Loading...
HomeMy WebLinkAbout191-1012-40-000 (2)-- 1-04 STC AS BUILT SANITARY SYSTEM REPORT - OWNER ADDRESS SUBDIVISION CSMV LOT W Town o rf�- SE"ICTION T N-R -� ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN �100 FE OF SYSTEM Ny i i L/ P) rry mnPTH A ROW -1 114 U I Provide setback and el of vation information 011 reverse this or-m Va 0 f- Pi-ovide 2 d imens io to center ro septic tanl< manljole C0vP BENCHMARK: (o ALTERNATE BM:_ SEPTIC TANK PUMP CHAMBER HOLDING _TANK INFORHATION Manufacturer: Liquid Capaci'ty: Setback from: �4ell House Other Pump: Manufacturer Modelt Size Float seperation e, e- Gallons/cycle: 1.3 L Alarm Location t -'.-SOIL ABSORPTION SYSTEM Width f Length Number of trenches L Distance & Direction to nearest prop. line: t:5 Setback from: well: tj Hoius e other ELEVATIONS Building Sewer ST Inlet.- ST outlet PC inlet- PC bottom_ Pump Off Header/Manifold.- I Q Bottom of system ) d , C Existing Grade D Final qrade DATE OF INSTALLATION: PLUMBER ON JOB: or LICENSE NUMBER: INSPECTOR:_ 3/93 : jt 4 L0Q,&TsVM0 a rMIL SON 45%17,. 2 9 , 15 Laborzint Human Relations ,Safety and Ouil,d ings Division GENERAL INFORMATION Permit Holder's Name: PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) E] City E] Village _-Town of: Tn's 'p' B 11% E I e"v BM DescriptioFY: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION Septic Benchmark Dose ng A9300242 is HI FS ELEV. Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St / Ht outlet TANK TO P 1 L WELL BLDG. Vent to ROAD Air Intake Dt Inlet Septic, I NA Dt Bottom ? Dose ng NA 1 M a n Aeration NA Dist. Pipe Holding Bot- System PUMP StMWN INFORMATION Final Grade Demapd Manufacturer —7- 1 9 q4 PI Model Number -4 TDH Lift Friction System TDH r Ft 't Loss- Head- :�l Forcemain Length -? Dia. C") Dist. To Well,, SOIL ABSORPTION SYSTEM its 'cle Dia. BED' TRENCH Width Length, No. Of T enches PIT No. Of P_ ins) Liquid Depth DI M EN I NS DIMENSIONS Manufacturer: SYSTEM TO P L BLDG WELL LAKE/STREAM LEAC-HJNG SETBACK CHAMB=ER-,- _,Aadel Number: Type Of T INFORMATION OR UNIT System: DISTRIBUTION SYSTEM Vent To Air Intake ib UtL n Pie (s) x Hole Size x Hole Spacing H*err/ Manifold Distri Io I p �,Y 60 Length Dia- Spacing Length JJA D i a, l SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only h Over Depth Over xx h Of Seeded/Sodded xx Mulched Dept xx Dept[1,y-es E] No Q-Yes 0 No B Topsoil Bed /Trench Edges Bed /Trench Center COMMENTS: (include code discrepancies, persons present, etc.) 7 "OX LAW\ 4.j LOCATIQN: W�LSON,27w29-15 1�3 c) 7 C Plan revision required? Yes 0A0 21() C) side for additional information. Use others Cert. No. r signatur SBD-6710(R 05/91) Date Inspector's Signa ur DJLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code —Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. --See reverse side for instructions for completing this application. I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION LAWRENCE BAIERL NE 1/4 SE'/4, S 27 PROPERTY OWNER'S MAILING ADDRESS LOT# 1660 WILSON ROAD I COUNTY ST. CROIX STATE NITARY PEJ3YIT # M I on heck El ' ck i revision to previous application t (- /! (3� STATE PLAN I.D. NUMBER S93-40833 T 29, N, R 15 E (or _TBLOCK # WI�.SONEZI540 PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER WI 1 7 It 715 1 772-474 one LJ VILL11. TYPE OF BUILDING: (Check o State Owned ED AGE: WILSON Fy-1 E][M JOWN OE: M Public L��_j 1 or 2 Fam. Dwelling—# 2 of bedrooms I PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 191-1012-40 1 ❑ Apt/Condo 20 Assembly Hall 6 El Medical Facility/Nursing Home 30 campground 7 Omerchandise: Sales/Repairs 4 0 Church/School 8 0 Mobile Home Park 50 Hotel/Motel 9 0 Office/Factory NEAREST ROAD WILSON . ROAD 10 El Outdoor Recreational Facility 11 ❑ Restaurant/Bar/Dining 12 Service Station/Car Wash 13 D Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑New 2. FX� Replacement 3. ❑DReplacement of 4. 0 Reconnection of System System Tank Only Existing System B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. 'TYPE OFSYSTEM: (Check only one} Non -Pressurized Distribution 11 ❑Seepage Bed 12 ❑Seepage Trench 13 ❑Seepage Pit 14 ❑System -In -Fill Pressurized Distribution 21 0 Mound 22E]In-Ground Pressure Experimental 30 ❑Specify Type 5. 1:1 Repair of an Existing System Other 41 0 Holding Tank 42 0 Pit Privy 43 0 Vault Privy VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE (Min./inch) C. SYSTEM ELEV. 7. FINAL GRADE I ELEVATION I REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) 300 .3 N/A 103.0 Feet I J5_ Feet, Vill. TANK CAPACITY in gallons Total # of Manufacturer's Name Prefab. Concrete Site Con- Steel Fiber- glass Plastic Exper. App. INFORMATION New gmsting Gallons Tanks structed Tanks I Tanks I i Septic Tank or Holdina Tank Lj ILI IL11 LW�11 Im Lift Pum Tank/Si hon Charnbejr50 500 1 WIESER CONC Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No St ps) MP/MPRSW No.: Business Phone Number: �-- . 3215 715 772-3278 BENNIE HE LGESON Plumber's Address (Street, City, State, Zip Code): W 1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY/DEPARTMENT USE ONLY --d Issuing Agent Si (No Stamps) F-1 Disapproved Sanitary Permit Fee (includes Groundwater ate Issue r_71 Surcharge Fee) Approved F-1 Owner Given Initial 9 .9331 I Adverse Determination — X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: o: Safety & Buildings Division, Owner, Plumber SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy T Fvisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of . abor and Human Relations Nvision of Safety & Buildings in accord with I LHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but OU Ty not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or FPARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 'I � I - j 6 )' '14, —44 R VI WI APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ;;ZN GOVT. LOT A) t=- 1/4 S L 114,Se) 7 T 0 N,R I cT- E (0116 PROPERTY GOVT. P T PROPERTY ONER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # A) A- E]CIT CITY, STATE ZIP CODE PHONE NUMBER [Y 5gVILLAGE ErfOWN NEAREST ROAD q �] zc LO k I'S C Wok" New Construction Use residential Number of bedrooms Addition to existing building 14--6epiacement I Public or commercial describe Code derived daily flow d -v— Recommended design loading rate _JJ f—bed, gpd/ft2 trench, gpd/ft2 Absorption area required Al bed, ft2 tom trench, ft2 Maximum design loadin rate bed, gpd/ft2 3 trench, gpd/ft2 rred to site plan benchmark) Recommended infiltration surface elevation(s) ft (as re e '0 Additional design / site considerations C" R Parent material :S14- nQeFlood plain elevation, if applicable _AZ A ft HOLD>Er TANK R 600 AT -GRADE SYSTEM IN FlUe CONVENTI ON M�� IN -GROUND P SURE S = Suitable for system [] S Q-T CAS S [19-15 Ers El U U 7=SUunistuitable for system El S 0 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Munsell Motbes Qu. Sz. Cont. Color Texture Structure re Consistence Boundary Roots GPD/ft2 Gr. Sz. Sh. Bed 'Trench in. .......... ................. 1104-C 0c C&11�' C e2 Ground Ct t elev. 7 C 3 V Depth to limiting factor K"am+ K. Ls. %X Remarks: Boring # ............. ................ .............. Ground elev. C6 - S1_3 f t. Depth to limiting factor 4 7, 1:f_71 Remarks: CST CST Name: —Please Print ST Naa Address- Signature: LLA.v co k. v-Y L 16�,.�� 13 SC � no% Phre: 7 zF� Date: umber: 3 1 rzcl PROPERTY OWNER IL DESCRIPTION REPORT Page A of PARCEL I.D. # 91 �" &/.' Ground elev, tft. Depth to limiting factor Ground elev.- Depth to limiting factor Ground elev. ' I. 5�3 ft. Depth to limiting factor, 7 Boring # Ground elev. -k--- f t. Depth to limiting factor fr I Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bed ITu& L) C) 3 C Remarks: -7 4p -7. IL L) 6L'r Remarks: .0� 3 r 7� 75- Y9 -) Remarks: c) e R e ma' rks:'*-- SBD-8330(R.05/92) PCLIe rp 1w I—aLL) lrtyLc v� CL C-L G C- <,-�LT- r [fiDI-4 � [ r le, F*� CIJ60 i E::* cev As o)v\, A-r- r e- s r � � h • N ow ■ -�— ci c i �l B ..►�l V ![. 1 eo - Q G Ou r, w 1 ..- —.- - P� Ge- �h¢� ab W­ f-onsin Department of Industry, Page T1_ SOIL AND SITE EVALUATION REPORT of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY C R 0 U ___ Attach 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 % of slope, scale or PARCEL I.D. # dimensioned north arrow, and location and distance to nearest road. V REV APPLICANT INFORMATION --PLEASE PRINT ALL INFORMATION F IEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION E 6 PROPERTY GOVT. P T GOVT. LOT 1/4 :S E_ 1/4,S,� 7 T c) N, R I S- E (o W PROPERTY OVYNE R':S MAILING ADDRESS (6,NGO LOT # LOT # BLOCK# SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER OCITY VJVILLAGE AWN []CITY F NEAREST ROAD 004sce.,_ J..(2 -2-7.�- '/7 q0 Li Vq C.� New Construction Use u' esidential / Number of bedrooms Addition to existing building i q-ffe'placement Public or commercial describe Recommended design loading rate to bed, gpd/ft2 trench, gpd/ft2 Code derived daily flow ZCCL gpd 3�,j ko— Reco Absorption area required bed, ft2 (0co trench, ft2 Maximum dqsign loaddin rate bed, gpd/ft2 3 trench, gpd/ft2 Recommended infiltration surface elevations) 10_?.0re ec has erred to site plan benchmark) Additional design 1 site considerations v, C� Parent material Flood plain elevation, if applicable Al A ft S Suitable for system CONVENTION El 211 S Mou�; EI-S El u IN -GROUND PR SURE El S e-T AT -GRADE 0 s LK SYSTEM IN FlWe Ej S Bt HOLal.Wer TANK FOS El U U Unsuitable fors ys SOIL DESCRIPTION REPORT Boring # 0 Horizon Depth Dominant Color Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Bed GPD/ft2 'Ter& in. Munsell x - ....._l ye Ground D t L elev. /C> I.6 ft. -7 5� Depth to limiting factor 12 or Remarks: Ground, elev. q-!L- _T5 f t. Depth to limiting factor 6,U) VVnS r C L_�, t, L) IL Uh CL C. I V V rz u& 4- 7 S' YR I r., c Remarks: CST Name. —Please Print — Ph r _e7: 2 J — -3 Address: -1 )c Lot, 51 1,/ )8 `Si 2 nature: I Date' CST Number: ,Orr A�_X S PROPERTY OWNER IL DESCRIPTION $4..PORT Page eA of - -� PARCEL I.D. # Boring # Horizon Depth in. Dominant Color. Munsell Motues Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Cons I istence Boundary Roots G P D/ft2 Bed Tmrch V 9 q,q jo Ground > 0 34 L) jel- elev. ,d, —SVOA. Depth to limiting factor .. ...... .. Remarks: Boring # Ground elev.. Depth to limiting factor Boring # Ground elev. `-I. 83 ft. Depth to limiting factor Boring* ev. Ground elev. ft. Depth to limiting factor Remarks: Remarks: Remarks: SBD-8330(R-05/92) Lk,) < IN pkcu-- C q'i y o /ci c ire s e-1 Fe k c %� JL 601, �-,AA elk, FL RECEIVED r' . A U 6 1 9 1993 SAFETY & BLDGS- DIV. C> C) Cr", c> ty\- 1 L-WvlfjtA Of Cross Section Of A Mound Using A'Trench For The Absorption Area IH IeJ 10 Medium Sand Fill F To p so e` 3 E D m- m PP -NORM f�' Trench Of h'0 -m,2h" Aggregate,,�� *---Plowed Layer 6"'Bel ow Pipe, Covered: With © Ft. Straw, Marsh. Hay Or Synthetic Fabr �qc A E F t F t F SI Ft. H F t of Plan View Of t4ound Using A Trench For The Absorption Area Force Main Distribution Pipe- FIP Permanent,. Markers Observation Pipe 60 W A - I - - K B Trench of 3? 2 Aggregate L A Ft K 13,3 Ft. W C2 �, Ft . e�D Ft, Ft. Li, Ft. ry License Signed: Number: Date* , >7L, c-, z:z 1 IDA � t - FTC�.D tr,, F cz. - , %-. P%T—=-V-A 1-.S N c E LA TT -.amok 41, a L� ask rig jol444 cs F "A A A - a3 HOLE Ij eX -r C-A P - 17 Page_-__ Of . . 408 ����S �� wm �� �� �� o`,mo ruu*n�u UuMb 1m*\Wm �cr/iu imm^ ` (No Sma Io) ,Approved Locking Manhole Cover With Warning Label Attached ' Weatherproof Warning Label Junction Box Final Grade-,. � 18" Mini -mum n � � Minimum 6" Maximum , ----� 4 C.I�- / Insp. Pipe Baffles Approved Joint IV Extending 3' to Onto Solid Soil '5 lot 4" C| Vent Pipe with Approved Cap, +25/ From Buildings Approved Vent Cap \ | j 12" Minimum -- \ \ 4" Minimum Quick Disconnect l/4° Weep Hole Approved Join- V/C.I. Pipe CExtending 3` | � | � | \ Onto Solid So- O Conc. Block 311 of Beddinq Under Tank Note: pump and Alarm Are On Separate Circuits Number of Doses: er Day//�� Gallons Gallons Per Day/f o� Uosese Volume of B��kflow'~~....�- -allons ' Total Dose Volume:.~.....~ Ga7lons Tank Size-Septic/Pump: Alarm Manufacturer: --turcr' inches ur--.Gallons llonsies: \ Number:-+ -El nches ------ -� GllonsMod Switch Type: Pump MunuT turer' n c h + inches � o Gallons o allons Model Number `" Total = n�hes o �llons Minimum Discharge Kate ,,,,, �_�__. Vertical Difference Between Pump Off and Distribution pipe:/�61,ZFeet Minimum Required Supply Pressure:.........move .~.~.~.~~^~^+d... -- Feet ' Feet of Force Mai � Friction Fa�t�r/lOO Feet: + T ��a' ' _=~2E�-eet Inch Diameter Force MainC).� Total Dynamic Head: 00 Internal Tank Dimensions: LenQthWfdthLiquid Dept ^ f�L-'s�� ��_ ~��.~� =�^~' L/�(�.T- --/����� =� ' Numbera� Signatureicenae� , MODEL WCTm1500 1000/500 Combination Tank r, MIESER GUHURETE Rt. 2 (Hy 10) Maiden Rock, WI 54750-(715)647-2:31 1 -4r SECTION FORMANCE DA-TA ENSIONAL DR HY,,E:)R,-O-,MfqT[C. llt-�-ait P, P 5 Ft MODEL: OSP33 16 I - - NOTE; CASTING DIM. MAY VARY S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER LAWRENCE BAIERL ROUTE/BOX NUMBER .1660 WILSON STREET Fire Number CITY/STATE WILSON WI ZIP 54027 PROPERTY LOCATION: NE ' , SE �4, Section 27 T -29 N, R 15 W9 '�/s% VILLAGE OF WILSON St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes, , Proper maintenance con - gists of pumping out the septic tank every three years or sooner, if needed, by a 1.1censed septic tank Rum_ 2er, What you pit into the system can affect the functionofthe septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grallL I -Or a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new SyStCma agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, Journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -rite site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three-year expiration. I/WE the undersigned have read the above requirements and aj,ree to maintain the private sewage disposal system in accordance witty the standards set forth, herein, as set by the Wisconsin Depar- ment of Natural. Resources. Certif ication form must be completed and returned to the st . Croix County Zoning Of f kqe within 30 days of the three year expiration data. S I GNED St. Croix County Zoning office P.O. Box 95 Hammond, W1 54 01 5 715-796-2239 or 715-4,25-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT S T C -- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be'retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - r -. r r r - - r r - r r r r r - r r r r - r - ... r r r - r r - r r Owner . of . Property LAWRENCE BAIERL NE 14 SE Location.of Property , Section 27 T29 -R 15 W Township VILLAGE OF WILSON Mailing Address 1660 WILSON STREET WILSON WI 54027 Address of Site SAME Subdivision Name Lot Number Previous Owner . o f property _:, ", Total. Size -of F;P'arcel Date Parcel was Created 'fir e all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ?-------- Yes ;�.. No Volume IL `7� and Page e Number h as recorded with the Register of Deeds. - 1INCLUDE WITH THIS APPLILU I0IN THE r OLLOWING: A Warranty Deed which includes a Document number, volume and and the Seal of the Register of Deeds. In,addition, a certified survey, if available, would be helpful so.as to avoid de lays s of the reviewing process. If the deed description refer- ences to a Certified SurveyMapthe Certified Survey Map shall also be required. - - - - - rr r wr r r r r r r r .+ r r r r r r - r ....r - - - - r r r r r - r r r r r - - - - PROPERTV OWNER CERTIFICATION I W cma that att 6tatemend on th,ta 4onm ate tJLue to the but 0.6 .my (aun.) e) �y am a/lLe the- own,en ($) o � the pnope�c ty dens cubed in .thiss �Znaw.�ed e; that I (we} ( } .ice a� the 9 in6anmation Janet, by vjl tue o 6 a waAAan�ty deed neeonded in the O � �i h2 ,end CountyRegiSteA o6 Deeds as Document No. 'IF. ., r ; and that I (We) n `ent an awn .te topozed �6 to ban the .6ewage di-6 Z y4tem (an I (we), have obtained an p easement, to nun -wi h. the above dea cxCbed pnopelt ty, 6oh .the conStAuction a a ern and the barge has been duly kecmded in the 0 46ice a 6 the County RegiSteA o � c Deeds, as Document No. • SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED '`ti DATE SIGNED DOCUMENT NO. rr THIS DEED, made between Edward Z . Baxter and Irene Baxter, husband and wife and each in their own right, Grantor and Lawrence S . Ba ierl and Orel A. Ba ie rl, husband and wif e as joint tenants, Grantee, W i t n e s s e t h, Th t the aid Grantor for a valuable consideration. Thirty -Five_ Thousand and no7iom'35,000.00) Dollars conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: The Northeast Quarter of the Southeast Quarte (NE - of SE l) of Section T�UentJ-Seven (27 it To:N-nsh ip Twerst Nine (29) N orth .3 of Range Fifteen (15) West. TP j%NS ER s. 0 0 STATE BAR OF WISCONSIN-- FORM 1. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA HEGIS -ERS OFFUCE ST. CROIX CO., WIS. Rec'd for Record this_�!,�',__- day of ____ June____I.D.1973 RegZstar of ids RETURN TO Tax Key # This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; And Edward Z. Baxter and Irene Baxter. 3 warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. S rin Valley,Wisconsin this _day of .� __-__ , 19�13_ Executed at _�. -_._-—____�_..._ `.,�s.rc ;. ;`:.:'r'�3� ��w-�.'.X.,,r»;rrr'lo�wur., 'dw:,yrwa...- .. , ,r.... w.,r.... ...r_ ... _ - - _ :rr•-� SIGNED AND SEALED IN PRESENCE OF .�i�4 �- � �' (SEAL Edward Z. Baxter (SEAL Irene Baxter (SEAL r (SEAL Signatures of Edward Z . Baxter and Irene Baxter authenticated this day of 3 J•L,11C1.t % JA Titlq6 Member State Bar of Wisconsin or Uther earty AutIkorized under Sec. 706.06 viz. �. STATE OF WISCONSIN j ss. i _County. Personally came before me, this day of the above named to me known to be the person_ who executed the foregoing instrument and acknowledged the same. This instrument was drafted by is Rich r son & Skow Spring alley, Wi. 51+'767 The use of witnesses is optional. Notary Public My Commission (Expires) (Is) 19 -- r County, Wis. Names of persons signing in any capacity should be typed or printed below their signatures. I WARRANTY DEED —STATE BAR OF WISCONSIN, FORM NO. I — 1971 Fi.G Mil ler Corr+parry