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{,NiscoellN-rvepartmentofCommerce PRIVATE SEWAGE SYSTEM
Safety~3nd Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1 }(m)).
Permit Holder's Name: ^ City ^ Village ^ T wn of:
Whitemarsh, Brian Hudson Township
CST BM Elev.:• Insp. BM Elev.: BM Description:
(3~ . I 0~ ! ~ ~ PAC ~ c SI- 1~~
......r.....---T.,..., D TA
Iril~n nvrvnmr+llvl~
TYPE MANUFACTURER CAPACITY
Septic )I~,1;(~,(A.JQJ~\ ~~ (off
Dosing ho C~tr~~ J) ~ ~)
Aeration ---- ~~~-
Holding
TANK SETBACK INFORMATION
TANK TO P/ L WELL BLDG. vent to
Airlntake ROAD
Septic }~~ r ,~ ~- ?j2 ~ -~ NA
Dosing ~ ~ NA
Aeration -tom NA
Holding
PUMP /SIPHON INFORMATION
rer
Model Nu er ~~~'~" G M
TDH Lift ~f< riction System TDH 'Ft
~s H
For~rftialn Length - - oVVell
ELEVATION A
County:
St. Croix
Sanitary Permit No.:
383905
State Plan ID No.:
~~
Parcel Tax No.:
020-1351-19-000
~ to - aa, I~, 1 S9Co
STATION BS HI FS ELEV.
Benchmark ~, 2 p~.~" ~ ~ . p `
Alt. BM
Bldg. Sewer
St/ Ht Inlet ~ Z` p .~6
St/Ht Outlet a•~O D .S.Sr
Dt Inlet ~^ - -
Dt Bottom - `~-•_-~-
Header /Man.
i
c,~a1,,,.i 9. ~-
ID . 2D
•oS r
Bot. S stem
Y 1(• ~ S
p. O •/o !
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Final Grade ~It.t { ~ O'f't •
St cover '" 0~ , ~~-1
fU1L AR~URY 1 IUIV ~ 1 J 1 CIVIL s/ 7 1 ~ U 1_ n~c ... U ~,_ -
TRE ... ~ w----•~- - r.. --- - .
f renches
O
Width r Length No. - -
PIT
No. Of Pits
Inside Dia. Liquid Depth
DIMEN I N -\\
~~-
3 ~ci DIMEN I N
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufa urer:n
Y~ 1
INFORMATION Type 0 ' - CHAMBER Mo e N tuber.
System: ~ 1V~ . ~ 33 ~ 92 ~) - OR UNIT
iIKTRIR11TItlA) tVtTFM I LG '~ ~~ rl Ira p~ciD... (v1,,.Q,
M
Header /
an~ifgl~l ~ S y
+
v Distribution Pipe(s) x ole Size x Hole Spacing Vent To A~ Intake
n
-,
~Di
Length'-- !
a_ L acing ~' q~
SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Systems Only
Depth Over ~ r~ ~,an 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.)
Inspection #1: o~{/ (9/0l Inspection #2: ~~~-=its =-;
Location: 912 Waxon Lane, Hudso WI 54016 (W1/2 SE1/4 16 T29N R19W) - 1629191896 Pleasant View Acres -Lot 19
1.) Alt BM Description = 5~w..~-C~'~ .~ !~;
2.) Bldg sewer length = ~jp -- 32r 4~n.9E"w.. ~l-t`~~ ~}-t~•~")
-amount ofcover = ~,~" ~- yam, co~v n n
3) ~~'15er.i. ~~ QLS ~,. cam.. ~~G~,.M..1oal ~w .~ >~ an.~[ .eav~ -~.~
~~ ~;~.~.-14- -loo GC~Iv~~'~ . 6 : ~ _ ,.~k '~.N~ ~ `tis ~i`°^ -
~~ ~
Plan revision required? ^ Yes ^ No < w^~
s other side for aId'ditional info~rymion/~ • ~! ~ ~ ~
- 710 (R.3/ ) ~^~` ~ - " v a e ~ InsRRect rq, s Signa re _f ~~~ _~e~ NJ~;,-~ ()
~c,Inr.Qaa, \.~~., s . ~'.~ `{ ,~tr~-A1__ d1,gt,~~ 8 ~r~IO Sa~e~ T~~°.
n
~~lZ W~-K~ ~- ~ •Sanitary Permit Application Safety & Bt,ild;
In accord with Comm 83.21, Wis. Adm. Code 201 W. Walt
iseonsin See reverse side for instructions for completing this application ~ P
Personal information ou rovide ma be used--€qr-s~co~tdary purposes Madison, WI
department or Commerce Y P Y
[Privacy Law, s. K 4t•I)rrt}}]' ! - ~~ (Submit completed form ro
5
Attach com lete laps (to the county copy only)~tih,lh$•~Fystem.vn oaoer not_k than S-I/2 a t I inrhrc in c~~r
~.uu'7~ G ~ St a ita PO ~ umber Ct-.li:k il'r~[SSypaltq~t ious app.' ion
i ~. ~. V State Plan I. D. Number
I. A lication Information -Please Print all Information "" Location:
Propeny Owner Name ,.~, I ~~~~ R ~ ~
~ Pro~ny Location
(~(.,J~
' -
-°~ ST Cox ~^
Propen
y
Owner
s Mailing
ddre
ss
{n~ ~~ 2C1~NGOFf~
~'~ Lot Number Blc
~
/
~
~
[
q ~ , ,
Ciry, State ~ 4 - Zip Code ~ r~bgrr_; ,,,~ Subdivision Name or CSM Number
11 Type of Building: (check one) O City
I or 2 Family Dwelling - No. of Bedrooms:? ^ Village
_
O Public/Commercial (describe use): yf~Town of
O State-owned /
III Type of Permit: (Check only one box on line A. C heck box on line B if applicable) Nearest Road I ,I
I
A
N
S ~~- !./'t
) . f~
ew
ystem 2. O Replacement 3. ^ Replacement of 4. D Addition to Parcel Tax Number(s)
S stem • Tank Onl Existin S stem
B)
^ A Sanita Permit was reviousl issued Permit Number
~ p~(~ '"-~J`~~'l~--QQ Q Date Issued
is ersal/Treatment Area Information: -
1 Design Flow (gpd) 2. DispersalArea 3. Dispersal Area
Required' i Proposed
~~ ~ ~~(~
VI Tank Capacity in Total N of
Information Gallons Gallons Tanks
New Existing
Tanks Tanks ~1(~
4. Soil Application 5. Percolation Race
Rate (Gals./day/sq. ft.) (Min./inch)
Manufacturer Prefab
Con-
Crete
6. System Elevatior ~ Z Fina.
f ~~ l(~r3t Elevau
Site Steel Fiber• I
Con- glass
structed
t5 .~ 1~ yS - ley / ~.ct~~~ti ^ ^ ^
t v. type of !'UW"1' System: (Check all that apply) /6 , o1CJ , ~/, ! (o
,ftiQNnn-pressurized !n-ground ^ Mound ^ Sand Filter ^ Constructed Wetland
^ Pressurized In-ground ^ Holding Tank ^ Single Pass O Drip Line
O At-~ade ~~-S tx 3r ~ I S ^ Aerobic Tre tme t Unit ^ Rec' culating ^ Other: --(A~--~
v n~
VII Responsibility Statement
1, the undersi ned, assume res onsibilit for installation of the POWTS shown on the attach
Plumber's Name (print) Ptumb 's Sign ure (no st MP/MPRS No.
- ~ - ~ ao3
Plumber's Address (Street, City, State, Zip Code)
tsusmess Phone Number
~7t5- ~8 -~~r~
VIII County/Department Use Only
O Disapproved Sanitary Permit Fee (Int~cludes Groundwater Date Issued Is uing Agent Si nature (No st
,Approved ^ Owner Given initial Adverse Sur arge Fee)
Determination ~,~
IX.~Clo~ndt~tio~ns o~f 'Approval /Reasons for, pisapprao.QVa~ A L~~ ~` ~ n _ n n
SBD-6398 (R. 07/00)
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. Nr~consin department of Industry, SOIL AND SITE EVALUATION
Labor And Human R9letions
Division of Satety end 8ulldings in accordance with s. ILHR 83.09, Wis.
Page / of
Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must ~O~ry
Include, but not limited to: vertical and horizontal relerence point (BM), direction and S~`• C~Or
percent 9bpe, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. A o1. • / o
AppLICANT INFORMATION -Please print all Inf 0~ Re awed by Date
personal InlormAtbn you provide may be used for secondary pu `P v~cy~.~w s f (1) (m)-. ~ a, ~ •
' t
Property Own9r ;~ Pf rty Location
~~ ;~~j_.~, ,r~'j (3ovt~ot ,~j~ 1/4 Jr~ 1/4,S ~~ T Z9 ,N,R ~7 E (or~
VE~'Nati ~~Y Dill ~~ ~ ,~ a
Properly Own9r's Maitlng Address ,/ Lots ''' Blocklt Subd. Name or CSM#
_,
City State Zip Code Pt%one Num ~ _, "~ Nearest Road
h/UDJ! ~(f s~,l~ (p ~ ~~,~•'8 ^ Git~ ~ Villa e Town ~N
;•.;
law Construction Use: Resldentiel / of tedri~oms ~• Addition to existing building
^ Replacement ^ Public or commercia - ~.
YSo -
Code derived dally flow Co 0'T~ gpd Recommended design loading rate ' ~ bed, gpd/ft2~trench, gpdNt2
Absorption ilrea required~_bed, tt2 7.50 french, tt2 Maximum design loading rate ' ~ bed, gpd/fi2 trench, gpd/tl2
Recommended Initltration surface elevation(s) .S~ ~ ~ tt (as referred to site plan benchmark)
Additional design/site considerations
Parent material /DES,$' 0~1~ .sj},VQ ~/ d U TLU/}-~~ Flood plain elevation, if applicable N~Tt-~ ft
S Suitable for system Conventional
~ Mound ~ In-A~roun~d ressure AT-grade System Fill
~ Holding Tank
^ S
U Unsuitable for system ^ U ^ S L"J. u L~ s^ U ^ S U 5[
^ U
Bori/ng #
!.
Around
elev.
bepth to
IlmiHng
factor
} C~in.
Boring #
2
Around
~~'' 'ft.
Depth to
limitin
g
factor
? ~~_tn. Remarks:
CST Name (Please Print)
~oF ~~ T' ~G,S~e/4~`T
Address
SOIL DESCRI PTION REPORT God ~Q_ -cS I~ `
Horizon Depth Dominant Color MoNles t
T Structure i
e
C
t B
nda Roots aPD/ft2
in. Munsetl Qu. Sz. Cont. Color ex
ure Qr. Sz. Sh. ons
s
enc ry
ou Bed ,french
~ b•G ~~~ 3r3 - ~ tfsh~ ~~~ s ~ ~ .~t ..s
z 6• ~ io yie 3~Y s~ i~'sh~ ~t ~~ cs ~~' . ~{ ' . s
.
~.
Remarks:
~ b •~~ ~o y/l 3/3 - ~ / s ~ iwr fe ~ ~ . Y • .s
y /I.37 ~o YR y~4 ____ SQL / f'S!~ ~ a ~' ~-. . Z ; • 3
~, ,
Signature
Date
/~/Or/• ZZ '' ~lr'~~
~ Telephone No.
~is• 3BG •I~~~S
CST Number
~.2~237.5
Pctvate Sewage Consultants
665 O'Neil Rd.
Hudson, Wis. 54018
n ^
U• ~(f f~~Q~(J SOIL DESCRIPTION REPORT
PgOPEgTY OWNER
Boring #
Ground
elegy.
/c3 ,~? ~.
Depth 10
pmittng
factor
C~In.
Page Z'- of .3 ,
t C
l
D
i Mottles Structure t
R 2
Horizon Depth
in. or
nan
o
om
Munsell Du. Sz. Conl. Color Texture Qr. Sz. Sh. Consistence Boundary oo
s Bed ,Trench
z .~
• .33 ,o y,~ , y
io~R Y6~ ___.
-- s~
s ,fs ,~,
/-~ fie ~, f~
d s ~s
~s ~ f
.~ . y .. s
. s~ . ~
~- `I~-}L1 t ,
~ g al ~. t~ ~.~2 ~.~Z ,
Remarks:
Boring #
Ground
elev.
~o3.~n.
Deptn ro
limiting
Tactor
7 ~In.
~ o • g
z•y io YR 3/3 ~ roar
~o ~ SC ~ f .C
~ ~
f .>"t vf'i ' C S ~-f
_ N ~ N
, ,.g
r
~. ~.. 24~ i o~ . ~ .2 ~„ ,
Remarks:
Horizon bepih Dominant Color Mottles
In. Munsell Ou. Sz. Cont. Color Texture Structure
Qr. Sz. Sh. Consfstence Boundary Roots
Bed ,Trench
G •3 ~oyi2 yl
y, o ~--_. S a-s
p, ~-e cs - .~ .8
-- - , 7 , .8
,
°(~• 3~.
p,Z ~.Z
Boring #
around
~ elev.
~ bepth b
limiting
factor
i ~ ~~1~.
Boring #
~.:
ground
elev.
S ~. Win.
Depth ro
Ilmlting
factor
2 ~ In. Remarks:
~ 6 ~~ ~ ~~
6
SBDW-8330 (R, a3/SS)
Remarks: ~~
7s CP ~ - ,
Z 0 3/ Si c. /1~ Stir- ~ f'c' r-- -- • Z ; 3
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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: Svstem Design Specifications
Sanitary Permit Number 3°1O5~
Number of Bedrooms ~
Design Flow -Peak (gpd) 8'O
Estimated Flow -Average ( pd)
Septic Tank Capacity (gal) b ~~
Soil Absorption Component Size (ftz) z
Type of Wastewater Dome is
Table 2: Soil Absorption Comaonent -Limits of Reliable Operation
Septic Tank Component Soil Absorpti n Component
Design Flow -Peak (gpd) ~ (~ ~ 5
Maximum Influent Particle Size (in) 1/8
Maximum BODS (mg/L) 220
Maximum TSS (mg/L) 150
rtaXF.~18v~
Tab le 3: Maintenance Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least 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 the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. he outlet filter shall be cleaned as necessa to ens
proper operation. The filter cartridges ou not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
R
Management Plan for a Septic Tank and Soil Absorption Component
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 tank shall have its 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 septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank maybe difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. 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.
2
t-13-1995 1.d7AM FROrt
`Mar-22-O1 12:55P
P_02
P_ 1
ST CRO1X COUNTY
SEPTlC TAr[K MAINTENANCE AGRErML•N"C
AND
OWNFASHIP~IC~~E/RTIIFICAT[ON FORMIY~ j 1 L
Owner/8uyer ~ra aA W~~ T*wtlr3 ~ ~ 7~a~ ~+~• TI~RI~s A
~~
Mailing Address `1 L y PSI ~ L ~.t r ~lrt•G. ~ ~ ~ .
~j ~ ff ,, !/
Proputy Address / ~a - WaiCbA ~!~!~ ti V s~.• r ~ •
(Verification repaired teen tnarrniag DepetpateAt for r~ew ooastetaetion)
City/State Ntra tta ~~• Parcc! ldeatification Number
~.LG DESCR.xPT ON
Prapcrty Location f tw '!., s E %. Sec. t i _ T L 9 N-R ~Q Town of I#td ~s~A
Subdivision ~~t~s ~~i'v: c v /t; ~~~ • Lot n ~~,.
Certit'ced Sarvey Map # _ . Valttsne .Page ~
Warranty Heed # _ /~> ,~~ l~ .~ 3 `~ Volume ~ i ~v Page ~ ~.~
$P°C ~~ O ya~l no Lot lines identifiable yes ~ no
SYSTEM MA)1NTEN,~~
~~ ose sad tstaeampaoCt ~ yvtn: septse system eoaM tesuft is eta premadere faihm to hnneAt routes. Proper maiateaatete
of pumpiAg out the septic tank evrry tlYree yeas iK soaaer, if aocded by a ticesmed pumper. What you put is-so 1$t Systette
can stFect flat function of the ax~iC rack as a Cteatmeat sage 3n the route disposal systetsa.
fin grogetry owner ageeas ~ stabenit to St. Croat 7.oaiag Depattautet s ctxtiiication fottt>, signed by the owner sttd by a
eeeasterplurtt'ber, jouraeyntan phrmber, restricted phtmt,rr os s )iceasedpuasptr veretying t5at (i) t3ae• as-site wastewaterdisposal systcta
is ~ ptt~pet opttatiag Condition attdlor (2) after iaspeerioa atad pttsapiaa (if accessary), the septic taatc is less than 113 Cull of sludge.
~"~, ~ uadersiaiaed ~~ d1e above roquireafeats rnd ag;+ee to maibaein the private towage dispose! system with the atandands
ace 1'oe$t, herein. as act of C.ostvrrctca and the D~neai of NatYtral R.esourtes, State of Wisoottss. Cattifiratiaa
~~6 tlyat Y~ ~ !mss been ttgiataiaed smut be eorrepkterl attd ettttc$ed to the St. Croix flffioe within 30
Qays of the t~'e ~ ~, ~~' 7.oaine
~ i =li al
__-~_
DA'1E
StGNA'RJft& OF
} ~wledge. E (we) aA- (art) flee o~wrder(a) of
Oilics.
S ~t/~ e/
DA'I'G
•,•••• play ia(orrtratiosr that is trria-tepresearedmay molt :n the sanitary peatnit Facing revolted by the ?,orn~ Departrrxrp. ••••••
'• Ldttde wills tAis applfeat;es: a atarr~red avarrNtty deed ft+aa- tke $egi~ of Deeds offue
# ~y ~' the aertilied suevey rorp ii refereteco is made its tltt aarr3nty doed
4 T N
t (wa) a rtilr ~ • nacn>e on obis form air true to ttte best aC my (our
~ ~°~~ y virtue of a warranty dead recorded is Rea" r of Deeds
SIGNAL OF App ~
~-
. ,~ -r ~- ~:..
,,t, .1_t~ bPa(:~~ r~ ~ l
STATE BAR OF WISCONSIN FORM ] - 1999
Document Number WARRANTY DEED
This Deed, made between Vernon Waxon a/k/a Vernon E. Waxon
and Irene Waxon a/k/a Irene S. Waxon. husband and wife Grantor, and
Brian Whitemarsh and Mar Whitemarsh husband and wife Grantee.
Grantor, for a valuable wnsideration, conveys and warrants to
Grantee the following described real estate in St. Croix County, State of
Wisconsin (the "Property") (if more space is needed, please attach
um):
Lot 1 Plat of Pleasant View First Addition in the Town of Hudson, St.
rotx County, Wisconsin
This deed is given in fulfillment of the land contract entered into between
the parties dated December 22, 1999 and recorded December 29, 1999 in
Volume "1480", page 512 as Document No, 616179.
Recording Area
638535
Y.ATHLEEN H. WALSH
REGISTER OF DEEDS
ST" CRl]IX CO., WI
RECEIVED FOR RECORD
o2-la-2oo1 u:ao aM
{RIRRANTY DEED
EXEMPT fl 17
GERT COPY FEE:
COPY FEE:
TRa195FER FEE•
RECDRDTM1i FEE: 10.00
PRGESo- 1
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Name and Return Addre~s j ~
/<ci' ~~~
3`30 ~(b,~•GaaO,t~,~G
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Together with all appurtenant rights, title and interests. 020-1351.19
Parcel Identification Number (PIN)
This I~ homestead property
(is) (is ray
Grantor warrants that the title to the Property is good, indefeasible in tee simple and tree and clear of encumbrances except
easements, restrictions aad reserv11ations, if any, of record. /~~~, ~
Dated [his ~ day of t~ , ~y .
" Vernon Waxon a/k/a Verno E. Waxon * rene Waxon a/k/a Irene S. Waxon
AUTHENTICATION
Signature(s) Vernon Waxon a/k!a Vernon E. Waxon and Irene
Waxon a/k/a Irene S. Waxon
authenticated [his day of __ ,
TITLE: MEMBER STATE BAR OF WISCONSIN
(ff not,
authorized by § 706.06. Wis. Stats.)
THIS INSTRUMENT WAS DRAF"1'ED BY
Knsuna Ogiand Estreen & Ogland
304 Locust Street Hudson WI 54016
(Signatures may be authenticated or acknowledged. Both are not necessary.)
ACKNOWLEDGMENT
STATE OF WISCONSIN )
ss.
ST. CROIX County )
Personally came before me this ~~ day of
~ppua. , ~,~ the above named
Vernon Waxon W Vernon E. Waxon and Irene Waxon
a!k!a Irene S. Waxon •,
- ---- - --~- --'-----_~J-r-- ----- ---.. t.___.
•~
to me known to be [he person(s) who nxQyvted the foregoing
instrument and acknowledged the same.
Notary P tic, State of
My Commission is permanen[. ([f not, state expiration date:
~ Nantes or persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du lac, W I
SPATE BAR OF WISCONSIN g00-633-2021
w ARRANTY DEED FORM No. i -1999
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