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HomeMy WebLinkAbout038-1170-90-000 ti ,z STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Terry & Linda Miller ADDRESS 864 N. Knowles Ave. New Richmond, WI 54017 SUBDIVISION / CSM# Country Meadows LOT # 12 SECTION 13 T 31 N-R 18 W, Town of St Paairi ST. CROIX COUNTY, WISCONSIN N 'v L. }}w/ PLAN VI VW f?' SHOW EVERYTHING WITHIN 00 FEET OF SYSTEM /Pyy 7,4 •~rr, I ° 1 It Aq c- V INDICATE NORTH ARROW Provide setback and elevation 'informat- i nn nn roue s -T+€ J-:hiS fQ= - Provide 2 dimensions to center of septic tank manhole cover. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor andliumanRelations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION PeMILLER rName: & LINDA city Village [ATown of: State Plan o.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No. /001 1 s w/ j 'a w~ TANK INFORMATION IV V ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic b_lr, Benchmark 103; 60' Dosing ,i Aeration Bldg. Sewer Holding 1_71 St/ Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet ~ot_57 C~7~ Z Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header/Man. 13 Aeration NA Dist. Pipe Z Holding Bot. System f f/ 7 6 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. mead Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO III CHAMBER Model Number: System: ~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 /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE.13.31.18W,SE,SW,LOT 12,STAR DUSK DRIVE } i 194 y r1., U r, R'9 ► 100 - 140 Plan revision required? ❑ Yes ❑ No In Q~ Use other side for additional information. h~-~] (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: T i ~SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix STATE SANITARY I Ogg E43 -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 sW q , S Terry & Linda Miller (Valley Cust.. H m) SEA, SW 1/4, g 13 T 3f , N, R 18 E (or)ffl PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 864 N. Knowles Ave. 12 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER New Richmond WI 54017 Country Meadows 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ]~I ❑ State Owned ❑ VILLAGE ;Star Prairi rX TOWN OF StarDusk Drive ARCELTAX NUMBER(S) ❑ Public LJ l or 2 Fam. Dwelling-# of bedrooms 3 P III. BUILDING USE: (If building type is public, check all that apply) 70 - Q© 1 ❑ Apt/Condo 20 Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 120 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. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 430 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 450 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 720 720 .63 7 96.1 Feet 100.1 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber 1:1 El El I F-1 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: (No Stamps) MP/MPRSW No.: Business Phone Number: Byron Bird Se. 1309 715 268,78317 Plumber's Address (Street, City, State, Zip Code): 1359 100 St. Amery, WI 54001 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa . ary Permit Fee (includes Groundwater roun Water Date Issued uing Agent Signa re (No Stamps)' Fee) ~~]~a Approved ❑ Owner Given Initial Adverse Determination / v X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(8.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ( ° t 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 systern. 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/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) ` Terry L. Miller_ (Valley Custom Homes) September 16, 1994 864:N. Knowles Ave. Lot #12 Township of Star Prairie `New Richmond, WI 54017 SW4, SW4 < S SE4, SW4, S 13, T 31 N, R 18 W St. Croix County l k~w PAv 3 Bedroo d i fyz:? / /ari ~ t Tie 0"0 f j t _ AOI )A Ilk P k/ At DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS S (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: T SHIP/ NICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 3E 1/sw 1/ 13 /T3,/ N/R'~E (or)W M / z MAILING ADDRESS: C ~UNTY: ~3 8~ Dr` Gtr. USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: EI OLATION TESTS: Residence /V New ❑ Replace L 1 ,g~J' Z z /79,3 RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: rr YSTEM-IN-FILLHOLDING AIr RECOMMENDED SYSTEM:(optional) ®S ❑U ©S ❑U ® S ❑u S ZU ❑ S ~ D If Percolation Tests are NOT ESIGN RATE: required ~ D _ _ _ ~ 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.) 13- 671 15 5"/ 34 13- 2- 93 2~?3 IC ell 5 93 B// 43" X. 2 3' 39 B- 3 8~ /aa. / ~,.:r 8,f 9-62_5 z-8/ ~s ~~-8~, ~►c s 0901`'6// !/-Z_ ,?.ljaJ, LJ - 3~ B- 90 /ClD. Co 94 $ - del ' C 4e4 J 4,0 - a o - a 'P 5- B- S p . / • % Lr~J / - oc " dpi! ~S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ o~ P- '3 V9 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 T 1 11 _ z _ 3E - Y t 3 r 12 ~x . Il /C20. =gym E i ' [ i e _ r......_. _ _ _ L _ E 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: 9 C_ 76 1-,-2 -f 23 1Q373 t-i A- ADDRESS: CERTIFIC TION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: C„ &TRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. L -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 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate mod s - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - 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 fff - 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 I 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. o v F x LL XV"\\ Of- 0 !2 CE 'Or-' GEE V t U z 3.La.8F,ot p • ` ti1_f o u, I W ~e 0 P~ ~1~: f o o; U. F'{ otiZq 1 u m ~v~'y A`✓'` yh /0 4 ~blC o O . ~c o vi of 3) N 1 O rn t. 0. tr N oo. d / t~ ~ ~ Sri v' ~n O tt I n / J QUM ~ z z WI l i w( H :r z n / 4z~. W Q ~ ZI y ti F cl a ¢ o n 1' f'- I 159' F0' r' L m U V f~-{ ~ a zu Wa 01 I 3.La.9F OON j1N~ .6s ca 0 yes Q oz< w w 0 Q O .N t~ I ZI $ N a tL o F- co a a P i q C 'My Cc 2mt.- O (q N 2 2 rlp y N L/ m Q t' t` N O Q I ry rte. N N u~ °o cn C L O A oc z I / w ~I, al t~ a: -Z I `nax QI cn 4 3~ °I to z Z v to N X I of 'oWiU JI " 4 0 Q r ti W ^ I ,00, 'L a >0'! (n 'o mw C,~< ~I N ' 3.La.AF~00N I ~ 3. FF. 61 Xq ° Q ~z~w~ 'g: wl I N yo IMa~~ U J~ ,,7~ OMU ~I LU 2.99 O o:t~ ILl of b ' r i Z J R idi C) (n trOj 2 ~uj o aJ zQ~z QI T+ ~-+f a ~ a I c,_~Wa W O z ^r ti z h9 I • I Q ~~~•pC11 I• U liQ Z O 0. I •rt ptoj }y Q S_ F CR U 0.I I v /1• (G. b~ k e fiCc o.;atl°p q ° ~~P~•• ~R,°/ J+ +0r 09s i co ~1 p J~u o cn2yv c / ;ot /(~i /~F ~~~dti ~oS2N U fnUo~K¢V) Y oJOQO~ / / i;(+~ 56 wo ti J 01 O (n ,n O h9 Ti / Q~• ~.~~`°by ` _ I r`r + re / ~ ao o ^ a 9~ ti / ~ a ~ ~j (Oil Q • 0p s96 coo W 00 -4. 0 4. 1 0~~ .y O J TYf PX ICnI ,z1I _ OF'EaE _ ~x~i'"~ ,66'669 M.,LE. C~ rAj '7o g~ n ® I q Q x cm '••M..W I G. T I ••••a raau.wu :u o vl I ~ cl O 1 ` I q' k co «I d cu „ ~1 w I,1LJ to z l C~ Q) QI 'i ~ ~ ~ L • aEa b to a ~ o x,94 I ,S4 M.L EF.OON %M 4n ml a - ~p 3 I pl w o .ro N CO z to to CD I c2; I \ ? IDW~ N Q ~`lo !U co 'u CD -OD O„ 'H1 0 m STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County I I~ V OWNER/BUYER L-i A a L. M 'f MAILING ADDRESS 8~1-f N 1(, Vow des I{ e , ( e'w I Z 5yQl 7 PROPERTY ADDRESS 17 a'2 }+Q r b to c K h - , (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~)Q_w 2 I ( V I VVI Ut'u~ . W~ Q PROPERTY LOCATION SG 1/4, S 1/4, Section T N-R o W TOWN OF ~'rCI Y N' rCi i y j2 ST. CROIX COUNTY, WI SUBDIVISION O U V\,+r V M -eG, d QW,5 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: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - loo 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 ~-Q q4 I- . Li n d a L. M I (1 e l Location of property 1/4 1/4, Section ,T N-R W Township 5~ a V' PAC(I rI ,e Mailing address 14VR . N)"V Q c, V\ affvJ' wZ S~1 0Q Address of site[?QX S E2 y Dust- r "R Subdivision name b)ULVITY-V M-i°_ad('7C.t C Lot no. I Other homes on property? Yes X No! Previous owner of property qy-V ~j r u h G,1 IL Total size of property Total size of parcel Date parcel was created 61Gr f C/ Are all corners and lot lines identifiable? Yes No/ Is this property being developed for (spec house)? Yes Y No Volume laq and Page Number 3,a~ 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. , 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. Signa e of Applicant Co-App ical nt Date of SianaturP natP of SinnaturP 'Room • DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 -1982 521099 - - - VOA1094P-11E - ST. CRCIX CO., W1 it Gary Brunclik Recd for R vord SEP ? 1994 - - - - - - s:30 A•M conveys and warrants to _.__Terry-L._-Miller--and-Linda_L.. Miller, husband__and.wife....................... - - of Deeds - - - - ! - - - RETURN TO Ii . the following described real estate in _..__..St ...CrQ1X......._........ -_-"--County, - State of Wisconsin: Tax Parcel No: Lot 12, Country Meadows First Addition in the Town of Star Prairie, St. Croix County, Wisconsin. ~i III Aj. i j 1S not homestead This - - property. (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this August - - 19 day of (SEAL) ---(SEAL) I' Gary 1 - (SEAL) II (SEAL) I - - AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gar Brunclik STATE OF WISCONSIN ss. County. authenticated this ..-day Of...August , 19..94 Personally came before me this ________________day of 19-------- the above named Kristina O gland 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 Ogland - -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 •Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSTN Wisconsin Legal Blank Co., Inc. 1 • I~Iilwsukne 'Nisconsin