Loading...
HomeMy WebLinkAbout002-1002-95-000NPAIn PRIVATE SEWAGE SYSTEM G0o"x St. Croix St. SPIN na SIII DI INSPECTION REPORT Anary P"I Xe GENERAL INFORMATION (ATTACH TO PERMIT) 630329 Pwwn uem tl.n tlPm nemar ee mrxm xe Ip^req lbw1 s aq p(mN , a as^lox° HAM same Michael L It Kay D Down Trust e, eM vllra v . IT.a Xn TOWN OF BALDWIN 002-1002-95-000 DM Em• .aP xn L // *n.NS'r Iwrn.iPXa^wm.P Oom 0au F^tr 02.29.16.23 TANK INFORMATION v vv.rrnu n.�. PE MANUFACT ER CAPACITY STATIdJ 575� I IaNj G top ntl s.p Wlbser I OOo BenN,maM 1. Z 10I. too DSNna Nq- D Alt B, (A r PA x as BI, Ier ,514G.3I ^NI^s svw III TANK SETBACK INFORMATION lS lomlel ipNNTO WELL BLDG uvarm Ol lnlel sPEnd ;0 ilGo' EOM Cohen, l3r ae / DDamp �' ilDJ 8(a 98• — Mamnman y.s 9s..{ p.rzn DIN Plce y, Its, ya N°lame BSA snlem .D317.73 PUMPISIPHON INFORMATION q 71 Final brans MenuMtlunr �U S GP Man fi4h s k Morel Number tsl TDH LNi'I FrIGaFL SYaNm a�1,41 T WS �. e �nl ^ a L.n�S. NP.RPTxw,.2 aL-Fen PIT DIMENSIONS NYPM LEAD DEEP SETBACKRtov SYSTEM TO p/L I BLDG WELL IgKEIST EAM nr/ Mem ' diesel Mmer, oie2' "I B„ Za" I,KK SOIL-toUl v priori syabms, 0n1 p IS End 04WnM SYatlma Only 4MOmr XXAi °I v&¢tleNStleM s, ill rADEdell 7Izal ., ENO m yx BE) NO COMMENTS pnnuaemaesempanoec cenonspres Nc) mapect (I 9lu El mepenlmpx Locallon. 118521 ST III SEE q' I)ASBMO.wipo°n=fi�kf Gl-((-Fx51+1� T,Ovs; 9JaX, n.v� 4f Lie, /CA 2) Bldg sewer length. O8 ` It ..mnen e =MAY 1v.5NIgW Pipe vwef il'IUet.,q,/ iD y1a1151, y ^FYD' i'LEPr >y7r, UM, mnuon RPIT addli []Vn No UM, CCORCamraEOln°nel lnbrmeL°'X 56PP]IUrB P9)I r nxp Gn rN r vDi 6ulomela Crean Assay- (AwausxIkly.Na (nru Xcyl ne snlurymhNanbm 01W on As,P Filter],82 m «andennwnV-716: 636329 oc � j SOffary emit Application -- III u Me 'VfkLXOM A mn -� � { pym.b4rvlJtilelm �In.lb®1 ru¢�firyynn..u� w u:"m.Mn. efswr.J IMP.wr ._ rvJry I145 BSJ`s _ 0920022i8C AYlle.mow, IA Ila"Ml -Vil t lrul Pvmrl)•'Iv )N.Ffidessed � M,ae.t dJ.YYY L Ooa'laa-4s-Yoc M. »,al.m.MXI.R mY m o m moa.791 3 1166 25p "'SF Cnr z.e Fh�N� .a, ✓d z IAW/all4 I-./1 5%x8' tas-L%Y-9o99 N x s� T_eT A R 11Traolemaln Uemk YI XiY.pplrl • SUMivnmNw. nn �WiFm11)MCYN-NumW ofPe4aams 3 ❑WLImCmmmnnY-R�mkl)n �U ar or ❑sserb,sJ-I+.meido, Vre_ ❑VIIIgea l CSMNumhr IILopeofPnmM. IChehonly nee hea on line A Complete line Rlfapliflul ❑Nsw Spem mmntto ❑ TuunwnMd"Tnk hplsnnem(I ❑ (ohm MOLlluord w Orent SFvee lvraom) B. ❑ Area liberal ❑Vamp III ❑CMSeoflumber ❑Pemn TmnlawNn LX Rerlw Fenn NunlmMAXWW ImeFM^Ivm Cl 11 r) p. TYw,r PTeP'F'S Splem/Cnmponenisenu _ ICheek Yl lhYa -'..i ...i I i..n. mUek ❑Mwetl_41iffIlifiessuredmofrvnik 7S nwlo �w am r,wo, o s„rur.m 4S0 1 Inrisk //ssrt /23L Po�oa IT Took oro Tetl I ul� Im.a M.urauv 33 T.s .rT.., ophie .l... Took /eso - say T.+eom U VILR nMElll Svlevenl-I.Ike.Ment.M_..w.e Y MbumYw. dtl.MWIS e. IMntvll hr'r N.zfVnnp - Wdandi mly &m w M+eNw M rrr 1G7985 hS-uS-yii5 4 Aml6om.alr w 2q Wei YnAJ2P 3 /Jo* ARC 41,,ldeaddel III sfe�3 Vnl C... me L .Iee Onl e ❑lac v �m�/W"s`a //�/ZOZO ❑O l.IM�iJ �/�✓� '^� _ IX board...e A Mp ft —�:T ra 3)aW T deal al Terp q u• SAnneEN III le Ilue oldieAnd h e n. /1 III eer aldoofio use in I ned se ItIs,a"ninIninsl 5£S`� 14)el �� MW� a,syl in enby s par man �e0 �_ p� LIT' All eeWadre k-DK-' � i --leezeds- IDD6l9r jR 11/111 Fl SOIL EVALUATION SmW:I-odd mSYSTEM PAGE20F(# m SITE MAP w m PLOT PLAN GIMDomi MI$0A f0' oEaroxP�av aE0 lke orwin nn. dl.gl rwss+wo f1A5'dJln nybeOrlYayn PM WYN IASTM Sauna R. W. a —Iwo N w..., we JAsTMDw w� w.oe.rym. To gtrtreMmv� wwn. We !AM 02%5 6,uirwl 5 O BM^'pmNr MtlWYYYtlM • h 5keef• �rarw eFL 96A1 YI =98.sa PV � 83• 9G.n• �"��� PI` - - ` ONISON OF INWSTRY SERVICES /i,.,mTa., 4,I OR£EN�wm moe .r \i�R I.m/Imw..lwnvro.+.r .m�w. oa.n cmn.s.w.rY SeplemM 50, 2020 CONDPPIONALAPPROVAL PLAN APPROVAL ERPIRES 2022-0430 Man Review: PWTS092W2278-C MICHAEL I MYERS 2943 11016 Ave Glenwood City WI5J0U SRE: Mike DnMo 1165 2501h St Town of BALDWIN Se Course County FOR' Desnlptlon: 450 GPARep4e evend Renagmadl Mwnl Maintenance RgmM CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES /f SEE CORRESPONDENCE Mound CnnlporctMU -Ver 20,513DI(91-P (N OINI, R IN121 Pressure Dlmlbmlon Component Manuel- Va 20. S ID-IO2MPO OINI, R INIO Thu,sAmulel lexnbed serve Par been revised fee minfomenew wiN epplumble Wiomium Admtmmuuve Codes andWwomm Statutes The mbmlml Into Even CONOITIONA1 IN APPROVED Thnvyeem:ambe w.md toed Ieuutl w ¢coNence wM Ae rndosed eppov t Plm• ern wtthmY sampiom[mvolullel rtfam[etl eMve The owre5 u defned m [gepta 1U1 UIHO), Wivnwln SUWv, m ¢spumtblc foreomplw[e wN all code rtquirtmrnu No pawn my engage m m work at Rambu:¢:n the sae taken IrtnuN in do ran by We fhglmlent pa a 14506, The following onall still be met dunning [om osown tar metal lauR n end me, m oavpmy inure Key Items- POWTS Deal" Approval • Title ryaem h to M onerru[rad and los eled to accordance with We appmvN plem, the'Mum:d ComPonem Manual Cor Pnvea Fresno We tewotet SSmeme Vernon 20" SOD 10591-P(N OM1) age Uw "Prtvwm Distribution Containment Manual fur Private Cane Penetrate, Trteweut Sumlmns Vernon 20. SR0.10706-P IN 01Np • Any tell¢rawer, Warn and damage shall be cut hoo and removed poor to siting tInc swore for Installation to geven marina Rdea the mm,nnl Wren Prior to ometrudien of the d4pereal area, cask the moisture consent of Oe evil m& ends of 9 inches Smmng and comp¢tmg ofwet of will result in interval the m60nmon apecny, of fee ARE Roper evil onsum a convert can be dieetmmed by rolling a w:Lvmple 4twm: the M1Ws If it Polls erne 1/4-Inch in, Ind siteto pmperr if ocrumblrs. ens Repnabon an ryniat lobe eigtsumwel0 prtWrt. do t Pcvm1 writ it Mea • Clemouu shall be insulted per 5PS 38235. • toaster, limding even became M feel per S5.V2]o(I IN9 • ProrWe surface water mraloo model the treatment tangs and mound Winston mmpeneat • The manage Is Impossible to, the entertainment and consumer, of the psis comom wmtewater goverment system (POWTS) invecoMomc Arm SPS 383 and the approved management Fiat • the owner of a pOWT5 sb11 be responsible for ensuring him opening rovm raaum locked or amurzd ertept fur elpeawa ewmmvuw mnmrnma or eervmmg purpose • 1Trnen shall reembe a copy of the approprin (,petition and mnintenmac atomiser summon owners mutual for the POWTS derrnbed in mus aporri • Pence copy of the mramited POWTS plane and Mh letter to We meter. A copy of the "proved pW; gtatfimoom end or letter shall be on mice during conservation sad open to inspection by wNmmed reprexmunva of the Department, which may mclude loml tmpecmrs All pmntb ammtml by O,a or the most commit oh,ll be onnnnd prim m vmmmencement Of rotumnmNtmlel Vnonapmust In gmmin8 this algmral due Acting of Industry Smtcn m cs the right b,rymre edginess m Wain,aMUW consumer umaking them rcecssmy to, room ,mphiI A, Mstele and 10112(2). comply in this m,w, shall rthme one Magner of the mlrsnnbilin for In umn8 a.safe bmWing avenue o, mmNII Lpuma concerning this mampuodmce may b, mWr 10 coo of th, telegram member LAW below, or u the Wdrrac on cots Introduced Thr above left abhemee III pmvtde a copy of this letter and the POWTS management plan to true owner and my must won am mmmnnble to, the msyllatmn, connotes or mommnanoe of Oe POWTS Sm!a //rt'nlI'ylnI /'1 Mark 5 Finger POWR Wastewater Spenalin, DMsmn of Industry Rrvicn (8O8(5I4.1189 ark bnssoriv mtv PAGE 10F6 Mound Plan Index & Cover Sheet Canpaienr Manual Desgn Reananoss' Vareon 20. SBD-10691-P(N 01I01 R.1002)a Verew 20, SBD0.1070612(N 01 V. R. 10112) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross -Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Attachments: E r e: Pum Curve POWiSA lication for Rewew Soil Evaluation Report & She Ma Project Name / Description Mike Donvin Owner Name(e)u Mike Dawm Phone: 715 -684 .9093 Owner Address: 11652501h St., Woodville, WI Zip: 54028 Project Address: SAME GoA Lot; _NW 1/4 of NW 114, Section ,T29 µR 16 EQorW© Township, Baldwin County: St Croix Project Percal ID a: Designer Information Designer Name: Michael Myers Phone: 715 -554 .0778 Designer Addrew: 2943 130th Ave, Glenwood City, WI Zip: 54013 E-mail: mcmyers@mntuMel net License Number: 267985 Remarks: Signature: Date. 9/08Q020 uar.rw.� .,er SOIL EVALUATION 1 40 0 SYSTEM PAGE 2 OF(, SITE MAP m PLOT PLAN PRWECT M4 <W an Mika GOrwln j ° An.n ewenfew =40euawfor 1001w4 pen p[ 119525A�sI.WrcYrY4. m Per, Watt/ 097M reor ffJIw W M a W 9M) 1000 _ N e.v....r we tASw4 au�m n wn rt Wem uan PVC I"TMMPDR7O3W5 sm.a��.wmAWv.emmmn4.a s It G 3 0*3 SwEef a }Mnu»n A" anars roe.,', 4,p4m,tA....-"4 FI =98.ce \ Bs = gsrc" w� SINGLE -CELL MOUND DISPERSAL AREA REcnTE o= 134 q I�mPpenealn MppulYn ppe fp' OF COVER MgCugn dye ana mwmn wbi MIN 6�0 E- 164 ry erywvM SYnMelk Mdkl I ^IM 1 0 ft sv+mm Envalu,= 9713 n nsTM ca3 snno nu Lmaa I,~ FM,,Iwa= 9820 II LLEC7C7JJ CROSS SECTION VIEW o h— A = 6 M --i (No Scale) Pa ea S,F m nn.nm= m %40 It 5 •aMP.,� ISMwlorte man nanaoN ass nuery eeFp Nglma un dnn :_f PLAN VIEW (No Scale) 1 112 ' e scnel as 1 PVC laleal a=wry 125 ry Ilrolcaq arRm I ___________ ______-- --- _ _- ------ —a- _ ________h' I - a=?5 q _ = 104 q 99 ry wqyl Beal as�necaca^IXo ha" mMwr PMM apoNaaoI aM,ena6r nR wnn Is Pao III eornmPa ba n...l vave D 0 O Co Co DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) FLUSH VALVE DETAIL (Nu Smbl Orhem __ auo- SgrJy camera mreaaaa cep vaw Rnx S= 3 n W Hand TnW8 (hauhLininw ap (cpmnap arsw R EaNVabe Imronwl / ¢ wn+Hrovae 1 Lem,, Le,gm (R)= 74 fl a YL,69ty hd, mu sad Ik}�1 /� �\ an+9 MNYmtl LATERAL INVENT ELEVATgN= 98.2 R (NNeel) L Uv[✓vIl r aw O""` ers (1Y*`Q na (xl. 20 18 In OBSERVATION PIPE DETAIL (Wr Sabl sb�aPraM++tlal EnNneacma aro RvC Rpa TWp cn..a rommeaw Imn.r rml M,bom ammo.. mwmaa.e. (4)1w-rP xws ®4vwt AMximi IMMWn snmw, .amw�u mum ^MYpaum1 � h OMdMI .1k,mh in m ma Sd xo PVC Lamml O= 1112 n IMMaII Number If Omani per LRmg• 4$ 41 Gm,¢ Gktlmpe Rare= 69 Ran Numeerdwrem. 2 Lma,w G4barb Ram= 1Rm gpm TOTAL DISCHARGE RATE= 3707 GPM Dump na nuer= 125 in (lyp,al qq gtY,e INaoll F---{ ❑� END MANIFOLD CONNECTION Marum Check aOPGcaMe box Ring Oft, I..,pbawbwl D (NpM xa—}—x--{ m IM+aII rml,wl ❑CENTER MANIFOLD 0 M'gM° CONNECTION m (H,w The eNMNI SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) _ m.w ilm 111PIXiTIM ���w .Aida, Win ds) isn.me..vI ra\T1 III P=eUse b SPS M 431aNpl rw e241t s CAPACITIES@ 17 9eNn Depm lnl vdame hell A 20.9 354 ] a 2.0 3d (Cl 54 91 3 D 10 i]0 Pump Tank LlpWtl Level 382 In Force Main Diameter = 2 in PAGE 5 OF 6 suaromna�n PUMP -OFF B_on ELEVATION= BE fi INSIDE BOTTOM ELEVATION= 86 6 Force Main Length = 50 fi r +,Pa.e e._nwe.eu�T Faroe Main Void Volume = 87 gal Ver lcel Head = 11 40 fi .Min Supply Head, 6.5 It [C) Total DoseVolume TOV 78 galldoee + FM Friction Lose= 143 M1 (41tItl Iel-( ape RW <p3%Mspikw) indr •fMx Minarebm weme) .Fmng Lose'= 196 fi •WM vmgNie.e. eN MIN PUMP DISCHARGE RATE = 3).1 gpm =TOTAL DYNAMIC HEAD = 21.28 It PUMP TANK SEPTIC TANKIS) Volume= 650 gal Tolai Volume = 1000 gal Pump ManufepWrer Goulds Pump Model PESIP1 _ r. Coneopuruann Manufacturer SJE Rhombus ConeolslAann Model PSP120V6H150P17A Float eMlicpea conhanIng mercury am prompted. Innall approved effluent filer at me oaken pink donal Immedotaly coa ream of the molenk nbt Flller Manufacturer Polylok Filter Model. 525 PAGE 6 OF 6 Mound Management Plan IMPORTANT The wmx of Mrs mwrd system small and responsible for as perpetual ge2em antl mainlerwnw gnsuent to rxunememe N SPS 3S2-3s4 W,x Atlmn C Pursuant to SPS My 52 (2), Wax A Grim, CWa, this system Mall W Conwall a human health M1aZarO If not maintained in accordance yeah this approvet management can Furthermore. all insppchon and maintenance actrodies shall be performed by a registered FGWfS MOlnbiner In accordance with SPS "352(3),Wlx Adman Cede Maximum Oh I Al Operating Limits. oesgn Flow• 450 Most, SOOs5220ml TSs5150mi FOG 530 of Inspection Checklist INSPECT EVERY 3 YEARS type of use was of system o mkraw factors 0 moos e . paper compounds etc uppr al m orrinem la a punon valvae 5wt lads nodesetc omound for 10 leeks, breaks . common ern I da5ds vaume in supportInaenem tands) and any dseilwllon appunenarrigs)(I e, diineubm l amp types) • negina or Improper use fa a exueding III Nepal prohibited imando s, etc ) • axiom of ppnd rig In dastaCueon woo Odor to dosing • dosing megulanew (r e, PumO ragtlang, Goat witch settings, eh ) m eanwl components la e, wlnw ng nnsal feelno-ars alarms s, timealas, erc) c eldumtivam lateral u-lanno orl pmggmg measure lateral Maul pressure— door to design aptifwem) c sunaw Miccarye of ful Of savage back up Into structure Proved Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) Septic end door Make shall be pumPod by a merit sepuge sending operator output under a. 28148 W ie Slats. when Me volume of wilds In Me Wi exc Mo one1MN (Ib) Me liquid volume W Me tinge) or as rrymrad by Iwal ordinance psmsal of contents Nall he mrsuam to NR 113 Mac Added Code o EMuwl flIM51 shall he Imported every 3 year and shall m tWMl when muaufy to RmWB any wmdated llidsa=rdangtomanWacturersspmagmu0ns Aserviorn pano]yeu gways be greeter Man l2 months OrWbutlen laterals shall W gushed once every, 3 yYn of when necessary Sysem malntwww rmrr shall be submMed to the proper Pool government unit In occasional wide SPS Usual WNc Adman Code ft m any wmflomm fanur or meMurlcdm to Name of obvious m company Northland Plumbing Inc Phone 715-265-4115 tgaalgwermmem gun St Croix County Phone 715-3864680 Lomlgwermentudta mw 1101 Carmichael Rd, Hudson, Wl zip: 54016 Any Mundane part of this system shot be regatrd replaced or rmroveM Oursuem to SPS 383.51(1), Mac Aaron Code Repae or eplacement of failed or malfunctioning components snNl comply with SPS 383, cox AdmM Code No wmuct or chemlwl or phya l material of PONTS may to used unless approved by Me depanmenun accordance with SPS 3M Woc Adman Code Contingency Plan n MB event that any failed treatment co nent Of hem POWTS cannot M relmam4 a shall be mOlawd pursuant e plan submitted to the appropriate agency for review and al9mval Afood owund dlePorsal component mayW reYnnstrvCM1d within Me originally approved Sass after removal of all failed wmpamnt5 System Abandonment If use of Mrs POY?S a dismnimmor It shall tie abandon In ettvnEanw word SPS 383 33, Men OGmn Cede. SOIL EVALUATION REPORT 4131 IRS C owl NSalely am PMtMAAmi Belvlar Pew 1 03 : New of Safety and Bullemgs in Munroe ,, m .amm As W.. nearm. NwMYne Pbmdng lndo. am plan 01 paid, not ku than en. 11 inmenrn eue Plen mu Gunry St. Gam nchampgb e but not Al to ve l[ And horlx[nbl mNlena RangVau'e Oerrem ctlW em Call10 Code Cole omm.namna ohh nmw em aboon anddignamto maml round vtu:e neataa laforinni _ non ranMYwtFnnlPnrp u'n alaa tptMl mfvedR DW embalm Gon NW1p NW1/<,80.MBN,RIBW r,,, - Wta BW4 SIM hams mcupsl:u =Dcmln cq Vllbpe Town M tRmd WI 5g02B ]15-06.4�2] BelWin 150 T181 on Nor Lmt bon Vn geeWenlgl/NumNrol Mpmgna 3 _ LWa eenv.f engn 0ownb 960 GPO Ranneoment iA,wnni ,-Cal Po MCATill _ _ _ - FIRM pen ma lgo IappllWle A Gereml mmmantl man ❑ Sol scoop Fe Grcund,maaew._98.20 in n Rapid to lmmnp boor 20Mp OIIIioWngq Raminml Rodaon Real CoRlor =Np 1pbw Teamm I Sual noontide," rY Wwb Gtt Munwil CIA Si Curl Cobr Gr Gz Gh m6 1 Omll 10YR3/2 91 namak 1pM CS 2f_ E8 _ 2 11 18 IVRS/9 oul rood mR CS .8 3 18-20 10YR5/13 All not mh a .0 6 q 20-M IV"/8 ]Sel RC sW6 sM Rrogi mfl ps 9 6 5 .'28i810YR6/8 25YR5/B RE SpcO sk Cal m5 a.2 3 F27ewln9P Men Pit Gi 11111, 9572 A Called pllmOnaMoor 20 n Sal Ppgbalbn Reb Nwrton, Di to waMcaor Rehm MwpMn tapure Slruapre conelebnd soune.n, Roab GPNM Munyll pu 4 coal one, 5z 5ume 58 1 09 10YR3/2 _ _ All m2sN mvh _CA2f 6 2 9-15 10YR5/9 se rel mh CA If 6 .8 3 j IS20 1P/R5/8 qtl m25bk mh cop .9 6 q 20.35 IOYRS/B ISYR Qe seats sd nni mar SM q 1 6 5 3552 lVR6/S 25YR Re MMM Ad misbk all M 2 3 'Efiffil= WOCa ad A Val end TGSand < 150 Came n <gODC</pmg-wi til mi Ni Colgan all) Spn CeTNumgr MIMxI Nall O S wart Fpdnu plvnp Plumprrp, ln[ oPw cab Eveluvlm C[nputlee Tebpuon umNr Dift E020 3Ba] Gkmaim CM WI5ao1] ST. CROIX COL 'TY SEPTIC TANTC MADN7ENANCE.AGREEME.'.rT AI.D OWNERSHEP CERTIFICATION FORM Madm3 Adh s Ifi.6 Proputy Address N' wt for vex covsvocoan7 Nmficwoo req d from PYvm08 S]Wades Dparm City/score de.lrlb ., Pezd ldmuficroov Numbw mOz—Imoi-9S—ee<7 LEGAL DESCRIPTION Ptoxny L a- on j;; A. N"✓ '/..��SqeC Z , T L!J R_&_W, Town Cf Zaa o Suh lemon Plar Z" 2U� ,Lmk= Certified Sun ey Map k Volume ,pagek R'srnnty Deed# I�ado3S (before 2007)Volume —,Page#' svx'nmee_rodve EW mes rdm�atl<Yre=m S}'STEM Kkn7ENANCE AND OWNER CERTIFICATION Iwechasuse We vmv Wua cn emcnuld rerulyuunvP'®awe leave tcemat dlauaste WUYO mivtyence comsts of P'�Pm40N the sryac UVQ evn�Wx yeanW C,J eed[Q EY L dmmPe.sune�Y PM MW .m eSen We!uo. w of!he sep'v=) nd m g�r 1 St C :he vase d:spDW sys<m Ouaer mawuveoce .enoesihwnes ea spxded m ¢SPS iBl.l3(I) mtl v ChePty IS � St Cmu Com) SVNvy Ordumu The Wopm) oumr, agras m nbvn to SL Cms Cowry Plewu6 B Zmu:g DePermiW a rr_i5cenan fade, ngssa by Ne nn and by a m'ene Pluaber.Jowoe.meo Pmmbm, mnneo Plumber W e La'msrE pauper vmfim3 Wv (1) We m-sue losstWon1 WEoflwige:smP'oPer oiea:mg wadmov evd.W(11 efle msiecom evd PumpwB (+f oecesssY), We uPat:m4:s less dao lii 1W1 o[sludge L'we, OW mdmrped have reed We abov<:ecuumim¢ me epee tc mavum the M'acc se"ge duyul sun® ueW We ssuwds sn Wm beev, as set by We Depamact of Su*e )dud ProfesstoW4 Sen':ces and We Duadmmt ofTaovel Reowces. S•sn of Wiswmm Cv]Seom <0mQ Wv yo:u sepne s'ysum Ms beev ¢viv'svetl muu be compinetl mtl retu:vedto de St trou Cowry Plmoivgk Lmtug DePvmmt vuWv 30 de>s of We t¢eeym expaanm tlam e LesmWed above. nv eofao Waey o"d vueto We benoteroff Office Ltwe am've We Oune(s)ofWe PrnPmr ae:mbea mows ty tmme ofa wmamy pwa mcWaea m xepam ofDeWs tiara Number of bgd oms 3 Ma �13�/xsyG SIG.A BE OP APPLICAHT(S) RAPE "'•MYmfommov Wets mierepresmted may tesub w We sm:on petmtt bemQrevokod by We Plawmg@Z ac&Deparmmut'^ Induce wtW We epphemw o mooned ua'tmry deed fiom Me Reprou of Deeds Office and a copy of We calOod survey map if reference m made m We warmry deea (REV OGLl) G51"alo Y — a0131 Page 1 d 3 MpAmE Plumblm Im $1 CMx prmmegv ruxwePlx�pintelllrrlpmmtlon�s�a��ro����re_„„y �, P,,mo �r� Ira 11504Ol a, P<w m..p�..e .�,.XP.w.,1P....M. lmll I'�;^ v • BMe SUM Nma/�CSW n.-. W u G AK Saw 29L Plvn Nnbr co Vixp Tmn NpaMR d N Con*VmWn Uee Rnmem* r N11W d m4mm jLNe ddn ~Kw M, am Vry RVlownenr P,mkdwmm l-oerob. eMma"i Glsoal Till _ FaWPYIn Wvm On, d8wma e _ A �wnneePd nnnv 91320ex M1dor 20 Nftce Pognblml4ry _ In gPXl4plblbn Rat, .M Lobr m }uWnfl CmM SaMFry _ _BFL11P _ _ Ou Si CPnI Cnbr v COO C ,ftM,xtw, Sh Gr Sz Sn m6 1 011 10YR3/2 41 m2sM MW a 2f .8 2 Il-IB IOYR5I4 Sil '. m2dEk mF 6 6 8 3 18-20 IMRS/8 w mXtk mh CS 4 6 4 2B IpYRS/8 25YR f2E spRs `b m3atk fl 9z 4 6 5 28i IOYR6/8 25YR5/8 ROs l W Mfi a 2 3 amN4 ryW 95R fiwMxurrgaW fl CeOmmrmbglxla _l0 wRaPN SlAW,alm Rab pgln Mi,dXCW Ppbx 0.ewµan Tenure SMMm CwmWMBwWdY GPGN Rpm, MunrM Oe. M tom C kK Gr 5 5fl sS £.8 1 p9 10YR3/2 sl m2zdr mNr 2f d 9d5 IOYAS/4 91 M2 Mk If 6 8 3 15-20 IOYU/S m2s mh is 0 6 4 10YR5/8 2 w m2i mh 9s 4 .6 _0-35 5 35-52 10YRNO 25YR f2d qw6w m2sM mfl CS R 3 'EIIUMW'PgD?M] 2m myM1 Mw Q-WDSSWO @ndTS8�]Omph NemeIWPM PMII Slenel CST Hum Mr MliiLSi MIC481I MYers 381885 -Mn ry EnW.WnC dWM TWpnw NPmna =3yhe m an 4mlao[W Ca, wl you PlM020 115-2554115 w4ab Mrs MIFG M.Wi P.rMIBe _ _ PI J t 3 -3 GI 0.pllrblmmfrq/etlor PM1 CWslrlereem 961J 6 ]J eflab 0. poGPpM'eX Xorlmn BepP BomlvMCnbr MEoxMrnpt In Te tun SWWn Cc to Bouneery N blI pu se pM Mm Gr 6i 311 �0cwl E8 1 P9 Ioca 2 a I mfi' 2f 2 9-]3 1IM511 sl m32k mM1 ¢ if 6 8 _ r 3 l53] IpYa5f0 z[1 2abk 7 a 4 .6 TI i 1y35 IMRSfB 7Mflfspots zkl mb[k mh 9z r 9 6 -T 5 3558 lulwAt8 7S yIBRdspls w MI mfi 2 .3 ❑6utye NnM trMmhnu9 rww vN.e fl _ �RNm XcI Xa4n MgM1 Onvvrl COW LHayN TMurt 6Nr9na Cwvebrlm scut GPI N MureM W 8r-Cont Lnbr OF L.III bn 1 ❑ BorMgM Bw1nx BeplO PII lLounEeurlemeM fl n bllmM1lq(etlor SOII Pbtlan Bab {pl n otI Ootn br Wo. WvglW TWWn SC[nuYnu BwM.ry _ 6pb8' PJ I a Sc, CM Ceb (I Or Sn •EmwnlM-Baor>sa <xxo mpM1eMrss.Y'J!1M1'J mpM1 •Emwm a- Boor( W rrI Ord TOO Sao mpM1 rneutp.rNWrl ersea].Iw Pmrbmw w.,�. r..n w,w oppon.ml..><,.,a pmvr8r W rngle,v. vy«, rmarmbeb rmn,n[MmYm.l rnmMr..n.n rmmn..,nW. m.. B.P:.Im.mMmu2m3ul n,mdWepn a.by