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Home My WebLink About018-1083-24-000r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM fety 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)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Bristol, Ron & Cheryl Hammond Township CST BM Elev.:• Insp. BM Elev.: BM Description: ' s . o' ~ . o c s'r vw~'1 - t~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ <<~ ~ P C t- Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~,SDr aq' NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION ~ Ma rep ~.~ Demand Model Number ~ GPM TDH Lift. = Lriction m TDH Ft ~cemain Length Dia. Dist. Tow ELEVATION DATA county: St. Croix Sanitar PermitNo.: 63992 State Plan ID No.: Parcel Tax No.: 018-1083-24-000 (b ~ ~~ ~ ~ ~~ 5~t(p STATION BS HI FS ELEV. Benchmark ~ q•o ~ ~o9,a~( ~ -O Alt. BM (~~ 3.D olo , o ~' Bldg. Sewer Cd) 3.G,Z JoS , c(2.' St/Ht Inlet ~ ,3p lo~(_}~r St/Ht Outle 'a ~t-}O o`~•3`~~ Dt Inlet .--~ Dt Bottom -~- -~ Header /Man. , ~ S' p (- o ~{' Q ~ Bot. System Final Grade ~,; St cover CQ , Sp O $ . 2 r SOIL AI~SD.~PTION SYSTEM ~o~ ~ rp~~ n~~ -~-.~,,.,~ NCH width r Length No. Of Trenc es PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 3 DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Mau ctu er: ~~ SETBACK INFORMATION Type O ~ `-~ CHAMBER Model Number: System: c,~tn1• ~-`f0 "' ,s OR UNIT DISTRIBUTION SYSTEM ~ ~ ~ ~ Header /Manifold q Distribution Pipes x Hole Size x Hole Spacing Vent To Air Intake ``//~ Length~~5 Dia- T ia. Spacing ~ ~'f0 SOIL COVER z 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: ~ /2°// °'~ Inspection #2: ~--f--~ Location: 1729 100th Avenue, Hammond, WI 4015 (NE 1/4 1/4 16 T29N R17 ~;- 162917596 Pheasant Hills o l.) Alt BM Description = !>d~~~'' '~ _„~, `~ '~^^~Q'~ o 00.09 °~ 2.) Bldg sewer length - 2°) r~ ` o~,y{ ( t~, 25 5 •~ I ~ ,~ K. l b -amount of cover = 18 + «~-9',"`~"y ~- ~ ~oi.zg 2 `F; 0 5' ~ - ~ •9~ ~S ` ~ ~s ~~~,.,.-~.~ ~~-(~.P ~-- 3 ~ ~ ~ 98.x' - 31 ~~ µ~"s ~crsl~ t Plan evi i n required? ^ Yes ,~'No ' ? Use other side for additional information. • ZZ Zaof ~ tt ~-t~'Z.6 SBD-6710 (R.3/97) ~ C~C ~S Inspector's Signature Cert. No ._ ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: P ~ I ~ e 3 ~ _ _. ~- - ~ ,~ 1 ' ~''~ ~ ~ r 1- r' ~Z9 ~ ~~ f~v~ Sanitary Permit Applica ' , ;~ 1 ~ ~ ~ ~ ' Safety & Buildings Division 201 W. Washington Ave. , In accord with Comm 83.21. Wis. d(n > - -+••. `~seonsin See reverse side for instructions for com .n ~s~p plication`~,(, ' PO Box 7302 ' Madison WI 53707-730^ Department of Commerce oses~ personal information ou rovide ma ~ be s r secoA~ t~ ~~~~rP )] (privacy Lati' 15 s . ' , Submit completed form to county if r ~~ U , . . c. stat e owner Attach com lete laps (to the county co only) for the ~ m. on a er no le 8- x 11 inches in size. County State Sanitary Permit Number ^ Check ~ ~sion t~ io ap~,~,ation tate Ian 1. D. Number I. A lication Information -Please Print all Information C ~ t~GF ~ ation: Property Owner Name ~~~ ~~? P perty Location O ~tJ h e r.` ~6 I 1--t' ~r~l/4 6r1 1/4, S T'.14 ,N, R/?E or Property Owner's Mailing Address - ._- Lot Number Block Number ?~ ~d Sty ~s Y 7- ~~ ~ Y City, State Zip Code Phone Number Subdivision Name or CSM Number II Type of Building: (check one) ^ City ^ 1 or 2 Family Dwelling - No. of Bedrooms: ~ ^ Village ' _ ^ Public/Commercial (describe use): own of ~7 ^ State-owned a /'n a ~- III Type of Permit: (Check only one bex on line A. Check box on line B if applicable) Nearest Road 74 A) 1. l~New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onlv Existin S stem Q~~"-~1G,35' -~'G'- Q o d B) Permit Number Dat Issu > ! 9 ~ ~ ~ ^ A Sanita Permit was reviousl issued ~ • / • 7 IV. Type of POWT System: (Check all that apply) ((7p `- ~Non-pressurized In-ground ^ Mound ^ Sand Fi ter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ~-3.D~ !zG '~r~.r~- ^ Aerobic Treatment Unit O Recirculating ^ Other: V Dis ersaUTreatme Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation ~' ~o /aa d 1~6 a ~ S o~- 9Q " Q ~o'~ VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ c ~.G .i ~ .? l ~-6~ .Z E' ~~ ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersi .ed, assume res onsibili fr'r installation of the POWTS shown the attached laps. Plumber's Name (print) Plumber's Signature (no stamps): P PRS No. Business Phone Number C.Q ,SCLi~~o-~eY `~ olv~2Q D l S ~..~ P'C~' /~ Plumber's Address (SVeet, City, State, Zip Code) PD•~d o ~ ~'a ~s~~ y VIII County/Department Use Only ^ Disapproved Sanitary Perrnit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) I~.Approved ^ Owner Given Initial Adverse S harge Fee) Determination ~ oZ-oZ-S , ~ g' Z (~ 7~'~ IX. Conditions of~pproval /Reasons for Disapproval: "~~t•~~/wCI~,7~'~i~~~/~ is .~ --~, .~l~R ett~~- ~~-~e.~ v,~..t~---~ ~. -~v~au„ ~~~~ tee-. n LsOY~eO W~'~DT~ l'a f, SBD-6398 (R. 07/00) ~o ,J ~ r. ~ r"o l ti„t 2=r ~~e~rsu.uT /Q ~~~~~~ ~~~ ~~ ~ Q rr~./ ~, .wsconsinDepartmentofCommerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings OR'G~With Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 83~ x 11 inches 'ze. Plan must i cl d b li i d i l Count y n ut not u e, m te to: vert ca and horizor14Al reference point (BMA, irection and Croix St percent slope scale or dimemsions north ow and locati n and d°isXan to nearest road . , , , . ~° Parcel LD # . p I $ - (pg 3 _L~ DDa APPLICANT INFORMATION - /ease pnr~f ~llt~irtfii?•mat~i,~: ' Personal information you provide may be us for' seconda ur oses (Pri°vac aw s:-t 04 (1) (m)) t Reviewed B ate YO ry p p . y . .~ ~ g ~ _ ,~ 1 n r OW Property Owner -- r' . ~, il?f party Location Bonte, Ron ~ - ~-~~~r ~ ~ NE 1/4 NW 1/4 16 29 17 W G ,Lot S T N,R Property Owner's Mailing Address ~ ~'~ ~~v±~~ts ~~"!~`~ ~~ t # Block # Subd. Name or CSM# . ._ 1011 170th St. "- 24 Pheasant Hills ' -` iP ° eN ~~ •` t'. City State Zi H d W 1 0 ''~ ^ City n Village ®Town Nearest Road ammon I 5 1 -5 6 5 ~ I~aammond 170Th St. New Construction ~ Residential I Number of bedrooms 3 ^Addition to existing building Use: __ Replacement ^ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ftZ •4 trench, gpd/ft Absorption area required 1500 bed, ftz 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 - install 2 - 5' x 112.5' shallow trenches along contours for 3 br / Additional design /site considerations Parent material till Flood lain elevation, if a licable N~` 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 •7VIL VG~7VRIr I IVI\ RGf Vll l Boring# 4->~ Ground elev 101.9 ft Depth to limiting factor > 7g" 2 Ground elev 101.8 ft Depth to limiting factor > 63" Horizon Depth Dominant Color Mottles Texture Structure Consisten Bounda Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ~ Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-13 7.SYR 2.5/1 - sl 2 f sbk mvfr cs if .5 .6 3 13-24 l OYR 4/4 - sl 2 m sbk mfr cs 1 f .5 .6 4 24-31 7.SYR 4/4 - sl 2 m sbk mfr cs lm .5 .6 5 31-48 lOYR 4/6 - s 0 sg ml cs lm .7 .8 6 48-78 7.SYR 4/4 - sl 0 m mfr - - .3 .4 1'-~ fo 0 Remarks: consraeraore gr strattnea is-s t" , 1 0-11 7.SYR 3/2 - sl 2 f-m sbk mvfr cs if .5 .6 2 11-30 7.SYR 4/4 - sl 2 m sbk mfr gs - .5 .6 3 30-48 7.SYR 4/4 - sl 0 m mfr cs if .3 .4 4 48-63 7.SYR 4/4 - sl 0 m dh - - .3 .4 ~-'~ ~' Remarks: uwn~ivuar ui~ru~rurw iv t n 4i4 rs m nortzon ~ CST Name (Please Print) Signature: Telephone No. Henry F. Grote y 715-665-2681 Address ertt to of esttng Dato CST Number Ref # P.O Box 57, Knapp, WI 54749 4/13/2000 222774 1044 PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT ~ Page 2 `of~ 3 PARCEL LD.# Certified Sojl e"I sting , 3 Ground elev 100.2 ft Depth to limiting factor 30" 4 Ground elev ~ /~/~ ~ G Depth to limiting factor > 60" Ground elev 1 l17 7 H Depth to limiting factor > 60" Horizon Depth in Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh, onsistence Boundary Roots GPDlft2 Bed Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-16 7.SYR 2.5/1 - sl 2 fsbk mvfr cs if .5 .6 3 16-30 7.SYR 4/4 - sl 2 m sbk mfr cw if .5 .6 4 30-46 lOYR 5/4 lOYR 6/2 sl 2 f-m sbk mfr cs lm .5 .6 5 46-64 7.SYR S/8 - s 0 sg dl - lm .7 .8 KemarKS: ~~~~° dlV4 JUIL0.VIl. 1Vl 111V LLII4 QJ 1\rk1161.V111 Vlll ,Vl VIIS11101~, 11V11LVll J Il4J Vlr4aa1 Vll6l b'l/VV V/Jl T VIIG I V 111Q111GLG1 111(.~UJ~U~~ G.J 1 [( 1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs 1 f .5 .6 2 3-8 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 8-27 7.SYR 4/4 - sl 2 m sbk mvfr cs 1 f .5 .6 4 27-37 7.SYR4/4 - sl 1 msbk mfr cw if .4 .5 5 37-48 7.SYR 4/4 - Is 0 sg, dl cw - .7 .8 6 48-60 SYR 4/4 - is 0 sg ml - - .7 .8 Remarks ; occastona gr co a ow N ay 1 0-6 7.SYR 3/2 - sl 2 f sbk mvfr cs if .5 .6 2 6-34 7.SYR 4/4 - sl 2 m sbk mfr cs lm .5 .6 3 34-60 7.SYR 4/4 - sl 0 m dh - - .3 .4 S~" s ~ Ground elev Depth to limiting factor Remarks: s , .. ~O~ JdO~TQ ~~10~,~`Ah ~~a~~~ Z e o S at 1" - ~ o zo t,o ~ ~ ~..-o~.q~ Gz., ~.,i~~ ~^ L~~ 13•t ~, ~1.~) 4?~2.5~, ~.z,.~ ~• a a~- Lm-s~~ a, ~ (~ ~ ~ ZbS CL - 44 ~h o t'~ti ~-a l ~' ~...n ~ 1 ~4 w w w. O h. z su •s aig- ~ ~- t~. y ~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWT~) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Design Specifications Sanitary Permit Number + / Number of Bedrooms ~ 6~ roo~~ Design Flow -Peak (gpd) ~,oo Estimated Flow -Average (gpd) Septic Tank Capacity (gal) 7 to Soil Absorption Component Size (ft~) ! G -F Type of Wastewater omestic Tahlp 2• Seil ~4hsnrntien Component -Limits of Reliable Operation Septic Tank Component Soil Absorption omponent Design Flow -Peak (gpd) ~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance 5cneauie Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not.removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a .septic or other Treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within The sepfic or other freafinenf of holding tank may contain lethal gases, and rescue of a person from the interior of the Tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ST CROIX COUNTY . SEPTIC TANK MAINTENANCE AGREEMENT .. -AND OWNERSHIP CERTIFICATION FORM OvvxierBuyer Mailing Address 72Z -: ~ -~ a ~ ~ 553~~ 7~9 ~V~ ~.,e.~ .Z Property Address ~ ~ ` (Verificati required from Planning Department for new constructton) ~ r~ rarccl Identification Number ~ ~ City/State ~ ' LEGAL DESCRIPTION _ ~ 7 W Town of ~ ~~ ~ Property Location N ~ -'/,, N txJ `/., Sec. ~ ~ . T ~ N R ~ ~ r`~ ~ ~ I ~ ~ Lot # Subdivision ~ ~- _, Volume .Page # Certified Survey Map # 'ran Deed # ,Volume ~~ . Page # ~~ War ty Lot lines identifiable L~ yes ^ no Spec house ^ yes I~ no SYSTEM NIAIlVTENANCE 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 lumber restricted lumber or a licensed pumper verifying that (1) the on site wastewaterdisposal system mastCrPl~ber+I°~e~np P the s tic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) a8er inspection and pumping (if necessary), eP Lwe, 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 Wisconso ~ w~i rtli fi30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of the three year expiration date. 7 /,~~/ ~ ~~~ 1, ~ J ~ DATE SIGNATURE OF APPLICANT 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) o the property '~ .12y yi~ue of a wamarrty deed recorded in Register of Deeds Office. ,. -~° `~ DATE SIGNATURE OF APPLICANT ent. ****** *****« Any information that is mis-represented may result is the salutary permit being revoked by the Zoning Departm ** 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 ~ STATE BAR OF WISCONSIN FORM 1 - 1998 6~~C~6$ ' WARRANTY DEED KATHLEEN H. WALSH r~ Document Number yQL ~5~iPA6E 4~ REGI5TER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Ronald C. and Dine M. Bonte, 05-16-2000 lO:QO AM husband aad wife YRRRANTY DEED EXEfIPT N _, Grantor, CERT COpY FEE: and Ronald G. and Cheryl L. Br istol, husbatdand wife COPY FEE: TRRMSFER FEE: 131.70 -- -- RECORDIM6 FEE: 14.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee [he following described real estate In St . Croix County, State of Wisconsin (the 'Property'): Recording Area Name and Retwn Address Lot 24 of Pheasant Hills Subdivision Please return to: Document # 622544, Volume 7, Page 86 Eagle Valley Bank N.A. (Towship of Hammond) PO Box 1106 5t. Croix Falls, WI 54024 018-1034-60-000 Parcel IdenUlkalion Number (PIN) This is not homestead property. (is) (IS not) Together with all appurtenant Hghts, [tile and Interesu. Grantor warrants [hat the title to the Property is good, indefeasible in fee simple and free and dear of encumbrances except highways, easements, and restrictions of record. DatRed t~hts QQ11~th dary of _jlli` y , _2000 (,~ 7- ,.~ 1V -" ~ , d~~ (SEAL) I~~~ / //. ~~~XiYGC~ (SEAL) .By: Ronald C. Borite By: Dine M. Bonte (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of Personally came before me this /f day of b^'~ ,the above named Ronald ~. Bonte and Dine M. Bonte TITLE: MEMBER STATE BAR OF WISCONSIN _ to (If not, ; Vp RElj/~.~ me known to be [he person ~_ who executed the foregoing authorized by §706.06, Wis. Stats.) : ~Q` ~-'"'~""~.tiC~ instrument and acknowledge the same. . ,~;. THIS INSTRUMENT WAS GRAFTED BY ~~~ • ~~YA~~ ~' ap~~ 7 Ronald C. Bonte i. `a~~~ fly~G~' .: ~ ~'~~ '7 /` 1011 170th St Hattlmond, V ~' ~ C~ Note Publtc, 5 e of Wisconsin WI 540Prae~'te D~ ~;SG : My ommisslon is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both a14••nob••~t" ) necessary.) Nsme, or persons stating In any capacity must be typed or pr5nted below their slgna[nre. STATE BAR OF WISCONSIN Wisconsin Lepat eiank Co., rx. WARRANTY DEED FORM Nn. 1 - 1998 rn~lwaukee, wra. i0 v -~ ~ co ~ , U Ili O ~ Q3 °~ Q, tQi W ~. o ~+ ~ ,. 0 0 ~ 3 •~"~ o ~ i 1 l j , < N ~ ~ ~J:~ ~~ ~ ~ ~ ~, • N ~ u p~ ~~2 jb - - ~ C!~ ~~ -~ ptry^' ~ , 25 96 , - o ~ Z - - _ _ ~ `~~'~' ~ 'i ~ ~6 -- 2 si o f ti .. tai ss "~. ~ . o _- ~ ,.~~_ /., _~ ~ ~ _ Z ~ ._~ U _. _.. ~ ` Z , ~ Z ~, 'oo o± ~ of _ ~ ~`~~~ 1a. ~ ,, OD - ~ ~ C1~ ""~ w, ~ i ~ ~ ~ ~ x.11 ~ ii ~~~ I o v ~ ~ - O'-- CD __ __ ~ r% O~ ~-1 ;: y ~ I - ~ -n ~ ~ ~ ~' ~ ~ v~' {tj ~ ~,,, ti O < i ' ~ ~ ~ ~~1 ! ~ Q ~ T -~N .a ~ d A ~ \ ~ ~ ~ ~ \ \! O N p _ \ ~_ _ _ 3.5~ Os , , ~ ', ` ~ , ~ "' b ~, w' ,cU ~ . o ~ t7F . ~ o : k ,fl ~ ~ ' :r / ~ w v ? co u ,~ W v i ~ ~ owi o f0 ~ 1~ .,- , .~ u ~ o ~, o i Cj ~ 1 r ~ .- ~ ~ _ ._ _ ~,. ~ 1 N A i ~p ~ ~ __, ~ \ ~ :: N ~ ~ _ _ _ ~ _ v~ ~ ~ ~ ~ ~~ N!; ~ ~ ~ ' ~ ~... ~ __. r ; ~ i is ~. N ~I ~ _ ;~, ~ i ~'~ ~ ~ ~ ~... l } p . _ ~_ ~ ~, V ~ r ~ ~ r ` ~ O •~i _ _ p _ ~.." - - ~ ~D '. ~ ` l~ _ ~ ~ ~ ~ i ~ ~ - ~ - ,,. . r -N ,' i .~ ~ ~' tn~ ~ ~ ~ ~~ ~ r {~ _ _ ~ o~ o ~ r '. ~, i ;. V ~ ~ '~-J' 1 ~ ~ fA ~ .r ~ - v h ~.. ~ Q' ~~ ~~ ~ ,~ .~ ,, ~`, ~ __ , ~ \ ,~ ~\ _ / r P f~ E~!~S A NT HI~.LS ,_. . -LOCATED l N THE NE 1 /4 OF THE NW t /4, THE SE l /4 JF THF_ NW 1 /4 AND PART OF THE SW 1 /4 OF THE NW 1 ~4, AND PART OF THE NV'/ 1 /4 OF THE NW ! /4, ALL I N SECT 101'J l o, T. 29N. , R. 1 ~W. , TOWN OF HAMNiOND, 5 T. CRO 1 X COUNTY, W I SCONS I N 1OO7N AVENUE "ET LOT 23 0 .~ Y 4 T . a~ ~' ~~ ~° .,- ~/~ a / e_ ~ i i I iN1S Mr-t ~+s 1 i .._.._..i..------ i i /LAT f.-.r ' K-,t i i :, -~ ~D • u LOCAT(OM JKtTCN '." `~*. f'~ st c n o. r., 1. tMr.. R. + ~r.. Taw or wr.a~ N W SIC- F (1pT 10 fCMt) N ` ~a T - - _ _ _ UTILfTY EASEMENTS NO POLE ~ R BUR!cD CA9LES ARE TO BE PLACED StiCf+ THAT T•~E INSTAl1ATi0N MOULD DISTURB ANY SURVEY STARE. GR OBSTRi1Cr YIS~CN ALONG A1Vr LOT LINE OR liREET LfNE. e 7ME O I S TUABANCE OF A SURVEY S TAXE BY ANYCMF f 5 A V 1 CY.4 T; ;,: G1F ~ SEC1 f ON 2.lff. ]F Of rrr SC'JNS rN STATCTES. uT tc -7r £ASFfENTS a5 MEaE ~ v > SE7 fCRTN ARE i'cKt THE uSE OF PuBL;C BODIES arO oorvATE ~TILfTtES riAVtNu THE RIGHT iO SFRYE TO AREA. ~\~~`' L0r 15 v SHEET ~ u ~ ~" --._ Q -, SEE v -- - ~ ti. n~ ~, r t ~ '~,, LEGEkO f FOUND f' IRAN Pf.°E O SET t'xJ0• fRON PtPt IfEIGMIrG J. 63 CBS. PER LfNEAR FOOT NOTE: SfT t'x2~' IRON PIPE iYf r.aMiNG 1. 13 LBS. ••°ER C INFAR FOOT Al ALL OTr+ER COT CORNERS ti UTIL tTr £ASEAEN7 f TrP. 1 ---~-- . SETHAI;xS • JAIVEWAY LOCATIONS ^ O ~~gC~~~~ '~ k~~. ~,• Q ~ Jet, 3~.~5~d~ ASTERS OtFIC1<: SLCAtx?C C0. Y"u `~ Jvcaw.ed fa Reoncd 1fi" ,~--•-~f d>+A 7A.Q° ~~ ___2 ~4 r~~~~~~ ~" +f J ~~l ~~_ .~ August 9, 2000 Bill Schumaker 1070 Scott Road Hudson, WI 54016 Dear Mr. Schumker: ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 Fax (715) 386-4686 Enclosed please find the sanitary application for Ron & Cheryl Bristol. The reason this application is being returned to you is that it has been brought to our attention that you. no longer hold a State Plumbing License. We received notification today from the Department of Revenue that your master plumber's license has been revoked as of 7/31 /00. Please let us know when this matter has been resolved with the Department of Revenue. At that time you may bring in the application to get approved. If you have any questions concerning this, please call our office. Sincerely, Rod Eslinger Zoning Specialist RE:skm Enclosures - WILLIAM E, HAWKINS - - uc. HzSZ-s25aao6a-oor~ 7s-2s4css 119 6 0 'r 976 - 170TH PH. _715-796-2793 21310201 _ HAMMOND, WI "54015 DATE ~ ~ ~ CI V PAY TO THE ~`1C G J" O f K ~ CJ ..CON ( ~''O ORDER OF ~ :~ M- f i.,~~ ~ v~C, I - ~r DOLLARS 8 _- :": °_" ::. _ : AELATIONSHIP ,... L~ ~ LJ ~'~Y~~~~~~'O~~' ~~~~ CHECI4NG .. QMy, ND9FFICE L"' PH.995-796-2211 J~/ ~ f ~~ MEMO h.r~.s~~ -- SYilr~•"' Z//`f~J ~ '-i:09 180 2 54 7~: 2 13 LO 2D iIP 1960_ • ~ Sanitary Permit Application Safety & Buildings Divisior In accord a-ith Comm 83.21. Wis. Adm. Code 201 W Washington Ave See reverse side for instructions for completing this application PO Box 730: ~SC~ns~n Personal information you provide may be used for secondan• purposes Madison, WI 53707-730' Department of Commerce [Privacy Law, s. 15.04(1)(m)) (Submit completed form to cou:tty if n state owner Attach com lete lans (to the county co 'only) fort a er not less than 8-I/2 x 1 I inches in size. County ' ~ State Sanitary Permit Number v i t p e ' us application g ~ State Plan 1. D. Number a X -- lr g2 3 ~ I. A lication Information -Please Print all Informatio Location: Property Owner Name ~ Property Location d ~ i S Tp ~ r ~/1`t'a( ~ ~•- (` t 1[ n r r~ ~ NG 1/4,l~lrJ I/4, S J~ Tc2 ,N, Iil~ or Property Owner's Mailing Address 4.,__.~ ~ ~`~ `•~ -• r, Lot Number Block Number 7.? 76 S TPU1arf~ Or ^~ ~ ST CRUiX a ~~ City, State Zip Code ID~RICE r h Subdivision Name or CSM Number ya ~'r'ie~fy/ 5 ~3YG ~ /( ~s'1ea Sa.d1` h~` %/5' II Type of Building: (check one) ^ city ^ 1 or 2 Family Dwelling - No. of Bedrooms: ~ o~ ~'~'' ~''b"" v SB P~~ ~ ^ Vitta ^ Public/Commercial (describe use): 6aTown of ^ State-owned Q. ~ III Type of Perm!t: (Check only one box on line A. Check box on line B if applicable) Nearest Road 70 ~~ A) 1. [I~New S s em 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onlv Existin S stem / -i 03 -~~~ $) Permit Number Date Issued ^ A Sanitary Permit was ureviously issued IV. Type of POWT System: Check all that apply) Non-pressurized In-grounc~a S'YI-LOr ^ Mound ^ Sand Filter D Constructed Wetland ^ Pressurized In-ground R.o~k-frthG~lt2S ~ ^ Holding Tank D Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dis ersaUTreatment Area Information: oc " 7 / = I renc k ~ f % Z =Ira•~xlt # L I. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) 99. Q % 1 ~ rZ,,, Elevation CGO is vo ~~ t~x'a ~ss•,• /e i. q ~ o~0lf ~ .~ .1JG~ t;;l III an atwl~nes ~ ~. f°~- VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ S ~~ ~ 1~i8 ^ ^ ^ ^ D VII Responsibility Statement I, the undersi .ed, assume res onsibilit fer installation of the POWTS sho the attached laps. Plumber's Name (print) Plumber's Signature (no stamps): P PRS No. Business Phone Number '/1 k ~ Sc~k`n a.`le~ ,~ ,2v2 r! Q d' 7 S " 3 G ~ 3l 2l Plumber's Address (Sweet, City, State, Zip Code) d'7 Sc ~ "G VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Ise to A ent Signature (N tamps) l~Approved ^ Owner Given Initial Adverse Surcharge Fee) 1 _ g, Determination p-o~- ~ /cT~ IX. Conditions of Approval/Reasons for Di ppro al: ~loodp(u~n'Whr~G~ G r Q {~.,t c~ ~ ! s ~-~- N~k t,a ~ .t l a ~ ~Ll, t ~ avt i ~' S vv( ~1G ~ ~, t>~,t g"rJ . S~ .. ~E~k~a- ~lrlal X100 5e ~~ ueK~" ~i I~C/' 4ti v~,'>` ~G ~R/~ tifrtG6/ >,r yF't~G ltitwh~~RO7{Lrt~/ . ~ P~ u i c ct,"f~ ~rl S SBD-6398 (R 07/00)