIP :i BORING TOTAL H T R UNDWATER-INLIfES CH ACTED CAF SOIL WITH THICKN •SS, COLOR, TEXTURE, AND DEPTH P1tAliBf t I ELEVATION OBSERVED Sy,Tr1-GHEEff . TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK,) 7~ 00 Tf o_ Ov 6' o y.. lA ! z 7- 9 ~ 66- ~ wcs r © r7 a' .3.2- -2 JAIQts a+ / O -/tS ~ is - - y'1 Z2 PERCOLATION TESTS TEST DEPTH- , WATE 1N HOLE TEST TIME O W T V HES RATE MINUTES N BISA H .AFTER SWELLING INTERVAL-MIN. PER INCH 3119 41 PLOT ULAN: Show iaatlorRl of percolation tell:, soil borings and the,dIMenslohs of suitable soil a e~-I d e stances. Describe what are the hori• /ne Meronce points and show their locetionfon the Plot plan. Show the ce elevation at all rings and the direction and percent ~ {i~, 2 3 t9V f MAY TI~NI 9' cis lyv, rt t N r< .a{(ys I ..f i 4 'MA I S•2 M - - t:. a a/ fivr ?h,13M undnsignW, hereby certify that the soil testa reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Code sad tat-the data recorded and the location of the testa are correct to the best of my knowledge and belief, TESTS WERE COMPLETED ON: Adz C TIFI ATION N BER: PHONE NUMBERIoptional): 12 66 716 2 .a CS S NATURE: kkkkk 9' t CiY k. 4JNt copy to Local Authority, Property. OWnef and Soil Tester. Jed 1N~_OVER DILHR Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S.C. Labor and Human Relations Safety & Buildings Division REPORT 13 E. Spruce Street Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date ~ ~-'-H DI09 (715) 723-8786 I-M v -4, 19 a Name of Premises Addressor Legal Description OhyfTownship County Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No. L\IlE M-rtT-~ ` R-Ir z. e, L17A Sanitary Permit No. ILL (~wtl ~ w;- 5'f -7 Z5 J /Soil Tester Licensed Person's Name(s) and License Number(s) 0~.daLi) Cop Mt(At,) c ~r 3(r, Yb Owner's Name and Address ~LtA~Wa1 10p C. v CA, _ E .`F : ~t;? ~ i~..F ~ ~ E'~1_. ~r ~ :~+2'C~- ...L~'' { . I T-!~~ /f-' `~'<P ~C~✓`-'~t'~" l.'✓`- /~{r C~ - AF ? J7 `..~:..i-~ . c , f~ ci-v1 -1~.E{ t ~v-- LL1.oG~-~d fLr /J^r. C~t~ .~{f~L~ ~rl,_, .4yCF~.s,~~7 1jF,.U. ~I /_1 <L/_71 ~jn ?tee r,~z . S'1 t -,-I 4'.ii 'ST s~ I f ` SIGN: U L - ZD:_l 1 ; ~ . ~3 1 Li - ij !J •~i~ ~ / ~ W ti (0 ur C (]1 P r L', ~''•ii1`,j_ i~ ~,-;fir"L G~ ~'~T. /5 7~ RECEIVED ! MAY 3 Q 1989 SAFF7-y g j3WGS. MV. 1 Page Of Signature of Responsible Licensed person (only one needed) Chck all l Signature of Plumbing CpnsultanVPrivate Sewage Consultant Copies t0: \thatapply) Original: - f . . SBD-6192 (R. 11185) District DILHR 0 Plumber 0 Owner 0 County/Local Insp. 0 Other o DILHR Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S.C. Labor and Human Relations Street Safety & Buildings Division REPORT 13 E. Spruce Bureau of Plumbing Chippewa Falls, Wl 54729 (715) 723-8786 Inspection Date /4.4V .2, Name of Premises Adds ar Legal Description G*rownship County .-AMP 5e_, SiF 7,31, 19Lj SCMr~SFf ST. Cf~O/X Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No. I 04 L E. M `•f r S 9,t Z ~Ox y7Q Sanitary Permit No. & vi w L 51+ 7 Z5' JORAFROYMOR Soil Tester Licensed Person's Name(s) and License Number(s) 00t4aLD COR ! CST. Owner's Name and Address ".P . C.-F'.l~!+ IOC, e ~".,iB2SE i wZ 5 2~ t2a a; 3 , 1 ~Cyit+~'2-.+~ -cry i i s<t~ y - ~O 1 ~ I~`I~3 _ R 5 t ~ 14L4 Co~ / 0,7!'„ ` S/ W/-evIU fa -G RS AkE it I r_5T u,E Q SAT : t S 2& . . - P4 OT V. f-0137-, w ST oRIZx COUNTY ZotMG tCE r- w0..!.(j . ~,,t.~.~ ~,,~,[.r/vZ~ ',,,:r,.,Fs~~p~i,~..I'r~~ ~.::.7 „ • ~ r t sa.A'=.~' C1" 7' i~ 4' ` ~l ~r may-,. ~-4' Page_J_of Signature of Responsible Licensed Person (only one needed) Signat of Plumbing Consult nt/Private Sewage Consultant Copies to: \ Check all Original: that apply sBD-6192(R.11/85) District DILHR Plumber 0 O erg r,_ my/Local I p. O er LA C`` I * L H R WiscotlNSin bepartment of Industry, INSPECTION D I Labor and Human Relations Leroy Jansky P.S.C. Safety & Buildings Division REPORT 13 E. Spruce Street Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date Al (715) 72,3-8786 A1*1 Name of P erhis s Address or Legal Description WTownship County Lam' ! 7 x 3, t /J Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No. ~►.~tt L4 Gr.~Eaii ►'t~ /e°-~_... 67 48/8 f2t \ C3u~t Co Sanitary Permit No. xj, J /Soil Tester Licensed Person's Name(s) and License Number(s) Owner's Name and Address 3 !f ~ , ,sx~g r J Q w Page of Signature of Responsible Licensed Person (only one needed) Check all 1 Signatu 'of Plumbing Consultant/Private Sewage Consultant Original: Copies to: /that apply SBD-6192 (R. 11/85) District 0 DILHR O Plumber E)C" r `Qa my/Local(( p. er Dimensional Data Performance iI§e ~ 40 10 9 MODEL: SKSOA Y MODEL: SK60M n 121/e---+~ SK75M, 36 ey 457m 8,116 Q. Discharge SK100M' 34 fl 5r/e - 1 •1211@ 0 (jOischarge 4314 1011116 0 ~ 4311 3'3/16 - \ - +6 2" N.P.T. O + 63/ OR N.P.T. 313116 41 FLANGE 2-NPT OR 3" N PT. FLANGE - l_ i 16 * h+ - -.--40 131h 16 ! Wiz -T --I ---A MODEL: SK75, SK100 SINGLE PHASE 1239 41/,6 8'h« SK60ISK751SK100 MAX SOLIDS 2" SPHERE - 1750 RPM 4u4 0 ~,,Q - - - - T-- j 1 ' I SK100 0 36 - - - - 1- _ FULL LOAD - - AMPS AT 146 115V. 6 30V N FULL LOAD 2:, N.P.T. 28 AMPS 230V 9.25 31111@ G 1 32 ~ SAT 30 2302. 4.7. AT 460V. ^.35 _ 3" N P.T. Z 24 _ the FLANGE - a a° 20 -i - H 18 SK60 SK75 0 12 FULL LOAD FULL LOAD - AMPS AT 16 115V. AMPS AT 10 115V. 11 5, AT 2302. 5.75 17.0. AT 2302 8.5 8 FULL LOAD I FULL LOAD ! • AMPS AT 36 230V. AMPS AT 30 2302. ' I O 2.25.2.25, AT _ 3.6, AT.L..L 1.8 - 21J4 0 20 40 60 80 100 120 140 160 1816 - U.S. GALLONS PER MINUTE I MARL'EY~ THE MARLEY PUMP COMPANY -7- ~L "0) HYDROMATIC PUMPS Bulletin 210.9 Box 327. Ashland. Ohio 44805 1419, 2893042 Rey. 12.12.84 In Canada - Marley Fluid Systems. 126 East Dr, Brampton. Ontario L6T 1C2 PRINTED IN U.S.A. International Sales - Mission. 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