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Parcel #: 032 - 1060 -70 -400 05/18/2005 12:20 PM
PAGE 1 OF 1
Alt. Parcel M 23.31.19.306F 032 - TOWN OF SOMERSET
Current ! X , ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
*
DALE F & DIANNE E COLBURN COLBURN, DALE F & DIANNE E
692 207TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 692 207TH AVE
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 4.000 Plat: 0451 -CSM 1012953
SEC 23 T31 N R1 9W PT SE NE BEING LOT 7 Block/Condo Bldg: LOT 7
CSM 10/2953 EZ -UT- 1606/279
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
23 -31 N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
03/23/1999 599890 1412/509 WD
07/23/1997 1133/495 WD
2005 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/1412004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.000 53,000 199,300 252,300 NO
Totals for 2005:
General Property 4.000 53,000 199,300 252,300
Woodland 0.000 0 0
Totals for 2004:
General Property 4.000 53,000 199,300 252,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 533
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
a LS 10 V LS
,..:
--.--
JUL 19 1995
ST. CROIX COUNTY
SURVEYOR'S RECORD
•
O ZO Q • ■ Bearings are referenced to the 0
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East line of the NEk. of Section Q
o L=J _ _ _ 23, assumed to bear N00 °28'30 "E.: - 0)
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This instrument drafted by Ed Flanum i A
VOL..10 PAGE 2953
1
Wisconslt Department of Commerce y'
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count 'St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar! NN No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. D3S 66
Permit Holder's Name: ❑ City ❑ Village ❑ To not State Plan ID No.:
Colburn, Dale Somerset ownship
CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.:
a r
100.0 �_ # 2 032 - 1060 -70 -400
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 00 Benchmark / 3, gg 3,8 00. 0
Dosing Alt. BM C9, s 1 1 3-
Aeration Bldg. Sewer ?
Holding St/ Ht Inlet j 0 / l ob -S
TANK SETBACK INFORMATION St /Ht outlet 3Z c�8 `
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet T� ---` --
Air Intake
Septic > 1 32- ,-- NA Dt Bottom `—
Dosing NA Header / Man.
V . 2( 94 6$ r
Aeration NA Dist. Pipe Z /'�• Z7- 95.6
Holding Bot. System /Y �'� /5 �� I 6�' 9S, ZZ
PUMP / SIPHON INFORMATION Final Grade
Man urer \ and St cover 11
Model Number GPM
T Lift L oss . on stem TDH Ft
Fo ain Length Dia. Dist. TO
SOIL AB ORPTION SYSTEM rj
BED TRENCH Width Len h No . f renches PIT No. Of Pits inside Dia. Liquid Depth
D IMENSIONS 3 oZ IMEN I N
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type Of r CHAMBER M del Number:
System: Ca�v. (� /o» OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x H x Hot g Vent 7o Air Intake
Length Dia. Le Dia. pacing -7 �' r
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 I ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS (include code discrepancies, persons present, etc.) Inspection #1• (0151 cv Inspection #2• 0 /
Location: 692 207th Avenue, Somerset, WI 5�5 �1/4 4 3 1N R19-W) - 233119306F -Lot 7
1.) Alt BM Description = (Of
2.) Bldg sewer length = 3z' /
- amount of cover =(� - cww d� a ikesQts►. - �i►Ht�)
CAE, 3) wQo ,nek
1) 4
Plan revision required? ❑ Yes No I S 6
Use other side for additional information.
�( SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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z Zoe Sanitary Permit Application Safety &Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302
14 sc o nsin See reverse side for instructions for r this application
Personal information you provid :{9j4e s d s dary purposes
Madison, WI 53707 -7302
Department of Commerce (Privacy s1 (Submit completed form to county if not
ti�
C state owned.
Attach complete plans to the county co 0 or the
AET n a of ess than 8 -1/2 x 11 inches in size.
. 4V C State Sanitary Permit Num Ch to previ ' .p lication State Plan 1. D. Number
- ca _343
I. Application Information - Please Print all Inform f' 1 ' Location:
Property Owner Name — X Property Location
Sj C�tOt "'
NAY
Elm ,I/4, S T N, R or
Property Ownet's Mailing Address 11NO Lot Number Block Number
7-, U �- '�
City, State Zip Code no / Subdivision Name g r CSM Number
So ..
II. Type of Building: (check one) 0 city
i ❑Village
2 Family Dwelling - No. of Bedrooms :3_ Town of
PQ 1 or y g I,>�
❑ Public /Commercial (describe use) :_ 5 E2
❑ State -Owncd
Nearest Road o 9 TN
3 r x ` r Parcel Tax Numbers)
III. T ype of Permit: ( Check only one box on line A. Check box on line B if app licable)31.1 306 F
A) 1. (9 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
A Sanitary Permit was previously issued 1
IV. Type of POWT System: (Check all that apply) ❑Sand Filter •❑ Constructed Wetland
91 Non - pressurized In- ground ❑ Mound ❑ Single Pass ❑ Drip Line
❑ Pressurized In- ground ❑ Holding Tank g
❑ At- de ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dis ersal/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 (GalsJday /sq. ft.) (MinJinch) Elevation
3 377.08 . 7 9� . 3 /d z' Z
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con - Con- glass
New Existing crete structed
Tanks I Tanks
&AU 000
VIII. Responsibility Statement
I, the undersigned, assume res on ibility for installation of the POWTS shown on the allLched Plans. Business one Number
Plumber's Name (print) Plu s Signature (no stamps): MP RS No.
Plumber's Address (Street City, State, Zip Code)
5 8d GE t EGU
IX. County/Department Use Only
San Permit Fee Includes Groundwater Date Issued Issuing Agent Sign lure (No stamps)
❑ Disapproved �`
Approved 0 Owner Given Initial Adverse Surcharge j
Determination
X. Conditions of Approval /Reasons for Disapproval:
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Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
IMS may Personal information you p rovide be used for second p ur p oses Madison, WI 53707 -7302
Department f Commerce p y ry p rP
[Privacy Lana -, s. 15.04(1)(m)] (Submit completed form to county if not
state "ed.)
Attach com lete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size:
County State Sanitary Permit Number ❑
ifvv4ion to previous application State Plan I. D. Number
• Ceo ( 3 1 619 I I
1. Application Inform ion - Please Print all Informa 'on\ `�. -'- Location:
Property Owner ame }• Property Location
1/4 1/4 N, o
Property Owner's Mailing Address "'I Lot Number Block Number
City, State i Code tuber 1 5 ivi on Name or CSM Number
14) 4TK9
NING OFFICE /, j R. ZQf3
II Type of Building: (check one); ' .� City
❑ 1 or 2 Family Dwelling — No. of Bedroom. ❑ village
❑ Public /Commercial (describe use): Town of
❑ State -owned -
III Type of Permit: (Check only one box on lhl• A. Check box on line B if applicable) Nearest Road �� J
A) 1. ANew System 2. ❑ Replacement \3. ❑ Replacement of 4. ❑ A ition to Parcel Tax Number(s)
System Tank Only Ex' tin S stem p 3 2 - /o(o o - ob
B Permit Number Bate - issued
❑ A
Sanitary Permit was previously issued 3. 31. (9. 3 6 r
IV. Type of POWT System: (Check all that apply) ` \\
IgNon- pressurized In- ground ❑ Mot ❑ Sand filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding\\T�ank / nit ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatme❑ Recirculating ❑ Other:
V Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. S ' A lication 5. Percolation Rate 6. System Elevation 7, Final Grade
Required Proposed R e (Gals. , ay /sq. ft.) (Min. /inch) Elevation
S
Al
VI Tank Capacity in Total # pf Manufa2ll rer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons nks Con- Con- glass
New Existing ` crete strutted
Tanks Tanks �
❑ ❑ ❑ ❑
VII Responsibility Statement
I, the un rsi ned, assume res onsibilit for instal latro of the POWTS shown on the attached DI ari
Plumber's a pri = �n y/ MP/MPRS No. Business Phone Number
L
Plumber's ddress (Street, City, St te, p Co e
�
VIII County/Departmen se Only
103 Disap roved Sanitary Permit Fee (Includes Groundwater Date Issued 1 uing Agent Signature (No stamps)
II�Approved ❑ Ow er Given Initial Adverse ureharge Fee)
Det ination �� S • cro \
IX. Conditions o Approval /Reasons for Disapproval: w
SBD -6398 (R. 07/00)
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Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of
La ,m�ii__Human Relations
Dw,�io'f*JMafety &Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less thanZ(Va -i she, Plan must include, but
not limited to vertical and horizontal reference,Qoih e
t M) direction and % of sl ,s ale or PARCEL I.D. #
dimensioned, north arrow, and location and +dis'ta�e to ne�rsv4lad.
APPLICANT INFO RMATION– PLEAS�,rINT Art INFOJ;1Ik'ATION �,� W0t, / REVIEWED BY DATE
PROPERTY OWNER: PA PERTY LOCATION
GOVT. LOT 114 1 14,S. T N,R , (o
PROPERTY OWNER':S ]LING ADDRESS 'LOT BLOC # SUBD. NAME OR CSM #
STATE ZIP CODE PHONE NUMBER , r' ❑C TY VILLAGE CATOWN N
,1 C ".
New �(] New Construction Use kj Residential/ Number of bedrooms [ ] Addition to existing building
(] Replacement [ ] Public or commercial describe
Code derived daily flow 9Pd Recommended design loading rate �Z_ bed, 9Pd /ft2 ,_ trench, gpd /ft
Absorption area required bed, ft trench, ft Maximum design loading rate __.,_ gpd /ft gpd/ft
Recommended infiltration surface elevation(s) 9 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material 0 Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem VIS ❑U ®S ❑U 1Z 0 ®S ❑U ❑S ®U I El �]U
SOIL DESCRIPTION REPORT
Boring # Horizon
Depth Dominant Color Mottles Structure GPD /ft
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trend
Ground
elev. --
16V ft.
Depth to
limiting
factor
Remarks:
Boring #
- 7
Ground
elev.
/&2-f ft.
Depth to
limiting Z
factor
Remarks:
CST Name: — Please Print Phone:
Address:
Signature: Date: CST Number
I
PROPERTY OWNER ��� ��s��Ai SOIL DESCRIPTION REPORT Page of
PARCEL I.D. #
4
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench ej
Ground — 17-
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
- 8 ,}
Ground
elev.
/
.LL ft.
Depth to
limiting
factor 3 ' 4 '
Remarks:
Boring #
v Y
Ground 3 _ r .
elev.
,9,U ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground ,
elev.
ft.
Depth to
limiting
factor
I
Remarks:
SBD- 8330(8.05/92)
9
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- O BEARINGS ARE REFERENCED TO THE t'
IN S00 43' 23 "W 392.35' EAST LINE OFTHE NE 1/4 OF SECTION 0
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UDEL�ALTED L9IJ05
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWT8) 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 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number 3b 3 9 b
Number of Bedrooms 3
Design Flow - Peak (gpd) S d
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal) Io
Soil Absorption Component Size (ft 3 +!�E
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd)
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least 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 shall 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
Management Plan for a Septic Tank and Soil Absorption Component a,
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 tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 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 within 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 difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, 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, and 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.
2
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ae�
Mailing Address 96 ` /90 � _ SO M e r Sew
y7a �2o7 r4oe-
Property Address _
(Verification required from Planning Department for new construction) - Y� -
City /State - 5Q ) n eYS % Parcel Identification Number d 3a ZOO - 70 ' `ADO
LEGAL DESCRIPTION
Property Location ' /,, ' /., Sec. , T�LN - _ - Q Town of �SD�'► �Y S�
P Y—
Subdivision
Lot # •
Certified Survey Map # , Volume 10 , Page # _ as
I
Warranty Deed # %�f��� , Volume Page # S
Spec house O yes no. Lot lines identifiable yes O 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 soonr, 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 licensed pumper verifying that (l) the on-sit wastewaterdi sal spo 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, tho 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.
S�CS�'c —� � /,�t���u � / •c.� —fib'
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (wc) 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. . P � r� � _0 � �� )
' � �, � - j
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * *• * «'
«s 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
VOL 1 12 FAu W
STATE BAR OF WISCONSIN FORM 2 -1998 599890
KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO_, WI
This Deed, made between Gary M. Zabel and Marjorie L. Zabel,
husband and wife, Grantor, and Dale F. Colburn and Dianne E. Colburn, RECEIVED fat RECORD
husband and wife as survivorship marital property, Grantee. 03-23-1999 10:00 AM
Grantor, for a valuable consideration, conveys and warrants to Grantee YAARAUT DEED
the following described teal estam in St. Croix County, State of Wisconsin (The E10]IPT I
, Property "): CM COPY FEE:
COPY FEE:
Part of SE 114 of the NE 1/4 of Section 23 -31 -19 described as follows: Lot 7 of RECatDECNER ; 114.00
IM6 FEES 10.00
Certified Survey Map filed July 6, 1995 in Vol. "10 ", page 2953. PA6E5: 1
Recording Area
Name and Return Address
First National Hank
PO Box C
New Richmond, WI 54017
032- 1969a6400
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 1999.
A or
J
•Get y =
0
sMadari L. Zabel •
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) as.
ST. CROIX County )
authenticated this _ day of Personally came before me this 19th day of
March 19 the above named GarY M-
Zabel and Mariorie L. Zabel
to me known to be the person(s) who executed the foregoing
• instrument and acknowledge the same.
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not,
authorized by J 706.06, Wis. Slats.)
Julie C. Dodge
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin
Hendrik W. Van Dyk My Commission is permaucm. (If not, state expiration date:
VAN DYK, O'BOYI.E & SIL" ' 'RIE C DODGE 04/07/02 _J
Post Office Box 12 Lary PublirJStttte of WM&n$ih
No w-Ric hm
(Signatures may be authenticated or aeknorlcdged: Both are nou
necessary.)
08,103%00 THU 15:16 FA 715 386 4887 I%rGISTER OF DEEDS 2002
r
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VOL. .10 PAGE 2951