HomeMy WebLinkAbout026-1064-40-115°. PRIVATE SEWAGE SYSTEM
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INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
..IP.a.W Lr a 15 w y)s'I
umN St. cmix
u,ywmmx° 624874
Afl, Paso No
Robert BxPatnua Peterson
ray V"
TOWNOF RICHMOND
Im
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21.3018 321A-15
TANK INFORMATION ELEVATION DATA
TYPE
MANUFP TLRER
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STATION
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SIMIInIN
TANK SETBACK INFORMATION
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PUMPISIPHON INFORMATION
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POWTS OWNEFIG MANUAL& MANAGEMENT PLAN Real N_
SYBTPaI
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Permit 9
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BFSION pAMMkTEBS
Number of BWrmma
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TENANCE
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MAINTENANCE INSTRUCTIONS
IvpMlbm N tanks sM diela/ul peeps Ma be male by M MINduM cw am of me Innn.lnp Ik ad caJlketlom:
MM Ramp: Miner Muslim RenmeE Spi POWTS Indigenous. POWTS ephemeral Saplgp SUNanq Opaelp. Truk
incppiow mutt Insure a orsual cartoon, or the hall io iJen4ly My rating or broker, nuJwaee, 'pain ily MY w Or bean
lM dbe the eowme at c men ad a and In xk up n mnein of their ran Np ground eunau
rewes capital Mall be severyun MMMI�o mete Theaopirml brJa an the obwrvede, real and to Malik fur MY pWdlna
of Affluent on the ground Operated. The pundine of affluent An the prouW u fv rude atdkMe A gaping m<bfat and "Ar"A" The
immediate notification of the kiMimpailmii Opera,
yMo the Mmbinm woumushon or sludge and aoum in MY tape MUD. on ,thlm IKI or more of and tme M M W W the Mere
u o1 ran time MM be rwnwed by a yptg Senieq (treasurer Am dbmeW of le n;mdace All ~an NS III
Washorean Admin1s ive Cane.
AY other services, including fee not mining M tna servitlnp of effluent iIIMe, mxhMlors or p.eeauused ooml 0, pMwe t
Mfm. se My eweiuq at RIw of 513 nwrths. Mall be WrOMd fay A oadFW POWTS ponderer.
A ""log moon shag be priori to the Mel repWnory euMwhy WOW 10 daye of cwnpbtim of wry eervke went.
GM Well
nal
sTARf UP AND OPFMnoM
For haw automation, pour in an M the PoWIS Cwak Vermont rmMal her the museum a monang Pia or mw i^snima
mn mrr Mpeac Ne naeh�sal a«.x «w« aampa maeAaml a+W. Ir Man cnain.uwe waa.muea nee ere an.ea
prma seam r.mpvad rev a mpipa awaee ePwaa Mlam w.
smwn xatWominn opwMwn aimmlXpnF are rmmn xmt Aplaamm ease.
gpmM poem aaagm pmpinb marts wweearefa ngnwmx mmm whn wwwbrmmm erases waamwa[w was
mznapm m na aMpamY ulNal n area � For. amrbaloB era mlkl aY mn rwM k ma heatup rc caeca PinJrape ur
tManr. ro aaol era mlw.uae ham era wn®in oe are prom ox �®gym+m m a saptaP. swm:a op®amt wide h. re®me
pw:Y m W Alust pump a rmmvt a Prmbw a, PaYItS Me'mYM1w m main w manual ppwclhep am pang mnYub m
reoma WeB ,has me puny Mnk
Cast dome Ummof ow inks orat pub lil en m axame or park one. wMswY ekmN mmmpact No see
wMeA rc rem dawn alma Y am seem aat�mae epN.hnmtia+area
.
PWctim a efiNnaUur of fie rdpwhg hom era wsamwaw sbeem may Arpiow flu pNprm®® wY Paiurr9 tln Gee M ere
POWIS: wulhioao: hats whom: Gp®nm hurts: outcome rotmn mete: signal eartal Mm: aiep al Pueaxfau: IeC
raxeaLLen dram Neap press)) Vul. We HA vepadaf pminga: PamFna: peas: nwhiumm: mum small mtlrxlmu: A
paYrMg Produces: pmacMm: umay ngibse: fmpans: sY home.
ARANCOMMEJT
lNwn ire PoWr3 fW alder is sumammiN tome wet of avian tlw klbaeAp MRS shall Ee Ybs he Asaa Nam fna sysem to
properly and Faster gents etl itcmp9ma aril o uspmr Comm 83.33. WNconM AamhlsaWa Cods,
upbkpmanrns al pia tau he eixwae.mm na me abwmoma pipe opnineaswm.
l l donna ar Yi M1rb al Pia Ntll he rnmvW aN gropes Paposal M by a Rep�e 9wvlamg Cpaa[or.
Ater Wani Mohsawlhe mcevami nasvos�a, roar coves mmovN era me vom naoa faro wiN
Will hamlet/et Y orn nwfnrs,aiiut MN mare'iY.
COMTiffil PIAM
If qm PCMRS 1ffi sht aver he asperse Use fa90whg mssams have been, or real he mks. m pause a ale rompGarc
,.emaernaa rearm:
A ndltly upmaennt ama hm been wafts al and may be uafaw for lim location of a replawrrart Nil akmpgon
ayamol The rapiwement a of be Pmtumd here NsNrbmwa aM temperance adswum rot Joel inhibition Won Isf
mlu4p eaeWcks ran visug ma IaoGaad aWcewe, lm from mitl wMh:. Falua m poFst Na mplvmn[+rea wII.
rv@ A Ne aces a reav sL aw vm evaluation m m[roleA a mrimbM rWla:eennt am Repimvrrurt syeMm e°®f
whocommN Mae Ne mineA offset at not sal
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A ati®hb rnlmwrmr sea A not dal asa au m soro altho Noll fimiaame. PaiYp Mvmcm A PoWfS
ieonnobpy a naming 4nk rosy he nwmlletl s a Its runt m rWlez eM fella) FOYRS
❑ rIm are rem nor hmn aeelnama m awmry a wdetA ryelasmmt w. upon rare re N. Pomrs a sou wp W
mapuaon must he pMonnM m bane a mataMe rplamnem see. X ro replemnvit as ¢ eviahb a M1OMeM Josh
❑ islowedmmcowpuo-nadaaair.nel t�ufta
a sell
reanwertorymealaelement element he nut
Iin plea tolerating mmo.ere homrt an Me
statism.tism.nrrxnaxems must QDMPIV with the mMa MHeetxNmthus
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S . PUMP AND OM M T lhlhENr TAMhs My Wei LEMML GASSES A MR g1511(flC1EM OMM. gC Nor
Mill A Will PUMP OR OTHER TREATMENT TANK UNg ANY CWCUMSIANCS, DEATH MAY RESULT. hill OF
P ON FROM THE DrOffl N OF A TANK MAY WE OIFFlWLT OR IMPoSel
pOW n; MGFAMEN PGWrG MAWtANImI
NafM Nana
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EPPFAGEEHL eOPERUi"W M LGGILL IE6NNTGRY d11RHGWrY
Russ Na^a _G CG.✓�._ i
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Txranw.xeFm roes A mrylsav MNAMw omen a3.zzlamimMMn rm uswn. w aw. xam�re m+mrwrame.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AOREEMENT
AND
OWNERSHIP CERTIFICATION EORM
ownea/Egyel
Marling Address L Sf0✓� DnJ / ah,�� µ-Z $1/O(w%
�PegY Address % �� HCa �lCNK� II
(vero,em,mim•ed ham Planning& L`mng Derynment fut new son
City/Sale h(*v Parcel Ideatmcenon Nagaland
LEGALOFSCNPTION
PanPntYIgnepn N6 'h, /., Sec y�. I_,0 ,N RILE, Trent of •d�gWw.✓.
Subdivision Plat, _ Iut p
CerffRed Sarvey Map# /D997o9 vnuared ?b_, Page# (177
Warranty need # 6 2 }}5 (bcfortsolnWolgme WJa s , Page #�.
gµc Mae Oyn� Wtl�w idmg(ebletljwOm
Imptopn uss W nulnauurce efpm vpoc ayalun could rsula iv iupmwame 4ilurc la lavtllc wenu Pmpv
with WmPmk of
fhM1eiepleand as, ermined
iwrco RneWM bYe Lre, Onn bl d"llt, pm ww
0pn,bd mneH¢I IM1e ILncnan oflFe rtpllc land avnncem¢maeg<maewaen tl8MoAyYtlem Ownu ilulmenenm
ruporeibiLtiu ern epcofed In §SPS YB] 5E(IJ eM m CM1ePler I3-gl Cmn Caunry Senimry Ordmenu.
TFe pmpeny owns egrtss to again w SL Gdr Candy Planing& ]tong IXyNnent a ,ndin ion amok agent by Me
omnr We LYanwsacpin ainlpanl, nn II911,,minclWPI[mMrm aIlcena IM venlYlnBdul (1)Ibeinah
ended Italian
llialem In yopee 1pemmgmMmon niW/mQ)efler npewoveM pumpm80frccewryl. Ukssp¢IUM ii
less @enll(J fill ofalWge a
loss, aLevMmignct lull reed the elwve aequnen¢Ta In epa to naton ttepmelc ecvnne donol SYinen with the
SAMads So IOM, wmm, is all by ad, Delunment of Snob AM Pmhaiolul SwiunW Me DepNrcnt of Nemrel gmwvs,
San of Wisc o Ciabrohon song dan yarn mpnc lyllcm US dens lvSunwl moa M wmpMN aM mwnt to We $L cam
dbno Pissan ad a ... a Don, ern wild 30 dayl of Ilan lM1rtl ymt eipinllM t•n
I/we cads that all staWnents on dvl aormme lime to die Fart of nihour m0wlWge l/weaNert IM1e owner(s)Of ILe
/ p//wp�ryryrty d/uxijE�JIN(�d/agq�Woovte(,'b/y/wnueT/ofe3wemenry hW tewltlW In llegnnrol Md50Rue
�e SIGNATURE OF APPLICANT(S) DATH
"Any MOnIds l Mn ¢ mi mP'e%mM only , W v d2 nmryry pennn Fempevoked by Me Pimns; As Starts; fasteners
Include who Ills ands"u n n,m,rdcd wnontyden fiona IM1e Regnty orrhi office and a body oftheanifed ivrvry, man R
mk ance kI nnm,a me wannny dam
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CERTIFIED SURVEY MAP
LOCATED IN THE "v<or THE SW v. OF SECTION 21 .w
BEING A DIVISION OF LOT 1 OF CORTHOSE)SUFFEADY MAP VOLUME
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