HomeMy WebLinkAbout020-1180-90-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ~q'lpy 415M L-"5
ADDRESS C 41,Aeo
~fypso-J ~~5 SYo/ G
SUBDIVISION / CSM# C EPA- 2 t'f 'i ((s LOT 3 d
SECTION. 29 T 2f N-R ( I W, Town of RVID 5410
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1 G1N
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover-
P~ , l df 3
r
2. = CST's 1 y~' Puc !6 yC~
= C ST's V.,L Xt' _ /00. 0
BENCHMARK'
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION
C~ ` 2, O
Manufacturer: W Liquid Capacity:
W ell "6 T'
Setback from: Well House ~ Other
ro Dtr -F- Pump: Manufacturer /VA" Model# S i z
Z.L_y 3 Float seperation Gallons/.cycle:
I- y
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 6 Number of trenches
Distance & Direction to nearest prop. line: S ` C4-^) ES 7- •
Setback from: well : NA- House 7S Other
ELEVATIONS
Lz /o j zD ' to 8. FO
Building Sewer ST Inlet: ST outlet
PC inlet - PC 'bottpm ~ Pump Of f
Ki' Ties,-jc4,
Header/Manifold Bottom of system /ow
7~.0
103 -(a µ i rR sw u.. 101 • $
Existing Grade `oO Final grade /oc4 ,
~ IOa• $
DATE OF INSTALLATION: ~V • ZZ I `
PLUMBER ON JOB: R6 1B T ~ L
LICENSE NUMBER: P Q S 33e)7
INSPECTOR: M RM
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TR>ENc t4 SPEc s 7oPl PIS I I I
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L "U rtHPWQ&st8' 29.19.1 VATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar rfhit
Perrpit Holder's Name: ❑ City ❑ Village Town of: State PI
ev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
020 ii8o_90 go e%
TANK INFORMATION ELEVATION DATA A9300236
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic': Benchmark flog?
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet 7
TANK SETBACK INFORMATION St/ Ht Outlet .09 / 8 r>
TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet
Air Intake
Septic 6r / y, NA Dt Bottom
/d~
> 5Z W44
/a.9/ 5.:07
Dosing NA Header / Man. A ,7 9g•q /
/a•9~ 'b
Aeration NA Dist. Pipe
Holding Bot. System 13. 9
I 7.
PUMP/ SIPHON INFORMATION Final Grade q. v g S'
Manufacturer Demand n d , o , i ab
N a
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemai n Length Dia. t f Dist. To Well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width / Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5 7~ z DIMENSIONS
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu acturer: INFORMATION Type O /ZZT . / / CHAMBER Moe Number:
System: ytt`c ' o ",``t, 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 t 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: HUDSON 28.29.19.1139 0?
I
- q
13- y Ia"
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 11#1 10 H
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
I
:ILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
Ezimmmmmmmmmmd 6T- CPO
STATE SANITARY ~ PE~T
#
-Attach complete plans (to the county copy only) for the system, on paper not less than RY P
8% x 11 inches in size. Chec 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
A s.y v s NV)%a $E S Z? T J-7 , N, R E (o W "
PROPERTY OWNER'S MAILING ADDRESS r LOT # 3
CITY, fl BLOCK #
STATE !/camW ZIP CODE PHONE NUMBER t~ SUBDIVISION NAME O CSM NUMBER
&3 0 c0o0b)f3 OA 4V ISS/i5 `73 1 6o0i (W fie $i I I S
II. TYPE OF BUILDING: Check one CITY LL., NEAREST ROAD
) ❑ State owned D V LAGS f I v ~D .
El Public L41 or 2 Fam. DwelIing-# of bedrooms - L NUMBER(S)
Ill. BUILDING USE: (If building type is public, check all that apply) Z~ ^ 24- /
1 ❑ Apt/Condo 02-0 / O U GO 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 90 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 4.0 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 L!TSeepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill 2 -RE,uC #6-5
VI. ABSORPTION SYSTEM INFORMATION: ?o , U
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIR,'1 10 0 ED (sq. tt:) PROPOSED (s q. ft.) (Gals/day/sq. (Min./inch) ~6 ELEVATION
CO C✓ 750 ~ Feet /0
-Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New Istln Gallons Tanks oncret glass App.
Tanks Tanks structed
Septic Tank or Holdin Tank 2(I - 12,oo
Lift Pump Tank/Si hon Chamber - ~dy
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): lumber's Sign lure: (No Stamps) MP/MPRSW No.: Business Phone Number:
P
1,, FWX 7- 'Z4 13
Plumber's Address (Street, City, State, Zip Code):
to•v G(J/S S `1
& 5"5 G' N/ L /240
IX. C NTY/DEPARTMENT USE ONLY
❑ Disapproved Saq#ary Permit Fee (Includes Groundwater Date Issued issuing en ature ( o Stam
Approved ❑ Owner Given Initial Surcharge Fee) ~i
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
i
INSTRUCTIONS tr
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
1. Changes in ownership or plumber requires a Sanitary Permit: Transfer/Renewal Form (SHD 6399) to be
subm=,tteci to the county prior to installation.
:i. Onsite ;sewage systems must be properly maintained. The p'±ic 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 seviage system, contact your local code administrator or the
State of Wisconsin, Safety 8t 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.
11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
111. 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 systery, type.
VI. Absorptie-t system information. Provide all information recrr•!e-°.cf in ##1-7.
VII. Tank :!l`o cation. Fill in the capau'fy c.f every new and/or ec tank iist the total gailtris r! Limber of
tanks anc manufacturer's name, kidicpte prefab or site const-ujIt=.d and tank material Coat,: (.-te or all
septic, pump/siphon and holding iar:ks for this system. Cheek <.,H,.,-.rirr!ental approval oily u tanks received
experimental product approval from DILHR.
VIII: Responsibility statement. Installing plumtler is to fill in r a~ , 'a,ense number with approprate prefix (e.g.
MP, etc address and phone number. Plumber meat: i r app' cation form.
IX. County/Department Use Only.
CountyiDepartment Use Only.
X.
Complete plans and specifications not smal!Lr that, R', 11 inches :rt ;e submi,3ed to tic county. The
plans mr,st include the following pi -1 .can, dravrn to sca'e or wtith f> dim :o, -ation of
holding tank(s), septic: tank(s) or otllif?• trea4lnl,ant tanks; bxiildirn waLcr rn?;n: .irr'tc- service;
streams and lakes; pump or siph,.:n ?3nkc., dfstr,but!on boxes, so- tusc(v <.< '~!stei )s; rP,D!NGc nk'.~3t system
areas, an,",* the !ocation of the building served 8) hot i ontal and •st!~t ~ io^ referee Pit, -IL's
C) complete specifications for pumps and controls; dose volume; e! vatio, t!rfferences; frict~un 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
-983 `JVisco, sit; Act 410 inoluded the c rf~ Tion a* surcharges (fees) for cat
regulated ptlactices which can effect groundwater.
The cronies cu!Ir?cted thrcrogh these s'.,rcharges att:~ used for ;nonitoririg gru:,:, twafer `s -;urld-
water r:ontamination investigations and establishment of standards.
SBD-6398 (R.11/88)
f" -
Wisconsin Department of Industry, S O,I L AND SITE EVALUATION REPORT - Page of 3
Labor and Human Relations
Division of Safety a Buildings in accord with II-HR 83.05, Wis. Adm. Code
COUNTY
Attach•comolete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of abpe, scale or PARCEL I.D. 8
`dimensioned, north arrow,,and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
"CS//vy fISMU GOVT. LOT 4W 1/4 1/4,S IeT z 9 N,R If E (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT~~tt ~ILLAGE OCK ar SUBR. NAME 0R CSM 8
C~ O GVE/2Cvo4v ~3~/~ 3fr c~Iie -
CITY, STAT E ZIP CODE PHONE NUMBER OCITY ®fOWN NEAREST ROAD
Gvbo~ 1-fid SS/2 S VlF#24 L31 -CoF2-F l-IuDSa^~ ALDP-b P-P
[4'New Construction Use Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily lbw (000 gpd Recommended design loading rate f~bed, gpd/ft2 ' 2 ...-.trench, gpolft2
Absorption area required bed, ft2 75o trench, ft2 Maximum design loading rate tied, gpd/ft2 --8 trench, gpol*
Recommended infiltration surface elevation(s) s-~ Pa • .-3 _ft (as referred to site plan benchmark)
Drt'oo/~ 13-ox 1i•s T,P~,BvT/c+-✓
Additional design /site considerations 't -7,fEW4Yj5'5- a-a 6/0~-2 'Oki/
Parent material ACS 'C6 fA• 4 .4e4, 3- r 13v e*,412,01- Flood plain elevatkxt, if applicable N~ ft
r~vTu~
S - Suitable for system CONVENTIONAL 7 MOUND PT-1 0 PRESSURE AT-CiHADE SYSTEM IN FILL HOLDING TAW
U - Unsuitable for s sterr, C ❑ U ❑ S ❑ U ❑ S ❑ U @-S-❑ U ❑ S
SOIL DESCRIPTION REPORT
Boring # FK-dizon Depth ominant Color Mottles Texture Structure Consiste,~oe Baxfdary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Wnch
0 - r
/6 /C 3/a- S/ -f S,b.r 5 • .s yve 31 s1 z,f, sb& 015 . s .
Ground d ~ %JO - 0YX 3/00 S O,C, S n ,2 .7. elev.
ft
Depth to I
limiting
. factor
Remarks:
Boring # f S y , 5
/S, 0-1Z 75 y' 31y 51 z, f, sk .ti.~fk 13- s z,~, s
/3L- 1-30 5 R 15 41,,,,,,, f9 ` u-F2 S ?
Ground
elev. 133 30-30- 7.5 ye 3// S
C
Depth to
limiting i
factor
I "Remarks:
CST Name: Please Print T0,6&X r Z!1 C4 7-- Phone: 7/.s_3n
Address: ~eSS O'A-)E'!L- P9 Huyso,-j 4.)ts• SVol(o -~-~'3 CsT~y2y~L
Signature: '2 _ n Date: CST Number:
ORIGINAL
This test site AppittjVj,:U
for a conventional
. septic system.
PROPERTY OWNER ( o i ~TS~U S SOIL DESCRIPTION REPORT Page 2- Of 3
PARCEL ID. #t
Boring # Horizon Depth D: -=ant Color Motffes Texture Structure Consistence Bound3y Roots GPD/ft
in. Mu_nsell tau. Sz. Cont. Color Gr. Sz. Sh. Bed rends
p lp 7.5 YX 315l fe S -4, • 5
Ground /S ~►„e s - • ~ . ~
elev. S .e 7
o • L(i ft. ~
Depth to _
limiting
Remarks:
Boring # a
16 ye 3i~ /s o ~~,e s z
~ - /5 75 YA 3/y ~e ,C C s L
E3
r3z 15-2Z s yP- Y/4 /s o, M n,, k cs - 3 _9
Ground s d , Cl 5 ,e / . 7 cQ
c 2-~s i~
106. ft
Depth to
limiting
Remarks:,
Boring #
El -1O 1 7,5 y/e 31 s/ 1J, S bK 1w4 p- CS 1~ S G
Gmund
/0 yR C, 5
Depth W
limiting
ftctor
Remarks:
Boring #
[31
Ground
elev.
it
Depth to -
limiting
factor
Aemarks:
JIB 0127^/U ^G/^12\
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Fresh Air Inlets And Observation Pipe
Approved Vent Cap
Minimum 12'".Above
Final Grade /f'6v lf'jp Wow W1.00 o2,0'
4" Cast Iron
Above Pipe
Vera 'Pipe
-to Final Grade
Synthetic C.,rering
min. 2"" ~ r.jrec ale
Over Pipu
Distribution -Tee
' PIPa
• ' Aggregate o Pertbroted Pipi Below
Beneath Pipe Coupling Terminating At I
0
Bottom Of S.ystem
57F
late
Fresh Air Inlets And Observation Pioe
Approv.e6 . Vent Ca?
Minimum 12 Above
Final Grade ~~.AJ1*5 ff t~ ~
_ 4" Cast Iron
Above Pipe Vent P'vs'
{ 'io Final Grade
i ~
i 4
Synthetic Covering
• ch 2" Aggregate
*'vc:r Pipe
Distribution sU'.'l y - Tee
Pipe 0 0 0 0 0
" Aggregate o Pertoratcd Pipe Below
Beneath Plpe o Coupling Terminating At
t~s~ Bottom Of System
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a c EXCLUDIN6
3 8. , 93372 SO. F
a o Z p 91772 $O. FT. (2.10T-ACRES) EXL , i INCLUOINC
CUC- 0'E='SAC t
o 97974 SO. FT. ( 2.249. ACRES) INC t W
CUL - 0t,- SAC s -►i a
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INE OF TEMPORARY CUL - OE -SAG TO
CENTER OF C AUT0~1_gjoAlLY VACATED NI1
FU '•11M -.EXTENSION .
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S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER In yo
ADDRESS Dale. re.UOV 6 FIRE NUMBER L3O
CITY/STATE- n .a ZIP.
PROPERTY LOC TION:__114,&1/41 SECTION, TiLN-R,_j
TOWN OF St. Croix County,
SUBDIVISION' <6 ~s , 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 expiration date.
SIGNED:
DATE :
St. Croix co. Zoning Office
911 4th St.
Hudson, WI 54016
STC-100
.This application form is to bs 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), thenta st:cond form should be retained and completed when
the property' is sold and submitted to this office with the
appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of property
Location of* propertvN W 1/4 SO 1/4, section 0118 .T N-R,_-W
Township
Mailing address ~~rw0,
44
Address of site
Subdivision name___ radw /-t7 WS Lot no. 3?
Other homes on property? vesNo
Previous owner of property
C"'~/ls'
Total size of parcel 2 4- S
Date parcel -was created
Are all corners aid lot lines identifiable? ,..4,_. yes
___ho
Is this F opwirty being developed for (spec house)?-Y,,s 0
Volume and Page Number 0-2, as recorded with the Re ister
of Deeds. 9
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
1 (we) certify that all stateme-Ats on this form are true to the
best of my (our) knowledge that I (we) am ( arp ; ; ;~;;er (s ) of
the daziv ILdd in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No . w~ 7 9 7_, and that I (we) presently
own tha proposed site for the s4wage 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 ::he office of county Register of deeds a3 Doc ent
No.
Signatu of applicant Co- 71 ant
17
Date of Signature Date of Signature
l
DOCUMENT NO. I STATE BAR OF WISCONSIN FORM 1-1982II THIS SPACK RESERVED FOR RECORWNO DATA
WARRANTY DEED
4279`9
This Deed, made between REGISTERS OFFICE A-1 c ST. CROIX CO., WIS.
Cedar Iirlls Deyelorgnent, I,
Recd. for Record this 10th
{wry------ 51t1lts Grantor, Ay of July A. D. 147,.
and U-30 A
ntOr Grantee, MrWr N DO
Witnesseth, That the said Grantor, for a valuable consideration......
- -
conveys to Grantee the following described real estate in St. r R&TURN TO
County, State of Wisconsin:
Tax Parcel No:
Lot 38, Cedar Hills Estates 11, Town of Hudson, St. Croix County, Wisconsin.
N -F !~h
is not
This homestead property.
(is) (is not)
Together VdW&yd singular the hereditaments and appurtenances thereunto belonging;
And .
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
and will warrant and defend the same.
Dated this 9th day of ) Y.......... 19.87...
Cedar Hills Devel piment, Inc., by:
•--•-••--••----.......-•------•----•---••-------••-------------------(SEAL) ......JCA-4.. (SEAL)
Dean R. Larson, President
.....................(SEAL) .>V !`~!!!!G-.. (SEAL)
William C. Harwell Secretary-'IYea
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
as.
• .....................................County.
authenticated this 9_----- day ot__.~....--_- 19_Personally cama before me this ................day of
°7_~ PGHZa/ iLr~R' `c%r!t'te.~ 19........ the above named
(~ii Sfi'~, ®fi
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by $ 706.06, Wis. Slats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
ttorriey -at. MW
. . . Notary Public County, Wis.
Kristin 0gland Lundeen
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
date: 19
)
•Ns nts of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leval Blank Co. Ina
coo.. jj a,