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HomeMy WebLinkAbout036-1038-20-000 O- O c w 0 d L 0 w c m 3 4 to** W rn ° v W °W v, o o m ~'S 3 a r- 9 -A. 4 0.0 z a o 0 N 3 (D W L Ili = V W O CD co N a O N N CD -I N rY 1 0-0 0 = (~D CD O O O rz (D .0. 0 7 VI 00 d C ' I ~ lr C7 Cn CD N C. a S O W (D ~o 7y O N m (n a m (D ~d w m p (D H. ~ CL N ~ rt ri n Z CD o W W 00 OD 0 r- Ci) CO) 0 N• [~rj W W S O 0 ~r 0 =r -0 M -0 3 0 H F' W a n f N N N o' D ~f O C'D Q D y (D p H 0' N CD A A cn CD t7' < N r k. N O A C2i Cl - - a C co d ~ t7 II 00 Z Oo Z D Q 00 H , d O N w 3 CD N C H Z (D m c a O W N L~J c m N F-h I-' W a Z a 3 V] I LT1 Z CD p Z A rt O p v 0 a A Z 0 O (7 z -i o W T m o rn rL CD z m rn o 3 A k-i O m v U) 3 Z CD W a d a O n 3 m c O O G W n D C N I n. CD I ~ I A N 0 ;A N N N O O V A 0 6p p O N p ° CL ti 'Parcel 036-1038-20-000 01/24/2007 03:13 PM PAGE IOF 1 Alt. Parcel M 16.31.17.241 D 036 - TOWN OF STANTON 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 SCOTT T & KONNIE R JERABEK O - JERABEK, SCOTT T & KONNIE R 2148 170TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 2148 170TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 13.080 Plat: N/A-NOT AVAILABLE SEC 16 T31 N R17W NE SE 13.08 A LOT 1 CSM Block/Condo Bldg: 5/1248 WHICH INCLUDES THAT PART OF RR R/W AS DESC IN 648/137 EXC P241C 666/211 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 693/119 16-31N-17W -Y~ Notes: Parcel History: f k j Date Doc # Vol/Page S Type 07/23/1997 693/119 07/23/1997 666/211 2006 SUMMARY Bill M Fair Market Value: Assessed with: 166614 Use Value Assessment Valuations: Last Changed: 06/02/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.080 17,000 143,800 160,800 NO AGRICULTURAL G4 5.000 1,000 0 1,000 NO AGRICULTURAL FOREST G5M 6.000 5,100 0 5,100 NO Totals for 2006: General Property 13.080 23,100 143,800 166,900 Woodland 0.000 0 0 Totals for 2005: General Property 13.080 23,100 143,800 166,900 Woodland 0.000 0 0 I Lottery Credit: Claim Count: 1 Certification Date: Batch M 115 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ~j.,<<ftya~ 1 SEC 4, X _N -R W ADDRESS ST. CROIX COUNTY, WISCONSIN. T SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 ¢3i~1 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM G r I di at N r h rr w BENCHMARK: (Permanent reference Point) Describe: 94ed Elevation of vertical reference point: ( 0 Slope at site: 1 SEPTIC TANK: Manufacturer: Liquid CapacIty Number of rings on cover Tank manhole cover elevati'6n:R77_ Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Ma nufacturer:~~s A~4~.~a, N tuber of gallons Number of gal. pump set for a cycle gallons; Total capacity of distribution lines gallon: size of p mp head; gallon per minute horsepower -brand name of pump and model number Type of warning device _ HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover ; Type of warning device SEEPAGE PIT SIZE; _ Number of pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SEEP AGE BED SI2',E: number of lines_=_ widthlengthtile depth &9 SEEPAGE TRENCH; wid h lepgth PERCOLATION RA']'E.~ AREA REQUIRED AREA AS BUILT INSPECTOR_ DATED PLUMBER ON JOB y„J rt_ LICENSE NUMBER j DROP IN WATER LEVEL-INCHES L PERIO 1 PERIOD2 PFR.YOD3 I ' P- /ej P- S - _P ' P- P- PLAN VIEW: 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 slop. SYSTEM ELEVATION C ~ Sti+tu~y .CSI` - 4Z /W el f~ a~fa/ K ► ' "So I/ / Jt fir 7ZN r . - . - _ _ ""'t (y~ : i = i m...., a N . I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TESTS WERE COMPLETED ON: NAME (print): ✓ i r.± PHONE NUMBER option CERTIFICATION NUMBER: ADD Sj ~ CST SIG T E: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plurr,'L-ing, 3rd page-Property Ov rer, 4th page-Soil Tester. DI LHR-SBD-6395 IN. 03/81) -y DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LA13OR_! HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 CJCONVENTIONAL ❑ALTERNATIVE State Pl-1,D. Number. assigned ) Holding Tank ❑ In-Ground Pressure ❑ Mound (If NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE Jeff : Brown RR it 3. New Richmond, WI - -Y'-3 ,l~/(rfj BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. NE SE, Sec. 16, T31N-R17W, Town of Stanton Name of Plumber: MP/MPRSW No. County Sanitary Permit Number: Calvin Powers 1563 St.Croix 38470 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER.. JP OVJ,DED: PROVI p ✓ J ~'-1YES LINO YESt LINO BEDDING. VENT DIA ' VENT MATL. HIGH WATE UMBE R,OF ROAD: PROPERTY WELL: BUILDING. ALARM LINE... AIR INLE ~1V0 NEAREST Uf` / jVENTT11RESH ❑YES O ❑ Y S FEET FROM J DOSING CHA BER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL. PUMP/SIPH ONJCIANUFACT URE WARNING LABEL JLOCKING COVER PROVIDED PROVIDED: ~ ,ra(5 ❑YES NO oaf ti 1 ES NO ❑Y , j GALLONS PER CYCLE: PUMP AND CONTRO soPERAnoNAL NUMBER OF PROPERTY WELL IBUILDIKG FRESH (DIFFERENCE BETWEEN FEET FROM LINE JVENT- AI NET PUMP ON AND OFF) NYES LINO NEAREST 311- '7 SOIL ABSORPTION SYSTEM. Check the soil moisture at thk depth of plowing LENGTH 1111AMFTER 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. GTyI NO. OF DISTR PIPE SPACING. OV ~R INSIDE DIA -PITS LIOU ID BED/TRENCH A j TREA H C ES > MATERIAL DIMENSIONS PIT DEPTH GRAVEL DEPTH FILL DEPTH D TH P F DISTR. PIPE DISTR. PIPE MATERIAL . NO BE LOW PIPE DI PROPERTY WELL. BUILDING. VENT TO FRESH S~t ABOVECOVER ELEV Ia1LET ELEV END, NUMBER OF f( A1,INLE (>Tf ! " 7 e`/ LFE ET FROM LINE r~l ar^ NEAREST s i MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture 4 the fill material for; PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium and. TIONS MEASURED. ❑YES LINO SOIL COVER TEXTURE PERMANENT ARK IRS OBSERVATION WELLS ❑`YES LINO ❑YES LINO DEPTH OVER TRENCH: BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED SEEDED 1111L CHID CENTER EDGES ' YES N0 EYES ENO YES 1NO PRESSURIZED DISTRIBUTION SYSTEM: LATERAL SPACING AVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH WIDTH ENGTH 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 INFORMATION HOLE SIZE HOLE SPACING DRILLED C RRECTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS: TION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE [:]YES LINO OBSERVA❑YES LINO INEAREST__~ i_ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE - ITLE. 'f DILHR SBD 6710 (R. 01/82) l DEPARTMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & BUILDINGS DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: _F1 - R 'J -3 rUQJ-) Property Location: City, Village or Township: County: fU - '/4 ,0 %S /T-3j N/ R or) W -57'q 745 r,,- c Lot Number: Blk NSubdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: n} N LAO, (if assigned) Aj TYPE F BUILDIN -I--~~1 ~r '4 Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER/(U MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit 3 ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on S it Test Report (If other than present owner): Private ❑ Joint El Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Sign ure: /MPRSW No.: Phone Number: czaluln p 'yam /-ql,. ( 7/S Q 1f4, 59/-3.,5" Plumber's Address: Name of Designer: U3 Alaz E442,~ be AA COUNTY/DEPARTMENT USE ONLY Signatu a of Issuing Agen 0, 7 14, t: (J'~2 ee:0 Q 0 Date: ~ APPROVED Sanitary Permit Number: (Z7 , ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) L ForIli IUI) Owner of Property eF Location of Property 4, Section A! ,'1' 3_ I -N 1Z/-7- - W Township p Mailing; Address Subdivision Name Lot Number n Previous Owner of Property- 4-LC.~1 Ge f C.LS4°-X - 'T'otal Size of Parcel---/3 5 Date Parcel Was Created Are all corners identifiable? Yes No Include with this a1-L ica_tion one oC t}le__1=01-Lowirl_g: .Certified Survey Map .Deed .Land Contract, or Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) 4ane~ doy -~-pu a t knowledge; that I (we) am (are) the owner(s) of the property described in this dee bt Men 1' 10o. 3 S.2 R. 6 q 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) Ve ( 6 SS Pq~ P I q3 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 HE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED t DESCRIPTION A strip of land 100 feet in width, *std strip of lard tieing 50 feet in width,.," aeasured at right angles and radia'liy on-each side of the centerline of the. main track (row removed) of the North Wisconsin Railway Company (later the Chicago, St. Paul, Minueapolis,& Omaha Railway Company, now the Chicago and lorth Western Transportation Company), as said main track center line was 4 and originally located and established over and across the 5L1/4 of the NE1/ the NE1f4 of the SE1/4 of Section 16, T31N, R17W, of tho Fourth Principal Meridian, extending Southwesterly, 1476. fe tt along said centerline of the main track from the intersection thaar~edf i'40 he East line of said Section.16. 4I.5O That TThat part of the :iauthe.i'tle<~ ,;g. thk• Norihcatit Quarter, and the .Northeast Quarter of the S`out;'h~4-4t ' urtedf said Scct ion 16, lying between lines parallel with at►d distant `and 260 feet, respectively, North- 4esterly measured at right.angItts aud' radi`.illy, from s.iid original main track ;:enter line, and lying Northovster•l, or a line drawn at right. angles to raid original main track center lino tit a poicit tberijon distant 1,476 feet South- westerly from the intersection thereof idith the- east line of said Section 16. ALSO: That part of the Northeast Quartor bf'the Southeast Quarter of said ;section 16, bounded and described as follows: Commencing at the intersection of said~oTiginal main track center line and the East line of said Section 16; `hence Southerly along said East line of Section 16 a distance of 173 feet 9 inches (173.75 feet) to the point ofbeginning of the tract of land herein described; thence Southwesterly parallel with said original main track center line a,distance of 140 feet; thence Southerly parallel with the East line of said Section 16 a distance of 65 feet, more or less, to a point distant 200 feet Southeasterly, measured at right angles, from said original main%track centerline; thence Southwesterly parallel with said center line a distance of 1,240 feet, more or less, to a point on a line draun at right angles to -original main track center line at a point thereon distant 1,476 feet South westerly from the intersection thereof with the East line of said Section 16, --hence Northwesterly :Tong said last described riglit';mgic Iine a distance 0L50 feet; thence Northeasterly parallel with and distant SO feet Southeast6r.i, measured at right angles and radially, from said original main track center line a distance of 1,445 feet, more or less, to a point Or, the East line of paid Section 16; thence Southerly along said East line of Section 16 a distance of 110 feet, more or less,.to the point of beginning. Subiect to an easement for existing town road right-of-way on the East 331, more or I -'s C x 4~ , r #1, i t F r z3' , nl~~l - c or less, of s.-iid NE1/4 of the 51;1/4. *This parcel contains 13.33 acres, more or less, being 580756 IJlj c Fect, more or less, in- '„iuding town road right-of-way and 13.00 Acres, more or less, being 1.-)ti6298 Square Feet, more or less, excluding town ro,id right-ol'-way. 1 certify that the above description and map are correct wid that i have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes anO Section 5.4.13 of the St. Croix County Zoning Ordinance. Date: July 20, 1982. '~AVNHZ & SUBDIVIDER Wilter J. Gregory S- 224 Jo No. 82-137 DWEI J. CASEY 6 MIC M-1 J. (ASHY Ogden lingineering Co. R.R. M3 322 S. MONI'MlA AVE. 123, E. film Street NEW RIOMM, W1. 54017 N1,W 1tla")) Rives- FarlIs, W isconsin. 5,1022 Wi. S40 i 7 (IMWE MIA ABJJ CURVE RADIUS ARC CH)RD U#c U NIf ,1i. '!'AN JNi' NLT H LIIy `II lENGTli i3FW_# W AANGLE~ 1st B ' IN nd 1-3 2110.08' 844.10' 838.49' S6003<'..£'. 2l°55'13" S49°06110"W S72-01 12311W 1-2 2110.08' 440.40' 445.57' S5f►`"f . ; ri 12°O7' 17" S49°O6' 101W S61°13' 271V 2-3 1.10.091 397.70' *7,. 1) 110°d" 5h°' 961013'271V S72°01' 2" 4-6 1710.08' 684.09' 679.54' N60033.'21~ .5'1 22°S5' 13" N72°O1' 23"E N49006' 10' E 4-5 1710.08' 322.31' N60037'251`1. 10°47'56" N72°01'23"E N61°13'27"E 14 NS5009148. 5111: 12°0 71] N61 ° 13' 27"E N49°06' 2011E I t1~ c fry, "o f V) i m z y I -i m ! to z -n ~ a Cis yg ~ y C/ej 90.814, (J-) ti.. _';>3. s ,,2 s 5 D j A cr/pM RN£~ 2p0.n,, z i.. 76, R3'F ` ;$0004,4 R~qo 70 9.08 Qrafted by Walter J. Gregory. X15 \ ~ ` DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,. cc DIVISION BOX HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON W 53707 LOCATION: SECTION: TOWNSHIP/M"eNIGIPAtITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: COUNTY: OWNER'S BUYER'S NAME: IMAILI G ADDRESS: USE r" DATES OBSERVATIONS MA E ce INa BEDRM RCIAL DES RIPTION: I 15ROFILE TONS: PERCOLATION TESTS: Residen jWNew OReplace 42 ~ RATING: S= Site suitable for system U= Site unsuitable for system / ? ' /r i '.fA _ 14i CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTE -IN-FILLHOLDI TANK: REC MEN D SYSTEM: optional) "sou ~sa~. ~s❑u as®u ES u If Percolation Tests are NOT required DESIG =RATE: STEM EL If any portion of the lot is in the under s.H63.09(5)(b), indicate: f 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. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B C3 - C' X11 r, . v, o -3 z ~ c 13- 7 7 ! C PERCOLATION TEQ,"Tc E to: LINDSAY BROS. CO. GOULDS SUMPTHING SEWAGE PUMPS; Model 3882 Performance Rating v 1I Model 3881 Gallons per minute Performance Rating WP1012 WPH1012 WP0511 WP1032 WPH1032 Gallons per minute Series No. lo- WP0512 WP0712 WP1034 WPH1034 HP ► Vx 1 1 W P0511 S Series No. ► WP0512S RPM ► 1750 3450 HP ► V2 5 150 170 180 190 RPM 0, 1725 i` F25 126 154 168 170 v 94 125 152 150 5 144 i m 56 9Q_y 121 128 = 0 10 110 E 3 17 49 81 107 q 15 75 14 40 86 a; o w 20 40 wii 35 10 64 d F°- 25 6 40 43 ~LL F- 26 0 45 24 Flood and pollution control 50 4 2l/x NPTSolids handling Discharge connPection. ty• Sewage transfer De-Watering waste removal 2 NPT Discharge ca c&r6e lity. n Discharge nectioA,.,* i` Sump draining 3 " Optional. Submersible effluent and sewage pumps - Model WP. Lindsay Product Number Model RPM Horsepower Volt Phase Order No. t 662372 WP -1750 x 1 3881 x 230 1 648949 x 1 11 108 651125 '12 208/230 1 WP0512 108 493244 WP 1750 3/+ 208/230 1 WP0712 110 656887 (3882) 1 208/230 1 WP1012 114 03533 1 208/230 WP1 2 50354 1 1 1 46 WP 1034 1 503525 WPH 3450 1 208/230 1 WPH1012 114 (3882) GOULDS Model 3870 Submersible Effluent Pumps SPECIFICATIONS Order No. HP Volts Phase RPM Solids AmPXs Wt. Order No. HP Volts Phase RPM Solids Amps Wt. WPH1012E 1 230 1 3450 V4" 11.0 70 W P0311 E 1 /3 115 1 1750 aYi" 9.4 56 WPH 1032E 1 208/230 3 3450 Y4" 7 70 WPH1034E 1 460 3 3450 V4 3.5 70 WP03 (1h HP) TDH GPM WPH10 (1 HP) TDH GPM Undaty 5 100 10 147 Product Model Total Number Number Description Dynamo 10 85 Total 20 124 593540 WP0311E 13 HP 115V Head 15 62 Dynamic 30 98 550604 WPH1012E 1 HP 230V Feet to Head Water 20 3s Wateo ao 71 *Contact Pump Dept. for 3 Phase Units 25 3 50 45 Availability. 60 18 MEN t'9 r". PUMP C}IAMBER CROSS SECTION AND SPECIFICATIONS Vent Cap Weather Proof Junction Box Approved Locking Manhole Cover 12" Min 4" C.I. ' Vent Pipe Final 4" Min Grade ~i Conduit 18 Min , 18" Min Inlet Approved Approved Joint w/ A Joints W/ C . I . Pipe C . I . Pipe 'I Extending "i Extending 3' Onto Alarm 3' Onto Solid On B Solid Ground Ground C Off Pump Concrete Block D SPECIFICATIONS TANK PUMP Manufacturer Manufacturer: Tank Material: Model Number i 7 Tank Size: Gallons Switch Type Total Dynamic Head: FT CAPACITIES Pump Discharge Rate: GPM Total Daily Effluent: Gallons A - or Gallons Number of Doses: Per Day B = or Gallons Dose Volume: Gallons C or Gallons Notes: 1. See pump curve for D = or 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: SIGNED: _ Model Number: LICENSE NUMBER: Switch Type DATE: • ~i 3 3 I V G 2