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HomeMy WebLinkAbout231-1047-70-055 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name- Ray & Yvonne Saxe City Village Township CITY OF GLENWOOD CITY CST BM Elev- Insp. BM Elev- BM Description - TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic cow�,� � ,2.(Do 71 Dosing uD Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 1� Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer L 14I e ❑j ian Demand GPM (,r m At( 9� Ell), 101- Model Number 9L� TDH Lift Friction Loss System Head TDH Ft 0.525 Forcemain Length Dia. Dist. to Well 22 2 . r2 SOIL ABSORPTION SYSTEM ELEVATION DATA County- St. Croix Sanitary Permit No- 651303 State Plan ID No - Parcel Tax No- 231-1047-70-055 Section/Town/Range/Map No- 27.30.15.754L STATION BS HI FS ELEV. Benchmark IOD - DD Alt. BM f Aug, i5v' IC�14I Bldg. Sewer W.2 102. I St/Ht Inlet s t Dt-atef Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover ci e�J�o(�_ (� I OD. oD cbfma 4vc BED/TRENCH Width Length No. Of Trenches PIT 97SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �0 2 i �� 5 - c,4& µ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer - INFORMATION CHAMBER OR UNIT nOf System: Type J�� I Al I ' Model Number- DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia Pipe(s) I ,� Length x`i Dia 5 Spacing SOIL COVER x Pressure Systems Only x Mound Or At -Grade Systems Only Depth Over Depth Over x Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges opsoil � �2 Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 165 SURREY RIDGE TRL 1.) Alt BM Description = /j� 134411nS cw� �VunJyli°n (9, l;vkne Of ivlsPec%rurl• %JUPS oh e,,,,I5. OiO .IJti}�o✓� pipe- ,�s I$ i;NA _� 2.) Bldg sewer length = kx I#A)e- lo' 22'� (�' �DN" - amount of cover = qhA 13' -I-o ink 3: Sal fi�� ply,,. �� plt,"Lt, W_&<< of st.,d fv 9� �, b�l p;-, 4,o ple„0- y'. G(�,�o�tic��lI-tin 4�n/t� �ja�se. Ste, pA`(a - Plan revision Required? ❑ Yes ❑ No I Use other side for additional information. I 1 1 2� � I I�j Date Insepct ' SkJDAture Cert. No. SBD-6710 (R.3/97) Department of Safety & ProfessiensJ Sernkes,, __ 28 2023 Swituy Permit Mmmber (to be fi I I e4 in by Co Industry Servim Division 1363 Cl I [TI ti SUran-sa�r� c% Number t Applicati M T on In acconiame with SPS 383-21(2), Ms. AdryL Code, Submimion Pf 1111,,; R)T-rn to thi2 :appropriez gave mmcn 4-ij umit 2 052 — C, 15 requirW 'or to ob PD mmi%l a 5xiltary permt NOW: Jkppfiollion, formq for staic-owTted POWTS are submitted To F*vj ect Address Ci f differmt than MaRing addnm) the Dqnmcnt OF Safety and Pmfessional,SeMcm pUsOnal inkamation. you pTovide inay be usfor Secondary __purposes in wxordancc with the Privacy Law, s. 13.04(t)(ro), Stmm I. AppHeation latormatiou — Pk=e Print All Informsation A/os Pmpcny Owner's Name [::LL . PIMPerty OWM*s Mailing Address Proptrty Loicalion city:. slatc X -,20 0.� 7 3 Govt. Lot Zip Code Phaw,Nimmber ]/�, Sct4un_,27 944;0 970 961(- J-5 73 11. Type cif Building (check wx�­ - ' an that apply) Lot # T N R E I L4O IM I camily o-2 I - Dwelling — Numhcr ofBedrooms SubffivWon Na= Cj P'Lib I I clComm ercha DegcTibeUse 0 Block ft P-0i V �V I &A 9 City of Z.-I 4J.0 0 A7 0 State Ovvned - Dc!scrite Use. 6049- C�NW Numba 0 ViRage of E� TMM Of Ill. YYFe Of POWTS Permit: (ChB eltber. "NW or "Replacement" and other applicable on one Check em box on Aw R. conqdeleAm- C h a]PP qHWrr.,1L-.,_ A. Ncw Systam Replacement SysIm O&a Modificai o n Up ENJ s-.fi n g S v.st c in (c xplaim) G Ad&iuiial PFUtlealMtrnl UF13-t (expbin) B. ----------- F] HoclingTank In -Ground A T-Grad e Mound Individual Site De.-jg'n LJ Othcr Type (exphLin) C. Reneunj Ber(),-L- �D Chan gL -ol'Plumber E] Trmsfer to Nc%v owncownerL,151 Previous PCTH tit NumbtTaW, Di Vic: I-rsii;:d Expir-aitan 1,2- 4 cM D TV. Disp e rN alffre2ftftt Arm =d Tmk D�ffffl- C-) aflon: �m Mn, D c-sign Flow Wd) DMign SW A05calim RAWzp&st) -11 Dispersal Amm Requin%d (sf) Dispe I A= —Proposed (sf) S)"51CM FICVallon V111e /L 1675 667. capw*y in TotW --T Tank Infomatioo Chdkms CUM= Ual-L%.5 173 Naw TaMb wsthw Ta-du L& M 11-j U) SCPI�X or U4Lk�- I " �, - Dosing Cuam��—:r— V. Responslbfty StatemL-nt- 1, the anderdwd, WSRUM inFtafl a tion of Abown on the a ttatbed phas. Plumbees Name (Prin. t) = ftR Plumbcignature 1-0- Bush im Mme Number —7, 711. Plumbcr's Add mis (S truet,. City, Sta tc, ZFp �.ode) Zko" A iw- 5-Y776 V1. Departmeat Use 0jjW' AMoved Disapproy Ptnult F= Date Witted En Agent Signffti= $ Io %. on for Dmm.i a��5�- lZ 7�23 Conditions o C4L MA "S"Y STE r-A OW NEE R 1 P,.,c ta r, effil u & Fi t fi 11a r and d dispersal s persal cell I . Sc i4AZ& pet rtk L4 MUSt be as per liagen-,jean, !,-J11::J-i ;-"rov.1';Lk;d by plumbm 2. Al I setback, r1a q!j I re �-,' r! [ S :)�! i sl he m N n lait n ed ,� asper applil c, a b- I-- Att3ch try COMPIele plaw for the sysWw maid submit to at Cmnty 0* an pImpp, "t ]CM M9a ]/Z)E JL] JeChe 1 5 If -S'LID-6399 (R- 0-3/22) I k� A? �` , Yo h,,wt-: 71 67 L job-0 i • �3. � tf ' .,i� 'l ; 'r r �` f # ri , a� r � r . _ _; �+ v e � ,_� - Ay � �s } _.�; Y *'irkAr , Yi*. � _' y {' aX` � Li�i �_ ..� ^ 9� f �, i '. erg- - � •�• _ ?'a -" _ r r .F � ' � ��� � `� � � ��f, _ �# _ � h t _ F pry 'e' ��- _- t��s � ♦ S. , c E s , � 15� g f qs k Jr- ty f - i _„r,.. � b.r �-�Y _ ,:. .�`a - -. ..-. - ='ism �..`_•{ .. "f-h.-�'� * �-- � 3 t. ^i k .V - - f '.. i S Jl ,. � ' _ !a. �7 �'4'�•. .,P�f{_ 'x - � - a � r yij � € + - �A rz. ,': �+.i��► { 'e fT.i� e. k - i'f S`+ --3 �: f+ i -;':j �,.-.. �4 r\.. . t z. f`:3., -rl {`,-�•. P;'-- a� ; ..';'�. - Wiscqnsin Departiiwnl of'.Safety and Professional Serviccs DiViSiOn Of ln&L'S_tSVr_ViCtS 4922 Madkion Y-11 T-ds, Way PO'Box -302 MadlNun, Wi 53707 Septeniber 15, 2023 .ENT I 10K.L PO BOX 10 COLFAX, W1 54730 FOU110, FITMJ PLAN AF I I I� ( )v,k 1,. LX 14 1 H ES: 091,15/202 5 MUNK` I I,A LH N.- CITY OF G L INWOOD CITY T. CTMIX (.'01_J'NTY SITE; RAYSAXF 165 SURREY Rl1)G11'_.TRA1L G LEN �V OOD C1 TY, WJ 5401 N W 14 5"s F. '1 /4 SEC 27 T 30 N R 15 �V FOR: Design " a ew�i i c r I. 14 ) �N \ `3 111 c -. N Redrooiw,. 4 Liniftin;2, 1-"act0r-(,o:_"7 I ticks Maintenance Required: Effluent Vilter Phone: 608-266-2112 Web: Email - Tony Evers, Gok,ernor Dan Hereth, Secretary Mcntificat tion Nuirnbiers Plan Revieii,, No., PWTS-092130205"2-C .Akliplication No.: 1)]S-08233; Site I D No.: S I T- 120789 Please refet- to all identification numbers in each correspondence with the Department. C-ondirionollily APPROVED DEPT Of SAF5-tY AND PROFrESSIONAL SEIROCES DrVISION OF I STRY SERVICES S E CORRESPOND F E.Elp Mound Componem %1,-dtiu-Li1 -'version 2.1 (May 2022-2027) Pressure Dictnhimoii Coii-;ponent Manual - Version 2.1 (May 2022-20-2 7) S IT E R EQ I - I R EN I L"NTS A Iti 11 size copy oftlic al)proved plans. specs tications, and this letter shall be con -site during construction and open to -Fispection by �] Ll t 1101-1 I.Cd VC1)VC1,CJ1 (a I I v es or the Tkpartment, whiChr may include local inspectors. A Department electronic stamp wid signattirc shall be on the 1)lanq which L-ti-cused at the job site for construction. The following conditions shall be met during construction or ini(allation and prior to occupanc,v (or use-. 0 A san i lary pemi. I ( must be obtained froni the co u tit y w lici-e Hi Is pl.o.jelA is I oca I ed i ii accordance with the i-eq Ll I rell] ents of See* 145.19, is. Stats. a [Irlor io the conwuctllcm ol"the dispersal area, chcck- thc moisture contew ol'ilic ��oil to a depth of'8 inches. Proper soil . nioisture content tali be deternilned by rolling a soil sampIc between the It- it rolls into a `:r,-Inch wire, the site is too -wct to prepare- If it crumbles. �itc proparatiori can proceed. If the site is too wet to prepare, do not proceed until it dries. 0 Inspection offfie private sewage sys[cm installation is required. ArfLang ewel i,r s for inspection shall be made with the le, ignated County of-fic-al in accordance with the provisions of Sec. 145.20(2)(d), %'is. Stats. a A el'lluew filter is, reqi.nTed. M-aintenance infori,ilation niust be given to the owner- ot- the tank explaining that periodic c1caning oftlie 1-ther is reclLj'tred. 0 All p1pincr shell con).'Unli to SPS Table 384.30-3 and SPS Table 384.30-5 0 1 ns u la t v 1) n i I d i ng sewer beyond 30 feet per SPS 3 82.30 (1 1)('c) 0 Well ;l c t 1) a c ks to ni ee'l clis - NR 9 11 &. R 12 9 Tank1ristallatio[i to f'011ow all inanulitclurcr'-s 1VC0111T11.L�1­1dationS. 0 Verifiv prol)(-riv tine(s) prier tO inS11111ati(Al. 0 Punip F Jo,-tls to he set and, verified per the approve(I plan. OYMR RESPONSIBILITIES s The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner`s manual for the PDWTS described in this approval and ?his._ Admin. Code §. SPS 383.54(l.). s In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, scats. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval, the Division of Industry Services reserves the right to require changes or additions, should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, <Worioeo P95561 Katie Petzel Division of Industry Services Phone: 608-574-1189 Email: katie.petzel@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 Onsite Wastewater Treatment Systeni- Ludex and Title Page Project Name: Owner"s Name: J I Owner" 9,� A(Idress j�) 4��. W602 73 z/- J-5 73 Lecpal Dc�sc -Ptiort: laicipality-. vi4ag of C 0 Uarl Lot NurnbeLr-- Block Number: CSM Number: Wil- ?,e Subdivisloia Name: 4/ 5- Palcel 0 Page I Index and Title -page Page 2 Plot Plan ?age 3 Cross -Section & Plan View 01 _Pa-rre 4 PiPe Lateral Layout Page 5 SePtic Tank / PtLmP Chamber Cruss-Section & Specifications Page 6 APPROVED 0 F P r 0 F 'S, A F E T Y A NO P W-1 F E 4SS)ON A I'UmP PeffOrmanm Infi3rmation Page 7 SERVK-C� PO-1) 1 V S I N 0 5 . I NaIJJS 19 Y 'S E R V OC E S WTS Owner's MMUS1 & Management Plan Page 8 POWTS Owner'js ManuaJ & M=agement Plan SEE CIE P0,40 Cr Fi I ter ICORRESPONDii forl_ OA Name of Desip, e1r: /V Uc=e Signatue-- 11111111,11 .. . .. .. . ... . .. .. . ... Daftv- t1D the &A,10win z PO WTS 'Cow p oin ent M an pal WA PLP�;S 3 8 1 r3 a 5. .:...A4ound C rnponeM Nfiwaml jDr pOWTS" Vers, ion 2,1 (May 202-1-2027) rensure 'stribudcm COMP(MM Mwfial for POWTS"" Version 11. (Mlay 202 2 -2 027 /VttaelirrlejjT:, Soil r--vallialif).-I Rerv"T I k� A? �` , Yo h,,wt-: 71 eject 67 L job-0 D 71 :c t E ft U PTURN ED LATIERAL & AC CESS B OX f t OBEER VATION PIPE & WATERTIGHT CAP G DISTMUTION LATERAL fin sch .4 pur. ronor ARTM r-lq z)k ft TC)PSM Uteaj Invert El.= ft -�Jb4d2 5 7�. 49 f t f t TOE 0 1 E 3 'k MCI a FA 4% P m f 4,pr 14P *.f dib A 0 we PLOWED SURFACE dr % SLOPE I)ISTRIBUTIoN CELL X FORCE MAIN (2 ri sch. 4 0 PVC D2 ad'65�)Jb — Z6—'o ft = — 4/40 ('1g"-2Yg" @ggragato) Mtn - Reqtjked w 4 11 sch. 40 PVC obs-ervation pipe m r Z ft o L: QL 21' 17nrr-cz N&Mir-, P bl'i d is, i u f b a n c e cl ncl V c i-,,Ic �]o Iraffic wilhin 15 ft of domislope loo. L — 1 117.8 Basal Area :-. i PLAN �ffEW OUND ft2 PIPE LATERAL LAYOUT OF jM0QND (center Manifold with Aggregate) ROLE DlmommR i n LATERAL DIA. i n MANIPOLD DIA. (SIC11- 40 JDVC Pipe 02666) FORCE MAIN DIA. in(�y�e . L,4e k,14' soa 0 Access p 7,Vf tA Box TINA"' S = t. X .3.9 tpt. y 3.9 x % \A0\11 Ylir^ x S -.3 op x p� x p , HOLES LOCATED EVENLY �\0\11 1/975 0N BOTTOM OF PIPE, Holes�Latpr,--jj y V Laterals 11 ------- 4� S,2 (3116") Holes x 0.66 gpm / (3/11y) Hoe - 3 Y. 3,7 GPM = SYSTEM FLOW RATE PI P E VO L Lj N-1 ft. [ a te m I S (total) x g I? = —Z7 x 5 B'F. 7 GAL MINIMU&q DOSE VOLUME P"I P E I NVERI C- I- V'1A .-I orq !�� k T-- CC" 33 ­� rLi -�L7 it r-'witl = r7NAL GRADE MAN H () L E R] SER & COVER 'rzTcl P! SPS 384-2-5(7) & (8). appruvw -'� -ground suftim a" from Wdgirg dewks. AL w8mft Wiiit Eift d 1121 nhde(s) for pmpa drainage) mmft e Tinr as % 4" Min- Sch, qa pVC Tm* Ven, SCh- 4 0 PVC T,-m-k Vunt C7MICAL 0mited * grade or 24- BUILUING SISIVER kx:M2d I Ly� abOvL- .9 rid 1.2abcve JUNG"ON d e or 24- BOX abt3ve REV10m] Romi Sev#wn Ipar SPS 382.30(il)l above Rp4onWl Flood Bevu6t.-) (comp!Y virith aps, 3 16 aW NEC 3!0 rz� R C E [VIA] N 0 P7. IONS owe A I 77-�" FQFW U Ink izap E 7 71 40of 4 .0 A= FI= L I R= TM% Aparmed EMuent, RLU On Raqided On OuDej, A ave- ---------- MINIMUM OF 3- OF SUTT-Aiqj_E a EE)EW NG SENEAT-Li TRIM' & JVVVJ1MUM SURY DEPTH OF 96-0 Anchodng of ink MY b8 i0q Ui red Pei- 8 P S 283.43(8) Lq) Tank ManuftcWrer. i&Zeej e4 Z CA) e. QallY Wastewater Fbw (DVVF)-. 6106 --GP,D SGOUPump Size," 2,11 Or's Numbe'r of daily closm: S. 'W 7. 3 C2' Alarm Menuf�urer- Model Number- Force miry volurn e- ,7 5' it t ga Vft J/ gal Switch Type: jevie .01 e. 0O.L Actual dose volume: la?6. 1 ga I gal (tctal use volume - -volLime of fons main) Effluent Pump Mangy chftr- 4 .1 MOM Ntnber. 2MTANK 19&.6CITIES: MInImurn DISChar!ge Ftatt=,. T 3,� Lieserve above alarm gal (D) GPIV Alarm float above on R'Dal -1 gal (C) OnlOff in= 9a i (B) Venice.! ffft (Pump O to later -n-vert)... ffaw e. 1 n,= ........... _JZ7.9 System head (distal pressure .7. 5 x 1.3 ft): 3.3 ft gal (A) ForCF- Main x /100 fticfion factor 6 PL DOSE :iLftj F-I Iter frictfon Joss, T' Length . AV in Width ITI Total DynaMIC Head CM H): 7 hot J4 ;( �Ie ,)4. (, of 9 EFFLUENT PUMPS A, T 9 aq 9K-aM 9EG43A-qF' fl-Ou (280 mm) 8-T (226 MM) TIV CM mm) AL CNN Epaxy-cwted caa] *Thurso I P�stj-c M040f Epoxy- coat�,., 0.�, I i ron ;,-la5t0MET Non C199 !,oWe - EpqV-mtLd cast. iron .-lle with carbon and ceramic Beadrigs ball beari %"r Cord SJTW "lasiTow ip on 59 Moft , 00.W W-M-RF MW vu tj 150 *1 Fran kfin igle ric ft'im"I.MUM I wff"WeWflL[cM Pace MANUAL AND MANAGEMENT PLAN FILE INFORAIATION Owner I ,L _.._ tif7 tr:(Apro) 1 a �gn flow, iDW') =. Soil Application R laflUeja'U"EMUent'QU'al,jtY FaLs. Oil & Grime (F) 0 i+ i l XVia'� Demand D, L TO— ',Mded Sob ds (TS S) 150 rng/L T ��� Solids ( ) Fecal M—! _ c mom) — ffi 10 cful l 1 i um Effluent Particle Size 1/8 inch diameter MI fgJA4Number- L16�ontal Dis=ce T s to ice f .�.__ 13 NA Soil Dispersal. End Cap f -- U jack ' ° - . .��i 'sTotal 'T ` h - _ 4. F At -Grade s° �Sr (Pressure or Gravi ' y r i '°.... .Y.. -14 0 Design Of Pressure Distribution NetwD& for Septic Tank -Soil Absorptiol- I blicatiOn 9.6 (SS VVW 14soud) 77 "'E-Z Row Mound Con'Ponen't Manual" Vemion 12/15/2017 (April 2018-20�'3) ° �I g P Version 2. i (May 2022- 7 0 Other. r POD." Version .1 (Ma 022- 0 ) MAINTEN�rIVCB Mc� BervEcz E►'Mt tT�1 S , Cie= filter hispwt ME 13 mmths 9 3 M 0 Vie: IS, al=rk PlebmtMent 0 3 yean 0 NA At i yem13 NA For new construction, pjiW to, P' d or oth r � Wingt pr e the cola ed the et mand/or i cWs - [` do t itye otor p�rtir t t the �.� su Abell not occur whm son eojjdjfi0= S" fraM qualityThe W� 0"" is =Ponxible for the operation md — erect tine mibm6sion of " and Iotng t of our �' vM. c installation, of water saw ,: aloe Of lCa m ea at ertc�, i rcmaval Units, clear d fimdaWn &dm5&xW be inc I u de laundry shoes the 9mund surfa= weer pesMblc.. Note: this does not This system i I hW I e +eqi te seeds, bones, f se r, t he dispoal of food, based, o , veto left able i[7M"1C ��should b mi��edToilet fime 3 �be cNigeinto the + ical% per that dentalcis and cotton t • p co g are e P �il." fl{�tsi ` ySUCh � co • t O UT an vwtem covwnmts- compaction i0fMMOW C)Ver&e wa&�Wg fi=uoold tho WOOL Avoid vehicle traffic over . drink' vraters I Page 9 of 9upp y. Maintain a regular steady flow by spreading allsystem components. Compaction o f P g laun dry washing throughout �e week. Avoid vehicle traffic over P snow overthe dispersal unit may cause it to freeze up. INSPECTIONS ENA CE: Inspection shall be made by an individual in of the eercertifications:Masteraster plumber., Master Plumber l�es�cted Sewer Po�TS il�iai carrying g one , following licenses or Maintenance Schedule). Tank inspections must include a visual inspection nta�ner, or Septa�e Servtctng Operator {per the attached sual of the tank to identify any missing or broken hardware., identify any cracks or leaks, measure the 'volume of combined sludge and scum and check for an backup P or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greger than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthori=d a the Wiry tanks. When the combination ofsludge and scum in any tank exceeds one-third (1 /3) or more of the tank volume,,the en � shad be removed by a SepMge Serviciq�g Operator and disposed of in accordance with Ch. I�R 1 lire contents of the Specrfic servicing mechanics must be provided. if vertical is >; 5 feet or if horizontal is >; ao Feet and instructionsl t be provided Admin. Code. o be provided below - The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids accordingto manufacturer's washed from the filter shall be retained in the tank. Filter cluing may be necessaryat more frequent e ' specifications. Solids maintenance schedule to keepthe system��g- o q tutex�valSaa stated in the Alarms should be tested on a regular basis by the home owner. if an alarm sounds, contact an individual licensed to service P O TS There is normally a I day reserve under regular operating conditions, however water should be conserved until an problems with prevent back-up of se Y P the system are corrected to g g wage into the dueling or surfacing_ A.BANQON ENT: When the POWTS fails and/or is permanently taken out of service the following steps shalt be taken to ensure that the system is property and safely abandoned in compliance with Ch. SPS 383.334,Wisconsin Admin . Code: a All piping to tams and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and property After pump' a all tanks and shall P i�"lY �Po� of by a Septage Servicing Operator. F� be excavated and removed or them covers removed and the void space filled with soil, gravel, or other inert solid material. CONTPNG NCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compl i ant replacement system: 13 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement arm should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existh'tg and proposed structure„ lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement systems must comply with the rules in effect at the time of replacernenL 13 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding rank may be instaBed as a last resort to replace the failed PDWTS_ 17 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be perfarrned to locate a suitable replacement aces. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. GF Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions o,fsuch systmns must comply with the rules in effect at that time. M'*ARNING!►:t SEPTIC, PUMP, AND OTHER TREATMENT TALKS MAY CONTIAN LETHAL GASSES AND/OR YNTSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCLNSTA.NCES. DEATH MAY RESULT. RESCUE of A PERSON FRoI'I+t THE MERIOR OFA'I"ANK MAY RE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POTS INSTALLER Name: r axe .� Phone: IT Z C-,2 _ V/S SEPTAGE SERVICING OPERATOR Name: Phone: POWTS MAINTAINER Name: "� �.+ Phone: Aco?"ll-cr LOCAL REGULATORY AUTHORITY Name: i s eA,.O' cr�� r �► . Phone: 715" 304 ~ d490 Oi. 9 a? M81t1�118I1Ce Insftwfions Akin m BN�e�efteae�,► Hwtoclowymff rlp�eotRbe� To ens yw eNuentIs� � fir l �. it mid be eevery yaa� ilnder norms condoms �,�. � � �� �►eara before � � 5 -� �„ s�hau�d be cleaned y� �{+ h ��� t�rgw � a w i� RiBMRi�s[P.S is Pumped, ft ffer should be cleaned whenevOr the tank moa pevp[s proft in have a sopft ur*s �c � �� � �n the YvUow P amof tbrm�nance and �u ken find a r a �• undue• Tangs & ' or Ctn e � � heahh lf VOu wish tO WWa ardor clove Vwr awe* a 3�ur�e #. he sane tv S dress wsk 9WM and � or &o Then � thm w a�ruw �- �r �� Pena and shirk � 1. Flenift the access Rd to YwsoPficU wiscrokw nk 'fl9 ts � bys m Id � � hid winch PWda .. If mo Id is *" d►1tvA ba to 64 SW tt mrtrthat kxkTWi ktsanw 2. Rwww the CwWga I?f W84ft to tee and itoutof" its handle f p,� t� 3- SPrGYI*cBfWQOtba wkhahmjaram ow any MBWW sticit69 in them Ism PIM A Enme the ftm vnces inthe 00" ffuw U*ubft biddefe are *ar Of 8W dob dL Maim me#* waW 10 Im housk1g. Rr* Place the carom- w beck into the 5. 3"w eMuertIftm eww wft as akn * a� when the iftruseds so�, if you base an aImM c'lo sure kisVWdft ffftft wvbaSkLA�na�h©rn��TW� owis Ont o We ofthe himm or in the garage. N IfVweffbwtSwdvesnfthow as #mjyou - ��cfeared 1Ur' front rm� mooft u she d ato =rtn or =de,9W� arsysWft lnt�u 'h" - �'■�' ?w AMch aumm Id byPlackV itor,.# aIN maux theav� in ow Rd w�h tW bmC �C Id bob bo coU$w andjgWwwdh hex head VAInch PmWdbi r aw I. JfwmQ Me f, r cartridge by Mg it OW sf I& log. ftfo3vta File #- ST. CKo UN-4-Y SANITARY SYSTEM Office Use Only F- OWNERSHIP/ADDRESS FORM Created 212021 L— - - ------ - - Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater f g surface water, property vaiues, and county resources. Once approved, this completed form and edUcational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scariried weblink. OWNER/BUYER INFORMATION Owner/Buyer id Li 0q u Ln�CA a X& {-' l Mailing Address U "Wim-A) City/State/Zip Phone Number (required) Q 70 Email Address (required) C-1 Pa -4 rcel Identification Number $.1 (found on the property tax bill) I ZL 14F93*P NL I �uK@Ykl 4 0 Property Locatin Vo1/4 , Sec. T N R W, f ux1 q V Subdivision Plat: Lot# Certified Survey Map1,---- Warranty Deed Number of bedrooms L4 New Property Address (Staff hltlals) 1. Volume (before 2006)Volume Spec hOUSe 0 yreS IQ no OFFICE USE ONLY # Lot lines identifiable 0 yes 0 tic) (Verification of now �-HJdress required frorT-, Cornritimay Develupruenl for new con struct;orij This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications_ N e vv System: Include with this form a recorded warran ty deed ,turn the Register of Deeds Office ors d a copy of the certified stirve,,, r- . 01 oGp if reference is made in the worronty dee-d_ ommunity Development Departmetit— Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax j 1101 Carrn ichael Road, Hudson, W1 54016 ti i t:i;c�,. LJ N I Y 1 SANITARY SYSTEM File # Office Use Only OWNERSHIP/ADDRESS FORM Crea red 2/2 0 2 1 Communr ty Development Department will utilize tliis lnfo!-w,atic�n 1C, �_,,,iuv cle on reg T L -y Sy5ter'T11 TI­is informat-tarding operation and maintenance Of YOUr new Dr re,.,,lacet ie 1, saf itat inforr-nation will be provioed as part of cur ongoing efforts toy PI-0teCt I)Ljblic health, your \%jell. -_,Iroundwater, surface water, prcperty, vallues, and COUnty resources. Once approvea, this cornpleted form and PdUcatiOral I I a r -y pet-m Y(141 ran information will be sent to you by email. :f YOU W0(Jld like to Vi(?W yoLl issied sanitar I I (110 So hy usinq 0',f e Pro et Files Scannlink. Ir i"RAEF Meik Owiier/Buyer P-*N ol-, V t,v1-ji11r1g Address 7 -2- City/State/) ro4,­ c) Phone Number 'required' 7C &C Emall Address (required) :5�4 C-� 0 Parcel Identification Number A� lfcunc or the pop rorty tax hill) 4 NEW SYSTEM: LEGAL DESCRIPTION Property Location AJ4V11, C7 4 S e C T 31 N Subdivision Plat-. L# _Zo� Certified Survey Map # Volurne Page tr -:?77OS70 Warranty Deed # (before 2006)VOLMle page it Nurnber of bedrooms 4, 1 Spec [-,,oease 0 yeso Lot lines 1dent1"fiE---bIe_S 1:1 no OFFICE USE 01 J LY New Property Address ) (OS� Z7�144V_15-Y R I bG1,-, 71 R), , k W Clic-IS ) Wertfic-ation o- re-�-� address reqiji-ed 0-0111 CC11rT'L.ri,-,v Gev0n:)r­)f,_n1k DepIrtr4w fi-,r coll"11"ji''t ("J", I ° �� 2Q2 (St;ff Ini-L 1 0 "3 CM� e This form must be submitted with all Privote Ot�7site Water Treatment Systeir (POWTS) applicatioi�s. New System.- iijclude, with this form a recorded warrGlIty deed from the Register of Deeds OffiCe GOd 0 CGP�l Of the cer-tilred stirvey moo if f-eferefice is mo.de �'n the warranty deed. CwTir-nLJP11y I)evelcTment Deb4artfneiit — Land Lige Ravi sine o 71 S-386-4680 SL. r Croix County Government Cei)ter cdd@sccwi.gov 1101 Carm 1r, liael Road. H Lidson, WI 540': 6 7 �5-245-4250 State Bar of Wisconsin Form -2003 WARRANTY DEED Document Number 11 Document Name BY THIS DEED, Georgia Neuberger (hereinafter "Grantor," whether one or more), convey and warrant to Raymond R. Saxe Jr. and Yvonne M. Saxe, husband and wife as survivorship marital property (hereinafter "Grantee," whether one or more), the following described real estate in St. Croix County, State of Wisconsin: Lot 12 of Certified Survey Map No. 3050, recorded on January 30, 1996, in Vol. 11 of C.S.M., pg. 3050, Doc. No. 539028 being located in the part of the NWt/4 of the SE'/4 of the SWI/ of the SE /4 of Section 27, Township 30 North, Range 15 Nest, City of Glenwood City, St. Croix County, Wisconsin SUBJECT TO AND TOGETHER WITH non-exclusive rights of ingress and egress over and across the private roads as more fully depicted on the following Certified Survey Maps: Certified Survey Map No. 3047, Vol. I 1 of C.S.M., pg. 3047, as Doc. No. 539025; Certified Survey Map No. 3048, Vol. 11 of C.S.M., pg. 3048, as Doc. No. 539026; Certified Survey Map No. 3049, Vol. 1 1 of C.S.M., pg. 3049, as Doc. No. 539027; Certified Survey Map No. 3050, Vol. 11 of C.S.M., pg. 3050, as Doc. No. 539028; Certified Survey Map No. 3051, Vol. 11 of C.S.M., pg. 3051, as Doc. No. 539029; Certified Survey Map No. 3052, Vol. I 1 of C.S.M., pg. 3052, as Doc. No. 539030. Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. (SEAL) ����,����ii �11 i�i!!►1����� A1�r Signature(s) authenticated lin ; 1000 oil TITLE: ME11►I A � �NSIN 0 . (If notti� authorized by THIS INSTRUMENT DRAFTED BY: St. Croix County Abstract &c Title Co., Inc. by Kylie Friendt at the direction of Grantor. 23-S35800 1164883 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/ 17/ 2023 12:02 PM EXEMPT#: REC FEE 30.00 TRANS FEE 196.50 PAGES: 1 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, WI 54017 231-1047-74-055 Parcel Identification Number (PIN) This IS / IS NOT homestead property. ACKNOWLEDGMENT STATE OF WISCONSIN } } ss. St. Croix COUNTY } Personally came before me on the & H&Tch MIZ the above -named Georgia Neuber er to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. YA-V 4PQ/FW�T Notary Public, State of Wisconsin M Con n�i ssion is ermanent (expires: Y � P �� P (Signatures may be authenticated or acknowledged. Bath are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. St. Croix County 1164883 Page 1 of ' REAR PQIR(dH r i 1040 " L T JjEDROQtdI I' 1' t� I /�� i _ MEW e T 6 F4 x f 2 I - i. ff6 �- - I _ i'^ : f CI-0 x 6-6 &4 �jj '¢jay _ Tel i R� jTu !� nm q-4 a 6,'Hr I g@ fT us LN q � � w ! 10 x 8-2 �'T 10 1 C4. CT. Hr. -I�m , _..®. ■ bar mom-: -44 o r- q.0 (2ARA6E - lb-6 _ LIVID . I DINING _< tact . H --------------------- l3Fm]2RQOhi2 11- 1 - e FRQNI FORC - 0 g� 7 i 44. 1 Wisconsin Department of Safety and Professionig Sevices Page Division of industry Services SOIL EVALUATION REPORT In -accordance with Pis. Adm. Code County Attach complete sde plan on Paper not less tnan 6 1/a x 11 inches sn size. Plan must ft[ude, but not limited to, verl'Ical and horizon al reference pol'nt (13M), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R ewed bye Date Personal information you ravide m _P av be used for secondau& LPriva L �12 2023 Property Owner /F'�) 3 Property L.ocafion �F C Govt. Lot 1/' S T N R IeE or W Property Owners,�Vallllih Aclidp�ss I Lot 9 Slock # Subd. Narne r Cp# C1 1/30 _0 s city State Zip Code Phcne Number C city Village Town Nearest Road 4 -, 4 1 ' ay L.� .4 L. New Construction Use Re side ntia i Number of bed room-s Code derived design flow it c C> G U T"XL( Replacement Public or =erda I DesDescribe;, Parent rn ate ri a I '/Ar V JCS ' �e-f Flood Plan elevation if appJicablj13(_\ ft. Genera[ commentt and rewrnmendations, Boring # Boring Pit Ground surface eieV4:3ft. Depth to limjt�rtg facto n. Sci:� Applica.t.iCr, Rate a ry 2 Horizon Depth Dorms an', Color Redo x Descrip-Jon Texlure I n. Murisell Qu. Az- Cont, Colo I T Structure Consistence Bound Roots G P D/ Ft r Gr. Sz. Sh- E f ','-4 2 -3 Y/. I "V 'In f�o Z r Tg: TL � � f i_ Bodng # Boring 61 '? -0 pit Ground surface elev, Depth to I'Miting factor Soil Ap2licati-on Rate Horizon Depth fin.Munsell Dorninant. Color Redo x Oescriptlon Qu. Az. Cont. Color Y�q Texlure i Structure G r. Sz- Sh, Consistence Bounds Ty Roots GPDiFt' *Eff#1 *Eff#2 I Y5� 7-T ................. Effluent #1 SOD > 30 5 220 m IL and 'SS > 30 S 11.550 rriq/L Effflusnt #2 BOD. > 30:9 220 mg/L and 7SS > 30 5 150 rng/L IL and SS > 30 s 51, CST Name (Please Print) ignatur, CST Number Address 4`4 1 LlN Date luation Conti Telephone umber eollo E; LZ .3 01 . ......... vondovi, W ll 54 6130-8330 (R04.115) L f-71 5) 579-97 Boring # Boring Pit Ground s u rftce e I ev, -Z" [depth to limitinq factor QUh ?A Y E!l Itod L I U D I Ma Lt lb Horizon Depth Dominant Color I Redox Descr,pts,,.,,n Texture Structure Consience BoundaFy Roots 1 GPD1Fil? I n. Munsell U. Az- Cont. ColDr Sz- Sh. LwEff#1 "Eff#2 r, N LTM C, k-1 - 6,6 t 3Ye C 13odng # Boring W,P7,1 i.mfting Car in. Grourd surface elev/—Depth to l W--a SON Application Rat Horizon Deoth Domin2nt Color Redo x Desci-lation Texture structire Consistence Boundary Roots GPD/FC Munseil, Qu- Az- Cont. Color Gr- Sz. Sig 'OrE ff#2 4 b YP LE k L? 0 r w f3oring # pit Ground sL;-:,fac4-- elev. Depth to limfting Nctor "qqW DS i:ADPkCat!bn Rate Hio r-LZ on Depth Dominant CalRedo Description T L L' re S t T-J ct L. re k--�ansisterce Boundary Roots GPD/Fe I r. Munsell Q.u. A-z- Cent. Gr. sz� sh- *Eff#1 -Eff#2 Effluent #1 = SOD, > 30 � 2-20 mg/L a nd TSS > 0 :S 150 mg!L Effluent #2= BOD, > 30 220 mg/L and TSS > 30.5 150 mg/L ass -hag C� ��; s r, D 6 .L �PI �'1!P 2.p�d pmfec: anal Services page a f I mid u 5- --W0-`L FVALUAT�ON REPORT ,I1;R=flJWC8 Vft SPS 385. Vft. Aft. (;me county I ess tear, 8 1/2 x 11 matw in size. Plan must inclu de, but not limltsd IM: VeMcaland, hcrtcnu�l retrence (RM), ftectior, and percent slope, Parcel I.D. l F.�MW MMgn*R§NO OM(I dil C '07-' ;;@ ,07 'm -I 1 ;45 ta F,.,z;a to ne a rw road. Please print, art irftrmatior%. Reviewed by Date .1-per'so,na] infor m4ation _YQU mvWe may be u890 for secondwy wMosn (Prtacy Liay.'. S. 15 -04(.1 ProparJy Owner Pmperty Locefion ;:7 V P- C-%Dvt Lot IeE 'W M =In e- Irs lb"g Add Lct Block 9 Subd. Narne or CSM# ffi c4dPhone Nuffg�er city V11fage Nearest Road �EA Tit Ne%v Concn Uw R &�'d et-ifial N Lrrnber of ted rocxm Code derived d",'o in. fli OW Mt,e Pub 11c ot com r7ier�at - Descr---. Flood Plan elevaUan it ap� -ef-i'a.7W CmMeMs I. B Boring C rim Pit Ground suftm etev/W DeUmflnpth toig Rate Dominant for Radox Dncri ption 1� Texture stnicture consistence Boundary Roots GPD/Ftz Munsell 'Qu. Az� CaOL 4Eff*1 *F-W r4 WIE _JD P;�13#11P - 01—k/�o '5 CY K : I iA ondoV1 , -TV I :J` 1 - 171-5) 579-958" 1:1 Boring 10IM16h 6" Wpit Ground surhoe eiev.-L E&M lam Sail ry Roots SED-8330 �RW15) r Pt Ground Surface ev_ -5 . . . �W fzcto��� ! 1 1 Ama�a+4' 6 1rR, i unzeP sedprmn Tom:Structure Qu4 Cont- Cola conswence Bound I ary Roots Soil Apolication GPO/FP i MFfIT7" f Poo ar cing T'd'A'i IMF 4 *'it Ground surface elev Depth to Rmiting fa*or*�2 in. Hofton Dooth Q ant Color dox Description IT�Structure � � � s s � o� ftcatio to Boundary i~ _t� PQVIr. crmetlQU. L r A Y7T 4a M Ov r 9 Y _ N R f � w 1 GWOLmd sufficew i e"M'- k Depth to 1kn1w f4c u a €, Rate H arizan Depth DomWn t Color Redox D Tim'StrUrCtUfe --a ry In. MU 11 QU� Cont, Uor Gr. Sz, Sh. 7711 w ._. ........ r 1d aX f f N r j w }a:� "� ii J ,#z a �, •..� ; ' `'^ - WSJ 1, + tot L. e41 B�.+ri.i RrT fLl� and TSB 30 150 fI�C n aD D. > 3 C. ,2 ;�' ��" f G o �i' Road He -njoc;V ,pj3503 NN 5 5 1,,AondoVIs 7rZ FFii CZ qro jo-k �rl� :!5 FrJW N[: Wi � Stock No. 26273 9 FILED I �j i lk -X al KATHLEEN H- WAS K!,P:f Of c4" x c-c" yyj CEPTIFIFD SURVEY MAP NO. .3-050 VOL UM F I I PACE 3050 & PART OF THE SOU FrIlEAST 1,/4., OF SECTION 27 TOWN',S1411" 30 NORTH, RANG' 15 WEST, CITY OF GLENWOOD (1TY, ST. CROIX COUNTY, WISCONSIN .6 Immopoom 00*010 cio c 0 Ai SCALE: 1`3000 DCHiALD M 71 150+ 300' 600, CL-ARK OWNER: "ENOX40N(E. S I wl 1673 1.3 1/2 AVF, HWY 6 E- P.0-80X 99 mol RARRON. M 5*812 CAR A TED BY DC)NALL) M. Ck, AN K tn qc ZD All 44J clk- 40 /e LOT I 6v, 175,296 SO. F T, ,-Ojrm L-w 1w wv lw4, Mm ir7 (4.02:tACRES) LESS LLJ 46N cj L W L4 Ln lro. b! Lql Nr UD L LdOT 12 320,346 S 0. FTC (7.35:LACRES) 71 rn 304,035 SQ. FT. LOT' 14 (6.98;LACRES) LESS R\W 3 -1, e� 4 G. FT cu s e cn 4E- 1-1 306.0748 SQ. FT. a73 EIA C.'< 7.04-tACRE+ LESS R\ I-D M6 410, In I-dOT I I 19'k),949 SO, FT, < 18,2 7 -+-ACRFS) LEGEND 704,680 SO. FT. <16 �0R NTM N 0 VT CORER .18±ACRUS) LESS 1R\W %0 r:l I L w ry LLJ I IN to % SET, 3/4mX24a REBAR Q-1 "CIGM14c; 1,502 um PER UNLAL FWT. C3 CLI II h S 87042!�48-P fb =1 A 76&37 WIDTVI OF R\W VARIE�i 17 .17' N eB*'5542' W SOUTH 1/4 CORNER SEC.2.7. T,10N, R15W SP�LiPlf-A%T CORNER ST. CRQrX CO. I UL UNPLATTED LANDS SEC21. r30N, R15V ST. ("FMIX CO. MUNIT CURVE DATA TABLE CURVE [JIT RADIUS ARE CENTRAL CHORD CHORD BACK F- 11] R E NO NO. LENGTH LENGTH ANGLE BEARING LENGTH IANGENT TANC iENT 1-2 664.ea, 580.15* 50-00'000 N.25-07'24*E. 561.91' N.00*07'24dE. N.5007'24'E. it, 664,80' 44407' 39*1620' N.19"15'34'E, 435.86' N.00"07'R4,'pE- W38*23'44PE, 12 664.60' 136.08' 11*43'40' N.44*15'340E. 135.04' N.30`E23044-E. N.50-07-OF-4PE. C6EDA4 CnRPA ORATION 04 N VENUF ME-NOMGtV ?F, Wl 54 751 PAG.F or f 715) 235 - 1-10e f --.a LAI oo 4�j-- 4, (7-1 cg()/)C . . . ....... .912 1 COUNTY �^ � No. b513013 . . . . . . . . . . . ...... . ...... PLUIVIBER���}{a�� L Iff a# Z2 m��x 7 :r uF CrrY oF! &LPtvU0666 Collm"( SEC -7?-j 2,qo ,T 3� Nq R ISbgs* AND/OR LOT (2 BLOCK V'V8' (- 11 9-- 3 0 5D CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval.. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: 1f you wish to renew the permit, or transfer ownership of # ca authority. t e erm�t lease contact he uu h permit, P ty If 60— i"Jim T111S 1 UNL-T"-JlJSS RENEU'JWE]V`� ..... ..... .. . .. .. SBD-06499 (RI 1/20) 1°I1z/zo23 1 . RM VAW ................ V