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HomeMy WebLinkAbout040-1207-50-000 I v° o p bo, `O 54 O N 4 es N I C : N d ~ I r., O O O O O l N CL N O N N ~ C Z in U. c C N N _ N O E C L G 0 3 ~ v ~ Z N (1 l Z 0 0 v 2 Z - CO d N CL CO z I 0 z v c fn F- c y '0 D) a) co Ni O O ° • M~Vy, d U -C U N S C _ ° O\1 0 ¢ 'Q O Z F- Z Z o N I E N N ? d _ d E C 0 CL M 0 N w N ~ a~ O d o~ 0 cn (n (n N F-' F- F- m 0 0 0 0 2 •rv M; Of a a a CL g Y n J O N (6 0 a) m } <n U 3 co n o _ o M O ~ E r 5i 0 o Y mi d v ~ N ►i N N C O N C rr\o °o U Z) in 00 Ln I- C: E O o a' o Y c• ~3 C: O O O T O C C O O 0) :3 'vr N C LO N 00 1: 00 0 ~I N T N N y N cO CO O L• L V O F- Z O N Z w O ~ I r. :E E r \ x E N V m 'co L a 7 k 5 i a r E ` E 3 'o © U a o w u Q o !I -0 0 o 3 0 o a I C O ' C p OU N .C N N0O wj C p s 7 n N L 0 C 0-0 3 o y N Q L N r O 3 y U y o O ~y O w O L - C U C y ~ 3 O ~ ~ y c m 04 C: 3: C Z o > cYi h U (0 L o E 0 _ o L 0 o fl" w z O N C N O N N C 7 m Y E Q) L N LL C O L C U~•~ C_ p f6 3 N N m Q O O C U O N Z y E rn Z O Ft z O d N ~n 04 a co ' o O Z it ce - h d Z to F- N Z c E a N O N N N C • p L a - 0 0 o Q Q w ~Ozzz N z C:) LO '0 N > l6 E N C CL O N W c = d L -0 0 O C0 = c o a c Z 3 3 E a o O O O Z • ►r,i o a a a a ~i riw o O N U) J p U O ` a) 0) \ Z N "O H ~ m d CU (n < LL 'O d Q Z J? m c N C -0 -0 1J R{ O m N N D co O m o aD c c U Q 00 c >1 -0 L N 3 J Vi C N O _ C N N C O ap F- : 00 CO O O N O O U • y?,~' O r O N Z Z U) r`O w £ a a 0 CL "on A ps a O co 0 L) FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER eP ilQ V VeP I N~ S TOWNSHIP Q SECTION ZTN-R~W ADDRESS WQ S SOd'i ~ Y1 , ST. CROIX COUNTY, WISCONSIN 't"Jer A/lS syvaa SUBDIVISION ~Ia, LOTS' LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ig t boo t `X 1w ~t rehA e S Sc 5 a w b %V[ tl 'gee, INDICATE NORTH ARROW Lin, ta .0 BENCIiMARK:Elevation and description: .,0 lo 3~aL pv Alternate benchmark ) SEPTIC TANK:iianufacturer:~s~ CQ$~` Liquid Cap.b Rings used: 3 Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front- , Side , Rear Ft. d0` From nearest prop. line:Front,, Side Rear Ft. '106 No. of feet from: Well> ~S , Building: /a I (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: X Seepage Pit: r ~ Width: 5 Length ,6I) Number of Lines: Area Built 4d Exist. Grade Elev.Proposed Final Grade Elev.-4h Fill depth to top of pipe: 36 7 No. feet from nearest prop. line:Front Side, Rear Ft. 5i No. feet from well: 7d 1 DO 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: 30 r 6/90:cj LRC oTIg PartmTentOof Inau6 -y28.19.979 NW, NE LOT 25 OMAHA RD. PRIVATE` SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and E~uildings Division y'- (ATTACH TO PERMIT) Sanitary Permit No.* l ENERAL INFORMATION 180285 Permit Holder's Name: ❑ City ❑ Village (X Town of: State Plan ID No.: NELSON, KELLY C & KERRI K TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 10: 1 i i6A nk q 5 C - r 040-1207-50-000 TANK INFORMATION ELEVATION DATA A9200366 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic ~CL ~QC7 Benchmark a U, Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 5,50 107,q4 TANK SETBACK INFORMATION St/Kt"OUtlet d Vent TANK TO P / L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic >1601 l a' NA Dt Bottom Dosing NA Header/ Man. 9. I 0 3, u t . ~ 5i e Aeration NA Dist. Pipe 91 s c./ y to, to a.iay Holding Bot. System s o 00,y PUMP/ SIPHON INFORMATION Final Grade ;q b °o y . Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length HDi Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DD DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O / ► v r ! OR UNIT Moe Number: System: jull ✓ 2 ~6 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/Tr nchCenter~~ Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) .1I?,OCATION: TROY 16.28.19.979,NW,NE,LOT 25,OMAHA RD. Plan revision required? ❑ Yes ❑ No - Use other side for additional information. 1/7 q SBD-6710 (R 05/91) Date nspector's Signature Cert. No. hh- e ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: p r SANITARY PERMIT APPLICATION ~'DILHR In accord with ILHR 83.05, Wis. Adm. Code couNTY -~v 3 -Attachcomplete tans to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. Q~ Q~y1 Ch if revision to pr~s application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY WNER PROPERTY LOCATION tc U,I 0 1 % E%a,S 6 To ,N,R/~' E(o PROP RTY O NER' MAILING A DRESS TJ.~S LOT # BLOCK # Wass C~ STATE ZIP CODE PHONE NUMBER SUBDIVISION AME OR CS UMB R oaf wee 5yq 11. TYPE OF BUILDING: Check one CITY : NEARESV OAD ( ) ❑ State Owned O VILLAGE : 5a 4QWjjWN OF: NOF ❑ Public [X 1 or 2 Fam. Dwelling-# of bedrooms L A X NUMBER( ) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo c~ v C. 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 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 130 Other: Specify IV. TYPE 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.E] Repair of an P-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 300 Specify Type 41 ❑ Holding Tank 12 Vq Seepage Trench ~X/OO 22 ❑ In-Ground 420 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) wvo07,5 ELEVATION 6 o © Qa0 46e) L-3D iF'o?ifap. 5 Feet /oAD, -1k y Feet VII. TANK CAPACITY . Site Fiber- Exper. in allons Total # of Manufacturer's Name Prefab Con- Steel Plastic INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank e7~U Wf S P Lift Pump Tank/Si hon Chamber El El F1 Ej I Lj F-1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er's Name (Print): ~ M Signature: (No Stamps) M SW Business Phone Number: ,I I Qs G✓4h -3D 3 / S S~' Plumber's Address (Street, City, tate, Zip Code). g &e IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu' AgentSign Stamps) pproved ❑ Owner Given Initial Surcharge Fee) 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 r 1. A sanitary permit is valid for two (2) years. 2. Your-bsanitary 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 youronsite sewage system, contact your local code administfatbr 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 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 o1 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) ' A i t S T C - 100 This application form is to be completed in full and signed b the ot;71ier (s ) of t1le 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 Location of property of propertyl/4 1/4, Section o;( TN-RW Township p trailing address Address of site Subdivision name /011 for Lot no. Other homes on property? yes---,_~-NO Previous owner of property Total size of parcel _ 0?.)/, Date parcel was created NA Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes -'No 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 i th office of the County Register of Deeds as Document No. ~y o, and wn the proposed site for the sewage disposal t system ) orr Ie(we) obtained an easement, to run the above described the construction of said system, and the same haprrty, for so been duly recorddc~ e office of County Register of deeds as Document No. sign a n tuyr p lican t co-appl cant (I Date of Signature l ante. STATE 0~0 N 4MIMI 4 Dennis R. Schultz ands hetwewt _ a each in their.+oi►ri' O rd Kelty_ Nels-pn and .Kerr•.-!C„. •Nelson- 12:46 as marital survivorship property,... ~ a how~ arante~ - v~~~.. Witneseeth. That the said Granter, for a vah"k aoaaideratien f CONVOYS to Grantee the following described real estate in St . Cro i x "Tuan h C. M. ByS County, State of Wisconsin: jiP.0. Box 167, Riv*r 'Xi 14422. f Tait Parcel No: I . i Lot #25, Glover Station Subdivision. i . ~0.0 i~ This . 1 S.. not......... homestead property. s;, i IgOxi[utt~E) it Togethar with all said afagNiar the hereditansents and appurtenances thereunto belonging; t DenB}is-.R....Schultz and C. M. Bye ' warreats that the title is ~ good. indefeasible In fee simple and free and clear of encumbrance except municipal and zoning c-dinances, easements for public utilities, and building restrictions, if any, and will warrant OW iN~ Ne same. ' Dated this day of November 90 (SEAL). (Eta►L)*................................. Dennis R. Schultz ; t; .(SEAL) (SUL) C. M. By E AO?BISNTICATION AC=NO W LSDOXXXT a+(s) STATE OF WISCONSIN St. Croix .....................................County. A' sWeatieated this ........day of ill...... Personally came before me this .....FA-day of NQY.C!$b~ il.9Q.. the above asaW Ag.~tlls R.....Schultz •and...............:........ G.f...M~• BY.e................. TITLE: KRUBEt ITAT! BAR OF WISCONSIN (If ask audnerisad by t 'Me.Oi, Qis Slats.) to Rw known to be the Person who eaeeufad tM . • • S , foregoin inacrument and acknowledge the same. THIS INSTRUMENT WAS COAFTEO air C., M..:. By..e..... Sandra qg.... _ Y....................... _ s• . Attorne at Law Notary Coup WIL aft *0 u'be authanbeated or acknowledged. Both my Comm A a+ arknt. (if not, State. espfr date: Cr' , ` 02101000 of Mnw "nn4e n" ""r ao.efttr dpulA M bfd or prkwod b@A- tWdr dsw.tu►w. '4,,~ CIS. ' p+' aa..~ ice. t - tt~t fMRIG N~,, , SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 1 OWNER/BUYER Sd ADDRESS: Lcr ~l` RE NO: LOCATION:_ ~(~tJ 1/41 1/4, SEC._ _lh T PN-R_A' W, TOWN OF: ST.-CROIX COUNTY SUBDIVISION: ( ~l er LOT NO. (2=51 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: v Y ^ i DATE: ~G St. Croix County Zoning office 911 4th St. Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP,O. BOX 7969 N WI 53707 'HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: CIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: NW 1 N~ 1/4 16 /T -4b N/R V7 E (or N ~-Vuz-=y z S - GL-OV M 311t-P oN COUNTY: MAILING ADDRE56: USE DATES OBSERVATIONS MADE IRNO.6 DRMS.: COMMERCIAL DESCRIPTION: R New ❑Replace Residence y N, A )Q)-1-90 7N,A- , I ~ S- Site suitable for system U- Site unsuitable for system RATING: CONVENTI NAL: MOUND: IN-GROUND-PRESSUR EM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ®S.EJU ❑S ❑U ®S ❑U ~S ❑U ❑S ~U z'C4~x►ct{f - erteN s'x)oo ~oNc If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: t-K-SS Z Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T GROUP DINA W-INCH S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBS RVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 C 1 1 8.0 )JNV L > q -7 S p>►~ G E 2 o f 2 B. Z Q L lou , e > 4 6 „ B- 3 time ~q.o > loo B- 95 yon- O > g 8 It B- 5 01s Zo3.s > C1 B- :i PERCOLATION TESTS •}i DEPTH , WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTE TEST f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PER INCH P- I~•A• P- F- 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. ~l~p+~- Q~ "Rl~' P- SZ gv~Z~t li OT- SNmitE CO)L PL*x .S C3~ 98. S SYSTEM ELEVATION S,JoZoo.s ®gb.s -WI o R , B` OF << _ i - oy I o s4 s1 w, , w *rT L-401 T in d 77 i ~ .s TH { t- r, B y I_M , I _ r c~ s^ s Lek 016-a- see 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 nd the to tion of the tests are correct to the best of my knowledge and belief. WEGERER SOIL TMINU`~ NAME print : Alqa TESTS WERE COMPLETED ON: DESIGN SERVICE 1~-t-qo ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): P.O, BOX 74 421 No MAIN ST, O-ST 00Q, S-?(o 11 S- y 2.S- 0 ) 6 S RIVER FALLS, WI 54OZZ CST SIGNATURE: 715-425-0165 9'0, \a6 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBO-6395 (R. 10/83) - OVER - pR 6~ 1 Of. Z SOIL DESCRIPTION FORM (Attach d Prof 110 a On a Su orate Shee ~fGE'R.1 N ..SON LINMB RATE: 3, o kw~~,v uC- N SLOPE: 1z'l 16 o1u J=bg )-o RLP - plwr-BUR L I.J E6 ~S'tM ASpFCT: DAYr 19 913 CURRENT LAND USES F "--~t> - COUNTY/STATE ST C- \ ~X ~AJN~T'y VEGETATIVE COVER: Gc \ss Lo CRI ION., Lor ZS GLou(zv- S-m-pr4t'i DRAINAGE CLASS: i 't'phJ /J Of= U GALLONS- PER 39. FT. PER DAYI O •6 D PARENT MATERIAI(s)/ P SOIL SERIES ~U~-\'~ RpT~ SPtT~.E C4M PLeX 9QU CLASS HORIZON DEPTII MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PII -BOUNDARY REMARKS G St. $hP COATINGS 6 O --1 Ib`f M 31 - :5L 2, 7-Zfo P. 316 - L ZrnS bk ~h 3 Zb-3Z, 7.SyR_ 31 S dG►- s M I. S 32-9-1 IC -10t.3 ^ S o S ~ z s 1. ) ~ m var. ~ s b lOy~ 313 2 -1 S lD`tlZ All - s l 1 S 1t m h S 3 1S -zb low! R %i /V f - s' 2 »T S bk 14 ~ h si owl. C.S y U.\"F- 316 - S O s M l~G 3 0--1 lb~fv- 31 - S >r rn v'~ c S \0`72 5// Si ( zn►sbk m`F►- sl~'s~~ 3z_yS 1~`ttZ l6 - 1 s • 1-93 bK m cy" S yS-lcu 1%~M t 316 - S 3 ht 0 - s' l P 1 m`r s Z 7;-151 to7l Y! 90 -3 g o g nA o S --1 lb`j R 1 - S 1- M U r: C's V2 -2;Y Zb' IR Yl s 1 1. ab *7 iu-Utz-sy23 I s l 1`Fsbk My h , _ cs S L) t _9S 1 b`1 [Z 31l S u s •n OTHER SITE FEATURES/NOTES: JO-1-ga 000s-16 i'~6~?oF? LIMITING FACTORS/DEPTH: Signature Date CST N t not H Cl) ON i ' L. ty D Cl) J Lr) { ''r 1 ..awl i M aJ VR ! f R4 J \ X" i f_' r" ray ~ ~ ti ~.v o J Ar~ t'1 t~1 N U 1 r O .Y ' ~•~-ri ISM-- IR d j~. 12 _ 1 c{ V 40 i) I oto: - _ D p - '.iii♦7~1ii,.ir""1 r1 co ~•i r I p Y ClJ r f p s IBC 0 C ~ r p f4fl r^ ,EI 4 I-"'.,- tL , 1 1 (r 1 i- alp woo. , •o.{..• 1 u~•r' 1 C'1 Ifl l 1~0(u 1 V{. .tip {t. V./Y T'~' , /r) F a N y f0 N N R I Y 7 Q r ,i, i w i t- a] ~wm C t titi p O I TV J ♦ t r Y I/~' J b f I ~i.^ \ t! {Sw w • 4 u --1 ' i ~ C f ~ ~ Q >y I l i 1 wr i?- ~ U N f (n cc 7 as t : I n t v f 3 ' N I. o s •rb url .p i:. uu r:,:1 nu'rr:_ _~'y- ~ a?V ~D ~c aea 4i$~ o, ld O l 6nc rele use a~ u Beira HC, $ax" REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 11/15/92 17:53 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/17/92 AREA: MJ Activity: A9200366 11/17/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 16.28.19.979,NW,NE,LOT 25,OMAHA RD. Parcel: 040-1207-50-000 Occ: Use: Description: 180285 Applicant: NELSON, KELLY C & KERRI K Phone: Owner: NELSON, KELLY C & KERRI K Phone: Contractor: WANG, TOM Phone: 425-9958 Inspection Request Information..... Requestor: WANG, TOM Phone: Req Time: 09:11 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTIONd Inspection History..... Item: 00012 FINAL INSPECTION