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HomeMy WebLinkAbout008-1025-90-050 ' W:scAnsm mMI OICPmmcrU' CI : I(11% PRIVATE SEWAGE SYSTEM ounry Solely and Building Division - - INSPECTION REPORT S-nnaryPermervo 173 C4NERALINFORMATION (AT IACH TO PERM T) Stare Plan ID No ncrsnnni m!un1'aaon you Froatle may Ix used'nr secondary C✓peses (Pmaor ; aw, s 15 nd (I)(m(I Permit Folders Name Cdy Village X loxnship poll Tax No Miller, Jcse h J Eau Galle• Town of 008--025-9g-ma CST 1414 F ev Insp. BM Ek`v L461 (k•ur.DWYr 1kx_mr~ Rrxu.Ranyo'IJ,, Ixa 09.281E 132 S TANK INFORMATION ELEVATION DATA TYPE NU\NUFACFURER CAPACITY STATION US HI FS E~EV Sealic Benchmark Dosing - / 1 - - AII. Bid Aeration ` Bldg Sevier Holding SUHt Inlet Fil Outlet TANK SETBACK INFORMATION St TANK 10 4P ItL WELL BI W vent ions Il ROAD Ul hill I Septic Dt Bottom Ucsing Headerill Aeration Dist. Pipe Held:ng ~ Bot System Final Grade PUMPISIPHON INFORMATION Man"facturcr UowirJ St Cover CF'lal Model Number TDH L.It Frialon Loss System Head TDH F: f wl e:main Lengtn Dia Dsl. to well SOIL ABSORPTION SYSTEM DEWTRENCH V.41in Lerrgln ldo Of Tferneres PR DIMENSIONS Nr Ct Pi L•: :nsice Ca I r:ud Uepr DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL IAKE:STREAM LEACHING Manu!u:uns INFORMATION Iype(Y System CHAMBEHOR UNIT Model Ncntx, DISTRIBUTION SYSTEM r loaocr;l lold Disinbunon x Hot, Size x Hole Sp: ,v Vent to Av Irrtal.c - P tel J Ir,gN J',a_ Length-- Dia Spacing__ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Ovtt Depth (IVer xs Dean of 7 SCUxGSo70ec xx 1&4hed Falylnrch Center Bed'Trench Edges ToDScil Yes No Yes - Na COMMENTS: (Include code ci screpencies. persons present, etc.) Inspection at _1Inspection 02._ I Location: 401 233rd SUeel Baldwin, 'Jill 541 (SE 114 SW IM 9 T28N R1SW) 40 acres Lot Parcel No: 09.28.16 132 1.1 AB BM Description = l~a~ I : r Y' (C ~o..t pr,✓ v{ 2. ) Bldg sewer Ierni = L/~- J ( r - amount of cover = D+t-~+~ T-4stK.. SP - 4 G ` ! O✓L U i i Plan revision Requi!ed? YesNO 1 C z cj Z S 3 (f 7S Use other side for additional information. - Dole SSD-G'10 (R 3,91) nsepel s S gn .ne for 1:: I O w p ~n a C 'I Y D n ` O U U W 1 Y rt E o w L rqZ ml u O L 0 q ] P' j Sy LL r C_ LL C O O Y O V 3 ~ ~Y ; C E C ¢n qp ~ U Z w I y Y Q o E E Q. UI J 00 Y Y ~ fir' a nw am a© ii r vi F 0 c O ti O Z e V m K c x u Z Q ° ~ o w E$ N 1- r !0 Y ~ c C - i9 m v w d N pU = Y C . ,i t fD E ti - S n g Y Y> \ E E w n LL o r 2 ~ Y vm n c O 0 c Z T. 0 m Z a Z i a ` Z `c e ~I A J N W .t.C Y r p Y- m $ C ~ Q ;i r m 3 C 3 ~ ~ AY m 'fi R = 0 0 a - O❑ a U ° c H F N N N E c ° a D c H H r 0 0 00 0 3 3 r' c 'h a a a a a m a 00 r a 's ~ • . 2i d' N N _Y N N r m ~ V o o Z in o V ° b m a w p ' Mac o A ~o~ r `i °y N p' = D p N O p = E m ~0 y Y q Z U) m ~O p ~ ~ ~ a w Q R' L Q a I Z OI C o Q w ❑ Q O ww cc V o F c c ° ' ~ c r ° O a O n O a' O Y L V Or F Q T. as C~ U ° Y Q OI O~ V a Y N n V O M t t C lVo. N E C N N N Y C~ ~ Y ° ~ C~ C N D ~./V Ta L' E u E o u J ° ii G € a € a n m !3w a Z. a L [`ti E o c c c° c 03 _J C U a 2 O H O 0 in 0 i County Sanitary Permit Application Sr CROIX COUNTY WISCONSIN Ir .yew will h,pun 1 Goi> Court) oarvtar I c r a: r,.e PANNING 8 ZONING DEPARTMENT ~~1L6 F rsinaf inhtnala yo.. P u, Je nay uc uscu f r .r(:: r7a , PI-Dc 'i( I% OJNIY GU V RNIdENT GcNTFP. Law S 1504'°I D7 CJn hraRa3C 1-1513M10 gtr it 461 W: i I e~dC -d5e[ Faz i? 51385-=636 Anne! ::rreplate ans. t th^_ 5ysiem on ooa.- not r•rt% than S-' r I - inches m so: GJJnt) $a'drarv "I'll, l'.hrx- tf rev,4,x IC ivemo'as;opbCanorl Application information - Please Print all Information 1 Location: Property Owoe' Name 1< r T $N• L;N. Frupc ly Ow.w.'s Mafloq.41]re;s Lo: Numher Black Number Cuy. State Zip Cox PhDne Nu°,u' -~u9t0s,or None a GSfANJm0v, 11 Typo of Building: ioheck one) 2e ^ • I r~ -.tarty U'sri! agc vin ut O tut Faoih-',.,nnp-'Jr. of Rvv,11.1 LI V;IGbNCOmmP-culldF;rrbe use 1. 2 k- ~I~,~y~n.Q~ etlL ❑ Slalr Va le_ AJ6 Nede (Road 70 f it. Type of Permit: i(Jnat. rl:y nne hn)on im A 7:-i,# tma nn hne ° f•aroei Tar Numbe'i<) 1 1.U 4epN( -7 R=core=c:'cx .~'v :r;tlu'nbap 4. ❑ Ru!u~aer,aUOr A) Sarn;a:~nn Pe,.! Nu(nbe: ICalr I>sucG B) Stale :Smnlara '.vu:; prevIDUSI'+issueC IV. Type of PO `.T System: (Check all that apply) t L. r' I. 'rnriv>s-t r. I'rprnuo=C M-jun!]24 i^ .ultabm m'i _ 1vlo: , i.:+,I-cl cal -lyc_n::n-7 Sand Fiper C n1nstn.C.re.([4Ve11anU _ Peal lIOr imP Lme C P.r;:r.czec In-yo.:rc F. -uiurlu Tank O 6'riale pas, n OUwa AI-grade C Aerodc f,estmsn: Unit = ke•rtir;,u.aUnp V Dispersal 'teralment AIPat Information: Desi;lr Frmv In?d' L1 - ;,;t' A(^a 3. J cpelsal Area A. Soil .C nl?I~m iwiP E. Sysle"Flevatinn I maGraU!4pAnoFile 7,77i, . 4u^.~ne7 Pmposrr. 13als +cay':A "d.r;inch,, 6levalron I. Tank InlormaGOn Caoalcic m Galion( Tot, -01 1da•mtaa.up• Pre:ab Ste Gr.- Steol F:rt:r- P asbc NUN Fx Fla,. Gallons ianx•: (bncrel9 struae;f Sias, ',mks. Talks _ ` ❑ J C ❑ 11. Responsibility Statement I. the mCFSSi~ned, aas.me resJOnst:abty lo. ror~artrroconro'rctwn~rquvenanrrv5rtnallabon d F, ,,rg for I-, 'O'•NTS shown cc I•ro attached plays. A Icen5e s nc: Ie4uUVI I;;- iv tdi ll ttlpai: of the installation of •Ipt „IJmbin sanitation (:Y' 1,1,T. Rumber's Nam . jpnnt: ~Iumt ers s4nalu2 n ianipC ~1.:cAP :f: tJc. tiu.aoe. Pnone'Jurnbul 1I,mL',rs Aodress 6heet. ~Ik. star(:. Ip :o0ef Ill. Counf Use Only 'bmi'1', Perri' Fee 2-Z5. s5us n_ nc,,, r l a Fe ~ O a JI :T 1% 6pnd,in`-IF of Pprov I Aeasons for Disapproval: .-Ad U a(led~ r l/(/ Z ~v ..1 C a11X d~ a' f f ~ ran K l ~ I~ ~.a_ dC % &:54a l it Y- 7I iV F t 1_- - y. ~l ~ I , it (J i ' < ~I r. z V ~ I J I ~L _ i il~ ~t CAw'nmcn: Nut:.N.t h:ni nnn kite SL Croix County 961297 BETH PABST REGISTER OF DEEDS Non-Plumbing Sanitation.41fidavit ST. CROIX CO., WI j c RECEIVED FOR RECORD ^:a1ne -(Owner) "PypeJ or printed 08106/2012 4:37 PM being duly scorn. states, under will, thaE EXEMPT REC FEE: 300.00 He/she is the owner of the`ollntving parcel of land I;w:atcd in St. PAGES:1 Croix County, Wisconsin, recorded in Volume Page D(:curnert Numbcrg6ovf~_St. Croix County Re4islcr of Deccs Office: parcel Wand located in part of th o' the and ti)e G of the 114 i. of Section T j f- \ Kj(-W. l'o-wn of ..St. Croix County, Wisconsin. being July Jescrib d a, ~ ~l rd (/e C° ~Y ; ` follo%s GDClutie lot no and ubdivision/CSNI or derailed legal description): 4G_L a S - 2a_ .000 Pawl Wusuh..enms Vu:. x: ~r'!h'; 1 A new structure on this lot will be used as a habitable dvv'cllirg bu: will :ontam no plumbing for potab'c water an,j or wasle•.vater. OccupjiLf of said structure utilize a vault privs• for dEsposa ul huma;t waste, '.chick coon mahuneed L-y v n.n: plumbing sanitation permit in e:umpliancr with Srctious I ~-A. I e and I? >n 2 ul tf:e cuuuly sanitary ordieanca Ko plamUinc may br irs::+llc(t in the prrmiscs scn•rd hp 16c nun-plunlbiug san.:anion ucvice cntil a son i(ary pennn ton, been obtained fo::nslalla,ion of 'd code-compliant POW! S. The contcns of thr vauh sh;ill be ths[xised in aecoldanec with KR 117, 'Nis- Adm. Code. 4 TI;k agrees:enl shall bz binding on the owner, their heirs, assigrecs and or lad commc•: purchaser also acknowledge tha: I win disclose this inlormation to any paroes :nterestc•.d it, purcbasi.lg in,, property rl the Hour:- cal.dlh5 day<i./J,,j x x AlITHEN1ICA I ION AchF0v1' 1.EDGh10 1 Signawrctfl $I', TF OF wuISISCON$I\ St Cn 6-r.us:. +11 oix authcntzatnd tbi: d:col ::na cla_' 3 ne assn a nxr.vd T. fLE MEMBER $T.4TE 84R QF N`LCi nVSIT' II 1 p t.nnH(: czccmcd nu I:n c: Ding instnet r I .stet. "]'III r.: (If rot _ - IIKU vcd 1)1 ¢ X6 6. K'rs. $InI5.1 . w l 5 iTY.l.4i-.C: w'AS iRArr>-. J /Pc~tn•u'a r- n hI-,i scrip .n.s t Nirnatwtc sane IK aulh<n:icatnl rt a:'<rnwlcdgcd. U: `a. t tuns ss:cn p w i s.-: note cx Fr Almn.tn.c n:u~can i I.a c _ _ J - - _"'1 H11 YAGF 1? VA1O 01 :If I5I.E6AL UOCt NEK'I'- 110 ?O [ RL%10%E" '.'hum,/wmano+mes•5a.a•'/,etr:ir+.uhnuee.dn.v_'i.Ne non:6 er _<i.1- mA%P. rJ <;m 1 01 Aaasei ilagv dtr:":Onvr t,:.tun :xY:nrJ oo lhr..Ja•;rv;e n' dv Ja wicot o,~ :gc n:A4: vK. cabr to_au da-u. ons:r.ts'.r: i:ar.:n tY.S' .Dr,r IUMLS. NO. STATF. DAR OFR'ISCONSIV TO-(M Ih ;J<' ~'iI!Illl~ll IIIhIL~II i 0 b' TRI:STFF CDLF.D c+;.q cI •r 960413 It:u ry Sevier, as Tru>lcr. rI Charlrs 1. Srricr and Ca[nan J. Series F.mily BETH PABST Tn,s[,fl-avxluAic un~l:c:a .m...... k. Juseph.l.]filler nd LiA,ie U. REGIS I' ER OF DEEDS Miller ~"ib(i~'1C, Y1(~ 4['G. V✓l!G;r _ (era t c, the !oL;: w::{z ST. CROIX CO., WI scdbcd real call in SI CROIX C,,,7,:y, SI f •,f W'+-.< I. 07/24/2012 4:37 PM l'he SES: ul Ihr SN"s and Wr S:i of S\\'S: oI the SF'4 of Sec Gon 7, T."nship EXEMPT=: NA 24 Nm'Ih, Ra+rir to \\est. I.,.n o! Pau G:dlc. S( Croi, C.O.t,AVhc.nsin. REC FEE: 30.00 -IZ'=-.U! (`.~rv~.,,, t".n-.` iili !%7f. r:=•1~ TRANS FEF: 576.00 PAGES: 1 i u.-1118,` lo - i ~cph J. 6ev*try nnr Va~y~; 1/1(111- Q-l Ch.,le,T. S\ ,irr (Uid Ca,.Iyn.J. ) i- 1, Is I .vial ICI •li5a rr'v 1er~ ~ - -IlmKC _ In..rK AU'I'l1ENT1C'ATf0N AC 6.NOWLP.DGMENT ::m •r l_i ' GT.ITI tT-N'ISCt7NSIV uthcnti atcd thin Ins of-- - ]U ' CO'-:MYOF 5T CROIX •'11 f MCMNhft SI'ATr bAlt DF WISCONSIN' Personaav can,c ictufc nw lhts <'4th das of .r.I,.:.I IJ. u,. .d n...z (;Y nat, uan¢,i Hal vs Se[ Iel, xs T{ us(ce of the C'hzrlcs I. Srrirr and .rwh~ / i I. ♦ f -.04 Nfn. Slats. r _ _ - Cxrelsn J ScI Icr Fn[mly Irust t me known ;u :w the 1 r i:.i . wnu eta.: ulu. the Ln cSC<v5 vn pl: n1 nd/ac W,owlea!YC [he .:m 1:A1 NSTRGMrC'T WAS DRAICLIVI r _ N :20?Ctl 1.. Lcbcrn 1ft~Llrny C~. /iJ --(:Pr.-tCr . -berg Law Office N.(.ry Public St Croix County, `\',s {`..Yr,auuu . ,.',y h^ a,.thcnlicatcd or acluwwledveA !!mh mr !"l~ Cn:mm~anm p ^maucr.a. 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