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HomeMy WebLinkAbout020-1351-18-000~ o a ~ d h a vriy C a O 0 N O r'~ 'V d d •~ 0 N •~ .~ r"~V r v ~ w Z ~ H ~ o zv' v N f- r c 0 a C m N 06 a °.-° :: R a, ~% J U d CC W n r~+ C~ CO as O ~ O O to C ~ OD O ~ s ~ M ~ p O' N 'yp o ~ 2 ~t a a 'v c~ 'c 3 v a ~ A O Z C 3 LL 3 3 `O a~ z ;,; =' °o v` m m a m v `•°- O U ~ a so ~ U d r N O 7 2 N `O a m z ~ z O d f0 H v p Q d ~ 3 3 3 c O O O o a a a v a~ ~ o° °o iy N N J to ~ C O O O M .~ d C y y ~ N C m N f6 ~ O a> ~ N M O i+ a a ,~ c O m v ~ °o 3 0 O ~ 0) c 0 ~ M Y t c .= :°. 3 y U ~ « N d Q. O ~ N ~ C O N 'O 'O U CA f0 f0 ~ y O p ~ ~ 3 O (O U 0)~`- 0) ~ ~ ry ~ ` •' O O ~ v 0 ) M ~ ~ t r L 4) U (A N U ~ N C ,000_.. N Z f0 f0 « ~ C U L t p d O U C ~ L N O OA O ~ O .-. a' Q t.C-_Nm ~ N E d ~ O O O O ~ v N O ~ o N ~ Z o a T N m .O ~ a ~ v .~ ~ d O ~ O Z ~ 0) O ~ Q = o -a N E ~ ~ OO_ N m c a N n ~ ~ ~ w Q A (n Q ~O E M O 3 O a 0 4 4 C 0 0 N N h O N ~ A N Q Q ~ di 7 ,~ N O •+ ~ j > ~ ~ 2 N Y Y "2 to ,t r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. Permit Holder's Name: ^ City ^ Village ^ To~yn of: Whitemarsh Brian Hudson Township CST BM Elev.: ' Insp. BM Elev.: ' BM Description: ' ' ' db ~ ~ C5D ~ c7 -tit P .-. G5~i8 -S U TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic (p ~ Dosing Aeration Holdin. U f r ELEVATION DATA TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic 2 + ~ NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufactur Demand Model Number GPM TDH Lift Lriction stem TDH Ft Force Length Dia. Dist. To en SOIL ABSORPTION SYSTEM~tg~r~a,,~_„~ „~~{ County: St. Croix Sanitary Permit No.: 353279 State Plan ID No.: Parcel Tax No.: 020-1351-18-000 ll~.~i, r~.l~~S STATION BS HI FS ELEV. Benthmark ~Z 0 ~ I IZ.D (Sp ,o ~ Alt. BM ~. ~ 1 o ~ Bldg. Sewer j,8 2 0 , (g ~ St/Ht Inlet ~ Y /p ~r St / Ht Outlet ~. `~' f p ~ . p (o f Dt Inlet ~ Dt Bottom "`-" Header /Man. Dist. Pipe ~;~~ ps ~ ~ Bot. System ; ~ ~p ,,~ ( Final Grade 2 3, 30 08, ~p r St cover , ~D p $", (~ p r 1~ tai ~_ ,~t.e.~ (I Z . ~-o ~,~ ~ - r TRENC Width ~ Le gth ~ No Of r nches PIT No. Of Pits Inside Dia. Liqui epth DIMEN I N ~ 2 •S , Z DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man a rer - ~ ~^- r SETBACK ` ~1J INFORMATION Type O I 2S ' ~~ _ CHAMBER T el Numb r: tf i System: -I- ~~ / OR UNI DISTRIBUTION SYSTEM (~ ~M^r-\ Header / nifold ~ h ~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Irtake Lengt Dia- Length ~- Dia. Spacing _._-- L 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.) Inspection #1/_ ~~Inspection #2: ~--~ Location: 913 Waxon Lane, Hudson, WI 54016 (SW 1/4 SE 1/4 16 T29N R19W) - 16.29.19.1895 Pleasant View Acres -La 18 ) P ~~ arE-'~~i9r-. 1. Alt BM Descri tion = 2.) Bldg sewer length = l ~ • ~ „ ' ~n ~/ -amount of cover = ~ ~~ ~" Plan revision required? ^ Yes ~ No Use other side for additional information. ~ i '~ ~ SBD-6710 (R.3/97) ~~ Inspector's Signature Cert No. I F`~SC011S%11 SANITARY PERMIT APPLICATION Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code ~ Attach complete plans (to the county copy only) for the system, on paper not less than 8112 x 11 inches in size. • See reverse side for instructions for completing this application Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1) (m)]. ' Safety and Buildings Division 201 W. Washington Avenue P O Box 7302. Madison, WI 53707-7302 Cot u~nt~y ~1 State Sanitary Permit Number 3 s3 a~-9 Check if revision to previous application State Plan I.D. Number I. APPLI ATION INFORMATI N -PLEASE PRINT ALL INF RMATION Property Owner Name- c,eNi'~~ Property Location p ~ 1ia Sr/ va, S ` T a9' , N, R ~ / E (or) Property Owner's Mailing Address r 2 G Lot Number ~~ Block Number City, State Zip Code Phone Number Suk-division Name or SM Number II. TYP F ILDING: (check one) ^ State Owned ~ !t~ ~ Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms Town OF ~Lli?S ~ IS L/V. III. BUILDING USE: Qf building type is public, check all that apply) Parcel Tax Numb r(s) `` l V• V 6~ ~. I~FI ~' ~$ ~~ l X95 1 ^ Apartment /Condo v ~ " 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 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an ______System ________System _____________ TankOnly______________ ExistinQSystem ________ Existin~System - B) ^ A Sanitary Permit was previously issued. Permit Number 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 ~ ~r't~-Tigi7312., 22 ^ In-Ground Pressure 42 ^ Pit Privy 13 ^ Seepage Pit StO~W`2G~- 43 ^ Vault Privy 14 ^ System-In-Fill C VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) . I ~ /o`f Elevation a o ------ - Z Feet Feet VII. TANK Capacft INFORMATION in gallo s Total # of Manufacturer s Name Prefab. Site Con- l Fiber- - Plastic Exper. N E i ti Gallons Tanks concrete Stee glass App ew x s n strutted Tank Tanks SepticTank or Holding Tank b 5(7 M'1t(J~ ~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ ^ VLII. 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 Signatur : (No S MP/MPRSW No.: Business Phone Number: ~ 35~ /5- 2G~ !~~ Plumber's Address (Street, Cit , State, Zi Code): - J ~ ~ r IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved itary Permit Fee (Includes Groundwater Ste SSUe Issuing Agent Signatur (No Stamps) I~Approved r` Surcharge Fee) ^ Owner Given Initial ads ~ t "5 -~ e Adverse Determination . X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTION S 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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 and Buildings Division., 608-266-3151. Tabe complete and accurate this sanitary permit application must.include: I. 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 on 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 for numbers 1 through 7. VI1. Tank information. Fill in the capacity of every new/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. VI11. 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 81/2 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 bythe 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 contamination investigations and establishment of standards. ~- ~S ~=1 /off' 7 =a = /0 3 ~ ~~ ~~ ~P~ ~ ~ ~,..3g ~o '"I t ' J !_ ~'~ yo ~ lIS ~- 3 ~g~ X ~ ~~~ ~ ~ //~~i° /oo '~ ~.~-~" / I~ January 5, 2000 Memo to file: I had questioned the length of the trenches since Comm 83:13(1) states that trenches "should not" be over 100ft long. I emailed Leroy Jansky, WI Dept. of Commerce, and his interpretation of the code is that when the code say "should not" it is not mandatory, but highly recommended. His suggestion was to contact the plumber and discuss the issue with him. I called the plumber, Brady Utgard, on 1-3-00 to discuss the trench lengths on this permit application. He was not available, so I left a message on his home voice mail. Brady Utgard called me back on 1-4-00 at 9:03 am. He said that the reason he was putting in trenches that were over 100ft. long, was that boring #6 on the soil report by Robert Ulbricht showed very poor soil conditions in that boring and had made a note to stay away from that area. Brady said due to site conditions and the poor soils in boring #6 that he was putting in two trenches with 18 infiltrator chambers each, that total approximately 117 $. long. He wanted to stay away from the poorer soils with the trenches. Since Wisconsin Comm Code chapter 83 allows trenches over 100ft long to be installed as code ompliant, I issued the permit as was submitted. Kevin Grabau Zoning Technician ` ~ Wisconsin bepartment of Industry, SOIL AND SITE EVALUATION Labor And Human Relations Division of Satety end Buildings in accordance with s. iLHR 83.09, W is. Page / of Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must ~.ourrry Include, but not tlmNed to: vertical end horizontal reference point (BM), direction and ~~~ C~~~ percent slopti, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # pz,p . /3 p ~ •/D ova ozo •/3o~.y0 ©zo •l3a~•,5"a APPLICANT INFORMATION -Please prln ` fq~rta - ~ Reviewed try Date personal IntormAtbn ~ you provide msy be used for second ur~g9se3jt'rivacy Law g: ~15.b4 (1) (m)). • ~~j,~,~ . RR' ~' Properly l~Nm9r r ~, Property Location (/~jQj(/ON w~X Qti ;~''-- ~ ~' ~ ;.. n aow. Lot $W 1/4 $~~ il4,S ~~O T Z9 ,N,R ~9 E (or~ Property Owner's Malting Address G ~ ~ Lot #; Block# Subd. Name or CSM# C,iJty State Zlp Code Phone M Q (' ~ Nearest Road /TU~~~IIJ 5~0~ ~~//~~3~I~*~1 "y~C~S/ /~ (~.~wil~age Town I ~~,~Q~/ G/(f ~ law Construction Use: Residential / - o °? ~ ~ f ~ L s .3 -~ Addition to existing building ^ peplacement ^ Public or commercial -Describe: y!So - Code derivdd daily pow CY ~ gpd Recommended design loading rate ? _bed, gpd/fl2 ' ~ trench, gpd/fh Absorption Brea required ~~_bed, ft2 ?S~ trettn,,~~ch, ft 2 Maximum design loading rate . ~ Zbed, gpd/ft2 • g trench, gpd/tt2 Recommended infiltration surface elevation(s) S~ Y~r1 ~ ft (as referred to site plan benchmark) Additional design/site consfderattons Parent material ~d~'SS !'~~i~ --•Y/~~ y 0f1TW~~~_ Flood plain elevation, it applicable ~~1>¢" ft S = Suitabletorsystem wave ~una~ mw~ nr~a~uu~ rnaamv nr-vi v~awm ... ..~..,...y.a.... r u unsuitable ror system s^ u s ~~ v s^ u s^ u ^ u ^ s Cori ~ SOIL DESCRIPTION REPORT Boring # Around el v /Ds•~rt. Depth ro limiting lector ~ /~in. Boring # 2 Ground elev. /D/ • ~k. Depth ro limiting Horizon Depth Dominant Color Mottles Structure i C t Bounda Roots CiPD/ft2 In. Munsell Qu. Sz. Cont. Color Texture Qr. Sz. Sh. ons s ence ry Bed ,Trench ~- 3 •zl ~oy~ 3/3 L /fsd,~ ~.e ~'S ~f , Y• . s ~• /D S --- S ©s ~~ ~ , ~ ~ • 8 Remarks: 2 / • y ioy,2 Y/C~ SQL /~sh,~ ~--~i ' Q ~~ ~- , Z ; . 3 3 ~ • ~a ye s, ~- s o, s ~ ~.~. . ~ .. $ racror 7 f In. Remarks: CST Name (Please Print) ~ Signature ~ Telephone No. ~os~T 77~,S~ei~ffT ~~/~~s. 38G •BI~S I Address ,/' ~D+~atef~ CST Number Ulhrlchf R Avfenr~laten 'i' 0~' ~~ r ~/ j r/ Z' L' ~ 3 1 S Private Sewage Consultants 665 O'Neil Rd. Hudson, Wis. 54018 PROPERTY OWNER y • ~~'~~~ SOIL DESCRIPTION REPORT Bering # 3 t3round elev. /D~, • DZk. Depth to limiting lector ~ ~In. Boring # t3round elev. ~ o?- ~'Lff. Depth to limiting lector 7 ~in. Page ~ of Horizon Depth Dominant Color Motttes Texture Structure Consistence Bounda R ts 2 In, Munsell Qu. Sz. Cont. Color Or. Sz. Sh. ry oo Bed ,Trench / ©•/o /o yp 3/3 s~ ~fShre •~~R ~s / f , s ; . ~ o • ~•srR y` S ~ s ~ cs -- .~ ~ .8 ~o ~ s ~ -- S ~l - ~- , • ~ ; •~ ;. Remarks: ~~ Remarks: Horizon Depth Dominant Color Mottles T t Structure i t C B u da R t In. Munsell Qu. Sz. Cont. Color ex ure Qr. Sz. Sh. ons s ence n ry o oo s Bed ,Trench 3 is ye S/~ ^--- S ,~ ~- .- , 7 ; . S i~ Boring # around elev. IOG -~p• bepth to Ilmilln~ factor 9 ~In. Boring # (~' Around elev. 7 Depth to Ilmiting r9CtOr -I"• Remarks: ~o~~ ~~~ ~~ ~~ ~ / yv SBDW-8330 (R. 08/95) ~~D~~~ / ~ e ~v~~~~~ ~~ s/~ /^, Remarks: z ,c (, /d x//1,3/ c z_o~ ~rof~' SiL / ~s`I~ ~~i ' ~- - , Z ; . 3 - 4y `o T /~ irs', f33 So ' 1 ,vo , Lo r" ~ s ~ y y~T~ ~~~ , ys~.~ C l~{i~,,, T~',GKG~ ~ ° y ~ G orv T~-ru ~ ~ 0 3 . ~ f'' zp ~pvu D ~ ~ T' A-T ~ ~i . ~s R~ 0 ., 5~.~~E: / = y0 . = ~~~l~e P % rs o~iE.v i 7z°~'.v ~S ~ su'~ ~ ~Go1,,~¢ s a,,,~ Go.~ -~ vR sfi~s~ ~~, o ~ ~° , I ~~ 58 g~/ o . ~ s ~1 • SG ~y ~~g ~ - .± .i ~ ~M~~ .. ~, ~- ; s~ ~ - Top ° F „ pv~ ~ ~ y X00, 0' vo~~ ~~ ~~~~ " av ~ i ~ F~4' o ~-- 12/27/99 11:05 FA% 612 Os,.c-27-99 08:37A ST CROIX COUNTY SEPTIC TANK MAR~FTENANCE AGRECMCNT arro bWNERSHiP CEATIF3CATI(N+I FgRM fool Owntr113uye:r ~~:~ 'f..l~t~~ ~.~~e..~a,~t~ Mailing Address PropeRy Address vLy Pa.~ ~,~ . ~" Lit 1 g /a'.~ -~ ~E~„,t ~'t:-~ F-,t A~tJ. r,..M.~~t,.~t,... oia (Verification required from Planning Departneerrt for ncvv P_Ol cityistate k~~-•- ~ ~~ ' Parcel Identification Number d ~.(,~ - / 3 ©J~ -SCE LE~L DESCRIPTION Ptvpetty Location S (,~( '/., S~,L '/<, Sec. ~ ~ , T~N-R~W, Town of h4.,G +~- Subdivision ~evs._~ V~d~++ ~•'•a~ ~d , LDt ~ ~. Certified Snn-ey Map # _ volume _ '- .Page # Warranty Deed #t / ~ ~ ~ .Volume Page {~ v Spat house O yes ~ no Lot times identifiable (~ yes ~ tto ~1~ MA-.I11T3EiV'AiYCE Improper ase and tnaintenanceof yot>: septic systeta could resuh in its pt+emawre failure to handle wastes. Propetm:intenance consists of pwaPiuC out the stptia tads tvcry duce years or aooaet, iF needed by a licensed pteroper_ What yon put into the system can affect t5e function of toe septic tank as a ttutmrat stage is 1ltt aasta disposal system. The property owner agrtea ro submit to St_ 4oix Zomipg Department a ctrtit9CatiOn form, signed by ffic owner and by a relastcr plumbet. jouraeymaaplumb~, resttiaedpLtrnber at a lieensedpumper terrifying deaf {!) the orrsite wasttwstcrdisposa! spstcm is in proper operating condition and/or (2) alter itesptuion attd pumping (if cu:cessaey), tL,e septic tactic is Less thasi 1!3 full of slutlgt_ ywe~ ibe wdersigacd Lave read tLe about rtrquin;rt~ snd agrr~e to maintain fire private sewage disposal system with the sgttdatds set fortle, herein, u set by e-ttmeot of Commerce and tle Departrturet of Natural sntiag d-at ~ taeen ~~~~ tttelst ~ Rrsources, State of Wiscomiar CertiFication days of the tl~ y~r daft. ~ and returned to tLe St. Croix Cotmry Zoning Office within 30 SlGNATURF OF Appj,tCA i 1' ~ Z.7~ ~9 DATE O R CE 'fi~'Y O (~`y c t 1 statcraeots ou this form are true to the best of ~ F+ntx~dCS . by virtut of a warranty deed rtcordtd is Ragisturof terDeeds ~e- l (~) am (ate) !Le owner(s) of SIGNATVi{& QF A PPLIC r s ~, L7~ 04 DATE •••••• Any infosrrwtioa thw is min-r~p~escntednosy tesWt in the sanitary pettnit bagg revoicod by the Zoaipg Depaetmeru. •••••• " Iatlttde with this :ppiicstiee: a stamped narrartry end front ~ ~~~ of ~~ oEliee a copy of the tettified survey nsp if zzfcrcnct is made in the watsattry doed ~- 4~~,1480PAGE 514 STATE BAR OF WISCONSIN FORM 2 - 1998 This Deed, made between Vernon Waxon, a/k/a Vernon E. Waxon, and Irene Waxon a/k/a Irene S Waxon husband and wife Grantor, conveys and warrants to Brian Whitemarsh and Marv Whitemarsh, husband wife, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): !~ W ~~ * Vernon Waxon, a/k/a Vern n E. Waxon * rene Waxon, a/k/a Ir a S. Waxon Pt 020-1309-50 Parcel I ent~ ication Number (PIN) This is not homestead property. Lot 18, Plat of Pleasant View First Addition in the Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ?i7~~~ day of December, 1999. AUTHENTICATION Signature(s) Vernon Waxon, a/k/a Vernon E. Waxon, and Irene Waxon, a/k/a Irene S. Waxon, husband and wifel ,_, authenticated this day cf December, 1999. * Krishna Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) 610180 Y.ATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12-29-1999 12:30 PM WARRRNTY DEED EXEMPT N CERT CDPY FEE: COPY FEE: TRANSFER FEE: 186.00 RECORDING FEE: 10.00 PAGES: 1 Recordine Area Name and Return Address ` '' ~"~~~~ i~1A OGLA ND ~', ~streen & Ogland '~ - .I3c~x 359 '''~"~8 `~I54016 ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this 1999, the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. day of