Loading...
HomeMy WebLinkAbout24-184S HINTZE�SS— OQ •°. -- ludusin Senicos Division Counll �`.SSP� 4822 ,Madison Yard, P'a., Bayfield S,nutnn l'crmit Numberlm he filled in by Cal -- — Madison. l057pi. ,. �, Sanitary Permit Application - SlmeTmnsaetio""amber In accordance with SPS 38321(2). Wis. Adm Code, submission orthis font to the appropriate gov, m rental unit is required prior to obtaining a sanitary permit Note: Application forms Ibr stateoxsntd POWTS arc mbmiacd to Project Address (ifditTcwnl than mailing mkhvss) the Department of Safety and Prorewamial Services, Personal information you provide moy he uaxl Ibr secondary Same purposesin wmrdarm with the Priv Law. s. I S.O4(1 Sm). Sins. I. Application Information -Please Print All Information Property Owner's Name Parcel a Joshua &Theresa Hintze 10183 Property Owner's Mailing Address property Location 43315 Robin Ln. )lox, , of 4 Pity. Suite Zip Code Phone Number Cable, WI 54821 262-225-3304 —'A. Section 17 T 43 N R 07 B or W It. Type of Building (check all that apply) Lot a ZI or 2 Family Duelling - Number ofBcdrooms 2 10 Subdivision Name Public/Commercial- Wwribc Use Block a OCityol' _ ❑State Owned - Duseribe Use Village of _ CSM Number aTownof Cable in. Type of POWTS Permit: (Check either "New" or"Replacement" and other applicable online A. Check one box online B. Complete line C it applicable.) . A.I•-�'' [:]New System 6/ pteplacement Sysem a0ther Modification to (Existing System (explain) ❑Additirmal Pretreatment Unit (explain) B' [:]ilulding Tank Oln•Ground OM -Grade 1:11.1twnd IndivkkNSitel -sign OtherType (explain) (conventional) C• ❑ kenesvol Before ❑Revision lunge of Number 1:11'ronsfer to New Owner List Previous Permit Number and Date Issued F_xpimtion 389600 8.22.02 I1'. Dis ersol/freatment Area and Tank Information: Design now (gpd) Design Soil Application Raw(gpd/sf) Disperwl Arco Required (s0 Dispersol Am Proposed (sl) System Elcl;uion 300 0.7 429 450 91.15 Capacity in Total nor Mamdacmrer Tank Infonnation Gallons Gallons Units New Tanks Exiting TW&5 ¢ Squeorlioldin, lank 800 800 1 Rasmussen (Existing) ✓ Dasinp Chamber O V. Responsibility Statement- I, the undersigned• assume responsili i v far installation of the FOIVI'S shown on the attached pia im Plumber's Name (prim) Plumber's Sign MI'/ht FIRS Number Business Pharr Number Jason Kuettel 1 675751 715-798-3355 I'hlmber's Address (Street. City. State, Zip Code) PO Box 66 Cable, WI 54821y VI County/Department Use Only \ Appmred 0 Disapproved Peit IY S 4J,�[ Uole Isatt7d isst 1 arc \ O owner Given Raxwnn mr Denial Conditi • of ApprovaVltcasons for bisa roval e;K gal rL►tit�erri exisf7r� C ; s�xal cau — �nJu cf�l�'fn" rS (�-'1l�7/+p lLi� GiDJrC�eG( Auueh o, annpkle plum for the atxmm and submit oo the ['"only onR en pup, not tn$ than a in x I I Web. in $nee SBD•6398 (R. 02/2-1) -fq)�) Industry Servi D is 4822 Madiso F. b geld ar s ay Madison, 37 tary Permit Number (to be filled in by Co.) �a tp P.O. Be 302�k 0 8 2024 WI 53707 Permit Sanitary Permit Application teTransaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this forth to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application fors for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary Same purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stars. 1. Application Information -Please Print All Information Property Owner's Name Parcel # Joshua &Theresa Hintze 10183 Property Owner's Mailing Address Property Location 43315 Robin Ln. Govt. Let 4 City, State Zip Code Phone Number Cable, WI 54821 262-225-3304 Section 17 T 43 N R 07 E or W 11. Type of Building (check all that apply) Lot # ZI or 2 Family Dwelling- Number of Bedrooms 2 10 Subdivision Name ❑Public/Commercial - Describe Use Block # ❑City of State Owned -Describe Use villageof CSM Number Town of Cable III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A. ❑New System Replacement System ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B' ❑Holding Tank ZIn-Ground E:]AAt-Grade Mound Individual Site Design g Other T Type (explain) (conventional) C. ❑ Renewal Before ❑Revision Ochange of Plumber Transfer to New Owner List Previous Permit Number and Date Issued Expiration 389600 8.22.02 IV. Dispersal/Treatment Area and Tank Information: Design flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation 300 0.7 1429 450 91.15 Capacity in Total # of Manufaclurer Tank Information Gallons Gallons Units c o $ yy u_ New Tanks Existing Tanks c v - d `d Septic or Holding Tank 800 800 1 Rasmussen (Existing) ✓ Dosing Chamber RB V. Responsibility Statement- I, the undersigned, assume responsib' i y for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sin MP/MPRS Number Business Phone Number Jason Kuettel 675751 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, WI 54821 VI. County/Department Use Only ❑ Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval Attach la complete pbms for the system and submit to the County only on paper not less than 8 In x I I inches in size SBD-6398 (R. 02/22) In -Ground Gravity Plan E fff lro Index & Cover Sheet NOV 0 8 2024 Component Manual Design References: Betrfield Co. Zoning Dept. 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 Hintze 2 Bed Drainfield Owner Nanrl Joshua & Theresa Hintze Phone: 262 _225 -3304 Owner Address: 43315 Robin Ln. Cable, WI Zip: 54821 Project Address: Same Govt. Lot: 1/4 of 1/4, Section 17 T43 N-R07 E❑or W 0 Township: Cable County: Bayfield Project Parcel ID #: 10183 Designer Information Designer Name: Jason Kuettel Phone: 715 -798 _3355 Designer Address: PO Box 66 Cable, WI Zip: 54821 E-mail: tim@andryras.com License Number: 675751 Remarks: Signature: e .611 Date: Original sigpratufe required on each submitted copy. - LV,trxj��t� �2Crn SI'lb � IIaT L I - _- S:a•Ld EilI S O L �'I''I T(dl I I I MA in IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I Geoteztile go Cover SOIL COVER p 12" C min, trench M16 depth t (typical) System Elevation=91.15 ft. (typical) min. 12" (typical) Septic Tanks) Manufacturer: Rasmussen (Existing) Septic Tank(s) Volume(s): 800 gal gal gal gal Effluent Filter Manufacturer. Orenco Effluent Filter Model #: FT-0822 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW Observation pipe shall be installed (No Scale) 4r1� at function between two units. Perforated Lateral Observation Pipe (typical) (typical) — — — — — — — -f — — — — — — — L---------------4�------- B=45 ft (typical) INSTALL PER TRENCH: 4 10-ft bundles @ 50 fly EISA/unit = 200 its + 1 5-ft bundles @ 25 if EISA/unit = 25 its = Proposed EISA per trench = 225 ft' OBSERVATION PIPE DETAIL (No Scale) Screw -Type or Slip Cap (loose) 4'0 PVC Pipe i j- Top of pipe to laminate at orabove finished grade (4) V4' K X "'Slats Q 9b loan Anchoring Device ..... 10 ft (typical) A = 3.0 ft (typical) __. I Bundle (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's Instructions. Required Infiltration Area = 428 ft' x 2 trenches = Proposed Total EISA = 450 ft2 m to m n n 0 T- to 0 m a — Finished Grado (mulched & seeded) — Topsoil Cover (min. 1 too[) Intiltmtion Surface Distribution Method: branched manifold In -ground Gravity Management Plan Innbi "If Fr 4 IMPORTANT: u u NOV 0 8 2024 D ff�� The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenaXA�llg Rrs?pApjbDept. requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BODS <_ 220 mgL-'; TSS <_ 150 mgL-'; FOG 5 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump recycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Andry Rasmussen & Sons Phone: 715-798-3355 Local government unit: Bayfleld CO. Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th St. Washburn, WI zip: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. : SaZON TV OAq JII s S3?IS XNV1 �Nu('1�•-? �.�sT'�W�{fjJ :ii3'de'1.i.Jb'dnly";;-i ;tl�l Ofid3 S SNOIIVJIdI'33 `.fk3'.L 'd:!CHn SNICICT38 (T5tLddJV ,,E Il os -7-T801ff p Tapow OIIOS OINO ODO-a-lo ,Odta .E 3dId s� 03AGdddV ��233 S 7I d El O — 3=Fd-"- ] (31M; d d V S37Zn0 13'1 N I 4 'NIF>I „BT 'NIH -7'9y7-�NIrai,M 310HIM ltlap buiu0Z 00 Pl@llAeg 03AOilddb bZOZ,80 AON lda Tol�"c1 sl 2�Qyxi-ow. +-alus �yc0) Q )'=Ctd9 ADE'd 'NIH u 9 ad.id •dSNI Jndo-,•r)5 „h I I I11 �J SN0?1'eJ?__D_es rid= 6'0_i--5 SSOcJ Y.trV.L O=IdSs SEPTIC SYSTEMS MAINTENANCE AGREEMENT M gr0tTd [gravely, dosed, and pressrun dstribu6mj. 4grade, and Maund Syeansj D U Property owner. 411tsovl NOV S 8'Z024 D y33I5�nbin t_a.he Legal Description: 4-01- /0. C ,gs-klieLi 2AT -31vi R 7u1 Bayfield Co. -Zoning Dept. -rbwy% of Co -We — Parcel ID # 01 Z -11 "7 $ - OS Type of Private ® (A) In -ground gravity ❑ (D) Mound Sewage System: ❑ (B) In -ground dosed ❑ (P At -grade ❑ (C) In -ground pressure distribution In the event the minimum standards contained in the applicable Wisconsin Administrative Code can be met, and a sanitary permit is issued for the installation of a code compliant private sewage system, at the above listed location, the owner of the property hereby understands and agrees to maintain the system in a manner prescribed by the Bayfield County Private Sewage System Code and Comm 83, Wisconsin Administrative Code. (1) Septfc tank (System types A and E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) yearsthereafter unless, upon inspection by a licensed master plumber or other person authcrtzed to make such inspection, the tank is found to have less than one -thin! (1,13) of the volume occupied by sludge and scum. (2) Pumo chamber(System types 8, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. (✓) Septic tank effluent filter (System types A and E): The septic tank effluent flter shall be inspected and maintained as necessary and in accordance with manufacturers suecfications. Filter maintenance reports shall be submitted to the County as required by Comm 83.55, Wis. Admin. Code. (4) Private sewage system dispersal call (System types A and E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, PCWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to detennine whether wastewater or effluent from the system is ponding on the ground surface. (5) Mounds. At -grade, and In -ground oressum system laterals (System types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. (6) The owner of the septic system shall famish the Bayfield County Zoning Department a copy of the inspection report verifying the condition of the tank(s), whether wastewater or effluent is ponding on the ground surface and the date of pumping and other service that was necessary whenever this information is required by the County. Reports shall be signed by property licensed individuals. (7) When the title to the property is transferred, a copy of this agreement should be furnished to the new property owner(s). This agreement shall be binding on all assignees and heirs. . a&4 ,L- Signature of Property owner �n Data t;.L`ab sO"Fam Ss Sva Maia.kg=t .Anva =0 ������ Wisconsin Department of Commerce SOIL EVALUATION REP D T ge�of 3 Division of Safety and Buildings NOVr� � 1 U /� in accordance with Comm 85. Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County nl 86yF/Q� include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. m/Z — //7S — O 5— Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner /yiti.20L� g4,pgA/2,.4 yN LL,C3'O�j/ Property Location Govt. Lot 1/4 114 S 17 T g3 N R 7 <(or) W Property Owners Mailing Address H.33/ S 12oai v "IE AE Lot # Block # Subd. Name or CSM# /o cz EZS& 9r City State Zip Code Phone Number la!/ ❑ City ❑ Village Ig Town Nearest Road ❑ New Construction Use: Residential / Number of bedrooms �_ Code derived design flow rate 3 O 0 GPD Q Replacement ❑ Public or commercial - Describe: Parent material Q rQG O L/TLS/.: S'fi� Flood Plain elevation if applicable NA ft. General comments and recommendations: � camoQc7e� s/�yhf/ ,Q� sr�/ k��/• 9z.�5' / Boring # ❑ Boring pit Ground surface elev. 97,25 H. Depth to limiting factor /Z,�p in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/H' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 / o-s 7.51k 3/4 A/A Z�sbk rn�i cw m 5 •9 z a 24 7,jy 9/c A5 f • 5 94 3 26- fe/ 7.syx 9/ 4/- 2 sYR 41 N/a Q m4rJs 0,5 col - - .7 Boring # ❑ Boring 1--1�,^ I `n pH Ground surface elev. 9/i •GS (t Dentin to limitino factor // 7 Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots mum. Ppmwuon mare GPD/H2 'Eft#1 'EH#2 l o // 7.SYR -114 /✓6 s/ 2�56K in�i � Zry 'S ,9 Z //- 24 7, 4 G A/4 S l .2 C J 5 // 3 24--'3/ 57R 9/e, ti6 C.S DS9 mJ C- - • 7 /, 4. / Y-Is' 7• SY< r6 /vb r r s O rn 1CJAJ- /. Z. S 5- //7 7, SYR 94 IvA rncd•S ©.s _ ___ -- ...y._ U� US_ov iuyr�ano iaa you mg1L CST Name (Please Print Signa CST Number �eVA S "41 SSEA/ � _. _ a.2 /r/G P0'�x44r C=64, �J/ s/,zfZI 00-/9-oz (71S) 799-33S,5- Property Owner /�a �"' � Parcel ID # ��Z ~�1 �8 S Page of 3 Boring #❑-yBoring _ - L� Pit Ground surface elev. 97 00sroz Depth to limiting factor 2.3 in. Soil Annliratinn Mop Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz 'Eff#1 •Eff#2 6�$ 7.s'yR. N s l Z 146k *14- CW 3M .6 . 9 z �• �� �.s-yx 51 ZMSA MVAr- CW 2P . S l 9 MA S SO• 12 7-SW 07 /• Z Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. C-nil Annliration Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 'Eff#1 'Eff#2 Boring # ❑Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fie 'Ef1#1 'Eff#2 ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (P-07100) an 7 -- lj I I Private Sewage System Maintenance Agreement J olkuq A Ht N't-7-E 1-/3?1S ZN, CR(SLLrr tk S`IbZI Site Address S41,-E Tax 1D# %O) g3 As owner, I (we) do hereby certify the private sewage system will be Installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal is required) 114 of 1f4 Section I—) Township y 3 N. Range O % W Additional Legal Description: Town of LA-r1 Ll (Acreage) /- 5 6 Gov't Lot t-i Lot /0 Block Subdivision C26'3TvIEW ft{S2-c5 Lot _CSM#Vol. _ Page _ CSM Doc# DOCUMENT NUMBER 2024R-605858 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 1 2/ 1 O/2024 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning d Z�5 pfpN g �QUUII arI tmeI�n 2UL4 t D Bayfield Co. Zoning Dept. Area C0 In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon Inspection by a licensed master plumber or other person authorized to make such inspection, the lank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specificattons. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At -grade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) —please Print Subscribed and sworn to before me on this date:vo o3tt� H 1� tn> zL ,,,•���p,ULT ��i Notarized Owner(s)—Signature(s) Nola blic ��� • aY it L/ y Commiss' Expirgs Drafted by j Ai LLB IL Date: Proofed by: u/forms/sanitary/septicmaintenceagreement Revised July 2020 �d y r i c ii 0 c z s