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HomeMy WebLinkAbout008-1095-10-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER v~~) ADDRESS 15 CDt1I ~Celi e- Edwin SUBDIVISIO(N~ / CSM# LOT ~ SECTION. 3 1 T N-R W, Town of ECI:-v C"Ill e °5t35.Jk' . ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _ 1 - .e CGS a~ REncCi tSr Sqt' ~-tee y6' rRE, y J` Hwy ~ rand Jim INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: IC Oh ~v5~ 4"I,-ha- C' Elf i r'e + ALTERNATE BM: SEPTIC TA14K / PUMP CHAMBER / HOLDI146-TANK INFORMATION Manufacturer: glj,✓rslfin AFCQ Liquid Capacity: Setback from: Well k )r W T- A, s'e ~,2 Other Pump: Manufacturer Model# Size Float seperation 6ti A- Gallons/cycle: Alarm Location I I .SOIL ABSORPTION SYSTEM f=r r~F.. 16, 2 Width: Lengthb-,rn~, rr~ ,ti 9S- I Number of trenches Distance & Direction to nearest prop. line: 00,t YE r Setback from: well: _r WA Fn House AZ! Other (Flow -Me,ft it' ~.pgvr5 hc~Tz~ ELEVATIONS(F/,,wL,br) ~F~cu~ Li'heJ Building Sewer ST Inlet; 3 ST outlet 0/r PC inlet PCIbottom Pump Off 'iL~se elevafiaas c,~~ LtO7,;-ro ±,7ee.3~, gj7 7 Header/Manifold5~ jBottom of system QorrcM T-FFrv y7. 2 Existing Grade Final grade DATE OF INSTALLATION: <)C 2q PLUMBER ON JOB: Me,) (GEC ~j~ p~^ LICENSE NUMBER: INSPECTOR: 3/93:jt LOC&ION: EAU GALLE 34.28.16.505A Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations S INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: -GENERAL INFORMATION 199811 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: EWBORG, REUBEN EAU GALLE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 14~ &0 -~-rs ,,~Q ~~5 r f'-'~6...--- 008-1095-10-000 TANK INFORMATION ELEVATION DATA 10h / 7,31 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark &J 7 Dosin ~97,:5_0 Aeration Bldg. Sewer -172 Holding St/ Inlet D 20 TANK SETBACK INFORMATION St/Outlet g9, 9lip' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic C~ a NA Dt Bottom Dosing NA Header / Man. ~%g X32 Aeration A Dist. Pipe Holding Bot. System ~s GAF7,o PUMP/ SIPHON INFORMATION Final Grade c Manufacturer Demand 7"o 0 "C- V 93' 37 Mod 1 Number GPM /V. TDH Lift Friction stem TDH F Forcemain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Widtj Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DI EN I SYSTEM TO P/L BLDG WELL LAKE/STREAM LE G Manuf urer: SETBACK S CHAMBER INFORMATION Type Of System: OR UNIT ~✓QrG~ DISTRIBUTION SYSTEM Header f Veen+44#6 „ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length IL Dia. Length 9 Dia. Spacing?' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste my Depth Over Depth Over xx Depth Of xx Seeded/ Sod d xx Bedr/Trench Center Be*/Trench Edges Topsoil ❑ Yes No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EA GALLE -34.28.. 6.505A 9(~ Plan revision required? ❑ Yes to / p Use other side for additional information. /U Q/ cf o SBD-6710(R 05/91) Date Zlnspector'sSignature Cert. No. ADDITIONAL COMMENTS AND SKETCH b SANITARY PERMIT NUMBER: Sed Evc&Wo» l6ifed uJee t~e ►w-,e of Wq!W Feh$hva. DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~ sw.n.~r s eewwtua~w.wn~w.vr i STATE S/ I7jYF)R7IT # -Attach complete plans (to the county copy only) for the system, on paper not less than C/y 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. PR PERTYPpWNER PROPERTY LOCATION t ul-oh he RE_ya E.'/a, S T , N, R I~ (or) W PRO ERTY OWNER'S AILINQ A ~ RE LOT # BLOCK # 1 /L~1 V CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER z S-z sf- Awl XXhkwja~ r-Y 11. TYPE O UILDING: (Check one) ❑ State Owned O VILLAGE NEAREST ROAq ✓Py ✓4e. ❑ Public X1 or 2 Fam. Dwelling-# of bedrooms - PARCE L M V ti III. BUILDING USE: (If building type is public, check all that apply) 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 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. ❑ 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 11N Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank 12Seepage 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 REWIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 81 ~p.TION ,lV1lfJ1 v Feet q 1. Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank F1 I [I 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. MBusiness Phone Number: Plumber's Name (Print): Plumber's Signature: (No Stamps 2 I gruc-r- 14.) WeL5ki- 715- S7 - D~~ er's Address (Street, City, State, Zip Code): Plumb IX. 0JJN TY/DEPARTMENT USE ONLY ❑ Disapproved San'tary Permit Fee (Includes Groundwater Date Issued Issuing A nt Signa No Sta ) )(Approved ❑ Owner Given initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPRO L/REASONS FOR D SAPPROVAL: 43 SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safetys Buildings Division, Owner, Plumber x INSTRUCTIONS r 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 criten;i m the Wisconsin Administrative Code will be appiicabse. 3. Al! revis a7s tc) this permit must be approved by tie permit issuing authority. 4. Change i , ownership or plumber requires a Sanitary Permit "s i-ansfer/Renewal Forr i (SRF', 6399) to be sub ni tc f to co..rnty prior to installation. 5. Or ± sewage sys'-erns must bt ,roperiy maintained. The a tank=s) muz3t bie putilped h y iioensed - pumpE'r whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sew:3ge system, contact your local code adrrrinistrator 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 'fie. 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. Absorpticr system information. Provide all information requested m #1-7. VII. Tani idzJ ,,iiation. Fill in the capa~,Jty of every new and or existing sa,41. !~st the tar:il gs -i llons, nurn""er of tani,cs an,! ;r,ufacturer's narne. lod.ca'so prefab or site constructed sr ; iwik material. ;orra[ :;tf or all se o- i`,Isiphon and holding t&As for this system. Check exp im,:~ ',A approva' c ly J ;4nl,s received e,xr~ ray. ~r~id_rcf approval from DILH.R. VIII, Respor-,ibifity starement. Installing plurnh4r is to fill in name, r--be, with rit,4ix (e.g. N11 t,1- ?Cdres phone number. ['lumber mu:-t sign application form. lX. Gounty/Department Use Only. X. County/ )e;arfinent Use Only. Corr`r "<ens a~-,d specifications not smaller than 81/2 x 11 inches rnu,-t be ,ubmitte 1~: thr: rorrr,tY. The ' foi!cwing: A) plot plan, drawn to scale or wits, :'''e din.)e'i. t..3.i of hC~l~ 1 s ;r tank(;.) or Other treatment tanks: building SE . E -1 wc P# d!'=E--,St r >f'rvice; gtrparyb I.i,os; .)umt; nr c_jph0,1 tanks, '-listribution oo[!~s, sro'i :y ?ern? i system areas, a0d ;he :ocation of 'h- tSu0' ing sef..'ed d? ha z-:)-^+a . n f Pf z C) compiei; specifications to( purrjps and controls; close volurrie, elevut:,),..i erencez,: fricdGr loss; pump -n perforrna.n(;e curvN; pump model and pump manufacturer; D) cross section ut the soil absorption -system if 1 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 surcharcles rfees) for a ;iumhar of regu!at-c practices which can effect g-.,-)undwater The r I r,; S c~ `'acted thr'cug l'hese sc:uharge . clfE U F,C `^r i ti l^, E `F t C.. w?te,( C;CMil3r,"n ?tion investigations and establishrnf-nt Cif at,: ;fir{? i SBD-6398 (R.11/88) . Iw",o fi- 2-g" ~ 2 f G cv 6 l `t5 ~ 2-G 3 a ~ 14 1, arW/ ~ ~°N~ c c h ryB~ ~~~{a` b 8~ ve"r P ~'L d 62, - Tvenc~ 7,s ' 1060p)l ah mf'L rkrh prcgst- INC venCHrs aYl drYp w!- ct&w&- osd 3 ►Ovae4 bov" .C ~ well evf- pq / Wilco sin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of _4 and Human Relations .11M.-d-n-of Safety & Buildings in accord wit IL 83.05, i . Adz od t"1741 / 4 vC 4 COUNTY St. Croix ' Attach complete site plan on pape ?ess than 8 x 11 inches in size. Plan must include, but 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 ~I •0Q REVIEWED BY DATE PROPERTY OWNER: eiV~ O PROPERTY LOCATION Walter Fenstra "Al GOVT. LOT NE 1/4 NE 1/4,S 34 T 28 N,R 16 W PROPERTY OWNER'S MAILING ADDRESS -Q J IV/ LOT # BLOCK # . SUBD. NAME OR CSM 285 25th Ave. s~ 51- qj~ - - NA li CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN NEAREST ROAD Woodville. WI 5462A~ - (715) A9R-9917 Eau Galle- 10th Ave, [X] New Construction Use ] Residential / Number of bedrooms 3 [ ]Addition to existing building j ] Replacement- [ ] Public or commercial describe Code derived daily flow 45n gpd Recommended design loading rate bed, gpd/ft 2 .45 trench, g Absorption area required t1 2 tied, ft2 ^900 trench, ft2 ' . M"mum design loading rate ,4 bed, gpd/ft2 =5 nch19p d/ 7 Recommended infiltration surface elevation(s) 87:25/88.75 It (as referred to site plan benchmark) Additional design / site considerations install 2 - 5' x 100' trenches 15' apart CL to CL Parent material till/fluvial outwash Flood plain elevation, if applicable =NA `ft4~5y ` S =Suitable for system M~QNVENTIONAL , MOUND IN GROUND PRESSURE AT-GRADE SYSTEM AN R HOLDING. TANK ; L U=Unsuitable fors stem ©S ❑ U7 S❑ U S U S❑ U El S U El S U SOIL DESCRIPTION REPORT,.,_. Depth Dominant Color. Mottles Structure ' GPD/ft Boring # Horizon > Texture Consistence Bourxiary Roots in. Munsell Qu: Sz. Cont Color Gr. Sz. Sh. Bed rends 2 12-22 10YR 4/3 - sil 2 m sbk mvfr- cs if f <r:::, .5 '.6 3 22-76 10YR 4/4 - sl 1 f sbk mvfr -Y :4 .5; Ground elev. 89.2 ft w/ occasional rockets 7.5YR 4/4 1 & commo gr & cob; t ,)e sl is'often csl is g neral-y - Depth to poorly sorted limiting factor I > 76" Remarks: Boring # 1 0-18 10YR 4/2 - sl 2 m sbk mvfr cs 1f/m 5 .6 2 boundary dip ; occasional gr 2 18-36 7.5YR 4/6 - sl 1 m sbk mvfr 1 1 2 .5 Ground elev. w/ gr & occ c 92.3 ft. - 3 36-78 7.5YR 4/4 - sl 1 c abk mvfr .4 Ilimitingo common is (0 ml); occasional pockets 7 5YR 4/6 s; 1 is o cs w01 2 ~j .113 w factor > 78" S t1N~ c Remarks: )OIN 0,11 T Name:-Please Print Phone: 9 Henry F. Grote 715-665-268 Address: PO Box 57, Knappi WI 54749-0057 Signature: Date: CST Number: 6/22/93 3065 PROPERTY OWNER Walter Fenstra SOIL DESCRIPTION REPORT` PARCE. l.l).# Depth Dominant Color Mottles Structure Boring # Horizon Texture Consistence BounCbty Roo in. Munsell Qu Sz. Cont Color Gr. Sr. Sh. a 'g 1 0-14 10YR 3/2 - sil 2 m sbk mvfr cs* if '.5 6 2 14-22 10YR 4/3 - sil 2 m sbk mfr ci if .5 .6 Ground 3 22-32 7.5YR.4/4 - sl 1 m, sbk mfr cs if .4 .5 elev. 88.7 ft w/' r & occ' cob Depth to 4 32-64 7 SYR~4/44/6~ -F r sl &.ls 1 m sbk mvfr cs 1f .4 .5 limiting .'poorly sorts ,£more ls~than sl; is is 0 g ml but-loa ing,should be asst ned b ed'on factor ..''a 'n r 6411 5 64 70." 10 '4! .pT5YR 4/6 scl 0 m; `i z NP .2 A g _ F esn }",r . w ua .G ~ r "y q Remarks. Gy> Si C08 dk Bn~ IS ins'C0(THiIOn :M or12 2 ~'t r i ~,s,.: • + _.`r _ p= Boring # 1 0-15 10YR 3/2 - sil 2 m sbk mvfr cs 1f .5 .6 2 15-29 10YR 4/.3~~. • - sl 3 m sbk L 4 t 3 29-38 10YW' 4/4 - sl m sblC- Ground f- elev. 4 38-78 10YR 4/4,4/6 - lcS ' 0 sg ` m w/ 9r.&. occ'c Depth to f limiting f78tpr Remarks: r" . Boring # s Y MIR. 1 0-14 10YR 3/2 - sil, 2 m sbk;: mvf c . 5 2 14-27 10YR 4/3 - sil 2 m sbk' mvf c a iv " c~' 3 27-36 10YR 4/4 - sl 1. m sbk m.:vfr cs"k1 45 Ground elev.. elev. ft 4 36-84 10YR 4/4,4/6 - lcs 0 sg ml - - .7 -8- 75.6 w/ gr & cob Depth to limiting factor 84" Remarks: Boring # 1 0=10 ',10YR 3/2 - sil 2 m sbk mvfr cs if. -.5 € .6 'z M., 6 2 10-25 10YR 4/3 - sil 2 m sbk mvfr as if .5 : 3 25-36 10YR 4/4 sl 1 m sbk mfr cs if .4 .5 Ground elev. 4 36-80 10YR 4/4,4/6 - lcs 0 sg ml - - .7 .8 76.3- ft. w/_ gr & cob Depth to limiting factor 80" - Remarks: SBD-8330(8.05/92) y. ew5 ♦a- ~uL ry~~ V$ %A' E ~L I i' b1b 17 A p,. 1 10 lo.o lv~ ~M1O •b C? , mow- A ~ I j Y ~W ,~~«.~1 . ZS4 • LSD • t~ Q- s aq K ak- Q e S SAa S-} Aa c-a .~cT'-t3.~1~ ,so .v i ` t ~ n l i i A\ Lll; C ? L.rt~~~ ~'g ~a e r t S: ~L -r , 9 .41 o o d o 0 0-3 p Qo O 0 a, 0 4 Y CN" U S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County R New OWNER/BUYER R oy, I ADDRESS ~zpfqv FIRE NUMBER CITY/STATE ° 1Ove ZIP PROPERTY LOCATION:1/4, AIF 1/4, SECTION , T~N-R TOWN OF V G-Cl ~'f , St. Croix County, SUBDIVISION , 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 a 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 Co. Zoning officer within 30 days of the three year expiratio date. SIGNED: DATE: Z Z2 -2 St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 S T C - 100 This application form is to be completed in full and signed by he 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), thenla 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 Location of* pro perty ? 1/4 1/4, Section F 0 Township _ t1 G Mailing address ~ ~ I'► et~J e ~Acj' , , oe5, o Address of site -.719 f 5~Ve subdivision name - Lot no. Other homes on property? yes No Previous owner of property +P✓~'►S r Total size of parcel __71V 71V q_W-'Z- Date parcel -was created 'Are all corners and lot lines identifiable? -Yes No is this property being developed for (spec house)? Yes xNo volumeI~~ and, Page Number ~'~V_ 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 & 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. U , 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 county Register of deeds as Document No. S©► 9D~ gnature of applicant Co-applicant I Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1988 THIS aFAC■ ResasvaD FOR R[CORDINO DATA .WARRANTY DEED 904 VOL 10 QPAGE 216 If 2 REGISTERS OFFICE This Deed, made between . WA.1AACA t.• Fens tra_and ST. CROIX CO., W1 Sandra ...D.%...1 ens_t;,a,...hs~shand._.And.-wife Rec'dforRecord .---•----••--•--••-•••-----•---•-------.....•---••••--•-•----•.•••••-••--•------•------•....__:Yy G:»cor, JUL 6 1993 and___Reube.n..): Qyd...~Iewborg-•and•-.............................. aiAnn_ at 2:20 M . .__.Ne~rbarg,___huskaild---And--wife--as•_•suryorship__________ ...-marital.. property Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... conveys to Grantee the following described real estate in t • __C16o i x........ CR DIT U ! County, State of Wisconsin: Box 305 The Northeast Quarter of the Northeast FRUYVII 1-11113, VVM WV-59W uarter (NEk of NEk) of Section Thirty Four Tax Parcel No: g34), Township Twenty Eight (28) North, Range Sixteen (16) West, except a square 295 feet 2 inches in the Southeast corner. TRANSFEb $ 3eV am This is...DQt.......... homestead property. (is) (is not) Together with all and singular the hereditament& and appurtenances thereunto belonging; And...Wall.ter._.W.....F_ens tr_a.. and..Sdndra..D_e.--Fens_tr-a--------------------------------------•---............... warrants that the title is good, indefeasible in fee simple and free and dear of encumbrances except easements, restrictions and rights of way of record, and will warrant and defend the same. Dated this . - .19.9.... day of _._...--•--•--...-----•---------------•---•--------...(SEAL) tauew (SEAL) ' fialte-.W....Fezt;3t_a---------------------•- ----.(SEAL) - 4..)r.- ----..---...(SEAL) Sandra D. Fenstra AUTHNNTICATION ACHNOWLEDGMBNT Signature(s) STATE OF WISCONSIN ` ss. - _ .County. authenticated this --------day of___________________________ 19 Personally came before me this 3 day of _ n3 19_-93_ the above named ~~andra__A...Eenat ~_.J TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized b - y 1 706.06, Wis. State.) to me kno per ~pY 4 forego n a a ai4eseme. Q THIS INSTRUMENT WAS DRAFTED BY L.__Gay_lordi__Attorney_....................... 3 River---Falls.,---WI...__54Q22------------------------- Notary Public Wis. (Signatures may oe authenticated or acknowledged. Both My Commission is permanent. (if not, expiration are not necessary.) --y date. --------<--•._1----- .Names of Densons sianins in any capacity should be typed or printed below their siraatar'd- WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leval Blank Ca Ine. FORM No. I - /fir! Milwaukee. WY.