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HomeMy WebLinkAbout038-1014-90-000 o E: j -d o ~ o ~ 3 ~D• CD m v m Cl) O N o O A O p W c (y~~,1 • 6 (O C,) N j W Fr C O V p- Z n N OW -D O .7 ~^1l O ? CD (D 0 N 1 0 0 0 O O O 0 0 O ' O ^ (D f~j N C) 7 f/1 O 7 O ~ S 03 C/) > 0 O p N A a s a (n W ~3 (D 3 CL N O OO L (O m 2 O W CD j ' (D CD (0 QD (D U) 00 00 :E w c O Z 0 0 0 3 M O 0 N C/) (n cn Q o D ° p v v O ? ID co N C,J 7 i D C CD - O 7 ~ ~ v m 3 m N D (D 3 Q 3 Z O C_ Z =3 D o v O 7 0 p_ :3 N ZJ ~ (D p c 3 W (D O 3 CD Z CD n i fn O C A Z (D y _ n 6 A Z O o~ CD N p Cl) -1 W W -0 CL 7 0 A ;D 0 CC/) N CD O 'O A W ~ O (D N DQ p 6- C O ^ O < 0 O n T O 3 z p -o o (D CD a ~ O ~ n o a 0 a ti 0 0 a a o b !v p ~aQ A Q o y yO O O y O C- ti Form - S 'T' C - 104 AS BUILT SANITARY SYS'T'EM REPORT OWNER TOWNSHIP S. tk,- % c:...; SEC. :3 T N-R / _W ADDRESS ; ST. CROIX COUNTY, WISCONSIN SUBDIVISION 4 LOT LOT SIZE c / c.~r2ts PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'c_ k%'., T~J h ~ .k z d A i_) e Ai 1,(✓~' / t • u i i INDICATE NORTH ARROW BENCHMARK: Describe the ver`Cical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: }Z ! Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearf~st Road: Front, 0Side,9Rear, (D0U'2'- /00' feet from nearest property lipe Front, GSide, 0Rear, ox fe"t dJU¢.~ Number of feet from: well building: (Include this information of the above plot plan)( 2 reference diiijensions to septic tank) PUMP CHAMBER Manufacturer: C.J~ Pr eri Liquid Capacity: Pump Model: _ Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: i',~I 2.1C Alarm Manufacturer: S;-" I_ t Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft Number of feet from well: Ova; Sy` Number of feet from building: e-,_ -;V Include distances on plot plan) SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length:' Number of Lines: Ll Area Built: 0 Fill depth to top of pipe: 1' Number of feet from nearest property line: Front, Side, O Rear, _ O Ft Number of feet from well: G eer /vo` Number of feet from building: (Include distances on plot plan). SEEPAGE PIT rv JX 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 TANKI Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: @ Number of feet from building: Number of feet from-nearest road: Alarm Panufacturer: Inspector: DatedPlumber on job: License Number: 111 1( y'e 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION MADISOBOXN, WI 7969 53707 BUREAU OF PLUMBING MA ❑CONVENTIONAL WALTERNATIVE state Plan D Number. of as~~gne<,I ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound X403434 NAME OF PERMIT HOLDER: ]ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Robed Noak R. R. 2, Box 99, New Richmond, W1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. SW SW, Section 3, T31N-R18W, Town of SpAing6ietd Name of Plumber. MP/MPRSW No.. Conroy Sanitary Permit Number_ Michaet pitzon G388 S Cnv~ x 54903 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER P OV DED. PROVIDED. 1 ak.` C: YES LINO DYES NO BEDDING: /VENTDIA.. VENT MATL. HIGH WATER NUMBER ROAD: JP Y' ROPERT WELL: BUILDING. VE TTO FRESH ALARM / LINE. LAIR L T FEET FR DYES ID ' ❑Y O NI DOSING C AMBER: MANUFACTURER JBIDDING. D CAPACITY PUMP MODEL 1PUMPISIPHON MANUFACTURER JWARNING LABEL LOCKING COVER F- f /~h^ ~ P O ED VI EDleiIt&, DYEYES LINO ES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL IBUILOING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE AIR INLET PUMP ON AND OFF) OYES DNO NEAREST I SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATEHIAL 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: BED/TRENCH WIDTH LENGTH NO OF JDSPACING COVER JINSIDE DIA -PITS ILIOUID TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH J I FILL DEPTH UISTH PIPF DISTR. PIPE It T PI MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BF LOW PIPES ABOVE COVER ELE V.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 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. 9YES LINO SOIL COVER TEXTUREy PERMANENT MARKERS OBSERVATION WELLS YES LINO YES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED :rO1 TOPSOIL SODDED SEEDED MULCHED CENTER EDGES D YES 3 KO YES LINO A / YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS ~1 97 S - ' ~C 45 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELF 77 EL ~i Zj DIA r EL €v.1 ,77 ~ PIPES DIA DISTRIBUTION C~16y1 / / INFORMATION HOLE SIZ HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LI T CORRESPONDS TO APPROVED PLANS ES LINO DYES ILI" COMMENTS: PERMANENT MARKERS OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING FEET FROM LINE: 11 YES ❑ NO L14ES ❑ NO NEAREST /'76 1 An t (c 47- 419 C----, ct''Lc ~ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. - TITLE. DILHR SBD 6710 (R. 01/82) Step 7. DISTRIBUTION SYSTEM X: 11 _ 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = ~y in. f 0 \t`~ 2) Hole spacing 72 in. r sr) Hj ~ 3) Distribution pipe length 2.1 to r- %C 4) Distribution pipe diameter = 1- in. 5) Spacing between distribution pipes 49 in. 6) Distance from sidewall to distribution pipe = 2 Lf in. M. 7B) DISTRIBUTION PIPE DISCHARGE RATE y L;Ne-5 ~e•72 -a, G. R. 1) Number of holes per pipe - 2) Flow per pipe 10~ 7 X = ~_6 GPM 7C) SIZE 14ANIFOLD Manifold is X central/ end 2) Manifold length = 4 ft. 3) Number of distribution lines Manifold diameter in. 7D) SIZE FORCE MAIN - 1) Minimum dosing rate = 4'x 6Q -IS.72 12.72 GPM 2) Force main diameter - 2 in. 3) Friction loss = •76 1.75 = 3 1.33 ft. .760 ~ Pe R 100 • J ~ 7E) TOTAL DYNAMIC HEAD Vertical lift = 1 Q~ ft. 2) Friction loss = 1.33 ft. 3) System head 2.5 ft. 2.5 ft. 4) Total dynamic head 14.51 ft. . 7F) PUMP SELECTION 1) Pump selected will discharge.18.72 GPM at ft. total dynamic head. 2) Pump model and manufacturer Zoe 7G) DOSE VOLUME ' 1) 10 times void volume of distribution lines .1 gal./cycle 21ct 24# 9.041= 34.411 2) Daily wastewater volume 4 doses/24 hrs. gal./cycle 5D qc~.-~'f. 2'' 3) Minimum dose volume'! 2.7= gal./cycle ;ma re ~.?a = G .7gat. ~Ra'rvba,K 7H) DOSE CHAMBER 1) Minimum capacity required = gal, 2 y f :)ClP ~,.i?.a gn~•~jCu"'° t2ic.", " gQ\,, c1R3,~ril ho Id iro .9 1 we,c SFace - ~t.25 un~d~ N a„ De i wee ro oN Sua to a►aFr~~ 7,2 XJ.7. PLArrip 42 A?11a~;` r ~a!iarw Pu~N PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS I Vent Cap Weather Proof T Junction Box Approved Locking Manhole Cover 12" Min ' 4" C.I. Vent Pipe Final Grade 4" *Sin / Conduit , 18" Min 18" Min + 1 Inlet ROIL Approved ' Joint w / Approved Pipe A Joints w/ C.I. Pi Extendin C.I. Pipe ui D Extending 3' Onto I_ ` R I :,I'*Alarm 3' Onto Solid a On $ Solid Ground Ground i C Off Pump Concrete Block D SPECIFICATIONS TANK PUMP Manufacturer W1~ 4~f' Manufacturer: Zbe~IER Tank Material: pR 'A_s"e"-,'. Model Number: Tank Size: `jcSc Gallons Switch Type : 750. q2'~_. 17.8E7 got ljCA;s p(ER 1NCh Total Dynamic Head:_ FT CAPACITIES Pump Discharge Rate: 1Q,72 GPM Total Daily Effluent: 454 Gallons A .?at~~ or 30Q.72 Gallons Number of Doses: Per Day B = or 35.71 Gallons Dose Volume: 4~.Q Gallons C or 4::, Gallons :Votes: 1. See pump curve for D -X5025' or _ 272.32 Gallons additional performance Total Tank information. Capacity Required . Gallons 2. Pump and alarm are to be installed on separate circuits ALARM as per ILHR 16.19 WAC. Manufacturer: SJ" EI2CtR0~ SIGNED: Model Number: LICENSE NUMBER: A,V1,6. Switch Type M P_RC,A,Z DATE: y TDH HEAD CAPACITY CURVE W I D X81+0343'+ N ~ ~ I a rv wl W LL 30-100 ` TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING 95 SERIES 53-55-57-59 97 137.139 163 165 28 M GAL LTRS LTRS LTRS LTRS LTRS 90 EFFLUENT AND DEWATERING 1.52_ 43'; 163 193 394 231 231 3.05 34~ 129 193 300 231 231 26 $5 4 57 19 72 163 242 227 227 v SEWAGE AND DEWATERING 6.10 104 136 223 0 227 \ 7.62 30 216 223 80 \ 9 , 4 206 220 12 \ z , 9 172 206 24- 15.24 125 191 75 18.29 { 57 161 j 114 22 \ 21.3a 24 .38 70 \ 53 M DE \ M DE Lock Valve 19 24.5' 26' 66' 87' 20 163 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE \ SEWAGE AND DEWATERING 18 60 fSER 267 266 262 293 GAL; LTRS LTRS GA Ll'RS LTRS 128', 484 484 1 492 681 360 598 55 89 337 337 -a- I 1 6 50; '.89 189 238 511 50 10 i 38 38 3~ 125 401 ? 288 45 60 1 227 14 421 163 77 292 174 28 106 12 ~40 5 24 _ 12 1 45 MODEL Lock Valve: 21.5 26 35' 53 35- ZVU 10 1 30 i 8 M DEL 25 6 ZO MO EL 14.51 //r- 214 4 Z I MO EL 10 2 tM(OD L ODE 27,28 S. GALS. 0 40 50 611a70$0 90 100 t130 140 15Qrf,: LITERS 80 160 240 320 400. 480 560 640 720 118-72 FLOW PER MINUTE Note: For Head Capacity on Model 112, industrial column-explosion proof pump, see FM 219. 3280 Old Millers Lane Manufacturers of ZZYZZZ)_7 O_ P. Box 16347 Kentucky 778-2731 cky 40216 Qaaurr PUMPS FMCT lff& n cn p g -a n r- m C7 ~/1 v m F m .5 , 4t 0) CD 3 n ~ n o W 3 w m r~ S m w O co o z o o z C', o o W m Z co y °w 'r o ~.y o~- m CD o ~.C, - o n ON 0 Q O O CD (D" 0 0 0 ~ ~ o 0 N 3 o o 7 N O 7 O U) Q M O I y~ C O O( Co N 0 c a m o A A ° 3 Q C) 0 A n> O a lot °ow i ~z :1 W CO CZD 7~ N G N co A y a ;s 7,J A (o W ~ O= o N S (D M ~ N Vl go P n - Q M (D j !V t 1 N O 3 1 W CL cl Ch P. O Z Z O fc~ G` I D D o ° O o N N• On N O C 3 w m O n 3 m (D cn 1 w S. A Z n co Ca ~ Z o o o 00 j (n (o W -v a w Z o 3 r r° o O w co ` w D w Co n (D m D 3 y ^ (D Q Q i c 00 w c 3 z o F (D (D w o_ fi N ~ ~ A W Ln L i a Z N O N O i O A ti C CD 7p b o O O Q O Q ~ V? Parcel 038-1014-90-000 09/13/2005 11:10 AM PAGE 1 OF 1 Alt. Parcel 3.31.18.40 038 - TOWN OF STAR PRAIRIE 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 ROBERT F & ANNETTE NOAK O - NOAK, ROBERT F & ANNETTE 1109 CTY RD H NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1109 CTY RD;F-t' SC 3962 NEW RICHMOND \ ~i V y1, SP 1700 WITC Legal Description: Acres: 62.000 Plat: N/A-NOT AVAILABLE SEC 3 T31 N R18W SW SW & PT GOV LOT 3 S Block/Condo Bldg: OF HWY Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 26.000 4,200 0 4,200 NO UNDEVELOPED G5 34.000 70,000 0 70,000 NO OTHER G7 2.000 25,000 87,500 112,500 NO Totals for 2005: General Property 62.000 99,200 87,500 186,700 Woodland 0.000 0 0 Totals for 2004: General Property 62.000 99,200 87,500 186,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 223 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Department of Industry, Labor and Human Relations Division of Safety & Buildings ~)DILHR Bureau of Plumbing t.,,,t.,<<x P.O. Box 7969 Madison, WI 53707 Tel. (608) 266-3815 ~1 IN ALL CORRESPONDENCE C REFER TO PLAN IDENTIFICATION NO. -1' NAME OF PROJECT At,~t/ W NL - GENERAL PLUMBING PLANS l Fee R_eceived: LO N Priority Plan Review Only ~g ITY OR T 4N J11 0 Examination of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of wnep required inspections are to be made. -iil t4--e event ii4stal latiei4 Aas Net 6equti withifi twe yeaia5 ~rem this date In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin',Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, For P*ata Sew&Va Systems Only: t This Koval is,`vakd for two ~~'GV i leef* or 4 " ale ~ until th S arg e expwallont dow of V* initW Bureau Dir' PLANS REVIEWED B: f cc: DPS - OWS Owner H & R & Rec. San. Section Plumber Bur. of Health Fac. & Services ount 0 Other DILHR SBD-6099 (R. 05/82) ~N 0-' COU N ty RD H 1111 Ies E.`4o SA AQini rie, D Owner R I Robert Noak ~ 1tt 112 lox 99 3 Bedroom E kew Richmond, 'v)i. 54017 w A Location: Sec 3 CIeaN cout, 11o uS e y W j, S'.J- , T 31. IJ, H 18 W, ~ H0r2. I `Vownship- Jt,~r Prairie Ref. PT. ;A. Croix- County uJeII~ ]'lumber: Mork G' iii_chael E. Wilson 13ti 4 13ox 66 / Amery, Wi. 54001 1',Iich el E. Wilson I.1P6388 ~0 t V11ooded Area 1000 GAL.. W1ESER SEPTIC TANK r-17`50 GAL. WI ESER Pump Chdmber I 4 x-175' 2" Force MOIN T I:. PLUMBING ~oiti0 n. a D C q r ncl 940 At AP VE _ AZ1jJ LABOR A40110MA l DEPARTMENT GF INDUSfR/, KLC~Ia„c.G DIV1510N F SAEr ('AN ~1 , 1~ti1 JiJfV ] 1~~34 - SEE CORRESPONDEN E Hay Field PE.U1V P,[NC: E>U 1=;=.=,1i i 0 0 % Slope Area In Areo of Mound arud 25'ow OII S'~de S 1+0 Acre Parcel Property- L i N e jol c1O t A 11 U'reelIONS Of MOUND P1 a H Vie vv C1 81 Owner: -41 Rob rt Doak ! ktd2 Box 99 1 IJew Richmond, Wi, 04017 9.75 I Location: Sec 3, SWA , :;W ' , `1'31N' It18~,J, ! 't'ownship-Styr Pra.irle St. Croix-County O 25 I 1 T I 6-13-84 2 2 Plumber: ! I Dlichael E. Wiison ! RQ4 Box 66 P1A I Amery, 04001 I 11ichael E. bJil~on I I ! PIP 6 388 ! ! I 1 i I I ! ~ I I I I FIB2 4? ! - - I I ! ! I I ! ! I I , I PJA ! I I " ! I o ' 2S ! >K- Pt pLUM+gl1~G I ~or~i~~on~~ ~ 9.75✓ Ar _ _ DEPA«ir~lEr11 ~~~d1510i! L , t. 1 kale /8 - 0-0kservcl±ion PI P e P1- Pere Test []Q-Bore, Hole PermoNeNt M0 r k e r s All Pipes SCH. Lt0 PVC HECEIwt--D J IJ I'r PLLJnIF)wv" C-. E-',IJRF-i.y11 Page _ Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil F _..._.J i = 3 E D II ~ I D% Slope Bed Of 2'- 2 z Force Main Plowed Aggregate From Pump Layer D j Cross Section Of A Mound System Using E -t A Bed For The Absorption Area F G 1 Signed: H License Number: Date: 1~,-~; Owner: Robert Moak H t,'2 Lox 99 New Richmond, 5~tG1'l Location:Sec 3, SW-, SW-, T311I, `.Township-;;tar tr~ilric; St. Croix County 6-13-84 Plumber: Eiciiael L. -viilson Rt;t4 lox 66 Amery , 6Fa . 54001 ~'lUi~llfili'IC, i-iicnael •;iilson 4~P ~ PiP6388 HLICLIVI-1) ' T lY r., r ~T,+N1 .k ~4Z ~r rr ~r'k ~ { +I~ t l~PW 1MD, f 1; u,i` I~ ' ~dn r ~.a JUN I PLUMNN( int-At ) . r, e L-citerol Loyout I I I I I I I I 6 6 I 1 I I I I I I I I 4 4 I I I I I Owner: I, I , I I Robert I1oak 11t##2 Box 99 6 6 IJew Richmond, Ili. 54017 I I I I Location: Sec 3, I I 21 I SWJ, SW-1, T31I1; R18W, 1 Township-Star Prairie I St, Croix-County I-' SC Fi. L-[O I I I 1 l• I 6-13-84 Plumber: 6 6 I Michael E. Vlilson 1 I Rt##4 Box 66 PVC Manifold I i I Amery, Wi. 54001 I Viichael L. Wilson 1AY6388 C SC H. ~O - - - - - - Lf 2 PVC Force 3 I I Maih 3 1 1 I I I I I I, I I 6' 6 I I I I I I I I I o I e S I Ze I I I I ~ 621 I" PVC S C F1. 6 I I L-0 D ism bu- F~ I I a I ion Pi Pes I I 7 L1'A1 1 { iv ~,rl, I~f (y.~~l_h~/t5k I /6' f,4DL d(L I I I I Scd le = 1 HECEI V LD l d,\. IqH i PLUMBINC. BUHEAlI PUMP CHAMBER CROSS SFCTION AND SPECIFICATIONS h Vent Cap Weather Proof T Junction Box Approved Locking Manhole Cover 12" Min Vent Pipe Final 4" 'tin Grade ' / t 1 Conduit 18" "fin - 18" Min I 1 11 i IIi 1 In1e t I/y U,, _-----111-- 1 1~1 Approved Approved 11 Joint w/ lil A Joints w/ C.I, Pipe i C.I. Pipe Extending PLUMBING III Extending 3' Onto > ~J ~~`Alarm 3' Onto So lid Cl0/1C11 ,CyJ4,r/fv ' I On B So 11d Ground ,frig.,, y Ground AF4 ~it*, F~ Of f D AF1MkNf OF Ih1lJSTGiY. I.AI;I-jrI AL) 1i.itil,-,1 , ~,CtiS DIVISION OF 3AFETY A!;D BtJIL(iit; D Concr to Flock SPECIFICATIONS TANK PUMP Manufacturer Manufacturer: Z Q E Tank ;Material; 0-RFl- E Model Number: Tank Size: '75•Q Gallons Switch Type Y U 750~~' /'7 857 9alIoNS PQ INC~ Total Dynamic Head: FT CAPACITIES Pump Discharge Rate:- 1i GPM II I, Total Daily Effluent: Gallons A or 9 Gallons Number of Doses: Per Day B or Gallons Dose Volume: Gallons C or . -Gallons Notes: 1. See pump curve for D or 10 -7, 1 - - Gallons additional performance Total Tank information. -7 9 1 Capacity Required - y Gallons 2. Pump and alarm are to be installed on separate circuits ALARM C'jas per ILHR 16 , 19 WAC. (1 Manufacturer: ~S Eckccx~ Model Number: LICENSE NUMBER: Switch Type eRCL1RU DATE:_ ~ nER 1.ac +%on'• Poobe6 "r, 51~Yy , St~ul~ 3 i w I P\~%W, Sec 3 r; 7 ~G;jq RAO 00)L99 ZOWr~Sh~p y 5` F Q, PR A ~ R► E , NE11Jf~dgWO)d, W '6401-1 5j,ecv IVCou^-~ PLUMBING URF':AL! FM 269 r• Qu~~/rr PutiPS SNCF /9.~9 Zj2rZZEf'' L./ L 0379 O ` 3280 OLD MILLERS LANE • LOUISVILLE. KY -102W (502) 7722584 40 HEAD CAPACITY CURVE TOTAL DYNAMIC HEAD FEET - CAPACITY GPM SUBMERSIBLE PUMPS Model 34 94 147 147-3 X47=4 36 96 149 149-3 149-4 35 - 54 MODELS 56 147-4 5' 46 88 103 149-4 71A' 38 82 99 10' 27 75 91 30 - 1216' 18 66 80 15 8 54 68 \ 17 5' 41 54 H 20' 24 39 52 w 25' 37 LL 25 30' 13 31 p MODELS 35' _ 6 Q 147-3 Zero Cap. 149-3 At 16.6' 22.2' 23.0' 32.0' 36.0' = Caution: 147-3 Use Impeller 141-010 U 149-3 Use Impeller 143-010 20 - Do Not Use Below 20 ft. Head Q 147-4 Use Impeller 147-010 z Iq ; Pm 149-4 Use Impeller 149-010 Q Do Not Use Below 271/2 ft. Head a 15 Ir- MODELS °~a 197' 147 - - 149 10 MODELS MODELS 34 94 96 S 5 0 GPM 20 30 40 50 60 70 80 90 100 110 TOTAL DYNAMIC HEAD FEET 30 CAPACITY GPM HEAD CAPACITY CURVE Model 703 1 i is ll ioi ion 71 11 112 COLUMN TYPE PUMPS 73 85 250 48 62 68 92 102 MODELS 735' 43 60 65 86 97 112 10' 35 56 61 78-...90 H 107 12W 23 50 57 70 82 w 15' 7 42 53 62 75 W 20 _ 17h' 32 48 52 66 MODEL 20' 17 43 41 56 101 25' 21 13 33 27W 16 w Zero Cap. V 15 At 16.0' 22.5' 27.5' 27.0' 29.0' a - _ .r z MODEL O 79 c J 10 MODELS MODELS r _ 03 111 „4. 71 106 73 1V - 85 HL- 5 V U 1984 0 ` - ALI GPM 20 30 40 50 60 70 80 110 ~ V' 1f1 M 01 ~ J tp M Q M ~ ti Of Of N f~ v O 01 Q1 Lai C9 OD at In W n j J w in N N y O F- OD Z 2 m M P- Q n N- J (/f N N O so M W W OD ix (L cn w W N M F. O 7t 0: - 4r CL in 'a 10 z ti W cr. ~ a N as O co 40 W W 4 O ,Q. W~- v~ O OQ1 GOD Q J W N OD ti O N O N In = O N tp O O J d N P- ~t u _j Q N O to N• O z O a 81- N V P-- O N N J V W 0 M O J QQ Q Q Q MI y W P.: W CL / 0 F- uLA. N N M O N O F- Z O O C O = _ Z W N O !A cr 4 J ~ W f- J _ N a lw AD N U a- a_ Q UJ C) 0 U Q ~ p W Q O 0 W N O O 13 3A M• N a a 0 N 0 t a: S U 3 1 3 M 0 °D t9 O CIV3H OIWVNACI 1V1O1 A Step 4. MOUND LENGTH f I --A) End slope (K) - (D + E1 + F + H x 3 ■ 9.75 ft. - t 75ti. L \ J a S ~3 '~-•7sT5,i 3,Q,)k s,~3- 9,7 s IB) Total mound length (L) B + 2(K) - lD ft. 47 t a C9,-7s~ _ q,5 to 5 Step 5. MOUND WIDTH Al) Upslope correction factor = I, A2) Upslope width (J) = (D + F + G)(3)(factor) ■ a•a 9 ft. (it -7,rt i) 3 (1,o)_ I, S'~ ~ I- 81) Downsl ope correction factor a aSX - b . `a S C B2) Downslope width (I) _ (E + F + G)(3)(factor o~ ft. (It.75't1)96,0)z a,7S' 3 xr,o= Cl) Total mound width (W) for bed ■ J + A + I a LI ft. 8,~Ej- a~e,as a4,5 C2) Total mound width (W) for trenches J + A + (no. trenches -1)(c) + A + I ■ ft. 2 Step 6. BASAL AREA A) Infiltrative capacity of natural soil gal./ft2/day D) Basal area required - wastewater flow natural soil infiltrative capacity = 3 7.5 sq. ft. r,ai.s~9ar = 3-7-s C1) Basal area available for bed for sloping sites = B x (A + I) ■ N` sq. ft. C2) Basal area available for trench for sloping sites ■ B W~ i J + A sq. ft. T C3) Basal area available for trench or bed for level sites ■ B x W a sq. ft. 4-7 WORKSHEET - MOUND SYSTEM DESIGN PROBLEM: 7~ Design a mound system for a Bee pzoom ho u s e- The site characteristics are: Depth to groundwater or bedrock in. Landslope © % Percolation rate miry./in. Distance fr= dose chamber to distribution system 1717 ft. Elevation difference between pump and distribution system ft. 4 50 gal. Step 1. WASTEWATER LOAD 570 9a I. X 3 bet~ =L)s©~ ~ Step 2. SIZE THE ABSORPTION AREA A) Area required 1,4+S-O 9Ck 3S, sa. ft. 4&,97S' B) Bed or trench length (B) 4 7 ft. C) Bey, or trench width (A) _ D) Trench spacing (C) n Vastewater load .24 gal/ft2/day B a D ~~renches J U N 1 1984 Step 3. MOUND ~ EIGIff PLl1M131NC i "I -~s A) Fill depth (D) z it. B) Fill depth (E) = D + 1 slope (A) Itox 9) = I v0- 1 , C) Bed or trench,oepth (F) _ f; . x.75 (~tI Ta-9" D) Cap and topsoil depth (G) a "t• E) Cap and topsoil depth (t!) ~L. ft. y Step 7. DISTRIBUTION SYSTEM 1A) SIZE DISTRIBUTION SYSTEM 1) Hole size = I~~ in. s 2) Hole spacing 7 a in. ~O 3) Distribution pipe lengths ice, 4) Distribution pipe diameters in. 5) Spacing between distribution pipes R 8 in. W s 6) Distance from sidewall to distribution pipes c~ in, at 76) DISTRIBUTION PIPE DISCHARGE RATE 11011~3 ± L ~n,c5 = ' ~,7 Z„ G h In 1) Number of holes per pipe - 2) Flow per pipes 1, 17 X 4 = 4, L ~(06 GPM (0 -4 innanvin~ -Q 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length ft. 3) Number of distribution lines - 4) Manifold diameters in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate - 4 y, GPM 2) Force main diameter n a in. o3) Friction loss;- •7$ Y I ?5' I .3(0 I,3b5ft. peR 7E) TOTAL DYNAMIC HEAD Vertical lift o tiECE►vt.D 83N ft. E) Friction loss ■ r 1G~iq UPJ 1 t. 3 b5 ft. J n 3) System head 2.5 ft. - - r S ft. PLUIVIE~II~G c~-,1. 1 4) Total dynamic heads ~a 14 ~ ft. w 1F) PUMP SELECTION 1) Pump selected will discharge ~ GPM at ~ ~,Mft. total dynamic head. 2) Pump mode)•and manufacturer - ZDC I I~R54 7G) DOSE VOLUME °r 1 4.10 times void volume of distribution lines gal./cycle %.041'A 10= 3,444Y 10=3,44 2) Dail~y wastewater volume : 4 doses/24 hrs. _ gal./cycle 450: y= Ila, 3) Minimum dose volume aAr,7tlla,s_ II~~! go, .a gal./cycle 175 , 164 = R9,79al, c Rc,n)batk Poace fAa'.N 7H) DOSE CHAMBER 1) Minimum capacity required gal. 5 QI. cycle t a8, 7 d,F~a~ Nback I~f-I,~ ~al,~cycle = ila, 9 340 9a1, h0(d;N9 0- apacIt3= 3bed(~vorns X Ioo~al. 1 N a•~51~..'~ga,~~ ,c~ e4A Space =toll w~ o R P U m p t bc`~weler~ r SuJ~tCR41,~~ ON 5~ ~-,os~ gQi. ~ x 17, g 5? 17,g5.7 air bellow 750 9QIION5 ~Nle~ a i ' er Department of Industry, Labor and Human Relations ~~w~~°^5°^ Division of Safety & Buildings 1~~ DILHR Bureau of Plumbing P.O. Box 7969 ~ OEPRRTTEfT OF onouSTRV, LRBOR 6 Humml RELRTIOnS Madison, WI 53707 -'7 8 Tel. (608) 266-3815 c9 N ALL CORRESPONDENCE f f Giy~F/fj~ REFER TO PLAN r ~FDy'ys ca IDENTIFICATION NO. NAME OF PROJECT PRIVATE SEWAGE ONLY - ~)--I GENERAL PLUMBING PLANS f% Fee Received: LO ATION , Priority Plan Review Only CITY OR TOWN COUNTY Examination of plumbing plans and specifications or this project has been completed. In accord witn Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of wnen required inspections are to be made. approval will UP void and new plan appcovaJ sMall hQ Qhfa~Awd bQ4Qr-o A - begin In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, For Povate Sewage Systems On 1y: Ttft approval is vatid for two Y' `tom t - years or it will be veU d urobl 1"` the expiraiic3n deft of the initial James SargE t, SwAary perm Bureau Dire or ;t- •w--~--N- " LAN REVIEWED BY:,, / DATE:, cc: DPS -~O S,) Owner H & R & Rec. San. Section Plumber Bur. of Health Fac. & Services County- Other DILHR SBD-6099 (R. 05182) S I C - 9 9 INSPECTION REPORT St. Ch.Oix County Zoning OA6-cce Name o n.emcs eb ate San c tcvcy Puem~t Num eh Loca 4-on SCE % e Section 7 T 3 ► N - R 1 W, Township }ZLL ~/l~-L=~ P um en So.c.e Te/S teh ebb 2 LJ L~~ wneh . I SL L~-- cQ tt~ a ~ V 3 TV cS / ! r C / w Ac ci,f{ F c Ir . - 13 YW~ .a Di'5 c"Is e wi th S,ignatuAe Stignatu~e o I"peeto,. S/84:mj WISCONSIN DIPAR IMF N1 OF INDUS IRY, LABOR AND HUMAN RLLAiIONS DIVISION OF SAFETY k BUILDINGS, BURFAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53107 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location SW 1/4, SW 1/4, Sec. 3 T 31 N, R 18 )fXAC" W Town (XXA40M)Gd" lW Star Prair=ie Street Address Lot No. Block Subdivision Landowner's Name: Robert Nonk The application for this site is for: 1.1new construction use. replacement system use. If this is NEW CONSTRUCTION USL, the alternative private sewage system is: ho have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota nu Wrs Issued to you.) I lone of the applications needing a quota number. The quota number assigned to this application is - - - L~_lfor one additional homesite on a farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. _]for an application on file prior to February 1, 1980. H for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USL, the alternative private sewage system is replacing: a failing conventional soil absprption system. [Ad holding tank that was installed and in use prior to February 1, 1980. L] a privy that was installed and in use prior to February I, 1980. If this is a REPLACEMENT SYSTEM USL and the lot meets the criteria for a conventional private Sewage system, check here. l I certify that the above information is true and accurate to the best of ny i knowledge. Thomas C. Nelson _ Nam! ZC Signature o_uIil.y Off ic~ial~ - Title Assistant- Zoniag Administrator haft, June 7, 1984 DILNR-S011-6158 (R 12IM2) S TATIT OF WIS CONS IN-ntPXA t ".,NT OF INDU8mft4 , LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township /H%aQUH,~41~i.Iilt )t SW 't SW~4 IS 3 IT 31 N/R 18 XgkRAW - r , . Street Address: Subdivision: County: Landowners Name: Mailing Address: Robert Noak R. R. 2 New Richmond WI I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted. I agree to have the system installed in conformance with the Bureau's approval of plans and spegifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DTLHTt ST+n- F,i, ? (r? n4 /RT My Commission Expires: ti ST. CROI X COUNTY WI SC0 N S I N 111 ,lu v 1 ZONING OFFICE +WIG~°IPGJ~I~ 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 7, 1.984 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Robert Noak property located in the SA of the SW'-4 of Section 3, 'r31-N-R18W, Town of Star Prairie, St. Croix County, revealed suitable soils at a depth of 33 inches, below which seasonable high ground water. was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator TCN:mj pnconsln~ APPLICATION FOR SANITARY PERMIT 7 DILHR OEPRRT1TIEnT OF COUNTY (PLB 67) UNIFORM SANITARY PERMIT # - InOUSTRV,LRROR6HUTRn RELRTIOnS S AIA4" -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 PROPERTY LOCATION CITY: /q.: ! 1/4, S ~T T N, R t E o VILLAGE: ==k - ~i . ~ 11:77-.1 mil'%r r ~c? , LOT NUMBER BLOCK NUMBER SUBDIVISION NAME T~tD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED ~t;-1 or 2 Family Number of Bedrooms: ❑ 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. ❑ Seepage Bed ❑ Seepage Trench l~ 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ?Q-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): `ZI Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: P PRSW No.: Phone Number: Plumber's Address: f Name of Designer COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved / BBC 4' ❑ Owner Given Initial 4 lV 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, PLS 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. S T C - 105 r 9 ti SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County o i 9 OWNER/BUYER y4eA'4 f Ayxew_a, wA NOAH ~ ROUTE/BOX NUMBER 4 Fire Number CITY/STATE Alta) C- ZIP 'yi0z i PROPERTY LOCATION: 25W ~4. Section T 3I N, R_~ W, -Tmftv~m of T_A (2- Piz ,}-10-4C 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 prier to three year expiration. GG F. 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- 'v 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 St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 115-796-2239 or 715-425-8363 Sign, date and return to above address. s 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 RDT Waal( Location of Property ,60 Section T -3' N - R Township Mailing Address A 1, ~2 &x Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel ,.2 L1~'%CS Date Parcel was Created 0le SC%yif t')•t iJSfe,~a Gh~~C~c.~, C)c .3 1 77 mss, :2 V Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _T No Volumed ;2, and Page Number ? as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFR7y OWNER CERTIFICATION 1 (We) eent~i 6y that "X statements on th.i s bonm cute tAue to the best o6 my (ouA) know edge; that 1 (we) am (ane) the owns (,s) oU the pnope)Lty de~scA bed in this 4116onmat%on 6o,um, b vvttue o6 a waAAanty deed Aeeonded in the 06Aice o6 the County RegisteA o4 Deeds as Document No. ~y3~-:; f-~3 ; and that I ve pne,sentty own the p~i.oposed site 6orc the sewage d pobat system (oA I (we) have obtained an eweme.nt, to aun with the above descAi.bed pnopeAty, 4ot the co"VLuction otj' said system, and the same has been duly Aeeonded in the 066.iee oA the County Rlegisten o6 Deeda, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) - ~ , DATE SIGNED DATE SIGNED