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Cl) z a �U) z �� a �cn a 0dt a L: IL • C d .V d rr `�Iv c c E 3 _1 A tiara !Oai0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � ,49-8 125 ad� Mailing Address aJ� U �-' / -�/ l/ . 7=� lC �•(�� S ���o Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION (211 �0 n 61 Locatio S V4 S '/. Sec T J N -RAWw Property .S�_., Subdivision _ / v . Lot # Certified Survey Map # , Volume . .Page # Warranty Deed # Volume , 1 �� . Page # Spec house ❑ yes Q no Lot lines identifiable Ef yes ❑ no SYSTEM MAINTENANCE 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 a 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal 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 of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. 2AL0,11ta ) rUL 6Y/Zs SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. �n AP &40 2 0 y � sl U SIGNATURE OF APPLICANT 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 of the certified survey map if reference is made in the warranty deed Parcel #: 006 - 1013 -10 -000 04/25/2005 02:50 PM PAGE 1 OF 1 Alt. Parcel #: 6.31.16.96B 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner " CURTIS W & BARBARA A OLSON OLSON, CURTIS W & BARBARA A 2302 HWY 46 DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 2302 HWY 46 SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 1.910 Plat: N/A -NOT AVAILABLE SEC 6 T31 N R1 6W BEG AT SE COR OF SEC 6, Block/Condo Bldg: TH N 22 RDS TH W 20 RDS TH S 22 RDS, TH E 20 RDS TO POB EXC P96G AS IN 652/173 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 06 -31 N-1 6W Notes: Parcel History: Date Doc # Vol /Page Type 11/10/1999 613627 1469/550 WD 07/23/1997 1040/170 WD 07/23/1997 806/506 07/23/1997 7111381 more... 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 52507 110,700 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.910 15,000 97,600 112,600 NO Totals for 2004: General Property 1.910 15,000 97,600 112,600 Woodland 0.000 0 0 Totals for 2003: General Property 1.910 10,000 81,900 91,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I ST. CROIX COUNTY ZONING DEPARTME,���N,r�aZ AS BUILT SANITARY REPORT AiNnoo 4 MHO iS Owner f z e, z e 9 i7 _ 41 Property Addr ss Q/19 City /State Legal Description: 01 Lot Block Subdivision/CSM # 5ec�,G TN -Rg!!�W, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Zzltu e 4 Size ST/PC6 / Setback from: House�� Well, � P/L,� I Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: l9 Width �_ Length _ Number of Trenc�es Setback from: House � Well 6h P/L Vent to fresh air intake ELEVATIONS Description of benchmark Elevation AO- j Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet - vZ PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System () g () ( ) Final Grade ( ) ! () ( ) Date of installation / ermit num er State plan number Plumber's signature License number 1, P 0 3 O� ? 7 Date Inspector Complete plot plan � 1 i 4 I NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW I Zv i' N Cn � I INDICATE NORTH ARROW I Safet and Buildings Division of Commerce PRIVATE SEWAGE SYSTEM $T. CROIX Safety nd Buildings D Coun INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanit a3p2P4"'Fo.: Personal information you provice may be used for secondary purposes [Privacy §aw, s.15.04 (1)(m)). Permit Per N , N�r E L9&% ] Village [I Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM�Des s cr ii iption: Parce — () TANK INFORMATION ELEVATION DATA A9 TYPE_ MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ��c� /�0� Ben mr Dosing Aeration Bldg. Sewer /00.00 Holding St /Ht Inlet /oo.00 S• `'Tq TANK SETBACK INFORMATION St/ Ht Outlet /oo T P/ L WELL BLDG. vent to ROAD Dt Inlet Air Intake Se -r fib' 3 / �U �+' NA Dt Bottom Dosing - Header / Man. Aeration NA Dist. Pipe -? 7, F� � z 9a� Holding Bot. System $.IV °// r PUMP/ SIPHON INFORMATION Final Grade 4 7$ Manufacturer / ,olnand , 964.)._ Model Number GPM TDH Lift Fri on System TDH Ft m ead Forcemain Leng Di Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length c ! - r No.Of Trenches PIT No. Of Pits Inside Dia. Liquid De h DIM N I N 18 -=`� DIMENSION SETBACK SYSTEM TO P/ L BLDG I WELL LAKE /STREAM LEACHIN manuf acturer: INFORMATION TypeO r _ C HAMBE Moe Number: System ""-' tq0 S 7 i" (ps -' OR UNIT _. DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length �Z Dia. n Length � Dia. `f �� Spacing L �7 Z? y 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 /Trench Center Bed /Trench Edges I Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CYLON 6.31.16.96B,SE,SE 2302 HIGHWAY 46 ve v A eft '; e l eVO4_7 'rrt — W1 he'r Gcs� ih��x_�. -t-ri� � GXiS{;`� ►�rUa ct,�.�aw��n,c.� P (h h J Plan revision required? ❑ Yes dNo 4 �9 Use other side for additional information. vv SBD -6710 (R.3197) Date Inspect 's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: o WG� I a� i i I Al f Safety and Buildings Division • SANITARY PERMIT APPLICATION 2 1 Washington Avenue Visoonsin Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Box Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County 1 �. than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitaarry p irpr&io Number Personal information you provide may be used for secondary purposes p Check if revls "ion aa Mication (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Nam / P perty Location !C 7��Spr! /4 1/4,S T,3 , N, R ,, E (or Property Owner's Mail ng Address Lot Number Block Number e15 � City tate Zip Code Phone Numb r Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned it ` Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Ei Ei Town OF III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) /�- �l�"' -0 � 1 ❑ Apartment/ .Condo 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2 Weplacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________System _____________ Tank Only______________ Existing System ________ Existing ----- System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Oseepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 11 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation jo "� 6 6� Ba , O? _ Feet l Feet Ca acit VII. TANK in allo Total # of Prefab. Site Fiber- Exper. INFORMATION New Exist in Gallons Tanks Manufacturer's Name Concrete st con- steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank e 5 9 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ LEI 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum ' ignature: (No targps r P /MPRSW No.: Business Phone Number: 466i -0/7 � � Plum r'sA dress(Street City, State,Zi ode): IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing Agent Signature (No Stamps) 0 1 Approved ❑ Owner Given Initial `� surcharge Fee) Adverse Dete rmination � , X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber , INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained, The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8.1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. NLU I PLAN PROTECT 4,p,/e- ADDRESS j P"r-,0P4 , r&1,AC 1 1 -5 IX � 1/4/S 6 /T N/R W TOWN J �� / o ^ C „ UNTY �5'f Gr`orX MPRS Byron Bird Jr. 3318 DATE BEDROOM CLASS PER ��'. C,.� CONVEN IONALSS IN -G OUND PRESSURE CONVENTIONAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE , /m�-� LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE ..— BED SIZE o Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. C! Borehole Q Well Scale = Feet O Perc Hole System Elevation S' Uent 12" TYPAR COVERING 2 " 12" 3' 4 6' O 3' 3' O 3' 6 „ Sewer Rock 1 8' 12' IIi� I � p I ► I ../ 0- - , hZ r l �,, vc�a Wiscon §in Department of Commerce SOIL AND SITE EVALUATION Division of-Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach c County c 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 ^ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 0 0 l r� 3 -`c7 - acyo APPLICANT INFORMATION - Please print all information. Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 4 - Property Owner Property Location �^ le �� Govt. Loth �/4�� 1/4,S T N,R �� E (or� E' l S ©/� Property Owner's Mailing Address Lot # Block# I Subd. Name or CSM# Ci State Zip Code Phone Number City El Village Town Nearest Road � � ❑ u - /I � ©Ol ( /�, >) -53�� Ca ❑ New Construction Use: C5�Pesidential / Number of bedrooms Addition to existing building IX Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate 5 bed, gpd /fi . o trench, gpd /ft Absorption area required _ ?eV bed, ft 2 ��Ff - trench, ft Maximum design loading rate bed, d /ft g g �, .� gp _ trench, gpd/ft Recommended infiltration surface elevation(s) �� , ft (as referred to site plan benchmark) Additional design /site considerations Parent material 6' - r ' I �A! Q%_ f Ls,, C( 5 "7 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system o-S El [As El Os El Lg S El ❑ S LX U ❑ S Q� SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench s G Ground O a elev. �ft , Depth to limiting fa 71n. 0?.5� Remarks: Boring # / a '3 0 3 Ground "1 ej ft 7 . 1 &;t to limiting fa to 7 in. Remarks: CST Name ( ase Print) ature Telephone No. f . /- �6l Address Date CST Number i SOIL DESCRIPTION REPORT PROPERTY OWNER Z,, (` �- � Page of T PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence hB:oun Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench !1 �l fig -e_. /y'� 1'► �� ''� • Ground _l ffJ _J elev. loe ft. Depth to limiting factor ' S Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) Soil Test Plot Plan Project Name / e . Byron Bird Jr. Address \ Lot Subdivision — Date j�1 /4 /4S � T y N /R_Z W` Township Boring Q Well PL Property Line County 5 f� �� �,, x IL BNI or VRP Assume Elevation 100 ft System Elevation - *HRP �W. ��,,., �� p� ���, �25.-c- "/1 C v ray 1a/rt uek1K i1 y Scale 1/4" = 10 Ft. When Dimensions aren't stated • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHIP CERTIFICATION FORM Owner /Buyer f� Mailing Address Property Address (Verification required from Planning Department for new construction) City/State z G Parcel Identification Number 4;� dl DDU LE GAL DESCRIPTION / P / Property Location C ' ' -6 -I f L �� r p rty o ation� /4 /., Sec. , 'T N R� , Town o Subdivision , Lot # ` Certified Survey Map # , Volume , Page # 9 L /� Warranty Deed # �� , Volume l/ , Page # Z �; �7 Spec house ❑ yes�no Lot lines identifiabiyes ❑ no SYSTEM MAINTENANCE 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 a 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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 of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SXNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of m our knowledge. I we am are the owners of ( ) Y Y( ) g ( ) (are) O the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIC'NAT THE F APPLICANT 6ATE * * * * ** 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 . VO 10401 RECORDIMO DATA DOCUMENT NO. WARRAMY DEF'D THIS S /ACE PEEERVED /OR I� i,STATE BAR OF WISCONSIN 1rbl4.l[ 2- 198s'� II fl j! rJQ6934 ► — ..- ... t 713nna M. Peterson f /k /a Donna M. Suitb Ftea'd fix Row ......... ..................... •--- .. ............ — — — _ -------- . OCT 81993 - -..... __ _ -- ..._ - - - -- --- -------- - - - - -- --------- - - - - -- 8:30 A. to L le Thomas Peterson i� conveys and Wsrranta to ....Y ......... .. .. ..............•------------- a�-- •--- ....__..... .,,,.•n..�` ���.. •.. secxy.. A.�...pet xs.QU.�...hu hazhd_- and --- V1fe,..as— ---------- ---- r +! sury vQrsh_ip_..(4a.# �S�l.� _.DrS?p�tl< Y--- _ - - - - -- -- -- �tt�.trx..� orcca ..... . .. ... ..............._._....... - - - - -- ...... - -.................. it --- - - - - -- - -- --------------- -•• - -- II .. .... .... .. ............_.... _.__ __...•__.___.____. _..__._. _._.___.__._.____.. _._. __._ _._-.......... -... RETURN TO ....... INIF ST AMERICAN BANK WI.SCA^NSIN • j' _Bo 107 104 y h - -- l the following described real estate in ------ .-- St.e ... G- ro- S-Z- - - - -. -- -...County. state of Wisconsin: 006 1013 10 Tax Parcel No:...._...-... I The South 28 rods of Bast 28 rods o f the Southeast Quarter of Southeast Quarter (SE 1/4 SE 1/4),` Section 6 Township 31 North, lm; a Parcel described Range 16 West BXCFPT the following paw ( volume "355 ", in Volume 0 354 ", page 629; (b) Parcel described in page 187; (c) Parcel described in Wailume "370 ", Page 89 and (d) w Parcel described in Volume "652", page 1 all TOGETHER with a rights and subject to all obligations of a Well Easement dated September 30, 1960 and recorded in Volume 0 372 0 , page 152„ Document e 263398, all recordings being in the Office of the Register of Deeds for St. Croix County, Wisconsin. 'j EM { I This ...... 8 ....... homestead property. (is not) ' ; , Exception to Warranties: Subject to municipal and zoning ordinances and I recorded easements and restrictions of record, if any. Ii � Dated this .- - - - --- -- - .... day of October l9. 93 . it ii .. -. � a (SEAL) (SEAL _- .. (SEAL, . - - -•- . ---- ••---- •--- . - - • -• . Donna F. Peterson -- f - Donna !. Smith (SEAL) _ .(SEAL) ` ... _ - ... AUTSENTICATION ACKNOWLEDGMENT -•------• ...............••-- -- •••--.._...._- ••----- -•--...— STNS OF WISCONSIN Signature(a) i ss. ........................................... ----•-- -- ---- - -- --- PK3L ` . County. ! authenticated this .__ ----- day of_--- •_ __ ____ __ ___ ___ _ __ __ 19 ------ Personally came before me this ........... day of u j � _ O!ctober . .. ....... .. ... ... 19..93- the above named ......... •--•--•...._...-•-•--•-•--------------•-----------•-•-•-•-----•---- Donna F .__• Peterson f jk f a - Donna - --• -------------- i ----••----••--....---•-----•--------•-•------ ••------ •-- ••- •---- •• - - - -- .. ..... . ....... .. . mth •... - -- 11 TITLE: MEMBER STATE BAR OF WISCONSIN __ _-_•-•-_--.__._.__••_..-__.___ „•------------------ ----- - - -• -- -- -- �� (If not, ---•--•------ ---- --- - -- °._. - _.... authorized by 708.06, Wie 3tata) to 2we known to 0 the peisdii --- who who executed the 11 !wing Zirmtr-im t and acknowledge the same. THIS INSTRUMENT WAS DRAFTED aY Daniel M. Byrnes of CWAYNA & BYRNES -- ` - - - -- -• - -- i: P ._- 0 BOX 179 , Amer , W_i Commission is permanent If not, state e a is. --- ------•-�---- --- --------- ----•-- --• ---- -vagary Public _.. _ _ Conntp, Wis. (Signatures may be authenticated or acknowledged. Both � (- ( / f are not necessary.) lase; - II I !Z 2 -- 19. /..ir..) *Names of persons sisnins in any capacity ahoulil be typed or printed kelo tl.;r u ;natures. Wisconsin legal Blank Co Inc. - WARRANTY DEED STATIC BAs OeT WZMD[yNSIN Milwaukee. Wisconsin FORM IN- 2 — Iw a