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026-1017-30-090
~ I o° o� 1 � I m N o 0 p. ro O N E E 3 I T E o `' oV 3 I co c`''n Ex m M N MO � a c z m m c z p m LL N 2 O C IL G y cm M E y L C C Q U0. 3 n aa) I I N z E z C w z w$ w$ v Cl) IL am am o I o O Z U I c W a) Z O Q C O fn F- r C N Z a a) Z E o I m C 0 = N 01 7 CL N D •� ; N O N O I a m 1 d m O Z m Z w Z m Z w N p p I � z I z m � d c V N � N � I a f�l v y� d � v w � d C: v o o G G a` ° w Q o Z L fn fn (n �I t fA N fA p �3 N > U a s p U rr rr a s 'o 2 3 3 Z 000 z 000 •N �; ! �aaa (Daaa ►i a z Iz 3 r r N O O O y U) J U rn rn rn rn z M� 04 O M O O M E fO E 0 0 0 'O O O O 'O O ca W IL �iy • M p a1 Q} (n c0 1 M O d Q) CO co Cl) O O O N 0 H H C d 0 C I L N C O 3 r D� r �� O o 1 d _c v a ° i s v a ° i O a) Y @ N a) C R N O .. N O N .. � O C j O I o f a c a °' I m n a i c • 0 0 I - 0) 0 z `2 U) 1 J M 0 z c Cf) V � I • a m .2 `m 0.� d a ,N E c ! ° w = m t� t A 0 a. 2 O U� V l 0 U) u R NING DEPARTMENT ST. CROIX COUNTY ZO AS BUILT SANITARY REPORT Owner 1' % �ck.��r r RECEIVED Property Address s vz J 1 U N o ti City /State � o ? ��� ^ do I�. �cS. rvcl , c�� 1 7 1 COUNTY Legal Description: S �WG�, Lot _� Block 6Subdivision/CSM # N f} Wo '/a ' / <, Sec. `�- ,TAN -RAW, Town of PIN # `I - j I ©© SEPTIC TANK -- DOSE CHAMBER — HOLDING TANK INFORMATION Tank manufacturer O L2d� Size ST/PC Setback from: Hous Well � P/L Pump manufacturer - Model ---- Alarm location -- --�� (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width /cP - Length y Number of Trenches Setback from: House Z 9 Well P/L �a , Vent to fresh air intake //D ' ELEVATIONS Description of benchmark 10- 1 t9 A _ Elevation / Description of alternate benchmark I Elevation Building Sewer ST/HT Inlet 1 ,, /9 ST Outlet � �,' 7/ PC Inlet - ---- -- PC Bottom `-` Header/Manifold 7 Top of ST/PC Manhole Cover 3 Distribution Lines () 7 l (} ( ) Bottom of System Final Grade () ( () ( ) Date of installation % Perm' tuber State plan number /� Plumber's si ature License number QQd 53 Date &/ / 4q Inspector . Complete plot plan i NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 6 � 0 3 t b �L INDICATE NORTH ARROW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Coun1iT . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitaj)y4 "!l Personal information you provice may be used for secondary purposes [Privacy iew, s.15.04 (1)(m)j. r�r�; NarL►e. j jjCANb ge ❑ Town of: State Plan ID No.: CST BM Elev.: Ytl Insp. BM Elev.: BM Description: Parce 0 17 0 /04 /00 7- TANK INFORMATION ELEVATION DATA A9900002 TYPE MANUFACTURER CAPACITY A STATION BS HI FS ELEV. Septic - fir 0 C3 79 /a 3 7 /"06 Dosing Aeration Bldg. Sewer Q, ! Holding &/ Ht Inlet / do., TANK SETBACK INFORMATION d Ht Outlet 0 w o 1 1 7y, TANKTO P/L WELL BLDG. Ventto ROAD D / Ot P" se Air Intake P ,8 I 6 6 Septic NA Dtj oktZm Dosin A Header / Man. ,lam Aeration NA Dist. Pipe vSZZ Holding Bot. System �Z d PUMP/ SIPHON INFORMATION Final Grade d ,zZ ,� 00- Manufacturer Demand �P 61, Model Number GPM P2- , z L Lift Friction System TDH Ft ]^� S 0 Z emain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM TRENCH Width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N 2— 1 1 2 DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of I CHAMBER mod Number: System: — �,� Q lV OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length � Dia. Length 30 Dia. Spacing Z 7 ?-1 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 p COMMENTS: (Include code discrepancies, persons present, etc.) q LION: RICHMOND 5.30.18.60B, W,NW 1037 HIGHWAY 64 t�Z�� �����i� SCr b6 (5 f6�a��`;" - bCcr��i� 7d �Q� T CfS/ / 5 `Lav�` Plan revision required? ❑ Yes ❑ No Use other side for additional information. o �(' VK Ii� SBD -6710 (R.3/97) Date nspector's Si ature Cert. No_ ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: I, V isconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. ` • See reverse side for instructions for completing this application State sanitary [ Pe er rm i it . N y m6 e err The information you provide may be used by other government agency programs ❑ Check if revision to p lcus application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Nu ber I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N 449ij(p Property ner me ��lPrroperttyy� S S T 3 L t 14 © , N, R or) W Property Owner's Mailling Addre s Lot Num er Block Number 03 � N City, State tip Code Phone Number Subdivision Name or CSM Number 11. TYPE F BUILDING: (check one) ❑ State Own Ic Neares Road rr -- Public 1 or 2 Famil Dwellin - No. of bedrooms o o l wn OF W YJ 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) - Q 1 wO Q 1 ❑ Apartment/ Condo �(_ `1017 — ' C> � lY r> 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 CA Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. t[New 2 ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ stem ________System ___________ __Tank Only_____ - _________Existing System ________ Exi qg yytem 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 [] Mound 30 [] Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 C] In -Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit 1 43 ❑ Vault Privy 14 ❑ System -In -Fill 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 .) Pro nosed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) �y EI tion �[ 3 :Q / Feet Feet VII. TANK CAparA in g allons Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete strutted Steel glass Plastic App Tanks Tanks e tic Ta k 4 boo ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El El El ❑ El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI tier's Sign ure ( o Stamps) MP /MPRSW No.: Business Phone Number: 'r I �i 3. r 6��pC �p sLY Plumber s Address (Street, City, State, Zi Cocley C ` D� IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee tl"cludesGroundwa:�4 D ate - issued issuing AgentSignature (No Stamps) pp ❑ Owner Given Initial App roved Surcharge Fee) Q e / 149 FGA Adverse Determination �lo0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO-MM (8.11/96) DISTRIBUTION: Original to County. One copy To: Safety S Buildings Division, Owner, Pkrnber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 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 whenever 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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. 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. I 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; E) soil test data on a 115 form; and F) all sizing information. I ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 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. • I Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 Tommy G. Thompson, Governor Viscon sin Philip Edw. Albert, Acting Secretary Department o Commerce September 30, 1998 CUST ID No.220537 ATTN: POWTSINSPECTOR CALVIN W POWERS JR 1969 185TH AVE NEW RICHMOND WI 54017 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 09/30/2000 Ide►tificafion Numbers Transaction ID No. 149146 SITE: Site ID No. 15938 Site ID: 15938 Please refer to both identification numbers, St. Croix County, Town of Richmond above, in:all correspondence with the NW1 /4, NW1 /4, S5, T30N, R18W agency. Facility: Phillip Laventure FOR: Description: Non - pressurized In- ground System Object Type: POWT System Regulated Object ID No.: 427163 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. Slats. • 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(d), Wis. Slats. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section COMM. 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 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. Si rely, DATE RECEIVED 09/23/1998 FEE REQUIRED $ 110.00 Gerard M. Swim FEE RECEIVED $ 110.00 POWTS Plan Reviewer - Integrated Services BALANCE DUE $ 0.00 (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM j swi m @commerce. state. wi. us '!�■■� 1■ME■■! ■� ■ ■■�711orl L� ■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ 1■r�11!!i, •..��'!!� ■fir ■ ■ ■ ■ ■ ■ ■►11J/1�11l�Fi 1■ o . l�!! ski ■ ■■■ ■ ■■ ■! ■d! !�.1i.!l�. i� ® ■�i IMPAW I A f lowerTrosommill Now nowillill IN IN INN - :! ■ ■ ■ ■ ■ ■ ■ ■■ I o Emu INN ■ NEW 'i11 ■ ■tl ■ ■■■■■ ■e■■�■■■■■■■■ 1 ■ ■ ■W�.�!:iY.! :111 ■■!1 ■!■ ■■ ■�'�!!•!! ■ ■■■■■■ 1 ■ ■i'�i' ■i:3� �1� ■��1 ■ ■I'rll4!11 ►10111 ■rliii ■IN , ' .- i■■■■■ 1■ ,1! , RUPP! !!�o! /1I1■ ■1I ■■!!C■,■■■■i1! Ill ■■!® 1■■■■■■■ % ■L'/1 iii ■ ■■ ■ ■ ■ ■�I !■►� ''�� ■ ■ ■ ■■ 1■■ ■� , �■�.�!'�'�'JI ■1 ■ ■■■■■■11 ■ ■►�. MEN III ■■■g- INl•S��lllf � 11 ■!!!ll�lr`� ■ ■ %ir1 ■ ■ ■ ■ ■■ 1 ■! ■ ■ ■ ■ ■ ■ ■ ■�� ■ ■ /I ■ ■ ■ ■ ■ ■ ■■1 ■1! /fwd 1 ■■ 1■ ! ■�� ■G#cJi ■l■■■■r / ■ ■■ ■��■!i111■■ MENEM 1 I CroSS to3 : 5 (oy y flash Alt 1111.11 And Obtstiotlon P(pe u ^� Approrl. Vehl Cap Y ` 3E�NfC�� a i ^ � ' ' 111nUnun� 12' Aaore flnolOrade 20. 42' Above Plpj _ 4 Call Iron TO flnel O(ede Venl Pipe �, etore� Hat Or 51mM1k Cevvtn �i 2 OwerPIP jOrepeU Olebl►allon 0 0 0 --Tea t 6 ' AOYreOale OeneU11 Ptpe ° Perloroled Ply below o Coptin0 Tuminellne AI 00110m 01 hale, 9gr9 � L�CJw� tCPn SOIL FILL DISTRIBUTIO1,1 PIPE ' APPROVED S`E)JjmETIC COVCR' 2 " , F hGGREOA'TE —� -.. — � OR 9 0 0 F STRAW � OR MARS" HA'i ELEV. OF El: } Y� t. " OP��z-2 1 �2 AGGRCGATE ��P•v ka DIS.rRI15UTIOU PIPE TV BC AT LEASY 11JC IiES BCLOw ORIG11.1�1L Ga, of AUU AT LY.AS'1• t0 11JCHC5 BUT 1.10 MORC THAI) ` 2. IIJCHES OELOW FItiJAL GRXbC I i • I MmuM Dami OF FXCAVATICIP FROM OtUGWAL 6RADR WILL BE INCHES nf(IM 05 MI 0f 'ExcAV4 r'A 0 14 NAL GR49f- WILL BC y' VI SIGIJCO:� I i LIGCIJSC UUMBE R: DATE . _._ 021 -- l g i Plb. # 60 1/70 PROJECT DETAIL DATA SHEET NAME OF BUSINESS - P IWy��e� ���PIt�� LEGAL DESCRIPTION 3c) tv I1 ja' w OWNER GL MAILING ADDRESS 1035 H c''4 (OY r t �/V� W�UllYlD `o -lip ARCHITECT, ENGINEER, C ` r ADDRESS j Q(pcj_ = lR'5 PLUMBER OR DESIGNER N•e. K.` Irt w� arty 43�Z P S c�D �' _ ':' ..'; , TELEPHONE NUMBER '71S S13—S 1. Check appropriate building usage(s) and fill in the information,requested opposite each usage listed. Please.consult Section H 62.20. Existing building New "build-ing - Addition ( ) Apartments and condbmaniums . . Number`of: bedrooms ( ) Assembly hdll Seating capacity ( ) Bar . . . . . . . . . . . . Seating capacity # of meals served ( ) Bowling alley . . . . . . . Number of lanes ( ) With bar ( ) Campground and camping resorts . . . Number of sewered sites Number of unsewered sites Total number of sites ( ) Camps . . . . . . . . . . . . . . . ( ) Day use only Number of persons ( ) Day and night Number of persons ( ) Catchbasin . . . . . . . . . . . . . Number ( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons ( ) With kitchen .Number of persons ( ) Dance hall . Number of persons ( ) Dining hall . . . . . . . . . . . . Number of meals served daily Drive -in restaurant . . . . . . . . Inside seating capacity 'a �''` Dog kennels Number of enclosures .., L—_ Pr 3. , Car - service -- Number of car s ges ( ) Dump station . . . . . . . Number of•.�dump ationsr� , ) b ( Employees ( total of all shifts) Number of cmpl� yees ( Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 ;persons pep unit.. ,.. Number of um s'�ith 4 - pe sons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, modic_�l,- staff Number of office personnel .w - 7 Number of patients ( ) Mobile home parks Number of sites ( ) Nursing homes . . . . . . . . . . Number of beds ( ) Parks . . . . . . . . . . . . . . . Number of persons ( ) Toilets ( ) Showers ( ) Restaurant . . . . . . . . . . . . . Seating capacity ( ) Dishwasher and /or disposal ? ( ) 24 -Hour service 1 Retail store . . . . . . . . . . . . Total number of customers Schools . . . . . . . . . . . . . Number of classrooms Meals ( ) Showers ( ) Self service laundry . . . . . . Total number of machines ( ) Service station . . . . . . . . . ..Number of cars served daily ( ) Swimming pool bathhouse . . . . . . Number of persons l OTHER . . . (Specify) . . . . . . . COMPLETE OTHER,SIDE Z. Indicate whether the following facilities are present... Floor drain yes no X Number of drains Food waste grinder yes no - Dishwasher yes , n.o Automatic clothes washer° yes • no ;_`Number of clothes wash6r� t 1 3. Septic tank capacity, Holding capatity4 Septic or E manuf %�Q •e r3 ' 4. SEEPAGE , T'AENCHES: o total.•squere•lfe�t width of trenches -1 ength trenches depth number of trenches P SEEPAGE BEDS: total square feet i . ' 0, width I length of bed O depth h SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit Signature of ers n c etin form: FOR DEPARTMENTAL USE ONLY i 9 � P g Address A" e. k.)5�Zi p 5k4 0 Telephone Number Date I i Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # 0 loi 7 - 3,0 -ace APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Pr Owner _ Property Location V,e Y „ Govt. Lot A] W 1/4 A w,1 /4,S 5 T36 ,N,R / 3(or) W Property Owner's ailing Address Lot # Block# . Name or CSM# 6.3 .6 W /� Yr Subd N 19 7.1K, ? cK r e4.s City State Zip Code Phone Number Nearest Road m Kkinacn` $ -a ( 11r) -20L ❑City Village Town 'New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement Pk1 Public or commercial - Describe: & t. Code derived daily flow gpd Recommended design loading rate 15 bed, gpd/ft2_-14__trench, gpd /ft2 a required bed ft 3g trench, ft, design loading rate LS bed, d/ft , -- trench, gpd /ft Absorption are eq , Maximum g g 9P Recommended infiltration surface elevations) I t!" O ft (as referred to site, plan benchmark) Additional,design/site considerations Parent material +1 (1 Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U M S El [X S ❑ t ❑ S � U El S au [Is A U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 I in. Munsell 11u. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench A l 56 LQ ak. 3 b Ground 3 S-3 /0 r, --- S O M S m r- C S m 7' , d elev ;•� 6Th ft. 3� • p &A S d l+� S Y(1 S T r C S i k •� Depth to S 5 /0 6 l.s �. 5bk m4/ s ,5 ' -,6 limiting ar �$ ( s P) s I� t- 7 ; fac , in. Remarks: Boring # l - /O a S' / by r y - /7 1 ' t '► S Ground yr� " 7, s• `�— 5 O r elev. �p.5 ft. Depth to limiting factor ain. Remarks: CST Name (Please Print) Signature Telephone No. W`�6 Ir 72.5 - A AS Address Date CST Number /969 gS r✓ wF SYof� 9 -31 -9V .5 3 �L SOIL DESCRIPTION REPORT PROPERTY OWNER �U � � — r—, -p � 1�Ir �_u � Page a of PARCEL 1:7 Borin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I f sbk m -w f Ground S /' )Y1 S 0 Yn 5 5 ee . ft: 5• / __� 075 Depth to limiting facto in. Remarks: Boring # 13 li;OA .5pt S 8'af� r s s/ �r sb r 1 - Ground ��� 7,,4' -s Drns elev. Depth to limiting fa r Remarks: Horizon Depth Dominant Color Mottles Structure PD/ - - - - - - 0- in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench Boring # 0 0)- '-'°^ s� k fi ►� Lo M iS �. 5 r S I 1 S- s Ground p - .S Y,, t� , 7 , Depth to limiting factor ;m Remarks: Boring # C3 , Ground elev. ft. , Depth to limiting factor in. Remarks: SBDW -8330 (9.08/95) ar No MEN 0 No M MEMOS Ill Mm Ill ME M no MOM ME Ill Ml mmm No No ME m 0 No Ill ME MEN ME 0 mom 0 MEMO M l E ll EMEM a MEN MEN ON MOM Ill ME Ill ONE mom ON ME 0 m m 1111 hl ONE me mom me f Wisconsin Dapartment of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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 or percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # oa /ar - 30 -60 5) APPLICANT INFORMATION - Please print all information Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Q tp /sj /is Pr Owner Property Location L k v N"' Govt. Lot Pj (j 1/4 /V W 1/4,S 5 T 30 ,N,R 8 3por) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 63 J W 4 / ►'�- ) } 111 A_ Q C, r e-a.s City State Zip Code Phone Number Nearest Road ❑ City ❑ Village Town 11, c✓ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial Describe: & "f - 1 $'i'b r C_ Code derived daily flow a- 3 gpd Recommended design loading rate -- j —bed, gpd/ft gpd/ft Absorption area required _ bed, ft .3g, 3 trench, ft, Maximum design loading rate rs bed, gpd/ft trench, gpd /ft Recommended infiltration surface elevation(s) 96,0 ft (as referred to site plan benchmark) Additional design/site considerations r �� Parent material + I/ Flood plain elevation, if applicable Wit ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system K s ❑ U Rl S❑ U Q, S❑ U I DS VI U ❑ S U ❑ S ;Ku SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench I " o- 0 /s l �r s�K M y U.-) am 5 a. -a 5 -- /s sb M4 t, L Z 01 *X b Ground 32 f k141 S o s in r c S m , 7� ,Z? elev ft. r S CIA 5 ,6 Depth to ; limiting I 15 J0 r C) M 5 1 L M h fa ' n. Remarks: �''� �} `,, bwc e4, 5 , 5 Boring # 5 �fp 17 V I /o !l Ground y '��" 7, f r "��j Q Yn S r' / ' ele C- , Depth to 30 „ limiting factor ��n. Remarks: - CST Name (Please Print) Signature elephone No. Address Date CST Number /969 19S WT5Y01? 537 PROPERTY OWNER f� �) o �R�J�rnu r,�SOIL DESCRIPTION REPORT page oZ of PARCEL I.D.# — 600 Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench WWII o= /D r / s 1 w 3m S b Ground S/ r m S D A 5 I Depth to limiting fac o �in. , Remarks: Boring # i bk m ►- �o r^ 5 G 7�S -- S d � CGS r S aa Ground .S jYl5 s.• r O elev ft. Depth to limiting gyp' M in. Q Remarks: Lac —'``- Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # O `7 D 1` --~• 51 k In LO � vv% 1 5 ' G 5 2 7 V I '7 a Ground r G �-. S Y•- Depth to limiting �q factor ;Min. Remarks: Boring # A Ground elev. ft. , Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) I � J 1 IV ov MAO rT 74 8C i I f I i POIQII al I j mod; �l t --- I I t ' t _ I I I I � I I it I I , j ! ' i I _ V r to + tk L cx � r i I I 1 I I I .ti �� < . � >'� �S �.1 • .�� 1 I � � � I it �� 1 . I • I � I 1 I I i I 1 _ , I I 1 A I I f 1 I : 1 _ I i 1 1 ! _ r � 1 1 I i \ _ I , i tr � � i — 1 ! 1 I - I • • I • I • 1 1 II I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM CL Owner/Buyer v Mailing Address 0 Property Address Q (Verification required from lanning Department for new construction) City /State L I .Q � Q A \V \ o Parcel Identification Number (`) Q(D— 10 — 3 LEGAL DESCRIPTION Property Location /V w '/4, N u2 '/4, Sec. � , T AN -R _W, Town of 4 Q % Ck w,0rA, Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 30) Q_ �0 , Volume 3 , Page # Spec house ❑ yes X no Lot lines identifiable �] yes ❑ no SYSTEM MAINTENANCE 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. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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 and/or (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 Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. q ,4--, �' L c'L /jU l ! SIG14ATUVE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. A �L , L4, C ) lw l 11S SIGNATL OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed A DOCUMENT NO. WARRANTY DEED STATE OF WISCONSIN —FORM 9 301 261 TMS SPACE AFSIRVED FOR nWIMING DATA REGISTERS OFFICE Ernest 0. Germain and THIS INDENTLJRT, Made y Laura German, husband an wz e, 9T. CROIX CO.. W IS. Recd for Record this - -1311 grantor s of St . Croix County, W i nsin, hereby n s and warrants day of sL?�Y------ A.D.19 - to Philip M.LaVenture and gratricia` af�''ent at ------ 83 ___ki M. Husband and wife as joint tenants, z . R too &es grantee 8 RETORN TO of St. C ro iX County, Wisconsi , for the sum of Five Thousand Three Hundred Twenty($5,320.00 Dollars the following tract of land in St. Croix County, State of Wisconsin; All that part of the Northwest Quarter (NWT) of Section Five (5), Township'Thirty (30) North, of Range Eighteen (18) West, lying _North of the Minneapolis, St. Paul & Sault Ste. Marie Railway Companyright of way, and South ofthe South right of `way line, of State. Trunk Highway 64; excepting therefrom -the following described" premises: Commencing -at the Southeast corner of Northwest . Quarter (NWT) ; ,.,thehc6 North along' the' East dine of, .said Northwest y Quarter,(NWk),1421.5..febt , toLthe.. North line of the right` of, ,way of -the Minneapolis; S Paul & Sault Ste. Marie Railway;=Company• thence Sou h_ 57 0 30' West along said, right. of way 35. 6 feet to the" `,- _ place of beginning of said excepted parcel; thence continuing on said right of"way.-line South 57 West 1422.$ feet to 'an iron pipe "stake; thence North parallel to the East line of said Northwest Quarter.(NWk) to the South line of State Trunk Highway 64; thence Southeasterly on said South ine `of the right of way `oD• State,Trunk'R ': Highway 64. a point,-that is 33 febt West of said East line of the Northwest Quarter (NWk); thence South on a line 33,feet West of and parallel to said East line to the place , _ _.. amended . ._.. (This deed given pursuant to -that certain/land contract between_ said panties, dated th 2nd day of October, 196$)0 FEE v a EXEMPT = nv wrrNESS wt iEREOF, the said grantor s "ha hereunto set their - hand and seat 8- this— h day of July , A. D., 19 70 . , { �., SIGNED AND SEALED IN PRESENCE OF �"'�- a � J (SEAL)' E rnest. 0._Germain... Jose h WA ugh (SEAL) p - Laura Germain K (SEAL) Frances Van Nevel (SEAL) < ._ .. _. • -, i ;s .: �. �• 1.' � I.i 3:�." e, Y..La� � ✓' i.-( .'J1 ,,_ ...a bi s .t ... i, A (This deed given pursuant to that certain/land� contract between said parties, dated th 2nd day of October, 196$). FEE EXEMPT IN WITNESS WIIEREOF, the said grantor s ha hereunto set their hand s and seal s this 10th day of July , A. D., 19 7 k f J AND SEALED IN PRESENCE OF//�t (SEAL) E rnest 0. Germain oseph W. ughes --- (sI.AL) T.a era Ge rmain ,_ (SEAL) Frances Van Nevel (SEAL) STATE OF. WISCONSIN, Sts, C ounty. Personally came 10 !� before me, this day, of July y , A. D., 197 .7 the above named - And - Laura aura Germain s ' h124hand and wife, to me known to be the person who executed the foregoing ins, trunier)� d acknqw1R1W d the same. - SEAL This instrument drafted by } No ublic St. Croix County, Wis. Joseph ili.:Hughes, .Att "' W My Commission (Lxpir�) (Is) Permanent New Richmond Wisco i r.. J (Section 59.51 (1) of the Wiecoodu Statutes provides that sii instrumen names of the grantors, 9MQtees. witnesses and notary). ts to hhh��. r riled shall have piainly plated or typewritten thpseoi WARRANTY DEED — STATE, OF WISCONSIN, FORM iBGJDI( 4 ` 3 PQ'1 E 1 q. C. NILUR Co.. YILWAII __...._ Wisconsln Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page J_ of Division of "Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches Plan must County / include, but not limited to: vertical and horizontal reference poin�(�, direction and percent slope, scale or dimensions, north arrow, and location d�di ant o noes oad. Parcel I.D. # Zj APPLICANT INFORMATION - Please print all informap evie ed by Date Personal information you provide maybe used for secondary purpose4(PriVecy Property Owner 1 F..wQperty Locatzpn Q t^ 2QN1 Vt.St�6 N ,% 1/4 W1 14,S _ T 3 Q ,N,R /6 &Vor) W Property Ow er's Mailing Address Lot # $I Subd. Name or CSM# city Sta a Zip Code Phone Number Nearest Road ❑ City & iIlage Town New strut Use: ❑ Residential / Number of bedrooms Addition to existing building Replacement L4 Public or commercial - Describe: Re to ; 1 S'j o r t Code derived daily flow _,Q_ gpd Recommended design loading rate nA.. bed, gpd/ft N,/'/1 trench, gpd/ft Absorption area required _ bed, ft ft 2 Maximum design loading rate / bed, gpd /ft / trench, gpd/ft Recommended infiltration surface elevation(s) Al /A ft (as referred to site plan benchmark) Additional design/site considerations Parent material i �� __ Flood plain elevation, if applicable A ft �) Tank S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill olding U = Unsuitable for system ❑ S U ❑ S U ❑ S U ❑ S U ❑ S U S❑ U SOIL DESCRIPTION REPORT ti Q IAA. w eo�s�t� Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 LX in. 7 Munsell Qu. Sz. Cont. Color Gr. Sz Bed , Trench l z fs I � t-_ n% i i Ground ..3 .3 7. 5 � , K C el � �xl ft• / .S f .S' / 2 1 5 M O i C Depth to / 4.0 7, s JI , 5/ limiting factor / 3-5—In. Remarks:— Boring # © i� S If /0 1, A, Je rA Ground � l-�- ft• Depth to t-7 limiting factor ; 0 in. Remarks: o� / S QY CST Name (Please P t) Sig tur Telephone No. Address f Date CST Number A e e fc`? II ` � ��v� -At A PROPERTY OWNER ,SOIL DESCRIPTION REPORT p age of PARCEL I.D.# 2 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Ts Bed ; Trench l e -b 7 a/ f sbk r ' S 1n 1 cJ S ' G .z -� �, ,3 �s ff S Ground -3 � Y V S� .5-6/< J CA eft. 7, S 51 /� SdA Depth to limiting factor Remarks: Boring # . Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench Boring # boa Ground elev. ft. Depth to limiting factor In. Remarks: Boring # 13 Ground elev: ft. , Depth to limiting factor (/ In. Remarks: o SBDW -8330 (R. 08/95) ��� m IN mmm a mom No ENE III IN EMENIMMIN No IN IN EMENIMMINNIM I Ell IIII MMOMMMMMME Ill m min MOM MMMMMmmll I MI IN MMMMMm 110M ME MMMMmMMR IN MI IN MIME llmml IN mmmm MW Emmmmim m MMMMMM' I Mal MENNEN moommo IN 100111111110111111 IN IN mom 0 BY 11MINERMEMINEIVIN 1 0 No ONE ONE MIMENIUMMEMININ I IN 0 ONE MINION 11 MENNIMMEMIN 1 0 ME OMEN no IMENEEME I OEM IN MMENNIMME ONSEEMEN I EMILE IN MINIMMEMMIRMISMIN is 0 ME Illmoblammmummoll 0 ENO 0 MENEM m ME ON we ON IN M IN EMIMMEMEMEN 0 IN lomm MEMOS mommimmmommmmosom N IN mom MEMOS m-EMOVIN IN IN NONNI No 0 mommomomm NONE MEMMERMUMMUM MEMORMEMEM 11111110 IN IN 0 0 a IN IN IN u EMMEMEMEMMER Illm a ME MENEMEM If ME MEN moommome � ME M EN on. MMINAMMEM ��ffl WA ----- - - Parcel #: 026- 1017 -30 -090 05/25/2005 03:22 PM PAGE 1 OF 1 Alt. Parcel #: 5.30.18.60B -60 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner " LAVENTURE PROPERTIES LLC LAVENTURE PROPERTIES LLC 1031 HWY 64 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1033 HWY 64 SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 10.116 Plat: 1371 -CSM 15/4189 SEC 5 T30N R18W PRT NW NW BEING CSM Block/Condo Bldg: LOT 02 15/4189 LOT 2 (10.116AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 30N -18W NW NW Notes: Parcel History: Date Doc # Vol /Page Type 01/27/2004 752805 2499/096 WD 01/27/2004 752804 2499/095 WD 11/27/2001 663177 1772/248 LC 10/17/2001 659365 1740/212 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 V Ions: 30/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 10.120 90,000 326,000 416,000 NO Totals for 2005: General Property 10.120 90,000 326,000 416,000 Woodland 0.000 0 0 Totals for 2004: General Property 10.120 90,000 326,000 416,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 F 7FFMB 6s 2002 I KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. WI ST CROIX COUNTY RECEIVED FOR RECaRD 0 _ " 2� 9G �s',2 ' 10 -11 -2001 2:45 PM o Z UNPLATTED _LANDS COPY FEE: N _ _ _ _ RECORDING FEE: 13.00 ( �, OWNED BY OTHERS PAGES: 2 C) 0 " E -- - W z r- sol•ao'5B'�E S01'40'S8 23 286.44 Z Z rn C CD BEARINGS ARE REFERENCED TO Ln v -n � � _ � c) THE NORTH LINE OF THE m m m - i ° O A NW /4 OF SECTION 5, ° O ° z o r °• O z m ASSUMED TO B N89'ST11 "E aw A .. ,-, • (n � cn m o -c cn \z 00 I =NCnv N ° O I�I� NO ;0 N Il w '0 N `J p I �! 11 Z r^ Z D C rrj 3 —• Ln 7 C 2 01) h 1`JI� mZL 0 D O O ° TI D= c H I( � 4 > m V)0> •C y fitly �m;0 _ -< I 1 � � frn r*1 ®U 0 • w 1, Hw : '��b �'�� V �� ��� �» -�w O i z f*1 m 7 - 0 •rl N -1 p r x X 7)M oo M0 m v „°;c� c�� N` C - 4 a N i is z � N _-1 0D z 0 z & __ ct c.. --I :r. n W � Ln S9 � I S9 z Z r� s v O v fTl GI •: a E-- ' O� j� O O y X ; r Z 1--+ 'i /� ° z I ( 4 1 N N C :) M %Q r t�*1 ry ti r ;' 0 z 2 00 c_`7 2I D 'TI D n r � z me N ,? r _� m 0 0 C7 £- p v N N c C Z Z - 1 m z v n .p. r ''� r`3 p f'7 r*I (� �� �' Z° ° o Z < �Zd m o'er �Z �°' ''I �� p z� a -� i o D j\ A -- o m N / m I � u+ 4° – D I 3 _ �� -9 to <I o o N y O D; H z i � -� OD Z -1 -I 1 to Z W r0 %' t5 I N c I ; '+ N r r' ' f T l ,_ y � 1 y 1 d i = o r m (7 1'7 tki -q kt%3 r�Id M / I Z O � Z — 1 IC11 �hr� O n I.A r X £ t 1 �y ��� t) I rn n D T C t• , ( / 1 2 ti z v C 0 0 OC ,�� X 0' v 0 z t l CC ' /�' v�i / ti I i ° ° C-) -I �•� V' I 0 `O z Z .l' 3 - AL N i �= 1" I ti , ` /2 N ('' o0 H G D ZZD • -i* c r �v► - r Z 0 � z 0 , 6: Oi 0 Cp O 207 24�) �o / o w ` a'.Op 78, cn o 0 ti - d� N� 'b'`r a4 � W �� I r 3�nc y C� c Nll •g 4, °,� v O' c z o _ _ 'E r r ,, _ cl �- L/� 0 ���� ` O ADD 14 N00'20'34 "W N Z Z "' N cn y o c N N O D n 315.46 a �A � m i on 1 n c OQ z o Ln u m ° �� C 1 QQ' cn z z w -+ Z m rn ccoo z ° D p �m w ° LANDS m z z C p UNPLATTED ________ OWNED__BY__OT_HE_RS f m -- - y SHEET 1 OF 2 SHEETS i Vol. 15 Page 4189 f Form -STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,1 LL TOWNSHIP SEC. TN -R r W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM � I J . INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference P oint used A/ �,,, Elevation of vertical reference oint: p ��i,G Proposed slope at site: -='-�— SEPTIC TANK: Manufacturer` /. Liquid Capacity: , Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: 9Z'9 Number of feet from nearest Road: Front, @Side 0 Rear, O _yt feet From nearest property line Front, ®Side,O Rear, O y��� feet Number of feet from: well building: � S l (Include this information of Ahe�above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: i Width: Length: 1 Number of Lines _ Area Built Fill depth to top of pipe; r, Number of feet from nearest property line: Fro t, © Side, O Rear, O Ft Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT 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 TANK 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector • A Dated: Plumber on job: , License Number: 3/84:mj 'DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 NW',NW14,S5,T30N — R18W MC ONVENTIONAL El ALTERNATIVE State Plan I.D. Number: Ill assigned) Town of Richmond El Holding Tank ❑ In- Ground Pressure El Mound NAME OF PERMIT HOLDER: DRESS OF PERMIT HOLDER: INSPECTION DATE: AD Phil LaVenture Route 5, New Richmond, WI 54017 B MAR (Permanent reference point) DESCRI E IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: �- Name of Plumber: I 1 ' I MP/MPRSW No.: ounty' Sanitary Permit Number: Calvin Powers, Jr. 1563 r St. Croix 92536 SEPTIC TA /HOLDING TANK: MANUFACTU E LIQUID CAPACITY; TANK INLET ELEV.: TANK OUTLET ELEV; WARNING LAB LOCKING DED: COVER Q RO IDED: PROVI (� /i YES NO E YES O BEDDING: VENT Of VENT MA HIGH WATER NUMBER OF ROAD: ROPER WELL: BUILDING: VENT TO F SH // ALARM` FEET FRO O /� IN 7 : 0 0 � ^ J 5 / J AIR INL ET OYES NO 4 l� ❑Y ❑NO N t � of V DOSING CHAMBER: MANUFACTURER: J BIEDDING, LIQUID CAPACITY: UMP EL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO ❑YES ONO DYES FIND GALLONS PER CYCLE: uM AND ONT LS PERATIONA L: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LI AIR INLET PUMP ON AND OFF) YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil m sture at the epth, f plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, , onstructio shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO. F STR. PIPE SPACING: COVER J INSIDE CIA *PITS I L IQUID BED /TRENCH ' / TRENCHES T / M ERIAL: PIT / �" DEPTH DIMENSIONS gQ 1 GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. D NUMBER OF PROPERTY WELL BUILDING. V NT TO FRESH BELOW PI PES. ABOVE COVER: E EV. INLET ELEV. END. PIP FEET FROM LI E (� AI tj AIR IN ET 1 0 -L 1` NEAREST --s �ob 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. 1:1 YES El NO OIL COVER TEXTURE PERMANENT MARKERS J OBSERV WELLS ❑YES ❑NO F-1 YES E1 NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER. EDGES: - DYES ONO ❑YES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL'. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL &MARKING ELEV.: ELEV: CIA.: ELEV.: PIPES DIA.: ELEVATION AND DISTRIBUTION VERTI INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED ❑YES —]NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES 0 N ❑YES 1:1 NO I NEAREST 2, j I,/ r a � J ' 7y 5 Sketch System on _.,�: \ ' �f f. Retain in county file for audit. Reverse Side. SIG URE. ^ t TITLE- j� ., + I(� c '1' _oning Administrato DILHR SBD 6710 IR. 01/82) =: LHR S ANITARY PERMIT APPLI ATION COUNTY D/ In accord with ILHR 83.05, Wis. Adm. ode ��...� ST AT SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. !0 � � �Q�' —See reverse side for instructions for completing this application. PETITION �j 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES Lbl NO PROP TY WNER � J PR PERTY L CATIO U %a, T , N , R Ig E (or)® PRO ERTY OW ER'S MAILING ADDRESS OT NU ER BL CK UMBER SUBDIVISI NAME CI Y, ST E ZIP CODE I PHONENUMBE CITY NEAREST ROAD, LAK OR LANDMARK ❑ VILLAGE: A T WN OF 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR Public (Spe ify): 111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable 1. a. X New b. ❑ Replacement C. ❑ Replacement of d. ❑ econnection of e. ❑ Repair of an System System Septic Tank Only n Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet mini um requirements. 4. El The System is shared by more than one owner /building. Attach Comm n Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ® Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑ seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. YSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet ®Private ❑Joint ❑Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank _ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oVhlbyripte sewage system shown on the attached plans. Plumber's Name (Print): PI b is ignat re: o St ps) MP /MPRSW No.: Business Phone Number: Plu er's Address Street, Ci State, Zip Code : Name of Designer 7 Vo l. SOIL TE TINFOAMATIO Cert' ' d S it Tester ( )Name CST # CST's RESS (S reef, City, S I" Zip Code) Phone Number: IX. COUNT /DEPARTM NT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuin Agent Signature (No Stamps) ®Approved ❑ Owner Given Initial a S charge Femme,\ C Adverse Determination d • d X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT, APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly , maintained.-The-septic- tan k(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the - State of Wisconsin, Bureau of Plumbing, 608 - 266 - 3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimenta only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material.. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill ii name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/ Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; welts; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------- - - - - -- ---------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more - commonly known as the groundwater protection law. This change in statutes was the result of over2.years of steady negotiation and public debate. The groundwater bill Ground . at8[� -- >* , included the creation of surcharges (fees) for a number of regulated practices which Wisco iK$ ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried area_ Ure ! is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03186) IZI .S,�,�,c �4 O 5--5 -ic • z pep j O .f[ r - E�my s 1 _ STATE OF WISCONSIN DILHR DILHR PRIMATE SEWAGE SYSTEMS DIVISI UOF PLUMBNGBUILDINGS 201 E. Washington Avenue, Rm 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 608. 266.3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266 -3358. 1. PROJECT INFORMATION Type or print clearly) Revision To Plan Number: Name of Submitting Party (Pla turned to same) Proje Name CA gW L4 Street & No. or Rural Route Project Location - Street & No. or Legal Description OR -3 B D A 9 R S City or Village State Zip City ❑ County D ( Village r ❑ OF- + Sf 1Lt.l' A lGIB 1� O cA WLs r- Jf G j Town Ipl 1� 1G/1 YYLOflC I Telephone No. (Include area code) 7i5 - Z V G - s1 Designer Telephone No. (Include area code) Owner Nary Telephone No. (Include area code) Street & No. Street & No. 1 1�f, s City or Village State Zip City or Villa a State Zip AAAA) ch rn o r d Wl S c , i/b ( 2 11 2. APPLICATION FOR: ❑ New Mound System (3a) ❑ Groundwater Monitoring (7) Conventional System - Public Building (1) ❑ Replacement Mound (4a) U Holding Tank (2) Replacement Pressurized System (4b) ❑ System in Fill (1) ❑ Petition For Modification (6) ❑ New Pressurized System (3b) ❑ System in Flood Fringe (1) ❑ Other Alternatives (5) 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750- 1,500 gallon septic tank - 50.00 4a. 3b. 1,501 - 2,500 gallon septic tank - 60.00 4b. 3c. 2,501 - 5,000 gallon septic tank - 80.00 4c. 3d. 5,001 9,000 gallon septic tank - 100.00 4d. 3e. 9,001 15,000 gallon septic tank -- 150.00 4e. 3f. Over 15,000 gallon septic tank --250.00 4f. 3g. 500- 1,000 gallon dose chamber - 30.00 4g. 3h. 1,001 - 2,000 gallon dose chamber - 50.00 4h. 3i. 2,001 4,000 gallon dose chamber - 70.00 4i. 3i. 4,001 - 8,000 gallon dose chamber - 90.00 4j. 3k. 8,001 12,000 gallon dose chamber 110.00 4k. 31. Over 12, 000 gallon dose chamber -150.00 41. 3m. 500 - 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 - 10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank -100.00 4o. i 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal O 3r. Priority plan review: walk through) 4r. O Submittal of plans in person, by appointment, with double fee 3s. Petition for Variance Setback - 25.00 4s. _ Site evaluation - 50.00 Total Fee � � State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION May 4 , 1 907 201 E. Washington Avenue P.O. Box 7 File loo. g - J jQ Madison, Wisconsin 53707 A9az r Art Rizzi & lsaooiato s to 100 � 17 Drummond Street Eau Claire, WX 54701 \ E Varehouso and Office-Chapter 54 Phil LaVenture, Owner LaTenture Crake Company 2 Hiles West of Now Richmond on I - St. Croix County Plan Musiber 87 - 04 - 0180 - E Volumes 150,000 Cubio Feet Art Rizzi, Supv. Prof. (Bldg.) Batilfding plans have been reviewed for compliance with the important code requirements sect forth in Chapters 50-64 of the rules of the Department. The plans wee stamped "CorsditionaElly Approved," and oonstrucstion may praaeesd subject to local regulations, but all items that are required to be changed by this letter must be aorreeted before *ommencing that part of the work. This plan has not been reviewed for ormsplianoe with Chapters ILKR 92 -85, the plumbing rules of the Department. You are hereby advised that the owner as defused in Chapter 101.81 (2) (e) of the Wisconsin State Statutes is responsible for all code requirements not specifically ei.ted herein. The building will be inspected during and after oonstruotion. The owner shall r4 notify the state building inspector and the local officials before talking possession of the building. ILRY 50.15 Kvidencer of a roval.. The arebiteet, professional eAgiseer designer, builder or owner shell keep at the building, one set of plans bearing the stamp of approval. This building in classified as No. 5H, exterior masonry unprotected oonstruotion, ILHR 54,12 The maxim= number of occupants in this building are 23 patrons rand 10 employes per the bathroom facilities. SBD -5850 , e. Y sw *webs 11M12 ml -fir " , Ada . or 1 baIdtg a►ted. _ ffid 6 1 't lr. lair�l.Y3tis�F , ,1 be t ^''0ld ti D aala�latat: ttitb' AP a['!"in.1 1r shod se two a ,u,d '�1� MOW that Ali oaapoamat. plan a it a at m rorm fte ` tom ' d $0,60 at feet in atkarw Sm u be 014p rd 't the bat1dIft ate: . der "the to t" Pvt"Olow air Via .p"Joet. v .3 aft d t+l n pbome 715-72,141 1I M 210%09"! � 1k M ` lift. PwOt O -Sw* ttfta str oot VI 70 J , : I t M1 1 1 w t � L Tr= peRTMET 0F' REPORT ON SOIL BORINGS AND SAFETY & R D VISION ,LABOR AN D PERCOLATION TESTS ( 1 115 ABOR AN P.O. BOX 7989 HUMAN RELATIONS \ / MADISON, WI 53707 (H63,09(1) & Chapt ®r 145.045) LOCATION S CTI TOWNS /MUPLI6FPfcC1TY: OT O.:BLK. SUBDIVIS N NAME: /T N/� (or) LINTY- `7 O ER' BUYER'S NAME- MAILIAJG DR DATES OBSERVATIONS MADE NO. B DRMS-: COMMER IAL DESCRIPTION - RO /LEDESCRIPTIONS: T ST : Residence ONew ❑Replace 1 1 - , 7 1 RATING: S6 Site suitable for system U- Site unsuitable for system / N. EN tO L UNO: lN_ -G N E S -f -F LL LDI TA K: RE MMENDE SYSTEM:(optional) S ❑u I so u ®sou aSZU os u . If Percolation Tests are NOT requited DESIG RATE: If any portion of the tested area is in the under s. H63.09(5) (b), indicate:' G� Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BQ.RfNG TOTAL DEPILI TO UNDWATE - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH ER DEPTH`tm. ELEVATION OBSERVED ST. HIGHES T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BAC .) B- u/ ify.CCt S 7 Z Z , 7- B• . > 3 B 99 R gve Q > ly 3� t 7 M4 — s PERCOLATION TESTS DE H WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES R INC1iG8 AFTERSWELLING INTERVAL -MIN- l t PERT PER INCH P, - 3 .S '' P P P PLOTPLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot Flan. Show the surface elevatinn at all bot ings and the direction and percent of lend slope. .A S"$TEM ELEVATION 61 Sf Ile X . 1 I i ► MF Y Y I + i 1 _ ' Ora vG 'j v 11 Q° -� 'r i ^5 I lk j sG �� r� ti� __.____,_ . certify that the soil tests reported on this form were made by mein accord wit ` the procedures and methods specified in the Wisconsin t the data recorded and the location of the tests are correct to the best of my I nowledye and belief. TESTS WER COMPLLETED ON: CERTIFICATION NUMBER: PHONE NUM ER(optional): 1 CST U cal Authority, Property Owner and Soil Tester. OVER Ilk— r y eP r d , n� LN 21 ddV L � 0 3AI303W ` F1 b. 60 1 PROJECT DETAIL DATA SHEET NAME OF BUSINESS �Ea��.n�C,_.tf ,2 �► � LEGAL DESCRIPTION ' p OWNER y� UC,Jru,P,c MAILING ADDRESS irJ ��,c%a�a�lo GU1' ZIP "HIT ENGINEER, f�A�� A DDRESS IUMBE OR DESIGNER f l +rLlol ZI? TELEPHONE NUMBER ��' 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building x Addition {') Apartments and condominiums . . . . Number of bedrooms ( ) Assembly hal . . . . . . Seating capacity { ) Bar Seating capacity # of meals served { Bowling alley . . . . . . . . Number of lanes ( ) With bar (; Campground and camping resorts . . . Number of sewere3 — sites Number of unsewered sites Total number of sites ( ) Camps . . . . ( ) Day use only Number of persons Day and night Number of persons' ( ) Catchbasin . . . . .. . . . . . . . Number (.) Church . . . . . . . . . . . . . ( ) No kitchen Number of persons ( ) With kitchen Number of persons ( ) Dance hall . . . . . . . . . . . . . Number of persons ( ) Dining hall . . . . . . . . . . . . Number of meals served daily ( } Dog kennels . . . . .... . .. . Number of enclosures Drive -in restaurant . Inside seating capacity Car- service -- Number of car spaces Dump station . . . . . . Number of dump stations Employees ( total of all shifts) Number of employees Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ( ) Mobile home parks . . . . . . . . Number of sites ( ) Nursing homes . .'. . . . . . . Number of beds Parks . . . ..... ..... . Number of persons ( ) Toilets ( ) Showers Restaurant . Seating capacity ( ) Dishwasher and/or disposal? ( ) 24 -Hour service Retail store . . . . . . . . . . . . Total number of customers Schools . . . . . . . . . . . . . Number of classrooms - T7 Meals ( ) Showers Self service laundry . . . . . . Total number of machines { ) Service station . . . . . . . . Number of cars served dais { ) Swimming pool bathhouse . . . . Number of persons ( ) OTHER . (Specify) . . . . . . COMPLETE OTHER SIDE 2., Indicate whether the following facilities are present. Floor drain Food waste grinder yes no Number of drains Dishwasher yes no _ Automatic clothes washer yes no yes no Numb er of clothes.. washers 3. Septic tank capacity ----- Holding tank capacity Septic or holding tank manu a urer 4. SEEPAGE TRENCHES: total square feet Width of trenches length of trenches depth number of trenches SEEPAGE BEDS: total square feet width length of bed - ---.Al2 ' P de th o0 SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit Signature of pe o completing form: FOR DEPARTMENTAL USE ONLY Addres z Telephone Number ' Date r !/ai f �/1•l/�•J�uh`'�t - ��srs�en (�:.323� - � TOM s/d1 7 '4� .SzAr^la 7 - j'dlj M6 /.vvoE'o , ew j1I1 j xs"� / // ' � : - ; ih1� �m'�xc t'Yr` \`'ii t'�.. its �'p ;: �.x ..r •� g»'M1 ' PAGE OF f/ rc)SS SZC�tut of l� 1�. ��7 SyS�i�nl Fresh Air Inlets And Observation PIP4 r t / ( .- Approved Vent Cap M Inlonu m 12' Above Fingl fin 1 Grade 20- 42' AOovo Pipe — 4" Ceet Iron To Flnei Grade Vent Pipe Wren Hey Or Synthetic Covering win 2' Aggrogole Over pip" oletrloellon — Too - Pipe _► a 6* Aegregal o Putol.le•i Pipe Geiaa Beneath Pip: Coupon/ Tornlineling At Bottom of System ' i y `` rA c• < �� i �► SOIL FILL. DIS TRIBUTIOM PIPE pPPROVEO g4kt 1£TIC COVER OR 9" OF STRAW c • OR MARSµ HAy Z" OF AMiGREWE °;f.P !o'OF!2'Z GGREGATE t DISTRIP5'JTI0k) PIPE TO DE AT LAST l►JCHES BELOW ORIGIAIAI_ GRADE AQU AT LEAST 20 INCHES SUT.AIO MORE THAI+I '42 IKICHES BELOW. FINAL GRADE MAXIMUM ®fiPrN OF EXcAVAT16o Rom OKI 6RAIK WILL BE _ WC-HES rMNtMU 0"" of MAVATMW CaRap€ WILL BE INCHES LICCUSE AJUMBER: AS7 E � � DATE' 1 10 ,