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HomeMy WebLinkAbout002-1079-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 178 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 Baldwin, Town of 002-1079-80-000 CST BM Elev: T77 BM Description: Section/Town/Range/Map No: 32.29.16.469 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Gw, 'a( �-a 70� Dosing P Alt. BM Aeration Bldg.Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ven to Air Intake ROAD Dt Inlet Ail Septic 7/Ob ��1 ��/ Z� Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift riction Loss System Head TDH Ft Forcemain 1L7e5th 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 SYSTE O P/L BLDG LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia cing SOIL COVER x Pressure 4y9tems Only xx Mound Or At-Grade ems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edg Yes [] No M Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 2237 70th Ave. Baldwin,WI 54002(NE 1/4 NW 1/4 32 T29N R16W) 40 acres Lot ((�� Parcel No: 32.29.16.469 1.)Alt B Descrip' n= •f a c. a W:`` Ge-1 e.reb� °L^'^`� 2.)Bldg se ength= ,� CDC oa ('� ,•�� -amount cover= 0+4� ir e Plan revision Required? Yes ,No Use other side for additional information. T Date Insepctor Signatur Cert.No. SBD-6710(R.3/97) p~ County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN P IE n accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT +b Personal information you provide may be used for sei;onda rp ses ST. CROIX COUNTY GOVERNMENT CENTER L!f 1101 Carmichael Road ` [Privacy Law. S. 15.04(1)(m)] v Hudson, WI 54016-7710 00 ' AP- (715)386-4680 Fax (715)386-4686 G & ZO1~ ach complete plans for the system on paper not less than 8 x 1 in size. County Sanitary Permit ❑ Check if revision to previous application„ STC 1. Application Information - Please Print all Information Location: Property Owner Name Alr_ 1/4 1/4, sec 3 ~r G U ~S /YO usto N, / R E (or n Property Owner's Mailing Addres e Lot NuCmb~r Block Number 2Z6.2 23 ,-01 tl_e . . ~~v9 City, State Zip Code Phone Numer Subdivision Name pr CSM Number 11 Type of Building: (check one) amity ❑ Village [RTown of 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State-owned Nearpyst tai 11. Type of Permit: (Check only one box on linrNn x on line B if applicabl e) parcel Tax Number(s) A) 1.❑ Repair 2. ❑ Reconnection mbing . ❑ Rejuvenation Permit Number Date Issued B) ❑ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) W e)rT 3.)o ❑ Non-pressurized In-ground ❑ Mound a 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 / /'.'V ❑ 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./inch) Elevation V1. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks v j 19 ❑ ❑ ❑ ❑ 32n <<,e ❑ ❑ ❑ ❑ ❑ V11. 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): MFG/ PRS No. Busyigess Phone Num4e ~'n e Y [ ~J Ilyk Plumber's Address (Street, City, State, Zip Code) VIII. Coun Use Only Disa ov Sanit Permit ate Issued Issuing ge, Q i atApproved O r Gi Initial Adverse J ZD G2iy'~"~ termination X. ditions of Approval/Reasons for Disapproval: r`O r - ( Ale/%'q Un tQ s,C Q Pr Vi ' kt° Gd rd -a -44 r- Lm b `n du~2 r.ko 4ham house . ~da i`n `ate Of a~Nie o~r✓~5©uJh-ter ~ Ca-l( ~ C'o 0✓1 ~ y 5~~''~ ~ Gte'h t c, eas 2 / Se CL am Q Q7 7 f- 5 "'Id<I~MA$4't.CluP_"- o co~ = C z y -a z z m o ~ O mC o ~ Cl) d Cl) m♦ m m 0 0 ` T O w Z r 17~ m D ~O m C:~ ~ 1#41, c Z= ccn n \ 1 m Q x m N Z 00 C m CJ) z C ZD Z o C C/) cn - ;u -n { M c n 0 Cl) < C) -I Z m p ' OZ m n z O M m F -6 CD ~ --i m S. m y a v a" < v w CD = o o CD~ ~s ~CD~ 6 m o< a o , o m o m co o m o cu -I C O N O N (Q m N w N 'O O? C r mm m m m g N o 0 0 JOJ 1 N ➢ N O N a ? p. d m O< 0 ~I O N m 1:2 y m O v O y (D 0 0 C~ 0 O N C O N N O 3 CI5 CD O N ~i C N O v S= f 3 5: m =CD X N N N~ y N 7U, (a CD CD ..i. X =r O. 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Parcel M 32.29.16.469 002 - TOWN OF BALDWIN Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - FIRST BANK OF BALDWIN FIRST BANK OF BALDWIN PO BOX 2060 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Prima Type Dist # Description A Z 3 v~ SC 0231 SCH D BALDWIN-WDVILLEc lo,w SP 1700 WITC ` f 16 7 22 z Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 32 T29N R1 6W NE NW EZ-U-1248/151 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 06/18/2012 958426 SD 11/26/2007 864715 Q C D 11/26/2007 864714 WD 10/19/2004 777412 2678/438 LC 2012 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/11/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 23.000 5,300 0 5,300 NO UNDEVELOPED G5 1.000 100 0 100 NO AGRICULTURAL FOREST G5M 16.000 27,200 0 27,200 NO Totals for 2012: General Property 40.000 32,600 0 32,600 Woodland 0.000 0 0 Totals for 2011: General Property 40.000 32,600 0 32,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 a 967222 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD WARRANTY DEED 11/12/2012 08:00 AM Document Number EXEMPT * N/A THIS DEED made between First Bank of Bald REC FEE: 30.00 win, Grantor, and Ura TRANS FEE: 255.00 Gingerich and Mary Gingerich, husband and wife, Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the **The above recording information "Property"): verifies that this document has been electronically recorded The Northeast Quarter of the Northwest Quarter (NE '/a NW Y4) of Section & returned to the submitter 32, Township 29 North, Range 16 West, Town of Baldwin, St. Croix County, Wisconsin. Recowffid to: Name and Return Address: Burnet Tltle Ja' MIX 5151 Edina Industrial Blvd. #500 Edina, MN 55439 Together with all appurtenant rights, title and interests. oAgt 0?88_q~ l osi n g CAI a APZG Parcel Identification Number (PIN) Op a -(t'l `I lb-ow This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements, Restrictions, Reservations, Roadways and Rights of Way, if any, of Record. Dated this 31 st day of October, 2012. First Ba c of Ba * Steven H. Perry, sident Z x: a • f~ r E * fo a AUTHENTICAT61VII,~ ACKNOWLEDGMENT Signature(s) TATE OF WISCONSIN ST. CROIX COUNTY. ) ss. ;cam.. ~ ~ t F ~.sy, authenticated this 31st day of October, 2012 Personally came before me this 31st day of October, 2012 the above named Steven H. Perry, the President of First Bank of * Baldwin, to me known to be the person(s) who executed the foregoing instrument and acknowled the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) * eri a J. tune THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: Larry S. Mountain, Attorney at Law 10/27/2013 ) 990 2Jn stjeak - 7D60 ULMI (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature . 1 of 1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000