HomeMy WebLinkAbout032-2146-20-000 0 r0° tw
E ; ■
-
§
Cl) ( I 0 ° t 0§ S -
[ 7 f a E % A 2%
[ ) @ A 2 f $ + o
C, cr %!
\ 2 ; c § 2 ) t
E E co :3 8
g @i� 2
E @ v >
E 3 , A @
3 \ §j K
CL ® I § §
0 k § § n r CO)
CL ® % k -
0.
\ CD 0 0 0
° Pi o
} 0 6 1 2 3 ■ ■ ■ § X
cr
CD CD <
_
/ • '
3 %
E a
7 ..
c 2 z i
k E z g m k
E E C, k K -b (
2p T _$
ECD 0 k k
J CL k
W !4
/ 0 ƒ\ / B/
0 2 (k k / §9
/ 2•;
0 ® G G
CD 00 z
£ A £ § A m
c o � @�
��
w ,
22 $ \
CD -
a�§£
m 0
{i0
C o-
E,0 E
, q
E
c
\ CL
�
2 §
§
D � 2
kE , �■
I "� t � )
ST. CROIX COUNTY
Jessie Nye ' :.�-� WISCONSIN
- - -- ZONING OFFICE
Subject: 's` i;; ci ° "0 ° C I efl ell
Location, Somerset ST. CROIX COUNTY GOVERNMENT CENTER
_ . 1101 Carmichael Road
Start: Wed 1/21/2004 2:00 PM Hudson, WI 54016 -7710
End: Wed 1/21/2004 3:00 PM (715) 386 -4680 • Fax (715) 386 -4686
Recurrence: (none)
032- 2146 -20 -000
15.31.19.1273
2109 54th Street
V A-11� #
10
�64
�w
m
1. 32-
'b
1
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety an gBuilding Division
INSPECTION REPORT Sanitary Permit No:
430473 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:
Thell, Scott I Somerset Township 032 - 2146 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
15.31.19.1273
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark �. CA , CD .O
Dosing Alt. BM 3�3
Aeration Bldg. Sewer to
Holding
St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacin
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
p � 17 1 Yes 0 No ]Yes
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: Inspection #2:
Location: 2109 54th Street Somerset, p WI 54_025 (SE 1/4 SW 1/4 )6 T31N R19W) Oak Ha en Lot 2 Parcel No: 15.31.19.1273
1.) Alt BM Description= 5"C.e- � eb"
2.) Bldg sewer length =
- amount of cover =
- - - -- -
Plan revision Required? Yes ❑ No
Use other side for additiona ' mation. EI L -
SBD -6710 (R.3/97) [l er Da� Insepctor's Signature Cert. No.
` Safety and Buildings Division Counh
an 201 W. Washington Ave., P.O. Box 7082
�seonsin Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 261 -6546 �?o q 7a
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide r" /,4
may be used for secondary purposes Privacy Law, sl 5.04(l)(m) Project Address (if different than mailing address)
I. Application Information - Please Print All Information C < .2 7
Property Owner's Name �
0/0 Parcel # Lot # � Block #
03Z - 2/ _ad —OX
Property er's Mailing Address Property Location
City, State J Zip Code Phone Number '- ' Section 1
4
circle
- T- N; R -&E or
II. Type of Building (check all that apply)
1:6 or 2 Family Dwelling - Number of Bedrooms 11/.A7
Subdivision Name CSIaHdnmber
❑ PublidCommercial- Descnbe Use
❑ State Owned - Descnbe Use l'»T ((� // Ch ❑City ❑Village Township of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
New System ❑. Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B, List Previous Permit Number and Date Issued
❑ Permit Renewal 13 Permit Revision ❑ Change of ❑Permit Transfer to New
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that appl
0 Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter hing Chamber Drip Line ❑ v 1 -1 s Pipe ❑ Other explain)
V. DispersaVrreatment Area Information: n Y
Design Flow (gpd) / Design Soil Application Radsf) Dispersal Area Required (sf) ` Dispersal Area Proposed (std System Elevation
VI. Tank Info Capacity in Total Number M ufa rer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units J /2�eM A —1do Concrete Constructed Glass
New Existing lJ
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, iksume responsibility for installation of the POWTS shown on the attached plans.
Plumber' acne Print Plum 's S' atu MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State Zip Code)
<S' U L2_,C1ir4Z b1z
VII Coun epartmenf Use Onl
Approved ❑ Disapproved Sanitary Permit Fee Includes Groundwater Date sued sluing Ag Si re mps)
Surcharge Fee) `� �Q 2
❑ Owner Given Reason for Denial Z o
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:6mm- 93. SZ
1 Septic tank, effluent filter an d G��ytYL� -C���
dispersal cell must all serviced /maintained O (� d
as per management p provided by plumber. `f
2. All setback requirements must be maint ined
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper sot less than 81/2 x 11 Incites IN size
SBD -6398 (R. 08/02)
r
;
1 '
T
r �
- 1
71 - �--
IK N -�
.
-- - - -- - - + - --± - - +- - - 1- -- --i --
TI
j
I
I :
t I
i
(� I
i
i
!- -- t -- ---- 4 ---- - + ---- +-- -! - -- -�_-- - + - -_- -�
-�---
;
:
: ff
t
,
IN � ,
I
r U
w �
1 .
ti
i
2
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND l
OWNERSHIP CERTIFICATION
Owner /Buyer 7' ok fx // ZG�3 4
Mailing Address coev
r
Property Address lie LRh � e',Stl
(Verification required frunt I'lanning Department for new construction)
City /State , Ce""e Parcel Identification Number - 21 q(0 , c e —00
LE GAL DESCRIPTION
- is - 73
T�N -R Property Location /, Lt/ / See,, _/7_W, Town o f e�Se
Subdivision �4�� c,�i7 , Lot # 2
Certified Survey Map # ,Volume ,Page #
Warranty Deed N — 7'T a Volume . 2 ! 2 Page 11 Vol-
Spec house V yes ❑ no Lot lines identifiable X 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 wastewater disposa I 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.
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
days of ee year e ton date.
�iI UNATURE OF APPLICANT DATE ---
OWNER CFRTIFICATION
1 c) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the ebeov irtue of a warranty deed recorded in Register of Deeds Office,
SIGNATURE OF APPLICANT 70/ �/ d
DATE
* * * * ** Any information that is misrepresented 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
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity a I E3 NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model _ �6 ❑ NA
Number of Public Facility Units ANA Pump Tank Capacity al NA
Estimated flow (average) al /day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer AS NA
Soil Application Rate , ' 7 gal/day/ft2 Pump Model ANA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ANA
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) .16 NA
Biochemical Oxygen Demand (BOD 530 mg /L OIn- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) :510 cfu /100ml ❑ 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: 0 month(s) (Maximum 3 years) ❑ NA
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
0- years)
Clean effluent filter At least once every: ❑ month(s) ❑ NA Myear(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ANA
❑ year(s)
❑ month(s) 4J NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: ❑ month(s) a NA
At least once every:
ar s
❑ ye 1 )
Other: Zt 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.
GMW 14/01)
Page of
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
replac ent 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
� *e'valu chnology a holding tank may be installed as a last resort to replace the failed POWTS.
he ite ha of been a uated to ide ify a uitable re acame t area. Up fai re of the P WTS a soil and site
ion us be per rm to loc a suitab rep ement area. If no lacemen are ' eve ble a ing tank
may b in tailed a st reso place the failed POWTS.
❑ 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 Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
This document was drafted in compliance with chapter Comm 83.220(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code.
WiisconsinDepartment ofCommerce SOIL EVALUATION REPORT Page 1 _of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. C r oix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 03 Z —
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ending 7 ,0 —a
Please print all information. Rev' ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Z
Property Owner Property Location
Gerald J. Smith Govt. Lot SE 1/4 SW 1/4 s 15 T31 N R 19 1(or)W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
11160 190th, Ave- 2 na Oak Haven
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
Elk River i MN 55330 (61� 441 -8888 Somerset 210th. Ave.
FK1 New Construction Use: U Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Outwash Flood Plain elevation if applica ' ' ft.
General comments
and recommendations:
trenches @ el. 102.40 spaced to code 3.50' below gra
F] Boring
❑ Boring # 105.40 SCp F�C�
1 �] pit Ground surface elev. ft. Depth to limiting factor V 5 4 ,
in. OG
$oil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistent 6q�indary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' r ff#1 `Eff#2
1 0 -12 10 r3/3 none sl 2csbk mfr gw if .5 .9
2 2
3 4 -9 7.5 r4/ none ms os ml na na .7 1.2
7
c2.
F- Boring # n Boring
21 ® Pit Ground surface elev. 106.10 ft. Depth to limiting factor 90 in. Soil Application Rate
Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
1 0- 7.5yr4/6 none is osg ml gw if .7 1.2
2 6 -90 7.5 r4/6 none ms osg ml na na .7 1.2
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD A 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature . CST Number
Gary L. Steel 02298
Address - Daff"EvaiLlation Gotfduct ed Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 6 -4 -2001 715- 246 -6200
Property Owner Ge rald J. Smith Parcel ID # pe ng Page 2 of 3
3❑ Boring # ❑ Boring 103.00
[� pit Ground surface elev. ft. Depth to limiting factor 88 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
1 0 -16 7.5yr4/6 noen
2 16 -88 7.5 4/6 none . 4
F-1 Boring # F] 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 GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
11 pit -- go - i�iAppiication 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 I *Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS 5 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 -8330 (R.6100)
r
STEEL'S SOIL SERVICE
Gary L. Steel Gera J. 1554 200th Ave.
CSTM2298 SE4SW' S115 T311N --r19w New Richmond, WI 54017
MPRSW -3254 town of Somerset (715) 246 6200
lot #2 -Oak Haven
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
�- --
= top of to @ eV. 10 - \
of 1" pvc ipe @ el. 101.30' \,
70 1
JA
0
Gary L. Steel
6 -4 -2001
- 7 /+ ? 1 1 -7 \\
U. 2 4 2 5 P 4 2 8 KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO.. WI
STATE BAR OF WISCONSIN FORM 2 - 1998
RECEIVED FOR RECORD
This Deed, made between Mark W. Kelley and Debra K. Kelley,
10/02/2003 09:15AM
husband and wife, Grantor, and Scott C. Thell, Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT 1
the following described real estate in St. Croix County, State of Wisconsin (The REC FEE: 11.00
"Property"): TRANS FEE: 144.00
COPY FEE:
CC FEE:
Lot 2, Oak Haven, St. Croix County, Wisconsin. PAGES: 1
Recording Area
Name and Return Address
�Q�f�iS"c� c✓y ��z�
Part of 032- 1043 - 80-000 and
032 - 1043 - 90-000
Parcel Identification Number (PIN)
This is not homestead property.
Exceptions to warranties: Subject to all easements, restrictions and covenants of record.
Dated this day of 2003.
\--T� W. - P ( DJJ�1) � - - 1 ,
*Mark W. Kelley *Debra K. Kelley
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
St. Croix County ) l
e onally came before me this g ` day of _
authenticated this day of , 2003. _, 2003 the above named
Mark W. Kelley and Debra K. Kelley
* to me known to be the person(s) who
TITLE: MEMBER STATE BAR OF WISCONSIN cxccutcWregoing instrument and cknowledge the same.
(If not, t
authorized by § 706.06, Wis. Sta[s.) w
THIS INSTRIWENT WAS DRAFTED BY * 03, U y 0
Ronald L. Siler Notary Public, State of Wisconsin
VAN DYK, O'BOYLE & SILER, S.C. My Co I miss on is permanent. (If not, state expiration date:
P.O. Box 118, New Richmond, WI 54017 11 I=^ - t•� '` '"
(Signatures may be authenticated or acknowledged. Both are not
necessary.)u r ',•. ��
a .• • s
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM N.. 2 - I sse s7 S1 I \�
INFORMATION PROFESSIONALS COMPANY FON J,pt.,, WI' ' 800.6552021
I a�
° I —1
t z
U �
Ali y t � c
Z
i z li M„l£,00.00N-
D I � /
m hi
-� I N \
o
o
D a j C M„l£,OO.00N \
Z i rn �.8t'Z9
\ ,4
-
\ 0 1
I w / --
v
i
Z I .--I
I co�I
.33' I �e
cn
°D
I I S13 ?r'4 W N
I i �
i w
� (0 O I
C �� I \ I \�{t�
--I )b
g �
N I
yl O I
1 �
I
I Z +I I
I
OD
> (0
r i
IB IQ
NZ-'
Z
°
co
rn 1 00 �
I � I,lCl9 �VA
(A I'
N �C.4�
1
OD allo N
.I
0
I , ry I
4
I co I
I st3 ?x•40,
W
I I
m'
I—A l C I
I
10
I
cO, o I
tn I
r w
c.) ' J
j�
N