HomeMy WebLinkAbout018-1083-40-000 (2)/*
wrsoa,sin Department a Corranerce PRIVATE SEWAGE SYSTEM
Satety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provice may be used for seoorMary purposes [Privacy law. x.15.04 (1)(m)).
Permit Ho der s Name: ^ City ^ Villa ^ Town of
ng, Daniel Hammond Township
CST BM Elev.: Insp. 8M E ev.: BM Description:
r ~
~-S d z, d
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~ ~L ~(}
Oosi ng ~U ~
Aera I
o ding
TANK SETBACK INFORMATION
TANK TO P/ L WELL BLDG. ventto
Air Intake ROAD
Septic - (~ CI ~ Z z ' NA
Dosing ~ (~ d' ~ ~ NA
NA
o[ding
ounty:
St. Croix
Sanitary Permit No..
384276
State Plan 10 No.:
Parcel Tax No.:
018-1083-41-000
ELEVATION DAB A
STATION BS HI FS ELEV.
Benchmark ,~ 9 , 5 9Z,,S
t. BM .~Z 92-0
Bldg. Sewer ~,~ • ~ '~
Ht Inlet ~~(o ~~~ '~
Dt Bottom
Header /Man. ,.S 3 - as
Dist. Pipe h~ °, s. 93 q 13. ~ ~
Got. System ~ sy s ~z : 3 9i. C/
Final Grade y ~ ~`~lP
Cover h
PUMP /SIPHON INFORMATION -~
Manufacturer Demand
Model Number GPM
TDH Lift .1 Friction System TDH Ft
Forcemain length ~ ~ ~ ~ Dia. Z ~~ Dist. To Well
t[lll ARSI(lRPT1~N SYSTEM t~ _( ~
.... I
BED / EN Width Length ~ No. O Trenches + PIT No. Of Pits Inside Dia. Liquid Depth
1 E ~ / 2S~ IMEN 1 N
SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu surer:
,.
~
SETBACK H B r•
INFORMATION Type ~ ~
~ ~ - O IT um
System-
~
DISTRIBUTION SYSTEM
Header / Manld Distribution Pipe(s) 4 ~ x Hole Size x Hole Spacing Vent To Air Intake
length ~ Oia. ~ Length ~-~ Oia. ~ Spacing L~ ±
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 presentJg~geCtion #1: ~ /Z3/o / Inspection #2: /
Location: 1711 100th Avenue, Hammond, WI 54015 (NW 1/4 N11~~ 1/416 T29N R17W) -162917613
Pheasant Hills -Lot 41 / \ `f•J~~ C~<<.- /a~/~cc/- n~"a/ rev%k~h
1.) Alt BM Description = ~ a~ ~~~.,` lWa,~i~oc~'~' J ~~~° k-s~crov~ ~7 p~o'f ~~''`
2.) Bldg sewer length = Zy' ~9 ~;~ earv< p, KSd
-amount of cover = ~~~li a~cl~,..ylra' ~ 3 ~r~..c~,es, sysF~..-. Was
3~o(,~'r valin•. va,,fs %Hs~il~d ,a 3'~c~ // /~~+ ~ < < Z y" Yirep. ii~q•:i.a/ ~.~ ~-~.cf pets~`6~t/
t~.(~rv trey+~ La
Plan revision required? ^ Yes ^ No ~,
Use other side for additional information.
Date Inspector s Signature Cert No
SBO-6710 (R.3/97) ``\ ~ ~~~ L '~Wd~
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I Salary ~tid 8ui~in,~s Division ~ Counh
:A: W. a'athinatcn Ave. , P•O. Bnx 713:? ; .$~~ , `x
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Wisconsin Department of Commerce OR'~ffT~'CL~d~ND SITE EVALUATION Page ) of 3
Division of Safety and Buildings h 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
include, but not limited to: vertical and horizont~~iI ~eferenc~point (BM), direction and County St. CroiX
percent slope, scale or dimemsions, nortfj-e>•row, and locabdtt~nd distance to nearest road.
~ ~, Parcel LD.#
APPLICANT INFORMATION ~ ~ Please pmt all infor ation.
Personal information you provide may used for sec~ondi~~l;u es (Pfivacy w, s. t 5.04 (1) (m)). sewed By Da
?~0C
Property Owner ~ Property Location
Bonte, Ron (•- /~. ^^ s '~ C:i~~~ ' c_ni Govt. Lot NW 1/4 NW 1/4 S 16 T 29 N R 17 W
Property Owner's Mailing Address'., . ;T ~ Holx ~ Lot # Block # Subd. Name or CSM#
1011 170th St. ~ ~,;pi;NTY j~, 41 Pheasant Hills
City St~~((e Zi ~ ne um r ~ City nVillage ®Town Nearest Road
Hammond Wl., 5015 715-7,9¢ ITammond I 170Th St.
New Construction Use: ~ R~ertti~U"mber of bedrooms 3 ^Addition to existing building
. _ Replacement ~ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate •4 bed, gpolft2 •5 trench, gpd/ft'
Absorption area required 1125 bed, ftZ 900 trench, ft2 Maximum design loading rate •5 bed, gpolft~ •6 trench, gpolftZ
Recommended infiltration surface elevation(s) 2a" below contours ft (as referred to site plan benchmar
Additional design I site considerations'nstall 2 - 5' x 90' shallow trenches along contours for 3 br
Parent material till Flood lain elevation, if a livable 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
Ado, . ~ ~..~e : ~ (. 20'~Dt7 -~1 2
Boring#
50 =~`
Ground
elev
94.0 ft
Depth to
limiting
factor
> 80'
2
Ground
elev
96.0 ft
Depth to
limiting
factor
~.
Depth Dominant Color Mottles Structure Consisten Bounda Roots GPDIft'
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ry Bed ~ Trench
1 0-3 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6
2 3-17 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6
3 17-30 lOYR 4/4 - sl 2 m sbk mfr gs Im .5 .6
4 30-51 7.SYR 4/4 - sl 2 m sbk mfr cs lm .5 .6
5 51-72 7.SYR4/4 - is 1 msbk mvfr cs lm .7 .8
6 72-80 7.SYR 4/4 - s 0 sg dl - - .7 .8
Remarks: occastonai gr m nortzon ~; nonzon a nas some r mc-ustons
1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6
2 3-10 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6
3 10-36 7.SYR 4/4 - sl 2 m sbk mfr cw 1 f .5 .6
4 36-58 7.SYR 4/4 - Is 0 sg dl cs - .7 .8
5 5 -64 2.SYR 7/3 f2d 7.SYR 4/6
-~ sl 0 m mvfr - - .3 .4
Remarks:
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715-665-2681
Address ertt t o- esttng p~ CST Number Ref #
P.O Box 57, Knapp, WI 54749 4/1/2000 222774 1052
~ S~S~ ~w~ °~°"~ cd,af;t~-~, .e~,,. roe. le ~ SYS-f~., a
6.8.0 ~
C e~' ~ ,~.s s~~
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PROPERTY OWNER: Bonze, Ron
PARCEL I.D.#
SOIL DESCRIPTION REPORT
Page,. 2 ~ of• ~
ra~:Fa,~ c,,:i
Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD/ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Be~Trench
1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6
2 4-11 7.SYR 2.5/1 - sl 2 f-m sbk mvfr cs if .5 .6
3 11-28 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6
4 28-35 7.SYR 4/4 - sl 1 m sbk mfr cs - .4 .5
i
5 35-49 7.SYR 4/4 - ]s 0 sg dl cs - .7 .8
6 49-61 2.SYR 8/2 - fs 0 sg dl cs - .5 .6
7
Il _.Y __I._. 61-65 2.SYR 7/3 fld 7.SYR 4/6
-------- sl 0 m mvfr - - .3 .4
I \VIIIGII\J.
1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6
2 3-10 7.SYR 2.5/1 - sl 2 f-m sbk mvfr cs if .5 .6
3 10-25 7.SYR 4/4 - sl 2 m sbk mvfr gs if .5 .6
4 25-37 7.SYR 4/4 - sl 1 m sbk mfr cs if .4 .5
5 37-61 7.SYR 4/4 - is 0 sg dl cs - .7 .8
6 61-64 2.SYR 7/3 f2d 7.SYR 4/6
.----- sl 0 m mvfr - - .3 .4
D.,.......L,.. ~
1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs 1 f .5 .6
2 3-16 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6
3 16-43 7.SYR 4/4 - sl 2 m sbk mfr cw if .5 .6
4 43-52 7.SYR 4/4 - Is 0 sg dl cs - .7 .8
5 52-62 2.SYR 8/2 - fs 0 sg dl cs - .5 .6
6 62- 8 2.SYR 7/3 flf 7.SYR 4/6 sl 0 m mvfr - - .3 .4
D., ...I,.. .
Ground
elev
Depth to
limiting
factor
' ;tViscdnsin Department of Commerce fr~~~~~~ ND SITE EVALUATION
Division of Safety and Buildings O~'`lif}~LbPa~th Comm 83.05, Wis. Adm. Code
Page 1 of 3
Certified Soil Testing
Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must Count
y
include, but not limited to: vertical and horizontal referent` point (BM), direction and
nd distance to nearest road
nd l
f~ow
ti
i
l
i
t St. CroiX
.
, a
oca
o
ons, nor
h-e
percent slope, sca
e or d
mems
l
Parcel LD
#
"~
o .
APPLICANT INFORMATION ~
nvation.
Please pmt all inf
Personal information you provide may b~ used #or sectond,~tr~c~uFpA~es (Privacy aw, s. 15.04 (1) (m)).
` i IBWed By Da
Z.~ l
Property Owner _ . ', Property Location
Bonte, Ron ~ -: ~~ ^ 4 ~~~;}i~ cn Govt. Lot NW I/4 NW I/4 S l6 T 29 N R 17 W
Property Owner's Mailing Address', , . : ~ :~ Bplx ,'• ~
, Lot # Block # Subd. Name or CSM#
~t,NN ice,
101 1 170th St. 41 Pheasant Hills
City State' Zipp ~ ne um 'rte
'
015 715
W
9 ~ City ~] Village ®Town Nearest Road
d 170Th St
A
L:.
-7
54
Hammond
~ unmon
.
~ Re~ent~'al-ff~tlmber of bedrooms 3 ^Addition to existing building
New Construction
~
_
Use:
_ Replacement ~ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate •4 bed, gpd/ft2 •5 trench, gpolft2
Absorption area required 1125 bed, ftz 900 trench, ft2 Maximum design loading rate •5 bed, gpd/ft2 •6 trench, gpolft2
Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar
install 2 - 5' x 90' shallow trenches along contours for 3 br
Additional design /site considerations
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 X U
Boring#
50
Ground
elev
94.0 ft
Depth to
limiting
factor
> 80"
2
Ground
elev
96.0 ft
Depth to
limiting
factor
58"
i
on
H Depth Dominant Color Mottles
Texture Structure
Consistent
Bounda
Roots GPDIft2
or
z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ~ Trench
1 0-3 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6
2 3-17 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6
3 17-30 IOYR 4/4 - sl 2 m sbk mfr gs Im .5 .6
4 30-51 7.SYR 4/4 - sl 2 m sbk mfr cs 1 m .5 .6
5 51-72 7.SYR 4/4 - is 1 m sbk mvfr cs lm .7 .8
6 72-80 7.SYR 4/4 - s 0 sg dl - - .7 .8
Remarks: occasronar gr m norrzon ~; nonzon a nas some is mauswns
1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6
2 3-10 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6
3 10-36 7.SYR 4/4 - sl 2 m sbk mfr cw 1 f .5 .6
4 36-58 7.SYR 4/4 - is 0 sg dl cs - .7 .8
5 5 -64 2.SYR 7/3 f2,d 7.SYR 4/6
--~ sl 0 m mvfr - - .3 .4
Remarks:
SST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715-665-2681
4ddress ertr ie of estmg D to CST Number Ref #
P.O Box 57, Knapp, WI 54749 415/2000 222774 1052
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Private Onsite Wastewater Treatment 5yst8m Nianagernent Ptah
Septic Tank And C3ravity in•Ground Soil Absorption Component
Pursuant to Comm 83.84 W#s, Adm. Code each Private Onstte wastewat+ar Treatment
System ~pOWTS} shall include information and procedures for maintai the department, agent,
the parameters of Comm 83 and 84, and the conditions of approval by
or governmental unit. The approved plans and permits far system are an file at the county
zoning or health department.
Thls management pl Ma ualpfoe Private Onsite Wastew~ stet Treatment Systems S r~~nd
Soil Absarptton Component
10587-P (R.6/9g}.
u
1
once a year aril clean at feast once
once every. 3 ears
Septic Tar,~k,
The septic tank shah be maintained by an individual certified to service s~-Pt{c tanks
under s. 281.48, Slats. The contents of the septic tank she{l be disposed of {n accordance with
NR 113, Wis. Adm. Cede (Servicing Septic or Holding Tanks. Pumping Chambers, 3rease
interceptors, Seepage Beds, Seepag® Pits, Seepage Trenches, Privies, or Portable
Restroc~ms}.
The operating coedition of thq septi k and outlet filter shah be assessed at least
once every ~ Yaare by Inspection. Th out et tilt r shalt be cleaned as pace to ensure
proffer operation. The filter cartridge s not be removed un ass provisions era ma e c
retain solids in the tank that may slough off the isiter when removed from its enclosure. If the
Tabio 3: Maintenance ~cne~au~e
~~..~... -ra„U Inars~Ct speller service Once eV 3 e~r8
Mound SystQrn Management Plan Page ~• of i
Pursuant to Camm 83.54, Wis. Adm. Code
s
ghe septic tank Bhall oe maintained by 3n indivtdua! cart~fied to ecru{ca septic tanks u~tcter s. 28t.a8., Stets. the cpntents of the
steptk tank shall Ise dtaposed of in accordance with NR t 13, W is. Adm. Code. The aCeradnq cerditicn of the eeptic tank and
outtet niter shaft tx asarxsaed at ieaat once every ~ years fay lnapect(vn. The outlet flier ahafl t7e leaned as neceaaary to
gnsurR proper operation. 'the f:ttar cti:`~idge t;nould not be removed unlaas provi3ians era made to retain soiida in the tank thar
may slough oft die flttee when romovad from its enctosure. rf the filter to eouipped with an viarm, the titter tt4all be ssntcad it
the alarm la acdveted continuously. intermittent filter alarrne mtay indicate surge ffowa or an impending condrwo-1s alarm, The
acetic tank ahsdl have its content: remavsd whRn >ctia veiurrw of atudge and scum In the tank exceeds 1!3 the Prgr:ld vo~ma of
the tank. !f the gonUlnts of the tank are not removed at the time of a tfienniat aaeasament, maintenance ReraanMl ahafl edvlse
the owner of when tt'te next service needs to be Ps~rmed ba maintain lees than metdraum st'.tro and aiudg' accurnulWion In
the Leask. The addldon of bbloglcal or Chemical additives tr7 enhance saptk tank pe+formance la genertdly not required.
Nowwwsr, K stx~i prOdr„iGti era used they:hap f» approved for septic tank use by the 17epartment of Commerce. 3afaty and
Sulldlnpe Division.
e~doainp) tank abaft be inapaoted at least once ever, 3 years. All awbchea, atanrte, any pumps shall he tasted to
verify proper opetatlon. Kan effluent flltsr a inataltsd within the tank it sttialt be tnaps3cted and aeroiced as necessary,
n
o trees or should he planted en the mound. Plantings may be mede around the mound`s perimeter, and the rnouad
ahttN be seeded and mulched as nscesaery to prevent eroalon Rrtd to pryvide Lorne prbteCdOn from'rost penetratken. 7rahic
[Cther then for vegetative maintenance} on trw mound ie not recommended line soil compectlon may hinder aeration of the
inR(t; attve surface within ~ttes mound and snow compeCticn in the winter will promote frgat penetration. Loki rveatts~
Instagaaons tOctobeaRebruary) dtetate that the mound be heavtty mu{shed for frost prAteotlon.
{nfluerrt quality Into the mound ayntern may not exceed 22Q mglL 6t7p5, t if<3 mgti 1'S$, and 80 mp/L FOCI. influent low may
not exCe~1 max~+tum deaigrs Bow sprcifled in the permit ivr this tnetallation.
'the pressure tltstr~-utton sytrtem N provide4 kith a flushing point at the and of each taters{i, and it 13 recommended that each
lateral be ftuahed of aCaumuiatad sotida at Isaat once every 18 months. When a pressure teat ie perbrrrted it should be
compared k{3 the inftlal :eat when the system was Installed to determine i<orHtce lopping has xcurred and i° orifice Ctsanin~ is
resqutrod t4 maintain equal dlatributbn wtthln the dispersal oelt.
Qtialrvtltl0n pipes Mrlthin the dtspersai Cell atsalt ba otseCkad for eMuent parading. Pending ievela shall pe reported tq the gwr;er.
and any levels above 4 inches eonsldered u an lmpendlnQ hydreu4c fopuro requiring t+ddtelonal, mare nequant w{onttorlnQ.
tam shall be oporated in accordance with Comm 524 Wla. Adm. Gods, and shelf malntalned in accordance with its'
catnpanent manual [ggp.1 pST3~ (ii. 8f99)] and boa! or state rules pertaining to ayatem tnairrtenance and maintenarw~e
~.
Na one should ever enter a septic or pump tank since dengeroue Qasea trtay be present that could cause death. Sepae and
pump bnk abandonment shall tea to accordance with Comm 83.33, Wis. Adm. Coda when the tanks are no longer used as
POWT$ components.
Septic or pump tank man.'sole risers, aet:esa ~tur+ and eovera should be Mepeeted fog water tlghtnesa and soundnest• Access
apenirega used for tterv{oe and asaeament shall be salad wetertiQht upon the completion of service. Any openir~ deemed
unsound, defacct+vve, or subject to failure mwt be replaced tatpoaed eccasa openirtpa greater titan 8-inches In diameter shall
be ibCUfed by en etreCtlve lar~dng devlt:a to prevent accidental or unziuthorized entry ink a tank or component.
Co~~~aertCV Man
if ttse aeptlC tank or any of its components became detect(ve the tank or component shalt be ropairea or roplaceG to keep ttse
syatern In propor operatirp condit4on.
if the doaireg tank, pump, pump controls, alarm ar related wiring beccmea defect[ve ttse dafsetive component shall be
immediatey repaired or replaced with s component c! the carne Or equal pedormant:e.
it the mound aomparsent fatly 6o accept wastewater or laepina to discharg! wastewater to the Around aurfacs, tt will to nps:rea
or rtiptacad Mt lie' preDttent loca{tlon by lnortastrrq t~sel area K hoe Ivalwpa actor: or by removirwp biolopitApy Cropped adsatptbn
and dtepersat melts, and rotated piping, and rs~acinfl said components as Cetrrned neceaaery to bdnp the system Urto proper
operatlrss conditbn.
Questions on the aperatwon or >naintenanCe of t:his~apetem shoul4 be .
directed to tltc County Zoning office at `1 t5-~~ab- X1680 or t:o the
lfcenaed plumber whQ instal7.ed the system,
.,
tvtanaQrment Plan far a Septic Tank and Soil Absorption Con~ponerrt
Ptentinpe of disQ-ros~d !na and shrubo direcNy owr of within t~a-4 teat of tho camPo~t
aha~ld 1» evaded since root intrusion into the oornpontttt r+tay obstruct Wtastewater flow.
Cantinpency Pian
lt1 tt~e even of system failure, a new system Could be iMtalled in Sn altarl'tata area. With the
instsilatian o! i dlwrter vaiva, the ewatinp system could also ba reused sf#er a period of three to
tour gran.
it fa ttte property ovrmers responsibility to maintrln the alternate area free from any planting of
trees, ehr~bs, etc. En cue of failure of the arlpinal system, the aiterrwu area will be needed. !f
arty trees, shrubs, etc. !rave bran planted art the alternate area, they wilt haw to be removed at
property owner axpenee.
if alternate area is destroyed, there are other altematlw systems that aar+ be used, in whicly,
oo,uld tool! in added exparlN to the property owner.
rer~ this oode~ p a~iN~cc~tas~ Your iloo.i Zasti Oftlloe or cot~tiatdthe EnatallpnA Piu rte. 8
ST CROIX COUN'T'Y
SEPTIC TANK DANCE AGREEMENT
•~AND
OWNERSHIP CERTIFICATION FORM
~wnerBuyer ~.~/I~L.. ~. AI~ND ~ A- ~. L~-!~6
Viailing Address ~~7 /~oRT?~} SMo~E ~~V+L~ ~~sT- ~ ~y ~~
?roperty Address - _ ~~/l /~~J~,~~' cs.~~~o.r C~
(Vcrificatioa required from Planning Department for new construction] ~
amity/State ~A~Id~ ~ Parcel Idenlif cation Number O ~ ~ ~ i OQR3 -41 ~ Om
LEGAL DESCRIPTION
E'roperty Location ~.'/., ,~'~'/., Sec. ~~ . T,~_N-R~_W, Town of ~~4/yV~1D1~1Q _.
Subdivision ~ .~J4`J'W~ ~/~$ .Lot # ~.
Certified Survey Map # ,Volume ? .Page # ~
Warranty Deed # ,Volume ,Page #
Spec house ^ yes ®. no Lit lines identifiable )~ yes ^ no
SYSTEM MAINTENANCE
Improper use and maintenanceof yo«r septic system could result in its premature failure to handle wastes. Proper malntenattce
consisb of pumping out the septic tank every three years or sooner. if needed by a licensed pumper. What you put into the system
can aflcct the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agcGes to submit to St. Croix Zoning Department a certification form, signed by the owner aad by a
masttrplumber,]ourneyman plumber, restricted plumber or a lice~ued pumper verifying that (1) the on-site wastewaterdisposal system
is is proper operating condition and/or (2} a fter inspection aad pumping (if necessary}, the septic tank is less than l/3 full of sludgy
I/we, the undersigned have Head the above requirements and agree to maintain We private sewage disposal system with the standards
set forth, herein, as set by the Department of Conunerce and the Departineirt of Natvral Resources, State of Wisconsin. Certificatioa
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da the three ear exp' ~ data. ~
~. ~ ~~ fb 1~~1~~
SIGNATURE OF APPLICAN DATE
OWNER CERTIFICATION
I (wc) certify that all statements on this form are true to the best of my (our) knowledge. I (we} am (are) the owners} of
operty described above, by v' of a warranly dee r ded iu Register of Deeds Office.
~~ DATE
SIGNATURE OF APPLIC
««ss««
•s~af s Any information that is mis-represented may result in flit sanitary permit being revoked by the Zoning Department.
•« Iaclude Frith this application: a stamped warranty deed frocu the Register of Deeds office
a copy of the certified survey map if reference is made in the warraaty deed
• S'l'AI'E BAK O1~ WISCONSIN FORM 1 - 1998
• wAlitznN•rY DcI:D
bocurnanl Number
This Deeci, made between Ronald C . Bonte and
_- ___-~~_Dine M.`Bonte-______
---- - ---- ------, Crantor,
ar,rl Daniel $. Kling and Debra M. Kling,
husband and wife, as survivorship
marital property
_ Grantee.
Grantor, for a valuable consideration, conveys to Crantee the following
described real estate in - St . Cr~~ County, Slate of Wisconsin
(the 'Property"):
Part of the NE ~ of the NW ~• of Section 16,
Township 29 North, Range 17 West, in the
Township of Hammond, St. Croix County,
Wisconsin, described as follows:
Lo of Pheasant Hills filed May 5th,
2000 in Volume , a 6, Document
#622544
To~ethcr with all appw•tenant rights, UUe and Interests.
Dine M. Bonte
Grantor warrants that the title to the Property Is good, Indefeasible In fee shnple and free and clear of encumbrances except
Easements, licenses, zoning ordinances, and restrictions of record
Dated this 30th day of Ma
~~ ~ • ~~~~ (SEAL)
(SEAL)
f Ronald C. Bonte
(SEAL}
AUTHENTICATION
Signature(s)
authcnllcated This day of ,
._
"I'11'LL': MEMBER STATE BAR OF WISCONSIN ~~ttruurtr,~
(If not. .~` ~NI ~... Rq/Id,~.'~,-
iierouliny Area
Name and Relurn Address
01 8-1 083-41 -000
Parcel Idenlilicallon Number (PIN)
Ttrts iS not homestead property.
(is) (is nol)
ACKNOWLEDGMENT
(SEAL)
State of Wisconsin,
ss.
St CrOi X County.
Personally came before me lids "30th day of
May , 2 0 01 ,fire above named
Rona on e
- Dine M. Bonte
_ _ to
04/05/200: 11:25 i7153'r782oo
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MID4IEST BANKEJ~S TRUS_
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PAGE 06
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UNPL A T TED LANDS
_ _ _ _ _ NORTH C ! NE OF THE NW / iq
° 36' O I " E 2644. 72' (TO NE COR. PL_A T) _ _ - - ~ -
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DEDICATED TO THE PUBLIC - - - - ----- - -_._
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877. 88~® I _ -----®348.20' -----------0, 66.00' ~ '
N89 ° 55' 16" E / 793.2 7 $
TO BEG. OF CUR VE) - ~ o ~ I
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o LOT 42 ~ LOT 4 ! "'!
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~ 112, l38 SQ. FT, 2. 99 ACRES
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HIGH WATER ~ '
EL EV, - 1044, 00'-~~' 1
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OT 40
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