HomeMy WebLinkAbout038-1207-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
I sanitary Permit No
INSPECTION REPORT
453084 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:
Ewlen Properties I Star Prairie Township 038 - 1207 -30 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
c(ciL� _ 1 �6r I A4 1 14.31.18.1118
TANK INFORMATION LEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
v 'e�e Z_
Dosing Alt. BM Se e
Aeration Bldg. S wer 97•
Holding St/Ht Inlet �D r�Z' / /_• O
�� �Gc k
TANK SETBACK INFORMATION St/Ht Outlet �c .
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic —� Gl } 2 Dt Bottom
Dosing — -- — Header /Man.
Aeration Dist. Pipe
Holding — Bot. System t c 1 +t �• yv
Zc7
Final Grade
PUMP /SIPHON I
Manufacturer Demand St Cover r I ,
GPM 3' �,
Model Number , . t
TDH Lift Fric Loss System Head Ft
Forcemain Length Dia. st. to Well
110-1 i
SOIL ABSORPTION SYSTEM r Z C t �S
BED /TRENCH Width Length No Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer tu
P7 INFORMATION CHAMBER OR c U LC'(e
Type Of System: Lit UNIT
Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribut to Air Intake
' q Pipe(s) i
Length (J 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 bed —
Bed/Trench Center /� r Bed/Trench Edges Lj Topsoil, Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /4 ect' /
Location: 2152 126th Street Star Prairie, WI 54026 (SW 1/4 NE 114 14 T31 R1 8W Prairie View Estates Lot 23 Parcel N 14.31.18.1118
1.) Alt BM Description=
2.) Bldg sewer length = r � -- 2,
_ U E� fen—
amount
of cover (e %vim ti'"
nd & 1 1"-' �°r e° I&-�y - ��—
��, _ — - -- — _ —T- - --
d IC
Use revis
de for additional Yes No Ins rs Si gnature Re
rr
information. ����
Date p g Cert. No.
SBD -6710 (R.3/97)
SA and Buildings Division county 0 J i r Di
77
p� hington Ave., P.O. Box 7082
Y wa , W1 53707 — 7082 Sanitary Pe t i�urO (
15-3 t�e filled in by co.)
F' Wisconsin (6013, 26
•.. State Plan LD, Number
De artment of commerce ,
Sanitary Permit Applicatho R.
in accord with Comm $3.21, Wis. Adm. Code, personal infottttatio You Provide )(rn) Proje t Address if different than ttlailing
tr dress)
(
may be used for secondary p Privacy Law,sl5.04 �}-
I � 215- 126
I, Application Information - Please Print All Information Lot # lockM
P eel #
Property Owner's Name /"1
�J
Pmpe anon
Property Owner's Mailing A dress /I 56J/, aG / �J
Zip Code Phone Number i
City, State % le
yJ
IL T e of Building (cheek 31 that apply) 1 3 bdivision Name CS Number
.'s
2 Family Dwelling — Number of Bodroorm _
❑ p¢blic/Commercial Describe Use. ❑City ❑ Villag,0111L.1wnsbip 0
y�` w0
❑ State Owned - Describe Use Z �ZL
IIL Type of Permit: (Cheek only one box on line A. Com let. line B if applicable) 3
A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only
❑ Ocher Modification to Existing System
List Previous Permit Number and Date Issued
(]
Change of ❑ Permit Transfer to New
B. ❑ Permit Renewal ❑Permit Revision plumber Owner
Before Expiration
IV a of fib VIr1'S S stem: Check all that a 1 oil ❑ At - Grade C: Single Pass Sand Filter ❑
Non - Pressurized in-Ground ❑ Mound >- 24 in. of suitable soil ❑ Mound lt 24 in. of suitable s El m ❑ Ra6rcularin g Sand Filter � C3 /1
Pea Filter ❑Aerobic Treatment Unit ^
Constructed Wetland ❑ Pressurized to round Holding ❑ Other (explain) J
Recirculating Synthetic Media Filter Leaching Chamber
❑Drip Line ❑Gravel -less Pipe
V. Dls ersal/ reatmeat Area nformatioa: Dispersal Area Propo sed (s 1, System Elevation
Desi flow ) Design Soil Application Rate(gpdsf) Di peat Area Required (sf) G r
J D Manufacturer a ah Site S Fiber Plastic
Capacity in Tom Number c to Constructed Glass
VL Tank Info Gallons Gallons of Units W A-
(Utz
New Existing
Tank$ Tanks
Septic or Holding Tank
Aerobic Tesatment Unit
Dosing Chamber
i
VII. Responsibility Statement- 1, the underslgne sum* re onsiblUty for P t PUWTS s on the
RS Nu ( a ttac he d
ness Phone Number
PIunipgrls Name (Print) Plumber's /) S
b I ZS Z
Plumber's Address (Street, City, State, Zip C
VIII. Coun /D artment Use Onl Date Issued lssui g Agent Signatur (No Stamps)
Sanitary Permit Fee„(tncludes Groundwater
1Approved ❑ Disapproved Surcharge Fee) Q� p�
C] Owner Given Reason for Denial �e J0 6
IX. Conditions of ApprovaVReasons for Disapproval -
3) � ° t 1 � V
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced /maintained � Q"
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attae6 eoetpku pla
as (to the County only) far tlse system on paper not less than 81/2 x 11 Inches In sve
SBD -6398 (R. 08102)
OT PLAN
PROJEjj Ewlen Propertie ADDRESS 1430 220th Ave New Richmond Wi 54017
SW 1/4 NE 1 /4S 18 W TOWN Star P rairie COUNTY ST. CROIX
MPRS Shaun Bird 22690 /30/04 BEDROOM 3
CONVENTIONAL )00( INURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 # of chambers 22
IL BENCHMARK V.R.P. Top of 1" pvc pipe — B MA ( ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOL O WE L *H.R.P. SameasBenchmark
SYSTEM ELEVATION 96.0/95.9 3.5' below qrade
1
°15� Zen �4
Using
Wel is to t all Plans Designe d Us g n d �
setb cks required by Conventional Powts
W R Mutual Version 2.0
Vent
,., 6 „ Standard Biodiffuser
o Cover Leaching Chamber
,1�,g „, with 3 1. 1 ft2 of Area
` ” p ' Long 11
Line Grade at System Elevation
34" y
�j Pro 3
Bedroom
House
v \ 3 '
T
2 -3' X 69' Cells
with >3' Spacing 3 q' _
Vents
Vents
Alt. B. 4. is Top
of 1 "PVC pi
@ 99.4
45' < � T . B.M.
iL 105'
10' B -1 47' 53' B-
v�
OT PLAN
PROJET Ewlen Properties ADDRESS 1430 220th Ave New Richmond Wi 54017
sv✓ 1/4 NE 1/4S 14 j/TtN/R18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/30/04 BEDROOM 3
CONVENTIONAL XXX IN- ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 # of chambers 22
BENCHMARK V.R.P. Top of 1" pvc pipe 80A 0- ( ASSUME ELEVATION 100' Filter Zabel A -100
❑BOREHOL O WE IL *H.R.P. SameasBenchmark
SYSTEM ELEVATION 96.0/95.9 3.5' below qrade
Wel is to meet all Plans Designed Using
setb icks required by Conventional Powts
W R Manual Version 2.0
6 »
Vent
Standard Biodiffuser
of Cover Leaching Chamber
18' with 3 1. 1 ft2 of Area
ert 'Long 11
Line Grade at System Elevation
34"
Pro 3
Bedroom
House
30'
ST
2 -3' X 69' Cells
with >3' Spacing 30'
X60.
Vents
Vents
Alt. B. M. is Top
of 1" PVC pi
@ 99.4 ' 45' B.M.
105' Z,
10' B -1 47' 53' B -2 '
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page — 1 — of 3
Divisiui of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
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.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. diri
Please print ail- ihfdrmatiori ''�, Rev' wed by Date
Personal information you provide may be usgdfor secondary purposes (F+ryvacy Law, s. 15.04 (1) (m)).
Property Owner 4 _, Property Location
. } r- • - °.s Govt. Lot S4�1 1 /4 1 /4 S 14 T 31 N R 18 IX(or) W
Property Owne Mailing Address t tot # Block # Subd. Name or CSM#
r iti
1430 220th. Ave. 23 na Prairie View Estates
City State Zip , ode PhorwN r –. ❑ City ❑ Village ® Town Nearest Road
4 `r
p ew Richmond, WI 54617 (715`\' Fla' 3� Star Prairie im "C"
New Construction User ResidentiM4 Nymbery be r ', 4 _ Code derived design flow rate 600 GPD
El Replacement El Public or com6*rdal'- Del '
t PP =.cam— ft.
Parent material 7a ch Flood Plain elevation if app n
General comments
and recommendations:
trenches @ el. 96.00'
E] Boring "....` " ad FEt -d
F, Boring # FLI Pit Ground surface elev. 99.80 ft. Depth to limiting factor +100 in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
1 ] our 2Z none L 2msbk mfr cs 2f .5 .8 , �p
7.5 4/4 none sl 2msbk mvfr gw if .5 .9
3 20 -10 7.5 4/6 none ms OSg ml na na .7 1.2 .'�L
ek °16 o
�lS•� 81. �
F- Boring # Boring 99.40 +100
21 Ei Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
-11 10 2/2 none L 2msbk mfr cs 2f .5 .8 ,(P
2 11 -22 7.5 4/4 none sl 2msbk mvfr gw if .5 .9
na 7 1
o�
` Effluent #1 = BOD > 30 220 mg/L and TSS >30:5 150 mg/L ` ue 2 = BOD < 0 mg/L and TSS 5 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel 02298
Address D e Evaluation Conducte Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 11 -29 -2000 715 - 246 -6200
Property Owner Ftul en Ar=e -r+; a s, Ltd. Parcel ID # 1pe— n Page 2 of 3
F31 Boring # ❑ Boring 99.00 +100
® pit Ground surface elev. ft. Depth to limiting factor in.
Soil liption Rate
Hddzon 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
1f 4 6 .�
3 7 -100 .5 4/6 none MS OSq ml na na .7 1.2
Z
Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Ap lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 ❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit Soil lication 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
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 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.
ssD433,0 (R e6=)
• STEEL'S SOIL SERVICE
Gary L. Steel Ewlen Properties, Ltd. 1554 200th Ave.
CSTM2298 SW'NE- S14- T31N -R18w New Richmond, Wl 54017
MPRSW -3254 town of Star Prairie (715) 246 -6200
lot #23- Prairie View Estates
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitabl or your uim. The location of the test may or may not be as shown
as permanent lot wer i not established at the time the test was conducted.
N
1 " =40' ..
BM.= top of 1' vc pipe @ 1. 100.00'
Alt. BM.= top of pvc pip @ el. 99.45'
670
CO
- 1
Gary L. Steel
11 -29 -2000
I
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. owner acrees to limit greases, garbage, and water conditione r discharge g into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. D 9
ischar Y
into system is not exceed those required as per Comm. 83
Contin Plan
ption # system fails, determine cause of failure, use alternate area and install new
system in tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option #3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace ,any other failing components as needed.
Plumber: %Shaun Bird 715-246 -4516
St. Croix County Zoning 715 -386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST CROIX COUNTY
ErTAIJCE AGREEMENT
.T
., `SEPTICANK AND'
/ OWNERSHIP CERTIFICATION FO
owner/Buyer
Mailing Address f
�a
Property Address _ Dep artment for new construction)
(Vf:rification required from Planning Dep
Pazcel Identification Number
City /State
LEGAL DESCRIP7
1 ec. / T N -R�w, Town of J-t.
Property Locatior� �� Lot # • �
Subdivision
Volume Page #
Certified Survey Map #
g Volume � `�° � Page # _,._- 5�5– ,2-°
# ---
Warranty Deed __ 3 / (P (' 7 � S
es no
Spec housxy
es CJ no Lot lines identifiable y
SYSTEM MAINTk NANCE remature failure to handle wastes. Proper maintenance
of our septic system could result in its P a licensed pumper. What you put into the system
improper use an d maintenance if needed by y
out the septic tank every three years or sooner, waste disposal system
consists of pumping e is the
a treatment stag
can affect the function cf the septic tank as of sludge.
D ep artment a certification form, signed by the owner and by a
owner agrees to submit to St- Croix Zoning p veri that (1) the on -site wastewaterdisposal system
The property` o gr p pumper verifying
masterplumber, j eYnaaplumber, restricted lumber is less than 113 or a licensedaum necessary), the septic tank
is in proper operating condition and/or (2) aRer full inspection and pumping (�
d h-,.ve read the above requirements and agree to maintain the private
Resources, State ivate sewage disposal system with the standards
, /we, undersigae artment of Natural t Wiscons ff ce wi 1� 30
set forth, herein, as set ty the Department of Commerce and the Department co mp lete d and returned to the St. Croix County
stating that your septic system has been maintained must be
day_ s of the three year e: cpiration date.
DATE
<SiGNA,r-URE OF APPLICANT
OWNER CERTIT.[CA, TION our' lrnowledge. I (we) am (are) the owner(s) of
I (we) certify that all statements on this form recorded best Reggis er of Deeds Office.
the property desc bed i bove, by virtue of a warranty
1:>> /c
Wes ' PC , 9 jc� 4 l jtvt DATE
SIGNATURE OF P..ICANT * « « « ««
- resented may r esult is the sanitary permit being revoked by the Zoning Department.
: ss «* A informah that is mts rep
cation: a stamped warranty deed from the Register of Deeds office
** Include with this app li if reference is made in the warranty deed
s copy of the certified survey map
�
VOL 1646PAGE 633
STATE BAR OF WISCONSIN FORM 2-.999
64 t6'J
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between EWLEN Properties, Ltd., a Texas RECEIVED FOR RECORD . �/f,
Limited Partnership, 05 -29 -2001 9:30 AN �� n_ 1,2 '91
WARRANTY DEED � l
Grantor, and Eric R. Wahlqu Marla R. Wahlquist, husban EXEMPT N
and wife, CERT COPY FEE:
— COPY FEE:
_ TRANSFER FEE: 15.00
-- — RECORDING FEE: 12.00
Grantee.
— PAGES: 2
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croi County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
(See Attached Exhibit "A ") Name and Return Address
KRISTINA OGLAND
ESTREEN & OGLAND
The parcel shown on this document is being added to the parcel shown on 304 Locust
the document recorded in Vol. 1158, page 257, Doc. No. 538707, St. Croix Hudson, WI 54016
County Register of Deeds Office to create one parcel, and this transaction is
thereby exempt from Ch. 18 of the St. Croix County Land Use Regulations 038 1057 -60 -000
pursuant to See. 18.05(Ax3). Parcel Identification Number (PIN)
This is homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. %X00
Dated this day of May 2001
EWLEN Properties, Ltd.
is General _
i , P rtner
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
St. Croix County
authenticated this __day of
- _— Personally came before me this , da of
May 2001 t riau�e�it I
EWLE Lt d., a Texad Li mited p hi �
F oy E W. John its _G_ene � _.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who ex or ng;
-- instrument and a k the same. '•,� !, Q r'�
authorized by § 706.06, s Stets
Wi. .) �
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristine 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. ldwmatgn Profe jai, comPan Fond du Lae, Wf
STATE BAR OF WISCONSIN aOD - 2021
WARRANTY DEED FORM No. 2 -1999
I
I
VOi..1646PAGE 634
EXHIBIT "A"
Part of the Southeast Quarter of the Northeast Quarter of Section 14, Township 31 North, Range
18 West, Town of Star Prairie, St. Croix County, Wisconsin, described as follows:
Commencing at the East Quarter corner of said Section 14; thence on an assumed bearing along
cite cast line of the Northeast Quarter of said Section 14, North 00 degrees 00 minutes 40 seconds O r
East a distance of 468.95 feet to the point of beginning of the parcel to be described; thence North
89 degrees 01 minutes 50 seconds West, parallel with the north line of Lot 1 of the plat of Prniric
View Estates as recorded in the Register of Deeds Office in said County, a distance of 455.42
feet; thence North 01 degrees 14 minutes 14 seconds East a distance of 233.68 feet to the
southwest comer of Lot 2 of said plat; thence South 00 degrees 00 minutes 40 seconds West,
along the east line of Lot 5 of said plat a distance of 208.71 foes to ilia southeast comer of said
Lot 5; thence along part of the north line of Lot 6 of said plat and along the north line of Lot 1 of
said plat, Soutt 89 degrees 01 minutes 50 seconds East a distance of 450.42 feet to the east line of
the Northeast Quarter of said Section 14; thence along last said east line, South 00 degrees 00
minutes 40 seconds West a distance of 25.00 feet to the point of beginning. Containing 11,845
square feet .272 acresl Sub
the above desert ect to all caseme restrictions and covenants of record.
A dip
vr.; 1468 PAGE 556
613378 WALSH
�U STATE BAR OF WISCONSIN FORM 2.1998 R EGIST E R H. DEEDS
O REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Ernest J Dosedel and Mariorie B. RECEIVED FOR RECORD
Dosedel husband and wife 11 -05 -1999 10:40 AN
Grantor, conveys and WARRANTY DEED
EIfENPT N
warrants to EWLEN Properties Ltd a Texas Limited Partnership. CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 1080.00
RECORDING FEE: 10.00
Grantee. PAGES: I
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of
Wisconsin (The "Property "):
Recording Area _.
- EST "
3, .. aCus
038 -1057- 50-000 & 03 &1057. 60-000
Parcel Identification Number (PIN)
This Is not homestead property.
S %2NE' /<, Sec. 14- T31N -1118W except commencing at the Northeast comer of said SE' /.NE' /.,
Sec. 14- T31N -R18W; thence Westerly along the North line of said SE %.N I/s to the Westerly
edge of the right of way of County Trunk "C "; thence Southerly along the Westerly edge of said
County Trunk "C" right of way a distance of 608 feet to the point of beginning; thence
continuing South on the Westerly edge of County Trunk "C" right of way a distance of 208.71
feet; thence Westerly and parallel with the North line of said SE' /.NE' /4 of Sec. 14- T3 IN-RI 8W
a distance of 417.42 feet; thence Northerly and parallel with the East line a distance of 208.71
feet; thence Easterly and parallel with the South line a distance of 417.42 feet more or less to the
point of beginning.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this ZS day of October, 1999.
*
��*Erwest J. D el
Mirjorie V. Dosedel
AUTHENTICATION ACKNOWLEDGMENT
Signa4° " St J. Dosedel and Marjorie B. Dosedel STATE OF WISCONSIN ss.
h !+ r authenticated thi County )
da;'d Ocro r;!t999.'
Personally came before me this � day of
1999, the above named
' Nu - Oglaiid
y to me known to be the person(s) who executed the
T[7t$ER STATE BAR OF WISCONSIN foregoing instrument and acknowledge the same.
..,... Dot
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin
Attorney Kristin Ogland My Commission is permanent. (If not, state expiration date:
Hudson, WI 54016 — )
(Signatures may be authenticated or acknowledged. Both are not
necessary)
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM M. l • IM
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