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HomeMy WebLinkAbout020-1359-29-000ST. CROIX COUNTY ZONING DEPAR' AS BUILT SANITARY REPORT w C Owner ;~,~ Property Address City/State Legal Description: Lot ~ Block -- Subdivision/CSM # '/a ~ '/a, Sec. ~, T~N-Rf~W, Town of cc I ~,~. a,~ F ~, `1~~~ tii ~, ~ ; J,,. ~ ~. ~~~sr~cs~r~~ d :; _ ~~~v- PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer ~ Size ST/PC Pump manufacturer Model ~ Alanm location ---- (HOLDING TANKS ONLY) Setbacks: Service road Meter location Alarm location SOIL ABSORPTION SYSTEM: ~ /Q Type of system: ,~.~.u ` Width Setback from: House ~D _ Well ~ P/L ELEVATIONS: Description of benchmark Description of alternate b~ Building Sewer _~~~~ ST/HT Inlet PC Bottom 7©~ ~sHeader/Manifold ~ r Length ~~ Number of Trenches SD7` Vent to fresh air intake (, ~. Elevation DD ~ o~uts~ Elevation y~/ 3, 7 ST Outlet ,- PC Inlet ~ l ~~ 7 Top of ST/PC Manhole Cover Distribution Lines () ~ 7~ a~ ~ ) ~ ( ) Bottom of System ( ) ~~_.~_ () ~~ ~a f ( ) G~ ~~ ~~ Final Grade () / /' ~s ( ) ~ ( ) Date of installation / er 't num er .~~33y-3State plan number Plumber's signature License number /1f1~ o~o~ ~~~Date 3~~ 8d Inspector ~~-- from: House ~ Well ~ P/~'~S Vent }o fresh air intake Water Line Complete plot plan ~ NOTICE: Please provide the following: A plan view sketch showing everything within 100 feet of the system. Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. INDICATE NORTH ARROW PLAN VIEW - 1~fliscG~nsin Department of Commerce PRIVATE SEWAGE SYSTEM ~'~Safety and Buildings Division INSPECTION REPORT ' GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. Permit Holder's Name: ^ City ^ Village ^ own of: Hudson Townshi ev.: Insp. BM Elev.: BM Description: o'O . (~ ~ Jt'D , c~ ~ C.Sr 8~~. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ t~ ~ Dosing ~ ~~,~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ~/~' ~ r ` NA Dosing ~~ ~~ ~~ n:.2R' NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer ~ e~s Demand Model Number ~~ ~ GPM TDH Lift Lriction System TDH Ft Fi Forcemain Length '~ ~ Dia. r~ Dist. To Wetl ~- ELEVATION DATA county: St. Croix Sanitary Permit No-: 353343 State Plan ID No.: Parcel Tax No.: - -000 STATION BS HI FS ELEV. Benchmark ZS ~ - gyp, p Alt. BM (0.3 qg• `~~ Bldg. Sewer ((, 1`j' 9' , fJ(~ St/Ht Inlet ~(.$~ q3,~/ St/ Ht Outlet -----~ Dt Inlet " Dt Bottom • ~ p gp, /5~ Header/Man. 6.~/ 8, Dist. Pipe 8'Oz .o z rj~. 23/ Bot. System ~; 3 qs, `j,z Final Grade ~-`fp~ 9°f .8S St cover / ,2s r ~'D• a SOIL ABSORPTION SYSTEM ~ zl ~ ~,,,. _ ~-„ i c o./,~~. ~vrut_r.~- RE , Width Len th No. f renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N ~ ~-s DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: Q ~ --S F ~ l ~ SETBACK °r l ~ -Yi'- ' eu- ` ' ~ INFORMATION Type O r ~ CHAMBER M de Number: //~~ System: ~.A n ~! ~ > ~ ~`" 90 r---~--- OR UNIT ~, DISTRIBUTION SYSTEM U Header / Ma ifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake cl Length ~~ Dia. ~ Length - Dia. Spacing q0'+ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 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.) Inspection #1• ~ /a`I/ ~OIns~ection #2• / / Location: 952 Meadowood Lane, Hudson, WI 54016 (NW/14 SW 1/4 16 T29N R19W) - 16.29.19.2125 Parkwood Meadows -Lot 29 I .) Alt BM Description = -~ a ~~au-~n~~ , lewcrd~" r~ 5~ ~,~~.~e- ro~~) 2.) Bldg sewer length = 19' ti -amount of cover = > ~~ Plan revision required? ^ Yes ~ No Use other side for additional information. 3 30 o~p ~o.~w,,, SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ,~~SCO/1S%11 SANITARY PERMIT A Department of Commerce In accord with Comm 83.05 Wi • ' Attach complete plans (to the county copy only) for the syste , than 81a x 11 inches in size. • See reverse side for instructions for completing this applicatio Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1) (m)J. ^ Safety and Buildings Division -' pp~~~~~'I~il~ ~ 201 W. Washington Avenue _ s ~ P O Box 7162 .Adm. Code„ {~, '`~ ~!~~ 4 ' ~ ' ` - Madison, WI 53707-7162 4, 4 ~n~ ` ~~unt orypap~'ti6rt~ess ~ t. '~ ~ State.S rflt ~~ C. Y Permit um er r"~ CAU. p C ? Ryf e c~ vision to previous application "" f~~ ~Oc~ State eview Transaction Number >.~ I. APPLI ATION INF RMATION -PLEA E PRINT ALL INF R ~ ~ ~'~'~ Property Own Name Pr L Cat'i N R 1 ~f ~'(or W 1ia ia S ( T a ~' , M~ , f , o S Prope y Owner's Mailing Address Lot Number Block Number •~. Cit ,State ~ Zip Code Phone Number Subdivis n Na or CSM Nu ber . (JS )3 - PE 6 ILDING: (check one) ^ State Owned ^ Ity Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ Town OF , III. BUILDIN USE: (If building type is public, check all that apply) reel Tax Number(s) 1 (~ -']~ , l~ . ~I'25 ~ a 0 ~- l 35 1 ^ Apartment /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 ^ Hotet /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) q) 1 _ ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5, ^ Repair of an ______S~+stem ________System______!______TankOnly______________ Existing System _________Existin~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 3 ^ Specify Type 41 ^ Holding Tank 12 Seepage Trench 22 ^ In-Ground Pressure 42 ^ Pit Privy ~~ ' 43 ^ Vault Privy f 13 ^ Seepage Pit ~~ --- 14 ^ System-In-Fill a ' ..~I:.t.,..•-r~~ 3 ''- VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pere. Rate 6. System Elev. 7. Final Grade Required (~ft.) Propo~ (sq. ft.) (Gals/day/sq. ft.) (Min./inch) o ~ Elevation r S (J `-' ~ pQ Feet Feet V ~ / V VII. TANK INFORMATION Ca aut in allo s g Total # of r Manufacturer s Name Pretab. site con- l st Fiber- Plastic Exper. N i E i Gallons Tanks concrete ee glass App ew x st n strutted Tanks Tanks Septic Tank or Holding Tank - (, ~` ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber Q ~ ^ ^ ^ ^ ^ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s age system shown on the attached plans. Plumber' N m - Pr' t) ~~ Plumbe ' ignat re: (No Sta s) M /MPRSW No.: Business Phone Number: ~~ U 3S r!7lS g- Plurryt~'s Address (Street, ity, St Zip Code)• ~ 6~ /l~ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved S itary Permit (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) A roved pp ^ Owner Given Initial Surcharge Fee) ~--~ Adverse Determination ZD T,~i n. wwlv~ ~ w~~~ yr r~rr vr-~ r n~r~w~~~ rvn ~~~r+rrRVVri~. _//V~uM:. ~r.2Q ~s I~ ~ c~Q~ . SBD-6398 (R.12I99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ~ ~ v 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. Onsjte 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 onste sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151., 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 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 ail 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 1 1 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 bythe county; E) soil test data on a 115 form; and F) all sizing information. GRpUNDWATER, SU RCHARGE 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. 1 ``Q . ~~ `QA '. •I ~ 1 ~ ~ ~ ~ ~ ~ _ ~ . ~ r 4:. ~ ~~ rt V z ~"'~ ~ ~ ~a ° ~ ~~~ ~ ~ ~~ ~ ~~ ~ z E Q N ~ O ,3 - _ ~ ~ ~ ~t0 . a~ N ~ ,-+ x A+ p N~W01 OO ~ ~~ O N$~ rtl ~~a.1.Qi O ~ Ud LZ ti Q' o `~ ~ M a ~b ~ w ~ ~ °~o p ~ Q o°~ ~ ~ z~~~ ~ ~ b S'~ ~ ~~~ ~~~ ~ ' WiscortsinDepartmentoflndustry, SOIL AND SITE EVALUATION REPORT Labor and Numan Relations ~ r)i~iision ef5cafaty 8 Ruildinns __~ ..:.~ ~~ ~ .n n a..:_ AJ.... rr_~_ Page 1 of 3 • 111 UVVV~V ..,1„ ~~~ ~~ ~ VV.VV, •~V. •.v ,.• vvvv ' COUNTY Plan must include but er not less than 8 1!2 x 11 inches in size Attach com lan on a lete site St. C , p p . p p not limited to vertical and horizontal reference point (BM), and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance r{i a e~t~or+a '`~- ~ ~ 020-1029-30 ,..,ir _"-" ~, u ' `~'' •` APPLICANT INFORMATION-PLEASE PR T~1~C•INFORM~?C~TCAN%`~. IEWED BY DATE ~ , ~~ ~ / ~Z~~~ < ~'' ~/• n PROPERTY OWNER: ` ' /r~ ; Pp~PERTY LOCATION S ~ u LaCasse Custom Homes Inc. ~ ,f~/ W1ia,S 16 T 29 ,N,R 19 t~(or) W t~~ LOT NW 1!4 ..._. . `~' ~ 1 PROPERTY OWNER':S MAILING ADDRESS s ~ ~~}~ BLOCK # SUED. NAME OR CSM # ` rc 521 McCutcheon Rd. -- ~9 ~__ na Parkwood Meadows CITY, STATE ZIP CODE ~, : ;~'410f~ r ITY (]VILLAGE ~c]TOWN NEAREST ROAD Hudson, WI. 54016 ~~ f'?.1$ ~ 5 ,-~ ~ '~~ Hudson Meadow d Ln. roQrlts~ ~ 4 [ ]Addition to existing building [ ~} New Construction Use [X] Residential / Nu ~ro `b~ G j ]Replacement [ ) Public or commercial des Code derived daily flow 600 gpd Recommended design loading rate ~_bed, gpd/ft2 .8 trench, gpolft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.90 ft (as referred to site plan benchmark) Additional design /site considerations na Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system U=Unsuitable fors stem CONVENTIONAL ®S ^U MOUND [~S ^U IN-GROUND PRESSURE [~S ^U AT-GRADE ~S ^U SYSTEM IN FILL [~S ^U HOLDING TANK ^S CCU SOIL DESCRIPTION REPORT Boring # .................. ................. 1 Ground elev. 99.8 ft. Depth to limiting factor +84., Boring # 2 ; Ground elev. 99.5 ff. Depth to limiting factor +88" Depth Dominant Color Mottles r Te t Structure Consistence Bourxi~ Roots GPDlft Horizon in. Munsell Qu. Sz. Cont. Color x u e Gr. Sz. Sh. y Bed Trer>ch 2 12-24 10 r 4 4 none sicl 2msbk mfr if .4 .5 3 24-29 10 r 4 4 c2 7.5 2 s m r if .5 .6 4 29-84 7.5 r 4 6 none ms Os ml na na .7 ~ .8 \t Remarks: 1 0-15 10 r 2 2 none 1 2msbk mfr cs 2f .5 ~ .6 2 15-27 10 r 4/4 none sicl 2msbk mfr if .4 .5 3 27-35 10 r 4 4 c2 7.5 r 5 8 sil 2msbk mfr if .5 ~ .6 4 35-88 7.5 r 4 6 one o s Os ml n na .7 .8 v Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave. Richmond I 54017 Signature: ~ Date: 7_8_99 CST Number: m02298 r PROPERTY OWNERI,aCasse Custom Homes , Igo L DESCRIPTION REPORT Page ? of 3 PARCEL I.D. # _ 020-1029-30 _ . Boring # .:::3:.:..: Ground elev. 99.9 ft. Depth to limiting face + rr Boring # >~ 4 Ground elev. 100.0 ft. Depth to limiting factor +88 re Boring # €< 5 Ground elev. 99.9 ft. Deptta to limiting factor rr 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 Trer'rh 0-12 1 2 12-27 10 r 4 3 27-36 10 r 4 4 c2 7.5 r 5 8 sil 2msbk mfr --w if .5 4 36-88 7.5 r 4 6 none cos Os ml na na .7 .8 5. Y8 g Remarks: 1 0-11 10 r 3 3 none 1 2msbk mfr w 2f .5 .6 2 11-21 IO r 4/4 none sicl 2msbk mfr 2f .4 !.5 3 21-32 10 r 4 4 none sil 2msbk mfr if .5 .6 4 32-88 7.5 r 4 6 none ms Os ml na na .7 .8 ~9. z/ . Z Remarks: 1 0-14 10 r 2/2 none 1 2msbk mfr 2f .5 .6 2 14-28 10 r 4 4 none sicl 2msbk mfr 2f .4 .5 3 28-90 7.5 r 4 6 none cos Os ml na na .7 .8 _-. Remarks: Remarks: . ,, STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, INc. 1554 200th Ave. CSTM2298 NW4SW4 s16-T29N-R19w .New., Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #29-Parkwood Meadows. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established. at the time the test was conducted. ~_ ~~=40' = top of 1" pvc pipe C el. 100.00' ee/~ Jo7j~ ,Alt. BM.= top of 1" pvc pipe C el. 100.20' ~ ?070 ~~ ~!~ ~~ 5a' bf ~' ~~, ~ ~ ~ ,yo. ~~5 ..~; r~~ ti'Q` ~6 ,. 8 ~" 9~ ~~ ~~~ to ~5t ~ ~'z ~~~ Gary L. Steel 7-8-99 Sep-O1-99 10:30A r_uc ' - _ ••• ...•n~,oaR C:KOSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 2?" MtN. A80VE GRADC E w~Ty~ PROOF ? 5 ' FROM DOOR. wIlifDOW OR JUKCTION BOX APPROVED FRESH AIR INTAKE MITH CONDUIT MANHOLE c FINISHED GRAPE y• CI RISER W/ pgD~,OC 6" !lIN. WARNING l ~~• A80VE G ADE ~~" MIt 18" IN. 6" MAX. _ IN WATER TIGHT SEALS y ~. 6AFFLE ~ A Ct PIPE ~_ 3' ONTO B SOLID -;- SOlL C PUMP OFF ELN . AFT. ~.. 0 ~' . ,,` ~p ~. ~• GAS- ~ • TIGHT. SF11L ~ ~ ~ • ~ LM ' ON 1 ~ FF 3" APPROVED BEDDING UNDER TANK •~ APPROVED JOINTS W/ PIPE 3' 0 SOLID SO! •• RISER PERHITTCD IF TANK MANUFAC TU! HAS APPRO' SPECIFICATIONS CONCRETE pqD :EPTIC / DOSE ~ ~- -~ ----------- -- --~ ......_ ........ . fANX MANUFACTURER: NUMBER DOSES PER DAY: 'WANK SIZCS; SEPTIC CEO GAL. _._. DOSE _~~~ GAL . ALARM MANUFACTURER: MODEL NUMBER S1iITCH TYPE; PUMP MIANUFACTURER: r MODEL MINBER : SWITCH TYPE: DOSE VOLUME INCWDZNG . F LOirBACK : ~~ CAPACITIES: A = ~/~jNCHES B = _ ?~ INCHES C ~DINCHES D ° I NC ~~ D GAL. - ~C = ~G - ig~o~ KEOUIRED DISC}(ARGE RATE a GPM ~ HES r ~~~ PUMP 6 ALARM IdIR ING AS PER I LNR 16.2 3 YUtTICAL DIFFERCNCE 8E41~iEEN PUMP OFF AND DISTRIBUTION PIPE . • MiNIKUH NETWORK SUPPLY PRESSURE .,_,,,LO FEET • ~.,~_ FEET FORCE'NAIN X~FT/ 100 ~FT. FRICTION FACTOR ~ . }' ~ FEET TOTAL DYNAMIC HEAD _ -~~, FEET INTERNAL OIHENSIONS OF PUMP TANK: LENGTH ~[ FEET i~IIDTH DIAMETER 1 LIQUID DEPTH •cf _~ . IGNED LICENSE NlJMDER : ~~ aaa ~~ ........ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerlBuyer ~ ~~ r`'T~ ~ ~a Y- e y , Mailing Address L v~. m -c w 9 s~. Property Address '~~^ ~ /'- - - / .z.,. o l 3~~~ta t~ (Verification required from Planning Department for new construction) !~ t~~a -- t ~~S `~' - ~ y City/State t-~ ~.~, ~ 5 m~ Pazcel Identification Number ~e --1~-a~~T" -~'~ LEGAL DESCRIPTION Property Location ru h1 '/., 5 ~ '/., Sec. ~, T~N-R~~,W, Town of ~v~--+~- Subdivision Lot # ,;,~~. Certified Survey Map # `` Volume ,Page # Warranty Deed # ~f o~ ~ a. a . Volume J ~ 3 Page # ~ g Spec house ^ yes L~?' no Lot lines identifiable [~' yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof 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, joumeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 da of the three r expiration date. ~" ~ I' I bo SIGNATURE OF APPLI 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 operty descri above, by virtue of a warranty deed recorded in Register of Deeds Office. ~IGNATURE OF APPLI 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 . ' ~ ~ ::~~ ~4fi3Pac~ 58 srATH BAR oe wlSCOxsnv FORM 2 - 1998 ' ~ ent N ber Y DEED ' This Deed, made between LaCasse Custom Homes Inc a Wisconsin Cormration Grantor, and Curtis P. Carev and Constance J. Carev, husband and wife Grantee. Grantor, for a valuable consideration, wnveys and wazraats to Grantee the following described real estate in St. Croix Cotmty, State of Wisconsin (The "Property"): Is;g ~12p~~ S7, CRQIX ~ a ~~~DS RFCEI{IFp FQp ~~+ W1 IO-1,1_1999 9;30 p~ ~r ~ ~Y ~Y FfEs R ~~ Fps 113 PAGESs ~ f~; 10, p~ 0 I Name aM Return Aad~~real Gur~iS P. C'~crP ~ v a 3 Sum m ~lj S772t ,t`7-n/U y~ut~sm, 4[J 1J'~/fJlrp GaO-iGa~i- 3C Parcel Identification Number (PIN) This is no[ homestead property. Lot 29, Plat of Packwood Meadows in the Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights-of-way of record, if arty Dated this /3-~ day of October, 1999. s r AUTHENTICATION Signature(s) authenticated this ~ day of -'~CENEKZINN Notary Pt~lic~tate of Wisctm361 LaCttsse Custom Homes, Inc. ~=. Gtt • Richard W. LaCasse. President t ~ X60 TTTI,E: MEMBER STATE HAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAI'i'EU BY Attorney Krishna Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are t[ot necessary.) ^ ACKNOWLEDGMENT STATE OF WISCONSIN ) //'~~ ~~ ) ss. .l.C U ~, ~ County ) Personally came before me this ~~~ day of August, 1949, the above named LaC~e Custom Homes. Inc.. by Richard W, LsCassyPresident to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. ~ ,, ~~ Y1 ~l t~ in1~ r t e n~y~~.'.T ; n r Notary Public, State of Wisconsin My Corm fission is permanem. (If not, state expiration date: .3 t~ 3c~ ! . - ) *Names of persons signing in any capacity should he typed ar printed below their signatures WARRANTY Da6D STATa aAA OF tY1SCON4[N PORM No.1- tfrl INFORMATION PROFESSIONALS COMPANY FOND DV UC, VN 8655-2021