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HomeMy WebLinkAbout040-1284-70-000 De ldingernof PRIVATE SEWAGE SYSTEM County: ety aitd Build °i`nsi°n INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) nrtary Permit No.. Personal information you provice may be used for seoondary purposes [Privacy Law. s.15.04 (1)(m)). 38 4264 Permit Holder's Name: ❑ City ❑ Vi la Town of: State Plan 10 No.: Mi ler, Sam Hudson Township CST BM Elev.: Insp. BM Elev.: BM Oescription: Parcel Tax No.: . o I IM-0 0 % 040 - 1284 -70 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic kA,_S-</- Benchmark , Z JC Los -b Dosing At. BM 2--22 far-. Aeration Bldg. Sewer to . I au . Z8 t Holding St /Ht Inlet -+'L Q4.5 - 3' TANK SETBACK INFORMATION St/ Ht outlet 94• Z3 TANKTO P/L WELL BLDG. Airi to ntake ROAD Dt Inlet Air I Septic 29 I 3 (/ NA Ot Bottom Dosing NA Header /Man. tZ. ID I f • 19 Aeration NA moist. -R+pe fZ.o1. gs-.1b Holding Bot. System 2S q 9M PUMP / SIPHON INFORMATION Final Grade . SO 8. 76- ' Manufacturer Demand t Cover 2..Io )as 1! Model N ber GPM TDH Lift Friction System TDH Ft Loss [ Forc ' n I Length Dia. Fi Dist. To We SOIL ABS PTION SYSTE c t 2- Z z Width r Length ,, 11 N f Trenches PIT No. Of Pits Inside ia. Liquid Depth D IMENSIONS 3 `�;• �+! [MEN 1 N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING t � Manu u SETBACK CHAMBER INFORMATION Type O M e Num :: r System: .,J'. S� r OR UNIT - DISTRIBUTION SYSTEM I -�- Header / Mani old rr Distributio ipe(s) x Hole Size x Hole Spacing Vent To Air Intake r Length \� a Oia. I � 5 Oia. pacing 3 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ep e O P De th Over O th v r xx De th Of xx Seeded /Sodded xx Mulched p Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, iml3ection #1: I 1 C f Inspection #2: --- — Location: 487 Bauer Road, Hudson, WI 54016 (NE 1/4 NW 1/4 9 T28N R19W) - 0928191611 The Orchard -Lot 17 1.) Alt BM Description = 64-t " 5 11 n sr 2.) Bldg sewer length = 3 t - amount of cover = }'�2. ", 3) _�b k --h 6'g'l4q-. Plan revision required? ❑ Yes No l se Cher side for additio I infor ation. �D D d UD l) M� �� tS Cert No 10 (R 7 e �e I,�_-�,�, • Inspector i Signature U S Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Nvil Madison, WI 53707 - 7162 ite Address Department of Commerce Sanitary Permit A 'cation Sanitary Permit N ber 3z� q In accord with Comm 83.21, Wis. Adm. anal info on you provide ❑ Check if Revision may be used for seco E Law, s15. 1)(m I. Application Information - Please P rmatio State Plan I.D. Number Property 1 Number Owner's Name --., r Dui, 2 . 8 ` - 43 a Property Owner's Mailing Address - S7 Property Location c ` AOIX -A � -A; S 7 V' ' To V N, R � E ,- City, State ` Zip Code Phone Number Lot Number Block Number � Subdivision Name CSM Number H. Type of Building (check all that apply) ❑City �1 or 2 Family Dwelling - Number of Bedrooms ❑Village �/� J ❑�I'ublic /Commercial - Describe Use ownship t �.-v ❑ State Owned Nearest Road Lz) 3 �x 9 3. �S - -{ rr,..� t,�n cr2QQ A U C (L- R 0 4j) . III. Type of Permit: (Check only one box on line A (numbering scheme for internal use) Complete p line B if applicable) A �/ For County use Oq , a 6 . 1 � to / 1 t,�iew 2 El Replacement System 3 ❑ Replacement of 6 ❑Addition to � b � � o� g � " ,? stem Tank Only Exist sum 0 -0 D 0 B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ? _ T3 (0DiR'VS . .(5CD l'�7 r ,& 44 Non - Pressurized In- GrounAFAC*111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip LineQ `TREW 04 S Y ,X 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other J 000/1 1 d CIZ I r i+ • /'^ V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./ Days /Sq.Ft.) (Min./Imh) Elevation r !S � -'- -:�3 1 1 A_7) ?e-1 TV J VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Y /010 A /L VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number or M- (� 1 ) r z-- Plumber's Address (Street, City, State, Zip Code) ii 7 p �b (© b f 4 v .t ILO ld' D 1 u LSD � VIII. county /De artment Use Only S ) su A Si Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent gna to o tamp Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Z� , �Ojl Determination LA � e IX� Conditions ns of ApProvaUReasolfor DilS pro al .!16W •5�^'rr" 1; S ' ry 5 Ak— 111 - l l5 complete plans (to the C for a cyst � �1��� dze 00 ivy s S SBD -639 (R. 05101) SWAX ( L /t op'"2 p ZdT# / 7 a L-t /Y1; TD,4 0� j3 -q - 46 1 a �- 3 _ d-S �,11�1 • T �r V 3� $ 3s' I N ov s� } � °WELL y M � V 4 t � E t 5AM M I L I- E/t oeCc H� 2 p �Co? / c 7 l ScQ M.. /0 , 4 L't_ :Y,g f oo- Novs� 4044,4 4e-- �'��Xr� ism °. Zyx3y� r � n^ V \ V 1395 Wisconsin Department of Commerce SOIL EVALUATION REPORT pap I of 3 Division of Safety and Buildings in accordance with Comm 86, Wis. Adm. Code A.C.E. Soil & Site Evaluations Mach complete site plan on paper not lewfti.N �vil, indhesin size. Planmust County St. Croix include, but not limited to: vertical and h6izi6iltal referencep mijow d= and - percent slope, scale or dimernsiowliorth wow, and location and diswj�e nearest mad. P arcel I. D. 040-1039-60-000, IN9.28.19,1132 Please M int all ln*r on. Date Personal Information you mWe in be used Lin, , By 15.04 (1) (m)). &a= Property Owner Property Location Miller, Sam , Govt. Lot ---NE 1/4 NW 1/4 S 9 T 28 N R 19 W —4 1 Property Owner's Mailing Addlresst Lot Li�Bloc k # Subd. Name or CS;M# P.O. Box 151 17 Plat Of Miller's Orchard 1 City State t C ode Nuoakj _j V City Wage Town je Nearest Road I Hudson wl j .; (71, WV69 Troy Bauer Road New Construction Use- 0 Residentiail / Number of bedrooms 4 Code derived design flow rate 600 GPD J Public or commerctal - Describe. Parent material Glacial outwash Flood plain elevation, if applicable — na General comments and recomirrienclations: Recommend installing 2 trenches at 3'x 90.625', using 29 high capacity B!oDffuser infiltrator chambers at system elev. = 94.00'. Boring # _j Boring 0M Pit Ground Surface elev. 98.93 ft. Depth to limiting factor > 1 24" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ff#1 QPDW *E *E 1 0-14 1 Oyr3/2 none sl 2%bk mvfr as 2f 0.5 0.9 2 14-21 1 Oyr3/4 none sill 2msbk mfr gs 1f 0.5 0.8 'm 0.5 0.5 3 21-32 1 Oyr5/4 none sl 2msbk mvfr as 1f 0.5 0.9 4 32-48 1 Oyr5/4 none Is I msbk mvfr CS 0.7 1.2 5 48-63 1 Oyr5/4 none s Osg ml gs 0.7 1.2 6 63-124 1 Oyr6/4 none s Osg m1 0.7 1.2 So " # I Boring e Pit Ground Surface elev. 98.90 ft. D to li f ac t or >127" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD/r -Eff*1 -E 1 0-10 1 Oyr3/2 none sl 2fsbk mvfr as 2f 0.5 0.9 2 10-19 1 Oyr3/4 none gr. sl 2msbk mfr gs if 0.5 0.9 3 19-27 1 Oyr4/6 none Is 2msbk mvfr as 1f 0.7 1.2 4 27-69 1 Oyr5/4 none S Osg ml CIS 0.7 1.2 5 59-127 1 Oyr6/4 none s Osg ml gs 0.7 1.2 Effluent #1= BOD ? 30 < 220 mg/L and TSS > <-i 5 mg(L Equeo #2 = BOD, mg/L and TSS <A mg/L CST Name (Please Print) Sig CST Number James K. Thompson dl �� a" 3602 Address ACE Soil & Site Evaluations Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 0 4/23/01 715-248-7767 �39s property Ownsr Miller, Sam Pancel ID # 040- 10 39 -60 -000, ID #9.28.19.132 Page 2 of 3 F # Boring - - 11j Pit Ground Surface elev 96.37 ft. Depth t0 limiting factor > 125" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 'Eff#2 1 0-8 1 none sl 2fsbk mvfr as 2f 0.5 0.9 2 8 -18 1 Oyr3/3 none sd 2fsbk mfr gs 1 f 0.5 0.8 3 18 -25 1 Oyr4 16 none gr. sl 2msbk mfr as 1 f 0.5 0.9 4 25-63 1Oyr5/4 none Is Osg ml cs - 0.7 1. 5 63 - 1Oyr5/4 none s Osg ml gs - 0.7 1.2 28 6 81 -125 1Oyr614 _ none s Osg t - - 0.7 1.2 4 ] Boring # F Boring ✓_j Pit Ground Surface elev. 93.63 R Depth to limiting factor > 122" in. Sod A Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -13 1Oyr3/2 none sl 2fsbk mvfr as 2f 0.5 0.9 2 13 -24 10yr3/3 none gr. sl 2msbk mfr gs If 0.5 0.9 3 24 -34 7.5yr4/6 none is 2msbk mvfr as If 0.7 1.2 4 34-60 1Oyr5/4 none s Osg ml Cs - 0.7 1.2 5 60 -122 10yr6 /4 n one s Osg ml gs - 0. 7 1.2 51 Boring # 0 Boring Pit Ground Surface elev. 94.26 ft. Depth to limiting favor > 120" in. Sea Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDr 'Eff#1 *Eff#2 1 0 -7 1Oyr3/2 none sl 2fsbk mvfr as 2f 0.5 0.9 2 7 -17 1Oyr3/3 none gr. sl 2msbk mfr gs if 0.5 0.9 3 17 -25 7.5yr4/6 none Is 2msbk mvfr as - 0.7 1.2 4 25-66 1Oyr5/4 none s Osg ml Cs - 0.7 1.2 5 66 -120 1Oyr6/4 none s Osg ml gs - 0.7 1. ` Effgaent #1= BOD s> 30 < 220 mglL and TSS >30 < 150 mg& * Effluent #2 = BOD <30 mglL and TSS < mglL The Deportment 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 deoarnnent at 608 -266 -3151 or TTY 608- 264 -8777. „• o A 99� J n � w o J V S9.o' Qi 97-0 96. 0, 0 54 S�� 9�0 "Cvn tau ZP oy ;k� i Bi oDiffuser •- • • I 76" 00 � o 00 00 00 00 00 00 00 �� D OD OO OD OO OD OO OD � DD DO Dl DO �� DO �� DO Chamber DD OO DO DO OD oo OO OO OD Height O OD OO OO DO OD OD 00 DO DO OD oo OD o �� oo D( 00 �� O DO �� DO OD OO O( O OD OD O OD 00 OO Old OO OO O All three ej #,' withstand H -10. oads Whan installed with property graded and compacted solls. A mini- Chamber Height mum of 12" of cover is required.for H- 10.load& The End View 14" High Capacity BioDiffuser is designed for H-20 toads. ;A minimom of 1,8" of cover is 3 '� I r 2. a «�r', 4" Knockout Universal End Cap r Avcdlable Sizes Chamb li ly Stan Length 76" 76" 76" Width 34" 34" 34" Height 11" 14" 16" 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 Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) � Soil Absorption Component Size (ft Type of Wastewater Dom tic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) I 5 2 -- a Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 T able 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 t k and outlet filter shall be assessed at least once every 3 years by inspection. The utlet fi r shall be cleaned as necessary to ensure proper operati The filter cartridge shou not be removed unless provisions are ma a 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 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 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 should 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 F 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 I f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Q �' .Y — 1S Property Address g / ate_ (Verification required from Planning Department for new co truction) City /State J �_0 t' J Parcel Identification Number LEG DESCRIPTION Property Location' /., NW i/•, Sec. ' T 48' N -R_!J� Town of leD division H A 2 D , Lot # 1 7 Certified Survey Map # Volume -- , Page # Warranty Deed # to 3 z-7 9 , Volume I ���� . Page # - 3 2 - -3 Spec house Ryes ❑ no Lot lines identifiable"%yes ❑ no SYSTEM M_AI1yMANCK 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 # 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, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 the Department of Commerce and the Department o f 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" the three year cxpi ti date. APPLICANT DATE rDWNER CERTIFICATION '4 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 pia desqi b��bove y virtue of a warranty deed recorded in Register of Deeds Office. zv S1 1 I 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 warrant deed of the certified s urve y ma y PY Y P if reference is made in Jq I STATE BAR OF WISCONSIN FORM 7 - 1998 TRUSTEE'S DEED 632796 WALSH Dotu mont VOL 1555PAGE KATHLEEN H. DEEDS �� ST. CROI OF WI DANIEL S. SOLBERG AND KARLA J. SOLBERG RECEIVED FOR RECORD 11 -01 -2000 8:30 AN TRUSTEES DEED r DANIEL S. SOLBERG AND KARLA J. SOLBERG REVOCATLEtee of EXEMPT I TRUST DATED APRIL 26, 2000 - CERT COPY FEE: COPY FEE: TRANSFER FEE: 2880.30 fora valuable consideration conveys without warranty to RECORDING FEE: (0.00 SAM E. MILLER, A SINGLE PERSON PAGES: 1 �� Hecatluy Area __: _: .. the following described real estate in X Grantee. -- - -- - - -- - - - - -' State of Wisconsin: County, 'Name and Return Address SAM MILLER PART O F ;THE NW-1 OF THE NWT AND THE SWk OF THE NWT AND THE 'i P.O. BOX 151 NFh OF THE NWT WT AND THE N OF THE NE AND THE NWh OF THE HUDSON, WI 54016 SWiy OF SECTION 9, TOWNSHIP 28 NORTH, RANCE 19 WEST, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN AND MORE PARTICULARLY,­-....,_ DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF 040 - 1038 -60 SAID SECTION 9, THENCE S00 0 50'54 "E ALONG THE WEST LINE OF 040 - 1039 -60 -000 SAIDNA 2626.30 FEET TO THE WEST QUARTER CORNER OF SAID 040- 1039 - 70 - ono P SECTION 9; THENCE S00 ° 45'32 "E ALONG THE WEST LINE SW1 OF arc�ldenhfxalxmNtxffierIPIN) SAID SECTION 9 150.31 FEET: THENCE S56 9 24 1 38 "E 70.00 FEET: THENCE N59 ° 15'17 "E 850.85 FEET THENCE ON AN ARC OF A CURVE TO THE RICHT 102.10 FEET AND WHOSE RADIUS IS 403.00 FEET AND CHORD BEARS N ° 32'30.5 "W 101.78 FEET; THENCE N00 ° 21'49 "E 569.05 FEET; THENCE S88 045'38"W 250.00 FEET; THENCE N00 °50'54 "W 350.92FEET; THENCE S88 0 57'07 "W 512.29 FEET; THENCE N00 ° 50'54" 100.00 FEET; THENCE N88 0 57'07 "E 250.31 FEET; THENCE NO3 ° 1O'51 "E 202.31 FEET; THENCE N32 ° 19'49 "W 95.25 FEET; THENCE NO2 0 24'54 "E 136.96 FEET; THENCE S87 ° 34'25 "E 198.63 FEET; THENCE S ° 54'33 "W 149.41 FEET; THENCE N89 0 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 S00 ° 47'30 "E 10.00 FEET; THENCE N89 ° 12'30 "E 554.46 FEET; THENCE N01023' THENCE N55 0 31'03 "E 651.90 FEET; THENCE N38 ° 09'35 "W 413.25 FEET; THENCE S89 "W 142.03 FEET TO THE NORTH QUARTER CORNER OF SAID SECTION 9; THENCE S89 ° 12'35 "W ALONG THE NORTH LINE OF THE NA 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. i Dated this day of O CTOBER 2000 o fv P.e-- S ( EAL) (SEAL) DANIEL S. SOLBER . KARLA J. SOLBERG Tnutee Tnatee AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. Count. authenticated this day of P n Ily came before me this day of ±, y the above named `. TITLE: MEMBER STATE BAR OF WISCONSIN (If no(, to me known to be the person � who executed the foregoing authorized by §706.06, Wis. $tats.) t strument and acknowledge the e THIS INSTRUMENT WAS DRAFTED BY H EYWOOD& . CARI j S Ofar 04 0 ttST STRFFT s mite of Wisconsin HUDSON, WI 54016 Notary Public. State of Wisconsin My commission Is permanent. (U n t state expiration date: I (Signatures may be authenticated or acknowledged. Both are not Tr ( � necessary) ) Namn of penor¢ aianln8 in an u t m,m be ' Y Pki Y Yf� or Pr1nuE below their ai8natun. T9USTEE'S DEED STATE BAR OF WISCONSIN WyC°nvn Legal Biani, Co.. ego FORM No 7 - 1998 Mdwswae. Wes. 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