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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
a a x 14 N 0 r a ST. CROIX COUNTY GOVERNMENT CENTER
- - 1101 Carmichael Road
, ~s Hudson, WI 54016-7710
(715) 386-4680
September 25, 1996
Darlene Sorenson
First Federal
201 South 2nd Street
Hudson, Wisconsin 54016
Re: Septic Inspection for Property Located at 742 Oriole
Lane, Hudson, Wisconsin
Dear Ms. Sorenson:
An inspection of the septic system installed to serve the above
described residence was conducted on July 31, 1996. This property
is located in the SE=, of the NE'; of Section 27, T29N-R19W, Lot 30
of the Humbird Hills Subdivision, Town of Hudson, St. Croix County,
Wisconsin.
At the time of the installation, this septic system was found to be
code compliant for a three (3) bedroom home.
If you have any questions with regard to the above, please do not
hesitate in contacting our office.
Sincerely,
Mare Jenkins
Y
Assistant Zoning Administrator
pe
cc: John and Audrey Hoffsommer
IMPORTANT IVMESSAGE
For A.M.
Time
Day
° 02e) V3
Phone Numtier Extension
FAX Area Code
MOBILE Number Extension
Area Code
Telephoned Returned your call RUSH
Please Call Special attention
Came to see you Caller on hold
Wants to see you Will call again
Message
aat or
Signed
LITHO IN 13:S.A.
V 48023
.r ,
NOTES .
' i
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER DM. ~~O~j
ADDRESS / t d;
SUBDIVISION / CSM#LOT d
SECTION a-] TQq N-RW, Town of_.
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r~
T
3 s
.t
~%lJo ~n
'j o
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
s
BENCHMARK: / P 41 Z07~ r
ALTERNATE BM:
SEPTIC TANK / P /
Manufacturer: Liquid Capacity:
Setback from: Well s. House Other
Manufacturer Model# Size
Float Aeration Gallons/cycle:
Alarm ation
-.SOIL ABSORPTION SYSTEM
Width: Length ,S Number of trenches J
Distance & Direction to nearest prop. line: L.J.-.* 7 g
Setback from: well: 71 House 3/ Other
,
ELEVATIONS
Building Sewer 9 9, a ST Inlet. 9 7, Ik ST outlet 7S
P_C__i-n1 et PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade_ q~ Final grade 91'. S
DATE OF INSTALLATION: 7,
PLUMBER ON JOB:
LICENSE NUMBER: / S(a 3
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor dnd Human Relations ST. CROIX
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan o.:
HOFFSO ER , JOHN
Insp. BM Elev.: BM Description: Parcel Tax No.:
CST BM Elev.: t 160
r
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet 98.) I
TANK SETBACK INFORMATION St / Ht Outlet S S'
verit
TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet
Air
Septic 5- NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System '
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift F ' ion System TDH Ft
Forcemain ength Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type 0 e c. , CHAMBER Moe Number:
System: ~.-4, ,_1 -2S J l 71OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
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
~ F•
Bed /Trench Center c~ ! Bed /Trench Edges Topsoil E] Yes ❑ No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION; HUDSON.27.29.19W, SE, NE. LOT 30, ORIOLE LANE
i
Plan revision required? ❑ Yes EY'No
Use other side for additional information.
SBD-6710 (R 05/91) Date I pedo ' Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: `
Safety and Buildings Division
v~i~=riR SANITARY PERMIT APPLICATION Bureau of Building Water System!
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. C r-0 k Y
• See reverse side for instructions for completing this application St ee anitary Permit Number
The information you provide may be used by other government agency programs 11 Check if revisionious application
[Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
G b .5C-114 Na114,S~7 T ,N,R/ *lbr)W
Property Owner's Mailing Address Lot Number Block Number
/a3 6
Ci , State Zip Code Phone Number Subdivi;i n Name.or CSM u rj
Ar' 5511 (tez) Sej &-e0 o?
II. TYPE F B DING: (check one) ❑ State Owned Ity Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ~olwn of z t'L
III. BUILDIN E: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo
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. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting 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
1 %Seepage Bed , 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12E] Seepage Trench 22E] In-Ground Pressure 42E] Pit Privy
13E] Seepage Pit 43 ❑ Vault Privy
14E] 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Edg e ation
o y 1 q I ~6 Feet / Jr Feet
VII. TANK Capacity
gallonTotal # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. ,
Plumber's Nam if. ( Int) Plumber's Sig U( o stamps) MPRSW No.: Business Phone Number:
(2a)U ~n
Plumber's Address (Street, City, St te, Zi Code):
916 s-~--ZLZ9,Zr,,0 Lar .1 "4-jy0-/-2
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (includes Groundwater ate Issued Issuing Age t Signat a (No Sta S)
XApproved Surcharge Fee)
❑ Owner Given Initial
Adverse Determination eC/d
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber -
INSTRUCTIONS ,
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any ne'.v criteria in the r
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 s"age systems must be properly maintained. The septic tank(s) must be pumped by a licensed Fumper 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, 608-266-3815-
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) of where the
system is to be installed-
11 . Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dw6!ing.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
Vi. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Compete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),'
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county- The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GRor"DWATER 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.
17
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Wisconsin Department of Industry, j
SOIL AND S ICEe ; EVALUAVON REPORT Pag -013
Labor and Hunan Relations
Division of Safety 8 Buildings in accord w*iLHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must ir~Odde, but
not limited to vertical and horizontal reference point (BM), direction and* ol-skopw; scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT S_c- 1/4 ,UE114,S 2 7 T 2.9 N,R E (or) W
P33 OWNER':S MAILING TSDST (/y'8 adf) ~o BLOCK# jjUMR PLC Hill (PA/~S~ Z
CITY, STATE ZIP CODE PHONE NUMBER / []CITY []VILLAGE E FOWN NEAREST ROAD
T MV4 /'1N- 5*5101 (Gri) ~i2-5SS>r }Iup-so/j
New Construction Use [ v]-flesidential / Number of bedrooms ' -w 3 [ j Addition to existing building
Replacement [ J Public or commercial describe
ys~ - bed,
Code derived daily flow (ooa gpd Recommended design loading rate ~ gpdm2 trench, gpolft2
;d trench, I12 Maximum design loading rate L bed, gpd/ft2__,Y'_trench, gpo19
Absorption area required ~S 7 bed, 112 /1/
Recommended Ifiltration surface elevation(s) sue? P Q 3 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material 5 oS G G 3 u4eA 1W P % - EMf-cX T Flood plain elevation, if appli6able 414- It
S = Suitable for system coM*NrIONAL MOUND IN-GROUND PRESSURE AT-T-G E SYSTEM IN FOL. HMDINGG TANK
U - Unsuitable fors stem O'S ❑ U ps ❑ U L 11 U C 11 U as ❑ U ❑ S
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bolnd3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed wndh
/ 0-/0 /a yf' /L S17 /f'sd t- /h,.6e c s 5 , y 5
13 2- 110-30 7SVe
Ground
elev. « S .s S a'~ • ~ '
n. 7
Depth to
limiting
factor
Remarks:
Boring # J'`J,~ i►►+ f ~'S 1 . S
Ground
elev.
It.
Depth to
limiting
factor
3
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Of
PARCEL I.D.! 3 0 UM13i R~ ~~1Lfs
Depth Dominant Color Mottles Texture Structure Consistence Boudkry Roots GPD/ft
Boring # Horizon In. Munsell Qu. Sz. Cor`L Color Gr. Sz. Sh. Bed Trench
3.::: I o-/s ~a 2/~ S~/, Zf s6~►f~ S f 5, 6
Ground / - 75 S
elev.
ft.
Depth to
limiting
facior
Remarks:
Boring # 0-13 /o le 3 L S/ /7~ s~i~ iy►^`FR S Zrt Y `S
1 f s6,~ s ~f - S
. ~So ~ SY~ yh
Ground
elev. it. D /o At I-
R
t
Depth to i
limiting
ffacttoo'r~ ,
Remarks:
Boring # .f~ l fS`Jr~ rn^`F/2 S .2 , y S
i z~ ~o y ,.}sl/~ f sbk wc-F R Cs
y ~s,~ o,s
elr nd
/PJ 1r. l2
it. i
i
Depth to
limiting
factor i
Remarks:
Boring # i
Ground
o
~ ~ h y
0
1
O
N
o H
1
v
Y Tio
c
o.
v ~
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% -
PONDINN I I ~
. EASEMEN ( N
J
i (DD d
/ LOT N
O 29
w°
2 .00 ACRES A I N89~ 39'42 E 223.78
o ro 87, 164 SQ. FT.
N o -LANE
CHICKA:DEE _
- t
L4
N89°39'42°E 230.51 w
-4
0
S84°30'57"E 317.62' o
r! i 616' 0
m
U 74 LOT 32
`4
m I 2.01 ACRES
co m LOT 30 m ro 87,649 SQ. FT.
ACRES c
~ z.00 A I D
87,162 SQ. FT. Z
M 2 i
_ ! 15
Q'! PONDING
~~-EASEMENT S?r004,35„e
/
Op3 ~ 288 80,
OT 31
a \ C ^ S4505d 0d V 4. A 1 2.01 ACRES
v 86.82 87,556, SQ. FT
O -
S44°10 oa E ?
66.00 S7602-7 ,
41 E
'463./3,
r
1 11
,a
SCALE IN FEET -
- goo
10o _ 50 0
a h 5 d n, ►r)e r--
PAGE OF
CrvSS .Scc~10 y5ten-n
1 1 Q ~+Om ,_J !
. i ssrs
fresh Air Inlets And Observation Pipe
Q Approved Vent Cap
Minimum 12' Abov
Final Grode
20- 42' Above Pipe _4" Cae1 Iran
To final Grade Vent Pipe
MvsA Hay Or Synthetic Covering
i - Mtn. 2' Aggregate
I
Olitrlbulion Over Pipe
PIPS o 0 0 0 - Tee -
6' AgarSgol$
Beneath PIPS ° Perforated Pips-Below
o _Coupling Terminating At
Bottom 0f System
~?t S
.SOIL. FILL
DISTRIBUTIOF,J PIPE
• APPROVED SsfWPETIC COVER
c OR 9" OF STRAW
r OF AGGR EGAIE OR MARSU KAy'
/ le OF l2 -21/t AGGREGATE
VLEV of-FEET
DI•ST11I9UTI0U PIPE TO BE AT LEAST a~ INCHES BELOW ORIG'IAJAL GRADE
AUU AT LEASTLO IUC14ES BUT.K10 MORE THAI) 42 IUCNES BELOW FIKJAL GRADE
MAXIMUM WN OF FXCAVAT110" FRoM 000441 6KADR WILL BE -90 INCHES
111MMUM 9EPrtt OF EXCAVATION FROM. 01KI6IWAIL GROE WILL BE INCHES
S I G W E D: (9th--.~
m~QS~
LIC EM SE UUMBE R:
,d DATE: y' / l~
rte'
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERMUYER XO C H c) SS a-nn m -e- r \
MAILING ADDRESS _ /o?,3 D U) Cu.- n e, V^ N Lye- d t 1on2 X11
PROPERTY ADDRESS - w / ~~C e, ►t . m 'JS "s
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE tJ id_-:;~ (Aj L S O
PROPERTY LOCATION 1/4, AJ f= 1/4, Section aC~ T ~N-R__Z_?W
TOWN OF 8,-Lj& , ST. CROIX COUNTY, WI
SUBDIVISION w\)o ( tj 11 s 1 1 1145 a LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for 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 systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three yeaZeira
t
ion to
SIGNED:
DATE: 3 ZI G
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 ,'11/93
y
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.
Owner of property -3-4' C., c)Ss o rn vn e. r
Location of property $p
, 1/4 A)F, 1/4, Section 2~;~ , T a~N-R__W
Township S Mailing address ~f--
Address of site a~4,
/e/e
Subdivision name Lot no.
Other homes on property? Ye No
Previous owner of property
Total size of property 3&
Total size of parcel
Date parcel was created ntif~~ble? Are all corners and lot lines id ,&_Yes No
Is this M; rty being developed for ('spec house)'? V Yes _ No
Volume and Page Number 1320 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:.
A WARRANTY.;DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. and that I
own the proposed site for the sewage disposal system, o r I e (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
ggnattuuAreoo Applicant /
Co-Applicant
t
9
Date of Signature of ignature
16.qCp--
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SeweE RESERVED ron RECORDING DATA
- WA NTY DEED
c~ REGISTERS OFFl
_ _ _5~402f3_-- - VOL . 4PAGE370
ST. CROIX CTY.,
This Deed, made between - Humbi-rd Lind, Corporate-on...... Read forRocord
a_Minns<5ota._ Corporate on----._
MAR 1 1996
• Grantor,
and..... ohn-_G,-,_Hoffsornmer--and. Audrey-D. Hoffsommer, at 10.15
.
husband and wife
Grantee, RegWerofDeeft
Witnesseth, That the said Grantor, for a valuable consideration.-_.--
_ - -
conveys to Grantee the following described real estate in .5t , - QQi x.............. RETURN To
County, State of Wisconsin:
Lot 30, Humbird Hills Second Addition, Qa Q _ 13 ~
Town of Hudson, St. Croix County, Wisconsin Tax Parcel No_
T A~RER
This ...........).5 not homestead property.
NX) is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And
warrants that the title is . . - .
good, indefeasible in fee simple and tree and clear of encumbrances except
Easements, restrictions and rights-of-way of record, if any
and will warrant and defend the same.
Dated this 2.1St................ day of ebruary 19 96....
.......................•---.-----...(SEAL) HUMB-IRD..LAND,CORPQRATION_.. _ '
.(SEAL) ,
• ' by ---------Z ~E.....
Austin J. Bai ton, Its President
......(SEAL) •-------------•--------•--..............(SEAL)
" .
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF iVJIXX?VG)6`X>!( MI nnes to
RAMSEY es.
_...County.
authenticated this ........day of 19 Personally came before me this 21 St day of
ebruary...•.._•.. , 19.9-6 the above named
Autin_J,, Ba_illon Pre _ s _ i _ de _
_ of
. nt
. __________1_..______..
TITLE: MEMBER STATE BAR OF WISCONSIN HUmbi rd. Land__CO_ _
ti on
(If not,
Ruthorized by § 766.9G, Wis. Stat4.)
to me e known to be the person n,A-.N t e
foregoing instrumen and Rcknswlee ~AAAA
T
'r HIS INSTRUMENT WASH
5
---pDRAFTED FIT
~ ~ IIJ1~rt
H mbl Land•-- o--r-•--ion
SL............. Cor • at-................................ o ~0 A
yd__ Paul A Baillon
Notary Public Wa5hi n tqn® 1, 2000
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, ataie expiration a
are not necessary.)
date: January..31-------------------------- Tx2QQQ)
•N- of persona alEninE in any mpaeity should be trpMl or printMt below their signatures. ~
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