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HomeMy WebLinkAbout020-1311-90-000 r, 0 O E9 P a as O. 0. O o ~ i 0 N it n ti I L w 4 O N N C O z m ,L Q 3 a M C Z Z O Q a £ Z a) i a m 0 c C7 p m O Z v c Qt f- i O y Z `t 2 o H N z cs 'a a) '0 N co J a) CD Q N N 2' N C • N 0) N ~ a L s O Q C C O U N O m z F- Z 'p a N Z N ~ ~ Y N O 6 N 3 N O N N d L C O I C G C a -p p . N co co coo H H F- w N 0 't • M o o 0 d z O N ~ I ~aaa ►~y~. a O O V1 O `n N rn rn Z"t W r O O ° O N 0 0 0 E N N I co D E oo oo J O T T CD N N ,'r O O D cn d Q > c9 cis m U) U) O °o n 3 ° o 00 O 0) 00 0 0 co a a d rn o 0 1 rn O co E E ID co co 00 w M O N L t b N In ~ rl N N N~~ N N _ C r O '0 N C 7 - cn u E E c~ CC O ~ N L4 d Q7 a at a L: a w ° STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SA A& ADDRESS 13 e)C Z ~yt~ SoN . i I -syo~b SUBDIVISION / CSM# 'r A ^(N C Y 2 E LOT # SECTION 1 Z T Z~( N-R f( Town of L) IJ S Q ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100,FEET OF SYSTEM IS f-zy 3 5 ~ I /vc D2 (VE W ktY a~Kjt ~ Ilk 3 ' A Aloff: OS Oig 14A WEli '07, 71/ _ R < <sE, ~ Wf 3g X~-- 160'_ U1 0 bs IN ICATE ORTH ARROW Provide setback- ation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK : "[Q- ~ 6; 1 PIPE AT IV C- 1 DG ,Orj l ALTERNATE BM: -7of' o-C SILL aT LVALK ow boot g l 0,17 SEPTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 6y E 1 s E oe-_ Liquid Capacity: /000 6 ,4 e Setback from: Well-V/O House SAS Other COS, To Sjr- ydds~ Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location. SOIL ABSORPTION SYSTEM Width: .S Length O Number of trenches - Z-Distance & Direction to nearest prop. line: ~3 'tc F ,-fti ta-r- LINE Setback from: well: Zoo House Other (.qf To CJ AN OUT ELEVATIONS Building Sewer ST Inlet. (0, 3 ST outlet 6 PC inlet PC bottom Pump Off - Header/Manifold )Oi n Bottom of system Z- 4p (o Z Existing Grade '2-7 y Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Lbbor and Human Relations INSPECTION REPORT ST. CROIX safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION ❑ City ❑ Village Town of: State Plan o.: Pef~p,iiLllder'' Ng" ER R 1 Hudson CST BIIMEElev.: E!M Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing ! ~0 i/a7. S/S~ Aeration Bldg. Sewer Holdin St/ 0 Inlet k7r TANK SETBACK INFORMATION St/ ~fl outlet ' /p- S3' TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic 75U S NA Dt Bottom Dosing NA Header: Z2 r v 3, 7D i Aeration Dist. Pipe 2, a.3.s~5 Hold Bot. System 3, e4j, Ida,O5 r PUMP/ SIPHON INFORMATION Final Grade 9ST Manufacturer emand Model Num 6PM TDH L' Friction e TDH Ft For6e ain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length~~ , No. Of Tr$nches PIT No. Of Pits I mw. iquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL El~SMIM ING Manufacturer: SETBACK CHAMBE INFORMATION Type Of clew m er. System: ^6)/1E, OR UNIT` DISTRIBUTION SYSTEM Header/Manifold v Distribution Pipe(s) x Hole Size x Hole Spa t To Air Intake Length f( Dia. Length 57 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At- a jSys-te~Only Depth Over , Depth Over xx Depth Of xx Seeded/ Sodded xlched _ Bed/ Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUdson.12.29.19W, SW~, NW, Lot 46, T Lane c-T Ali. o ¢e~~G~~ W Plan revision required? ❑ Yes Q'N'o p~ Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert.No - SANITARY PERMIT APPLICATION safety of Building l ng Water Sn Bureau o 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 8 112 x 11 inches in size. • . C/" • 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 ❑ 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 A4 Z" / L L 5 Luc /4 g4di4,S / Z T 2_17 r N, R I E (off"J Property Owner's Mailing Address Lot Number Block Number 3o LF L 3 City, State Zip Code 3-g(o) one Number Subdivision Name or CSM Number ,So M L,J S-VO/4 Z2(0r,44R- :5_3/15F V t II. TYPE F BUILDING: (check one) ❑ State Owned it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms -3 E] Toiag OF #U~so 7,40 FYL.¢N-= 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo L O _ / 3 - y4 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. Cg 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 12N 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 Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft-) (Gals/day/sq. ft.) (MinAnch) Elevation `f SQ 5(P (e o o - 8 / 0 X.0' Feet i o ens Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank /000 W F_ 1 SE le to ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ 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 tamps) MP/MPRSW NO.: Business Phone Number: /I11 / ko M o N E e-4 S-o Sz-zzp 711= 3 16- S4aFz- Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Ag ht Si ure (N tamp A roved surcharge Fee) pp I ❑ Owner Given Initial- ~ j p~~~ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe Tenewed 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. qrm y3 a ,,,,sal o ~ y nl ~ ~ ~ap o. z cn► 4 ti ~ n Z W o L4 M i i \ O ~ _ +p 1 ` Nil ` c N _ z p h w ~ a1 `•4 n ~ N v Y 0~° , ~ C Lb ~4~Vi W C9 (j ~1 F 'ter 0 0 o o ~Y Q •Q ti p fl OP -v > Lit I I H 93 CL I M ~ I z_ N N j CL I I a i I M 1 LL. z I ' I w h I ~ I v c D ~I i I W ' I ~ ~ I I 3 I ° ' m '44 N ut I v 4 I a~ v w a. ~ 3 I 0 ill ~ I V I ~e U1 I • ~ I w a -4 -4 Wiscqnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page/ of 3 bor and'Human Relations vision . Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COU Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 1 GAO t'x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dist nearest road. APPLICANT INFORMATION-PLEA T L~Q MATION REVIEWED BY DATE Zrv PROPERTY OWNER: PROPERTY LOCATION q ~rQ/h ~JLZ GOVT. LOT 'S (-J 1/4 t4L.J 1/4,SI I T ( N,R 9 E (or) W PROPERTY OWNE)~)Q+ MAILING A L QT BLOCK # SUBD. AME OR CSM - - V ^ ~ i / n I'~ o tt CITY STATE OD :PHONE NUMBER ❑CITY ❑VI LAGE OWN NE REST ROADI MOUE Number of Addition to existing building / K New Construction use [DQ Nul" Replacement rrtir "agdir' Code derived daily flow gpd Recommended design loading rate 0A bed, gpd/ft2 6.7 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 1bed, gpd/ft20 ,~o trench, gpd/ft2 Recommended infiltration surface elevation(s) (as referrr~d to site plan benchmark) Additional design/ site considerations EVA LU ATIO)Q hO Ni . TOE ~ 7~~'~6 VAL Parent material Flood plain elevation, if applicable ft S = Suitable for system c~tVENTIONAL 0 ND 1N-,GROUND PRESSURE AT-GRADE S TEM IN FILL HOLDING K U= Unsuitable fors stem ®S ❑ U S❑ U N f s ❑ U ~I 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 c;.::s:<.:<tx<•:< / /a >2 1 2 rn a ,K CS 4 S O.C zg O~~ 'r Y 3 wi'•:•n'•w\t::~n~ J s1 - Cs 1 O,Z o,3 Ground > J-/I 6L 5 rY1 / 037 01 elev. /o9,Coft. Depth to limiting f for Remarks: Boring # (3-16 96p / ~ ~ <t- nTG CS 6. C 1,1....::.....:::::. 16-1 7. ~;YR 4 Il lay '~2 414 s d r rh 07 OR Ground elev. Depth to limiting factor. 7 67 Remarks: CST Name: Please Print 0 Sy 0 4NS6 J Phone: Address: P U U AS a ) ,{p Signatur Y] Date: 7/Z I CST Number: `'t 04 PROPERTY OWNER 1AA, M)LUN, SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. # L 36 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell ()u. Sz. Cont. Color Gr. Sz. Sh. Bed TMr1ch dY IR ! r L, fh q k 7 0-2o GS Z D 04; CS 6,2 -8) 120- ~:7 10 q Ground -114 fake 4 S Q r )'vl 0 7 0 elev. At& ft. Depth to limiting ~f~tors~ Remarks: Boring # or 7-'Vyg4L 17 R Ground /6 4 4- s , D ~1 p g elev /"ft. Depth to limiting factor 5 Remarks: Boring # Q Q- 10 3 1 rM Cr cs 1 a. o.~ S ? ~d~ k 4A r' f'h 0.7 Ground elev. 1053 ft Depth to limiting factor ->AQ -5g Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: p~ A .~NCKMd~k.- I r,~oN~iPf LvT Jg VI Vp-l r N ~ / r rd~~ I X30 - ~ Z t• ~co~~ i~ ~ ? r I M I ~ ~ >s _s LANDS ;e 8 x M 248.83 S .car a rM[ o. r•t s+n., ucn4a a soo.43'040E 1315.86' 249,93 110.00 409.20 30a0O = s3/ a N ~ ~ O ~ 84°x. pC O N - I O i u Lt r~n C7P`-a W~A? "n Q V a b Nra+ v7 u 4 omN 0 n9i1V a Ao0 \ 4 a ~1. :z W p I m .i W w a -1 0 0? W a s O J p ND uNp4 w(A0 74 N N f N23,93`3c d~\~7t\ Q CT 0 V UNTfR O F:~ -'~'~'C,~Q !i=ce 32 J3 _ \'/a$ / i V, ` a N ~S / 4i I ci :I o o $o.or ~\\\<< :N opN_ o°o :qZ~t do, ~ , -0 a - 4e m oy c \ w 4c'' \r O J~, cc~ A \ - C> N M N Z o \ Q mNr ! \ u 'C \O~ 97' CA i o' O rn C) I 0 A O i Q+ n ~ 0 505.56 rn tv ~A- 1Y \ ornW 35a46• C. 03 N I I I F \Ee y f / c~ O g'• (A Q1 8 X39 60 645.%6 \ 294N06.56'42'w 0 Q~ a' , m d^ v~ ' \ 1A CD o~'•. 0 z, 0° R \c~ = '~N X23 4A m W 4 s 4 a f p 'o" :.9t ~4S - i \g(~ ~ .h• : • o 0. Co e, o a N Qit W O i4ggOti W O vi W ~O i \ cl) i , 74 . , N a. s . 500-41'18'E-- 7084 © \ TD, 'v. ~c'OO 0 0. ---22927 457 O - SOO'41WE 27084 9 W N a ~1 33 L4 ° S i O O SA N 3 O 54.0 N -a 4 O s 0 m 0 \ m N r O D W N O LZ4Z4 ' N r Y (J~ a 0 0-0- 'o , n \ Q m O / Op n ni r *i \ M. 4 0(~ a .n ~ O A' / „e9~~ / f 6 ooZ i 9Z 622 Zc OV , -o .0000 M.90,9f..OON If \ Icy -I 10 ~c~ I t4 1 (D b IL1 S, rn 1 r ~m I I' ` J` Q 20 ,b \i •.~i \ ~ ~ Z W J I .Q. \ O D u 90' Sll•48' ~ v 1{ ~z o 66.a 4 " 2 p v 'A o / S w m •N-' y m U p 7~ I p 4cS' C C~_ U °Q N \ O `09 y= 0 o AD. E'er Z O W S Cl f'1 ~10> e x O NW20'00'E p 0. _ 0 8 c z O a O W (}e s~ - MOON . °EOr~a7 0 a p : _ ~~pr! 1 V ~ - 9 In ^ - 0. C G Q M x.90$ N (n o 4 CA A O DDW e`' W my oIT ~ ~ ~ (r 1 u ^ ,7' 00 :E m 1 - rn1 a \ o Iv o~wJ !m! F _ (n .0 ILA 'In - a i ti \ (11TJ' O 1 8 A -R3~42'S9'E ~ `N03'42'59'E 501.64' u { ` D 75 .D 26589' r z 470. 234.25' O p O 00 J N03'42'59" z- 317.06 121n i / - 31.64 f E ' 0 O D ego / Z o 14 r:) %A Ln xt,. 88 f~ -U rn 0 o Noaos'o9"W 453.12' (•fT lIn( Of TlI( 3wV• O/ TM( nwv4, f(CTWn 13 T o M a X* (n 2 uzi~ rn 1~ 1'J D p KR r Z rt c~o m I FOE r o [[•,,ING[ •w[ "(!(w(nCIO ro T..( i•7r. . *CST Z fV "4 Un( Of 7[CT,On ~I, •71VY(0 TO STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~4 M 1 C L J /Z MAILING ADDRESS BO X ~ L 8 L PROPERTY ADDRESS / 0& Z T A N N E D L A- N C (location of septic system) Please obtain from the Planning Dept. CITY/STATE K v!~ S o T k W 1 : b PROPERTY LOCATION -S Lk 1/4, Al w 1/4, Section I L- N-R L S TOWN OF H U D S O N ST. CROIX COUNTY, WI SUBDIVISION -r k N k E.Y LOT NUMBER 3A 6 CERTIFIED SURVEY MAPS3 / 9 y 2, VOLUME PAGE 3 / , 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. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 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 _5,4.14 Al /I-L,CaL Location of property S c,.J 1/4 IV to 1/4, Section / e-- ,T N-R~ Township#tJp.0ty Mailingaddress ,(3pX z-YZ /yLP-,"T . LA-) 1 yo if, Address of site /o 8L, 7'~4 lstN~ y Lf//~E Subdivision name 7`~qAl )V~Fy lCJ Lot no. , ?r, Other homes on property? Yes_ _No Previous owner of property AeX ail pALe- 55-N•AN Total size of property 2 ?-6 4Z Total size of parcel 2- z x A e Date parcel was created y-l- s3 Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? X_Yes No Volume 1631 and Page Number 17s4 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. So V YS"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. so Ya'S.S`~ 91gnatur of App ica t Co-Applicant ys~ Date of Signature Date of Signature r DOCUMENT NO. STATE BA F WI$CONSI ORM 1-1llgi THIS •+ACt RtatRVto FOR 1118COPPOING DATA ARRANTY D D 504855 v-L 103friice 456 _C1STUER'S OF1CE This Deed, made between 0.. MI W. Synan and Patr-ici.a_ E....Sxnan, esc'~ for Retook • .....---husband...a.................. d........................................._....___.............. t Grantor, SEP T 1993 and ...Sad..E.....Mil:~er...............n..1e...Person at 10:45 - A:'M Witllesseth, 'That the said Grantor, f ra valuable consideration...... Randall W. Synan and Patr~cla E. Synan St. Croix ftTuno$ TO conveys to Grantee the following described real estats'in County, State of Wisconsin: U 'Pas Pared N0:..».» The SE1/4 of NE1/4 of Section 11; the SWl/4 of NW1/4, the N1/2 < of SW1/4, and the South 53 rods (874.5 feet) of the SEi/4 of NW1/4 except the East 74 feet thereof, all in Section 12; all in Y~ Township 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin. FF Aj AND A f 4A40X 'A A parcel of land located in part of the NE1/4 of SE1/4 of Secti Tn 11, Township 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the y 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 S00 281030E, 500.00 feet; thence N89 30100"E, along the North line of Certified Survey Map filed in Vol. "30, Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. !t This ..........J.*1 rkQ.t... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And-----R3[ AII._.1"1.f._.SY.n n._an.j ..Patgjcia..E-...Synan 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 3_............................. day of A UT LSD 19... 1. v~ys~?u!!J...(SEAL) i..4F'r- 4 e✓ ...........................(SEAL) Randall W. Synan Patricia Synan ........................-•---................._......................(SEAL) ....................................................................(SEAL) • • a. AUTHXNTICATION ACKNOWLSDG1dBUT l Sigaatnre(s) STATZ OF WI MIMN jj Std-- Croix -County. i authenticated this day as..... _ 19 p~~ cam before sae day of AuquSt F 19....... the above named il • t2anda1l...N. sXrian ..Patricia'--~-. TITLE: MEMBER STATE BAR OF WISCONSIN S~nari II (If not, i r _ oy ti authorized by 4 706.06. Wis. State.) Nix e I to me known to be the person J1 II In i t and e THIS INSTRUMENT WAS DRAPT10 BY l r Kristina Ogland 0 ors At Borne3r.. A at f.aW Alice Joy , st.... -croiX Notary Public County, Wis. (Signatures may b• authenticated or acknowledged. Both NY Commission is permanent. t not, state exp' scion are not necessary.) , IA's date : . . "Names of persons signing in any Capacity should be typed or printed below their signatures. i Y WARRANTY 0192D eTATE BAR or wISCONsiN Wisconsin teed blank Co. IRe- FORM No, i - tss2 Hilasukee. Wit.