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HomeMy WebLinkAbout040-1191-95-000 y p 3 w 0 0 ~D n• 7 fD CD T 7! C ~ O Cl) A A `C • n v O N O Co j p E3 O) 3 Z n O ° CD CO O 0-4 N~ ~ o o y cc N O O~ O N C 0 N j O '-T• 7 oO O T 7 OT. O m O O Q1 ~3 N K N rn ° O v (n D a cu cQ CD m d < ~ N co F 3 `L rn 0 CD rn CD N O O 0 r, en C CD Co Z0 N CO N< K G !r N ~ Q z 0 0 0 n n' • n r'S o a fq N N v y v a X a 'm A N C x N C d CD co CD cc N (D N CD z N Z z co z 0 O D m o CL :3 o CD CD (D N t+l v c (n N - (D N W N d n 3 7 _ Z CD Z C D C o 3 to A 0 CL Z o o. M N A co m w (D CD , z o 3 0 C/) 0 y z CD p w ~ D CL n o - m c z a m S Ell A I b I a z N 0 0 a 0 0 CD CD Dro En O ti a °o CD ° CL r\ O N U N U 00 00 0 CO r w t~ N O I I ON v1 x C'A N cd .i ~ o 94 "IA 4,j x UA 4-3 ~4 ~4 a) rtt z a) b ~4 w om o a~4 w N O rd,C cd 3 ~ }4 ,J b u cdd P rl '4 UO x •rlrl , Qn pa clA Parcel 040-1191-95-000 12/14/2005 10:33 AM PAGE 1 OF 1 Alt. Parcel 24.28.20.856 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HUPPERT, MATTHEW W MATTHEW W HUPPERT 226 PLAINSVIEW DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 226 PLAINVIEW DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.700 Plat: 0234-CROIXRIDGE SEC 24 T28N R20W PLAT OF CROIXRIDGE LOT Block/Condo Bldg: LOT 10 10 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 01/11/2005 784673 2729/242 QC 09/07/2001 656105 1715/302 WD 07/23/1997 1161/238 QC 07/23/1997 1024/579 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 103543 243,600 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.700 66,000 168,500 234,500 NO Totals for 2005: General Property 1.700 66,000 168,500 234,500 Woodland 0.000 0 0 Totals for 2004: General Property 1.700 66,000 168,500 234,500 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 AS BUILT SANITARY SYSTEM REPORT ~ S~PIoNyG OWNER y x° TOWNSHIP 10 ADDRESS ST. CROIX COUWlY, WLSCONSI~. r~'.►.ia L F ,r /r g r ~l SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 yF.$YTHING WITHIN 100 FEET OF SYSTEM JV7 tix 9 I \ i. t I di a e o th Arrow I SC d. '3ENCHMARK: (Permanent reference Point) Describe: Elev tionl of vortical reference point: _ slop at Oa.te : _ r SEPTIC TANK: ufactu er Lid Cad c ty _ Number of rings on cover : Tank manhole cover elevations? Tank Inlet Elevation:' Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal pump set or a cycle _ gallons; total-capac i t y o distribution lines gallon: size of' pump____ gallon per minute ; horsepower brand name of pump and model number ; Type of warning device BOLDING TANK: Manufacturer Number of gallons _ Elevation of manhole ccver Type of warning device-. - - SEEPAGE PIT SIZE: ftum~er of-pits feet diameter feet liquid d4pEE seepage pit inlet- pipe-elevation___ bottom of seepage pTiteleva on _ feet. SEEPAGE BED SIZE: number of lines rl width _lectgth tilt ~ieptt~ = SEEPAGE TRENCH: width "length PERCOLATION RATE -77- AREA REQUIRED f INSPECTOR DATED PLUMBER OIVJ bB ~ LICENSE NUMBERS F- 9`3 ST. CROIX COUNTY h WISCONSIN ~t V ZONING OFFICE yc~7 ' X ST. CROIX COUNTY COURTHOUSE l"I 911 FOURTH STREET • HUDSON, WI 54016 / y SEPTIC INSPECTION / WATER TEST REQUEST FORM specify desired test( s) & remit. appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 'Q Septic $25.00 9 Water (Nitrate & Bacteria) $35.00 (Visual inspection) vZS a Owner: - `~c c~~t • Requested by:-~t<< Address:~{L Address: City & State: City & St G 0 Zip ode: 1, z Zip Code: _ Telephone N4: (Z,) Telephone N': (L) Property address (Fire N° & Street) Z Location: ~i ~,Sec. T N, R_W, Town of ~c St. Croix Co., WI . Tax ID N4 Parcel ID Na 6 `-b - / House color: Realty firm: Lock Box Combo: C Water sample tap location: TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied? ❑ Yes ❑ No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced by: Date: Previous Owner's Name(s): Have any of the following been observed? < ❑Y ❑N Slow drainage from house. n RECEj~F ❑Y ❑N Sewage Back-up into dwelling. ro 11 ❑Y ❑N Sewage discharge to ground sur e,~i iv road ditch or body of water. ~g~~ OY ❑N Slow drainage from the dwellin ~r q' ?n CuyTy 4, ❑Y ❑N Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: X /y DATE: 4/93 Ve r~ OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION f ~N TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: OBelow grd OAt-Grd Mound Approx. size 'X ❑Gravity ❑Dose ❑Pressurized Ft.' OBed OTrench ODry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther ❑Unknown Septic tank Setbacks: ❑House OWell OProp. line 00ther Dose tank Setbacks: ❑House OWell OProp. line ❑Other Mocking cover OWarning label ❑Pump/Floats ❑Alarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell ❑Prop. line 00ther OPonding: ❑Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY r~k yrm ' i WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 1101 Carmichael Road Hudson, GQI 54016 (715) 386-4680 July 7, 1993 Q'K Carrie Johnson Edina Realty 200 2nd Street Hudson, WI 54016 Dear Ms. Johnson: An inspection of the septic system on the property of Richard Power, located at 226 Plainview Drive, River Fals, WI was conducted on July 7, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator mij GWIVIERCIAL' TESTING LABORATORY, INC. 4 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX-715-962-4030 Lit K-POIRT DATE; 7/i4/93 CARMICHAEL ROAD DATE RECEIVED* 7/09/93 `N, WIT )TION2 226 Plainview Dr., River Falls i SECTOR2 K. Jenkins COLLECTEI4 7-07 COLLECTED: 9100- OF SAMPLE-1 f 'NALYZED:7-09- N'AUZED 2112 0, -R`f,MFCC2 0 RPRETATION' Bacteriologically SAFE I 4 ppm 10 ppm exceeds the rec^)mmended Public. ,2 err J,~ O: ' A ' OEGENp =coF EH..; roved Lab No, O n Zd O OO PROFESSIONAL LABORATORY SERVICES SINCE 1952 GLPAR%QTENT OF INDUSTRY, INSPECTION REPORT FOR / SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 : C, CONVENTIONAL ❑ALTERNATIVE StatePlanLD.Number Ilf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NA OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE: BENCH MARK (Permanent refere re point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT ELEV. -S 6 :S: Lc~ e NPlu er. MP 1PRSW No.. c,, Sanitary Permit Number: . I t/le) SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV. JWARNING LABEL LOCKING COVER y PR12I OVDED. PROVIDED. li° J I YES LINO ❑YES LINO BEDDING: IV ENT DIA.. VENT MAT L.. HIGH WATER NUMBER OF ROAD'. PR OPERTV WELL: J BUILDING. VENT TO FRESH t L ALARM. LINE. AIR INLET ❑YES LINO `I FEET FROM ~ ❑YES LINO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAP CITY gMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. jj' ❑YES LINO ❑YES LINO ❑YES ❑N GALLONS PER CYCLE: ! vU, N CONTROLS OPERATIONAL NUMBER OF jlI;(TFRTV WELL JBUILDING, I VENTTO FRESH M vF AIR INLET (DIFFERENCE BETWEEN / 11 INEAREST FEET FRO PUMP ON AND OFF) / ZI Z ❑YES LINO SOIL ABSORPTION SYSTE Check t W e soil m6istu re altthe depth of plowing f Lr,r 1 I OIn^. r TEH IMATEHIAL AND MAHKIN , 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 ISIDEDIA #PITS LIQUID BED/TRENCH ^ TRENCHES MATERIAL PIT DEPTH. DIMENSIONS 1 C P (;RAVEL UEP7H FILLDEPTH DISTH.PIPF DISTR.PIPE DISTR.PIPE MATERIAL- NO.DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH . ILINE AIR INLET- BF L01, PIPE .S ABOVE COVER ELEV. INLET ELEV. END. - I PIPES FEET FROM Q - V C NEAREST-►~ 1 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER. TEXTURE. PERMANENT MARKERS OBSERVATION WELLS El ❑YES LINO ❑YES LINO DFP1HOVER TRENCH BED DEPTH OVER TRENCFI;BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED 'FN FH EDGES. ❑YES LINO ❑YES LINO ❑YES LINO PRES_S_URIZED DISTRIBUTION SYSTEM: _ WIDTH. LENGTH NLATERAL SPACING. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV ELEV. DIA. ELEV. PIPES DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL' BUILDING. FEET FROM ,NE ❑YES LINO ❑YES LINO NEAREST- i I ~l o l.~ c; Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE'. DIL-HR SBD 6710 (R. 01/82) i _ State and County State Permit # PLB Permit Application County Per t # - for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. O ER OF PROPERTY Mailing Address: i B. L CATION: '/4 Section T,,WN, R,12-1a E (or Lot#/_i City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: `Commercial *Industrial *Other (specify) 'Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY A0 L!9,6 Total gallons No. of tanks 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 Pref b co crete Poured-in-Place Other (Specify) E. EFFLUE'NT/ DISPOSAL SYSTEM: Percolation Rat Total Absorb Area sq. ft. New y Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Tre ches Seepage Bed: LengthWidthDepth_Tile depth (top)-No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land_~ ~CJ Distance from critical slope WATER SUPPLY: Private ❑ 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 Certified So Tester NAME C.S.T. # and other information obtained from (owner/builder). r Plumber's Signature W MPRSW# -"2 2-, F~ Phone o~J - Plumber's F.ddress 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. E t 7. - F E E i iE Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT U ONLY ,y Date of Application J•_ ~s2 Fees Paid: State p County Da Permit Issued/R.ejtQWd (date) Issuing Agent Name Inspection YesNo State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 _ J ¢~~~~r~fatt, .DEPARTMENT OF - REPORT ON SOIL BORINGS AND RFC - I ;DINGS INDUSTRY, LABOR AND PERCOLATION TESTS (115) _ M1l6 'P.O: B X 7969 HUMAN RELATIONS Ml~PI N;_ 53707 - LOCATION: SECTION: TOWNS HIP/NV44&G4R46+-~: LOTNO.:BLK.N BDIVQWCf NAME: St~t 1/s+4 z-v /TAN/RWE(o W`r COUNTY: OWNER'S Bk}YE 'S NAME: MAILING ADDRESS: XI/ ST. c - . I X \ C1 fi< y', :5~ " ~ S • S, 4-E Fi 7. - - - USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R ONS: ER LA ON TESTS: dResiden New ❑Replace ce RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: ISYSTEM-IN-Fl LLIHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ❑S ®US ❑U ❑S ZU ❑S ❑U IZ x3QED SYSTEM ELEV. Percolation Tests are NOT required DESIGN RATE: If any portion of the lot is in the under s.H63.09(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 IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~Z 94°_ Nc~ m SZ 131LTs,b; sl,zD pis ho Qjs,33 B- Z `1 S ~2 S It ? -7 73h ~S Ll -71 B- 3 1~C~ ~S S , 7 1C> l5; 11 iL 9~ 7 Z B- L{ 1Z6 91 S Il 7 9Z ,23; t, B S 1~Z 9b~ 1,>c~rJC > \~Z I 3~ '~hL ZO < ~5' ja~4njv s'21 JB- 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_ \ 3 (o - '3 P- Z S - 3 wPT~Z ?r o -r r t~ ~f s 5 1 P- 3 bh 3 3 t~ ti~ - / P- L_P_ P N VIEW: 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 slop. C1tJ1TIP~L~ QE4~- LRGL N1E~_ T ~•~I So[L SLI~VEL/ SYSTEM ELE TION E M si CH~TEk-01~1AMr~ cE>t,PLEi X 0 a : . SL> t4- C, P06 a e<u RZ. ~J 5 ' N s J r ~ r r Q ° t1'E 1 E~ Satvt~tlWt.ST~f~` L ptAlu SCAL.L \ - 3d tx.C~T hs St4ow►~ 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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: V/l-2 /gz ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): Z i C. 43 !.,,aca~ r! ! 7 S7(I X115-~=s'-.938/ CST SIGNl TUBE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. ©F DILHR-SBD-6395 (N. 03/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, - DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 N WI 53707 HUMAN RELATIONS LOCATION: SECTION: -TOWNS HIP/I 4N-I-6FF-A-L-FTY: LOT NO.: BLK. NO.: SUBDIVISION NAME: SES1/ 1/ zL/ /Tz8N/RzoE(4W COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 3 _ tit x lZ~c-h1A1Z T~,~1 Z~ S_ l7A`-Lz- fl-jYj- *365 ST. pRu L, 3SS 1D I- USE DATES OBSERVATIONS MADE NO. Residence BEDRMS.: COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS: ER _A ON TESTS: Z r IgNew ❑Replace t y~ Z L/~~~7~a Z RATING: S= Site suitable for system U= Site unsuitable for system l 7 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ©S ❑U ❑S [;Su 13S ❑U ❑S EU ❑S EU IZ'X 3S' Zjseb If Percolation Tests are NOT require DESIGN RATE: SYSTEM EL V. If an any portion of the lot is in the under s.H63.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. OBSERVED EST. HG-HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- P- P- P- PLAN VIEW: 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 slop" SYSTEM ELEVATION O ~ WObD 9 ji' f io e 91° /-~art/.1tRlfJa. ISLOPE 3 r 9 ~4h1'l'~R tom- ost91 y8 e El."Eti .°~1~= ~tsl~l$OTIO/v t?i rD~. 'Pc'f C L f_v . w _ _ S:C kN ~47~.: N Pca N'ttt 11J A k Y't X I M.as Fes! QF . OF C®\j oiz Ou e`Tt t SYrL)~~ ®~l P) pjEt.S. _ we Z4 5 P t` S uCt Fltce= aEv i~'D TD L= L I N1 I A_)AT e I~s?*-C ~01~.lltz!Lc nF°: , fL. k Lt r!~ ' . I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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: CERTIFICATION NUMBER: PHONE NUMBER optional): ~1? rel. ' 5~0 715-V2-S--9'$) CST SIGNATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. SHEET 7 OF Z DILHR-SBD-6395 (N. 03/81) f-Xmer's name San. Permit No. H63.05 PLOT PLAN Show: Q Location of building served Q Dosing chamber Septic tank LT Vertical reference point Q Building sewer Q Horizontal reference point [A Effluent system Well EA Replacement system area Lvj Property lines w/in 50' of system Distribution boxes F- Scale 1 or dimensioned 0 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: to 7 O w~~ ova Lo T 1 L~~T l D ~C L-C' P D~a UJ, Rr~' 35 VG \~t t or. ,%'3o ,z ~f3N SPtr. tn~ to, 3 i(.. Loo - "LO -7 10% ~10T E ~.1 ~ SffP't~ C TA !J K 'to Q E. Z RoN ? Lv the granting or approving of the above plan, or upon the event of a subsequent permit being issued,?", 0 ~t County and the _:--,xCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan fission, examination oversight, construction, or any dam e that may result in or _ installation. f i; ' San. Permit No. • ' Owner's name H63.05 PLOT PLAN Show: Location of building served L-1 Dosing chamber Septic tank Vertical reference point L_.l Building sewer Horizontal reference point F -1 Effluent system LA Well 1.A Replacement system area r ~:l Property lines w/in 50' of system Distribution boxes i Scale 111 , , or dimensioned El 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 I 1a n below: . Place check mark in appropriate box, indicating item is shown on plot plan I l o - wet 1 'h -10 ~ 1 a K 11 / rai ~3 vlr 1P W@_ _r u ~ i Ra'h~ PIPG ~ v i VENT -LP \ 7A% Jr. C "rr1 Q K -M lai e - I ~r !)ZA/J G V By the granting or approving of the ab.)ve plan, or upon the event of a subsequent permit being issued,.,, Counnty and the xCounty Zoning Administrator, does not assurne or hold itself liable for any der"ects in plans or specifications, plan remission,- examination oversight, construction, or any dame that may result in or after installation. Plu~rr,<~r's ~i,-rn.1`-ure