HomeMy WebLinkAbout038-1148-50-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Bung Division
INSPECTION REPORT Sanitary Permit No:
479235 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:
Wilson, Burt I Star Prairie, Town of 038 - 1148 -50 -100
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/ dL� Im 17.31.18.646
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic tJ� ` vKJ Benchmark
Alt. BM /,7.c7
7� I L J(e�.Q, 6.
Aeration Bldg. Sewer
4 o /
Holding St/Ht Inlet 9 /63
TANK SETBACK INFORMATION St/Ht Outlet 5!•Z J 03 L
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic � / Z5 / If Dt Bottom �
Dosing Header /Man. 7•
Aeration Dist. Pipe 7 ,1 ff 1
Holding Bot. System
b
PUMP /SIPHON INFORMATION Final Gra des `T 16 I
Manufacturer Demand St Cover Z•C ,16(6
GPM
Model Number l �• p� •'
TDH Lift Friction Loss System Head DH Ft p I ,
Z I
Forcemain I Le Dia. D' ell qr-/ C
SOIL ABSORPTION SYSTEM
BED/TRENCH Width j Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid epth
DIMENSIONS 4:5 i 1
SETBACK SYSTEM TO P/L `'t BLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION 11 C CHAMBER OR Type O System: Z I � / UNIT
Model Number.
Q -`
DISTRIBUTION SYSTEM +- - - = 7 9
Header /Manifold Distribution x Hole Size x Hole Spaci g Vent to Ai ntake
Pipe(s)�
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over j Depth Over xx Depth of \ xx Seeded/ S xx Mulched
Bed/Trench Center Bed/Trench Edges \ Topsoil \\ No
es �� No
Y :,i Yes i ]
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection
Location: 966A Brave Drive Star Prairie, WI 54026 (SE 1/4 NE 1/4 17 T31 18W) Wigwam S D Loth Parcel No: 17.31.18.646
1.) Alt BM Description = ^ / GIIIVt�,
2.) Bldg sewer length = W 9 .Q 15
- amount of cover =
revis Plan o
Use other side for additional information. — — _- - -- - - - - -- �� J
Date Insepctor's Signa re Cert. No.
SBD -6710 (R.3/97)
County {
Safety and Buildings Division
201 W. Washington Ave . Box 7162 �!
.r "' Madison, WI 5 62 Sanitary Permit Number (to be filled in by Co.)
l0Cons`n (608) 266 1 4 ��
Qepartment of Commerce State PianI.D.Ntunber
Sanitary Permit Application O
In accord with Comm 83.21, Wis. Adm. Code, personal information y nu provide project Address (if different than mailing address)
may be used for secondary purposes Privacy Law, / ^ nn
I. Application Information - Please Print All Information t'o 1p A akr W
1#
# � lock #
Property O ' ame JUN 0 6 2005 ; D
, property Location
propeny O Mailing Address ZONING OFFICE ��,! / �
��� 3 /,,J ' /,, Section 0
Phone Number
Zip Code
City, State , &I
cle ne}
T .5/ W. o�
CSMNumber
II. Type of Building (check all that apply) QI,
Subdivision Name
or 2 Family Dwelling - Number of Bedrooms G(/:z ✓Ind >
❑ Public /Commercial - Describe Use [3Ci -[]Villa ip of cR.ln�
State Owned — Describe Use
TIT. Type of Permit: (Check only one box on line A. Complete line B if applicable) C� 3
[] S T Tank Replacement Only ❑ Other Modification to Existing System
A. ew System ❑ Replacement system
❑ Permit Revision ❑ Change of ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
$. E] permit Renewal plumber Owner
Before Expiration
IV. a of POWTS System: (Check all that a 1) El Sin a Pass Sand Filter El Non _Pressurized In- Ground [I Mound >_ 24 in. of suitable soil ❑Mound <24 in.
of suitable soil ❑ At-Grade �
❑ Pressurized In- Ground ❑ nk Holding Ta ❑Peat Filter ❑Aerobic Treatment Unit ❑�R /ecuculating Sand Filter
Constructed Wetland [] Other(
Rec Synthetic Media Filter explain) 7 O�Q IF
R thing Chamber Drip Line
[I Gravel -less Pipe
System Elevation
V. Dis ersal/Treatment Area T formation: Dis ers� ea9u" ( Dispersal Area 1 'r°P°S� ( Y
Design Flow (gpd) Dn Soil Applic ation Rate(gpdsf) P ! J c �� C'J L /
esig �, / D
li ) _u Site feel Fibe Plastic
[ Manufacturer Prefab Glass
VI. Tank Info
� Capacity in Total Number Concrete Constmeted
Gallons Gallons of Units
New E)dsting
Tanks Tanks
Septic or Holding Tank CCAZ-�
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, a e responsibility for innssttaallll2tiiRos NumbepOWTS shown on the attached p a Number
Plumber's Name (Print) Plumber's Si Y J�
7 7
Plumber's Address (Street, City, State, Zip Code
VIII. Coun /De artment Use Onl Sanitary permit Fee (iqludes Groundwater Date Issued lss ing t Sign (N Stamps)
Approved ❑ Disap Surcharge Fee)
❑ iven Reason fo Denial V � ' • ... - -
IX. Conditions p rov 3� f u g-✓t�M ` r`
SYSTE ER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced ! maintained ZO 10 OL (4
as per management plan provided by plumber. go 1
2. All setbackMEquirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in C � `T -
�\ �Q J l5
SBD -6398 (R. 01/03)
PLOT P AN
PROJECT Bert Wilson ESS 2168 Shore Drive Somerset Wi 54025
SE 1/4 NE 1/4S 1 7 /T 31 M' W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9 BEDROOM 3
CONVENTIONAL xxx IN- GROUND RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 901 # of chambers 29
IL BENCHMARK V.R.P. Top of P.L. Stake ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 100.7/101.0 4' below qrade
setbacks required by Plans Designed Using
seDNR Conventional Powts
Manual Version 2.0
Please note: system may be
oversized if SL are found
during installation. I did do Squaw Lake
one boring, but the original soil
test was old, I did another test
on lot 12 and found SL 3 -3' X 45' Cells and 13' X 52' Cell with >3' Spacing
present.
277' Property Line
5 '
25' S Pro 3
Bedroom
B -5 House
B -2
35' 70'
3% Slope
105' B -6
15'
B -3
35' B -1
35' 5'
BraveDrive 220' Property Line
B -4 25'
5 '
B. M.
50' Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
6' Long 1199
34" Grade at System Elevation
r
P OT PLAN
PROJECT Bert Wilson ADDRESS 2168 Shore Drive Somerset Wi 54025
SE •1/4 NE 1 /4S 17 � 31 /R 1 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 22690 DATE6 /4/05 BEDROOM s
CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
,BENCHMARK V.R.P. Top of P.L. Stake ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. SameasBenchmark
Well is to meet all SYSTEM ELEVATION 100.7/101.0 4 below qrade
setbacks required by Plans Designed Using
WDNR Conventional Powts
Manual Version 2.0
Squaw Lake
277' Property Line Please note: system may be
oversized if SL are found
during installation. I did do
one boring, but the original soil
test was old, I did another test
on lot 12 and found SL 1_ C1 111.
present.
2 - 3' X 69' Cells with >3' Spacing B - ` o
B -5 Pro 3
Bedroom ,
House
35' 70' y�
3% Slope
105' B -6
15'
15'
35' B -3 B -1 ST
35'
Brave Drive 220' Property Line
B-4 25'
5 '
B. M.
50' Vent
>6 » Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
6' Long 11 "
0 1P *1
34„ Grade at System Elevation
P OT PLAN
PROJECT Bert Wilson ADDRESS 2168 Shore Drive Somerset Wi 54025
SE '1 NE 1/4S 17 T 31 /R 1 W TOWN Star Prairie COUNTY ST. CROIX
_� 4
MPRS Shaun Bird 22690 DATE /4/05 BEDROOM 3
CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
IL BENCHMARK V.R.P. Top of P.L. Stake ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 100.7/101.0 4 below qrade
setbacks required by Plans Designed Using
WDNR Conventional Powts
Manual Version 2.0
t� Squaw Lake
277' Property Line Please note: system may be
oversized if SL are found
during installation. I did do
one boring, but the original soil
test was old, I did another test
on lot 12 and found SL U-1.
2 present. 0 `
2 -3' X 69' Cells with >3' Spacing B -
B -5 Pro 3
Bedroom y
House
35' 70'
3% Slope
105' B -6
15'
15'
B -3 ST
35' B -1
35 9
Brave Drive 220' Property Line
B -4 25'
5 '
B. M. * 20
50' Vent
>699 Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
6' Long 11 "
Grade at System Elevation
3 4"
RECEIVED
WisconsnDepartmentofC mer4iA� 1 2004 S IL EVALUATION REPORT Page of
Division of Safety and Buildi s
S7 , CF4680OMhhk�with mm 85, Wis. Adm. Code
ZONING OFFICE F
County
Attach complete site plan o lies 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.
Please print all information. NRevi ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property 71 Property Location
j ^ Govt. Lot 114A,14 � 11 S N R E ( ) W
Property Owners Mailing Add re Lot # Block # Subd. Name or CSM#
City State Zip Code Phone Number ❑ city ❑Village Town Ne est Road
New Construction Us esidential /Number of bedrooms Code derived design flow rate _�!� GPD
❑ Replacement ❑ Public r commercial - Describe:
L –ez =
Parent material z Flood Plain elevation if applicable
General n
and recommendations
:
F-61 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 GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
4- o I, o
bb-
a Boring # Boring
El El Pit Ground surface elev. ft. Depth to limiting factor In 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
r
• Effluent #1 = BOO > 30 1 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BOD 130 mg/L and TSS < 30•mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 540T7 715- 246 -4516
I
' s
i
Property Owner _ Parcel ID # Page of
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. 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
F-1 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 GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
F-1 Boring # ❑ Pit Boring
❑ 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
I
Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD 130 mgA- and TSS 130 mg/L
I
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 (RAW)
Soil Test Plot Plan
Project Name Burt Wilson Shaun
Address 2168 Shore Drive
Somerset Wi 54025 CStd #226900
Lot 11 Subdivision Wigwam Shores Date 2/27/04
SE 1/4 NE 1/4S 17 T 31 N /R18 W Township StarPrairie
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of P.L. Stake
System Elevation 100.7/101.0/101.3 *HRpSame as Benchmark
Alt. BM Top of 1/2" Pipe C 98.5'
Scale is 1" = 40' Squaw Lake
unless otherwise
277' Property Line noted
B -2
B -5 70'
35'
3% Slope B -3
105' B -6
B -1 220' Property Line
35' 5'
5'
B -4 25'
Brave Drive 5
20'
50'
.M.
Alt.
B.M.
DEPARTMENT OF REPORT ON SOIL BORINGS AND S AFETY & BUILD DIVISION
INDUSTRY. REPORT
LABOR MAN RELATIONS PERCOLATION TESTS (115) MADISON, Wt
• IHe3 & Chapter 145.00)
L A 1 N3Hw1MU Y: OT NO. S
Sg 11� 17 /T31 N�R18 F ( od w Star Prarie 11 n/a Wigwam Shores
Y: UVERZKOWTPM NAME: IMAI LING ADDRESS;
St. Croix W=en KIWdson Co mtryview Ct., #27, Somerset, Hi.. 54025
USE DATE$ OMFRvAnONS MADE
3 n/a l�ioew OR.pha� 2 -7-92 3-20-92
RATING: $- $ito suitable J for U- &M elmtitoble for eyuem
S QU 4S OU S U �S ECOMMENDEOSY$TEM:(opdorrel
conventLOW trench
If Perc0latial Testa we NOT roquked DESIGN RA If my portion of the ton ere is in the
undo a M$3 09(s)lbl, ItN$Ceh: n/a Floodplain. I n leote Phtodplaln aWmtbn! n /a
decimal' PROFILE DESCRIPTIONS page 11 AnC2
BORM AL ELEVATION t: AND OEM TO B K IF OBSERVED E RV N BACK I
e- 1 7.42 705.50 none 57,42 .5810yr4/3 l.a., 3.4210yr4/4m.s. .7510yr4/41.s.
2.671 4 4m.s.
B - 2 7.08 105.70 none 57,08 •7510yr4/3s.1., 1.0010yr4 /31.s., 3.0010yr4 /4m.s.
.831 4 4 La. , 1.501 4 4 m.e.
g. 3 17.25 1 105.90 none 57,25 .5010yr4 /3s.l., 1.2510yr4/41.s. 2.2510yr4/4 m.s.
B- 4 6.67 104.50 none 56.67 4 s., 3
g. 5 6.50 104.90 none 56,50 .6710yr4/3 s.1., 3.8310yr4/4 m.a.,
ciam 91111 t PERCOLATION TESTS
NM DEPTH- A t�T
R 1 N VAL�h11N. I WIMMI RAT MI NUTES
PER INCH
- none 10 3 3 3
2 3,50 none 10 3
P. 3.70 none 10
PLOT PLAN: Show locations of pareoledon wets, sail borbW end the dimeMlons of suhable sell sms. Mdlo,a soda or dhmww=. Oaseribs what are she hoN-
soMal end vsrdeel elevation reference points and show thwr weatlon on the Plot Plan. Show the surlw slevatloo et ON bodolp and the direction a Paasnt
of land slope.
SYST ELEVATION _ _ 102.20
4
I ' t `
,...� I (. L,. i
i t •) - ,
1, the wrdendensd, hereby V"fy that the @oil tests eported on this form wwe nude bV me M accord wM the procedure h'�thi 's1�5oiid
Adndrdstratiw Cods, and that the des romrded and the loestion of the DMts sm correct to the best of mV krKwAodeo and r.w
NAMe (or i n - $T L:{M),
EM RE OW
Gary L. Steel 3 -20-92 T0 ,�``
ADD
C ERTIFICATION NUMBER:
1554 2QOt Wi 54017 2298 0'
CST $1
T e:
DISTRIBUTION: Oripiiud and one [ropy to Loml Authority. Property Owner and Soil Tester.
OILHR- 3$06395 (R. 021821 - OVER -
A�
i
4 0 �
. a
r
', �, %� •. ,.�. •, a �,..�:,
i
Ul
COD
I la
tI
Main tenance and Contingency Plan for a Septic System
Maintenance Plan um ed once every 3 years.
1. Septic Tank is to be p P
2. Effluent filter is to be clean once a year, Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter. actions pipes at the ends of
3. Once every 3 years, cells are to be inspected via the insp
the cells.
reases, garbage, and water conditioner discharge into the system.
4.Owner agrees to limit g
5. The owner agrees to save this pla
driv over system.
6. Do not plant trees nor park no from system.
7. Watershed is to be diverted way exceed those required as per Comm. 83
8, Discharge into system is no
. y plan
lls determine cause of failure, use s$rnate a(�d and install new
Option #1. ysterrt fa ,
sy in tested replacement area.
r elevation, by removing chambers, removing biomat,
Option #2. install syste at a lowe
and install new system.
Option#3. No a d e qu ate 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 neede d
Plumber: Shaun Bird 715- 246 -4516
St Croix County Zoning 715- - 4680
Pumper Tom Mondor 715 -246 -
Shaun Bird #226900
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer
s � r"Q
Mailing Address Vz
Address De artmeat for new construction)
Property a from Planning P
(Verification requir ,
Parcel Identification Number I �4E-- � p / 60 .
City/State j
JXGAL DESCgIPTYON / 7 T 3� N - RL_—y W, Town of
on�� 1 J4, L_%- A, Sec. —
Property Loci Sig D Lot # —
Subdivision Page It
-- Volume
Certified Survey Map # Page It `f
Deed # D Z � � Volume
'Warranty � Q no
no Lot lines identifiab
Spec bouse�Y Y
SYSTEM MAINTENANCE remature failure to handle wastes. Proper nuaintca
ce of your septic system could result in its p What you put into the system
Improper use and maintenan three years or sooner, if needed by a license P
consists of pumping out the septic tank every the ' p ° � 1 s
can affect the function of the septic tank as a treatment stage in by oar and by a
cation form, sigma waterdisposai systc
to submit to St Croix Zoning �ymg th (I) the on- site was� m
The property owner umber, restricted plumber or a licensee Pe the septic tank is less than 1/3 full of sludge.
masWpiumber° journeymanP r lion and pumPmg (If necessary),
in proper operating condition and/or (2) of a inspect with the stancLuds
is
agree to maintain the private sewage disposal wi w sin. certification
have read the above requirements and tb went of Natural Resources, State of zo g Office within 30
Ilwe,
th undersigned ent of Commerce and the Depart the St- Croix County
set forth, herein, as set by the has b m must be completed and returned
to
stating that your septic system has been maintained n
da f the year expirati date.
f DATE
SIGNATURE OF ICANT
OWNER CERTIFICATION true to the best of our knowledge. I (we) am (are) the owner(s) of
I (we) certify that all statements an this form a
deed recorded in Regist of Deeds Office.
t rty describe ve, y virtue of a warranty p )'
DATE
OF APPLICANT
rmit being revoked by the Zoning DCP � ent.
ssst :* Any information that is misrepresented mny result in the sanitary Pe
tamped warranty deed from the Register of Dees off
Include with this application: a s P if reference is trade in the warranty deed
a copy of the certified survey ma
U 2553P 9`78 -7 's 12 !1z4 - 7
STATE BAR OF WISCONSIN FORM 2 - 1999 XATHLEEIi H. YALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., VI
RECEIVED FOR RECORD
This Deed, made between Burgee O. Amdahl and Joyce E. 04/21/2004 09:30AM
Amdahl, husband and wife Grantor,
and _Burton K. Wilson and TJ Jane R. Wilson, husband and wife VARRAATY DEED
rantee. EXEMPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.08
the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 300.00
(if pace is needed, please attach addendum): COPY FEE:
LA 11 a d 12, Block "D ", Wigwam Shores in the Town of Star Prairie, PAGES: 1
St. County, Wisconsin.
Recording Area
Name and Return Address
KP,I`?`, OGLAND
ATi`% ?'dEY AT LAW
P.O. BOX 359
HUDSON, WI 54016
038 - 1148- 50-100 & 038 -1148- 50-200
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this ( - ` day of April 2004
* * ee tndahl
* * oyce E. Amdahl
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Burge O. Amdahl and Joyce E. Amdahl, STATE OF _ _ )
husband and wife ) ss.
`w County )
authenticated this 1,4 y of April 2004
Personally came before me this _ _ day of
the above named
* Kristin& 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 Kristin Ogland
Hudson, WI 54016 Notary Public, State of
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. Infomation Professionals Co.. Fond du L,F wl
STATE BAR OF WISCONSIN 800-655'.
WARRANTY DEED FORM No. 2 -1999
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This instrument drafted by
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1.. R. 18 W.
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