HomeMy WebLinkAbout040-1222-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453302 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:
Beske, Brian Troy Township 040- 1222 -90 -000
CST Ele :
C; Elev: BM Description: ` Section/Town /Range /Map No:
&0 16.28.19.1087
TANK INF MA ION r ELEVATION DATA
TYPE MANUFACTUR CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
V iz oB.
1 2160Q
Dosing Alt. BM
Aeration Bldg. Sewer
9.38 ,
Holding St/Ht Inlet �0•ZS
St/Ht Outlet
TANK SETBACK INFORMATION 1 SZ
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic, > sO' 34 Dt Bottom
Dosing Header /Man. 10�`�2 1 q
Aeration Dist. Pipe ` �, .v ! t0l 9.0 elf
Holding Bot. System 1Z �/_ Z. • Z
"}( �I
Final Grade
PUMP/ IPHON INFORMATION kO OU- p
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift ric Loss System Head DH Ft
Forcemain L94gth ell
SOIL ABSORPTION SYSTEM (Z aAr to "
Width \ No. O Trenches PIT DIMENSIONS No. Of Pits Inside Dia. tLiquidDepth
DIMENSIONS 3 Vngth
O'rt�
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:, � /)
INFORMATION CHAMBER OR lx�iC►✓
Type Of S stem: • � UNIT
Model Number/
DISTRIBUTION SYSTEM Irca
Header /Manifold Q Distribution V x Hdre Size Ix Hole Spacing Vent to Air Intake
�,pp Pipe(s) ' 'SS'
Length ^L Dia Length Dia Spacing T
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over De' es To th Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed/Trench Ed soil
Edges p ❑ Yes H No U Yes ] No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: — i
Location: Unknown (SE 1/4�,,NE_ 1/4 16 T28N Ra9-W_).�Gllover Station Add III Lot 54 Parcel No: 16.28.19.1087
1.) Alt BM Description = W6-.-I 1% /rte"''•"_
2.) Bldg sewer length = 3 JJ
�. O; �''
- amount of cover
--
Plan revision Required? ] Yes No
Use other side for additional informatwn. • e I
Da a Insepctor's Signature Cart. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County r :
201 W. Washington Ave., P.O. Box 7162
SCQ�SI,� Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151 53 3O2
State Pla I.D. Number
Sanitary Permit Application
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy I awe s 15.04 1 m Project Address (if different than mailing address)
L. Application Information - Please Print All Information ' f Pb
fl-
JUN 2004
Parcel # Lot # Block #
Pro Owner's Name ,
Property Owner 's Mailing Address S , CROIX ,;UUI�i (` Property Location
Z01'v ^JG I ")rFi(_',E
_�- � /�, ,�,� %., Section
C __ j,�„__
City Zip C ode Phone Number t;
(circley�e)
T,2,$- N; R.ZILE OOP
I. Type of Building (check all that apply) . n
or 2 Family Dwelling - Number of _ „�_. � Subdivision NamO J _ � ❑ Public/Commercial - Describe Use -
❑ State Owned - Describe Use (Z) 3 t >< Fe— "Zrt� e�s ❑City_❑Village �Townshi of
III, Type of Permit: (Check only one box on line A. Complete line B if applicable).
A' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
List Previous Permit Number and Date Issued
B. E) Permit Permit Renewal ❑ Permit Revision Change of ❑ Permit Transfer to New
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that appl
Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter XLeachinICh.ber ❑ Drip Line ❑ Gravel -less Pi ❑ Other (explain
V. Dis crsaVrreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in s' Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units t,,rlg 1 — (dfl I \ Concrete Fpso'ucted Glass
Now Existing l / J
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, y#sume responsibility for installation of the POWTS shown on the attached plans.
Plum is ame (Print) Plum is Si t e MP/MPRS'Ntanbef. Business Phone Number
Plu tier's Address -(Street, City, State, Zip ode)
VIII. County /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater I Date Issued = gnature o Stamps)
Surcharge Fee)
❑ Owner Given Reason for Denial 2 � �- i fl ?(1D
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all 0 serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than $1R s 11 Incises In size-
SBD -6398 (R. 01/03)
La '
a
a
r 1
a
Co
/.t-ZlIs '
,� ,�,�,� .sue /� -,i/,� yy -s.�c /� � ��?8� �9r�
/ 8� l S %�tsr�t � ��6� / r l�rs
� sew �.� s-����
Sae ��/ 9a'
ba'
� S. /,�,�.;��5
� /� =�s��
_.�.-
� � /�1�h3� m�'r�
U7" ,D�,J.�,�,� �
�,r�a �
P ��: -�
��k
�� � �o- � i
�' ®uv,�
a
� /y� 1�� �/ �fi ��� � �� I
N /
� ��
� �rP
/D
�.
�/ q
r
`�� �/
� � 7 /
��� ���� �
��- S7 `
a
ti
��- �,��5
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor and Human Relations
DI;ision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Att&A ,complete site plan on paper not less than 81%2 x 11 inches in size. Plan must include, but • C 1 X
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION EWEDPY DATE
PROPERTY OWNER: PROPERTY LOCATION
0- M E D��1 - �FJ 1 S SC U L Z GOVT. LOT S N. 1/4 IJtZ 1/4,S /b T 2 - 8 .,N,R 19 E (oA
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
lO tV . I IF LQi, 3 S - 1 &Lbk')eR �'(f SDrw
3 �� �'r�At170N
CITY, STATE ZIP CODE PHONE NUMBER QCITY ❑VILLAGE MrOWN NEAREST ROAD
W 1 5 1 4o2.Z ( 44 ? 3 - 8J C 1 o`f S PO'CtFiC kp
[� New Construction Use [)q Residential / Number of bedrooms [ ] AdditiQn to e xisting building
] Replacement ( ] Public or commercial describe
Code derived daily flow 6'Z Q3 god Recommended design loading rate - bed, gpd/ft2 0, % trench, gpolft
Absorption area required 8Sb bed, ft "? S O trench, ft Maximum design loading rate o bed, gpd/ft 0 trench, gpdtft
Recommended infiltration surface elevation(s) SEE' 1v0h OAl 1 kS 3 ft (as referred to site plan benchmark)
Additional design/ site considerations R* Cg4 y kl-lb Z ") t�C-H S ' A - )S' L 6
Parent material sr GR u EL Flood plain elevation, if applicable N • A It
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE STEM IN FILL HOLDING TANK
U= Unsuitable for stem 0 S El ® S ❑ U 0S ❑ U M s 11 U Qd S ❑ U EIS W U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consisbencie Bw Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch
"� ti_1 lOK 3/ 3 - S\ - 2 `F Sbk Yn F� !-S Zv o•S 0.6
rn f"
Ground 3 3Z -qS - ).SYR vl(. - S , O S w� 1 cS - o•� O,$
elev.
q e ft. y
Depth to
limiting
facto .6
> 93"
Remarks:
Boring #
� v I o -1 v042 3/3 - S1 sbK VA cs 2ui o.S o.�Q �O
2 -'`' z ► 3 -Z I to -J Y!y — S j J 2'� s bk VA
3 Z) -37 tQJ ' fZ 3 /ro — S t I - 2 `F S J),Yj y4 J►, c S 1 •1 0, S o. t
Ground
elev. y 3) _V9 ") `i2 Y/b
% b .6 It
5 u/4' -9y 1o yl6 _ S o s9 brfI
Depth to
limiting o
facto
Remarks:
CS T Name--Please Print Arthur L. We erer Phone: 715- 425 -0165
egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
a�.
c)3 -y 11-49 -4 3 M00576
PROPERTYOWNER �`t� — g =Z SOIL DESCRIPTION REPORT Page? 01 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw&
3J3 sf`1 Z� sbk m`F� cS Z �f o•S o•6 tv
S 9 G�- CZ sg VA 1
Ground
elev.
to ft.
Depth to
limiting
factor
5 9 Z
Remarks:
Boring # -
< >:<; >;Y,: >::: zo'F o• 5 10 L
.�
o S CS — o•� i °'�
3 33 _ ft 1(3 4 R y / S U S g ,rn
Ground
elev.
� oL.7 ft.
i
Depth to
limiting
factor
Remarks:
Boring #
" \ 0 -6 �l�` 3 � 51 � Z.`F S1* w►�-ti, c Z�� �,S �•6 .�O
32 • s (Z �t /` S 9 m 1 c S - o.� •�
3 32 -9 Z vo' S O Sg �) — 0 �7 ' � • �3 • ?
Ground
elev.
lo . S ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. _
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
r
Page
P L OT PLAN 3 of 3
rA
w"
J
p
N
0 ; Z -
6b tRST
1
)►J �'r�R L 9' l��'1� T)2S:7uG�S � i i �, 5b
• P LOT PLAN Page 3 of 3
�G
z
w"
r
9
N
I
66'
I
� I
�N IT IN L d 1�� ` ►��?l TELl:`klG$ ! . I
rl
CIO
i L
POWTS OWNER'S MANUAL & MANAGEMENT PLAN, Pago —Z-01
FILE INFORMATION �>- SYSTEM SPECIFICATIONS
Owner Septio.Tank Capacity. �� :, ; . a l O NA 1
Permit # Ll 5330 Z Septic Tank. Manufacturer n f ci O NA
DESIGN PARAMETERS Effluent Filter Manufacturer C7 NA
Number of Bedrooms O NA Effluent Filter Model I le 0 G NA
Number of Public Facility Units 13-NA Pump Tank Capacity a l XNA
Estimated flow (average) al /da Pump Tank Manufacturer. D%A
Design flow (peak), (Estimated x 1.5) g al/da y Pump Manufacture r '1` r "` r -
Soil Application Ra al /da /ftz Pump Model Iz-NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit JM?-NA
Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter C] Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L 0 NA 0 Mechanical Aeration Ca Wetland
Total Suspended Solids (TSS) 5150 mg /L 0 Disinfection ` Q Other:
Pretreated Effluent Quality Monthly average Dispersal Call(s) O NA
Biochemical Oxygen Demand (BOD 530 mg /L *n- Ground (gravity) 0 In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L RNA O At -Grade O Mound
Fecal Coliform (geometric mean) 510 ofu /100ml O Drip -Line 0 Other;
Maximum Effluent Particle Size Y In dia. O NA Other: - 4 O NA
Other: 0 NA Other: , .., ., O NA
* Values typical for domestic wastewater and septic tank effluent. Other: Q NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
months N
Inspect condition of tank(s) At least once every: ear s a f ; (MaxiMym 3 Years) , O NA
Pump out contents of tank(s) When combined sludge and scum equals one- third .1Y tank volume O NA
Inspect dispersal cell(s) At least once every: D month(s)' (Maximum 3 years) O NA
earls)
Clean effluent filter At least once every:' month(s) , _.. O NA
ear(s)
Inspect pump, pump controls & alarm At least once every: monthls) ,ANA
0 year(s)
Flush laterals and pressure test At least once every: O monthls) ; r:: > t' Mr NA
O year(s)
Other: At least once every: O month(s) O 'NA
O year(s)
Other, O NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to Check for any ponding
of effluent on the ground surface. The ponding of effluent on the around surface may Indicate a failing condition and requires the
immediate notification of. the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance,. with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 1 O, days of completion . of any service event.
OMW (4 /01)
START UP AND OPERATION
PaQe� of
For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or o0or, chomicalz
that may Impede the treatment process and /or damage the dispersal collie), If high concentrations are detected hwrthe contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess, wastewater will bo
discharged to the dispersal cell(s) In one large dose, overloading the collie) and may result In-the backup or surface discharge of
effluent. To avoid this situation have the - contents of the pump tank removed by a Soptage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manuallj- rain , pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over,tanks and dispersal cells. Do not drive or park over, or otherwise/,disturb or compact, the aroz�
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers;'dielpfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicide; i, lyiest;Wap$;;1{7s oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.,
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed, .
• The contents of all tanks and pits shall be removed and properly disposed of. by aZoptaga<,Setvicing_Operstor.
• After pumping, all tanks and pits shall be excavated and removed or their covers romm,d .and.the;yoid space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a.codo compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the roplacement area will
result in the need for a now soil and site evaluation to establish a suitable replacement area,' Replacement systems must
comply with the rules in effect at that time.
0 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS. � .
O The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area.. If no replacement area is aveil#ble, + ,.ho iog tank
may be installed as a last resort to replace the failed POWTS,- _ .
O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAYANULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER, - , POWTS MAINTAINER
Name
Name ?r , r, , ,•,t
Phone _ Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone `y ��r , r,r:., ,r, u; �t•
This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(0 and 83.54(l), & (3), Wisconsin Adminiatrstive Code.
May 07 04 09:44a p.2
i
V0iu1r4VV4 14111:410 MA 1 rlo Z41 JuJtr DhUbLb U(;AVATINU t0001
. ST CROIX COUNTY
SEPTIC'TANK MAINTENANCE AGREEMENT,,.
AND _rr
OWNCRSHIP CERTIf•ICATION FORM
O vneri°Buyer
Maiiing Address tq
Proper Address s eo is
(VOfi(tc0liint rrytnfatt ifoht hlatTnntb DCpartrriCnL for new construction / )
�.;ity /$isle t Parcel ldc till lication Number
E GAL DESCRIPTION
I roperty Location �� t /., � !,; Svc. � 'I N -RR W, Town of _
3 166-d .yd jTZe'X-U Lot #.
Certified Survey Map # , Volume Page #
"Narranty Deed 4-2 -- , Volume 2 5T , page # � T39
Spec house d es no Lot lines identifiable Oyes Q no
SYSTEM MAINTENAN_C'a
Improper use and nlainicnanceclf your srt)lIV SYSIV M1 Mild RJL1it Ill 115 I)fCnIJ1Y(C failure t0 handle WasICS. Proper m +in[cnantil
coIt,isls Of pumpinb uut the scpti%� lank ovary Ihree yauts or souurr, il' neerletl by r licensed punipar. Wh ;-1 yuu put into the syStcul
Cass all ect dw function of (tic st:p11c tank us a troo►nrcni stage in the wuslc disposal system.
The property owner agrees to submit to S1. Croix Zoning Department a certification form, sigagd by the owner and by a
master plumber, journeyman plumber, rc5trtt:tetl plumber or a licensed pwnper verifying th (1) tho on -site wastewatertlisposa) system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic,iank is less thslti, I/3 fall of sludge,
iJ,:
I /wc, the un,it:rs+gned have rend the above requirements and agree to maintain the private sewage disposal system with the standards
set torih, ht:rcin, as set by the Department or Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained inust be completed and reiumcd to the St. Croix County Zoning Office within 30
days of tno thr year expiration da 7'
E OF APPLICANT '� DATE
OWNER CERTIFICATioir
I (we) certify that all slotemt:nis on tolls t'orm are true to flit best of my (our) knowltdge. I (we) am (ere) the owncgs) of
the props ribed above, b i c of a warranty deed recorded in Register of ooeds QfCtce,
�� APPLICAN DATE
�•'s•' Any inl'orn,ation that is tnts•representcd may result in the Sanitary permit being revoked by ilia Zoning Department. ••••••
" lnclude with this application: a stamped warranty deed from the Register of Deeds office
a copy of the ceniried swvey map if reference is made in the warranty deed
U 2581 P 539 76'3'942
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD
Document Number WARRANTY DEED 05/26/2004 02:10PH
THIS DEED, made between Thomas A. Stewart, unmarried, Grantor, WARRANTY DEED
and Brian Beske and Elizabeth Beske, as survivorship marital property, EXEMPT #
Grantee. REC FEE: 11.00
Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE t 357.00
described real estate in St. Croix County, State of Wisconsin (the COPY FEE:
CC FEE :.
"Property "): PAGES: 1
Lot 54, Glover Station Third Addition, Town of Troy, St. Croix, Wisconsin.
Recording Area
Name and Return Address:
Land Title, Inc.
1900 Silver Lake Road #200
New Brighton, MN 55112
3787
Together with all appurtenant rights, title and interests. 040 -1222- 90-000
Parcel Identification Number (PIN)
This is homestead property.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
I
Dated this 14th day of May, 2004.
* Thomas A. Stewart '
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF MINNESOTA )
RAMSEY COUNTY. ) ss.
authenticated this 14th day of May, 2004 Personally came before me this 14th day of May, 2004 the
above named Thomas A. Stewart, unmarried, to me known to be
* the person(s) who executed the foregoing instrument and
TITLE: MEMBER STATE BAR OF WISCONSIN acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Minnesota
My commission is permanent. (If not, state expiration date:
Gregory C. Booth CATHE
(Signatures may be authenticated or acknowledged. Both are not necessary.) NOTARY PUBLIC — MINNESOTA
*Names of persons signing in any capacity must be typed or printed below their signature Q1MV Comm. Expires Jan. 31, 2005
a
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000
May 07 04 09:44a p.1
'• i 1C�Y`� � , gy p '`'� �'� °cam r• �' �,
a w m i
/ / /' \ - Ln Q
LO ^ o
rp W
to
N r
m r \ \ �tp • ° c _
w ml
s Q
1 .a
O o N m
�• 0 0 H O
s � � OE.f► "GO 5
kL
L ) 9
a
N Q r 1 1
lo Cl)
m a) � Z N ^ lD Cu ' N w N V U G] _
I f .
1 U- ' z z
i
O N
Loo I o N Q co
Ln to
ui
gu
° I r
a
~W . � W c ) r
O
CA
i
M
r }�p'
y
$ 3.3 A.
517 Ac. w ' W. 097 S.
..
110,536
VO
4 }
„G
x a
z ' " r z a �� �'.� ✓ ``�`
h
Vs *, L ;