HomeMy WebLinkAbout040-1252-40-000 Wi,consin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division W
' INSPECTION REPORT Sanitary Permit No:
395268
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Troy Development Corporation I Troy Township 040 - 1252 - 40-000
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
13. b3
Septic Benchmark t [
W E1�2- 1 Z5� l [ 3• �
Dosing Alt. BM
Aeration Bldg. Sewer ?)
Holding St/Ht Inlet t� K (4.
o8 8L
I ; u
TANK SETBACK INFORMATION St/Ht Outlet 5 CS t o8 4$ r
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic I Dt Bottom
F"- Header /Man.
Dosing `
Aeration
Holding Bot. System
�I y g` Z Z 8. z / 105 'f 2'
2 �Z 9.2 1 0 '
-
PUMP /SIPHON INFORMATION Final Grade b {-
Demand v
Manufacturer St Cover
e
GPM
Model Numbe
TDH Lift ion Loss System Head TDH Ft
Forcemain Length III Dist. to well
SPIC AB ORPTION SYSTEM ,Z9
RENCH idth Lennd� No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
°f3•TS
D ' 3 ' 63•so c t.) c
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING M ufactu r: 4I
INFORMATION Type Of System: 1 f / �+ CHA UNET OR 164 l Model Number:
wJ. iv
DISTRIBUTION SYSTEM _
HeaderlManifold r Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s) ,� 2
L Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges To
[� Yes � No �] Yes�� No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:11/ 2- / Inspection #2:
Location: 283 St. Andrews Drive Hudson, WI 54016 (NE 1/4 NW 1/4 T28N R19W) Troy Villagigp Pa rcel N .1325
1.) Alt BM Description = vuv& ,,.,aq S �u"" �� � � o K�N.os�o.. •� �-
2.) Bldg sewer length = 7 - , w 1�
- amount of cover = ? ` 14 5 41 2 l 1 �
A -I eo 6(r. 1 P Lk-.r -
11 3 I C�
Plan revision Required? Yes No
Use other side for additional information. 2
Date Insepctor's Signature Cert. No.
` SBD -6710 (R.3/97) '
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Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W Wa shington PO Box 7302
14 sconsin See reverse side for instructions for completing this application
Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)J (Submit completed form to county if not
state owned.)
Atta c o mp lete plans (to the county copy only) for th system, on pape n l ess than 8 -1/2 x I I inches in size.
Co un State $gyp* (s P erm
S CfLo tx, 5` NNumber 11 Check if revision to previous application State Pl I. D. Num ber
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
T J cl C, �� " 6f ✓ 1' 1/4 /1r X14, S ZZ = Z' � � (or
Property Owner's Mailing Address Lot Number Block Number
n
City, State Zip Code Pho a ber yC►3 ' S division Name or CSM Number
II. Type of Building: (check one) Ity
�i 1 or 2 Family Dwelling - No. of Bedrooms: k ' ag
• Public /Commercial (describe use):_ z own of
,r
K
• State -Owned
t Neare�t Road
�Z Parcel Tax Number(s)
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) — S --
A) 1. 5PNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only , X, / R Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland rJd,
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line G
❑ At - grade `� ❑ Aerobic Treatment Unit ❑ Recirculating 13 Other: J
C �e � P'' —c00
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate ystem Elevation R 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) le--"6 Elevation
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel F' r- Plastic
Information Gallons Gallons Tanks Con- 4nn- glass
New Existing crete structe
Tanks Tanks
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber's Si na (no s MP/MPRS No. Business Phone Number
Plumber's Address (Street, City, State, Z ode)
r--7
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Surc ge Fee)
Determination 22 (f> 2,00
X. Conditions of Approval /Reasons for Disapproval:
fie" -4� �,►_ s o-.� s;�.� I
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L SBD -6398 (R. 07/00)
_CONTTWATAI LEV C.ORP TEL N0.7 - -'532 Aug 23.01 9:16 F.G_
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Wisconsin Department 6f Commence SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
Environmental By Design
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must Coun ty
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.#
APPLICANT INFORMATION - Pleas iht 'glfl 6f61*a00a R ie By Da
Personal information you provide may be used for `r>iuFposes (Privacy Law, s. y 5.04 (1) (m)). y
Property Owner `�� (,�a r, ; Pr rty Location
Continental Develop - ' v ' ° � Govt, Lot NE 1/4 NW 1/4 S 19 T 28 N,R 19 W
Property Owners Mailing Address `a {' tot'# Block # Subd. Name or CSM#
12301 Central Avenue NE, Suit 23p 4 Troy Village 2Nd Addition
City State p„ e Ph Fj ity ❑ Village Town Nearest Road
Minneapolis MN ZOlviNG O Troy St. Andrews Drive
❑ Use: New Construction ❑ Resl tiai {u f fns ❑Addition to existing building
E] Replacement F Public or r i be
Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft •8 trench, gpd/W
Absorption area required 857 bed, ftz 750 trench, ffz Maximum design loading rate .7 bed, gpd/ftz .8 tr ench, gpd/f 2
Recommended infiltration surface elevation(s) By Designer ft (as referred to site plan benchmar
Additional design / site consideration
Parent material Loess Over Glacial Outwash Flood plain elevation, if applicable ft
S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable for system ® S ❑ U ® S ❑ u ® S ❑ u ®S ❑ u ❑ S ®U ❑ S ® u
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/fts
Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bed Trench
1 1 0 -6 10yr3 /2 - sl 2msbk mfr cw 2f .5 .6
2 6 -24 10yr4/4 - sil 2csbk mfr cw if .5 .6
Ground 3 24 -49 7.5yr4/4 - s osg ml cvva - .7 .8
elev _
109 ft 4 49435 7.5yr6/4 - s osg ml - - .7 .8
Depth to
limiting
factor 3G ITZ-
>135
Remarks:
2 1 0 -8 10yr3 /2 - sl 2msbk mfr cw 2f .5 .6
2 8 -23 10yr4/4 - sl 2msbk mfr cw if .5 .6
Ground 3 23 -38 10yr4/4 - sill 2ms1bk mfr cw if .5 .6
elev
105.2 ft 4 38 -54 7.5yr4/4 - s osg ml cvv - 7 8
Depth to 5 54 -140 7.5yr6/4 - s osg ml - - 7 8
limiting
factor
>140
Remarks:
CST Name (Please Print) Signature: - - — Telephone No.
Thomas C Nelson i �~ 715 246 - 2454
Address Environmental By Design Date CST Number Ref #
1432 120th Street, New Richmond, Wl 54017 2/3/98 MO2605 23
PROPERTY OWNER: Cohtmental Development SOIL DESCRIPTION REPORT 0 Page 2 of 3
PARCEL I.D.# Environmental By Desi
Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ! Trench
3 1 0 -11 10yr3 /2 - sl 2msbk mfr cw 2f ..5 .6
2 11 -24 7.5yr4/4 - is 1mgr mvfr cw if .5 .6
Ground
elev 3 24 -42 10yr4 /4 - sil 2msbk mfr cw if .5 .6
108.35 ft 4 42 -130 7.5yr6/4 - s I osg ml - - 7 .8
Depth to
limiting
factor loc. o f • 3�
>130 - �� t
Remarks:
4 1 0 -25 10yr3 /2 - s1 2msbk mfr cw 2f .5 .6
2 25 -35 10yr4 /4 - sil 2msbk mfr cw if .5 .6
Ground
elev 3 35 -48 7.5yr4/4 - s osg ml cw if .7 .8
108.7 ft 4 48 -140 7.5yr6/4 - s osg ml - - .7 .8
Depth to
limiting
factor
>140"
Remarks:
5 1 0 -20 10yr3/2 - sl 2msbk mfr cw 2f .5 .6
2 2042 l Oyr4 /6 - sil 2msbk mfr cw 1 f .5 .6
Ground
elev 3 42 -130 7.5yr5/4 - s osg ml - - 7 .8
110.65 ft
Depth to
limiting
factor SS 8 /qt. g
>130
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
'EUNVI;0NMENTfit BY DESIGN
1432 120 STREET, NEW RICHMOND, WISCONSIN
715-246-2454
PROJECT NAME: TROY VILLAGE 2nd ADDITION
DESCRIPTION: NE%, NW114, SECTION 19,,T 28 N, R19W
TOWNSHIP: TROY COUNTY: ST.CROIX
LOT: 74 SUBDIVISION: TROY VILLAGE 2n ADDITION
C)
SCALE I"=40' Tom Nelson
BM 1 NE corner post ground surface elev. 100' cstino2605
BM 2
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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.6/99).
Table 1: System Design Specifications
Sanitary Permit Number 3�S Z S
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd) n
Septic Tank Capacity (gal) 1 S
Soil Absorption Component Size (W)
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) 2. SI 3
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean 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 se nd outlet filter shall be assessed at least
once every 3 years by inspection. T outle Pe shall be cleaned as neces agc.#e9iie
proper operation. The filter cartridge uld not be removed unless provisions are made to
ret'ain-9e44ds4pAthe tank that may slough off the filter when removed from its enclosure. If the
'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 1/3 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 confined 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 Absorption 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.
2
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CONTINENTAL DEV CORP TEL N0.'�7-25?2 Aug 23,01 16:24 P.0
ST CROIX COUNW .
SI3P"1'lC TANK MAINI�NANC$ �!►
AND
OWNBRSM CRRTIIriCAn0N pORM
0yaWISUyer C
Mailing Address ��
Property Addrms
( Verification required from planning Deparanont for new oonstr wu*a , m C
City/State � ,j,)i L'U Ft 5iri I'ttrcelIdentificationNumber
J,KgAL nKSCr urrlc�N
Property Vocation /Y 'r / YGc/y,�. Sec. T�T_ Town of
Subdivision /� /f /..r��.= Lot # � .
Certified Survey Mar ft �. "
__. Vohune Page #
Warranty Deed _� �� 7 Volume 2 J Page # j
Spec house 17 ycS 1..1 no Lot lines identifiable V yes C3 no
SYSTEM MA><N
lmlu+opu use and mainteuanm of your agWc cystan could result in its pninsture fates to handle wassm. Proper maintenance
oonnsisis of pumping out the seftic tank every three years or sooner, if needed by a Ukwased pumps[ What you put into the system
can aneot the function of the septic tank as a trts tmew page in the waste disposal syswmL
Mae propeny owner agrees to submit to St. QVk Zoning Deparun ew a cerddeatlon tbM signed by do owner and by a
wastorplumber umber, resuaetedphmberoralicensedpwrgm verifying dw (1)th an-dbow*dvwaWdisposal"em
is in proper operating condition and/or (2) after inspecdon and pumping (if necessary), the apdc tank is leas thin 313 full of shWge-
Dane, the undersigned have read the above roquiretaaft and agree to maintaln the prtvm sewage dbpoul qmm *dth the standu h
sat forth„ herein, as set by (fie, Department of (:o� and the Depatoaem of Natural Reeeurom State of Wisoottsin. Certification
sb kdM that your septic System has been maintained mast be eomnpleted and neMmed to dw St f. Wk 40ounty Zoning Office within 30
days of the tluvc yeas exphutiot► date.
_
SIGNATURE Oh Al'I'LI( AN7 DATE
OWNER t'l;IZ'l IMATION
1(we) certify that all statemouts un this form are true to the boat ofnay (our) Imowrledgo. I (titre) am (are) tiro owucr(s) of
the property described aNive, by virtue of a warranty deed recorded in Regfow of Deeds Otlioo.
SIGNATURE OF AI'I•L F DATE
•••••• Any information that ix mis- rcprcunted may result in the Sanituy permit being revolved by the ZQnl1nff Depar>meut-
•• Include whit this application: PP on a cramped warranty deed fsem the Aegistw of Deeds otT[ee
a copy of the certitied survey map if tceteooe is made in t>rs warranty deed
08/27/01 MON 14:38 FAX 715 386 4687 REGISTER OF D 003
STATE BA ` OF WISCONSIN FORM 2 - 1982 C �
C1 II � T i. DOCUMENT NO- Val1;j�P4Cf
'F John J. Ruemmele ant, Barbara A. Ruemmele, his wife, an d REGIS7�R'S OFFICE
•. —._ -- ST. CRG!x C o. , wi
-Ru emmelp , h i v . Rif „ Fsc'ri (nr 'ona•d
i APR 0 6 1998
ji agate) -t and or 8 :31)
�`re ?e ro
ve po men d orpora d"f - AM
T _ • � THIS SPACE RESERVEO Pe 't RECOPD•NG DAT
• NAME AMD AETUAN AQVgF:S
the following decnbed rca rtrate in 9F. C ro ix
tsw �- _County.
Sr +�ofWnsin: - FFjyw p od & Cari, S.C.
F ( Box 125
it son, WI 54016
ot 6 to the Plat of Troy Village, St. Croix County,
Wisconsin.
I , ��
Wisconsin. I ((/ �
�� �� PWACEL iOENnFiCATiON NUM6Ep
This deed is ive a
g n in partial satisfacti of
1997, Recorded May 27, 1997 in Vol. 1241, Page t 331 -332, aDocumentCNumbert559970,May 20,
FEL
EXEMPT
This is not homestead property
at co eat)
Exception towarranttes: Easements, covenants, restrictions of record and any liens or
Encumbrances created by act or default of grantee, its vuceassors and assigns.
Dated thts 1 daynl -- APril A.D.. 19
— (SEAL) _ e sa.,r (SEAL)
Jah Ruemmele _ Thom s J. Ruemmele
(SEAL) �,w--.n -� csEA1a i
—r —�
Barbara A. Ruemme + Nell 1„ Rvetneneip jl
fj � ff
AUTHENTICATION ACKNOWLEDGMENT ; I
�I
Signuure(s) John J. Rvetmaele and Barbara A. Su[e of Wisconsin,
l� Ruemmele, his wife, and Thomas J. Ruemmele ss !{
marts wife. Coo
1
i�
authenticated t _ of r> Personally came Wore me this day of !�
i
19—, rlli above rla,ttcd ji
Cali-
TITLE: ASMUR R OF W15CAN51N _ E�
authorized by §706.06, VAL, Stou.) to me known to K: .i: person whu executed the foregoing
instrument and acWmw(edge the same
THIS INST'RUMF.NT WAS DRAFTED BY
f Heywood & Car' .C.
204 Locust Street, P.O.. Box 125, Hudson, _ WI 5406 — T4
{ I ataxy ublic. _ County, Win.
(Signstures may be authenticated or ackno- ledged. &nh are not My commission is permanent. (If Tim, Stale expirancrit date:
+' n-cesctry) ) !
'' ' Nutri of JsiM54 • m m :+pxNy should by i)•prd ct pmaed betty [Ace ,rRnwrcS . _......_ —_ -- •- .- s —. —a_ .._ -._ . —.— {I
WARRANTY NEED STAI6 NAP U, WISCON-,;,%i wgppngn lsDS BatYt Cip. Vt. li
Form No, 2 - 1982 M"*.Aea. Wt:- ;�
,
08/28/ TUE 07:37 FAX 651 439 3417 AMERICAN CLASSIC HOMES IM 002
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ST CROIX COUNTY = i
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
O wner /B uyer 7 o t , 4 ,
Mailing Address
71
Property Address c2 i - 3 s dad jL S �L/L4,,/ ��!?
(Verification required from Planning Department for new construction) \�
City/State Z Aj, Z 0 51" SI h Parcel Identification Number
/`.
LEGAL DESCRIPTION
Property Location %., %<, Sec. . T N -R W, Tom -of
Subdivision ! Lax,##
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house 0 yes ❑ no Lot lines identifiable V 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 sep tic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification foam, signed by the owner and by a
maswplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-ate wastewaterdisposal system
is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
eso State of Wisconsin.
Certification
' as set b the of Commerce and the Resources, set forth, herein, Y Department Department of Natural R
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.
$3 O!
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of�my (our) knowledge. I (we) am (are) the owners) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
�- , 6' /d310l
SIGNNATURE 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 waaanty deed
l