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HomeMy WebLinkAbout026-1116-70-000 0 3 0 0 ti 0 d a' ~ I e N > ~ I 'E ~ c I N 0 O z C L C LL c C O _ U E L N Q U a M N z > co O zo d d z a m c o I c (7 _u o z o a 'z v ° to t- z E -a ~y] _ N Cl) m U) 0) •IV a N t g O y O N Q wU' 3 z co z o o z N E C I~ IA > L m CL co O 10 Mo d w U cy U) cn U) E ~1 N H H F =3 O N -6 CL ~i. 0 0 0 0 d z° •ti Egan. U a O U) 3 ~j N J U ~ rn rn ~ ~i Z N M O aa) O N - Q p p ~ E w d O N N 0, `I~j • ~ ~ ~ ~ Q cn Q I G O c r N C 0 3 o c c E co n 0 o °p Fes- > (D h N u d oo C) 0) rl- CL 0- .0 rn W c o o C ~ U c\ ° V : L L M N O E i 0 A N f-' f C a) Lo C? 00 1 O O N O z N =5 =5 (n O ~ N I dt a n. Y rw0 cC Q Z. V d C f A U a 2 0 y U t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ae1 ESL. ADDRESS /..A5 SUBDIVISION / CSM# 1` a i~1.5 LOT # c`1 SECTION l T ,30 N-R_/4~?' W, Town of CA ~ri0) ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHI WITHIN 100 FEET OF SYSTEM lv c~ r \r 1 INDICATE NORTH ARROW r Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ld7) ALTERNATE BM: d S, in SG✓ SEPTIC TANK / pHi B'8R ORMA Manufacturer: (_j,4,&54 Liquid Capacity: /8V'0 Setback from: Well House a Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM, -Z.~-rtes Width: /a Length Number of tr-@RehQs 02. Distance & Direction to nearest prop. line: 7' SsZCK f Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet ?3,44- ST outlet PC inlet Al PC bottom Pump Off Y Header/Manifold Bottom of system Existing Grade Final grade y~ DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: ~S(Q3 INSPECTOR: 3/93:jt L ATST, rtR4q4M ,-1.30.18W PR1vl4TE EVV]~t;E ~~5TJ44th Stre ounty: Labor and Human Relations INSPECTION REPORT Safety and BuyWings Division "NERAL INFORMATION (ATTACH TO PERMIT) Sanitary ermit o. GE: ' Permit Holder's Name: ❑ City ❑ Village fX _1 Town of: State Plan D No.: 19* ev.: nsp. BME ev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400036 S Zd TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6t).; 'a Benchmark Dosing G o5 Aeration Bldg. Sewer Holding St/ Inlet g. ~ TA_ CK INFORMATION St/ Outlet to( TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic .A NA Dt Bottom Dosing NA Header. Aeration A Dist. Pipe ~2, 771 Holding Bot. System / 75 PUMP/ SIPHON INFORMATION Final Grade Manu rer Demand oo, s. 7 u7~ S~ Model Number GPM TDH Lift Friction ea m TDH Ft oss Forcemain Len Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth NSI N DIMENSIONS ~ DIME SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Man ure,: SETBACK CHAMBE INFORMATION Type O Ks. Mo el Number: OR U System: DISTRIBUTION SYSTEM Header/ IVFamfut Distribution Pipe(s) /x Hole Size x Hole Spacing Vent To Air Intake Length _Lz Dia. Length ~ Dia. Spacing ~P SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems On Depth Over Depth Over xx Depth Of xx Seede dded xx Mulc Bed /Tzero:b-Center C0 Bed /T*etC Edges W 26n Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: DRichmond.1.30.18W, NE, SW, Lot 26, 1,441th Stre t / i Plan revision required? ❑ Yes to Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ` SANITARY PERMIT APPLICATION TDIL,.DIHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITAR~j PER T # -Attach corhplete plans (to the county copy only) for the system, on paper not less than ad o-I P 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 PROPERTY LOCATION c c~ k c:~k: s- N= Y4 S vJ %4, S T 3 D N, R E') W PROPERTY OWNER'S MAILINGADDRESS LOT # BLOCK # N / A~ I S n 5 lad Q10 I CITY, STAT ZIP CODE PHONE NUMBER SUBDI,~(ISION NAME OCSM NUMBER ~ O u3 ~ II. TYPE OF BUILDING: (Check one CITY NEAREST RO D El State Owned VILLAGE - O I 4~h ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms-3 PARCEL TAX NUMBER(S) 0a4-1 //(o _ III. BUILDING USE: (If building type is public, check all that apply) 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 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. ❑ Replacement of 4. El Reconnection of 5.0 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 Ip 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 140 System-ln-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 sO LO ) . Feet S, S Feet CAPACITY VII. TANK Site in gallons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank ©60 ~ S 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): Plumb 's Si natu . o Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): A ` _ ` V N ' vv~ r S OI IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S 'tary Permit ee (Includes Groundwater Date issued issuing A sent S No mps Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination / `~r'~ X~ 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 1 R INSTRUCTIONS y 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. 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 B% 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; close 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. GROUNDWATE14 SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharces (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) P) ot /V J9 Ld k p J k 1 -5 ~ F- Ot 111-1,5 1 /0,01 D C,jsac c ~ K9dm- 22~ \Y ~ f h- /do / 02~ 1-pie-~ fresh Air Inlel► And OD►ervollon Plpe ~ Approriet Von, Cep ►Ilnlm urn 12' Aber e t ~~6rU eer mpg. + j nn.l Geed. D/ 20- 42' Above PIpP _ 4' Cost fear, To flnel 016ee Venl Plpe ween Hey Or SrntMtk Ce.4,lny LIn 2' Agpeepete Over PIP, 0161/10.1100 , PIp6 0 0 0 --Tee ► i C' AIOeeOele j Dense Its Plpe ° 1`61101614/ PIp$ ft .l,. o -Ce,glin2 7.emtn611ny At Botlem 01 System I ~Ic,~•.~' Ion ~a/~ j i SOIL FILL D15TRIBUTIOU PIPE Y 6 APPROVED ,~4),!~'NETIC COVCa 2"of AGGREGATE -MATM&t. OR 9" OF 5'rFtAW 'Y •'Y:~ Oil ARSN HAy j tLEV OF& FEET L~0IF. 2/= AGGREGATE i DIS'1'RI5UTIUU PIPE TU BE AT LEAST _ IUCHES BELOW ORIGIIJAL GRADE AAIU AT LEASTLO IUCHES BUT 1.10 MORE THA}J tit INCHES BELOW FILIAL GRADE 11AXUwM DaPrti OF EXCAVAT100 FXoM ORl6YJAL 69AnF- WILL BE ILICHES rurr~MUM 0~:F li of EYCAvATl0W rAOP\ 0 116 NAL rjRjvf- WILL BC 36 - INCHES S i G t.1 C 0: P-j2LLI-L~~ ' LIGEI,USC klUMBE11: DATE: - 1 Ii 10 i i {I 1 lvl iisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L_ of _ Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but -,15/. 6 h 0 'not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION C GOVT. LOT r 1/45 1/4,S I T N,R (or) W PROPERTY OWNER':S A!I.IN ADDRESS LOT # :,BLOCK # SU D. NAME 0 CSM # 26; A1,4 7AJ I t1 = S O CITY, STAT ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE GOWN NEAREST ROAD -510 17 O~~ 04- 6 ] New Construction Use r,~f- Residential / Number of bedrooms -,3 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft21sE_trench, gpd/ft2 Absorption area required 6,4_~3 bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/0 . trench, gpolft2 Reiwmmended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations 4/. Parent material /0 S4 U.9 S Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem s C] U S ❑ U C] U S El U El S EU ❑ S NU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 2- -le Ground '.0- 5/ la to elev.,~,s- Depth to limiting factor Remarks: Boring # D Liz Ground S S S 8 elev r 9_S7ft. Depth to limiting factor Remarks: CST Name:-Please Print / CL✓~ , P,bOneZ spa Address: z a +0 Signature: Date: CST Number: Z Af - P CbS~ z~ 8 PROPERTYOWNEP41 & +e.K lh&-, SOIL DESCRIPTION REPORT Page 2--of -2 .3, PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bojxbry Roots GPD/ft in. Munsell I Du. Sz. Cont. Color Gr. Sz. Sh. I Bed iTnerch Ground L 'D ~2Y/ p S I elev. i y 1 Depth to limiting factor d Remarks: Boring # 64 Ground ft. ozn, L~ ..S S A2i - Depth to limiting factor Remarks: Boring # 0 ye 3( n4 Cd 2- Z ~ s/ Ground CCelev.!~, l~ft. Depth to - limiting factor Remarks: Boring # ,r~~4•••,ti Ground elev. ft. Depth to limiting factor I T-1 Remarks: SBD-8330(R.05/92) M STEEL'S SOIL SERVICE Gary L. Steel 988-W. Shere44ive C.S.T. 2298 DFv, r C 'K 0 C) n New Richmond, WI 54017 MPRSW-3254 (715) 246-6200 Y4 -51 o 130 6 Li w 133 \k, AT , Vr D0 ~ 5 o• 33' ° ° ~v ZOa 100 S'W' GS' /3' 2o' lG' zd f 5' ' • OOait 90 a2S.10Outict 1 17 1.07 AWW Willow M River 16 ' zot Aa9s 19 Aar A A Meadows b~,r 20 A s Zos AiIM 15 7.16 Aaa A 14 M Z= AeeN 30i y ~t • 20i v 13 ~ a 1 N p iS i Aau 21 " W* Aa99 N w 9 O 191.13 300 293.19 2.01 App „i 2.00 ACM o ~ n 11 r~ 200 Aan 12 22 Z am "m +J aAO AMU ~ 2oi sts tssai ~r Public lis dirt, 'I 40.74 23 N 8 p •r ~i 2.22 AMU Z00 « 200 AGM in zti t!0" 24 soaao ~ z ao Ao.. - - ~g ~y 2= ACM a~, ,,.ss s2s.ss cP r - e C 31.32 Y 25 w ~7 201 Aaft ZW AGM ..0..9 m « 27 N 29 gas A&M w a= ACM 4 wow 2A Aa99 F UM •'i 33 00.0 • q n.io csy of ww Ri W"o 26 $ 921 A~ 2a0 Aas M tri 507.09 30 00 311.03 S 2.M = o Carny ft GG 323.20 32 33 „ In " «t.N AaM 2 ^ a " 31 tat. Aaft « 10 ACM + : S loo 0 329.37 229 Highway GG (715) 246-2320 Route New Richmond * RRICK $Q Wis°°"Sin CONSTRUCTION STC-105 , SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER M%C_14AEt_ (Z-. S vENs ~~l~~ww f2-1vfe- MAILING ADDRESS VO C50X NEw ~1C,t-t Mo d , %W% S4-011 PROPERTY ADDRESS 14+_1 1 l co -n" Avc NytE (location of septic system) Please obtain from the Planning Dept. CITY/STATE t-" C.44 MOO O , \Is/ 1 S ~O %1 PROPERTY LOCATION KIS 1/4, Sw 1/4, Section , T Flo N-R I -E> W TOWN OF (21 chl M o t4 D ST. CROIX COUNTY, WI SUBDIVISION \IV t ~ww f2i v4C)- h'lc A, PO VV S LOT NUMBER Zlo CERTIFIED SURVEY MAP VOLUME , PAGE , 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 a ration date. SIGNED: DATE: 'd- St. Croix County Zoning Office Government Center 1101 Carmichael Road _ Hudson, WI 54016 11/93 STC-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 ~n delays of the pormit issuance. , Should this development be intended for resale by owner/contractor (s ec house), thenla 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 ~c.NA.~~ 5 ENS 'Wtu~,w yr~L fatty- V16" Location of property NG 1/4 SW 1/4, section 1 , T 30 N-R 115 W Township - V-4" My Np Mailing address FCC aok A- C,44ANOO 0, \A/1 `54-011 Address of site 44'1 k,-rls AV\;4C 0I--VV Subdivision name- WIL-s.ow C .v Pie-;AOpw S Lot no. Zoo other homes on property? yes X No Previous owner of property UE YM ~g C4AM 101- Total size of parcel Date parcel ,was created 1 - l4i -90 Are all corners and lot lines identifiable? X Yes No is this property being developed for (spec house)? .x Yes No Volume Z01 and. Page Number g(a as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICA'T'ION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME MD PAGE NUMBER & 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 nronarhv J_ - i azngeubtS 3o a~sa 9~rn4su5TS go 84sa "a uo"Tr Tdde-off Musa ddt3 xT ~o azn4subxs luouunooQ sa spaap zo .104STBOU AC uno 4Z 55}L ON ATnP ueaq set auzes euq pus 'uuags4s pFssa~o'puou~a u~ p .xoaax x o3 ' ~C~xadoxd pagx p eAoqe T~ nx~suoo at{q (am) I zo tuagsAs Ts odsTP abvmas~ ay4x xo; e4Ts a aoo Ue Paui~Ugo ~CTquasaxd (am) I qsuq pus ' ~ p dozd ac{~ uMo go ; za-4sTb9U X-4unoD auk 3o as oZ SS f7 'off quaucooa se spaaa e 3o angx n F33° auk uF papxoaax paap AqusxxeM T q ulxo3 uo_F-aeIU .ZO LIT REGISTER'S OFFICE Michael. R.-Stevens'. William 11. De.rr,ick, St. CROIX CO.r WI . • ~ William..M.. Derrick, Thomas.. . Derrick. a.ltd.......• Rec'd for Record Ronald L. Derrick as. tenants-in-laommon IJAN Ig EAU of 8:30 ~1. M rmlcl}s :11111 uarlallte In Willow. River. twin .....venture. Rept~ler of deed 1........ ' . nRrunN to ....i...... ............................1....... , I.hI (111111%V11 w der.cl11,111 rent ertnte hl 8.t.. CMIX ..................county, Stile of IfiiFCOn.4111s Tall parcel Nos II Southeast Quarter of Northwest Quarter and NtheasE Quarter of Southwest Quarter of Section It Township 30 North# Range le West. `i . .aA 5 tot 1 y II '1'1010 , ...~tl•,t1b~..:.., IIa1~11Eilanlt p~a(irt~lr. , , il~rr~~ii,(;,••~,;1..; I (Is) (111 no~~ r.>< •1' eetptapll to wnrrrlnl. eo! Municipal and toning ordina~tnces r easements hnd I . rebtrictiond of records I~ 1111) nt JanU rY.. , - / -~8 --(arn1,) C........... (SPnt.) Michael t Stenng William M. per...ick. a C l-`Ce! T t. Th rase f be I It r, V -Rt~l d w tx AUTUPINTICIATIoN ®N T Michael R•, SEevpn!a, -STATE OF WISCO149114 m M. . Wi l a 114 Derr Ckr W1i Ia aff n >y. Derrick.. and Cuunt). Derr. ~C....Thoma Rona d 'b peer ek nuthal~n~icnjt~ed ttde .:.7J..._6•~,~nf...::.J.a7tf1tt181rj►,.:1 1t1..~~1 __t'c:eollnllq eNln~b~tore.rne t111e .......:........11ny el ►'~w. r a~~,.. U1l.t~t 119 above nnmc.. ditt>I A. Rem ngton Tii► >ci hilrntni~i 8 Vii; nAti nr' ~vt:ariarr::irr (lt not. huthotlted bpd 70U.Od, VGIe. Stnfa.) to me kno«•n to he the person who executed the forepelnq Instrument find acknowledge the flame. TM9 IlrSrrlUMF_Mt vN1R brIARME) nY . R M LAW orrix p i 4V....... f 7..on."....5!0.17 Nnt11,•\ 1'111,I1c Counts, Nis. (;11rnnhlrra mnp lye nolhrnl.lcnled m nricnnl~Icrh•r11. 11o1.h My t'mnmissinI in. permanent. (if not, fltnte enl41ntlan are not 1lercaRnrc.) dnl.el ........................................:.....1 19........1 r ".mre or prfnllnf elr,nlnpl In rnr rnrnrlly nhnul.l 1.0- t}Pt-1 or 1•►inb•d 10-11111. 11n•Ir rle11011►r+. ..rwnnwar• turn StAtll 11411 Of TVIaGONn1N ~l'lyrnl~ln 1.11<nl 11101111 1•... 1...