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HomeMy WebLinkAbout026-1114-50-000 CROIX COUNTY ZONING DEPAR'1'MEN'l' !� AS BUILT SANITARY REI'OIt'I' Owner QD ti }-1c //�� k l.t�nS�Ar I01y\ J� Address a City /State WX- J e/ Legal Description: - Lot �_ Block — Subdivision/CSM I/ l d '/• Alt '/, 5 W Scc. L, T 3i7 N -R f9W, Town of PIN tt ev �_ //S - S© SEPTIC TANK — DOSE CHAMBER — FOLDING TANK INFORMATION: Tank manufacturer Wieie ti Size ST/PC /o? _ Pump manufacturer Setback from: House 1,9- Well P /L�ll ---� —� Alarm location Model (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: 8 ao Width X0 Length Number of Trenches Setback from: House �_ Well -- P/L /o ' Vent to fresh air intake 4 ELEVATIONS Description of benchmark f (/G. Elevation ,,IM Description of alternate be chmark Elevation Building Sewer ST/HT Inlet 9g� oZ ST Outlet- 9 7 g PC Inlet PC Bottom `` Header/Manifold �/'�O �� Top of ST/PC Manhole Cover / Y Distribution Lines ( ) _ 9 G, .5 O ( ) Bottom of System( Final Grade ( ) q I ?S Date of installation // / /9 erniit number 3a6o23k State plan number Plumber's signature License number c�aOS3 7 Datc/ //2/ J Inspector compictc plot plan .� 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. ` 1 0 �p PLAN VIEW Aj V 1 �y INDICATE NORTH ARROW I Wisconsin Department of Commerce PRIVATE SEWAGE and Buildings Division AGE SYSTEM Count y ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar�P,gffh: Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. G 332255 DERRICK CONSTRUCTION D Rib RU e Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: I BM sction: Parcel � np T dte=' 1114 -50 -000 TANK INFORMATION ELEVATION DATA A9800429 /�/ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ��� f^ ��, �" Benchmark 13 ' Aeration Bldg. Sewer Holding' — St /K# Inlet 9y, I9 TANK SETBACK INFORMATION St/ IK outlet 4 7, Vo TANK TO P / L WELL BLDG. Aeintake ROAD Dt Inlet Septic �2Q / NA Dt Bottom - -. ... Dosing..-- NA Header / _ 7 (� „aii,, ` Aeration`' NA Dist. Pipe g(, Holding Bot. System 7 5. Y O � PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand J�el C � 7s 9• Model 7Num _....._. LL� ' GPM TDH Lift L riction System TDH Ft m ead Forcemain . Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT - ., A No. Of Pits Inside Dia. Liquid Depth DIMENSIONS l� 7� DIMENSION LEACHI1 r . Manufacturer. SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM --- INFORMATION Type O M e ,,,, r r CNAeMBER Model Num eP^ - v System: d, /D z (o ` ' OR UNIT DISTRIBUTION SYSTEM Header /AAerri40td Distribution Pipe(s) r x Hole Size x Ho Zing 0 1 n t-TO Air Intake Length _ Dia. T Length 699 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Gra Syste my Depth Over Depth Over xx Depth Of xx Seeded/ Sodded f `x — x'T*dk1W _ d ,__ Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 01.30.18.658,NE,,SW 1758 1 / STREET /'I �j�ry� ,� f :I...+� F ✓5�1 / GL'� F" � � "C; ' "„✓• ^KJ'� . 1 I, / ��.'v �`�r�?"•6m"�;,,"S..r rLr kS,,�. P�+.IrliE„ �A -.:'l -� �I� t � . � �. .. ' H Plan revision required? ❑ Yes [ No Use other side for additional information. // l� �" 1 ,9 1 SBD -6710 (R.3/97) Date Inspector's Sign ure Cert. No I� SANITARY PERMIT APPLICATION 20 1eE W and shngton *6consin In accord w i t h ILHR Wi . Adm. Code P.O. Box 7969 Department of Commerce Madison, t 83 05, s Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. % • See reverse side for instructions for completing this application State Sanitary Per mber The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)1- 1 75 Q / 44 ( � O t) State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Prop Owner Name Property Location r c �r-1/4 S 1/4,5 1 T , N, R ) W Propert Owner's Mailing Address /J Lot Number Blocumber L c2 City, State Zip Code Phone Number Subdivisio Name or CS umber 1 5V O17 ( - 7(S) Q ` II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity ge Nearest Road Public 1 or 2 Family Dwelling E] Village - No. of bedrooms own OF AA I III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 1 . g /9' (P 5 8 G © aLo ° 1114 `SZ) 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. E] Replacement 3, E] Replacement of 4_ E] 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)1?Seepage 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 I Rlgd (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Minh) Q 7 6�e ,q va , tion ' t 7 5 ' Feet / l,.3 Feet VII. TANK Capacity all0 5 Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank t ` ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install io f the onsite sewage system shown on the attached plans. Plumber's Name: nt) Plu rs Signatur : (No S mps MP /� No.: Business Ph Number: t ry 2 a � /J 'Plumber's Address (Street, Cit , State, Zip Co clop): IX. UNTY / DEPARTMENT USE ONLY ❑ Disapproved S anjtary Permit Fee (includes Groundwater ate ssue Issuing Agen ps) ) (Approved E] Owner Given Initial W ) Surcharge Fee) Adverse Determination �� �� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBa8398 (Ft II B81 DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Number I co f � rs r k w„ �� - lV Sw 73 � uJ t� IU _ l sns f4w I I LO I .JyfT • I j _ I I I } I , I ' I I i I I , I I Sib � ♦ d a I i � I I I I I , ' ✓ 1 0 IN O C't Y5 i5os M0 V . cum fr41h Air 111114 And Ob►•rrallo PI P • y�1 ADDrori• V•M C •'� ►llNmum 12 Aaar1 finol Go•d• 20. 42' Abo.• PIP. 4' Call Iron V•AI Pip. To Final Or•d• ua.A Hoy Or SynlMlk Co alny ilm 2' Aata�•pol• 0.•r No - 011 Ir Ib.l IoA • 0 Too 6 A7al•p 0 60••1• PIP• ° Pot '"Id Ply• (solo. a Col'OlAll T.aAln•Ilno At Y Gollom Of s"14m 9g, P ���n�ep �1�..� 11 c���.c�t -• SOIL FILL DISTRIBUTIO1.1 PIPE ` APPROVED Z`INTUCTIC COvcA 2 "oF AGGREGATE OK 9" o sTa�w ------------ I:LEV. OF EC ( Y 1. F!2 AGGREGATE �P "vF % �•, a DIsT'1115 JTIOU PIPE TO BE AT LEAST 1 IJCHES BELOW OR►GIIJAL GRADE AUU AT LCAsTLO IIJCHES BUT 1.10 MORE THAN 42 IAICHCS OELOW FI►JAL GRAOC MAXUwM OaprH OF F-XCAVAT1 FKo/1 OR16VlgL 6RAVV WILL BC - r� _ IUCHES PVIiIM OEM OF EACAVAT100 H \ OM, e1�1644AL GRnDV- WILL BE INCUE s 51G LICCUSC UUMBEit: - s DATE: - - -- - - -- I I o _ r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division oTSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 'nctws in size. Plan must include, but St. CRoix not limited to vertical and horizontal reference poi of slope, scale or PARCEL I.D. # -� 026- 1114 -50 dimensioned, north arrow, and location and di ns � fl4arest'road. ''" ., APPLICANT INFO RMATION PLEASEtRt t L * MAT#0{ � REy,IEWED BY DATE PROPERTY OWNER: OPERTY LOCATION Derrick Construction, In `,', r t- r� a ^:.C� VT. LOT NE 1/4 SW 1/4,S 1 T 30 N,R 18 1t (or) W PROPERTY OWNER':S MAILING ADDRESS ST GRDA r..._ T # BLOCK # SUBD. NAME OR CSM # 1505 Hy. #65 OUNTY na Willow River Meadows CITY, STATE ZIP COD PH011►9 CITY []VILLAGE [MOWN NEAREST ROAD New Richmond, WI. 54017 ; (�l 246 -23 Richmond 144th. st. [� New Construction Use [ If Residential / Numt�i`�f s 4 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft • trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) 95.40 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I ®S ❑LI I ®S ❑U ®S ❑U ®S ❑U ®S ❑U El ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -12 10yr3 /3 none 1 2cp1 mfr gw 2f n* .2 1 2 12 -30 10yr4 /4 none sil lcsbk mfr gw if .2 .3 Ground 3 30 -84 7.5yr4/6 none ms Osg ml na na .7 .8 elev. 9 9.3 ft. Depth to limiting factor +84 Remarks: Boring # 1 1 0-13 10yr3 /3 none 1 2msbk mfr gw 2f 1 .5 .6 2 2 13 -32 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 32 -84 7.5yr4/4 none ms Osg ml na na .7 .8 Ground elev. 9 9.4 ft. Depth to limiting factor +84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th Aye., New Rich nd WI 5 017 Signature: Date: 9 -3 -98 CST Number: m02298 PROPERTY'OWNER Derrick Constructi DESCRIPTION REPORT Paget of 3 PARCEL I.D. # 026 - 1114 -50 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourck3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -10 10yr3 /3 none 1 2csbk mfr gw 2f .5 .6 2 10 -30 10yr4 /4 none sil lcsbk mfr gw if .2 .3 Ground 3 30 -84 7.5yr4/6 none ms Osg ml na na .7 .8 elev. 99 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2co1 mfr gw 2f np L .2 4: 2 9 -30 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 30 -84 7.5yr4/4 none ms Osg ml na na .7 .8 Ground elev. 9 8.7 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -14 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 2 14 -36 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 36 -80 7.5yr4/4 none ml Osg ml na na .7 .8 Ground elev. 98 ft. Depth to limiting factor + 80 11 80 Remarks: Boring # ................. Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Derrick Construction, Inc. New Richmond, WI 54017 MPRSW -3254 NE4Sw4 S1- T30N -R18W (715) 246 -6200 town of Richmond Willow River Meadows lot #6 N 1 " =40' BM.= top of 2" pvc pipe C el. 100, + 7 Alt. BM.= top fo 2 pvc pipe @ el. 98.25, d 3 Z' 24 O e 5z' � 03 X g�3 4/ A" Q Gary L. Steel 9 -3 -98 Wiscoo n a Deprhmentoflndustry � D SITE EVALUATION REPORT Page -of .Division of Safety 8 r q with ILHR 83.05, Wis. Adm. Code 13.1 LI Attach complete sit n orgp��9aryrlot le"Sn 8 11 inches in size. Plan must include, but St. cRo: x not limited to verfi hoYYtffontal`frreference poi ), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow UWI�IiJp4�r nearest road. 026- 1114 -50 IC�`� APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Derrick Construction, Inc. GOVT. LOT NE 1/4 SW 1/4,S 1 T 30 ,N,R 18 f (or) w PROPERTY OWNER':S MAILING ADDRESS LOT # TBLOCK # SU80. NAME OR CSM # 1505 Hy. #65 6 1 na Wi11ow River Meadows CITY, STATE ZI P CODE PHONE NUMBER ❑CITY OVILIAGE (TOWN NEAREST ROAD New Richmond, WI. 54017 (715 246 -2320 Richmond 144th. st. (� New Construction Use [ Residential / Number of bedrooms 4 (} Addition to existing building [ } Replacement (} Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate. -7 bed, gpdtft •8 trench, gpdAt Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd$ • 8 trench, gpd/ft Recommended infiltration surface elevation(s) 95.40 ft (as referred to silo plan benchmark) Additional design t site considerations na Parent material outwash Flood plain elevation, if applicable na it S - suitable for system I CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for ! Stem S Q U ®S Q U ®S ❑ U ®S Q U ®S Q U Q S ® U SO IL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Motto Texture Structure Cornsistence Barry Roots GPD /ft in. Munsell Qu. Sz. Coat. Color Gr. Sz. Sh. Bed Tmnch 1 0 -12 10yr3 /3 none 1 2cpl mfr gw 2f Q 1 2 12 -30 10yr4 /4 none sil lcsbk mfr gw if .2 .3 Ground 3 30 -84 7.5yr4/6 none ms Osg ml na na .7 .8 elev. 9 9.3 It. Depth ro limiting factor +8 Remarks: Boring # . v_t 1 0 -13 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 ,0 2 2 13 -32 10yr4 /4 none sil lcsbk mfr yw if .2 .3 3 32 -84 7.5yr4/4 none. ms Osg m]. na na •7 .8 Ground elev, 9 9.4 ft, Depth to - limiting ftIctor +84 Remarks CST Name: -- Please Print Gar L. Steel Phone: 715- 246 -6200. Address: 1554 200th e. New Rich nd WI 5 017 Signature :� Date: 9 -3 - CST Number: m02298 I i PPMRTY OWNER Derrick Constructi DESCRIPTION REPORT Page 2 _ _of 3' PANEL I.Q # 026 - 1114 -50 Boring # Horizon Depth Dominant Color Motlfes Texture Structure Consistence 8ancf�ry Roots GPDIft in. IiAunsell Qu. Sz. Cont. Coles Gr. Sz. Sh. Bed T wch 1 0 -10 1Oyr3 /3 none 1 2csbk mfr gw 2f •.5 .6 2 10 -30 10yr4 /4 none sit lcsbk, mfr gw if .2 .3 Ground 3 30 -84 7.5yr4/6 none ms Osg ml na na elev. — 99 i ft Dept to Nmiting factor +84 Remarks: Boring # 1 0 -9 10yr3/3 none I 2cpl mfr gw 2f np .2 ` r Ma 2 9 -30 10yr4 /4 none sit lcsbk mfr gw 1f .2 .3 3 30 -84 7.5yr4/4 none ms Osg ml na na .7 .8 Ground elev. 9 8.7 ft Depth to factor + 84,. Remarks: Boring # 1 0 -14 10yr2/2 none 1 2msbk mfr gw 2f .5 .6 2 14 -36 10yr4 /4 none ail icsbk mfr gw If .2 .3 3 36-80 7.5yr4/4 none ml Osg ml na na. .7 .8 Ground - --_ 98. el Depth to limiting f actor 0, _ Remarks: Boring # Ground elev. it Depth to �.. limiting fact R . c STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. GSTM2298 Derrick Construction, Inc. New Richmond, WI 54017 MPRSW -3254 NEASW4 S1 T30N -R18W (715) 246-6200 town of Richmond Willow River Meadows lot #6 N 1 "=40' EM.= top of 2" pvc pipe @ el. 100 r 44- r7 Alt. BM-= top fo 2~ pvc pipe @ el. 98.25 'j l.4 -J4- 8 G if fl -1 �dlo ti Gary L. Steel 9 -3 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �nl t ►-+�.a w �.v ..� c r. ► �!� rte A �4 � � IS.�� �- • Sr_ v Mailing Address f" 9 9 c KC 04e_w VZ 4 ` 4 nA o w t�., W Property Address 1 7 e b 14 (Verification required from Planning Department for new construction) City /State Weav (Zr c,�4 nno►.t% \fdl Parcel Identification Number C��Lb 1 l 14- - c� Gc'� LEGAL DESCRIPTION Property Location Wc-- '/4, `�y 1 /4, Sec. � T N -R W, Town of P CH al t l 0 Subdivision \/VI V N* S. Lot # Certified Survey Map # , Volume . Page # _ Warranty Deed # 4 , Volume '� . Page # Spec house Byes 0 no Lot lines identifiable )4es O 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, journeymanpl*ber, 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 your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da7of year e / 46 1 , T ATURE OF APPLICA DATE OWNER CERTIFICATION , I (w ) 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 prope described abov by f a warranty deed recorded in Register of Deeds Office. 9 .17 9 �' SIG ATURE OF 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 45276'7 I GUARDIAN'S DEED REGISTERS OFFICE This Deed, made between ................................................. ST. CROIX CO, WI ....................................................................... . .................................. Gertrude E. Schmit by Beverly Buckner, Gua ... 1 Rec d for Record ........ ................................................................................................. I Grantor, ........ ...... 0 GT 2111989 .. .................................................................................... of and ..... ... i.chAipl ... R.....S.t.ev.e.ns., ... Wi-1.14.am..H..•.•D.err.i.ck .............. 8-00 A. M W illiam M. Derrick r ..Thomas "E.." ...... .......... RqT1 ............. Reg of Deeds ................................................................................................... Grantee, Witnesseth, That the said Grantor, for a valuable consideration Gertrude E. Schmit by...PqyL .................................................... convert to Grnntec the following described real estate in ....... r9 i.n County, State of Wisconsin: Southeast Quarter of Northwest Quarter and Northeast Quarter of Southwest Quarter of Tax Parcel No: ................................... Section 1, Township 30 North, Range 18 West. This deed is given pursuant to the Order to Sell, dated October 16, 1989, and the Confirmation of Agreement and Order, dated October 19, 1989, both duly authorized by Order of the Court and whereas the undersigned, Beverly Buckner, is authorized to sell the same by Letters of Guardianship certified on October 22, 1989. MA'NSFZR S-.4% col-1. 0 This ........ is not homestead property. (is (is no Together with all and singular the hereditaments and appurtenances thereunto belonging; And ..... Gex.tr.ud.e .. E.....S.chmit—by ... Bemer.ly.. Buc.kn.er ..... 0 ............................ ........................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. . .9 0 C. i v Dated this .............................. . ..... ........... 89 . day of ......... October ............ .............................. 19......... .............. 0 ..... ................. (SEAL) h. ................................... (SEAL) 0 Gertrude` E. Schmit by Beverly ....................... 0 .......................................... .... aackner ,uardi*an ..................................................................... (SEAL) .................................................................... (SEAL) .................................................................. .................................................................. AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................................................ STATE OF WISCONSIN Beverly Buckner ss. October .............. ...... 0 ....... ..._...... authentic ted tblsr-"�( ..... of .......................... 1 19 ...... Per3on--Iiy came before me this ................ of ........... 'fee . . ............... !. ....................... 19........ the above named -� .. ... ....... .................... a Kristina Ogland Lundeen ................................................................................ .............. 0 .................. 0 ................................. 0 .......... .......... 0 ................................................................... TITLE: MEMBER STATE BAR OF WISCONSIN (if not . .................................... authorized by § 706.06. Wis. Stets.) .......... .. .................................. .... ............................. to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. KN9 tTfiW"'15W'111fcf Men ..... Att.ornay ... at...La.v ....................................... ............................... I ................ 0 ................................ .............................................................................. ...................................... 0 .......................................... Notnry Public ........... ........................ }, Wis. (Signatures may be authenticated or acknowledged. Both 'My Commission is permanent. (If not, state expiration are not necessary.) date: ......................................................... 19........ • Names of persons signing in any eRpneitir should be typed or printed below oeir signatur".