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HomeMy WebLinkAbout020-1372-05-000 (3)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and 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 ^ TaTwn of: Miller, Sam Hudson Township CST BMElev.:- o Insp. BM Elev.: . 2J ` BM Description: C s~"r3 wc`~`2. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ (ZSt7 Dosing Aeration Holding TA>~SETBACK INFORMATION TANK TO P! L WELL BLDG. vent to Air Intake ROAD Septic }S'O ` as" ~ ~---, NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manu urer Demand Model Number GPM TDH Lift L ~ tion tem TDH Ft Force n Length Dld. Dist. To ELEVATION DATA of s County: St. Croix Sanitary Permit No.: 363933 State Plan ID No.: ~~ Parcel Tax No.: 020-132-OS=~ STATION BS HI FS ELEV. Ben .~p loS•9 lUO -D /~ ht Bldg. Sewer `t• 3 5 1(, •~~ St/Ht Inlet ~r`8Z, •o8r St/ Ht Outlet /a.13 ~} I l D n t et -~ Dt Bottom Header /Man. lQ, 9L ~~ q8 ` Dist. Pipe ~ ~~ . ~ q pr Bot. System s • 9s ~ • 00 43.9s o r Fin Grade 9- ~o ~ o S i (o•2O ~ . ~o SOIL A~$~PTION SYSTEM~i2,~..~2~,,,,,,`,b,uc, ,e~,~ ~~ ~®. Width ~ 3 Lengg,th i No Qf enches PIT No. Of Pits Inside Dia. Li ui h DIME I N -t'S ;Z, DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact r ~ $ ~ ~ SETBACK ,,,~~ ~° c " - " INFORMATION Type O ~ ~- ~ ~"~ CHAMBER Model Num er: System: J . y~ OR UNIT DISTRIBUTION SYSTEM Header / ni old ~r Dist ibution Pip x Hole Size x Hole Spacing Vent To Air Intake Lengt ~ Dia. Dia. Spacing ~ I ~ t 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 ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: eB / I~ /°'° Inspection #2: / / Location: 536 Raider Drive Hudson, WI 54016 (NE 1/4 SW 1/4 21 T29N R19W) - Raider Estates -Lot 5 ~ g 1.) Alt BM Description = ~'1>'f''~ {`"~`- °e1e~ • 3 -~ 2.) Bldg sewer length = -~- zS•o ~ ~y -amount of cover = ? 18 " Ste- c,e+~ Plan revision required? ^ Yes ~ No Use other side for additional information. SBD-6710 (R.3/97) O~ 1 o aD C~~w•.• ~ Z f!o Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~~ ~... _ i :. ~.... I , ~ 5~b t~,a-/per 0~_ `~SC011S%11 SANITARY PERMIT APPLICATION Department of Commerce In accord with Comm 83.05, W' e 1 • Attach complete plans (to the county copy only) for the sys ~ ;~ pap~r~not le than 8 to x 11 inches in size. ,~ ~C~~~ • See reverse side for instructions for completing this app! a~i n J~~ EQ Personal information you provide may be used for secondary purposes ~~ ~ n iPrivacv Law. s 15 04 [1) (m)l ~ S~ Co.. Z~OA Safety and Buildings Division 201 W. Washington Avenue POBox7162 Madison, WI 53707-7162 unt ~' Ceai Sanitary Permit Number 36 3 ~ 3.3 C k if revision to previous application .. Al, ,...I~sr "M~ - e-... .-... ..~..-_. ..~.._-___.. I. APP 1 ATI N INFORMATION -PLEA E PRINT ALL N Prope Owner Name ;~ l~ Prop oc Z' T Zy rN~R~~ E( W Prope y Owner's Mailing Address ~ Block Number 't..-. City, Sta a ~ o W Zip Coe Pon Number (~~> z 9' Subdivision Name or CSM Number ADD ~. sT T~ II. TYPE F B ILDING: (check one) ^ State Owned ^ !t ^ village 1~U~~N Nearest Road (A ~a '~ b~~~ Public 1 or 2 Famil Dwellin - No. of bedrooms Town oFf1 I III. BUILDING SE: (If building type is public, check ~alyl that agpply)r~ ~/~ Parcel Tax Number(s) ~ /~~ ~ ~ 65 ~~ ~~ . ° I - ~ i . O~"/~ J ~ Q W I 1 ^ Apartment/ Condo 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/ Repairs 11 ^ Restaurant/ Bar/ Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash S ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1, ~w 2. ^ Replacement 3. ^ Replacement of 4_ ^ Reconnection of S. ^ Repair of an ________stem ________System _____________ TankOnly______________ Existing System ________ Exlsting5ystem B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 Seepage TrenchLElaGN 22 ^ In-Ground Pres t~e a X3' ~ 42 ^ Pit Privy 'C~~~b X 7 S ~ ~~ ~ll V l P i Q ` r vy 43 ^ au t 13 Seepage Pit 14 ^ System-In-Fill p~ ~ ~~2 ~~~. ~~~ F~c i'4- VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Env. 7. Final Grade /~ Required (sq. ft.) Proposed (sq. ft.) (Galsldaylsq. ft.) (Min.linch) Elevatiory ~~ ~ ~ ~ ~t ~ C.. 1 ~ 4 e ~ -- • Feet 7r s Feet VII. TANK INFORMATION Capacft in allo s Total ll # of k Manufacturer s Name Prefab. Site Steel Fiber- Plastic Exper. N i i E Ga ons Tan s Concrete u~t glass App ew x st n st ed Tanks Tanks eptic Tan r Holding Tank ~Q ~ ~~ ~ ^ ^ ^ ^ ^ Lift Pump Tank !Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) 1K~ Iltt,-`~~X~L~- Plum~er's Si natur o Stam ) MP/MPRSW No.: z~~~ 3~0 Business Phone Number: 3 S~-8'~9' Plim~b ~ ~ dre;s_(Street, Cit , State, Zp i tie): ~ ~ ~ n ~ ~ Q S O w~ ~ `~ Y V l ~ ~ /DEPARTMENT U IX. COUNT SE ONLY ^ Disapproved Sanitary Permit Fee llncludesGroundwater ate slue Issuing Agent Sign ture (No Stamps) ®Approved ^ Owner Given Initial Surcharge Fee) ~ ~ (, Adverse Determination ~~ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber . ~ INSTRUCTIONS 1. A sanitary permit is valid for two (2) years: r , ,__ ~ 2. Your sanitary permit'may 15e renewed before.#.he`expiration ~~te, and at a time of renewal any new criteria in the Wisconsin Administrative Code willbe applicable. ,.~ ;y R:, 3. All revisions to this permit mustbe approved by thepermit issuing authority. 4. Changes in-ownership or plumber requires a Sarbt~~~errnit Tiansfer/Renewal Form (SBD-6399) to be submitted to the county prior to installation " 5. Onsite sewage systems must be properly, rr'j~rttained.. T~he'septic tank(s) must be pumped by a licensed pumper whenever. necessary, usually every 2 to 3 years. -- ' 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name~and~mailing address. Provide the legal descriptiorrand parcel tax number(s) of where the system is to oe installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for a!1 septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. •~ IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 1 15 form; and F) all sizing information. GR®UNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ,, ~~f~~r ~'lrtc.~~ r~A~pE,e F-~~~~~. ~" ;~ ~, ~. ~ ~ ~ Ems.... '~4~, w ~, a ~~ ~' ,I/// ! ~(/ ~~~J /'./ ..- z~6, n ~' 107- J- v r ~'a ~.. ~ L1 ~'' ~ '~ w i ~ '.i ~ / ~~~',~ J ~ ~~ (~% 51G, ~ ~- ~~' ~ - r ~ ~ _• ~.-, ! - ` ~ ~, ~ ~ e' ' 3i ~. { h i B~ ,/-r-~3~tl~i, -f oP o~ D h F i'ti1 ~ to ~ Lo"r S7i} KE ~ ~. _ loa.do' ~-~-~. l~,cAtF i>y''_ ~~ , S y~T~~ll ~!= 93, So. ~~~ ~~~~ . ~•• ` 11 ~. ~ J •_ `~ ~ ~ q ~ ~ `~`~~,, ~~ ?~ 3 ~+• S v -- ~ ~ N ~, ~ .~ ~ V A, ' --.. `~- I . .~, ~• `~'~ . ~~ ~ W: O .- Z °' -- ~ a~ ~ . W~a U ~ 0 (~ _ ~~ rn f- C/~ U u' ~. _ .~ ~•~-~~ ~ r ~ (h E ::. N .. ~ ,v ~ M X (p ~ ~ ~ N ~ Cl O r' '- cti M N O O N a ~ g. ~ c ~ 3 ~~F~cCo O •O- v i ~ ~°~om ~ ~ N ~ o~ o ~ >n- rn x n , c ~ ~ c c~N;~~~rno ~ X . c~ m O O C U C ~ ~ : •; C ~ . : O ~ J N lL ~ ~ r= U~ Rl U N v~ > ~ a ~cn~~ ~ • • • ~o ®® ~ ~ ®® a ~~ a ~ W ~ N W ~~ ~ 0 ~~ ~ / O .. U r' a pV 2G a a ~ ~ c ~ © • U "~ t ~. l ~ Z ~~ • .gigg 3 O ~ td ~ .O ~ ~ rn U, E • . $ °~ ~ p~ ~~ .~ ~., .., ~ • . a ~ ~ ~, ,~ «~ .. .. a s" ~~ s i {~~ !; D~ ~~ ~~ ~~ ~~ ~pp~ t~ ~~ ~~ ~• ~~ ~~ ~L ~~ ~~ ~~ ~~ ~~ ., ~? h-- `° ~ Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code AC.E. Soil & Site Evaluations Attach canplete site plan on paper nd less than 8%Z x 11 inches in size. Plan must include, but not limited to: vertical and horizontal r~erence point (BM), direction and County St. Croix percer-t slope, scale or dimemsiais, north arrow and distance to nearest mad. parcel I.D.# APPLICANT INFORMAT~N - .~I~asep~nt~att.frtfQ anon. 020-1055-60-000 ID# 21.29.19.206A Personal information you provide maybe used ftx~secon urposes ~k'ri~Yaoy `Law, s. 15.04 (1) (m)). viewed By Date Property Owner '? ~v r -~^~ Property Locates Miller, Sam _, ~ ` '~ Govt. Lot NE 114 SW 1/4 S 21 T 29 N,R 19 W Property Owners Mailing Address ; : ~ '`~ ~`-' "~ - Lot # Block # Subd. Name or CSM# P.O. Box 151 X ' - :~+~ i 5 Plat Of Raider Estates City ~tate ' Zip Code'.' r f ^ City ^ Village ^Town Nearest Road Hudson Vr~I 54013~~' 86-2~~9 Hudson ~ R aider Drive ^ New Construction ^ Reskiential f tduatde~tf bedrooms 4 ^Addition to existing building ^ Replacement Use: ^ Publir; or c~rttrrtercial describe y Code Derived dail flow 600 /ft2 gpd Recommended design loading ra#e .7 bed, gpd •8 ~~~ 9P~ Absorption area required 857 bed, ft~ 750 trench, ft2 Maximum design loading rate .7 bed, gpd/flz •8 trench, 9P~ Recommended infiltration surface elevation(s) 93.50' ft (as referred to site plan benchmark) Additional design I Site considerations ~~ trenches using high capacity infiltrators. Parent material Gl~ial outwash Fkxxt ain e~vation, if icable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Hokfing Tank U=Unsuitable for system ®S ^ u ®S ^ u ®S ^ U ®S ^ u ^ S ®u ^ S ® u Boring# 1 Ground elev on~ra Depth to limiting factor >106" 2 Ground elev 96.81' ft Deptlt to limiting factor >105' Depth Dominant Cokx Mottles Structure i t C B da Roots ~~ Horizon in. Munsell ~. Sz. Cont Cokx Texture ~. ~. Sh. en ons s oun ry Bed ~, Trench 1 0-11. 10yr4/2 None sl 2fsbk mvfr as 2f,lm 0.5 0.6 2 11-22 10yr4/4 None is Osg ml cs 2flm 0.7 ~ 0.8 3 22-86 10yr5/4 None s Osg dl gs - 0.7 0.8 4 86-106 10yr6/4 None s Osg dl - - 0.7 0.8 arf' T~.Sfl S$•YY 9Y•Y~/ Remarks: 1 0-10 10yr4/2 None sl 2fsbk mvfr as . 2f,lm 0.5 0.6 2 10-16 10yr4/4 None is Osg ml cs 2flm 0.7 ~ 0.8 3 16-75 10yr5/4 None s Osg dl gs - 0.7 0.8 4 75-105 10yr6/4 None s Osg dl - - 0.7 0.8 R.~2 ,~' Remarks: CST Name {Please Print) Signatu Telephone No. James K. Thompson 715-248-7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake lane, Osceola, 54020 4/19/00 3602 1199 PROPERTY OYVNER: Miller, Sam PARCEL I.D.# 020-1055-60-000 ID# 21.29.19.206A Ground elev 97.72' ft Depth to limiting factor > 103' SOIL DESCRIPTION REPORT piss page 2 of 3 A (R Snil ~ Site F.valoations Honzon D~th in. Dorrtklant Color Munsetl Mottles Qu. Sz Cont Cokx Texhlre Strllc~ilre ~. ~ ~. s~s6ence t3oundary Rods GPI T-_____.. -_ Bed ~ Trench 1 2 3 0-7 7-15 15-70 10yr4/2 10yr4/4 10yr5/4 None None None sl Is s 2fsbk Osg Osg mvfr ml dl as cs gs 2f,lm Zf,lm - 0.5 0.6 0.7 0.8 0.7 ~ 0.8 4 70-103 10yr6/4 None s Osg dl - - 0.7 0.8 • ~Y .6 Remarks: 4 Ground elev on ~a~ e Depth to limiting factor >107' 5 Ground elev 100.02 ft Depth to limiting factor >102" 1 0-8 10yr4/2 None sl 2fsbk mvfr as 2f,lm 0.5 ~ 0.6 2 8-12 10yr4/4 None is Osg ml cs 2flm 0.7 0.8 3 12-72 10yr5/4 None s Osg dl gs - 0.7 ~ 0.8 4 72-107 10yr6/4 Nane s Osg dl - - 0.7 0.8 Remarks: 1 0-10 10yr4/2 None sl 2fsbk mvfr as 2f,lm 0.5 ~ 0.6 2 10-21 10yr4/4 None sl 2msbk mfr as 2f,lm 0.5 0.6 3 21-26 10yr4/4 None is Osg dl cs - 0.7 '~ 0.8 4 5 26-80 80-102 10yr5/4 10yr6/4 None None s s Osg Osg dl dl gs - - - 0.7 0.8 0.7 ~ 0.8 Remarks: Ground elev Depth to limiting factor Uw~-.e. r: Sarn ~'I,'/%r- h~u-elao~, u71. SYo/G / ., n ., l :~ ., . ~~S Pla.~ °~'~a~alQ~E~~eS .'I E`'Y~ wiy 5 e c, z ~, T. ,29 rf., 1 ~, I ~-~G, oP ` Q-~. ~.//1. ~ Tod of lob 5~e. C/eV: = SAO.&7 z~98~, ~, 30'3 ~ ^ Soy / O6Se/'da-~/or> ~,"b • 5o c~~ Pro~o• ~~ ~. h ~ v'1 a ~ ~ ~ `{.1 V ~ v ~ a q ^^d.. lL ~`~ W 62 s/~ y1 Q~ /t~ nc.1~ yY~,l~: Toi'0 of /Ot ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~~ ~ ~ ~ ~~'--- Mailing Address t~ ~~ ~ / -s Property Address 5 3 ~ ~ ~' ~ ~ ~ fl ~ ~ ~ (Verification required from Planning Department for new construction) City/State ~~U D S ~ N W ~ Pazcel Identification Number ~~n~1-!~l~-~ LEGAL DESCRIPTION Property Location ~ '/., 5 ~'/4, Sec. Z ~ , T 2'9 N-~~~Town of ~ y ~ ~ ~ . Subdivision T~ ~ ~ ~ ~ S~~ r ~--5 Lot # ~~. Ce ~ o ~ ey M~a~, # Volume ~ ,Page # Warranty Deed # ~ ~ ? S 3 ,Volume ~ S~ Page # Spec house yes ^ no Lot lines identifiable yes ^ no SYSTE 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 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 standazds 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 da a three year expiry ' te. ~ ~~~ / ~ ATURE APPLICANT DATE OWNER CERTIFICATION I (we} certify that all statements on this foiYn are true to the best of my (our) knowledge. I (we} am (are) the owner(s) of the property d cribed above, y virtue of a warranty deed recorded in Register of Deeds Office. co /Z~ UCH t ATURE O APP CANT 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 1 CQi"t.;~.~cr,T N!1. tl 'NAi;ii."-..: i Y uEE~ ~ Y~~ ~458~~~,~ 65 ~ EXCEPT parcel conveyed to Donald !_. Johnson in 'volume 500, pagen525; and EXCEPT parcel conveyed to Dc^ald R. Jordan in Volume 580, page 354; and EXCEPT parcel platted as we!`s cargo Sta*_ior, in ti'olurr_ S of Plats, page 89, as Document A478658, ALL in __ction 21 (21 ), Township Twenty-nine (29) North, Range Nineteen (19) West, T,~wn of Hudson, St. Croi>c County, Wisconsin. The East Half (Ela) of the Southwest Quarter (S'My) EXCEPT parcel Taz Parcel No: ~Q.~~D,~o~~~ conveyed to Alfryd L. Ekblad in '.al:sne 498 y ~~ ~~~~~~"~'~'""' page 484; and EXCEPT ~i^~ /O~ 6 ~ parcel conveyed to Leslie L. Swc^son in Volume 498 pa a 504• d 6 1 07 5 KA I ;iL.EEH H. WALSH hEGi.~+Ek OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09-22-1399 A:30 AM iiARRANTT QEED EXEMDT N CERT CODS FEE: COFY FEE: TRANSFER FEE: A17.50 RECtSR4ING FEE: 14.00 PAGES: 1 . .... ........................_ _.......... ncr nw t ........., .. .. .. ... .... ....... v ................ fF~ ................................................................... . tl:o tolluwin~ descril,ed rc:ll estate in ..... 5,1<,,.Croi z ..County, - ............... ............ State of Wiscunain: Subject to unrecorded agreement sated October 11, 1491 by and between Donald R. Jordan, Cail Gordan, John A. Elbert and Eric J. Lundeit regarding fu*_ure land transfers and roadway conveyances. Subject to covenants, conditions, -estrictions and ease~rents created by preliminary plat of Nells Fargo Station First Addition. Subject to easements, restrict9:,s, -eservations, and r+;hts-of-way of record, if any TLis ....... ~.S..not........... `:^~estcad property:. (Ndq (is nol) F:zcep!inn to warranties: As ^oted above Oatc4 this .. ....,...20th ..._.......... _ ..... .. Jay ~: . ... ........................... (~'~AL) AUTHENTICATION Signnturo(s) .......................................... u.. ....... - __.. TITLE: AIG~t13E[2 S'CATE IIAZ ^F'.Vl~^?`.!:: (If not . ...........................•- .......... . authorized by 6 70G.OG, W:s. ,~'.:aU.l • THIS iN$TRUMENT `N.>.^. ;;i»F-'E:7 BY' -... Hur+_bird land Corporati•..n ............................. ... ... (Signnturca may t:c nuts:cnti°a'; i ackao~c4. ~1;•..' a:. . sec not r.eee=sa:v.) August.... .............. 99 ....................... 19... HUMBIRD LAND CORPORATION .•-..(SEAL) bY. ~ .. Austin J. Baillon, Its President _..._ .. ............................................(SEAL) ......................................... I ACKNOWLEDGMENT ,. STAPE OF lY(DB4E9YISIlo MINNESOT ss. ' Ramsey ...................County. I „;onai:y •:.,mc buioaro me tuffs ... 20th•.-,..day ui August........ ......... , 1:'39.... the above unmed ..... . Austin J. Baillon President of '~r:nbic4 .Lan,d..Cnrpnratinn ......................... . r ;c roc known to t:e _l;e arson who t.xecuted the P ............ iurc~oir.•: ir,st-ununt'lnc a.cis,ww(eub~aft,)te,,~ztuRti,~~~ti,,ti..., ,.. ...,~ -.Paul A. 3~,i1,)rn. ~, --° '~-:' •~:~'v000;JTY ~.~:, , hla ~'ashirgtdrr" `T:Abwt4,X`AK-S;~ N ~1~ ::ol l ..;:n~ g ne.mnr.cat(It not, state ezi~irntion /Dp` 1 ~ I m`~~ q i ; 1 ~ .~~~ ~~ 7 ~ I I 1 ~ ~~ ~~KL ~ ,LL.LG60 S I ... ~ ~ 1 -~ I ~~ I ~ ~\ I l l ` 1 -r t ~ y• 0 `~ \ ,ter ,•~ ~ ~ h~ d ~s~s o ~ ~~~ ~ ~ ~~t~ ~'6 73 QS Q ~tt~~ ~ ~~M ~$ 4 [ A s Y f4f` , C ~Q~ 4 • -- III" I I I I '' I I ,; I I ~, ~ ~ ' ~' ~ •'b`a!. ~ I I. \``` ~ I<I I I I l i l i l kl i ~y ^ I ~~ ,`` ?~ i `'- V a - ~~\~\ I \~I`I I I T~ I ~ i,~+~ ~?' ..r~ r~ ~ ~ ~I a FA `:?F ~ ;umi ~ ~ 1 i ~ ~v.I , ~~ ~ I ~ I=I ~ . 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