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HomeMy WebLinkAbout020-1441-79-000 (2)C.n PRIVATE SEWAGE SYSTEM " St Croix sM.y.m a,IMl°ew . INSPECTION REPORT '•tl°nin°x° B3D.i7S GENERAL INFORMATION (ATTACH TO PERMIT) wmoea eeelPmew Lew nuw T)(,l n n.N Jeffrey&Christine Gibson a TOWN OF HUDSON o 020-1441-79-000 eM EM. InwOO. .mlPl /�A (o r rt 36.29192805 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER LWAOITV STATION BS HI ra ELEV swl�o FAi3 r,. Kser 000 Berman .IS 1021 loo fi� CnT�i �iLflfl ii-Wo An. SM c eae s.w E MdEIre SNX Inw E TANK SETBACK INFORMATION e+141- tun .'19 9G.G7 TANKTO PM1 N£LL BLW 1.1, ROAD Dt lW SeGrc EAI gBolla° ovlm ,-1 weo-lMe° ,q5 TG.2 Ow ripe .45 T6.2 Rm�..e BM sL.wn s. 9% 75 PUMPISIPHON INFORMATION E�`Icme 3.20 Q�45 umwry anMn. sl Co..l �1., MMa u % At Sw 62a Ts. e% fIX9Nl09 OH IT , On oww SOIL ABSORPTION SYSTEM 3.u' Y50 it I I S VZORZIAThMae SKTEM TO rn N+h Dl>,.wn >zs' RLOG 3 2' WELL Aso' LANE/STREMI — uxR T lNu. 37� H�IrMlftdL« h475'W, 2,• °° )!55o, 2„ (.�75, Mwe�., e.s�I,M JrJ.11eld , �,., SOIL COVER vPmore SnL ,O Nr .. MwwaAwne. Sy bm.Only o.wc..�- manes... a.. 13.a" .n w• 712" II LL. 'MIN, COMMENTS. Ilnlu.em.e.aoependea pamnspremnt e¢1 LncaJnn EST MARY JO CT I)AUBMDeec.p.on-vc^4 Uf ,cA1S �'� M..1.L, 2)......t lenan- ..moomm.- Repuee., we. r+Ne IL Z Zv x mn�., sme for em.lonolmmrirrelmo Sem0 nse(R 31B°"° Inepecllon rl InePMYvn IR -VRII: IKS:+/4d }o VA UiSfi� /IX/i/ 1404Go FmarzrNiP k Nov U6 2020 Sa.i.�Y.M. a..>� . CaOrx 630 3�-S em�wyPmart APPlicauan N .we.ai.xiaro�w.ra,a r. • .,��r a SAME OoKRt LUE 5 CA E Ozo- 1441-�9-DCD 451 /tililuty J� rbUi9 nn �1 '�E K1Ker._Je +l nsoa i 95Z a1-160 , `1F •ram 7q r . rgrp- I C(TKNWM�11'IQiE y� DYrI�Y-d,.ru. � 04l s.r ilLL� n n..rr�ar.4�r.�r.w r..• rtir SO yCC 63 .O� Oa.�r YY4 O.r>i l M1 Osi,Y 6�^ ii0 I xIs < y. nxrr a � u.. aw .,..iry,r 250 LY+ 1 Nry m fYrYlr rrrrYr�arer�rrr� nWy.�.] G uY949 7AS-424-'p58 Wgy�z In ff*Po6,uE -Kiii FA LLs WI IXfJr• — j �e4 "I ONAER San:: lank el0ueni 0l,eran± 0+ � y y'Y! dap, al09 muIt±e aary c11 nlnmed r as ps, mange pia i pmmeN n/nw,ia, - rye>4 s a�nfe.wti a,a,a»n.sdraadmo,anan,e, Asrr.sS s«Q 5A w «l- 6L.�ei Qe�-h '�•- a.:'w{�ip9�s..A.y.d hF!? aPw.�aen 1 p..,e.'is �tea#.P2ckw.1� _64en 6Lks�l�es"6.k.d.,Re4o�deP��+C.••�!�-�d�sA.'S..$b, p, p�. POwd W a me Inwmoe Pi rer Po6i Memmin Member 10Is 7154255 14 DON'T BUY THE "OLD" TYPE OF LIFE INSURANCE! Get the "NEW ' plan with beneJfts you don't have to die to usel Youe"OW" Llle Iauanre Plvn Pan any iryou au Tne "New" LBe Inawenee Plm Dewh Benefit-- Pays when you die just Ue the ohl plm Crifical Biness Benefit. Pays a benefit if you have a hart aaad6 Stroke or Cmcer bat you live! Cluronic Bmess Benefits Pegs a benefit If used Lows Term Care: Termiml Bum Benefit- Pays a lump stun ear V given less shsn 6 menthe b Bve Smo4n 10 Year LevelPmnrun Naale lamaunu rab Muse Female 40 S10 $14 S23 S3 4 S10 $ S19 $9 45 $11 $18 S30 45 $10 S5 $1 50 S14 $29 $45 S82 S $67 SS 519 39 S76 $141 55 $IS 56 $IOI 93 $73 S121 $2 60 $2 $52 $$9 $IJI 4 S96 $i$J 62fio 3 6fi5 fi5 $33 $74 $41 $275 70 S79 $189 P72 6 $55 S129 S 22 S496 75 $133 $325 $644 S1278 S12 $45 For a FREE Personalized Quote FAX THIS FORM TODAY TO: 888-315-6284 ___DOB Tobacco Use Y N Sproul? mtner M/F_pOB_Trrhurw Use Y N Parson to Pok For Amoam ofWC Coua4e Eamil To lrnm W erlue pnue Wen vww.uambwelbemynum ber cem C 7864 Tg 7)201027C 28 � PAW J:m col, z4r « « % $ . - ff t ` � \ . � �� ? :\f-> n CdolMld and Dial nlablEMtlon CoolpureMOal Cealgn Wn�k+bn�. Iff"Yom anon _ _ -Rj Reveal of CcmmOrcel Doi M ISD Required? -lBY.bS, Esl'unakO Wmarwal Fkw(WE) 1 XOT PeMn9 Factor A g 15=llM %) 00o tp Del Flav(i a.00 51k S1CIPOM iL .. 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Capacity Cal) A _ F1brMaM Mr UU ~Nieser Cam, Inc �MaanlNaarar N FINr MOM Nual t rolect- JEFFREY A, a CHRISTINE S GIMN D.pa3 di6W M ('eaQs=(2)3.zS XS�G3oFc41 CJAS�Oe.aP w = 12X52 =624¢ ETC atbns I t W fl A 325 ft Ssa4Area Raqured EWrHt K to tt GatlAm Pm BOOfl S 350fl R ft B 59 l 53 w lzao M G1 AimLCoeaGlan6t lRwanb GeGMPel L eANRCWzaBaRv¢eblA�GsulmmrMaN4m.r tor II=Tetl BJO r Tdal M Pm NumL W CeYa 3 GacMet WNllr 325 R Caw 5090ft0Mal Rott 933 Mrn Cdl R 1irea Fwtof GecMffi PmroaeU 1W1 Oa5 359R� NOTE MNSNmenvm=t' LmOm F m„r9t-ayttoMmo asT rt 915Bfl 308 R YMn Oiretlron PlaywM1h ca111engN 'to get Eesiretl call soleamg length and wMM1 Remember system SHOULD be bal9el them t rs prq y JEFFREY A B CHRISDNE S. 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownmtarcer Jo E 6 m.- n i b is,, Meilme AdMae �i51 Mc.��� - Ck F'�rti9»r, W1 `' ttl b Property Addrcag SV r(�n �m Cam. ucAy,„_, wi -4 l IVen6mtwvrtqu'ved Phnemg 82onmg Oepumwnl fen row connection) Cityl$mte F-L,A tASc�r— l � Patal Wennficmon Number LEGAL DESCRIPTION Propmty Locanna_SE v,,�YJ r\.sec 31 TN R��Towa of fhf4WL l Subdivision 2hu 1200J `i'y )ZA ,Lop Certified Sarvey Map R fyAr� ,Volume PageIt Warranty Deed H �3 I� Volmne ,2Y ! . Page N $lac 1plue ya7w �b ! ` tlive.Jauifuble nn SYSTEM MAINTENANCE AND OWNER CERTIFI ATION Doper ao vM metoteome of yam sepbc eyemin wuW resaLL m In prenamre Ihllem m MIMI< warms. licit mnaieh ofpuugm6 out the septic Welk every Seen years or wooer. JneWed, by a licensed partner. WXol you put into Ibe sy6hm cerW<Rml Me Nmtlonocm, 0.52humoe< Chinon 12-St. Ownm wiohtuM< reupooaYilrmv ueepectfndm QComm 53.52(1) nW m CNpta 12-SI. Cox Coney$aWbry Ordmmxe. lbe Property, comer agrteu to submit to 3t p mCmmy meaning& Zahn Depeoma a cmtlRcetlw IDtm, intend by on wanroot by ntmeen' Phobm. iaameymmplov5er, rescinded plm baora Second pointer vMMng that (1)Site oatim watie W Lapesil system h In proper operthog wvditka odlw(2) after uspmtion od pnl¢mg (dlmacusiry). the scplm ma is Son nun lA Poll Oftimi Un'<. tM wWertlgrcd Inow food Ik above leanirtoenh and agene to m<iMw the Pawn reed® deposit notion wed coin anndub mfieW, hnaigne on by the Deprnmot ofCotmmave and the Department ablamil R>nnrtq Since ofloinmra. Cemlkatim shdng that yew sepbe sranm bas been ten W W cal root be o mgkled sod aomd to So St. Conn co®tY Flooding & 2mdog Deparmnm wehet 30 dap of the three ywr <xphebon date Iromemdrymeten pl.mmenu w sure r rm.a ens m roaba<t armrramkno..xag<. 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MIRY 30 COURT �Naw OmWvnn UnQ Rstlentlalrvuilenof6aYvam 3 N,aft M0YM IwrY GPO ONWmen ❑PWLSANDY Wl.Genb. PaenlmablY saucer MMRnscr4nnepYatle MA. a aiemni w. BORING CONDUCTED PER REQUEST OF DIE COIJI CONVENTIONAL IKGROI I RENCIILS-0 ] WADING RATE-. USING GEOMAT WITH I 0 -01 RATE F1 BavVa El al Pa GwNawenMv "57 A CegnloaNvp Mnr >92 an w Pi Mown G a NnrnM MI RNa pwpkOen m Se Cdv G Sn 5[ Sh sr. CnnYnia PaNvy SalinasSalinasCml GINWIf 'Eaal £AR 1 0-12 IOYR39 - I 2fsbk mvfr 06 08 2 12J2 IOM, A 2fvM mfr, 06 O8 3 32 0 73YRll4 I N9 ml 07 16 4 &DSQ 7SYRSl4 s1 2fsbk mvfr 06 IO 5 62-W 7SYRM4 - Ng 111 07 16 a [:] Et G,nd,umallosion,X. 0.pAbYmYYp IeYwX Sce Rmn I No,111I MI Rtln 4ev[pon On 6e con Cob To,duft sbwbn G $ 56. 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