HomeMy WebLinkAbout182-1036-10-000 lAftconsin Department of Commerce Count
Sa�'e and Building Division PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT Sanitary Permit No:
399442
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 Holders Name: City X Village Township Parcel Tax No:
Roett er, Ronald I Village of Star Prairie I st" 00
CST BM Elev: Insp. BM Elev: B
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic d�5 I Z /l Benchmark S
v i
� Dosing Alt. BM
2 10 zO
Aeration Bldg. Sewer
/ro, �
Holdi NHt t Inlet
TANK SETBACK INFORMATION outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Ssd i Dt Bottom
Dosing -- -_ _ Header /Man.
Aer r - ation Dist. Pipe
Holding Bot. System { 9- I fq 7-' -r 7
L
Final Grade
PUMP /SIPHON INFORMATION R- 16 J
anufacturer Demand St Cover
PM
Model Number
TDH Lift F ' on Loss System TDH Ft
Forcemain ength Dia. Dist. to Well
SO ABSORPTION SYSTEM S r
DrrRENCH Width Length No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 —F L
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM L E ING Manufac mer-
INFORMATION C MB OR ATA
Type Of System: / s r i T Mod Number:
DISTRIBUTION SYSTEM
o Air Intake
Header /Manifold Distribution x Hole Size x Hole Spacing Vent t
Q r a Pipe(s)
Length 1 Dia _ Length 3 - Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of eded /Sodded Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
r ❑ xx Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: O / 10 / Of Inspection #2:
Location: 970 County Line Aven S r Prairie, WI 54026 (NE 1/4 NW 1/4 T3 N R1" A Lot 1 ����If `'� Parcel No:
1. Alt BM Description = 42 d7 H' well � Ke Af
2.) Bldg sewer length = 33
amount of cover = > 3
3 701C�SSrv6i�ig �.�e5 %wser` �
Plan revision Required? ❑ Yes VNo
Use other side for additional information. L
SBD -6710 (R.3/97) Dat Insepc ors Sibature Cert. No.
Sanitary Permit Application r Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code V n ' 201 W. Washington Ave.
See reverse side for instructions for completing this application �l'd�_ fQ PO Box 7302
Iv i sconsin Personal information you provide may be used for secondary purposes C {'Cv Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)) mit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the syste [iape Less than 8 -1/2 x 11 inches in size.
County ., State Sanitary Pe it Number ❑ Check i isioti to previous app lion State Plan I. D. Number
h ^,
I. Application Information - Please Print all Information Location:
Property Owner Name ,,0 Property Location
�j - /VIA U14, S fr T,.?/N, R
Property Owner's Mailing Address ULj U j of Number Block Number
5k
f OF0
City, State Zip Code m Subdivision Name or CSM Number
s., 637 014 t/- � 4 l 0 3k
II. Type of Building: (check one) C
1 or 2 Family Dwelling -No. of Bedrooms: illae
❑ Public /Commercial (describe use):_ ow l
❑ State -Owned
77 / !sue ���_, Nearest Ro 1
✓ l C14Iti 'fib ,C 3 93 - W / C4 Parcel Tax Number(s)t R'
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Q( —,R — a/
A) 1. Eq New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) — (CrD
P Non - pressurized In- ground ❑ Mound ❑Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At - grade ( ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area oil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed ate Gals. /day /sq. ft. (Min. /inch) I C � Elevation
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks, Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersig assume responsibility for installation of the POWTS shown on the attached plans.
Plumber' Name (print) Plumber's Si nature (no stamps : MP/MPRS No. Business Phone Number
Z zz
Plum 's Address (S et, City, Sta , Zip Co e
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued su' g Agent Sign a (No stamps)
X Approved ❑ Owner Given Initial Adverse Surch Fee)
T 229. Determination 229. m- f b p
X. Conditions of Approval /Reasons for Disa
At sue• � s vo ► - t��^Q d' " per- �, -It 1 I -
'�'e.r �c�- vaa.�w �s-e t Kctreal.e.
- moo) is ms s M �W= P�
SBD -6 ��„ t
PLOT PLAN
PROJECT
ADDRESS
1/4 / 114S /Ty N/R W T1 � ��r G COUNTY Cjr o� jt
NPRS Byron Bird Jr. 220527 =— — r DATE , 149 BEDROOM �f
CONVENTIONAL XXX At rade CONVENTIONAL LIFT HOLDING TANK T
MOUND SEPTIC TANK SIZE 1,;216 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE O LOAD RATE ABSORPTION AREA # of chambers
IL BENCHMARK V.R.P. TION 100' u _
❑ BOREHOLE D WELL sH.R.P. i' G-> ✓`�
Vent SYSTEM ELEVATION
of Sidewinder High >12" o O
Cov Capacity Leaching ( r j o
Chamber with 17.2
(" t ^2 per chamber Ar�"
Long 34» Elevation
t o
_ 3E
uy y
1
,c PLOT PLAN
PROJECT X �� / ADDRESS / �OZ �` "�• u ` M uir, CIJ, `
1 /4 / �'J /,/ 1 14S /T �7,/ N/R W T �` � SOUNTY
MFRS Byron Bird Jr . 220527 DATE BEDROOM
CONVENTIONAL XXX At rade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE /v�� O LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE f,_Z ABSORPTION AREA �o # of chambers
BENCHMARK V.A.P. - r='ASSIIME �LRVATION 100'
❑ BOREHOLE O WELL *H.R.P. « �' G-� - -----
AT' nt SYSTEM ELEVATION a
Sidewinder High Capacity Leaching 6i rJ" Chamber with 17.2
t "2 per chamber �l� /rte"
Long 34" Elevation
r
l` o
s �
y�
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
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.
1 0 9 , - f QC9 6 V —
Please print all information. R sewed by Date a
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner / 1 Property Location
c-{,� (L b c- .e, r- Govt. Lot IVIA7 1/4 1/4 S T2/ N R) E( ) W
Property O�e� M� ling Address Lot # Block # Subd. Name or �� c
City State Zip Cod Phone Number ❑ City Village ❑ Town ORtarest Road
Z4 (/ 5 ox- OV
New Construction Use Residential / Number of bedrooms Code derived design flow rate C70 GPD
❑ Replacement ❑ Public or co m cial - Describe:
Parent material <� Flood Plain elevation if applicable ft.
General comments � ua � r
and recommendations: l � Z
Boring # ❑ Boring
Pit Ground surface elev.
d o a o elev./ d ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
t#5 A-7
as 8fl
,Z
® Boring # Boring
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 /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * Eff#1 *Eff#2
� V t2 G
`1. 7-11 . Z
* 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) � � ignature CST Num
s_S /t` i � - C/ `i
Address Date Evaluation Conducted Telephone Number
SBD -8330 (R07 /00)
I
Property Owner Parcel ID # Page of
Boring # Boring
/ \ i Pit Ground surface elev. ,Ze:V-3 ft. Depth to limiting factor � in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
0
F-1 Boring # ❑Boring
❑ 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 /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
❑Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
El pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 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.
SBD -8330 (R.07 /00)
Soil Test Plot Plan
Project Name Rick Roetger Shaun
Address 972 County Line Ave
Star Prairie Wi 54026
64rM #226900
Lot 1 Subdivision ------- Date 5/8/01
NE 1/4 NW 1/4S 6 T 31 N /R W Village Star Prairie
❑ Boring Q Well PL Property Line Count ST. CROIX
BM or VRP Assume Elevation 100 ft. C Top of 2" Pipe
System Elev ion 95.8 *HRP Same as Benchmark
Alt. BM Top of Survey Iron @ 100.6'
-- ����� County Line Ave
133'
50'
26 Pro 4 Bedroom House
a
0
62'
40'
B -1
0 50'
30' 1 %
* B S
50'
B -2
00' 101'
Al
191' Property Line
POWTS OWNER MANUAL 8L MAn"'Url -Ict'" rcr+"% _—
.FILE INFORMATION SYSTEM SPECIFICATIONS
Septic Tank Capacity 6 a al ❑ NA
nPermit c r! � � Let.-
# Sep tic Tank Manufacturer fs,cr C3 NA
DESIGN PARAMETERS Effluent Filter Manufacturer ��. k/c ❑ NA
Number of Bedrooms
❑ NA, Effluent Filter Model �%o ❑ NA
Number of Commercial Units ❑ NA Pump Tank Capacity gal ❑ NA
Estimated flow (average) gal/day i Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ❑ NA
Soil Application Rate l- ,2 gal /day /R Pump Mode! ❑ NA
Monthly average* Pretreatment Unit ❑ NA
Influent/Effluent Quality y ❑ Sand /Gravel Filter ❑ Peat Filter
Fats, Oil az Grease (FOG) :530 mg/L ❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BODs) :_220 mg /L ❑ Disinfection ❑ Other:
Total Suspended Solids ( TSS) :150 mg /L Manufacturer
Pretreated Effluent Quality ' ❑ NA Monthly average* * Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) :530 mg/L A In- ground (gravity) ❑ In- ground (pressurized)
Total Suspended Solids (TSS) :530 mg/L ❑ At -grade ❑ Mound
Fecal Coliform (geometric mean) :510 cfu /100m1 ❑ Drip -line ❑ Other:
Maximum Effluent Particle Size inch diameter
* Values typical for domestic (non - commercial) wastewater and septic
tank effluent.
* * Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
11 months ❑ year(s) (Maximum 3 yrs.)
Inspect condition of tank(s) At least once every �
Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume
y ❑ months
❑ ears (Maximum 3 yrs. )
Inspect dispersal cell(s) At least once every
Clean effluent filter At least once every 6 months ❑ year(s)
Inspect pump, pump controls 8i:alarm At least once every
❑ months ❑ year(s) ❑ NA
Flush laterals and pressure test At least once every
❑ months ❑ year(s) ❑ NA
Other: At least once every ❑months ❑ year(s) ❑ NA
Other: At least once every ❑ months ❑ year(s) ❑ NA
MAINTENANCE INSTRUCTIONS
dividual carrying one of the following licenses or certifications: Ma:
Inspections of tanks and dispersal cells shall be made by an in
ic
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspect
must include a visual inspection of the tank(s) to identify any missing or broken hardware,
Identify any cracks or leaks, measure
volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersa!
cell(s) shall be visually inspected to check on effluent levels
ound surface observation
indicate to check
and requires the immediate
the ground surface. The ponding of efflu ground
notification of the local regulatory authority.
the entire
When the combined accumulation of sludge and scum in any tank equals one -third (%) or more of the tank volume, Wiscoi
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113,
Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other
maintenance or monitoring at Intervals of 12 months or less 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.
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 c em
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contf
nr rho rant-0 rarno \iPd by i senwe servicing opera prior to use.
4
Page _o f..—
System start up shall not occur when soil condltions are (roan at the Infiltrative surface.
During power ouuges pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell($) in one large dose, overloading the cell($) and may result in the backup or surface discharge of
e ffluent.
ower to the effluent pump o contact a Plumber or POWTS MiIntal eo ssist in manual) Opp acing the pr to
contr p to
restore ncrmal levels within the pump tank.
Do not drive or park vehicles over unks 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-trade soil absorption area.
Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the lift of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; dtstnfectanu; (at;
foundation draln (sump pump) water; fruit and vegetable peelings; gasolne; crease; herbicides; meat scraps; medications; oil;
palntinR Products: oesticides: sanitary naakins: tampons; and water softener brine.
ASAN DON EM ENT
When the POWTS fails .aid /or Is permanently taken out of service the following steps shall be taken to Insure that the system is
P Pe Y and sa fely pi
fel abandoned In co with ch. Comm 83.33, Wisconsin
Administrative Code:
r
ro f
• 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 property_ duposed 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 falls and cannot be repaired the (ollowing measures have been, or must be taken, to provldt a code compllant
replacement system:
O 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 exi sting and prop o se structur tot (Ines and wells. Failure to protect the replacement area will
,
result In the need for a new soil and site evaluation to esublIsh a suitable replacement area. Replacement systems roust
comply with the rules in effect at that time.
O 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.
19 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.
D Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the
InfiluaQve surface. Re<onsvvctlons 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 TKE INTERIOR Of A TANK MAY 6E DIFFICULT OR
IMpneMRI F.
ADDITIONAL COMMENTS
POWTS INSTALLER r' 0-7 1��rc �.•, POWTS MAINTAINER
Name Na me ,.�" iN 7 , Si
Phone 2z — er y Zo Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name
Phone 1 7 hon �7��
ST CROIK COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT y
AND ��'/ ��
OWNERSHIP CERTIFICATION FORM
Owner/Buyer , n l d d - tlle�"
Mailing Address
Property Address 9/ Co" t
J' /,
�
(Verification required from Planning Department for new construction)
City/State ,' Parcel Identification Number
LEGAL DESCRIPTION
Property Location ; r "r /
Pro /`, L /., Sec, ., TN_R_�2—W, TwiLnw
Subdivision Lot #
Certified Survey Map # Volume 15 . Page # o
Warranty Deed # _ Volume �� 7 1 5-- Page # 6 �
Spec house O yes �'' no Lot lines identifiable A -yes O no
Sy -S LANCE
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 um What
c a n a ff e c t t h e f u n c t i o n of t h e septic tank as a t r e a t m e n t s t a g e in the w a s t e disposal s y s t e n - L p y o u put into the 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, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is is 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 acquirements 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 34
days the three year expiration date.
SIGNATURE OF APPLIC DATE
OWNER CER.TWICATION
I (we) certify that all statements on this form are hue to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPffCANT 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
i
— VOL L 1715PA(;E 619
STATE BAR OF WISCONSIN FORM 2. 1999 656204
%i
WARRANTY DEED " I' 1 H. Of DEED
REG S
Document Number ISTk DEEDS
CROIX CO., WI
This Deed, made between Ricky A. Roettger RECEIVED FOR RECORD
9:30 Ail
WWANTY DEED
Grantor, and Ronald A. Roettger and Veronica D. Roettger, hu sband HkT q
L'ERT L'OF'Y FEE:
and wife, COPY FEE:
- - TRANSFER FEE: 30.90
- - -- --" RECORDIN "o FEE: 11.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
That part of NE /4 N W 1/4 Sec. 6 -T31 N -R 17W being part of Lot I of Name and Return Address
Certified Survey Map recorded in Vol. 13 of Certified Survey Maps, page
3530 as Doc. No. 588423 described as follows: Lot 1 of Certified Survey DAVID J. ESTREEN
Map recorded i Vol. 15 o f Certified Survey Maps, age 40 as Doc. No. $Q4 LOCUST ST.
639076, St. Croix County, Wisconsin. ; HUDSON WI 54016
ten
A /K /A LOT 1 COUNTY LINE RIDGE
182 - 1021 - -60 -400
Parcel Identification Number (PIN)
This is not __. __— homestead property.
)=(is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of -� 2001
" Ricky A. Roettger
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Ricky A. Roettger STATE OF WISCONSIN )
) ss.
—" - County )
authenticated this day of August 2001
Personally came before me this day of
_ the above named
,Kristin Oyl
TITLE: MEMBER STATE BAR OF WISCONSIN to the known to be the person(s) who executed the foregoing
(If not, - instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristin Oglan -_ Notary Public, State of Wisconsin
Huds°n., —bIZ —_ -__ __ _ My Commission is permanent. (if not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
" Names of persons signing in any capacity must be typed or printed below their signature. Normmwn protesdana s company. Fond d� tr. M
e dd.LE M
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1999
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