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HomeMy WebLinkAbout040-1210-20-000 (2)Lx Planning and Zoning St. Cro'* y Monday, August 27. 2001 a[d:5/:SO PM Page i of 1 � Detail Sanitary Infvrmatian Computer M. 040-1210-20-000 Sub/Plat: St. Croix Highlands Section: 25 Parcel #: 25.28.20.997 Lot: 12 TNIRNG: T28N R20W Municipality: Troy, Town of CSM: 1I4 114: NE 114 SW 114 Owner: James, Tony & Laura 237 Glen Circle River Falls, WI 54022 State Permit: 199813 Issued: 08/20/1993 POINTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 12/07/1993 POINTS Detail: Bed - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Dotes Issuer/Inspector As Built Plumber Other Requirements Additional Notes1one Owed Tom Nelson Yes Lickness, Chris $0'00 Mary Jenkins Sjg n�.' Off-, Yes Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 7/16/2004 4/12/2005 4/ 1212008 12/7/1996 6I9I1998 6/9/2001 7/ 16/2001 STC 104 AS BUILT SANITARY SYSTEM REPORT OWNER S ADDRESS ��� �1-P�'� uY SUBDIVISION CSMf `4 0 1 k Lett -ef LOT f SECTION .� t7- T :N--R OJOTown of Ck awn ST. CROIX COUNTY/ WISCON ICI � ,.� � �' "� PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYST INDICATE NORTH AF:ROW on Provide setback and eleva0o�eWfof(ffllriCo�reverse of this form - Provide 2 dimensions to center of septic tank manhole c0veI. BENCHMARK: L;- 7- ALTEP,NATF, BM.. SEPTIC TANK PUMP CHAMBER HOLDING ..TANK INFORMATION Manufacturer: L, Liquid Capacity 000 Setback from: Well House Other Pump: Manufacturer M.odelf size Float seperation Gallons/cycle: Alarm Location -:-SOIL ABSORPTION SYSTEM Width: Length —Number of trenches O.A Distance & Direction to nearest prop. line: i 4 Setback from: well: o House Other ELEVATIONS 3 107 "#^1 F Z 4f r,,,A eo7 Building Sewer W. ST Inlet; ST outlet PC inlet PC bottom Pump Off Header Manifold Bottom of system Existing Grade Final grade tip DATE OF INSTALLATION. - PLUMBER ON JOB: LICENSE NUMBER: TNSPECTOR: 3 / 9 3 : j t TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic a. Dosi ng Aeration Holding TANK SETBACK INFORMATION TAN K TO P / L WELL BLDG. Vent to Air Intake ROAD Septic >d 0? ' r � NA Dosi ng NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction System Los Head TDH Ft Forcemai n Length TD -ta . Dist. To Well SOIL ABSORPTION SYSTEM LWAMIQ a rtirWFAQV In 5riy8. 2 G. 9 9 i fW FRY E 1§%/"E VAIFEMIRCLE Labor anel Human Relations INSPECTION REPORT ,iafety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) 'ermit Holder's Name: ❑ City ❑ Village ❑ Town of: t X ev.: Insp. BM Elev.: BM Description. ELEVATION DATA County: Sanitar Knit - State P1 Parcel Tax No.: A9300215 STATION BS HI FS ELEV. Benchmark, , r., Bldg. Sewer J.3 St / Ht Inlet -7, Oq �f , St/ Ht Outlet r' Dt Inlet Dt Bottom f Header / Man. Dist. Pipe 6 Bot. System 1,0 qq- 16v Final Grade .. j w BED / TRENCH Width length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / ) �� a �1 DIMENSIONS- SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION CHAMBER Type O i ' ' r ,r / Model Number: S stem: `. ( r OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _ Dia- Length Dia. Spacing SOIL COWER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION** TROY 2 5.2 S . 0.9 9 ? , E , SW , LOB" 12 , GLEN CIRCLE a I rvu Plan revision required? [] Yes I Q 1 r Use Other side for additional information. -7 SBD46710 (R 05/91) Date l rj, pe r` Signature Cert No- Uj=CCr%W% RANITARV PFRRAIT APPI IP.ATInN ,�.. -- - -- -- - - -- - - - -- ----_ _ _ _- - -- - - - - - -- _ In accord with ILHR 83.05, Wis. Adm. Code COUNTY ,1IITARY,PERMIT # STATE SA 101 Attach complete plans (to the county copy only) for the system, on paper not less than inches in 1:1 8% x 11 size. Checlif revision w)evious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION A %4U) 1/4, S T N, R (or). .2 LOT # BLOCK # PROPERTY OWf4F:R'S MAILING ADDRESS ClACE ZIP CODE PHONE NUMBER SUBDIY!.210N NAME ;,OR MZ BE 71, L17: ,.2, _ 4 '000P 11. TYPE OF BUILDING: ({Check one State Owned- Li CITY NEAREST ROAD VILLAGE E] Public 5§ 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 111111. BUILDING USE: (if building type is public, check all that apply) en 1 El Apt/Condo 2 El Assembly Hall 6 0 Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 1:1 Campground 7 ❑ Merchandise: Sales/Repairs 110 Restaurant/Bar/Dining 4 El Church/School 8 Mobile Home Park 12 0 Service Station/Car Wash 5 El Hotel/Motel 9 El Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. El Replacement 3. El Replacement of 4. El Reconnection of 5. El Repair of an System System Tank Only Existing System Existing System 13) EIA _Sanitary Permit was previously issued Perrnit# Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 5�r Seepage Bed 21 El Mound 30 El Specify Type 41 El Holding Tank 12 El Seepage Trench 22 El In -Ground 42 El Pit Privy 13 1:1 Seepage Pit Pressure 43 El Vault Privy 14 El System -in -Fill V 0 ABS V1. ABSORPTION SYSTEM INFORMATION: ORPTION SOR P' 1 . GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE G fAN S 0 RE E(s q. j t.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION (1-' Feet C Feet Vill. TANK V11. I TANK INFORMATION INFORMATION CAPACITY in gallons Total Gallons #of Tanks Manufacturer's Name Prefab Concrete Site Con- Steel Fiber- glass Plastic Exper. App. New xisting Tanks Tanks structed Septic Tank or Holdina Tank ig 1 7 Ll Lj I Lift Pump Tank/Siphon Chamberl F-1 I El I El I El Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No St mps) MP/MPRSW No.: Business Phone Number: < L JP 0&r, 7 ? Plumber's Ad6ress (Street, City, Stat6, Zip Code): 'eat IX. COUNTY/DEPARTMENT USE ONLY Approved Disapproved ©owner Given Initial Sanitary Permit Fee (includes Groundwater p)Surcharge Fee) o;pl-) 0 --- 4 0, U Date Issued Issuing Agent o Stamps) Adverse Determinition 1 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. . of �" gar" `�"„ ► }ay` b+ renewed before ? ;� f 'Y ` o ' '�. �,t tho t y -► -, °� ail rng,� l e ► .r criteria in the Wisconsin Administrative Cade will be applicable. 3. All revisions to this permit must be approved by the permit issuing authol-ity.. 4 Changes now ownership or plumber raga►res a Sanitary Permit Tr nsfer:�Renewal Fore; ISBN 93 9) to be submitted to the county prior to installation. 5_ Onsite sewage systems must be property maintained. The septic tank(s� mu-st be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or, the State of Wisconsin, Safety & Buildings Division, 608--266-3815. To be complete and accurate this sanitary permit application roust include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. V11. Tank information. Fill in the capacity of every new and/or existing hank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site cr.�nstrUcted and tank material, Complete for all septic, purnplsiphon and holding tanks for this system. ,,heck experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in nary e, license number with appropriate prefix (e.g,. MP, etc.), address and phone number. Plumber must sign application form. X County/Department Use only. X. Co ntyl Department Use only. Complete p"ans and specifications not smaller t1han 8'� x 1 ;riches n-� s be submitted to the c;ountv. The plans must ► include the following: A) plot plan, drawn to sca!e or with �'_op� t� 01 o lef�Er.�°�en��$�}��Y iOcr) of ho kill!ng to k�a(s), se- tic i,lank(s) ofr` "' � r f Sieatr--'--,n1 tanker, ��s� �i,.-};_• ^� b'ie 140��'":_ .;..'�#4�' .•r'::�i.�^:� �..I �i! _. r w� �.�:':s� ..`�srl�?���? r �j �� -� r q t i j� L�} i r`_' ens and laL-;es-, p s; 1 n. or is' � hoi� tanks, d -�'`.z..fi g? +f.��'p7���'a �i,�hi�yC' 1^4t•�', .��y,f•f�rr�:5,4t`3� ���r+Lt�ar� i�� ! L3��'g�`=� �;e 4.e �f es y sf�.c !.' F / e y a i E- p d h ! L hw "•.° f R �. a' y •.. - 9 4 .' 1 .5 7r areas- and the location of the buillding servo - ' her, on"kal 'l��� �����'���-5 �b�Ie V ,-.0r; ric, f r !v- CC. ' po; its- w' c s plat specifications # Pumps andcontrols; ,� ^RR0:" '� Ids � + ► ^� ; " z� �� i�. °,. ; t= =:�� 3 � P ya. ,�,� Y' ^� �'�j•+� �''a curve; ` p /�] r� ' i 1i and pump * } . $ g( i y� cross 'j {•� �v �. - /'�• ��i^! x..,!$:i +� s� a.: if �.b performance r! S ance �.lu ► e; p� nip oriel a i�� pS,Rm niG nu! ach. .,, et'. , D) 'cross ��'"i.�Slk.:�a S of Lhe so;; -- bso pi.in,i�'..y ��•��.�Ar�; io required by the county, F,) sail test data (in a 11.5 fore and F1 all-siz (1014 � GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges fees; 1or a EAM•$l,,,'_A_ of regulated practices which can effect groundwater. : -: Fr)Lj,g1 `=s are tjscx vtTi .sst r�charge .. �: water, investigations' rand estc-bl ishmant of SBD-6398 (R_11/88) 7'A Lt -3 0 1q 4 0-,g Ae �. --c, A-f- 10, rZo Fresh Air InI016 And Observation Pipe - Approved Vent Cap Minimum 12" Above Final Grade rn DISTRIBUT 10F.1 PIPF--� APPROVED S40 ETIC COVER -T 9 AW OR. 911 OF S OR MAKS" H 0FAG(j91:-GAJE,---� P� out - CRY , 9 n f- F AGGRE AT t:LF—V. OF dt .6mmumd" 7%6 IL D I S-r T-1.0 U, PJPE TQ PK A, T L.V- k S 7 1,►JICHIES 8,1:,L,0\A/ OFIGN-�- P, Te Ht: AM L4 2- Ak-) A.. 7k�. �.k 0 1 S �.1�0 �C V/ I L L B L u c 4E Pk-e-ni. Or- F-.XcAVAT10Q rAOM OR16*JAL ��'°. 1�,�h����., ]���t� SILL. BC IMCHIES M, Qi�rp Tli Or- CACVA, TIO .0 77 LICLUSE k.IUMBF-R:// DATE Eli' ' A P f MENT OFsi'Nrz�.TY BUILDINGS REPORT ON S���~�BORNGS AND DIVISION r,1�I '.�,if4J�.� �' (). BOX 7969 PERCOLATION TESTS (115) 10 i�. D 1,� 0 N, W 1 5 3 70 7UNIAN I'A`L'VF)ONKS'(H63.09f1) t Chapter 145.045) . J . u P. flivu.; R zctiL A 1%) A M C V - 4T 7 7- T C"i, L W 55 AMD p/pM A,I>Ge -rerpr..4C-F. DATES OBSERVATIONS MADE 5FICE-1517IM"prions.- PFFIC0 AT 7;FSTS: A. L_ - I (_-v -_ 'I / XNOW r-jrjel)14�c# 7/ / zg�e Ze Moo I L SIP6- )(Cz Y..o ph... P-b r 4TING: 1.3- Sott.- suitable for systevi U4. Site 11"Suilablip for system Nt I ilqkt.. e. 1, YSTEM4 N+ LrOLDI G TANK:,RECOMMENDED SYSTEM (optional) 9SL "IU , 'Wou S'DU EMS' ElULi S U ?'vlV, "04,4! N(lil.( (1(111 lit 4101 tiny portion of the tested alron k In tht., !:�LAI; 6 3�. M 01 Floodplolnv F , illcliciltloodplain .01(tvallow c < D��TMPt-i- PROFILE MCRIPTIONS AND DEPTH !I? I "o, Lt! I 'WA I t Q 14 El _',1;00C'WjYH 'rkltK IMIA,14 ioi l"TTMI J1faq.K I . 0 8 S E 14 V--0 WE ABBRV. ON BACK.} ).30' 8L S,%j_ T-S; /, Z 0 Spq S; L) 61 10 0 45AJ rs e4 s .' L o p %Nj Tn 2, 0 lepo, 3-7 1l.1 o rat ar l...y 2. 0 1,0o' Bi- S . ' L 7-,S; O.eO t3oj 5-* 4o 4 Aje) r,4re� 7 7. /oz, 5 8 0 1 70' 8j_ 5.'L 7,15; ZIZ.01 lea �31%/ S so, ?..D 0 A10 Mr- -7. C) M 4­ 0, S .'L T'S; 1.7o, 3" %.'L; 1.00 iE6 OAJ doS > 7. 7.. U 4-. 0 0' i PERCOLATION TESTS W-) DHOF TN"WAT TITT 9\/ E L-I NC H 0i MINUTE IT. T T I M F- RAI E TEH SWE I. L I NG INT L-MIN. P-11-11 _�CT_­_ PER INCH F. MO z > < FLFIV ST.J. ,I, i, 1 19, -oi pirt;oli6on -�-,cfll liwings iv)d th dirn n6ions of 14! c.) r t -scrib6 what arty tho hori Qu.'aflom 0 e sultrioln Guil Alre.4%. Ind,rate m") -listonois ut ;lit otol ;,.plrlvmi 011-tvAtirvi point- md 0-jovv th6i location 43so the plot plan. Show dick surt.-jce, eltivnrionat Lilt tnirioq% oric., vif.- (woution dn(1't)0rc0nt YSTEM ELEVATION _T_ tN �wloby t,ertf tv that lov, �-(Jll testy 1%xifted On this form were 11fade by My mveccif-d with t.hki pi-ormtorer, find nwthodslqx%ified i!l ttw wiscoll.&M . t,tilLi I - I ;;,w,1%t! Ccclu, ,irxl thq (.4*ta rvC1jj'd(tt.1 4110 It.9 Jocatjutt r) I tho tests are correct to thm hest of nly 4 nowk-111s. mo. 1 114! 114f C 'D OW �A A I P 1,111MI-1H P 10 N 3V6 11-v #5 P_ 4j. N A 11.111 4:) V F f a Iq Lp a Lv Z- r a 11� a0, �y\'D � ib N Ave WONO 011 -do �/rayou�a.] ova cnp�i,�D.�/ � ir��yr,po• , . toil w 0 ci, 0 11 V -Doi -;U 6 uJ 0 0 W 41-V "3t 0 81 z W J CL z D 4zr j 0 • C', e 118.11, ` F Jpo 00 10 0 L 13EC NOTE) 49115Z "W M^ Nab" 4y, :)e 11� ....---.--GLENMONT- 14 dfi•A C K m 0 D -0e 1 J J r- Z WOM OQTLOT I TO St RETAINED BY OWNERS -LISTED Ht"O" AS A NOMCO14FOAWIWO LOT AS PER wISCON31W ADWHISTRATIVE a awn IT CFIOIX AT N40WN A Ik C>i j TA, V4 r- C 1% f- 3 1 3 8 "W 13 3 0 9 5-3 164 H 'T AWC^LC TO "(-'CL-r" oKjc.%4-• DFW*Y OW Cti—F—NMONT RGA,0 UNPLATTED LANDS OWNED BY OTHERS LOCATION MAP CODE CHAP I LK r%R 61 ui At COUNTY ZONING ORDINANCE CRAPTIER I'S 7: 0 SEC- 25, T 284- 920W�- 10 0 0 x 0 14 W YkA a� 0 7 U) 0 *-E N V 11% T H 0 A 0 L AJ Ix C� 0 loci 7- SCALE 1000' Er 0 N -z 0 3 r T IM SHEET I OF 2 ..W J S T C 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER, 01A L'A 1, 4Q ADDRESS c�� �J CITY /STATE_ ik.vv �.X C?�,I1 PROPERTY LOCATION:,�,1/4, 1/4, SECTION�TcQ9 N—R-�_W FIRE NUMBER TOWN OF d 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 consists 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 of f ect the function of the septic tank as a treatment stage in the waste disposal system, St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. cro lox County accepted this program in August of 198o, with the requirement that owners of all new systems agree to keep their system properly maintained, T ' he property owner agrees to submit to St. Croix Zoning a certification 'form, signed by the owner and by a matey plumber, journeyman plumber, ' restricted plumber or a licensed pumper verifying that (1). the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements, and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiratio di te0 SIGNED:. ECA DATE St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 STC--1®o This application form is to be completed in full and signed b owners of tale inadequacies 9 � �the( ) property being developed, Any will only reauLin delays or t1jo erffl.it .isgua � nce . Should this development be intended for resale by owner/contractor,(spec )louse), then+a second form should be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. -wr r.....w- w-www-www r•-raww-ww--rr ww---ww---ww--w-w--www-www------------------- A Owner of property1441_q�44 Location of - property—NiLl/4 1/4 , Section T, g N-RcD6 W Township Mailing address Address of siter�' Subdivision name7h ►)n Lot no. Other homes on property? yes No Previous owner of property Total size of parcel, Date parcel -was created 'Are all corners and lot lanes identific.ble? k Yes No Is this property being developed for (spec house)?_Yes No Volume .and Page Number 5j as recorded wi th ith the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER i & THE SEAL E OF THE, REGISTER OF DEEDS. In addition, a certified survey, f available, would be helpful so as to avoid delays of the reviewing process. If the deed description .references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on th"s form are true to the best of my (our) knowledge that I (we) nm (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded. in the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction ,of said system, and the same has been duly recorded, in e of Tice of County Register of deeds as Document N o.\. IT.. _�_. Signatur of applicant Co-applican I 116'/ Date of Signature Date of Signature (^ `` - - -- ---'7 - - .� DOCUMENT NO. WARRANTY DEED n�wr� n���comam�roa�u xm� 1 ' e�o _ / ��7��7~� ` ` 9ft)?Aa �r�VOL �n'x . l .������'��..��������.��.single .������_______.__.. --'--'-'---'---'----'---'-'-------'----'--' 1 --- ----------------------'---'------ '| ` ��.��+e^�.p��������.����-_' ............... ............. ........................................ ..................... .................... -......................................... ................................. ............................... -..................................................................... ...................................... ............................................................................................................... -'---------------------- .................................................................................. -- ---.----.. , the f0lowing described real estate in .......... �........................... County, , State "«Wisconsin: �Lot Twelve (1s),St. Croix Highlands in the Town of Troy, County, Wisconsin. St,% Croix *61rup"41 TO is not This ............................ homestead property. � 0* (is not) � Exception towarranties* � Dated this - ------._'mw,r -------------------(nEAL) .. ���^/ "______________---------------- ^_,�����.e^.�����'.----------------- ----------------------------------------------------------- .----'-_'----_-..................... ---.... ........................ ..................... ...... (mE^L) , ---............. ........ ... ....... .......... .... -. AUTHENTICATION ACKNOWLEDGMENT m4�"��*/ ------------------------------------------------------------ STATE nnW�Comaov - 33. authenticated this ........ day zm_-'Fe�rsqlly came before me thi .................................... .................................... .......................................................... W ---------- TITLE . MEMBER STATE BAR OF WISoommm ..................................................... ............ ....... .-. ^if authorized ~"" '~~~~ W--'-^ to me known to be the person Who executed the THIS INSTRUMENT WAS DRAFTED BY aw . �4 -'--------0L.' ----------'----' /�- . z Wisconsin.��g�___~_.__ ` 49 --------- -County, Wig. (Signatures may be a������� "f``��� ~ ��^,` �_ expiration�_ are not "=es"ary.) omm' ............ --J��n�Tnx�rn�#n�'uw......... � ^m"tnes of^ers"nssigning many capacity should ` typed ~ printed below °~.,is~tu,~ Nourymm.c am"oCol u My Con. musicn Expires J3:.u.��.` ST°`���������u� Stock N�V3m02