HomeMy WebLinkAbout020-1029-80-001Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Pri Law, s 15 04 (1)(m)j
Permit Holders NameI City Village Township
Jerilyn Jacobs
TANK INFORMATION Q.,_,,,,
TYPE
MANUFACTURER
CAPACITY
Septic
1 ,
O
Dosing
Aerallon
Holding
TANK SETBACK INFORMATION I rN \/— r) `4 M4 c
TANK TO
PiL
WELL
BL G
Vent to v IntAj
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
nufacturer
Demand
GPM
M el Number
r
A
TDH
Lift
Friction Loss
System ead
TDH Ft
Forcemann ALength
Dia
st to Well
TOWN OF HUDSON
ELEVATION DATA
STATION
BS
HI
FS
ELEV.
Benchmark
"1
o
Alt. BM
Bldg. Sewer
C'Q
J 1
SUHt Inlet
6•�
SUHt Outlet
G S
S
Dt Inlet
Dt Bottom
Header/Man.
U
Dist Pipe
II``
Bot. System
4 • 0
7
��' , I,
Final Grade
U
St Cover
.-....
..
BED/TRENCH
DIMENSIONS
Width I
Leyth I
I
No Of Trenc es
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
Pi S
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufyptu e
T pe Of System-
38�
r
IW.
\
,v
Mode
beif
DISTRIBUTION SYSTEM -
Header/Mani[old `\
Length � Dia
Distribiution
Pipe(
Length Dia Spacing
x Hole Si
x Ho Sp ng
t
Vent to Aiirr Intake
l�I lamlpvr'
SOIL COVER x Pressure Svstems Only xx Mound Or At Grade Svstems Only
Depth Over
Bed/Trench Center
l
, i IDepth
? `
Over
BedFrrench Edges
7
xx a of
Topsoil7
SeededlS ded
xx Mu
✓
l�
Yes El
V Na
COMMENTS: (Include code discrepencies, persons present, etc.)
Location: 950 CTY RD A p r
1.) Alt BM Description
2.) Bldg sewer length =
- amount of cover =
Inspection #1 Inspection #2
Utq' 6k S tea
Flo Weft t01�
Plan revision Required? Yes �y/ No / ZC 01 ( 0 6
Use other side for additional informatiod�, LD,JJ_ � .�
Date Insepctors Signature Cart No
9N -dear — 113
Industry Services Division
1400 E Washington Ave
COOKY
S
cx.aPRt21
2L;
ev
P-O.Box7162
Madison, WI53707-7162
,
Sa�Pao@Nmtbw(mbcfiUcdmbyCo.)
ere 33335
Sanitary Permit Applicatio W
In amxndauce with SPS 39321(2), Kris Adm. Code, soon of 61is form to the appsoRvte
holier Adilmas (ddifferent than mailing address)
a requited PW to OWMMg a sanitary, permit. NOW Applicadm Fame for state-owowi sohmaoned b
the Department of Safety and Professional Services Pcnmd mfo®ahon you provide may be mid for aeeomdary
ympooes ID atsudance with the Isw, s IS ) Stets
l
So 1 -j Q v " A—
r�
L inanwAm- Mes m Print A® isrmakan
Property Owner'
7MI �p��bs
Parcel #
OaO -IOaq -8b- Ono
>y
ftope"9 2 cfi >zd
G
r ,� I
state I
\
7�(p�Cade Phone
Numbs
.
u))S D U w
J 1
(sae Eme)
T a 9 N R� 9 Bar W
U. Type of Building (beck an tw apply) � Lot
Subdivisim Nona:
❑ 1 m 2 Family Dwdl'mg _Number of Bedrooms
Block
O
❑ PmbOuCammemiel-Describe Use
i
❑City of
❑ Scale Owned - Desclibe Use CSM
❑ VMw of 4461613
Numbs
Z O /U
INTown of
ID. Type of PerniiC (Cbeck ody mare box an Bare A. CeAplete Hoe B if appliabk)
A.
�kw3yaem
RcpLczmea
D TreamnamutloMvrg Tart Rep6mmr Only
❑ Otber Morkrsaliao to Existing Sygm (explain)
&
❑ Permit Renewal
Before Evustfon
❑ Pencil Revision
❑ Chn$e dPbtmber
❑ Permit TMw fcr m New
Owner
U1 Previous Permit Number ard Dot EMW
IV.
TMw ofPown CkekaBtkat
I.-Quawl ❑Psesutmedla- round ❑A4Gade ❑Morm1>_24m.ofssaablesail ❑Momd<24in. of—m &Ie sod
❑ mlift Tart ❑ ONc D"rml Cmpmmt ( ) ❑ Prtneetmew Device (explain)
V. Amltdarmliw•
D®gs Flow - Sal limatim
Dr�l O (sf)
Oispasal_Amu Pimomdl�
_ ✓
33
Systra FkvCtim
3 J Vh
VL Tank Info
Capomdty in
Callus
Tad
cautrm
Itof
Units
Maoofam9ner
o/1 1
I d/ 10L' sz�
Y
yq
e
Ne. Ta4
t T�
Scpdcer HoMin Tall,
r
—
10OU
i
tau
Dwft Chamha
Vd Rapowbiky SttikeaW- L me mierifped, aortae rnpoaarlgiy for �Ihfiem of Ne POWTS eiewn oa the attacked plain.
Phrmber• )
s Si
MP/MPRS
Bncnea Phone Nether
,+ti IN
�:x-Ao
Plumber's (ISIo,MYn+tJ
CkY, Sane. ZOO Code)
W' S V
��'� u
f V W U e� I
VUL Use
Approved
❑ Disapproved
Per`mii Fee
Dole bond
Lemingwgent
❑ Owner Given Reason for Dend
$
J �S, evo
5
LZ1
for Disapprove! Cre .
1. Septi:. tare, 'Perand
dispersal cell niui,t he serviced r•.mmco II la1N A'4 "L et
//
as per mana_aemer! plan provd:bpmb
2 All setback requirements must bo maintained ryt�pp �j �y ibdlnQ(
as per applicable code -ordinances.
ANMaoeaa batpseafatae`'awl moors a the Carly o� a ir has N paw ad a e¢ a ll irlrtfardmr
�JTwo l)XAe5, Owe-
//Srr•v�c.'t"`�a / NE. 5'xeJ
SBD-6398 (IL 09/14) AOK"L ft{'KDL�fd ff- D S }�rj JT A, f2oG)t0�"-rJ�
-pkt 'MAp
fella rn� : �R►I yN Scobs
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Owners tftm-
GONVE-ONAL ANT DESIGN
Mau AM TM-E PAGE
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Page 6
marPlan
Fade 7
S, Crre Ciy SWW Tank ForM
Page §
Warmay Deed
Page 9
C&M arPwi
SCQ T®i a mouse. Mi,aT
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Vd &- Opse scion Pipe
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�iSA€ir i7g. Per Man we! Soil AapQisp/a�ii(ti�7t £• �`,
bWd
Design FjmR
2SA = _ T S _BPS
I �fvtAtS p` a d-M. lW3 e. / c�61 C
Page of
ST. C% NTY SANITARY SYSTEM File #-
Only
OWNERSHIP/ADDRESS FORM Office Use
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email.
Owner/Buyer _
Mailing Address
City/State/Zip _
Phone Number
Email Address (ri
OWNER/BUYER INFORMATION
�4GO
sCi C�'M ILOp�
b56}� W1 S�0
�lS-531 ?0�
\fIZ1 t410 1 ��
10
Parcel Identification Number
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Locatiorf" F- t/4 ? L t/4 , Sec. II 4 T N R I T W, Town of PADS 03
Subdivision Plat: Lot #
Certified Survey Map #
Volume Page #
Warranty Deed # (before 2006)Volume Page #
Number of bedrooms Spec house 0 yes 0 no Lot lines identifiable 0 yes O no
OFFICE USE ONLY
New Property Address,
y ` S �tytt �o 5-cry rr by ►2U
(Verificab& ol new Address required from Community Development Dep#ent for new constmction.)
(Staff Initiats) (Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form 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.
Community Development Department — Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.gov
drinking watm supp!N latata;^ a RSslar steady flow 6_r w..---+:�.., ,a„m.,- - Pa4P o f
As+'.>`ceapvnearti. CbmPaciton or -snow over the dispersal trltlt II18y G8t1SC It t0 flC4E up.
INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or
certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached
Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware,
-' i� or :oaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the
ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed o peningc
Wester than 8 inches in diameter shall be secoued with effective locking devices to prevent accidental or unauthorized entry the tanks.
When the combination of sludge and scum in any tank exceeds ono -third (1 /3) or more of the tank volume, the entire contents of the
tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Ch. NR 113, Wisconsin Admin. Code.
Specific servicing mechanics must be provided if vertical is >15 feet or if horizontal is >1 So feet and instructions to be provided below.
The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications Solids
washed from the filter shall be retail in the tank Filter cleaning may be necessary at more frequent intervals than stated in the
maintenance schedule to keep the system operating.
Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS,
There is normally a I day reserve under regular operating conditions, however water should be conserved until any problems with the
system are corrected to prevent back-up of sewage into the dwelling or surfacing.
ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken in ensure that
the system is properly and safety abandoned in compliance with Ch. SPS 383.33, Wisconsin Admin. Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
grovel, or other inert solid material.
CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a
OTcompliant replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The
replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks
from existing and proposed structure, lot lines and wells. Failure to protect the replacement area renders it unusable_ Replacement
systems must comply with the rules in effect at the time of replacement-
0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must
be performed to locate: a suitable replacement area If no replacement area is available a holding tank may be installed as a last
resort to replace the failed POWTS.
0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions ofsuch systems must comply with the rules m efi'ect at that time.
WARNING!!!! SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT
OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH
MAYRESULT. RESCUE OFAPERSON FROM THEINTERIOR OFATANK MAYBE DIFFICULT OR IMPOSSIBLE,
ADDITIONAL COMMENTS:
POWTS INSTALLER POWTS MAINTAINER
Name: m ,atyt� K Name:
Phone: (, U' D I I L Phone:
SEPTAGE SERVICING OPERATOR m LOCAL REGULATORY AUTHORITY
Name- l N S Name: 5'1- e— K ")t 2(,n) 1N
Phone: Phone: 7 / c- i MION-1 HI
Page
POWTS OWNER'S MANUAL AND MANAGEMENT PLAN
IRME INFORMATION
Owe 11 1 N J r + )
Permit #
DESIGN PARAMETRR.V
Number of Bedrooms (100 d/bedmom)
Number of Commercial Units
Estimated flow (average)
3 0 0 gaVday
Design flow (DWF) = ester x 1.5
SQ der
Soil Application Rate
der /fe
kffmnf/Etflnmt Quality (O NA)
Monthly Average
Fats. Oil rk Grease (FOG)
_<30 mg/L
Bwchitaf Oxygen Demand (BODs)
<220 mg/L
TOW Sided Solids MS)
< 150 mg/L
Preheated Effluent Quality (O NA)
onthly Average
Biochemical Oxygen Demand (BO%)
<_ 30 mg/L
TOW SuWmckd Solids (TSS)
< 30 mg/L
Fecal Colifoffi (geometric mean)
< 10 cfu/100mL
Meomntmt Effluent Particle Size
1/8 inch diameter
SYSTEM SPECIFICATIONS
of
SqAiE T=k Capacity
foodON
Septic Tank Manufectme r
{,`
O N
Effluent Filter Manuiactom
Qv
(3 N
Effluent Filter Model
Cl N
Pump Tank Cqmity
Rai ON
Pump Tank Manufacturer
O N
Pump Manufacturer
p NA
Pumpmodd
O N
Pretreatment Unit (O NA)
O Sand/Gravel Filter
❑ Pad ilter
❑ Mechanical Aeration
Cl Wetland
O Disinfection
O Other.
Manufacturer.
Model:
Soil Absorption Component (O NA)
21 In -ground (gravitS')
C) In-ground(preSwrimd)
❑ At -grade
13 Mound
O Drip -line
13 Omer:
Vertical Distance TankBotromtu Service Pad
ft
Horizontal Distance T s)toServicePad:
ft
Dispersal Unit MfE./Modd Number:
Calcalatisas:
Soil Dispersal End Cap (Dispersal Unit EISA)
QWF A&RIMMon Rate = Area Reauued - EISA = or (lr=h W idth)
Yam- .S 4vo _1�-dad 3
NA
Fotal L400h of Imch(s)
a b- u
O 'Desiga of Pressure Distribution Networks for Septic Tank -Soil Ahsuptim Systems" Publication 9.
O "10C Flowtech Mound Component Manual" Version 12
O "EZ Flow Mound Component Manual" Version 8202007
O SBD-10854-P (R.1/12) "At -Grade Component Manual Using pressure Distribution" Version 2.0
JR SBD-10705-P (N.01/01)"In Ground Soil Absorption Component Mannar Version 2 0
❑ SBD-10691-P (N.01/01) "Mound Component Manual" Version 20
O SBD-10657-P (R.6/99) "Drip -lice Effluent Disposal Component Manual"
O SBD-10706-P (4_01101) Rtesstm Distribution Component Manual" Version 2.0
MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT
Service Ewan
I Service Frequency
cean clean fibs
At last anee
a 13 months
Cl 3 yearsOther.
13
& cormok. alarm, t or&
At east once
_ Cl months
133jycm13NA
Flush and testbrek
At least once
O months
133O
NA
START UP AND OPERATION: For new construction, prior to using the POWTS check treatment mWs) for the presence of panting
products or other chemicals that may impede the ticubbent process and/or damage the dispersal cell(s). If high concentrations are detected have
the contents of the taak(s) removed by as~ servicing operator prior to use. Sy startwpaiupaetoecar when = i cmdi ieaa are hizem
at the hrllitrattve anrr6on
The property owner is responsible for the operation and maintenance of the POWTS and submission of required repents. The quantity and
quality of the wastewater stream will a$ect the perfxmmce and longevity of your POWTS. The installation of water -saving appliances and
fixtures along with prompt repair of leaks redoces the wastewater volume_ Also the brine or waste from water sofbeneaa, iron removal units,
other clear water treatment devices and foundation dramas should be discharged to the ground surface whenever passible. Note: this does ant
include humdry waste, showers, dishwater, etc.
This system is designed to handle domestic strength wastewater, however, the disposal of food based greasa, oils, vegdabktft t peels,
seeds, bows, and food solids, such as those produced by a garbage disposal should be Toilet tissue is the only
be discharged into the system. Other non -biodegradable Paper thatshould
terns, such as baby wipes, tampons, sanitary napkins condoms, cigarette butts,
denial flo
ss, and cotton swabs, should not enter the system_ Chenucals, such as petroleum products, paint, disinSectar pastieides,
antibiotics, solvents, etc, should not beflushed into the system becamthey can seriously damage your POWTS andcontami an -your
W.
41.1 1
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1E
q
0
Ah
mg
IIIIIIIII II IIQIIIIIIIIIII I �a��$-�.
LEFT ELP/ATION r/B" = 1'-O'
s
b'-' J,V CTIL114G @ MA Il LMV
9'-1 1M CEILR vJ G"AT ITCtl[I{ LINING { ✓OY R
FOR BIDDING ONLY
NOT FOR CONSTRUCTION
°IC,HT ELL%ATION I M' = I
#2 150 - a
V-
r
LJNtK LEVEL FI N 114" = 1'-0'
9'0'POURDC�W FOUNDATION
FOR BIDDING ONLY
NOT FOR CONSTRUCTION 8 �sl� �11 SS�, iii
3
NN 150 m v,
�an'a 0ramnj Room, LLC 2020
r p�y
';rw /'`�� laln'a Dradng Room..
950 Canty Road A. Nodaaa. VI 34016
FOR BIDDING ONLY
NOT FOR CONSTRUCTION
0�
CST-a�ao — q7
Wisconsin Department of Safety and Professional Services Page 1 of 3
Drvr;ron of Industry Services /j C /_ _ _
SEP 08 2020 SOIL EVALUATION REPORT l YU[nay-
Inaccordance with SPS 385, Wis. Adm Code County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must include, St. Croix
but not limited to vertical and honzontal reference point (BM), direction and percent slope, Parcel I
scale or dimensions, north arrow, and location and distance to nearest road. From Pcl #020-1029-80-000 Ref# 2590
Please print all information. a ewed by Date
Personal information you provide may be used for secondary purposes(Privacy Law, s. 15 04 1 m 7 20 20:
I Property Owner
P r1Y Property Location ❑
lerlyn Jacobs Govt Lot NE % SE % S 16 T 29 N R 19 E (or) W
' Property Owner's Mailing Address Lot # Block # Subd Name or CSM#
City State Zip Code Phone Number ❑ City ❑ Village n
Hudson W54016 (715)531-0®<Town ❑ New Construction Use ® Residential / Number of bedrooms 4 Code derived design Flow rate 600 GPD
❑Y Replacement ❑ Public or commercial - Describe __ f
Parent material Glacial Outwash Flood Plan elevation ff applicable na ft
General comments arld'Fecommendations Site �wtatllQ for In -ground POWTS with 0 5 gp sq/ft design loading rate Reu
surface elevaton to e 93 50'
1❑ Boring #
❑ Boring /
® Pit Ground surface elev 99 19 It
Nearest Road
system infiltrative
Depth to limiting factor >106" in.
_
Soil Application Rate
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Qu Az Cont Color
Texture
Structure
Gr Sz Sh
Consistence
Boundary
Roots
GPD/Ft'
•Eff#1
`Eff#2 _
1
0-8
10yr3/2
none
I
2fgr
dish
cw
3fmc
06
08
2
8-30
10yr4/4
none
sit
2fsbk
dish
gw
2fmc
0.6
08
3
30-0
10yr5/4
none
sl, 40%8
r&cob
lmsbk
dish
av
-
04
07
4
1 48-106
10yr4/4
none
Ifs, 20%
&cob
Osg
dill-
-
05
1 0�
—J
L
� IAi•
$
C2 Boring #
❑ Boring
® Pit Ground surface elev 97 30 ft.
Depth to limiting factor >93" in
Soil Application Rate
Horizon
1
2
Depth
In
0-15
15-33
Dominant Color
Munsell
10yr312
10yr4/4
Redox Description
Qu Az Cont. Color
none
none
Texture
I
sit
Structure
Gr Sz Sh
2fgr
2fsbk
Consistence
dish
dsh
Boundary
cs
M
Roots
2fmlc
2fm1c
GPD/Ft'
•Eff#1
0.6
06
•Eff#2
08
08
3
,03-93
10yr4/6
none—
Ifs, 40%
&cob
Osg
ml
-
2fmtc
05
10
136 u
o
Imo_
- tmwent #1 = BUD, >
I CST Name (Please Print)
.,air es K. Thompson
Address
40 Paulson Lake Lane, Osceola,'
>30s 150
-�--
Evaluation Conducted
= BOD, > 30 s 220 m /L and TSS > 30 5
CST Number
Telephone Number
(7151248-7767
-- Boring # ❑ Boning
_-_ ®Pd Ground surface elev. 97 80 ft Depth to limiting factor>96 in
FAoohcation Rate
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Ou Az Cont Color
Texture
Structure
Gr. Sz. Sh
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
-Eff#2
1
0-16
19yr3/2
none
I
2fgr
dsh
cw
3fmc
06
0.8
2
16-33
10yr4/4
none
all
1fsbk
dsh
gw
3fmc
04
06
3
33-39
7 5yr4/6
none
gr at
1 msbk
dsh
cw
1 fm
0 4 e-
07
4
39-50
7 5yr45
none
Ifs 20%
,
r&cob
Osg
dl
cw
1vf,f
05
1.0
5
6
50-72
72-96
10yr4/6
10yr4/6
none
none
gr s
s & gr
Osg
Osg
dl
dl
cN
-
-
0.7
0.7
1 6
1 6
Boring #
93.5
❑ Boring
❑ PR Ground surf ce elev. ft.
Depth to limiting factor_ in
Soil Application Rate
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Ou. Az Cont Color
Texture
Structure
Gr Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
•Eff#1
'Eff#2
Boring #
❑ Boring
❑ Pit Ground surface elev.
Depth to limiting factor
Soil A22fication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou Az. Cont Color
Texture
Structure
Gr. Sz Sh
Consistence
Boundary
Roots
GPD/FN
-Eff#1
I -Eff#2
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.. Cfoi X COUNTY
NO. 633335
'�'*`FTATE SANITARY PERMIT
OWNER Sff i
ata
PLUMBER Tj hn Bdv*,tSjrLIC.# Z
TOWN OF von
SEC,T Zt_N, R- /I_E
AND/OR LOT
PERMIT EXPIRES
BLOCK
SUBDIVISION
Zo&L--
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(t) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
ISSUING OFFICER - DATE
UNLESS RENEWED
AIN VIEW
V
THAT DATE
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (Rl 1/20)