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INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT
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October 10, 2019
CONDITIONAL APPROVAL
PLAIN APPROVAL EXPIRES: 2021-10-10
Plan Rown PWFS-101902170-C
RYAN BECHEL
371 Cannon View Drive
Red Wing MN 55066
SITE:
C & 1 Buildershi 29 Frequent Ridge
1089 1741 Street
St, Costs County
Town of Hammond
NE% -two S9-T29N-R17W
FOR:
Description: Mound Component Manual—Vec2.0.58P
O Bedroom Mound —6W GPD — New 10691 P N.01/o1, R 10/12)
Consternate -20" to limiting factor— Pressure Distribution Component Manual —Ver.
Effluent Fitter- Maintenance required 2.0, SBO-10706-P(N O1/01, R. 10/121
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 manuals) referenced above. The owner, as defined in chapter 10101(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.D6, state.
The following conditions shall be met during conduction or installation and prior to contrary or use:
Reminders
• The building sewer shall be installed/insulated per SP53g2.3D(11)(L)
• The mound site shall be properly prepared prior to plowing. Any grasses longer han 6"shall be
cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up
and removed. Cut trees and shores Rush to the ground and leave stumps. Awaid operating
equipment on the mound site. If necessary, use only tracked equipment, during dry conditions,
with minimal passes, to avoid compaction.
• Asanitary permit must be obtained from the county where this protect is located in accordance
with the requirements of Sec. 145.19, Ms. Scats.
Inspection of private sewage system Installation is required. Arrangements for Inspection shall
be made with the designated counts official in accordance with the provisions of Sao
165.20(1)(d), Wis. Sots.
• Astate approved effluent fiber is required Maintenance information must be given to the owner
of the tank explaining that parodic cleaning of the filter is required.
approvedA copy of the plans, specifications and this letter shallb -ite during Constructionand
en tol cettion W authorized reoresentaG sof tM1e Deoanmenlnwhich may intlude local
limmarporn
Owner Responsibilities
• The current owner, and each subsequent owner, shadi receive a copy of this letter. Owners shall also
receive a copy of the appropriate operation and maintenance manuals)and be responsible for
sling that POWTS is operated and maintained In accordance with this chapter and the approved
management plan under s. SP5383.50f1f.
• In the event this soil absorption system or any of its component parts ammunitions so as to create
health hazard, the property owner must follow the contingency plan as described In the approved
plans.
• The owner is responsible for submitting maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at Intervals appropriate for the
mmpori utilized in the POINTS.
In granting this approval the Ilvlsion of Industry Services reserves the right to require changes or
additions should condition arise making them necessary for [ode compliance. As per stare stats
101.12p), nothing In this review shall relieve the designer of the responsibility for designing a safe
building, structural or Component.
modries concerning this Correspondence may be made to me at telephone number listed below, or
at the address on this letterhead.
The above left address" shall provide a copy of this letter and the Pawn management plan to the
owner and any others who are responsible for the Installation, operation or maintenance of the POINTS.
Sincerely,
C&6�/ Rud kic l
CeCe (Elizabeth) Rudnick)
Wastewater Spardmist/POINTS Plan Reviewer, Division of Industry 5ervices
(608)QO-3186
thicalleth rudin ck'(dwlscon in.cry
ADVANCED
crvviuouM En Tnc
Property Coiner C a J Swidens Phone Date: O92919
Site Atlareas: 1009174TH ST, Hammond WI 54015
INDEX
Page:
2
Site Plan
Nye:
3
Management Plan
Poi
4
Management Plan
Page:
5
System Design Summary
Page:
6
Mound Design Worksheet
Page:
2
Mound Design Worksheet
Page:
6
Mound Design Worksheet
Page:
9
Pressure Distribution Design
Pape:
10
Pressure Distribution Design
Page:
11
Pump Design
ONg�Np
Page:
12
Dose Tank
p\SC
Poge:
13
Tank Specifications
' * RYAN
= BECHEL
Pope:
14
Mound Material Estimates
3
D-2263-2
'-
Page:
15
Soil Test
RED WING
NN
Page:
16
Soil Test
'r,�ESfGNE�.°°�
Page:
12
Soil Test
,
Component Manuals: Seo-10591-PMouno(n.01101; R.i0112)
Rai 'Pressurefistribution (NOIJOS: RA0112)
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Management Plan
no erwake m,N idemeaxapw waling tommo anemia„remei he Ms" arerem phenomenonay<w anMgyxreer.
pemmw by the foreseeable lawmen Groem;oeer mergxmeMnice rai be samovar by I uv ruin kepis
nreMeMvwienerepm✓Mer Mugrer, to 1whommwne/a rexpvrxAigybenauree e.Wx PtettamgixMO Ing governor'
11, Keep this Management Plan with your Septic System Owre(a Guide.
0 Keep copies a an pumping records, maintenance anlvltiea and repair invoices val this document.
Ph Review this document with your maintenance professional at each visa, discuss any changes in product use,
activities, or water -use appliances
Management Frequency
My sneeds W be checked cognac ireGR uenay'. C, kave 36 Months
r2y 36 Domes. Sheri Gov t ley Famency.Check way 36 ins
Deaian PammM m
Number Of Bedrwme
a
Sep(ic Tank ManWacturer
Sep(ic Tank Capacity
Winer
12M
Det n Fb On 600
Set LoadingNOle(gpolfil
0a
Effluent Filter Manufacturer
B Model
-Pun Tank Manufacturer
east eF-10
WWUV
Star MFormen(Oualtty - EMueat I
aiolol ulOryyen Ran ne(a001 220 may
inumended ollnx p551
ISO rawMo
Pump Tank Capacity
Pump MCOWacWrer
No
Par lnaAller
016
Fee .ollc,Greaua ((FOCI ]II mg4
Treated Quality -- -
l(genl
ge rsleOOl
&dootal
_
.my1
DModel
Dlapersal Cell Type
Pretreatment Unit m_eec_npllon
Mound
NA
Sl Solos
_ motel®rk solga (i66t
4.OI4,Gremes lFOcl .myl
Max Effluent PadkJe Siff
1IB
_
Regularly check Orwel or apmgy son"unit yooraon
treatment area. Contact Fromm browi if abuse shoo.
CC`W ordinary animas ("hem, gmumtwga, etc)
Keep bikes, ohli armmmubika and other tmMc dt
argument area
Nfarma. Contact yeal ins pre(aSbnaof any alarm
arenas
Let Fider- cheek far lint bussm and mean when Mowery
nym do not hero near add one after waahiw mashing.
mmi
Caps - Makc arm that an caps ant nog are imam and m
Place . however for damaged com often. Fix or terrain
momes every 36 months at a minimum.
I talk inlet and m1i baffles (swasa cabRl
aalnllan emuent rerela mayplmabml
lime, and alarm system screening drapplzabN)
!wMnp for Morgan, antl lunolbn(IF wargemble)
Lear Itl kremk mappunadla)
coach c,mi'mai nine Maier and coldest, 'am,
law Mmparea to system domed now.
credit o,K,, and effluent Israeli m lank
fora.mi of effluent as other germ a receivers.
nspeclsen Moos am aagency and most
r homeowner aim llsml Management mgi any any
MAINTENANCE INSTRUCTIONS
Inscecnona Of tanks and barren cane shall P man by an seampriately licensee maimanal or nsiness Tank impemards
must Maude a Visualspecnpe of the tanks) to identify any missing Or broken hardware identify any cracks or leeks,
measure the volume of combined III and scum and to check for any backup or Pending of effluent on the goeo und n® s.
Access openings used for cal and assessment shall be sealed watertight upon command, Of mince aclmuies. Any
aoundmefaane schwa opening¢ most de replaced immediatey.
Theoiapenel relnq shall be aiimally InspeaM to check the effluent levels In IM Observation pipes and to check for any
pending of education Me around unlev. Pending of eMuenton the ground auraco may indicate a failing condition That
repmres immeelate attention by a licensed septic professional.
Tanks must be pumped when all formulation Is within tl inches onne bottom of outlet haft or Meneverthe scum
Mae is Edged ]inches of Me bottom of Me ounce battle In no cuss shall total dodge add cam volume occupy greater Nan
zs•A onne tanks liquid capacity.
The effluent The shall be neared as newdaarym ensure proper operation. The Inner mould not de removed unless
pool made to rate,, solids in me tank that may slough off the Men during removal. )tine filar is equipped wth an
rte he Men abeu be aemree nine alarm Ia activated continuously. Imemmnamnner alarms may molests surge news or an
w ending continuous alarm.
Porminiment components mall be maintained and serviced by a liwnsed septic professional according to the manufacturers
recommendations
START-UP B OPERATION
For new constmctlonprior to Delete operation, check eaptitlpump books brthe presence of paintlrp pmdutl¢ or other
shall)¢ that may Impede the treatment proceaa andar damage the drape Mall cells. if nigh concentrators are deNa d
have We contents of the tank removed by a licensed aeptic prolesaional prior to use.
System Mal shad not Occur when sally are noaen at Infiltrative surface.
During Power M e; pump tanks may fill above normal high water levels car system teliong pumps. When pourer IF
restated. Nee ewaterwame discharged to the dlan peal call ol none Is Me de potentially resulting In ova not
Ne ¢us. It may result In backup of Sunare discharge of emaem. To aqua ins elfuanon, it is highly recommenaed to nave
the cons¢ of pump Unit removed by a licensed Septic pmImional or a septic professional manually done the
system to when the pomp snit ad normal operating hens pear to reasoning power.
Do noldnee orpark null Overany septic system components. Oe nelson, perk oval armnersame diaw2 or compacune
area wimp fs feel immsiope Of any mound or at grade system or sewnda y sepna System sea
CONTINGENCYP"N
UNe¢eactank. crony of components became entrance bank or component shall immediately repaired or
replaced according A the anginal system designspecifiutiona�s
to dosing tank, pump, pump controls, alarms, or related wiring becomes detective, they shall be immediately repaired or
replaced with comcene soon performance
It the soil treatment component lays be accept wesommeteaordisenages assessment to the ground surface, Annual be
removed or replaced by; increaeirg basal area lib Ice leakage occurt rebuilding the component who aewndery aeNm Site,
or removing and replacing biologically cogged ebaogtion and dispersal media and associated piping.
ABANDONEMENT
Inbe sepncsystem Full Mal la pmmanentlytaken our of hall Me Mal shall be abandoned according m achimed
abandonment regulations. These Include:
-Al piping to tanks mall be disconnected and abandoned pice openings sealed.
The contents of all banks seal be removed and disposed of by a licensed semal professional.
- Tanks seal be crushed& Hall or removed.
-A septic system abandonment notification shall be All to in, appr,p"K local governmental hot
WARNINGII
SEWIq PUMP, AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANOIOR INSUFFICIENT OXYGEN.
DO NOT ENTER A SEPTIC TANK, PUMP TANK, OR OTHER TREATMENT COMPONENT UNDER ANY
CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE
DIFFICULT OR IMPOSSIBLE. ALWAYS CONSULT A LICENSED SEPTIC PROFESSIONAL BEFORE WING ANY WORK.
System Design Summary
DESIGN III WASTE STRENGTH, Th"i
FILED Titan It Am. , 'Its A DAN I.n. Effluent FIGNAMI Sat M-10
C. Porman Tank (GAMES Wadirm. C�i� PLO Gai Pump Tank 2 (Cold III VA (i
Amignim Min, (wagadvar 800 Galkno dump Toy' 2 happougger IN I VA daily,
Pump 10 0 cup, Task head I I I it map 2 GPM Task No ft
humming Thap) daily Mmingurn III III - SON III as 5x �Pma� daily �e�ter How; astmandar Is greater
UPS EVALUATION DATA
Guys
in
Mound Design Worksheet
SYSTEM SIZING: Parcel ID: 0181096.29.000
hi Flow: 600 GPO
Sall Loading Rate a 0.Ad GPD/t° J w�
Depth tL 'On9 Condition: 1.0 R
Pernent land Sedi 5 %
Desen Media Watling Rate: 1.0 GPD/R` _, e
DISPERSAL MEDIA SIZING
Dispersal Died Area fat B) - Design Row a Design Media Watling Rate
Bed GPD e 1A GP(i - 600 W
If a larger dispersal media area is Eesire4 enter side !t'
A. Select Dispersal Bed Width od: 10o it Cant emN TO tree
Linear Loading Pale - Bed Width X Design Media Loatling Rate
10 it x 1D GPD/!t' iOG gal/It Conman taus
B. Minimum Dispersal Bed Length Ed Dispersal Rod Area +Dud Width
6W it, z 10.0 1t WA it
DISERIBUTION MEDIA: ROCK
Rock Media Depth Below Distribution Pipe
0s0 1t R+Nmwe noteri suared" ACUrad An Wund patinaeme)
DISTRIBUTION MEDIA: APPROVED TREATMENT PRODUCTS: CHAMBERS AND EZFLOW
1. Seleel015persal Media:
1L Enter the Component Length: if Width: if Depth: It
iii. Number of Components Per Row- Bed Lengthtr Component Length IROond up)
R a ifcomponents per raw
is Actual Bad Length = Ni Components her X Component Length
Per row X it 1t
v. Number o1 Rows - Bed Width s Component Width
Rs R= road a0m Atma Ann la a.aae N.
A. Total Number of Components =Components Per Row X Number of Rows
- Components
D. Fill Depth Below Lboloce Edge Lot - 3 feet. Depth to Limiting CoMinon 0, Mm.l
Ka it - 2.0 it 1.13 it Design Sand Lift (optional): in
E. FIII Depth WOW Downslope Edge (EI - feed Width %Land Sloce e 1 WI' D"
10.0 IF 5.0 A+1W. 12.00 in - I&C in
F.Distribution Cell Deptb(F).8". Immmal Side size of distribution lateral rn'prappn..ar murny
8.00 to . 1.25 in . 9.E5 in
m pAnal Pipe sill tlymW on Stems Merl
G. Cover Material Depth at Cell Edged (Go 6.DO in 116 Mill)
H. Cover Material Depth at Cell Center Nb! 12.00 In 112 MeI
I. Daµncicpe Width (1). (E. F. G) x horizontal gradient) x Oowslope Correction Factor
2J7 h x 3.00 x 1AS - 9.78 it Or It
J. Upolope Width (J)-10. F. G) x (hmlzantal gradient) x disinter Correction Factor
$.D it x 3.00 It x 0.87 It 5.92 it
Downuoce Correction Factor. 1.18
dpslope Correction Factor: 0.81
Enddode Horizontal Gradient: 3.00 hUmdUy 30 or 4.0)
R. Entlalode Width IR)- (ID. EL: Z] . F H x Endslope Horizontal Gradient
30.00 s2. 9.25 In. 12.00 h In 12x 3.0 - 9.1
L. Nnund Lengthh (L)- Broad pe Berm Width. Be tl Length . Ensured, Berm Wtlth
9.1 it 60.0 it 9.1 h 78.1 ft
W. Mound Width (W) - Downdode Berm Width. BN Width. dpslope Berm Width
9.8 h . 10.0 1t . 5.9 It - 25] it
Verification of Minimum Required Baaal Area
"Sl�ioJ Simea-5x
( A.11
MNINd1M
10Po per Onor L War mit PAre)
W.o
fix On) It .
48 it
1187 fl+
•'Level�Sl[ =BxW
MINIMDM•
- h°
IAll -4W.1mdliq Nlel
it x ft
ha
1.... ..............
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MOUND DIMENSIONS
r
ClUs
Apes
I c
_K_
i
WI
N.i
B O �
I
_J
L
A 10.0 It E 9.3 In 1 5.9 If
0 50.0 It L 6.0 in K 9.1 it
D 11.0 in H 12.0 in L 78.1 in
E 18.0 in I 9.0 ft W E5.7 ft
Obs.PIpe5(1/10Ih ofB) 6.0 It Atnptlon WIJM 1AJJ 19.8 It
DISTRIBUTION AREA CROSS3ECTION
lw
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— T S n
rm.m yx MON luO KINC; s D
OBSERVATIONPIPEMTAIL
sinnw
n,t," w
71Pa pw m�ummlw amr
emnr wrreee me wain awe minimao
Pressure Distribution Design
MMla Me Wah 10 it Allred cmnmin Type: End
mar... Hater, ITLZra m"le "/,me {Ilmea2 aea width nnil.px A 00wrv31noun6 nP)
tl 10 -qs 31.1) 1 1 Mooal) - Tlateral;
Designer watched x or Laterals uowmr'. 4Yals at. t an min l.xmbnarae0
Mn. lateral Spend, 35 it Geller, urea) Sheila Opnuap: it
min, Monitdd Length, zo it temper Mamrold hameler ow maw:r
Saida 0nnee Simmer 3.0 it a now 011e. owning ore ynanl
3/16
swat Omme III Men dr.11.nrae<,a a. rI. on Ga.)
Lateral L<lym - IMeJR and Lmam-z Reg. a a ttnes
_ nit
rather of Ward Stereo -Lateral Lengths OrPke sparing Indeed down to the health while roller)
19 Spam
11m per lateral be l- Number of OnOaiShelter
r1
19 Spann - 1 20 _ Orfet; per Lateral
Tout Number or Orlhrn - Number M (lRkn per bixat a Number or Lateral;
E0 ONNm Pen Lateral % l lat"Al, 60 Totalofflm
Mmmmsaed OrlH¢hnaNM 4-11 feI Per earli urf samara 12 ft'
Onfla Der yty. fail Area s Total Number of 01 Pa..r APPM to At 61hon
690 Drill.. 10.0 Wionficl
Lateral mamem. Den Ad, 6)'. 11
Mmlmum e.earex ze It
OMIce DeCharge Raze 0.66 OMw nmedw iode0 GPM per
Pressure Distribution Design
Lli verge Pate arrml- Onticea ce, rating a onroe m¢wrge Fate
ee
Clark
aSO M Orifices Perleapletter a
eral a 66 ar, GPM per Ont R.1 GPM per Late2i
snlem Ra.Pate= toter number retention Greece Drainage, Fate
w Outer x par Onn o.ta GPM Le
Nstrai RPIP LP,P Vnwne Per fat are¢ tt mm
Volume of Dntn0Obn Prying Lf of Laze Me x Latent Larger x L1ei Vdure Per fom of Piping]
51 it x D.Db Plitt R11 Geller
Minimum Dinert Poiune= Vpiume of matnWtinn Piping; x5
5 5517 Gawps
PRESSURE DISTRIBUTION LITERAL LAYOUT
P 58.0 ft x 30 R 5 3.5 R
P12 ft %/2 It Y 3/16 in
Ml Length 7_0 ft Maaifola Diameter 1 114 in
Isteral Diameter 1 va In
r
e
Pump Selection
Iom nolnv UPn �v MwUP, Got Per manure ta�e punne GPM (10..,other)
o rtoq
Adt Hotel U1, I: low to Met GothotO of I
F,,WH GII=Fn./mdw, Pireoe.F of F�Pnn,om T,uee:IVFweema.4.am
Add
rr
'Pooded_ubeet [e LWPrh GUM
MOYYP 1thert UP GotdISHWOL Ore,
FISIOf ueauna her fimmq IM,I
ortemeN Ip/ Y135= Fquimp� Got Weal 0/w rm
Fwm.: mmnnee. m GII xm feet -Adt Need Fuss. FoWWPI n:mu. Lots =Total goemk ww pop
40.0 tf,q
I wml ow. I: 6,11d, then P.mo Not Ct Mw z:
MUT
WI
oef
Demand Dose Pump Tank
,ap,ran,„m M.ar:,.,.,no GULF,rt.
a'im
eauekPlaInch from mearthat 22 2 GelPer Inch
frefroeper 1..,.Parm.tT,«ea.a,rae,.e.
11IN death of Merce wank tan PUA
Cal Ner,m,,...ane Tral.,w,eePUMPMa,,,�.,i..,4MONfree the M. a� PUMP tank a z race, of Near ce. PUMP it
.m
Freft ae larack haN,. z race,. T>ra Gala, Per inch .mli.,I.,..., ther
. m7.k a.M.. Area marl
al", Gat Day - I Nor I arlorl, IN.ON
on gal 5
berance n,oer
Optical
Ganc."OCar, X Norencem,eed Per nick For, of Pike
eta Dirt. Ma. aPeaae..hm<. ara a
aw
Me
mimum a,,. �.wra-301IN If tank
I ran alarm IN ��d 10 Ill
3 in X 211 All Pan al
FLOAT SEPTINGS
Fralt opparatern Monte Me plan
nksw ....•o.� For arch
ol wvra.
Data" AItPUMP i . PUMP t Nall Pont alarm
Ill 10 on PURD On o,,a —ftworf nor ,fro.„
era"dt oh an in
a.nn,P mom,.
.w,..ra
222
TANK SPECIFICATIONS
violated cover - 6Inafiesl Maximum Craver - 9 het I mess sped/led by manu/aRmeel
All manhole cove's I extend 4 I nib¢ above Owl gentle
Ifthe And, is within 2 feet of fork grade,'msul ale the 114 to an RTVa l ue of 10
Quick oizc RI(And -pulp reachable from final grade Q4 spread axl required for pump installations
If f0demaln will have a Hook" assembly, drill a weep hole In the Tork
holding sewers No 90'u keep 3feet between 45'b maintain l Inch in 8 fact Pal slope, install eepoed AN the
cuiMmg Amplitude and every 100 het at minimum
Insulate Tuilning sewer if less than 2 fret 4om final grade and Tender all high traffic areas ld... wave pecI
43.W
iane'ssx
\
pump...ed
andademm.
�
an
ha
y
�.rr:Revad.
ands
ypp4�
L
1/f'
ryou da A I Y l , wa aw
!varall
Ed,
94.00 --c
VILP1200/800—MR
TANK SPECLCAMNS
di
Weep I,
.n 'MMM mad.
iwi
I'm W OD
unI
I I t_
cuu_A-aArm
np'nw
AND Well
�m
Goods _
�.
am i canduch An
used, Tax, Add Mi
sum mrno
Top mrw
wwxa uxznw.rzo Arm
1i e o
VpdwAm Tandy
h Jlr
P�f
And wew radius �.ro.�m
--
an,,FOR P Ye aput0"WINGSvsovni
Mound Materials Estimate
ARock Vowre_ - n.rnlxe
I!
n
n'ry'lo
m.wel by zz o¢
20
p
me box rw.arl."znbiy: p„ I.z
_
p,
FW 'Pill' m 4nmweyni wr - wgnr I be lye. Ri ww
www'e+III ... our cu.wnmu�ai I� emn we• lb,
pol
e•m.u...�...�y
mpmmnn��re
W+bl vaumn rvMal znemlMlx I
II 9
NbInfibbia{wvlape iM:Ml npmrpbn xWP� 1—
II
ftbInIff
Iq<wermm. b vll r
n 1.011 x
Oyd' If by zv lip' W olitubicnM • SI
by Ip
ax/wcmrtmai 17.1 pIv In
126.3
p
�rou van,,.
dnr:Wmnex(b.eywiwelow,N 4einnmbnfly, w,mA x.w,zx.bn5dlnepAq:
t4bvx
in 0 it 1 1,
a.,blw=A..mao..,.a•m.. w.,el A..o.,,m
IS it x I
Iro•ly.x�n, �....wl•rn.: owlm•e•,.. z59 xnxAnz'bo.0
[m�bpeeemcwe.vwurc. Fyi Gyrrn LObindi XDWUI n2Ij X2
omae li by zr lPlp' innmweo III, w,en 23081 111 zr
8y5p.
AcAf an Iffy 05,5 Of
03
ADVANCED
"°
o�
^^'
Po°"`
b.a
Y
$'T. CROM COIINTIf
SEPTIC TANK MAINTENANCE AGREEhfENT
AND
OWNERSHIP CERTIFICATION FOAM
own mu, G+S Buhtloc-s, =Do -
Mailing Addross 316 KAnl,00PS P1-ACe
emPercy Aaareea lOb9 I'rHYp S'f'rw'r
(VeeificaHavrvquvetl Goss Pla®iog@ Invivgpepmpvevtlm vew comEucdoo.)
City/Stab HAf M4,\.lI Parcel Identification Number
LEGAL DESCRIPTION
PropertyI anon_'/.,_
y., Sec.__,
T_N
R_W, Town of
Subdivision
PK�9Pr#r
Wto
Lota
Certified Survey Map #
Volume Page#
Wamnty Deed # Volume Page #
Specleeme yes ® Lorlomsidemifiabk M an
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
IVPsopm oee evd maiaevavice ofyom septic ayatwroWEremJl wimpmmmn ftibvemdWle wane Psiyc
' m orpvogieg ws0,e aepue moteveey Wa yore orro®er, ifoeeaed by a mameapompn. wbsr yoo put mro
We eyat®canovRctOc ftvctiov ofebe xpac sof a a eeaareol m8e iv the wubauPerl system Oawnmeakvavice
tupamibalaq x yyecifiN in 4Comm. 83,52(l)f°�" Chepb l3-Se vloi Cmury Saoismy 0etli®ro.
Tice progary owur a �
gwro visai m uCauvry NaasnB@ZovmB RPon, veleiq not (1) ifeGoebaaabY one
wvermd by amuar Pon 0 in Plont, s ev Ping ives,cwm msNGed Pt®M.rore 4arved pwPumpin (inn Wrsar the ovens
rWiffism stemummaPe. oPmutiabcaaaitiav mNarmafter w.+twtwtiou ma Pmspm6 (iramseur), me septic moku
kss the t3 adhofdudge.
Vve, the uWunined have read the above requhemevv avd e®ce m m,"Wast As private sewage disposed mass wiM the
emmWL ml fords, harem, u wt by the Depaem mat of Commmw and WC Depemrsut allatuN Remmae. issue orWiuwam
�tim estmg thy your septic system low base enhanced mutt be compk4d and seasonal m the SL l ix Coovty Plameng
lmsDepertmeut withim 30 days oftha drae year upiradov due,
Vw candy flat all sleamevm oe thin form us cue to Ne beat ofmyless Pmwoolsa Vwe seVart Oa owmja) of the
pqurydmvild.bove, br`dtmean sty deN recoNed on Reeisar of Danis Office.
Number oof b�edr(a�oma�,�,
' SI O �'Y --LL lDIaot9
0 l S[fINATI1RE OF APPLICANT(S) DAT—T E
.aapvYtlutamiveprcxvueatmY remltw@es®srypvwtbemg ravaYetl by the Pbvmry@] irgtkpummtaaa
lessWe whhthu applia0ou a rewdM wanmry del from the Re®etcofDew Office and a copy or the ardGN score amp it
mf pass is needs h We wevamy deW.
(REV. e&➢v7
i Pm Neona
Ilie 94%hiiiiii
Done 4ot6
OWNERSHIP CFF.(RRTIIFICAnON Fell
Mti1m8MNeu-4jIG..Y)Ltl'f aS COH'Q� O JCr (pni .$$O(6
pmmnaar¢�..tL�—�-114^` rSi- �s
lym nx rn,J,a nm,N.anu&u,wuwnmmr rmee. �' I
rinn'I,m d 1/l�nti �U�L(T p,,,n m[.rr[.Jao N/Pm�be /$J 4e .22' 000
Pzo yGweYm�VC
fertl(utl 5orvy pLpN Vo;Jmppage 4
w OeedA_ �_(Ee2ro WTJkValome { �one0
w �Ya ' nxifubleppFOno to
JV TFM M 4 INTENA NC E 4 hrFo Ol CVRTWr a
led rsue Wlmubsfimn'nn"Mib nesvut w<ri`avy hbl o1morcq I f�il,,d,d, by VIIaexNp,,p,' WXrpeupminm
IwrvrbrLuezu[zyn{gprn S SP mM°`dzW knc�wssYJ6rynJ.ypem Owevunimpurc[ R)83�f11xnd to CWpkrlv- Fi Crvu Cwmr sennneyoralnorxv
Tbl'e Pxnrty mervn®xna zubnrir 10$1,Cw"Cormn meeniny& bn,ry Wwmmnn a amifrcvion A viyM bYMe
u v`raiygvlzYJ[m MrPnWPo vlwMu, rcyayelPkmhro,a FuvwNpampvrvil9in¢tMIl111lrc Ghen,
lee Jrmr V]fu 11 a(JWyc aN <^OIOmr,Mn ldlegn,mp lon All pnmmn06fnceuylle h,ec mMh
q rM ueaee iBmtl Wre ema%ems
sm ora�eel (um8, lertln.n[n by am ImI�jIJiM Ma g biil nreulehd dhm[,pal hpml s�mnirn the
k fNim [ C[nigeJim ur^n¢rWrypmryea<mpmnu M1mr n crc Ore lh,a �mJ Rell Sl
Gu'ey p'"09& Z 1111g Neegnc inia 30d or rh Nrt meinreineamum be mmvleNaM wl rutb¢S. Chi,
[..mulrnrr e.m.
<[mrr u.l,u[mmmpnm fnr.WSrulmenoumw[neJnrmrbwwwka¢[. a „erne nwne,tl orue
PmFenY awniibeieNrc, bYvim¢p(aoilnrytleN rtspNca in RegivinplOeMSORm. we eM
Numheral
S1 EOP APPLICAM(8)—
➢ATE
-e[allY inPonn'rnon lyllu n<P�n'm<ameY mu0 in 1p[miNryp[emil6pin6ev'vo4J M1y:n<p;mmiotlm%rrtin8OePaN
Grvluae wiOlpia eppliealrou a r¢vkatl wxnnry aced mm r5e gey,inecar4erh Ogwc ona n o�'Py+flee eu4(rM ewv<p mvq it e
..seem. i. rrr.d[„ue x[,..alY uad.
IIiCV. WU)
aa ,SOCTIM e - Ices. Y1'
dXRSECIttmB-O,B. B,'
W I/8
3� ..............�_:,.
.. (NO XItF)
XV
SECTION B.
p U 1
_ _
50('4r 41W NOI e]'L8'E 999'91'WE
454. 59'
--
l 240.
210 00
013 1]
I ®
_
u
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l8 j
f.O
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b
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1.90 RMEB
M'.VI 90.F].
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.7
DRAMAGE
. ry
EP9EEENT g
..'•' yak
OT 30
'a
21�. 88'
su. so'
D2�{64
889e51'03'W 235.,
e
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o b
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ee
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LOT 28 ''�s '"
So Fr
F #kv
4
b �'
OE/10 1005 M 12:47 FAX 115 BBB All HOYPORRY EKO RRIM.INC b01/000
EXHIBR 'n
30 gyp
iq �®/�L0fE9
a 2`s .4.+wxww
s` n ms awi
LOT ?e . 0a. dam-wmn
X,� SHE 2 OF 2
02/10/200S 7N0 12:40 PEE 715 N06 3441 Ni NNGINNNNING, INC ®002/004
EXHIBIT B
tiff rLAVZKUE
LOT 1
1
LOT 31 LOT 32
I I
I I
Mi 10820
jMARE.
W620
LOT 30
/ HVI 10620
/
LOT 29'
Mild- d��e
N'IaERN 1052.0
DDIIIUDi PJSq@IT mom
5 G..0 OR `N� NO WATIM
....
6
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BRIM¢
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2 M0116f
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REPARM
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n l uaua.
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ON OF,
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81
limmmon OF D6Im, goRNA—A
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511 Ri0403WN319 noiea „$Dill, 11, till
8
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exbrnaepg�n nm �. �.
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ER 91— aRROmyLvlie5130 yim myl FMWK=<b ss AL
The Oepelmenl ofcommeme Is an egml OMvvn1V uMtt pvaWer ana cmvi%er. If yw naE miaome m exen servim or
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nW myaial 0 w elwma fmmn, plmee amen 62 &T,o em m 6N M 3151 or TTY 00-16a071t.
PAO¢Z_OFa
IATpTZ _LEON,D&SCRIPTION:()EI14�1/4,S
9CA18: 1"� y�
�y,I ELEVATION:
BM 1 DPSCBIPIION: ���� � �
BM2ELEVATION:
BM 2 DEEOWI N:
nmM VATION: 20
b
(ei14
PAO 3 OF
NAME: _�pIW, LMG DEWIMV204�W$-T-TZILN.0.I2E(wQ
F,,IBLEVATION: 100,
d /////IllIIccccc �'W�
BM I0EStlUPT10N: ��y{�{ZjQo���
BM 38LEVATION:�(
H"I
BM2UESCNIITION:
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SY TEMELEVATION:
.x5amdeMpgpuanaro-m�.® SOIL EVALUATION REPORT pagLWa
IML• m ct s9hly ard 9uaGno-
m avme.mxmrann ss. mil. uu (Ind.
ubNmiml+a nlb Manmwpdndwa mae ve:ll aawz Mz2e. Plmmnt
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The Oe{asmenl o(Comrnceumequal oppamoiry semcepsoviJuuWemployee.(sssiabwetoeccm ttmces or
neM smemal m ev almnase (asma4 Plisse <mi2n sFedegmrcnl et 608-366313151 mT1Y E08-2648777.
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need me¢nelmena@ma¢fartoa4 ple+ae conlen Ne depvmmem It W8-2663151 w=WB-26 8777.
PAOB_,� OF 3
SCALE:Ilm 9O n��
BM 1 ELEVATION Iw.O
BM t DFSCAIPTION{tV-p ej'®vc Or p
BM 2 ELEVATION q%OU
BM2DF RIMON" 2p oil"pk .,
SYSTEM ELEVATION 9f60
srsrEM TYPE m.,,��d Sy�Fe,,,
CONTOURFI.E,VATION 786-0
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