HomeMy WebLinkAbout018-1083-10-000/~
Wisconsin Department of Commerce
Safety and Buildings Division
GENERAL INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Personal information you provice may be used for seconoary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holder's Name: ^ City ^ Vi e ^ To f:
Sarnstrom, Lee ~~mmonc~~ownship
CST BM Elev.:- Insp. BM Elev.: BM Description:
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~ ~
Dosing ~.j tl
Aeration
Holding
TANK SETBACK INFORMATION.
TANK TO P/L WELL BLDG. vent to
Air Intake ROAD
Septic ~ }S ~ ~, ' .- NA
Dosing }'~-S' ~~ ~` -• 3}' NA
Aeration NA
Holding
PUMP /SIPHON INFORMATION
Manufacturer ~~~. S
t -
~p Model Number ~ - ~ a
~~ TDH Lift ~p.''A Lriction ~ Sy!
Forcemai n Length ~~ C7 ' Dia. FFii "~; Dist. To well
SOIL ABSORPTION SYSTEM~I ~ 1~n~..~
ELEVATION DATA
Countyst. CrotX
SanitarXE.e~~.iL1VO.:
State Plla33n//ID N2255o~y.:
Parcel T~~~oT083-10-000
STATION BS HI FS ELEV.
Benchmark ~• ~ ~ O -D ~ ~ ~• ~1
t. .l0 ~ oz. o,
Bldg. Sewer ~~/S Z,$Z'
St/Ht Inlet j ,$~j 9Z•Zo'
St/ Ht Outlet _..
Dt Inlet ~-
Dt Bottom ~ .30' ~• ~'
Header /Man. ~. ~ f 3 C~q .S'~'
Dist. Pipe 'r q`f,S~
Bot. System '~ ~ 8.O ~
Final Grade ~-aS '
-S
St cover 4 ~~
n~
BED /TRENCH Width Length No. f Trenches PIT No. Ot Pits Inside Dia. Liquid Depth
DIMEN 1 N i 93•~'s" oZ. DIMEN 1 N '
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ~~~"hre~_S:dK
rr`
SETBACK ,.
INFORMATION Type O 5 r
•' ) OR UN T R Mto~'~ e`.l Num
System: + (up
~r~
au
DISTRIBUTION SYSTEM ~.o' _~_ c _ _ I.`_ ~.•`i1' «•`/ _ ~
Header / ~Aani old
~ u
Length ~~ Dia. ~ Distribution Pipe(s)
ia. x Hole Size x Hole Spacing Vent To Air Intake
~ OD f
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; ~D/a-}fats Inspection #2•~~
Location: 1739 96th Avenue, Hammo d, WI 54015 (E 1/4 NW 1/4 16 T29N R17W) - 162917582 Pheasant Hills -Lot 10
1.) Alt BM Description = ~ ~~ ~*'~ `~' ~ S ~ - S S
2.) Bldg sewer length = ~.p'
-amount of cover = > 2~" ~~c~f
Plan revision required? ^ Yes ~ No
Use other side for additional information. ~Z Z°( o - _
SBD-6710 (R.3/97) Date ~ Inspector's Signature Cert. No.
Demand
s5 GPM
TDHt~,.~ Ft
` ~ Safe~y 6c Buil+~ings Division
~~
- Sanitary Permit Application
i
h C
83
21
Wi
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C
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d 2ul ~3 ~ ~~' ~o Box 7302
~~i
a,~$/n e
In accor
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.
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omm Madison, `7VI 53707-7302
Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed for.:i to ^ounty if not
[Privacy Law, s. 15.04(t)(m)] --..,` Gate owned.
Attach tom late lans to the count co onl for the s stem r e s 1 /2 x 11 inches in size. ~~
County ~ C ~ ^ ~ t'
' s appliCa
State Sanita ~ rmit Number ^ Check if rev' n evio
u
~ :e Plan I. D. Number
0
~-v 7~ ~
p a
I. A lieation Information -Please Frint all Information ~~~ - ~ tion:
Property Owner Name n (r ~j n ~ /~ --- ^Opo
~ ~' L U
J ~/ ` ~ / V 1 ' `
v
~~ ~~ I `
~' ~ y Location /
~
Q
~
!
,: 1 4 /4, T ,N; i2/
or
~
Property Ow~s®ailing Address .. sj G .f.~
Q N -~-t~ " ~~` spa ~F1GE Block Nurrtber
mber~
r
~
O
~' ~% rs `
Ci State Zip Code Phone Nu e ~ division Name or CS'_VI Number
II Type of Building: (cheek one) ~
ta ~. 5 S w(a~ ~ FleG~
/ a S pew
Dwellin
~ 1 or 2 Famil
- No
of Bedrooms ^ City
village
^
e
y
g
.
: p}
~
p ~COwlt of
^ Public/Commercial (describe use): ~/ A n
"
`~~~
^ state-owned lT
~t
f-~
iLI 'I'3*pe of P~rmtit: (Chick only one box online A. Check box on line $ if applicable) ~ Nearest Road (_ ~~ /~ I.~
~q,) 1. iew System 2. ^ Replacement 3. ^ Replacement of 4., ^ Addition to Parc ]Tax Number(s) /(,- z (~, S 2
S stem Tank Dnt Bxistin S stem ~~$ -- ~D - d O O
$) Permit Number Date Issued
O A Sanitar Permit was revioust issued _
IV. Type of FOWT System: (Check all that apply)
Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetla:~d
Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line
^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ~ Other:
V Dis rsal/Treatment Area Information: Q ! G/4-p / ~~/G CSR A'~/Z.s _
1. Desi low (gpd)
+
-
~ 2. DispersalArea
Req fired 3. Dispersal Area
Proposed
s
/
y
Z 4. Soil Application
Rate (Gals
/d /sq
ft
) 5. Percolation Rate i 6. System Elevation /! ~. Final Grade
6 / i Elevatior
/~
'g
/inch) Q' 9
(Min
(~,
J~~ /
_
, . /
~.
~
-y
~ .
.
. .
~ 6
~,
.
(~ ~/ 9
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information
4 Gallons Gallons Tanks Con- Con- glass
~
-IOrJ New Existing, crate strutted
~ ~
)
r/ Tanks Tanks _
c~
,
G '~ ~ Gt~f Cpl apt ~- ^ ^ C] ^
~ ~
VII esponsibility Statement ~~
I unrkrs' assume res nsi ili far.'n 1 Lion oft e FOWTS shown on the attached laps.
Ptu s Name (pidnC)
~~
~ Plumbm '"Signattire'(no s): MP/11iNo.
~ Business Phone number !/
~~ ~ ~
~ ~ ~~ ~~1~
lumber's Address (Street, City, State, Zip Code
~LC Sw I -~- fiv ~ ,>~~o //
VIII County/Department Use Only ~....
^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (Nc stamps)
Approved ^ Owner Given Initial Adverse Surcharge Fee
~
VDU
~
Determination Z Z q Z 5
2 v o ~
IX. Conditions of Approval /Reasons for Disapproval:
/~ f•~ o,c G~f¢n,6e-- ~ksf 6{ ;mss{<//~~ 6~low ov~'q,Ka/ y.4cr'c aK.c/ /.arc >/2'' o,C coocr• oue~ ~nt
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' Wjscon~in Department of Commerce /~ SOIL AND SITE EVALUATION Page 1 of 4
Division of Safety and Buildings flRIGIM~d with Comm 83.05, Wis. Adm. Code Certified Soil Testing
Attach complete site plan on paper not less than 8'!z x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
l
di
i
ti
d di
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th
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percen
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on an
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o neares
roa
.
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ope, sca
arrow,.an
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= ~ `" • "~
Parcel LD
#
,,
~.
APPLICANT INFORMATION -
~t/ease pra~nta/l
imation .
F;
;
.
~
Personal information you provide may be 1rSgd for 5econdarK, purposes{f?fivaD,~ Law, s. 15.04 (1) (m)).
.. ; ed y Dat
Re
`~ zs Oct
Property Owner s` "-• .. Property Location
Bonte, Ron % Govt. Lot SE 1/4 NW 1/4 S 16 T 29 N R 17 W
_
Property Owner's Mailing Address r -- Lot # Block # Subd. Name or CSM#
1011 170th St. ~'M>
r 10 Pheasant Hills
City `State Zip Code Phonet~~mbe.'
~
H
d FIJ
@ L5
~1 ~ 3=
~
~
5 ^ City n Village ®Town Nearest Road
d 170Th St
H
ammon
4
Y
Hb-
y
I
' .
ammon
~-.Residential) Nutrt of bedrooms 3 ^Addition to existing building
New Construction
Use:
Replacement ~ Public Qrl~rifinercial describe
Code Derived daily flow 450 gpd Recommended design loading rate. •3 bed, gpd/ftZ •4 trench, gpd/ftZ
Absorption area required 1500 bed, ft' 1125 trench, ftZ Maximum design loading rate •5 bed, gpd/ftZ •6 trench, gpd/ftZ
Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar
Additional design I site considerations `nsta112 - 5' x 112.5' shallow trenches along contours for 3 br (B-7 - B-3 - B-5 -area OK for conventional)
Parent material tilt Flood lain elevation, if a licable NA ft
S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U=Unsuitable for system ~ ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ® U
.'EVIL UC.7~rR11" 1 IVIY RCI'VR 1
Boring#
1
Ground
elev
95.8 ft
Depth to
limiting
factor
38"
2
Ground
elev
98.2 ft
Depth to
limiting
factor
40"
Horizon Depth
in. Dominant Color
Munsell Mottles
Qu. Sz. Cont. Color Texture Structure
Gr. Sz. Sh. Consisten Boundary Roots GPD/ftZ
,B d ~ T
1 0-3 . 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 ~
2 3-6 • 7.SYR 3/2 - sl 2 f sbk mvfr cs if .5 /
3 6-24• 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5
4 ~ 24-38 • 7.SYR 4/4 - sl 1 m sbk mvfr cs Im .4
5 38-50 ~ 7.SYR 4/4 7.SYR S/8 sl O m mfr - - .3 /
Remarks: tuts pit ana entire area swtable Tor at-grade which is probably best system for 3+ bedrooms given the sods vartabthty
1 0-3 • 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 /
2 3-7 • 7.SYR 3/2 - sl 2 f sbk mvfr cs 1 f .5 ~
3 7-32 - 7.SYR 4/4 - sl 2 m sbk mvfr cs lm .5
4 32-40 SYR 414 - sl 0 m mfi cs - .3 J /4'-
5 40-52 ~ SYR 4/4 ~}- lOYR 6/2 sl 0 m deh - - .3 / ~
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote ~ IS-665-2681
Address ertt to of esttng Dato CST Number Ref #
P.O Box 57, Knapp, WI 54749 3/27/2000 222774 1022
Ramarkc•
PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT
PARCEL LD.#
Ground
elev
100.6 ft
Depth to
limiting
factor
> 65".
4
Ground
elev
94.9 ft
Depth to
limiting
factor
> 63".
\ ~~
Ground
elev
99.2 ft
Depth to
limiting
factor
> 64"
6
Ground
elev
93.2 ft
Depth to
limiting
factor
> 65" -
2~ 4
Page of
Certified Soil Te'stmg
Horizon Depth
in. Dominant Color
Munsell Mottles
Qu. Sz. Cont. Color
Texture Structure
Gr. Sz. Sh. onsistence
Boundary
Roots GPD/ft~
ed T~Fi
1 0-4 ~ 7.SYR 3/2 - sl 2 m gr mvfr cs If .5 ~
2 4-14 " 7.SYR 3/2 - sl 2 f sbk mvfr cs if .5 / ~
3 14-29• 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 • ,"6'
4 29-35 • lOYR 6/4 - fs 0 sg dl cs - ~`/rfl
5 35-65. lOYR 8/2 - fs 0 sg dl - - _ ~ ~ ~
b o'~
D.."„.,,.1, ". . S 2r1 S:
1 0-3 ~ 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 ./ ,.6'
2 3-11 • 7.SYR 3/2 - sl 2 f sbk mvfr cs if .5 ~
3 11-37 ~ 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 ~'
4 3~,7-63 • 7.SYR 4/4 - sl 0 m mfi - - .3 ~"4'
rcemancs:...,....,.......w .._..~.,..,............,... ~.,, ..b, ., . ...............
1 0-4 • 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 /
2 4-12 ~ 7.SYR 3/2 - sl 2 f sbk mvfr cs if .5 / ~
3 12-31 ~ 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 / ~Cf
4 31-64 . lOYR 8/2 - fs 0 sg dl - - •~,fi' f.
D I~I ~ ,,
.
1 0-3 - 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 /
2 3-10 • 7.SYR 3/2 - sl 2 f sbk mvfr cs if .5 ~
3 10-25 . 7.SYR 4/4 - sl 2 m sbk mvfr cs lm .5 i
4 25-35 7.SYR 4/6 - is 1 m sbk mvfr cs - .7 /
5 35-65 • SYR 4/4 - sl 0 m mfi - - .3 ~
rcernancs:
PROPERTY OWNER: Bonte, Ron
` -PARCEL I.D.#
Ground
elev
100.6 ft
Depth to
limiting
factor
~~~,
52
Ground
elev
~Mfi
Depth to
limiting
factor
d'~" .
Ground
elev
Depth to
limiting
factor
SOIL DESCRIPTION REPORT ~ Page 3 of 4
Certified Soil eT sting
Depth Dominant Color Mottles Structure onsistence Bounda Roots GPD/ftZ
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ry ~
1 0-12 • 7.SYR 3/2 - sl 2 f-m sbk mvfr cs 1f/m .5 ,/ ifs'
2 12-24 • 7.SYR 4/4 - sl 2 m sbk mfr gs 1 f .5 / ~£f
3 24-31 • l OYR 4/4 - is 1 m sbk ds gs 1 f .7 / ~'
4 31-77 • l OYR 8/2 - fs 0 sg dl cs - . '~~fl
5 77-85, lOYR 8/2 - S
~ qP•(, LYk
(~ o
Remarks. JJDl~ IJ WG6Rl~' liGLLlGIIIGLL, gG11G1 ally IWIJl6111 W EIGIIGL16L1V11 W/ 1V 11~ ~/~ 1J Vw~u v i ivi ~e.v~i ~ ~~w ua~.bui awv.+~...uv u~
1 0-6, 7.SYR 3/2 - sl 2 m gr ds cs if .5 /
2 6-12 • lOYR 4/3 - sl 2 f sbk mvfr cs If .5 / ~
3 12-24 - l OYR 4/4 - is 1 m sbk mvfr gs 1 f .7 /
4 24-43 . 1 OYR 7/2 - fs 0 sg dl cs - • `~ .6
5 43-72 • l OYR 8/2 - SS
Ground
elev
Depth to
limiting
factor
O v~ 1 J o.~ ~~ - P 1 ~o ~ ~ 1 a.1
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Combination Sep>~ic~ Tank and
PUMP CHAMBER CRUSS SECTION A~JD SPECIFICATIOtJS
•VEI,.1T CA,P WEATHER PR001`
/-- JuucTlo-a pox
`1~C.I. VCfuT PIPC ,1, APPROVED LOCKII`!G
'-•lO' fRUM DoOft..' ~/~A-JHOLE COYER
'+~i1JDOW OR FRESH I 2 ~'ARNI~JG l_~`d~L
A~ I !J T,~ K E -~"`
,i
~k_
I IC~~F,~N,I /~Q -nc
16`I`IIN.
IAJLET
APPROVED J01>JT
V,!/C.I. PIPEDRP
~~ 1-
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y Ilusr~cnorJ ~i
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PROVIDE
~'AIRrIC.HT s~A~ I
I
I
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I
~I
I
P u rr P -`, r,~- ~
~~ ~ 1.
A
Tank construction
sha11 comply with
1133.15 and 83.20 ~
Cor1 r~
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5
GO-JCR[TE
B~pCl~c--
Y~ NI}J.
I I -~~ I rr' r~. I ~..
111 L I:~~~~~
II
i I I ~f
I APPROVi:D .~o1uT:
II ALARM
II
I
i ~j o -~
OFF
-~- RISER E:XI7 PERMITTED OI,1Ly IF TA-JF; MANUFAGTL1R14.K HAS SUCH APPROVAL 3~kPr'~c~nc~
.,. ~EGD;ty~
SEPTIC f SPATIOt~.1S
DOSE
T~-.1K MA-JUFACTURCR:~~~~~~- 1-`~~~-~`-~!~
iJUMfSE,~I OF
~
_ DOSE5:._,~,
Pf=R C.~.;,`
TA1.1K SIZE : -._/a/J(J GALL01~I5
ALARh1 l~AUUFACTUR!`A: S'S• ~'~Z-1~~~ S~y`I'~`}'2
3 DOSE vC)LUME z/~ ,
IAJCL~JCIIJG 6AGICF
OW:
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l1UDEL uUMBER: 1~ ~ ~U._) _ g
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CAPAGI""1La: A_ `~ U ~~~~ Z
INCHES OK C!~ Gal
Lni~S
_
swITCH T~PG: i`'~ ~'1Z~U~.-~' .
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B =
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PUMP MAFJUFAGTURER: `t ~1ZS
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S! IIJCHES OR
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L
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MODEL FJUM6ER: `~~ 4.O ._
~
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Q
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D ~ ~ INC
~~~~
SWITCH T'UPE: ~L~Ze'~Y HES oR
Gn,LLC)1.;5
DOTE: PUMP Ar!D ALAkr•~ r~K- TO 6C
MIA71MUr~ alscHAa~E R~rE--~-~---GPM INSTALLED Ot~1 SEPnRATE CIRCUITS
/
VERT{ChL DIfFERENCI< DETWCEJJ PUMP OFE Aup
D15TRlpU'F"IOU PIPE
~
1
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_
rE.ET
f MII.11MlJM AJE1'1„/ORK SUPPLY PR
E
SSURE FCET
~
[
-f- ~ FEEl OF FORCE MAIIJ X t ~3~/i~o~T.FRIC71ou F,acrc~R.,.~~~ ,-EET
'" TOTAL Dy1JA,MIC HE:AJ =.
Pump chamber DIAMETER _
IuTEFZtJAL. Dlr'1E~lS10NS OF T1+FJK~U.ENVTHw --.-.;WIU1'H
AREAS--~ -_ x.12 3 :1.=
FEET 6 ~l ~~ FJr,l..
---~.~~LIQUID pEPTH
`~~ SAL/INCH
~4a Series
x/10 ~#~' Ef~uen#
er~d dratr~ Wa#er P~m~s
t~erform~nrce Carve
40
~ 25
20
E5
O
F-
l0
M ~..
k~00EL ME4t~ EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 i50 204 250 300 350
35
30
-_-...
5
0~
0
l0 20 30 40 50 60 70 80 90 100
CAPACITY C~ALL.ONS PER MINUTE
F.E. Mye.~, A Pen#abr Company • 1101 Myars Parkway, Ashland, Ohia 44805-1923
419/289-1144 FAX A19/289-8658 Telex 98-7443
12
10 ~
8
Z
.,
6
d
4 ~
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2
0
K3328 7/g1 Printed in U.S.A.
s"r CROIx COUNTY
SII'1'IC 'T'ANK MAINTENANCE AGREEMENT
AND
OWNI?RSI-ill' CL;R"I'IFICATION FORM
Owner/Buyer ~-- E~ Sa. r n s+r a -r,-,
Mailing Address _ a Q $ _~o ~+'h C~l+h st- 1 '¢, i V 2,t' FGZ.I ~S , ~ ' .
,. ~
Property Address
I `I 3
(Verification required from Planning Department for new construction)
City/State _-_{tCl. m M onc~ , ~f _ C'arcel Identification Number (~ / g -/~ g3 -~~ ~r~d
LEGAL DESCRIPTION
Property Location SE '/,, __ 1~ y,,, Sec, ~ , T~_N-RAW, Town of ~~c/~mch C~
Subdivision ~~ea S a n t ~~ ' //S
Lot # ~.
Certified Survey Mah # ~ ___~__~__, Volume ~ ,Page # ~~
Warranty Deed # ~.~_<1^___ ___, Volume ~5~, Page # 3
Spec Mouse ^ yes ~ tto
Lot lines idetitiCable,L~ yes O no
SYSTEM MAINTENANCE
Improper use and maintenanceof your septic system could result in its rremature failure to handle wastes. Propermaintenance
consists of pumping out the septic ta~rk every three years or sooner, if needed by a licensed puruper. What you put into the system
can affect the function of the septic tank as a treahnent stage in the waste disposal system.
17~e property owner agrees to suh;nit to St. Croix 7_.oning Department a certification form, signed by the owner and by a
master plumber, jou-ueyman plumber, restricted plunibcr or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition aucL'or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, 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 Coormerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintairred must be completed and retwned to the St. Croix County Zoning Office within 30
days of flue three y r expiration date.
-----_ 9 / /9 /Zp°°
SIGN 1RE OP APPLICANT DATE
OWNER CEItTITICATION
I (we) certify that all statements on this fornr are true to the best of my (outr) knowledge. I (we) am (are) the owner(s) of
the property descr' ed above, by virtue of a warranty deed recorded in Register of Deeds Office.
_g / / l / 2a~
SIGNA' 1RE OF APPLICANT DATE
****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ******
** Inct+ude 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
y1.,1541PAGE343
STATE BAR OF WISCONSIN FORM 1 - 1998
WARRANTY DEED
Document Number
This Deed, made between Ronald C. Bonte and Dine M.
one '
- _ Grantor,
and ee arns tom
_, Grantee.
Grantor. for a valuable consideration. conveys to Grantee the following
described real estate In S t . CrO.7.X County, State of Wisconsin
(the "Property'):
Part of the SE ~. of the NW ~ of Section 16,
Township 29 North, Range 17 West, St. Croix
Countyr Wisconsin described as follows:
Lot 10 of Pheasant Hills file on
May 5, 2000 in Volume 7, Page 86,
Document #622544
Dine M. Bonte
Parcel Ittetuification Nttn'b9r iPIN)
This 15 nOt homestead property.
(is) (is not)
Together with all appurtenant rights, title and Interests.
Grantor warrants that the title to [he Property is good, indefeasible In fee simple and free and clear of encumbrances except
Easements, licenses, zoning ordinances, and restrictions of record.
Dated~this,,8(~th~ d`a^y{or_, September 20n0^0~, ,
~krJ' `e~J~ ~ " ~3'~ (SEAL} 'K~IYLQi ~~ J~YTlf (~1 (SEAL)
Ronald C. Bonte
AUTHENTICATION
Signature(s)
(SEAL)
Patricia Coates-Knutson
authenticated thNota~ryPiaublic
St&t8 Oi W ~SYCO~'
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not.
authorized by §706.06, Wls. Scats.)
THIS INSTRUMENT WAS DRAFTED BY
Ronald C. Bonte
1011 170th St Hammond, WI 54015
(Signatures may be authentlcaced or acknowledged. Both are not
necessary)
62959 1
KRTHLEEN H. WALSH
REGISTER OF DEEDS
5T. CROIX CO., WI
RECEIVED FOR RECORD
09-08-2000 11:14 AM
YARRANTY DEED
EXEMRT M
CEki COPY FEE:
CDPY FEE:
TRANSFER FEE: E6.70
RECORDING FEE: 10.00
PAGES: i
fiecording Fvea
Name and Return Adtlress
Le E. strom
208 th Street
Ri er Falls, WI 54022
v'~-"f 04~~(oa~'
018-1083-10-000
ACKNOWLEDGMENT
(SEAL)
State of Wisconsin,
53.
St. Croix County.
Personally came before me this 8th day of
September , ~Q, the above named
Rona Bon e
Dine M. Bonte
to
me known [o be the person S who executed the foregoing
instrument and acknowledge the same.
Notary Public, State of Wisconsin
My tom iss' n s perms nt. (If not, state expiration date:
~~~a 3~~ a
' Names of persons signing in any capacity must be typed or printed below their sgnawre.
STATE BAR OF WISCONSIN Wrscona'ri Legal frank Co., inc.
WARRANTY DEED FORM Na. 1 - 1998 Milweukap. Wis.
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