Loading...
HomeMy WebLinkAbout030-1028-80-000 C o 3 -0 0 0 o ! p e» c C~ O O N O -O C 't U T N i ~ o c ! ~r N N L N U f0 U N ) ~ C ~ I O z L. (6 O LL o a-0 c L) U ° ) E ¢ U a ° U N m rn Z O I Z m r H Z a m o I 0 z c U o w _ fn F- ~ O 03 7` ~ m ° m I y _ N C- U~/Vl N O N o CL 0 :s I c O m O Z H 2 < 0 1 Z N ° N d c C • E O N i _ l0 C O co O C 06 III, 7 Li O (D T 0) i~ O 0) O O N O c a a E C N N CD 0 0) N N N U w N N r.~ E F- ~ ~ d I w. ° 0 0 0 z o 0 • rv o a a a N a = I LO o N m CD ~w ` to J V 60i OOi } ~`V! O O :1 00 O N O - . Q N i O m O : CL p 'p N ~ C7) N (D R C: O W 3 o °0 3! o N c © o io o o 1 n m 0 co o°o m a w rn °o °o rn L C.1 'D N N 00 CL 10 E E 016 C O O N 4 N O N O GJ 'C L 'O e- O C Cn ? O 0) H F- C 0) O cn am a E E v • O O In 11 N O y U) ~r > w E rrC^C t E d \ Vl M L V 7 a L CL T , 0 G :C w C A U a O m 00 ISTC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER C7"/G- ADDRESS. j /?a(.l'7 ~oo l~ 1&a Soly- fps SUBDIVISION / CSM# LOT SECTION. ;?_T12 N-R/j W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Fp5r1 Uri l(1 ! RalycitE-5 All i ~ 61-f- j cp 0 r`" 5'L GOQN /7 lIi' f ~T/O ~L /dam y5'TE/ C: L /}P~j~►O>c , g j INDICATE NORTH ARROL',l Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: y~ pT 45 e o-cy ~ di= AT/d ~ G /OO; CJ ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: tQ~/r= Liquid Capacity: Setback from: Well House j 5 l Other ufacturer Model# Size Float seperation Gallons Alarm Location SOIL ABSORPTION SYSTEM Width: Length j- 0 Number of trenches Distance & Direction to nearest prop. line: ,1 D' 0 ROAD Setback from: well: Q 7' House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom A Pump Off IVA Header/Manifold D,8 Bottom of system 99 S 3 Existing Grade Final grade DATE OF INSTALLATIO S PLUMBER ON JOB: LICENSE NUMBER: zoo 5~ INSPECTOR: 3/93: jt WisconsirrDepartment ofIndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION INFORMATION P FRI oV1 6D,m CRAIG El City Village ❑ Town of: State Plan o.: St- joseph CST BM Elev.: Insp. BM Elev.: BM Description: X Parcel Tax No.: .1% d G~ SarO TANK INFORMATION ELEVATION DATA , 7111?, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic k /51 Benchmark Dosing Aeration Bldg. Sewer Hold in St/ Ht inlet ,Q,,rcJ F TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic~~ 3 f NA Dt Bottom Dosing NA Headed ZS 54LI, 9d Aeration NA Dist. Pipe /0,:38" Holding Bot. System a 89,~~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer mand Model Number GPM TDH Lift ls-ri L ion System TDH Ft ead For aln Length Dia_ Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r Lengths i No. Of T enches PIT Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O e Number: System: o, e has OR UNIT f DISTRIBUTION SYSTEM Header Distribution Pipe(s) > x Hole Size x Hole Spacing Vent To Air Intake Length L 77 Dia. Length Dia. _i_ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste my Depth Over Depth Over xx Depth Of eeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] No El Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.7.29. 9W NE, NE Trout,Srook Road i Plan revision required? ❑ Yes to Use other side for additional information. ~j SBD-6710 (R 05/91) Date Inspector's Signature Cert . No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION t~i'~L~7R In accord with ILHR 83.05, Wis. Adm. Code T STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than C, 90 8% X 11 inches in size. 1:1 Check if revision to precious 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 4, & t/a L='/4, S T , N, R E (or a PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # /0,86 c //toor IVA CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE : T O ~ L!T OO rC ❑ Public ~ 1 or 2 Fam. Dwelling-# of bedrooms _I PARCEL TAX NUMBS (S) III. BUILDING USE: (If building type is public, check all that apply) p3 r 10A8 S© 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 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. X Replacement 3. ❑ Replacement of 4.E] 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 D9 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 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 0 1 -3 26-0 0 J 4o Feet FY, S Feet / -7 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 Holdin Tank L~~j /&Ao Fj - F1 F] Lift Pump Tank/Si hon Chamber I El 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 e s Signature: (No Stamps MP W N Business Phone Number: IlAtAQZ& Q;r 0s_ / G s ! Plumber's Address (Street, City, State, Zip Code): 96 LLB, IX. LINTY/DEPAR MENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued suing Agen Signat (Approved F-1 Owner Given Initial Surcharge Fee) / Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: ' SBD-6398(R.08193) 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. 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) 36 ` t1 PPRov~ A 36,, C ~:'e~ 36N 4 SYSTell ~~us BAY CXisr//N1: /eve ~.r 5~7~ 'ti ~ r i! r r r r 3 - K 50 -Sec-PA c-e WEW Q~S~ T12 ENCRe-S J.3 0 4 n L n 0 S cxvi, /"=Yo Tjf-/. Ton ar sF colplvE2 01= AArIO Ar Cc. lUd. c r OkAturA16 GRAiC- 1086 T~or/~/1ov,f' RD Ab vAe~~ y CJ/EG(JT/d, HU,Osdlv Gad/`. S'yaf Sc~i~i~Rs~~ rlJa` s yo2s I"li~~su~ 305" .nss:1411siiIwep4su,wiaul111uusuy. ,UIL ANU 511 L tVALUA I IUN Hr-F'UH 1 rage 1 01 3 Labor and Human Relations DivisiroeV Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less tha 1 i ch e- in, Plan must include, but not limited to vertical and horizontal referenc p~h (6M), direction and of slope, scale or PARCEL I.D. # r-80 dimensioned, north arrow, and location an i 'stance to nearest.road. 030-1028 i APPLICANT INFORMATION-PLEA 'V INT 4006RMAT REVIEWED BY DATE ROPERTY LOCATION PROPERTY OWNER: Craig & Melissa Frisvold OVT. LOTNE 1/4 NE 1/4,S 7 T 29 N,R 19 for) W pi, P 1000 PROPERTY OWNER':S MAILING ADDRESS C fJrE LOT # BLOCK # ISUBD. NAME OR CSM # f e, , 1086 Troutbrook Rd. *11 r\ na na na CITY, STATE ZIP CODE "`,,PHONE . []CITY []VILLAGE MOWN NEAREST ROAD Hudson, WI. 54016 r? f3 • =3 St. Joseph Troutbrook Rd. (j New Construction Use [x j Residential / Number of bedrooms 3 [ j Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft2 .6 trench, gpdm2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .5 bed, gpd/ t2 •6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 89.83 it (as referred to site plan benchmark) Additional design / site considerations area of B-2 to be cut to code for f inal grade Parent material pitted glacial drift Flood plain elevation, if applicable na it S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for system MG ❑ U ~.S ❑ U as ❑ U ~1 S ❑ U ❑ S lal l ❑ S ZtU SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color MotwS Texture Structure ConsistencelBounck3y Roots GPD/ft in. Munsell Ou. Sz. Cortt. Color Gr. Sz. Sh. Bed Trench 1 0-12 10yr3/2 none 1 2msbk mfr gw 2m .5 .6 'e 2 12-20 10yr4/4 none sil lfsbk mfr gw lm .2 .3 Ground 3 20-53 10yr5/6 none sil M na gw na np .2 94.2 4 53-94 7.5yr$?~ NONE LS Osg mvfr taa na .7 : .8 Depth to limiting factor +94" Remarks: Boring # ,,.1 0-9 10yr3/2 none 1 2msbk mfr gw 2f .5 .6 ZX " 2 9-41 10yr4/4 none sit 1fsbk mfr gw 1f .2 .3 ~x3:S~1S•.A~ii: 3 41-70 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 Ground 9e5v.. 4 70-1015 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to limiting factor +106" Remarks: CST Name:-Please Print Gary L. Steel Phone. 715-246-6200 Address: 1554 200th. Ave. , New Richmond, WI. 54017 Signature: ~Q Date: CST Number: oc 9-21-94 cstm 02298 PROPERIYOWNER Craig Frisvold SOIL DESCRIPTION REPORT Page 2 of 3 PARCELI.D.# 030-1028-80 I GPD/ft Boning # Horizon Depth Dominant Color Mottles I I Structure Consistence Barbary Roots in. Munsell Chu. Sz. Cont Color Texture Gr. Sz. Sh. Bed ITrerxi~ 3 1 0-12 10 r3 2 none 1 2msbk mfr gw 2m .5 I .6 lima 2 12-2 10yr4/4 none sil lfsbk mfr 9w lm .2 .3 i Ground 3 27-50 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 9elev. . 4 50-90 7.5yr4/.6 none sl 2msbk mvfr na na .5 ! .6 Depth to limiting factor +90" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. i ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Craig Frisvold 1554 200th Ave. CSTM2298 NE 4NE 4 S7-T29N-R19w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 N 1"=40' BM.= top of se corner of patio at el. 100' A ~~`y~y~~ 1241 2- 80 d lo' 911 Gary L. Steel 9-21-94 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT A FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the RA 16- 'O isV01.10 residence located at: --Vi 1/4, L 1/4, Sec. _7 T_gq-N, R-LY-W, Town of 70, a,D~} Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced MME 199 Did flow back occur from absorption system? Yes NoX(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete-Steel Other Manufacurer (if known): Age f Tank (if known) : AP1712O)C 15"jren125 4 f)/7 u,/v s ~ (S gnature) (Name) Please Print al7n w 31 o s- (Title) (License Number) -7-1 -9y (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Namepowiyw c)Gff/iiTT Signature MP/MPRS 3~~5 5/88 STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS ~y LFG ~2u ~32vv 2 ® t ""~dc,~b PROPERTY ADDRESS 5 ool (location of septic system) Please obtain from the Planning Dept. ' CITY/STATE t7-(-v VS v PROPERTY LOCATION IVY 1/4, IUD 1/4, Section - T ZC7 N-R W TOWN OF ~yS P ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUMES" 'PAGE 33F , LOT NUMBER I 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 expira i date SIGNED: DATE: 1 ( St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, Wl 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 C*rz,41 n'1~Li SS~9 F k Sw L D Location of property N~- 1/4 fJ L 1/4, Section - , TZ,N-R r 1 W Township -r 301-el),N Mailing address t4yjLSQ N w~ 1e Address of site 2.1,,~ Subdivision name ''~ra.,-~ ✓~r~r~ k w Lot no. Other homes on property: -Yes No I- Previous owner of property Total size of property :S- G i Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X' Yes No Is this property being developed for (spec house) ? Yes Y_No volume 'SI\ and Page Number _33 W7 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. lid,%L Signa o Applicant Co-Applicant ((1(., 197 Y ///&i/a(4 Date of Signature Date of signature ' DOCUMENT NO. WARRANTY DEED THIS 00-ACC RtatRVlD FOR RlC00001N6 DATA STATE BAR OF WISCONSIN FORM 2-190 REGISTERS OffiCE 3T. CROIX CO., WiS~ 17 George._..._. Petersen and Geraldine C. Petersen, be'd. fW Renard Mtls th .husbsind..end...-wile.................................................................... dop of June A.D. 1987 12: 1 r--P convoys and warrants to .4t?:ig...,T.e..-Frisv9_id__and_...•._.,,-_•_.......... Melissa..Ii....Frisxald ,...huslsand...arul..Vi,f.P..Aa............ for RCTURN TO . the following described real estate in 5t...Cr.O.iX ..................County, state of Wisconsin: Tax Parcel No:.............................. Part of Northeast Quarter of Northeast Quarter of Section 7, Township 29 North, Range 19 West, described as follows: A parcel of land known as Parcel #1 located in Northeast Quarter of Northeast Quarter of Section 7, Township 29 North, Range 19 West, Town of St. Joseph, describ d as follows: Commencing at Northeast corner of said Section 7; thence S3039'50"W (true bearing) 330.46 feet; thence S88055130"W 33.02 feet to Point of Beginning; thence S00461W 391.62 feet along Westerly right I of way line of an existing Town Road; thence S88055'30"W 562.00 feet; thence N0046'E 391.62 feet; thence N88055130"E 562.00 feet to Point of Beginning. TRANSE ' 47- a FED This .._ls homestead property. i (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. it Dated this ~a A day of June--- 19.87... I . --........(SEAL) ~ (SEAL) W_e._.RE~ SEN . GEAR (SEAL) ------------------------------------------------•----.-(SEAL) ' • G-ERAL1)-1NE..C_..._P.ETERS.BN............... BNT AIITHBNTICATION ACSNOWLSDOM STATE OF WISCONSIN County. St. Croy as. 12th authenticated this day of 19 June Personally came before me this day of .19.87_- the above named George. W' Petersen__3nd..Ge 1 n ;C. 0 Petersen. !.n-.: . MEMBER STATE BAR OF WISCONSIN - v (Ii not, • ti r .r authorized by 1 706.08. Wis. State.) to me known to be the person -5 t3v)io qapcstemthe for ing instrument and ack e` sag e. Q t !I: THIS INSTRUMENT WAS DRAFTED BY /j, o'I - T1N..J:...DUNItAP , Marlene M. Peterson ) Hudson ,...Wisconsin Notary Public St._•-Croix...--...... County, Wis. (Sig urea may be authenticated or acknowledged. Both My Commission is permanent (It not, state expiration j are not necessary.) date: -•-------41Q 19.-$8... t •Naass or persons signing in any capacity should be typed or printed below their signatures. STATS BAR OF wiscONSTN FORM No. 1982 Stock No. 13002 Kcrrd,txRo.M~