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Home My WebLink About004-1010-80-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. TJoe:Miller older's Name: City Village Township TOWN OF CADY CST BM Elev: Insp. BM Elev. BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO PIL WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number I TDH Lift Friction Loss System Head TDH Ft Forcemain I Length IDia. I Dist to well SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: SAN-2018-327 State Plan ID No: Parcel Tax No: 004- 1 0 1 0-80-000 Section/Town/Range/Map No: 1 05.28.15.71 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet ISVI-It Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type Of System: PIL BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer. Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER Y o.dhaaaa n Awatimme Onh. YY Uniend Or Ot�rade Svstams Onto Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [g Yes Fw-] No 0 Yes Q No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 557 CTY RD NN 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover =- Plan revision Required? W Yes F15-1 No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3197) 4 �545867 Document Number Document Title,-,�",\ TX: 4452707 1072656 St. Croix County 13ETH PABST Non -Plumbing Sanitation A davit REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/11/2018 11:30 AM Name — (Owner) Typed or printed EXEMPT #: being duly sworn , states, under oath, that: REC FEE 30.00 COPY FEE 2.00 He/she is the owner of the following parcel of land located in St. PAGES: I Croix County, Wisconsin, recorded in Volume — Page Document Number/46IO&St. Croix County Register of DeedsOffiCC: Recording Area Name and RetuCnAddress ,To -C /1r A parcel of land located in part of the 5W 1/4 of the *4"J '/4 of Section �, e � '41 15 , T 2-$ N — R 15 W. Town of C�1 q -, St. Croix County, Wisconsin, being duly described as follo4s (include lot no. and subdivision/CSM or detailed legal description): 60ji - /6/6 y T6 Odo Parcel Identification Number (PIN) I . A new structure on this lot will be used as a habitable dwelling. Occupants of said structure utilize a pit privy for disposal of human waste, which was authorized by a non-plurnbing sanitation permit in compliance with Sections 12.A. Lg and , 12.3a.2 of the county sanitary ordinance. 2. The contents of the pit shall be disposed in accordance with NR 113, Wis. Adm. Code. 3. This agreement shall be binding on the owner, their heirs, assignees and/or land contract purchaser. I also acknowledge that I will disclose this information to any parties interested in purchasing this property in the future. Dated this %day of ___ __ AUTHENTICATION Signature(s) authenticated this _, _ _ day of _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not� authorized by § 706.06, Wis. Scats.) THIS INSTRUMENT WAS DRAFTED BY St. Croix County CDD Staff (Signatures may be authenticated or acknowledged. Both are not 1% ACKNOWLEDGMENT STATE OF WISCONSIN ) )SS. St. Croix County. Personally came before me this day of FF Fr C, 0 the tve named f1A Pt t 11 A A 11-z- to me'l&ovn -to the person(s) who executed the foregoing ins"95 t yin c-L-Vickriqw1e the same. fn N Notary Public, State of Wisconsin L4 My Commission is permancril. If not, state expiration date - Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMFST - DO NOT REMOVE" This information must be completed by submitter: docume nt title. name & return address and PIN (if required). Other information such as the granting clauses, leagal description, etc. may beplaced on thisfirst page of the document or may beplaced on additional pages of the document. Note.- Use ofthis cover page adds one page to your document and $2,00 to the recording Lee. Wisconsin Statutes, 59.43. St. Croix County 1072656 Page 1 of 1 -'l-lop-County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN Or -.wd with Chapert 12 St. Croix County Sanitary Ordinance personal PLANNING & ZONING DEPARTMENT crt X� 55:�, inf rmation you provide may be used for secondary purposes [Privacy Law. S. 15.04(1)(m)] ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, Wl 54016-7710 Fax (715)386-4680 (715)386-4686 t'IIc to plans for the system on paper not less than 8-112 x 11 inches in size. ermit Check it rev"-`s o to previous applicat . ion. 1. Application infoon - Please Print all InformatiW 1Location: Property Owner N6-me 440* UZ 114 W1 /4, Sec Property Owner`s Mailing Address ILot Number Block Number City, State Zip Code I Phone Numer Subdivision Name or CSM Number S' 0 1-7 Wl ' 11 Type of Building: (check one) Comity 0 Village own of r% r %W1 2 Family Dwelling - No. of Bedrooms: ED Public/Commercial (describe use): Nearest Road V -Z-41 W-1 E3 State-owned box line A. Ch k box fine B if It. Type of Permit: (Check only one on on apphcaf e) Parcel Tax Number(s) (,b 016. 1 1 1 A) I.E3 Repair 2.13 Reconnection 3. Non -plumbing ED Rejuvenation 0 0 o --(,)0 Sanitation B) Permit Number Date issued [3 State Sanitary Permit was previously issued IV. Type of POVVT System: (Check all that apply) ED Non -pressurized In -ground ❑ Mound 2! 24 in. suitable soil ❑ Mound 24 in. suitable soil ❑ Mound A+0 ED Sand Filter ❑ Constructed Wetland F7 Peat Filter 71 Drip Line 0 Pressurized In -ground El Holding Tank 0 Single Pass Other ❑ E3 At -grade 13 Aerobic Treatment Unit Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area A. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (G a I s. /d a y/s q. ft.) (Min./inch) Elevation V1. Tank information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete strutted glass Tanks Tanks E3 11 13 ❑ 0 E3 1:1 ❑ V11. Responsibility Statement [, the undersigned, assume responsibility for repair/reconnenction/rejuvenationfinstaliation of non -plumbing for the POWTS shown on the attached plans. A i'llcense is not required for terraiift repair or the installation of non -plumbing sanitation system. Plumber's Name (print) PI Sig (ryo s��erXs): MP/MPRS No. Business Phone Number P V -------- Plumber's Address (Street, City, State, Zip Code) VII[. County Use Only D'I s :Sanitary Permit Fee is Date Is ued Issui Agent Si atur No s ps) Approved Owner en �Iniftt�ia�verse Z 25 /49 Determination Conditions of Approval/Reasons for Disarr at: go L .54TOC —ul c-, . Rev. 8/05 6-L. th 1 0 e6 t_e_4V .W I- IA. ►`♦I'*[IM AM .[ 46 er *i A�' � a ' M1 � ;` �'- ." - � _ jai 1 •ir, L.. t J t • i Rt I * f / I � I ' 1 i1 I ,�, fir, ram' t• !2 1 } OL ill `{1 � � `' '� f,� #1!'� i r .,: - ■ .y ';�' �i Road - j - - _ _ .., t - .s ,��,:R �. ,.n 'f ,.. ' - -'t r ^''46�: "'w - •41�'k•�. ..,.a:►., ! ..,+.0 .r•d .'R: 461, lr.4 11 Vacoled ROW Railroads - - �, j`_+:, iy'+i •jK#•, -5 -'1-` :.` � '.k ,Y+ •� ri t.:l.�r S.A-In "A. ,�1��1:" i. Soils - ,�` +i �,;,►Cti:`/4"f +°� r °,'I? , � . ' f,p. ,+rf..a , .;+.' w rr, '° - r�.f,y � � ,ems[: - 6{,e �Y-. ys ,Yn r� �, : Conveyance Division I- �Y• �7*r• ..�Ilr•'�;' Is, rT~'r' •� ',•� � YMF.T ,z � i�° t It>. 'f.k ..n -i �+ �'� �[ .1.. 1 .i �. � ��i • S* �'�t". 4 � ,d fn �� 4 t 4 f • ' " y 4, 1`-V$'- fr L,Yk;#t _y„1�r•'`�i•�4`'I ,[.1�-'r`F • `..}f Y� .'. /A,S'� �� , l r r. '.�##• [ � � I + f,��1Y t' i , 7 • lr.�'. k�Y•�r'i .�� i _�i t�� r' 7. t�' VJF•''�^.. � 't •..a} � I ... l - � � �_ ,4 1. ��n%'!��`d,N �'s�`��:"��flr.S.XFtiriF�'$S ,' `�; 'iiy �� tr ;^r 1 n� r,. iT f t.�,'• � .. - } �l, ,-,Y Y,J-�l a .,E'# yr ,. «(�irr.�'}.a"i +/: .. L I`•r - S �(y, ii"�y ,, - e' , ?1 '' STr - �"�'1.�" �T.+•� �i`..ii1,5 [ 1~ ♦ N. 4 ,r ISMrN • .' 1 .{ y.-.r f ��M �r 1.11E 7.MI�ft �•xF 1�� ` „T�� i• t !0 100 200 DISCLAIMER- This map is not guar� te, correct, 1-tY.+tl a+:tlF'-�` t �'r• ' ° . rr r 1 ` [f ` 'iV1' 17`�3�•M�1 conclusionsa:• - respons • • III �'� !�•.,i�JI, 1 r `f..iN T - �ft • _[ ii :.l,.+5 r7 ,+�, t�7Fy Y, P r • 1 1 Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Page Of Division of Safety and Buildings "L�ancio ew'Bith SPS 385, Wis. Adm. Code County st croix Attach complete site plan on paper not less thaw 8 1/2 x 11 inches in size. Plan must I include, but not limited to: vertical and horizontal referent*,polnt (BM), direction and Parcel I.D. percent slope, scale or dimensions, r#Mh arrow, and location and distance to nearest road. e> 00 Please print all information. Reviewed y Date' Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). IProperty Owner JOE MILLER Property Location I SW NW 5 T/ 2(—' 0 Property Owner's Mailing Address Govt. Lot 1/4 1/4 S N R 'E (or) W 569 CTY RD NN Lot # Block # Subd. Name or CSM4( City WILSON State Zip Code Phone Number [lofty �Villa ge Ofown Nearest Road W1 54027 na60th ave — Cady E) New Construction Use Residential / Number of bedrooms Code derived design flow rate GPO 0 Replacement OPublic or commercial - Describe: Parent material Flood Plain elevation if applicable General comments PRIVEY USE ONLY and recommendations: 11 Boring Boring # 13 Pit Ground surface elev. Horizon Depth Dominant Color Redox Description Texture in. Munsell tau. Sz. Cont. Color A 0-10 10 YR 3//2 ---- -- — --------- SIL E 10-14 e7.5 YR4/4 -------- SIL B 14-22 7.5YR 4/4 — ------- — --- LS C 22-86 7.5YR4/4 S/CB Boring# Boring L� Pit Ground surface elev. Effluent #1 = BOD 2 > 30 < 220 mg/L and TSS >30 < 150 mg/L CST a (Please Print) Si ature Address Depth to limiting factor in. Soil Applicabon Rate Structure Gr. Sz. Sh. I FBK onsistence MVFR oundary I CW I Roots * 2M GPD/ft 2 Iff#l- - .4 tff#2 .6 IMABK IFSG/CB SG/CB MFR MFIR CW CW CW 2M I VF .4 .7 .6 1.6 .7 1.6 Depth to limiting factor icture onsistence oundary Roots E. Sh. Soil A Eplicabon Rate GPD/ft 2 ff#1 *tff#2 LMuent #2 = BOD 45 < 30 mg/L and TSS < 30 mg/L CST Number Date Evaluation Conducted Telephone Number SBD-8330 (RI 1/11) 8287934 State Bar of Wisconsin Form 2-2003 Tx:4236188 WARRANTY DEED 1008676 BETH PABST Document Number Document Name REGISTER OF DEEDS ST, C RO IX CO - r WX 03/05/2015 11:34 AM THIS DEED, made between Harold Halverson, aka Harold H. Halverson, a single EXEMPT#: NA RFC FEE: 30.00 person TRANS FEE: 1350.00 ("Grantor," whether one or more), and er.PAGES: 1 husband and wife, holding as survivorship marital property ("Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ("Property") (if more Name and Rentrn Address space is needed, please attach addendum): Thomas A. McCormack Southwest Quarter Of Northwest Quarter (SW 114 Of NW 1 /4) and PO Sox 2120 Southwest Quarter of Northeast Quarter (SW 114 of NE 114) and Baldwin WI 54002 Southeast Quarter of Northwest Quarter (SE 114 of NW 114) of Section Five (5), Township Twenty-eight (28) North, range Fifteen (15� West. 004-1010-80-0009 004-1010-30-0009 004-10 ■ 0-90-OOo Parcel Identification Number (PIN) This is homestead property. (is) (is not) Exceptions to warranties: Easements and restrictions of record. f J Dated AUTHENTICATION Signature(s) authenticated on (SEAL) �' ' (SEAL) * Harold H. Halverson (SEAL) (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. ST. CROIX COUNTY) Personally came before me on the above -named Harold Halverson, ajeaHarAR Halverson TITLE: MEMBER STATE BAR OF WISCONSIN It (If not, to m known to be. e� person(s) hoc used the foregoing;authorized by Wis. Stat. § 706.06) instle over .� �� 1� THIS INSTRUMENT DRAFTED BY: * Thomas,A. IVI'cCormackf _ Thomas A. McCormack Notary Public, State efolVlisconsin Baldwin WI 54002 . f, �^My commis ionj(.:s,Lne nn�r. ent),(ar (Signatures may he authenticated or acknowledged. Bnrh°ari! not necessary.-M NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOW D HENCLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF VI'ISCON'SIN tr FORM NO.2-2003 *Type name below signatures. INFO-PROT'"wwwJnfoproforms.corn St. Croix County 1008676 Page 1 of 1 ST* R X T Y -Wil RE: Non -Plumbing Sanitation, privy Community Development Government Center 1101 Carmichael Road Hudson WI 54016 Telephone: 715-386-4680 Fax: 715-386-4686 www.sccwi.gov A sanitary privy can be installed provided there is no interior plumbing to a structure, but only with an approved County Sanitary Permit, a recorded non -plumbing sanitation affidavit and supplying a plot plan showing all setbacks are met. Please be advised of the following requirements: 1. A Soil and Site Evaluation to be completed by a Certified Soil Tester in the state of Wisconsin. 2. A copy of the recorded Warranty Deed is required at time of application submittal. If you do not have a copy available, you can obtain a copy from the St. Croix County Register of r)nnrlc =+- n minim=l fno Thic nfFrn is Inratorl arrncc tho hmil frnm the rnmrni inihi 1600 %. %.0 %A %J %A %. bl 1 1 1 1 1 1 11 1 1 bl 1 1 v. `. ■ 1 1 1 14 .0 V I 1 1 1 \/,rM 0 �r I. %A A• It v I / 1 1.1 I V v v 1 1 1 1 1 I" I I 1 4 • Development Department office. 3. A Non -Plumbing Sanitation affidavit is required to be recorded with the St. Croix County Register of Deeds; a $30 recording fee will be required. Staff will be able to help you fill out the form. Please contact the main office at (715) 386-4680 to schedule an appointment with a staff person to complete this affidavit when you drop off the application. 4. A site plan must be included with the application with the following setbacks: a. Well must be 50 feet from a privy. b. Privy must be 25 feet from a dwelling, 25 feet from a lot line and 25 feet from any slope 20% or greater. c. Privy must be 75 feet from the Ordinary High Water Mark of a stream, lake or river. 5. Vaults must be 200 gallons or greater and a State of Wisconsin approved product. 6. Privy openings shall be screened and all doors self -closing. 7. Vent for the vault must extend at least one foot about the roof and be at least 3 inches in diameter. 8. Owner must call for an inspection, 24 hours prior to requested inspection time. Due to the amount of sanitary permits submitted to this Department every day, staff cannot guarantee that a permit will be approved the same day is submitted. Please plan for approximately one (1) week to receive your approval. Upon approval of the sanitary permit, then you will be able to pursue approval with the Town for a building permit for a structure intended for habitable purposes. Each Town contracts with a Building Inspector, it may be easiest to contact the Town Chair to get this information. A driveway permit may also be required if there is not an existing residential access, please contact the Town Chair regarding this as well. The Town Chair for Cady is Michael Tully and he can be reached at (715) 772-4578.