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INSPECTION REPORT
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GENERAL INFORMATION (ATTACH TO PERMIT)
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TANK INFORMATION I ELEVATION DATA
TYPE
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PUMPISIPHON INFORMATION
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CONTACT:.. ,
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SEPTICTANK t.h\UTTMANCIR AGREEhifP T
AND
// )) OWNKXtEIrPCERTFRICATION PORM
owneriRuyar LV C LO,n/L 0 i
Maatng Addma,sLp-/13 5�}l, AAb,;, grJL L Je! e jj a.Jr S�e2i
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LEGAI.DESCRIPTION
ProParfy Locabon %,_S,5_
Sumivietall 90�l� �F7
Cernfietl survey Map # �41Sg��v
Warranty Dead #
Spec Mua yet no
T__NR___W,Towoof h`Gue.�Zol
76
,Volume Page#
Lvl lln-s tdMtfiahk )To no
SYSTEM MAINTENANCE AND O YNER CER PIETCATfON
btprovuuvc eud mucnrnav¢aflmvsepnv aYctw�.oultlmxull min Psemseuc NlurtbhaWle wssla Proper
no t+o putrmaig scarnot,soy tjo,yneetlaq Eya nsetlpioq rme�cc
we.>+rcm�oarar.rreat rowoarwaawuta.atra.,da.g1 Grasor, �,Opw n want chetah r.xm. D.mn m
rcaptmihtLeeS arc manluy tr Korea,Korea,S35252(1) aM w d.a+o 1 IIP- av Cron Cowry Smmry Ordwme.
The Property ,,our agrzs to October to So laow C TJy Pbeyvy &Lrvmg Department aentleuem racer; srgrN by We
owov aM by a" ban PW„ei m
mber,laumeymvO Plrmb,, ,,s ph,rxr or a beaeEforecast, ae,t ant(1) Weaoane
an,W IfairorlryshmiS wPmPer opetatm; rovdmwarvVor(3Jetkrivsprcbmlmtl PamPtv6 Gfvausuy), We sepec uvhu
en Wm 1/3 full olslWge
Vwc, th, rrvlmco,r] base and the aborc regautm� u,, aad nW,, to bamtaw thepnren aeavae canon, syamv wah IEe
ndu& stt fllffi. hereon. um Fc We DePare _ mallbc lhpmovu of Natval R sowcan, Sbte or Wac
QNIw an tivg chat your seye a has rnv:mwauufl ban cougbo rvW reryeuW 1, n, St Cfou Cmmty pro vowaa
Zomog Dot,, unhm] 0 dsya Of Wa three rtv"costa .. : an
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Prepare x pettyden2d- ebre o, by sane maf
of wav Jttd rtcoN- in
:RegtitvofDeeN office
NumberofbMiSarms ]
SIGNAT➢RE OF APPLICAN'f(S) DA]H
aa.Any llllovmeoa tham,tueprcsantrJ say tenor m We so r ary Wr tlament Worked by the YYomvg&Zmmg DepMmatt,
belab nth Wh a rallabona r,OrI wamnry deed how We Regina o(DeW Omce coda Cray o!r a cvelW swary reaper
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@ LOT 74 „ L '1 o eiwM6
Av 1 1 \L�.'o'.womE n .g/ '16iI 1 yi 1 mo :M
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wlMw.hootsystems'-
H-Series Gravity Treatment System
Green Choke Applications:
i Single and Mukiimmily
Dnellinul light commercial,
Churches, and other similar
Residential strength uses
Performance:
9856 Reduction CBODs
ea0b Reduction TSS
9 ai<nwvenndR:dfisb INH51
Fecal <!,OW Sy/c disinfM.bn
Range of Simil
SOD, Sol 750 & 1000 C>PD
Nigh per/wmaeece, kew rani eaewq eflac ent treatment srst®
The H-sene5 Gavnybeatment SyAem s•o5'Mes high µAonrance at a here compxffik to none mM level A1V
Nuadming Wound of less than 3 rtgM1 on CSOD, and 3 irgh on tSS. It far excereirme secondary srantlaNs of 25 mg/L on
CBOD md3omg/Lon TdS With thew result; mam krtatimsalbw reducrvn5 in disposal areas between 35 and wa%
t®rment the growth
roundwainto prevent nitrogen
Mnofihewatwithn<n organc soil
ntent surface pant growth YM tlrpin to groundwater to parent nirto3err WIIunM of the water Ode.
Simple inatallakon, rellaalo perToemanQ, lost cover of ornmeeship
cols level of performance is emvnrN b/ in simple lnsWlar energy Nficlmt performance anti low cost long term
maintenance and ownership. The systems comhonems are assembled at corrparetl mamdactunlg adlmses rather than in
the fiend, to entree Mude performance wMi loin supoorr
Eiraggir concern, Mvkeeeecental prefecdon
Made Ml Ily available ands mfedund concede. the K5Me5 termini an energy efficient linear compressor than
uses less power than an average light bulb its pullnewiene Wrther Iwpper Is made ofrerytlN milk lugs. Choose Hoot,
and you make a senate, riectspost to protect the ennmndomt as you protect our door precious rewurce ourWarer
UrearrReM and vwncal Sepanatlpn ReaeNtlonr
With greyly discharge, the H-Series allows w u to dense your disposal apglmtion fian conventional Ineml lines
leeching chambers, other alternative dralnfieM materilly In some
areas direct discharge is mi option as walk Reductions
ofverirzl grammars to groundwater and Implay ermeable layers such as user range horn I W 2 ket.
Make the green choice for wastewater veatmmt
Yaw warewater starers is the moan expensive and important applNnce you will ever purchase. Dann l settle for lug arty
stmem Prumi your family and the environment with a boat H-Serles Swings
Wieser Concrete Products Inc. l-9O03312! {56 w .wlaSerceewMe.eOeee
St. Croix County A
Occupancy Affidavit In OCT 24
Tarr `L 0 Rae o Nara- net) Typed printed
bang duly swam ,slates, antlerro pprinatM1, IM1at.
u1111Miiiiiiuiu
Tx d528581
1ow9s6
Me
MR RECOR
1012apuaf 1047 AM
RK Fee SO 00
COPY REPaOEs a 2.00
Hexhos Is the Owmedlart owner of me fiec ing yarcel of land located In SI
Cmix County, WlssonMn, recorded m volume Page=
Document Number 89 Z8 St Cmlx County Register of Deeds Office Rea
Aparcelof land kxRmdlInthe 5 /of Me +_Et Y. ofS Uaijt,T my Heniaerin nneenxp�� Od C_LC
—R 11 W, Town of No. St Cmix County. Wlsrooslp berg duly W C _=`-
desomedasFollows (include lot n0 and subdivisiDNCSM 0r deal legal 1135 /Isi
description) LiI 7(e or Raft"..) 4-Alls L'Derr a� Val sy
P. 5:. GFa,r C-04^4,.6 _-' pl>�-- Foeim.. Z01
9x. (0-� .rlil
As owner of the above described property, I acknowledge that a Private On -site Wastewater Treatment System
(POWTS) Riving Me primary, residenec is sized for I bedrooms) with a design wastwater flow of Adogellondday
(D WF M bved on l5O gpd )bedroom rat 2 persons per bedfoom) A mvumum of 8 occupants are pamideC, if the
umber of occupants exceeds the maximum for PO WTS designs, the system will bo undersul to accommodate
craved wastewater flows ami contaminant loads and may be Subject to premature failure I also acknowledge
that I will make Nis information available to any future parties restricted! In pumhi Mrs pmperry
AUTRIENnLATION
—mithwomi Me — day Of
TITLE MEMBER STATE MR OF WISCONSIN
1r Ne
eyg ros os, w. sm.l
THIS INSTRUMENT WAS DRAFTED BY
Community Development Ceoarimen 5 Cmix County
ACNNOWLEOOMEM
STATE OF WISCON31MI gp,iorreln Use//��''"" aLc r/ oa me Inrs o=3' dayav//��ac rl
_ r
5ignaurn rely Is auNemNalM oraO',modam Bola eu or M1 Cem""P'a7""a.._ n not wits, earmm. dl
...v core O}
St. Croix County -
AEROBIC TREATMENT UNIT (ATU)
SERVICING AGREEMENT - - -
tale Plan Transaction Number -
Name- (Owner) Typed or Panted
Bong duly swam, stales, under beat, Nat
1 Hdshe is the owner/part owner of ate following pace] of land
located In St Cmix County, Whicunsm, race dad In Volume, Page,
Docu
ment Number 16"r dated 9 b 19 , St Croix County
Register of Deeds Office
A parcel of land located m eg 9Wf ate 511 of Section 79, T22
N -R 17 W, Town of �arect St Cmix Comfy.
WISWWin, bang duly desrnbed as follows (nclude lot no art
#HSM Zonated! legal desrnpoon) AI n 01VIs As. sL Gla.mrco .r urat PIS
Agmmnem o
d1111101111111
Tx.a51g581
2090957
She aWIM
1u7n/u9 ,Rao,e7A.ME ME 30M
all a anon pemmAr a Powrs edmpnea.an en Aambm Tran,mm unit on the am,.d,,� dpmpenr.
same to ao the tothe
saner w pmmry me m
im curmm eemxa mnmmawThe mope, mW M a»eneL n Element by a 65 mr], such
t The caner ayraenn malnuln a mnyq with a I", M Po1Ns mamtoNr for Ins tih of the syamm ID*Income MY Pono
pooh[ m acco a and mainbnanx a rvyuM by the manuletlumr AM the Wpanment InclWlnq, on am llmu 11 IN taw, Wtln
concorm, and treatumt unit Iwn and aura e, depth TNae mhMgam are to that aGMukb awry 6 mi for AN 6m1 to "am
ogralwn and peaM Inereaget
]. M PryMs mamrnnerlmmerWlary upon any maHuntl n 0 No momman oil and to memmin ay IN w As Ed
npmam a nnmm nears haaam in Wry Ina]N 59. SAY
e ml leffine abooffillm, that the comew mom or POWTs m.muin.r mar mdo pit insp ns of the wmponence t5 wm
nn
5. The owror or the owners cment a,ees to mpor to the ae""Olt or anduld all tlue mmpkuon of earn melMena� or
manner apecrn by the aep,m,,t or anlanif agent wlNln 16 busoam ,aye full IN nine OF papetNoddencrad or
This agreement we remain In �
ffly All
he
ty office monsiceffir for the
on Of ingi craffinal
6 unit no Singer eshe properly In eaaXlon' thle ores may be canmlAa be maarbna and mmmina as
to one Allotment In son manner"Ich Mil perms Oe Existnce drum wrlaloti5n be deArmmed by references
7 TMugmmenuntll be binding upon no dwror she Mln or the wmr and mairmene, at owner meawnerI
bR 1,11 th Ma Wank ea evlcsenu 5f Ne ai
byrM"nae 0 prop .nynwhere'ub>ArseK Tre.b�nmm Ulna ainstoW
o 9)NPMU-w.e¢ePIPE p sat SO a meonwna.
ere- P l��ca.edc+✓� . a3.yull
fu��ero�enw,snnmagn taY.n /� yRa