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HomeMy WebLinkAbout004-1052-50-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER gofO try W c. ADDRESS 2 l l (wC J SUBDIVISION / CSM## LOT # SECTION T ~ rN-R $'-W, Town of 6', ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 f/ fL , V 10 i rf D i s , INDICATE NORTH ARROW Provide setback and elevation information on reverse of---Ws form. Provide 2 dimensions to center of septic tank manhole cover-" BENCHMARK: UU ke c~►. ~k'$ C ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House 2 L' Other Pump: Manufacturer Model# Size Float seperation m-,~- Gallons/cycle: I Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: Ll House ~~U r Other ELEVATIONS Building Sewer ST Inlet; ~Gr S ST outlet PC inlet PC bottom Pump Off Header/Manifold O. y Bottom of system 7 1~ 0 Existing Grade ~ • o Final grade DATE OF INSTALLATIO "I PLUMBER ON JOB: G LICENSE NUMBER: t~ !rf too INSPECTOR: 3/93:jt I'Q1QAT''- rtPrA0NrhaAN28.15W' S$RIfXTE 9i of S+ff E M County: -7 mod' Labor and'Human Relations INSPECTION REPORT Safety and Buildings Division Sanitar r it (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan o.. TAIL, rativ CST B Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: III,Gb d~ od ~~m~ as J TZ =C ~ TANK INFORMATION ELEVATION DATA A9400067 Gw TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ! ~/~~,5 > Benchmark , 7 3. 9 ' GCS Dosing A /I L J/ Aeration- Bldg. Sewer 7? Holding St/ VInlet ~ TA BACK INFORMATION St/{Outlet fir- ~51~ TANK TO P/ L WELL BLDG. Vent Intake ROAD Dt Inlet 9 p d3 Septic NA Dt Bottom ~-c% dam' d7 106, gs~ = Dosing NA Hea4ef/ Man. Aeration Dist. Pipe ~ U3 22 aZ Holding Bot. System PUMP tIMMINFORMATION Final Grade Manufacturer EP Demand' sCy r Model Number GPM TDH Lift Friction Syestem ~52 TDH Ft Forcemain Length Dia. a Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width I Length _ No. Of Tjenches PIT- No. Of Pits Inside Dia. Liquid Depth DIMENSIONS s / DIMEhi I Manuf er: SETBACK SYSTEM TO F3P/ BLDG WELL LAKE STREAM LEA INFORMATION TypeO _ , CHAMBER Model Number: OR System: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s x Hole Size x Hole Spacing Vent To Air Intake Length Di Length -ter Dia. Spacing f'~ ! (D n SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Q' ! Depth Over „ Q xx Depth Of xx Seeded/ Sodded xx Mulched Bed / 11_~Center ICS Bed / T.re~clges /__1 '/~a Topsoil C~ U_*e~Jj /No es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Gady.22.28.15W, SW, SW, Hig,bWay 128 , ft Ji _ s Plan revision required? ❑ Yes 0410 Use other side for additional information. / SBD-6710 (R 05/91) Date Inspector's Signature Cert No. =iffl-- SANITARY PERMIT APPLICATION R In accord with ILHR 83.05, Wis. Adm. Code C0 X III STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑o~~~ 8% x 11 inches in size. chec if revisi to pr vious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PR ERTY OWNER PROPERTY LOCATION Bit 91 Y) W-4 in Cd %4 S ~ Y4, S ) Z T2 ? , N, R / 6^2 (or) W LOCK # PROPERTY OWNER'S MAILING UA ESS , LOT # B 7_ zl q 6 is con CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER w,.ISah w, IT"101 1015 - 1(( 1-1 CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) State Owned VILLAGE : /tw ❑ Public Fk 1 or 2 Fam. Dwelling-# of bedrooms AR LAX NUMBER(S)IF III. BUILDING USE: (If building type is public, check all that apply) 00 ~ - ~ CJ s- _ 5 U 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. ❑ New 2. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 L/ L REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION J 37s 37s C1 0 Feet M6. S'Feet CAPACITY VII. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank O GO 4 G QC ~t K S7/ ` Lift Pump Tank/Si hon Chamber 1~-- 17 1 FT D 1 rT VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum is Signature: (N Stamps) PRSW No.: Business Phone Number: e/C d-&f- st^ Plumber's Address (Street, an, State, Zip Code ,14 at §o~ IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved tary Permit Fee (Includes Groundwater Date Issued Issuing Ag it Si Lure (No tamps 000 Surcharge Fee) Approved ❑ Owner Given Initial 90, Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 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 (SDD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & 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. 11. 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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'f2 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, ground- water contamination investigations and establishment of standards. I SBD-6398 (R.11/88) PLOT PLAN Page Z of Scale 1"= BO E o.* NO 1~V SSO~S U OR O~i• ~`~`StpN ,q~,C1G~ I s ~n'or- 4."cuc I S ~i"pv c T?t'E tines To 6E R BAjibNU eo. J NS PAR CA DE. RO`oF Z'`puC _ Foac-~ I~R~w uo uN of A~P~wxlrikT~ hl~ _ ~I ~ 8~-+~2.1~ ~~TSZIC C~C9L~ i lp o. o c",3 eA~+~YtcT ST. °~-V2AL~c ~TL'MI C V1 SP1hE 18""OUr 9S Pt2~oCL }-t ~o~Sl~~~lloN C~2AU1~~0 1T.J Zo'DlA- 2"1~ W t , Iii I i ~ I ~ Q • 8.3 III I I • I I PmcTsm~g • I Do JUoj- c tP1t~T oR a' I D I S 1uRH -rtv LS Nit-eh i 6! -j S,93 c.0~.,1V Vtz R... q 8 . o ' - - -Z S BuRDt1 oF-MC%JCy ~~t ~ '[90• 8.Z NOTES : ei . 9G 3 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be tk-~oo gallon capacity manufactured by )"1.VDwLST~II I~R ST ) IAJC- • '150 &AL-. 'PUM'P •s/aIJK 5. Bench Mark ~p~ ~Lfl 6. Divert surface water around mound to prevent ponding at the uphill side. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 3, 1993 2226 Rose Street La Crosse WI 54603 ART WEGERER PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S93-40653 FEE RECEIVED: 180.00 WANG, BRIAN SW,SW,22,28,15W TOWN OF CADY 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. Note: If there is an easement present for the buried electric cable shown on the plot plan, the installation of the proposed mound must be co-ordinated with the easement holder and a notice must be attached to the easement stating that the mound and an underground force main have been placed within the easement. Inquiries should be directed to me at the number listed below. P1~ ~e~`~fta•~ the plan number shown above. Sincerely, 1 6erd JMS wim Plan Reviewer Section of Private Sewage (608) 785-9348 C7 SHD-64231 k. 01/91) Page of b MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE SW 1/4 OF THE SW 1/4 OF SECTION ZZ,T Z8 N, R IS W, TOWN OF C )llxZ0 ( - V-aLK COUNTY, WISCONSIN. INDEX PAGE 1'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN .PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR la R~NNZ wF4QG 11-111 1-iwY lZ$ W l LSOlJ ~ W 1 5~lOZ.~ ~9 PIMPAIM BY ~`~,oooeoteo~~ WEC-sEF;tER SOIL .TESTING AND, ° ~ s° 33ES I Ism SEl:zw m CE • = ARTHUR L. • WEGERER L 0.915 P P.O. BOX 74 421 N. KAIM ST. j "L wa _ RIVET F&LS.. Vi 54022 j. 715-425-01 OJ 4j ~SIGIZ~ ~hNgt 6--23_9.3 JOB NO. 43- 111 Page 3 Of 6 Approved Synthetic Covering Distribution Pipe Medium Sand _ H ~G Topsoil - - F Eled_ q 4'- O - _J E 3 D , b lO % Slope Tt2JoCtv 1w Of 2 %2 Force Main Plowed Aggregate From Pump Layer Undisturbed D O Ft. Soil E 1 • S Ft. Cross Section Of A Mound System Using F o.B Ft. 1 Trench For The Absorption Area G N•~ Ft. A S Ft. H I- S Ft. B S Ft. I 1 S Ft. Linear Loading Rate= b•o GPD/LN FT _7 Ft. Design Loading Rate= o. 3GPD/SQ FT K 11 Ft. L °l1 Ft. n,~ + I]._.L, .,f Cnvro Main W Z-1 Ft. Force ' B K - Main_ A 4- w Distribution Trench Of 2 - 2 2 Pipe Aggregate t Observation Permanent J Markers Pipe s A Sy or securely) PH MY 5 DEPT. OF rnuSTRY, LABOR & ht %ing 1 Trench For Absorption Area Dltitst OF SAFM Ago ILbU SEE C HE' NDENCE Page LL Of Perforated Pipe befall 0 End View )Perforated J"'~ End Cop.) PVC Pipe 1 . ~o~so oc~e Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop + PVC Force Main i DistnDution Pipe Lost Hole Should Be Next To End Cap r m S~ Distribution Pipe. Layout P 34.1 Ft. FHIVATE: SEWAGE SYSTEM X 64 _ Inches C~; 0, ally y 6`4 Inches } ? Hole Diameter '111 Inch Lateral Ir Inch(es) DE~f. OF 4a3 41STRY, LABOR k: ~.,~tC►~s Manifold - Inches OF SAFETY Aii DIOSIO . Force Main Z Inches # of holes/pipe SEE ' I' lei) 11t,er GO H Invert Elevation of LateralsgL-5 Ft. Place lst hole 3Z`I from tee with succeeding holes at 6Y gintervals . Last hole to be next to the end cap. VENT CAP 4' C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE JULICTION BOX COVER WITH WARNING LABEL ~t 10' FROM ODOR, 12'MIU. WINDOW OR FRESH I AIR INTAKE f GRADE 48 $ 4" MIW. !6' MIIJ. COWDUIT S, -TW&VIDE I IAILE T . ' " AIRTIGHT SEAL I III ~y I III v APPROVED JOILIT A Tank cgas~, rtrction , ~b~ll comply APPROVED JOINTS with approved with ILHR 83.1'5 and t,LHR 83.20 I pipe extending rm, 4 _i 'I ALARM 3 feet onto e K + r=3tt7►;18 I I t LAgIB solid soil. °vz 4LAB,',, 4. I ( ON sr~~ I I Both sides of D of ~r L~~t~.t~ila t3't• tank. I g~_~S « LLEV. FT. C) le dc.E PUMP OFF CO, SE' LL 86.S CONCRETE BLOCK PPRwE ~ K15EK EXIT PERMITTED OWLy IF TANK 'MANUFACTUREit HAS SUCH APPROVAL ILA SPECIFICATIOh1S 13 DOSE 1_MbW0T1Lr 0 PRE-CAST 1JUMDER OF DOSES: 3 PER DAU TA14K MANUFACTURER: TANK 51ZE : DSO GALLONS DOSE VOLUME 1 ~S 6 • S ALARM MANUFACTURER' S .:S-- EL.FC-MZ SYS 7? 5 INCLUDING GACKFLOW: GALLONS MODEL AIUMBER: 11~j I HW CAPACITIES: A= 16 17_ INCHES 09311-8 CALLOUS SWITCH TYPE: M CJ.~R~ B = INCHES OR 39 611 LLOL15 PUMP MANUFACTURER: C.Or1Gs -7 INCHES OR 136'5 0ALL01,15 MODEL WUMDEK. Q1 Ds 15 INCHES OR Za~'S GALLONS SWITCH TYPE: v-1~Zcw~~-Y UOTE: PUMP AIJD ALARM ARE TO OE MIWIMUM DISCHARGE RATE L6'3~ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEIJ PUMP OFF A1JD.OISTRIBUTI6U PIPE.. t1`-Is FEET S93-406) + MINIMUM NETWORK SUPPLY PRESSURT7E~~.... . . . 2.50 LE c ♦ QO FEET OF FORCE MAIN X 0'SZ FYooFLFRICTIOLI FACTOR. 014E FEET + TOTAL Ot JAMIC. HEAD - ti4-02' FEET DIAMETER - st IAITERUAL. DIMEIJSIOIUi OF TAWK: LEAIGTH 6"4"NZ ;WIDTHS'22 ter;LIQUID DEPTH X0112 5•gtt2r 9pT S''4`• 80T. BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = Cg 5 GAL/INCH W per` 6 of 6 . •YL W • LL HEAD/CAPACITY CURVE 4'/F 6'' MODEL 97 4% 10 30 m s a~ 25'- 1112 - -11112NPT 20' 43/16 Q 6 W m S V c 4 J Q O 10' t6,3g 2 5' 0 , Us 10 20 30 40 50 60 70 GALLONS LITERS 0 60 160 240 1011/16 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATEFUNG CAPACITY 35/16 HEAD UNIT 51MIN FEET METERS GAL LTRS 5 1.52 56 212 10 3.05 46 174 I r 15 4.57 35 133 20 6.10 15 57 Lock Valve 23.75' CONSULT FACTORY FOR SPECIAL APPLICATIONS e Electrical alternators, for duplex systems, are available a Mercury float switches are available for controlling and supplied with an alarm. single and three phase systems. e Mechanical alternators, for duplex systems, are avail- a Double piggyback mercury float switches are available able with or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard All Models - Weight 33 lbs. -1h HP 2. Single piggyback wide angle mercury float switch or double piggyback mercury float switch. Refer to FM0477. 97 Series Control SelseUon 3. Mechanical alternator 10.0072 or 10-0075. 11110" Volb-Ph Mode Amps simplex Duplex 4. See FMO712 for correct model of Electrical Alternator, "E-Pak". M97 115 1 Auto 12.0 1 or l &7 - 5. Mercury sensor float switch 10-0225 used as a control activator, specify duplex (3) N97 115 1 Non 12.0 2 or 2 ii. 6 3 or 4 & 5 or (4) float system. D97 230 1 Auto 6.0 1ortd7 - 6. Four (4)hole "J-Pak", junction box, for watertight connection or wired-in simplex or E97 230 1 Non 6.0 2 or 2 R 6 3 or 4 & 5 2 pump operation, 10.0002. 7. Two (2) hole "J-Pak", for watertight connection or splice, 10-0003. 6 zed 93 -40 CAUTION For information on additional Zoeller products refer to catalog on Combination All Installation of controls, protection devices and wiring should be done by a Stater, FM0514; Piggyback Mercury Float Switches, FMO477; Electrical Alternator, qualified licensed electrician. AN electrical and safety codes should be followed FM-0486; Mechanical Alternator. FM0495; Alarm Package, FM0513; and Sump/- Including the most recent National Electric Code (NEC) and the Occupational Sewage Basins, FM0487. Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. L, ZAIZZLff 3280 Old Millers Lane Manufacturers of . O_ P. 0. Box 16347 - Louisville, Kentucky 40216 © (502) 778-2731- FAX (502) 774-3624 ~QU.atirr PUMP9 ~NCE /~3~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor.and Human Relations ' Divisiorof Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 5r. c3_~tX Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ©Ok4 - r j.9 Z -S13 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: GPROPERTY OVT. LOT LOCATION J 1/4 S W 1/4,S ZZ T Zb N,R \ S E (00W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD Lv\~Soly W 1 SL4 OZ-7 (CIS) ~7Z_ 3186 i= O`-( ST1~ \-L~y [ ] New Construction Use 14 Residential / Number of bedrooms ~ [ ] AddW n to existing building Replacement [ ] Public or commercial describe Code derived daily flow 45) gpd Recommended design loading rate bed, gpdAt2 0.3 trench, gpd/9 Absorption area required '315 bed, ft2 3-1 S trench, ft2 Maximum design loading rate v . S bed, gpd/ft2 0 ,~trench, gpdtft2 Recommended infiltration surface elevation(s) `t9-• o ft (as referred to site plan benchmark) Additional design/ site considerations m oukjD w/ S ` >L 1 S ' Tv-env c.S - m 1K)' m u "-t I' oi-- SAx t 1=t LL Parent material S R~ ta`i "P%" -rX Rood plain elevation, if applicable flt- ft S = Suitable for system CONVENTIONAL MOUND T IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = unsuitable for system ❑ s ® U [as ❑ U ❑ s WU ❑ s [ u ❑ s ou ❑ s u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench r w~ o_1, tzs'ttz 313 S1~ Z~sbvz wt 1' c'5 z'1 4 C, .5 a-~0 $-Lb to ~t[Z 316 S l Z~ g ~k ~n`Fj cS ~v o. S o. L Ground 3 t6 -3 3 ~S ~t R 3/ 2 M s bvZ`F1~ cS 1 v o S o. elev. cz ~,s~tast~ _ CIdS-o It 33-q S`1lz 31 al lu`iQ b!1 Sc~ ~i _ Depth to limiting factor ~i Remarks: Boring # Z 2 6-9 jrJ4R 316 S l~ 2 FS~k ►M`f1~ oS 1u'F rJ.S u L 3 ~_3 -,~s~IIZ31X - S1 1c Ibk YA\j ~s Tv o.Lj 0.5 Ground - -S \1 elev. L4 3y 6 5 tiR Sly g I. u~te ~(,ll~ a e l owl _ _ I. -3fL R Depth to d- AJ S E) °1 $ G "-Ve _ to 612 S to Jb dhT'S PA. S limiting factor Remarks: T Name:-Please Print Phone: Arthur L. We erer 715-42 165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: 4 3- 1 S Date: 6 -11 q3 CST Number: M00576 PROPERTY OWNER wR►~1~, SOIL DESCRIPTION REPORT Page?- of .3 PARCEL I.D. # ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench k{ 3 r a- 1v`~~L313 - -S S~"t N'%7 r o.S o.~ Ground 3 W -3c) 7-S K tz 3!y _ S1 Z '~L s~v" 1n ~ - Q. S o• L elev. 9q .o ft. ;j,o G wt A SOtL pRuBe Depth to limiting factor > 30`~ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # h Ground elev. ft. Depth to limiting factor Remarks: Boring # }4~ Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 30 ' hi x we1.L i a N ices vocJ C& J Q ! TQO'e, aCI S ~v PSG SL2Fi~cJ='l 11,l `ntt7 PrfZ~l , k~ ~~IST• T h/lC NOT "-#,N-TM R'PP`2.uk11"tArT~s L,uct~'T1ON V, sP1tc-C-~ 18"c'rBou~ o W~Z11t~T S ~ ~~NIC GP_oUNp !N Lo"Dtq.l~zC't z,! ESL 9 S - PLz Lo 2 r E I i I ~ I 0 • I I Q F3.3 u I ' ~Lg9- I Z.IM Li'(1 ul'i•/ I ~ I ' P~D~s1n~g ! r D~ 1~oT e~P►R~T oR I d' I D t S lv\ZB `1'TF lS Nt RE+fi ~ I 3 tv J I I co,.,NvNt UL.. Ct 8 . n - s BuN-mm of me)ucy 2-' O' Oi4.o, 8,~ 3 43_L15 -93 ( 715 ) 425-0169 M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY sT- cie-~tx Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. a O U - 1 13S Z_ so APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: GROOPEROTY LOCATION 1/4 4 S W 1/4,S ZZ T -2-16 N,R \S E (or V~V 13Z.~(~rJ W~1JG PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # . CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD WtLSoly W 1 SLr~' z7 (11s) 3186 [ ] New Construction Use [J4 Residential / Number of bedrooms 3 [ ] Addit' n to existing building Replacement [ ] Public or commercial describe Code derived daily flow 4S'3 gpd Recommended design loading rate bed, gpcW 0 •'I trench, gpde Absorption area retired '315 bed, ft2 - n S trench, ft2 kwimum design loading rate o • S bed, gpolft2 0 , b trench, gpolft2 Recommended infiltration surface elevation(s) ` LCL. 0 It (as referred to site plan benChmaN AdEltlonal design ISM considerations M oukjb w/ S' )L1 S ' 'T'2q~vc.ft - "tN t n v M I' or- S+~n b R t.f_ Parent material S Pt>u'o4 - usNm --i%-L Flood plain elevation, if applicable N- N, It S = Suitable for system coNvwnoNAL MOUND F IN-GRO MD PRESSURE AT-GRADE swrEm ILL HOLDm TANK U = Unsuitable fof system ❑ S ®U INS ❑ U ❑ S Eau ❑ S EzU ❑ S ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistience BotrtdW Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rench Sly 7-1-s1)z C'5 zU4 o.S o.10 ~v' Z $_Ib to`t[Z 31~ - S 1I Z~S~k tit2'~ cS ~v o.S o,L Ground 3 ~b -3 3 ~i R 3/ - S 2 s'bvc vn'~ti-• CS 1$ o S o elev. c 2 S 't R S)% _ CIS.o ft. 33-V1 S 42 31y tote e/I Sc~ Q V V\ i Depth to limiting fact ~ ~ ~ Remarks: Boring # Z 2 b-9 1~~fQ 31 ` S A I z~ 3VV vn~'~, cS Iv4 u.S t, 3 9-3 -)-S yR 31yr - g 1 Ibh rnv ~ cS 1vf c" :0.5 Ground elev. y 3y 6 SL.R Sly ~a~o~e ~~i~ ac.~ ow, gI. -aft Depth to d~a" -to AJ S S °1 k G V'*Aj t- v O tZ 6 12 S aoftTs Cti elo S limiting fa~ I Remarks: CST Name.-Please Print Arthur L. We erer Pine 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 540.22 Signature: 4 3- 5 Date: 6_ 1 X13 CST Number: 0 5 7 6 PROPERTY OWNER LvPR►VG SOIL DESCRIPTION REPORT Page -Lo! PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. Bed Trends 3wt; o- b Ll~`1~2313 - S~ Z $-t~ 10'123]/. - 1 5~1c Yn~H o.S 0,b Ground 3 N -3o -)-S 11 W 34y S1 Z'-'L 5~1~ ►n 'F 1- Q. S o. b elev. 9q . o ft. Bo G ~ f w h!1 A S O I L N7=)MO VS e Depth to limiting factor i Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ti K Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) • PLOT PLAN Page 3 of 3 SCALE 1"= 30 ' h/ x weLL I ~ ~ 3 ~ ORY'1 0 •Res 1a %J C-e 0 Q MOE- x~S SQTZLP NCM JUG UJ ` tT Pr- ct~ ~~ctsT• l ►vYt NuT "c.tr7m A~PCUlxlwtlrTk wchT►uN 0r I 8vR 1 ~o t' L%m-'R I C - ~?'1 - ~1.• O oN / ~,~,•Cy~cT• ST• c-12AU[ ~~TRI C V! Sp1Yc 18" (~Dou e Est 9 S Pt~oC2 10 (2zx► *3'MUc-TION GRAVt.~ !0.i 20"ptq.lT.l~ 2~' _ p/1----+ t I q~ I I i F1 E I ~ 1 I 1 it ~ pol ~ • I I Il Q a.~ I I L-.g9°- 1 BvRI~U Li'T1l.L~../ I I I I P~D~1vtUg • I r ,,.+'~Do 1~oT coMPR~7 oR a' 1 ~ 1 S lv~2B 'Slt lS ►}tz-eA ~ I f 3I ' c? ' I ~ J I i I vjt.. Cis. O - s l BoV-M" QF-MehJCt( Z-7. EFL 019. p' 8. Z cz*-QL znA~ ~st„g6 3 43_l~S 6-H -93 (71 ) 42q-0169 M00576 CST Signature Date Signed Telephone No. CST # STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County rP/~ OWNER/BUYER o ,1 t✓, S' ~ a t 1 MAILING ADDRESS 2 1 y fr la, ~ /.C PROPERTY ADDRESS S 4 (location of septic system) Please obtain from the Planning Dept. CITY/STATE IS v h S PROPERTY LOCATIONS V 1/4, •S w 1/4, Section T_L? N-R IL_W TOWN OF G d L/ ST. CROIX COUNTY, WI SUBDIVISION , LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME 73 PAGE LOT NUMBER 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 ear expiration date. SIGNED: DATE: I St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC~100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. should this development be intended for resale by owner/contractor,(spee house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property LJI/4 S(, 114, Section'R T_2.? N-R_L5_W .Township G Hailing address -/41"4t 2 ~ l✓, ~ / c oe,~ /.✓.'c S..r/(, L ~ ' Address of 'site s4,0*t +fr Subdivision name Lot no. Other homes on property? yes No Previous owner of property LZI Total size of parcel _ /00 4e. (Date parcel was createdl 4-' Are all cornors and lot lines identifiable? Yes ci' No la thin property being developed for (spec house)? Yes -tio. volume ?3 and Page Number lw_ as recorded, with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A 11A1U . U1TY DEED which includes a DOCUMENT NUIWER, VOLUME AND PAGE NUMBER & THE SEAL OF THE HEGISTLR 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 Hap shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of ny (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the county Register of Deeds as Document No. L/U q? 4 , and that I (we) re own the proposed site for the sewage disposal system or (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 County Register of deeds as Document No. e Sign ture of'ap~l Ca t,' Co-appl cant i Date of Signature Date of-Signature _ 16 __.-Z+f-S~--:`. ~ C~y`_ THIS SPA,, RICSLRVLD IOX RLC ATA • DOCUMENT o STATE BAR OF WISCONSIN FORM 11-1982 1 • LAND CONTRACT AECi1STM OFFICE IRdiv idu•1 •nd Corporst• C~ 1T0 BE USED k'OR ALL TRANSACTIONNON~CUNSUMER~ ~Q,, W~S• OTHFR CRO • ED AND IN ~UV7 145.000 IS F[NANC ACT TRANSACTIONS) Recd. for Record this 6th dv of March A.0. 19 86 I Helen _L ___Lorentson y i Contract by and between tit 1 • q _I M' erson .a..singe p- ( Vendor , p~Connell James e) C , Mang........ « sr o..+~ whether one or more) and..rlaXt--Wan a~la..~i-X------ ._......husb.and._.and..wi.f e..as._ joint...t.enants_-------•------ . - - ("Purchaser", whether one or more).Q on the prompt and full per- Deputy I Vendor sells and agrees to convey to Purchaser, up ro ern to ether with the ' formance of this contract by Purchaser, the following P P y. g rents, profi~y fixt es agd other appurtenant interests (all called the "Property"), - I 5t l.roix County, State of Wisconsin: RLTURN To in ' Parcel No. 1: The Southwest Quarter of the South- ~I I west Quarter (SW 4 of SW 4) of Section Twenty-two I~ (22) Township Twenty-eight (28) North Range Fifte Eli esC: I Parcel No. 2: The South 16k acres, more or less, o t e Nort west Quarter of the SouthwesToQwnshier'IfaentyCeeight .(28) North I (NW3 of SW 4) of Section Twenty-two (22) P IlRange Fifteen (15) West. ~If Purchasers transfers or. conveys said premises and/or upon the death of ;Vendor, the entire balance due shall be accelerated and become due and i'I owing to Vendor or her estate. ross" and NOT on a "per acre bass This transaction is based upon a sale "in g acre bs, j' ;.Vendor makes no watrtheysametshall belinaworkinglordertas of theddate of 1` ,,but represents the resents that they have inspected, or will ;possession. Each of the parties ep remises being received inspect prior to date of possession the respective p each and accepts the same in their "AS IS CONNDITION" as f datetoeenotheiisio by 'The :terms and condition. of the Purchase & Sa e g parties dated December 27, 1984 survive the clos~ g to the extent not inconsistent, herewith. raert 1 This ......1S. homestead p p y (is) (is not) This is not rental property. wherever -directed_______________ to Vendor at - - Purchaser agrees top urcha~e the Property and to pays QQ,0;:00_..._- in the following manner: (a) $ 110, QOQ U-0...- - ,together with interest from date the sum of - Q00.,.00------• the balance of $ -.Z.S-,.- - - , er cent ,~erOOnnum ' at the execution of this Contract; and (b) o P d / 1 hereof i the balance ollows:dIn (monthly tinstallment8 ofgSix Hundred an no . 60 paid in full, l follows: 1985 and on like date of each month ($600.00) Dollars each commencing May. 1, rincipal ;thereafter, said payment including interest on the outstanding 1, 2000 or balance with the entire balance due and owing on or before May which upon transfer of premises by Purchasers or upon the death of Vendor, a ever is earlier. The parties mutually agree that of the $35,000 down p ym specified herein, $30,000 thereof is paid by transfer by Purchasers to Vendor of premises-descrbed.in a Warranty Date bearing even date herewith. lst day of Provided, however, the entire outstanding balance shall be paid in full on or before the.:_. Mag 20,0.0--.------, - . . ( the maturity date). _ .per annum ott the entire amount Following any default in payment, interest shall accrue at the rate of ....12__- in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient. to pay reasonabl Vendor, ent of paned annual taxes, spy paaII nts totthese obi gat ons when dues Such an ounts receiived byhthe Vendor for paym Vendor agrees to apply P y taxes, assessments and insurance will be deposited into an escro+v fund or trustee account, but shall not bear interest unless otherwise required by law• Payments shall be applied first to interest on the unpaid balance at the rate specified and then to 19n8pl.(An rincipal at any time after.-._May-•L amount may be prepaid without premium or fee upon p -there-mwi-l3-e-no-g'repa!ovoR r ef-Ar+neiaal-vcithei~t-pQUtaisFiaw af- 3;ve"I"_ - +ment so long In the event of any prepayment, this contract shall not be treated as in default with respect to pay ments been as the aid princ pale of less than the amounttthatdsaid `indebte dnc>sl would havetheen~h idnth.et monthl1p-aiyl be treated as unpaid p P made as first specified above; pro~-ided that mon=e~i es}be g thereafter excluded herefromnt of credit of any proceeds of insurance or condemnation, the condemned p Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: none Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall he retained by Vendor until the full purchase price is paid. 19_. .5. May-.1'- Porehaser shall be ent tie to take pos>ession of the Pronerty on.- -C,-a ouc o,.~. 3T:~T0 n-+R or: wl I.J42 v Stock No. 13011 N.. M~~t~. CcnV/'Y ®M F~1)i2+1 \n. 1l - 1:~2 ~ - , y yam- - :t~. IPac 17 Vendor's promises to pay when due all taxes and assessments levied on the Property or upon interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall koe the l rovementa on the Property insured against loss or damage occasioned by fire, x- tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum, of *Full- insuranbe -Valueut Vendor shall not require when du in an amount hmore all than the balance owed tinder this Contract. Purchaser shall pay the insurance premiums the reel final notice oY loss to contain the standard clause in favor of the Vendors interest and, unless Vendor otherwise agrees in wii ing, the shall of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give insurance companies and Vendor. Unless Purchaser and d, proovidedethesVendorr deems the restoration or repair to be be applied to restoration or repair of the Property damaged, p economically Sessible. the Property Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep in good tenantable condition and repair to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances a.n~ regulations affecting the Property. aid and all conditions Vendor agrees that in case the purchase price with interest and other moneys shall be fully p clear of all demand, ndeencumbrances, except shall be fully performed at the d times and dimple, of the Prooperty frree ,andVendor t the e Purchaser, s Warranty Deed, any liens or encumbrances created by the act or default of Purchaser, and except. " all--_xl~s.. ~es~x~.~ti.s~zls...and._rights...of..way o£..recnr_d ..10 a Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or in the event of a default in interest which continues for a period of 6.0.. days following the specified due date or (b) ther contract of n(deother lvered personally or mailed by certified mail), then the entire outstanding balance under this performance thereof by Vendor shall become Vimmediately due and payable in , at Vendor's option and endor shall also have the followinglrights and remedies (subject to any limitations ihp ovidedaby law) in waives and provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's addition to thane and recover the Property back through strict foreclosure; with any equity of redemption ment.of the entire outstanding balance, with interest thereon from rights, title and interest in the Property conditioned upon Purchasers full pay the the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously fulfill this performance of tthisdContract to compel fals to redeem); liquidated may sue failure V are ert pfourrchaser shall r p Y P ent of the entire outstanding balance, with interest thereon at the rate in effect on the date of Purchaser immediate and full paym uctioned default and other amounts due hereunder, in which event the Vendor may sue at awpforythesent reaunpaid purchase price rice or and any portion shall be liable for any deficiency; or (iii) thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as acloud on title in a quiet-title action it the y and interest Purchaser is insignificant; and (v) Vendor may, have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during. the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any or if and whether abated or not) to the Ven be bindi only remedies shal when ncluding reoasonable attorneyslfees of Vendord curred to denforce any rem dyshee underg(h and all costs an expenses ?f the extent not prohibited, by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or, during the pendency of any action of foreclosure of this Contract, Purchaser consents ofits to the appointment of a receiver of the Property, including homestead interest, t collect the rents, issues shall and held and the Property during the pendency of such action, and such rents, issues, and profits applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the. prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract soley as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become imme w- due and payable in full, at Vendor's option rov.on without notice. Purchaser Vendor shall make. all payments when due under r any mortgage outstanding secured thereby,pp Property .on the date of this Contract (except for any mortgage granted by Purchaser) or under any makes timely payment of the amounts then due under thi such payments directly to payment r thiss so Contractmade. by Purchaser Purchaser aser may shall make be any considered payments made on the Mortgagee if Vendor fails to do so and all this Contract. or prior Vendor may waive any default without waiving ananaher subsequent benefits odetaelt of Purchasrepresentativeser. All terms of this Contract shall be binding upon inure to the heirs legal suowner of the bject Property andtagrees to j use -t Vendor fora valu lue le rein in the execution the rights in the an suconsideraticcessors jonei herein toereleasen homestead Purchaser (If not deed to ba made in fulfillment hereof.) 19-" of Dated this day - ' --.---(SEAL) S~r (SEAL) Helen L. Lorentson. • ian- ng-..... - •-....(SEAL) - (SEAL) sy C. Wang AC SNOWLEDOMENT AUTHENTICATION Signature(s) STATE OF WISCONSIN Helen.-L._..Loretnson- ~ ga. Brian Want ,•.-Ga CWant..................... County. ) = • 19. Personally came before me this ................day of authenticate this _.3°--day of.... 19 the above named . T..: be t J-'---Richardson---------------•---------------------------------------•----•--•--- +M MBER STATE BAR OF WISCONSIN j j (I4 not, tc me known to be the person who executed the ~uthorized by § 70F.00. , Wis Wis. Slats.) ) foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY V A t _ ROBERT J. RICHARDSON - t o r ney - . nt% wig y----at T_ aw ` ( - co . ation Sperms au en WI : acknowledged. - Notary Public My Commission is permanent ([t not, state a°pir Signatures may p be be autt.enticated or r 5476-7- acknowwle-ledged. Both lg.- . . are not necessary.) or printed date: .Names of Dersnnv silfn in0. in anY cat,arity ah-]d he ty De': h,l- their ±ignat.;res. - ~