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002-1059-30-000
Department of Commerce PRIVATE SEWAGE SYSTEM Building Division INSPECTION REPORT 0 (ATTACH TO PERMIT) GENERAL INFORMATION Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel City Village X Township 000 Permit Holders Name: , Town Of rs.ctionnilTrown/Range/Map nN Luckwaldt A ricuiture, Inc., Dan & Ma Luckw Baldwin CST BM Elev: Insp. BM Elev: BM Description: 62 ELEVATION DATATANK INFORMATION CAPACITY STATION BS HI FS ELEV. TYPE MANUFACTURER Septic Z66 Benchmark Z 46 /OZ Alt. Dosing II MM ✓ gW _ q4 d v>w~0 Bldg. Sew r Aeration J!Z/~ p d ~ SUHt Inlet Holding St/Ht Outlet TANK SETBACK INFORMATION vent to Air Intake ROAD Dt Inlet TANK TO PI L WELL BLDG. 116 ! ` Dt Bottom ~S Septic 7 25 120 l q -7 Header/Man. ~C Dosing 7Z :5 Dist. Pipe 3 /0Z Aeration Bot. System If Aj I , 5 Holding Final Grade 1 7 / C PUMPISIPHON INFORMATION GPM '435 /(t 55 Manufacturer Demand St Cover GPM Model Number . 2, Z~ z 16Q, (Et TDH Lift y Friction ~s'~ System Head TDH Force main Length i Dia. I Dist. to Wel ' SOIL ABSORPTION SYSTEM BEDITRENCH PIT DIMENSIONS No. Of Pits Inside Dia` Liquid th Length No. Of=renc Width q. DIMENSIONS -7 / S~ a LEACHING Manufacturer: p/L BLDG WELL LAKE/STREAM CHAMBER OR SETBACK SYSTEM TO UNIT Model Number: INFORMATION Type Of tem: DISTRIBUTION SYSTEM i x Hole Size x Hole Spacing' ven Air Intake HeaderlManifol~ Distribution Pipe(s) ~()1 ` 3A ~ Dia ~ Length V T Dia ' SpacingIt(._k, Length SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only u Depth of xx Seededl odded Depth Over xx M ched Depth Over \ Topsoil Yes No es No Bed/Trench Center A BedlTrench Edges ~ ~ .3d / l Z- Inspection #2: ~a / l l Z. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ~ J ~ P/D t,~ f arcel No: 24.29.16.362 Location: 2606 Cty. Rd kVWoodvie, WI 54028 (SW 1/4 SW 1/4 24 29N R16W) 40 acr/i U~~dL v Z . = i 06L' j 1.) Alt BM Description AwL -lam ~~P 2.) Bldg sewer length Le-- - Z.... ail 4 amount of cover = I' C Jte.1: 14_ f1l tto. r"`'' - 53' 61' ANOf'o- Plan revision Required? FRI Yes kNo J =2-21 I C Use other side for additional information. I Date Insep is Sign re Cert. No. SBD-6710 (R.3197) ~ M~,nIURE SITE PLAN ''Pa T SW,SW,24,29N j 13W Baldwin township ~i r~ os~d M,1 t k n o -S St. Croix coon " o k~ LEGEND 1 BM: 100. ' trip of spade Qan~ -S+,1{ of flagged T-post A2~~.. 2BM: 100.0' top of spade rotl of flagged T-post R„„~ X - pits ~Rt a- grade 4 contour No Comm 83 setback ~ a problems Scale 1" - 40' except'``'' .1 where indicated 1 ank X300" w a~« ~ , System Elev. 101.33' on contour 100.0' Zoo / 2-` (alto a~a K _ `''(s.' part of 236A.C. f 1 ~ f SIa~ ~ , / n f j ~ J / 0' ~'D ltnt~Q bra . ~.•Q.lre,, 1 Ilk JAIL, -ILS- (I Q f project: LUCKWALDT p0~ r page 2 of 11 COMBINATION SEPTIC TANK / PUMP CHAMBER (No scale) A4.11 pproved Gap, -Approved Locking Manhole Cover With Warning Label Attached n Weatherproof Approved Warning Label Junction Box Vent Cap to~c. a,w~ 1 4 12 Minimum Final Grade- \ 4" Minimum Quick z 18" Minimum Disconnect i 1/4" Weep ' ~5. Hot e Saffl e - - Approved Joint A w/4"i"46 k'i e Extending 3' Alarm 64 onto Solid Soil B Approved Joint On b; W/41 SA0e- " - + C Extending 3` q ;Ev. Onto Solid Soil . Off 6' ~ DQ0,1 r1 ck ? o -~-arti~{ Conc. Block 3" of Bedding Under tank-/ 74 10r1 w ' 106.00 d Alarm Are On Sep rate Ci rcul s + 7. Cd'l~~ r, caw Wcst Tank Manufacturer: )el S tp ! oj-C..", i Tank Size-SepticlPump: 1200 /~oc:~ Gallons Al arm Manufacturer : p r P, 0 r C_ Model Number: m . v x. Capacities : ate? inches ov. P C. Gal l ons Switch Type ,me c v~ "t CaA + B 2 inches or. q Gallons Pump Manufacturer: IJ + C , inches or J3 . Gallons Model Number: Co S J / ' o ~i nches or 25s Gallons. Minimum Discharge Rate: a Total nches or F73 a . iq Gal Ions Vertical Difference Between Pump Off and Distribution Pipe I,nFeet nc~ tR Z,Lq Minimum Required Supply Pressure:. '.-3. 0.54 Feet ZoD Feet of Force Main x 9-,.S 6 Friction Factor/100 Feet: + . l .Feet Inch Diameter Force Main Total -Dynamic Head:...- _5 Lo Feet project: LUCK)XIALDT page- 5 of 11 , ti [qGOULDS PUMPS Submersible Effluent Pump i MODEL 3885 WE Series e'•'~.r rJ.r ~ PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion-resistant, Single phase (60 Hz): can be operated continuously Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully following uses: design. Locknut on all models maximum starting torque. submerged. • Homes to guard against component • Built-in overload with ■ Bearings: Upper and • Farms damage on accidental reverse automatic reset. lower heavy duty ball bearing • Trailer courts rotation. • SJTOW or STOW severe duty construction. • Motels ■ Fasteners: 300 series oil and water resistant ■ Power Cable: Severe du • Schools stainless steel. power cords. • Hospitals 'h -1 HP models have rated, oil and water resistant. ■ Capable of running dry Epoxy seal on motor end • Industry without damage to NEMA three prong provides secondary moisture • Effluent systems components. • grounding plugs. barrier in case of outer jacket 11/2 HP and larger units have ■ Designed for continuous bare lead cord ends. damage and to prevent oil SPECIFICATIONS operation when fully wicking. Standard cord is 20'. Three phase (60 Hz): Pump submerged. Optional lengths are available. • Class 10 overload protection • Solids handling capabilities: MOTORS must be provided in s 0-ring: Assures positive ( 3/•" maximum. separately ordered starter sealing against contaminants • Discharge size: 2" NPT. ■ Fully submerged in unit. and oil leakage. • Capacities: up to 140 GPM. high-grade turbine oil for • STOW power cords all have AGENCY LISTINGS • Total heads: up to 128 feet lubrication and efficient heat bare lead cord ends. TDH. transfer. Tested to UL 778 and ■ Designed for Continuous CSA 22.2168 Standards • Temperature: w Class B insulation on k_S By Canadian Standards 104T (40°C) continuous IA-1 V2 HP models. Operation: Pump ratings are Association 140T (60°C) intermittent. ■ Class F insulation on 2 HP within the motor manufacturer's C File #LR38549 • See order numbers on models. recommended w 'rking limits, Goulds Pumps is ISO 9001 Registered. reverse side for specific HP, voltage, phase and RPM's ME 40 FEET SERIES: available. 130 - - - t H - - 120 - - - SIZE: '[."S OUDS 35 - - RPM: 3500 Be FEATURES 110 z H -5 GPM ■ Impeller: Cast iron, semi- 30 100 - - - - - s Fr. open, non-clog with pump- n 90t tt out vanes for mechanical 25 Bo 1 H - - - - - seal protection. Balanced for 70 _ of - - - - smooth operation. Silicon 20 bronze impeller available as o 60 - an option. a 15- s0 - - ' ■ Casing: Cast iron volute ° 40 type for maximum efficiency. 10 301 M _ 2" NPT discharge. 20 w os _ ■ Mechanical Seal: SILICON 5 CARBIDE VS. SILICON 1Q CARBIDE sealing faces. 0 00 10 20 3 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM l Stainless steel metal parts, BUNA-N elastomers. 0 5 0 is 20 25 30 35 WVhr J_ J CAPACITY Goulds Pumps 02004 ITT Water Technology, Inc. ITT Industries Effective December, 2004 www.goulds.com VVV~~~JJJ 83885 A!6 2~ Safety and Buildings Division County W. Washington Ave., P.O. Box 7162 St. Croix VI SI c o nsii f,- Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 55 Cn3 (0 1 k it , e • • • State Plan I.D. Number State Sanitar,y-Pe ~j~pplication Trans Id. 2_135 2 Z (0 In accord with Comm 8RW04k~t~Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(l)(m) Project Address (if different than mailing dregs) 1. Application Information - Please Print All Information tf l- 24 D Co G~ Property Owner's Name Parcel # Lot # Block # Mr. Dan Luckwaldt j M2. - /46-34) Property Owner's Mailing Address Property Location CCC) 2606 Cty. Rd. D City, State Zip Code Phone Number SW section 24 n Woodville, WI 54028 715/698-3240 T 29 N; R 16 W II. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number X Public/Commercial - DescribeUse Milking Parlor/ dairy farm 8 ❑ State Owned - Describe Use l ❑City_❑Village XTownship of Baldwin OJ III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. X New System Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System B. _Permit Renewal Permit Revision _ Change of _Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) Non -Pressurized In-Ground Mound > 24 in. of suitable soil X Mound < 24 in. of suitable soil At-Grade ❑ Single Pass Sand Filter ❑Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑Recirculating Synthetic Media Filter ❑ Leaching hamber ❑ Drip Line DIGravel-less Pipe ❑ Other (explain) l V. Dis rsal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Ra gpdsf) Dispe al Required Dis a Propos sf) System Elevation 6~ 600 0.4 1 sq.ft. 1 Osq ft. `~f~ 101.33' VI. Tank Info Capacity in Total Number Manufacturer Prefab / Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New ksg Tanks `ale 5Z or Holding Tank 1200 1200 1 W eser C Crete X Aerobic Treatment Unit Oiftg Chamber 800 800 combo X VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) 1 #Id4c~ AM~ Plum er's Si MP/MPRS Number Business Phone Number MP224850 715/283/4422 Matthew Hurlburt Plumber's Address (Street City, State, Zip Code) N6705 St. H 25, Durand, Wl 54736 VIII. Court epartment Use Only ----n pproved isapp Sanitary Permit Fee (includes Groundwater Date sued Issuing Signature o S&fips) Surcharge Fee) /0 / t4AmIr Given Reason ial 7 IX. Conditions of Ap1r ro--v-g1_/Reasons for Disapproval t f . ,$6ptic tank, effluent filter and ctt,l`L r ^ P-~ ~"t'~-~' °✓I : S ~e~'w•r ' dispersal cetf must all be services / maintained a&-per management plan provided by plumber. 2. All setback requVements must be maintained n per q*110able code / ordtwt = Attach complete plans (to the County only) for the system on paper not less than 91/2 z 11 inches in size SITE PLAN 'P1 T SW,SW,24,29N 13W Baldwin township '_T~o os~A M*k l k L'n '?~.,Vo r S " St. Croix cTV x3 0 LEGEND 1 BM: i U0. of spade of flagged T-post - A 2~~ 2B%4: 100.0' top of spade roa of flagged T-past ►~+R <~.k Room 3 ,F, X -pits grade contour J o 4 s ck 1~ No Comm 83 setback problems ~2oQ Scale 1"-40' except 4- where indicated ~300~ w aver w a System Elev. 101.33' 4 , is on contour 100.0' zoo' f M~tx~~ ~r~low ~n~,-dc part of 236A.C. / v v > Soo i Ob_ ,1 V d J' / p f, °:v--~~ ,tip 0 J R project: LUCKWALDT p00 page 2 of 11 1~9tiT~TME,~TO Safety and Buildings . /may n s , 3824 N CREEKSIDE LA ® 9K HOLMEN WI 54636 3 S K Contact Through Relay P S www.dsps.wi.gov/sb/ ~Gw www.wisconsin.gov ~O SS[ONA1 S~ Scott Walker, Governor Dave Ross, Secretary August 15, 2012 r CUST ID No. 224580 ATTN.- POWTS Inspector LORETTA LARRABEE ZONING OFFICE L AN L PERC TESTING ST CROIX COUNTY SPIA N2089 CTY RD Y 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2014 SITE: Identification Numbers Dan Luckwaldt Transaction ID No. 2135226 2606 County Road D Site ID No. 782797 Town of Baldwin Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SWIA, SWIA, S24, T29N, R16W FOR: Description: Commercial Mound System / 10% slope Object Type: POWTS Proponent Manual Regulated Object ID No.: 1386768 Maintenance required; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. R O No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, Conde stats. APPR The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION O AF dj~ Reminders iT • 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. SEE CORRE • 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. V • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • This approval covers only domestic/sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic/sanitary wastes. r LORETTA LARRABEE Page 2 8/15/2012 • 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. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 rev, &4-1 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 j erry. swim@wisc ons in. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be ti modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. 9ti?ART~Tg~ Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 3 D $ Contact Through Relay www.dsps.wi.gov/sb/ r S w www.wisconsin.gov A S ~O~'ssJO:~Ati ~ Scott Walker, Governor Dave Ross, Secretary August 15, 2012 CUST ID No. 224580 ATTN.- POWTS Inspector LORETTA LARRABEE ZONING OFFICE L AN L PERC TESTING ST CROIX COUNTY SPIA N2089 CTY RD Y 1101 CARMICHAEL RD. MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2014 SITE: Identification Numbers Dan Luckwaldt Transaction ID No. 2135226 2606 County Road D Site ID No. 782797 Town of Baldwin Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SWIA, SW1/4, S24, T29N, R16W FOR: Description: Commercial Mound System / 10% slope Object Type: POWTSomponent Manual Regulated Object ID No.: 1386768 Maintenance required; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code P O requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ~~12u1i stats. APPR The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION 11 /!1 Reminders • 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. SEE CORRE: • 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 state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • This approval covers only domestic/sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic/sanitary wastes. Private On-Site Wastewater Treatment System (POWTS) Mound and Pressure Distribution Component Design Residential application Index and Title Sheet Project Name: LUCKWALDT 0 2012 Owner: Dan Luckwaldt 2606 Cty. Rd. D Location: SW1/4 SW1/4 S24 T29 N/R16W Legal Description: Baldwin township, St. Croix county Township/County: Contents: Page 1: index and title Page 2: site plan Page 3: general information & lateral diagram Page 4: mound drawings Page 5: dose tank Page 6: pump information V.T.S. Page 7: tank detail ionally Page 8: filter information OVED Page 9: management plan Page 10: contingency plan Page 11: DWF worksheet Y AND BUILDINGS l Attachment: soil test to state plan ONDENCE Designer's name and license no: Loretta Larrabee #1872-007 4t~l~.t.t Address: N2089 Cty Rd. Y Menomonie, WI 54751 4-, Phone: 715/664-8184 i d, ; Fax: 715/664-8164 ' Cell: 715/505-1628 ; 1 f * t e-mail: lanlperctesting@wwt.net ~ ~ I~',/I1, Designer's Signature: 244 Date: July 31St , 2012 \11-1 V1_ I the undersigned submitted these plans under my authority Mound component manual for POWTS Version 2.0 SBD-10691-P (N.01/O1), and Pressure Distribution component manual - Version 2.0 SBD-10706-P (N.01/01) page 1 of 11 S ~~`_MANuRE SITE PLAN 'p1T SW,SW,24,29N 13W Baldwin towns p ~o5~d M*11 k t'n~ ?4r ~ A.o r _ S St. Croix counbi '~Va Lcl,.~nq ~ ~ k~ ~ oss~ LEGEND 1 13aM: 100.(' (gip of Spade A of llagged "T-post- 213% ,1: 100.0' top oi'tipade - roa M ol`1'1agged "F-post k Q„ ~RZ 0.- X -pits a~ grade it contour No Comm 83 setback - - 3 l~il problems Scale 1" - 40' except where indicated m --1 P .Z3C'O ~ W a~ er W 1 ~ - System Elev. 101.33' on contour 100.0' ®++d~aSis % • 1 d t,7 _ 07 part of 236A.C. Slap- 1B L-n,) U 04-4 114; 1fi-gin Vak~- , i-®m cm a~.~n o~ f r y~ ~d r r ~ 4/ ~ r^ o u.,-~ ana..w. , `O -42 U-1 C) ,r project: LUCKWALDT lpo page 2 of 11 0- N 11110 11111111 COMBINATION SEPTIC TANK / PUMP CHAMBER (No Scale) Approved Locking Manhole Cover Approved Gap, With Warning Label Attached Weatherproof Approved Warning Label Junction Box Vent cap 1.~ 5ftu, 12" Minimum Final Grade--\ ' 4" Minimum Quick 18" Minimum _ Di sconnect 7 f2 1 /4" Weep Baffle- Approved Hol e Joint w/gti'ssAgo A' e I A Extending 3 Al arm 64 Onto Solid Soil On B Approved Joint ' WIT 11 q3 , C Extending 3` Off Onto Solid Soil f Ai tack ~-o p i Conc. Block i 30 of adding Under Tank P nod Ala. Ars p 20 , o. , 5 2 t'aw t= - 5 Senarata C rcui[s 'L ub i . 28 Tank Manufacturer: i S y Y for, Clt : 79.58 10 ag ~~E. - Tank Size-Septic/Pump: zoo 900:5 a ons CL5 sew Alarm Manufacturer: rr Model Number. --Y) zy -T I C pacities: A_LS inches or W,32 Gallons Switch Type : M. e rh,C'- ( cam.. t + B 2 inches or =Gallons Pump Manufacturer: + C ~s inches or -/W. D Gall ons Model Number: / 3 7 + D nche*4•ora55-.7e, Gallons. Minim= Di scSarge a fte: GPM Total nches or o o, Gal 1 ons Vertical Difference Between Ptop Off and Distribution Pipe: 8e Feet 2,2 Minimum Required Supply Pressure:.-A.............+. eet !!L 2©D Feet of Force Main x!4,116 0 Friction Factor/100 Feet: +s. I eet 2 Inch Diameter Force Mann Feet Total .Dynamic Head: =/9,o project: LUCKWALDT page" 5 of l l Ate`, ~ ~ T . ~ rQ w~l~ I' w bb' ,g,. rr~~ tee'" 1!!!t TOTAL DYNAMIC HEADIFLOW 1 PUMP PERFORMANCE CURVE PER MINUTE 413x16 77116 ; MODEL 137/139 EFFLUENT ANDDEWATERING 25 MODEL I 1371139 6118 B Feet I Meters Gal. Lfters v 25 5 ! 1.5 93 I 352 10 I 3.0 79 299 413116 6 20 5 64 242 20 6.1 36 136 a _ ig 25 7.6 8 30 4 Shut-off Head: 26 h.(B.Om) 0 0 11/7 - 11 V2 NPT 10 otw92t 2 5 0 ' 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 80 160 240 320 1 12314 FLOW PER M6dUTE r 31516 Stc373 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V, 230V or 460V. • Variable level control switches are available for controlling single and three • Electrical alternators, for duplex systems, are available and supplied with phase systems. an alarm. • Double piggyback variable level float switches are available for variable Mechanical alternators, for duplex systems, are available with or without level long cycle controls. alarm switches. • Over 130°F (54°C) special quotation required. Simplex Panels are available for 3 phase pumps. • Refer to FM1922 and FMO806 for temperatures over 130°F. Control alarm systems are available for 1 phase pumps. 1_3.7_ Series - 47 lbs. 139 Series - 51 lbs. no! seat _ C_omrd SeWon Lisd°9.s ' SELECTION GUIDE Model - Voft-Ph Made Amps Sim lex Duplex CSA UL j M1371139 115 t I Auto ! 10.7 1 4 Y Y 1. Integral that operated mechanical switch, no external control re- N1371139 115 1 Non 1012 or 3 or 4 Y Y gUl(Ed BN137 115 1 Auto 10.7 i 4 Y Y 01371139 230 1 Auk 5.8 1 1 4 Y Y 2. For automatic use single piggyback variable level float switch ordouble E1V7n39 230 -1 Non 51 f 2 or3 4 Y Y piggyback variable level float switch. Refer to FM0477. • H1371139 200-208 1 ^Auto 6,2 3 a Y N •w3. See FM1228 for correct model of simplex 1~1tro1 panel. 11371139 200-208 1 ! Non 1 3 4 Y N 4• ~6e~or 0DR@Ct fn Te of f U' pfiex Rf1fir01 panel or rgfbbs TOrw"N" 4 J1371139 21)0206 3 i Non 2.6 1 3- 4 Y Y a residential alternators tem. F137/139 230 3 Non 2.8-- I 3 'T 4 Y Y 9137 460 3 Non 1.4 1 3 4 N N G139 ~i 460 3 Non 1.4 3 4 N N ' No molded plug ..Single piggyback switch Vdded. Pumps must be operated in upright position. s a►►ur~ All installation of controls, protection devices and wiring should be done Three phase units require a control switch to operate an external magnetic contactor. by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the For information on additional Zoeller products refer to catalog on Piggyback Variable Occupational Safety and Health Act (OSHA). Level Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Alarm Package, FM0732; and Sump/Sewage Basins, FM0487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. TO. P.O. BOX 16347 Louise , KY 40256-0347 Manulacturem or.. SNIP TO. 3649 Cane Run Road AWL (502) 778.24731(800) 928-PUMP 4=zrr Avvw SaCf /9x99 www.zoellercom kLMW !O. FAX (502) 774-3624 0 Copyright 2004 Zoeller Co. All tights reserved. c 1 TOTAL DYNAMIC HEADrFLOIN PUMP PERFORMANCE CURVE EFFLUENT MINUTE EYJATERiNG ; 7116 MODEL. 1371139 25 A10DEl 1371733 b tie 8 Fe t to tars Gal Lifers e 25 5 5 93 352 z 10 ! 3 0 79 f ?9° a 4 Me cv 6 20 15 j 4.6 _i 64 242 l a 20 6.1 36 1 136 fo ' o _ t5 25 7.6 5 30 -4 I Shut-of Head: 26 ic(8.0m) i 1+2-- t112 NM 10 2 l 10 20 30 40 50 60 70 80 90 tia0 ~I Gr:LLQNs 1 LITERS 0 8a 160 240 320 If 12 V11 FLOW PER MINUTE 1 I 3i5,tIf SK373 'I CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 2001208V, 230V or 460V. • Variable level control switches are available for controlling single and three • Electrical alternators, for duplex systems, are available and supplied with phase systems" an alarm. • Double piggyback variable level float switches are available for variable • Mechanical alternators, for duplex systems, are available with or without level long cycle controls. alarm switches. • Over 130°F (54°C) special quotation required, • Simplex Panels are available for 3 phase pumps. • Refer to FM1922 and FMO806 for temperatures over 130°F. • Control alarm systems are available for 1 phase pumps. 137 Series - 47lb3 139 Serves - 51 bs SingkSeal i_ _ comml Selection LIsNn_gs SELECT iO'~ GUIDE Model lrotts-Ph Mode Amps p;ax Duplex GSA UL trE1371139 15 1 I Autp z 10.1 1 I 4 Y Y ! 1. Integral float operated mechanical switch, no external control re- N10139 115 1 Non - _T_ . __-1o30.7 2or3 2or3 Y Y ` { gUired. "8N 137 15 1 1 qua .7 j A Y 01371139 230 1 Auto { 5.8 j 1 4 y v 2. For automatic use single piggyback variable level float switch ordouble El 37113 230 1 _Yon s s 2 os a 4 Y Y piggyback variable level float switch. Refer to FM0477. ' H131113A 200-208 1Auto { 6 2 3 I 4` Y N 3. See FM 1228 for correct model of simplex control anat. ' 11311139 1 M208 1 Nan 6 2 3 -~-4 Y N J1371139 200 238 3 q Non , 2.6 --3 j- C Y Ye~~20r c°rreotmo ET'ot"dtp~`ex cflnTro pane! ari'M 66 0of F1371139 230 3{ Non i.6 I 3 4 Y Y a residential alternator system. --ti GtsT 4S3 - 3 hlor 3 4 N N • G139 _ 460 3- Nat i 1A i 3 1 4 N N 'No molded plug "Single p nelbahk switch included. Pumps must be operated in upright position. a cAVnoN All installation of ccntro!s, protection, iavln~zs and whing should be done . Three phase units require a control switch to operate an external magnetic contactor. Y a r;callfied ii,- er.ssd ei2ctrician. At; elsctriral and safety codes should be folloLvei it luCiin,^the rriosi recent f atlon2l =ieclric Code (NEC) ad the For information on additional Zoeller products refer to catalog on Piggyback Variable Occup;-:Jio Zi Safaty and Health Act (OSHA). Level Float Switches, FMO477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Alarm Package, FM0732; and SumplSewage Basins, FM0487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. PO. Box 16347 - v _ Louis~i,4e, KY 40256-0347 bWW'acturers of.. L ©4 )G~ pa~l SH T17: 3649 K Gam Run Read I oursvi6e, !{Y 40211-1961 'j /t~ (502 778,2731 • f (807) 92& DUMP uRCVw zoeflercom Lf ! FAX (502) 774-3624 0 Copyright 2004 Zoeller Co. All rights reserved. , 53" 96" 41" z r rn w ~ n II ~ 1 3- e 6- 44" / D n r- J r- 0 ;oo ;o O I I I 0 o+ < II < - rn n(70) tin 39" D ~i rn Z M C y 4 D F4 ~ X p D Z O Z Z p U) z DD X O ZA O O DTa ? n~ mac) A_yOmpPrrn>OODON 47 ZO p DO E fool lI00 0*.SOaSS~OrrN r" n m rrnn D MOO m U) i - ro- - 4i N 3 M CDC rt2t pp N {,4 ,D.r ""r U) D --1 A:4 E7 ' O A 0 A 0 Oy n N 1) D t~f rn N `0 N tmn w j rn W L-9 O - -n OD m rn m Z C) 4L (n n O~ NA r~ -nUUD~~D OD OsQ• p 0 % M h z cC Z Z DD mDrn r*tp Op v D 0 rn -~i r*1 0 D r r n >>O r 00 0 I Z a) 0 0 N A A ZZ O W2 In~ N 2 >7 Q r- O m N Cl) (n g cm A 0 0 Ni m = O m N ~n ;d 2c z D n O O_ m r rrn m f7 Z ;D r C A OC O r- D ~ X r ~ z m z m N -i WLP1200 800-MR SCALE:I C = V REV NO. DATE: ° rn WIENER oullIETE DRAWN BY.SWT 4 SEP nC MANUAL W3716 US HWYIO. MAIDEN ROCK, Nt 54750 DATE: JANUARY 2008 J REV. JAN. 2008 800-325-8456 FILE: "1200 800-MR WC-KWArLDT (E~ Filters ;h PL -525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its - „ -~9 new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD Alarm I^;~ (gallons per day) making it one of accessibility Accepts Pe VC the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok P6122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every fitter. When the filter is of 7110° - removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other fitter on the market can make that cfaim! accepts e & 6` SCHD_ 40 Pipe PL--525 Maintenance: The PL-525 Effluent Filter should ' - operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned <11 every time the tank is pumped or at least every three years. If the installed filter contains an optional i alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be ; Gas deflector done by a certified septic tank U ` r3.G pumper or installer. automatic shat-off bail when fitter 1. Locate the outlet of the U.S. Patent Nor- 6,015,4as ~ is removed septic rank. 5,877,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off falter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank, flake sera all solids fall 4 or 6 outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the fitter cartridge bade Extend & Lok or piece of pipe into the housing making sure _ to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. ~.-~~e~t • I AC,KWALD T ale? $ of 11 X01' r-~ Filters PL-625 EFFLUEW FILTER (COMMERCIAL) Polylok, Inc is pleased to add its view commercial filter to its existing line of quality effluent filters. The PL-625 is rated for over 14,000 GPD Alarrn , (gallons per day) making it one of accessibility accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1116' filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. 'Ashen the filter is of I[IV, . rernvved for cleaning, the ball will filtration slots Rated for over oat up and temporarily shut off t0,000 GPD Rost the systami so the effluent won't leave the tank. No other filter on the r;ra&et can make that claim! Accepts V & - SCHD_ 4-6 Pipe PL-5215 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years ~ under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed fitter contains an optional ' E alarm, the owner will be notified , by an alarm when he filter needs r_p-r---- a Gas deflector servicing. Servicing should be dons by a certified septic tank Automatic shut-off pumper or installer. ~ ball when filter i is removed 1 Locate the outlet of the U.S. Patent Nor- 6.015.488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL 525 Installation: Locate the outlet of the 3. Do not Lisa plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-E25 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off files over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4 or 6 outlet pipe. If the tank. Make sure all solids fall filter is not centered Linder the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge bade Extend & Lok or piece of pipe into the housing: making sure to center filter. the fixter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. j Ut Ki>~LL~ T Pre- c 1 l Mound Svstent Maintenance and Operation Specifications Service Provider's Name: Hurlburt Htg.,Plbg Inc. Phone: 715/ 283-4422 POWTS Regulator's Name: St. Croix Zoning Phone: 715/386-4680 System Flow and Load Parameters Design Flow -Peak 600gpd Maximum Influent Particles Size 1/8in Estimated Flow - Average 350gpd Maximum BOD5 220mg/L Septic tank Capacity 1200gals Maximum TSS 150mg/L Soil absorption component Size 600bed Maximum FOG 30mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100mL Service Freauency Septic and Pump Tank --------Inspect and/or service once every 3 years Effluent Filter-------------------Should inspect and clean at least once every 3 years Pump and Controls ------------Test once every 3 years Alarm----------------------------Should test monthly Pressure System ---------------Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other----------------------------Initially filter should be checked yearly to determine service schedule Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap and are secured as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(1), Wis. Adm. Code. 3. All gravity and pressure piping materials confonn to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration 6. Lateral Turn-up to finish at grade or above, enclosed in a 6-8" diameter lawn sprinkler valve box or similar product. (lateral turn-up consists of a long sweep 40 or two 45degree bends same diameter as lateral) 7. Lateral Turn-up on end of distribution laterals after the last orifice. project: LUCKWALDT page 10 of 11 Mound System i<lanagement Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code. And shall maintained in accordance with the component manuals and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8" in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slip off the filer when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personal shall advise the owner of when the next service needs to be done to maintain less than maximum scum and sludge accumulation in the tank. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings maybe made around the mound's perimeter and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations dictate that the mound be heavily mulched as protection from freezing. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral and it is recommended that each lateral be flushed at least once every l 8months. When a pressure test is performed is should be compared to the initial test when the system was installed to determine if orifice clogging has occurred, if clogging has occurred orifice cleaning is required to maintain equal distribution within the cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner and any levels above 6" considered impending failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or components shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank or its components become defective the defective components(s) shall be immediately repaired or replaced with a component of same or equal performance. If the mound fails to accept wastewater or discharges wastewater to the ground surface, it will be repaired or replaced. Increasing basal area if toe leakage or by removing biologically clogged absorption and dispersal media and related piping and replacing components as deemed necessary to bring the system into proper operating condition. See page 10 of this plan for the name and telephone number of your local POWTS regulator and service provider. project: LUCKWALDT page 9 of I l Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated hi accordance with Comm 82-84 Wis. Adm. Code. And shall maintained in accordance with the component manuals and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 8333, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8" in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shalt be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slip off the filer when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personal shall advise the owner of when the next service needs to be done to maintain less than maximum scum and sludge accumulation in the tank. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings maybe made around the mound's perimeter and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations dictate that the mound be heavily mulched as protection from freezing. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral and it is recommended that each lateral be flushed at least once every l 8months. When a pressure test is performed is should be compared to the initial test when the system was installed to determine if orifice clogging has occurred, if clogging has occurred orifice cleaning is required to maintain equal distribution within the cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner and any levels above 5" considered impending failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or components shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank or its components become defective the defective components(s) shall be immediately repaired or replaced with a component of same or equal performance. If the mound fails to accept wastewater or discharges wastewater to the ground surface, it will be repaired or replaced. Increasing basal area if toe leakage or by removing biologically clogged absorption and dispersal media and related piping and replacing components as deemed necessary to bring the system into proper operating condition. See page 10 of this plan for the name and telephone number of your local POWTS regulator and service provider. project: LUCKWALDT page 9 of 11 DWF Worksheet 15 present employees & 10 future employees 25 employees @ 13gals = 325gals 1 bathroom floor drains 1 floor drains @ 25gals = 25gals Estimated flow 350gals 350gals times 1.5 = 525gals DWF Proposing 600gals DWF system project: LUCKWALDT page 11 of 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owned er a (d 4 Mailing Address io$ ou Y.- Property Address 2 (Verification required from Panning & Zoning Department for new construction.) City/State ` Parcel Identification Number / `30 o'-di (e LEGAL DESCRIPTION X Property Location SW '/4 , S&J '/4 , Sec. T -2-9 N R 16 W, Town of J? d 144w r A V Subdivision Plat: Lot # A . Certified Survey Map # "Volume IY `3 Page # N4 Warranty Deed # J l GI JJ (before 2007)Volume I qO ;-Page # y~~ SPe Aw"se-t yest im Lot lines identifiable 0 yesXno SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 I/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 Planning & Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are true to the best of my/our knowledge. [/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms AA J_)A e11V L"kwaUt A Lwkwayt _ _ ' l- 1 d q~ 12 SIGNATURE OF APPLICANT(S) 7y97 DATE - Z3s8 ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) f s Sc~ a 7?lo -7K- ~G VOL 1.4 Qn PACE 4 n, . 16 9,3 2- ~RV9 DOCUMENT NO. LAND CONTRACT ST. CROIX CO., WI RECEIVED FOR RECORD OP-02-1999 9:30 AM CONTRACT, by and between Marvin L. Luckwaldt a/k/a Marvin R. L2-D CONTRACT Luckwaldt a/k/a Marvin Luckwaldt and Angeline M. Luckwaldt a/k/a Angeline Luckwaldt, husband and wife ("Vendor", whether one or more) DENT N and Daniel M. Luckwaldt, a single man ("Purchaser", whether one or CUT COPY FEE: more). Vendor sells and agrees to convey to Purchaser, upon the prompt COPY FEE: and full performance of this contract by Purchaser, the following TRANSFER FEE: 639.00 property, together with the rents, profits, fixtures and other [jDj FEE: 16.00 appurtenant interests (all called the "Property"), in St. Croix County, 4 State of Wisconsin: Real Estate description attached hereto as Exhibit "A" and made a part hereof. The total purchase price shall be allocated as follows: Asset Fair Market Selling Discount/Gift Value Price Farm Machinery $ 105,525" $ 18,290 $ 87,235 Livestock 229,450 18,745 210,705 . . . . . . . . . . . . . . . . . 14 Farmland 129,850 20,790 109,060 Rodl NAME i, AND Beakar, RETURN ADDRESS Boles & Krueger, S.C. y, Farm Bldgs 149,329 149,329 _0_ 219 North Main PO BOX 138 M House 42,846 42,846 _0_ River Falls, WI 54022 Totals $ 657,000 $ 250,000 $ 407,0 00 002-1059-30-000; 002-1055-10-000; , 002-1055-30-000; 002-1056-60-000; Should the Purchaser sell this property anytime within 5 years of the 002-1056-95-000; 002-1059-10-000; date of closing, a portion of one-half of the net profit from the sale X102-1059-20-000 002-1059-40-OQi1; of said property shall be paid to the vendor for each year following the Parcel Identi ication Number (PIN closing as follows: 002-1058-70-000; 002-1058-90-000; Percentage of profit 002-1060-10-000; 002-1060-40-000; 002-1060-80-000; 002-1060-90-000; sale within 1 year after closing (1999) Sot 002-1060-95-000; 002-1063-20-000; Sale within 2 years after closing (2000) 404 002-1072-10-000; 002-1072-50-000 Sale within 3 years after closing (2001) 304 Sale within 4 years after closing (2002) 204 Sale within 5 years after closing (2003) 104 This is homestead property. P-u=_haaer agrees tit pu=hase_. the_ Property. and to pay to Vendor at such place. as_ reasonably_ dirPrtPtf_ the_ mum.. nf_ $657,000.00 in the following manner: (a) $407,000.00 by gift at the execution of this Contract; and (b) the balance of $250,000.00, together with interest from date hereof on the balance outstanding from time to time at the rate of 74 percent per annum until paid in full, as follows: monthly payments of principal and interest of $1,938.25 per month. Provided, however, the entire outstanding balance shall be paid in full on or before the 2nd day of January; 2019 (the maturity date). Following any default in payment, interest shall accrue at the rate of 124 per annum on the entire amount 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 reasonably anticipated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. There shall be no penalty for prepayment. In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. VOL ~.~OOFAcF~jj4. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: no exeptions. Purchaser agrees to pay the coat of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on date of closing. Purchaser promises to pay when due all taxes and assessments levied on the Property or upon vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of full insurable value, but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property 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 and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully_ paid and all conditions shall be fully performed at the times and in the manner above specified, vendor will on demand, execute and deliver to the Purchaser, a warranty need, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: no exceptions. Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 30 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 30 days following written notice thereof b personally or mailed by certified mail); then the entire outstanding balance under this by Vendor (delivered contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity; (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned'upon Purchaser's full-payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if Purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) vendor may declare this Contract at an end and remove this Contract as a have cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may ha Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits durin Notwithstandin9 any oral or written statements or r i, (ii) or (iv! above. 4 the pendency of any action under ( ) actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to pri.na4aL and paid by Purchaser,. as incurred,. and shall be included in any. judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held direct. and applied as the court shall 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 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 solely 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 immediately due and payable in full, at vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. to the benefits of the heirs, legal representatives, All terms of this Contract shall be binding upon and inure t successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) VOL 1400mu405 Dated this 2nd day of January, 1999. (SEAL) i /0/• _ _ SEAL) M n R Luckwa t Ange a M. Luckwaldt (SEAT,) (SEAL) Daniel M. Luckwaldt AUTHENTICATION ACKNOWLEDGMENT Signature(s) Marvin R. Luckwaldt Angeline STATE OF WISCONSIN ) ) ss. M. Luc aldt and ani 1 M. Lu kwaldt COUNTY ) suthen i ated this day of 'L v -6 19! Personally came before me this day of 19 the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. * Le A. Beskar TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 5706.06, Wis. Stats. + THIS INSTRUNSNT WAS DRAFTED BY: Notary Public County, Wis. Rodli, Beskar, Boles & Krueger, S.C. My commission is permanent. If not, expiration date: River Falls, WI 54022 19 ) I -VOL Q PAGE EXHIBIT "A" • - SOUTHWEST QUARTER SW3 OF SECTION TWENTY OUR ( FOUR (24), TOWNSHIP TWENTY NINE NORTH (29) , RANGE SIXTEEN (16 WEST, EXCEPT Lot 1 of Certified Survey Map, in Volume 9, page 2566 WEST HALF OF NORTHWEST QUARTER ( W~ s OF NWT 4) EXCEPT PARCEL IN VOLUME 611, PAGE 533, OF SECTION TWENTY FOUR (24), TOWNSHIP TWENTY NINE (29) NORTH, RANGE SIXTEEN (16) WEST. SOUTHEAST QUARTER OF NORTHWEST QUARTER (SE; OF NW;) AND NORTH HALF OF SOUTHWEST QUARTER (N2 OF SW;) EXCEPT North 16 rods of west 12 rods thereof, ALL IN SECTION TWENTY FIVE (25), TOWNSHIP TWENTY NINE (29) NORTH, RANGE SIXTEEN (16) WEST. EAST HALF OF NORTHEAST QUARTER (Ek OF NE;) OF SECTION TWENTY FIVE (25), TOWNSHIP TWENTY NINE (29) NORTH, RANGE SIXTEEN (16) WEST. NORTHEAST QUARTER OF NORTHEAST QUARTER (NE; OF NE;) AND NORTH HALF OF NORTH HALF OF SOUTHEAST QUARTER OF NORTHEAST QUARTER ( 2 4 4 N2 OF Nk OF SEh OF NEB) OF SECTION TWENTY NINE (29), TOWNSHIP TWENTY NINE NORTH RANGE SIXTEEN (16) WEST EXCEPT art to~ Richard E (29) p ggen in Volume 600, page 617. EAST HALF OF NORTHEAST QUARTER (E'k OF NEk) OF SECTION TWENTY THREE (23), TOWNSHIP TWENTY NINE (29) NORTH, RANGE SIXTEEN (16) WEST. PART OF EAST HALF OF SOUTHEAST QUARTER (E'k OF SE;) OF SECTION TWENTY THREE (23) AND PART OF NORTHWEST QUARTER OF NORTHEAST QUARTER (NW; OF NE;) OF SECTION TWENTY SIX (26). ALL IN TOWNSHIP TWENTY NINE (29) NORTH, RANGE SIXTEEN (16) WEST DESCRIBED AS FOLLOWS: East Half of Southeast Quarter in Section 23, Township 29 North, Range 16 West, excepting therefrom a small lot in the Southeast corner thereof that was heretofore deeded for church purposes. Subject to the easement to St. Croix County Electric Cooperative, in Volume 251, page 279. THAT PART OF THE NORTHWEST QUARTER OF NORTHEAST QUARTER (NW; OF NE;) OF SECTION TWENTY SIX (26)_,_ LYJ.NG_ ON. THE_ EAST SIDE. OF THE- ABANDONED- RIGHT OF WAY AS FORMERLY LOCATED IN SAID SECTION TWENTY SIX (26), TOWNSHIP TWENTY (29) NORTH, RANGE SIXTEEN (16) WEST, EXCEPT highway conveyance to St. Croix County in Volume 229, page 8. EXCEPT land to St. Croix County in Volume 1011, pages 132-134, as document number 499586, AND EXCEPT land in Volume 1011, page 135, as document number 499587, in Volume 1011, page 136, as document number 499588 and in Volume 1011, page 137, as document number 499589. Subject to easement to Wisconsin Power Cooperative, in Volume 251, page 148. St. Croix County Wisconsin. 4 Wisconsin Department bFL merce SOIL EVALUATION REPORT Page / of Z - Division of Safety and Bu dings 3 J~~2 1 in accordance with Comm 85, Ws. Adm. Code ~y~ F ; ~ . County -.ILI ' O t X Attach comp than 81/2 x 11 inches in size. Plan must include, twt tal reference point (BM), dii d~' parcel I.D. percent stop crow, and location and dista%13 ~o Please print all information. ` eview by Dat Personal infornnation You provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) Property Owner Property Location / ~ L20 Leickb* a Govt Lot W 114.SN/ 1/4 S 211 T 29 N R Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# <o ( 'i 201?. --0- rk-C-0 Zp Code Phon e Number 0 City0 Village own Nearest Road r Ut' ~,1 / ~ S4/o 1$ STIn IN D4/O ~ (~GZ /CC (.l/ y 17 Co ur WNew Construction Use:0 Residential /Number of bedrooms N .A • Code derived design flow rate 330$-L - S -2f cs GPD 0 Replacement Public commercial - Describe: &CdR -M i /k % n K /v:Q b a r qj Parent material _ (l- eQ w p [ L y tea /u'a Plain elevation if applicable R General commen andreoommendations: ea /171W '/9a/ A. 'I77,01 14,1 W 33 / (o "0~~/l. /DO,c'~ ,fd~v.n~¢.~ , /3.a~~t.ea. 9~t[,c.~u,it. /~~im;.aT vCIP, dizcLz*L 17" 41A4 'JA g3= o Boring # Boring Pit Ground surface elev. O ft. Depth to limiting factor in. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff# I 'Eff#2 l• 13 /0 0 31:3 1 2' ct6k m fe s 1 4S. -qj 2 . 13- 0 /0 % .s 1 2 c -6 k -fn -Ca s ~1 8 7. S M 4/o -0 5✓ T J M, q1C +k S 0,(0 0,9 S 6 S7 5 4 6 ~2d 7 R 610 ¢S/ S i 56 k •-P1 o-4 o Boring ❑ Boring Fil # Pit Ground surface elev. q~• q0 ft. Depth to limiting factor > in. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f F In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 'Eff#2 0- D S 1 /j t k /Ir (460 . 9-18 0 Yg q/ y~y; 4bk m-K *c 18-13 y..31 !y a m r f,?X"< ' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30:5 150 mg& ' Effluent #2 = BOD _5 30 mg& and TSS 30 mgtL CST Name (Please Print) Signature CST Number Ms. Loretta Larrabee .&-g CSTM224580 Address Date Evaluation Conducted Telephone Number N2089 Cty. Trk. Y, Menomonie, WI54751 , `7'002 715/664-8184 r. A property U41 rk Parcel ID# Page 2 Boring # ❑ Boring F 7-~ . ' Pit Ground surface elev. ft. Depth m limiting factor 2 3 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf# 1 'Eff#2 / - /Z D e adk rn te. q S t. 8 2: 2-1D R `1,4 9 i f a6k rnl~ -3. 19-23 7-iYK-4 3 7. 5 k Z 3 yk w y 3 i 2 m, i2 - w► r' S a Boring # ❑ Boxing ' x Pit Ground surface elev. 9 (O 0 it. Depth to unOV factor in. Soil catlon Rate Horimn Depth Dominant Color Redox Description Texture Structure Corte Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh 'Eff#1 "Eff#2 -i~ lO R 31S i a abk '2 s qS (o, FS' a, /2--L IDYK'41q rri~2 CA S ~p 3. o- S R "16 Ss ~ 2 m 2 mT!L ~j k-3 i k"N6 ISyA-° d 2 m n 1n rz s (o fj 8 34,15'0 S y~ r~2d '7 sYR ¢ s~ I Z Fs-1 Boring# Boring Pit Ground surface elev. O tt Depth to uniting factor l 0 in. /4 Soil Rate Horimn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EMM _-/U /0 yk 3/ M-Fr- s i-C CA 9S (i z ' Effluent #1 = BOD., > 30:S 220 n#L am TSS >30:5 150 ffWL ` Effluent #2 = BODS 30 mg& and M :s 30 mgfL The Department of Commerce is an equal opportunity service provider and"employer: If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBW330 (8.07100) 4 cop*l Property Owner _Zan Parcel ID# Page ;2, of . Boring # O Boring _ F-5,] Pit Ground surface elev. ! ~ -30 R Depth to uniting factor 2 3 in. ' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GMM in. Munseli Qu Si Cont. Color Gr. Sz Sh 'Etf#1 'Etf#2 &0 411 ~i a6k 46 .23-j I3 73Ye~' 0-S -4d4 1,06 a Boring # 0 Boring , A Pit Ground surface elev. 9 , 6 0 fL Depth to limning factor O In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD11F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 :-Eff#2 lO k 31s+ I atk -infer s qS (o cb, F~ 2- o yR i4 .2-~ cLb k m rrz 3 a. 3Z41~ 2, M, y? pa-- 3 . S dZ ~~6 7.S ye o ~8 ~rzi++y 2 to. rt. !n; 'Z S --tom to QS ~ a Boring # Boring Pit Ground surface elev. 9' . O it. Depth to limiting factor l ~ in. Son ncation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf1h I= ~v /o yk 31 A; mfg 2 Z O- /D R Iy 6-2 7S i fr r.6k fa Mont #1= BODS > 30 220 mg1L and TSS >30 950 mgA- ` Effluent #2 = BODs 5 30 m91L and TSS 30 mg1L The Department of Commerce is an equal opportunity service provider and"employer.- If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seD-n3o (is RI T SOIL AND ITE EVALUATION REPORT, os~d M'% 1 K; - oJo r S page 3 of 3 A k%AA Dan Luc SW,SW,S2 T29N/R16W Baldwin to ship St. Croix co iY- - - ` rou M lQrz' e~ ~.k Re°r~ 3 oretta Larrabee CSTM 224580 LEGEND y s qg,y~ 1 BM: 100.' base of orange painted flagged steel 'I'-post 213M: 100.0' base of orange painted flagged steel T-po* . -2-00 X - pits ® - grade elevations 2300- w a~« w 4y - - -contour - No Comm 83 set back problems Scale 1" - 40' except l e- where indicated DO LAO ~ - l 7 as f ~ a yL_ 0 7 ~bl tI 0& O O O h ~ O V C Oq N N C a O N it ~ ~ O T v ti 9L m o w o L N o - >Q rna~N Co a" tm r cmo3oc~ v (D N- C C N y L n a y C Ew y S O L O V-0 O r L E V O N O ~ _ N ?i L L M yam O Co 0 N L O E v w N m w V O O C Q c z 7 m c O C f0 m f0 LL C E`O0Ey O CO 00 =.m W ~a0 Q)•O .O U pL E Q ammo aH > h 0-0 z y y m 3 v N a m N F- C N y C) C p 7 N p Z c M r m ~ ~ ~ r w v d C40 F- e- N C N w E m U) L O Y U y 0 N N 0 C N N E ~ N m 0 a w °O rnotsa 0 r- Z 0 o Z N w ~ 0) 80 w (D CL - 0 ID m d ~ ~ N O D d a O ~ I~ H H H O W a Y 000 'VIIA o ~a(L a ~i CL J 7 o U) m 0 0 N p U) -j L) I 0 0 O Z N N o W r Go 0) N 0 V Z 0 d 0 m O N ° 0 0 = 0 a 7 C CD r C a 0) d Q A (A m y N v O '0 7 M C C 1~ O O U O b+ O ~p C V Q E O N C'4 (M V M M O III ¢ N C L = O N N Vl m f6 w C 16 Op ` } d N l=xl Ly 3 Y N d N C C C N T r•1 O N v 00 m J v O Z N Y mod' fn O ~ v1 Q d a E L: a E c c o _1 A ciao Ovid r HURLBURT HEATING & PLUMBING, INC ~~44~~ O~ 4 p n ~~~~44Q~ 50 Years of Service N6705 State Hwy 25 Durand, WI 54736-1598 DATE JOB NO. ww 715-283-4422 FAX 715-283-4421 ATTENTIO TO ^ RE: s Ito ;f l4"A40&-~ft), 1.vZ' SY611P - 7710 002 - 6 59 • - ooh WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION l.. ZS s THESE ARE TRANSMITTED as checked below: V,For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify us ft once.