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018-1408-65-400
3~ c~ ~~~ a~~Vy ~~,~~~ ~ ~o~o~,~ April 11, 2008 JOM Properties 225 LLC c/o Judith & Orlin Myrlie 3624 Ashbury Rd. St. Paul, MN 55122 Code Administration 715-386-4680 RE Land Information ~ Planning 715-386-4674 Parcel # 018-1086-54-000 -Computer #20.29.17.674 Lot 54 Hammond Oaks - 869 1615' Street, Hammond, WI Dear Mr. & Mrs. Myrlie: Real Property Our office received a complaint that an existing Private On-site Wastewater Treatment System 715-386-4677 (POWYS) installed on the above parcel is malfunctioning and causing damage to the neighboring property. Recycling 715-38b-4675 An on-site inspection was completed on Friday, 4/4/08 to determine whether the complaint was valid.- Lot 54 utilizes an At-grade POWYS that receives pressurized wastewater dosed at intervals. The western end of the At-grade extends onto Lot 55 as a result of error by the installer in determining the location of the shared property line. There is concern that the forcemain has been damaged since its installation on May 16, 2003 and is discharging wastewater into the ground on Lot 55. At this time the residence is vacant. An area of soil erosion was observed off the southwest corner of the POWYS, but a licensed plumber needs to conduct a pressure test of the distribution pipes to determine whether or not the forcemain is operating properly. If the pipe(s) are found to be damaged, a plan must be submitted to the Planning & Zoning department by the plumber, along with a repair permit application for staff review and approval. The permit must be issued prior to any work being done on the POWYS. The plumber's inspection and report on findings must be completed within 30 days and/or before anv new tenants occupy the residence. Please feel free to contact us if you have concerns regarding operation, maintenance, or inspection of the POWYS servicing this dwelling. Sin , i Pamela Quinn Zoning Specialist Cc: Mike Rogers, Rogers Plumbing Kevin Grabau, Code Administrator Town of Hammond $T. CRO/X COUNTY GOVERNMENT CENTER 1 1 O 1 CARMICHAEL ROAD, HUDSON, W/ 54016 715-386-4686 FAX n~/li (-~ nninir ~-n/~iV Inii iit^ \nn Al\nl !`l~ I~AInIT.I^IIIIIV toil II(~ rQ l b~ t Q G 0 -~ P ~ ~ // _~ p t ~ t i :~ ~ ~ ~~ A ~~. i t r-~, ~c,~. f ~: ~ ,n o s ~ ~'-~ ~. ~ ~ ~~~~~~ ~~ ?~~~~ ~-- \' I~r'~ ;°'~~ A i~ V` ~'r ~ try " 7~ .. 1/Til') ~,~. 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O iR i O ~1 fO C 1• O 0 ~• 0 a N N O d W Vp O~ ~ N 'r N "+ y 'v Al Wisconsin Department of Commerce PRIVA'CE SEWAGE SYSTEM Saf~,ty and Bu~ ing Division 7 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 M rlie, Orlin & Jud Hammond Townshi CST BM Elev: Insp. BM Elev: BM Descri tion: l 0 0 .- a ~ S ~ Co rvu~ o >~Y ~ itil ~ rn~l~ IucnQnnerlnwl FI VAT N DATA TYPE MANUFACTURER CAPACITY Septic - /~ ~ O Dosing /y ~D ( ~~ Aeration ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~}~ / /O ~ ~ I ~~P. Dosing ~ ~ ~ Aeration ~,(~, Holding PUMP/SIPHON INFORMATION D~.-(/~.t ~. Manufacturer Demand GPM Model Number ~ ~ I s„Z ~ Q TDH Lift Friction Loss System Head TDH 0 Ft IS•1 `~ i 3 •R ~ ~,~~,,,u,,. ~ .. ~- ~ ,v y-E-~' SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches DIMENSIONS 12 ~ !/~~ ~ ~~ SETBACK SYSTEM TO / P/L~ BLDG WELL INFORMATION Type Of System: ~ ~ ~ DISTRIBUTION 5Y TEM County: $t. t:rOiX Sanitary Permit No: 420632 0 Stale Plan 1D No: Parcel Tax No: 018-1408-65-400 STATION BS HI FS ELEV. Be~ tsa ~ h/t ~ ~ . S~ /a/• ~ l ~ ~ ~ lS Ai~Ba-~{7rn S Ian/1.1.. S ~ ~ ~S ~ O S, Bldg. Sewer f ~~ ~ 3, 3 ~ / . 7 8 • ~/ St/Ht Inlet , ~ ~ n .7 SUHt Outlet '- ~.._ Dt Inlet ~I~rib ~ Dt Bottom ~/. / ~ ~v /8 ,/Z S~ ~ n d Header/Man. ~ .,L~iM.L - f/K, Dist. Pi/pe~ 1 .~1' ~i+/'1' a f' 7 ` • ~~•~~ B ,Sys m / ~ D`, ` D, 1 Final Grad ~ ~ /- l St Cover l -~ • - Sia~,~ 8• Z X3.3 85 - v s ~ % ~d ~ I ' ~fF~ PIT DIMENSIO S No. Of Pits Inside Dia. LAKE/STREAM ACHIN Manufactu CH E OR D Model Nun Header/Man~fol Length Dia 2" Distribution Pipe(s) Length ~ Dia 2 ~ ( /" ~ Spacing x Hole Siz ~ ~ ~o t x Hole Spacing 2 3 1~ Ve to Air Intake .+,, " SOIL COVER v Procc~~ro Svetoma rlnly ~ vx Mnnnrl Or Ot-Grade SV$temS Only ~' c.P~~ ~U Depth Over ~- ,,,,nAJ _ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center u v~_ , _~ n ~ ~, r Bed/Trench Edges Topsoil ~] Yes ~ No ~ Yes [~ No COMMENTS: (Include o discrepencies, persons present, etc.) Inspection #1:~/~/ Inspection #2: / / Location: 869 161st St Hammond, rWI 54015 (SW 1/4 NW 1/4 20 T29N R17W) Hammond aks L~ t A4 ParcCeQ~lbNo: 20.29.17.674 1.) Alt BM Description = ~ Cr Slag GvP~I/ ~-: S. -1®""v p,~ ~ - Gl"~U~ ~ r ~ 2.) Bldg sewer length = 1 ~~y~~~~It~ ~6L,, _ /_ ~~,.~~ b - amount of cover = I.~ Y~1 ~`' W~t~ ~ lrvt/ .S7~v~ ~v~%~"'~ - v ~~' r~~ 1D fivv~,a Fu,rre~.t/•a/ M~~ vr'~~i~_ ~° ~~'~ ., r--~--~ ~ -- -- --- i , Plan revision Required? ~1 Yes [ No ~ ~~~ ,~~/j ~ i ~ ~ ~ ~ ~i Use other side for additional information. !,---J~__[____'i ____ _____--- ~'w~____ __ J ~-- _-~ SBD-6710 (R.3/97) Date - / Insep tot's Signature / ~ Cert. No. G r a 9 a J s G .-~b l n,. y s r l~ S f _~ 9 e i 0 ;. 3 c" 1 Q 3 on .9 ~~ ~ ' ~ ~ ~ i ~ n ~ .1 1 $ °¢ .~ ~, N ~ t ~ ~, a ~ y -~ -- ~ ~ a ~ s r i , a `~ ~ - o ~ I ~ ~~ ~- ~~ '~ ~ 3 ~ 3 .N ~ .~ ~ -~ ° ~O ~' .~ ~ ~iI ~ ~ J ~ ~ ~ ~ V ~ , ~ tJV ~/ ~ I" f .~ `~ 9 s, J S ~~ J v ~ , ~. v ~ .. ~~~ ` ~i ` \ / 1_` o.~ `~~so ,2L. ~~. '~ n` i y t_/ 0 ~~~ ~~~ 3~~ O s s, ~ 1ks u o b N v (~ \_ ~ I ~.~- J N !. ~ S J1 ~ I .j ~,, ~Q -~ N la ~1 r ;~, -- _~ r^ ;is ee d ~~ (~ _()~J J V _, a v ~, ~ ~_~ ~_-~- S ~`J ~ t`5, ,C V ~ .`5 v = v ~m~ ti, r-NC^ v jjr,-, r. / GLT'`/ --~Nl J !'it J »> c '_>r- S~ ~ d ~-- ~ ~ ~ 3 a I N C Z C; Safety and. Buildings Division County `~ X ~ ,~ 201 W. Washington Ave., P.O. Box 7162 <S~® ~Se ~ Madison, WI 53707 - 7162 Site Address < , De i I Z•9o•oZ- 3f ~`f`g~ ~+ ~~0 ~ ~i ~ST~ ST . Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide L` "~ ^ Check if Revision 7 ~~ ma be used for second ones Privac Law, s15.04 1 (m I. Application Information Please Pri nt All Information CE'v State Pl I D. um er ~~2~9,/~,5. , Q ~~ ~ r~ Z S ~ op O n~r's Napie p Parcel Number 20 . Z ~" ~ `~ DEC 2 3 2002 ~ ~ _ _ ~ t operty Owner's Mail ' g Address Y Property Location /~~ ' Vl S ZONING OoF CE ~k i,4; S T N, R ~t1 City; State Zip Code ne umber Lot Nu r~ Block Number ~f- _~ ~ ~1 l~l~-~4 -`111 q Subdivision Name CSM Number II •Type of Building (ch ck all that apply) ~ ^City ~1 or 2 Family Dwelling -Number of Bedrooms - ^Village ^ Public/Commercial -Describe Use ~ ownship ^ State Owned ~'~ 'G~G~_ !~~ /02 )! // ~ ,~~ Neares oad III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if pp able) ~'' 1 New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S s Tank Onl Existin S stem B • ^ Check. if Sanitary Permit Previously Issued Permit Number Date Issued 1V. Type of Permit:.(Check all that apply)(numbering scheme is t'or internal use) 44 ^ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland 22 'zed In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 5 At-Gra 46 ^ Aerobic Treatment Unit 49 ^ Reciiculating 30 ^ Other V. Dis ersal/Treatment Area Informati on: / o // Z . S . / Z ~ So 14 6 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Eleva ' n final Grade Required ,/ Proposed / Rate(Gals./Days/Sq.Ft.) (Min./Inch) El on ~ISo ~i~~ ~ ~~, i~a 4 ~~ ~ ~` ~ ~o~ ~ 9a. . ~ VI. Tank Info Capacity in Gallons Total Gallons Number of Tanks Manufacturer ~ ~~ ~r-- ~ Prefab Concrete [te Constructed Stee Fiber ss antic New Tanks Existing Tanks ~ 7' ~ /„ / P i~ Septic or Holding Tank _ Dosing Chambet ~ t ~ /„ ~ `S ~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. P)grpber's Name (P ' Pl bet's Si MP/MPRS Number Business Phone Number 11 ~rllJ 715- ~- Plumber's Address (Street, , State, Z Co e VII Count /De artment Use Onl Approved. ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Ins ' nt Signature o Stamps) ^ Owner Given Initial Adverse . Surc ge Fee) ~ ~ S ~ ~ Z a ~ ` ~ ~~ Z %~~' Determination Q tu G - q. IX. Conditions of ApprovaUReas/~ons for Disapproval ~ a ~rn- s W~-~~.~~/~ii..d C / ~~ a/ Y+-~tsLr[-ate `{~ a:~i~u~ J~~ in7to ~ - J - l ~J~O~ ~..2-S .~ I!"utio f" ~ / A.T-3~/(,¢ ~ ~ hOY ~ ~ n n~ ~ilti ~ i i`t- ` P~~~ -~ ~ o~ ~~ d F - Po~~ /~l ~~ ~/~ c ~~`~ /~~„~ w[tgcn cogip[ e p ~ t6C l;o~ y) fpr jd[et9f~tym-yn paper,not lesg,thgn 81/2 x 17~6~ g ~ (/h ~ I C~ ~G%~ F-LCD-cam/ c~ ~{/~~ /s(J~..~~7/ ~Q y~"l bY~LtLd ~. ,~,~ir~P~ /12 ~~Zt SBD`6~3\98 (R. OS/Ol) /~ o~u'''' , ~ - s~r-' ~'~`~`'~ ~ ~ ~~ ~- l~ ~ Q,vi'L-~~w S~'~.~ Quo ~1-P/`t/ ~d ~wv~-, . ~'` 3 . ~ 3 Jj' ~,a.,.,., la l /~%z-e- r s ~ iscons~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 December O5, 2002 CUST ID No.225094 MICHAEL P ROGERS ROGERS PLUMBING N4563 320TH ST MENOMONIE WI 54751 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 ~~~~~~ CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/05/2004 SITE: Orlin & Judy Myrlie Sandpiper Lane Town of Hammond St Croix County S W 1 /4, N W l /4, 520, T29N, R l 7 W Lot: 54, Subdivision: Hammond Oaks Identification Numbers Transaction ID No. 817147 Site ID No. 654053 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Three BedroomAt-Grade System Object Type: POWT System Regulated Object ID No.: 884448 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 "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570-P (R.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 are prohibited. / CO] ~ • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption ~~~ area. chs. NR 811 & 812c • 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. sEE ca • 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. MICHAEL P ROGFRS Owner Responsibilities: Page 2 12/5/02 • 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/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should ' conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 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. SincerelyQ z~~ ~~_~~'~~~~~,yii~~ 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 Henry F Grote ,Certified Soil Testing .c Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: At-grade, SBD-10570-P (6/99) Pressure Distribution, SBD-10573-P (6/99) t ~~~~ Orlin & Judy Myrlie - At-grade System ~~,~ €r, 4 2002 Transaction # . „~ ~~ Location: Lot 54, Hammond Oaks SW 1/4, NW 1/4, Sec. 20, T 29 N, R 17 W Town: Hammond County: St. Croix Date: December 6, 2002 Owner: Orlin & Judy Myrlie Address: 3624 Ashbury Road St. Paul, MN 55122 Plumber: Mike Rogers .~/ Signature: License # MP 225094 Attachments: 6748-Plan Approval Application SBD-8330 page l: cover 2: design criteria & calculations 3: plot plan 4: plan view, system cross section 5: lateral detail 6: pump tank exit detail 7: pump curve 8: system management ~on~, a 'ovED f ~ C~E~r =SppN~N page 1 of 8 ~~ ~ . , %~ Design Criteria ~ti~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L ~ Bedrooms x 100 gal/bedroom/day x 1.5 4S'n gallons/day hydraulic load Design Calculations In situ designed loading rate ° `g' gallons/sq. ft. per day Depth to estimated high ground water ~~ 3 ~ in. Depth to bedrock ~ ~'~ in. Cross slope at system ~ ~• ~ % "* "" Force main length ~ 3 ~ ft, of Z' in. Manifold/header length N~ ft. of in. Drain-back ~.~ • Z ~ gallons Lateral length 2 @ ~~'•~zs ft. of Z in. Lateral elevation Q °~ ~ ft. @ bottom of lateral Lateral hole size 3~~b in. @ ~3•o in. ( l•g~'~ ft.) Spacing ~9 holes/lateral S ~ holes total Lateral volume ~~~ ~~ gallons Total lateral discharge rate ~ $' Z $ gallons/minute @ 2' S ft. head Network pressure compensation losses °'~'S~ ft. Elevation difference ~ b'3~ ft. Friction loss 3.9 ~ ft, @ ~ gallons/minute Total dynamic head Z3•T°I ft. Pump/siphon 4'~- gpm @ z.a~ ft. of head Manufacturer ~ °~~~°~'' Model # ~r 3 Dose volume 112. S gallons Lift/sip'hon tank ~ % ~-~ ~ ~ -vim Co ~•.Gso V~ gallons Septic tank ~' '' ~' 1°"°'~ allons g Effluent filter ~~ ~ -~`~ Measurement pump on and off ~ ~~' in. Height alarm from tank bottom ~ ~' '~' in. Reserve capacity 3s} gallons specs.calcs.res Page Z of $ ., d 3 6 .~ V, 0 ~I s 3 G .-b n~ y S r d '~ f 9 e J f O 3 a 1 Q I 3 ~~ 9 f~ ~ s s, J 3 d Y N ~ rt f ~''~' ~ ~ 0 r~ N r4 1~ J ~ ~ . ~ 3 C.~ 9 Q ° ~ ~_ % n ~ ~ D ~ i J ~~ ~ s c4 r .~ ~~ 3 o ~~ a ~ ~. .J ~ ,~ o d J ~ V ~ ~~(J ~ _~1 ~ n D r / I~1 J ~ > ~ } 1 7'~ f ~ /~ u a N v 1~ 1(1 V! `~ ~~~ ~ ~~ ~ ~~ .t ;t.~ ~ d~~ :. , ~'~ '--~ ..~ 9 d tljJn `_ ` vl ~ 1 ~ ~ ..~ i ~ ~~ ~ d _~ d O ~=1 \; ~ :__ S3J'v_nuO~~.s. ~~~?? ~~r"n~:~-=m ~•-'1 ~~"I' ~T'1 T ~~. '. -ZD»~ _-:.NC'T s»- `/4' b" ~ r ~4- a.~. ... e .. ~,~~.<~Fabr~ - Observation We I I ~~ ~~ 5'.J~ _~ ~.1.s~~ ~-° ~ `~ `' ~1'~~`.. • 12 ~.., .• L l ¢.v ~~ b Distribution Lateral ~ , ~--Soil Cover 2ii ~ _`~ ~-,..., R~.~ • •. Ohl 1o•c~. G 2s.c7~ _ ~~o ~~ ~ ~~ ~ V .t ....~- A ~ ~JL ~ ~ .~ 2 ~ c...; ~" 'n v c S ~. 40 ~ Z". 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I~I~JS 005E ~,~~~ 4 T~u~.S MAUUFACTURCR: 'g~ pEk D,,~ IJUMDER OF OC)SCS: TA1JK SIZ C ; l W~ - two G^LL01J S OOSC VOIUMC At_ARr1 S , ~7~ ~c.i~~s NI/WUFACTURCR; IWCLUOIA.IG 6ACKFI,ow: I C Z' ~ ;,~..;;~;, MOOCL 1JU1hpCR: 1 ° ~ ~~ `~' C1-PACl7lES: A- 2~'~ IUCNES Ox 3rd ; :~ ~ SWITCH TyP[; ma'y`'"`` w~~, , ~_ ~ _ - ~3'SZ . g = Z' %~MP MAIJUFACTURCR: oe' ~' _ _ lucks oa ~+ A . ~. ~lZ'1 ~'} 1S3 C• IuCHCS OK ;,~..~~: ;k MODEU 1JUMDCR: ~u.~'S(o _ D ^ ~ INS HES GR ~WITCN TtiPQ; W`~'~' "' J^,. _" ~ 3 IJppE; PUMD A1JD ALARM ARC TJ BC 1 111JIh1Ur1 DISCMARGC RAre ~_G//•~ INSTALLED 0-J SEA~RAT'E C~KC.. '_ { VCRTIC^u DIFFCRCIJCC DCTWCCU PUMP OFF AUp OISTRIDUT101J PIPE., Ib~3~/ FELT (/ + Mi-JIh1uM -JETWORK SUPPLY PitCitUllE . 2'S FCCT ~~'a•S ~ ~ ~ + 131 FEET OF FORCC MAIIJ X S'3 F/ 100/tFRICT101J 3'.19 y~^p FACTOR. FEET ~ ~1 ~~~„~ "- TOTAL Dy-JAMIC HEAP ~,S"sq fEEr , IIJTER-,IAL pIMCiJb10AJC 'Or TAIJK: LE1.1CsTH ~ ,, ,, ;WIDTH ~g LIQUID DEPT H ~~ / C ---~ Z~•3 ~~ .. HEAD CAPACITY CURVE MODEL 152/153 w~ ~- ~, ~, ~~ 50 12 40 152 0 a w 30 ~, a 8 z r 0 _ - - 20 - a 0 4 ~ 10 20 40 60 80 100 oiasoe 0 GALLONS LITERS p 80 160 240 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS Timed dosing panels available. Electrical alternators, for duplex systems, are available and supplied with an alarm Variable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. Sealed Owik-Box available for'outdoor installations. See FM1420. Over 130°F. (54°C.) special quotation required. 1521153 Series - -- - 1521153 MODELS Control Selection - ' _ M_odel Volts•Ph Mode Am s Sim lex Du lex _ N152_ _1.15 t Non 8.5 1 2or3 _ BN t 52' _. 115 ___ 1 Aulo 8.5 Included 2 or 3 E t 52 230 t Non 4.3 1 2 or 3 BEt52~ 230 1 Auto 4.3 Included 2or3 N t 53 ^ 115 1 Nan 10.5 1 2 or 3 B_N 153 t t 5 1 Auto 10.5 Induded 2 or 3 Et53 - 230 1 Non 5.3 1 2or3 • BE 153 ! 230 1 Auto 5.3 Included 2 or 3 O CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. Ail electrical and safety codes should be followed including the most recent National Eiectrtc Code (NEC) and the Occupat{onal Safety and Health Act (OSHA). TOTAL DYNAMIC HEAd/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gol, Liters Gol. Liters 5 1.5 69 261 77 291 ; 10 3.1 61 ~ 231 j 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 I 197 25 7.6 34 129 ~ 42 ~ 159 30 9.1 23 ~ 87 33 ! ? 25 I 35 10.7 ~ -- -- 22 85 40 12.2 -- -- ~2 Lock Vclve: 1 38.0 Ft. (11.6m)!~G0 Ft. ('3.4m1', ~-- s i / a -~.; 3 27/32-t---vita 5/8--~ i I I e ~ . ~ ~ _,i~z '~ ~~ e 2"-= -~- ~~, -~ i ,~, i _ _ rte- ~ _~ _ L sKZOSa SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E•Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. ~ ~~ ~ 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 Z . '~ ~ Louisville, KY 40256-0347 Manu/acturers of O ~f ~~~j' SHIP T0: 3649 Cane Run Road ~~~"' I~ ® Louisville, KY 40211.1961 QU4C/TY PUMFS SNCE ~,9,~,9 ~ O//w ,/p ~O (502) 778.2731 ~ 1(800) 928-PUMP http:llwww.zoeller.com rL//Y~!" FAX (502) 774.3624 © Copyright 2000 Zoeller Co. All rights reserved. .. System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the homeowner, and the homeowner must be provided with a complete set of plans including this management section. I f problems develop with the adsorption system or any other system components, the installing plumber, Rogers Plumbing, 715-235- 1132, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal residential use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. ~. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 1 1. I f construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance I . The septic tank must be inspected every three ears by a proper) ICPn caries Prcnn _/ " ~j , 2. lfuesessary; the septic tank must be numned to~tr'e/move solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. ~/~- ~S ~'~ 1d~~ 3 yrZ-S 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. ~. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. I f the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 I . Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for residential systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and haul ing of wastewater maybe necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 1 Wisconsin Department of Commerce Division of Safety and Buildings vR'~~~~~ SOIL EVALUATION REPORT in acrnrdanrr± with Cnmm R.ri Wis. Adm. Code 1668 Page 1 of 3 Certified Soil Testing County Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must i l d b t li i d t h i St. Croix nc u e, u not m o: vertical and or te zontal reference point (BM), direction and percent scope, state or dimemsions, north arrow, and locatlon and distance to nearestroad. Parcel I.D. ~ - `D~to~ .5~i d~c7 Please print all information. evie Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15,04 (1) (m)). ` ~ oj-G rs ~ ~ Property Owner Property Location Myrlie, Orlin & Judy Govt. lot SW 1/4 NW 1/4 S 20 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3624 Ashbury Road 54 Hammond Oaks City State Zip Code Phone Number City Village Town Nearest Road Saint Paul ~ MN 55122 651-454-7179 Hammond Sandpiper Lane New Construction Use: ~; Residential / Number of bedrooms 3 Code derived esig 50 GPD Replacement _: Public or commercial -Describe: Parent material l oess over till Flood plai (~ LL ii '' elev~b~y~f ~ppGa~~~ NA Genera! comments and recommendati ons: install 10' x 112.5' effective (12' x 112.5' overall) rock cell at-grade yster~7inr~f~r~C~C3hMbTnYing 8 .6 contour h s-f-e~r. e Irv, ~ 3~ ~~ ir,~.~,n NG OFFICE Boring # Boring Pit 89 6 ~ 78 Ground Surface elev. . ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-6 7.5YR 3/2 - sl 2 f sbk mvfr gs if/m .5 .9 2 6-15 7.5YR 3/2 - sl 2 m sbk mvfr cs 1f .5 .9 3 -- 15-22 10YR 4/3 - sl 2 m sbk mvfr gs 1f .5 .9 4 22-40 10YR 4/4 - sl 2 m sbk mfr cs 1f .5 .9 5 40-53 7.5YR 4/4 - Is 1 m sbk mvfr cs - .7 1.2 6 53-67 10YR 4/6 - s 0 sg ml cs - .7 1.2 7 67-78 10YR 5/6 - s 0 sg ml - - .7 1.2 a Boring # 'Boring / Pit Ground Surface elev. 89.6 ft. Depth to limiting factor 3~ in. Soil Application Rate Horizon Depth Dominant Cotor Redox Descripton Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 7.5YR 3/2 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 8-22 7.5YR 4/4 - sl 1 m sbk mvfr gs 1f .4 .6 3 22-37 5YR 4/4 - scl 1 m pl mvfr cs 1f .2 .3 4 37 66 5YR 4/4 f2d 7.5YR 5/3 scl 1 m pl mvfr - - .2 .3 I "Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS _< 30 mgr CST Name (Please Print} Signat re CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 11/11/2002 715-233-0398 Property Owner Myrlie, Orlin & Judy Parcel ID # S Page 2 of 3 11_2 Boring # --~ Boring /3 Pit Ground Surface elev. 87.6 ft. Depth to limiting factor > 60 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10YR 3/3 - I 1 f sbk dsh cs 1f .4 .5 2 10-16 10YR 3/3 - sil 2 f sbk dh cs - .5 .6 3 16-38 10YR 3/4 - sil 2 m sbk mfi as - ,5 ,6 4 38-60 7.5YR 4/6 - Is 1 m gr ds - - .7 .8 Ulbricht pit as reported 10/24/99; elevation relative to new benchmarks; Ulbricht benchmarks not used Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i ^ Boring # ~ Boring ~i Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 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-8330 (R.07/00) Certified Soil Testlng y~i~ r a 9 0 e~ ..~- 0 3 ~^ ~., ~ ~ ~~ f ~ ~ ~ ~ ~ ~ ~ N,' ~. O Z G ..n 1 n_. y S I~ s s V; 9 d ~"t / i a a S/ ~ __ 9 '-(' Q-• fi f s~ I'r 90 a ss J f d 6 S ,~ r0 O !'~' •~ ~ ' H ~ ~ ~ ~ ? S ~ o ~J I n ,; -1. 4 ~ ~ , a -~ ~~~ ~ ~. ,~' o ~J ~ ~ ~J , 3 '"' ~ J ~1 ~ZOS ~ o ~ s ~ { d Z e ~~~ cr S \ ~ 00 o M ..E- d ~ a a ~ N ; iU ~ kJ ~ ~ ~ ~ ! ~ ~ ~ `~' ~ i > ~ ~~ ~ (..r O ~$1 m \ = ti ~~~\ ~~~~~, '\~~~~__ T", =~ ~~~«~ ~~.T = ==~=N>: i i p ~~~ ~:._ _~ `»-.T~- O y ^ r V ~ ~ ~ ~ ~ '~ ~ "~ fd "' : ~ ,~ tri ~i`. ti •' 1 '~ ~ . ~ ~, ~ ~~ _ r ~ ~ ~.. t ~~ ~ ~I, ~ ~ ~ ~ ~ `I ~ ~• ,~ ~ ~ to fi ~0 ~ t a~, ~ ~ ~ i ~ ~ .` -•s ~~ ~~ ~ ~.r~~ ~~• ~~ 5~ a. i ~ / ~~ ~ ~ I ~ C ,~~ ~ ' ~ ~ ~ I,I r Z0'd 6~I1 tr~b ~T9 3I'7~I.i,W NI'lJ0 ~ .lanr Zb:TZ 3f11 ZO-ZS-~3Q ~ .. • ~ r ;~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations ILHR 83.D9 Wis. Division of Safety and Buildings in accordance w~`s. + ., ~`4' t ` 1 F~.s '~ Attach complete site plan on paper not less than S 1/2 x 11 inches in si n m f include, but not limited to: vertical and horizontal reference point (BM , f~ir~tion ai~ h,, `' ~ ~ a percent slope, scale or dimensions, north arrow, and location and di nc~b to nearest road. `~ ._ ' ~'' r `~'~ APPLICANT INFORMATION -Please print all inform ti,~. Personal information you provide may be used for secondary purposes (Privacy L wc's-',15.Og~~ra(~ '' _ '.. Property Owner ~ (~ H Q l QO L>A~ ~ ~ d ~ Property Locatio V ~ S't7~~ C3~ i l~l?~ ~,~.~~.::~'~t Lot t Property Owner's Mailing Address 332.-hiuN~SoTAI sT E~isT .Iyo~ S City State Zip Codb Phone Number ~ City ~ ST• PAUL-- I !'~ ~v. .~35/o I (loS/ )~zZ •55SS County ST G, p0~• y Parcel L~ . # O /,~ /~ l v~ ~d ReviQw byj~ p .~"/Y 4 n.Y A ~n.nt A ~~,~q/4/V~1/4.S 2~ . Subd. Name or CSM# ~'l~M~tON~ /illaae ' LJ ~ o`nrn Page / of Z • yl7 •'uv SQ'~ Date I l Z~ r5 T ~ ( ,N,R ~ 7 ~ (or) W Ne~~~j w ~. (Gob [residential / Number of bedrooms 3 Addition to existing building []'New Construction Use: ^ Replacement ^ Public or commercial -Describe: ~f,'/~ c Recommended design loading rate ^ ~ bed, gpd/ft2 trench, gpd/ft2 Code derived daily flow ~-~_- 9Pd 2 ~.? 1 d/~~_trench, gpd/ft2 Absorption area required ~~bed, ft trench, ft2 Maximum design loading rate _' ~ bed, gp ,3 ft (as referred to site plan benchmark) Recommended infiltration surface elevations) •S~ Additional design/site considerations ft ~DEt'S ~~~ Q~NS~ T~~~f Flood plain elevation, if applicable N __~_____--- Parent material Conventional Moun~J. In-Ground Pressure AT-Grade ~ System i~n,,Fil~l Holds 9 C S Suitable for system ^ S ~ ~„/_ ~ U ~ S ~ ^ S L/J U ^ S I.S u U Unsuitable for system L~l Boring # Horizon Depth Dominant Color in. Munsell ~ , o.~z ~oYR 3~3 n z ~ •~~ •aYR 3L Ground elev. ~ p3,~ft. Depth to limiting factor Lin. Boring # Z Ground elev. ~0 3 .eft. Depth to limiting factor ~ /~ /~ in. Remarks: SOIL DESCRIPTION REPORT Mottles Texture Structure Consistence Boundary Roots Qu. Sz. Cont. Color Gr. Sz. Sh. _ w _._. G ~7SA ._... ~ SAC. Z~ s SiL Z,r.+ ~V ~~ /f ~~ c - ~~i' s ./ ® i- -' Bed ,Trench •~ S ~; •+~- s~.. c, . ~ ~ .~ CST Name (Please Print) ROBERT NLt7~~C~ 1 Signatures ~_ ~ ~~s~ ~~G . g~ ~ S Date w, ,~.~f,,,.,o. . i is ~ ~, w •~ /~ •Z / ~i s~. V N $ ~ ~~ L ~aL7 SOIL DESCRIPTION REPORT PROPERTY OWNER _ ~~ ~~ ~ S S n g PARCEL I.D.# ~D ~ -~-----~~ M M O ~~ Boring # Honzon vepu~ ~~~~~~~•~• - -- Munsell Qu. Sz. Cont. Co or in. 3 / •,~ /oyn. 3 3 • ~0 3 -' Ground ~• ~ ~ -^ elev. • ---' - ~ f11~ MOTS 0. 2Z . /D Depth to limiting factor m. ~. Boring # Ground elev. ft. Depth to limiting factor in. -- --~ Remarks: Horizon Depth Dominant Color Mottles Qu Sz Cont. Color in. Munsell Boring # ~_~_ __ Ground elev. ft. Depth 40 .:limiting factor in~ Remarks: Boring # -- Ground elev. ft. Depth to limiting .. ~. -` r Page ~" of I Structure Consistence Boundary Roots Bed ' Texture Gr Sz Sh ~ ~ '~ H ~ ~Q L ~a~ ~'IV $1 SOIL DESCRIPTION REPORT Page ~ of PROPERTY OWNER _----- ~d 1 5~ /f gMM ~~ ~, S S ~g~ oNt7 PARCEL LD.N 2 Horizon Depth Dominant Color Structure Consistence Mottles Texture Gr. Sz. Sh. Boundary Roots Bed ,Trench Boring # in. Munsell Qu. Sz. Cont. Color ~ 1 /~ !,~ L S ~ s Ground 5 ~..- ` S ~j s '` i 1~---n. /d MOT L /7~S s/C f I ~! D0.2Z /D , Depth to ; limiting factor m. Boring # Ground elev. ft. Depth to limiting factor , in. --~~ Remarks: - ~I rizon Depth Dominant Color H Structure Texture Mottles Gr. Sz. Sh. Consistence Boundary Roots Bed , Tn , o in. M4nseB Qu. Sz. Cont. Color , Boring # Ground elev. ft. • Depth fo .,limiting factor in. Boring # Ground elev. ft. Depth to limiting factor ^~. .. a .• Ulbricht 8 Associates Private Sewage Consultants 855 O'Neil Rd. Hudson, Wis. 54018 ~st-z243~S ~a-rsy sc~~~: /'~ = 3d se ~. ' <a °~,,, ~ . ~ ~~ l~ov~~ S~/Si w~~ /~~~-~~~t~ X70 ~~ -~ / = sv~'v~- yoR's ~ 0 coR,~;P,~ of ~~ 3~/ ~ -, Q3 .- ~y ~ --.'~~---- yg ' --.. ~~ 33 ~ °4~ ~z ~ ~ ~ ~~ ~ ~~° c<~. zo X03 r ~ n ~?` zy t ~, ~.. .yak ~'lov . /d ~ /1 ~ ~/''!~ Z SVPVtYbQ~S ~1 1 =. ~ . Jc. , ~' , Go T CD~N~ / 07. ~ to G~~~ 1n ~~ X01 3'~ Dec 16 02 10:56a HOMES HY OWNER NETWORK 1G~lii/GIOIOL a"J~~'f CUII`~-R<tlil r ~ 7~olaior~c , 4y t1 . WhcfruMDap~rlwonlolhvaW. SO1L AND $11'E EYAI.UATION l1lO/ aM MNMf11101~1a dl~uan of 6~r wo 11d11npa in oCeora~nae wilt, s, it,FW e3A4, wls. MlaeAeanyYWYlop4nanPaM+nelawaetoflBlR>;itbrcnaahalesPhn'mud Ooh ltiONa. Dull Inllladfo~ wAbalard Aalcanld raareneaPUm 16M1. daadMa tnd Pa~ltl a~a~ aa>. al f»Ia011a~011~, Mflf, Nfaw, On/ beYiba HIIO at[danca 1011a1Nl11fla6. PaiCtll A-RLICAlR INFORNATiON - Wsaw prdli sn ialo-nalgan. nalan P~r10,dMUIM W~ pY ttT~d.~ tr wM te,a+u~Jq P•?rN i-ilaM lar, r. ff d11111aUb Pap ~ el Z p.3 ~aing M Massa, oq ,~ M ~ o~ y alas. L~rl O , ~f l owa, f. rref 7 ~ --- ,_ /0. 3 :~' ass o~H.u na. u,+daan, w~~. c~+e ,R ~e ~ ; S4iv'/j SeyU ~ ~f fps Yi,Ani t~ •~f ~eo~,,,p Cd~f~.f«.`E• ~YsT, fvet.+au. -t-~sr'~- ,.~ ~. L Dec 16 02 1Oc58a 1G/ 10/ GL' I:IC IJ7..J 1 1. ~ ~~ HOMES DY OWNER NETWORK LL11~P1RCI9'... ~ 1 ~ J..IC.IJOY 1 p.4 I.u. OJJ Vc.l-. L. ? ~ .~ ~ fwd Nu~6~ ap gpiL DESGgIPT10N pEPORT t•.p 'DDMERTI aW1EN ~o r 5 N~~-+ t Sd~D ~~ Y~ S o,~a t ~ISIClL Lp. fI1YC~We Cas~17WKa ~~ perr~Wll Coin Meal" Te~lwa 41. Sz. Sd.. Nen o.d+ l No01e 6d .TNM x ®ahp ol 1 lYmge W.&. CoM, odor k f /~' ~ . 5 ' i ~ 'll.. ~~ ~-•~-- ~ ~ [' S n 1 w~ ~ ~ ~ , . 3~ "~ _ ~ eollirQ ~ St ^'N"'~ ~~~ i , ~ w , x. pMtA is 11nigIW M t er e ...~ ~• tl~mules: ~ Se!uclule . paleuMne9 peandllY ~°~' 1~ OelNlla111 CDkI }gAeen Oa{Me MuMeN ~ 1(O~Yee Tollilra ~. St. SE. eau. Sl. Cpal. Cola ~I. r 1.~ w.. ~ - _ ~~. ~.li. . •rr'~ INnWI+p I~CgI ~r gdtin0 Y ,.sls- ~4~ ~ .~ ~~ 0•oIM~ . ~. A. fla(aEl A a6+P~Y IaelOf NDW~ NL eel6N. . ~ A ~ I G.u L Dec 18 0'? 10:S9a HOMES HY OWNER NETWORK 1G~ 1G/ Ck.fYJG ICJ • .~ f Gu I IT1i1L~P9_ ~ t . .~.,ru a.ivu ~ . i ~ i WO+~i~r b At1o ~~wiupu wlwb gr~n+0+ b66 O'WM Ild. y~~y~, WIS. 6018 c s rzz4.315 - ~.`_._._ ~o . ~ o ~` ~" 4 7' S SL'ALE': i "' 3D ~f ~~ ~ ' ~ W~P~f fd0+~ S 4 A', ~• v c a (~iJ Q,1,. o f t.r~ F ~~ M ~,/r~' i 1~;~ r w 1 ~~ ----~- ~ ---" • ~8 + T 33 ~~ <\.. ~' s° ~~ ~~~ ~~ { +~ ~ a~ ~' , M ut~ Ul1 sYsr~ ~'r~v . p.5 ~bns 35 ~~ ~M~ Z : SuP~kYoQ~J ~l , v ~ ~ ~7 ~u~- y, ~, Lar ld,P~Lc. ~ ~' -----,o L N P 3 a `~ 3 ~. r 9 POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE ORMA ON owner Permit 0 DESIGN PARAMETE Number of Bedrooms 100gpd/bedroom ^ NA Number of Commercial Units -- NA Estimated flow {average)* gaUday Design flow (peak), estimated x 1.5* ,~j gaUday Soil Application. Rate , gaUday Influent/Bffluent Quality (NA^) Monthly Average** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (BODs) S 220 mg/L Total Suspended Solids (TSS) 5 250 mg/L Pretreated Effluent 'ty ^ Monthly Average*** Biochemical Oxygen. an ; ODs) 5 30 mg/L Total Suspended ds (TSS) S 30 mg/L Fecal Coliform mein can) +cfu/108n:L Maximum Effluent Particle Size 1/8 inch diameter *Wastewater Flow Verification on and calc (Other than bedroom based) ** Values. typical for domestic (non-commercial wastewater and septic tank effluent. * **Values typical for pretreated wastewater. SYSTEM SPECIFICATIONS Septic Tank Capacity gal ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ^ NA Pump Tank Capacity gal ^ NA Pump Tank Manufacturer ^ NA a Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter D Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) - and (gravity) ^ In-ground (pressurized) - de D Mound ^ 'p-line ^ Other: ^ Leaching Chamber Manufacturer Model Approval Stipulatio n Soil Application Rate~gpd/ftz Area Req. Absorption Area Credit per unit ftz Minimum Number of Chambers ^ Aggregate Design Flow/Loading Rate= min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIA ^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ^ -"Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Beds". RJ. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 ^ SBD -10570-P (8.6/99) "At Grade Component Manual Using Pressure Distribution" ^SBD -10567 P (R.6/99) "In Ground Absorption Component Manual" ^ SBD -10705-P (N.O1J01) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD -10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" ^ SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ^ SBD -10572 P (8.6/99) "Mound Component Manual" Cl SBD =10691 P (N.Ol/Ol) "Mound Component Manual" Version 2.0 ^ SBD -10595-P {R.6/99) "Single Pass Sand Filter Component 1Vlanual" ^ SBD -10657 P (8.6/99) "Drip-line Effluent Disposal Component Manual" ^ SBD. -10573 P (R 6/99) "Pressure Distribution Component Manual" ^ SBD -10706-P (N.O1/01) "Pressure Distribution Component Manual" Version 2.0 ^ Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units __ ._- _ -__ ______~jjr1~1VAlVla±A1VL1r1A1VAhL1ri1L1~1 ~ MAINTENANCE MONITORING SCHEDULE ~ e v n Service Fre uency Inspect condition of tank(s) At least once every D months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (1/3) of tank Inspect dispersal cell(s) At least once every ^ months ear(s) (Maximum 3 yrs. Clean effluent filter ~/ At least once every ^ months year(s) Inspect pump, pump controls & alarm At least once every D months ear(s) ^ NA Flush laterals and pressure test At least once every ^ months ^ year(s) ^ NA Valves At leasfonce every D months ^ year(s) ^ NA Other: At least once every ^ months °'^ year(s) ^ NA Yage~_oi_~ aTART UP .For new construction, prior to use of the POWTS cheek 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. System startup shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream. will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along. with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fiuit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be *n;nim;~Pd. Toilet tissue is the only paper that should be discharged into the system.. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, ania'biotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maiutain a regular steady flow.. by spreading laundry. washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the. dispersal unit may cause it to freeze up. ^ Valves Valves shall be operated in the following manner: ^ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the. system are corrected to prevent back-up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). ^ Septic Tanks Component Tack inspections must include a,visual inspection of the tank to identify any missing or broken hazdwaze, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking. device to prevent accidental or unauthorized entry into the tank. When the combination of sludge andscum in any tank exceeds one-third (1/3) 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 Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning maybe necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ^ Pump ChamberlTreatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hazdware and the condition of the filter. Any service needs or repairs shall be promptly taken caze of. ^ In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or dischazge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page 2 of °~ ~,, Moue At-Grade -Ground Pressure ' Th coon shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned incompliance 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 andthe-void space filled wish soil, gravel or other 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 infi-inged 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 from existing and proposed structure, lot lines and wells. Failure to protect the replacement area- will result in the need far 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 technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank maybe installed as a last resort to replace the failed POWTS. ^ Mound and at. grade soil absorption systems maybe reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMII~NTS PO ST Name ~ Phone -• SEPTAGE SERVICING OPERATOR (Pumper) Name Phone K:\WPDATAIEH\POWTS OWNER'S MAIVUAL.doc POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY _ Agency ~ 1. Phone ~(., - ~ ,~~ ~i Page~of DEC-26-02 THU 23:46 JUDY a'7 ORLIN MYRLIE 612 454 ai~!~~rlr, •C.~rt~ r,~~l~r~'i't~IJANCI? Avl~]iC:~'C'l,:N'i ~'•Il:r U~~'!~1L"•'!:`.~l~lC' C_'i~T:'1'll'~fl,'-ATI(?T~' I'ORlrti . ~ ~ b 1`i.:i?ino .~;iascss ~Z 11j1~ ~ ~ ~~~ _•____ 1'~;;lil)t?C'.~5' :4.w~ir'~•SS _~. ~lf~_~. r ~,~s~- c-! ^J~1(XiC%4_--- --.-......,.,-~~.,--...'-.. _~..~ (Yerlt)_ation required ft'um I'lannfog C1N~~;,rtmont for nrw cofLSwctioa),,,_~ __,_,,,_ Litt'/St_3te ,~,~_ Ptucal !dc>nCiticAtioi: Number ,„,,~.~ 1 ~~~Z,~"~'(.JV[J- ~~ 'Z~j. !7. c~7T Pzoperry Location l~ :f. ~'i;, Se•~, g~,,.., 'r~ ~-R~7 W, T~~v~i c,f ~~,inrn~!l.~ . :iU~3l1'1Si0£~ l:'ertifird Sut~'~y Riap ~ _,_, - __._~ `'olum~° _•---__-- _._, Page ~ \tii-t'an.ty lleed ~ C a ~ _ 'L~o!un1C ~d`~ Z Pa,~rz # '~ ~3 --~...r--..~..-~ -+..y -- .....-,--~r...i O ~pcc house ~] yes ~I r-O l~.ut iin~.s idcn{ifi~ble U yes i:...! no ~~~~ ~/ZO/d Z ~~`~Tt11i ATAI1~'Fl'~f. '~' ltapropcr use aad tAaiatananceoCyoyl =eptla sysrern coul[1 reyu11 ip it, prcn1ahue f8ilure ro beadle wastLs. Proper mainrrl~e:c caasi~w of pumping ouc the aepKc tataic ev~ty three years or sooner, i#' naeCed by a liccn3ed pumper. ~V1iat you put into [ho sysr.'.re .3n a:fcct the 1'iu-etion of ~e septic tan!: as a tr~aunrnt stage in tLo ~asstc disposal system, The property osvaer ttgreaa to submit to St, t:.tOit 2.oning 1~Cp9rrnlCUt A G$Ct~f1CAt1PJ~ {'PDl1~ signOd by ire owutr and by : m•ct~rpittmber, joorueymgnplumber, re&lxietcd pluu,bcr or a liern3ec! pun~pcfvorStyiag thdt (1) Lbe on-site waste~tcrJispQSSI sysr4i-~ is ie proper operating condition and/or (2) aticr inspection en:i ly,ntl~~ing (if necessary), tht: scnRC tank is leas {hr,u 1/3 ft,ll oC s1.i3~c. 1%ti•c, tl]o tiedcrsigned neve rzad the above rtquir~ments and e,~ea to n:aintnin rite privakc sewage ~isposul syscom with the st,~xd~r;l: set forth, hrrcin, ss sot by Che DeparRttettr of Cot'wreree and tlu Tie~anrnanr of Nannal Rcsottrces, State of'WiseoASin. Certifieari:,r~ sisdng tr~~ your:optic systctl] bas Lecn matntaincd nauat bt cotr.nlttad end aeri-tnad t~ ty~n St. Croix Cuunrr zoaiug pfftcc tvithi~ 3i) dsyx of rho r'arar year expirarion dart. S NaTU^~ OF ?,.PP~.YCANT y DAl"]s ~a ti~~~~ ~~ r.~r~ c Tr I (~.c) certiry that all stsre;napr,~ on Wis farm are rnie to tit'„ b,:t of n-y (our) fasoq`ledge. 1 (W~+c) em (~XC) floe O~Yt1Ct(S) of rte preprr•ry ~s6t;ribcd al~oye, tyy virtue of a w'~rranry deed rc.:or~icrl iu l~bgister of DeaQs Qti`lce. $ A."PL.~,4NT LlA"Cfs ""`~ .4ny information thst ie etis-reprasentC$'may t':suil in t1~c satritary ptrmit Ucing ravolrod by the ZoAlag DOpattrlant. '~v.r.r •' l;ucludo with chi, tpplicArion: a star:-prd K-atrgnty d«d Franc tP:G ttcgistcr of Uccds otrco a copy of tiro certified sun•cy map if rcfcranc~ is ttusJe in tht; ~vatranry docd DEC-17-02 TUE 28:43 JUDY a~l ORLIM M7'R.LIE 612 4°i4 7175 P. 03 r/~SZ ~ 5 ~ 3 K , , STAT$ BAR QF WrSCOiti3IN FQ9.M 2 • 1998 ._ w,~~xANr~t DFa~n ~ ~ ~d~'~ Tbie Deed, rmadc between Harnnnrnd Lartd, LLC~g )Minnesota Limited 1GiabiJJt Cpnrl any Grantor, and Orlin JD, Myrlue dtnd .Tgliitlt A, Myrli~, hu~aband and wife Gran tee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real ostaie in Sf. Croix County, State of Wlsc.cnsin: -"~ Lot 54 nlond aak~ Subdivisian,xorvn ofIiammoad, St. CraiM County, Wiscoas ri o~ csw. ~~/2 ~/p y ~I8-1086-5d-04D •~~ notztosteaa property. ~^'s) {ls not) l~xtcptions to warranties; Subject to notes, easements,r~stnctions,covenants and ngklts of way of record, if arxy, including but not limited to those for dralnage,water mtetktion,pondizig,and or utilities as may be shown an the plat of Hammond O,~ks Subdivision recorded in Vol. 8 of Plats, page 2, St. Croix County, Wisconsin., 'The wtmcanties of this deed, clttler expressed or impliod are limited by the grantor to the grantee, or stty0ne in the chain of tide, to the Coesideration expressed hereiq that being the sutlrt of $29,400.OD. Dated this - 18th day of Novt<anber 2002 Ftammond Land, t..I.C * * by ~ Prcxident * .Austin J. Baillpn AiJTH1tHT1CATIQ~,' ACKNOWLEDGMENT ST~.TE CF W,fSCQNSIN ) Signaturela) ~ ss Raarsey ~ Coux~.ty. ) Farsolraliy came bef6re me this I$tlr day of auti~enticatea this _ dny of ~ _ NOvt:nnber , 2002 the above named Austin J, Raillon ---- Tl1'l,l;: MEMBER STATE BAR OF WISCONSIN fIf not. eathorixed by §706,06, Wis. State.) TFII81NSTttUM$NT WAS DRAFTED EY Paul A. $~3Hon, Attoxtrc at Law to me icrlown to be tttr. Mrsrm(v),sha executed the fore pins instrur~,elrt a clalowledge the sp e. ''~! ~+: Paul ~. Bai1Mn , ._ r~or,,Fw,•~ltxic:MUINESO7A NAfAN RehTic Rhfa .,f ~xr.., ., r,~ ~~~ • ~-~ ,a DEC-26-02 THU 23:45 JUDY a'l ORLIN MYRLIE 612 454 7179 P. 01 t ~~- ~ a ~~ l~ s7- ~G.S?~ '7i7 ~ ~ ~u~="~' • ~ r r Owner:. _~ Project Name and SysCte~,m'T,~ype5^: Location: ~~(,~~'If,{~' Contents: Page 1: Page 2: Page 3: Page 4: Page 5: Page 6: Fage 7: Page 8: Page 9: Attachments:< Plumber/Designer: . .Credential Number: inn ld 1~l ~ ~ fin-`-F vk~ -~ Private On-Site Wastewater Treatment System (POWYS) -~ Indeac and Title Sheet 11 ~~~ ~ ~ri~,.~i~1 d C''~ti'~ . -~'~^ ~~ ~igned: Date: ~~-~~'~r~' ~~:~ ~ o~-~~ ~ ~``` y i, t. ! ~ 11Yi.. HgH$ ~ •~` ~ .....; < ~ ..~ ~ ....... _.__ __ ~ ; {~ t ~ ~, ~ ~ : e ~ ~ ~ ~ - 1' ; ~~ r" i f N ~ i e 1 ~~ It~(~ ..;~ :~T NOV.26.2 ~~ ~ ' ~ Q02 ::s~49PM UBC - HRSTIN~ 4Y'A' riVO^ ~ °e ;b I i ~ W am ~e m' G ~I~ ~uu , I~ eet~ae er- u' awae l~11 M 6 PebTW~ ' ' ~ f,.bH PG{RM1B IY oTw wau. ' S ~ t eelness on s" ecomte ~I M + ~ x s' warn~o t- -' ~ ~ U~_ ~h411,T 8001"1 ! ; ' I t q, ~ T-T+~nt. E'd9FMENr ~oa~~ i ~ t+bRe~A+T ~ mt I^d T 1+AP'Ole 6AW 192 Lldea" r adle ~ 13 Y r ' . R i ~' 191lD MBUUiTIdI f° ~ ~ it ~ ~ COl'iPAG'M'-0 gFlfi~01L4R FN.L S~ . . s ~.T ' ~PP" ° i y ~ ~ I~ I j~ ~ y wva° rd.l b u Pla'~,C f I I ' ?aRNSi I i , I Ifac ePl~ wxk '_~.1-~..sa nFalelr°ea I y `~J/ L'°'°~/ ~h it ~r I ~ I I ~ I ° ~~ I r ~ I I.; I iclt ~ I ~= ~ f~ i t ur . - I vs+trr ~'~ ° i i ~ I TM I~ N r l ' ~ ~'~, u N0.626 P.2~2 10'-0" ~~ i ~ .i Ivae" ~4+' IY•ta' ~ ' I ;, YtI ; ~ ii ',i ;ICI, l i r ~ ,, I l I i uNf7SGA1~ATG~ , ..... f ................... I s oP rc e~ief~, I _ .. ~ ea° x e' rorrl~sc ' ;~ i' I e COlgi! ~ 4p PI.GGIf •: ~ 'I N° X e° flpTtµ~ ~ '.I 7 ~ 16C,3R6p O' n" 9LOdC ~ ! m Calit~9G of Y" I '4-~eK ~ ~ M^ M B' fODTN1de J ~~ yi `i I~~ ~~! i' p,~~.? 1 Cfl11?SE QF 6" 5 dA1R~ Q @^ m0"ke"F ,~~ ~,_ ~-- ,.. ~ f~ I„ ------------- a, mT.~IG4 ~~--------- ..,.. ~ '~ 19.0° - ' ~~A~~ IR.{, I I !!~ ~our~aT~o~ P~A~ I>rF ..o r~ -~• Wmmowe a+oun Ima' ea. Pr...~prkeae. _ DEC-17-02 TUE 23:42 JUDY a'1 4RLIN MYRLIE Ea12 4S4 717 P.0.T1 w ~ ~ l O D "`~'~ +~ • ~ * ~ ~ ST CR(11~ COLTN'TY ' SEPTIC TANK IYLAIt'ITI,1d,4NCE AGREEI~~NT RECEIVED Arm OWNERSHIP CIRTIT'ICATION rORM JqN 0 3 2003 r ~ C~~~~nerlBuyer ~ ~ sT. cFlolx COUNTY ONING OFFICE 1~13ihng Address I'ropart}' Address ~~ / ~(¢ ~ --' J (Verification required from Planning Department for new construction) / Ci ~/State ... ~~~- ~~ h Parcel Identification Number ~~~~~~ ~~- O/8 - iY08 ~d' yo LEGAL DESCRIPTION ~,~ ,,1 Property Location ~~ vv '/4, ~ Y,, Sec. ~ , T~N-R~W, To~_/~vn of rn~ . Subdivision Certified SurveSf hiap # 1~~4'arranty Deed # but Volume ,Page # Volume ,Page # Spei house ^ yes ~] no Lot lines identifiable ^ yes ^ no Sl'STEAi MAINTENANCE Improper use and maintenance of your septic system cool d result in its premature failure to handle wastes. Proper maintenance cansists of pumping out the septic tanl: every three years or sooner, if needed by a licensed pumper. VThat you put into the system can affect the function of the septic tanl~ 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, journeytnanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the nn-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Departement of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your sepric system has been maintained must be completed and returned to the St. Croix County Zoning Office with y 30 days of the three year expiration date. SIGNATUI.E OF APPLICANT DATE O~'F'NER CERTIFICATION I (we) certify that all statements on this form are taste to the best of my (our) la~owledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Q ,~Zl.c'c..~-~ IGg NATUP.E Op APPLICANT /ai 3/ioi DATE ***`~* Any information that is rxus-represented may result in the sanitary permit being revoked by the Zoning Department. ****** F* 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