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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 $2._1_1_ Location: 401 233rd Street Baldwin, WI 54002 (SE 114 SW 1114 9 T28N R16 W) 40 acres Lot Parcel No: 09 18,16 132 //~/~1 1.) All BM Description = FdD~ t10~ Ali L/..+, ` e Aw AD PoJ rc" 2.) Bldg sewer length = n 1`~ - amount of cover = cuC-Q., 01r- at^5 p tcR-. oy~ y Li r Plan revision Required? III) Yes KNo I~ J_ 7~} I (y Use other side for additional information. ~l 16 ` I /J L_. _ Dabs k,aepcl s Sams re Car N. SSD-6710 (R 3197) D` E z z z co m r O o O C/) 0 y~ -I \ J < K O O 00 O co r m r r ~O m 0 2 D w{ D r N c fv Z= _ n n m m m 00 C N Z ttl Z cZi~ o Z O C Z7 `M C m CD A -n U) c c;o --i zz ;u 0 cn n OZ m o z I ~Q m x °v3 mm 5S su IF ma gam L tv m ° m~ dm mm oC~)$g~ m~ am~ I` co § m 2 ? m m g T m °o ° G Oz aB m~ g8 ;u SO r c o a= xa m G = o° o~ i cu m m S m s m w X v c , n c n" Z Z o c S o" c & C m ;1 a3@ 4qq5 1 ~OD - v a m 5 a m to = 3° O O Z O D m d~ e' ao z zc) z 8 ❑ p~ ❑ ❑ ~a , \ i 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 i Na D/u n...~.t 4110")J ,ham NO A-ta_ ✓vUr.ss Ol Z Ow~<,` ~a cQi( ~r gas c on a~ (tis1,11a L 3)l A l l 5 "5 a~o~ _ ~i i ^ I I~ aP ' ~or~" L'-~`-~ •N M l JL~ S 1 ~ ( 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 ~ , ~ N favs ~~ys - S S ~ ~ I~ ~/opp G4- I I 1~ 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