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AS BUILT SANITARY SYSTEM REPORT
OWNER S~ M ,M-r/~~✓ TOWNSHIP,/7~ o ~a
SECTION-,2-j-K-T-,,? -9N- /J
ADDRESS BOY `L 7-J- ~ ST. CROIX COUNTY, WISCONSIN
9cf, /S a rt w T S'/D / G
SUBDIVISION C 14E P, ff Y jy,'l/ LOT l LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Chsrry woeel
6a•v~c
I IT,
i
va
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: SPIKE TA/ 6" F IM C71 = 100-00 r
l r Q.~ (
Alternate benchmark 1,C'
SEPTIC TANK: Manufacturer: WE 1 S £ P- Liquid Cap. 60
Rings .used:__L_Manhole cover elev: Final grade elev: Sam
Tank inlet elev.: 7.9 Tank outlet elev.: V- 3 S
No. of feet from nearest road:Front , Side X, Rear Ft./yo
From nearest prop. line:Front , Side , Rear__Ft.
No. of feet from: Well 40~ , Building: 3rd
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
j
PUMP CIA KR
Manufacturer: 111id 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
"bi tance from nearest prop. line: Front__,
Side, Rear-Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: o~+va lttileJ Trench : Seepage Pit:
Width: C9 Length
Ky Number of Lines: 3
Area Built 7Z0 sy 7-
Exist. Grade Elev. Proposed Final Grade Elev._ (I
Fill depth to top of pipe:qe>"
No. feet from nearest prop. line:Front '
11 Sider, Rear -X Ft.L
No. feet from well: S( No. feet from building b o
HOLDING TANK
Manufacturer: 41.4
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:
6/90:cj
,LOCATION: HUDSON 34.29.19.1351,NE,SW,34, CHERRYWOOD LANE
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Cabor and Numan Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) 5anitaryPermitlVO.:
GENERAL INFORMATION 149267
Permit Holder's Name: [I City ❑ Villages] Town of: State Plan ID No.:
MILLER SAM HUDSON
CST BM Elev.: Insp. BM Elev.: B De~i tion: ~r Parcel Tax No.:
ed eo 020128140000
TANK INFORMATION ELEVATION DATA A920011 S zo 2.
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic l, Benchmark l0 2- 3 1 / Ode
Aeration Bldg. Sewer
i
Holding St/ t Inlet .2S
TANK SETBACK INFORMATION St/ Outlet 8,35 vU,
TANKTO P/L WELL BLDG. Ventto ROAD --at Inlet
Air Intake
NA Dt Bottom
Septic 1X50 /
30
Dos' NA Headers d. S~~ (LSD
Aeration NA Dist. Pipe gb.08'
Holding Bot. Systere' ` 27-22-
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer- Demand 51 si D 3, I
cAnKle-
Model Number GPM r A a
Ex , ,-acLC,
TDH Lift Friction System H Ft 5.7-, 6-25' O 98'
Forcemain I Length Dia. H Dist. Towel al~j~ 3, OS~~~
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~6 ( DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM
INFORMATION TypeO LoKlJ-, CHAMBER Mode Number:
OR UNIT
System: lv
DISTRIBUTION SYSTEM
Header Distribution Pipe(s) „ 1XIole Size x Hole Spacing Vent To Air Intake
Length _L7- Dia. Length r- Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of x Seeded / Sodded xx Mulched
Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes [I No E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
D ~7 e &AJ7~P -41
5
Plan revision required? ❑ Yes No
Use other side for additional information. 9a2
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
0.
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
a~wv
STATE SANI ERMI
-Attach complete plans (to the county copy only) for the system, on paper not less than q~
8% x 11 inches in size. ❑ clfeck i# revision to pr ious 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
14 aL/ '/,S&/ '/a, S 12 T25? , N, R Jy E (or
1h; NF
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
Sv,~ s I'd It, 8't. C /f r X A- Y
11. TYPE OF BUILDING: (Check one) 1:1 State Owned O VILLLLAGE : NEAREST ROAD
Q o Y! ~~1 ~✓o~ ~a n~
114 OF:
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms 2 AR E, NUMB ( )
I
Ili. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo 0 D _ lag y~
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 El merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 5n New 2. El Replacement 3. El Replacement of 4. El 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 N Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
4eS0 LD 2,0 ~.(p~-S 7 9S• ZT Feet i8l•5110 Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank ~OGp Lv4i $ tL( F1 I
[Ell El 1 El
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
, 3 2 2
Plumber' Address (Street, City, State, Zip Code):
IX. CO NTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Ag nt Signatur m
Surcharge Fee)
Approved ❑ Owner Given Initial
`
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber
INSTRUCTIONS
f
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 administrE.tor or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
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.
ll. 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. Complete fc r 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.
IMP, 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; replacemerr: system
areas; and the location of the building served; B) horizontal and vertical elevation referenCE points;
C3) 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 off standards.
SBD-6398 (R.11/88)
S T C - 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 tn n j; N-✓
Location of property_N6 1/4 5VV114, Section
T
Township
Mailing address Z8 L
Address of site
subdivision name G rr y Lot no.
Other homes on property? yes- No
Previous owner of property /ji ~'!e A, A e
Total size of parcel -5-$p
Date parcel was created /-ZO -Lf L
Are all corners and lot lines identifiable? X Yes
No
Is this property being developed for (spec house)? X Yes No
volume 131 and Page Number L 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 & 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. 5/7 $p(Pg
oand wn the proposed site for the sewage disposal t system ) orr I e(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 County Register of deeds as Document
No. 11-7104-V
signature of applicant
Co-applicant
Date of signature Date of signature
ucu.L~nn.r~I rn•.
WARRAN FY DEED 111167 !wACr. RE'LkVED FOR RECORDING DATA
S'T'ATE BAR OF WISCONSIN FORM 2-1982
l (o rj
t
First National Bank of Hudson a United Vol, ?
States Banking Corporation
! Z 6 z
_
conveys and warrants to .......Sam E. Miller,-. a.. single
--..persQB ,D D AM
- -
RETURN TO
.
the following described real estate in • Cr'01
.........•--....-.County,
State of Wisconsin:
Tax Parcel No:
Lots 4, 12, 13, 14, 15, 16, and 17, Plat of Cherry Hill in the
Town of Hudson, St. Croix County, Wisconsin.
Part of the SW4 of NWk of Section 34, Township 29 North, Range
19 West, St. Croix County, Wisconsin described as follows: Lots
2 and 3 of Certified Survey Map filed June 27, 1989 in Vol. "8",
Page 2117, Doc. No. 449209.
Outlots 1 and 2, Plat of Cherry Hill in the Town of Hudson,
St. Croix County, Wisconsin.
~ SAS, Da T~
This --..is_.-n0t.......... homestead property.
(is) (is not)
Exception to warranties: easements, restrictions and rights-of-way
of record, if any.
Dated this ..h--+-................... day of January 1s9~_....
F s Natio B k of Hudson, by
- . (SEAL)
(SEAL)
V ll
i `
topQicr-- r
(SEAL) .f...... (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
St. Croix as.
County.
authenticated this day of 19_...._ ersonally came before me Ts ......day of
anuary .................119-------- the above named
*
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.) '
to me known to be the person who executed the
folrego• g instrum nd ackno a ge the same.
THIS INSTRUMENT WAS DRAFTED BY t\ t ii
Kristina 0 1
ney at and Law Lundeen Alice Jo o Sloy Con1wrs I~
Attor -
S-t CrAg
ar
Notary Public Pub
_~glnty, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanc lt7(efC 0 i .Wpiration
are not necessary.)
date: July 12 19_........)
93
I) Names of persons signing in any capacity should be typed or printed below their siRnntures.
i WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
FORM No. 2 - 1982 1
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER _f Q, ,•y, ~'l,~~/~✓
ADDRESS: &O t O X92-- WT: SYd*FIRE NO:
LOCATION:,WE_l/4, $ l-CJ 1/4, SEC. a/' T 1 N-R_L! i ,
TOWN OF: ST.-CROIX COUNTY
SUBDIVISION: C,/~/~1e Hi LOT NO.
~o
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 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 to
help with the cost of the 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 the St. Croix County
Zoning 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 (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification from will be sent approximately
30 days prior to three year expiration.
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 form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date.
SIGNED.
DATE:
St. Croix County Zoning Office _
911 4th St.
Hudson, WI 54016
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, c DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969
HUMAN RELATIONS
N WI 53707
r (ILHR 83.09(1) & Chapter 145)
LOCATION: ~'/Sw ~ 534%TZQ N RI E(or)W TOWNSHIP/CrCTCrPt4ti~W: LOT NO.:BLK~NO.: SUBDIVISION I~A/VI,
COUNTY: OWN S/BUYER'S NAME: MAILING ADDRESS:
~aM
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE ESC IPTIONS: ER TI N TESTS:
Residence a N1G - New ❑ Replace 2 ! 3~9~ ~47 Z
RATING: S= Site suitable for system ,LS U= 'E Sous
Site unsuitablefors stem $kC.~- &*,V-149&_ - CO]bz- C/JEtItK
CONVENTIONAL: MOU D: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optio )
mS ❑u xs ❑u ~s ❑us ❑u ❑s Wu>vVT,o>~A~
If Percolation Tests are NOT required DES~„~iN RATE: I If any portion of the tested area is in the Q
under s. ILHR 83.09(5)(b), indicate: LASS I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHIM. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- j 0.5a ID) ,~a o~ /p.Sa 12 "$~s~- ~ 20"8e~, X75 76 8" GS 24 "SeLcS-f6k Le > je'8L.LTS /9" $,Q&j 7''$a,SL ce / ~6~u MS
B- z 9.%3 99.Z~ CS I6"6R4C'SI[4*
B-3 'g.39 97 2~ o E F •3 7"6L CM l9"8RN L +4t Z I 'Sju 1541AO-- t.L SB'"'8gAjCS
B-4 v75 9 ,Z E > 5 g"&.c.~ 33'~~ B,er„S L G4"B a>r cS,f G le -~~ab
B- 'S 9•~7 97 9 > ,67 /8"BLC.Ts /4"UmL z4"Re$QUMS6a"Baw~iS ~.>►c
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 14001 ft AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P- I 16•515' r4apif 10160 3 Z < < >
P- 3.95 NeNc 1i0 3 Z <2 < 2 >3
P- 3 •D5 o►,r p ~2 <2 <Z
P-
P-
P- AA''
PLOT PLAN: Show locations of percolation tests, soil -f and the~BAnensiwas of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and showe i cation on the 0161, Tan. Show the surface elevation at all borings and the direction and percent
of land slope. LOY
SYSTEM ELEVATION "
S -Z Z F S / _SV"~57Er1 E+-eVIITI&J-: r
~I
,
E
"SCALE
E..X-~►M+IlQom-' f 1KEG r
L
r
--callow D
,
I
A t;
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAM (print): TESTS WERE COMPLETED ON:
RAIN ~Y N~saN Jo NSo►~Sc.,,~v v- F-E$ , /94
ADD ESS: CERTIFICATIO NUMBER: PHONE NUMBER (optional):
CST SI TURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
L
`RUCTIONS COMPL.ETI" rf. FORM 1 - SB - 6395
To be a ct=rd accur tt YOU!, rep< Iacie:
1. Compi, ` i : `scription;
2. The uses- dust clearly whether thi ',idea e or commercial prc.Dgec;t;
3, MAXIMUM of b- ',0mry`ercia1 j;
4. Is this a nevv or
5, complete the . A SITE. IS SUII,' FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTFI 1T BASED ON SOIL '-ONDITI NS;
6- PLEASE use the abl -evict ions r~ h ere for vvr itrn .r-iptiboris and cm 'ng the plot plan;
7. MAKE A LEGIPLF diagram accu locatir-g yoc.r .stions, Dra,-6ng Lo s is preferred. A
separate sheet may be used if desi• <
E3, Make sure y€:D.Sr bEa;DCI r,rark and v vatio l reference _ "e arly shown, and are permanent;
9. Complete all I--opriate boxes names, addresse i data, percolation test exemp-
tion, if tap; ,
10. If the i fo ;Ir as flood {3;.. =orn} does not N.A. in the appropriate box;
11. Sign the f4 ~ , your curl i yor.rr c" nurTiber;
17. Make legible cc and distribute as ALL SCE '`aTS MUST BE FILED WITH THE
LOCAL AUTI4ORITY t ITHIN 30 L AY !"OMPLETION.
ABBREVIATIONS FOR CERTI '-'`L TESTERS
Soil Separates and textures - nibols
Sly 3edrock
st: _ StorrE, (over 10"4
cob - Cobble ?3 - 101 SS -Sandstone
Gravel (under 3") E rrmestorf>
g:
G r,,,. r•
~s _ Sand
CS - Goa; se Sand
rrnd s Medium ;land
F:nc Sand F :1
1. Sand
4
Lc a! n
1.
sc;' C I ,nm f, E
sic! l L mot rlr
sr: Clay ~a ...witil
sir. Silty Clay -l' - few, fine, faint
~c Z ~ )orTirnon, coarse
Pt Many, medium
rn Ick. distinct
p proiTa
f A W L Higl, "
Six ,it textures J
ICJ ~si:JC>saI BM Ben.;
VRED Vertical lerei F
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 Hermit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority its order to
obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction.
So- Hn I ~1; `I ¢ ,r C h r y ~I I ~J c~ cl . L o't
S y
1 QS.25 L•113eras(B~~kkea) Q ~P4~~ s(-}Qs~ 9S,zs
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c` 8, I1h - s Pl K F IS 6" F I M -r-R E E
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REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1
05%18/92 13:01 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/20/92 AREA: JT
Activity: A9200113 5/20/92 Type: CONVSEPT Status: PENDING Constr:
Address: HUDSON 34.29.19.1351,NE,SW,34, CHERRYWOOD LANE
Parcel: 020-1281-40-000 Occ: Use:
Description: 149267
Applicant: MILLER, SAM Phone: 386-2769
Owner: MILLER, SAM Phone: 386-2769
Contractor: STROHBEEN, DOUG Phone:
Inspection Request Information.....
Requestor: MIKE MCDONNEL Phone:
Req Time: 13:05 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
I
Inspection History.....
Item: 00012 FINAL INSPECTION
JREPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1
05/18%92 13:01 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/20/92----AREA: -JT--
SELECTION CRITERIA
INSPECTION DATE - 5/20/92
INSPECTOR AREA - JT
REQUESTS SELECTED - 1