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032-2193-11-240
Wisconsin 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 [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Dan & Susan Mickus TOWN OF SOMERSET CST BM Elev: Insp. BM Elev: BM Description: I UD- vb on �%,1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic �N c Dosing WO io / TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic f�d wcll2�' �fik OM56&A . d o Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer G bu�G� Demand GPM 55 aim 2&.9lb Model Number ,- P� 1 TDH Lift Friction Loss System Head TDH Ft D - I T 2.5�- q.5 5 17 29 Forcemain Length Dia. Dist. to Well 0, 21 loo Wc`` SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 648484 State Plan ID No: Parcel Tax No: 032-2193-11-240 Section/Town/Range/Map No: 06.30.19.1643 STATION BS HI FS ELEV. Benchmark 515 I0515 IDD.00 Alt. BM r I I I c -rof Vt w4k a IouN�IQ7�b'1 �b�'f� JI��L 'I b$ 9$ }1 Bldg. Sewer St/Ht Inlet S u le Dt Bottom Header/Man. IDS, 11 Dist. Pipe Bot. System 3.28 lo2.s�- Final Grade 8fLd%erg �,1� (.A� 2 . 103 3 5- Cb,,4vr BED/TRENCH Width Length , No. Of Trenches PIT DIMENSIONS No. Of Pits Insid ia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: ►� oun j � D ��� Model Number: rck r P"�. DISTRIBUTION SYSTEM Header/Manifold Length Dia 9 Distribution Pipe(s) Length �S-yJ Dia I Spacing 9 p 9 x Hole Size 5 �3ir x Hole Spacing 3. °& Vent to Air Intake 3`OIL COVER x Pressure Systems Only x Mound Or At -Grade Systems Only RR RUA )epth Over Depth Over x Depth of xx Seeded/Sodde xx Mulched 3ed/Trench Center Bed/Trench Edges opsoiI ` I'L Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 1718 35TH ST 1.) Alt BM Description = -rP Df w4lkw� 4t�a�, noA side 4 6ML 2.) Bldg sewer length = Frpnn b�il�ii�9 q, f 45 2�` + - amount of cover = �^ + Plan revision Required? ❑ Yes No �j 3 Use other side for additional information. I Date SBD-6710 (R.3/97) Inspection #1: Inspection #2: (Q 111 ' o� J�h� . (`t �tI` d. Cert. No. Wk K /A 7 ■ RHO.. H U 0 A _ N K N . A . 4822 Madison Yards Way iz w "j ,�A4.1�11 ' ► R 1 ` 5401 g Madison, W153705 Sanitary Feint Nnrnbe�r (to beird in by Co.) lkl FOR ©EPOSI ONLY UNP P.O. Box 7162 1lUl'� Stave Ton Number .. In aocordame % SPS 383.21(21 Wis. Adm Code, s�xl fission oftb s form to the apgnap to gc��tat unit to % wry per . : A fa ms for s -owmd �1`S am wbmftcd to Pui`s— a5 23 00 9►2� --L p'ro t A� (ifc�i t tin mailing �) the �wt ofS�r and � S�vives. � infO► t you �►ra de be used for morifty in aa�1 witfr the Law, & iS. l ,n�j, Scats. L AppEmden f raaat - Pleam h tist AN Xaraa&a > P"Cel # /J 032 219S 1.1 2qO Owwv8 MailA*kws Ptoty Locatkm Z' City, S p Code Phone NumberGOVL Lam. �. Section ` U. Type of Nding (chi i� t6 apply) Lot N T �Z6��N R E i or 2 Family E3 affing-- Nm»bw ofits Subdivs Now awleia) -- Dt=ribe Use Bkoctc of tate Owwd w- Dowie Use C511r# huarber iiaga of 2AJ Down 0 f UL_ . Tyke Of ' 'S 1'andift (Cheek ofthew'"Newft or "PK0* t„ tad at r appfinb#a on Um A, Qe& one box on Hot B. Cm- UP-1 C I - a , AL tacxta ,t SystemsOMMfKatintoEmWi%Systain(Modio SYMMrkWing --- al in) Addiik Pre�t t (�) Tank Ism �• 1�dc Mound Individual S�t�c i gp C al Type ("P ) f Yet) .2 C R� & Oftvi ofI'1mnb r r to � Per wnit N� and Doe Issued Expimion L'WL W. `r+eat Az old Talc I OWN D , Sp resign lbw (pd) Des�p Soil Applicatkw Area Reo e+d (d) Dfi6mwl Area Ampo (af) Syswn Wavatim Capsicity in Total 0 Of Mwx1fictunr Talc Infonnaddn pie t trues Now Talcs Exiltwg Galums Units Team r 1 I ,r Cou tm t the W& howdSYSTEM Owe,: L Ck�0 Ps_Aw01y0_Q CLA.0 LA/\_ 1. Septic ` s tank, effluent filter and dispersal cell must be serviced J maintained a r management plan provided by plumber. U D e ' I o c erS �� Ob L l ��� Cr�.N'JN'i`^ l� �;b4f C � ca�'J&4r` S % . All setback requirements must be maintained s as per applicable code I ordinances. +ft 3w »� i�#�r +► as pater a�ottnr �i SOD-6399 (R. 03/21) Wisconsin Department of Safety and Professional Services :,� ���r Phone: 609-266-2112 Division of Industry Services C � ram, p. n� � Web: ht� '!cl:; �.v��� ov 4822 Madison Yards Way = Email: P 5 tt. Wisconsin. ov PO Box 7302 Madison WI 53707 Tony Evers, Governor Dan Hereth, Secretary May 25, 2023 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2025-5-25 Plan Review: PWTS- 052300921-C Kim O'Connell 504 3rd Ave E Osceola, WI SITE: M ickus 35th St St Croix County Town of Somerset NE%SW%S6T30N R19W FOR: Description: 4 Bedroom-600 gpd-30" to limiting factor- Effluent Filter - Maintenance required. Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES r SEE CORRESPONDENCE Mound Component Manual — Ver. 2.1, SBD- 10691-P (5/22-5/27) Pressure Distribution Component Manual — Ver. 2.1 (May 2022-2027) Verify proper dose is achieved and system is not being over dosed. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec.145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A cQ2y of the aipproved plans, specifications and this letter shall be on -site duriniz construction and open- to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54( 1 ). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services 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. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ,,7&sh"a11T&w&y Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 634-5124 Joshua. rowlev@wisconsin.sov •`,,�.-y�'� fair APPLICATION FOR REVIEW .Compme all pages- ' S NOTE: Personal kftmu lion you provide may be used for secondary purposes [Privacy Laws. 15.04(1 }(m} Stag.] Private Onsite Wastewater Treatment Systems oh;sio, of Industry sew ❑ Plans to be EAled. Provide SharePoint User name below. For plan status, check our website at - - - Email technical ©ode questions to _ .. Several counties have been delegated certain authority to review plans in lieu of Division of industry seances. For a current list of those coun des and their des' nation check our websfte at 1. Projee!! lnfonnation -FIR in all imwn infW madon. Conn innation of asslomwnd to a reviewer. PmJs cVSft Name. i.aisactlon IV: Location, Number & Street of project (if unknawn, wed nearest road) Previous Related Trans. ID: L Estimated Completion Date: Legal Descr fpfio : .S rt w �� ; Assigned Reviewer: f County Assigned Office! ❑ City ❑ VMage // Town of ..,......, _-,_-,- - •S"� .�.,,.. email to your office of choice below: La Cr'°g' w Green Bay 2. After plans are roviswed, pleasc (check all that apply) ❑ Call customer 1, 2 (cirde numberr NOTE: We r ser" the right to m-distribute plans to another ofMM N Requesting party will pick up needed to reasonably balance turnaround times. Check [A -Mall plans to customer 1, 2 (circle number}* -- - - - for next avallable review date 'Refers to customer number from below. 3. Complete the fi owfing infoCnlud#on. milee the check boxes when %IWO er, owner or requeo ng party Is the same to avoid i+spe ng qMM pffwt�M. Designer rmaMm (CustomerDSPS rt, tither Please Specify Below (r 2) DSPS F'� Customer First Name Customer Number Co Ipahy V f j , i Al IC F \. o t Name Address City ' fate Zip" (9 digits) City, Slate 23p+_ 4 9 dk I _ � Phone Number E-mail address Cep phone Phone Ntanber E-ma address Ceti phone (area code/ f _ r (area code) ) 1 f Check if appicable Check if applicable or sped(y Monship Q Owner I kfOwrw� E] Odw — reiabonshi tnfa nnatian and Plan Subtnift Checklists. To request electronic plan review complete the an ate application form and e-mail it, along with your registered SharePoart usemame to - - If plans are being submitted via paper, they _ -_ _ . _ . will be assigned to a reviewer after receipt at a DSPS office. Submittal mists can be found in each applicable component manual appeatigg on the POWTS progf pMe under Publcabons - HotnleriMnalaska Nea DSPS Green Bay DSPS 2850 MWwest Or Ste 104 2331 San Luis Place Onalaska, W! 54650 Green Bay, %M 54304 608-785-9334 920-492-5641 Fax 608-785-9330 Fax 920492-5604 EmaU:._ Email: #Make Checks Pasble to: Divftion of Industry Sw%iam OR �] Check box to Invoice designer and sign below TOTAL A OUW DUE Review Code 7633 Designer Signature SOD-10577 (R 3/19) 5. PCWTS SULWITTAL (check all that apply — Incomplete forms may result In processing decays) El NEW Aerobic Treatment Unit(s) E] Tank Replacement Only Chlorinator REPL-ACEMENT Commercial System []LIV DisinfectJon Unit Q Add Effluent Filter SYSTEM TYPE(S) NOTE: Submit separate shoots for each system If submitting multJple systems on the same site Enter Fee Revision to previously approved plan $83-00 Mlscellane*us Review (.9, r*placement of a septic tank, addition of an effluent niter or pretreatment device to an existing system, etc.) $801hr rComponent Manuel At -Grade Component Manual - Ver. 2.0, SBD-10854 (N-03107, R. 1/12) Design Wastewater Flow in Hl� In -ground Component Manual -Ver. 2.0, SBD-10705-P (N.01/01, R 10/12) Gallons Per day Mound Component Manuai —Ver. 2.0, SBD-IM91-P (N.01/01, R 10/12) Pressure Distdbuton Component Manual Ver. — 2.0, SSO-10106-P (N.01/01, R 10/12) Other - Please specify GPD 0 Soil Based Individual Site Design* [:1 At Grade 0 Non -Pressurized In -ground 0 'Pressurized in -ground 0Mound C3 Drip -line 0 Constructed Wetlands DocurrIentaflon must be provided to support treatment and dhpmw claims. In a separate statement, provide rationale for the project and attach supporting documents (code sections, test reports, technical papers, research adideo, etc.) State-owned facilities: DHoidtng Tank Component Manual, Ver. 2.0, SBO-10855-P (N.03107, RI/12)t ' Non -state owned Commercial and Residential Holding tanks that completely utilize this manual and have an estimeW daily flow of less than 3000 gallons per doy must be submitted to the appropriate governmental unit for review Imsteed of the Deparlmont. [see SPS 383.32(3)(a)) C] Holding TV* IndMdual Site Design*, (i.e. 9ft constructed, <5 day holding capacity, Co - mingled wastomter, etc.) Please specify: * Documentation must be provided to support the rationale for the project. In a separate statemeK Please include aN code ejections, test reporb, technical papers, research otdes, etc.) Design Wastewater Flow In Gallons Per dart' GPD Design Wastewater Flow In Gallons Per day AJI treatment comparmnts are previously approved under s. SPS 384.10 (2) or (3): Design wastewater flow of the proposed system: 1,000 gpd or less $250.00 1,001 — 2,0W gPd $325.00 2,001 — 5,400 & $400.00 One or more treatment components are not previously approved under s. SPS 354.10 (2) or (3): (individual site design/deviation from component manuals and use of components without product approval); Deslon wastewater flow of the proposed system: I 10W gpd or Ifts $450.00 1,001 — 2,000 gpd $600.00 2,001 — 5,000 gpd $760.00 greater than 5,000 gpd $900.00 plus $0.08 for each ga§on over 5000 gpd Holding tanks PrOVIOUSly sWoved under s. SPS 384.10 (2)(3). Design wastewater Row of the proposed system: 5,000 gpd or less S90.00 5,001 — 10,,000 gpd $150.00 greater than 10,000 gpd $225.00 Design Holding tanks including site Constnicted tanks NOT Wastewater Flow in previously approved under s. SPS 384. 10 (2) or (3). Gallons Per day Design wastewater flow of the proposed system.- 5,000 gpd or less $180.00 5,001 — 10,000 go $300.00 --- GPD greater than 10,GOO gp,� $450.00 SaWration Determination Report (using cL,_-'.-.,,'vation pipes) C3 warpret[Ve Determination exoerimental System (One time adclitional fee). Submit fee for Individual system as per appropriate above system type) Expedment NurnL or Priority Review (enter same amount as normal review fee listed aboVe) Enter ToW (rowed to the nearest daHer) $240.00 1 1 $400.00 1 SBD-10677 (R 3/19) MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Mickus Conditionally Owner's Name: Dan & Susan Mickus APPBOYED DEPT. OF SAFETY AND PROFESSIONAL Owner's Address* 320 WSERVICESedegewood Drive [111JIgInbi Qrz INCU-MIRX "RVICES e Mathomedi MN 55115 WW_ Legal Desc(tption- NE-SW-sec6 T30N-R19VV Township.- . Somerset County: St Croix Subdivision Name: White Pine Ridge Lot Number: 24 Block Number: Parcel I.D. Number Plan Transaction No.: Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 nPcz-iqnPr- Kim A Ononnell Index and title Data entry Mound drawings Lateral and dose tank System maintenance specifications Management and contingency plan Pump curve and specifications Plot Plan Filter Spec_ ATT soil evauation License Number: 224263 Date- 0 5/01/2 3 Phone Number., .715-381-7917 Signature: Designed Pursuant to the Component Manual Design References: Mound Version 2.1 (May 2022-.2027) & Pressure Distribution Version 2.1 May 2022-2027) Version 7.0 (R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design, Design Worksheet Site Information (R or C) R Residential or Commercial Design 460.06Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 600,001 Design Flow (gpd) 3.40 Site Slope (%) 102.00; Contour Line Elevation (ft) 30.061 Depth to Limiting Factor (in) 0.60 1 n-situ Soil Application Rate (gpd/ft' Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) 1.00Dispersal Cell Design Loading Rate (gpd/ft) 11 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (C or E) e� Center or End Manifold I 4.001 Lateral Spacing (ft) 2 Number of Laterals 0.156 Orifice Diameter (in) LDY 3.001 Estimated Orifice Spacing (ft) CO 1.50, Forcemain Diameter (in) 90.00i Forcemain Length (ft) 90.6b"Pump Tank Elevation (ft) 4.55 System Head (ft) x 1.3 12.33 Vertical Lift (ft) 5.79 Friction Loss (ft) 0.00 In -line Filter Loss (ft) 22.67 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. options choice 0.75 1.00 1.25 1.50 x x 2.00 x �73.00 x Treatment Tank Information 1200.00 Septic Tank Capacity (gal) Wieser Manufacturer Note: Sand fill (D) calculations assume a Table 383-44-3 in -situ soil treatment for fecal coliform of <= 36 inches. E,- 8.001Cell Width (ft) Are the laterals the highest point in the distribution Y network? Enter Y or N If IN above, enter the elevation (ft) of the highest point. L _„__� 12.00 ft2 /orifice _J Does the forcemain drain back? Enter Y or N 8.26 Forcemain Drainback (gal) 67.38 5x Void Volume (gal) 75.64 Minimum Dose Volume (gal) 26.931 System Demand (gpm) Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) 1200.00 Total Tank Capacity (gal) 36.00"1 Total Working Liquid Depth (in) 33.33] gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) Polylok Filter Manufacturer 22.24 Dose Tank Volume (gal/in) PL-525 Filter Model Number Wieser i Manufacturer Project: Mickus Page 2 of 10 W Mound Plan and Cross Section Views .. 4bservabon Pipe . .., .- -. .. .....i. ..-• . -. -. .•...•.-.-..... _ . ..... , .. _ .,. . . . • .. • • ••♦. .• _ tea• •r ••, .•, • ,•.•_•'.• ;.•` •• •`- ••.� •.•. � • • a . . . • , • • - _. . . . . . . . . . . . _ .......... I ' , . . . • f • • • . • . • . . • • , . . • . . . • • . . • ... . . . . . . • r . • . - . • - • . . • - • • . . . . . • • , . . • . - • . .. . . .. . . .. . L Mound component Dimensions A 8.00 ft E 9.26 in H 1.00 ft K 7.28 ft 1 75a00 ft F 9.50 in I 6.89 ft L 89.57 ft 6.00 in G 1 0.50 ft J E 4,88 ft W 19.77 ft 600.00 (ft) Dispersal Cell Area 1117.07 (fe) Basal Area Available 8.00 (gpolft) Linear Loading Rate 7.50 (ft) 1 / 10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 104-29 (ft) rsr.w■■aa.a a era• i ia.i.a■iraaiirr. �� 103.00 {ft} Lateral F . • rs Dispee Ce11 . . 102.50 f t --� Invert ) Dispersal Cell D Elevation.............. . .......... .,: ` •j 1 i ` ^�i,1 �} ,• �. ti��, •�.�� • ,] i ~_ a ��• • • l�,i�C^1 1 �i : ,f -� �■�r ��i � _�■� . � s ■ _i ■ J . r + ► _ ■ _R � • e c ! '• ,! ) ! +� ~ ��� a �: ■ J. t `r l ■ • 1`�■ ) •A` -,a s jj. �■ ■ = r 1■ ■ y� . s ■ y=1, • i c J i ^ ,f ` r ■ 'f a + 1 1, a a + - 102.00 {ft} Contour Elevation 3.4 % Site Slope Geotex ile Fabric Cover Shading Ker Dispersal Ceti See lateral details on Y .�. Page 4 for number, size, Topsoil Cap o 1.5 ft ' : • . • : g9 ao : `''�''• '�'' • -''' and spacing of laterals. !/rr/! Subsoil Cap = ::� •.: . �,. •, •..::,: _.. : • Laterals are equally ASTM C33 Sand T= � � `�.'•'''•'• �'' ' _ . � , . ='' '::'�'' . spaced from the •� 0. ft Typical Lateral `:` : :•: Tiled Layer c . ; ..�+ •ti.r• • , --•: distribution ceirs © f� Aggregate = centerline in the IL 71 A distribution cell (AxB). Project: Mickus Page 3 of 10 End Connection Lateral Layout Diagram Caterals centered over thc-A "e e, ijirr,(-n_.tori 0 = Turn -up velball velve or clera nout plug P All laterals afe identicil 1�_ x Holes drilled on the bottom of the lateral equalig spaced Force main connection via tee or cross to manifold at any point. Laterals & forcemain Sch 40 PVC per S P S Table 384.30-6 Number of Laterals 2 Orifice Diameter 0. 1 56'in Lateral Diameter 1.50 in Orifice Spacing (X) 3.06 ft Lateral Length (P) 73-44 ft Orifices per Lateral 25 Lateral Spacing (S) 4.00 ft Orifice Density 12.00 ft2/orifice Lateral Flow Rate 13.46 gpm Manifold Length 4.00 ft System Flow Rate 26.93 gpm Manifold Diameter 1.50 in Total Dynamic Head 22-67ift Forcemain Velocity 4.89 , ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and 177 SPS 316.300 WAC Disconnect 4 in. min. Tank component is properly vented Alternate outlet location Wieser Capacity_ 800.00 Volume 2224 Manufacturer Gallons gal/inch Dimension Inches 7 Gallons A 21.57 479-72 B 3.00, 66.72 C D Total - 71 1401 8.00 35,97F 75-64 177.92 800-001 3" Bedding under tank. Alarm Manuafacturer SJE Rhombus -Tank Alert Alarm Model Number 101 -01 H Pump Manufacturer ,Goulds Pump Model Number !PE 5 Pump Must Deliver 26.93 gpm at 22.671ft TDH Forcemain diameter 1.5 in. Weep hole or anti - siphon device Pump off elevation (ft) F 90,677] Id Dose tank elevation (ft) F 90.®a ..NNW..A Note- Switches containing mercury may not be used in this system. Project: Mickus Page 4 of 10 Mound System Maintenance and 0 eration Sp cifications Service Providers Name Phone POWTS Regulators Name St Croix Coun Zoning Phone , 7 15-386-4680 Sntem Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 Pn Estimated Flow -Average 400 gpd Maximum BOD5, rl- 220 mg/L Septic Tank Capacity— 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size, 600 ft2 Maximum FOG 30 mg/L Type of WastewaterDomestic — Maximum Fecal Coliform >10E4 cfu/100 mL l Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service FmQuency Inspect and/or service once eve a 3_years - Should Inspect and clean at least once every 3 years Test once eve a 3 years, Should test monthly__ Laterals should be flushed and pressure tested every 1,5 years Inspect for ponding and seepage once eve 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384-30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished Grade 6-8" Diameter Lawn Sprinkler Valve Box Distribution Threaded Cleanout Plug or Ball Valve I Sweep 90 or Two )eqree Bends Same Diameter as Lateral Project- Mickus Page 5 of 10 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01, R. 11/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33. Wis, Adm. Code when the tanks are no longer used as POVVTS components. Septic or pump 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 a tank or component. Se tic 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. 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 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 sludge and scum 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 a triennial 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. if such products The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, 1 are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the mound be heavily mulched as protection from freezing.150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 Influent quality into the mound system may not exceed 220 mg/L B005, exceed maximum design flow mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 CfU/100 mL for highly treated effluent. Influent flow may not e specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test I I a when the system was installed to determine If orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider, Pretreatment Units units or disinfection The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units are attached as separate documents and are considered part of the overall management plan for this system. Project: Mickus Page 6 of 10 Wastewater m RS FEET 40 m0oas: • PE31, PE41, PE51 2 u 101 01 HR .33, .40, .50 • :. 2 GPM ; 30 1 FT 25 10 0 0 10 20 30 40 so 60 70 CZM 80 0 5 10 15 M3/h CAPACITY PERFORMANCE RATINGS PE31 Totat Kmi (im of watw) GPM 5 52 10 42 15 29 20 16 25 0 P"I V" ftad (fast of "men) GSM 8 61 10 57 15 46 20 33 25 16 PE51 TOW New GPM 10 67 15 59 20 50 25 39 30 26 35 8 kik z U A of Po:, �oh to The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear fmit of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Rated for -10,00D GPD (gallons per day) 525 linear feet of 1/16" filtration. Accepts 4" and 6" SCHD 40 pipe. Built in gas deflector. Automatic shut-off ball when filter is removed. Alarm accessibility. Accepts PVC extension handle. Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL.-525 Maintenance:: - -4 4 . -1 w The PL-525 Effluent AAtefsoperate efticlently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. L;ocate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all ` solids faU back into septic. tank. M)t `0 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. Accepts 4" & 6 SCHD 40 pipe lot' Alarn-v Switch (Optional) GPD Arcents I" PVC lesicion Handle Rated for GPD 525 Linear Ft. of 1/16.#p Nitration Slots Certified to NSFIANSI Standard 46 iGas Deflector Automatic 0 Shut -Off Hall APs in i vi i ki •-�- L to 1, Potvtok, Zabel & Best filters accept Easily installs the SmairtFilten0switch and alarm. into existing; tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 IbIl Free: 877.765.9565 Fax: 203.284-8514 wyAv.polylok.com ST. CR NTx SANITARY SYSTEM F'l`"` Office Use Only OWNERSHIP/ADDRESS FORM C�a�0Z, 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. If your would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. }_1or . .. I m I � • � � New Pronertv Address .... _. lu akwodr (Staff initials) (Verification of nW c address required from Community velopm- ent Department for new construction.) NEW - (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form o recorded warranty deed from the Register of Deeds Once 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 acid@sccwi aov 1101 Carmichael Road, Hudson, Wi 54016 www.sm i.Qov Document Number State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Name BY TMS DEED, St. Croix AR, LLC, a Minnesota limited liability company, (hereinafter "Grantor," whether one or more), convey and warrant to Daniel Edward Mickus and Susan Karol Jones Mickus, husband and wife as survivorship marital property, (hereinafter "Grantee," whether one or more), the following described real estate in St Croix County, State of Wisconsin; SEE EXHIBIT A 1165322 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/03/2023 08:00 AM EXEMPT#: REC FEE 30.00 TRANS FEE 509.70 PAGES: 2 "The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area This cariveyance is being given subject to a restrictive covenant which grants Wittstock Name and Return Address Builders, UC, a Wisconsin limited liability company, the exclusive right to construct a St. Croix County Abstract & Title Co., Inc. new home and other improvements on the property; unless authorized by Wittstock 575 N. Knowles Ave., Suite #B Builders, in writing, Now Richmond, WI 54017 Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated 3 f 31 j 2- o �S St. Croix AR, LL limited liability company Croix " LL (SEAL) BY: Richarff:!9.1 Wak=ne�n, President AUTHENTICATION Signature(s) authenticated on 032-2022-90-000 (part o� Parcel Identification Number (PIN) This IS NOT homestead property. AWMOTM- AUSSA FAITH GRAY No" Pub U01, S%ft of M h"tata My Comffft:6on Explaw ACKNOWLEDGMENT STATE OF ss. J COUNTY Personally came before me on the DILL MEMBER STATE BAR OF WISCONSIN the above -named St. Croix AR, LLC, a Minnesota limited (If not, habilityCGMpany -- By: Richard S. Pakonen, President authorized by Wis. Stat. § 706.06) to me n to be the perspn(s) who executed the foregoin insir me tand ack e *�Ie. rMf i �e. THIS INSTRUMENT DRAFTED BY: St. Croix County Abstract & Title Co., Inc. by Amanda [C LA - Wayne at the direction of the Grantor. 22-S34784 Notary Public, State of My Commission (is permanent) (expires, (Signatures may be authenticated or acknowledged. Both are not necessRry.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDEN41FIED. WARRANTY DEED Q 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures, St. Croix County 1165322 Page 1 of 2 Legal Description Exhibit A Lot 24, County Plat of White Pine Ridge in the Town of Somerset, St. Croix County, Wisconsin. St. Croix County 1165322 Page 2 of 2 LEFT ELEVATION 115" = 1'-0" ii VII INS E 3: Lirlo -y—r.- fo,:,x�:t, �"!nm ofqr;rca.J t- ." on R, a lw"" t'esff r-tim- t�: C-1 5v.,-Vm Ism-- D-.ovp.j rettryes j rp*5 T d1. t r-Av a' rc-,,,cJ 1-,v Any ide- tao-A sA vc.. c-. ,.,y ;�:L t-c' 3-'s, Cr. -�f'�p-lf. A f—t -,tw , — w"dt;n ^'l r. J-,-' ' — L K-" RtAK ELEVATION 116" g 1 '-0" i NMI WWIIlid OEM FOR BIDDING ONLY E NOT FOR, 0 CONSTRUCTION o J -xl C-11 Li IV E 0 11 it FT7 ILU Ell d 1 0 u - FRONT ELEVATION 1 /4" = 1 '-C)" ul' m 9'-C" POURTE) CONC. fOUNDATICNI LP-tR 9'- 1 1/8' CEILING MAIN LE�El- Tcrow /8" CEILING LIPPER GaWL #22-17-5 I.Ml1ri 7, u O O CLI tir f�v IJC4. 'ql n rvv-fj r, 1. r- K ur Vx- , a 1~�J I!, t" .-,o r --se rtm� t..- '-A o "m --tT - "-v d r T -s 1-i fk-% nja v It —N _nctu. e. j--< LOWER LEVEL FLAN 1/4" - 1'-0" 9'-0" POURED CONC. FOUNDA-ICIA E 0 0 CCUX � 4e CUM 6- Apia d 61 S 0 n N 0 "I E 0 tic UL W :t 0 -j �'iwTv urr A IA n -);AT LF)tR 52A TOM �-WA Gil" IVA rlm- #22-175 imm 2 or qW f-,T cv-*A. -q, Ur v: vR tr a fcr ck I , -in t rAtw 7a.:i iwwre�,j .'3 qf;mc J t,- 5p t 'mie pia" v Y. d:. c-s 5,t, -c-L, Z Lim 0 -a x, rrt9erve5 j r rj" T, -_*!! ou - s I Aw - o' f-V any ;de, Lk -;'A ",x _ el- ff ly %:,t L-C I am ., ay e,-% I , , reA r a y h� 40 - N- x w—tf- f. ;, r'i ' r U- jv.iruj K MAIN LEVEL PLAN 114' — I' -Cy' 0'- 1 1/8"CEUNG 4� MAIN LEVEL I;hw: LO E 0 4) :3 0 _j Ci "rwTcl LW A I 1A R 7,-A 1 1-77cp A24 T _� TAI d,-SCA .&Urz IA74 I Illm- #22-175 inn —) or Qiain'5 Drawing Room. LLC 2023 L 0 A L; & L - - - - - - - - - - - - - - - - - - UO Ct r II II II II II it II 11 u LA a :1 I 00 n i 0 7' Rrjur lain Drawing Room, Pon &,fu5an Mickus Lot 24, White Pine Ridge,fomerset W1 54025 `usan 17iain s Drawing Room., Dan & f Mickus y -'. :1 Lot 24, White Pine Rid e,fomerset Wi 54025 w I _? Wis. Dept of safety and Professionalservices SOIL I EVALUATION REPORT Page of r"75 Division of safety and Buildings in accordance with SPS 385, Wis. Adm. Code county Attach complete site plan on paper not less than 8 112 x 11 Inches in size. Plan must include, but not limited to: vertical and horizontal reference point (13M), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed by Date Please print aY Infonnatiorr. pefsond Inkwnuffion you provide may be used for secondary purposes (Privacy Law, s. 15-04 (1) (m)). Property Owner Property Location GovL Lot 1/4" 114 S T N R E Lot # Block # Subd. or CSM# rty es Mari Address Prope Owne ROO City Statue Zip Code Phone Number 0 CdY 0 Maw Mown Nearest N P eso New Consbuction Use: Residential I Number of bedro(xns Code dived dflow rate 0 Replacement Public or commercial - Describe: i,w, Flood Plain elevation If applicable Parent material LL, General comments and recommendations. Boring Bodng # pit Ground surface elev. Zzf' Ground surface slay. it. Depthto limiting factor In. 1 / Depth to firnifi1- ng factor . .- / Z .- in. mg/L Effluent #1 = BOD > 30 220 rnq1L and TSS >30 :5 150 Mg Effluent #2 BOO 5 �530 and TSS < 30 Mg&_ CST Narrmy'(Please prSignature CST Number o) Address Date Evaluation Conducted Telephone Number 3BD-8330 (KI I/ 113 Parcel ID Baring Boring # pit Ground surface elev. ft. Horizon Depth Dominant Co4or' Redox Desc3ipfion Texture in. Munsell Qu. Sz. Cons* Wor e /V -27 Page of Depth to knifing factor SoR cation Rate Structure consistence oundary GPM z ESoll,A ff Gr. Sz. Sh. ff#1 02 ois Boe �.Vguul%u Z1LJ13C21-PV, =MV. It. Lj=VU I tv t" i HUI nj IMPM-4 FSoil Appfication Boring#a1 � �_�g U Pit soi, 611�k;dbun Ra-'w P�� LLtu I g1r,cT o 3"i6anc*;CI %I�UVA UCI IOmuta aUiIUCH Y —4 * Effk*nt #1 = SOD $ > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD , � 30 mg/L and TSS :S 30 mgiL The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. M-8330(R11111) ON ti , • cl Vol vow--, h boll as o�to coo 24 I • 133,379 Sa FT: \ " ' ,� F. ,� I31,81,6 SQ• FT. 3.062 ACRES,ry f \ '1 ' ���' !� f 3.026ACRES .'/ s � � �� L.B. Qf 896.6 � i c • s4fo- ILdo / NO2"55'21i ---" ��3\ 79,941 If lK � 54 - '� / DRAINAGE N10 53 W�� ".73`q�'c� Q r EASEMENT \ \ --- - �i► 1Ott\ \ A4 is At I V . •� s 132,770 Sa FT. 3.OU ACRES 'h It L.B.O.= 934•o °� ,� JAN '0 3 2023 10 V/ Ms. Wit. ' `' � SOIL EVALUATION REPORT Page of Divi" I` in acco"dar►oe with SPS 385 Wis. Adrn. Cute County r Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must Include, but not limited to; vertical and horizontal reference point (BM), direction and Parcel I.DTk,'f+ d percent slope, scale or dimenslons, north arrow, and locaWn and distance to newest road. Please print all information. R94eyied by Date P'essonW in€ormaUon you provide may be used for second" purpoum (Primacy Law. s. 15.04 (1) (m)). t Property Ownier Proputy Lo cauan �`' '► Gov . Lot 1/4 j • 114 S •> T - N R E (00*11 PropertyOwnees MaftV Address Lot ## Block # Subd. or CSl1 Z., _w City State ZIp Cade Phone Number ] City j„ 'Village own NeerW y � �..1��✓�11 �.�L�� � � � � � `' --'fir New ConStructim Use: Residential /plumber of bedrooms • Code derived design flow rate � . J G � -� -' � GPD 0 Replant Pub# cw CW- De'scribe. Parent material Flood Plain elevation If amicableZane • 7General conwrAmUs and recommendations: r 1,484;A Boring vy Boring # Ground sudiam elev. ` /, ft. Depth to limiting factor In. pit Soil #l+an Rate �n Depth DwiOnant Color PAdox Din Texture Structure Roots P 2 ff#1 102 In. Munsell Qu. Sz. Cont. Colair Gr. Sz. Sh. ` r Pit Ground surface elev. ft. Depth t4 limiting facto-. Horizon Depth Dominant Color Redox Description Texture Structure sistence in. Nhussell Qu. Sz. Cont. Color Gr. Sz. Sh. f,_ x Soil 8MciaVw Rate Roots GP'Dift .� 01 t ff * Effloont #1 = 8QD a 30 i 220 mgA- wW TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mgA- and TSS 5 30 mg/L CST No Signature r r f CST Number Address ' Date Evaluation Conducted Tabp#xxa Nor ,�..— or SBD-8330 (RI 3 r 1 t ) Prop�iy Owner �fi .. 1� 1� 'L Parcel ID # 0 Batv Pit Gaud =fiaos Nev. ,Z42 42 R page of 'S Depth to W"&g few In. sn aerArAMM aMA WIN ERE MM� PA Ao�= M VAA Q l�.....,.J 4 t..J Y� yi w �unla� �►. ii. ii� � iNcr � i� i+�i�tur '��. Sd Rabb a � irini.►'1 + � �� �::. � y..�r"i � %iir: i � L�, � � .`.�: ��rl� rv�r�i� i�if�� : � . i...�+.►� r � �/ri rr'Ln'.a/a :r � r.7.�+i'{ i\rir �.r'v�iir pia. � � . r� • � : • • - qY., !M- -) -- t+LL�- V�.•AL V�1N,M V�..7C.1, - ---- --_! _ _ U ENr�c . Z l A t iii 11 BaAV --moo-i 0 pit G=nd stufaw dev. ft. Dopth to &nWng bcOr in. owing # r�r.rw+w�i�.'_w...xvs-+�.+.w,-aa.rrw�sxa,..r._�.r. r...y,....-.��«..+t..�...-►--_.-.....�.M.-�. r.�._�-.- ..,.r�..�.-.... �. �. .---.. �� .+w•�- ��-...��..._._.....�_-, �...w,. _..-.+J...,.-rr.-..-�.-. .._..r�_....���.�.*rr..w- IMI 11 loll I P111- E11mrt #1= BW I > 301220 nV& and TSS >30 5150 nV& * Effluent #2 = BOD f 130 fr#L and TSS <_ 30 m9& The Dept. of Safety and Professional Services is an equal opporauuty service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 60-2W3151 or TTY dmmgh Relay. �•i:�*T���RIII7 / fq j IIr 1 i �011\ 1 l • ♦ ♦ i\ I r \ I �__q 1 4 r Jf/ 1 ! \ I+\\\\ 1 ti I 1[ I t '. �� i 11 \ \�-rf o a' 5 .-��-� y ,, 1 4i �_ I I N, f)flj[ri �l``L.y\ r l 1[ \ t \ 1\ 1 I 1 r 1 1 v f J i I I J �rlre! I 1 i 1 I t . 1 ley _r t .... Z56.��_ l f �1 1 ✓f L \-` 1 �\ ,n I \ Ir [ r `! \ \ t i ~, \ 1 l J r _ l 1 0+ ,- _I_ , . 1I L 'N. 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(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. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: 1f you wish to renew the permit, or transfer ownership of the permit, lease contact the coup authori P ty tY. Fj I w. ._M . ... .. .. . ... ......... . .. ...... ............. . . ... .............. .. .. . . . ....... ... .... . ..... . ..... .............. . .... .............. . ... ...... .......... ................ ....... ................ .... .... .. ............... ................ ...... . ....... ....... ..... . ... .. .. .. .. . ... Ica-M.M.-... iistKO ..... ..... SBD-06499 (RI 1/20)