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HomeMy WebLinkAbout038-1192-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM count9t. Croix Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaomlNo.: Personal information you provice may be used for secondary purposes [Privacy Law, j15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ �jW ?�iTfeTAvnship State Plan ID No.: Viebrock, Randy Jt CST BM Elev. Insp. BM Elev.: BM Description: Parcel N I M-0 -0 at . -D ' � = Cs� 9� ± asps Pf92 -2o -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 05,E 00 r Dosing er bs % Aeration Bldg. Sewer �.10 % • �S/ Holding St /Ht Inlet q.( cl5 TANK SE ACK INFORMATION St/ Ht Outlet �-`� qg TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet -- `—"—� Air Intake Septic > Sa ' $' NA Dt Bottom Dosing NA Header /Man. nl- f,,$) �� 88 Aeration NA Dist. Pipe qy•(o , Holdi . Bot. System o 517.7s- PUMP/ SIPHON INFORMATION Final Grade Manufac St cover errand Model Number GPM TDH Lift L oss Iction tem TDH Ft F ain I Length Dia. Dist .To SOIL ABSORPTION SYSTEM L BW RENCH Width , Len th _ r No O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I3 ' L DIM N I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu rer SETBACK INFORMATION Type Of CHAMBER Mo um er: system: � V W . > 1 �$ — OR UNIT DISTRIBUTION SYSTEM y � .4- [. Header / Manifold �� Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. n 7! 5d SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over v Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nch Center ,?� f Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 0 41 2 (1 01 Inspection #2: -4 Location: 2208 129th Street, Star Prairie, WI 54026 (SE, 1/4 SE 1/4 11 T3 IN R1 8W) - 113118990 Huntington Meadows - Lot 6 1.) Alt BM Description = jrq . 2.) Bldg sewer length = I S.o - - amount of cover = 7 18 "� - � c 3) � - A- (W Q�Seru�i��� -S 1 5 1 Plan revision requi ed? ❑ Yes No Us oth side for ad 'ti n I infprnyfptif�n. , �o SBD 6 R.3 ty � is I Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i f x P ! s f f � E a f c � f � � p i q tiii 3 E ° E E ° i $ g Y € � f � �— 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 Box 7302 NVisconsin Personal information you provide may be used for secondary purposes Madison, WI 1 5 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned. Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County I X State Sanitary Permit u r ❑ Check if revision to previous application State Plan 1. D. Number I. Application Information - Please Print all Information Location: Property Owner Name Property Location /1 KN©y Y c n ]< SE 1/4 SE 1/4, S II T S1 N, RSE or W Property Owner's Mailing Address Lot Number Block Number 1 J9) I' J /nT N S`r td City, State Zip Code Phone Number Subdivision Name or CSM Number Mw WI 0 -A Mn 1 1) m �4 D )'7 ( ­7 15 ) Zvi L, -2L 77 AuAMNG 7DN InferQCs II Type of Building: (check one) ❑ City �( 1 or 2 Family Dwelling — No. of Bedrooms: ❑ Village ❑ Public/Commercial (describe use): I XTown of Sw t1 X11-1 C- 0 State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road 1Z9 TH A) 1. XNew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number (s) System Tank Only Existing System 6 —11 -- zo — ,mow B) Permit Number Dar is ` ❑ A Sanitary Permit was previously issued 55 IV. Type of POWT System: (Check all that apply) A 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: ..11; f /6N L'AP INFiL7RAToRS 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Require At) Proposed Rate ( Is. /day /sq. ft.) (Min. /inch) Elevation ,I� �8�w Rio. , 51 Z .7 ll L --- I 93, b 9 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks SEPT" I L rzkL i� 12�Q l WE E kS ❑ ❑ 1 ❑ ❑ 13 13 13 VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown oV plans. Plumber's Name (print) I Plumber's Si ture (no ps): MP o. Business Phone Number :11E)= G � _V_ Y /' ZZ3ZLi 2 71 S- Z T L) - 3l L) Plumber's Address (Street, City, State, Zip Code) -RD x 2q S bRES S X12 W'I 51461)9 VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Dat Issued Issum Age t Signature (No stamps) 'Approved ❑ Owner Given Initial Adverse Surcharge Fee) od Determination C7�7� IX. Conditions of Approval /Reasons for Disapproval: (oOp = ► •2 - Soo SBD-6398 (R. 07/00) �kAµVA&/5 f i )? 1 bY V1CBRoeK < IF 1y sE Av !See- T 3), Ic R 7S t,J STAR- RAR C, - t Wl P. old a �i�i2S zZ 32'� 2 33� Al. 7nf> OF 2' QMF- ALak)b EAST L[7T L7Nc r:3 SOIL ISD'R1 6 o Y1 1 0 9 Q 2 TIZ"CHCS W'tT"+1 15 ARRA MZ-4 L'AP. S.v✓ IiVr)L, EAe+A iZ� GOAL WE£KS S£Pfi� �/ _ - rAuic, A 1 oc) zNBzc rt116k W � Mu-,+ C"- l�cklaC� �1, �3 � � S Z-.. J�Ra ���a r Obstv+✓wh p: pe s ia,rc y Leo G/�RAGE - 0 c SRC 4� ) bD 0),r- T S`r Commerce SO �1tt � ORT Page � of Wisconsin Department of �� ' "'� `j't Division of Safety and Buildings In accordenca witfa`Cdnjrn 8 Code b Attach complete site plan on paper not less than 81/2 x 1 iii s In s Ian m St C )ZO Include, but not limited to: vertical and horizontal referent' Point (BM), directtona�n � I.D, p G► p „ O percent slope, scale or dimensions, north arrow, and loca*M..4nd di: to �e� road. 7 — Please print all informal �, � kk Sco `G E cR wed b D to (�� Personal information you provide may be used for secondary pur (H�iyacy Law, tiM �') � (m))^ 1 P Owner t" Pr e r-aV\ IC�1 r C)1D 0e.`�Ib E 1145E1/4 S I T 31 N R E( W Property Owner' Mating Address Block # Name or CSM# 5t.'. -f "„ o MC. - Sow tats Zip Code Phone Number City ❑ Vitage T Nearest Road CRY &w ' i Lkrn m Syv f '7 7 IS V6 677 1 Pra '� V" c... Y• New Construction Use: ❑ Residential ! Number of bedrooms 1 4 Code derived design flow rate t'o O o GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _0111 A- G 1 4 ` c5 w A S 1^ Flood Plain elevation if applicable — n General 00"WrIerits 1"`Y :'Suc�SeS-} a -3' $L�7+`eret v5�.•� h�, I+ �S and recommendations: O'd -(,I. T3 ( 43.9$' (13,57') T. et3.YD' 5 Boring # 0 Boring Pit Ground surface elev. _ �1. V it. Depth to limiting factor _LdtL_ In. Rate Soll Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP In. Munset Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Elf#2 L a F�12 a F S IF 5,b F 5 9 o- F I, 7, 54 e -5 L 4 W — a� (9 o� Wng # ❑ Boring Q (} pit Ground surface elev. _ 1_ / fl. Depth to limiting factor __ D in. eoll ADDkA Vale Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munset Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 -b 7 3 SL 6 d Q5 OF . 9 Sc.. ;kF55 7.5!@s/ L tA2 IV F `-f - 7.5 Yk Y1Y f ., — -- 7 Effluent 01 s BOD > 30 E 220 mg/L and TSS >30 _< 150 mgA. ' Effluent #2 a BOD -< 30 mg& and TSS _< 30 mg1L Qff Name (per printl Signature a Dale Evaluation Con ducted Telephone Number — �1)Q -a - 35$ e = 6gDA. J Property Owner o G AL. Parcel ID # �S2' ` �'� p C Page of _L_ a Ong # Boring q �. pit Ground surface elev. �! n. Depth to limiting factor ! 3 D in. Soil motion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - 10 tk l al s L a Flo e 045 aI= . 9 fR / S L I iF sbv- e. w F- .5 1/ 3 -1 15Y O S 6- ►U1 I6:k Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication 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 F ❑ El 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 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 3 220 mg/L and TSS >30:s 150 mg/L ' Effluent #2 = BOD 130 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 (RAM) I t � f , I nI� , lot } >orri Fp e, CLV { i : ,r C i ; f I I 4 1 � - ---- a , 4 • I � i � � i � � i i , Pot r o - 1 jSv le�: ►� I � _ ; 1 1 ,p 61 ; w�',.v�. i_ $ ► o•�� ref , twE,GP+�- iD I I I • 1 . Q t 99.dtD� , A t I f rf 4 ¢t. 5 t� w► c,n in O f I � r 1 : 1 , { i ! , r i , r r r _ s I I I i r I 1 i 1 r _ I : i 1 : _ 1 i I I r , : j I , . r , , f : , 1 , 1 I i s : A T L i `r 1 t -29 ` 1: - . F4i• f , r i f ky{ , r A � Jt 6 qg e d_y " Ike ;I_ , Wisconsin Department of Commerce SOH AND SITE EVALUATION Divi s�L�'l of -Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm Code � , County r C Attach complete site plan on paper not less than 8 1/2 x 11 inches i i 7 tio k irit�sk.:,.' include, but not limited to: vertical and horizontal reference point a a .r, percent slope, scale or dimensions, north arrow, and location a nce ? rod Parcel I. . # s APPLICANT INFORMATION - Please print al/ i AKA7aton. " F Reviewed by Date 3,. Personal information you provide may be used for secondary purposes r v_ law, s. 1 4 (1 (m)},' O i Property Owner C Ubvpefty Locatigh i ''C?Pal rtt 1/4 1 /4,S T ,5/ N,R -g— E (o � Property Owner's MailingAddresi �' < Lnt# •c Sub P. Nam.�e - or CSMM ## City L / tate Zip Code Phone Number El City 1:1 Villa Town Nearest Road �Gr� /'/ fit !� ` 5 �� . i' yv 15 New Construction Use: Residential / Number of b9drooms Addition to existing building Replacement ❑ Public or commercial - De scribe: Code derived daily flow t�� gpd Recommended design loading rate , 7 bed, gpd /fl e trench, gpd/ft Absorption area required S bed, ft 2 5— trench ft Maximum design loading rate gi bed, gpd/ft - 2r trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations / �� Parent material /77v L r � 1tr2 Flood plain elevation, if applicable Ay__ ft S = Suitable for system Conventional Mound T - Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system s❑ u S s [] u As ❑ u l Zs E u I ❑ S E U ❑ s PR u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottl )s Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Co it. Color Gr. Sz. Sh. Bed , Trench Ground 11 1;24� _ elev. Depth to limiting QZ' fa or 2 `E Z Remarks: Boring # 2 � Ground slay. , y , Depth to limiting factor ,7 9 in. Remarks: CST Nam (Please Print) Signature Telephone No. AddFefi Date CST Number �� SOIL DESCRIPTION REPORT PROPERTY OWNER -� / Page o PARCEL I.D.# �fd Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground ; t� elev. Depth to limiting .2. .2 factor Remarks: Boring # Ground elev. Depth to `� Z iii• L limiting factgr /O in. ', // Remarks: N` / Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # v �' , or Ground elev. Depth to limiting factor in. Remarks: Bori g # ..:........................ Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) r T X Soil Test Plot Plan Project Name' �� Byron ' d Jr, Address o2o2O /�7r��� 0� - ���i�n�.�� CST ©� d Lot �_ Subdivision _ �«�„,�� ate �f^7�� � 1 /4 /4SZT fL N /R Z!:5 W -,— Townshi I3oring Q Well PL' Property Line County S 4 BM or VRP Assume Elevation 100 ft: System Elevation *HRP� a Ar lv _ �o 0- f �° �-f 4 P is G.- � Scale 1/4" = 10 Ft. Mien Dimensions aren't stated 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 (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 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 '37q9 0 Number of Bedrooms Design Flow - Peak (gpd) (moo Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft 2 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 r Management Plan for a Septic Tank and Soil Absorption Component 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 ma ximum scum and sludge a 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 es and rescue of a men of holding tank may contain lethal , treatment g y gases, 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. ffi round or over the soil absorption component Traffic should be avoided particularly a p P 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 ' Management Plan for a Septic Tank and Soil Absorption Component 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. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 0 -Il d y #z i ol e Mailing Address _ f j �� S i� (,� ✓2i C � ©�, l.�1 �y © Property Address 0908 14-9 6T (Verification required from Planning Department for new construction) City/State Parcel Identification Number (9 LEGAL DESCRI Property Location S�— '/4, -SL '/4, Sec. 1 r , T N -RYW, Town of Subdivision 11al? Ti /7,1 % O/I G� S , Lot # Certified Survey Map # Volume / , Page # Z11 3 Warranty Deed # , Volume , Page # Spec house ❑ yesAno Lot lines identifiable Jkyes ❑ 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 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. 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 Ae three year p' tion date. S ATURE 91 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 described v , by virtue / ° f a warranty deed recorded in Register of Deeds Office. .,� r f f SIa TURF O , "ALICANT 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 I unl. i 5 " 07oAGE 4 l� 622202 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Clay A. Edin, a single person RECEIVED FOR RECORD 05 -02 -2000 9:30 AN WARRANTY DEED Grantor, and Randall J. Viebrock and Heidi J. Viebrock, husband and E CERT P COPY FEE: wife COPY FEE: D6 A S TRANSFER FEE: 77.70 PAGES: FEE: 14.00 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area �9 Name and Return Address Lot 6, Plat of Huntington Meadows in the Town of Star Prairie, St. Croix KRIS T i N, ^1 OGLAND County, Wisconsin. ATTORNEY AT LAW P.O. BOX 359 HUDSON, W /' I54016 vZ °� 038- 1049 -50- 03 — 1( 9 Z Zo arcel Identification Number (PM) This is not homestead property. (9) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of April 2000 �Orn A A * * Clay A. Ed s * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Clay A. Edin, a single person STATE OF WISCONSIN ) ) ss. County ) authenticated this 7 day of April , 2000 Personally came before me this day of , the above named * Kristina Ogland 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 Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ') * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals company, Fond du La ; WI STATE BAR OF WISCONSIN e00- 656-2021 WARRANTY DEED FORM No. 2 -1999 l � � 't0'd 6E2L8VZ5TL:WOHA QHAIHOAU T5:fT 66 -TT -80 11 �I�tYI Grp, 1 1� UPS l � ' r ' � W` cs �yi � '�i Ul� �� �.7 ��w, -�.� I�1 ` ���i�l'li,� I I ,�.. 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