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HomeMy WebLinkAbout012-1067-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420602 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Knutson, Darrell I Erin Prairie Township 012 - 1067 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: �.O m-0 \ Zj1PVC- = CiT"gM�" ! TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi ` Benchmark 4- S - 0 off• � � Ov • � Alt. BM l� &C--X. Z • bo 02,U' Bldg. Sewer �St/Ht Inlet — c ��c.� �. Ics� 5 we11A_ SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet SeptiA Dt Bottom o _�3 4O I f 6 r ead /kAnnr 9 (J'Q S IF 3- ! Dist. Pipe r Bot. System 1 •bo 3.9v� PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover 3 GPM Model Numb / (� q � � • I u s �� � TDH Lift ✓ riction Loss System Head T Ft L �I sy t Forcem*fi Length Dist. to l C� SOIL AB ORPTION SYSTEM q s 31 ENCH idth L �i S No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN ' 2 3 >,ta•�s SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: nn,* INFORMATION CHAMBER OR ,bd�S� Type Of System: yp y,. , N �� 3 �t t _ UNIT Model Number. 1 ii DISTRIBUTION SYSTEM Header/ anifold U Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) � cO t Length e Dia Len Dia Spacing J 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 Fill No M T�de(coodde�diiscrepenci ( SE 1/4 SW 1/4 31 T30 s, persons pr sent, etc.) Inspection #1:12 -/�/ OZ- Inspection #2: / Location: 1548 County Rd E New�R hmond W N R17W) NA Lot arcel No: 1.30.17.475B 1.) Alt BM Description = Stab _ ����CpLQ�o��`KSO' ��3� T.w�' 2.) Bldg sewer length = Z f i v ` - amount of cover = • QtiS t .( _ _ () L�Q "l �+►t. W' S """^� 3> � � o�Rlt�J-�'�'� r ,zPn �evts �e c.se.��l .aol� W IS..� Plan vision Re quired? it Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County 1 2 01 W. Washington Ave.. P.O. Box 7162 S - F' cle d j " C eonsr►n Madison, WI 53707 - 7162 C Sine Address Department of Comrherce a p -oz 3 f�Cj� 71) G ynac. - Sanitary Permit Application Sanitary Permit Number 0 In accord with Comm 83.21, Wis. Adm. Code, personal ' Check if Revision to y ma be used for Priva La s15. I. Application Information - Please Print All Information State Plan I.D. Numl Property Owner's Name Parcel Number � T CROIX COUNTY O l _ DG � - A0 - DDD Property Owner's Mailing Address ZCTt•tlbl:G 577 iut Property Location .his 13 ',f 3 46' -A. S 31 T30 N, R W EV City, State Zip Code Phone Number Lot N or Block Number Subdi tsion Name CSM Number II. Type of Building (check all that apply) / Doty 1 or 2 Family Dwelling - Number of Bedrooms `7 - 1, �Ly /�� (]Village ❑ Public/Commercial - Describe Use WI ownship E ❑ State Owned 3 Ui` /3 !� �¢ �[i� = ��! Nearest Road 3' 8 III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete &e — B if applicable) A. 1 0 New 2 Replacement stem ❑ For County use p Sy Replacement of 6 ❑Addition to stem auk ON stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) �: o d, 4e:jA � 1_ e 44 R Non - Preswrized In -Ground 21❑ mound 47 ❑ Sand Filter 50 0 Constructed Wetland 6 7 SA r=tx 22 ❑ Pressurized In- Ground 410 Holding Tank 48 0 Single Pass 5111 Drip Line 3! /l y / daZ 45 ❑ At - Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 3o ❑ Other V. DispersalMwitment Area Information: Design Flow WO Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required ✓ Proposed Rate( Gals. /Days/Sq.r -L) (Min./Inch) Elevation A U--kA o - ✓ 5 9 ,� .0 99 3Y VI. Tank Info JNMew city in Total Number Manufacturer Prefab Site Steel Fiber Plastic llons Gallons of Tanks /j / / / /DD Concrete Constructed Glass Existing f�dCL � Tanks Sepdo or Holding 3 6 r VII. Responsibility Statement- I, the undersigned, assurne responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) is Signature RS Num Business Phone Number Plumber's Address (Street, City, State, Zip e) S - 7- - r VIII. /De artm Use Onl roved ❑Disapproved Sanitar Permit Fee (includes Groundwater Date I sued L� of Signature (No Stamps) Phdin Surcharge Fee) ❑ Owner Given Initial Adverse Determination IX. Conditions of Approval/Reasons for Disapproval lug. -i��•. �2P�.��Uc�� f , 3 . t� "3 - �. Attach complete plane (to the County only) for the system m paper not less rhea SW x 11 inches in sine SBD -6398 (R. 05101) 3�s 3 - -- - -- - -_ - -. -- - - - - -- y rC _�_- 94.0 - - - - -- -- - - - - -- - _ - - -- - --- - - -- I O -- - - - - -- ----- - - - - -- ew 8 ate• -- oltc -- L- •1{sT_r�U� N - -- � - -- - -- - -_ CTy n - DWAWIN6. 0:2 rN-a - saw -.- _ 1VEW1 ' -N. _ ".0,460_. 02 3%S _,- -- -- tai R •+r E I9r / -FVJ l %/N 3 - - D t I — p ', GARnc —: - — isi. 2,3 00 GL. . . ii vf G ee l r — - -- - - - -- – o �4 - - - 2 0 - -- -� - - - - - 19 ,' 0 r 7�70 - - ��rG :_- eye - - - -- �` 17y',( 1145 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must r St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to n4rest road. Parcel Please print all information. 7 - 00 Reivl d Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 16.04 (1) (m)). l Z 6 6 - Property Owner Property Location Knutson, Darrel Govt. Lot SE T)W -_S4V1/4 S 31 T 30 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1548 Cry. Rd. E 1 20 Acre Parcel City State Zip Code Phone Number City Village ✓ Town Nearest Road New Richmond WI 1 54017 1 715 - 246 -3174 1 Erin Prairie I Cty. Rd. E New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ✓ Replacement Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.5 gpd /sgft rating. Possible system elevation for replacement area is 96.0'. Area is on a 7% slope: ❑ Boring # Boring ✓ Pit Ground Surface elev. 99.12 ft. Depth to limiting factor >121 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-11 10yr3 /2 none sil 2mgr mfr cs 2f .5 .8 2 11 -22 10yr4/4 none sil 2fsbk mfr gw - - - - -- .5 .8 3 1 22 -32 10yr4/6 none Is 1 msbk mvfr gw - - - - -- .7 1.2 4 32 -45 7.5yr4/4 none sf 2fsbk mfr gw - - - - -- .5 .9 5 45 -79 7.5yr4/6 none sl 2msbk mfr aw - - - - -- 5 9 � 3•R 6 79 -121 10yr5/4 none Is 1 msbk mvfr - - -- -- -- 7 1.2 tit, 3�. -7 3 `f h m,6-,, 41, q,�,, Z' x4,-e- Boring 2 Boring # g ❑ ✓ Pit Ground Surface elev. 100.64 ft. Depth to limiting factor >120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 I " Eff#2 1 0-14 1Qyr3 /2 none I 2mgr mfr gw 2f .5 .8 2 14 -22 10yr3/3 none sil 2fsbk mfr gw - - - - -- .5 .8 3 22 -36 10yr4/4 none scl 2fsbk mfr gw - - - --- .4 .6 4 36 -72 7.5yr4/4 none sl 2msbk mfr cw - - - - -- .5 .9 5 72 -120 10yr5/4 none Is 1 msbk mvfr - - -- - - - - -- .7 1.2 � • r Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD < mg /L and TSS < 30 mg /L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt �L r -, __�. 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 10/31/02 715- 247 -2941 ;Paine o K /�`� -' � � � Cap -erg o�-► TY�^ �1�' � arc f� _ G f, �o� p � ' k 11 7' cle T s -- _2q7 e rw -i 7, P; B ly 73ON l 7rA1 �Tfs� sal a ys�/ 1, `f 2, Z ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ELL t 4�(/ residence located at. - T R W Town of � �/I /,�f - St . Croix Sep~ . .�_ T 3 Q__ _ -L County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption: system? Yes No (if no, skip next line• gallons minutes Appro:€imat.e va.�ucre or length of time: _ g LAGS rapacity: L3 DC� Cffr. /© �O SiCEL poc�R�O -7 /� ('.C>Tlst) uCt.ioil: Prefab Concrete Steel DD Ot.. er X3 04 Manufacturer (if known) Age of 'Tank (if known) : (SignatYzre) (Name} Please Print (Tit1 1 -vw - -- (License Number) ( -Dat ---- Form to be completed by licensed plumber (s. 145.06, Wisconsin Sta-utes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber iappl } - ing for sanitary permit.) Certification: _z accepting the above statement. regarding existing septic tank condition, I cewt.ify that the tank, to the Nest of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Corse (except for inspection opening over outlet baffle) „I /i / Signature Name r VY►�1 -�-- MP /MPRS Attention: Schmitt & Sons Excavating i Site Location: 1548 County Road E New Richmond, WI Owner: Darrell G. Knutson Phone # (715) 246 -3174 Septic Tank(s) Specifications: 1 Tank Concrete construction PouRED 2300 gallon capacity 2' tank Steel construction 1000 gallon capacity Tanks are connected with a 4" diameter gravity flow pipe, approximately 5' long, between tanks. The pitch of the flow pipe is i / 4 inch/foot. The 2 nd tank receives primarily only overflow liquids from the 1 st, larger tank. The discharge from the 2 tank is directed to the drain field. Both tanks have pump out orifices and are accessible. i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of ?/ FILE INFORMATION SYSTEM SPECIFICATIONS Owner _ ' 7 Septic Tank Capacity a l ❑ NA Permit # 1 O L Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer z C L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity a l 19 NA Estimated flow (average) a00 gal/day Pump Tank Manufacturer 91 NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer 99 NA Soil Application Rate al /da /ft2 Pump Model Of NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit 10 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODj :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ITSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L I$ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA e. "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ear(s;(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ® ear(g) IM month(s) arl ►(s) (Maximum 3 years) ❑ NA Y Clean effluent filter At least once every: ❑ month(s) ❑ NA ® year(s) ❑ month(s) X NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ' ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) PC NA Other: ❑ month(s) At least once every: ❑ year(s) NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ` Page 7— of Z� START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the-treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surf ace. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name SC 77- C , Name OLu E Ic Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Tif R0 Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(fl and 83.540). (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �/� iP - L L rZV "7!'Q Al Mailing Address /5 yB C 7 _ 17 Property Address ` _ (Verification required from Planning Department for new construction) S�i'►�� City/State ff5- & RL Parcel Identification Number /012. & - 0100 LEGAL DESCRIPTION Property Location Jt F V4, _2 L /4, Sec. 3 / , T 3c N - Town of ERIN Subdivision I G A G 12 gF, . Lot # /YA Certified Survey Map # , Volume . Page # Warranty Deed # 0 - 1 25 9 3 l , Volume Page # � _ • Spec house ❑ yes O' no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards on set forth, herein, as set by the Department of Commerce and the (Department of Natural Resources, Smote of Wisconsin. r== *des =u3 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three year expiration date. S ATUItB APPLICANT OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the proDerty described above, by virtue of a warranty deed recorded in Register of Deeds Office. Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: 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 DOCUMENT NM ��±± Q STATR BAR OF Vn3C ONSnr -FORM 1 VOL U'� A:. 8� wARttAnittr ogeD 375932 l THIS SPACE RESERVED 001. RECOR DATA itsp� betwee David J. Anderson and ri! Crla f,ita Office' .d T cY �it;erson, n an e, as o enan s , ST. CRO!X CO., W iS. Recd. for Record fait: 2Ktr, an d Derrell G. 1E 5t_scn and Jom F. Knutson, Grantor day of rb_ 11.0. 1982 husband and wife. as o t tenants, at 102K0 A_ Grantee, &WMW of Dads w tne>tsg�h, That the said Grantor for a valuable consideration One CCDD1l ar and other valuable consideration RET N To conveys to Grantee the following described real estate in St. Croix Realty World Of New Rietatlond, County, State of Wisconsin: New Richzri ld, Wisconsin 54017 TRANSFF3i = 00 Tax Key No. FEB The M of the SE's of the SWk of Section 31- 30 -17. Subject to recorded easements, reservations, and rights of way. This is homestead property. (is) (is not) Together with all and sin ular the hereditaments and ap urtenances thereunto belonging; And David J. Anmrson and Nancy L. AnAeragi warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except no exceptions and will warrant and defend the same. Dated this , 24th day of Februa _ 19 82 (SEAL) �� (SEAL) DTA J. Anderson (SEAL) f ,I (SEAL) Na� cy L, derson AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 14 __ ss. St. Croix County. Personally came before me, this 24th day of Feb 1982 the above named TITLE: MEMBER STATE BAR OF WISCONSIN David J. Anderson and Nancy L. Anderson (if not, authorized by § 706.06, Wis. Stats.) _ This instrument was drafted by Eric J. Lundell, Box 151 to me known to be the_. erson S who executed the fore- going instrument and ackn ledged the same. New ldchmmd, Wisconsin 5 4017 (Signatures may be authenti a � ,,,,, Both * L Paul ate not necessary.) t' PRti'� Notary Public St - County, Wis. NCT." My Co mission is permanent. (if not, state expo ton STATZ i _ , 10 ) . date: c�A �v� (C a *Names of persons side in an �g�t'ligl'tntiSl inted W.. their signatures _ NARRAN DZIO -aTAT[ BAR OF WISCONSIN FORM NO. 1 —t977 .. .. ». ».rye 7111 225.9 +. Sea Pxw 68 s Sew Pwoe 66 v` K w et Mills paF • James & Carol Richard & Patricia �, oos s W &J B d & Judith Olson, o w 53 • Ori s5 Y 66 �i Dittman 76 Casey 138 x 4J1 Trailer °r a • n a 107.3 Hexselink 143.5 " 97.5 ceaasa • Michael &terra V • V kip sal `""" l w.Mla J°h" &� .r Gary & y Heaaw M • tx.x so Canty. Halleen Sdrmir Kette of T, . txs Kathleen D.1 &Gayle WR etal w n Aweman 68 Y Jewell Milk aF l3 Bel - • Mary roe w d Monteith i'17 �r ra leap. •e 59 y ""�' Monty 40 1 •a LT • wet _ Charles etal` „ emell • r 63 146.1 4 Lyle T V & Donna 240 120.7 Dunn Farms O Carrie �. Inc All -Rick NP 43, 9 Nippoldt Skoglund Jesse Brute Quam 239 160 t ale. Properties • s � h • 120 etas • ,e 3 ca LLC •""'" • ^ • $ •' • aM s W .5 Lillian • ,° • • • cra Ta Adelawe s _& ^ to 160 I.wn 19 to • GG S 3 39 am- � � IM & Lyle � N Rncxala Gill a x`ri A y 2 DemWiiy, NippOldt Joseph u`u' 40 ^7 fn n" 1 O A a{ Y ; & Lorraine 147. James Donn i � : Thomas � -5 _• Donald & c - aauM p Emmett & o°reen A s�.n ; 60 Glllen N&B e & IRY Fa J Haver t` • x Sdurrit M.d P tx Emmert eta ' g Gerrit & Theresa Maho°eY C , l - a Barba. 78.1 w • v 1 Lorraine Theresa , Anderson O • 1-ald Gillen • e Jason 280 S aHa Baran& Van Dyk *Dwayne a K. a wail en Ter -Rae 59.7 238.5 `� 80 ob mu a F y eeaaae 163.6 Peggy Milton Jr & Bruce Farms Inc E q L Peterson Fo &Jason Ter -Rae Farms cue. xx 36.9 160 ,e .69.6 Raymond 74.9 Eleanore 160 Inc 158 29.8 e<al • ayne &Linda 151.5 Is r • Borgstrom gren• va• m Dwayne. Peggy a 40 • r. T x Kathleen & Jason Raymon 40 Ter -Rae 116.9 ea 80 Farms Inc • & Mary 110.6 40 Monty 145 Denn Tom^ 1 • n �Ell l"Jr 16 James & ' 632.6 Stoddard He.bad c Miller Michael & Lynn 240 .� I . 1 A • # 73 Albert x Pe so Donahue Jerry 1 J a F �t °a Wesley Emmert 558.4 R h Donahue Rodney Herbert Geurkink Tr • 16 200 & Julie GG • Dairy Inc k Haffner 'ton & Bebhan Dennis &Grave t >QUrkink c T� Corners 8 t 280 108 Doro Emmert • • + T 42 • 107,. Petersor� Bo• 80 40 • • I G •: G • n. 7s.4•' g • •� • av r r" • • 320 K. • ° & Br dy ' �io 75.4 99.9 Cr w.aar John & . m . Donn & • Dennis & Grace 78 Gerald & Helen Georgine Donald & Marguerite 1Caddeeo on 237.8 Emmert Clemas 40 Schottler Maloney 159 A , Y J 3 e0 4 320 Jerry arie 69.8 ° � Donavan & Karen R 320 Vernon &Rebecca 40 en Kukuska & Kathl & K mm o Kamm 42.7 Sta[sholt Harold Nagel 160 ca ly Griffiths 160 160 eo 156.2 71.6 p bnhOw 240 • w • 80 • 3 • ^ • • i • i lau. a. • o �4 170 • rrie gr.la 40 °'& • Marvin John & 40 John ¢tie 437.7 • W. w& am oo ahue Heinbuch Georgine Mickelson 2�0 Jo 75 , ° ,� =Q a 60 a A d y R v 3 D��)g 70 240 • Schottler 200 170 , Scholder Kruiz �` A - m 5 p, ea $ a 6 Jeffrey 1. e ti eaten a wannr Cihlar 320 M.ry 187.9 40 Fern a • Richard ,CtiG Dennis , E sere.aa 160 Tt�nts Partnership Stafsholt tiff & Grace 80 S r & • &Tamara LLP 155.5 70 Allen Emmert $ y • Tho n arol �� • sd �n 120 • • a ao ss 144.9 ax • wss.r Berg MM a • 7 yi Carl • •4""y'&a` t 139 • -. ti ro, ra LW Bliss & Kuhlman 230 Roger James mmert Dennis � Arlene TE Wm Potts Howard 63 Stafsholt N a, 160 Stoddard Stoddard 120 WIL IM Mw"alm &Edna = 143.5 ° v lzo 746 A 155 120 walker • ^U 120 WI 1 2 V- & B I S 8 rk & DNR B.dley & Peterson & Daew & Melinda abe to Carrie Savadge Lynn F.ney a Joseph & Debra 17.7 40 120 ., " Bowl Quam R 70 Ken Ga M_ John & +o e _ Lux d B.mw Inc ag & Mary Cl r•-I Carolyn :2 g oodiak R a_ 1 Ca ss gg 91.7 `: E _ F ta a a v to a y 152.8 & rr &Robert Dalton • T x C C Club g p ;; Arthur Lam • < 100 a ss 9 +s 150 80 • r • • 80 u J Trust • Emmert Derrick 119.5 E z 2100 Soo lsoo 1700 leoo See P AGE 34 1900 2000 EJJSWOR#7# CO -aA CREAMERY CHEESE CURD CAPITAL OF WISCONSIN 4 PO BOX 610 • ELLSWORTH WI 54011 (715)273 -43 1 FAX (715) 273 -5318 4 '•