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HomeMy WebLinkAbout020-1310-60-000 Q o ~ ° p ° o c c 4 0 q ~ C. O ' Q ti U L ~ C I N v I C/~ O ° I X O r0 Y Z C _ 7 m LL O ~ 0 C) Q ° Cl) z N _rn E (n O a O` z a a co z 0 o z v c 0 Q o - m Z d c o co H N z O N (h _0 0) J~ N C ►~1~/Vl Q O (D ay y .N- U) C a U o •iy v ) Q C C O U O N m Z F Z N z N d c m Y N 72 ` N ~►l 0 Y! N O C 0 O N O ~p co U) U) U) 0 N F E N - 3 O 333 o I o 0 0 z o •rv -IL IL IL a 3 7 o N o LO LO N to U -,On rn rn } = M c co 0) co rn E N _ O O - N O 1 a N N N N ~ d7 Q ~ m N N N C C, E Qs O 0) O I O Lo 3 O O O a j` c4 ° E n a 0) C. CL c E E ~.r C !U) o O O QS 3 0 U-) A CD • N04 7 - f V) E E O U O 2 N O N UJ 0 cC I I w Xk w w E d a w it EL • CL d 'U y C A U CL 2 0 Vl 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SAM ADDRESS SO X rCly~ 5o n! Al SUBDIVISION / CSM# 7 A, N N E Y 11~ 6~ LOT # Z3 SECTION / L T 2-N-R W,)Town of v D S o N ST. CROIX COUNTY, WISCONSIN i PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OY SYSTEM Gp2KCe 1 p~~ur ww`r i 0o I \N ELL ~ Ilk- Y ~ s 5 s k'~ i ~l n E,S 13. /,A, "1,Po N PIPE El.logmc° --6 07 L L, INDICATE NORTH ARROk%l L oT -if z y Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ^Tpj> o-r ~•~l~k j)7- S F LaT eOQAlEg. E1 100 oa ' ALTERNATE BM: Tp~ of HovsE roc,lupA'T I a N SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (.U:rj S t/L Liquid Capacity: 100<9 G.a( , Setback from: Well (AS House 11' Other 33' '10 sw _eaREp_ cf Pump: Manufacturer - Model W Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length G O Number of trenches Z Distance & Direction to nearest prop. line: 7.5- To S©v7N Setback from: well: b l House Z 'S' Other ELEVATIONS M44-1 Building Sewer % ST Inlet. ~,.gZ=1()q -SAT outlet 7,Z Z U7. PC inlet PC bottom Pum Off IP r ..n 3- 7. Heade / ifold Bottom of system r? q( Existing Grade 7 (Z~' 110','? Final grade 71(1~= /Qy /7 DATE OF INSTALLATION: It PLUMBER ON JOB: LICENSE NUMBER: 6)?. e-00 INSPECTOR: 3/93:jt rt WiscnsinDepartment ofIndustry, PRIVATE SEWAGE SYSTEM County: Labor a ntd Human Res INSPECTION REPORT ST. CROIX . Safety artid.B uildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village pp Town o : State P) o.: MILLER, SAM X CST BM lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 6 6 '50, 1 A9500252 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B5 HI FS ELEV. Septic O~), GO Benchmark r Dosi Rg- / co 0,0S -9 7 Aeration Bldg. Sewer Ho Ing St /1E Inlet TANK SETBACK INFORMATION /IV, Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic f NA Dt Bottom Dosi NA Header/ Man. Aeration Dist. Pipe /0• 2 76 /d1' 3.;L' _ Holding Bot. System /0 3 97-52- PUMP/ SN INFORMATION Final Grade ,>fe~os ~a Za 0 /a' Manuf and el, Z' Q(D~ Model Number M TDH Lift Fric System TDH Ft mead ngth Dia. Dist. To Well S ABSORPTION SYSTEM BED/TRENCH Width / Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S &0 DIMEN 1 S 041 SYSTEM TO P / L BLDG WELL LAKE / STREAM G acturer: SETBACK INFORMATION Type O " Cca, , CHAM Moe -u-rff . System: - jr-,,,coS ~~I5e2 $ Co/ OR IT DISTRIBUTION SYSTEM Header /u& Distribution Pipe(s) x Hole Size x Hole Spacin ent To Air In ke Length Dia. Length 5 7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ems On y Depth Over r Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed/ Trench Center o Bed/ Trench Edges 0~ 4 6 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.12.29.19W, NW, SW, Lot 23, Hunter Ridge f''~~`~•~-~,{..i`'~''.E ~7_ -7"~,-,,Q„J7~ ~ Plan revision required? ❑ Yes Use other side for additional information. 13 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division 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'~7. than 81/2 x 11 inches in size. State SanitaryPe 6 mit NymbeJ • See reverse side for instructions for completing this application vi The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Pr perty Location 4 14 ~'f ~244 , /V~4.~ w 1/4, S / Ta , N, R/9 E ( W Property Owner's Mailing Address Lot Number Block Number zox z G_3 City, State Zip Cod Phone Number Subdivision Name or CSM Number so w/ ~ o L 392'Z F/W_ AD 7- ~ II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms id rowan OF !Tu~ Sin/ 114;Z4R/ 19 -C, III. BUILD[ USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo D z U _1310 -(00 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 online 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 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 1 ❑ 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) A= 9900' Elevation, OC7 _ .6.= /o o.so 'Feet 103, c1o Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank 000 ❑ ❑ ❑ ❑ ❑ ❑ 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 Name: (Print) Plumber's Signature: (No tamps IMP/MPRSWNo.: Business Phone Number: Plumber's Address (Street, City, Sta, e, Zip Code): IF N / 6 ~ Xj f G L G~ ~5 ~ So w SS~D 416 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing A nt Si nature o mps) AA"'pproved ❑ Owner Given Initial GV Surcharge fee) / Adverse Determination 01,0e X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Coonl y, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) 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, 608-266-3815. 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 number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 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 informatior requested for numbers 1 through 7 VII. Tank information. Fill in the capacity of every new/or existing tank, list the total (jallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for al! e,)tic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental -,roduct approval from DILHR VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate )refit': (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. C "mp!ete plans and spe(i fications not smaller than 8 1/2 x 11 inches mwt be suli .i tted t,, i.he ~ _nty. The p'~ins must ae Dili' ioilowir,g: A) Plot Dian, drawn to scale or vviih complete ~1EiiiioC~s iocaUo aing tank(,), septic he(~rE,is~_ "let) tankb~' dingSk'WerSI wells, W'atf'.'t`1J1"~:`_.-r-va tc'r58r,'<<e Strt~ s.;.. i IdKF's; purnpOrslphon _.:uutlcr'.so!i-,51,orp[10nsystems;replacementsyst_,r, ,eaU, LhelV~_:` the buildino served,- -.i_dl ~,rlo el-,b: . Jer(-(e points, C,1 cor"lple` ih,itior), of _ lr.;l Onti01S; dos-E' Volume; etch !~,Jfl tJlr-rpn~c~,f, iCtlOn 1055; pltrnr r)(?!' Oman<t' ;UrVe p u -1 r C,13nd .'?,_'<ir' D) cross section of 0 son absorption system if required by the count/, I-) soil test da_a un a 1 Ur, ,1 sizing information. - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of reg~,dated practice which can effect groundwater The monies collected through these surcharges are used for monitoring groundwater t;ontamination investigations and establishment of standards_ - WEST nor ciNE~ yob zo' ~i~/p S~ffL,:C) x~ o ~ O ~ r *Nl Ll Q IC < _ o v lit n ~ylE lV \ ~o7V, W N i co 0 ~Y O ~ a a I 'tn I M p I n ~ ~ I i 110 \ z I N Fr I W a_ i o L M z i 0 W i w ~ ~ I a v ~ ~ I m z i ~ U I L Li Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations ~Pivision Of Safety & Buildings in accord with ILHR 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 C9 l u not limited to vertical and horizontal referenc action and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location &*a c n ad. APPLICANT INFORMATION-PL wA$ Ril~j ALL 1 TION REVIEWED BY DATE PROPERTY 0 ER: PROPERTY LOCATION p Q ILL t X GOVT. LOT r4L,) 1/4 SI.U 1/4,S Z T 7- / N,R E (or) W PROPERTY OW ':S MAILING 4 LOT # BLOCK # SSJBB. NAME OR CS &C, c IAN R4 15 Roov, 73 CITY TATE DE . I E ❑CITY ❑VIL GE OWN EST ROAD 1-4 U QsN 1/\ I) tNr U &sow NNLY L;4NI< [Df New Construction Use (01 Resi 1 o ms A/K [ ] Addition to existing building j ] Replacement ( ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 ©.7 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate - bed, gpd/ft2 O.trench, gpd/ft2 Recommended infiltration surface elevation(s) ft as referl,[e,~,d~,,to~,,site plan benchmark) Additional design/ site considerations EVAL04'rif 01) Nom t'LA-T- N YA L Parent material Flood plain elevation, if applicable ft S = Suitable for system VENTIONAL UND I ROUND PRESSURE T• RADE SYSTEM IN FILL HOLDING T K U= Unsuitable fors stem S❑ U S❑ U as ❑ U S❑ U S❑ U El S 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 /h o-13 b 5b~ n, r e5 Z d 4 p - IS K.ti +4 / Ile 1 h:ti I~-ss 16y,2 14 S~Z 1 m sb my cs i 8.Z a,3 Ground ex -112 JIaL t~4 S yY► 0.7 O elev. q 4 ~s4-ft. Depth to limiting Remarks: Bow ng. # A 0- ,j ~dYi23 I S 1 rnsk K yn~r C5 o. 4 0 -S ' 18-3 >D`l 4 4 5)L l rat sb ,Ny r cS 1 ©-Z 6,3 8z 418 16YR ¢ S m 1 C L-7 6 A Ground elev. 168'CIft. Depth to limiting ~f~tQL ~ Remarks: CST Name: Please Print Phone: Address: u es1S~1!`W~ gC_pndS Signature: Date: 7L 1 9 CST Number: 3AIK4 L) U PROPERTY OWNER ~dm`'`~tL SOIL DESCRIPTION REPORT Page Zof• 3 PARCEL I.D. # &-F'2-3 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench -W-0-27 16V011 -5 v Tr) 6~5 z~-11 6 zo~i~e+I¢ - s 0 ,►,1 - o.? a.g Ground elev. isam /ft. IC Depth to limiting > Remarks: Boring # 0-13 /6Vk Z 5~ 1 m s~k rn CS 2 Q, 4 _S b,, 4 - S, j sbK ew I 62 6,3 r24 I f4 Ground elev. ft. Depth to limiting or fiat/ t U ~ Remarks: Boring # A `~s owe3Jz SL 1 117 .6 Y, rti, l cs 2 oA 16 ~s 3Z o~ik 4 ¢ s~ r rh l c S 1 0;4 6's, . Ground elev 9LO ft. Depth to limiting Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: gnn_oonnIR n'711,11 4 ¢ 4. U i 6 ~ i r~ I J` I M V' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S19- M 1'J /ZL £iL MAILING ADDRESS I3 D X L S Z_ PROPERTY ADDRESS 10 7 fay tj_rF le- 2 1 D 6 E (ldcation of septic system) Please obtain from the Planning Dept. CITY/STATE 141-)D .50 ICI k-,4j I Z:~& / ~o PROPERTY LOCATION N uJ 1/4, 5 Ck) 1/4, Section / Z TAN-R Z 9 W TOWN OF jqcJD 5 w M ST. CROIX COUNTY, WI SUBDIVISION 7-4 A(YF- R LOT NUMBER CERTIFIED SURVEY MAP -5_7~ 1,7 VOLUME PAGE 3 LOT NUMBER vZ , 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 year expiration date. Q SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 j 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 i & llz-" Location of property 1/UJ 1/4 S u~ 1/4, Section T, 97 N-R ~7 Township /f v pS o AZ Mailing address ~oXZ BL-- ffUD So// uJ / -s-/o/ 6 Address of site /D 7 Sl Subdivision name /ST ,Qpj~ io T~f~Nf' &Ipe.~ Lot no. 3 other homes on property? Yes No Previous owner of property w. S r, a~ Total size of property 3 . 7 f} c Total size of parcel 3 , 7~- ~q- Date parcel was created 6- 9 S Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house) ? X Yes No Volume /03/ and Page Number ys~ 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 (we) presently own the proposed site for the sewage disposal system or I (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. natu of Applicant Co-Applicant 11t(- Date of Signature Date of Signature v DOCUMENT No. STATE BA F WISCONSI ORM 1-1883 r"u rrAC[ """"o FOR s[COSOi"a DATA ARRANTY 0 D 304855 YOL 1031PAGE 456 r._OSTER'S 0 F1CE This Deed, made between 1 1 X co. %VJ Randall W. Synan and Patricia E. Synan, ;eeQ'txRecord _husband__and . . . . if e ife . Grantor, 1 SEP T 1993 ' and §am E....Mi...ler.,....a.s3ngle..person. ~t 10:4 A. M Grantee, { q. ~y.e, ,f Uesa9 Witnesseth, That the said Grantor, for a valuable consideration...... .r Randall. W. Synan and Patricia E. SynaJnX Raruam To conveys to Grantee the following described real state in St Cro.1 County, State of Wisconsin: TaH Pared No: The SEI/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 < of SW1/4, and the South 53 rods (874.5 feet) of the SEI/4 of NW1/4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. AND part of the NE1/4 of SE1/4 of Section A parcel of land located in 11, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point ~q of -eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence SOO 28103"E, 500.00 feet; thence N8q 30100"E, along the North line of Certified Survey Map filed in Vol. "30, Page 722, 38.08 feet; thence NOO 11133"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. This .1A..nQt.... homestead property. T (in) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And..... Ra.ndikI.J. W-. . S naY.... •-n• and Patricia . . . ..E. . S _y..n..-.an warrants that the title is good. indefeasible in fee aim ple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. si slid will warrant and defend the same. ti Dated this day of ..-A.LIy.LAS.t............... 19...91. GLYtOr~J`f...wr. ....!'!...(SEAL) ~Glakl~.tc!ti.E~..!!✓ ...........................(SEAL) ' Randall W. Synan Patricia )Synan .r, . .....(SEAL) (SEAL) ' • t. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATZ OF WISCONSIN r! as. St. Croix ...................................County. authenticated this .........day of 19 Personally came before me ;tty ✓-i---•..•.day of August 19.......... that above named Randall W. Synan, Patr~cxa E. TITLE: MEMBER STATE BAR OF WISCONSIN Synan (If not, A~4. ~0 authorized by 706.06. Wis. State.) ~I to ma known to be the person ..-I....... Hawy:9 ha I going inst2v nt and a n w1e*e*tfCOfW1>i THIS INSTRUMENT WAS DRAFTED BY 1 Kristina Ogland _ r At............................................................... GCSrney at i;aW Alice Joy o ors k Public County. Wis. t (Signatures may bA authenticated or acknowledged. Both My Commission is permanent. f not. easte ezp' anon are not necessary.) date: - •••1 1Q k .Names or person, dgnine in any capacity should be typed or printed below their signatars. WARRANTT DEED STATF. BAH OF WISCONSIN Wi-omin Lod Blank Co. Inc _ FORM Na I-1912 Milwaukee. 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