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HomeMy WebLinkAbout034-1078-70-025 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 2 D GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Gin erich, Ura& Mary I I Springfield, Town of 034-1078-70-025 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: -J I 34.29.15.526A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV, Septic Benchmark Dosing J Alt. BM 1� Aeration Bldg.Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic >?5 SZ 146 /f Dt Bottom _...- Dosing Header/Man. Aera' Dist. Pipe Holding Bot.System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH 11-ii ft Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT 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 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/rrench Edges Topsoil 0 Yes [E No ❑ Ye7[7] No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 3070 60th Ave Wilson,WI 54027(SW 1/4 SE 1/4 34 T29N R1 5W) 40 acres Lot Parcel No: 34.29.15.526A 1.)Alt BM Description= -3 !� 2.)Bldg sewer length= �/ -amount of cover= Plan revision Required? � Yes ❑ No � Use other side for additional information. � SBD-6710(R.3/97) Date Insepctor's Signature Cert.No. nt.J unty Sanitary Permit Application ST.CROIX COUNTY WISCONSIN GOv�q Ord with Chapert 12 St Croix County Sanitary Ordinance PLANNING&ZONING DEPARTMENT �OAA� ,»I ersonal information you provide may be usgd for secondary purposes ST.CROIX COUNTY GOVERNMENT CENTER G�p4 1(� [Privacy Law.S.f&04O )} ; 1101 Carmichael Road je% �, z Hudson,WI 5401 6-7710 (715)386-4680 Fax(715)386-4686 C> - e plans for the system on paper not less t an 8-1/2 x 11 inches in size. c 1 ui7tyj unary Permit# ED Check if revision to previous application ��,, •.' 20 C,o I. Application Information-Please Print all Informatio Location: Property Owner Name 54J 1/4 S 1/4,Sec 3 T QI T Z01 N, R /:5 E(o W Property Owner's Mailing Address Lot Number Block Number — -- O —�O mss_ ----- — --�--------�------- --- --- City,State / Zip Code �7 Phone Numer Subdivision Name or CSM Number 11 TV6 of Building: (check one) laity ❑Village Nown of 1 or 2 Family Dwelling-No.of Bedrooms: `/ r ❑ Public/Commercial(describe use): Y aJ t�' ��t �� c �► 13 State-owned a est Road Ii.Type of Permit: (Check only one box on line A. Check x on line B if applicable) b Parcel Tax Number(s) A} 11.[] Repair 12.❑ Reconnection 3 on-plumbing 4.❑Rejuvenation it�1 !6� .� 76 -6Z—> 6.1 '/ 1 Sarntation B) Permit Number �f'7', Date Issued ❑ State Sanitary Permit was previously issued , 2— IV.Type of POWT System: (Check all that apply) • Non-pressurized In-ground ❑ Mound? 24 in.suitable soil ❑ Mound<_24 in.suitable soil ❑ Mound A+0 • Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V.Dispersal/Treatment Area Information: 1.Design Flow(gpd) 12.Dispersal Area 3.Dispersal Area 4.Soil Application Rate 5.Percolation Rate 6.System Elevation 7.Final Grade Required Proposed (Gals./day/sq.ft.) (Min.rnch) Elevation VI. Tank Information Capaicty in Gallons Total #of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks _760 L i L ❑ ❑ ❑ ❑ ❑ ❑ ❑ 13 ❑ VII.Responsibility Statement 1,the undersigned,assume responsibility for repair/reconnenction/rejuvenationlnstallation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Plu ber's Name(print) Plu is Signatur (no stamps): MP/MPRS No. Business Phone Number rc i� Plumber's Address(Street,City,State,Zip Code) VIII.Coun Use Only Sanitary Permit Fee )Da a Issued Issuin ent Signature o st s) Approved Owner Giv ial e 2,2-S � �/��� I�' Determination DC Conditions of Approval/Reasons for Disap oval: /) I A- 0�w.�►`'k- 4,I b��� �`� Ina� V r�t�s.9 C.. j5 .4154--lea , n I e�C GtnGlps _ VV S r N sir '1—' I .� � �Q1 �, � >3� �, h -� �w� -JL �� ±� �0 ve_ x D unty Sanitary Permit Application ST. CROIX COUNTY WISCONSIN v~~a accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT GOVERNMENT CENTER CO- tOtf~ Perso formation you provide may be used Al~hd oses ST. CROIX 1101 COUNTY Carmichael Road g► G n`¢ `f[Privacy Law. S. 15.04(1)(m)] t• V Hudson, WI 54016-7710 Q t:. (715)386-4680 Fax (715)386-4686 -W66 complete plans for the system on paper not less than x 11 inches in size. P county Sanitary Permit # ❑ Check if revision to previous application 01- I. Application Information - Please Print all Information Location: Property Owner Name ~ ~IV 1/4 S~ 1/4, Sec 1 N, R 1 57 E(or W U a ~v- /Vin -S ~S 2A W Property Owner's Mailing A dress Lot Number Block Number City, State Zip Code Phone Numer Subdivision Name or CSM Number r W11 ~ .a II Type of Building. (check one) tNea illage ;Mlown of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: S~nk9 FiC~ J ❑ Public/Commercial (describe use): J ❑ State-owned oad It. Type of Permit: (Check only one box on line A. Check box on line B if applicable) (1P7~ umber(s 1 s 2s A 6)-34- A) 1Repair 12. ❑ Reconnection 34. ❑ Rejuvenation Sanitation _76- Permit B)Number Date I su o 5 ❑ State Sanitary Permit was previously issued 1 l+' IV. Type of POWT System: (Check all that apply) 'L 2 ❑ Non-pressurized In-ground ❑ Mound z 24 in. suitable soil ❑ Mound 24 in. suitable soil ❑ Mound A+0 _ ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass %Other p,_,t/N ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq.ft.) (Min.rnch) Elevation 1. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks ' W ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) Ill. County Use Only L_J Dis roved Sanitary Permit Fee Dat Issu d Issuing ent Sig tur o stam ) Approved Owner Gi niti verse Z Z S Q Z De ation IX Conditions o/f~Approval/Reasons forffDisapprov 5d~~ n i1 v Alp ~~v I& i54ix (C e-J 2-> ®ti.+J~-ate 4, Cp 17- ~ 'Sp~C~~ o✓~ ,-4- 0.vt V S r J\ W,4 ILI, •J~ State Bar of Wisconsin Form 2-2003 8 1 0 II3 ~2 4 7 Tx:4081053 WARRANTY DEED Document Number Document Name 966874 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between James A. Stauffer and Annette M. Stauffer, husband 11/06/2012 4:37 PM and wife EXEMPT#: NA ("Grantor," whether one or more), REC FEE: 30.00 and Ura H. Ginaerich and Marv D. Gingerich, husband and wife TRANS FEE: 359.70 ("Grantee," whether one or more). PAGES: 1 Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): KRISTINA OGLAND The WI/2 of the SE1/4, except Lot 1 of Certified Survey Map recorded in Volume ESTREEN & OGLAND 22 of Certified Survey Maps, Page 5335 as Doc. No. 841476, all in Sec. 34-T29N- 304 Locust R15W, St. Croix County, Wisconsin. Hudson, W154016 034-1078-60-000 34-1078-70-025 Parcel I&en u1) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated I or (SEAL) (SEAL) * * ame A. S uffer (SEAL). 191,11 fil SEAL * Annette M. Stauffer AUTHENTICATION ACKNOWLE GMENT Signature(s) James A. Stauffer Annette M. Stauffer authenticated on l ( STATE OF ) ) ss. COUNTY ) *Kristina O gland TITLE: MEMBERS ATE BAR OF WISCONSIN Personally came before me on , (If not, the above-named authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the same. Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 # Type name below signatures. INFO-PRO'" Legal Forms 800.655-2021 www.infoprofbrms.com 1 of 1 2012 Property Record I St Croix County, WI Assessed values not finalized until after Board of Review Property information is valid as of Nov 5 201210:27PM OWNER CO-OWNER(S) JA MES A N & A NNETTE M STA UFFER 2092 90TH AV E BALDWIN, WI 54002 PROPERTY DESCRIPTION PROPERTY INFORMATION SEC 34 T29N R15W 40A SW SE EZ-UT 1452/331 EXC CSM 22-5335 Parcel ID: 034107870025 Property Address: Alternate ID: 34.29.15.526A Municipality: TOWN OF SPRINGFIELD School Districts: SCH DIST SPRING VALLEY DEED INFORMATION Other Districts: CHIP VALLEY VOTECH Volume Pace Document # 917109 Section Town Range Qtr Otr Section Qtr Section 17108 34 29N 15W SW SE 915802 Lot: 2409 569 74004 Blo2k; 2409 567 740048 Plat Name NOT AVAILABLE LAND VALUATION TAX INFORMATION Valuation Date: 0810712012 Net Tax Before Lottery. First Dollar Credits: 0.00 CQde Acres Land Value Improvements Total Lottery Credit: 0.00 G4 11.000 1,900 0 1,900 First Dollar Credit: 0.00 19.000 20,900 0 20,900 Net Tax After: 0.00 Amt. Due Amt. Paid Balance 30.000 22,800 0 22,800 Tax 0.00 0.00 0.00 TotalAcres: 30.000 SpecialAssrrnt 0.00 0.00 0.00 Assessment Ratio: 0.0000 Special Chrg 0.00 0.00 0.00 Delinquent Chrg 0.00 0.00 0.00 Mill Rate: Not Available Private Forest 0.00 0.00 0.00 Fair Market Value: Use Value Assessment Woodland Tax 0.00 0.00 0.00 Managed Forest 0.00 0.00 0.00 Prop. Tax Interest 0.00 0.00 INSTALLMENTS Spec. Tax Interest 0.00 0.00 Prop. Tax Penalty 0.00 0.00 Period Bid Date Aniount Spec. Tax Penalty ? 0.00 0.00 Other Charges 0.00 0.00 0.00 TOTAL 0.00 0.00 0.00 Over-Payment 0.00 PAYMENT HISTORY (POSTED PAYMENTS) General Special Date Receipt # Sore Type Amount Tax Status Assess, Status Interest Penalty Tot S r a N s r ~ ~a~ e_JE J~ Q ~ve _ l I II I IIIIIIIIIIIIlI!I I I II I I II I 8104312 Document Number Document Title TX : 4082004 St. Croix County 967114 BETH PABST Non-Plumbing Sanitation Affidavit REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD ~~ra ~inacr.?c~ 11/08/2012 4:09 PM Name - (Owner) Typed or printed EXEMPT being duly sworn , states, under oath, that: REC FEE: 30.00 . He/she is the owner of the following parcel of land located in St. PAGES: 1 Croix County, Wisconsin, recorded in Volume Page Document Numberyf,6 &sSt. Croix County Register of Deeds Office: Recording Area A parcel of land located in part of theQ'/4 of the 5E'/4 and the N,t"te and lie'ttrn address of the SW of Section , Td _ N - RAW, Town of aM H G 'e St. Croix County, Wisconsin, being duly described as ~a 23.. ollude lot no. and subdivision/CSM or detailed legal ►L. description): rh, WA of tAe SEA dW,Kce-pf Lbt/n4 eert,'4t~~sw•~«y~A~13L71f 07970025 ,p,!cct K e 11C14~tt? a1 2, e~ Certir~e ~SKnvex to Rase 5335 45 Parcel ldenotication Number 011N) Dot..Ne. Bq W't4 ql( t_. 5~,e. k 15w StL4M;y (,fy. Wjt mica s)N 1. A new structure on this lot will be used as a habitable dwelling, but will contain no plumbing for potable water and/or wastewater. Occupants of said structure utilize a vault privy for disposal of human waste, Which was authorized by a non- plumbing sanitation permit in compliance with Sections 12.A. l.g and 12.3a.2 of the county sanitary ordinance. 2. No plumbing may be installed in the premises served by the non-plumbing sanitation device until a sanitary permit has been obtained for installation of a code-compliant POWTS. 3. The contents of the vault shall be disposed in accordance with NR 113, Wis. Adm. Code. 4. This agreement shall be binding on the owner, their heirs, assignees and/or land contract purchaser. 1 also acknowledge that I will disclose this information to any parties interested in purchasing this property in d,e Future. Dated this day of _Loy, '.Z * * AUT E~NTI~ATI ACKNOWLE10CMhN1' Signature(s) a. STATE OF WISCONSIN ) )SS. St. Crois County. ) tl authenticated this day of P rsonally came before me this o day of _ NUwV ~ ~it,'V - the above named to tile known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person(s) who executed the foregoing instrument and acknowledge the (If not, same. - authorized by § 706.06, Wis. Slats.) AMANDA DUROW ' THIS INSTRUMENT WAS DRAFTED BY Notary Public l~Ir e, ~~cp c y State of Wisconsin f Du ►'U~J Notary Public, State of'wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. It not, state expiration (iatc: necessary.) Date: G . J "THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO No,r ItF,N90VF" This information must be completed by sabmilter. document title name & return address, and P/N (f required). Other information such as the granting 1 OU6uses, leagal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Noie: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.43.