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Home My WebLink AboutSAN-2018-328Wisconsin 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)]. Permit Holder's Name: Daniel Gingerich City Village Township TOWN OF CADY CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: SAN-2018-328 State Plan ID No: Parcel Tax No: 004-1013-70-010 Section/Town/Range/Map No: 06.28.15.93A-01 STATION BS Hl FS ELEV. Benchmark Alt. BM Bldg. Sewer iSt/Ht Inlet St/Ht 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: P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Model Number: FBI &-vt ZII -*k"I 1i&4l � &�_� �_11� Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Onfv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 540 CTY RD N N 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover Plan revision Required? ❑ Yes ® No Use other side for additional information. Date Insepctor's Signature Cert. No. Sf�w�-a C, 19 _ 3a County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN oe [h accord with Chapert. 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT 0-11! erscmA I information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Pnivacy Law. S. 15.04(1 1101 Carmichael Road D1 Hudson, WI 54016 7 710 (715)386-4680 Fax (715)386-4686 AftacA complete plans for the system on er not less than 112 x 11 inches in size. s 1c, ry ermft [] C ,Goijoit Mn4# heck if revision to previous ap . �' iioafion -&IT- 3 • I. Application --information - Please Print all Information Location: Property Owner Name 1/4 :5;� 1/4, Sac (.0 R E (oKowoo) Property Owner's Mailing Address Lot Number Block Number ILL City, State ZIP Code Phone Numer Subdivision Name or CSM Number 11 Type of Building: (check one) amity 7 Village Xown of F44 1 or 2 Family Dwelling - No. of Bedrooms: [:1 Public/Commercial (describe use): 71 State-owned Nearest Road 64b 6.j a OA) Ii. Type Permit: box line A. Check box line B if of (Check only one on on applicable) Parcel Tax Num5er(s) A) 1.[] Repair 12. El Reconnectior r.;t�Non-plumbingj. 1`7 Rejuvenation 00 4 , 1013-- 70.0110� r Sa n itaiEfion (j J.0 6 - 3 B) Permit Number Date I ud [3 State Sanitary Permit was previously issued 2Z IS-* 3�o / �;/ IV. Type of POWT System: (Check all that apply) Non -pressurized In -ground ❑ Mound 24 in. suitable soil Ei Mound:5 24 in. suitable soil ❑ Mound A+O Sand Filter ED Constructed Wetland M Peat Filter ❑ Drip Line Pressurized In -ground ED Holding Tank ❑ Single Pass Other El At -grade ❑ Aerobic Treatment Unit ED Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 16. System Elevation 7. Final Grade 'Required Proposed i(Gals./day/sq.ft.) (Min./inch) Elevation V[. Tank information Capaicty in Gallons - Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic Gallons Tanks Concrete structed glass New Existing Tanks Tanks El V111. Responsibility Statement [, the undersigned, assume responsibility for repair/reconnenction/rejuvenationfinstallation of non -plumbing for the POWTS shown on the attached plans. A license is not required for terraiift repair or the installation of non -plumbing sanitation system. Plumber's Name (print) Plumber's Signature (no stamps), MP/MPRS No. Business Phone Number lo Plumber's Address (Street, City, State, Zip Code) VIII. County Use Only Disapproved 'Sanitary Permit Fee is Date Is ued Issu Agent Si tur amps,, Approved LJ Ow iven IffMat-764verse 57. 6 Determination IX. Conditigns of App oval/Reasons for Disapproval: IL Q ot%- 1r\602;L_± jz, Rev: 9/05 1 _ Gam �7-+ o V I p qa� ol� ��-- OCT 0 8 pp�g S- Lt. &oix County COMMunitY Deve i L-D�---• SCC ArcGIS Web Map OCT : _ Ail -ko, 4 a-, 41 fig, rw- - F•. ; - } - s - r 8/31 /2018 2:49:05 PM 1: 2, 257 0 75 150 300 ft Public ROW Lot and Units Park General Common Element .` Floodplain Storage Outlot 0 20 40 80 m Private Right -of -Way Lot Tax Parcels El FIRM Panel Index St. Croix County Community Development, WI Dept of Natural Resources, Unit Limited Common Element ® FERC Project Area Boundaries Eagleview and SCC CDD, Wisconsin DNR Web AppBuilder for ArcGIS :ounty Community Development and the Townships under County Zoning I St. Croix County Community Development Department 1 St. Croix County Community Development I National Geospatial-Intelligence Agency (NGA), Delta State University: Esd I Eagleview and SCC CDD V ED 1 E_ OC 08 2018 8 5 4 4 2 8 1 1 IIl111111111 State Bar of Wisconsin Form 5-2003 T (: 4461367 PERSONAL REPRESENTATIVE'S DEED -,oix County Development 1072262 Document Number Document Name I —BETH PABST THIS DEED, made between Carey Kerr as Personal Representative of the Estate of The Estate of Mary E. Kildahl ("Decedent") ("Grantor", whether one or more), and Daniel C. Ginj!erich and Rebecca DO Gineerich, husband and wife survivorship marital promEy ("Grantee," whether one or more), Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interest, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): REGISTER OF DEEDS ST. CROIX CO., WI 10/03/2018 01:28 PM EXEMPT#: REC FEE 30.00 TRANS FEE 540.00 Recording Area PAGES: 2 See attached Exhibit "A" for Legal Description Name and Return Address WESTconsin Title Services P.O. Box 607 Hudson, W1 54016 004-1013-70-000 (Part of) and 004-1013-80- 000 (part of) including part of 004-1013-90- 000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Personal Representative by this Deed does convey to Grantee all of the estate and interest in the Property which Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. Dated: September 10.2018 ��,THE TATE OF MARY E. KILDAHL A HC �f *age **'m (SEAL) 4e By: _Z (SEA f )tl : —0 *Carey Kerr, Personal Representative Z 0.0 *us L\q AUTHENTICATION 0 ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat § 706.06) THIS INSTRUMENT DRAFTED BY: Ton R. Schrader, Attornev (715) 235-3403 File No. OR- 18-11864 )ss. COUNTY OF ST. CROIX Personally came before me on September 10, 2018 the above -named Carev Kerr, Personal Representative of The Estate of Man E. Kildahl to me known to be the person(s) who executed the foregoing instrument and acknowledged the samq. .Ak *Tara Hoff LO/ 1i Notary Public, State of Wisconsin My Commission (is permanent} (expires: 03/02/2021) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLI, IDENTIFIED. PERSONAL REPRESENTATIVE'S DEED C2003 STATE BAR OF WISCONSIN FORM NO. 5-2003 *Type name below signatures. St. Croix County 1072262 Page 1 of 2 1 ADD EXHIBIT "A" LEGAL DESCRIPTION OCT OS 2018 5t. Croix County Community Development The Northwest Quarter (NW '/4) of the Southeast Quarter (SE '/.) and the Northeast Quarter (NE '/.) of the Southeast Quarter (SE '/4), lying North of I-94; ALL 1N Section Six (6), Township Twenty-eight (28) North, Range Fifteen (15) West, Town of Cady, St. Croix County, Wisconsin; EXCEPT that part conveyed for highway purposes as recorded in Volume 368 of Records, Page 9 and Volume 368 of Records, Page 10. ALSO EXCEPT Lot Three (3) of Certified Survey Map recorded in Volume 29 Certified Survey Maps, Page 6541, as Document No. 1070154; Located in part of the Northwest Quarter (NW '/.) of the Southeast Quarter (SE '/4) and part of the Northeast Quarter (NE '/4) of the Southeast Quarter (SE '/s) of Section Six (6), Township Twenty-eight (28) North, Range Fifteen (15) west, Town of Cady, St. Croix County, Wisconsin. File No. OR-18-11864 St, Croix County 1072262 Page 2 of 2 Wis. Dept. of Safety and Professional Servicet S01 . L EVALUATION REPORT Page of Division of Safety and Buildings oc� in accordance. with SP$ 385, Wis. Adm. Code County ST CROIX Attach complete site plan on paper not less than 8. 1)211f `c'es in size. Plan must include, but not limited to: vertical and hotizoritat-reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 7e) Please print all information. Rev' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 46 Ig Property Owner Property Location "F a DANIEL GINGERICH Govt. Lot NE 1/4 /S E 1/4 6 / T 28 N R Is E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 481 CTY RD NN City State Zip Code Phone Number Ocity []village EFown Nearest Road WILSON WI 54027 CADY 60TH AVE New Construction UseE] Residential / Number of bedrooms Replacement Public or commercial - Describe: Parent material General comments and recommendations: Code derived design flow rate F" Plain elevation if applicable PRIVEY USE. WITH OUT A VAULT MAXIUM DEPT 4211 GPD] ft. Boring # 11 Boring Ground surface elev. ft. Depth to limiting factor in. El Pit I Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence oundary Roots *Iff#1 GPD/ft2 liff#2 A 0-12 10 YR 3/2 ------------------------------ S I L 2 M S B K M F I CW IF .6 .8 B 12-22 '10 YR 4/5 ------------------------------------ L 2MSBK MFI CW 1 VF .6 .8 C 22-31 10 YR 5/4 ------------------------------------- L 2MSBK MFI CW ------- .6 .8 C1 31-79 10 YR 5/4 ------------------------------------ SICL 2MSBK MFT CW .4 .6 C2 79 10 YR 7/4 ------------------------------- BED BED ROCK CW ------- 0 0 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. :Snit Annlir-nfinn Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. :' onsistence oundary Roots GPDtft2 ff#1 *[-".ff#2 * FfflijPnt *1 -Ron > 10 < 990 mq/1 anci T.q.q >-,An < i-so mg/L * Effluent #2 = BOD < 30 ma/L and TSS < 30 mcVL CST Name (Please Print) Si � iWure CST Number 71 Address Date Evaluation Conducted Telephone Number SBD-8330 (RI 1/11) teJct Document Number Document Title IIIII111111 Illl 4 Tx: 4462079 6 1072501 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/08/2018 12:59 PM EXEMPT #: REC FEE 30.00 COPY FEE 4.00 PAGES: 3 Recording Area Name and Return Address 6/27 C35e Rol 0 wovc/u,'Ve- W1, 5yo2e 004 - �0 — 0'-'Lq -C)OO Parcel Identification Number (PIN) THIS PAGE IS PART OF THIS LEGAL DOCUMEN ry - DO NOT REMOVE. This information must be completed by submitter'. document title, name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document- WRDA Rev. 12/22/2010 [�7 St. Croix County 1072501 Page 1 of 3 Document Number I Document Title St. Croix County Non -Plumbing Sanitation Affidavit 0agi-'k, I C _� Name — (Owner) typed or printed 'y He/she is the owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume ____ Page Document Number. Croix County Register of Deeds Office: 4 A arcel of land located in part of thA)L01/4of the 1/4of Section T_;sY N — RJ�W I l'own of CaOILI.- St. Croix County, Wisconsin, being duly described as folloUs (include lot no. and subdivision/CSM or detailed legal description): OCT 0 8-2018 St. Croix cointy Community Development Recording Area Name and Return Address 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 -plumbing sanitation permit in compliance with Sections 12.A. Lg and 12.3a.2 of the county sanitary ordinance. 2. The contents of the vault shall be disposed M' 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 0C I. C) xt 1'r I !( ENT TION- A Signature(s <' D authenticated this day of 11 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY St. Croix County CDD Staff (Signatures may be authenticated or acknowledged. Roth are not ACKNOWLEDGMENT STATE OF W160 !'10 S6N I ft a ow S J�i�? County. )k . th ) Pcrsonally came before me this day of 20 the above named Df.rtict to me known to be the per J7i acknowledge the OZIM ft" 4d same. KOLTEN CHASE ADC)LPHSEN NOTARY PUBLIC— MINNESOTA MY CmWissim Evkn JM. 31,2423 Notary Public, State ofxva" . i"Pi 4 ri eco 4-%, . sv 4A #*X My Commission is permanent. If not, state expiration date-. necessary.) Date: )Q I Iff "THIS PAGE IS PART OF THIS LEGAL DOCUMFNT— DO NOT RLMOVE91 This information must be completed by submiller: document title, name & return address, and PIN (if required). Other information such as the granting clauses, leagal description, etc. may be placed on this first page of the document or may be placed an additional pages of the document. Note: Use of this cover page adds one page to your document and $2. 00 to the recording Leg. Wisconsin Statutes, 59,43. St. Croix County 1072501 Page 2 of 3 MnCEfi.VEDI EXHIBIT "A" LEGAL DESCRIPTION OCT os 2018 5t. Croix County Community Development The Northwest Quarter (NW %4) of the Southeast Quarter (SE V4) and the Northeast Quarter (NE 1/4) of the Southeast Quarter (SE Y4), lying North of I-94; ALL IN Section Six (6), Township Twenty-eight (28) North, Range Fifteen (15) West, Town of Cady, Stu Croix County, Wisconsin; EXCEPT that part conveyed for highway purposes as recorded in Volume 368 of Records, Page 9 and Volume 368 of Records, Page lo. ALSO EXCEPT Lot Three (3) of Certified Survey Map recorded in Volume 29 Certirted Survey Maps, Page 6541, as Document No.1070154; Located in part of the Northwest Quarter (NW %4) of the Southeast Quarter (SE '/4) and part of the Northeast Quarter (NE '/) of the Southeast Quarter (SE Y4) of Section Six (6), Township Twenty-eight (28) North, Range Fifteen (15) West, Town of Cady, St. Croix County, Wisconsin. F'dt No. OR-18-11864 St. Croix County 1072262 Page 2 of 2 St. Croix County 1072501 Page 3 of 3