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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Cuilding Division
INSPECTION REPORT Sanitary Permit No:
430314 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:
Pinediff Partnership Somerset Townshi
CST BM Elev: Insp. BM Elev: BM Description: ` Section/Town /Range /Map No:
( 00.0 " i 1 M • a = CST %VA 26.31.19.
TANK INFORMATION U ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 'Z bO Benchmark
Dosing Alt. BM 3 i .-
Aeration Bldg. Sewer
Holding St/Ht Inlet
Q D 7
TANK SETBACK INFORMATION St/Ht Outlet 9.o o - z -
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic > � { , �� ! � �! �J Dt Bottom
Dosing Header /Man. (? i
•
Aeration Dist. Pipe
c
Holding Bot. System . bz
.03
PUMP /SIPHON INFORMATION Final Grade S -610
Manufacture Demand St Cover
GPM
Model Number
TDH Lift F ' n Loss System Head T Ft
Forcemain Length Dia. Dist. to W
SOIL ABSORPTION SYSTEM
RENC Width Leng No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIME NS 3 p1 -� l -7
SETBACK SYSTEM TO OO P/L BLDG IWELL ILAKEISTREAM LEACHING Ma gturer
INFORMATION CHAMBER OR O�
Type Of System: / ,.
�,�.uCA6 n I UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold I..� tf Distribution ��x ole Size x Hole Spacing Vent to A[i —r Intake gl�
Length Dia Dia 1 Length Dia Spacing Jam
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
hi Yes No Yes No
CO =Tf :(Include code ^cre tci ss, persons present, etc.) Inspection #1: r / M3 Inspection #2:
Location: Somerset, WI 54025 (SW 1/4NE 1/4 26 T31 ' R1 9W) NA Lot 36 Parcel No: 26.31.19.
1.) Alt BM Description = doo 5' a�'�`(S lid "I C
2.) Bldg sewer length = 3 f 0
- amount of cover
3 -
Plan revision Required? �?: Yes No .� �
C19 t
'
Use other side for additional information.
SBD -6710 (R.3/97) Date I Cert. No.
nsepctor's Signature
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 1
,�'C►On��n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
De artment of Commerce (608) 266 5 ?� 1
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, 05.04(1)(m) Project Address (if different than mailing address)
I. Application Information - Please Print All Information; _ /4 dCkre S is
Property Owner's Nam II ,i.� Parcel Lot X Block q
Property Owner's M ailing Address Prope Location .
Cit , St a Zip Code Phone Number
_m w
Y p ber
(circle one)
I1.. Type of Building (check all that apply) � �, 5 �, �, T �_ N; R��E or W
i 1 or 2 Family Dwelling - Number of Bedrooms s • Subdivision Name CS,M /N,u�miber
El Public /Commercial - Describe Use
t
❑ State Owned Describe Use K 6 *-• S - - []City ge Township of it S
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ' A�Ncw System y ❑Replacement System 'I'rrauncnUi lolding Tank Replacement Only ❑ Other Mtxlifieathin to Existing System
1 (
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that appl — /
•
fVNon - 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 ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) `
V. Dispersal/Treatment Area Information: / \)
Design Flow (gpd) Design Soil Application Rate( SO Dispersal Area Required (so Dispersal Area Proposed (sf) stem Elevation
� e2
s /
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, ume responsibility for installation of the POWTS shown on the attached plans.
Plumber's a me (Print) Plumbe 's Si tur MP /MPRS Number Business Phone Number
PI ber s Addre ss (Street, City, S te, Zip Code)
VIII. Count /De artment Use Onl
X Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued s Agent Signa (No Stamps)
Surcharge Fee)
❑ Owner Given Reason for Denial 25D • �9 7,co
IX. Conditions of Approval/Reasons for Disapproval 3> No l
SYSTEM OWNER: �o e }{ , W , 1. owQptp • (�
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained ` n ' n �,,1 2 • �J
as per applicable code /ordinances. 6ut0� -t�we+ro�y�
Attach complete plans (to the County only) for the system oa paper not lea than 81/2 x 11 Indies In alas
SBD -6398 (R. 01/03)
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ' of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S)0'
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.
Please print all infonnation. ev' ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). . eq
Property Owner y a Property Location
l i 4 f n rr ,j _
C Govt. Lot 5 1/4 / r C 1/4 S T 3 1 N R j 9 6 (or )(0
Property Owner's Mailing Address d r n • , 1 Lot # / Block # Subs. Name or C�S+�M#
City / v State Zip Code Poone, Number ❑ City ❑ Village gTown Nearest Road
[?� New Construction Use: a Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - ( Describe:
Parent material j4 TD if h e Dr r f/( Flood Plain elevation if applicable
General comments
and recommendations:
Boring # Boring
❑ y2 /s 96
❑ ® 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 /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 o- /z / oY'f 3 i s� 2 r S el C w '2 e-7 0, S 0,
Z 2- 1, lo k A .SG 2 rJ bk n VF- c z,,, 0j_5 q
3 /7- l 7 °sy� s/ /VA S L 2�S6h- n�vA- C k. jr-1- 0,5"
D , �/
y sz-sY -7-sr,( '% I VA �� os c s �� 1,
Boring # ❑ Boring
.t Ground surface elev. 2.ds ft. De th to limitin factor in. F ❑ pit � P g � Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 o -/2 All Y/- Z / �, 'err+ 0,S 0, Q
12 -1 P/A `l /V X SL 2.-1 ) 6k „4'r ,S 0 I
3 /8 - 38 � .SrR /U� L Zn�L /� P� C (.� � 0,9
3g - 18 7
' 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 N me (Please P ' ) ign ure CST Number
�1`ar, Q�ne/
Addre g Date Evaluation Conducted Telephone Number
_ /9 2 o2 7IS 2 yT .7203
SBD -8330 (R07 /00)
�ot36 •
Property Owner J , '� '' '� Parcel ID # Page of J
Boring oring # 1 ❑�I Boring
t� Pit Ground surface elev, 93•-75 Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 C> 3 / kA 56 1-,s /n L/— C '(-- z 2 O,.r c).
2. _ /('� IVA S %L -�S9 /t r CA S n 4• 0 , 8
2- / y- yy � % - ( �i/,4 wl S /,h� A c �, � 0, 1,2-
El 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 GPD1ft
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.
S011 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 >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.
i
ssn -8330 tx.o7ro0>
OWN-EF, Page 3 of 3
Name b"ie 61"k Brian Parnell
Address_
CST 231314
Date 6 -20-02 -
(12
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lk Benclu nark I f �0 ��
A Benchnaark2 )Oqs o- /O/
0 Soil Boring
L-1 Saitable Area
1 40' Scale
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' AN Page of
POWTS OWNER MANUAL &MANAGEMENT PL g �
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity a l ❑ NA
Permit # 3 Septic Tank Manufacturer - S ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer L ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model _ ❑ NA
Number of Public Facility Units XNA Pump Tank Capacity a l J3)'NA
Estimated flow (average) g al/da y Pump Tank Manufacturer 1f NA
Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer &NA
Soil Application Rate al /day /ft2 Pump Model 9 NA
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) ❑ NA
Biochemical Oxygen Demand (BOD S30 mg /L # In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric 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: ❑ month(s) (Maximum 3 years) ❑ NA
J% 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: 13 month(s) (Maximum 3 years) ❑ NA
JS year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
0year(s)
❑ month(s) C2(NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
Flush laterals and pressure test At least once every: ❑ mo nth ❑ year (s) ) !� NA
ls►
Other: At least once every: ❑ month(s) /_9 NA
❑ year(s)
Other: ANA
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 (4/01)
i
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
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.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locatq a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace 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 INSTALL FR POWTS MAINTAINER
Name Name
Phone _ i� Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name !
Phone Phone _ 3
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.
ST. CROIX COUNTY
SEPTIC TANK MAINTAINANCE AGREEMENT
AND
OWNERSHIP CERTIFICATE FORM
Owner/Buyer p i - y) 'c' C' 1 kv �' t v� '
Mailing Address I /d^
Property Address
(Verification required from r?anning Department for new conruction)
��f
City/State c,6,,d ,, a t)Z Parcel Identification Number ,r -Doo
LEGAL DESCRIPTION
Property Location �T v c ' %., JZt ; Ser, �T,:LN -R W, Town of
Subdivision i•1t✓(/`i ��� Lot#
%ratified Survey Map# `—� , Volume Page
Warranty Deed# 63 � � , Volume -, 5 "7 / Page 4 2
Spec house yes no Lot lines identifiable d es no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result 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
d is posal sy stem.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the
owner and by a masterplumber, joumeyman plumber, restricted plumber or a licensed pumper 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 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 th Department of Commerce and use 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 Zonis^ Office within lO dais of the three year expiration date.
94
Q;
S GNATURE OF AP 1 ANT 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 described above, by virtue of a warranty deed recorded in Register of
Deeds Office.
SIGNATURE OF AP (CANT DATE
•••••• Any infornrtion that is misrepresented may result in the sanitary permit being revoked by the Zoning Department•••
•' Include with this application s stamped warranty deed drom the Register of Desch office
A copy of the cenifted surrey nap irreverence is made in the wamnty deed.
VOL 1571PAcA24
AWE BAR OF WISCONSIN FORM l - 1998 636104
WARRANTY DEED KATHLEEN H. waLSH
REGISTER OF DEEDS
CORRECTIVE ST. CROIX CO., WI
Document Number
RECEIVED FOR RECORD
This Deed, made between ANTHONY TEASLEY AND 01-02 -2001 12:00 PM
WARCY ALLISON - TEASLEY, HUSBAND AND WIFE VARRANTY DEED
EXEMPT K 3
_ Grantor. CERT COPY FEE:
and AKA PINECLIFF PARTNERSHIP COPY FEE:
TRANSFER FEE:
RECORDING FEE: 10.00
PAGES: I
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate In ST. CROIX County, State of Wisconsin
Recotdimj Area
(the 'Property "):
SOUTHWEST QUARTER OF THE NORTHEAST QUARTER, SECTION 26, carne and Return Address
TOWNSHIP 31 NORTH, RANGE 19 WEST. HEYWOOD & CARI, S.C.
204 LOCUST STREET, BOX 125
BY ACCEPTING AND RECORDING THIS DEED, THE GRANTOR IMPOSES '! HUDSON, WI 54016
AND THE GRANTEE ACCEPTS THE FOLLOWING COVENANTS AND
RESTRICTIONS WHICH WILL RUN WITH THE LAND AND BE BINDING
UPON GRANTEES AND ALL FUTURE GRANTEES OR OWNERS:
1. USE OF THE PROPERTY SHALL BE RESTRICTED TO SINGLE 0 1072 -60 -000
FAMILY RESIDENCES AND MULTIPLE FAMILY OR OTHER USES SHALL Parcel ldentirlcatiw Number IPIN)
BE PROHIBITED. This IS N OT homestead property.
( Is tot
2. THERE WI BE A ONE- HUNDRED (100',) BUILDING SET -BACK ALONFTHE ENT IRE NORTH
BOUNDARY OF THE SUBJECT PROPERTY TO MAINTAIN A BUFFER BETWEEN THE SUBJECT PROPERTY AND
ADJOINING PARCELS LYING NORTHERLY THEREOF.
3. HUNTING ON THE SUBJECT PROPERTY SHALL BE PROHIBITED.
THIS DEED IS GIVEN TO CORRECT A CERTAIN DEED DATED OCTOBER 23, 2000, RECORDED OCTOBER 24,
2000, AS DOCUMENT 632297, RECORDED IN VOLUME 1553, PAGE 138.
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
EASEMENTS, COVENANTS, AND RESTRICTIONS OF RECORD
Dated this of DECEMBER 2000
_ (SEAL) �
(SEAL)
ANTHON TEA SLEY
(SEAL) /� - (SE AL)
D' ARC ALLISON- TEASLEY
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) A NTHONY mvecTFY ANTI
State of Wisconsin,
D'ARCY ALLISON - TEASLEY `, r
County.
2000 personaD came before me this 9 7 't-al day of
authenticated this _, day of D R .R Y 61DO0
j p y -2(ky the above named
1 `i 1 U.R 1R � IcU�
TITLE: MEMBER STATE BAR OF WISCONSIN —. to
(If not, me known to be tile person who executed the foregoing
authorized by §706.06, Wis. Scats.) instrument and acknowledge the same. JUDY K. TANNER
�� {� r Notary Pudic of wiseemm
�
THIS INSTRUMENT WAS DRAFTED BY -- f=�''�
HEY1400D IS CARI, S.C. 204 LOCUST STREET y \F�.
_ Y
HUDSON, WI 54016 Notary Public, State of Wisconsin
My commission Is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
Name, of persons signing ,n any capac ny i.mst be typed or printed below their signature. CO.- wlsconsn Legal Blank Irq.
STATE BAR OF WISCONSIN Miwauk O. wis.
WARRANTY DEED FORM No. I - 1998
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