Loading...
HomeMy WebLinkAbout020-1135-20-000 nuro> ! 3su c d `+1 -3. 0 3 r° m v ~T.'. o ~c 3 3 \ 1 Cn 3 2 !n Z O CST on C O N • S 3 p C ~ 2 =CD N IV Q A Cn N a "O* Z 0. f' CA'I O ►y 00 A N = O W= 7 P CO CwT O I 3 0. 0 N N 10 H co", CD :3 n CD COj o O N ~Oy O O co OD w oo c ro Q ° 5 N ~ ° to Oy M 90 m a w O PD G A c` m U) W a = C CD R. ~ f'I'I I ON`D A CL IS. N N (D 0 N N O ::I (D ~J CD 0 CD Z C) CD y CT CT Co rt H I rn 0° Cn G !V Q Ul T "a -0 "NA O o o Z O O O y• z y (p o o c CO) N N CL w cr "a 0 CD o c°n con o Si v CD m CC~n _C I N A N A l CL z '~rn D N O Z -I Z a d I D m 0 W m = Ul s !V ro = O CD W N • N o N z m N• rt S N N oa (D a z z w w I a CD CD to z A Z co 0 0 `n z CL H N n I y Z H. F- H !rt O R O Z E N i co m moo O ,d t-h N ' Z W O O (~D a. y Z CD A H O CA) H n o 0) o a I m rn I I I ~ I I a' tt I ~ h N I N I °o a I A I o °p m aro w I ~ w o O o0 °o CL Form- STC-104 R AS BUILT SANITARY SYSTEM REPORT f , OWNER y`4 "'r TOWNSHIP SEC. T5' N-R W ADDRESS c~- ST. CROIX COUNTY, WISCONSIN SUBDIVISION~OT :3 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM q a by k INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used. Elevation of vertical reference point: `Csz~ Proposed slope at site: SEPTIC TANK: Manufacturer: (.CSC Liquid Capacity: , ✓yC~ Number of'rings used: Tank manhole cover elevation: .Tank Inlet.Elevation: Tank Outlet Elevation: Number of feet from:nearest° Road.: Front0 Side Rear, O feet From `nearest. preperty line': Front 10 Side 10Rear,0 feet Number of feet from: well building:' (Include this information of the above plot plan)(Y2 reference dimensions to septic tank) SEE REVERSE SIDE w PUMP CHAMBER 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, a Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: 5cJ Number of Lines: Area Built: :!50C) Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O RearFt. 3 Number of feet from well,: 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 or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK 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, 0Ft. Number of feet from well: Number of feet from building: Number of.feet from nearest road: Alarm Manufacturer: Inspector ?7,/Y Dated: Plumber on job: License Number : 3/84:mJ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: + (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound A NAME OF PERMIT HOLDERI ADDRESS OF PERMIT HOLDER: INSPECTION DA Robert Schef fen R. R. 5, Hudson, WI 54016 -/;z -'?5- / " 30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV. CST REF. PT. ELEV.-. NW NW, Section 20, T29N-R19W, Town of Hudson,Lot#53, Willow Ridge II IName of Plumber MP/MPRSW NO, 1"'Y. Sanitary Permit Number. Ro er Timm 3224 St. Croix 75011 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: i :z.. ~ 7 1 -7 11YES ONO DYES IYNO BEDDING: VENT DIA.: VENT MATT J HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUI LDING: JVENTTOFRESH ALARM FEET FROM LINE / AIR INLET. DYES NO C. DYES NO NEAREST_ _ DOSING CHAMBER: MANUFACTURER BEDDING. J LIQUID CAPACITY PUMP MODEL PUMP; SIPH( ol-M ANUF CTUREH WARNING LABEL LOCKING COVER PROVIDED- PROVIDED: DYES ONO ' f DYES ONO DYES NO GALLONS PER CYCLE: PUMP ANO CONTROLS OPERAT NA N BER OF PROPERTY WELL BUILDING (VENT TO FRESH (DIFFERENCE BETWEEN F ET FROM LINE AIR INLET PUMP ON AND OFF) OYES ❑ O AREST~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth owing T1 [11,1MF TER IMATE HIAL AND MAHKw(; 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 DISTH PIPE SPACIN(; COVER J INSIDE DIA API IS LIQUID BED/TRENCH THENCHES MAT iIAL PIT DEPTH DIMENSIONS J L) - GRa 'FL OFPTII FILL DEPTH ' ft PIPE DISTH PIPE DISTR. PIPE MATERIAL NO IJISTR NUMBER OF PROPERTY WELL BUILDING- VENT TO FRESH BELOW PIPES ABOVE COVER ELEV INLE I ELEV ENO PIPES FEET FIR S_ LINzE AIR INLET. s~ ( _ j 9oLr 2 u 2 / `2' Z NEARESTO ~ J J / lC7 7 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- DYES O meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PE HMANi NT NIARKf ITS JOBSERVATION WELLS OYES ONO DYES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED OFPiH OF TOPSOIL SOOOFO ISEEDED MULCHED CENTER EDGES DYES. ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NREONCH ES LATERAL SPACING JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO OISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA ELEV. PIPES DIA: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECI LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑ YES ❑ NO ❑ YES ❑ NONEAREST- r. 1 i Sketch System on Retain i county file for audit. Reverse Side. SIGNATURE. > ITITLE DILHR SBD 6710 (R.01/82) ~ wlsconsln ,APPLICATION FOR SANITARY PERMIT EM L H R COUNTY ~ OEPRRTmEnT OF (PCB 67) UNIFORM SANITARY PERMIT # -`InOU5Tg4,LRBOg6 HUTRn RELRTIons~~// t -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP RTY OWNER MAILING ADDRESS Eaer k err PR'O"PIERTY LOCATION CITY: fO 1 /4N /4, S .Q , T , N. R / E-fer) W O N GE: ~ OrJ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER Lc/i / d*Au i s TYPE OF BUILDING OR USE SERVED r~ '7a - ~~3 c~a 1 or 2 Family Number of Bedrooms: 3 Public (Specify): O( THIS PERMIT IS FOR A: 19 New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity ~J4O Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: /k IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQU,IIRED (Square Feet): PROPOSED (Square Feet): ' 7 J~ 0 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Naly,Plumber (Print): Signature- MP/,f_RSw No.: Phone Number: Ka s' e m ,ti► .r,,.,~,•.,~ 32z y 4/S ► 316 Plumber's ddress: Name of Designer: 7'~ t` COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Q~ r x~ a-®6 ~d7~r ❑ Owner Given Initial ~ pproved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 ; To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 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 A&2,7-? aMa ~CNeli~ Location of Property Section ~710 , TN-R W Township a Mailing Address 4~ a ~ Address of Site Subdivision Name Lot `Number r / Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume f7 ! d and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eeAti.by that att 6tatement,6 on thin botm atce tAue to the best ob my (our.) knowledge; that I (we) am (ahe) the owner (,s) o j the pro pen t y dens ear ib ed in this .inbo.mation bonm, by vi tue ob a ww anty deed %eco&ded in the 066,iee ob the County Regiszen ob Deeds as Document No. ; and that I (We) ptaentty own the ptoposed site bon the sewage dispozs system (on I (we) have obtained an eaaement, to nun with the above de,6cAibed pnopeAty, bon the eon6tAucti.on ob said .aystem, and the same hays been duty tecmded in the Obb.ice ob the County Regi,6ZeA ob Dee ab Document No. SIGNATURE OF 0 R SIG ATURE OF CO- WNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H r : z H a STC - 105 r a _ y SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z '4--/ H ~ OWNER/BUYER ROUTE/BOX NUMBER ZD Fire Number .CITY/STATE4&Y) Ik ZIP PROPERTY LOCATION:, 34. Section-W T 24 N , R__Zj W Town of St. Croix County, Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I/WE, the undersigned, have read 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 Wisconsin Depart- 'V ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zonin ffice within 30 days of the three year expiration date. SIGNED/ /L DATE J &,4/ QJt-- .14/ y St. 'Croix County Zoning Office P.O. Box 98A, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. O N r = m N a ~D Gl N N N 0 =r N a O x Cf t7 N O_ ~ ? S w f° c ~p O C o 0 w E Z S0 3 CcocQ 1~{ r► a M (D O A. " 0 'D c =r CD 'a CD Cn a p O w p- CD O cD $ mo fmaw-t- m CD CD gr =r CD 0 CD o 0 °~M o ~:3~ w o ° 0 3 0 < c c =S CA o -3 Z (O a < a• : 0 C =r (D w A f~D C 0 •C) °N~ 0DSQ9~ nC o R -4 CD O ? O CDa " 0 W A w p a 0 CO) (A w m~»w ~sw 5D~CO). n :3 z m CD (1) CD 0 CD (D N? a ~ D a N w a co M d w o p fTi w CL ElF c w Ewa ~DN=r a c ?m O N•N w w m C m CD 0 CL =r M CD w o w a n a 0 -I N 0 C~ °ao c~0E:E awo m 0.0 CL CA -4 - ~m N . M. N O 7 C tD (D ~ 3 N n CD C a p N 0~ 0 7 C a...°a c°cQw ~r m C p. C N 0 0 e` er ' CL 0 ~ 0 ° m wad aw moo, N a o < 3 z ~0 ~o~ r 1 • it I I r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION:/VW SECTION: TOWNSHIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: N w 1/ Z o /T zqN/R 1 E (or) W /~/upfa"cl COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: S~ Cro/X ~o EQi ScAk fEti b 3 56'"'44;-x /(/ox o/v 7yvv1ro,J 4>is• . USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLATION/T~EST : Residence A_ New El Replace I o0 L ,3 074 RATING: S= Site suitable for system U= Site unsuitable for system YC'S a MIS VENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) 6/f- ❑ u ZS ❑ u ©s O U ❑ s 2U o s a u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation: 2c- PROFILE DESCRIPTIONS /A.' J7tCi14A1_ Fj•. BORING TOTAL DEPTH TO GROUNDWATER-IN' CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ' 43' _&-6y V., 133'^4_rVPf" of. Ir , .67' /W..6/e. B- y 9. or 70" Z33'&-6-Y" S/ .4-71 41 4,.. 4'w IS/, y. ` oe 3o. S/ i B- o-S' •1s . 66 a>j. /5 7.2-' MV 1/" V_ . cs . ' . fi' Ae. do. S/ .,S' 43,. s/ .75- ' aN. S1 y2 /s B- p vex of ' ~S Y7' / v le41 t 5/ . I f' 0 S j c t GiP ' T N 114A S. B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD 3 PER INCH P- 3.0 ' L PE (0,A, 013 d ( y P- mm es' P- Z 2 2 P-3 L- C9L Mi v E` a , P-I I - I C__ 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. 86 77OM OF ~ED ~,rG~ (f/~ j j0,v = 3. !6 FT SYSTEM ELEVATION _ V0.4 1 _ Ch~ 77 te -APPi 3 This test ~i stem' for a cony nt ohat E sy - a ~ WSW E ~ T , - -y - - TN a E -~14 _ T P, E`iI x 3 ~ ~C G~ w - - - I E I eVhTto>J r 169.1 d 3 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. NAME (print): TESTS WERE COMPLETED N: 91 ~_z 3- Po 4-A T ZlG C1174-1 - ADDRESS: FA CERT,,FICATION NUMBER: PHONE NUMBER (optional): RT•3 D NFi~ p• ~5" ~z if IaV* 9'g~ CST SIGNATUR DISTRIBUTION: Original and one copy to Local Authority, * Tester. D I LH R-SB D-6395 (R. 02/82) i-OVER - INSTRUCTIONS FOR COMPLFTI"' FORM 115 - S BD - 6395 R To be a cc fete and accurate soil test, your rer irclucle: 1. corp. description; '2. Th-e u, ; :t. n mast clezirly indicate a residence or com.merciM project; 3, MAXI' 1 umber of bt Jr :)r c planned; 4, Is r( lacerr, Cc ti fa S 'ITABL',, : ')TRIG TANK ONLY IF ALL OT C SOIL G 6, Pi. is sh ~ ofil --ompleting the plot plan; 7. i 1 to scale is ferred. A t; eF c A, the OX; L T B EIL-D ITN THE O y" (OMPLETION, I _ ABBREVIATIONS FOR CERTIFIED SOI, ~ ~3S parates: $ 1C. BR Ss ler 3") Is > r,il Si )am --k / Loam Loam ay t I-I W L w ,s 7osal BM G th first neat IT J( , fnr t}' y Ci~~t~ih I~ ~~r ` ROHL & TIMM EXCAVATING JOB SHEET NO. ~ OF Z 310 Arch Street HUDSON, WIS. 54016 CALCULATED BY (715) 386-8664 CHECKED BY DATE_ /Z 6 SCALE . - o I w 1 T W O y`AA co) C .(A- ,may. e PRODUCT 204-1 ~ Inc., Groton, Man. 01471. JOB eo W ~ `lGc2 • ROHL & TIMM EXCAVATING / 310 Arch Street SHEET N0. G OF Z • HUDSON, WIS. 54016 CALCULATED BY 6 sLf'a. DATE_ 2 ✓ _ (715) 386-8664 CHECKED BY DATE- SCALE /I 4111 J f , 3rd c r ~ ~ ' ~ t o E AoJ,i _ PRODUCTM-1 Eas Inc., Croton, Mass. 01471.