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HomeMy WebLinkAbout028-1050-40-000roF.M STc to4 15, 7< -t-l .1L'1. is BUILT SANITARY sYsTEH REPoRT -1 t I l.-J C TOWNSHIP a sT. cRolx couNTY, wrscoNsrN ,3 OWNER l({r\ I --T SECTION ADDRESS bt SUBDIVTSION di,,^ r \> N -R ..?q La't ' 'I,r,L 1 LOT LOT STZE SHOW EVERY r PI,AN VIET{ w/rHru loo FEET oF sYsrEMc \. l. t.J i'l : BENCHI,IARK: Elevation and description : k-- | .'t '/ ,.: L-ll^ I ,1, Alternate benchmark SEPTfc TAI{K:Manuf acturer: ',t-) { 15, e f r,iquid Cap. Rings used,r'- tl"nhore cover elev: FinaL grade erev, | : { .Q C, Tank inlet elev.:' (t")*.n* outret erev.: l, l, eq No.offeetfromnearestroad:Front3!,siaei./,Rear..-,Ft.- -+-' From nearest prop. Iinerrrorri-"-!, sidep, Rear Ft. \)c., I No. of f eet f rom: Well,Bui lding : ( rncrude this information in the above prot plan )(2 reference dimensions to septic tank) SEE REVERSE SIDE 0 4I R ICEffi I I 0CT 3 1 tii$Ll sT ci:i/ji.r. (oultTi' ICilrlilGCf,flCi i".- Y _r. I.*. I; ''-.1 ,i't" ,y'\\ \ r,J 1"'s N {i., ..t( j Air J v)yLY J/A -t \li\? $.Yt':,,,, t (, II 4 o4 ,o,Y 7 L t -4 ?Ll /n d rt.,i*'!V I t/' "{3 .-/, .)t'.' n l.)-j, $€A 6,-** lfrf t*,n €l Ll :.ri r./ .r^'r)*VC-.-t r" -[ o ii C., I 'i'r' I TNDTCATE NORTH ARROW ir-r-'-f/ i1i t grLe t(- I { I \' l. -.-__--i I $ vtl. toG, j c PT'}IP CHA}IBER Manufacturer:t--Liquicl capacity: looa,/{o <> Pump Uode DiErtance fron nearest prop. Distance fron: weII -*' Iilanuf act .Pump Size_ -.r 1',. ,-2 -l. Elevation on of tank eLevation punp on "r"v. dpQl]fpunp of,f etev. : ? 7, t,' baLrons/cycre :?vii Alarm: Ir!an.:_ Switch Type:t ocatTon /zc/lit ..-| 5.( Llne: 4E ,ronS, srd;nea$ rt ,Buildi ng (sSt..€L<..-,r- t\3.oG SOTL ABSORPTIOII SYSTBTI sea: /)loun-'f Trench:_Seepage pit: width: Leng th Nunber of Lines: Area Built Exist. crade Elev. lt t.i (-Pro posed Final crade EIev. ICl bL Fill depth to top of pip e: ,8 No. feet fron nearest prop. Iine:Front_, Side_, Rear_Ft. No. fe6t fron wel.]: No. feet fron bulldi HOLDING TArIK Manufacturer:5 r+-.-,'.Capaci ty : No. of ringe used: / Elevation of inlet: No. feet fron nearest prop. LinetEtontl!!, sideJ, nearlrt. No. feet tron: wetl ? {, uutraing____6 nearest road Alarn Dlanufacturer: INSPECTOR! PLU!,IBER Oil iIOB:l.jg-; Elevation of, botton tank: q {, )7 oe,6t ?. DATE: 6tl90:.c) IJICENSE {v ({ /v,n ^n ^ /l-*{f"-'-*- 6 a, P-, . *-v._ *. &t. 2 /o iphonra rO Permit H sN d own oe CSTBM Elev ./( lnsp BM Elev BM Description \)O Wisccrnsin Departm ent of lnd ustry, Labor and Human Relations Safety and Eurldrngs Divisron GENERAL INFORMATION TANK INFORMATION TANK SETBACK INFORMATION PU M P I,W}#T*+NFO R M ATI ON SOIL ABSORPTION SYSTEM PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Cou nty Sanitary Permit No State Plan lD No Parcel Tax No ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic h),'t (,7r?,/)2" Dosing Aeration Holding STATION BS HI FS ELEV Benchmark Bldg. Sewer St t y. lnlet Fd) St / Ht outlet 2s Dt lnlet -t Dt Bottom ?/ 17' Header++#aTt /a 7,30 Dist. Pipe / 07.26 Bot. System Final Grade ?,1 ty'' TANK TO PIL WELL BLDG Vent to Arr lntake ROAD Septic 4r-I I NA Dosing NA Aeration NA Holding Manufacturer %4;Y)CI/Demand I t,(f GPMModel Number * /37 TDH Lift Friction Loss \Svstem Head TD H \)Ft Forcemain Lensth l Dia.Drst. To Well* ?.i/ BED / TRENCH DIMENSIONS wrdth I )lens$)No. Of Trenches/PIT DIMENSIONS No Of Prts lnside Dra Liquid Depth SETBACK INFORMATION 5Y5TEM TO PIL BLDG WE LL LAKE / STREAM LEACHING CHAMBER OR UNIT Ma n uf actu re r Type Of System: ModelNumber DISTRIBUTION SYSTEM Header tmarrtrr Length Dra a( Distribution Prpe(s), Lensth -//spacins y'F "// Dra y4 I x HoleSpacing I| y'f" I x Hole Srze Vent To Air lntake >25/ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Bed lTg* Center /?l"T}**. g",/L': tt"l xx Depth Of Topsorl G xx Seeded /Sodded @-W- t] No xx Mulched EI+6- E No COMMENTS: (lnclude code discrepancies, persons present, etc.) t( (/' ;' i /06, f3 Plan revision required? E Yes 6 Use other side for additional information.E la/23 s--v 7 sBD-6710(Ros/e, o fu WLK*DrGx-'"'" lnspect s Srgnature Cert No /a trilOa sz,Qe. /a, I /) 7 j,/ 7 ,(< .1 /; S/AA 1 ft Y tfrrrrF]lriJ-Irj;] ; rllfI5rl ln afcord wllh ILHR &1.(5, Wb. Adm. Codo trTI -Attach complote plam (to lho county copy only) llor the syltem, on pap€r not les tian 8,. x 11 lnch6 ln slzo. -See reyerse slde lor imtructiom ror compl€dng thls appllcetlon. b p.wlout appllcauon STATE STATEPIAi{I.D. UMBER T i lrOT L s i) Eioi: ii rzf.I,liorrl RI 34 - q //e 7l.IlT-{I"'U]1-.]fil 8I.|BI'IVIS|oN NAME OA C8M NUMEER I 4a<i/OF BUILDI]6: (Ched( orc, Publb Eh or 2 Fam. D*ell II lngF+ ol sitrEl Permit # -- Date lssued - -] tY. A)1 A 2.3. OF PERII?3 (Ch6k only on. ln llne A. Ch3d( llne B It appllcabl€) Roconnec-tionof 5.rolan Sy3tem w,r,t ltEued. Syr0em ExEting System Now Syrtom Replacememot 1. Tank Only A:EFE fzJooL - lll. BUILDIIC UOE: (r bulldlng type b pbllc, ch.d(glthlr rDply) 1 2 3 1 5 6 7 8I M€dlcd Faclllty/NulBlng Hom.10 't1 12 13 Outdoor Recreatlonal Faclllty Church/School Hotol/MotBl Sorvlce Statlon/Cer Wash Ohor: Sp€city 6 z?losa O@Aat52 Y. TYPE OFSYSIEI: (Ched( mly mo) Non-PressurlzedDlstrlbullon Pr$surlzedDlstribution v -t ftSp€clly Type 11 12 ,a other FIila Pr€ssur€ M]tEfl Soepege Plt n+ill ,TI Holding Tank Plt Prlvy Vault Prlry 11 12 13 11 S€op.ge B€d 2a 1-2. fr) ffi AB{!ORP. AREA /o 6. SYSTEM ELEV.7. FINAL GRAOEIRATE ft.)ELEVATION . ABEA (!q. lt.) 5. PERC. RATE (Mln./lnch) IIiTf,i]TIT3 Exp€r. App. l, th. underrionad, a$ume rs.ponalblllly ior lmtall.Uon ol lh€ on3lto !3weoe sy3tem shown on the altechod plans. Iffi rEEitTl, lzTtrliia Tfi,E](t{o 3)i8 Ll"Ti't=T,i'ltilTlliiiTr!? ffi ADerolrld 1. GALLONS PER DAY @o NawTank!L Totrl Gello #or Tank!r,rilrrEEn:tzTlriiri Prelab. Concreto Slie Con- Etructed t+!ll Fib€r- gles!PlasUc dJl ) - o.zttt - a,-*.,, -/t*-F)-J 91 ]ItrItrIItr IN r aTT7[r]:l':lil R.od) lllfiIIr:FllLr:IzP Z9qa Olaap9not rd Or'l.r OlY.n lnldd 8-t3- SADGS (brmrly Plb{r) (R. f frSt) DlgTnlBUTlO : Orlelnd bCounly, Om CopyTo: Strty e BulldlntL Dlvlllon, Oin r, Plumbrr ,l 2 4 5 6 INSTRUCTIONS A sanitary permit is valid ror two (2) years. Your sanilary permit may be renewed before the expiration date. and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. All revisions to this permit must be approved by the permit issuing autherity. Changes in ownership or plumber requires a Sanitary Permit Transler,/Renewal Form {SBO 6399) to be submitted to the county prior to installation. Onsite sewage systems must be properly maintained. The septic tank(s) rnust be pumped by a ticensed pumper whenever necessary, usually every 2 to 3 years. ll you have questions concerning your onsite sewage system, contact your local code administrator or the Stale ot Wisconsin, Safety & Buildings Division, 60&266-3815, To be complete and accurate this sanitary pormil application must include: l. Property owner's nama and mailing address. Provide the legal description and parcel tax number(s) ot \,vhere the system is to be installed. ll. Type o, building being served. Check only one and complete fl of bedrooms il'l or 2 Famity Dwetling. lll. Building use. lf building typo is Public, check all appropriate boxes that appty. lV. Typ€ of permit. Check only one in line A. Compl€te line B il permit is for tank replacemenl, reconneclion, or repair. V. Type ol system. Check appropriats box depending on system type. Vl. Absorption system information. Provide all inlormation requested in #1-7. Vll. Tank inlormalion. Fill in the capacity of every new and/or existing tank, list the total gallons, nurnber oI tanks and manufacturer's name. lndicate prelab or sile constructed and tank material. Cornplete lor a// septic, pump/siphon and holding tanks lor this system. Check experimental approval only ii tanks received experimental product approval lrom DILHR. Vlll. Responsibility statement. lnstalling plumber is to fill in name, license number with appropriate prelix (e.g. MP, etc.), address and phone number. Plumber must sign application form. lX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% Y 11 inches must be subfl]itted io the county. The illans rnusl inciude the following: A) plot plan, drawn to scale cr with cor,piete din)ensi.rns, iocation of haldirrg tarriis), septiL- tank(s) or othe. i)'eati-nert tanks, buiidriig si--,.ai,s, "!sir!, .^/alt,i ;rr,iins/water 5e.\,icrr, st!'eams and lakes; pumF or siphon tanks: Cistribrrticn t-rcres; ::eil Bbs,trFlia. -systen's, rFplacemei.!t s),,siern areas, and the locatio,l a,i the bijildi,rg servr:d, B) horizorrtal and v,jrl;;?i i:leviitii--ii icfei.irlce points, C) complete speciiicalio$s lol pumps and controls; dose volurne: elevation (irfferences, ,riction loss; pu!.ap performance curve, pump model and pump manufacturer; D) cross secti.jx nl the soil absorption syste[ i{ required by the county; E) soil test data on a '1'15 torm; and F) all sizing information GROUNDWATER SURCHARGE '198:l Wisco,rsiri Act 410 included the creation of surcharges (fi:es) icr a i'iurlrhi)i ci regulated practices which can elfect groundwater. The nroties, (;cllecteC llrrough these surchalgcs are used i(rt mot)itoring 'r rou, rd,.,,,aite r, giot!nd- water corrtarnination investigalions and establishntenl of standards. sBD-6398 (R.11i88) ,SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 10, 1993 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING PO BOX 74 RIVER FALLS WI 54022 RE:PLAN S93-40758 TALFORD, KEN sI{, sw, 35 , 28 ,17W TOWN OF RUSH RIVER MOUND SYSTEM FEE RECEIVED:180.00 COUNTY OF ST CROIX The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. A11 noted itens must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHB 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval dater or if & sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The Iicensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. AlI permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. to the plan number shown above. --. ')' P1ease refer S incerely, nn 1s renson Plan Reviewer Section of Private Sewage (608) 785-9336 /1 si.. s.)'{ 3\ j ',torl) f* StsD.6423 (R.0l/9lr t\ Page \ of 5 MOUND SYSTEM FOR A Z BEDRoot{ nESTDENCE LocATED rN THE srdr/4 oF THE Sw r/4 oF sECTroN js,Tl,8N, R nw, TowN OF \a,ss [1 fit u q=,ST . C-f.O tX COUNTY, WISCONSIN - INDEX PA GE PAC'E PA GE PA GE PA GE PA GE 1 2 3 4 5 6 of of of of of of 6 6 6 6 6 6 TTTIE SEEET PLOT PI.,AN PI,AN VIEW-CROSS SECTION DISTRTBUTION PIPE I,AYOUT PIIMPING CEAMBER PUMP PERFORMANCE CURVE PRBPARBD FOR tssu-uuETN TAL FoRD3rt ort sT r}ue-. B\LSI^JIAJ tl*tl svo6 ? SRSPARED BY I^IEGEREFT SEf II- -I-ESTI]\IE AND DES T GNt SEFI\, I CE P.0. mI 7{ {2t I. ttAlt( ST- RII'EP Ff,tLS. II 5{OZ 7rs-{Ht65 ?- t')-?3 sg3.- 4o7 58 w,s. cctr AFTHUR L. YI'EGERER 0915 P E.LSWORTH. JoB No- 93-ts7 PLOT PLAN Scale 1"= 30 t e C-TH Y $ q5A b\s;$.lg^B qR o,AY1trheT ftrs Fnus\ lt N t' l t- d-, LIa o ul 1".3.19 I sLhB' e- BH - EL. t\o.' 6N Q-o\JqdL!{TE- qu\I.PqfL.L I !D!€x 35'ot= tl Y puc. - t -r Q.tru\fttp $4tf,r. $Ltl caut5t sugfiPtpE nrfpR. \ rr 3q F$11 . o /! Lr....tru I f 3 lss 1 Tt-qE- r-z:..rs > tl4Fgrt-tY Lt pe -T\te c-R6ssb1+TCHs PFrtul 0r-- T*€ To BE. (*rSW FUswQtr oR- Q-QLIrYL ftl-.rV ctlhtrtcT)W. S{-eSQ\ k,.rb qs1 zt |at|*r-s Dry.-r$ crfi\hBEf< \rg\rr Tto E'Q. FtT- LAtOf Ls' ft-oPl BL\: G - 1s..l}a TU Bt hf LgtOT ZS't-f r.1 Ll.)€l-L. a N! 1:rlfclEJ^/ 6 M.gq Tt\ gl-l ,-r rez ttTE, RIn-y2 L ,?,S.. i\\'-n 'os.) 32' Ftr R. *tE {Llss o B ? o/3 z -- i --F { Lr I F') NSI'TE SEY/ B.\ sL 106 1 C C,N &p,$&ffiB DEP li; 0F INDU$Ti:li' LA80R AND ilUf,{/rN tlELATtOlriS i.:,'r'iSl0 0r sp.Y AND BU!LDITJGS NOTES : !it; Ca:l-'{ilsf[iririii,Jr 6,l.on]Il-Elevations shown are existing ground elevations unl-ess otherwise noted. 2. Install permanent markers at end of each lateral . la_ required) 3. Install 4" observation pipes with approved caps. ( z. required) 4. Sep tic tank to be Looo lSoOgallon capacit y manufactured by \^)LES 8R. c.$/\Jc-trg]-&-T5I?O\UC-Ts. s93 -40?58 ?- EEtLli'1 \AqS \tl(TJ € T,J B 5. Bench Mark S€E- ttrGlou€.tr LAN'. 5. D r_ver t surface water aroun mound to prevent pond t_ng at the uph l_11 side. r( Page Z of 6 o E Approved SYnthetic Coverrng Medium Sond Topsoil istribution PiPe Page 3 or t Erev- \Dt- P lowe d Loyer G C f,i S i l" f. $ [:iit,r,G FShftqn' Co*,j;l;onr,'t{', Appffiq'flg$-flffiffi Be d Of ,'- Aggregot e uIt RE B3Z r Ib JA K \rc. 5 Ls3 t^J 32. Forc e Moin From Pump 2l ritP NT OF INDLJSI l.'.Y DIVi N I .'i i): ':\r ; , Gros,s--$ir8tfon of A Mound system using \' .tr,'iu suiLUit!GS A Bed For The AbsorPlion Areo D \- o E r.zf F o.8 G \.s H \-5 Ft. Ft. Ft. Ft. Ft. .|.r $i[ [ull,ii:.-ii]uilr Ji i-iUt Linear Load.ing Rate= 9 - Y GPD/LN FT Design Loading Rate= D.3q cPD/SQ FT ffiiorr o,f.- furer-f+a-in Fr. Ft. Ft. Ft. Ft. Ft. Ft. L Observolion PiPe B Kr.a -t >---- T Force in\r OPPDS \TE E}JS w t \irtribution Pipe 'Observotion Pipe (rurchbr securelY) Bed Of L.'- 2 r; Aggregote Permonent Morkers s93 -40?58 Plon View Of Mound Using A Bed For The Absorption Areo TF End Cop Porf orol ed PiP e Det oll Per f oroled PvC Pipe PVC Monifold Pipe Disl I ion Pr End Cop C) End Vicr Q Pase I of L Install permanent'marker at end of each lateral Holes Locorcd On gottom, Are Equo[y Spoccrt PVC Forcc Moin c Losl Holo Should Be Nexl To End Cop f**dru*n-* &Pffiffiq$#$atr$N; ,.,.; :l' ' .t., !.1-r tlt $sl1'E suuf A.BE's, Vlq \'S'.hj Dislribulion Pipe Loyoul !, riiitiirl P lY rt. s Y Ft. X V8 Inches Y UE Inches Hole Diameter Lateral rr Manifol d rr Force Main r! rlY Inch I Inch(es) Z Inches Inches0FIt,l$Tliii, I " 't l:ii riri iii Z $il ei, E f,iiti,lF f{l} iltji (.;.i r i.,hl1:, t ii.iilt # of hot es/pi pe V Invert Elevation of Lateral s \or- ZFt. se3 -407 58 Place 1st hole zV '' f rom center of manifold with succeeding holes at t/8' intervars. Last hole to be next to the end cap. PUIAP Combina t ion Se CHAABE R CROS5 S Ptic; Tank arid ECTIOU AND SPECIFICATIONS .PAGE S OF L V E \IT CAP U/EATI{E R, PROOT JUucTlou aox APPROYE D LOCKIN6 AAN6OLE CgVEX r,or-fH tcrHENlU6 LABeL la'Al u.COL'DUT T {'Atu. l0'Alu. t- 8-L b.o l6'AlN. APPR.td w/? E XTINDIU oNTO 60Ll ol ,I' C.I. VE NT PIFE :10 ' FnoA ooot UINDOW OR FR EsH AIR INTAKE URER, HAS SUCH APFRO VAL dote err*Ncres' PzE bErre-ree ho^l L UAr-u Slrotct] td\gs€T<- c0^, gR€TG Nu \BER oF DosEs: Soo 6ALLO\JS DOSS VOLUI4E S-S.ELRY}OSYSTWSlTlcLuorNgoAcKrLow: CAFACITIES: A = ZY NcHEs oR 6= =Z rNcxEs-oR c. \o lucHEs oR o- )B tucHEsoR AP?ROYED JOINTS vc.I. ?lFEotrFt',c EXTENDIN6 3. ONTO SOLID EOIL ti \,rtL't $g? X KrsER ExlT srPrrc f 005 ET^N(S AeTtUfAcTURER: TANK 1JIZE"Lb AL^RA AA\TUFACTURER: AODEL UUTAbER:) s I Hr,,-: SWITCH TSPE:ra\gR&Jrz q PERAITTED OULS IF TAUI( A^NUFACT SPECIFICATIOUS t ,r' lppRov . JesDDrxs (rou.o) ,qq,+ R LONS PUl{P /1AUUFACTURS i,: AODE L NUADEN,: ZO eZUgt C,CPrfsfrLtY \i']t1 6 SWITC H TUPE: ItlNlftUf't DISCHAR6E RATE IB .-12 GPA VERTtcAL DIFFER.ENcE DETwEEU PuAP orr AUo.DtsrRtburtou PIPE.. It'zs FEET + r.UUutuf't NETWORK S0prr-y PRESSURE.... . .... .. 2'5() FLET + \ \o FE ET oF FoRcE ,1AtN 1 .D' bL rYorrrFurcrrou FA.croc'-. o' -r3 FEET UOT E:PU'1P AND ALA8.I'T ARS TO DE / INSTALLED ON SEPARATE CIRCUITS TOTAL OSNAI{IC HEAD - D IAD{ETER OT TANK: LENoTH - ;WID BOTTOI,I AREA ? AS PER ,o*uu;;ru*u* Iq.v 3 TH - i LlqUlD OE,PT H GAL/ INCH FEE693.)4 0? 58 Pump chamber INT ERUAL DII{ENSI o*rl x INLE T \\ A I t- c ) o PUAP -- A]RTI6}IT SEAL PROVI OE C ONCRETE qLocK ON off ALARII g\-q.s iii 91. oo . ,''J ,R.t_ '\.,;t S htw1 023TJ'.' 't T.FLVE .rj$ I }}t.lr, 23L= GAL/ INCH l t [: 1 on Ffr-crs t 6- ly, >l r 7lt k- 6',t 4v, OF U)t 1,1.,F UJ F UJ u.lr 30' 8 TOTAL OYNAHIC HEAO FEET/ HETERS CAPACITY GALLONS/LTTERS 110 2Q 4m FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS \Yr11k NPT o UJ I o z o J FoF 0 u.s. 80 0 o Three phase pumps are available in 2OO/2OBV or 230V. o Electrical alternators, lor duplex systems, are available and supplied with an alarm. o Mechanical alternators, for duplex systems, are available with or without alarm switches.. Combination starters are available. Standard Al! Models - Weight 47 lbs. 1/a H.P. 'No molded plug Three phase units reqrrire a control switch to operate an exlemal magnetic or combination starter. For information on additional Zoelbr products reler to catalog on Comtrination starter, FM(E14: Paggybacf Mercury Flo.t Switchesi FMO477; Eloctricel Attemator, FM(N86; Mechanical Altemator. FM(X95; Alerm Package, FM0513: en<! Sump,/Sewage Basins. Flm487. 5r3/u o Mercury float switches are available for controlling single and three phase systems. o Double piggyback mercury float switches are available for variable level long cycle controls. o Long cords are available in lengths of 15-25-35-50 feet. . Over 130'F. (54"C.) special quotation required. SELECTION GUIDE 1. lntegral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback mercury float switch or double piggyback mercury float switch. Refer to FM0447. 3. Mechanical alternator "M-Pak" 't0{o72 or 1&0075. 4. Combination Starter. Refer to FM0514. 5. S€e FM0712 for correct model of Electrical Alternator "E-Pak"- 6. Mercury sensor float switch ]04225 used as a control activator, specify duplex (3) or (a) float system. 7. Four (4) hole "J-Pak", junction box, for water taght connection or wired-in simplex or 2 pump operation, 10-0002. 8. Two (2) hote "J-Pak", for Watertight connection or splice' 10-0@3. CAUTION Atl inrtallatlon ol conlrols, protecllon dcvlcct end wlring rhould be donc by a qualilied liccnrcd elcclrlclrn. All clectrlc.l and ralety codcr rhould bc lollowed lncludlng the mort rcccnt N.tlonrl Elcctrlc Codc (NEC) rnd the Occupruonrl S.lcty.nd Hcalth Act (osHA). 12* -T 1 ( RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of "$^gg ,,40? 58 ump.ler p HEAD CAPACITY CURVE MODELl37-139 25'. n' I 61.q3 T 1s',-,a .-t a 10' 5' 10 30 4020 I 50 60 70 80 90 100 HEAO CAPACITY UNITS/ITIN FEET METERS GAL LTRS 5 l0 15 n 25 m 1.52 3.05 1.51 6.10 t.Q 7.92 1(X 79 64 36 8 0 39,0 300 242 136 30 0 SELECTION GUIOE 137/139 Series Conlrol Selection Model Volts-Ph Mode Amps Simpler Duplex M137/139 N137/139 D137/139 E137/139 'H137/139 't1371139 'J137/1il) 'F1371139 'G137/139 115 115mm 1 1 1 1 1 1 3 3 3 20G208 2m-208 20G208 zfi 460 Auto Non Auto Non Aulo Non Non Non Non 1 0.4 0.4 5.2 5.2 8.2 8.2 2.2 3.0 1.5 1 1or1&8 2or2&,7 1or1&8 2or2&,7 1&8 2 &.7 2 &.4 2&4 2 8,4 3or5&6 3or5&6 3or5&5 3&4or5&6 3&4or5&5 3&4or5&6 @ /orurnfr /3280 Old Mlllers Lane P.O. Box 16347 Loulsvllle, Kentucky 4021 6 (s02) 778-2731 Manufacturers of . . 4 2 / Wisconsin Department of lndustry, Lebor ard Hufuran Relatiors Di.ision ol Safety & BuildrBs SOIL AND SITE EVALUATION REPORT "i1 accord with ILHR 83.05, Wis. Adm. Code Attach complete site flan on paper not less than 8 1l2x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distarrce to nearest road. APPLICANT INFORIIATTON-PLEASE PRINT ALL INFORUATION SOIL DESCRIPTION REPORT Borirq # 3olPage G Ground elev. rD s-o fr Deph to limiting tactq ..s8', Rernarks: COUNTY sT. c-rao Lx PARCEL I.D. #o7-8- [o50-Yo REVIEU'EO BY DATE PROPEHIYOWNER:\(exsNeTlt TNup6Itb PROPERTY LOCATION GoW. LoT s l^) 1/4 Slru1s35 T Z8 .,N,R )-1 E(@ PROPEHTY OWNERS iTAILING ADDRESStsv qt sr Due. LOT, rJ 45 BLOCKfb SUBD. NAIVE OR CSMt LtrT OF l*) e!i.) c-e$T\St Lr[ ur. t- CITY, STATE BftLDfutrtl ,hJl ZPCODE SVsoz- PHONE NUISER("ls)6gv- 3r \ z DcnYRt:sH \) NEAREST ROADg I sr s7: I ll,le Cdrshrdtm tsom Reid€ntd / !tumber ol berfuns Z f I A(ffii b eldfio h,ildns - P( nepaoanent t I RUhcqxnrnercid deqrihp Code d€riyed dailf f,or 3so * Reconrnended desrgn lqliru rare o - 39 bed, gil,f - rendr, gpdfP Absor@naearequired zso bed,frz ZSo rendtftz [&ximumdeignloarfrgrate s.S bed,gErf-]t rrno,,gpdm2 Recomrrended hfihation surhce dardion(s) \ Q [...-1 ft / SE @r6iderafq6 I.sUI\rb r.11 lT$ 8 'X 32' B eD . (as refened h site dan UenctrnatQ h? lAJlr',?uh \' qe Shrtr} Ft.t 'Addfiod d€si,St Parentnderid Ls gss- 6u uL dain derdlixr, if apptcable N-\. ft S = SuiEDle fur svsbm U =Ursuihble ftf svsbm coNvB{IIot{ALtrS BU uotoEIS trU N4fiOUNDPRESSUREtrS E.U AT€RADEtrs 8lu S'YSTEII N FI.TDS EIU tfl.orG TAir(ns Eu l{nriznn Deptr rn Dominant Golor Munsell lvlodes Qu. Sz Cont Color Texture Stucture Gr. Sz. Sh Con*#re hndny RooE GPD/ftz Bed Ircrdr )o-q \\YR S /Z oi\z f sbh v.t ( r^q-S lu{o t Z 9 -zt [O YR 3/L si I zSbx ynfr 45 o.S o.t 3 2b -39 Ib 7R V/6 s I 1 c- sbh )rUS CS o.Y o.S .J 3E.AY t\.tR 3/6 c-zJLs1tr 3lv sc,\ - e\oYn r"fr Boring # Ll Remarks I o-?Lu.tn e / r si)z f sbt vn(r^q-s )u{s. s io.I Z 9-L3 Lb Y ra- 3/G \S)z $: bv,h{u os : s.S :0. I 3 5-z?LO Y tz v/L \\\ es\v.ynu{r os : o.v i..S v zq-6 \ U? B-:/E O Zq\s.{tr e lg so-l -c-\Sv, r \^"S f F CST Name:4ease Print Phone: 7 L5 -425-0L65Arthur L. Wegerer ffittfter"r Soil Testing & Design Service-P.0. gox 74 River Fal1s,Wf 54OZZ 93- \3-l CST Number: u00576 t sqnaw*l%il*, f <','t-n^Date:)- ))-?3 o.S Ground elev. )bs o fr Deph h fimitirq hctorzq 1 PBOPEBTY OWNER PARCEL I.O. , -r^\LFot D SOIL DESCRIPTION REPORT oz8-!oso-Yo Page _:.iol _1*r Boring # Ground elev. lDs:_l_tr Depth to limiljng factor .3\" Remarks: Horizon O6pth in. Dominant Color Munsell Moues Qu. Sz. Cont Color Texfure Structure Gr. Sz. Sh.Consistence BoJrday Roots GPOtftz Bed Tlgdl l o-8 !s5B 3/ r.sr\z+sbR Yr{ x c{- S lvt o.s o.( z B-zz rl5YR 3/6 "i)z * s\r-h{r-c-s o.s o. ( a 2231 ISYR, V/L )I \ a-c\k h ufr'c-s o.v o.S c 3)-S13 \\YE l/6 +z&' sYE 3/y s"\ - "l 6ry\Yt .[r Boring # Ground elev. ft. Dsplh lo limiling factor Remarks:IIII EBoring # Ground el6v. It. Depth h limiting factor Remarks: Boring # ffi**t#5S ttit Ground elev. It. oeplh to limiting lactor I i i I E III Remarks: sBD-8330(R.0s/92) ++PLOT PLA}T Page _3 of 3 \srs\}\r({'Tlt trtuf+t-D \b Fr 62-8-tOSo-VoSCALE 1,'= 3O , tt l14 \"-3 .r 5 S ss1 b\sn a8 qR trrts\ TlhS mr$l G,\' ss'rrcTx\o.l. B - Eu. L\o.b' e-o\Je{L€TE- S \-f\9. t A, T ^lI t-{r ilo o ul )x lv oufta6-1S tDr€) fr' \:s ER. c,SY-l twE gr-toS _o B ? s z L\u.: p ? fr ?, tss 1 -f{ 04 ".\\$. ) B.l EL Fq B.l EL 106 l NoTE: -r\ts - 3 .ro-qE \z-f, . ''l s > t'4FqsLYY Ll 'r^e c-Rass b\flTLHqD PFrtul o\= Tlt€ FrlrLk/^/ 6 kE-EAtBE {HISW FuuwQr: oR- gQtrryL \t\ Et-tprrezttTe. ft,\^.l cuh tr n cT) U,\r r S tl'N Q\ Ffr.r$ Rn-y1 L ,Z€D .. 93^ r371-l)-q3 (lts ) 4^s-or As M a-o 5 7.6_ TIS ?- E EILI-,1 \aq3 \s€xr c4 TL)B gnature Date 5igned Telephone No.CST # I STATE BAB OF IYISCONSIN FORM I - 106r WARRANTY DEED ,,.. ffi[,*,e l0g D . (sEA1; BY: Ro ld. H (sEAL)a. lxra araca ifrtHvao 70i ttcoiomo DA?A {8ffi8{ r= I -t Grantor, rnd. .. fi e.n net h. L.... . T.a lf.o rd. . an d.. .Jp.ys.e. A ^...Ta.L f Q.f d.r.-. . .h u.s. b.e.n d. . . aa.d. . .w i.f.e . .a s. . . j e.r' n.t.. .!.e n.a. n.t.s. wii;,;;;ih; il;; ;; ,* ;;;;;;;; ;;; ; ;.i;i;;;;;;;:.i,lllo .....Thi r.tee.n. T.hou sand. . Do rlar s .. a.nd.. no1 I.0.0,.. I s t i...0 0.0 Lots 4 and 5 ln Block 'Dr, plat of the Town <lfNew Centervi I le . REGISTERS OFTICE sT. CROix co., wtst Rcc'd. for Record thir zna of-.rr."e----AD. t 9&78:30 A .00 ) conyeys to Grantec the following described rcal estate in ..S1....Cr.oi.x..... nrYUiN to county, statc of srisconrin i !s rEcr s-scus r' "Y)''t"'!''A'Yt''{t' Dura'd Fgdgral s& I 1O1 So. 2nd St. Rlver Falls, Wl.s. 5t+eZ This deed is given in completion of that certain land contractdated July 23, 1984 and recorded on August g, l9g4 in voJ. 694of Records, Page 9'l , as Document numbei 395430. and will werrant and defend the same. Dated lhh.... . .z?nd.... Tu Prrcel No: ..------- ..., 19..8-7 .. SAVINGS & LOAN ASSN. ..... (sEAL) Y.P dent..... (sEAL) ACENOvyLTDGMENT STATE CF WISCONSIN ss. ws This .....iS.-.nO.t-..--...- homrxtead property.(ia) (ir not) Together with all and singular the hereditrrmentr and appurtenances thereunto belonging;And......Du.r.and.Fe,dera.lsay.rngs...&....I,.oan.Ass.oq.i.at.iqn warrants that the title is good, indefeasible in feI simiie and free ani clear or encumuirrr."" except t -P.eP.in--- --county. Personally came before me ttris --2-?-D-d----.aay of , rg-8-7--- the above named ..8 p-.n a.Ld-..tI e.rruBy_ r.Pres id e.4-t and 't . $.q.n y.a. . . J. ... - _ -H- a-tr. I .e- -e r . - . S .e. -q r.e. !.a.r y. . - b.e.! h- . p fTITLE: MEMBER STATE BAR OF wIScoNsIN . -P.u.r e.nd...Ee..d.e-r_q-! g 4 v i n s & Loan Assn. euthoriz'ed by.l$Wis. Stats.) D u RA N.ar $SlgSn +S av.r. N.G. s. . . &. . . .I,.e A.!,t . . a s.s. .N . '-....^ .r-l : ( JAL )''' -"' --({'".;Ji.;rTr-L $t"rs---'-'-... fJ -X# #-&"r?..f.a.u rlie n t i c a t ed or ack n owl ed ged' Bot h ., .i .>) .. .t -. t. rr 1).THI{t tNsrRursENr w.As DRAFTEo Byv a'{ to me known to be the person ---_S-------- who executed theforegc\ng instrument and acknowledge the same. )l/n1?*)/,tfr,r'*/ ......p.e.h.o-E eh. .. f.. r... .F.e c_h s l Notary Public .... _... P.epin_..-. _._ r.-.... _.... _..County, T[is.M:r Commission is perriranent. (fr--not, staie-ei;i;^ii;; date : ....-... -. .Au gt;,sL..2ll.. -....... _...-..... -, 19g.9..... ) 'Nrmcr of perront rlralnt in eny crprcit, ehoutd bc typcd or prirrted bclor thcir ci3nrtures. }tCIlllrrCctpry ffit=d ATATE BAB OF WISCONSINFORil No. l-lrtr Stock No. I3OOI :1__ ' -._-, - r DOCUMENT NO. _-T at This D eed, mrde bctw*" .. P.U RA.ll P...EF..P. 8.8.4 Ir.. . SA.V.I.I! 9.9.. .. .....aN.q.. 194.N.. A.q 9q9 I.4T _r.QN.. ... . a Son sen .r sg9r9!?ry AUTEENTICATION Signature (s) Wisconsin Department of lndustry, Labor and Human Relations Division of Safety & Buildings SOIL AND SITE EVALUATION REPORT in accord with ILHR 83.05, Wis. Adm. Code Page \ of 3 Attach complete site plan on paper not less than 8 1l2x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and"/" of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION SOtL DESCRIPTION REPORT Boring # Ground elev.\DQfr. Deph to limiting factor ,t38', Remarlcs sT. c-rao Lx PARCEL I.D. #o"-8- toso-yo REVIEWED BY DATE PROPERTY OWNER:\(ex:)JeT}t T\Up6Icb PROPERW OWNER':S MAILING ADDRESStsV gl sr ftuE. LOT #rl 45 BLOCK#b SUBO. NAME OR CSM# PL4r\ oF l-l e\^J c-eNNIt Lrt ut \- CIW, STATE B \LDh)t^J ,hJl ZIP CODE SVoo z- PHONE NUMBEH(fts)(gv- 3r\L DcrrY DvrLr-AGE EIrowNpsSH P\O€R NEAREST ROADql sr 57: [ ] New Construdion Use [K Residential/ Number of bedrooms z I I Add,Iq,h exbting hrilding Mne0hoerneot t I Puuic or commercid desoibe Code dsived da} llow 3so 916 Recornrnended design toading rab o - 39 bed, gpef-___:_femh, gpd,IP Absoethn arca rEuired zSo 6sd, fi2 ZSO r€nd1, ft2 lhrimum design toading lar o.S teO, Spdid ,]: ! reod, Spd,IP Recommended infi Mation surface elwation(s) Arlrtitional design / Site 69r6ideratiq6 v-r\Ur\rb r^J rT)+ 8'K 32' B eD . (as refened to $te phn bendmark) h?lrUlrr.ruh \'qr: Shru! Fr,-\-. Parentmaterial Lsess- oueR TtLL Floodplainelaration,ifapplicabte N.\.ft S = SuiEble for U = Unsuihble svstem foi system CCI.IVENTIOf{ALDS trU MOTJNDEIS trU II+GROUND PRESSUREDS ETU AT-GRADEDS KU SYSTEM IN F]LLtrS EIU I{OLDII.IG TAt,lK-S EU Horizon Depth in Dominant Color Munsell frroffies Qu. Sz. Cont Cokr Texture Structure Gr. Sz. Sh Conslsbnce Bqndny Roots GPD/ftz Bed Trcfih \o- q \\YtL S./z si\z f sbh h.r(h q-S lrr{6.S o t L 9 -zt IO YR 3/L s; I zftbrr Ya(r /4 Q,o.S o.t 3 2b-38 Ib 7R V/6 sl 1 c- sbx )- \rfb ,,^ c\-)o.Y o.S Y s8-6Y t\ "t\a 3/6 c-z&SLIE 3l v sc-\ - c-\oYn \^{ Boring # Ground elev. )bs.o ft. Deph to limiting factor 261 I o-?tb'tR f / r si I z fsbt h^(r-q-s )u{0 t6S 9-L3 rb Y tz 3/G st \z $)bh wr{u OS 0 tsS 3 5-29 LO Y tz vlL \\\ cs\r.yn uS.u.=qH o.Y i o.S v zq-6 \blR3/6 o z&.snE 3tg sc-l -e\\vrr ,,60}r'\\ I t>-A,rerY ..c(\(\ \Y o. a,rt t \i (:"i.; Name:-Please Print erer Phone: 7Arthur L. We & Design Service-P.0. Box 7 4 River Fal 5 4022s,rer Soil Testinf GST Number: M00576g3- \31 )- ))*?3Date:Signature: tf Remarks PROPERTY LOCATION GoW. LOT S l^) 1/4 SW1/4,S3S T "-8 ,N,R )I E ({0 Z I $ 1 PROPERTY OWI{ER -f,\LFoEb SOIL DESCRIPTION REPORT Pqe Z otn PARCELI.O. Boring # n 6z8-toso-Yo Grcund elev.lbslltt. Deph b limilingK Remarks Horizon D6pth Dominant Color Munsellln Modos Orr. Sz. Conr Cobr Texture Structure Gr. Sz. Sh CorsisEnce Bo,dry Roofs GPOfitz Bed lTlqdr )o,E \sYE 3/ r.st\z +sbk Yvt F ceS 1t,o.s o.( hr c-s q.s 0. ( lqu c-s L.v o.s In +i z _zz Irl t{ lt 3/ L 'il 2 $sN, 3 2231 \'}YR. V/L \ a-c\k v l-so \\YL ]/6 €z&' SYtr 3JY s.l - "\O 'r Boring # ffiwffiffi ffi**# Ground el6/ ft. Deph h llmiting hchr Bgmarks: Boring #wwffiffits t{8 E*--*,ffi Gmund el6r. tt. Depth h limiting hcbr Boring # Remarks: ffiffi Ground elev. tt. Deph h limiting lacbr Rsmarks: sBD.833o(R.osE2) ,PL P c--n}'Y" SCALE 1"= 3o ' Page 3 of 3 Vds\NurA TTILFoLDrb Et O ?.8- rSSD-q o z tjo LI ) YL3 .-' 5 '--f 2, EL l\S 1 ss.fr<*) o o ul r.ln SS \llt OA ILTI\JIT SRr.rFr\eT -\1hs BtuA Llr.^) N, A.l Ef1 - q r-' tts. u' l-o\rL.ta'<T5- s Lq8, ,\, f,l 2N6 o!Sr(t i\\.n.ros.) )1' s zER.s.a -+rs(.1 NotE: -Tltq \?-1.'l S I|.F€TLYY LI ,{. e\.58S lt^TCl{ED PFffLT oF T}t€ FArrkr^, 6 heqhBE' CtltsqL FLr}l^,Qr, oR- SQ\JI\L \ ELIF r^r +TeF Ri{ a$hFtcDl)^J r stas€\ ft,lJs F€frYr L,z€D.. 1-t)-q3 ?- tstll-1 \\ql\sE\)c€ lrJ B 93- 137 Date Signed Wisconsin DePartnent of lndustry, tabor and Human Relations Qivision of Safety & Btildirgs SOIL AND SITE EVALUATION REPORT in accord with ILHR 83.05, Wis. Adm. Code ofPage 3 Attach complete site plan on paper not less than 8 1l2x 11 inches in size. Plan must include, hlt not limited to vertical and horizontal reference point (BM), drection ard!" of slope, scale or dimensioned, north atrow, and location and distance to nearest road. APPLICANT I NFO RITATIO N-PLEASE PRINT A LL IHFO RiTATIO N SOIL DESCRIPTION REPORT Boring # Ground elev. \Ds-o fL Deph to limiting hctor ..38', Remarks sT. c-rao Lx PARCEL I.D. #o7-8- to50-Yo REVIEWEO BY DATE PROPEHTY OWNER:t(exsxlsTlt =rNup6tcb PROPERWLOCATION GoW. LOT S rt) 1/1 St^r1l1535 T ZB .,N,R l-1 E (@ PROPERTY OWNERS MAILI NG ADDRESS3V gl sr fil..re. LOT* tJ 45 BLOCK*b SUBD. I'lAlvlE OR CSM* YLtr\ gF l-rexJ c4uT\s(t-rl.utQ- C[TY. STATE B frtUt",,t0 ,h)l ZPCODE SYooz- PHONE NUIEER (7S) 68V- 3-) r Z DcrrY Dvrrr-AGE EIrowNR.rlsH PtOgR NEAREST ROADgl sr 57. [ 'l Nar Corsfudim use t{ Rsidentd / }tunDer of bedmnrs z I I Addpn h erbling hriHng\ P( nepaenent t I PuUicscomrnercial Code derived dailf fron 3so * Reconrmnded desi$r loailng rde o - 39 OeO, g$rf - rerdr, gptf Absorffon aea reqired ZSo bed, ft2 ZS O fen4 d [eximm d€xign lodrg r& s .S bed, gp6rn2 o.t fen6r, gpd,nz Reornrenlerl ffitfdon swh dardin(s) \ O \.-t n (as refened h site ptan Uendrna*) rzlAJrP?uh \'qr= shru! Fru\.Add6md deslst / $ts considerafas I.sutlrD kJ rT)+ 8 'K 32' g eD . Paent rde$d Ls lss s - ou ere Tr uL Flod dain devdin il applcable N-\. n S=SdEblefrsatsm U =Ursuihble bfsvsem c0N1/B{TU{ALDS EIu ucrfioEIS trU il€MU{DPRESSUREtrS E.U AT€RAOEtrs 8lu SYSTEI N rutrS EIU rfl.DrG T lr(Ds Eu Horizon Depfrr tn. Dominant Color Munsell iloiles Ar. &.Con[. Cdor Texfure Sfrncture Gr. Sz. Sh. Cssistsne Bqndny Roots GPD/ftz Bed Trsrfi )o- I \\YR s./Z si\z +s bvt r^t(x q-S lu{o.S o.t L 9 -zt [OYR 3/L sil zftbrr yn{t /tt o. S o.t 3 2b -38 IbTR V/6 sl 1 c- sbh )l.r u'er^c-s o.Y o-S .l s8.{v t\.tR :/t c-z&SLIE Blv sc-\-c\oYn \^ {i Boring # Grourd elet/.!b.so1 DAh to lffirq hchrzn q Remarks: I o-?Lu'tn 3 / r sil zfsbt vn(r^C\- S )u{o.s io.t Z 9-a3 Lb Y r. 3/G Si\Z Ssbvr h{u CS s.s io.I 3 5-Z?Loytrv/U \\\ cs\t Yn u{l os o.Y o.S v zq-6 \ u.r R 3/6 o acq.SnE z19 sc,l -e\\v+r vn$ r F CST Name:-Hease Pdnt Phone: 7 L5 - 425 -0L65Ar thur L . [,le ge re r ffi8tfEr"r Soil Testing & Design Service-P.0. go* 74 River Fa1ls,Wf 54022 CST Number M00576 sq**"hl f."w@ g3_ \31 Date:-)- ))-?3 COUNTY rlac/.riha PROPERTY OWNER -T-I\L FO I'D SOIL DESCRIPTION REPOBT Page Z ot '\ PAFCEL t.O. t 6 Z8 - lo so - Yo Boring # Ground elev.'rDqtt. oepth to limiting laclor .3\" Boring # Ao-.,Lo. El6m.rL.. olw _ lt. Ground Ground Depth lo limiting lactor Boring # elev. ft, Depth to limiting factor R6marks: Horizon Depth in. Oominant Color Muns6ll Mot[€s Qu. &. Cont Color Texture Structure Gr. Sz. Sh.Consistence Budary Boots GPD/ftz Bod lTEfih I o-8 rsl?. 31L Sr\z +sbk 'lr,r{1.ci- S lu{o.s o.( z B-zz !s tR 3/t Itl z S\h cs $.s o. ( 1 2"31 \SYR V/L \ a-ctk h ufr'c-s 6.v rra l-so \\YL }/L $z E3/s"l-c\6'h Yt, .[ rv Boring # Ground elev ll. Deplh lo limiting factor Remarks: sBD-8330(R.05/92) PLOT PLAN Page 3 of 3. \s-rs\XrtITl+ trfufoeb tb EF 62-8-LSSO-Vo --a SCALE 1" = 30 ' I rr, T NI t-a ilo o ul e C-TH,( '.' \,"-3 .15 s\t\TtLLE tgE \"-s.1 s }tuegcr:r Lrr.t Ts c-R53sbtfiTLttS PFTILT sr= Tlt€ trry,rlEr^, 6 m.gABE' €tYrSgL FurswQrr oR- gQ\rr\L \\ El-lFrrezttle Rr.-r.,t cr.)ra F frep 0Ir r S (S A\ Ff,,*rS RSryl L ,?,eD .. 93^ r371*l)-q3 (Its I t+25-o1G5 Mry.6_ csr # Co.,.i\",..eS.) \:q Fq lsoTE: -ft. twG ?- E,btLt-,1 \1qS rS er.J c.e },J B L}1r-{ r.\, 32' g.: eu ro( l ) B ER. x aq N s z J 6,S ON B S 641 D\Sn\rr.B oRY1trhe\ Tltrs qLros ss\qt.qr& &tss1 -\- i-rl I EI - tu. rso.b' c^\x-ttqTE- s r-hg. S2, I T nature Date Signed Telephone No. N