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Home My WebLink About018-1048-60-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division - INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Couch, Jo ce Hammond Townshi CST BM Elev: ~ Insp. BM Elev: ( BM Description: ~ I ~'° •a Oo . 0 S. . Cyr"-8~'-~ ~ ~ TANK INFORMATION I_EVATION DATA TYPE MANUFACTURER CAPACITY Septic ~~S Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~ !~ ~ +. 3` Dosing ~~ Aeration Holding PUMP/SIPHON INFORMATION TDH Lift FTi ion Loss Ford ain Length Dia. SOIL A RPTION SYSTEM TRENC DIMEN IONS idth ~ ~ Lengl ~' ~ SETBACK INFORMATION SYSTEM TO Type Of System: C,~nJ• DISTRIBUT ION SYSTEM to Demand GPM Ft I county: St. Croix Sanitary Permit No: 420404 0 State Plan ID No: Parcel Tax No: 018-1048-60-000 ~+ ~ STATION BS HI FS ELEV. Benchmark / Alt. BM ~~ Bldg. Sewer ~ ~~7 g ~ r SUHt Inlet ~ ~~ t7Z•77 ~ / 77 SUHt Outlet s.~ , q~ Dt Inlet Dt Bottom Header/Man. Dist. Pipe . (~.~..~ ,~.~ 9~:6 I 93.24 i 4 z. 9 ~ Bot.System/~~~~ ` J -~I qZ•O 9~• ~ Final Grade ~.bD ~ •S"g ~ St Cover wccl~al5 l'f ~~4 fi Of Trenches NIT DIMENSIONS No. Of Pits Inside Dia. :3 i BLDG WELL LAKE/STREAM LEACHING Manuf CHAMBER OR t ~ ~/ 1 '_ UNIT Model Nur c~~ Header/ nifold .,,( '"' Distribution x Hole Size x Hole Spacing Vent to A i r Intake _. -~" Pipe(s) I . . L ~' Z Length Dia Length Dia Spacing T SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes (~ No Yes ~ No C M E T sl I~ LLde colip~¢t Jcrep$ncie~,tpersons present, etc.) Inspection #1: ~~/ ~ ~~/~2. Inspection #2: T-7' Location: 860 190th Street/Hammond, WI 54015 (SE 1/4 NE 1/4 22 `~S ~~ P/ '- I No: 22.29.17.3396 1.) Alt BM Description - M/ ~syc ( ~•+r ~ Z ~ ~ f 2.) Bldg sewer length '~k ~ ~,,,~ Ot-2 ~ ~ ~~ ~_~ 3 ~~ 8. ~j"~ : -amount of cover ~ $ , ~ . Z~ ~~~ ~ ~ `7 ~a g ~} $ • ~ b ~ ~ ~ ~ (~ • ~•f`t - 9~xz. 10.` f -_ - ---- Yes No Iol D2~ Use others de for add tional information. ';_ ~~_._ ~ ~. _~ ~~ _ ~ _ ~ ~~~~~ -- - SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. isconsin See reverse side for instructions for completing this application PO Box 7302 WI 53707-7302 Madison Department of Commerce Personal information you provide may be used for secondary purposes [Privacy Law s. 15 04(1)(m)] , (Submit Completed form to county if not , . i ,.pZ ,~ S~~/ 2._- state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit umber ^ Check if revision to previous application State Plan I. D. Number ST. Gf~ ~ X20 0 I. Application Information -Please Print all Information Location: Property Owner Name C ~ C V G ' -• -~ -~- --°--- , Property Location .33 -. ~O y L ~ r .. .. ~j ~ 1/4 /-/t~/4, S a~T ,N, Rl W Property Owner's Mailing Address Lot Number Block Number 1 g City, State Zip Code Phone Number Subdivision Name or CSM Number f-~ a ~ ~ o r~cl G~ ~ ~"y o I ~ :.:~_ ? ! ~ ~,?~6 - ~~ ~ `~"ls.~ ~Q gad II. Type of Building: (check one) ^ City j~. 1 or 2 Family Dwelling - No. of Bedrooms :~ ^ Village ^ Public/Commercial (describe use):_ _~ Qf.Town of ^ State-Owned ~~ Nearest Road ! Q O tA~ ~~ r ' / // 3 ~. 2S `-~Q.tti~,lll ~ ~ 39 Parcel Tax Numb er(s) a ~ 8 _ 10 4 S - 6a-a III. Type of Permit: (Chec ox on line A. Check box on line B if applicable) A) 1. ^ New Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ~ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Trea ent Unit ^ Recirculating ^ Other: V. Dispersal/Treatment Area Information: t~~ S~i..~--~-~. 3 ~ ,,,,.~~ 13 .aa~- , 1. Design Flow (gpd) 2. Dispersal Area Required ~. 3. Dispersal Area Proposed l2 (3'~ 4. Soil Application Rate (Gals./da /sq. ft.) 5. Percolation Rate (Min /inch) 6. System Elevation ~1~ ~~ • 4 ~ 7. Final Grade Elevation ~ . ~ ~7 4 / • G. VII. Tank Capacity in Total # of anufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ~ /oo0 1 ~ ~ ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Pl umber 's Name (print) Plu mber's Signature (no stamps): MP/MPRS No. Business Phone Num ber 11 ` . \ (~Jw~T~-- ~~Z,C-I'~V~ ~tf ~ ` [r~ ~~~ 7~Q 2 '~t~-7`~Q -3J~t~ Plumber's Address (Street, City, State, Zip Code) ~~~ ~ ~~ R ~ ~~ ~t~~a~ IX. County/Department Use Only ' Approved ^ Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee (Includes Groundwater Surch~ge Fee) ' Date Issued Iss 'ng Agent Signa (No stamps) Determination -Y~il~ ~~~ ~~ , Z3 ~. ~.onamons oz approve[ /xeasons for ~isapprovat: _ ~ E-x.;s~,~ Sys. ,M.,,.~---~ a~..0 oA ~,~,~, Caw , c~s 83 .we,~s . SBD-6398 (R. 07/00) L j t~s~~k { \~ ~~~ 3 ~.,.,a, lye ~~ ~ ~. ~~~ -rY1~: ~~" 9~.4 ~3~ ~ ~-9=11 ~I ~ ~ 4~•y° ~ __.. ~ ~ . A ~ ~ ~ i3-i•~~-`°)°--rte. ,=~-~=o-- - ~ ~ ~ J t a,~yw'~" P-f'''" ~ y 8 5~ 9,~ , o ff z z~ , 9 ~s~ G ,Are . Ste. R-~.'1 ~ ~''~ _ ---.- __~ 9~ `9 c\o 0~ ,~ ~~ 5,~,~,o.,A ~-Po ~ • ~°~ f.° s~ r ~~ ~G, -, i~ ~ _ ~O ~~; S ~~~~ s ~-~- A- ~°° '~` ~y ,~s~'~~`- P-~=f `ZO~° ~p 9~.9 9~.8 9~• ~ ---7~--~ 3' 9G . 4 4 -~... .~ Q-~-o .l. ~ o117'i~o qa.~l qa.o 9i•7 l ~a ~•' ~~ ~ t~ ~' ~~, ,~ ~3~, ry' ~ ~~ ~~ ~ ~ ~ c, ~,~ =<< // o\o \. 4' t~ e-e'-° • Iv'7a~ ~a~c~ I`~= ~o ~~ s ~,-~~ ~~,~-,~, ~a-- ~ , ~, W .~.~. ~~ ~ ~~~ a ~ s.~.,~- A- goo ,~.` ---,0-- ,, ~y s~~ `- P-`f i~ ~~ 96,9 ~~;,~ ~ R, 8• . c q`.9 q~.8 q~, ~v ~ 3'- 9~ . ~ ~4 qa~~ q~.o q~.7 S~.o. ERA. c ~z. g.,,, ~. ~ - q • ~ J ~~ 9~• 4 "`' ~ r J .~ a ~ P--N° L3 ~ a- - l3~ ~_eA,A.ti,.Q~.,.~. ~ O Ste. R~•'t ~ -f - ~~ ~r P~ M 'Msconsin Department of Commerce SOIL EVALUATION REPORT 3 -tvision of Safety and Bulidin s Page ~ of g in accordance with Comm 85, Wis. Adm. Code /Mach cornplele site plan on paper not less than 8 1/2 x 11 inches in size. Include, but not limited to: vertical and h i t Plan must Counfy S7- CpO~.x /~ or zon al reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.. O~ p _ ~O ~~ , ~ O , ~~ Q Please print all Intormatlon. Reviewed by Date Personal Inlormalion you provide may be used for secondary purposes (Privacy 1_aw, s. 15.04 (1) (m)). Property Owner ` -~3 ~~ J-oycE Co vGG, Z. l4 l~ ~ Property Location Govt. Lol s~ 1/4~~ 1 /4 S ZZ T 1' ! N R ~ Pr rfy Owner's Ma1Dng Address ! ! (or) W ~f~ o ~ 9p d2.. ,ST-. 4 Lot # N~ Block # - Subd. Name or CSM# E'~TS ~~- /~oU,vv CDT" C ity State Zi Code Ph - p one Number Lfd~/Aip~~'1 /,./. SuD~C (~/C 7~~ • a~G ^Cit/y/ [] Village ®Town Nearest Road o~ ~ 9o sr. ^ New Construction Use: ~, Residential /Number of bedrooms , v ,"-- ",rdertv~+c~~f sign flo rate yj~0 GPD rr~~ Replacement yam- ^ .Public or commercial -Describe: ` Parent material ~O f ~V~ s ~Q /~ G ~ ' Flood W~r el eJ~ti~Q~pplica le~~" n eneral comments fem. f. ~, ~iJ and recommendations: ~ G ~v ~ d w~ t ~ . ,, s ~- ~~ s~ %~tv ~T-~ = , y ~~olf~. z.. Boring # ^ Boring ~, ~~ ~~j pit Ground s f / l , ,~ r ~~ ~~ ur ace e ev. ft. Depth to limiting factor in. Horizon beplh Dominant C l Svil Application Rale i o or Redox Description Texture Structure Consistence Boundary Roots GPD/ft' . n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff# 0•/3 ~oyp ~3 G /fsh~ M+fiP liJ Zf 2 . y . ~ z- 3 '/ /DyiQ 3/ $ic. ZfS ,~' ih~t~iP /~ . S . 8 y /o ~/ . s n ~ SQL /fsf/~ v`i`i' cs -- ..Z . 3 ~-~~ r _____~ ' ~ O ~~ ~ Boring # ^ Boring ~// ~0 ®pit Ground surfa l (O ~ ~ / ~ ~ y , / ~ ] ce e ev. fl. Depth to limiting lector ` in.~ Horizon bepih Dominant Col R Soil Application Rate in or Muns li edox Description Texture Structure Consistence Boundary Roots GP D/ft' • e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 • Etf#2 " rr /r rr W l r ^ ! /. p I(•~/ ~Z.'F 98'. `~a Efliuen t #i = GOD > S 30 < 220 mg/L and TSS >30 _< 150 mg/l. CST Name (PI . s Si • EfOuent #2 =GODS < 30 mg/L and TSS < 30 mg/L ~ ~~' ~L~~/ G~ ~ gnature ST Number ZZ 4 7 Address 3 f Dale Evaluation Conduc ed Telephone Nu mber ¢ p / ~ Z~ ~'" ~ls " 3~~ ~ O~d S Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 h Property Owner- ~• (~ U~ Parcel ID # d~O ' ~~ 70 ' ~Q I Uy`~ Page Z of 3 Boring # ^ Boring d f~[I nu Rrrn ~nrf cnri~re nin.. ~V•~ D n....~h r., n...u~__ r__._- ~ ~/ln ~_1 R .~' 7-- - - - r- -- ..-.......~ .__.~. ....~ Horizon Depth Dominant Color Redox bescriplion Texture Structure Consistence Boundary Roots Soil Application Rale GPD/(tt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ett#1 •Eff#2 .3~ ~o ~-- ~S/L / S ~f ~ . Z . 3 S ~ S y,P S ~- ~e~ S O ,Q 9/• ?off ~~ ^ Boring # ^ Boring ^-pit Ground suNace elev. ft. Depth to limiting factor in. Soil Application Rale Ftorizon beplh Dominant Color Redox Description Texture Slruclure Consistence Boundary Roots GP D/fl= in. Munsell c]u. Sz. Cont. Color Gr. Sz. Sh. 'Elf#1 'Eft#2 r .4 Boring # ^ Boring ^ Pit Ground surface elev. fl. Depth to Ilmiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Slruclure Consfslence Boundary Roots GPD/ttx in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •EH#1 •Eft#2 ~' - o i~ 'Effluent #t = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • EHfuent #2 = BODE < 30 mg/l_ and TSS < 30 mg/L Zhe Department of Commerce is an equal opportunity service provider and empbyer. If you need assistance to access services or need :material in an alternate Cormat, please contact the department at G08-2G6-3151 or TTY 608-264-8777. SAD-RJJO (R 6l00) ' ~ ~ V~~ ~'~ ',,, ~. z~ z4 3 /3~~C'/`'~S iy q ~~~ ~-o~R `a C .._-- 1~~, 3 0~3 - SQ 2(, ,_-. cFsSp~o~ ~ poR(.k ~~ /(/ ~ d 977v ~ 30 SUM ~ o~ `~ ,~~ ~~= ToP of /aw~sT ~,/ ~.v o __-. ~~ ~~ ~ ~ 5T. - • --- 9~'yv ---- --- ----3 ~'~8a -------- ~ I---- --- ~~~ ----~ ---------I sYSr~ y~' .~ ~x~~'. y~, ~' ~ - -- -- - - - - - -- --~~~ -- - - -- ~ 2~ _~~~~ ~n ,~ - ----- -- O 3 ~X ~O~ _--_--.. •---. -- q~ - s ys/, ~~ 9/ 70 J ~~ 0 i~. ~ i . f----. i ~z~l'~ --~ NON'CONFORM~NG TANKS SHALL RENT PROPERLY -NDONED ,nnM. 83.33• PER PLUMBING PRODUCT APPROVAL ~ ALL ~~CODES, ALL ABOVE-GROUND PVC ~. EF PIPING (FROM TANKS & SYSTEM AREAS) g~A MUST BE SCH.40 PVC MEETING ASTM PER D1785 OR D2665 STANDARpS. ~ ~j d ~, C ~ ~ T. r ~- ~r ~~ ea w~ ~. ~: . to Private Onsite Wastewater Treatment System Management Plan ~ Septic Tank And Gravity In-Ground Soil Absorption Component L ~ J~ ~~~~ ~' Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment .System (POWYS') shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, "~~ . ~~ or governmental unit. The approved plans and permits for system are on file at the county ~ _ < ~ zoning or health department. y.. i ~ This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- f !.~ `~'- 10567-P R.6/99). `' ~~~ ~. ~~ "~ L Table 1: System Design Specifications Sanitary Permit Number o Number of Bedrooms ~ 3 Design Flow -Peak (gpd) S'C7 'Estimated Flow -Average (gpd) o-c~ Septic Tank Capacity (gal) DO Soil Absorption Component Size (ft2) 1ZS" Type of Wastewater omestic T~hln 7• Cnil Ahenrntinn (:mm~nnant . 1 imits of Reliable Operation ~t r~a ~. '`;, . r< Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) cvp z/~ ,o+ Otis Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance 5cneauie Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years `:!#c i~.;` Septic Tank ~ The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease :7 Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). ~ . The operating condition of the se ti and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter hall be cleaned as necessary to ensure ~' proper operation. The filter cartridges o be re~rw ~ ~! unless provisions are made to rata solids in the tank that may slough off the filter v~f ~~ ~ moved from its enclosure. if the 'L,~; ~~rt . #,- Mana~7r;ment Plan for a Seatic Tank and Soil Absorption Component ;" Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. ,, ~,~,~,,e~"z. ~~~ .~ ~~ /J ~~~~ ~~ ~~ / 7-y~ 9 ,;~3 , "~' ~~-~- ~~~. ~ x ~1,~-~U` ~ a"~"`~ ll~ tax ~l ~_ ~` ~7 ~'f g - 33 ~ ~ f... ~ , ,L L-~ /o ~ ~~~" ~` '~ c v ~ '~ ~ ~ ,~ ~~~~ G~~ ,r( ':!'. ~~• ~. `~1~ .. ~' ,a,. _ ~~ ~~~. :r;' . 3 ST CROIX COUNTY SEPTIC TANK MAINTBNANCB AGRBBMBNT AND OWNERSHIP CERTIFICATION FORM Owner/B~r v ~ CC Mailing Address ~ ~° a ~ 9 ~ d ~ . Property Address ~ ~-~- (Verification required from Planning Department for new construction) - o !~ - /oY8 -loa-oaa City/State ~-~ ~ ~ Parcel Identification Number LEGAL DESCRIPTION Property Location S F_ '/,, I ~ ~~ '/4, Sec. ~ a , T~._N-RAW, Town of l~ ~`~'ri'`~`"~ Subdivision ,Lot # Certified Survey Map # ` ~g ~'~ ~ .Volume .Page # Warranty Deed # 3 qS" ~ ° ~ .Volume /° q `~ .Page # ~ 8 Spec house ^ yes [ono Lot lines identifiable (~ yes ^ no SYSTEM 1VIAAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on site wastewaterdisposal system is is proper operating condition and/or (2) a8er inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office withm 30 da of the three year expiration date. ATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~~ d ti SI A OF APPLICANT ~l°l/a.~ DATE artment. ****** *•**** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Dep ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~ 8.3~ ~~ ~~ _ --- , - --- --- _ _...~_ . - DOCUMENT NO. WARRANTY GEED ~~ TM1e """ ""`""`O'O" ""O"Di"` °ArA ij ' ~ 1t STATE BAB OF W[SCONatN FORS[ !-iNf,~ ~4 395 ~" 07 ~ ~ Irg~ _ F$~~Pac~ __ ~ ~; - -._ ___ .! REGIETtia"5 OfFiCE l~T. CROiX CO., WlS. '~ Wallace C. Voskuil and Marion E. yoaku;<,1,~.•hu9banZ•-and_.-_. ~~ ~'d ~ Reoord fh(17~ wife,._.~oiti[ly..and,-individually-.•-..._•..--....•- .. (~ --~ :', ...................... ~ dalr of Au us A.O. 19$4 ... ......... ............................. .•------........-. ..... ..... .... ii of 12: P ~ conveys and warrants to ...$.L.~li~.9y...~1....aAd...~Qy.Gf:...y......CQ~1Ch>..hushand'y' ` 1 and..t~if~..aa-,).oint..tenants, ............................................................ ~' ._....., tom. Oew+r ;i -.---.- -r - -.._ . _..- - .. _ ._ .__. _ St. Croix Count the following described real estate in .............................. y. State of Wisconsin: A parcel of land described as follows: Co~teacin, at the South East corner of the Korth East One-Quarter (NEB) of Section Twenty-two (22), Township Twenty-nine (29) North, Range Seventeen (17) West; thence North along the East section line a distance of 'hree Hundred Sixty- One and one-half (361.0 feet, to place of beginning, thence due West Four Hundred Two (402) `eet, thence due North Two Hundred seventeen (217) feet, thence due East Four Hundred Two (402) feet, to East section line, thence _ South Two Hundred Seventeen (217) feet to place of begin- t'~:::. sing, said parcel being about two (2) acres. Q_J This Deed is given in fulfillment of a certain Land Contract between the above parties,. dated October 31, 1962 and recorded November 13, 1962 in Volume 390, page 120 in the office of the Register of Deeds for St. Croix County, Wisconsin, Document Nc. 270744. This ._~s--not -.-..- homestead property. (~ R~~1 Exception to warranties: Dated this ....--- -•-- •---.26th..--......-•------• day of ........... ......311.~.y----.....-•-- ---..-..- --•-----......., 19..84.. .. _- - - -- _ - ------• ............................./SEAL) ............................•-----------........-----_.-------- (SEAL) AUTHgNTICATION Signature(s) •-----•----•--•-------•-----•--.....--•-°-----•-- authenticated this ......._day ot ........................... 19.... TITLE: MEMBER STATE BAR OF WISCONSIN (I4 not, Wallace C. Voskuil A~.t s -f n /' ../.._~ yr~Ir ~~.(~'..~-F.~yt~.---~ ........(SEAL) • -, Mar.ion..~,...Yoekuil ................. ACHNOWL>16D0>1[SNT STATE OF WISCONSIN St. Croix ss. - -•--•-•----------•----•---•--•-•---.Countp. Personallq came before me this ...26th.....dsy of ..._..._July......-----•--•---•---•__-. 19.-8k.. the above n,timed Wallace..C,,.-Voskuil-.and.-Marion--S.-•Voskuil-, hushand.-and..wife,.. jointl3r-.and--individually, wuthorized by ~ 706.06, Wia. Stats.) to me known to be the person ..s........ who executed the ~,,,,,,,,,_„ ,foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS ORAFTF_D BY „~`~~ +` ~ •• ~~' -/ .H;axQ14..A..---Qlsun- Alt ,: ` -.- _r; ;........ ~ •- -.. -~,- --- >•• y'>'----'--'-•--......... ,~-~~ - , s,?? Harold D. Olson .$~?.S(ld~l?s_.WZ--~__4RQ2 ................•--...-._..._.,:?;:._..9C..~ ;- Notalg Public ..---St.,...Croix..---.-•.-•-•---..-Councy, wis. (Signatures may be authenticated or acknowledged. ~th '- My4Commission is permanent. fIf-wstT~tate-wspisaiion are not necessary.) >% •~• ~.' ,,e,p, : t9 .1