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HomeMy WebLinkAbout022-1083-90-000 0 r M 0 d r� (D ° c 1 . 1 IN CD '�' T� T. N Z O CA r _5'j (n rvl CD 5 0 C 0 w CD 7 N IV 0-0 W a w 7 7 N 0 cn 0 f1 OD O = lAl A CO C G)� _ O O r�C N N D d N N N : ? W R h CL 0 CT 0) 0 n CT O h 0 0 0 0 c c CD 00 W 3 ro c c 0 (D! p-n o l+.1 rn o O O m o 0 n� Z CD tQ 0 N d Ir o CD _� V N 3 O w w O CD se v 0) �r U1 ` N 0 0 CA O C 0 0 0 3 !* Q T M 9 Al • Op O O O O N ! _ Z 0 _ 3 0 u� c N y y m N O '0 G G p CD !� 00 O 7 C CD A CD y O co CA .Z) bi O N 9 CD N CS N p. CL y N z z 0 0 D m 0 O > Pi _ N ? Cd CD Cd CD CD C. CD w m Cfl C. FL CD Z 5i a j O A Z n N c � � � n > A Z O _ a N C 3 0 fn � N W m N CD Co (b ' Z O 0 z 3 m w I v o � CD M 0 =r a CD CD n CD a Cis — D CD CD C N D) C D to d CD cn�fA 0 CA) N O o O N A CD N W a+ 0. — ti v� as CD c m D o m o a CL , A fi 0 7 p� A CD N O =r 'q f1 CD 0 O '0 (� � Oo CD Cf N N 0 0 7 0- O CN C L 77 A CD 0 ti 0 O CD pQ p A O 69 0 ti W O CL y Parcel #: 022 - 1083 -90 -000 02/02/2006 10:34 AM PAGE 1 OF 1 Alt. Parcel #: 29.28.18.452F 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner ROBERT &JANICE LINEHAN O - LINEHAN, ROBERT & JANICE 906 COULEE TR HUDSON WI 54016 Districts: SC = School SP = Special erty Address ): " = Primary Type Dist # Description ' 906 COULEE TR I ``� SC 4893 SCH D OF RIVER FALLS d`J D l— Pj SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.880 Plat: N/A -NOT AVAILABLE SEC 29 T28N R18W PT OF SE NE THE E 528' Block/Condo Bldg: OF THE S 320' OF SE1 /4 NE1 /4 SEC 29 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 28N -18W Notes: Parcel History: Date Doc # Vol /Page `n Type 12/26/2003 750077 2480/621 qq U" SAD 12/26/2003 750076 2480/6 9 `�U� ' U SAD 07/23/1997 794/291 U n 1 07/23/1997 647/303 �C,C 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 143879 226,600 Valuations Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.880 60,000 169,100 229,100 NO Totals for 2005: General Property 3.880 60,000 169,100 229,100 Woodland 0.000 0 0 Totals for 2004: General Property 3.880 30,000 133,300 163,300 Woodland 0.000 0 0 Lottery Credit Claim Count 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ✓isconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353355 Permit Holder's Name: ❑ City ❑ Village ❑7Town of: State Plan ID No.: Kinnickinnic Township E ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 00#0 r I l a D .0' 022- 1083 -90 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic IZBO Benchmark ,2.0�{ o pD Z. Dosing Alt. BM IVIA Aeration Bldg. Sewer lax [ Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet ,* a,88 �q, ld TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet ir Septic 3-b `f�� r --®-- NA Dt Bottom r Dosing NA Header/ Man. S 93 • S Aeration NA Dist. Pipe q3. yz Holding Bot. System lo.o Q2 av PUMP/ SIPHON INFORMATION Final Grade Manufacturer errand St cover Model mber GPM TDH Lift Friction S stem TD Ft L oss ffead FOfcemaln th Dia. Dist. To well SOIL IRPTION SYSTEM 5 �� — Z �J— • �) = 3� RENCH Width , Length , No f enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I $ -2 a J DIM N I N SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING M anuf tur r: SETBACK � � �^ INFORMATION Type Of CHAMBER Model Number System: C TW- X3 Mel ti 13a OR UNIT DISTRIBUTION SYSTEM t -- Header /Manifold r, Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length' Dia. Length "— Dia. Spacing > IZ 0 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 #l: 3 /-Z 9 /Qv Inspection #2: -- 7i=7t Location: 150 Liberty Road, River Falls, WI 54022 (SE 1/4 NE 1/4 29 T2 N R1 8W) - 29.28.1 .452F 1.) Alt BM Description= ^ °►� �) Pte$" ` i �" "'" 0 2.) Bldg sewer length= E �Z- - amount of cover = >+2 3) EH Plan revision required? ❑ Yes No ) _ I t _ 2 / Use other side for additional information. 03 Z9 ����,, �0 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3 se. ee e. i 3 s E .a i Safety and Buildings Division Asconsin SANITARY PERMIT APPLI N 201 W. Washington Avenue Department of Commerce In accord with ILHR 83.05, Wi �) Y odd P O Box 7302 - - Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on pape",ess c�� ty � C 0�� than 8112 x 11 inches in size. i`I • See reverse side for instructions for completing this applicAtion Stjt nitary Permit Number Personal information you provide may be used for secondary purposes if revision to previous application �+ [Privacy Law, s. 15.04 (1) (m)]. "5'� Stye, Ian I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL I M Property lener Name 4 ^ O ICE L I , I6 r f P roperty Location- T Z , N, R E (or Property wner's Mailing Address l's /V 1` � Lot Ntr =- "' Block Number V 06 « -- Cit State b� , t Zip e Pho e Number Subdivision Name CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned it ` Nearest Road Public or 2 Family Dwelling - No. of bedrooms if if row of A)AII � 1 �k— �`�-� �-D III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) d ^ 9-4 1 E] Apartment/ Condo d Z' _/0 lgJt !/ o _ O o p 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 box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. btf Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an ______System _________ystem _____________Tank Only______________ Existing System _________Existing System 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 12aSeepage Trench 2,2 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit ,/ 43 ❑ Vault Privy 14 ❑ System -in -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate �- System Elev. 1 7. Final Grade ,q. V Required (sq. ft.) Propos ft.) (Gals/day /sq. ft.) (Min. /inch) ,� Elevation V (© r (7 ' ? 2 , v Feet Feet Capacit VII. TANK in Ca allon g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks I Tanks Septic Tank or Holding Tank 0 00 WV 1 6 __ 9 ❑ ❑ ❑ I ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT �a (0 49 } I, the undersigned, assume responsibility for installation of the onsite se wn on the attached plans. Plumbn Name. (Print) Plumber's - gnature: (No S s) MP/ o.: Business Phone Number: bk. 6 27 -L� Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate slue Issuing Agent Signature (No Stamps) g(Approved []Owner Given Initial Surcharge Fee) ` Adverse Determination ob 3 -� } -2� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �� IQ•Qon�r�.�• � � a1°� fie; � sep�u., -�+.� p�u�.�,Q.1� -�-e -- 2 A �S � � P e", C — f / Pv41CAJ = Z SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divisio ner, Plumber z 1 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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 submittedto 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 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 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 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 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 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 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 contamination investigations and establishment of standards. o � 4 Za /L � Ci h Jw�z� 3 -Zf 6v MP 6 31� Wisconsin Department stry, SOIL AND SITE EVALUATION REPORT Page N of 3 labor and Human Relations �_..- ,., g — Division of Safety a Buildings in accord with ILHR 83f13,' i.' fm" Code ._, ' COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches iX Plan 0 but not limited to vertical and horizontal reference point (BM), direction`an p/o of sloe scat"i PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest rohd: ' 0 UUo APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION R IEWEDBY DATE PROPERTY OWNER: PRO IbCATION ,, �13�Z -T 5 1 L Lt tv �}f- NF U - 1/4, 'NE 1 /4,S Zq T 2,b ,N,R It E(a1E PROPERTY OWNER'S MAILING ADDRESS • `�, !'LOT If - - BLOCK # BD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE MOWN INEARESTROAD V�SO)v S OLL, n1s) L-)ZS- ��{13 1 livh� tClrz lhJ 1V l L� �C^SLl 1� [ ] New Construction Use Residential / Number of bedrooms L-I [ ] AdditiQn to existing building Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate -" bed, gpd/ft - trench, gpd/ft Absorption area required tiZO o bed, ft oo trench, ft Maximum design loading rate • S bed, gpd/ft •� trench, gpd/ft Recommended infiltration surface elevation(s) & Ru '11Z UCti£S ft (as referred to site plan benchmark) Additional design / site considerations sip tUUT'E - M UuS Oty I GE 3 Parent material S PCKJ O uYw RS N Flood plain elevation, if applicable h3 A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑U I OS ❑U 0S ❑U OS El ❑S LOU ❑S 9 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer rtt :k ) 0 -9 S Ground 3 33 -e-� - 1. S'-1 R 5� elev. g Depth to limiting Z a factor Remarks: Boring # O -to lo 3l3 L aS1�1Z vhV'f t. Cw . q S S - . S 3 33 �Z Z.S li y/6 Ground elev. c m2s ft, Depth to limiting factor 7 $ Z. Remarks: CST Name: — Please Print Phone: Arthur L. We erer 715- 425 -0165 e Soil Te tin & Design Se - ' g g Service -P.O. Box 74 River .Falls WI. 54022 g Signature: O` S Date: 3 `,,'�� CSTNumbe: 2 2 0254 PROPERTY OWNER L1rvIv SOIL DESCRIPTION REPORT Z 3`• ' Page _ of PARCEL LD. # 0 ZZ - l U b1 - 0 10 - UULi Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft M \ \}� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. C \ Bed Trench \M +: 3 �' 1 0 -to ►ok 2- 3 / - \ S 1 e� b k wl � `Fi� � �- • � . 8 Ground 3 SO -q3 1 -S `tR 516 elev. _ ft. Depth to limiting factor I s Remarks: Boring # 1 ' k : Ground j elev. ft. Depth to - limiting factor j Remarks: Boring # : I Ground i elev. ' ft. i Depth to limiting I factor Remarks: 3oring # <..;, '. around ' ;lev. it. )epth to imiting actor Remarks: __ PLOT PLAN Page 3 of 3 SCALE 1 "= L.O ' 1 E" S x 6 6 WELL �i✓i 1 x ` st�*Tl 't'11� -kt I Sr x vl S .3 LL Utt)\LM Lr..ab 3 ✓ � n WCLL W J PU U& ► OTC_ _TZ3 l .J,: t'm . � _ - �NSTt'�1 -: I- TTLE)VO -IJ ", Z� N1 :GL�- �P�1?I�CL`Y`� - - :S -1 D�- 6u1�JD!` 12_ :_L_�.N_- L- �'i'i�Y'►.13L�2S. -1� - - -_ -. oo -Sq —00 (715 425-w65 _ CST Signature Date Signed Telephone No. CST # S 'F CROIX COUNTY SEPTIC "DANK MAINTENANCE AGREEMIN I AND OWNERSHIP CERTIFICATION FORM Owner/I3uye1 D 81- 5f� LING'✓ Mailing Address _ _ . / `� CO UL Property Address 1_ beK Roaa ( Verification required from Plaruung Dep ent for new construction;; City /State 0056 to/ �K �6 Parcel Identification Number I___,GAL U ESCRWTI DN Q v Property Location % N�' /,, Sec. Z9, T_Z0_N -R_11 W, Town Subdivision __ -- Lot # Certified Survey Map tf _ Volume Page is Warranty Ueed # - - - -- t 31 ✓ O I , Volume , Page ii l Spcc house 0 yes /11-no Lot lines identifiable 0 yes L� no S YST F,M MAINTE NANCE Improper use and rnaintenanceof your septic system could result in its premanue failure to handle %, aster f'r1 l cr rnaintcuanir comists of purnpang out the septic tank every three years or sooner, if needed by a licensed pumper what X01, tilt 11110 the s,stcr:r 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 ownct arid hN a rnasterplumber, jowneyrnan plumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewatcr disposal system is in proper operating condition and/or (2) after inspection and purrrping (if necessary), the septic tank is less than I /; Cul! of sludge I /we, tilt undcnigned have read the above requirements and agree to maintain the private sewage disposal 5vscern w, f; the standard; set forth, hercur, asset by the Department of Cortunerce and the Department of Natural Resources, State of Wisconsin (erttficanon stating that your septic system has been maintained must be completed and teturned to the St. Croix County Zoturip, c )f hce within 10 da s of the three year expiration date S (' �11JR )F APPLK'ANT DA'l F O WNED CERTIUCATION I (we) certify that all statements on this form are true to the best of my (oui) knowledge I (we) 1111 ilrri thr nwnel(s ) 1f propctty described ahovc, by Vutuc of u Worranty decd recorded in Register of Decd~ Ofl'1<r UNA IU(Jh AYYLICANI' DA I " "" Any infornrathon (fiat is mis- ropresented ruay result in the sanitary permit being revoked by the Zoning I rcpartrncnt " "" " 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 aced DOCUMENT NO. STATE BAR OF WISCONSIN FORM 15 -1989 r "'s SPACa Rcsaw ID FOR aacono;NO DAM ASSIGNMENT OF UND CONTRACT 431301 794?kcE `491 REGISTERS OFFICE ST. Mix M., WIS, Assignor, Whether one or more, for a valuable consideration, essigna ROC'd Im ftaofd *6 21st and conveys to .. Robert and Janice Linehan, husband and - -. wife as survivorship marital property ._ "1(2... ,A.D. 1987 .. ......... .... ... ..... M. ...................... ......... 1... ............ _. .....( „ Assignee” whether one or more) the (7a1>YiIi j1W Purchaser's) interest ;n a Land Contract dated the ....... 1.9.t .... ...........day of ... .... JUne......- ._...., 19. ��., executed by William_.d,..Younggren. a single man _... _...... .......... ............. . .. .........._ .. __ . _ ..... as Vendor to ertuew To �tVQh �• 40(r ............_ .... .............._... . _ _..... ....._ ? 10 ,IV Mp,v% Kenneth..Kasinski. and Beth Kasinski _ ......... ... ........... .....• 1Zwe� �wtly krt SYoiL . ... ............ .._. ........................... ................... ............................... as Purchaser on lands in ....... St... CioiX .. ...... ....... ....... ...... • _„C oun t y , State of Wisconsin, toge,her with ( the indebtedness therein referred to and) all the interest of the i Ia�lV�� Assignor in the Land Contract and the lands described therein, which Land Con - : ' tract was recorded in the Office of the Register of Deeds of said County, on ............. j=e-- 3 .................. ., as Document Number .... 3.7.7.9 2.2_., in OVA" (Records) Plxii" (vol.) -- .- b.47- ..................... of 0hkwXM on (Page) .... .373-.............. ..... The Assignor covenants that there is now owing and unpaid on said Land Contract, the sum of .. > if.ty-gi Thousand Five - Hundred. - Forty- six -and 60( 100 -- ($38,. 546. 60,` - - - - -- ...Dollars, and also interest at ...... 1.e .............. per cent per annum from . -.. October -• 1, 19 87 ............... ..................... that AGsignor is the owner of the above described interest in the Land Contract and has good right to assign the same, and that the condition of the title oi' Assigi,or's i:,terest is the same as at the time of recording the Land Contract. PARAGRAPHS APPLYING IF THIS IS AN ASSIGNMEN "C OF PURCHASER'S INTEREST: (Strike either 1. or L) By accepting and recording this assignment, the Assignee agrees: 1. That Assignee assumes and agrees to pay the obligation secured by the Land Contract, to comply with all +erms and conditions of the Land Contract, and to hold harmless and indemnify Assignor as to the performance of all obligations, terms and conditions of the Land Contract. (OR) all payments required on the Land Contract anr! to comply with all terms a e Assignor retains the right to occupancy of tha property covered b ac . his Assignment is to have the same effect as a lortgage. In the e e part of the Assignor on the obligation secured htreby, the Assignee's remedy ohm if ib h - l d PARAGRAPHS APPLYINC IF THIS IS AN ASSIGN31ENT OF VENDOR'S INTEREST: (Strike either 1. or 9.) 1. This is a complete assignment of the Vendor's intereAs in the above described Land Contract. The Purchaser under the Land Contract is :nstructed to make all further pacme its to Assignee upon receipt of a copy of this docu- ment. (OR) 2. This assignment of the Vendor's interest in the above described Land Contract is for collateral purposes. The Assignor shall be allowed to continue to receive the scheduled, periodic payments on the Land Contract. Any extra or balloon payments shall be made payable to Assignor and Assignee. In the event of a default by Assignor on the obliga- inn secured by this assignment, Assignee has the right 'o receive all payments on the Land Contract upon notification to the Purchaser. This ----- is_flo.tr .... ... homestead property. 9W (is not) Dated this .- ----- ...._....�.� day of . October _........... 19. 87 � .•/ � - ice _ (SEAL) �l� ..f� _7 _. ........(SEAL) Kenneth Kasinski (SEAL) �QrJ,' --------- .(SEAL) Beth Kasinski AUUTHENTICATION ACKNOWLEDGMENT Signature(s) - - STATE OF WISCONSIN A.�,p Tt1 /G,qy /,✓s /G/ sa �✓ii. ------- .............................. County. authentic this ........ day of . . . .... .... ... . - . - - -., Personally came before me this .- .------ - -. - -- -day of -•--- --- ------- ---- -- - - - -- - 19- --- - - -- the above named '•--------- 0 --fA,0 r ✓L'9Cg ---------- .. ............. ............... ...... .. ............ - -- ........................................................ TITLE: MEMBER STATE BAR OF WISCONSIN (If not- - -- -- - - - -- -- -- -- -- ...... .... ............ -- authorized by 1 706.06, Wis. Stats.) to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Steven B. Goff, Attorney at Law. ----- - - -- ......• - - -•• _............_. .._ ............................ 7T0' Nortli Mani Sti"eet; -- Boil -- 167 - -- -- ---- - --- - -' _ River --Falls.- ._ ......... .. . .... Nota Public . ... _..... ------------- .. ......... .County, Wis. (Signatures may be authenticated nr acknowledvod. Both My Commission is permanent.(If not, state expiration are not necessary. � ) date. ...... ___ -- - - -- ._, 19...- •) ! Names of persons aitt,ioi in any eaGac itY sh„uld be ty Ped or p -iw•d brL,w rh.•ir sig na:•ir ;. . -� - 87.a1 : R BA o. 5 — WISCONSIN M4M"~'Carw ~� .- BA O IS I CO Stock No. 13