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HomeMy WebLinkAbout038-1132-10-400 0. c I ~ q I a Q o r c te. ' °o I N N I y y "U I I I C I Cr I ~ I ° c z c LL c O a I I Cl) ~ 3 I a~ Z N (n O st O M > (L m N co Z H co O Z V j O O d Z C (n E- c °D -zo I E -o ~ M I N I co a) -~V 7 CL N O C N N r• m • O ~ O N Q O U I O Z co Z _ LO O C a) N 00 N E N m U aJ _ a) O n- 'a-i O o! m a> 0 o a3i G c G a ' E 0 -Z~ N Q ° z ' (D zv>m333 az oo • w 0 0 0 0 Z a a o v:i L, ) J U o `n } (A c 0) rn ~ n I N O O m Q _ N m v, W R O Q 7 ~j o 0 3 I its a c I o o c E O" O N C a) r- 15 a c a rn O 7 LO N N O M o0 m C E C 0 V 04 'v..i r O a) 5 L O 00 '.I M • c,) N E M E ca U O M (n (n N O (n O ~ ~ I ✓a , # a a • a 'ar .U `m y rw c L) (L 0 U) 0 273, 775-3 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ` v 4- ADDRESS SUBDIVISION / CSM9 ff~ LOT SECTION. Z--T N-R W, Town of 9~7 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r ~JV w- CC T ~o 3L .kL e 54- 2 ~PLf-G~•" c¢ N ~ h4z INDICATt~ NORTH I~RI~Ot:' 1 Provide setback and elevation information on reverse of this foam. Provide 2 dimensions to center of septic tank manhole coven. BENCHMARK: (f 4- N t~l ~CZ Zevl U ALTERNATE BM: © / SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: l~ ~~KS Liquid Capacity: Setback from: Well House--// Other Pump: Manufacturer Model Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYS,pTEM Width: /z Length r j~ees Number of -4-;r~"cF-es Distance & Direction to nearest prop. line: .7 Sd / Setback from: well: A ~ House 7- Other ELEVATIONS Building Sewer- 17 5ST Inlet. 17(OeIj ST outlet ?~j j PC inlet PC bottom Pump Off Header/Manifold 0 Bottom of system C-A). Existing Grade S Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LF_ 66 14/ LICENSE NUMBER: / INSPECTOR: 3/93: )t Wisc~nsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 11'2 11 A 0'7 Pe wt}H,ald;r's,p KY" ❑ City ❑ Village ❑ Town of: State Plan o.: CST BM Elev.: t33tt{{11 Insp. BM Elev.: BM Description: ~i Parcel Tax No.: /00i NO" ~C~rYu~ Coo 'TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /0'/ 00 Dosing Aeration Bldg. Sewer 7, 75 Holding St/ Ht inlet -7,~ a 79 TANK SETBACK INFORMATION St/ Ht Outlet rO;L' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ya5' ° NA Dt Bottom Dosing NA Header / Man. 9-~ , 7 Aeration NA Dist. Pipe 9 75 gL Holding Bot. System 10,7 q 1 oZ X PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ~r ~F r aJ q Model Number GPM TDH Lift Friction System TDH Ft Loss Hea Forcemain Length Dia. Dist. T, SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N~ DIMEN I NS LEACHING Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION Type O F.r.r CHAMBER Model Number: System: 4'i s1 0 ~ OR UNIT DISTRIBUTION SYSTEM F 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: Star Prairie.32.31. 18W, NW, SW, Flandrick Drive Plan revision required? ❑ Yes ❑ No Use other side for additional information. I 'Y161 d- SBD-6710(R 05/91) Date nspecct/CSr's Signature Cert. No. SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code C~o(x STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than A33 7-d 7 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER t+-ff PROPERTY LOCATION 942 1<9W VA %,S T ,N,R E(o PROPERTY OWNER'S MAILING ADDRESS C4XO, LOT # LOCK # CITY, STATESO:vi ! ZIP CODE PHONE NUMBER SUBDIVISI N NAME OR CSM NUMBER iv/ 5YO-y-jr 12/5- 237 - O L /O G 7-90S- 0 II. TYPE OF BUILDING: (Check one) CITY ROAD El State Owned VILLAGE NEAREST /?l9~Rii= ~Cf}.~/D2lCft ❑ Public L'j~!14 or 2 Fam. Dwelling-# of bedrooms.~ r9L ;OWN OF: PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo JJ Q l 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 90 Office/Factory 130 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.E1 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 430 Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQ/UIfRE/D (sq. ft.) PROPO'S/ED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ~~d IPt 3 L` p ?3h, 7 Feet rO Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank GtJ j ::R~E] Lift Pump Tank/Si hon Chamber --6 F] El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name (Print): Plumb s Signature* (No Stamps) MP/MPReW-No.: Business Phone Number: o ~-5 3 Plumber's Address (Street, City, State, Zip Code): 4 IX. LINTY /DEPARTMENT USE ONLY O Date ssued;jlssuing A nt Signat St ps Disapproved Sanitary Permit Fee (Includes Groundwater Surcharge Fee) Approved ❑ wner Given Initial (f~ Adverse Determination M61, X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & 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. 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 & 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. 111. 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 Dill Vill. 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) I, 921A-AJ S~ --/-4 o,,j,jc-R - 2 7-9 ~~~~ypR~etL pvt`v~ Csf fo/1NF2 3 / L4 ~p-p0 6 A L UEN~' O ~v / l 2sle n PAGE OF CroSS Sec~lon or /~1 ~eQ Sy5te~1 Fresh Air Inlels And Observollon Pipe Approved Vent Cap Minimum 12' Above Final Grade 20- 42' Above Pipe _ 4' Cast Iron To final Grade Vent Pipe Mash May Or Synthetic Covering Mln. 2' Aggregate over pipe - Distribution - Teo Pipe - 0 0 0 0 i 6` Aggregate o Perforated Pipe Below Beneath Pipe o -Coupling Terminating At Bottom Of System P/`OPOSCD t'Inal. 1gr~,~1< ~~cJ.•.T ton \~~/\~~Cf./\\ .SOIL. FILL DISTRIBUTIOU PIPE APPROVED ~4WTNETIC COVER • !"-MATER~Kt- OR 9" OF STRAW 2" of AGGREGATE OR tAARSN HAy ° (e"OFlZ-21A2 AGGREGATE 0;:- \~`\\\\~/i~ ALEV.__~i2FEET_.. DI•STRIB!UTIOW PIPE TO BE AT LEAST iuCNES BELOW ORIGIUAL GRADE AUU AT LEASTLO IAICHES BUT 1.10 MORE HAU H2 MICNES BELOW FWAL GRADE MIMUM OWN OF F-XCAVAT100 F90M OWMAL 6KADR WILL BE INCHES 3R4o€ WILL BE INCHES rurnMUM gerTti of FACAVATIOM FROM 0~I4IWAkL C SIGLIED: LIGEIJSE AJUMBER: DATE. Wisconsin Department of Industry, SOIL AND SIT T N REPORT Page _ of • Labor and Human 'Relations Divisiar of Safety & Buildings in accor 8305, Code COUNTY Attach complete site plan on paper not less than 8 1/2 nches frt. must e, but x not limited to vertical and horizontal reference point ( , irectao %of slope, PARCEL I.D. # dimensioned, north arrow, and location and distance rest r & - r ~ APPLICANT INFORMATION-PLEASE PRINT A FORk rfox REVIEWED BY DATE ` 'OCATION PROPERTY OWN ' RflOPER , T _A_ GOVT. I;BT 1/4 4/1/4,S T'fl N,R E G PROPERTY OWNER':S MAILING ADDREPS LOT' BLOCK# SUBD. NAME OR CSM # CITY STATE `y. Z C gE PHONE NUMBER ITY ❑VILLAGE OWN NEAREST ROAD ~41 to; New Construction Use PK Residential / Number of bedrooms Addition to existing building j ) Replacement [ ] Public or commercial describe Code derived daily flow 4(, y gpd Recommended design loading rate :2 ed, gpd/ft2 - gtrench, gpd/ft2 Absorption area required ky 5 bed, ft2 4.:; trench, ft2 Maximum design loading rate _,_,7__bed, gpd/0,g-trench, gpd/ft2 Recommended infiltration surface elevation(s) l' ft (as referred to site plan benchmark) Additional design / site considerations Parent material ~<< 4 S~ Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem Q'S ❑ U S❑ U JA S ❑ U So U ❑ S ❑ S .RU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground a a i2 ` , el v. 7 ft. Depth to limiting factor i Remarks: Boring # l ngg Ground elev. 147f Depth to limiting factoiJ Remarks: CST Name:-Please Print Phone: Address: Signature: . Date: CST Number: 16- I PROPERTY OWNER - IL DESCRIPTION REPORT Page' of 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 Trends le -1-4- ow 5- 011 Ground j' elev. ~t• Depth to limiting fator S/ Remarks: Boring # 00- Ground ~ © 3~ ' / ~ 7.. elev, Depth to limiting factor ,0~r eo~; Remarks: Boring # A, I ook Ground t elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) s s Soil Test Plot Plan Byron Bird Jr. 4-9a,22-.Property Owner L 896 68th Ave. A d d r e s s ~,g~V~ -5 Amery Wi 54001 ~o 1 /4~1 /4iS, z /T„ NIR%W CST #3479 Township,,- Dater- ~v County r _m......... ~rl ~iorn C Boreing ► Benchmark - H.R.P. System Elevation / moo A -;2 ,8 3 i g9 ~i O 1 s F~~E® 8 AU G 2 4 1994 ► 2 JAMES O'CONNELL 3 Register 01 Deeds 520599 ti St Croix co" wi CERTIFIED SURVEY MAP cr Located in part of the NWa of the SW4 of Section 32, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. MEO N = 41 41 AUG °~M Z N M O 0 OO W O O :~;01X COUNTY ~ L OWNER d 3 co in Feet ; Russell Flandrick .~_'oning a 5il~ C_ 4, + o R.R. 4 Box 192 f:._,-i<s Comrrjttee 100 200 400 L c J New Richmond, Wi. 54017 ° d ■ ` gut recorded 01 ..d N •.-1 r--1 l0 vi :an 30 days of ,pproval'date d C; &royal' shag be -A4 void W} Corner of VOLUME log;> PAGE_ 408 TEMPORARY ROADWAY EASEMENT Section 32 CUL-DE-SAC TO BE REMOVED UPON M ROADWAY EXTENSION , - 713 (APLA-1 TED LANDS O k N dI 7 H I N89°291034 756.23' C~ N 690.22' _ 66.011-/ t0 O .y Ni~ O ° LOT 4 CD 04 0 -4 00 NO0°10' 2611W N 3.80 Acres °I' 202.11' L~1 165,372 Sq. Ft. h_': © Z~~ a L71 n I I LI S89°29'0311E 684.38' 9' LI 41 <I N12°37'.58,1E 33/33 3 N120 3715811E JI x 57.15' 4- 57.15' W O n l 3 W LOT 3 I I nl i ~1 s 6.92 Acres 6I6 I~ ~U 12 CD ~I c 301,288 Sq. Ft. N p N li __j 0 41 n l c w Lr w U-I C_ DI „ N U N ~I v ui J O cli dJ 3 N k O M O Z a Z L 649.80' 1 66.00' N S89°29'03"E 715.80' N M x ' ( y.~ o Sri \_/.9, I'C.~~61 O of c... = 4 O to M, ~ ?.f r T'i.'~ ° LEGEND ,I. v SW Corner of-0 Section 32 -Aluminum County Section Monument Found V!, • 1} Rebar Found Fll %Tj 0 111 Iron Pipe Found 0 111 x 24" Iron Pipe Set, weighing 1.68 tir~''s~~U lbs. per linear foot x Existing Fenceline 100' Poadway Setback line SHEET 1 of 2 SHEETS VOLUME 10 PAGE 4'805 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Fr MAILING ADDRESS 1~+ 3~ Cv Sn-m~ vs >a _ u~ 55~U z PROPERTY ADDRESS g 3~. W (Y'd ~rc., ( z s (location of s/e~ptic system) lease obtain from the Planning Dept. CITY/STATE Can S c-T L{l-,r Szlm 5 7 PROPERTY LOCATION 1/4, S 0 1/4, Section _-3-Z , T -3/ N-Rj_W TOWN OF _S ST. CROIX COUNTY, WI 44 SUBDIVISION / LOT NUMBE CERTIFIED SURVEY MAP y , VOLUME , PAGEa90 , 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 W' consin DNR. Certification stating that your septic has been maintained must be completed and returne o the St. Croix County Zoning Officer within 30 days of the three year ex tion date. SIGNED: ~J DATE: li 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 g 11 1 aaln k S~ 1'1(/k Location of propertyl/41/4, Section T Township S ~ra~ r~ r° Mailing address 1 ~3S Co4>d' 6 ws 5- 116 z5 Address of site 192,;7- Subdivision name Lot no. Other homes on property? Yes_ ~Nojj Previous owner of property ~w 55~(( a ✓ dy,i L1~ Total size of property 3f res Total size of parcel Date parcel was created 6 /9~7g rf Are all corners and lot lines identifiable? _Z Yes No Is this property being developed for (spec house) ? Yes J<4 No Volume I and Page Number N 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. , 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. 771 Signature of Applicant Co-Appli nt Date of Signature Da f Signat re I~ DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 530370 r 1127PAGE 7O ST. CROiX C1, Russell L. Flandrick a/k/a Russell Redd for Racz;lj 1. - a ------.l JUN 2 1995 Fandrick a/k/ Russel Fandrickt' - a single person , le 9:30 A. F, - convey s and warrants to ....Brian R. Smith and Amy '~.~:JL,~+ t` t .ice wi fe--as--survivorship - - Smith.,--•husband--and----- marital..Property O° - R ETU I TO C_ .532 s. ~GrLn~ - - the following described real estate in St_._ C_rolX County, State of Wisconsin: • Tax Parcel No: A parcel of land located in part of the Northwest Quarter of the Southwest Quarter of Section 32, Township 31 North, Range 18 West, Town of Star Prairie, more particularly described as follows: Lot 4 of Certified Survey Map dated August 24, 1994 and recorded in Volume 10 of Certified Survey Maps at page 2805 as Document No. 520599. Together with a non-exclusive easement for ingress and egress over the public road shown in Volume "10" of Certified Survey Map at page 2805 as Document No. 520599 and also over Outlot 1 of the Certified Survey Map recorded in volume "9" of Certified Survey Map at page 2661 as Document No. 503275. This deed is given in full satisfaction of that certain unrecorded land contract between parties hereto dated April 4, 1995. This ..1S---riot homestead property. (is) (is not) Exception to warranties: municipal and zoning ordinances, easements and restrictions of record and any lien created by act or omission of Grantee. Dated this day of - Jurie - - - 19._95.. -----(SEAL) - .....(SEAL) * - - - - - USSELL L. FLANDRICK a/k/a - -------an- - Russell Fldrick a/ a (SEAL) Russe-l--- Fl.aI1dxi_Qk.......------ --------(SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. ST. CROIX - County. Gf"/L authenticated this day of___________________________ 19..... _ Personally came before me this / .day of June 199.5_._ the bove named Russell L. Flandrick a / k / a - - - - - - - Russell F landrick a/k/a TITLE: MEMBER STATE BAR OF WISCONSIN Russel Flandrick, a sin-- le (If not- person authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoin i en and a the sa THIS INSTRUMENT WAS DRAFTED BY REMINGTON LAW OFFICES -y- - 1 th A. Remiri £ori kk~ A, AK (_'s C) gg I- 5-4-0.17 Notary Public t C ~___R _~hmondl._WI 54017 S. roi count - - Y> Wis. Tres may be authenticated or acknowledged. Both My Commission is permanent. (If not,. state expiration iecessary.) date: VXUL-A-PRt1tiW ~~-J----------------- 19`i_4_-•) •an~ Duhlil` Sta4a of W6;on in is signing in any capacity should be typed or printed below their signatures. EED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 2 - 1982 Milwaukee. Wisconsin