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Labor and Human Relations WI 53707
(Attach Soil Profile Locatio ,~ja~p - To Scale - On A Separate, Signed Sheet) Madison, Z
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HOMESITE SEPTIC PLUMING CO.
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6S5 O'NEIL RD., HUDSON, WIS. 54016
ROBERT ULBRIGHT
r!S. MASTER PLUMBER LIC. NO. 3307 M.P.R.S.
r !r*I. INSTALLE1 & DESIGNER LIC. NO. w~ I
Additional Remarks:
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MI
Other Site features:
` CST 0
Limiting facto(viDepth: CST Signature Date Signed Telephone No.
SUO-03301N 01/90)
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SEPTIC PLUMBING CO.
6s1 % O'NEIL RD., HUDSON, WIS. 54016
ROBERT ULBRIGHT Y
:NIS. MPSTER PLUMBER LIC. NO. 3307 M.P.R.S. ~ O
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MrNN. INSTALLER & DESIGNER LIC. NO. 00663
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3, 4o'Irl AS BUILT SANITARY SYSTEM REPORT
~iP /yRS IP4A-) 101A S1111- -7-° 11
OWNER f~ TOWNSHIP
SECTION T Z" N-R W
,Ole
ADDRESS 6 ST. CROIX COUNTY, WISCONSIN
SUBDIVISION' LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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See SQ`~ c la 7- /f A.~
RgNAL INDICATE NORTH ARROW
BENCHMARK:Elevation and description: /fl G/DO.O '
Alternate benchmark
SEPTIC TANK: Manufacturer: co.v~,PtTz" *-_Liquid Cap.
Rings used: Manhole cover elev:fyl',Pl Final grade
elev:
Tank inlet elev.: ;F5. Tank outlet elev.:
i
No. of feet from nearest road:Front 17, Side , Rear Ft.
From nearest prop. 1 ine : Front /G~, Side , Rear Ft .
No. of feet from: Well Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
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PUMP CHAMBER
Manufacturer: Liquid Capacit
Pump Model: Pump/Siphon Manufact.• Pump Size
Elevation of inlet: Bottom tank elevation
Pump on elev.: Pump off ev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from rest prop. line: Front-, Side_, Rear_Ft.
Distance om: Well Building
SOIL ABSORPTION SYSTEM
x
Bed: Trench: Seepage Pit:
Width: f Length Number of Lines: Area Built Z g3_ &~yl
Exist. Grade Elev. O Proposed Final Grade Elev.
Fill depth to top of pipe: Z
20 9 '
No. feet from nearest prop. line:Front , Side , Rear Ft._
No. feet from well: No. feet from building
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom
Elevation of inlet:
No. feet from nearest prop in
j., ip Pe
, Rear Ft.
No. feet from: Well , building , T1tarest road
Alarm Manufac er:
INSPECTOR:
DATE : O Z Z PLUMBER ON JOB:
LICENSE NUMBER:
6/90:cj
Hv^i.`-SITE SEPTIC PLUMBING CO.
665 O'NEII_ RD., HUDSON, WIS. 54016
R01=ERT ULBRIGHT
VIS. MV';TER PLUMBER LIC NO, 3307 M.P.R.S.
I ' ~i!.EI? & fOES'GNT:I? LlC. N0. 00663
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J HO? ESITE SEPTIC PLUMBING CO:
655 O'NEIL RD., HUDSON, WIS. 64010
ROBERT ULBRIGHT
w7A 7•Yp4-t ~1 A qjS. MP7ER PLUMBER LIC. NO. 3307 M.P.A.S.
► *-Jnl IM . "At, rn u DESIGNER UC. NO, 00662
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`Wish',Co il~partmentOot lndustfy$ -19 .873 , NE NE LOT 2 HIGH RIDGE DR • Count
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Labor and Human Relations PRfVAYE SEWAGE SYSTEM
Safety and'Buildings Division INSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 171492
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
KODESH DAN TROY
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/l1D , O /j_0 . D Sll , 0-5 C s~ 040-1194-20-000
TANK INFORMATION ELEVATION DATA A9200258
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic e l1 C , q~ 0 Benchmark /J0,5 y /60"
Dosi ng
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic S l f l NA Dt Bottom
Dosing NA Header/Man-I g a 3
Aeration NA Dist. Pipe
Holding Bot. System `
r a,e I s
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Len th / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manufacturer:
SETBACK
INFORMATION TypeO CHAMBER / model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over 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`1 CJ-A- V~ M - 3, ~ - y cn e~t Lti
/ Cl I ~ l-4"61 I
Plan revision required? ❑ Yes BIN"o
Use other side for additional information. ~U oZ Ic I ell& I!J,~_
SBD-6710 (R 05191) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:{' ,
i
~ILHR SANITARY PERMIT APPLICATION COUNTY
~In accord with ILHR 83.05, Wis. Adm. Code?
STATE SANITARY PERM
-Attach complete plans (to the county copy only) for the system, on paper not less than ky/ 4
8'f x 11 inches in size. Chec if revoon to previous 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
D^ A.) /~4/~E✓! N4- Y. Nom'/a, S y T 2R, N, R E (or&.J
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
&'3'7 ~vw7R s"o~ L~
ITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
9soN w~. S'4~oe G 3 esys-/ ff i6-A /R I P 6-F eo L R T
II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD
State Owned o VILLAGE : •T/'20Y~, Aloe .
,MW QF
[R I ❑ Public 'W1 or 2 Fam. Dwelling-# of bedrooms _ PAR
CEL TAX NUMBER(S)
111. BUILDING USE: (If building type is public, check T11 apply) d 0 Q
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
40 Church/School 8 ❑ 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. IX 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 420 Pit Privy
13 Seepage Pit Pressure , 43 ❑ Vault Privy
14 ❑ System-In-Fill 76P
VI. ABSORPTION SYSTEM INFORMATION: Ole S/'
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERe. 6. SYSTEM ELEV 7. FINAL GRADE
D IJ REQUIRED (sq. ft.) PROPOSED (sq. f.) (Gals/day/sq. f.) (M' in./nch) g/. 7S . ELEVATION
o -760 /.2- a i 94•6 f Feet /DO, -5* Feet
CAPACITY
VII. TANK in allons Total # of Prefab. Site Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank ZOO /
Lift Pump Tank/Si hon Chamber e
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's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
mR-r u b)e eAT 1,; 1330? U6 9/c?
Plumber's Address (Street, City, State, Zip Code :
655 o''vieu- ,e ~{v1~Sa ~v~S Sys/G
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent e o Stamps)
pproved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination ~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
f
INSTRUCTIONS
1. A,,Sanitory 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 installati:QR-
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every2 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, SOS-266-38.15.
To oe-complete-end,accurate this sanitar}Y 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 i's 'to be inst411166, . ' _
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 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 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;-bErilding sewers. ,,Wells; water mains/water service;
streams and lakes;, Rump 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 sizitig information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) fora number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-,`.
' s
water contamination investigations and establishment of-standards.
SBD-6398 (R.11/88)
S T C - 100
I
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 /ji1
Location of property l/4 ~1/4, Section TAN-R1LW
Township
17
Mailing address
17
I
Address of site
Subdivision name ~/11_;150~. Lot no.
Other homes on property? yes No
Previous owner of property
Total size of parcel.
Date parcel-was created r ,'7 <
Are all corners and lot lines identifiable? -Yes No
Is this property being developed for (spec house)? Yes L -j-0
Volume and Page Number 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. y.6 , % , 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 County Register of deeds as Document
No.
Signatu a of applicant Co-applicant
Date of Signature Date of Signature
T05~18~199Q ilt16 '
DOCUMENT NO. ( sT+~'rr: BAK OF WiSrONSIN PORN 1-- IM ~i aMr~ aaaawtlrr apt
'J! c'' If WAl1RAMTY DIED
I~ This Deed. made between in San Wang Ind Katen..5.,..
44
I) Wal>g, h4Rband end. wife as joint tenants ♦
MAY l 9
j _ Grantor. '
anc 'DUA .el J.-Kodesh and Carolyn A.Aodcah,..huvband ~ a
and. wife a!arvivoubip maritn3 property I 3:30 P.
jf _ Crantaa, II r
~i Witnefiseth, That the said grantor, for a .aluable consideration
t~ conveys to Grantee lhu following descrAted real estate in - St. Croix
comity. State rf Wisconsin'
i Lor 2. IIJKh Ridge Court in the Tuwa of Troy.
~I Tax Pared No:
1
1 -
I
1.
.j
'J'.:is :aGC - ).~r•c.Ued propcrl~ ~s
:ogPt; aJ all and m:nguhtr t`.. Lt ltditamentr and ayportenanct, theseuntrt bo!wiginl;
.,att Va!;g aitd Kattn S. Wand
•,I,r~ t r.,.. t I P r. J Vl , ^I.ta.. ~►.i. in fet a I m p I nrld !rEC w.1 clvar of oncumbranres except
a _1 .:'P:`' F :]r;l 1'c'. rl,•[ f V14 t ]P~t.l .1, Jf arly,
I w r.; ; r„ 1 •!pftn~ the aanlr
day of
fir,
(71, in Sar. Wang v ki
lr
i AL. R9tt•1 WAt~
+
A IJTH9NTICAT10N ACKNOWi.11DOWUNT
u n~ r STATE : OF tlilel(Nf!!iM ] i
M.
CountlI.
a , i,Pr.t:ca'• _ .ti do) r•f iP I er, . htfr, a n•a this lki ..Am 4
il8j.... , 19.92... area aNW am"
Chia t)an. Wan and 14asn..9,t..Nsns....
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• ! k~.'+n r he the p^rsnng whoata0Y1MM1
in., o -o wnvnt and uAnowlwaa the osaw r
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S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER BUYER
ADDRESS
-FIRE NUMBER
CITY/STATES ZIP
PROPERTY LOCATION: L 1/4 , X Z--1/4 , SECTION- , T ~ Y N-R_~W
TOWN OF St. Croix County,
SUBDIVISION
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 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
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 Co. Zoning officer within
30 days of the three year expiration date.
SIGNED:
DATE: St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016
Safery a Buiiwngs Division
vvisconsrn I,epartment of industry. SOIL DESILKIPTION REPORT P.O. Box 7969
Labor an4 luman Relil,tiofss (Attach Soil Profile Locatio ap - To Scale - On A Separate, Signed Sheet) Madison, WI 53707
c- ~t) page / of
S va wuon Date ' wrens un Uw or '119w live over Partnt Matena
4 wtomerName 'D
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Mk MRS P am eeatron
sumate • owett ro~ water ~ ~
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uttomer r.u SiOE GN, f~UDSo J lu/ . $ 4-'0/
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UcJ-r/Q/~ yttemloa urgRatem a on$PirPe( ay
ounty err aru 0 40 2 -rR N G4^S p
j .5 T, CdOI X { O f 7-' pe en bpeR '-'''JJ FFF I '1
Lot legs suripLOn ysteQcometry an Dept %O
Ali F, 5ce- 4, T a O , R 14w Txa.~ of TRa/ P -
Structure Remarks: clayskins Loading
Horizon Depth Dominant Color Mottles
in. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consist nce Roots Bound ores Hand other GP2
0-& to ye 3/3 ye
Y X Y = S/ O yh t vf,~ 3f s , S
G 3 y- ~f Y/z S/ S D G 5~ S "
flEZIAr,0,J l5%Y'o
-
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Structure Remarks: clayskins Loading
Horizon Mottles .
u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bounder ores Hand other GPD/ft.
16_ 34 5ye
44,
rMu 13
715 W 4A1
PPROtC -
This test site A
oil -
-
Structure Remarks: clayskins Loading
Horizon Depth Dominant Color Mottles
In. Mun ell u. Sr. Cont. Color -'Texturr Gr. Sz. Sh Consistence Roots Bounds ores H and other GPD/
a 7
41-5
132 ,y
- s s ,tM~ - s
C 1_ 7s YX sle"
S::; /E !/mot % oti /OQ OS
I'
Ii. Structure~ - - - Remarks: clay skins Loading
l i Horizon Depth Dominant Color Mottles
In. un ell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bounder ores Hand other GPD/f
4-u ye 2/z, F O S yk y
2 -so -7 clam .S o,
C
I~I C z o-IGY, ~s f//' 4/ s , 5 ~,.Q S
~i
Y
Remarks: clayskins Loading
Horizon Depth Dominant Color Motu*$ Structure
In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bounder ores H and other GPD/ft.=„
f
f
J 131, 2-1-3 /Q 2 4 ~S D, f~' U f S '00
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f HuAESI-i E SEPTIC PLUM61NG CO..
63L O'NEIL RD., HUDSON, WIS. W16-
~ ya'Z
s
ROBERT ULBRIGHT
ifs. MASTER PLUMBER LIC. NO. 3307 M.P.R.S.
, v, i r'TAf F I 1 & DESIGNER LIC. 110. f108fi3 - a
t-' I ti , nrrv-t 1
~ idditionall{tmorks:
7Xe,,vai -5- 1 le 136K
X71 S ?-r~ r' g c)T ~'o o S !o t~ ~ ~ ~,o Sim- /o.~ o G- Tom`'- a~ -
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Omer Site Features:
l S t 9~L1 ~!S , 3 ~6 -q0/?S y y~
?'r~ limiting fectorslDepth: CS] Siyn:,turr D"tr signed Telephone No. - «CST M
i Ulu b130 iN 0VIM
ser, 1 PVC pipe
5
57 /0
a
This test site APPROVED
for a conventional septic sYst
SEPTIC PLUMBING CO.
NOp!;rc~TE
6,05 O'NEIL RD., HUDSON, WIS. 54016
ROBERT ULBRIGHT Y
WIS. MASTER PLUMBER L►C. NO. 3307 M.P.R.S. o
MINN. INSTALLER & DESIGNER LIC. 140.00663
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135
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- - HOMESITE SEPTIC PLUMBING CO.
855 O'NEIL RD., HUDSON, WIS. 54016
ROBERT UL BRIGHT
VVIB. MASTER PLUMBER LIC. N0.3307 M.P.R.S.
MINN. INSTALLER & DESIGNER LIC. NO. 000
r
g7
- y'?~.
Fresh Air Inlets And Observation Pipe /,puJ
Approved Vent Cap
Minimum 12"Above
Final Grade
4" Cast Iron
Above Pipe -
i Vent Pipe'
`to Final Grade
Synthetic Covering
min. 2" Aggregate
Over Pipe
Uistrlbution 7 yI Tee
pipe o' 0 0 0 0 ,
Co Aggregate 0 Perfbrated Pipe Below
Beneath Pipe o Coupling Terminating All
Bottom Of System
Fresh Air Inlets And Observation Pipe
i
Approved Vent Cap
Minimum 12" Above
Final Grade
7'
Cn " Above Pipe - 4" Cast Iron
"To Final Grade Vent Pipe
Marsh Hay Or Synthetic Covering
Min. 2" Aggregate
Over Pipe
Distrlbution~ e e,, Tee
.Pipe 0 0 0 0 0 ,
"Aggregate a Perforated Pia Below
Beneath Pipe P
-Coupling Terminaf~ ing A
o At
Bottom Of System
REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1
10/26/92 14:17 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/21/92 AREA: MJ
AcIfivity: A9200258 10/21/92 Type: CONVSEPT Status: PENDING Constr:
Address: TROY 4.28.19.873,NE,NE, LOT 2, HIGH RIDGE DR.
Parcel: 040-1194-20-000 Occ: Use:
Description: 171492
Applicant: KODESH, DAN Phone:
Owner: KODESH, DAN Phone:
Contractor: ULBRECHT, BOB Phone:
Inspection Request Information.....
Requestor: ULBRICHT, ROBERT Phone:
Req Time: 434-14- Comments : /t~O
Items requested to be Inspected... Action Comments Q20 ~ a Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION