Loading...
HomeMy WebLinkAbout008-1010-10-100 ~ y o ~L o I h ° 4 0 ea g N O C Q N ~ ° U 0 I 'U O I N ~ C O - C Z CL V LL O R .10 Q ~ I ~ i 3 Cl) Z y to Z 0 0 z m co W 0. co F- Z i o I 0 z w m Z ~ z cn F- o E M N 3 ~ o z D w o I z d ~ N N l6 E C _ Cl) O H 4f N O C {Oyu a ° c N Z > d m co Z O > C Z n ° O O O ° 0.CL CL a 'N o I rn rn y N J U I ai rn rn N o ° N or- rn ° ~LO ° ° m d W Q d N z m in a I L 7 Q ~ O N H = E C co c :3 04 tQ 0) O p m O M y V a 0 0 rn W F- N E C N N 0 p N O O = d• d. W .y,y (0 L d n a0 C - GO N C t N.y CO N 7 Y Cp ~O O O W N O Z ~ I v1 d ca ~ a I V CL m d c rraj +r E C r- 0 1 A caz l0(n0 • M V tr IC ~ STC - 104 AS BUILT SANITARY SYSTEM REPORT E OWNER ADDRESS 16C~~ SUBDIVISION / CSM# LOT SECTION - C T ~N-R~-~~~ Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM O P ej~ 19 1000 e` y, 1 NUl C1V'i'E tJOR'1'H T~I:IZU1' _ I Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of sept.ic t aril. rov(" BENCHMARK: I C'7U Ty D T .S L' c7~" C'u~/1~.~' U. ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (nJ'AWQLS}" EfC~ Liquid Capacity: Setback from: Well- S C) i House ;;~Ol other Pump: Manufacturer Vf\.4Aj'0 ' A'K(, Mode14 SeJo15Size i/ Float seperation e oci Gallons/cycle: ~S 3a Alarm Location '4 6004e- cad Floyar-t-- SOIL ABSORPTION SYSTEM Width: on's Length Number of trenches Distance & Direction to nearest prop. line: 401 S Adlecaff Setback from: well: House gO Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet - PC bottom Pump Off Header/Manifold Bottom of system__#Q J Existing Grade j01d,•!5_ Final DATE OF INSTALLATION: PLUMBER ON JOB: Q--0'( U1 L --y~ V1, ton ,ICENSE NUMBER: INSPECTOR: J lm 1 3/93:jt V~ isconsin ljpartment of industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268521 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MIKLA, JIM/MENTER, KATHY EAU GALLE Parcel Tax No.: CST BM Elev.:~ Insp. BJM Elev.: , BM Description: TANK INFORMATION ELEVATION DATA 9of~/~~' ?x TYPE MANUFACTURER CAPACITY STATION BS HI FS /EELLEV. Septic Sri,) Benchmark Dosing Aerati Bldg. Sewer 4.2, Holding St/ Ht Inlet a Goa d TA1~IK SETBACK INFORMATION St/k~'Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Airlntake NA Dt Bottom Se (o r ptic Dosing NA Header / Man. a Aeration NA Dist. Pipe 5`y Bot. System Holdin PUMP / INFORMATION Final Grade Manufacturer Demand ~ ? Model Number GPM TDH Lift Friction System 'TDH Ft Forcemain Length,,r/6~ Dia. a Dist.Towell(ip SOIL ABSORPTION SYSTEM BED /TRENCH =,d__ No. Of Pits Inside Dia. Liquid Depth No Lengt i No, Of Trenches PIT DIMEN 1 N L Manufacture 5_ 91 SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM CHAMB Mo _ tuber: INFORMATION TypeO 0R, / © O IT System: YVt(r, d~` DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent To Air Intake Distribution Pipe(s) Header l Manifo - / _ Length Di Length Dia. Spacing 1 J SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over ExxDD h Of xx Seed ed / Sodded xx Mulched Yes ❑ No ED] Yes ❑ No Bed /Trench Center es ❑ COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE.4,28.16W, NE, NE, 60TH AVE ;j" ' r'iyy r*%'~'.,~,1.<...Ir'r ~~-rJ...~^-'~'Y~' i >~,;1•~.j!E,7.I flan revisio required?] Yes ` information. Use other side for additional I '7 WEE CID SBD-6710(R 0 /91) Date Inspector's Signat re rt. No. -T 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ")7 ;1 1c.r; Safety and Buildings Division Itlr~~i ■ ■rs ~~■~r■■,. SANITARY PERMIT APPLICATION Bureau of Building Water System: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. . L' v-tt • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pro erty Owner ame Property Location / - 1/4 1/4, S T , N, fp or W Property Owner's Mailing Addn- Lot Number Block Number .0 r S CI St to Zip Code ~ (hone ;umber Sub isame gr C-IMN~mb10, er a~ l/1 Ill. TYPE F BUILDING: (check one) ❑ State Owned !tyage Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms VIl Town OF Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) v, /0(0 1[]Apartment/ Condo 0010 1610,-16z 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. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an ystem System Tank Only 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 X„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 Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank D08 B Oo (f 10 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber d ~Q W1 I ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Pem is Name: (Print) Plum er's signatP Business Phone Number: "I I 4a-1 g 0 71,S-(97S-' _73y1 PI beer's Address (Street, City, State, Zip Code): f V S4"' IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San' ary Permit Fee (Includes Groundwater L;ate Issue Issuing Age Sign ture (No m s) Approved ❑ Owner Given Initial a0iSurchargeFee) Adverse Determination 46 7//' X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS , k 1. 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 prior to installation 5. Onsite sewage systems must be properly mainta_ fined. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. 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 Dwel'ng. Ill. 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, rsco nnection, 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- V11. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number.with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 26, 1996 2226 Rose Street La Crosse WI 54603 RED CEDAR PLUMBING N 4676 471 ST MENOMONIE WI 54751 RE: PLAN S96-40631 FEE RECEIVED: 180.00 MENTER, KATHY NE,NE,4,28,16W TOWN OF EAU GALLE COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items 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 ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed 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. All 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. Please refer to the plan number shown above. Sin erely, . Dennis Sorenson Wastewater Specialist Section of Private Sewage (608) 785-9336 1 SHDA-7987 (K. 10/84) PRIVATE SEWAGE SYSTEM Safety and Buildings Division Bureau of Building Water Systems REVIEW APPLICATION LaCrosse Office Madison Office Shawano Office Waukesha Office Hayward Office 209 W. 1st St. 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay St. 401 Pilot Court, Ste. Suite 300 Waukesha, WI 53188 Rt 8, Box 8072 La Crosse, WI 54603 Madison, WI 5 Hayward, WI 54843 Phone (608) 785-9334 Madison, W 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715 524-3626 Fax (414) 548-8614 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 266-3151 ) Fax (715) 634-5150 Fax (608) 261-6699 Fax (715) 524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least two working days prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. 1. APPOINTMENT INFORMATION - If you have scheduled an appointment, fill in the information requested below to save time: Reviewer Name Plan Identification Number Appointment Date 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: County Project Name ❑ City ❑ Village ❑ Town of: Project Location GOVT. LOT 1/4 1/4,S T N,R E (or) W FEE SUBMITTED 3. APPLICATION FOR 4. FEE COMPUTATIONS System Type (check one): System Type' (include new and existing tanks) A ❑ At Up To 1,500 gallon septic tank ....................................$110.00...................... H F1 Holding Tank 1,501 - 2,500 gallon septic tank .....................................$120.00...................... 2,501- 5,000 gallon septic tank .....................................$160.00...................... M C] Mound $200.00...................... N ❑ Non-Pressurized In-Ground (Conventional) 5,001- 9,000 gallon septic tank P ❑ Pressurized In-Ground 9,001 - 15,000 gallon septic tank .....................................$300.00...................... O ❑ Other: Over 15,000 gallon septic tank .....................................$500.00...................... Up To 1,000 gallon dose chamber 70.00...................... Building Type (check one): 1,001 - 2,000 gallon dose chamber 80.00...................... D ❑ Dwelling, 1 or 2 Family 2,001- 4,000 gallon dose chamber ...............................$100.00...................... P ❑ Public Building 4,001- 8,000 gallon dose chamber ...............................$120.00...................... S ❑ State-Owned Building 8,001 -12,000 gallon dose chamber ...............................$140.00...................... Over 12,000 gallon dose chamber ..............................$160.00...................... Up To 5,000 gallon holding tank 60.00...................... Code Derived Daily Flow gpd 5,001 - 10,000 gallon holding tank ...................................$100.00...................... Over 10,000 gallon holding tank ..................................$150.00...................... ❑ Check if Replacing Existing System Experimental System (additional one time fee) ................$300.00...................... Revisions to Approved Plan 2 60.00...................... Petitions for Variance: Setback ...................................$100.00...................... Site Evaluation .........................$225.00...................... C] Petition for Variance Plumbing $225.00 Revision 75.00...................... ❑ Groundwater Monitoring Groundwater Monitoring - Per Site 60.00...................... (other than a proposed subdivision) ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring 60.00 Subtotal: Priority Review: Enter same amount as Subtotal: Total Fee: MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION 5. SUBMITTING PARTY INFORMATION Contact Person Telephone No. (include area code & extension) Company Name No. & Street Address or P.O. Box City, Town or Village, State Zip Code Aerobic or prepackaged treatment system fees are calculated based on equivalent size s ptic tanks and dose chambers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing app NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. SBD-6748 (R. 03196) 03 b y z ° A i0 1a N 0 co _u O m O O V Z~ 2 D y W 0 D m g n 0 o'44o o' mmE$2~~x~NS mAT Cy'C ° O D O 3 m D ~'_•'To D amIwoo m mm m u° p I $ o i c w c~ p'D o c 2 D n m ? O 5 r$ C1v:~3X 33 oa a (V-2~ n _ 3b d P S ° c m i CA ~4 1 m 1A Z3i 15 o m u v, n N m o T A 5 O m N a O m° m O O' 2 $ m a f y N c <j 'J Q o D o m 4Q N -1 R_ Z o $ OQ a w m t n S° Z. I T A O 1 D emi n o $ -0O~ m D 3 o ui L~. m `o N m 3 m O y IZ °cdma m S ;a Oo~$ m r = o S m y G5 Pi x a 91 T a..3 21o ° O z r m ° 2 m 3 3 c° _ 1 O o p c m m om x m n m c g x m = J X 3m~ m O in D 30 o~m -nyrN~ 3 3 -1> O N n i m O- x O m N n .0 .0 m ro O m m o m cmu a Erna° Z 0 3 9 O = pg Q = N m`~ N~$oo gg~p~$ z c o o mm' ° ry C. vam' O a m .Z. .m.. Z 3;m N m N 7 41 O 5 w FUN C A ~E m ma~3o w' w5. n~c°E ow Aa p .o Qr ~m 3 ry~ N O Z Z = W m G m= C m m ((:,I 3 N y o G1 v A m 0 C O °o A N C ~o cn N Q 3 a n N m O a w < v m< v < b b o o v o o in in v A ° c g m C < = a' m $ A o 0 0 o i m o 0 0 o N - m< o cam' n• y e?d o_o 3m am vN;a$mx000 p m B O .m. O = O O~ N N do A N N N f0 fn N -i m • Z' O m 44 OM c n z o m° o m g o 0 0 0 0 0 0 b 0 CL x g. -.9--o -y ,u' 3i m p T I Rd ~a =.ao _ v w oo$ ggo°o°o0 $°0$~ 3 ~oOrn?'92 nN-^.?a 41 o ro'. xo'`N. mdm mmmwmm dmmwm~o m^= x21m His. i>m m m 2 ` 3 > > > IS > > > > o S o 0 0 0 o n -Cj c ~c W o m $ rn °i ' R r 1O o * ~ O m ° N n -0 ^m s of f n n n n n =a e D 3 oc o (D ° c rv H o A n A nI z (D 'Z ~ a' m N T° o g~ ~ D m m n o N a. o m nw y m^ d m m m m>; y^ y Q_ S S m m ~•1 CO) S Y! lD = C R- ? S 3 3 3 3 3 F F F F F Cl O m° R m ° O N ~I.yl ~3 ~^p y m m m g n Cl ❑ c m Z CO) m u o x a- 3 al N -f a fv Y ; 3 0 N c 5'0 " -n -u ca V) cr m O f7 m m m ~ ~ m C N ~ x O m .I t i d O m V! O = m 0 C m o m wTm m O C F R T j O O 3 a^ = G P~ m to c g 10 m C C M M b1 N N N N ER f9 M M {q fA d1 M fR W n H M fR fR M J j w p Ol Ol J N N O N0 0O ut0 O W 0I A N N W N m v' 0 3 0 •t m y o O o oNN 0 0 o 0000000000°?oo p O 2m =d~wm ~ cm o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0$ o o _ c a 6 E g o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 co ~O 3 c m d Co co c 3S Y a vow -n u O=c < -n roc X c c ~N m ' m ~m3 am vR O .'0 m m s v~= o w. 9J I \ c m°ca AYnm y0 1 4 O p m m g°c O O 8 O c -zi ~;La a 3 o I°O p m F ° N O O O O O ° v 0 m y N~ m m y _ = M 3 (D v 0 N Q. (D = CD v n m m m 5 pZ y ;U (J) O 0 0 v Q D N' CD O, 0 m O p S n a m y O n CD CD CD m N< CD = N o' 3 N 3 m N p 0 N m CD 0 3 7 d m m, 3 .~3 y o m m y N v`< ~ ~~mco a~ y' Q' 0 n O "a << O, C m a) rt ;K O Q art rt 0 CD O rt m 0 (D 0. M =t - O D n - ;r y y 3 N 4: O y O y r y (D m m =i, 0 M ID (D Cq CD ca a) CO) a) CD (a 01 p~ n ti. O O. O.► N p =r 3 O W _O N y. m ca m m O rtSD 3 ° 0. O O O t7 7 O -4 Q° 0 y 3 O ,Y O O (D• < _n m < < W y'a c O p = 3 N m O- 7 • O C. =r m - 7 C1 O rt 0 0 m ~ d C c m N O rt N rt O_ y O CD CD 0 Q' -0 C E O .~i cl) (D y :3 A 3~ ~ O O 0 y N C :3 N D m" y C O M O in (D 7 m 2 a 7 y CO C CD 0 O o N m>> < 0 m CL _7 :E m O m (0 0 y (D C C. = O N (p p(D . m N (7 C =r 0 -1 S. Q-) !a CD < CC c JRP :3 CL CL - =r :3 :3 W l< CD 0 -0 N N < 3 CD 0 < ca - C (SD N o° Co N v y O O Q Q C- (DO CA M CD cn 'o oN n °:3<~Q`< ~~~3~' < yam m myap rn'~ fDo °o c =r cc ~y cn - 0 =1 ~(o - o CD (m m y mm 0, o p _3 m .0 CD p'.< m O 3 p ~ X N c y (=D y N 0.O N n N v CD - o y m am m' (SD yv o m 3 3°° y y z _ C. =r T -3 =r m ° o, ~ 3 .=0 . M pp cook - CD Q CD . ' < (D CD C rt m tC (C y p 0 O 3 -0 3 0 m O d m 3 (a = O 5.0 CD CD o ° a ° rt~ m M= ca cc a •3'0 ~v y m m y ;m c o- N. m o m Qm Cl) N .00 O C. j (p - 0 - -1 y 3 Q co 0 0 O 3 Q ~ CL O 0 0 o- c) f CL CD Z n) CA 0 =r 7 N a =r y N N r' -0 a9 7 =0 0 0 C CD Q m (03 3 C (P 7' r. Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID # Owner's Name Legal Description Address CityNillage/Town County Contents Comments/Special Instructions Page # Included Two copies needed for all plans 1 Plot Plan 2 Plan View/Lateral Q Return by Mail 3 Cross Section 4 Tank & Pump/ Q Fax Letter to (County) (Submitter) Siphon Information Circle One and Provide Fax ( ) 5 System Sizing (Public) 6 E] Call for Pick-Up: ( ) 7 0 Other I, the undersigned, hereby certify that the Seal (if applicable) plans and specifications submitted herewith were prepared under my direction and control. Plumber/Designer License/Registration # Address City State Signature For Office Use Only Attachments: Application Soil & site evaluation Fee Needed for Holding Tank Submittal: One copy of notarized holding tank agreement. (Originals to County) Needed for At-Grade Submittal: Original signed and notarized Application for "Use of an At- Grade" County on-site One additional set of plans SBD-10268 (N.01/96) S96-40631 Kathy Menter - Mound RECEIVED 596-40631 JUN 2 4 1996 SAFETY & BLDGS. Div Location: NE 1/4, NE 1/4, Sec. 4, T 28 N, R 16 W Town: Eau Galle County: St. Croix Date: June 25, 1996 Owner: Kathy Menter Address: 469 315th St. Knapp, WI 54749 Plumber: Kevi Lannon Signature: License # MP 7320 Attachments: 6748-Plan Review Application SBD 8330 page 1: cover 2: calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve page 1 of 7 system Calculations One family residence 3 bedrooms Loading rate o' gallons/sq ft per day i Depth to ground water in Depth to bedrock > in 4 a 6 Cross slope Z- 3 Force main length ZZ ft of in Manifold/header length N ft of in Drainback gallons Lateral length @ 9 ° ft of in Lateral elevation ft (bottom of pipe) Lateral hole size in @ G°'0 in ( s•0 ft) spacing \C~ holes/lateral, 1C~ holes total Lateral volume gallons 3 Total lateral discharge rate 22'Z- gpm @ ft head Elevation difference ft Friction loss 2-~ ft @ ZS gpm Total dynamic head ~2'J 3 ft Pump/sii~von k6 gpm @ 4' ft of head Manufacturer '•,.a~ti , Model # Sw Z Dose volume » 2- gallons Lift/sii~hon tank SEW6 1 i TEM Septic tank OWL Measurement pump on & off in ',V t P Height alarm from tank bottom 16•9 3~ g DIVISION OF SAFETY AND BUILDINGS Reserve capacity `ons gl~ --'LL- CORRESPONDENCE calcs page 2, of N 596-4®631 4si.F~.JC,-uc. / PRIVATE SEWAGE SYSTEM Conditionally EN& Oak R uO% %v' E ~°r" , DIVISION OF SAFETY AND BUILDINGS \ .l SEE CORRESPONDENCE ' , J S ~s.+~i C. vo >i Z l e. t ova 1fZ~~,l wa.:4a~ ~ ~1w~1 3 /1~l\ reek °'~'areq "it ~r' ~aa~ow Z" i t (15 ~ it . o».Q p av ~o.,..rv. 45~~, I1O.~ / o 3 ~1 I I O.O ~ 1 Aar. \ ~o t o~ a ~ 1 ~~I.1` c_1I N tt \ ~ irb[O i1 z. ROLL". *041. , t7 ~ = 4 S7 3 S96-40631 i PRIVATE SEWAGE SYSTEM : Conditionally P DIVISION OF SAFETY AHD BUILDINGS SEE CORRESPONDENCE 14L v ; ~-a 1~•1 • (Z ' ~ t ate. Jl ~((`.~,.ll .,..n- ~a+~.t o~..~ a,.,~ }o ~ : ~ Jl O: PVc of b.' l 46 ,V o`~Is ; \ w.~ 4rv~ MX ~~r w.: +~i~S 2 , i ~r o.+~ o~.~ o i 1r o~ 1c `mil 31 1'\.) c s ;IV r - - I _ s ' S. T-- e..N ( ( S 1 ` • 1/4 Y►ol Oy ' aT/~Wr~.. CA.r►~1'aM ~~.1 6~t°+ 1TE~ 00SY o ~C dC.`►i eal.+~. 2. 1. ' 04 onditiona A P OV E D ` DIVISION OF SAFETY AND BWLDINGS S SEE CORRESPONDENCE va.~ wE~T11ERPaQUI~ LOCKOUG COVER .TUNcTICH 6W1cK aK.orytcT-~ ~~~-c 4~ C.T. Iw~/tiflo11~t11N1i N . 6 .I. PIPG X 177 0 M016TURMID So1L, 24" Z. D. I 4"C.t. c~~ M41i1'tOLE M1N. YENT y ~~iir ~ ~IVr Lj APP40WLQ A ~o k No:G KET JbImrS L. P01% _ BAFFLES ~ t.z. Plc *wECT1oKi `---P`iVATE SEWAGE SYSTEM ~..AE 3~ Ow*o I -r- ON - w~o~szu~o. Conditionally ,cr 1204 --f-Ah~IPP ow-c- P%W awSwN OF &Miff AND MMMGS e~ SOLO SIC SEPTIC S Ir 0059 P~ TNIKS MAIJUFACTURER. TAWK 512C: 1*-we VO•~ WUMaER OF DOSES: PEK D" CALLOUS DOSE VOLUME ALARM MANUF'ACT(LIRLR: 1 1 J Z IAICLU011JC OACKFLOW: I"100EL UUMOER: +®1 H`•v GALLONS CAPACITIES: A= ZI' 1 WCHE5 OR 3 S$.•} >iWITCM Ty/[: GALLOtuS PUMP MAIJUFALTURCR: ~''w~r• nn B= INCHES OR I t CALLOUS L~+o MODEL IJUMpCR: INCHES OR I~ Z GALLONS 1 SWITC INCHESOR k`~ Z H TYPE; h GALLOAJS MIAIIMUM► DISCHARGE RAT NOTE: PUMP AWD ALARM ARE TO DL ~F,/M INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFLREWA oETW[EN PUMP OFF AIJO OISTRIpUTION PIPE. Ct,s_ + MIAI~ALIM WETWORK SUPPLY PRCtiURE FEET + FEET OF roRCc MAIN X 1, I • • 'S - FEET op nFRICT10e1 FACT01t. FEET Zr ` TOTAL ObIU/IMIC HEAD -L•rS U~+ FEET UTERAIAL DIMEAIiIOWt OF TAWK: LEW&TM 39 •;WIDTH ;LIQUID DEPTH 1 wl..~ _6 0IL I r memo Performance Data Pump Characteristics 32 LEFT ~T= Pump/motor Unit Submersible Manual Models SW25M1 SW33M1 LL 2a Automatic Models SW25A1 SW33A1 °a 1/3 HP Horsepower 1 /4 1 /3 v Full Load Amps 8.0 10.0 z 1s 1/a HP Motor Type Shaded Pole 14 pole) ° a R.P.M. 1550 o a Phase 0 1 ~ Voltage 115 Hertz 60 0 0 10 20 30 40 50 60 Operation Intermittent CAPACITY-U.S. G.P.M. Temperature 120" F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A /4 HP 44 41 36 33 29 26 23 18 12 6 0 Insulation Class A GPM 11' /3 HP 47 45 43 40 37 34 30 26 22 16 10 Discharge Size. 1-1/2p NPT Solids Handling 1/2" Dimensional Data Unit Weight 30 lbs. ' std. I. All dimensions in inches POW@f Cord 18/3, SJTW, 10 3-1/2 5-Ile 1. Componemdimensions may (20' optional) 4-1/1 vary * 1/8 inch 3. Not for construction purpose 3-1/2 1-t 2 NPT In"" cenified Materials of Construction DISCHARGE mensi.nlandweights are . approxunate Handle Steel L S On/Off level adjustable mu LYbfl(Otln 011 3-1/ 6. reserve the right to 9 Dielectric Oil Were sermons to our products and then Motor Housing Cast Iron specifications without notice Pump Casing Cast Iron / Shaft Steel J/ Mechanical Seal Faces: Carbon/Ceramic Shaft Seal Seal Body: Anodized Steel I . Spring: ctininless sled ~W r B@B@ Sum-N PUMP ll t, t1 -impeller ON Then, elastic 10-1/8 9- 1,;2 ~ Upper Bearing Bronze Sleeve Bearing )ISCHA. Lower Bearing Single Row Ball Bearin HElch Strainer/Base Plastic -s- 3-1n PUMP Fasteners Stainless Steel OFF AURORA/HYDROMATIC Pumps, Inc. } 1840 Baney Road, Ashland, Ohio 44805; i " (419) 289-3042 in accord with ILHR 83-•05r, W.., . , . . s. Adm. Code Attach complete site plan on paper COUNTY not fimited to vertical and honzoe! eteei~ce po nt 8h M). direction 'andi/• of slope. must scale or PAACELnclude, txrl I.D. s dimensioned, north arrow, and location and distance to nearest road. .D. APPLICANT INFO RMATION-P ASE PRINT ALL INFORMATION REVIEWEOBY PROPERTY t7~YNER DATE e S PROPERTY LOCATION PROPERTY OWNER'S MAILING AD GM. LOT /(J~ 114 Alk1/4,S T ~ LP N.R J I W S Frn w PRESS i LOT I BLOC K# S(JBD. NAME oR CSM I CITY STATE a W i Wi SIP CODE PHONE NUMBER ❑CITY ❑VILIAGE )TOWN yt10 2 (7/3) 6gyi- ZZy yQ G~ NEAREST ROAD N New Construction Use O ,()Q Residential / Number of bedrooms 4&1l o Y~ j j Replacement ( J Public or commercial describe Code derived daily flow 9Pd - Absorption area required bed, fl2 Recommended design baring rate-. 9P trench, gpdfit? Recommended Infiltration surface elevation(s) trench, Maximum design loading rate bed, gpolfR trench, gpde Additional design /site considerations It (as referred to site plan benchmark) Parent material s fJ ~e46,,, ~ Flood plain elevation, it applicable S = Suitable for system oorrvExrloruL MOUND U = Unsuitable fors Iem El S U $ 11 U KGPOUN~:}yPRESSURE AT• W() r~ SYS 11' ❑ S Jd! U El $ U ❑ Sa (J L ❑ S~ TANK ~ SOIL DESCRIPTION REPORT Boring # Horizo Depth Dominant Color Mottles Munsell Te;ture Structure ln c M w.. . 3 Qu. Sz. Cont Color Gr. Sz. Sh. Consistence JG P D/f t Stv ( ~''I '7.$ y fi' Roots Bed T z- t n M e. Z_ 17 -Z0 7,sY~e ~y one ` , ~v s elev Ground 3 .Zb`.35 7'~y' y ~o ~o, /~✓~i^ CcJ C AoS•Dt- 35-y 5 `l ~ t' 5 s~ rnc/ c w c Depth to 8 SG l ~ 2 3 limiting ' lac~s,~ , I Remark's: Boring # s,'1 2in s~ 3 sy won c i' 2rns~7~ Ground 2-14-3 75 1R `f/I elev. -Ab-12 C, Sf! ivy, ~v • Sc r~s ~ 1.3 Depth to V, "I Gelling - facto( j co ST C Remarks: I CST Name:-please Print l /l OFFICE - Address: Q / e f f CXS DYE- Phone: - 2,7 Signalure: rti GJ.' Sy~Q ~ Dale: CST Numbor: 1-7--95 3y13 - ROOlS~ •C~1'U/It` Depth Dominant Color Mottles Texture Structure Consistence Y bed.Yru~ Boring # Horizo in. Munsell C!u. Sz. Cont. Color Gr. Sz. Sh. A,? Y79 :5 3 Z s~ C-C-0 cry •5 Z JZ°Z 7-5'Y ' /(ton e-, c, ~l r 15YR#/ one, ~ cs rn✓~',~ c~ c • ~ -5 ~7Ground elev. 147 s Depth to limiting factor 39 Remarks: Boring # Ground elev. - ft. Depth to limiting factor Remark: Boring # Ground elev. it. Depth to limiting factor I I Remarks: Boring # C.A min i _ Ground elev. tt. Depth to l - limiting 1_ _ - - lactor Remarks: ' CERTIFIED SURVEY NAP JAMES AND SHARON NIDIKER,, Part of the Northeast 114 of the Northeast 114 of Section 4, Township 28 North 16 West, Town of Eau Galle, St. Croix County, Wisconsin. Range N114 COR. SEC. 4, r 28 N, R16 W, /?"/ROM PIPE FOUND) NE COR. SEC. 4, r28N,R/8W, /COON rY SURVEYOR'S MOM,/ UNPLA rrE*D LANDS 60 H A_ Ic -s ;8-. -0 -I - 560.0 6-- DO "E 2674. 83, _ A' LINE NE 114 ON 360, 00' 0_00' 560, 00' „ „h, l~l11 N BB• 6'00"W W /069.97509,97'^ _ \ h „4`; ~fr^ O 41 Z -SOT 2 z L 0 T Q ~O O 4.883 ACRES QI ° 9. 76S ACRES M „h, 212, 683 SO, Fr, b J J o III of o = Q 4?5, 366 S0. FT. °O 4. 060 ACRES EXC. ROAD R.6 W, •M O I Q Oln 9,341 ACRES EX C. ROAD R, O. W. O 176, 853 S0, Fr, M p"~'~ J 0 406, 885 S0. Fr ` I M h Q O b S 88' 06'00"E 560,00'" I• A W W ~II y J ° 00 9, 50 97' O O RQT ~ o I c 50' L zI0 0 l 3 m 'qI I~ Q ~ J J 4.883 ACRES o I I 4 4 112, 683 s0. 'Cr. 4.466 ACRES EXC; ROAD. O I p 50, J , h R:O., W. M /s4, ss/ sa. Fr. ~ ! o 0 N 88 • P6. Od "W /7, 0/I co 560, 00' I 3~ NI N 00.00,100„E 033 N88.06 00" 516.98' 51.61' , 133.0.- ~i. W 1/20,00' hI Q LATTED LANDS vl4J Ownerts Address: - 1560 Franklin St. 3 Q1I N Baldwin, WI 54002 °j o m 0 a O! O ? 2 E1/4 COR. SEC. 4, r28N, R/6 W, O N CO /2 "/RON PIPE FOUNDI h Z N h I. O W Z y, li O ..SCALE 1 " r 200' 0 Indicates 1" x 2411, iron b o 50' /00'150'100' 300' 400' 500' Soo' pipe weighing 1.13 lbs./ ~ o Z J0 Z 133NS •uTSUCOSTM 144unoo xTojo ';S sdeW AanUnS paT314ua0 ---abed TOn UOAOAjnS puel poia;sT as AgdunW •M aouaune-i ♦`~~~fIffffrifip ♦ ♦ S661 `TE 4ouaW :pe;e0 ~ j ,~~.•~S pN b 1 ~ . a o M w • Hd W ` cr w ,r .37N3Lind~ . AgdjnW •M aouainel Aq pagjeJp ;uawnj;SUT styl •.,~jtiiSN o 0S\c % -4oaJa44 UoTgequesaudau 40auu0o pue anu4 a aue uoTgdTuOsap pue dew sTy; 4egq pue AqunoO xTojO •4S 3o seausuTpuO aye. pue sagn4e;S UTsuoosTM a4 jo VE•SC2 ua;de40 °spuooei TeTOT4JO 4-}TM aouepuoooe uT uoa.:ay uMO4s spueT aye. papTntp pue paAanuns aney I 'ueNTpTM uoje4S Pue sawef °suauMO ay4 do UOT;OauTp Aq ;e4; A4T;uao AgaJa4 OP ' UOABAjnS puel PGJ3 STBaa ' AgdunW • M eouauneq ' I (aoiaTo 4o A;uno0 (uTsuoosTM 4o aqe;S a~T/~pe Jo4 pieos uMol 94eTudoUdde a4; pue aor.440 6uTuoZ A;uno0 xTOJO •;S a4; ;oe;uop 'Taoued Aue SuTdoTanep Jo 6uisego4nd auo4ea •(•o;e 'Taoued off. sseaoe 'azTs ;oT wnwTUTw 'spueT;aM 'a•T) suOT;BTn6au pue saTnu 'smeT dT4suMol pue A4uno0 'aqe;S oq 4oergns sT dew sT44 uo umoys Taoued eq1 :a4ON Z 30 1 133HS 'UTSUOOSTM 'Aq unOO xToJO '4S sdeW AanunS PaT4T4uaO uoAaning puel pauaq-sT6aH AgdjnW M aoua~n`"1 aSed 'Ton -1 r H uu Y l :t to .'~•••0. A4dunW M aouaune- n a a ,Slid kte • cl~~ a o f L S w Aq pa deJP 4u9wnu4sui sT41 ¢ k 1~I~OHd~I W M ' T UoueW :Paa, / \\I v 531176 CERTIFIED SURVEY MAP JAMES AND SHARON WIDIKER Part of the Northeast 114 of the Northeast 114 of Section 4, Township 28 North, Range 16 West, Town of Eau Galls, St. Croix County, Wisconsin. N114 COR. SEC. 4, T28N, R/6 W, NE COR. SEC. 4, T28N,R/6W, 12" IRON PIPE FOUND) /COUNTY SURVEYOR'S MONd UNPLA TIED LANDS - -9-W-f H AVM, • ` `sse•06- - - - _.I 00 "E 2674. 83' N LINE NE I/4 /120.00' 560,00' 560, 00' O 0 p p 33.02' 509.97 O - N 88' 6'00 "W 1069.97' h . Y. LOT 2 I 0 0o p I ~ t2y ~ y z i LOT) z) o p 4.883 ACRES O Q n M ro 212, 683 $0. FT. tk. III_ M W O 9.765 ACRES M 4.060 ACRES EXC. ROAD R. W. ^ N Q JIC 425, 366 So. Fr. J O I m I y ^ 9.34 / ACRES EXC. ROAD R. 0. W. 176, 853 S0. Fr. b ~ ~ o ~LI R LU I q 406,885 SO. FT. r~ b I ^ t (V S 88. 06'00 "E 560.00'kr I k, "0 4 b W = kr J Q 0 N 0 509.97' Y I o 2CZ3 ~I I ~ O O (1 aoo LOTS m; 0 50'~II J t. • n I a r. O < W e ~ 2I -~O 4.883 ACRES a kr O ( Z 2 Q 2 O 212, 683 SO. FT. y I 2• I O 50' J n 6dV ^ 0 4.466 ACR£SEXC.ROAD O I M o I, 00 C/ 2 4 'gyp rn /94, 56/ SO. FT. I M _I' m N 88.06' Od 560. 00' ( 3' 360.'00', NOO.OO~00"E 33 N 526.98' 5/.6/' )33,02' ~I tU N88.06'00"W 1120.00' Q UNPLAffED LANDS Owner's Address: - a 3 1560 Franklin St. °j °o a I J Baldwin, WI 54002 m o m ~j~ jI o ~ °oN I 2 E 114 COR. SEC. 4, r 28 N, R /6 W, 2 (2 " IRON PIPE FOUND) J q, = N • ti h o SCALE /200' 0 Indicates. I" x 2411-'iron i k, 0 50' 100'15a 200' 300' 400' 500' 1600' pipe weighing 1.13 lbs. / C 0 /VS c "Revised this 12Th day of July, 1995. r STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER. SQ M~ S P m i 1 q MAHING ADDRESS _ ~2.~ Q Cur i c S~ PROPERTY ADDRESS 7 too 4-1, All P AA~goalVr l! /,c)~ 210 (location of septic system) Please obtain from the Planning Dept. W6DjtA*1L(L CITY/STATE rr Z PROPERTY LOCATION 1/4, 1/4 Section ' 4 T-2La_N-R_ j i W TOWN OF E Q r w C7~~ P ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEEDSURVEY MAP~~ J_,15, VOLUME LD, PAGE226~, LOT NUMBER_j__ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: i DATE: 0-7 6 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 This application form is to be completed in full and si ned b owner(s) of the property being developed. g y the Any icies only result in delays of the permit issu ancenadequ ould will development be intended for resale by owner/contractor this , spec house), then a second form should be retained and completed (when the property is sold and submitted to this office with the a ppropriate deed recording. Owner of property 1. 4u Location of propertyD E_1/4 Mt 1/4, Section Township.~~ N-R-~--w n 1. Mailing address /A 70 (sj,,,~, S, Address of site Subdivision name f ~ ~u Other homes on Lot no. property? . Yes_No Previous owner of property Total size of property CtGV.17 S- Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Is this Yes No property being developed for (spec hou e)? Yes Volume -1 _0 and Page Number ~G~(~ NO as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified Survey Map shall also be required. - PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge that I we am owner(s) of the (are) described in this information form, by of a warranty deed recorded in the office of the County vRegist r of Deeds as Document No. own the and that I (we) presently proposed site for t e sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in .the office of the County Register of Deeds as Document No. Signature f Applicant Co-Applicant Date of Signature Date of Signature iI AIL HAR OF vFi~,( ON, IN FOR '1 ) J WARRANIY 1)1: [G 00cur.IPNr NO James _R ',lidiker and Sharon K. Widiker, -husband and wife, holding as survivorship__ _ APR 10 13135 um and ...tr .at, dames Ptikla, a single 10.15 , -p-ersOn- . u i r'd cTI_RN AE {7RFS u,e fuLu\cing > ,.Ikd teal tote to St. , Croix___ Lo"',-:,_ Thomas A. McCormack '111e990 Hillcrest St. Baldwin, WI 54002 0 0 8--LQ1_Q-.1_Q- \0o _ _-CEL O$NTIFICATION NJMBER Part of the Northeast Quarter of the Northeast Quarter (NEQ of NE`:) of Section Four (4), Towns;iip Twenty-eight (28) North, Range Sixteen (16) West, Town of Eau Galle, St. Croix County, Wisconsin, more particularly described as Lot 1 of Certified Survey Map filed July 13, 1995, in Volume 10 of Records, at Page 2956, as Document No. 531176, office of the Register of Deeds for St. Croix County, Wisconsin. T A%FER Iles . is not homestead property. XXX hs not) Exceptwnto«arranaes: Easements and restrictions of record. Dated this day „iW/~ 96 -------..i D.. t9-- - tSEAL) ~~~/~iC L tSEAL) James R. Widiker / (SEAL) (SEAL) Sharon K. Widiker AUTHENTICATION ACKNOWLEDGMENT Signaturc(s) State of 'Xisconsin, - St. Croix count". authenticated this _ day of Mort me this _ day of ~6A . named James R. Widiker and, arson-*u- - Widiker rl FLE MEMBER STAI E BAR OF WISCONSIN - 2~ i• M not, r ' P~'~1_~.~ authun_ed by §;0t) ob, Seats l g - I:) n e 1e t:~e person w+Ctk. th• aS utl 'LR? instrur r,: I HIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack of c,•'~ Baldwin, WI 54002 +1 4• ~ r Goy"-E' ,Lo f" # 1 i4~c , G Y' JGi M S ~ i OI i ~ Y' ~ r a u3 ILL ~ y ~olA/w; y.~ Gc~i'. SyooZ 6629 CsT 3y/3 7-Z-9`-; Sea.4 te, AlF N hr ~zSN~ldc~ 99 , yon BZ B3 - io9~9