Loading...
HomeMy WebLinkAbout020-1305-00-000 Q c m ° I p °q N h c a 0. 0 ~ I r, I p N N r.' wS' ti I c e aoi c aa) a I CD ~ ~ I I c o I U D c Z ~ a p U. c -o o ns 3 Q o I I 3 co v a' z ~ I ` rn z °o z L a N C14 a m 0 o z d c m Z v o o to F- a5 Z c p a~ m N N ` j~ i, N a a .`iJ o a~ I y C ~ c Q r c O O o o Q w m z 1- z N z to V Q1 ~ Y c CL c (D •al i Q) C O a) Mn C D O a O N C: E C) 0 't 3: 3t 3: O O O z •~w `O IL IL IL 0 0) N to ~ C) I, N rn rn } 7 N O U-) 00 E = O O N 72 G o 7 Co J _ N N 0 0 `r° I cc ® O O C O O C C E M O U') o E w a a c .-a r' N E O r O GFy co CO D L L r- O N rn (n d° o H H N O • 7, NC~ 7 M N E E CJ U O 2 N O N co C~ E •E Q .a a a a d 'u y v E 'c c o Coo r A 0 a 0 in 00 Parcel 020-1305-00-000 09/17/2007 09:52 AM PAGE 1 OF 1 Alt. Parcel 11/12.29.19.1518 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 O - SALTNESS, DAVID A & PATRICIA A DAVID A & PATRICIA A SALTNESS 1076 BUCK RIDGE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1076 BUCK RIDGE SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.240 Plat: 2535-TANNEY RIDGE SPECIAL ADDITION SEC 11/12 T29N R19W PT SE NE-11 PT SW Block/Condo Bldg: LOT 13 NW-12 LOT 13 TANNEY RIDGE SPECIAL ADDITION 4.24AC (EZ-U-1130/231) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 11-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1135/132 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.240 91,700 211,200 302,900 NO ' Totals for 2007: General Property 4.240 91,700 211,200 302,900 Woodland 0.000 0 0 Totals for 2006: General Property 4.240 91,700 211,200 302,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 S STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SAPS 171 ADDRESS q0X 'Zg -z #aD.SO N uJ f SS/d /G SUBDIVISION / CSM#-rAN UFO( 'k/,D(E LOT SECTION t Z T Z ( N-R (7 (Z Town of 403>SON ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM q o b ' I ~ ILA TAN*2)El~ 10 , fi~ P o " t oT P/P4 f1 T A(k) e- 60 P/5Z- 3 a SC LE CO/-DF:54c PGF bk1VE uJA V yes? WELL ► 1 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i BENCHMARK: IoP ZA T NUJ coT Ca~N /mo o S- ALTERNATE BM: 7"D P O 4 p J F-0 v EPTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Is F le- Liquid Capacity; Setback from: Well House l~ Other TO Pump: Manufacturer ~ ~ C~Q~E~ kd~1£ Model#__ Size Float seperation Gallons/cycle:- Alarm Location ':SOIL ABSORPTION SYSTEM Width: Length (o p Number of trenches Z Distance & Direction to nearest prop, line: S /%o s% Z l/y~C Setback from: well: 13- ° _ House _<47_ Other-221' To s ~ ELEVATIONS Building Sewer ST Inlet; 3L=9ys~ ST outlet 9, ?8" PC inlet---. PC bottom Pump Off - -ti Header/Manifold /Z-3S Bottom of system Existing Grade /O, D~ ~ ~ 9d 3a Z 9d,Dc~ Final grade /0,0c) 9~os- DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93: it J n Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Parr t Holder' l\l% E • ❑ City ❑ Village Town of: State Plan o.: CST BM Elev.: aAM Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer o fl~ - - ~r aJ Holding St //R( Inlet 9911 TANK SETBACK INFORMATION St/ ICE Outlet d • X71 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >50 7 NA Dt Bottom Dosing NA Headers-. Aeration - Dist. Pipe l3 9/~f,r7l~9' Holding-- - Bot. System I PUMP / SI PHON INFORMATION Final Grade 95137 Manu Dema 6, 7-" M del Number GPM TDH Lift Fr' on System TDH Ft Forcem ' Length Dia. FFii Dist. To well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits inside d Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM ILEA CHI Manufacturer: SETBACK CHQrI BER INFORMATION Type of _ ; :f i Model Number: System: Ed e y~tS `~5+ 47 R UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) „ x_Hole Size x Hole Spacing ntake Length L/ Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S !s Only Depth Over , Depth Over < xx Depth Of xx Seeded / So xx Mulched Topsoil E] Yes ❑ No ❑ Yes No /Trench Center - 7 B~ / Trench Edges mil ! Z,- I COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.12.29.19W, SW, NW, Lot 13, Buck Ridge Roa d ' o!'f1'"-fr~G1^ Plan revision required? ❑ Yes 'No Q Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signat re Cert No. it ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i • ~i€.~ r~'i SANITARY PERMIT APPLICATION Bureasafetyu aofnd Buildi Buildi ng s waater System, 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 81/2 x 11 inches in size. 5L • Olro • See reverse side for instructions for completing this application State S~t33e~©Ner 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 SA-M M ILLF- /L 5kA14 &(,/1/4,S/-Z T 29 N,RIt E(o4~W:)` Property Owner's Mailing Address Lot Number Block Number X Z 8' z-- ( 3 City, State Zip Code Phone Number Subdivision Name or CSM Number RuDSo vJ l SyDl (114) 274a1 -rANA!Y R.l 4E II. TYPE F BUILDING: (check one) ❑ State Owned El Cit(Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 El Town of ►TU D 50 ALL R I b~01- k 111. BUILDING E: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment / Condo 45) 2Z r t 30 0 O 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. ❑ 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 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 Flev. 7. Final Grade r-D Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) a t,q1.0 Elevation S~ Z (p 00 - 'ez, 170,00' Feet S Feet VII. TANK Ca in gallac gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel New Existing strutted glass App. Tanks Tanks Septic Tank or Holding Tank 0 D / S 2 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber FL4`~` ❑ ❑ ❑ ❑ ❑ ❑ Vlll. 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 Sig~~ature~~(,,N~~Stamps MP/MPRSW No.: Business Phone Number: MIKE sDoNE L-L-- Plumber's Address (Street, City, State, Zip Code): 4(0l 6 BEN ILL LANE 14Ub.DA W t SyOI IX. LINTY / DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee (Includes Groundwater ate Issue ;Issuing Si ature (N tamps) pproved ❑ Surcharge Fee) Owner Given Initial Adverse Determination X. CONDITIONS OFAPPROVAL /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 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 game, license number with appropriate arefix (e.g. MP, etc.), address and phone number Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. Corplete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the CC Unt.y. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of ?c idincl tank(s), septic tank(s) or other treatment tanks; building sewers; well<,; water mains/water serv!(e; strF ~+rri<_ c r, lakes; pump or siphon tanks, disuibution boxe ; soil absorption systems; replacement system areas; aral the loc.-tior ( f the building served; B) horizontal and vertical elevation reference points; Q complete sped fications for pumps ar;c ont,ols; dose volume; elev_tion differences; friction loss; pump performance curve; pump model and rump rnanufoc:urer D) cross section of the soil absorption system if required by the county; F) soil test data on a 115 4orm- and F) al sizirg information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practice; which can effect groundwater. The monies cglIected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i N !n ~ l 0 7 v, Z U y / (A i h tau ~ q \ \ T G O r- 0 p m p O / ~ o o y J 0lA► c~ \ \ \ o S . ;3p A7 ~ v9~ P = p vy 9a - 1 ~ o oy rh A H~ RI r fn i s N W ~a5 o ~~ay LA a n i1 ~i r m C a I 11 m i O 0 co w m I ~ , I C I ~ I I ~l I I 4 Oll CT1 rlo, n~ I m i f j ~ I z ~ I o IH I M r I N ~ 41 .U I Z W I I m O - I --L-=U ° go " 0 0 Wisconsin department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 ,Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code W COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ~S CRO fY not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to neare ( REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT A 6-144471o~ PROPERTY 0W ER: 1. 00131E TY LOCATION ~a 'f GO T C 1/4 1/4S ZT Z~ N,R E or W -SAM iLLEP, PROPERTY OWNER':S MAILING ADDRESS ....r c!t ' 0 L LOCK # SUBD. NAME OR CSM # 9 '1A AJ /A CITY, STATE ZIP CODE NUMB Cl r VILLAGE OWN NEAREST ROAD ,New Construction Use [ Residential / Num f ooms ( J Addition to existing building j ] Replacement [ ] Public or commercial de ' " 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 : yAt-()A7Zio- Fn A ! pP+20vA L Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE Y TEM IN FILL HOLDING K 'V I U= Unsuitable fors stem QS ❑ U WS ❑ U S ❑ U C O S ❑ U S❑ U ❑ S U 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 Trench 0.4 0S 16- P9 CW 6A OS' Ground LIZ J(~ 4 S v l d, O elev 9! .5 ft. Depth to limiting ct r3 Remarks: Boring # ' 4 _0A 01 -747 A, rki CL -7,& S m C' w 7:4 Ground elev. g t- Ld Y q S r- A/ O .Z ?7 ft. Depth to limiting > /Ga~ V(S Remarks: CST Name: Please Print / 4k(Ly 36N N S60 Phone: 44)%76 Address: T U N Signature: Date: 1111,7194 CST Number:V PROPERWOWNER SAM hLLk-Q SOIL DESCRIPTION REPORT Page?- of • PARCEL I.D. # 4,6_1 Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bourxiary Roots Bed rends 13 A -g /d r2 / L ~h S6K r 4r . w 2 7A ,S 5,-/7 lO~/12 4 S; L / rt s bx j'fjr C w 1 -z- 6.3 5 r A, C w 0:7 .6,X Ground 17-~~ /L /k 4 elev. ft. CO s Depth to limiting f TO;% ~ Remarks: Boring # _ /a 0-7 MIX 3 Z L l m sb rv►~r r- 1,0 2 0A O. ,P, 7-V 16\1R0 m/ Cw / oA 6 S Ground 9Z zZ ft. Depth to limiting ~ctor~ 7 7 Remarks: Boring # OA kOA Oa J -LE ui g-Zd Jay t~ S,L n, laK rnr C w 0? '0.3 13 Ground Depth to ~ -i2 J®`/►~4 S d r n► ~ 4;?'a.8 limiting factor T 006 Remarks: Boring # 13 Ground elev. ft Depth to limiting factor Remarks: SBD-6330(R.05/82) M M ~ Q V' M P x - 1 a S i i F i A c,t V ~ _ r lI ^ O N C4, 4 ~ 4 -.j) a \ U `~a Q v V%-ot,4 r sv n/ a o• V r~ r r n f iari'i~iinineoo C•/r~nVr r/r/~._• --w 0 '~rnr' ~ O WeD RO O" y ~ "rOCC ~rw~ C. P ag $ O L .p q V P O • 0 0 DEMINOD M( R[F(R[MOCD 10 T"E GfT- W[DT M E; nr a n nNr0 .09. DW310N)009W 6[RXNI II, ♦fDYY[0 TO WAR n r V ■ O 6 Ir~(f !rjr o pWw. 0. IF nrr. °•i ~r O •rM"r=Mr rrn i' r 0 • Oi V P O n $ ' G00 ^4 'nviY - a".e 0 s 9 ' e$ G r• UNPLATTZ0 LANDS W[DT lIX[ OF THE ffW OF THE X[W, SECTION 11 Wmm -k E 1244.73' 63.2• ]0{.M r ~ ~ 2.SI M}rD• r-- I8 : s o~ X\ 0~ ~ep`AI JJ Ivlm 0» x ox ~px 4) a ` Z '00; co 03 179.17 ` EDICATED D00 •If. w PUBLIC ROAD _ -j-MOUNdO-ROAD / SOUTH- . g yY r- !~8 JO w ITT I_ iy _ yRf ~1 , Iti m I0 8 m a 1o A W M~ : N Iv f 0 8 I° RI B w • w u o ? ' 1°n ° oa s poa ;p N N K u2.s•• ~ / / ' i V m ~ IUr W w 504 44 oe E 24o.24 o 2 N u2.•Y w o w m ZZ 1X g IN I .d m u OD~DI IO / / ! Da.rY tot Lf) _ / S00 03 20 W 481.72 uo.oo v N , Y 74 4j I•~ I~ It)y1f ,per - S m lj 03. IN 7,fO_ 1~ 'LAY eQ $ I f 1 I0D a' IW O ~^''3~" 0 4092• 10 b m I /T' \ \ _ p T • I 2ptip r AcF ~2, o : y ~ N 07 ~ r•1 w o ( rn' r la ^ o " _ s o OJ y1 g 1 • A / r3 rl • ,'-1 a i ..i c 8 1 p $ R tv s3• ' t' u a 3e~ ~ 9 i r i y0• a $ 9L9 1 " sJ~ ~e $ 89 r $ " $ F IND t LAUDS 1 ' o ISM; i! n x L "ro- x C1.1 _ ~r STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER 5 A M M IL~ VF_ it_ MAILING ADDRESS o x u 2 g z y 7 5 o N w l S y0 I f. PROPERTY ADDRESS /o 7 C3 v c -At b (OE (location of septic system) Please obtain from the Planning Dept. CITY/STATE 14 L) D S© N W t S y0 /f, PROPERTY LOCATION S W 1/4, ALA/ 1/4, Section Z T Z% N-R I W TOWN OF J-W D S o N , ST. CROIX COUNTY, WI SUBDIVISION 7A N NY A/ D 6 F- , LOT NUMBER 3 CERTIFIED SURVEY MAP SZ51S4 , VOLUME _(,,PAGE LOT NUMBER 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. r 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 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 5AM M/LLE~ Location of property s W 1/4 At L,.-) 1/4, Section /2_ ,T z~N-R ~9 Township t!g b z o m Mailing address gox' z ~rZ_ _ }atu D 5c m W I S'/D/4 Address of site Io?4~ 3'c1 c k- '~k IDr.-F- RL) pSooy U) i 5-yo/4 Subdivision name "rA-VA)F RID6E Lot no. 13 other homes on property? Yes X No Previous owner of property 12.4NDALL 5VIVA4/ Total size of property z 5' qL Total size of parcel 2 /#Z Date parcel was created 9 - 9 3 Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? X Yes No Volume 1031 and Page Number YSG 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 ygS~ 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. -50 y 9 0 S ture &K-AplAl icant Co-Applicant Date of Signature Date of Siqnature c ~ v R 1 ' DOCUMENT NO. 1 STATE BA F WISCON$1 ORSi 1-1883 THIS sraca nesenvca Post "scoeo.NO DATA ARRANTY D D 504855 roe 103iWE 456 r:-C1STE.9 OF1CE 4 This Deed, made between i CO..M Randall W. Synan and Patricia E. Synan, %ec'd br Recoed husband. and wife Grantor, 1 S E f T 1993 and ....Sam...E.....Mia:~er-'- A.......ngle...person at 10:45 - A: M , Grantee, ( R-Ts~. d pease Wit esseth, That the said Grantor, fqr a valuable consideration_...._ 4v Randall W. Synan and Patricia E. Synan conveys to Grantee the following described real estate in $t • Cr0 X R{TUAN To County, State of Wisconsin: s .y Ta: Pared No: The SEI/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 t 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. FEZ _ }~/V AND ,A A parcel of land located in part of the NE1/4 of SE1/4 of Section 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 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point of '.eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence SOO 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 58'34"E, 351.07 feet to the point of beginning. This $_.AQt.... homestead property. a (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And.. );~.Ilaa~ W_e...Synan-. and..Patr_icia...E....Synan.......... warrants that the title is good, indefeasible in fee aim ple 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 day of AUg-USt-................ 19..4.3.. Gi~Yldr .w, --.(SEAL) ~GIaLIF.u - - ..14W ................•.........(SEAL) Randall W. Synan Patricia Synan ....................................................(SEAL) - (SEAL) • i c. AUTHENTICATION ACENOWLEDOMENT Signature(s) STATE OF WISCONSIN z St. Croix _ ••-•------•-....County. n j authenticated this ........day of 19------ Pe;sonaUy came before me.---.--.day of August - 19 the above named s I RandalW. nan, Picia E. ( TITLE: MEMBER STATE BAR OF WISCONSIN Synan..- (If not, . A.....4_Y~' authorized by 4 706.06. Wis. State.) he to me known to be the person .,g....... H6W11z~~~tllEliW ~fSCD/LM 4 n wle ftft :4, MingI illatru nt and _...__--THIS INSTRUMENT OWA9 land DRAFTED BY Kristne e Jo--- i ors r Alic y At cornep a-t to r Notary Public - County, Wis. T# (Signatures may be authenticated or acknowledged. Both MY Commission is permanent. ((j_f not, state ezp atian are not necessary.) date: !G7 •Names of peraoru signing in any opacity should to typed or printed below their signature,. WARRANTT DRED STATE BAR OF WISCONSIN Niecon,in Deal Blank Co. Ina FORM Ne. I - 1913 Milwaukee. Wis.