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AS BUILT SANITARY SYSTEM REPORT
I
OWNER ~o~Gcrr~e~^ TOWNSHIP ci~~cG
SECTION N-RZ-C _W
ADDRESS fo /~1 fl ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE----
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYST9M
d ~
~h
~a
°r`
3
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: Alternate benchmark ~Ee- e -7 SEPTIC TANK:Manufacturer: Liquid Cap. ~y
Rings u ed: Manhole cover elev:_.nL~Final grade elev:
Tank inlet elev.: Tank outlet elev.:_,~~.
No. of feet from nearest road:Front , Side , Rear_AFt. gS
From nearest r
prop. line:Front , Side, Rear Ft. .3/
No. of feet from: Well Building: /Q ur g s~
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
i
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:
f ~ _ s
Width: IL Length 7 3 Number of Lines:-?-Area Built
Exist. Grade Elev. Proposed Final Grade Elev. S S
Fill depth to top of piper 1V
No. feet from nearest prop. line:Front , Side, Rear Ft.92,~-51 {
No. feet from well: J` No. feet from building 15- S
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: p~ PLUMBER ON JOB:
LICENSE NUMBER: L l
6/90:cj
LOCATION.' RICHMOND 1.30.18.2B,NW,NE,CO.RD.K
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 149334
Permit Holder's Name: ❑ City ❑ VillageX] Town of: State Plan ID No.:
VARNER, JEFFREY A & SALLY J RICHMOND
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
026100030000
TANK INFORMATION ELEVATION DATA A9200182 2
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 60u,ls Benchmark 301, 0
Ong Z, w$ 0.2. 615
Aeration Bldg. Sewer , 8d lzw- v
Holding St/* Inlet t1 99.8-1'
TANK SETBACK INFORMATION St/j0[ Outlet 5,73'1
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic U) O NA Dt Bottom
Dosin NA Ueeder4-Man 6.3a 9209
Aeration NA Dist. Pipe 9~'
Holding Bot. System 7, fez~ 7 P8
PUMP/ SIPHON INFORMATION Final Grade
Demand S•7 " r
/3~
cturer 7'.
Model Number GPM
TDH Lift Friction Syste TDH Ft
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length r No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 DIMENSIONS
LEACHING Manu acturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM
INFORMATION TypeO ov1 ,n CHAMBER Moe Number:
System: -25 / (3a e1 ~ ( OR UNIT
DISTRIBUTION SYSTEM
Header / ~ r, Distribution Pipe(s) rr x Hole Size x Hole Spacing Vent To Air Intake
Length ~ Dia. i`'" Length :50' Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over r, Depth Over r, y xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Z-~ led 51,1 /Trench Edges 8 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
777,11
C/ "S
,Zzl
Plan revision required? ❑ Yes 21 0 - o ~e/
Use other side for additional information. o ,
SBD-6710 (R 05/91) Date inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
I
1~__1L R SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /
8% x 11 inches in size. Check Y!,,?9Vp: 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
C_> r,17 e/^ WY4 S T p, N, R E (or
PROPERTY OWNER'S MAILIP#G AD PRESS LOT # BLOCK #
CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
-40/7 / r)2116 37
II. TYPE OF BUILDING: (Check one CITY L NEAREST ROAD
❑ State Owned VILLAGE
❑ Public N 1 or 2 Fam. Dwelling- # of bedrooms EL Ax NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply) V Q ® a
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 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 120 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.iz New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5.0 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 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
~ REQUI ED ( q. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
11
IG 5 `t - L~O /~g/Feet /0"IraFeet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank ~Q
Lift Pum Tank/Si hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber' nature: (No Stamps) MP/MPRSW No.: Business Phone Number:
PI e s Address (Street, City, State, ip Code):
x,1L L/ er i .sy- DO
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuin A e o 55taff iiM>
Surcharge Fee)
Approved ❑ Owner Given Initial
Adverse Det rmination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6396 (formerly Pib-67) (R. 11/68) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber
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 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 pumpec oy 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 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 in line A. Complete 'ine 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 aid/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, drawr to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains1water 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.
s
SBD-6398 (R.11/88)
STC-100
This application form is to be completed in full and signed b
the owner(s) of the property being developed. Any inadequacies
will only result in delays of the permit issuance. Shoulthis
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 tk)=F"V A , SA2L~
Location of property IVWI-14 E114, section 1-36-18 T N-R W
Township PI Ct4mA
flailing address 12h. K 7&-cb I/J
i
Address of site
Subdivision name G S' yf-,
Lot no.
Other homes on property? Yes
X No
Previous owner of property -71-)i//ia rm & ell
Total size of parcel_
Date parcel was created q-22-g9'
Are all corners and lot lines identifiable? X
Yes No
Is this property being developed for (spec house)? Yes No
Volume ~~~r~L "
Land Page Number -l. = as recorded. with the Re
of Deeds. gister
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARIUVI.I'Y DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & THE SEAL OF THE REGISTGIZ OF DEEDS.
certified serve In addition, a
y, 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 statem
best of m ents on this form are true to the
y (our) knowledge that I (we) am
the property described in this information f(are) the owner( orm, by virtue sofof
warranty deed recorded in the office of the Count a
Deeds as Document No. 4141(. o '-7Z- Y Register of
o~:n the propose and that I (we) presently
d site for the sewage disposal system or I (we)
obtained an easement, to run the above described
the construction of said system, and the same haso bee y' for
record pd in the office of County Register of deeds n duly
No (o ~j Z Z as Doc
• nt
s gnatur of ap cant
4r
Co-appl c nt
5!
Date of Signature
Date of Signature
.
li
DOCUMENT No. WARRANT it DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BEAR OF WISCONSIN FORM 2-1982
4.6 ,0 2 VCL 891 P W627
•
William__L..__•Buell-__and__ Gail__S_.__Buel_l_,______,__ - REGISTST. CRERER'S O. OFFICE
FI
-husband__andl__wfe-- as __survivorshp_.marital ,
Recd for Record
property... -
- - at JAN 3 01991
conveys and warrants to 9:00 A. All
.._Jleffrey.-A.... Varner. -and --Sally_.,I__..uaxner-------------------
RegiaterofDeeds
-
RETURN TO
-
the following described real estate in S----t--.-.• C _ _ro i•---x ___---.-----.County,
State of Wisconsin:
Tax Parcel No:
!
l
I
Part of the Northwest Quarter of the Northeast Quarter JNW 1/4 of
NE 1/4) of Section 1-30-18 described as follows:
Lot 1 of Certified Survey Map filed September 22, 1989 in
Volume 8, page 2153.
TOGETHER WITH and SUBJECT to a 66 foot private roadway as shown
on said Certified Survey Map.
ii
r tV4~
J f .rA. - F
This ls_______________ homestead property.
n
(is) (is not) i!
Exception to warranties: municipal and zoning ordinances, easements and
restrictions of record.
I
- - day of January -----------------------------------1991_....
Dated this - f E Y I~
-----------------------(SEAL) (SEAL)
Willi_ am L.,7Buell
-
--------(SEAL)G!i(SEAL)
j -
Gail S. Buell ~i
li
AUTHENTICATION ACKNOWLEDGMENT
I
i
Signature (a) STATE OF WISCONSIN
ss.
ST. CROI-- !I
- T - y County.
authenticated this day of..._.•.___•---------------' 19...... Personally came before me this 2_......_2nd ..-__day of
January 19. 91 the above named
William L. Buell and Gail S.
- - -
Buell, husband and wife
•
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by § 706.06, Wis. Stats.) to me known to be the person S__.... who executed the
forego' instrument and acknow a the same.
}
THIS INSTRUMENT WAS DRAFTED BY
t
llCr~~_ e -t-
Judith A. Remington
- - - - Patricia A. Rohow
REMINGTON LAW OFFICES
New-. Croix j
RlchmQri,r1,...~Z..--•---..5.~0-1-7 Notary Public S-- -t-. •---•-------•----•-•---..__County, WIS.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date:
*Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No. 2- 1982 111ilwankee• Wis.
,,.ww..w..v-~R.4•axa~r)wwMt"';.'S.!f'.`FY...:P
3 5 8 sLS
4 51 19 SEP2.Z I13
vNELL 2
CERTIFIED SURVEY MAP " CIO-
!h PART OF THE NW} OF THE NE} Of f(I]ON 1,730N, R18W,
TOWN OF R1CH40ND, S1. CROIX COUNIt, Wls,'ONSIN Q
r NP OWNER
'ei, °ounty Sectir, corner monument aluminum cap in concrete Lloyd Peterson
Rt 3
• 'r T 1De f ound
New Rieh'mend, Wi.
5401
o run pipe weighing 1.68 pounds per linear foot, set
~--it exist;ro fenceline Ep
swamp `BT.CROIX~
C1E+1E3~1S1V1 , •
A1rE)
NJ corner l'7~•t1
NE corner
Section 1-30-18 TH "K" ' Section 1-30-18
_ _EAST 308.26' d c north line of the NEI_
405.00' 275.26' v 1939.31'
i EAST
I - - - o 242.16' q~ e 6-
LINE DATA TABLE
o o
C
i line bearing length
CERTIFIED SURVEY C> LOT -L
a - b S00°23'47"E 55.00'
I HAP_v_,t,_Q9=1~~~ 'E i
a - d WEST 33.00'
o A% b - c S00°23' 47"E 78.15'
CD w b - e WEST 33.00'
\ o b - g WEST 66.00'
0.0O' 325.00'
EAST 405.00' >t 1 = e - f S00°23'47"E 78.38'
477.25° - y WES 33.00'
g - h S00023'4711E 78.61'
w 1 / i'~ • o 1 - j S62°49' 19"W 167.84'
66' PRIVATE ROAD j - n S6204911911W 59.88'
M. i, o k - 1 S62049'1911W 103.57'
X 1. ' w i a- n S6204911911W 227.72'
Z' In
' n r9 o I¢4 ¢p r I - j WEST 72.25'
1 N ~
' rt Z O
0 CD Ic m- o S62°49' 19"W 227.72'
LET 2
II I ;a p - t S0003010811E 253.92'
i m Q. q - s S00030'08"E 253.34
o o ' I I existing house "
~ ~ r 1o r - s EAST 50.431
;0 ME
s t EAST 66.00'
I ~ N 00 ( S
I lD
d f S00023'47"E 133.38
I o IN
171 7' _ 422.59' - d - e S0002314711E 55.00'
` `WEST 711.9' r N SCALE I N FEET
Cr, / 200 100 U _-.or
Bearings are f^f er e,.ec c
nurtt line a' tre NE} asc;
LOT to bear [AS'.
~pt1.03J7; ^e,
ya.
`r, n
cr ,j
` w t $0V,;.- I
ti
.Sr en r"1: tYi 4T'<- w°r C
.
t It
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNE UYER J,,57F7=,-,?V 14
ADDRESS: (.UU A:f z /qi. &JZ44PAP uJ/ FIRE NO: /Uv!- /4W; l~~.~ce
LOCATION:-A/ IiV
1/4, /I/ E_ 1/4, SEC. N-R W,_
TOWN OF: C /-fill 0 ►J ~ ST. • CROIX COUNTY
SUBDIVISIONS LOT NO.
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 b t
Certification form must be completed and returned s to Wisconsin DSt.
Croix County Zoning officer within 30 days of the three year
expiration date.
SIGNED: L
DATE : C5- L41
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
- - -
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
TOWNSHIP/ LOT NO. BLK. NO.: SUBDIVISION NAME:
LOC ; ION:
, SECTION: on
NE /4 1 /T 30 N/111118, W Richmond- n/a n/a n/a
COUNTY: OWNER 5 B E: MAI N ADDR S
St. Croix Wm. Buell Box 189, New Richmond, Wi. 54017
USE DATES OBSERVATIONS MADE
NO. BEDR : COMM E IPTIO DESCRIPTIONS: FIzR A ESTS:
®Residence 3 n/a RkNew Replace 11-8-90 n/a
RATING: S- Site suitable for system Us Site unsuitable for system
M ENTINAL: MOUND: IN-GROUNDU TEM-IN-FILLHOLDING TA K: RECOMMENDED SYSTEM: (optional)
® S ❑U [as ❑U .0 S ❑U 1:1 S ElU E] S ®U In-ground pressure
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n/a
under s. ILHR 83.09(5)(b), indicate: class 2 Floodplain indicate Floodplain elevation:
,decimal' PROFILE DESCRIPTIONS page 28 CoC2
BORING TOTAL DEPTH T R NDWATER-INCHES CHARA TER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGNTSf- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-1 7.75 none X7,75 ..67bl.1. .75bn.sil. 1.83bn.s.sil. 3.00bn.m.s.
101.37 1.50bn. ve hard s.l.
.50bl.1. 1.50bn.s.sil. 2.75bn.l.s.
B.2 6.75 101.19 none >6.75 2.00bn.ve hard s.l.
•58b1.1. 1.75bn.s.sil. 3.50bn.l.s.
B-3 6.75 101.36 none >6.75
7.49 101.41 none >7.49 •58bl.1. 2.58bn.s.sil. 3.33bn.l.s. 1.00bn.v.h.4s 1.
B- 4
B- 5 7.25 101.35 none >7,25 .67bl.1. 2.00bn.s.l. 3.08bn.l.s. 1.50bn.very hard
I S.,
B.6 7.01 101.06 none 1>7.01 .67bl.1. 1.67bn.s.sil. 2.67bn.l.s. 2.00bn.s.1.
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME -DROP I A R L VE -INCHES RAT ES
INUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 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 97.81
I E,~j
I
0
- - T
i I I t ~ b
_T_ 1
r1(_ J12)
_ r.. I .
IRV
rah' T~~~L _ I I I _ I i► '
1, 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.
NAME print : TESTS WERE COMPLETED ON:
Ga L. Steel 11-8-90
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave., New Richmond, Wi. 54017 2298 71 -246-6200
CST SIGN E:
av-
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
. PLOT PLAN
PROJECT el UQrr^ e~ ADDRESS >
1 /4 e 1/4/S /T O N/Rl W TOWN
< COUNTY
MPRS Byron Bird Jr. 318 DATE - -
BEDROOM CLASS PERC__:r2_-CONVENTIONAL
IN-GRO RESSURE
CONVENTIONAL LIFT MOUND_ HOLDING TANK
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
A
116 BSORPTION AREA PERC RATE BED SIZE
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark
:Z12 -
❑ Borehole Q Well Scale = Feet
0 Perc Hole System Elevation y7
Uent
12" Gradp
TYPAR COVERING
2"
12" 3' 4 6' 0 3'
Ilr- 6 " Sewer Rock
12' Gd
3y
per ' I~ 7
I
I ~ L~ , 13-5
2r ~"6 I'
'6`
b
l,~y h `'0
~d~ ro
REPT131 RICHMOND ST. CROIX COUNTY ZONING PAGE 1
08/ti3/92 16:49 REQUESTS FOR INSPECTION WORK SHEETS FOR: 8/14/92 AREA: JT
Activity: A9200182 8/14/92 Type: CONVSEPT Status: PENDING Constr:
Address: RICHMOND 1.30.18.2B,NW,NE,CO.RD.K
Parcel: 026-1000-30-000 Occ: Use:
Description: 149334
Applicant: VARNER, JEFFREY A & SALLY J Phone:
Owner: VARNER, JEFFREY A & SALLY J Phone:
Contractor: BIRD, BYRON JR. Phone: 268-7616
Inspection Request Information.....
Requestor: BYRON BIRD JR. Phone:
Req Time: 13:08 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION