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HomeMy WebLinkAbout032-2114-20-000 ST. CROIX COUNTY ZONING DEPARTMENT ` AS BUILT SANITARY REPORT Owner ? - - Property Address City /State - j < : l , Legal Description: c ti ' f` Lot _, 2 Block Subdivision/CSM # s 1 /4,- 1 /a, Sec. -?, T3-? N -R, W, Town of SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORM N: Tank manufacturer " ` - <_ Size ST/PC Setback from: House L- Well P/L tZ: 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: Width 3_ Length 7s Number of Trenches Setback from: House_ Well 1 L P/L mil Vent to fresh air intake ELEVATIONS Description of benchmark Elevation e2 Description of alternate benchmark - S -) Elevation , 97j Building Sewer ST/HT Inlet - 2�24-. j ST Outlet 9/, 7, PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System () () ( ) Final Grade () () ( ) Date of installation / / P mit number State plan number Plumber's signatu a License number Date 1121eV Inspector Complete plot plan a 1 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 77 / $V 3 b 1 7-Ir INDICATE NORTH ARROW Wisconsin Department of Commerce C Division of Safety and Buildings SOIL AND SITE EV Page of Bureau of Integrated Services In accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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 1. D. # APPLICANT INFORMATION - Please print all information. =vie y Date Personal information you provide may be used for secondary purposes (Privacy�wt, s. 15.04 (1) (m)). 6 _4 Property Ow er Property Location — ovt. Lot IV J 114 J 1/4,S 3 T N,R 9 E (orO Property Owner's Mailing Address L6t # Block# Subd. Name or CSM# City Stat Zip Code. PhbheNumber City ❑ Village Town Nearest Road S" New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Descdb8: Code derived daily flow gpd Recommended design loading rate � 7 bed, gpd/ft gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate 7 bed, gpd/ft _trench, gpd/ft Recommended infiltration surface elevation(s) 69 c5�' ft (as referred to site plan benchmark) Additional design /site considerations I Parent material Flood plain elevation, if applicable ft r= U = Sui table for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank Unsuitable for system I ® S ❑ U as ❑ U C[ S ❑ U 0- s ❑ u ❑ S 9—U ❑ S 23 SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ile Ground elev. eft. Depth to limiting factor },(Win. Remarks: Boring # L 3 -s Ground [[yyelle�ev�. r Depth to limiting factor >- Remarks: CST Name (Please P int Signature Telephone No. . I vim. s = Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots 13 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground elev. ft. Depth to limiting factor in. Remarks: Boring # <_ M FS H 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 in. Remarks: SBD -8330 (R.9/98) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 353273 Permit Holder's Name: ❑ City ❑ Village ❑ TRwn of: State Plan ID No.: G Inc. Town of Somerset — CST BM Elev.; Insp. BM Elev.: BM Description: p Parcel Tax No.: �9 -C) V� u-i tti. ecK L 032- 2114 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 0 10(.30 160 0 Dosing Alt. BM 20 13-, 10 Aeration Bldg. Sewer 's Z. `& I Holding St /Ht Inlet C1,Z8 TANK SETBACK INFORMATION St/ Ht Outlet 9 S$ q/. - *Z ' TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet - -' Air Septic 5D �� 7 Z5' 1 3 NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP /IMPHON INFORMATION Final Grade Manufac r Demand St cover ZS Model Number GPM TDH Lift Fric ' �ea TDH Ft Force n Length Dia. Dist. To we SOIL ABSORPTION SYSTEM (j_2)� &I&/ t& Width Length ,t No enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS . r DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manuf ur SETBACK CHAMBER INFORMATION ypeO � S�f 30 c OR UNIT M _e , NCm Num S , System: DISTRIBUTION SYSTEM Header J Mani old C a Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. t n 3 b SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over I/ Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center TV f Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: o(p / 09 1 00 Inspection #2: - Location: 2328 53rd Street S merset' ` 54025 (NE 1/4 SW 1/4 T31N R19A) - 3.31.19.1050 1.) Alt BM Description 2.) Bldg sewer length= - amount of cover +�eeu� I � ► 26� ' Plan revision required? a Ye No k Use other side for additi ' ormatlon. D 31 SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ' r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' g e � € d � E r _ fl E g t t t i 4 d E � � 1 *I sconsiin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste , of' t ,arf less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this applic ti rf , ^r State Sanitary ermit Number Personal information you provide may be used for secondary purposes Check if revision to previous application p [Privacy Law, s. 15.04 (1) (m)]. L � State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL IhNIF R Property gwner Nam f Locatio[f,_ `. 1/4, 5 ' T , N, R E (or Property Owner's Mailing Address LotNumber Block Number p 1 y, St to Zip Codq Phone Number Subdivl on Name or CSM Number ( ) II. PE UPTUIL DING: (check one) ❑ State Owned : 40 it Nearest Road E] Village Public 1 or 2 Famil Dwellin - No. of bedrooms O f 111 . BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment /Condo �^�O 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. O New 2. ❑ Replacement 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 ;A Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 2- 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORM ATIO _ 1. Gallons Per Day 2. Absorp. Area 3. A . ea 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min./' ch) Elevation Feet Feet VII. TANK Capacity In gallons Total # of S Fiber- INFORMATION Gallons Tanks Manufacturer's Name C oncrete ete Con- Steel Plastic Aper. New Existin structed glass App. Tanks Tanks Septic Tank or Holding Tank ,� t _ y �/S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in all tion of tbliponsite sewage system shown on the attached plans. Plumbe , ame: ri t Plum is Si at o s) MP /MPRSW No.: Business Phone Number: ff A - r u ber's dress (Sree , It State, Zip Cod '0 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature ( o Stamps) QZApproved E] Owner Given Initial ^ Surcharge Fee) Adverse Determinatio �oZ-5 ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Pluarbe. . 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 r r! rr " in " . , Th i t nk m m Iicen - - -' h n& r 5. Onsite sewage system must be proper) ainta ed a se t c a (s) ust be u ed b a sed um er w e e e 9 Y P P Y P P P Y P P 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 Divisions , 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 td 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. �e 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 1.15 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for inumber of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. r.3.3� - lx'194t) 4 A ,ate i /3D 1 Wisconsirf Department of Commerce SOIL AND SITE EVALUATION Division `ofaTafety and Buildings Page I— of 3-- Bureau of Integrated Services in accordance wjth 9 7LHR 83 -.0.9, Wis. Adm. Code • f ', ;.. County Attach complete site plan on paper not less than S 1/2 x 11 inchedjn �6 Plan s4wt include, but not limited to: vertical and horizontal reference po ($1vf}, dire �Adr,9 . f St. Croix percent slope, scale or dimensions, north arrow, and location 4stance to•r5'e'*6i YD Parcel I.D. # P1 , APPLICANT INFORMATION - Please print all 49n ation R¢viewed b D Personal information you provide may be used for secondary purposes (Povariy,Law, s. 1 LII4i(1NTrr)). Property Owner t roperty Location," Richard Stout Govt: Lot N 1 SW 1/4,S 3 T N,R 19 E (orkW Property Owner's Mailing Address - .LOLiE $lock# Subd. Name or CSM# 1353 Awatukee Trail 2 Meadowoods City State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road Hudson Wi 15401 7151649-t731 Somerset 1232nd Ave New Construction Use: Residential / Number of bedrooms 4 Addition to existing building Replacement H Public or commercial - Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate 7 _ bed, gpd /f1 —$_– trench, gpd /ft Absorption area required 8 5 8 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd/ft • 8 trench, gpd /ft Recommended infiltration surface elevabon(s) qt ID I t p I an ft (as referred to site plan benchmark) 1 Additional design /site considerations �� Parent material 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 sysi 0S ❑ U S ❑ U ®s ❑ U I fI S ❑ U ❑ S f] U ❑ S FvZ U SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 1 -6 10 r4 3 sil 1 b m 2 -52 10yr4/6 -- ice ,Z S'b // mfi cs -- .4 ,.5 Ground 3 52 1 1 10yr4/4 Ins osg ml cs -- .7 .8 _ elev. 96 Depth to limiting factor 1 in. Remarks: Boring # 1 0-12 1 r 4 AWL? 2 2 2 -4 10 r4 6 -- ice 2 )"Srbl -( 3 10-9f 10yr4/4 IRS osg ml cs -- .7 .8 Ground elev. 9 3-6-aft. Depth to limiting factor 9 n. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER -hgrr7 Stnti Page - -3 A PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 1 0 -9 10 r4 /3 Si 1 yllSgFt . 2 9 -45 10 r4 6 -- "1sbif mf 1 -- Ground 3 4 90 10 r4 4 Ms OSCF ml CS elev. 95 ft. Depth to limiting factor 9 in. Remarks: Boring # 1 0 -8 -- hvSb 2 8 -56 10yr4/6 -- sicl 2 mfi Cs -- .4 .5 3 _} ;8, 1 Oyr4 /4 Ms osg ml cs -- .7 8 Ground elev. 95 80 ft. Depth to limiting factor 108 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 # ; - - m SbrG 5 2 8-5E 1Oyr4/6 -- sicl 2 J( mfi cs -- .4 .5 3 58 -112 10yr4/4 ms osq ml cs -- .7�.8 Ground elev. 9 3 .-7-0_ft. Depth to limiting factor 11 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) e elty. too' rw, f +c , ,,c. h Mark i co, loo Q ; l i n k �ySTL°rh�(�U 0 6A 2- f ox, �6� • ac t ,t china 100 ; y y?'Grn i � c v N ° 10 ss" sw- S© X38 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address 135"9 � 6yAllck, TA / Aosonj Property Address 3 9- q (Verification required from Planning Department for new construction) City /State '`.JO Parcel Identification Number 0 LEGAL DESCRIPTION Property Location ' / <, ' /a, Sec. 3 , T V N -R /7 W, Town of Sohn t , 'srT Subdivision 127eAcd -ey as Lot # _ . Certified Survey Map # , Volume , Page # Warranty Deed # /_� / , Volume / , Page # Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM .MAINTENANCE Improper use and maintenanceof 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 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 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. AA SIG ATURE APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on dus form are true to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. la / 9 l Q SI NA OF A PLICANT 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 12/08/99 WED 13:39 FAX 715 386 4687 REGISTER OF DEEDS 001 j STATE BAR OF WISCONSIN FORM 2 - 1995 4EP 1 t5. 3L !' WARRANTY DEED ; KATHLEEN H. WALSH Y.._ �� ��� . ST C OF DEERS Ducurnent Number �; nl FAGS i ST. G ROI ROIX CO. iJI RECEIVED FOR RECORD I his Deed made between RT_ -___, C Q R'r0T1T jn ... I 12 -06 -1999 12:45 PR P STOUT, husband and Sri €e, — _ IIIARRANTY 1EE1 EXEMPT N ---- CERT COPY FEE: and M & G, Tun . CDPY FEE: _. _ .... _ . _.. TRAWER FEE: 124.24 -� RECORDING FEE.- 10.04 I PAGES: 1 — Grantee: Crantor, fur a vuluable consideration, cumveys and warrants to Grantee the following described real estate in ---$t� T-ni t, _ County, State of Wisconsin: j fti4:C.r. ;A,l r} Area Lot 2, Plat of Meadowronds Town of Somerset w �a ��a Rewt. n Address St. Croix County, Wisconsin. ; t+11' L I. 13 s - 3 A vcL4' , �i 4urtso h, lU r- S qO 10 t ;l n Q,32,-.,0.0,6 -90 -000 Parcel Identification Number (PIN) This X 8 nnOtnot homestead property I(* 'is not) ' i l ij I, 11 i ii Exceptions to warranties= easements, restrictions, rights --of - and covenants of record. Dated this 8 t h__..._....... day of __ nRr m 7'p 1 9AA i i i�ic -hard O_ Ito tt (SCAL) Janet P... •Stout- -- (SEn[) ll ' i h Vi r _ (SEAL) - - (SEAL) I� AUTHENTICATION ACKNUWLEDGIMENT Signature (S) -` State of Wisconsin, ss, St. C r 1x_ County. i authenticated this _ day of _ , Personally came before me this day or „_Sj pr_e�mh¢r 1 94q the above named Ric hard I - Stout and Janet P_ e ' TITLE•.: NI MUR STATE BAR OF WISCONSIN (If not, C , me known to tie the person r b - who executed the foregoing ; authorized by §706.06, Wts. Stets) H�Ry� in -itrurrent and achnowxdge the same. S�$ /VotQ pG`p�S �' o Qblic eAl THIS INSTRUMENT WAS DRAFTED BY S co Janet P. Stout .I ou * .........,._..,.,.... ................� 1 'A SA A W.atukee._. Tx, _ -... Hudson, Wi . 54 01 6 Notary Public. Star of W45con My comrnission is pernian t. ;I not, state expiration date: (Signatures may be authenticated or ecknow: edged. Both are not necessary.) Namvz al pennns signi[tg in any' capacity rnua r* typel Cr pnnwl belo u t1u u St�rith lrc. STATG 9AR OF WISCONSIN Wisconsin Legal &anrc v WARRANTY DEED FORM No. 2 - 1998 Aiiweuk i C - � I It's been a pleasure doing business with you. I look forward to working with you next year. i �i ASAW MORTGAGE A VIMALS FARGO company O ion Nomeat M6rIpAp1, Int. All laprtte Reserved. Th;e moterlsl may not be MprotlutW In ory rprma {+Athena written permhslon, Informatlor au mm to thanpe W*W nodes. aAt 120 P OGR4M 41TE' 30 Year Fixed 70 20 Year Fixed, 15 Year Fixed 7 1 3 75 FHA\VA 4040 0 30 Due in7 7 JUMBO (30 Year Fixed) ell 0 00 NOT!!> a fete6 9re;u91 6 sample of the Irnny c6rtorrmnq end ron•cttntaminp 2r6greDI6 that ure ester, It you need wo,ahlh a °8peael° buyer, p ve me a ceq, we hm 9 pprrogram to t7: thdr needs. This 4dmh+rtlon le Drovld6d to eeslffi reel estate prol6eslon9b 9nC le net er edverllamat to 6Yimd co aumer credit a dNlned by eectiat:26.6 0l Repulettort I, These terms era wbiect to champs whhout notke, Thle form may not be noroduoed without perminlon of NORWRIT MORMOL Offile (715) 386.7380 Office (715) 42,54132 Teri Renslow Metro (612) 436.5335 Fax (719) 386.1$48 Mortgage Consultant r " 600 2nd Street, Hudson, W1 54014 Date: /a• 0010, Into ' matiaeitwAuotaitaff t date at OHM, and Isw heattoahanpa .NarvnetMsrtme, Inc. eriowtnnartpapa loans lramusprloctpalof ea is Aruonaundor lfeanwsea6K 1T56:lhMatteawsetbu derii% owNo, ML0274; inNowNompshireunderLicmwW. 6767Mlforfbttmort6aee&& MUosm4a. 67$$ MNLSnuaondrartp ";inCot Retldeh IGI Mottaette Lando- keente ehd uadar a What liwas istued by the 0epoenont of Raal Estate; is a keened hurt"" 6arksr N"' " U �� S 0 lU e1 {s a 0sarg4�,1V6nsle, end A hade lalend Aeddb id Yottgp6 Lkentw, h'� j i h U U ! C U — .al. 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