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HomeMy WebLinkAbout020-1324-50-000 CROIX COUN 'I'Y ZONING DEI'AIU'MI:N'I' AS BUILT SANITARY REPORT owner Address _ / 4) City /State Legal De cription: Lot BI ° k Subdivision/CSM It l{ N N r (�, '/4 '�• �•� !Sec. L , T N -R I `1 W, Town of V Z S 0 N PIN # 0 3Z s o SEPTIC TANK — DOSE CLAMBER — FOLDING TANK INFORMATION: Tank manufacturer W 1� t 5 f , " , p 0G ' / ' Size ST/PC� / Setback from: House - Z " 7 Well l07 p/L �] � - Pump manufacturer Model W Alarm location (HOLDING TANKS ONLY) Setbacks: Service road -- Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: r � Type of system: l 7 C r rkWi Length �(, . 2S" Number of Trenches Setback from: Hous Well P/L Vent to fresh air intake ELEVATIONS: - -- Description of benchmark p� / PL ,d I ' GtJ X401'? ., / 0 Elevation NC OO f Description of alternate benchmark v -)F (0 K/ : 3 , a - S Elevation to ti Building ewer 5' - 7 Z ��1 � g ST/HT Inlet' g ST Outlet- �1 2 PC Inlet —` PC Bottom _ Header/Manifold L?�35 =9 '7' Top o ' f ST/PC Manhole Cover � b� = 1 c� l , 3 3 S JT +4- N 0nw7 h Distribution Lines ( ) / G. 3 �' M �''� � S O / v , 35' � °t 7 Bottom of System ( ) 1 1,70 Final Grade ( ) 4►. t�l ( ) � ,1U': Ivy,% Date of installation Z /q Permit number 32 O Z State plan number Plumber's signature t � " License number W P S' d3S Z Date Inspector C(in,pi<« pio( r' NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. g (M, (" 40T S *KF_ PLAN VIEW U,) -o-t M 5 11L �t NAT IC © � `. �aX s ���oll / 4 _ -raTo( VIE �a, 1 40 INDICATE NORTH ARROW Woo Wisdor1sin Department of Commerce S YSTEM PRIVATE SEWAGE Y Safety and Buildings Division $ S County: 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)]. 320214 Per mi LLER, t N SAM HUD� Village Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: <"y,nlr 020- 1324 -50 -000 TANK INFORMATION ELEVATION DATA A9800402 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �i t+ � Benchmark 6 ' Dosing- -- - -- ((� ..r ,:�f • �,5� /��� r Aeration ^ y- �"'�- - - - ---- ' Bldg. Sewer , �t°?� 0�� Holding -'` St/ Inlet TANK S ETBACK INFORMATION St/ Outlet y 22' �8 TANKTO P/L WELL BLDG. AirI Veritto ROAD Dt Inlet Airintake Septic NA Dt Bottom Dosing _ - NA Headerf NUFrF. Aeration NA Dist. Pipe i Holding Bot. System ��•7a �9� PUMP SIPHON INFORMATION Final Grade Manufacturer -- Demand �����,.� ^� • "��. �7 Model Number •- GSM TDH Lift r F- Loss ction ystem° - - DR-­"' Ft H Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r gth / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth T en DIMENSION -� k S IP 2S DI N _ . - ..__...__.__,._..__ SETBACK SYSTEM TO P / L BLDG I WELL LAKE/STREAM ` CN4lN Manufacturer: INFORMATION Type Of A, 3r "o , r CHAMBER Model ` Number: System: /g ' 1441 OR UNIT DISTRIBUTION SYSTEM Header)' -M* /� Distribution Pipe(s) x Hole Size X Hale Sparirl' "ttentTO Air Intake Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound t Grade Systems O T9­-k.__ Depth Over Depth Over xx Dept f xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Tops El ❑ No Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LO ATION: HUDSON 12.29.19,NE,SW 1052 MOON GLOW RD - TANNEY RDG LOT 4 1 A l ,�io! iy^vt Q.y'�.dT.. a ^b �.. ."3.,�;�p'1 , p�'_zf... � J'..�% �.P'f� G,,JA' " ra C.1� �-, '� eal. - +.• _, - Plan revision required? ❑ Yes UrNo Use other side for additional information. -7 SBD -6710 (R.3/97) Date Inspector's Signatur Cert. No. Safety and Buildings Division NVIsconsin SANITARY PERMIT APPLICATION 2 1 B Washington Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 0 Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. 4 34% e,r o 1 x, • See reverse side for instructions for completing this application State Sanitary Permit Number Ll Personal information y ou p rovide may be used for seconds on Y p y second purposes �) heck if revisi on to previous application [Privacy Law, s. 15.04 (1) (m)). /0549 moo Glow R(�lr • State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION I C�>� Property Owner Na Propert Location <ZV � (` jjQ E 1/4 ?"t 1/4, S l Z T Z . N, R l E (or( W Propert yOwner's Mailing Address Lot Number Block Number City, State Zip Phone Number Subdivision Name or CSM Number 11. TYPE OF BUILDING: (check one) ❑ State Owned 6rcel It� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms v ows OF 6/ 5`0 /NomN�COUJ �� III BUILDIN USE: (If building type is public, check all that apply) Tax Number(s) 1a . 9. 19. 14* 7 7 1 ❑ Apartment/ Condo , , - )ZO - � 3 7 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 [ 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. ❑ 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 Number 3 ZO Z / d/ Date Issued 'T - Z- 51 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 M Seepage TrenchS /1�k. NIDEIZ , 22 [] In-Ground Pressure 42 [] Pit Privy 13 Seepage Pit V INFILTot 4TaA . 43 ❑ Vault Privy 14 ❑ System -In -Fill 3 /. VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ySQ Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 13 Elevation, i (c 1 :;7 Z-- . $ — 1 4 � 3 Feet ( 00f !o Feet Capacit VII TANK in Ca g Total # Of Prefab. Site Fiber- plastic Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete Steel glass App. strutted Tanks Tanks Se t' 1000 / FfS&e C9 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamberl I I 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb is Signat : (No t mps) MP /MPRSW No.: Business Phone Number: dyb ef lWp lvEl�. r SRS -o1 - 1 Vo s� Plumber's Address (Street, City, State, Zip Code): o v _ 2110Gir J vC u-4S OtV W-) ( IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuin Agent Signature (No Stamps) Surcharge Fee) Approved E] Owner Given Initial Q Z/.3 Q aAdverse Determination 6 l X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber toT 7N NN ,Zia�f A 7 s -R VQ r r I J ✓ S L . , LOT \ 1 s `< , ; r k .. t X .. N "a N w 0` x Q N N O LD r- V _ T f, T O T A 9 O N O !z N N Q w CL to N. ggg ' 0 c co w w �O (d O c O .2 cu N L O O c N > p� ' _ O p •O O N CL O O x 4 N L E T 'N • O y O J c- E N plc �; E a�a� a 0 c> >oo —o� cu N_ > O m O J cd LL O :� 2 U O p O 1 ` b a 00 zo Re Ui �. °' ) LU `" rz S v y COO � a CR r E 8 R co \� V ca C Z.0 !n c CO O W c, E C y m G a� c C co °° U 6 o O ce Q C � U a o � co W � �^ Q o L In o w c� � T �" g co y F � .c � vJ ffi "It . J Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 D'aision of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmentat By Design Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and _ St. Croix _ percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Pleas t I f ih /matlon. Personal information you provide may be used for ..puirftises"(Ppvdcy Law, mss. 15.04 ( (m))• y M B / D Property Owner 'Property Location f " Miller, Sam _;` E1 % �� Ggvt Lot NE 1/4 SW 1/4 S 12 T 29 N,R 19 W Property Owner's Mailing Address LAt # Block # Subd. Name or CSM# Troutbrook Road r 48 Tanny Ridge 2Nd Addition City State i,,Code Pbdn~Mr City El Village ®Town Nearest Road Hudson WI ' 4616 _ '(AUNTY /' Hudson Moon Glow Rd ® New Construction Use: tNum ms 3 ❑Addition to existing building Replacement Pub rbtnr> e I ribs — Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/fP .8 trench, gpd/ft? Absorption area required 643 bed, fP 563 trench, fly Maximum design loading rate •7 bed, gpd/fF •g tr ees, gpdff Recommended infiltration surface elevation(s) 96.30 ft (as referred to site plan benchmar Additional design / site consideration Parent material LOESS OVER OUTWASH SAND Flood p lain elevation, if app licable na ft S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ®S ❑ u ®S ❑ u ❑ S ®u ®S ❑ u ❑ S ®u ❑ S M u SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistent Boundary Roots GPD/fF Boring# in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tr .......... _......... 1 1 0 -12 10yr3/2 - sil 2msbk mfr cw 2f .5 i .6 2 12 -102 7.5yr5/4 - gs* Osg ml - - .7 i .8 Ground elev 100.70 ft ! 0- Depth to limiting factor >102 Remarks: * with bands of gs 7.53r4/2 2 1 0 -10 10yr3/2 - sil 2msbk mfr cw 2f .5 i .6 2 10 -100 7.5yr5/4 - s Osg nd - - .7 i .8 Ground elev 100.65 ft n.z Depth to limiting factor >100 Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson _ 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, W1 54017 2/5/99 227387 162 PROPERTY o wNER: t+Qi i., sam SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL LU Environmental By Desi Horizon Depth Dominant Color Mottles Texture E nsistence � Boundary Roots Structure GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -I1 10yr3 /2 - A 2msbk mfr cw 2f 5 6 2 1148 10yr4 /4 - sil 2msbk mfr cw - .5 .6 Ground elev 3 48 -102 7.5yr4/6 - s Osg mi - - .7 i .8 1 00 . 42 ft DeA to limiting factor >102 Remarks: Ground elev Depth to limiting favor Remarks: Ground elev Depth to limiting factor Remarks: Ground etev Depth to limiting factor Remarks: .4 ENVIgONMENTHL BY DESIGN 1432 120`h STREET, NEW RICHMOND, WISCONSIN 715- 246 -2454 5 2"W ADq)CUq0%,iW," PAGE 3 NE Y SW 'Y, SECTION 12 T 29 N, R 19 W TOWNSHIP HUDSON COUNTY St. Croix Wisconsin -a� E V) d D 7 4e � TOJr yak O 6� �S SCALE 1" =40 Tom Nelson BM 1. SW LOT CORNER Top of iron pin ELEV. 100' 227387 l BM 2. Top Of Concrete Block On Side Of House ELE 104.45' r Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Vscons In P O Box 7302 accord with ILHR 83.05, Wis. Adm. Code Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number 320 214 Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner N e Propert Location 1 1/4,S Z T Z1 , N, R I E( Property w�er ssMailing Address of Number Block Number xng City, State 0 Zip Code P one N umber Subdivision Nam or CSW Nugtber G X/ 0 , t II. TYPE BUILDING: (check one) E] State Owned ❑ It� Nearest Road Vile Public 1 or 2 Family Dwelling - No_ of bedroom C Town O /Yj DS O 44O4) 2,0r III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Mediiiial 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. ❑ Replacement 3. ❑ Replacement of 4_ E] Reconnection of 5. ❑ Repair of an - System ________ System __ 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 12 Seepage Trench .S /aFW)Aj(j,`2 ❑ In- Ground Pressure 42 E] Pit Privy 13 E] Seepage Pit I t4 F(A. r AA 7 IL �' 43 ❑ Vault Privy 14 ❑ System -ln -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/ /sq. ft.) (Min. /inch) Elevation COO � Z a y "" ' o of Feet 140 Feet VII. TANK Capacit in g allons Total # of r Prefab. Site Fiber- Exper- INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete st uocnted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ 1 ❑ ❑ VIII. 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: ale QbNfL, L umber's Address (Street, Cit , State ,p I . COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanity Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stapops) ❑ Approved Owner Given Initial Surcharge Fee) Adverse Determination — X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber o /3 z4 - 5`v � �� 2 - TfZ o N o L.o7�� r « , ,¢1 ;r o �I = ►Da�eo' `1 -� "lot 0� R, CD;i Cl Q CD w e F r • A co 1 ®�, o w �1 '^ l t • • S fA Ey (A n ', ��,'•. CD D c y. C 2 4•y o a � lb n- (D cD N o N W °. O' w 02 e O r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of Labor and Human Relations Division df Safety a Buildings in accord with ILHR 83.05, W' � � , F .o'�F��la COUNTY o_ r a St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. /4,a'°nA6st incdOde but not limited to vertical and horizontal reference point (BM), direction and %$ "pe Ike or'; CEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMAT ill ;" y WED BY DATE � J PROPERTY OWNER: PROPERTY LOCATION , Sam Miller ;'• byT. LQT 1/4S 14,S 12 T 29 N.R 19 E (or) W PROPERTY OWNER':S MAILING ADDRESS T BLOCK # SUB'D. NAME OR CSM # Trout Brook Rd. -- 2nd Addn to Tanney Ridge CITY, STATE ZIP CODE PHONE NUMBER []CITY - O VILLAGE- SOWN NEAREST ROAD Hudson Wi. 54016 ( ) Hudson Tanney Lane [ J New Construction Use [ J Residential / Number of bedrooms [ J Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd /ft trench, gpolft Absorption area required bed, ft trench, ft Maximum design loading rate ,613 bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) - - - - - It (as referred to site plan benchmark) Additional design/ site considerations Soil evaluation done for plat approval. Parent material Flood plain elevation, if applicable ft � Fu= Suitable for system 0 VENTIONAL MOUND IN ROUND PRESSURE AT-GRADE SY TEid IN FILL HOLDING K Unsuitable for system MS EI U �(S E U �S ❑ U I S O U S❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BcurxJary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITrerch A d Z b L ftA r C 5 2 O A evs Ground 7- S r !yt ! 6,7 01 elev. lout Depth to limiting factor y I p,SO Remarks: Boring # E3 L Ground 7 /0` 4 S m r A / elev. /0L. (Aft. Depth to limiting factor > /O,S Remarks: CST Name: PleaWarrve G. Johnson Phone: 386 - 4080 A ddress: P.O. Bo 91 Signature: Date: Oct. 96 CST Number: 3484 :1&" PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of •� PARCEL I.D. # 1 9 , Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba.rd3ry Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rrtrch L I rn sb1; - 77 r - C5 Z p ,S 5 L 1 r� sbK Ground $ -Cg IMP-41 4- S L elev _ / !li ft. FC M R S M M 4. 0 Depth to limiting factor S ID 5� Remarks: n Boring# I �''•5b� ►'�'1`t GS Z� , h 0.5 L 1 61 sbK �, ��- Cw I� 2 0 3 Ground $� ( -4C 7,s Depth to limiting facto S Remarks: Boring # S 19, 11 -3s 7 -SYk 4/4 - SL 1 rh < 1 0 K 6 A d ,s le-Z si t- 1 yh sb r CS — .z b.3 Ground elev. Depth to limiting factor ] Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: con 000nro n�roo $d g- o / IF r r o q) � '�� as O Lcs� 49 [� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 5 -4 lM YY! l L I CJZ- Mailing Address Property Address I d S Z f1� (' eolqz (Verification required from Planning Department for new construction) -�„ Cit R y 0S O I Parcel Ide n tification Q r 3 2 O tt ty t�l W nttficatton Number y S LEGAL DESCRIPTION Property Location4fi '/., 5 LV ' /4, Sec. Z , T Zq N -R /� W own of #cJ,D soy Subdivision /O6 E Lot # 7 Certified Survey Map # S -3 Z , Volume C71 , Page # Warranty Deed # S�d� �S Volume / 3 / , Page # Spec house L(yes' ❑ no Lot lines identifiable yep❑ 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 fort, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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. Itwe the undersigned have read the above requirements equuements 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. NA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this fort are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of SASIO rty ibed abov by virtue of a warranty deed recorded in Register of Deeds Office. C 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 BA F WISCONS�OR 1 1 --1982 TP 6 SOACII aiscRrco FOR R[collol "o DATA - AARANTYi - 5048zi5 O 1031PAGE 4Jt.) _ This Deed ' made betwt:en CE — r.' CJST4.'V5 -- ...... -.- ....... - - - -• . Randall W. Synan and Patricia E. Syiin, ............................. — _.. •, ^ec'Q nx ReaD•ti . husband wife ............. ......... and , ............................... ... ......... .......... • - -_.. ............ ....... ........ - r .........5.�.�........E'.''.r sari . ............................... 1 .............................. t 10: 45 A: ' ... ....................................... ............................ . .• •------- ...- ......._......., grantee, oeeft Wit�les W. Zhat the taid Grantor, f r a valuable consideration...... *�- Ran all. W. S�+na.. and Patrycia E. Synan i . ............................ ...... .. .............. ' conveys to Grantee the following described real state in St . Croix "aT� "" Te County, State of Wisconsin: t Z Tax Parcel No: ........... " The SE1 /4 of NE1 /4 of Section 11; the SW1 /4 of NW1 /4, the N1 /2 of SW1 /4, and the South 53 rods (874.5 feet) of the SE1 /4 of NW1 /4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. -� AND - � + .a 'i A parcel of land located in part of the NE1 /4 of SE1 /4 of Secti n 11, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1 /4 corner of said Section 11; thence S89 30 "W, along the North line of the SE1 /4 of said Section, 1212.32 feet to the point of :.eginning; thence continuing S89 30'00 "W, along said North line, 66.00 feet; thence SOO 28'03 "E, 500.00 feet; thence N8q 30 "E, 44 along the North line of Certified Survey Map filed in Vol. "3 ", Page 722, 38.08 feet; thence N00 11 "W, 150.00 feet; thence NO3 50'34 "E, 351.07 feet to the point of beginning. .� This ........... i- P.- AQt.... homestead property. a (is) (is not) Together with all and singular the heteditantenta and appurtenances thereunto belonging; And ..... R ,1.rla ... .:...Sy.pAp and...Patr_i -... Synan ........................... ............................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except ,y easements, restrictions and rights -of -way of record, if any. si ' and will warrant and defend the same. Dated this .............. 3 1 day of .......... .... Aliq. LlS. t_....................................... 1g..4... . �.. ...(SEAL) �GlOfilll........... .* 4�t✓ ................. (SEAL) Randall W. Synan Patricia Synan � ............ • ................................... ............................... ... ........................ ............................. .. .....(SEAL) ..................... .....(SEAL). • ................................... .............................. • ................................... ............................... �i r AUTHRNTICATION ACHNOWLNDGMRNT . I ,z Signature(s) ............................. ............................... STATE OF WISCONSIN i ............... ............................... S s. St . Croix a _ --• ....................County. authenticated this ........day of ........................... 19...... partsonally cams before me I .... _ ..day of August ......... 19.. the above named I — _... .._ ^ .........................._ Randall W. Synan, ii Patr E........... ..... ...........•----. .........._.................... A ii TITLE: MEMBER STATE BAR OF WISCONSIN Synan 1 ........................... ............................... (If not, ed b .... �jjCIL ,.00► �Offfi0l'J authorized b -•"" ...... .•• ...... ....... ...... ;i 9 4 408.08. Wis". . Stat_.e.) ........._...........--•• .... ............................... .... I� to me known to be the person . V ......�A��xfcKtlli`t�h}e •I } ( qgulng iastru nt ;and a n wle &V0e*IW�jscoiv n THIS INSTRUMENT WAS DRAFTED BY r Kristina Ogland . ......... ................ Atcol a: t' - l; aW ..--- •- •• ... ................•. •� , Y'� Alice Jo 0 ors i ------------ St.,... Cro ix................................. .................... .............................- .. Notary Public ................ .......................... County. Wis. ' (Signatures may bn authenticated or acknowledged. Both MY Commission is permanent. I not, State ezpuation are not necessary.) i7) date: . ........... ... ... .................... ... ............ R.. 'Names of Demo d,nlnE In any capacity should be t)ped or printed blow their algnatares. - - •- - WARRAW" DIED STATE. BAR OF wISCONstN Wieeon,in Iw[al Bleak Co. Ina MR.M Na. I —lftt Wlw kce. Win. - TANA MIDGE SP HE NWI14, PART OF THE SEI/4 0'F THE NWIi4, FART OF THE NEV4 4, ALL !; .uN 12, T29N, R19W, TOWN OF •;UDSON, ST, CROIX COUNTY, WISCON iii T HL. 1 -,DD, 1 TANI: CGE SPECIAL ADD, LANDS I 1 4TH r.,NE OF T.L Sa1Tn 53 REOS I 674.' 1 OF TnE SEIr4 OF 7N( ..I,. "1B 48 f, f VAT.I)N w St)J ° 24'02 r 'W 1253.90' ..1 � ..• 15) tll' IW.2!' •• - 'lr� — .•rev ', rY9. fir' 19� i1' • S to / N � 916.♦ \/< "�' p . .�� r �� . 1 � LOT 64 LOT , / } (7 I 1 ,. 2 J AC. 777 ',h5 SO. FT. /` �, ai �q / j / ��\`y' ' `1 d "l,ril :W fT. bT, 1111 !U F1 2.50 c loot LSUT I12,7G SQ. FT r --- - LG I 65. N N t �� LOT 64' er,us so i 3 3 AC i ESUt M �A ♦ 1S .� IIQ.4Y1 60 rt. 'O it ♦ � ` I , AC. kxc E5M1 ♦•�` NP LL e•9 71) 42' I /�.}. — Itl719'� - - - 17541 - •. 1954 1' — ... ...r1T. � � _ .ems' _.• �� I � - - -TME - — -PUBLIC 773 4 Ll _zc) LOT 59 LOT t - �♦ �`'. .'i2 AC. EAC. ESAIT � �• \ \M `� 2 IO K N r Ou AC. 4 ... _. .N,•Qf f4.fl ,. '.11. 1 , . 5 „ \ 91 SO. iT. x}� B7, NY Su. rT. (0 `� or q . K. F.. ESwT. �,• b4 .65 S4 FT LOT 46 r u Ac. a �. - � °� .@ 4.'•,797 0 fT. - ►�' ; �� ♦ t � KSmf Y I •r,rle i:T. FT. i40 x2 c j � I 2 r ^) • .. �•. ' , ,t�/ 1,16 At I' N♦ . c3f.W , +4 ^ ry 1 1 1 Al 1 — \ /`. a. E`C . • `fit /�''� r I04,0 3 7 SQ. F7 1 2 tl, I:C. \` ""•a �. //� 97f •41.5, �t ►'�" A: �;1' P LOT :6 Wor 011. ,., rl-s ", ,rn,utr.T(Q OO ' 'y: Li I 1 111 AC O 1 II 15e,19t su rt 1 1 Stl9 '4J 55 4�S.14 I I I r �� -1�� Y tlG AC fxc 1`:'l by •- / i ' 1 � ll 121, d1] Su r FAX ST. CRODC COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016 (715) 386 -4680 DATE: �' 0-99 TO: Fax Number: - ( q C�' g Name: 'Jaw FROM: Fax Number: 386 -4686 Name: �C(� Number of Pages Including Cover Sheet IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NAME: TELEPHONE NUMBER: ST. CROIX COUNTY WISCONSIN ZONING OFFICE 4 N H g q q p N w ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 _ - - (715) 386 -4680 March 8, 1999 First Federal Attn: Tammy 201 South 2nd Street Hudson, WI 54016 RE: Septic Inspection for Sam Miller located 1052 Moon Glow Road, Lot 48 of Tanney Ridge, Town of Hudson, St. Croix County, Wisconsin Dear Tammy: A septic inspection of the above referenced property was conducted on February 9, 1999. This property is located in the NE %4 of the SW' /a of Section 12, T29N -R19W, Lot 48 of Tanney Ridge, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. ely, ames K. Thompson Zoning Specialist /sm