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Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inche in size. Plan must include, but a 1 C126) ,x not limited to vertical and horizontal reference int (BM), direction % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location an lance to arest road APPLICANT INFORMATION-PLEA `IN7!Kt RMA* REVIEWED BY DATE PROP PTY OWN R: - PROPERTY LOCATION Q L~~ 'n Alf GOVT. LOT NE 1/460 1/4,S 1'Z T -R AR / ! E (w) W ~C PWERTY OW9R':S MAILIN Q~ D DDRESS SAY LOO~TT## BLOCK # UBD. NAME~ OR ~'cDU Ta N I fa /~~II CITY, STATE ZIP CO ER, []CITY VILLAGE OWN NEAR ST ROAD/ 7X1,uu8Y [ ] New Construction Use[ ] Residential / Number o drooms (j Addition to existing building j ] Replacement [ ] Public or commercial describe / Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 6.6 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 6 . s bed, gpd/ft2 O~trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE QT,•GRADE STEM IN FILL HOLDING T K U= Unsuitable fors stem as ❑ U WS ❑ U WS ❑ U IKf S❑ U S❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bourtdary Roots Bed Tmrich Lima A 10A 6VA L sbK n, Y S OF I kc£: L Ground2 -123 JISVP- `-S S6 !ti - 16-S 0.6 elev. /d. Q ft. Depth to limiting factor Remarks: Boring# A L l I't-,Slob /hr' CS Z~ A fl~ sic 1 61sbt 4), w l ,Z 03 Ground . . g -I Z7 MV d S sG `a I ft. Depth to limiting fact0 orb Remarks: CST Name:-Please Print Y~ JONN~1,, Phone: Address: Q~+.r Signature: tv,& Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # w " Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rich M -17 6Y2 / L rh sly, rn 4 .S Bf /7-31 o PK4 sI~ msb m6r- cS I a.Z a.3 Ground -S-Z 7-Sy 4 4 rf'S SG ~S 6,5 p l ft. 2-I29 y,Q 4 S SG Depth to limiting factor_ Remarks: Boring # ' p-11 16A RV/ - L l m w Z 0.4 D S R //-ZZ ~d~~Q 4 5 L I rh sbK m C S 1 D 2;0,3 7-M 7.svr2 4 Cs _ 6.s o 6 Ground elev. $ -/3~ 1 4 ~S Ski m ft. b.S D. Depth to limiting factor -7 /a, 3 Remarks: Boring # A 0-9 loxk 3 1 rh, ; c 1.3 ~ 5.4:6 4s- 9-/9 v44 4 o.3 $-z 19-41 '7.&Y94/4 FS SG ri► CS 6.S d-6 Ground elev. D 1-13) IbA 4 ~S 5G m 6 S CS.~ ft f eeppth to limiting factor 7 9Z' Remarks: Boring # Ground elev. ft. Depth to limiting factor F7, Remarks: SBD-8330(R.05/92) c r ~ _ ~L~OA1 C.7~~~ Tip i d R Z r Q _ I S 'P I .p I IN J W\ I I ~ J ' n ~ zi SAS J r 1 j I Sd - ~I r' I ~ cA a vZ O q°-' - 73 r a a ' I I rn cqe , ,pf 1 ( o w ,\r SLOP1~ ~ 121 ~ ' t 7 17 S'Q J ' LA . I v Q ` r n 1 m (7 r R► c~.l m n r r r j ~ p I STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 5 f} /~j l L I- E~ ADDRESS /4 7jp~ ~L QGt> /2oA O SUBDIVISION / CSM# 7)fA/A/Fq API/)/- LOT SECTION t Z T 'Z , N-R Zf, Town of SD !V ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r s / SP 5 s o~ ~ Fia e1 s U1, 2 fn "7 E r = ► oo, cc^ ~icT~R Nt\ r f P i !QV O TIN, ,4XSa38 R3oi INDICATE NORTH ARROW ! t)2iv15. w~4Y Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- r BENCHMARK: -7-pi) or Lo% PIP Ar, 1 S~ SS ~ ~Qa a~ ~ ALTERNATE DM: I P D (L a 1.C) `IC 0~3T .L'~0 l a $ o~ _ 9 (:SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: U.) r=. I 5 Liquid Capacity: -2-.T-0 Setback from: Well /oS"'-` House v d Other S'(oTe SECaRN~~ a~ l~Id„S ~ Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length ( o cO Number of trenches 3 Distance & Direction to nearest prop. line:-/3 Te ,Savy le7 Setback from: well: ASS _t House 10 Other 17 ELEVATIONS Building Sewer ST Inlet: '/l'Sir!75:7 T outlet: ~0 1/0 yj- PC inlet PC bottom Pump Off Hea er/Manifold Bottom of sys7em / r11o ~ Existing Grade , ld / 7Fina grade 7, ( r DATE OF INSTALLATION: PLUMBER ON JOB. LICENSE NUMBER: L1 INSPECTOR: 3/93: it Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299115 Pdrmit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MILLER, SAM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax 0- J 020-1325-20-000 L /DO~ /dO~ 5~y TANK INFORMATION 1( f ELEVATION DATA A9700433 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 05,5` Dosing 3 Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header/Man. uo 52-. s•~~,. U 70 ' vu. kj' , Aeration NA Dist. Pipe .<,;L! A 41,,7V Holding Bot. System 3 PUMP/ SIPHON INFORMATION Final Grade X 1q, q Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTIO SYSTEM BED/TRENCH Width Len th No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth DIMENSIONS DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type Of /lt,,> CHAMBER Moe Number: System: -v OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over TDepth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center V ed / Trench Edges o7,? b Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 12.29.19,NE,SW 1047 MOON GLOW RD TANNY RIDGE LOT 55 07- i3 Ajb 01 Plan revision required? ❑ Yes ~No rA (,I koj Use other side for additional information. 7 `17 r z. -a SBD-6710(R 05/91) Date d s ctor'ssignature Cert. No. r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION Safety and Buildings Division Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs f( ❑ Check revision to previous application [Privacy Law, s. 15.04 (1) (m)]. A61147 /fit 1Y00n Ol ow Rd.. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name P operty Location $Ait1 WIL~11i, 1/45 U)1/4,S L TZ7 ,N,R/q E(o V~ Property Owner's Mailing Address Lot Number Block Number 13oX ~ iS ~ City, State Zip Code Phone Number Subdivision Name or CSM Number f oascaN W ( -5, t/40,111, (33(.) 7.7 4 E 12 I 414- II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road el El rowan OF a ®w MM4/ a4ocd /Z L) Public 1 or 2 Family Dwelling - No. of bedrooms III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 16?. Q qr 19. /6 fff 1 ❑ Apartment/ Condo O Z,O 3 s ZO 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. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. E] Repair of an 5aSystem 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 11E] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit 43 ❑ Vault Privy 14E] System-In-Fill 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 e~ Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft_) (Min./inch) 0. Elevation 067 *15-0 9 as • ---a- 9 y 40 Feet Feet VII. TANK Caacit in all0 5 Total # Of Prefab. Site Fiber Exper INFORMATION g Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank x / 7i S C~ ' W E; 5 > ❑ ❑ ❑ ❑ ❑ LOM Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VI11. 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 S mps) MP/MPRSW No.. Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 0 70 Ha Nre A- A_ eA64 R-c K J4 A0,0609 W 5 y0 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination -4~ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety 9 Buildings Division, Owner, Plumber INSTRUCTIONS 1 _ A sanitary permit is valid for two (2) years- 2_ Your sanitary permit may be 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 submitted to 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, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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. 0 IA z c z ML Ri ~ R u ~ Q p ~ y v 2 oa-~ va x c r `C s W ~ d I y -jk - Ff,: 04 o_ 1 3Z. U t W a ct_ i -Ift ► 0 _ .y z ; 1 -b u o p +1 kA 01 w m I I f v { Z m ~ o Z , IV C6 N 0 -Tj L Wisconsin Department of Industry, 1 3 - Labor and Human Relations SOIL AND SITE E V A L U AT I O l O R T Page of bivision of#Safety & Buildings " v in accord with ILHR 83.05, Wis.' Adm-. Mde 4 COUNTY St. Croix Attach complate site plan on paper not less than 8 1/2 x 11 inches in size. Pian must includ' 'but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or T RCEL I.D. # dimensioned, north arrow, and location and distance to nearest road.. . APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RED VIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Sam Miller GOVT. LOT IVt 1/4~~ 1/4,S 12 T 29 N,R 19 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Trout Brook Rd. S5 2nd Addn to Tanne Ridge CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE E]TOWN NEAREST ROAD Hudson Wi. 54016 ( ) Hudson Tanne Lane [ ] New Construction Use [ j Residential / Number of bedrooms (J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 0.1;7 _bed, gpd/ft2 6.6 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate ~ bed, gpd/ft2 a •~X Uench, gpd/ft2 Recommended infiltration surface elevation(s) - - - - - ft (as referred to site plan benchmark) Additional design I site considerations Soil evaluation done for plat approval. Parent material Flood plain elevation, if applicable ft S = Suitable for system CO iiVENTIONAL UND IN-GROUND PRESSURE AT-GRADE S~YSTF1d IN FILL HOLDING K U= Unsuitable fors stem ®S ❑ U IS ❑ U WS ❑ U S❑ U fd7 S❑ U E3 S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BRoots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch -Il, i - L m k ni r cs -O-A- 5 5 Ground -lZ /QY 4 4 $ el v. /D ft. Depth to limiting factor Remarks: Boring # _ I&I 3 r L I m be or~- CS Z~ Z 91 ;6-21 10"14414 'Sit- 1 r~ b~ t /-S7 16XIP-414 - c F9r Yh ~ c... - O. ~.5 Ground 7- / p~ j $ ¢ _ S rit r /h 0.7 O. 9 ev. ft Depth to limiting factor Remarks: CST Name:-Plea nnt Phone: 386-4080 arve G. Johnson Address: P. O B 91 Signature: Date: Oct. 96 CST Number: 3484 PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD%ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trench -I 161IQ3 I A sbK m r w Z~ O .q ,S 17-~T /D1 2S SQL 1 A, zbK M L~ Ground - S-Z 7.Sy 4 Qr S V fh r 1Yt CS d. x.15 lev `1 e ft. 8 -1 16y4 A L3 6.7 69 Depth to limiting factor Remarks: Bori ng # 4 0- I J /0~/r23 / - L / rrtsb /h r Cw Z 6,4 :b EN cs 9-z ?-44 IS`RI Q CS O.? A; Ground elev. -0 Ib'l2 S f~ r d,~ 0 44 101 ft. Depth to limiting factor > 1.Qig3 Remarks: Boring # k. A L 1 rh sb rn -~a- C w 2 ,9 :05 5~ ~ -1 Id`/~2 4 4 S >L. /h -S k M r CS ~sr O.L 0.3 Ground 9- 4 7.SV, A S >h r rh CS 10 eft 83 41 13 /6YP 4 3 S rn r !'h / d, z Depth to limiting ~ f~cto ~ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: eon o0 on/o nF!n O\ X r rc s Z 45~, ~U i IT s ~ ~ ` \ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Lt-*:: li-.,.,_. MAILING ADDRESS Z(OX /S f PROPERTY ADDRESS I Q 'q - MOO i4l 16 ZO CJ,' (location of septic system) Please obtain from the Planning Dept. CITY/STATE A L) XS 4 0 W f `/p t (o PROPERTY LOCATION NC 1/4,'5L// 1/4, Section I T__Z-~N-R / TOWN OF (4 L)O ,.,So k( ST. CROIX COUNTY, WI SUBDIVISION `C U 4' ( LOT NUMBER 3 S CERTIFIED SURVEY MAP S 5703 , VOLUME , PAGE? , LOT NUMBER 5 S' 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will dnly result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property III 111 1 L L F iL, Location of propertyll/ 1/4~1/4, Section I -X- ,TAN-R Township a uc e 19 Mailing address a(nX Address of site q '7 t" bO'/ ~ / Df► 1, Subdivision name A NNt J~ IZ0"L Lot no. S~^ Other homes on property? Yes u No Previous owner of property K,n A L._.[. $ ylV Af Total size of property c t4 4__ Total size of parcel '0 L.- Date parcel was created? 1 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? ~'_Yes No Volume & 31 and Page Number -S~ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner (s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 1-41 1/ g S`S- , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signs ure o pplicant Co-Applicant Icc - ~ I Date of Signature Date of Signature THIS 8114C[ R[AtRY[p /Oa etCORO1N0 7ATA oocuMeNr NO. STATE JUAF WISCONSI ORX 1-1962 -V AR~'A tJ D ~+D SO48SS OL 1031►AGL 56 :CIST4R'S OFF CE This Deed, made between .........itanda.ll. W. SXnan and Patricia E. Synan, .....husband ,.and vile t Grantor. ! SEP T 1993 and....Sam .E.....r!i.l:le................ person 1 it to:45 O : M 7 a . 7 a-s. ~1 aw L W1tI1@SSeti . . h, Us . t the said Grantor, f Orantee, r a valuable consideration...... =r. Randall W. Synan and Patr~cia E. Synan t • Cro x SATURN To conveys to Grantee the following described real ptate' in County, State of Wisconsin: Taz Pared No:..-.......» " The SE1/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 y< 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 Tovnship 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin. FF~ AND A ' A parcel of land located in part of the NE1/4 of SE1/4 of Sectib"n 11, Tovnship 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin further described as follovst Commencing at the E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point 'j of .,eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence SOO 28103"E, 500.00 feet; thence N89 30'00"E, „ along the North line of Certified Survey Map filed in Vol. "3", Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. This kP...r.%R.t.... homestead property. (in) (is not) 7 - Together with all and singular the hereditaments and appurtenances thereunto belonging; And..... RBAZda.1,I.M.. ynan _ n Patr.ic.ia ._E.._S nan warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Dated this 31 day of .....aug.LiStL....................................... , 19 z ayt . V~!!^ 1t4~ V (SEAL) .4 ..............,~.4~et............................. (SEAL) Randall W. Synan Patricia Lo. S nan • •~I .................................................................(SEAL) .............................................................._.....(SEAL) i • • i ' AUTRSNTICATION ACKNOWLEDGURNT ' Signature (a) STATE OF WISCONSIN tl .z St Croix Conn i authenticated this .........day of.. . . County 19 Aug Pemnally came before no '31 .......day of ii 19........ t1w above named II TITLE: N EMBER STATE BAR OF WISCONSIN 5~►1~a...... ~G1tlI0r'1 (It not. AI~. j I~ sathosized ti~.4 T08:06.•wL. Sta4:)1 ~r~~;g~ i to me known to be the person f .NQWYX ftisR't~l a I rd Z b (!1 m F.{ r 'a"" W ~ ,..,.«~.1N'•~,,., ,r~11~d~M+,'t, ~«9MN~+!~n+~IpMI1iR~{'r+u~a~.+~+.w«wn~ISIM•«,w....,..~.w..... G O C: O d £ N N r m~ r 0 N p 3 m 0 d N c c o c1 rt 00 a T d A !Z o N p _ c (fa N w Ln c S Z y z o to N C N N C ~yO1• fD N m m o ur o is r-~ 1 lfl N 3 a (cD ID co CO o U1 a ` m ` u p _ Co CD (D M cn F) O O N N a Z p N \ 1 0 0 -0 0 :3 CD :E CO CD UI -1 co o C (D a 0 O 7 A p O o d `m o O O C D C) C a `D N 4 _C) N H \ C C O N Hi-3H~, 3yyZ N3 o f J Ul ! o ° d ta &I- m rn Z O Z` y (O (0 ~ (A 0 cc -4 -4 ~u En CL rT C7 0 a d w-~J A o 0 0 o g (Q o cn i 0 cn I o 2 o (a co CA n m~l (D_ ro o 0IQ MQQO 'm p r rt _ o (C (D ct O t O N 3 m m u, n a v ~ N Ln J z m O N N ° z z ! of D 7 0 D v o -0 a 3 m N h • 3 CD p C/) ti a 'D CD D w (aa a a (D - z CD -1 N :3 O A z A n A z 0 v a C 3 O E, _ z --q W M N N (D M (0 z 0 3 A Cl) C y z F A av) CL r- D o_ a O N ~ N a G_ N M N (D U1 C K M CA) T (D o F m v a z a N 3 go O I o v T. ~ th oz am 3 m COL° m o orw 3 a -0N cn J' CD v~N D a +i Op 770.3 i Ln 0=3 ; a 0 =r r 0 :3 n ti G) Er o o _ v F w a N 0 N O EA O oho O CD O p Q ~ y Parcel 020-1325-10-000 01/12/2005 09:07 AM PAGE 1 OF 1 Alt. Parcel 12.29.19.1683 020 - TOWN OF HUDSON Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax,AddyWW., Owner(s): * = Current Owner * PHILLIPS, CARLA M CARLA M PHILLIPS 1043 MOON GLOW RD HUDSON WI 54016 Districts: SC = School SP = Special operty Address(es): * = Primary Type Dist # Description * 1045 MOON GLOW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acre 0.000 Plat: 2534-TANNEY RIDGE SPECIAL 2ND ADD'N SEC 12 T29N R1 9VV LOT 54 TANNEY Block/Condo Bldg: LOT 54 SPECIAL ADDITIO 2.57 AC EZ-1-1260/298 NOW PARTS OF LOTS 53 & 55 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 12-29N-19W NE NE Notes: Parcel History: Date Doc # SGNy' Vol/Page 9/17/1999 610530 1457/153 0 997 2004 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/05/1999 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 Totals for 2003: General Property 0.000 0 0 0 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