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020-1011-60-200
c~NO c ~ ~ o ~ ~ ~'o~ I C\ d w .a C ~ ~ ~ N ~ ~ OOD ~' W I V Q y N 3 -, ~ m ~ O c ~ ~ O "' ~ ~ 7 O CA fU V1 o ~ S, ~ m ~~ ~ I (A ~ D , Gp m co y rn ~ a ~ I ~ m c ~ r w o I ~ J I ~ .. ~ oo = ~ f00 GOO N I ~ Ul A 7 ~ I o ° O O O a ~ ~ gg gg o N ~ .. l p' ~ ~ v v ~ i _ ~W co ~ d N C 3 ~ .. ~' 00-1 w o m .. m o I ~ ~ O D n ~ I ~ m ~ m GyA ~ ~ ~ m c ~ I w ~ a I a 3 ~ Z ~ ~ ~ ~ o c ( ~ d I ~ W ~ a ° o r, tl! Z I f W GD S ~ y d N 3 :Z O __. N ~ 7 ~ ~ N . N C °D S C Nf o D WO~ ° a o~ .~ ~ ~ ~ y ~ N N ~ Ol y I ~ any ~ ~ GT 7 ~ ~ O ~ ~~ ~ 'G7 ~ f~D GG ~ ? ~ d o ~ I ~~.°3 '_1 N r .O . GD + ~ N N -~i. I p ~ I o~ 'I V Z M N K y faD n I ~ O D ~ a I~ I ~ Z I~ C ~ I ~ ~ I I c I ~ I I I m I ~ I ~ I ~ ` c 7J m I ~ ~. I 1 SIN N c ~ ; '' ~ ~ ~ ~o 3 O ~P T ~ ~_. ~ ~ O y O 7 ~* C V y ~_ r d A ~ 01 COJ~ y O O O ~ o ~vo~, ~ ~~ c~i ~ D ~+ w ~ o m y p c ~' m a a ~ ~ 3 C a ~ A a °o ~' H ~ m v A 01 f~D C GD G "' T C a I d O ' I ~ I o N I I ~ , Y I ~ O O 1. 3 m c ~ ~ 3 n '? v m _ ~ o C N d O O ~ J ~ ~ O GO ~ Q Q O ~ O y .Cr. c 3 M i ~ A -{ O ~ J o .~ Go ~ a o `~ O A A CZ,' ; m N .a GO ... ,Z m A d eo G b r~0 R ~1 ~1. 0• O ~• arq O ~• fi Q ye A t.,~ O N O H ~~i. ti b ° A k+ 6p O ~ A ~ O v, a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Bi/ilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) Permit Holder's Name: City Village X Township Freitas, B on Hudson, Town of CST BM EI ~~ ~ Insp. BM Eley: _ BM cription;:~ _ .Urn{/) ~~+,pr -°b'r~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 'l~~ ~ ,~,\ (JU V D h Aeration ~6 l i~ Holding TANK SETBACK INFORMATION TANK TO Q~ W~FLL BLDG Ve~o Air Intake ROAD Septic ~~~ ~ ~ Dosing C~ Aeration Holding ELEVATION DATA county: St. Croix Sanitary Permit No: 479250 0 State Plan ID No: Parcel Tax No: 020-1011-60-200 Section/Town/Range/Map No: 11.29.19.50b STATION BS HI FS ELEV. Bench ~.~ Alt. BM e ~ ~ Q ~ ~ -f SUHt et / 1~Y/ z ~ J St/~tlet _ s Dt Inlet r ~~ Dt Bottom ~ Header/M~n. ' lY 7~ to • 3 Dist. Pipe ~~ a~~ ~, ~ ~_ 6 , 37 ~b Bot. System ~ VJ (~--~ Finat.Grade /~ s-~ ~. g -~ g St Cov r ~ s-~-, 3.'7 0~ h - ~- h BEDlrRENCH Width ~ Length/ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ -~ ~ ~(Q dl.~ UUOD 1 i ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA L ACHING Manu~:~ ~~ "~r INFORMATION CHAMBER O , Type f System: ~ ' 2,S ~.~/ ~ / ~ U Model Number: DISTRIBUTION SYSTEM H~~aauhR.a1 Header/ anifold Distribution I . Pi Z ~~,w ~0'~ x Hole Size i / x Hole Spacing Vent to Air Intake ~_ / Length ~ Dia ~ pe(s) L Length ~ ` 7y'' Dia_ Spacing ~ ~ 7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only \ Depth Over i Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~~~~ Bed/Trench Edges Topsoil ~ Yes ~ No C Yes [] No •~ IV• COMMENTS: (Incl a code iscrepencies, persons present, etc.) Inspection #1:~/ ~ p/ Inspection #2: / / Location: 1067 Tanney Lane Hudson, WI 54016 (SE 1/4 NE 1/4 11 T29N R19W) Tanney Ridge Lo~~'',, ,T. n~ ~ ,,~P~ar~ceMlo: 11.29.19.50b 1.) Alt BM Description = !~ oCJ, ~(F 5~ t<jJVt°~/ ~~~ ~%~T ~v 6~A CA! '~- ~~E~ 2.) Bldg sewer length = ~~-~/ ~(~k- - ~ S f`~'' - amount of cover = ~ S l h~ j~~a~Y /,,- - O ~/ .,1- ?J ~ ~~ ~ ~~f-~~ Plan revision Required? ~ Yes ~o ~ ~ O~ ~~~'/~~ /w~~ 1_ Use other side for additional information. _ i - - Date Insepctor's Signatur Cert. o. SBD-6710 (R.3/97) SOIL ABSORPTION SYSTEM ~ ~ ~ d Buildings Division Ave., P.O. Box 7162 County S `,~ 0~, v T' /~` ~scons~n dis~ 7 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 8 ~ ~j~ Sanitary Permit AppliCati sta Plan I.D. Nu~mjber In accord with Comm 83.21, Wis. Adm. Code, persona! informati n you p~P}' e ~ !" may be used for seconda ur oses Privac Law s15 lxm) J v ~ s~ J~~ P Ad ry p p y , . ;/± ro dress (if tfferent than mailing address) - I. Application Information -Please Print All Information !X COuN~1" ~GT!Yt.C~- ~ ZONING OFFICE Property Owner's Na me 3,QyoN ~ Btu ~/~eT~9- s 1 # Lot # Y Block # °Z 7 O • /o/% 2 00 Property Owner's M ailing Address Property Location • so /d G ~ T iVit~ Gti ~ c ~~ S`j ~~ ' Ci~tyy, ,Staate l7 t/ ~O 'l~ ~ ~ Z`ip Code / c7 y D~ W PhottepNu/mbar ~ 4 (s7 • ~ ~ 7 'i° k,S~tion u. ~"~ / ~ (B l II. Type of Building (check all that apply) / T N; R 'C~% s~,n~ r~ULt~-2i ~ or 2 F il D lli N b f B d y r Subdivisiottrrldmne . am y we um ng - er o e rooms ~ 5~-7 7 ? ~ ^ Public/Commercial -Describe Use ~ / ~"' ^ State Owned -Describe Use ^Ciry' ^Village wns ' of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New S stem y (Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~ ~ p' 9 D~ ~d / ~~ 0 / a IV. of POWTS S stem: (Check all that. a 1) ~ Z ~ on -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sattd Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirctatng Sand Filter ^ Recirculating Synthetic Media Filter Leachin Chamber ^ Drip Litte ravel-1 Pi ^ Other ) V. Dis rsal/Treatment Area Information: ~(,G ~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Pro System Elevati 7 s~ ~d •~ ~S / Q // ~. t7 ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel •Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tanks Existlng Tanks ~~ G S Septic or Notding Tank ~ CO J /O t7 ~ ' -1 ` Q J Z~ ~N ~ e v!/ ~.t~C Aerobic Treatmen[ Unit Dosing Chamber VII. Responsibility Statement- I, We undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) R.u~a~z~~~r- Plumber's Si tore Number zZ~3~s Business Phone Number ~Is'~~~ '3y~ Plumber's Addre ss (Street, City, State, Zip Code) VIII. unt /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee utcludes Groundwater Surcharge Fee) ~ c1v Date Issued ~j ing Ag Signa re ps) ^ Owner Given Reason for Denial ~~v , ~~~JJ ~ ~y 1X. Conditions of ApprovaUReasons for Disapproval SYSTEM OWN R: ~1 Septic tank, effluent filter and ~ //~ ~ ~ ~ ~ S v dispersal cell must all be serviced /maintained f -1~-~ ~ ~ ~ ~"L ' ~ as per management plan provided by plumber. , , , ," ®D ~ai.ro > /„ ~~ / ~ /~,.. i ~ ,/,~..., .,.. e.,. t. Hu setoacic requirements must be maintained ~" " -' - "" ~W w X '~"' """ ~ - as per applicable code/ordinances. ~j~~ ~fC(/~(~af ~ ~I~h-t, n3, C~(~ B~ ~N~c -~. ~° ~ ~ N~ `+ `i ~ ~~ "-~~ <' ~ vypi ts~ EIS, ®O ~ v ~~ ~. I • ~ ~~~ m~o~' ~~~ 1 D s c • 11 ~_ Q~ . ~vm~ -o ~ J Op ~' 7° ~ ~ wC S T .~ it t- O W ~ ~_ w ~ .~ o ~ D ~. _ `n o - y~ ~ ~ ~ ~~ ~ \ R `~. Q, ~ y ,, ,: , ,~.~ ~~` ~ ~ ,~~ 1 s~ ~~ ~ ~ ~ \ ~ .. ~. .. o . _~ 1 ` ` `~'~1` 1 ` \ ~ ~~ Vi Rl O ~ m 7y~ o \\- \\ ~. \ ~ `per ~ 7 b~ ~ ++ o S~ uW /'`\~ ~ l ~ O n ~ o ~ ~-=- - -~,,, ___. ~ ~ ~ O '- . c~ '', ,'z © ~' ~ ~ ~ =--~ {( ~~~ ~~ ~~ S'~ ~ O d - w- _A ~/-~ ~ ~ - - - ~-- s - -' - • - - c.r~ ,~.,, Q ~ ~ ~ i .. ~, ' ~ ~ Z Y~ W O S t ~~ O I~LBRICHT & ASSOCIATES CO. • 2812 10th Ave. • Spring Valley, WI 54767 Reg. designers of Englneenb-g Systems 715-772-3442 Pyre serge consultants PROJECT INDEX ~ PLAN ID # G ~ ~-S DATE p/ OWNER ~~y~/tJ 3 /~~~ ~~E/• ~/9' S PHONE 36 (O ~ ~~~t~ ADDRESS /mCe 7 T~,vrv~y G,~ . ~U~sv~..? _ ~!• S yo c ~ LEGAL DESCRIPTION `UJr ~' ~ ~f 1U C~ 20 - (6 ((" C®D Zbb CSM. ~' S~"j ~ 3 ~ Vo(. ICI y ~ . 2.. ~~(o • TOWN OF _ t~v12SDa COUNTY SZ~' G~'~'O~'JL ' csTM Td~ N~LSoa ~ ~a.73~~7 LOCAL AUTHORITX/ SUPERVISION S"f ' C~•~ t X ~7 y. Zoe c 1~? PROJECT DESCRIPTION: ~ ~l~v~v sys T = 3 ~~F . U ~~ . C~ i L S ~"h' ~'~ ~ I iC' '~''~4~v k ~ ~ (( s ys 7- ~„~ S~~ ~~ SYSTEM S9-I>~LL -: _ ~ POWT pER COMM. ~~,, ;ORPORATA PROPER ZABEL Ss.44c2)c ~ FILTER MODEL r ^ ! O ~ ~~ S O i L -T' ~ 51' ~ i2 --- `~, ~X t S 7 ~,c~ ~~ S Si /3L~ ~ G~~T /.v T~q-cT---- ,~ ~ v ~ v~lv..~. ~a~t(~ l 2fLI32cc~i.~'' Uibricbt & Associates Private Sewage Consultants 2812 10th Ave. Spring Vatie~, WI 54767 1~~2 S ~ z~..~3 Pq•1 INFILTRATOR SIZING WORKSHEET PJ•2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg . 4 ~~ ~~ ~~ - - ~~ ~~ n z c rt N O m m A 7C' .La m a m a a ti~ Z ~O~ o.~ ~. ~~ ,~ ~1~~~* ~.r ~ '~ ~~ ~. `\ ~ ~ ~ ~i ~ ~' ~' ~ ~ ~~ `~' ~C1 ~, ° ° i ~ ~ ~ ~~ ~ ~ y ~ ~ `V ~ ~ ~ ~ O m~ ~- t OG' ~. ~~~1 V i ~ O I 4~~ ~P ~~ ,\ ~_ 170 ~ )° w W ~ ~ ~_ ,~ ~ ~ ~ ~ ~ ~ 0 .~ ~, -~- c ~ ~ _ ~ y -a ~'o C ~~~~ b i ~ _~ ~ !~ ~~ lv ~® Caw ~ ~ ~ ~ ~. ~ ~ m Z -f N ~ a o wC S T ~ ` ~. ~N ~ N~~ ~- -x```22 sy~ ~ . r' ~ ~" "N . ~ ' " ` Q `` ``` ` '~' ~`9 1 C ~ ~~ a v _' ~ ,, O ~~ d v~~~" ~{ a~ . ~~ ~ ~~ i 1i~ - I ,, CrNcut~/tT~ t ' "~` - ~ fZ„ /9Pf'~~~p ~~,v T c,~4jo U~ /.uS~J~'c T/®,v ~d /~ its/ - ~j Z. ~P.~,u~nr~-~ sc~. ~0 9iP~f~~' T~~~~~ _ ,- .~ -- -- ,: ~i~v,Ir' a . SO r Cho SS Sic ~ Gov ©~ T~'~""~G~l~ ~ ~ ~s _ ~1 J ~N ~' 1 ~~- l ~~r~.~v11~j c~,rf<-~.~~ ~ Sic 7~~'o~J ~/1S s- ~ std. `~`~ , °'~ /NS~I~~T/~,c,~ p~ /tf/.t/. /,'z ~ /// .i ~~.~~ ~,v~G~X~To~E' sc~. ~o n--p~c "Z.._; F~;vis~ED ~3 ~ ' p~~~~" ~~~ ,~ .r~tv1SK `s MAINTAINCE OF ___ -, - ' SEPTIC SYSTEt, PoWTS {landowner - ' maintenance } is reponsible For SerYiCit} of. this system. Regular proper operation and SYst-em. g fs necessary for the Periodic ins maintenance owner is safe health peCtions and . /inspectionequportsbY Cade to submptrallon of; this re to the necessary. c©ntrolling,authorities. SPECIFIC CONTACT ~' Governmental AGENTS authors t S~ • C • Y/ inspectors ; '`'~ ! X C ~~~ Licensed installer ~ ~~ - ~~ V ~' ~`~ maintenance ~< responsible Users "manual: for providin ~~ S ~~ ~~ ~ ~~.. g IC operation/ ~ y~ ~R ~~- * Licensed servmce ~ ~-~ ~ ~-Z- / i n s -~-------____ pecton -agent other than -~---~`'S ~/P/-- GT f .~5~,tlf`Tff-T%4~ • Installer: ~ -~~~' ~~f3 4 Elect rician, for pump, electric cont ` rots, wiring units: r .... _ --`_ ~l ~ 1 . ----~•• ~ ~ivANCE RE UIREMENTS Minter traffic- area shalt {sledding, shove~rin the cell not be permitted g. etc. . freezin or frost ) across the winter, (a vacactio up the can/will penetrate lead n tri System. Oiscontinuos into. to freeze ups- _ P, resultin use in the g In no water .use) can also z- Water conservatio - designedafoi ovt'rioadedsa~a de exercised! Or a maximum stroyed, This SyYstem can be wastewater flow of skein was ~ - PQWT'S are ~d'?j . not d es i _________-- gals . daily . gned modate Anyp~nEroduct~ or any othercun Wastes fro 8estra °n of such Was ~materi source ov aas~ebage, Y this system. to of w Ials wil erload and 9• if a power otatage occurs, or cell temporary overload a Pump fails, it ' • which may adverselof effluent may result recommended that Y stn act t being pumped into the a-~lowin a licensed p he ce.L1 Consultg the pump to retur pumper empty theeakage).~It is Your installer n to dosin dosing tank, 5. immediate) g the correct amounts. Neglect of Y for advice. traffic Prevhe v~}tcanve cove ent' r {the ceps REGU also can lest lead tO failure. Insulation & the-~Yste WATER THE rOY t he system. Compaction or VEGETATION OVE It IS NECESS heavy -y` ;~°Fcov~rbeneath R A SYSY'EM! r ARY TO IS NOT sufficient alone Effluent 6. t0 mainta.i,-I ~n -- Periodic ins neeessar Petitions by the into they- inspection °Wne~', or h Inspection ystem: on thelmou and ports haveabeet$' is laterals, a Pipes,), cleanouhna„basal area (pr~,~_IncOrPoratp~ Wisconsin Department of Commerce SOIL EVALUATION REPORT page l of 3 Division of Safety and Buildings in accordance with Comm 85, . Adr~~E~ St. Croix Attach complete site plan on paper not less than 81/2 x 11 in es in siz Plan must include, but not limited to: vertical and horizontal reference BM), di lion a~,,1 b ~ par I.D. 020-1011-60-200 percent slope, scale ordimensions, north arrow, and to istan to neaoa . 10 Please rint a!I informatio A 4 ST. CROIX C Revi UNT Date Personal information you provide may be used for secondary purposes Y ~ $~ 15•4~~i ~ F G,~',(/Y(.~ s ~ 7 Pro.~ej Owner perty L ion `, Q yO JV Brian & Beth Freitas Lar SE 1/4 NE 1/4 g 11 T 29 N R 19 Property Owner's Mailing Address of # Block # Subd. Name or CSM# 1067 Tanny Lane 4 Sam Miller City State Zip Code Phone Number ity village • Town Nearest Road Hudson WI 54016 ( 7~5-386-1976 Tanny Lane New Construction Use Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement ~ Public or commercial - Desaibe: Parent material Loess over outwash sands Flood Plain elevation if applicable ,_ ft. General comments Replacement system suitable for a conventional below grade system....Soil tester has determined that the soils in and recommendations: the area of the initial system is code compliant and can be in an alternating fashion with the replacement system. 1^ Bori # ~ Boring ~ ~ Pit Ground surface elev. 89.95 ft. Depth to limiting factor >I00 in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-11 10yr4/4 - sil 2msbk mfr as 2f .6 .8 2 11-29 7.5 4/4 - ~ s Osg ml cw - .7 1.6 3 29-100 10yr5/4 - cos Osg ml _ _ ,7 1.6 ~,~ ? ~ 3 7d ~ .~ 3~ N 2 Boring # ®Boring 95.55 >100 Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/iP in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-7 10yr4/3 - s%l 2msbk mfr as 2f .6 .8 2 7'21 7.5 4/4 - s Osg ml cam' _ .7 1.6 3 21-100 7.Syr5/4 - cos Osg ml - _ .7 1.6 2 •~' ~- 9 `' ~ ~ 3 Ga- "Effluent #1 = BOD > 30 a ~0 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BoD 30 mg/I. antl 155 _< 3u mgrL CST Name (Please Print) Signature ~~ CST Number Thomas C Nelson `'-'"• ~ 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 11-IS-04 715-246-2454 Property Owner Freitas Parcel ID # 020-1011-60-200 Page 2 of 3 3 eorin # Boring g ~ Pit Ground surtace elev. 89'25 ft. Depth to limiting factor >100 in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tP in. Munsell Qu. Sz. Gont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 1 0-6 10yr4/4 - sil 2msbk rnfr as 2f .6 .8 2 6-20 7.5 4/4 - s Os ml cw - .7 1.6 3 20-100 7.Syr5/4 - cos Osg ml - - .7 1.6 ^ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffiz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ^ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bourxlary Roots GP D/iF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-6330rest (8.07/00) .. ~~~ Scale 1" = 30' BM1 Top of well 1 t10.U~' BM2 Top o septic tank cover 1 Q0.25 B1 89.95' B2 95.55' B3 89.25' Beth Freifas 1 - - - ~ ~ar+aey~a+aee- ,~ --i T~ R3 zs 5~5 ~ ~ Vent pipe I 1 B 1 st 1 Q6' 78' Clean out pipe >5 ' ~ 3 Tank cover- .BM1 BM2 ~ ~+~-_ , 32'-- 90' wel I 92' Residence ~'~ ~ . Thomas Nelson "~' 227387 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address 1 y ~ 1 -f a.a ~.. ~ i ~ ~ Property Address ~ [' ~3 "l ~-d. wl ht ~ t ~.. c~. • ~ t t (Verification required from Planning Department for new construction) City/State tt v.. N. Snti.- t,J ~. Parcel Identification Number a 2-d ~ ~D ~~' ~ d , ~, p ~,7 LEGAL DESCRIPTION ~, S~ _~ 1 Pm Location s~ '/4, N ~ `/., Sec. ~ I . T 2 / N-R I ` W, Town ofJ ~ D,~ !y ~ P~'h' Subdivision .Lot # Certified Survey Map # 5~- ~ ~ ~ Volume ~ ,Page # Warranty Deed # CP Z.. 5 Z S~ .Volume j s ~/ .Page # ~~ ~° Spec house ^ yes J~" no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joureymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is in pmper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the- standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three year expiration date. / ~/ ~~ SIG A OF APPLI ANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. / / S OF APPLI ANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic /~ serving the (3/Z~o,~ ~` ~ ~`~ ~~~~ T~-S residence 5 ~ 1/4, /" ~' 1/4, Sec. 1l T Lf N, R ~ 1 W ~'u DS o,J tank presently located bt: Town of Upon inspection, I certify that I have found the tank attd baffles to be in good condition, and it appears to be functioning properly. Last time serviced- ~~ ~~ ~ 5 Did flow back occur from absorption system? Yes/` No (if no, skip next line) Approximate volume or length of time: t S'D O gallons minutes Capacity: ~OD(j ~)~ . Construction: Prefab Concrete Steel Other - Manufacurer ( i f k nown) : ~ 1 ~ ~ Ca'~ G.~ f --~ Age o f Tank ( i f k nown) : d~?T' ~ t { (Signature) (Title) (Date) (Name) Please Print (License-.Number) FGrm to be completed by licensed plumber (s.145.06, Wisconsin Statutes) ar Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: in accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection o-p~epn7i~n-g over o~u/t let baffle). Name IZo3 ~-'~ ` ~(~~~ (Signature MP/MPRS 2~G ~ ~ S 5/88 , (' S ~ ~~~ ' `' /~ . . ~~~ 1521 ass 6~~250 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Docrmeat Number VV~-RRANTY DEED S7~ICROIXDCD~£Ei~II This Deed, made between Jaynes D. Fibisou snd Lisa F. Fibison, RECEIVED ~ ~~ husband and wNe, 06-23-2000 9s3E1 AM MARRIINTY DEEb - exEllvT it Grantor, and Bryon iR. Freitas and Elisabeth Freitas, husband and CERT C~1f FEE: COpT FEE wife, : TRANSFER FEE: 65.00 - RECtntDIN6 FEEa 10.00 ' PgBESs 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Rooordirtg Area That part of SE 1 /4 NEl/4 Sec. 1 l-T29N-R19W being part of Lot 2 of Certified Survey Map recorded in Vol. id of Certified Survey Maps, page 2830 described as follows: Lot 4 of Certified Survey Map recorded in Vol. l0 of Certified Survey Maps, page 2906, as Doc. No. 527739, St. Croix County, Wisconsin. ~a Nsme and Return Address DAViD J. ESTREEN 304 LOCUST ST. HUDSON W3~5401fi ozaiol [-bo-2oo Pvcei Identification Number (PiN) This is homestead property (is) i14.1i00 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~'~ i'h day of June 2000 AUTHENTICATION Signature(s) Janes D. Fibisoa rnd Lisa F. Fibimw, husbawd and author 'cat d th' 1 day of Jrre 2000 s Kri:tina Ogia T[TLE: MEMBER STATE SAR OF WISCONSIN (If not, authorized by i1 706.06, Wis. Stats.) nt D. Fibiso * Lisa F. Flblson ._~ ACKNOWLEDGMENT STATE OF WISCONSIN ) 83. County ) personally came before me this day of the above named to me known to be the person(s) who executed the forcgOing instrument and acknowledged the same- TH[S INSTRUMENT WAS DRAFTED BY • Attorney Kristtaa Oglaad Notary Puhl~, Stan of Wisconsin r on, My Commission is permanent. (If not, state expiration date: (Signatures msy be authemicated or ecicoowledged. 13otlt are rat necessary.) ~) persons signing in arty rapacity must bt typed or prirNed bekrw tlwir signature. wo"^ab^ °r°"""°"'i' emw.rry~ r-wwaoo-~ass ozt WARRANTY DEED StTATEgAROFWI3CONSIN FORM No. 2 - 1~J99 ~1' F!l.ED APR i 7 1995 - KXTHtR7~7 H. WALStt ~ ~~ ~ 52'7'739 \F/ ;~ LOT 5 CERTIFIED SURVEY MAP Located H i.n part of the SE} of the NE} of Section 11, T29N, R19TiP, Town of Wisconsini being Lot 15 of Tanney Ridge Special oix County St C , . r udson, Addition and Lot 2 of Certified Survey Map recorded in Vol ume 10, Page 2830 at the St. Croix County Register of Dee % office. N ~'JT Imo? ~ ~~7T 3 ~ ~ .. e~ c.li -'~.. ~ C g,~ \ ` w n i!')1 ... SSOd4 ~ ~ I !l ~ ~ ~i ry ~l e ,NN ~1 C I Gn tsJ L7~ ~_ ~( r~ r 8~ M w~ LOT 4 ~=. ,O ~ 2.63 Aerss (114,462 Sq. Ft.) ,a ~ y,~m,~J~' ~' ~~ c M ~ ~~ `P ~h m ti~ ryg'. ~• y ~~ 589°30'00"1M , j 7.58' .` _ 2.98 Acres (129,984 Sq. Ft.) ~ ~i 407 3 j~~ND t~t11Z'3 ~~,.'. 4778.51' ~~~~ ~ 589°30'00"M 365.00' M}. Corner of East-West ~. Lins, Section 11 Section 71 ~~rJF~,~TTE~~ L_'V'JG~ Scale in Fect 1" ~ 100' 0 50 100 200 (~j~ _ `--- ~i a' ~'~ I lLij I rl ~ I Ji ~~ ~i ~I j-1 ° L~J 1 r I ~ ~I ~I LEC ND Aluminum County Monument Found ~ 2" Iron Pipe Found • 1" Iron Pipe Pound 0 1" x 24' Iron Pipe set, weighing 1.68 Ibs per linear {oot. -~--1r- Existing Fenceline -•---•- 12' Utility Easewent ••--• -------- 50' Roadway Sstback line ~~' 589°30'00"M 110'00' Eli Cornsr of =- Section 11 owt~lF.x Sem Miller P.O. Box 282 Hudson, IYI 54016 This instrument drafted by Michael Erickson Prof. No. 95-21 VOLUME 10 PAGE 2906 C1 to O c ~ ~ ~ ° ~ ~ ~ I 3 I ~~ ~ ~ ~ °' ~ m O ~ . W ~ ~ ~ ~ N ~ ~ v (D ~ ° ~ N ~ ~ c m ? 3 1 3 ~ 7 V! ~I I ~ ~ o ~ a ~ C ~ , ~ m W o. ~ ~ I c 3 m c ~ - r w o I I ~ ~ ~ 2 r r C I y CT A ~ ~ ~~'a o 0 0 0 ~ ~ ~ O O ~~ S N N N O~ ~ ~ N ~ ~ K ~ A ~ f ~ C 3 m N I °~ w ~ .. I Z ~, .. ° coot I n x a ~ ~ ~ ~ N ~ C ~ ~ C .~.. ~ I W ~ a a I Z ~ = ~ ~ I ~ =i ~, c w ~ a I ~ ~ a ~ I p a7 9 y z I F W o a N O c o p G I rn> > c fl? T c v m .. N d ? y Q ~ Q I 7 I ~ n ~ 7 \. (~ ~ I ~ a rV I ~ ~_ o I o ~ ? ~ O I ~ O 7 I m I ~ 2 O L 3 d o ~ n 3 ci '? v d _ ~ o C ~ N d N O O ~ ~ ~ O ~ ~ ° o o~ ap o N ~ O 'O 0 C 3 '~ o N D O IG N W W 0 ~ ~ A ? ~ .a TJ ,~ A ~ ~ m z ~ ~ z m ~ A d A'+ D FBI C3 O ~s ~• ~• Q C O V O i v ti 0'p Cn fp ~ ti < Parcel #: 020-1011-60-200 11/17/2004 09:39 AM ' PAGE 1 OF 1 Alt. Parcel #: 11.29.19.506 020 -TOWN OF HUDSON Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 C Tax Address: Owner(s): * =Current Owner * FREITAS, BRYON R & ELIZABETH BRYON R & ELIZABETH FREITAS 1067 TANNEY LA HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 1067 TANNEY LN SC 2611 SCH D OF HUDSON SP 1700 WITC escription: Acres: 2.630 Plat: N/A-NOT AVAILABLE SEC 11 T29N R19W PT SE NE FORMERLY LOT 2 CSM 10/28 0 NKA LOT Block/Condo Bldg: 3 4 CSM 10/2906 2.63 AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/23/2000 625250 1521 /186 W D 07/23/1997 1146/561 W D 7f1~1d CI IMMARY Bill #: Fair Market Value: Assessed with: 214,700 Valuations: Description Class RESIDENTIAL G1 Totals for 2004: General Property Woodland Totals for 2003: General Property Woodland Acres 2.630 Last Changed: 10/26/2001 Land Improve Total State Reason 55,600 126,700 182,300 NO 2.630 55,600 126,700 182,300 0.000 0 0 2.630 55,600 126,700 182,300 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 149 Specials: User Special Code 018-RECYCLING 001-WATER Category SPECIAL ASSESSMENT SPECIAL ASSESSMENT Amount 27.00 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 A ~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ ~! /~ / L ~ F rZ ADDRESS ~ pX ~ Z Q" ?~ ~_l1( (~(.J~ SUBDIVISION / csM# ~ANNYRip6c LOT # Z SECTION / I T 2 9 N-R ~ ~ ~ Town of ~( ~.J ~ S O N ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM --_~_ T,4,a,,v t- ~- _--_ ~ -- -. __ _ __ ~ __ /l L T ErZ NA'T E ~ ~ $, M ~ Tc P o~ ~-~2~E'A .~ 3~ I'~p/D~ oK t S ~~ ~ ~ J 40 ' ~ i ~ W ~. S j WELL-~j- ~ I ~i ~' ~ ~ ~ _ 5 GhLE ~~~' . ro' 9 s ~ T N INDICATE NORTH ARRO~~' Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARR: -ro~ mF /~~~l~,E oH(CUiQ.Ut ~(- fOO,QO~- 3.55 ~ ALTERNATE BM: Tof' mF ~OcJS,~ ..f=0t~~lD6~T/t~N ~ /. = 6,2Z~ SEPTIC TANK UMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: WETS ~2 Liquid Capacity: ~UC~O ~~L Setback from: Well S Z' House /S ~ Other /t~n47~ tcTL//YC gq ~ Pump: Manufacturer ~---- Model# -" Size -' Float seperation `-- Gallons/cycle: ~` Alarm Location _° SOIL ABSORPTION SYSTEM Width: /$ r Length `/d ' Number of trenches ~~~ Distance & Direction to nearest prop. line: ~7d TO No 2'r /Y ~~~iM~ Setback from: well : 6q/ House~_ Other /2 ~ 70 S,T ELEVATIONS Building Sewer ST Inlet: //,7~-~ i ST outlet / 2 • Zd PC inlet PC bottom Pump Off ~-- ~'H l2,go Header/Manifold ~N ~z.~ Z Bottom of system / ,~, y Z Existing Grade~j. ~/ "~---Final grade c1 . c,/ Z_ DATE OF INSTALLAT]IO~N~:~ ~ ,, c /~ PLUMBER ON JOB: py~ LICENSE NUMBER: ~TP'"~3S INSPECTOR: 3/93:jt Wiscorisin Department of Industry ' La;aor and Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ~ Town o MILLER, SAM CST BM Elev.: ~ Insp. BM Elev.: BM Description: _ //// ~//,, C _ ^ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic //'' /I ~ ~~ Dosing Aeration H g TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic >SO ~ ~ ~ /~ ~ NA Dosi n NA Aeration NA Ho PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction stem TDH F Forcemairl_ en Dia. Dist. To well SOIL ABSORPTION 5YSTEM ELEVATION DATA ST. CROIX Perm STATION BS HI FS E LEV. Benchmark 3,S ' ,, ,7 lG~ C~ C Q ~. ~ . 3~3 Bldg. Sewer St / Ht Inlet ~~ ~ ~~r ~ St/Ht Outlet ,,, ~3y,, Dt inlet Dt Bottom Heade ~~,30' , ~ ' Dist. Pipe ~ 3' ~ ~ Bot. System ~ i Final Grade ~.~~ ,5,~~ BED /TRENCH Width ~ ~ Length / No. Of Trenches pl No. Of Pits Inside Liqui epth DIMEN I N ~ DIME SYSTEM TO P/L BLDG WELL LAKE/STREAM anuacturer: SETBACK INFORMATION TypeO CHA, R Mo a Number. System: bk.~o( -~3Sn. -~ ~ ~ ~ ~- OR UNIT DISTRIBUTION SYSTEM Header 171~ariife ld ~ Distribution Pipe(s) r~ ~ , x Hole Size x H acing Vent To Air Int e Length ~~ Dia. ~ Length ~ Dia. ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or A ade Systems Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOC TION : ud n . 1 . 2 9.19W, SE; N , Lot 2 , ann ane ~, ~~.,~n~;.r ~ ~~~~~ d ~p ~j -~ ~`'' ~(' o~a-~~-~-~''~ ~ ~. Plan revision required? ^ Yes 0'No Use other side for additional information. 3 SBD-6710 (R 05/91) Date Inspedor'sSignatur Cert. No. SONITORY PERMIT OPPLIIC_OTII>oN ' v~i~rilfr'i -- -- - - - - - In accord with ILHR 83.05, Wis. Adm. Code cou ARY,PEjMI # STATE S -Attach complete plans (to the county copy only) for the system, on paper not less than ~~ B (-'~( Q~(t/P_ 8'/i x 11 inches in size. ^ Check if revision to previous application wee reverse Slde for InStrUCtIOnS for Completing this appllCatlOn. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ~~ ~ ' S~ /n /LL ~~ E (or W / T , N, R /a, S '/a >~ PROPERTY gWNER'S MAILING ADDRESS ~ LOT # Z BLOCK # Z Z ~)C CITY, STATE > ~ ZIP CODE PHONE NUMBER Z7~ SUBDIVISION NAME OR CSM NUMBER . ' NIY 12 I ~ 6~ ~51~1 ~ S~ZZ Sy~ - 1 t~J 0 3 . ~ CITY ~ NEAREST ROAD II. TYPE OF BUILDING: (Check one) State Owned ^ VILLAGE l~u Ds~ Ti4 N ~ ~+ ^ Public 1 or 2 Fam. Dwellings Of bedrooms ARCELTAX NUMBERO Iil. BUILDING USE: (If building type is public, check all that apply) ®Z ("'j .- f ~ r ~ ` ~ a ^ l o d 1 ^ Apt/Condo 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 11/. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) ^ Reconnection of 5. ^ Repair of an ^ Replacement of 4 ^ Replacement 3 New 2 A) 1 . . . . System System Tank Only. Existing System Existing System. B) ^ A Sanitary Permit was previously issued. Permit # 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 42 ^ Pit Privy 13 ^ Seepage Pit Pressure 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.) (Min./inch) c~ELEVATION Q ~ SO ~ `~~ ~ Z O a+ 7 g , g0 ~ Feet Feet / ~ VII. TANK CAPACITY in allons Total # of M f ' N Prefab. Site n- C Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks ame anu acturer s oncrete o glass App Tanks Tanks structed Se tic Tank or Holdin Tank Lift Pum Tank/Si hon 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 s) ` ~ MP/MPRSW No.: Business Phone Number: ~ ~©u~ s~~v S~ ~ ~ o rte- 2 z z.3 Plumber's Address (Street, City, State, Zip Code): ~ zz ~ - v.~ R E ~. ~- ~ a rr a sy IX. COUNTY/DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater fOharge Fee) a e ssue Issui nat o S ps) Approved ^ Owner Given Initial ~~ Q w ~~ Adverse Determination ' O . CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(8.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS + 3 ` 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 8 Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. 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 in 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 in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// 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'/z 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) port 1 G S ,M '."~--.__._ TA N N Y ~ A NE _,---_ .__ ~L_ .. .. . . ... ,. ~ sa [TE.1'A7E 13G 2~ `*~ ~1 /t E,q ~ ~~ ~~8., I_`_ __. _ ~o__'~ -S~ ~ - ,-, ~~~ <~ era ~ ~ r I ~ ~~ ~~ I ' ,r ~ v ~IousE Zg'XSo, LO"r 2 C M ~~ ~/N I' ^'k 1 D ~~ ~ e7 j~ 5 s~~M ~ I- ~9, go LC~~v°'`~d~ ~ ;1~ ,d !o ~o ~, i~ ~~ Z LOT ~~ fv fo ~v 4~ W i~ t fi { `t 4 r i ~.. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa a of 3 Labor andfluman Relations g ~,[~ivision o'f Safety & Buildings in accnrri with II HR R'~ n~ Wis Arlm C:nrta COUNTY x ~ ~ ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must include but d ) l . , 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 nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: j/Q~ /~ ~ PROPERTY LOCATION (~ GOVT. LOT j F 1/4 /v~ 1/4,S % / T ~9 ,N,R / 7 E (a) W PR~ ~ C~IN E R':S~ 1 ~IL21N G ADDRESS LQ~# BLOCK # SU~ N A ME M # OR CS ~ ~ - 6 Z `a a ~ ~ ~ ~ ~ ~ CITY STATE 1 ~ ZIP CODE PHONE NUMBER ^CITY ILLAGE OWN NEAREST ROAD Ca Or/ W I ( ) U~s~rJ I AA1Nl;L A~lr New Construction Use [~°J Residential / Number of bedrooms [ J Addition to existing building j ]Replacement [ ] Public or commeraal describe Code derived dairy flow ~5 ® gpd Recommended design loading rate 4 ~ ~ bed, gpd/ft2 0. ~ trench, gpd/ft2 Absorption area required ~4 S bed, ft2 S~5 tr nch, ft2 Maximum design bading rate 0.7 bed, gpd/ft2 ~ $ trench, gpolft2 ~ Recommended infiltration surface elevation(s) ©>, 3 of 3 ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft S =Suitable for system U=Unsuitable fors tem CO VENTIONAL S^ U OUND S^ U IN-GROUND PRESSURE ~) S^ U T-GRADE ~S ^ U S TEM IN FILL ~S ^ U HOLDING K ^ S U SOIL DESCRIPTION REPORT Boring # Ground elev. 9~ ft Depth to limiting factor 7 (d.Z.~ Boring # Ground elev. 95.6g ft Depth to limiting t~z Horizon Depth Dominant Color Mottles Texture Structure Consistence Bamctary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends Q O-~ i 0Y 3/ '"' L 1 ~. /h r S Z p 4 ~,~ / Tom: ~-~ %a .--., 5> L ~ 6{~a~ /1t~r L; S ~ ~ .9 A.; 7r~ Sg I[~y ~ _ 5 r n~ ~ r i' t. 0.7 1S g -~ ~c~ 4 v S ~ ~,l l ~ o.~ .~ Remarks: ,4 U- r - Y~43 ! -" L, l n, c r- ~ r (' S ~ . 4 ~o. $ 4 ~9 id 3 ~ -- S ~ ~ ~ / 0.7 ~$ ,~ 7-/i9 a ~ `~ S ~ ~ I 4.7 ~O~ Remarks: PROPEItTYOWNER SQN` I,~~L~'E'~' SOIL DESCRIPTION REPORT Page ~ of 3 ' PARCEL I.D. # Boring # Ground elev. 9S~/ft Depth to limiting factor ? !d. C~ Boring # .. Ground elev. gyp, 3 f ft. Depth to limiting 7 .F~ Boring # .... .S, Ground elev 92 •~~ft. Depth to limiting ~ i~t ~ Boring # ~,: ~~ ,,.,.. Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Color Mottles ' Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerxh Remarks: IQ () -~ I vY£. ~jI ~' S L I rh 5 b~ M~r ~ S 2 ~ 0.4 O.S ~ o-f~~' /dye ~ ~- 5 ~ ~ ~ / O.~ ~D.g Remarks: Remarks: Remarks: ~ 3 ~ ~ 3 ~~ n ~ ~ r r ~ ~ ~, r n ,~q ~ p~4 V ~ - O v~ c~Ji . ~ !~. ~ Orl .D ~ ~ V N ~ ~ ~ .p. ~~r, cn L ~ ~ k .~ H o ~ ~ I „~,~ N ~ 0~ ~ ' ~ o~ t w N y .. as ~` y~ ~ k C ~ ~ p N Vv ~--a h ~ ~ ~. ~ t ~ h ~ ~ ~ 1 ~~~ ~ ~ ~ L b ~~ ~ r r ,' ('vr ~ db ~ R~~ ~. ~~~ << n c '- ``~ ~ b ~l 5 Q` P1 (~ b ~~- 52`7'739 nu ti.4y,. ...:.taA,Sk.>E:-.. r.•Ltii.SS:,, .. .. ~...,.... e..a,,. ... .~ ~vc~ ~ ~I~~D APR 1 7 1995 - KATHLEEN H. WALSH Replster of Deeds ~~ SL Crolx Co., WI ~oa~-- 130s-ab l5 ad ~ ti ~~ ~ ~" Cs~n lola9o~ of i .~ ~~~_ _~ ~' =~•'' V ~jA VN '~~ CERTIFIED SURVEY MAP Located in part of the SEA of the NEB of Section 11, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being Lot 15 of Tanney Ridge Special Addition and Lot 2 of Certified Survey Map recorded in Volume 10, Page 2830 at the St. Croix County Register of Deed office. N L~~ I I Q L X71 3 I ~i ~ ~= C. S. PJI. I ~J ~-~~~ ~ _ ~ \~ ) , oo_ ,!~Np ~~~~ / ~ ~° ~w~, ~ ~ d ~~ ~ - -~I~JI ~•~ ~ ~d~ (? I ~` ~' ' I-I SI ~ \ \ • m d o I `- ~j~ •''- ~ ~ ~~~ (J•)I -'4 S50°45'03"E ~ ~ LOT 4 •:~. •' ~® °~'~ 2.63 Acres (114,462 Sq. Ft.) ~ h~~ ^~O• ~D B O Lo,F A QSM C ~prw~er(`~ iu~203~ ~Oc~``W ~ ~ ur'i I a°16 1~ O1 n ~ 561-><1 ,2 4 I--' i; o nl o ~ ~~ ~ d c W Z ~I :- No ~~i ~vl ~~ LOT 5 O JI UI 2.98 Acres (129,984 Sq. Ft.) L7~ ~ lS ~Qy /[IQ ~, ~ ~I ~~/~a~~~f~PW ei '^•t ~ ~'.~ ~ '~ 1111 ,~ ~ 1:N C. ` ~r,.c ~~ ~ tiotio~. ~ i4d7 = ~ ^ ~' 1fiUBv~N, `i EPdiS. ~~,r~~<; .P t~ ,r,,, ~ ~, ~.9Q~~kD SU~~'I ~a~" S89°30'00"W ~ _ _~ say ~~69~iGA~+"~'~~"~ ~ `,~ ~I al I J~ ~-I -I CJ ~ ~,~ ~ I JI `~ L~ ~I io u N ~ `I `I ~I M ~ LEGEND 0 N ~ Aluminum County Monument Found ~ 2" Iron Pipe Found • 1" Iron Pipe Found 0 1" x 24' Iron Pipe set, weighing 1.68 1bs per linear foot. -k--Jr- Existing Fencel i ne -•-•-•- 12' Utility Easement • • • • • • • • • • • • • • 50' Roadway Setback line S89°30'00"W ~~ . _ ~ .. a h N N 'o 0 ~`i N~ N ~ ' t~ O~ V ~ ~ '~ ~ v ~ -- -- -- y ~-~, ~ ~ a ~~ ~ o~ w m ~ v t~ v; ~ ; J ~' w 4 d ~ O w = F- N V w C1. LL ~ a ~ F- ~ X ~ ~' CCC~~~ O ~ F- 0 J .- O X aj Ra. z ..---~ U z w w~ ~~ O 2 LL'v ~r •d, C9 XX O . ' 'H O r' Z T O r I a I ~" ~ I M F O c /~ I I U I a =,d. ~ z I ~. ~ ~~.~ 7 I o- I L ~ a ~ I w I w 0 U ~3 x L 522546 ~~~~~ FILED Q C T 1 7 1994 0- JAMES O'CONNELI ~ Register of Deeds / ,~ st, Croix co,, w! CERTIFIED SURVEY MAP Located in part of the SEQ of the NEQ of Section 11, and in part of the SWa of the NW; of Section 12, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. "J-1 ~ ~ co r n~ o ~ G.) t-+ ,. O ,.' • O - ~ t0 O N ~ O O CI E "t~ 7 N O (D '7 ~'~ N O '7 ., o_ d N O N C e'h 9 S fD N o_ '+ o. O N ~~ ~_ d~ -, f-r GCi +t 7:'~~! S~'. ~,',nOIX COI;iVTY :,'~rrpranensive Plannir Zoning and !=~:rks Ccrnmittee OWNER Sam Miller P.O. Box 282 Hudson, Wi. 54016 SEE SHEET 2 MATCH LINE v 1 ~ I , v , tf not rocarded ~ ~ ~ ~ i within 30~iia.ys~of j i approval date ~' ~ ~ approvat'sh~lf `bE! ~ ~ ~i nuii ~ void C ~~ ~ / ~~ , J~' ~~, I ~ , i ~j~r ~ Ss ~ ~,~ /~ / ~~ c ~ ~ 1•~- ~~ ~ ~ <, ~ / , ~ ~ ~ ,~ J ,~ k.0 u'. O , o , ~ o° ~'P o ~° y~ , ~° ~~ ~~ ,~ ; l ~J eti ~~ / 53 y / /~v ~\ .~ o VARIAQLQ O~ ~ ~ ~' % RIGHT _ ~ WAY i OF- S89°30'00"W %n ~ .- z 0 0 0 0 0o w w - • N N O S89°30 :00"W '? S89o30' 00"W east-west 1/4 line " V 3942.19' g g , 00 ~ of Section 11 1212.32' Wzt Corner Section 11 VARIABLE RIGHT-of-WAY W L~J c_ ~_ Q J ~ - ~(~ ~C~ J Zv` ~ ~ , I .` [.~, ,. E} Corner Section 11 --1 N ... N rt a. 7 w ...,, rr a m a d c 0 a- 0 N described and mapped the land parcel which is represenLea Ay znis Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as •follows: A parcel of land located in part of the SE1/4 of the NE1/4 of Section 11, and in part' of -the SW1/4 of the' NW1/4 of Section 12, all in T29N, R19W, Town of .Hudson, St. Croix County, Wisconsin; further described as follows: Commencing at the E1/4 Corner of Section 11; thence S89~30'00"W, along the east - west 1/4 line of said section, 1212.32 feet to the ,point of beginning, thence continuing S89~30'00"W, along said east - west line, 99.00 feet; thence N00~03'20"E, 83.24 feet; thence N53~40'00"E, 350.40 feet to the point of curvature of a 167.00 foot radius curve, concave westerly, whose central angle measures 5336'40", whose chord bears N26~51'40"E and measures 150.62 feet; thence northerly along the arc of said curve 156.26 feet; thence N00~03'20"E, 179.17 feet to the point of curvature of a 233.00' radius curve,,concave southerly, whose central angle measures 10745'07", whose chord bears N53~55'S3.5"E and measures 376.41 feet; thence easterly along the arc of said curve 438.18 feet; thence S72o11'33"E, 266.63 feet; thence.N00~03'20"E, 481.72 feet; thence 54002'31"E, 458.81 feet to the point of curvature of a 80.00 foot radius curve, concave southwesterly, whose central angle measures 21421'38",whose chord bears 522 51'42"E and measures 152.86 feet; thence southerly along the arc of said curve 299.30 feet to the point of curvature of a 80.00 foot radius curve, concave southerly, whose central angle measures 4504'10", whose chord bears S61~47'02"W and measures 61.32 feet; thence southerly along the arc of said curve, 62.93 feet; thence S39~14'57"W, 164.59 feet to the point of curvature of a 233.00 foot radius curve, concave•northerly~, whose central angle measures 0829'51", whose chord bears 55658'01.5"E and measures 34.52 feet; thence easterly along the arc of-said curve, 34.56 feet; thence 52847'03"W, 410.92 feet; thence 58515'52"W, 115.81 feet; thence N04~44'08"W, 240.24 feet; thence S89~30'00"W, 385.00 feet to the point of curvature of a 233.00 foot radius curve, concave westerly, whose central angle measures 5336'40", whose chord bears S26~51'40"W and measures 210.15 feet; thence Southerly, along the arc of said curve, 218.02 feet; thence S53~40'00"W, 192.17 feet to the point of curvature of a 167.00 foot radius curve, concave easterly, whose central angle measures 4941'26", whose chord bears S28~49'17"W and measures 140.34 feet; thence southerly along the arc of said .curve 144.83 feet to the point of beai~nnina. Above described parcel is subject 't o, all easements of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. VOLUME 10 PAGE 2830 G E:~~ CERTIFIED SURVEY MAF Located in part of the SE a of the NE a of Section 11, and in part of the SW4 of the NWa of Sectionl2, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. ~~I LEGEND Aluminum County Section Monument Found O 1" x 24" Iron Pipe Set, neighing 1.68 lbs. per linear foot N ~-+ ~ ~~~ ~a r d o ~ w rr r• o.-•~ ~~ o re y 0 o m a •+> -~ m N A 7 A fC .-r ~ r• to o z ~ m .- o. •••••••••••••• 50' Roadway Setback Line -•-•- 12' Utility Easement i ~~~Jc --1 S N• N ... N rt rt o_ d -„ a o- m a r d C 0 o- 0 r I N d rt N O N c 'r a s m m a m cr a O N f'Y c I ~_ ~~ 7 N e'F `/ THE _ -ice. ~ / ~'~~_ 3'~"E ~ ~ ~ ~ s ~ ~ / ^\` PVe~ /C \ M ~ ~ \ ` ~ 6 6' 63 , ya ~, ` 380.00 ~ '`~ N1 0 ~ % ~ , ~ , ~ , ? 11'33n ~ , ro ~ ~ , r ~~ '~' U ~~l ~ / 33. . j ~ ~ ..~1._.... / ig .•~ ~~ '• I50.00~ ~ ~. W `' 380; 0 ~ F' 0 2 ~~ N ~ / 33 / ~ / ~ d~ i ~ i ••~.,•• L_~,- ~ ~ ~ ~ l y ~ ~ ~ '' ® ,- o .7- ~ ' LOT ~ ~ ~ ~ ~ .D "~ m x p °0 2.69 Acres ~ = z o ° 117,233 Sq. Ft. t, ~ . --~ o J O ,., ~ ~ ~O ~ J w o z ~,, ~ l0 O w ~ 6 6' ,e o ° ~ J N I ~ _ ~ p~ CrJ Q v ~ , Oaf 17.:'94; ~ 5.89°30'00"W. 385.00' MATCH LINE S'. , CR©#X COt1NTY .„~:~r~ensl•re Plarnir SEE SHEET 1 Zonir,~ and OWNER ~.:'k5 Committees Sam Miller P.O. Box 262 E# not rocorded Hudson, Wi. ...:,~::., Zn rl~ve of ;``~` I ~,~' ~~.~ ~~~..~ ,,o.,.. v~`7 "~ ` ~.~;; ~f.jt{j. 1-2 Rd. 167.00' S3°36'40" N26°51'40"E 150.62' 156.26.' N53°40'00"E NOC°C3'20"E s-4 Rd. 233.00' 107°45'07" N53°55'53.5"E 376.41' 438.18' N00°03'20"E J7[J11'33"E 5-6 3 233.00' 19°28'27" S62°27'19.5"E 78.81' 79.19.' S72°11'33"E S52°43'06"E 7-8 3 80.00' 45°04'10" N16°42'52"E 61.32' 62.93' N39°14'57"E NOS°49'13"W 8-9 Rd. 80.00' 270°08'20".,, S50°45'03"E 113.00' 377.19' ..N05°49'13"W S84°19'07"W 8-9 3 60,00' S5°46'42" N22°04'08"E 74.84' 17.88' N05°49'13"w N49°57'29"E 8-9 ~A Rd. 80.00' 214°21'38" S22°51'42"E 152.86' 299.30' N49°57'29"E 58~:°19'07"W 9-10 Rd. 80.00' 45°04'10" S61°47'02"W 61.32' 62.93' S84°19'07"W S39°14'S7~'W 11-12 2 23.3.00' 08°29'51" S56°58'01.5!'E 34.52' 34.56'. S61°12'5.7"E S52°43'Ob"E 1.2-?13 , 2 233.00' 10°27'54" N55°59'00"W 42.50' 42.56' N61°12'57"W N50°45'03"W . 11-13 2 233.00' O1°58'03" N51°44'04.5"W 8.00' 8.00' N52°43'06"W N5C°45'03"W 14-15 2 167.00' 21°26'30" N61°28'18"W 62.13' 62.50' N50•°45'03"W N72°11'33"W 16-17 1 167.00' 107°45'07" S53°55'53.5"W~ 269.79' 314.06' N7?.°11'33"W SCO°03'20"W 18-19 Rd 233.00' S3°36'40" $26°51'40"W 210.15' 218.02' S00°03'20"W S53°40'UO"W 20-21 Rd. 167.00' 49°41'26" S28°49'17"W 140.34' 144.83' S53°40'00"W SO3°58'34"W VOLUME 10~ PAGE 2830 . f ~ ~~? G ~~ ti .CERTIFIED SURVEY MAP Located in part of the SE 4 of the NE~a of Section 11, and in part of the SW a of the NW a of Section 12, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. Ir_. I~_ i ~ ~~ ~~- ~o 0 i ~ z `'' I-~ O ~1~ ~~~~~' i ~~1 O Iv W \`~/ ~ ~^ ~~ ~ ~V I~ ~~ ~~~ ~'' -LOT , . 3 0° 2.1`8 acres ~.,, N 9018 / / F t . ~ ~~ ~~,~ .' ~ J / ~ /\ I / \ / \~\ / / 8 / \ ~ S ~2 011 ~' \~~~, ~`~ s U 266 33 "~' ~ lid ~~ ~ c~ '~ 23 1 33nE ., ~ ~ J ~ a ~ ~ '~.~15~ ~~ ~Q~~ ~ ~~ m (~ ~ ~ ~, x Y m m .~ r Z 0 N .~ O CTJ r 0 cp w 0 2 0 O ~ 0 O •50, pQ ~ LOT 2 2.66 Acres 116,077 Sq. Ft. ~~ ~~ ., qry o' Otiy ~~J/ ~i .3 ~ ~ ~/ ~~ ~,- , _ :..n ~.. N y r W t0 A N o -~ ~~~• O f.. 7 7 tQ O !0 N ~ O N z ~,~ N O ~ C1 N fi ~ r• m o '~ ~ m ,.. ... .Q < d~ ~ N O (~ ^ T ~ ~~ ~ ~- m rt m O N P'F O' I to = w ~ ~ N rt a 44{ id y^ 4q ~~~ II ~i~ air ~t~:'9a S''i . CF;UIX CUUlVT~Y ::~s:1 ps•r: h e ~ s i vo ` P t~rini r .'~afil;~~~ 3!1(~ ~~rks Committee [f rof recardod vaiti~in 30~dt~ys~b'f aAprova! date a~provaf ShaU'be till R VOFLI OWNER Sam Miller P.O. BoK 282 Hudson, Wi. 54016 r ~ ~~ Zo~ "' ;\ i T r• r• r+ c e a d -ff rt d O" m a d B ~-• a 0 N Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and appropriate Town Board for advice. OWNER'S CERTIFICATE OF DEDICATION As owner, I hereby certify that I caused the land described on this Certified Survey Map to be surveyed, divided, mapped and dedicated as represented on the Certified Survey Map. I also certify that this Certified Survey Map is required by S236.10 or 5236.12 to be submitted to the following for approval or objection: St. Croix County Planning and. Development Committee and the Town of Hudson. WITNESS the hand and seal of said owner this ~_day of c~.fnb~ r- 19,~ . In the presence of: Wi ness Sam Miller State of Wisconsin ) SS County of St. Croix) Personally came before me this day of 19 the above named Sam Miller to me known to be the persons who executed the foregoing instrument and acknowledged the same. Notary Public,Jecces My Commissio expire . ~,~ A JD%''~, n : P <... C ~' Ugl1 ~~ •, ,y~~k~•,,: ,' ~``•. Vi~' .'f '~~r ~F~`.~~~', ,. isconsin _ ' TOWN OF HUDSON CERTIFICATE I hereby certify that this Certified Survey Map is approved by the Hudson Town Board. J¢A ert, Clerk ~°~~ ~l~y Date VOLIIMI: 10 PAGE 2830 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S A~ /~ ~ 1 L ~ +E V~ MAa,n~rG ADDRESS ~ a ~ ~-z ~' ~- ~U ~ 5 ~ ~l cw ~ S yy~~ PROPERTY ADDRESS ~~~ ~/ / % ~~~~~~ ~~~/~'~~. (location of septic system) Please obtain from tl~c Planning Dept. CITY/STATE ~!~ D ~ ~ ~ W ~ S f01b PROPERTY LOCATION ~' ~ 1/4, ~ 1/4, Section / / T_~_N-R_~ TOWN OF ~y D S 4 ~ ST. CROIX COUNTY, WI SUBDIVISION Ti4 I~ Al }~ ~ I j~ 6 F LOT NUMBER 2-- CERTIFIEDSURVEYMRP ~~ ~ sy~ VOLUME !o , PAGES 3 y ,LOT NUMBER Z-- 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 tl~e 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 SIGNI/D: / __ DATE: ~v- .1__Z _ ~~__ --- St. Croix County Zoning Office Government Center 1101 Carn~ichael Road Hudson. A~~I 5401 G 1 1 /93 ~. 8 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 propertyS~} /~ /~ /L,,L,E Location of property~~1/4~~1/4 , Section ~ / , T ~ N-R / Township l~Sa Mailing address ,~j,(''~` z-~Z ~y s a~ ~y~ s~/r~i~ Address of site X07/ ~~ ~~~ ~..,.~ ,~ ~. Subdivision name 7i~~N ` /'~.~D(o,E Lot no. Z- other homes on property? YesX No Previous owner of property /2 ~~ ~~.~~/ S' ~ ~ a/I Total size of property Z, lP(-, ryt~. Total size of parcel ~ , ~~ /~ ~- Date parcel was created ~U - / 7 ~ S Are all corners and lot lines identifiable? _~Yes No Is this property being developed for (spec house)? ,( Yes _ No Volume U.3( 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 o_f Deeds as Document No. sD ~ $ 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. Sd SS's ature o pplicant O~/z Date of Signatu e Co-Applicant Date of Signature ..._._, .. '' ~ ~ f • ~ ,' i DOCUMENT NO. STATE $A F WISCONSI ORSS 1-1883 *"~• sr+cc wcscwvcD row wccowo~"a BATA _ ARRANTY D~~~~++D SO48SS JOL ~~~/AGE 4JV Y This Deed, made between ----- _---•------•--------------•-•- - . - --•-------.-- .--- - Randall--W. Synan and_ Patricia E._ .Synan, _ -- ---husband-.-and--wife-• _•--- _ - ------•----- ------ ----- ---- ---------•---••- ----- ---- - --• --•-------•--- --------•. Grantor, and.-..Sam-B.--Mil,ter,-• a_-s•~-ngle---person---------------------------- -----•-------• -----• ......................•---•---.....----...------- •------...--•--------------~ Grantee, Wltz1esseth, That the said Grantor, f r a ~atuable consideratioa-..._. Randall W. Synan and Patr~cia E. Synan conveys to Grantee the following described real estate in ...St . Cro ~ X County, State of Wisconsin: I :_CJST~4'S OF7C~ ^ec'~ br Reowti - SrP 1' 1993 ~t ~0:4~ O ~ :•M ~..~*~.+-act a-~ ~ oaeaa RlTU11N TO The SE1/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N112 ' of SWI/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; ali in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. F~~ AND A parcel of land located in part of the NE1/4 of SE1/4 of Sectio""n 11, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1/4 corner of said Section 11; thence S89 30'00"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 28'03"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 11'33"W, 150.00 feet; thence N03 58'34"E, 351.07 feet to the point of beginning. This .....-_...i_,g...nQfr.... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And.-.--A~.r~da~l.. W-,...Synan.- and--Patr-ici-a.- 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~d{efend the same. Dated this ---•----•----.,./..'....--•----•-------•----•--. day of .-. ~GIiYIG!r~T wr ,~ .---G.~'-`~---(SEAL Randall W. Synan -----...---A,ug-ust- --- ----------------------------- ---- ls_.93.. .~~~.~'-1~ ~KK~!~ ............ ..... .......(SEAL) • Patricia Synan ----•-----•-•--••--• .............•-----°--•-----••--•--••----• ----(SEAL) AIITHBNTICATION t authenticated this ---.----day ot-----._-•----•.-------•---, 18..__-- TITLE: MEMBER STATE BAB OF WISCONSIN (If not, ------ ----- •--------------- -•---•-•-----.....----•------ anthorized by ¢ 708.06, Wis. Stata.) THIS INSTRUMENT WA$ DRAFTED BY Rristina Ogiand ------------ -Rt-corflep--a -- -aW------------------------------- (Signatures may be authenticated or acknowledged. Both - - ----- - --------- •------- --•-------•-•-•--------....(SEAL) ACHNOWLBDOMSNT STATE OF WISCONSIN ss. St . CIOiX County. .._..---•-•--------- Y --------•-- -- Pe~sonall came before me ~ _______.day of August --•----------------------- 19. the above named Randall W. Synan, Patricia E. ---••--•--•-------------------------•-•-•-•----•-----•-••--- •--•-------°---•--- Synan ---- -----•----•--•-• - l~IICC ~. -- - -- - --•-••---•-•- •----- • -••-•-------------•---- ~RtC+O to me known to be the person . ~....._.N~'Yz he going instru nt and n wle~~e~ ~ ifs • Alice Joy on~hors St-:•--Cp-a ~ .................. -- ------------- ----- --------------- Notary i'ublie -•-..---•-------------------.....-..._--County, Wia. My Commission is permanent. Sjf not, stste ezpXation