HomeMy WebLinkAbout038-1166-30-000
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AS BUILT SANITARY SYSTEM REPORT
OWNER i LE~iJ GU/nrich' id TOWNSHIP STY-~i~
SECTION T N_ ,f W 1 6'4 K- .
ADDRESS 4277 ~-z~r~itl -7k. ST.--CROIX COpNTY, WISCONSIN
SUBDIVISION a) ~fl SIZE..
PLAN VIEW ,
SHOW EEVERYTHING- WITHIN lijia FEET OF SYSTEM
I
- M D
W
3 !30 Qec o a0i
.o s
-1404Aia.- AT
e 7'
121" A-~r~"C'7~•-
INDICATE NORTH ARROW
BENC~Q~l►RB:Elevation and description:, - ` ► S~
Alternate benchmark 16y
SEPTIC TANK: Manufacturer:, L~E rt t~ 1"t~Liquid Cap...f
Rings used: in--Manhole cover elev: c-'Id Final grade elev: > v
Tank inlet elev.:Igel --Tank outlet elev.:-`Z? No. of feet from nearest road: Front.,., Side , Rear Ft.
From nearest, prop. line: Front , Side , • Rear'~LFt.
No. of feet from: Well Building. •
(Include this information in the above plot plan)
(Z reference dimensions to septic tank)
493 REVERSE SIDE
PUMP CHIIMSB~t .
Manufacturer: Liquid Capacity:
-Pump Model:Pump/Siphon Manufact.: Pump Size_
Elevation of inlet: Bottom of tank elevation
Pump on elev.:_,Puap.off elev.-.-Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front, Side-, Rear-
Ft.-Distance from: Well Building
SOIL ABSORPTION SYSTEK
Bed: Trench: Seepage Pit:
Width: - Length ~j~~_Nur:ber of Lines:-.4---Area Built=
Exist. Grade Elev. Proposed Final Grade Elev.
Fill-depth-4o-top of pipe-:---;2
No. feet from nearest prop* line:Front , Side , Rear.~Ft. 2z
No. feet Prom wel 1: _Z.Z__No. feet from building- 2
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
Alara.Manufacturer:
INSPECTOR: 'T ~.i,r~',~r✓
DATE : PLUMBER ON JOB : X45
4LICENSE NUMBER: /9 2i>~>~ ~ /~E
let
6/90 : c j
"x9nirt ST ncus ry IE 28.31P~IVATE ~E~AG~SYTEM' 142ND County:
Labor and Human Relations INSPECTION REPORT ST_ CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
,GENERAL INFORMATION 175667
Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.:
IC ELMAN EILEEN STAR PRAIRIE
I Tax No.:
Parce
CST BM Elev.: Insp. BM Elev.. BM Description:
038- 66-46-000
TANK INFORMATION rELEVATION DATA A92 0328`x Of Z
TYPE MANUFACTURER CAPACITY STATION BS HI F ELE
Benchmark8djo
s Cb~
Septic
A rf
Dosi
Aeration Bldg. Sewer
Holding St/ Inlet 778
TANK SETBACK INFORMATION St/ FXOutlet 37 e171
TANKTO P/L WELL BLDG. Ventto ROAD Dt
Air Intake
Septic > NA D
Dosi NA Header- - C)el
E~V
Aeration NA Dist. Pipe 9 -iy 9%,0/ /
a,?d
Holding Bot. System ' 9 , oe
PUMP/ SIPHON INFORMATION Final Grade $ ~l6
Manufacturer Demand ,6Z ,
Mo Number GPM
TDH Lift Friction stem TDH Ft
Loss d-
Forcemain Length Dia. tlt~owello
SOIL ABSORPTION SYSTEM
BED/TRENCH Widths / Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
LEAC G Manufacturer:
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM
INFORMATION Type O /1 Z7 ~ ~ ~ / Z~ CHAMB Mo el Number:
System: /-10 /s 6, R UNIT
DISTRIBUTION SY TEM
Header"Aai~,+ ~ Distribution Pipe(s) r x Hole Size x Hole Spacing Vent To Air Intake
-7
Length D . Length brelf 6kia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over `f r Depth Over 'pry Irxx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center 7i .3Z° Bed /Trench Edges 49 -3Z Topsoil El Yes El No ❑ Yes [I No
ICOMMEPTS: (Include code discrepancies, persons present, etc-)64-
V ofI ~ r a
Plan revision required? ❑ Yes PITO
Use other side for additional information. 112-10919Z
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
S
t
DILHR SANITARY PERMIT APPLICATION couNTY
In accord with ILHR 83.05, Wis. Adm. Code
~ swwn~rrv
~ ~eanw,ue.sw,~
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 Z7 `7
8% x 11 inches in size. c k r sIo o vI us appIication
--See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY O NER I ( Z?PERTY V/4 TION
, S
C e~ h'I ~-hv T N, R 2~E (or )o
( r~
0j/
PROPERTY OWNER'S MAILING ADDRESS LOT BLOC #
3 3 /Y a
CITY, STATE g ZIP CODE PHONE NUMBER SUBD NA SM NUMBER
11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
AGE S ( J
❑ State Owned Q VILL
k%N OE 1Pd N2_
❑ Public 91 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX N M ER )
III. BUILDING USE: (If building type is public, check all that apply) d3~ _ rl~G 3-
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 13 ❑ Other: Specify
IV. TYP OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 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
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
REQUIRED sq. ft. PROPOSED (sq. ft.) (Gals/d y/sq. ft.) (Min./inch) Z nELEVATION
Feet y Feet
Vil. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank o /
Lift Pump Tank/Si hon Chamber E
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans.
Plumber's Name (Print): Plumb 's Signs re: (No Stamps) P PRSW No.: Business Phone Number:
le, J . ~~L 2 r 7/-S -G ,3~?, sZo
Plum is Address (Street, City, State, Zip C
Z 3 ~ " Q 9::) 4/7 -'1 ~e r, , _ ) ~ ~ e r, f, it Je S
IX. C TY/DEPARTMENT USE ONLY
❑ Disapproved sa ary Permit Fee (includes Groundwater ate Issued Issuing gent Signat a (No Sta ps)
,4'Approved ❑ Owner Given Initial 6Q Surcharge Pee)
Adverse Determination IIAV)
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R.11/86) DISTRIBUTION: Original to County, One Copy To: Safety & 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 6e 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 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.
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 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 muss: sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8'f 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 r= rding.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property F _N1 ` ► e-~ r,'
T.
Location of Property Section g , T__:~ t_N-RW
Township .9-
Mailing Address
Address of Site LA' ev um .
Subdivision Name
Lot Number 3
Previous Owner of Property
Total Size of Parcel C--3.9 Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes- No
Volume q sq and Page Number 13 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) cmajy that att .6tatementz on this bonm cute tAue to the but ob my (ouA)
knowledge; that 1 (we) am (ane) the ownen(.a) ob the pnopenty ducAi,bed in this
.in6oAmatlon bonm, by viAtue ob a walvcanty deed neconded in the Obb.ice ob the
County RegisteA ob Deeds a6 Document No. 1/$ Srj1/ ; and that I (We) pneaentty
own the pnopobed site ban the sewage dus pops system ( on I (we) have obtained an
easement, to nu.n with the above ducnibed pnopenty, bon the constnucti.on ob said
system, and the same has been duty neconded in the Obb.ice ob the County Register ob
Deeds, as Document No. Q A1*7 1.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
9a
DATE SIGNED DATE SIGNED
QOCUMENT NO. S'1A' E DARK OF W16JU:t~ SI-N FW A'1 1 *a
WARRANTY DEED
485947 VOL r'A13
REGISTER'S OFFICE
This Deed, made between R c t,~~.rc~. -a---Ai5 Z•-an4•- • ST. CROIX CO W11
...P ..w :.f.4.,..-as..~.o n
c Rac'd for Record
t.x>ax~z
- - Grantor, JUL 16 1992
Xman-..•--.......--•---•-•
and. .
at M
10:45 A.
................Grantee, $"4W V L,~~l..t"Jr.
WitneSSeth, That the said Grantor, for a valuable consideration...... R08ister of Deeds
RETURN TO,..
corrrevB to Grantee the following described real estate in S ......GY:41.7
County, State of Wisconsin:
Tom Parcel No:..••-------------------------------
Lo t' 3 .
e f Re d Pine Estates, being located Southeast 1/4 of the Northwest 1/4
of Section 28, Tuwus}',ip 31 North, Range 18 Wcst.
Tl2iS 15..110 T homestead,. property,
(is) (is not)
Together with all and singular the hereditamenta and appurtenances thereunto belonging;
And rantv__x_
warrants that the title is good, indefeasible in fee simple and free and clear of encumbraucea except
I.
municipal zoning ordinances and easement: of i-euul-d
and will warrant and defend the same.
Pate s day of ........3U1y----•-•--•----............_..........., 19,.g
------._(SL.A,.L)
* r J. ier
' .......(SEAL) ..................(SEAL)
:t
Diane M. Wier
AUTHENTICATION ACKNOWLEDGMENT
KEATE Wi' 4C1 ' 11iT1$i?~{
Signature's)
MINNESOTA
h
authenticated this day of. - _R11N"................... ...County.
19_ Personally came before me this f Ql .day of
Ju1y------------------ X9.9 2., the above nantod
Richard J . Wier and
Diane M. Wier
TITLE: MEMBER STATE BAR OF WISCONSIN
- - - -
(If not,
authorized by $ 746.00, Wis. State.) to me known to be the person 5.,......., who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAF'T'ED 6Y
BAKKE NORMAN S . C k~---• .~~1.__:G~.~c~d.~!!~"~
New Richmond, W1 54017. *-----------------------------Ramse county, .f..~CMN
Notary Public y
state expiration
(Signatures may be authenticated or acknowledged. Both MY t1--io Permanent. Of nvtr t
are not necessary.) date !
a x:
NOTARY FU'0UG-Wdd%M
*Diaw" of persona signing in voy cspnritir shmild be typed of printed bviow tacir s2xnatur HENNEPINCODUNTZi~'
-TJAC.
19AR>EtANTY D>819D f3TATFORM No WI5982 51N ~ COR1:1~~Y`. fi~~o eRa Milwsulces;
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STC - 105 r
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• SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
t ` d
OWNER/BUYER 1 1 e e r W` H
ROUTE/BOX NUMBER ~pqt~. Fire Number
,CITY/ STATE ZIP I.")"
PROPERTY LOCATION:<5F-_;4, SQ ;4, Section?', T3 l N, R, b W,
Town of Vr m'rj Q. , St., Croix County,
Subdivision's fkZ1r\t jg- P_A Lot number.
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
three year expiration.
0
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- ~v
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.
S I G N E Di Q®Q~, ) /~/~1`
DATE /a
St. Croix County Zoning Office
P.O. Box 98.
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
N OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INbUSTRYRY, DIVISION
LABOR AND PERCOLATION TESTS P.O. BOX 7969
HUMAN RELATIONS q MADISON, WI 53707
(H63.0911) & Chapter 145.045) /g0Z - j o2
L•O~ATION: SECTION: WNSHI MUNICIPALITY: LOT NO.: BLK. NO.: SU N YE:
/ ' 4 .,r /T 1N/Rl ( a<'
COUNTY: NER'S B YER'S NAME: MAILING ADDRESS:
5 , lirvi le eh 7 ® Gr f J
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
Residence New ❑Replace Z- A o C! ~ -~~l
RATING: S= Site suitable for system U= Site unsuitable for system
ICDOS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: optional)
au s ❑u s ❑u ❑ s u a s u 72d
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: .,f S Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
4-0 -
13- q
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IM@Mi& AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER D PER INCH
P- 02- 3 1;2
P_ G
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
41-
_~o-
_ e
- '
E~
f ~
~ E
E
i {
3
t
It -A 0
1, the unders 46by cerr that the is reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
AdministrativfAnd that the data and the location of the tests are correct to the best of my knowledge and belief.
4
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
6 eL- cd F-100/_ L3
>
CST SIGNATURE:
6
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) -OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SB - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2, The use section must clearly indicate whether this is a residence or commercial project;
3, MAXIMUM numl - of bedrooms or cornmercial use planned;
4, is this a new or -went system;
5. Complete the 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 veriting profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE n accurately locating your test locations. Drawing to scale is preferred.A
ate sheet: may b_. u< (r-sired;
8. e sure your benchmark :rnd vertical elevation reference point are clearly shown, and are permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box;
1 1 . Sign the form and place your current addre.ss and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED VVITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONFOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - `_St01,(over 10") BR Bedrock
cob (3 - 10") SS Sandstone
gr! (under 3'") LS Limestone
*s - HGVV - High Gror1136 ~'ei r
cs old Pere - Percolatiw',
med s - Sand W - Well
fs - F Bldg - Building
Is Sand > Greater Than
sl Sandy Loam Less Thar
n I3rovvn
sil yarn Black
si -Gray
Cl - ~ Yellow
sc-I - Li am - Red
siel - _r.:.n mot - Mottles
sc; with
src - Silt fft f Jv, f_int
w
c CC - corns *I, coarse
p1 mm - h ..~Iy, medium
in d . c in ,f,
p
HWL -
Six Lures
for nc=;al BM -
_ i,..,l R
160
TO Tl 'q R:
r
a county f?~ a~
y r egUeA
r ~
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REPT131 STAR PRAIRIE ST. CROIX COUNTY ZONING PAGE 1
12/08/92 14:51 REQUESTS FOR INSPECTION WORK SHEETS FOR: 12/ 9/92 AREA: JT
Activity: A9200328 12/ 9/92 Type: CONVSEPT Status: PENDING Constr:
Address: STAR PRARIE 28.31.18.795,NE,SW, LOT 4, 142ND
Parcel: 038-1166-30-000 Occ: Use:
Description: 175667
Applicant: WICHELMAN, EILEEN Phone:
Owner: WICHELMAN, EILEEN Phone:
Contractor: MYERS, LYLE Phone:
Inspection Request Information.....
Requestor: MYERS, LYLE Phone:
Req Time: 09:12 Comments: Q,06
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION