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HomeMy WebLinkAbout018-1083-45-000/* YWso«~n°epattrrtera°fc°"'r'ne`°8 PRIVATE SEWAGE SYSTEM m+"tr~ • ' ~~~~ ~~ INSPECTION REPORT t. Crolx GENERAL INFORMATION (ATTACH TO PERMIT) sanitary Permit Pto.: Personal irttortrration you prvvice maybe used for seowxfary purposes [Privacy Law, s.15.04 (1Nm11. 84285 Bo V y~ Permit H er i Name: City Vi a Town o schatz Cath Hammond Township CST 8M E ev.: Insp. 8M E ev.: BM Description: ' 9S So' c ST gw~i'` z- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic .Q_t.7~t~ cR~D ~(os-p Dosing ~7 Aeration Holding TANKSETBACK INFORMATION TANKTO P/L WELL BLOG_ vent to AiTlntake ROAD Septic 3D ~. 3-0 ` NA Dosing cc ~ i ~- .... ~ ` NA Aeration NA Holding PUMP /SIPHON INFORMATION _ Manufacturer ~ C Model Number -p TDH Lift ~D Friction System TOH Forcemain Length 5flr Dia. Fib„ µ Oist.ToWell SOIL A~H~TION SYSTEM ~j S ~ ~,n,,,,,,, GPMI Ft ELEVATION DATA 8-1083-45-000 STATION BS HI FS ELEV. Benchmark~Z ~Z,.o3 ~ ~-, S-p BM Bldg. Sewer (', ~•~ ~S-; $3 ` St/Ht Inlet 12.30 QS Z3 r St/ Ht Outlet ~-- _---- Dt lntet -. ~--~ of Bottom lb. b 9r• s31 Header /Man. ~ '4~ 9°i, a-$' Oist. Pipe . 9 ~ •.rb Bot. System • 3L 9 , io , . z 9g. • Y3 Final Grade }-zp ~.zo lao. z~ .a> over ~ _~, 9 , gb ' ENCH idth Leo h o. f Tenches PIT No.Of Pits inside Oia. Liquid Dept IM ~ ?i• _ 2- OIMEN I N SYSTEM TO P/l BLDG WELL LAKE/STREAM LEACHING a" ~gture~~`~ SETBACK INFORMATION ype o , 1 \ --- CHAMBER M e Num er: ~~~ ~ S r yrtem• ~ J - OR UNIT - a.u, DISTRIBUTION SYSTEM U'{oGa..~i ~•~ 'r- ~ v Header / Mani o) tl Dirtribtrtion Pipe(s) ~ x Hole Size x Hole Spacing Vent To Air Iniak length ~ Oia.~ I Length Dia. Spau SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Oepth Over Oepth Over I xx Oepth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes Q No COMMENTS' (Ifn-cnludecode-di'scyrepancies,personspresentJ,~3ti~ction #1: OS/off/ 01 Inspection #2: `-/--- Location: 981 170th Street, Hammond, WI 54015 (NW 1/4 NW 1/4 16 T29N R17W) -16 91761~7~Pheasant Hills -Lot 45 ~ 1.) Alt BM Description = ~ '"^~ 2.) Bldg sewer length = - 's81 ~. ~,~ °1.32 ~ =~9 -amount of cover= ~'~s"~'`l~r-P® ~t,~.esSer~~- a~,`D ~•Zo Plan revision required? ^ o ~~ SU~~r side fpf addgiti~o~ 'forma. 10 (RK315'971 J ~ ~'~/~ - Oate 1"spedo~ s Signature Cert N< ~"' fig' 2`'t` +1 hy~QI~W-r~A.f7lJ~-- _-a,~ f~a.A- ~~ti ~~~~~ ~I I', ~ `s ~ St „'~^^ ~ ~/ ~'~+~. C.h. P ( the Coanh only) tar the system on paper not less than 81/2 a 11 inches in she w ~ ~.G .~ ;SBDy6398 (R. 05!01) ~~~ ~~~+~.~~~``"'~- _ Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 S'T ~ o , ` ~,S'COns',~ Madison, WI 53707 - 7162 Site ~eldress Department of Commerce / y'~l ~~ ST• ~~ Sanitary Permit Application Sanitary~PeQrm' NumbeC~ ~~`~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ~-"' ^ Check if Revision ma be used for seco ses Privac I,aw, s15. 1 m '"' I. Application Information -Please Print All Information ~ ``:~ ~, :;_ `, ' = ! r ~~,._,._.._.. ~-..,~ 1 rate Plan I.D. Number Property Owner's Name ,~`-,,! }r- ". ,r" ~'~w~g'S~'x,, Number l b . ~ !~ . (~j . (' l ~ , ~° ~ ~ s. Z ~e :~'.:~"~~~~ ~: i - D ~3 - 1't'S- -moo O Property Owner's M fling Address ~ ~ ~. F ~ ~ t Pr w Location ~ nn c3 7 S~ .:~ ~ 6 ~ St ~ ~ ~~53 ° .fJ~ '.6; S %G T o1 ~ N, R/ E City, State Zip Code hei>~Number~yp~. ber Block Number ~~ ZOPJFNfsOFFlir~ `~ ~ .~ ,~ ,,., ~~ ~ ~ t 'vision Name CSM Number `~ ~ 6..J ,~''Yd % G d ,~ '' a asa.,u ~ ' l S II. Type of Building (check all that apply) / a4S ~ S .., rw ^City i or 2 Family Dwelling -Number of Bedrooms 3 Int-•;r,.e.. ~5• ^Village ^ Public/Commercial -Describe Use N ~Tovmshi 11 ~ p ^ State Owned Q1 ~ -~ ~ (~ ~ ~/ -• `-i'S~ b0 d Nearest Road I(o• 2 . l`~. (01~' lTo7`dt 5T~ III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A• 1 New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Onl Existin S stem B• ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued ~ IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ~,, A 44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland /~',.Apll~ l~_ 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line ~ . 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other ~ ~ Y. Dis ersal/Treatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate stem Ele 'on Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) T/ i~a~.2 vation ~a,~,2 ti'So 9~~ ~~'~ ~ S ,r~~. .~ sd/. ~~ a rD3 ~ VI. Tank Info Capacity in .Total Number Manufacturer Pre Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ ~ ' B t' ~/ Dosing Chamber VII. Responsibility Statement- I, the undersigned, asstnne responsiblHty for tlon of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number ,.`lam sG mml/ - / o? ~9 ~ 71S-3~G-3/0?l Phnnber's Address (Street, City, State, Zip Code) 7 S al .v D/ ~ VIII. Coun !De artment Use Onl Approved ^ Disapproved ~~Y Permit Fee (includes Groundwater Date Issued I Agent Signature (No Stamps) ^ Owner Given Initial Adverse Surcharge Fee) ~ ~ ZZS-.. Z~ - Determination ~ 1 ~ IX. Conditions of ApprovaUR easons for Disapproval _ .. ll (( ~• n ~s~ v~S~' ~ tWy,p~ G- C,l1MS• VCR..a.~A~ l ~j `iv~.Kit4 I hr.{-i,~i~rvo~e~p v~~" G.v~-- ~~~c-:~~Q .Y-~ `~-~no~. 2.~' ~ ~uT- ~',~,",Q`"~" D C.6.ti~~ ` e.-~~,N, 5 w~ce. ~ t~^a :s ~as~vx~e~e.lc w -~- s - ~o.e 6 ;` ~Y~a ~-E- ~~ 3b ~ d _ . _ . x. ~.s PD'' j'_~~/ 8n ~ c~ 5G ~i c~c J Z ~ e ~ ~ ~ .c~/~ e a ~ a .u 7" ~~ /l ~~ ~.~.c/ e tom' ~ei ~ nc o.v ,fdnLi ~ot`pee 16d ° //~ Z ~--7-- - - ~, ~ ~r~ ~ Yct 7`~ ~Y Brs ~ g Sc ~ c~: l 2 1. a ?~ 5~ .~/~ e a ~ o -u ~ ~~ /l ~° ~.~.c/ d N"J ~i`a. ,~ roc o.v o~ ~c v L e' l ' ~SG- ~~ ~ a ~,~P ~ i6~ p ~ ' ~r /_ ~~~ C ~~_ ,t7r, ue ~G~ 4 ~.- c~' ~' S \~ i~ ~ ~~ ~ ~ ~ ~ ~ `~ ' / ~~~~Z" ~~ ~~_ -__ ~,my 83 ~ ~~ b• ~r~ Z ~,cj,1s /off. ~ '~ a -3x 9y 1yc ~~ s ~ ~/. ~,"~ ~ ~ 8y ~ ~~ ' B ~ s,~~~cv~'~~~e''cdo~-ba~ ~~,~~~y9o, ~l ~a~ Vt'~'consin Department of Commerce IL AND SITE EVALUATION Page 1 of 3 ~' Division of Safety and Buildings ORIG~Niord 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 (BM), direction and St. Cr0tx percent slope, scale or dimemsions, north arfsw;'and~loc'~Itieq.,and distance to nearest road. Parcel LD.# APPLICANT INFORMATION -,r; lease pra' tall infor,?n~ation. Personal information you provide may be ysed for seco0.dary"~rpos„gs (Privacy C@w, s. 15.04 (1) (m)). Reviewed By Date Property Owner ?`' -=~ ,... Property Location Bonte, Ron ~ ,, ,, „:, y --- ~ Govt. Lot NW 1/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address -' '~ Lot # Block # Subd. Name or CSM# 1011 170th St. sT Gwa+x ~-'~~:~~ 45 Pheasant Hills , ~~.~_, City State Zip Code: ~AhoneNurrrber ^ City n^ Village ®Town Nearest Road d 170Th St H Hammond WL. 54015 715-796-5240 . ammon New Construction Number of bedrooms 3 ^Addition to existing building ~ Residential / __ Replacement , Use: ^ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ft2 •4 trench, gpolftZ Absorption area required 1500 bed, ftZ 1125 trench, ftZ Maximum design loading rate •5 bed, gpd/ft2 •6 trench, gpolft' Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar Additional design I site considerations 'nstall 2 - 5' x 112.5' shallow trenches on contours for 3 br Parent material till 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# 30 Ground elev 103.6 ft Depth to ~ ply limiting ~-factor Z`~bb > 76" 2_ r Ground elev Depth to limiting 2`~~0° factor > 65" H i Depth Dominant Color Mottles T t Structure Consistenc Bounda Roots GPDIftz or zon in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed ~ Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-12 7.SYR 2.5/1 - sl 2 m sbk mvfr gs if .5 .6 3 12-26 7.SYR 4/4 - sl 2 m sbk mfr gs if _.5 .6 4 26-36 7.SYR 4/4 - sl 2 m sbk ds cs 1 m .5 .6 5 36-44 7.SYR 4/4 - Is 0 sg dl cs Im .7 .8 6 44-58 l OYR 6/4 - fs 0 sg dl cs - .5 .6 7 58-68 l OYR 4/6 - s 0 sg dl as - .7 .8 Remarks: 625-76 SYK 4/4 SI (U, m, dh); occasional gr Xc cob in horizon 4; considerable gr m honzon 5; some gr rtc cob m nonzon / 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-19 7.SYR 2.5/1 - sl 2 f-m sbk mvfr gs if .5 .6 3 19-56 7.SYR 4/4 - sl 2 m sbk mvfr cs - .5 .6 4 56-59 7.SYR 3/4 - is 0 sg ml cs - .7 .8 5 59-65 lOYR 4/6 - s 0 sg ml - - .7 .8 SST Name (Please Print) Signature: Telephone No. Henry F. Grote ~ 715-665-2681 4ddress erti ie of esting D to CST Number Ref # P.O Box 57, Knapp, WI 54749 415/2000 222774 1056 Remarks: gr d'c con to horizon ~ PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT ~ Page 2 of^• 3 PARCEL LD.# ~ Certified Soil Testing Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPDIftz Bed Trench I 0-5 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 5-21 7.SYR 2.5/1 - sl 2 f sbk mvfr cs if .5 .6 3 21-33 7.SYR 4/3 - sl 2 m sbk mvfr gs - .5 .6 4 33-46 7.SYR 4/4 - sl 2 m sbk mvfr gs - .5 ---- .6 5 46-58 7.SYR 4/4 - sl 1 c abk mvfr gs - .4 I .5 6 58-65 7.SYR 4/4 - sl -~ 0 m _--~. mvfr - - .3 .4 rtemancs: 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-14 7.SYR 2.5/1 - sl 2 f sbk mvfr cs 1 f .S ~ .6 3 14-28 7.SYR 4/3 - sl 2 m sbk mvfr gs if .5 .6 4 28-40 7.SYR 4/4 - sl 2 m sbk mvfr gs if .5 .6 5 40-52 7.SYR 4/4 - sl 0 m mvfr cw 1 f .3 .4 6 52-65 l OYR 4/6 - is 0 sg dl - - .7 .8 I Keman<s: b.,.,.,.,,~..,.,.,,.... 1 _ 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 ~ .6 2 4-11 7.SYR 2.5/1 - sl 2 f-m sbk mvfr cs if .5 .6 3 11-16 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 4 16-22 7.SYR 4/4 - is 0 sg ml cw if .7 .8 5 22-28 l OYR 4/4,4/6 - s 0 sg dl cs - .7 .8 6 28-60 SYR 4/4 - sl 2 f-m sbk mvfr cs - .5 .6 7 60+ SSBR rcemancs:.,.,~ .,, Y., .. ., .... ................ ~W. ~, ..,..~.,.. „ ..~ .,.,,.,.,.,.,., .,, ... ~,~ ~ ~,,, ~~, ~~, ~c~y .r C ~~ _ ~ J ~a~e ~ h~ 3,d V u 281.E l~l~- Nw-~b-Z.4-1~w Q C vwN: ~Aw VKO tifT `4.4~.r~, 318.3! C ~ ms ~b--~~-j'^ Cy~i 1'~ - } o~.b~ ~-~ 'S~• r----- .._-~' 345 ~- - i ~~ ~3K ~~ nom, N~ ;~oN ~~t°.~~ Q ~Oa.L1t~d2 :F a • 4~.~i~i+~1:'1- ~Q•v 3 ~~ 3 . vt'i"0~ Z1'L "}} 4. • ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT •-AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~cCfj v c a-r'.z ~-~,G~ Mailing Address Property Address ~~j 4 ~~ -~ ~ (Verification required from Planning Department for new construction) City/State Parcel Identification Number ~ l ~ ' ~d ~3 ~ y`~l ~ ff ~ LEGAL DESCRIPTION Location ~ -'/,, / '/., Sec. % ~ . T=2~N-Rf ~_W, Town of f~~z s~ ~~ ~~ . Property ~ Lot # ~• Subdivision ~~ ~ a ~' ~ ~ 1" ~~ i!s° Certified Survey Map # ,Volume , Page # Warranty Deed # ~'l x''33 Y ,Volume f~3~ ,Page # ~ Lot lines identifiable ,~ yes ^ no Spec house ^ yes .~ no SYSTEM MATNTIJNANCE Improper use and maintenance of your septic system could result in its premature failure to handle~waasteou P ~ ~~ ~~ sy~m consists of pumping out the septic tank every three years*or sooner, if needed by a licensed pumpe • y P can affect We function of the septic tank as a treatment stage in We waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owners bem mastorplumber, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdispo yst 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 We above requirements and agree to maintain the Private sewage dispoe of Wisconsin. Certiflcah ° set forth, herein, as set by We Department of Conunerce and We Departrent of Natural Resources, Office ~~ 30 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. r' DATE SIGNA OF APP CANT OWNER CERTII+'ICATION I (we) certify Wat all statements on this form are true to the best of my (our) knowledge. I (we) am (are) We owner(s) o We property described above, by virtue of a warranty deed recorded iu Register of Deeds Office. /~ ~ ~' ~~ ~ DATE SIGNAT[AtE OF pt~rii%Aiv i v De artrnent. ****** ****** Any information that is mis-represented may result in the sanitary permit being revoked by We Zoning p ** Include with thls application: a stamped warranty deed from the Register of Deeds office a copy of We certified survey map if reference is made in We warranty deed -i Private t~nsite Wastewater Treatmont Systom Management Pian Septic Tank And Gravity in-Ground Soll Absoirption Component Pursuant to Comm 83.54 Wis. Adm. Cade each Private Onatte Wastewater Treatment System (POWYS) shall include Information and procedures far maintaining the system within the parameters of Comm $3 and 84, and the conel~m is for spptsm stay on file ata#heeeou went or governmental unit. Th8 approved plans and p Ys zoning or health department, Tuts management plan complies with Com ~ Wastewater TTree meat Syst ms SB[3~nd Solt Absorption Component Manual for Privets Ons i 0587-P (R.BI$g}. The septic tank shall be maintained by and i tainic shat be~d® posed of in accordance with under a. 281.48, Stets, The c+antentg of the sap c NR 113, W~• Adm. Code (Servicing Septic ar Halal egT ench® upnv~es~vr Portaiai Orease interceptors, Seepage Beds, Seepage Pits, Seep g Restroom~~. The operating condition of the septic tank ash cut~iet fi~ite~~ as nsr~ssary o etnsure once every 3 Years lay Inspection. The outlet fluor proper operation. Tt~e fitter cartridge should naf~ber when~emoved fromiitsaenc~osured f the retain solids in the tank that may slough oil the .. Management Flan for a Septic Tank and Soi! pnsorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated aantinunusly. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. Tha septic #ank shalt have its contents removed when the volume of scum and sludge in the tank exceeds 'I!3 the liquid volume of the tank. !f the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the own®r 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 c.°overs should be inspected far water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the carnplstrnn of service. Any opening deemed unsound, defective, ar 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 unauthor'~ed entry into the tank. ~o one should enter a septic or other treatment or ho/d1nQ tank for any reason without bs/ng do fu11 ca~mpllance w1d~ OSHA atandrrrds for entering a conflnod space. Tht- sfmosphan within the septic or other Treatment of holdlnQ tank maycontain Nthal yasaa, end rescue of a pe~ron from fhe interior of flee tank may ba +a-ftrAfe+ilf or Impoaaibte. Tank abandonment shall be in accordance with Comm 83.33, wig. Adrn. Gods when the tank is s~o longer used as a PpWTS component. ~#.l Abst3rt~®~~1J~Q~t9~ 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 Shawn in Table 2. Tha longevity of a soli absorption component depends greatly an proper and timely maintenance, and system use within or below the limits of reliable operation, Good water cortservatian practices by all occupants and the installation of water canaerving pltlmbing fixtures era key factors in extending th8 useful life of this component. Tha soil absorption component`s operation must be assessed by inspection at least onc~+ every three years. Tho inspection shall include recording the levels of ponding, if any, in the cabservation pipes, and a visual inspection for any evidence of surface seepage ar discharge from the carnponant, ©n steeply sloping sites, areas of erosion should be identified and reported to the owner far repair. The surface discharge of domestic wastewater ar sewage from the system is prohibited and considered a human health hazard, Traffic around or over the soli absorption component should be avoided partlcuiarly during vvlnter months. The rcmpaction ar removal of snow cover over the component may lead to hydraulic failure by freezing. This Type of failure is uauaily temporary, but is difficult or impossible to repair until werather condltians improve. !n general, soli 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 o! the soli. 2 ,~ .~ sVlanagamant Plan for a Saptia'fank and 8011 Absorptian Component Ptarztiirtga of deep-:c~otad !na and shrulu diraatly over oI within bM hrt of the corrtponrnt ~houid br avoided Ana root lntnubn into the CcrrtpoMrtt may abrtnut wat~wstsr !'low. Contingency Pisn !n tt+e want cf tytt.,n fallun, s nrw tyttam oou}d bs ln~lted in sn eitart"tatr ~. w}!h the initulatlon +N r dlvart•r va}vs, thr axi~nq tyttam could alto ba nutad attar s prriod of thrar to four yaart. k k t{~s proprrty owr~an ntpontibiiity to mairtsain thr s~tarr~sta arcs fns from any planting of tract, shnibr, aec. M cart of failures of the onppanal eystarrt, the atOtrr~abt ar+ta wilt ba naadrd. if any tnrt, ihn,tb•, etc. haw barn piantad drt th~- aftrmats area, they wilt ttn-s to br tarriawd at property ownan axpanta. if aitrrnetr uses t: danroyad, than ars other alt.:nsdve tyttams the an ba utad, in which, ooUid result in added sacprnp to the property owrtar. rsgatlin~q thi~cxsds, plants eon}trotyour ~ Zonir~ OtN}os ar cwt the Er»tallinpyplaumbar.: Sc ~ wha-~~~`ss y rp~ ~,. ~"~1~ i •~~t ~ ~G~ -- 3 f X2.1 STATE BAR OF WISCONSIN FORM 1 -x+1998 W YR~~~~~ ~ ED~Y6 Ibcument Number This Deed, made between Ronald C . Bonte and Dine M. Bonte Grantor, and Cathv R. Borgschatz Dine M. Bonte , Grantee. Grantor. for a valuable consideration, conveys to Grantee the following described real estate In St. CrOlX County. State of Wlsconsln (the 'Property`): Recording Area Name and Return Address Part of the NW ~ of the NW ~ of Section 16, Township 29 North, Range 17 West, in the Township of Hammond, St. Croix County, Wisconsin, described as follows: Lot of Pheasant Hills filed May 5th, 2000 in Volume 7, Page 86, Document # 622544 Parcel Wantiacation Number (PIN) Thts i8 ri0ittomestead property. (IS} (is not) Together with al! appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible In fee simple and tree and clear of encumbrances except Easements, licenses, zoning ordinances, and restrictions of record. Dated this ~,3~0~th~ day ot~A,,p_r,,i~l ~ 20n01 (f~ 6KeST~•.•"'c~` ~ ' ~~y ' vv~ (SEAL) X/ /J~O r KJL~~ (SEAL) Rop31d C. Bonte AUTHENTICATION Signature(s) authenticated this day of , (SEAL) THE FIRST NATIONAL SANK ~j OF 8AL'DWIN 990 Main St. Baldwin WI 54002 018-1083-45-000 ACKNOWLEDGMENT 64 4334 KATH!_EE4 H. WALSH kEGISTF.k OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECWID OS-02-2001 9:30 AM YARRANTY DEED EXEMPT q CERT COPY FEE: COPY fEE: TRANSFER FEE: 1+0.70 RECORDING fEE: 10.00 RAGES: 1 (SEAL) State of Wlsconsln, ss. St. Croix County. Personally came before me this 3 0th day of Apr i 1 2 0 01 ,the above named Ronald C. Bonte Dine M. Bonte TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the peton who executed the foregoing authorized by §706.06, Wis. Stats.) Ins m t and acknow~sa, r~e~_~ THIS INSTRUMENT WAS DRAFTED BY r : ` "' ~ ., ' ,,..`.,~_ (~\c~"-~ ~. . Ronald C. Bonte, 1011 170th,.~~Y.'e~,. `~'•.~~.'; ~ J Hammond, WI 54015 :'~ • ° '~~ J ~: ~1y ~o i (Signatures may be authenUCaced or acknowledgd' r rt ~~t, ~ necessary) ,~ ~~' •' • Names of persons signing In any capacity must be typed or printed below thek stgnaturc.~`~ STATB BAR OF WISCONSIN WARRANTY DEED FORM No. t - t99H I- J~~ = lam" ~--n ~ ie S i LF'r) Public, State of Wlsconsln mmisslon is permanent. {If not, s expiration date: ~,., , a„t>t;c-State of W~ ~ ~ Fjtptres ~''.' ~DD2 . .) Wisconsin Legal blank t:n.. Ifw. MihewkN, wU. P H ~ ~.fi AI V ! L~ l-~~~ } . L OCA ~ ED I N 7HE NE t i4 OF THE N;~l t i4, S E t i4 JF THE NW t i4 AND PART OF THE SW t i4 OF 7HE N1V t i4. AND PART OF THE NUrr t ~4 CAF ThtE NW t i4, A~. E { N SEC T t OJ'J ~91V , T R. ! TW. , TDWN OF t-tAMNiOND, . ST. . CROtX COUNTY, WISCONS 1N IOOt*t ALCM.E _ _ _ -_= -- i - - ^ 1 ~ _~ E T ~ pT 23 ~, ~~ ~~ 1 ~'~ ~~ /,. i ,.f ~' ;~ .~'' • ~' ~. ~ T ! ~ _~ _ m .o `~ F N ~ ~ 4 r~ c 1} t ~ t ia4r+o. txEic-e .t L t r Ot a ~, f, tM• • ft, r fK . Idr.r f/' wr.Orr l.pt T9 if.l1 } U7ft t Ti' EA$fREN; 7HE to> ~y ': -~ rt0 P0. f ~ R BuR : c :A8Lf5 ARE FO 8E P: ~~E: 3st++ `e+# F .,,E rxsr~LLATtfN! IOuiO Oty"GRB Aw+r SURVEY SrrufE. pt oesra.;cT Y+J':.N <Ot4G AMY LOT L lME QR 4TRFE T t rxE. d' Fi+f R 1 S tLRBttf~f OF 4 SG'RVE ~ STARE 8r .aAllr,`.sE r5 A Yd x 0 r ~ ~ ~ ~ 'ftSlGw 2313.3E t1f ~Y7SC7MStk S14TlTf5. JTr~i7Y fA5EME++': Oa «f~f Y ~ S£f FORTH ARE +:aN THE u5£ OF I;tat:C Bt)OtfS ~ha o4,vitf Jt,LIT'ES ~+4v~a., Thy RrE~r To sfav3: Ta tn£A. /`w LCT J5 v SNEE T ~ ~,B 2t-+ -.... -..,~~. ~- ~ ' -~ 4 "' -. t EGFKfl f - f p.Wp 7' 3RCIN P J.°E O Sf / 2' X7O' tRUlf P rPE ~ !:rf:ss 3.63 ces. P£R ~rx£dR soor xaFE= sir t'zN- tRQM vrPE rfr:,t.+~ 7. t3 t9S_ PER L tkf.ai fOOT 4T AL! 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FT. .~ rn '~ I 33.01 3 / 1.99' I N89 ° O I' 3 7" W ACCESS EASEMENT ~ I------__~-__~-__~~__~--------T- I I I I I I I 1 I i o~ I 1 o, I ~' I I I w I 1 •1 I ~1 1 I _~ I w UNPL A T TED I ~~ I ....... 1 1 I ^'_ I 1 LANDS .................. 1 I I INER ~Np 1 1 1 >.ENT ORAf TED BY J 1 M WEBER Ne N ~ ~ ~ o W 0 m ~ N W EXISTING 66' WIDE EASEII~I~(T I N VOL /~V ~ PAGE YY~ ® .a 3I9. 68' m ; 664. 68' ~, I 1 ----' CER T 1 F 1 ED - -- ............................. -fi- i ..VOL., 14 I LOT 1 '~~"` I SURVEY ( PAGE 3 783 ....................... MAP