HomeMy WebLinkAbout012-1016-20-001
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Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC . T .C N-R / W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT - LOT SIZE e6 71
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/per _ ✓ qn ~ s<, } - ~ ` i
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: i C» -c7 _ Proposed slope at site: ln
SEPTIC TANK: Manufacturer: ~tei_~c Liquid Capacity: a~.5 1
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side, 0 Rear, (3 r J feet
From nearest property line Front,0 Side,0 Rear, O jt, feet
Number of feet from: well 55 " building: -30 /
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity: 17AZo-,
Pump Model: Pump/Siphon Manufacturer: f;~Yy
~ /(~1 Pump Size
Elevation of inlet: Bottom of tank elevation:/.~j f
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: z 1172 Alarm Switch Type:
Number of feet from nearest property line: Front, O Side Rear, Ft.~I,I
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:'
Width: Leng'th: 6~J) Number of Lines: Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, ® Rear,0 Ft..CC~
Number of feet from well: 2":jy-
Number of feet from building: 15-71;75 - f f;
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: iameter:
Liquid depth: Bott of s page i elevation:
Area Built:
Has either a drop box O or dis ribu i box be n used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elev t on of Otto tank:
Elevation of inlet:
Number of feet from nearest prope y 1'ne: ont, O Side, O Rear, O Ft.
Number of feet from 1:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: Dated: Plumber on job:
fa~
License Number:
~jr
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & yUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.Q. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
LXkONVENTIONAL ❑ALTERNATIVE state Plan LD. Number.
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound nass9ne~)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER'. INSPECTION DATE:
Ltoyd W etan.d RR# 2, Batchvin, W1
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.
NFU NE, Section. 8, T29N-RIN, Town, a6 Ba,2dwin.
Name of Plumber. MP/MPRSW No_ Coun~y. Sanitary Permit Number:
EVehett Batdt 4489 St. CnLoix 58876
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
❑YES LINO ❑YES LINO
BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL'. BUILDING: JVENTTO FR ESH
G~ ALARM FROM LINE AIR INLET
❑YES LINO I I ❑Y FEET
ES LINO NEAREST CID
DOSING CHAMBER:
MANUFACTU ER BEDDING: LIQUID CAPACI iY PUMP MODEL PUMP SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
/r PROVIDED PROOVIDED.
IL 01- I~ ❑YES NO C,:7g.os// ( C'L 4LC. YES LINO 26ES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PH OPERTV WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN C FEET FROM a"E AIR INLET
PUMP ON AND OFF) l J J ES LINO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the epth of plowing I J Ncf H DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE _
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO. OF DISTR. PIPE.SPACING VER INSIDE DIA d PITS 11-111111D
BED/TRENCH E \ TRENCHES M TERI DEPTH
11 J
k L PST
DIMENSIONS
GRAVEL DEPTH F ILL DE DIS R PIP DISTR. PIPE DISTR. PIPE MATRIAL. N R NUMBER OF PROPERTY WELL. BUI LDING. VENT TO FRESH
JBELOW PIPES ABOVE COVER ELEV N FT EL. V. Nf PJPEZISI FEET FROM LINE AIR INLET:
/ c ~r NEAREST 10 AD CID gaol /00 /
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-
❑ YES LI meets the criteria for medium sand. TIONS MEASURED.
NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES LINO ❑YES LINO
DEPTH OVER TRENCH.BED DEPTH OVER THEW H:BED DEPTH OF TOPSOIL SODDED SEEDED JMULCHED
CENTER EDGES
❑YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. INO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL a MARKING
ELEV.. ELEV.. DIA. ELEV, PIPES DIA..
ELEVATION AND .
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES LINO ❑YES LINO
COMMENTS: l PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF L OE ERTV WELL BFEET FROM
❑YES LINO ❑YES LINO 1NEAREST------]P-
a_
'v
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE
DILHR SBD 6710 (R. 01/82)
wisconsin APPLICATION FOR SANITARY PERMIT
D I L H R (PLB 67) S-74' CARO ~ V COUNTY
-VEPII TT-EnTOF UNIFORM SANITARY PERMIT #
'.IOUSTq V, LF1.0.6 HumAn RELRTIO 1 L q 7
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER / MAILING ADDRESS
L.L o cr W/ Fi4APWW 1Q ' )0dQL.1W";V G.zJ
PROPERTY LOCATION CITY:
KW 1/4 HE 1/4, S T29 N, R f6 (Or) W OWN O . ~RL~w,N
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME AREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
A A- I'1ri4
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify):
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity 0-00 0^I C, X
Lift Pump Tank/Siphon Chamber O O N X
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
g' 'rid Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for inst Iation of the private sewage system shown on the attached plans.
Name of Plumber (Print), S nature. MP/MPRSW No.: Phone Number:
. e~ e ~o L y/ f o--P,o(Sd'` P P,1- 337
Plumber's Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: D;ew :
}tea y ❑ Disapproved
-s ❑ Owner Given Initial
,jkz~~d a _X G' 7 Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1 . Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
APPLICATION FOR SANITARY PERMIT
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 ei/j'9 ! !
Location of Property IVW '4 NE- Section g , T N - R W
Township HA LC/ C,✓ *PQ
Mai1_ing Address.
Subdivision Name
Lot Number
Previous Owner of Property C&yi de k 5a I A(
Total Size of Parcel qr 6 b A
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes X No
Volume _ and Page Number (O as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
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 the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) eeAti6y that aU statements on this ~oAm a4e tnue to the b"t o6 my (ouA)
knowledge; that 1 (we) am (anLe) the owneA(6) o~ the paopwy descAibed in this
in~oAmati.on 6o", by viAtue ob a wa4 anty deed AeeoAded in the 066iee o6 the
County Registel o{ Deeds as Document No. 3,9& 96- ; and that 1 (we)
pAesentty own the pnoposed site 6oA the sewage disposat (oA 1 (we) have
obtained an e" ement, to Aun with the above d" cA bed pttopetc ty, 6oA the
covvstAuc ion o6 .said .system, and the same has been duty Aeeomded in the 06¢iee
o6 the County Reg-is,teA o6 Deeds, as Document No.
r
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
r
DATE SIGNED DATE SIGNED
H
y
ST C- 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
0
OWNER/BUYER 6L,)l ~ a
e- L 4 .✓q7
ROUTE/BOX NUMBER _
~ R171-• ~ Fire Number
CITY/STATE /c]~4Ldwr►•~ ZIP
PROPERTY LOCATION: N"J A16 ~4, Section_ g T_a_~N, R W,
Town of 1,Vi w St. Croix County,
Subdivision /y fl Lot number NA
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 pum)er. 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 i`ur
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. H
0
E
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- i
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.
S I G N E D i
DATE , 84 _
i
i
St. Croix County Zoning Office
P.O. Box 9$•
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, CC DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707
(H63.09(1) & Chapter 145.045)
LO ATION:)w SECTION: NSHIP/ UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
Nw 1/4 / ? /T-19 N/R/d j(or) W OW r3AC.d /Y4- NA- NA
COUNTY: OWNER'S BUYER'S NAME: / MAILI ADDRESS:
V7• Geo 1* x ► e L A+~ f A 1. C1 w / :V Wt's
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: JCDESCRIPTION: 12C 1
eplace PROFIL DES RIPTIONS]PERCOLATIONTES
gResidence 3 ❑ New 4 _ . l _ b y
= Site suitable for system U= Site unsuitable for system 7 ~I G O 7
RATING: S
Orcks ENTIONAL: MOUND : IN-GROUNcDP(R~ESSURE: SYSTE~+M-IN-FILLHOLDING TA fN'K: RECO/MfMENDED SYSTEM: (optional)
o ❑J Nu ❑J IL u ❑J ®u EIS ®V lie4J'V/G4y4-1&4A(..
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
F,t PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH 1, ELEVATION OBSERVED ES . HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
1
B- //7.7P y 7'
B- 117.7V' y 7 ..2SaLS;L /.o okae /.o'R.g t J/.zs' e. s:
B-3 (o.o~ 1/b•3~ 77/ .1'41...5;(- 0 "/4►es,*4 3.,~6eC9 .Z.~?,,e-9 .
B-
B-
B-
FT'. PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER M"1111Rl6 AFTERSWELLING INTERVAL-MIN. P RIOD 1 PERIOD2 PERIOD 3 PER INCH
P_ i 3.53 c i o
P- o o Z. '12- ' o
P_ .oi o o / O
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 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 V 4 - 9 4 5 4'
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1, 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 WERE COMPLETED ON:
t✓e ►e e,4-4- V o l d 4- 9- 8 y
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
f~ a L w c,J ~'S 7i r- 6 el- 3 3.7
T SIG URE: D
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DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
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C.5?- 00CS ,rr 9-~-gy
` Bulletin CL2.1A
July 8, 1983
• For Homes
• Farms GOULD
• Trailer courts Model 3885
• Motels (Supersedes Model 3870)
• Schools • ~ .,~F a._...~.M..~.M y , .
Submersible
• Hospitals Effluent PUMP Effluent Pumps
- - -
• Industry
• Effluent Systems Pump Specificl'~Itions
anywhere effluent Solids Handling Capability to
or drainage must be fMar p Discharge Size
disposed of quickly, -"w I NaT.
Semi-Open
and efficiently. Impeller
quietly 3 vane design, threads c it f I ;r=: I,.
units use impeller locK.)~~ :vent
back-off. Pump out var) on 1,,,j( k,J(le
for protect.on of mecrtar'!c ,i ,-al
Casing
Volute type f~:r inaxirnw,. , ftl:a~ n ;y.
Stainless
Heavy-Duty Solids Handling Steel Fasteners
:;pries 300 stainless t s= , t r,n!ros,i;;n
Dependable Capability to 3/4" f t ist7ln Ce
Mechanical Seal
Ceramic vs_ Carbon ,Cali f r st iinr
Spnnq and Buna N
Maximum Tehiperaiure
1/3, 1/2H.P. 60 Hz 160'`
Capable of Running Dry
Single Phase 115, 230 Volt. without damage I) cor il,U i-
Motor Specifications
1/2, 3/4, 1, 1'/z H.P. 60 Hz Motor Fully Submerged
in high grade turbine oil for + rrranei t it
Single Phase 230 Volt. Three tion of bearings and mech seal arc,,
Phase 208-230, 460 Volt. efficient heat dissipation- ;lc'(', r ealed f,
environment by rugged rant iron -:n
hearings
- Heavy-duty all ball bearing co:istruchorr
Stainless Steel Shaft
Series 300 stainless steel G,r ;rr~)sior'.
resistance. Threaded shaft
Single Phase Units
90 All single phase Units h rtht r -11
overload protection with ~:;.trn .uc reset
80 Three Phase Units
v Overload protection in starter unit 2( tt 77
460 volts Threaded shah 60 H c perati ,
70
u~i ~7 Power Cord
t, ;aa Water and oil resistant ~cr y peal on r
60
acts as a secondary m 'JtUit lal per In
J;1 1
damaga to outer jac En c _>;o
= 50 gland nut
U n
,F Single Phase Units
r,
40 H P models eq f
- SJTO with 3-prong q , . nt
wM
L r~
11
models equipped with , ? Sf C)
„.4.
- C-~ cold
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SPECIFICATIONS ARE SUBJECT TO CHANGE
10 WITHOUT NOTICE,
fE
0
0 10 20 30 40 50 60 70 80 90 100 110 120 rn GOU LDS PUMPS, INC.
GALLONS PER MINUTE u SENECA FALLS NEW YORK 1314e
PAGE OF
; " PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
_-VEUT CAP
`"C.i. VENT PIPE
WEATHER PROOF APPROVED LOCKING
25' FRCM DOUR, JUAICTIOAJ BOX MAWHOLE COVER
WINDOW OR F'RE'SH 12"M W.
AIR INTAKE I
I
GRADE I
i I 4„ MIU.
k ~ I8"MIAI.
CONDUIT--
w 8
INLET PROVIDE:
AIRTIGHT SEAL, I i i I ` / ~pr✓
APPRO`JE.T) JOIN A APPROVED JOINTS
77
kJ~C.I. PIPE I I
EXTENDING 3' W/C.I. PIPE
I I I EXTEND 3'
ONTO SOLIDr,11_ ALARM
i' ONTO SOLID SOIL.
ON
C ~ I
OFF
IBLOCK
COAICRETRISER EXIT PERMITTED 0 JL 9 IF TAUK MANUFACTURV.1t HAS SUCH APPROVAL
SPEC•IFIGATIUKIS
^ TAAIKS MAAIUFACTUP F-R: d~Aj Ca es NUMBER OF DOSES:
TAAK IZE : /000 PER DAy
1 GALLOMS DOSE VOLUME: • S GALLOAIS
LARM MAIJUFACTIJREq; L_+4 R1 m CAPACITIES: A 0.2 ~ INCHES OR c~Q ~GALL0 JS
MOUEL IJUtAbF-K oZ O Oo 6.00 INCHES OR GALL OM5
SWITCH TJPIE: these c- 0 re', C= X. 77,
?
PUMP MANUFACT Ua1 R: emu JC• INCHES OR GALLOWS
9.Ob INCHES OR 476tGAL:.UIJS
MODEL NUMBER: 1~1 F t5 /7 OT-: PUMPTAMD ALARM ARE TO BE
SWITCH T9PE:. t,.a[iGu~C _ IMSTALLED ON SEPARATE CIRCUITS
PUMP DISCHARGE RATE. SCj GPM 19. (o czA/. ~PR
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE., EET
+ MIUIMUM NETWORK SUPPLY PRESSURE . , , , " , , , , ,FEET
+ - FEET OF FORCE MAIN X F/ ooTr.FRICTI0M FACTOR.. L FEET
I
TOTAL_ DYNAMIC HEAD = ~~,Ye FEET
INTERNAL 01 tiSIONS OF TAA]K: L Id,l }I ;Ia I .,_T,,,_,,, LIQUID DEPTH
SIGNED: ao-e~ - L_ICEA]SE MUMBER: MOO 14CA92 DATE:,/49-9- 'c
• PAGE OF
r
L/oyc~
a Ld w~'w 7`,~s p.
CROSS SECTION OF A BED SYSTEM
SOIL FILL 21" OF AGGREGATE
DISTFZIBUTIOA! PIPE-?
APPROVED SUKITHETIC COVER
o.
° MATERIAL OR 9" OF STRAW
OR MARSH HAy
/el. 2 0 F%2 AGGREGATE og
ELEV. O F FEET, DISTRIBUTIOM PIPE TO BE AT LEAST INCHES BELOW ORIGINAL GRADE
AAJD AT LEASTaO IKICHES BUT KJO MORE THAhJ H2 INCHES BELOW FIIUAL GRADE
MAXIMUM UV-P-1 11 01= EXCAVATIOAI FROM ORIGIAIAL GRADE WILL BE ~ IUCHES
MINIMUM DEPTH OF EXCAVATIOKJ FROM ORIGIKJAL GRADE WILL BE
-Z INCHES
SIGLIED:
LICENSE AJUM5ER: ~y1 - l '~z J
DAT E : 9
' / 0 y
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47
Parcel 002-1016-20-001 09/08/2006 05:04
PAGE 1 OF 1
F 1
Alt. Parcel 08.29.16.105B 002 - TOWN OF BALDWIN
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 - MARKLOWITZ, KIMBERLY L
KIMBERLY L MARKLOWITZ
2266 107TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 2266 107TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 4.680 Plat: N/A-NOT AVAILABLE
SEC 8 T29N R16W NW NE 4.68A LOT 1 CSM Block/Condo Bldg:
5/1462 (ADD'L HIST 698/120)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1117/357 WD
07/23/1997 1115/113 QC
07/23/1997 1071/181 QC
07/23/1997 1062/260 PR
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/02/1999
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.680 12,100 57,200 69,300 NO
Totals for 2006:
General Property 4.680 12,100 57,200 69,300
Woodland 0.000 0 0
Totals for 2005:
General Property 4.680 12,100 57,200 69,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 510
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
I 1
FORM NO, 9855-~-A j
nC M.ii.l-+nY+.rY~ / V
/i
Stock No. 26273
CERTIFIED SURVEY MAP NO.
VOLUME - , PAGE ) 4 a-
LOCATED 1N THE NORTHWEST QUARTER OF THE NORTHEAST
QUARTER OF SECTION 8, TOWNSHIP 29 NORTH,RANGEI6WEST,
TOWN OFBALDWIN, ST CROIX COUNTY, WISCONSIN.
NORTH QUARTER CORNER
SECTION 8, T 29 N., R. I6W.
LEGEND
Q~ SET 2"x 30"IRON PIPE WEIGHING 3.65
LBS./L.F. WITH BERNTSEN ALUMINUM
CAP IN CONCRETE.
I
I / 0 SET 314 "x 24"REBAR WEIGHING
1.502 LBS✓L. F.
SCALE.- l " = 200 `
10 2 0 4 0
cn
0
CN
o BEARINGS REFERENCED 7"0 THE WEST
N I LINE OF rHE NORTHEAST 4X4H7_ER OF PREPARED-FOR: NORMA BERKSETH, OWNER
SECTION 8, ASSUMED AS S03°26'J2"E
N. I
n1 I PREPARED BY: CEDAR CORPORATION
w 604 WILSON AVENUE
N WEST LINE OF THE NORTHWEST M~NOMCwI~, wI
00
QUARTER OF THENORTHWEST OF
r: t r7C?N x.
I /
I
N
01
_UNPI_ A T TED-' LANDS
I
C
(3 z
S89°52X56"EE 845.84' I
I I~ Isr.2a' I~
I~ E4C PO EASEMENT] o
01
r.nj❑O 4, N OD w) OUT- pp Op
T N SEBUILDINGS
S O
co
N89°52r56"W 84 .84 '
Z~l ~---199.68'R/W
270.00--~07TN AVE. NB9°5256 W 845.84T GEN7ERLlNE~- `
RIW
I ~ 1 \v1
UNPLATTED -LANDS
co - -
o SOUTH LINE OF THENORTHWES
QUARTER OF THE NORTHWEST NO
QUARTER OF SECTION 8. ,
rr00692aawe~r
CENTER OF SECTION 8 ~•s 5 0 ry
T. 29 N.,R.16 W.
, 0
LEON R, •
HERRICK
"
r
S-1303
MENOMONIE.
WIS.
SEE REVERSE FOR CERTIFICATION ~•'.~d SURVt.
q