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HomeMy WebLinkAbout040-1196-95-000 I a 3 C) o v), I r' I x z ~ v L ~ U O C N i c i M i Y ~I U Z a C L M LL = (d Q O) T.7 p CI f p z OO C~ d Z C 04 a CO O z d v z d o !A F- 'r' O y y, a c N 0 0 o pN hl -O a C Q 9 Q O Q O Z H Z Z C) N to 7 d Z! O N £ > w U io L CL m w Y `V ° O O a ° E z ;7 N fn VI !5 WJ 2 In I N ~ O O O I •rv a a a 0- 0 ,p 0 Sc. I N N M ~ p W to r c) = rn rn } _ co o p p p T O O ~ J ~ N Q } :G M d ~ J O O N C O _ N O C C C O O p ® C U O O ss p O l0 't O N N N Q. p 0 O W C Y O- a '6 N O 6S p O N C O O W H >O N L L 'O a) (D 6 C'4 (n d' 2 O r T U • ' t L O O f O -7 Cn O i y V d rm a _ - L: a 0 o o C in o 0 a m 0 XTION: TROY 4.28.19.894,SW,NE, LOT 22 r4-aboropotl consin Department of industry, PRIVATE SEWAGE SYSTEM County: tand BHumauildinngs Relations Division INSPECTION REPORT ST. CROIX ty an (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 149323 Permit Holder's Name: ❑ City ❑ Vlllage)f] Town of: State Plan ID No.: DERNOVSEK MATTHEW V & WENDY TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: A~ 040119695000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z~ Benchmark 6'' Dosi r , Aeration Bldg. Sewer Holding _ St/Ht Inlet 3 ZS a~~' 4~' TANK SETBACK INFORMATION St/ I Outlet 3,- TANKTO P/L WELL BLDG- AirIVent tnta ROAD Dt Inlet oke CO- y7 i -,~SDr r NA Dt Bottom Septic Dosin NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand <7 z Zza 17;2 Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length , No. Of Trenches PIT Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING =nufarer: SETBACK INFORMATION Type O on u/_ i CHAMBER Model Num System: re_ri >/a >Ao OR UNIT DISTRIBUTION SYSTEM Header / n Distribution Pipe(s) r .r r x Hole Size x Hole Spacing Vent To Air Intake Length o2a r Dia. Length (PS 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 4ae4iW Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present etc.) LI 9.3C 7, s3 Plan revision required? ❑ Yes [o J / Q Use other side for additional information. 0 J SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: f s AS BUILT SANITARY SYSTEM REPORT If OWNER ~ z~:T .02fk TOWNSHIP Ybw~ SECTION T 2 Z-N-R--Z`W ADDRESS wmL~ a~ h/G ST. CROIX COUNTY, WISCONSIN SUBDIVISION J~`~~► t-ofv 'T LOT R'~- LOT SIZE 'd cGCr~S PLAN VIEW SHOW fVERYTHING WITHIN 100 FEET OF SYSTEM o to a G~J~ O `I k i INDICATE NORTH ARROW San ,e aS' l5- BENCHMARK: Elevation and description: Alternate benchmark ,z/'uic- ' SEPTIC TANK: Manufacturer: m '~we3T Liquid Cap. la C Rings used: Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road: Front , Side X- , Rear Ft. Ag-9,11 From nearest prop. 1 ine : Front , Side, Rear Ft . /li!Dcpt"+- No. of feet from: Well SD" V-- , Building: l "y' (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 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: Length Number of Lines: -J_Area Builtz-r Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: ` .14 No. feet from nearest prop. line:Front , Side, Rear Ft.: S No. feet from well: 13-ad- 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: ~3- 6/90:cj SANITARY PERMIT APPLICATION NOUN 7DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than El Q 8% x 11 inches in size. c eck if r vi n r ous 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 No- 7-t- Z2 e a s: c- 4) '/4, S T.0 N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ,C a 'G s®,✓ ~cJ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD IIC~II4 ❑ State Owned ❑ VILLAGE ~~mt ❑ Public L1 or 2 Fam. Dwelling-# of bedrooms PARCEL Ax UM ER ) III. BUILDING USE: (If building type is public, check all that apply) ©,c/r D _ 1 / Q~lr 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ 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. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. LRCl New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 R 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/day/sq. ft.) (Min./inch) /Q4,$'a EkEVATION Feet Fee r (t /Olt Q'Q U Zd 'd _15- r . O d • VII. TANK CAPACITY Site in allons Total # of refab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name P oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank K+ I Fj F] F1 F1 F] 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) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 7 d IX. CO NTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ' ary Permit Fee (includes Groundwater a e Issued. INo S rcharge Fee) 44'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 & 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 perrnit 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 owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. If. 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 i' 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 3% 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) STC-100 1 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 _N G-fthp_yj V. f' We_Y h- ~'rncv5eK Location of propertysl~/ 1/4 6 _1/4, section' T 2L N-R_J_~_W .Township Tv_ Hailing address 106 MUr14 Crpi Urlve #L ~Soi, W~ SZ~a11, Address of site 5(r L n Lakie (.JSon WI J'/Q Subdivision name Irk ~tdGe (~ur~ ~S~1~dd~ 4~0►~ Lot no. a~Z . Other homes on property? _yes ✓ No Previous owner of property _Br'ia~ ua, BILK+(t aq Total size of parcel A9 acre5 Date parcel was created 6f & Al )97(o Are all cornors and lot lines identifiable? -IL-Yes No Is this property being developed for (spec house)? Yes ✓No Volume and page Number j `7q as recorded. with the Register of Deeds. I1dCLUDE WITH THIS APPLICATION THE rOLLOWING: A WAItitA ITY DEED which includes a DOCUMENT NURDER, VOLUME AND PAGE. HUMBER & THE SEAL Or THE ItEGISTLtt 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 ny (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( &1lee , and that I (we) presently o,,:n the proposed site for 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. 41gg tur e of 'a licant p~ Co-ap 1 cant Dte of ~.gnature Date of signature DOCUMENT NO. it WARRANI?Y DEED T1,18 SPAI;E RrSERVEO FOR RE6OROING DATA !1 STATE BAR OF WISCONSIN FORD 2 -llei 46SLIX0 VOL S~ ra~►1~'q - REGISTER'S OFFICE - ST. CROIX CO., W1 ...Brian ..E. Haag and Tamara. R....Haag,_f/k/a- Recd for Record .Tamara-. R.. -Bartlett s APR 191991 C1 11:40 A. M conce an<i <~arrant to Matthew V. Derno.vzek rid enidy K. ~Dernovsek, , husband aril wi~e,. . Survivorship Marital Property Rpkk►ofDssds RETURN TO ` the following described real estate in .__St.-, Cr O.IX .......County, State of Wisconsin.: Tax Parcel No Lot 22, High Ridge Curt Fi_ 3t Addition in the Town of Troy, St. Croix County, Wisco.sin rftarv5 ~eh s 5 !O PEE t; k r 1 is not hantcAead property. (is) (is not) Exception to warranties: easements, reotrictions acid ri(,hts-of-way of record, if «ny. p l.f r Dated this 18 dagof I1r)1'1 ] 91 (S E A L) 1 (L r (f (t Brian E. H Tamara H. l+.aair (Sf:A 1.) trEAI.i I AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE. OF WIS(.'u1SIN Ss. _ it Croix 1'uunt;. authenticated this day of. 15 Persowilly canto bt-fore rile thta 18 day of Ar> r i 1 11.0 the :,hove naroe.i I1'r1ari E:. iiaaf~ and T,-Amara H . 3 ifq'if* TITLE: NTENTBER STATE BAR OF WIS(•t)NSIV (I f not.. ~~y to authorized by Y 706.66, Wis. Sl:,t~-) to roe I:nn.c•n Y Pip the t•• Iron , ul a cxi-vated the Z ont' in.•tfnfi~ It :,nr! ar61~,~1,,1~t, liar ~:u,t. t\ ; INi7RU ME NT VIA' C)Ft =.r1rL 1 T Z of 4~7 4,1-. d l . 1. , J~J 1 n t i1L (Intl t 1 ,1)00 Al I ct: I p t,r 7 1 I 7Ii t l t Ii nZ i. 1nt 1'ul,llr County, wiS. (Sir natures may 1w aufix~ntu• . d .,r .u•6nt ,~lc•1;rI• i. Iit„h \l ) .nu.u-:inn r~rQFli~T not, slat" eet,:ratioo an- not nrces;ary.) -1-) ' 3) darl•: ~ 1J *Names of I,rr-R, >iKnmx in any eai- t1 .'.,1 1.. to r 1 1 to .1 'I i ~ n•.:~, .u WARRANTY D1 F0 ~TAT1' It It I,F \l 1400% -TV N .n 1 w:•I 1 t'. - SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER_ ~G.i~he W V Wty~cly Jai. ~~+'~cVSeK ADDRESS: Lur1dV Laic -4"aSoh W1 57401b __FIRE NO: 50 LOCATION: S W 1/4, ~(E 1/4, SEC. L4 T U N-R 0 W TOWN OF: -Troy ST.•CROIX COUNTY 0 SUBDIVISION: - G Wd8410)l LOT NO. a{Z 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: ~.._~`1~C~~~~ DATE: O7"/~- C'~. St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 ti~w. GO STiP uc Tio~ - Q t,P t2 AA Satet & Buiiurngs Division SOIL DES~KIPTION REPORT P.O. ox 7969 Wiicon in Department of Industry, Madison, WI 53707 se-5 7 file L tion Map - To Scales O On Separate, Signed Sheet Labor and Human Relations Page of (Attach Soil Pro 3 urrent Lan Use or vegetative over Parent Maters s 0 urw~s~ uauon Date 9'P'¢ssES' ustomtr Name P fNp E-R No uSEK Y- ~e/- 9 2- V,44,f "T i°t rT y F P am evat.on Mf} sumate a owest rou water ~ l0 AY A, N ustomer teas Z 1f psDn! W!. 5t106 //p M,9417- 7Q ~ ystem Loa mg w a m a om Per p. Ft. Per ay ounty Z / r -~0 F_ T (2 E N G(ti S ST Cieo I X as arcs No. /-0 7, y c o v,e 7` ope an As ~ Pie 'rj 4k qlj f yuem eometry an Dept /O %D Lot Lega Descnpaon CI f~i a,- 7;e 0/ 5'QA P 'C ! Remarks: clayskins Loading se nce Roots Bouta GPD/11.2 Horizon Depth Dominant Color Mottles Structure res Hand other In Munll u. Sz. Cont. Color Texture Gr. Sz. Sh. Consiste e • S Z s vex Y ,AA01 S 7- p y /0 yK 31 z Ix A), 9 57- /32. ye h1(Q ye 516, fs D f, S M, ~ ~ s g icy !2 S ~ STEM D T h D / 00 !j 1 - - Suucture Remarks: clayskins 'Loading ores Hand other PD/h.2 Horizon Depth Dominant Color Mottles In, Munsell u. S:. Cont. Color Texture r. Sz. Sh. Consistence Roots Bound oex y >3 ( _25 /o Vie 3// 51 fie Zf Sh,C -)1A/5 SroeA74- Ito - 10V 516 /.v .fit/lam- ~ oc,r a Structure Remarks: clayskins Loading Depth Dominant Color Mottles Horizon In. Munsell u. Ss. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bounda ores Hand other GPD~. In yie ~rv► 2 2,wt s S o-/s /0 Y,e Z// 0, c, s /o ye 51 0, ,e .>r ufe 2 l of S f3 ~ yy y~ ~o g o yif 416e 13 ~ ~/Ev~t%•o.v X02_. 7(° ~ ` Structure Remarks: clayskins Loading Horizon Depth Dominant Color Mottles Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. qj-c Roots Boun Sr ores Hand other GPD/ 2 jy, 12 -1~ /D YX 3/ y - S 1, f 56 k 2f S - I f~~ zS-y~ /0 I/R / f5 /6 Y/e 4/<v f $ C~ f , y2 S aG~~ TS °F i o ye S/4~.Q I APPROVED - C/irfk~.r1A-) /076,0 ~ for a conventional septic system. Structure Remarks: clays ins Loading Horizon Depth Dominant Color Mottles In Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bounda ores Nand other GPD/h.2 a-/y /o ye 2/1 s I L f, 9~ ,►~.e z 5 • s /3 y- 2 /o YR 313 5 / 0/m, 1 .,r 7r~e I f ~ s liiols T C V 9 /o -F; 15 Of 9A n~►,~- i s CoN+~~N s , ac Ts aF ~o yR f HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 5018 ROBERT ULBRIGHT AS. MASTER PLUMBER LIC. NO. 3307 M.P.A.S. ',,-•!N. INSTALLE71 & DESIGNER UC. NO. 00683 ~ ~1JC~ '4 Additional ' iniiks: ~OGK GZ~~ - /USf~I/IEJ2. ~dVG~ hAUE` TD ?lSt` d2 F-I. ff ~ i2Gct.PJL~ to 215 - -r,~~ti s a v y ~/IL- awn o x laic r`R1i3 r1°-~ A 7- t7~PTGt S , !'ES/(rev ~D>4Di'N 6-- ~/E4 T" Other Site Features: s~ ~ PIP 5 N~E 1 y~ 2- Data Signed Telephone No. CST # limiting Factors/Depth: tST Signature SUD-U330M 0140) L 0A Di,v (J- ~e4 TE- o` , G ~F 0 2 T'e E,,,) d,,- S 2 GU 4 QARM I+oME , fD4& so. 4+. _ s u ~ e sT E t7 -PT C& Go ,v f /'j OR 40 a • T~ 5 3 TEST Itk6lt CN e,4 A 5 r1C /iV Is y - S I E U AT Q) A.) S S / 5 T E "-A U~f- Ti o.Us yti.es r 746N e-e, Z T3 ne d/E- a Z . 4p O 13 0~? s / 9.130 102,-7 4 0 w .esr T~ f /a j3o~E ~ 7.G6 SEE PI-07- Pt,,-., . I S 1it~Ct l7 O u T" I 3 O ~ i fi4U-•+r~ S ~ rte"" I pj~ • o~ z3 0 pp~ox . ~ 5 0 i SMA/~ U I/~ Tie E i~ NA N 3~Z cu, ri~ 13,',eo pr ~2 ttOVSE. tihiL ~'S / ft(3ov~ cjiP~9DE. E1Eu~Tio~ OF A)A dZ Re pt,ACCAACA)T A KEk S~,E SPECi:t-~ % No TES X30 Ck -A `,3\ o~ 1 • 30 ay , , , = ,13144 ftiaE- 101•7-5 i z4 a j This for test site App ~ no'rt) a conventional s.trr H, # str I'll" nuc P+'p..e- I" AfS00 J P- Ap LUG/FT O L/[~Q~~ ~ lA. 1 4 pos 7- . 40T ~/Ev,¢Tio v - /o L9 D I HOMESITE SEPTIC PLUMBING CO. 665 O'NEIL RD., HUDSON, WIS. 5401 Z ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC, NO. 00663 SrKtd Our p~ . 3 a f 3 TOp OF ~90/U PP~°1` 5 0 /'ti 514AI/ pop/.rl 711?eE Gu i%1t. T3 %R D I+o u $ c' . ;V h i L I'S (1L t} ~3 o v E ~j ~P O D E, 6 l£ vA'rrv o f x tiA~~ 6p 132- A pt.~tcEM~NT KEA- NOTES 35 s ~ ~ 30 SAGE 111-30 i4l y `r i - A D E D F~'D • s - Foavt7 .P~ I T3 M . $ S t T' y " PUG P I' -l A (3 00 tL 6hE9 o t--- S!`~ T ~ r A pE L o --,4 r.co Z/&,O E e f cAte-Q N . "T 5 f •jE~ t c f.Q.M~ Ji1) X r To i o spo5 r S. u7- G/vim > M r°°~ E/EV,47-4 l /0 O, 0 Fo u,v p s cu S a e VC yo R ' S L or ' /lfo,v ► Ty ~X 7- r'D RAW- . s~ L 1 t&to p~sT--, ~ HOVESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 5401# ZyBL ROBERT ULBRIGHT -c 6 WIS. MASTER PLUMBER LIC. NO. 3W MAR.& " MINN. INSTALLER 8 DESIGNER LIC. NO. 0001 4 1-07 s~~cvti L~- ~ y -sue 1 5 rtffeO our- , A j' 3 o f 3 23 , v pox . l 5 0 7-90 8 Z IVA; i "Al S, f,►ii papi~t~e 7V eE Guilt- 73"A'o "wsE. rvhiL I'S !7.~A(3ovE rjiPgDE. ~I~uhTr'ou of x A,,A 52- RePLACEMrA)Y' A I;EA- ;t-~ s~E sPEC0 NOTES I) 0 5 C ~'Q 670 ~ J \ \ • 30 3 ~ ~ r /3AG/c'yDE" ~D~'TS y I 16 f A O,E 55 33 Fou..,D , .PSI r I ~.M.$~ ( StT~ I yrr P VG PP-t I" A OU>= 9 Sr'` -Few't I' A DE . L r, cf Tco Z/tiDE~' -F~ 5~ ~J N f bo 7"_ ,V 16~ X 7- TO 12 ~rQ S f ~ ~ c. f F.~n.c~ i S' bps r (S. <~T GivE" M r°J~ N i F°u,ln s to 5c jeu{yo R'S L o T- Me. r p~ rr p%~ ti C-X T TD / tk / ~4 ry I et pos T--. W~ i HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, VVIS. 54016 2WP2ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.& MINN. INSTALLER & DESIGNER LIC. NO. 00663 11 - ftl C ,j ~4 f~ " m Zi wof° o L z v r i~NNNN~~~ n C ~;6 N I ~ wi b STAB v o p ^ y, A o z - r - - - = r ss. oo ZD ° *D 0 e • m M. , Z v, Oo Dr rn mr m i co w 2 tp (D N_ m m r to z • D v m W : C 190' G) M m - r- p p z G) G) O Z Z NO°23'E~ ro r- N mN ODs m N Z mo pm _ r- 160.00 ° -10 ZZm No z v m mm `gyp 2 Co ~ ~Z W m m 8m .5~ z e w~" - co to G) m x r _ m -13 - - I' 66 = v N N ,01 N Z N m m Y z (oOD `-4 ~I _ a cn i 3: ° v~ w r e` `rs. ~s o ~ o m-4 -n r :0 257.56,• 1~ \ m zN vF~ 8= Z m OD LA D D r w O -7 m o n w D \ a) mz z It -4-- X r - D~ • le p i • • - t_ z m -I Z z Tm y N w_ O <9 C U) N D D m 0- _m OD W p- - - 9 N x► m r r :O -(AU(Aw D .c b O W N _ N lA O p z M z pn O w co N - G) 0 ~sF o T 8 O z tT D r ,m p v -i G) N. N m N o n m w -410 (n rn ti O~ y'0 m D 0 _Ko -.cp • m CD p. OD.N_ gyp 0 o v m m (b U) O Dm~ N m D a 9 wN o~0-< p : n Oar Z O~~ /000 W D N D m LO co o i m w n p 5 I2.98I S7046141 E z 0 O w N 2E, Z -4 rr a. y C e y T~~ ~P /QW o w - . -74 5 L 139 rv` i ~G s o~ r3 ~ 1~ ~6 J ~a 00. j Taor,4 or F e, e j) REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 07/,1.7/92 08:31 REQUESTS FOR INSPECTION WORK SHEETS FOR: 7/17/92 AREA: MJ Activity: A9200169 7/17/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 4.28.19.894,SW,NE, LOT 22 Parcel: 040-1196-95-000 Occ: Use: Description: 149323 Applicant: DERNOVSEK, MATTHEW V & WENDY K Phone: Owner: DERNOVSEK, MATTHEW V & WENDY K Phone: Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121 Inspection Request Information..... Requestor: BILL SCHUMAKER Phone: Req Time: 15:07 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION I 1