HomeMy WebLinkAbout014-1049-10-000 , onsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
,ety and Buildings Division Count
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353260
Permit Holder's Name: ❑ City []Village ❑ xTown of: State Plan ID No.:
R ichard t Town of Forest
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
olJ Z /` 014 - 1049 -10 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. " NN
Septic L O pp bob Benchmark, z� �� b
Dosing Alt. BM(t -Z ' 0 Z Z
Bldg. Sewer d 9,00 d og, Z
Ho g St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet —
TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet
Air Inilke
Septic y / l 3 1 �g f NA Dt Bottom I �, Z
Dosing > /00r / Z NA Header /Man. ti —
Dist. Pipe
Hold' Bot. System _ 9
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer � b Demand St cover
Model Number Z0 GPM 3 s- Z
8
TDH Lift 2 15' Friction Syste Z /TDH Ft p 3.(p 3. p 00
-t
Forcemain Length Dia. Z Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Len th No. Of Trench s T No. Of Pits Inside Dia Depth
DIMENSIONS — M — E UMOUS
SETBACK
SYSTEM TO P / L BLDG WELL LAKE / STREAM Manuf acturer:
INFORMATION Type O C MB a Num er:
System: hhu ,,j >/00 1 A1 OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold /f Distribution Pipe(s) x Hole Size r x Hole Spacing Vent To Air Intake
Length Dia. Z Length Dia. Z P Spacing I l —
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes [] No ❑ Yes [] No
COMMENTS (Include code discrepancies, persons present, etc.) Inspecti nT : I /a�1 #2: L// 0 4
Location: 2017 County Rid P, E lj, WI� (SW /4 SW�� �r 31N R�15W) 23. 31.15.363 :r/
1.) Alt BM Description
2.) Bldg sewer length = (� a e J -�` °t w
- amount of cover — r, 4 ' 1 p/�v of .: - ( /w W�// a <d c,��•,� a'o� s)
3.) contour = ti3 , (, . z 3'�- qsg C,Otr2.� Y /t� /If ;o 'a-44 eager a
4) tA5 " - � `� � ux�✓o^c —� w� "(4- .6 w 1 a,,,,.� w ; !/ � -�i e � -�o o � cr►o.� � �f so-&
v 4 /gkel a 1 A v
Plan revision required? ❑ Yes No ..�
Use other side for additional informa i n. y od G
SBD -6710 (R.3197) Da I ature Cert No.
ADDITIONAL COMMENTS AND SKETCH •
SANITARY PERMIT NUMBER:
1-4
1 Y
«..,5«.«„N. bey.- .«use.«. � ... � m.. ...�. «...p...«�.e.. a=.«..�.<}....« ...v...« ..„..„ .�
fl
u
I � «
n
i ;
t
—r ...w.—
If P
9
3
� I �
i 9
I
E ff
,_1 Q Safety and Buildings Division
Vi scons i n SANITARY PERMITAPPLIC Q 201 W. Washington Avenue
��' L% P O Box 7302
Department of Commerce In accord with Comm 83.05, Wis. Adm. `' adison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on p pe not less County
than 8 1/2 x 11 inches in size. ; DE C a
• See reverse side for instructions for completing this application , �T bVft$anitary r Number
UNT'I
Personal information you provide may be used for secondary purposes si o previous appiicah �
[Privacy Law, s. 15.04 (1) (m)]. /
Stat . umber qwgEalfo
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFOR MATH OIEf �� a.
Prope Owner Name 4/P j 4 Sw 1/4,5 23 T 3 j , N, R,/j (orb
Property Owner's Mailin Address Lot Number Block Number
IV
City, State TY � Zip Code Phone Number Subdivision Name or CSM Number
FT I
11. TYPE OF BUILDING: (check one) ❑ State Owned o it Nearest Road
p Village
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ore s T
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number
1 ❑ Apartment/ Condo 0 / 7' ` y /O
2 ❑ Assembly Hall 6 ❑ Medical facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station /.Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------ System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21.8 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure / 42 ❑ Pit Privy
13 ❑ Seepage Pit X l y 43 ❑ Vault Privy
14 ❑ System -In -Fill C.,4kX — xt (p_, 0
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
3
3 Feet Feet
Ca acit
VII. TANK in g allons Total # of Site
INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber plastic Aper.
Gallons Tanks Concrete glass App.
New Existing strutted
Tanks Tanks
_ Septic Ta or Holding Tank /OW ET ❑ ❑ ❑ ❑ ❑
Lift Pump an iphon Chamber I OO 660 ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewa e system shown on the attached plans.
Plumber's Name: (Print) J P � ber's Signature: ( o tamps) RS Business Phone Number:
CAE / MP 1 2IJ - C3
Plumber's Address (Street, City, State, Zip C de):
YQ 1K sT AM-eN V i X -Snyao
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved San' ry Permit Fee (includes Groundwater ate Issued Issuing Agent Sig at re (No Stamps)
Surcharge Fee)
pproved F1 Owner Given Initial //
Adverse Determination �� Z-4
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two 2 ears.
Yp Y
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
,Wiscori in- Administrative Code will be applicable.
3. Aii to this permit must be approved by the permit issuing authority.
4.` Changes in oWnership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper WhOn&er
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3151.- - - — - -
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement- Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number.. Plumber must sign'application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; EY'soil test data on a 115 form; and F) all sizing information. -
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
Safety and Buildings
2226 ROSE ST
LA CROSSE WI 54603 -1905
TDD #: (608) 264 -8777
Visconsin www•commerce.state.wi.us
Department of Commerce __.._ Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
October 16, 1999 t ti
CUST ID No.221471 ATTN: POWTS INSPECTOR
LONIN9 OFFICE
DENNIS J GILLE ST C R IX COUNTY SPIA
372 140TH ST C1 y ,; �rhtG' : I,IGI tARMICHAEL RD
AMERY WI 54001 ;IS ON WI 54016
t Ia
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 10/16/2001 Identification Numbers '
Transaction ID No. 251678
Site ID No 182364
SITE: Please refer to both identification numbers,
Site ID: 182364 above, in all correspondence with-the agency,
St. Croix County, Town of Forest
SWIA, SW1 /4, S23, T3 IN, R15W
Facility: Richard Tiberg Proposed Residence
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 495716
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 10/07/1999
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
erard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM
jswim @commerce.state.wi.us WiMAR'1 code:
Safety and Buildings
2226 ROSE ST
LACROSSE WI 54603 -1905
TDD #: (608) 264 -8777
N visconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
October 16, 1999
CUST ID No.221471 ATTN: POWTS INSPECTOR
ZONING OFFICE
DENNIS J GILLE ST CROIX COUNTY SPIA
372 140TH ST 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 10/16/2001 Identification Numbers
Transaction ID No. 251678
Site ID No. 182364
SITE: Please refer to both identification numbers,
Site ID: 182364 above, in all correspondence with the agency.
St. Croix County, Town of Forest
SW1 /4, SWIA, S23, T3 1N, R1 5W
Facility: Richard Tiberg Proposed Residence
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 495716
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 10/07/1999
lY ` FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
Gerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM
jswim @commerce.state.wi.us Wi�MAR ° �n
I
MOUND SYSTEM DESIGN
Residential Application
INDEX AND TITLE SHEET
Project RICHARD TIBERG
Owner RICHARD TIBERG
Address 2044 CO RD P
EMERALD WI 54012
Legal Description SW SW S23 T31 NR 15 W
Township FOREST County CO RD P
Subdivision Name Lot No.
Parcel ID Number 0141049 -10
Plan Transaction Number SO NGS S'(S -EM
PR,�Pt� 5� rip,lly
Index and title sheet Page 0na
itio
Mound calculations Page
Mound drawings P GS
age
Pres. dist calcs. and laterals Page
Q
TDH and pump tank drawing Page 0*
D �NGC.
S CO FtE
Designer DF^IS GILLE License Number 221471
Signature 4 Phone No. 715- 268 -6637
Date 10 -4 -99
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1 Xm)].
SBD- 10462 -E (R.05M) Pagel of
MOUND SYSTEM DESIGN
Complete red boxes as necessary. 1000 gpd maximum design flow.
Inch - pounds Metric
Residential or commercial? R (r or c) (y or n) C_j Replacement system?
Creviced bedrock site? n (y or n)
Slope 3 %
Wastewater flow rate 450 gpd 1703 Lpd
Depth to limiting factor 25 in 63.5 cm
In situ soil infiltration rate 0.5 gpd/ft 20.4 Lpd/m
Contour line elevation 96.0 ft 29.266
Use standard fill depths? X OR Design depth? L -- Jin cm
Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth.
Center or end manifold ®tc or et Hole diameter 0.25 in 0. 125. 0.156. 0.188, 0.219,
Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. 0.25. 0.281. or 0.313 inch only.
Estimated hole space 4.00 ft Not a final calculation.
Number of laterals Pump tank elevation 88 ft Outside bottom of tank.
Forcemain length g Forcemain diameter in 1.5, 2, 3 or 4 inch only.
2.067 in Actual I. D.
HOLE DIAMETER CONVERSIONS
1/8 = 0.125 114 = 0.250
SYSTEM SOLUTIONS Inch-pounds Metric 5/32=0.156 9/32=0.281
Estimated daily flow 450 gpd 1703 ]Lpd 3/16=0.188 5/16=0.313
7/32 = 0.219
Absorption cell
Design load rate & area 1.2 9PdW 375.0 ft 34.84 m
Linear loading rate (LLR) 4.79 gpd/ft 59.4 Lpd/m
Design width (A) 4.00 ft 1.22 m
Cell length (B) 94.0 ft 28.65 m
Depth of cell (F) 10.0 in 25.4 cm
Sand filter
Upslope fill depth (D) 30.5 cm
Downslope fill depth (E) 1 in 34.0 cm
Basal area required (gpd /infiltration rate) 900.0 ft 83.61 m
Supporting components
Topsoil depth 6.0 in 15.2 cm
Subsoil depth at center 12.0 in 30.5 cm
Subsoil depth at cell wall 6.0 in 15.2 cm
End slope toe length (K) 10.18 ft 3.10 m
Up slope toe length (J) 7.80 ft 2.38 m
Down slope toe length 9.70 ft 2.96 m
Total mound length (L) 114.36 ft 34.86 m
Total mound width (W) 21.50 ft 6.55 m
Project: RICHARD TIBERG
Transaction Number. p age 2 of
r
MOUND PLAN VIEW
(typical)
J
1 21.5 ft -
A
A - 4.00
ft 1.22 m
6.551M
B - 94.0 ft 28.65 m
8 J = 7.80 ft 2.38 m
I K I= 9.70 ft 2.96 m
K= 10.18 ft 3.10 m
L—
114.36 ft _!
—
34.86 1 m typ. obs. Pipe
(anchored securely)
I = down slope dimension = absorption cell (AxB)
J = up slope dimension = plowed area (LxW)
K = end slope dimension 6' (152 nun)
T
MOUND CROSS SECTION
subsoil ca D = 12.0 in 30.5 cm
lateral topsoil G H p E = 13.4 in 34.0 cm
invert 1 97.50 Ift F = 70 - 0 in 25.4 cm
elev. 1 29.72 1 m F G = 12.0 in 30.5 cm
D ASTM C33 E H = 18.0 in 45.7 cm
Sand Fill
sYs 97.00 ft
elev. 1 29.57 m F 96.00 ft contour
29.26 m elev. 3 % —, y
slope
D = upslope fill depth plowed layer
E = downslope fill depth Note: Absorption cell media *11 consist
F = absorption cell depth of aggregate and pipe with laterals
G = subsoil + topsoil depth at cell wall centered across AxB media. The cell
H = subsoil + topsoil depth at cell center media is covered with geotextile fabric.
Designer notes:
Project: RICHARD TIBERG
Transaction Number: Page 3 of
I
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch -pounds Metric
Width (A) f 4 ft 1 1.22 Im
Length (B) 94.0 I ft 28.85 m
Lateral specifications
Number laterals 1
Holesnateral 23 holes
Lateral length (P) 91.67 it 27.94 m
Hole diameter 0.2 in 6.35 mm
Lat. dis. rate 26.80 gpm 1.69 Us
Sys. dis. rate 6.8 gpm 1.69 Us
Hole spacing (X) in 127.0 cm
Lateral diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm) " Place X in red
"V one choice 1 114 in (32 mm) box of chosen
from the options 1 112 in (4o mm) diameter.
provided. po mm) X X
5 mm) X
Manifold diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm)
X" one choice 1 114 in (32 mm) None required.
from the options 1 112 in (4o mm) No choice necessary.
provided. 2 in (50 mm)
3 in (75 mm)
4 in (100 mm)
Distribution system contains: 1 Lateral(s)
LATERAL DIAGRAM - END CONNECTION
Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area.
Laterals centered over the A & 8 dimension end dap
P
Last hale dkilled next to end cap Laterals & force main od PVC Sob 40
Hades cluilled on the bottom of the lateral (per COMM Table 84.30 -3)
eJuallg spaced • = permanent and marker
Inch -pounds Metric
Lateral length (P) 91.67 It 27.94 m
Lateral spacing (S) 0.00 It 0.00 m
Hole spacing (X) 50 in 127.0 cm
Manifold length 0 It 0.00 m
Hole diameter 0.250 in 6.4 mm
Lateral diameter 2.00 in 50 Amm mm
Forcemain diameter 2.00 lin 50
Project: RICHARD TIBERC
Transaction Number: Page 4 of
Total Dynamic Head TDH and Pump Tank Drawing
Operational head 2.50 ft 0.76 m
Vertical lift 8.70 ft 1ea 2.65 m Are laterals the highest point in the
Friction loss 1.89 ft�' 0.58 m system? Yes 'x' here. u
Total dynamic head 13.09 99 m If no, what is the highest elevation
Dose Volume downstream of pump? L_.J
Dose is > E26.1 times lateral volume Forcemain drain
Lateral void volume gal 60.6 L back to tank? ( "x" one)
Minimum dose gal 605.7 L x Yes
Drain back gal 98.8 L No
Dose volume al 5 L
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC.
approved manhole cover with
7� weather proof warning label and locking device
b
grade levels Junction ox '—� .���.
disconnect grade levels
alternate
4" vent a electric as per NEC 300 and F--- outlet
Comm 16.28 WAC location 18" (46 cm) min.
watt of pump �— a p p s
chamber or outiet JaM
combination tank
A Provide 1/4" weep hole or anti-
, alarm on siphon device as necessary
pump on B
C Grade levels
pump 88.8 ft - pump tank manhole = 4"(10 cm)
Off elev. 27.1 m J minimum above finished grade
D - vent =12" (30.5 cm) minimum
above finished grade
8870 ft Pump tank elevation
3 " (75 mm) of bedding under tank 26.8 m bottom of tank
Tank manufacturer HUF CU
Pump tank capacity 12 gaUn
Pump tank volume 600 gal
Pump manufacturer Z ELLER Inches Gallons
Pump model number 98 c A 26.5 317.9
A B 2 24.0
Alarm manufacturer ILIEVIL ALARM a C 15.5 186.1
Alarm model number DVL E D 6 72.0
Project: RICHARD TIBERG
Transaction Number. Page 5 of
f �I8 ✓
�o
t
7 Ate
PAP 7s
f�7
3oS'
........
y HEAD CAPACITY CURVE y i
MODEL "88"
I ,
iI
15 v 4 3/
10
0 r -
U.S. to 20 7 30 40 t50 60 70 80
so t60 240 '
O FLOW ►eR MINI ITIF
roTe�a► .,r.�,t,c „e.�nrs�aw.eRMe+u,F ' -- . .____ .
e /FIN/NT ENO of WICTQ1104d
I cArAGN }
"GAD i?NITS(MI - - --
FIET MITIRS GALS l7Rs
S 1.52 72 273 ,
10 305 0' 231 ._
15 4 57 45 170 j 4 .3/16
20 a t0 25 95
oak v abs
WI N
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical altemators, for duplex systems, are available and Variable level Float switches are available for controlling single
supplW with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available with Double piggyback variable level float switches are available
or w0hout alarm switches. for variable level tong cycle controls.
5F LEC1100Gu”
Standard all models - Weight 38 lbs. - I A H. 1 IntWal float cpanted 2 hole mechanioal aie toh, no external control retired.
2. Single plppyback vanaM elevel float switch or double pfppybadt variable navel,
w ioA Control s etecson float twitch. Refer W FN1047'
NOW Ita•ItA I Moos altn x lax 3. Maohaniral eiternetor 10.0072 or 10 -0075,
t 4 t t 4. Sea FM0712, for correct rrtcdel of 61"10081 Alternator• E - Pak,
4 r 5 Control Switch 10.0225 used as a control activator, specify duplex ($) or (4)
on 30 t A to 4.7 1 or 1 6 7 . _ Four 2260 or 4 A
6. Four ( (4) hole J -Pak. 1un�;tur for watertight connection of vW►ed -in
E88 230 1 Non 4.7 2 or 2 3 6 3 or 4 d 5 simplex or dupl o psrat�t:n 10.0002
7 Two (2) hole J•Pak, for wolen,ght connection or space,
CAUTION
Ftxfnfomlaaaronaddaonsl2ailarproduetsrefatocatabponCom motionMoner. FMO5/4;Pi00ybsck All installation of controls, plotectrorn devices and fairing should De d"s by a qualified
Variable LOW Srdkhat, FM0477;ENdrt,?etAlt malor, FMOW ;%KNinir�MAFemalm,IMO49o;Surnpf ticansedateelneten. All etaan�al and sst sty codes thoatdbs followed Nroluding the mar
Sset9e 8611111`14, 04040 ?; and 51021111' Phalle SWOON Pump CondW/Alonn Systeats FM0732, recant Natlonat Electfrc Lad# (NEC) and the Occupational Sofety and Room Act 108NA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL To! P.o. BOX 1834?
l0(AfYH1e, 49 t023tS•M Menu(aGUnai of
8
0 M!' 1p; M 49 Cane Run RAat:+
CousvN/e, KY 40211•f961 ,/�rifrr�tatro(F S,vatr '"
PL L'O I30 ?)
77 F I 0? (1111 JQ?4 PUMP
VIscons.!n. Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau' Integrated Services in accordance With S. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and S C D -
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcel I.D. #
10 ZILI
APPLICANT INFORMATION - Please print all information. Reviewed by I D + /D Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner , Property Location
Govt. Lot S IV 1/4 540/4,S.2 7 T ,N,R UP4 W
Property Owner's M iling Address Lot # Block# Subd. Name or CSM#
_
City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
Fic al' L IV S' o (� /.sr 6,s- .�',� o s 7L -
New Construction Use: [Residential / Number of bedrooms _ Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate _ bed, gpd/ft ,c � � _ trench, gpd/ft
Absorption area required -- bed, ft — 3 - 2 S
rench, ft2� Maximum design loading rate bed, gpd /tL ench, 91
Recommended infiltration surface elevation(s) 9 �� 00 ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material L f1j L 1 41_ Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System In Fill Holding Tank
U = Unsuitable for system ❑ S �R U ®S ❑ U ❑ S ® U [Is ®U I ❑ S F& ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
S , 6
6 r- �S
Ground a-2) St✓ 6 r /►1 v f'.Z'
elev. ,
�3ft.
Depth to
limiting
factor
Remarks:
Boring #
, S S� G S ✓
Ground S�'Re A KS
elev.
• ,� ft• ,
Depth to
limiting
factor
min. Remarks:
CST Name (Please Print) Signature Telephone No.
G A e bov Sm i t Lv 71,5 6� .�S
Address Date CST Number
22 a F Y lv Y / / w oo C 0 3 - /D' y :2 ::? 3
.�R`�1IOWNER /� SOIL DESCRIPTION REPORT
Page. ,�„ of -s—
ARCEL LD.0 %- A0
Boring Horizon Depth Dominant Color Mottles Structure 2
9 in. MunseB Qu. Sz, Cont. Color Texture Gr. Sz Sh Consistence Boundary Roots
Bed .Trench
U1 M Mr
�. S A g O L4 H it S
Ground e L 2 C .4 h
elev.
srA o rs -
Depth to
limiting
ctor - -- -
in.
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots '
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench!
Boring # ;
Ground
elev.
— ft-
Depth to -
limiting
factor
in. Remarks:
Boring #
fFS i
..i
Ground
elev.
ft.
Dep to -
lirrdting
factor
in. Remarks:
SBD -8330 (R. 07196)
i I
Of
P
e . jr
1
I
• I
_
I
i -
o O �" V
Z
'Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page _ / of
Bureau of Integrated Services in accordance with s..A, R 93 Q Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in A must County
include, but not limited to: vertical and horizontal reference point (*-,direction " �� Q
percent slope, scale or dimensions, north arrow, and location and ,4,0ance to nearest road: `." Parcel I.D. #
APPLICANT INFORMATION - Please print all infokn ation. Re dewed by Date
1. Personal information you provide may be used for secondary purposes (Privacy..Law, s 5.b� ft�I" I ).
Property Owner ftoift4,ocatlon
Govt. Lot s ' 1/4 S � /4,S 93 T N,R �� 4W W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
a e o Rol - —
City State Zip Code Phone Number ❑ City ❑ Village LN Town Nearest Road
[� New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft trench, gpd/ftz
Absorption area required bed, ft ft Maximum design loading rate _bed, gpd/ft gPd/ft
Recommended infiltration surface elevation(s) 9 7 DD ft (as referred to site plan benchmark)
Additional design /site considerations y—
Parent material L A e l d L // y L Flood plain elevation, if applicable /Y ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S X U ®S ❑ U ❑ s [RU ❑ S ®U ❑ S ®U ❑ S 29 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
v -la �.� ,S ;2 , 6
6-
Ground C,? SL 6 /1�l vr'.z — — .S
elev.
ft .SJ'i/ j6A /f' S
Depth to
limiting
fitctor
Remarks:
Boring #
o- 7 /o 3 S L .1 Al 7 A S Al ..5 .
S YR YA 57 4 2 M G ✓
3 2,�U S6
Ground /Qv oKS'
�
y ;:,�J ft• ,
Depth to
limiting
factor j
2„jin. Remarks:
CST Name (Please Print) Signature Telephone No.
71, .7X6
Address Date CST Number
w ooh Gr r e -2 /D °9 1 2 2- 2 3
r .
PROPERTY OWNER kCA d f/2 6"f 9
9 SOIL DESCRIPTION REPORT Page .2 o f — ?
PARCEL I.D.# D Zq- 46 Ly 4 XD
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Al s6 ir Mr.r ;2 d
a..
A Z2 A4 M /-`9 C- S yr .s ,
Ground C L C A V ✓ -
elev.
"'ft.
Depth Depth to
limiting
f
in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ff2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
...........................
...........................
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
C3
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
Ay 4 1
_77
A k
ol
-A'
3� v � 1
I L
"
41
�I
II
Peo
i
I _
I
-
i '
I
I
li � --
_f
I
4 � r
� I
I
I
' I
i I
I,
i
' I
� I � I J
i
i
f
I
I
!
I I I 1
TUFt-24 -99 01:33 PM P.01
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer IatlA4;2 9 - 7 _ )a 4o,eo2G
Mailing Address �o`�y C7'y O f1r7sc,
Property Address tab I
(Verification required from lanning Department for new construction)
City /State Parcel Identification Number 6/4/—
LEGAL DESCRIPTION
Property Location �� ' /., Sf�/ ' /., S T31N - lY Town of A_ o T
Subdivision . Lot #
Certified Survey Map # . Volume J . Page #
Warranty Deed # G/ 3 Fr . Volume / y O . page # �� y
Spec house O yes e!� no Lot lines identifiable 2ryes 0 no
SYSTEM HA
Improper use and maintenance of your septic system could result in its premature failure to handle wastes- Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. Wbat you put into the systera
can affect the function of the septic tank as a treatment stage in the waste disposal systern.
The property owner agrees to submit to St. Croix Zoning Department 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 andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the DepartMOAt of Commerce and the Department of Natural "ouroes, State of Wisconsin. Certifeation
stating that yo•ar septic system has been maintained must be completed and retuned to µ 4 Wit• Croix County Zoni^g D!Yicew^.rd..'n ?0
days of the three year expiration date.
...l.. j ./Y /
SIGNATURE OF APPI.IC DATE
OWNER CERTTFICATIQ
I (we) certify that all statements on this form are true to the best of my (oar) ianowledge. I (we) am (arc) the owners) of
the pfoperTy des "b d above, by virtue of a warmnty deed recorded in Register of Deeds Office.
JLLljq
SIGNATURE OF APPLIC DATE
- - -- tiny ""?armarlou that la tnis- rapre- entatl may result in the ■anitory parlor bein& revoked by the Zo ning r7epartmene. eeevee
•' Atelude "'1911 this appllcationa a ataml+cd warranty deed prom the Asaistar of laeeda ofnae
e caps er the oertinea survey map If rerbrenoe 1n , as 1n the warranty aaaa
' 11/'16/99 TUE 1.3:56 FAX 1 715 386 6560 Z1LZ & ESTREEN 0002
STATE BAR OF WI ONSIN FORM 5 - 1998 6 S$4
SPECIAL ADMINISTR TOR'S KATHLEEN H. WALSH
DcenmentNumber DEED REGISTER OF DEEDS
5T. CROIX CO., WI
RECEIVED FOR RECORD
Adminis trator of the estate of Avis waene�l
Kri.Rtina OQiand, as Special Admtnts 11-15 -1999 3:30 PM
a/k /a Avis Swaneopel ( "Decedent "), for a valuable consideration conveys,
without warranty, to Richard_ E. Ti _berg Grantee, the following described real DEED
estate in St. Croix County, State of Wisconsin (hereinafter called the EXEMPT M
CERT COPY FEE:
"Property "): COPY FEE:
TRANSFER FEES 84.00
CORDING FEE: 10.00
POES
Recording Area
erne and ReturriAddreas
Lois A. Murray
304 Locust Str@t
Hudson, WI 54016
parea�1� Number (PLN)
SW 1/4 of SW 1/4 of Section 23, Township 31 North, Mange 15 West, St. Croix County, Wisconsin.
The deed is given in satisfaction of a land contract dated May 4, 1981 and recorded on May 6, 1981 in Vol. 628, page 588
as Document No. 370690.
Special Administrator by this deed does convey to Grantee all of the estate and interest in the Property which the
Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Special
Administrator has since acquired.
Dated this le day of -�-- �•---
* *Kristine Ogland
Special Administrator
*
AUTHENTICATION ACKNOWLEDGMENT
5ignature(s) STATE OF WISCONSIN )
as.
C otxr County )
authenticated this _ day of personally came before me this day of
LM, the above named Kristin
Offjs to' etirilai admintstratur for the Est tt of Avis
Swa eooel a/k /a Avis Swanenoel, to me known to be the
person(s) who executed the foregoing instrument and
4 ackn e thhe TITLE: MEMBER STATE BAR OF WISCONISIN (If not. authorized by § 706.06, Wis. Stets.)
Notary f Wisconsio
THIS INSTRUMM -rr WAS DRAFTED BY My Commission is permanent. (If not, state expiration date:
Lois A. Murray, Zilz, Estreen & Ogland, LLP It —1
304 Locust Street
(Signatures may be authenticated or aoitnwwledged. Both are not i
necsassry.)
-Names of persons signing in any capacity should be typed or printed below their signatures
Pa:RaONAL it1PagaBN7'A71Y1'aD
trrATa BAR or wascoNStN
roa>tn Na s - inns
INFORMATION PROFESSIONALa COMPANY FONO DU LAC, W 900.066-202'