HomeMy WebLinkAbout012-1059-60-000Wisconsin b ~artment of Commerce PRIVATE SEWAGE SYSTEM
.afety and Bsilding Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary ourooses IPrivacv Law_ s ~s na r~ vn,u
'ermit Holder's Name: City Village X Township
Rin ,Kate Trust Erin Prairie Townshi
;ST BM Elev: Insp. BM Elev: BM Description:
! flr7 • b /~a • b 1 • s 9 t~YC a.~--xo~-f-h y,~,al .f ,Ie.~,.~
'ANK INFORMATION ELEVAT N DATA
TYPE MANUF CTURER CAPACITY
Septic
S-~
Dosing
W ~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~
~ a
> ~c~'
~`
~ o f
Dosin
~ ~ 5~ /
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Number ~ ~ ~~
TDH Lif~ ~ Friction Loss System Head TDH Ft
' ~` ~- ~-~
Forcemain LeL~hr--/ Dia. 2 ,r Dist. to Well
County:
St. Croix
Sanitary Permit No:
420745 0
State Plan ID No: /
N
Parcel Tax No:
012-1059-60-000
Section/Town/Range/Map No:
27.30.17.411
STATION BS HI FS ELEV.
Alt. BM
s7 .
~ ~'' ~
Bldg. Sewer
Sty t Inlet
~.3
y3.3s
SUHt Outlet
~-
Dt Inlet
~
~-
Dt Bottom
- - ~ ~ ,
Header/Man.
~~
~
7 3
n~
Dist. Pipe Z '1• ~ ~,
BoX. Syste ~ • S •~
Fin Grade
-S S
~~
•Zs
St Cov r
1~
3.S
X00: lS
.7vILr\o.7vRr11vIV JTJICM J7 (;YIQiv-,~t'L(~\ J- 17 n/_ n___ I e~ ,.. ., _ / _ /_
BED/TRENCH
Wi / Vll.w •1Ir ~- ~ .rL KX/- ~' J (j' mow- t
DIMENSIONS dth L
~/ ~7 Leng
~~ 'r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
SETBACK
INFORMATION SYSTEM TO P/ BLDG WELL LAKE/STREAM LEACHING Manufact
~
~~~
Typ Of System:
t
r HAM E ~(
F~d-Q/!/
~
nlCro1Q11•r ~
lr\.1 w~.T~.. y'(~
"'VV J~
Y
Y \ C~ /
/ "- Model Number: // i~
Header/Manifold)
8 f;~
Length~_Dia
Distribution ~
Pipe(s) ~- l
Length~_ Dia a'te' Spac~ J
x Hole Size
/ (
x Hole Spacing
~ ..~'[w~L ~/d11'~
nt to Air Intake _
~/0~ i
CAII /+A\/CD
Depth Over /~ ~
Bed/Trench Center LI, I Z
` Depth Over
Bed/Trench Edges xx Depth of
Topsoil xx Seeded/Sodded xx Mulched
T ]Yes ~ No 0 Yes No
~:VMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~' /~ o Inspection #2: / /
Location: 1814 130th Ave Ham~mo,~npd~Wl 54015 (SW 1/4 SW 1/4 27 T30N R17W~) 40 a/c~r~es Lot (((»>~((( Parcel No: 27.30.17.411
1.) Alt BM Description = ~'~~"_" ~ ~S ya..C.X~ d ~'~~~0~-`~
2.) Bldg sewer length =~~
-amount of cover =~ ~ ! /-~ • S~) „ /J , 5 / „/, _ L,
Plan revision Required L] Yes [~No c~ 2-,~ _
Use other side for additional information. / ~ ~ i ~ /~ A/Lls~~ //,[~~ ,,. ~
SBD-6710 (R.3/97) Date ~~ Insepctor's Sign~ture
it
l~ -J
Cert. No.
~'~
F~ ~"
Safety and Buildings Division C~tY
~ 201 W. Washington Ave., P.O. Box 7082 , l~ /x
SCO~S,~ Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.)
De artment of Commerce (~) 261-6546 20 ~ ~S
Sanitary Permit App ' State Plan I.D. Number
(n accord with Comm 83.21, Wis. Adm. code, personal
E D
may be area fa sceondarY Purposes Privacy La , s15. Project Address cifd; t than mailing aaaresa)
~~
I. Application Information - Please Print All Iatormatioa MAR 1 8 2 0 0 3
5 G,(,~,2.
Property Owner's Name
r ST. R01 COUNTY # Lot# Block#
~
- I ~ t{O a~ c ~-/
Property ailing Address property
Location
l ~
~ '/
~'/
i
S
Ciry
State
i y
ect
~
.,
, Z
p Code,s~ Phone Number
of Btliiding (check all that aPP1Y) ~~"
2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number
^ PubliclCommercial - Describe Use ~
/ ~/
^ State Owned -Describe Use / 3 ~~ /~ • ~ ~
~~ ^Ciry ^Villa owaship of ~' c
III. T ype of Permit: (Check only oce box on line A. Complete line B it' applicable) ~ ,,, / ds ~ ,. Ov
A' ^ New System
epiacen-ent System
^ Treattnent/Holding Tank Replacematt Only
^ Other Modification to Existing System
B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Pemit Transfer to New List Previats Permit Number and Date Lssued
Befiue Expiratial Phunba Owner
IV. of POW I'S S s tem: Check all that a 1 -/op
on -Pressurized in-Ground ^ Mound> 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^
Constructod Wetland ^ Pressurized round ^ Tinkling Tank ^ Feat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fiker ^
Recirwhuin S thetic Media Filter g Chamber ^ Drip Lme ^ Gravel-less Pipe ^ Other (explain)
V. Dis al/1'reatmeat Area In ormation:
Design FI ~ ) Desigit Soil App1~ on Rate(~dsf) Dispersal Artea Required (s~
~
J
p Dispersa(Area Proposed (sf) Systar4 Elcva '
!!
~
f
j
~ O ~ ~f
~J
'~
VL Tank Info Capacity in Total Number Manufacturer Prefab Site sled Plastic
Gaikuts Galkros of Units Concrete Conateucted lass
New Existing
Teaks Tama
Septic or Bolding Tank ~ ~ ~ J
Aerobic Trcatmert U~w
Dosing Cbarnber / ~
N7 J
I
\
VII. Responsibility Statement- I, the as
assume responsibility for iastallatton of the POWT
S s
bown oa the attached plans.
's Name (Print)r Pl tgnature M~ ~ ~ ~ B rune dun ~~~~
~~~ ~J/ i
Plumber's Address (Street, Ci State, e) ,
VIII. Conn /D artment Use On
~APPro~ ^ Disapproved Sanitary Permit Fce (includes Groundwater Date leaned Agent Signature o Stamps)
^ Owner Given Reason for Denial Surcharge Fee)
2 Z ~ `~~~ .
UC. Conditipns of ApprovaUReas~ s for Disapproval
~s~ -~o~,k~ ~sYs~..
.v~~ b-~ a.L~ ~ p-~,~ ~~
.
~ ~-~ lam- ~ ~~
-~,1
(
V~~~ S S~~ S •
p,{
I ~e ~, Ip~i t.~ J~ ~ v~n~- an ~ cso ~ C C,e~ o-t
tpasea complete plans (to ttu Coeory only) ror the system oa paper net less fYaa 812 s I1 cackles 8a size
i-vtC~$ ~
PLOT PLAN
PROJECT Rina~revocable Trust Account AD Ess 1814 130th Ave Hammond Wi 54015
SW . i ! 4 SW i /4 S 27 /T 30 N/ W TOWN Erin Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE3/17/03 BEDROOM 4
CONVENTIONAL XXX IN-GROUND P S RE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 LIFT' TANK SIZE765 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39
,BENCHMARK V.R.P. op of 1.5° pipe wi-~I ASSUME ELEVATION 100' Filter Zabel A-100
^ BOREHOLE O WELL 'H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.5/94.3/94.4
Alt. BM Top of 1.5" Pipe ~a 100.0'
~_ County Road T
Plans Designed Using
Conventional Powts
Manual Version 2.0
3-3' X 82' Cells with >3' Spacing
' _ ~_ 50' ~t-~' _ 0% Slope
~n ~ Vents
150' _
B_1 100'
10'
Huffcutt Combo Tank B.M.
1 Alt.
90 .M.
u
> ,
Q DW 0
1, ~ld Tanks to be pumped and buried
'" 25'
Vent
Exiting 3 of Cover
Bedroom House
6' Lons 11
~~
Standard Biodiffuser
Leaching Chamber
with 31.1 ft2 of Area
at System Elevation
0'
30'
Well
PLOT PLAN
'PROJECT Rin4~revocable Trust Account AD ESS 1814 130th Ave Hammond Wi 54015
SW . 1 / 4 SW i /4 s 27 /T 30 N/ Jw TOwN Erin Prairie COUNTY ST. CROIX
3/17/03 BEDROOM 4
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN-GROUND P S RE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 LIFT TANK SIZE765 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39
,BENCHMARK V.R.P. op of 1.5" pipe vvf~"I ASSUME ELEVATION 100' Filter Zabel A-100
^ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.5/94.3/94.4
Alt. BM Top of 1.5" Pipe ~a 100.0'
County Road T
Plans Designed Using
Conventional Powts
3-3' X 82' Cells with >3' Spacing Manual Version 2.0
' S0' ~- 0°Io Slope
Vents
2 Vents
150' _ _
D -1 ""'
10' 1
Huffcutt Combo Tank B.M.
1 Alt.
90 .M.
a~
> ,
d DW 50
M 1, ~ld Tanks to be pumped and buried
' 25' ~ nVent
~~
> 6„ Standard Biodiffuser
Exiting 3 0' of Cover Leaching Chamber
Bedroom House with 31.1 ft2 of Area
6' Long
0'
30'
Well
at System Elevation
~.
wrscor>sin Departrnent of Commerce SOIL EVALUATION REPORT
Division of safety and Buildings
in accordance with Comm 85. Wis. Adm. c~d~
gi -`f--dz- p~~~~~ c«,~,tr J~
Attach complete site plan on paper not less than 81/2 x 1 inches in size. PIS t
include. but not drttited to: vertical and horizontal reference point (BM), dirediort and Parcel I.D.
percerk slope, scale a dimensions, north arrow, and location and distance to nearest road.
Please print all informa8on. ~
Personal hrortnation You P~~ maY be used for secondary WxPoaes (Pmraq law. s. 15.04 (1) (m))- _
PropeAy Owner ~ -, .. , - Location
Lt~
Page ~ of~
Date
M-wc~n ~
` ) Govt. Lv 1/4 51,1/4 S'Z T N R~ E ( W
Property Owr>er's Mailing ss Lot # Bbdc # .Name or CSM#
v ~~ 0420- -- 0
City State Code Number fl City ^ Yllage Nearest Rp~i
..:.e-`
^ New cansauction Residential ! Number of bedrooms .~_ Code derived design flow rate Gpp
eplaoement ^ PubGc cotnmerciai -Describe: __ _ _ _ _ _
Parry rltaterial ~~ '~~ c,~„(~ ~ Flood Plain elevationrf applicable NI ~ ~ tl
~ 9' - 7 rvol~p„~..
~!~s~4 B~ s ~ I.CrC~rS< ..C.~--~ U ~ ~ f 1~~~ r ~~ /~ .dew ~ r e.C hb,~.! ~-n.~ a~. •,s r
V ~ ~~
Borirl8 #
Pit Ground surface elev. • R Depth to irnifmg factor
~
in.
,
_ Sod Rate
Hpiaort Dept Dontir>errt Redox Desaiptiort Texture Struc4xe Consistence Baxdary Roots GP D/iP
in. Mussed Qu. Sz Cori. Cobr Gr. Sz Sh. 'Eff#1 'EB#2
`z Pa o , s ~---- ~ Gv - ~ ~ ~
®# ~ ~
Pit Ground surface elev. ~~ , ft. Depth to limiting rector _~! ,[_ in.
~ Sod rcafion Rate
Horizon Depth Dominant Redox Description Texture Stnxxure Consistence Boundary Roots GP D/rP
in. Mussed (]u. Sz. Corrt. Color Sz. Sh. 'Eff#1 'E
tf#2
~_1 ~ '~'-~- .t.ri ¢
~ O
3 .~--, ~ r ~ i , Z-
EftlueM #1 = BOD > 30 < 220 rrxrll and TSS >30 mgll. ' EftluerN #2 =BOO < 30 mgll and TSS < 30 mglL
(Please ) 'gnature CST Nugm~beyr;
ZZ ts/ ~V
Address Date Evaluation Condixxed Telephone Number
3
ParoeilD #
Page Z~ 3
Boring # Bonng
3 Pit Ground surface elev. i U . = ft. Depth to dmiting factor ~ in.
Sal Rate
Horizon Depth Dominant Redox Description Texture Stnxxure Consistence Boundary Roots GPD1fF
in. Mussed Qu. Sz Cart. Color Gr. Sz. Sh. 'Eff#1 'E
j s ~' ~i~, f!'1 ,
~----- ~ /j7 /~/~'1' 1`~~~ ~~ Z
^ Pit Ground srxfaoe elev. ft. Depth to limiting factor ~. Sod ication Rate
a # ° ~~
Horizon Depth Dominant Redox Description Texltse Structure Consistence Boundary Roots GPD/ft'
in. Mussed Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Etf#1 'Eff#2
^ Pit Ground surface elev. ft. Depth to dmiting factor in.
Sod ication Rate
i
H th
D Dominant Redox Description Texture Structure Consistence Boundary Roots GP D/fP
or
zon ep
in. Mussed .
Qu. Sz. Cart. Color Gr. Sz Sh. 'Etf#1 'EfF#2
• Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mg/L • Effluerrt #2 = BODS < 30 rrxyl and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
sew3wtR.a~r
Soil Test Plot Plan
Project Name Kathy Ring Trust Account Shaun
Adda~ess 1814 130th Ave
Hammond Wi 54015
Lot ------ Subdivision -------
S W 1 /4 S W 1 /4S 27 T 30 N/R 1 ~ W
Boring Q Well PL Property Line
BM or VRP Assume Elevation 100 ft
System Elevation 94.5/94.4
Alt. BM Top of 1.5" Pipe @ 100.0'
a
d
K
P.`~~3
#226900
Township Erin Prairie
County ST. CROIX
Top of 1.5" Pipe
* H R Psame as Benchmark
Date
Gi,
Mane of `"
- SEPTIC TANK ~ FUMP CHAMBER CROSS SECTION ANn SPECIFICATIONS
w" Ci VENT PIPE 12" MIN. ABOVE GRADE ~ NEATNERPROOf
> 25' FROM DOOR. WINDOW OR JUNCTION SOX
WITH CONDUIT APPROVED
MANHOLE COVER
FRESH AIR INTAKE W/ PADLOCK 6
FINISHED GRADE WARNING LABEL
6"K.a. ,,, ~4" MIN.
ie ° iN
y c• z. ae~af,r~-oa sy"
r. A.
~
u
. r{~E ~+~
. Mf N.
t8
INLET ' '.
1
WATER TIGHT SEALS
, ~" GAS- , `
TIGHT + ~. .
~lPPR0YE0
fit,TER - A SEAL ~ JOINTS WITH
__l__ ~ ~ ALM APPROYEO PIPE
APPROYEO B + ~ ON
~ 3' ONTO
PIpE 3' "i-" + SOLIO SOIL
ONTO 50l.IO
~ ~ ~ i ~
OFF .
SOIL ' T •
PUMP OFF ELEY .
D
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS ~ ,/ 7y~,~
SEPTIC ! DOSE
TANK MANUFACTURER: _
TANK SIZES: SEPTIC ~•~ ~ GAL.
DOSE ..s GAL.
ALARM MAANF'ACTVRER:
""!"" MODEL HUMBER
SWITCH TYPE:
PUHP MANUFACTURER
-""~' MODEL NUMBER
SWITCH TYPE:
RFOUiRED DISCHARGE F
NUMBER DOSES PER DAX:
~~~
DO5E VOLUME FLO BAC~K~r ~~~'_-~ GP-L•
CAPACITIES: A =p2~~NCHES = GAL.
B = 2 INCHES = GAL.
C = 7-~ INCHES = ~TGAL.
D = ~ INCHES = ~O~ Gp-L.
PUMP ~ ALARM WIRING AS PER ILHR 16.23 WAC
FEET
VERTICAL DIFFERENCE BETWEEN t'UMP OFF AN13 DISTRIBUTION PIPE -.,FEET
;MINIMUM NETWORK SUPPLY PRESSURE •'-- FEET
+ ~ FEET FORCEMAIN XAI~FTJ100 FTOTAL;DYNAMICAH£AD •=~1,~",~---FEET
~2s/ G2~1~,,-- : _t~1IDTH~I: DIAMETER
IN ERNAL DIME SIGNS OF PUMP ANK: LIQUID 6'Ep'i`A- ~ __-
~- ~~~~~
LICENSE NUMBER: ~i~~~~DATE: r
SIGNED:
1188
HEADtCAPACITY CURVE
EFFLUENT and DEWATERtNG
WARNiN6: Modes 18514185 should not be subjected to~tess than 30 feet TDH.
U_
O
r
Note: For Head Capacity on Model 112, industrial column-explosion prooof pump, see FM0219.
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715-246-4516
St. Croix County Zoning 715-386-4680
Pumper Tom Mondor 715-246-5148
Shaun Bird #226900
OwnerBuyer
ST CROIX COUNTY
. SEPTIC T~-NK 14~I~fi'TENANCE AGRELMENfi
-_ . -.-. AND . .
. ~ OVVNE$,SHIP CERTIFICATION FORM
~.. i !/ 'T~ , ~
Mailing Address ~ ~ ~ ~,~.rt 1~ 1R~,..c~ tic-~_s~ ~.o.. ~-~ 1 ~ ~1 ~ ~ L
- _ - -
Property Address - _ _ ~ ~ ~-
(Verificationrequired from Planning Department for new construction)
City/State Parcel Identification Number
J
LEGAL_ DESCRIPT/ION /
Pro Location~`~/ '/ ~~/ '/•, Sec. ~ T ~ N- W, Town of ~~-,~~. ~f a`~ ~'
PAY ''~,1--
r-~- .Lot # '-
Subdivision .
Certi£ed Survey Map # `- ,Volume ,Page # ~
Warranty Deed # ,Volume .Page #
Spec house ^ y~S~~o
Lot lines identifiabl~es ^ no
SySTF 1~~IAINTENANCE
Improper use and maintenanceof your septic system could result is its premature fair to ~hawdle wastes. Proper maintenance
consists of pumping o~ the septic tank every throe years or sooner, if nettled by a licensed Pte'. What you put into the system
can affect the function. of the septic task ss a treatment stage in the waste disposal systenn.
.The property owner agroes to submit to St. Croix Zoning Department a certification farm, signed by the owner and by a
masterplumber, joutaeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the oa-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Ilwe, the undersigned have read the above requirements and agree to maintain the.private sewage disposal system with the standards
set forth, herein, as set by die Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
of three year lion date.
~j0 _
OF AP CANT DATE
OWNER CERTIFICATION
we) certify that all statements oa this form are true to the best of my (our) knowledge I (we) am (are) the owner(s) of
the rty above, by virtue of a warranty decd recorded in Register of Deeds Office. ~ ~I ~
~V!1L.G
SIGNA OF APPLICANT DATE
****** rmit be' revoked b the Zoning Department. ******
. Any information that is mis-represented may result in the sanitary pe ing Y
'`* Inetude with this appiicatiaa: a stamped Warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
. , ~ vlt! 1639P~~E 22`7
STATE BAR OF WISCONSIN FORM I - 1999
Document Number WARRANTY DEED
This Deed, made between Catharine L. Ring a/k/a Catherine L.
o:..,.
Grantor, and The Ring Revocable Trust dated May 11, 2001
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (ifmore space is needed, please attach addendum):
W l/2ofSW 1/4 of Section27; W I/2ofW 1/2ofNW 1/4andW I/2ofSW
1 /4 EXCEPT part to LeRoy E. Nyberg and Sharen I. Nyberg in Vol. "442",
page 286, Section 34 atl in Township 30 North, Range l7 West.
Together with all appurtenant rights, title and interests. \
Grantor warrants that the title to the Property is good, indefeasible in fee
easements, highways, utility rights and reservations of record, and will warrant
Recording Area
64527
KATHLEEN H. WALSH
kEGISiEk OF DEEDS
ST. CkDIX CO., WI
RECEIVED FOR REC~iD
05-15-001 9:30 AM
WARRANTY DEED
EXEMPT II 16
CERT COPY FEE:
COPY fEE:
TRANSFER FFE:
RECORDING FEE: 10.00
PAGES: 1
Y° ~
~ _ _~pt/~Q ~ ~S -
~p S t
i" ~ .,,1~
~~
Name and Rcturn Address
BAKKE NORMAN, SC
900 Main Street
PO Bar54
Parcel
This
1LL7~1-9 }~2=t9 1-80, 012-1072-30 I ~~
Number (PID
homestead property
le and free and clear of encumbrances except
defend the same.
Dated this _ / / day of May 2001
+ Catharine L. Rin
AUTHENTICATION
Signature(s) Catharine L. Ring _
authen ' i d f 2001
ACKNOWLEDGMENT
STATE OF Wisconsin )
SS.
St. Croix County )
Personally came before me this day of
May , 2001 the above named
Catharine l« Rini ,
' Thomas R. Schumacher
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stnts.)
to me known to be the person(s) who executed the foregoil(E
instrument and acknowledged the same. /~/
THIS INSTRUMENT WAS DRAFTED BY +
Thomas R. Schumacher Notary Public, State of
BAKKE N RMAN, SC My Commission is permanent. ( not, state expuauon ate:
(Signatures may be authemicated or acknowledged. Both are not necessary.) )
• Names of persons signing in any capacity must be typed or printed below their signature. intwmetw~ a,~te..~~,am company, rora a tac, w
STATE BAR OF WISCONSIN eoo-ass-soz,
WARRANTY DEED FORMNo. 1 - 1999 ~
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