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HomeMy WebLinkAbout002-1055-50-000St. Croix County Planning and Zoning Detail Sanitary Information Tuesday, Marclr 27, 2007 at 8:34:13 AM Page 1 of l Computer #: 002-1055-50-000 Sub/Plat: NA Section: 23 Parcel #: 23.29.16.340 Lot: TN/RNG: T29N R16W Municipality: Baldwin, Town of CSM: 1/4 1/4: NE 1/4 NW 114 Owner: Jensen, Dale 2541 90th Avenue Woodville, WI 54028 State Permit: 353282 Issued: 01/06/2000 POWTS Dispersal: Mound Permit: New County Permit: 0 Installed: 05/02/2000 POWTS Detail: NA Bedrooms: 3 WI Fund: No POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Kevin Grabau >4/1/00 -Not Required Hudson, Dale pump curve (EO311M) for some reason Dale installed a 1250/750 combo $0.00 Jon Sonnentag Signed Off: No tank to 8' x 47' mound. Note on unsigned report was that plumber changed pump to a Goulds WE 0311 M, but didn't provide the pump curve to inspector. Should have looked -the TDH is 23.7 at design rate 37.44 GPM, which is beyond the capacity for this pump. Maim&nance~ Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 1/5/2003 2/6/2005 04/0112005 2/6/2008 wh ~, /*. Wisconsin Department of Commerce pRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ wn of: Jensen, Dale Baldwin Township CST BM Elev.:- Insp. BM Elev.: BM Description: ~ ~ r ~ fJ L TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Z ~ Dosing ~ Holding TANK SETBACK INFORMATION TANK TO P! L WELL BLDG. vent to Aire ROAD Septic > Z ODi ~ (6 6 r ~ (~ ~ tl^ ~ NA Dosing >~tOD/ 5/6G~ } s/ ~~ ~ NA A Holding , PUMP /SIPHON INFORMATION Manufacturer Demand Model Number ~ ~~.,`'{G~M TDH Lift ~s 5 Lrictio~ Syetem S TDHZ3 ~Ft Forcemain Length ~ ~ 9p~ Dia. IZ ~~ Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No.: 353282 State Plan ID No.: Parcel Tax No.: 002-1055-50-000 STATION BS HI FS ELEV. Benchmark a •~o ~ o z. ~ d v Alt. BM o~cjC ~ Bldg. Sewer 102, ~~-~ ~7. S°l St/Ht Inlet 31q~~F~ ~, St/ Ht Outlet ----'" Dt Inlet _~ Dt Bottom ~~~ yv Z Header/Man. 2,5 Ub , (Z- Dist. Pipe 2•`!~ z. ys lb0. 00 Bot. System 3 Z~" 9 ~ y Final Grade St cover 9 ~ ~ g ` p-~~t,e,,r- 9~ z6' BED /TRENCH Width ~ Lengt ~ No. Of Tren hes PIT No. Of Pits id Depth DIMEN I N 2, r I SYSTEM TO P/L BLDG WELL LAKE/STREAM ~ ING Manufacturer: SETBACK INFORMATION Type O ( ,~ ~ . f A ' ' HAMBE OR UNIT odel Number: System: - Z ~Q 72 UQ j /V 1 DISTRIBUTION SYSTEM ~~~,.~ / 3 Z " _ .l~~rd..c~ ~~ Header / Ma%ifold ~r Distribution Pipe(s) ~~ / x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. Z Length Z ~~ Dia. ~ Spacing ~ /~ 3/ 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 #14`x/ 2/~bInspection #2: s- /Z ~a U Location: 2541 90th Avenue, Woodville~,~ "W/I 54028 (NE 1/4 NW 1/4 23 T29N R16W) - 23.29.16.340 / ! 4s 1.) Alt BM Description =~o~({a~w o ~-S;U i ~., g =7 ~-~ , i3-1'l ~ ~ ~ N ~~u-~ ~,.~~~,6Y t ~ ~ { 2.) Bldg sewer length = 3G r / [~~ ~ JJ -amount of cover = >' S~/ ~` ~ , G ~ ~ ~o C ~ed >~ /~xr ~° t c~,~.s, i~ 3.) contour = ~~, Z 6 ~ t->!1 - 102. ~ ~ ~ ~ ~~~~ p~j0 ~,Gc/'U '- ~ . `1 ~~ for.- ~... ~~-~. s~.r ~~ ~~ ~ ~~ I n revision re~re G~es ~q No Use other sitle for additional information. SBD-6710 (R.3(97) Date Inspector's Signature Cert. No. ~GOULDS PUMPS Submersible Effluent Pump WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer coups • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: 3/a" maximum. • Discharge size: 2" NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104°F (40°C) continuous 140°F (60°C~ intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ^ Impeller: Cast iron, semi- open, non-clog with pump-out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as an option. ^ Casing: Cast iron volute type for maximum efficiency. 2"NPT discharge. ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. ^ Shaft: Corrosion-resistant, stainless steel. Threaded design. Locknut on all models to guard against component damage on accidental reverse rotation. ^ Fasteners: 300 series stainless steel. ^ Capable of running dry without damage to components. ^ Designed for continuous operation when fully submerged. MOTORS ^ Fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation on '/a-1'/~ HP models. ^ Class F insulation on 2 HP models. METERS FEET 40 13( 12( 35 11( 30 10( 9( 0 zs ac ~ 7C a zo y 6C 0 Q 15 5( ac 10 30 5 2c 1a 0 00 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM 0 5 10 15 20 caPaarr 25 30 35 m;/hr Goulds Pumps ®2003 Goulds Pumps Effective July, 2003 63885 vvww.goulds.com Single phase (60 Hz): • Capadtor start motors for maximum starting torque. • Built-in overload with automatic reset. • STTOW or STOW severe duty oil and water resistant power cords. •'/3 and'h HP models have NEMA three prong grounding plugs. • 3/a HP and larger units have bare lead cord ends. Three phase (60 Hz): • Class 10 overload protection must be provided in separately ordered starter unit. • STOW power cords all have bare lead cord ends. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage when fully submerged. ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture bamer in case of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS S ~ ® Tested to UL 778 and csa xza 108 staiwlards By Canadian Standards J(ssodation C US ~#LR38549 Goulds Pumps is I50 9001 Registered. _ ___ ___ ____ ___ __ __ __ __ __ __ ___ _ _ __ __ _ __ _ __ __ ~ SERIES: WE SIZE:'/," SOLIDS RPM: 3500 & 1750 -- --- --- --- -- -- -- -- -- - -- - -- 5 GPM - - -- -- - - - - -- -__ --_- - --- -- --- - - - - - - --- -- - 5 F i - - - - -- -- -- n d-- -- -- --- ---- -- - - -- -- --- -- --- -.- - -- ---- ---- ---- --- - -- -~ -- ___ __ __ -- _ ___ ___ ___ _ __ ____ ___ ____ ___ __ _ ___ _ __ __ ___ __ __ ___ ____ ___ ___ 0 _ -- -- -_ _ -- --- -- __ _.__ - __-_ __ __- ---- --_ -_ _- -- _- _ ----i - - --- i--- --- -- --- --- --- -- -- ---- --- -- ---- -- -- -- -- _ - -- -- -- --- -_- - -__ --- ---- -- ---- ITT Industries A `~~- I ~sconsin Department of Commerce SANITARY PERMIT APPLICATION to accord with ILHR 83.05, Wis. Ad d~ Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system;`on`paper no~ss u~' than 8 t/2 x 11 inches in size. ~`~ ~ , .' ~i~~ , ~~,,o ' • See reverse side for instructions for completing this application ~ ` StatA:Saii'ttary Permit Number Personal information you provide may be used for secondary purposes - t.~ ~r Ch~klf revision to previous application (Privacy Law, s. 15.04 (1) (m)]. ! - ° ~ ~ Sta la LD. Number F 7~ 6~ I. APPLI ATION I FORMATION -PLEASE PRINT ALL IN fl; ~ Z % Property Owner Nam ~a ~C '' ~nsC' y`, coperty Locati ~...dta;- ~, T ~,9 r Nr R ~~ ~i(or W Property Owner's Mailing Addres f,, ~~0 ~ So~7 ~ V C/ Lot r °4• Block Number, l N~ City, Stater ,_, Zip Code Phone Number Subdivision Name or CSM NumbeS ,~ 11. PE B I (check one) ^ State Owned 3 ~ !t ~ Vo~an ~ ~ ~~'~~ Nearest Road /~ ~~ Public 1 or 2 Famil Dwellin - No. of bedrooms - OF / C~ /YYCi , III. BUILDING USE: (tf building type is public, check all that apply) Parcel Tax Number(s) v?3 a~ ~ ~ b ~ 3~~ doZ -,/D$~~- ICJ 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) q) 1. ~Vew 2_ ^ Replacement 3. ^ Replacement of q. ^ Reconnection of 5. ^ Repair of an ______S~rstem -_______System _-___- __ TankOnly______________ Existing System __^_____ Exlstin~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 0 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground Pressure ~ 42 ^ Pit Privy 13 ^ Seepage Pit ~ - `'f ~ 43 ^ Vault Privy 14 ^ System-In-Fill r_. 9Q,0 VI. ABSORPTIONS EM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate b. System Eiev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/s . ft.) (Min./inch) Elevation ~f~C7 " 3 ,3 -- /OLD • O Feet ~ %.~ Feet VII. TANK INFORMATION Ca acct in allo s g Total # of Manufacturer s Name Prefab. Site Co"- r s Fiber- Plastic Exper. N E i i Gallons Tanks concrete tee glass App ew x n st strutted Tanks Tank Septic Tank or Holding Tank .ZGG3 -"' ~ / Se Y ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber % ~U ~ Co,'~'1, p ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT - I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: .tea 1 e ~. u t~~or.• c>.~ ~• 7y~col~'~ 2ZDS.~..~ i/-`-6gfjl -.3.37 Ptumber'sAddress (Street, City, State, Zip Code): ' ODD r ~ r Q t -^. ~' W r Yom-- i IX. COUNTY/ DEPARTMENT USE ONLY ^ Disapproved s itary Permit Fee (IndudesGroundwater ate ssue Issuin Agent Signature o Stamps) C Approved ^ Owner Given Initial Surcharge Fee) 3zs ~ /-6 ~~ Adverse Determination X,. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: ~ ~ ~~, SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety & BuilJings Division, Owner, Plumber INSTRUCTIONS `~ '' t. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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 priorto 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,Safetyaod 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 81/2 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 11.5 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. ~ ~ ~scons~n Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www. commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 16, 1999 CUST 1D No.267341 WEGERER SOIL TESTING & DESIGN 421 N MAIN ST / PO BOX 74 ~"~'~ RIVER FALLS WI 54022 ~ • ATTN.• POWTS INSPECTOR _,_„ ZONING OFFICE ;-' ; ; ' ;`S"L,CROIX COUNTY SPIA 01''CARMICHAEL RD `~'r;°~ RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11/16/2001 ("" ' ^ ^ ~r~ ~;JUi~Tv SITE: ~Ji`.;1~G©~FIC~ ST CROIX County, Town of BALDWIN NE1/4, NW1/4, 523, T29N, R16W , ~~,,% DALE JENSEN 90TH AVE ~'---"" FOR: . Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 636922 WI 54016 .~ ldentification Numbers Tr, nsaction 1D No. 276766 '`Si ID No. 184085 lease refer to both identification numbers, bove, in all correspondence with the agency. 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: ~ On page 5, the inspection pipe shall have an airtight cap as specified in s. Comm 83.15(2)(1)., Wis. Adm. Code. 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. S PLAN REVIEWER II g (608)266-2889 , M - F, 0745 - 1630 HRS PEPAGEL@COMMERCE.STATE. WI.US Since 1 , .~ ~~ L~ER E PAGE , PO Inte rated Servic DATE RECEIVED 11/08/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: DALE JENSEN Page ~ of 6 MOUND SYSTEM FOR '`'~-c~ V` A 3 BEDROOM RESIDENCE •-. %~.%i~ ~ o fir.. J '~-~~ 9 v ^~ ~~, - LOCATED IN THE 1VE 1/4 OF THE NW 1/4 OF SECTION Z3 , T 2~ N, R 16 W, TOWN OF 13'~.~\jtyLlV , ST- C~LX COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 PAGE 2of 6 PAGE CORRECTION NEEDED pA GE SEE CORRESPONDENCE ~ PA E 3of of S of 6 6 6 TITLE SHEET PLOT PLAN PLAN VIEW-C.R.OSS SECTION DISTRIBUTION PIPE LAYOUT PUMPING CHAMBER PUMP PERFORMANCE CURVE PREPARED FOR ti~ o s so -~ >~v~ - -- PREPARED BY P.O.W.T.Sr cond~t~onatiy APP OVE~D DEP Nt OF COWIM6pCE SEE GORRESPI 2 7~ 7~~ WEGEE~ER Sp I L .TESTING AtYD . . I3ES 2 GN S1ER~1 I CE F.O. BOI 74 421 K. 1lAIN ST. RIVEF. F+1LS. YI 54022 115-42`.,-016 ~`,v f,....."""ti.. aRmua ~ Weer-t-~ER P9ivP ~ S. [-ua'v~oaTy. t ~U IG~~' t t- 6 49 JOB NO . ~ ~ ~'~ PLOT PLAN ' Scale 1 "_ ~~Q ' ~q O.~l Wl1 ~7 z.so `T1+ ST. ~l~l"lltA Pve ~iaE P RuPt1zT`1 L lh1E, ~0.~ 6 a. ~ tvOT ~MP+R-~'~ O1Z ~J1S~L2B ~ `S`EA l.g ~'~~A '~~ .\ CbN~ovR lt, g R ,O ' Sv1~Ow1 ~~ .8~~ ~-_ IAII. o' -~-~-~ TO @ E _ ~ ___ Page Z of (~ NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. (~ required) 3. Install 4" observation pipes with approved caps. ( 2 required) 4 . ~ Septic tank to be ~Z.c~o ~'1 So gallon capacity manufactured by w~~:s~ eon al~~ ate-~o~ a-~ 5 . Bench Marks ; S ~- ~ ~ ul? , 6. llivert surface water around system to. prevent.ponding at the uphill side. 3/y "DI A Pic ~tP~ .~ Zs,~~ Page 3. Of 6 Approved. Synthetic Covering ~STM'1 C 3 3 Medium Sand Topsoil ~~ ~ 3 ,3 % Slope Bed Of 2~- 2 %2 Aggregate istribution Pipe ~~ D _/~~ b Force Moin From Pump G ,..Elev. 1.pU•L~ Cross Section Of A Mound System Using A Bed For The Absorption Area Plowed Layer A ~ Ft. Linear Loading. Rate=~• o GPD/LN FT B ~Z Ft. Design Loading Rate= o-y.GPD/SQ FT I 1 b Ft. J ~ Ft. K ~~ Ft . ni+~-~~~ Position F ~'7 Ft. of Force Main W ~ = Ft. F L 0 ~•0 Ft. E ~-Z~ Ft. F ~-~ Ft. G ~• ~ Ft. N 1.5 Ft. U ~ Observation Pipe ~-- -- $---- --------- ~ K A I - (o --- -------------- ----------------------•I W --~------- ------- ~Oistribution Bed Of 2M- 2.2 Pipe Aggregate I Observation Pipe Permanent Markers (Anchor securelyl Plan View Of Mound Using A Bed For The Absorption Area Page ~~ Of ~O Perforated Pipe Detail End Cod End View 'erforoted 'VC Pipe Install permanent marker -'~ nd of each lateral Holes Located On Bottom, Are Equally Spaced Lost Hote Next To _...-. .,., r P 2Z•5 Ft. Distribution Pipe. Layout S _~ Ft. X 3 ~ Inches Y 3 ~' Inches Hole Diameter d~ ~ Inch Lateral 1 <<~f Inch(es) Manifold Z- Inches Force Main Z Inches # of holes/pipe F3 - Invert Elevation of Laterals~~b-S Ft. ~x~•11= q•3~y~~~ 3~•~1y Gt~i Place lst hole ~~~~from center of manifold with succeeding holes .. at 3b` intervals. Last hole to be next to the end cap. ' •~ - Combination Septic~Tank and '' ~ PUMP CHAMBER CRO55 SECTION AND SPECIFICATIONS ' PAGE S OF 6 ^- - ~ - • -VEI.tT CAP WEATHER PROOF JuucTlou eox 'i~C.I. VENT PIPC ~ /APPROVED LOCKiI~lG tP~~(ti~ ~~ ~ lO' FROM DOOR. ~ wARNI-J6 VL•1~6E~ ~GG~~rr~vv~~~~~ 'AJ~ IWTAKEFRESH ~ Ca.~Dv1T c y~. ~ i •~~ ~ ,~'~M~N. GKA I ~l-' ~-- _18•MIIJ. y"ilus3~c~on~ PIPC 1 PROVIDE I Il.1LET AIRTIGHT SEAL 3 41rFL~.S I APPROVED JOIA17 ~' I W/C.I. PIPEOR Tank COnStrUCtlOn I I shall comply with ') ILH~ x;3.15 and 33.20 e I C 'j I LLEY.$3',SFT. PUMP-~ --~ D CONCRETE ~,~ , ~-L. Sv ~ BLOLK Y~ MIW. ~. 16' Mlu. 11~ III V I I ~ APPROVED .101uT: I I I W/C.I. PIPE~P~o II ALARM I I ~ o-J I OFF L RISER EXIT PERMIT(ED 01JLy tF TAIJK MA-JUFACTURER HAS SUGH APPROVAL~3~•kPPFtaFD 8r<Ot~ t N ~ SEPTIC E _ SPEGIFICATI~t`tS DOSE TA1JK MA-IUFACTURCR: w~~t ~h.1C~S~~. AJUMBER OF DOSES: 3` ~~ PER DAy TA1JK :,IZC: ~Z-VO ~1SU GALL0IJS DOSE VDLUME P O S~J~~"'IS ~ ~~T1~ S•T INCLUDiAJG 6ACKFLOW: «1'y' GALLON;, . - • ALARM MAUUFACTUR.CR: MODEL 1JUMBER: ~ ~ ~ ~W CAPACITIES: A= Y ,I_-uCHES OR 306`5 GALLOys SWITCH T~PC: k''l~'l2CQJlZCf B = Z 11„1CHE5"OR 3Z" 3 GQLLOUS PUMP MAIJUFALTURER: Z"0 ~-~-~1Z C = `~ IUCHES OR 1,~' CALLOUS MODEL AIUMBER: X40 D= 1S INCHES OR Z'~Z'OGALLOAIS SWITCH TYPE: ~ ~EJ2- IJ07E: PUI1P AND ALARM ARE~TO 6C$~Z MIIJIMUM DISCF{ARGE RATE ~"~~ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEU PUMP OFf A1,10..DISTR16UT1 0-J PIPE.. 16'-15 FEET t MII.IIMUM I.IETWORK SUPPLY PRESSURE . . 2•5p FCET + Z~S FEET OF FORCE MAIA7 X Z.~~ F~oFt.FRIC7lofJ FACTOR. S•~9 FEET TOTAL Oy1JAMIC HEAD = ~S"1 FEET ~ Pump chamber DIAMETER ~ IAITERAIAL DIMEIJSIOIJ~i OF TA1JK: LEIJ6TH ~~ ;WIDTH ;L.IQU10 DEPTH BOTTOM AREA 231= - GAL/INCH AS PER MANUFACTURER = ~ ~~.~3' GAL/INCH ' - - --- - . , ? ~~.~ ~~1Z.~ 121"'1 ~'j'1V ~ . C.U~ZC)-~ - P~G~ 6 o tF~ 6 1 1; 11 O Q w = 1 U Z O ~ 4 O c us. cr LITERS ~~ °u r~ n° ea 7oD 77D 80 760 240 320 ~ 400 0 FLOW PER MINUTE 010940 i6 lI2 NPT CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical altemators, for duplex systems, are available and supplied with an alarm. • Mechanical alternators, for duplex systems, are available with orwithout alarms. • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. • Sealed Owik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. • Refer to FMOfi06 for 200° F. applications. 140 Series - 53 lbs. 4140 Series - 73 lbs. 140/4140"' MODELS Control Selection Model Modei Volts-Ph Mode Amps Sim lex Duplex N140 N4t40 115 1 Non 15.0 1 or 1 ~ 5 2 or 3 & 4 E140 E4140 230 1 Non 7.5 1 ar 1 8, 5 2 or 3 8 4 BN140 BN41401 115 1 Non 15.0 1 or 1 8 5 2 or 3 b 4 BE140 BE4140 230 1 Non 7.5 1 or 1 8 5 2 or 3 8 4 "' Doublesealpumpsareavailablevrithoptionalmoisturesensors.SealFailmdicatorlightavaBableinNEMA1orNEMA4X control panels. 1 SELECTION GUIDE s SK7524a 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0447. 2. Mechanical aitemator M-Pak 10-0072 or 10.0075. 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. 5. Four (4) hole J-Pak, junction box, for water tight connection orwired-in simplex or 2 pump operation,10-0002. CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. -~~'~', ~ s MAIL T0: P.O. BOX 16347 -. Louisville, KY 40256-0347 Manu(aciurersol. . ® ~ _~' ~ ~~%! -/~ SHIP T0: 3649 Cane Run Road j•~/ G 7 1 LWISVIIIe, KY 40211-1961 Q~a~?Y PUMP9 SNCE ~,9~~ PUMP L O. (502) 778-2731.1(800) 926-PUMP FAX(502J 774-3624 W ~ W ~ HEAD CAPACITY CURVE MODELS "140/4140" TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING Ft. Meters G°I. Ltrs. 45 5 I 1.52 91 34a 10 3.05 ea 318 40 75 4.67 I 76 I 296 140,4140 20 6.1o sa zs7 35 25 7.62 59 ~ 223 30 9Ja 49 I 795 30 36 10.67 39 744 - s0 12.19 2t 79 25 ~ • ~~ 45 73 )2 . 5 19 20 Lock V°i ve: 46 ' 15 ~~~ 7 70 5 . ,..._ I _! I ~ I ~ ~ I f 112 NPT SK1524A n~rrbleSeal Design ~ht731bs Wf~onsinDepartmentoflndustry, SOIL AND SITE EVALUATION REPORT labor and Human Relatans Di~mEon of Safety 8 BuikSnos __J ._~.~ ....r, .,.. ~~ aae_ w J. n_J_ p~ ~ ~ 3 .,, aa,.,.,.a, ..,a., .~.... a,...a,.,, ~.w......... w..v COUNTY ~ ~ k ~ ~~ ~ C Plan must include but Attach complete site plan on paper not less than 81/2 x 11 inches in size '' , . not limited to vertical and horizontal reference point (Bfun, direction and ~o of sbpe, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. OOZ-1 b 5 S - S O APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R BY DATE ~a ~~8 d PROPERTY OWNER: ~ PROPERTY LOCATION NE NW l Z Z ° ~ ~~Z,~, -( `,0~~ tt fl6V~-E:AT- 1/4 1/4,S b E {or .3 T - 1 ,N,R W~ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # S @-f zso `nt sT• - CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE ®fOWN NEAREST ROAD L~ooDVLLI'~ ~[ s~oz,8 {~t.~ 698-z3g>e 3~`. ~ 9 ~ `1Tt /~Vf?, ~ New Construction Use IK] Residential / Number of bedrooms 3 [ ] Addit~n to existing building j ]Replacement [ ] Public or commeraal desaibe - Code derived daily flow ~S b gpd Recommended design baling rate • y bed, gpdAt2 try. 9P~ Absorption area required ~1 S bed, ft2 3~ S trench, ft2 Ma~amum design baling rate ' S bed, gpd/ft2 • ~ trench, gpolft2 Recommended infiltration surface elevation(s) ~JU• O ~ ft (as referred to site plan benchmark) Additional design /site considerations wtbyu~ w / 8' X ~ 1 ' r3 ~'D . )vl f ut --t l.Ay \Z` pi=- S`1't~ ~r ~~ . Parent material fro ~ s o V ~ G l~~ 1'CL- ~ r-~- Flood plain elevation, if applicable ~ K1 ft S =Suitable for system ~~~ MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLD~VG TANK U =Unsuitable for s stem ^ S dU [~'S ^ U ^ S [~'U ^ S j~U D S L~'U ^ S ® U SOIL DESCRIPTION REPORT Boring # -:>-a->;:.:~~:: Z<< ~~<: ~~-: ~~~• ~~-: >:< ~.., SigR:~3~. Ground elev. q Q, to ft Depth to limiting factor Z6` Boring # Z` ~:, ~.: Ground elev. 9Z•~ ft. Depth fA limiting factor '7 f h Horizon Depth Dominant Color Mottles Texture Structure ~ y Roots GPD/ft in. Munsell Qu. Sz. Cunt Color Gr. Sz. Sh. g~ ~h 0-9 ~o~tz. 3t3 ~ s~1 z`Fsbk w~~t~ cS ~ , S .6 Z 9 -z.c, \O `1 ~Z u! - S ~ zm s bk yn U'~- CS ., , S , ~ 3 z6 3~ 1.S b (Z Sl/l, ~-~. ~[2 SJ`~ 5S ~I ow, m'Fh _ tvP • Z Remarks: 0- L O L p`1 R- 3 l 3 S 1` Z T Sb 'Pvl '~y. CS - , s a y Z tp~ -oHfZ y!Y _ s) 2.m S}~~ 1~U CS ~ .S . ~ 3 Z6 3S ~ •S `12. yl ~ ~ ~•S 4 R S/$ Sscl C~v~ vh `~Y• ., NP `•.. Z ~` "~ 1 __' ~ q, 1 ~:•^,. ~ i .,t ~~~ v . .. t. -~ ~~ 'S "" ~~a Remarks: - ~ `a'vrry~Q n' TName:-Please Ptint Arthur L. W e e r e r Phone: 715 - 4 2 \ ~' egerer Soil Testing & Design Serdce-P.O. Box 74 River Fa11s,WI Signature: ~~ - Date: CST Number. ~ - (_-~-1= ~~ ~i S-qZ y -~~-~1 ~ M00576" PROPERTY OWNER 1-o~E1..lZ PARCEL I.D.# OOZ.-LOSS-SO Boring # 3 Ground elev. 9q•o ft. Depth to limiting factor Z~{ ,~ SOIL DESCRIPTION REPORT ~" ,, Page Z~ of "3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh ~ O-~ l0`rR 3l3 - si 1 Z Sl,~ w~`FI^ CS ~ ,S ~~ Z ~- `S l0`~.R Ul y ~ st'i 2,`Fsbk ~, ~ti- es ., , , S , 3 1S Z~ ~•S `1R Yl6 s) ~ ~sb1Z h~-~`FI- CS '~1 ,5 y Zy 3 ~ 5 ~'1 -Z ~! l 6 ~ ~ •S ~t ~Z s ~~ s ~l C~--, w- `F>^ ~ ti~ . 2 i i Remarks: .Boring # Ground elev. ft. Depth to ;. limiting factor t F i • Remarks: Boring # Ground elev. ft. Depth to limiting factor ,Boring # ~- ~ Ground elav. ft. Depth to limiting factor E ' i marks: Remarks: SBD-8330(R.05/92) _ •t PLOT PLAN SCALE 1"= ~'~ ' `; --°' `~--i-1~ ZSO ~ ST. _ ~. _9 0 ~+ '~v F. ~$y"1 b4 2 _~L, °C1,1' ON $"!i'lG H ~/~kDlq Pve PtpF ~ W / Lft'1'?1 r • ~~~ / 2S ~~ ~.q~ ~ ~ ~ a.z ~~ oR plS~2B ~~ ~: '~~. `/ `~ ~./ 3z , 8.3 Crt,c~~ 3l n u .o ~ Z--B}"'1 `~ ~ - mil, l0 u . Q' ON ~ 1 k l~}-~ 6 H ~ 3/y "pI A Pve. ~CP~ w/~l~l Page 3 of ~ ~~ 6 a•1 8o~h OF 8~ e L-NV • W I~ .O r ~~5~ ZU 8E~ (~7 l.F(tsT ZS' ~-uys ~uvkA . w~Ll- ~ ti 4 .. SO" Y t _ CST Signature Date Signed q8-qZ t 715 ) 42.5-ni ~S I40 50 76 Telephone No. CST # Wisconsin Department of Industry, SOIL AND S LT E EVALUATION R E P'O RT Page ~ of 3 ,, Labof and Human Relatans Division ~f safety ~ su~~: in accord virith,ILNR 83.05, ~Vis~ Adrn `code ' ° " ~ - 000NTY • Attach comptete'site plan on paper not less than 81/2 x i l inches in size. Plan nrust include, twt . ~. ~~`~'~ • C" ~ '~ k , ` ' - . , .. rat limited to r-erticaf and horizontal refererx~ point (BMl); direc6on-and % of sbpe, scale w PARCEL LD,,# ,: ~ - :. ~mensionerc!l;~rtottharrow,~and~location~and:~starxeto~nearestroad:~~• ~,~~~,~,~ ~;.. ~ OC~~_ ~~.~$:~.-.~~ .~~. ~_ ~.~~, ~' ~ :. APPLICANT INFORMArtCON-PIfASE PRINT ALC INFORMATION ~ ~` '- ,.~ ~ ~' = ` ` "DA PROPERTY(nNNER: ~Z-~`i ~.~Q.~ TZ PROPERTY OWNER':S MAILING ADDRESS $ $ `l 2.S p `Tlf SY" CITY, STATE ZIP CODE PHONE NUMBER 1NOoDV~.LLE ~ ~~ S~oZB (~~ 698-Z3gL _.._e _. PROPERTY LOCATION ~691fT-L~ NE 1/4NW 1/4,S23T Z°1 ,N,R L6 E(or~ LOT ~ BLOCK ~ SUBD. NAME OR CSM # ` T ROAD ~ `Ttt R V f? . ¢q New Cor~stnx:Gon Use lid Residential / Number of bedrooms ~ [ ] Add'rti~n to existing building j ]Replacement [ ] Public or commerdal desaibe - - Code dermed daily flow LlS l~ gpd Recommended design baling rate ' `~ bed, gpdAt2 trench, gpolft~ Absorption area required ~l S b~, ft2 3-1 S trench, ft2 Maramum design baling rate ' S bed, gpd/ft2 ' ~ trench, gpolfl2 Recommended infiltration surface ele'atiaf(s] ~Op. O ~ ft (a/ referred to site plan benchmark] Additional design /site considerations w10y~ w / ~ ' K t_(7 ' t3 LD . }~ A11 Y- Ury \Z,` U~=- S'11-~ ~i ~~ . Parent material ~.,o ~ ~ - o V ~ Gl~~-r. f'~ Y7 ~-L. Raod plain elevatbn, if applicable ~i r'~l ft S =Suitable for system ~~~ MOUND W-GROUND PRESSURE AT-GRADE SYSTEM IN F~L HOLDVJG TMBC U =Unsuitable for system ^ S ~U (~S ^ U ^ S . f~'U ^ S [~U ^ S Q'U ^ S ® U SOIL DESCRIPTION REPORT Boring # ~.. -w ~ ~: ~ti .A- ~: ::., ~:~ ~:::n rx~, Ground el~r. 9 g. ~ ft Depth to smiting factor Z64 Boring # Z Gto~d elev. q~.lo ~ ~~ smiting factor ZI.~4 Horizon Depth Dominant Color Mottles Texture Structure ~~ Roots GPD/ft in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. y Bed tends 0-9 to~tZ 3c3 ~ stt Z`F~bk ~.~fr- cs , S .6 Z q - z~ \o ~. tz y! - s ~ z~. s b k ~n ~ ~- c.s . s . ~ 3 ~6 3(3 1.S~t R Y/` ~-~. KR S/~ 5S ~I o~ vh `~-- _ tvP • Z Remarks: o-l0 ~o`-I tz- 3 t3 - s i ~ Z'~sb '~ ~~ ~S - , S . ~ Z 10?~ I O H R v!Y _ S~ 2.m S }~ 4r 1~ U CS . S . ~ 3 Z6 3S ~•S`12 yl~ f`~•S4RS/$ sscl C~vh vrl'~'1- _ NP' •2 Remarks: ~TNarne:-Please Print Arthur L. Wagerer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 river Fal1s,WI 54022~~- - Sgnature. /~~ `~.~~L ,~~ ~ 8 ~ Z Date. y M ~~ _~ ~ CST Num ~O 5 76 PROPERTY OWNER 1-o~-~Z SOIL DESCRIPTION REPORT PARCELLD.# OC~Z-.LOSS-SO Boring # 3 Ground elev. 9q •o ft. Depth to limiting faczto` , y ~ Page ? of _~ Horizon Depth In Dominant Color Munseli Mottles Qu S C l t C Texture Structure Consistence Bax~dary Roots GPD/ft . . z. on or . o Gr. Sz. Sh. Bed Trerx;h ~ o-~ l.0`~R 3l3 - si•) Z S~ m`FI^ CS .~ .S ~b Z . ~- t5 , IOyR Uly ~ st'i Z~sb~ ~, ~f-- es ., . , s - b _3__ . 15 Z-~ ~•S `1R Yl6 - s~ \ ~sbi~ Vn1,`~h cs 1 •~l ,S l/ Zy 3 L 5 `-•1 -~.. ~l ~6 ~ ~ •S ~t tz. S 1~ s eJ vk, w~ `F1~ ~ tip ~ • 2 i .Remarks: ,Boring # "' Ground .elev. ft ~ Depth to ,. limitlng factor • Remarks: Boring # Ground elev. ft. Depth to limiting factor ;Boring # :. i ,: ; ~~.~-E Ground .elev. ft. t)epth to limiting factor rtemarfcs:. SBD-8330(R.05/92) ~/~C"Dlq Pve l~t~F ~ b.~ / L~rn~ i ~~~ / 2S ~~ k~.0.~ 6 / i a.z ~~ a1L aIS~LRB ~~ '/ 3l ~~~~, ~ n u ~\ .a 3~ B•3 tT1.9q °_ •'• ~yp~~ ~ ~8 3/y "OI ~ Pve. ~lP~ w / ~-11'{'l~l ~~ 6 a.l corscov~2 ~1J~V - 9a.0 B~1`lUV~ OF 8E'C~ eZ_HU• ~OU.p' _ nu~Sz lv ~E~ (~T ~~sT ZS' ~-ur-t j~uvy._A . ~~~~ k 4 4 4 J 0' Y t ~~r! ,1t~: _ ''~~I'`~``~- ~ ` 7~_'_~~' (715 ) 425-t71 h [ ^y 4 V~ C~ 5 I4 S0O 76 CST Signature Date Signed Telephone No. CST ~ 32• f ~~~ [a-~ t°,~ .1~~~~7 St. Crow County Zoning -„ 1101 Carmichael Road ~ ~ ,~ f~~~h~ ~ ~" Hudson, WI 54016 - , - ~'~rvrryG;~ ~~ RE: Sanitary System Sizing ~d:, Properly located at NE '/a of NW '/a of 23-29-16 January 04, 2000 Dear Sir: We realize that the mound sanitary system was sized for a three bedroom dwelling. It is our intention to design and use the house as a three bedroom, even though the room marked as a study/computer room on the blueprint could be interpreted as a fourth bedroom. Please feel free to call if you have any questions. Sincerely, ~ ~ "~ i~ Dale R. Jensen ST CItOIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~.~`7~r~ ~ ~ ~ y~..~~ s~-- Mailing Address ,91,,5' Sd~ ~q~e¢., , ~ p~Q/W' ~,~, ~ f,,~ ' , Property Address a 5 ~~ 9 D ~ ,~- ~ . ~~~ (Vcp~i~tipa required from Planning Deputrnent for new consfzuctioaj , ~,~/ /, City/State , ~ ~ , Parcel Identification Number ovZ - /0 5~~Z0 ~,EGAL DESCRIPTION Property Location h/ ~L ;, ~/ ~ ~/., Sec. o~ 3 . T o2 9 N-R1~W, Town of ~« w ~ ~ zc Subdivision ~~ Lot # N~ . CerCatted Survey Map # /~/~' Volume /l/r~ .Page # y~ Wan aaty Deed # _ G 1 ~ 8 S^ 1 Volume _ / ~ S ~ P e # ~ 1 ~ ~_ Spec Ronne ^ yes ~ o Lot Imes identifiable (B yes ^ no 'STEM ~1dAINTENANCE Imps use and maiate.aaaceof Your septic system eoald msalt is its prnmatnr+efailane to handle wastes. ~Pa oansistx of paanpiz;g out the tcpde tank every throe years or sooner if needed by a licensed pamper, What you pat into 9be system qa affod.the fimch'a~n of the septic taalc-as. a stage in the ~rasbe diSpo al.~sysOcm, The. proputy~ owner ageoes to submit to St. t:ronc Zoning Department i .ooa faun, signed by the oarnec and by a p~i~Y~p rGStsictedplamberor i 1i~dpemrpervecifying that (I) the oa=site wastewaterdz~alsysOcm is ih pmpcx operating condition and/or Cl) after inspxtia~a and pmmping.(if a~sarY), tTtie tePtio~tank is less dines I/3 full of sludge. I/we„ the tmdersignod haves read the above r+oqu and ag~nx to maintain tic private sewage disposal system with the standards set forth, . as set 6y the Department of Comme:oe and the Department of Natural Resooa+ecs; State of Wisconsin.. Cation ~~ ~t Y~ ° bas beta main~ia~od mast be completed and t to the St. C~+oix.Couaty Zoning Office wifl~ia 30 days of the throe year expiration date. ~'~ ~~ ~~3~ 99 SIGNATURE ~ APPLIGINT DATE UWNER. CElt7`IFICATION . I (we) certify that all statements oa this form are true to the best of my (our) knowledge. I (we) am (are) the own«{s) of the descn'bod above, by virtue of a waaaaty deed recordad in Register of Deeds Office. i ~~ ~ Z i~3i 9 ~ SIGPtAT(JRE OF PT;ICANT DATE «««««« pay infocmatioa that is min-represented may Insult in the sanitary permit being revoked by the Zoning Department. «««««« •« Include Frith this appiicatioa: a stamped warranty deed from the Register of Dodds office a copy of the certified survey map if t~efer+ence is made is the warranty decd t' -I~~ .1~58PAGE 31g T~ E,.1 C7 $ 51 (<.~l'f HLEE'N H. WALSH REGTSTEF: DF I7kEDS 51 ., Gr~CJTX CO., WT RECEIVED FOR kECORD Jerry Lorentz, a/k/a Jerry R. Lorentz, and Carol A. Lorentz, husband and wife, conveys and warrants to Dale R. Jensen and Mary C. Jensen, husband and wife, holding as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: 49-03-1999 9:30 Apl WARRANTY DEED EXEl~pT # cERT copy FEE: CORY FEE:' TRflNSFEk fEE: 246.44 RECORDING FEE: 14.04 pAGE5: 1 Name andRetum Address ,~~1' ' Thomas A. McCormack ~~"""" 740Ma1n PQ S'l/ Bald 154002 I~ ~~ 002-1055-50 (Parcel Identification Number) The Northeast Quarter of Northwest Quarter (NE '/4 of NW '/4) of Section Twenty-three (23), Township Twenty-nine (29) North, Range Sixteen (16) West. Exception to warranties: all easements and restrictions of record. This is not homestead property AUTHENTICATION Signature(s) authenticated this day of , signature type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack Baldwin, WI 54002 Dated this ~ day of ~ ti ~;~, 1999. "Jerry .Lorentz \~ ~~~~ "Carol A. Lorentz ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY s~ QQ Personally came before me this d.~+^~Cday of~ ~~~, 1999, the above named Jerry Lorentz, a! ry .Lorentz and Carol A. Lorentr to me known to a the erson(s) who executed the foregoing instrumen and;, y+/I~dge the ~ i same. ,z k ,J' signature ~ , // J ; u+ type or print name ~~f~i~ s ~ . ~ c~fdfLnA~drr.(,~: L ~~ v Notary Public St. Croix County, Wis srn. Q My commission is permanent. (If nod . ~,~alion date: •) *Names of persons signing in any capacity should be typed or printed below their signatures. Information Professionals Company Fond du Lac, Wisconsin 8068552021