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HomeMy WebLinkAbout018-1070-90-100wisconsin+Oepartment of Commerce ~ r ~ar~ $~fetyand Building Division 7/~r D5 3PRIVATE SEWAGE SYSTEM ` ~ ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Hawkins, Lo T. Hammond, Town of CST BM Elev: Insp. B~ lev;, y BM Description: 2 ~ v-~, ~ sT TANK INFORMATION n TYPE MANUFACTURER ~r/~a CAPACITY Septic ~'~`~ ?~ i e~e~.~ il= ~a .5 /Z.~J' Dosing ,' ~ /ODn i' { L ~~ ' ~ ~C.r C77i Holding TANK SETBACK INFORMATION TANK TO ~ P/L , O WELL BLDG. Vent to Air Intake ROAD Septic 1 / /~ ~ Z eJ -~ Dosing /~O/ /C~ / ~~ / OL _~ Aeration O~ /~, ~ ~~ Holding PUMP/SIPHON INFORMATION xl , Manufacturer Demand ~ ~ GPM Model Number ~ ~ ~ / TDH Lid, 5 Frictio~Los s System ~ ad TD ~ ~ ~ t ~ r ~ s , Forcemain Lengt / Dia. / Dist. to well ~ S~ Z SOIL AgSORPTiON SYSTEM County: St. Croix Sanitary Permit No: 515130 0 State Plan ID No: Parcel Tax No: 018-1070-90-100 Section/Town/Range/Map No: 32.29.17.490A ELEVATION DATA 7_ ~S5 !oZ •4fS 4~h STATION B$, `~ , `1 HI /l,~, .~ FS ELEV. `7 ~ • t Benchmark 'S. l7 ~d3. 74' Alt. BM ~ o~ 3 ~ ~~ 94 , 1 Bldg. Se er ~ ,,Z , y'(o . / 3 SUHt Inlet 7, 9s, 3(0 St/Ht Outlet ~,~ 9 s . z~ Dt Inlet q ~ 99 / 9z. ~G Dt Bottom /3' 37 9,~~5 Header/Man. ~ ~~ ~ 11.~~, Dist. Pipe / ti 9 7, o l.~ Bot. System ,71 ~~ r,I~ , Final Grade ~' ~'Z c ~-e ~ , Z 9S, 3 BED/TRENCH DIMENSIONS Width ~, Length i ~ f ~_~, No. Of Tfe/nches /~,~~~, ~ ~,.~ ~ PIT DIMENSIONS ~.___ No. Of Pits _ "- Inside Dia. Liquid Depth '~`~ SETBACK SYSTEM TO P/L LDG WELL LAKE/STREAM LEACHING Manufacturer: ~` INFORMATION CHAMBER OR - Type O S tem: j F,. ~ , UNIT Model Number: r11CTRIRI ITl(1N CYSTFM <~I_...!! Header/Manifold .! i Distribution ~ f/~ ;/ / x Hole Size (~ x Hole Spacing ~~ Veto Air take ~° Pipe(s) f ~ i £ ~ ~ S ~ ~ / ' ,_1 f ~ ~' ~ °~ / Length~_ Dia ng pac Length Dia ~- ~ SOII (:OVER v D.nccnrn Cvc4omc (lnh. YY Mni~nrl nr At_C,radP Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / ~ ~ / (~'~ Bed/Trench Edges \ ~., Topsoil + '~ ~~r-. ~-~s ~ No -'i'ts [~ No 7 ~, COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ /~ /~~ Inspection #2: ~~ /~/ C~~ ~,~ (-~`~n p ovlr 6,ocation: 655 Cty. Rd. J/R~erts, WI 54023 (SW 1/4 NW 1/4 32 T29N R17W) >35 acres Lot ~ "~'~C P~ arcel No: 32.29.17.490A it 1.) A!t BM Description = - ~ Go/ ~' G~ : ~..4 ~ 1 ~ O t", c:,) Bldg sewer length = Z ~ ~..Oc~{riS p ~ - amount of cover = / ~~v (;~~ ~~~ Plan revision Required? ~ Yes o ~ ~ C( 17 `~1 ~ ~ - - Use other side for additional information. ~_ ____ .__ ._..__ ____-J :__ ----- - -' Date Insepctor's gnature Cert. No. SBD-6710 (R.3/97) r '~ePU~Cemer ~' commerce.wii.gov Safety and Buil d ings Division County ~~/ 201 W. Was / 7~x 7162 ~l • C(bI i sco n s i n so lCl Sanitary Permit Number (to be filled in by Co.) Department of Commerce ~ ~J /~V ~J Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental ~ (~ 7 3 / I (~ unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS aze Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ur oses in accordance with the Privac Law, s. 15.04 1 m , Slats. ~ ~ 1~ ^ n ~I I 5 U I. A lication Information -Please Print All Information • G ~ Property Owner's Name Parcel # ._ ',,~,~ UG 2 62009 v~g -/ozo -pa -ioo Property Owner's Mailing Addre _ ST CROIX COUNTY E Property Location ~/~n '' ~- _ ~p S s ~ <--1 PLANNING & ZONING OFFIC . VV ii Govt. Lot City, ~ Zip Code Phone Number ~ y, ~ j(/` y, Section ~ Z ~~~ ~ S°a ~ '3 ~7i s~- 7p6 - s S``~ S- (circle one T ~~ N; R ~ E o~ II. T pe of Building (check all that apply) Lot # _ `/ 1 or 2 Family Dwelling -Number of Bedrooms -7" Subdivision Name + t Block # ^ Public/Commercial -Describe Use ^ City of ^ State Owned - Des~ribe Use CSM Number ^ Village of x /,~ _\ _/y'1Q ~ ~ { ^ Town of III. Type of Permit: (Check onl ne box on line A. Complete line B if applicable) ~'' ^ New S stem y Re lacement S stem p y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued ' Before Expiration Owner IV. T e of POWTS S stem/Com onent/Device: Check all that a I • ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: ~ Design Flow (gpd) Design Soil Applic i n Rate(gpd Dispersal Area Required (sf) Dispersal Area Propo (sf) System Elevation ~~ ~~ ~10v S'~ ~ 3~ .~ VI. Tank Info.. Capacity in Total # of Manufacturer Gallons Gallons Units D o '$ v New Tanks Existin T nk ~ ~ ~ "~ g a s c aU ~ ~ H ~ ~ ~ wC7 a Septic or Holding Tank ~ i~~ ~ EJ ~ ~~~ Gv A/! / ~' Dosing Chamber GO _ ~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature M PR Number Business Phone Number Plumber's Ad ress (Street, City, State, Zip Code) VIII. Count /De artment a Onl Approved ^ D' Permit Fee Date Is ued Issuing A Signature ^ O er G' eason Denial G~ 25 • S~i~ 05 1 IX. Condit-~~~~~easons for Disapproval 3~ d~ A ~ ~~ 1 1_ _ G( _ ~ ~l Tt> W~~ '~i 1: Septic tank, eftlUent lifter and dispersal cell must all be servit;es !maintained G I LD . O as per management plan provided by plumber. 2. AU setback'requirements must;be maintained Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398,(R. 02/09) Valid thru 02/1 ] AdO~(~ ~. `. ~~ 0 ~ J ~~ ~~ ~ o ~~ .o o ~~ t~ , ~~ .. _.~ ~:. ~. ~O' ~ ~~ ~~ ~ -O $O ~ ~ ~!" M C~ d ~~ M_ -- I i t ~,~' 1, ~ ~ ~ ~ l` , t ~~ `_ 1 ~ t, ti 1 t l .~ a `'`-L 3 ._ ~ ~2. ~ ~' ,, - ,- t `, ~~ rt 1 ~ o ~- ~` -~ ~ ~~ ~-- ~ ` Q : ~: ~ ^ 1 ~ 1.1 ~ `1 ~~ °~ `~ ` ~ ~ 4 " ~ ~ 4 ~~ ~i 0 ~ ~ ~~ ~ ~p V ~ '~ ~ ~ 3 ~ ~' '`~ ~ ~ . vt ~, ~ ~ 1_ ~ ~ --~ ~ ~ - q i I~sr o ~ '= - - - - a a! ~ q ~3 ~~ 0 ~ ~~ ~~~ ~ ~ ~ ~o ,, ap v w ~~ u ~ °4 J 3 4 si I ~r ~ •© ~ ~ ~ ~ ~~, N _~ ~' 4 ~ ~~ .~ ~ ° ~> ~ ~~ r.~i ~ ~ ~ _;~, ,_~ ca~,,~.. ~ .~ ~~~~ ~. ~~.:cvv~ it 1~ ^^Y V `i ~J ~ o ~~ . ~ M Cr 4 ,. -~'" C~ ~-- t, ,9` t ~ 1i ~, t ~, ~, ~ ,; t~ ° "`~ ~ ~--- tr t' 1 ~ ~ ~ 1i l 1 cl .o o ~~ ~, ~ ~ .. :t -,~, a =' ~, ~~ ~ ~~ O V .'' v ~ ~-- ~ ~ ~ o ,~ ap v ~~ u v °Q ~.. m ~ ~ J O ~ ~ `, J ry ~. ~ ~ Q 3 3 - ~ ~ ~` o ~~° + 4 ~~ ~s o o ~ „~~ -~ ~~ ~ ~ ~ ,- ~ ~ ~ ' ~- ~ t i~ 1uw'2 ~ ~1 ~ ~' c ~ ~ ~~ m o 1 ~~ r I p ,. ~ U 1 ~ ,, ~ _._,~ ~ ~ of v ~ ~ ~~., ~ _. 0 --- ~ '-- _ - ..~ ~ LL cV U? o -µ,. ~ ~ p ~ ~ o0 commerce.wi.gov ^ ~sconsin Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 Contact Through Relay www.co m me rce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary June 25, 2009 CUST ID No. 226375 ROBERT W ULBRICHT ULBRICHT & ASSOCIATES CO 2812 10TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/25/2011 SITE: Lory Hawkins -Dwelling 655 CTY Rd J Town of Hammond, 54023 St Croix County SW1/4, NW1/4, S32, T29N, R17W ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1673116 Site ID No. 748652 Please refer to both identification numbers, above, in all cones ondence with the a enc . FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1228834 Maintenance required; Replacement system; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.OI/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/Ol) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stars. 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. 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. Sincere] Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 ter E Pagel Private Sewage Plan Reviewe ,Integrated Services WiSMART code: 7633 (608)266-2889 , M - F, 0600 - 1430 Hrs pete.pagel @wisconsin.gov ~C~ " Y 0 P OiVi SCE G( cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. RECEIVED 2812 10th Ave. • Spring Valley, WI 54767 JUN - 4 2009 `~"~'~ ~,~1~;._7efrtvay~t~"ry~`e;;,~~~`"~'~ 715-772-3442 ` SAFETY & BUILDIl~GS PROJECT INDEX Plan I.D. # Owner LOR y ~~u~k/~NS Address (oSS ~'fy. ~f~. ~', Ro13F_RT'S w~S. SS'O 2 3 Legal Description pR~2.~" O~ /,3~ AC~,Q Fi¢~iy, ~ ~N ~r8 , ~~70 . O sw, ,vw , sEc . 3z. , r ~ ~ ,~, R ~7 uv ~ 1 •% Town of ~i4/KMOND County s~• C~OryL C.s.T. ~C? Zr/~bR%Ctii 2~-Ce37 S Local Authority/ Supervision PROJECT DESCRIPTION ~~S • 3d?~• ~~~0 ~' ~~pl~4c~"~1~,~T M o v.v v Fo ~ ~4 ~ t3 ~nR ~ . s; ~. ~-~ MME. .~i>f% y ~s ri,~.,,q. Tt~ ~~s% ~~ 'F/ow 15 (~Da ~ir~s. s ~-. cRc t X cry. Z o~ uu G- ~ ~ p •r- . M o v, ~ D Date ~~~ ~ ~ ~ ~ ~ 9 Phone 7/S • 740 • ss~,! Installer s ysT~h zc si~1G.. Fi !/ i S ~ /pa~GtS~~ , Rw . ~ ~ r' ~- ~~~ ~~ - ~~~ ~~ ° ~ ,~ A . p,. fj • ~~~ ~~ ~~r~ _ c u, ~<„ ..~ \~~v~nDe~w. .~ t. ~ u~.snic~ ~. (~ G116A ~G .HUDSON. WI ~~ d` ...... '4~ Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS ~ SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN ONTS) Pg.4 DOSING CHAMBER CROSS SECTION ~ SPECS. Pcr.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) ~9- ~v i~~.c~Tie,u ~ L ~~~ NON-DONFORMING ~p6~~MENT TANKS SHALL ~~,~~ANDONED PROPERLY ~E~ ~®MM. 83.33. CRO55 SECT ~dti? o~ Nlpu~ D -- w ~ r tt 'f3ED ~~ ~ ©-~ ~ ~iStRiQuT~aa Cs•~ TkickaFSS P1P~'~G- oF T° P S O i L ~ ~,s E~~~iU~- ~ ~° ti Uu~ FCJ~?M ToE ~r ~ N ._. 3 _. ~_.___- MCD. ~ ahT~o @ ' ' 5AW p , .. //// PIow~L> ToPSoi ~- /// /// ~ % 5-opE ~• ~ ~ F r. E /• 3~ F T. ,g~ ,.~ FT'c9•g. C~ • 5 FT' H ~ D FT, talc o F '/~, " ro ' ~.` Ayg~eeSATF s ysr~M E I Evl! 1-io,~1 /9~. 3~ , ~=- ~ • 9 , ~~"`~ ' VIJ i Fo(~P1 F°RoE ~ t~VAT~oa v,u DER ri~'~ t3~ 9f• 3 ~ ~ . t -- E~EV/4T~o~J S -' L " G • INV~Rr of ~ 2 I AT~R/41 s ~ ~ - g ~ • Top o f Rock g 7. Z~ _ ~ u • T'o °~ ~ Z IATERAIS ~~ ~~ P f'LA N V~ EW ~~ Mou~D ~ w~ rat '[3E ~ FoRc~ M~1iN i i• s - _ _• ~ i ° ° K ~~ f 6~ W Y `~ ~ I V ~ . ~ PVG ~App~D nl3Se rt Vhr~ o,~ ~ ~ F r• d ~a° Fr k •L Fr l~ /~ Fr ~ $ FT ~ ~~ F r W s ~,~ QED o F ~2'~ To 1 is qq ~ RE'6-P,~'~" Observation pipe Fill material ,-- ~..~ tASTM1 C33, fine ~ ~ [~~ aggregate ~ _~ _.. ~_ .~-~ Siope •nr.~~..~ N..Mf ..~.. couplings vraac~ \.~Vial a.uum Figure 8 -Observation Pipes ~~ r~ ' 5~ ~~~U '~' 1!~ Figure 6. Cross-section of a Mound System ~ti.~ Dom, ~~~~ lr~~5 /~ ~ s~N~ ~~ G F~ o~~ ;` - - --- r{- sr~-~ ~ ~ ~ F( ~, Fl ~ " ~~~. a~ ~~~~av~D ~ / yc9~=~ r9- ~'~ ~~D~2, I __------ --__ • ~isT~i QuTip~l 1~i~E' L~4~/o(~T_" C~i~ TS~J4L-. 1`~f~~ ~' ~`o ~. • 4 ",: 6 ~p/E'i~ F''~s x/~ ~EIaT~I~-• ~ n R c E M A i tit __.-----___. __ 0. ~~ l ~ ,s ,~ ~.. ~~ ~ iZ ~ -~.~ ---- .~- ~~ \~~ -~. ~~ a P~~ ToT~t, VI~tD VbIv~E H O 1 t; ~~ A~ N- ETE` R L~14j E RR ~, ~r ~E~TRhI M~N~F~Ln ~~ Fc~t2cE 1yA~N -~ .~ ~*b .? h~- Q .~'. ~~ I~oIES/ jai pE g• 2 ~A~s . 3~~ ~N~ p ES f %2 ~~~~~s . Z iNCr~~s ~' tu~~~s 17 SEE ~~UE~S~ SIDE ~'oP '1~~M iNAL c/D ~tT~4i (. ~~ i~4i ~ pi QE PE R Fa R ATE D _._.-- R~MovE- hll DRill f3UR S ~ ` Y R ~~ P y~ F,- R Z ~r _______ x ~ ~~~~ ---_._._ Y ~~ Iucy ~RR~'hR~E 'pi 5T^a ce TOTAL UO~Uy of A~Tiva~,~ ____~_ I.I~VERT EL~UhT~O o~ LATE~R~15 s~. ~~ ' ~iPi Fr c~- D~ S%T`Y O ~~T~gIL off= LRT~ERft~- ~~p /~~P~s D~JE /4. l L /~ ~ ~,v~ o~ ~`~.c~ ~iN~sf~~D ~'Iovvp 9iP,¢DE __----_ ,____ ~-- L~wN S~iPiv,~~ I~ ~~l~~I~U~ " /30X ~rE~vTL~' GU /~ /4-CG,ESs 7rO ° SGUE~~ 0 2 ~~ ~av~,~ ~~> y5~ ~E-[> ~~ --.~ /RUC /.3~4 // v~9 /U~ ~-~9 ~-~~ ~ PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS fJ~}cf- :~ ~,~ --J - 7 ~!/G . VENT PIPE f q~, o -a' , 1.0 -I~U~t' n~v INLET ~f a r APPROVED JOINT 1J~ PIPE LXTENDIIJG 3~ oUTO soup sDl L s~~ , go Pay ELEV.~FT ~~ ~? k ~~ ~v,~ ~ l ~F~ l~ v:l f i0 ~ `'J• 25 e Q `~ ~ RISER VENT CAP I P~ PE WEATHER PROOF JUNCTION BOX 12"MIU. GRADE couDU1T I I I I L-- V `: PROVIDE AIRTIGHT SEAL ~Ny ~~ K N~ 'ly y ~° ~~ 8~ 'Z ~~ 3 3q I . ! ~ ~ PUMP -~ 3 1 6LOCK-~ 0 APPROVED LOCKING MANHOLE COVER w/ tv~-~'N~^~L•' ~f1/3E~ y'~ Mi1J. (~ ~ IB" MIIJ. III ~~I ~, ~ I ~ I ALARM o~ APPROVED JOIIJTS W~ PIPE EXTENOItJG 3' ONTO SOLID SOIL s~ . gv Pv< OFF ?~sE 3 0~2 ~1~.PE eF S~.~l~ ~~/~ U. ~-z.--~ EXIT PERMITTED OA,{Ly IF TANK MAIJUFAGTURER HAS SUCH APPROVAL. .-'~ SEPTIC E S P E C. I F I~GAT I OILJ S DOSE f/V /~ ~/~„ NUMBER F DOSES: ~ PER DAy TAIJKS MANUFACTURER. )~O TANK SIZE : ~~~~ + GALLO~I~JjS DOSE VOLUME T ER: L'QV'G~ ~~~RM -`r INCIUpt-J%~ AGICF ,aw: - ~ O GAt~ONS ALARM MAAIUFAC UR ~ ,,// MODEL 1.1UMBER: ~' ~"~~ ~' CAPACITIES: A~~INCHES OR GALLONS SWITCH TYPE: ~~Q~~ '~'r INCHES OR ~d GALLOAIS ~'~~E+'~, -~. C. ~• Z INCHES OR ~~~ GAL~01J5 PUMP MANUFACTURER: •~ ~ {T~ '- D= ~,7•a INCHES OR ?"'~ GALLONS MODEL NUM9ER: ~•~ 7 {T . SWITCH TYPE: ~~ ~Gy ~AcK ~`O~r DOTE: PUMP A1JD ALARM ARE TO BE INSTALLED ON SEPARATE CIRGUiTS MINIMUM DISCHARGE RATE GP~"~ /~ SI~tGS VERTICAL DIFFERENCE BETWEEU PUMP OFF ARID DISTRIBUTION PIPE.. ~~ O FEET ~A~~`_____7 r' ...3 ~~5 FEET EA~~t 1 6{' ~~ (--~ -~ MI MUM NETWORK SUPPLY PR SS REQ~. . -{- ~ FEET OF FORCE MAIN X ' r~F/100 FLFRICTIOIJ FACTOR•.~=- FEET .Lt'(;~~ ~ S Z ~f" _ IC HEAD = ~~' ~- FEET - TOTAL Oy1JAM ~ ~ ~~ -t Qj ~~ O C~ ~ LIQUID DEPT H (IJTERNAL DIMEIJSIONS OF TAIJK: LENGTH /O ;WIDTH - i Pg. 6 of 6 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Sec~tic Tank ,,~ The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retairr'solids in the tank that may slough off the ffler when removed from its enclosure. If the filter is equipped with an alarm, the filter shalt be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. if the contents of the tank are not removed at the lime of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. . Puma Tank The pump (dosing) tank shall be inspected at Least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shat) be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost:penetratbn. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice leaning is required to maintain equal distribution within the dispersal cell Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. ti/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no kxrger used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent acddental or unauthorized entry into a tank or component. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating conditbn. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component tails to accept wastewater or begins to discharge wastewater to the ground surface, it wifl be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologicafly dogged tin and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into p per operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. SEE REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS TO TNiS SITE, nFGTr_u_ n*rn ..,.~.,,,,..,,...~.. ~~s • 3~~ y~ ~o * Licensed installer, responsible maintenance "Users" manual: his • 7Y • 33 z Z. w•~~~~e. for providing an operation/ o~ ~~~i~y .i(l~~~v:~~-~ * Licensed servmce / inspection agent other than installer: pis • '~~ ~ • 3 y ~f Z. * Electrician, for pump, electric controls, wiring units: ~, LDS ~s ~' lec ~ ~ ~~,~,.~ ~~~~•~ IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shove ring, etc.} across the area shall not be permitted, or frost can/will penetrate into the cell, freezing up the system. Discontinuos uses in the . winter_(a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed.. This svs¢em was designed for a maximum wastewater flow of ~~ O gals. daily. 3. POWTS are not designed to accomodate wastes from,a garbage; disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. _~. a 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leak~'ge). It is recommended that a licensed pumper empty the dosiL~g tank, allowing the pump. to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative~~~cover (the cells insulation ~ erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'TEM!! Efi_luent in the system beneath IS NOT sufficient alone t0 maintai;z a yt `~`COVHr. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover/manhole). Only a licensed properly quaii~ied person should be performing this work which invoi~ves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. r 1 VlfisoorrsMDeparb~nentotCormrerce SOIL EVALUATION REPORT ~ Page ~ of Division of safety and euildrrgs rn accordance with Comm tjs, w~. Adm. cone courxy s`T C Off' X atath compieoe site plan an paper nd less than 81/2 x 11 irx;hes ~ siz Pla ust irx~de, t~ nd Nrrdted to: vertical and horizontal referertoe Parcel I.D. ~~ (/_ j /} ~ ~ _ C~j ~ ~ ~ JS ~) . t slope, scale or drnensior>s, north arrow, and location a ! V ~U (,I Please print all information. R ~ Date Pen nd YY H l 6 ~ ~/~ 7 o on you pmv om~s d mry beussd tortsoondr+ry prrpasas 15.04 (1) (m)~ P'opert)'°wner G ~~ y ~! /T J~~E ~ ~ . (O ,~ .~ lot $G(J 1l4 Nw1M S ,3 Z T 2 f N R /7 E( W PrvparlYOwner's X55 cy%• ~t7• ~ ..DEC 07 Z~ # 81odc # Subd. Name or CSMti N• ~ •-o!S ~~-~07o.~-ya-- /° . -State Code Phone ~COIJNTY 0/3~Q T-S ~~. S'1aZ3 ( NING OFFICE ~ ^ Town Nearest Road _ ~/l,J/L! (~?~ CYy. 1217 ~ c.1 New Corn / Nurrrber of bedrooms Code derived design Aow rate O ~ ~~ GPD ReplaoatrrerN ^ Pub6c or corm~rciai - Descrrbe: r gent material SA.vD y '>`i //S 4U~"/e 4~~-K LY Flood Fain etevauon if app~Cable _ $. c3eneral tormrerrts C.2W, .?.t1 ~-~_ -si9~V~-S~tJ-ca-e. , . n a d ~ / ~ - Spot Tested suitable for y'{e~n~ ~~(~ --~ ~j5~ 3 $ Area mound (P.O.W.T.S.) system using / ( 0 ~3~ 8a'"'° ~ ~ Pit C3rorard satiate elev. ~ 5 R DepUr >Bo factor ~~ / i<,. . SoA Rata f~ottaon Dept Dornkrerrt Redoa Description Texture Strrrchne Corroe Botxdary Rods in. tYtunsel Qu. Sz Cor>t. Cctor l~ Sz Sh. '~i1 'Eff82 / a • ! l /o R .~/ - sG fsh 11-F/2 w ~ f . y • 7 Z l/' Ly D R •j L -F /Z CGv Z f' • ~ / ~ 3 Z ' /o R s/~ -- SL ifs ~ ,ter ,FK cs . ~ • 7 • ~D 2 • S $ C i~ H o•f ~ A~,V S ~tlR.. w c. ~.y~'.f~ ~- D ~ s yR ~ (~ 0 ~,~ ~ 4 5.3~ /s.s s . Pit Ground surface elev. ti DePlh to factor Z ` ~• .. Sal Rate tiorixon Depth Dornirrarrt Redox OesaipGon Texture Structure Come 8owrdery Roots CP O11F in. tNunseq . tlu. Sz Cont. Color tar. Sz. Sh. 'Etlk1 'EtFle2 a • 8 .-- GS o, s a2,Q. 1,~ ,3 ~- ~ ~ B•~5 a~ SL f- ~ ~ c~ Z • 7 •~ a R - S~ z ~ ~~R ~5 •~ /o •S Q 6 ,v ~ SG ~ f, R ~ f i ct. 5 -- • 7 a . s y / r3A NC7i D S.gN$ ,v,c --• ~~kK ~ cE.y ~ o v cs.•e ~ ots 5y~2. ~ • Effluent #'t = t~00_ > 30 < 220 moA. and Tss >ao < 1 50 moll • iStluerd lf22 = t30D _ < ao moll and TSS < 3o mdl. -- c;.sr Name~Plaasa P ~ T 2~ L ~3 ~ 1 G I~ T-`. >~=~- ~/,/j ; ~ ~..,~` . _ .. ~ C'~i 3 S Address ~~3 t>de EvaN,adon carduc.~sed Tetanhone Ntanber ' ,adv. 3 - X007 7/s•~~Z•3y~fZ l Il4,r8..he~ f~~ nni-++o - Private S~w~~e Consultants 2812 '~ nth Pave.. /~_ /~•~- so: c ~~ r ~ ~ -- , Sp~in~ ~~~~ie~, ~~vi 5~.~s~ ~,r~sr%Ny• sys~~~ ~~~,~~. ~3-5a ~a~~ax ~ ~~ ~. ~~~ ~ ~. ~ ~,~ ~ Sa~~S ov <opF l~hr /: ~_a 4F-la~o ~ h Ir ~ r W I ~/VS r 1 .... ~ Z. ..5, G o~2 y ~}~ ~ ~Par~ ~ # ~ ~ .~ 3 a~1 ... _ ,,S.S:S . # lct Pit ca surge slay qZ ~ ~ R Depth m t factor 2~ ~- sw Rate Hotiaon Deplft Ootr~inartt Radooc Desaip6ott Texdea Strttcture Cattsiseettoe Batutdmy Roots GP OiAE ln. Murrs~ Qu. Sz Card. Color Qr. Sz Sh. '151ttF1 '~ ~ o ~ ~ ,a y~ 3, --.- ~s o, s w 3 -~- • ~ %~ .~ w ~ ~ . ~ . 7. !z ~- SL Zf SbK nMf R cGc.7 F . G /. o . 7 ,s B,~,vps - sG /,~ M, ~, s - . y . ~ N 2.5 8 i4,v~s " w ~~ c~ ~ ~r~ ~ ,S~a o 0 c ~~ ohs s y/~ ~(p a t~ar:rg . ^ plt c surface eletr. ft. Depff,>o limiting fattor in. ~ Rya ftotimn Dept OaMnat~ Redoot Oest~ott Teudue Sttt~tre Cct~tetrae Roots ~ ir. lNunsell Qu. Sz Coat. Color (ar. Sz Sh. 'Eifgi 'fit T ~ ~ ~ ~8 ~ Grwrrxt surface elev. R b factor ln. SoN Rare Hortton Depth Dominant Redax Destxiption. T Stnresa+e Carrsi~anoe Botrrtttery Roofs GP' QI~ lrr. tNunse9 Qu. Sz. Cont. Color Gr. Sz. S'h. •~'1 "E1t1R2 n n / L____~ ~,.pm ° ~ .pit surer n uep°' w ~ ~ -` sa Rate Tea~a~e Shuatre Cansintenoe 8otattlaty Roots Floriaon Oepth in, Donirard Mts~se/ flu. Cont. Galor Gr. Sz. Sh. 'mi'l f ~ ~ `s ~ ~ _c ~ o x ~n»~; ?~ ~' ~:- :7~ ~ '~w. ~ ~' '~ ev .,_, _.. ,__ ~ ,-. •`' ~ r~ ~~ ~~~ ~~ n n ~ ~ ~ CD ~ N N ~ ~ v ~=~ r* 0 r-~ N~ -- ~~ ~ ~ ~~~ 'o`'~, G ~~ ~~ (~ ~~/ a J - O ` ~ ~ \ ~ ~ /: _ _ _~ ~. ~ _~ O L ~' I ~~, a ~3 ~ ~ ~ ~~ O S ~ ~ ~ ~ o ~ '~` ~1 0 t °~ p0 do o, ,~ ,l ~~ o v~ D -~ ~1 W oO Z Q n e ~, ________ n ~, ~ ., ~O 1 O ~_ C 3 t~ t-. c ~a ~~ ~ ~~~ ~~ March 6, 2008 Lory Hawkings 655 Cty. Rd. J Roberts, WI 54023 Code Administration 715-386-4680 RE: Parcel # 018-1070-90-100 -Computer #32.29.17.490A Land Information ~ Dear Ms. Hawkins: Planning 715-386-4674 The above parcel currently has a Soil and Site Evaluation Report on file with the Real Property Planning and Zoning Department that indicated the need for a replacement of the 715-386-4677 existing Private On-site Wastewater Treatment System (POWYS). Enclosed is a copy of the report for your review. Recycling 715-386-4675 The soil report was completed on 11/3/07 by Certified Soil Tester Robert Ulbricht, but as yet no permit has been issued for a replacement POWYS. Department staff will be conducting a site visit this spring to determine if there is any visible indication of a POWYS failure, such as surface discharge of wastewater, on your property. We will notify you of any findings of POWYS failure, which will be documented as a violation of Sanitary Code 12.1.F.4.d & e. Please feel free to contact us if you have concerns regarding POWYS maintenance or how to proceed with replacement of the POWYS servicing this dwelling. Sincerely, Pamela Quinn Zoning Specialist Enc. _~ ST. CRO/X COUNTY GOVERNMENT CENTER 1 1 O 1 CARM/CHAFE ROAD, HUDSON, Wi 54016 715-386-4686 FAx ~' n z Z 'p s ~ ! ~ y '1 ~~ i " ~ ~~ rt z V n ~ (D ~ O Q ~ Q ~ Q ~ ~ _~ _ _ ao o'er ~ ~ m ~ ~ ~ II ~ ~ ro ~ ~ m m o _ I ~ ~ 7 N ~ ~ N ~-+ l~ ~ ~ I -... i ~ 7 N fV '~ V ~ M N v r d rt n T QQ - 0(~~ - . ' ~ C i S W ~ . . °~ o . . + o m ~~ C ~ I i n V1 (A ~ ~ ~ ~ ~ ~ y ? n ~ o n !,~ ,~ y ' N ~ ~ , ~ r~r N (D O 0 0 _ _- _- ~ ~ ' ~ o 0 n o ~ ~ ~ l0 rt ~ O rat ~ ~ d ~ I , i ~ C ~ ~ ~ O n ~ _ ' W °~',~' o a 3 ~' ~~ ~ , o rn ~ N . ~p O V7 ~ p j O CO N . _ _ ~ ~ ~ ~ i 7 ~ (D `~ (D ~ • ~~ Q ~i ~ ~ ~ a i e-h N ~ ~ ~ d i -z C N ~ ~ ~ ~ (D ~ r=-r ~ (D ~, O '~ ~ n ~ ~ r C W y Vl lD t- N Cl 7 d O II '; _.... N C 3 Obi O ~ 3 A °: ~ r~ ~a ~ ~' # rt ~ d ~ ~ ~ W d N ~ Ul ~ ',~ 00 ~ o r of N d ~~ ~I O ~ ~ f g D ,p E o I -_J ~ Ji I '~ n n ~ o ~ a. ~ ,~ ~_ ~ ~i ~ iu ~ rn ~ o cn 6 ~n 3 ro nip .. ~ ~, ~ in d' < ', II ~ ', ~ ~ .A O N ' W I c0 0 ~ c ~ ~ ~ v Q ~ ~G r=t o W O ~ N ~ ~ ~ ~ ~ l~ N ~ ~ iD O ~ z j ~ 'r T "O ~l ~ ~~ Q I ~ ~. ¢ tp I i Q ~ ~ O O N O S ~ C ~ ~ ~_ ~ ~ fD N ~ N Q ~ ~ ~ N ~ 3 0. a o I o ~ m tt.! Z D m cn D v' I ~ ~ W 3 ~:, m ~ ~ ~ o I ~ C "D ~ C ~ ~ I ~ O a !D C m ~ m ' ° o ~ o I °' O ~ ~ 0 !A to N D 0 N 0. Q. - a 0 3 0 ~ ~ a ~ v (A ~ ~ C ° ~~ ~ N co m I o ° O x c ~ N N N O ° V (° ~ O C N ~ ao . ~ N ° N C y ~ ~ O i ~ ~ ~ O ~- ~+ o ~ ~ ~ ' ° !~ a ~ ~ ~ ~ m ~ ~ 3 -~ 3 ~: =~ ,~ x~ o = = w o N ': !, 7 r '. O ', ~ 'i ~ i ~ rn y 4. ca ', m .. n' o. ,~ 0 o a 0 0 ~ o a' 0 0 ~ N '' v~v~'', O O O - !, A: N Ul N N ~ovW' ~° °1 m m ~ d ~~ y W 3 M Z W Z D a ~ ~ ~ m ~ m ~' ~ N ~ C ~ ~ a N N -+ 00 3 V O Q A O o D o ~ °o 0 ~ ~ a .. ~ d V W v ° m N 0 0. z ~ c -~ ~ a !' ~ W ~ < N a ~ ', ~ z O - i _ A ~ ~ :-. ~ ~ ~ N Z ~ A W <_ T C 7 a d a ^~ C "'S fi'i O fi y A ~. R a 7C N ti ti A ~. ti O trp Op ~ O ~ ~A ti n ~ ` ~ ~ Farce! #: 018-1070-90-100 ozi2v2oos 10:32 AM PAGE 1 OF 1 Alt. Parcel #: 32.29.17.490A 018 -TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01 /04/2007 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -HAWKINS, LORY T &MARLYS M LORY T & MARLYS M HAWKINS 655 CTY RD J ROBERTS WI 54023 Districts: SC =School SP =Special operty Adt~re~ss(~es): * =Primary Type Dist # Description * 655 CTY RD J SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 32 T29N R17W THE S 605' OF W 435' OF Block/Condo Bldg: ~ SW NW ~ '~ Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 32-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 01/04/2007 841840 WD 07/23/1997 925!442 07/23/1997 863/632' 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Land Improve i ~~. Last Changed: 02/13/2007 Total State Reason Totals for 2008: General Property Woodland Lottery Credit: Claim Count: 1 Certification Date: Batch #: 302 0.000 0 0 0.000 0 0 0 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address !v SS- ~- 7 y ~ ~~ --J. Property Address /~~a=-~u.~ C.~.-~ -~'i~~ ~ ~ (Verification required from Planning & Zoning Department for new construction.) City/State ~ Parcel Identification Number {~ D / fi' ° 1 ~ T ~ ~ ~ ©~ I D O LEGAL DESCRIPTION Property Locations ~ 1/4 , ~'/4 , Sec. 3 ~-, T ~N R~Town of !T~/t? ryt eNd . Subdivision Certified Survey Map # Lot # Volume ,Page # Warranty Deed # `~ 7 ~ ~-3 / ,Volume ~'~ ,Page # ~/4/~ Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 yeazs or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities aze specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal 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 Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three yeaz expiration date. Uwe certify that a1i statements on this form are true to ~e best of my/our knowledge. Uwe amaze the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SI ATURE OF APPLICANT(S) ~3/Dq DATE ***Any information that is rnisrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. **' Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (ItEV. 08/05) ..~,.g .... ..T -:y 'Xis' -. ~--• _i a,wcs"~",Htl" Iy~i:W,,, <'tK ^'<s?at.f ','.K_'...-.... '. ..:.. _ ~..; __: _ _ _ _ _'~ _ _ _ Vi I ~.a _ ._ - __. __ ~. ~ ___. .- _.._ - _a _ _ _ ~~ Y __ ~~~~'a_i J _ __..._SCIt~ _' _ _ - _ _ z~~ q Fd F{~~at~it3~ ~- ~" DaAo~~s ~ -ru.~zr ~4~~ r _ -_ - - -- - .~~ t..]\Tfl lL,d UY ,, w., _ .. .~-.. _. ,,5y.Vy yy//~~, ~yt [}l~~ hnst~artc] grad r i~'+~._ ~a ~5".? ~ ._ . ~ ::-:._~ .~, ~-c"_~L, iTi:z eo ~ b,X Y `r' . _ ~1 a ~.t)r i F6 Q ~ P ~ , h e~ `t d i nR a s {~ ~,~~c,~ , .. 3 i ns ... . H3vk tal property ...- .. ! rvivrr~hip aar ~ ;. '~~`~ , ((JJ _ , e~t, .___ ~ .._ ..~ _ ~ _... _ _. : G~ "r.g '_' _ITA ~~.r z 4~ fi} ~.~ ~_. - Cfi71 16iY0Win$-LSca.i~ t- _ _ _ _ a __ _ _ _ - ~ir53'~1 Y.~`. _~.-: - _ _ _ k rv, "'~ ._ :-...: ;.. _ 'rl'.e !~orf.h~-half t~f L-)te 3outhtir~8t t2uari:c-r - ,Ifn t}'In.._~Ot3t.}'iVB[3t-. !`.. . {i~`~1°€ ndi ~hc~ South-ha]f ) " `w ~ r. is a r i= e r (~ tii~ o ~ f h a " , ~~ rrr.,:aest -~uda= r.= of _the rlorirkwe~t, `~~ L In T`ownRkti n 'C'w~nty Ni nc- Alarth , 2 ~ . 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