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HomeMy WebLinkAbout020-1287-40-000 -0 C) 0 3 o I M p Esr o to c I a a o o I N I c I ~ I C I 'y o, I Eti I I a z C U- 0 ~ I Q I 3 M I v o rn z E z °o z E CL co c-4 LU N F- (n I O z L) o v in H a I N a) 7 I o_ ° o a O o O a ~ M M N I -0 .2 w O O z in z O o N z Z o N ° U) ) ° L m a' m a R L LL H N L D ~p a 0 a Q o o ° co c n ) E o I CL a a • ~v M (L 0 a CLO LO ) a) N to -j U a rn rn > 2 'V a) o c O a o o a ml ~ a I a o fn o I m _o ~ I o ° y c E 0 O O W CD (n U) ff (M I CD 0.) r\ o r w ~ a~i a~~~ I v c V) 70 Cl) 4) a, (D e=xl ON N C N p N cu m t4 V •~1 ~y O N= J N O z N U V ~ N f6 ~ G. ° n. w • G N V d c r_ 7 ♦x r~ r A 0 a m O cn 00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L~i2 ~E/e L fJi~l DELL ADDRESS 8OX Z Z _ ~k A SUBDIVISION / CSMW WEI-L 5 jr/44 0 STATIO N LOT SECTION c / T O N-R Town of H C)D S O W ST. CROIX COUNTY, WISCONSIN PLAN VIEW. SHOW EVERYTHING WITHIN 100 FEnT OF SYSTEM kl KE ~ z ~ loss ,2 110," 311~ 49 ScRlE IV :7 SYC1: ~y0l7 I Ae~vE - WA,J WELL j3 AA - DDv&r JA! L/ IJODD INDICATE tIOP'l'i Provide setback and elevation information on reverse of ti, i forr, Provide 2 dimensions to center of septic tail-: BENCHMARK: De)vj?<E asb//cE /N r'Xte` A WO ?41r Ar SE(ofjt~~ /Gb00 '-2 z ' ALTERNATE BM: Si// pF C✓AtK -otJ'j' X002 eE~= 5!9Z SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION r Manufacturer: C.yEiJE tt Liquid Capacity: /4000-4L, Setback from: Well ~9r House 0_/,&" Other / F6 was? L074 Pump: Manufacturer ModelV Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 410 Number of trenches E C4) Distance & Direction to nearest prop. line: /jol*'O i Setback from: well: 10-5- House Other Vs To '57- ELEVATIONS D Building Sewer ST Inlet. 0 ST outlet ~e$ PC inlet PC bottom Pump Off Header/Manifold (Qr~ Bottom of system Existing Grade Final grade -7 Z DATE OF INSTALLATION: 1-2 PLUMBER ON JOB: '/O T~Z -1 _ LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan LUNDELL, ERIC & SAM MILLER X CST BM Elev.: Insp. BM Elev.: BM Description: !Iudgen Parcel Tax No.: 166 ct,4 ~a-6 A91500004 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Da,~ 00) Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 61 S~ 2s- TANK SETBACK INFORMATION St/ Ht Outlet 0,13 Vent TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic /y~ l a 6 }a S" NA Dt Bottom Dosing NA Header/Man. 7 3 /7 Aeration NA Dist. Pipe Holding Bot. System 7 95,2 PUMP/ SIPHON INFORMATION Final Grade f6l/ 90;C, /o Manufacturer Demand s0a,_jv, I Model Number GPM I Loss Friction System TDH Ft TDH Lift Ii ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 18, D DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O model Number: System:` 6(iS 1 ~O S 4) OR 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 Bed/Tr nch Center Bed /Trench Edges Topsoil El Yes C] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.21.29.19W, SE, NW, Lot 4, Prairie Lane - 4fit,67~ o Fr ^ q6/ g Plan revl~Sion required? ❑ Yes ©-14o Use other side for additional information. Ic SBD-6710 (R 05/91) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code o~"",jTM STATE SANITARY PERMIT 01 X31 0 # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION P4-("-- C ugDeLL SAR fu k_ S~ '/a W 1/4, S z/ T z"/, N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # o 4f 7, V, 2 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER vp So w~ Yo / Z 76 Q' tor-U, S r/9 Gd _sT)l T I b 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD / ❑ State Owned ❑ VILLAGE Hui) 0 1prAIX14- 4414,E ❑ Public 1 or2 Fam. Dwelling-#of bedroom S3 PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 7 / 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. P New 2. ❑ Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Xn Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 r~ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION J (P y~ 7Z O D, 7 ! y~0 Feet F IF 00 Feet VII. TANK CAPACITY Site in gallons Total of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1 W f 5 iC F1 n F1 1 171 Lift Pump Tank/Si hon Chamber Vlll. 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 Stamps) MP/MPRSW No.: Business Phone Number: !~l(15 Mt ~ O LJ IMP(Z 5-3 $oc7 3g 8p9 Z._ Plumber's Address (Street, City, State, Zip Code): ire o.,. JYi; k~ U D o n $ s IX( IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I uing Agent Signature (No Stamps) Approved ❑ Owner Given Initial sY~ Surcharge Fee) ✓ / Adverse Determination u X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 the 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 & 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. II. 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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. 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'/z 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. 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, ground- water contamination investigations and establishment of standards. I SBD-6398 (R.11/88) LUN DE LL~S,At11f ~ILL-FR_. Sro NAl RAE LAtVF ~ )FlLS F-A,240 ST roxt ~o~ y A'Rk S- 3soG -I,)P SOIL ".5 ZEF-N STS; P a f lb -1 n Th;s f3-L A LT 14 07/ = 9yoo i v t a ri h , o r'I s' ~e~F ae. bo' sYX3o ~ ~S ! p Wt: u R I z~,y ~t I'15 aA, 1 l- 'SPIKE uY t148 ~ ~ S~~NG D21d~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT C). P, Page I of 3 Labor and Hinman Relations Division of 3a;1,y & 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 Ix 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION p p 5 1,' f GOVT. LOTSrr 1/4NW 1/4,SZ1 T 29 N,R E (or) W PROPERTY OV~]~! ER':S MAILIINA ADDRESS LO # BLOCK # SU D NAME OR CSM # Td$ -AA WEc S '?Ak6o S-sAT/C)" [RINMU TATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE 57OWN NEAREST ROAD, Aso rv ( ) s4 CT N u w New Construction Use [Af Residential / Number of bedrooms Addition to existing building Lg j Replacement [ J Public or commercial describe Code derived daily flow6 gpd Recommended design loading rate (17 bed, gpd/ft20 trench, gpd/ft2 Absorption area required 6A; bed, ft2 s6s trench, ft2 Maximum design loading rate O. 7 bed, gpd/ft2_0 Z trench, gpd/0 Recommended infiltration surface elevation(s) AE A ( - 95.76 ft (as referred to site plan benchmark) Additional design / site considerations AREA Z 94-00 Parent material Flood plain elevation, if applicable ft S = Suitable for system ONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING T _MK U= Unsuitable fors stem S0 U ®S ❑ U PUS ❑ U 0 S 1:1 U MS ❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend E3 -91 J--Z'K_ /,OYJC I t7,-sGK r1i Q S 1-~F (32- 6, Ground -43 /p 3 s m r S l 02 0,$ elev. - - Q ,7 ~ gg.6Z ft. 3-119 I 414- 0 o r Depth to limiting fac or Remarks: d a ~ S6 I L Boring # _ 1 oY 3/ M S L k rh ~r C S 1 d 416 Ground elev. t~ - Z C9 4 3 p, 7 16 8 /d2. f 3 ft. Depth to limiting factor >/6.33 Remarks: CST Name:-Please Print Phone: ~E6 4oga Address: U ~C)X ^I 1~ n/ W I Signatur Date: / 2~ n CST Number: ~W PROPEMOHINER"54M, MI LLE SOIL DESCRIPTION REPORT Page of PARCgt„ f.D.1; ~ 4 ~ C LL S FA P,(, C) Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench SbK M c o,4 o s 14 10-2-6 &M-311 - r , s 4! -•Z / U`/~ 4 M r Yh 03 .g Ground 9-7 elev. bb-, AK ft. Depth to limiting factor /O.o6 Remarks: Boring # D _ r c5 -sL (3 h .7 o. 8z ~ -7 i ~ o-,IR 4 o Ground elev. qi •5-, ft. Depth to limiting 4ctor > .~3 Remarks: ~tL Boring # D} _ y~ 4 S L O M r I17 , c s On, 5e ri s / /ove 4L4----- Ground elev. CY Depth to lliiamitionng~ > '7 •S" Remarks: I L Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) C 3 0~ i Nw -RA iL*o,at pA~;~ 3 1 ~ l~ STS N L►'~~. 100• - , \ .r ►S i J 1 0 qs 4 Q~.16, 7S _ - - • is i 1 i l ~/V N W Fo= N ° aa.. ow w FL n, a. w o y u _J = Z 0 ^ C7Y UJ F- p (n F- S b :D M x Jd g I C" 1 M s Z F- ~t z ~ F ~I a W I s.. o1 1 1 M 1 I wd I 1 I 14- ' l.L I w i= I I I d ,r,~ 1 r~ 1 1 Qz I I I J a ~ ~ U l I a I LIJ I I I I I I x C.~ v I I I ~ 1 ~ I I I o I r: ~ M I io I i~ I M I - 1 1 1 F CL i ~o I l I 1 -Oj V) ~ 1~ 1 1 z ~ 1 to I o I I o w I ~ I ~ I I w " 1 4 a ~ ~C Lw I I I " I I Z 3 10 J I I I ~ ~ s I ~ I Q I s~ J ~ I I H °~f' Z I 1 to l 7 -~eAr,•, , i, ti.d ;•y rid;<~,y4,., 4 - 104 08' a - ro .'.-1''-~i_i~'S l 1~. ~(i' .-'.-.t1*. ~ yy qr w...~ ~ _ ~ ^:1 1 iyc~•. R .l. . - 1. Lv:•0..CTl-+4hA.: . _ ( e#'•'~ Ru.w£ aor~ a fi ol..~ (p 0'q , \ 'A * v w sr CY, _ ° lb. ,A. Mfr. 3v o N) ED 00 N p % OS, 98.45' DRI VE 4 ♦ / 20 L8 45 Z 00 \ N o 1'rl i rn f- No_ a~ m o ~s 10 [v \ oo `a w o \ w *S cn a) UI N \ 1-a f n N V7 y G a 0 o fD W V ' c0 A ° w \ cn to ~ r > o a ~ ro ~ ~ v IA~ ) . ~ ° 266.08'_ rn ' y+ 3' 1 .ti4.~. r. n r f,, S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~~IG- GU~lD~ Lt, SA ~'7 /?'I 8 Z... FIRE NUMBER T-/cO ADDRESS qV_.P CITY/STATE tl 50& ZIP PROPERTY LOCATION: X1/4,,V14) 1/4, SECTION T LN-R / W TOWN OF L) D S o, , St. Croix County, SUBDIVISION /(,f-l-L5 EA460 57AT/P& , 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 a 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. Cro' Co. Zoning Officer within 30 days of the three year expiratio date. SIGNED: DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 i S T C - ioo This application form is to be completed in full and signed by fthe owner(s) of the property being developed. Any inadequacies will only result ,n delays of the pormit issuance. ,should this development be intended for resale by owner/contractor,(spec house), thenla 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 ,L ONE Df L I— ~ SA W /i? /LLaE~2__ Location of property5 - 1/4 /VW 1/4, Section Z , T _j'7 N-R LZ W Township _ So N Mailing address A*t*,O Y ~-(u Dso~I W~ S~oI~ Address of site _S lc /21 C_~: L 14 AIE Huo,SVA z W -S"`5`0~6 Subdivision name W E L4~3 F~j~ LQ r"XT CAN Lot no other homes on property? yes- _No Previous owner of property 4/(//7A k 2 k LL. S Total size of parcel Z~C Date parcel -was created _ (2 30 'Are all corners and lot lines identifiable? Yes No is this property being developed for (spec house)? A- Yes No Volume 7-_2g and. Page Number Sf9 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICA'T'ION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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. _q"17 a-9 / , 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 County Register of deeds as Document No `I-77 Z9 Signatur of applicant Co-applicant Date of Signature Date of Signature DGICUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA • STATE BAR OF WISCONSIN FORM 2-1992 477291 voc 1 t,319 REGISTER'S OFFICE ST. CROIX CO., WI Recd for Record Anita G. Wells. a single woman DEC 3 01991 M conveys and warrants to John- A. Elbert. and Eric JLundell&Allto Regh& ofDe aa.Tenants-in Common,. an. undivided. .one-half. interest...... vach.... RETUPN TO the following described real estate in .....St.-.Croix - -__-County, State of Wisconsin: Tax Parcel No: All that part of the Northeast Quarter of the Northwest Quarter (NE}NW}) lying Southerly (Sly) of the Railroad Right-of-way; The Southeast Qu&.rter of the Northwest Quarter (°E}NW}); The East Half of the Southwest Quarter (E}SW}), EXCEPT part to Alfred L. Ekblad , in Volume 498, page 484; part e to Leslie L. Swenson in Volume 498, page 504; part to ~p Donald F. Johnsin, in Volume 500, page 525; and part to Fi++~ Donald L. Jordan, in Volume 580, page 354, all in Section Twenty-One (21), Township Twenty-Nine (29) North, Range Nineteen (19) West. This Warranty Deed is given in full and final satisfaction of that original Land Contract between the parties, dated December 4, 1989, recorded December 13, 1989," at 11:30 A.M., in Vol. 858 of Records, on page 633-634 as Document No. 454203, Office of Register of Deeds for St. Croix Co., WI. N This - is "t.- homestead property. (is) (is not) Exception tl• warranties: Easements, restrictions and rights-of-way of record. Dated this Z7.th _ day cf _ December 19 91 (SEAL.) (SEAL) Anita G. Wells (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signs e(s) OF Anita G. Wells, a STATE OF WISCONSIN si gl woman ss. . ~ gut a d t .ZTt~la of...---December - - - County. 19q1 . Personally came before me this - day of 19.---- the above named Leo A. Beskar - _ - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, - authorized by $ 706.06, Wis. Stats.) to me known to he the person wlio executed the foregoini instrument and acknowledge the same. T'1:S INSTRUMENT WAS DRAFTED BY Leo A. Beskar, Attorney . . Rod119 '3eskar-6-Boles9- ---9: C: . . 22e19-NorrFth1.MaiaTStr, Notarc Pnhlic (bunt}-. Wis. (SiiedtrUrPti~~ fie ali'Ke E, ted or acknowlod~ed. Roth WN Cmiimi<sion is nernnuunt.(It not. state exhiratimt are not necessary.) date: 19 ) •Vames of persons signing in any rapa,rity ::,h~,lld b., t,I-I ..~.+.,I !h. it - : W:gcOnsln L•~ ,a' Blank Go Inc WARRANTY DEED STATF, BAR OF W S SIti FORM KM No. . 2 - I:. -02 Milwaukee 7Visc onsip