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HomeMy WebLinkAbout004-1024-70-001 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 179 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 Cady, Town of 004-1024-70-00t CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 11.28.15.1068AIU TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. p Se tic Benchmark I '7�� Dosing Alt. BM Aeration ✓1 ✓ Bldg.Sewer h t Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO LI� P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / / �� r _ Dt Bottom a Dosing Header/Man. Aeration Dist. Pipe Holding Bot.System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift 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 JBLDG IWELL 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/Trench Edges Topsoil 0 Yes 0 No F7, Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 3105 50th Ave Knapp,WI 54749(NW 1/4 NW 1/4 11 T28N R1 5W) >35 acres Lot /i Parcel No: 11.28.15.1068A 1.)Alt BM Description= ( tl�`( D 2.)Bldg sewer length= �� J d ✓` V �'N� -amount of cover Plan revision Required? ❑ Yes No - Use other side for additional information. Date Insepctor's Signa ur Cert No SBD-6710(R.3/97) O~ County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN Ov 4 In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER b ~ G e o lk ~ [Privacy Law. S. 15.04(1)(m)j 1101 Carmichael Road $t' O~ Eoq°udson, WI 54016-7710 6 p4 Q ~o GO v5 4680 Fax (715)386-4686 S e plans for the system on paper not less than 8-1/2 x 11 inches ' size. _ oft' Fo ry~ ~ t ❑ Check if revision to previous application 1. Application Information - Pie;, .61 11 information Location: Property Owner Name 1/4 N~J114,Sec E~cn crCA N, R 'f(or) W Property Owner's Mail' g Address Lot Number Block Number City, State Zip Code Phone Numer Subdivision Name or CSM Number YGv ~ IN S~Gr/2 II Type of Building: (check one) Eity ❑ Village Town of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): Q It- Ad JA < ❑ State-owned 9-Nearest Road 11. Type of Permit: (Check only one box on linXehe box on line B ifapplicable) Farce : Number(s) A) 1.❑ Repair 2. ❑ Reconnectioplumbing 4. ❑ Rejuvenation 4 /i/o G1 d d ion l7 Permit Number Telssued • W+' B) ❑ State Sanitary Permit was previously issued Willi IV. Type of POWT System: (Check all that apply) i~ v Q}se,, 3 ;,Z0 c;o„Q ~ • ❑ 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 ❑ Single Pass Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ~46dp~ 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 0 Required Proposed (Gals./day/sq.ft.) (Min./inch) 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 0 a ) iE'S~1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume responsibility for repair/reconnenction/rejuvenatiorLrinstallation 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 Signatur (no s~ampS): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) urn. Grs`~ : SyGa 2- .Za6 - 3tio' 14", III. County Use Only roved Sanitary Permit Fee Dat Issu d Issuing nt Signa re ( t s Approved Owner Giv i i verse De a nation ~f G- IX. Conditions of Appproval/Rlleasons for Disapproval: 11544 d c~ l ~d w-C 4~ ► i.. 400 cam c/vt,~P,55 a. Z d / Ca mod- a ~ 3 ~~/oae-lc(s p i i v CA 3~ 0 Q) X .fl 4 y' F y2 8 1 1 1 2 2 6 State Bar of Wisconsin Form 1-2003 ?x:4688299 WARRANTY DEED 968715 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Randall G. Thompson, a resident of the State of Ohio, 12/04/ 2012 12.29 PM an undivided 1/3 interest EXEMPT#: NA ("Grantor," whether one or more), REC FEE: 30.00 and Ura H. Gingerich and Mary D. Gingerich, Husband and Wife TRANS FEE: 199.20 PAGES: 2 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): t PARCEL 1: The Northwest Quarter of the Northwest Quarter (N W 1/4 of N W Thomas A. McCormack Section Eleven (11), Township Twenty-Eight (28) North, Range Fifteen (15) West, 1020 10th Avenue more particularly described in Exhibit "A" attached hereto and made a part hereof. PO Box 2120 Baldwin, WI 54002 PARCEL 2: Outlot One (1) of Certified Survey Map recorded September 29, 1999 inVolume 13, Page 3737, as Document No. 61 1219 in the Office of the Register of 0 1024-70-000 and 004-10040.100 Deeds for St. Croix County, Wisconsin and being located in the Southwest Quarter of the Southwest Quarter (SW 1/4 SW 1/4) Section Two (2), Township Twenty-Eight Parcel Identification Number (PIN) (28) North, Range Fifteen (15) West, Town of Cady, St. Croix County, Wisconsin This is not homestead property. is not Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements and rights of way of record including easement for town road purposes as now laid out and travelled; Suitability of Parcel 2 for bbuildable lot or private septic system; Taxes for the year 2012 now accruing Dated p D L (SEAL) (SEAL) * " Randall G Thompson ,,%tttlt~,~' (SEAL) AUTHENTICATION ACKNOWLEDGMENT- ago Signature(s) C4k STATE OF VICI.SCQAISAN =a s~ . authenticated on s eza COUNTY ) 7iittOf tpt~~~. * Personally came before me on tZ~~ -24)1 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Randall G.. Thompson (If not, exe e f regoing authorized by Wis. Stat. § 706.06) to me known jacknr instrument and THIS INSTRUMENT DRAFTED BY: Francis X. Rivard " Menomonie, Wl 54751 Notary Public, My Commissioes..-UL 3-ZU ) (Signatur es may be authenticated or acknowledged. NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. 1 ~R NTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 -Type name below signatures. 8 1 1 1 2 2 4 State Bar of Wisconsin Form 1-2003 Tx:4088299 WARRANTY DEED 968714 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Thomas L. Thompson, a resident of the State of 12/04/2012 12:29 PM Minnesota, an undivided 1/3 interest and Galen R. Thompson, a single individual, an EXEMPT#: NA undivided 1/3 interest REC FEE: 30.00 ("Grantor," whether one or more), TRANS FEE: 398.10 and Ura H. Gingerich and Mary D. Gingerich, Husband and Wife PAGES: 2 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in [Recording St. Croix County, State of Wisconsin ("Property") (if more space is Area needed, please attach addendum): t` PARCEL 1: The Northwest Quarter of the Northwest Quarter (NW 1/4 of NW '/4), Thomas A. McCormack Section Eleven (11), Township Twenty-Eight (28) North, Range Fifteen (15) West, 1020 10th Avenue more particularly described in Exhibit "A" attached hereto and made a part hereof. PO Box 2120 Baldwin, Wl 54002 PARCEL 2: Outlot One (1) of Certified Survey Map recorded September 29, 1999 inVolume 13, Page 3737, as Document No. 61 1219 in the Office of the Register of 004-1024-7U-000 and 004-1004 40-IUU Deeds for St. Croix County, Wisconsin and being located in the Southwest Quarter of the Southwest Quarter (SW 1/4 SW 1/4) Section Two (2), Township Twenty-Eight Parcel Identification Number (PIN) (28) North, Range Fifteen (15) West, Town of Cady, St. Croix County, Wisconsin This is 1101 homestead property. is not Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements and rights of way of record including easement for town road purposes as now laid out and travelled; Suitability of Parcel 2 for buildable lot or private septic system; Taxes for the year 2012 now accruing Dated ~Z " o ✓ (SEAL) /Vl~,,c rj l ~'lae,-~ (SEAL) * * Thomas L. Thompson 11 ' wl (SEAL) (SEAL) ~7 s * Galen R. Thompson AUTHENTICATION ACKNOWLEDGMENT „Ma STATE OF WISCONSIN autSL r 01 of , ) ss. S' d1ticate , a 0 COUNTY ) X * ,~~,~I L t UPersonally came before me on TIT E: MBER STATE BAR OF WISCONSIN the above-named Thomas L. Thompson and Galen R. Thompson 1 ot, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Francis X. Rivard Menomonie, WI 54751 Notary Public, State of Wisconsin My Commission (is permanent) (expires: ) tSignatures may be authenticated or acknowledged. Both are not necessary.) NO'T'E: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. 1 ~RANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 Type name below signatures. / 2012 Property Record St Croix County, WI Assessed values not finalized until after Board of Review Property information is valid as of Nov 5 201210.'27PP4 OWNER CO-OWNER(S) GALEN, THOMAS & RANDALL THOMPSON 1105 CTY RD N ROBERTS, WI 54023 PROPERTY DESCRIPTION PROPERTY INFORMATION SEC 11 T28N R15W 35A NW NW ExC 5A SW COR Property Address: Parcel ID: 004102470000 TOWN OF CADY Municipality: Alternate ID: 11.28.15.168A School Districts: SCH DIST SPRING VALLEY DEED INFORMATION Other Districts: Volume Paae' Document # CHIP VALLEY VOTECH 956447 Section Tow n Range Qtr Qtr Section Otr Section 956446 11 28N 15W 812 326 Lot: Block: Fiat Name NOT AVAILABLE LAND VALUATION Valuation Date: 0412312012 TAX INFORMATION Code Acres Land Value Irr rovements Total Net Tax Before Lottery First Dollar Credits: 0.00 G4 25.500 5,800 0 5,800 G~ 9.500 12,100. 0 12,100 Lottery Credit 0.00 Frst Dollar Credit: 0.00 35.000 17,900 0 17,900 Net Tax After: 0.00 35.000 Total Acres: Amt. Due Aria. Paid Balance Assessment Ratio: 0.0000 Tax 0.00 0.00 0.00 SpecialAssmnt 0.00 0.00 0.00 Mll Rate: Not Available Special Chrg 0.00 0.00 0.00 Fair Market Value: Use Value Assessment Delinquent Chrg 0.00 0.00 0.00 Private Forest 0.00 0.00 0.00 Woodland Tax 0.00 0.00 0.00 INSTALLM ENTS Managed Forest 0.00 0.00 0.00 Prop. Tax Interest 0.00 0.00 Period End Date Amount Spec. Tax Interest 0.00 0.00 Prop. Tax Penalty 0.00 0.00 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 # Source Type Amount Tax Status Assess. Status Interest Penal Total - t a~ r_ ~ ~ p'~"'+k, * £ 'Yy. ,y:.; y~~-, ~yyy ~M 8"+~E ryv.: 'tt' r,~7;`.,~i~~ t~1~ 'qep• ~ . 3 ~~.,..v., ° ~ a~:~•'4~'~~,.~.~).,. ~ ~ Ash-~.,~ 4 ay,, ~ .'Wi't 'f: Ma. '~;j' ,9"°`"K~'°.'~~;, yygeiy y,~y~~• h i ~X~" r9 ~.W'~"•„x,..~* as. 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