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HomeMy WebLinkAbout042-1060-20-000 0 > CD Q k 0 ts 2 / � C U. C 0 c) } � � = § � . C-4 W 0 E 0 z E Ea -0 Cl) ID N CX M (D c 0 r o r- z z z 4i z'a c a CZ41 0 2 2 CL 0) to 4) CL > E -r- 4) E Z z m 000 z CL co co 0 0 U) i co co U) C) m .0 E co (L © o PM < z 0) cu E co & CO co a) a c CL 0 C.4 Cl) a CN Cl M 0 r- 75 co CD 1: U) -a Z Z .0 -0 C3) CN c 4) 00 C� " :3 E E C-4 0 12 12 m CL u CL (9 06 .2 0 2:1 0 s : . 0 C 0 =0 CL U) 0 Parcel #: 042-1060-20-000 02/08/2007 01:03 PM PAGE 1 OF 1 Alt.Parcel#: 21.29.18.336B 042-TOWN OF WARREN 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 MARK L&MONIKA K JENSEN O-JENSEN, MARK L&MONIKA K 812 HWY 65 ROBERTS WI 54023 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *812 HWY 65 SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.166 Plat: N/A-NOT AVAILABLE SEC 21 T29N R18W.78A PT SE SE BEGIN 401 Block/Condo Bldg: FT N OF SE COR IN CEN OF HWY,TH W 203 FT,N168 FT, E203 FT, S 168 FT TO POB& Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) INC PT DESC AS COM SW COR SD PARC;TH W 21-29N-18W 100FT;TH N 168FT;TH E 100FT;TH S 168FT TO POB Notes: Parcel History: Date Doc# Vol/Page Type 10/22/1998 589658 1368/388 WD 07/23/1997 838/475 07/23/1997 446/70 07/23/1997 414/377 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.166 27,100 136,300 163,400 NO Totals for 2007: General Property 1.166 27,100 136,300 163,400 Woodland 0.000 0 0 Totals for 2006: General Property 1.166 27,100 136,300 163,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 111 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISO%,WI 53707 SO4-,SF 4-,S21,T29N-R18W MCONVENTIONAL ❑ALTERNATIVE State Plan i.D.Number, Ilf assigned) n ❑Holding Tank ❑ In-Ground Pressure El Mound Town a� (AlalA e s HWY 65 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Stan Lewes Route 1,Sox 3, Robetc t6, W1 54023 S'k !'30 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: JMPIMPRSW No Co-,Iy Sanitary Permit Number: Henry NeehviUe 3258 St. Croix 112825 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIOU CAPACIT TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER ..�� PROVIDED: PROVIDED: ❑YES ❑NO DYES ONO BEDDING: VENT DIA.. VENT MATE 3 WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING: VENT TO FRESH rARM FEET FROM LINE. AIR INLET: OYES ONO DYES L1 NO NEAREST DOSING CH MBER: MANUFACTURE BEDDING LIQUID CAPACI TV PUMPMODEL PUMP:SIPHON MANUE M:TUHEH WARNING LABEL LOCKING COVER J PROVIDED PROVIDED ❑YES ONO ❑YES ❑NO I DYES ❑NO GA LONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PH OPEHTY WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST 101 SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing f rv1,TH 1111AMI T111 a1ATE HIAI AND MAHKIN6 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: BED/TRENCH WIDTH LENGTH TH PIPF sPncW(7 VATEHIAL PIT NSn7E Uln SPITS D PTHD DIMENSIONS GRAVEL DE H FILL DEPTH 11E)ISV ITIt PIPE DISTR PI PIPE MATERIAL NO DISTI7 NUMBER QF PROPERTY WEE:17 NG: VENT TO FRESH BELOW PIPES ABOVE COVER E .INLE t ELEV END PIPES FE1:T FROM !LINE AIR INLET: 1 N EARESTw-- ---#► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PEHMANI NT%1AHKf HS oBSEHVATION WELLS ❑YES ❑NO 1:1 YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEO DEPTH OF TOPSOIL SOOOEU SEE OFII MULCHED CENTER EDGES ❑YES. ONO E:1 YES 1-1 NO DYES El NO PRESSURIZED DISTRIBUTION SYSTEM: 1ED/� WIDTH. LENGTH TRENCHES. LATEHAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMIENSIONS T MANIFOLD PUMP MANIFOLD DISTR.PIPE JMANIIOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV. CIA. ELEV. PIPES DI A.. ELEVATIDN'AND' DISTRIBUTION„ '! INFORMATION HOLE SIZE HOLE SPACING DRILLED CQHHFCTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED ❑YES LINO DYES 1:1 NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF ', PRTOE ERTY WELL: BUILDING: FEET FROM ❑YES ❑NO ❑YES ❑NO NEAREST' ' J Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: �-' TITLE. DILHR SBD6710(R.01/82) tY.. Zoning AdYY11.(n4:zt&ato,% SANITARY PERMIT APPLICATION COIN ! EZ 51�.HR In accord with ILHR 83.05,Wis.Adm.Code 9.,o�,,,, �,,o� STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES'PI'NO PROPERTY OWNER PROPERTY LQCATION ,q 5'70'04" ,v /,-AV/ S :r E' % 15E %, S Z� T % , N, R IP E(o nw P PERTY NER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STAT ZIP CODE PHONE NUMBER CITY NEARE ROAD LA E OR LANDMARK S Aw 5¢o O VILLAGE: ��"'Y✓ � II. TYPE OF BUILDING OR USE SERVED: 3— OR Number of Bedrooms if 1 or 2 Family ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. Replacement c. El Replacement of d.❑ Reconnection of e.El Repair of an System ASystern 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.❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) Z L A/L — 5 ��7 �i¢G� 1. a. ❑ seepage Bed b., See a e Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 15.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIREquare Feet): PROPOSED(Square Feet): !l'3 / 10001�L!/ Feet N Private ❑Joint ❑ Public VI. TANK CAPACITY Site in a allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank t� I & El _�J___R_ El Lift Pump Tank/Siphon Chamber Qb J N ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plum er's Signature:(No Stamps) M RSW No.. Business Phone Number: Plumber's Add es s(Street,City,State,Zip Code): Name of Designer: fs ev, S�y VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name v' 1:.,; CST# 1/�g fJcIL RD.,HUDSON,WIS. RIGHT CST's ADDRESS(Street,City,State,Zip Code) vi MASTER PLUMBER LIC.Nth.3307 M.P.R.S. Phone Number:�/ `?JN.INSTALLER&DESIGNER LIC.NO.00663 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial rcharge Fee Adverse Determination 12�� !moo H &/�"'.14,� X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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- rooms, 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 submitted 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. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner'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; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; 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'% 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 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 Ground attar included the creation of surcharges (fees) for a number of regulated practices which Wisco CIi'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried i�,asure a is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. a The monies 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 , water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty 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 �' ;t �' 3t, Section , T )N-R /8 irO Township Mailing Address _ � .,�,x Address of Site � � Subdivisiqn NameJP, Lot Number Previous Owner of Propertyfl/ Total Size of Parcel Date Parcel was Created 9 z-&. I Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (epee house) ? Yes �o Volume 14 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (toe) cut i.6y that ate statemewtA on thus for eAe thue to the best o6 my (ounl knautedge; that I (we) am (ah.e) .the owneh(,s the pnopenty ducAi.bed in th.i,a .in 6ohmat i.on 604m, by viA tue 06 a waA.an ty deed rceeonded in the 0 6 6.i.ce 06 the Count Reg usteA o6 Deedh ass Document No. $ S° ; and that i (We) pnesen,t£y eRun the pnopoaed s•i,te 6oh the sewage posat system (on I (we) have obtained an edhe-meat, to nun with the above deAcit,ibed pnopehty, bon the eonbttAuattion o6 said ayat", and the acme haA been duty keeo)tded in the 066.iee 06 the County Reg.iateA o6 Detd&, ab OoaanRent No. 1 . SIGNATURE Op 01rMER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED u OOCUMENr No, + WARRANTY 0160 • ,T. R l� ° buts Olt WIBtlCiN9IN�+irdltM 9 C" ft VA06 tM�91M MOR UM MO DATA THIS INDENTURE,Made by Gardiner -A. Graham and REGISTERS OFFICE Viollet A. Graham, s w e + ST. CAOIX CO., WIS. . Recd for Record this-2flai- grantor S' of St. Croix County,Wisconsin,hereby conveys and warrants day of je�t811t er„AaD,lg 0 to Lewis and Elsie Lewis husband and at aav ai,,,,As M. wife as joint tenants ' �` Register f eds of � St. Croix ntee 8 RETURN TO County,Wisconsin,for the eutd of One Dollar $1,00) and Other Good and Valuable Consideration the-following tract of land in St . Croix County,State of Wisconsin; Beginning at a point in the highway 519 feet north of the Southeast (SE) corner of Section Twenty-one (21), Township Twenty-nine (29) North, Range Eighteen (18) West (21-29-18) , thence west' 203 feet, thence north 50 feet, thence east 203 feet, thence south 50 feet to point of,-',beginning, being a parcel north of and adjacent to the parcel conveyed by the deed recorded in Volume 414, `page 377 in the Register off, Deeds, office for St. Croix County. IN WITNESS WHEREOF,the said gtantor S ha Ve hereunto set their hand 5 and seal s this 4th " day of September SIGNED 5E E III ENCE OF /// - (SIrAL) ;. Gir' diney A. Graham !.I a A r, (SEAL) �( Hugh Fan Grain_ / Violet A. Graham �l,Q,�% , . 1� ,�L� � -�✓ (SEAL) Barbaric- J. Bahneman (SEAL) STATE OF WISCONSIN, ST. 6ROIX 89' County.1 , Personally came before me,this 4th day of September A. D., 1�8 the above named Gardiner A. Graham and Violet A. Graham, his wife to me known to be the person who executed the foregoing instrument and acknowledged the sam r f°� + i��T' ugh F. Groin t St. Croix This instrument drafted by �Y .; !, '�f+ �, ; Notary Public County,Wit, !3 Gw in Hugh F. u. ; •.��'y� 'd , � My Commission�►pires}(Is) permanent _ 19rcHot►59.61 (1)et the Wisconsin Statutes vtoAdel iu,&$� ,um be toeotded%JM biN#OW*printed or typowdtbn thereon the names of the wonton,grantees,witases"and WARRANTY DYtEtf 9tAT8 tilt Wlgdomm,#ORirt'fqo,0,' a,a.rnu�te.,riueAUttt STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County `. OWNER/BUYER ROUTE/BOX NUMBER ® FIRE NO. CITY/STATE (st/. ZIP `�` L PROPERTY LOCATION: 1/4 1/4, Section , T N, R W, Town of St. Croix County, Subdivision �/y'� +, 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 of 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 �f DATE 0,i'' 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 DEPARTMENT OF REPORT ON SOIL BORINGS AN Q.00W,19-_�'-4AFETY&BUILDINGS INDUSTRY, _ DIVISION LABOR AND P.O. BOX 7969 HUMAN AiELATIONS PERCOLATION TESTS (11 f MADISON,WI 53707 r (1-163.090)&Chapter 145.045) A :f N: TOWNSHIP/MCfd1CTPfiLTTY: OT NO.:BLK NO.: SUBDIVISION NAME: r` s� 1/ 1/ Z 1 /Tzl N/Rif E la All/I/ Eti CO UN Y: OWN 'S 'S NAME: MAILIN ADDRESS: s 3 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMM ESCRIPTION: / U Residence 3 �--= ❑F-_ New ,Replace 0 G� . , — /9�� Q Lr . 7— Imp ' RATING:S-Site suitable for system U-Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND ESSUR : S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:loptional) 0 s ou Rs ou Qs ❑u a s ©u ❑s au e"ov y"rlov4/ — [unde,'r7H673.'09(5)(b),Ptio Tests are NOT required DESIGN RATE: If any portion of the tested area is in the .� indicate: C(4 S S Floodplain,indicate Floodplain elevation: 7'L�" PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER-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.) c s i X01 TS 2,0 , B- �, r /�o ✓L`'�� �' a . 0 v R S ( S . n�' 3 - S ?A3 S. w/ 5� • B- M B- 3 7it� > �, O c o v IZ k /5 f ' G G ' ? .� Eie I �.U ��. S v I S 13 l e. S p�' Sa o'R B. 3 & Try V o Q PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES Q NUMBER li>Q"&& AFTER SWELLING INTERVAL-MIN. P RI D 1 P I D PERI QJ PER INCH . P- P. ?� , 2_ 4 P• ' J► 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. DUES T T P>rti�GL � 3 . / �S pow T�eEtic�. J SYSTEM ELEVATION -rye a U mac- n , , IN P/0 Rr S %c,,P v �•, C. , --- ! I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS W RE COMPLETED ON- H(j'.iESITE SEPTIC PLUMBING CO. O� • � � / 4fj, ADDRESS: 655 O'NEIL RD.,HUDSON, CERTIFICATION NUMBER: PHON//NUMBER(optional): ROBERT ULBRIGHT - CST SIGNATURE: f'NN.INSTALLER&DESIGNER LIC.NO.00663 I' DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. I nn uo canAiag; IR n,)/R91 OVER tic-sr /olI 5• �G0R)" t&6 6 I � SE/nc { � I � I I , 1 j 1 C Ip� , I I toe//. " s8z FI&URTIoo -Top of O L-I 1 - � /oo, p r Zo 1 .p 000 4jwiA. ot h Sw lo1- r� V co a ae P- d ,I N-� F, F' S � i 1 M� of r Lt n1 s ys rF,-1 6 y rw 13, o r ° ► kJ N � I (Assn x ' /000 5F c T N r1 fP�4 KF�ES C o . p w y�T U T, PE � ^, i sr►aU NEW uJ o p � W i` PuMp ehAARER eN. 8z wEEKs FItOfr1o.) -topof COAl 30 of 3 'Ave ..000 44AA4A� rt So. lof Ir'uc k T sw poi- d yiyti-�sT F'/�v�ria,� CORaEl_ ?o /0om EKE cAS r D�Po� 3 0 K 11 EAST T��ENG(ti fa �EV A I ,ttid 404'4— n�;� y oll All BA(e4lor PG 07- IDG4AI EA5 7 i�PE•�� Fresh Air Inlets And Observation Pipe I k OF Approved Vent Cap Minimum ;c'! Above Final Grade .� �iviSfi/,�t� Jcie4A- ' I D �- _ 4" Cast Iron Above Pipe Vent Pipe' 'ro Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution z 1- Tee Pipe —�' 0 0 0 0 0 " Aggregate Pertbroled Pie Below Beneath Pipe 0 p U �3 �� 0 Coupling Terminating At Bottom Of System i vFresh Air Inlets And Observation Pipe `J 0 Approved Vent Cap Minimum 12" Above Final Grade IKI;VIJh/6AP 4" Cast Iron 36 " Above Pipe Vent Pipe –ro Final Grade ` Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe F Distribution z 1� Tee Pipe 0 0 0 0 0 " Aggregate o Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At C Bottom Of System 3 � PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 40C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING � 25' FROM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 12"MID. AIR INTAKE 971 L GRADE ' IC'I vy � y°MIAl. COUDUIT �fl INLET PROVIDE AIRTIGHT SEAL � APPROVED JOINT A I I APPROVED JOINTS %J/C.I. PIPE I I(( W/C.I. PIPE EXTENDING 3' ( EXTENDING 3' ONTO SOLID SOIL ALARM ONTO SOLID SOIL o D OE °N ELEV. FT. pp� PUMP , OFF D 1,4o CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIONS i DOSE .(�Q TANKS MANUFACTURER: IJUMBER OF DOSES: PER DAy TAWK SIZE: Q(�OQ GALLONS DOSE VOLUME ALARM MANUFACTURER: 1--V--1 41AXAI 4dr- INCLUDING BACKFLOW: �CO� GALLONS MODEL NUMBER: y' U' ` CAPACITIES: A= 'S INCHES OR 300 GALLOWS SWITCH TYPE: if yCuR �� g= 2- INCHES OR 541f GALLONS PUMP MANUFACTURER. �O C=INCHES OR GALLONS ' MODEL NUMBER: -97 Y2 H P D-16 . 7 INCHES OR 303 GALLONS SWITCH TYPE: PI 6,G%/6*Lt Aenpet y� / S NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE�GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.._L_ FEET + MINIMUM NETWORK SUPPLY PRESSURE , . . , , . . . , FEET 7�Nt ,51El s I ♦ 3 O FEET OF FORCE MAIN X ' W FT. Z j YO FT FRICTION FACTOR.. FEET EAl�c. r of I I TOTAL DYNAMIC HEAD = �O•.S FEET D�P�, l� • 2 J�s I Po 0A) I INTERNAL DIMEWSIONS OF TANK: LE TH ;WIDTH 77 ;LIQUID DEPTH n �� SIGNED: LICEQSE DUMBER: DATE: v a>'�� v 04 vw0 O,ez 3 o j� 3 �hl/c _ /� '' S ul _. VA HEAD/ R� CAPACITY 32110 N CURVF 26 8B EFFLUENT 24 w MODELI and Q 75 MODEL 189 DEWATER/NG 70 X65 20 �- a > 18 w ` y 55 18 50 MODEL a 163 MODEL O 14 4S 1at 12 40z 5� 35 10 Oar MODEL MODEL 1,37,139,' SEWAGE and DEWATER/NG ° MODEL ; 15 -MODEL 161 :�k 4 7 10 MODEL W2 5 53,55, M 57,69 0 ' GALLONS 10 20 30 40 50 60 70 w 90 100 110 1P 24 w LITERS 0 w ,w 240 320 400 75 t 22 FLOW PER MINUTE x 70 20 .F. G ,8 w_ — MODEL 29S W 65 !?: Z 16 •r• ti: V w P Z t4 45 MODEL_t 294 p. 12 40- Q 35 MODEL I C 10 283 MODEL 4 H 284 MODEL S 20-____ 2°2 10 MODEL ZffzlLEIP O. 2 5 267,289 0 i 3280 Old MN M Lane GALLONS 70 20 30 40 50 w 70 w, w 100 110 120 130 140 lisp tw 170 tw 190 P.O.BOX 18317 :'; ' Louis0e,Kentucky 40218: LITERS 0 w 160 240 320 400 480 S60 840 720 FLOW PER MINUTE "97" Cast Iron Series HEAD 1:APAI:ITV UNITS/MIN Feet Meters Gal. Lira. • Automatic or Non-Automatic. g 1.52 57 216 6 � • vz H.P., 1 Ph.,115V or 230V. 10 3.05 51 193 r \\� • Non-clogging vortex impeller design. 15 4.57 43 163 20 6.10 27 104 • Passes 1/2"solids(sphere). • 1'12"NPT discharge. Lock Valve: 24.5' r Float operated submersible (Nema 6) mech- anical switch. listed ° . 5 • Automatic reset thermal overload protection. • Stainless steel screws,guard,handle and arm and seal assembly. • Watertight neoprene"O"ring between motor and ' canwwn Slon"a pump housing. /aswc.Approval araiwola I(. N97,non-automatic,available packaged with a piggyback mercury poet switch.