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Home My WebLink About020-1286-00-100Wisconsin F~epartment of Commerce PRIVATE SEWAGE SYSTEM Safety and B~Iding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township RMF Pro ernes, LLC Hudson, Town of CST BM Elev: Insp. BM Elev: 9~• ro BM Descriptio ~ m z c~ ~ i TANK INFORMATION TYPE MANUFACTURER 4 CAPACITY Septic L ~. F~ t ~a~. Z • ~ ~t 2 i /Z'S 8 rri~ L / ~ Ya ~ Q ~5 Aeration Holding TANK SETBACK INFORMATION TANK TO ~ P~/L ~ T`EL BLDG. Vent to Air intake ROAD Septic ~ 4 / U. ~ /M ~(.~ y ~D ~ / Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number - TDH Lift Friction Loss System H TDH Ft Forcemain Length ia. Dist. to well 4nll ARSnRPTInN SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 506158 0 State Plan ID No: Parcel Tax No: Section/TownlRange/Map No: 21.29.19. STATION BS HI FS ELEV. Benchmark ~ •~ ~~• ~~ , Alt. :1 Go~4... S~ j ~,` ~[ T Bldg. Sewer 7~~~ 9.7 ~ ~ 3 St/Ht Inlet $ ~ bD S, ~Z. St/Ht Outlet ~ 7 ~ • $~ Dtlnlet \ ~ Dt Bottom Header/Man. /~, ~9 3 . a Dist. Pipe ~ 1~ • SZ Bot. System ff' Ib' ~ /L~*• °f/ • 9s .~ Final Grade 5.5 I ~ • ~~- StCove~~,~ ~J s`) ~~• BED/TRENCH Width ~ Length No. Of Tres f . ~ PIT DIMEN IONS No. Of Pit_ ~ Inside Dim Liquid Dew DIMENSIONS ~ $t~( Z I rey~ ..JJ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ~~-+~ ('' LL~~.. " ~ ~ ~ ATION CHAMBER OR L.~M y Y"Ig. INFORM Typg O f~ystem ~ J ~ / ~ ~ ( a ~ ~ UNIT Model Number: ~ D ( / u IIISTRIRIITInN SYSTEM -'~' Header/Manifoh ~~ Distribution x Hole ze x Hole Spacing Vest (Air nta~Q 3 [~ ~ ' ~ Pipe(s) ~ ` \ ~ ^ ` Dia 7 Length Dia Spacing Length J • S(~II rnVFR ,, ore~~~~.a c.,~•cm~ n.,i., YY Mnnnd nr Of-Grade Systems Only Depth Over Depth Over xx Depth f xx Seeded/Sodded xx Mulched Bed/Trench Center /„ • ~~ ((/ Bed/Trench Edges Topsoil Yes ", No , Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:__/ /. Location: 592 Schomme~~ye Hudsoy, WI 54016 (NE 1/4 NE 1/4 21 T29N R19W) St. Croix Industrial Park Lot 2 ,~,`, (~pva-~-- 1.)Alt BM Description = 2.) Bldg sewer length = 5~ - amount of cover = ~ 1 /~ A~.~j -r~6~ lo~'n vim,. Plan revision Required? ~; ' Yes No .~ ZLl '~ Use other side for additional information. Date SBD-6710 (R.3/97) Inspection #2: / / Parcel No: 21.29.19. T Cert. No. cOrnmerce.w3.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 , /~ ~ ~ ~ r M1 Madison, W 153707-7162 Sanitary Permit Number (to be fill _ in by Co.) Department at t,ommerce ~D 10 ~. Sanitary Permit Application State Transactio"Number submission of this form t riate governmental Adm 21(2) Wis Code 1n accordance with s Comm 83 ~~~~ y . , , . . . . unit is required prior to obtaining a sanitary permit. Note: Appli f rms for state-o S are Project Address (if different than mailing address) submitted to [he Department of Commerce. Personal information r se ry you p~~ 1'+Cs,v~th .~izrv~ 59~ 04 I)(m 15 Stats u ses in accordance with the Privac Law s ti,r G 1 aP C L..I u G I of L_ L.+ , , , . . . 1. A lication Information -Please Print All Information ~ Property Owner's Name s APR 1 5 ?UO? f arcel # ' ... . "\- " a.. /~ ~ - ~~C. - - Property Owner's Mailing Address ST. CROiX GOi_1N-f~' roperty Location ` - ~ ~~~, _ _ _ _ Govt. Lot ~ City, State Zip Code Phone Number y~~ ~~ y., Section ~ - (circle o ` .~ T ~fi .~ ~ W T ~ N; R ~_ E Type of Building (check aB that apply) Ii Lot # . tr} t or 2 Family Dwetting - Numberof Bedrooms -~ Subdivision Name Block # A.? ~1 ® Public/Commercial -Describe Use /17ttry~/c~/,:' ~//~o-r ¢` ^ City of fACZZ~ ry S o ^ State Owned -Describe Use CS r I ~ ~ ~ ~~ ~~ Village of 1~ T n of ~ tt~ ro.-r/ [II. T ype of Permit: (Check only one box on line A. Complete Gne B t licable) '4' ,® New System ^ Re lacement S stem p y ^ Treatment/Holdin Tank Re la g p Other Modification to Existing System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Dace Issued Before Expiration Owner of-POWYS /Com onent/Device: Check all that a 1 Non-Pressurized In-Gr ^ Pressurized In-Ground /^ wAt-Grade ^ MoyP > 24 in,~..,o~fpsu~~itab~~le soil o d < 44 in of suitab .II " ~Z•'~ / ~~`7" ~ ~~ ~ n ~ ifi) ex Gd'Yfeheatrt5ent ic ~ ^ Holding Tank ^ Other Dispersal Component (explain) ~-C~~ V. Dis ersal/treatment Area Information: - °~ - - Design Flow (gpd) Design Soil Application Rate(gpdsf) al Area Pro s System Elevation ~ - ~ cP/.s' a~O ~ot - G' C~ VI. Tank Into Capacity in Total # of Manufacturer O U Gallons Gallons Units ~ _ y i New Tanks Existing Tahks d c a U J ;; ~ ti y ~ rn ~ a~ 'w C7 fs N 0. Septic or Holding Taok /~ v ~„~~ ~ - v -,~ Dosing Chamber Vll. Responsibility Statement- I, the undersigned, assume responsibility for installation ofthe POWYS shown on the attached plans. Plumber's Name (Print) Plumber's Si ture MP/MPRS Number Business Phone Number Plumber' Address (Street, City, State, Zip Code) 7 O Vlll ount /De artment Use Onl Approved ^ Disapproved Permit Fee ~~ Date Issued [ ing Agent S~ ttaIUr r r Giv e n Reason f r Denial o 1l R e f Q IXy Co~n~~~' ~Iuent tll~er and r Disapproval S,~ -- ~lG~y~~2 S - dispersa{ cei{ must all be serviced /maintained ~ ~ ~ COn as per management plan provided by plumber . / 2. All setback requirements must be maintained ~ ~ (tiY~~i i~12Lo as per applicable code/ordinances. Attach to complete plans for the system and submit to the County only on paper not less than a rrz x t r mcnes m sree zl2~ U SBD-6398 (R. 01/07) Valid thru 01/09 ~.,/~r7/= /~u^ro~iorl-u~ ~E/Ji~R ~ czLITY ~ ~.1.1'rE ~~N 4 ~.~.~.F ~-r l.~~r ~.irzN-~ rv f~ov cF ~E---EDGE Or /31TU~NOt[!' ,/~.J,oN/OLT ---J ~o?So ~irotcow ,~//IESE/L f~~/1'c T.pivk, ~.,.py /$cr lcG `Q3 /oL - 6a.5`EffLu6ivr F.ILr~ .-Vi/p Jyrlr9~T ~vc~ ~ .~7 s~~E - SS L . F. y ~°t% .!'cvt 4 5'c~ .lficrc.aLVG 1,~ wErZ /'~i/..3=o'Cvvr/t ~t~vo_Zrvrir[.AT6a Al ~Ei2. -,R,~.ro=~ Cv~. ~t..?v(cJ3.~cr ~~y~ur~+eo 00 . . F-- 88.47 ® is QI ~Y ~- 8D~ .y:~FFF«tNT CFu.S' So` Er la/Ec~ o~uTp' SNoro A/QE1.1 /i~iPosf_/J QurcGl~/G /~jtoParEO FF=lay 60 `.S'SL.F. y ~:pvc J`crrt~ Yo .Quatcn./G .~*wER, /'fro. SO `Cv~rit i9rv0 .Zir~'uu9T~D ~s'.Ae? (agim ~ dt • 3o,C~ 3 r4S /ZELjKZREL~1 '.G/y/ = Tyro oF.c`1czfa~/G /loiuzr'a/{TivG l~e%EtL, .G~Lr`v =/pv. ov -AtT..Q/''J= -S'1•/~iroP~zTrCo/~.vti., /.L7on~r~i4E f1t~ = 96.,0' -- --° f N~/~i~+lE/1 ~ZZV~ J'C~vLE / = Yo 0 0 ~-NON /~O/'1E1'TlG ti/~LfTEWioTtR /~a[QIrvG TArvk ::JY,S'TE~ .as FER . l,~s..Ow~ (c,N rv,~ ati3 G/.25. r90/7 CvaF) NocarNG Tir~vK Sl'.fTr-r~ /3~4Y W.9STE -~~ ~'~ ~gGF~oF c~ ~,6sS commerce.wi.gov ~ ^ iscans~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TD4 #: (608) 264-8777 www. commerce.wi.gov/sb/ wvuw.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary April 13, 2007 CUST ID No. 222373 GARY T ZAPPA ZAPPA BROTHERS 1NC 715 SIXTH ST N HUDSON WI 54016 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/13/2009 SITE: RMF Automotive Repair Facility 592 Schommer Drive Town of Hudson St Croix County NE1/4, NE1/4, 521, T29N, R19W FOR: Identification Numbers Transaction ID No. 1385419 Site ID.No. 722367 Please refer to both identification numbers, above, in all corre_s ondetzce with the aaenc . Description: Commercial Non-pressurized In-ground POWTS 1 New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1126061 Maintenance required; 555 GPD Flow rate; 130 in Soil minimum depth to limiting factor from original grade; System(s): Conventional POWTS Component Manual, SBD-10705-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that maybe required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • The plumbing for this project discharges to a private sewage system. The approval covers only domestic/sanitary wastes directed into this system. The Department of Natural Resources (WDNR) must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic/sanitary wastes. ~c~t~ ~_- ~ ~~~ T~ _ ..,,.ennFRCE GARY T ZAPPA Owner Responsibilities: Page 2 4/13/2007 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~ ~ erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wis consin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 VJiSMART code: 763 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. R ~[r Y~ N F ~ ~L ` APR-92001 ILDINGS SAFE~~~SIDENTIAL CONVENTIONAL POWTS DESIGN INDEX AND TITLE SHEET Project: RMF Automotive Repair Facility Contact: Zapna Brothers, Inc. Address: 715 Sixth Street North Hudson, Wi 54016 Legal Description: NE 1/4 NE'/a ,Section 21, T29, R19W Township: Hudson County: St.Croix Subdivision Name: St. Croix Industrial Park Lot No.: 10 Parcel ID Number: 020-1286-00-000 Plan Transaction Number: Index And Title Sheet Page 1 System Design Calculations Page 2 Site Plan Page 3 System Cross Section Page 4 System Management Plan Page 5 Attached Soil Evaluation Report Page 6 Designer: Gary Za/pA'a Signature: ./~ Date: Apri105, 2007 License Number: 222373 Phone No: (715) 386-2850 i,~ct.iSJ~d.r.~ 1JG~~y~yv,,._ ~'` SA¢ES`~ N 4 pl'J65~~ 0 ' ..--~---."'~ ~~G t~!G~ _....--- ~ -pQ~ ~,~~~ SYSTEM DESIGN CALCULATIONS RMF Automotive Repair Facility JOB DESCRIPTION: Automotive Repair Facility, System Design Based On Proposed Facility With 20 Patrons, 20 Employees, And 2 Restroom Floor Drains ABSORPTION AREA SIZING' 1. Design Wastewater Flow: 555 and (370.00 GPD Estimated Wastewater Flow) (150% Conversion Factor~555.00 gpd Design Flow (20 Patrons) (3 Gal/Patron~ 60.00 gpd (20 Employees All Shifts) (13 Gal/Employee}= 260.00 gpd (2 Floor Drains, For Restrooms Only) (25 Gal/Drain~ 50.00 gpd Estimated Wastewater Flow = 370.00 gpd 2. Existing Grade Elevation: 99.56' Ave 3. Depth To Limiting Factor:> 139" (Elev. = 87.98'1 4. Proposed System Elevation: 92.00' 5. Infiltrative Capacity Of Soil At Or Within 36" Of System Elevation = 0.7 snd/sa.ft. 6. Absorption Area Required: 792.86 555.00 gpd Design Flow/0.7 gpd ~ 792.86 S.F. Absorption Area Required 7. Absorption Area Proposed: 813.80 S.F. 792.86 S.F. Reanved/19.10 S.F. EISA Per Infiltrator Ouick 4 Chamber~41.$1 Chambers Reauved & 4 Infiltrator Ouick 4 Standard Multi Port End Cans At 5.8 S.F. EISA Per Pair. 42 Chambers X 19.10 S.F. & 2 End Cans X 5.8 S.F. = 813.80 S.F. Number Of Trenches: 2 la, 21 Chambers Per Trench & 2 End Caas Per Trench Trench Width (A): 34.00" Trench Length (B): 86.67' SEPTIC TANK CAPACITY: 1. Design Wastewater.Flow = 555.00 Qnd 555.00 gpd/75 gpd = 7.40 gpd Person Equivalency 2. Minimum Required Capacity: 1.072.93 Gallons (555.00)+(11.61 X 7.40 X 2(46.77 X 7.401072.93 Gallons *(Required 2 Year Maintenance Cycle) 3. Proposed Capacity & Manufacturer: W 1250 MR Wieser Concrete Septic Tank 4. Effluent Filter: PolvLok PL-625 With Smart Alarm EQUALIZED EFFLUENT DISTRIBUT'ION' Distribution header to be constructed to equally distribute eflluent to all trenches. See detail at page 4. Page 2 of 6 . /'~I~'1/C ./~iiTO/+iar1-vE / ~E/si~R ~/~GZLITY / ~.z'7,E ~L~/~N Y liivFS' ~Y~'r'n/ J/°.~ CE EaGE or QzTU~ivv~,tP /iffJ'AiYA[.T ~~~~ I /~tsa ~occo„~ .d/.z~-S'ErZ ,jE~rsc T.wvfc w_n~ /~cr L.x, ~ ,C33 ~L - 6•x.5 EFFLu~vr fSLrP/Z .'ni/O JY~lr9/{T flLTfR E-- 37 s~~e - SS L . f. 5' i°vc .t'e.~rt c Yv .Clur~a:,,.G..1,~ w~i~ ~y s=v'CvY~+rt ~w:,o~,urvegrEp ,qr ~E/t. -L~&.ra=~ CUA~M. rfbt.3v(c~3.rtr /~E~{uliteo 00 ~/ ~Vt E"FF(vtaT ~-~ . , ~ss,~,f y ~:ovc J`c~tc ya S,yoP S ~'Cvvr-~ ivvo ~-sa~J~ cEU.s ~9/?E/~J Iil~cS'acArEO .AS" AE/1 88.b7 ~~• ~ot.3ofC}3 AS' liEgKSREO ~s~ So. fltoPersEO ~f=./O/. 6D 1J I ilY ~ Ii ` ~• %' Ofr`ZGE 8O/ ~ , ~~ ~ ~~iru~tr./~vs /~J/~ryiVL r ~/D/ta/~oJEO L/EGL '.Q/y/ = TcaA oit`nz.I~SNG /lo/utrra.27tiG h/EtL~ .ELr`v. =/OV. ov -AtT..!!/~7: Sl/A~tvPF/1TY Co/Lvt%t~ /I/7on.'/~-r9E flt v = 96.P0 ~ _ ~____. .j' oAi.A1~Y1 _YE ~_ _ ___ 0 0 ~S'C~9LE / = Yo -Nl~N /.~a~EST1'c ~/AS7EWRTtiE /,~oLQZNb TAivK::SYST~in .qs NER. t,~ts. ov.? (cN .vp Ai3 /was. Ao~l Cvc~~ /4~OGQ7N6 TJWK l'J7EM /3~4Y Wq.-'TE ~GE~~ c~ /%~1lS~.!" ,QrSIQ,ER,f,9L CELL J JJTE/~7 L../laJ'J' ' ~JECTZo/~-/~ ' / liv// ' t/~EW .DETi4ZL , ivo scvc.E N f1 n w 0 z M e~ C f~l ~~r `_g ~"~~ c ~- v D m ,,; a~ 3'?~ A ~~ ~ o ~ ~ Z ~ ~ ~: ~ .. ~ ~ ~. ~~ ~ • ~ 3 ~ ~ ~ o . ~ ~ ' ~ ~ ~ ~ - ~ ^~ ~ q 4~ ~~ ~ a v ~ a ~ ~ .~ ~ ~~ , ~„ y ~; ~' o 0 ~` ~ ~ lu ~+e ~ O 3 b a ~~ S . . ,~ h a` ~6~ yor ~~~s Conventional Septic Sya~tem Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General Tho conventional septic system shall be operated in accorda~tco with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10?OS-P (N.O1/Ol). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be compiled with. Sg tic Tank Septic tank servicing mechanics comply with Comm. 83.54(lxe). Septic tank to be located within 1S0' of service pad, with bottom of tank to be < l 5' below service pad elevation. The operating condition of the septic tank shall be assessed at least once every two years by inspection. The septic tank contents shall be removed whoa the sludge and scum in the tank exceed l /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Coda, by an individual certified to service septic tanks under s. 281.48, Stets. !f the contents of the tank are not removed at the time of assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1 /3 scum and sludge accumulation in the tank. ~Tho operating condition of the outlet filter shall be assessed every six months for the fist two years of system operation and once every two years or as needed after that. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed wiless provisions are made to retain solids in the tank that may slough off the filter whop removed from its enclosure. If the filter is equipped with an alarm, rho filter shall bo serviced if the alarm is activated Septic tank manholes risers, access risers, and covers sbould be inspected for water tightness and soundness. Access openings used for service and assessment shall bo sealed water tight upon the completion of service. Any opening doomed 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biologics! or chemical additives to enbaaco septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Abso iort Cetl Troos or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within rho system and will promote frost penetration during cold weather months. Cold weather installations (October-February) dictate that the system be heavily mulched for frost protection. Influent qusGty into the system may not exceed 220mg/L BODS, 1 SO MG/1. TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within rho dispersal cell shall be chocked for effluent pending. Pending levels shall be reported to the owner. Levels above 4 inchoa indicate an impending hydraulic failure requiring additional, more frequent monitoring. CoaiinQeney Plan If the septic tank or any of its components become defective the tank or component shA11 be repaired or r~laced to keep the system in proper operating condition. Excessive pending within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to installing plumber, Gary Zappa at (715) 386-2850, or the St. Groix County Zoning Department. Pogo S of 6 Wisconsin Deparimertt ~ commerce SOIL EVALUATION REPORT Division of sarety and l3uifdings Izage ~ of r. in acaxdarlce Muth Comm A5 lMa e,t... r.,.ae Attach complete site plan ort paper not lass than 8 i/2 x 11 inches in size. include but not Iimtt d t ' Plan must ~ ~ ~• . e a: vertical and horizontal ret erertce point percent slope. scale or dimens#ons, north arrow. and location and r t r Pancel I.D. / ~ ~ ._ (•~ I~ ~~ _~ ~~ Please ~flilt all inforntalHon. Reviewed ~ Date Psroonsl lnfamation ypu provldm rttey be u N ~a y l.aw. .18.44 (1 i (m}}. Prt~ ert r ~ ~ ~ a 7 ~ ' p } ~ ~ S ~ roperty 1_ocetion Pro m Owner's Melling Address . i.ot ..v ~ 1/4/jfL tta S Z T Z` N a ~ E (or V~y ~ UJ COUNTY t # 81odc # fD Subd. Name or CSM# OJT: C~~~ g(/S ~~ ~Y State ode Number ~S ~, [~ Waage Town ~ Nearest Road . c vc Sya ~ ~~, t' ~~.~ I C~~ ~ u New Cor>struc~icm use: ^ P.esidential ! Number of bedrooms, Repiacetnent ,_...____, Code derived design flow rate __ _ u 1~ rJ ,~ 7 ~U .- GPD '' II (~ Public or commerGal -Describe: s~ ufa trtctc~l',n2 1/ 2~ ~ ",~' ~ ~..~~? ____•. _______._._..___, Parent material _ ~ ~J'T'~~.J ~ ~ ~ ~ Flood Plain elevation It applicable ~ / 2 tt. and recorrantendatinr>s: S~ ~-S-f ~ ~ -~ ~-~ V + ~jT ,, ~ i U ~ (~j `'~ ~ (i2 fa~~ ~r ~. ~ t~n~ , ~ Sv~~S t~ Pit Ground su+face elev. _ L n • oL-~tt r~,n, 5, ~;.,aa~„ •~,..... / ~ ~ ~, Harimrt C~th Dominant C b ---- Soir icaition Rate in o r M Retiax Description 3axture Structure Consistence Baxtdary Roots GP DIt~ . urtseq Qu. Sz Cont. Color Gr. Sz. Sh. "ES#1 `Eff i!2 1 ~ ; Z 3 ~ ~ /°-ZS zs-r3ci /~~ ~3 r / ~~ ~ ~ ~- -- .Sr"I f,~zC ~ Fez r ~ 45 ~ tz z -c ~=~..~ Z i/I~, l ~ ~ - t ul I ~ ~- - , S ~ r ~- , , U ~~# u ,.......y Pit Ground surface ele~r. /~ jU ft. rm~x, ~.. n.K:~;.....,,...,..12i Horizon Depth Domina t • - - ~. ----- -_---- --• - Shc lication Rate in n M l Redox DescriptE'ort Texture Struchxs ~Cortsistertoe 8otxtda ry Roots GP D/ft= . anse l Qu. Sa. front. Color Qr. Sz. Sh. 'Effp1 "ER#2 ~'~~ r'3/ - S' u~ .~~~ j~ S Z ~d Z~ / / ~ L ~/~Z.e~- f=~U r~ _ ~ • ~ ''1 ~ ~ / - S a S m ~ - -- ~ 7 / Z " Ettkrertt t*1 = SOD > 30 < 220 mgilt. and 75S >30 < 1 SO mg1t, " Et'Acrent t92 . BOD = 30 mgA. and T33 < 30 mglL CST Narrie (Please Prtrlt) .. Slgrtatttra CST Number ~ ,litt,;v-Z a ~ ~,''~ ZS3 A Date ~,r Conducted Teleptrorte Number /(D ~ ~ •. Property ~- _... ~-~~_~!_~L!~~ Parcel ID # Page z ar 3 ~~ # f^~ ti~Oring ' ~ ~~ a~ Pit Ground surface elev. ~~ ft. Depth to limiting fads in ~~ , . , _..._ r~ ication Rate korlmn Deph Domins~t Redox Description: Texture Structure Consisterioe Boundary Roots OP D/fF in. Munsett Qu. Sz. Cont. Gokx Gr. Sz. Sh. "E1f#1 'Eflfi2 -t' r r3/3 ~ ~lY~ /` ~U~ .s ~ ~ Z I -3lr ~~ iyiy --- L c ~ _ , ~, 3G~-3Z ~ S/~f e-- S ~ G ~ yq ~, ,n^ r- ~' - , y U ~z- i ~y -~ ~ s ~ ---• ~_. /. Z # ~ ~"~ n _ _ .._..-, --~----- -~-- ,. _ ... .. .., W F'IY ~•••••••••• wn.vw wo ___ -.~ wNur w nrrnru ry rauw _ ~ nr. Soil Rate Mtorizort Depth Dominant Color Redox Descriptton Texture Shuch:re Cansisterlce Boundary Rtwts QP DIPF ~. Murraetl Qu. Sz. Cont. Color Gr. Sz. Sh, 'Etf#1 'Etf#2 0 8ardrrg # ~ ~~ Pit Ground itrf?ac+e elev. _ ff. Depth rcr limiting fac8ar _-- ht. SoA Rate l-lorizpn Depth Dominant Color Redox Desaiptlcm. Texture Stn.~cture Ccxtaistence 8ourxfaty Roots P _ fn. MunseN Qu. Sr. Cont. Color tar. Sz. Sh, "EfT#1 ~ "Eff#2 • Efttuent #1 = BtJD~ > 3Q < Z2D mgA. ac-c+ TSS >30 < 1 SO ntglt. ' ERluertt a~2 ^ BC~Ds _< 30 mg,A,. and T5S < 3d mgll. The Departrnant of Commerce is an equal opportunity service pravidcr and employer. if you Head assistance to access services or need material in an alternate format, please contact the department at 608-266.3151 or TTY 608-264-8777. sso-easd ~taroo! 'NAMi ~L~ S V~~~ M `C~ i D 1rT1 N~ SGAL`! 1 ~! ^ ~~ / ,.. ®M t ELivAV1AN jU0 , C~ 8M t Dascpa~~raoN~~ ~+.~ ~Vlor~~~~r~~~~~ We ~/ ..... ®M a SL.ICVATION ]yC/f ~~ ~-. ®M 2 tirscte~r~rrow_~p o-~ /i~ 1-~~_ Q~'~-~ 9aY>a<'ftM ELiVAVlOf~,,,, Le' ' ~ 1 L>2-~dw ~~. Y~~."~. t3YSTtM TYrac ~I~ii~y1~r'~~;0.~ ~~ ~..~... t*Aaaa:..~_ot~ ~ .91~ (~otv~ 1~ 1 ~q. J~' ^~'~-~ V ~~ ~„ , M ~~` }e t ~G ~~' ~~ ~" ~ ,-- C~1 ~ v I~~, ~ Z S° r C .~._ _. ~.~. . ` , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~~~/~ ~ T,~r~ar~' . PLC. ~~vo. ~ `L,orrur, ) Mailing Address /~'~ 9 r; Yrv r. .~~Q,-„~, . />_ S~1'o~6 Property Address (Verification required from Planning Department for new construction) ~~ ~ City/State LYc~o.~• , ~_ Pazcel Identification. Number - - - no - ~~ ~; LEGAL DESCRIPTION ~ /3 ~7~ Property Location /y~" %., ~ '/,, Sec. ~ , T ` N-R W, Town of /7'~u~rJ,~i /~ ~ K~ Subdivision ~T ~~ x 1.-~,~~rr r~ /~2~c ,Lot # ~O ~/ ~ T-' ~-- ZZ oZ~a3 0~ Certified Survey Map # ~~~ 3 ~ ~_, Volume ,Page # ~ 3~0 ~ . Warranty Deed # ~S'~.?~S ,Volume ~ ,Page # Spec house ^ yes ®no Lot lines identifiable ®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 masterplumber, journeyman plumber, restricted.plumber or a licensedpumperverifying 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 set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of~, three expiration date. -.`'---~ dY lo`i0 / 07 SIG OF APPLICANT DATE 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 owner(s) of the pro descri ed above, by virtue of a warranty deed recorded in Register of Deeds Office. s- ,.,__.~,,,,.__ O% ldy l v, SIG OF APPLICANT DATE ****** 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 s 84534'9 VOL 22 PAGE 5361 KATALEEA H. M REGISTER OF DEEDS I ST. CROI7I GO. YI ~ o ~ v z n ~ -•, n a ao v -I RECEIVED FOR ~tECORU I - ~ O ~ ~ ~ =ozm0~ ~o~omms 02/23/2007 04:10P1f I m.D<rnc~ m~~~~vcn I I v r- z ~ P' O w D m o m~ m CERTIFIED SURVEY tlAP I v cn m T cn m fTl ~ ~ ~ ~ o ~, ~ v z z m ~ REC FEE : 13. 00 m~ ~~ic A o m~ o o nc G~ mDnc» ~z~~m°~ COPY FEE: 3.00 'm-^~ rn~c~ p m mp v v Zv ~ °-D~~N ....-~~=~vcvi~ PAGES: 2 ~ z n m cn O o D D O ~ D ~~ O a n C D~ m v A v v D G7 C C T;t7 Z-1 r C~ S V7 C O~ m-p m m~r(A~ D c~ m ~ j T z v -+ ~ - v nD ~n y ~ ~ cn r^ O -i r~i oz may ~ G)m cn Oc me tvc ~ ~myp-< pD ~O n - v m ~ ~~ m<~O mZZ'i~ G7 Ym O wD ~A cmm={ ~G)Or z m D y A ~~ v m 0 0 z j Z ~ z ~~ mm ° ~'~ mss' ~v ~z m~ ~' ~'m n°z°~ '-'m ~~ v v ~ -m-I ~ ~ ~ om ~z A~ z m ~ om=_ _ z~~ ~ D T Z m O ~ Z ~ A , 0 o A D o Z~ ~ -~~d~ ~do~~~rnc~~o ~~ ~ m ~ 00 ~ m ~ ~ O (M.L L.40.LON) °o; ~~ I Z '~ z `" ~ `O= Si-'S£i~' M SO 8£.OO`N ~~'-------------- ~ ~ .84'ZOb ~J 'Y j~ ~I~C7~J ~r70~J1L~f~C4lfr~JO I I ~uo~~ °b~ ea ~o~ ~, p ~ ~ ~:+ __1 (M..LL~bO.LON) C~I1~ ~ - D,~~~ I° I I ~OGZ MrSO S ' ~ r = ~~CC ~ IS m cn rn O ~ . ,~ wy X2..~ ho C m I W o ~ `o r N m I N -i r Zj .~ `'-' ~ p CD"I O n ~ w .OS I O O ~ I ~Oi c°n Zm ~m °D- 1'I Z ~ O ~ ~ m TI I I ~ S y o b i '~ n~ f~ ~ ~ C w O I C~ 9 ~'-' ~ 2 p m N ~ ~ m ~ ~ Z ---I ~~ in. T to fl p c rn tG w O O -~ I N ~~<~ ~ I ~ -T-I a O e m I ITI o I m~ Z O Mh"T~~ OZ I 69 ~ ,. L , -. ~~p~ u0i W g ~ W ~ -n C7 C7 m u I o, ,~, I m ~o - -------'~ I ~1J ~ J .oo'osz ~ ~C~ ~ ~ rn A °~ ~ p m N `O ~ ~1N~W3SH3 3~JVNIVZIO :N ~ ~~ ' ~ ~~vJ ~ ~ Z O I ~ ~ Iw cn ~~jti• :Ijj I .OS AS ~ ~ ~ m 1.~ ~ ~ ~ ~ 'OD ~ yti~ e0 z I Q~na NI I - ~ v cn L" IA ° w W ,8b'S8£ ~ r I{+~ p Z m o I i = `A ~"„ vci r ~ ~„ oNO ~' .8~'S£~ 3«50.8£.OOS o . m ~' -~ oo ~ jC= can n D i Q ~ I~~~ (M..LL.bO.tON) ' ~? IO I ~ ~ Z ~ II ~ I D ~ ~ i ~ ~ ~ I~ I~ ~ ~ ~ I O ~ f I l 0 ~ -i ~ ~ Ri c~"'n i~7 1 ~ m 2 ZY w . ~ ~ cD cNO I,.J~~ I~ n N ~ I~~~P. I^ Z G~ ~ ~ A~~ ~ n Z I~'~ T CTI I I~1 ~ ~ ~ ~~m~ O Z y7 M I~~ r ~ I~iO ~ m C) Z ly T ~ ~ V .~~ I O ti .00'062 3.,9Z,L£.QOS Z A ~~" ~ ~ y .A M2i HlO1M 3l9VRib'A ~ ..Il. ~H~1~~ 2i31ZItJf101SV3H12lON 3H1 ~O 3NI"1 1S`d3 0 ~~ vo~oz ,,. ~-~~Tq o o v° °c C o o n o ° T ~ ~ T r~,i = n'~ caj ~' <n z0 C7 N z <nNm ('rl ~2Z0~01~ _ ~q: ~ CC S my `L-tn~ ~~ ~^CO~~nI ~ ~'~ ~~~ ~ oA~~ ~ ~~~ own ~ ~O~Ty>3>2 _ ~~ ~ -i { g 'T7 ~ ~ a ~ c~ THE NORTH LINE OF THE NE1/4 OF III ~ N~~r ~ D ~ ~ SECTION 21 BEARS S89°50'09"E AS * z ~1 ~ REFERENCED TO THE ST. CROIX o n ~ ti COUNTY COORDINATE SYSTEM. ~ SHEET 1 OF 2 SHEETS Vol. 22 Page 5361 /~ ~'arcel #: 020-1054-20-000 04/27/2007 11:05 AM PAGE 1 OF 1 Alt. Parcel #: 21.29.19.198D 020 -TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/23/2007 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -SAFE-WAY BUS COMPANY SAFE-WAY BUS COMPANY 596 SCHOMMER DR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 587 CTY RD A SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 6.760 Plat: N/A-NOT AVAILABLE SEC 21 T29N R19W PT NE NE LOT 1 CSM V Block/Condo Bldg: III P715 EXC .15 AC TO HWY AS IN 660/610 &EXC 2.65 ACRES AS DESC 882/127 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 12/04/2000 634694 1564/350 WD 02/04/1999 597207 1401/412 QC 07/23/1997 1116/156 PR ~nn7 CI IMMARV Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class RESIDENTIAL G1 Totals for 2007: General Property Woodland Totals for 2006: General Property Woodland Acres 6.760 Last Changed: 10/25/2005 Land Improve Total State Reason 66,400 138,900 205,300 NO 6.760 66,400 138,900 205,300 0.000 0 0 6.760 66,400 138,900 205,300 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Rarcel #: U2U-1286-UU-000 04/27/2007 10:51 AM „ PAGE 1 OF 1 Alt. Parcel #: 21.29.19.1387 020 -TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/23/2007 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -SAFE-WAY BUS COMPANY SAFE-WAY BUS COMPANY 596 SCHOMMER DR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.480 Plat: 2496-ST CROIX INDUSTRIAL PARK SEC 21 T29N R19W PT N1/2 NE1/4 LOT 10 ST Block/Condo Bldg; LOT 10 CROIX INDUSTRIAL PARK 2.48AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/30/1998 582032 1336/072 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 2.480 102,100 0 102,100 NO Totals for 2007: General Property 2.480 102,100 0 102,100 Woodland 0.000 0 0 Totals for 2006: General Property 2.480 102,100 0 102,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Rarcel #: 020-1285-90-050 oai27i2oo7 10:52 AM PAGE 1 OF 1 - Alt. Parcel #: 21.29.19.1386A 020 -TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/23/2007 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -SAFE-WAY BUS COMPANY SAFE-WAY BUS COMPANY 596 SCHOMMER DR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2496-ST CROIX INDUSTRIAL PARK SEC 21 T29N R19W PT N1/2 NE1/4 LOT 9 ST Block/Condo Bldg: LOT 09 CROIX INDUSTRIAL PK (2.8AC) EXC PT TO HWY PROJ 8949-02-23 ('03) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-29N-19W NE Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 963/200 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class COMMERCIAL G2 Totals for 2007: General Property Woodland Totals for 2006: General Property Woodland Acres 2.637 2.637 0.000 2.637 0.000 Last Changed: 10/25/2005 Land Improve Total State Reason 104,200 922,400 1,026,600 NO 104,200 922,400 1,026,600 0 0 104,200 922,400 1,026,600 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 . ~ 1. , ~' ~~~~d~ ~~nD c O o~ 35;~64fl CERTIFIED SURVEY MAP UNPLATTED LANDS _ ----- -- - --- I TRUE BEARING E. ~ ~. ~, W W li. Z w J Q V N -o ~~ 9 ~g8' ~, ~~ 43 5.48 0°38r07~~ 402 8 • ,~ .~ ~ ~ 3 Z N ~ ~ z ~ o O ., U I-- Z 9°~~ 33r 33I ~ 6 6r ~~ I W ~5~'~ °M ~° HOUSE °N°cNv SO°38rQ7~rE 33r 33r 17.00 I V -O N I O O .ol o z~ ~ ~' ~ I I °I 9.56 ACRES INCLUDING IW-I 3 ~- C.T.H. RIGHT-OF-WAY Q I O ~ ~ _: d' ~' dl ~~ .~ N 8.26 ACRES EXCLUDING ~~ Z rn ~ ~' C.T.H. RIGHT-OF-WAY NE-NE FI ED ,~ 26 X78 Rsplsf~O°Cpe tlFll S4 Crolx Cevnr W N z 3 ~zrn n .... 4 RIGHT OF WAY LINE 0 M v \ ,--, 5 Or 8 3r +' -a ~ } cc Q u~ ~ 3 I = I cn. f ~ o zl w = I Qi O Y I ~ Z ~ i ~ 00 ~'- WI ~ I w O O ~ ~ ~ 1- Q~ -~I tn~ ZI o Z~ ~I N U I C}' U ~ ~ W N 2 N ~ Q r U w O w _Z J W H Z w d~ W Z W x W 0 W 2 J NNN 1.L O ~N~ W ~ ~z~ .~~ State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number ~ Document Name THIS DEED, made between SAFE-WAY BUS CO., a/k/a SAFEWAY BUS COMPANY INC. a!k/a SAFEWAY BUS COMPANY, a Minnesota corporation ("Grantor," whether one or more), and RMF PROPERTIES. LLC ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Part of the NE'/. of the NE'/. of Section 21, Township 29 NoRh, Range 19 West, Town of Hudson, St. Croix County, Wisconsin; llw~gpart'rof`Lots9 artd ltfogttte - R ,plat of 4t C~pjv inAnetriBl p rlr anrt parr of Lot 1 of Certified Survey Map in Volume 3, Page 715 described as follows: ~t`Z8~9srraY ~~~-2~.~@"f'iit Vol. 22, page 3~I-,~~Ie.~. SAFEWAY BUS CO~[PANY, INC. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, reservations, restrictions and rights-of--way of record, if any. Dated March a ~ 2007 (SEAL) AUTHENTICATION Signature(s) ~ffDa#s cS ~ a c' - authenticated on /~ a /~ ~ ` ~ c ~' 7 11 I ii""ii""'iiiii ~' ~11111111ii1111 f1 ~~~~ ~~~~~ * 8 4 7 3 2 5 847325 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECDRD 03129!2007 10:45AM WARRANTY DEED EXENPi t REC FEE: 11.00 TRANS FEE: 480.00 PAGES: 1 Name and Return Address sarry C. Lundeen MUDGE, PORTER, LUNDEEN & SEGURV, S.C. ! t0 Second Stroet Hudson Wl 54016 Parcel Identification Number (PIN) This is ~t homestead property. (is) (~ not) o2o-lzss-so-oso; o2o-t286-00.000; ozo-losa.zo-ooo V.President (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix COUNTY ) s (~ Personally came before me on Mazch 2007 , TITLE: ME STATE BAR OF WISCONSIN the above-named SAFEWAY BUS COMPANY, INC by Thomas Stiles and Jane Stiles-Wahoske (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Barry C. Lundeen Hudson WI 54016 Notary Public, State of Wisconsin My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not. necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFtCAT[ON5 TO TH[S FORM SHOULD BE CLEARLY IDENT[FIED. WARRANTY DEED m 2003 STATE BAR OF WISCONSIN FORM NO. I-2003 • Type name below signatures. toff