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HomeMy WebLinkAbout030-1015-20-000 ~ -0 o '`C o 3 0 o ti 0 6F). ti d M O O (D N O O Oj a /y Jl N CWX vv N C o U tl1 N Y C O eN. w0 .N C N 0-2 C3 h t O CL E~ (n CL U) 0) CL (D , C3 O O z a O lL 6 f0 _ O f0 N 3 " L N L6 E Q N C 3 Cl) d' N z N rn z = O rn ~ z H a m v z ~ o O z U a' r 7 ~ w d Z c z m H N C E '2 ~ N M N C d w y N N •IV O a U L _ o O 0 z co z 16 w z '0 1 N co c ~ V w r N m a co d - N m U a .r c m o f G O a vi o bap U~> as 0 000 z •rv •,CL aCL o U) LO U') N O ~~yy m V rn rn J .2: o o Y O D v, a Fn N N N co ~ N Q } U) N CD r) d ~r p 'IT 7 w CD 3 N w c ~l E 0 ° W `m d 0) co co LO o U O rn o 0) 0 Cl) r N CD L U C T~ N V o oi of -2_t--se I~ C4 U w N C L • O O Cn <n N 0 z c z (n O ~ ( w a ~t a ` (L • 0 a y .2 m E 2 c c _1 A o CL o o VAL . . f ST. CROIX COUNTY WISCONSIN r r ■ ■o.■~ ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER , 1101 Carmichael Road Hudson, WI 54016-7710 _ (715) 386-4680 December 18, 1995 Charisse C. Schaller W6485 Wendtland Road Onalaska, WI 54650 RE: Septic Inspection for Property Located at 498 Bluebird Drive, Houlton, Wisconsin 54082 Dear Ms. Schaller: An inspection of the septic system serving the residence located at 498 Bluebird Drive, Houlton, Wisconsin, was conducted on November 11, 1995. This property is located in the NWh, of the NWT of Section 4, T29N-R19W, Town of St. Joseph, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, Thomas C. Nelson zoning Administrator St. Croix County, Wisconsin mz STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Q h r 5 5c C ~1 C.~ ADDRESS IA2 ti v,C 55'~ a SUBDIVISION / CSM#A&Kl LOT # SECTION T N-R_1,9 W, Town of ti ~uS1. ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f f /bd e ~7ri ~ ve INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: .5 ALTERNATE BM: SEPTIC TANK / R / HOLDING TANK ON Manufacturer: La-&~. Liquid Capacity: j pzr6 Setback from: Well House It, Other Pump: Manufacturer QU/~} Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: Length Number of es cy~ Distance & Direction to nearest prop. line: Setback from: well: House ag Other ELEVATIONS Building Sewer ST Inlet; 96, ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system 9'~,s' Existing Grade Final grade J5:79, 7 DATE OF INSTALLATION: j' PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt f 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.: Permit Holder's Name: ❑ City Village ❑ Town of: State Pan o.: SCHALLER, CHARISSE X CST BM Elev.: Insp. BM Elev.: BM Description: ST. JOSEPH Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent to TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet i Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemai n Length Dia. Dist. To Well FI SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number: System: 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 Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH.4.29.19W, NW, NW, LOT 1, 48TH AVENUE Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: II DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code -..d„~..o..,..,..,, G roc STATE SANI SARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than , ex 1 8% x 11 inches in size.: r_ .;neck if revision to p1,71 revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER OWNER PROPERTY LOCATION e 5C- ~ 1^ /U '/4 VA) Y4, S Tc~ , N, R Igor) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # W yes cae,h 40, / N CITY, STATE ZIP CODE b PHONE NUMBER SUBDIVISION NAA C1 ME OR Q . CSM NUMBER 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD nz~ ( ) State Owned ❑ VILLAGE tIN 1~ =N OF: _VP 24 ❑ Public %1 or 2 Fam. Dwelling-## of bedrooms PARCEL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 3Q ` / .r oZ~ 1 ❑ Apt/Condo 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 in line A. Check line B if applicable) A) 1 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 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 1140 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) ELEVATION 0615 Q 17 2_3 , Feet ?49, t Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Holding Tank 11.1LA~~ 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 (P ' Plumber's Signature: Stamps) AMMPRSW No.: Business Phone Number: Gt. ~ VI ir+ ~f'Lc~-Q~rs 6 -3.S Plumber's Address (Street, City, Stat , Zip Code): 1 IX. C U TY/DEPARTMENT USE ONLY ❑ Disapproved Sa i ry Permit Fee (includes Groundwater Date Issued Issuing A nt Signat re (No S ps) Approved ❑ Owner Given Initial 2 .~~~Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/RFA*ONS oo, F PR DISAP~ Gil 1 ~ _ SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS t 1. sanitaq permit is valid for two (2) years. 2. YOur'safary 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'priorlo installation:; 5. Onsire sewage systems must be properly maintained. The septic tank(s)'must'be pumped by a`lic"enseti pumper whenever necessary, usually every 2 to 3 years. ~ 6. If you have questions concerning your dnsite sewage system, contact your IoCal 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~Jnstalled. _M ll. 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. 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 _ Qerformarwe curve; pump model and pump mginufacturer; D) cross section of the soil absorption system if ' required by the county; E) soil test data on a 1151orm; 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 mpkies Wfected through...these-surcharges are used for monitoring groundwater, ground ; water contamination investigations and establishment of standards. , ...q. n 'i. :tom .r. R• 1 SBD-6398 (R.11/88) 1 1 ~s c 1 Vo- i S 0 Ll D _ 1 7 l 1ss~ Ile, t- 4 r 1 l PAGE OF w 6' CrvSS Sec~lun O SyS~er'~. r S-y~,~s a froth Air Infolt And Obtervatlon Pipe C2)1- . Approvsd Vent Cop Minlmum 12- Above final Grade 20- 42' Above Pipe _4" Cast Iron To final Grade Vent Pipe Marsh May Or Synthelle Covering Mln. 2- Agareg'ate Over Pipe - Olilributlon -Tie plpo 0 0 0 0 6- Aggrogale o Perforated Plot Belor Beneolh Pipe o -Coupling Terminating At Bolcom Of System PrupoSeD Fined gr~.~1c vto .4 Ion SOIL.. FILL j DISTRIBU'TIOU PIPE APPROVED S4WPETIC COVER /"1ATj!RIA1- OR 4" OF STRAW 2" OF A6GR EGA?E OR fAARSI! NAy AGGREGATE. A8 MEV- QF / FEAT-•. . DIS"rRigUTIOU PIPE TO BE AT LEAST INCHES BELOW ORIGINAL GRADE AWU AT LEASTLO IUC14ES •8UT1.10 MORE,TMA.J 42 IUC41ES BELOW FINAL GRADE /"1AXIMUM W N OF CXe-AVATI013 FROM 0Pj&jN A,L 6RADF- WILL BE -~c-= IMC14ES I6IaA2 GRaD WILL BE S3 INCHES MINIMUM grPrtt OF EXCAVATION F.R014 . CDP • 0 SIGFJEO: LICENSE NUMBER: ~J - DATE: DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDING INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN'RELATIONS (H63.0911) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ Y: OT NO.:BLK. NO.: SUBDIVISION NAME: 410 ~u1/a /T25 N/R I (or) W / ~ s'_ ~ COUNT : OW ER'S/9WaEIiS NAME: ]MAILING ADDRESS: t ti , . IrE 15~ t Z,A~ ~Z EO c USE DATES OBSERVATIONS MADE M Residence BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: P R A ION TESTS: 1~1Residence ®New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FIL6HOLDING TANK: RECOMMENDED SYSTEM: (optional) MS ❑U ®S ❑u 13SS ❑u ❑S NU ❑S Chu X) 4 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: Floodplain, indicate Floodplain elevation: Dss ! A4 i PROFILE DESCRIPTIONS sd BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WI THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 5~ 33 ~93 i E1B-2-7-6- q7to~7 B- c033 ~j N e (J ? to 33 ~Ipl,~ 33 L. B- T~ oo 75 'fin. on. _6 en - C. Q B- d~Ebfma~ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER, 4A' 44E6' AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- o P P_ AM 3 / 3 .3 1 P- 3 O 3 P-_ 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 I J_ : ~ i ~I ri 1 s J-- s ~ ~I E 3 7-1 t i E ! ~ E t C5-~~Ke 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 : TEST WERE COMPLETED ON: ADDRESS: r CERTIFICATION NUMBER: IPHONE NUMBER (optional): r5 / __7 Z B / S ~ -lam o CST SI A RE: n DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. IR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 T a coin plete and accurate soil test, your report MUSt include: 1, C legal description; 2. Ti tion inust 'early indicate whether this i.. residence or co,: .'a] I, 1 Nf drooms or commercial u ned; 4, a or , ent system; re sui rating boxes. A SITE IS SUITABLE FOR A F DING TANK ONLY IF ALL OTHER SYSTEMw r-,-?E RULED OUT BASED ON SOIL CONDITIOP= 6. PLEASE use the abbreviations shown here for writing profile descriptic, and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A sel.aarate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, ar armanent; . Complete all appropriate boxes as to dates, names, addresses, flood plain data, per exemp- tion, if appropriate; 10. If tl,,, information (such as flood plain, elevation) does not apply, place N,A. in the appropriate box; 11. Si;+ he form and place your current address and your certification number; 12. ' le ible copies and distribute as re<luired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Sepit~ ;e- and Textures Other Symbols st - Stone (over 10") BR Bedrock cola Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone ~`s - Sand HGW - High Groundwater cs - Coarse Sand Pere Percolation Rate med s - Medium Sand W - Well I's Fine Sand Bldg - Building is - Lo.imy Sand Greater Than .sl 5 )dy Loarn Less Than wl :rn Bn - Brovvn 4sil - Loarn BI Black Silt Gy - Gray Clay Loam Y Yellow _ Sarady Clay Loam R - Red - Silty Clay Loam mot - Mottloc Sandy Clay wr - t.iti sic Silty Clay fff - (int .e Clay cc n 1, coarse pt - Peat mrn - =..y, r>iediuM m Muck d i. p I.>, ,irnent HWL - Hit v evel, Six general soli textUres for liquidrwaste disposal BM VRP V C F P TO .r it) securing a sari; I au e r h S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County -I~~SSE G, ~jGl-}ALLY OWNER/BUYER ADDRESS '004-4091 \lVCt-WTL.§10 FIRE NUMBER CITY/STATE Ol44LASY-wt i VV k ZIP S4(o19, G PROPERTY LO/CATION : _VAW1/4 , NW 1/4 , SECTION- , T Ift_N-R_ 1I q W TOWN OF N , St. Croix'County, SUBDIVISION {.1 LOT NUMBER Lo'< k iv. v o ~aG g~ 1 l~ ~p 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 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/Ile, 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 expiration e. SIGNED. ' DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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 GI IA~IZISSE L. ~C4- A,k L1 Z, Location of property Aw1/4 J,1W 1/4, Section 4 ,T-ZP1 N-R 9 W Township t5-r Mailing address W 64lb5 ' gg~N"QTi '1•P O O P-O 4c4S O Address of site 6t ~ CS N\ un1 s - ,per/y7(0 Subdivision name e"kj ,404"0 Ic- Lot no. Other homes on property? Yes ) No Previous owner of property M!-n " Cr7-E ISEt r Total size of property 3. (dam ASS Total size of parcel Date parcel was created Q~~ - -iO Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? Yes X No Volume X03 and Page Number S4 9 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. 4CSS gfsq , 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. 4S& q Vg , YI-1 Signature of Applicant Co-Applicant II STATE BAP OF WISCONSIN FOAM 2-1Q62 II iji SPACE PESIMEOFOR RECORDiYG DATA 1~I DOCUMENTNO. i W + ;I • ~JS:~Sg I PNT U A6E . i IfI, REGISTER'S OFFICE ,L~nccs„~.1 Sr. CRoix C©.t wi I Roed for bcord li - FEB13 WU M ~ - I 11,20 A. convey/ and warrants to ia /YI, f~ _ /fin i VRrMbrtoF~^~'~'~t.X3C. 1 RETURN.To I~•- - r-II the foliowing described rear eats+e in ! County, i $tat*of Wlsaoonsin. c t Tax Parcei No: (7ctr r 0 W l 04 W YL! dt ) S~f.e~ t M'I j r z 9 N R j g W , -rb-o-, oir 5*- -11159't cl ey c- r- .,0 It s ;Oil 16xs i I I I..G~" .L r F'~Q~ P7 StLM~i1l~P ~r~~s. ~'CrT.~1K~•~ .~~{,►~4f'Qy ~rt/•:~~ rq L,,,.,io & 0e_i•ober £3~ l4 R q I K trod kv> f A n ra11 I k 7ic~ +I I&, r i f c *,e Ca't' t tr f C D C Ka vl f f 4 j I ~C C s~ II ih vpLwnar yq7 *kq 0i4+twe df Rev;+W, o• Def 4 ~j 5 -dot" S~ C,lra 1 k C~ K _ L t Sf~i II This, tv1 e t nomestsad proou+Y (fe) hs "Ili II Ex0opt+on to We•ranties: I I (7 day ofd TM"'. 19_.r=-. . v Doled this / (SEAL) (SEAL) ISEALS (SEAL) ~I it l) AUTHENTICATION ACKNOWLEDGMENT eTATE OP a .4 r4 ar{yMl.Ina) es. COVn!y. C~~ Ii puthentieated this day of ~,....c- IQ- Per ovally Came before me this-] n day of ,1@=ty_the above named II 1t e r i~ II TITLE: MEMBER STATE BAR OF WISCONSIN IIII (It not, to me known to be the Person..-.--wtto executed the authorited by i ?OA Od, Will, P 41111i foregoing Instrument and acknowledge the Vame. i TN18 iNSTRUMENTW ORAPTEOiY Ii Not rY Pu lk 4 • ` countY• VYirr y i~ ( ignsiures may be aulhentin' Commission +s perman M. (it nr- state expipratlo~ ~I are not necessary.) W d-11 , ::I:%- r, J 1 M 19-L~.Y ` 'Namoo of 00,10Ax xpnlny m aw cwaa+y e a 10 992 10R 777. N V i1 WARRANTY 0190 A110/ Wt{CONaiN Nuko Tux Porgy. P.O. Box 10200, Green a", W, 612074208 orm No @ - taaT 25 ~~'s,o~ o I~~ ~ y X U ta, sr o \ G ~ d