HomeMy WebLinkAbout020-1472-00-004 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
I INSPECTION REPORT Sanitary Permit No:
488291 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
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 Parcel Tax No:
Jannusch, Matt & Sharon I Hudson, Town of 0 - lq 430
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
G ST 22.29.19. Z
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ,•� CAPACITY STATION BS HI FS ELEV.
Septic y ty. St /tea Benchmark S. /D
— 1 �v a - 7 '
�esing Alt. BM / �/ � yZ
F Ike. r l 3.7—
Aeration Bldg. Se r 6
s'3 iai. q
Holding St/Ht Inlet L o 7
TANK SETBACK INFORMATION St/Ht Outlet (p, 57 /00.
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic i / Dt Bottom
7 Z5 27 25 7Z5 �.
Dosing Header /Man.
Aeration Dist. Pipe y7•
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION 5. 1dD •$
Manufacturer Demand St Cover g2
Model Num �W
16 , 4 4 . 3
i cA
TDH Lift Friction Loss System Head TDH t
/a.4 9co• 3
Forcemain Length Dist. to Well 77
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of�Tr PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS C'L Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION Type Of System- CHA MBER OR
em: G
C I./� _ Model Number J 4 f
a
r
DISTRIBUTION SYSTEM Sa, Z-3
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipes) \ � ` � a3(�offa.�+t
Length AD Dia Length Dia Spacing Q
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over i Depth Ps No
th Over xx Depth of xx Seeded /Sodded xx Mulche
Bed/Trench Center Bed/Trench Edges Topsoil \
Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: pending Germain Lane? Unknown (SE 1/4 SW 1/4 0 Unknown) Cedar Wins Estates Lot 4 ! Parcel No: 22.29.19.
1.) Alt BM Description
2.) Bldg sewer length = Z$
- amount of cover =
CO
Plan revision Required? Yes o /V
Use other side for additional information. ( 4 p
Date Insepctor's ignatu Cert . No
SBD -6710 (R.3/97) /
J
a an
Safety and gs ivision County �
201 W. Washingto 7162
Madis 1 537 o Sanitary Permit Number (to be filled in by Co.)
N visconsin ( log Sl yss z f
De artment of Commerce
Sanitary Permit Applic (' `, Plan LD. Number
In accord with Comm 93.21, Wis. Aden msaral Code, p on po7�' V / V
may be used for secondary purposes Privacy Law, sl 5.04(l xm) I roj Address (if different than mailing address)
1. Application Information - Please Print All In on PillQ�rl/�C( Gi'7
Property Owner's Name /�' I # Block #
/M/00 -� P"' .; , (7)
Property Owner's Mailing Addres � 0 � o � �� Section
City, State Zip Code Phone Number
T � N; R�E le o
If Type of Building (check all that apply) ale a� SubvN tl
n vtsicn Name CSM Number
1 or Family Dwelling - Number of Bedrooms �o �5�. r �Q••� 3 e�� , J �f � ����
C1 State C] Public/Commereial - Describe Use State Owned - Describe Use A 5� G�t <•J Z3 t' 2 L,r� r( ( ) I
a. 0 --� ❑City_❑Village,pl'ownship of i9 /l)
. C � I 3 G
111. Type of Permit: (Check only one box on line A. Complete dine B If applicable)
A Ne S ystem ❑ Replacement ys Rep System ❑ neahnmUHolding Tank Replacement Only ❑Other Modification to Existing System
B. ❑ Permit Renewal ❑Permit Revision ❑Change of ❑ Pamir Transfer to New
list Previous Permit Number and Date Issued
Before Expiration Plumber Owner
1V. Type of POWTS stem: Check all that apply) O a
AF Non - Pressurized k- Groumd ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized W- Ground ❑ Bolding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculat Synthetic Media Filter ❑ leaching Chamber ❑ Drip We ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis nal/llreatment Ares Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation
D
*7 ✓ S7 X90. Z 9s
V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Cfallons of Units Concrete Constructed Glass
T dr. rTank$ yam, w L Ue
�pr �• Hn�T 4 f��(/
Aerobic Treatment Unk
Doming Chamber
VU. Responsibility Statement - 1, the undersiped, assnwe nplZmilibility for installation of the POWTS shown on the attached plam
Plumber's Name (Print) P 's 3i MP/MPRS Number Business Phone Number
L �� -'/39 6 x- 1 - 71r- zTs= z bW
Plumber's Address (street, City, State, Zip )
S"b0 9' ?O
V Conn /De partment Use
X Approved ❑ Dis gse Sanitary Permit Fee (includes Groundwater Date Issued
❑ O' an A Fee)
1X. Conditions of Approval/Reasons for Disapproval '7
SYSTEM OWNER:
1. Septic tank, effluent filter and
dispersal cell must all bit seryk4n / makrtai W
as per management plan provided by pkxttbar.
2. All setback requirements must be makftakfsd
as Per applicable code / ordinances.
Attack eomptete plans (to the County only) for the system on paper not kas than 81/3 s 11 laeha In size
SBD -6398 (R. 01/03)
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E. C, 2005
Wisconsin Depa omme {L E ALUATION REPORT Page of
Division of Safety and Buildings ST. CROIX COL7f�Tf
ccordance ' Wis. Adm. Code County
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Re �'w�b Date >7
Personal information you provide maybe used for secondary purposes (Privacy Law, s. IS-u4 (1) (m)).
Property Owner Property Loc -fig.•
Govt. Lot 114 /4 S 2 ;�,T C N R � E (o C
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
��' � s eJ
City State Zip Code Phone Number City Village Town Nearest Road
L New Construction Use Residential /Number of bedrooms -- Code derived design flow rate Yet > GPD
❑ Replacement ❑ Public or commercial - Describe: - - - -- -
Parent material Flood Plain elevation if applicable -� —v - - - -- ft
General oo ti ons: a
and recom �
M � # ❑ Boring o Pit Ground surface elev. ft. Depth to limiting factor in• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Mun ss ell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
All
a a
a Boring # ❑ Boring
it Ground surface elev. ft. Depth to limiting factor �a Sal plication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2
4-1 DU r 3z r re r C- -S
w
kt—
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD _< 30 mglL and TSS < 30 mglL
CST Nine (Please Print) re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Date Evaluation Conducted Telephone Number
Address 715- 246 -4516
1008 192nd Ave, New Richmond, WI 54017 — —
Property Owner _ Parcel ID # Page of
❑ Boring
Boring # Soil Appl ication Rate
a Spit Ground surface elev. fl / �ft. Depth to limiting factor _ �•
Boundary Roots
GPDAf
Texture S t ruc t ure Consistence rY
Horizon Depth Dominant Color Redox Des cription '
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 Eff#2
1 r��� �3 a � �✓ �5 y
2, 11 I- 33
5
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor In. $pjl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 'Eft#2
Boring Boring # 0
❑ Pit Ground surface elev. ft. Depth to limiting factor in- Sod Application Rate.
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
Effluent #1 = BOD, > 30 220 mglt, and TSS >30 5 150 mglL ` Effluent #2 = BOD < 30 mgll. and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
SOD -8330 (RAMO)
r
Soil Test Plot Plan
Project Name Dave Alwin Shy( O rd
Address 413 6th St. N /
Hudson Wi 54016 TM #226900
Lot 4 Subdivision Cedar Win's Estates Date 12/12/05
SE 1/4 S W 1/4S 22 T 2 9 N /R W Township Hudson
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe 5" above grade
System Elevation 98.2/97.7 *HRP Same asBenchmark
Alternate Benchmark Top of 1/2" pipe 5" above grade @ 100.0'
575' Property Line
Scale is 1" = 40'
unless otherwise
noted
40' B -3 103'
30'
101'
B -1 85 ' B -2 i
Germain Way 8% Slope
15' ,�
B.M. is 150' 334' Property Line
t
2�
I
o DD 040 00G'1
I
LOT 2 I
2.61 AC. / d °
\ yea- &&0990 I LOT 3
MM 0 0 2.71 AC. /
�44p4�3 i.ea.- 009.90
LOT 1
3.39 AC. \
LOT 4
2.35 AC.
60
looms
— - - -- _?o - - - -- _
= T a 3
\ \ �\. �\ 4004 �R
N 211 oR,wAGE EA541EIR
\ �� LOT 5
2.18 AC.
LOT - - - - --
2.01AC.
LOT 8
2.66 AC. `
Laa —saaso
4Q4@3 --- - aaw0� sRF1101E —�__ —_LOT
L.B.0.�1610
7 �� aaTn9E aR�saaE a0O4 2
MO-915.10 100 YR 1RRr91&00 ML-914.00 100 YR FROM L -914.00 I
LAM-916,00
DontEmm
/aYRmR. -91&10 600496.3. O0
&1 C�.900s
L&a-910
I
� i i d004 9
REMOVE E)GSTING DRIVEWAY
CONNECTION TO BADLANDS
ROAD NO
0 40
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of
FILE INFORM SYSTEM SPECIFICATIONS
Owner v- i j/sC� Septic Tank Capacity /�j�'!D a l O NA
Permit # Septic Tank Manufacturer 4AW17- ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer & 0 ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ieewab Fr
Number of Public Facility Units . MA Pump Tank Capacity a l . -B-MA
Estimated flow (average) 00 gal/day Pump Tank Manufacturer ,,.99-NA
Design flow (peak), (Estimated x 1.5) �DD g al/day Pump Manufacturer - - !I NA
Soil Application Rate 7 al /da /ft2 Pump Model .AB" NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit _'1aA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD <_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L Akn Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) :510' cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month(s)
Inspect condition of tank(s) At least once every: ;:21T 1 y ear(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: Pep 3 O month(s) (Maximum 3 years) ❑ NA
year(s)
Clean effluent filter At least once every: ❑ month(s) 4Z ❑ NA
A• ear(s)
Inspect um y . ❑ month(s) NA
Ins
p pump, pump controls & alarm At least once ever ❑ year(s)
Flush laterals and pressure test At least once every: O month(s) NA
❑year(s)
Other: At least once every: ❑ month(s) NA
O year(s)
Other: NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tanl
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondinj
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires th
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entin
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmen
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS MWntainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
a '
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal c@II(s). , If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacement system:
4K A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
• Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name � L,� Name
Phone ?r' - Z3 r Z4 �{ Phone
SEPTAGE SERVICING OPERA O (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name `J+. GTo e Go,;
Phone 9 /6W AE� Phone - 715 - 39-(r – !. 66,;0
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST CROIX COUNT
SEPTIC TANK MAINTENANCE AGREEMENT
AND
0 CERTIFICATION FORM
O w nerrBuyer — m a y au rl 0 h SGh
Mailing Address
,
Property Address LIeD -f• C eel arr 6) l ris fafes er Y7� i h
(Vcufscation required from Planning Department for new construction) r� r e'�
City/State � i�9 LgQ , -- .--- -- Fazee3 Identification Num I; _
1 aAL REACRIPTIM ��, ,
Property Location_ ` %,
, '!, Sec. -, T.c -N - R 1j _OY�Town of
}. � �� ,Lot #
Subdivision CAL V-
Certified Survey MAP # Volume Page #
Warranty Deed #
99 (n 9 9 , Volume _..._�.- - past #
Spec house O yes X no Lot lines identifiable'6 yes L ro
Improper use and uiaintenanceof your septi:. system could r if n eded by a licensed gumpor�dWhat you put the urn
consists of Pumping out � septic • every three years or So n ,
can affect the ft=tion of the septic tank as a treatment stage in the waste disposal System.
St. C Zouing
The pmgerry owner agrees to submit to D e u v erit�+ing that (1) the an -st wastewaherd a sc
msstcr plumbs:, journeyman plumbsr, rae5rictod pluaibaa or a lice p P
e septic tank is lass than 2/3 full of sludge•
is in groper operating condition and/or (2) after insptctioa and pumping (if uet;eESary), tin
I1we, the undersigned have read the above requirements and agree to maintain the � Pri i v to 50v ¢cs�State of y Wts � sin + Certifi ati a
Set forth, herein, u set by the Depattmcttt of Commerce and the Department of Na
stating hat your septic system has beau maittained must be completed and returned to the St. Croix County Zoning office within 30
days the three expiration date.
DATE
S GNA F APPLICANT
OWNER MTTFICAMN
Y (we) car* that all etatenieats on this form are true to t:ie best of my ( knowledge. I (we) am (are) the owMer(s) of
the roperty do ribod a ve, vims of a warranty deed recorded in Register of Deeds Office.
DATE
SIONATURE OF I:ICA1c
*00000 Any information that is mis- topresented may result in the Aanitary permit being revoked by the Zoning Department.
•" include W10 this app "tion. a stampod warranty deed from the Register of Deeds office
he waaanry deed
1 reference is ma
'tied serve ma t.
a cop of the cent � P
P
6'`9699
KATHLEEN H. WALSH
REGISTER OF DEEDS
State Bar of Wisconsin Form 1 -2003 ST. CROIX CO., WI
WARRANTY DEED RECEIVED FOR RECORD
Document Number Document Name
07/17/2006 10:00AH
WARRANTY DEED
EXEMPT I
THIS DEED, made between ALWIN CHILDREN, LLC, a Wisconsin limited
REC FEE: 11.00
liability company TRANS FEE: 345.00
("Grantor," whether one or more), COPY FEE:
and MATTHEW A. JANNUSCH and SHARON M. JANNUSCH, husband and CC FEE:
wife as survivorship marital property PAGES: 1
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address
needed, please attach addendum): 0.F Seguin
MU OR NDEEN & SEGUIN, S.C.
Lot 4, Plat of CedarWin's Estates in the Town of Hudson, St. Croix County, t to Sec
Wisconsin. H on WI 54016 u
1
020 - 1059 -20 -000; 30-050; 65 -000 & 020 -1060- 20-000
Parcel identification Number (PIN)
This is not homestead property.
(is) (is not)
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 July /L� 2006
AL LLC
(SEAL � (SEAL)
* * David D. win N\ _ Q y ,/-
(SEAL (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
authenticated on
• St. Croix COUNTY )
* Personally came before me on July /4 2006 ,
the above -named ALWIN CHILDREN, LLC, by David D.
TITLE: MEMBER STATE BAR OF WISCONSIN AlWm 0 �� m 15x
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument anda cknowled d the same.
:i�i THIS INSTRUMENT DRAFTED BY: P SCQUIN
* Nt7TAFlY PUOUC
Attorney D. Peter Seguin Notary Public, State o isconsin■
Hudson WI 54016 My Commission (is permanent) (aqvirec: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
" Type name below signatures.
1 of 1
LOT 13 ° PLAT OF PHEASA
RUN FORT ADDITOOK
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