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HomeMy WebLinkAbout018-2019-53-000Wsconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM County: St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 641994 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: Jeff Husby City Village Township 1 Parcel Tax No: TOWN OF HAMMOND 018-2019-53-000 TANK INFORMATION TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH FI Forcemain Length Dia. Dist. to Well JUII- ACJUKI- I IUN SYS I EM ELEVATION DATA Bottom BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO JPIL BLDG IWELL LAKEISTREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: Model Number: vIJ I nICJU I I VI\ O T J I =W1 Header/Manifold Distribution x Hole Size x bole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing vvt� vw • VIx v PraeRuro Ruareme nnla — RA-..-.t n- w1 r-..a., c Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Q Yes ❑ No D Yes No UUMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1617 75TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? (] Yes C No Use other side for additional information. I�_JI SBD-6710 (R 3197) Date Insepetor's Signature Cart. No Industry Services Division County 4822 Madison Yards Way St. Croix Sanitary Permit Number (to be filled in by Co.) hI �, V✓�.,��9 �i jj, Madison. WI 53705 '`P.O. Box 7162 WI 53707-71 r 9 q San><�ary Pub ication fate Transaction Number 072001438-C In accordance with SPS 383.21(2)_ Wis. Ad . Cqd@ mission of [his form to the appropriate ental unit is required poor to obtaining a sanitary on ote: Application forms for state-owned are submitted to Project Address (if different than mailingaddress) the Department of Safety and Professio ices. Personal information you provide may be used for secondary 1617 75th Avenue purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 1. Application Information - Please Print All Information Property Owner's Name Parcel # Jeff Husby 018-2019-53-000 Property Owner's Mailing Address Property Location 316 Kamloop Place Govt. Lot City, State Zip Code Phone Number River Falls Wi. �54022 715-222-9731 %. /4, Section 29 T 29 N R 17 E or W IL Type of Building (check all that apply) ✓ Lot # aI or 2 Family Dwelling - Number of edroom� s 0.s 53 Subdivision Name Rolling Hills Farm p�ha) Block# �ttblic/Commercial - Describe Use City of rate Owned - Describe Use Qvillageof C SM Number Town of //Q. nax III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i a licabk A" x/ ew Sy DReplacemen[ System ❑Other Modification to Existing System (explai Ir l")itional Pretreatment Unit (explain) of 600 B' Holding Tank ❑In -Ground at -Grade ndividual Site Design Mound 90�er Other Type (explain) (conventional) )' 7- C. Renewal Before Revision hange of Plumber ❑transfer to NePrevious Permit Number and Date Issued ExpirationR 624935 8/19 / 2020 IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation Existing Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units o '$ o New Tanks Existing Tanks w o m U Septic or Holding Tank 400/921 1 WieserlHoot Dosing Chamber Q V. Responsibility Statement- 1, the undersigned, assiluse res bTtyr instanst➢on f the POWTS shown on the attached plans. Plumber's Name (Print) PI rfs.Si e MP/MPRS Number Business Phone Number Keith Knudtson 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts Wi. 54023 VI. County/Department Use Only Approved ❑Disapproved Permit Fee $ Dale Issued (0/13/20z2- Issuipg Agent Signature 1/ ❑ er roen Reaso for Denial lfY yin e1/vhl.�e,"1� yltC/navyt",``� Conditions iff Approv rs-ferBisiMproval ^.�- �-__ _- .e SYSTEM i 3) C� i' ;^ W" 1. Septic tank. effluent filter and 67�Q�("3 r'_ Te_- �� Is 1T%A0 .`-t ) G dispersal cell must be serviced / maintained cL r as per management plan provided by plumber. l) *T ATIL r¢ rvdc2t{1 �p t+,p �15 W r 2. All setback requirements must maintained n •� „n as per applicable code/ordinancece s. d"�St t ru.uts+�10�. 5) P-Qw•t.�aer vevtd2s c`nFeiwt � to co a plans for the syste" and sttru���bmit to th ouoty one 'pal r not less than g in x 11 inches in size O 1" ye v`"`rr Rs 3L%Aa�(f�t�o w / "` �) s1 ls�t' e.Anec & -tu .sue woo Q eS eQ �er L ois 572 51. Im /j� CE y/5 ^* s q-a FIELDWORK COMPLETED. 4JiSf22 .. i NWH 75TH AVENUE SCALE: 0 40 80 ELEVATIONS SHOWN ARE 1 •`co T. a' m T.O. LEGEND 9 ` � =10 O.i A; �1076.4 1077.28 60D NAIL SETAT IVOFFSET OR rO�ID�✓ ON BUILDING WALL EXTENSION N2 G 1 26.0 N 8 D_ ✓ I Q FOUND 3/4' IRON BAR in k'.y G i 7' T.Q.N. TOP OF NAIL ELEVATION S6' I 16.0 I w HOUSE T.O.B. TOP OF IRON BAR ELEVATION I 46.0 Q — ,. — — DRAINAGE & UTILITY --- _ ___ __ __-_-_ ^', EASEMENT DRAINAGE EASEME �LO.H.-3082.22 ® p X 100.0 EXISTING SPOT ELEVATION !2 yo BUILDING SETBACKS: `OD v �y 35' FRONT sa M 10' SIDE IV REAR Ln N - jN i 3li �,icopY oe ocB ✓ ,E e,- a L�a0-i f 33 bn / lobe ����• CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Lot 53 Owner's Name: Jeff Husby Owner's Address: 316 Kamloop Place River Falls Wi. 54022 Legal Description: Township: County: Subdivision Name: Lot Number: Parcel ID Number: Designer/Plumber. Date: S29T29R17 Hammond St. Croix Rolling Hills Farm 53 018-2019-53-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Keith Knudtson 06/02/2022 License Number. 648443 Phone Number (651) 470-1737 Signature Designed pursuant to the In -Ground Soil Absorption Component Manual for POW7S Version 2.0 SBD-10705-P (N.01101). Page 1 4 Pl o f le2 a e2 A00t- ---- - — ft Q yb ^ 6 dFIELD WORK COMPLETED: 4/15/22 ?- Aol %.40�r - vec, NORTH NUE SCALE: 0 40 BO ELEVATIONS SHOWN ARE NAVD 1968 DATUM. 86 to 8 75TH AVE ` T.04,—' -'° 10.1 _1076.4 LEGEND 1077.28 60D NAIL SET AT 10' OFFSET OR - — — p�Joa-(V ON BUILDING WALL EXTENSION i 12.0 0 26.0 a 4A- N G 1 8.0_ 1 © FOUND 3/4' IRON BAR in 16.0 F m T' T.O.N. TOP OF NAIL ELEVATION 16' 16.0 W HOUSE T.O.B_ TOP OF IRON BAR ELEVATION 1 46.0 — DRAINAGE 8 UTILITY --- --------------- EASEMENT `S 1 DRAINAGE EASEMENT `T_O.H.=1081.22 go) X 100.0 EXISTING SPOT ELEVATION �D yo BUILDING SETBACKS: OD 35' FRONT ILi 10' SIDE � 1V REAR -0.e.-1092.5 d O wA.,.t 012 Zo Bi^ Cr,O-`���bL� 1�8d.33 br K. DObe (b� Private On -Site Waste Treatment System (POWTS) Inspection Agreement The correct operation of the equipment noted below significantly influences the life of the wastewater system. Periodic inspections will help extend the life of the system and prevent the need for costly repairs. The agreement authorizes access to your POWTS equipment by a trained and authorized technician, during daylight hours, to provide regular inspections and routine maintenance to help assure the equipment is working properly. It is hereby agreed by and between Purchaser and Knudtson Plumbing and Contracting that in consideration of the payments provided for herein, Knudtson Plumbing and Contracting will provide the services of a factory -trained representative to perform periodic inspections of the equipment described below. Knudtson Plumbing and Contracting will prepare a written report after each inspection and provide a copy of the report to the Purchaser. This report will contain recommendations for any operation and maintenance deemed appropriate by the inspector. This agreement does not assume any responsibilities for obligations that are normally the responsibilities of Purchaser and does not extend to cover any costs that may be associate with any recommendations made under this agreement. In no event shall Knudtson Plumbing and Contracting be responsible for any special or consequential damages, including but not limited to loss of time, injury to person or property or incidental economic loss due to equipment failure or for any other reason whatsoever. Knudtson Plumbing and Contracting may supply additional services, parts or labor only after authorization by Purchaser. This agreement shall remain in force for a period of _1 years, beginning —May. 2020_and will automatically renew each year thereafter for one year unless canceled by either party with at least 30 days written notice. This agreement may be canceled by the Purchaser only if replaced by a service agreement with an authorized service provider for the equipment listed below. Knudtson Plumbing and Contracting may delay or cancel future Inspections if payment becomes at least 15 days past due. Periodic Inspections: Association agrees to pay Knudtson Plumbing and Contracting $_200.00 per each house's annual inspection. Any additional testing or services required will be billed on time and material amounts. Equipment Covered Under This Agreement Description Model No. Serial No. Install Date Location N different from system owner ATU'S Hoot or Micro -Fast I Knudtson Plumbing and Contracting Sign Date: 927 150"' St., Roberts, WI 54023 651-470-1737 Signature: Rolling Hills Nownert Association Inc. Date: moo, 5 - 31 - la), a Print Name: fc44 Street: 3[ Kc- .J e�PS pI at�C. i Phone: 7 i �� i Z CA? 3 I City, State & W fZIP �' 1 Fax: �1 0,. /G/ ral�, Z S_ `i Email:.%F4A„sfititi._�— 106• 31�" a — w o I co 4" CAS P4 II/'Mill •:II IGII _ lL r1L=_ I 41" o to 74j" II 4" CAS /F"'r 40" POLYLOK 12" ACCESS LID (TYP) �Z SET RISER (TYP) TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WO GPD GRAVI Y DISVAROE SYSTEM H-600 A TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" b COVER: 4" MANHOLE: 12" & 24" I.D. PLASTIC RISER 8 HEIGHT: 70" O.D. 8 LENGTH 106" O.D. $ WIDTH: 74 1/2" O.D. BELOW INLET: 57" O.D. LIQUID LEVEL: 51" W S P WEIGHT: 11,135 LBS. W INLET AND OUTLET: 4" CAST —A —SEAL (CAS) BOOT OR EQUAL Y co COVER: MIX DESIGN #8 (NO FIBER) ®,�� � TANK: MIX DESIGN #9 (SMALL FIBER) Y CUSTOMIZED TANKS: = N FOR CUSTOM TANKS CONTACT WIESER CONCRETE PO CA00 MCA Q z a v S tI F DRAWINGS SUBMITTED w FOR APPROVAL = APPROVED BY: SMOLT NO. APPROVAL DATE: PRODUCTS NEEDED BY: /OF Homeowner Guidelines for homes equipped with Aerobic Treatment Units The septic system for your home depends on the proper functioning of the Aerobic Treatment Unit (ATU), which is designed to treat and degrade solids prior to discharge into the shared septic system. To avoid breakdowns and costly repairs, please observe the following guidelines: • Avoid allowing any inert materials such as plastic, rubber, scouring pads, dental floss, cigarette filters, bandages, hair, mop strings, lint, rags, cloth and towels to enter the system. These materials can build up in the tank, resulting in system malfunction, clogging and premature pump failure. • Do not flush or drain chemicals and toxins into the system, as they kill the microbes necessary for treatment. These include paint and paint thinners, solvents, drain cleaners, automotive fluids, fuels, pesticides, herbicides, fertilizers, metals, disinfectants and sanitizers. • Paper products including disposable diapers, paper towels, baby wipes, facial tissues and moist toilet paper are not designed to dissolve in your on -site treatment systems. Neither will excessive amounts of toilet tissue decompose. • Limit garbage disposal use to food waste that cannot be scooped and thrown in the trash. Do not put animal fats and bones, grease, coffee grounds, citrus and melon rinds, corn cobs, egg shells, etc. down the sink. Also avoid putting spoiled dairy products and yeasts from baking into the system. • Do not put medicinal materials, automatic disinfection tablets and similar items into the system. Also, septic tank additives generally do more harm than good. • If possible, spread laundry practices out over several days, rather than one "wash day," so the ATU can more efficiently process the water as it enters the system. Liquid detergents are recommended over powder; fabric softener sheets are preferred over liquid softeners. Use bleach sparingly, at half the recommended rate. • Clear water waste from dehumidifiers, HVAC units, gutters, whole house treatment systems and sump pumps can increase the flow to both your on -site system and the shared system, leading to shorter life. Both clear water and backwash from water softener regeneration should be discharged to an alternate outlet. Talk to your contractor. Do not disconnect power from the unit! Your ATU is equipped with an alarm that will notify you of a malfunction. If the alarm does sound, for diagnostics, service and repair call: Knudtson Plumbing and Contracting 651-470-1737 Cr Crott s- i M H-Series Gravity Treatment System Green Choice Applications: Single and Multi -Family Dwellings, light commercial, Churches, and other similar Residential strength uses. Performance: 98% Reduction CBODs 99% Reduction TSS 99% Conversion of Ammonia (NH3) Feca! <! nnn Ai In disinfe:o .,....., act n Range of Sizes: 500, 600,750 & 1000 GPD High performance, low cost, energy efficient treatment system The H-Series Gravity Treatment System provides high performance at a price comparable to most entry level ATU's. Producing effluent of less than 3 mg/L on CBODs and 2 mg/L on TSS, it far exceeds the secondary standards of 25 mg/L on CBODs and 30 mg/L on TSS. With these results, many locations allow reductions in disposal areas between 25 and 40%. Because the H-Series completely transforms ammonia into nitrate, it is best suited for applications with rich organic soil content, surface plant growth and depth to groundwater to prevent nitrogen pollution of the water table. Simple installation, reliable performance, low cost of ownership This level of performance is enhanced by its simple installation, energy efficient performance and low cost long term maintenance and ownership. The systems components are assembled at controlled manufacturing facilities, rather than in the field, to ensure reliable performance with local support. Energy efficient, environmental protection Made of locally available and manufactured concrete, the H-Series features an energy efficient linear compressor that uses less power than an average light bulb. Its polyethylene clarifier hopper is made of recycled milk jugs. Choose Hoot, and you make a sensible, decision to protect the Pnvironment as you protect our most precious resource, our water. Drainfield and Vertical Separation Reductions With gravity flow discharge, the H-Series allows you to choose your disposal application from conventional lateral lines, leeching chambers, other alternative drainfield materials. In some areas direct discharge is an option as well. Reductions of vertical separations to groundwater and impermeable layers such as rock range from t to 2 feet. Make the green choice for wastewater treatment Your wastewater system is the most expensive and important appliance you will ever purchase. Don't settle for just any system. Protect your family and the environment with a Hoot H-Series System. Wieser Concrete Products Inc. 1-800-325-84S6 www.wieserconcrete.com BE MD APR 16 2020 St Crd)c County___ `IQ.203s HOW LLC . �l�1$ IA 1 FiE.H[o 2010M 1. �a�tarpiarts�#his�,�uueEt�d �t3�i�.� Tis�approEv4�n�f. _ : "ddto �. -[iT9s apprnvai ts,c+�t�ti�ft,p4i;�n;� � �r� �(s�•' - - ,:. •. - d Plow MMWWP at �jp*WPM �» nftVwAuutmWnotr � �>_ir� } dihe ftIOL iod& a �..a,l- ��i-L.J �c 0.� •LLK�A. sbiwmmwp- A ent Imp 011, r. !j- E shall be OA T*,Mmtoo MAIr "robilimo bowdifft are". wuch.-W not Rao tftd Tro UMOS tot mmmm" ip bahsWWWWMsMUMW Are =DOM OUT*% slow-ofto The & 4 kxhw in in ft ftemdkmdm - minal . h . b VMS", mar W !� (6E" 20YA401 P WM (608) m4m m L / r II -I,: IIII ICI I• r ��I I'l r • �` IIIIIIIIIIIIIIIIIII�I���l� 111 ,I IIII I I I� IIII II I IIIII I I' II II'l�'IIi I� IIIIIIIIIIIIIIIIIIIIII ld III I �I III I III'. `1,e IIIIIIIIIIII I�il�'IIIIII'!'l ©� i i � ■ I I I' I = —_ —IIII o �' I IIIIIIIIIHIIII I �� ti �:i�'i rnm rl I I' III IIII ■ r ■ ■ u ®=.°. o n n ROCM T� m m O wO ' Q R `erg Bectton m O ya � Q1 U w - ��yi�e _ ��•_' •vY N�Y.v'eL 4 _ _ - vlPy� f.�,� y.uY v � � Wy Yw• - e ' iiv'�4v. M1wti `�^8 Beetlan n�4 — C4J BUILDERS HIGHVIELU 50NUS ROOM (3-B ED) �r 46 IF . ..... ........... . .. . . ...... ®r P, ij i Ili . .. ........ .. ta E3 3 B S E3 C:4J BUILDERS HIGHVIEW BONUS ROOM (3-BED) S-r C� O 11 SANITARY SYSTEM c r.:ruiic,a Office Use Only OWNERSHIP/ADDRESS FORM 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 INFORMATION Owner/Buyer T��k 4' _ 5 b Mailing Address Kr_--(V005 Pj&�c City/State/Zip A;ya— re, (I5 W�_ S'4C);L� Phone Number (required) 7 (S Email Address (required) r1 Parcel Identification Number o/ dO (found on the property tax bill) Property Location Subdivision Plat: NEW SYSTEM: LEGAL DESCRIPTION t/4 , _ 114, Sec. � T�N R_UW, Town of �� Q1,2 ; Certified Survey Map # Z,%_ _. PV.'LL Volume Page # Lot # �3 Warranty Deed # (before 2006)Volume Page # Number of bedrooms Spec house Kyes O no Lot lines identifiable 4 yes O no New Property Address ( taff Initials) USE ONLY (Verification of new address required from Community 0° /,3 LZ (Date) C_� Department for new construction.) 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 Parcel #: 018-2019-53-000 Valid as of 06/09/2022 01:01 PM Alt. Parcel #: 29.29.17.1253 Owner and Mailing Address: C & J BUILDERS INC 316 KAMLOOPS PL RIVER FALLS WI 54022 Districts: Dist# Description 2422 ISCH DST CROIX CENTRAL 1700 1 NORTHWOOD TECH Abbreviated Acres: 0.000 Description: SEC 29 T29N R17W PT NW SW BEING ROLLING HILLS FARM LOT 53 TOWN OF HAMMOND ST. CROIX COUNTY, WISCONSIN Co-Owner(s): Physical Property Address(es): * 1617 75TH AVE Parcel History: Date Doc # Vol/Page Type 12/07/2021 1144763 WD 09/27/2016 1036337 / WD 11/11/2011 945547 / WD 02/05/2007 843836 11/19 PLAT more... Plat Tract (S-T-R 401/4 160'/4 GL) Block/Condo Bldg * 11-019-ROLLING HILLS FARM 018-07 29-29N-17W NW SW I LOT 53 2022 Valuations: Values Last Changed on 11/04/2008 Class and Description Acres Land Improvement Total G4-AGRICULTURAL 1 0.5001 100,00T 0.00 100.00 Totals for 2022 General Property 1 0.5001 100.001 0.001 100.00 Woodland 1 0.0001 0.001 0.001 0.00 Totals for 2022 General Property 0.5001 100.001 0.001 100.00 Woodland 1 0.0001 0.001 0.001 0.00 2022 Taxes Taxes have not yet been calculated. Key * - Primary 1277.1 & N89°47'SWE 691.99 3C -� 7 TH "�EMi UE ELEV 09MOAN EMULI ce4 ecl 1 Ill79 r)Q q.7 Wit 1JU 11v P 1• +v..,.v.. 88.89 84,91' 85.2V 86•23' i 1 i • LET LOT LOT LOT � 52 Q 54 �r 1219781 SOo + I21 Al SO* ! �" 21 �781 SOP 21,781 SQ• � Fr. FT* FT• L85.W L85.28' L85.23' !-- 81.73' • N89.81'1 Q" L 580.24' S8t TO oj S , ' y ,� PRIVATE SEWAGE SYSTEM ;aria• , .r t H ,.: � . ,... INSPECTION REPORT - GENERAL INFORMATION Rolling Hills Farm Owners Association TOWNOFHAMMOND W 1 In. 1• :n krd I t,•v led e.-t q.aorr b 7 7 Irl - —1 J1 U10 TANK INFORMATION __ _ --, ELEVATION DATA 7YT'r 6iANJ-AC JNE 1y7 -5C-) Arra'�a 6 r_ rI 4,WS n� v0 TANK SETBACK INFORMATION/ TANK I,1 PL .^:Ftl H; 1:r. r7r?,V, Z 5 ' ArS > limo > J oo ' _— Aviahv, Hd:ltrel _ -- PUMP/SIPHON INFORMATION Z- r L y I�4 1-- Fua,•rrno ICI y�'y' � Uia � N I"+ ..a IW SOIL ABSORPTION SYSTEM BEDITRI.-NCH 'vY d•h /� I,:m•R� DIMENSIONS (C,•If ` SETBACK ,'rt!'C] •'� -1L7"� WORMATION `\ L-7 % v' DISTRIBUTION SYSTEM L•sotrc St. Croix 624935 018-2019-79-000 rlr•r I ur � Io.vn: Hanyc tl:q: Nn 29 29 11 1279 STATION H9 HI rS v�7�. y y 6 tG77.q( l:t r uJ ovu -- 7 Llopp. 33 H61J, SPb'E' 2,VHI Inha SIMI MAW i it PJet " ba 1061. N 6'a ium 0 r„•.t Prx 5 Hut systertt 5 . Jo7e . !� 1 vial G•ade r1 76 166v, ?3 i PII DIMENSION No I i•r-. I,.yl :.� X^'tf"I r am IMW - y v . ,. / , - t-, r . . �. -. % 1 ., �. ., . 1 , F,.._ A.. o.06 z 96 DOSe �4 JUIL I.UVr.K f Pressure Systems Cinly .. INmuul CIr ArlraAn %w.rnm. CkAu yz e IV /., - J. . ' , M Ib 6' '' \/ ''j I I .m %17 li ., YY..., A� ✓r..., COMMENTS :•,_' e aje i, r.. l ' LOCallon ._.]'rs .•.ff� -.1111,gam, .-'I} �o•�e. Pr 1.10 4. Plan n•v •.ern NecuireV Yea ) N.- 5 J •tPrrt u1e to• .k dda:n31 n`n rsi!inn Ze / 'Z `. /�! �I 411mop 6ft4W&0^ courvrY NO. 641994 STATE SANI�ARY PERMIT � #poi} 'fi - Ave eaevIocrvo.T OWNER PLUMBER TOWN SEC 9T_?A_N, AND/OR LOT KZ SUBDIVISION ISSUING OFFICER CHAPTER 145.135 (2) WISCONSIN STATUTES (a) 0 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 maybe 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. (f) 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. DATE_7fr3/j& UNLESS RENEWED BEFO POST IN PLAIN VIEW THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)