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Home My WebLink About018-837-22-4101-SAN-2022-325 _-._ Indushy Services Division C��tY � � =�.", < = 4822 Madison Yards Way 1�r�� - Madison,WI 53705 ry ( � "' � .�� - Sanita PeRni Nuf mber to bc;f Iled in by `� := P.O.Box 7162 ( 1 � `-'- _� Madison,WI 53707-7162 �p �j �� 1 � ��.s,��." , Sanita.ry Permit Application State Tiansaction Number � In accordance with SPS 383.21(2),Wis:Adm.Code,sabmission of this form to the appropriate governmental unit �,1 is required prior to obtaining a sanitary permiL Note_Application forms for staie-owned POWTS are submitted to Project Address(if ciifferent[Lan mailing the Departmciat uf Safety and Professional Sen�ices.Personal informatic�n you provide may be ased for secondary purposes in accordance witt�the Privacy Law,s. 15.04(I)(m},Stats. I.A licarion Inforroa6on-Please Print�All:Xniqrmation " ` � PP �O /�_COuw/�'`y�l.i�C ('roperty Owr�r'ti!�ain� Paicel# _� . O�B`$ 7' • O Property O�t'ner�s Mailing,4ddress Property Location (� a�'► l�' Govt_Lot--,— City.State � 7_ip Codc Phone Numbet � / /�/ .7 -/ '� ��•J L...-�/,, Scction ��.__ II."T_ype of Building(check all th3t appty) 1��` T 3 N R E or ' Subdivision Name �l ix2 Fatrih:ll�cclling-Numberofl3edrooms�___ Block# �'ublic/Commercial-Describe Use _ ❑City of _ ❑State q��7ied- f)c>cribe Use -_ CSA1�lwnber illage of_ �Toa�n of ��p� ----- - III.Type of POWTS Permit:{Check either"1New"or"ReplacemenY'aod other.applicable on line A Check onc bos on Iine B:C�mplete tine C if a Iicable.) '4' eu�System �Replacement System ❑Other Modification to Exisung System(explain) ❑Additiona(PretreaUnent[3nit(explain} — �' �Holdin�Tank I❑3n-Ground �AAt-Grade ❑Mound Individual Site Desigy Other Type(explainl � (conven[ionaO C. �Renewal BcCore �❑Revision hange of Plumber ❑Transfer to I�ew Owner List Previous Pem�umber and Da(e Issucd Expir,�lion ��1�. � IV.DispersaUfreatment Area and Tank Inforcnation: • '' _ '�'. r: =- . ' Desi�n Flot.�(epol Desigr.Soil Application Rate(gpd'sf) � Disp.rsal Area Required(s� Dispersal�Arca Proposed(s� System Flevation �O o —' `. `, - C:apacity in Tota( #of Manufacturer � � Gatlons Gallons Units � � � � •= Tank tnfom�atiun ,� � U ,, r v Ncw T<raks L•xisting Tanks m � � G � .fl � � � W v v� r :.� u. c; a � - +- Septic or olding Tan- � O O � � OOd � ��Q� � Dosing Chambcr --- .. f � � � V.Responsibility Statement-I,the undersi�ned,assume responsibilit5�for inst:�llationof fLe'P,OWTS sho�rn on:the atfached plans. � Plumber's Namc(Print) Plumber's Signature Iv '�1YKS Ni�mber Business Phone Number Adre ��fcP,�d ��a Yy� i7�� gy�-.�3s Plurabcr':Ad�'.rc�.�Strcct.Cit}'.5tate.Zip Code) �f" w o � e J 3S VI.Countv/Departmcnt Use Only - `- -' Pem�it Fec -�c Issi�ed Issuing Agent Signaturc �APPr -ed �7 l�isapproved g u,�1 dU �� I 3 �a a- �A!C�t�-� �--- � �Owner Given Reason for Denial �W` Conditions of rlpproval./Reasons for Disapproval ` f :: � , .� � _ .� ' �a t� I 1 3 2 ,- � =�� --_, :� . � ...��1--�.�_� _ _. � , , �� '�� Chk#1��._�-___. m ..., �� .�=�, �� 0 � ��L2 ��: L ;y "'?t��J W�r��J � 40�� .. -- CS 1 N�-�--- �e�. -�.r- �(:�' � �` �`` - �� _' �*�f� N�,t,,�r. z. At(ach to compfe6e plans for the system aod sabm�t[o the(:oun[y only oe paper aot kss Wa S 112z 11 inches�n siu � �� " SBD-6398(R.03/2l) NO R�FJNDS AF�"ER ISSU�OF PE�iMt'T = Sawyer County Zoning & Conservation Administration �� 10610 Main Street,Suite 49 � --: �. : � Hayward,Wisconsin 54843 � � � �� (715)634 R288 � ��\��,�j FAX(715)(38 3277 � i J--�+ (� �°„� wi�_�s , ��c ccsu it� oc.ui� � �\ � , i E-mail zoni.i ��c,c�p��uc unt o� ,,r�, �� -� � Toll Free Courthouse/General Information I-877-699-4110 I ` "`'�°�, ,'��\��` ' Holding Tank Approval Checklist L Sanitary Cover Sheet Date Stamp�1_/ 03/ �2 0� Parcel ID# O � g- �d 3�- 2 a- �( ( O ( II. Plot Plan �Property Lines �Benchmark BM ♦ �Site Address �( North Arrow �C Structure Scale �Well <25' to Service Road Legal Description �Nearest Road Intersection �Setbacks to: Properiy Line, Well, Structure, Water bodies, Roads IlL Required Plans . � �Index Page with Original Signature �Management Plan/Contingency Plan _Servicing Contract �Holding Tank Agreement form IV. Holding Tank Specifications � Cross-section—Manufacture, Gallons: �'�W �a"�� Tank Anchor Calculations [SPS 383.43 8) g)] �Locking device, chains/locks � ?(Alarm and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) and State Statutes 101.862(2) and 101.862(3) �3" Bedding Material < 1/2 " V. Holding Tank Plans per Component POWTS Manual �Version�SBD-10855-P (R.3/07)C�2,�-� ) \ Owner: ��`�,�o� Plumber: V��zev�d� Application Review Date: I l � 3 ��-� POWTS Reviewer: ��r�.,._ �✓�� Name �G�( � l Lice�sc# � Revised 4/11/2013 CONCRETE HOLDING TANK DESIGN Single Combo Tank Option INDEX AND TITLE SHEET Project Mikkelson Holding Tank Owner Amos Mikkelson Address 502 Chatham CT Neenah,WL 54956 Legal Description NE1/4-SE1/4-S22-T.37N-R.8W Township Meteor County Sawyer Subdivision Name Lot No. Parcel ID Number 18837224101 Plan Transaction ID Number Index and titie sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Tank Drawing Page 5 Designer Bruce Vitcenda Signature � Phone No. 715-943-2382 License Number M.P.220498 Date 10/29/22 Designed pursuant to: Holding Tank Component Manual For POWTS(Version�-6j 560.1085�sP(N_03I07)(/K� 1 l �'� \.�'`'-��/ Version 7.0(03/12) Page 1 of 5 HOLDING TANK SPECIFICATIONS �Number of bedrooms Non-residential estimated flow(gpd) 2000.0 Minimum holding tank volume required (gal) Side A Side B Total 750.0 1250.0 2000 0 Proposed tank capacity(gal) Skaw Tank manufacturer 12001750 Tank model number SJE Alarm manufacturer 01-H Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 16100 Ibs Weight of tank and cover 47.0 Liquid depth below inlet invert(in) 1.50 Safety factor 8.0 Maximum depth of soil cover(ft) 20512 Ibs Weight of anchor required 57.0 Height(in) Outside 29.9 in Soil cover req. for anchor or 154.0 Length (in) Dimensions 5.1 yd' Concrete counter weight 77.0 Width (in) Only FALSE FALSE HOLDING TANK CROSS SECTION Electrical complies with NEC 300 and SPS 316 optional vent pipe vent pipe manhole coverwith � finished location � locking device and grade junction warning label box —� �4"min. 4"min. F—23 in. conduit 18"min. thether - � weiynt Note: All tank joints, and joints - � � — belween tank openings and building sewer serv�ce piping are sealed watertight. All �n�� blind plug alarm on to seai pipe and vent materials comply ouaec with SPS 384. Manholes with 90% Full 34.5 in locking device are typical for each manhole opening . Side A 750.0 gal S;re 8 1250.0 gal 3 in.bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Mikkelso� Holding Tank Transaction Number: Page 2 of 5 I owNer P��,�s�r amOJm�KKtlto✓ ��ctV;+�eoda r��t G4Ai6ae cT �47v�✓frryWyyo N CtYah�Wz.y'41fL fXcla.vd�w;.64B,u ��f.yy3-a3r.t M.p.,t9o498 � lzo.��• (ru•1- T^' Nf y-tf yv S.zx T.y7,✓ A.yw � � acu a o�aY3�.�1 N�ei � 7ow.i�n��cof �� r ��^�vo.v'w;ult/ap � M4"�o/!Li� S�(aw I7,00��6oCOw11 R�Jeq vlc14�✓-[�eN Z U i _ _ _ � � _ _ � � �O ' � a4d�. � � , 0 M I �'D ♦ I J��` H�, I � � I � I � �O I � I LSCwlta _ _ _ _ _ _ _ � � � fCaIC �"-Ja' ,�,noff HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SP 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P N. 03/07), and the Sawyer County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 40 to 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90%of the tank(s)capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing ConVact must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s)and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the counry sanitary ordinance and SPS 383 and 3&4 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes fank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discon6nued, components no longer in use it shall be abandoned in accordance with SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons may be contacted- a. installer.............................A-1 Plumbing Phone: 715-943-2382 _ - --- b. Service Provider.................. Northwest Sanitary Phone: 715-943-2650 c. Co. Zoning or Health Dept. Sawyer County Zoning Phone: 715-634-8288 __ 11. Project: Mikkelson Holding Tank Transaction Number: Page 4 of 5 WARN/NG DEATH MAYOCCUR IF TANK IS ENTERED i SKAW 1200/750 � Q WITHOUT PROPER EOUIPMENT i ^ i 0 i � �o.00 NOTE:SEE/NNER WALL PHOTO ON THE"EXCLUSIVELY AT SKAWS'PAGE. i1 � i I 11 � I � I � I � I � � I � I 1 � 3.00 i i � � �.� i i � L____'_____'________'_________J �27.00--{ �27.00-{ 27.00 �24� OUTLET END VIEW OF TANK �29.00 I 24.00 I 5.00 i 16.00 1.00 J �2.00 2.00 INLET �� 8.00 OUTLET � p� 1e� 41NCH 4 INCH PRESS � PI7ESS SEAL GASKET S�� GASKET INS7ALLED WHENPOURED / BAFFLE FILTER 47.00 s.00 SECTION VIEW OF TANK AND COVER 3.00 Model Number. 1 ZOO � 7SO gE(qW PRE-CAST Phone: (715) 967-2277 ApprOv6dfo�: SEPTIGSEPTIC,SEPTlC/PUMP,SEPTIGSIPHONORHOLDING Toll Free: 1-800-924-8625 eig n e �m. u e im. Liq. Depth Gal./In. Nom. Cap. 26255 105th Street, New Auburn Wisconsin 54757 Fax: (715) 967-2707 16,1001bs. 54" 50" 47" 16.05 754.35ga1. www.skawprecest.com . �'Q�DIl�G TANK SERVICTNG CONTRA.CT Co��:c�A:a� i o /�/ �'`L �I��p`�it�r�,a�eris nn•ade b�tween t�ie Holding 7Cank 4wncr and the Pnmper, k�aldi:ng Taxa�t�'�`�i�r's T�1ame: Pumpez-'s Name: a �,✓ it/at e s i .�' ' a/ Paxc�l I�ct��u� ��n�a�i'�n l�unxber: (12 Digit L�gacy ID) a ! �' - � 3 7 - � � - �l t p � 1. The owner agrees to file a copy of this contract with the governmentat unit, Sawyer Counry, ` which has acc�pteaanr? r.ec�r�ee� ��r.th tue Qf g�:: 4f►r�e r^.egis�er az�eeds, the Nlaintenance Agreement fox a �Ioldi.ng Tanl� requixed under the Sawyer County Private Sewage Sys�em �xdinance �or the issuance of a Sanitary Pem�it for the installation af a halding tank(s}. 2. T�e owner a�rees to have the halding ta.n�C(s) serviced by the pumper and gvarantees to permit the p�mper to have,access and to enter upon the property for the purpose of se�vicing the holding taa:a�{s). The owaer agrees to rnaintain the a11-weather acc�ss road or drive so that the pumper can servi.ce the holding tanlc(s) with the pumping equipnnent. The awuer further agrees to �ay the pumper for charges incurred in servicing the hoiding tanlc(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to tb.e Governmental Urut, Sawyer County, a report fQr the servicing of the holdvag tanlc(s) as required under SPS 383.55, Wiscansin Adnunistrative Cade and the Sawyex County Private Sewage 5ystem Ordinance. The pumper Curther agrees to include the following in tb:e report: , a. The nam� and add.ress of the persan responsible for servicing the holcling ta�,k; b. The nanle of the awner of the holding tanic; c. The site address of tbe holdiug tank; '� d. The da�e Clae bolding tank was serviced; e. The volumes in gallons of t}ze conte�ts pumped from the halding tanlc for eacb servicing; f. The disposal sites to which the contents from the hoiding tank were de�ivered. �. lh:5 '�P!:��z�'1C 'Lrt �/?� SCII2�' 'L� SII ��PCf 1113E�.1 �� dLt�Z rr YL2TJ'1�pT tE�?.^..'�C� tl�+1S ..^.^�h'2CI, � the eVent Ofa change in this Caniract, the owner agrees :o file a cQpy of any cl�anges to this service eontract or a copy of a new service cantract with Sawyer Caunty within ten (10} business days from the date af cJZange to this service contract. Owner's Name: (3.'rint) {}WllCT''S Sigllattll'e: (Oniy oue mvncr signaturc rcqufred} � � ' I � � ' A/// .l /�t x dViU.� _j �'�i L�-{Sa�7 � � W f I Fumper's Name: (�'r'i�C) -- �ump 's t ignatuxe: ��'ZLGf' Gr �c.�% Pumper's Registz�.tion Number: � �� , Rev. 03/2b113 Real Estate Sawyer County Property Property Status• Current Listing ' Today's Date: 10/29/2022 Created On: 2/6/2007 7:55:34 AM Description Updated: l/8/2005 Ownership Updated: 6/1/2022 _ _. _____ ___ . ,. .._._ __ _ _ _ _. _ .---- .___ ..._ __,. ..__ , .__ Tax ID: 19911 AMOS J MIKKELSON NEENAH WI P�N, 57-018-2-37-08-22-4 O1- ' 000-000010 Billina Address: Mailing Address: Legacy PIN: 018837224101 AMOS J AMOS J Map ID: .13.1 MIKKELSON MIKKELSON Municipality: (018) TOWN OF METEOR 502 CHATHAM CT 502 CHATHAM CT STR: 522 T37N R08W NEENAH WI 54956 NEENAH WI 54956 Description: NESE Recorded Site Address * indicates Private Road 40.000 __ __ Acres: 1061N COUNTY HWY C EXELAND 54835 Lottery � Claims: Property Updated: 4/7/2022 First Dollar: Yes Assessment _ _ _ . _. __ __ _ __ _ ._ _ _ _. _ _. _ _ Zoning: (A-1) Agricultural One 2022 Assessment Detail ESN: 431 Code Acres Land Imp. G1- 1.000 5,000 7,500 Tax Districts Updated: 2/6/2007 RESIDENTIAL 1 State of Wisconsin G4- 18.000 2,500 0 57 Sawyer County AGRICULTURAL 018 Town of Meteor UNDEVELOPED 1.000 100 0 540735 Bruce School District G8_ 001700 Technical College qGRICULTURAL 20.000 13,000 0 FOREST Recorded Documents Updated: 6/1/2022 2_Year 2021 2022 Change _ _ _ QUIT CLAIM DEED Comparison Date 439253 Land: 20,300 20,600 1.5% Recorded: 5/20/2022 Improved: 7,500 7,500 0.0% TRANSFER ON DEATH DEED Total: 27,800 28,100 1.1% Date 397973 Recorded: 10/5/2015 WARRANTY DEED Property History . _. __ Date 288435 N/A Recorded: 12/28/2000 ;r�s,�y.�� ,es 4 '- '' '� a ,'� i t + *'..r�+'�� s �"� -' yYr� � �fi� ' 7 r �+'S,.�Y a�s.f's� -i''' . � ....�y. .4 . L, �.! k �;-: k '.y_ ,.. - .#�1'�SK: .. '� �'S�y�' '�'N � f `i*'a. 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"r� �}''�,�-+` �'a'i e . �� :��.f t:� �`'yu, r�t��r,C h .. �ir t y� n- yT t r� �7� y t'` - �'� � �'^�-'^`�' ., �1 �'y`�'�YI ��" �t '�.. ,��f -ni� V..r w't '�� F � �.,i �7' �'Y_,y � ` 'y;"�._ Y +�- r ay � "r - ti y}.� . y� �'•-' � � � '3,'�`pa .s�:.,..� ��t �_ ��'�.D�+ .t ti�[`� �-�^�� s k r'�-Z, r �i� �y_'`��i � � [ '�i p 15r �� `L r� y y Y '��-i5t� C+}� i \ � �K •�fi'' � r,. �+' �,r; ~S,.�.r..r..,�„ia_ �'`.+.,�rr ,2 .. �«�`„� � �. '.J� .:. r�,�,.� � i ,, �'=,�i �,.4 , � y_,ti;;'T ....�a q*��_- �- � � . . ��U � . . '�r r ; ��' _� `� �t�. � �', �� z i . ? � ,a, ,�- � I � ...'�-� J 5� .. 1j7� '� 'J a:ay. R. . '�.._, iw. +Y i.� 7 �_ ( -` f.a,�S�.1�4 ..�� S � ' .,F' :s...''� .}: l . . F � ^41 S � .�:Lry. . .��"M � ' � ,i Y ti�a'��i�F' '�a'^�" 'w.�L" `�,r.� -�ww.G�hFr��' .��' ' '�` '--+.`'r�.-�.'� �+'�t�'"�,,,�.��,�}� �-•_„SyF�. s �.�' *'k;�. ��rt._r'. r:�.xn-�-r._,:�` ,y �'�.. _ _ .f_��. �,i I i; j I I' � I 11'�Il�II� �I�lil ��I iIIIIII) -USE Bl..ACK tNK UNLY- � u�=v�ii:�:)��71 POWTS MAlNTENANGE AGREEMENT i;�:�0�+17�� For Holding Tanks �'�'�1�9 PA�LA CtiISSER Owrter's fVame(s)as shown on deed: REGi�TER�3F E3EEDS " SAWYE�R C{)UNTY, WI 11/03/2022 U�:�6 PNI '`� RECC}RDING FEE 3D.OU Parcel identi�cation Number. (i2 Digit LegaCy!D) O f � -�'�7- i� �- � 1 D � � ..._. P�G��; � Legal Dascription oE Property: , -SEE ATTACHED SHEET� We acknowiedge ihat appficafion is being made for the inskaila6or�of a holding tank(s}on the property described on ths attached sheet i2etum Ta;Sawyer Cvunty Zoniag arcd Conservafian Ad►r�inisfration ` 106'!0 Main S�Suite 49,Mayward,W154843 � ... As an inducemenk#o the County of Savryer to issue a sanitary permit for a hotding tank on the above-described properiy,the awner is responsible for the operaGon and maintenar�ce of the holding tank,loaking device, alaRn and access,and agrees to corrform to all appiicable reguiremenls of SPS 383,'J11'ss.Adm.Code relating to hoiding tank rnanagement,including the following: 1. The owneragrees to cantractwith a persan who ts itcensed under Ch.NF: 113,Wis.Adm.Gade,except as provided by Section 281.48(3)(d}, Sfafs.,fo have the holding tank properly serviced and ta file a copy of the service cantcact v�rith the govemmental unit The owner further agrees to file a copy of any changes to the setvice contract,or a copy of a new seivice contract,with the govemment�at uniE within ten(1 C1)bustness days fmm the date of change ta the service cantracf. 2. 7he owner agrees to cantract with a persan(icensed under Ch.NFt 113,Wis.Adm.Code,who sha[I subrnit pumping �eports to the govemmer�tal unit in accordance with SPS 383.55,Wis.Adm.Code,for fhe servicing af the hoiding tank. �n the case of exomption under Secfion 281.48{3}(d),Stats.,th�awner shall submit the report to th�govemmentai un'tF. The governmental unit may enter up�rt ttte property to invesdgate the condition of the�hotd[rtg fank when pumping�ports rr�ay indicat�:the holding tank is nat being properiy maintained, 3. If Yhe owner fails to have the ha(ding tank proper(y serviced in respanse to orders issned by the gavemmenta� unit to prevent ar abate a human healfh hazard as descrit�e�in Section.254.59,Stats.,ttze gavemmental unit may ent�r upon the property and service,or cause fhs fank#o be serviced. Pursuanf to Section 'i45.20(4}Wis.S#ats.,a govemmentai unit may assess the awner of a pri�ate sewage system far cosis related#o fl�e pumping of a septic or holding tank.The charges wiJi be assessed as prescribed by Section 66.0703,s#ats. i'he owner agrees to pay ail charges and cost incurred by the gavemmenfaf unit for trtspecf�on,purnping,hauiir�g,c�r afherwise servicirrg and rrtaintaimr�g the hoiciir�g tank in such a manner as to prevent ar abate - any hurnan healih hazard caused by the holding ta�k, 4. This agreert+ent will rernain in effect onty un#�7#he goverr�men#af unit responsible for the regulaiian of private sewage systems certifies that eith�ra sait absarptiaR systerrT that camplies wifh SPS 383,VVis.Adrn.Cade,ara municipa!sewer serves tne property. In addition,this agreement may be cancelled by execuEing and recording saici certification with reference to this u;�r��;;L•�t;��suc��;��a�:;��r vYi�i:,h�viii Ne:rrti�fhe exisience of the certlfcation to be determined by reference ta the property. 5. This agreerrient shalf be binding upon the owner,the heirs of the owner,and assignees of the owrter,The awner shaf)submit the agreement to the register of deeds,and the agreement shall be recorded by tize register of deeds in a manner which wil! permlt the existence of the agreerrtent to be determined by reference ta the property where fhe halding tank is instaEled. -OnE one aw er si na a e uired- ACKNO��,F.�,�MERlT Uwner's Si n�ture: , � f � iN ��''��, 8 , � State of: I�J C `� �CA , County of: _E.'�' '.F ��' ., Owner's Name(Print}: S�s ribed and�inra t �me t�is ��'�l� ��'��•� l'� day of= � ` '� � - ,.20 �� Date: By(Owner's Narfa�� `�7��Z� Notary Public Sig, � � C?rafted by: Q Pubtic Natary Nam�.�r�� - ' � � r/ {�r'u c� ��`�.2holq My comrnissior�expire�'4r,�,C . �� " � L��' Persanal infarmation you pravide may be used for sec�ndary purpose�[Privacy Law,§15.04(I)(m)} - Rev.03/26113 The North half of SE 1/4 of Section 22, T. 37 N., R. 8 W., Sawyer County, Wisconsin.