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HomeMy WebLinkAbout010-1023-50-000 n y O 0 N O' 3 v n d r~ = 1 -0 7! -0 n ^ v m d # ° 1 3 3 3 3 I ! ~ ~ o= z ao O o m z rn rn v m o° `C • m 3 0 cn o CD a) (n 0 CD 3 o c i coo K CD o° 00 Z E (D N O d Z a` N N • O .~.y a 0 (D 00 (D -0 ° 7 CD (D N N 7 o 0) O O CO °0 3 CD ° D 0 3 N 7 N o O c~ Q d CD flt CD (o (D (n CD (n CL N W S 7 N Q7 S O 7 CD c D (D c D a CD CD 3 p o co\o o0 m rn 0 0 w c c 0 L 0 m o m m c CD -4 -4 3 1 CD n co o~m 3 !1 N co co (D N o 3 Q v N Z: CL PL ,u -0 -0 T IV m "fti 0 z O O O O O O o a 3 N 3 y ai a w m - 3 0 rE 0 cn ? cr ? O A (D Vj CO n 0) 7 D) 'O d 'O N (D CD ' A (D N 7 m 3 m CD m N D m 0 D CD? O 7 o' ~ ? cn h m 7 m m m CD o c v c CD (D C T. N C N N ~f W CL CL 5 3 n Z CD _ -4 N O C c R 70_ o. Z 7 R C) O (D m (D < O O (D M d Q . Z ° 3 ° 3 A 3 0 _J) CD CD A W N w N CD CD D 3 D 3 a- CD CD 0 0. CL N c -a o a v c f. n n m c -1 o N ~ 'I o a BCD o a CD in' 25' m N N o 5- Dc 7 C (D O (D 7 k x. m y I 0 CD a ~ v 3 A a n S A CD o CD T= o (p Q N °o C4 a V W A O_ p b n CD (D 7 DQ b (A O ffl0 O O a O (D O (D b y O L O L ti AS BUILT SANITARY SYSTEM REPORT ©WNE") ,l tf.e TOWN SHIPr-'..,,~~' ; SEC. T N, R jnT P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements.of H62.20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM .'4 1" u A Cr tc i ` N SEPmIC- si^-ii~n S :`~FGR. • CONCRETE STEEL NO. o rings on coyer_ Depth :,t f, DRY WELL TRENCHES No. of width length area BED no. o-f lines widtFi length area dept to top of pipe .AGGREGATE PERK RATE AREA REQUIRED ARFA AS BUILT DISCLAIMER: The inspection of this system by St, Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croi_. Cc;,~r.t no 1. X1.1_ -y for _ ys ein operation. ucT~ever, if f.ail_>>re is not:E'd the vO:in'L:y will ilia e every el l"ort to aeteriii;.ne C-RU "e Ol failure. GREASE'S AND OILS Si~OULD NOT BE DISPOSED T1I::0UGH THIS TE~1, INSPECTOR DATED PLUMBER ON JOB LICENSE .;-Z ~z 4 ~ _17 Rt PORT Of INSPECTION - INDIVI"DUAL WAGL SYSTEM Savt ' tart tl PeItm< I StaScpt<c /W/ _ ( u w w It 4' p( -------5 .t . C It o i x C o u vi l iI Scct.iovt _16Lot SubdiviS.Iovt I'I It' IANK gaQLoviA Nurnben oh eornpvt,tmen;th ti I,~ttr (~rorrir woe ButiTd.<vtq 12"s hd'opc If t: shwa to It " i HMI'ING CIIAM13tR St re --qa -Ekovi.b P ump MaPi.(4 a=ctuncIt Mode Numbed i(Ol01NG TANK Si zc gaffovtb Nunit) cit o6 CornpaIt trncvtt5 P Ialpo'tt Aeahm Stlbtvai J(~ ((1 um; W V e f 8u4Xd4 ny__- 120 ope Nt.ghwatvIt 11;~,ORI'TION SITE I~t'I ~ LhPYI('II f We hm; We ee 8 Pd<v<<~ i7`0 n N(pe - f _ I14 gIt wa,tc It A~; i'I Ii1N CIII Of Ml NS IONS ( dl01 o Ole yleh ht Rcgtt-lIted a it -ea I. I cvtgtlr ofi cacPi Yivte (fi DcpfIt Itoch bceow tiev tvt NurnbcIt o~ I(Ytcb Oct.) tit o~ ioet" overt tiYc tvt 7otae Pcvtgth oYivieS -_--i~t Dcptit c111 t-('- kV bcPOW gItade ivt U<6 tavtce ho two cvi eItneh At _~kope oA 01ewcIt vt. pofl 100 1 l otae ab's oI( pt'("orl aIt ca i {.t Typc oA CouvIr Papcn oIt h thaw I)iMIN"I IONS ~Jtruil,r p( tb Grtave ( aIr(1uvrd p< t5 IIc) vtu tlti(~ldiatit c.tcIl {t Dcp(It below 4'kiPet (t '110('Itptcovt aIt ca _-------h_I AIf ca rtc(Iui1ted lit I'ljPI CH O by 7-1TLI Aili'ROVI 1) OAII 1(I n I I I t' I I U VA-I C 19 b n1;(1N I OI: RIJI CT10N PLB State and County State Permit # Permit Application County Perm' # N? ~ - for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: L,,1 '/4 !i✓ '/4, Section _O, T~:& N, Rj *(or) W Lot# City i Subdivision Name, nearest road, lake or landmark Blk# Village Township ZC- ,,.4 Ld C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) `Variance Single family _ Duplex No. of Bedrooms No. of Persons D- SEPTIC TANK CAPACITY /Q 8 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 X Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private X 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 Soil Tester, NAME C.S.T. # and other information obtained from (owner/builder). f Plumber's Signature NAP/MPRSW# Phone #2,1K6 y~ Plumber's Address = - li✓ tt 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 { a _ .r e m i ( Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application if Fees Paid: State Co my Date rmit Issued/Rejected (date) Issuing Agent Name _tion Ye,,~ No State Valid# Date Recd ty (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 link copy) 4. plumber (canary copy) Revised Date 7/1 /78 j v 4r). _Plumbing PHONE (715) 265-4838 GLENWOOD CITY, WISCONSIN 54013 cAA e AI ve- /N d R tile Feivoe- t Sao 1 t 4' 4. Z 2+ RAIN ;i~idkd 30 146 z o