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Parcel 040-1119-10-200 03/11/2009 03:15 PM
PAGE 1 OF 1
Alt. Parcel 31.28.19.484B-10 040 - TOWN OF TROY
Current X! ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
05/25/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - HALVERSON, DANIEL C
DANIEL C HALVERSON
78 CTY RD F
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 78 CTY RD F
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 5.000 Plat: 4984-CSM 19-4984 040-05
SEC 31 T28N R19W PT NE NW BEING CSM Block/Condo Bldg: LOT 01
19-4984 LOT 1 (5.000AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-28N-19W NW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
12/05/2007 865174 QC
09/28/2007 861353 TD
06/19/2007 853400 WD
12/08/2006 840239 TOD
more...
2009 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/23/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 93,800 183,700 277,500 NO
Totals for 2009:
General Property 5.000 93,800 183,700 277,500
Woodland 0.000 0 0
Totals for 2008:
General Property 5.000 93,800 183,700 277,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF TROY
COMPUTER NUMBER 040-1119-20-100 Parcel Number 31.28.19.485B
OWNER NAME: First %MICHAEL J HAHN PRES Last HAHN DA ROSA FARMS INC
PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment
SECTION 31 TOWN 28N RANGE 19W '/4160 '/440
Line Description Line Description
TOTA T LOT BLK
S20A 15
16
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE N OF O
COMPUTER NUMB 040-1119-20-100 arcel Number 31.28.19.4858
OWNER NAME: First °o PRES Last HAHN DA ROSA FARMS INC
PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment
SECTION 31 TOWN 28N RANGE 19W 1/160 '/440
Line Description Line Description
PARCE L VOLUME & PAGE HISTORY
TYPE VOLUME PAGE DOC# NOTES
LC 2027/ 235 696177 WILLIAM KASTEN TO HAHN DA ROSA FARMS
716/ 509 0 716/509
Use Arrow Keys to Select, F7-ROD, F10-Exit
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF TROY 'n
COMPUTER NUMBER 040-1119-40-000 Parcel Number 31.28.19.4871/" ` ~I
OWNER NAME: First JENNIFER N & HEATHERS Last EASTON d Q
PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment y
74 CTY RD F tit a~✓
SECTION 31 TOWN 28N RANGE 19W '/4160 '/440 ~l/y'
Line Description Line ~ scription
TOTAL ACREAGE 32.845 PLAT LOT BLK
01 SEC 31 T28N R1 9W SE NW 15
02 EXC HWY AND EXC PARCEL 487B 16
03 AND EXC CSM 8/2223 17
04 INC PT OF LOT 1 CSM 6/1567 18
05 DESC AS COM N1/4 COR SEC 31; 19
06 TH S 1 DEG W 1679.75' POB; 20
07 TH S 1 DEG W 26.54'; TH N 88 21
08 DEG W 361'; TH S 1 DEG W 22
09 361'; TH S 88 DEG E 361'; TH 23
10 S 1 DEG W 49.46'; TH N 88 24
11 DEG W 499.35'; TH N 1 DEG E 25
12 437.24'; TH S 88 DEG E 26
13 501.62' POB 27
14 28
F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit
A S B U I L T
a~,Iner's name Township, ripality-- Sanitary Permit No.
Show:
Q Location of building served Dosing chamber
Septic tank/Manufacturer Vertical/horizontal reference point
F
Building sewer System elevation is:/~y
Effluent system Q Well
Replacement system area Property lines w/in 50' of system
Distribution boxes 7 Scale or dimensioned
Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal, per Cycle
Elevations: Distribution Pipe: ^ f<':-~ )•<r'~: i~i/r,~,
Inlet Outlet Manhole -fni-e-t -End
Place check mark in appropriate box, indicating item is shown on as built below:
' i }
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v0
l_
Plumber's Sianature License No, Date
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON,-WI 53707
MIZONVENTIONAL ❑ALTERNATIVE state Plan LD. Numbe
(lf assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTIO E:
William Kasten 6101 Courtly Alcove, Woodbury, MN55125
BE rmanent reference point) DESCRIBE'. IF DIFFERENT FROM PLAN REF. PT. ELE41. 7F . PT. ELEV..
E NW, Section 31, T28N-R19W, Town of Troy
umber. MP/MPHSW No Co~n[y Sanitary Permit Number
Russell G. Anderson 4595 St. Croix 69655
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED'.
❑YES ❑NO ❑YES ❑NO
BEDDING. VENT DIA.: VENT MATL. HIGH WATER FNUMBER OF ROAD. PROPERTY ~IVETL. BUILDING: JVENTTOFRESH
ALARM. T FROM LINE. AIR INLET'.
❑YES ❑NO ❑YES ❑NO REST
DOSING CHAMBER:
MANUFACTURER BEDDING. 11-1101UID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY JWELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 FN(TH JDIAMETER MATERIAL AND MARKING
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:
WIDTH. LENGTH. NO. OF DISTR. PIPE SPACING COVER INSIDE DIA. -PITS LIQUID
BED/TRENCH TRENCN ES MATERIAL
DIMENSIONS _ PIT DEPT"'
GRAVEL DEPTH FILL DEPTH JDISTR. PIP' DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTH UMBER OF PROPERTY WELL. BUILDING'. VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV. INLET ELEV. END PIPES'. LINE. AIR INLET'.
_ _)2 / FEET FROM
L NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑ meets the criteria for medium sand. TIONS MEASURED.
YES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
LE VER TRENCHBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDEMULCHED
TER EDGES.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. jNO.r1TR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV.. DIA. ELEV.' PIPES. DIAJ
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE' TITLE.
DILHRSBD6710 (R. 01182)
NWMMMEW~ wlscdnsln APPLICATION FOR SANITARY PERMIT -
AIL H R COUNTY
~M OevRRTmEnT OF (PLB 67) UNIFORM SANITARY PERMIT #
I InDUSTRV, LABOR 6 HumRn RELRTIOns
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
PROPER Y LOCATION G'tfi,F
VIEEA6E
~ a
1 /4 /4, s 3 , T-7 N, R /`I r W 'ER ~
_S E ' TOWN OF:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify):
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed Ky Seepage Trench ❑ Seepage Pit ❑ Holding Tank
System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity L)~
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: ) >
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
/o h 17-f Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Sign at r J } MP/ No.: Phone Number:
Plumber's Address: Nam~pf Designer:
# ci C au ~ l r7 ~ ~ ~ c. ~ 5 7 ~/rt e'
COUNTY/ DEPARTMENT USE ONLY
Sign at re of Issuing Agent: Fee: Date:
❑ Disapproved
Q~ ~j f P ❑ Owner Given Initial
J / 9 (J c71 Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.) ;
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
APPLICATION FOR SANITARY PERMI
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 KJ) (,l_ /~CTY~ l C /V ~021o~L L~jQSJ~
Location of Property ~4J ✓C~/ , Section T2Y N-R~ W
Township
T
Mailing Address
'ate nTL Cc mac' wc~crw ~~u~.c~ ~✓i; n ~ ~~~~%~c
F
Address of Site
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel was Created / Y
Are all corners and lot lines identifiable?~ Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number C 7 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTy OWNER CERTIFICATION
1 (We) ceAti6y that aU Statements on this botcm cute ttue to the best o6 my (outs)
knowledge; that I (we) am (cute) the ownelt(6) of the pnopetcty des cAibed in this
in4o,tmat on 6ohm, by viAtue ob a waAAanty deed hecotded in the 046ice o6 the
County Regis teA o4 Deed a s Document No. 410' 4- V E4 ; and that I (We) ptesentty
own the puposed site 6otc the sewage di6po~5~ystem (oA I (we) have obtained an
easement, to nun with the above desnibed pttopehty, {soh, the con/Stn.ucti,on o6 said
system, and the same has been duty /tecottded in the 066ice o4 the County Register of
Deeds, as Document No. ) .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
H
H
a
ST C- 105 r'
r
• a
H
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
d
ll~~ _ a
OWNER/BUYER(,
r~
ROUTE/BOX NUMBERCe, T(C Fire Number
CITY/ STATE &/A5 ZIP
_
PROPERTY LOCATION: /{'W Section 3/ , T 61Z N, R W,
Town of, St. Croix County,
Subdivision Lot number
Improper use and 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 septic 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. H
0
E
I/WE, the undersigned, have read the above requirements and agree Cn
to maintain the private sewage disposal system in accordance with az
the standards set forth, herein, as set by the Wisconsin Depart- b
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
DATE
St. Croix County Zoning Office
P.O. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, G DIVISION
LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 7969
HUMAN RELATIONS
NEM 0 ~ y (H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHI P"' 11 A
LOT NO.: BLK. NO.: SUBDIVISION NAME: 0, 11 y I P,11
COUNTY: OWNER'SfWH-'?'NAME: MAILING ADDRESS:
; t e _a rl 'Alcove
USE DATES OBSERVATiods MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence - New ❑Replace
-3 1 4, g;
RATING: S= Site suitable for system U= Site unsuitable for system -S'j
rCONVENTIONAL: MOUND: IN-GRI~O((UND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
®S DU ®S oU ;]S ❑U E]S ZU EIS ®U C E', e
I If Percolation Tests are NOT required DESIGN RATE: I If an
L y portion of the tested area is in the
under s.H63.09(5)(b), indicate: 4 r Floodplain, indicate Floodplain elevation:
OFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
Alone JSL,
U IF
O~ 1 ,S
~ - A /I ^t r
B- 7 i ifih le) 4
Very
j,.
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P-
P-
P- vl r--direja lr0 peet-
P_
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicat/-c ale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elev ioat all borings and the direction and percent
of land slope. Yr. /
ik, `
I'll SYSTEM ELEVATION
Z -14
c'cj r
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corn
ADp 0 r
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34 pre
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sowk tent 1. so F&'Ice
extra yy /101
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 WERE COMPLETED ON:
ADDRESS: CERTIF CATIO NUMBER: PHONE NUMBER (optional):
y~
CST S TUBE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DI LHR-SBD-6395 (R. 02/821- - OVER -
air H KAWN1 OR C ONW4=. e OW '4 A 116 S BU QN,
'o.p and racc ;i-3 aC'v test, yt>Lti" r q,.i " ri ms_ ale:'baJ
i=' ,.t .;e a!=Wy „ di ste poi o..E Vs ..z a rc!,J i. ra-, f, .r-nn 3 raial project;
, ayme L~w srJr.al-, h!,v r,,idreA luxes. A SITE K SUITABLE FOR A HOLDING ONLY F: ALL
OTHER SYSTEMS ARE RULED OUT BA~SE
PLEASE use On, £_ac a; €iom shC)i,a , 1,o Wr w ig p;i„ .du i` a .i#irmaris am d completing the tAot gala ;
M se' F A 1 GIB E dia rain acr u€ .?a o{ kwatog ysif t,dt amahons. E a a <vsrig in s aalr. > ref{?"cd. A.
w, €f: Shen! a : 5 t if as edt
Wke sure € =,i' a. afarn and vent's! t s[ n«l:aa; lee 'e joint arm r;(5.,,..riy as . oe nanisid;
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Owner's name San. Permit No.
H63.05 PLOT PLAN
Show:
Location of building served a Dosing chamber
Septic tank Vertical/horizontal reference point
Building sewer System elevation is 1~. yys~`~,C/
Effluent system Well
Replacement system area Property lines w/in 50' of system
Distribution boxes Scale = ys YZ4' , or dimensioned
Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
( B A ,j C12Ita1`11- A T ee
fence
7 J diM /cry
Of 9-c"'A5 "3 o f fjic•A'l
03 A P ~
/ceo
pp
00 o O c~ ~o~.c~Lr ,:2' cf ~'cck 1
6 e ~t ~e.o° Poe
ovvccg DGCc
6t+ c G GC a n c c Rk/~itis I
' i)
e' l
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, St (-Ao;Y County and the y r rr ;y County Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after installation.
um er s signature Zi"
icense o. Date
Rev. 3/83