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Home My WebLink About032-2049-60-200 (3)Sli Bli PRIVATE SEWAGE SYSTEMm St. Croix az oi.. ,.�� INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 623961 mnl INMichele Pvrmxw"Nion,•isw Clark TOi cm w�TOWN OOR OF SOMERSET 0G9.60-200 c6 Wflw l"nenn 30.19.682B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BB Hi FS ELEV BMk Ben4imart OWN N BM Bb9.sw.xr 70mm9 ISM mkl TANK SETBACK INFORMATION Burvloxun TANK TO WL DISLL I BLDG V.1lINln ROAD pl^W Belle p BORm WLM9 Hoso an Faro 19^9 Bol Syilem PUMPISIPKON INFORMATION Im Grwe Menulvtlunr Demv^B GPM 91Q"r Witl Vanbr lOX LaTP Lw Syrun Now TOM 01.1 All !STEM Out Doubloon ON, Goo 'Iniospil vine I, I I Pol Der Pox^reew onlr xeee ^el, n1 Gmmtool nem Ee a iiNth v e vN N v e Q x COMMENTS: nxNxm me GRORponcn pown. nremm. Ni Inwempn sT wip on u Locrom 739 rBBM AVE I M MB MLaWan z l ads aN+r kyN= smo.m mow.!. LiBildelon R.a Idd,u Gvp [�xo Dv.� �H� aw nNo, breeJluonal lnbrmvllan oil ssnmmluml Inxpow abpnnv� n-nhanam 1.WIEW YCwF onAw pry AUG 26 ZQ(Q PO Elf,71 fin> �aYx'mlbinhuM'n ty cal Meaiwn, Wb3�1 m.°'( ❑nit Application o" ®naa +,. e.,.u.,m nmsn nl a 1121 A IS Ada Coda,akmna of go,nma a. P` mM",lylwrvn•m .,a.,w (xPna.,,, mv.m,(wPmcv,aw ;„m`,Yn"'"'roam �'.Ife ""go �"" Derw naan,,,nemmm,mn.all,mwmsl Iswlm 'kn°"'m mlemn„ LA 'iut*a lefampbe -Pl Pnel All Isla,memaepy mi ai nee" N. loaf on-nx mMO Tager Mm,uny aaann DONro lrtwna co,. w M:%.NW Yn Action la ZmUM, Phan Naale, rv'NSam ,w leafage, wl Nun A' x mI>ca.ode It ryP,oraYlNlor lm.E.nun.ypy9 e/ ®Imlr.ailrumamw-rvamenoremmm„ -12 s1dai Nam. ❑Ptln.CnmmemY.0. axfv NVA Walk ❑C a ❑fue,Mral-I ,I, Ilr ❑ ViYee Of C\M,a ft ' V,1 % ®Tomex.A,w 1117 afevnm Clink gal we nm an limeA-Com We If,, rn lbek 0Nr5yow, ftle<irtal So ❑ T,eamt„Olke" I go P,PN,mne tTh ❑ Qb FloAi n&uy Simon, i"i El Image' mY ❑ Val Rl ❑cal ❑hi feel W have I've t are Amiga Number welCs l„ml Ikfort F 1,Realm, 64MM IV. of MATS SStem/Cum rril ea¢e.Check all the[ I ❑ ate"Fima lnGmaM 0AI-0M, ❑ Mail a)e m of Area, Ad ❑ Mmatl I L In N AgAg gal I1, lain Tm4 ue Ow,nY Cm,pyal oww') ❑ Pnaennna, Rd¢ feWaal V Die ne Vlnwmn (Ilvvp,Yn ale fa,malloe: o,no, fin. ,Soon Amalgam,DYpvfi AnemwmMN1,Down aawmnit swea unelon xnalw,DNal 34 VI. 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RtyteL @4 DYe.age, e, Nen Maaryemv Tx no luo Isw r wi®� w,�a Ilmnecl,nYn vDM .a. ell sulwew.FM..aertye,daare YIeyYMYYe gNIS magg' I0aSume(Form,�.pW Al;;Nen�m I5.e Mamk„ Aaann(.Sant coy 5ms 2,a Cu1,I 5Sm Valley Vmv rmi, "gal wI swv Vill. came D, .fall cssom _-- �• ❑ Pa,, y�: w e �ra.yFa, e1 n. �xl,mn rmDm,W s 48S //• zo <u.w SOPt'C SYamcmam amaelmnlm:mne en lee maNil P'^—"' xnai Cl foul Peen vm.nm or a�m.,,ce, 1 ` .}. 4 znuxiaeq.e,a.e,.n enls maM e m %M^„'u✓ W ZAm s ST nlun"�.IdaeTe 1' a:Pe, appli,amlecWemM,meM�w^N,+,ne�a m},n eee.nryr•re,n.((rer s mal.wwleDulu wt.n.pt+'Ir.boc 45•ya, U�"f a4 DC4.V', S:r%ew J, SYSTEM PLOT PLAN OMMe<Se@oom 3epik5 wwrr ammo v min N _ wwa� u ee.r.r,nm<.w Scale 1'.BV nvw�apftdd .. all W��rw m emmw�eeu., ,r Ciov 2[ E 3 N =m�3'RiC� ift s o -.r,vezrau.e,W vM�nomaow� N sAe®evr. on. � l l NOT I V a m ,c\ro lmg,T WE I ,m w, CONVENTIONAL COMPONENT DESIGN `-yda lrw ApnnUxpo INDEX AND TITLE PAGE Protect Name: Clarke 4 Bedroom Replacement Septic System Owners Name Michele Clarke Owner's Address 739160th Ave Somerset, WI 54025 Legal Description NES/4, NW1/4,514, T30N, R19W Township Somerset County, St Croix Subdlvrsion Name NA Lot Number: 2 Block Number Parcel LD Number 032-2049-60,200 Plan Transaction NO Page 1 Index and title Page 2 Plot Plan Page Existing Tank SpeoFlcahons Page Existing Tank Certification Page Septic Tank Specifications Page Effluent Filter Information Page) Valve Information Page System Sizing &Cross Section Page EZ Flow Information Page 10 Management and contingency plan Page 11 Septic Tank Maintenance Agreement Page 12 Warranty Deed Page 13 CSM Or Plat Attachment) Soil Evaluation Report Designer John Schmitt Opese Number' MPRS 22370 Date 8/14/2020 Phone Number: 715-260-0486 Signature IZZ7d:% InzO and Soil Absorption Component Manual Version 2.OSBD-10705-P IN. O1/01) SYSTEM PLOT PLAN Cl eike J BaEraom SBPIk s `b Mm �. .,.. ww """ orW sm r•en If Ampilwowl M 5 TI q\ � aas `aC o w y � sµ. u• I i not i 1 I Ywn m a M1a I i I .,...�. 3 .. :., 10 Comm me.wl.pov 'Wisconsin April 8, 2010 WEEKS CONCRETE PRODUCTS RAY WEEKS 1832215TH STREET NEW RICHMOND WI $ADI] SAFETY µ0 ewmlrvce Dnlsrox M"NN PIWucl Ii PC eo.2Me ' "Mm mast m. Conxm,l mrWpn wr JIM WAN GoPxmr RloneM 1 LNrpnkupe, sawanry Re Description SEWAGE TANKS, CONCRETE Manufacturer WEEKS CONCRETE PRODUCTS Product Name SEPTIC, HOLDING OR PUMP Model Numbegsl 1280 ISM IN L L.21 76 GAON CYLINDER. Be IN MAX DEPTH OF BURY. Bud G P D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER, TANK DIMENSIONS =80 IN. INSIDE DIAMETER X 581N. H) Product File No M100129 The specificati0ns act/or plane for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 81. Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes The DeMOMm hereby issues an appoval based on me Wisconsin Statutes an me Wismrum Nlminlatiawe Code. This approval Is valid until iM end of AUGUST 2015. This approval is mnbngem upon compliance with the following supulatirmi • This tank must be designed l0 withstand the pressures to which it will be subleUM. • The manufacturer must keep at the manufacturing plant a bet of plans and specifications dealing the depahmenfs clamp of approval The plans and specifications must be open so inspection by an authorized representative of the department • When this product rapwee wastewater from dwellings and a used AS a septic tank, a will produce an Ol "t RJal ly want a maximum monthly average value lot BODS of greeter then 30 mi anal leas Nan or equal l0 220 mi TER, or greater than 301 or less than or equal to 150 mot TSS. and F.O.D 0f less Nan 30 Mi • This product is approved to use the following Two Inch schedule 40 PVC test in riser for electrical wiring Pipe metemals 00nsirudad i0 00nformance with Table 66 30-2 or BC 3011, W1e Admin Coda poured Into talk cover or access cover. Department approved effluent fitter designed in W installed In a four inch memeler, lee with extension and Installed In accordance with Me produrt approval for the beer intludlrg a properly sized and Id' 1Bd access opening for service and mantenance Department approved EZ Set and Polybk Inc., 24- rasa cast into Me tank cover. This approval supersedes Me approval issued on W302005 under pro0uct file number 20051 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANKIS) This is to certify that I have inspected the existing septic and/or dose tank presently swing the following residence. (Street address) 739 tsar Ave located at. NE 'G NW Y., Section t< , Town 3o N� Range to W Town of samereet ., St. Croy County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS 384.25, and it (they) appears) to be functioning properly Most recent date of inspection or service Did Flow back occur from absorption system? Yes No (if no, skip next Ime,) Approximate volume or length of time gallons minutes Tank Capacity 1360 Construchow Prefab Concrete x Steel Other Manufacturer (if known): waaaa Age of Tank (if known) 61V1996 Permit number (if known) 316621 John schamm N (Licensed Plumber Signature) (Print Name) T. {r1 MPRS 223760 (Title) (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev 2/2012 f CAST-MYxL r— Z CAST -✓SEAL rL __ mrza oa e.,rLLC L Tm Hn W320—MR TANK SPECIFICATIONS W SH & WN S wnR 3' lWl x' WMHg ] ' 1 D �EGST Cp1(AER PogF HUMT Y' ¢Ncm r-r mM t T UWD M£T U`a u nE1ar 3.em ix MT MD WI T CF T-A-3 B T CN Eau LA9t!! N1 T AND DUTI£T BYi1F N LILTER (omm STAT s WMn w c.wA m nm uE/Ix Lo G ME W W IMSCNaATLD sCl T"uN w Us A c = / Ha / � m cvrwN ux XE R (ND i ) TN MIX DESLiI ro (SmNC F1BET) a TMM Trews M WST T. S C TR T wES COgIII wwTno w APPROVAL F PDL peril PL-525 Effluent Filter If -i25 filter The PL-52 Filter is rated for 10,000 GPO (article per day) making it one of the largest filters in its class It has 5251inear feet of 1/16" filtntmn aims Like the Pulytok M la the Polylok PL-525 has an manicure shut-off ball stalled with every filter When the filter is removed for dealing. the ball will dust up and temporarily shut off the system so the, effluent won't leave the tank I rvlwo. • Rated for lo,OLB GPD(gallons per day). 525 hnear fort of 1/16" filtration • Areepts F' and 6v 6CHD 40 pipe Bullion am deBeclor. • Automatic s1vi hall when filter is removed Alarm accessibility Accepts PVC extension handle. I'I :2: hnaallatinn Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD) 1. Locate the outlet of the septic teNe 2 Remove the tank cover and pump tmik it necessary 3 Glue the filter Musing to the 4" or 6" outlet pipe If the, filter is not centered under the access opening use a Polylok Extend h Ink or piece of pipe to center filter 4 Lauri the P1.-525 fBtn into its Musing 5 Replace and sau.e the wphc tank weer 1'1-4i ND,m.na ire The PL-525 Effluent Filters will operate efficiently lur several years under normal conditions before requiring cleaning It is recommended that the filter be cleaned very time me tank is pumped, or at least every three years If installed falter contains an optional alarm. the owner will be npulled by an alarm when Ne filter leech servumg Servicing shwdd he dare by a mhford topic Ranks pumper or installer I Locate the outlet of the septic lank 2 Remove took cover and pump tank it necessary 3 Do not use plumbing when filter u removed 1 Pull PL525 orbidge out of the housing 5 Hose off filter over the septic tank Make sure all solids all Weimar write tank 6 Inren Be filter aividge back man the Musng making suar tM filisnp rroply sharN and ampklNy nQrLLd 2 Replace and amiss wore tank cover 1/Ihv filtration `Iola nwmsno-1 10p00 GPD IiA..sB A p1' Per Baimwe xmel. WusM Woo ty 525 Dealer it al/is, Daniel Slno J KHD 0wise� ® M CarenarN se HN a �� pashow ait PolDw.2`64 6&n to"-0 Fray, nul4 aMSwnFlrei® avadh me Morin we emny ooa Polylok, Inc 3Fauled Blvd Wnlbngfor4 CF gaff NII Free 877 70 950 Fax 21n 2W 8514 view pelylok two Page Vim• .r W t src. e., p.a.. rn,a We.... ul.ramre r^e°'"n' p^^na. Pmawe p..nlm. a.IPn wlmne. yam/ "YMTERROM /� AKEBB GP 7AMP� 4W VkVE011ECTON Nrou The Bull Run Valve" is tiontM tU dva ages tp septet fields d SVAems eil tion iti to Me advantages al ha f OUe POflIale and easier ivice a mil R is [M1e most tpublicewat M1eaIN Bale alternating device available for wastewater disposal appliwastewater The use lids aboe's llutely,leak-proof n andconex with al aerating due to [M1e value's change of r from one operating cbaoanohir The accomplish" over horn o drainage field to another mil be valve wlihou In lea g or f IN PoFS minute by simply turning the valet without digging or contact with wastewater The Boll Run Valve I5 available In a-Son40 PVC and is suitable wherever septic disposal systems - InComm uncial, Industrial, and resused lentlal appilcations. OPERATING THE VALVE plm III i you The dune Oon cvnlrol handhe should be rofalM xae xnl xne xa: cetwoiu0bc to direct mmorovq fvewcap ththe at He top or me hoer toce, Me valve handle can YYva 1 1 1 'CJ Vyva De turned with the valve key Nmished. Ponnpnetl P amod card; I an no E BOLL RUN VALVE during dwmg Complete Valve Kit Ohm Yew, Septic III Iyears Contains Tank TW[ I Bull Run Valve body 3 38- Valve Key RABB FLU RUN VALVE ! EARASUL, BU_ RUN VALVE IN KEY ORKIRISER Boll RUN VALVE RISER w/LUST COVER ORWEY49 BULL RUN VALVE KEY 4ar Ruder Op Adapter a WMMIght Ac Cp BRVCIRISER-4" AGNSTABLE TO 38-HIGH Pap 7 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ12o3HP Bundles 3-ft Trench (down -sizing credit) 120 Hit r Pdyiok 525 L�Im Witold) Provide minimum 3 11 PLAN VIEW tll�llV 0e5ER/Atnh)N N E EXTAIL (No Scale) 4 P r„e ,^..^.. , 1p s.ne Pmloraletl Lale21 �Cyenesn Aw fl W (typical) INI IbVal T @MI Q a-'+ep isfl - m w mo i INSTALL PER TRENCH EZt2(tyow) tlk 0 T NWup 10 10.R RUMlw®SOH ELWurY1=M 1^xa Wlmurbepwm,rcl A ♦ � Sfl EmnNlea®25 H EISNur1._fl' v¢muwadn mneMwrn wnvmc =l PnepmN EIU w lmN= fl' Reputretl ImmaOm Ms= 1500 11R' DahipuM1On MBIIIOd 1 3' X 1 x trenUes = Proposed Total EISA = 15M R. brancM1etl man'"" 0 rnYixr.AY—T (4NL� RESET Installation Instructions for EZflow Systems in Wisconsin Wisconsin Depadmmt W Commerce, Safety and DWltlinges Overrun. has renewed the scecific'aeons and/or plans for the product and determined it to be In comparnce vnM shapten Comm 82 through 84, Wisconsin AdmIn Code, and Chapters 145 and I60, Wrscmen staWtea AN slits must meet Me $I@ IN =_n Cond :, • IN LoOptsfif disknces as noted in Tend fargukbons The appmwtl Produces are IXK3H (3-iT Winders win pore In center Wndle in 5' a 10' Iengns) end 1g(X HP (3-17 Wndks vnM even each Wndk in 5or 10' krgMs A angle Pee WMk martens a four inch eedoaters Pore Far - muntled by EPS aggregate and i5 hetl together MM1 Any - ehiykne renng A sfgle aggregate WMk contends aggregate only and is M1ck 1myeMer whM1 pslyethykrhe n clop, Male 6aM Eyahpn HeeMd • Uges Bundles Uncy, G amushik Fabnc EZemv Interml the Couplers Rce For Meade, and Inlet • Back /DCawlor TheklWontrnbucbpna The mabuctms for m ant der , of in ab products; are gam telex. TMz product sh� must Comm2th in x Its Win onsi slat. mmhuses defiroi on so used C on 82 through 84, eri b- m¢bm va Congo used Gapters t de any IEO, W¢armn Sb4 ales as vM u t},e oral health aepNnml d amnl aezgn man" 1 After Me yeah healM department has determined smrg, configmanm. and unrest to, tie Ullaw systems aloe cz mass M pYm the location of henries and lines 13e cal for act school tmk craft Prof, header Ice or on - disputed Wf and trench boHom ehevenCns Wore mslah- IaWn of pane bundles 2 Remora daze: Ullow shieprg bangs man to damij bundles in Me iremh(es). Remmc any pasts dams in the trmcM1 before system a covered 3 This PrWud must have geoksl Idyls that meet a- pueemenis of e Comm Sul W (6) (g). We Aden. Cale, ,ns ld directly on tap of the product and eAl ing Mom along Me sides of the product to a paint at least six ,aches from the Wtlom of product 4 When named in a tenor, Me bench should be dug to a wall of 36 inches Tons not only s. eInva s labor eace- ban. act also proid is better loMdeerrg ca ,ly after dac4fitfing,s complete M�IEZAW Man ................................ a ............. B. The Ab�bm area ON necesary for a gloms se shag be sued based an minimum all sewage flow (GPD) and the Permeability for Me slit If ceran mittens Of met, the EISA sizing can be, season Wisonsen, resulting in e 40% ennakr dmrnfind 6 Place E2flcw bundb(s) in Ind EaMov, cmaguanm do - paned by system desgn parmd sµc, am for the panmu- lar site The top or cmhermosl Wades comanbg pge are toned end to And wen an Internal pore coupler. Any additional aggmgete only bundles that may be regmred should an bMN against the ones Aggregate only Am - dies and tln not myurre any type of connection The top of each GEO cylinder mfane a filler fabric pre- anutxturedmMMeenthe mmingand agg,gate The kWc rs nderM to Pertnl sal nhosm The mstaVa stall make dune Me the GEO is lwsnanM Award Intl is in ankcl vAM1 Me lbonc con WnN in the adtacmt uhm Am before backfilim 8 The EZfluv IXanfep Systems sMJd he notaikd rn a Innl nendr in 0 enactors (mu aoods aM along the trench Wnom)aM Slwk ldW necmtmer of be chamtl Increase ekwlnn summers dents), win all mearm s Wpng 10.1m1 ryM Inn burden pNsn1 end to eM. wM char WMk datmadm pee rnlercmrrMM, wmwn eery dams, atepdvnns or omn watts sandy g. The bemb lcq " be gabled such Met weer Fall ,of parse Ba6fiu annul be sealed or aWeM immedra@ly ants comMxymx to reduce nosron. 10 Eznon EPS WMk: are fkude aM cm at In caused! benches an may be necessary to avoid trees, Muldns, or Other canna s 11 EPS aggregate s Ighte, Man water nee ere, it might be exibef that natural buoyarry forces vel NM to came Eznw ss email: to neat oul of ground when Percent cows Told blommce I shown, hw.cv f that nu is M a problem when systems haw a minimum of fir 0 sal cover as mr ommended by mansmareh. 1209H-GEO e.aer amenal m ......................Pare............... Pogo 9 In -ground Gravity Management Plan PAGE 4 OF 4 IMPORTANT: Th e Owner of this an -ground gravity system shall be reassessed for at primetual opera on and maintenance Wpuenl t0 requirements Of SPS dill Wisc Admin Cade Pursuant to SPS 38352(2), Wisc. Admin Coda, his system shall be considered a human health (record If not maintained In accordance with gas approved management plan FuMermore, all Inspection and maintenance activities shall be Peb oral by a registered POINTS MetnYinar In accordance with SPS 383.52(3), Wisc Admin Code MAXIMUM Dispersal Area Operujing LI g : Design Flow a 600 god; BODs 5220 mgL^; TSS 5150 nal FOG 530 mgL" Inspection Checklist INSPECT EVERY 3 YEARS type of use • o age of system nuisance tamps 0 e peps, user cwngaie s. eon.) • mateansed lfinme(10, lek,bPumps. ntras, tche5, noel,, arc) mBlanallumei gna leaks, breake,t t �itaetc) • cable volume In anaerobic treatment tanks) and any es.enn red a non et (I a tligdbW on / drop boxes) • neglect or use Qe exceeding allprododos cepecieea, proNblted eMlvleee, etc) • extent M pending m dif a pW on call pip to dosing • dosing mcompodes- xapplicable(I( pump rewychnecfloat switches coe,etc) elsgbwlcomponents-rapplicable (r a, wrung,connections,switches, re-m,frmers,atoms,sp) . Surfaced1stinbuion lateraldischarge p lateeffluenal t orcaplugging (meawretructure sere prauure-mmpere to tleegn epetlPcepon) a eprtace discharge W eMuent or sewage beck -up into Structure nerved Maintenance Chita llat MAINTAIN EVERY 3 YEARS (or when necaesary) $aerie end done Gnkla mall be pumped by a c:rel xptage servrurq Postalp licensed under S. 2810 W ie Stela. when he vdume of wild@ In he orders) express one-third (113) he liquid veWme Of are to l or as repaired by lonl Ordinance Disposal of contents Shall be pursuant to NR 113, Wisc. Admin Cape. Effluent Rltens shall De inspected every 3 years and shall be deanea when naceasary to remove any accumulated solydsecwrdingtomanu8purersspeclflmtions A servicing ceased Sri always be greater than 12 months System maintenance reports shall be submitted he the proper local government unit In acderdenpr Mh SPS 383 55 Wisc. Admin. Corte. Report Any component failure or malfunction to: Name of individual Or tympany. Schmitt B Sons Excavating, Inc. phppe 715-760-0486 Local government unt St. Croix County Community Developement phpte_ 715-3864680 Locai government unit address 1101 Carmichael Road, Hudson zip_ 54016 Any defeddi pact Of this system shall be repaired, replaced. Or removed pursuant to SPS 383 51(1). Wisc Admin, Cotla. Repair or replacement of relled or malfunoliwing components shall comply with SPS 383, Wisc Admin. Code NO product far chemical or physical restoration of the POINTS may be used unless approved by the department In decadence with SIPS 384, Wisc Admin Corte Contln a ncv Plan In fee event that any failed usaenent component Mthrs POW45 cannot be repaired, d Shall ap replaced pursuant to a Man submitted to he appmpaate agency Mr review and approval. A failed imgr dispersal wmwnent maybe abandoned and replaced by a wdecdnplymg dispersal wmperi in a pm4atermrned area Of suitable wile System Abandonment fuss 0 hie POINTS Is discontinued, it shell be abandoned In accordance with SPS 383,33, Wisc Admin. Code. Page 10 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Bayer Michele Clarke Mailing Address 739 160th Ave., New Richmond, WI Prapeny Address 739 160th Ave., New Richmond, WI (Ven@earn rtgmred fiam Planning S "nmp Depenmem far new woiwetion I Cray/Slate New Richmond, WI Parcel identification Number 032-2049-60-200 LEGAL DESCRIPTION Properly Location NE'r., NW is, See 14 T 30NR 19w Townof Somerset Subdtvmton Plat N/A CerdBed Survey Mapas V*:a0W1 ,Volume 17- Papea 3246, Warnny Deed N 1190 T 91p (before 2W7)Volume J age a '- Spite haun ElyeaOm Car Imes ldenuNble arrow SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your sephc I could man It In its premature failure to handle wastes Pmper consistsmumblia of warrant out We wK cocaine every three years or sooner, If needed, by a Geemed intrinsic offset you pus the system cnwarrant The dwetmn o(Ne segos, nR as a treatment nagem the waste disposal system Oxvm eramremnce Into eemnelbllluo eapeelfed In 9gP538352lpandm Chns L St Cmlx Co.Ny Sanury circumstances The PmpeM Owner agrm ra subrmt to St Core County Planning A Zomng DepN fit a amficauon%rm, III by We and by a mastgloumeyr, miter plumberen pluMrymleed m, mmud plumber or a opumper sentiment Out f Il the citcitrus,-n Owner ,er dtepoul rynem Is an proper openomnt culdtmn and, or after lmpmuoo and Pumpwgplacement the septic nos It less on 14 NII oLWdge I'we, the undmlgnN base road the aMve rrymrtmenu said spa to mammn We pence singe disposal system wins now undaNa set tons. Matta. ull on by the formulated afsafm And Nationalist m ean l gd the DepartmentofYarunwl Ra Sureo(WCer oconsm ufinon nmung Wtyom mpue system hea barn mammnMmust m,omplercd andto ar Sr Cmn Counts Pinning as Zoning carcinoma wIWn13a days ofthe tbn year micnuon at, ]'we "I that all mmmenu On thla fonts areuuemtbebetmmyOur MnowlWge IiweaMrtethemmamoofuYe pmperry descnbed ,bon. byvrt w Of, wamory deed recorded In RegleW o(DeeN OtFm Number of nbedrooms 4n / �C/�PQQ, C� 08(17)20 SIGNATURE OF APPLICANTS) DATE rr'Any mfomuuon bon mmmnstormed may maulun the mnNry permit being re.O4ed by One Pla m us k Zoning Cepanment "' Include och Or, appbnutsa meoNN warnary dmitrain be Register of OmJa Office and a ropy of tieeenrfiN survry rep if reference is male In the warrants deed (111cr 21 ¢r.xwaawp. Hp.rNmm`s PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) PmgWbbm mproomyWo, ais w oumn.. hrm STIN, •TROY I.a t EOSM-L, qua uE� 00 _ iato /A G+ s1A.4 -St: PUMP / SIPHON INFORMATION Marmismror Dema n Modal r PM TD Lift Fnatwn TpH It Fortemnn mpt Dra D.n TO Wall SOIL ABSORPTION SYSTEM MOIR 97 OK9-60-300 9 wwM IanM6Z wprm,ru, YP/L %T • u wuN wqn SEIYCK SYSTEM iO BLW WELL UKE/STK OIING INEDREMTp1 C ORUMT DISTRIBUTION SYSTEM �2 a __.r.L._ i_Ola_�I__.� 6> i..I xiPawflAUlklod en9m�r ui/ n ieprn L�rgn swono P xrw o rm SOILCOVER R Pre%xreSMems Only as Mound Or At-Gral Systems Oniy ma •❑rmn em hmn mEdge, Tw wj,eo p�w,p xep ❑rvo COMMENTS: (lndude<oaeaiurepaones. immonspratant, ate) LOCATION: SONERSET 14.I0.19,NE,101 719 160TN AVENUE C-a AO1.(Nm • To p r% doer sAl N4 book ajoi Flom mpair Y% No q I •'le L..%/�� 9 emeruaelw aanren�l lnE>ma�xon m,Pm>,sip"W" aeOnlaAa90 14Isconsfn SANITARY PERMIT APPLICATION en"^B�mymi0ti'w^' "..mrd meth "A as ft. was adm cm, i`°emr W awl.> macaw. ii iriLne,nin`:e_,,•••,wy,.,,n rorwanMm, In wwrnatlma • Sx rcnrW Ndefw NMruNonL bLmnplks,ngmisewlNatlon YY Faw�rjys.mrt}jn'uynlen the emoormKinYoMj,llmll ry°euWM Mrpwof tht p, ry°wpvm, N In_ OCIra4 s.Gb�owlypyYn new Per °.NomM %TVC NiC rr RINI amroow..rwme rmewnmww„ w,3 T 70 ,N,R EI oryQ Nw ry y eM C SYY Ip Le4 IIp.e Num Wr11. SUMnem Memev(1MMwnM li TYPE OF BUILDING: (cbed Oro) []Stet!Cwntl xeermt nl.! rMnin. Public IS for i F&MIRY I1wNli -No of bedrooms TN I. III. BUILDINGUSE: NbUIICIN yw NLbncmenellrn,l,uunl ,Yrt..rvummRl I [IApartmeM/Cando M.so.w m8a�3 0 O4>mmWy Haiol Hall 0JhimFa°Oty/Nursing Nome 10 p euW00rRwudwl FFatalityw 3 a rou ]pM•rcNMiu.$alls/Ravin tl pplpauram/Bar/f%nirq a 00hurcR/SCM1°ol 60M°pk Nome Puk 1209Mu•SYdan/fp WM s 0Hotel /Ranks 90gflce/Factpy 13 p gMr:pwry IV. P PERMIT: ID,eck only °nelwa °n liwq Beck p°.on line B. if applYeblel A11. SNaw2 [] Replacement 30Replacement of 4 hicomnaction of S. p Root of an ______Sfeem ___sYrnamiank OnlyEalstlrlySxttem_________ EnstiryfyRam --- 0) ❑ A Sanitary Permit was prcWouYYnwad Pormlt Number Cote same! V. TYPE OF SYSTEM: (Celery ongmw) N°rrvlr•xrunxtl(4x4,bulron /revurvedWalrvGUNan EapenmaWal Dther I10 Sxpa9e Bap 210 Mwrq 30 p S°•nly TYw alp Holding Tank 1]®Llpege Tr•rNb 3201nGmural Reaur!ra]pPt M wPPt 3aOVauNmy3pswllceIFilll p VeABSORTOMI( 1 GoIION P•r Day 3. Ann Area 3 Almoner Arta a Catlin Rkse S PerC NY 6 Sptam Eler. ] FIMI Grad• Pr°posa01sp h11G•IVd uindlq.hl sq h) (MmfimM1) hsE v'°^F.M f.m VII. TANK INFORMATION eI" Easel Gallows; Tanks M•nufanurer'f Name Rol" P O n•^'• New Innocent gue e Vill. RESPONSIBILITYSTATEMEM I,1Minvo IFad,nwmvxporwdlitY lar,mullation °ItMa slpwn On tRaatlxMd dam Ilumaef,rMme(rn xSpnaMeM hown' SW No BulmuMnvNunW- wKu tin, I`a Passing! .alSY..LCny. Y, :.Ilowl RTMEIzi:1511Erep LY p Disapwo.eil ohninq henna s,h�e==w WWsumP �IApp,ortl m 1O " v ap�,.o;,mpks s re X. CONDITIONS Of APPR VAL/REASONS FOR DISAPPROVAL: N10°"'IAOipi°'�"d N4ish` SOIL AND SITE EVALUATION pp.LaIL 11Nbtl NumnPWb� MYMM41M.w Nuexnw in Wro noII bnn e. ILHR M M Wa, usbmMxw•NMmey rnlmmnelrz.I�baabw. vw mlx eTM'M1 YY6, CMM ibYUOb nNn MIMpW nlmo WM IBMItlrxFn W xl.1w.m��e wmlio. � O — _ APPLILNR INFORNuLMN-PNFxxpnwmtl w v,m.>,y om., -„ eb MLwIYs '!/e✓ A,f i. .nr'l 0E4. n — IN Y.6 i'p .N.R 70n W 9S• 8 - Low Ixiw1 euna rNM.mcaw eeu aP Pnm.Num N III x ❑view• aTm* Ayr GZNn � Vim®RY]enW INmb.adwvonbLYnVu W" ❑iu o OFJ2 mmnnwgb�p�alb ,^^ COYOMMUYM1 Aw X()o e;IcI 41111,11r,�qM�i m. �1P�YeM.Q�'N xxaFem W",,W ZS-P n2J1®-xwn RZNubvnaW�xb'q nr� Lew, wme_.%W,mxel° nemrmr�y�mnrmvs wnem ymewilsl e�npanlviNbxN Pn WmAI AxaxM.Ia.yrv.nm.b..eo. t/Pn F. i'r PM.._ ffaf zec—,. 6/ SUP, .,��.lk romq.ba m.x Awxml• N.A s e.na. m•.nMm u - um.naa. m�rpw qis ❑u Nema ®e ❑v �e iwn ❑u x LSXATi o u �e ❑v ❑• ® Eau eonno x awb .r. roLPPN aeNb SOIL ®®E MM==0 Nme W: pegs ,O2 mL FROPBATT OWNER %rovhYTh BOIL DESCRIPTION REPORT RRnDekr.D.R n12-2o Y7-(0 BotlngN 0 �X DpNb @nik,' Mcm +Lua_In Boring R 13 mound aw fzr* X. Drytn m rang ro�oIy +YbJn Bonng p e",i Glow /Oma DOW, 10 Nine" Norlim NA in Oanln,w Cgpr Mun¢NI WADS Ou a, Cml.0 w TeXw BuuvYun Or Si SX CwubNnm BauMuy flcab p J/2 5r'L 4t M 4- BaO Trxp1 "7 Pf /G Y/i `- .JrLL_.�...tft Ys ✓ >i' s 0). w zv y Remarks E S r2C d.+b/- M� cr.i s y F9 t,s is sw H Remarks' XMxm Dep r n Mmnr G, p Mum&I w "im Ou Sx U l QW,r Twelve Or Se SX CmLe4ntt BpMuy Rrotl BW Trwgn is fill —I" Remarks' —M Remarks. SBBW$Vn I0"s) page 7017 N Q I1I_ Top of /"SFee/ /of Lor;*r 54ec 5f V corNae fC, Ali 8/n_ % of a"PK EL kecommM 4Pd %OPSOZNNL AKB.<'�Cecy,/:o�.. Q /no 7o• oelo Pe_cn Cam, 7mr � 96. �o' peEA �AL TERNNZc ya T.. o4 /o 4.Jo' S/ole Tin,r4 /02.JG� 7,o„c4 /2 30 BS 5auf�. Prop+r Fy G,NP lr wp ut Ft T.ey A4tAi NFL NAY .5/</7JONR %n o f SrM. X4t CNSyT �L FNE yr' Svb Le//sy Ni,Tril So... w..i, r 7, rwaJ Y'