HomeMy WebLinkAbout008-1025-90-010
wishes n Department of Commerce PRIVATE SEWAGE SYSTEM County
St. Croix
Safety and Buedrg DivuiOn Sanitary Pemmd No'.
' INSPECTION REPORT 170
i GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Persortal information you provide may be used for secondary purposes (Privacy Law, 6.15.04 (1)(m)).
Pemvt Holders Name: City Village X Township Parcel Tax NO
' Miller Joseph J Eau Galle, Town o1 008-1025-90-099-
CST BM Elm
I 1 into, and t;wv- BM Desnlppow SecuonrTavmrRarlgeralap No
09.28.16.132
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic , .1 Benchmark
LLJ t 3Z
Dosing AIL BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION SUHt Outlet
TANK TO PA. WELL D G. Vent to Air intake ROAD of Inlet
ys Of Bottom
Dsnc / xs zs Header/Man.
Aeration Dial Pipe
Bonding - 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
BEDITRENCH width Length No. Or Trenches PIT DIMENSIONS No. Of Pill hslde is Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO PIL BLDG WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR
Type OI System' UNIT Model Number.
DISTRIBUTION SYSTEM
1HeaderMandold Distribution x Hole Size X Hole Spacing Vent to Air Intake
P-piri
Length Dla Dw _ Spacing._
SOIL COVER x Pressure Systems Only as Mound Or A14rade Systems Only
Depth Over Depth Over xx Depth of u SeededfSoddeo xx Mulched
BeMrandr Cromer BedrTrench Fdges TOpsol Fill] Y" lei No 1ift yef 7% No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection Inspection $2._1_1_
Location: 401 233rd Street Baldwin, WI 54002 (SE 114 SW 1114 9 T28N R16 W) 40 acres Lot Parcel No: 09 18,16 132
//~/~1
1.) All BM Description = FdD~ t10~ Ali L/..+, ` e Aw AD PoJ rc"
2.) Bldg sewer length = n 1`~
- amount of cover = cuC-Q., 01r- at^5 p tcR-. oy~ y Li r
Plan revision Required? III) Yes KNo I~ J_
7~} I (y
Use other side for additional information. ~l 16 ` I /J L_. _
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SSD-6710 (R 3197)
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County Sanitary Permit Application ST. CRaX COUNTY WISCONSIN
Io aa:mtl with Chaperl 12 St. Croix County Sanitary Ordinance PLANNING 6 ZONING DEPARTMENT
f ew Personal information you provide maybe used for sceor py~sos ST. CROIX MINTY GOVERNMENT CENTER
(Privacy Law. S. 15.04(1)Im)l 1101 Carmichael Road
4 Hudson, W 154016-7710
(715)386 4680 Fax 715 386 4686
Allach corn plots plans for the stem on paper not less than L x 1 es :n size.
County Sanitary Permit F1 Check if revision to previous applicatio
Application Information - Please Print all Information 4 Location:
Property Owner Name {
JJ A~ 1l4 {t/v4. Sec
7 F Q r E (or
Property Owners Mailing f ' Address~ Pv ~llt'N\a6- Lot Numtwr Rock Number
e1~ x Suberasion Name a j Number f r
M. State Zip Code Phone Num`' -RAJ
j Ge r [v`ysj zyd* .733
1 Type of Building: (check one) [Liry ❑ Village own ti
L4 1 or 2 Family Dweling - No. of Bedrooms. s',y,'y~^v' Z33 ❑ PublidCommerclal (describe use): P,;&,
❑ State-owned Nearest Road
I. Type of Permit: (Check only one box on line A. Check box on file B if applicable)
JJ Parcel Tax Number(s)
A) 1.❑Repair Reconnection .l9NOnylumbing ❑Rejavenation
Sanitation OCT-loz5- 90.. G~
B) Permil Number Date Issued
❑ Slate Sanitary Permil was prev.ously issuexl
IV. Type of POWT System: (Check all that apply) 1Q.,~~/~~' 3G ( vaoa-
0 Non-pressurnzed In-ground ❑ Mound : 24m. sulable soil ❑ (Mound 5 24,n . suaade 01~ Mound A.0
❑ SaM Fitter n Constructed Wetland n Peat Filter ~p/Drip Une ~`t V
❑ I'mssurzed In-grni d t-] Holdvg Tank ❑ Singto Pass Oa Orner
F) At-grade ❑ Aerobic Treatment Unit ❑ Recirculating
V. DIs ersal?realment Area Information:
1. Design How (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade
Requ rod proposed (GalsJdaytsgJt.) (M-n.fineh) Elevation
I. Tank Information Capaicty in Gallons Total s of Manufacturer Prefab Site Con- Steel Fiber Plastic
New rx'sting Gallons Tanks Concrete sln.ctod glass
Tanks tanks I
❑ ❑ ❑ ❑ ❑
n ❑ ❑ ❑ ❑
II. Responsibility Statement
I, the urdrusignod, assume responsibility tot m"rlrecornercborvreNvenatioNinsialtation of non-plumbing for the POWTS shown on the attached plans. A
license is sal required for Lariat 11 r it rx the installation of non umd AAnpAIlen s stem.
Plumber's Name (print) Vlumbers Signature ( stamps). MPMPRS No. Business Phone Number
Of l1 'LN
Plumbers Address (Scree.!, City, Stale, Zip Code)
Vill. County Use Only 17 17
sapprove Sanityry P7orm7il Flee 1,42-
1 ss Atl Issuin gent 7
Approved Owner en I Worse nation
Conditions of ApprwalRieasons tot Disapproval: I
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LxX.'UMENT NO. STATE, BAR OF WISCONSIN FORM 16-1982 I IIIIIII 6 III9I181111IIIIII
TRUSTEE'S DEED 99 Tx:4051510
960413
Barry Seri<q as Trustee of Charles T. Serier and Carolyn.). Serier Family BETH PABST
Trust, for a valuable considemtim coveys to Joseph J. Miller and Liuie U. REGISTER OF DEEDS
Miller 11,wbGnd"A _vA_k,- Grantee. the following
described real estate in ST CROIX County, Stale of Wisconsin: ST. CRoXX CO., WI
07/24/2012 4:37 PM
The SF.'/, or the SW'/. and the S'h of SW'/, of the SEY.. of Section 9, Townsldp EXEMPT40: NA
29 North, Range 16 West, Town of Eau Grille, St. Croix County,Wlsconsin. REC FEE: 30.00
45krviVlrsht0 , fYukelt0d Ph P"ll TRANS FEE:
RETURN TO
J05" J. Mlltev
z(oaz 4w4iti a.4
Qerfty MD ts*4 ra3
Tax Pareei No: Oox-1026L,30-onji,
009-1025-90-"
Dated this 24dr day of July, 2012.
Chart e T. Serier d Carolyn J. Serier Family Trust
1 -Z;eLm 3e. (SCAT.) (SEAL)
Barry Serj r
Tmsm; Trustee
AUTHENTICATION ACKNOWLEDGMENT
Sigromimis)
,PATE UY WI5CUN5W
aurhem,cated this _ day of .20 es.
- COUNTY OF ST- CROIX
•
'I 'I ILL: MEMBER STATE GAR OF WISCONSIN Personally came before na: this 29th day of July, 2012. the above
(If not, named Barry Serier, as Trustee of the Charles T. Serier and
authorized by ¢ 706.06, Wit Ruin) Carolyn 3. Serier Family Trust to the known to be the person(s)
whoe~xecuted the foregoing instrument and acknowledge the same.
- - THIS INSTRUMI-N'r WAS DRAFTED BY
Robert L. l.ober¢ ~y'Yly" ~y'J~/Y/v C`- l a v P.-rtfl~
I.oberR Law Of Jut _ alnv Notary Public St Croix County, Wis.
(Signatures may be authenticalod or acknowledged. Both arc My Commissimi is Permanent. (If not, sate expiration date:
not necessary.) ) r~2-7~Zal to ' j~*t"
css,.t , ~sfr.,
•N•mu of psn•ra Haag •M'.F ~rY ,tuuMl lz ,Ylwd ur iwi,~ed Eplew ,Ma eyprwrt.. x~ E, N T E R y~
:.ai o ~ m '_wC
Y.''i rrte.rrgys~
~r• a
'1'R0.S'1'CN.'S UCl:D
1 oft
Parcel 008-1025-90-000 08/0712012 09.49 AM
PAGE 1 OF 1
Alt Parcel 08.28.16.132 008 - TOWN OF EAU GALLE
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): 0 = Current Owner. C = Current Co-Owner
0 - SERIER, CSC FAM TRUST %BARRY
C&C FAM TRUST %BARRY SERIER
2150 33RD AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist# Description
SC 0231 SCH D BALDWIN-WDVILLE
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 9 T28N R16W 40A SE SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
09-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
12107/2006 840184 JUD
03/01/1991 466865 894/209 OC
03/01/1991 466864 894208 QC
0524/1985 402209 712/558 QC
2012 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/06/2012
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 39000 7,700 0 7,700 NO 05
UNDEVELOPED G5 1.000 50 0 50 NO
Totals for 2012:
General Property 40.000 7,750 0 7,750
Woodland 0,000 0 0
Totals for 2011:
General Property 40,000 6.550 0 6.550
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 0411712001 Batch PRGRM
Specials:
User Special Code Category Amount
S ial Assessments S
Total P~ 000 pedal Cherge0s0 Delinquent Charg000
8074579
Doctarsent Number ones, mI Title Tx:4055659
961297
BETH PAB
St. Croix County I
PABST
Non-Plumbing Sanitation Affidavit REGISTER OF DEEDS
ST. CROIX CO., WI
JOo ~~L L'r r RECEIVED FOR RECORD
PM
37
Name-(Owner) Typed or printed E 08/0XEMPT
being duly sworn , states, under oath, that: EXEMP
REC FEE: 30.
0.00
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 6dv13_St. Croix County Register of Deeds Office: Recordia Arra
A parcel of land located in part of the $E_'/. of the W % and the Name and Return Address
of the SW of Section , T_.7F N - RILW, Town of m"Y'e'e,
St. Croix County, Wisconsin, being duly described as
aC la y` d Gje ~~"r;~
folio s~+G (include lot no. and subdivision/CSM or detailed legal
description): 00 - 6~S- YO -ooo
PNcel IdentifKalion Nwnber (PIN)
I. 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. Lg 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 PO WTS.
3. The contents of the vault shall be disposed in accordance with NR 113, Wis. Adm. Code.
4. This agreement shall be biricling on the owner, their heirs, assignees and/or land contract purchaser
1 also acknowledge that 1 will disclose this information to any parties interested in purchasing this property in the future.
Dnodthisday of ,`a[± -ILL .4-1140 l! III`
e e
AUTHENTICATION ACKNOWLEDGMENT
signalurt(s) STATEOFWISCONSIN )
)ss.
s. Croix County ) T'
__aurhentiumd this day of Purimsally came before me this day of .
t the above named
a nm known to he
TITLE- MEMBER STATF. BAR OF WISCONSIN the person(s) who "muted the foregoing instrument and acknowledge the
(Ifnq, sense.
by k 706.06, Wis. Stms.)
b.) y,,horiVA
T}~~S/a~a1RUME T aWAS DR
f~ ~`r U,M ~U✓N ZA~!~ 1.W.r' 1\Y M. ~U~
IH. Cw e/h- Public, Stale of \VI r nsin
(Sigmares may be autlxnticased or ackmswlWgW. My Commission is permanent. If wt, state expirafims dam:
Dale:
""its PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE"
TVs arfarawfton must be completed by sub miter: davmenl nlli. name d return adoYra med P!N f/f required). Other informonon such as the gm tang
t Of ttiousrs. kagal.4 ^.iixan, etc may be pia rd oe, thisfiat page of the document or way be pla¢d on addinonol pages of the dmunsem. Nae. Use of this
ewer pogr adds one page to your document and S2 100 to rhr recwdiar fee. Wiavrusa Sasaaes. 59 517
County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN
In accord with Chaperl 12 SL Croix County Sanitary Ordinance PLANNING & ZONING DEPARTLENT
` Personal nlorelion you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER
7 [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road
Hudson, ,Wl WI 540167710
(715'3854680 Fax (715)386A686
- Allah com etc la ^ 7 me system on papor not lens than ti-W2 x 11 inches in size.
County Sanitary Permb # ❑ Check it revigioq t~,praZ~.pl' ication
Application Information • Please Point all Intonation option:
Property Owner Name
/ 1r0 Wt/4, Sec
L J vl l (V r 1 R E
Property Owners Making Address - Lot Number Block Number
"I X3 I -
City, Stale D Zip Cade Phone Numer Subdivision Name gryCSM Number
S yo a a 37 Z3
Type of Building: (check one) ZOA t ty ❑ Village wn of
❑ 1 m 2 Family Dwelling - No. of Bedrooms:
❑ Public'Commercial (describe use)' tti 1 414
❑ State-owned Nearest Road L!
essississis 7c) H. Type of Permit: (Check only one box on line A- Check box on lire Bit applicable)
Parcel Tax Number(s)
A) 11.L] Rep., Reconnection .'[JNOn-plumbing ❑Rejwenalion do~-•- ~Oa•~' - r~0 •QM64
Sanitation
e) Peril Number Date Issued e
L] State Sanitary Perri was previously issued
IV. Type of POWT System: (Check all that apply) &,d.4A' j 17 r2""
❑ Ncniressunzed In-ground Cl Mound 2 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+O r
❑ Sard E ller ❑ Constructed Wetland ❑ Peat Filler ❑ Drip Line
❑ Pressuzed ln-ground ❑ fioldarp Tank ❑ Single Pass ❑ Omer
❑ Ai-grade [7 AerohiC'I roatnlera Unit ❑ Recirculating
V. Dls rsaLTreatment Area Information:
1. Design FIan fppc} c Dispersal Aroa 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Gmde
Rixlw, oo P*opcsx (GalsJday/sq.1L) ;Mtn Ankh) Elevation
i
VIL Tank Information Capaicty in Geaons Txal a of Manulacurer Prefab She Con. Slen Fiber plastic 'i
New Fnstinp Gaaons Tanks Concrete structed glass
I anks Tanks
❑ ❑ ❑ ❑ O
I. Responsiblllty Statement
the inders greed, assume respomibility, for repo:r/rocornenctionhojuv horArnstallatwn of non-plumbing for ft POWTS shown on the attached plans. A
Iconse is not regwrW for ltvraPh repair or the installation of non-plumtin sanitation stem.
umbers Name (print) Plumbers SI ature (rm stamps;: MP/MPRS No. Business Phone Number
LCrr
lumbers Address (Street CAy, Stale. Zip Code -
II. Cou use Only
Sanpiulap~ Ppmn Foc
provod Owner Giv nil W o a ~nn
AP D H21
n
apndiie1ou of provjLRea m forDisapproval:
r J\ AJO Ywvrbi w.~ r11104~ Lip ,I Sts ~'l /~t! /~✓f
f-:~ 4 3'~w. iS i~a(lec~ r/(I
4vw.n_ t t I
c47~1~. ~ . ~ •c,~- ~-r a~' adj.
i
~ I
~ ,
~
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favs ~~ys -
S S ~
~ I~
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UI8 II0 UIIII4I5I7 IIII~
Document Number IkicurrKnt Tide TX : 4055659
St. Croix County 961297
BETH PABST
Non-Plumbing Sanitation Affidavit REGISTER C DEEDS
ST. CROIX CO., WI
Ja a /~J~~ L r RECEIVED FOR RECORD
PM
2012 Name-(Owner)/Typed or printed E OS/0XEEMPMPT
E
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 Numberq(dv~3_St. Croix County Register of Deeds Office: Rrrardun Brea
A parcel of land located in part of the SLIA of the -Yw'/. and the Name mud Return Address
of the SW of Section 9 , T 2 P N - R-/LW, rown of ~p t
& 4 St. Croix County, Wisconsin, being duly described as v a to y6 d G~ Cy /ao Gt rs,
follok (include lot no. and subdivision/CSM or detailed legal
description): d0 - 6aS- YO -000
Parcel Idrnlincnrion Number (PIN)
I. 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 pi ivy 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. 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 PO WTS.
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.
I also acknowledge dim I will disclose this information to any panics interested in purchasing this property in the future.
baled this day of
~~TT~~
AUTHEN'11CATION ACKNOWLEDGMENT
signature(s) STATE OF WIS' NSI )
)Ss'
t. 'pi s County. I `
authenticated this day of Personally came before me this dry of
e U named
m\l~
* -
tow known it, be
TITLE. MEMUER STATE aAR OF WISCONSIN ` the poison(s) who executed die foregoing instrument and acknowledge the
(If not, _ same.
onicd by ¢ 706.06. Wis. Stats.) tv`"
tt~pSS NSTRUME T WAS
i s~ era,' G Z~, }{~fY (Y~. 18K~-_
i /f rn, ~ra~ owy Public. State of Wisconsin
i (Signatmer maybe authenticated or acknowledged My Camnuvvcn is puuutnent. ifriol, state mpastion due
necessary) Date.
"t'HIS PAGE. IS PART OF THIS LEGAL DOCUMENT - DO NOi REMOVE"
77+is irf/wmation wort be tomyfettd by wbmLNr- tkrsrmsn! rifle, rams d error oddrrQt and PL (frequiredJ. Utha infwma/ion sucfi as air granting
1 of claavs. leagal detc gonm. tic. may be pit ..d nn die first page of th, documem or maybe planed on addiumat pages of flit docnmenl. C'OK: Use of ihn
caws, pogo adds mr page ro your d«ameot a,d S2 00 to the recard me fee. Wiscr;mm Stanues. SP.S I7.
DOCU.MT.NT NO. STATE. BAR OF WISCONSIN FURM 16. 19R2 " I I III sll~~lll_IIIIII III
TRUSTEE'S DEED Tx:4051510
960413
Barry Serier, as Trustee. of Charl" T. Serier and Carolyn J. Serier Family BETH PABST
'frost, for n valuable eensideratio!1~coveys to Joseph J. Miller and I.irsie U. REGISTER OF DEEDS
Miller hUS4r(iyld n/lt1 IM-~P.'F Grantee, the following ST. CROIX CO., WI
described real cxtate in ST CROIX County, State of Wisconsin: 07/24/2012 4:37 PM
I'br SE'/. of the SW'/. and the SY. of SW'/. of the SE'/. of Section 9, township EXEMPTO: NA
29 ,North, Range 16 West, Town of Eau Calls, SL Croix Counly,Wiuonsin. ROC FEE: 30.00
-XSu•NIVIYSkj) marl(a1 py°pWy TRANS FEE: 576.00
PAGES: 1
REt11RN TO `
Joseph ,J . kit kt t-
QeYt Yy MD V ~6
'1'u Pucel No 00R-! 026-3Q O(!0~
nOx- 1021-90-000
Ili
Dazed this 24th day of July, 2012.
CharlesT. Serier d Carolyn J. Serier Family Trust
y nom,.--~• : ?n.a.,7a• (SEAL) (SEAL)
Barry Ser' r
Ttustre Taunre
AUTHENTICATION ACKNOWLEDGMENT
Signamre(s)_ STATE OF WISCONSIN
authenticared this day of__ - , 20 } a'
COUNTY OF Sr CROIX
TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before the this 24th day of July, 2012, the above
(if not, named Barry See-ter, as Trustee of the Charles T. Scrier and
authorized by § 706.1M, Wis. Suits.) - Carolyn J. Scrier Family Trust to me known to be the person(s)
who exrw;uted the foregoing instrument and acknowledge the same.
- 'I IIIS INSTRUMENT WAS DRAFTED BY ti• C~,~_ ~r T!`
Robert L. Loberg 7 /YY av > r y
Loberx Law_08ice__ _nlM Notary I'uhhc St Croix county. is
(Signatures tray be authenticated or acknowledged. Both ate My Conunission is permanent. (if not, state expiration date:
r.
not necessary.) ) 2- 217.o1 Lo
inner. or~mn.aane.n eni..e.u.r reua t»iy>.n «nneea awa•n.n sis,ww•t .i ~s`PQ EK Tq
-r,~g tr✓vo~. :.d
s•2t iAom ~h
.c
irrr4s1 0
TRUSTEE'S DEED
1 Of 1