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SURVEY MAP LOCATED IN THE NWI/4 OF THE NE I/4 OF SECTION 25, T28N, R20W, TOWN OF TROY, ST. CROIX CO., WISCONSIN. OWNED BY: JOHN SALMON R T. 3 NI/4 CORNER SECTION 25 SEE DRIVEWAY HUDSON, WI ST.Ar,EMENr 54016 SO.04'35"E 8.25' SHEET 2 OF 3 NE CORNER SECTION 25 S,$,8044' 537E 11 719 79' PLALf_VI E W DRIVE M 649.26' 70.5 NORTH L6 'NE~1~4-* M p~ -~p t6.0 in S"80•44M63', 649. 3' ~ NOTE: NORTH 1/2 ROD e I I ^ A drive I O F-I ~o 'r o:l: et N QVIT CLAIMED TO TOWNSHIP, I O N~ ao ` (REC. IN VOL. 377, PG. 210). I N N C Aouss ZY u w~ Z ' I Nk' Z N _ c ,0, / W fence 'a' i V 4 v~~ O r.f V u U W C O ly In 7 /i4 O X 40 BEARINGS ARE REFERENCED I It F-"~•~ O W It drive % ;4%E NORTH LINE OF THE NE 1/4. I Oo:W vt \ T ~ 1/ 0/ O Z (RECORDED BEARING), - .r O>,u ¢p 4 eb rr _j ,e W ~E N O 0: o> P/ N ¢ O e ` twA o, t(1 ;~~ched z S88°44''.53~'E 399.66' 1►'I~.: S o ' S88044'53"E' 9 177.BB' a ,7o' 139.09' 208. 71' 4. 9b ` b ° LOT .1 co~ lPl ,°o~ ti0/' a ro co • 'r I$.88 ACRES N TO BE ADDED > h p /33 (691,735 S0.FT.1 LOT 2 vt /b ON C EEL. ~3 I5, 23 AC. EXC. R. 0. W, ry PARCEL. Z• Ln 1663,390 S0, FT.) L✓' p 9 0 H• Q, M t v> 2.77 ACRES A ~ (120,811 SO, T)0 v • 'a l 1 2.7 3 A C. EXC. R.O.W~4 Z~ r • 0 I (110, 066 SO.FT.1 0 ~ . ' % _EXISTING EASEMENT • ~ • Z jG) N W. Ol NOTE: SEE CURVE DATA ON SHEET 3 OF3. L O T 3 Y 1 12.1 9 AC RES , x "Z• ~j, 'o ( 530, 827 SO.FT.1 O 10.50 AC. EXC. R.O.W. Y Oy 1 457,325 SO,FT.) V N W 476' 89' ■i w ' NOT ' LOT 3 IS FOR THE PURPOSE OF INCREASING, ! tt 2 N880 54' 33" W 647.80' en C. IW TH SIZE OF THE PARCEL AS DESCRIBED IN VOL. ' I 484, PAGE 458. ANY FUTURE SALE OR SUBDIV- Y 3 3. a ISION OF THE COMBINED PARCELS MUST FIRST y Z SEE ENLARGEMENT O 66'1-1 COMPLY WITH ST.CROIX COUNTY SUBDIVISION W to p v ORDINANCE IN THAT A CERTIFIED SURVEY r = SHEET 3 OF 3 Ip MAP WOULD BE REQUIRED. fence ~Tv O tL PARCEL REC. IN VOL. 7770 in H ~ ° Po, 40. O Iy - o r.XISTING 40' FASr.MFNT y ? 6a.ol 617.50' 13'.,t ~j D N88054' 337 W 678.51' cY: - W SOUTH LINE OF TIIE NW-NE v' 3 EAST LINE NW. NE V y •UNPLATTED LANDS n><sa+l=11M~eMpe~ Sit COUNTY MONUMENT FOUND. ~1^~ co s O - SET 1 x24" IRON PIPE WEIGHING 1.13 LOS. P e~ ER LINEAL r•oor, . ee A JAMES M. ~ WEQER B ■ 1" IRON PIPE FOUND IN p~py 4~ S• 1804 RECORDED POSITION. PD4iY 1 srRIN I Vnu>:Y . St. CROIX COUN WIS. , f (r 1" r 001 W3~ ■ I R O N PIPE FOUND IN INCORRECT AND S(` (1~~1/1hI O ~~/i/O'~►.. ~~0,`` POSITION (SEE sueET 3 OF 31. a ~1 e S5 V e8#81astAl SCALE 1": 200' JAMES M. WEUER S-1804 D A T E D AsWL *,s_ 19-8a 0 100' 200 , 400' SHEET I OF 3 ft"t Lib MAK 4, %1m•0 . B8 - 75 THIS INSTRUMENT DRAFTED BY A11i VOLUME 7 PAge 1967 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT ` OWNER A ( l1 } I(3 rr,e S TOWNSHIP SEC. S T a N-R o~ VJJ ADDRESS ~~lN J ! l,J ST. CROIX COUNTY, WISCONSIN qa SUBDIVISION ~U LOT LOT SIZE Y~ PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~000)A) Se~l`~C ©l►Jel~ I~x(o0 C3eo 33 3' 3,1 0 ~ z / Q~p1ZC~J ~ Oo Noly 3a so ~~I 3~r I I i INDICATE NORTH ARROW V 117Q BENCHMARK: Describe the vertical reference point used SvUI On, )oOK Elevation of vertical reference point: Proposed slope at site: ( /o SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: 9V JS Tank Inlet Elevation: 9~4.7t~ Tank Outlet Elevation: ~(p Number of feet from nearest Road: Front,O Side,0,Rear, O G yepc. 300' feet .From nearest property line Front 10 Side 10Rear, ~ ~pr► feet Number of feet from: well ~ U , building: ~'j (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances hogn .p yqt plan). HZAO~n_ V SOIL ABSORPTION SYSTEM iou ju _ ~w~_ AND ~Y$(P ~v $a J 13 to Bed: Tren& 5 co (3~ tom ~eD Width: lo` Len$th: Number of Lines: of Area Built: r~o~ U Fill depth to top of pipe: Number of feet from nearest property line: Front, ~Side, O Rear,0 Pt. Number of feet from well: 8 'J Number of feet from building: 3 U/ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter:' Liquid depth: Bottom of seepage pit elevation Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated:Plumber on job: License Number: U V O 3/84:mj u1/is~COAns'iI'6epartmTeRntOoIn~usJtry2$ • 20.622 P V/dTE f EWAG~SYSTM IEW County: Labor and Human Relations INSPECTION REPORT Safety and Bindings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 171476 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: MAR-WAY HOMES TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 040-1159-72-000 TANK INFORMATION ELEVATION DATA A9200241 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark c/9 /DU, r,o Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 79 3 Verit TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic !P7 -70 i 7 NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe (O qu 9~ I Holding Bot. System I S6 q 3 Z PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length 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 Type Of 'Y1jt, CHAMBER OR UNIT Model Number: System: A 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 Cent r; Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS` (include code discrepancies, persons present, etc.) , Plan revision required? ❑ Yes ❑ No b / Use other side for additional information. JP C)N'} SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I 14" =~770ft-' SAN ITARY PERMIT APPLICATION LHR In accord with ILHR 83.05, Wis. Adm. Code couNTY D .X STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8%x 11 inches in size. ❑ cAk>Fr~Visi5nt6p viousapplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. P OPERTY WNER PROPERTY LOCATION p /U W Y. S oL5' T doo, N, R M E (or PROPERTY OWNE 'S MAILING ADDRESS LOT # BLOCK # r Lo.~aa CI , STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF B 19!5;1ILDING: (Check one) El State Owned 13 VILLLLAGE rD NE ROAD ffiWN ❑ Public X1 or 2 Fam. Dwelling-# of bedrooms PIQ- Li9dieW CEL TAX . UMB ( ) AR 111. BUILDING USE: (If building type is public, check all that apply) 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. RNew 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 N71 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 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 6-0 a 0 720 63 , < 3 Feet ff, JA Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank e 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 tamps) MP/MPRSW N Business Phone Number: un v Plumber's Address (Street, City, State, ZIP Codertj 42,16 QA 7-L.0 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee (Includes Groundwater -Date Issued Issuing A m Signatur (No Sta s pproved ❑ Owner Given Initial S rcharge Fee) Adverse Determination 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 INSTRUCTIONS . z 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. bnsite 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. 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 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 recording. Owner-of property ~'A - \ ~.,~5 Location of property x_1/4 1/9, Section;` 4lofta, T ~ ~ N-R a W Township ov Mailing address S 0 1_- Address of site Iy L/ I C cJ Subdivision name N ln~ Lot number Previous owner of property Total size of parcel Date parcel was created / Are all corners and lot lines identifiable? 11_ Yes No Is this property being developed for resale (spec house)? Yes No q Volume and Page Number \qL7_ 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 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. '13 ' 3 0 2. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Signature of Owner Signature of Co-Owner (I£ Applicable) 5- - y- S Date of Signature Date of Signature WAU 3" or muccom HORN _ W!! 917m m M .......Jan"..W...Deiitolf ..and.................. _.husband...and.-ache...as. iauit+ak.ngrY .xQrWh ID...... conveys and warrants to Mat-Way...HaoeB.-•-IAG-,-•-a....... ; . Minnesota... corporation i. - . RETURN TO lqo r Si'. troix, UL ..................County. S y. the following described real estate in r State of Wisconsin: Tait Parcel No: . . That part of the NWk of the NE'k of Section 25-28-20, described as Lot 2 of Certified Survey Map recordein Vol. "7" of eraof/Dee a 1967, of the Document No. 437307 in the Office St. Croix County, Wisconsin. ofdLote1 ofaccess II TOGETHER WITH an easement 25rfeetjoint Certified oSurvey i North 75 feet of the Wes Map recorded in Vol. "3" of Maps, Page 724• a + W' k homestead propert,% This is not S (is) (is not) Exception t+, warranties: easements, restrictions and rights-of-Way of record, if any. April Is 92 day Uat kamis,W. tSEALP Ellen L. DeWolf . D eWolf (SF:AI.1 ja 1NI:Al.t ACKNOWLEDGMENT AUTHENTICATION NISt'U\~Iti James W. DeWolf, STATE OF Signature(s) - % ss• f Ellen L. DeWolf 1 [r /1 da> of April 19 92 1'i.1-ll;t1! can,l. I„•r file 0.1s day of authenticated this the shove nanne+i L ` l CL. v l 1~ Al Kristina Og and TITLE: MEMBER STATE BAIt ttl•' NVIS n\~IN If not.. suthnrized be 706.00i, Wis. FL t<.1 to • i.m Wn to ho the 1!1 r-u❑ wl o executed the inle-Ulli''It WA Wk1ll,wIkdu-e the same. ;Rumf _47 W45 L'. Kristina Ogland Attorney at Law County, Wis. t.. 1'ubli - \l nl! I I: _I. n noe ;u: • e ,I} I I f not. xtatt• enty io (^~ignature may he authentirato~l ~,r ar~mmL ~?.~~•d C~~t 19 are not necessar~.l date: .z , -N&Mrs of pen-, !ruing ~n wuy al x STATE BA16 OF UNtAN ~F DEED (T EFTT,C TANK MAINTENANCE AGREEtiENT St. Croix County r, PD 014NER/ BUYER o ROUTE/SOX NUMBER Fire Number CITY/STATE ZIP PROPERTY LOCATION:' Section , T $ N, R40W, Town of St. Croix County, Subdivision_ Lot number mp_oper use and maintena-~ce of you septic system could result in it premature failure to dandle wasLes.' Proper maintenance con•- sists of pumping out the soptic tank every Ar.ee years •ir if needed, by a licensed 'sept'ic tank _um~ e,:'. ,.hat.: ,o~i •.~~tt il%to I the system can affect t e :uncE.ion ~the±..:- ept :,j =ray r. as a eat- I ment stage in the waste disposal system. St. '--oix County residents may be eligible to recieve a grant fc° a maxLmum of 60% of the cost-of replacement of a failing system, whs.ct 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 'sys't'ems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater 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)•a£ter 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. H , 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- x ment of Natural Resources, Certification form must he completed .d' and returned to the St. Croix County Zoning Office within 30 days I of the three year expiration date. ~z- r~--- SIGNED- DATE S y- l St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON SOIL BORINGS A1'& SAFETY & BUILDINGS INDUSTRY, 1 DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) VCATI ~ SECT Ij~ZyN/R~~o S UNICIPALITLO ;NO.:BLK. NOISION NAME: #Ff - OWD E5ERR'S BUYFP'Q rlTM ING ADDRESS: A0 _LC USE DATES O ERVA IONS MADE NO. BEDRMS.: COMMERCIAL ESCRIPTION: PR FI DEC PTIONS: PER O ION 7 STS: kRrh esidence New ❑ Replace !Z S Z RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIaAL: MQU DU IN-Gf:1111 PElU SYSTEM-IN-FILLHO~LDS NU : RE~`MENDED YST ptio 1) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the s. ILHR 83.09(5)(b), indicate: : Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH.W. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVE (SEE ABBRV.ON BACK.) ,zs ~s s, y, vs GMs B- ZS B- L Z 91533 > 9Z, o g„ s , 7S /jy s ~1• Bhp B- B- B- PERCOLATION TESTS TEST DEPTH Pr"WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE R INCH MINUTES NUMBER I AFTER W LLING INTERVAL-MIN. PER OD 1 PERT 2 PER! D P- S3-3 P- Z 9y Z 1 P- _9 S' 2s Z 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 E E . E s a~ = `f P fi L . /Od E g~~ 0 3 E - r• - S E t 3 3 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 and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS W RE C MPLETED ON: ADDRESS: CER IFIC ION NUMBER: PHONE NUMBER (optional): o ` b~ 501b ~6~3~ CST G T , DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - 11 TRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a coz E e arid accurate soil test:, yoc.tr report must include. 1- Comp'; ~ ion,' 2. The use E do _ °ust clear ly v,this is a residence or commercial I > 3. MAXIMUivi number of bedroorns r ccrmereial use planned; 4. Is this a new or replacement syste.:;, b. Complete the suitability ratting 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 shon here for v, riting profile descriptions and completing the plat plan; 7. MAKE A LEGIBLE diagram ac -"-Iy locating your test locations. Drawing to scale is preferred. A separate sheet may be used if c° 8. Make sure your benchmark i Lei elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes dates, names, addresses, flood plain data, percolation test exenip- t€on, if appropriate; 10. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification nu€riber; 12. Make legible copies and distribute as requirecti. ALL SOIL TESTS MUST E FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. DEVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st (over 10") BR Bedrock cols - Cobble (3 - 10") SS - Sandstone gr toravel (under :3") L2 - Limestone - Sand }3t High Grow,,;, t r Coarse Sand 'ercolat. rr= Medium Sand Well sane. - Building F 'Ind Greate€ Than t n) Less Than i - - th"n ~sil c arr~ si Gy { t SO y Loan€ R sic! - Loam root Sc - Cr : VVII s€c I'~y gay fff VV, -Se, faint c common, coarse pt Mir) Many, € d €iistinclt p promir €,t: i- WL High rr6r level, Si, .rene€alsoi Comm s€ (rater for ; ,n~aste di L3,IN1 Banc lark VRP Ve,€ tical Reference Point TO THE OWNER; 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 appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. P L OTA N I i _'0 SS T I 1\1 5 EC P I n ~1 L - J~ `.j M E1~ _N AIM 71,~c~.M~es i i 0 C A T ION) F1_,'' q_j_ 1_4~w _IC E N Sr.,_.. 3 U . _ ~ 9 P3 s i f 0 a~ 0 a► ova .E 1, I p i i M 1 , ~ w x tV ~a B.M 1 bade,UY1 eu1' door •-Sok~t Cs'Ae n~side wo~kou~- _ door Y` ` t ~ w ~ ! J~ j. 'fir J,rri Sep"1 1C ~ N b I Q. ~ -1 ~1 •I 3 "TAa. N N FRESH AI1; INLETSAND OBSERVATION PIPE CROSS SECTION Approved Vent Cap Minimum 12" Above r Pinal r~j~~__~ _ Q~• 1, 4" Cast Iron Above Pip Vent Pipe To Final Gradc* Marsh flay Or Synthetic Coveri.nC Min. 2" Aggr.cyl Over Pipe DistribuLion ~ _Tee Pipe _.I Aggregate I Perforated Pipe Below Beneath Pipe ~t Coupling Terminating P N J..j I not•tom of System 9 3 _ g~ l3 a~'o • J W u -v O v r- z p r- , ii g K o C002 Z ao m O z co OD ]D ]0 O m WSW ~ r C= n XU m x -D < 50- cn 50 m m co U) r m ~ co 00 C p Muo Z C O r O rn _ D n Q M ° m z o p p m C/) D cn 0 C z z < (-)4 m o C) O U ~ Z Fl 0 Z Z o c m D m= ° noHV o~ gym' 3 = = 3 . -I z > Q dm _ ---i = m ~ Dz 'o --:r . ~m ~J = dam ~s ~s m C m Ho ~c m o° 3' aH a oa 0 r m o f a 3 o n d 3? a ,.o m e = ° `3°° moo -<0 0° N- p ~ o = c Q Q'~ - m m m 15 A all= W n3 M3 m~ H mama fD m co *m cc H 3 m ~I m S; . CL o = ao< Ul 0a) CD an d c v o c a = - c H s, ~~.a Z T o Er ` 3 3 3 < ~ m v1 JlJ ' m d 3 1 O _ p D-:k m o< T c N 3 H Z co m rri - D am < am : o Z ID CD 0) - 0 CL D o W- a m 3 ~ -DI f 5'0 m a -"o 0 33 C 3 0 1 m' » d s 3 y < D o o :1 :3 N 3 o v <M d 0' o H 0 N 0. 0 LOCATION: TROY 25.28.20.622E,NW,NE, PLAINVIEW, LOT 2 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: La and Human Relations INSPECTION REPORT ST. CROIX 'Safety and Buildings Division GENERAL INFORM (ATTACH TO PERMIT) Sanitary Permit No.: 149327 Permit Holder's Name: J- ❑ City ❑ VillageXj Town of: State Plan ID No.: MAR-WAY HO *S V-f-- 573 TROY CST BM Elev.: sp. BM Elev.: B escription: Parcel Tax No.: 040115972000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit ir Ito ntake ROAD Dt Inlet TANK TO P / L WELL BLDG. A Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeO CHAMBER Moe 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.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. 's ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i 7 DfLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY _,._.a-.~..-~....~. Coo STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 / i / 4 a ~-7 8% x 11 inches in size. Check If rr1e'visvoo revius 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 M4, - WA ,s N Wya1V Sas T Z2? N, R E (or) W PROPERTY OWNER'S MRIL ADDRESS LOT # BLOCK # IVA b 8o ~r dSo C'I`T11Y, STAT/1E~ ZPHONE N MBER SUBDIVISION NAME O CSM NUMBER -71 Ll~l II. TYPE OF BUILDING: (Check one) El State Owned VILLAGE T~ NE ES~,oD I NW OF: ❑ Public 214 or 2 Fam. Dwelling of bedrooms3- NARGEL AX NUM13 ! III. BUILDING USE: (If building type is public, check all that apply)' 49 4/ O 1_51? 1,44 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nurse ome 10 ❑ =estau reational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 r ant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. New 2.E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 130 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 ~Eo REQUIRED//(sq. ft.) PROPOSED (sq. ft.) (Galls//day/sq. ft.) (Main'./i h) C~ 41V ION V Is V Q • 7 1 V A. 1 S. Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. Manufacturer's Name Con- Steel Plastic INFORMATION New istin Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holdin Tank (()00 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) MP/MPRSW No.: Business Phone Number: 3~ 381,^9 IT, M 14 M4_01 rc I is / Plu A dress (Street, ty, Stat ,Zip Code): U mi L ~ SU4 AN, nl0N ) t, (j IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date- ssue Issuing gent i nature (N tam 4'Approved ❑ 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 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 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. 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'f2 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) (MAKE NOTES HERE REGARDING ANY UNUSUAL FINANCING...C/D WITH SO MUCH DOWN, SUCH & SUCH INTEREST RATE, BALLOON IN SO MANY YEARS, ETC.... UNUSUAL ASSUMPTION REQUIRE- MENTS, ETC.) f i+ I I a a I r E I DIRECT IONS TO PROPERTY:e Sou fh. 0 14udsorv Ufe,S T D - tola i nV e cv ~.---1- ' - r _ L L I 1 I 1 1' I L U U 11 v L 1 I„ r, 1 LOCArEO IN THE NWI/A OF TIIE NEI/4 OF SECTION 25,TZON, R20W, TOWN OF TIIOYr Sr. CDOI% CO., WISCONSIN. o.wco •r. JON. 1•Jrow R 1 . ] ~ IrUO{ON 1 !♦Y i ~ a.. _ r `4 r wr . -.rte•~ , r _I~b».♦ f~r,p /la. ra- 1>LAIN v1EW •Ogly~ .4fL 1.•r• w Iar w..w l•l 1 'l a/ Y I LOT I ' •t•.IIIM _L_O T~ J 1 I' • u ~T-11.1/1.1 l•rl rl•r 1 1 AI, W' h' sirt iralr J. LOT 3 d• / ~•1 1 ~ -17-1'J •C TICS r u1.Ir' J, I^ • r l nl r u . nr. r r..+rou er ..a.ry\. Ya. N I • N•••!•']]•N {♦I.{U' . r:u11r~~.. V••... lt11•. •r~u•1 v°1 ' : • i~ •,I+ .\1VV ar .ul fVr •.w. `rwwR' \VYV, . I •,r • -lll r•a• V w1 rr~~ ~ ° Iwn.r•,[{ Iw rrr•~r• !•1./111 rV•,r•~ • 1r111'I,1/! ~ •„11 I IY w•V ••Ya•.. •1111n1•. r••rr •l'1r• ♦ N 1R11r\IYI rl. rir • 1.~!~.~- 11'1 aI \ rwrw ar•{ •I r•1 w.. •r' t•rr uwr w4 .'L 1 I 1 I U N P L A r T E D LANDS ` \II,l1,,,,,, 1 ~ NMI fD. c•YRrr w••YYl•1 1•V•). • • <4~~1~c,G0 S/'~'h4 LU u1.•VY• ui•J r11rT} JAGrs Ir. ^ wl:w R ' R ..nY. I ' `..eo~u r11n u.. 1• - N•MN6vIIAa f wls. . 1 //111,1N1 'IT •r„ sung\\a .~allfi]' _i.l~~ 1`V1• i•.ii~- E ~•]ri•l[ -01 1,777 O' ~ NIY' rUY ul' _ 1 n D rrn 1.•uvrur o•rr • 1r w••~ 1 lrLw..Llc_. . L • DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION:N SECTION: I UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: Nk' 1/ /a zs T~ N/Rzo E (0 _rfi y 1 - 171pupo9em Cl_ s COUNTY: OWNER' UYER'S NAME: MAILING ADDRESS: ~Zv~7-rte 3 S'~ ~ZO 1 X ~o H N S R L x'10 NJ HvL~SOti1 /.c~ svo/6 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: ZIResidence A QKNew ❑ Replace S - 3 -a V N. . RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ®S ❑U S ❑U ❑S ZU ❑S ZU m y-lo s ' 7FJ M 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: SS Z Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-tnfs++ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) r ~.7' art 30 TS ; l.S' By\ wia Sw/Gh ~ 3.4/ /,t-T By, B- 1 S.b ~pv,`c3 t~~>vL ? s,b YM42S S w/ f's aff mS B- Z F)•~r 103,-1 l~lp>.1~, n-6 i 1 TS; I -vBn si ; 1•y `13 r1 6hs I w/ flEE~SE Spots 34,' I_ Mal S lQnSf` TS 2 -2'enMad Sw/Gi,.; O•$'Sn fs B- 3 S_S` G}°I C~r IJOivE 7 S.S' ),g' L'~-.TaMa S ~ ~ ' B- y -1•S 1 03.S K~OJ > 7.S VA QASW/G►,- ; O, 'cr3n ' 1- 11.T• leh madIR o• b' @nSt I TS • 3.0'-a n M-a S w/S1,70, 6',t h m's ; B- S .1 l 3 •b K_ 06r 1Lzt~ 7 -1. 3. S' t,T. /1f J B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH P- P- 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. I ~ lT l l~ l- 019.5 r, S11) SYSTEM ELEVATION R~~c~-r►e'jr-2 8-S I U1 Bra( r~_Z_ woo IV 3 E } ! i o o1, S©' t-~A s r.. ~o ATi _ _ E : r 71~m wt 3 R- : RE D - 19 i SCE LIE 1" = S ' / . ZON . 5~ c . Zg I, the undersigned, hereby certify that the soil tests reported on this for v rp made by merfn'kcc with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests rrki@.#o h~ of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: S _ saQ ~RYTI'U~Z L. Lv C7 ADDRESS: L4 euk `ZZ( CERTIFICATION NUMBER: PHONE NUMBER (optional): C L. w Z s G -74b pt S- L/ cu b CST SIGNATURE: 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 - SBD - 6395 To be a cor a accurate soil test, your report must include; 1. Complete legal r scription; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or- replacement system; 5. Complete the suitability 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 writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sere your benchmark and 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, . ` v Lion) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current Ltd r and your certification number; 12. Make legible copies and distribute as ri -.iired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. I ABBREVIATIONS FOR CERTIFIED SOIL TESTERS ~I Steil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sane' HGW - High Gror iv cs Cc° ,,f Pere Percolati- coed s - Me I'd W - WeII fs Finn >.;I Bldg - Building Is - Loarny Sand > Greater Than sl - Sandy Loam < L, -s T' r,. *1 - Loarn Bn *sil - Silt Loam BI E:., si - Silt Gy cl - Clay Loam Y - scl - Sandy Clay Loam R sicl - Silty Clay Loam mot sc - Sandy Clay wi - to sic - Silty Clay H! - few, 1'c Clay - ornmon, pl Peat n - Many, m m - Muck - distinct: p - prominent H1,r1rL - High wat° - soil textures surface )r id paste disposal BM - Bench 11 VRP Vertical 'joint st TO THE OWNER: t tlfi.r s` :urri- a sanitary 1 ' % or the D., ~ni rnay request w' p,,rmi. t `1e private ler ."ROSIS SECT I 1\1 -P- B-L.. - 6 7 PLOT, Allh 0 !`1 .~~P!N el,J _ -IC E NS E tU,. P.L..O AP 'r I • o B e ' I o p . ' cxo d gl ' 2 6 Qu + 1 SI'p-~s v~~~ . UNdtn ~le~acK. r - , aM I . ~vu,o pN "sF Nye; Ad}Pce,~ lots) Will S ARA +JCWt~&, r [()O; r, Fromm Sezq d 6rn~'a~ )OLD oN ' N Ole : IrJ~ 11 I ' i gin e FRESH AII: INLETS AND OBSERVATION PI.PE CI;OSS SECTION Approved Vent Cap r;j Minimum 12 Above Final Gr fA 4" Cast Iron Above Pip Vent Pipe 4 To Final Grade Marsh Hay Or Synthetic Coveri.ng Min. 2" Aggreg'dI Over Pipe Distributi~~ Tee Pipe Aggregate Couf aintePmpnaDenoa~ Dencath Pipe 1, g Te g r ~5.~~ r w Bottom of System REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 06/2'9%92 10:47 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/30/92 AREA: MJ Activity: A9200173 6/30/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 25.28.20.622E,NW,NE, PLAINVIEW, LOT 2 Parcel: 040-1159-72-000 Occ: Use: Description: 149327 Applicant: MAR-WAY HOMES Phone: Owner: MAR-WAY HOMES Phone: Contractor: BOUMEESTER, JIM Phone: 386-9020 Inspection Request Information..... Requestor: JIM BOUMEESTER Phone: Req Time: 13:06 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION