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HomeMy WebLinkAbout020-1353-45-000 1111VDepartinent WV di ngs ivi i orrunerce PRIV SEWAGE SYSTEM County: �dings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provlce may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 384116 Permit Holder's Name: ❑ City ❑ Village [Mown of: State Plan ID No.: Willox, Rich Hudson Township CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: 1b0 , leo •a I ; , ( �, 4 Description,: = C9 T IS mot ‘ 020 - 1353 -45 -000 TANK INFORMATION ELEVATION DATA 367 - `I. 19. joi-f5— TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Bencmar / p C 1-)4.,z S• �6 f f c1D J , Dosing Alt. BM . Aeration Bldg. Sewer !o, (¢b 9Lf.zo.' Hold ©Ht Inlet 7.W 93.39/ TANK SETBACK INFORMATION St/ Ht Outlet 7"g '73 -2.6,' TANK TO P / L WELL BLDG. Venttake ROAD Dt Inlet - - Septic f , (k) °1 ' - NA Dt Bottom • Dosing N Header / Man. g CP ° q2.24' -..„9„,..- I S (;•) F),(00 r92 - 2o' Aeration A Dist. Pipe �J , i-p 4.341 Holdin . Bot. System C ) / o • 3 i .4 g PUMP / SIPHON INFORMATION Final Grade (,.-50 L . / 3 / Ma facturer De - nd �� id) lc . `1.3 / St cover a=te �-`� Model ber • M TDH 7 Friction ion (l a dm I TDH Ft •FOFcemain I Length Dia. • . . o Well _ SOIL ABS OPTION SYSTEM 1 , e _ o mo t.., • 1 - ',1_� Width 3 , N Of Trenches PIT • N No. Of Pits Inside Dia. Liquid Depth Ma urer: SETBACK SYSTEM TO P 1 L BLDG WELL LAKE / STREAM L ` • ' G "'- �., j INFORMATION TypeO / I� System: :,, . + (7 si► - — DISTRIB4TIQN SYSTEM ..../ I Header$ slbld lr Oistrib Lion Pi e(s) x Hole Size x Hole Spacing Vent To Air Intake Length e.,e- Dia ..1 Length Dia. AJ4 Spaung sigramatilllark ~ ZS SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only - I Depth Over Depth Over Bed /Trench Edges xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Topsoil ❑Yes ❑ No 0 Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:057031 l Inspection #2: — 7 - 7 — Location: 870 Alex Lane, Huds �15,4Q �1 (Nly 0.91 1/4 SE 1/4 36 T29N R19W) - 3629192045 Cottonwood Ridge -Lot 45 1.) Alt BM Description =XI try °.9l c�°,,,,a� -��. t•- �"4/) 2.) Bldg sewer length = q .0' - amount of cover = 16 - Z `f N ,S.■ ( ver - :6 (--) � a r evision required? es Nb ME� I . 1uj�+• _ WEE Use other side for additional information. a Cert. No. S130-6710 (R.3/97) Date Inspector's Signature - 0� �„ Sanitary Permit Application Safety & Buildings Division iik, In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. S ee reverse side for instructions for completing this application PO Box 7302 isconsin personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State S Permit Number ❑ Check if revision to previous application State Plan I. D. Number 57 te , Cil r. g II L Application Information - Please Print all Information Location: Property Owner Name Property Location / R I—GI1 t N bit 1/4.561/4, S3 To7y,N, lt/ Y(oA Property Owner's Mailing Address Lot Number Block Number 3s 97 G / ca_i Ai City, State Zip Code Phone Number Subdivision Name or CSM Number J PIP, mss`/ (C C 777 -9 / GEYTTDIU u-' a o1, II. Type of Building: (check one) ,-.),/ r ac wl,6 ❑ City 1 or 2 Family Dwelling - No. of Bedrooms : , i ce` ❑ Village �,t►+t� p,0p,., . s Town of ❑ Public /Commercial (describe use):_ /- ❑ State -Owned #(_/_,_.(. -.'-' \--- Nearest Road 6 -a - /3.5.? -95-- 0 09 Par mber(sJ , III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) . 3G , a c , ,q C crt,5-- A) 1. ,4New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to "Symms em System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued L IV. Type of POWT System: (Check all that apply) [Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade , ❑ Aerobic Tr atment Unit Re culating ❑ Other: (�)3 x. Lc. ero -- /b 7 /� V. Dispersal/Treatment Area Information: 1---D7 - 1/ c 7) . 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) (� Elevation V5 373 37? 1/ ,P, ______ VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks itt5C I r L il< ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement . I, the undersigned, assume responsibility for installation of the POWTS sho . • .n the attached plans. Plumber's �ri ) Plumb Signatu (no stamps • 40 PRS No. Business Phone Number i (1/5/ / 023 35 7 Plumber's Address (Street, ' , State, Zip Cod V ( ‘ /.5 . / t7 e-6_,?x D /X vi 4714-- mod - - IX County/Department Use Only < J/ ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is `Agent Sign (No stamps) ', A Approved ❑ Owner Given Initial Adverse Siliyharge Fee) S _ n Determination �¢ ,S-- Z eo ' X. Conditions of Approval /Reasons for Disapproval: _. - Fr " a rl " c �.� v ( '0� �1 �t�. CLAM- , ,W,, PCB: or J CST 1 , s uw.+.. 1as - \'c. Q ve. -fa S .. �% ZONIr G OF FI CE — C01.044 /044,a iu J arc per '" 1 arlS,,,. -orb. — S 21 t, 2.i a - -- S ,ISf •%w:� s- -fewtth& SBD -6398 (R. 07/00) 1 - a I • /V' Z fr4 -1 ; eQ2 {{ - W • L . 7cj3. ( a� B-) 3 9-1 x , 0 %-., /-%+-- 3�3 • ■• /av %s o VI, Nnw). Nov-A4z, A, / i bt,‘-til q ,I1A - / _ /Pam" 15th -a = it c --. // /-/ii—i— 17,-a. X,200 — z -? • , ‘ 01 , / I—, 172-/O, 0. r 0, ge l / -1- --)o 0 N" 1 ► g 9, e a Wisconsin Department of Commerce SOIL AND. SLTE.EVALUATION ' Divisio'n'of Safety and Buildings Page 1 of itif " " Bureau of integrated Services in accordanc&'with 5! ILHR`85 O9, Wis. Adm. Code • �, County n Attach complete site plan on paper not less than 8 1/2 x 11 in�hes.en size. �h�1+i7U$t,1 include, but not limited to: vertical and horizontal reference point,(BM), direction and S-E , L ro f" y percent slope, scale or dimensions, north arrow, and location and disc rice tonearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all l iformatio?, , ` , 'i + Rev' wed by Date Personal information you provide may be used for secondary purposes ,Pfivai;y 1-140514%q';1/4018). 4,401 0 4 1 i ( t 7 Property Owner � � property Lye on Y U JF' \ ( ( t / . b.o 1 /4 1/ T N,R r)6), R f c how-d, �-Fd �-k- �..� J � vt, E �,. ...� -�,�t� s E 336 Z 9 ' � cr E (o Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /? 53 Iow -}ukeC fC. `ir CCJHc)p wciocd ki City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road 14 vdLah I c,.rt I s /(o 1(71s )617 -6?31 140dsdn 1 C -tY k /U ® New Construction Use: ®Residential / Number of bedrooms .- — `7 Addition to existing building ❑ Replacement 6 / 7 ❑ Public or commercial - Describe: Code derived daily flow 00 gpd Recommended design loading rate • ! bed, gpd /ft - 8' trench, gpd /ft Absorption area required 857 bed, ft 750 trench, ft 2 Maximum design loading rate • .? bed, gpd /ft • O trench, gpd /ft Recommended infiltration surface elevation(s) ttpne 40. KO aawer A-I. ft (as referred to site plan benchmark) Additional design /site considerations _ 4Li. weer $ 80 t L o i f Fr7 40 Parent material (s G eo- ( C CTW G-,S h. Flood plain elevation, if applicable /(1! Pr ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system © s ❑ u ®S ❑ U ®s ❑ u ® S ❑ u ❑ S ® u ❑ S f] U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 a — I I loy ( 3 -- £ L /mmb wt-Cr c--S l -C .11 :,-5 Z 11 -37 Io.j riP4 l-- S /`ns en ) CS — . 7 . i" Ground 3 371zy loy( //l s csc on 1 G. • 7 , - 8' elev. WO ft. Depth to limiting factor , 12••1 in. ' Remarks: Boring # 1 G_(G 10 r3 s L l ..... mq� »'\-cr c s , y , S 2 fip3Z1Oj /�/ LS 1 �s5 m i CS — . ; .8 - 3 34 1 Oar r Yi _ MS �S IM / C,S . 7 ., I Ground , elev. fN)• ft. Depth to / limiting S� (AO factor 12T in. Remarks: CST Name (Please Print) Signature Telephone No. 1,. • c... I vv..a. , e � --- ?l.5 = o ��j'7- 1C$ Address Date CST Number " 70n Gec�.cr S� 7 `/ i S6mer.e± wI y - Y7 r9A.30c PROPERTY OWNER S 400+ SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # H orizon Depth Dominant Color Mottles Structure G D /ft g Texture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o -8 Io 3/Z —' S L wla,dok wx-cr CS , �/ s--yo I o y r y /� 1-S (vrt S� >n 1 CS — • Ground 3 I 7U' Kb 10 Y ( (,.//6 / � n 5 C+� v 14 ( C 5 • 7 • elev. 4..ZO ft. Depth to limiting factor 4 f i in. 9 V Remarks: Boring # 1 6 -1/ 101r3/3 SG- nutb K 14 4r C I - �' .1-/ e 1/3f5 )Oyr`1/ /`j -- l -5 1 ✓vls Y►'1 l C'_S – • 3 3 s -,z io.frq /( r►'► 5 vs3 v✓t ( cS – . 7 Ground elev. 9 tt. Depth to limiting k\41 factor Lin. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring# c-d/ S /m46,l• I14r C-S I-' • 2 ri I c y r WI 1-5 114 m I C5 — . 7, g 3 ro-f2i to ` /67 — ms 0.S5 wl l c- - , 7 ;. $ Ground elev. 41:00 ft. Depth to limiting factor -1-11-1--in Remarks: Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Y * Aid,t, , ( S. ,,.. S P= i -C3 / 21'.1 :40 ' A /7t- 4-De-c4 Property Owner g t✓1i (4./0/(0.c Parcel ID # ee,7 ' S / wood Page V of 7 ❑ Boring Boring # q6 in. ® !(� Pit Ground surface elev. '6f0 ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 I o - Y /a y 3/3 1 _ GS /siss rn-P- CS 1 C , 7 / ' 2 2 4 1- 30 /o y ry /Y — GS /msc 141,Cr cs i C ' 7 / Z 3 31-46 /Oyf V/6 — {r.5 cD5c3 rn I — - • 7 /.z 7 Boring # ❑ Boring 9 ® / Pit Ground surface elev. 7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 / G -4 /iyr3/3 — G /,#n s5 li't CS (: . 7 / 2 z 6-30 /oyrfr // GS /o, s3 l ,CV C5 If , 7 /z 3 3,-9A /e,r - As os mi - - , 7 7z Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L 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. SBD -8330 (R.07 /00) ,51 tV L et 4 15 01:44oM. wuo 12; dyk 4.4•■•••,Ziewil■•••' /00 (1a; I r. Is "oq k (301 1 e lc I. 100. IIaPI ; V ' fern Z etc, ‘0v•0 (yet r q °, 8•V £ysMv% elc✓.LoW.ergcl•$O 3 rp vrP &r €6' ,4/t efev- 1-uubb gd _ 1 mar -411 0. 4 fr te Q , l- • p4-T35 � 0 ♦ �� Pr'• a a N N • 1'0 6n+Z • 8'7- e . ,0 / 0 4, Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the .In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment. Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 3CN j16 Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) , Septic Tank Capacity (gal) \ 0"Q0 / � Soil Absorption Component Size (ft') 3 - K _ ad `�� ��� ci\ Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absor tion Component Design Flow - Peak (gpd) t ��� 'e -- i5ns4• `B+'t Maximum Influent Particle Size (in) V 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years - Soil Absorption Component Inspect once every 3 years 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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se• ' • and outlet filter shall be assessed at least once every 3 years by inspection. The • - 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 slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge 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 an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole 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- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 • Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 it ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /rick V41 L X Mailing Address 3" 97 6-e1sku st) « N d e_ "ix) Crg Property Address 3 O a-Q_o . 4.v1/4.s _ ✓ (Verification required from Planning Department for new construction) City /State Parcel Identification Number C 0 - 1/ 0 8 - 20 - OOd LEGAL DESCRIPTION Property Location ML- /, 5�- '/., Sec. 73(0, T 9 N -R /? W, Town of Subdivision Z2A , Lot # V,5 Certified Survey Map # , Volume , Page # . Warranty Deed # l 0 / L-/ co , Volume / 917 oZ , Page # 90 5 . Spec house ❑ yes ci4 no Lot lines identifiable itp yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1 Uwe the undersigned have read the above requirements and agree to maintain the private sewage disposal ste m with the standards 1� P g sP Y set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year e iration date. 'kR c si6g 111111 1 / d ?oI SIGNATURE VAPPLItA DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro erty describedd a, e, by virtue of a warranty deed recorded in Register of Deeds Office. l� (, c- 1_112,4 SIGNATURE OF APPLIC • S% /1) DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed - - - - - as" 1472PAGE 408 STATE BAR OF WISCONSIN FORM 2 - 1998 1 42010 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO«, WI Document Number RECEIVED FOR RECORD This Deed, made between BIC'HARD_O 11 9:00 AM JANET_P.STOuT, huAhand &nii wife, WARRANTY DEED EXEMPT A , Grantor, CERT COPY FEE: and RICHARD---A. M. WILLOX, COPY FEE: TRANSFER FEE: 179.10 huiEv741 _ RECORDING FEE: 10.00 PAGES: 1 , G rantee . _ Grantor, for a valuable c conveys and warrants 1.o Grantee the following described real estate in 5.• --Croix —_ County, State of Wisconsin. Lot 4 'lat of Cottonwood Ridge, Town of Name and Return Address •u.son, St. Croix County, Wisconsin. 14400 /4 31.97 4 d'M •e" 5-s-yee- F Number (N) This j s no t homestead property. (is) (is not) _ . Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this ? day of Novprnbizr , 1 999 . Rirbard 0 Stout (SEAL) Janpf P. Stout (SEAL) * ii _ (SEAL) . (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of Personally came before me this 0,1 of November 1 999 , the above named Richard O. Stout and Janet TITLE: MEMBER STATE BAR OF WISCONSIN NOTARY PUBLIC to (If not, me known to STATEe0E - • 41. ,ted the foregoing authorized by §706.06, Wis. Stats.) instrument and acIKERRON dBAST • THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout f - -1353 Awatukee Tr, Hudson, Wi. 54016 Notar Public, State of consin My ornmission ' peeinent. (If not, state expi4i n te: (Signatures may be authenticated or acknowledged. 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