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HomeMy WebLinkAbout020-1022-30-000 s r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / (Z ^ ~S ADDRESS 7,1 /7 /T'O/~C9ir SUBDIVISION / CSM#_~7 LOT # SECTION /y T N-R_jj W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIE SHOW EVERYTHING WITHIN 0 FEET OF SYSTEM, • ex;~ L..~ ~e G( Ups ri..ec r'VW 1-4x tza t( ~'•G fw.~k 63 S /e..t / 30 ~ ~re,.ztlta' S,C57`~ ~L w 5 cd S4+rt,7~, 7 I ~L Alk /~rCw 6~d ~ • G s" i INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form- Provide 2 dimensions to center of septic tank manhole cover. ' - i BENCHMARK: o /a yorl c/`t *'ti•- , ` ~C Sara T ALTERNATE BM: re ~i.c. SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /~La Setback from: Well House ;26' Other Pump: Manufacturer Model# Size Float seperation 19 Gallons/cycle: Alarm Location 4 SOIL ABSORPTION SYSTEM Width: Length 5 7' Number of trenches Z Distance & Direction to nearest prop. line: 69 Setback from: well: /3d' House /?ci"' Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: fe/ PLUMBER ON JOB: ~u.~ LICENSE NUMBER: /~fiPS 3.?a' INSPECTOR: 3/93:jt 'Wiscons;,n Department of Industry, PRIVATE SEWAGE SYSTEM County: Laborand Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ village Town of: State Plaii~W KAAS, KEVIN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ' /~01 C0 If5G%1117Q TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. S r $ySeptic Benchmark r c . /alb Dosing , 45, n''. a asp' /off. Aeration Bldg. Sewer Holding St/ld Inlet 73jz 0 51" TANK SETBACK INFORMATION St/ bk'outlet :5* 160 ( i TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet J~ Air I Septic 3 g3 IN-- NA Dt Bottom Dosing NA Headerthilloe+r Aeration Dist. Pipe N 1694- 27, '5 Holding Bot. System 12 PUMP/ SIPHON INFORMATION Final Grade $'7 S' 1V1alwfacturer Demand 'r Model Number i~4,&-o h /o"3-s- /7 3 TDH Li L System TDH t y P ro /U H oc 49 Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length i No. Of Trenches PI No. Of Pits Inside Dia. id Depth DIMEN I DIMENSIONS S 7 C;? SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACH anu acturer: SETBACK CHA R INFORMATION Type 0 the ~qr , Model Number: System: ,cZ NIT DISTRIBUTION SYSTEM Header I Manifold Distribution Pipe(s) „ x Hole Size x Hole Spacing o Air Intake Length ~ Dia. Length _m~ Dia. _~L Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gr ys nl Depth Over Depth Over xx Depth O xx Seeded /Sodded xx Mulched Trench Center -~S $ol~rench Edges "aG To oi ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.14.29.19W, NE, SEf Lot 7, Holden Lane fs 3 (3 4. jr ~~,,p jai- / 1~~ Cvr~ffQ //{a",, Q2 C~ OLIN (vim) U 7 Plan revision required? ❑ Yes P- 6-- Use other side for additional information. W) P~~ Z a - L -A -[91 j 1 SBD-6710 (R 45/91) Date Inspector's Signa ure Cert. No. 1 n ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 1ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COS STATE SANITA13 PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ap9 q&gZ 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 r~(v~~, to\ IC Y. Y, S JI/ T 2p , N, R LQ (or PROPERTY OWN R7ZLING ESS LOT # BLOCK it CITY STATE ! ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NU BE !4 IP19 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE TAX M R El Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms A L 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo (mod v 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. TYPPEII OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Jam) New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 S 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Mindinch) ELEVATION 4! ~6 7D . 7 A / uFeet VF 7 Z Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 4,4u .1, F1 I F-1 Lift Pump Tank/Si hon 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):-~--' Plumb is Signature: (No Stamps) MP4NPRSW NO,: Business Phone Number: r ~ /qtr a'i 715 '77Z- 3Zl Plumber's A teas (Street, City, State, Zip Code): Q IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing Age Sign re (No S s V¢~/ Approved El Owner Given initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 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 years. 6. If you have questions concerning your onsite sewage system, contact your local code administ, rator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. 4 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 a// 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 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; close 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 (8.11/88) C' Lit . JOB TIMM EXCAVATING 12- Route 1 Box 192 SHEET NO. OF WILSON, WISCONSIN 54027 CALCULATED BY DATE '"t (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE 9tALE o... i. ;f . ...i i i [ i . . < \i . i...................... l i S . . i S e : r p w / Gtn6 gl b__l, 0- . .....1 _ . V 15l.~~ .~6'r/►7 _L_ LJ P I~ ~G,_... ( fi ~°O Al. 7+!+k.'c'..C C a ~rt°n c ue 5 .X J~ 7 22 PRODUCT 205-1 Inc. Grotaa,Mass. 01471, To Order PHONE TOLL FREE I-800.225-0380 JOB (/✓yt ` ~u,1 TIMM EXCAVATING SHEET NO. Z. OF Route 1 BOX 192 E WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE . 72 _ t q~. S -s o ---Goo Zz. t, fib.. 5 PRODUCT 205-1 ~Inc., Groton, Mass .01471, To Order PHONE TOLL FREE 1-800-225-6380 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Paget of 3 Labor and Human Relations Division 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 St. Croix 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 Fdina Realty GOVT. LOT TTF 1/4 SF 1/4,S14 T 2.9 N,Rlq XR(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 700 Second St. 7 n/a Hudson Hills CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE RJOWN NEAREST ROAD T [ ( ) hudson liolden Rd. ji New Construction Use [xk Residential / Number of bedrooms I [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate 7 ed, gpd/ft2 . F trench, gpd/ft2 Absorption area required 643 bed, ft2563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 96.22 ft (as referred to site plan benchmark) Additional design / site considerations n /a Parent material nit twa gh Flood plain elevation, if applicable n'j``t-- ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem )M S ❑ U )MS ❑ LI ~ S ❑ U f2 S ❑ U ❑ S ~U ❑ S d 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 1 0--1 Wyr_3/2 none L. 2/m/gr mvf_r c/w 2/f .5 .6 2 14-26 10yr4/4 none sicl 2/m/shk mfr g/w 1/f .4 .5 Ground 3 26-42 7.5yr4/4 none Ls. 2/m/shk mvfr g/w 1/f .7 .8 elev. 100.57t• 4 2-80 7.5yr4/6 none S. 0/sg m-1. n/a n/a .7 .8 Depth to limiting factor „ >80 Remarks: Boring # 1 0-21 10yr3/2 none L. 2/m/gr mvfr g/w 2/f .5 .6 2 - 2 21-34 10yr4/4 none sicl 1/f/ r mfr ,/w 1/f .2 .3 3 34-48 7.5yr4/4 none LS. 2/m./shk mvfr g/w n/a .7 .8 Ground elev. 4 8-84 7.5yr4/6 noen S. 0/sg ml n/a a/ .7 .8 9.90 ft. Depth to limiting factor >84" Remarks: CST Name:-Please Print Phone: Car L. Steel Address: r~r 1 .5 200th. ve New Richmond, t•;T. 54017 Signature: Date: ~ 5-25-q3 ~ 8 ZLi'~~4 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-12 1 2,/2 none L. 2/m/gr ar mvfr w f .5 .6 2 12-25 10yr4/4 none sic! 1/f/shk mfr F,/w 1/f .2 .3 Ground 3 25-45 7.5yr4/4 none LS. 2/m/sh1: nlvfr p/w 1/f .7 .8 1-00.00 ft. elev. 4 45-82 7.5 r4/6 none S. O/sn ml n/a na/ .7 .8 Depth to limiting factor Remarks: Boring # 1 0-8 10yr3/2 none L 2/m/gr mvfr gV71 1/f .5 .6 4 2 8-14 10yr4/4 none si].. 1/f/shk mfr Cr 1/f. .2 .3 3 14-2 7.5yr4/4 none ls. 2/m/sh1; mvfr g/w 1/f .7 .f Ground elev. 4 26-87.5yr4/6 none S. 0/s ml n/a na/ .7 .F 99. 75 ft. Depth to limiting factor >80" Remarks: Boring # 1 0-8 0yr3/2 none J1. 2/m/gr mvfr g/w 2/f. .5 .6 2 8-13 1 r4/4 none sicl 1/f/shl; mfr /t,7 1/f_ .2 3 3 13-39 7.5yr4/4 none LS 2/m/shl; mvfr Ground g/w 1/f_ .7 .19 elev. 4 39-52 7.5yr4/6 noen. L. 0/sg ml n/a n/a .7 .P 9° - 7? ft. Depth to limiting factor >82" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE 1554 [vvue rnvc Gary L. Steel 29C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 PIE%SV514--T29N--Rl0 T (715) 246-6200 town of Hud s n lot #7, Hues n Hills as/ X/O -/(,"I /,t, s Iser u0` N C © 00` 4- nz 2 ,Y • . ~xIPU6Ya lUOP . 1 T~' • » `[wflEXlr BIGOT-Of-WAY LINE • . • e.. P o.9. 33 - OF EXISTING TOWN ROAD o }I EAfiF RLr RIGNT- F-WAY LINE I v OF EXISTING T WN ROAD 0 ~ O * m ' . A O 0 T O • 1 V\ o• O X y O ~ M 1, + = n n N C • g a o w O a e !7500• c + u o M I. 06 20 W > O • ~ n • 2 A02 T2f VI R• m u. i M Z _ ~ 33000 a ~ N I. O{ t0 W N I j g ~ N 620.42' N I' Of 20 W • N ' ' e 1 6!2 20' Z o S 1. 06 20 E ~ N O 0. o ^ O 0° a N m • 8 • o n a o n i o y w 3 0 62049' I I m \V\ a ._g 671 b6' ~ ~ N I o P LiT Y O- E--- z ° 4 a ra IF O 0 a y ~ \ era > ON N a 1 ~ ~ 0 A a° A _ 56-- 10 w N V (Ffi; 0" w 0 m ' • s in 3. a 0 = s s ti CL v Y N n Fs M IF M I* 06'20"w o Qn ° I 62062, ~ :g /O/ OX c3D x~' Z _ . . _ p . m !_'OQ A o Q 'op m N II a ° I t o ►r aoY 14.44 20 E .Is{A.{o Lg / Q 1 N12• tt I ER~ .,oo►•f~ ' 1 ~1 /6~ . I I l A_ N 0 '4 A G t^ f ~ w o • ' T-ID nn \5 ' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Ke, 01'N I. i- r R N C, J~ aj-5 MAILING ADDRESS / PROPERTY ADDRESS 7 -7 cz/ (location of septic system) Please obtain from the Planning Dept. CITY/STATE 45~16 16 PROPERTY LOCATION //Vi- 1/4, S 1/4, Section , TAN-R W TOWN OF GcEJ') ST. CROIX COUNTY, WI SUBDIVISION A4 4 19~ti~,CS 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 year expiration date. SIGNED: y DATE: ,or Ile, St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11193 K~ ~ r~ d-- m,~,ey as 8 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 ~Ui /V T. 9- fi? R V 15. fk, Ar A5 Location of property NC 1/4SF-_1/4,Section /Y ,T 29 N-R fQ W Townships Mailing address Address of siteZ ~ Au.1~ LP Subdivision name )Vi6, AO(//S. Lot no. Other homes on property? Yes X No Previous owner of property Cr jU S Total size of property Total size of parcel 5.03 rej Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes K No Volume ~6- and Page Number 4~7y 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 i the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the ewagedisposal 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. Signature of Applicant Co-Appli ant Date Si ature Dat of Si nature • / DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA 51.832'7 ;STATE BAR OF WISCONSIN FORM `L -1982 II J 4 f27~ • XL 77. 108 PAS ~/i y~t• ~~ss;,~.yy Crystal A. Baer, a/k/a Crystal Baer, a single 'd forR"Wd person, l i - JUN 2 7 1994 • t 3:45 P. i conveys and warrants to Kevin T. KaaS and Mary. KaaS-, . . . . . . s and Mary. E.. as husband and. wife RETURN TO . the following described real estate in .._...........,,St....U.0iX ...............County, State of Wisconsin: Tax Parcel No: I~ Part of NE 1/4 of SE 1/4 of Section 14-29-19 described as follows: Commencing at E 1/4 corner of said Section 14; thence SO°44' E on line of said SE 1/4 922.88 feet to Place of Beginning; thence SOe44'E on said E line 240.0 feet; thence S68D39'40"W on Nally line of Right of Way line of Railroad 455.51 feet; thence N12°33'W 594.8 feet; thence NEly 123.75 feet on SEly line of proposed Town Road, on 85.0 foot radius curve, concave NWly chord bearing N67°44'20"E 113.11 feet; thencell, S63D58'15"E 496.1 feet to Place of Beginning. i This lS not homestead property. (is not) Exception to warranties: Easements, retrictions and rights-of-way of record, if any. Dated this 53.1-5 day of .June 1994... (SEAL) LV r..8cuV,.. (SEAL) * Ystal A. Baer, aA/a Crystal Baer . . .............•--••-•-.....---•••---..(SEAL) (SEAL) I AUTHENTICATION ACKNOWLEDGMENT Signatures STATE OF WISCONSIN it ss. St. Croix County. authenticated this day of 19 Personally came hcfo.e :n., his . - - - - - - .day of une----........... 19..94. the above named • Crystal A. Baer a/k/a- - St~l Baer TITLE: MEMBER STATE BAR OF WISCONSIN Auc c~'. . (If not, ~{{bjiC authorized by § 706.06. Wis. Stats.) to me known to be the per199 y ~ f~j#kecuted the f going instru t an~ Ae the same. THIS INSTRUMENT WAS DRAFTED BY Kristina 0 land . ..........g.---•--•-••-•-•----------.....••-••----------•- Alice Joy nn s * ttorne..................................................... taw Notary Public 5tb.Croix County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is perina/lent. (If not, state exiXation are not necessary.) date: -171 - LP 1~1-".'F}.•) *Names of persons signing in any capacity should be typFA or printed brlo%c their signatures. 1 I [['A1t.TtANTY T)Ern ~''t'ATF nnlr nr n•icr!---