HomeMy WebLinkAbout012-740-36-2117-SAN-2023-174 ' ,�3Y��narx�a:�r�, County �
-��� �, ,;. lndustry Servk�s Division Sawyer
z �k��� , -K'� 14W E Washington Ave Sanitary PemnitNumber(to be filled in by �
� P.O.Box 7162
'�;. ���� �' Madison,WI 53707 7162 � ��U -1(„ �
ss. ,��: W
C4�`'csh)�1�-`� �
Sanitar�y Permit Application Ste�e Transaction Number J
fn accordu►ce wit6 SPS 363.2](2),Wis.Adm.Codc,submission of this fmm to du apQropriffie govemmmtal unit ,�
is required prior to obtaining a sanitary permit NoLe:Application forms for stgte-owned POWTS are submitted Uo
tt►e Department of Safety and Professionel Servias. Persa�al inforn�tion yon provide may be u�d for secondary �Oj�Addtess(if diffareat than mailing
in acoorda[ece aith the Priv Law s.15. 1 m Stata. `��� �� ��� / /
L A licxtioa lniormation-Plouse Priot AU loformatlon �' �'�
Property Owner's Name Parcel#
,Ax c�� o j �? �-I �3 h� i I 7
property Ow��er's Mailing Address ��Y�
160713d St
GovG Lot 7
City,Stete Zip Code Phone Number �n l�
H�,w,�� 54843 rcle oru)
Ty�N ; R�EorW(�
II.Type of Building(eheck all t6at apply) �# �
� 1 or 2 Family Dwell ing-Number of Bedrooms _ Subdivision Nauie �
❑PubliGCarocnercisl-T)escribe Use Block#
•�g����- �8 7� ❑City of
❑St�e Owaed-Ikscribe Use ❑Villa�e of
CSM Number
�Town of ��i�V 7 t�,
III. of Permlt: Check on one box on line A. Com lete line B if a licable
A. �New Sysb� ❑Replacerr►er►t System ❑'htatrnenUHolding Tanlc Replacesnent On1y ❑Other Modification to Exis6ng Systmn(exptain)
$, ❑Permit Renewal ❑Permit Rerision ❑Change of ❑Pertnit Transfer m New List Previous Pe�mit Number and Date Issued
Befon Expir�ion Ptumbcr Owner
N.T of POWTS S stem/Com onent/Device: Check all that 1
❑Non-Pressurized In-Ground ❑ Presawiud In-Ground ❑ At-Gra�de ❑ Mound>?A in.of saitable soil ❑ Mound<24 in.of suitable soil
�Hold'mg Tank ❑Other Dispersal Componrnt(cxplein) ❑Preheatioent Device(explau►)
V.Dis sUTrentment Area Ioformation: �
i�Flow(gpd) Desigo Soil Application Dispersel Area Required(s� Dispeisel Arca P�oposcd(sfj System Elevation
a� �(s�� ,
VL Tank[nfo Capacity in �
��o� Total #of "
Manufacturer � � �
Naw Tanl�s F�d�tmg Tanks Gallmes Units �'C� y � 'p',C7 a.
Scptic or Holding Tank 2000 2000 l W ieser
Dosing Chamber
VIL Re� oasibi Statement-1,tge undersigned,aarame qg 1 r tlon of tde POWT3 ehown oa the atuched pl�ns.
Plurtber's Name(Ptiat) Plumber's Signatuc MP/MPRS Number 8usirless Photre Number
D�B�b 253808 715.416.1642
Plumber's Address(Street,Ciry,5taoe,Zip Code)
1128N Front Street Spooner WI 54801
VIII.Coe artment Uae Onl
� ���ro�� Permit Fa Dete issued [ssuing Agerd Signature �
owner Qiven Reason for Da►ial s OD°° �'�y ��-3 ^
,� �
IX.Conditions of ApproviVRessoos for Disapproval �''`�( �a 3 � �_'�1;�� `�i�'''��i` ��
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`ii ii� �i�m�II� ol�u � ,__,�--_--- —
Athc4 to oompkEe plans Por!he�and submit to the Coanty oaly on p�per�et ka thaa 8 t/s:I1 P:�~ ��,=';._ . .
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GS.1.._ �a_��{�$� zor�.. ��-r��s
SBD-6398 3/14) NO RCF�N�S A�TER
IS3UE Or PERlUiT
Sawyer County Zoning & Conservation Administration
10610 Main Street, Suite 49
���R C��� Nayward,Wisconsin 54843
'�� �Ci�l (715)634-8288
�S1/ I
��� `��� FAX(715)638-3277
/� ' _ � -- '�/ www.sawvercounlv�o�
� o� ��-- i o� E-mail:sanita�ian crsawycrcounty�ov.o�
I�,�:� � :_.y j � Toll Fmc Courthousc/Gencral Information 1-R77-699-4110 •
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�� SCONS�
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Holding Tank Approval Checklist
I. Sanitary Cover Sheet: Date Stamp C� / f�3 /�
Parcel ID# � ( �- 7�{Q- 3�, _ � � � �
II. Plot Plan:
v� Property Lines �Benchmark BM ♦
�C Site Address North Arrow
�Structure �Scale
�Well �<25' to Service Road
�Legal Description �Nearest Road Intersection
�Setbacks to: Property Line, Well, Structure, Water bodies, Roads
III. Required Plans:
� Index Page with Original Signature
anagement Plan/Contingency Plan
Servicing Contract
Holding Tank Agee�nent Fonn ($30 to ROD)
IV. Holding Tank Specifications:
�Tank Cross-Section: Manufacturer: (�nG�e� Gallons: wa�
D�Tank Anchor Calculations [SPS 383.43 (8) (g)]
JCLocking device, chains/locks
�Alarm, electrical per SPS 383.43 (8) (e)
�3" Bedding Material < 1/2 "
V. POWTS Component Manual Reference:
`�Holding Tank Version 2.1 (May 2022-2027)
Owner: �/`"� `�� 02 Pluinber: ���`'�
Application Review Date: ��I o� ��3
POWTS Reviewer: �!/L,�
Name
6`�� (� Rev. 4/27/2023
Credential#
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4 Index&Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section &Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report&Site Map
Project Name/Description
Owner Name(s): �"�" c�0�✓�! Phone: - -
Owner Address: � 7 ��="� S� � w a/�r (�S Zip: ��{'8`l S
Project Address; '�E� 3 A1 � �./ C�
Govt.Lot: 1/4 of 1/4,Section�,T ���N-R�E❑or W Q
Township: ���(-� County: S�^ti/i/c T
Project Parcel ID#: D, �7�I D -'J � � �l 7 �
Designer Information
Designer Name: Dan Burch Phone: �15 _416 _1642
Designer Address: N5921 Cty Hwy K Spooner WI Z�p; 54801
E-mail: burchplumbinginc@gmail.com ,� :��<�� .a�<��, >,�.:..�,����,,,
License Number: 253808
Remarks:
2; c�-1-a 3
Signature: Date:
Original si nature required on each submitted copy.
CHECK BO%AS APPLICABLE CM W K BO%AS APPLICABLE.
Q✓ SOIL EVALUATION o Scale: 1ao 30 as so ❑� SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: �5, DESIGN FLOW: 3OO GPD
JAH Construction Attach design flow calculations for commercial plans.
PftOJECT ADDRESS: 7BZ3 N L2SIf18K RC� Pipe Ma[edal/ASTM Standard(Tables 384.303&384.30.5)
NSani�ary Sewer /
BM Symbol�. � BM Elevalion'. FT Force Main' /
BM Descriplion:
I�aicate nonnry IMPORTANT:
Slope Gredient(%) wen symcoi(if appiicaeie�: p a�aw��9 a�ar� Show ground elevation contours at suitable intervals.
of Tested Area: on me avvmpri�e iire.
� a�� �
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HOLDING TANK SPECtFICATIONS
Number of bedrooms
Non-residentiaf estimated fiow (gpd)
2000.0 Minimum holding tank volume �equired (gal�
. Proposed holding tank capacity (gal)
ef Tank Manufacturer
Tank model number
om us Alacm manufacturer
an ert arrn model number
Tank Dimenatons and Data Tank Anchor Calculations
X tor round tanK � Ibs Weight of fiank and cover
Liquid depth below iniet invert (in) Safety factor
. Maximum depth o#soii caver (ft) Ibs Weight of anchor required
Height (in) Outside 41.2 in Soil cover req_ for anchor or
150.0 Length (in) Dimensions 7.6 yds Concrete counter weight
Width (in) Only
HOLQING TANK CROSS SECTION
manhole cover with ��nt cap
�""—' lodcing device and finished
junatWn waming label grade
�x —'� 4"min. � 12" min.
�—23 in.
Manhole and vent locations ,�nt pipe
�u� 18" min.
�
tether weight
buiiding sewer
service � 12.0 In ._._._._._._ inlet
� aiamn on Note: Ali tank joints, and
blind p�ug joints between tank
�0�a� openings and piping are
outlet
Eiectrical as per 37.0 in. sealed watertight. A11
NEC 300 pipe and vent materials
and SPS 316 comply with SPS 384. .
3 in. bedding under tank.
Tank is anchored as necessary to nagate buoyancy.
ProJect: psge 2 of 4
Transaction Number.
PAGE 4 OF 4
Holding Tank Management Pian
IMPORTANT:
The owner of this holding tank(s)shalt be responsible for its perpetual operation and maintenance pursuant to
requirements ofi SPS 382-384,Wisc.Admin.Code. Pwsuant to SPS 383.52(2),Wisc.Admin.Code,this holding tank(s)
shail be considered a human health hazard'rf not maiMained in accordance with thia approved managemerrt plan.
FuRhertnore,ali inspection and mainte�ance activities shall be perfortned by a rogiatered POWTS Malntalner in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Estimated Da11y Wastewater Fiow= 3 O p 9Pd
Insoection Checklist INSPECT EYERY 3 YEARS
o type of uSe
o age of system
o nufsance factors(i.e.odors,user complaints,eic.)
o mechanical malfunction(i.e.,pumps,v�ves,switches,floats,etc.)
o material fatigue(i.e.,leaks,breaks,co►rosion,etc.)
o neglect or improper use(f.e.,exceeding design capacities,prohibited activi�es,etc.)
o elecMcal canponents(i.e.,wiring,connectio�s,switches,co�trGs,timers,alarms,�c.)
o surtace dfscharge of effiuent or sewage back-up iMo struclure served
SERVICING FREQUENCY
o The tank(s)shall be pumped by a ceRifled septage servicing operator Iicensed under s.281.48 Wisc.Stats.
when the wastewater In the tank(s)reachea a level of one foot below the inlet Inve�t of the tank(s).
Disposal of Contents shall be pursuant to NR 113,Nfisc.Admin.Code.
T�k pumpMg repo�ts ahall l»submitted to ths pcoper bcal 8cvamcnant unk tn accordance with SPS 383.55 Wis.
Admin.Code. RapoR any component failure or maifunctlon to:
Name of individual or canpany:
Burch Plumbing P,,a,1e:715.416.16452
�ocei 9ovemme�c un�c:Sawyer County Zoning Pno�e:715.634.8288
�ocai 9o�ernment��n adaress: 10610 Main St#49 Hayward WI ZiP.54843
Any defective part of this system sha{I be repafred,replaced,or removed pursuant to SPS 383.51(1),Wisc.Admin.
Code.Repa(r or replacement of failed or malfunctioning compo�ents shall comply with SPS 383,Wisc.Admi�.Code.
No product for chemical or physical restoreUon of the POWTS may be used unless approved by the department in
acxordence with SPS 384,Wisc.Admin.Code.
Contins�encv Plan
In the everrt that any failed component of this holding tank(s)cannot be repaired,it shaff be replaced purauant to e
plan submitted to the appropriate agecy for review and approval.
Svstem Abandonment
if use of this tank(s)is discontinued,it shall be abandoned in accadance with SPS 383.33,Wisc.Admin.Code.
C `--
HOLDING TANK SERVICING CONTRACT
Contract Date: c�� / z � / z� z
This contract is made betwecn the Holding Tank Owner and the Pumper.
Holding Tank Owner's Name: Pumper's Name:
Northwest Sanitary, Inc.
`\ ��,,� �,��-�v�,'T��,,.,� PO BOX 155
� Radisson, WI 54867
Parcel ldentification Number:
( 12 Digit Legacy ID) � � � - � � � - 3 � - �-- � � �
1 . The owner agrees to file a copy of this contract with the governmcntal unit, Sawyer County,
which has accepted and recordcd with the Officc of thc Rcgister of Decds, the Maintenancc
Agrecment for a Holding Tank required under the Sawyer County Private Sewage System
Ordinance for the issuance of a Sanitary Perinit for the installation of a holding tank(s).
2. The owncr agrees to have the holding tank(s) serviced by the pumper and guarantees to
permit the pumper to havc access and to enter upon the property for the purpose of servicing
the holding tank(s). Thc owner agrees to maintain the all-wcather access road or drive so
that the pumper can service the holding tank(s) with the pumping equipment. The owner
further agrecs to pay the pumper for a charges incurred in servicing the holding tank(s) as
mutually agrced upon by the owner and pumper.
3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for the
scrvicing of thc holding tank(s) as requircd undcr SPS 383.55, Wisconsin Administrativc
Codc and thc Sawycr County Privatc Scwagc Systcm Ordinancc. Thc pumper furthcr
agrees to include the following in the report:
a. Thc name and address of the person responsible for servicing the holding tank;
b. The name of the owncr of thc holding tank;
c. The site address of the holding tank;
d. Thc date thc holding tank was serviccd;
c. Thc volwncs in gallons of thc contcnts pumpcd from thc holding tank for cach scrvicing;
f. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In
the event of a change in this contract, the owner agrces to file a copy of any changes to this
servicc contract or a copy of a new scrvice contract with Sawycr County within tcn ( 10)
business days from the date of change to this service contract.
�wrie1''S �1aIT1C: (PT'irit� �wri�C'S I�TI]BtUfC: (Only one owner signature required)
� �}—�� �� .��;Tr...;��s�./ � -
Pumper's Name: (Print) Pumper's Signature:
Ronald L Vieceli, owner Northwest Sanitary,lnc � �L �1
.� ��
Pumper's Registration Number:
#2389
Rev. 03/26/I 3
W2000—MR
TANK SPECIFICATIONS � a
a �
12'_�• DIMQJSIONS: ��" o
WAIL• 2 1/2"
BOTTOM: 4'
COVER: 6"
MANHOLE: 24' I.D. PRECAST CONCRETE RISER s
� �'—________________� HEIGHT: 68. o
%'�+r^ `�\. LENGIH: 12'-7' �
���4" CAST-A-SEAL 4" CAST-A-SEAL ��`\ WIpTH; 7'-2" rc
� u , � BELOW INLET: 53"
� �-� i' •�� L10UID LEVEL: 48" ��
�� � WEIGHT: 15,370 IBS.
� �, I 1 1 � g E
� ��� ' j�4• � ,ii INLET AND WTI.ET: a � $ R�
?� ii 4�CAST-A-SEAL 800T OR EWAL 6ASKET � m o Y>
���\J� FlITER OR BAFFLE 'i W �
��\\ INLET AND OUTLET BAFFLE AND FlL1ER: a � a �
, WISCONSIN. SEE DETAIL/10 `� a o �
�--_-___________- " (on��a srnr�s s�cwnR» W�
�
LIQUID CAPApTY: 42.92 GAL/IN W x
§
TOP NEW H OU'N1LET HOLE PLUGGED ���
ACNAL CAPAqTY: 1.085 GALLONS ���
�W I
w LOADING DESION: 8'-0'UNSATURATED SOFL a�
��
a� TANK CAN BE U�D AS: a j�
w� SEPTC /MOLDiNG /PUMP OR 9PHON ��o
{ � ro
COVER: MIX DESIC�! /8(NO FlHER) �
---- ---- . _� TANK: MIX DESIGN ,�10(STRUC7URAL FlBER) �m
INLET� _ --- --— -—- —-- ---- - OUTLET CUSTOMIZED TANKS: �3
� r � �a FINt CUST�t TANKS CONTACT NAESER CONCRETE
U � � I � U
� °r,� 7 Y � � � �� 7 6 � �
�n I I � � Z
I
t 1�-
ZZn ��______'_'_. __'____-�� O �
----- -- REVIEWED BY N F
a REVIEW DAIE 3 W
�
��N� DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY: $HEET N0,
AVPROVAI DA1E: � �
�
PROd1Cf5 NEmED BY: / �
TANKS ARE MANUFACNRED TO MEE7 OR EXCEEO ASTM C-1227 REWIREMENTS �
� � � � !�,' �� ;�; � i I i�-�._ �
I�,.IlII��� l���II� � l�,l�l
ocI :8071 5 445436
fx:4046154 pA1t1LA CMISSER
REGISTER OF QEEDS
SAWYER GOUIVTY, WI
��, 07l17l2023 12:49 PM
; � a �;�f RECORDING FEE 30,00
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8l4/23,8:31 AM Reat Property Listing Page
Real Estate Sawyer County Property Listing Property Status: Next Year
Today's Date:8/4/2023 Created On:7/28/2023 10:38:05 AM
�Description Updated:7/28/2023 "�Ownership Updated:7/26/2023
. . . . ... . . . . _.. .. . ...._.
.. .. .__ _..._.
TaxID: 44775 lAH CONS7RUCTION LLC HAYWARD WI
PIN: 57-012-2-40-07-36-2 01-000-000170
Legacy PIN: 012740362117 Billing Address: Mailing Address:
Map ID: ]AH CONSTRUCTION LLC JAH CONS7RUCTION LLC
Municipality: (012)TOWN OF HUNTER 8899N CONNER LN 8894N CONNER LN
STR: 536 T40N R07W HAYWARD WI 54843 HAYV✓ARD WI 54843
Description: PRT NENW LOT 2 CSM 38/162#8719
Recorded Acres: 0.860 �Site Address *indicates Private Road
Calculated Acres: 0.000 7623N COUNN HWY CC � � �HAYWARD 54843
Lottery Claims: 0
First Dollar: No J property Assessment Updated:N/A
Zoning: (RR2)Residential/Recreational Two 2023 Assessment Detail
ESN:
Code Acres Land Imp.
N/A
��Tax Districts Updated:7/28/2023
. . . .. .. ... _ . . ___..._._._..... .
1 State of Wisconsin 2-Year Comparison 2022 2023 Change
57 Sawyer County Land: 0 0 0.0%
012 Town of Hunter Improved: 0 0 0.0%
572478 Hayward Communiry School District Total: 0 0 0.0%
001700 Technical College
• Recorded Documents Updated:7/26/2023 �C�'Property History
.._-----. .
CERTIFIED SURVEY MAP Parent Properties Tax ID
Date Recorded:7/17/2023 445436 57-012-2-40-07-36-2 01-000-000040 15856
WARRANTY DEED
Date Recorded:5/il/2023 444453
WARRANTY DEED
Date Recorded:12/3/2020 428445
WARRANTY DEED
Date Recorded:7/3/2001 292132
CERTIFIED SURVEY MAP
Date Recorded:4/28/1987 204407
�hlld History Record Cou[IILl-
HISTORY O Expand Al)History � White=Current Parcels Pink=Retired Parcels
O 7ax ID:15856 Pin:57-012-2-40-07- -2 O1-000-000040 Leg.Pin:012740362104 Map ID:.5.4
44775 This Parcel Parentr Children
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- USE BI�AG�c INK ��t_� �� DocI :807���0
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Tx :4046555
POWTS MAiN7ENANCE A��2E�i��hl�" , 445747
For Nc�iding Tar�ks � PAULA CHISSER
REGISTER OF DEEDS
---- - SAWYER COUNTY, WI
Ovrner > N�r�r�i.�) as �.ho�v�� ,n �1�cd- Q8J04J202� 09:19 AM
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� , , .� �, �c_�� cn � RECORDING FEE 30.00
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' Parcel �dEntlfir,�Cir;n Nur� {w;'
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L�;g.al �?r;scri(:�tiun ��f f'r �,�� ;!;'
- SEE �1T7ACHED SHE�T -
vVe � :K[�gwl�d��a taldt �� i. ;� -:[i r. �:s Li��inu i n�-:;;�� t ,� U u: �.��� 1 � tiur' ,1 _ � � ' �;%�( � . `��� ��
.. ��;n�;i,rty �es�:��u�,d or'�. tI �� att,:+c'ut;c >�ncctt. �
� f��eturn Tu Sawyar C�uniy Zoniny ancl Gon��rvation Adia��niytrat;c���� �
� 1U61C� Main St. S�a�'te 49, tl�yw<,rd. W! ii�8�3 � _ . _ -
� .
As ar� induc�men# io U���� Co�r�ty :�t �,,wy��r� j � i���:�� a �:'i'ta�y ��','����it lur �a t�ol�_liriy t�rk on tf�c� above �ifascribed prope;ty, the owner is
respar�sible for the operation and rxi�3int�r��ar��r, <�t t!<< h��lGi�aca t�i,ik, iu�l<.ir,i, j��v����., alarm <�na .�cc�s�, �na agre�s to conform to ali
app6Cable reyuirem�nt� of SP:, 38:i, Wis. Ad�n. +�udt relai��,�� to hol�,i��,g t:;ra1< r ��nar7ement i�ii1•!ding tl��e following:
1 , Ttae Ownc�r agrees io conf�aot tiviih �: {�erson wnc, +� ��c��n5�;�1 under � i;. N�< ' l:;, �Vis. F�iJ���. C;ode, except as provided by
Sectinn "l_8i .4Y, (3j (c�), Stais , io h ivc ti�e hciidir�cz t��r3k pro���.r�y serv���t::J �ria io f�ilt� a coF�y oi tiie servic� cunt+z;ct with the
governii�ier�tUi u��it. The own�r Purther ayr�,E:-� to iil< <a r.opy oE ��ny� chanrac: � i� !he 5ervice coniract, or a copy of a rew service
contract, with ihc? �overnm�ntal unrt ��n-itY�in t��u I,1f�i .,���,ii�t �� cis�y�.� frc�in th�, �i�3.e oi ci7any� io tl��e scrvice contract.
2_ Tha c�wncr aqrc;�� to contract �vftt� f�c„���i: Iiccr�sc� i�nder t �i�_ P�I'Z �i 1 ��_ VVis t:di�i C;o��e, who sh�il stibrnit pumping reparta tv
th�; �overnmcnt.�i urnt in a�a!rd<,atx t, witi�i SP`� .3�?:j `�5, �.Ni 7 '��i�>>. ` �u�=. tu� t�i � s� rvic�ny of the l��oi�iing t�nk in the case of
exomption t�n�.lc,r Section 2t31 .4L� ( j � t��?. �tut� , t��e owner �hall suornii Ih� r:.;�ort t� Ehe <a��vernmenfal tinit. T17e yovernment�l
unii rn�y enter upc7n the pr��perty C� i��v��st�caate th� ;,��r�d�tio�� vf th��; l��ol�._i�r�y t;�nk wlicn pun��;iny reports may indicate th�
,. S�ol�ling t��nk i� not 't�eing ��r��erly n���irit��in�;u.
3, If tiie oevr�e�r ��iis ic� h�rvr� the hol�iin�a t:-nri< E�r�� �_,r1y ��rvict � �n <<���w�� :��- iu �y,�r_:�:, � ���,i:�i 'i�,y tl�c govet�rntient�l unit 10 prevenl
r�r �bate � h���>>,rn i7e��ith i�-�:ar�i �,5 desi;ni�f��i ir; :�r�;t�on 17�1 ���i, `� �ts th� yuv�,�nrnental unit m��V enter upon ihe property
� � 1 :.'i.�([�.� 1�1y �t;1fS.. '� �1(1Vt�',(IIf71(;(ltrl� lllllt lili]�� c3�.`(?titi (fle
a,�d s«.rvi�< <,r ;:��,� t�� the tr�r7k to �,� ,��rv�� �• � r u*, ;ant t , ,>r� inr i , '� �
t�wnr.r Of u Urivat� 7t�vragc, �ystc•ni fu� c;u,,t.y i�_rir�tt �� lo tt:� �� rr�piiir, ui ,., s�� pti� or tioldirag t2nk. The C1i�jrges will b< <�.�sessed
20 �IL171�(tOC�(1 r)�/ �iL3C�1011 l�b.�}l�)J bt�31:i. I IlP O'Jvtl('f iN_I(f t .� 1.3 j�.id i�� Cil 11�)Lc� ;:(I.� CU51 IIIGU�IC[� t)y' Tft(,' !�OVU(flfllt llt8) Uillt 'Gf
ins��ection, �.�w�i{�u�y, hai�iir,y, Ur �the;wis� ;�;rvi���� �3 ����d „i�.n�:.ani�,. ; tt��c huidiny lai�k in such a n�anrier as to preveni or abatr,
any humr�r� ht�alth haz<�rrJ causi:tl i�y ti;�; n��lding tt�n;r.
d. This agre�ment wiil rciY�ain in e'ic�ci u�aly �ir�iii th� <aovernn3ental ��n�t ��.sEx��� at,le ior tii� regul�3tion t�f private se�vage systems
t:ertifies t1{a; �itr�e�� a soil at.�sorptic n 5ysten, ti���i .. � r{�lie� � �ti, ' ;�' , ; � �'. H.`ir�� `�idJt � t fi�ation�with,;e crence to'tnise
�(pecn ent in ,ulc'hrrnanrwywrnc�h��tiili peimr. U;e � .. �t��n�,c u' ih�.��t. �rtni,,i `< cor^�rr °„
�� , , , �»�< < �� 'uti J � �`
� � „� . nu�� i,,, be detenrni��a by referer�ce ti> the propr�rty-
. � , �
5. Thls ac�reemerit st�all k�e uinc�inq i�{�or,�tii� ,�w���," th�e1 ��,nt s'��:a�ll k�E r��t;�>;cled hy�the register���i cic.��,ds n��a manner��whi I� w�iliit
the agrEei7i�nt to th�_ r�;�ist�� uf �i < � _, J �
permit the existence c,f tne ��gra�mE:n? to ue ;iert;rrrnn�.�i t��, .�:,t,-,�,n� � to tl��e ��oE���rty wh�xe the hol�my tank is �nstalleu-
- On1y one owner sic�nature required - . ,.
ACKNOW�EDGMENT
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! :�.i�te Of. " �
( Owner's «ature: -------
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Seven(7)West.Lot One(1)CSM 38/162#8719 Doc#445436