HomeMy WebLinkAbout026-1298-15-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 488133 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 Village X Township Parcel Tax No:
Schulz, Charles Richmond, Town of dZfp- IZSSI 16-060
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/0'Q 15 Gvy\ I.- C5 T 34.30.18. f S 3
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
3. 103.G /Zb. /5
Septic 5 I ZOO Benchmark 03 z,(
t y`r~_ IG
Dosing Alt. BM IT. 0
Bldg. Sewer
Ho ing St /Ht Inlet D ~Q 7 Z • G4
7 D 1
TANK SETBACK INFORMATION St /Ht Outlet
TANK TO P/L WELL BLDG. Vent to it n a e ROAD Dt Inlet
ep is S ~ ZtJ o om • ~g
osing 54 -75 z44 f z44 ea er an. Z ~ i5 /Q S Aeration Dist. Pipe
/61 r rj
7,17
Holding o . System
r3,, i
12-15 iad 7T
ina ra e
PUMP/SIPHON INFORMATION 1.11 anu ac urera I~ Demand cover
GPM F. \ : rOC
oe umer ITV 45 ,f 3•
-3 IAA s
I UN I rl ion LOSS yS em ea i
111$Z S 11.LS Zvi -Z(
orce ain eng ` ia. St. IQ Vvm
Z5 Z 75
jlqul. u
LPlIVItIqSIU!40 NO. UT r115 Trivae pia. epul
"luill
DIMENSIONS 7' 161 Qe
v .
\
CHAMBER OR
INFORMATION
UNIT
(n 60 7-1 4;5, P50
I D( Pipe(s) 81 I
Length Dia. Length Dia Spacing b 1a -
x Pressure Systems Only xx Mound Or At-Grade Systems Only `
Bed/Trench Center / Sco Bed/Trench Edges Topsoil 1 es No ~4 es No
COMMENTS: Z4R ction #1Inspection #2: (Include code discrepencies, persons prese t, etc )
WI 54017 SW 1/4 NW 1/4 34 id eadows North Lot 1 Parcel No: 34.30.18.
Location: 1209 128th Avenue New Richmond,
1.) Alt BM Description
2.) Bldg sewer length = Z~
- amount of cover = f
Plan 1 Use otheriside foruadd tional in Yes o
formation.
1 Date L - --fnsepet nat - - ' Certi.-No.
SBD-6710 (R.3/97) -
coiciivo cur, 1c:A0 rAA '115 U?Jtl 4UbU ST NING 10003
/0
` Saf uildings on Comfy 201 W. Wayhin x 7162 n V I -L
u
F sconsiMadi VED tv mlxx (to be filled in by Co.)
Department of Commerce (6 8)2GG-3 33
Sanitary Permi t Applic ion4PR 12 2006 $ T te Plan I.D. Number '
In accord with Comm 83.21, Wis. Adm. Code, personal info ion you provide 12 / a2 w7
may be used for secondary purposes Privacy taw, sl ,04(1 CROIX COUNTY joct Address (if different than mailing address)
1. Applicalion Information - Please Print All Information /Z6, ! /Z -9 Ave_
Property Owner's Name Pat a t i! (flock u
~N a ~ti s sc1, v Z Pets;
Properly Owner's Mailing Address b'nrpar[y wvtion
2'/'/o A/ _Lhctr1e5
Y, QW.%, Swim
City, State Zip cede Pliore Number
v 5 621nJ 5 S ro 5/ ~Yfr- /0 57 T2 N: R I~(`Uar '
U. Type of Building (cheek all that apply) olr p pL SJID f+1. r
❑ 1 of 2 gamily Dwelling - Number of Bedrooms r.^ i a 4 Subdivision Nstne C5M Number
base he / JY1
❑ Public/C;ommcrei it - Describe Usk Z 11Aa, : p oc3t _ _ c}eY;(~ / ` r/► / rC D
❑ Slate Owned - Describe use Z ~O / MO ,J ✓l. Ce-t ( -f - ❑city_ V' 1agc gowns ' of
Ill. 't'ype of Pei-snit: (Check only one box on line A. Complete linen if applicgble) ~ ZZ
A2- oco
. jqNcw System
0 Rgiloeeurertt Syslt:m ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Fxisring System
B• ❑ Permit Renewal U Permit Revision List Previous Pcnnit NunlbeI land Date bssuexl
❑ change o1' ❑ Permit Transfer to New
Cseforo L...pimtibn Plumher Owner /
IV. T
jp~ of POWTS System, Check all that a 1 O VVT
❑ Non -Pressurized In-Ground ❑ Motmd >24 in. of suitable soil IlMound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized ln•Cround ❑ 1•Iolditig'l'ank ❑ Prat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Satin Fitter q
Recirculating Synthetic Media Filter ❑ teaching Chamber ❑ Drip Uric ❑ Gravol-less pipe ❑ Other (explain) 5.4 13.&K
b f
V. Dis al/Treattment Arcs Information:
Design Flow (pd Desig n 'Application Ratc(gpdsf) Dispersal Area Required (sf) dispersal Arco oposed (s System Si 'erg
.
Old J ~ ` 60® /s'o~ U` i~ SisQr~ I ao f 7 g
2
VI. Tank Info Capacity in Total Number Mnnufat:uuec Prefab Site Stall Fiber Plastic
Gallons (,menus of units Concrete Consuucred Glass
Now Existing nn
Tanks Tanks l✓ V C(~iAGU
Septic IV I lolding 11nn1 12 ot, 0~ L
Aerobic Tlnotmriu (Jail / C`~ e
[roShsb C:handgcr
O V ~
VII. Res nsibllt Statement- I, the U!%_ aed, assatt a respoasiNUIly Ior installation of the POWTS shown at the attached plans.
Plumber's Name (Print) Plumber's Sig MPP/MPRS Number I Vuuus`iness Phone Number y~
Plumber's AddrcSR (Street, Ci y State, 'Lip Code)
Gr/.Ic r-, i, is'c Arr., ~ ~ ~~o/
VII uuo%Dc rtment Use Only
Approved ❑ D' Sanitary Perulit Fee (includes Groundwater Date sstlc lssuiu , „cut SiRna ne
Surcharge Fec) 550 y~ fH d~
for Denial ( S mp
❑ weer n Rr tson
IX. Conditions of Ap rovat/Reasons for Disapproval
SYSTEM LINER: \ n t
rd
1. Septic tank, etthlent filter and 3, Co a ti S ; l e
dispersal cell must all bia services / maintained a f Q
as per management plan provided by plumber.
2. AN setback requirements must be maintained
as per applicable code / ordinances.
Attach complete plans (to the County only) tor' Me system on paper wd kas thaw M 111 inches is sire
SBD-6398 (R. 01/03)
7
~y~w~~.„!s yam:, ,
"B~,'
~i9NWf3 M3Tty?
I
I
SITE PLAN
LEGEND
S~'''~su~•.
IBM: 100.0' top of 3/4"
pvc pipe
2BM: 100.15' top of
pvc pipe r Os C Z . R X pits
No Comm 83 problems
Scale 1"- 40' except
where indicated .
System Elev. 100.74'
on contour 99.65' it 7V A
Site area is 200yds. south
Of 130 Ave. on the _ t c c; 410
east side of road, lot 15 of
subdivision Riding Meadows _ 1• ~.~/,c.K 61AL,-
~z+7~OS~ 41Y~►M'~u4t. ~G
North
- err.
i
b
Stu
fie-
.
2-brie too,15 ' \ q9- 2,51
1~• v' Z.7,
.5
l~r
tie
/of
Project: ZINN tLA P /Qf f cd ~a" dsr page 6 of 8
SITE PLAN
~ _ e.. y.d as 3
x
s~
LEGEND Ste, S~oc~t
Coot x.R•-
IBM: 100.0' top of 3/4"
pvc pipe
2BM: 100.15' top of
O, o s c
pvc pipe
X pits
No Comm 83 problems
Scale 1" - 40' except
where indicated
System Elev. 100.74'
on contour 99.65
4"
Site area is 2~Yds. south
t
of 130"' Ave. on the - _ r ~ cs 2
east side of road, lot 15 of - _ av*` -F, f
subdivision Riding Meadows t'•-
1 sz+7~OS~at 4lP~M ~+v~o~
North
w
r`„~ \
IBM S ►W.v
S 14
D
~0/ I? 95 i
Project: ZINN P /0. f cd dss page 6 of 8
Safety and Buildings
4003 N KINNEY COULEE RD
Cot'11111ePCemi.gov LA CROSSE WI 54601-1831
isconsin ■ TDD (608) 264-8777
www.commerce.wi.gov/sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
March 22, 2006
CUST ID No. 225410 ATTN.• PO WTS Inspector
ZONING OFFICE
PAUL R KOEHLER ST CROIX COUNTY SPIA
E5678 704TH AVE 1101 CARMICHAEL RD
MENOMONIE WI 54751 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 03/22/2008 Identification Numbers
Transaction ID No. 1249778
SITE: Site ID No. 710434
Zinn Q 0%)11 Please refer to both identification numbers,
120'x' Street above, in all correspondence with the agency.
Town of Richmond
St Croix County
SW1/4, NWI/4, S34, T30N, R18W
Lot: 15, Subdivision: Riding Meadows
FOR:
Description: Four Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 1066270
Maintenance required; 600 GPD Flow rate; 23 in Soil minimum depth to limiting factor from original grade;
System: Mound Component Manual - Version 2.0, SBD-10691-P (N.01101),
Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Biofilter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
Condith
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06;
P-P
stats.
tip v F *.I
The following conditions shall be met during construction or installation and prior to occupancy or use: EP TMENT 0
Reminders OF E
SEE CORRE:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
component manuals listed above.
• Per manual cited. above, limited activities are allowed in the area 15 feet down slope of the component. area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and
dispersal are prohibited.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area. chs. NR 811 & 812c
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats. .
• Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated
county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat
PAUL R KOEHLER Page 2 3/22/2006
• Comm 83.22(7) A cop, of f the approved plans specifications and this letter shall be on-site during construction
and open to inspection by authorized representatives of the Department, which may include local inspectors.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer If , Integrated Services WSMART code: 7633
(608)789-7803, 7:45 am - 4:30 pm Monday - Friday
charlie.bratz@wisconsin.gov
cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544
I
Private On-Site Wastewater Treatment System (POWTS)
4 Mound and Pressure Distribution Component Design
New Residential application RECEIVED
Index and Title Sheet
MAR 2 2 2006
Project Name: Zinn SAFETY & BUILDINGS
Owner: David Zinn
Owner's address: 7466 Cty Trk S, Colfax, WI 54730
Location: 120` Street
Street Address
SW.NW.34,30.N/R18W
Legal Description
Richmond township, St Croix county
Township/County
Lot 15 of Riding Meadows subdivision
Contents: Page 1: index and title
Page 2: general information & lateral diagram
Page 3: mound drawings
Page 4: dose tank
Page 5: pump information
Page 6: site plan
Page 7: management plan
Page 8: contingency plan
Attachment: soil test to state plan
Grp
B 1GS
Designer: L an L Perc Testing LLC (loretta)
;PO NDENCE
Plumber (print name): /"Q~/ •r~~~r Signed:/
Credential Number: Date: _/'~j 11 24!~w ZO6krl
Mound component manual for POWTS Version 2.0 SDB-10691-P (N.01/01), and SSWMP Publication 9.6 Design of
Pressure Distribution Networks for ST-SAS (01/81)
page 1 of 8
I
f
GENERAL INFORMATION
NEW SITE
Four bedroom home, 600ga1 DWF center fed system w/4 laterals
2.0% slope system area dispersal cell design loading rate 1.0
0.4 soil application rate linear rate 5.94
23" limiting soil factor orifice sq/ft. 10.5
1200/800 Wieser tank with Orenco filter FT-0822
effluent quality #1
LATERAL LAYOUT DIAGRAM (not to scale)
Center Fed System
Number of laterals 4 orifice dia.. 3/16in. (0.188')
Lateral dia. 1 'h" orifice spacing (X) 36in. (3.0')
Lateral length (P) 49.5 ft. orifice spacing X/2 18in. (1.5')
Lateral spacing (S) 3.5ft. orifices per lateral 17
Manifold length 3.5ft. lateral discharge rate 11.22gpm
Manifold dia. 1 Vein. total system rate 44.88gpm
Forcemain dia. 2.Oin.
♦Valve box \
Pressure lug finish grade
X- P
X
X/2
1 1/ "
S 3.5' (42" /
1 Last orifice next to fitting
1.7' (21 2 Orifices located on bottom of lateral
Force main 2" dia.
Project: ZINN page 2 of 8
PLAN VIEW OF MOUND (not to scale)
A= 7.0' D 1.09'( 13") J= 7.0' required bed 600sq.ft.
B= 101.0' E=1.23' (15" I= 8.0' proposed bed 707sq.ft.
F= 0.83' K= 9.0' required basel area 1500sq.ft.
G= 0.50' W= 22.0' proposed basel area 1515sq.ft.
H= 1.00' L=119.0' observation pipe @ 20ft.
Observation pipe
J
5 A
W O O
H
FK] 0 I
FT-1
L
Mound Cross Section View (not to scale)
Finished grade elev. 102.57'
Lateral invert elev. 101.24' H
2 /JIl/
Dispersal cell elev. 100.74'
4 dispersal cell + 2"
O♦ lateral - -
- Aggregate bed 6"
- E D -
-
tilled layer tilled layer
contour
2.0% site slope elev. 99.65'
Numeral Key
1 topsoil cap
2 subsoil cap 1.5ft.
3 ASTM C33 sand 4in. dia. observation pipe
4 synthetic cover over cell with 1 /4in slot
5 aggregate
I
O.Sft.
Project: ZINN page 3 of 8
s~No®lans ~ ~3~ds
oooz o ti ~dw
(33N3038
Combination Septic Tank/Pump Chamber
(No Scale)
.Approved Locking Manhole Cover
With Warning Label Attached q„
Weatherproof Approved
Warning Label Junction Box Vint Ca
wn-. ! l} 12 Minimum
~ 4" Minimum
Final Grade-~ ;
Quick
18" Minimum Disconnect
' 1/4" weep
Hole
Baffle ;
proved Joint A
'K"s~40 Pipe ~
:tending 3" Alarm B Approved Joint
ito Solid Soil On w/4+ 5&P ft &
t C Extending 3'
Elev. L7 Onto Solid Soil.
Off t
D
Conc. Block
3" of Bedding Under Tank-/
Gl 08 g~. 5 br9_~
Note: Pump and Alarm Are On Separate Circuits lAD.pp o O DW
q 3 p„ N1 bold
Tank Manufacturer: QX*M Xk l ,mrt1~ _t ~0 4Z 1~1q 3 "L°'~' nsQ4
Tank Size-Septic/Pump oo co L.P Gallons
Al arm Manufacturer: S M,. "
Model -Number: ~ -r-.,,,~,R Capacities : A~~i nches or q0.3 Gallons
Switch Type: + B 2.. i nches or•~44L l ons
+ C Inches oT;-L 1- l orts
Pump Manufacturer: 6y, jj_qjj~al
Model Number: D + D j4 _i nches oriLZ406allons
or:-
GpK 'fotal.....= (o inches or g Sal Ions
Minimum Discharge ate• 4.r,
Vertical Difference. Bitween Pump Off and Distribution Pipe: ja.o Feet ga]L/'n - ~
, . s Feet
Minimum Required Supply Pressure:.... +A :'k: 3
J12_Feet of Force Main x '1.11 Friction Factor/100Feet: +=A eet'
2 Inch Diameter Force Main
Total Dynamic Head:...=23•65 Feet
Project ZINN page 4 of 8
I~
]PAIN
try',
vffluenir
On-fife
r
JA„ j 1 RON SER1E3 ! "4140 Do, BLc
TOTAL DYNAMIC HEAD/CAPACITY
Models available packaged with a PER MINUTE
piggyback variable level float switch. EFFLUENT AND DEWATERING
Durable cast iron construction. L MODELS 140/4140
• Non-Clogging vortex impeller design.
Passes 1/2" solids (sphere). Ft. Mete" Col. "r"'
• 1'h" NPT discharge. (1 W X 2" PVC adapter 5 91 3"
10 3.05 a ale
fitting included with BN and BE models.) 15 4.57 76 sea
Automatic reset thermal overload protection. 20 5.10 68 • 757
Stainless steel screws, bolts, guard, handle. 25 7.62 5a 223
• UL listed 3-wire 15 ft. standard cord. 50. 9.14 49 165
ModelBN140
Poured IS V - 14o mode 1 35 10.67 36. 164
40 12.19 71 79
45 13.72 1 19
Model N4140
P11.d Lx9 vaw: 46'
0109408
yyky
"W" NIGH HEAD SERIES "4160 DOUBLE SEAL SE''
i BE 160 Series BN/BE Models available packaged with a TOTAL DYNAMIC HEAD/
' PicUred FLOW PER MINUTE
ARR ~ slardots EFFLUENT AND DEWATERING
piggyback variable level float switch.
5
' 1 & 3 Phase models available. 17 11489/916 MODEL 161 4161 163/41631165/416
R. W GAL LM GAL LM GAL. L7R5.
(115, 200-208 & 230V -1 Ph). 5 I3x 100 379 61 231 61 231
/ (200-208, 230, 460 & 575V - 3 Ph). 1s 10 4 3.. 505 07 65 93 332252 60 o 60.5 229 60.5 229
/ xxT ao3 229
• Non-Clogging bronze vortex impeller. 20 6.10 76.5 297 39 223 60 227
"'~/J• g 25 T.W 70 765 57 216 59 223
• Passes 3/4" solids (sphere). 30 9.14 61.5 233 55. 206 56 220
40 12.19 45 170 46 172 55 208
• 1'/2" NPT discharge standard. 50 15.=4 20 76 33 125 50 189
60 16." 15 57 39 148
• 2" or 3" flange available. 70 21.34 773 85
• Automatic reset thermal overload protection,1 Ph. only. 80 24 27.43 10 J°
. Durable cast iron construction. 100 3o.48
I= WW-. we ss• s63•
• UL listed 34re 20 ft. standard cord. 0099M
NOTE: No UL Baling for 2w208v/1 Ph. panpe.
>v'a - , .r, .n3*~;~e~+E9` • . m~ra~f.a,.. ryru„y,w¢,,~.: ,~.N,~.L -_~-,~,{,ri~~
"I" HIGH HEAD SERIES "4180" DOUBLE SEAL SER0-_'s
BE4180 Belies
Pig SINGLE SEAL DRIP PUMP e
• BE Models available packaged with a SE rob*
piggyback variable level float switch. TOTAL I3Y91AL9C N1 Ni/
1 & 3 Phase models avalable. FLOW PER 16WN
EFFLUENT AND DEWATERING
(200-208 & 230V -1 Ph). MODEL 185 4 85 186 4186188 488 1 4 41 91
(200-208, 230, 460 & 575V 3 Ph). FT " CAL. `1"5 ` Ca` "R6 ` Ms.
5 I32 6e I.3 549 l 43 170
10 SAS S6 Iq 530 43 170
-Clogging cast bronze vortex impeller. 20 4.10 --a -M 128 4" 130.9 4" . 170 .
30 " 4S
• Passes 3/4" solids (sphere) -180/4180 series. 40 "`12.19 70 70 265 W 730 16 472 Ip 454 . 170
q ie 310 1033 392 IM 413 45. IA
Model 191 passes 5/8" solids (sphere). 50 15.24 51 193 56 220 90 341 97 367 43 170
50 IL29 32 121 56 220 71 269 C - M
• 1'/" NPT discharge standard. 70 21.34 9 197 51 193 I N 170
60 24..78 "65 170 2e 106 .1 I93 45 170
• 2" or 3" flange available. (2" flange on 191) 90 27•43 30.5 115 2 e 34 IM 45 t7o
100 39.4s +6 60 $7 64 40 151
• Automatic reset thermal overload protection, 110 37,9 4 15 114
` 120 36,58 20 76
J 1 Ph. only. 130 39.u 10 36
LOCK VALVE: 73' 114' 91' 1J11 13r
' Durable cast iron construction. 0099038
' UL hated 3-Wire 20 ft. standard 1;Ard. WARNING: ModN 185 should na to subjected to Tess Than ao lest TOH.
9 NOTE: No UL Bating fa 2110.208411 Ph. pumps. model 186 d 791, or Double
F e L r n n seal Series. 8 5 0
I
~ HEAD CAPACITY CURVE _
EFFLUENT MODELS
sL~
42 140 O CAUTION Model 185/4185 should
135 not be subjected to less than 30 feet MH.
w 130
38 125
120
36 191
ns
34 110
32 105
30 100
.5-
2a go-
26- Q41aG
24 60 165,
q 75 4165
YI z2 '
70
20
fe 60 163
.
4163 41ag
ss
16
14 45
12- 140 160.
41
35 41 1- )L I
10
' 30
6 23 137 4185tes
6 20
15
, 4 1
10
2 5 4661
53.57 98
0
U.S: GALLONS 10 20 30 w 50 60 70 60 90 100 110 120 130 14 1SO 160
80 160 2w 320 400 480 560 640
0 FLOW PER 119611E
. ~ 009922
TOTAL - DYNAMIC HEAD/
FLOW PER MINUTE
EFFLUENT AND DEWATERING
85 1
MODEL 53.55. 98 1,37 t4 161, 1 1
186, 188, 191
0 4161 4163 4165 4185 4186 4188 4189
iT M. GAL. LTRS GAL LTRS GALL CAL LTRS GAL. LM CAL. L CAL L GALL GAL. L CALL CM. L CAL L
S ; 1.52 34 163 72 274 93 352 91 344 100 379 61 231 61 231 58 220 145 549 t43 349 45 170
10 4.57 129 61 231 79 299 84 318 93 352 61 229 61 231 58 220 1w SJO tw 340 IS 170
iS 4
.57 19 72 45 170 64 242 76 286 55 322 60 227 61 231 58 220 134 307 135 511 43 170
20. Ni 9S 36 138 BB 287 79 299 89 223 60 227 58 220 128 484 131 496 4S 170
All 7.66 b 3 70 263 57 216 59 223 36 220 122 f62 125 473 4S. 170
JO 9.147 , 22183 62 23S SS 206 'J6 220 63 322 IF 220 1f6 4~ 120 454 4S 170
Z '12.19 21 79 45 in 46 172 SS 206 70 265 SB 220 104 394 f0y 4 ~5 170 - -
DO 18.24. 20 78 33 125 50 t89 51 193 58 220 90 341 97 367 45 170
60 18.29 15 57 39 148 32. .121
SO 220 71 269 BS 422 4S 170
70 21.34- 23 87 9 34 52 197 31 193 69 261 45 170
90 24.48 10 38 45 170 28 106 51 193 45 170
90. 27.43. 31 117 2 8 J< 129 43 1St170
110.: 30.46 18 60 17 64 w
110 36:00.
120 4 IS 30 114
36.59 20 76
130-39.62 10 38
LOCK VACVf: 19.25'23' 26' 48' 56' 66' 88.3' 73' 114' 91' 110'.. 1JT '
tPMA SD
PUMP . ASSAL
Mound System Maintenance and Operation Specifications
Service Provider's Name: L an L Perc Testing LLC Phone: 715/664-8184
POWTS Regulator's Name: St. Croix Zoning Phone: 715/3864680
System Flow and Load Parameters
Design Flow - Peak 600gpd Maximum Influent Particles Size 1/Sin
Estimated Flow - Average 400gpd Maximum BOD5 220mg/L
Septic tank Capacity 1200gals Maximum TSS 150mg/L
Soil absorption component Size 606bed Maximum FOG 30mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100mL
Service Frequent
Septic and Pump Tank --------Inspect and/or service once every 3 years
Effluent Filter--_-------_-----Should inspect and clean at least once every 3 years
Pump and Controls -----------Test once every 3 years
Alarm-----------------_----- -Should test every 6months
Pressure System ----------Laterals should be flushed and pressure tested every year
Mound ------------------------Inspect for ponding and seepage once every 1 year
Other-------------------------Initially filter should be checked yearly to determine service schedule
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap and are secured
as shown in the mound component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(I), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce
frost penetration
6. Lateral T_ urn-un to finish at grade or above, enclosed in a 6-8" diameter lawn sprinkler valve box or similar product.
(lateral turn-up consists of a long sweep 90 or two 45degree bends same diameter as lateral)
7. Lateral Turn-up on end of distribution laterals after the last orifice.
Project: ZINN page 7 of 8
, M
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code. And shall maintained in accordance
with it's component manuals and local or state rules pertaining to system maintenance and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no
longer used as POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness.
Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening
deemed unsound, defective, or subject to failure must be replaced. Exposed access openings > 8" in diameter shall be
secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48, Stats. The
contents of the septic tank shall be disposed of in accordance with NR 113, Wis Adm. Code. The operating condition of
the septic tank and outlet filter shall be assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed
unless provisions are made to retain solids in the tank that may slip off the filer when removed from its enclosure. If the
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid
volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personal
shall advise the owner of when the next service needs to be done to maintain less than maximum scum and sludge
accumulation in the tank.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings maybe made around the mound's perimeter and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration.
Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder
aeration of the surface within the mound and snow compaction in the winter will promote frost penetration.
Cold weather installations dictate that the mound be heavily mulched as protection from freezing.
Influent flow may not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral and it is recommended that
each lateral be flushed at least once every 18months. When a pressure test is performed is should be compared to the
initial test when the system was installed to determine if orifice clogging has occurred, if clogging has occurred orifice
cleaning is required to maintain equal distribution within the cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to
the owner and any levels above 6" considered impending failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or components shall be repaired or replaced to
keep the system in proper operating condition.
If the dosing tank or its components become defective the defective components(s) shall be immediately repaired or
replaced with a component of same or equal performance.
If the mound fails to accept wastewater or discharges wastewater to the ground surface, it will be repaired or replaced.
Increasing basal area if toe leakage or by removing biologically clogged absorption and dispersal media and related piping
and replacing components as deemed necessary to bring the system into proper operating condition.
See page 7 of this plan for the name and telephone number of your local POWTS regulator0ftervice provider.
Project: ZINN page 8 of 8
Visconsin SOIL EVALUATION REPORT #1722
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Steel's Soil Service, Inc.
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix
include, but not limited to: ve ' al and horizontal reference point (BM), direction and percent slope, scale or dim north arrow, and location and distance to nearest road. Parcel
I.D.
P riri ~c1 pe in Revie By Date
Personal information you p y used for secondary purposes (P vary Law, s. 15.04 (1) (m)). b~
Property Owner Property Location ~UL r ' 200'
(9 y4 Stallion Development LLL Govt. Lot na SW1/4, 1 , S34, T30N, R18W
Property Owner's Mailing S ROIX 70 U N T + Lot # BIoGc # Subd. Name or CSM#~
1221 130th Ave ZONING OFFICE 15 na Riding Meadows 6r+-
City State Zip Code Phone Number E City Village ❑ Town Nearest Road
New Richmond WI 54017 715-246-5440 Richmond 120Th St
❑ New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe: na
Parent material Ridges, foot slopes, and valley escarpments of sandstone Flood plain elevation, if applicable na ft.
General comments Mound design, system elevation 100.74ft based on contour line elevation 99.65ft.
and recommendations:
a Boring # ❑ Boring ❑ pit Ground surface elev. 99.65 ft. Depth to limiting factor 38 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EW2
1 0-6 10yr3/2 none A 2msbk mfr a if .6 .8
2 6-15 10yr4/4 none stcl 2msbk mfr gw na .4 .6
3 15-38 5yr4/4 none sl imsbk mfr gw na .4 .6
4 38-48 10yr8/2 c2d 7.5yr5/6 ;andstonr residuum mfr na na .0 .0
a Boring # ❑ Boring /
® pit Ground surface elev. 99.65 ft. Depth to limiting factor 44 ✓ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
*Eff#1 *Efr#2
1 0-12 10yr3/2 none A 2msbk mfr a if .6 .8
2 12-24 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 24-44 5yr4/4 none sl 2msbk mfr Cs na .6 1.0
4 4460 10yr8/2 c2d 7.5yr5/6 ;andston residuum mfr na na .0 .0
Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S30 mg/L and TSS <_30 mg/L
CST Name (Please Print) ignature:` CST Number
David J. Steel / 248956
Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 6/27/2005 715-760-0347
Property Owner Stallion Development LLC, Parcel ID # pending Page 2 of 3
3] Boring # ❑ Boring ® pit Ground surface elev. 99.25 ft. Depth to limiting factor 23 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 10yr3/1 none sit 2msbk mfr cs if .6 .8
2 10-23 10yr4/4 none SO 2msbk mfr a ivf .4 .6
3 23-48 10yr8/2 c2d 7.5yr5/6 andston residuum na na na .0 .0
❑ 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/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
❑ Boring # ❑ Boring Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L " Effluent #2 = GODS < 30 mg/L and TSS <_30 mg/L
T _ T,.....-a.._......a ..l _,.....1 ..~_....a.....a.. ,...-.....,...-....:.i.._ ....,.~1....e« YF..... --A n.......4......n nus.A- n«
I 116 MFPal U11U,11L V1 VV11U11G1 V lA all UgUal VPPV1LU111Ly Z0c1 V1LG PIVYLUVI ailU ULIIPIvycl, Ll )'VU U%~'U a.l.?lluul\A, w c I-00 vt
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. S$D-8330 (8.07/00) sted's Son savim, Im.
STEEL'S SOIL SERVICE INC. 3 of 3
David J. Steel Stallion Development LLC 994 200' St.
CST-POWTSM SWl/4,NW1/4,S34,T30N,R18W Baldwin, W154002
Lic. #248956 Town of Richmond, St. Croix Co. Direct 715-760-0347
Riding Meadows Sub. Lot, 15 Fax 715-684-3449
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
The location of this test may or may not be as shown, as permanent lot lines were not established at the
time the soil test was conducted.
Legend N
1" = 40' I
= Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100.15 ft
Top of 3/4" pvc pipe
Q = Borings
Boring Elevations
B1 = 99.65 ft
B2 = 99.65 ft
B3 = 99.25 ft
B4 = 0.00 ft
~7-
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6 -`1
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~t
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX GO., WI
STATE BAR OF WISCONSIN FORM I - 2000 RECEIVED FOR RECORD
Document Number WARRANTY DEED 04/05/200G 03:20PK
THIS DEED, made between Riding Meadows, LLC, a Minnesota Limited MARREZ TW # EED
Liability Company, Grantor, and Charles Schulz, Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following REC FEE : 13.00
described real estate in St. Croix County, State of Wisconsin (the TRANS FEE: 255.09
COPY FEE :
'Property"): CC FEE:
PAGES: 2
SEE ATTACHED EXHIBIT A
Recording Area
Name and Return Address: < ,s':1.4 ;x ROAD
FILE -S; 20 M1 12
096-1170-154M
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 31 st day of March 2006.
A CA
Ri VesSclh~ulz, s C
Chief Manager
* *
AUTHENTICATION ACKNOWLEDGMENT
TA )
Signature(s) STJFA
RA) ss.
authenticated this 31st day of March, 2006 fore me this 31st day of March, 2006 the
nager of Riding
abSchulz, the Chief Ma
Me nesota Limited Liability Company, to
TITLE: MEMBER STATE BAR OF WISCONSIN me person(s) who executed the foregoing
(If not, ins dged the same.
authorized by § 706.06, Wis. Stats.)
*
THIS INSTRUMENT WAS DRAFTED BY
Notary P to of Minnesota
My commission is permanent. (If not, state expiration date:
Larry Mountain, Attorney, 1900 Silver Lake Rd #200, New 1/31/10 )
Brighton, MN 55112
(Signatures may be authenticated or acknowledged. Both are not necessary.) CINDY M. LEFAIVE
*Names of persons signing in any capacity must be typed or printed below their signature ) Notliry Pub11C-M1nfl8WtB
My commission MOM Jun 31.2010
I WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000
i
EXHIBIT A
Lot 15, Riding Meadows North, St. Croix County, Wisconsin.
I
2of2
i
APR. 5.2006 1:47PM CSS BUILDERS INC NO.828 P.2i2
. • ST CROIX COUNTY
SEPTIC TANK MARMNANCE AGREEMENT
AND
n l OWNERSHIP C:RTIFICATION FORM
Owner/Buyer
Mailing Address 7 ~ ~ _ 1J rl C2 Y^ le S 7~~
Pmpexty Address l d,09 as:
(Vetiff don required from Flaming Depanmew for new cngjA lion) ,
Cityi'Stme Pus) R C40Aoj y k Parcel Identification Number '
PAZ DRSCRIYrY'J<dN
Properly Location S w Wi/,, Sec, T_2_'DN-R.L,_W, Town of +1
i
Subdivision c a D\V D C Lot
CoMfied Survey Map # Vokum Ida # i
warranty Deed # q2' -L VplAnt3 . Page #
Spec house ❑ yes 13 no Lot tines identifiable ❑ yes ❑ no
S`Y''sTEM 1~rLen~rr~lalyANC>r
Inwr%nruseaadmaiattstanoeofyam:=pdcxy=mcouldr*mdtia itsprematuw1kd=to bsndlewastm Propormaktonam
oea:isee of pate ant the septic teak ovary Woe years or sooetar, if needed by a Hcensedpotaper, VW yen put iam ft system
can sf'opt 9w fhae ion of am septic teak as a tre una t stave in, the waste disposal rim=
Mz peopaty oavam agraes to xubma to St. Cook Zoning Daparkwa a amtdGutiaa form signed by the awow snd by a
mssterplunsber. jomFoymaapt=2ber, tabicWphussba ors liceaaedpostoparvccsif~riagtist(i} dteats~+tikNttratt rvMerdieposal systreo
[S is proper olxsatiugcaraditiaa and/or ( after itsspectiost end Ming (tf uecemqy), the xptie tstak is less than 113 full of simke,
MM, die tmdea q and Lave oad toe above vgma meats and agree to =ajnub *e pane smp disposal qMM svM idle slaatW&
set forth, butim, as at by the of Co =v= and the Depuumat of Nstuml Resousees, Mats of WtaeCro m Catti4atm
aiata
ioed nod be ooarWkeed uAreturned m the St, Clare Cosaty Ofte within 30
s Fr
d
athe a dI
ATfIRB OF APW DATE
I (WO earthy fiat all : M acts on this form arc true to the bat of my (our) bwwiedga I (w*) am (ace) due owner(s) of
the Shown
i
WawmW deed recorded is Register of Decda OfAoo.
S; OF A DA?$
Any inform don, is T~~~■•
M440pnommd nn:y Mu[t is the taaitst)r pFrmit being revoked by the Zoning Depastmeat•
" include with this appliestion. a stamped warranty doed ft!om the Registmc of Deeds office
a copy of the cudded survey map if reference is made in the wprranty decd
7-d 9999999 JNIIVAVOX3 110IN dqo:Zl 90 90 Idy
c .off
i~
7 ~a
~
3~
ti
Parcel 026-1298-15-000 03/10/2008 03:23
PAGE 1 OF 1
F 1
Alt. Parcel 34.30.18.1573 026 - TOWN OF RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
01/18/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - FEIST, MICHAEL A
MICHAEL A FEIST
1221 130TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1209 128TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.500 Plat: 10-097-RIDING MEADOWS NORTH 026-06 LOTS 1/2
SEC 34 T30N R1 8W PT NW NW & PT SW NW; Block/Condo Bldg: LOT 15
BEING RIDING MEADOWS NORTH ('06) LOT 15
(1.500AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4)
34-30N-18W NW NW
34-30N-18W SW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
01/29/2008 867955 QC
01/10/2008 867047 QC
04/05/2006 822206 WD
04/05/2006 822206 WD
more...
2008 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/09/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.500 39,400 170,200 209,600 NO
Totals for 2008:
General Property 1.500 39,400 170,200 209,600
Woodland 0.000 0 0
Totals for 2007:
General Property 1.500 39,400 170,200 209,600
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
Wisconsin Division WISCONSIN UNIFORM BUILDING pp tp -
of Safety and Buildings PERMIT APPLICATION 1 " -W D
Wisconsin Slats. 101.63, 101.73 Instructions on back of second ply. The information you provide may be ParcO g 2007
used by other government agency programs [(Privacy Law, s. 15.04 (1)(m)J ~V U V
0jjNTy
'MIT REQUESTED J.COnstr. PHWAC electric "umbin rosion C ntr
is N e Mailing Address Tel.
Sc: 4 K 2-40v eWq,r1k5 524 Adf 21 S
Contractor's Nam: ❑Con ❑Elec ❑HVAC.WPlbg Lic/Cert# Mailing Address Tel.7is.z3S 2lvd
a PIK b~N y~Z 'E5,609 aV A/vl/ Wz S-/75-/ FAx#7 s z 5,f
Contractor's Name: ❑Con Mec HVAC ❑ Plbg LiclCert# Mailing Address Tel.
r iu11~Z'? Si- 7r r!/S~SaS'-/56
MS s 11 c--,z C Z52-Q9Z o. C ev; 1e_ w5, 77-5 FAX#715632 -Z
Contractor's Name: ❑Con ❑Elec aSVAC ❑ Plbg UdCert# Mailing 5-j- Tel65I 775155'n
K IZ t o t : gSZ Z N-e..,.D k a ek *t-a . u r 5vi i FAx#
Contractor'sNanlal ❑Con ❑Elec ❑ AC ❑ Plbg Lic/Cert# Mailing Address. Tel. J_ fo -a0
~-s gZO2~5GZZ5 E9ld66 Co ed
FAX#
rirZS4Cw4I(if #4^05 g -z1,J~ 6413o
PROJECT Lot area
LOCATION ~',S ZjLI/ Sq. ft. 1/4, 1/4, of Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
140~ 5 /Z D a Agot)e- i cU t-wel D' ,5 NvaAi
Zoning District(s) Zoning Permit No. Setbacks: Front Rear Left Right
/3~'- 135 ft. ft. ft. ft
1. PROJECT 3. OCCUPANCY 6. ELECTRICAL 9. HVAC EQUIPMENT 12. ENERGY SOURCE
X New ❑ Repair JFSingle Family Entrance Panel XForced Air Furnace Fuel Nat Gas LP Oil Elec Solid Solar
❑ Alteration ❑ Raze ❑ Two Family Amps: ZOO ❑ Radiant Basebd/ Panel Space Htg 01
❑ Addition ❑ Move A!5~Carage ❑ Underground ❑ Heat Pump Water Htg /C
❑ Other. ❑ Other. ❑ Overhead ❑ Boiler ❑ Dwelling unit has 3 kilowatt or more in electric space
7. FOUNDATION pCentral Air Cond. heating t capacity.
AREA INVOLVED 4. CONST. TYPE ^Concrete ❑ Other. 13. HEAT LOSS
C' Fite-Built ❑ Masonry
a Sq Ft ❑ Mfd: ❑ WI UDC ❑ Treated Wood 10. SEWER d y . ~L J B f "iiR Total Calculated
❑ U.S. HUD ❑ Other: ❑ Municipal Envelope and infiltration Losses ("Maxi-num Allowable
g
Area Ft 5. STORIES S. USE Sanitary Permit No.: Heating Equipment Output" on Energy Worksheet; eJb ❑ 1-Story ❑ Seasonal 1 "Total Building Heating Load"
on MECcheck report)
Garage 2+ (OSq Ft &2-Story A Permanent 11. WATER . 14. EST. BUILDING COST
❑ Other. ❑ Other ❑ Municipal Utility
Deck b Sq Ft. plus Basement Private On-Site Well O pQ, s,-e.,
1 agree to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; understand that the issuance of the permit creates no legal liability,
express or implied, on the state or municipality; and certify that all the above information is accurate. If I am an owner applying for an erosion control or construction permit,
I have read the cautionary statement regarding contractor financial responsibility on the reverse side of the last ply. 1 expressly grant the building inspector, or the inspector's
authorized agent, permission to enter the premises for which this permit is sought at all reasonable hours and for any proper purpose to inspect the work which is being done.
APPLICANT'S SIGNATURE DATE SIGNED y---'o -'a -4
APPROVAL CONDITIONS This permit is issued pursuant the following conditions. Failure to comply may result in suspension or revocation of this
permit or o 1 . ❑ See tached for onditions of approval.
• m
44;t5z We
cnt,
r..~
ISSUING ❑Countyof ❑State-Contracted Inspection Agency# Municipality Number of Dwelling Location
JURISDICTION =tyof
"Ts: PERMIT(S) ISSUED WIS PERMIT SEAL # PERNIIT ISSUED BY:
2eview $ nstruction
:lion $ AC Name haal~
Permit Seal $ tIr lec ttric g 3& V3Y(,
inher $ un Date OLD Tel. U Z S-- 7~G
Total $ am
rosion C Cert No.-70 3 7L
n.•r. I—- ne- nn._. I M4, n.....n:.... rIDI.. 7 a~..e..•..~ MDI.. A e...a;.......