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HomeMy WebLinkAbout030-1014-50-000 n ca o ■ 0 m tv . § 7 § § ; § ° � ■ = q; 6 � 2 4 ' \ \ lu . 0 7 ƒ S£ \@ a m k f m E §/\ o \_ 3 ` @ ~I\ Co Q K q i 3 j ; @ ƒ CD @ o § , -4 ; Q g § m } / § £ \ 3 2 §�� o \ § E \ CL ® a . / § o \ \ n r @ Z � CA) - & [ "WA. . §. Z - / 0 0 0 \ O } 0 J CO) 2 �' r 2 a Q \ )_/ k 0 { m E E ; \ \ 7 ƒ \ g } CD p 2 N C a 3 co } ) (D 0 CL § \ ƒ ; w T ) A 3 / m § m @ .. z % ; ® I 2�)± �8E§ cr a F a cn ) \CD % = \I( 0(g kf2 � f/g Z. %�7 ƒƒ\ g @a © _ / ; cn \ 0 % � § §i �\ Wisconsin D;p9rtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building DKision INSPECTION REPORT Sanitary Permit No: 430632 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. -- ----s Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam St. Joseph Township 030 - 1014 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: 6b . o �CID a CST t5'►A # i9v� PAC 04.29.19.60 TANK INFORMATION EL VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 0 •� D Dosing Alt. BM 2• t ,lo Aeration Bldg. Sewer / 2• z + `f- PAZ o Holding SUHt Inlet TANK SETBACK INFORMATION St/Ht Outlet X87- q? -6o ' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Dt Bottom Dosing Header /Man. t g• SS Aeration Dist. Pipe •O i l / Holding Bot. System U t .O PUMP /SIPHON INFORMATION Final Grade D Manufacturer Demand St Cover O f GPM Model ber TDH Lift i ' in Loss System Head TD Ft Forcemain ength Dist. to well SOIL RPTION SYSTEM L %VpftRENC idth Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI S 3 3 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer- �` INFORMATION CHAMBER OR - v c&:z Type O System: *> UNIT Model Number: ( [ DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe ) Length Dia Len Dia SOIL COVER x Pressure Systems Only xx Mound O At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil g p f Yes No i Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1 ;d�,,,,,�1 Zl /� Inspection #2. Location: 1151 56th Street Hudson, WWI p 540116 ( 1/4 NE 1/4 4 T29N R19W) Park Hollow Lo 11 Parcel No: 04.29.19.60 1.) Alt BM Description = -To 't V-W—L 2.) Bldg sewer length= L f 2- - amount of cover = t. 3 � Plan revision Required? Yes No - - -- Inse ctor's Signature Use other side for additional information.' __ Date p g Cert. No. 7 (R. 97) 1 t �C>(# T JT 5f S 7 t tYL-1 -- — ------------- ��s f l �a r k N e r ew YLl t��x 4 C-L wct y o J �c,U�Lt- �PL�T Gt'' 0 osc� PR �' a Sr•� 1 � 3_Cka.w.bcvfs Each. T.v.��c,l, wA� 3` . A 8 9 Q V /'D " IX f� 5 5W .r CL I V. V V l ��jt t3 N 7: T�� f 5fa�k 15W. 9D. 338�rt E Safety and Buildings Division County _ pp 201 W. Washington �j ( L U`O IMF c ons/n Madison, Wl 3707 LIV ani Permit Number (to be filled ut by Co.) N vis De artmeen of Commerce (608) 2 6 -3151 /3a ( Sanitary Permit Applicatio DEC 2 3 20A late PI in LD. Number in accord with Comm 83.2 1, Wis. Adm. C6&,-personal information F provide y may be used for secondary purposes Privacy 1Aw, s15.04(1 ST. CROIX COUNTYroject dress (if different than mailm add: as) ZONING OFFICE'� 5 r � I. Application Information — Please Print All Information o Ia�y_ -ooc� I Property Owner's Name Parcel H C I Lot loc'> o L130 -1 ' SA pp M 11- L C ►a` - SO _ m 00 Property Owner's Mailing Address Property. .ovation X3 0 X - tt: r w L 4/ City, State Zip Code Phone Number Y', Section I at O Lo 1 y� ((0 3 �p'Z 7 �o T Z/ N; R�E o W 11. Type of Building (check all that apply) II or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ PublirJCotrwmer W - Describe Use f F1 O •I O e e� ❑ rate Owned - Desgibe Use 1.10 ❑City_❑villagevTownship ofst• 's I-U 3 +QEN CN E S F E 0 svr V7.7 Ill. Type of m t• (Check only one box online A. Complete line B if ap cable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System Fi • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New list Previous Permit Number and Dace Issued i Before Expiration Plumber Owner IV. Type of PO WI'S System: (Check all that apply) _ X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter I1 Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Tt'eatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter rLewhinSChamber ❑ Drip line ❑ Gravel - less Pipe ❑ Other (explain) y V. Dis ersairrreatment Area Information: ; Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal ea Proposed (sf) System Elevauou 00 V1. V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Gallons Gallons ofuaits Concrete Constructed Glass New $xiating Tanks Tanks S..pti or Hokbng Tank / 2 S Q X Q✓ X A robes Tmumcoi Unit Dewing Chamber V11. Responsibility Statement - 1, the undersigned, assume responslbWty for Installation of the POWPS shown on the attached plaits. Plumber's Name (Print) Plumber's Signature MPRAPRS Number Business }'bone Number IDoKc J` c ZZSo 3 612 - A.y- j } Plumber's Address (Street, City, State, Zip Code) nn �J - -- /D 14. - t, (fie �4 m le'r. V11L County/ e artment Use Onl Approved ❑ Disapproved Stary Permit Fee includes Groundwater Date lssue� nt Signature N anupsi � ani Surcharge Fee) � 13 Owner Given Reason for Denial 1 2SD - 3f) �3 is g ge 1X.. Conditions of Approval/Reasous for Disapproval SYSTEM OWNER: - Tki S - k - S - 64, _ re S`dSvte 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach eompicte plant (to the County only) for the system on paper not k» than 81/2 1 11 Inches in slze SBD -6398 (R. 01/03) 5,a mILLFR_ IZ u� i 105 t ��SC3y l-��.,sQ t 2!S7p SC S T ,,,/e p o se.f P� P a 120�� a I � 3 f1 S 5✓ •►• CL E I V. l o© J r v h E f V - - 9D. 60 —N 338 t ov*l � « L E , a - 3 c, o l U 3y 1 d 5 i ZSCm��� W�LL� SP��r (2 �o Sa.l s r IA P � oP oscj ol r �2` i off' �4 1 djq • toy � J s v 60 l� 1757 Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pending from 030 - 1014 -50 -000 Please print all information. R B Date Personal information you provide may be used for secondary Purposes (Pnvwy Law, s. 15.04 (1) (m)). C.. 3fl Do Property Owner Property on Sam Miller Govt. Lo ( SW 1/4 NE 1/4 S 4 T 29 N R 19 W Property Owner's Mailing Address Lot #/ 2, Block # Subd. Name or CSM# P.O. Box 151 A< Park Hollow City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson WI 1 54016 1 (715) 386 -2769 StJoseph I River Road ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install three trenches at elev. 97.50' using 39 leaching chambers. ❑ Boring # Boring ✓ Pit Ground Surface elev. 100.88 ft. Depth to limiting factor > 128 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 P D /ft 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-10 10yr3/3 none sil 2fcr ds as 2f,1 m 0.5 0.8 2 10 -21 10yr5/4 none sil 2fsbk ds cs 1fm 0.5 0.8 3 21-60 10yr5/4 none sil 2fsbk dsh cw 1f 0.5 0.8 4 60 -72 10yr4/6 none sl 2msbk dsh cw 1f 0.5 0.9 5 72 -118 10yr5/6 none gr s 0 sg dl gw - 0.5 0.9 t .Sp 6 118 -128 10yr6/4 none gr s 0 sg dl - - 0.5 0.9 H#'s 5 & 9-contain - 114r - 2" wavy bands of 10yr4/4 Is at 10" - 1 fi" intervals. Loading rate reduced tc reflect reduced permiability associated with banding. a Boring # Boring ✓ Pit Ground Surface elev. 100.84 ft. Depth to limiting factor > 126" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 /ft 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -9 10yr3/3 none sil 2fcr ds as 2f,lm 0.5 0.8 2 9 -26 10yr5/4 none sil 2fsbk ds cs 1fm 0.5 0.8 o� 3 26 -36 10yr4/4 none gr sl 2msbk dsh cw if 0.5 0.9 4 36-43 10y none gr 1s 2msbk ds cw If 0.5 0.9 5 43 -81 10yr5/6 none s 0 sg dl gs - 0.5 0.9 6 81 -126 10yr614 none s 0 sg dl gs - 0.7 1.2 H# 5 contains 1/4" - 2" wavy bands of s 4' -10" intervals. Loading rate reflects reduced permiability associated with banding. . Effluent #1 = BOD 5 > 30 < 220 mg/L and SS >30 < 150 g/L Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 1 54020 11/132003 715 - 248 -7767 � ■ 501 C'dc1�u�'o� !fie d �o�e f�ca le, :/ w 5ec.y, Tn.ofSt Joe. ■ �o LI P,-6po sea To'i 'l s! 5 lo 9? 99' �oa.d ti �6y'• Ass4►n a {c = Boa. dD! B : 7 of /od 5 . �1 33b' 3 OF 3 r r .r ..r .� �. ..� �... �. r.■ r ir. �. r r r. �. TA BioDif fuser Specific Ions, CMmber Heigm rr �= �� �• r �� �� — = ctwrbw HOP End Oew Universal End d I Chamber 11" Stan• 14" High 16" High • a • • Dimensions dard Capacity Capacity ti ly � ,� ` ' { v "_yy,,,,t,�► � ,,��yy� ` � ` Y t i t \ 1 r i , y ' } d it a ��{•' ���t,,y� ��� ^'t1, !�k •,. I ya>f , � �' :•!�i�, .a � �' /•V,,;� t • v �. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Cwner I SA / n / L L F,Q Septic Tank Capacity 2-5 a l ❑ NA Permit # 1 b 6 3 Z Septic Tank Manufacturer W ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2 r4 L ❑ NA e Filter Model — O O ❑ NA Number of Bedrooms !� C3 NA Effluent ,Q / Number of Public Facility Units A NA Pump Tank Capacity a l t NA Estimated flow (average) _1{0n gal/day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) too© g al/day Pump Manufacturer 1KNA Soil Application Rate d. S gal/day/ft' Pump Model ®' NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L AIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s1 (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 3 ftf Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 5ryear(s) Clean effluent filter At least once every: _ 2- ❑ yea�(s) ❑ NA O month(s) A Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s). N Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) At least once every: A ❑ year(s) Other: A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. f Page 2 of y START IIP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that ; lay impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of thAank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s► and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua If nu ItYp 0100 1- OV-0ilzrIta a o mg ank naal b e tai a>?DI- /181? �Ci /�/bb✓ CaDNS7R(l�Tt D� ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name M' �� � p ��` Name Phone G I 'c- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S G ( (y 20AI �Cl Phone Phone /S— 3g(p_ 4 /& 9 97 ) This document was drafted in compliance with Chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administr ;tive Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM er/B u er own y Mailing Address s fl, �- Property Address AISJ S(. Tia (Verification required from Planning Department for new construction) City /State 4 o m -,, LX) ( Parcel Identification Number 03 O - 1 2 l - 00 0 LEGAL DESCRIPTION • ��� Property Location 5 W ' /�, u L ' /a, Sec. T �`� N -R J!t Town of :S Subdivisio k © vi, ceQ Lot Certified Survey Map # , Volume . Page Warranty Deed # - 7 1'& 2_.- `f 2 , Volume z Z 1 . Page # �o 3 Spec house ;R yes ❑ no Lot lines identifiable , yes ❑ no SYSTEM MAINTENANCE 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 in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 within 30 days of the three year expiration date. SIGNA OF ICANT 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. ` TUBE OF AP ANT DATE « « « « «* Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * « «« •• Include with this Appliextion: 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 1 2214P 003 718249 �( KATHLEEN H. WALSH ` STATE BAR OF WISCONSIN FORM I • 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIx Co., WI Document Number RECEIVED FOR RECORD This Deed, made between James E. Ebbe, an adult single man and 04/21/2003 03:00PM Thomas A. Ebbe, as custodian of Theodore A. Ebbe, a minor, under the -- WARRANTY DEED Wisconsin Uniform Transfers to Minors Act EXEMPT R Grantor, and Sam E. Miller REC FEE: 11.00 TRANS FEE: 1477.50 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Rerordine Area Namc and Return Address Sam E. Miller P. O. Box 151 Hudson, WI 54016 L The SW 1/4 of the NE 1/4 of Section 4, Township 29 North, Range 19 West, St. 030 - 1014 - 50.000 Croix County, Wisconsin Parcel Identification Num ber (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except continuing easements and restrictions of record, if any. Dated this 17th day of April 2003 6� vetkz - — 1 1LAa— a _ ames E. Ebbe . Thomas A. Ebbe custodaan for Theodore A. Ebbe ii(' ACKNOWLEDGMENT AUTHENTICAT PY`pu8z ksff, rr fi STATE OF WISCONSIN ss. 1 Signalure(s) �, ) i St C roix County. ) _ DEBO �r Personally came before me this 17th day of authenticated this day of P REW r April, 2003 the above named James E. Ebbe and Thomas A. Ebbe �h fl An r41:r h ' 1, tN" ,U ±rnH 1 TITLE: MEMBER STATE BAR OF WISCONSIN to me It own to be the person(s IO executed the foregoing (If not, inst t t nd acl tows get authorized by § 706.06, Wis. Stats.) / THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law 502 Second Street, Hudson, WI 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is (If not, state expiration date: necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR Or WISCONSIN WARRANTY DEED FORM No. I • 1991 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800- 635 -3011 smrtrorsel�+u�lw r�alr�►er�vstrxoeyseinsNisu ._. �� � R het!/ I dnacip 541;/ v I d/�'AMW k*3 f 13 �V .�'!'.?� J'd = = er Y-777/n IMP � _ iz C F ir u �� +ate � t t tt',' I, �+ ltie� "N "'�'�''Y''t°,�,.'.ys- �.•. >' �` : S \�� 1 ', y r`• � r � OI y a sTr /.• ! . V* lr �. Wt'1a v' a'>E•f r Lti� \b; , s'I_ = ' ILM �!tlkfi' � K �ki4a ;k ?:< ; x f /r� �y, ' (� ltl \ \�� a -Y�`1x \' ' ` '' i k S +l: • ��i o A 7 7r/ •� �q 1i �•, \ \. \s � \� 11 7 1r�� !!rr�� O = C yl� \� Y \ \ \ \�.�: �1 ��' h� \�Jr M1r >t�✓ �,. iy I� T y kf t� �.�� \ C, \" k ai •� xx., ti • \�! ✓.,a,: • � �' UP LL V t J r • �+t � J .i. y r { .�r 1' i 4 , +�. r y, ••, w. ! j��i' •1 ... ^'ff•If:..:.•..:' 1 C '' r� a }: #J, +�t ` \ , \� `� � i ` s.) 1 / \ •\ s {�,. �_ � .� . 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