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HomeMy WebLinkAbout020-1057-60-400 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ ADDRESS SUBDIVISION / CSM## "ge~~ti LOT SECTION ~Z. T_9 N-RI ~ W, Town of ST. CROIX COUNTY, WISCONSIN , PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Poe sr i 2 ' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. } BENCHMARK: Gb; ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: [r Liquid Capacity: Setback from: Well House_ / X* Other-- Pump: Manufacturer Model Size Float seperation G s/eyc Alarm Locatio SOIL ABSORPTION SYSTEM / S ` Width: /.2- Length g -am' Number of a era 4 Distance & Direction to nearest prop. line: SB ' Setback from: well House 1 ' Other ELEVATIONS: ~~•OZ Building Sewer ~ e-1- ST Inlet. y~ S Z ~ ST outlet PC inlet PC bottom. Pump Off Header/Manifolds 76 Bottom of system- 'yv Existing-Grade '7 Final grade f f g r DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: kM4 Cn15 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: PeBV I erb TRUCTION ❑ City ❑ Village 1~ Town of: State Pl anID No.: CST BM Elev.: Insp. BM Elev.: , BM Description: Parcel Tax No.: /lrv. c') 140, cd I A9600020 TANK INFORMATION ELEVATION DATA C8 °~%6 TYPE MANUFACTURER CAPACITY STATION BS- HI FS ELEV. Septic S' Benchmark , Gtr ("ale /0 Dosing 101-56 1 Aeratio Bldg. Sewer (0 7~~ 7 16 olding St/ Inlet ( v' TANK SETBACK INFORMATION St/Wt Outlet .29 96,~;~ ' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet - Air Intake Septic sv NA Dt Bottom Dosing NA Header /1IU022 Aeration NA Dist. Pipe 7 u6 9 /(o ° Hold' g Bot. System PUMP/ SIPHON INFORMATION Final Grade 3'o 9$- /6' Manufacturer Demand 99 Ig' Model Number GPM 4 9q TDH Lift Iction System TDH Ft to oj Loss He d F cemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of renches PI No. Of Pits Inside Dia. Liquid Depth DIMENSION ~a DI N SYSTEM TO P / L BLDG WELL LAKE / STREA HIN adurer: SETBACK INFORMATION TypeO //eir ✓ CHAMBER- M System: c~ OR UNIT DISTRIBUTION SYSTEM F} / Manifold i Distribution Pipe(s) /r r x Hole Size x Hole Spacing Vent To Air Intake Length - Dia. Length 1 Dia. ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grad stems On y Depth Over & Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed / TAsel*Center Bed / Roeeh Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) f 145 8CLJ&/1kt LOCATION: HUDSON. 2.29.19W, NW SE, CSM #5, IGHWAY 12 - CJ%~l~P /~Ck'ft✓T c Gf~v^(VQ .CQ~' ~QcU^ ~t'j C✓C~fT7 GYM lJ ~'/1 C/ r Plan revision required? ❑ Yes R""' / Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signat a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I i Safety and Buildings Division ~~.i_'■'~■~r'i SANITARY PERMIT APPLICATION Bureau of Building Water System, 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 5g4426 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 14 114,5 T z N,R / E( Pr perty Owner's Mailing Address Lot Number Block Number Cit State Zip Code (hone Number Su2&~ SM Num ber ~S y75 I; I © 8 6 . TYPE F UILDING: (check one) ❑ State Owned City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms _ T own of le7l G~ N 2- III. BUILDING USE: (if building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment/ Condo m2 0 - /O r 7 d 08 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4- ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Vj Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp- Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ,p t Elevation .3 -7 .7 JEZ~ Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel Plastic p New Existing strutted glass App. Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tan~/Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume respo ility for installation of th site sewage system shown on the attached plans. Plu ber's Name: (Print) Plumber's Signatur s PRSW No.: Business Phone Number: v U er's Address (S reet, ty, So(ate, Zip ode): d &0 r !,u a 3 IX. COUNTY DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑Owner Given Initial Surcharge Fee) ~ / Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SRI)-6398 (R. 05/94) DISTRIBUTION: Original to @ounly. One copy To: Safety & Buildings Di-.ion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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. 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. Onsite sewage systems must-be properly maintained. The septic tank(s) must 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 and Buildings Division, 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 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 Fam ly D;raelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, n.connection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers throug'-i r. VII. Tank Information- Fill in the capacity of every new/or existing tank, list the total gallons, nUrrh r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all't'ptic, pomp/siphon and holding tanks for this system. Check experimental approval only if tanks received experim rnt; product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with apprcpria._ prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department: Use Only. ro i'J!et ineciflcat (1' S i101_ smaller t ?<i 4 '2 X 11 InCtlr" it best- unty "Ie plans must i„cie:l~e r,e "<_,;,rw✓ir~ r A) pIo;t).an, drawn tc of rvith io~,;t,~ , dincq tank(s), septic ernt lvli `<< I~ti~ldlOq S61r'ri,' e j, water mi,F~4i i.i2r s~ rlj Str d ;=1 pump ors~phon ;,hcement sy,!,ti f he wilding served; complete ; e+ Clt,"" io! ~ UI-,r 1 Ontr~,~S, dose VOIUme; -C C ~e~ [ior 3;~~_ ctic pulap per" curve, pur..., ;j-np rT erg cross section of 0i,=_ soil absorpttur if required by th- cvt„ . , L) soil testd,u a a I ` J'- sizin~l information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges ;fees) for a number of regulated pr,ct ce s which can effect groundwater: The monies collected through these surcharges are used for monitoring groundwater contain nati :,rr investigations and establishment of standards 3 S737 ; h, 1F; h o c 3 O Z H I > ; YYv s~ sfi: ~c~ ~ f ° f VI\ ~ V v M Am ~~~wA o z z Z ~I I . ~ W i y v, 1 171 V_f (A 0) :y c abobor and-HumaDepartrnenttions Industry, L SOIL AND SITE EVALUATION REPORT Page/ of 3 . Labor Relations Division,of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1 Ogh s ze. Plan must include, but X'• ° not limited to vertical and horizontal reference p ' of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and di a o neare roa APPLICANT INFORMATION-PLEASE T All , I ~(ATI REVIEWED BY DATE PRO RTYO ER: S~ PERTYLOCATION C M(IVT. LOT Gv 1 /4 f 1/4,S -22 T ,N,R 9 E (oAO ERTY OWNERS MAI 1N A RESS 04~ s T # BLOCK # SUED. NAME OR CSM # -Zb ;9 CI , ST TE ZIP CO/DE P N ER xx []CITY ❑VIL E OWN NEAREST ROAD New Construction Use Residential / Number of bedrooms Y [ j Addition to existing building j j Replacement Public or commercial describe Code derived daily flow 440 gpd Recommended design loading rate 2 ed, gpd/ft2 . ,F trench, gpd/ft2 Absorption area required &,j~ bed, ft2 7S-V trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 . P trench, gpd/ft2 Recommended infiltration surface elevation(s) ftje~ . It (as referred to site plan benchmark) Additional design / site considerations LoT eSew ~/OL 2G "975' Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN tl HOLDING TANK U=Unsuitable fors stem S❑ U ❑ S [Z! U (Z] S❑ U D S O U D S V 13 S E U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botndaty Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o - cs 6/< i r R MA Ground 2- elev. f g ft. t. 1 Depth to 3 limiting • factor Remarks: Boring # G ound 2 ff 2~' - c 7c s6/< ,cst - Z elev. ff,L ft. Depth to .S - 6 limiting factor Remarks: CST Name:-Please Print Phone: Address: / c l r w,T J 104 3 Signature: Date: 7 /-~~lrT CST Number: 3~ PROPERTY OWNER . Z~W4 SOIL DESCRIPTION REPORT Page.2- of 3 'PARCEL I.D. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench C SC It #-4 Ground 2 - 2 / - 37C c Z elev. a2 ft. Dto limiting factor Remarks: Boring # 3 e 41' 4'.S 3- .y.. f'y 2• _ 1,6 ,Y round z - G elev. f8, d ft. Depth to 3 -3~ x • a - /-t c r v . , limiting factor 9 <a - 6 3 - s - - p Remarks: Ztj c a Boring # f 7 z Ground s' a- S v r s - elev. d.2 f t. Depth to 3 'Ty o - T s o / - , limiting factor Remarks: Boring # Ground elev. FOG RTY PLUMBI G ft. 0. Box 130 Depth to limiting factor Remarks: SBD-8330(R.05/92) • ~,4 ' DAVE FOWTV PLilbli Wa licensed Perk Tester i Plumber 113233 OM Fe y HoWits Read ROBEfITg.-VASGONSIN 54023 Phone 749-36 x 1S ' Q X ~ *q 1,f 9 sir / " = ~FJf/ '~fH7.+c /off •D P/~, _ 93.E GIST ~ /ao.~ r Ale . d~ za /z 8 rr X06 ~~cor~ N~tq< Q74 J~ A i G, f # 73oD r LOS I All. S. M. VOL. FAG. 621 VOL. PG. 2490 NORTF U. S. H. 1211 w N89°59' 16"E 364.34' 181.93' w - - - - - all N89°59'16"fir oo1 . ~ I _ ,ter...... . 15 ° m LOT 0 :a a OD 5 ,m ;,14 2.23 AC. 0 L'i C L ~~i_6O/•'rP.LL 97,104 S0. FT. ~pOno lot O ' I"W ~ phi = VOL. 1136 PG. 1481 LOT 6 rTS69°5916"W 323.18' 6 13 1 2.91 AC. Ln c N Z 126,914 SO. FT. O O O LI-W 40/ 4C. O U1 A~ (nW 1 QQN N N V I 1 LOT 2 p 2.27 AC. CD N 2.27 AC. ~N -N CD fTl I ro 98 , 849 S0, FT. I I I t 12 3CAIDE EASEMENT FOR ' / I / -1 I rJ N89°59'16"E 355.00' INGRESS 4NDE6RES5 f- \ FOR FUTURE USE / / I ~l LOT 3 r,; - ~ ~r D 2.10 AC. a 91,450 S0. FT. N88 09'52"W 266.01 ~j1 ' 9 11 1 ` I G7 11 °4'49 W Qz - `nvj• S I J 50.0./ Ir- , co S >S °°5 'oe •.E / \a~' 3.19 AC. G> r-aIr?CLL RE- pL ~r1LL. I^~ zi / LOT 5 LOT 4 _ - - - Io o I✓oL . PG. 2.00 AC. i S, o 87,166 SO. FT. I - - 1V N O0 V7, 2.33 AC. Co If - G P; 29 75 FT; 293.10' 66.00' 1N89°50' 17 "E 358.34' / LOS I 1 r1. t . S. 1W. f',, ✓0 L. PG. o 6f I 10 ' -9 PG. 2490 NORTH W N89°59'16"E - _ N89°59'16"E 364.34' © 181.93' 3 oOOo~ i eg a o p !1 4'I 00 m 1 . Z N LOT 16 , OA ° m ° M r 5 ' Q1 cl 2.23 AC. 14 N F',",RC~ L R7"O-;DLE /N 97,104 S0. FT. n 10 O C, VOL . 1136 PG. 481 LOT 6 - - - S89°59'16°W 323.18' 6 13 i 2.91 AC. cJ C Z 126,914 SO. FT. O O I< 4 01 AC. C? LOT 2 Q4 ~A~N I w rv I i YN 8N I ~p I_ U 2.27 AC. N~ N A -r O w 98,849 SOFT. In I r I 12 I ~f 7 r 3c' WIDE EASEMENT FOR N8 9°59'16"E 355.00' INGRESS AND EGRESS I_ \ FGR FUTURE USE 'r 1'1(7/ / / / I L LOT 3 c 2 10 Ac. / m 91,450 S0. FT I e U N88°09'52"W 266.01' A \ / / „W I G> I I> rev/ 81°41'49 Q2 I i, 50.00' r- Co S;'o 5 05 '0g 3 19 Ac. G> LL -RDED 1,"J LOT 4 _ - - A VOL. PG. W 10 0 - - - - W 2.00 AC. 1 t U CO k, ~A. 0 87,166 SO. FT. I - ro o N w I ° I 2.33 AC. ~ c~ I ° PG 2975 I rn NRQ°Fr1'17"[ -2rn STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 14417 MAILING ADDRESS. 5QG 75 Z ^-67. PROPERTY ADDRESS _ F57 rx 1Zq0 (location of septic system) Please obtain from the Planning Dept. CITY/STATE /bladf6/1 V u~ Yo~6 PROPERTY LOCATION Ntw 1/4, S,E 1/4, Section -X.2- , T 2 7 N-R /f_W TOWN OF 1160_40'o ST. CROIX COUNTY, WI SUBDIVISION d Eg&,L1L LOT NUMBER GS/K CERTIFIED SURVEY MAP VOLUME _,PAGE..? 9n-; 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 licensed septic tank pumper. What you put into the system can affect 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. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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 County Zoning Officer within 30 days of the three year xpiration Ite'l SIGNED: hr~ DATE: Z Z g St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • S T C - 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 /lcL Ti¢ 0Wx7 Z Location of property_d[,k) 1/4 Ca 1/4, Section 22 T2-9 N-R W Township 64aArVA'I Mailing address Address of site J"J Subdivision name ~j~,€sQc~ f j,✓ Lot no. Crhl Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel ,-1eA.Qer Date parcel was created 49fr Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house)? Yes __j,,=No Volume 4-SV and Page Number //I 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (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. 3 ~m 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 the office of the County Register of Deeds as Document No. 7 /O2- S LatuV f JAApp Co-Applicant Z Date of Signature Date of Signature . • DOCUMENT NO. WARnANTY DEED - TNIS SPA.E RESERVED FOR RECOROINO DATA STATE BAR OF WISCONSIN FORS[ 2-1982 t S Crc;it 5376VOL 1154PA'_ 11-3 _ - i C"IMCOOVI R ; d for R~ ord ~I EDWIN. _-C....ALBERGs. a---single. person,- Grantor. D EC 1 9 1995 - - t 10.30 A. z11 conveys and warrants to .DELTA-_CONSTRUCTION-.CQMPANYL-_-a._-__ , Minnesota...corporation-- a/k/a--aELTA_-CONSTRUCTION it Gran.tee--------•----------.. !i . iI • • _==='I D I ii RETURN TO the following described real estate in St.....CX:02.X--------------------- County, State of Wisconsin: Tax Parcel No: 4r.T- 6 i I; I art of SW4 of NE4 and Part of NW4 of SE4 of Section 22-29-19 i~ ,scribed as follows: Lots 2, 3, 4 and 5 of Certified Survey Map sled August 16, 1995 in Vol. "11", Page 2975 EXCEPT Certified I~ urvey Map Lion t "7", Page 1817 and EXCEPT Commencing at the NW !I orn,r of Lot V2 0l- Certified Survey Map in Vol. "11", Page 2975; hence S00016135"E 500.01; thence M89-59116"E 355.0'; thence 00016135"1N 500.0' to the North line of said Lot 2; thence 89°59116"iii 355.0' along the North line of said Lot 2 to the Point If Beginning - f • I This deed given in satisfaction of the Land Contract dated July 28, 1995, recorded August 23, 1995 in Volume 1136, Page 607, as Document #532930, in the office of the Register of Deeds, St. Croix County, Wisconsin. This ...i S...l?G t______-__-_ homestead property. (is) (is not) ,I Exception to warranties: Easements, covenants, and other restrictions of record, if any. • ~I Dated this 1Z................... day of •---•----December------------ 19.95-.. i1 I. (SEAL) (SEP.L) , Edialn C.• A.lbe. ---•---•-•-•---•--•••-••--•-•---.(SEAL) (SEAL) i s I - II s i SNO LSDOMENT I I.i.. Signature(s) I r A. Ed1d1.A._ CC $lher STATE OF WISCONSIN ss. I) --------------------County. authenticated this _.12_.day of.__ 8cember__., 19_.95 plasonally came before me this ................day of ? 19-----.-- the above named 1 ; - y _ - j. +.Thnmas__A_._Da.hls---•••--_..••----•--------------•-----•- TITLE: MEMBER STATE BAR OF WISCONSIN (If not. I authorized by 4 706.06, Wis. Stats.) to me knosn to be the person who executed the foregoiW instrument and acknowledge the same. If THIS INSTRUMENT WAS DRAFTED BY II