Loading...
HomeMy WebLinkAbout004-1003-60-100S't. Croix County Planning and Zoning Tuesday, January 30, 2007 at 2:59:38 PM Detail Sanitary Information Page 1 of I Computer #: 004-1003-50-000 SublPlat: NA Section: 2 Parcel #: 02.28.15. Lot: 1 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 16 Pg. 4419 1/41/4: NW 1/4 NW 1/4 Owner: Halverson, John 595 310th St Spring Valley, WI 54767 State Permit: 420700 Issued: 02121/2003 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 07/17/2003 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Insaector As Buiit Plumber Other Requirements Additional Notes Monev Owed Not determined NA Helgeson, Bennie $0.00 Kevin Grabau Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/17/2006 Parcel #: 004-1003-60-100 01/30/2007 03:06 PM PAGE 1 OF 1 Alt. Parcel #: 2.28.15.22A 004 -TOWN OF CADY Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-owner O - HALVERSON, JOHN A JOHN A HALVERSON C -MENNIS, CAROLYN A CAROLYN A MENNIS 595 310TH ST WILSON WI 54027 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 4.912 Plat: 4419-CSM 16/4419 SEC 2 T28N R15W NW NW LOT 1 CSM 16/4419 Block/Condo Bldg: LOT 1 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-28N-15W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 05/19/2003 721920 2245/222 EZ-U 01 /31 /2003 707889 2127/463 W D 01/31/2003 707888 2127/462 WD 04/26/2002 677403 1879/297 LC 9AAR SI IMMORV Bill #: Fair Market Value: Assessed with: 164269 Use Value Assessment Valuations' Last Changed: 04/17/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 245,900 273,900 NO AGRICULTURAL G4 2.912 600 0 600 NO Totals for 2006: General Property 4.912 28,600 245,900 274,500 Woodland 0.000 0 0 Totals for 2005: General Property 4.912 28,500 245,900 274,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date; 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin~Department of Commerce Safety and Building'bivision PRIVATE SEWAGE SYSTEM 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 X Township Halverson, John Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~Z ~ Dosing ~ ~ ( p t Aeration Holding 'y TANKlSETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , Jr0 / ~,,,/ b ~ ~s i Dosing ~ ~ u ,~ ~ -~ .2.5 Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand t~LE6L. ~ GPM 1~• odel Number ~ (~ ~t,~~0 Lift ~ Friction Loss System Head TDH Ft ~~ 12.3k ,Sip (a. Sa 20 Forcemain Len ~ Dia. ~ U Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DAT county: St. Croix Sanitary Permit No: 420700 0 State Plan I Parcel Tax No: 004-1003-~.~-000 Section/Town/Range/Map No: 02.28.15. STATION BS HI FS ELEV. Benchmark I ~ [g T ~ ~ . b 1 Alt. BM ,~-_ Bldg. Sewer 'O 92.~~ St/Ht Inlet 2 , ~ p, l~ ~1~% _t SUHt Outlet Dt Inlet Dt Bottom ~~O' O ~p Uo- Header/Man. ~ ~ / OI. Dist. Pipe ~ ~ Bot. System • ~e o (. oo' F' al Grade `-~1 w ~ l~ ~ ex*' ~t -Ir -- ~ St Cover - `~ ~fSr OD •~' BED/TRENCH DIMENSIONS Width ~ ~ Len th ~ o. Of .~ ~ ~«~~ PIT DIMENSIONS No. Of Pits Inside Dia. Li uid Depth J ~ ~S SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ma acturer. INFORMATION CHAMBER OR Type Of Syst .,~, ~ ~, ~¢ _ r S~ UNIT Number: DISTRIBUTION SYSTEM -te d~ew~nss{,Op~, ~., Header/Manifold 2 1 lIl ~ ` Distribution ~ t~ ' pipe(s) c ~~p~" ,' 1 Z ~~~ ' x Hole Size (~ ~ ~ x Hole Spacing t~ 1 ~ Vent to Air Intake Length 7' Dia Length~Z ~7 Z' Spacing ia ~ Z SOIL COVER z Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I.x ~~ Yes ~ No ~~ Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspec Location: 595 310th St Spring Valley, WI 54767 (NW 1/4 NW 1/4 2 T28N R15W) NA !~) tion #1 ~ Inspects #2: '•T- % ~ r~ p~~ j. ~6t~~~~ ~`~ Parcel No-02.28.15. 1.) Alt BM Description = 1 ~ S 2.) Bldg sewer length = Zq~ '' ' I ~ ~ r -amount of cover = ~~ •' ~ry""~ 3) ~~ a- roe Plan revision Required? [ :1 Yes No • ~ ~ ~ i ~/ /_ Use other side for additional information. ( ~__ I 1~._ SBD-6710 (R.3/97) ~ D3te ~ ~~ Ins ctor's Signature Cert. No. Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 ST CROIX iseonsin Madison, WI 53707 - 7162 Site Address De artment of Commerce 5°~.~ 3~0 5T. Sanitary Permit Application s~~y Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ~~ ~ d~ ma be used for seco I. Application Information -Please Print All Info State Plan I.D. Number • /TR~ I ~ . P petty Owner's Name EEB 2 0 2003 Parcel Number&004-1003-50-000 2 UHN HALVERSON 004-1003-60-000 Property Owner's Mailing Address ST. CROIX COUNTY Property Location 4418 42ND AVE S ZONING OFFICE NW , y NW u• s 1 T 28 N R 15W , City, State Zip Code Phone Number Lot Number Block Number 1 IviINNEAPOLIS MN 55406-4044 612/203-2095 _ Subdivision Name CSMNttmber ~~Gn ~'`~7 "7 II. Type of Building (check all that aPP1Y) .~ ~ City {~ `f'~/ °J (/, J/~ 1 or 2 Family Dwelling -Number of Bedrooms 3 ~ ^Village ^ Public/Cotntnercial -Describe Use ' ]Township CADY G~ ~`~ ^ State Owned ,t'r~~ ~'`~ ~ ~ X ~7S Nearest Road C~-,1,-{~,t~ ADO, 2 ~ ~-~/ /. o ~s~a' c.f `I~'' 310TH STPcEET (vo -k'`igVE III. Type of Permit: (Check only one box on line A (nttm sting scheme for internal use). Complete line B if applicable) A' 1 ®New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to .. For County use S stem Tank Ohl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ^ Non -Pressurized In-Ground 21~ Mound ~ 22{ r~SDIC.47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade ~equ}red~~ ddOO"~~I-- Proposed 1 Zcb~ Rate(Gals./Days/Sq.Ft.) T, -~~-ii (Min.Mch) Elevation . ~,C7 ~ 450 450 450 ~~(. l ~~' ~ ~" N/A 101.2 ~ 103.02 IZ'~ D~ VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Steet Fiber Plastic Gallons Gallons of Tanks ,,,//Z~~ ~-IOZ~ Concrete Constructed Glass New Existing ~• ~ ~~ Tanks Tanks Scptic or Holding Tank 1000 - 1000 1 WIESER CONCRETE X Dosing Chamber 600 600 1 WIESER CONCRETE X VII. Responsibility Statement- I, the undersigned, assume respo bility for installation of We POWTS shown on the attached plans. bet's Name (Print) Pl 's Signature MP/MPRS Number Business Pbone Number ZtSENNIE HELGESON 20292 715/772-3278 Plumber's Address (Sheet, Ciry, State, Ztp Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII Cottn /De artment Use Ohl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surc ge Fee) Date Issued a I gent Signature (No Stamps) en Initial Adverse ^ O Gi ~ , /oZ/ ~ . wtur v ~ ~ ~ D GZ~~ ~ ~~~ Determination " ~ 1X. Conditions of ApprovaUReasons for Disapproval . /, , ,. - _-~ e.eh~rn~c~+ • 2,~ (.rnG~- °~.5~~-~e._G~~J r^'+ ' O ~e c~ w/7'~'~~ ~ Q ~ -Gt~c..~- ~ ~ Pou~_ Mph Pte. ~u~, ~.~/ , ~z ~ U~o-~~. ©rrr~-tom w/~ _JG^~t!'~I!W`~%V ~ /1 i ~-~ _ /1 / / ~ _ ~ .. _y _ J n l~ ~_ !F~ w ~u ~O _ _ / ^~...~ gyn. ~ L C.C!'~CS °'~->r-s-iri/h .,,wv.v,rn.~....__ ~,v~r.w----- --- ~~..r..... ._ i (to the Conatj otil~) for the r~stem on paper not less than 81/2:11 inches Lt she •.: ~ SBD}6398 ~R. 05!01) ~\ JO ~ (a J `n c~ ~~ ~ ~ ~ ., _ ~, ~~~ cr ~ .~ or ~ cr- 1) ~ e ~~3~~ ..s'~ -~- o ~ M ' ~i L d~ o ~?-i o ~ c~ a~ 0 d ' ~ ~ i 4' / p~ ~ ~ J ~ / ;- ,~ ~ ~n - ~'~" ~ ~ 3/ m ~ ~ i ~° a o _ i ~ V/ ~~ `~ ~ ~ r ~ ~~ In ~ 1" ~s ~ ~' ~~ ~~- ~ r ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary October 08, 2002 CUST ID No.220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 COND[TIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/08/2004 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 S[TE: Bruce French ~.~ job, h 1~Gc~V~2rS~ 310TH St Town of Cady St Croix County NW1/4, NWl/4, S2, T28N, RISW FOR: Description: Three Bedroom Mound System '~'~ Object Type: POWT System Regu ate bj~ct ID No.: 872449 Identification Numbers Transaction ID No. 792444 Site ID No. 651058 Please refer to both identification numbers, above, in all corres ondence with the a enc . 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal t^ottdltt are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption AP P RI area. chs. NR 811 & 812c pEPARTMENT 0 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. i1F SAFET ~~ CQRRES • 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. Stat • Comm 83.22(7) 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. BENNIE W HELGESON Page 2 10/8/02 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 INDEX SHEET PROPERTY OWNER: BRUCE FRENCH 3026 60TH AVENUE WILSON, WI 54027 PROJECT NAME: BRUCE FRENCH .h, ~ ~: ~, ,~~_; I V .. V `'`„ ~'~ ~`~oo~ ~~ ~r/~' , PROJECT LOCATION: NW 1/4, NW 1/4 , S 2, T 28 N, R 15 W MUNICIPALITY: TOWN OF CADY COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section & Specifications Page 5 W 1000/600-MR Zable Tank Specifications Page 6 Pump Specifications Page 7 POWTS Owner's Manual & Management Plan - Pg. 1 Page 8 POWTS Owner's Manual & Management Plan - Pg. 2 ~nally Name: Bennie Helgeson Signed Address: W 1229 770th Avenue ~ COMMERCE I AND ILDINGS Spring Valley, WI 54767 Credential Number: 220292 Date: September 12, 2002 •POND~N 00 (a a ~ p ~ ~ ~ ~~ v ~ ~ 4, `y a ~ ~' ,, cr w ~,. ~ ~ d ~~~~ '~ ti ,~ ~ ~ '0 ~~ 0 s~ ~- ,_ o ~ M ~~ ~~ ~° ~~ ~, ~ ~ o ~-~ ~ o~~ ,i ~ d~ _ ~ ~ d ...~ ~ ~ L ~ , ~~~ M~~ `~ ~ o 0 ~ ~ ~~ J ~ ~ ,~ r, v> - `~~ .~/ ~ ~ ~ ~. ~° m , ° i r i ~~ V~ ~ ~ ~ ~ ~/ / !- l o vi ~ ~` ~ ~ _~ ~ ~ -~ ~ ~, `n i ~ _ `` ~ ~ ,_ ~~ ~ ~ ~~ Synthetic Covering AS7"M C 3-3 Medium Sond Topsoil ---~ ~ E 3 (Q % Slope C C L~.0 f 2~- 2 %2 Aggregate ~" Cross Section Of A Mound Signed: License Number: Date: Page ~ Ofd -Distribuf ion Pipe /c/. F ~~ ' D C ©~ n`~c~u. ~ IQ y. , Force Main From Pump q ~ Ft. ~~ ~ g _~~ F t . K~_Ft. L ~ Ft. d ~ Ft. y L. L, ~• = `5/~~-day r ~ Ft. L. Observation Pipe ~ ~ K r-_-_----_---'-_---_-__".--_ 1 I o A ( ~ G Q ~ __ ---------------------_ - - - - - - w ~~ - _ T ------- - ~Distribution CALL Of 2' 2'2' Pipe Aggregate I Observation Pipe ,/a~~ ,8~s.~,~i-c~.- Plowed Layer D ~_ Ft.'s E /, 3~ Ft . F ~g~ Ft . G , S Ft. H ~_ Ft . W ~ Ft. ______-- Plan View Of Mound ~~~er^ ; C ~eo.~,o~-t A.L(CSC C. ~ IE'CW 0~-~-/ Pertoroled Plp• Oeloll l End Vlew P~rlorolad ~ ` 1 Holes Located on Bottom are Equally Spaced 'orCe. ~~ ~^_ ~, -..lam ~o Ic /Ue x~ -E~o /~ah; +ol ~ If'~ rip• Distribution Pipe Layout R S X~~ Y ~,3 2 Signed: License Number: Dace: Hole Diameter ~ Inch Lateral " ,j,~___ Inch (es) Manifold ~ _ Inches I~'orce Main " ~ Inches Na IPS T Pd; ~R~FI~'Q./' 3 k 7"~ ~ ~ a~.~~ I s -- 7 ( fi6~ ~ dlc?VIP ~ ~~ k~~ ~ ~ncl~, Page `f Of$ SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ~~ 4 .QVC..VENT PIPE 12" MIN. ABOVE GRADE E >_ 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE FINISHED GRADE ~~ b K~n• 18 " I N . y~~ Pv ~ ae~sEaw-T~o~ PIPS INLET ~ WATER TIGH SEALS - A FILTER ZA 8 ~ I- __1__ APPROVED PIPE 3' ~~ ~a..X ~~ B -~ ONTO SOLID C SOIL PUMP OFF ELEV . OFT D WEATHERPROOF JUNCTION BOX WITH CONDUIT Zy" • s, d. ~, ~ ~, GAS- ~ ~, TIGHT• SEAL ~ ~ I ' 3" APPROVED BEDDING UNDER TANK APPROVED MANHOLE COVER W / PADLOCK 8 WARNING LABEL 4" MIN. •„ ~$ MlN• VAPPROVEO JOINTS WITH ALM APPROVED PIPE. ON 3' ONTO SOLID SOIL OFF CONCRETE PAD SPECIFICATIONS Yot~ l C ~.1 s =- ~ ~i- GIs SEPTIC / DOSE ` ~•~,~C/ x ~ ~. (~6~ ~ G~~. TANK MANUFACTURER : ~ ~~i.~S~~ TANK SIZES: SEPTIC /~Od GAL. DOS qV7~~ FLOWBACKG ~. S/ GAL. DOSE / o ALARM MANUFACTURER: S. e~ ro 5~,,~SCAPACITIES: A = MODEL NUMBER: /,•~i t/ B = SWITCH TYPE: M r =~-M ~=/oas.~ PUMP MANUFACTURER: ~b•e.l~'e~- C MODEL NUMBER: D SWITCH TYPE: .~ ~~ ~~d~~ REQUIRED DISCHARGE RATE .~ ], 1(o GPM PUMP E ALARM WI INCHES = 3~/• 6b' GAL. 2 INCHES = .3.3• S-> GAL. ~o INCHES = ~~ S~ GAL. INCHES = ~~GAL• ING AS PER ILHR 16.23 WAc VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ~_ FEET + MINIMUM NETWORK SUPPLY PRESSURE ~ ~ FEET + ~- FEET FORCEMAIN X 2„~. FT/100 FT. FRICTION FACTOR •-• ~~FEET TOTAL DYNAMIC HEAD WIDTH DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LENGTH LIQUID 3~0'' y- C/ o~ (~ 6 ~ 7~ G~.1, ~P~ .~`~ ~ ~, ~~Pa S e ~ t ~ cc n ~ S~e c . J''l SIGNED: LICENSE NUMBER: DATE: 1/88 -~~~~ 150' s s ~• ~~ _ ' { _, ~ ~. TOP VIEW SCALE: 1 /4' a 1 OUTLET a o, SIDE VIEW P WLP1000/600-MR ZABLE TANK SPECIFICAl10NS DIMENSIONS: WALL: 3' BOTTdrI: 3` COVER: 5' MANHOLE: ?~4' I.D. HEIGHT 56 O.D. LENGTH: 150' O.D. WIDTH: 84' O.D. BELOW INLET: 42' O.D. UQUIO LEVEL: 36' WEIGHT: 14.795 18S. INLET AND OUTLET: 4' 80RE WITH STOP FOR OUIK-TITE. FERNCO GASKET. CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLES: WISCONSIN. SEE DETAIL X10 (OTHER STATES SEE CHART) 4' VENTS uQUID CAPACITY: 27.68 cAL/IN sEPnc) 16.76 GAl/IN PUMP) «.__ LOADING DESIGN: 7' 0' UNSATURATED SO1L VLET iY ~Oa~p~~~ MiJ716 US HNY 1Q YA~OEN ROgC. VM 3730 800-325-8456 M000. WLP1000/600-MR ZABL.E SEPnC/SEPnC. SEPTIC/PUMP OR SEPTIC/51PHON JANUARY. 2000 FA.E: r+~iooo Boo-uR -~ U u1~~r ~, l car ~. ~ e ~r-~n c~h . ~, ~ HEAD C APACITY CURVE MODELS 1371139 MO DELS 137/ 139 M l G Lt Ft. eters a . rs. 5 1.52 93 352 s 2s ~ 10 3.05 79 299 Z / 15 4.57 sa 242 6 2 • t 20 25 6.10 7.62 36 8 136 30 1 s Lock Valve: 26 fl. 4 ~ ~ . `~ 2 10 s 0 S. GALLONS 1 0 20 3 40 50 60 70 80 90 1 00 f 10 TERS 80 160 240 320 400 0 FLOW PER MINUTE 009921 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V, 230V or 460V. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Mechanical alternators, for duplex systems, are available with or without alarm switches. • Simplex Panels are available for 3 phase pumps. • Control alarm systems are available for 1 phase pumps. 137 Series - 47 lbs. 139 Series - 51 lbs. Sin le Seal ConVol Selection Listin s Model Volts•Ph Mode Amps Simplex Du lex CSA UL M137/139 115 1 Auto 10.7 1 or 18 8 - Y Y N137/139 115 1 Non 10.7 2 or 2 8 7 3 or 5 8 6 Y Y ' BN137 115 1 Auto 10.7 Y Y D137/139 230 1 Auto 5.8 1 or 18 8 Y Y E1371139 230 1 Non 5.8 2or287 3or586 Y Y • H1371139 200-208 1 Auto 6.2 18 8 Y N ' 1137/139 Z00-208 1 Non 6.2 2 8 7 3 or 5 8 8 Y N ' J137/139 200.206 3 Non 2.6 4 384 or 586 Y Y ' F1371139 230 3 Non 2.6 4 384 or 586 Y Y ' Gt37 460 3 Non 1.4 4 384 or 586 N N ' G139 460 3 Non 1.4 4 384 or 586 N N ' No molded plug "Single piggyback switch inducted. Pumps must be operated in upright position. Three phase units require a control switch to operate an external magnetic contactor. For information on additional Zoeller products refer to catalog on Piggyback Variable Level Fbat Switdles, FM0477; Electripl Alternator, FM0486; Mechanipl Alternator, FM0495; Alarm Padtage, FM0732; and Sump/Sewage Basins, FM0487. SK373 • Variable level control switches are available for controlling single and three phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. • Over 130°F. (54°C.) Special quotation required. • Refer to FM0806 for 200° F. applications. ~~e (o O~8 13/16 ~ 7 7/16 4 13/16 _ ~ 1 f/2" - 11 1/2 NPT SELECTION GUIDE 1. Integral float operated 2-pole mechanical switch, no external control required. 2. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 3. Mechanical aflemator M-Pak 10-0072 or 10-0075. Refer to FM0495 4. Simplex three phase control panel. Refer to FM1228. 5. See FM0712 for correct model of Electrical Attemator. 6. Variable level control switch 10-0225 used as a control activator, speafy duplex (3) or (4) float system. CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 L• W Louisville, KY 40256-0347 Manufacturersol.. ~ SHIP T0: 3649 Cane Run Road ® ~ ' ® Louisville, KY 40211-1961 Q~,Y PU,wPB S%vCE I9~9 http://www.zoellercom ~~/Y//- ~0 (~2) 7 x(502) 773624 PUMP © Copyright 2001 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL 8~ MANAGEMENT PLAN Page 7 of b FILE INFORMATION -r- " ~ Owner BKL'C ' NCH JONfi~ I~ ~V Permit # n~etrN PARAMETERS Number of Bedrooms 3 ~ ^ NA Number of Commercial Units ~ ~] NA Estimated flow (average) 300 al/da Design flow (peak), (Estimated x 1.5) 450 aVda Soil Application Rate p , 5 aVda /ftz Influent/EffluentQuaiity Monthly average' Fats, Oi18~ Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) 5220 mg/L Total Suspended Solids SS) 5150 m /L Pretreated Effluent Quality .~ [3 N Monthly average`' Biochemical Oxygen Demand (BODS) s30 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer IESER CONCRETE ^ NA Effluent Filter Manufacturer ab~~ ^ NA Effluent Filter Model A-100 12"x 20" ^ NA Pump Tank Capacity 600 al ^ NA Pump Tank Manufacturer WIESER CONCRETE ^ NA ,Pump Manufacturer ZOELLER PUI~iP CO ^ NA Pump Model 137 ^ NA Pretreatment Unit CS NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other. Manufacturer Dispersal Cell(s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Dri -line ^ Other: • Values typical for domestic (non-commerclaq wastewater and septic tank effluent. *• Values typical for pretreated wastewater. .....~r~~iwu~-c ~rucn~n c IYIM1171 GI~AIwL. ~av~ ~a.V vr.r Service Event Service Frequency Inspect condition of tank(s) At least once every 2 ^ months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every 2 ^ months ~ year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1 ^ months ~ year(s) Inspect~pump, pump controls & alarm At least once every 1 ^ months ~ year(s) ^ NA Flush laterals and pressure test At least once every g ^ months ~ year(s) ^ NA other. At least once every ^ months ^ year(s) ^ NA other. At least once every ^ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servidng Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatipment components; and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. STARTUP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. OWNER: BRUCE FRENCH • System start up shall not occur when soil conditions are frozen at the infiltrative surface. Page ~ of ~ During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior tti restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the pertormance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump primp) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMNIENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. ~ After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: , ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction, and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS r technology a holding tank may be installed as a last resort to replace the failed POWTS. not identify a suitable Upon fie of the P a soil and I ~/~,ite a aluatiol~mt~f be erf e o locat uitable placer4a~larea. If replac~~t'area is avt-e a ~~ holding tank may be installed as a I ort to a the failed POWTS. l'~1 Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the ruses in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Phone 7i5 772-3278 POWTS MAINTAINER Name ' Phone 715/273-5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Phone 715/273-5811 Agency ST. CROIX COUNTY ZO ING Phone ~ 715/386-4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agenGes. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) R (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (Z/01) ~,~RIGINAL ~`~.~~ 3 0 2002 16os Wisconsin Department of Commerce SOIL EVALUATION REPO Pa e 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S7. r/F~:)IX CC)UP~ ~ i, C rtified Soil Testing C Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must i l t li i d b d l i l f M i St. CrOIX nc u m u e, not te to: vertica and hor zonta re erence point (B ), direct on and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 004 03-60-000 Please print all information. Re ewed B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ a,(f ~ 3 Property Owner ~ '[3(/l ~ ~ ~ Property Location French, Bruce p}{ J i~W~1ZS0 Govt. Lot NW 1/4 NW 1/ 4 S T 28 N R 15 W Property Owner's Mailing Address Lot # , Block # Subd. Name r CSM# /~ ~ ~~~ " 3026 60th Ave. , tF l City State Zip Code Phone Number City Village Town Nearest Ro d Wilson ~ WI 54027 715-772-3334 Cady (pp+kl 310Th St. lT(K. New Construction Use: _/_I Residential /Number of bedrooms 3 Code derived design flow rate 450 Replacement ,~ Public or commercial -Describe: Parent material loess over till Flood plain elevation, if applicable General comments and recommendations: install 4' x 112.5' rock bed mound on 100.2 contour as upslope edge of rock w/ 1.0' sand fill ~~ (p f ~G~iS>F~ ~QQ GPD NA ^ Boring # -Boring /! Pit Ground Surface elev. 101.2 ft. Depth to limiting factor 41 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 ---- -+ 0-9 - 10YR 3/3 - sl 2 f sbk ds cs 1 f/m .5 .9 2 9-15 10YR 5/4 - sl 2 f-m sbk mvfr cw 1 m .5 .9 3 15-27 10YR 7/3 - fs 1 m sbk ds cs 1 m .5 .9 4 27-33 10YR 6/6 - s 0 sg ml cs - .7 1.2 5 ~ 33-41 10YR 7/3 - fs 0 sg ml cs - .5 .9 6 41-51 10YR 7/3 fad 7.5YR 4/6,5/3 fs 0 sg ml - - .5 .9 ^ Boring # _ . Boring Pit Ground Surface elev. 100.2 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D,'ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. `Eff#1 `Eff#2 1 ~-0-6 10YR 3/3 - sl 2 f sbk ds cs 1f/m .5 .9 2 -; ~i 6-11 --- 10YR 3/3 - sl 2 f-m sbk mvfr cw 1 m .5 .9 3 11-22 10YR 4/4 - fsl 2 f-m sbk dsh cw 1m .4 .6 4 22-32 7.5YR 5/6 - Ifs 1 m sbk dsh cs - .4 .6 5 i 32-40 7.5YR 5/6 f2d 7.5YR 5/3 scl 0 m mfr - - 0 0 horizon 4 has some inclusions 10YR 4/4 fsl; horizon 3 loading downgraded from code 0.5/0.9 due to fineness of sand - tmuent ~~ = csws > 3u < zzo mg/L and TSS > 0 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS _< 30 mgr CST Name (Please Print) Sig at e: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 8/20/2002 715-233-0398 Property Owner French Bruce Parcel ID # 004-1003-60-000 Page 2 of 3 Boring # -.~ Boring Pit Ground Surface elev. 99•$ ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Du. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots ' *Eff#1 *Eff#2 1 0-5 10YR 3!3 - sl 2 f sbk ds gs 1f/m .5 .9 2 5-11 10YR 3/3 - sl 2 f-m sbk mvfr cs 1 m .5 .9 3 11-24 10YR 4/4 - fsl 2 m sbk mvfr cs 1m .4 .6 4 24-32 10YR 4/4 c2p 7.5YR 5/8,5/3 fsl 1 m sbk mvfr cs - .4 .6 5 i 32-48 10YR 7/3 f1 p 7.5YR 5/8 fs 0 sg ml - - .5 .9 horizons 3 & 4 loading downgraded from code 0.5!0.9 due to fineness of sand Boring # ~- Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 'Eff#2 I ~ __ _~ i i I ~I Boring #~ Boring '! Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I -- I i ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <_ 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-Si30 (RA7/00) Certified Soil Testing J 9a J z J ~' 3 nJ `ice 0 n r d Y f ~~ ~~ r ~ S 0 "' N t ~1~ M f'~' ~ ~~ } J p J'~ `m ,~, ~f r.w.n .~ 1~ ~~ d J J r 0 r~ a Q -.~ P ~, 5 ~n ~ M '~ d v f 0 7 ~ ~ ~~~ ~~~ r ~. » i ~ ~ a ~ v ~~ o~ 6_~' } ~~ Gs~ !~ ~ ~i i 0 ~`f n~ / N 0 a1 y ~ S ~ ~~ J O f~ V 1 ~r ~.! ~ .~ $ e a ~l ~ ~ `b ~pp ~ t ~` 7 ~ i ~ a. ~ }}~ J d .L'p V A' ~ so~ ~ ~ ~~ V ^, R ~ j f ,~ •~ ~n J ~ J r e~ o -' ,~ ~ ~ ~~ ~l 9 M4 i a ....I tV ~~ ~:1 ~- ~~c• a '_ r~~ti ~= - ~F aTi T9 T' >=> ._Y~- . C ~D T i e Q U~ ~ C ~fi7 1 ~ ~a~~e ~ ~ ~~ ,r, f~l 1! S', ~ ~~~ ~~~~~ e ~ Y ViP ~ ~ ~ ~ ~ ~~ . ~ 4 ~ ~~ ~rrtiae 1!!¢C1f~~ ~~ ~~ QX ~~ ~ ~~~~ ~ ~ ~~! ~~~~~~ ~3 ~~ ~ ~~ ~~ ~~ ~~ . ~~ s ~o~~ J ~ ~ A ~~~~ c~ ~~ 0 ~s ~~ .000O- .Zp' •00'ff .~lY _ _ ~. ~~~ ~tl1S F~ti` ~o~ ~~Q I~ Ito xe ~~ ~ ~ ~ ~ ~ SdIVrI10311Y7diV~T ~Qa ~a~~a+~i~as~ ....~.n~$.~..,~~ s~ jp;~ ~ ~'~~~~i east ~~ ~ t lde[3 ~OL~N LO~Ziss/[T aaua ~i ~ aus~o~ . i~ ~' ~ xiob •as r®8Q ,~0 ffiLSI~ ~LC~d~L ~_ N ~~~ o ~ ~~ oo~t ~ ~ F Document Number U 2127 P `I63 STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED This Deed, made between Bruce A. French and Ruth A. French, husband and wife Grantor, and John A. Halverson and Carolyn A. Mennis, both single Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate i;~ St. Crain _ County, State of Wisconsin (if more space is needed, please attach addendum): 7'07689 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 01/31/2003 03:30Pt[ EXEIPT # REC FEE: 11.00 TRANS FEE: 89.70 COPY FEE: CERT COPY FEE: PAGES: 1 Recording Area Name and Return Address Lot l of Certified Survey Maps in Vol. 16, Pa a 4419. Being part of the ~~ NW '/. of the NW '/<, Sectton owns ip 28 North, Range 15 West, Town nn of Cady, St. Croix County, Wisconsin. ~, ~~ ( ~(,~,~' lv~' N~erlamDln~e wi ~-~~ i ~~~ 004-1003-60-000 & 004-1003-50-000 Parcel Identification Number (PIN) This is not homestead property. (~) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~~ day of December , 2002 * * Bruce A. French / ~ 7 - ' ~ ~ ~ '+, * AUTHENTICATION Signature(s) authenticated this day of , TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) * Ruth A. French " a . '~ -~. ACKNOWLEDGIF~)~I~' . ~b'j 0 N ~ ~ STATE OF WISCONSIN ) 'z~~! ~:~. •` r' County ) ~~~gpyn~.~~~~~N, Personally came before me this ~~ day of December 2002. the above named Bt~:.'it~t and 1:uth A. French, husband and wife to one known to be the person(s) who executed the foregoing instrume and/acknowledged the same. * ~.CI~C LGl a~---'~ Notary Public, tale of Wisconsin My Commission is permanent. (If not, state expiration date: ~~ ~ ~ j ~J~~~ J * Names of persons signing in any capacity must be typed or printed below their signature. iroormacar, care:aione~s c~Peny, Fora au tee, wi eooess-zoz~ WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~ ~ . ~'I~ - /r~y Mailing Address Property Address City/State Parcel Identification Number LEGAL DESCRIPTION Property Locaticn ~_ `/4, .~C~ ',~, Sec. 2 , T .2 8 N-R / 5 W, Tewn of ~ u Subdivision Lot # ~ t Certified Survey Map # '7~ Volume ~ ~ ,Page # ~yi q~/~~0~/0 2 ~Varran Deed # 7b7 ~~r/ ,Volume ~/a ~ ,Page # !~ ~v /3//03) h' Spec house ~ yes ~i no Lot lines identifiable ®yes O 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 car .,ifect the fimction 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, restrictedpltunber or alicensed pumper verifying that (1) the on-site wastewaterdisposalaystem 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. Uwe, 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 tl"iat your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the ee ear expiration date. ~//~/off NATURE 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 owner(s) of tiie pro e es 'be bove, by virtue of a warranty deed recorded in Register of Deeds Office. S ATURE OF APPLICANT DATE "`~`*** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** o~~ ~ '~'~ .ST (Verification required from Planning Department for new *• 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 FROM Fq?i h1C. Mdu. 21 2@10._ i2: ~~Ft'I Pl BIOS abed 9:'ioJ1 ~ .~ ¢¢¢ a ~_ E A i 133+6 f ` ~ ~~ I „~ £ - ~ ~ ~~ i. ~ r~''~j I ~ k O S iii~~~ 1, ~ '~ ~ a~_ _ ~ ~ u ~~ ~~ ~ 4~~~~"~~•~ paa~ k' dl s ~ ~ ~ ~ ~ V~ ~~ 3 ~~ ~~ ~ ~ $ b ~ 4 €~~ ~ ~ ~ ~ ~ ~ ' e '3 ~ PAC E ~ # ti ~ i~ .. .~5~.: r..~, y - i x h -.-. ~ iEl~ ,FORS m~41 I ~~~ ~ ~S {f~ w y ~~ '~ gAp7ySVtl!'3~IZ A ~r+~ ' i x ~ ~ Yr~ ~ - - ~ ~ ~ 3 ~s~j~s ' ~ ^~~ ~Y~Y N ~J P] ~~ _ _ ~ JM ~ ~ ~~~ ~~~~ ~~~ ~~~~ ~~ ~I~~ S ~9~~ ~ Q ~a ~ 4 ~~ ;~~~ P ~ ~ ~ ~ ..->;r~ ~~~.. .._ ,~~ - 171!!; F{I~l~ ~ ~~ I~I ~ ~ ~ ~ ~^~~ ~ ~S N~ ~ ~ ! 6N3~tlD A9 ~'11D $~ ~.~(~ ~ ~~ ~~ ~ I ~~~Q~l~ ~~ =w~ au of aa,~em33e ~aae+3a & n $ ~ 51 p ~ ~ IY ~~' ~ ~ ea ~C 1 ~yJ~ G~C1 ~!'ET ~37d ~3tl E 1![33 WBS~GY L8tEr4irCT , Q~O~s3 71Di RdAI7~Y to • ~ x;?oa~ •as $®~. fQ ~~Il'~ g8'1T~ 'N 1RttZH L-GiioCdiO~