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HomeMy WebLinkAbout034-1000-40-125 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 592182 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Kyle & Tiffany Edinger TOWN OF SPRINGFIELD 034-1000-40-125 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Ct + ( 01.29.15.4B-25 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~Qa Alt. BM f t, 1 f~+ J..~. 117. 3S Aeration - = _ Bldg. Sewer 9 7• 'r~5 Holding St/Ht Inlet /0,7 93.7 TANK SETBACK INFORMATION St/Ht Outlet /l• 0 9 3 . `l4 TANK TO 8 P Ly _ WELL BLDG. Vent to it Iptake ROAD Dt Inlet Dt Bottom Septic /a•, Z(0 Dosing Header/Man. AeratiorL Dist. Pipe 1Z-Z_ 11 Holding`` Bot. System a t PUMP/SIPHON INFORMATION Final Grade $ .Z '7/Y, Z Manufacturer D emand St Cover /mot .7 y 7 3 F^ GPM Model Number TDH YH Friction Loss Systerla..~d TDH Ft Forcemain Length Dia. Dist. to Weu SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM IONS ENS q~ 7, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Ty Of Systemr~: CHAMBER OR -1' J~ o Z Sr 93 UNIT Model Nymbe J ` + DISTRIBUTION SYSTEM ;Z3+-,F,3 Header/Manifold 1( Distribution x Hole Size x Hole Spacing Vent it Int e S Pipe(s) Length Dia Length Da'®= Spacing" 5'oAA^- e_1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of ~xx Seeded/So ed T Mulched Bed/Trench Center Bed/Trench Edges Topsoil . No Yes U No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1159 CTY RD W lee; 6 j 4,A, 1.) Alt BM Description = a 2.) Bldg sewer length = Yo - amount of cover Plan revision Required? ❑ Yes No ] 2% / 3 Use other side for additional information. I~ 1 f~ -4.,- ~ Date Insep_ s Signat Cert. No. SBD-6710 (R.3/97)V #K u ty, SAN, - all _._--_34HK82P5C95J6 ` industry Services i ~f ~f2a/X 1 1400 E Washington Ave ! y1.6 El p fl Box 7162 Ft Permit Number fined in b)Co.) + VW 4 tladison, -_,?t7i-7ifs? 5'~z ST. CR41X CC U t t E ansaction T Ettmanitary Permit Application in accordance w7tb SPS 3S3? 1(2) VI'is. Adm. Code. submission of this :orm to tttc apprapriate oNutamental unit prier to obtaining a sanitary permit Note; Application trines lilt state-owned YOLK rS arc submitted to Address {:f iliii? ten. than mailsn address) i tis he Depar required tment of Safety and Professional Service,. Personal inianna[ion VOL provide may be used fer secondar} 1 t4 ~Q{ u ores in accordance w ith the Pri ' acl Law', s. i S.C)v(i )(m). Slats. i 4 I, l tication Information - Please Print -Nit Inf ation Parcel s i'rope y O+rncr's Mama T/Fi{ ~rY EAt^1~~r pro eLocation 1 I top y Owner's ivlaiiinR Address t ' ( 5 y a - rFf 3 /,8 Gnat. Lot ; lip Code Phone Number 'Vs- Section I Gt~•, State {ciroie oam LE,►JcsaOQ 1-Y I $~yA/ 71-5` ),40l-,877 r a`t~ ti; R !S $o ~t I } Lot;, t 11. Type of Buitding {check aii ak apply) Subdisision Ivan e 1 tar 2 mini]}' Dwelling -Number of Bedrooms 3 Block r ' k ^~ir"tsf I ❑ £'+rt+licit'ammzrciat - Describe Use t~-~'*H'mc of Ni umber G ❑ State Owr ed - I)ascnbz Use Town of y 3 t- Z 3 Q,n`c III- Type of Per 4ri, mit: (C:heck only one box on line A. Comppplicable) A jtiez. System ❑ Rcplauwmcnt System n TrcatntentlHnidin? Patti Replacement Only ❑ Other',Aod=6eation to Existing Systerit iexplain') T Previous Permit i4umber and Date Issued t i l i ` 4;. t ❑ Permit Renewal l Permit Revision j L Change of Plumber ❑PermitTransferioi+lew- 1111 1 ~ t;)ti-.net i aefr-e Expiration 11'. rN e of P(31\'TS S~'stemJC'omponent/Deyice: tC:heclt all that a t ly) `1 1 \un-Pressurized in-Ground Pressurized In-Ground C At-Grade Q Mound > 24 in, of suitable soil 0 ydoundd Hi- of statat)}c soil " i Pretreatment Device texplain)~_ 1- ❑ I din2Tanl ❑ Other Dispersal Component (tsptain)_ V, Dis ersaliTf iI t Area information. Design Flow (gpd) Design Sail Application Rate(gpdst} Dispersal .4ret. Rc }aired ts,) r)ispersat Area Proposed t. S)stcnt Ele ttion a 9,? 9 9/. G • 960 ysp - o) ivlanuf'acturcr c , 1 - Capacity in I Tola1 I I SL`Ianklnfo Gallons Gallons ( units } ring `,:e.,- lanky 1 3 I'V 8ec 06 ScPeieorii~fis^!3=ere!c dad ~ ~f i GOn3LRE'TE i d/ ~ _ _ 1 4'11. 11c5ponsibilita Statement- 1. the undersigned, assume responsibility for installation of the Po'tt rS shown on the attached Plans. Number Business Pttone Humber "Ofts Plumber's lame (Ptini) i Plumber "s Sin tr ' plumbers Address (Street, Civy_ State. Zip Code) 1/ d 98 =Sr. fPrJy ~S ~uRA,~sA 1,~~ Sy7t36 t'11 ountv113e ariment Li Se nt~ Permit Fee Date ! ued issuing m Signature Approved % Disapp! S (J V • /Y . ewson for ,7<n ai - A-RR I-X. C:ontiiE}?nto {el >iMf j~;n4isapprosai i t}isperzs, cell must all be tir,toic?_S i m nt-rec' as-per Management plan provided by plumber. / ~ 2. '"*-('}l,((fEl:'1M1kS f1A1tSt-k!e ►:lalntelnE4 ~ L n par WpkWs CO& 1 ~FMatlB I. L- Attvet! ca complMe puns far th<.<~tcm :!rid subtnii to the County only nn !M[irr nu! i~ss chars S Iii ti i t iuehes in size S1313-6398 (R. 08/ 14) \9 nLk v - L. olz en lk, h a to - 4 is *v 4V L } 441 Q ff 13 o ~ lZR 3 k ~ a ` of @ hi °-m F~uz 41 N Ilk 3 ty 11 tt V It C 4t Q Q v ~ o J f 4 o ~ Ike t ~ v W @ { a e° o z: v `yt 4 ? Ilk g ~ ~ y ~ aS • 3Z . M aIQ ...•~-::.l ~'~wu =1>_l ice?; if x~:,~ ..~r_ >..:1..5.c.....:_.~ C?~~C~!~1~.~: 1 1fFi4a~lY G~J•JCEit. ~it ~.P.~G/Lor~a~ ~ae.Ij"S ('nJ¢'r.J~ la's h?e. 5318 G E'~ r Gla, r f.3 C~~-s~:'~ cSS: ,G7GEnltJaaD C1J'Y zul- .1 3rdf.9' era! mc;nt)sar. i rrz j 0' Ss AJAt[F/EtD `u f. - l1 &;.1 f c7 . s'?G~:U rA ✓Z ~ Jar' o3nl cs i:.. / ,t tt t J~tG i~U 1oJa.rarJa ~ r~ ~,cL~s~i•;~,-vet 1r7'~--a?3135'4 . X11 . n ~ i~6 G- 1 S ~rOSS_l0 a- ^G'a t IRT,~ 4i ,l: Ly 411:+-~t-~' t~ ? wG`l f~oY ',ft~..~j L7r~1.+''U IJ ~ +~e l c i41f f O n d ° o fv 1. ats o tY {i t' s v ~ Q., v ~ • 1, f ~ ~ i it ~Zi 1 t Q Iz:I 14 e 4j 2 0 ' 3 ~ y L3 ku +u ~ ~ o v Cl~ h a a Os~trs ~ tOO~ +v~ei~rv a ~r~`I ` O =anod-ssJa~ -Go0 OtOZ Aavnrnr -a,v Ot .j^ IVnWrl OU35 atrOd-3adt .,o-.t=e7 t ~3 masf ~Ys s NtAaaaPj ~ ~ky~~ ~i ~ 'J~E {ice ~ i ~~I. s 2i1~!-QOOldl~lc F` L 44 ~ l~ ~ f 1 I ' f ~i U it O V) Cam.) FF~F- 'Llu~ U LO - e ~ i 00 D 0 00 W G: n O~ O cr h ca 0 V) n1 Q U ,,y F < T` ct Q W Cj Z ; w ~tl 0 m ¢ f i ot~< ¢ac~ v a a? < CL { U m :F7 -f b~i C~~? too \ U3 ® in c%t Z 7 K l O w t w a t~3 ) U v v°~ ~ o 000 LLI a- > ~ ¢ Qn G 4 Q UZ ~UO Q in mw I p W ,a © ~~t- caFa t- R ¢ t-"'¢ 1~ co O 1 wO zz rn i ¢ r. w ¢ w z ~Oir>~ui 31 U [Ft2~ t}bV Sze j~ Ica C; w aa? a ~xrx v z~ ' t,y < wv w N~ t OE= f- O.<)v OOG.1 ¢ <6,F s w S mF = pOf t77 'l Li r T C s S U U r L J X U . Lcl ( ZJ > ZU'r {J `-O 0 Gi LR zul Q hh}^ ~ 1 0L'i ! O~~ zc3-lcsw z a -o c~ Oa< ¢R f Nd0 0< sI d~'S ¢`fU d^'>v Z Z Zd U MO Q tz iJ Lf Q ¢ 77' >Z I v 0 O z q Z < d U) <q L• 21 CD U.? 11 {I o Q w 01 LU Y ~ >z w . ~f CWl I~ Q O w I tt f ~ r- N ~ I i{f j ~ zv zl F ~{YhHf~ LL Y In Z ARAM' AGETT N y I` AN pSq? / oS FILE INFORiTiATiw4 SYSTEM SPECIFICATIONS { Owner /ffh'~!Y ~/I i.Jl ~!L ! Tank Manufacturer: (~/ES E~ L~aNCa ~T 1^1 tdA Perrriif= gSe; tic Q Dose 0 Holding Volume: /tSLtO (gal) DESIGN PAR }?ERS Tank Manufacturer: ~ IIA r Number of Bedrooms: Q NA z Q Septic ET Dose Q Holding Volume: (cal) Number of Public Faciiity Units: 91 i',?A € ! 'vertical Distance Tank Bottom(s) to Service Fad: !e (ri i 1 f ~c r ; peyda E 'sdCtTlZOnfc# Distance Tcrk(5l t0BniiGB Pad: , f d (t t) Estimated larverage1 , , = ow : j pp ( t> , ; Soecific servidno me0anics must 02 provided ii varxicai is >15 teat or uesigil (nlesk) Floes, = (estimated %'.5)_ y,JO {93tfdi+}'} S ~ if haizontat i3 >150 fee! Soaciit^ in-atruttions to Be or rlded an bacK. In Situ Soil Application Rate: {catldaytlt`~ Effluent Filter Manufacturer des r 0 NA Standard (Oornestic) Influentle lueni Monthly average Eiiuert Filter Model: ~9f /t> Fats, Oil Greass (FOG) r30 maiL It Pump ivlanufaciurer: ~ NP, csi4cnemic2l xyoan Demand [,Boos) S"o mett Q {+iA l Total Suspended Solids x150 mglL = oump model: High Strenath inluenttEitluent ivionthiy average I i Pretreatment Unit # (FOG) >30 molt j t iJanutacturer. NA { {3ClD.) >220 mglL X NA ' Q Mechanical _c~anical Asraiion Q Pea`: Filter ~S5} >150 m3lL ~ j Q aisint'ecGan i? ii:r2iland 1 1 ?retreated Effluent Monthly average 1 Q Sand/Gravel Fitter Q Gther. (BODO 430 ma!L i 1 Soil Absorption System ! 91 t" (TS5) s30 rriaft p 91 in-Ground (grav~tyl Q fri-Ground' (Pressure) Q NA _ ~ci Gaiiiarm (gsametria m=an) <_1 G' ' _ Q t irad~ i~ Mound Other: :I:Tlt1.m 1=i 1JanL l~artiCl° .~,i2"' is in pia" irl t`9n 1 ,l or.in. Une 0- ClIher. t flti~sr: / l O Q 1Nr'. ~T'RAaa Quicx Y MAINTENANCE SCHEDULE i e7 ,vice Event F Service Frequency j tffit,:hen combined sludge and scum equals one-third {;'1 of tank volume °limu out contents of tank(.,, V+Ehen " = she (ball viater alarr, is acidvated r,~ month(s) (P tantrum 3 years} r,! i~. In-peEd condition of ter (5) At i@a5t OnCB aVcr}: S? + e8rt5) fl month(s) (Marimunn. 3 years) r_1 NA Inspect ispersal G°li(s) At least one every: Year(s) # »'i month{a) i i Clean effluent filter f Al least once even,.: year(s) # (mot month(s) i Inspect pump: pump controls & alarm j At least once 2ve?"y:°ear{,) i month(.,} (tie 01 € Flush laterals and pressure tit !"At least once ever}: _ ^l.. year(.,} ! i { Other: i , AL1$c5i once a1 i e..1 yj-- month(s) f- NA Yew (a) Other j l I MAINTENANCE I NS T RUCTiO;NS nsp= ions of, tanks and SCiI absorption £jrSi('IiiS shall be i318Cia bV all individual iamying one OT the iiollovving licenses or certiicakns: :Master Plumber, Master Plumber Pastricted Sevier, ?OMITS Insp2CtDr, P0kNr-,,S ivlaintainer or Septage SerVlCno Operator (pumpar~. Tani; irispeciions must include a visual inspection of the tank(s)lo identify any missing or broken hard ere, identi'N any cracks or leaks, M=-azure tike volume of combined sludge and scum and a Cha&, for any back lap or ponding o"v e fuent on the oround surface" The soi! sbsor on system shell be Visually inspected to check the e lueni l eels in the observation pipes and to cheer for any oondina o! effluent or, 1a ground surface. The pondinlg of eiYTuent on the ground surface may indiCe"iie a -tai ling CondiiiDri and repuire5 ire imrnBdlaLe not; lc2tion of, the local regulatory authority. 'When the combined accumulation pi sludge and stunt in any treatment tank equals one-third (`;'3) or more of the tent. volume, the entire contents of the "tank shall be removed 3y c St'pi8ge $o^riGirig Operator (pumper) and disposed of in accordance ..pith chanter NR 113, v"is4 :nsin AdministrcZt3do Code: All other services, including but not iimitet} to the servicing of eriuentfilters, mechanical or pressurlzed components: pretreatment uniis, and any servicing at intervals of X12 months, shall be performed by a certiited 00'Af t S Nflaintainer. (1 s.,9MGA F.+cri10rt shall De prD:flaeo to `the local rcgulatorj authcri+y aitrtm 3U ctoys of compie'an ei any ssrvcs ev+}n?_ Page .S of START UP Ai%ID OPERATION For new construction, prior to use of the POVVTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater ievets. When power is restored the excess wastewater wit! be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POVVTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at grade soil absorption area. Deduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics: baby wipes; cigarette butts: condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting products; pesticides-. sanitary napkins; tampons; and water softener brine. ABANDONMENT VVhen the POWTS fails and/or is permanently taker. out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter SPS 383.33, Wisconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. o The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. e After pumping, all tanks and pits shalt be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POVVsaS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: j,, suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure; lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POVVTS. C The site has not been evaluated to identify a suitable replacement area. Upon failure of the POINTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWT. S. 0 iViound and at-grade soil absorption systems may be reconstructed in place following removal of the biamat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR IN.. U FIC IEN T OX*1. G2N. DO NOT ENTER A SEPTIC, 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. ADDITIONAL COMMENTS POWTS INSTALLER P0VV1 rS MAINTAINER Name a,a~r / F t 1c E' i 9 - ~?3! yG lame 914E it ze4,.t..a c - Phone ?hone I 7.?-5o?L i SEP T AGE SEMI/ICING OPERATOR (PUMPER) - ~ LOCAL REGULATORYY .WI THORITY 2 Name G/torx 2o.Jo,J . blame a I _ Phone Phone 715" .3,9G 34G96 - i - --f i This document is intended to meet the minimurn requirements of ch. SPS 383.22(2)(b)(4)(d)&(f) and 383.54(1), (2) (3), VVisconsin Administrative Code. Use of this document does not guarantee the performance of the PC1WTS. Rev-(3113) LLI ti ~ GIJ ~ ~ Y T v V V U V W v c 14 a 4 G 47 - z m 1' r Ci V (j LL y, , rry- N J > SO NCI u T ~ i y _ j N > o -t 7~ $ y a. vt o 'II ~ vc c y~ C.n F= o i d s 15 c c r ° d 7 '2 0 y r, _ i6 {pPg~ 5 m ~ a `sR~ E O N L 'i' u 70 U .D ~ c a w'= d~ ~ a ~ u E m~ e. v w~ s v'~i E ' cad ~n ~ s c cn o ~ 14- N v m y re ~ v a L o y a C" 22-= w • . a) M CL t, Y®• a J 'b] d v .f v ti Gr to N V v+ Land Use Planning & Land Information ST. CROEX,, QWUNTY Resource Management f<5'' 4717 Community Development Department Address Assignment St. Croix County CDD manages property addressing in the unincorporated towns of St. Croix County. New Addresses and changes to existing addresses are executed in coordination with the local Town officials, County Emergency Services and the US Post Office. Any questions regarding this process should be directed to Joe Ayers at (715) 381-4934 or e-mail: Jose h.a ers~a co.saint-croix.wi.us Date of Assignment: 11/10/2016 Tax Parcel Legal Desc/Subdiv Lot Address Comments TBD CSM VOL 27 PG 6222 3 1159 CTY RD W New Home TBD CSM VOL 27 PG 6222 2 1155 CTY RD W Existin Home Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686 www.sccwi. us/cdd www.facebook.com/stcroiXcountyw i cdd @co.soint-Croix. wi. us ~ r ! i p .P " ttyerJSf-' itl~t=l` 0.ti d i 3~GC~Uttl qz / 1 } ! ui ntr Q 1%Irm 3:nt f c or f oraar - uc.iun ~ ti'3)~-1do 0-~o-~~25 ~f JOIN, Rrvf)er y Location 1t1 ft dries idmiaw: ';es no }fi r yq,L y111 t A L' t*~ ' AJN ;w~~ y+y ,a. ;~-L, ~-+E IN I) s yy +g~ gn ,3 SYSTEM t' 1 i~tirY i t Fa f ~Y X~d4 : 4 i-Mropzr- use and r>>int na.ice o-,-you iYy'=nfa1]BnCr consists could rtiStitt in t ter tt acurt : lme w ~imdk w w t7i`;JU n''a1Ft~; out ihr F)i.(, Y,j an Pmper I- c. SI'Merr~ can affect the fU Cti101 0 die Se r1 #hCti le3ra {ir Silfl"~ !tYi'U~a , 'lt, b 1 -~aCCriz",eCi ,,3Ui7pP,Y. W'i):lr yflii put tl7tf }-.IC C;; P' 3'Fi'C FrYiG r'It tagti in he va3tr(113poS:, i'ySi' in. 0%,-1cr lmirit~mluce -..pon:;ioillti-~s a_e sPrciferi ni jccl rlrn_ 81,M) and in t_i2a7nr ! S#. ri'Gi-. COL`r;^• 5:173iar~.% C3r'3iri3nce. 'r' h j`fGtl`IrJ C)4i itCi $gri 0 6 S31UC^a7( in .t',i i FUa ; C 11Gt'rj' P1101- & 1r] IIIr I) tJ1r'~1 1 i . 4. 7(IliCdtt©a form. *„'i f,,'?l~:Ct pq :Pl; /r r and by a n "5 t I)fttY :-7 y'i'.~pt., pi'. ~r'Y7 z.1tI p un) ranked phgrib_, or a ji ceasS! d purnpUT L' riF)-iila thar (1) We 471 Ac of j 4 -,~tthane ii.;p Lal ystcrn .y in Nrt PW DXa,-A,', C~.!S3l ai(2 zn {:o (2) zitzr inset ori and tai nec-~6saryf, Idle Scp-i: t sm", is ! 1 <rw uy,:yi u.'c3lia:'rread a C}CS t r quire nezis 'afid ag-,_e to ni.ji ain the rr 4te s,:% agc disposal at r;dafds t tU7t~ herein, ar sci by W, Dep riTnerl J Cnri ii . Le „ ~ c S;'~t is o sli tli- ~ ~ !~{.d11.~n S#21ii13~ ~1 f2d die D .~-d`a~3t'a~i L~~i >~:;iCLr,~] f~CSk"?~lICt9, ~C~tr ~t , t31:03151Ii. W roll:' Wp6c Scslern has been inaha n d Tani Ent corr,plazd and rcrtu d -o the St. Cr3r _ County _ n` Oeparra:, t .,i,hin 30 daq of riic We year szora.i I dam. til c cei it'y' Or an raterricr-ts on t it r-,ra mw i.i IN b o nay our Wo vt.,dne p aL'p rty described above b v irw ;)t ~ cac - , _ .'t17. are t]?(; O'.73er{S') of the - 6 r-°cordc-:3 ir. ~Rc.~is.rr of "~,:?js C1rsirt- N?irnb cr of be rt;otm '510N'ATURE OF A2KJCANT~'-,~,, DATE , ay i orn *iion t Iat 15 rziamprewm d r'lu at'Sui! 2 t3 micr pima C i P ::,:d t. ~ Jnclnce- !i f i,3aa application a rma ded `.4.43rrmay d ,Viin we Rd§,r;,r of M Ur)b' ai tnc. ~$*tlrl'Ll S9zF :^.Idij7 i! Y"''°Y.?CC 75 12ALtt- in iit:; tV?ff !3 h7 Ct,^,ea