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HomeMy WebLinkAbout004-1035-40-000Parcel #: 004-1035-40-050 Alt. Parcel #: 15.28.15.236A-05 004 -TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -JOHNSON, JAMES G &DIANN C JAMES G & DIANN C JOHNSON 345 HWY 128 WILSON WI 54027 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description " 345 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 31.360 Plat: N/A-NOT AVAILABLE SEC 15 T28N R15W 38.56A NW SW EXC PART Block/Condo Bldg: (0.60A) AS IN 633/208 EXC AS DESC IN CSM 17-4574 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-28N-15W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1064!252 WD ~nnQ ci innnneQV Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class Acres Land Improve RESIDENTIAL G1 2.000 28,000 85,600 AGRICULTURAL G4 26.360 3,900 0 UNDEVELOPED G5 3.000 1,900 0 Totals for 2008: General Property 31.360 33,800 85,600 Woodland 0.000 0 Totals for 2007: General Property 31.360 34,100 85,600 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 06/12/2008 01:56 PM PAGE 1 OF 1 Last Changed: 04/01/2008 Total State Reason 113,600 NO 3,900 NO 1,900 NO 119,400 0 119, 700 0 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ` ~NisconsinDepartmentofCommerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: I fl Citv fl Village rl Tiown of: CST BM Elev.; Insp. BM Elev.: BM Description: ~s•z$ ~ 9s •z~ ~ Csr g~~ 2 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~5~-y~ ~~ Dosing ~ ~Q Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. ventto Air Intake ROAD Septic ~ ~O r T ~ ~ ~ ~ NA Dosing 5 (aft r ~! ~ r ~ ~ •r NA Aeration NA Holding PUMP! SIPHON INFORMATION f~ Manufacturer s ~ .~ F~-1 yti Model Number l~~ r~ ~~.~ TDH Lift ol~.'Lj~ Lrictiono ~2f Syete a~ Forcemain Length ~` Dia. 2, " SOIL ABSORPTION SYSTEM ~ GPM 2,,5 TDH~.,S'~Ft Dist. 7o Well 7 ~ W ~ ~a J g~'Ssu+~C-t' ~ R •1-0 ~~ ~ ED Width t 8 Len th ~ o Of ~~ s PIT No- Of Pits Inside Dia. th ENI N ` DIMNI N SYSTEM TO P / L DG WELL LAKE /STREAM LEAC gnu acturer: SETBACK MBE lN d b INFORMATION TypeO . ~ ' ~ ~ ' OR UNIT um er: o e System: 5 t ~' 03 ( 8Q DISTRIBUTION SYSTEM . ~3. 3~,~-°`z) ~ _ c. 3 :~..~1....~ Header /Manifold ~~ th t ~ Di L ~ Distribution Pipes) rr ~~ in ~$ th ~ Q°~'~' i L I'~ S x Hole Size r1 ~ o x Hole Spacing / p Vent To Air Intake ~""'~ ~ eng a. g eng pac a. f b0 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over I xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes' ^rNo , ^ Yes ^ COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ~,b2/40Inspection #2: ~'1'J3/~ Location: 345 State Highway 128", ~Wils~on, WI 54027 (NW 1/4 SW 1/4 la T~28N R~1S•W - 15.28.15.236A 1.) Alt BM Description =~~'Q °~~w--/Co~.•-~ ~- ~0~~ -+~~ ~, 3 2 2.) Bldg sewer length = ~j' ,J -amount of cover = > r•q H ~'`"'"6{~ '~'"~ 3.) contour = ~ ~ aT.O rs SG~a'~~ 3' ~S a}- ~ :. (o 1.6 3~ ~~ ~ ~,n u2w `~/ n _,~~ I~ m~ 18 "o~,t. ,r«~k. l~ ~o~'-~ °o (vv i e P'I"arS r vision re ulre ?~ ^ Yeses ~ No Use other side for additional information. DS~ 03 00 ~ ~p SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. Township ,..~._". ELEVATION DATA County: St. Croix Sanitary Permit No.: 363820 State Plan ID No.: ~s i.D~': 08 ~f3 Parcel Tax No.: 004-1035-40-000 STATION BS HI FS ELEV. Benchmark ~, 3,j Ip(•63 ~8.zg Alt. BM ~'° l l S.~EZ 1 . I ~ Bldg. Sewer 3~0~ l2.38~ St/Ht Inlet ,S/$- p.ZSr St / Ht Outlet . 3 b ~ - 6.0(0 ~ Dt Inlet 6~•(0 2.`f6 9`(:b~F~ Dt Bottom (~,oZ r 91.00 Header /Man. la ''~ ~ b. (,pf Dist. Pipe 6®~~ qb •S~ r Bot. System Il• ~ ~ 96.0 ~ Final Grade S# S St cover ~~ ~~~~- ~12.90~ .9 .2dr s Safety and Buildings Division SANITARY PERMIT ON 201 W. Washington Avenue ' ` isconsin 1n accord with ILHR 83 ~ ,~ ~ P O BOX 7302 Department of Commerce ~ Madison, Wt 53707-7302 ~ , • Attach complete plans (to the county copy only) for the m, op ~- ~ot less` \~~ ounty than 8 1~2 x 11 inches in size. ' : T CROIX • See reverse side for instructions for completing this a doQ~,, ~ a-. ~~~~ ( r -° t to Sanitary Permit Number ~`~ t~ Personal information you provide may be used for secondary purposes ST ~i31', ' Y J(O Check if revision to previous application ~ (Privacy Law, s. 15.04 (1) (m)]- y' , '~;N r ~ d> ~~ p~r;i,~E :'. - ~ ate Plan LD. Number ITE ID 189810 1. APPLI TI N INFORMATION -PLEASE PRINT AL ATION ' ~ TRANS ID 308413 Property Owner Name `,1,. :. ~ ;---Pr oAeR L~ JINI & DIANN JOHNSON / 114, S T N, R W ~ 15 28 15 }Xq'') Property Owner's Mailing Address Lot Number Block Number 345 STATE HWY 128 N/A N/A City, State Zip Code Phone Number Subdivision Name or CSM Number WILSON WI 54027 (71~ > 772-46 6 N/A II. P F ILDING: (check one) ^ State Owned ~ !t Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ rowan OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 004-1035-40 ~g'~h ' Z~~ S 1 ^ Apartment/Condo - 2 ^ Assembly Hall 6 ^ Medical Facility! Nursing Home 10 ^ Out oor 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) q) 1 _ ^ New 2. ~ Replacement 3. ^ Replacement of 4_ ^ Reconnection of 5. ^ Repair of an ......System ________S~rstem_____________TankOnly______________ Existing System ________ Exlstin~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 ^ Seepage Trench ~ 22 ^ In-Ground Pressure , .i 42 ^ Pit Privy ( ~ 5 ~ ~ . x ~ 43 ^ Vault Privy 13 ^ Seepage Pit 14 S Fill ~ I ^ ystem- n- ~.,,.,~ ~S; p VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loadin to 5. Perc. Rate 6. System Elev. 7. Final Grade 60U Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 500 500 1.2 N/A 96.0 Feet 99.1 Feet VII. TANK INFORMATION Ca aut in gallons Total # Of Manufacturer s Name Prefab. Site l s Fiber- plastic Exper. N i E i Gallons Tanks Concrete act tee glass App. ew x st n st ed Tanks Tanks Septic Tank or Holding Tank 1200 1200 1 MIDWESTERN PRECA ~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber 1000 1000 1 MIDWESTERN PRECA T ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum er's Signature: (No St ps) MPlMPRSW No.: Business Phone Number: BENNIE HELGESON 220292 715/772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved S nitary Permit Fee ll^cludesGroundwater ate slue Issuing Agent Signature (NO Stamps) Approved ^ Owner Given Initial ~~s- Surcharge Fee) ~ cL ~'~~ Adverse Determination ( X. CONDITIONS OF APPROVA / REASONS FO"R D~IS,,APPROVAL: j, ~~~~ gal ~~ SBD- 8398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (Z) years. 2. Your sanitary permit maybe 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: L: Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system into be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. IIL 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. ~" Vltt. 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 81/2 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 toss; 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. ~ ~ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. co m m e rce. s tate. wi. u s Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary April 18, 2000 CUST ID No.268093 BEN HELGESON HELGESON EXCAVATION INC W1229 770TH AVE SPRING VALLEY WI 54767 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIItES: 04/18/2002 ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Site ID: 189810, Jim Johnson St. Croix County, Town of Cady NW1/4, SW1/4, S15, T28N, R15W Facility: Jim Johnson Existing Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 657039 Identifica ' s Transaction ID N 308413 Site ID No. 189810 Please refer to both identification numbers, above, in all corres ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The changes made to this plan on 4/18/99 by this reviewer were acknowledge and approved by the system designer. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ~~ erard M. Swim POWTS Plan Reviewer -Integrated Services (608)-785-9348, Mon. -Fri. 7:15 AM to 4:00 PM j swim@commerce. state.wi.us DATE RECEIVED 04/07/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7633 INDEX SHEET PROPERTY OWNER: JIM JOHNSON 345 HWY 128 WILSON WI 54027 PROJECT NAME: JIM JOHNSON p ~ ~ u~~~' PROJECT LOCATION: NW 1/4, SW 1/4, 5 I5, T28 N, ~j,1' j~~,~iDn' 1, ~ MUNICIPALITY: TOWNSHIP OF CADY ~~~ MERCE 1 j pF poM ,~p1t ~,P PR,t S E 0 COUNTY: ST CROIX ptvlS~oN , i ct~ CONTENTS: Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Cross Section & Specifications of Septic Tank & Pump Chamber Page 5: Pump Specifications ~' Name: Bennie Helgeson 5igne Address: W 1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: Apri16, 2000 Plot ~(~ c~v~ ~e v- ~ ~ w• v l ~.. ~ ~~ cso~ ~aaa~~ J • ~o~ b, U~S~ AYE' '~ y_ 3.~ ~- U. R• A o e; Top o-F l" xa" ~sf4.k~ ~th~t ,(~o7F Pro~e t ~pfL . ,/V000/'CS~ ~Y~B/'y7~/ ~ ~ ~.,e a~• i l Q ~C ffi c_s rs t-~-~ 7 1~8 f //y ,~ ~ ~..1~ ~'' = So' ~70 ~ ~l Y ~ dh~O(.UP a'' ~OUC ~~ ~lc~ . X15. d ~S > f3.M . ~tc.z~.+~ 98.8 rro~n5~ ~ D`1' '!~~r,puC Q~P.G ~ 000 6a~. T p~,r,,,,~ c.in4.~•b•~ y" ~~ ~I ~V Yi (~' ra...r ~ t 1 ~ ~in-e ~o ~ ~e s h~~ .fir Prc~OOS~ loo ~G ` ~N e ~ 1 y ~~~~ '7 EY~s/~~KS d S•d~~c~fJry /.L~a~~ to b ~ ~'~,.,,. ~R aK ~ ~.u~ ~y~ f-/wr f~~ ~~1-1- (~ IIS~.`f ~ ,~l W~ `~.1 D Y1 Y.3 SD iJ Fermanent End Markers Holes Located on Bottom are Equally Spaced eNo c N ,~ -~' Locl N~:1 To End Coo Distribution Pipe Layout F 30 ,.. R _~ S ~~ ~X r ~ f Y „~--~ Signed: Hole Diameter ~ Inch License Number: Lateral " ~ _ Inch (es) Dare: Manifold " _~ Inches force Main, " ~_ Inches Inver-~" E~r~v. ~1~. S 7 (-iOL~S I LATERAL .. .r Perloroled Pips Deloll ~ ''~' -~l ~~" • V 11'11, ~ ~ ~) SO iV Straw, Marsh Nay, Or Synthetic Covering Medium Sand Topsoil ~~ __J 1 ~7 Page _; Off istribution Pipe ~~~~ . ~9 ~G E D ~9L,0 ________J 9.~0 Slope• Bed Of ~= 2 %2 Force Main Plowed Aggregate f=rom Pump Layer D ~Ft. E ~ Ft. Cross Section Of A Mound System Using F , ~ Ft. A Bed For The Absorption Area G ~ Ft. Signed: License Number: Date: Force Main q ~ Ft. H /. S Ft. 6 ~•S Ft. K ~.6zFt. L 83.9 Ft. J 7.3 Ft. ~ T ~ Ft.~fc ~ w ~7,~~,Ft .3 G .3 ~ Observation Pipe-~ A I ~ • ~o ----T--------------- ----------------------•I w - --------- --------- Distribution Bed Of iN- 2'2" Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area I'/t(.1 PUf•1P CHP./^.BtR CfiuSS :EC"10:~: Aft![, ~PECIFIi:l.IIU~!': y' L. i t ~.'~T PIPC wINDOw OR FRESH AIR INTAKE 18"MIAI. IAILET APPROVED JOIIJT A W~C.I. PIPE EXTENDIAI(, 3' 01JT0 SOLID SOIL D C ~,~~ VE WT CAP WEATHERPROOF ' JUUCTIOW 80X 12"MIU. I I GRADE I ' I `-- GOIJOUIT PROVIDE ~ AIRTIGHT SEAL APPROVED LOC.P :•ii• MA~IHOL C COVE F'. Y" MIAJ. ~L Ifj" h111J. - , X11 III =. _/f~ (I ~/ I III APPROVED JOIfJ?, I I I i W/C.I. PIPE.; I 1I ALARM EXTE1d01uG 3' I I I OAITO SouC 5011.' I 1 o-J . 'I I ELEV. d ~ FT. PUMP-~ ~-, OFF j r I. D ' COAICRETE BLOLK ,.1 ~- RISER EXIT PERMITTED OIJLy IF TAWK MAIJUFAtTURER HAS SUCH APPROVAL ~ ~~/ SPECIFI•GATIOAJS""' C~SEPTIC E /l• 3'q TANKS MANUFACTURER: ~~v' W ~`S~~rn r~C~ uUMl3E OF DOSES: I PER OAy j~a.a(cf'1ow 6:~6'b TAWK SIZE: 100l~ GALLOWS DOSE VOLUME ~~y INCLUDING 6AGKFLOW: ~S'7• ~ GALLONS ALARM MAI.JUFACTURER: ~• ~ ~I`4-`-'"i6 ~uS~`t~S Q ~GIJ CAPACITIES:, A = ~S~ IIJCHES OR Y~7~ 6SGALL0u5 , MODEL WUMBER: ~ L ot..Y ~~~ B =~IWCHES OR ~.~= GAILOAJS SWITCH TYPE: :(~a~.~IAILHES OR ~B~+ALLOUS PUMP MAAIUFAGTURER: ~s Caw MDDEL IJUMDER: ~ ~~ I ~ IE- ~' [~ j` D= ~y INCHE9 oR..~ al-~v GALLONS . SWITCH TYPE: ~~ '~" I ~ UOTE: PUM1P A1J0 A1-ARM ARE TO DC - -~~ ~~ INSTALLED OAl SEPARATE CIRCUITS MIAIIMUM DISCHARGE RATES-GPM VERTICAL DIFFEREIJCE DETWCEAI PUMP OFF AIJD DISTRIBUTION PIPE.. lOi `~ FEE•7 + MI-.IIMUM NETWORK SUPPLY P~RE~IS~SUR,E/. 2.5 FEET .~ T'C~ FEE7 OF FORCE MAIN X a~r~-F~oortFRICTIO-J FACTOR.. ' 9~ FEE7 TOTAL Dy1JAMIC HEAD = 7Z'`.~-L~ FEET ~ rr ~ ~ ri ~g~~ IIJTERI,IAL DIMEIJSIOWL OF TAWK: •i'LE`..C~TH ~~ 'WIDTy ~-----L--~i~-IC1U10 DI=PTH ' GaI , Pte- fi~ e,~,. ~~. 3 I•• SIG-JE D: LICEN56 1.lUMBER: UATE: T Submersible Effluent Pump METERS FEET 25 20 15 10 k.5 "•~' 5 ~ ~ ~ - ~~--- - - ~~~~~~~ MODEL: 3871 SIZE: 3/4u SOLIDS RPM:1550 H P: 0.4 ;~ ; Y~„ .; o ifl88 Goulds Pumps, kic. SPECIFlCATIONS ARE SU9JECT TO CHANGE WITHOUT NOTICE Elfacdva Octobot. iS00 PRWTED W U.S.A. , ~DF~PARTf1ijENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS I~JDUSTRY, __ _-__ - ___ _-_ _ DIVISION I.~BOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSH UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: >Jwl/ Sw ~/ is TZaN/R 1sE (or ~r~o~-( - - ,- COUNTY: WNER' UYER'S NAME: MAILING ADDRESS: ~~pV~ l Q~)C 4 S ST. C~-ulX 1~-o~~z..T p~ Goc.k 1~ t ~.so,v w I s ~ o z.`7 SE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: ~PROFILEDESCRIPTIONS: PER OLATION ESTS: Residence I / ~1„)`~', ~ ~,~~,., ^ New ®Replace 6 - ! _ c~ ~ 1 - ~ /_C? 0 i21.~ I Q C'~KE RATING: S= Site suitable for system U= Site unsuitable for system ~~l.J S tl~ R~1 'S'! W `'Sl~tuH ~S11111 C~l~ (~- U._ 9l~ CO NVENTIONAL: ^ S L~U MOUND: ~ S ^ U IN-GROUND-PRESSURE: ^ S ~ U SYSTEM-IN-FILL ^ S ,(~U HOLDING TANK: ^ S ®~~_- RECOMMENDED SYSTEM:(optional) '1-')O~v"'D- t-~ 161t GRov>v~~T~z - If Percolation Tests are NOT re wired DESIGN RATE: I If an q y portion of the tested area is in the ~, ` 1~ under s. ILHR 83.0915)(bl, indicate: N • A_ Floodplain, indicate Floodplain elevation: ~1' r'\ - PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 63 ~iS, ~ 1tior~~, z,~ SL~~ h~-GE 3 eF ~ B- Z 5~ q,~, b '~ Z~ ,~ g- 3 6~0 8~.5 '~ ~-~ ~ `' B- ~ 6Z 9 s, o << 3 Z r1 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIODI PERIOD2 PER PER INCH P_ 1 Zn No 30 ll~g 11~~ 1 ~~tl. z8 P_ Z Z.a Il.-v 3 O 1 3)16 1 1/lb 1-/rb Z-7 P_ 3 -Lo IUO 30 ~/ 13~ 1 3!~ Z2 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. U~StIZ WE Dl)2l~16 ~~'SIG/J ~~GE B~j ~~tP1~~ kS 5~~~ S1 I SYSTEM ELEVATION C ~ I>v , ~' of s'~w~~ ~ `~~'`-14^"~ Si ~ TN _a M Ste- ~S I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 1A/G(,~'R~R 0'111 T~CTIAI~ NAME (print : AND TESTS WERE COMPLETED ON: 6-y_4o ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): esTooos~6 '~IS_U2S-o16~ RIVER FALLS; Wt 54022 CST SIGNA RE: .,,_ r C~2~~ 715-425-0165. . o DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - fi,:-`~,,,~~~ ~ oF3 ~' s" . } ~1"~i T~-i ~ E E~ ~" s i sport is ,~ {z i,€'st step in sc_..aring a sar7itary per€nit. "fhr cou~~ty ~ ~ `ne~~7t may rep e,t _`':- -- ~ ' °°r~.wr to permit issua«ce. A complete s<; p(ar~s for 'I~e `e se ~ a€Zd a _ sui~snit ed to the app~opr,~te .;.gal ~uthc~rite~ in o ~' r~ ~ ~ r~~~tit_ TP- . - =1d posted prior ~<~ the start os ar~y ~4 ~ , • 4 ',, . ~L.OT PLP~~_ _ s~~~w X11=s~~ 8.3 ~r ~~` 8. Z`. ~ Zp ~ Sv t1w~3L~ ~j ~ -' FoR 1~aux,p ~~ "'--'93 1 pai_ ~ i 1 ~ e. _ ~..~_ ~-- ---f____ g y , -- ~- ~ _ _~ ----95 - ---. z. _..... __ '_'-- 96 ~_.___---.~-.._, _._._. - - ~S ~~~ . _ C Nu'1"' PRoP~RT1 I.INN _... Q~RN I I I I .. 1._.._--. --- --- nT~.C~QO S ~ Cow STC~v e'(l p rv $r~ _ t_'1.LV • 101. Z. oN ~o1Tp r'I 01= 1" 1~1Y1L S loliu(, Po L~ C~`p6 ~----1 P~Q.\ztN G - -~ 1}OvsE• uR`twE~L ~. a,w ~ ~ r r 3 ry 01 ~' ~~~-~z.- co~,r~rN ~- 16~ -~~-tZe s ~~r;ST PR1,P~R.1tf t.,rNE - - Sz _ S.T _H ` ~ zg ~ . _ - - ~hG~ Z of 3 SOTL DESCRIPTION FORM Attach Soil Profile LocallOn Map On a Suparete Sheet) Cl E ~~~ ~~ ~`' ~~~~~ J~~•' LINEAR LOADINGp~RA>TE: PURPOSE ~~~-V~~ ~R ~)L ~SUR~~OI.) S~JS~~ SLOPE: ~ V ~\~~~~ ~ HIV ~ ~~V DESCRTPTION BY ~ 1 rI UgR L' W6~~~`~~ ASPf:CT; ~~~~y - DATI 6 ~ ` ~ CURRENT LAND USE• ~ ~~'~ COUNTY/STATE ST~ ~~~~X COV~.1~ !- ~ ~ VEGETATIVE CoVER• GI?~SS LOT DESCRIPTION ~ W ,ELI Sw ~~tt SAC 1S,'j7~31J1 R I S~RAINAGE CLASS' ~~ ~-~-- ~RAIAJ ~~ ~t.`) /J Ql"' Cl~~ GALLONS PER S fT. PER DAYt~~C~ ~ O•~~ ~~k• LOCATION: p~.~ ~j _._-... ........... r.~ mcnni. ~ SOIL SERIESa S • ~ 1 1 ICE `S2r I ~ J 1 1~'~~~ ~ `S ~' J -_ s2 STENCE CLAYSKINS/ PORES ROOTS PII •80UNOARY REMARKS FKXTI20N pEPTII in MATRIX COLORS moist MOTTLES TEXTURE STRUCTURE Gr. Sz. Sh CONSI COATINGS oZZ1 ~1G ~ st~v~ 1 3 0-~1 3 5 3S_~1(~ ~oKR- 31Z tib `'t R ~! 16 l.bti,R-~!/~ - Z 1'-~1 P 1'n Zp -- s ~ 1 s I ~ ~ 2 ms~k Z.'PS~ r1v ~- ~ ~, r1. _ _ _.._ C S - C2.`J CS ~ ~.s~z2 s/s lnej' ~~~.o `' S ~tb_~3 tio~tti ~1 m Z-P ~S o S M ~ _. `~ of ~ Z 2 lb -fib tio~c ~z 316 -- s i I 1 ~ ~ blz. m'~~ G S 3 2.6 Z9 1AK~. 31 CZ 5~~~ ~'F~bh m~~- a.-S ~.s~sid ~,or -- $b ~ z9-sz 1~G 3 b- q ti~~P- y J l0`-l R. 3 1 c 2 0~ - ~s S l 1~s~Yc ~'~' 3l~ k ~ v'F~ M V 'Fa C S '' Z 3 4'-Z6 ?~ b lb~-t2 3J6 ld~-12 ~ / - C Z~ Si ~ S Z r-'I S bk O ht ~ r~U ~r w~D~• 8N `~ • 5 ~ -~S BY~C~Vp 7~SY)251~} {' Ib btt ~/ Ino ~A12~ ~ C~ ~{ a-8 lb`tR 3)3 - s) l s b~c », u'F'~- c s _Z 3 $- t8 lg - 3 Z 3Z_6Z 6 S ~-sYR,s i8 ~.S `t i~ ~8 7•S YR G - C- 2 ~ -~s I ~FS 'F'S l~ ~bk o S ~ SS m v~~ ti'I V 'E'-(~ 1"l U'F-^ ~D1z$ `~i ~ gw C g S SyC2 5~'/6 -*-~T ~ ~ O- S s - ~ ~3 l~`1 R 312. tio~ z 31~ _ L ~s ~ 1 ~r 1 S bk h1 U i,• Yvl V `fir- C S ~ S ~ Z U~ tort [z Y lb C ~ ~ S ~ S h1 v ~ ~ ~. S Y2 S!9 ~ o (~ t>/r h o `Z. ~l Ok/ L l WL - L U ~ L S V S U QF S! ~--5 >~ ~.~v~ o~ tYv T~ -- 1 s l s `` .Tp.. ZZ, ''8hs ol~, sot ~ 11'1 D `S . L S ~ l G ~ ~- S i t - ~OtL ~ Lac Eau 'MU Sty ~ h.) ~.. W V ~u~ V ~~ r-) o ~ ~ S 1 S '~ Sow g ~, ~ 1 ~ '~ - So ~ ..l E N o OTHER SITE FEATURES/NOTES: LIMITING FACTORS/DEPTH: .. ~ ~~'i~~,srti. 6-y p0 00o S~~ nn~t 3 of 3 Signature Oate CST k - D~EPAf,TIdIENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, _ _ DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNS UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: Nw~/ sw ~/ 1s TZeN/R 1SE (or e.r~~~-r~ - - ~- COUNTY: WNER' UYER'S NAME: MAILING ADD ESS: ~~,pV~ 1 Q~K 4 S ST • o-~-u~X 1~-o8~~z-T pv GO C.~c 1,~ t ~.s o r.~ tv i s 4~ 0 Z`7 l1SE NO. BEDRMS.: / CO MER IAL DES RIPTION: ^New ®Replace Residence I ~1,,)~S ~~,~~.'., DATES OBSERVATIONS MADE S: ES S: Il 6- !- go b- y-9o ~io~ R~TIN[;• S= Site suitable fer system U= Sita unsuitable for system 01.1 S' il't ~Y ~') 1~1 `-"~1.`~'l~Y"1 t~S~l11U ~~ 6- y- 9D CONVENTIONAL: ^ S L~U MOUND: ~ S ^ U IN_ -GROUND-P UR : ^ S ~ U S STEM-IN-FILL ^ S U HOLDING TANK: ^ S ®U RECOMMENDED SYSTEM:(optional) ~~~ - t~ lGl-t GR..uv x,~wlt-1~'~Z DESIGN RATE: If Percolation Tests are NOT required If any portion of the tested area is in the ~, ` under s. ILHR 83.0915)(bl, indicate: N • A. Floodplain, indicate Floodplain elevation: N' ~ - PROFILE DESCRIPTIONS BORING TOTAL PTH TO R UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) a- 1 63 qS, ~ r~o)v~, z~ sc..~ T~~-~E 3 eF ~ B- Z sZ a3, o ', Z~ ,< B- 3 6~0 8 $ • 5 ~~ Z~ ~, B- ~{ 62 q S• o << 3 Z u B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR PIN WAT RLEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RI D 1 P RI D PER INCH P- 1 Zn NO 30 ll~g 11~~ 1 ~/!I. ZS P_ z z~ -uv 3 0 1 ~J.16 1 I/lb 1 ~/~b Z-i P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface eQlevation at all borings and the direction and percent of land slope. UE~>3Tty( I~L1E DuQ11U G p~`S I GN ~~ C'E 8 cj ~ ~1'~ ACS ~~'~' $1 CYCT~M FI FVeTIIt1N C' ~-, IIV . ~' c~>r ~,ak~~\ ~ `~~'"`~ Si 1 TN a S~ ~S I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. WF~FRFR SnIL TF.STlNC~ NAME (print : AND TESTS WERE COMPLETED ON: 6-y_9o ADDRESS: CERTIFICATION NUMBER: PHONE NUMBERIoptional): esTooos~6 ~is_VZS-ol6s RIVER FALLS; WI 54022 CST s~ Na~uRE: LV'~ C 715-425-0165 ~ a DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ~Grr ~ pF3 DILHR-SBD-6395 (R. 10/83) -OVER - ~~~T" PLAN:_ _ Sc-~~. ~'~= soy T • ~ ~ 8.3 ~- ''_ tom` S.Z`,~~1Zp ~ F-oR 1~iou,~~ ..~~_ P • I a. z 1 '--.,, ~ ~ --_. ~ -`~--- ~ 95 8.y _., .- -_. -~-~ ~,j ~. $'N - ~-~ , 100, O ~ ~ ---- _ 57RttL w/LATH ~ B ~ S F~•~ck - .. C 1.1 u9'• C~i2CPERT/ 1.11y t' _ .. BARN I I .. L.. ..t - --- -- Pc~Pos~ 01= 1`"1 ~1'R 1. S i iD l iu 6 I----a wC~~ PP.Qtt1l..> C _--~ i - --~ 1}OvSE oirtwE«. ~. a.w tv r 3 _ ... _ iy 0. ~' ~~-c.Lt. co~~r~ti s~ 16~ -''~~-Re. S ._ ~~~ST 'PRaPt~Si.`r`f ~rNE`~ . 1~t~G~ Z of 3 .. SOIL DESCRIPTION FORM Attach Soil Profllu Location MaP oa s 5uverote sheetl ~~ ~ C ~~•„ ~`~~'Z,S~ S NEAR OADING RAT .. 'l:) L~ ~' R SOi ~ SoRA OJJ S~ls sto l~3 3 °/u - 6 °/~ PURPOSE: ~.~1,U L. W6G~~R ASf'FCT: ~~~252LLI '----- DESCR1PilON BY S'~Z - /~ R (> -' - ~ Q CURRENT- LANG USE: ~~'~~ OATf.: S L~,~Z() ~, CAU1U LI.)) VEGETATIVE COYER": G S S COUNTY/STATE: IOT DESCRIPTION ~ ~ t~~ Sw !l~ S~C 1S TT~~1 R~ S~RAINAGE CLASS' ~} ~'L ~~1~ CI~~ GALLON9~ PER S . FT. PER DAY c ~t~ ~ O • ~ O M'1 Rx IOCATION• ~~ ~`'~ Of` ,, - SOiI SERIESt S~~ `s~,' ¢ ~"'~~ ~ --~_- FKXtiZON OEPTII MATRIX COLORS t i MOTTLES TEXTURE STRUCTURE G Sz. Sh CONSISTENCE CLAYSKINS/ T NGS PORES R00T5 PII •80UNOMY REMARKS {n, n s 0 1JG ~ sArv~ 1 3 0 - ~ ~ Z$-3S ~ o~cR- ~ 1 Z tib~ 6 - L-- Y-1.? P s 1 ~ ~ ~ Z rnsl~k r~ v ~ •~ ... . _ _ c S Cw ~ '~.S`1RSI$Jnor ~, 3S_4~ Lb`1R. /~ m Zp s I z.~s~ CS ~~~o S pl ~lb_~3 !c>G Z tib~cCi ~1 ~ Z~ '~S ©S M ~ _. ~, ~ o-~ 0 1b~R• 31 z - ~ 1~ r !ri y r c s 2 lb -Z-b 1o~c ~ 31 b - s i t l~~ ~k m f -- L S ` 3 2,6-Zq IA~,R, C Z S 1 ~ L ~~ ~h m f g a-S ~',S YR S/d hro'f -- i9-sZ ~~ttz y~ c Z~ f s l~s~~ ~ v~~ '' ~o ~ !vG 3 b- 9 l0`~l R. 3 1 - S l ~ `~' 3lu k M V '~- c S Z 3 ~ - Z 6 ~,6b lb~t2 316 1,b~-1. (L 4/ / - S i ~ C Z~ S Z rn S bk O ht >^ w,.v ~r ~J/Dtz. BI.~ ~ • s l _ ^c-S 81'C~VD t.ds R ~/~ ~p `t 1 )n T ~UpR.I ~ C~ ~{ o -8 lb`iR. 3 J~ S 1 '" I S ~h »~ U't`~ c s _Z_ 3 _~ $ - l8 tg-3z 3Z_6Z ~S ~-sYiZ s ~S ~•s~z2 6l$ 7•S YIt L ~F's ~ - 'FS c 2 ~ 'F'S ~~ J bk o s Za S3 Yn v.~h nv`t~ rit U `~-^ '-'! Dtz 8 n `~ i ~ ~ w c g S _ vn5oT2 Y/6 1 z O- s s- ~ t3 log 2 31 z. 1.0~.~. 31~ L - ~s l 1 ~. 1 s~k M y m v`F- c s ~- s ~ 1$ -2.7 l0~-! tZ Y16~ ~ ~S O SS '~I U'Fh cg ~. SY2 S!9 =f` L1 "27_ ltd lp`-t[~ Yl~ C 20~ S ~ S In U'~~ a P- 4/r r,o ~ Z ~l Oh/ L 1 Lt.1L. - V ~ L S V S U W QF S !•Tfi . ~--g Y~lo M ~.~v~ LS of t ~ c.r/ .. S ~ ~ -1 S - l s `` Cott. .T,p.. ~ Zz.. ."L~-fs ~ o!~! so! L ~ "I~,IU Su ~ ~ `, W V w~. ~? L ~ S l Sou ~ ,~ j ~~ O ~ .?.~_ E ti o OTHER SITE FEATURES/N01E5: ^ ~ o~C~~ - [, / ~.s..~ 6-Y-po 00o s~6 n~d~ 3 of 3 LIMITING FAC10R5/DEPTH: Signature Date CSi k ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer TTM R T)TANN JOHNSON Mailing Address 345 HWY 128 WILSON WI 54027 Property Address 345 HWY 128, WILSON WI 54027 (Verification required from Planning Department for new construction) City/State WILSON, WI Parcel Identification Number 004-1035-40 ~. s ~ ~~~- LEGAL DESCRIPTION Property Location ~ '/., SW '/a, Sec. 15 , T 28 N-R 15 W, Town of OAny Subdivision N/A ,Lot # N_ a___. Certified Survey Map # ~ l ~ ,Volume N I~ _, Page # Warranty Deed # ~~a`g9 3 ,Volume ~0(~~{ ,Page # aka-' Spec house O yes f~ no Lot lines identifiable ®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, restrictedplumber or alicensed 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. r~y~ ~~ ~ ro ~/ l%~l ~d 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 ~ .. '. a -. Q .~. F .I, t : « - i. - ,. '_ !S• I t ~ i ~ .. - 000UMENT NO. ~WAARANTY DEED " 'I *~~s +-._~ R[s[RV ED .DR R[GORO~MO DATA ~' STATE BAR OF WISCONSIN FORT[ ~-19t39;~ ~~ .rs128~.3 ~! i~ 2 RECISi~~'S C:. :' t ;! ,_ _ _ _ _ . ~_. __ _---~ _-_~~ -_ - _ __ _ __ - --- ---- ---- !; ST. CRC~X C~•.. ' '~ i ~~ Wilsun Rock Farm, Inc., formerly known as Wilson ; P^:'df-•, ~• Rock--and--Limestone Cotnpany;;•Inc::;:-a Wiscoiisiri ::::::::::.:::: ,. Corporation, • G. Johnson and Diann C. ' conve g and. wa ran to ....-. James ~us~and and wi:fe ~' Jghrlson ~ i _ -,•--••- .-....- ,_ • -- -- • ----• ~I ...... .•• . .. ----- - -----•-----•- ~~oa~~ _ . - i - . .. . --- - - -• ~.I ... ..... ................... ..... .. ...... ............. ...... ......... ..................... ........ '~ - - -_ - RETVRM TO -i ...-.. ... _ . ... ......................... ..... .. ...... ......................................•___ - . the following described real estate in .....-..._ $L,__Croix . .............CountY, ''=--= ___ -- --'- ,- ~~ State of Wisconsin: ~~ ' ,~ Tess Parcel No: _-• ........................... a , vy Nf J~ ~ r J f Sec. 15-T28N-RtSW. ~w ~~', t $~!_~- F~:~: This ..-..-.i.3._.-._._.-__.._.- homestead property. tis> X14~(~EX Exception to warranties: Existing highways, easements and rights of way of record. Dated this .. .....-.... -••------------------- day of •~GRi ~tctrl/_ - •--- - --. .... - ....- _ _...., I9. ~ _ Willlson arm, Inc., f/k/a Wilson ime tone Company, In~~ .-..._---• -_ .... ---- •-------- -- •----------------------(SEAL) B ~ ~ (SEAL) y. ........... .........•---.._...-. --•-•---•----.._._.._....--••----(SEAL) By:----- - '~~~- -•-- -- _ _ ..-..-..._ _ Sonja Gilgenb ,Secretary AIITHSNTICATION ACSNOWLSD(3iKSNT ~~ Signature(s) ___ STATE OF WISCONSIN +; -------------------------------------•--------...--°•--- 1 I ~ ~' I ...........................•-------.._._._...-----.._....__.._.._......_..----•• St. CroiX Count ~ ____day of ~{ authenticated this .._.__._dsy of___________________________ 19______ ger-s-ovally came before me94ia .___ _._____ ,[~ ~_ -- 19_,___ named i ----•_=_- ----•-------------------------•---------•---------------------------•- Wilson R k Farm Inc. slxa'~-- ~, ., .-; _.. I ----•-------•----- --------------1-•----- •x - ' '----------------------------------------------------- - - - - - - - - -- - -- Rock an__d Limestone - -.r~ r.'~Y';_ ~ TITLE. 'EMBER STATE BAR OF WISCONSIN Robert Gilgenbach Pies ~~~-- •. Gib enbach Secretes ~ ~ a~?' _ f4-•-_- (If not- ------------•-•------••---------------------------------•--- -------~--------•---~--------- -------r`-~'r~} 1"`~;- ----c~---. - anthorized by ~ 706.06. Wis. States) ,~ ,ne known to be the gsrsos~_~:4. 0 _ ~o ~ecuted the i+ foregoing inst ent a ' snore. - THIS INSTRUMENT WAS DRAFTED BY ~~ ~~ y bfy., s_•.S ~streeri-----•----------------• Y -- - --- -'f - -/ -------------•--------- 4i ._.. _t~l]CiSQiIly.-~OtT~_...~~.~t .............................•--._ _... Notary Pubric .~t__.._~ • ~.---•-•--•--•--..-_County, Wia. I~ (Signatures may be authenticated or acknowledged. Both My Commissio is permane t. (If not, state expirat- ~' ~.:, not necessary.) //~~ c~. I~ date: _.I/_~ [-...__._.._._._._ ~ .......:.........•°-_, 199.__..J ~ shames of jVreoO9 sltnfn~ in am pDAeitr should be typed ur printed belos+ their [iEnatuea. II WA~iiiw,_`rI! DEED S[A?H HAS OT WI9CONSiN West^nsin Legal Blank CO.. Int. ~• , 1RORI[ Na. E - 1982 Milwaukee, Wisconsin - i '~.> r ~ >i. ~ s.' 3 kale ~.. g.~. ~ ! r A, '-