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HomeMy WebLinkAbout026-1078-70-110 C c -0 I p Q) M y 4 w tl n O N ti y I `O I ~ I I J N C LL C O Q Cl) z " z E °o v E L z y N IM- z a m o O z c U z ° o to t- c z _0 co aD y N ~ co N N N N C N N • N FV i d a O 0 Z co z N a ro I N E O N (V O d L d a (O - a Q t+ C L co H m 0 °o ° o G D a N X 0 0 0 FL 0- Z01* •n•~ m ~aaa , E A Z to to N ~i O (n V1 r U rn rn } > a L O W O m CL LO < o N p O O N N E O ~i On M O O C U) 0 0 a) c 9 [L 0) °O N W c w C C N p pp I- fn • 04 r U O d0' q 0 (D (V r'Cj 0 C!J O N CC Z N O z -1 • m a m U d y C r~ E L C C r A L)ILE ',oV1U I STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER et,b-P-ti-~- o p k1 hS ADDRESS ~S b --~-~~LG~~iYYL0~1c~ lt.J~C SUBDIVISION / CSM# LOT # SECTION~ZT -3D N-R_Z~f_W , Town of -4my ncLlST. CROIX COUNTY, WISCONSIN PL VIE SHOW EVERYTHING WI HIN 10 FEET OF SYSTEM \ Is/ ~~O r 3b ~ 5D INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ~F . a ) V,, a BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: A n Setback from: Well No &jz House f$ Other Pump: Manufacturer IV /A Model# Size Float seperation A Gallons/cycle: Alarm Location A) -:SOIL ABSORPTION SYSTEM Width: fJ.- Length s.a. Number of trenches Distance & Direction to nearest prop. line: Soy SO Setback from: well: N,8 House Other c~ ELEVATIONS o~ Building Sewer ST Inlet. 6 ST outlet 'D PC inlet PC bottom Pump Off Header/Manifold 'D+( Bottom of system 9 7 Existing Grade /cr&- Final grade DATE OF INSTALLATION: -/"r PLUMBER ON JOB: LICENSE NUMBER: JS (Q3 INSPECTOR: 3/93:jt Milli, - Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: taffeety aand Human Relati nd Buildings D viission INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Peif6r Altlgj Narry~OHERT ❑ City ❑ Village Town of: State Plan o.: CST BM Elev.: It Insp. BM Elev.: BM Description: Parcel Tax No.: Q /00, I "k ~ Z y fir' TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic- Benchmark 105 !06. Dosing f. Aeration Bldg. Sewer Holding St/ Ht Inlet 19. 6 TANK SETBACK INFORMATION St / Ht Outlet 99,22 Vent TANK TO P/ L WELL BLDG. A irIntato ke ROAD Dt Inlet Ar Septic NA Dt Bottom Dosing NA Header/ Man._ Aeration NA Dist. Pipe t1_ ` 97_ `HIV Holding Bot. System g, a° 9//. PUMP/ SIPHON INFORMATION Final Grade q, 4, Manufacturer Demand``, Model Number GPM TDH Lift Lricti etem TDH Ft Forcemain Len oil/ Dia. dirt To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER / Model Number: System: SU ~lo (J/~ 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 COVER 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 Centers Bed /Trench Edges a4 p' Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Richmond.27.30.18W, NW, NW, Lot 1, 144th Avenue Plan revision required? ❑ Yes ff No Use other side for additional information. 1-3o SBD-6710 (R 05/91) Date Inspector's Signature Cert . No. SANITARY PERMIT APPLICATION t.'~L■ ■R 1 ; In accord with ILHR 83.05, Wis.. Adm. Code COUNTY 5/ ~ G r0 STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~ 8% x 11 inches in size. ❑ Checkvision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPS JW~NER PROPERTY LOCATION v -1 S Y4/Vtj Y4, S T 30, N, R/ or) W PROPERTYOWNER'S MAILING ADDRESS LOT # BLOCK # a,-5, A40ti v .e, N A • CITY, STAT ZIP CCODQ' PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER n 54E 7 AP nt II. TYPE OF BUILDING: Check one CITY / G NEAREST ROAD ~r ( ) ❑ State Owned ❑ VILLAGE ❑ Public 1~ 1 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 6,2 4 14 7 k - 7.0 //D 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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 in line A. Check line B if applicable) A) 1. 45, New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 N Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 i 1✓ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Q i ELEVATION & /5 look a *7,3 / Feet I&r Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks Concrete structed glass App. Septic Tank or Holding Tank Tanks Tanks elm ~ F-1 1 F-1 El Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu er's Signatu e: o Ste ps) l4ilr/MPRSW No.: Business Phone Number: 15 6 3 7/,S` a YG -~S/S Plumber's Address (Street, City, State, Z' Code): '19,4610 7 IX. COUNTY/DEPARTMENT USE ONLY e Issued I ng Agent Sig t (No Stamps) ❑ Disapproved San' ary Permit Fee (includes Groundwater a~ L~[1 Approved El Owner Given Initial Surcharge Fee) ~ _7T / 141JA-cr Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A 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. 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. Onsit6-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 quesUpns 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 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 Family Dwelling. III. 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. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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; pump or siphon tanks; 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; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) t r- I• : ~ t i A)W 1 Z I s : S 1 I 3 i __C~ C'„! l/h Cl~t• hA r"To P.~ ~Ck?. / - T • " d V • j I I I - ~ s y_ k E t Y v ) i 1 ~ . t , ' Y : t ! I y "Al - JL- k I _ .:._.._t 1 y.. ~ i. , , 1 4 , y F i i I I ~ E a i TTI I b t t 14 s - ^ ~ 1a e "K Irk s 1.~ L7b 0-r PAGE OF C,rvSS Sec~lon o~ ~ Sys~en-~ Fresh Air Inlets And Observation Pipe Approved Vent Cap Mlnlmwn 12" Above Final Grade 20- 42" Above Pipe _ 4" Cast Iron To Final Grade Vent Pipe Marsh Hay Or Synthetic Covering min. 2" Aggregate I Over Pipe - Ol~tributlon - Tea Pipe 0 0 0 0 j 6" Aggregate . o Periotated Pipe Below Beneath Pipe 0 -Covpiiag Terminating At Bottom 01 System tJ ~ Prp~oSe~ ~Inal: 9rc%cl< .SOIL. FILL DISTRIBUTIOM PIPE APPROVED $4WNETIC COVER ° -MATpp _ OR q" OF STRAW 2" OF AGGREWE OR IJARSN HAy p8 (o .OF 12 - P-'/i AG GREGATI- t.LEV. OF FEET_._ DIS-rRIl5UTI0 J PIPE TO BE AT LEAST INCHES BELOW ORIGINAL GRADE AQU AT LEASTZO INCNES BUT,IJO MORE THAN 42 IMCNES BELOW FINAL GRADE MMIMUPM WN OF EXCAVATIOP FROM OKi&w AL 6RAK. WILL BE ~O INCNEs MIK1MUM gff r1i of FACAVATION f.ROM IOIWqL ORaD€ WILL BE INCHES SIGHED: LICEkJSE ►JUMBER: U a INQUS RY-, - OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INf~USTRY; 1 c DIVISION LABbR AN P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 3707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TO SHIP/MUNICIPAL/ITY: LOT NO.:BLK. NO.: S DIVISION NAME- s Nlo~/ ~ M'7 /T3nN/R l~ (or)W /~hrnjantf ~ 41k ~i /4 O ft'( o COUNTY: OkNER'S BUYER'S NAME: MAILING ADDRESS- 54, CC'roaX l G h 't'rcl a kxrs ~.t.J l'C,c -^cl C,15 x y 0 / 7 USE DATES OBSERVATIO MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence /V 1 New ❑Replace I -~v t~9 C' RATING: S= Site suitable for system U= Site unsuitable for system Y u r , P"y D ONVENTIONAL: MOUND: IN- RO NDPRF~SURE: S STEM-IN-FILL HOLDING TANK: R CO MENDED SYSTEM: (optional) S DU S OU S DU 0S ZU CJS If Percolation Tests are NOT required DESIGN RATE: 4 If any portion of the tested area is in the j~f under s.H63.09(5)(b), indicate: C/)ljs Floodplain, indicate Floodplain elevation: ~V PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED T. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 6= / -7 /9 None. 7 , , s•t- ~r I - y4 8 -r s J/4 - 7 4t 54 r B- 7 1U D n .Q D . 7 5 /J / 7 - 3 ► s/ r d j 43 (v 6n Js *L O-.b 81 5~ G Lan s/+~rJ lici ~-01~1 5 -0j~ B-3 7 IOd o'r-Z 7 s il,5'- Ct tlk N 9 6 /1 3 S/J / • - 3, / e. S' 1 4- 1 -S', 4 9, + ~ B- 3 i - J 9- r• B- 3 cti 0--,9 C31 s/~ /y-/. y 13,,5,/07 0 I/ Od,6 CE rs ~S i -3y "-t r B- l~c., St PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 4AWY-hES AFTERSWELLING INTERVAL-MIN. PERIOD t P RI D 2 PERIOD PER INCH' P_ 3,1 3 -3 P' ATE _0 i P. U 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 g 7 #/0 T jPrP~aS l ; i ' i _7 r I ' - - r ~ Ii i I f - r r I r ~ ~ ~ r ~ , ~ I, ~ r / i 1 _ r r 3 r ayaltr P I r r r V O 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures n '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 nt : TESTS WERE COMPLETED ON: 10_ 3v - 89' ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - r , 458588 CERTIFIED SURVEY MAR Located in the NW 1/4 of'the NW 1/4 of Section 27, T30N, R 18W, Town of Richmond, St. Croix County, Wisconsin. l NI/4 CORNER SECTION 27 YY^ J30N, R'18W UNPLATTED LANDS ai rn EAST LINE OF THE NW 1/4 OF THE NW 1/4 SO°18'02"E _ u► ____3530' S ' 147.68' S 00' 18' 02"E 434.97' I -0-~ w 399.67 7c D I O FENCE CID 1 I I1 M O z I I l l Z co I I I II ~ I 101 II ® LOT I 3 I 194192 Sq.. Ft.,. (4:,458 A)r, FILED a z I Including R -O -W = I / 179024 Sq, Ft. (4. 11 Ac) M in MAY 161990" I Excluding R -O -W U_ M Z JAMES O'CONN_s 0 ~ O Register of Does z I l h l0) s St Croix Co•. W1 = W tu/ i 0 0 1 In z~ ~I I a P/ 33.6S 00*18'01'E 471.04' UNPLATTED V I I m m. ---------L-A-N-DS 437.35' o LOT 2 APPROVED 123101 Sq. Ft, (2,826 Ac) w Including R -O -W MAY 16 1990 wl I 1 p 114743 Sq. Ft. (2,634 Ac) in I b Excluding R-O-W a COt PAWS COUNTY PPIM~G n 1 _ AM ZONING C00ATIV of ci_ 1 0 (D ID 461.89' Owned by: W " Wil X133.111 N 0018'02"W 495.00' NI zll N I Richard Hopkins w11 UNPLATTED _LALVDS Route 4 I 1 I New Richmond, W i. a; of 1 w I BEARINGS REFERENCED TO THE 54017 ZI 11 COn OD WEST LINE OF THE NWI/4, al HII C 1 ASSUMED S '.00 17.'00"E. J 1 SI ~I 011o N I ~i v_1 CD 1 I '1 z i _j~1 I 133' 33'1 al ~ I 1\ SCALE IN FEET 1" = 150' t . 150' 75 0' 75 150' 300' I \ \ \ A=35°1056 LEGEND K=375.00, \ \ R \ \ \ CHORD o226.67 ST. CROIX COUNTY SECTION N67 17'30 E CORNER MONUMENT L = 230.27' \ O I"X 24" ROUND IRON PIPE WEIGHING I HOUSE \ \ 1 .68 LBS . /LI N . FT. SET. \ , 9c \ \ 0 WI/4 CORNER NW CORNER SECTION 27 SEC. 27 (20TH _ STREET S001 7' 00"E 348.70 ' - tMr> 2294.33 ' 2643.03 ' WEST LINE OF THE 490-1686 NWI /4 DRAFTED BY JWG VOLUME 8 PAGE 2207 STC - IOS SEPTIC TANK MAINTENANCE AGREEMENT Ro St. Croix County OWNERIBUYER L~lc ,r , MAQ.ING ADDRESS, J' C-) PROPERTY ADDRESS )440Ah A. (location of septic system) Please obtain from the Planning Dept. CITY/STATE (1-N YN!,o nil PROPERTY LOCATION N \A-~ 1/4, N V) 114, Section c~7 T ~ N-R W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAPS \clc11VOLUME , PAGE AO LOT NUMBER 1 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 (I) 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. l 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 Cron County Zoning Officer within 30 days of the three year expiration date SIGNED: ~_'601 _ DATA©' St. Croix County Zoning Office Government Center 1101 Carmichael (toad liudson, Wi 54016 t U=vcivpmt:irL L)e inr_enaea ror resale Ay 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. 4O ~ 9 F- ~ 04 r~_s Location of property k - 1/4Myti1/4 , Section -7 , T3c)N-R~'~ W Township me A Mailingaddress f v'l~~ /yall, ve r 5 017 Address of site ► % y C Subdivision name Lot no. Other homes on property? Yes _No Previous owner of property 1 1A 1C, rt-S Total size of property Gtr acts Total size of parcel Date parcel was created - S Are all corners and lot lines identifiable? -4--yes No Is this property being developed for (spec house) ? Yes x No Volume and Page Number 57U 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 i the office of the County Register of Deeds as Document No. . .345 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. 533-!1 : (n G~ Signature of p icant Co-Applicant Date of Signature Date of Signature r Jv3533450 State Bar of Wisconsin Form 2i~i"I' WARRANTY DEED REGISTER'S OFFICE DOCUMENT NO. ST. CROIX CO., WI Redd for Record Richard W. Hopkins and Wanda D Hopkins, SEP 6 1996 at 9:30 A.M conveys and warrants to Robert W. Hopkins and Brenda J. Regl W6f Deeft Hopkins /0 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix _ County, State of Wisconsin: (e©7 7 ` L (Parcel Identification Number) 07~ Part of the NWJ of the NWJ of Section 27, Township 30 North, Range 18 West, l escribed as follows: Lot One (1) of Certified Survey Maps filed May 16, 1990 in Volume Eight (8), Page 2207 as Document No. 458588. ' o EXEMPT UZ This is not homestead property. (is) (is not) Exception to warranties: Dated this 31st day of August , 19 95 t (SEAL) "41 ~ (SEAL) * * Richard W. Hopkinees (SEAL)-~ ~f~rst~t~ (SEAL) * * Wanda D. Hopkins AUTHENTICATION ACKNOWLEDGMENT Signature(s) Richard W. Hopkins and STATE OF WISCONSIN SS. Wanda D. Hopkins St. Croix County. authenticated this day of , 19 Personally came before me this 31st day of August 119 95 the above named Richard W Hopkins and * Hendrik W. Van Dyk Wanda D. Hopkins TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me known to be the erson s who executed the foregoing instru It ledge the same. tti1, ~ ~II~N THIS INSTRUMENT WAS DRAFTED BYMa`% REINSTRA & VAN DYK, S.C. ZU1 South Knowles venue New Richmondd W1 5401 7 _ Notary Public t County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is ?&Mnent; (If )tot, state expiration date: :97 necessary.) yul Q a 1 19 ) "Names of persons signing in any capacity should be typed or printed below their signatures. N'rV STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. ~"'~!+ttA I11~F1) ~ Milwnnlu ~ Wi•. F01!Rl No. 2 - 1982