HomeMy WebLinkAbout038-1170-60-000
M
M 0. O
Q
N
N
a
y
a
a ~
~ x I
y ~ I
FV m I
z y
7 m
LL C co
4 m
O
Q ~
m
v ~ I
W E
°
O
L
z a
m m
co W a m
o I
o z v c
avi z d o
_ E
` N N
ca a)
O N C
CL u) C I
Q CO 0 Q p tll
0
Z 00 Z V_-
O
N
O N
N Lo E
Q O O O
C O
J~ ? 0 0 d Y
~~V E U N
U rn E cL to _ o
r
s: o00 Z o
•w a o. a m
o N a) U-) to
to J m rn rn }
0 N c C)
0 0 ~ O N
In E
N
-p m d
N
co cn Q)
Q ; ya
[ O I- 7
O C co N C
O 30 C
E 00 0)
O". O N~ (0 N C rn La If rn O
co L2 CL r-
00 -r
v O co 'Fu Y O C E N p
CD 0 r- Lo
42 F-
04 d .U O Wf N
C6 'u
p m ca E tzi
C6 * N _ 1
O fn m N 0 Z fn
it -
~ I
O _
v cz I
m EL CL
• O. V d C
r~ 7
A 0 n 0 in U
1
` 19q6' t 1 _
FORM - STC -
AS BUILT SANITARY SYSTEM REPORT
OWNER Kf F•Ju ~ 74,-C TOWNSHIP
SECTION 3 TN-R__t/e_W'`
ADDRESS_ POv ST. CROIX COUNTY, WISCONkFN 1 1 l 1
~S,C ~C, lCj- C01, SUBDIVISION OC vAJ r-,4 /Ve a (3t .J' LOTJ-LOT SIZE y~ x Q
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
,tau S, VIA ''U
f~ q
~PrA
~ t-o t~-
~~I'
Cl
a a a` i
INDICATE NORTH ARROW
BENCIMARK: Elevation and description: e, ,4 ~e- slt coil fveh.
Alternate benchmark 00.5'e.
SEPTIC TANK:Manufacturer: P t-f C,-A" Liquid cap.
Rings used: jNanhole cover elev: /0""Final grade elev: /Q ~6
Tank inlet elev.: 9? ,g ~ Tank outlet elev.: C? P 6 7-
No. of feet from nearest road: Front 110, Side 9c) , Rear,yFt.
From nearest prop. line:Front/ie, Side?U, Rear?Q Ft.
No. of feet from: Well ~-a J' , Building: ~z V
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front-, Side_, Rear-Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed:- Y Trench: Seepage Pit:
Width: Length 6 ~Number of Lines:_,J,_Area Built
Exist. Grade Elev.ll-$L),J r Proposed Final Grade Elev. Jd 6; 1-7D
Fill depth to top of pipe: 3.5.-
No. feet from nearest prop. line:Front , Side_&" Rear.leJ Ft.
No. feet from well: 5U No. feet from building 'y6
~rS7/eA4 51e,, C/ /
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR: nJ
DATE : ~I J J PLUMBER ON JOB : ~
LICENSE NUMBER: /V S'
6/90:cj
III
i
i
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and'Human Relations
Safety and Buildings Division INSPECTION REPORT' SIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
PeBRUNCLIKrmit Name: GARY ❑ City Village Town of: State Pla o.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
k
DU
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic C Benchmark 59~~ ~OIJ c~'
Dosing /ez),
Aeration Bldg. Sewer i 9 St~'
Holding St/y( Inlet 9fl'
TANK SETBACK INFORMATION St/ Outlet '
7. of ~,L
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake _
Septic ~S0 70 /9' NA Dt Bottom
Dosing NA Header04
Aeration NA Dist. Pipe Gp ,pS'
Holding Bot. System
r°'~' lo, /Sl
PUMP/ SIPHON INFORMATION Final Grade'
Manufacturer Demand
Model Num PM
TDH Lift Friction H Ft
Forcemain Le Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length i No. Of Tr nches PIT No. Of Pits Inside D' i epth
DIMENSIONS o2 ~d DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC Manufacturer:
SETBACK
INFORMATION Type O pe MBER Mo a Num er:
System: laud OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) cif x Hole Size x Hole Spacing Vent To Air Intake
Length -(Z- Dia. Length -:22/ Dia. Spacing __LL
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S
s
Depth Over Depth Over / xx Depth Of xx Seeded/Sodded xx Mulched
Bed /Trench Center 3Co Bed /Trench Edges - Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) -t A5 f-bt Lt _S2[
LOCATION: Star Prairie.13.31.18W, SW, SW, SE, SE, Lot 9, Stardust Dr.
V ~
Plan revision required? ❑ Yes Lti'No-
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
i
SANITARY PERMIT APPLICATION
UILHR In accord with ILHR 83.05, Wis. Adm. Code couN
STATE SANITA@Y PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than pnL`II'V~Uq[~r
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
GY. SWII., S 13 T.3/, N, R 8 9 (or) W
PROPERTY OW R M ILING ADDRESS LOT # 1 ~ BLOCK #
/f/ o a i*C 7
C TY, STATE ZIP CODE PHONE NUMBER ISUB VISION N ME OR C,aKjNUMBF,R
~)TJ
Q2 (71
j ;7
WE' 1--g
II. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) State Owned ❑ VILLAGE
❑ Public 1 or 2 Fam. Dwellin J r dw s
g-# of bedrooms 3- PARCEL TAX NUMBER(5)
III. BUILDING USE: (If building type is public, check all that apply) 3 / 7 C
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
50 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. New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E1 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 Z 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 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. YSTEM ELEV. 7. FINAL GRADE
>\DAY REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gy/sq. ft.) (Min./inch) 8 ELEVATION
` O -7o .72 3- g Feet / Feet
CAPACITY
VII. TANK in allons Total # of Prefab. Site Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank ter G 1: G
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): Plu tier's Signa re: (N tamps) idP/MPRSW No.: Business Phone Number:
Plumber's dress (Street, City, State, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued I ing Agent Signature (No Stamps)
pproved ❑ Owner Given Initial V Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/86) 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 the time of rer)E:wal 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 (SB'--) 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. Comp+ete 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% 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/%vater 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; (Jose 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.
SBD-6398 IR.111881
a I~r U Av
2 S1ys~e Elegy 96 ~-2e ~4)
7 I S - 7S75- 7,7 SCALE I 'I x t X C ~2~~ I~c J N~} / E'
' I
p T' -h NL' ~~~y'
IN -/-op
S~►~ 1e 5'9 Co wee r _ Joa'
Q - gar Q
• I /Jr o~o~,3e~
/0 0
A/e
#y Pl
u,3 :5
09 7,3
~dc/< C.'~. o/
D~PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
,INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76
N WI 53707
HUMAN RELATIONS n
jw - ' cam! (ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: NIL & W TOWNSHIP/ NICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
~;6 1~ L-) V4 13 /T 13i N/N8 C (or) n 9 "10
C NTY: ( MAILING ADDRESS: Jr
6USE DAT S OBSERVATIONS MADE
rra~tt NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DE CRIPTIONS: PERCOLATION TESTS:
~IResidence At V ~~1 New ❑Replace ZZ /91g-f ~p3
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
®s ❑u Ms ❑u ®s ❑u ❑s 2u ❑s,~u £D
If Percolation Tests are NOT required IDESIGN RATE: I If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-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- e 08 o. S8 > P8 ®-8 e , - z ,e cs~~,• , z~ - 3 s ",e. e7 s 3Y-
B- Z
Z-rSrus /-pct" s 'v - z "Bay' S
B- .-s S~ ~ Bl c✓, /-LV 4~ ~~`~i / Za-356
69
B- LJ~ • ~JU ° 6(/ - y 3 ` 2. 67J,/ , 2-3- 36 4a`L~Bh.~ e" Vs 0-8 n _s-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P- Z Y Y
o
P-
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.
SYSTEM ELEVATION •z $ D ~"-'t-~-`
-i-~
4
D 4 Ac _
2.~
f
o4- N
> z s SCENE' N
CV)
- -
G '3
P 01
O og
C!x
COST C
i 1- Y9 CaiH
_ FFIC
I 5 _ C)NtNc±o,
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.
NAME (print TESTS WERE COMPLETED ON:
u ~ ~J r X93
ADDRESS: CERTIF ATION NUMBER: PHONE NUMBER (optional):
~uc4 lay ~~s y71
CST SIGNATURE:
C ,
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use suction must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER
SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
8. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet
may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if
appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and yur certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL
AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 1U') BR - Bedrock
cob - Cobble (3 - 10") SS - Standstone
gr - Gravel (under W) LS - Limestone
's - Sand HGW - High Groundwater
cs - Coarse Sand Perc - Precolation Rate
med s - Medium Sand W - Well
is - Fine Sand Bldg - Building
Is- Loamy Sand > - Greater Than
.sl - Loamy Sand 'c - Less Than
'1 - Loam Bn - Brown
.sit - Silt Loam BI - Black
si - Slit Gy - Gray
cl - Clay Loam Y - Yellow
scl - Sandy Clay Loam R - Red
sicl - Silty Clay Loam mot - Mottles
sc - Sandy Clay w/ - with
sic - Silty Clay III - few, fine, faint
'c - Clay cc - common, coarse
pt - Peat mm - Many, Medium
m - Muck d - distinct
p - prominent
HWL - High water level,
surface water
Six general soil textures BM - Bench Mark
for liquid waste disposal VRP - Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system
and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary
permit must be obtained and posted prior to the start of any construction.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
ti
OWNERBUYE
MAILING ADDRESS Q
130-7 r Ll
PROPERTY ADDRESS s Dr O
(location of septic system lease obtain from the Planning Degtd~' (3~`'`'
CITY/STATE
PROPERTY LOCATION s~ 1/4, c5_6L-) 1/4, Section ~-3 T_2,e~_N-R If W
TOWN OF,~~ c v ST. CROIX COUNTY, WI
SUBDIVISION v✓~-~ LOT NUMBER "191_
CERTIFIED SURVEY MAP , VOLUME , , PAGE 9, 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 year expiration date.
SIG
DATE: g
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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-
Location of property 1/4, Section . , T -S) N-R_Lf _W
Township,~)Mailingaddress
Address of site 1
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property
Total size of property
Total size of parcel
Date parcel was created e ° r 9
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
Volume Z5E and Page Number Zo~ 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. .1-4-leCG o , 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 Registe Deeds as Document No.
Sig atur p 1' nt Co-Applicant
Date Sig ture Date of Signature
it
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3 198211 THIS SPACE RESERVED FOR RECORDING DATA'.
QUIT CLAIM DE!~D ii
s .~so6 VOL 085PA,-110
Allen L. Lunde and Gary Brunclik, d/b/a Homestead
]x,'xi
Development
JUL 5 1984
i
nit-claims to GaryBrunclik rfi 10: 00 A:
9 y
~I
a 2 srr truaat
II the following described real estate in .............St,__-Croix County,
State of Wisconsin: RETURN "Gary Brunclik i
P 0 Box 531
~ OS~_Pnla, WT 54Q2Q___ ~
Tax Parcel No------------------•-----..-----
j I'
j Lots 7, 9, 10, 14, 16 and 17, Country Meadows First Addition in the Town of
Star Prairie, St. Croix County, Wisconsin.
j { Y"l
3
i
I~
I,
~I
This is not
-T homestead property.
~A (18 not)
Dated this Z~l day of - June-------------- 19 94
- ~I -
-----------------------------------------(SEAL) L's'~{ / ------------(SEAL)
* Allen L. Lunde
(SEAL)
- . . ---(SEAL)
j * - - - - - * Ga C1 -
jj - ------p-----------------------
AUTHENTICATION
'I ACKNOWLEDGMENT
it
Signature (s) Allen L. Lunde Ga_ r_ y STATE OF WISCONSIN
Brunclik
_ ss.
---------------County.
authenticated this v~__.day of June------------ 19 94 personally came before me this day of
------------•-------------------------19- the above named
Kristina 0 and
* -
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina 0 lan
- Attorney at Law
Notary Public - _ -.--.-County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
date- 19---------)
QUIT CLAIM DEED STATE BAR OF WISCONSIN Wisconsin Lrgal Blank Co. Inc.
FORM No. :1-1982 Milwaukee- W..