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HomeMy WebLinkAbout022-1009-95-000 0 cn 0 m - 0 0 t7 0 0 CD 1 d ID � A N c O D > N C 1 7 N ►� fD CL 0 CO { co CO 0 O M a> > 0 9 cw m° O rn x 'i , O 't 3 o io m CD D! D 1p O CD < o m o Q o 0 N N j O O O Q Ls z D u D w a o CL 0 C v N J z o a— ' o r cn 0 O D y 0 C CD *. 0 0 0 a ai ai ai ° m � I� v o 0 0 c m d a rn PO CD m a � y M O N z z D N O D D Cl) O m m CD 13 CO) CD c A z n N z 0 (n N A W m z a 3 a A 0 cn m z A N O Q Q � C C7 0 O I n o z D fD N H I 7 I c i a I � I w N O 0 O (D 'Au O @ O H Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499283 0 ti -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 Vanbeek, Alvin Kinnickinnic, Town of 022 - 1009 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: 04.28.18.60A 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 TDH 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 CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x 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 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 497 Valley View Road Roberts, WI 54023 (SE 1/4 SW 1/4 4 T28N R1 8W) >35 acres Lot Parcel No: 04.28.18.60A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. -- - Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) r Safe a Buil ivis' n County /� t commerce.wri,gov Y 201 W. Washing ve., x 7162 t iaepartment �+r QnS � " y Madison, WI 07 -7 Permit Number to be filled in by Co.) �7�,�/ Sanita / cq of Commerce / / / Z 7 F State Transaction Number Sanitary Permit Application in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 7 /aA9 13 42:5 Z l 7219 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you - pEe� l� at ��G•� V"e u oses in accordance with the Privacy Law, s. 15.04(l)(m), Stats. T / / / -7 U L Application Information - Please Print All Informatio Property Owner's Nam 1 n I l Parcel # � p� L i/ J H cn a /(fl �i U Property Owner's Mailing Address Property Location / !/ �i / G r t11., Govt. of City. State d Code oneNum6er _. r /,.L 'G, Section trcle e �� 4� 6t, (:)_ T N; R or 11. Type of Building (check all that apply) ak Lot # ceo � Subdivision Name l or 2 Family Dwelling- Number of Bedrooms t � - /� - - *w�^. k h (-tw.4- Block # eCsC�'Q ❑ Public/Commercial - Describe Use ❑ City of /a 1/D G` (� _ CSM Number ❑Village of - El State Owned - Describe Use �, " � {� IL7- K Townof �f!/l/ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑Replacement System ❑ 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. Type of POWTS System/Component/Device: Check all that appl ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground )K ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersalfrreatment Area Information: 6 ALI d L" Design Flow (gpd) Design Soil Applicatio7Rt Dispersal Area Required ( t) Dispersal Area Propose so System Elevation G, . S ,� Vt. Tank Info Capacity in Total # of Manufacturer C y U Gallons Gallons Units � New Tanks Existing Tanks /� GS I o °J .�°' a ce / a U n rn w C7 Septic or Holding Tank Dosing • Chamber T� x VII. Responsibility Statement- 1, the undersigned, assume s nsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's a MP /MPRS Number Business Phone Number Plumber's Address (Street, City, State, Z% Code) l VIII. County/ e artment Use Only Permit Fee Date Issued Issuing A n ignature Approved ❑ Disapproved $ lfi[.(J ❑ O er ven Reason Denial IX. Conditions of ApprovaUReasons for Disapproval \ �b SYSTEM OWNER: 3 J l C o� ✓` (� 1. Septic tank, effluent fifter and 5 L GC', dispersal cell must all be sefvlees / maintained t OS per manapement plan provided by plumber. �� 'L C^„p �✓It r �tucmunle n r t a ys em nd submit to the County only on pap r not less than 8 I2 s 11 inches size pw s / Pa V ('aJ SBD -6398 (R. 01/07) Valid thru 01/09 PLOT PLAN P)ROiwir Brian Vanbeek ADDRESS 448 Vallev View Rd. Roberts Wi 54023 SW 1/4 SW 1/4S 4 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX SYSTEM ELEVATION 101.0' BEDROOM 4 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .55 ABSORPTION AREA 1100 # of chambers none IL BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 1320' Property Line 500' 200 System is to be installed along the 101' contour, Pro 4 B -2 Grading is to be done to Bedroom divert run -off away House from system 5% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels B.M.* EN B -3 Huffcutt Combo Tank 102' B. M. cQO� To Valley View Road ��• COP Y 101 B_1 S�rbo' Area 15' below system is 1100' Property Line Scale = 1/4" = 10' to remain undisturbed Well is to meet all setbacks found Unless otherwise stated in Comm 83 PLOT PLAN P'ROJ> & Brian Vanbeek ADDRESS 448 Vallev View Rd. Roberts Wi 54023 SW 1/4 SW 1/4S 4 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX SYSTEM ELEVATION 101.0' 4 BEDROOM CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .55 ABSORPTION AREA 1 100 # of chambers none ,BENCHMARK V.R.P. Top Of 1/2" pipe ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 1320' Property Line 500' 200 System is to be installed along the 101' contour, Pro 4 B -2 Grading is to be done to Bedroom divert run -off away House from system 5% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels S� B. M. B -3 Huffcutt Combo Tank 102' B. M. To Valley View Road B-1 101' 0' Area 15' below system is 1100' Property Line to remain undisturbed Scale = 1 /4" = 1 OI Well is to meet all setbacks found Unless otherwise stated in Comm 83 Safety and Buildings commercemi.gov 4003 N KINNEY COULEE RD s LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.w.i.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary January 18, 2007 CUST ID No. 226900 ATTN.• POWTS Inspector ` SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/18/2009 Identification Numbers Transaction ID No. 1362522 SITE: Site ID No. 721986 Brian Vanbeek Please refer to bath identification numbers, Valley View Trail above, in all corres ondence with the agency, Town of Kinnickinnic St Croix County SW1/4, SW1 /4, S4, T28N, R18W FOR: Description: Four Bedroom At -grade System / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1115350 Maintenance required; 600 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual - Version 2.0, SBD- 10706-P (N.01/01) 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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. • 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. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • 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 Comm 84 product approval conditions. • The site shall be checked by the county prior to plowing to ensure that the dispersal cell is not located on a concaved slope. If it is determined the cell is located on a concaved slope the design will require a revision as an Individual Site Design. Additional fee and deflection calculations will be needed to show equivalency. • Boring no. 1 shown to be located under the stone aggregate of the cell shall also be inspected by the county for proper filling and compaction prior to plowing of the site. This area maybe subject to settling after the construction of the dispersal cell. P.O.W.T.S. Conditionally APPPROVED SHAUN R BIRD Page 2 1/18/2007 • 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 inspec tors. 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. • Comm 83.52(1)(a) - 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. 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 r Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. . RECEIVED JAN 1 7 Zoo? SAF �'& BUILp� Cover Page Nis Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 1/15/07 Owner:Brian Vanbeek Location:SW1 /4 SW1 /4 S 4 T28 N,R18W Kinnickinnic Township Valley View Rd System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency r an 9 -11. Soil test Shaun Bird Signature OIViSjQh SAFETY AND BUILDING License number 226900 S� � COR �SPON�DENCE L 5 �i > 5 PVC FG1+fLGE.3�+►A1 i�t .... 2; %% "E' PL14— LIPS" 5 { STAStz�£#s a.c,krsers --__ > 5 a rrA t/ B 1/2 B ._... F 1. 4 Ft, �t�e,Rd�rEa SXmtft - nt. Fabric Distribution Lateral STABI .I - trr- Observation b Observation..,,_ Sail Cover Well - 6`} :_:: a Pima viav and Cross Siection o€ uiscc►rsixx At, grade Unic with a Single Absorption Area on a Sloping Site Sti��flr7U �� . Page Of ()istribution Pipe Detail For Lateral Xetwork TutktA -uP �LLR� g - PVC Forte plain PYG Distribution Pipe P * Last Hole Should Be Next To TUAM- up P Ft.. Hole € iamte x _ . -, inches Lateral Diameter Inch(es) It � I nches Force Main Diameter inches Of Holes /Pipe Invert Elevation Of Laterals/ Sighed; License Hoer: Date: - i i S£�'IC TAN3C � �'ut'!p C��Ri'SS£R Ct2flSS SEC�It� AND SPEeI FCATaS I k-EATHERPMF ApFROV ED �,$0 E GRADE ju NCT'f Obi B ox MIDLE COY ER }Z 2413 - a vEN'r piPE wiNoow OR WITH cONDUiT ji1 PADLOCK 6 ?: ` mom D LASE gr ,97 t . i s, INLEt GAS ` D WATER TIGHT S EALS . �IE -oll"s 11zT AppRoM ALM i ON gme SOIL AV a C. _ FF plK 13g FT wg pu ' L EV - D SOIL I ! 1. � .. ppgD�tED BE3DIt Ujw� 1. CONCRETE P DOS . pER DAY: -- DQSB Y i46 SEM'ItC4AN;7p�,C RERz Dt3S£ v�LCHE NC CK= ----) G�i3. T K GAL- iC SIZES = . SEPTIC GAL. DOSE CA p^r_ITIES: A .: " _ GAL- .5 MOM Am INC14E Ilac ES S / ) C P47T4P � RF.R s 11111Pxool 'PER I 16,23 Wh MODEL DW3'4R� ri i�Z'RIi= AS SWITCH TYPE Ga pyjmp E ALfsR FEET T_ ItEQt3IR£D DISCHARGE DIST � RITZON PIP£ - FE£'I pI OFF AND v FEET V,gTICAL DIFFERExc S $SEEN ET1St3� ,FT- - FRICTION FACTOR - FE PitESSUz"4E ! y � £T pRK SL�FFLY :iC ' nN� p££' FORCE � x TOTAL �Y " IDTH TA NK : I1qTj; ML Di�4E145'�i}N� Ci` � LIQi�II3 4 �l$8 Sent By: HP LaserJet 3100; 1 715 bbC VUf may - - vo t er t . 9 EH SERIES SUMP /EFFLUENT PUMP 11.65 8.95. v Spe+cifiC�tions 1B�s oa �:1f ww•c �anBwctawa�tAn � � �� a�w BwBMB 1N YI: IISDi BI I�f OLk) AWAVU 8 4 N IV 93i-OM 503394 MCA 4r0 115 314 13.0 tow 70 64 55 41 32 13.8 21Y 24 9.17 x11b4XB94 rS44 8IM 4i.0 M 3X 63 1000 70 54 55 41 32 13.8 2D 24 317 x17b4XBS4 J3i4&W3 508350 . WCBA 4"0 M. 314 13.0 1000 70 64 55 41 32 13.8 27 27 171 x ri54 9 8.84 nsars 191E6A 4rQ 280 311 6b 1000 70 64 55 al 32 W 2C - - - 27 111 x 11.64 x 8.94 Co�eat5 DolyNtleQ —"1i6M 6a3W+ sterolirprmpsmsraeAtaMnuaesOwYasbnDas >MYarsrwtwi� FLOW- E ITERVMGM - s`metion 0 1000 2000 3000 Motor Housing Exy Coated Cast Iron Iler Material Poly Carbonate LmPe...... to Impeller'I a Closed Vane Volute ABS -- Power Cord SJTW-A 1120 7.5 mechanical Shaft Seat Nitrite with carbon and ceramic faces a° s Fasteners _ - Stainless Steel _ 107- i Shaft 4tainlea Steel 2.3 - -- -- - - Upper Sleeve and Lower Bmings I Hall Bearings _ a +1 TrTI V" I I 1 0' 0 20 4D 60 so PUMP 9RMANCE Liltue Glint ftmP CO. 115V 6" ` PA Box 12010.OkWww City, OK 73157 Phozw.4053473SU •Fat: 409.22 OSO F+ -adl: www. Ut1t1cG1aAtPamp.cflru C.t Form M236 — 07JW i r page � of 5 MANUAL & MANAGEN[Ei�T PLAN POWTS Owr4F- ' �1(STEM SPECIFICATIONS �� a! DNA septic ?arsk Caps i3 tan Ea. JNIFORFATION ll a. r�' S�ttxc Tank Manura�u+ Own°f r ` [�v v✓ S (3 t+lA te[ Effluent, D NA DESt� t�RAt��� LLD NA C- fRuenf F�t�er M � 6.. D NA �w of 8e&Wm$ Pump Tank CaPat tY O NA Units p Tank Mattufac u�r N�nberof Comm alld Mariufaaut� :t7"/��iQ NA 3 NA Desilgn fiv+� . ( x 3� J d p ump Unit SO AP01coeo" R91W Monthly sverag revel FVW ❑ Peat Fitter dent r_,.30 mg 1Vlec anic2d Rena n C3 Other. Wetland QuardY G) ❑ Few, Oii & G BC}Ds7 ,.220 mg II Disinftson �� Oxygen Daman ( ss ss 5o m /L Nlanufactur aedt satiate {T ) average Disper jai Ce�Cs? II In ground O O NA monthly in - g �nd (gravity) O Mound p Enluent Quak . �11 m91L grade r-3 Other Total loot Oxygen ( ODs . �0 rng/L Q Dri no S Suspended ) 51 acs/1 00ml nor► ` "�°'Hm` sn6 via WP Qo t Fepi t.ardocm 19aDn'e mean y inch Alameter sew tak � for UwV- M Ei jeitt Pafticie Size •• VslLI types for P °d t,![A1t4TSNA�CE SCHFM 1LE service Frequency D months s) (ii8aunmu°n 3 yrs.} Service Event At least once every usis one -twcd (V of ink v olume inspO °Ondtion of t an k(s) when combined sludge and scum e4 Maximum 3 ym -) oaths r(s) { Pump out contents of tank(s) At ieast once every yeaKs) Inspect cat! s) p months } disP� ( At Least once every s O NA p months Cfean effluent 10ter At least once every s) O NA controls A atanr+ � Q rnon inspect pump. PuMP At least once every' O yeas) O NA test ths Flush and P At least onoe every C1 mon O montfts 0 yea s) O NA 0I At least O nce every orr>er� iiunses of uP or KWXTE1�tANCE IN S T RU CTIONS and �� �ti be made by an indnrtduat t: Ts l s of P0c bV1 , i�tarner; btol�e cbor, n ot tanks and d1sPe� Rester Sewer; POWTS k s to idertttfy any any bade i a� Master pqumbar: Maser Pl i cl de a moat inspection of the tan ad to d its effluent effluent Sef+ 9' plimaw • T ks, measure the volume of combine sludg of went on the identify any The dispersal well {s) shall f ro . nd surface or -� pp�utg or �-� of effluent on the 9 'd -ran �d'rng of effluent on Elie 9 on of the local ro9u ' in the ob�serAfi d >aPBS and to cpnd-oon and reQuires the im mediate notifx ti tank volume- th SU r f a* may ind®tie a fain$ or more the NR d m n of slu min any tank equals tor rcP� of in acco<dance '" Ch V VW g Combined �ltStltS Of the tank shah be t+eirtaved � a P�9$ Servicing Opera - P t corn; '�Ma 113, pdministra Code onents, reVf�F� P OWTS er t� Or pressurized pOY1('fS raomF a � Tie 9 of effluent ift M, 1 � of.12 months or less shalt be pOrI telion of any serII ant oMermah tenance or monifdn regu latory authartfy wb ;n 10 d� of camp A sel.A* report shall �be provided the local r u P of a aother pinting � START UP AND OPERA POW S .b%0tment tank {s} far the P� aJE ltte jai celi(s). if high concept .trot new o� . Prior to use of nt proc es s anQlor damage #te disg for p� to use �Ye the Contents of the s) Waved by a septage senrtcang aP —' �(A '• � - Pte.---- -°f--' s ., - 1 candtlions are frozen at the'rl surface- y-fad Li p sna not acatr wfaen _ {M above normal highwater levers. IAfhen der is resbmd the e)== During per ont�� Pip a oet4 {s} in one ivVe dose, rnret fl3 S3 re ut the the �wlt be � �'� contact a Pi id tfus sitlrativn have the contents of rte pcdTeP ilex temov+ed by a t or surface Dower to the effluent pumP of Lrtnbes or S �?50 ttl Mmiwope 'he rltrlp c mbpjs to restore normal levels within the pump tat31C drspeYS2i Do not drive or park oYerj Or O�etwjse d rub or tromp t, Do root d(to or park VeWis mid or at -grade soft absorption are within a - MW ,in 15 feet down scope � a�Y i mprov e the peffoltrlan� and pt�g tw fde R a� erunirlatidoll of Me �g f!iQm the wastewater sham may P d . d enta l ASS: alims pf ft p0VVTS: al ,bW �Y tte butts; condoms, a�iton swabs,' bs; � r herbicides; meat dia�It {swnp p,,p) Water, fruit and vaegetabie peermg� Ste% S ���r bt 00AW products: Pest Akins: tampons: '�irafiersof�ner brine . takeut of service the following s tep s shall lB taken to Insure !fiat the VWM the pOwf'S andlor is permalre�tY n o trance wifh ch. Cornet 83 -33, Wisconsin Adn� Code- system is p and saf iy abandoned in �P A!! PtPt<+9 to tanks and Pits shall be disconnected and the abandoned Pipe openbVS � of by a Septage Servicing - m e contents of sU tanks be and ERs sesatl - removed and Property d -spored d the void sp�ace After pumping, all tanks and pns shall be e�ocavated and removed or them eels rerriwed trued w& sotL g� or another inert s old rnatetiaL C,otrMGENt`Y PLAN the following measures have been, or must be taken< JD provide a code if the POWTS fails and Cannot be repay Cornpliant repbCsMent'sYstem evaluated and maybe ut aized for the location of a replacement sort D A suitable MPlat�ernent area has t area should be protected tram d-sturban ce and compaction and should ra absorption The 't s from existing and proposed. structure, rot rules and t+re[ES- pasture Zn be infringed upon by requ pr,Qtct th replacement area v�r[li iesult in the need for a new soil and site =evaluation to establish suitab replacement area- Repfacer'nent systems must comply -i the rotes in effect at f3s g rin . D A suitable rrEpfacement area is not svas7able*due to setback andlor soil rsmitatior s- Barring advances In POINTS technology a hofd'mg tank tray be installed as a last resort to rep lace the far7ed POINTS_ e sit has not been . evaivat d to identify a suitable replacement area_ Upon failure of the POVYTS a soit.and site evaluation must be perf xn to borate a suitable replacement area If no 'Placement area is available a hof&M tank may be insWed as a tact resort to replace the failed POvYTS- r�movat O the Dsosnat at and at- grade soft absorption systems maY be reconstructed in Place fallOwing the InfiftraWe srttfetCe, R�n�ctiOns of such systems must sromplY rvstfi titre soles m etiecZatttrattisae <- e TANKS EIfAY GONTAtN LErI #AL G1�.c•SES pNDIL1R tNSUFFICMMr OXYGM SEPTIC, PUMP AND QTH1 =R TREAT71d1'NT Do HOT E NTER A SFpTiO, PUMP OR QTHER TRPATMI =M TAT[K UNDER ANY CIRCIJMSTANt�S. DEATH MAY RESCUE OF A PERSON FRO T THE INTERIOR OF A TANK MAY BE DIFFICULT OR %(POSSI ADDITIONAL COMIiRI"_ T'§ POVItTS INSTALLER POIfS(1'S MAINTAINER // Name u 4- Name cS f� Gt-u v..% Phone Phone , j SEPTAGE SERVICING OPERATOR PUMA LOCAL REGULATORY A€fTNORY Name ty Ag��r p �_ �i9ct �1�•� Phone rtes do was d� by'sire af�s of the great Lake, mamuette and Wassshara Cow&y Zosrlrsg srsd Sar�at7rset 'nth darxstttent areeb the nzkknwn +e4 of eh. Cecatu }UMAM and 83 ---A(l). a) & (3). Wisconsin Admfntsira6e Cede Use of d& dot d0% W1 goarantft the perforrrr aW of ttse POWrs. GWW (Ml) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County C + ' C ro' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must cJ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D Oa '1 /� b � D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. (9 / Please print all information. Reviewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ll Property Owner Property Locat7 ' t Govt. Lot S 1 /4 S T a (� N R E (o P Property l'�,Mailing Addr jss Lot # Block # Subd. Name or CSM# a U , J iP�,Q 3 s p- City State ode Phone Number ❑ City [3 Village Town Nearest Road - t ® ( ) &1 A; Ck Ci A2ll V Tr ew Construction Use. Residential / Number of bedrooms Code derived design flow rate GPD [ ' 0 Replacement ❑ Public or commercial - Describe: __— Parent material _ Flood Plain elevation if applicable NJ+ ft. General oomments and recommendations:► /�7 System Type / / 1 . L� rr >�GG System Elevation 0 M Boring # ° Boring�,,, y Pit Ground surface elev. Depth to limiting factor �/ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F � # ° Boring f ® pit Ground surface elev. ft. Depth to limiting factor I 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 I 'Eff#2 1 - /-- - , 1 , l-'j 1 Z 7-11 Id S r t� 3 v 1 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 , j —D 715- 246 -4516 Property Owner _ Parcel ID # Page _� of © Boring # Boring pit Ground surface elev. Z/— Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0`13 r 2 3 _ yd D- 6 F-1 Boring # Boring ❑ ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring El Boring # El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 I 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/_ ' Effluent #2 = BOD, 130 mg/_ 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 (8000) Property Owner _ ❑ Boring Parcel ID # Page of F31 Boring At pI�Lpit Ground surface elev. 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 13 _--_' C r' D- 6 5 OS n/l r4 / - • 7 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil icetion Rate Horizon Depth Dominant Color Redox Description Texture Structure ' Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. -Eff #1 - Eff#2 ❑ Bodng # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/FF in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. - Eff#1 - E11#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/_ - Effluent #2 = BOD 130 mg& and TSS < 30 mg1L 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 -13)0 (RAMO) Soil Test Plot Plan Project Name Brian Vanbeek Shaun B' Address 498 Valley View Rd. Roberts Wi 54023 CSC' #226900 Lot ------ Subdivision 35 Acres Date 1/15/07 S W 1/4 S W 1/4S 4 T 28 N /R W Township IUnnidcinnic Boring G) Well PL Property Line County ST. CROIX IL BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 101.0 *HRpSame as Benchmark Alternate Benchmark Top of 1/2" pipe @ 101.3 500' 1320' Property Line Scale is 1" = 40' unless otherwise 200' noted B -2 5% Slope B.M.* aN B -3 iit�s. To Valley View Road 102' 101, Alt. B.M. B -1 100' 1100' Property Line Scale = 1/4" = 10' Unless otherwise stated ST. CROix COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM /�.✓ v /'L zPv' Z_/ Owner/Buyer l v Mailing Address � // g J �.) Property Address Department for new construction.) (Verification required from Pl . g & Zoning City /State Parcel Identification Number LEGAL DESCRIPTION C E �' N R W, Town of I ��/ Property Location.. 1 /a , � 2 1/ , Sec. / , T Lot # Subdivision 1,b � Certified Survey Map # r ,Volume "- , Page# Warranty Deed # _ G (0 � � ,Volume C) . Page:# Spec house yes no Lot lines identifiable C5 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 years or sooner, if needed, by a licensed pumper: What you put into stage in the waste disposal the system can affect the function of the septic tank as a treatment ordinance. responsibilities maintenance o wner are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form s ign by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) h 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. I/we, 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 year expiration date. Uwe ce t all statements on this form are true to the best of my /our knowledge. Itwe am/are the owner(s) of the property des crib ove, b e of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Deparunant- * ** 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. 08105) ! I� DOC I N0, WARRA"Y DEED 1 i Robert L. Iakler and Barbara J. Ickler, husband and wife, and each in his and her own right, Grantor, conveys and warrants to Alvin D. Van I� S T• L!�tix L v. Book and Solly L. Van Book, husband and wife, holding as survt- :>rsh:p marital property. Grantee, the following described real estate :n St, Croix County, State of Wisconsin# OC + 14 1997 45 A_V The Southwest Quarter of the Southwest Quar -er (SW 1/4 SW 1/4) and the South One -Half of the East Cne -Half of the Southwest Quarter (S 1/2 E !� 1/2 SW 1/4), except the East forty (40) rods thereof, all in Section Four (4)1 Township Twenty -Eight (28) North, Range Eighteen (18) West. I � This Warranty Deed is given in full and final satisfaction of that original Land contract dated January 26, 1993, r=corded January 28, 1993, at 8:55 a.m, in Volume 991, Pages 219 -220, as Document Nc:rt�er 494448, h EE I NAME AND RETCZN ADDRE: >S I N_17 ��C1�I�tEl r f ) This is not homestead property. � rc. ( r 2 Exception to warranties: (• 1,� - /( �'�1 -y"& All easements, restrictions and rights -of -way of record, if any. Parcel Identificariot; Number,PIN� Dated this 29th day of January, 1997, " AL Robert Robert L. Iaklnr _ i Lt L•.�. <'! r __ ( SEAL 1 C 'Barbara J. 2akler AUlRZ31 IG1IO111 1 - AC"p" i 1 Signature(s) L_ 1' _ f �, �_ �� L,',( "k SPATE OF WISCONSIN Pierce 1 S. COUNTY ) authenticated this S_ day of / � = -I )q / / Personally carne before me this 2 9 t 1 day of January, 1997, the above named Robert L. Iaklnr and Barbara J. Iaklnr tc me know,, to be the persons who executed the foregoing instrument acknow l�gel e me. \ c TITLE: MEMBER STATE BAR OF WISCONSIN I1 ' n . `� (If not, - r authorized by §706 .06, Wis. Stats.) D I. Deiss V' IRIS ISSTRLSOM WAS DRA"ZD art Notary Public Pierce i deunrq Leo A. Beakar My commission is termanent. (If not, el* rvuoj RODLI, BESKAR, BOLES & KRUEGER, S.C. -+a J . 219 North Main street P.O. Box 138 Ju rte 25 ;-1X L 0 ® I,.: .'' - -- '*—� River Falls, WI 54022 T , "••.. ! s 01/26/07 FRI 11:53 FAX 715 386 4686 ST CRI[ CO ZONING [t ool � MIT r ^-Z a t TT -- t n GUIJA y oN - D9r wtT • L T •L s 4CTT . �- tT �1 � • � A 99LT • 'TL • Ti��,+. r • � • • � 75 , �w WIT ? v � • 5£tL ��`e 7 � .d •� � OTtt • _ r OtTT . r • 5071 Mtt • L. •" IS .V Uziger Rd . �o d o O w � • U4t + 5 • . � 9445 5• a C • • PLOT • f90T \ • T90t - -' L5 . • �: . 9Y4t • COD • CEOT i Z . FOOT • L•d eV L L L OZ Ddb' EROSION & SEDIMENT CONTROL PLAN Parcel ID #04.28.18.60A Address: 497 Valley View Road., (Kinnickinnic Two) Owner(s) Alvin Van Beek Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and /or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be excavation for the driveway and house foundation, as well as any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on any exposed soils will prevent erosion. Schedule application of seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement off site. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. Do not allow diverted runoff to be directed onto neighboring properties. (Refer to specification sheet for temporary diversions provided by county). 4. If sediment cannot be contained on owner's property with temporary diversions and vegetative buffers, then installation of approved sediment control products (straw wattles, silt fence, etc.) will be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & sediment control installation. Prepared by: Ryan Yarrington POWTS Inspector #683475 Owner acknowledgement of ESC Plan requirements: —/—/2007 Parcel #: 022 - 1009 -95 -000 01/26/2007 02:25 PM PAGE 1 OF 1 Alt. Parcel #: 4.28.18.60A 022 - TOWN OF KINNICKINNIC Current X`, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner ALVIN D & HOLLY L VAN BEEK O - VAN BEEK, ALVIN D & HOLLY L 479 VALLEY VIEW RD ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A -NOT AVAILABLE SEC 4 T28N R1 8W SE SW EXC E 40 RDS Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 04- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 09/26/2003 741459 2420/375 SC AF 03/20/2003 713950 2178/89 QC 10/14/1997 566895 1270/207 WD 991/219 LC more... 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 178593 Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 10.000 1,000 0 1,000 NO AGRICULTURAL FOREST G5M 10.000 25,000 0 25,000 NO Totals for 2006: General Property 20.000 26,000 0 26,000 Woodland 0.000 0 0 Totals for 2005: General Property 20.000 26,000 0 26,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 RECEIVED EROSION & SEDIMENT CONTROL PLAN 0 2 2007 Parcel ID #04.28.18.60A ST. CROIX COUNTY Address: 497 Valley View Road. (Kinnickinnic IMTLI Owner(s) Alvin Van Beek Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be excavation for the driveway and house foundation, as well as any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on any exposed soils will prevent erosion. Schedule application of seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement off site. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. Do not allow diverted runoff to be directed onto neighboring properties. (Refer to specification sheet for temporary diversions provided by county). 4. If sediment cannot be contained on owner's property with temporary diversions and vegetative buffers, then installation of approved sediment control products (straw wattles, silt fence, etc.) will be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & sediment control installation. Prepared b Ran Yarrin on POWTS Ins ector # 83475 Owner acknowledgement of ESC Plan re uirements: �/�/2007 ICJ ERO & SEDIMENT CONTROL 4 9 Parcel ID #04.28.18.60A 2007 Address: 497 Valley View Road.. (Kinnickinnic Twp.) ST. CROIX COUNTY Owner(s) Alvin Van Beek Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: I . primary r for the a and house The ma source for construction site runoff will be excavation a drivew • p rY Y foundation, as well as any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on any exposed soils will prevent erosion. Schedule application of seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement off site. i 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the r conditions h ma all w ff o e during construction. Avoid muddy, rutted that o c property rtY g Y� Y contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. Do not allow diverted runoff to be directed onto neighboring properties. (Refer to specification sheet for temporary diversions provided by county). 4. If sediment cannot be contained on owner's property with temporary diversions and vegetative buffers, then installation of approved sediment control products (straw wattles, silt fence, etc.) will be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & sediment control installation. Prepared by: Ryan Yarrington POWTS Inspector #683475 } Owner acknowledgement of ESC Plan requirement s: / /2007 a. . r i i av � �