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HomeMy WebLinkAbout020-1304-90-000 S 'O Q o M II. p 6' M C °o I I N I I I i C ~ N U N O ~ t N N o Q) z 3 m I LL c ti Q O Cl) z E Z = O v Z a m o I O z :j c y u o 'o Z v N H Q) z W co ` m V) c o •,y -C Q c c O L) © o Q m Z F- Z U z (D N Q U N O N Y R ~l d N N i U C Q p rl C O O C (L 0 N U (n fn fn _ O I ' D - H H F- - 0 0 O z o IL CL CL CL N g in LO *i o t~ (n 0) 0) m J y rn rn = O N U O O O _ - = I E CO 8 N U *Ali C m ~ 7 ~ ~ p I O w N N ~V O U n N C r C O O O f~ 4 CC ° co O 0 O. a O r N V w O O~ : C O O O O C M C N N m L: C) N N N F- F- In 00 • y O 2 N O N=5 =3 Cn O ~ I w I V ~ a V o '0 O O u(L mc~ Parcel 020-1304-90-000 09/17/2007 09:48 AM PAGE 1 OF 1 Alt. Parcel 11/12.29.19.1517 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner KELLENE MORIS CO - MEETZGER MICHAEL METZGER MICHAEL 1074 BUCK RIDGE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1074 BUCK RIDGE SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.530 Plat: 2535-TANNEY RIDGE SPECIAL ADDITION SECS 11/12 T29N R19W PT SE NE-11 PT SW Block/Condo Bldg: LOT 12 NW-12 LOT 12 TANNEY RIDGE SPECIAL ADDITION 2.53 ACRES Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 11-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 03/05/2003 712103 2162/50 WD 03/05/2003 712102 2162/48 WD 1125/126 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/05/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.530 87,100 182,400 269,500 NO 05 Totals for 2007: General Property 2.530 87,100 182,400 269,500 Woodland 0.000 0 0 Totals for 2006: General Property 2.530 87,100 181,900 269,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 118 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 5.44") ADDRESS /o 7,Bye f- 106E Q~wE 11v/QS0 N w Z S~O~ SUBDIVISION / CSMW 7, hk6/- ,e1r}6Z LOT SECTION- Z T_1? N-R 9 Town of 14LJ D'sa N ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S c A L K: ld /VaTE f2 11 p0.0~ I CaT /3 q1 0 a 7 ~ { 7zo?B"xso~QIeld U44 `f WE CL ~ IC Provide setback and elevation info-mat i o;1 on F(IVoI S~ of th i i0rl`i. Provide 2 dimensions Lo center I~ tin?. m„inl,: 1~'~" 1 BENCHMARK: lob 0 ®/Y -stool-if LoT L/NC G. SD. /OD,00~ ALTERNATE BM: 7-/315 W4L(L O U-1- S LL g_ I 9q = G7SS`o SEP`i'I~ PUMP CHAMBER / HOLDING TANK INFORMATION I Manufacturer: Liquid Capacity: 300 Setback from: Well House /7 Other 7S TO Pump: Manufacturer Model# - Size Float seperation Gallons/cycle: Alarm Location.----- . SOIL ABSORPTION SYSTEM Width: Length say Number of trenches Z Distance & Direction to nearest prop. line: 10o ' To Z00-A) Setback from: well:- 96 , House Other ejl ~ ]-O 6o(oCAZjZ ELEVATIONS 114f}AI HDLF- 2 •!o~ _ ~03,~~ Building Sewer ST Inlet. 4.6S- ST outlet '5-,o PC inlet - PC bottom - Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATIOON,:, PLUMBER ON JOB: LICENSE NUMBER: r 5 Q 3SQ~ INSPECTOR: 3/93:jt t , Wiscon in 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 Pe 1mILLERs Name: ❑ City ❑ Village ❑Town of: State Pla A SAM i CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ Syr c Benchmark 3, J4d. ~ Dosing----____ Aeration Bldg. Sewer Holding _ St/ Inlet TANK SETBACK INFORMATION St/pd outlet (03' 3,5;16 93,9Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet Air Septic 1-7 NA Dt Bottom Dos' g NA Heade Aeration NA Dist. Pipe Holdin Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufactaref_ Demand er.r c~.. u. 9 U9~ ~00 4~5 Model Number GP /J 3 s1' TDH Lift Fri on System TDH Ft mead Forcemain yength Dia. Dist. To Well I I F SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No. Of Trenches P T No. Of Pits Inside Dia th DIMENSION S Sv DI N SYSTEM TO P / L BLDG WELL LAKE / STREAM I Manu Manufacturer: SETBACK INFORMATION TypeO t. ~V ( CH UNIT R Model Number: System: j DISTRIBUTION SYSTEM Header I Vldrilfold „ Distribution Pipe(s) p x Hole Size x Hole Sp g Vent To Air Intake Length Dia. Length Dia. Spacing 1/(L i SOIL COVER x Pressure Systems Only xx Mound Or At-Grade stems On y Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson-1,2.29 1.W, SW, NNW, Lott 12„ Buck Ridq'Ce/Jyr / (~v✓IP xlrc>~~ C4 t!(l c ~1 \ t 'c.?j-':/ Gi7 / /pvr'~.'~r' t j "Z _'Gtc~F'~ c'j_ ,ate' 19 ® GUlL=+' °Y ~ ~~,i`,~ ~ f t. cam-", ~~~n~-/ ,t ~ y ~ '''"1 ~~/~J-~ f kb !~P ~i"eA,~ Plan revision required? ❑ Yes Q-Mo Use other side for additional information. S o~p ~5 p 9 SBD-6710(R 05/91) Date inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 4 te a. : SANITARY PERMIT APPLICATION BureaSafetyu anofd Bildi uildining Water System., s ter 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 8 112 x 11 inches in size. -'~L . Cr'®i • See reverse side for instructions for completing this application State Sanitary Permit Number 8' 335-- The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Spsm 5W114 NtO 1/4,5 T 7 , N, R ( E (or W Property Owner's Mailing Address Lot Number Block Number o Z% "L l Z City, State Zip Code Phone Number Subdivision Name or CSM Number v IDO INN w yon 105191le > 7_-ItecA *Ir A N ~ a (o Road II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ 2 age p VII age \ 1 Public 1 or 2 Family Dwelling - No. of bedrooms Town OF v~ S \ w~ Rk tI. cc F III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo D 2 Z - / 3o 41 - 90 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10E] 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 130 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 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 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 b Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6_ System Elev. 7. Final Grade O Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) "A" 913. S- Elevation 4/-5- 5 Z O d • 18 2. S Feet 9(0 ,S Feet VII. TANK Ca in ga al city Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank OIDD F P_ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, 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: 4 ~L S o o Nb'~~ 5 z Plumber's Address (Street, City, State, Zip Code): fk\ LL L 0 O IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa ary Permit Fee (Includes Groundwater ate Issued Issuing Age Si nature (N to s) Surcharge Fee) Approved ❑ Owner Given Initial VQ~ Adverse Determination D U X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) - DISTRIBUTION: Original to county, One copy To: Safety $ Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable_ 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be 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 const. icted 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 Ccunty. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of I,:oldincl tank(s), septic ?a -,k(,) or other treatment tanks; building sewers, welk; water main ';,,vatt~r service; streams,in lake-); puma or siphon distribution boxe-3, soil absorption systems; replacement system ar;;l th e V--t.ion c f the building served; B, o~ lortal end vertical elevation reference points; Q complete specific alion:, fo f w p, .ir - - ont-cls; dose volume; elev,tion differences, friction loss; pump performance curve; pump model and I;unip m~~~1ui..~: urer; D) crosssection of the soil absorption system if required by the county, soil test data or! a 115 ~orni; arv F) I sizirg 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. ° NoR7y !oT litiE ,~Yv, cb ' li1~vS~~ N r ^y o N p N p N y / ❑ , Ga A h N ~ ~ Dd - a ~ r. ~ D 1 \w y..- ~ ~ ~ x 11,E \ I i / aC U. i C4 ?b C! ti vlOo 1,v 0 o O ~ ~ ~ i 14 1, W ~o 3 D- 14 --y G (a m b x a ~ i c 41- min In o r -V ~p ISO t ~ 1'n r . X ~b E I_ ra N ~ r µ I I ~ i I b m I 2 S (A I' L4 r I i ~ m O t m I , tv I ^ I ~ I Z d I b w r I , ~t IN- 4% I I fh t v ti elb m i ' N ro N O I z kA) o 2 (A I m o , Sl., 1 LA < n r J ~ L O O o ~ N H ` z - 46 fn LA Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page f of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 'J T C R t k not limited to vertical and horizontal reference point (BM), dire of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to flea ttSa~. 10 APPLICANT INFORMATION-PLEASE PRINT L ORMATI0 REVIEWED BY DATE ~j PROPERTY OWNER: PROKIRV LOCATION AM t?1LLEA GO SW 1/4 Nw 1/4,SiZ T Z9 N,R ~9 E(a)W PROPERTY OWNERS MAILING ADDRESS} r LOT LOCK # SUBD. N OR CSM # cD y` " J ANN Y 1C CITY, STATE ZIP CODE P ❑ VILLAGE OWN NEAREST ROAD ( t kjflx U&&S-k) -A Aj n►~ ClnN~ WNew Construction Use [4 Residential / Number o ` roor0s (J Addition to existing building j ] Replacement [ ] Public or commercial descxibli Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations IZ-'A i- w 7roo INC)"ic- Fad AT A-tafokoVp -L- Parent material Flood plain elevation, if applicable It S = Suitable for system c NVENTIONAL MOUND IN ROUND PRESSURE T- RADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U 0 S ❑ U INS ❑ U S ❑ U 91 ❑ U ❑ S CCU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color' Gr. Sz. Sh. Bed mrch 4 13 8., O -b ovAz3 z - L, "slot m r S Z 0,4 o s 6-n -7.sy +14- _ S(- r n-, l Lw o _4 a:~ Ground 8Z -1 Zd D`/ 4 r !►i Q O.~ elev. 92 ft Depth to limiting factor c)b i Remarks: Boring # L C'S 7. sy 4 m CU z~ (3,4 30j z V:?- /8 >c~ oe 44- S !vf 6.7 oZ Ground elev. 9SS9 f Depth to limiting Remarks: CST Name:-Please Print 4 RVI-v N N ,~CN Phone: dress: . d c) ~N Sn n/ Signature Date: / / / 7 9 / CST Number: e PROPERWOWNER SAM MILU10 SOIL DESCRIPTION REPORT Page of PARCEL I.D. # 'LOT , -Td N,v ~y IU-- t Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench l4 0-6 fayi23 SL 1 m cr thh it CS Z 4,4 ~.S -i~ 7,sY a Q S d r rn 1 c w 0•~ 0% Ground 61 -127 16'14414 S Q ~V► 0O`~ ebev. ft. 96 Depth to limiting factor >10-~ Remarks: Boring # N 0_6 /Dy 3 S~ I Al ~.r M Tr C 5 Z~ d. 9 d S lovk 4 4 1 m s6~e- mli,- S0.4 ~ Ground a 54t 7 SY 4 S ® e th C W J 0.7 0, Ground 83 Z-)1 1 y,24 tl r ri~ 0.7 9S.Fs7 ft. Depth to limiting ~ .YZ Remarks: Boring # S -7-7 6 4-14 C I 0.4 ,E 15 7.S 4 /4 S (3 c to I CL,) O,7 O,`6 Ground $Z 7-3 g elev. 10` S n, 0,7 r~ Depth to limiting factor n-ia% F-7 Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD-8330(R.05/92) ~ X23' .00 LoT!? LT 3 Scac z~ / h 30' C,~,' CLEF/A An etc► = tz'. • e t fix,, I SOfvR'l i a ~ ~ ~ 8 S4, H 4 g s a s bet 88 al I I I 6 M ~ ~ I I r (V s F- v z G t/ 1 N Y \ J Z _j Ij V) U) So t z 4p u ~ 241 91•1er A LM to 2 F-1 ~jy 1 W 91 0I E;~ 10- a. w, yl l S/ j' rrorz a aor. ros A -J. J~" § 1 , ~1 pr - 8 w V+ r, p 1 Cr J UN' 9 1 Q ! K nos avo _ 0Nf10W ~1-- mou Z - - F- Y In A Z - creel a as «.g 1 _j r) Q v r r (D a ~ tU~ k F- z z S, F- r z N U) \ \ 0 ;1 0 ;f _j -i G 051 051 F_ qg _j a J 1 $K \ :^O'" ~ 8I • w.v.oc _ »a1lN. •Mi1 =M1 b Ma. 1Ml !0 .Wl l..e Wig a31mgFm A S ~ E .~e as 3a e tai "z :reed ;sa~.zze ~ ~s 1 ei =sz~777ynz gyp, ea°a~ i•«.a.r eYr ~ ew 4 .=IM.p 41 IIp17Mib 7M.1.TJ Mj trM-uas iu al asraYLa, an H~.Y.p U= e = • e . s ~I q Ysia•aiv.:sia••a° r iw. .e•ra :.i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S V~ M MAILING ADDRESS "60YCY-' ? _Z "Z- *QD S 0 %N \ S J Q t ~ PROPERTY ADDRESS ~ 600j- Q.\0bE_ \kOtN 9 (location of septic system) Please obtain from the Planning Dept. CITY/STATE V Q 5 p W\ SCI 0\ lp PROPERTY LOCATION 6W 1/4, 1/4, Section Z T__?::~__N-R l W TOWN OF N ST. CROIX COUNTY, WI SUBDIVISION N K 1Z~9 6 LOT NUMBER ~2 _ CERTIFIED SURVEY MAP 5_2 S' VOLUME (P , PAGE Z S , LOT NUMBER 2 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: YMIQ0--~,a DATE: 5--- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, Wt 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 only 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_ 5 A rv\ OA 1 LL _ (L Location of property SuJ 1/4 N (A) 1/4, Section I -z-, T 2t N-R Township f+uD.S Mailingaddress Q3I-OX o ~l 6L)D sr,k w I s go H. Address of site 107L( 13ULIL Rtt)6E Subdivision name I ANMV IZ(D6a Lot no. /Z Other homes on property? Yes A- No Previous owner of property R A D ALL s YNAN Total size of property Z; S3 Ac- Total size of parcel z. T 3 AL Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? X Yes No Volume 163i and Page Number 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. ' - SD S~ 8 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. 5°'{£SS'S nature of Applicant Co-Applicant C9, -a,s--9_ Date of Signature Date of Signature f ; I► DOCUMENT NO. STATE BA F WISCON$I ORM 1-1983 THIS sOAC[ RESERVED FOR RECORDING 2ATA ARRANTY 0 D 504855 YOl 1031MGE 4% _ r.' C)STER'S OF1CE t This Deed, made between e n and Patricia E. Synan, tec'-j W Row d Randall W. Syna hus ba nd and wi Grantor, SEP 1t 1993 and .Sam E. Mii:`e..... ...-s_3-ngle person Ct 10:4 A . M a-ns . r oa.a. Grantee, Witllesseth that the said Grantor, f r a valuable consideration...... ~y. Randall W.'Synan and Patricia E. Synan conveys to Grantee the following described real estate is St • ero i x TO County, State of Wisconsin: 0 Ta: 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, Tovn of Hudson, St. Croix County, Wisconsin. AND A parcel of land located in part of the NE1/4 of SE1/4 of Section 11, Tovnship 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin further described as follovs: Commencing at the E1/4 corner of said Section 11; thence S89 30'00"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 S00 28103"E, 500.00 feet; thence N8q 30100"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 1_9--A'Pt_... homestead property. (is) (is not) Together with all and singular the hereditamenta and appurtenances titereunto belonging; Ana.---.Rartda.lj.. W_:...Synan and Patr-icia...E_.._.Synan.............................................. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-vay of record, if any. and will warrant and defend the same. Dated this day of AuguS.t_.................................. 19_..~ a'~'! .w-- 04o---(SEAL) ~C7alrlL.u .E. !(1..-✓ ..........................(SEAL) Randall W. Synan Patricia S S ynan (SEAL) . ......................................(SEAL) - AUTHENTICATION ACENOWLBDOMBNT Signature(s) STATE OF WISCONSIN St. Croix County. ; authenticated this day of 19 P nally came before me ✓_-i.---..-.day of AuguS 19_ . the above named ' Randall W. S' y- Patricia E. TITLE: MEMBER STATE BAR OF WISCONSIN Synan (If not . p authorized by 4 708.06, Wis. State.) to me known to be the person H"axh he I' L r going instru nt ;and s n wieg ft.*tN ~fSCOns THIS INSTRUMENT WAS DRAFTED BY ' r ; Kristina Ogland At:carney--a-t__l:a`v------------ S Alice Joy onlhors gt.....Cro a tio; . be a _uthenticated - or r ommission is permanent. (jf not, state gpA-V I. are (Signatures not may be a Y acknowledged. Both oth My C t ' date- 1 -r •Nsoaea of persons ,1Eaine in any upaeity should be typed or printed below their signatares. WARRANTT DIKED STATE BAR OF WISCONSIN Wisconsin Leal Blank Co. Inc. FORM N. 1 - 1912 Mil.aukee. Wis.