Loading...
HomeMy WebLinkAbout032-2008-40-200 o C) 0 Dug, m I o I 4 0 U N d O O U LL N N H-E c N y L ti 0) Lo� U C 0.0 � d� (n o •� o CD>'SS c cc > y X S N L ? >d0 O N U C 2 y N CL O.O O U CD M L C p I U 'O «01 Ow N o C Z m0� c0 C Z m �o N E ci c LL E 0 C y s Ex� E� a �: !� > Q Q baton c axi2 I I 3 0 3 co zt 3 3 z Z E z °o $ v` con a m a m c O z C w Z � ucc o y o o c aci E ' a� Cl) c y m o a CL CL aoi ayi y c •� a r ti N L o 0 z° m z o z° m z o N I Z �T N y R > R '6 N ��vv d *i a % Lo a .O`. U C d V o0 0 n N N d ` y `y-" 01 �. O O o o G G CL a G C CL v o 0 Q p to m N 04 N fn fn O N Z � > 'I � EL (L as z Cl •N a� aaa 3aa0a y a� fv V \ co co N J o o z n 0-) 0,- Z E — co o < �N f0 � C C 0 N m o o ±. 0 d o .`—' Q E 3 > CD a L (n rn QI r to N N O 0 N H H c 4 O O_ 0 c � N H C p E Co O N m C V �" U C C U (L 0) p W F- O � O O O C N r ��pyy N V �y LL N f0 f0 C N f� C Cl) O O co O 12 0) = m m 01 Cl) - z z ad.+ - LO N CD c°n E o �i c0 p vii m m ° N o y E E t0 S ID u • ' o o ton d N Z N 2 2 a o Z '� Io- H to a # m a d y c • c � m c O w +� E 0 _1 A c°� a2 ': o U) 00 omc� 44175.5 r• N to Z ;''',� n f3:� - r• IF,,•�•1 ,,,..,,..... >LI�, _ -h V rt cn y'U O O a Unplatted lands owned by platter d ---------------- -n m N 0 g N00°40 ' 15"E 425. 00 100 rr a H. „ 375.00' 50.00' o N Co N r CD to I= d i 00 0 00 i� H-] l a to 1O t'r' o �, W A' X I rt z O 1 0 O n 'r i M N r. a w .- ss w I Cn F-' _ i rrr Z rr r• -7 W � w I n rn n to D o m I• �� 1 1_ 00 cn w o - w to - rD - 'n- 0 Cr i 0) O O a o m n aoo r- E w 00 l y A o r^ i d z I o_ F v I ° � - o C) O ov I x 171 N I= t✓ N to cn r- Co to r- I• 1 a 1�0+ ft I • N .O C N .0 C •F' l0 O I N 10 00 1 g 0- 0- 00 4 N tD I O (D Co I= QO T = m = I-"` S 1 s t, lTl - rt n rt to o m I W v '= y z CD- orl 10 0 Z�; H wit/ A cC/> i o O I su w n Irt I s O F-h - Ito 1"h o jy �' ast ine the NVj} of the NW ' of Section 2 = n N 0 m M 375.00' H5001 n S00040 ' 15"W 425'. 00 ' W Air -n 50' rOr p1 rn Unplatted lands owned by platter ¢ � d ------------------------------- X 7 C/) -� rn � Ct' I-'• C tort o :3 C < S O h C) cn 0- N• rr n X o (7 10-x1 v+ M O 0 to -1 fi H 0 rl j 7 z 0 x o '< O o -1 Z _ !c LTJ < o N. Co X � � .� z cn O F•- LTJ 0 1'-h o c r• z �, °c .0 O ti 0 n UI �- •O � N N f O tD m tD O to rt H X I••�• (D N -, = N O <n ' r• r• o rt o w O .� 7 b C N D C G w rt to a •7 N co rt -h rt Cn r• o - c o y �r1 Yr t'�?•Y'j� rt E < � .T r• 0 G0, w� to O •C n u GCS °� Ch �� I-- y E 44, Z n Z N `•4}c '?1107 C ' �� »r , Bearings are referenced to the north "j G �EJ line of the NW} of Section 2, assumed �It, 'L�' to bear S890191.45 11E. 14 W SEP 2 F W8 U. ". k) . If,, VOLUME 7 PAGe 2026 t DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR& HUMAN RELATIONS SAFETY&BUILDINGS P.O`BOx7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON,WI 53707 BUREAU OF PLUMBING NF%,NA14,S2,T30N-R19W WONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number Town o� Someuet ❑Holding Tank ❑ In-Ground Pressure ❑Mound (if assigned) Hi hwa 64 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA Ra P2 , de Race 1 Bax 173A Some�se t W1 54025 -3 -gg U• BENCH M RK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW Nn.. Cnumy. Sanrt ary Permit Number: Catvin Powers Jn, 1563 St C&oix 112813 SEPTIC TANK/HOLDING TANK: MAACTUR ER: LIQUID CAPACITY JZ /� TANK INLET ELEV.. TANK OUTLET ELEV WARNING LABEL LOCKING COVER /"• !�'�../ 4 '/y®d Q( /p_ PROVIDED. PROVIDED: BEDDING: [VENT CIA.. !!!���_ VENT MATT HIGH WATER �� �ES ONO ❑YES ®NO ALARM NUMBER OF 'ROAD: PROPERTY WELL BUILDING: VENT TO FRESH ttT FEET FROM h LINE (AIR INLET OYES NO 1. ❑YES ❑NO NEAREST C7` ' " lag 43 DOSING CHAMBER: MANUFACTURER BEDDING: LIO UIn CAPACITY PUMP MODE I PUMP;SIPHON MANUI ACTUHEH WARNING LABEL LOCKING COVER YES ONO PROV IDED PROVIDED: ❑ GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL YE ❑YES ONO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WE BUILDING VENT TO FRESH FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES NO NEARIr5T--- SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I f N(,TH DIAME TER (ATE I I A D M HKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH'' 'WIDTH LENGTH OF UISTH PIPE SPACIN(l COVER �� 5 TRENCHES PI INSIDE DIA -PITS LIQUII DIMENSIO IS �1+ MATERIAL RAVELDEPTH FILL DEPTH I)ISTH. PE UISTH PIPE DISTR.PIPE MATERIAL NO U H NUMBER OF BELOW PIPES ABOVE COVER EI E V.I LE I ELEV.END 'PROPERTY WELL BUILDING: VENT TO FRESH 1) y PIPE SS FEET FROM LINE AIR INLET. T q3.53 q3.�o a� ?-� d NEAREST---- +- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES 0 N meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PF HM1AANF NT MAHKE HS DEPTH OVER TRENCH BED DEPTH OVER TRENCH HEU DEPTH -- DYES ❑NO CENTER OF TOPSOIL SO UUFI)EDGES U MULCHED ❑ PRESSURIZED DISTRIBUTION SYSTEM: S UE YES. ONO ❑YES ONO OYES ONO BED/TRENCH _ WIDTH LENGTH NO.OF LATEHAL SPACING GRAVEL DEPTH HELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS TRENCHES. MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UISTH UISTR.PIPE UISTNIBUTION PIPE MATERIAL&MARKING ELEVATION AND.ELEV, ELEV. DIA. ELEV. PIPES DIA DISTRIBUTION INFO( ATIAN HOLE sIZE HOLE SPACING OHILLEDCOHRECT FY COVER MATERIAL �+ VERTICAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: PERMANENTMARKERS1 YES Q ❑YES ❑NO OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: 3 Gj FEET FRL3M.; ' LINE ` Q ❑YES ❑NO DYES ❑NO 1 NEAREST ` 0 C/ Sketch System on Reverse Side. R n in my file for audit. SIGNA RE DILHR SBD 6710 (R.01/82) �I nnAA 11,, Zing adrnini.6tAl SANITARY PERMIT APPLICATION COU<NN� DILHR In accord with ILHR 83.05,Wis.Adm.Code V J. .., .o.�....,.�...o. STATE SANITARY PERMIT# /i aY/3 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES K NO PROPER OWNER PROPERTY LOCATION N, R (or& PROP FRTWOWNER't MAILING ADDRESS LOT NU BER BLOC NUMBER SUBDIVI N NAME Cl TY,STATE ZIP CODE PHONE NUMBER CITY NEAREST WAD,LAKE 911 LANDMARK VILLAGE: II. TYPE OF BUILDING OR USE SERVED: ' Number of Bedrooms if 1 or 2 Family �� OR ❑ Public(Specify): A III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. Aj New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ®Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.El Pit Privy d.❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. W Seepage Bed b. ❑Seepage Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): z/r­-1 V, Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Mee —F: Lift Pump Tank/Siphon Chamber ❑ H1 ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plum er's me(Print): Plum er's Signa re:( Sta ps) MP/MPRSW No.: Business Phone Number: iz Z,� 1? Plumbe 's Address(Stre ,City,St e,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certifie Soi Tester(C )Name CST# -CS-4,;s AD RESZ(St t, Ztytate,Zip Code) Phone Number: Zos ) &S 4 J,�9 14 J,,- Ilk COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved F-1 Owner Given Initial char a Fee Adverse Determination "" `K'�� kt k-., X. C MMENTSIREASONS FOR DISAPPROVAL:iah SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT- APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundt � included the creation of surcharges (fees) for a number of regulated practices which Wisco ilE' can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TB &t2rB is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 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/ KA%A&La.ddwt�ILQ`, Location of Property ME; k �, Section 'Z, , T ID N - R �9 W Township Mailing Address ; 130'A Subdivision Name t Lot Number Previous Owner of Property Exid"a -��irv► �1�1� Total Size of Parcel .c, Date Parcel was Created 10"3"`J"v Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes x No Volume 40b2,4- and Page Number 197, as recorded with the Register of Deeds _ INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: Warr e .__. 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTV OWNER CERTIFICATION 1 (We.) cen ti•b y that aU a tatements on this bonm ane tnue to the best o b my (oun) knowledge; that I (we) am (ane) the ownen(s) ob the pnopenty de cAi.bed in this inbunmati.on bonm, by viAtue ob a wahAan.ty deed neeonded in the Obb.ice ob the County Reg.iAty, o4 Deeds a6 Doctimen.t No, !!j-411143, ; and that 1 (we.) p4eeeatty own the proposed site Jon the sewage dispozat system Ion 1 (we) have obtained an easement, to nun with the above ducAibe.d pnopeAty, bon the e.onstnuWon ob said system, and the same has been daty neconded in the Obbice ob the County Reg.is.ten o4 Deeds, as Document No. 4141 q 4-1 ) . SIGNATURE OF OWNER SIGN URE OF CO-OWNER (IF APPLICABLE) �0At- At BATE SIGNED DATE S1CNI:U DOCUMENT NO. WARRANTY DEED—By Corporation STATE OF WISCONSIN—FORM 2 4 94,E B�Q K it !` :.1192 THIS SPACE RESERVED FOR RECORDING DATA S OFFICE THIS INDENTURE,Made this.................».........day o(........................................_.........» REGISTER' ST. CR��X A. D., 19..»88., between....Plourde_Farm, .Inc_._-__..•-__.. I ....................»...........................---• Recd f Co.,,' .........................................___....................................................».._---..»................................._.». or Record .......................................................».....................».....................».».............................»..a Corporation OC^ duly organized and existing under and by virtue of the laws of the State of Wisconsin, located (it 3 1988 2:40 P IM at...........................................................Somers...... .......wisconsin, party of the first part and »RQx.. .,.-.»P .Qurd .. :�l�d.._MY-KII ...J.....P.louxdea.._ha -.wi.f ,_...a ...-_......._..._ ....aurvim lrsb-ip...00ari.Lal-__pro.pe-rty........................................... ........................_. Reohrerof ..................»»_»........................»......................................................._.............................................»......»» part],eS....of the second part, RETURN TO W I t n e s s e t h, That the said party of the first part, for and in consideration V 1j " ofthe sum of..............................................................................................__............................................. °r' ot1 ............................................................................. P o . 9 H ••••••••••-••••••-•••••--••••--••-•__•-••................................to it paid by the said part_].ea...of the second part,the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained, sold, remised,released,aliened,conveyed and confirmed,and by these presents does give, grant, bargain, sell, remise, release, alien,convey and confirm unto the said pard ex...of the second part;the.l]heirs and assigns forever, the following described real estate situated in the County of.......,St....»QuI*X.................and State of Wisconsin,to-wit: A parcel Aoncated in part of the NW-14- of the NW-14 and in I- part of the NE-14- of the NW 1/4 all in:Section 2, T30N, R19W, described as Lot 1 of the Certified Survey Map filed September27, 1988, in the office of the Register of Deeds for St. Croix County, Wisconsin, in Vol. 7, page 2026, Document Number 441755. Subject to the reservation of easementsand to the first refusal option described on the reverse side of this document. The above described property is being sold as vacant land, and .tbb existing buildings are to be retained by Grantor and are to be removed by Grantor within the next 12 months. (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditament,and appurtenances thereunto belonging or in any wise appertaining;and all the estate right,title,interest,claim or demand whatsoever, of the said party of the first part,either in law or equity,either in possession or expectancy of,in and to the above bargained premises,and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances,unto the said part'Les.....of the second part,and to.. hetir_....heirs and assigns FOREVER. And the said..............Plourde Farm,•._Inc........................... ......................•--••----.......---.............._.................._....................---........._........_.........................._--. ... party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said partieg...of the second part.......the r- .......heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described,as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law,in fee simple,and that the same are free and clear from all incumbrances whatever.........E]tiat_ing...PlAbliC...UZ11WAY. -and...ut11 i..ty.--lwaseIDeras.............. ....»of record,...if...a nY.................................................................... .:L...._......_..». .._........ »... ........_................................... .........._»..............................................................................._............».. ................................-....._....................». and that the above bargained premises in the quiet and peaceable possession of the said rties.....of the second parch - eirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT AND DEFEND. In Witness Whereof,the said...........P-1.oUrde...Farm.,....Inz........................................ party of the first part, has caused these presents to be signed by Frank J. Plourde ...., its President,and countersigned L Y.............RO Y... ..C...... lou............................................................. Its Secretary,at....Ru.dson.... ......:...-....-......... Wisconsin,and its corporate seal to be hereunto affixed, this........ Z�...day of............... 4-....- A. D., 19..$$...,, SIGNED AND SEALED IN PRESENCE OF PLOURDE FARM, INC. I air Name ............................................................ _ F Frank J. Plourde ' ����+•.J+� .................................................. IIL COU .RSIGNED: ^ O �.C� �/rJ 2 1;,.j a c U s- G^. ` Lary Roy V Plourde .............................-......................... STATE OF WISCONSIN, ''�•,,, � ,, ss. ............................�St..._CT-Q X................C�n� Y Personally came before me, this....................da of............ . ..... A. D. 19...8.8.. FraN J. Plgamd -». ............................................................................................. President,and........RoY.... A...Plourde.... Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument,and to me known to be such........................President and........................................Secretary of said Corporation,and acknowledged that they execute the foregoing instrument as such officers as the deed of said Corporation, by its authority. Z) „ ZAL_j e- This instrument drafted by r ... v Notary Public...»..§t- Croix , —_....._.County,Wis. John D. 11e)T od, Iiey My My Commission:NW*(Is)_2' Is)._P t..................... (Section 59.51 (1) of the Wisconsin Status&provides t6de ill Instruments to be recorded shall have plainly printed or typewritten thereon the moms&of the Grantors, Ilmatees, witnesses and notary). WARRANTY DEED—STATE OF WISCONSIN, FORM NO. 2 N.C.e1LL94 CO..IIILWAO Lt ppnn p .1 �,�,'i� ..w ., •r:r..', LQJK 824 PAGE1.93 EASEMENT RESERVED Plourde Farm,. Inc. Grantor, reserves to itself and to its successors in title easements over and across- land conveyed hereby, to use the existing road through the farmyard to provide ingress and egress to and from the other :;end owned by the Grantor in Sections 2 and 3, Township 30 North, Range 19 West and for installation of utility lines. The road shall be of sufficient width to permit the passage of automobiles, truck and farm vehicles, with turn out area right South of the house to permit such vehicles to meet and pass. All cost of maintaining the road South of the house on premises shall be by Grantor. Expense of maintaining the culvert and road from the public highway to the South Boundary of the home to be shared equally by Grantor or its successor in title and Grantees or their successor in title. The Grantor also reserves to itself and its successors in title an easement to take and use water from the well located on the land conveyed for use for farm purposes, and to use, maintain and replace if necessary the existing water line from the well on the premises conveyed to the barn on Grantor's land. The costs of maintaining or replacing the well and pump shall be paid by the parties equally, or if requested by either party, in proportion to water consumption to be measured by meters to be installed. The Grantee or his successor in title shall have the option at any time to terminate this water easement by providing at Grantee's expense a new well and pump located in the vicinity of the barn on the Grantor's premises. OPTION In further consideration of the Grantor's conveyance of the land described on the face of this deed, the Grantees gives to the Grantor an option to repurchase said property, which may be exercised at any time within six months after the premises cease to be occupied by Roy C. Plourde or in case of his death, by his widow or one or more of his children. Notice of intention to exercise this option may be exercised by giving notice of intention to exercise the option by personal delivery or by certified mail addressed to the owner at his, her or their last known address. Unless the parties can agree on a price, three appraisers shall be appointed, one by each party and one by the two so selected. If the three appraisers cannot agree on a value, it shall be established as the average between the two appraisals which are closest to each other. This option is intended to be subordinate to the rights of the person or institution making a construction loan or permanent mortgage to finance the home which Roy C. Plourde intends to build on the premises. Further proof of subordination on forms requested by the lender will be executed on request. - �� U VJr Y III SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County 0 t � OWNER/BUYER MVS: 4' �1az� ROUTE/BOX NUMBER (^1-Ja Fire Numbers CITY/STATE --'�MiErL j ET _1 WI —zip S40`7-S PROPERTY LOCATION : WE, �, VAW �, Section , TAN , R 19 W, c I Town of , St . Croix County , Subdivision Lot number Improper use &nd maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of 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 systems properly maintained. The property owner agrees to submit to St . Croix County Zoning ,a certification form, signed by the owner and by a master 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) after 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. o I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED V/ DATE St . Croix County Zoning Office 11 . 0 . Box 227 Hammond , WI 54015 715-796-2239 Sign , date and return to above address . �I4 sko 40 fo i R a' 36' 1 •/�I hr� rc4s'a w{` r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS D VISION INDUSTRY, HUMOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAI�1 RELATIONS M63.090)&Chapter 145.045) LOCATION: SECTION: pp TOWN IIMAIJ N'eIPAe61TY: LOT O.:BLK- O.: SUBDI ISION NAME: /'��/ /T N/R/ E (or � C UNTY R'S BUYER'S NAME: IN G ADDRESS: ) USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMME IAL DESCRIPTION: I PROFILE D S RIPTIONS:1PERCOLATION TESTS: Residence New ❑Replace 7 RATING:S=Site suitable for system U=Site unsuitable for system MIS VENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK.RECOMMENDED SYSTEM:(optional) ❑U ZS ❑u COS ❑u ❑S ®U ❑S ®u If Percolation Tests are NOT require DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: r, PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEFTH ift. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- B- 16A - S B- r B- 7 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 44"reS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- tP- �L J�_ "iz Z /X/,6- 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 th 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 rBrcent of land slope. J�rp SYSTEM ELEVATION ,, aa? ( /. -t_ I .At I t al i _ TN I t___ _ jj s ( { LfAyz /� 1 i � F 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 tests are correct to the best of my knowledge and belief. NAME rint . TESTS WERE COMPLETED ON: AD CERT FICATION NUMBER:, PHONE NUMBER(optional): C G TUR DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — N r INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To he a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. 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; 5. 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 he used iI desired; 8. Make SHI-0 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- tiori, if appropriate; '110, If the +nforrnation (such as flood plain,elevation)does not apply, place N.A.in the.appropriate box; 1 1. Sign the form and !:ghee your current address and your certification number; 12= flake legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY VVITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stonc (over 10" BR Bedrock col, - Cohi le Q 10"j SS Sandstone gi -- Gravel (under 3") LS Limestone s Sar"I HGV%/ — High Groundwater r:s Coy tse `saPid Perc — Prrc,rolatior, Rate rued s — !rrlodium Sarin IN - k&!/ fs Fine Sarld Bldg - Building Is - Lowy y SarA j _ Greater Thari 'Sl Sandy Loam t\ _. Less Than _ Loam Br, - Brow 11 sil _.. Site Loam 131 - Black si Sift Gy — G aly 6 - Clay Loam Y - yeIImv SO -._ Sandy Clay Loam R _- Red sicl — Silfy Day Loam mot - lfottles sc _.. Sandy Clay 'o,"! w!t1, sic Silty Clary f`f fevv, fine, faint r clay cc - '(;cennigow, coarse pt: Peat tnn) Many, rneelium in -- Muck d - distinct p prominent HWL — High water level, Six gear-ral soil textures surface wad 0r for liquid""faste disposal BM Bench Mark VRP Vertical Reference Point TO THE OWNER: This soil test report is the first step in sectrrirgg a sanitary permit. The county orthe Department may request Verification of this soil test in the field prior to permit: issuance. A complete set of plans for the private ,ewage system and a permit application must be subrnitted to the appropriate focal authority in order to obiain a permit, The sanitary permit must: be obtained and posted prior to the start of any construction. � i+t44 °n J kk � t urn � KO k 5� � I Pt Fresh Air intp4a And 968#fvA00A Plpp " e Pf J N4,p uY.tl Vent Sip {3 `„ Minimum 12"Abovs i j 4"Coal 1f0n r h?G�S�'� t ' 20-42' Ahoy. pipe !---.,,.� k t - ..;---•j \+►nl Pipe A� � x ; n # 4 , (i Mw.�I nt II�rN 114 t.BY0f 111Q I� j f ,y ^. x ptpfrlbullon C A 1.----5—^—de• b' + pip. Y, 4' °--° ;� ✓nv"a 6`AilQr.QOfe ��1`° t A Pertwet.d pipe 844610 �}", @An.alh p{p. c.,t,*4aV Terminnnn0 Af s ' x SL Of 0164M Pro 3. w y 1 ,.)lL r• `LL \� y �SZ "F t► QISTRIBUTIOE.1 pIPE""t, APPfIOVEQ ��111��ETIC�E�CJC-, , "" '_/+1A BRIM 0R aF y O 4 ' A4 V `*r•i .•+.wwx,�xraawwu,«namui""'m`t,n"wa!rc+t :..w�n..."p-Lk G r,Al 2, + ' ZA O R i G 1 AJ A1.. J [31raPFllPlllrtir�l�1 TG P �7 PIRf l 1. i; , TNP.i+' ! 1 i',i.c:.:i F1f.LOW FWAL Q*RADE AtJtj AT LEAST10 1►JC.NF..; f',ikl w.it� M(?RC + WILL BF- iMCMES r ¢ IMUM OEM OF l-xGA'/,� �€ .M1A �t'V ?"� 3•A � rya a,, , , �r,e�� WILL '0E ,y fit; � =6` L1GE►,JS�, AIUtHBER� �., �: _' DATE ' " ..,.i - --- -_..-.�.-_.-___ .�j��CQ'4 �� (./�1� ��O�CvG2�� ✓V/�/� � /���,vz dam--• AS BUILT SANITARY SYSTEM REPORT 0/wv -/VJ/V , TOWNSHIP&,, 1'.14 ,- SEC. T-3-. N. R.1�._w j. ADDRESS , ST. CROIX COUNTY, WISCONS N. 3DIVISION , LOT LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM � I I -I I I 1 i I _ a9 1 i ' a Indicate Nan h Annaw TIC TANTK(S)-, MfGR. z CONCRETE STEEL cate� NO. of rings on cover Depth _ DRY WELL "'NCHES NO. of - width length area no. of lines .3 width' le th area , depth/to top of pipe 111 ' 33EGATE • "K RATE AREA REQUIRED �f 3�'� AREA AS BUILT ;claimer: The inspection of this system by St. Croix County does not imply complete ,�.,•Dliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for ,tem operation. However, if failure is noted the County will make every effort to ::ermine cause of failure. .aASES AND OILS SHOULD NOT BE :DISPOSED THROUGH THIS SYSTE$. _ `'INSPECTOR C - DATED1j'i "// - / 7 . PLU:iBER ON JOB -s LICENSE NUMBER I C6 3 z i REPORT OF INSPECTION_INDIVIDUAL SEWAGE SYSTEM Sanita&y Pexmit -T • State Septic NAME-_I,C�� � " z ' �.� ;�' ✓C�;�� _Eownb h�p S Cno�x County Location � _ L Section l< _ SEPTIC TANK Stiz e 1 C C✓ (�i ,J 9 attons . Number o6 Compaxxment6__�L _ I Dbtance Exam: Wett ,'7u - 6z. 12� ox gxeatex a.Cope � i Bu.itd.i.ng 6t• Wettandb 6t• H.ighwazen^,'. ' 6t. . DISPOSAL SYSTEM Diatance Fnam: WeCC ��• 12% ox gxeatex sto e 6 • Bu.itding ,5�� W ettandd Ft. H.i.ghwatex 6 • FIELD DIMENSIONS : width o6 txench 1 6t• Depth o6 xock below tite °Z'�n• Length a6 each .Cane '' 6t. Depth o6 xock ovex tite in. I Numbex o6 tines J Depth o6 tite below gxade -i.n• ( 5 Totat tength o6 tines `%C 6z. Stope o6 txeneh in pen 100 6z. rz � D/idtance between tines Depth to bedxack 6t• 4 Totat ab,s oxbtion axea 6t2 Depth to gxoundwate 6t• %j� 2 ' � Requixed axea Type o6 Covex: Papers x Stxaw PIT DIMENSIONS : Numbex o6 pit-6 Gxavet axound pitz ye.a no Out,6 ide d.iametex 6t. Depth betow .inlet 6t• 2 Totat absoxbt.ion axea 6t z A 2 Axea x�qu.ixed 6t 1 INSPECTED BY c, ,L APPROVED DATE 191 r REJECTED , DATE 197__ r C i -P L B •� � . State and County State Permit # Permit Application County Permi z52 '3 for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED / 7 �-/�j y Date Approval Received from State if Required -I ` ` State Plan I.D. # A. OWNER OF PROPERT Mailin Address: B. LOCATION: A10 % '/a, Section 2=, T_21- ' N, R )?' for) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial 4 *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks �4, , HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other(Specify) E. EFFLUV DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq.ft. New Replacement Alternate (Specify) Seepage Trench: No.of Lineal Ft. Width Depth Tile depth ( op) No.of Trenches Seepage Bed: Length `�� Width Depth Tile depth (top) 30 No.of Lines Seepage Pit: Inside diameter Liquid Depth No.of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Z Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certi P d Soil Tert .> f/ NAME 14�A n��, C.S.T. # S r 5 _9 and other information obtained from ti (owner/builder). Plumber's Signature MP/MPRSW# Phone yl -Slr Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. i -. i ? E , , ' � I Q I sy E E I � s , ma � � i e e , E .. . aw .. ... m . _ ..�.� __• — b. .� -a m �_ E , F i Do Not Write in Space Below PR COUNTY AND STATE DEPARTMENT U ONLY Date of Application �C? -/- / Fees Paid: State h (J Co nt Date Permit Issued/Rsjoeted (date) lC -/- / Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 94 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH P.O.BOX 309 MADISON,WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS f/ LOCATION: /�L.%,/A(Z'/4,Section �L T3 N, R/.L ID(or Township or Municipality SMBrSC r County Lot No. , Block No. Subdivision Name Owner's Name: goy )/ur ° e, Mailing Address: LK P73 .Sdhr'-"��� ` .r`lV S� TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS — PERCOLATION TESTS SOIL MAP SHEET 2 SOIL TYPE OAJ �7r�ar 4!ye PERCOLATION TESTS Sati4Jy 1®9A", HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE TEST DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN BER P— 42 y re P 3 /V��E' ,(jd rG- D GZ l 0 �Q ! L / / �/ °L. SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES (DEPTH TO BEDROCK IF OBSERVED) OBSERVED ESTIMATED HIGHEST B— / Q�. /(loin Most/.�+G- F.F. 6" Wc,`7`S� a/,•5.�� �3" ,2 // Fi B_ 3 ��„ MoytZWGFf Qc" to„�s, /e-sc, � s,G, 3�„s B— s FF M 071L/0�6 f'f' Y6” /� tS, !S”S,4j 3 3­ FSL lc� PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the locationand square feet of suitable areas. Incjic�t number of square fe jt of absorption area needed for building type and occupancy. p 1 ,� aoc� d SK.> 6� ��' �'r Ys: -%— Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. t /1e�// `�' •,�, 1 \ r &x s G- A/ 6. . N 3 Bo S B A O / {{ I \ I e- CP �v •� M`lam s 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 location of test holes are correct to the best of my knowledge and belief. l ¢rte eN Certification No. S–S — /s Y9 Name (print) , Address ���6 � �"� �Ut, Ar Name of installer if known CST Signatur r COPY A—LOCAL AUTHORITY �M P 1 b. # 60 } 3/70 PROJECT DETAIL DATA SHEET NAME OF BUSINESS V*r P., LOCATION OWY Son,vr,S It+ strelet or highway city or township county LEGAL DESCR I PT I ON '04 A u w 114 J,, . o�� T,31) Nj OWNER Qo 4 ;;-4 P%k l Mai 1 ing address RR z W s z t ARCHITECT OR ENGINEER Address _ ZIP PLUMBER QOX�)%v% ?0Wtf,S P Address RP- e%#--) W,0^ Z I ,S 1 . Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building Y New building Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant . . . . . . . . . Car spaces ( ) Restaurant Seating capacity (10 sq. ft./person) ' ( ) Dining hall, . . . . . . . . . . Per meal served Toilet waste Yes No ( ) Motel ( ,) Hotel 1 (• )•Cottages . . Number of units : 2 persons/unit 4 persons/unit TOTAL NUMBER OF UNITS ( ) Churches . . . . . . . . . . . . . . . . . . . . Number of persons Kitchen Yes No ( ) Bar or cocktail lounge . . Seating capacity (10 sq. ft./person) ( ) Nursing or rest home . . . . . . . . Number of beds ( ) Mobile home park . . . . . . . . . . . . Number of units - dependent (camper trailer) - nondependent (mobile home) ( ) Retail store . . . . . . . . . . . . . . . . Number of employees Number of customers T10_sq. ft./person) ( ) Service station . . . . . . . . . . . . . Number of cars served (daily) ( ) School . . . . . . . . . . . . . . . . . . . . . . Number of classrooms Meals served Yes No _ Showers provided Yes No ( ) Factory or office building . . Number of persons (total all shifts Apartments. : : : : : : : : : : : : : : : : : : Number of bTA s Other Specify TQry 2.' Indicate whether or not the following acilities are connected: Food waste grinder Yes _ No _ Dishwasher Yes No X Automatic clothes washer Yes No � Automatic potato peeler Yes Other . . . (Specify) No !� 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned �uvo 41S. Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPO 909 i JUN 14 1979 COMPLETE OTHER SIDE PLUMBING SECTION, �# '� 4r 60 Seepage trench bottom area planned width linear feet _ depth Seepage bed area planned �A width �� 1 linear feet t depth O a� Seepage pit planned outside diameter depth below inlet depth 4. See approved plan for specifications and details. Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION P. 0. Box 309, Madison, Wisconsin 53701 Approved: Address: R Date: + <I O17 THIS APPROVAL IS BASED ON STATE PLUMBING +�,,�, CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: .. �_*`? R INSTALLATION FROM CITY, VILLAGE, TOWNSHIP OR COUNTY PERMIT REQUIREMENTS AND SHALL BE VOID IF REVISED WITHOUT THE WRITTEN APPROVAL OF THE DIVISION OF HEALTH. DEPARTMENTAL USE ONLY EX/WINED and reported upon by the Section of Plumbing and Fire Protection Systems, Bureau of Environmental Health, Division of Health, Department of Health and Social Services. JAMES A. SARGEP 4T, Chief Section of Plumbing & Fire Protection APPROVED by the Division of Health, Dept. of Health and Social Services, subject to conditions set forth in the letter of approval. Verification .... .. ... •. ...... .. .. ................ Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER D _ TOWNSHIP ����,E7 SEC. T N-RW ADDRESS gY .3�._ ST. CROIX COUNTY, WISCONSIN IC SUBDIVISION LOT .t'" — LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of II- HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM > / /l / y 16 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used d/ ,f i,� Z�'g &,/-- Elevation of vertical reference point: A"a Proposed slope at site: SEPTIC TANK: Manufacturer:Lz,r 4--2LAiquid Capacity: Number of rings used: Cl Tank manhole cover elevation: 7 Tank Inlet Elevation:. _246J Tank Outlet Elevation: 0z'? Number of feet from nearest Road.: Front, Side ,O Rear, O �_ feet - From nearest- property line: Front,OSide,�Rear,O feet Number of feet from: well _, building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE f 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 on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: Length:___..,1c�.. Len ffi _y Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, Q Side, 0 Rear,0 Pt .16Q Number of feet from well: / 2-i' 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: Dated: �� Plumber on job: License Number: 3/84:mj