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HomeMy WebLinkAbout022-1055-95-000 '0 0 a o c <y 0. 0 ° o I' c N O ti m L m c n wE . n [� 0 L CL o . w Z N _ O U 9 Z o0 li c o O m N o E v E � m Z y C Z ( 6 N d C) H � a m o I O 2 d U Y a 2 a c Z I E � � M i wU a, I c c p m O o Q Q N �zz z E N N N L — d ° m m m ,n a w c O W y p D O a c Q m vi H H H w N Z v> ii O O O a Z •� ;� a�a(L a of a > 3 O !!1 J V o rn rn } M CD � 0p a 'O d N co W 'D N Q) O c o O O F- y 0 C @ N cD O) ` o It E ci m _ c a o 0 0 M 'E m E N C- N N N L b V �r O In C M C N C C N M 4r O Y Y M ` N O C •� y am, ° o m Y i ', N cl) O Z Z U) CL � E m L: a • ca a m . m y c E i E c "' 1 A 0 a O ) 0 'r' EH 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: - %, ' /4, Section T_ *) W, Township or Municipality � v INi- Lot No. , Block No. County Subdivisio Name 10NIN6 Owner's /Buyers Name: Mailing Address: R ou i c TYPE OF OCCUPANCY: Residence No. of Bedrooms OMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW �'� REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 6// ,/e4 PERCOLATION TESTS SOIL MAP SHEET 0 .__ x 7 NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTEF INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P— P— P— P— P— / i P— ry SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B — > 16 �" .� j „6 - )yC a B- L 5j 7 yr B- $ b 11 rL < O a PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areasYrndicate on the plan the.location an4 square feet of. suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy '* Xa 17 Zt .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. N _fit. r� F 3 c� 44 �. S n , R R Y u r ... -d —_ s 011 ._ •€ I �S !'rl c t a Ci •- �fl t E , I, the u dersigen hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. i Name (print) 1CSeth M.t'p elm S e Certification No. e Sr 3.'n Q y Address &Wdee i i ��l �� =� � 1 4 ` 74 67 Name of installer if known CST Signature Copy A —Local Authority i� ' i < •Y l �s � � .. `� � .. \ .. 4_ ti _ _. _ ._ s � . i� - / 'k • � � a u �! J` i .. � w .. .... .. � � +r f d � � _ � ST. CROIX COUNTY ZONING DEPAR -j AS BUILT SANITARY REPORT Owner Property Address S. v J 1 City /State r. Y ZONING OFF I GE Legal Description: Lot — Block — Subdivision/CSM # 5 1 5 9 3 VO I n fl� a 7 '/a ' /., Sec./ To�N -R-LLW, Town of k inn i V I C PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer U4 ;s S e r Size ST/PC la / 70 Setback from: House f 7 Well P/L 30 Pump manufacturer /111 C N D Model A 11P s Alarm location JIRA n (HOLDING TANKS ONLY) Setbacks: See d Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: A ftgt j _ Width _� Length C o 3 Number of Trenches r air intake Setback from: House 60 Well � P/I, �Z 3 Vent to fresh � 00 ELEVATIONS Description of benchmark 102 / ► q �f y � a V UC- f - Elevation �C►, Description of alternate benchmark Elevation Building Sewer 9y. ��_ ST/HT Inlet 9Y. A 3 ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) `Z1, 9 2 Bottom of System Final Grade () () ( ) Date of installation / / Permit number -53 8 P / 3 State plan number Plumber's signature5 ( License number 6 2I `/.S 1 Date ,3 l /G/ bo Inspector O !'l Complete plot plan Or 0 11 --33 SUN 21:24 RAG PRO] �"PPOR1 F1Y N0. 61P2331- .9 P. 03 r •apps ttzt�dn atK� �� bu puQc� _��uaAa�d o� ma -4sXS puno_Te x9'4'eM a:�eg:7nS '4x0nTa '9 iJ .NOTICE Please ' ' ^+� p &IfM ' 0-4 xn t�d�S • ' A p 'coedLID � 0TTQb a5 �- vS Z. aq c ' axcnli = 'z } "'• �aanoacdt� tilrM sadzd. uaT - 4Vnxasgo A pl 'a1ae°ld]pi&0(l4feee%gyst"Xuuad TTE4suz z ai f � •pajOu ssqj'un sun punosb 6u a3e tcri011s s.uoiapea ''T ' Two horizontal reference points to center of septic tank manhole cover. s�o • Show alternate benchmark, if a s pp licable. I 4 1 i PLA 0 - 1 Z6 �B I t I. t ! J } r. (� c t 10 ,91y j -6 I JA a J 4.- %.Aua S.0 ry oZ sf V IP 1 � t #�s.,,`,_ ` � + 0 b gb l3 �'- r 3' $ Ij "L'� iv f�+o•,� i. + 1 CA� i x t j S`,E* ,, v,(N-s� AJU 3a M-* - 031 rn - INDICATE NORTH ARROW r i I . Z Ley h 1 ' r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338813 Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.: 2YDUCK, JAMES M. KINNICKINNIC CST BM Nev. Insp. BM Elev.: BM Description: Parcel Tax No.: �? " U r C,4 022 - 1055 -95 -000 TANK INFORMATION ELEVATION 6ATA TYPE MANUFACTURER CAPACITY ST TON BS HI FS ELEV. Septic WelSC' ✓ (J chmark e - , o .S O Dosing �S !� 9r4 Aeration Bldg. Sewer Holding O Ht Inlet 2 3 r TANK BACK INFORMATION utlet TANK TO P/ L WELL BLDG. Ventto ROAD D e Air e Septic > 5'0 r r 2-2 r NA Dt Bottom S P. I Dosing > SO ' 3r' r 3 — r NA Header / Man. �'` z Aeration Dist. Pipe i - r. Holding Bot. System G - 99• Z PUMP/ SIPHON INFORMATION C Final Grade �' (,I Manufacturer ��S L�S Dema d `� odel Number 0 3 `GPM DH Lift i2,y8 Frictionr System. TDH Ft Loss Forcemai n Length q Dia. Hit Dist. To Well 3� j SOIL ABSORPTION SYSTEM E / T EA4Gbl Width r Length r No. Of T- a PIT No. Of Pits Inside Dia. Liquid Depth EN I N Y ( 10 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Type Of 9 r ) �D r � r _._.�' CHAMBER Model Number: System: /bl ( I Is OR UNIT DISTRIBUTION SYSTEM , Header/Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake r r i Length Dia. �� Length � "ia. "a Spacing / c /o � / Do 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 El E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) _Tr TION: KINNICK 19 2-8,18,304G SE, SE 1008 QUARRY ROAD o��arrage '[Yeo( bI , It, e- Plan revision required? Yes �ja o Use other side for additional information. Z Z G 4 SBD -6710 (R.3/97) Da Inspector's S are Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: P P .... ....... 1 _„ s a i d b f � a e a ; E ..? � I e e e e , e..,. �. a .� � � ,_ -. e., ,,.-. eve e _ a 3 e ..... . . ...... .. E .... ..< em,.. „tee.. e ,..,,.....q4 ,..e.E �.�., e ..... e... . . . .......... . .... �. F. te r ._. .......�.,.,, ; ,.,..„,. ,—« ,., a_......... , e ,....... _ � , , .,, .. ... , , ......, .... .,, ...,.t ........... »»e � a,.., , .�....�- .,, „ g, vammm. e .,... .ae. e M e �,..,� em . £ , .._.. 3 1 3 € e Poe � r f g s r e z f a 6 5 G Ee.., € em. e m........�. e,.,.a. .ate ..... . €._». ....e...,_ 3.. .e _a, _. '. ...,. ._ _. .. .� ' mm� l 3 £ i J 3 me.. _ edem .,_ e. �.,m__ r £ w �m mmmee m £ F � l m m ..m_e. P «....,...... . . '.m� ... �. ,....€.. ..� mew -_. ., . ............. .. ... .e.. .. .. �_... v _. � ,mw. 7 - - E e 3 V isconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 0 1 E . 7969 Department Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81 /2 x 11 inches in size. �, • See reverse side for instructions for completing this application State Sanitary Permit Number 33 �1 The information you provide may be used by other government agency programs ❑ Check if rewslo o previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I tuber 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION -T Propert Owner Name Property Location E 1 /4 1/4,S /9 T a�g �N,R /g 800 W Property Owner's Mailing Address Lot Number Block Number li4 !S• �t I �rty, State Zip Code Phone Number Subdivision Name o CSM Number 6r mN 5 n 1 b (bla ) n P a 76 a .. E OF BUILDING: (check one) ❑ State Owned I ffearest Road Pub TZ 1 o r 2 Family Dwelling - No, of bedrooms Town OF % ' )G 06a r Rd 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) �� 1 ❑ Apartment/ Condo 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 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. Ix New 2 ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an - _____System ________System _____________ TankOnly______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 600 60 © / 17,E Feet JnI Feet VII. TANK Capacit g allons Total # Of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank." Wekliat44plr Q Ja50 h ~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Sipfaca- EFtew6er ~ ® ❑ 1 ❑ I ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plipraftr s Signatu : No Stamps) MPNIi4PR5rVMO.: Business Phone Number: Teluk c� _- Plumber's Address (Street, City, State, Zip Cod S IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Q * gnature (No Stamps) 3P-5 , Surcharge Fee) I " ` /9 l gApproved []Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I 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 systern, 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 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. i Safety and Buildings PO BOX 7162 t � MADISON WI 53707 -7162 - �sconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary May 12, 1998 CUST ID No.267341 A777V: POWTS INSPE. WEGERER SOIL TESTING & DESIGN ll 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 T 0RC)I;rU' r 1OUNTY RE: CONDITIONAL APPROVAL Transaction ID No. 7 3� 1 ,MNG OFFICE APPROVAL EXPIRES: 05/12/2000 V SITE: — = -. Site ID: 7629 ST CROIX County, Town of KINNICKINNIC SETA, SE1 /4, S19, T28N, R18W JIM ZYDUCK FOR: Description: MOUND Object Type: POWT System Regulated Object ID No.: 18733 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 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 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. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Sincerely, DATE RECEIVED 05/11/1998 FEE REQUIRED $ 180.00 JAMES B QUINLAN , FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)266 -3937 Page of 6 n MOUND. SYSTEM FOR FIV A BEDROOM RESIDENCE FF� � I99 O LOCATED IN THE SE 1 4 OF THE SE 1/4 OF SECTION 1 9 T Z8 N, R L W, OF ST• C 1 TOWN 1t,t r..�tv t C �'t. iy L C RU X COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PA GE 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 SA M ftKA�, z'-i. b C�c - - -- P.O.W.T.S. Conditionally - I l X1'1 1 W1n X2.1 Tt � OF • 5 �1VT1.1 �o 6 APPROVED DEPARTMENT OF COMMERCE 1 iv1s1ON OF SAFETY AND 8gWD1*G$ a SEE CORRE%WNDEN- CE PREPARED BY y J WEGEE�ER SOIL AND 4 SERA! I CE �e R • �NNM.., •y I� F.Q. BOX 74 421 K HA ff I �� NN ST . j ARTNVR L. RIV£F FXIS. KI 54022 WFc.RER 2 axis P 715- S�.r-0ib5 ELLS'&ORTH, �r►y�� s �Q�oNaot� - cl -9 Jos NO. 9$ -103 .. A I x � I r' PLOT PLAN Page Z of (� scale 1 "= tip' CS T 1. _r 3 Y Z S , l:__Iz Y_i rftr1A_S . -- -- I- . N J9 N Mr �r.Ttv�ct lL. 5 8 _5' — gL G8 9 0 % mm CAF QNO �L ° ►9.S� �z` . a •3 ` I N 1 1 - / 1 zs -�a 3 V d I \ tea$ 3 LL O i d ia 'Ipvc l VtvVE�E I � 21Uk, NOTES •1. Elevations shown are existing ground elevations unless otherwise noted. required) markers at end of each lateral. ( 2. Install permanent � 3. Install 4" observation pipes with approved caps. ( 2 required) 4. - Septic tank to be VLSI / gallon capacity manufactured by coy, a2Li)� aow► Q ov Ir k 5. Bench Mark EaZj . ku p p' cp-a \Z," V A (S H , 3) q u D1 VU Q_ P 1 PN' W / Fla4cs Pos�- 6. Divert surface water around system to prevent.ponding at the uphill side. I � Page 3 Of 6 Approved Synthetic Covering X97" c- 33 Distribution Pipe Medium Sand H G Top 5 soil -_ -- _ ° ! ° l• P - -- - -- F Elev . E " b 4 % Slope Bed Of 2 2 %2 ( Force Main Plowed Aggregate From Pump Layer D 1- O Ft. Cross Section Of A Mound System Using E \-3Z Ft. A Bed For The Absorption Area F b -`b Ft. G \ -o Ft. A 8 Ft. H l -S Ft. Linear Loading Rate= q-S GPD /LN FT B (,3 Ft. Design Loading Rate = C).y.GPD /SQ FT j `b Ft. J $ Ft. K \ Ft. of, F 85 Ft. W 3 Z- Ft. d Observation Pipe -� K - - - - - -- -- - - - - -- � OI A (• - - - -- ----- - - - - -- ------------------ - - --�I Force Main M N Distribution Bed Of i — 2;2 Pipe Aggregate I Observation Pipe Permanent Markers (,Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page 1 4 'Of Perforated Pipe Detail 0 End View ) Perforated End Cop. l� PVC Pipe Install permanent marker a at end of each lateral Holes Located On Bottom, Are EgaoQy Spored S PVC Force Main Q PVC Manifold Pipe Disiri ution Pipe Last Hole Should Be I Next To End Cap End Cap P 30 Ft. Distribution Pipe_ Layout S '4 Ft. X L/ $ Inches Y Vg Inches Hole Diameter 11 L/ Inch Lateral Inch(esl Manifold Inches Force Main Z Inches # of holes /pi pe_L_ Invert Elevation of Laterals 1ob.o Ft. Place lst hole Z 4 y from center of manifold with succeeding holes at LIZ ° intervals. Last hole to be next to the end cap. Combination Septic; Tank and PUMP CHAMBER CROSS SECTIOW AIUD SPECIFICATIOMS .;'. PAGE S "' : OF •VEIJT CAP WEATHER PROOF JuAICTION box 4'C.I. VENT PIPC APPROVED LOCKING , 10 FROM DOOR, MAWHOLE COVER .huoOW OR FRESH wA(1iJ11JG C.146EC.. A� IWTAKE S cosapu�r i t � �g � (��MIN, +laRJ't t •f� MIIJ. --- - - - - -- PROVIDE I LET " ' j"gIRTIC.HT SEAL I I I D JOIIJT 3�aF��CS A I I { { W /C.I. APPROVED JOIIJTF APPROVE I l I PIPE�f"c W /C.I. PI PEaR Tank construction I t { { shall comply with _ I I ALARM ILH� 113.15 and 33.20 a t I I t o►J C I I $b•b� I 1: Y, f T. PUMP -� --g OFF C. L D COUCKETE �Lt?V• 8�.0�' 5LOCK 3" APPRo+F: .X - RISER EXIT PERMITFED OIJLtJ IF TA►JK MAIJUFACTURCR HAS SUCH APPROVAL gFODING SEPTIC f SPEC.IFICATIOUS DOSE W��� � � WUMBEK OF DOSES: 3 • �{S TAUK MAIJUFACTURCR: - PER DAy TAWK :,IZC tZS(� 7 GALLONS DOSE VOLUME l ALARM MA►JUFACTURCR: S- S. Z 5`:'S"T I S IWCLUDIUG 6ACKFLOW: °' 3 ' GALLONS MODEL QLItABER: CAPACITIES: A= INCHES OR L403 - � GALLO SWITCH TyPC: �ZeVR I ( B= Z IIJCHES`OR 31 ' 3 GrLLOU5 PUMP !''%AWUFACTUREK. Y�I� s C= Z. IULHESOR \0t3 GALLOIJ5 MODEL NUMBER: M�1E 4 � D- S INCHES OR LZ " a ' O GALLOIJS SWITCH TYPE: CJ�z -�r M OTE: PUMP AUD ALARM ARC 5E Z MIMIMUM DISCKARGE RATE 3�GPM INSTALLED OW SEPARATE CIRCUIT5 VERTICAL DIFFERENCE DETWCEW PUMP OFF AIJD_015TRIBUTIOLI PIPE.. 13.3 FEET + MI►JIMUM WETWORK SUPPLY PRESSURE .. 2.5 o FEET + �Z� FEET OF FORCE MAIN K 2 •_ F�orl.FRICTIOU FACTOR.. FEET TOTAL OtIUAMIC HEAD = 19 ' FEET Pump chamber DIAMETER IMTERIIAL DIMLWSIOIJ� Of TANK: LENGTH - ;WIDTH ;LIQUID DEPTH BOTTOM AREA — 231= - GAL /INCH AS PER MANUFACTURER - �b•`3. GAL /INCH ME40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 to W 30 W cr 4 - W M 25 8 X Z O ~' Z 6 20 O J S 15 a ° 4 10 5 2 0 1 LL I 1 0 0 10 20 30 40 50 60 70 60 90 100 CAPACITY GALLONS PER MINUTE 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. .► sG Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page ` of 3 Labor and Human Relations Division of Safety & Buildings in accord with 1LHR 83.05, Wis. Adm. Code COUNTY . Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distant st E O _1_Z _ M ST_ 0 1 5 APPLICANT INFORMATION - PLEASE P I �INFORMAT(ON \, REVIEWED BY DATE PROPERTY OWNER: cc NECEENEU PnhPERTY LOCATION :::�Im f)IVO bv�l Z.`-1 Sl 1/4 SF 1 /4,S Z8 ,N,R 1$ E(or Wo PROPERTY O WNER' - .S MAILING ADDRESS — 0 r T � t 1997 LOT BLOCT#SUBD. NAME OR CSM # 1wia frlt. 1 ='.� Sow' - CS"1 \w_ 10 P9 Z1 S Z CITY STATE ZIP COD HONE N �1IILLAGE [MOWN NEAREST ROAD �o GF Ciaz e , MN SSol -';( l2}z 9 r, rj N C_ �l kAiN C Peens 1ZU+1 -t� [4 New Construction Use [id Residential / bf'Lb b�d s� V ` [ ] AdditiQn to existing building (] Replacement [ ] Public or commercial Code derived daily flow boo gpd Recommended design loading rate _ bed, gpd/ft - trench, gpd/ft Absorption area required Soo bed, ft Soo trench, ft Maximum design loading rate • 5 bed, gpd$ • b trench, gpd/ft Recommended infiltration surface elevation(s) 1 �t ° t • S _ft (as referred to site plan benchmark) Additional design / site considerations Y t+*r� w / W Y - 6 3 " $ e� , t")1 AJ • N OF S N-b Ft LL Parent material ` I t_'t w Iaz ov'Twrt-g N Flood plain elevation, if applicable 1 A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable for s stem ❑ S ®-U N S ❑ U EIS ®U ' EIS ® U EIS O U ❑ S N u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench "'': 0 -►1 �oti� BIZ — sl z�YLSb m`�h a,s S - b Ground 3 ly - ZA - I , S 'l R V/6 S o S W1 1 Cw - - 3 elev. ft. y Zo. r13 • °ttz Sl6 —� c� s9 �,v'�> e — •6 Depth to S 41-60 2 S L limiting factor y e0,v >vS spu 0 low I2 S g ->voT e� ,u vou s X13" V S FI (eb 9S - AL'S LST9 t p�Th1 �lC1>V . Remarks: Boring # w1 S .� 4v:• Z ly_ l o H li316 - s ) �� Mud C LS 3 I 0 loyR sly Ground — e le v. ft. y 3� -�! °I �. S `9 tZ 3! — s 0 GI- O S9 a ,► >:ti Gg l Depth to S 1 .49 -st6 tbti2 Sly �.s �tRs�f3 �S $G�, C> W\ 0Q _ •S limiting factor 3O" Remarks: CST Name: — Please Print Pine Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service - P.O. Box 74 River Fa11s,WI 54022` Signature: Date: CST Number: 3Z2v �7- � Z Z 0 --2 Z.-9 - 7 M00576 PROPERTY OWNER C SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# bZZ_ IpSS_ qs - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench 3 1 o -t I t rL 3 2 — s ti z i LD`112— 3 /(. -- �g c--., s� i Ground 3 16 =2 6 ) v`-t rL 6 !3 elev. 1 9 $__ • _t° ft. `-I R 6 L . 4 rZ S thw lr1 U iQ - - . �{• . S Depth to L s tvu Pr S S ) Prr N31 ' limiting fa� rc� s 3 I Remarks: Boring # 13' i i j Ground elev. ft. Depth to limiting factor I j i Remarks: Boring # I i Ground i elev. ft. Depth to s limiting factor Remarks: Boring # i i Ground elev. ft. j Depth to limiting factor Remarks: SBD- 8330(R.05/92) PLOT PLAN Pa 3 of 3 SCALE 1 "= yp ' ` 41 W 0 0 r eunvr.� nF 8No B.� TA ti►OT � - r n2 �� 1 B� 1 N � B• jV Q` Etta! $ 9 u J d2 v tb0. o , ow `Z lilcam, 'Sly" b/A. pu e_ P1 pt--- -- L`}tivsE 10 �3E Aft C Eft 1zol Mou�1J - - -- 17 7 42 � CST Signature Date Signed Telephone No. CST # r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ` of 3 Labor and Human Relations Division of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x t 1 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. o Z-Z- - t0 S S- Cl 5 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Slm fRfuO 1 6V C e8V 4T- SI�E 1/4 Se 1 /4,S N T Z 4i ,N.R Xb E(or W PROPERTY OWNER' :S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # t q 7 1 rlomi ert - P°NE Su 'J'TN L.) i - C Sti") Vox- tO V-) Z. S Z CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (MOWN NEAREST ROAD Lo�'�aPcG� GV?_0Ue,MN ssolb (61 U S8- 169 ��t hu yv�C �ct /.1►.ulC �v PFQR `t Ru f{1) [A, New Construction Use [J4 Residential / Number of bedrooms y [ ] Addition to e xisting building [ ] Replacement [ ] Public or commercial describe Code derived dailyflow boo gpd Recommended design loading rate bed, gWt 1 trench, gpd1ft Absorption area required Soo bed, ft SoQ trench, ft Maximum design loading rate - S bed, gpd/ft • b trench, gpd/ft Recommended infiltration surface elevation(s) — 1 �t ° t • S ft (as referred to site plan benchmark) Additional design / site considerations "ova w / 8'Y- 6 �'B e� M ln; . N Z " OF SAD n LL Parent material t_yy w v'_vZ Flood plain elevation, if applicable N !a ft S = Suitable for SyS CONVEHTlONAL MOUND IN GROUND PRESSURE AT -GRADE SYSTEM IN RU_ HOLDING TANK U = Unsuitable for sy stem ❑ S NU ENS ❑ U EIS ®U ❑ S ®U ❑ S ®U ❑ S (R U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. �'` Roots Bed Tmnch s -- - - - - -- - - - Ground 3 ly -?SJ - 1, S ti tz V j'6 - 1 S o Q_' elev. cl � ft. y 20 t13 10 ° t (Z S l6 • �' Depth to S y3-6o l Z - 1 �Z_ S'aQ S ! 3 Si `�S tih "� - • S limiting factor y CU�1 >uS SpO �} 1O`1 CL S S y ->uvr ed �UV vu S q V S 'Pt L S - 5 STS l VV_: Remarks: Boring # X . .:>�;;; 1 o -ty to�icZzlZ — sal Z�sb1t wrF� o'.s — •s .� 1 0 'j Vz3l( S) Z�sbk Mud, as -30 1 p `?R sly etGw o Sg m b Ground _ elev. y 3o _y 9 "1, S y R 3l S a GM u 49 c ,o cS 9 € ft S X1936 1 b�d(Z S lc7 l, - t - 1 R sj b 4s $6ti, o rs *A u i, _ .�{ -S Depth to limiting factor 30" Remarks: CST Name: - Please Print Phone Arthur L. We erer 715- 425 -0165 Add ress: egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 - Signature: Date: CST Number: tz' .� �7- Z ZZ C )- ZZ-9 - 7 M00576 I PROPERTY OWNER Zvi L C 1r- SOIL DESCRIPTION REPORT Page — of 3 PARCEL I.D:# b !O S S- 4S Boring # Horizon Depth* Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. Bed Tirench 3 1 0.1 to 3!z — s z sly - Z s 7s 7 Ground elev. 9$�° ft. �-GS 1 l� �I R 6 l �1. X12 S JP� � N Csrv� 1^1 l>'�h — i 'S li o L s Ivu1' PrS S Prr X31 ' fat, i � 3 j — i Remarks: El Boring # � I I j i Ground elev. ft. - Depth to - I limiting i factor 1 --- i Remarks: _. Boring # I I s i Ground f elev. ft. ' i Depth to limiting factor j Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1"_ 1 40 .41 1 Qurt;� c�� 8No iTL i B.1 'ba N O'� ��" �•�cT aR Ttf'1S t 1 � I � •9 N � 8•i � � t� tea, g a u o I V I V 2 � J � . N a1 i = EL - Cbti� o • ON, k t1lis8 7y' __1�ivsE - - 1D BE Wf .L:� ?S' �t11�( �ola�A � .._ _ -- • L � / - )-ZZ Z, - - M 00576 1 4 5 MFiS CST Signature Date Signed Telephone No. CST # ' ST' CROIX COUNTY SI'.I'TIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owna Buyer Mailing Address '715x'7 l M t' ��-� z. i4.y S e -Yl A s Ggq- e M nl 590 Proper Address 160? G�,m%V. �a> P.l'r e f- T4 " W I 5q 6ZZ (Verification rcquirrd fro,A PUnnint Dqurtment for new coas(mction) city/state IZ 1 AtwcS L1� 1 Paned Identification Nutnber a - I oS S -qS - app JjI( AL DESCR PnON ° I. 28 .1 8. 3l y� I'ro t Loc E r E r per y Iron S /<, S /., Scc. 49 . T ZL N -R 18 W, Town of g►wN►W►.jnx iC Subdivision _ N,� Lot 0 (`ctiilied Survey ff _ /. '17, `r - V o l ume /c) . Page it 2 752 Warranty Deed (I _ 5i & 77a 770 Volume /o7� . Page # 3y Spcc Boost ❑ ycs ❑ no Lot lints idcutiS,ablc ycs ❑. no cansisft SYS1F.Nl•��dASN�ZNA:l!ICE I � uprvper � emdm �y� t Y��t�altmil sptrsiu�c�yfa�t4Lanrilewastcs .Propermaim6caaaAC ar pmmping f wa oat f &c � � Y� cc � if wc&d by u lkcased p=pm Whit y�oa put.iato the tystcm PO stank as.a tccatm�cmtttagcia the vPts(c>;iyL 111c Property owner act= to sabmd to St Quk Z Dot x boa form, tigmed by 9m aw= and by a - ' P7�Y�apt�ctcdplumbaori�y��t( Ijt4vcoa- sitc�rastcavat�rduposaltystcat ism pcoper operating coal ,= andlor (7) after mvechoa and P=*g cif ummsmy). the ccp&taaicis less d an M full of budge. U tt` undIkm,�d have read thc:bore wVR=cnft and 19me t4 Mil "I" true pmatc uwage disposal systcan wi& tha sUndards od f°rQ , iczci ols sd by the Dgwtmcnt of 0=m= and the Dot cf kxbuaz[ etas Y tcpbic system hu t�oac mai�ai,mod must be R+osoatas: Suit of Wisooasin.- Oatificzh oomplctod and mUmod to the SG Qoix County Zoning Office wider 30 f dw throe year crpiration date. SI 'LURE OF Arp DACE OWNER. GER'IRCA.'ITON . Y I (wc) certify that all statancats on this form arc t= to the bat of m d�e. y (our) knowIo I (wc) am. (ant) the owna( of Qrr; dcsai'lrad above, by vitdre of a watraa ty flood r000rdod is Register of hoods OtTicc. T DATC • • • • An inform ution dint Is misAqmxcn(ed mny =ki the nnituy pemrit being ncvolced by the Zoning Dgmtmcnt' • • • • Ladadc wf(tr (Idf xMicatton: a cumpod warranty dcM from the Rc&ktec of Doods ollroc a oopy of chic ccrtificd tuuvcy aup if mfcrcnoc is MILdc in the wtnan(y dcod FILED APB; 9, 1 ,) 1994 ► 12 515993 9 JAMES O'CONNELL Register of Deeds St. Croix Co., W( / �A C E RT I FI E SURVEY MAP LOCATED IN THE SE4 OF THE SE4 OF SECTION 19, T28N, R18W, TOWNSHIP OF KINNICKINNIC, ST•CROIX COUNTY, WISCONSIN. PREPARED FOR: Donald and Margaret Pausch EI /4 CORNER SEC. 19;(COUNTY MON- UMENT FOUND). NOT BEARINGS ARE REFERENCED TO W �' NE�45T LINE OF THE SEI /4 ( RECORD n BEARING. cN � :0 N:0 CER T 1F1ED SURVEY NIA° 000 V 0 L 10 PG. 2738 `37.58' N 86 31 15E 28.931 708.6 1 I I I I 1 I } BUILDING SET- I �; BACK LINE I O O ' Q Q • to O V1: z• ti / I � Q to 0 Z . 1 0 I a. a a J. I t0 p 3 LO T 4 1 oI`° I W. = 9.83 ACRES , 0 3 H Q: N ( 428,314 S O. FT.) I tO ti 47 W �• O 8. 81 AC. EXC. EASEMENTS I mI� W I S Q. N ( 3 8 3, 6 3 3 S 0. F T.) I O �,,,• 0 1 I c N LL dJ..� o I IN O I W J. a• APPROX. IOOYR. -� I o Z Z �• FLOOD ELEV. LINE I O (913.5). tu I I � I Q Q_ S. 3 1 ' 1 33' 331 R = EAST . 1 ••.'..:'_'. "_ " " "'_" " "' � � S 88 °40'05 "E 3 66 . 31 ' C N88 a 4005 W 288.12 ReE4ST O of (o EXISTING EASEMENT. t0 9 co (D W UNPLATTED LANDS o 366.04' 33.0 w :B N 88 40 05 W : 399. 04 'I �" - R= WEST - O Ia7 M M (0 o_ 0 0* T T E D LANDS VOL. 472,PG.593 I N ? � ? ^ ' _ .. ....... r Y.....J. .__...... SE CORNER SEC. 19 S T .:;R -SAX v0(,#h1'i`I ( CH I S LED N I N CON- CRETE FOUND.,_. and o= SET 1 " x 2 4" I R O N P I P E WEIGHING ... �':::, �r.'Y:'?itYS a''',!�1 F`� � ., 1 1.13 LBS. PER L (NEAR FOOT. �•`,;, a I" IRON PIPE FOUND l'Yt.o(mcOfdp_d witlsun 30 days ct R e RECORD DIMENSION ,,•gygfCiai�' �� •, i,,._..�,:y�LL�Y � %' w0pinv*t Shall bor. vnid V `.,p `�• j SCALE I"= 150' -`''''�'• t •'v 4�' 2 0' 75 150' 300' JAMES M. WEBER S -1804 SHEET 1 OF 2 NELSEN-WEBER LANDS ftKfEYI�NG 94-14 THIS INSTRUMENT DRAFTED BY JIM WEBER. DATED 3 -tz -g� R�v•y- VOLUME 10 PAGE 2752 l r , r - c , "A" : Found 1" iron pipe S6 "E 4.31' from recorded position. "B" : Found 1" iron pipe S4 "E 4.36' from recorded position. "C" : Found 1" iron pipe N26 "W 0.40' from recorded position. DB SCi2. I PT I O1tI A parcel of land located in the SE 1/4 of the SE 1/4 of Section 19, T28N, R18W, Township of Kinnickinnic, St.Croix County, Wisconsin, more fully described as follows: Commencing at the E 1/4 corner of said Section 19: Thence SOo00'27 "E along the East line of the SE 1/4 of said Section 19 a distance of 1766.28' to the POINT OF BEGINNING: Thence continuing SOo00'27 "E along said line 664.50'; Thence N88 "W (recorded as WEST) 399.04'; Thence N0 "E (recorded as S1 "E) 74.35'; Thence N88 "W (recorded as EAST) 288.12'; Thence N5 "W 531.73'; Thence N86 "E 737.58' to the POINT OF BEGINNING. Contains 9.83 acres subject to Quarry Road right -of -way and to an existing easement over the southerly 66' as shown. Also subject to any and all additional easements, right -of -ways or conveyances of record. SURVEYOR'S CERTIFICATE 1, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.Croix County and Township of Kinnickinnic Subdivision Ordinances and under the direction of Donald and Margaret Pausch, owners, I have surveyed and mapped the above described parcel of land and that this map is a correct represe - gAti; w of the boundary thereof. Dated this k day of ,1994. � `�`' °0 y - z�a - � ,,, James M. Weber S - 1804 S - 1804 ►' NELSEN -WEBER LAND SURVEYING � SPRING VALLEY wis" RIVER FALLS OFFICE (715)425 -0164 �P ME1�1Cy,MIE OFFICE (715)235 - 6641 ' ? � ...•• % - " J A'D LiuT NOTICE: The parcel shown on the face of this map is subject ta•c'��'� County and Township laws, rules and regulations (i.e. wetlands, minimum lot sizes, access to parcel, etc.). Before purchasing or developing any parcel contact the St.Croix County Zoning Office and appropriate Town Board for advice. SHEET 2 OF 2 94 -14 This instrument drafted by Jim Weber VOLUME 10 PAGE 2752 Il DOCUMENT NO, STATE BAR OF WISCONSIN FORM l — JOYS T "18 SPAea R us RV tto FOR RBC DATA WARRAMTW DEED s • This Deed, made between ..RA. canl d.... l _. ... zblti7s_0l...aJRd........ H •a n ,, f, ; �, . Mar. Bare. t.. C... Pausch , ... livaband.- niad ... wife --- and ............... 2 .]Harriet... Mae.. Ei..y. nck.. a1• kI- a..Harrie.t..Pi.... r.k.......... MAY 4 1,. 94 .as... tenants ... in.. c nmmoa .................. ..............................r Grantor 8:45 A. E r and.JBmS... ...2yduQk... and.. Debra... K.... .ZysiUGk ....................... � ��,.,� husband- -and.. wi.fe...as...aunviY.9 rabiP..m nt ar.i 1 ............... pr.op,ar t ................ . y ........................... ............................. ............... 'ma►oir . ............. ............................................... ....._...•--- -..__ ............9 Grantee, Wltnesseth, That the said Grantor, for a val labie consideration...... RaTURN TO conveys to Grantee the following described real estate in ...St .....Croix.......... 70 / Ids S County, State of Wisconsin: 5q Lot Four (4) of Certified Survey Map, in Volume 10, Page 2752, as Doc. No. 515993, Tax Pared No :... ...........__....._.._......... Register of Deeds' office, St. Croix County, Wisconsin, located in the SEk of the SEk of Section 19, T28N, R18W, Township of Kinnickinnic. , W Ell 4 OS FEE_ '4 This .... Ia..no t......... homestead property. (is) (is not) Together with all and singular the bereditameats and appurtenances thereunto belonging; And...... Gxan>iox g.....-•-• ... ............................ warran's that the title is - ._.... c ...................... nc -. good, indefeasible in tee simple and tree and clear of encumbrances except easements, restrictions, and rights -of -way of record, if any, and will warrant and defegd the same. Dot this day of ......... ay ........ ..................... . ......... .............. y. ! +•,• � , { (SEAL) . Tae ....... v.... ''•• (S`EAL) t �Opia{l� t, ��suS�ki ............................ .Mar C. Pa uscl�C �' _ P 1 i r -•, �(��{ :G, t.,.: .................................... (SEAL) t A SEAL) .... .... . .. :..... ........ ......... •--- •--- ......... - - -•- • Harrie t Mae Eiync•k' /. ^•• Harrit M. Eiyn -_ k AUTHENTICATION ACHNOWLHDGMENT I Signature(s) ............................. ............................... STATE OF WISCONSIN II ' B& V .... - • ... ........ . .. County. // authenticated this ..__day of_ .... . .............. -----, i9------ Personally came before me thin ..L.._......day of ............... UY ..................... 111.94.. the above named ....... ............................. .. .•- - - ....... _. _- - - ............... Dwaald...' . ... ?eu _ -KAmol at.._ ' . .............. G.% ... RaulsQh.,...a.nd-..HA -c e- t_---- ....... TITLE: MEMBER STATE BAR OF WISCONSIN .•_ ........... MAP_ . aiynOk..A1k/.4...H#U1e1 ..M.- (If not, ............................ ....................--- _- -_.... _XnC�4 ......_.. authorised by 708.08. Wis. Stats.) to me known to be the person ..4 ......... who execu the foregoin m /a the same THIS INSTRUMENT WAS DRAFTED BY .._... `- .— ........................ .. - .�K... ,.._l kirL ✓!�N�[�!wi ...... ............. R1YEr_.FB� -- ------- -- --------- - - - - -- Notary Flub c ../!lld k,4j1 f . ... Connty. Wis. _ (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: •Namea of pet an signing In any capacity should be typed or printed below their signatures. �I I e I� WARR #,NTT DYED STATE PAR OF WISCANSIN Wi,con.in Lee.) Blank Ca Inc y �e FOR]I Nw 1 -1982 Milwaukee. Wis. •'�1 n �,i: i l 1l 1l ft�fa F.i ��` e' z y Vi i }} .`.).• 1: {f 4"' r�..51� "� :'1' .�':ei R:'..� Y1Srti• d•.r:.' S�' 111 t ' �' ", „ — J