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HomeMy WebLinkAbout030-2033-10-000 I n ti p v n d t_ c d m O eD CD c A. to 3 m m 3 r o` o` N n ° owo N w w C• S > 7 c W L (\D 1 a °S fn fn O t�ta N j O O N 3 O O N N O 1 Ooo A O (C—p %3 7 7 N 0 � <wj �.0, O O 7 7 O ? Ul CD o ° v ° o ° a M : y o D o y N N ° O Dl C O D c V y O N c O O N t� A cn a O) T LD N May w A c c, ° o° V N N 3 C t N m U v A D N N O o f o o m e Ch N O c °- c a (D O O O w �� ao o < v 2. n N N U1 � CO N T O C O! N p cz SU '6 N CD 7 CD = (o N ° o " ° °• z o (O A ID N < n a _ N 3 0 j O T< 0(o eo � • Z a 5 CD (n O. T 0' (D ? M N @ p p C FT �• (D w N !n CD N co N 'O CD ° q C ! 77 O 7 A Z O O N (D Z _ oo M ° CL N cn S A 3 A �. (O z p (n n o CD CD m o z (D A A (D F d N• = O. C w0 N. O G \ =r W C K) 3 m o ° m < m 3 y N y ° a N 0 O' O D x w, w y c= w U A CD 0 CL g CL x� a (D p N !) ur O co CD ~ I N X, S O O 00 N w 0 CD w o ti 0 0 Wisconsin Department of Commerce S ,Ifety and Buildings Division PRIVATE SEWAGE SYSTEM Count 9t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita.WjoilNo.: Personal information you provice may be used for secondary purposes [Privacy Law, j 15.04 (1)(m)). d e it Holder's Name: E] City ❑ g To n f: State Plan ID No.: a�Von, iames 19 �c 6p fownsh p CST BM Elev.: Ins . BM Elev.: BM D tion: rcel Pa N p dV- 2033 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' �� Benchmark Dosi 0 Aeration Bldg. Sewer S qs Hol g V Ht Inlet 3 Y 411 TANK SETBACK INFORMATION 6/ Ht Outlet , ` 9 , TANK TO P/ L W BLDG. Ventto ROAD Dt In et Air Intake Septic y /�O/ 3 $' NA A Header/Man. /. a1 92. 71 Aeratio NA Dist. Pipe L. 3 ding Bot. System 9 39 f (. V/ PUMP/ SIPHON INFORMATION Final Grade Ma turer Demand St Cover Model Number __ — M - S, /00. 0 fo TD - ift Friction S stem TDH Ft Forcemain Length Dia. is . owell SOIL ABSORPTION SYSTEM I G art 4 &-ZZs 3o >lr BED rTRENCfi Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth M E14614MS - Z, DIM SYSTEM TO P / L BLDG WELL LAKE /STREAM L G Manua er: SETBACK HA INFORMATION Type O o e um er: System: x(60 3 3 3 IT i r DISTRIBUTION SYSTEM Header/Manifold f/ Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length � Dia. Length ( f Dia. Spacing _ 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 nspection #1: /ZO /o( Inspection #2: Location: 1426 20th Street, o Iton, WI 54082 NE 1/4 SE 1/4 23 T30N R20W) - 233020457A 1.) Alt BM Description = ,) sS( W04 (40, y� °v a ✓�v�5�gc 2. ) Bldg sewer length liu&o, - amount of cover = > z y (�• pp f / / r �! D�S (A/dfG Gtlf�roYl(1r u,S 8ar/ � 81.�,y�l°ICVGtA>�h^—' �)rro We I( a� /k a,� / 7 an revision requi a 60 Yes ❑ No Use other side for addition6i information. SBD -6710 (R.3197) Date Inspector's Signature Cert No. PLOT PLAN PROJECT James Dalton ADDRESS 1714 Hvw New Richmond W. 54017 NE 1/4 SE 1/4s 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Byron Bird Jr. 22052 ATE 7- 18-01 BEDROOM 4 CONVENTIONAL XXX -Grade CON ENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ❑ LOAD RATE 1.2 ABSORPTION AREA 500 # of chambers 30 BENCHMARK V.R.P top of white stake ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. 20th stand 40 line SYSTEM ELEVATION LVe f dewinder High Of pacity Leaching #Alt. BM top of white stake Cove amber with 17.2 2 per chamber 34 Grade at System Long Elevation # 275' 1320' 80' 4' �, W ob pipe 4 bed house Pr..6 4 95' 15 ' p. A 0th st BM 1Q'S 1 driveway B1 B4 garage 3 B3 1320' Safety &Buildings Division 2, p Sanitary Permit Application In accord with Comm 83.21 Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 l Visconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15 – (Submit completed form to county if not .Q4{.iX(r�)� f 1 _ �., state owned.) Attach complete plans (to the county copy only) for the system, on pap than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number Cl C eck if rev evioul li lion State Plan I. D. Number Gro 83 21 �a' I. Application Information - Please Print all Information E` Location: Property Owner Name .� - Property Location ti te r G� �Q � � � 'e5 G� � /CX1 /4 /4,Ss T O�N,K"E(oo Property Owner's Mailing Address G Lot Number Block Number X C City, State Code n riil5et "' . Subdivision Name or CSM Number a w e 33 II. Type of Building: (check one) ✓ _ q y W o b.wt "s ❑ City 1 or 2 Family Dwelling - No. of Bedrooms: _ yS - O , own of Wage T Public /Commercial (describe use):_ ❑ State -Owned ✓ Nearest Road dos Parcel Tax Number O III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) a 3. 3 0. a o . q 5 9 4 A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Pf Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade _ Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) r �C�� Elevation 4� 37 Sr 3 /'S' / eZ r. 1 - G VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks �PP f ❑ ❑ 13 ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, ass responsib for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumb ignature (no stamps): MP/MPRS No. Business Phone Number 62- PlunjWes Addre (Street, City, State, Zip CO S �CGgo/ IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) `(,Approved ❑ Owner Given Initial Adverse Surc ge Fee) r l Determination �$ - ( ' 2 X. Conditions of Approval /Reasons for Disapproval: ur, w�.a�. t�x rr w�.e,��a►f� S SBD -6348 (R 07/00) 1 PLOT PLAN PROJECT James Dalton ADDRESS 1714 Hvw New Richmond Wi. 54017 NE 1/4 SE 1 /4s 23 /T 30 N/R 20 w TOWN St. Joseph COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 ' DATE 4 -6 -01 BEDROOM 3 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22 BENCHMARK V.R.P. top of white stake ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. 20th st and 40 line SYSTEM ELEVATION T- 1 =91,� �dt'.9�•. A T" ent Sidewinder High Capacity Leaching #Alt. BM top of white stake J 0 © Chamber with 17.2 t ^2 per chamber 34 Grade at System Long Elevation # 275' 1320' (�`• Ov -� 4 r ob pipe 60 3 0 5 .A I m h st 5 1 > 3 bed house 30' 10 t 0 # Alt 8' 0' 1320' -7� 11 3 .., PLOT PLAN PROJECT James Dalton ADDRESS 1714 Hvw New Richmond Wt. 54017 NE 1/4 SE 1 /4s 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 4- -01 BEDROOM 3 CONVENTIONAL XXX - Grade CONVENTIONAL LIFT HOLDING TANK i MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22 BENCHMARK V.R.P top of white stake ASSUME ELEVATION 100' ❑ BOREHOLE Q WELL *H.R.P. 20th st and 40 line SYSTEM ELEVATION LVe f 12 " dewinder High °f pacity Leaching #Alt. BM top of white stake 00 Cov amber with 17.2 2 per chamber 3 4 Grade at System Long Elevation # 275' 1320'` p B1 4' job pipe .A 20th st B 5 1 ' B4 3 bed house 30' 10 t 0 # Alt B U' Bt 1320' y y� _ T Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must C/ 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. 30 `00 Please print all information. eviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner � — Property Location -I Q M ,L d $- C q l/ �7 Govt. Lot &,f- 114,5 1/4 S� T30 N Rap E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 4 Nu City /State 7jp Code Phone Number ❑ City ❑ Village ZTown Nearest Road oi /�/ � Xzliij ' I J� CY . 1 (Z 15 12 Vl' i Ze I s f - 3 e "r 7&4 -.51 New Construction Use: 5 Residential / Number of bedrooms — Code derived design flow rate _ SO _ GPD ❑ Replacement F3 Public or commer al- Describe: Parent material r OZ& e� Ol i ez > f S!! _ Flood Plain elevation if applicable General comments - and recommendations: F/ I Boring # ��1 Boring _ // tat pit Ground surface elev. /l`_S� ft. Depth to limiting factor ��' in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3% �- Ilk, Bo^R g # Boring F�] `� Pit Ground surface elev. }�? ft. Depth to limiting factor `� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDPf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 .Z ,:G aP t .5/ V z Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name Please Print) Signature A CST Number Address C6te Evaluation Conducted Telephone Number - �1� C" ,may% �,� � cam,-• � �;.. ,�'-� -�� /,.�'�� , �- Gl� i Property Owner Parcel ID # _ Page of .a F-31 Boring # F1 Boring G�r pit Ground surface elev. y -It _ ft. NO to limiting factor O in. Soil Appli cation Rate 'Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color J Gr. Sz. Sh. •Eff#1 I 'Eff#2 O -/.z U I Boring # ❑ Boring G� Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth . Dominant Color , Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD•9330(R.6/00) - Soil Test Plot Plan Project Name James Dalton Byron ird Jr. Address 1714 Hwy 64 New Richmond Wi. 54017 CST4 #220527 Lot --- -- -- Subdivision ---- ------ Date 4/6/0 N E 1 /4 1/4S T 30 N /A W Township Joseph Boring Q Well PL Property Line County ST. C ROIX ,BM or VRP Assume Elevation 100 ft top of white stake # Alt. BM top of white stake System Elevation T- U- 11 4T -2 7/.41 H.R.P. * 20th st &40 l in e # 275' 1320' �L . B Pr d 60 R p. A 20 th st 3 bed house 30' Alt B BM 8' 30 Ba, 1320' ell l Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity !n- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) 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. This management plan complies with Comm 63.54, Wis. Adm. Code, and the In Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). ell IF, is i!x Table 1: System pest n Speciflcat6 s Sanitary Permit Number Z Number of Bedrooms Design Flow - Peak gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) ---z> Soil Absorption Component Size ! �Ej Type of Wastewater Domestic Table 2: Soil Absorption Component • Limits of reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak ( pd) I Mrfl z Maximum Influent Particie Size (in) NR 1/8 Maximum BOD (mg /L) NA 220 Maximum TSS (mg /L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years . Soil Absorption Component Inspect once every 3 years 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 shat! be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter Is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic V r Management Plan for a Septic Tank and Soil Absorption Component tank shall have its contents removed when the volume of scum and sludge Ih the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being In full compliance with OSHA standards for entering a confined space. The atmosphere wlthin• the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the Interior of the tank may be difflcult or impossible. Tank abandonment shall be In accordance with Comm W.A Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure Is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, If any, In the observation pipes, arid a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be Identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard, Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure Is usually temporary, but Is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 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. 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address / y /`7 7 Property Address d�r�v �i y o l �a� �o � S7� (Verification required from Planning Department for new construction) Y City /State Parcel Identification Number LEGAL DESCRIPTION Property Location Sec. T � -7 N -H W, Town 'of Subdivision �' . Lot # Certified Survey Map # . Volume- . Page # Warranty Deed # q 3 z loon . Volume g . Page # 98 Spec house ❑ yes no Lot lines identifiable )2( 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 masterplumber, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fiill 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 within 30 da f the three year expiration date. - / Z / e/ ATURE OF APP CANT 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 ovmer(s) of ; roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. N A URE OF APPLIC DATE ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** 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 ►dSWM by ♦a wain lists a oboes" 0% $jj1LrF, Made this 4th day oft November ,A. D.,19 87 Ntaows Detnfs R. Skogen and Patricia A. Skogen, husband and wile, . parties of the first part, and *, James R. Dalton and Bark J. Dalton t ; k part ies of the second put. Wtatooeto, That the said part ies of the first part, for and in consideration of the sum of I • Twenty five thousand and no /100 ($25,000.00) ' to them is hand paid by the said put ies of the second part, the receipt whereof is hereby confessed and acknowledged, ha ve given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm onto the said part ies of the second part, their heirs and assigns forever, the following described real estate, situated in the County of St. Croix and State of Wisconsin, to -wit: NE 1/4 SE 1/4 Section 23, T30N, R20W IRAN F $ .0• FU COgttotr, with all and sir;ular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the testate, right, title, interest, claim or demand whatsoever, of the said part of the first part, either in law or equity, either in possession or expenctancy of, in and to the above bargained premises and their hereditaments and appurtenances. probibeb Voiotbtr, that the above bargained premises are subject to a, first mortgage in favor of Federal Land Bank of St. Paul in the amount of $60,208.16 (FCS Northwest Wisconsin - River Falls Branch, Account #36411) go $abe anb to i ? Olb, the said premises as above described with the hereditaments and appurtenances, unto the said part ies of the second part, and to their heirs and assigns FOREVER. Anb tot t3tib parties of the first part, for their heirs executors and administrators do covenant, grant, bargain and agree to and with the said part ies of the second part, their heirs and assigns, that the time of the ensealing and delivery of these presents are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, except as to the above mentioned conditions and restrictions, and that the above bargained premises in the quiet and peaceable possession of the said part ies of the second part, their heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, will forever WARRANT AND DEFEND. Jn QUtnt88 01trtot, the said part ies of the first part ha Ve hereunto set their hand and seal this Fourth day of November , A.D., 19 87 . Signed and ealed in Presence of (seal) .y A (Se (Seal) (sear IN-AL—Ch. ww Who. State. provides -.Sat an instruments to be reeorded ■ban have plainly printed or typewritten thereon tbo masses of the grantors, Kraaaees. –ttntn - ^a and notory.) rip fin • • 11t. [a7���t vN etatr rt � ' �► ss. RAMSEY County. Personally came before me, this 4th day of November , A. D., l9 87 , thesbovenamed parties of the first part, Dennis R. Skogen and Patricia A .Skogen, to me known to be the persons who executed the foregoing instrument and acknowledged the same. MICHAEL 0. KULA Notary Public, County,W$. MN NOTAII Y ►U SLI C- M INN99*YA ar RAMOCY COUNTY Mr cowwusloN ca►u[s MAR. 7. 1991 My commission expires .._... A. D., l9 Drafted by _ ROBERT W. JOHNSON P. A. 173 Grand Avenue St. Paul, MN 55105 i �I i 0.� ti 00: € b 4 4 ° 0� r t o U f a y q a�1 i 00 . i a on ° ILI