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Home My WebLink About014-1054-70-000 0 y 0 3 v n d A V n 9 T cn3 zT.v, z °w� 3 o m 0 O o o n ° y w r ° M 0 0 3 m N N O d D) O O O O O O y ° R 3 a o ° °° O i y m d I su tnzD ,� a�j m cp O m CL v o W c° OL 00 0O V o _ (� C L o o \' z ! I ° c m o t ,a c a ' 3 .. c S 000 -! °'• z 1 7 I 3 to to CA 0 1 D _ - r ( o v v S (D CD ! � l �Zi I Z . o z W z c � lei 0 Er I G a m y N 0 co 7. O C C CD m a a O N n A m a A cn I w rn O W � (� m M CD W 0 CL }� I CD o c q CD I d O v cr N m m a � C> " N ° o CD do a m En O .. p Parcel #: 014 - 1054 -70 -000 09/05/2006 04:26 PM PAGE 1 OF 1 Alt. Parcel #: 26.31.15.407A 014 - TOWN OF FOREST Current X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner RICHARD W & DONNETTE M STEINBERGER O - STEINBERGER, RICHARD W & DONNETTE M 1969 CTY RD P GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1969 CTY RD P SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A -NOT AVAILABLE SEC 26 T31 R1 5W N112 SW NW EXC HWY Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26-31N-15W I Notes: Parcel History: Date Doc # Vol /Page Type 10/08/1999 611834 1462/237 TI 10/05/1999 611556 1461/233 TD 07/23/1997 QC 298494 456/463 WD 2006 SUMMARY sill #: Fair Market Value: Use Value Assessment Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 20,000 231,000 251,000 NO AGRICULTURAL G4 16.500 2,500 0 2,500 NO UNDEVELOPED G5 0.500 100 0 100 NO Totals for 2006: General Property 20.000 22,600 231,000 253,600 Woodland 0.000 0 0 Totals for 2005: General Property 20.000 22,600 231,000 253,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 516 Specials: User Special Code Category Amount i Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division 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.o4 (1)(m)]. 353173 Permit Holder's Name: ❑City [] Town Village ❑ .Town of: State Plan ID No.: Gbar fForest e nsp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand qtcover Model Number GPM TDH Lift Friction System TDH Ft H ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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: / / Inspection #2: Location: 1969 County Road P, Glenwood City, WI (SW1 /4, NW1 /4, Section 26 T31N -R15W) - 26.31.15.407A Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E . i ( l j E a .....„. «.p,s... g j W t 6 p r E 1 3 [ � i > m qq j y „�..,,,..., .e .. � �,.««».i }_.. -. ,, e .,. .,ee..... ,.� m .m}«« «.e. e } - ,e -¢•w. �...,m- �.,...,m® ®�} --.». .,., m em ..-.. E T q 6 y 3 Safety and Buildings Division ,- - SANITARY PERMIT APP �►iT /� 201 W. Washington Avenue �wisconsin -, �:, P 0 Box 7302 Department of Commerce In accord with ILHR 83.05, Wi ./A� ode c� ^� � `'�' Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste , o pa r no untyti? than 8 v2 x 11 inches in size. �� „''� . _ I - • See reverse side for instructions for completing this applicati 3* 7 State SOmt ry Permit Number �ax, 9 ; .. a Personal information you provide may be used for secondary purposes �, <iiy M 3 ,5 7'3 l y k` revision to previous application lPrivacy Law, s. 15.04 (1) (m)]. ❑ CFc �� / S�4 Pl n I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFO r - _ ' ' . Property �Owner Name , e L cat orb:% i d i e �j114 ,S 6 T 2,/ , N, R/ »A1W Propert Owner � 's Mailing ess, Lot Number Block Nu mber City, State C/YA r p/ Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C ity I Nearest Road / p Village /:—d � ��r Public 1 or 2 Family Dwelling - No. of bedroom Town OF /� C:• III BUILDING USE (If building type is public, chec a a ply) rcel Tax Number(s) 1 A Ap artment/ ❑ p / 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) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4_ jV Reconnection of 5 ❑ Repair of an System S�rstemTank Only Existing System Existing System 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 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit r _ 43 ❑ Vault Privy 14 ❑ System -In -Fill J �K VI. ABSORPTION SYSTE I MA Capaciit TZO : fiiVB 1. Gallons Per Day 2. A sore. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Pro osed (sq. ft.) (Gal q. ft.) (Min. /inch) c7 Elevation .-5 p l -J' / Feet Feet VII. TANK in gallo Total # of Prefab. Site Fiber- Exper_ INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Exist in structed Tanks Tanks Septic Tank or Holding Tank d�jj jy,� f' ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's S'gnature: (No S mps) MP/MMl" No.: Business Phone Number: G /_ e Sri 7`h �ltJ Plumber's Address (Street, City, State, Zip Code): _ 3 l� C eq D IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved anitary Permit Fee (Inc odes Groundwater D ate Issued Issuing Agent Signat re (No Stamps) Approved [I Owner Given Initial Surcharge Fee) Adverse Determination S• X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 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 installation o, 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 - 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. 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 appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Co %Vlete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic 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; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) 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. i _ _ k Al v -- - ° r- PA - -- of - c ZP _- - - - -- - -- - - - ANd s -. y - - - -- - -` - ---� -- - - - I - i— ff I 4 1 � i I ' i WisconsirrDepartment of Industry SOIL N6� EX( $CTE >�L TION Labor and Human Relations > Page of Division of Safety and Buildings in accord*6 with *&LHR 8 is. Attach complete site plan on paper not less than 8 1/2 x 11 incties W size. Plan must 6 mnty include, but not limited to: vertical and horizontal reference poi 11413M), dijj��A on gnt 1999 / percent slope, scale or dimensions, north arrow, and location a tfdistand8 to Se 0 t3Td. cel I.D. # CoutNTY , APPLICANT INFORMATION - Please p rint all info onZQNINGo` :FICF e� by D , 7oDate d P '" ## . Personal information you provide may be used for secondary purposes (Privacy W,.. (' r � Property Owner JEdpdopLWcation e / Govt. Lot s,/ 1/4 A14114,S,;�, T3 J ,N,R 4W W Pro erty k# S Owner's Mailing Address Lot # Blocubd. Name or CSM# M d _ — City State Zip Code Phone Numb /er. %%�� Nearest Road ��G W00 �/ 44 D.(� (9�� )R= /O� ❑City ❑Villa Village To Coi ❑ New Construction Use: Residential / Number of bedrooms - .J? Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow �,�/ �,.g �S-0 Recommended design loading rate bed, gpd/ft gpd/ft Absorption area required j1 ft ft Maximum design loading rate i bed, 9pd/fi trench, 9Pd/fi Recommended infiltration surface elevation(s) �.1 . 7 ft (as referred to site plan benchmark) Additional design/site considerations ,� / Parent material G'f- / 4 L t/� G /Y Flood plain elevation, if applicable d ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S El X1 S El [V S❑ U ® S El U ❑ S 0 U Lis W U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu, Sz, Cont. Color Gr, Sz. Sh. Bed , Trench 1 o- /o YN PA SI 1 M 56 e s 3M /b S,4 amW Mr-2: CE S Ground VS Y - S LR a M A 6 , �e ; (, Depth to limiting factor Remarks: Boring # [3 Ground elev. ft. Depth to limiting factor in. Remarks: CST Name (Please Print) natu „ Telephone No. Address Date CST Number w o �eN � oo�C ��- �v' o/ - -1 _ �P :2 2 SOIL DESCRIPTION REPORT ' PROPERTY OWNER Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ,M x: Ground elev. ft. ' Depth to limiting factor Remarks: Boring # :, . Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; « v 1 115, son= Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in ' Remarks: I SBDW -8330 (R. 08/95) Al - i J , i - - - - - - . - -1 - -- - - -- - - -- - - - -� -- -- - i I- I i� I I I I - - -- I I I I-A LJ - -- -.. - -- L -- - - - - - - -IJ I I I - i I _ I I JI I I 1 I i I I I I I I I I I 'a 1 i I i I l I ! l I I I I 1 - - -�- - - -- - - & oy - - - -- -- - ----- - --- -- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer R i- �oyun) Mailing Address ) 9 t ? 7 ( n C. L N ti,acxda Property Address 1 C,, IAA- P (Verification required from Planning Department for new construction) City /State (n t- T wa_ Parcel Identification Number C) f �/ - /OSY - 70 LEGAL DESCRIPTION Property Location .6k ' / a, A141 '/4, Sec. , T_Z1 N -R Town of Fv A . Subdivision i , Lot # Certified Survey Map # , Volume . Page # Warranty Deed # 6 l � d , Volume 6 Page # 3 Spec house ❑ yes W no Lot lines identifiable ❑ yes 14 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 masterplumber, 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 Office within 30 days of the three year expiration date. -Z- 6&�- 5j SIGNATURE OF ATIMICANT 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 owners) of the roperty desc'be d a ove, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF PLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** 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 VOL 1461 PAGE M STATE BAR OF WISCONSIN FORM 7 - 1998 G 1L 1556 TRUSTEE DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD Tamac H Gillman and -Bernard Curtis 10-05 -1999 12:45 PM TRUSTEES DEED as TrusteeSof EXEMPT M Gillman and Schur - tz Living Trust CERT COPY FEE: COPY FEE: TRANSFER FEE: 120.00 RECORDING FEE: 10.00 for a valuable consideration conveys without warranty to Richard W PAGES 1 Steinberger and Donnette M. Steinberger, husband and wife, as survivorship marital property Recording Area Grantee, the following described real estate in St • Croix County, Name and Return Address State of Wisconsin: 2 + li /1 57 e- i 114 C jc r N 2 of SW 4 of NW 4 7 Section 26-31-15, 1q? 7 Co 2IP P St. Croix County, Wisconsin. i- - Syo 3 014- 1054 -70 Parcel Identification Number•(PIN) i i I i- i! Dated this 0 - 5 day of October 1999 , (SEAL) X I (SEAL) James H. Gillman Bernard Curtis Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. County. Personally came before me this day of authenticated this day of _ October , 1999 , the above named James H. Gillman and BPrnarrl Curtis TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me nown to be the person _is _ who executed the foregoing authorized by §706.06, Wis. Stats.) i strument and knowledge the same. THIS INSTRUMENT WAS DRAFTED BY Bert D. Petersen, Attorney at Law N of Wisconsin C Lake , WI 54005 J0 permanent. (If not, state expiration date: a a be authen - -3 ( may hen tcated or acknowledged. Both are not �� , off ) necessary.) ut3 8 01 vvnivul Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. TRUSTEE'S DEED FORM No. 7 - 1998 Milwaukee, Wis.