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AS BUILT SANITARY SYSTEM REPORT
OWNER
TOWNSHIP G~Ss~
SECTION L/ T~'% N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION- LOT--Lt-LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
yy., '
,~/,''C ~ a rte, • c%
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yr- ~
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INDICATE NORTH ARROW
BENCHMARK: Elevation and description: ~ 1-/112 S f< ~c
Alternate benchmark-
SEPTIC TANK: Manufacturer:~e Liquid Cap.
Rings used:~2-Manhole cover elev: 515-q SFinal grade elev:
Tank inlet elev.: ? Tank outlet elev.:
No. of feet from nearest road:Front,,, Side , Rear Ft.
From nearest prop. line:Front , Side L Rear Ft. 7
No. of feet from: Well- ~ ~ b /
Building. 3~
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
ti
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model:_Pump/Siphon Manufact..: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front-, Side_, Rear._Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepage Pit:
Width:- _LengthGam? Number of Lines: J Area Built 251
17.1 e-1
Exist. Grade Elev.
Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side' , Rear Ft.~r~~'
No. feet from well *e-- c c>
No. feet from building
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE : PLUMBER ON JOB :
LICENSE NUMBER:- ~l
6/90:cj
- - - - - - - - - - - - -
i Wisconsit, Department ofIndustry, PRIVATE SEWAGE SYSTEM County:
labor and Human Relations INSPECTION REPORT
' Safety and8uildings Division - - - -
(ATTACH TO PERMIT) Sanitary Permit No.`v~
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village,§ Town o : State Plan ID No.: v
lLDT I5
CST BM Elev. Insp. BM Elev.BM Description: ~yt- Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /00, o
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet S, S- goy, 7
TANK SETBACK INFORMATION St/ Ht Outlet $ 9a . 9
Vent
ir Ito ntake ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Air
Septic rZ 0 50 1E NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe A S_ I? 7
Holding Bot. System d, 5- g8117
PUMP/ SIPHON INFORMATION Final Grade 10,o 0//,
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED / TRENCH Widt 1~ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
~ Model Numer:
INFORMATION Type Of CHAMBER
System: yj -70 6 o y 5_0 OR UNIT
DISTRIBUTION SYSTEM
Header/Mani old Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Length (o Dia. Length CPO Dia. `7` `1 Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over 6L 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.)
S ~
113
13 IL
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. QS_ /,3 PFG a A
SBD-6710 (R 05/91) Date inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH "
SANITARY PERMIT NUMBER:
e
s
I
I,
CILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
51,-
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than El ~p?'7
8% x 11 inches in size. ChecYlrYis on top vious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION ,
--e- c/I t ® k 70' ~nL &1d '/4, d<JS Tod , N, R E
PROPERTY OWNER'S MAILING ADDRFS OT # BLOCK #
Y^ rJ
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMB
rr c j- 1(71:;F- X6367 4 o /?i C/ X -c t
0 TY
II. TYPE OF BUILDING: (Check one) El State Owned VILLAGE : sd~ NEAREST ROAD
❑ Public [541 or 2 Fam. Dwelling-# of bedrooms A
R EL TAX NUMBER(b)
oao- (~67- o20
111. BUILDING USE: (If building type is public, check all that apply) l /A
1 ❑ Apt/Condo
20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Off ice/Factory 13 ❑ Other: Specify
IV. TYf(PPEt OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. [Z 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 # - 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
120 Seepage Trench 220 In-Ground 4420 Pit Privy
13 ❑ Seepage Pit Pressure 430 Vault Privy
140 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
41 SAO REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) t~ ELEVATION
;Z_ dZ7 C a2 S 3 / Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank Y_ ~~0`D fry F-1
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' Name (Print): Plumber's S' re: (No Stamps) MP/MPRSW No.: Business Phone Number:
; n
Plu b s Address (Street, City, State, Zi Code):
1-7 Z, C/
r r o v
,a -e
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved SartUary Perm It Fee (Includes Groundwater Mare ssued %j Issui gent Signal
Approved ❑ Owner Given initial 99~ urcharge Fee)
7/caw, 0,5--
Adverse Determination 1100, r
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
e
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 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 & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owne-r'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.
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 gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Compete 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; 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.
- - -
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)
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor,("spec
house"), then a second form should be retained and.completed when the property is
sold and submitted to this office with the appropriate deed recording.
Owner of Property I
Location of Property N (~j S w , Section Q~ T A°) N - R W
Township _ILd-so n
Mailing Address
A
r
Subdivision Name 5UV1 12,11 e. De V,,
Lot Number ,
Previous Owner of Property 3kCQ 1= A 5•
Total Size of Parcel 12~ 5;3Cp AC
Date Parcel was Created (Q~]
Are all corners and lot lines identifiable?~ Yes No
Is this property being developed for resale (spec house) ? X` Yes No
Volume -prp-iZ, and Page Number 7% as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3.• Other recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) eeAti6y that att 6-tatement6 on this 6oAm ahe totu.e to the befit o6 my (oun)
knowtedge; that I (we) am (aAe) the owner (6) o6 the pnopen ty ded cA.Lbed in .th i.6
.in6o4mati.on sown, by viAtue o6 a wa4Aanty deed neeonded in the 066.iee o6 the
County Reg.i6.teA o6 Deed6 a6 Document No. and that I (we)
peed enttt y own the p4opo6 ed 6.cte bon the 6 ewage diApo,&at 6 y6.tem (oh 1 (we) have
obtained an ea6ement, to hun with the above ducA bed pnopenty, bon the
comtAucti.on o6 said 6ys.tem, and the Game has been duty tecoaded in the 066.iee
o6 the County Regi6.ten. o6 Deed6, a6 Document No. y, !Z
SIGNA OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
Q
DATE SIGNED DATE SIGNED
~l
,%"~DCCUMENT NO. WARRANTY DEED T11 S SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
445646 V.. S34PAGEREt~I,~`~~ S OFFICE
5T. CRIO ON cut W1
Reed or Rmrd
Verlyn F Beno ' Arlyn L Benoyand Wayne A Beno f
Y y,...----- .t
as tenants in common FEB n
.
8-30 AM
conveys and warrants to ...Greenwood En_terprises.,•-Ine a.__-•--"_-_
ewe
. Wisconsin. Corporat-1-Q11
-
- _ .
- 1
RETURN TO
t
the followin described real estate in -St. Croix
g - County,
State of Wisconsin:
Tax Parcel No:
See attached Legal Description
MIANSFTA
44
This is not
. homestead property.
2(1t~ (is not)
Exception to warranties: easements and restrictions of record, if any
Dated this . Cl`.d--------------------- day of ..February 19-8-9...
.
.
~e - -(SEAL) - . . (SEAL)
Verlyn E. Benoy *ArlyL. Benoy
1
GL ,
13
- (SEAL)
- ---------(SEAL)
Wayne A. Benoy
- -
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF WISCONSIN
St Croix n
ss. r~J'
County..,..
authenticated this day of--------------------- 19 Personally came before me this day of
I 19x9.... the above named
Vexlyj1._Z._Benoy_,...Ar1yn_1.-_.B=oy_-Ana.......
Wayne..A:.. Beau = t
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
F r - =
authorized by § 706.06, Wis. Stats.) to me known to be the person 5.......... *ho execirted >l~e'
for stru t an ac owled e 6i6 same:,
THIS INSTRUMENT WAS DRAFTED BY ;
,q 4
Lai s..A-..Murra)r,-.HEYWDDD,--CARI--&--MIJRRA-Y--- G d
O 1 S ! I yY-al- •
P.O. Box 229, Hudson, WI 54016 ~.,r:-' II
. • ry Public S-t-• Cr-o-~------------- ,
- iCounty, Wis. II
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19--------•)
Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Cu. Inc.
FORM No. 2- 1982 Pii;waukee. Wis.
• z
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ST C- 105 a
H
SEPTIC TANK MAINTENANCE AGREEMENT
0
St. Croix County z
d
a
H
~}`r FIJ LJOO3p EQ-\ I IJC_
OWNER/BUYER
ROUTE/BOX NUMBER 1yt~p TN 1~~ S7V Fire Number
.CITY/STATE ~A U~c501\,3 UJ ) L`^~4D1 L, ZIP 54o 1(p
PROPERTY LOCATION: 'Z, Sectionoj5, T p I- N, R/ _W,
Town of qua St. Croix County,
Subdivision Skn9j'rj!re Lot number
. I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
H
three year expiration. o
z
I/WE, the undersigned, have read the above requirements and agree cn
to maintain the private sewage disposal system in accordance with rx,
the standards set forth, herein, as set by the Wisconsin Depart- 'b
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office
P.O. Box 984
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
INDU
UEPARiMFNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AN P.O. BOX 76
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 3707
(ILHR 83.09(1) & Chapter 145)
LO ATION: SECTION: MUNICIPALITY: LOT N .:BLK. NO.: SUBDIVISION NAME:
W146&;'14 a~ /Tg~N/&ZE (o & 1 4 ged,
OUNTY: MAILING ADDRESS:
~S/ J x
tJ 1 S G C~ ~D ~'1 "V D
USE DATES OBSERVATIONS MADE (o
NO. BEDRMS.: COMMERCIAL DESCRIPTION: y~ PROFIL PTIONS: ATION TESTS.
Residence Oq New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:loptional
$❑U CAS❑U ~$❑U ❑SC I U Ze-z 0 If Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: _ Floodplain, indicate Floodplain elevation: n.
PROFILE DESCRIPTIONS
BORING TOTAL D TH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF O SERVED (SEE ABBRV ON BACK.)
o- yf'os y-~~ ~N~ 36 -sue s
> io
B-,3
7 S 7 ~0 3' 7.•Z 5,.
B_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER WIN&W AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P-
P "
P-
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
J_j
E
- t E I
r~ .vcy. ; _ 0 5 _ i
L
D_
i 3
I
E ~s
a
1
I, the undersigned, hereby certify that the soil tests reported o )this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): ~7 1 TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
irr r~ !r1- j~o~✓ 7
CST SIG URE:
P_ 's
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
' 7.
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use suction must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER
SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet
may be used if desired;
6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if
appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and yur certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL
AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 1U') BR - Bedrock
cob - Cobble (3 - 10") SS - Standstone
gr - Gravel (under 3") LS - Limestone
's - Sand HGW - High Groundwater
cs - Coarse Sand Perc - Precolation Rate
med s - Medium Sand W - Well
is - Fine Sand Bldg - Building
Is- Loamy Sand > - Greater Than
'sl - Loamy Sand < - Less Than
'1 - Loam Bn - Brown
'sil - Silt Loam BI - Black
si - Slit Gy - Gray
cl - Clay Loam Y - Yellow
scl - Sandy Clay Loam R - Red
sicl - Silty Clay Loam mot - Mottles
sc - Sandy Clay w/ - with
sic - Silty Clay fff - few, fine, faint
'c - Clay cc - common, coarse
pt - Peat mm - Many, Medium
m - Muck d - distinct
p - prominent
HWL - High water level,
surface water
' Six general soil textures BM - Bench Mark
for liquid waste disposal VRP - Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system
and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary
permit must be obtained and posted prior to the start of any construction.
PLOT PLAN
•'PROJF,CT_~er~ ADDRESS /,dI/y Ji~eli
~.%'1~'ir~1/4 tv 1/4/S,;?,4/Ta5 N/R /yW TOWN_ d o COUNTY S~.Grt,,x
MPRS Byron Bird Jr. 3318 DATE .3- / ,~z -
BEDROOM~ CLASS PERC Z CONVENTIONAL -IN-GROUND PRESSURE
CONVENTIONAL LIFT MOUND_ HOLDING TANK
SEPTIC TANK SIZE ~..A'IFT TANK SIZE
DOSE TANK SIZE HOLDINGIANK SIZE
ABSORPTION AREA 7 a O PERC RATE 3 BED SIZE a X 6
Benchmark V.R.P. Assume Elevation 100
Location of Benchmark
* H.R.P.
C3 Borehole Q Well Scale ~ Feet
0 Perc Hole System Elevation ~j
Uent
12"
Grade
TYPAR COVERING
2~
12" 3' O 6' 0 3'
1 6 Sewer Rock
1.2'
R
v~G~ ~ t o r L
y~
6~
RBPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1
05/1~/92 17:04 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/13/92 AREA: JT
Activity: A9200122 5/13/92 Type: CONVSEPT Status: PENDING Constr:
Address.je 29.19.1312,NW,SW,24,MC DIARMIDRD
Parcel: 020-1267--20-000 OCc: Use:
Description: 149276
AMMIM
Am" Phone :
Applicant:
Owner: GR. WOOD ENTERPRISES Phone:
Contractor: T` Phone: 268-7616
+-----_----------..-----.r -w...--....r..
Inspection Request Information.....
Requestor: BYRON BIRD JR. Phone:
Comments : VJ0 ,
Items requested to be Inspected... Action Comments ay,~yur^' Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1
95/12/92 1:7:04 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/13/92 AREA: JT
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* * * * INSPECTION REQUEST SUMMARY
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Address Time Activity Type
HUDSON 24.29.19.1312,NW,SW,24,MC DIARMIDRD 13:05 A9200122 CONVSEP
Item: 00012 FINAL INSPECTION