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HomeMy WebLinkAbout018-1083-32-000/~ Wi~nsin gepartment of Commerce PRIVATE SEWAGE SYSTEM S~fery and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law~.15.04 (1)(m)). O~~~oh~~~{ame: ^ City ^ a~Clll~p n bWnSlll CST BMElev.:- Insp. BM Elev.: BM Description: h~ e TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ,,~ ~ ZO Aeration Ho g TANK SETBACK INFORMATION PUMP /SIPHON INFORMATION r Demand Model Number TDH Lriction m TDH F rcemain Length Dia. Dist.Towell TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic >IUU~ 2 y ~ !^ Ztc, NA D in NA Aeratio N olding ELEVATION DATA STATION BS HI FS ELEV. Benchm rk ~ , (~ ~ SOS ~ O Bldg. Sewer ~03 S /Ht Inlet ~„~~ ~2 , ~5-- / Ht Outlet ~,~/~ /OZ - ~ Header /Man. - ~ 9~ ~ 5- _ Dist. Pipe , -~~ t ', ~~/ ~g- Bot. System z. '' . 6 ~~6~ ~D- zo ?~: 90 SOILA~QRPTION SYSTEM ~,~ ,.~_ ~ _ _ -~_ BED / RE C Width ~ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME N L~ Z DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LE G Man f urer: r INFORMATION Type O ~ ~ 3 ,~ A T Mode Number: System: ~~~13 ~10U - O r DISTRIBUTION SYSTEM fi0 ~`"~"~ F ` Header /Manifold ~ ~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ~ Length --~- Dia. ~ ~ Length ~ ~s Dia. ~ Spacing b N ~ d ~ 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 InS eCtlO #'Cl Yes/ ^~NO InS e®tl~n #~1 No / LLOMMENTS: (Include code discrepancies, persons present etc. ~ 25'6 Location: 1716 96th Avenue, Hammond, WI 5401 (S~ 1/4 NW 1/4 16 T 9 1~W) -162917604 Pheasant Hills -Lot 32 r~ n 3~S -t`Y~~n.. G~-/~ ~vc ~l2 ~' o-F c-s-ver 1.) Alt BM Description =-~oP a~ ~mer~fa~-~ v~" wa.~~ot,~;f ~/~ 7'~`hrs~Nef. 2.) Bldg sewer length = 2S~ -amount of cover = ~~~~~ ~.} sLys{~ S~r~ ~~ s(a~,~ ~ ~~~~~~ '1', r`,c~( ~ ~'~u-~~ ~O/c /'~Ow~ ~ o_rc~/'S p ~{k, c ))~ , No WC~~~1~ -t~ ` / -Fa v YC I A~ LeM ~',ti,~ --S Sc~ /su..C.IC ~6 Cr'~ ~, ObstryQT`i'f.,s f ~~' i i... / Cl~d.v~hP/ -fVp»,~ a revision requi ed? ^ Yes ,~ No Use other side for additional inforn4ation. SBD-6710 (R.3/97) ~~ ~ F v ~ L _ Dat Inspector's Si nature Cert. No. i;~ Sl ~Z-13 16' l,~ b - Sanitary hermit Application In accord with Comm 63.21, Wis. Adm. Cock Sce rcversc side for insuuetions for completing this applicadan ~meecra Pcrsanal infornsation you pm~7dc may be vsad for secondary purposes (Privacyl,aw,s, 15.04(1)(m)] wch co7r late tnns (to the Doan co von for the sum, on er not lass than S~t~3dr~~frmit Number ^ Check if rey~eiotl to wLViotu ntrohexden I. ~CRy UWi7Cr$ fV11c17 ail I-to - Please lzrint al! Information ~~N Ar+~1 .y, omm Zip Codc 0 ~, S~ ~ t S` IY. Type of BuSldSng; (check one) 1 or 2 Family Dwelling - No, of Bedkooms ;_ D PublidCotrunercial(describe uso)~ `7!S A 3 rK IZS"l of permit: (t N. Type of POWT System: (Check all that ~'?dan-}rrossurizcd In-ground ^ Pressurized In-ground Q At-grade V. 17iSAe1'5.11/TYCatment Ay-eA Tnrnr,,...tin~ Iiue A. Check box on line ,$ 3 ^ RLplaccmegt of 4. Tank 4nI l'crmic vum or ply © Mound ^ Holding Tank __ ~ Aerobic `I'*catment Unit ~cPg3~7 Safety & 8nildirig3 Division 201 W. WashinEton Avo, PO Box T302 Madison, WI 53707-7302 (Submit compkucd form to cannty if not _ state owncdJ x 11 inches in stzc. T~ 7,N. ~~ Netyp OI CSi~ Numlxr ~'~ F~-I U--S ^ Ciry ' - ^,~/village IKDrt10 p Town OP _ ~7~ Ncarost Road O ~ $ .,r ~ U g3 to O Sand Piltcr C Constructed Wetland ^ Single Fass ^ Drip t,iue ^ 12~circtzlatinc. f"1 hrh~- a~ '' 1ieQ7rirpd Proposged G ~ ~ ! ~ Ram Ga19Jday/s , it. '~-- s ~ q ) (Minl~_ ~~- "~ .~,]_.~•••• • ~ ,,.. ,,.~ L'icvetton 1 ( . ~ 'VII. Tsnk Capacity in Total # of Manufacturer Frtfab Sitc C Fiber- Pl~ Information C3a1)ons Gallons Tanks Can- Con- glass Ncw Extstin8 crere strutted Tanks Tasks %L D -- D / ~W ~ ^ ^ Q ^ ^ ~ ^ 'i'IZI, Respot:sibillty 1 the crsi ass Staroment ume asibili installatio n of~ POWTS shown on the attached slang. trcet, IX. Caunty/De~artiment Use Only ~ bisapproved Sanitary Pcttnit Fx (Sncludas Ground~vatar Dam tssvod g Agent S~ (No stamps) ~,r>,pptvvcd G Owner Given Initial Advtr6c ~8oa,~. dD nn ~ ` c Daterm7inatian IY l X. Conditions of Approval seasons for )disa~-praval: ~ `I ~eM.J~les ~ -4- 4~,L tM,$~~ s~ ~Q. ~ s 3 C ' s u.t ~s_ ~ ~e~~n .It.Q,¢ ~ 6+~ ~v¢r.~e,, ? wv-.a~. i ~S~+o~~m~~e+~t-~ A.Qtved-ia. l(~ J-tts l ~' ~ I Z tt true/ ~ r ~~ SHD-639'~CX'00 '`~~ !~ ~ ~ ~0. ~ ~Y~ ~Q,. 5 ~ ~~ ~ . t~Yl Unw`,~n~+~~- od per. ,Me.~n.~~t~V~ ~-CS re.cs-wt.w~etnd~«~-+~ . ~n~, ~1oe~ ~~ ti C ~ ~ia~lE~ ~j 3~ ~ ~~ ~~~ ~ T ~, ,P~v~.s. ~?cE /Bi~,r~ ~N 2- ~~~- 23 ~' ~ ~~ _~~. ~. T.L. Sinz Plumbing Inc. E5609 '708th Ave. ~,o ti1 l~-~ ~ ~ tom-©T t~LA-~1 Menomonie, WI 54751 ~.eT 3Z I~h~~s~7' ~,Ils Svc ~:1 vJ t~ a q I `~ ~ / `-~ Q6~ =~~o ~~ ~ ~Ju~ ~ ton 0~-~~ ~~'"'`~ , Phone: (715) 235-2644 Fax: (715) 235-2592 Iv / ~~' lib ~g,~bY i T.L. Sinz Plumbing Inc. E5609 708th Ave. ~,o ~ ~~ ~ ~ t~©-i- ~L~A-~1 Menomonie, WI 54751 1..eT 3Z ~~~~~T ~,Ils s~+ -~ vJ ~~ a~ f -~ ~ / `~ (~ ~~ =fDD GL_,.~ d~ 1-~ r I Q ~~~ ~ ~9` ~,~ rye -J~,J ~ 2or DN~ ~fY9-A,~ ` , Phone: (715) 235-2644 Fax: (715) 235-2592 /'~~ /.b ~ ~q,~bv ' Wisconsin Department of Commerce IL AND SITE EVALUATION Page 1 of 3 ~. 'Division of Safety and Buildings ORIGIN,~ord with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than S'/: x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal refe[ence oin, direction and St Cr'O1X ercent slo e scale or dimemsions t road n rth rr w an~i l di n ~ti t t . p , p , o ; . o a oc o a s a ce o neares " ~ ,r ~ ~. ~~ ~ APPLICANT INFORMATION - P e ~ pr-nt 11 info-'In a~iOn Parcel LD.# J . \ Personal information you provide may be us ~ nda(#ye„s rivacy.k5v~,~§. 15.04 (1) (m)). ~. "'CC' r'~, ! ' ', Reviewed B Date Y Property Owner ' -- - Property Location Bonte, Ron ~-+ ~;° ~ ~~= ovt, Lot SW 1/4 NW l/4 S 16 T 29 N R 17 W Property Owner's Mailing Address ~- fi'- C~,1,x a of # Block # Subd, Name or CSM# 1011 170th St. ,-' _ ^.~uv~r• 32 Pheasant Hills City State ~` Code'`~fi~iBheN~r~F= ' ^ City n^ Village ®Town Nearest Road Hammond WI 1~5 715-796-5240, / Hunmond l7oTh St. I^ New Construction ~ ResiI..BWmlaer'of bedrooms 3 ^Addition to existing building Use: ~' Replacement ^ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •4 bed, gpolftZ •5 trench, gpolft~ Absorption area required 1125 bed, ft2 900 trench, ft' Maximum design loading rate •5 bed, gpd/ftZ •6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 2a" below contours ft (as referred to site plan benchmar Additional design /site considerations install 2 - 5' x 90 shallow trenches on contours for 2 br Parent material till Flood lain elevation, if a licable N~' ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ® ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ~ U EVIL UC.7tiRll' I IVIV RCrVR 1 Boring# 1 ~` 3 Ground elev 99.5 ft Depth to limiting factor ~ >70"' 2 a 3~ Ground elev 99.0 ft Depth to limiting factor > 72" Horizon Depth Dominant Color Mottles T t Structure Consistenc Bounda Roots GPDIft2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed ~ Trench 1 0-6 - 7.SYR 2.5/1 - sl 2 m gr mvfr cs Im .5 .6 2 6-17 • 7.SYR 2.5/1 - sl 2 m sbk mvfr gs lm .5 .6 3 17-39 • 7.SYR 414 - sl 2 m sbk mvfr cs lm .5 .6 4 39-49 7.SYR 4/6 - Imcos 0 sg ml cs - .7 .8 5 49-70 • l OYR 4/6 - s/mcos 0 sg ml - - .7 .8 Remarks: occastona, gr ac con oetow su° 1 0-6 - 7.SYR 2.5/1 - sl 2 m gr mvfr cs lm .5 .6 2 6-20. 7.SYR 2.5/1 - sl 2 m sbk mvfr gs lm .5 .6 3 20-40 7.SYR 4/4 - sl 2 m sbk mvfr cs 1 m .5 .6 4 40-72 7.SYR 4/6 - lmcos 0 sg ml - - .7 .8 SST Name (Please Print) Signature: Telephone No. Henry F. Grote - 715-665-2681 ert, ,e of estm Address P O Box 57, Knapp, WI 54749 4D~16/2000 222774umber R 1073 Remarks: occas,ona, gr as con PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT j~ ~,~ ~ Page 2 af-~~ 3 PARCEL LD.# • ~ Certified, Soil el sting Horizon Depth in Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh, onsistence Boundary Roots GPDIft2 Bed Trench 1 0-6 - 7.SYR 2.5/1 - sl 2 m gr mvfr cs lm .5 .6 2 6-18 • 7.SYR 2.5/1 - sl 2 m sbk mvfr cs lm .5 .6 3 18-32 • 7.SYR 4/4 - sl 2 m sbk mvfr cs lm .5 .6 4 32-48 • 7.SYR 4/6 - lmcos 0 sg ml cs 1 m .7 .8 5 48-62 • SYR 4/4 - sl 2 f sbk mvfr gs - .5 .6 6 4 • SYR 4/4 - sl 0 m mvfr - - .3 .4 a ~ ~s~„ mot- q Remarks: -TYf 't'o 1 1 0-4 • 7.SYR 2.5/1 - sl 2 m gr mvfr cs lm .5 .6 2 4-22 • 7.SYR 2.5/1 - sl 2 m sbk mvfr cw lm .5 .6 3 22-35 • 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 35-50 7.SYR 4/6 - lmcos 0 sg ml cs lm .7 .8 5 50-54 l OYR 4/6 - s 0 sg dl cs - .7 .8 6 54-61 . 7.SYR 4/6 ~ mcos 0 sg di cs - .7 .8 7 1-72 - SYR 4/4 ~•tO ,~,(, sl 0 m mvfr - - .3 .4 Remarks: 1 0-4 - 7.SYR 2.5/1 - sl 2 m gr mvfr cs lm .5 .6 2 4-20 - 7.SYR 2.5/1 - sl 2 m sbk mvfr cw lm .5 .6 3 20-34 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 34-58 • 7.SYR 4/6 - Imcos 0 sg ml cs lm .7 .8 5 58-70 SYR 4/4 - sl 2 f sbk mvfr - - .5 .6 Q,, 9 ~ • fro 26 •`'~ 6~•'fa Remarks: «.,~ ~~~„ •, .~~ ~.,~~~~ ~~ ~. ~~~ Depth to limiting factor zM4~ ~3~M -3-Z ~14.'t. ~ t-~~14q .o ~ i~~e R• ~~ C~4•g~ 4-so ,~ 4' ;a^~ L94A~ ~.~ ~4•s, •c~~ 13x-1- (~ u~o.o +Q ~-3 ~1 ~,.1~ ~ g~•$4' Lod 3Z ~~~~4Y~ L~,~ts Sw-Nw-\b-2q-1-}w ---~ IV o zo ~o c .~ ~+r~c zzi~~ l3 Z`g~tS N ~,w, o., Nw .row (q4.z) • ASS •OS ~ ~-~.t,qt 3 ~,~3 ~~ _ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow -Peak (gpd) ~d0 Estimated Flow -Average (gpd) ~ Septic Tank Capacity (gal) p Soil Absorption Component Size (ftZ) 6 (,~ Fr Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soif Absorption Component Design Flow -Peak (gpd) mo (r $~s L7- Maximum Influent Particle Size (in) NA 1/8 Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of th se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. The utlet felt r shall be cleaned as necessary to ensure proper o eta' r-~-- The filter cartridge shout not be removed unless provisions are ma a to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic Management Plan for a Septic Tank and Soil Absorption Component tank shall have ifs contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the sepfic or other treafinent of holding tank may contain lethal gases, and rescue of a person from the interior of the tank rrray be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Ws. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility.'-The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIN'ICATION FORM OwnerBuyer for Qor~e.. ~To Mailing Address ~~ ~ I ~ ~a~"h property Address ~~~~ ~~~ ~y~ (Verification required frnm Planning Department for sew construction) CitylStateT ~ O~IrY~ tr0~ W~ Parcel Identification Number ~ ~$ ~ ~~~~ 3O~-~~ r EGAL DESCRIPTION ~ ~ ~ ~ ~. ~ I ? ~y l~c~ r ~ r ~ ~ ~ ~ 7 W Town of O-Y~ 1~ P't+nperty Location s /4, N /~, Sec. . T N-R , Subdivision P ~Q0.SC~r~ }-~' ~ ~ I S Lot # 3 a Certified Survey Map # C~ ~ a J ~ ~ .Volume ~ ..Page # $~ Warranty Deed # ,Volume ,Page # Spec house ~ yes ~ no Lot lines identifiable, yes D no ~SYS'~TEM iV(A11N'TF~tANCE Improper use armd mainteaanceof your septic system could result in its premature failure to handle wastes. Proper maintenance comusts of pig and the septic teak every three years ar sooner, if needed by s licensed. What Yen put into the sys~D° can rrff~ect 8~t funt~io~n of the septic tank as a treatment stage in the waste disposal system. 'Che prgxrly ownea agrees to submit fie St. Canix Zoaiug Department a certification farm, signed by the owner and by a masbcxplumhet; j~rneyaianplumbe~ resbrictedplumber ar a licensodpumpet verifying that (1) the oa-site ~c-astevvatexdisposal system is is p,c+apCr operathrg condition antUar (2) after inapectiorr and pumping (if Y~ ~ c tank is less than 113 full of sludge. Sue mod, have road the above a~ sad agree to maintain the private sewage disposal systcan with the standards set furdr, hrx+ein, as set by the Departareut of Comarercc and the Departmart of Natural Rte, State of Wisconsin. Certification that y~ septic system has bees maintained must be completed and roturaed to the st. Croix County Zoning Office within. 30 of ~ year expiration date. ~ /O' ~. SIC#NATURE OF APPLICANT' DATE OWNER CERTIFICATION I (we) certify that ail statements on this form are true to the best of my (our) knowledge I (we) am (are) the owneds) of the property descn'bcd above„ by virtue of a warranty deed recorded in Register of Deeds Office. SIt3NATtlRE OF APPLICANT DATE ,~«„~,~«,« t being revoked by the Zoning Department. «'`«««« Any information that is mis-represented may result is the sanitary penal ~« Inclade with this appiicatian: 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 . vfrf. ~~~~~~E V 7 2 620963 KATFILEEN li. INiLSH REGISTER OF DEEDS ST. CkOIx CO., WI REI:EItA] FOR RE00~ tine M, Elortte, as Trustee and Ronald G. Bartle, firer alternative Of-i@-r'000 10;30 AM Trustee of the ttacl M. Ulferts and Katt~ina G. UNerts Fam17y Trust, for a va~atNe consideraticxt conv~rys without warranty. to i OEEO Ronald C. Bonie atxl C1'yne M. Eionte, 1aft/d and wife, Grantee, CERT t~P1t FEE: Bing described real. estate in SG Crax t.,otrrrty, State ~' C4PY FEE: Wisconsin; TfIA FEE: 210.00 RECOROIfi6 FEE: 10.00 PAGES: i Thomas A. McCormack 1p201p!" Ave, B~dwFn. W1540p2 , 04&1034-60, -70 (Parcel Identification Numt~er) The Nol#ll Half of the N~ Quaff (N ~ ~ {yyy'i'.j of Sectia~- Sixteen {2Sj, Township Twenty-nine {79j North, Range Seventeen {17j West. meted tr>i~ 24t~,y ~ , . AtrT'NENTtCATtt3N al ~_dayat sgnwure r9gte or pry Heine TITLE: MEMBER STATE 8AR t}F WtSGOMSIN _(R rrot. six~writer3 by § iD6.08. Wia. Scats } ^^_ ~`t,r,,: ' ~ THIS #dSTRUMENT wAS ~i ~ J Thomas A. McG ~ --+ . Baldwin. \A115e0tS~. O t ~ i~~ Q ~ ~~ ~ ~~~,~ 'Orre M. 8onta Trvatee `~c° ~ ~ rN-s ee j 'ROr~d C. Bonte Tn>rsYee AGCtit!{I~f LEflCa~ENT STATE OF iMSGCM~IStN ST. tiF2pIX GOUN7Y PersorteRlr came before me this 24th~y o; t+larctt 2000 the atwve manned i?ina M. 8ar1e, Trustee and Ratiald C, ear'Itte, as fast ~ Trustee of Kaal M. tJiferts and Kattrarina G. iJlrerts F~nity Trust, tb me kravwr to !~ the Pensonts) uitw axet~led the fonegoirtg instnxarent end acknowledge ~ same. tXpe a print ~r+e_ Ik~l~e $~ Jensen tWotary FhrtiQc St. Groin Camly, Wis~in. MY is permanent- {ir rte, state expiration date: 0~-'3 .) 'Names d perwoc srgrws9 in arty cppacity should be rypsa m Primed Debw tlair signaduas. M11o1kPiilgfl i6ohpeaMa ~Y FONI W 41•L. VKlO0m.1 lOOdSS- PHEF';SANI HILLS . ' QED 1 ~# THE NE f 1~ OF THE N'N ! i4, THE ~ OCA f ~~ OF THE N~'V l ~4 AND PART OF THE ~~ !~~ OE THE N'lli 1 r4, AND PART C?F THE NU~~ ~~4 OF THE ~'W ~~~. ~L~. ~N SECTtOI"J 29iV T . ~. i ~'11~. , TOWN O~ HAt~11~OND, . . ~". CRQ P X ~aUNTY, W 1 S CONS ~N aCOI're aY€1wE ,~. _~ ~L+i L.7 ~_ .~f ~~;` ~, r .. ~; . ,,,, ~ ~^ .+, ~ .,? rt ~a fff~ -~ °a ~~ LCii 15 ~~~~ C 2 r r s~xrt +~ Eas~'~rr-s R `i Y .~ Via, xO PAt E ~'R 9ttA ' c t} CaBt E5 ARE tQ BE Pi t,'Ct ^. S:.<~f. 7t+A7 ~'~# IhSTaLIAT+(1N I4uiD 41YTURS3 ,iIUY SURYEr STaXE. Cit c~37rrtCr kt3'CN Q1rG >3i~Y t A7 C 1 ~rE ~ '3 TRf F T t t ~tE. 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