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HomeMy WebLinkAbout020-1001-00-000�::a a:`nd o".Id F. Mbn2r PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) St Cri a e... N. 600281 Pi T. N. 020.1001-00-000 wx.nvaux. 0] 2919.1J ® /PiYillia�®�� YEt 1 II 1., 1)u DISTRIBUTION SYSTEM p dp=l'_ ��Yl%IP S 5OIL COVER nbpu sOnly x Mound 0, uLaeuaymmc Di 0./1 eY COMMENTS pnuWe cWeegru+o°p°ncxe penom pream, e¢I impeuwnpi mepem n 1 � Lia x1 At BNDiii eu•a xOT lFRi1nd $f C'fM��i'�DI bIbN 9Ro : v cai0 OkrJdut ntirll�r au of la�i no I it ivpo l 9 �vre1(ti� 'nu��� pwphx D mAWdkh� eke' ••.[dv.J. 41= N,r',] )7 PA c.�.WS I w 3 oils. 'Dry ve rk7f'e_ J 4 pyt mn .SF6C /.OG�91C - 5M-apli-yoo ••• •.. Ixeuwr5wita Ulruon 'y •:RECEIVED L�fo�"" <ortf '. eta xunR.lmYmm�er 1 JIO ]I>ro^Il Nov 2 0 2017 it AppUcati�l. a�• r,..a. n uU /p ,ww .,,•e.,>^-,ram=x,�.wl�a bmao..o.�eiwii...mm. u rPamroemleas....u...wamel ommIn rs.m.wPmrtswm,I a nm Sad x,NY[Mm, hxrl5 m"'P bbmnm. vi1ber,nRrgr4 M4mvlw„Fml J. M.-Innr l pzp_ /al-oe-oc� /�YZ G%aIN (�Ks DR wfsJ w, ,Ut x lave, d7 u SW 'PCm xw,. L aasiu ur o/b — — aKw rZq x, e-2`Ly 11'Y Ap BeW n4wn.n na.ePH1 Ind— Ina ❑.a.o.,w-�.,. ❑wls.rT sw.mrW, PlsqAmom rAtc wl fZe 2Z fA4m In. ]'>va•rv.,.,,: Ice _ x c..q.. x.enreolk,el.l Iowsn, s,..m Rcpl,, nlr., Wy ❑mm,a��:>n,. e,�..ws,�su.P�l ❑wmll&Cw , Ce�m�,kaso" ok,..P..rnw,o-: oPm.:u,Nmr„rkx �CettYAl zAIA afPoWI6 len• eVJmtlmyadwJ _v nO pI ❑waW+m ❑om nnay.mlwix V4ey i-I Iab` m.n wml 1. oW,...l.x. Im T"k TIPP 4r Mad Nu[I fil/v/n 8 n 5 s Il.b ielY $ww-4n..4nkd. �.� �x,�zz4a37 xwllm, /fEi7n /-1FaltiGS �n� L �ql J15-5]q-�.Sb NP52 CNIppG:�.'.k eT. cA�crr l s+vzv n c.s � °oxav�a.I.pe�u.mIt(�tal��'711y��•,,o-....ery.w�s 1 IN. cunel,lonSTEM EF ma. rv.nupp,wxl 5 [i�'i Y4H'� N be tAw u y] 1S pI¢lank e@uanl elbr and J dlapanm,nnmumce s."C', .mmmm M 1 Pe ✓��� Orl) /o 2 al sseelxaCk rt UIPOPWpnas mus [e msnpaumed as re OVA 19 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that 1 have inspected the existing septic and/or dose tank presently serving the following residence (Sneetaddress) �V S� .(�{ -L r�� y ' located at �xJ y4, j� /, Section /)7 , Town Z/ N, Range_19 W, Town of /-}i,./�.� I , St Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly Most recent date of inspection or service Did flow back occur from absorption system9 YesNo (if no, skip next line ) _ _ Approximate volume or length of time _gallons minutes Tank Capacity Construction. Prefab Concrete X Steel Other Manufacturer(ifknown): �Air<r.ta Age of Tank (if known): Permit number (if known) C Cr 11J (License lumber 1 azure) (Prot Name) (Title) (License Number) MP/MPRS �11 h7 Date Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s 145.(H6, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev.2/2011 PAGE OF In -Ground Gravity Plan Index & Cover Sheet Component Manua Deogn Reremnces Vegan 20, sB0­1070S (N DIMI, R. 10112) Pg 1 of 4 Index & Cover Sheet Pg2of4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg4 of Management Plan Altachments: Enclosures: Ic R � slzc� POWrS Application for Review ,Y *s..� Soil Evaluation Re ort85ite Map Project Name / Description Owner Name(s): Z�R XA T 1d V JAf44me: r}wmrAooleo: ICSF 4L2D nJ fiAKS nR iianxn Lp: &yDlj[ Pralicl Aooresa: /s+mci Govt W1:_ uu- 114of NE1/4,Secbon DI ,T YI N-R_L�' E❑orW® Tovmah1p;- iurAMu,l county: -X CdtLlx Project Parcel to s: Cd=-lory- LO-COC Designer Information Designer Name: llane Jr. iluerLrtr Paorla 7L5 ;':(. rl7.s Deslgner^dd g ;2S' 9i KA's:IATNw,i$ 6'4 DASKLKy w ➢P: -0a Eanell: Ii�l45tndes a. odlmK eam License Number. J 6 x1 CC l Remarks: Signature: 2 >vi:C ,zF.�- [ .ate Y 1ls OhYH •(\'IS{1 P. � � 921a'Jy hJl za*,t old told %oilJN°K/�MLS Yew ? I IN-GRODND GRAVItt DISPERSAL AREA ✓ LIM UnRarm ElavaOan Trenches with Oulcm StandaN-W Cnemlwrs ,,,,,,,,d, }fi Trench(down-sizingcrad1l) y_0_0_0 L vWWmww. U 9 � uawv ww, TYPIC.RL TRENCH CR SECTICNVEw si IN, Scald wm.�_� �° 9ra kmn, auurnyN [bnrvfyi MN'sNw, u' TYPICµ TRENCH mow• RANwEN INusule) A-100 4L::-� -I -------� ----.v .- dI m _ � INSTALL PER TRENCH D _—w`4 =L onranwO AKErew�s..�C K w��.rrnrr �g.yereow. b r Z VwVw,AWoeeeTWEiCA- W9 r /1 AN'Va� &C,03,af _ 0.7 LR = asz n - f.� Kn. /T - 2C b lmr < 43 ",Te H � x V F- /iL -2 w:E WE5 _ 4B F/ EACfI 17) ? x 8B' aREUA>=T /nu/JAnFy �AMe'S PAGE 4 OF In -ground Gravity Management Plan IMPORTANT Too owner of this Iin-ground gravely system shall the lawyer for ns uspetual operation and maroYdanes puRuarAb requirements W SPS 382 beef, Who Admm Cade Pursuant to SPS 3N.52(2), Wipe Admin Cale, the system shell be wlBldent a human healm hacard d net malrealned m amddanre wolf this approved management plan Furthermore , all nspaiwn and marntenanre apparent stall be Pormensd by a regYUred POWB Maintainer In expresses whir SPS M352(3) Was Armin Cape Maslmum DYcetsel Area Oceretlna LMIB: Design Flow/VC% gPdi BOD65220ml T8,35160ml F00530nal Inspection Closi [ INSPECT EVERY 3 YEARS ¢ or"use o age of System fears if a drops, paper complaints, etc) mechanical Paris en I, a, ppmpc valwe, SMxnee fleas, etc) maenad fuel (r e, leaks, breaks, common, etc) vibes w4ume in mostrouxic treatment tanks) and any 0elnbubdn apputeoance(s)(I a, tltaurphon/drop byes) method or improper use (re, exchadmg design espai prohibited a wMN ,Nc) • extent G pending In dlommuhm esll poor to smeng o druing rnaguYribes -d applicable it a, pumprechcling, Peat switch senses efc) el¢MWI wmponmis- rappleabk (Le, wrung, mnnetlwns swdcbes, controls, borers, alarms, ate ) o dlsinbutrm kteral or lateral denim Pluggng (measure lateral drelal Pressure -pointers to bases speuSmepr) e sprat enchants M a muse or saw2e trial are structures W Malnterrenca Checklist MAINTAIN EVERY 3 YEARS (or when necadi in Sepft and dine tanks shall be tamped by acertified Seplege wmosng opemlorlicensed under s 281 Q Wla State when Mevolumem si rn Matanys) eaceds oneArlN (113) Me Imuml volume of Me tenk(s) or asregulredbylocalordlranes depasalNconlema Mall bepurwanl to NR 113, Wow Adorn CM¢ o Effluent Opens shall IS IrspacYd every 3 years and shall be deanatl when newssary to assume any accumulMM ships according to manufacturers spectral A servnng penal well always be grafter than 12 months Sysdm maintenance reports shall be automated W the Paper local government unit in amordance with SPS W3.55 Wild. Admen Cale Report any commkinu meant fallure or maMundern ta. Name N abandoned or company ADUAP�TcD SEP11CT!)Sfl4tliT/C�Zt).Phone 71,i-7L3-fi 7 Local eo+emmem r.Nr S U1Wk lbu CT1' YOMMVJalTV nE vcvPhore'e�/$-3yb -`/6 �a L llgwwnmentonitmdmY 1-IunsaUr orris i> —ZIP 5HD/6 Any defeslow pan of this system shall be mpalted replaced, or removed pualuam W SPS 383 st (1), wdc Admen Cate Repandr r¢plac¢ment of Y physical ouor m urn oflthe P Wmpanaybshall Amply wits SP3 383, he r Admen Cate No orMucr gr h brat 3l or Vocc:Areed Cop n of the POVRS may be used unless approver by the repayment m accordance with 5P53eG. Wisp heroin Lod¢ In the avant that anyfailad treatment mmpnn¢nt of IN, POWfS snot be repaired it Ce mepo dpursuant to a Plan submdtad to the appmenare apencyfo- remewaM approval AfNNrn rmunddi"malxm nentmaybe abandoned add replsass by a codemnplylm imperial compenenl in a Preoperational area of suitable Souls. SVNm AbaMonment If use of this POWTS rs discontinued, R shall de aMMoned in wooMenot with SPS 38333 Wise Admm Cale lid � 0 24.60 `$C i iSECTION A —A J 1lc 002S 00 --�� ERMANENT FOAMED —IN � POLYURETHANE GASKET 4 THIS AREA MAY BE FILLED WITH CONCRETE FOR ADDITIONAL WEIGHT t 3 10 4.50 Material: Copolymer Polypropylene Color: Green Drainage and Septic Products PART T,I Tic. Inc TELEIRRME' 147550.1011 1200 FaC, ,t T FREE: 1413382 nice PART • ••^- .tiW7 F" w2 Ss0.EfN 24" RISER LID 24 - RISL - GREEN ;n I p5 za.7o Y� i c 12.00 I i 1 A SECTION A -A \# a- �F A Material;Copolymer Polypropylene 13.00 Imo— -�_ Color: Green Drainage and Septic Products TO-na. Im. TEtH w 502se0Jm2 1MO Fn Omm -- - TOLL FREE' W 302 T009 NAME: 24 X 12 RISER 24 X 12 • Rig - GREEN The Only Septic Tank Filter You II Ever Need roe. The lifetim ter The I, fen me fi'ter is the Most eflloem: low maintenance eff-uent filter on them a met rated 35M Gi With flea filtenng capacity of other fItare IIIme fIter Is the best value for your dollar The unique plate design elle sods Inside the cartridge virtually eliminating mamterance Cleaning is made easy through thee] I Mina tron of Wnroen dates. nahng tie tarn mein and replace mlmmal Cu, unique durable construction and patented I wtmade moral o'tne difield -he are[me Ereisavailable In 1/8', 1/15' 1/32' and Vol filtmboc SIZE < In addition, our distributors buying directly from he manufacturer allows them to get our product to theme reasmable occe ® hint mmmm vno Qualify Single -Piece Filter Case Made of high quality materials. thesrngle-plece Men case conmme noglae or sensors. pried no r,n...rn,Ver.mrglmrn� OnmrsmuINIMI( nrer much 8/2220/7 LiOZ/ZZ/8 dyd ap0-NUM-agdae/woo olpall9awnyq/fdlty iow Jana sapmmo gm lapis leuop.ppeagj asnlo >onu voddns a>papow wo+na e seg ,ally au sgnH jjoddnS ui-papjoW m paaly ian3 HPOA gape Jul aildas ,cryO aU TO Pat ten mu ch. flex I. ... .,. aw=....... g, Pod on ether end of are W rk4 standard Chamber APPROVED.. EMW tNmem cl mm II I66S���tEl@� r�?3i� �Ili41)11� IEFfEcmg lEN31111 Pal EmGp FROMVIEW SIDE VIEW M)IJIM Typo) Tmcll New I—x�ruon_ 40 34-W z53-L, 12'w 86d mm r 1341i mm R 305 mm) E el Ul 48- 1219 mm) lacer Hall 3" r203 mm) Stan, Lap¢IV 43 gal (183 L) ll Haight 8'J203 mm) TITTER; Porax,,I Irv. u.ww.,..m. neaxertnew�nee Sram�m¢awnnryon�nlq immnw n ra Nca gwmaN And local Rewmw o so Iti Weaker wrwmadsg+dtsam • 'a The Ormun Through Relay co, nr" And wi broader 0.1 ill Andrei s SWember262013 (RevLsed Nwembar 13 MID, INFILTRATOR SYSTEMS INC GOVERNMENT AFFAIRS DEPARTMENT a SUSINESS PARK RO PO BO%T66 OLD SAYBROOK CT 06475 Re Decorous LEACHING CHAMBER Menanica er INFILTRATOR SYSTEMS INC Product Name. QUICK A STANDARDW Model Numberp) OUICK<STANDARD W (EISAforchambersvainorenthoulacre osud R/chamber EISAtorendcaps.SA 60sg X'puroI Andcam, Lawn9lerlglh M chamber - a 0 fit laying le at end caps 1011 WEm•N inches Haght. 12 school, Mal daplh of bury -B IF, FOR BED INSTALLATIONS. All DEPTH OF WRY 13 REDUCED TO ae IN qxn ismard area- 9 6d ON it member 35 sin H,cast of end caps) Product File No 20130191 The specRicalons and or plans for this pfumbfng product have been reviewed and baseball to been For ance with adapters SPS 3821Mough 390 Wisconsin Admfmslra0ve Code, and Chapters 105 and 160. Wisconsin Statutes The DepMmerll haddyIssues an alferreb amws to a. BPS 3fl] At Stan A 384 5 t Won the Wisconsin Stables and the Wisconsin Administrative Code The 8""e "feet is "Rd uMll the chi of Bplambr MIS This approval supersedes the approval issued on IsidrM9 under product fie cancer 2O070551. This approval alter mat be Incorporated with our Wwfbusty approved titans anabr medical approwed under webuct fire damear 2o70551 This ememare appwet 6 consultant upon compeanee wrlh me foddering shpuWhonfa) • This Awl must NrnitNled in xmrdama with the manulanuders pushed rueful wwudmprWal.and plan approval If Thom n e comficl bmwean the consu lurm i minsual and Me pl ii windows] arM/m pion appoval, the product approval and/or plan approval will lake precedence • Wrom this prWucl canceller a dowasal call mat is cfml dacM bn the EISA rating scroll the bararCng block Ol me prWcl atimbi ON, Nr WM must rxerve wazerfu r havag a B005 valve answered 3o add 220 mph add a T55 value be on 30 add ISO mi • When this product Is installed In a Recall cell that s steed based on me EISA rating elated in the regarding block of the product approval earn, this product must he Instalbd in occasional excavations mat create a row of chambers that are horizontally anuamled from other rows in other subproblems by al least 3 feet The 3 teat measurement is measured confirm the closest butsde edge$ of the leaching cliamgers Vbh� thin product 11 mdaled m a of 111 Ball that rc eras sagas on the full rating slated in the r99,mong dttlt of me pmtluclapproval letler the electrical call hcgn or allow at bast prior of commit in the chasms"thi baunow ofvasu water,,, in, drar,ri mat dnchmpasnto Oe chamare SOD 105yrrN 1ald For 130TY020(fp s SWember262013 (RevLsed Nwembar 13 MID, INFILTRATOR SYSTEMS INC GOVERNMENT AFFAIRS DEPARTMENT a SUSINESS PARK RO PO BO%T66 OLD SAYBROOK CT 06475 Re Decorous LEACHING CHAMBER Menanica er INFILTRATOR SYSTEMS INC Product Name. QUICK A STANDARDW Model Numberp) OUICK<STANDARD W (EISAforchambersvainorenthoulacre osud R/chamber EISAtorendcaps.SA 60sg X'puroI Andcam, Lawn9lerlglh M chamber - a 0 fit laying le at end caps 1011 WEm•N inches Haght. 12 school, Mal daplh of bury -B IF, FOR BED INSTALLATIONS. All DEPTH OF WRY 13 REDUCED TO ae IN qxn ismard area- 9 6d ON it member 35 sin H,cast of end caps) Product File No 20130191 The specRicalons and or plans for this pfumbfng product have been reviewed and baseball to been For ance with adapters SPS 3821Mough 390 Wisconsin Admfmslra0ve Code, and Chapters 105 and 160. Wisconsin Statutes The DepMmerll haddyIssues an alferreb amws to a. BPS 3fl] At Stan A 384 5 t Won the Wisconsin Stables and the Wisconsin Administrative Code The 8""e "feet is "Rd uMll the chi of Bplambr MIS This approval supersedes the approval issued on IsidrM9 under product fie cancer 2O070551. This approval alter mat be Incorporated with our Wwfbusty approved titans anabr medical approwed under webuct fire damear 2o70551 This ememare appwet 6 consultant upon compeanee wrlh me foddering shpuWhonfa) • This Awl must NrnitNled in xmrdama with the manulanuders pushed rueful wwudmprWal.and plan approval If Thom n e comficl bmwean the consu lurm i minsual and Me pl ii windows] arM/m pion appoval, the product approval and/or plan approval will lake precedence • Wrom this prWucl canceller a dowasal call mat is cfml dacM bn the EISA rating scroll the bararCng block Ol me prWcl atimbi ON, Nr WM must rxerve wazerfu r havag a B005 valve answered 3o add 220 mph add a T55 value be on 30 add ISO mi • When this product Is installed In a Recall cell that s steed based on me EISA rating elated in the regarding block of the product approval earn, this product must he Instalbd in occasional excavations mat create a row of chambers that are horizontally anuamled from other rows in other subproblems by al least 3 feet The 3 teat measurement is measured confirm the closest butsde edge$ of the leaching cliamgers Vbh� thin product 11 mdaled m a of 111 Ball that rc eras sagas on the full rating slated in the r99,mong dttlt of me pmtluclapproval letler the electrical call hcgn or allow at bast prior of commit in the chasms"thi baunow ofvasu water,,, in, drar,ri mat dnchmpasnto Oe chamare SOD 105yrrN 1ald For 130TY020(fp Mun�.+K�J'nire� INFILTRATOR SYSTEMS INC Paget September 26 2013 Product Place M13019T • When Ins product is installed in a distribution cell that Is smed based on the EISA raMg stated in the regarding dock of the product appoval Inner this product must be Installed in a dlsinblaion system, witch has the tap of the dtsinbufmn cell at or below orrgnal grade • When this product is installed next 10 esch other n adiitribution cell that rs NOT szed based on the EISA rating spied an the regarding pack of fine pmdu t approval leper, the effluent (agartaneen area is bi 0 the length times the such of the chambered area The use of geotetlik fabric in this type of InstallMmn is optional • Woen this Tha rs installed wish geote+We ghee on the sides of Pis product in a orsonWOon cell fore a razed based on are EISA raurg staunch the regarding black M the fount approval under, the gmRNle fapc Must est all of the following spsskohons Gcutenule strap be nonwoven Weight shall be 0 as or/sa ra to 1 5 Di yd Apparent opening size (AOS) shall he 2630 U S &eve tASTM 0-1)51) The depadmenl is in no way endorsed this product Or any advenlsray, tnd is not responsible for airy situation wnmh may result from ds use Sincerely Glen A Jorge, MS POWTS Product fieveiver phone (608) 267 5265 fax flich 2e7 9723 email glen lorsoff goy ST.0 OIX COUNTY SEPTIC 1'ANK MAD TENANCF AGRE6A4NT AND OWNERSHIP CERTIFICATION FORM O.weJ9egg� - lA vt� F r�T k.A M uVAK Malljng Addles W;;�1=���Gw�.apbzk CfiK''D✓.n +lul>5/G�n1 nOpcny Address i Imlbo�dPn I/Gk.S !A"IVP fan r W uirM Rom Pla�mine R ]name DePmmml fa now rmmtmml CLW/Smc A.11si�1 I La Pmael ldemefiaoo Nmnbm UAL—/GC/—CG—eeO LP Al, 18F.RfRNT80N Prupalyl.omDm �v' ''%, Ai� ''/.,Src 0 T ey NR I� W, Town of fl tll7✓`�`% Certified Sarvry Map d Lmd Volume / Page% AT wefr.aty Daedx L!P (hefine2W7)Vohme 23_ 1 pw# HPl pcbw Q'g 5lra Lot lure r@enfiablevywo" SYSTEhe MAL NAN , ANM OWNRRf ERIrtI A 1 N Impmpuutt nrd memmare oryaw awlie.ryxm mwatudl in in Peaulwe rmlme ml,enam w..te. Prop" Wbupupmmb Me rynem ban el(eb the fmcaon of de upueWk m n uumvnl slags m the woos digad rys¢m Ounu m k=m rtspmtlblitiesuepuib�io g$v539152(1)andinCbpb112- Sr.Cmia Cowry9avlarr Ora cc The pmpny owry sgb m sbout m SL Cmv Cauay PlamwB A ZOM9 DAartmet a umfimnon romy aped by rM1e andby a rplumbu,lawaMaan plumlu. ruPdNplwbzrore Lvnud pumps rnrhm6 bm(1) me aetim r& wa rymm la In pmpe, Pe ... y Webb bon W&U,(2)nllvtroepuuonaM partryn0(ifnectzsary 1. lk tt cmks Iess then 113 We ofdudge I then empef bane read the above uau ,,,mas Meps le mveram lb, pnve¢>vxpe armosal rys¢m mN tee aWWmds We Nrb eerury as ssI by dre Dtpe iofwety Mditfimgma Smatxcand Cx DwmmemaN,WJPmvrac Swmar Wrwnnn Cem canon n.nne reu. esevayenmm mamminGmun ee mmy MeM rewmMmAe St Cmia Cowry Plvmurg & IDnrnB Depemm vitlim 30 dap of be br¢ Ym epi Moo daR. Ore vernry Nu ell Nbmuru an Ws( mn to Ne beat of W"w MrWdy. l(m&ebm Ne ewer[) aaA pmpany dxmbea share. by Vm of a uaumry dead Ned m RegavrofD Mcz NamE<r oFhe4mame \n1L� SIGNATURE OF APPLICA (S) DATE • Any mforwbu d*t emuMumW ary e"'kim Ne awOry perms Mne mwtr by the Pl a ms A Ia'a^9DeRamb ue maul, mbt 0i 9 Vpll=cb A W=edW u Whed now 0e Reprer ur Dmda Ofeb end a wpy of ue eueaM a yrrf Adfigm,Qe um meve u Pva (RN.YNll) CST QO(7-ayq %FINED SOIL EVALUATION REPORT P I N 1 na smM mm mrc 57 CROIX i1a A �o�;o,igi reroie�reom P.w i� oea raol.a-000 ��nrmoFinaaon^ Oyu Ra6a•sa ( / e.a IAMESA CBARBARA, MLINAR IC Lv'—>W;p NE w5 47 f 39 N N 19 H,d... i WI i 54016 4.cu FbMP4M1.Mm�6WOM Cmvmnwl Ugm(�uM�T 5e-0.7IOWin6 mil 6 o dS hiago O\iLh (PUt&ent Zn!5f 92 f1q p1 NF e fl �� c,am..+,an., �_ oafrNvm e� ere r...d >s6 08 Li �Bomq. o& "" OB����QOQo some®me��ml mo,x._sa,n�.N,s,m<rso�wL sPi' r MARTIO HLPPERi Hollnul, Sollhmn BOm /I (//'/ 6r 3R.812 wa *ipu. N,mv 6~ EM9+ Kmy Anbun Coun, 0e11bmy. WI 56910 II 1q EOII 1I5A36�i1]5 6BRBX( 911) ,yp , MLMAR lamcs&Buebera pnwi op 020-1001-W-000 2 —rt—� PaOe _a_ ❑�n^9s l❑J PUI^^9 GnuMawkmeln 93 N1 —ft hMmliNd9tic, >94 in a®tea®�®�immi a�ms��am�®semen pa�mminn.am� �villri!►l 0mnmm m"�Sr^� �mm�ii�� mum.,. _porn„= ., 1151 � m. -nw,_>o ,� nww x � IMPIM Pie e� �'OMY ?AME�z BArt6Aw1 :N IJNaR 7^=Nit � v LJ