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HomeMy WebLinkAbout008-2009-01-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CfOIX Safety and Building Division INSPECTION REPORT Sanitary Permit No: 57$960 0 15 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Vadnais, Jerome & Mary Eau Galle, Town of 008-2009-01-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 01.28.16.568 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head T DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution ix Hole Size X Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No E] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 598A 270th Street Woodville, WI 54028 (NE 1/4 NE 1/4 1 T28N R16W) White Pine Meadows Lot 1 Parcel No: 01.28.16.568 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes ❑ No Use other side for additional information. LI SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. 7 Now I V I.. %.r County Industry Services Division ; t QIS H t 2 4 2011 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P O W07-f7,162 ;CROIX COUNTY ` I r _ PMENT I "I Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the approprla,, _ r-~ ~ < Ll 3c is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS aro Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for seco : ur oses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application -information -Please Print All Information TTT Property Owner's Name Parcel # Property Owner's Mailing Address Property Location A C- ,il Govt. Lot City, State R Zip Code Phone Number 7/ , E 1A Section t' l "'r - (circle o p&) T N; R E Cr II. Type of Building (check all that apply) Lot # Ly'1 or 2 Family Dwelling - Number of Bedrooms i Subdivision Name Block # ' i'~ t 1 (1A tf'`Ct c~L1i ❑ Public/Commercial - Describe Use ` ❑ City of CSM Number ❑ Village of ❑ State Owned - Describe Use S r Town of Gx (3 r /4- a? i ' 111. Type of Permit: (Check only one box online A. Complete line B if applicable) t A' ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) -77 B•r ennit Renewal p Permit Revision List Previous Permit Number and Date Issued ; ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner / IV. Type of POV 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) i V. Dispersal/Treatment Area Information: vation tem Ele Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propos7(sIIS~~ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units to V N N N New Tanks Existing Tanks a U 2 r w t7 a Septic or Holding Tank Dosing Chamber / C•:-'~ ei(. i r f V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State ip Code)- t , Vill. County/ eartment Use Onl Permit Fee Date Issued + Issuing Agent Signature El, Approved ❑ Disapproved ❑ Owner Given Reason for Denial VVI IX. Condi easons for Disapproval 1.: ~k, e~fltistt' lilts f~lr< ~ ~ ~t e!` ~ ~ I r~ v tilsparvT,i cell must all be sel 'Ic*s !r ±a m~-;e~ f n AS per iparayement plan ! sided uv plurnbe~. ~ ~ ~JG•~C. Ut4, 2. "IAA s,it fct~jrat ^enTS mlr~t tt• t >a:rrt~ IrE d) go Per *pF h colo / •:.ftiiilB,N:E,F. fir. , c Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 incheis in size a SBD-6398 (R0313) RECEIVED ~j .:acxu;~, County r4 Industry Services W S ~ i~CC; X MAY 2 201 I / 1400 E Washington Ave Sanitary Permit Number to be filled in b Co. S7. CR IX COUN P.O. Box 7162 < a n, WI 53707-7162 f ! / 30MMUNITY DEVELOP c t~ , Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ~ r / 3,-'; is required prior to obtaining a sanitary permit Note: Application fors for state-owned POWTS are submitted to Proy'ect Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary .1 purposes in accordance with the Privacy Law, , s s. 1 15.04 1 m , Stats. ~//r"If~ `yV( I. Application Information zAPlease Print All Information Property Owner's Name a Parcel # ! t Property Owner's M iling Address f Property Location / C/ / State Govt. Lot City, ip Code Phone umber / Section (circle one T N; R / C E ~e II. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name 6k Block# Lt 'Gl ~Y t , ' I FuC~~}c`--' ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of r l U Town of 64 / t- III. Type of Permit: (Check only one box on line A. Complete line B if applicable G A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replac t Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ C nge o lumb erit Transfer to New List Previous Permit Number and Date Issued Before Expiration wner I t a IV. Type of POWYS System/Component/Device: Check at I ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At- de ❑ Mound > 24 in. of suitable soil .Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVTrea ent Area Information: J., L417 /j Design Flow (gpd)_/ Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation l C, y 7Y~ _7 I -f 'c s- VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c New Tanks Existing Tanks r G u c7 w d 1afG. U cn in P. Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation ofthe POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number TBusiness Phone Number / _ Plumber's Address (Street, qty, State, Zip Code) l VIII. un epartment Use Only Approved Disapproved Permit Fee Date sued Issuing Ag ignature • n Reason for Denial IX. ConditillYGMWO MgReasons for Disapproval iS GJ r✓`~~' 1. Septic tank, effluent filter and 3) v dispersal ceflmust all be services / Maintained ~a.r (J et per m+ negetnent plan provided by plumber. 2. Alll'setWck t+kgtllrements must be maintained ,1 ~J as per epplicable code / ordinances. -T Attach to complete plans for the system and submit to the County only on paper not les n 812 z 11 inches' size ire e~ (A,J~q(d pCN /VLF SBD-6398 (R0313) / To e) i / I S /or t'~ I ~ ~ 4r To cr~ -po C- (3 ~ © voU~ S"oc Gaf, i z;)c, l ce oc G~ Ao !Y l o /Ara- Gr~~~~ Elegy , FvL, 96.0n p~ Sic. I ~ S7` C~k T"y I&) fE .gc C, ~2 g.U 16 ~~tiY~x7:t1F,~r DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 = f j d S a~ Contact Through Relay 1 < http://dsps.wi.gov/programs/industry-services www.wisconsin.gov A- ~ossror+NScott Walker, Governor Dave Ross, Secretary May 21, 2015 CUST ID No. 220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON ENTERPRISES ST CROIX COUNTY SPIA N7649 STATE ROAD 128 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/21/2017 SITE: Identification Numbers Jerry Vadnais Transaction ID No. 2542130 598 A 270th Street Site ID No. 812409 Town of Eau Gallo Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NE 1/4, NE 1/4, S 1, T2 8N, RI 6W FOR: Description: Two Bedroom Mound System / 2.5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1534853 Maintenance required; 300 GPD Flow rate; 21 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. CONDIT101 The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code APPRO' requirements. DEPT OF SA No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06PRQFE$SIQNA stats. DIVISION OF INDUI The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the CORREE requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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 IIELGESON Page 2 5/21/2015 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 rard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 j erry. swim@wisconsin. gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm BENNI NV HELGESON Paee 2 5i21i2015 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2); nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The aboveleft addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 Fee Received S 250.00 Balance Due $ 0.00 Arard-r--, M S wim PTS Plan Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim cr wisconsin.gov cc: Edwin A Taylor; Wastewater Specialist, (715) 634-3484 ; Monday -Friday 8:00 am To 430 pm QEIVEF MAY 1 y 2015 INDEX SHEET ~,p9UsTRY SERviC PROPERTY OWNER: „l"e jr V-7 Ua i~ r1a 14 PROJECT NAME: J,; rfr V'~ + s PROJECT LOCATION: 1= y o-A) E y Scc I T ~-L) MUNICIPALITY: >c~u (sue l1 e- COUNTY: S T. CRO/ k DESIGN: PRESSURE DISTRIBUTION MANUAL VERS SBD-106706-(N.01/01) ~ MOUND COMPONENT MANUAL VERSION 26~ 10691-P (N.01/01) ERR% CONTENTS: w SERVICES -r p y SERVICES Page 1: Plot Plan Page 2: Cross Section and Plan View of Mou NLENCE Page 3: Distribution Pipe Layout Page 4: Septic Tank and Pump Chamber Cross Section and Specification Page 5: W f~O~SDU - MR Tank Specifications Page 6: Pump Specifications Page 7: Observation Pipe Detail Page 8: POWTS Owner's Manual & Management Plan- Pg 1 Page 9: POWTS Owner's Manual & Management Plan- Pg 2 Name: Bennie Helgeson Signe Address: N7649 Hwy 128 Spring Valley, WI 54767 Credential Number: 220292 f y 'li 1 r , c~ 1- r ~ ~ yl Itl t -~---_-~-~.s~ c'"C, c • o~ ~ vc~t jf'c~ v ~ loC~~~ ,~v C~ No . o p Top a-~ -oo P~ lY to k :~as~ ~~rh Crhoc,wtc~ Elegy , q" P` '4° pn S1~ I I N E o~ ~l1 t ~ n -4= Se c, / v 16 Page 0 y Synthetic Covering ASTM C 33 Distribution Pipe Medium Sand /oa-17 H G Topsoil s=== F 3 D b ° Cow Elegy. 97. ~ % Slope. C E U 0 f i"- 2:2 Force Main Plowed Aggregate From Pump Layer Cross Section Of A Mound E V Ft. F g.2 Ft . ' G , S- Ft. A Ft. H Ft. Signed: B 3-0 Ft. License Number: K S" Ft. Date: L Ft. Ft. '1 T Ft. 7 5-0 . W Ft. Observation Pipe o _ G -7-------------------------------------~:1 W - - S Distribution ~MLL-- Of 2~-- 2 Pipe Aggregate Observation Pipe 7S"0 a ~ 1"CC~ Plan View Of Mound C ) Eo-~,o~ r fr''`~CSJ Po//O/olnA lIp• Do1011 ;.-.l~GI-L.~•(' Cam. End Vl4.w P~N,orolro ~ ' JOINo5`t PVC Pip( ((J~r+i Ci/1l S✓I(f o x 1. Holes Located on Bottom are Equally Spaced VC Co. M CA, I I F", Dig It Ibv I Ion.. Pip. Distribution Pipe Layout P _ X Y Signed: Hole Diameter Inch License Number: Lateral " Inch (es) Date : Manifold Inches Force Main " Inches AC~to~es Qelr- I-cx~e' f-~t..I = Page_Y_Of._9 SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" fLk-VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK E WARNING LABEL 4 " MIN. 18 IN. 5.b. ' rni►►. INLET ~WATER TIGHT SEALS GAS- TIGHT ~t \/APPROVED FILTER --i- A SEAL JOINTS WITH APPROVED -v ° -L- ALM PIPE 3' B ON 3PPONT00 PIP: ONTO SOLID SOLID SOIL SOIL C PUMP OFF ELEV. 70'0,FT. t OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE To LJem C TANK MANUFACTURER: TANK SIZES: SEPTIC /000 GAL. DOSE VOLUME INCLUDING DOSE 6-co GAL. j'?. 93 6j,1. FLOWBACK: a~3 GAL. ALARM MANUFACTURER: ~Tr CAPACITIES: A = r~ INCHES =20/.,7 GAL. MODEL NUMBER: jp SWITCH TYPE: /Ll ec `un ~cce~% & B = 2 INCHES = M,69' GAL. PUMP MANUFACTURER: - C = /0 INCHES = GAL. MODEL NUMBER : SWITCH TYPE: ~laQ/4- D = 1JJ INCHES = 1 fD.0yGAL. REQUIRED DISCHARGE RATE 3-3 GPM PUMP E ALARM WIRING AS PER I LHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE rS_FEET + MINIMUM NETWORK SUPPLY PRESSURE . ~S • FEET + FEET FORCEMAIN X ~,-3 FT/100 FT. FRICTION FACTOR.. e~ FEET TOTAL DYNAMIC HEAD = / . 3 3 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID Z, G O 611-/ . / Pr 1,4 SIGNED: LICENSE NUMBER: DATE: 1/88 aw-009/000 3113 99-v8-SZ2 -008 ti00Z 'NV 'A3d \ loot k6VnNVr 31VG 09Lt9 IM 'N008 N301VVI OI.IMH Sfl 9lL£M lvnNVN OI1d3S Z o 1MS l8 NMVdO Li \ :31V4 'ON A36 :31VO S 31300!109 13331M ~w-O0S/0001M 00 W cn z J ~ W z z w 0 w Of U C,_ Li J Li O O w w 0 u cl~ w /,J W n LLJ 11( > N J cn w O - Z =O w: o o z z a F ¢ Ch _ U d U U¢ 1 _J w 0- ~ - O w ' W :2 z U cn l 0 OF- va w O S U O¢ Z Z_ F=- 0 W ¢ U ~ LLJ ~ o O ¢ 0 ¢ > o Q N Q J J N W I m o a¢ z zo n W 60 O O O 6. m J wpcn CD0 ~ j~ N n O 00 x tn _j LL, LLJ O C~_- h.-J ¢ Q W c000 4- U) O W w ¢ V d W LLJ 1 z 0 mww on 0) a U V \~~0 o~ 0o Ln w N 0)0 LC) I ~cn¢ co 0= w w U w \M: No, C). L'- J ¢ J z~ } w In (n m J ~ Lij "n O C n (V J _ - J O~ O Z W' U (n = m F- V) Z Q lii O~ 0= F- 3: U C)= d W (n J O CI- Q U O a vWi o °z o IL: O Y °a00aww~~ow Q c° C) z3 LLJ Z m U:5 2 J m J ~i Z ¢ N_ W Q W 1- F- p ~ `L ¢ 0Y H J J 0 ¢ Z Q U H p Z Z J F- U7 U Z w N Y Z ¢ ~ „bS F- D 0 / z I °a / y \ w ~ I as > 3 II w II w . I 1 I 5 I 5 a w w \ I I r In , ^ J 1 ZO O W W ~ ' O V l9 cjj ¢U W om I \o~a it \ / I I W (`1 J Z „L5 S6 „~69 MWJIJEL • 3`871. w ' Submersible Effluent Pu 4 r ■ to '~`y N+s S Tl:'d }j i i 33 61 4 .17 METERS FEET a ao ` _ MODEU 3871. ~ S Y _ EPOS o i 3 10 0 2 S 1 ' C e- 10 U Y0 0 60 Ui ft11 04 2 1 6 8 10 12 naAr• CAPACITY Pump-Specifications. Features and Benefits '/1o end Y: HP • EP04 impeller- seml-open design Up'to 60 GPM . With- pump out varies.to protect Maximum head to 32' mechanical.seal. Discharge size 11Y NPT •-EP05 impeller enclosed desigrp Solids: 1/4' maximum for improved performance. . Motor *Rugged glass-filled thermoplastic All motors feature ball caslnq and base design provides bearing construction. superior strength and corrosion Single phase: 115V resistance, Materials of Construction 'Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability, Stainless steel 'Corrosion resistant threaded stainless steel shaft. 'Available for automatic and manual operation. •CSA listed.models available, operation and /eature:stainless steel hardware, Water tight cap 4" rain. dia. Piping material can be ABTM D2665, D1785 or D3034 Slot 6" min. 6" min.' Infiltrative. surface Water Closet Cellar Bar (3/8" min. dia.) Observation pipes must.' • be located such that there area minimum of ends from one another two Installed in each dis ers p al cell at opposite • be located near the dispersal cell ends • be at least 6 Inches from the end wall and sldewali • be installed at an elevation to view the horizontal or le vel/nflitrative surface within dispersal cell the Observation pipes may be located less than 6 inches from end walls or side walls If stateapproved manufacturers, installation instructions. specified in r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 0 of f FILE INFORMATION SYSTEM SPECIFICATIONS Owner I'Crr (AJ Tank Manufacturer: Wiese-y- 0 NA Permit # 5'Septtc ❑ Dose ❑ Holding Volume: /000 (gal) DESIGN PARAMETERS Tank Manufacturer: w eScr ❑ NA Number of Bedrooms: ❑ NA ❑ Septic {S Dose ❑ Holding Volume: S oci (gal) Number of Public Facility Units: ❑ NA Vertical Distance Tank Bottom(s) to Service Pad: 7 (ft) Estimated (average) Flow : -')©d (gal/day) Horizontal Distance Tank(s) to Service Pad: 106 (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow= (estimated x 1.5): 3OCj (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: , q (gal/day/ft') Effluent Filter Manufacturer: ~c~ (Y ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: 6%D S Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer: (TBcc/ S. Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ NA Total Suspended Solids (TSS) s150 mg/L Pump Model:- '7 High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L NA %'NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection Pretreated Effluent Monthly average e El Wetland Y 9 ❑ Sand/Gravel Filter ❑ Other: (BODS) 5530 mg/L Soil Absorption System (TSS) 530 mg/L R'NA Fecal Coliform (geometric mean) 510' ❑ In-Ground (gravity) . ❑ In-Ground (pressure) ❑ NA Maximum Effluent Particle Size Ya in dia. ❑ NA ❑ At-Grade 9 Mound ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: El month(s) (Maximum 3 years) ❑ NA 'year(s) Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA c ldyear(s) Clean effluent filter At least once every: / 3 month(s) El NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: 13 month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every:. ❑ month(s) ❑ NA 3 Zyear(s) Other: At least once every: ❑ month(s,) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface, The soil absorption system 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 treatment tank equals one-third ('f) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: All other services, including but not limited. to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) ,6Ue~ • . START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process 'and/or damage- the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will bedischarged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons;'and water softener brine discharge. ABANDONMENT 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • 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 the time of their permit issuance.. A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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. ,r 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 rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY. CIRCUMSTANCE. DEATH MAY 'f RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A`TAN-K'M7 Y NOT B-E-POSWBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAFNER Name N ;Z 4Q ~S• Name 11✓'.S0t"' SQ(/\l i Vv\ Phone C IL/ S 7 a7 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name h b r it o Name S ro I' 6 X7 W Phone Phone ^7fS- 3 8'f, L/6 OA This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page J_ of For new construction, prior to use of the f OWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system, if high concentrations are detected have the contents of the tank(s) removed by a SePto9a Servicing Operator prior g (pumper) to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be4scharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid thissituation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT 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 s. Comm 83.33, Wisconsin Administrative.Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • 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 the time of their permit issuance.. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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 may be 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY (RESULT. -ESCAPE OR.:RESCUE.FROM THE--1NTERIOR-0F `A TANK9tIG" -NOT B'EPOSSIRLL. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name A r ~2 'H(( -e a Name ✓~SOSc, U (4-1 O H Phone -71 S 7 ~7 Phone i SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name f vt S C:v ~i, ' (o Name S7' r o ! CO -N Phone 7is _ 5 I Phone 7 / S' 3 F(c, ' y6 ~p This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer { f' Mailing Address _ Property Address (Verification required from Planning & Zoning Department for new construction.) vJ Parcel Identification Number QD 9 l d ®C3 City/State (A 00d " i ~ I-e LEGAL DESCRIPTION ' 4 F '/4 Sec. , T E N R_L~W, Town of 6- _ Property ~ , LUG Location Subdivision Plat: P, Lot# r~ -e e n c r- - Certified Survey Map # l ' 0 -,Volume / G , Page Warr antpeed # L ~71 ~13 (before 2007)Volume , Page # Spec house Oyes[5rlo Lot lines identifiable ®'yesono 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 years 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 are specified in §SPS. 383.52(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 Safety And Professional Services 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 year expiration date. I/we certify that all statements on this loom are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warra deed recorded in Register of Deeds Office. Number of bedrooms r. 'StGNAM OF APPLICANT(S) DATE y, ***Any information that is misrepresented 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. (REV. 04/12) ~v ,a ..J J~- s 1NiscbnsintepartmentofCommerce SOIL EVALUATION REPORT Page/ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County A/ include, but not limited to: vertical and horizontal reter ce point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and ldcation and distance to nearest road. i3 LL L .~i.} Please print all information. viewed Date/- Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 Property Owner Property Location E (o W; 1 l Govt. Lot 1 /4 fL' 1 /4 S f T GS~ N R )6 ~C~ (..L. I C Sec Property Owner's Mailing Address Lot # Block # 'Subd. Name r CSM# p / OX-~fno, A. City State Zip Code Phone Number ❑ City ❑ village Town Nearest Road Lac Ut~ ~ 1591 ( 71 3 F~Y~. G' l1 A~•e . New Construction Use: Residential / Number of bedrooms 7 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: / Parent material Flood Plain elevation if applicable VA ft. General comments and recommendations: Chit ULTr1aV- Cul;II S s C', eIe~i.. 9~hC,s Boring # Boring P"Plt Ground surface elev. V7 ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 e JCL c b ~ 4 c a Boring # ring Ground surface elev. 7 L~ ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-1 r< 1 C LA Effluent #1 = BODS > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Ppit) signature,, (CST Number Address ( V Date Evaluation Conducted Telephone Number ter V/ 7 Property Owner F j)' I ~ r? 16c, Parcel ID # Page of 3 T Boring # ❑ Boring R pit Ground surface elev. ft. Depth to limiting factor C in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -fC l~ yY~ s b IM 1 l c, Y2 -3 6 1 1 1--7 ❑ 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 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. S B D-8330 (R 07/00) Property Owner F0- I i e I,5c)±~ Parcel ID # Page of Boring # Boring ,3 YPit Ground surface elev. 9 o ft. Depth to limiting factor a 1 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 -I C) '3 T- ID-_1 f2 - (c b , 3 I 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. El Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 * Effluent #1 = BOD5 > 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. ,RI)-83}0 (R.07/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page/ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S 7' C e Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location PC, ' e l 5 c Govt. Lot U E 1 /4 ~ 1 /4 S/ TN R f E (o W Property Owner's Mailing Address Lot # Block # ubd. Nam CSM# City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road ~yq Etc, A,, e [New Construction Use: El"Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material SlZ2~ Flood Plain elevation if applicable [ft. General comments fir- [c~l e d and recommendations: /s5a'" Le 6~c~E o~ ~ ~J oil- 99.©s / Boring # F] Boring [DyPlt Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'q LL) t4 10 s c L e t-L') t 3 qq . , v i L . C. O- I T J Borin # Bring it Ground surface elev. 7 y ft. Depth to limiting factor in. Soil Application Rate j~ g pit' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ti V Z ( VLt I f l i I I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Pri t) Signature CST Number Address Date Evaluation Conducted Telephone Number 77~:~) -3,-) 7~ ter szi il 7 Ar. 7c- -I cf L~,~E --Awl Top I~~ ~L)L ~r1p~ R3~\ Sro ~ L~ "A4 f ~ N1, Tc-- of ( ~u~_ t-o i I~' )ws ~oc-~ 79ao7o sr AND IN THE REGLSTER's OMCH ST. CBODC co. Wis. ON 1, TOWNSHIP 28 NORTH, R---i-dll.R-dm,~ 1'3 .,RUNTY, WISCONSIN, or q r. vm~m~ 1 O I tfrs ~11c ~s %LU SCALE UTAr= A-TEJ _v,~;DS `orn~a. c °D -oc -cc -NORTH -NE OF THE NORTHEAST 1/4 -S 87'41'46" E 2657.10'- 1 - - - - - - 607 a"vENTE------------ - s ~;-6.1'46" ~ i _ S 87.41'46" E 350.16' 3 02 „3 Ct-Cif' -O NE _COR - - -3.0?' ~l 4p,. 317-75. 1 FOUND 31A- - - - - - - - - - - - - - - - C2, i 1'7 c(, O n. ~OT 6 ~_oT b o E IF EC SURVE" w j M,AP o TOT 1 c-" /OL_1C 277; 1'n ~n E. I o d 11 2.03 AC. 8 7 _ o.a_ S 87'41'46" EL 330.00' - Z u c SC TOT T O~ ti ?E S. C)~ P,pN I LOT ~ X21 Q A.C. 1 - - . i •.9_ 8 ,6 S. ~ n _ 011 m I c' C i~ HWE H YE 1140.43 LBO 1146.30 ; o p ~LBO = 1142.63 LOT 3 - , m r - a z s_~ 2.0C Ac. o °N' zl cG CD o u <a r CD U / z r Z n y ~.1 LO 1-0 y 39.4 y - _FI 1105 9 _ - LOT 11 a - _ G1 ` - HWE = 1135,561,060716 5 ".1.~' ]t LBO = 113756 - ~ J' JJ'i HWE 1135. 5 56 6 LBO - 1177 6 N T T 50 '6. TOT icc k. ,182 ,g T ^ Loanco J cu /LOT 1 ~J o~ _ HWE = 1134.00 O C. h , N 8i'~7 a _ - I 2. 99 .9 i 0 1T ~ H LINE OF THE NCRTH -1/2 OF THE NORTHEAST 1/- N 0 S _.d~ m II i 1HI - L 'DUND I DRAFTED BY: KEVIN SAMUEL SH F_' T OF 2