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161-1092-95-000 (2)
Wisconsin, Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ,Safety and Building Division INSPECTION REPORT Sanitary Permit No: • 488048 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City X Village Township Parcel Tax No: Krenz, Jerod I Village of North Hudson 161- 1092 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: � Section/Town/Range /Map No: VV\ d ° o - ° C' 0 13.29.20.734 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark o 97-S q7 -� Dosing Alt. BM Aeration Btdg-sevver^ D-3 S la •ZS g,3.5 ok Holding St/Ht Inlet A1el TANK SETBACK INFORMATION St/HtOutlet QVJ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic z 1 t J 24/ 1 5 � J Dt Bottom \ Dosing g Header/Man. 7.15 94.5 Aeration Dist. Pipe V . Z .(10 Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 3• c J Manufacturer Demand St Cover GPM `I Model Number rr TDH Lift Friction Loss System TDH Ft �• L ' Forcemain Length a. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO uD P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR J Type Of System UNIT Model Numb Go��ev. a&cL 7 -1 ` J 7 1 M2. MIA" 5rck- !' DISTRIBUTION SYSTEM �j / ,L J� ec'j Z-Z� ht- Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Ai ntak� Pipe(s) \ ` Q ( `� Length_ Dia Z / Length Dia \ Spacin \ ` z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center /1 Q Bed/Trench Edges Topsoil rr� c� �k \ \Yes No Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 203 Station Circle North Hudson, WI 54016 (SW 1/4 SW 1/4 13 T29N R20W) St. Croix Station Lot 10 11 ( Par No: 13.29.20.734 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = , I � `.� g d-- p �, d V' — Plan revision Required? Yes >CNo � Use other side for additional information. L� 13 _ _ _— Date Insepct s Signat Cert. No. SBD -6710 (R.3/97) Safety and Buildings r County ` JIM 201 W. Washington Ave., ,���i�SI� Madison, WI 53707 Permi Number to be filled in by Co.) De artmen of m ce (608)266 -315 � LLd� ermit Application lan I. Numb / er D In accord with Comm,113 21 rWts'Adm. Code, personal information you p vide ST• CROIX (✓ 14 A , - °'milyb used for secondary purposes Privacy Law, s15.04(1)(in) j t Ad dt ss (if different than mailing address) I. Application Information - Please Print All Information Za �i t/nJ Property Owner's Name Parcel # t Block # fr �(� v Property Owner's Mailing Address Property ca 73 � o .> 3 " `V /., l� /., Section City, State Zip Code Phone Number �f�1 rcle i ©` T �N; R W 11. pe of Building (check all that apply) Subdivision Name CSM Number or 2 Family Dwelling- Number of Bedrooms ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City a Townsh of III. Type of Permit: (Check o y one box on line A. Complete line B if applicable) A. ❑ New System lacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. El Permit Renewal El Permit Revision El change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner -7 11 IV, of POWTS System: Check all that a 1 51 on — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of sui le soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- and ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter_ )❑ Recirculating Synthetic Media Filter ing Chaz94r ❑ Drip Line ❑ Gravel-less ❑ Ot4er (explain) J rlw s V. Dis ersaVrreatment Area nformation: ( % i Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area oposed (sf) System Elevation vzD -? gS 9 7 .�-- X38- $ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks I Tanks Septic or Holding Tank g, < L Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersiggo responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' ' ature MP/MPRS Number Business Phone Number / 71,5 � - q-S - 1 Address (Street, City, State ode) VIII. un /De artment Use Onl Approved El Disapproved Sanitary Permit Fee (includes Groundwater Date slued I ing �Sign S ps) Surcharge Fee) 3 �0 El Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval () a4 _ YSTEM OWNER: �' e YytIJIJo " J�� 1 ep "� conk, effluent filter and / dispersal cell must all be serviced / maintained �1�� C GiJ Gt�zx as per management plan provided by plumber. 2. All setback requirements must be maintained y Q( -� as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not lesfffian 81/2 x inches in sire SBD -6398 (R. 01/03) PLOT PLAN PROJECT Jerod K renz , ADDRESS 203 Station Circle N Hudson Wi 54016 NW 1/4 NW 1 /4S 13 /T 2 N/R 20 W VillageN. Hudson COUNTY ST. CROIX 12/30/05 MPRS Shaun Bird 226900 DATE BEDROOM 4 CONVENTIONAL XXX IN- GROUND RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZ 1000/283 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 IL BENCHMARK V.R.P Top of AC unit ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 88.9/88.0 4.5' below qrade Alternate Benchmark Bottom of Stucco @ 97.8' Property Line s 20, Plans Designed Using B -2 Conventional Powts 100' Manual Version 2.0 Scale is 1" = 40' 40 10% Slope unless otherwise 2 -3' X 88' Cells with B -3 noted >3' Spacing /��� 4 c Vent 40' >6 Standard Biodiffuser of Cover leaching Chamber 'Long 11 " with 31.1 ft2 of Area 30' � �J 6 -1 3 4" Grade at System Elevation 20 70' 2' S0' Well AtI.B.M. iel 70' ST ing 10' 15 1 T 15 Existing 4 Bedroom house B M A valve will be instal d if possible �./ Property Line Station Circle N r, PLOT PLAN I ` � ADDRESS 203 Station Circle N Hudson Wi 54016 PROJECT Jerod Krenz I NW 1/4 NW 1 /4S 13 /T 2 N/R 20 W Village N. Hudson COUNTY ST. CROIX 12/30/05 MPRS Shaun Bird 226900 DATE BEDROOM 4 CONVENTIONAL M IN- GROUND RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZ 1000/283 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 kk BENCHMARK V.R.P. Top of AC unit ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 88.9/88.0 4.5 below qrade Alternate Benchmark Bottom of Stucco @ 97.8' Property Line --� Vents 20' Plans Designed Using B -2 100' Conventional Powts Manual Version 2.0 Scale is 1" = 40' 40 10% Slope unless otherwise 2 -3' X 88 Cells with noted >3' Spacing 45' B -3 Vent 40' >6„ Standard Biodiffuser of Cover Leaching Chamber / with 31.1 ft2 of Area 6' Long 11" -1 3 4" Grade at System Elevation 20 70' 12' X 50' Well At1.B.M. Drainfiel 70' ST Failing 10' 10' 15 15 , ST 15' Existing 4 Bedroom house B.M. A valve will be instal d if possible �./ Property Line Station Circle N RECEIVED DEC 3 0 2005 Wisconsin Department of Commerce SOIL EVALUATION RE S P�a�y Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Cou Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) Property Owner _ Property Location - / z f e-_ /– _ Govt. Lot ILIZC, 1/41f j4A /4 S / ✓ T 0? N R E (or Property Owner's Maili Address Lot # Block # Subd. Name or CSM# ' D� S7,4- e7 /C/ � (- "o i/ State Zip Code Phone Number ❑ city Illage own Nearest Road ew Construction Use sidential ! Number of bedrooms Code derived design flow rate GPD EJ�Replaoement ❑ Public or mmeraal - Describe: __— Parent material �� ± , ,c /,._� Flood Plain elevation if applicable General continents and recommendations: 51 Ong # E] Boring ZI pit Ground surface elev. ) ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roott D/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#2 Fa-1 Boring # a Boring ., Pit Ground surface elev. / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 s - lIm tLV16 S 0e- rn I • Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address - Date Evaluation Conducted Telephone Number 715 - 246 -4516 1008 192nd Ave, New Richmond, WI 54017 —� _ ��`� Property Owner _ Parcel ID # Page of Boring # ❑ Boring J Pit Ground surface elev.9 I j ft. Depth to limiting factor / / n in. 17 Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. j*Eff#1 'Eff#2 G `l - 2- © 3 n o Z iZ -Z F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 I •Eff#2 F-1 Boring # E] Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.6/00) r Soil Test Plot Plan Project Name Jerod Krenz Shau d Address 203 Station Circle N Hudson Wi 54016 C #226900 Lot 10 Subdivision St.Croix Station Dat 12/29/05 N W 1/4 N W 1 /4S 13 T 29 N /R W Village N. Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top AC Unit System Elevation 88.9/88.0 *HRpSameasBenchmark Alternate Benchmark Bottom of Stucco 4 97.8' Property Line B -2 20' 93.5' 00' 40' 10% Slope 45' B -3 Scale is 1" = 40' unless otherwise 40' noted to 30' 1,1" -1 20' 12' X 50' Well AtI.B.M. Drainfield 709 Failing 10' 15 1 9 ST 15' Existing 4 I Bedroom house B.M. Y oe Station Circle N Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 'i9le ncy Plan If ystem fails, determine cause of failure, use alternate area and install new ted replacement area. " . Install system at a lower elevation, _by removing chambers, removing bbmat, new system. � kl Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer (-� -J . o �- b Mailing Address C910 1 J�C�,tn•..� l/t�" Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION o Property Location / v W 1 /a , 1 /a , Sec. a, T � N R Z W, Tow��'�'� L� Subdivision 5 1, L ✓ r ' , Lot # LL2.. Certified Survey Map # , Volume , Page# � 2 Warranty Deed # 9 1 1 12 6 5 , Volume 2 7 VJ , Page # / Spec house yes no Lot lines identifiable (9 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe ertify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property des bed above, by v' e of a warranty deed recorded in Register of Deeds Office. 7 SIGNA RE OF APPLICANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) r qw- ST. CROIX COMM ZONING OFFICE CERTIFICATION STATgb=T FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to ae tify that I have inspected the septic tank presently serv�:ng the ern re--n resident to sled at : — if, ��t�/ Sec. 3 , TN, R 2-y 00, of at. Croix County, Wisconsin. Upon inspec� XV, that I have found the tank and baffles to be in good conditlon, and it appears to be functioning properly. Last time serviced 1 Cl/ 2-00 S� Did flow back occur from absorption system? Yes vo! (if Ito, skip next line. Appreximate volume or length of time: gallons minutes Capacity: Construction ; prefth Coz)cr pie Other Manufacturer (if known) Age of T ' f known) : lal tt�re ,Name, Please Pr t 6 Title (License Number (Date) Farm to be completed by iiaensed plumber (s. 145. Wisconsin statutesr) or licensed disposer (NA 113 =aisconsin Administrative Code) Plumber (vpplyi.ng for sanitary permit) Csrti£icatiQn: in accepting the above statement regarding existing septic tank cor%diti0n, I certify that the tank, to the best of MY knowledM will Conform to the requiremnt:s of ILHR 83, Wig Aft. Code texcept f r nspection opening 4ve= outlet baffle). Name ��` u- G� Signature MP /MPRS U ..2943 f' 57 8 814263 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number Document Name RECEIVED FOR RECORD 12/14/2005 01:35PH WARRANTY DEED THIS DEED, made between John A. Foss and Julie L. Foss, husband and wife EXEMPT # REC FEE: 11.00 ( "Grantor," whether one or more), TRANS FEE: 1112.40 and Jerod Krenz and Joanne Krenz, husband and wife COPY FEE: CC FEE: PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address �i et - r0 /(�Q interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space (l riu is needed, please attach addendum): Lot 10, St. Croix Station in the Village of North Hudson, St. Croix County, '►" PT�;�j /4 MlUE, SUITE 150 Wisconsin 0 �[[ �$ � M►�" 55401 -2211 Metro Legal Services 161- 1092 -95 -000 EDIRET 488697 A Parcel Identification Number (PIN) 52379£ NN D 394387 This is homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated I 1 ( U 6 (SEAL) (SEAL) * *Jo". Foss (SEAL) 'A -I- �- �v, (SEAL) * *Julie L. Foss AUTHENTICATION ACKNOWLEDGMENT Signature(s) John A. Foss and Julie L. Foss, husband and wife STATE OF ) authenticated on 6 ) ss. _� COUNTY ) *Kristina O land Personally came before me on , TITLE: MEMBER ST TE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Osrland Notary Public, State of Hudson. WI 54016 My Commission (is permanent) (expires: 1 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFI ATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO -PROTM Legal Forms 800 -655 -2021 www.infoproform & com r - ST' C X _ ST.A LOCATED IN GOVERNMENT `LOT I OF SECTION I i, GOVER 1/4 0 F THE SWW OF SECTION 12, AND THE NORTHEAST 0 F SECTION 13 , T 29 N , R 20W, VILLAGE OF NORTH VI UNPLATTED. LANDS LIMI rH END. (I69.54 ,S_89w57 " E — — _ 4 69`.07 �— — — ).74* 152.53 °�� 12 11 c0 239.05 230.02 s , 352.27 a '�`� /' s 139.28' 199.7 7 M o 1.06 ACRES / /' 10 a 1.52 ACR S rn N 2/00 ZOd 13 / 10 / oo / 170 00417' ICE". !y aj r 4 1 ® 9 100 053'48" 20 DR 411YA E \ E s 2g3 7 ✓ �P 6 6 . E MEN' 12'3 N88 N 88 °34 W _ 1.17 ACRES 100.00 gp' 240.00' r4 n N 88 0 34 \ \� h \ r v v O� � o ° � - z In N w 6 ��� \\ ` \\ 1.18 ACRESN N 1.10 ACRES ° o ,(\ M IQ81' _ •h �� ` �. \`\ v N 8 °34. G9.Q N .Q \ 8 101.33 7 LANE _ N. 9 101.33 8 8 34 E X20 to \\ ES ^h O w �z O _w a�\ 00 32 Nor o" \ y 1.08 ACRES °-c6l.W N z i.11 ACRES X 16 Z N 46 0 26'E o 4j - N Cn rl n M O O H Q 41 41 -H aai -3 a Form- S T C - 104 rn o -W 1 4 q (n =LT SANITARY SYSTEM REPORT cn z m 'H ON b o N N 0 i TOWNSHIP S - cn H ' x P C E T N R W r I i J ST. CROIX COUNTY WISCONSIN Ln A ^- ' a z LOT SIZE C„) ° z PLAN VIEW Ln -It Cd 751 w 3 , o eet requirements of H 63 - rd P a J w � THING WITHIN 100 FEET OF SYSTEM M o ry r'- z�x- cv L ft; I i 1 ?Qx, ! /� r INDICATE NORTH ARROW � -" °� �G- �F ° %NC�•..s,4 � „~�`".,......._� 8 /ri lC� C• r 11'x. »'`• - BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: L06 Proposed slope at site: SEPTIC TANK: Manufacturer: p �.s Liquid Capacity: 1Z2 Number of rings used: � Z Tank manhole cover elevation: Tank Inlet Elevation: �jb, 2 Tank Outlet Elevation: ids 6 7 Number of feet frgm nearest Road: Front, Side, Rear, �) ?0D C\1 (P"'tJ ® O Q 7 y feet From nearest p y pro ext line Front , OSide , ©Rear , Q feet amber of feet from: well - , building: 3_A .elude this information of the above plot plan)( 2 refe - e ' dimensions to septic tank) SEE REVERSE SIDE 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. Trench: Width: / Length: Number of Lines Built: Zg Fill depth to top of pipe ow Number of feet from nearest property line: Front, O Side, ( Rear, O ._ Number of feet from well: Number of feet from building: '� 3 (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, O Ft. t Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm - lanufacturer: Inspector- Dated: Plumber on job: License Number: 322c y ' A 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HlJMAN RELATIONS P RIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ❑ALTERNATIVE [t Plan l.D. Number: assigned) ❑ Holding Tank In-Ground Pressure 1:1 Mound NAME O RMI HOLDER: ADDRESS OF PERMIT HOLDE INSPECTION DATE: BENCH MARK (Per. nent reference point) DESCRIBE IF DIFFERENT O PLAN REF. PT. ELEV.: CST REF, PT. ELEV.: Name of P ber. MP/ No County: Sanitary Permit Number: dl s e y9y� 4 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER // PROVIDED: PROVIDED. / � 7 N EYES ENO EYES ❑NO BEDDING: VENT DIA.. VENT MAT L.: fGH LARM WATE R NUMBE OF ROAD: PROPERTY WELL BUILDING: VENTTO FRESH . FE>T FRO 11 ❑ NO ❑ ❑ LINE: "7� AI� LET. 'tom ' YES NO NEAREST 1. w DOSING CHAMBER: MANUFACTURER. [ 71 : J LIOUID CAPACITY. PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: S 0 N 1 DYES ONO [:]YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. N.UMBER'OF rPROPERTV WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET F RDM LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION . SYSTEM. Check the soil moisture at the depth Of plowing LENGTH DIAMETER. 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 J DISTR. PIPE PACING. COVER J INSIDE DIA.. #PITS: LIQUID DIMEN NS / (J(/ TREN S. MATE IAL: PIT DEPTH: DIMENSIONS U X /`�( GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL: NO R NUMBER OF PROPERTY WELL BUILDING: V NT TO FRESH BELOW PIPES ABOV VER EY INLET EL ND� PI FEET FROM LINE. �7 AIR INLET / (j `' .J c NEAREST MOUND SYSTEM: Mound site plowed perpendicular to sl pe 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- 1:1 YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS 1:1 YES ❑NO ❑YES NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL: SODDED SEEDED. MULCHED: CENTER EDGES. EYES 1 NO 1 1:1 YES 1:1 NO ❑YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: B 61TR I " WIDTH LENGTH TRENCHES LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER €11 1�E�I l7NS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: I NO,DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV. ELEV.: DIA_. ELE V.. PIPES. DIA.: E, EVATIflN ANIa tNIFO I RM BA HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED NFO PLANS. DYES ONO [11 YES 0 N COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: IpUIUI ER OF I PROPERTY WELL BUILDING: FEET FROM LINE: ❑YES ONO EYES ONO NEAREST I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE: DILHR SBD 6710 (R. 01/82) "t- wis[onsm APPLICATION FOR SANITARY PERMIT C ' I q eDj/� r. OUNTY DILHR (PLB67) # - DEPRRTmEr1TOF UNIFORM SANITARY PERMIT � inou5TRV, LRBOR 6 HUMRn RELRTPDnS — 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 1ING DDRESS ,D l PROPERTY LOCATION S LA21 1/4, S j 7 , T 29N, R Zo k (or) 1@ T•ewnt �e. LOT NUMBER BLOCK NUMBER J SUBDIVISIONNAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER , Y t TYPE OF BUILDING OR USE SERVED r 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: X 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. X Seepage Bed ❑ Seepage Trench U 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 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): (1p 2 T K Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na of Plumber (Print): Signatur • f' r MP /MP o.: Phone Number: t7 /" le P Z.,c (7/ 0% (o Plu ber' Adder s: Name of Designer: �- �� rvc y' � ��✓s l�J s 1'�i� S��e COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: I Fee: Date: ❑ Disapproved PO ❑ Owner Given Initial Cf 2 ' 1 T 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 i 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 PERMIT S T C - 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - l " I Owner of Property ��t�.sLl� � �ld ✓� Location of Property .J (t� ) _ 4, Section I Z , T N - R 2b W Mailing Address J Z Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all. corners and lot .lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes x No Volume and Page Number _Z 3 as recorded w! "' tit the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 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. PROPERTY OWNER CERTIFICATION I (We) eeAti6y that aU o.tatements on ,thi,6 6on.m ate tAue to the but o� my (ouA) knowledge; that 1 (we) am (ane) the owner (.6) o6 the p&opeAty de c i.bed in thi,6 in6o4mati.on jonm, by viAtue o6 a wantanty deed neconded in the Oj6ice o4 the County Regiz ter o6 Deeds a6 Document No. - � 2 Z and that I (we) pie,senay own the p4oposed .6 to bon the sewage dispohat system (oA I (we) have obtained an easement, to &un with the above de�scAibe.d pnopeA-ty, JoA the conht"uction o6 said .system, and the same has been daty neconded in the OA6ice u6 the County RegisteA o6 D eeA, a.6 Document No. ) . SO ATURE 0.' OWNER Yv SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ti r t _q� � r � I� °'i f • .n . � 4 . _.:�j.. �» � a �y� eD y�, �j 'a►y1�y�`v�w«. + .,��. 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P' RIO, � a l 1� ,i ,Y a e � f•��� li ' 'I. �• r" � � !� �( l' ipf ai41 , y/ 61f + � q IY 11 ik,, { � ' a � , ``{'' �� w• " o^' , a g uu ou11Oj3,- `` •�Y *1 �N- s s O N3 v N 8 0= 10 Nr • 1�• °` P a ' 88S Nis • + V h► 7'� pal '� � j p 0 u ?� J i r to c y qe sr� tiw� R a� ; �► b ti � s''� a w •. 39 � �FF r C i �C1C 0. T - ll s �►3 . ,w'� ► I p a 209 90' •M p4. e - a M I .8 < r ' N 1. 26' E N I.24 [ to r 1•_ I I r _ a i�+ 230.00' I60.06 u• . r ' r I r i d O / A Ito !�. I -1 r n it lowit _ N : 200.00 • f' N' N 1 2t I Or 200.00' / r �/ r tO /� ��? 2 4 / r ! m / qi m t o }V 4s 8 - gam, N % i Sv'ae • a - I . �N3' N I o pl / ` �/ .NnZ o c i r .'' ' 4• i'�y S - o. I -� ff Z p -i ♦ I ' N.1•see I tp 0 I nN 1 ; ,/ 1 i s- t '�' Z 0 w �• 'O O N I . 2t'[ �/ i i �� ;y3� "• to /, o C i o o OIrOOO' r F t {►} Nret to• :le / / v •• + Y e �1[ •' N w /•tt t . . �a! - -p�_ z 2!l.00 O ti ► Q[ O) Itrr.00' 200. a g s N P2! E S4f.21 D to x + - >~ I r wr•e•'[ moo -- r 44;' ...... ~ w ' T O r MNf � N lam' RI -1 Z6 -- ff (A l l �N _ 200.00' - - m r r / r � c O N I 28 E Ir �1 a 200.00 r, X. $ / = m to • ^p � �i )' �' ° fir F ! 4� s 1 p ► I x Z •- ° g i c +s o • C 2+ m �o soz � a w 1 M � A � P z � b mI ��� z v w to 7 � t G Owl. 0 p j } 0 i ' y � 111 ' N � a ''b�� ir 2iSO0d �. VILLAGE 34141 S 0ow3O'w 1[t7oo' LIMITS 1 alp- UNPLATTED I ANDS 1 o I ' ICI 'u v O � 6 Q� � • � � � �� I' ; t 1 2 �, F gyp• n IF �1 ��A«y�11 � N p r[S f o � w = •iS py�( /N� w r cn H STC - 105 r , y H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County 0 y OWNER /BUYER �abcr ROUTE /BOX NUMBER f uje Z Fire Number CITY /STATE ZIP PROPERTY LOCATION: ,$(,c} tt, 5(J Section /Z T Zf N, K ZO W. T '' o QUO 464.50-I St. Croix County, Subdivision CI'U1fr �.' ✓ number /0 A ') " '? Lot Improper use and maintenance of your septic system could result in its premature to handle wastes. Proper maintenance con - sists of pumping out the septic tank every three years or souuer, 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- went stage in the waste'disposal system. St. Croix County residents ma be elib!:.te 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 piumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -bite 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 o I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x r, the standards set forth, herein, as set by the Wisconsin Depart- ho went of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offi,pe within 30 days of the three year expiration date. SIGNED S DATE - T - Al St. Croix (aunty Zoning Office P.O. Box 98 Hammo'lid, W1 54015 715 -7.)6 -2239 or 715- 425 -8363 Sign, date and return to above address. .DEPARTMENT OF REPORT ,ON. SOIL BORINGS AND SAFETY & BUILDINGS INDU.STIRY,, DIVISION LABOR AND PERCOLATION TESTS (115) , MADISON WI 79 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: i WNSHI MUNICIPALI TY: LOT N.: OBLK. .: SUBDIVISION NAME: SW � /4SW l/4 12 T29 N/R 2O E (or W LLAGE OF NORTH HUDSON 10 ST. CROI X STATION COUNTY: WNER'S UYER'S NAME: MAILING ADDRESS: ST. CROIX ROBERT ELM 2423 CROIXWOOO BLVD. STILLWATER, MINNESOTA 55082 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRI (PROFILE DESCRIP IONS: ERUNATION TESTS: Residence 4 ® New ❑Replace 3 - 84 3 - 31 - 84 RATING: S= Site suitable for system U= Site unsuitable for system r ONVNIONAET MOUND: IN- GROUN M TEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) �S �V �S I ®S �U SU I--] S E I CONVENTIONAL 28X 30 BED If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: CLASS I Floodplain, i n d icate Floodplain elevation: NO PROFILE 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.) B- 1 9.3' 93.4' NONE > 9.3' Bn1(0.5') anIs(1.5') Ons(7.3') B_ 2 9.1 ' 90.9' NONE 9.I B 1 (0.6') 8 I s ( 2.4') 8 s (6, 1') B_ 3 7.8' 88.9' NONE 77.8' 8nI (0.5') Bls (2.6') Bns (4.7'1 B_ 4 8.9' 91.5' NONE >8.9' BnI(0.6')8ns1(0.8') BnIs10.7') Bns(6.0') B_ 5 9.2' 92.8' NONE 79.2' an sl (1.8') OnIs(2.2') Bns AND gr(0.5')Bns(4.7') B- 6 Bd"o " 89.9' NONE > 6..6' B l ( 1.2') B I s ( 1. 1 ') B s (6.3'1 PAGE 49 SOIL MAPS PERCOLATION TESTS CHETEK ONAMIA COMPLEX TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIO PER PER INCH P 1 61" SAND TEST 10 MIN. 4 1/ 2 " 5 " 4 3/4" 2 P P- 2 54" SAND TEST 10 MIN. 5 1/2" 51/4" 51 /4" 2 P -_ P- 3 38" 1 SAND TEST 10 MIN, 49/ 16" 5 I/8" 5 " 2 P- PLOT PLAN: 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 slope. IN I T I A L 88.3' SYSTEM ELEVATION REPLACEMEN T 66.4' d �V.. P. TOP IRO PI dE A SU ED 00' i SCA E I" = 0' O BAC (HO PI " I RO N RI PE FOUND SPO ' ELIEVAT10 ' f _ I € 1 B 1 d NIT AL _ .. ! tH SLITABLE AREA700' S FT 0 o O. 9 4 1 j 9 R IS. Q) i 77 ! S I 1 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: LAURENCE W. MURPHY 3 REVISED 4 2 84 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 314 N 2ND STREET RIVER FALLS WI. 54022 55 - 2445 715 425 - 9032 CST SI NATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Te er. DILHR -SBD -6395 (R. 02/82) — OVER — S , INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be 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; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; S. 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; 6. 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 be used if desired; $. Make sure 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- tion, if appropriate; 10. If the information (such as Hood plain, elevation) does not apply, place N.A. in the appropriate box; 1 1 . Sign the form and f lace your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob Cobble (3 - 10 ") SS Sandstone gr— Gravel (under 3 ") LS — Limestone * s — Sand HGW Nigh Groundwater cs - Coarse Sand Pere. -- Percolation Rate tried s — Medium Sand W Well I's - Fine Sand Bldg - Building Is — Loarny Sand > — Greater Than `sl Sandy Loam < Less Than �l — Loam Bn -- Brown 'sil — Slit Loam BI Black si — Sint: Gy — Gray �cl -- Clay Loam Y Yellow scl — Sandy Clay Loam R — Red sic[ — Silty Clay Loarn mot - Mottles sc - Sandy Clay wl -- with sic Silty Clay fff — few, fine, faint � l c Clay cc — corninon, coarse pt: Peat mrn Many, medium rn -- Muck d distinct p — prominent HWL — High water level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP - Vertical Reference Point TO THE OWNER This soil test report is the first step in securing 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 sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a perrnit. The sanitary permit must be obtained and posted prior to the start of any construction. PAGE OF C r oSS S� Cl�u A &co Sys�e� hattiA Ali In1e16 And Obpliallon PIPS Approved V..t Cep MW040 12' Ab.re fl - Ul Glad* 20- 12' Alwve Pipe _ 4 ' Coal Itch To flaw tired. Veal Pope Merge "ON Or Synthetic C.warinp MM 2' AOOr.pelo Over Pip. purl►Wlon ,Ipe Tee i' ASOreyete Paloreled PI • solorr ieMot► Pipe n o CoOiAS T.nnlneling At ielw.t 01 iaal.re o tn�� .► Q�r P �uP scD� 11 r. SOIL FILL DI9TR18UTIO /J PIPE • APPROVED 5'J1t1THETIC COV1 ' Z " OFA46AIE 1Ala a "ws'—OR M R HAy9 OF STRP4. �p AGGREGATE F- 3 3 DIS'rRIf5UT10M PIPE TO SE A7 LEAST Jb / IAICHES 15CLOW ORIGIAIAL GRADE AMU AT LEASTLO ILICHES BUT AIO MORE THAW 42 ILIC14ES BELOW FIAIAL GRADE MAXVWtA 06PTH OF EXCAVATION FRoM ORIGINgL ORADR WILL BE 6_ IWCHES NYNOW14 ORrW OF EXCAVAT109 FAO)IN 0it G R AP E WILL BE .30 IN,CHE ` J J SIGAIED: LICCUSE M 3 Z S Al 8 E R • I DATE: -- �� JOB T6 la! -1.5.. �'►' ROHL & TIMM EXCAVATING SHEET NO OF 310 Arch Street • HUDSON, WIS. 54016 CALCULATED BY DATE 5' y 8y (715) 386 -8664 CHECKED BY BMtTf_ SCALE ...... ...:_. ...__. _._ .... .__. _. .� ass . rQ we ► 2L7� �4R .S�p Isla tk ((dee ks cc tic t � \ r e / B 1 4 61- ira6 PjPA.: E1- ' too P4000Cf W l ®Wc, Gmbm r.. 01471.