HomeMy WebLinkAbout040-1203-95-000 l�
ST. CROIX COUNTY ZONING DEPARTMENT -'I; !
AS BUILT SANITARY REPORT
Owner ' t CZ
Property Adckess
t-
City/State
Legal D scription: '
Lot Block ub'n/CSM #
SW ' a S '/4 Sea Town of PIN #
/,
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer//(r dWtS I Pf« I' Siz�fa /6,U Setback from: House /5 Well PAL �� r
Pump manufacturer Model ZtP2
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
3�
Type of system: Cap U Width Length Number of Trenches 0
Setback from: House Well WSJ' P/L Vent to fresh air intake JS"U
ELEVATIONS - (�
Description of benchmark ! d �° / l- �D Elevation
Description of alternate benchmark t l i-e a Elevation
Building Sewer ST/HT Inlet K • V 3 ST Outlet PC Inlet
PC Bottom Ll 6 Header/Manifold � 6 �D Top of ST/PC Manhole Cover �-
Distribution Lines uzv ( ) ( )
D )
Bottom of System O Q C O (
Final Grade () ! • 6 () ( )
Q ��, ,�.,�• 93,1
Date of installation Permit number 3 J State p an number
Plumber's signature License number �
g Date
Inspector (z" t"^
Complete plot plan or
o
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
' m 1
b n° 4D
ro
M
1
toy-
INDICATE NORTH ARROW 9q
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX
Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 338970
Permit Holder's Name: ❑ City village Town of: State Plan ID No.:
MEYER, TIM TROY
CST BM Elev.:- Insp. BM Elev.: BM Description: C5r B � #Z ` Parcel Tax No.:
Ice .0 4 80 .�, C J 040- 1203 -95 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Al i a"� -- -C& IUD /bSb /�
Benchmark (��Z(p 821 / (�'1.�1 7 •T
Dosing - e; fi'3 q3, }
Aeration Bldg. Sewer
Holding St/ Ht Inlet 0,63 . Y3
TANK SETBACK INFORMATION
TANKTO P/L WELL BLDG. Air to
I ntake ROAD D
Air
Septic > 30 1 NA Dt Bottom lS:�f3 g h3
Dosing a NA Header/ Man.
Aeration NA Dist. Pipe
Holding Bot. System 9l�.,Z v
PUMP/ SIPHON INFORMATION — f inal Grade g
Manufactured 7• 2 '92 - 92-
Model Number GPM
TDH Lift (p. L Ion ,3S System T i�' F
Force in Length FUla. Fi Dist.ToWell
SOIL ABSORPTION SYSTEM al
gM t TRENCH J Width Length p No.Of � enches PIT No. Of Pits Inside Dia. Liquid Depth
DIME 2 r Q I D IMENSION S
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Man- tut r:
SETBACK _
INFORMATION TypeO f CHAMBER Mode Numb r:
System: rt\t, '0 sS �J OR UNIT .
DISTRIBUTION SYSTEM
Header / anifold K Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length eL Dia Length I >/cci
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 Topsoil ❑ Yes i ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LO C TION: TROY 35.28.19 946,S ,SE X 13 D � Y RUN ROAD Gs
� 'i g1/V � � -�I �Ot�,�Q�� e'►� _ (aw S t�'JQt. tot�,e_
' •�. a-�'� °w� a. owt� w - tt 6- c •• GsT s o - �� t a�Q
Q
Plan revision required? ❑ Yes WNo
Use other side for additional information. 1 13 I t
SBD -6710 (R.3/97) Date nspector's Signature Cert. No.
SANITARY PERMIT APPLICATION Safety E and Bngton a "Si °n
Vi s6onsin P.O. Box 7969
department of Commerce In accord with ILHR 83 -05, Wis. Adm. Code Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County 5 G
than 8 112 x 11 inches in size_
• See reverse side for instructions for completing this application State Sanitary Permit
The information you provide may be used by other government agency programs ❑ Check it reon o previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Property QWer Nam Propert Location
1k /4 j 1/4, S T, N, R E (orrg)
Property wner' Maili g A ress Lot Number/d Block Number
C,' State Zip e,� Phone Number Subdivision Name or CSM Num er T
II. P F BUILDING: (check one) E] State Owned ❑ Cit
Nearest Roa
❑ Village /\�
Public 1 or .2 Family Dwelling - No. of bedrooms Town of / /'� LJ
1111. BUILDING USE (If building type is public, check all that apply) Parcel TaaxNumber(s) 35•19.M al
E] j
1 Apartment/ Condo `� Vo 3 1_ -606
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. W 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Q Seepage Trench i h ean. 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit � yy j�dr, �' nl' C �°• ZS 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION: ?r
1. Gallons Per Day 2. Absorp. Area 3. Absorp?Ar 4. Loading Rate 5. Perc_ Rate 6. System Elev. 7. Final Grade
/� Requirgd ( ft.) Proposed sq. ft.) (Gals/da /sq. ft.) (Min. /inch) 7� b e 9J _AW Elevation
v j _5 , b�P1pt41irt p4"+t' Feet
Capacit
VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con - steel glass Plastic App
New Existing strutted
I Tanks Tanks y
Septic Tan f�, sI ❑ ❑ ❑ ❑ ❑
Lift Pump Tank ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑
VIII. HSPe SIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage s hown on the attached plans.
Plumber's Name: (Print) Plu r' Signature: (N Slam ps) MP/ RSW No Business Phone
Nu
mbes�
4 7 V_X
Plumber's Address (Stree �ty, t Zip Code): fLl U K S W ) C2 j
L,j IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing gen i ature (No Stamps)
Surcharge Fee) OL
Approved ❑ Owner Given Initial Ch
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAIN
SBD -63M (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Pkwnber
I P40r U4 v
0, 4o 1 Z03- 4s- Scw� e. - 40' "kA,-T
7 /h Me ew 7y6
� as 9
nit 1�l� �Ap.n'lll, e�c4�9
EL. 94.84
9L.. I op oC
qs.,S
0
RITERNAtE /1RF7
3
;3 QQ
o 3oa
Combination Sept,.ic;Tank and
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' PAGE S OP b
-NEWT CAP WEATHER PROOF
— JUAICTIOIJ 80X
'I'C.I. VENT PIPC APPROVED LOCKING
�:. 10' FROM DOOR. MANHOLE COVER wI
:i OR FRESH wARnalIJ6 LaeErr.
ALP, co�aDvtT
tj
r _
S
---- - - - - --
7 74
y "tusl��•tlaa P I Pt 111 — —
PROVIDE I
DL.E
I T I
i AIRTIGHT SEAL I i
APPROVED .ta 1 rJT A I ( I APP JOINT
W/ C.1 ?IPEOlt Tank construction i iii w /C.I' PiPEaRPUC
shall ALARM
1 comply with
ILHM <3.15 and 83.20
I I OD
� I I
LLEY. FT PUMP
OFF
O COIJCKETE
BLOCK
KI5ER EXIT PERMITTED OULy IF TAUK CTURE
MAUUFAR HAS SUCH APPROVAL 3��AVPQovED
8600 r N4
SEPTIC f SPECIFICATIOMS
00SE 1 `�� GtiJ �1�SZtU P RT J'T
TAMKS MAIJUFACTUR.ER: DUMBER OF DOSES: _ _ -PER DAy
TAUK SIZE: l b`J'J I bS0 GALLOWS DOSE VOLUME r
ALARM MAMUFACTUR.ER: S�S, 11. 'ttO S`tS 'LS IIJCI- UD1IJG OACKFLOW: l S GA LLONS
MODEL (UMBER: 1 O 1 h a w CAPACITIES: A= UICHESOK 3b �' GALLOIJ5
SWITCH TYPE: � Z� B= Z IWCHES`OR ` 4LLOL15
PUMP !"IAUUFACTURCR: �OUL'�S` C= R INCHES OR ,S3 CALLOUS
MODEL DUMBER: 3 81 1 0 D - 2 . INCHES OR S3 GALLOUS
� `h, b U b
PE: MOTE_ PUMP AU L
5 IT T � P D ARM O
5W ITCH y A ARE T 6C
MIU IMUM DISCHARGE RATE - '-g'V GPM INSTALLED OW 5EPARATE CIRCUITS
VERTICAL DIFFERENCE DETWCEU PUMP OFF AUD.13I5TRIBUTIOM PIPE.. 1S FEET
+ tAi IIMUM METWORK SUPPLE PRESSURE , , , , .. , . , , - FEET
"{ FEET OF FORCE MAIM X \. (a I F YO ft .FRICTIO J FACTOR. - FEET
TOTAL OyUAMIC. HEAD = FEET 4 '
Pump chamber DIAMETER
IWTERLIAL DIMEWSIOIJ� OF TAUK: LELI&TH ;WIDTH ;LIQUID DEPTH 3 _ a
BOTTOM AREA — - 231'= - GAL /INCH
l
Goulds
Submersible
Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas-
•Homes Available for automatic and g
components. tic cover with integral handle
• Farms Motor: manual operation. Automatic and float switch attachment
• Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points.
• Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant.
automatic reset. ■ Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing
115 V, 60 Hz, 1550 RPM, construction.
Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo-
Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING
3/4• maximum. • Power cord: 10 foot with pump out vanes for
• Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. 1P Canadian standards Asmiation
• Total heads: up to 24 feet. with three prong grounding _
• a size: I'/i NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo -
Discharge plastic enclosed design for (GSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with improved performance. end in "F" or "AC ".)
rotary/ceramic- stationary, three prong grounding plug
BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10
• Capable of running
dry without damage to s 30 5GPM
components.
Pump: EP05 25
• Solids handling capability: 0 25
3 /4 maximum. w z ___---
• Capacities: up to 60 GPM. s 20 ' I
• Total heads: up to 31 feet.
• Discharge size. NPT.
g Z 5 - --
• Mechanical seal: carbon- r
BUNA -N asto ers nary , 4 15
0
• Temperature: 3 10 �� $
104 °F (40°C) continuous EPO4 - _
140°F (60 °C) intermittent 2
1 5
0 00 10 20 30 40 50 GPM
0 2 4 6 8 to 12 m3/h
r
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page I of 3
Bureau of Integrated Services in accordance with s. ILHR 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 ST C Y o I
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
04c - 1 - S -oo0
APPLICANT INFORMATION - Pleasgp#bf all.406rmation. R hewed by Date
Personal information you provide may be used for pocondary purposes (Privacy La*, s. 15.04 (1) (m)). � � 7
Property Owner Property Location
1 ;7 t�r� Govt. Lot 5 W 1/4 1 /4,S 3 j T a 8 ,N,R � C� E (or)(@
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
)3 X10 O 1 ` :. 10 Cer�D ws
City Stoke Zi PA'Or_t91 ber ; ❑ City ❑ Village (� Town Nearest Road
D Y h
E F
C& New Construction Use: ® Residen I t f- �lurMYa edrooms 3 Addition to existing building V A
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 4 S O gpd Recommended design loading rate 6.7 bed, gpd/ft d 6 trench, gpd/ft
Absorption area required 4 3 bed, ft 5G 3 tre ft Maximum design loading rate 0.7 bed, gpd/ft 0. — 6 trench, gpd/ft
Recommended infiltration surface elevation(s) Ta te,n ' h� � S� l�e; ft (as referred to site plan benchmark)
Additional design /site considerations re co m m e n � Tr e n h 1 rJ rn e k S 0
Parent material 7)/ Flood plain elevation, if applicable ry A ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system INS ❑ u 3 S ❑ u ®S ❑ u I .®s ❑ u ❑ S ' M U EIS ®. U
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
g Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
�_► I u YK 3 3 5; ! 1 ak" v1, ! ZJ� O o.�o
u 30 QZ 4 1 1 3 1 vf a.S ;o. to
Ground 3 30, ES 'l , 5 r 21 3 — n �f S 0.53 i1~
elev.
Depth to
limiting
factor
7,',S in. u}�l
Remarks:
Boring #
0- 8 1oY2 rr 0.S 2V�
2 Z 8 -2 -2 ,J-Y< `` s; / z f sb ` Yrr v 1 a C I L),'
Zs -9 os
Ground
eft. ;
Depth to
limiting t
factor
> 90 in. Remarks:
CST Name (Please Print) Signature Telephone No.
L &r j 7!S 4 2 5 21 7 S
� cr5�
Address Date CST Number
S r" u 1 LJ ge a a a ss 4
i 1
SOIL DESCRIPTION REPORT 4:
PROPERTY OWNER M� t �,a< (rn Page 2 of 7
PARCEL LD.# 040 - 1'Lo3 - 9.S - 0
Borin g # Horizon Depth Dominant Color Mottles Structure 2
i~ Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
,.�(• 4k1i
0-11 1 o Y 5 I sbk rn i z V f p, s' n .
2. /q_zz 7.5Y1`4 / 3 1 f r, ;o,(,
Ground 2z 39 7, s Y Ci( 5; r-" G C
elev. �
951r tt. 4 34 -Vo 7 /3 mtFs 6 ,,, i
Depth to
limiting
factor u
? 90 in. iP
Remarks:
Boring #
1 0 -Z) 1 U -S �- ��; 1 f54 4 5 a -; o.L
4 .... z- 0 33 ?,S�oz 4 s % fsbk Mv4r q s I v4 o.S ,a.�
33- 4 i v 9 S; I 4 s b * 4-
c 0.5
of 'o,
Ground 4 4 z- 4 8 7, S Y C, 4/A rti <a 5 D 6 n, E C. ,1 , O, 8
elev.
O S
Depth to
limiting
factor
L BS 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 # C , -,'L / u YK 3 S; I �s6!<' rn 1 A 5 - z i
z iz - Y2 4 S; / z Fsbf of as � 0 1�
.3 z2 -al 7 .Sr2 4 / s; z FS6k ,% V f� � 1 �� as ;o.�
Ground 4 3L - - 24 7 5 N &/ rhel g as rn a C� d 7 '®. 8
elev. l � S ,�
7.5 Y 2� Uf s �, — — — —'
Depth to
limiting
factor / 1 1
� Remarks: T thG� ;., this b O r jrA r», liS - t be ,0x_47 3L " I e � 1-r, K.
Boring #
Ground
elev.
tt.
Depth to
limiting
factor
' Remarks:
SBD -8330 (R. 07/96)
rc& a &I s yv."t PLOT PLAN PS 3 of 3
040 - ►,203- g5-000 5 C e, 1'`: 40'
I
C� rnTo i 4
� -one c 9
CL. 99.84
QZ 2 �we r
a r/ �t..iop op
�- RtrERinJ/17E I��EA
3
o � 30o i
o �✓
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
i
(
Mailing Address 7 0 / A (° Y U
Property Address Olt Fk Y, .
(Verification required from Planning Department for new construction)
40
City /State /, i 0e V [ l �' bjo,,.'�1 c0 J parcel Identification Number
LEGAL DESCRIPTION
Property Location S Gt) 1/4, 1 / a, Sec., T c? , P N -R /Y W, Town of 9�6
Subdivision ��r� C�' /7 d C! �' Lot # 2
Certified # c %,A) Volt ne V Page /
g #
Warranty Deed # , Volume / x� Page #
Spec house ❑ yes U no Lot lines identifiable ,8 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 a year expiration date.
SIGNATURE 016APPLICANT 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 owner(s) of
th e = �escribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APA ICANT 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
1 19 PAGE 6
VOL 601 529
STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number WARRANTY DRED ST. CROIX CO., WI
This Deed, made between Michael G. Smith and Mary K. Smith, RECEIVED FOR RECORD
husband and wife 04 -19 -1999 4:20 PM
,Grantor, and Timothy D. Meyer and Sandra L. Meyer,
husband and wife, as survivorship marital property, WARRANTY DEED
Grantee. EXEMPT # 17
CERT COPY FEE:
Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE:
the following described real estate in St. Croix County, State of Wisconsin (The TRANSFER FEE:
RECORDING FEE: 10.00
"Property"): PAGES: 1
Recording Area
Name and Return Address
- + -� y D, At y eAr
9z ii l.-� Ave.
S e� tM,P,✓'St�t W 11'G . S�o2s
040-1203 -95
Parcel Identification Number (PIN)
This is not homestead property.
Lot 10, Cernohous Addition in the Town of Troy, St. Croix County, Wisconsin.
This deed is given in fulfillment of that certain Land Contract between the
parties hereto dated January 13, 1999, recorded January 21, 1999, in Vol.
1397, Page 552, as Doc. No. 596242.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of April, 1999.
sw�
*
*Michael G. 2N , il.)
1�x I * * Mary K. 't
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Michael G. Smith and Mary K. Smith, husband and STATE OF WISCONSIN )
wife ) ss.
,, &. authenticated this _ day of April, County )
1,
Personally came before me this day of
the above named
*
lot", I d;'
to me known to be the person(s) who
TITLE:.9tMB15R STX rE BAR OF WISCONSIN executed the foregoing instrument and acknowledge the same.
(If not,
authorized `
by 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin
Attorney Kristin Ogland My Commission is permanent. (If not, state expiration date:
Hudson, WI 54016 )
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800 -655 -2021
Confirmation Report— Memory Send
Time May -11 -99 08:06am
Tel line 7152475031
Name FIRST NATIONAL BANK
Job number 925
Date May -11 08:04am
To 16512916250
Document pages 01
Start time May -11 08:04am
End time May -11 08:06am
Pages sent 01
Status OK
Job number 925 * ** SEND SUCCESSFUL * **
i
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NORTHERLY 1
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33 33 OETAIr_ /NORTHERLY RIGHT -OF -WAY LINE