Loading...
HomeMy WebLinkAbout004-1018-30-000 i o ` ° o ° 0 d d K v m q v n 6 c N 3 (D CD rr c M o u 0 o�� o m 0 n o N� N OD o � S < C 0 � 3 3 C — V OA d N � I� CD j d.. O sh N m CL d trt N C ''. O 0 0 d cn n cn rn m N O m m ° a t 0 0 0 C Cmi N n O A O y O dD N N C Q O A O. O _ S 3 N (.n 7 N O O CA O �? m o d m A m D a C: Z D a cn @ N N G o cn O n CD C C 0 3 O O O O O 0 0 �' o o a r " o o -4 'A Z ! cn N co c0 Z Z c0 c0 N 0 r to m cD c0 c O j a o c ur Z O l�r 0 o Z O O O O O O o lliil O A D o c N y N a a N ti o N N 0 o Q O G° m� V C 0 O O Q' m cp v N m cn ! O O O m d '8 7 m 3 d a C- Z ' I Z --I K3 Z (n Z O D rn o D CD z v O 0 : O m , Q 3 ? @ (D N C1 x '0 CD m m m I w @' cc m a n 3 m 3 5 Z m CD c6 -i N O :3 , A Z m cn N n C) A Z O N CL 0 C/) --I W W T W M — W G 0 O m N Z 'o g c 3 X O ! o N ;o H N '0 W pj N N N N Q 3 Q CD < a j 0 ° o. N O m n O co d 0. C o W _ Am Z d J N Z X Q O O- O O ` CD v W cn OZ n o p -4 O CD O (d O 'y O co y 3 SQ s 3 m N 7 :3. O CD m a O 0 0 A _ O O O N CD '.i bQ I � En O '69 O c O CD O CD I parcel #: 004 - 1018 -30 -000 03/20/2007 12:13 PM PA 1 O F 1 Alt. Parcel #: 8.28.15.124 004 - TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DR ALANA L ALTNOW C - GLAN M ALANA L GLANCY GARY M 405 CTY RD NN WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ` 405 CTY RD NN SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 8 T28N R1 5W S 1/2 SW SW & S 1/2 SE Block/Condo Bldg: SW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 28N -15W Notes: Parcel History: Date Doc # Vol /Page Type 04/16/1999 601397 1419/180 WD 04/16/1999 601396 1419/179 WD 07/23/1997 592/91 07/23/1997 503/370 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/17/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 38.000 2,200 0 2,200 NO OTHER G7 2.000 24,000 152,000 176,000 NO Totals for 2007: General Property 40.000 26,200 152,000 178,200 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 26,200 152,000 178,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04117/2001 Batch #: 516 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I Wisconsin � � �?f H l yS� ial Services ,. Pib. X67 3/70 Division of Health VV p �Z-2^- 3 -7 0 SEPTIC TANK PERMIT APPLICATION . A/4 0 TYPE or USE BLACK INK S /2 S( f �y l qI3 A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) y B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Check Ones CITY VILLAGE LEGAL DESCRIPTION ��.. TOWNSHIP 1 c CcJ C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALSs Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Check Ones One or Two Family Residence x Commercial Industrial Other Specify Number of Persons to be Accommodated Vii:- Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Names s;,, :? Address: License Numbers r MP Signature of Applicants -. ';:s ` , MP RSW Address: H. (To be Completed by Issuing Agent) Date of Application 17 Fee Paid f P.Tit Isaued (data) / Permit Number Agent (Name) c / lam. {.( 1 Fort„ CIL oY Town, Village, City, Ctounj etc. (Specify Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forKard application, the fee of $1.OU for each septic tactic and tho third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY RETURNED (Initials) (Date) See Corres. FEE RECEIVED VALID. No. PERMIT N0. III es or No REVIEWED BY APPROVED DATE (Initials Yes or NOT COMPLETE OTHER SIDE SEPTIC TANK PERMIT NO. � 7 Z 2 - REPORT ON SOIL PERCOLATION TEST AND SOIL BORINGS TO DIVISION OF HEALTH - PLLMINO SECTldN P.O.Box $09, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code PERCOLATION TEST Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches Minutes Number Inches Thickness in Inches Since Hole in Halo Interval Second to Next to Last To Fall lst Wetted Overnisht in Minutes Last Period Last Period Period One, Inch Example 0 36" Top Soil 10" CLU 26" 25 Yes or No 30 1/1 2/2 1/2 60 3 4`o P s. �+� Y� /�t era► yo ji`o J 13 J4tVA0%jX Z4 d1j— RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B O R I N G S- Minimum 36" Below Pro Posed Abso tion System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observedl Estimated Character of Soil with Thickness in Inches Example B - 0 72" 72" Black Tog Soil 12"s CjU 18"j Sand 18"t Gravel 24 '� /T ono v�✓K ' �� „ 3T-4 7A ' P SiJ.[& &AA-Y- 4.+M• fitRe AK S _X*1 -6,7X RECORD DATA FROM MINBM OF 3 BORE HOLES PE OF OCCUPANCY= M o'Q. A - Wd F ^ RESIDENCE: Number of Bedrooms OTHER (Specify) Number of Persons '- D WASTE GRINDERS Yes No Dishnashers Yes No Automatic Clothes Washers Yes No FFWENT DISPOSAL SYSTEM: NEW 1K EXTENSION ADDITION REPLACEMENT i Tile Size No.Lin.Feet. Trench Width 3 Depth ye " Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Diameter rky ' Liquid Depth W ' i. D j 4 I, the undersigned, hereby certify that the percolation tests reported on this fors were made by as or under my super- vision in a000rd with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME Qd1T r J'- TITLE ~ A S' Type or Print REGISTRATION NO. 2- or MASTER PLUMBER LICENSE NO. ADDRESS P e A dX / e h'_ +.f DATE of y6 13 /q 7/ SIGNATURE 0 ? 0 J , ; $ % ° c k ' 1, ° � E M ( 0 §@ 2 E 8 �- m E [ m g e§ £ \, w }/ E« / d k @ 2 k ) \/ 2 G @ f g k t E � to « 1 © E e 4 > g .. : � £ 0 m CO e .. J PO a \ § k k § C ® -4 � z . / w % {I g E c 0 M Z- z o 0 0 Oro � � % § § I� t \ / ( v v B ; g & 0 § ° A) CD 3 # E § z E / o \ � o [ - § = [ / I \ . % � - � ■ � / § $ 0 .. C/) ¥ oo CL � z § % 2 3 ° , ƒ / � 2 0 _ ( xao % t$ƒ 0 � C) f � { � / $ 0 / [ ■ � � f g ~ k-4 I 2 00 o � CD t \ a . � k �\ Parcel #: 004- 1018 -30 -000 11/18/2004 08:43 AM PAGE 1 OF 1 Alt. Parcel #: 8.28.15.124 004 - TOWN OF CADY Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): ` = Current Owner DR DR ALANA L ALTNOW GLANC GARY M ANA L GLANCY GARY M 405 CTY RD NN WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 405 CTY RD NN SC 0231 BALDWIN- WOODVILLE AREA SP 1700 W ITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 8 T28N R1 5W S 1/2 SW SW & S 1/2 SE Block/Condo Bldg: SW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 28N -15W Notes: Parcel History: Date Doc # Vol /Page Type 04/1611999 601397 1419/180 WD 04/16/1999 601396 1419/179 WD 07/2311997 592/91 07/23/1997 503/370 2004 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/24/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 38.000 1,200 0 1,200 NO OTHER G7 2.000 6,000 85,200 91,200 NO Totals for 2004: General Property 40.000 7,200 85,200 92,400 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 7,300 85,200 92,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 516 Specials: User Special Code Category Amount Delinquent Special Assessments Special Charges D q uent Char g es Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT �► Owner C4 r C/ C f 4 h c. ca Property Address y 5 -I f 11 (Y ; City /Slate L 1 s t,✓, s" Y 2 7 �� c CQi1 T'! ZONINGOFFICE Legal Description: Lot Block Subdivision/CSM # S � ' /a S L✓ ' /a, Sec. cY , T2LN -R 15 W, Town of d V PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer N , 'd w eStcr4 Size ST/PC /EGG / GG �U Setback from: House 5 Well 96 P/L Pump manufacturer 2 /fit Model A l a r m location eC e t 1 G 1t (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location S0?.L ABSORPTION SYSTEM Type of system: N ti d- Width L 1 Length Number of Trenches Setback from: House GU Well U P/L Vent to fresh air intake ELEVATIONS Description of benchmark 00*to w o V S d ,`y f, Elevation G U Description of alternate benchmark 13 &&6 o�r W 6 on/ S a(� , N Elevation , s Building Sewer S 5 7 & ST/HT Inlet 3. S - ST Outlet PC Inlet PC Bottom 7 9, Header/Manifold Top of ST/PC Manhole Cover �� 3 Distribution Lines Bottom of System Final Grade ( ) 1 2 S ( ) ( ) Date of installation l Gl / Permit number 1 °Z State plan number q z d 1 Plumber's signature r License number - ` ,S Date U/ 1 v Inspector N" ✓wy Complete plot plan �' NOTICE Please provide the following: , • A plan view sketch showing everything within 100 feet of the system. i • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW Q � d s J�I I I 1 •�i3's'�`'1 INDICATE NORTH ARROW tf/ Wisconsin Department of Commerce y Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. 53129 Permit Holder's Name: ❑ City ❑ Village ❑ T n of: State Plan ID No.: Glancy, Gary Cady Township y 3 c f CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: ,p' 0 0 1 = g/� 004 - 1018 -20 -000 1 LID TANK INFORMATION T3 &VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I M i awu P I ppp A SO Benchmark . �� lo2•'f Dosing Alt. BM 100 Aeration Bldg. Sewer (A) Holding St /Ht Inlet (A �.IS g3.5q TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air i to ntake ROAD Dt Inlet Air I Septic > lap ' �� > /ap , NA Dt Bottom 13 8 3 4.91 Dosing NA Header/ Man. ) gq•g'p Aeration NA Dist. Pipe rs o 9q.$p Holding Bot. System -qs �j. PUMP / SIPHON INFORMATION Final Grade �- Manufacturer oc..� Demand St cover (A\ 34 Model Number 4- I - f o 32 'PM I1f 0 -2 ,t! ) 0. 2-o 3. }4 93. TDH Lift 11 Friction b.g Systerr2,S- TDH.A.S4t MCI t=1 ,2 . 2 b )02,2 Head Forcemain Length 2 �' Dia. Z " Dist. To Well ' SOIL ABS PTION SYSTEM $EB/ RENCH Width i Length No. f T enches PIT No. Of Pits Inside Dia. Liquid Depth DIME N 1 �" I DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of � , � � CHAMBER model Number: System: > fdD 1t0� > t OR UNIT DISTRIBUTION SYSTEM Header / Manjfold Distribution Pipe(s) r $A r x Hole Size x Hole Spacing I Vent To Air Intake u Length I(O Dia. 2 Length ��' Dia. ( Spacing 16 1 at g of SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [:]No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present etc.) Inspection #1: to /off/ 94 Inspection #2: Location: 405 County Road NN Wilson, WI 54027 (SW 1/4 SW 1/4 8 T28N R15W) - 8.28.15.123 1.) Alt BM Description = A/•ns - as a �.�.� 13M e^ 0& .a..,Lx. S�NU�a+ , r 2.) Bldg sewer length = '4-3 S-) �-t• Q,..,.,po / 6 a*— le !&& � Gotr� - amount of cover= 42 ., _ ; � � `T�l"�`� A� { c e,� j Sr 3.) contour= 9*.25 S C! )TO-P� ry�,vJ� p / ow 1 Plan revision required? [:]Yes RNo P1 Use other side for additional information. O ( 1 03 DO S SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e_e s � 4 i t Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353129 Permit Holder's Name: ❑ City ❑ Village 9 Town of: State Plan ID No.: .9 1 Town of Cady Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S O Benchmark oZq' 02. Dosing Alt. BM - ' V /A Aeration Bldg. Sewer $, �g F67 S-(., Holding St/ Ht Inlet Q �0, 5' 8'3• TANK SETBACK INFORMATION 5V Ht outle TANK TO P/ L WELL BLDG. Ventto ROAD t Air Intake Septic I w : a , -. _ _ > �� ' NA Dt Bottom t 3 ,193 Ct / Dosing > jai ' RS' >/U0 > 6 NA Header / Man Aeration A Dist. Pipe Z Holding Bot. System q PUMP/ SIPHON INFORMATION Final Grade *g Manufacturer Demand cove �h , 3( 8 3 Model Number Q GPM Y*Z 650 v.ZO 1 3.7 G3 5 TDH Lift N !\-_V Lri no & l9 Systd 5 TDH $,S Ft 16� #, p p� , o l Forcemain Length f Dia. F u Dist. To Well 'Ir SOIL ABSORPTION SYSTEM RENCH , width r Len j N Of Tr n hes PIT No. Of Pits Inside Dia. Liquid Depth DIME DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type0 �� > �06f }( OR UNIT Model Number: System: DISTRIBUTION SYSTEM Header / Manifold VI Distribution Pip (s H x Hole Size x Hole Spacing Vent To Air Intake Length f Dia - �_ Length Dia Spacing �jz{ 3 O rt "'� I SOIL COVER x Pressure Syste s Only xx Mound Or At -Grade Systems Only Depth Over Told pth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: /0"+/ T1 Inspection #2: Location: 405 County Road NN, Wilson, WI (SW1 /4, W1 /4, Section 8 T 8N - R15W) - 8.28.15.123 o �i` C R,I . �g, I C 84A, ) a,.a._ oar. S IL Plan revision requi d? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date \ Inspector's Signature Cert. No. 3 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r t z % 1 % £ � 3 % J g . .. � y 8 e �. . ,. ......, . .f Z i 5 . ..a_...... .....� .u� .a'�.... ... � M.e W .. < w .M.. �wa �..,.a ...�. ..w.. .�.. "." .... a� _.. ....M mr £ � ...... .,., .,e.,..{...." m �w. y e e E , Pe x t i i ... ._. � x g s fi 4 x Y f ' i s _a. f x t ...... ....,, _, _ . _ �. _,. �.� m �, d_ ... 1 � 6 j ... ..,mv gy m_. € e e 3 E •, a _ } s �p waem L A 7 r.. r i £ r Y r P .; ..,.,. a £ F° - Safety and Buildings Division 14sconsin SANITARY PERMIT APPLI 201 Wa in In accord with ILHR 83.05, Wis. Department of Commerce j� Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system ;a/ape cou than 8112 x 11 inches in size. ? �� • See reverse side for instructions for completing this applicati to S ry Permit Number E y 353 L29 Personal information you provide may be used for secondary purposes ST CROIX 0 Ch klf vision to previous application !Privacy Law, s. 15.04 (1) (m)]. i1AN I,pl} N'IY . ��+ `—+ t t iNO OF F 9 eta �K;7LD. Number ZON I. APPLICATION INFORMATION PLEASE PRINT ALL INF ` MATT N Pro j' erty Owner Name 'Pr'op ert t pc �f�o� (T 4 r u I S 4Y 1/4 T i� y . N, R 1 j'(or) W Property O ner's Mailing Addrest Lot Number _ Block . 0 um r 14 N ri i UO 5 C t City, State Zip Code Phone Number Subdivision Nam or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned It Nearest Road CI Village Public 0 1 or 2 Family Dwelling - No. of bedrooms 4 Town OF 111. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Number(s) �' ; 1S, 3 1❑ Apartment/ Condo U O q" U e 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3• ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash. 5 ❑ Hotel/ Motel 9 [] T Factory 13 [] Other: specify IV. TYPE OF PERMIT: roTlty >3ne k>,ox on line A. Chetk box on line B, if applicable) A) 1 ❑ New 2_ ®.Replacement 3_ ❑ Replacement of 4_ E] Reconnectionof 5_ E] Repair of an ______System _ ______ System __ __ Tank Only______________ Existing System ________ Existing System i B) ❑ A Sanitary eviously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) i Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed 21 94ound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure � �� / 42 Pit Privy 13 E] Seepage Pit J 43 C] Vault Privy 14 E] System -In -Fill C . �ul, = 9 a- Z,5 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Re wired (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) p Elevation `t 3 � i 3 7G Feet 1 01, Z. Feet TANK Capacit VII. INFORMATION in g a llo n s Total # of Manufacturer's Na Prefab. {on Steel Fiber Plastic Exper. New Existing Tanks concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank 2 ❑ ❑ ❑ I ❑ ❑ ' Lift Pump Tank /Siphon Chamber V L S 7i i t ❑ 1 ❑ ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum is Signat r o Stamps) MP /MPRSW No.: Business Phone Number: c�C SL4� c, Plumber's Address (Street, Ci , State, Zip Code lz s �4 4,,,, `( /'ot I _)n d cue` U IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee (IndudesGroundwatef ate Issued Issuing Agent Signatur (No Stamps) Approved E] Owner Given Initial Surcharge Fee) Adverse Determination 3 fo' X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: ata X c*J& 0.k litau.4 SBD- 6398 (R.11/97) DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, .608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the - system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval. from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to.scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ------------------------------------------------------------------------------------------ - - -- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD t. (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 27, 1999 CUST ID No.267341 ATTN.• Rod Elsinger WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/27/2001 Identification Numbers Transaction ID No. 243284 Sit ID No. 1795 SITE: Please refer t' i e _ ' ien hers, Site ID: 179564 above, in a ondence with the' envy. St Croix County, Town of Cady SW1 /4, SW1 /4, S8, T28N, R15W `" ;" ` LU r Facility: Alana Altnow /Gary Clancy Residence FOR: 9 y� Description: Repl. 3BR Mound ST Ch COU1VTY Object Type: POWT System Regulated Object ID No.: 487621 Igyi The submittal described above has been reviewed for conformance with applicable Wiscons ve Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of j construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 08/19/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Deem s R ore on BALANCE DUE $ 0.00 Wastewater Specialist (608) 785 -9336 dsorenson @commerce.state.wi.us �IiS" dr76,,3, Page of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE 5W 1/4 OF THE S W 1/4 OF SECTION S , T 26 N, R 1 S W, TOWN OF C C• \— lK COUNTY , WISCONSIN. i INDEX PAGE 1 "of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR li LN>uP V) Crk Xw f�� c ,�'�J C 'Ir REC EIVED 4 o G C-`n+ " N M I, ,AU G 19 1999 w��_SO►v, wi S4.oz. u 0 yy 7 4 PREPARED BY WEGE[7EI:;z. AC3 X L . TEST I NG DES = CaM SI =F:ZV 2 ls P.O. BOX 74 421 N. MAIM ST. o� •••• RIVU. FALLS. MI 54022 WEG NER 715- 42`, -416J EuSWQHni. g , O .W.z.S. Condition 3 d ......� �SIG1 DEPARTt.4Et'T OF COMP�E.FIt:E �, - �,...� DtV1SiC� f SAFETY D BI1ILD�NGS SEE CORRE. NDENCE JOB NO. Page 3 Of Approved Synthetic Covering PP Y g r-�STm C v! Distribution Pipe Medium Sand H G Topsoil - Elev. g9 D ,3 E 3 % Slope Trench Of k7-T 2 Force Main Plowed Aggrega From Pump Layer Undisturbed D 2.0 Ft. Soil E Ft. Cross Section Of A Mound System Using F Ft. 2 Trenches For The Absorption Area G Ft. A q_ Ft. H Ft. B �-« Ft. C loo Ft. Linear Loading Rate= `4- GPD /LN FT I \c Ft. Design Loading Rate= GPD /SQ FT Ft. Tutq cy1 V 0 .30 _ . 1—%W eR, \-V .1 C%4 : o . 2Lf k K _ Ft. L Ft. W Ft. L J K A " Observation P Pipes Markers (Anchor securely) y - - Force Main _ Distribution - --- - - - - - - -- �— — — — — — -- — — — W t ,� %� Trench Of I — 2 2 Pipe Aggregate ( Mound Using 2 Trenches For Absorption Area Page Li Of 'o Perforated Pipe Detail / 0 End View Perforated End Cap j PVC Pipe Install permanent 'marker t . b�� e ` at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main Q PVC Manifold Pipe Distri ution Pipe Last Hole Should Be Next To End Cap End Cap P Zb.1c Ft. Distribution Pipe Layout S 6 Ft. X 38 Inches Y 38 Inches Pole Diameter !�U Inch Lateral, 1 Inch(es) Manifold Z• Inches Force Main Z Inches # of holes /pipe '7 Invert Elevation of Laterals aq -) SFt. Place lst hot �� e from center of manifold with succeedin g holes at 38 intervals. Last hole to be next to the end cap. �I C ombination eptac- ank and PUMP CHAMBER CRO55 SECTION AND SPECIFICATIOUS ' PAGE S OF 6 VEIJT CAP WEATHER PROOF JUUCT101.1 50X H C.I. VENT PIPC , APPROVED LOCKING 1•10' FROM DOOR, MAUHOLE COVER wlV % INDOW OR FRESH u'P'RNIU6 LPeEI,.. AQK IWTAKE Co1JDU1T c b N 6 6Rl1 _ 4 WSV�_M3i ply PROVIDE Ii.1LE T 7 AIRTIGHT SEAL 3 tiFFL�S I I I I APPROVED JOIUT A ! I I APPROVED JOWT: w /t.z.�1PF�xp�� W /C.T. PIP£D 1 Z Tank construction i i shall comply with - I I ALARM ILHP (')3.15 and 83.20 I i ou c ! 1 . I CLOY. FT. OFF PUMP —�, - -� ti D COWCRETE BLOCK 3" 1►FP>!c'rF� Ki$EF. EXIT PERMiT(ED OIJLy IF TAWK MA WUFACTURER HAS SUCH APPROVAL DOING SEPTIC f SPECIFICATIOUS DOSE 7A�.IK MANUFACTURER: P� L sT IJUMBEFL OF DOSES: 3' q PER DA,U TAWK :,IZI` : � 1 6 S© GALLO DOSE VOLUME z ALARM MAWUFACTURC.R: S.S.�t S l�1S _ IMC1- UDIIJG 5ACKF1.OW: �S GALLONS MODEL ►.!UMBER: � 1 ^-J CAPACITIES: A= � � IIJCFICS OR 30 JO CALLOUS SWITCH TAPE' `F'I�ZC°C1R >Lf $ = Z INCHES OR 3 � GrLLOAIS PUMP MANUFACTURER.: z Cr \D AUCHES OR GALLOWS MODEL NUMBER: D= g INCHES OR �3b GALLONS SWITCH TYPE: WI CEJI2 C I NOTE: PUMP AMD ALARM ARE TO 5L b MIUIMUM D15CKARGE RATE 3�"`�� GPM IN5TALLED ON 5EPA9.ATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF A►JO.0I5TRIBUTIOIJ PIPE.. 110 FEET + MIIJIMUM METWORK SUPPLY PRESSURE .. 2'S o FLET ZSI) FEET O F FORCE M X �� 1 � F 001LFRICTIOU FACTOR.. 5 FEET TOTAL DyNAMIL HEAD = Z �'� 3 FEET Pump chamber DIAMETER 4 ILITERLIAL. DIMEWSIOWl OF TAUK: LEKIGTH - ,WIDTH DEPTH _...._..... BOTTOM AREA 231 = - GAL /INCH AS PER MANUFACTURER �"l•O GAL /INCH I 6 EE o� w n TOTAL DYNAMIC HEAD /CAPACITY SingleSeal w HEAD CAPACITY CURVE PER MINUTE = J 7/6 6 1/4 MODELS "14014140" EFFLUENT AND DEWATERING 4 s!e — Ft. Meters Col. I Ltrs. 14 45 5 1.52 9t }u 3 7/8 o 10 3.05 I 94 I 318 40 75 a_57 76 288 0 0 {{ 1 40,41 4 D ` 20 6.10 I 68 I 257 1 7/2 - 11 112 NIT 35 25 7.62 59 223 10 I 30 9.11 49 I 185 30 Z ,�> 35 70.67 , 38 f 144 40 12.19 21 I 79 8 25 45 13.72 5 I 19 a g Lock Valve: 46' W y 20 i U < 4 5/16 J 4 15 I SK1524A 4 O 10 2 e• Sea(De 5 11 —J 3 7/9 L.-- 6 1/4 0 1 —4 5/8 U.S. GALLONS 10 20I 30 40 50 60 70 BO 90 1D0 110 0 37/8 LITERS e0 160 240 320 400 0 + 0 FLOW PER MINUTE o 010940 O 1 1/2 - 11 1/2 NIT CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied 1613/32 with an alarm. • Mechanical alternators, forduplex systems, are available with or without alarms. - -� • Control alarm systems are available for 1 phase pumps used in simplex 4 _� s /1s SK 15248 system. See FM0732. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable SELECTION GUIDE level long cycle controls. 1. Single piggyback variable level float switch or double piggyback variable level • Sealed Qwik -Box available for outdoor installations. See FM 1420. float switch. Refer to FM0447. • Over 130 °F. (54 °C.) special quotation required. 2. Mechanical alternator M -Pak 10 -0072 or 10.0075. • Refer to FM0806 for 200' F, applications. 3. See FM0712 for correct model of Electrical Alternator E•Pak. 4. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. S. Four (4) hole J -Pak, junction box, for water tight connection or wired -in simplex 140 Series - 53 lbs. 4140 Series - 73 lbs. or 2 pump operation, 10 -0002. 140/4140"' MODELS Control Selection Model Model Volts-Ph Mode Amps Simplex Duplex N140 N4140 115 1 Non 15.0 1 or 1 & 5 2 or 3 & 4 CAUTION E140 E4140 230 1 Non 7.5 1 or 1 & 5 2 or 3 & 4 BN140 BN4140 115 1 Non 15.0 1 or 1 & 5 2 or 3 & a All installation of controls, protection devices and wiring should be done by SE140 SE4140 230 1 Non 7.5 1 or 1 & 5 2 or 3 & 4 a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Double seat pu npsareavailablewithoptionalrroisturesensors. SealFadindkatorfigMavailableinNEMAIorNEMA4X Occupational Safety and Health Act (OSHA). control panels. RESERVE POWERED DESIGN For unusual conditions a reserve safety fac is engineered into the design of every Zoe pump , MAIL TO: P. 0. BOX 16347 - Z � Louisville, KY 40256-0347 Manufacturers o SHIP T0: 3649 Cane Run Road Louisville, KY 40211 -1961 r=177 C LIAIPS S A'C6 19,99" ( 502) M-2731 -1(800) 928 -PUMP FAX (502) 774 -3624 I Wisconsin Department of Commerce SOIL AND SITE EVALUATION a Division of Safety and Buildings Page of Bureau of Integrated Services � � accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but nct limited to: vertical and hotizontai reic,rence point (BM), direction and �f - --- 5 I— percent slope, scale or dimensions, north ewow, <ii c ucation and distance to nearest road. Parcel I.D. N Op -i Ztu APPLICANT INFORMATION - Please print all infor, Rev wed by Date Personal information you provide may be used for secondary purposes apys( o — �- k Property Owner // Property I- Nation lfn4641 a a� c -/ t. �a1 ':- w 1/a S� 1 /4,s T ,N,R I S E {or vv Property Owner's Mailing Address t6f # BI # Subd. Name or CSM# City State Zip Code Pho e - N mber CO C:qp/ City; Village Town Nearest Road S �7 { } tac;d C•r /t1AI r ❑ -��New Construction Use: esidential J Number o r dio'mis ' , Addition to existing building ` FL I rseplacement ❑ Public or commercial - Descn Code derived daily flow -..L fQ gpd 1 , j BSra /A&LRecommended design loading rate bed, gpd/fe ..� trench, gpd/ft Absorption area required _-Alp _ bed, ft trench, ft Maximum design loading rate N� bed, gpd/11 gpd/e Recommended infiltration surface elevations} 4�N ft (as referred to site plan benchmark) c Lt a (l r Additional design /site con / 37 sideration 5 L7 t-e N�-� St -5 / X e S er Parent material s.` / ('�O err 7 .'C Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system El t- u al � El U El 9 ss S 0 ❑ S E ❑ S 19' ❑ S SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD 1ft 9 Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench r b Ll VVl r 1? 5 , r 6 Ground r SC c 5�G I S elev. Depth to limiting factor _f m in. - J� q t ll.G.u Remarks: Boring # c 4 1 sb 'A C) Ground elev. ft. , Depth to limiting factor --s-in. Remarks: _ H,(r p Add ress (Please Print) Signature 1 Telephone No. 1 /5--1 / 77o - -) 7 Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page of f 1 PARCEL I.D.# G 0 to I8'2l� Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda ry Roots 2 x, in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench P t r F 3 Ground QcCe-�lev5--- � Depth to limiting factor Remarks: Boring # c �,t G S S r S � c.d Ground 3 , 96 S�s e lev. Depth to limiting factor - Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # S , b c2 �cJ r vF zawe a k-t t� Ground O elev. D Depth to limiting factor ,4, Remarks: Boring # } Ct t V sw P c L s U" h2 J r Ground elev. Depth to -- ---- -, -- -- , limiting factor - in. Remarks: SBD -8330 (R. 07/96) SOIL DESCRIPTION REPORT �PROPEiITY OWNER �� -- _ — _ Page 3 of PARCEL 1.04 Boring Horizon Depth Dominant Color I Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. Bed , Trench S t CJJ (V S Ground 6 elev. ({ 6 c 3�k S c, i- C S , Depth to limiting fac r in. cyf Is ,cLl Remarks: Boring # . (a ldf Ground _ ` eiev q�ft. Depth to limiting factor . b,� Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. Bed , Trench Boring # TI Ground elev. ft. Depth to limiting factor in. Remarks: Boring # LIN Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) il l Wisconsin Department of C.orrii?ier SOIL AND SITE EVALUATION Division of Safety and Buiidif;gs Page o'/ Bureau of integrated Services accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper ne( iess roan x i 1 inches in size. Plan must County include, but not limited to: vertical and nolizontai reference point (BM), direction and percent slope, scale or dimensions, north arrow, anti vocation and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may oe used for secondary purf)oses (Privacy Law, s- 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 1/4,S T N,R E (or) W Property Owner's Mailing Address Lot # I Block# Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road ❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow __` gpd Recommended design loading rate bed, gpd /ft trench, gpd /ft Absorption area required bed, ft trench, ft 2 Maximum design loading rate bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ❑ U ❑ S El U ❑ S ❑ U ❑ S ID U ❑ S El U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor in. Remarks: Boring # LE i s Ground elev. } ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM �/ Owner/Buyer CJ u r n li n C- y Mailing Address �l S Property Address S 1-h e- (Verification required from Planning Department for new construction) Cit 15 �� LJ �" G CS 0 ty Parcel Identification Number � t �' LEGAL DESCRIPTION 00q v - 3 O w Property Location .S l✓ ! /4, 1 /4, Sec. r7 , T N-R 5 W, Town of C 4,0 t y Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # G U 3 "� , Volume 1 ` f Page # ,. kO Spec house ❑ yes E] no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of three year expiration e. ' ,� X SIGNATUO OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro described above a of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 701. 1419PAu 184 601 X97 KATHLEEN H. iIALSH Document r _ ST. CROIX CO., W1 AEMYO FOR KM ` This Deed, made between Jon L. Mork, a single person, Grantor, and Dr. W1649" 1005 All Alone L. Altnow and Gary M. Glancy, husband and wife, as suwivorship marital propert Grantee. MWOAIitY 1EF1 WKnesseth, That the said Grantor, for a valuable consideration of one am 0 C dollar and other valuable consideration conveys to Grantee the 01 FEEt fFFt following described real estate in St. Croix County, State of Wisconsin: TNIIVFA FEET 50.00 P II111 FEE: i0.N Recording Area Name and Retu.n Addren e omurn, S.C. air Streel x 54 B WI 54002 004 -1018 -20000 004 -1016 -30000 (Parcel Identification Number) The South % of the SW '/. of the SW % and the South % of the SE %. of the SW % of Section 8, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin. This is homestead property. Together with all and singular hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this /E day of April, 1999. ork AUTHENTICATION ACKNOWLEDGMENT Signature(s) Jon L. Mork STATE OF WISCONSIN ST CROIX COUNTY Personally came before me this day of April, 1999 the above named Jon L. Mork to me known to be the person($) autherp�� day o 9. who executed the foregoing instrument and acknowledge the same. signa ture 27•V signature typv or print name type or print name TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wisconsin. (If not, My commission is permanent. (If not, state expiration date: authorized byg706.06, Wis. Slats.) .) THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing in any capacity should be typed or Thomas R. Schumacher printed below their signatures. Baldwin, Wisconsin (Signatures may be auMenticated or acknowledged. '?nth are not necessary.) "arm it-an prof- ssanNe cwpanr For,-- du Lao. W,,*c-~ 01.3.655.2021 a � �I no , Q \ V Za \� \n C V3 . p ^V r�Q Q. L4- z k ` 0 I i i 3 s ,V ( 8 V a � d � � d a rn r V d � y � A Ic 3 3 C � � y v a s _ 'CJ i N N 4 00' 'ro I 0 T�+ F) V (3 . 0 Z Z i D G " W G a � �z � z x p `Z �Q O� ^ T , z ti i . p �-3 En En M M �GNaww rr H H rt N pi rh ~ O fi 7r "" .� A. ( N rn Lo x & v PU �r m O L A U) Pi ft o y o 0 m rt- n 0 o cr c n o ro•En En m I'd rt wmru to F, N rr W „ , O N 0 LQ p O '4 o ro b " tj pi aro ro 0hwm �s r •on m rrC �r 'C a ►J c ixi s_ �\ r P) (D O r \ tv A7 Q+ I En ) CS m h O o� (N 0, cn v -- m ` Q m V=