Loading...
HomeMy WebLinkAbout020-1028-10-002 � o m °o, o " O 0o ao a� W v; 4 o C) � I w I o W 'D _ I o rn o III N — N c I y I N N C C € cc L Y $ I I N aNi Q) ai ° = zo Z N E m c LL cc o y LL o > - 3 0 CD E ¢ v co ¢ v CL M 3 Cl) z LU I E rn z O :% O EO O � E z O H Z a m a m o I o I = O o z a c c o c o z z H r a c E •a � � �-, •o � ch I N a) CD a) n N 0 N (n a) U) a) c •� 4 ID L I a U) O O N C 'o 0 N Z c I m Z z o z m Z z C o- a) m N in vi E r N A E v CL c a L > CO O O- c , C d H O O cc B a CL U')+ i O•O O C ' 0 15 CN N wp O N F O 0. Z N Z o 1 0 0 0 a z ° •►v a a a �, I a s a a c Ic 7 N N co 0o N y O m J V c 00 00 } c rn z a N 00 _ N =O N �1 l I — ) O O C O O j ° O O a) CL w v co z in m �a w e U y C �i N C ^i N w 0 O N O E N O V "O E O `rO O N O 3: LO a) C O C a C> tq l0 00 0 d N O 00 O UOi N p R U O cD O y O O U •��ii O 2 LL O z N H Cl) LL O O z Z Z g fn E I = € - E d o ma a) a L: IL � a4� O• d a) d o d d o +� rrww y p 3 ; c 1 3 ° 'o _1 A Va OmU OU) U Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP _#w at,a SEC.X 0T4_9 N-R _W ADDRESS /1 Z l*►c C aT_ �,ser., Rd ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 jSHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ti X c.r Lk a . ac-f b ,fir, �'},�'� � Lt�1' INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 4?oM -. off' 5,1., Elevation of vertical reference point: 10U~ Proposed slope at site: SEPTIC TANK: Manufacturer: C„i('C1 ,,, Liquid Capacity: /©UU 4; C f i ► 1 Number of rings used: ZZ Tank manhole cover elevation:,/, 7 Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,®Side,O Rear, O / y �' � feet From nearest property line ' Front 10 Side,®Rear,0 6 feet Number of feet from: well 20 P , building: QLd (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER �v l Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: r Number of feet from building: (Include distances on plot plan) . SOIL ABSORPTION SYSTEM Bed: ?L. Trench: Width: /2,f Lendth: ,. Number of Lines: Area Built: Z2yP Fill depth to top of pipe: 5/11' Number of feet from nearest property line: Front, O Side, ® Rear,O Vt :J- Number of feet from well: ae Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK WI Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 6 , 3/84:mj x rDEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILD INGS I LABOR&HUMAN RE DIVISON -CATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7909 MADISON,WI 53707 NW'-4,NE f )S16 T29N—R19W kRCONVENTIONAL ❑ALTERNATIVE State Planl.D.Number: (If asst9nedl �. Town of Hudson ❑Holding Tank ❑In-Ground Pressure El Mound McCutcheon Road NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:: Joel F. & Jennie K. Foust 416 Vin Street Hudson WI 54016 b - )" Da BENCH MARK(Permanent reference Point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber-. MP/MPRSW No.. County: Sanitary Permit Number: Michael E. Wilson 6388 St. Croix 112649 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.V.. TANK OUTLET ELEV_ WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. rF�� q/, VYES ONO DYES LJNO BEDDING. VENT DIA VENT MATL.. I-I -G WATER NUMBER OF ROAD' PROPERTY WELL: BUILDING. VENT TO FRESH ALARM. LINE AIR INLET FEET FR DYES NO C OYES VNO INEARESOM '/70 J-0 DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER W LOCKING COVER PROVIDED. PROVIDED: DYES ONO DYES ONO I OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES 0 N NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING Or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING COVER INSIDE 11111 uPITS LIQUID BED/TRENCH TRENCHES , MATERIAL: PIT DEPTH DIMENSIONS Z S L — �' GRAVEL DEPTH FILL DEPTH IDISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL. N DISTR. NUMBER OF PR OPERTV WELL BUILDING VENT TO FRESH BELOW PIPES r ABOVE COVER. ELEV INLET ENV.END Z PIPES FEET FROM LIN AIR INLET t(! Z ' NEAREST—s .Z OS So 'Ld MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO OIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ENO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. � ❑YES ❑NO DYES ❑NO DYES El NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHE : DIMENSIONS MANIFOLD PUMP NIFOLD DISTR.PIPE MANIF D MATERIAL N DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKIN(; ELEVATION AND ELEV.. ELEV.. DIA.. ELEV. PIPES DIA.-. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACI G DRILLED CORRECTLY VER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS YES ❑NO' I DYES ❑NO COMMENTS: PERMANENT ARKERS: ! OBSE ATION WELLS: NUMBER OF PROPERTY WELL. BUILDING �j FEET FROM LINE 1 ❑ ES DYES 1:1 NO NEAREST J Sketch System on 1 I Retain in county file for audit. Reverse Side. SIGNATURE j TITLE r 12 ,� Zonin g Administrator i DILHR SBD 6710(R.01/82) - COUNTY SANITARY PERMIT APPLICATION —� DILHR In accord with ILHR 83.05,Wis.Adm.Code STAT SA�ARYPERMIT# . .o //49 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAM I.D.NUMB R 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATIONt I ANCE ❑YES X No' PROPERTY OWNER PWEYATY LOCATI �F '/a, S T219 , N, R /7 E (o PROPERTY OWNER'S MAILING ADDRESS /� LOT NUMBER BL NUMBER SUBDIVISION NAME �C .Z T 4 'ev,, 4 d Z;X- lY st1 CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST LAKE OR LANDMARK !T L_.."' .S—`!O 1 '�/J— _? - 8' ❑ VILLAGE./ 4,01 /J7 II. TYPE OF BUILDING OR USE SERVED: tom` Number of Bedrooms if 1 or 2 Family -3 OR ❑ Public(Specify):hj/,� 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ® New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. Sanitary Permit was previously issued. Permit## Date Issued 3. U An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1'and only one in##2) 1."a. .Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1`. a. [kSee a e Bed b. El seepage Trench c. El SeeDacie Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): �o l.r .� Sl�7 Feet EX Private ❑Joint ❑ Public CAPACITY VI. TANK ##of Prefab. Site Fiber- Exper. in gallons Total Manufacturer's Name Con- Steel Plastic INFORMATION New xistin Gallons Tanks Concrete glass App. Tanks Tanks strutted Septic Tank_or Holding Tank /Oe w ` Lift Pump Tank/Siphon Chamber ❑ ❑ Vil. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) P/RSW No.: Business Phone Number: .3 - 7/,S— _X C. P-A --_�,7 Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## Mf,C4 a, .L o 1. CST's ADDRESS(Street,City,State,Zip Code) Phone Number: V Q / >O / r �! -s—Y6 7/ a„gF--�S-3 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S�ggtary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ owner Given Initial V�[J ��S 6S Sµ ia�rge�Fee Q� Adverse Determination I �''W J�'O�✓. }�C1 X. COMMENTS/R EASONS FOR DISAPPROVAL: -may SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCT IONS dWCOMPLETING`A-SANITARY PERMIT �[ 4 APPLICATION Td THE APPLICANT: 1. This sanitary permit is valid for two (2) years; ° ;2. Your sanitary.permit may be renewed before the expiration date, and-at4he time of renewal any now criteria in the Wisconsin Administrative Code wiH be applicable; 3. All revisions to this permit must be, apprpved by the permit issuing authority. A new permit may be needed if there is a change in your.-building plans; system location, estimated wastewater flow.(number of gybed rooms, etc.), depth of system, or tYP a of system; Y 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form(SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained .Thiseptic tanks) should be pumped by a liceased pumper whenever,necessary, usuafly,every2 to 3 years; E " 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: ft public is checked, indicate type of use (i.e. 10 unit apartment,-30Iseat " restaurant, etc.). Fill in'number of bedrooms if'bui#ding is a one or two family dwelling; III. Purpose of application: Check only one in #1.Complete#2 if permit is for tank replacement,reoorwfWion or repair; , IV. Type of system: check all appropriate boxes depending on system type.:-Check experimental only,i#project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in#1-6; - VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,, number of'tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Gofnplete for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; ; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone numbe�. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A)plot plan, drawn to scale or with complete dimensions, location of, holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes;-dosing or pumping chambersi distribution boxes; soil absorption systems;feplacement' 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,rurve;•pump moddl and;pump manufacturer; D) cross section of the soil absorption system if.. required by the county; E)soil test data on a 115 form. GROUNDWATER SURCHARGE - - On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 yeais,of steady negotiation and public debate..The groundwater bill Ground included the creation of surchar es_fees for a number of regulated practices which--- Wisco can effect groundwater.The surcharge took effect on July 1, 1984. All of the water that buried t# k is used in your building is returned to the groundwater through your soil absorption g ® ' system or the disposal site used by your'hold ng tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) _ _ lz NA CL .. r d S C� d v • h 1 1 C'� O � �. � � s yt r 1 J 1_et Q Kp s �N do � J � 0 Qi v! � o � c o 0 1 t `S Irs" t c o as �y g a 3 �- - T a DIL�HR SANITARY PERMIT APPLICATION COUNT' In accord with ILHR 83.05,Wis.Adm.Code - ..a°'"'� .o�K STATE SANITARY PERMIT#.. J - —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER h 8%x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 2 NO PROPERTY OWNER PROPERTY LOCATION t , t . PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER 7n CITY NEARESTROAb,LAKE OR LANDMARK { f; P, Q VILLAGE: II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):,ii, 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. Sanitary Permit was previously issued. Permit# Date Issued 3. LJ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.' IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. [>`Z Seepage Bed b. ❑seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet EA Private ❑Joint ❑ Public VI. TANK CAPACITY Site in ga ons Total • ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank `�- El El ❑ Lift Pump Tank/Siphon Chamber - - ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. z Plumber's Name(Print): Plumber's Signature:(No Stamps) < P/MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: - VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 1X. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: t SBD-6398(formerly Plb-67)(R.Q3/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399)to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The-septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; , 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; _. IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the.capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system.Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county'The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding-tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. -------------------_ —_----------------__------------------------- ---------------------------__---_- I� - GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco fE1�S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, f it's worth protecting. SBD-6398(R.03/86) i DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code " "!- C x STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER~ = 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ENO PROPERTY OWNER PROPERTY LOCATION '/4S T >? , N, R E (o � ► PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER CITY l NEARESTAOAD,LAKE OR LANDMARK ❑ VILLAGE f F_ .1'r. 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):f+/,:,%� III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. 0 New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. FtA Sanitary Permit was previously issued. Permit# Date Issued 3. An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building., Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ❑Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 0 seepage Bed b. ❑seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): ' Feet ❑X. Private ❑Joint 0 Pubiic VI. TANK CAPACITY Site in aa ons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank , kJ ❑ ❑ ❑ El ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. , Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: if Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY j ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number'of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE . On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill GroundtB[ included the creation of surcharges (fees) for a number of regulated practices which Wisco 4 11r$ ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried [easure is used in your building is returned to the groundwater through your soil absorption e . system or the disposal site used by your holding tank pumper. o The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR Alva PERCOLATION TESTS{ (115) MADISON WI 53707 HUMAN RELATIONS (1-163.090)&Chapter 145.045) LOCATION-: 'SECTION: OWNS MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: N/R/ E COUNTY: W BU ER'S NAME: LING ADDRESS: Sf.Crv�� 201L - .? 'T d. A/4-is .' S- of USE DATES OBSERVATIONS MADE NO.BEDRMS,: COMMERCIAL DESCRIPTION: PROFILE D 1 NS: PERCOLATION TESTS: Residence 3 / gNew ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSUR :US EM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:loptional) ®S ❑U CAS ❑U RS ❑U ❑S YU oe d s- - If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: T PVFIV DESCRIPTIONS BORING TOTAL P H T GR UNDWATER-INOMM CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH aj. ELEVATION OBSERVED EST,HIG HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) i B- 1 9 It ? on > It o a s t ' c 7 0 ..d d J. B- /Q 5h 5/ we." e V r B- s- /o' i. 1 h >io s- ' n L 3, y ' , IC o.. B- 'C PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INO"IES AFTER SWELLING INTERVAL-MMY. PERIOD RI D PER INCH P- 3a AVO 2— All P- me P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION g5 l ; E I . u�P �! Ti ' t i E I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. h NAME(print): h, TESTS WERE COMPLETED ON: ADDRESS: ++ CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SIGNATURE: DISTRIBU,'ION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SOD-6395(R.02/82) —OVER— DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS P.O.60X PRIVATE SEWAGE SYSTEMS DIVISION 1969 tVADISON WI 53 07 BUREAU OF PLUMBING W-, - 4,S16�;T29N-R19W CONVENTIONAL ❑ALTERNATIVE State Plan LD.Number Town of Hudson (lf assigned) ❑Holding Tank ❑ In-Ground Pressure El Mound McCutcheon Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Joel F. & Jennie K. Foust 416 Vine Street Hudson, WI 54016 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.P CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.. County: Sa rotary Permit Number: Richard Hopkins 1059 St. Croix 96046 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ONO] ❑YES ONO BEDDING: VENT DIA.. :=HIGH WATER NUMBER OF 'ROAD: PROPERTY WELL: BUILDING. VENT TO FRESH ALARM FEET FROM LINE AIR INLET DYES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: HDNO UID CAPACITY PUMP MODE I. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE I AIR INLET' PUMP ON AND OFF) ❑YES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TENCH WIDTH. LENG TH. NO.OF DISTR.PIPE SPACING. COVER JINSIDE DIA. #PITS. LIQUID TRENCHES MATERIAL PIT DEPTH: DIMENSIOtNS GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER'.OF ".PROPERTY WELL. BUILDING: VENTTO FRESH BELOW PIPES ABOVE COV ER. ELEV.INLET ELEV.END: PIPES. LINE: AIR INLET: FEET FROM NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE J7A NENT MARKERS OBSERVATION WELLS D Y ES ❑NO ❑YES ❑NO DEPTH OVER TRENCHiBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED: CENTER. EDGES: El YES ONO ❑YES 1:1 NO ❑YES El NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCFI WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: I�IMEN$IONS - • - MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. ID:STR.PIPE DISTRIBUTION PIPEM ATERIAL&MARKINGELEV.: ELEV.: DIA.: ELEV.: PIPES: D A.: ELEUATJON AN �1ISTRIB#lTION L1�IFt1I1011 HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED w PLANS. ❑YES ❑NO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OFt PROPERTY WELL BUILDING. FEET FROM LINE: OYES ❑NO ❑YES NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710(R.01/82) Zoning Administ L SANITARY PERMIT APPLICATION COUNTY 1�y DILHR In accord with ILHR 83.05,Wis.Adm.Code � ,�,....., STATE SANITARY PERMIT 9 0� —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/z x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO PRO TY WNW PROPERTY LOCATION _ 2� �{ �= Q u LIJ% '/4, S T , N, R E (or PFq[F,JTY O N R'S MAILING�A ESS s a , LOT NUMBER BLOCK NUMBER SUBDIVISION NA {lT1f P/ �j c /J� • CITY,STATE ZIP CODE PHONE NUMBER 7 CITY Q/V N EST R AD K OR LA DM ❑ VILLAGE K. 12 TOWN 0,II. TYPE OF BUILDING OR USE SERVED: t� Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify):C�NV< & III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. rxNew b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: Check only one in 1 and only one in#2 ( Y # Y ) 1. a. KConventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. XSee a e Bed b. ❑seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes er inch): REO IRED quare Feet): PROPO D quare Feet): � �. Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in aa l Ions Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Ci e' Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) 1 MP/MPRSW No.: Business Phone Number: ^i (� N / v 3h - 4U 6 PIO bet's Address(Street,Ci S te,Zi Code): O N e Qf Des' ner: e ` c��rt C S , c d VIII. SOIL ST INFORMATION Certified�gi1 Tester(CST)Name CST# .,TJ A S C CST's ADDRESS(Street,City,Slate,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial S rcharge Fee Adverse Determination ��� D� I� �—����7 • X. COMMENTS/REASONS FOR DISAPPROVAL: r(-�L.ed tO�3 -TLC hi as C. AJe /S v c SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT' APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the systern is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; "11 1 . X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z 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; dosing or pumping chambers; 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. -----------------------------------------------------------------------------•---------------------------------------------------------------------------- GROUNDWATER SURCHARGE May 4, 1984, 1983, Wisconsin Act 410 was signed into 'aw. This legislation is more imonly known as the groundwater protection law. This change in statutes was the f It of over 2 years of steady negotiation and public debate. The groundwater bill Ground#leer ed the creation of surcharges (fees) for a number of regulated practices which Wiscorf iWS pct groundwater. The surcharge took effect on July 1, 1984. All of the water tha= buried tireasure, n yo.fr building is returned to the groundwate° through your soil absorption u the disposal site used by your holding tank pumper. a c;olio:;ted througi- these surcharges are credi':ed to the groundwater fund admini:;- :repartment of Natural Resources. These funds are used for monitoring g,ound- t water contamination investigations and establishment of standards Groundwat!, .ting. S A I L-1 Y -!o( F1,lk 11 1 L I)I N G S PC,I'll-if ON SO t_ BORINI-10 la DIVISION I raloli AND. P.O. FiOX 7959 PERGOLATIOIN TESTS ('11 -3) tium-AN RJA'ArION". 1`0ADiSON.W1 53707 (1463.(19(1) & Chapter 145.045) 1`06y '_Sl fIC41VILINICIPAL11 Y; OT N1)TEa K.r�0. SuHU1Vis10.'N�t.lc 1/4 r' 1/4 T 7-7N/R/'7Ew W141-1011) -ay . CZ-_rt 7- 1:0UNI Y: e 1.2 DATES t),W;EF1VATION%MADE "ti. t( E 0 C"Ut-S-fffir ffdN T Ti:STS: 1 d uAflesidence NNew ❑EIReplace IIATING.- S-Site StWible for SYsturn U-Site uribuitahle for system ONWENDEL) SYSTEM:(opnollcl!) .6 U S L]U I EIS Nu - ]s ❑� ��s El 111 nz1-AJ,16:-ALJ7-10 AJA( If Orly pol t-oll or lni: z,rLfl the !-.•rler c,F163.Onici)ll•!,i I 8. /r..,r i, ,.. t`,.:?12. M. ^r. i Flooclp!ain, fle•colaziciri Test,aru,.1:01 required PROFILE DESCRIPTIONS TOTAL 50nING DEPTH TO GROUNDWATER-INCHES CHAnACTEF] OF SOIL V411 H THICKNESS.COLOR. TEX FURF. AND DEPTH NUMBER DEPTH F#11i_ ELEVATION OBSERVED EST.fIIGiTF_!;!_ TO BEDROCK IF O9S!:HVF0 ISE[ ABBRV.ON BACK.) C 7 r J_ L; -0,7o' ;e z) e-j S-7c- /1 2-L) > 8L M e t3"j Nf6b a rr- 13- 3 /0 .46 j 1.29' SL 1— I.9G Pjri S 1 O.9e-S, P-1, L_e .7, 9 7-00' 54 IjlA,11 61 LE- � PERCOLATION TESTS TEST DEPTH DROP IN WATER WA fER IN HOLE TEST TiKir- A LEVEL-iNCHES RATE MINUTES t E -1jNeNES AFTEItS%-JELLING INTERVAL•WIN. P PP PULF11ou a PER INCH 7,10 d. P. P- &g-7_1q 1"'.1 -j ............ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances.Describe what are the hori- zontal and vertical elevation reference points and show their location an the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM .ELEVATION 55710 5_4 Ll P NOT s _ 0 T F 1.V L_(Tx--j T;ION 83 Sor"511) 1 1 14" A 4ee 7 0 1W % !0 V - . t 7i 0 1 14 :MA PY. —,:r" i A 13 i lie 13-4 1, the undersigned,hereby certify :h the soil tests reported on this form were made by me in accord with the procedures Owl methods specified in it •iscontin Administrative Cod(r,and that the 4 Ia recorded and the location of the tests are correct to�he nest of le I yk icivilec (I belief,orrg 1 L_0 500 r R-0 P I— r rt•+AME(print). TESTS WERE COMPIETE 4 11oM5 ',0` ADDRESS:.. CEHTIFICATION NUMBER: JP HONf NUMBER[optional).' r7 IRE: DISTRIBUTIOWOriginal wl�,#nw-*ca�p'y 00.1-tv"w-Authority.Property,Owner end Sod Tester .t4v, �),04R-SI3113�4195,IVA cl2lnn D. 7 zi APPLICATION FOR SANITARY PERMIT 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, ("spec 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 3pe.� F. G.,� J2,v�ni� FG k5-� . Location of Property NW it NE 34, Section T N - R W Township �-� �5-o n Mailing Address y I to V,%h e CI s b,r�, . L& 4 o i (� Subdivision Name .5 • M y y Q C�5T ) y y Lot Number a Previous Owner of Property Lj e,5 I'Q-y Fer V1 Total Size of Parcel Date Parcel was Created Y Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes x No GG Volume 7 01 and Page Number 3 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTV OWNER CERTIFICATION. I (We) ee4ti6y that a•P.Q, .6tatemen.t6 on :thiZ Sonm ahe tAue to the but o6 my (ouA) know.tedge; .ghat I (we) am (cute,) the owner.(e) o6 the ptopex ty descA bed in .thi s .tnSonmati.on Sonm, by vi tue o� a waAAanty deed aeeonded in the 066ice o6 the County Reg.ceteA oS Deed,& a,& Document No. ��6 and that 1 (we) pAuentty oun the pnopozed site Son. .the .aewage pops by,&tem (on I (we) have obtained an ea.,&emen.t, to nun with the above descAi.bed pn.openty, Son. .the constAucti.ox o6 said .,&yb.tem, and the bame has been duty n.eeonded in the 066ice o6 .the County Register. o6 Deeda, as Document No. S ATURE OF OWNER SIGN URE OF CO-OWNER (IF APPLICABLE) -n_____T 7-a- DATE SIGNED DATE SIGNED DOCUMENT NO, THIS SPACE RESAVED FOR RECORDING DATA II l i STATE BAR OF WISCONSIN FORM 11-1982 .I •I LAND CONTRACT i! Individual and Carpnrnte RECASTERS OFFICE Y•" I(TO DL USED FOR ALi, TRANSACTIONS WHERE OVER �02i ig�:3 $25,000 IS FINANCED AND IN OTHER NON-CONSUAIER S1. CRDiX CO., ACT TRANSACTIONS) J ♦ WIS. j __ Rec'd. for Reoord this 8th i ContraCt, by and between Marjorie Elaine Fern, day Of June A.D. 1987 alkla i-!Iarjorie E. Fern f and _Wesley Fern, I at 3: 15 P� f -a1k--a- Wesley W Fern, _her husband ("Vendor", I James O'Connell°> whether one or more) and......!7.Oe1 F Foust and Jennie K. I ' II Fous_t,_._hust��x1d__a? a---Wjfe_.as--survivorship----------------- maX .i<al...pogerty_.......... _______ ("Purchaser", whether one or more). �j� �I Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- Deputy H formance of this contract b Purchaser, the following II Y g Property, together with the rents,profits, fixture* and other appurtenant interests (all called the"Property"), I St Croix in------------- ------------------------------------------------------------------- County, State of Wisconsin: RETURN TO (I ij jl Part of the NWc of the NE; of Section 16, Township 29 North, Range 19 West, described as Lot 2 of the Certified Survey Map filed I in the office of the Register of Deeds for Tax Parcel No. .................................. St. Croix County, Wisconsin in Volume 5, C.S .M. , Page 1447 , Document #395024 . This ....is_- not homestead property. ¢��Q (is not) their residence in Town of Purchaser agrees to purchase the Property and to pay to Vendor at -------------- ---------------------*.................. .... the sum of $ 1 Q_ 5 0 0 0 0 in the followin* ( .. 0 0 0 0 0 ...... s o it ..... ♦...-•----1------------------------------ -------- 6 manner: a) �•--.t_...._..'-----._...------•-----•---... --- I, at the execution of this Contract; and (b) the balance of $.8.1.500 .OQ___________________ together with interest from date hereof on the balance outstanding from time to time at the rate of....10 4%............................. per cent per annum i until paid in full, as follows: $216 . 62 one month after the date of this contract and a like amount on l the same day of each month thereafter, such payments to be applied j; on interest and principal as specified below. I Provided, how r' the ire.out standlng balance shall be paid in full on or before MeA... QAX.5........ r:Kf 1! after the date hereo (X'K4X4�9XX1 Following any payment, shall e s rate of u o a o annum entire s in defaul t (which s hall include, withoutlim limitation, delinquent interest and, I acceleration or maturity, the entire t principal balance). it Purchaser, unless excised-hy Ver+dovs agrees te•pxy monthly-to-Vendor amounts sufficient to pxy real>onabby ar+tici- (I pato4 annual taxer, special wsemmontsr fit:c and seilWred inauri+noe pr-0 mialmswhen-duerTo-the-ex�kn6-reeeived by Vender, Ucndor-a roes-to•a 1 g pp y-paymctlts-to-these obligations-when Luc: St+ch-unreulrts received-by-the Vender for ps►ymelrL of taxol:, asserrments-and iasur-anee will-be deposited unto-un-escrow-fu+id-or 4rustce-aceount, but-ehali net bear-itAcrest "Ica& othetrwice required-by-law. !� Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any II ji amount may be prepaid without premium or fee upon principal at any time j6""..............................1 49-....... (9R) I: there.may .be -no -Frepayment o€-p»inoipal-without pern*ission�f-Vendor.' I. I� Ij In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long I; as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated I, 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. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser I' for examination except: Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall it be retained by Vendor until the full purchase price is paid. II Purchaser shall beentitled to take possession of the Property on......t1le ............... ......... jl j "Cross Out One. I LAND CONTRACT—individual and STATF TZAR OF WISCONSIN Wisconsin Lcaal Blank Cu. ine. Corporate F!II4 1I tie., 11—1982 Milwaukee, Wis. J t t ) jl "t 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. k arehaser eha4 keep-the-improvernento or}the Rroperty- ineuped -agaarstr-loos o-r dsm&ge-ocossiened-by-firQ,_Qx. terided coverage perils and such other hazards as Vendor may require, without co-insurance, through hmF&rers approved by Vendor, in the sum of $............................................. but Vendor shall-not Mrjuire coverage in an amount more than the balance owed under this Contract. Purchaser s_�1 aJl pc�y�the—Insurance premiums when due. The policies shall contain the standard clause in favor of the_V tudorls-interest and, unless Vendor otherwise agrees in writing, the original Of all policies covering the Pcoperty--971all be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance cor paufes all'iVendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall bt�ap�litTto-iestort�tioe ot+ repai-P,of-the•Property-damaged,yrrovided bhc-Vc»dor-deems-the .restoeatien or repair to be economically^-f c=ible. 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 Deed, 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: _.easements of__record, f__•any-�___and-__Protective _Covenants of record. -•--------------------------------------------- Vendors__consent to Purchasers mortgaging their interest in this property __to__-secure_ financiaq_ of..new construct_ion,.. but such mortgage is subordinate to Vendors ' and lien under this contract. 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 ...45...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..45.._. days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then tine entire outstanding balance under this 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, term i nate this Contract and Purchaser's rights, title and interest i n the Property and recover te Property back through u b h strict foreclosure with any equity t of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interestthereonfrom the date of default at the rate in effect on such d•lt t 1 le• " Cando heramountsduehcrant .1 (ulwhich event all amountspreviously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may site for :specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon nt 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 it in end and remove this ContractasaClOud on title in a quiet-title action if the equitable interest of 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 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 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 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 and 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 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 inmediately 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 grunted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment or 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. All terms of this Contract shall he binding upon and inure to the benefits of the heirs, legal representatives, 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.) Dated this _---------------------------- 8th _ day of June ........ 19__87._. �- ,.���..(SEAL) ..��c- ..... -•. .......................(SEAL) Ma jorie Elaine Fern + Joel F. Foust ------ ----------------- lJ'C�4 ...............(SEAL) '- .. (SEAL) i ✓� ' Wesley F n Jennie K. Foust ................ •--................--•••-•-•...••••--••......-••- •-•--•........---•••-•••-.. ................................ AUTHENTICATION ACKNOWLEDGMENT Signature(s) .... all parties STATE Or WISCONSIN ss. .......................................•----------••---•-•--•----•-•--•-----•-- --.....----•---......---•--•--..__....County. all is ed this 8thday of....June . 19..8.7 Personally came before me this ................day of ..........................................1 19........ the above named .......---•.......................•••---•................-----••---•••.......... ois A. M-u rr ay ------------- ....------... ......................... -•-........---•-•-----•-•--.........------•---.....--•-••......-•---•-----•--•-- TITLE: MEMBER BAR ISCONSIN (If not, ............................................................ ................................... ......... ............................._..,,...... authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the foregoing instrument and acknowledge.the.same. i THIS INSTRUMENT WAS DRAFTED BY ft-hn D. Heywood -----------------------------•--------.......---•----•••-••..................... I ywood;...Car -i...m rray •--•---------•-•--•-••- P.�•.C1�..BOx. Notary Public ............................. County, Wis. v{ (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration �0 i not necessary.) date: 19 ) Nmce of persons signing in any capacity should he typed or printed below their siltnslures. O D CONTRACT—Individual and Corporate—State Der of Wisconsin, Form No. It'—1982 H u, H • STC - 105 r y H SEPTIC 'LANK MA1N`I'L?NANCE AGREEIM ;N'1' 0 St . Croix County OWN I:Ic/liU YEA, � _ \ ��1�.�� D K0U'I'E B 0 X NUMBER Fire Number C 1 'f Y/ STATE ¢ /t����'�-- --��' /. I h PR.(IP E R.TY 1.0CAT10N : JA) I,. N� ' Scc' L itI[I �( > T .N > it �_L-._W + Town o SGY� St . Cruix C:0UII L y > Subdiv:isi.on Lut numbLr. Improper LLSO and maititcnamcc of your :;c-pLir system could resulL in iLs pruotaturu lailure to lt:tit dLe Wtistc:; . I'ruper nulinLcnance con- Li ul puotpinp, out L11L- SL 1)C it' Lank evcI y three years or sooner , it itutcticd , by it liLLrised : LpLiL yank hitniher . What you put. into 1 Lhe sysLum Cue a1 1 eL: Lf Lhe i utiCt iuu Of L hL' :,t•pL iC Lank itS A Lrear- oteuC SLaEe 1n the waste di ,ipusit Sys Lew . St . Cro ix COu11 Ly reSidentS muy be eligibIv L reCeiVU a gra11 L for a lit axi Ill uIll ul 60 Z 0 LIte Cust of replaCetoenL ul a faiIiIIp, sysLe ill, which wa;; in opera Li-on prior to .July I , 19 /8 St . Croix COUnCy acCepCud Lhis prugritot ill August of 1980 , with Lhe rL:yuiI-L:menL ChaL owners of a_ l new sy__tems igree to kuep thtrir systems properly tea in La iitCLI 1'he prupet- Ly Owner tgrtus Lo submit Lo SL. . Cruix County uninp, a certif i c a L ion tur[it, s.i.i;tted by the OWUer aUd by a toaster p.lumbur , journeymait plumber , resLrit Led plumber ,,r a licensed 1)Lt Ill per veri- fying that ( 1 ) Lhe Ott-situ WastuWatur disposal systuIII is in proper uperaL in COltdi L Ion and ( '2' ) of ter inspc,CL ioif and pumpint1 ( i f nec- essary) , thu sepLic Laitk is Jess Lhan 1 / 3 1LtII of sludge and scum . Certification form will be scut approximately 30 days prior to three year expiration . a 0 I/WB , the undersigned , have., react the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth , herein , as set by the WiSCOnsill Depart- w ntent of Natural Resources . CerLification form inuSL be , ompleted and returned to. the St . Cruix COUnLy 'Zuni-ng Office Within 30 days Of the three year expiraLioti date . SIGNED SL . Croix County Z u n I n g 01' 1. ice P . O . liux ;& Ilammc nd , W I 511015 715-i 116-2239 or 715-425-8363 Sign , date: and return to above address . SAFE-1 Y 6t L 1)1 N G S 1);41AR-1 'it -1k, T -C ID O'E P 0 0 N S 4 J B.0 R I NJ -"t A�' !4NOU-S-TRY, DIVISION i bOX 79.-,( 1_;' lof 'AND 0. t -I 7 AT 10 N�,; PE'..'COLATILLIN TESTS3 (11 fit AD iS -370, 1!00,11 A N A 1 0 N, Val f) (1163.(19(1) q., Chapter 145.045) 10 N: :ATION: — TK VV,NISFI MUNICIPALITY: f(5 ff6:T-) N w tj 1,4� /4 N/R E (.UV j- U N TY: �j F f S F 1-1 T)F I I --M F. COti1MEltCIAL UESCFiIPTION] LAResidence NNevj FAReplace DATING:S=Site SLWA)tP FO.- SyStBfn U=Sita unsuitable for systern �q lt-1 FILLIHOLD 0M.'WE NDED SYSTEM:(op!jomd) 6��V r4Y16 I'm 6 L)I ri U L S L If"IJ ,"-'J 7—/6 IUA L - S EA L A 4 JU I EIS NU I I, any pt,1 1,on cj! ( te,('(1 z"k:, 0 th, Hoodpi,iin, �ndf� i, L PROFILE DESCRIPTIONS '10RING TOTAL DEPTH 1-0 GROUNDWATER ItJCHLS- NJUMEIFFi DEPTH F#*. ELEVATION OBSERVED EST.tl FG,F1—Ff;T— TO BEDROCK IF OHSF:HVf-D ISEE A8PRV.ON BACK.) fz- L L-; C 5 Z t3 t5 .4 b JIJ V O.>G' P—,: L- S7 PERCOLATION TESTS FFST DEPTt 1':A TER IN HOLE TEST Tilvi- DROP IN WATER LEVEL-iNCHES RAVE MINUTES i WiMBER -kNe"ES AcTEIt S5-JELLING INTERVAL4.11N.. PFRIOD 1------ P filC 1) `T QFIT,15 P Ft INCH 7-10 /oo !0 7�5. I 2 P. PLOT PLAN: Show locations of percolation test-s, soil borings and the dimensions of suitable suit areas. Indicate scale or distancei. Describe whit are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at a!I borings and the direction and percent 0 land slope. SYSTTM ....ELEVAT-1-01 f N t-5 5-, .7 ra IT all TIAz 44. i V ..... ..... ri A 0 T, !0 P-4 4- 0 0\ 113 '14 i�i L go Is W! I Ir tw (sol P—r�E:R-- �E-iz2e:�- 7-90, 1, the undersigned,hereby certify -hlc the soil tests reported on this form were made by me in accord with the procedures and methods specified in t hscon!,in Administrative Code,and that the d recorded and the location of the tests are correct to he oest of my kiio%rjle IW?Od belief. 0 40 7 50U ?_0 P F- O-rrrg R--f Ir L ik-,NA F—.(P—,i nu.— TESTS WERE COMPLETED ON: ADDRESS- CERTIFICATION NUMBER:rl UMBER(opt ionat) -,ee-z 71 7 aza6 4 450 ST NATURE: -A D!STR I BUT110W Or igi n at a n,1 nn copy to Lorm A Ll th Oritv,Propep ty.Owner and Soil Testdr..�-,, OV I-R, 4r rxa 17, am+++M P B. L. 6 7 P L 0T A t,, r► �; I D S S SECTION N A' M E 1 w e e 'K� s N n�M E R' c.�cl c } 0 C AT 10 N :_. i C; E ni S_E -tAt- 1 .2._---- (4 P C) -I- M A rah �)t + { Y 0= (arc tae s �S L { u}i ILI 10 4� _} Q 1 ,s 4 — �o . � 5p 12 7 {ppp 6eKA NhWr s To -vv 100,p SoLktk FP\0 op P t4 t ,F ' FRESH AI , YNIF TS AND OBSERVA110N PIPE {` CROSS SECTION Approved Vent Cap - 9 �J Minimum 12" Above � rA Final S st,t 4" Cast Iron w Above Pipe- vent- Pipe To Final Grades-- �Y it, r ;:. Marsh flay Or Synthetic Covering Min. 2" Agg.r.eg'a i. c Over Pipe Distributi_o7 ,., __I J .� Tee Pipe x Aggregate Perforated Pipe Below P Beneath Pipe 4 Coupling Terminating At &&tom '{ Bottom of System I" R _ L OT A N D C I: O S � SECT 101\1 P R 0 �i C _r ---.._.._..._... _ _.. . h L U M k-� i : �N A M E ��� i �" tf��N� � 5 N... �M E R � A�� 'z " 0 C AT 10 N_M_. ,��_ Rc�. �- 1 C E N S_E =i t_.. 10 - P -- ;7 y VAS r' 10j, a, r� 7 a .. z e \ ��. I X10 � Iook tit .�1�k ''1•�5� � 1, 4f�� ' S� 1 air ('' pips h � � 100,0 FRESH AI12 INLETS AND OBSERVkTION TRIPE C120SS SECTION :Tyr —•-� _.............. _ ------ [___� Approved Vent Cap y z` Minimum 12" Above Final Grade. I'I ' 4" Cast Iron 1 Pi e Above - P � Vent Pipe To Final Grade--- ., r ___ ..�_... . ..._. ._._...._ Marsh Ilay Or Synthetic Cover:i.ng kin. .2" AggregI',:� ' Over Pipe �V �r r Tee ' Distributi_o 7� t� - I Pipe Yti Aggregate Perforated Pipe Below Beneath Pipe 4 Coupling Terminating At -4 — _.__�_.._.. �� _.. . Bottom of System �a ~.J's `yr b•. 1 �t1 J i I � Y/I 3N 7M1 IO 3Nn 1Sa7 M61H'N6Z1 91 NOLL.035 ava1;;t H3Ntl0O 3N ••I w,pso il,o u AN80O Y/13 1W a6ed 9 'LOA ZI Oi M„64,314ON oNltla]B •oil 3N ] �. • - F, I I i 3N1 a0 3rlt Is"3N1 01 03:N34373M SONIYaA , B 0]wn5$V 1 =I }� N31 W: 1.1 cl 1 I 'a;l.•:. J l 4ya+ ,aoLs-- O00 Oct 0 HilmW03o a1110=qH >. 133d ul 31vu 1 °y f1N:NNa11 S73f J,"S�N,ryllfyJwO2' to 0 III zzi i z <� . 1r r.^) x1oa�'JS ro v 5 M A M �+ 7N-4/I MN)•1 16 3NIn 15V3 I I n i 861 C - - . r// - OOS90 M„ZI,v oN--;I, 4 inr I'.. MI >1 $. _:oo• NKt 'ia,�--- Vii— b Froi:: 3 s? ,, of _ o o 'l: H a �i.._ _ `• -, WI O.' C> O� .+ ly N ,..•�+0 O N 5 g f °Q� I I u1 1d .o v 'p M u o od•Ir1 l ;�:. ~O 2 Z �• m.� d rh N ri N 1 a<• 1. -J 1 �- ----- �� - - 0 0 Q• A FNS N M„11,a 40N �L.� pl ' ml ro O O In U Co C 3 A4 G l' 0 OOM C.0 7 kI gI I O' 4ti1 C 000..1°..p. C 16 ~ aJq o N 3 of JI ,•-.1 U Q V V•N d)4 oe In r� C O E N•-•.O C m ; oostY 1 "'I I � F-I d 4a •-•�� �A p C�M N N.n .`r:�w s... My2..a ISON i 1 I M Ai (-I W a b it' I QI OJl I 1 • zi W w m o Nco m W ,4 O C .p 1+1 W .Z 'd d X e .. M Yc j.1, � (�r •`�J. r+1. �i 1 �..1 I M ro$ ~ H WN� F•I 1- 0 1 1 5:1 01 0 x3I"DI .�. �. -LI (•" i W W 1d w oro C 1+1 1• , `itly6 •� `\v- V 1 W Q. - O`d' > m H fi1 0 U r!a •\ - _$I8 W C 1n O• �•CF�.0 0 W •.''O m •.a+r�� #'M. o ro o o M ?A NNN Qi _M1O� r _ w l I U U ftl 1n z z N oo y 3 E" 0.,ao-• s:+s -p �� Jri I } C N N N -• ,J O l a AH St 1 ; al 6 V' a z r 0 H «: 1 p i ° I JI r rJ r 'n M >,0'N U C *, y,m q 1 i. o w w to o.al00 rN 1:r _ 4011 I W i z lu z I' ra f+ to C 1'•1 m O 0,U ro •'7`0 a• �O s 0 7�orr� f^ ,0O.01C 3.sC,aP S > 3 0d C J//f/' 3NV� 0-MOOaW " ' • •-dl•7!-H+MN 3.11J iN13 163M '.7 O �' ,�Q m G C 'l.+ k•0 '0. SONVI 0311tl1d N(i .0C w;�ro 0 13S'ld'Nll/58199.1 1'" Id a .a Z—N rn.0 ONIHO13M 3dtd NONI,1 -1 - w ONnod bV8 NOW ONnOu j,/C l: 3d1dN081„62x„1H11M 910b5 IM 'uospnpl 033tV1S SU NHOD 101 U31410'ilV 1 •32I f 13S'1J'Nn/S8lS9S ONIH913M 0 u.ia1 aU.11 112 /salSaM :coJ paAoAlnS 3dId NON1,VZlt,Z 1N3WfINOW tl3NH00 NOI1O A1 35 1Jf10O UtS000SiM 'AjU1100 X10.10 'IS ON393'1-- unspn}I Jo Um01 'A\61 N 'N6Z1 '91 11011"S Jo b/1 3N a10 JO b/1 MN atit ul p01c30-I ddw �]njns ILI.. � 111 1 086 ��7nr '- A