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HomeMy WebLinkAbout040-1284-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399595 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: Miller, Sam I Troy Township 040 - 1284 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION I BS " HI FS ELEV. Septic Benchmark r Ly �cS 2. o .3 o k-ls av Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/1-It outlet �, 2 QS of TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ti 3s Z $ -� Dt Bottom Dosing ( Header /Man. 'Y 35- t L Aeration Dist. Pipe Q •��� . 9 ,(30 Holding Bot. System cl' S ri 92 . 90' PUMP /SIPHON INFORMATION Final Grade 97 r Manufacturer Demand St Cover � `�'' 9 l • 0� GPM Model 14tier TDH Lift riction Loss System Head TD Ft Forcemain Length IDist. to Well SOI PTION SYSTEM S /TRENC idth I Length i No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 13•�S 2. SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEACHING ' Manufactu r:� INFORMATION CHAMBER OR % o 9r Type Of S stem: r• e r UNIT Mod NNuBber. , DISTRIBUTION SYSTEM up-sf VlL Header /Mifold If Distribution x Hole Size ole Spacing Vent to Air Intake Pipe(s) „ 3d Length Dia Lengt 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 xx Mulched Bed/Tren er Center Bed/Trench Edges Topsoil Yes [0 No ® Yes :[*:No] COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: O �' / boa -- Inspection #2: Location: 541 Orchard Dr. Unknown l•(NE 1/4 NW 1/4 9 T28N R19W) The Orchard Lot 14 Q Parcel No: 09.28.19.1605 1.) Alt BM Description = S f i ^^°�`�' tftt,—' 2.) Bldg sewer length = 2$ it - amount of cover = > 3(, 10D l;lrcr-. Plan revision Required? ❑ Yes WNo PAA Use other side for additional information. - f Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) Al-l?. kj L 4cple - f Vt C , Z/ k' 1 7 it rvi -T_o L) a r, L r T I Ta � Q N'S hS ©o IFAb Safety and Buildings Division 201 W. WashhWwn Ave., P.O. Box 716 ' 2 M madimn. WI 53707 - 7162 Sift Address - consin 'g-q I r tment of Commerce S Permit Number Sanitary Permit Application Is &CCOg wilt Comm 8311. Wis. Adm. Code. pulood WOrMA6 provide 00 YOU 0 check if Revision be MW for pir; Privacy IAW, 915-040 In S1210 ruNumber I.D. A.M Number f 0A L ApPediM 109---, Print AN Infennadan - 7 pared Number P owmes Nuts dqo ff f li ft?._._ PMPUW Location property owmes MWft Address /V E- 'ANOIA; S TZF N,RI El X '41 �e— Number Lot Number Block Number Zip Code Phom C0. sum Subdivision Nam CSM Numbe , —Lf 0 � L- - 7 E 00ty IL Type o f B (duet A dkd SPPIY) L'T ,k1 or 2 Pan* Dwell ft - Number Of DI 0 N m s Doscrft Use cute Road 0 > applicable) Hot B it UL Type of PWML (Cif C* Wt bas OR line A (num tree JXN 2 0 R System 3 0 RcPWXMM Of Addition to seem sw Tank OnIv B. ❑ Check it Permit pfcvim* Issued Permit Number (3 _ Z F IV. T of Permit: Permit: ((beck an dot apply)(ambWing scheme is for Internal Internal me) - 's t—v 1-7, F;O 44 Non _p resaur i se d I 210 Mond ft" 510 Drip Lim 47 0 Sand Filter 50 0 Constructed Wetland q_ P 49 0 Single IV 22 [03 Preaurized IsAkound 41 HOW04 Tank M 4 o A 46 0 Aerobic Treatment Unit 49 0 Recirculating 30 0 Other 0 V. Area Percolation Rate stem Elevation Final Grade ;a — rsal Am Dispersal Area Sod Application Elevation Design Flow (gA NW R&te(Gals-/Days/Sq-Ft-) (Mm./Inch) Proposed ✓ Roqiited 9,0 MamActurer Prefab site Steel Fiber Plastic zg Number VI. Tuk info Cip �y in Total Concrete Constructed Glass Galims 'GAUM Of Muda New RIM" _Laiji T TW* ZZ ity for inA& o f the POWTS shown on W attached plans. Itsponsil i Business Pbone VII. RapondbRity Statement- L tht % - -L - --- Number Plumber's Signahze r N ��� ._._ , „ N * Plumber's Address (Street. C IY, St ate, cede) 140 r VIII. Me t tat use Only Sani tary Permit Fee (includes Groundwater Dam Issued Agent S (No Stamps) Approved 0 Disapproved Surcharge Fee) 19 . I 0 owner Given Initial Adverse , C� � I WO I Determination_ S 22 13L Candidans o f A essons for Disapproval W LA c ��� re e,_ c ....... .. ..... . . . . . .... . .......... . : '11 ...... . .. . ....... .. ..... t ie .. �5 ) for the ' Wer Wo dm SM Awes compkie pkai 100 it ':I 10111111 OWY Sy'v'% -6398 (R. 05 t F IVY Dy a - �2gy •ye).coo , r , 1 � 13 Y s 7aN v ba r° T ?Yf 1392 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than.8% x t1 inches in size. Pfau must County . St. Croix include, but not limited to: ver and horizontal reference point (BM}, direction and Parcel I .D . percent slope, scale or dimemsions, ng6arrow, and location and dishntce to nearest road. 040- 1039- 60 -000, ID#9.28.19.132 Please pr#rt all "info"N"P. By Date ar :; t �01 P®rsonal information you provide ma lx+ used for gior ses (Prniacy Law, s: X5.(14 (t) (m)). 4 .. Prey Owner `�., ioperty Location Miller, Sam z ti ;r vt Lot NE 1/4 NW 1/4 S 9 T 28 N R 19 W Property Owner's Mailing Address "� _ y (" N C' s �� # Bbdc # Subd. Name or CSt1N! P.O. Box 151 ' -` 14 Plat Of Miller's Orchard City Shakefp P Numby\�`'� _j City J VBage To NetRoad Hudson WI '1� r �2 Troy Orchard Drive & Bauer Road 1� New Construction Use: ✓0 Residential /Number of bedrooms 4 Code derived design flow rate 600 GPI) Replacement _j Public or commercial - Describe: Parent material Glacial outwash blood plain elevation, if applicable na General comments and recommendations: Recommend installing 2 trenches at 3' x 90.625', using 29 high capacity BioDiffuser infiltrator chambers at system elev. = 93.00 . Boring # J Boring Pit Ground Surface elev. 98.00 R Depth to limiting factor >133" in. Soil Application Rate Horizon Depth oninant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts *Eff#1 *Eff#2 1 0 -11 1Oyr3/2 none sl 2fsbk mvfr L� 2f 0.5 0.9 2 11 -18 1Oyr3/3 none sl 2fsb mvfr 1f 0.5 0.9 3 18 -24 7.5yr4/6 none Is Osg ml - 0.7 1.2 4 24-35 10yr516 none s Osg m gs - 0.7 1.2 5 35 -70 1Oyr5 /4 none s Osg ml gw - 0.7 1.2 6 70 - 133 1Oyr6/4 none s Osg m1 - - 0.7 1.2 01 Pit Ground Surface elev. 97.53 ft. Depth to limiting factor >127 in. Sal Application Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GPD/fe ff 1 0 -8 1Oyr3/2 none sl 2fsbk mvfr gs 2f 0.5 0.9 2 8 -14 1Oyr3/3 none sl 2fsbk mvfr cs 1f 0.5 0.9 3 14 -19 7.5yr4/6 none Is Osg ml cs - 0.7 1.2 4 19 -25 1Oyr4/6 none s Osg ml gs - 0.7 1.2 5 25-68 10yr5/6 none s Osg ml gw - 0.7 1.2 6 68 -127 1Oyr6 /4 non s Osg ml - - 0.7 1.2 Efffuerrt #1 = BOD? 30 < 220 mg1L and TSS >30 < mglL * E BOD -5.30 mg1L and TSS <-0 mglL CST Name (Plem Print) Sgnatu T Number James K. Thompson L_ 3602 Address A.C.E. Sal & Site Evaluations Date E uation Conducted Telephone Ncunbw 340 Paulson Lake Lane, Osceola4 WI 54020 4123101 715- 248 -7767 13PL property pwner Miller, Sam PSI ID # __040- 1039 - 60 - 000 ID #9.28.19.132 Page 2 of 3 F # 3 ] Boring _j Boring 0 Pit Ground Surface elev. 97.20 _ ft. Depth to limiting factor > 129" in. Sal Apples Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 *002 1 0 -12 1Oyr3/2 n one sl 2 mvfr gs 2f 0.5 0.9 2 12 -21 1 Oyr3/3 none sl 2fsbk mvfr cs 1 f 0.5 0.9 3 21 -26 7.5yr4/6 none Is Osg ml cs - 0.7 1.2 4 26 -34 1Oyr4/6 none s Osg ml gs - 0.7 1.2 5 34 -71 1Oyr5/6 non s Osg ml gw - 0.7, 6 71129 1Oyr6/4 none s Osg ml - - 0.7 1.2 SiS. • `( F J Boring 4 Bonng # 1I Pit Ground Surface elev. 96.70 ft. Depth to IimitirK,I factor >122 in. Sol A RBf Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP *Eff#1 *Et'f#2 1 0 -12 1Oyr3/2 none sl 2f mvf gs 2f 0.5 0.9 2 12 -17 1 Oyr3 /3 none sl 2fsbk mvfr cs 1 f 0.5 0.9 3 17 -20 7.5yr4/6 none Is Osg ml cs - 0.7 1.2 4 20 -27 1Oyr4 /6 none s Osg ml gs - 0.7 1.2 5 27-60 1Oyr5 /6 none s Osg ml gw - 0.7 1.2 6 60 -122 10yr6 /4 none s Osg ml - - 0.7 1.2 vY y go •`f 6 Boring # Boring Pit Ground Surface elev. 97.41 ft. Depth to limiting factor > 124" in. Soil App Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW *Eff#1 *Eff#2 1 0 - 10 1Oyr3/2 non sl 2fsbk mvfr gs 2f 0.5 0.9 2 10 -18 1Oyr3 /3 none sl 2fsbk mvfr cs 1f 0.5 0.9 3 18 -25 7.5yr4 /6 none Is Osg ml cs - 0.7 1.2 4 25 -31 10yr4/6 none s Osg ml gs - 0.7 1.2 5 31-63 1Oyr5/6 none s Osg ml gw - 0.7 1.2 6 63 -124 1Oyr6/4 none s Osg ml - - 0.7 1.2 S2.q z��• 9 z - * Effiverti #1= BOD 5> 30 < 220 molt. and TSS >30 < 150 molt. * Effluent #2 = BOD S mgi1. acrd TSS <,90 mg& The Department of Commerce is an equal opportunity service provider and employer. Kyou need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608264 -8777. 93' z cap " a ■ foil Ob�er'Vav�'o� ^ D c �o /o /Y,� e 6 i 5t-c. 9, 7. o Toy, 66. Cry i,t �., �.) t. �w 83 a y h'' �a ■ road 62 cri c.l, Mark': T oF-�8 "rebar: �55c4, med elCV: /00. 11. 6. 1 k6l1ty Pole. z 92. co' s o ' �. ma F� 13 9,Z Bi m o Diff user S Y 76 00 00 00 00 00 00 00 00 00 ot� 00 ot� 00 ot� oo Qo 00 00 O DD O� O Ol Ol DD OO 00 Chamber DO OD Height DD OD �r OO OD DO OO OO �� DO 00 OD �� O D Dl QO DD OD �0 00 �o 00 00 00 00 00 00 AH three BioDiffuser sizes can withstand H -10 loads when MIA With Pr'°Wy grelded Chamber 81 91ME1112aled soils. A MU* Height of giver is �q H�10 . The End View 4" i for H -20 loads. A of 1 B' of cover is 34" regyirqd for 14 20 loads• 4" Knockout I Universal End Cap Avcdlable sizes D imensions ' ; Ca ' Ca Length 76" 76 76" Width 34" 34" 34" Height 11" 14" 16" v Invert ; 6.5 9 11.3 10 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 392 S Number of Bedrooms Design Flow - Peak (gpd) G© o Estimated Flow - Average (gpd) t7o Septic Tank Capacity (gal) Soil Absorption Component Size (W) S PT z _-'re Type of Wastewater Dohiestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) S Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 F :: Maximurn 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 se and outlet filter shall be assessed at least once every 3 years by inspection. TIO outleffilte shall be cleaned as nec to`rm re 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 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 cif 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 mould 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 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. Th; s &_; /'ac e)­� , f-/ vs c- 7 - A Al Q W'I 9 6¢ O S o r T S ✓S'Q'v/\ �°se �i � �►Ka Do rld 1 ZZSD 3 f his - 3 Yom g (c Z -f L � -f I y Zo 3 ! ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION 0ORM owner/Buyer Mailing ` Address Property Address S ( C G (Verification required from Planning Department for new construction) " Nyips a�•1 t,y Parcel Identification Number city . t F&L DESM=ON � T N -R , Town of Property Location .9L '�•, _._._ '/,sec. - bdiviston T � _ D «.,(� � Lot # �• CertIlled Survey Map # �, 3 Ln , Volume Page # Warranty Deed # volume , . Page # _ — Spec house Ff yes O no Lot lines identifiable yes 0 no use and maintenanceof your septic system could result in its premature failu a licensed pumper. • Y to . What You Put into the system of pumping art the septic tank every three Years or sooner, if needed by can aiTeet the function of the septic tank as a treatment stage in the waste disposal system a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning Department 1 waatewaterdiapossl system masterplumber, journeyman plumber• restricted plumber or that a licensed pumper verifying tank is less than er isp of sludge. is in proper operating condition and/or (2) after inspection and pumping (if necessary), the ( ) the on -site septic 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 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 St. Croix County Zoning Office within 30 da of tbp thre ex p' 'o te. �( / 6( O- DATE NATURE F APPLICANT TION knowledge. e I we am are the l dwner(s) of �; I•(we) certifq that t statements on this form are true to the beat of my (out) g • ( ) (are) e y virtue of a warranty deed recorded in Register of Deeds Office. ~ DATE NA•PU RS OF 12PLICANT 1. •00040 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 STATE BAR OF WISCONSIN FORM 7 - 1998 632796 TRUSTEE'S DEED KATHLEEN H. WALSH RER DoCUMO Number VOL 1555 STG WI DANIEL S. SOLBERG AND KARLA J. SOLBERG RECEIVED FOR RECORD 11 -01 -2000 8:30 M TRUSTEES DEED as Trustee of EXEMPT 1 DA S. SOLBERC AND KARLA J. SOLBERG REVOCABLE CERT COPY FEE: - TRUST DATED APRIL 26, - COPY FEE: TRANSFER FEE: 2880.30 RECORDING FEE: 10.00 for a valuable consideration conve s without warranty to PAGES: 1 SAM E. HILLER, X SINGLE PERSON Recntkrv� a va Grantee. the following described real estate in ST. County. 1 ; Nawns and Return Adams State of Wisconsin: SAM HILLER I PART OF THE NW% OF THE NA AND THE S141C OF THE NWk AND THE `' P.O. BOX 151 HUDSON, WI 54016 NEIB OF THE NA AND THE NA OF THE NEIL AND THE NA OF THE SWIG OF SECTION 9, TOWNSHIP 28 NORTH, RANGE 19 WEST, TOWN I OF TROY, ST. CROIX COUNTY, WISCONSIN AND MORE PARTICULARLY:- DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF 040 - 1038 -60 040 - 1039 -60 -000 III SAID SECTION 9, THENCE S00 0 50 1 54 "E ALONG THE WEST LINE OF 040- 1039- 70 -nnn SAIDNA 2626.30 FEET TO THE WEST QUARTER CORNER OF SAID Paroel Identification Ntrnber(PIM SECTION 9; THENCE S00 "E ALONG THE WEST LINE SWIX OF SAID SECTION 9 150.31 FEET: THENCE S56 ° 24'38 "E 70.00 FEET: THENCE N59 ° 15 1 1:7 "E 850.85 FEET THENCE ON AN ARC OF A CURVE TO THE RIGHT 102.10 FEET AND WHOSE RADIUS IS 4'03.00 FEET AND CHORD BEARS N07 ° 32' • t " 30.5 'W 101.78 'FEET; THENCE N00 2l 49 E 569.05 FEET; THENCE S88 ° 45 1 38 "W 250.00 FEET; THENCE NO ° ' 4 "W • t tr 0 50 5 350.92FEET; THENCE 588 57 07 W 512.29 FEET; e THENCE t u N00 50 54 100.00 FEET; THENCE N88 ° 57'07 "E 250.31 FEET; THENCE NO3 ° 10'51 "E 202.31 FEET; THENCE N32 • t ,r • , t, 19 49 W 95.2 FEET; ° , 5 FE THENCE N r • � �� 02 24 54 E 136.96 FEET; THENCE 587 34 25'E 198.63 FEET; THENCE ° „ E SO1 54 3 W r 3 149.41 FEET; THENCE N ° r t. 89 46 50 E 148.76 FEET; THENCE S2 27 16 W 256.95 FEET; THENCE N88 °57'07 "E 1065.55 FEET; THENCE N89 ° 12'30 "E 325.61 FEET; THENCE SOO ° 47'30 "E 10.00 FEET; THENCE N89 ° 12'30 "E 554.46 FEET; THENCE NO1 ° 23'32 "E 587.22 FEET; THENCE N55 ° 31'03 "E 651.90 FEET; THENCE N38 ° 09'35 "W 413.25 FEET; THENCE S89 ° 31'02 "W 142.03 FEET TO THE NORTH QUARTER CORNER OF SAID SECTION 9; THENCE S89 ° 12'35 "W ALONG THE NORTH LINE OF THE NWlz OF SAID SECTION 9, 2666.45 FEET TO THE POINT OF BEGINNING, SAID PARCEL CONTAINS 96.52 ACRES AND IS SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. Dated this day of O CTOBER 2000 ' (SEAL) X a o . 7/ r u (SEAL) DANIEL S. SOLBER i KA J. SOLBERG Tom•• Tntswe AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, , ss. i Count. �P�sorylly came before me this day of authenticated this day of the above named TITLE. MEMBER STATE BAR OF WISCONSIN to (If no(• me known to be the person L who executed the foregoing authorized by 5706.06• Wis. Stets.) i sirument and acknowledge the e THIS INSTRUMENT WAS DRAFTED BY W O ' rary rouc HE YWOOD& CARI, S C 204 LOCUST STREET _ Sfnte g f Wiscons HUDSON, WI 54016 Nota Public. State of Wisconsin My commission Is permanent. (If not state expiration date: (S goatures may be authenticated or acknowledged. Both are not necessary) • tl,mp of penom ,4401ne in my c,pecity mute W typed or Printed below thew syn,wr,. ..... -.. STATE BAR OF WISCONSIN w.,contn L490 Blank Co. rent TRUSTEE'S DEED FORM No 7 - 1994 keiwa we Wa _t tu z n v \ �! ` P I z A 1 0 n a. s u 3.1UZ.1ON ZZ'Z99 ot lo '0q .. p z loll 0 p 0 1 < jZ11 k..;; r"V, J( z , z 0 10 1 � ! P o ll 't WL 0 3: . . . . . . s orib. 4 ,% "r) OY08 3dnlnj I b 8 ro V1 I -i o < g '4 1 CJO a 0 8 .91 99Z z 3.40.00,00N ........ I ................. - - - I - - - - - - - - - - — v N E-- o K � ID 4 � CO 0 .(K .00 I � ° �0' N .`� � Ir`f1\LI � I � v ( � 0 0 co .O . IL 1 ILI /i KC Ict I ;: I . I j(.1000 s f n V1 01 CQ E- 11.9 ki -q co C\1 0 11 KK s k 0 z 01 (x fit