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006-1060-40-000
St. Croix County Planning and Zoning Wednesday, :Y(arch 28, 20©7at 12:27:08 PM Detail Sanitary Information Page 1 of 1 Computer #: 006-1060-40-000 Sub/Plat: metes & bounds Section: 27 Parcel#: 27.31.16.4186 Lot: TN/RNG: T31N R16W Municipality: Cylon, Town of CSM: 114 1/4: NE 1/4 SE 1/4 Owner: Mason, Daniel 1948 240th Street Deer Park, W 154007 State Permit: 363994 Issued: 08/10/2000 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: 08/18/2000 POWTS Detail: NA Bedrooms: 4 WI Fund: No POWTS Pretreatment: NA Notes Issuer/Insaector As Built Plumber Other Requirements Additional Notes Money Owed Kevin Grabau >4/1/00 -Not Required Fogerty, Dave Mound. No one entered final inspection date, so 7 $0.00 Kevin Grabau Si'~€ied C7tf: No years 3ater it is now in maintenance tracking? Note attached that owner might want to apply for WI fund, but no apparent follow-up. Note that tank had to be replaced due to holes in original tank. Weeks 1260/800 combo to 6' x 135' mound cell ii~aintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 8/18/2003 8/18/2006 Parcel #: 006-1060-40-000 Alt. Parcel #: 27.31.16.4186 006 -TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -HIRT, JON-PAUL &IEDA M JON-PAUL & IEDA M HIRT 1948 240TH ST DEER PARK WI 54007 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 1948 240TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.380 Plat: N/A-NOT AVAILABLE SEC 27 T31 N R16W 3.38A IN NE SE COM NE Block/Condo Bldg: COR, TH W 27 RDS, S 20 RES, E 27 RDS, TH N 20 RDS TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 27-31 N-16W Notes: Parcel History: Date Doc # VoliPage Type 08/28/2000 628926 1538/72 WD 07/23/1997 863/241 07/23/1997 818/106 07/23/1997 492/411 7M7 CI IMMeRV Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.380 17,500 151,000 168,500 NO Totals for 2007: General Property 3.380 17,500 151,000 168,500 Woodland 0.000 0 0 Totals for 2006: General Property 3.380 17,500 151,000 168,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 512 03/28/2007 12:25 PM PAGE10F1 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 J WisconsinDepartrnentoflndustry, SOIL AND SITE EVALUATION REPORT Page~of .3 nor and Human Relations .eision of Safetv & Buildings~~~ ~~ ... w ................~. ...., ,_.,._,... ~~ `~y ~ COUNTY / Attach complete site plan on paper not less than 8 1/2 x 11 inches i Ian e 6af , / D # PARCEL I not limited to vertical and horizontal reference point (BM), direction /o of sl r ~ . . dimensioned, north arrow, and location and distance to nearest ro • ~ i_; ~!p ~ -- ~D -~ APPLICANT INFORMATION-PLEASE PRINT ALL INFOR IONS[J ]_ Q ~ 2~~~ •' REVIEWED BY DATE PROPERTY OWNER: PR0121~L7MLbCATI0h4 ~ ,, ~ (~fuL~FF;,E,.'ii~[S~' 1/4,S~7T 3 .N,R ~ E (~ P P RTY 0 NER':S MAIL ADDRESS ~1 T T,#_. - BL R CSM # - ~` v ~~ Yss t .~ i 7 CI STATE ZIP CODE PHONE NUMBER ^CI ILLAGE OWN NEARE _ R9AD [ ]New Construction Use [/f Residential / Number of bedrooms ~ [ ]Addition to existing building Replacement ~[ ] Public or commeraal describe Code derived daily flow ~_ gpd Recommended design loading rate bed, gpd/ft2~trench, gpd/ft2 Absorption area required bed, ft2 ~QD trench, ft2 Maximur~ design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) Cbi!Jr`OII,~ - QY/. S ft (as referred to site plan benchmark) Additional design /site considerations /~'~ f~ Parent material S`/f.~ 1i~d S'SLT L0~/H S 8 Flood plain elevation, if applicable ft S =Suitable for system CONVENT( AL M UND IN-GROUN PRESSURE AT-GRADE SYSTEM I FILL HOLDING NK U=Unsuitable fors stem ^ S U S^ U ^ S U ^ S U ^ S U ^ S U SOIL DESCRIPTION REPORT Boring # ~~ ;~:. . . F::r Ground elev. X5.2 ft. Depth to limiting fact Boring # .tip }in~:::::iti::} ``~~ 2 Ground elev. y~ ft. Depth to limiting factor „ ~ZS H i Depth Dominant Color Mottles Texture Structure Consistence Boundar Roots GPD/ft zon or in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. y Bed Trench m -7 /o - 3 sr~ IJrrsd /N s r- 2 3 Z - a o -- ---- ..rtG .Z c s8 F ~ Remarks: # Y Pi1~i~7`-~~ ~"o CE~,CrttT.CY~. -- ~ - 3 3 -- ~ .3 z -/ 7. ~ - y -- ,~rL cs ~ 3 ,~' -3 - s'L s - cS -~ S Remarks: -- D/9~,t7~'iy~" Name: Please Prin ~ ~ . ~ ~..~ .~ m .~. --.~g7 ro,~ Phone: 714-' ~6rG (Signature: ~ ~~ ~' ~~~2/ // / Date: G/tea/~ ~a// 6D I t~ PROPERTY OWNER ~J~o.~ SOIL DESCRIPTION REPORT Page 2 0-_.,. PARCEL I.D. # Flo - /D~vb- y0-A~ Boring # ....: .. ~ 4 ::: > :: ; .:: :ti`: tia~ ~~~~ :: :.:: ~:;. Ground elev. y'37 ft. Depth to limiting f~t~ „ Depth Dominant Color f~lottles Texture Structure Consistence Ba ~ry Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. . Bed Trench - ~ !o ~ 3 ---- L ,2yT,s , S . ~ - 3 - y 6 - ~ L dct"/f/C Iyt ~ . S . ~ 3 -a .s ~ 3 -- sG ~s~3/~ v ~ -- . '~ . s Boring # <<; ; Ground elev. ft. Depth to limiting factor Remarks: Boring # 4'~:: r......~'~tiii.... Ground elev. ft. Depth to limiting factor Remarks: Boring # >~:} :~~; ::; ~< Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ~Yo ~~ s~. ~7 Do ~~~ ~a ,¢c~2ES ~~ ~ '~~- iii ~~st V s'c~,CE ! ~~= 4~0~ Q ,~ ~ -- rod of cE-~,~-s~r s4~a, rl-# i - Tvf' o~ ST I/~'~/r P~. Y "-a~v~. 3s, '~ g9'. ~ a-~ ~-3 ,Y= 8c,~rr,~v~ , • = Fouup ~rT CoRN~ u/ELL. Fogrty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 ~~%~ ~1~i1/ /1>f~J~D/!~ ~j/ DYJ ~,-z ~~s '~ zY' ~i ~~ ~~ F 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 ^ T n of: Mason, Daniel Cylon Township CST BM Elev.: Insp. BM Elev.: BM Description: U a TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic c ~.1 Dosing ~~ ' n Ho ~-.__~ TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~Z~ s NA Dosing _ NA ~ ~ Aer t NA PUMP /SIPHON INFORMATION Manufacturer Demand Model Number 5 GPM TDH Lift Lrictiorb•3y Systema 5 TDH Ft Forcemain Length !7 ` Dia. F3 'r Dist. To Well ~ ~p' SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No.: 363994 State Plan ID No.: Parcel Tax No.: `... 006-1060-40-000 STATION BS HI FS ELEV. Benchmark , ~ Z D~ Alt. BM Bldg. Sewer 5t Ht Inlet a ~ D , ~ ®t/Ht Outlets a'Zo Dt Inlet C (.Z 8 Dt Bottom IcF~ Header an s-~ Dist. Pipe ~'~ 5~ So Bot_ System '~ "Z 8 q` . ~-8 Final Grade St cover A D ' ~M.~ ~ 3.( o3.r~ ao. a ~ BED !TRENCH Width ~ Length ~ No.O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 3 DIMEN SYSTEM TO P/ L BLDG WELL LAKE /STREAM L NG Ma urer: SETBACK CRAM m er: INFORMATION Type O ~IS ~ „~'D 3 .) ~r O NIT u System: DISTRIBUTION SYSTEM ~"~~~..~`~`_I.`,"~i ~ 1''STL,.~.,, . ~ (c•Zo + F3, fo41~ )c{.6~ Header /Manifold ~ n Distribution P ipe(s)r ~ r r r x Hole Size ( ~r x Hole Spacing Vent o Air Intake L Length 3•~r Dia- / l Spacing 3•D Length b~' Dia. ~ ~2 /$ ~ ~~ --' SOIL COVER x Pressure Systems Onty 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.) /Z ~ 0 Infection #1: ~lI `~l d 6Ins~ection #2: / / Location: 1948 240th Street Deer Park, WI 54007 (NE 1/4 SE 1/4 27 T31N R16W) - 273116418B 1.) Alt BM Description = ^rl~ ~l iys~cn~-- i.~-(~ ~ e C Ccri/ Cc~ S(,,d~~~y 1~i ~ 1~ la,,~oc~,r 2.) Bldg sewer length = !s ' Jr/ ~, \ -amount ofcover = ~/'u^uo` Plan revision required?4 ~~ ~ ~~ No U~(~other si a or addition informs, tipln SBei-6710 (R.3/9 ~r ~'''"~~ fnad~ q~ Date Inspector's Signature Cert. No. t~.ti V i On /r~i. /n.ile.~/ ."w..... 'anitar~~ Permit Application Safety & Buildings Division A ' `~ In accord with Comm 83.31. 4~'is. Adm. Code See rr~rrse side firr instructions for completing this application ve. . Washington 201 Vb PO Box 7302 W! 53707-730^ Madison sCO/fsin be used firr secondan purposes . ~ide ma o ~ i ti i , ce f C y ~ on ~ ou pr rrmat n Personal (Submit completed form to county if nn ommer pepartment o ~1'ri~ac~ I"aye.,. 1~.04(I)(m)J state owned.: Attach com Icte tuns Ito the county co v onlvl liir the se stem. on a er not less than 8-1/2 x I 1 inches in size. County State Sanitan~crn a Numhcr ^ Chect, it rrvtsion to previous apptRation State Plan 1. I). Number / ! -- "~ D 1. A lication Information -Please Print all Information Location: Property Owner Namc Property Location ~~. ~/4 I/4, T ,N, o Property Owner's Mailing Address Lot Number Block Number City, State ~ ~ lip Code Phone Number Subdivision Name or CSM Number ., x 7 S ~ yld•-' l0©7,~ yss 79 ~ y d`3 = ~f/ II Type of Buildin (check one) ^ City ^ village 1 or 2 Family Dwelling - No. of Bedrooms:_~ f~Town of ^ Public/Commercial (describe use): / ^ State-owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest oad ~ f~ p) l . D New System 2. ~ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) ~/ ', System Tank Onl • Existin S stem ~- B~ Permit Number %a a Issued ^ A Sanitar Permit was rre~ioush issued IV. Type of POWT System: (Check all that apply) ^ Non-pressurized ln-ground ~ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ero is Treatment Unit r ^ Recirculating ^ Other: ^ At-grade r i 13 ~ ~~ 9~.~-5 V Dis ersaUTrea ment Area Information: ' 1 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Arra 4. Soi Application 5. Percotatibn'I~ate• 6. System Elevation 7. Final Grade Elevation - - Proposed Rate (Gals Iday/sq ti.) (Mialinch) Required . VI Tank Capacity in 'l'ocal ~ of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- gSass New Existing Crete structed Tanks "Tanks ^ ^ O D 1r" -'- 2D L ~~ ^ D D ^ VII Responsibility Statement the undersi ned, assume res onsihilit~~ for installation of the f'OWTS sh vn on the attached tans. I , Plum r' ame mt Plumber's Signature (no stamps): tetPftvtPRS No. Business Phone Number get ~um~n~ & Perk Tes ing / ~ ~ /~~' U ,~S' X60 ~ Plumbers Ad ress trees, .icy, tare, Z.ip Code) Spooner, WI 548.11 VIII County/Department Use Only ' ^ Disapproved Sanitary Permit Fee (Includes Groundwater Uate Issued Iss 'ng Agent Sign re (No stamps) Approved ^ Owner Given Initial Adverse Sur rge Fee) 3O25r ~ g -fit) Determination • IX. Conditions of Approval /Reasons for Disapproval: ~E ,A-~~.r~.P.~.. ac.s~ ~wn~3 4-S Ps..-c.e~Q-~- SBD-6348 (R. 07/00) ° ~~ ~ ~ iscons~n Department of Commerce August O5, 2000 ~'" "~ ~ I ~ ~~ CUST ID No.691727 /~ ~y I ~•~~~ A _ 1` p ~ ARTHUR L. WEGERER '_'~ `\~'~E ,~4~Q Z 421 N MAIN ST ---~ ~ ~ S PO BOX 74 ~1;.• (~\~ ` ~a4~x 1 RIVER FALLS WI 54022 , ~' ~j, ~ ~~ vN~` E #~ 1\~ RE: CONDITIONAL APPROVAL ~•~'~~~;'~- Z t=, r. •. ~. PLAN APPROVAL EXPIRES: 08/05/2002!.' `~Y j i j~ ~ ~ ,!% SITE: Site ID: 196143, Daniel Mason St. Croix County, Town of Cylon NEl/4, SEll4, S27, T31N, R16W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 752805 Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary POWTS INSPECTOR OFFICE K COUNTY SPIA [ZMICHAEL RD f WI 54016 Identification Numbers Transaction ID No. 409806 Site ID No. 196143 Please refer°to both"identification numbers, above, in all corres ondence with theta enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. ARTHUR L. WEGERER Page 2 8/5/00 Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ., erard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:15 AM to 4:00 PM jswim@commerce.state.wi.us DATE RECEIVED 07/19/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 TITLE SIi.EET MOUND SYSTEM FOR A ~ BEDROOM RESIDENCE Page 1 of ~ This plan has been prepared in accordance with the Mound Component Manual SBD-10572-P and the Pressure Distribution Alanual SBD-10573-P LOCATED IN THE ~1~ 1 /4 OF THE SE 1 /4 OF SECTION ~~ , T, ~ 1 N, R Ll, 6J, TOWid OF C~L,,,p~j S'T'• ~°-1~`.~( COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM riAI~IAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAP•iBER CROSS SE CTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR y b ~l l ~. ~ ~~ S O N---_ _ __ IE ~ Z ~O `l~{ ST ~ QI , . , b~~z. ~~.cr<< <..~ ~ 5 ~-Eoc~'7 r ~ r ~ C D o ° o PREPARED BY WEGEf~ER SQ I !_ .TEST = NG G, AND . ~ - DESIGN SERV = CE P.O. Box 74 421 N.Piain St. ~~'~~~~ ~ River Falls, WI 54022 1VS~~ ~05G '"' ' ` Phone 715-425-0165 .~ •~., '~ ~r~ Fax 715-425-6864 ~ ~~ o WEGERl11 t D~fBP ~ 6l.L.SWOfITM, ~itlo ~...... ~ ' ~~ e()fb ~ ~ SIGN . ~tCE C ENT ~t CQM BE ~NgS pEPAR~Ej~A~ l i ~ 1 N '1_1.1_00 JOB N0. V ~ .SYSTEt4.MAN~iGEt~1E2lT Page z- of 7 Management and maintenance of this system is critical to its proper operation and longevity. The system owner must be provided with a complete set of plans including the management section. GENERAL Proper functioning of any type of on-site waste disposal system is dependent on the amount of water entering the system and the quality of the water. The lower the volume of water and the lower the level of contaminants, the more efficient and longer lasting. the system will be. Typical system components include a septic tank 'to settle out and break down solids, an effluent filter at the septic tank outlet .to filter out small particles, a pump tank with an effluent pump and controls and an absorption cell to dispose of the water in a manner which will protect the groundwater and public health. RECOMPIENDATIONS 1. Install water saving devices when and where possible. 2. Repair any water leaks as soon as possible. 3. Do not pour greases, oils, chemicals such as paint or paint thinners into the system. 4. If you have a garbage disposal, use it sparingly.. 5. Do not dispose of any paper products other than tissue into the system. 6. Try to avoid excessive flows of water in short periods of time. Spreading clothes washing throughout the week is recommended. MAINTENANCE 1. The septic tank should be inspected by a licensed pumper every three pears or less and pumped if necessary to remove solids and scum. 2. The effluent filter must be cleaned periodically to remove any accumulated particles. It should be washed back into the septic at 6 aonth intervals or as per the manufacturer's recommendation. 3. Periodic inspections at the observation pipes should be made by the owner to determine if any ponding is taking place in the absorption cell. Also check for any seepage to the ground surface. If consistent ponding or seepage is noted, a licensed plumber should be contacted. 4. This sytem.contains an alarm which must be installed on a separate circuit from the pu~p~. If the alarm activates, minimize water use and contact a licensed plumber immediately. CONTINGENCIES Monitoring of the volume and effluent quality map become necessary if problems develop. Monitoring must be done as per the requirements of COMM 83.54(.2). Pumping and disposal of wastewater by a licensed pumper map be necessary while analysis and repairs are made. 1. Failed mound systems may require removal-and disposal of the existing sand fill and replacing it~with new sand or installing an aerobic pre-treatment unit to reduce or eliminate any clogging mat.that may be present. 2. In-ground soil absorption systems or at-grade systems may require the installation of an aerobic pre-treatment unit or replacement of the system. Additional site and soil evaluations map need to be done and additional plans may need to be ,prepared and approved by the Safety and Buildings Division of the Department of 'Commerce. PLOT PLAN Scale 1 "_ ~~ p' Page -3 of 7 ~ `w L. 3. ~ w-e.,~ ~.a~- x. ~.v ~,L ~S i 1~, ~~c ~spuG S~'ll T'PD~kS CFVv 2~.PR N IN l'(_AC.E (F t~-1.P~Y.+~uG.~I,P~~ `T~i~ Z~ T~Jrc t'}-~ PSwv1D~ pwu~ lvl -`'1.V~-1.avT~`~':1ftT/c~ WST2~~~l.OfJ S :_. was ? ~ ~ 8~~.~-t !~-o wig ' ~~ S~oF4`I pUC _ w K to p~ y s ^o o vG~ ~. ~ M t#-2 \ \ \ ~ 3 ~ t~`sT ,~2oa cvc~. \ 9 s~~'1ic mss. ~'~~Tni G ~. \~ O C ZU ~ ~ v~V.1DO+J~ ~ ~ ~ PL'1Z ~aD~) ~~ ,S oa Yvor \\ \ ~ \~\ ,r 4 ~ 3TuRB ~ , ~~ ,Z ~T~i1S R1ZS.s1! \~ t't. ~ 8 ~~ ~oT~~ o~ ~2.~ L''~-C~t. °t6.4.S' QQ++~~ yVT.~ F ~ ~~ 0 ^J^ll Iv DoT a ~ S.=,pr~ Np -- - ~1.tioo. o' a.1 SDP of c~~2 pwt~Z ~t,q8 •~ ors ZDP OF S~aT1C TY'O~Yc. NOTES: ~ ~ 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be Zt~pQ gallon capacity manufactured by ~~'~C.la~uG T~.~125~ ~ PAY-~,c~ T Tu 8~ 80o Grcc.. Nt~2.y l~~s fi'~k, 4. $ench marks; SEE R:~~e, 5. Divert surface water around system to prevent ponding at the uphill side. .. _ Page ~ Of ~ Approved Synthetic Covering ASTM C33 r Distribution Pipe Medium. Sand H G ~~ Topsoil-~~ ____ _ --=-- F Elev . G, b . 4 S ~ I E ;; p 3 ~„ ,~ b 3 % Slope Distribution Cell of Force Main Plowed 2" to 2'Z" Aggregate From Pump Layer D ~ •~ Ft. E l•88 Ft. CROSS SECTION OF A MOUND SYSTEM ~ F O-~ Ft. G o • S Ft . A (~ Ft. H 1.- o Ft. Linear Loading Rate=~•~yGPD/LN FT B L3 S Ft. Design Loading Rate=~•~9.GPD/SQ FT j _ 1~ Ft. ~ q Ft. K _~ Ft. ~e Position ~ X51 Ft. of I Force Main W 3Z Ft. o-~- ----------------- -- A ~'~v $ ~----------- ---------------- -----t Distribution ~--Cell of Z" to 2 z" Pipe aggregate Observation Pipe (1lachbr securely) ~ ~~`rvation Plpe 8 I _ c - - --~- K .---- --------------------- gox PLAN VIE~rl OF A MOUND SYSTEIT P -~ o- - Distribution Pipe Layout Place the holes at the bottom of the distribution pipes . at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 4f ° fitting to a point within six ~~ inches of the final grade. Terminate the ends of the laterals with a valve,: threaded cap or .threaded plug. Provide aces from final grade for the valve; threaded cap or threaded plus. ~LCC`SS B1X:_ T`t P.1 Ct~ L L,~Z.OS S _S~'1111-v pvc ~ . Fvc Svc Lateral ~ r-Manifold r-Lateral x x z x xlI xfl x x x x 'Lateral Length _ Lateral Length - P ~L~P+-N V\~ - h ft-iJ 1 Fc ~ Page S of ~1 Prcr~s sOX - -o a- -- ---0 • ~=pQC~ Nf'St/a p ~ ~. Ft. Hole Diameter ~ ~~ Inch --~" Lateral ~ 1 1~Z Inches) S _~ Ft. Manifold 3 Inches X Z ~{ Inches ~~ 3 Inches -- ~ Force Main ' ~: . ~ of holes/pipe 3Y Invert Elevation of. Laterals a ~•qs Ft. . ~~ PUMP CHAMBER CROSS SECTIOIJ ARID SPECIFICATIOAIS ~ PAGE ~ OF 7 VEIJT CAP 'i'C.Z VENT PIPC WCATHER PROOF ~ 10' FROM DOOR. JUIJCTIOIJ DOX WINDOW OR FRCSH 12~MiV' I AIR tIUT/-KE I , GRADE I ~- ~~ * I cou~ulT ~-- It3'MIN. APPROVED LOCKING MANHOLE COVER WITH WARNING LABEL `1" MI1,J. ~. Ie~Mlu. PROVIDE I IAILET AIRTIGHT SEAL I I i I ~}~" I i I I APPROVED JOIUTf A Tank construction shall comply I II with COMM 83.15 and CO~iM 83.20 I III I I I ALARM b ~~ it i I oN ' c •I I -- 8a.nn I LLEK FT. PUMP, "-J ~ OFF D ~~ $$,OO~ CDIJCRETE pLOCK APPROYED JOINTS 3" APPl2oVED ~• RISER EXIT PERMITTED CAILy IF TAWK MAi,JUFACTLIRCR HAS SUCH APPROVAL~ggDptµG SPECIFICATIOI~IS DosE - ~~cz`t w~1z-S T~~ MANUiACTURCR: IJUMbER OF DOSES: 6-~ PER OAy TAAIK 51ZC: g0~ GALL01J5 S ' DOSE VOLUME CLUD11J6 OAL I Z : 1t~',~ GALL IS ~S• ~~d S~S~} ALARt~1 .._MAy13FALTURER: KFLO N W ONS MODEL AIUM~ER: ~ ~ ~ ~W CAPACITIES: A= Z I INCHES OR D~-~ GALLONS SWITCH TRPC: ~ ~~CU~Y ~ 6 o Z tNCItES OR `3~'~ GQLL01J5 PUMP MAIJUFACTURl:R: GOU L~~ ~ C= ~ ItJCHES OR tiL._~=~ GALLOIJS MODEL ~IUMSER: ~ a a 6 D s l Z INCHES OR Z_ 3~ - ~ GALLONS 9WITGH TYPE: - ~~~-~Z"Y MOTE: PUMP AUD AL _ ARM AR£ TO bE MIIJIMUM DISCH/aRGE RATE S~~~D GPM INSTALLED O N SEPARATE CIRCL ' ITS VERTICAL DtFFEREIJCE OETWGEtJ PUMP OFF ANO.OISTRIBUTIOtJ PIPE.. ~~~,- FEET ' + l'1IA14MtUM iJETWORK SUPPLY PRESSURE .. ... . '6' Sp FE,1<T • ~ O FEET OF FORCE MAIN X O' g 0 F~o FLFRtCTtou FACTOR. ~ ' S ~ FEET _. TOTAL Oy1JAMIG HEAD- = 1S~' .FEET -- --- As per~wanufacturer ~~~t•S) gal /in. Liquid depth ~_ ~~~+G L'yI,CS _ L7~JJ~~~J~~~E ~~ ? o>= 7 ~7~~~~~ ~~~~ T~ 3886 ~~~ P~Z~R1" 1fY~v~ CI~ZU E-- • • APPLICATIONS Specifically designed for the following uses: • Homes • Sewage systems • Dewatering • iNater transfer SPECIFICATIONS Pump: • Solids handling capabilities: 1'/z' maximum. • Discharge size: 2"NPT. • Capacities: up to 140 GPM. • Total heads: up to 26 feet TDH. • Mechanical seal: silicon carbide rotary/silicon carbide stationary, 300 series stainless steel metal parts, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • Single phase:'/ HP,115 V, 200 V, or 230 V, 60 Hz, 1750 RPM. Built-in overload with automatic reset. • Three phase:'h HP, 200/230 /460 V, 60 Hz, 1750 RPM. • Class B insulation. • Overload protection must be provided in starter unit. • Shaft: threaded 400 series stainless steel. • Bearings: ball bearings - upperand lower. • Power cord: 20 foot standard length (optional lengths available). Single phase:16/3 SJTO with three prong plug. Three phase:14/4 STO with bare leads. On CSA listed models: 20 foot length SJTW or STW are standard. 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, adaptable for A10-20 slide rail systems. METERS FEET Io 30; i zs t, 0 a W U =s 0 J Q 0 () L Di f 0 20 0 5 15 ^ 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 three phase models to guard against component damage on accidental reverse rotation. ^ Motor: Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuous{y without damage. -- toGPM ----. - zs Fr .~ AGENCY LISTINGS SA Canadian Standards Association UL Underwriters laboratories m 1995 Goulds Pumps, Inc. 40 10 15 ~ CAPACITY ^ Bearings: Upper and lower heavy duty ball bearings construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. ^ 0-ring: Assures positive seating against contaminants and oil leakage. ^ Fasteners: All Stainless Steel. ---.-- MODEL 3886 i SIZE 1'/z SOLIDS ~ RPM 1750 ---i IMP. DIA. 5Y2" 100 120 140 GPM zs 3o m3m Effective May, 1995 83886 ~ ~ iscons~n Department of Commerce August O5, 2000 ~',.~ Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary CUST ID No.691727,~~: ~; ~ ', ,,: -mot 42 N MAIN ST GERER ~ <. n t , ~ ~O+ :_._ ; PO BOX 74 CC~~ ~~c~G~ ;-~~,`~` ' RIVER FALLS WI 54022 ,~ ZaN~NGO \~., ~~ :~' \ :?~~r RE: CONDITIONAL APPROVAL ~ _ PLAN APPROVAL EXPIRES: 08/0512002 ATTN.• POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI. 54016 SITE: Site ID: 196143, Daniel Mason St. Croix County, Town of Cylon NE1/4, SE1/4, S27, T31N, R16W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 752805 Identification Numbers. Transaction ID No. 409806 Site ID No. 196143 Please refer to both identification numbers,; above, in all`corres ondence with the a enc The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. ARTHUR L. WEGERER Page 2 8/5/00 Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ~ erard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:15 AM to 4:00 PM j swim@commerce. state.wi.us DATE RECEIVED 07/19/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 Wisconsin Department of Industry, S O f L AND S 1 T E E V A L U AT t t1 w1 P O R T Page ~. of 3 r Labof and Human Relations ~~-s-""`- ~ Division of Safety ~ Buildings __~ ...:.~ u ~ m nn n~i(~i:'ti. 1 „fit., n~eal~ ~~~ 4VVV~V ••~u~ 11..E ~~ a VV.V .I.'/ ~Y•J..~~~~a,~~~i~ V~UIYI 1 , / ' lete site lan on pa er not less than 8 1/2 x 11 inches in 'z~~ an m}~' lo~¢~ but ~~ Attach com ~ ` , ;,. p p p ~ l ~'~te dF i BM d li i d i l d h l f i di i f ARCEL I.D. # or erence po ), on a ~ o op ; not te to vert ca an zonta re nt ( rect s m f dimensioned, north arrow, and location and distance to nearest road { ' ~~ p ~ ~- ~D -fiLR> _~i' ~ O ~~ 20~~ % APPLICANT INFORMATION-PLEASE PRINT ALL INFORM ~QN 51 ~N~~x ,` IEWED B DATE -o_~a PROPERTY OWNER: ' ~ PRO ~QN ,!~~ ~_ ~ ,~QVT: L ~ k~ ~ ` 1/4,S,~7T 3 .NCR E (4~ P P RTY O NER':S MAIL ADDRESS .(0 ~ ; BLO(i]C;it R CSM # CI STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE OWN NEARE _ R9AD , ~7 - ~ GcL~ Lv .?Sf9 ~j. [ ]New Construction Use f/( Residential / Number of bedrooms y [ ] Addipon to existing building , ] Public or commeraal desaibe Replacement /[ Code derived daily flow ~ gpd Recommended design loading rate bed, gpd/ft2~trench, gpd/ft2 Absorption area required bed, ft2 ~ trench, ft2 Maximur~ design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surtace elevation(s) CbAJr'OII,e - ~y. S _ft (as referred to site plan benc~tmark) Additional design /site considerations /~'~y Parent material s'Il.~Tl~r) S'.t'L T L0~/yl S' g Flood plain elevation, if applicable ---- ft S =Suitable for system U=Unsuitable for s stem CONVENTI ^ S L U M ND S^ U IN-GROUN PRESSURE ^ S U AT-GRADE ^ S U SYSTEM I FILL ^ S U HOLDING K ^ S U SOIL DESCRIPTION REPORT Boring # .~e;,:,.~.f ~~~ € Ground elev. X5.2 ft. Depth to limiting fact Boring # \4•.}y Wes,... . ;~:< 2 ~` Ground elev. 9~ ft. Depth to limiting factor „ Depth Dominant Color Mottles re T t Structure Consistence Bou'tda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont Color ex u Gr. Sz. Sh. ry Bed Trench ~ -7 /o - 3 s~~ ors /tt- s r 2 3 2- - ~ a -- 'r .s~rL ,~ s F , ~ . ,~ s L Fs ~X F ~ - - • s• Remarks: # ~ P/R~~1~-~~ ~o CE~l.C'rt9TL'1~ ~, y _ 3 3 --- 1x ~ .3 _~ S 2 .s . ~{ .z .~' . `{ .~ Remarks: / ~-- /f~ TTiV~ rT/ /tlt'-'JV ~#Z '~'.~7~j O CST Name:-Please Prin v-.r~ ~O~L,~,y,,,t Phone: 7yg`3`s.-G ress: X.. D B 2 'Y©.?~ Signature: Date: CST Number PROPERTY OWNER /~~~ SOIL DESCRIPTION REPORT PARCEL LD. # .~lo - /D~b- y0-A~ Boring # ~~ 3 ~} >4:;{ Ground elev. 1'3,7 ft. Depth to limiting f~t~ ~~ Page 2 of Horizon- Depth Dominant Color Mottles Texture Structure Consistence Baxidery Roots GPD/ft in. Munsell Qu. Sz. Corrt. Color Gr. Sz. Sh. Bed Trench 9- .~'-3 - sL K !/F/Q - -- . ~' Boring # }{?}, Ground elev. ft. Depth to limiting factor Boring # ;,;.,,~ .< ~~ ~.~ Ground elev. ft. Depth to limiting factor Remarks: Boring # ~:. \v. ~~~vx••:.ty? Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) ~" Remarks: /// ~Yo `' s~• .,% ~~ ~ ~1~~ Q #i ~~' ~I ~. ~ ~ ~~ .?3 ~cR~s sco¢CC ! ~~_ Flo ~ ~ ~ rod of cE-~,E-s~r s4¢a, ~mpp ' --dy+a. ~L-~ i ' To~ o~ ST Uc ~/r, P~. Y"-~. fo8srty P{umbinE #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 ~~%~ f~1~il/ nib~IO/~ ///~ /7S Q i •.c s' ~,~o ~s~ 3 ~~ ~~ x~/~~ . = ,~'Ouud GrT CoRN~ wets ~ = ~rrc r.~k C~~ -~~cs~-r~~. p > Dl~Y w~cu. Ci) - ~-~-rrNG. '~' ~~ .tom-'---- zY' f~ -1 AUG-~3-2~~JE~ 1G ~ 3~ L~AREh! .7 . Pi~I.,.IEPS CPA T-l~-~'i,-?i~ 2 6 ~ 89 I .F . F~W~PS CPR ~1s 24~ ~~~~ P. G1 7I~ 24~ ?"r`E+? P.01 ST. iii x1iiG d~!'=CE , C~i'IF~G1~'t01t 8'1'!1 FbR [Pi'ILIZASI~ Of' ~11f ~I~TI1~fG iE~IC '!`l11iu Tlsis is to eert~t~ t,~uat ~ 3~are,/~isas~e~ec+~ Chi ~sptia task pr~saat.7,Y ~~'~n9 ~~+ _ G~Y1 ~ 5~' -i_,_.~~.~~~~ zasl~d4l#O! ].daal~d it? ,~ ~ r _~. SeCt#OA . T~~IiI. I~_11, ~o~e~n ~# .~ - aP~ iasps~tite~, t caerti#x tit S ~t+l-~-e fa1ti18 tie tank and batli~s to ~t i.tt qae~. canditis~rr, aad it amts Gp ba l~lotiao~3aRj ps'oP'as.1Y• zs~ c~ sn~ri~a: ~~ ~Of] _ .~ ~, ~f~ ~ bac]c accwr ~rca *bedrgtia~f s~tesa? . hi Yas ~.,,,_ pa (I ~ ~1a, s1ci,~+ naact i i~~ .~ ~t~ vvl~e v~ IRng#.~e of tiwe: 'T,~' ~alleas ~~ ilea Craa'Cfori; 8~a~a~ ~ta~~ Stasl ~~, OtAat *. ` ~ XIRllnfiCtt#'a (I~ Jalarrp) : v .~' ~•. . . ~, o~ t ]u~v~m}: (xaa Fi~ V ~~~~~~ i~WM~~ ~~Y (~.i~Ga~isa Numbaac7 'y i~~r .....w. !'ora to be w~lalaed ifs pier (s, i~S.Oe, 1-~.src~o~dgr3a setts) ~r Lima vispo~r t~ ~Z~ tistoasin iAisT,~atits ~) ~aa~r (appiyi~ far saaita~r~ ~erai~? ~ertiSi~:atis,~: i~ i~.aagtiaq trim abotrR stattlgetYt ra~ardfc~q exiatftlg ~ taNE aaaditieu~ i certif~ that klt~e tank too Otte bwat ~~ ~ 1lp~ya ~ii.l ~~oL'# tb bb! ra~~i ~ ~I~ 83, 1iis. 1Yd1. ~ala~! !~ ~i,atiosa apa~inq av'ar a~itlst BYa)r~ ~-' ~~~~~~~~~~ ~n~?~ ~~°~ TtlTp~ c ro~~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/~j+er di)~!/ ~l.~et/ Mailing Address Property Address yo 9'" ~' (Verification required from Planning Department for new construction) City/State ur Parcel Identification Number LEGAL DESCRIPTION -~ ~.~ 5~ P~``~ s,;,~ce- a~e.e. G, 142. Property Location,~~ '/., ~~'/4, Sec. Z 7 , T,~_N-Rf~_W, Town of EyION Subdivision ~- Lot # Certified Survey Map # ---- ,Volume ..Page # Warranty Deed # ~"S7l`~f/ ,Volume X63 ,Page # .fit!// Spec house ^ yes ~ no Lot lines identifiable f~7" yes ^ no ~ 1,~9~f'~~~S~/Sr~~-yr SYS~M MAZNTENANL~. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. - iii o~v SIGNATURE OF APPLI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~ ~.~d~ ~~ SIGNATURE OF APPLIC DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed fl s DOCUM1rNT No. ~ BTATE BIAR OF WYSCONtiIN TrORllt 1- iL >s ', 1NA~AANTY DEED 4s~°7s4 a _ _ ~ • ~s~PA~=241 ~8 Dee ,mad. between .William J. Hennessy ' -and,•-Jo..Ann.•~a-rie-•Nennessy, }iusTiand:::and;:wife;::; ..................................................... ..-......, Gtantos, and...I?.~11.]..e.1...H.r_.-Mason.--an_,_. Ka t_hleen.-~-'---Mason,-..•.--•.•_.-_ husband...and-•w; fe,••,as--.survivors•hip-.marital ...............................•---.........---......................---••---...................., Grantee, Witnesseth, Thaf the said Grantor, for a valuable consideration.-.... Tl,la NACa Ilaa[RVaO IOA aaCO1lDiMe W7A REGISTER'S O~iICE ST. CROIX CO., WI Reed for Reen~d a FE B 12 13~.~t~ ~ 10:50 A. M a ~~~ ~ ~-oFpw~ aonveya to Grantee the following described real estate in St CrO1X„•_•__--_ R[rulea ro County. 3tata of Wisconsin: The East 27 rods of the North 20 rods of the Nor±heast 1/4 of the Sotltheast _/4 TezPareelNo: of Section 27, Township 31 North, Range 16 West. This warranty deed is given in satisfaction of that land contract between Grantors and Grantees dated July 29, 1988, and recorded August 1, 1988, in Volume 818 of Records on Page 106 as Document ?do. 439971 in the St. Croix CountyrRegister of Deeds office. ~~ 1 S n0 t__-_• _. homestead property. This --••----•--...... . (is) (is not) Together with all and aingulrr the hereditaments and appurtenances thereunto belonging; Aad..-..---.~.TaIl.k52S5---.-....- - - --•-•- - - ----- - •-•- - - - - - -- .......................•-----•--- warrants that the title is good. indefeasible in fee simple and free and clear of encumbrances except municipal zoning ordinances and easements of record. and will warrant and defend the same. Dated this ..----•--.......7?7t...-......-• .............. day of ....---.FebruarY_....---------------.-.....-----•-- --._., 19....9. ~~Jf `ttl.~ -~.-~._/--(-~-. -- - •-- - ---•-•- -(SEAL) ...........................•---...-•------...------•---••-•----.....(SEAL) „ iVilliam J. Hennessy L •i- %`llx`---•l.~f~.tl,c43----!!~'=='=_~.`,'<:'`-I----(SEAL) --- --•------------- ------------------•-----•------• ---•--..(SEAL) _~ ;~~Jo-Ann Marie Hennessy AIITHSNTICATION signature(s) of__Wil_liam-•J.-_-Hennessy___ and Jo-Ann Marie ~iennessy antheaticsted this I.t7#...day ot_.February 90 .___.G :.• E._••Norman TITLE: DdEMBER 3TAfE BAR OF WISCONSIN ~~~X--------------•-------------------------------------------- ~x~>~~o~x ~ xos~o~c.~c, THIS INSTRUMENT WAS DRAFTED BY Bakke, Norman ~, Schumacher, S.C. ...._ 11~f~b__~e_x_.ita--e-- --ive--•----------------------------- _-;'Vew__Richmon~ ~!~ 54017 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACSNOWLBD(3MSNT STATE OF WISCONSIN sa. •--• ------•-•-----.... ---•-----•------County. Personally came before me this ................day o! .............. 19_._.._.. the above named -- ------------------------------------------------- to me known to be the person ._..__-._._. mho executed tFe foregoing instrument and acknowledge the same. Notary Public -..-.-----•-------------------------•----County, Wis. MY Commission is permanent. (If not, state expiration datE • lg ) •Nameo or persons sign ing in any capacity uhould be typed or printed below their ei/tnatures. WARRANTT DBHD 8TAT6 nAP. OF q+I3CUN31N Wi:pnn=in Leea( Blauk Co. Ina FURM No. 1-198s. iiilw~ankee, Wis.