Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1292-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division * INSPECTION REPORT Sanitary Permit No: 463173 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: Heikkinen, Paul I Hudson Township 020 - 1292 -50 -000 CST BM Elev: Insp. BM Elev: BM Description. / M Section/Town /Range /Map No: 7 f 27.29.19.1442 I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic A eratioiY Bldg. Sewer Holding St/Ht Inlet Zr� �, TANK SETBACK INFORMATION St/Ht Outlet / 9S*- t TANK TO P/L W BLDG. Vent to Air Intake ROAD Dt Inlet r _ Septic / /� t . Dt Bottom v--- g � ' 7 r ) 5 v > 2,o Bader/ �� a Aerati Dist. Pipe / � — p _ Holding Bot. System 1 Final Grade PUMP /SIPHON INFORMATION 3• S �I _ o� Manufacturer Demand St cover / w cl `T Model Number TDH Lift Friction Loss yste ad TDH Ft Forcemain Length Dia. I Dist. to Well SOIL ABSORPTION SYSTEM —� BEDITRENCH Width Len / No. Of Tre PIT DI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS x SETBACK SYSTEM TO l/ P/L BLDG WELL LAKE /STREAM ACHING Man r LL' I . INFORMATION C MBER O 70 Type Of System: / o � Model Number. s IBUTION SYSTEM Hea er anifold Distribution Tole Size I x Hole Spacing lVent to Air Intake Pipe(s) (1nn 3 Length is Lengt Dia Spacing 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 FA, L] No [ I Yes [ , No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / (� /� Inspection #2: Location: 773 Hillfarm Road Hudson, WI 54016 (SE 1/4 NE 1/4 27 T29N R19W) HumbiirrdHills Lot 16 Parcel No: 27.29.19.1442 1.) Alt BM Description 2.) Bldg Bldg sewer length - amount of cover = I ' dn— - - -- - 1� - _ Plan revision Required? Use other side for additional information. No � se SBD -6710 (R.3/97) Date Inpctor's Sign I Cert. No. D RECEIVED o p p OCT 2 9 2004 ST. CROIX COUNTY ZONING OFFICE Safety and Buildings Division County 1*ksc 201 W. Washington Ave., P.O. Box 7082 t 1 onsin Madison, WI 53707 - 7082 Sanitary Permit Mutnber (to be filled in by Co.) De artment of Commerce (608) 261.6546 L k 1 3 1 3-3 Sanitary Permit Application State Plan I.D. Number In accord with Comm 8321, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address (if differeml than mailing address) r� I. Application Information - Please Print All Information a -�►ti- pro Owner': ame f Parcel N Lot N Block N Property Owner's Mailing Address Property Location ! 7 73 J14 -4%1J�. City, State Zip Code Phone Number` Section L`'� .Z S V0 (o rs-- eucle IL Type of Building (check all that apply) T N; R�E o- A, or 2 Family Dwelling - Number of Bedrooms Ll Subdivision Name CSM Njuber f ❑ PubkXommercial -Describe U , ❑ State Owned - Describe Use ❑City ❑Vi lag ownship oC wgg III. Type of Permit: (Check only one box on line A. Complete line B If applicabl) v Z 1,4A, �4��A "I ) A ❑ New S ten ys � Replacement System ❑ TreatmentlHolding Tank Replacement Only ❑Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 0 — lZ 2 50 ^ j 0 4 - 4on - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < m of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Consmicted Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculatin S thetic Media Filter Leachin Chamber ❑ Dri Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/rreatment Area Information: Design Flow (gpd) Design Soil Applicatio n Rate(gpdsf) Dispersal Area Required (sf) Dis Area Propos System EI -7 600 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S eel i Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or HoldinN Tank Aerobic Treatment Unit losing chamber VII. Res onsibilIty Statement- I, the undersigned, assume responsibility for In tallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum s S' ature P PRS Number Business Phone Number 0 3s hi G 9 Plumber's Address (Street, City, State, Z• Code) // A/ / .-�� Ott VII I. Coun /De artment Use Onl I pproved ❑Disapproved Sanitary Permit F (includes Groundwater ate Issued lss ing ent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial b . D Z ZtJD IX. Co TfMQN(IlEO.Reasons for Disapproval 3� S�S �• 7 Septic tank, u filter and t �p�� dispersal cell l M must st a.� '�'� ail be serviced J maintained `Y' �` r ( , -- ,� _ n J as per management plan provided by plurrlber. �� t S '6 6-- a CL6_ 2. All setback requirements must be maintained as per applicable code /ordinances. ® 131-Y 7 fv 9l - 0 773 1 boo 7 a/ 3 /� 1 o o, �Co T � - r -a x r -1 T3 O x d� V x � 1576 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. Attach complete site plan on paper not less than 8'% x 11 inches inV&n must C ounty St. Croix include, but not limited to: vertical and horizontal reference point (B n and percent slope, scale or dimensions, north arrow, and location and t rgad. Parcel I.D. [ //! 020 1292 50 Please R ewed By Date Personal information you provide me be usedR 11 aoy s. 15.04 0 Property Owner Property Location Heikkinen, Paul UL 1 1 8 2004 Govt. Lot na SE 1/4 NE 1/4 S 27 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 773 Hill Farm Rd ST. CROIX COUNTY 16 na Humbird Hills City Sta J City I Village 1jM Town Nearest Road Hudson WI 54016 715 - 386 -1416 Hudson I Old Hill Rd J New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 01 Replacement _{ Public or commercial - Describe: Parent material outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, sytem elevation 91.70ft. Trenches spaced and depth to code rL- below grade. 69 /(DS Boring # I Boring 0 Pit Ground Surface elev. 97.45 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -13 10yr3/3 none sil 2msbk dfr cs 2f .6 .8 2 13 -39 10yr4/4 none sicl 2msbk dfr cs 1f .4 .6 3 39 -60 7.5yr4/4 none SIAS 2msbk dfr cs na .6 1.0 4 60 -120 7.5yr4/6 none ms osg ml na na .7 1.6 6 S7• J-G //0/. 9 /� d Sr Boring # Boring 16 Pit Ground Surface elev. 97.45 & Depth to limiting factor 120 in. Soil Application 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 1 0 -16 10yr3/3 none sit 2msbk dfr cs 2f .6 .8 2 16 -37 10yr4/4 none sicl 2msbk dfr cs 1f .4 .6 3 37 -54 7.5yr4/4 none sl/Is 2msbk dfr cs na .6 1.0 4 54 -120 7.5yr4/6 none ms osg ml na na .7 1.6 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg /L and TSS <30 mg /L CST Name (Please Print) ignatur CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 10/15/2004 715- 684 -5680 Property Owner Heikkinen, Paul Parcel ID # 020 - 1292 -50 -000 Page 2 of 3 3] Boring # Boring #I Pit Ground Surface elev. 95.95 ft. Depth to limiting factor 120 in. Soil 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 1 0 -17 10yr3/3 none sil 2msbk dfr cs 21' .6 .8 2 17-46 10yr4/4 none Sid 2msbk dfr cs 1f .4 .6 3 46 -56 7.5yr4/4 none SIAS 2msbk dfr cs na .6 1.0 4 56 -120 7.5yr4/6 none ms osg ml na na .7 1.6 o• F-1 Boring # . j Boring .,,_j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F J Boring # -� Boring _ Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L 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. STEEL'S SOIL SERVICE INC 3 of 3 David J . Steel Paul Heikkinen 994 200' St. CST- POWTSM SEl /4,NE1 /4,S27,T29N,R19W Baldwin, Wl 54002 Lic. #248956 Town of Hudson, St. Croix Co. Bus.(715) 684 -5680 Humbird Hills, Lot 16 Fax.(715) 684 -3449 Legend N 1" = 40' = Benchmark Ele. 1 00.00 ft Top of 3/4" pvc pipe = Alt Benchmark Ele. 100.50 ft Top of 3/4" pvc pipe = Borings Boring Elevations BI = 97.45 ft B2 = 97.45 ft B3 = 95.95 ft B4 = 0.00 ft i 7b, �fou5-e S e ceme'4 �� POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORM TION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity gal ❑ NA Permit # 33 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model _ oo ❑ NA Number of Public Facility Units s— ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) Qa al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 0C) gal/day Pump Manufacturer ❑ NA Soil Application Rate .7 gal/day/ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 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 Kin- 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 IC I MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ❑ month(s) s) At least once every: earth (Maximum 3 years) 11 NA jq � 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: ❑ month(s) (Maximum 3 years) ❑ NA year(g) Clean effluent filter At least once every: [3 month(s) ❑ NA years) Ins Inspect p ump, pump controls & alarm At least once eve 11 month(s) ❑ NA P P P ever [3 year(s) ' ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: 0 month(s) ❑ NA l 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. Tank 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 ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the 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 entire 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, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. I Page Z of 2 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 cell(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: • 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. T alua ' o mg tank be ' e ai e ' �120i -118 Tim �D�- A/� �NS"lXfl�' ❑ 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 Name ` Phone 715- _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / E e S Name S . ( b ne Phone /S— 3g( (p Z) This document afted in compliance with chapter Comm 83.22(2)(bl(1►(dl &(f) and 83.540), (2) & (3 ), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FOi:M Owner/Buyer _ /i/U eU Mailing Address 7;7 7 Property Address 7 ) -7 (Verification required from Planning Department for new construction) City/State ' 7 r - svti �✓/ Parcel Identification Number �2 7 5', / `� . /V9 LEGAL DESCRIPTION Property Location k 1 4, %., Sec. , T -R -9W, Town of 11v oSc;- Ay Subdivision 4 0 looe-c.r /s7 ,G�o a, ;�"c' -✓ , Lot # Certified Survey Map # �— , Volume . Page # �— Warranty Deed # J� /8 , Volume d0 7 Page # la Spec house ❑ yes lP no Lot lines identifiable F 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 ro owner a g r ees to submit to St. Croix Z oning Departm a certification form, signed b the owner and b P PertY gr Z g Departm nm, gn Y Y a masterplumber, journeyman plumber, restrictedplumber 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. I /we, 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 day f the three year exp lion date. z' 00/0 y1r, Y S G ATURE 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 rty described above by. virtue of a warranty deed recorded in Register of Deeds Office. y I 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 DOCUMENT NO. !! STATE BAR OF WISCONSIN FORM 1-1982:: THI• srRCC RESERVED FOR RECORDING DATA WARRANTY DEED 51847 . I This Deed made between .••..Sam E. Miller a single....... I 4'3 Person ......................... .......... ........... ...... ..................................... �� x�SflbrR°ow'7 t . . .. .................... •- - -• - -- ---- ••--- ._..._ -• -- - -- .................................. JUN 3 0 1994 Grantor, 1 and Paul K. Heikkinen and Rhonda J. Heikkinen husband I rt 10.3 P p P Y an a wife . as ' marita ro ert . . ...... ... ....................• -• - -•. - •- •-- ...... - • dam . ...... ......... ......... ......... .....•-•----. .._............................ ...... Grantee, Witnesseth That the sa-d Grantor, for a valuable consideration ------ j...................................................... ............................... .... ........... _ ........ .. RETURN TO (I St. - -- I .. ,, conveys to Grantee the following described real estate in ._.-- .._._. •.._ .... Co' to of Wisconsin: Lot 16 Humbird Hills 1st Addition Town of Hudson -- — - -- — - St. Croix County, Wisconsin. Tam Parcel No: .... ............................... Ii A L } Y -• 11 '« s I I This ... ____is- not _ • -•• -- homestead property. x+ � t 1 (is) – (is not) if Together with 0 and singular the hereditaments and appurtenances thereunto belonging; Sam E. Miller And ...................... ... t is warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except + easements, covenants and restrictions of record, if any. 2 !4 and will warrant and defend the same. k y Dated this ................ ............. ................. day of ..- --- --.Jut -e ----- ---- --............................. 19_. -.. �. . ..................................................... • - - - -- -- (SEAL) - ----`e ms .-. ..... ... ...(SEAL) • Sam E. Miller ,q.. ............................... .............................. ------------- _-.................................. ................. ............... .... . ... (SEAL) .............................. (SEAL) • AUTHENTICATION ACKNOWLEDGMENT II 1, Signature(s) ............................. ............................. .. STATE OF WISCONSIN y I� � s p 9a. I' • ST. CROIX .. .................................... County. �{ authenticated this ........ day of ................. ......... 19...... Personally came before me this ..... ----- day of ; r June ............... 1994 - - -- the above named I , ••••------------------------- ------------ •--- .---- .--- -. -. -- ---- •----- - - - - -• Sam E. Miller, a person .. 11 - .. ................... . .. ............ „ ^ .............. ........•- •----- °----------.... ............................................ q aw„n „ .... ............. TITLE: MEMBER STATE BAR OF WISCONSIN c .k u not , thoriz ed b ._.706.-- is. State. • --••-• ................... ..... ....... � -- � ...... +' authorized by $ 106.06. Wis. State) to me known to 5e the persdn , ?_ wl4dexagftec� the foregoing instrument and aclt�oiwledv theme: Y THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari, S.C., by Samuel R. Cari .............. # ---•-• .............•--------•-........ ....------ •-- •- •---- •--- •• - -••. P.O. Box 229, Hudson WI 54016 �' ' ” " " "" "" � ....... . St. Croix Nota. Pubhc ......................... .. a 'r_. �. ouoty, Wis. • X54;3 ! (Sienatures may he authentirated nr aelmnwiaA — T2n +h My Commission is permanent. (if nnt. state ezniratinn L W l d d m o s�� ►' - . M C G z o � •� H' O'er co ,., �d 6 4 (d `tea .4 \ • c d � d .cL _ M � v- • �O. o � o •Q� -? y' - O �41 y + 3 4.. kn .o w •., cT O 'cz C O ° a V to ;4 old v w OD U- Y N Cdd A + of 14 � a � N } , ^y a O H o x 3 Id mx O O 0 60 kfR W H H 00 G:. 3 o� ' O m a 4 SaNO' 1 Q311a�dNf1 o v .VE'Li8 M qw. 68 S Y 4 'LLZ % .. O A W z :5 , 0. z 0 w 71 N V71 cr z - Si — 3 ldVIN 0 8 X 0 0 Wt 0 cy , �o U < -j 3: z - �- a ol C � W LL w z o l co 0 M< 00 OV*649 3.GW.SV.sg s %10 z o wl 0 n 46 ; 4 En <- El r 0 t- cu Ln ol w : It _0 0 .00 0 0 3191p.sv.so s 0 U) - Ji 3NV-� go-oss 3-10180 i)- T- .00*09V 3..9V.6V.6Q S 99 X 0 0 MI 3 %4 in 0'. 41 o 46 Z A '04 r :14 oll w -1 4) >, - Ji u .0 F- 2 .4 cd V) D < V) n 2 0 n m 0 r o o , ■ c n § § / M e { 4 (D � a m 7 � ] i § A Q! § 2 k I� Q. j $ e � } ( \ m \ ¢ + ® - ® O ) 7\ E E ® g _- S± E o CD , E o 2 c c o } 2 j S. } \ / § \ § O 3 CL w § o - �� - 4 I c ■ / § I CL / / § £ CL ] G w c s / ] 3 'CO, w 2 / © 0 � ® \ \ z f § �� f } } COL ® ( 0 & % , § 2 �� 0 00- z 000 ƒ { CA Cl) j� 0 / { 3 (A CO) j \ 7 o / 7 ° 9 cr @ } / ¥ g / 0 § 0 o \�� w 0 \/� E / ° & J 0 m § / ƒ k » 2 N ± E g d E E \ > / \ \ k k - k 7 k § 9 0 .. T ■ m q 2 % E § E § / z k o F / @ 7 m . U) z � #f � �% k k ) m k 0 F a 0 ƒ ƒ < / ƒ 0 R e 0 E ƒ i I � � I 7 . 2 ■ 0 ƒ , CD (D § \ _ o ' _ o § § I § cl 2 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Ste_ M ILL f k ADDRESS L3oX #Z � L SUBDIVISION / CSM# H y 111 1�, 1 21) H I L L S LOT # 1 6 SECTION Z 7 T Z'? N -R Town of 140 Z)ZON ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM u _ 2° At 7 PiY.1E �•M- SPIKE IN lo" A / � �Y yo 2y'rjo' 1P XZa I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /Y /J ALTERNATE BM: To SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ltiJ0- Liquid Capacity: Setback from: Well Va House �S Other Pump: Manufacturer _ Model # - Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: /g� Length 5/0 Number of trenches — Distance & Direction to nearest prop. line: 7s "I- 3 "i 5 % L•)` /, Setback from: well: S L House 33 Other �b s� 3F ELEVATIONS Building Sewer ST Inlet; ST outlet j,oS i PC inlet PC bottom Pump Off - Header /Manifold 10. Bottom of system Existing Grade -2 Final grade E -Z DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt LQ''sTrRpartirsi��7 My /ATE'SEVIT/4GYSIVI Farm R ounty: Labor and Human Relations INSPECTION REPORT Safety an��uildings Division Sanitary Permit No.: IISENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: v.: nsp. BM Elev.: BM Description: « Parcel Tax No.: TANK INFORMATION ` ELEVATION DATA A9400040 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 9,53 g3 TANK SETBACK INFORMATION St/ Ht Outlet 7 42,9 TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet Air Septic 150 o 1 /5 y�s' l NA Dt Bottom Dosing NA Header / Man. to -y3 o l,a y Aeration NA Dist. Pipe /0,77 Holding Bot. System J 1.79 0 ( g PUMP/ SIPHON INFORMATION Final Grade - 7,XT 03.79 Manufacturer Demand 5 .17 q ,5 Model Number GPM TDH I Lift Friction I System TDH Ft ad oss Forcemain Length Dia. H Dist. TowelI SOIL ABSORPTION SYSTEM BED/TRENCH widt Lengt O No. Of T nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type of , Model Number: System: 75 / 3 / `' OR UNIT DISTRIBUTION SYSTEM Header/Manifold I Distribution Pipe(s) I x Hole Size + x Hole Spacing I Vent To Air Intake Len Dia. L e n gth Dia. S p acin g 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 v Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: Hudson.27.29.19W, SW, NE, lot 16, I Hill Farm Road z t a2 01r b t e Plan revision required? ❑ Yes ❑ No Use other side for additional information. Y SBD-6710(R 05/91) Date l Inspector's Signature Cert.No. f ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I i EIL,H� SANITARY PERMIT APPLICATION Co�TY In accord with ILHR 83.05, Wis. Adm. Code ( x - STATE SANITARY PERMIT # — Attach complete plans (to the county copy only) for the system, on paper not less than �Og q 161 8% x 11 inches in size. ❑ Check if revision to previous application zi -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY L09ATION Sti ! LL 4 57w y /4 A/e Y4, S Z T Z% , N, R /7 E (o PROPERTY OWNER'S? AILING ADDRESS LOT # BLOCK # 86 l- * "Z CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 0,0.50IV Vr I S%i le. 39 2749 NUMBtRD Old- S I. TYPE OF BUILDING Check one CITY NEAREST ROAD I ( ) El Owned O ja VILLAGE * DS L NV oY (�1L 7ARN1�1�D ❑ Public ®1 or 2 Fam. Dwelling –#� of bedrooms 3 PAR EL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) (' Z Q Z C Z $ p 1 ❑ Apt/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 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — 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 Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 1 LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE / REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION — I 5O 7 7- 0 - 7 Zr, o 1 - 00 Feet 3. S/ Feet VII TANK CAPACITY Site INFORMATION in aallons Total # Manufacturer's Name of Prefab. Fiber- Exper. New xistin Gallons Tanks C oncrete Con- Steel glace Plastic App Tanks Tanks structed Septic Tank or Holdina Tank ' Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: o S+ d► *Lo V �iD L y7 z 33 Plumber' ddress (Street, City, State, Zip Code): P.O. EO *IZ N42 o W T- -1'$'6 IX. LINTY /DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater a e ssue Issuing ent nat ( Stamps 1$ 10 �4v Surcharge Fee) Approved ❑Owner Given Initial .3 /, Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The 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 & Buildings Division, 608-266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all 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'/s 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 115 form; and F) all sizing information. GROUNDWATER 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, ground- water contamination investigations and establishment of standards. 4 SBD -6398 (R.11/86) a ka o � e� :�� o � o� J o0 rn w T1 v � n Ile tm 0 N ,'^ F 1 aX 1C V + t TV 1 M 0 o _ �afli /Ot /� 303. 9s 'may fta /c r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page / of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S (f f-OI h not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION SA M M f LLF4 GOVT. LOT 514 1/4 4 1/4,S Z T Z 9 N,R / 9 E (or) W PROPERTY OW ER':S MAILI ADDRESS LO # BLOCK # SUBD. NAME OR CSM # rA4 ooI- A -- /4601$ V11_'LS / A.&&P► CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑V LLAGE WTOWN NE EST ROAD ] New Construction Use Residential / Number of bedrooms 3 (] Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow ASO gpd Recommended design loading rate 0.7 bed, gpd /ft b.% trench, gpd/ft Absorption area required 64 S - - bed, ft2 4 � trench, ft Maximum design loading rate 6.7 bed, gpd /ft trench, gpd/ft l i Recommended infiltration surface elevation(s) 40mg P A4 c 3 0lL 3 ft (as referred to site plan benchmark) Additional design / site considerations LoT LAN Parent material Flood plain elevation, if applicable ft S = Suitable for system � 0 i VENTIONAL � M ,,Q UND IN- GROUND PRESSURE AT -GRADE YSTEM IN FILL HOLDING TANK U= Unsuitable fors stem JbI S❑ U 9 S ❑ U (�[ S❑ Ll ®S ❑ U S❑ U [IS f f U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .may b 'F C S 0.6 7 ,2 b K �, Ground 19 -34 16114 3 I 7 0$ elev. S v�► C f p� 4,$ 9 g X-6j i OYk 4A _ Depth to -// /bN 3 — S O r rh 1 O poX limiting fC r Remarks: Boring # 0-ITS 7.SYR V sbk .� Z $ 1U7 wi 3 .:..:� Ground $ 53 io � 3 4 S 0 �'h 0 2 elev. S 3-111 S rh 1 4.7 1 6 Z %A ft. Depth to limiting factor Remarks: CST Name:— Please Print 14f'\l &.y Phone:��_ O A ddress: 1 U &S6.j W 1 Signature: Date: CST Number: ��� .� PROPERT,YOWNER �j°'`"' M �«TA SOIL DESCRIPTION REPORT Page 3 PARCEL I.D. # '1 16 14u M.$, 0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Z Z Q �::,<w; :: }t :f $ 2 -3L o X2 3 3 S � � / sb K rn Ground $ 6 -S8 16 \14 S 0 r rh C 0 :7 6 1 e1 �S_�t . v44 4 Depth to limiting fa for 7� Remarks: Boring # x \ � c• ::. J SID 1• f r �r 1 O Z ' 03 Ground 35-iZb /o-ye-4/4 S r O A, j 7 0.� elev. 9 A SO ft. Depth to limiting factor 7 /p•Ob Remarks: Baring # :.:��.•.ti:4 { : A -JAS o 3 Z ---- L Z sb K �T d .S � 0.6 1 . 4 d� 3s io�ire,3 3 -- L, 1 �, s A� � o Ground S -s7 � 0��2 -- 5 (� r r►, � �- 1 O•? �0,� 9 ft. -[ 7 R 4 S 1 m f' 1 0. Depth to limiting factor , 7 S Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) OIL ; �Y ELE�lk� 1OrJS " AiA-A 4 - 9a. $ -z A2EA P, B- O � BLNU4 KA f L -SIP) K.E J Q \4,`, \,� \ L�r 8 t -- la rri o z 0 1 ° f I rn I I I m I O j r I I I I I I D I I I O I I I op I I I I j -D I I I -� 4% 1 m l ! - v U) I a z rn x CA I i ° w I m I � W 41 : V I � � m i�= o cn OS rn x m z -° b v m O C m O �(n -P, z m `�, ID S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER S X11 /rI L f �- ADDRESS BOX FIRE NUMBER �� 7 CITY /STATE 1&,4sokk W = ZIP PROPERTY LOCATION: 5W 114,_&L_1/4, SECTIO T_ _ TOWN OF 14u f S o , , St. Croix County, SUBDIVISION y 0116: ✓ 9 P; 0 , LOT NUMBER 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 septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and ( 2 ) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and SCUM. I /We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED:,-- L�. DATE: 1 St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 I STC -100 This application form is to be completed in full and signed by the owner(s) of the property being. developed. Any inadequacies will only result ,n delays Of the permit issuance. ,Should this development be intended for resale by owner /contractor,(spec house), thenta second form should'be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. owner of property Location of property 541 /4 1/4, Section � , T? N - R2 2� . Township �. s 4 Mailing address 41Q r Z19 Address of site __7/7 /1; // Subdivision name 9LA.w%6; VX W 1 S Lot no. Other homes on property? yes , Y No Previous owner of property Total size of parcel _ 2 -04y AC. Date parcel -was created - 2 ` 1 Z - o f _Y , 'Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house)? X Yes No Volume IQZ/ and•Page Number 2 a Z. as recorded with the Register of Deeds. INCLUDE WITI•i THIS APPLICATION THE FOLLOWING: A WARRANTY DEbD which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful • so as to avoid delays of the reviewing process. If the deed description .references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register' ^of Deeds as Document No. _...0 Z Z o 9 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded, in the office of County Register of deeds as Document DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -198$ THIS $PACK RESERVED rOR RECORDING DATA WARRANTY DEED r 50220 VOL REGISTER'S OFFICE Y ST. CROIX CO., 4VI i This Deed, made between __Humbird Land Corporation, fi�c d for record " A Minnesota Corporation oration authorized to do business ......................••• -- ................ .............-- •------ •-- ...... . i Y.i.gconsin .................... ••• -•• -• JUL 1 2 1993 --...----- •- •....••-- • ................ , Grantor, 4:20 P. and ..... ...11er _ ... . - -•• ...................................... . ... Registar of Deeda 3 ............................... ........................_...... ......., Grantee, 5 Witnesseth, That the said Grantor, for a valuable conaidezation__.... 7 ...:. -_. .._. .. _.. .._ __. •• RETURN TO conveys to Grantee the following described real estate in CLO ZX ....... ....... County, State of Wisconsin: Lots 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 in the Plat of Humbird Hills, Town of Hudson as filed Tax Parcel No: .... ............................... __and recorded in the office of the Register of Deeds for St. Croix County on April 7, 1993 in Vol. 5 of Plats, Page ;•.99, Document No. 497107. r Y : 13, 14, 15,16, 17, 18, 19, 20, 21, 22, 23, 24 and 25 in the Plat of Humbird Hills 1st Addition as filed and recorded ' in the Office of the register of Deeds for St. Croix County on April 7, 1993, in Vol 5, Page 100, Document No. 497,108 .. r, This ....... ia..na......... homestead property. (.ia) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And...HL3IIlb 7.rSl..la &AS..� ^.rP4rnt.io?� . ............................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements shown on the "above mentioned plats. and will warrant and defend the same. Datedthis ........ 12t. h .................. .. day of ... JuiX ........................................................ _., 19..93... _Humbird Land Corporation, a Minnesota Corporation authorized to do business in Wisconsin ....... .......(SEAL) B..._ (SEAL) Austin J. Baillon, President ................................... ....................... ...... .• -----•-•--•-••-•................... ....--- •-- .....__......._ -_.... •- •--•......•- •••--•.... .. .= _:K....---...- -•-•-••••....._ (SEAL) ..- . ....................................................... (SEAL) y . i • AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............ ............................... ........................................ STATE OF WISCONSIN ....-•-- -••--••-- -- -• •---•--•••---------------•--- -- -- .......------..._........_ /' as. ---- –�C/ ---- ...County. authenticated this ........ day of ........................... 19 ...... Personally came before me this ....... I A, of July ....................... 1 19..93.. the ababe•YAkKned ........................... .................................................... �' • + J ..--° ............................^^.... ._ '- --• • ................•--.. ..............-•••---•-- ....... ---- ...... ... AuvU u._ J,.. Bai114n ,..Presiden>r:oj.....,.�./ �. -. TITLE: MEMBER STATE BAR OF WISCONSIN 8uokbird _jand (If not . ....... - a ....... t .. authorized by § 706.06, Wis. Stats.) ' to me known to be the person ........v W ecuted th� f foregoing ' strument and acknowledg lop safn4 0 H •; O THIS INSTRUMENT" WAS DRAFTED BY - L H -N h )( t v jD•Q,k - �, f _ .Kue ers Hackel.. &,.Kue era .................... 0.... ...... _--• ..............�.+........•_........... ....... ._.... e , ... L350.- Capital__ Centr._St.._.P.au1,..MN._.5.5.102. Notary lic ..._ .l._...___C. . C). /.K....... -- .County, Wis. ____ t- --- "-- - - - . . . .. .. ER.. /TO __. - ......__t.__