Loading...
HomeMy WebLinkAbout038-1113-20-000wax^^v^W"d6'^"xd PRIVATE SEWAGE SYSTEM t��28 St Croix G.Nnm+G+arc o..� INSPECTION REPORT GENERAL INFORMATION IAriACI TOPERMIT) mlc oa 0Nm11 ap L Bruce 8 Tracy Bader e. abTOWN OF STAR PRAIRIE38-1113-20-000 web. 31.18.479C TANK INFORMATION m /..I... I ELEVATION DATA TYPE MANUFACTUB CMACITV STA90N BB I HI I FS EIEV Septic ` QOO Benchmark 1001 1�D GCN", evAbe a OD A I u S 94. ♦ 1 Ls GM4 46 93(cs. Lv HdSq SNiI IH 2L L TANK SETBACK INFORMATION LnikS-ClN.Llas� uH TANK TO i& imAlnn .e ROAD I"I e m >50, oIbu��50' JW Zo' "'°""a"fLAjpeq II.d% 9 . HoMI^p Bat SWm" 11 92 1 PUMPASIPHON INFORMATION I' Gree. Li 9 ,S GOM MW.I Number 3 ` `1-' ;A. 4.1 96.02 K ui` N vnclocras Y sy:rem K.ea rOpIt I ma L.naMO BL,LnDst 10%N sysM rGre ^ PiL Aso SLOG 30' wGu LOKGrsrREaa CHAIMERGR BRR ION Lerbeh SOIL COVER suneprimi 6 y .. Mw.e o.uam.aamm. oa tium w. u" 7s_g jIqrwa .me �1z" nm e :I.m COMMENTS: (1wIaxweanoewwaa numb, vre.mt um) m.vedlm xl Ic,MNokr.x LWMud, 19ROULtHST —1/t 445 p t t5 fj J iron BMDWILOINO 4'Iw Dm,NV -(%15CO, 2)Glee e...erlm9u•v5 lu't*LsttwF�. U' ntw� 11 lL mom ofCONK ` FqL Plan ,.,e WRmue.n, a Yee k In IZ 10 Zco mans b%[NanT inlmyt[n sene,ia x lx.wn �e�b°^ ro OCT 282D20 4rv.a l]rson �� 14M1 lkwhntlwnAw ,( ]143 Mal"mylWy0716R LPUDLV n py.yl 63o._/ Seen •Permit Application µ.d«eeann PP nnmmmn.N "n ,um5, mw de,l . kede nnn.woha.,ad Fm 0 amrrv;nw. a"odo nbly.<.ml r« " pm11UNdS.Iuwand, Ler` Ik m. pn,.,m YO .m,Wn or.nnnr oewrcmn onaWmo Pr1AV Iq.e, wm. PnMe a.. nen lopm16m. Scene IUA n...n .mm.A.X..-ne.«Pwm Alnnb.m.e nn fl1,pnY uvmrNu¢ & 3 38 1113 zO.00o P,oxnr ltiM. a4 Pmnr l.vm ZB.31. Ie. y1gG I 1 ly S T_31 N, P_tg7E`,¢kj N2ta Fl _ 01 If. Type of PulWlnp (check 11 thee.pply) o 01Pr 2 Iumly lMJmg-NumM.nllkyoo.' ,nun New we. ❑ a hl.Anmmemel-Ile.,., L. ❑ LOne ❑sv(al -IksaRO Z") K ❑ V, gloyma� Sgs�i�ien [SM Sol �1 qn k F-b.pl Xf Trpenlpn.a IGlxkonly,mil o.Xne.l. CmpIRlim Xlf.pplulll " ❑Nw fpw. �,pmiQ^ml lyAn ❑ TrAlmlmwmnP Ank Replaccrl rnl ❑ enc m.urwmm a Tim„P S,=lnwmm ❑an. ,ml P„mmemvxl Rm,n lem,n Chan 131UMh. ❑ Pmnn1A,ol m New .myv�row pen1gn Nunnarm Mloded IV, Type of MINT$stleMcm nvw.Na Cheak 01 ifloyl _ ❑mw<z.m wv,wkml I A Nde. m ❑flmm,w lncm.a []Alcor.. 0ww' Nmr«oak.. m ro�e,.wm.I l" ❑IlooTTok ❑amu 0 flm.mm lk+m Aral V XbPoolI/pone AM Mononab.: T 1pN1 �c}SD sml µq,nm Feel UgvWA No (v42,� L53n R2 VI Took Info nn Tn6 Im. I.vMv ell Xoponi611hy Solemn[-I,l«e.enmx.ek.me� pnM1 bl�ulb a. pKeS..oeeYeeme w N pleea M9 N I r v �rur si m.lPmlln,�.yml�l VIIL Cnun Ne tlloene Dee Oa �APonn ❑ M1inelgrovd ❑Ihry Gm Priam InlknW ls�mc A'Adssuin II II 2O .nm It.CwkXb.eNAppm.6'Xown fee OWppror.l 3 EKIS e`j Tyli 4 MK} kaC 4 qT tCr, en SYSLfM OWNfR �Iy¢1.11<C S"t\ fell 51sko, Miuvlweol c Ilrv{. l k ed�new fife, all +a P^pr-N d,,p 1,111.. n m slee?enud 1 nln moored one "6 2 PiE w F'a;� ; 0i rl Kd, ,3n,n= `)Li C4 -l0 9%;? 5p" seoe�Px1X [NIa1 1 ❑ SOIL EVOHCI�ALUATION %T'm ®SYSTEM PAGE 2OF SITE MAP o PLOT PLAN PROJECT N4ME M' OE9P�M' Ao ISPnp Nvf Yw6i.Meblp¢b m.or's Pno�a. �V94 li JT, Ne-i 2�A. // .way Ppa MCMeIl A6lM 6bnpp}E(leEM9B19088HB{,ppl raeaB .�e.r.TT �I�� duc T '/ vnva.e Y IYA'b—i4 ^^ Y 1(a7.6 uwmwr aimm�xs rr n.wu k 0MPO 9rar RTm aam�ny.y rOP, I 3,a �.wlw ns gllu 3_I 4y0 2.¢euS lb [L44'L'� Gtiamle.3 � �••� ' UR o - y erg` i fnnk- tb 1>�.'Fll%4 3 �i! I ' 'off 13T I CONVENTIONAL COMPONENT DESIGN Resieenmal npprawn INDU AND TITLE PAGE Protect Name RDAp,( purees Name �/" Omer s Address yy Iit) 5. liQW (L"McrrvL Lf4 S4A 1'7 Legal Deampbon siac,. a -r i� amQIR M� TsMp Star Yfat! f, county ST CFDDC Sul Name LatNumber Parcel ID Nomear: UN — 1113 — ZD — DDD Paget Irl and We Page] Pact Pawn Page a Symm Going 6 CmseSectnn Page Her Specs Page 5 Maintenance Inbrmatron Page 6 Management Plan Page 7 St Cm CN Septc Tank Neura area Form Page It Warranty Dead Page CSM or Plat Atlacemem Gel Test A Nwse Plans DesgnerlPWmeat ��7 Afd gr6gN,L"nse Number 999"773 Date ZD L� 2 Zs Phone Number Y44— su f Signature 41 Feely 1-1 N me Incmm b1 Al CDmeDrc all he v m z p Smtamw IN Dtmrl vupr ❑ SOIL EVALUATION m SITE MAP Per Ci NAME Ba T �M ]944 P ST, N4-j a,.a al w a+s A W a..e. Ov TI rc7�nia10_ A'roaPrAaul 0 ....�... I I0� 57: ® SYSTEM PAGE 2 OF PLOT PLAN YjNWLEeegn Mx�9ivleYom bmnmertlM Nyp, Pw �bul�usmgp petw��pan �� IMPORTANT Sb YmNMwbn�F n 6� r.uwy m POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pile a �' Flu 1t60NNAMIN SYSTEM sPECIFN:AnOW Owner l/C T/eC Septic Tank Capw* [CWkyj a" pon n f 3aptic Talk Manufacturer DNA CESION PYIAJRA 6 EMInt FlIV MnNvvaw , ! ukG Number of Betlrooms 0 NA EXluml fixv MWN O NA Number of public Factory make m NA mp Tenk OgrM I 0 NA E arrlMelPowI avwNN Yltl Purr Tank Meulec'rww ONA Domain flow Ipeakl, IEWma a1,51 aUd pony Manufacturer ONA wall A[9f m Me Ieytl FYmp MMai O NA I mr BtmYSE lnikrwmV%MMo OuefM Moab avenge' Rmmonmt Um R Fete, Oil A Greme IFOGI 530 hol C $enEIGIBMN Flow O Pond Fkw Mommlcal Oxnpm command IB 930 mOIL 0 NA O MMmMc&J Alkali O We" Tam ^wepertlal SOMs 1581 slso molt. O Dlunlecpwm o DOv' Reo w EMUWI Ouel'rly MorMM aMelape Dupersar Celllul O NA Bmchimmal Orman Demand flal z30 m0IL f]ImGmunb(91",Wf O hrmoulb 1pwumnetl) . anal S,mwwdl SAds IT551 90 mpIL mall 0AtGrtla 0mori bond CMilmm l Ommevicmml it Or clullWml OOnpLm0 00f Maximum Enlum in $¢e , inbe 0 NA 0 NA afor om vow Wpmal mr danwaw.ao.a.I mr, aaaaa ran. afpem °tliw oxA serWaGmt sera frequency open m of tank(,)At mat 11car wharr3 A vla el IMWmen 3 pP1 0 NA pump Am cmnms of All All marronal all and aoum ecuYs coal I .I a tank volume 0 NA Inyxr EupvsL canal At burl on w eery O m'1 len IMWrun 3Yvel OMA Cleans uMt fiker At Import once every )0.mvlgsl Om m.pm wmrp, trump comae s Nwm At a obow aware 0 mmmlal 0 MA PUM Malawi Intl Pleawn tan At lain once Ivry mmN'al RNA door At ldM anti rvW' OmomAlI?Idol OHA ON MP W Telabal IflsiNfICPONS Ingren'al of t " and d. g bed, al be mean by Am iyff dow carMe mane of w tabwng kmrae or mxTw�ema Maser Plumb®. Mener PlurMw S w Saww: PoWTS 1,gc , PoWTS Mmtmw, S Nt $wi's0 Dp Tank rembotons Trust ncluEe wN mapanm of me alto muN a modern m or bkm butiv:a itlmtily a cka or back volumeal the mm, of binM scum AM end scuvA to check for any back up or ponding a effluent on the Around wrface Tha dnepeel cellla1 mall be welly nopM k the effluent Isveb m Ne oowve and to k no M ondm0 enMimt nn ffC *nOf vol MUIRT 4M pfcelllue^t oprnuW oNu mry vdcmpa fYlkq arcdalwn and rary.0 Act al. nctaaMan of me lira reAm.lary eMraky. Men Ike combined accumulmon of all and sum in My tank anuds comfort IKI or more a fire Tank volume, the mere dentoods of tact tank area be removal may a Socal smwnng Opwww and db 11 in amderce won mptr NN 113, Atlmmap.tw. coop. IcW npw aonork, mcbdmA eta not bnrM to Na wincing of enWmt fikaa, mchanlcal w Ve mW comannenls, mope rot offer and my s rrYl o intwat of 512 formed, shall be p rmM by a whand POVRS MeiMemo A auv[e sport that M povtlM to M koL regulatory mm,ow wdbn, 10 days of empbrun of my awwce event Pays ?n v START UP AND OPERATroN Fat are« aonsrrunlon, pole to rise of me POWTS check VU wl tankld for Me prasanm of people) pmautta or other cbammus Ma may enpeae me ImportsR process anaror damage TO dlmnvl up a h,O aonCMVWim, are aneatea f.a a tho wnme M the thri removed by a scorns nrvmmg summit prim to use Sychapor mrt no e net occur when eon ao ermath anmflbn nd at, me ve mi During power mimes pumpmka my Lem Wave no ial lughwRm mvebwean Power a restored me stop wenowNx win be dncbwgad to the cometual OWN,) n one Imae ei munmi rig the cell) ma may result an the backup or suHace discharge of affluent To void them on have Me contents of Me tank rmwM e a manage Sarvaing Opa. m me affluent wm01a ,lm or PUVnSPvni m auin n nu pri opmep the PUMP to to O u, norm d Mvels when MerpamPgank Donor aril, or park veboaas over tanene and map,mal not, 0o not dove o, park more, or afternoon domm or comps-, the area woman 15 fan down slope W any mama or at grade eon Vaccination me Rtlumim or elimination of me mllowmg from Me latewe w seeder may Impala me paTomunt, am prolong me life of the POwTS. nryhmnca, baby wipes, cpueve mum, condoms xt[m Swab,, degreasers: dmttl Mi At mvnfeommur its foundation drmn hump pump) water, hart and vegnffiIe p rmalg6 gaaolmp grow, Merman mean scraps, nemwampur mire mneng moducts, propumAps ,mnaly napkNs. tmnaoner and water „hmw arm, ABANDONMENT Wharf Me POV✓TB fall am/n Is community taken out of saww the milawag naps shall be mkm for Insure Nit Me ay,bn u PropMy card mfely abandoned an compbmm wit chapter Comm 83 33, Wnmmin AdmnkveWe Code I All piping to tanks and pans Waal) be disconnected and Ne abmtlmal pipe opemnps seats] e The mntads of all tank, and pits shah M remwM end prepvN nspose] of by a SUMPS Bnwcrng OPrenm. Afire pumping, at tanks and pits Mall be uc,rmuld am removed or Mae coven removal am the loch space tilled with Si par are,) Or another Inn mild matxml. CONnWMCY PLAN if Me POWTs fens and mmt by Ignored the fume r; measures he" deem, or must be mom, to wowda a code comphare remaa�pememt me,tm pal A suitable impressment use has been a elumed and may be pump for Ma mcepm of a rep)xmem in,; eLwrpom Imend ,rneteb s" from so ome =pnm prnd oposal parr mparcmd . bit maenrand ..� vmlms ton ar FictionUthe t be o�naram peal sun mad , a now sun a,he aWmmn to eameem m , mba Ieolummmant aria Pmbcemmmemos mile memman amform ev ply with Me minister ¢Ram n Mn ome ❑ A wnp replacement aatlage o semack and/or aml Lmrsom, Manuel awances inPOWR achnalogy, holtlnOtank may ba amtWed as ales motor to mice the failed PONTS !fA Ia a Ing VIA b aI 12DN181T✓;[] Top CeArsTxEvkD Q Mmnd and ngede rem memo systems may be roon,tUmp 11 pane flowing run, real of Me bpi n Me ,numerousumemm nion, RttnnsWnlona of such , Must Comply wan Me rupee In effect at that time c c WARNWG» BE➢IIL. PUMP AND OTHER TRFAn NT TANKS MAY CERTAIN IE711AL GASSES ANOIOR INSUFFICI M OXYGEN DO NOT ENTER A SEPn4 PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE mO s INBTA PoWTS MAINTAINER Name Nem Fhone _ L� Phan, SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REOULATORY AUTHORITY Name 0�yxp { Name I ST. r_ 1 ZDAIfA, fri 21e "758,- 4M I Final -Ifs— 3W(A- L40X0 ms oonumem Our drimp In o mgfam, wit mUmp Gomm 83 ZZOMbarrla161R and 83 64I11. DO A Pa. Wmemun AmlmobmNe Cape Septic -Dose Tank Cross Section And Pump Performance Specifications - _lRi g�IRT.S�� FilterMmufamlref Fdmx Model Number I I Miew�w qunp Paf Beguiled ZD� OFM (ul Ft TDH OWp MaMula Mm e' AMve Cando Wit I uig Devnm Inks McMok <6"Belo Grade Smled WitmigM MenuEmmmr I Model Nmber Akw Mmufwvum Akw Mack Nwmba gAk Sbilch Type TiiW is HealaD -Fag Ekvwoa Head oaw pm..m< Nowak Lon Farr Mein Lan O. 3D Toml Mao Wi Mm. l.m<"Abavae N `� Secwely Mow 1 Wpm b �3 y yo Watlhenpmof-4.nEJJ�� n -I amwm e_ —ll ham_ A F I 1 I WM V 1 11 11 D'iciannien Mmm Y." Weep tCo HokOffEkuvwnFt t0 :' Ek Wion 06NBm Ag. HyBfAL nON: The xpWdme amk a beddetl enil back filled m aaadma "ih me msnukcmm'a produm appmvnl epeclfiawam Mewmum dqm ofbwy m g ffiM by W mmufalumr may M M mcmlel whlwm poor eppmval. M ole coven exp y m grab tave vn eflktiva kcking devi« (pM k) imWleL Fpfiy a me ink ma Oink u of appnv mYWel, mooW m me tmk wiii velcdgM fining; ImmylMm IemJ mpvcisim mgaggmg Thef main oilm dw NEC 3M aOWCto!ridge AC mmvman mtl me 9mve u eNM wue4gM1t Elamml eervim eo�Bm wim NEC 1W vd Comm 16.ig WAC (Ma5W PW—_. of Pump Specifications �5PER .muTEi2o 25 - L L L— — �ALLWS PER MINUTE r ,, " 2, A I d ".. WLP1000/600—MR TANK SPECIFICATIONS MMENsgls WALL. r CAST -A -SEAL eonoM. r CDAER 5' MANHOLE 24' ID PRECAST CONCREW R14R WILMT W LENGTH 12•-e' WON >-N WLM INLET Ar LICUID LEA£L JS' M WT 14.e70 Les INLET AND W1LET A' CAST -A -SEAL SOOT OR EQUAL CASYET WLET AND WHET aKRE AQD 911E1 WSCCW9N. g DETAIL 00 (OTHER STATES SEE CHART) UQUm CAPACtn 22.ee MAN (WP%) 1675 GALAN (WMP) LOA ING ms(N: a'-N UNSATURATED YR TANK CAN K U30 AS SEP11C/9.PTC. YPTC/FUMP, OR SEPnc/ %oN W'hR MIX DESIGN EB (NO MR) TANK - MIX XSGN /1O (STRUCTURAL FIBER) WSTWIDED TANKS. FOR CUSTOM TµHS CONTACT WESUR CONCRETE d] RENEWED eY RExEw DATE g 4 y d 1RAWINGS SUBMITTED FOR APPROVAL AwwvLO n SHEET PSP2 120V C MODEL PSP2 1200EL ipOV 2-SAJF 00EYlCL p,I, -Oil pumptel pump =w,M�eN3 FLAP • Pll Paul; Rm mum (wSfW• u 0opmemps a mmA Xa♦ 6 = sups p 111 pump =ve=e IIROv = ols MI B=No ppACDmele v = lza vnc opuele Host nzAe, Bump='e*=n to A Fl.0 0 FWAt 9urpi"FALICRl10N e H Allwp(eulnm 711 11 Amos OPTIONS u+.r ,, It DIO Wall Nwum�.el se�aeamMill m r.mn..ae sI TO po = 20 mpMil Ar (n6 NJ s m.a_epha w.. Ift pE omm�ol 16A 10 III, m20A.,mw 30 mqu A AM It Oil SEA, few, z� psp a. ., zpipe clamp lva�m Malaee/ pipe Slump Gam Mi)• po N Mecnenicelp eRlial ♦ Mel whire(ed M Ib.O� N�NFYe M gir L'aei OIIns l)n MNn Pav[FN mP.,Ou A3e&M,FM i�IIl AMJ O. Po9l IIJJ mpnOMd,HI�ivna' AeoMbN na^oM9pyIII 2 Sam, 10G1A psv[I'[PbN90PP W.EnSA SIE�iMh=N,wNmubgpa LLM AaeA paaenwenurenm pmzvw.mw�msm20 vss>.Ilanr svps,we m.,m.a3 pm nears pzuw.�eN�„nw,p �m� srsn..s.-w, �,«em All lNneel �mm Nna n. all Call or f= your orderl .N...lCa IhIE(I-888.3<3-5753) • Fax 218-804613 Khl 10, SJE RHOMBUS www.:johearnbusco,n c we rurvce@Eleinc.cem CST-al,ao—soy ��� yg 202� SOIL PORT °���enf WM9P63B9.W Mm a �� nwnmmc -e Inbmuy'ngeMA alremm ena per' Plow pinf e111nlw ow. �u FIml VbinehWMNeglbhle ^� " n1ere 6.«..a F\.. •rr 'fa.K ���e ® Phi� Gwn.uslotlw 9� 66 ft M1W,b NiFYYAyY�F `96 �Npft ®GIB Gv+E a.W ebr y6 o GYft�b WNYglcb'�F © Bmnvx ❑Sawa I o e ',ern c,a ne.w.a fia. rt p.nA w AnM1np maolg b :...... ©:.. o® I, NA IN m FA m� Ummmmm" mm M" eoxnpx ❑mxna ❑re w"nmMurton, .Ao n ofignaummmelmor_m ewipr ❑Bmn ❑w Wxan Oqq pcmu m� nsall a nOeem^o TGAUM pyNbBrNpbc4r�A Boune.ry 'Effluent #1 v SM. 1305220 MIL fine TSS> 00 s 1 So mpg • EftawnQ> 8O0,1E0 nUOn Ond TSS I Ws 190 mph �IAYn� dlMsl�ry6eMue W Rolaoeb+ISaMm¢ 1 SOIL EVALUATION REPORT tiamw.rce wnh srs �ea.wm Mmcaca mow, }O i Jl :�ecagmm�mtIam0rwio tlspa�ni �nWo .lw'd iw, MWAtm3d Pleasa Mal all lnWalavon. nrvwnfM Cau flT 5%, IT F1'nA_ pwnrpl°�. � e_ ,.om .6o comb., Le tkl. ❑1 °Ll ®°pa°`° �mwwwmmx..-a"ft o�m�a.«+wudal9—� �Qv- 8Yi,c4 a lnwc gwraLr \o A""' - NE SE bR 19 0 Toga^„ ok 5rwr .P\ itix.) Sr Cto�k Ca \b 038-\\\3-q0 -000 MST To S�tlr, Y 5" Lea\ 3 Roag.,- l�'�c �/ � 1URp tiw Nw1L , Ky J-or \ �3 5r6n 9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CF.R I IFICATION FORM OwnerlBuver 13r is Ir Meiling Address 1444 Ito z7 14Cml ICaeLR..s.e.Y W SN�Dl7 Property Address 1 Tq { It Du 67, 0 �u�� nnCm,fication rcgmrtd fmm Pluming & dames Department for new Coastnmtmnt City/Sub lida4LiaParcelldennflcation Number C)Be— lj13 "2Q-rsD0 LEGAL DESCRIPTION Property Location -k'G, Y., sec. T NR-W, Town of XRf 0✓ee!/C. Subdivision Plat 1 //�� , Lot # Certtfled Survey Map# fyi2-Ia se-9f wnl/S ,Volume ,page WarradntyDeed# G78578 (beuremo7rvomme Page Spec house uy,,Q, Lnl lines idemdirble 0yes0no Impmpe, nxWmu tpn<e Orrvmsepu< mole multi upremu rtrnnrt to nutlle» Proper a ofpump ng om Ne equinmk every rhme Y ee * nr mntg Rnmletl by l,,m a p,me, eB ,l you qn mm the system Can ulfx the funeton oflbc spec lank es a Comment stage in the want dmposal system Omermamonrr<me responsibilities art dictated in silos 383 5111I and an Chapter lE -Sin ('mix County Sennery Cadmium The pmpenyuwneragrmsm,tur milt Cmrc County Planning@ Zoning Capartment aamfiatmn linen,agnW by in, and bya er plumbentomrcyman plumMt aced plumMro elatenxtl pumper �enyang Yut llltheoto less than 1/3 f¢I oil of system n an pmpnopennng<admm mGnrlyl site arupapnn arm pumpangl'frcaavryl. mbt ssPt'<ran4 ai aull f slWge Vwe, the undemgnM have mad the aWvt m,mm mmte end mm, to meadows the prone sewage tloposal system Arab the Wderds set farm, mom, u at by the Oepanment of Safety And I'mlessmScoSconcesnal Sconces and the Department of Scandal Reurm we, sale or Wismnsm. Cemfitmaon swung that pan' scene system hoe been mamnarmd must be compleud and rammed to the St Cm,, County Plmmng @ diamond Department %don 10 days of me Nree you expam inn Chad i muly may all shadeint on the famake beet ofmymmkmwletlg, Owe moms M...... loft,, pmperry do'enbW ad..e, by rinueofevnrnnaY dml moNN an Reysrnof UeNs OR<e Numb rof bedlroo ®It0 SIG AlIRF OF APPL[CAN IS) DATE •. Anyrofommnon Cat n mmmpreseiatN may mull an am s nuu y semi Causing mvokN by the Plan nang k C nang Exam m'ent re Iodine[ wed Nap application reported womanly deed team me music,uflumd, Office and a wo, of me causal survey mpR reference is made In the unmanly deed (REV. 04111E) 4sl Yy iimp �ar BYM.C�.1 1�1�C tY&2\ly (U� 1k aa.A�b3 \o iK-Y.n.S - dE-S� baL as T31 U - R 19 W Toa^n aE Sr4.r �4s..�Yi e-� 5f Cfok Co- '��` Nol ?a ScH,li ' k B6wn�F / kx, T„� 1...�,. •(ns,a- Flo S � �v � 9 60 ({3 1 r rr lw d 0 s