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HomeMy WebLinkAbout002-1038-80-000 0 3 o M O to N 4 o a I � C 5 O d O N U t!' D C N O .p (D c j t� d N c � @a3 (6 i � Oco C s � c o m y U E N N @ N > O Z o o m Q)w10 Y C rn C U <� N O O N N Q U E :5 U O M N � N N E N (�O O (n " O i Z E •O (4 r rn w a m o c rn o c C7 c O Z : h O N E o (n _ a N � M c O O (6 O Z Z 0 N N N c O O N m N U-) N N N 0 0 0 E �v E > _ O O O �i 3 0 0 0 a 2 0 0 0 a c O (n O co co to J U � rn rn Z > �V Q N N 4 N Q .L 0) 0) E �I � O o N m N c d C$) N 3 w N N O O (d N C O 6 m 3 fUU co c d. O 'O Y 0 N FO- O N N E O (D .- VO M r c N CO O O qcj O N N FBI N N '_3O L N ,0 7 E N _ O N O (6 rB y CD U)i 3 EL i a.. w 0. m .2 m t A Ua2 0 U) 0 a I Y Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �piel I � o p TOWNSHIP �_��� SEC. T 1 N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN C) SUBDIVISION SUBDIVISION ���� LOT AI LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N� 7 S%� r a D, r 0 \ j '� an INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used g,"V, Elevation of vertical reference point: C-"L) Proposed slope at site: ^ � (0 S SEPTIC TANK: Manufacturer: L,�,C ty���,. .RF_" Liquid Capacity: lbe)o Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: �' l Front;Side,�ear, 0 �� feet From nearest property line Front,O Side,OKear,0 �� - feet Number of feet from: well 5-0 ''buildig: (Include this information of the above plot p1d"AX 2 reference dimensions to septic tank) SEE REVERSE SIDE 1 + �• • • a -i PUMP CHAMBER / Manufacturer: QSleir � 5 Liquid Capacity: Pum Model: fu /Siphon Manufacturer: Pump Size P �)m Elevation of inlet• 713- LC-1 Bottom of tank elevation: SO , Pump off switch elevation: Q/ , � Gallons per cycle: t�arm A1''r c f 0 t Alarm Manufacturer: -`� Pc��1 Switch Type: �k�" J— < o� Number of feet from nearest property line: Front, O Side, ©Rear,0 Ft. . . Number of feet from well: i Number of feet from building: i 3 (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number. of Lines:^ Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, &Rear,O ht . Number of feet from well: Number of feet from building: (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: r Plumber on job: Dated: License Number: �7 3/84:mj