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HomeMy WebLinkAbout032-2155-10-000 Wisconsin Department of Commerce P RIVATE St. Croix RIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453337 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Peterson, Ray Somerset Township 032- 2155 -10 -000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No: 4O •� M .p / � CQ�t e �k 03.31.19.1336 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing 0 Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet qq 5 .10 I I.SS TANK SETBACK INFORMATION St/Ht Outlet S . 7 >5 7 `�� •30 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic '7 5 -b f 6 1 Z` r T / Dt Bottom Dosing Header /Man. r Aeration Dist. Pipe ,y " •Zo 7. / r Holding Bot. System , �tZ q(Q •23 PUMP /SIPHON INFORMATION Final Grade p ) cc .2.5 I Manufacturer Demand St C ver t i .0 2.� 102.5a Model Number TDH Lift Fric Loss System Head J TDH Ft Forcemain f6rigth Dia. Dist. to Well SOIL AB ORPTION SYSTEM ENCH idth Length 9Z No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM 3 � / e- SETBACK SYSTEM TO I P/L JBLDG WELL LAKE /STREAM LEACHING Manufactur r: INFORMATION Type Of System: CHAMBER T OR ModeTt -N DISTRIBUTION SYSTE W 4 S a ,�� P L Header /Manifold u Distribution x Hole Size x Hole Spacing Vent to Air Intake Pi e s Length Dia Length Dia Spacing So SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only r7e�odded Depth Over Depth Over xx Depth of j xx Mulched Bed/Trench Center Bedrrrench Edges Topsoil Yes [] No � Yes [] No C OMMENTS: (Inclu ode di cre ae persons present, etc.) Inspection #1: / % OD � Inspection #2: -- - l - - - t ocatlon: 505 235th Ave. Somerset, (NW 1/4 SW 1/4 3 T31N R19W) Deer Trail Estates 1st Lot 22 Parcel No: 03.31.19.1336 1.) Alt BM Description = S.Z . m-- � CD,r " 1 -- ' 2.) Bldg sewer length = 2 - amount of cover = `�{ 3) o�► P` p� 3 � -( -.�t�. Plan revision Re uired? Yes q No J - __ Use other side for addition ormation. l_ J L - -- - -1 J, Insepctors Signature Cart. No. SBD- 6710(R.3/97) i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453337 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Peterson, Ray Somerset Township 032 - 2155 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 03.31.19.1336 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet E j D TANK SETBACK INFORMATION St/Ht Outlet S 35 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' Z ! Dt Bottom Dosing Header /Man. / b Aeration Dist. Pipe t( Holding Sot. System 2 C' PUMP /SIPHON INFORMATION Final Grade 7� qq Manufacturer Demand St Cover r F .O GPM 2. C) Model Number V 2 TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well I F SOIL A ORPTION SYSTEM Z 3 IZZ RENCH Width f Lengt No. Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth DIM SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM' LEACHING Maaufactu INFORMATION CHAMBER OR v� ! ' Type f System: I / UNIT Model umber: tc L l DISTRIBUTION SYSTEM L� 4,1 � C I Header /Manifold Distribution - x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length 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 [7 Yes 0 No Lg Yes E] No CIQAIIM�ENT,$: ,(L nclLyc)ee�,co dgis�ygpen ' pers s present, etc.) Inspection #1: /� Inspection #2: 1 �� e - �/- 7, Location: 2 1 � 505 235th Ave. Somerset, W1 54025 (N 1/4 SW 1/4 3 T31 R 19W) Deer Trail A u 1st Lot 22 Parcel No 03.31.19.1336 1.) Alt BM Description = 2.) Bldg sewer length = amoypt of cover = Avg Plan revision Required? Ye [] No U se other side for additional inform i I — L - J 1 SBD -6710 (R.3/97) v ^� c; <' 1 1�^� /t Insepctor s Signature Cert. No. I Safety and Buildings Division 201 W CO1IIry C , rn l � W. Washington Ave., P.O. Box 7162 V � ` I cc onsin Madison. WI 53707 - 7162 Site Address 7 Department of Commerce Sanitary Permit Number V Sanitary Permit Appli t/3 3 3 7 I In accord with Comm 83.21, GVis. Adm. Code, personal ' orma _ CJ Check if Revision be used for secondary ses Privac Law s15. in State Plan I)aer I. Application Information - Please All Information t X11 Parcel Number Props Owner's Name . Property Location Prop erty is M ' ' Address D - NUA �A : T3 N, R E ` Zip Code Phone Number um r Block N ber City, Srete p , Su ton N SM Number J lI. Type of Building (check all that apply) 3 ! �o �, •'�`'L ❑City 1 or 2 Family Dwelling - Number of Bedrooms ❑Village /l Z Z ownship S C3 Public /Commercial - Describe Use a 1ST (� Nearest Road / ❑ State Owned yrj q y 33S L/ OD Z scheme for internal use). Complete line B if applicable) LII. Type of Permit: (Check only one rin8 For County use A• 1Ncw 2 ❑Replacement System 3 ❑ Replacement of 6 ❑ Addition to Tank Otil I Eiisfm SySECM S stem r Date Issued B. ❑ Check if Sanitary Permit previously Issued Permit Numbe IV, Type of Permit: (Check all that apply) (numbering scheme is for internal use) ❑ Constructed Wetland ❑ Sand Filter 44 Non - Pressurized In-Ground 2111 Mound 51 ❑ Dri Line ❑pressurized In Ground 41 ❑ Holding Tank 48 ❑ Single Pass p 1k Recirculating 45 ❑ At -Grade 46 C1 Aerobic Treatme t 0 ❑ 0 r �/ / It /C V. D' csa.Vn eatment Area Information. percolation Rau System Elevation Final Grade Design Flow (gpd) Dispersal Area Dispersal Area Soil ication �� / , /' / / II vadoa Required Proposed Rate(GalsJDays /Sq.FQ (Min•�h) 7 0O / rer Prefab Site Steel Fiber Plastic Capacity in Total umber Manufacturer Glass �. Tank Info Concrete Constructed Gallons Gallons of Tanks New Existing Tanks Tanks Septic or Holding Tank D as Dosing Ctrambcr lion of the POWTS shown on the attached plans. VII, Responsibility Statement I, the undersigned, assume responsibility for ' RS Number Business Phone Number Pi bet's Name (Print) Plumber' gnature 715-, �^ 6 1 ?� Plumber's Address� City, State, Zip VIII ou nt /De Sanitary Permit Fee (includes Gro water artment Use Onl ate Issued I ing Ag t Signature o Stamps) und Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Y ' tion (51eptit Ikf 6Ff1UMY*$F for D' a' dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. C+ g 3 '/ r 7 /aso 3a y gp � B 7V T a = �©, DD /a�D �aa 2- (cd 3 4 - ol B D 7 Wac.;,"sln Departrrw^t of Commerce SOIL EVALUATION REPO .� DlvfsicMOf Sahty and Buildings Prise of In acoordanoe with Comm 88, Mo. Adm. Code Attach MrOft Ift OM M paper not less ftn 81 12 x 11 inches in size. Plan must ' Include, but not titttlhd lo: vertical and horizontal reference point (BM), direction and P `.. -i. ©. CADU% percent slope, sale or dIrnanalone, north arrow, and location And distance 10 nearest road. Z�t1N1G ©FFlG� <•� PtaasM print all lnformat/on. ny ' ` Date Personal lnbrine ion You proNde may be used Jbr sacendary purposes (Privacy Law, s. +6.o4 (9) (m)), Property Location �� �) - c Govt. Lot S 1 i4 ' V ITA g 3 T N R � Property Owner's Mal n Add Lot # Blodt # Subd. Name Or CSM# rc vrly ne Number [] City [] Village own Nearest Road h Pra7ouz NSW Construction Use: Realdential / Number of bedrooms © Cods derived design tlo►v refs GIRD ❑ Raplacement ,c� Public oornmercial - Describe: Parent material _�/ ez � Flood Plain elevation if applicable a : .Sy.5 -1- rev ,i acting # Q Boring L..LJ Pit Ground surface Slay. , Depth to Ilminng factor In. Hoftm Soil Appiloadon Rah Depth Dominant Color Redox Description Texture Structure Consistence 1 Boundary Roots QPD1W In. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. +Bq*1 .602 o .� - tii AI) 9o. a =- ® B ig # ❑ Boring I . Pit Ground surface ebe,r rt. Depth to limiting factor Z in. itartion Rats Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDM In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •EH#1 •EfHl2 2 ' Effluent #1 M SOD > 80 _< 220 mg /L and TSS - 3 < 150 mg/L • muent #2 = BO D < 30 mg /L and TSS < 30 mg/L 7 N*tne (Please Prince) Sign C3 Number Address Date Evaluation Conducted Telephone Number j S130-8330 (807/00) r G- o-1 2Z Property Oww Parcel 10 # Page of D Boring # 11 Boring inn -pit Ground surface elev. ft. Depth to limiting factor _ r 6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM' In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 y �� Nr ti) 9 1•l0 ' �© ❑ 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 GPDfft' In. Munsell cu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 [3 Borin g Boring # Ground surface elev. ft Depth to limiting factor, in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' In. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS X30 < 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. SBD4330 (R.07=) I Soil Test Plot Plan Kowski Farms Inc. Project Name Sha Address 6A 260th St. Osceola Wi 54020 M #226900 Lot 22 Subdivision Deer Trail Date 11/17/01 1/4 1/4S 3 T 31 N /R19 W Township Somerset ❑ Boring 0 Well PL Property Line County ST. CROIX �r VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 91.1/90.1 *HRpSame as Benchmark Alt. BM Top of Survey Iron @ 96.4' 322' Prop Line Soil test was done to satisfy zoning requirement, test may not be suitable for owner's desired building location t~ a� 0 Alt .M. B -3 35' 0' 96' 30' B 70' B -2 95 ' 5% Slope 66' 479' Property Line POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa I of 2 FILE INFORM ION A I SYSTEM SPECIFICATIONS Owner Septic Tank Capacity gal ❑ NA Permit # 33 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model — �j C� ❑ NA Number of Public Facility Units ❑ NA: Pump Tank Capacity a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 00 g allday Pump Manufacturer ❑ NA Soil Application Rate 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 Al In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L NA ❑ At - Grade ❑ Mound F ecal Coliform (geo metric mean) <10 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 Inspect condition of tank(s) At least once every: months) (Maximum 3 years) ❑ NA y ear(s) 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 4n year(g) Clean effluent filter At least once every: ❑ month(s) ❑ NA � year(s) Ins Inspect pump, pump controls & alarm At least once ever ❑ month(s) ❑ NA P P y' ❑ year(s) Flush laterals and ressure test At least once ever ❑ month(s) ❑ NA P y ❑ year(s) Other: ❑ month(s) [3 NA At least once every: ❑ year(s) Other: ❑ NA 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. Page 2 of. Z START UP 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 may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(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. Th al a� a o mg ank �NST7edc -7 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 A POWTS MAINTAINER Name Name Phone I Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name s'(', C kb l e) u N 2DIl��� Phone Phone - /S— 3W / - &9 C This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Jun 07 04 02:51p LISA ANN KROLL 715 - 246 -5700 p.6 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Ty t �iSQ �e7`�i"So� Mailing Address Ave.- vl w D4 v17 A,' cc°11& 575 Property Address 5-05 7 (Verification required from Planning Department for new construction) City /State f Parcel Identification Number LEGAL DESCRIPTION / Property Location /U W y,, � '/., Sec. 3 , TAN- R�W, To� of Sos„P,- Subdivision � �•- fryl`� s f4�c'S I ," - c o. , Lot # Certified Survey Map # , Volume , Page # ? Warranty Deed # 76,51 ?-) �)- 1 Volume Page # 3S Spec house ❑ yes)j no Lot lines identifiable A 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, journeymanplumber, restrictedphmiber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition andlor (2) after inspection and pumping (if nccessary� 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 tb Te tion date. /1 / /OC XGNATURCOF 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 desert abo by virtue of a warranty deed recorded in Register of Deeds Office. / V6111ATURt OF APPLICANT DATE sa•s «s 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 U 2595 P 351 76 t5 82 7 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. NALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIK CO., MI This Deed, made between Kowski Farms, Inc. RECEIVED FOR RECORD Grantor, 06 /15/2004 08:00AH and Raymond Michael Peterson and Lisa Marie Peterson, husband and WARRANTY DEED wife as survivorship marital property Grantee. EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 TRANS FEE: 128.70 (if more space is needed, please attach addendum): COPY FEE: 2.00 Lot 22, Deer Trall Estates 1" Addition, according to the plat thereof. CC FEE: St. Croix oun y, Isconsm. PAGES: 1 Recording Area Name and Return Address qia i + a o35 C�l•.j 12� 4 C J�.p�it.•w� � ��✓ SS /o9 32- 2155 - 10-000 , Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of June 2004 Kowski Farms, Inc. * By: * R er Kukowski, President ` * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Kowski Farms, Inc. STATE OF W *% Se O NS t to ) By: Roger Kukowski, President ) ss. ST Cti►e ► X County ) authenticated this _U_ day of June — 2004 2004 Personally came before me this _ day of the above named * K_r istina Ogla TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY _ -4 aky Attorney Kristin Ogland * rx w v- as • a V- 1 - l u @ p VV — - Hudson, WI 54016 Notary Public, Siate of tA,# _ _ My Commission is permanent. (If not, state expiration date (Signatures may be authenticated or acknowledged. Both are not necessary.) – (f * Names of persons signing in any capacity must be typed or printed below their signature. ��y nt Is Co., Fond du L ". wl STATE BAR OF WISCONSIN gpp. -2021 WARRANTY DEED FORM No. 2 - 19" powsm of W air.. . . Croix 'a^ n '`4 Count M Y Re � � r 1 M r t � } `' "E 322- 322.33 y i 00 "'� � •'� 1 1 as s 1� F ! f r"+y \ ti hL