HomeMy WebLinkAbout038-1170-80-000
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ddi111g11N11N - -
"""_"d ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
August 10, 1994
Mr. Evan Vieregge
1318 Stardusk Drive
New Richmond, Wisconsin 54017
RE: Septic Inspection
Dear Mr. Vieregge:
An inspection of the septic system serving the residence located at
1318 Stardusk Drive, New Richmond, Wisconsin, was conducted on
August 8, 1994. This property is located in the SW, of the SW; of
Section 13, T31N-R18W, Lot 11, Country Meadows I, Town of Star
Prairie, St. Croix County, Wisconsin. At the time of the
inspection, this septic system was found to be code compliant for
a three bedroom home. Should you have any questions, please feel
free to contact this office.
7mprely,
>
J es K. Thompso72~~
Assistant Zoning Administrator
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER e L,
ADDRESS / r -5 11,-
SUBDIVISION / CSM#_jtr LOT # / l
SECTION __.Z 95 TAN-RAW, Town of JS 1a T~r.e
ST. CROIX COUNTY, WISCONSIN
PLAN VI
SHOW EVERYTHING WIT 100 FEET OF SYSTEM
sQ_
77~
i
9a
J
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
1
a
BENCHMARK:
ALTERNATE BM:
I
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: /,Jee 1Es Liquid Capacity: 10ov
Setback from: Well 111' House 30 Other
Pump: Manufacturer /Z,//19 Model# Size
Float seperation Gallons/cycle:
I
Alarm Location
SOIL ABSORPTION SYSTEM
Width: .5 Length 6o Number of trenches Z
- -Di.s-tance-&-D-i-r~ct-ion-to--newest-- r-Gline-- - 07~-'- - - - -
Setback from: well: '77 House 'If Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DA -
TE OF INSTALLATION:
PLUMBER ON JOB: 6cP i -7-,,on ov'
LICENSE NUMBER: /V& 3zzy
INSPECTOR:
3/93:J't
t J
Wisconsin 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
P V 1&gri t': m e, ❑ City ❑ Village Town of: State Plan MAP!'
EVAN CST BM Elev.: Insp. BM Elev.: BM Description: 1~ f, P Parcel Tax No.:
TANK INFORMATION ELEVATION DATA g D~49
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic C9Y n' IOCf Benchmark 3 D¢
Dosing . Ix X06 r
Aeration Bldg. Sewer
Holding St/ ~W Inlet
TANK SETBACK INFORMATION St/ W Outlet CI f
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic > jd >(Do a NA Dt Bottom
Dosing NA Headertis 111
Aeration Dist. Pipe 4
Holdi Bot. System
PUMP/ SIPHON INFORMATION Final Grade",
Manufa Demand 8, 3
Model Number PM 6°d aj G,7yL"
TDH Lift Frictio Syestem TDH Ft
In mead Dia. FFii Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 600 ' DIM N I N
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACH-17M_anu rer:
SETBACK CHAMBER Model Number:
INFORMATION Type0 nxuA06,VL- 33 0 v, 75i - ORU
System: tre,r,(1- 20~
DISTRIBUTION SYSTEM
Header / Mae•i 4W Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length 11,1 , Dia- Length ~57_~ Dia. Spacing ZZ
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste
Depth Over Depth Over „ xx Depth Of xx Se Sodded xx Mulched
/Trench Center W /Trench Edges - Topsoil E] Yes E] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Star Prairie.13.31.18W SW, SW, Lo 11, Stardusk Drive
60, cc-7
t
Plan revision required? ❑ Yes to Q
Use other side for additional information. 7
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
E DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code Cjn ~l %
STATE SANIT Y PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than a 00q
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 ^
4, S 13 T 31, N, R (or) PROPERTY OWNER'S MAILI DDRESS LOT # / BLOCK #~Q
CITY, STATE O cZIIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~v 7'~
11. TYPE OF BUILDING: (Check one) CITY NEA EST ROAD
❑ State Owned ❑ VILLAGE :
❑ Public & or 2 Fam. Dwelling- # of bedrooms 3 PARCEL AX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply) X38 _ /17o tr`O - ae+~
1 ❑ Apt/Condo
20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 1o ❑ 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. A New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5. ❑ 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 29 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
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
4156 6~,s (04~0 .75 7 r5:6 3 Feet F1'8. 75 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank C
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): Plumber's Signature: (No Stamps) MP PRSW No : Business Phone Number:
32Z 7i$ >72 - 3z<
Plumb 's Address (Street, City, State, Zip Code):
05- 6-45 2
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater E aIssued Issuing Agent Signature
Approved ❑ Owner Given initial I t jurcnarge Fee) 7 g
4217 i
Adverse Determination
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
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 (SBC) 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.
Vlll. 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)
JOB ~(IQ vl 6e e!y -e
TIMM EXCAVATING SHEET NO. OF '2-
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY O fir" DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-8D0-225-6380
TIMM EXCAVATING JOB ell L/ SHEET NO. Z - OF 2
Route 1 Box 192 -Z
WILSON, WISCONSIN 54027 CALCULATED BY y DATE L
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY - DATE
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PRODUCT 205-1 A Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800-225-8380
DEPARTMENT OF SAFETY & BUILDINGS
`INDUSTRY, REPORT ON SOIL BORING'S AND
' G DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
'3 wj -S' W It " (ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ ICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
S~ S 1.3 /T.~ N/R/.FE (or) W es.. i
COUNTY: MAILING ADDRESS: YR - Z~i
f a bey D-e. w= S spa z
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTSp:
Residence /jj ®New ❑Replace /7 Z ii93 a 9/3'
RATING: S= Site suitable for system U= Site unsuitable for system C
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: MS EM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
®S ❑U E S ❑U ®S ❑U ®U ❑ S ®U
If Percolation Tests are NOT required DESIGN RATE:
~ If any portion of the tested area is in the
under s. ILHR 83.09(5) (b), indicate: (f/' Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
0e. Z S' YZ -,rC. 03,71
B- ?Z, 520P B- L 8l~ r/ i G'/% i J z n _ell j, / Z 6 - 3,9 81 44, e S -
ZG -3r "2 ~~.s
Z96 99 rr-z1"
" 7 "h. Qh S. / YZ "'e.6,
B- 9( 99 6S 3 3 -,r-/ s - 9i " :1 _.Z Z 37- 15,7
B- £3 9! ~o ` ~s o -moo ` 86 - 8r "c . s
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH
P_ 1 ' ra //r B G e. `7
P- Z 4 lle~ f d fir /~ii~ /fir 4, '7
P-
P-
P-
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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 elev tion at all borings and the direction and percent
of land slope. / ~„Q<~J. ~.rL
SYSTEM ELEVATION ° 3 O_A_4 -
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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.
I
NAME (print)- TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST S GNATURE-
'UTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
s-SBD-6395 (R. 10/83) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use suction must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER
SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet
may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if
appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and yur certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL
AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob - Cobble (3 - 10") SS - Standstone
gr - Gravel (under 3") LS - Limestone
's - Sand HGW - High Groundwater
cs - Coarse Sand Perc - Precolation Rate
med s - Medium Sand W - Well
is - Fine Sand Bldg - Building
Is- Loamy Sand > - Greater Than
's1 - Loamy Sand < - Less Than
'I - Loam Bn - Brown
'sil - Silt Loam BI - Black
si - Slit Gy - Gray
cl - Clay Loam Y - Yellow
scl - Sandy Clay Loam R - Red
sicl - Silty Clay Loam mot - Mottles
sc - Sandy Clay w/ - with
sic - Silty Clay fff - few, fine, faint
'c - Clay cc - common, coarse
pt - Peat mm - Many, Medium
m - Muck d - distinct
p - prominent
HWL - High water level,
surface water
' Six general soil textures BM - Bench Mark
for liquid waste disposal VRP - Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system
and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary
permit must be obtained and posted prior to the start of any construction.
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S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
~ / / ~ ~l9ddres~
OWNER/BUYER ~Rl ► it $L Q !54fd IT
ADDRESS d e
~ FIRE NUMBER.
CITY/STATE- ZIP- 2 -4"10111 ,1~
PROPERTY LOCATION: w1/4 ,,~/4 , SECTION, T,~~N-R_/J W
f
TOWN OF GYY ~/`G/Tr , St. Croix County,
SUBDIVISION kaal K,//
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/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 Co. Zoning fficer within
30 days of the three year expiration -date.
SIGNED/- 2 ✓
DATE • _ )7-,
St. Croix co. Zoning Office
911 4th St.
Hudson, WI 54016
S T C - 100( T Clf"L'G lj -1/7C~80- 000
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 ~a
Location of property 1/4 /4, Section -,T/N-R~W
Township G~~ ~t-~ f r Mailing address
Address of site X X b:LL rrv ~
Subdivision name &12~4 Lot no. 1 /
Other homes on property? Yes No
Previous owner of property g,
Total size of property e
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes ~No
Volume joi~ and Page Number 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. . -rSff 3 7 0and 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.
i~3zo
ignatur `of A cant Co-Applicant
Date of Signature Date of Signature
' DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
Allen L. Lunde and Gary Brunclik, d/b/a Homestead
JUN 2 4 1994
Development,
r 10.50 A
. P
• III
- -
Evan D. Viere g.
conveys and warrants to ga ,
_ 1.
:I
RETURN TO
- - -
the following described real estate in _.St. Croix County,
State of Wisconsin:
Tax Parcel No:
iII
Lot 11, Country Meadows First Addition in the Town of Star Prairie, i
St. Croix County, Wisconsin.
so
I
1S not
homestead
This - is - property.
IM (is not)
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any.
Dated this day of - -JllTle-- - _ 19 -94..
- -
- SEAL (SEAL)
L.. Lunde-
Allen
...(SEAL) - ..-----.(SEAL)
* Ga unclik
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) Allen L.- Lunde_____________________ STATE OF WISCONSIN
Gary Brunclik ss•
County.
IµS, of
authenticated tk i° - day of June 19. 94 Personally came bcforc me _h's -
------------------------------------------1 19-------- the above named
Kristina land
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina 0 land
--9------------------------------------------------
Attorney at Law
Notary Public ----------------------County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date- 19---- )
'Names of persons signing in any capacity should be typed or printed below their signatures.
Wisconsin
DEED STATE BAR OF WISCONSIN Legal Blank Co., Inc.
it FORM No. 2- 1982 Milwaukee, Wisconsin