HomeMy WebLinkAbout038-1098-90-200 ii Department of Commerce PRIVATE SEWAGE SYSTEM count
'Sat Buildings Division INSPECTION REPORT S Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes (Privacy Law. s.15.04 (1)(m)]. 383890
ermi yol er's Na e p� City ❑ Village town of: State Plan ID No.:
m ew hIcAmond Congregation of Jehovah nnesses, Star Prairie Tov rns hip
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
C �
0 a t
TANK INFORMATION LE ATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic c O Z (/Q - S Ino
o in " 3.5� 9 G . f
A f , e o Bld SCWC rt 9� �Z
Aeration g a { r
Holding /Ht Inlet / 3. ,
TANK SETBACK INFORMATION t Ht Outlet 7 :Z 3 93,
TANKTO P/L WELL BLDG. Ventto ROAD
,t Air Intake
Septic > 3S " �b I .S r /� NA
p NA Header / Man. I f f l, Os
Y
Aeration NA Dist. Pipe y 3r 0 ,_
olding Bot. System M 3 -3I 9 2-
PUMP/ SIPHON INFORMATION r etf I raeP� 2O hS 3 Z
urer Demand
no ev
Model Numb
TD ift Friction em TDH F
oss
Forcemain I Length Dia. Dist.To
SOIL AB ION SYSTEM r5 PQC�
BED / Wt N Width i Len th No.Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
I N 3 z.5 1 3 11 DIMENS N
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM L Mau , t r:
INFORMATION
Type �Sd i i � Ya r --� A IT Van
u er
System:
DISTRIBUTION SYSTEM
Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
t� / y �
Length �2� Dia. Length - �(o- 2 -� ' Dia.ALk- Spacing Afh f/
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulche7d
Bed lTrench Center Bed /Trench Edges Topz S ectiOn # s / NId1S a tl rr 2
/ q(3
pV24 �R�AW, `I fl�i 4� (SW 1/4 N �] 24 T3 R1 8W) - - Lot 1
1.) Alt BM Description = 0 � �1., SZ c P w Q �� s �`'UPeh Cver.c key were
2.) Bldg sewer length = 2s' /1 bey Stoma (�y We s 'veyed j dc_ -K. ®rt ; ^a�
- amount of cover =)gy � (,i l( d � �sr �0 bC cWi It
)6�_w UA�` 0s 9 �/ / / r e i` � p C AicYv�.� l�v� S�rkG�t,�.rc- GaS U6ovA
i o f C,Itiat.+�. er - t r r
p �a+n 6er 1 w S-f *_1� t` Wc�`o" p' r Y O�."f - 'k .d Via s ed y�-
Plan revision required? ❑ Yes 9 No
Use other side for additional information.
SBD -6710 (R.3/97) Datel Inspector's Si ature Cert No
Y_
rs - Q q38
y ' Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
Ifi sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1 (Submit completed form to county if not
2 �. state owned.)
Attach complete plans (to the county copy only) for tlAyst - • dn'p t Fes an 8 -1/2 x 11 inches in size.
County State Sanitary Permit Number ❑ C vision tq�vious iippli6atipn State Plan I. D. Number
St Croix 395 W p °� 631
I. Application Information - Please Print all Information Location: LL
Property Owner Name � „ , Property Location / 0
New Richmond Congregati n-.�Of h2vif 19 "s 1 8W 7 es s' SW NW 1/4,s24 131 ,N,R )w
Property Owner's Mailing Address 7yr �l„, Lot Number Block Number
C/o Einar Opdahl� f\
1320 210th Ave.
City, State zip Code Ph g24 - - k, Subdivision Name o SM Number
New Richmond, WI 54017 715- 8 �1 4,�s3OV;70 - Ooi.-1
II. Type of Building: (check one) ❑ City
❑ 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village
CXPub1 /Commercial (describe use):_
Kingdom Hall IRTownof Star Prairie
❑ State -Owned Church ;?O S7 QV, /e/
�Q�(L Nearest Road ,�,� A? e .
S Parcel Tax Number s)
1 GTt : IL- � C C> - -
III. Type of Permi (Check only one box on line A. Check box on line B if applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
AD Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
/7•/ A .,
V. Dispersal/Treatment Area Information: 1- G ' x (,
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
542
Required 51 ` Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
o 462.78 -. r!Z 92.0 97.0
VII. Tank Capacity in Total # of ...— iufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
1 1250 1 Huffcutt Con
ER ❑ ❑ ❑ 13 T ❑ ❑ ❑ ❑
VIII. Responsibility Statement
1, the undersigned, assume responsibility for installation of the POWTS shown on the attached pl
Plumber's Name (print) I Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number
Albert H. Krueger ;�� 220054 COIL 715- 754 -5574
Plumber's Address (Street, City, State, Zip Code)
W11706 Swamp Rd., Marion, WI 54950
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
fs1 Approved ❑ Owner Given Initial Adverse Surcharge Fee) 00 ' �d �INQ&A
Determination 1 J� / 00 5 L k 0
X. Conditions of Approval /Reasons for Disapproval:
RcstacKtce.f-
Y F�oodQlaivt ' �.eNC +L •• /
the Y- eet, /
p OroPc✓ -C,lnt SaNll SGr�ic�{ Ma,.r7 '� -4 -1t rXClve,& ecr �tL--,u... ,
ff r
SBD -6398 (R. 07/00)
i
Safety and Buildings
r 1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
TDD #: (608) 264 -8777
�sconsin www
www.commerc .wis c ons
.wisonsin.gov
Department of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
March 28, 2001
CUST ID No.220054 ' `; '`y ATTN: POWTS Inspector
ZONING OFFICE
ALBERT H KRUEGER CROIX COUNTY SPIA
W11706 SWAMP RD 1101 CA.RMICHAEL RD
MARION WI 54950 -9170 ti OGUNTY HUDSgN WI 54016
ZON OFRCE
RE: CONDITIONAL APPROVAL ; „(t Identification Numbers
PLAN APPROVAL EXPIRES: 03/28/2003
Transaction ID No. 631808
Site ID No. 627778
SITE: Please refer to both identification numbers,
SITE ID: 627778, NEW RICHMOND CONG OF JEHOVAHS above, in all correspondence with the agency.
WITNESSES
ST CROIX COUNTY, TOWN OF STAR PRAIRIE; 1320 210TH AVENUE, NEW RICHMOND 54017
NW 1/4, NW1A, S24, T31N, R18W
FOR:
DESCRIPTION: IN- GROUND SOIL ABSORPTION SYSTEM FOR NEW RICHMOND KINGDOM HALL
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 785992
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.
A copy of 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. 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.
Sincerely, DATE RECEIVED 03/26/2001
,x, FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
KEITH A WILKINSON BALANCE DUE $ 0.00
POWTS PLAN REVIEWER, INTEGRATED SERVICES
(715) 524 -3630, FAX: (715) 524 -3633 , M -F 7 AM - 3:45 PM
KWILKINSON @COMMERCE.STATE.WI.US WiSMART code: 7633
cc: NEW RICHMOND CONG OF JEHOVAH'S WITNESS
Safety and Buildings
1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
TDD #: (608) 264 -8777
isconsin www.commerce ns ov
www.wisconsin.gov
Department of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
March 28, 2001
COST ID No.220054 ATTN: POWTS Inspector
ZONING OFFICE
ALBERT H KRUEGER ST CROIX COUNTY SPIA
W 11706 SWAMP RD 1101 CARMICHAEL RD
MARION WI 54950 -9170 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
Identification Numbers
PLAN APPROVAL EXPIRES: 03/28/2003
Transaction ID No. 631808
Site ID No. 627778
SITE: Please refer to both identification numbers,
SITE ID: 627778, NEW RICHMOND CONG OF JEHOVAHS above, in all correspondence with the agency.
WITNESSES
ST CROIX COUNTY, TOWN OF STAR PRAIRIE; 1320 210TH AVENUE, NEW RICHMOND 54017
NW 1/4, NW 1/4, S24, T3 IN, R18W
FOR:
DESCRIPTION: IN- GROUND SOIL ABSORPTION SYSTEM FOR NEW RICHMOND KINGDOM HALL
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 785992
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.
A copy of 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. 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.
Sincerely, DATE RECEIVED 03/26/2001
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
KEITH A WILKINSON BALANCE DUE $ 0.00
POWTS PLAN REVIEWER, INTEGRATED SERVICES
(715) 524 -3630, FAX: (715) 524 -3633 , M -F 7 AM - 3:45 PM
KWILKINSONt7a COMMERCE.STATE.WI.US WiSMART code: 7633
cc: NEW RICHMOND CONG OF JEHOVAH'S WITNESS
,
WASconan APPLICATION FOR REVIEW POWTS
°spit"""` of ° ommeras - Complete all pages -
Safety & Buildings Division ( ) Check If Confirmation is Desired: ( ) faxed, A mailed
Bureau of Integrated Services
NOTE: Personal information you provide may be used for secondary Confirmation of assignment to a reviewer.
purposes [Privacy Law s. 15.04(1)(m), Slats.) 6318
Transaction ID:
1. Private Sewage Submittal 2. Type of Submittal:
System Type (� New Previous Related Trans., ID:
( ) Soil Saturation
Determination Report ( )Revision Estimated Completion Date:
( ) interpretive ( ) Replacement Assigned Reviewer:
Determination ( ) Petition (attach form SBD -9890)
(� POWTS System ( ) Experiment, approval# Assigned Office:
( ) At Grade ( ) Component Manual (Include each
( )Holding Tank Circle your choice of offices below;
( �O Nonpressurized In- component manual name, # and
Ground date on title page of plan) Next available appointment in ffice, 2. Green Bay, 3. Hayward,
( ) Pressurized In- ( ) Individual Site Design 4. LaCrosse, 5. Madison, 6 hawano 7. Waukesha
Ground
( ) Mound 3. Project Information - Fill in all known information.
( ) Aerobic Treatment Unit Project/Site Name
( ) Sand Filter
_single pass Location, Number d, Street of project (if unknown, Indicated nearest road)
—recirculating Legal Description:
( ) Constructed Wetland County 7 O X City Village Town of A
( } Drip Line
( ) Other: 4. After plans are reviewed, please: (check all that apply)
Building Type (check onep
( ) Dwelling, 1 or 2 family — Call customer 1, 2, 3, 4 (circle number)* 'Refers to customer number from below
( )C) Public/Commercial _ Requesting party will pick up
Building X Mail plans to customeo, 3,4 (circle number)`
( ) Stife -owned Building r
rF 26
Gallons per Day ,-¢ L S- p�V
i 5. Complete the following designer /owner /requesting Information. Utilize the check boxes when d9l0Jl; er or requesting party is the
same to avoid ra eatin information.
�: +t oast n' °'Ra': if(etantdha`ri'
Desi" rier�Jrifonnation •Custorie ,; ; a 3dest tier(Gustomer 3
First Name Last Name Customer Number First Name Last Name Customer Number
L E 7 u 6 /
Company Name Company Name
Address Address
WI1 b6 - S WAMP
City State Zip +4 (9digits) City State Zip +4 (9digits)
0 7 ,
Phone Number (area code) Fax or Internet cell phone Phone Number (area code) Fax or Internet
71 ,, 7 S'
Check others if applicable Check others if applicable
Owner Pa er R uestin a Owner Pa er
Owneranformaflon: Customer•.i2 w
st rti'era ,,
First Name Last Name Customer Number First Name Last Name Customer Number
Al f– W R re 8 M c u 4 e ry (, 0,4 J o vo MK W j r J ¢,t c
Company Name Company Name
C /O E i "l 4R 0 tf L
Address Address
13 ;-0 A / o-rH 4vE
City State Zip +4 (9digits) City State Zip +4 (9digits)
/Vaw RIeNMoN s o I `7
Phone Number (area code) Fax or Internet Phone Number (area code) Fax or Internet
Check others if applicable Check others If applicable
( ) Payer ( ) Payer ( ) Other
MAKE CHECKS PAYABLE TO DEPT OF COMMERCE TOTAL AMOUNT DUE $ / 7! `? °
Attach check here Review Code T633
SBD -10577 (R 7/00) THIS FORM IS VALID ONLY FROM 09/01/2000 TO 08/31/2001
6. Plan Review Fees for Private Onsite Wastewater Treatment Systems
Type of Project ( CIRCLE THE APPROPRIATE FEE BELOW) FEE
1. All treatment components are previously approved under s. Comm 84.10 (2) or (3):
Design wastewater flow of the proposed system:
1,000 gpd or less .................................................................... ............................... ........................$175.00
1.001 — 2,000 gpd .................................................................... ............................... ........................$225 00
2,001 — 5,000 gpd .................................................................... ............................... ........................$275.00
greaterthan 5,000 gpd ..................................................................................... ............................... $300.00 plus $0.05 /910
2. One or more treatment components are not previously approved under s. Comm 84.10 (2) or (3): (Individual site design /deviation from
component manuals and use of components without product approval):
Design wastewater flow of the proposed system:
1,000 gpd or less ...................................................................... ............................... ........................$300.00
1,001 — 2,000 gpd .................................................................... ............................... ........................$400.00
2,001 — 5,000 gpd ..................................................................... ............................... ........................$500.00
greaterthan 5.000 gpd .............................................................. ............................... ........................$600.00 plus $0.05 /g /d
HOLDING TANKS ONLY
3. Holding tanks previously approved under s. Comm 84.10 (2) (3
Design wastewater flow of the proposed system:
5,000 gpd or less ..................................................................... ............................... .........................$60.00
5.001 — 10,000 gpd ................................................................. .....................I......... ........................$100.00
greaterthan 10,000 gpd ........................................................... ............................... ........................$150.00
4. Holding tanks NOT previously approved under s. Comm 84.10 (2) or (3) and site constructed tanks
Design wastewater flow of the proposed system:
5,000 gpd or less ..................................................................... ............................... ........................$120.00
5,001 — 10,000 gpd ................................................................... ............................... ........................$200.00
greaterthan 10,000 gpd ............................................................. ............................... ........................$300.00
Experimental System (additional one time fee) ................................................. ... ............................. ........................$300.00
Revisionsto Approved Plan ........................................................................... ............................... ......................... $60.00
Petition for Variance (Include form SBD- 9890) .............................................. ............................... ........................$225.00
Revision to a previously approved Petition for Variance .................................. ............................... .........................$75.00
Soil Saturation Determination Report — Per Site (other than a Proposed subdivision) .................... ............................... .....$100.00
Interpretive Determination Report ........................................................ ............................... ........ ................. ....$100.00
Subtotal .................. I................. / 7 3
Priority Review: Enter same amount as subtotal ..... ...............................
Prior approval from a section chief is required for a priority review. If approval Is granted, the priority will be reviewed within 5 days
of receipt.
Enter TOTAL (rounded to the nearest dollar) here o 0
and on bottom of FRONT PAGE
Note: Fees are pursuant to Ch. Comm 2 and are subject to change annually; please contact any of the offices listed below for the
most recent copy of this form. Comm 2 provides for a partial fee refund if a plan action has not been taken within the 15 days
of receipt of all required information.
7. Appointment, Scheduling Information, and Plan Submittal Checklists. POWTS scheduling is not available. Plans will be assigned to a reviewer
after receipt of plans. If you wish to receive confirmation of the assigned reviewer and estimated completion date please check the box in the upper
right corner of the front page. Also note In the same location that you can designate a specific'office for review. If you select a specific office your
estimated completion date may be considerably greater than what would be possible in another office. Submittals received without a specific office
indicated on the form may be assigned to offices other than the receiving office depending on reviewer availability. To obtain a submittal checklist call
the material order unit at 608 - 266 -1818 or one of the full service offices listed below.
Madison S &BD Hayward S &BD LaCrosse S &BD. Shawano S &BD . Green Bay S &BD Waukesha S &BD
201 W Washington Ave 10541N Ranch Rd 4003 N Kinney 1340 E Green Bay 2331 San Luis Place 401 Pilot Court
53703 Hayward WI 54843 Coulee Rd Shawano WI 54166 Green Bay, WI 54304 Waukesha WI 53188
PO Box 7162 LaCrosse WI 54601 -
Madison WI 53707 -7162 715 - 634.4870 1831 715- 524 -3626 920 -492 -5601 262.548 -8600
608.266 -3151 Fax: 715-634-5150 Fax: 715-524-3633 FAX: 920 -492 -5604 Fax: 262.548.8614
Fax: 608 - 267 -9566 Email: haywardsch@ 608.785 -9334 Email: shawanosch@ Email: greenbaysch@ Email: waukeshasch@
TDD 608.264 -8777 commerce.state.wi.us Fax: 608 - 785 -9330 commerce.state.wi.us commerce.state.wi.us commerce.state wi us
Email: madisonsch c@ Email: lacrossesch@
commerce, state .wi.us commerce. state. wi.us
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of cz
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code paper minty �1 �' X
Attach complete P lete site Ian a P er not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. 7 ew y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 1 9 t7
Property Owner Property L ocation
2v� RrC�jrhoNa �oN r a'^i eT J�rrovc�r J �'T^� Govt. Lot /UJ 1/4 A/ S -11 T 3 f N R Ir (or)(9
�p rty Owner's Mailing Address Lot # Block # Subd. Name or CSM#
� %,va r 0 c�a�i / /320 �/ o A ✓� �
State Z Phone Number t/ p/ ❑ City ❑Village Town Nearest Road
'Y C o J-Iqt.- I(f .A a /0' 41
10 New Construction Use: ❑ Residential ! Number of bedrooms Code derived des' n flow rate SyoZ GPD
< L
rw O �1 yC
❑Replacement � Public or commercial - Describe:
Parent material Er 1 A Li 4 t b / W a S Flood Plain elevation if applicable /U R
General comments /93 Sett TS i o l S 3 T /ov ✓ v�k rk! S /�/ofJO J e c�
and recommendations: Q 1
29 r - e r..oM^ - 1`-k /iv krV -1,V0 .t0 a6sor�!•'� - t.rfs�a+�
3) iu4i l rev , -Oo -v o% cam, 2r V '�A✓ -c c %ems.
Boring # Boring 90
a ® Pit Ground surface elev. 0 ft. Depth to limiting factor /�a in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
l 0 - /,z 10YR "A ti i � / -rs6 rllxV ) s 3 fC Or ; 0.3
.2 /2 -3(p JOY Y13 s 6/ w. gar G a >� o . � 0. (o
3 3(0 - /0 YA 7 / q ea s 0-c rrt -- D. 7
ail'
Coo;
[� 89 "� /aq n
Boring # Boring nn > ia9
l�J Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2
/ o -$ royg 3 z ,vDj s/ -rbk kvir^ s 3 0, -; 1 . 0,
-D-a o q/3 c a s M ki' cs a 0, y 0, to
3 Aa-1 I oyp, DS4 D. 7
� �z$
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * #2 = BOD < 30 TSS < 30 mg/L
CST Name (Please Print) Signatur CST Number
z E 4R ),
Address # Date Evalua ' O Conducted Telephone Number
13 20 PAc.kfQ��1� .�i� I(� 6 N44) 6A , I,(1 1 3 // r 92- -q 9e -0190
�2W Ki c.N �6.n.dC
Property Owner � Parcel ID # Page - of
Boring # Boring G� � ,• , fo � � 9 ii d 0 10q
pit Ground surface elev. I ` ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2
( D_lo loy� 3�� No�-2 s� �5bk /Ku S 3 o,a o, 3
a i a- ;t 10 Y I : a m s k n1 r C o f 011
3 ao -107 AD � V _ -d
_ 0_5_ Osq M l — 0,'7
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 /f 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
' Effluent #1 = BOD > 30 220 mg/L and TSS >30 a 150 mg/L " Effluent #2 = BOD < 30 mg/L and TSS 1 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (R.07 /00)
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I
NEW RICHMOND KINGDOM HALL
3/26/2001
Septic Tank Size
3 floor drains at 25 gal. 75 gal
143 seats at 2 gal (no kitchen) 286 gal
361 gal.
361 X 150 % = Peak per day 542 GPD
Lsanhind_Ar�a
9 Units per cell of High Capacity Sidewinder of 3 rows
p YV cxA�t A+ (Act v� 59b- 10 S — 7
CONTINGENCY PLAN
If the proposed soil absorption system fails additional area will be tested and a new POWTS
will be installed.
c) o .� }
CRo55 S ECTLD IJ oF' Pt TYPICAL CELL
SYSYf -M
USING A LEAGHtt�iG GSA M�>c K.
APPROVED CAP
NN
Vrr�t �pQ� SERVAT I� r� PIPE
�� � INAL GRADE
12 M1 N.
M�t1.
�r
SYSThM LEAC-HI►JG
� C.H A MaER
r
LL EN AT10 �Z.O FT.
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TOP of LE ACRI I IG CRpimagg TD Bf- &T LEA5T $ Y tSC"ES
6 ELwl O R CS I N A L G Qf<D E.
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L) N E C C LL O F eff / N Cr c l�/l "o?
03 LION 11:11 FAX 715 386 1686 ST CK1 c.:U U),N1:\G WJUU2
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6199).
Table 1: System Design Specifications
Sanitary Permit Number
U S V- f d,
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal)
Soil Absorption Component Size
Type of Wastewater Domestic
Table 2: Soil Absorpt Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak ( pd) 67-5 cal Per Dity 549
Ma ximum Influent Particle Size (in) 1/8
Maximum BOD (mg/L) 220
Maximum TSS ( /L) A 150
Table 3: Maintenance Schedule
n every Septic Tank Inspect and/or service once 3 y ears
Outlet Filter Inspect once a year and dean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
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 slough off the filter when removed from its enclosure. If the
03/26;01 NON 11:45 FAX 715 386 4686 ST CRX CO ZONING Z003
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
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 greater than 8-inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being In full compliance with OSHA standards for
entering a conrned space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absoration Component
The soil absorption component serving this structure Is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard,
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County S'f - cY'o i'x
Attach complete site plan on paper not less than 81 /2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
�1?� R rc4pt,aNG� �� P r� eT tovah J !�✓�j�N Govt. Lot /U(IJ 1/4 A" 1/4 S.; l T S/ N R (or)(0
Prop rty Owner's Mailing Address Lot # Block # Subd. Name or CSMI#
�� ,�,V4 D o�ti4 l 1320 a /o ' /lv�
State Zip Code Phone Number ❑City ❑Village Town Nearest Road
SY0 (7 /S) Y(i - y /4 1 J (- ^ ✓'4,V;--e I (f .A .1 o�A�Z
New Construction Use: ❑ Residential / Number of bedrooms Code derived desi n flow rate 5W GPD
❑ Replacement Public or commercial - Describe: K W ,�On� /tA If �C .rc
Parent material Gil. Li 4 ( 6 N-1 A S Flood Plain elevation if applicable TA_ R
General comments Q / 1/ 3 Se k 74s to 1 w s .3 ? lo r d Na tv $ /a/o�o J e-
and recommendations: � n
z) re "m^ / i iv ro �Nt� Joy l " s090.7, ",A -r ,7rtg,.'
3) e-.^ Z ia ' 09 ,4-< -ete = 00.0
1 O Boring # Boring 90 r � �v /'2X >
® pit Ground surface elev. ft. Depth to limiting factor a in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2
()-/a /oYR 3 t A)otJ e i � I 1'-6 b k rAV s 3 r- 0 r .1 0, 3
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[4i Boring g9 r� /o2q'f
a Boring # > AaQ
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Ni:lApplication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I •Eff#1 •Eff#2
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-Xa. p `/ 3 a s M �� Cs a f 0. y 0,
3 aa o 7 s 0( 0J .
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg&
CST Name (Please Print) Signature CST Number
j E a A 3/a7
Address D e Evalua Conducted Telephone Number
13 10 1 9'a" I f /6 644A) 6A , W 1 3�a1/01 920
1
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Property Owner ff Parcel ID # Page of
F-31 Boring # ® Boring 9� ��'fo l 61
Pit Ground surface elev. ��` ft. Depth to limiting factor 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 'Eff#2
0 -lo loyt� 3A Natj -2 A5bk ins e S 3-f o, a 0 - 3
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3 ao -to' /o -7 V -�- e-o S o s M / — 1 0, - 7 , a
D Boring # E] 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 /fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
�t
' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 1 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (R.07 /00)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer New Richmond Congregation of Jehovah's Wi +no &ag
c/o Einar opdahl, 1320 210th Ave., New Richmond, WI 54017
Mailing Address
T �- f T.Tn 1 l �'� /30 3 C'2
Property Address 1 AtL
(Verification required from Planning Department for new construction)
City/State New Richmond, WI Parcel Identification Number
LEGAL DESCRIPTION
Property Location NW %., i/4, Sec.2 4 , T _ 21 N -R 18 W, Town of star Prairie
Subdivision . Lot u #
Certified Survey Map # V �T" . Volume l ` . .Page # 1
Warranty Deed # _ (D y `f 2 -7 , Volume / G q . Page #
Spec house ❑ yes KI no Lot lines identifiable Q yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date le
�i
/Z 4/ O
DATE
SIGNATURE OF APPLICANT
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the be st of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
S / 2yi cr/
ATURE OF APPLICANT DATE
« « « «* « Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
«« Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
VOI.1646PAGE 66'
646423
STATE BAR OF WISCONSIN FORM 2 -1998 KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Bruce V. Emerson, Grantor, and New RECEIVED FOR RECORD
Richmond Congregation of Jehovah's Witnesses, Inc., a Wisconsin 05 -24 -2001 3:45 PM
Corporation, Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED
the following described real estate in St. Croix County, State of Wisconsin (The EXEMPT #
"Property "): CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 180.00
That part of NW 1/4 NW 1/4 Sec. 24- T31N -R18W described as follows: Lot 1 of RECORDING FEE: 10.00
Certified Survey Map recorded in Vol. 15 of Certified Survey Maps, page 4077 as PAGES: 1
Doc. No. 644270.
Recording Area
Name and Return Address
rU2� 13 �✓� S */'o -7
038 - 1098 -90 -000
Parcel Identification Number (PIN)
This is not homestead property.
Exceptions to warranties: Subject to all easements, restrictions and covenants of record.
a
LJ
Dated this day of /' � ! M
001
C� G�iLI c
*Bruce V. Emerson
* *
AUTHE ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) SS.
County )
authentica d this day of , 2001.
Personally came before me this day of
2001 the above named
* (` to me known to be the
TITLE: MEMBER STATE BAR OF WIS ONSIN person(s) who executed the foregoing instrument and acknowledge
(If not, the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Hendrik W. Van Dyk
VAN DYK, O'BOYLE & SILER, S.C. Notary Public, State of Wisconsin My Commission is pennanent.
Post Office Box 118, New Richmond, WI 54017 (If not, state expiration date: )
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800-655 -2021
t ` L�'ID �z •� PNII. carfxnNUe
• N0 2p41 MAY 01 2001
Mir 4o N W Wafd" wigM 30 oey of
air T awoval do" WA" Sw be
pe w
i ow vw
MAP
Bruce V. and Pamela Emerson
Located in part of the Northwest Y4 of the Northwest Y4 of Section 24: Township 31 North, Range 18 West,
Town of Stor Prairie, St Croix Cowety, Wisconsin.
LEGEND N
A xI rA7ES f' x rrOMPffSU a> AM
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I p soR eoRaxx;<s �ROVOSSO S[�1+C SrSTEAq rn mtw �s iwm k `
CERTIFIED1 Z; ; a sEOWNCoAIm osNo" • 'a'E
�u�vEY
-- 161 ---- < OWMMAQM aaMEa►FWr r•sor
2087 C T.N. 'CC'
VOLUME 9,1 \ NEW NCHMAQ WI 31017
. ............... f
PAGE 26661 VARIABLE` �•�T -3,
°-"- °-- -"--' _J WID \CR.T 1 flna0RVEY4P�__V_-OLUM� 3 PAGE 86 3
- - ----
g .10.E €3 410. 1QrH��
!"Coma
3lCTx7W30. : • jy f Y!M p E
icaaa�nsF,f VARIABLE
—� kurawrnf+io WIDTH ,,�lb't NoRr►r , ae+cna *rK A++w
\ .4 1, $ AU AWNHOWAOM
\ • •
• ,%
11.2 1.2s� �' nor 1
W
�C 188084 SQ. FT OR 3.858 AC.
100 I
1E'f (( 13!,285 SQ. FT. OR 3.014 AC.
4 I Z wl i D(CLUDIIVD ROAD RIGHT OF WA 1 0 F
_ ' f Note: pia lot awt aowss tsar
V 22M Maus.
• 2I �' t
41.26 1 366.74'
' T N 88 W 410.07
1.2 1.25 Dated: March 16, 2001
Q. Q "Revised this 2nd day of
April, 2001..•
f II • • • 'devised this 27th day
LAUR • •' : Of April, 2001.'•
W my ; w
I = I *• 13
RIVER .
1y A_ FW
9 WEST 1N OOAAER �i '. •'' �►
I:, , � aeenowactrACAnw `T .•.••
B/SMYRA IENTORAFMO SY&RAtD1_ LARSON SHEET 1()F 3
VoI A S Page 4077
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— d"TIFTE117S URVEY MAP
Bruce V. and Pamela Emerson
Located in pairs of the Morthweat % of the Northwest r/. of Secfim 24, Township 31 North Range 18 West,
Town of Star Prairie, St Gott Conroy, Wisaonsirt
DESCRIPTION:
That attain parcel of land loud in pact of the Northwest'/. of the Nortrwest 1 /. of Section 24, Township 31 Noah,
Range l8 West. Town of Star Prairie, St. Croix County, Wisconsin, nary fully described as follows:
Sg0wing at the Northwest corner of said Section 24; trance S 99 10" E. (anumed bearing on die North line of the
Northwest % of said Section 24X a distance of 410.00'; thence S 00 09"W. 410.00'; thence N 88.34' IV W,
410.00' to the West line of said Nordhwest % of Section 24; thence along said West line, N 00• 15' WE, 410.00' to the
POW OF BEGINNING. containing 168.064 square feet or 3.958 acres, subject to all aasamath and nsUittions Of
record.
State of Wisca bin)
County of Pierce)
I, Laurence W. Murphy, Registered Lod Survelror. do hereby on* that by direction of the Owners. Bruce V. sad
Pamela En arson, l have surveyed and divided the lands shown hemon in accordance with o ffi c ial r000rds, Chapter 236.34
of Waocasin Statutes and the Ordinances of St. Croix County and dot des trap and dwriPtiOn an a true and cosecs
npreuaicn tbemoc
Dated: March 16, 2001 — _"__._ - - - -. ... _ - - -- - --- - -•- ----
Revised: April 2, 2001
NO'!E: Eaa parcel shown on this reap is subject to State, County. and Township laws. rotes and regulations (.e.
aedeads, minimum lot sine, access to parcel, etc.). Before purchasing Of developing any parcel, contact the St. Croix
County Zoning Office and appropriate Town Board for WVIM
CI ,OF NEW RICHMOND
This Certified Survey a hereby approved and ac cepted by the City of Nov Rich nond.
David A S M. \N4�
�-S S gait :.. Q
Mden E. Demang, Chslt Tressu Date:
\s �OnN
Nu
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IVER
Wi.
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uwo
flK W5TRLNJE'iNFDR4FWfiYJERALDL LARSON SHEET 2 OF 3
Vo1.15 Page 4077
Bruce V. and Pamela Emerson
Located in part of Ilse Northwest %. of dw Northwest % of Section 24, Township 31 North, Range 18 West,
_ Town of Stry prairie, Sr Cron County , W ixortrin.
NOTE: Phis subdivision is within 1.5 miles of the New Riehmotd Municipal Airport and within the Right paths of
aimft using the airport, W owners in the subdivis ion, by virtue of their ownership, hereby sgras:
1) To restrict the height of any improvrntatts or vegetation on said lots) to less then the height indicated an de
height lundatian zoning map for the Now RidaticM Municipal Airport. New Riclunond, Wisconsin.
2) To not knowingly interfere with ra& communication or navigation necessary or appropriate for the safe
operation of aircraft appmu ping or departing 5nm said airport; and
3) To not shine or display lights which interfere wide aircraft approaching or departing fi+em said airport; and
4) To allow any and all legal airport expansion to ocoru without objection.
Said kit owner(:) hereby aclowwledge the irnportanoe of the airport to the City of New Richmond and sumunding area
wad sclohowledge that the airport or expansion therw(catild impact dwir intanded use and enjoymox of their lat(s).
The sbm declaration and the following building standards for omstruction will be on the abstract and deed of any lot
purchased within this subdivision. Als% there wdl be a disclosure notice signed by future owners.
New homes oenstructed within the Airport Area Zoning District *0 incorporate the following building standards for
construction:
a) Use of 2" x 6" studs or bettor for all exterior wall cavity canstructim to be shown on building plans,
b) All exterior building elements shall most the following minimum STC (Sound Transmission Class) values'
Walls (40 STC). Roof (40 STC), Windows (30 STC),
Doors (20 STC). Manufacturers STC Rating fbr each window, door and slcytight shall be attached to the
building plans. Upon approval of the building official, typical 2" x 6" walls and truss roofs constructed in
accordance with the Uniform Dwelling Code ( UDC) shall be miside ed as g with this requirement.
c) All homes shall incorporate the following acoustical design features, which shall be shown on the building
plans.
1) A mechanical ventilst ion systMn d%U be installed that wit! provide the minimum air circulation and
fresh.•ir supply requirements as required in the Uniform Dwelling Code for the proposed ooapancy
without the need to open any exterior does or windows.
2) The perimeter of all eoderior windows ad door frames shall be scaled airtight to the exterior -wall
construction.
3) Fireplaces shalt be equipped with vre11•fkted chimney c+p devices.
4) All vientilation duds, except range hoods. oonneditrg interior space to outdoors shall be provided
with s bend such duns no dired line of oght exists fran oderior to interior through the vmt dud.
S) Doors and windows shall be constructed to that they are close- fittirng. Weather stripping sals shall
be incorporated to eliminate all edge gaps.
6) All penetrations through exterior walls by pipes, duds. conduits and the like shall be sulked sirtW
tothe exterior construction.
��
e'
• 713
• R
PALLS.
WI.
. Mateo 16,2001
LAOS Revised:
April 2, 2001
bra arsTaulwe<nrr owarEO SY JERALD L LARSON SHEET 3 OF 3
Vot.1S page #077