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STC - 104
AS BUILT SANITARY SYSTEM REPORT
0
OWNER
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ADDRESS 2 1l s' S11
SUBDIVISION / CSMI 24~4~ vv% ~ -S LOT-SW C?'~~►~R
SECTION T 30 N-R W Town of 7
ST. CROIX COUNTY, WISCONSIN
fid)
PLAN VIEW
HOW EVERYTHING ITHIN 100 FEET OF SYSTEM
g5
S- G r r u~e,
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: 61 PUC 111 1 p~ fft joy
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Low Liquid Capacity: /dab
Setback from: Well Afp- House c Other
t Pump: Manufacturer Model# Size
Float seperation Gallons/cycle :
Alarm Location
:SOIL ABSORPTION SYSTEM
Width: / Length t Number of trenches j
Distance & Direction to nearest prop. line:_ Na-t-U k,,.
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet gQ, ~,3
PC inlet - PC bottom Pump Off
Header/Manifold , (A, Bottom of system. 17-9
Existing Grade "g?, ' Final grade 9 9
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: )S L
INSPECTOR: ~8m
3/93:jt
Wiscoh;in Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. C-'ROI.
Safety and Buildings Division Sanitary Permit No.:
GENERAL INFORMATION (ATTACH TO PERMIT)
?tiEtS34
of a 's Name: ❑ City ❑ Village _ Town of: State Plan ID No.:
giL. ` ~JILDERS; INC. ERIN PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
> ) 0 Benchmark
Septic W
Dosing
Aeration Bldg. Sewer C,
Holding St/ Ht Inlet f' e.) I , C)
TANK SETBACK INFORMATION St/ Ht Outlet 8l 5a . l 7.
TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
v
Dosing NA Header / Man. 7 ' y qq
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade 1 ° n l
Manufacturer Demand
Model Number / GPM
TDH Lift Lrictio ystem TDH Ft
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Len No. OLTrenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
LEACH Wf~ y4 n er:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LE
CHA ,4
A E
INFORMATION TypeO p 1~ ~ Mo Number:
System: LL/ OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Di a. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
[Bed epth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
/ Trench Center Bed/ Trench Edges Topsoil El Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Erin Prairie.4=30,17W, NW, ,W, 176th Street
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Dat Inspector's Signature Cert. No
ADDITIONAL COMMENTS AND SKETCH }
SANITARY PERMIT NUMBER:
o ~ 9
v
r
SANITARY PERMIT APPLICATION couNnr
I
In accord with ILHR 83.05, Wis. Adm. Code .
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than A & d 53
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PRO ERTY OWNER PROPERTY /~WION
s4 u.)% N/•~t,J'/4, S 1-4 T 30, N, R -15W) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
1-7 -l 5;"9"T
CITY, STAT~j ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
v.~ K` Mon o E -7 1 Ladd I If- S
CITY NEAREST ROt
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE /s ST
❑Public ~1or2Fam.Dwelling-#ofbedrooms ~ PARTOWN OF e%
CEL TAXNUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) [ a _ 00 k - Ct 13
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 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 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. XNew 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 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 ❑ In-Ground 420 Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION!
1. GALLONS PER DA YSTEM ELEV. 7. FINAL GRADE
ELEVATION
/i -S--Feet d? Feet
VII. TANK Fiber- Exper.
INFORMATION feel glass Plastic App
Septic Tank or Holding
Lift Pump Tank/Si hon
Vlll. RESPONSIBIL \
I, the undersigned, a IS.
Plumber's Name (Print) Business Phone Number:
~is .2 y (0 S'
Plumber's Address (Str
151 tag
IX. COUNTY/DEPA
❑ Di Signatu (No Stamps)
r~ aarcnarge reed
Approved ❑ Owner Given Initial
Adverse Determination b
W
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08193) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
e
INSTRUCTIONS
1. A 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.
4. Changes in ownership or plumber requires a Sanitary PermitTransfer/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 & Buildings Division, 6013-266-3815.
To be complete and accurate this sanitary permit application must include:
1. 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 Famil/ Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallon., 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% 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; fric,:ion 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.
- - - - - - - - -
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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION
'Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. is. Adm. Code
nty
A ch complete site plan on paper not less than 8 1/2 x 11 inches in n mu
include, but not limited to: vertical and horizontal reference point (B ctio c
percent slope, scale or dimensions, north arrow, and location and d' a to n p ce LD. #
APPLICANT INFORMATION- Please print all infor n, It
Q() R ed by Date
,
Personal information you provide may be used for secondary purposes (Privac w s. 15.04(
tj'xy b
Property Owner Q, S 4 i~ f. P~ a w
/ii'4.GG^ r4T/ Lgi~s 1/4,S T ?O N,R E (or)b"/
Property Owner's Mamng -,,,dress
x #
No" I Subd. Name or CSM#
/Us- /,o , S r T c'r ;~S-
City State Zip Code Phone Number PA
El City El Village Nearest To
New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 300 - gpd Recommended design loading rate 1 7 bed, gpd/ft2 oQ~ trench, gpd/112
Absorption area required _bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 . a trench, gpd/ft2
Recommended infiltration surface elevation(s) 9?~ It (as referred to site plan benchmark)
Additional design/site conside ations /
Parent material . - 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 ❑ U ® S ❑ U ® s ❑ U ❑ S Q U ❑ S [9 U ❑ s ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
g Texture Consistence Boundary Roots
in. Munsell ' Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
,
no
Ground
77.6 ft.
Depth to
limiting
factor
Remarks:
Boring #
d-H
it 30
Ground
Depth to
limiting
774 in. Remarks:
CST Name (Please Print) Signature Telephone No.
~~e,'.s 0,//e 7~r-zip 6c3?
Address Date CST Number
3 ?Z /yb sT Ao{r Gc/j- s- l 6 azs= 9 G Sic, 91
A 1
Q~CT SOIL DESCRIPTION REPORT
PROPERTY OWNER ~ Page of
PARCEL I.D.# +
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
elev.
Depth to
limiting
f or
?tin. ,
Remarks:
Boring #
Ground
elev~
/rev. FS ft.
Depth to
limiting
fa or
~in.
Remarks:
Horizon Depth Dominant Color Mottles Structure GPD/ft2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
Depth to
limiting
major
M in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page L of 2-
Division of.Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
ch 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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel .D. #
D/Z- 200/- S 0
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)).
Property Owner /J/ Property Location
Q~
_ /t,G Govt. Lot 1/4 Wit/ 1/4,S y T 30 ,N,R / j E (or)t0
Property Owner's Mamng r,,,dress Lot # Block# Subd. Name or CSM#
IU S` /'>o , S 1'~ c,L' 7S~ EG~TI 0%6-9
City State Zip Code Phone Number d
E:1 City El Village Town Nearest
u'- lvl SS/oo (1!i' ~.25/t:-S'yb'd E/f`2'h Q'r 06 s7'
New Construction Use: ❑ Residential / Number of bedrooms 3 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 36P _ 7 . gpd Recommended design loading rate i bed, gpd/f12 ~a trench,
gpd/ft2
Absorption area required bed, ft2 trench, ft2 /
Maximum design loading rate _ bed, gpd/ft2. a trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material 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 KS ❑ U R s ❑ U ®s ❑ L ❑ s u ❑ S PR U ❑ S RU
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
r • Bed Trench
Ground
g
/ 1 ft.
Depth to -
limiting
factor -
Remarks:
Boring #
1.3®
_'013 '7_.SV1kk0,A
Ground V
77)3 ft •
Depth to
limiting
'/94 in. Remarks:
CST Name (Please Print) Signatu e Telephone No.
Address Date CST Number
3"7 z- I,& 7~ S ' Gvj` Sr 9 G ? S~r~
Pf3APERTY.QWNER SOIL DESCRIPTION REPORT
Page of 3
PARCEL I.D.
1
Boring # Horizon Depth Dominant Color Mottles Structure 2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
Y T- CL
Ground
elev.
Depth to
limiting
fac or
) in.
Remarks:
Boring #
Ground
elev~
Depth to
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev,
x7. c) ft.
Depth to
limiting
~faj or
Tem. Remarks:
3oring #
around
Ylev.
n.
Depth to J-1 I
limiting
factor
in. ~ - -
Remarks:
SBDW-8330 (R. 08/95)
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SCALE FOR QUARTER SECTION Each side large blue squares= 10 chains, 40 rods, 660 feet; area of square 10 acres.
400 FL 1 Inch Each side small red squares=2.5 chains, 10 rods, 165 feet; area of square .625 of 1 acre.
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SCALE FOR QUARTER QUARTEREach side"lare b ue squares= 5 chains, 20 rods, 330 feet; area of square 2.5 acres.
SECTION, 200 Ft.= 1 Inch. Each side small red squares=1.25 chains, 5 rods, 82.5 feet; area of square .15625 of 1 acre.
PRONTO LAND MEASURE 20-40 MAP SHEET PRONTO LAND MEASURE
Copyright, 1967, James Hamilton Adair, Flint, Michigan
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERBUYER
~ ~ ~r+r .r , frls
MAILING ADDRESS / Ili 17 111-d S' All,
PROPERTY ADDRESS /w_ 54"/
(location of septic system) Please obtain from the Planning Dept.
`✓.`l ~y//`7
CITY/STATE Aew A"o'-z".
PROPERTY LOCATION --i 1/4, NW 1/4, Section s T_3 b N-R~W
TOWN OF c ST. CROIX COUNTY, WI
SUBDIVISION A LOT NUMBER 9-.7,?
CERTIFIED SURVEY MAP , VOLUME _ I PAGE , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix county
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year
SIGNED:
7/,/
t't
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road _
Hudson, WI 54016 11/93
s T C - loo
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property . //A//,, Location of property V %f 1/4 0 w 1/4, Section ,T_3_<~ N-R_1~7_W
Township jEk N Mailing address 1'7(o7 I) Sr':*- S T
Address si47 q0 1'74 fAI
Subdivision name P~,~ f e eA, /yJjLot no. 9-! le--7.7
Other homes on property? Yes >C No
Previous owner of property 5-, h rrm LC' h, V% 104 ww
Total size of property A/ X C r r s
Total size of parcel /r / A G l s f
r e
Date parcel was created / 7 P'd s d o r e
Are all corners and lot lines identifiable? Y, Yes No
Is this property being developed for ('spec house) ? Yes _,W No
Volume I.Q 0t and Page Number 315 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY-:DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER'AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner (s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. 9 7 4@:(p , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature, f Applicant Co-Applicant
Date of Signature Date of Signature
~ MENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN ~FORM 2-1982
49722 VOL 1001PAGE (c
3 OFFICE
Sharon L. Cunningham IxCo.,W1
i lvr Recd
APR 9 1993
10:15 A.~I
conveys and warrants to Halle Bui1der_s.,__.1n-C-. /
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- L
RETURN TO
the following described real estate in .___...-SL_._._CrQ1_X ...................County, -
State of Wisconsin:
Tax Parcel No:
Lots 9, 10, 11, 12, 13, 14, and 15, EXCEPT the East 6.0
feet thereof; and Lots 32, 33, 34, 35, 36, 37, and 38, All
being in Block 1175" of the Plat of Jewett Mills; AND
I
Lots 16, 17, 18, 19, 20, 21, and 22, EXCEPT the East 6.0
feet thereof; and Lots 25, 26, 27, 28, 29, 30 and 31, All
being in Block 1175" of the Plat of Jewett Mills.
St. Croix County, Wisconsin.
I
l
~F
A-A
i
I.
I
This js__no:t--------- homestead property.
(is) (is not)
Exception to warranties: easements, restrictions and rights-of-way
of record, if any.
Dated this --•-•-----6 d----4/1^ day bf April 19_ _93
--(SEAL)
Sharon L. Cunningham
---------.-(SEAL) _ - ------(SEAL)
i
M
- - -
li
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) SharAn_..L STATE OF WISCONSIN 1
r„",,;,,nl-Imm 1 ca.
{ PAGE OF
Cr S S S ec ~ l u n O~ r~l J y 5 t'en-~
37,41/36 -17tt
FrecA Aft Inlelc And Ob6cryallon Pipe
1 Approved Vent Cap
Minimum 12" Above
Final Grade
20- 42" Above Pipe _ 4" Caen Iron
To Final Grade Vent Pipe
Mores Hay Or Synthetic Covering
min. 2' Aggregate
-
Over Pipe -Tee
Oli lon
pip:
pipe -1 0 0 0 0 0
i 6" Aggregole o Parforaled Pipe Belay
Beneath Pipe
o -Cooing Terminating At
Bottom Of System
L V
Pf`u(~oSCD Pin-I. ``gre,c1t
~L~cJ.•.T ton
\p~
.SOIL. FILL
DISTK18UT10~.] PIPE
APPROVED ETIC COVER
MIKURIM- OR 9" OF STRAW
Nwr
of A6GR Ev GA'iE OP, MASCSM "ki
le.0F12-2t/Z AGGREGATE
~~Ev of ET--.- _
3 _ t 3
DI•S-1-1119'JTIOU PIPE TO BE AT LEAST INCHES BELOW ORIGIMAL GRADE
AME) AT LEASTZ0 IUC14CS BUT 1.10 MORE THAI) 1I2 IUCINES BELOW FIAJAL GRADE
MAXIMUM ®EQrH OF F-XCAVATioo FRoM OKI&WAL 6KAor WILL BE 34~1 IMC14ES
M KIMUM 9SPrtt OF EACAVATIOM f.RoM. cD4?,f(IWAL C3R49f WILL BE INCHES
SIGHED:
LICEIJSE WRABER:
DATE : 2-