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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Div?sion
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353121
Permit Holder's Name: ❑ City ❑ Village a Town of: State Plan ID No.:
Town of Hammond
CST BM Elev.: Insp. BM Elev.: B Description: Parcel Tax No.: 3�yo
U d d 018 - 1034 -80 -696
TANK INFORMATION ELEVATI N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic S f iUtAl f QUV Benchmark / C/
D ing Alt. BM Z. 39
Aeration Bldg. Sewer
0
olding / Ht Inlet L 0,0,
TANK SETBACK INFORMATION t Ht Outlet �. 0-(�
TANK TO P/ L WELL BLDG. Air I to ntake ROAD
Air
Septic "2:-G / z / NA
Dosing A Header/ Man.
Aeration NA Dist. Pipe ' Z S �-
Holding Bot. System "��
PUMP/ SIPHON INFORMATION Final Grade f4 A Z- a
Manufacturer errand St cover
Model Num GP
TDH L' Friction S stem TDH Ft
L e ad
orcemain Length Dia. t. To well
SOIL AB PTION SYSTEM Z ,s \
BED RENO W Width Len g No. Of Tr ches PIT No. Of Pits Inside Dia. Liquid Depth
DIME I N - - :
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM LE CHI Manufacturer:
INFORMATION Type of ¢ ,/ r J CHA R M el Number:
System: L4� J U 3 A
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s)� x Hole Size x Hole Spacing Vent To Air Intake
Length Dia _y_ Length Dia Spacing /�/ n/ /� -1 3 C7
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded I xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ [I Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) Inspection l: y / � V/fflnsp tion #2: Location: 951 170th Street, Hammond, WI (SW1 /4, NW1 /4, Section 16 T29N
-R1 - -30
1) �✓�wG1�l i 5 ! -t/P/ - 4d
Z) Z y 6; �'w�� > o >< Cev�✓� S— 8lwQ� t
3.) 4, �411 oaY
Plan revision required? E] es ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date I spector's Signature Cert. No
r
• y Safety and Buildings Division
V i scons iSANITARY PERMI _ N 201 W. Washington Avenue
n, ti , �f P O Box 7302
In accord with Com
Department of Commerce t1,S,llYts. Adm. Cline:,
$$ � .i Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) fort e. )rstem, Onot I`eSs Count ,
than 8 112 x 11 inches in size. s`
• See reverse side for instructions for completing this (icai' (State Sanitary Permit Number
s�. 9 ; _w 33�2�
Personal information you provide may be used. for secondary purpose `:.. -'
ST X %•., Check if revis n to previous pplication
) ;`' \ ate Plan I.D. Number
[Privacy Law, s. 15.04 (1) (m)J. St
/ � � -� ZCININ(3 pfFICE �d,, �1
I. APPLICATION INFO MA I N -PLEA E PRINT A RMA TM
PropeIly Ovyner Name "p cation d►
. �v, S j& T a , N, R l / ' f (or) W
Property wner's Mai in Address • Lot Number Block Number
City State Zip Code Phonumber >r Subdivisi n N e or CSM Number /
( r r
PE B I ING: (check one) ❑ State Owned ❑ it ea rest Road t
Public 1 or 2 Family Dwelling - No. of bedrooms row OF ��0 �S(
III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Numbers) I ` �� ?� �?�
1 ❑ Apartment /Condo 5 Q
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)
q) 1. New 2 ❑ Replacement 3. ❑ Replacement of 4 ❑Reconnection of 5 E] Repair of an
System ____ - ___ System_____________ Tank Only__________ - ___ ExistingSystem _________ExistingSystem
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 /' a q. ound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench � 22 ❑ In- Ground Pressure / i / 42 ❑ Pit Privy
13 Seepage Pit ( 3 ZS 43 ❑ Va It 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.) (GaIs/day /s . ft.) (Min. /inch) Elevation
Og r Feet �' Feet
acit
VII. TANK Ca in gallon Total # Of Prefab. Site Fiber- plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App.
New ExMin strutted
Tanks Tanks
Septic Tank or Holding Tank "� ❑ ❑ ❑ ❑ ❑
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) Plumb 's Sign ure: (No S a s) MPRSW No.: Business Phone Number:
t� o 1s_ - 66,
Plumber's ddress (Street, City, State., i de): 44-eL S oO
IX. COUNTY/ DEPARTMENT USE ON Y
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Si nature (No Stamps)
[Approved ❑Owner Given Initial / Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FO DISAPPROVAL:
�
SBD -6398 (R. 4/99) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
permit i , li f - -t 2 ears.
1. Asanitary lye t s ua d �� wo ( ) y ,
2. Your sanitary permit may be 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 instajlation
5. Onsite sewa e s sterhs must be prop maintained.�The se ptic tank(s) must be um ed b a ticens 'd um p er whenever
9 Y P P Y P P p Y e P P
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsi`t<e sewage system, co_rltact your local code, adrpinistrator or the State of
Wisc6n4i►a; Safe tyatd' 1uiIdingsDivtssion,'6 a4isM154:-4
Az
To be complete and accurate this sanitary permit application must include:
I. Propert)n -9wner's name Ad maPing.�ddress:`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 approp'ri,ate pl'efix (e.g. MP, etc),
address and phone number. Plumber must sign application form. '
�,lX: ,4utlty /.Departmeflt Use Only.
__
X. County / Department Use Only.
Complete plans apd �ecifications�not smaller than 84/2 x 11 inches must be submified county. Thg:pla,►ls�must
include the following: A) plot plan, drawn to scaTe or with c6rtip14�te dimensions, location of holding tank( serphic
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; pumt,perforrapce pump modal and pump marwfacturer; D) cross section
of the soil absorption system -if required by the county; Q'soil tesk data on a "115 form; af'dIFr all sizing information.
----------------------------------------------------------------------------------------------------
DW R R
Ga0_lJN ATE CHARGE
1983 Wisconsin Act 410 included the creation of surcharges (4es) 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.
1Nis J&q Department of Commerce SOIL AND SITE EVALUATION Page __1_ of 3 _
Qvision of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
Certified Soil Testing
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (W), direction and St. Cr
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — --
Parcell.D.# 018- 1034 -80 -000
APPLICANT INFORMATION - Please print all information. ------ - - - - -- -------- - - - - -- --
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). R (3y Date
Property Owner Property Location
Bonte, Ron Govt. Lot SW 1/4 NW 1/4 S 16 T 29 N R 17 W
- - - - - -- — - -- - -- - - - - --
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
101 170th St. 3 Bonte CSM Pending
City State Zi Code PhoneNumber [] City n n Village ® Town Nearest Road
Hammond WI 54015 715- 796 -5240 Hammond 170Th St.
X New Construction Use: Residential / Number of bedrooms 3 [ to existing building
Replacement ❑ Public or commercial describe
Code Derived daily flow 450 9Pd Recommended design loading rate 4 bed, gpd/ft°- 5 trench, dlft
Absorption area required 1125 bed, ft' 900 trench, ftz Maximum design loading rate 4 bed, gpd /ft` .5 t rench, gpd /ft
Recommended infiltration surface elevation(s) 98.2 ft (as referred to site plan benchmar
Additional design I site eonsiderabon i nstall 3 174' S ewinder, Hi capacity "turtle shell" trench for 3 br
Parent material outwash plain Flood piain elevation, if applicable NA ft
S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system N [ -.1 U P9 S 1 1 U D' S I U [ S _; U S U S U
Depth Dominant Color Mottles Structure GPD /ft
Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. !Consistence Boundary , Roots Bed Trench
1 0 -8 10YR 3/2 - sil 2 m cr _ mvfr I cs 1 f/m 5 .6
2 8 -32 10YR 3/2 - sil 2 f -m sbk dsh gs I I m 5 .6
Ground 1 3 32 -43 l OYR 4/4 - sl 2 m sbk dsh gs 1 m .5 .6
e1 996 ft ._ 4 43 -65 l OYR 4/4 - A 3 m sbk - mfr - _ ___. f
. 5 -
_ i .6
Depth to 5 - - -- - - - -- - - -- - - - -- -g II dl cs - �. 65 -72 1 OYR 4/6 s 0 s 7 .8
limiting 6 72 -98 lOYR 6/4 - fs 0 sg dl - - .5 .6
factor
> 98'
Remarks: band IOY 4/4 sl (O,m) @ 75 -77 & 82 -84; occ asional Gy si coats on poeds below 36 "; very occasional gr & cob
2 1 0 -10 1OYR 3/2 - sii 2 m cr mvfr cs Inn .5 .6
..[ 2 10 -24 IOYR 4/4 - sil 2 m sbk mvfr cs If .5 .6
- -- jl
Ground 3 24 -33 7.SYR 4/4 - s 0 sg ml I cs .7 .8
elev - -- -
-
101.2 ft 4 33 -47 7.5YR 4/4 - is 0 m dsh a 7. 8
Depth to 5 47 -54 7.5YR 4/4 - s 0 sg ! dl cs f" ^te 7 }\, - 8
limiting - - --
factor 6 54 -90 l OYR 6/4 - fs 0 sg dl
- - - - --
Remarks: irregular 5YR 4/4 A band (O,m) @ 37 -39 " 1/2" @ 50" & 51.5 ";; occasional I /2" 10YR 6/ fs / dZQ (9 AMiea ional 1/2 R
4 41fsbandsbelow5r -- - - -- - --
CST Name (Please Print) Signature: "AiV0..
Henry F. Grote 715- 215811
Address
- Certified - Soil 'I estin -- - - -- - - -_ -_ - - --
P.O. Box 57, Knapp, WI.54749 111/14/1998 22774 R 1091
PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT os page 2 c�V
PARCEL I.D.# 018- 1034 -80 -000 Certified Suil Testing'
Horizon m Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots GPD /ft2
Depth Dominant Color Mottles Structure
Bede Trench
3 1 0 -10 10YR 3/2 - sil 2 m cr mvfr cs lm .5 .6
2 10 -26 7.5YR4/4 - s1 1 m sbk mvfr cs lm .4 .5
Grown - -- � --- - - - - -_
elev 3 26 -31 7.4YR 4/4 - s 0 sg ml cs 1 f .7 .8
101.2 ft 4 31 -57 7.5YR 4/4 - sl 1 m sbk mvfr cs - .4 .5
Depth to
limiting 5 57 -90 10YR 6/4 - fs 0 sg dl - - .5 .6
factor
- > - -
Remarks: very irregular U Y K 6 s s tnc ustons - m
i con uous s an s u - - ; very
occasionat s' stem ctu. d st encountered 3I -54" - -
4 1 0 -6 10YR 3/2 - sil 2 m cr mvfr i cs Ina .5 .6
2 6 -15 10YR 3/2 - j sil 2 f -m sbk mvfr gs lm 5 .6
Ground - -- - - -� - --
elev 3 15 -23 l OYR 3/4 - sil 2 m sbk mvfr cs If j 5 6
-- - -- ---- l... - -- -' -
r --
_ 101.6 ft 4 2349 l OYR 4/4 - s1 2 m sbk mfr gs If .5 .6
Depth to 5 49 -80 7.5YR 4/4 - sl 0 m mfi - - j .3 .4
limiting - - -- - -- - - -- - j -j
factor
> 80'
I I
Remarks trregu inclusion ► con tnu u DC 10W
5.. 1 0 -6 10YR 3/2 - sil 2 m cr mvfr cs 2fim S 6
2 6 -19 IOYR 3/2 - sil 2 f -m sbk mvfr cs ! IM 1 .5 .6
Ground
elev 3 19 -36 10YR 3/2 - sil 3 m sbk dsh cs if j .5 .6
100.5 ft 36 -50 l OYR 4/4 - sil 3 m sbk dh gs I IF .5 ; .6
Depth to 5 50 -71 7.5YR 4/4 - A 1 m sbk dh cs - .4
limiting ----- - - - - -- -- _ _ � .5
factor g0' 6 71 -90 10YR 5/4 - s 0 sg ml - - ! .7 .8
Remarks: I ban -
Ground - -- .. - -- - -
elev
Depth to
limiting _
factor
_ I
Remarks..
PROPiRTY OWNER Bo nte, Ron SOIL DESCRIPTION REPORT page 2 of 3
- ' PARCEL I.D.# __ 018- 1034 -80 -000 Certified Soi }Testing
De
HI S pth Dominant nseColor Qu. S MCont Color Gr. Sh. IC Boundary Roots _ GPDIftz
Horizon Texture onslstence ry
Bed Trench
3 1 0 -10 10YR 3/2 - sit 2 m cr mvfr cs I'm 5 .6
=� 2 10 -26 7.5YR 4/4 - sl l m sbk mvfr cs lm .4 .5
Ground t - - - - -- -- - -
elev 3 26 -31 7.4YR4/4 - s 0 Sg ml cs if .7 .8
1 01.2 ft_ 4 31 -57 7.5YR 4/4 - sl I m sbk mvfr cs - .4 .5
Depth to 5 57 -90 l OYR 6/4 - fs I 0 sg dl - - 5 .6
limiting
factor j
>90. -
Remarks: very irregular s an s s inclusions - iscon tnuous s an s ; very
occastotra} -gr; size system-for weakly-structured -sl encoumcred 31-57'
4 1 0 -6 1 OYR 3/2 - sil 2 m cr mvfr j- cs IM .5 .6
2 6 -15 IOYR 3/2 - sit 2 f -m sbk mvfr gs lm .5 .6
Ground -- - - - -- ------- � - - - - -- '--- - - - - -r _
elev 3 15 -23 10YR 3/4 - sil 2 m sbk mvfr cs if 5 6
101.6 ft 4 23 -49 l OYR 4/4 - sl 2 m sbk mfr gs if .5 .6
Depth to 5 49 -80 7.5YR 4/4 - A 0 m mfi .3 4
limiting -- _ -_ -- . - - -._ ___....__ _ _ _
factor t
> 8 0"
Remarks: irreguiar to uston iscon tnu us banas Below
S.. 1 0 -6 lOYR 3/2 - sil 2 m cr mvfr cs 2f1m .5 .6
2 6 -19 IOYR 3/2 - sil 2 f -m sbk mvfr cs lm .5 .6
Ground - - - - - - -- - -- -_ - - I - -- - - -- _ _
elev 3 19 -36 10YR 3/2 - sil 3 m sbk dsh cs If ! .5 .6
100.5 ft 36 -50 l OYR 4/4 - sil 3 m sbk 1 dh gs If 5 .6
e th to
p 5 50 -71 7.5YR 4/4 - sl 1 m sbk dh cs - .4 I .5
limiting- - -- - -- - - - - - -- -- - 1 -
factor
D g I _
'
6 71 -90 lOYR 5/4 s 0 s ml ! 7 8
Remarks: IUYK 374 i Was -
}}- -- -- — — 1
Ground x — -- -- - - - -- -' I
elev
i
Depth to
limiting
factor -± -- - - - - - -- - - - - -. _______
i
Remarks:
I - i
Wiscorx�in Department of Commerce SITE EVALUATION Page _ 1 - of - 3
Divi,ion of Safety and Buildings (( P. Ies?size. omm 83.05, Wis. Adm. Code
Certified Soil Testing
Attach complete site plan on paper not less than Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - - - - - - --
Parcel I.D.# 018-1034-80-000
APPLICANT INFORMATION - 4ciq prii►&,a, " ormation.
Personal information you provide may be ed !fir s!Idary purposes (Pr cy Law, s. 15.04 (1) (m)). Reviewed By Date
Property Owner r f ` Property Location
Bonte, Ron / - 1 Govt. Lot SW 1/4 NW 1/4 S 16 T 29 N R 17 W
Property Owner's Mailing Add res Lot # Block # j Subd. Name or CSM#
1011 170th St. t� 3 i Bonte CSM Pending
City 3Aale Zi oneNumber [] City 41 Village NTown Nearest Road
Hammond 4 IS 796 -?�4 Hammond 170Th St.
X New Construction Use: t id�Ntl� erltia4 f bedrooms 3 _lAddition to existing building
Replacement 0_r dal describe
Code Derived daily flow 450 gpd Recommended design loading rate -4 bed, gpd /ft2 .5 trench, gpd /ft
Absorption area required 1125 bed, ft 900 trench, ft Maximum design loading rate .4 bed, gpd /ft2 .5 t rench, gpd /ft
Recommended infiltration surface elevation(s) 98.2 ft (as referred to site plan benchmar
Additional design /site consideration install Y x 174' Sidewinder, Hi capacity "turtle shell" trench for 3 br
Parent material outwash plain Flood plain elevation, if applicable NA ft
S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system X ❑ U X S , U Xf S 71-1 ti S U S; U S U
b% Mil, VF=5L;KJFT1UN KI=PDI=
Depth Dominant Color Mottles Structure GPD /ft
Boring# Horizon in Munsell Qu. Sz. Cont. Color I Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
1 0 -8 10YR 3/2 - sil 2 in cr mvfr cs 1 f/m 5 .6
2 8 -32 10YR 3/2 - sil 2 f -m sbk dsh gs lm .5 .6
Ground 3 32 -43 l OYR 4/4 - sl 2 m sbk dsh gs 1 m .5 6
elev - - --
99.6 ft 4 43 - 65 1 OYR 4/4 - A 3 m sbk mfr cs 1 f .5 I .6
Depth to 5 65 -72 1OYR 4/6 - s 0 sg dl cs - .7 .8
limiting 6 72 -98 l OYR 6/4 - fs 0 sg dl _ _- .5 .6
factor
I
Remarks: bands 1 OY 4/4 sl (O,m) n 75 -77 & 82 -84; o ccasional Gy si coats on poeds below 36 "; very occasional gr & cob
2 1 0 -10 10YR 3/2 - sil 2 m cr mvfr cs 1111 .5 .6
2 10 -24 l OYR 4/4 - sil 2 m sbk mvfr cs if .5 .6
Ground 3 24 -33 7.5YR 4/4 - s 0 sg ml cs im .7 .8
elev- - - -- -- - -- - - - - -- - -- - - -- - - - - -- - - _ i
1 01.2 ft 4 33 -47 7.5YR 4/4 - Is 0 m dsh cs - .7 .8
Depth to 5 47 -54 7.5YR 4/4 - s 0 sg dl cs - .7 .8
limitin
factorg 6 54 -90 10YR 6/4 fs 0 s g dl
- - _ -- - - - - - -- - -I - -
.5 i .6
Remarks: irregular 5YR 4/4 sl ban (O,m) @ 3 7 -3 "; 1/2" 50" & 51.5";; occasional 1/2" 10YR 6/4 fs bands 47 -54 "; occasional I /2" 10YR
4741f's band- below -5V- -
- -- - - - -- - - - - . -
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715- 665 -2681
Address �erti RxFSoil Tesfing - -- -- - Date CST Number Ref #
P.O. Box 57, Knapp, W1.54749 11/14/1998 222774 1091
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer , \� � �
\� Q-_
Mailing Address N\ ai_\ IN
Property Address
(Verification required from Planning Department for new construction)
City /State s Iti(- Parcel Identification Number
LEGAL DES RIPTION Crvo/'�—
Property Location SU,(, y /I/ll t y Sec. , T'2�_N_R_,�ZW, Town of
Subdivision e-6 —M-, Lot #
Certired Survey Map # _5 - 1_ 5 L Q , Volume 13 Page # 3
Warranty Deed # O , Volume I Y Page # Si
Spec house ❑ yes )Q no Lot lines identifiable A 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
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (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 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 Orrice within 30
days of the a yea expiration date.
SIGNATURE O APPLICANT 1 / 1 4/11
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 Property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT / 1
DATE
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
« «s «ss
!`* Include with this application: a stamped warranty decd from the Register of Deeds office
a copy of the certified et.tr ;—ey M f, ;, reference is made in the warranty deed
i
1 STATE BAR OF WISCONSIN FORM 1 - 1982 6Q6307 H
KATHLEEN H. I, WARRANTY DEED (! REGISTER OF DEEDS
ST. CROIX CO., WI
=— - - -_ = -- VaL 1439 567
DOCUMENT NO. I
This Deed, made becweeD - - - . Bonte and 07-07 -1999 9:30 AN
�EIVED FOR RECORD
Ronal C
Dine M. Bonte, Husband and Wife VAWAM pEp
EXEMPT E
Grantor, CFRT COPY FEE
•
Timothy M. ale an Holly L. Hale, Husband
�I and y y i TRANSfOt FEE: 77.70
an ff RECORDING FEE: 10.00
PAGES: 1
Grantee,
Witnesseth, That the said Grantor, for a valuable considerati �I
j St . CTO1X II THIS SPACE RESERVED FOR RECORDING DATA
conveys to Grantee the following described real estate in I------ _ - ._..---- - __---
j County, State of Wisconsin: NAME AND RETURN ADDRESS
;! Timothy M Hale
! Part of the SW k of NW % of Section 16, Klein Drive
i Township 29 North, Range 17 West, St. Croix i Ha Klein
WI 54015
' County, Wisconsin described as follows:
Lot 3 of Certified Survey Map filed March 22,
1999 in Volume 13, Page 3616, Doc. No. 599880 018- 1034 -80 ^�
jj PARCEL IDENTIFICATION NUMBER
Ij I I
j
I
�j This is not homestead property.
(is) (Is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
highways, easements, and restrictions of record.
j {
and will warrant and defend the same.
Dated this 2nd day of July 19 99
(SEAL) (SEAL
Ronald C. Bonte ,Dine M. Bonte
i
(SEAL) (SEAL
i!
I'
AUTHENTICATION ACKNOWLEDGMENT
Signatures) State of Wisconsin, l
St. Croix ) ss.
k county ff''
authenticated this day of 19 Personally came before rtu this 2nd day of !I
o`'t► July 1999
the about mmed I;
` • �i,� Ronald C. Bonte and pine M. Bonte,;
4
' ;��•_ ''y Husband and Wife
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, _ �f
authorized by 8706.06, Wis. StatsJ G AD me known to be the person who executed the foregoing
r
ID(B� `instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY _ ,� • SS • `, ``���``
' Ronald C. Bonte 1011 170th �C 7a�
Heather A. Serier !
Hammond, Wisconsin 5 Notary public, Councy,w,s.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (if not, state expiration date:
^, r
i necessary) -I11 aA /L 3 y�_
I
-- - -- - --- --- -- - --
-. -- y- -_ - -- _ —_ _ --- ..._...._.. - -- .. ... - _ _ _..._ ...
i. Names at persons signing 1n my - - op should by typcd or punted lxlaw their ag�uwres !�
STATE BAR OF WISCONSIN Wnicon•n too SIw* Co.. Inc. tj
.. WARRANTY DEED Form No. I - 1982 µh kk ". Wo. is
n " 9 .7v
v
CERTIFIED SURVEY MAP
LOCATED IN THE SW 1i4 OF THE NW 1i4 OF SECTION 16, T. 29N. R. 17W.
TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN
PREPARED FOR:
RON BONTE
NORTHWEST CORNERS
SECTION 16 - FOUND o I —
COUNTY MONUMENT
o I a . UNPL A TTED LANDS LOT AREAS:
WEST LINE OF THE I n��j LOT 1: 1.91 ACRES
NW 1�4, SECT J6 APPROX. 6.0' E. 83, 315 SO. FT.
OF FiL N. AND 1. 74 ACRES EXC. Ri1V
I 14' S. OF FiL W. 75, 794 SO. FT.
UNPLATTED LANDS S89 °OI' 37 "E 363. I5' LOT 2: 1. 77 ACRES
.. ..............................- v 76,957 SO.FT.
-� 330. 14 1.61 ACRES EXC. RoeW
33.0P
1: 0 : 69,959 SO. FT.
-- V -•
1
------------ $ LOT 3: 1. 77 ACRES
' I N I N o
N o 76,957 SO. FT.
m = o LOT 1 1.61 ACRES EXC. RAW
' LOT I C. S. M. �^ I o I w o 69,959 SO. F T.
�p
8 I 33'I 4e w
VOL. 6, 33 33.02' m
PG. 1668 I p ,o N88 1 27' 17 1 W 363.27' . C
....................
O 33. 02' - y
W J
-------- - - - - -- I '
lk
LOT No ?�
w $ w 2 r,:,: ..,.,..•:c
or
UNPLATTED LANDS Nea•2r n•w 363.27 �°+, cur «,,,
I 330. 23
33. 02'
100' N
I; Ln N IN A
1 • ; i LOT 3
g EAST OUARTER CORNER
°- SECTION 16 - FOUND
~ I COUNTY MONUMENT
WEST QUARTER CORNER I 33.02'
SECTION -FOUND : 3 _ _ - -
2" IRON PI 493877_
PE N88 ° 27' 17 "W 363.27' - 1 ° 27' 17'W - -�
1 I S88 ° 27' 17 "E 5302.04'
UNPLATTED LANDS
. .............................. EAST -NEST QUARTER
L I NE, SECTION 16
LEGEND
O SET I' X 24" IRON PIPE WEIGHING
1.13 LBS. PER LINEAR FOOT c.
r.
r,
BEARINGS REFERENCED TO THE WEST 4
LINE OF THE NW 1-�4 OF SECTION 16.
MEASURED AS S00 ° 39'03'E.
(ST. CROIX CO. COORDINATE SYSTEM) •Y
1' • 150' NAMES Mf.`�YEBER S -1804
SHEET I OF Z DATEDN B�ER��AI�D�kURVEYING
O 75 150 300
98218A THIS INSTRUMENT DRAFTED BY JIM WEBER
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