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HomeMy WebLinkAbout020-1290-50-000 r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S/~/17 /LLL~/Z ADDRESS-/_70,!- -""Z,FZ- yv>sow wr e1016 SUBDIVISION / CSM# LOT # S- SECTION Z- 7 T Z 1 N-R / 9 Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM uu 1 L4 F A e rt,\ Ro rFD i'____... Pal _ _ _ BM,TO~ O~ /r / W PIPE NE gfo R N E 2 I W LL I ~I too' No6sF (13 L Zy'K zv 240' z? N w ____._:w._ jot)' 1 Alf[ i YA E y' A ! j I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form- Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK : 7e)P /4T 1412 ZOT ~~,~il'x•~ ~ = 3.7 Z ALTERNATE BM: A-9_]PTIC TAN9:77-~UMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: jr~Q i s w Liquid Capacity: /®oo, Setback from: Well (0'?_ House 2- 7 Other Y4 - - ~rrtmv- Pump: Manufacturer - Model# ------Size Float seperation Gallons/cycle: Alarm Location ..SOIL ABSORPTION SYSTEM .11 Width: 1$, Length y0 Number of trenches -Distance-&-Dixect on-to-nea-r-est-prop:-lie:--1-60 -70 X62 j-t4 J-4-Al E Setback from: well: 10 House -7(- Other 140 57, ELEVATIONS Building Sewer ST Inlet; ST outlet 7, Z PQ, nlet P,-.bottom Pump Off Header/Manifold % Bottom of system 10,01 Existing Grade 7• S Final grade DATE OF INSTALLATION: PLUMBER ON JOB: 'I LICENSE NUMBER:- INSPECTOR: I~ 3/93:jt i 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 o 421 Permit MILLER s NacJme ❑ City Village Town of: State Plan o.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: HvIdaGn r J' ,C # TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Lat-Al Benchmark X03 Dosing apt /0 q,g Aeration Bldg. Sewer Holding St/Ht Inlet 6"? ~ s TANK SETBACK INFORMATION St/ Ht Outlet 7.07 Vent ir Ito ntake ROAD Dt Inlet TANK TO P / L WELL BLDG. A Air Septic t) t '(a 3 7' ' NA Dt Bottom Dosing NA Header / Man. o 9q S Aeration NA Dist. Pipe q, 3 Holding Bot. System /D, 0(0 ~ LA PUMP/ SIPHON INFORMATION Final Grade (o,o q 7 Manufacturer Demand Model Number GPM TDH Lift Lo *on System TDH Ft mead Forcemain Lengt Dia. Dist. To well SOIL ABSORPT ON SYSTEM BED/TRENCH Width Length , No. Of T riches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 8 '//6 DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Moe Number: System: +rt9, ~ J~ ► 76 ~ 113 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing C_ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over q 't , xx Depth Of xx Seeded/ Sodded xx Mulched Bed / Trench Center ,rt Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code-discrepancies, persons present, etc.) LOCATION: Hudson.27.29.19W, NW, NE, Lot 5, Hill Farm Road 0.06 a = c. c 6 ~`y= ' _ - wo e 0 ~ ~c ~ q. r K f 374 Plan revision required? ❑ Yes ❑ No G 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 W._ _F SANITARY PERMIT APPLICATION Cs'■~■~R CO In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a' 0~ 47, 834 x 11 inches in size. 1:1 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 L L0 U)%NE %4,S z7 T29 N,R E(or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 'Cox a t-. 5 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER uDso w S elA, 1(.39G 27(67 WO M Z 12D K (BLS II. TYPE OF BUILDING: Check one CITY NEAREST ROAD l ( ) State Owned ❑ M TOWN OF: ::1 VILLAGE OU DS O N LL FA 2 M pokD ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms3 PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 62-0 J 2 70 -S-0 1 ❑ Apt/Condo [ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. [A New 2.E] 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 11 171 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) , ELEVATION yS0 G q3 2 O , p 7 .7 ?*00 Feet O Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New )Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank DOO WA " $ e ✓ 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): Plumber's Signature: (N S ps MP/MPRSW No.: Business Phone Number: )pOu 6 STR~H f3EE/V ~~Z Z*r'7 3L ~j Plumber's Address (Street, City, State, Zip Code): a0 x v/ Z z 0 of n, e- N A40 D Gv2 r 540i7 IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved SanitaryPermit.Fee (Includes Groundwater Date Issue uing Ag t 7re~No !m Approved ❑ Owner Given Initial Surcharge Fee) /&V Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) 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 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. Ill. 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 El% 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. SBD-6398 (R.11/88) I SAM MILLER HUMQIRP +IILLS Lo? . _ j'`/~ ~7~3~ a aM • l x'0,4 P/r'6 XT AYE IORXE ~2 E/ _ /ao, oo _ IIIIL FARM ROAD B•M. IRoN PIPE AT V6(F-: TOINT bR)VEWAY NE 10T noRNEfL- LOT S- -.0, 6 E I. = IDo. oo ~ ~J' I ~1 o WEIR HOWE i a9,XS'~GARAGE 3q y i a 30' ~Nc~ S c a. t t-~ ~ i S 37 LoT y (o' LCT .S 1677((o O > >Zo' i; loo " ~D~ j n z 'W 9 ' i q~rE,e- T7~ IoS v° Q, d //A 7--r u. B ~ fj~QFIF j a Z i O 72 p t i t( S WEST /OT //A!E ZOo,Do' ~~1 t L L l~~ ~M • ~ q ~a a 4 N ~ r 4 A~ r -'g;4L OIQ ~ M , / A. eP 4 M ,CIA W a ~Q l' Wisconsip Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Wuman 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 S~ C~~ tx 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 OWNE : PROPERTY LOCATION p "-C~yh i ILL e GOVT. LOT N W 1/4 NL 1/4,s7--7T 2-3 N,R E (or) W PROPERTY OWNE 'AS MAILING AD NESS LOT BLOCK # SUBD. ME OR CSM # -re f6ROO~ Ke)A& NtaMa)ktl /1) L (-_S CITY ~JAT~~ ~ ~ ZIP CODE PHONE NUMBER [:]CITY ❑VII,L GE [MOWN NEA%ST ROAD [J~ New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow S6 gpd Recommended design loading rate 6 7 bed, gpd/ft2 O.~ trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum deign loading rate (3.7 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 3 -o c> l N1 Mid Z )(It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IL-GROUND PRESSURE AT-GRADE Y TEM IN FILL HOLDING-TANK U= Unsuitable fors stem S❑ U ❑ S U S ❑ U El S ,U ZS ~U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoUnday Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench a 17- 33 1 dy L r, s6< r4T, s Z o .g o.S -7- 1 Ground 5 ] i0Y , M s~~ rv, i C) S 7 0 Q.3 elev. 9% Sat. -~ZI 1 S rh) 1 o~7 0. Depth to limiting factor > /D, 6% Remarks: Boring # z.: sic Ground elev. r J~o tuft. -l2 pyrQ r r ry, I -t 0~ Depth to limiting factor 7 J0.0~ Remarks: CST Name:-Please Print / 1QRAY ()N :SdN Phone: Address: Q ufsstwlV I `TU Signatur Date:? J CST Number`~4. PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourx~ry Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Had: Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # {:p is i4.ti~ Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 3 PROPERTYOWNER~'4yh M'LLC4 _ SOIL DESCRIPTION REPORT Page -7 of PARCEifl.D. # La S Ul~~ i~ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench loY 3) L j C-- n!5"1 Cis Z 0 4 0.5 13 -37 ~ s - , L iaK Mir s ~ o_z. 3 i 4 ~ 1 ~ c Ground TSYr2 4 r !'bl I S (3? 0 elev. /4 n. Depth to limiting fjtOr3 7 .6 Remarks: Boring # FA O-J`~ /0 3) 5L 1 e►- 14r C 2 0.4 0 5 L C, 13 Ground 3Z `6 f dY~ S 3 S L~ k /h 7 S / 6.Z eaS ft. g 66-(Z /©yk 4 4 5 ^ r 0.? d Depth to limiting factor Remarks: Boring # Q o_~ /O`/~ I SL 1 rh crr C "s Z O.q `13,5 9-16 /01/A4 L 1 m sb - tr C o 2~' 0 q 6,5 9-2 b-39 S 4 S ~ r M~ C w 1~ 0.7 `O,~S Ground Depth to limiting Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 1 . I M U ~ ~ C9 O 0 LLI =3 d LLI S t, F- 0 YY F- 0 V) 0 D T~~- Rd' W O X i T ~O L R,d. z I 4 I F i M 4 o I z a I j I I o.. o1 1 1 o rq I I ~a I I I O a Z0 0o I s I I Z I V) a. JL1- a i W I I I ~ I n.~ I I I J ~ I I I I W I Z. I a. I I ~ ~ I w C-j I I I z m O I O I I I V U I I ~ I I _ i a i i z ~ ~ ~ 1 ' I i i a3 I y~ I I I I v I I I > I O { $ I I I i ~d v -v 4~1 ` I I I ~ w N a- STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 5 A M All I L 1_,F 12 MAILING ADDRESS BOX 2? Z H U D S O U u) :r- _s-yo PROPERTY ADDRESS 7 Z ~ I-II LL FA 41A P-0-40 Nu~soA Lot (location of septic system) Please obtain from the Planning Dept. CITY/STATE 40b s nK W1 PROPERTY LOCATION N k.) 1/4, N,,9~ 1/4, Section Z-:Z, T L y N-R~ TOWN OF YL) D SaJY ST. CROIX COUNTY, WI SUBDIVISION H y M 3 I Q_ D 141 L L S LOT NUMBER S CERTIFIED SURVEY MAP j97/0 VOLUME S , PAGE 9 9 , LOT NUMBER S 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: F-. DATE: -7 - Z© St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 I 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 5AAA A41LLO2 Location of property~~1/4 NE 1/4, Section Z 7 ,T":~N-R / W Township &0,50AI Mailing address ,Bo,Y z L --Avisp h "Jr SS/D/G Address of site _ 782- / 114 frd e iy/ Subdivision name ~/U ft _l~l /2,D P11-45 Lot no. Other homes on property? Yes X No Previous owner of property /1 u M g) )zp L.4141O w- Total size of property 2, O 2 S Ae. Total size of parcel 2. o ZS 4 e. Date parcel was created / 2 - 7 3 Are all corners and lot lines identifiable? k Yes No Is this property being developed for (spec house) ? 'r Yes No Volume 102-1 and Page Number ZSZ. 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. So ?-7o 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 the County Register of Deeds as Document No. S~Z2o9 gnature of Applicant Co-Applicant 7 00 r-g Date of Signature Date of Signature THIS {PACE RESERVED /OR RECORDING DATA - DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1882 WARRANTY DEED • 502209 VOL 1021 Fare 2R2 2 REGISTER'S OFFICE ST. C. oax Co., wl rporation, fi~C'd for ficcord This Deed, made between Hum ...bi...r..d..,-andLand.. -..Co. . . A.. ...Minne. sot.a.. C.o.r Poration..authorized.. to.. do.. business n..Wisconsin JUL 1 2 1993 Grantor, at 4.20 ~ P. and....s?4..E,...Miller.............................................................................. Register of Deeds , Grantee, j Witnesseth, That the said Grantor, for a valuable consideration...... f . TO conveys to Grantee the following described real estate in OerO1X ~~~rGP Gli1~d G County, State of Wisconsin: - . 7 oy jo ~•~.~~.~taJ~ Lots 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 Tax Parcel No:................................... in the Plat of Humbird Hills, Town of Hudson as filed and recorded in the office of the Register of Deeds for Croix County on April 7, 1993 in Vol. 5 of Plats, Page _;.99, Document No. 497107. Lots 13, 14, 15, '16, 17, 18, 19, 20, 21, 22, 23, 24 and 25 in the Plat of Humbird Hills 1st Addition as filed and recorded in the Office of the register of Deeds for St. Croix County on s 'April 7, 1993, in Vol. 5, Page 100, Document No. 497,108. kZ, t ftP K, tix ~`^i•+' y,'` Y°.X'~3ati1., r . t'"'-. _:~l Ff?.n."ekF.7 S Y Z - _ O / "'mow- ~ Y1.\-• ~ .dr r This iA,.nQt......... homestead property. " (is not) Together wi'h all and singular the hereditaments and appurtenances thereunto belonging; i And...ttuulbi.>~d..I.and..C^.r.P.4.c.~i.~on warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements shown on the above mentioned plats. a and will warrant and defend the same. Dated this ........12th day of ...JulY.............................. 19..93... Humbird Land Corporation, a Minnesota Corporation authorized to do business in Wisconsin (SEAL) BY.... <%'2P!QW~ (SEAL) Austin J. Baillon President . .........................(SEAL) .......(SEAL) ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. ems . -.County. authenticated this day of 19...... Personally came before me this .........4.,,..day of ..------...July 19..93.. the abase `ngpted ..i .1 ............a~--. e AlI5t7Ll..~r.. Ba 11Qn,._ Presiders[ :e......._.:::.; NLlA4b7.T_d ..Land..g.4rPoratiog_ ~.l.l.~_P..:~. TITLE: MEMBER STATE BAR OF WISCONSIN (If not . .n.;......r~.:~..~..: authorized by § 708.08, Wis. Stets.) to me known to be the person e,~lecuted thj j foregoing stru /me(nt and acknowledgifll4e safn1 0 ~Y ' D•~'Q•~'~•••• ` ! THIS INSTRUMENT WAS DRAFTED BY LJ H N 0. 4 .Kueppers,..Hackel..&.-Kuepp.er-a 2 1350..Cap ital..Centre,._St...P.au4.MR..5.5.L02. Notary tic 5-T...... C -6.[A ..........County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date' 19.........) -Names of perscIns sicnins in any capacity should be typed or printed below their signatures. II WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leal Blank Co. Ine. ' FORM No. I - 1982 Milwaukee, Wu. • vim. i, .'Y J. .G / : J . . 1 n% ..:1 ~ '