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HomeMy WebLinkAbout028-1041-40-100 N O Q O ii I 3 0 y ~i O I e I 0 N t -O s I d I ~ I T CO I N v z O C 3 N E LL 00 O Q ~ I M 3 I z in Z w o z y y ao d OD M I- N c O C O U O z Z d' I' c D' r II w aUi Z a I :21 ° c o I (n F- (D z w a) E M N co O ~l1 N U) C • ~V ) L O O Z F Z w z N I M E U N N N % i ai o y ' m co d a a M c m L m a o 0 o a N m E L) U) U) _3 0 w I 3 0 0 0 a z CL CL 0. a co o US to -1 U = rn rn D U N E O O O ao m (D a N O 4 u7 m o ~ c IIN m e~ c ~ F CQ, ° co (D to Q 0 n o rn ,o v CO N m c c E c 0 t y OMO LO •a c Z~ c s N I~ CO cn °c' (n ca E 04 0 ~ ~ L • Q d V N N rr~~l y E 3 3 0' Nv ~1 A Ua2', 0 eve" q A\ v~vt ®V' j 2~ +f~~✓_n~ 4 u ,o a V~ eIPIICIf io~ l~ri~~/u Q 1 ~ BFn)fv Coe, Aril, ~Of OIN \1 U ~vl tic H -4 r~ G;0 TIZF ~G ~ RE F9 o f E1~-uF~•n r T~~,. f,f~ Tot (low/,~V ~A~' TPf V" XL - - 9y- 3 a 5 r g 5 3 0 _ p 73,7 r C~ S4 esp. as ►5 , SJ 30 -7,09 33,73 f aS~~3pr Z9. l I'l s ~ LQgAI T,,%4,t $ In tY~1E'r.35.28.~ AlFt9EV1tAG" SYSTEM County: a d Human Relations INSPECTION REPORT 'Safety fety and Buildings Division (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village R Town of: State PIA "D o.: ST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: add, 6d 1,d, ccd TANK INFORMATION ELEVATION DATA A9400018 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S t/ Benchmark J~a 60 Dosi g Aeration Bldg. Sewer 3 Z(p Hol St/~4 Inlet 3,95 TANK SETBACK INFORMATION St/04 Outlet TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic S NA Dt Bottom yt* Dosing NA Header l~~l Aeration N Dist. Pipe U Holding Bot. SystemS,&5 PUMP/ SIPHON INFORMATION Final Grade Ma u ac Demand -°r' /r,-, Ca m- -2,70 /Z21, Model Number GPM oss TDH Lift Friction e m TDH F Forcemairv gth Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS 5 ~ S ' DIMENStONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM CHING Manufactur SETBACK el Number: INFORMATION Type O YI,¢_~ C~n"tf CHAMRM, System: je,„Gp$ 11-Z - OR UNIT DISTRIBUTION SYSTEM Header Distribution Pi e(sZ~u S x Hole Size x Hole Spacing Vent To Air Intake Length Dia- T Length Dia. `1 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade SystemPNo Depth Over Depth Over xx Depth Of xx Se 15xx Mulched 01 Lj _BgvA4Trench Center L Bg~lTrench Edges Topsoil ❑ Yes ❑ Yes ❑ No ~ COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Rush River.35.28.17W, County "YY" Plan revision required? ❑ Yes Ej_No--' Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's S gnature Cert. No. SANITARY PERMIT APPLICATION 7DILHR In accord with ILHR 83.05, Wis. Adm. Code C~ N CVO ~.e.;. STATE SANITARY PEERMIIT7# -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 9 9 O 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 WNER a PROPERTY LOCATION Toe, AW t J ,f Y,, % S 3 5 T,,,a, N, R 17 (or PROPERTY OWNER'S MAILI G ADDRESS LOT # BLOCK # C ,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER S~ rt a_ g - 11. TYPE OF BUILDIN : (Check one) ❑ State Owned VILLLLAGE NEAREST ROAD i vev` coo k-► ❑ Public ;_9111 or 2 Fam. Dwelling-# of bedroom PARCEL TAX NU III. BUILDING USE: (If building type is public, check all that apply) O O O 1 ❑ Apt/Condo O 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) 1t"-"' 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1; 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 PE AY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE j ' REQUIRREDsq ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 95.1 94.192.7 ELEV TON -f U 0333,* 1.7 Feet /eet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App strutted Tanks Tanks 44 1 Se tic Tank or Holding Tank r✓'C Lift Pump Tank/Si hon Chamber 0 El E] VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. 110 MP/MPRSW No.: Business Phone Number: Plumber's Name (Print): Plu er's Signature: (No Stamps Sr y P483-Y-1 ddress (Street, City, State, Zip Code): Plu ber' A 23 kt- 16 t; a-A IX. COUNTYIDEPARTMEN USE ONLY A E] Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue Issuing Agent Sign No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination ~f V VV 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 i 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 rene~ d airy new criteria in the Wiscot~ sin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in owrv~rship or plumber requires a Sanitary Permi5 TransferiR newal Form _r 63439) to be submit!=-3d to the county prior to installation. 5. Onsite ,ewat,e systems must be properly maintained. The t-;A,. tank(s) mr.:st be pun ~itl = licensed - pumper whenever necessary, usually every 2 to ,:I years. 6. If you have questions concerning your onsite sewage systeryi, contact your iocal code >adr-;iriistrator or the State o` 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 ni,mber(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 in line A. Complete line B if permit is for tank replacement, ieconnection, or repair'. V. Type of system. Check appropriate box depending on system type. Vl. Absorptic r system information. Provide all information requested in ##1 7. Vil. Tank info r,?atinn. Fill in the capat-it'd of every new and/'or existir.- 'i t the tolL,! y,n"ber of tanks anc' manufacturer's name. lendi(:atr: prefab or site construc,tkj mj tank mate, i ; _r_, . ,tr a!/ septic, pt ino/siphon and holding tanks fo- this system. Check ex R~rirr~rr;tal ; pprivG. + irs, ;ecceived expcr . r: ,^,3 product approval frc•m DIL.HR. Vill. Respofr ssi!'Oity statement Installing plumber is to fill in name, Ii+:e r. e ri!-nbe, with 4al Y yrrr~ ? H prefix ;;e.g. MP, etc address and phone number. Plumber must sign appli(.~aion form. IX. County; Department Use Only. X. County/Department Use Only. Cornp eta plans and sperificatior-. nod smaller than 8'/z x 11 int9- be suoni,t'.r_:' ~ !s : • r;o!:nty. The p:a ns n,~_i•,t include the following A' Mot ~jfan, ;drawn to scale o:- voilh ^~)-,ple.e )r;atior, of hOi j = r kjs) septic tank(s) of tre?tment tar ks, building wale 118' Service: strearyi- ar,(i lakes, trump or siphr;,, +anks; distribution boxes; s{, ; , >;,0;011 systFir ? , .1 ottiei,t systern areas, a!, 1, the location of the bui; :':nr: -;er.red; B) he rizontal ar+C C) compl(te specifications for pumps and controls; dose volume; ?levy%,or: a.'erenc fi ict.. loss; pump performance curve; pump model and pump manufacturer; D) cross sect cn ct the so ! .z.h .r,n,tiarr system if required by the county; E) soil test data on a 115 form; and F) all sizing infonration. GROUNDWATER SURCHARGE 1983 Wisconsi 2 Act 410 ?nc!ude(~ the creation of surcharges (fees) for ~ num.: -r cf regu!ated pra(tic;es wh'c, car elect groundwater The monies hectec !Moto ~~yc? S , chap ies «r, water LCSntar<<r ~l3fiarf it+vesi'owi~,ns and ti~S'tablis- s 1 4 SBD-6398 (R.11/88) PPP' 6AI -to P of U~ POS j FZ 4 r-V#Iro J /00,0, Two w OF r3FNCM dNC-- MhRk. IV w U)?AjF vT' 7RoytA 6 F- Alvd, rwo ;MAR KY N C vRrVR-L R O'T 7 F-va( y 41~00" E v ~1 f3c~R,E i q!, 16 QoX S 9?, 5 a Y0.8~ ~q7, o y 3 g2.2S q S- 6a s F4 ~ qs..3~ s g3.2y 1-7 7'RENct1 N i.. ys, 2. 9K . 2 - L ~-l Li S 9a, q`t -r ~6 t 7 f e '7 „O CZ a 0 0 a 300 VW5 fo nod 11 epv Cf lob' Ift~,e ~IgP7 l~ 7300 ~~s yo lot [,~?t fiat ok ,post /do past !6 >1,V fo l0I //117 s" S s s ir~ house ~ ~r 60 P ~ S S' ra s ~ ~ S ,o ~ S S S 3" S~ ~j--~ n ry -Arl o Yqd s f o G y~ DILHR in accord with ILHR 83.05, Wis. Adm. Code ` ~.....g,...~.«~RM COUNTY AN -h complete site plan on paper not less than 8 112 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 PROP ERTYICWNEfT: PROPERTY LOCATION `7 Joel t KcI ~ fdA GOVT. LOT ~ F 114 E 1/4,S35' T ~ N,R A ' W PROPERTY C INNER'S MAI ING ADDRESS LOT # BLOCK # SUBO, NAME OR CSM I _LLaQ R t1~ oeho CITY, STATE ZIP CODE PHONE NUMBER CITY LOGE OWN NEAREST ROAD ocilki'm n'4 et- I_ w~ JrlDO~~ ) aft New Construction Use [xj Residential / Number of bedrooms 3 Poe -to cfw"r."; SO// j j Replacement [ j Public or commercial describe ~j crtiJma~ r« r «eti pR r recoa,n•nJ o-12 and/1~~ Code derived daily fow 1~0 gpd Recommended design bading rate ed, gpd/tt2 0 3 trench, gpd/ft2 Absorption area required I /A bed, ft2 ! 00 trench, tt2 Maximum design loading rate bed, gpd/0 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Lvrs9lj Flood plain elevation, If applicable d S - Suitable for System VENTIONAL MOUND ROUNDPRESSURE AT-GRADE SYSTEM L MOLD TANK U= Unsuitable fors tem S❑ U S❑ U S ❑ U S❑ U ❑ S ❑ S SOIL DESCRIPTION REPORT boring # Horizo Depth Dominant Color Mottles Texture Structure Consistence 8ourxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. CokN Gr. Sz. Sh. Bed Trend, f .a K. 9 1 0-1 ►o YR Sol) 2 d 14/ 2" o.s d% r 3 # , r 2 i7-3~ 7,5YR 3/f s• 2 A s 0 Ground 3 36'V Y 1 C,47 2 T N/ T 0©, ; D S 0,r D,6 el ft. 1 SI 6l~ 7 Y11 5 S d Depth to limiting - factor > 66 r FT7Remarks- Boring # S ~ 31Z r., Pr 0,5 10'g rye y,yq„ , f 3 I! - R - M rV ,S 'F O~ O ~9 - - ~~cos---- M a Fr-1 f 6 o, 7 o,? 33-68 7, S YR 6 Ground elev: f Depth to limiting factor - - Remarks: CST Name:-Please Print Phone: ~yure h ester _ 7/5- S-9Y -7 0TQ Address: p Signature: 01 Dale: CST Number, LHR in accord with ILHR 83.05, Wis. Adm. Code . COUNTY "4ch complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but Sfi' t X not limited to vertical and horizontal reference point (EIM), 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 t PROPERTY LOCATION ' 7oe~ Ko Aftd I GOVT. LOT Sr-114NE 114,j/ Ta?Q N,R ( W PROPERTY C7NNER' MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 1180 SA AVELIK CITY, STATE ZIP CODE PHONE NUMBER CITY ❑VI LAGE OWN NEAR ST ROAD 5`t c ? r~ ICJ New Construction Use Residential / Number of bedrooms 3 jJ Replacement ( ] Public or commercial describe } Code derived daily flow 150 gpd Recommended design loading rate bed, gpd/0trench, gpd/ft2 Absorption area required bed, ft2 trench, h2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design ! site considerations Parent material L v ef; e• s Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND INGROUNDPRESSURE TGRAOE SYST #J FlLL HOl DING TANK U= Unsuitable fors stem S❑ U S❑ U S❑ U S❑ U ❑ SZ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. Bed Trend- 4v: ©-lD 1,5 Y l2 ; rS v O+5 0 ;vpll Ground "b 0 7.5 ~`R: ~6 Coy ~2 elev. g1•(6n. Depth to limiting factor ~ 68 Remark's: Bonng # d - l ~D Y~ 5l 3 - i ~Q V/ f 0,. Id,6 2 2 9,yg Ib YR `t 3 ~k m Pr rrF OS 016 ~ -A 38'60 Ground j o Y 6 ,6 M elev. 7,5 Y ` _ 5, mfr - O~y M Depth to - - limiting factor Remarks: CST Name:-Please Print Phone: rJc2 ~ ~aeh ~/S~e~~te,r ~r~ S9Y 3oSa f Address: R3 Bo -13 ! 015kmA .'c Signature: Date: CST Number. CS f9d2 m _-`_..._.a..,.~w'e....-,..wwwsraon....a.,_.. _ .Y... _.w~..,w,. ~ .__.1. J: . ` _ SOIL DESCRIPTION REPORT Boring # Horizo Depth, Dominant Color Motties Structure Gp y in. Munsell Texture [Co nsistence Barclary Roots Qu. Sx. Cont Color Gr. Sz. Sh. Bed ;ice %Tk _ ~ sl 3 ilk cs 3 of ati d s Ground 3 Y-62 - ~ ~6 S r ~'G k @Iev, M v fir d, a ppp r Depth to l e limiting ` s factor- Remarks: Boring # 0-17 1b YR 61 0,5_fj ~ 3 16 Ground -Y$9,SI~4 IS ► 1~~'~~y~ V., a q-elev. a b J~ k~ 9$ - 52 ~s YR y s Depth to , ' 6b I R 3 a 0, 9 : rb 01 tco 6 6 -72 Y•SYR 5/6 CS 0eq p.7 > '12 ,µf Remarks. Boring # y z SI 2 S 2,SYR 5h r, 41 m A o~ t~ n n t Ground ~~to ,C fv ' w a' S z ti elev. { I Depth to limiting factor i . ~b Remarks: i Boring # I vFa © 3 3 5_ YZ ~ 1 I w i r~ 0,7 a;, g Ground 3N-39 o Y 9 co •7 ; 0,$ ~3 ILL ntK S W( I k l,i ft 1 YQ 4 6 - cos s 1~ - of 0,7 Depth to S- 39'6 limiting factor Remarks: STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OwNER/BUYER Joel apf f%t J " U MAILING ADDRESS I O #C/f S" wZ PROPERTY ADDRESS (location of septic) ,system) Please obtain from the Planning Dept. CITY/STATE N pwl~' I A/ '-5 ~ 00 2~ PROPERTY LOCATIONS 1/4, rL- 1/4, Section , T O N-R_L7W TOWN OF Rol 91,1,e- r- ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUMED PAGEb, 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: I DATE: a - < < St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 i STC-100 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 permit issuance. . Should this development be intended for resale by owner/contractor,(spec house), then ia 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 D ei - Pr~.,)OM Location of• propertys .1/4 !V F 1/4,, Section 3_5 T~N_RL7-w Township uS ✓C~4~' Mailing address ©✓f~ "S co Address of site J 31N y y ~Y Subdivision name Lot no. other homes on property? yes No Previous owner of property _ D,Aa" Malz i Total size of parcel'_ _ 3 ° Q C w S Date parcel was created 'Are all corners and lot lines identifiable? Yes No is this property being develo ed for (spec house)?,,,_Yes X-Ho Volume Qand. Page Number as recorded with the Re ist of Deeds. g er INCLUDE WITH THIS APPLICATION 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 off'; a warranty deed recorded in the office of the County Register*of Deeds as Document No. S1. C16 5 , 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. i he office of County Register of deeds as Document No. Si ature o applicant -appl ant el 44 Date of Signature Da e o Si gnature . .'i • " THIS SPACE RESERVED FOR RECORDING DATA DOCUMENT NO. it WARRANTY DEED ' STATE BAR O(F~~WISCONSINnnFORM 2-1982 j' 51.296 YOl - lJSIPAGE,U - ~I Dean Monicken a/k/a Dean R. Monickers R~~. CROI y 1 I~~ ~ a.. s.i-n le-- ers.on..........._ ST. CR01X CO., b~'1 l id: FE 6 1 1 1994 conve s d warrants t Joel D. Afdahl and Katherine••.E.~ p, 1.30 ,f ahl, hus~and and wife --.holdin_q-.a....• ' M .survivorship...mari ta.1...P.ropertY.........- Re$1.3ter of Deed _ ..I--._..... s _ it RETURN TO Bank St.Croix 2212 Crestview Dr _ Hudson WI 54016 the following described real estate in _......-,S_t.....Cr_oix ..................County, - - State of Wisconsin: I~ Tax Parcel No ii ;i I~ South 912 feet of East 477.7 feet of West 897.7 feet of the Southeast Quarter of the Northeast Quarter (SE4 of NE4), of Section Thirty-Five (35), Township Twenty-Eight North (T28N), Range Seventeen West (R17W) This deed is given in partial satisfaction of the land contract between the parties of even date in the original principal amount of $41,720.00. I~ s i s riot homestead p y. This pro ert x (is not) Exception to warranties: Easements and restrictions of record, and except any liens or encumbrances created or suffered to be created by the acts and defaults of the grantees, their heirs, successors or assigns. I' l Dated this ..............~.1-----.._-......--•----._._.. day of 19.~.. . SEAL `C'.~r?.......:.<??~~`-..............(SEAL) II * Dean R. Monicken ....................................................(SEAL) ................(SEAL) I' i m * I AUTHENTICATION ACKNOWLEDGMENT i I~ Signature(s) STATE OF WISCONSIN ~I ss. ---County. ) r ii i { 1 authenticated this ........day of 19...... Person lly came before me 94 day of 19.....-.. the above named I~ Dea R. Monlcken ! TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by § 706.06, Wis. Stats.) I to me known to be the person who executed the ,"'L1pu011do of g instrument d acknowledge the same. Ii THIS INSTRUMENT WAS DRAFTED BY ~~,,0~"• Thomas A. McCormack .o ~0~kR ....~~c St. _1.Croi.x..... Count wis. Baldwin, 7CM WI 54002 7 y C sione is permanent. (If not, state expiration (Signatures may be authenticated or acknowledgti tly • are not necessary.) UB~~~.f' ;1-~~ , 19 -.Z...) v„~ -Names of persons signing in any capacity should be typed or printe~4~~~V,h's,ijsh~tures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. Fhpm wr,. 9 _ ~4R2 Milwankpp Wisconsin