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HomeMy WebLinkAbout002-1069-50-055"° PRIVATE SEWAGE SYSTEM O'nn" $L Cf01X S.I.N.nd mXmP III INSPECTION REPORT uGP.nmxo 630330 GENERAL INFORMATION (ATTACH TO PERMIT) silly Pmn to OR ran �Vlll. rtvx Ousts al WoIveH p. TOWNOFBALDWIN n 002-1069-50-055 BM EIm sp OD a OM l nnrt l2... zs"�6420B-05 TANK INFORMATION ELEVATION DATA T)NPEMPNUFAC ER PdM1f$ CAPACITY STATION 5 1oXl FS SUED Septic ieAer zN lZoo 9. y2. toll /oo 30—so be Ys em q�aBnWal r,M�r L z.9a 99.oy fr VP1 br szs R"° Holding SYIIt InIH B.59 9i.37 TANK SETBACK INFORMATION L-Idl ♦--rL Iµi. surv,Gxvn TANKTO PL ,mnuln ROAD le, of Bo,Mm,L.zs__ &MLLSLDG «NMn^ y.31 97.5'),I pansc/7.5/ nmWI,1. Bmsystem .0296.8 PUMPISIPHON INFORMATION M0 P?h IK( 329Fnsl ca nxNnrr,., G(%V G.m.na 5 GPM ±53 sG �r T3 Y .I N.mna Ceut Ton L47.38 P,I -n law mm .,ns T9�. PorRarma Li�, .Gr.2. mw IV" VENORTIENCH DIMPP v"m,�n L'n'75" ,Pn. nl. „n"o.pu ZI,nls BYSTEM iO PIL BLOG WELL LAKE/ R M M qMn oq TiPo ;7' 3o' yo ti ,L. eu Zr, �°`ir','s4 3. I.s B Xn1S. 05 •' vUG.d..rLK Dial RI, .1�ddi. WIL COVER um Symms Only Is Poland OrADG2d Syeume Only IDs` ®w ,.nm IIIWIOy n) IZ more.. ONo COMMENTS:pnaw. we. mso.p.noi.. Palo,$ P,.s.m ll aspsawnel Pl<a ILI-0I LA mspalon 02 BM L sL xamH ST (Avar -ND WtN PL+ lo} 9; ® iH15�CCi-ic.+. „AnBill wayeraPith-35lkr rzl Bmasm,N,mol= Nrd— o 1 pv d' N•f+L• Ge '}e,+ck el ®iHSfeid.�l, .mPnmmm�.,->y,,` I ne,ubrLd {haw b�IdiT� 5�d.l kTS. Plan novel Reerrmit Or.. No Use Pros, 608 for fall lmPrmPepn Ba0,6710w 3MI Date I..P.rwn s�onwre c.n xn ',1^II li saroty am a�mm�va oro�aw m, Sf Pr.-rKlY .w \II tl � rr=✓ 2m w. wassa"Mon rive Po 9o. 110$ sa Im pmm�i xunbnnY rlMYmnit Madol W15PW-01U j of toto 2 — & o33 e,_, 1 - Sali�a5y emit Applicati _ .. or vh.n mm� lmmmmr N •,•,•I "'�....�.. rozee2�9y—c rm,m.aemreemm..r-wemem .m amm. be���nnn lm.r.n...me aWn 9-11 23 x Ali ,using, r�1 ua ,r Fauna, rm�„lm..mm Zbne1423on'sf �v1units, Yf cuR Asia rA ew. W/ I5'l+ppt_ bf/-7fy-8ris flyM1 n Ty" OF e'Eiy InmY 1t11n:i.rW)I IR3 Rjo:4n �� nmmxm I ,l,lmrlliny xnmhrn(Il.drum, y •s PvJR,L a --- iF ❑wro.M. .lnl,. ❑Vanilla,✓ Mx M J3mvF7R Bill as// Sale! f IILTyreol M.miL ChM1onlvone EoawlneA Couplelelrne6rr.pplKAW) n Rglo'mmum �Fexnmwmn�lm ry mul, oCuv xW fiuimmhnrua>rb^le.gml R ❑e„mn R.mna uremnr R.rmm� ❑\,m,p nlM. r nrrm, rm,Irrmx mx uT ert�m �,l Y,m,noMM lnM ml,mrnnn rm i a rvTg er POWTS F+Rmrcnmonneneoevn, enrtxolllh.i.00ir e ox..n.,.,,mKeln.l.n.,m ❑rmrunmam-omnnu o.."Oli, anu .z �. oMn.na<,la..Osl.n10 ❑ImlmnRTWk urnM nnpernlCmnrynw n) ❑ nnmvnnm All lw6mJ v0.a eo1R. Ylnem Ana Ialoreallnn xm�a,rinn lwel �w,o�lnrrurmnR o mmra.AFnR „e a., irw rmmM�i.o ,nm�,4,a n 2P VI Task Isle R,. nr MnWnum cc:llmEuwas;. Fasomn t�T... VOYCuu,FO All - �1. \'ll Rnpomiblp34.lem<al- 4rhaxraxneJ M pav . rime rep+namlm en unnxrnen(ih Pox-r5 Wvs iM boar iml >Y.z MPRAPRSM1umhr Nuwan lime Yivle 267y85 7i5-Z6fY/r5 rn .. nm.T m>xm.2mo..I " TEI(f /SIB A+h / syeI5 vm Coonl ma Mnenl UM 00l _ AnR .r 0 n�mlmrm.a ma iIF, law'111,A Ise Is. Cnnanlnal p nm.mn nr on.w •I 3)d11 !wOMPi w (ah Mask and - SYSTEM W9 ISe lanF omuem nnnana Imamramd } d d,gY' l� m ,l nR m�'Auu" M i'S s�S' +n /actin +nrcz Fn6rM "° 4) P/JahPe 2ARulmne"em..n•okoF b$ ., RvaY nr.n.m.RMRI..I.rr Na1fl+Q (-(��ttoVPh..Y �M aNT-'� ��^tA I� j' jTf� 'I $(x <Q .Mw+a.R-ST d.aY Vy i SL SBD46I981R IVIII p _ G„Iewj�'p.T(�yivaxx ��yyyRgm rr ,&a csn'i ❑ SOIL EVALUATION ''°" A SYSTEM PAGE20F6 SITE MAP w PLOT PLAN MOJECTfNME Dustln WaHert noneq mr wsnxww &tl w .VeT EuiFbu WV Wwfa tumwd.I V.n. rorr.m� ni ZYAM1 Bt eaaarw Pp w`urnatuama.artm.xtannx..tDni W ynv.e WM.r Iwo n N x...lu! PVC rA41M 6Ahl! .rx.,w. a.a.. w• r.....n m ,nsnJDssas 'a%xel'x to 00 1, Cr i "e^cd T "�� 1 4d o17 rl� gSSB � i Pr•q...J ISDRr�* 0.��' �¢e' HeoSc- 35e' oQ�l vnM the repulramentsof Sec 241 Wins. Stab Inspection of the private sewage system Installation Is required Arrangements for mspeetlon shall be made with the designated county official in accordance with the provisions of Sac dAs.zgz)(e). Wis. stm A state approved effluent filter s required Maintenance information must be given to the owner of the pink explaining that periodic cleaning of the filter Is required A Way of the approved ns specificandons and thisle er shall n!ruction and open roins e[ authorized representatives of the Department, which may include lml auspicious owner Resporuldlnks • The current owner, and each subsequent owner, shall receive a copy of this letter Owners shall also copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring Mat POINTS Is operated and maintained In accordance with this chapter and the approved management plan under s SISIN 5Af1). In the event this soil absorption system or any of its component parts malfunctions or as to create a health hazard, the Property owner must below the contingency plan as descdbM in the approved plans The owner is rencionsible for submmmga maintenance verification report acceptable to Me county for maintenance tracking purposes Reports shall be submmed at Intervals apprapnate forthe components) utilized in the POWrs In granting this approval the Division of Industry services reserves Me right to require changes or additions should conditions may making them necessary for code compliance. As per state sots 10112(2), nothing in cols review shall relieve the designer of the rnpombillty for dnlgmng a safe binding, mr,cture, or component Inquiries concerning That comnpondence may be made to me at the telephone number bsted bebw, or at the address on this letterhead The above left addressee shall provide a copy of this liner and the POWTS management plan to the owner and any others who are responsible for the Installation, operation or maintenance Of the POINTS Sincerely, .A0*0i wXowky Joshua Rowley POINTS Man Renewer, Division of IndustryServices (715) 813-9111 Joshua rowlev(olwaconsm Roy PAGE OF Mound Plan Index & Cover Sheet Cwnporwnl Manual Dann Relenmces Version 2 0, SBD-10691-P (N 01/01. R. 10112) 8 Version 2 0, S80-10708P (N 01)01, R, 1&12) Pg 1 of 6 Index & Cover Page conchnonall2 Pg 2 of 6 Plot Plan APPROVED Pg 3 of 6 OEPT OF SAFETY AND PROFESSIONAL Mound Cross -Section & Plan Vi6ARVIcEs Pg 4 of 6 Distribution Network S %�M816&fUSTRY SERVICES Pg 5 of 6 Pump Tank Specification 4.7e,(.. Pg 6 of 6 Management Plan ANa fi ta' SEE CORRESPONDENCE m n Encl e : Pump Curve POWTS ADWCaton for ReVIew Soil Evaluation Report & Site Map Project Name / Description Dustin Wolvert owner Nama(a): Dusan Wolvert Phone: 651 734 8475 Owner Address: 769230th St,Baldwin, Wl ZIP: 54002 Project Address 791 230th St, Baldwin, WI 54002 Gout Lot: _NW 114 o1 NW 1/4, Section 28 ,Tn N-R16 E❑WW© Temiship; Baldwin County: St Croix Project Partial 10 a: Designer Information Designer Name: Michael Myers Phone: 715 -554 .0778 Designer Acidness: 2943130th Ave, Glenwood City, Wl ZIP: 54013 Email: mcmyem@centurylel.net Lillian" Number: 267985 Remarks: Signature: / ✓1ti.w--e Date 9/14/2020 ❑ SOIL EVALUATION I`•sp m © SYSTEM PAGE z OF SITE MAP Pl07 PLAN maser �. m Dustin Wolves ni zmnx a«aw.w' rp. u..iu�+rel swmart.a. alwsa�Soel ...,.«sq Wa.,m. Imo i" we �nsn paws a'imy to o ene..ew... IMMRTAmoW.«.wu...� Yeo --�®py�t anq 4y I I / I I I I I I� II F; Q I`l l 7«� al 83. "'r•ei W � o I 4 0 sc- o L_ (^Q; Y� 35. SINGLE -CELL MOUND DISPERSAL AREA p S. To s WASHED aaaKwM (Min MIN o= .67 emala pa.,e aaw.a.an arOFiaasdLCOWR E. 147 II slypra] synNHk lehk) LmIv 10P Scam EWvala. 9667 R El ASiM Gll SAND FILL m0Sa Lally InuM EWalbn= 97.M k T-, ---a- CROSS SECTION VIEW o I —A= 8 X—i (No Scala) u (slna,mu n,m marvbtl all IE.N k.lo2lkn 1 to ¢sna w PVC Lal rypml - - --- _ - �____________e- _75 _^ _----_ Ball as necevary b Mass ss cmkur 10 xsm PLAN VIEW (No Scale) J- 4.8 12.$ R INP-0 - - - --_ � ------ 12..0 8.6 room 962 p wmu auiannm am..nlen+ MNYI IS MINA Wan Lw a. Rxal Pepe D IT IT 0 r m DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) _2 vaeaxo P Pom LL., FLUSH VALVE DETAIL (94"a a"r,lawk IM Smkl 1�� an, MnasAl w 1 O,Yb hi — V.IVO Eo, L.IaM 5Wrn9 cmnnaTm.e IN insulation national)s- 3 n far R.aE IeNa+.p resae+. ra+ana 1 a.m.a M1Wotl IIM-NI Iwa,xl / �� v� �l srna no wclal.M e= 1i2 n j I GIeM Length IP1= 79 n Ranter of Dnncn Per GwM. 60 m.em+r moms mn wNaapr.l Aw•b/ � •ac Mbnd Yb& nwa-... amD VQ7y1/� JI w+qm n LATERK INVERT ELEVATgN• 97.34 It(hVaI) on Letl IMlmOiNio omxe now Rl- 15_05 in p Umli'al) OBSERVATION PIPE DETAIL pmsmbl Sae.-Tlwm 54 GPR 1 rltnea 6 rm In..cm.em41 .9 we Poe Twr^L cmw Tmdaemaaa. la, +wal naamw Ywrlpisb HI ut--I9 xf 4.e Pt Jntq CeM. IMItlWn olam aemwr= 125 in (rrvlM) fa CYfe IDPart k—x—{ END MANIFOLD Chalk CONNECTION aPPNnde box. f,te 4w.rgpeogaall D d a G) I--x--{—xrz xm—}—x—I m I+NaI 14.N1 A N.su CEMER MANIFOLD m IAmrPm. m+a„R CONNECTION a QMm DnWrpe R.m. 42 Ran rA+mmrd LNe,.N. 2 Lai" Dmmap, Rol.. 24_12 ppn Torsi DISC MA RATE. 49_43 cxa SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) Irw pwwmt In sFs av aa(eN914 Min CAPACITIES® 1745 won o.anlnl Vdume (wp A 230 4014 B 2.0 34 9 Iq 50 e]3 D 18 2]92 PAGE 5 OF 6 H7 B� 111 Pump Tank Liquid Leval= 460 In na ELEVATIFGN• 88.8 ff Force Main Dill 2 In OM w ELEIVAETION 66 11 Force Mein Length • 80 M1 �womw•.mneueuw�n.w Fors Main Vold Volume = 13.1 gel Vertical Head. 885 A ' Mtn Supply Head• 65 ll Total Dose Volum DV= 87.3 galMme ♦FM Fddon Lose• 3.91 s fax toad medvde wmme<TDv.o]xaer mwl I Hbn* men amne.ea vane) .Fitting Lose'• 195 M1 'NN w eo]I MIN PUMP DISCHARGE RATE= 2.9 35 gpm TOTAL OVNAMIC HEAD 18.91 M1 PUMP TANK. SEPTIC TANKISI Volume = 800 gal Total Volume • 1200 gal Manufacturer Vleser coronets Menufactum(a) Wieser Comets Pump Manumunw.: Goulds Install aprovea effluent fiherat one wood; pink outlet Pump Model. PES1P1 Immediately urseeam of the pink Inlet ^ oumn Controls/Alamo Menumicturer. SJE Rhombus Filter Manufacturer POIYIok CoohdstAkemn Model: PSP120V6H150P17A FIIbr MWN525 Fbet evA4hea mntalnno menbury amhldbdMae PAGE 6 OF 6 Mound Management Plan 11,7z i , The owner 0 this mound system sbau be responsible Iw its pryewal condition and maintenance pweuam to rppremenb 0 SP538]-3EO, Wine, AOnm. Code Plrspnl to SPS M U(2). Wlsc Mae* Code, this "am wallas ederede M1uman heap hepl Arid manlained lnaawdenu WMlhsa approved menapement plan Furthermore, all mapednm and aamenwm aohvl➢p shall by performed by a raplabM Poll Nslnbiner In saanrderlw with SPS V1352(3), Wise gtlmin Code MMIMUM DblosedualSees Coati LI Ns; Dsall Flow 600 Sod; 60lis5220mi TUSINnal 1`00530mSL' Insbapdan Checklist INSPECT EVERY 3 YEARS ybed use open or system w m lands (I a Oil user wmpann, al imattemcal ins bee ueY(Ia I (ie,pwnp,vdvp aetc) .opals etc) mdena repgp (t a Iwxs. beaxs, cantonaletc) c sdltls vdune in anaemlic lraeMeM tank(sl and any dgllMbn pen aci nence(a) ti e.. tllAnbupm l d p hap) extent w imptty- in dbi (I to d ceedirs d0 det upxiop, gMIGIM ecWNes, etc) • extent MpMhq In 0a dump u p nail dhn IOoat sg 0 0.ayIrtegulan0ea (ia gmpmcoarenoat sNtgleetthgs,etc) Nxdaal won" We (r a v.mw. ousall inm eutares rmuds sonars, aemis. sec) c d ffhad] dlous" w bla' lOX asprindes pays hglmwWrB lateral nuctur to pre54tR-¢snprBmdBv2n B[YJficalicn) 0 9dbw dl6cNlge d 9fluenl w eewaya Cask -up m;o sltuctune served Mebbrunu Chscul MAIIRAIN EVERY 3 YEARS (or widen mcxury) a 5eptle and dow tondos "I he pYnped by a renRlM stptap painters opnelw efBnpd under a at so we State sal the volume of sell In She Small) annual oneahlm (1hi) tlw haul volume of me down or as all by Ideas wdinanw Dais of contents Shell the pursuant to NR 113, Wied Pdnin Code. a Effluxn fl bhp shall o mµSs3ed every 3 years and shall by dpred whin twepaary to lemwe any u,atw edids av rding to manNanumrs p lf,abms A serviprp penof Wll dweya bB gteelen flan l2 Months piMbutlon atxa s "ll Ins nuY mode avry 3 yen w Wye ns q Sy melnbrance repo shall be SUb my this door but povemmad and InaxwNnq win SPS 3M.55 Wild Admin Cede WpM any CpnpomM edluawmslNnclbn0 Name d Individual ameal Northland Plumbing Inc phpp 715-265-4115 Loal govenament um; St. Croix County plrxw 715-366-4686 Lomas pwwnmenl unit alersp 1101 Carmichael Road, Hudson WI tip 54016 My delectip pal of his system shah Ins refusal replaced. d demanded pbbuare to SPS 383 m (1), Wuc Aden Code Replror replacement of falad w melNMbnlrq comiK'nenb shell amply wb SPS 383, Wp !Wain Code. No product far chemical or physical Mode lm of the POINTS they o all unless approved by the ownmdlt In acmNerl wish SPS W. Wise Admin Code. Condnoenc Plan In he pent dot any felled treatment Component of this POWI5 wool be wished. h shall de metal oppose to a plan Submit to the appropriate apenq ter eMew and approval A hilted mound deorwl cwnppnt may W re-consommad Within the wgi ally aproved erect alter dempel of all final comparable If use of this POIMS Is discontinued, it Shell the abandoned In attadence whh SPS W3.33, Wbc Admin "a ,R SOIL EVALUATION REPORT dfy BR8 "OquP4kdyFFlNPdsn-A Ss.aa F4 _t_d.3 D•dwrd6aRlaN BRyV maaa rrr..an �,,...0 Ym. ..�. xeraurd NMPIPM P*tt aNaRlan WPM 10ln"1 man 8%. ll.m In Wnman Ca^p W�a Mnmin St CrA Pora110 "I WP swk 0' Ormenaione Irmo, aE oyrwnOaMEUYnab to MInN ww.p ednulllnbmaaon f"OPIWWam, MMaa maalaya "W"WmwIMaa lrm vu..Is wllmmu wl by Bn RmNM Caa RmNRy6ouba WMM.PgOn Gwt l_tl ~W RI 53B P1311, RIM __ >^PF0.rWaayi9.tl4w - W BbPS BZPIPIPuC LF S710 Cai puns Nar4w Ch 1'fan Twn IYbtl Rao WIMn N9 S 2 651-Y348a)5 BRMRnn IypTB yy MwCwmww n UP RuP,Ui NumMr 6 Mama < LWe P,mo III I"'m Rada¢mmr NPIC Or wwPWal. CaunM _ _M - _pm GarwAmabnl glatlsltll _ _ FkWppmaWalcn la[pu06_ 1 Cwrmar �Mru9a �� Gmml91 aw_9958 6 Cagn lO 1M1mr 38_ bRI µpyWn PaY Mppw. CMIr Mminanl CM, RIylua n an 'CCnuua BIv% Y :pIrm Ou &C Cww Sa SA mq 1 09 1pYl13/] III m2Ibk mrh a If 6 8 - _ _ ] 4l8 10YR5/6_ RI m]sN mrh-~__—•- 1f 6 .8 3 1bm 10YR6/6 _ sq nQv* �- mBa 1f .a 6 a 3835 1 Y 18 VO Mrm ) 16 5 3 m MR5/8 ),S ulffif pp x mlA* MI 9F 00 00 oBwm9a ft.; Cn dwmavbaabu 95.53 6 pn umumprp knm 38 mpw0 Sµµyppw pay Cn Dapn Rmaad CFb Ptln 4avpar TaWn Cannma RwaYy C_-0OR In W 6[CM.CW 6 YSn _ 1 p) 1O /1_ al - m22R mAr if 6 .8 I 7-16 10YR5/6 %I MI III mIf 6 8 3 $38 10YR6/8 5 ory Ma if 7 16 4 38W IRM/8 7SYR5/8 flf sp[tl MIRUk III a 0.0 0.0 bwMCwar w°RNS(I n _ nmllo. __ _ Pape 2dr 3 ftnN Nt cr'v^il Capm I WnIneMCokr Muneee 'i Rbp.Ceeulpl0n Oi 52 COM Cobr ] $Xutlyre Gr Bx Sn Cpp ylem pauMeN, P uoxµpetebn Rgle -GP0.T` �.8 1 05 IOYW'/E AI MI mMrM If 6r E 417 lOYR)/E YI mEAlr mfi. ` ..—.If 6 8 V-33 IOYg6/B z Osy -no If .7 16 4 31-51 IOYRS/8 JSYRS/9flfvFls mlyM met __¢ 00 60 ❑P ngs BmmpIII R n GwN w.we M.— [eMWWdiy dmr GP m. w s.•wu... e.i. u PX munG wMneM CMpbIYnXinp Mtlar -EMMMM•POGeaw< 330 mA II TSS ap ar ryp mOh m".112• WDS130m and i56•]Om The Ce UlmmolSeM)end PaUralIw01c'ec i fl,I Uuppaw d1wmc pmridnend em II fl,,v Reny ueem Jnr ei iararnze muenel inw J¢mu<formLL<onYn Jrc tlepaMenl ei WB-]6y31JI or TfY Owu�ReUm m tidabx ❑✓SOIL EVALUATION^*•� ❑SYSTEM PAGE 2OFJ SITE MAP tl a PLOT PLAN MOJECT Wp ° Dusan Wdvert .b.naep�feneV3..bwe.mn�a�pw.. rwe movft re+40%s e.e.... vn ro. un.uira.0 er�s+ns wweawve� .»... y ,..`., iwo N ..�. Y6s,A1 in wn b+y' I,agewlp ....vim. SbxV�d w�1YYYOwY awl�r� f I / '•q / 1 � I l� Ill ss r�r i dz - 95.5T yIol e 33-9 % Awlr pw'/y S28 T19N R/bw wl� MP/Ct* E6797S ST CROIX COL'. SEPTIC TNKMAP.7E: NCE AGREE.4 Ff AND OFNTFSHP CERTIFICAT10N FORM OwnerBuyer 1"4-& Kiel W&6t —t MaIinSAddms ZL% -�1i Ss lliF Property Address (\'r.5uvm tapmM 5om PI®mv{ & ZovmB Depvmevt [or veu wmvucuwJ Crtylsmte $d�na.. wl Parcel ldmLScanovtit�lxr DEZ— ICb9 'SG —CSS LEGAL DESCRIPTION Property Locamv ,dal Y. Kay V, Sec t$ TAN Raw, Towns of S.bdnisiov Plat ' LC)t a — CernucdSarreYMapa 1o9�`{S"9 ,vorunne 30 Page. G959 'rrul�'s Wamery Deed(before 2007)Voltune ,PageW Spin Intense D yes)Cua Im Voes 0 no SYSTEM M 41NTEN'ANCE ANTI OWNER CERTIFICATION' ,M,MM use endmuntmence of vow sepnc mtem could moult to es premanue fedme to bindle ernes Pope tsn Of pumpmB out the SVic tmk cerytNee years or Mona, tattled, by, licensed pumper P2uyoupmmto ntynoc -m allm Ne[wmm of Ne7ac most as anecmmtMine en the vvu disposal sysum. Cheeses meanes e besteemibilm" ate spec5ed to ASPS 30 520) end m Chapter 12 -S Comm C tuyb Sewmy Ordmmce Tne ptvpery Must, West to submit to St C us Comes Plammp&Lomng Depamem a caadcaiw foam, signed by the onnne end byemasta Plumba.Joumeymm plumbs, toMMod PIumM or a hcrosed pumper veNym6 Chet (1):he on Me x amx arm duposel , Men m to pops owaune wadmm mdbr(2i Y mepeenw and psopm8(Jviceersv+l. the sepnc but:: s less them 113 Wl of sludge L'we. the undersigned beve teW me above requtemevrs end ague to memo m One Mvate xvnge dmPosel Mount won but Meads set fmd,hwm, a set by theDepomw of Safet)'And Pmfevstoml SetiCes and time Depaztmeat ofTeoml R�urces, Soon of P'isrmsw C�tmon smmgdw Yom sepnc s>st®Inaeven maysmed must be completed and returned to Ae h Crom Caney Flannery &Zorang Degetvnmt xn0m 30 dmx oftbe Wee year expuenotu dete e Iwu -mte illsxtemms mm<nueto Ne ben of Mowledge Lwe w'ete the owvet(s)of tIne xoPstY tleseirtd Mbve, bytaae ofR1vdcCrsmdM m Reps oflueSs Office Number of betlroo �I.Jgzo Z.o SIG.' PLICA\ (s) DATE ••• 4'y mfoanow tGt ismurRtesemN may rtsdt m We smmn psmrt beiu8 Tvte4ad by d. Plewng & Zowy Depvmiev, ••• mobsteso de war a ty deed tl va-rmry deetl¢om tLe Regtsta of Dectli 0�:e and a wpy of the:Tfied covey map t[ rt¢'evice u motle m de warranty tleed ( V ",12) EL i H 0 - I .. -• _ .. - iWLOeTW r i 3 ��- o"M - . r f . I i Q - 'I 1 1 �� _ — orram.n TMSEc.wr�is '..E f `E, OCT012021 w9YIw�RyEPORT c5T, �m V rt3x .., 43aUTw 6YweC 1 P.Ve t M l Mm Gcb X MHnIGq.lm. w PtliNm peer mlbs Nen B%ntl mNea lneW PYnmutl LwmY $I Cmlimn mtluGe WM imI1M 10."IIIA aM bmcnitl Wemno, pomg6M1direction Ford IF ID -- --' pevni.wP.,.r or 01mm.10m r.,mn eno.m a ,.IFoWn One wm ne nto r0 X .e RYeee pent w Nb ifon &. L a.mvrP<wmlem ru.. In) RIsrL PmpeNo.,., PXMem lxafn wMM,DueEn Gvn Lt MIM. 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