HomeMy WebLinkAbout026-1137-23-000 Wisconsin De p artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
i Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 405063 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, 5.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Halle Builders Inc. I Richmond Township 026- 1137 - 23-000
CST BM Elev: Insp. BM lev: IBM Des ription: tl
U f
TA NK I ORMATION N ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ti �� 2 ,
k4f COS
3 S. 2 i o5 OCR
Dosing d Alt. BM k
A -Jo tit - 3 3- /0/- 4P
Aeration Bld . Se er 3 ✓?
Holding _- St/Ht Inlet
r 3 " $. 2,<
,
TANK SETBACK INFORMATION St/Ht Outlet � (o
TANK TO P/L WELL BLDG. V Air Intake ROAD Dt Inlet J
Septic $ A j� / t-j , t �, Dt Bottom ✓_
Dosing Header /Man. /
Aeration Dist. e �)
Z
Holding got. S tem 10 / t 10• (�
lo ` Z 2
Final Grade
PUMP /SIPHON INFORMATION �5
Manufacturer Demand St Cover
Model Num r
TDH Lift Piktion Loss System Head TDH Ft
Forcemain Length Dia. Dist. to welt
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Tenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 0 r I � d l�i
SETBACK SYSTEM TO P!L BLDG WELL r LAKE /STREA LEACHING t
INFORMATION O CHAMBER OR A �
Typ f System: / �f j r / / UNIT Model Number: l 2 c
16 l' 2 r ! — I /
DISTRIBUTION SYSTEM Header /Manifold Distribution rr J x Hole Size x Hole Spacing Vent to ; take
I Pipes) t ' 4 ilQ q .J f
Length Dia Length 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 BedfTrench Edges Topsoil
.] Yes (] No [ , Yes ( '� No
COMMENTS: (include code discrepencies persons present, etc.) Inspection #1:_/ Inspection #2: / !
Location: 1095 148th Avenue New Richmond, WI 54017 (SE 1/4 NE 1/4 20 T30N R18W) Golf View Acres Lot 23 Parcel No: 20.30.18.979
1.) Alt BM Description : 50 , i'y (.t�'4 rdt+�.V
2.) f O't (
Bldg se length =
) g se leng 30 �l l4 �.. T � ^- ` a3 o CST T 3dY'�
"
- amount of cover = i
i Plan revision Required? additional Yes to
Use other for m side formation.
SBD -6710 (R.3/97) Date Insepctor's 'gnature Cert. No.
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Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
�� See reverse side for instructions for completing this application PO Box 7302
' Vis�onsin Personal information ma ou p rovide be used for second p urposes Madison, WI 53707 -7302
Department of Commerce y p y p
[Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
/ Q / /,Sd �j state owned.)
Att c omp l e t e p l s (t6 th e c ounty c opy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County State Sanitary ermit Nu ber
1 ❑Check if revision to previous application State Plan I. D. Number
L Application Information - Please Print all Information IV hU Location: ,.pp
Property Owner Name Property Location
AA —"-,4 ", i
1/4 1/4, Sol T,3Q,N, P/A (or) 19
Property Owner's Mailing Address Lot Number Block Number
ilia �
ST. CROiX COUNTY a3 qj
City, State Zip Code Phon NumbQO ubdivi ion atr1C or CSM Number
. G✓� �S'� o (7 /aim ).2 SSG G �'/3 ��,
II. Type of Builds ❑ ci � n check one
YP g ( )
1 or 2 Family Dwelling -No. of Bedrooms �� [I Village
❑ Public /Commercial (describe use):_ 'Town of
❑ State -Owned
��`N�, -/�3 �/ �Al22� �i!► O1tZ� l0 122 Nearest Road VF T
9 - '7 X e S 1p �. ?i - j ydyr��y Parcel Tax Number(s)
III. Type of P rmit: (Check only one box on line A. Check box on line B i applicable)
A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
on- 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/Treatme Area Info
1. Design Flow (gpd) _ 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
✓/ Required / Proposed Rate . /day /sq. ft.) (Min. /inch) / Elevation
VII. Tank Capacity in Total # of anufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
S A= /axe` 7 ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the und ersigned, as sume responsibility for installation of the POWTS shown ched plans.
Plumber's Name (print) PI is Signature (n stamps): M RS o. Business Phone Number
VE n►' al'i 22/L/°7 /J-
Plumber's Address (Street, City, State, Zip Code)
IX. Co nty/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued uilAgell Signatu stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination
X. Conditions of Approval /Reasons for Disapproval:
p (,d 1 & �o Q 6 v
G'�t�vnc ei` Cover - ) 4u 19, 19, ,
6 ter.
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SBD -6398 (R. 07/00)
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Vftconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3
,Division d Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
x 11 inches in size. Plan must S-� • C r Ul
Attach complete site plan on paper not less than 812 _
include, but not lirrMed to: vertical and horizontal reference point (BM), diredion and PSI I.D.
percent slope, scale or dimensions, north arrow, a c 69nand distance to nearest road. 7 • Z 3 -fib
by Date
Please print all
' ' Privac L* s. 15.04 1 m �d
Personal information you provide maybe used r sdary pu( Y (� ( ��• G ?�N
Property Owner � ; �� i j,; �,: P (operty Location
R 1v u d e S 11 GQvL Lot S F 114N p 1/4 S T 3r7 N R 1 E (or) Q
Property Owner's Mailing Address �� 7 t d# Block # Subd. Name or CSNI#
ST 7 P,s/ ., 3 ol��►evd Acres
c ity State ;' City ❑ village [Town Nearest Road
10
Sl.) - � Ch m
[S New Construction Use: ® Residential ! Numb"~` .. " - ` Code derived design flow rate 1 456 k o 00 GPD
❑ Replacement ❑ Public or commercial - Descnbe:
Parent material _ _ (f U o g 0 Flood Plain elevation if applicable ti / ft
General comments S y S74CC r✓\ P/ C✓ g S 3 O
and recommendations: lA G../ V • � 30
❑ Boring # n Boring
l ® Pit Ground surface elev. O ft. Depth to limiting factor l 1 in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cott Color Gr. Sz. Sh. 'Eff#1 `Eff#2
I -1 2 ') Zrmobk vr c S V-� 5
Z 12 -3 (� `t I &cl Z k Wily C — �-►
310 -
F11 Boring # Boring
® Pit Ground surface elev. 9 3 y0 ft. Depth to limiting factor 1 I in. Soil Ap lica6on Rate
Horizon Depth Dominant Color Redox Description Texture Stnxdure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I 'Eff#2
C
I � -t.2 n4c 3lz 2mabk
Z 'Sid
3 42 -113 Li l mS /• 2-
, -3 �. Z ti v j q o re. di r di rya ea/
i`n p,,
• Effluent #1 = BW > 30 < 220 mg/L and TSS >30 150 mg/l- ' Effluent #2 = BOD < 30 mg1L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Ada JchU kelr �- 25330A
Address Date Evaluation Conducted Telephone Number
21t3 8� -' �• • SomerSe-� �•.t l 5' -�02� S'- -ol C� 15�2�1 Z- �-IOO$
I
Property Owner N e j5orl Parcel ID # " F2.3 4v4-V►eA-) Page 2 of 3
Boring #
F 3] ❑ Boring 0 a - n 3'7
Pit Ground surface elev. � ft Depth to Igniting factor (� in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Cob" Gr. Sz. Sh. *Eff#1 I *Eff#2
i 2 k ivy g
I � -t� l0 CZ Si mob s
Z 14 - 4b ( 0 4 S t c.l Zrnrbk n i
3 - 1. OS m \ 1 2
0
1 $ L� �
3
Boring # ❑ Boring 9
F] ❑ 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/fR
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring
Boring # Ground surface elev. ft Depth to limitin factor in.
1:1 pit g
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *EfW
*
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L 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.
M-1030 st07ro0i
PAGE 3 OF 3
NAME Aug f Sd � LOT# L S LEGAL DESCRIPTION,U E %A4 e_ ,,S Lo T3p,N,R t n E (or) 40
SCALE:
BM 1 ELEVATION �QQ - d
BM I DESCRIPTION &, d X 1
BM 2 ELEVATION 9 s ec Z c)
BM 2 DESCRIPTION A o �e v✓ l P e
SYSTEM ELEVATION YS. :� d
ALTERNATE ELEVATION 9 S- 3 6
CONTOUR ELEVATION VI o .51 (0-e
A/a 5 /ooOC
3-3
,� � � l ( ■
SkaeQC
■ AL4.
13 - r
BW B�
SIGNATURE DATE 5' /C� O/ - -
I
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
zzy--l—
Mailing Address L- 1-7
Property Address 94
(Verification required from Planning Department for new construction
City /State Nt-W -Z, 10 Parcel Identification Number 0C)_ /'e 3 - Z 3
LEGAL DESCRIPTION
Property Location S �� ` /., N4i� `/4, Sec. e .20 , T_3D N -R, _�V Town of �0#U_p•
Subdivision A LF �16zj 4r el , Lot # 23
Certified Survey Map # , Volume Page #
Warranty Deed # LO - 7 q qF / - -- , volume Page #
Spec house 2 ❑ no Lot lines identifiable L9 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 property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
ed 1 ber or a licensed r ve ' that (1) the on-site wastewaterdisposal system
mastorplumber, journeymanplumber, restrict p um pump �y�
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
days of the three year exp' tion date.
AWRE O 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 property described a ve by irtue of a warranty deed recorded in Register of Deeds Office.
NATURE 0 APPLICANT DATE
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
from the Register of Deeds office
Include with this application: a stamped warranty decd g
a copy of the certified survey map if reference is made in the warranty deed
i
MANUAL &MANAGEMENT PLAN Page of
POWTS OWNER' S M
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner A Septic Tank Capacity Odd al ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
Effluent Filter Manufacturer ❑ NA
DESIGN PARAMETERS
Number of Bedrooms
7 ❑ NA Effluent Filter Model 01 /00 ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity / al ❑ NA
Estimated flow (average) 300 al/da
Pump Tank Manufacturer �"— ❑ NA
Design flow (peak), (Estimated x 1.5) S (� al /da Pump Manufacturer ❑ NA
x Pump Model �^ ❑ NA
Soil Application Rate G , 7 al /da If
Standard !n #luent /Effluent Quality onthly average" Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (SOD 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 ❑ In- Ground (gravity) 0 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
months) {Maximum 3 years} ❑ NA
Inspect condition of tank(s) At least once every: 3 earls}
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
❑ month(s) (Maximum 3 years) ❑ NA
inspect dispersal Collis) At least rice every. A3!year(s)
`` t� ` U ❑ month(s) 0 NA
Clean effluent filter N ! � - At least once every: �r' years)
❑ month(s)
Ins mp controls & alarm At least once every: ❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) 13 ear(s) ( NA
❑ month(s)
Other: At least once every: �FNA
❑ yearts}
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.
GMW (4/01)
I
Page of
(,;TART 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 u shall not occur when
so!] conditions are frozen at the infiltrative surface.
Durin g p ower outages pump to may fill above normal highwater levels. When power is restored the excess wastewater will be
Y c discharge a of
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the p
backu or surface
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
ken out of service the following steps shall be taken to insure that the system is
When the POWTS fails and /or is permanently ta
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shalt 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
asures have been, or must be taken, to provide a code compliant
If the POWTS fails and cannot be repaired the following me
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.
❑ 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 b)omat 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 - 2 1!r-24L G �`� Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY -
Name Name s`� 7ohlsi
?hone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)11)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
i
� U 1864P 125
674943 1
STATE BAR OF WISCONSIN FORM 2 .1999 ]KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
i
ST. CROIX CO., WI
This Deed, made between Hillvale Develo Limited, a —
RECEIVED FOR RECORD
Minnesota Limited Liability Partnership,_ _ — — 09 -01 -2002 10:40 •AM
tliNiRANTY DEED
EXEMPT le
Grantor, and H alle Builder Inc. — - -
— REC FEE: 11.00
—• -- — — — — - -- —' TRANS FEE: 163.80
-- - -- - -. —. —. .__.— - COPY FEE:
CERT COPY FEE:
Grantee. — ~!~ PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in S t . Croix _ _ County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Lots 23 d 26, Golfview Acres, Town of Richmond, St. Croix County, Name and Return Address
isco m, KRISTINA OGLAND
ATTORNEY AT LAW
P.O. BOX 359
HUDSON, W154016
P art 02 1060 - ft 026- 1 -95 & 026- 1 064-10 —
Parcel Identification Number (PIN)
This is not homestead property.
OE) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this t! day of March_ _— _ 2002
- Hillvale Development Limited
t By: Ri chard S. Nelson - --
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) H illval e Development Limited, a Minnesota STATE OF WISCONSIN )
Limited Liabili Partnership, b Ri chard S. Ne lson — , ) ss.
-- County )
'auth%ntlE.$(; Vkis � - _day of March 2002 Personally came before me this _ day of
the above named
Wistfris b te land
------- - - - -_— — _— .—_— - -- —.
E, 1' STATE BAR OF WISCONSIN to me known to be the persons) who executed the foregoing
instrument and acknowledged the same.
"ed by 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY — - -.— - --
Attorney Kristina Ogland _ — Notary Public, State of Wisconsin
Hud WI 54016 -- My Commission is permanent. (if not, state expiration date:
(Signatures maybe authenticated or acknowledged. Both are not necessary.) —
'
Names of p ersons signing in an c a p acity must be t y p ed or rimed below their s i g nature. namerwnPrmessionaf: eompony, Fong Cu
Na 5. 21
P g g Y P Y yP P g WO-655-2021
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1999
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