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AS BUILT SANITARY SYSTEM REPORT
OWNER ~rC1i4~~ ~`/rLL TOWNSHIP
SECTION- LG) T"N-R,# W
ADDRESS ST. CROIX COUNTY, WISCONSIN
46:C4
SUBDIVISION LOT -LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/ 30
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(rf~~,ir lid
Or
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71°1'
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INDICATE NORTH ARROW
vy
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BENCHMARK:Elevation and description: IM,0' ~e
Alternate benchmark /r",*e
SEPTIC TANK:Manufacturer: &~4S Liquid Cap. 27-yz)
Rings used: Manhole cover elev: _Final grade elev: /D
e'a
Tank inlet elev.: ...X Tank outlet elev.: e?,1, '
No. of feet from nearest road:Front , Side, Rear Ft.? ,>F
From nearest prop. line:Front Side , Rear/ Ft. > ,Da
No. of feet from: Well oO6. &,Ieel~ Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
. 1
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: Area Built 7.2 D
Exist. Grade Elev. /D/. 5- Proposed Final Grade Elev. "o,/
Fill depth to top of pipe: ? 7
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 tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
n,
INSPECTOR:
DATE: 7 1 2 PLUMBER ON JOB:
LICENSE NUMBER:
6/90:cj
ConTI
P,N part m~ eRntOo Indus ry28 • 1`~' 478p VATS 5EWAGI?54?rMRD. F County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
171499
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
KEILEN MICHAEL TROY
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax o.:
D~ C) o - q _ 13QSe 0_ V Q J_.. ~ Y a
TANK INFORMATION ELEVATION DATA A9200260
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 0 D 0 Benchmark qa .
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P/ L WELL BLDG. A
irito ntake ROAD Dt Inlet
ir
Septic 100 NA Dt Bottom
Dosing NA Header/ Man.
(7
Aeration NA Dist. Pipe 9 3
Holding Bot. System '95,11
PUMP/ SIPHON INFORMATION Final Grade D Lj D
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 0 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Model Number:
System: a l V U N l~ OR UNIT
DIST I TION SYSTEM
Hea Distribution Pipe(s) r ` x Hole Size x Hole Spacing Vent To Air Intake
Length L t Dia.' Length ~L Dia. Spacing \0
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 y Bed /Trench Edges ! Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Plan revision required? ❑ Yes Ea/No l F77 a /
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Si ature Cert. No.
i
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
t
:EDILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code CouN
STATE SANI RY PERM I #
-Attach complete plans (to the county copy only) for the system, on paper not less than El , C " z
x 11 inches in size. c ec if revis on to p ous application
8%
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER YOPERTY LOCATION
F_ Y, w '/4, S 3v T N, R / E (or)611-2
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
c~'a(~tavr~ S~• 3
CITY, STATE ZIP CODE PHONE NUMBER StJBBIVISIeN R CSM NUMBER
/7o ~~r'r4 U%L D 7,96 S3 3 7377/0
11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
I ~-v ❑ State Owned ❑ VILLAGE
QaQWN OF.
RCEL Ax NUMBER(S)
❑ Public L+~ 1 or 2 Fam. Dwelling-# of bedrooms _3 PA
111. BUILDING USE: (If building type is public, check all that apply) 17- 3 D
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 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. 2 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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
140 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) ELEVATION
ro
'_)p0 9;9, 4 Feet , Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Se tic Tank or Holdin Tank
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.
ILI-
um er's Name (Print): LPJ umber's S' /MPRSW No.: Business Phone Number:
L_~F\ ~
rs Addre (Street, , State, 1p Code):
/ o Gc~ 5 yo:z 3
( IX. COUNTY/D P RTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing ent Sig ture (No S ps)
Surcharge Fee)
Approved ❑ Owner Given Initial QJ) 7/7
Q(J
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
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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 Saritary 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.
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 courty. 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; close 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. rn }•nies collected through these surcharges are used for monitoring gropndwater, ground-
water contamination investigations and establisfrw6tit dts'tandaris.
SBD-6398 (R.11/88)
APPLICATION FOR GANITART PCRHIT
• 9TC-100
This application form Is to be complntod In full and signed by the owntt(s) of
the property being developed. Any lnadoquacles will only result In delays of
the ptrralt Iatuancaa -Should U15 development be Intended for rssalt by
ownet/conttactot,(spec house), than a second form should be tatalned and
completed vhan Lila property In mold and submitted to t h I a office vlth the
■ppcoptlatt dted recording.
----------------------A-----------------------------------------------..-----•---
OwnIr •o( property (C`-~- fl-fC CVA) ~ld~ `~`'t C (~N
lv S ~
Location of property 114 ~ k, 1/1, Bectlon T 20 M•R lq v
Township
Kai l lnq address Qe#7#7G#*ln 4~)(S S~O Z3.
Address of site V'F r rv2r2 f f~~l~ ~~l ~yo
Subdlvlslon nape S(%hJ •
Lot number 9-3 Z~'(7,5~ 44tf WS 71g
Pterlous owner of property
Total mile of petrel
Date patrol Val created -
All all cornets and lot lines ldentlfleblet yen No
Is thl■ Pic patty being developed e$Ale (Byte house)1,_,_Yes K_1to
Yoln and pays slumber as recorded with the Register of Deeds.
.
111CLUDg VITII 7)(19 APPLICATION1 Till FOLLOVIHCe
X YAARANTr DHID which Includes a DOCUHKHT )UHOIR, VOLVHL 1WD PAOt 14VXIIA, and
the 91KL or THIC R9010THR OF DBRDII. In addition, a certified survey, If
available, would be helpful so as to avoid delays of the tevlewlnq process, if
the deed description references to a Cettliled Survey Hap, the Cattlfled Survey
Hap shall also be required,
PROPERTY OVIMR CKRTIrICATIoH
live) certify that all statements on this form are true to the best of .y (out)
knovltdgcj that I (we) am (ate) Lila owner(s) of the property descrlbtd In
thIa Infocmatlon (arm, by virtue of it uerranty4pd~toc,~rded in the o((ice of
the county Register of Deeds as Document )10.
pttsently own the proposed alto for tho news a dis osal -system (or I Iwo I lave
obtained ■n 4aaement, to run with Lilo above daacribad pproperty, Iar h~he
conattuctlon of said nystatn, and the aame has been duly tecordtd In the oIIIce
of t A#, q •s ter of Deeds, as Document No.
Blq uce er
Sign ture of Co-owner III Applicable)
Date of elgllatucr Date of Signature
THIS SPACE RESERVED FOR RECORDING DATA ~
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -1982
WARRANTY DEED is
I Ij
85975 j ffi 959 489
This Deed, mane between .-.Paul.--H_....Jah.ns.on... and......... REGISTER'S OFFICE
D.e.lphin.e R,. John s.on.,...hus.han.d..and...wite............... ST.CROIXCO.,WI
sd'
a Reed for Rewd
Grantor, JUL 16 1992
and ..Michael...E.t...K.e.i.1.en...and...Cy.n.thi.a_.._...Ke.il.en.,..........
husband and wife,..a.s..surviv.ors.hi.p. mar.ital at 4:35 PM M
property . .
. . _ Grantee, C.flfAgf~~
Witnesseth, That the said Grantor, for a valuable consideration......
Register of Deed;
. .
• I RETURN TO
conveys to Grantee the following described real estate in ....5 t.!... V.>~ Q.I.X.........
County, State of Wisconsin:
Lot 3 of C.S.M., recorded in Volume Nine (9),
Page 2509, as Doc. No. 485718, Register of Tax Parcel No: ..91J9 Deeds' office, St. Croix County, Wisconsin
being located in part of the SEk of the SWk
and in part of the SWk of the SEk, all in
Secti30, T28N, R19W, Town of Troy.
J
Together with an easement for ingress and egress over and across the private roadway
easement as shown on the Certified Survey Map recorded in Vol. 9, page 2509 as Doc.
No. 485718.
1 II
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This ....is , not......•.,.- homestead property.
(is) (is not)
Together with all and singular the hereditaments and awwrtenuuues thereulltu belonging;
warrants that Pthe title is good, indefeasible in fee esimple and free a and cllea Oof encumbrances except I
easements, restrictions, and rights-of-way of record, if any,
and will warrant and defend the sane.
Dated this .........................1. day of ........Jlll.y.... 19-92..
~
....~'1~~1k~ (SEAL)
.............(SEAL)
I
• Paul .H.,...J nso.n......
(SEAL).-,..1. (SEAL)
. De.. phin.e..R.. Johns.on
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN
Signature(s)
ss.
......................................County. 1.4 authenticated this ........day of ..........................119 Personally came before me this day of j'
Ju 1 X 19-9.2.. the above named
Paul H . .Joh>?s.Qn...axad.
------------------D
• elphine..R...... Qhns.Qn...............
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
foregoing instrument and acknowl the same. II
THIS INSTRUMENT WAS DRAFTED BY `r!%'-`-f!L~
Atto
C. L. G.-a_y... --..lor.d .._........?~.~?Py ~j
~~n.......2:.....0..:..~Hew
Rivex...Fal1s.:.. WI - S4Q.22 Notary Public 4 -t% County, Wiu,
My Commission is permanent. (If not, state expiration
(Signature; may be authenticated or acknowled,red. Both
are not necessary.) date : l./ --71........................... , 19.
i
.Names of persons aisninir in any capacity should be typed or printed below their signutures.
l
--fi'Lf,'rFORBAR M NaFlµ' 1982NS1N Stock No. 13001
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER_ r A)
ADDRESS: 7~I FIRE NO:
LOCATION: _ 1/4, 1/4, SEC. T~_e N-R__W,
TOWN OF: T4-~ ST. CROIX COUNTY
SUBDIVISION: _-V?4JSdk) 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.
it
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:
DATE : '7- I I~ -LI a'
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
•INDUSYRY, ' DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 3707
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TOWNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME:
S _f, 1/ .3 0 /T,2x N/R i ~E (o /ra 3 - )m c
COUNTY: OWNLR'S/~tPtiS MAILING ADDRESS: /
'a ~ Z ' v e-1 F. ! S 1/0 12
USE L/.;15-- LI DATES OBSERVATIONS MADE
NO. BEDRP COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
[E Residence 3 D- New ❑Replace I ` 6 _ 9 2 9l
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED Y!TEM:(optional)
DS❑u aSCA 2S Flu ❑SChu ❑S12t o z ,
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: j - Floodplain, indicate Floodplain elevation: 41A
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
3.3' 8n45 w/9 co6.
B-
B- 0 /01"0 7 S t w GS W G` n C 3 -Aq.
q9a
B- J 00.2 N t o/ x'13 / .2 s A2' °.s' w c
qy,b
B- S 11.5- pd,r 41+C S r w r 23ol c w s.
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
Sv 3 . s
P-
P_
P- q ` 3 > ° b
P-
P_ S 44 1 .3 _S_
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 ve~rtLical 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.LEJ
SYSTEM II ELEVATION S 96. o ' ~~1 /v
, ,
30
_ 'al J6e- ro . l<w ra.._ _ D i
.
4d
01
x{a Y~ f
t i 3
E /
i
. 2/
92
,
NNW 6~rr1+ ~T1~/r..cl~j p~tity Y° 7+rt/~I T~
It` y~
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 th Wis onsin
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): Dow 1111060" PLUMONG TESTS WERE COMPLETED ON:
LJOWd Perk Testa Plumber
o ~1
#3233 #
CERTIFIC TIO NUMBER: PHONE NUMBER (optional):
ADDRESS: F ROW
ROBEWWIS ONSIN 54023
CST,£31
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) -OVER -
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I RUCTIONS FOR OMPLETIN-_ M 115 - S BD - k
To be a accurate soil test., y, saur report nil.;
1. Corr on_
2. The use ciea€ IV her this is a r:s oi- €`.on nierc;ial project;
3. MAX IN,:_ of bedrooms rraercial use plane
4. Is this ~ „ttent syst:e::;=
T
h. Cc ~ ,y iating boxes. A SITE IS SISIACiL- )R A HOLDING TANK ONLY IF ALL
01 f- RULED OUT BASED ON SOIL CC AIONS;
6. PLEASE a.. li;s shown fiere for vtiriting profile a. Lions and completing -"-,e plot plan;
7. MACE A jibs I a€.curately locating your test Ic Drawing ~~'red. A
si~'P<Ira. _ de ired;
S. Make sure , ).jr be ctt(j vertical elevation reference point are €:lead s` s)wn, ai are permanent;
o. Complete all app€ r,, xes as to dates, names, addresses, flood plain I, ,--colation test exemp-
tion, if appropriate;
10. If the information {sut.h a~ fir-i in, elevatiora} does not apply, place N.A. in the appiopriate box;
11. Sign the farm and place yow address and your certification number;
12. Menke legible copies and requiredALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY W11HI [ ; OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates a.rt Textures Other Symbols
st - Stc; e l BR - Bedrock
cob Cobble i - 10") SS &andsloi
gr Gravel (under 3") LS - Limestor
s Sand HG VV - High Ciro ter
c;s Coarse Sand fare - Percolatec
rued s Mediuii S,in(] W Well
is F'ne Bldg L ail
I~s' Lo > Grc, ` r, ra
sl - Satz, ~ :n < _ Less ; _-tan
Esc Bro"run
Isil SiE L, l Black
si - Silt Gy Bray
'mac{ 0ap% Loaii} Y - Yellov",
sel Sanely Clay Lotarn R Reef
sic! Silty Clay Loam; mot - ties
se - Sandy Clay tr,
sir. Silty Clay ff_f - fine, faint
'c Clay cc - fmrtron, coarse
pt feat mri Many, mediurn
al M 16k d distinct
p prorninent
I-4W L High water level,
Six general soi textures surface =mater
for liquid avaste dispo Bench Mark.
L==' _ Vertical Reference, poifA
TO THE OWNER:
~I
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to~the apYbpPiaYe~lt>ca>t,authott`sa order to
obtain a permit. The sanitary permit must he obtained and posted prior the start 6f~Ar"yydr4struction.
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REPT1.31 TROY ST. CROIX COUNTY ZONING PAGE 1
07/28/92 09:28 REQUESTS FOR INSPECTION WORK SHEETS FOR: 7/28/92 AREA: JT
A6tivity: A9200260 7/28/92 Type: CONVSEPT Status: PENDING Constr:
Address: TROY 30.28.19.478A,SE,SW, LOT 3, CO. RD. F
Parcel: 040-1117-30-000 Occ: Use:
Description: 171499
Applicant: KEILEN, MICHAEL Phone:
Owner: KRILRN, MICHAEL Phone:
Contractor: FOGERTY, DAVID B. Phone: 749-3656
Inspection Request Information.....
Requestor: DAVE FOGERTY Phone:
Req Time: 15:07 Comments:
Items requested to be Inspected... Action Comments Time Ex]p
00012 FINAL INSPECTION a
Inspection History.....
Item: 00012 FINAL INSPECTION
REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 2
07/28/92 09:39 REQUESTS FOR INSPECTION WORK SHEETS FOR: 7/28/92 AREA: JT
Aetivity: A9200260 7/28/92 Type: CONVSEPT Status: PENDING Constr:
Address: TROY 30.28.19.478A,SE,SW, LOT 3, CO. RD. F
Parcel: 040-1117-30-000 Occ: Use:
Description: 171499
Applicant: KEILEN, MICHAEL Phone:
Owner: KRILRN, MICHAEL Phone:
Contractor: FOGERTY, DAVID B. Phone: 749-3656
Inspection Request Information.....
Requestor: DAVE FOGERTY 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