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HomeMy WebLinkAbout032-1090-80-000 (D °o 4, ° I N C 0 3 I c m ~ s; I ' I ~ r I I!I' ~ I o c I N N E m 0W Z o E 7 m 3 o LL CO > _ N O C_ I a v ~ ~ I Z N E L,) w a m c+•) F- Z o I c m o z w i' o o m z N H e= i' O O Z I c E -2 o E m N N 7 N N N O C U) L • Irv Ll O O Z co z z c C: I N o P- E E N I' OR A Y tZ H M y c o v I: N O a a a c O N O O a o LO H F° H U w O Z <L Z O • ~ a a 0a N C N m' U I' E 0) rn o Z _ U)_ a) O N N o N rn _ E N O O O L m w N O O O N C °o 3 a o c c o O O N y N y U 0.. O O d0 _ f6 Q a C N N o i' 0 E E N o f C~ O y O t o C N N y" N O M N H H Q) O) t , M 93 *rxrl/ M M E U g E E U • L' O co n M (n Z N O A E cl E m 4) m y a t EL aL a m .2 m • c~ f Parcel 032-1090-80-025'5 06/11/2007 02:17 PM PAGE 1 OF 1 Alt. Parcel 33.31.19.432D-10 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/29/2004 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - NICHOLS, DAVID E & SANDRA S DAVID E & SANDRA S NICHOLS 1832 45TH ST SOMERSET WI 54025-7220 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1832 45TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 17.750 Plat: N/A-NOT AVAILABLE SEC 33 T31 N R1 9W PT NE SW & PT SE SW LOT Block/Condo Bldg: 4 CSM VOL 1/106(4.96 AC) & LOT 4 CSM 10/2731(12.79 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-31 N-1 9W Notes: Parcel History: Date Doc # Vol/Page Type 10/29/2004 778377 2685/193 AFF 07/23/1997 1186/437 WD 07/23/1997 1186/434 QC 07/23/1997 1130/331 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 58,000 175,300 233,300 NO PRODUCTIVE FORST LANDS G6 12.750 51,000 0 51,000 NO Totals for 2007: General Property 17.750 109,000 175,300 284,300 Woodland 0.000 0 0 Totals for 2006: General Property 17.750 109,000 175,300 284,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 11/08/2006 Batch 06-19 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor ar }1 Human Relations ivL-ion or Safety Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA # dimensioned, north arrow, and location and distance to nearest road. 032:1090-80 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VIEWED BY DATE PROPERTY OWNER: PR ERN LOCATION Dean GeD GO LOTNE 1/4aW 14,S33 T31 N,R 19 iF. (or) W PRQREfV OWNER':S MAILING A DRESS LOT # BD. NAME OR CSM # 06 150th. Ave. na na na CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN REST ROAD New Richmond, WI. 54017 (715)246-2834 Somerset 45th, St. ( New Construction Use JxJ Residential I Number of bedrooms 3 (J Addition to existin ilding j J Replacement J J Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate bed, gpolft2 60 trench, gpdm2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate • _5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.83 a (as referred to wie phi, benchmnak') Additional design / site considerations na Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SO" YTEM IN FILL HOLDING TANK U = Unsuitable fors stem I ®S ❑ U ®S o u ®S ❑ U ® S ❑ U S ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends X.t { 1 0-12 10yr2/2 none 1 2msbk mfr 2m .5 .6 1: ^i4 2 12-28 7.5yr4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 28-86 10yr6/3 none fs Osg mvfr na na .5 .6 elev. 102.83 ft. Depth to limiting factor +86" Remarks: Boring # 1 0-10 10yr2/2 none sl 2msbk mfr crw 2f 1.5 :.6 2 2 10-26 10yr4/4 none sl 2msbk mfr gw if .5 .6 I 3 26-84 10yr6/3 none fs Osg mvfr na na .5 1.6 Ground elev. 102.7, r~ Depth to , limiting factor ~ ~ +84" ' J f L'J r " Remarks: CST Name:-Please Print Phone' Gary L. Steel 715- 6 00~ Address: 1554 200th. Ave. , New Richmond, WI. 54017 i Signature: Date: umber: 11-1-94 cstm 0229 PROPERTY OWNER Dean Gehrman SOIL DESCRIPTION REPORT P41e, 2 of 3 PARCEL I.D. u 032-1090-80 Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bonctary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITmnch 3 1 0-21 10 r2/2 none sl 2mgr mfr gw 2m .5 j .6 €~<':<< 2 21-31 10yr4/4 none sl 2mgr mfr gw if .5 .6 Ground 3 31-82 10yr6/3 none fs osg mvfr na na .5 I .6 elev. i 101.83 ft. Depth to limiting factor +82" Remarks: Boring # 0-15 10yr3/3 none sl 2mgr mfr gw 2f .5 .6 4 » 2 15-34 10yr4/4 none sl 2msbk mfr gw if .5 .6 3 34-67 10yr6/3 none fs osg mvfr gw na .5 .6 Ground elev. 4 67-80 10yr5/4 none co s Osg ml na na .7 .8 101. 13t. Depth to limiting factor +80" Remarks: Boring # 1 0-19 10yr3/3 none sl 2msbk mvfr gw 2f 1.5 .6 Mf 5`~` 2 19-3 10yr4/4 none sl 2msbk mvfr gw if .5 .6 3 30-8 10yr5/4 none fs Osg mvfr na na .5 .6 Ground elev. 101.581. Depth to - limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) i STEEL'S SOIL SERVICE Gary L. Steel Dean Gehrman 1554 200th Ave. CSTM2298 NEgSW4 S33-T31N-x19W New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246-6200 t N 1"=40' BM.= top of SW lot survey stake at el. 100' /t rJ0 ti .oll r 0)"6 A 3s 2 ~ Gary L. Steel 11-1-94 APARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 3707 HUMAN RELATIONS o0 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: OWNSHI /MUNICIPALITY: LOT NO.: LK. NO.: SUBDIVISION NAME: s~/avll~/a /T N/R I ~h z COUNTY: MAILING ADDRESS: _ r17 0(- a c' 01 G y' o 1x e r~~ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI LE DESCRIPTIONS: iPERCOLATION TESTS: Residence New ❑Replace , / RATING: S= Site suitable for system U= Site unsuitable for system CO VENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) V$ ❑U ~A$ ❑U $ Oil [:]S [ZU .®U O ~orw. _71 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: 6/,a Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) p - /0 5t 9 /5r a-- fylo~~ 55i, -g ~--e B- a L/ I IC B-3 -4 © /o s~ o -,.;Ie a B_ q a► , r" 5-7j .7 ?/OT ~ S~ B- e, f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTERSWELLING INTERVAL-MIN. PERIOD L PERIOD 2 PER OD PER INCH P_ 1 o'Z a''`-'L G P_ a ~i P- P_ PLOT - PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent R of land slope. Z SYSTEM ELEVATION ' ago ~ ~ ~ ~ 666 7 ,1 Z-~i ID 1 9 1.._ ~V~~ I r 1~ ra lo~e fro u, Ict _ At IL e~k INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soll Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate meds - Medium Sand W - Well fs - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water ' Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point )L'rAR T °vIEN7 OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION NDUSTRY, -ABOR P.O. BOX 7969 WMAN RANEDLATIONS PERCOLATION TESTS (115) MADISON, WI 53707 HUMA (ILHR 83.090) & Chapter 145) _ .:BLK. NO.: SUB (VISION LOCAI'iON: SCCTION OWNSHI /MUNICIPALITY: LOT NO AME: S/T N/R ( ~1,L COUNTY: ~ MAILIN ADDRESS: lc,~ !C J nd~ Of ORATES OBSERVATIONS MADE JSE 7 l-Reside-nce NO.BEDRMS.: r OMMER ~A-C D~ RIPTION: S: ~ ,New ❑Replace { RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) $ ❑U ❑U $ ❑U EIS CgU [Is .®U t!orw. II Percolation Tests are NOT required 7DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: /Lc~~j Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH (NUMBER DEPTH IN, ELEVATION OBSERVED ES HE TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) 13- q, 121cr'-'e 1-5 , Ay 0.7 51 r o 13- / d s 00o B- /DO 9 vim- 160 ,z.Lf PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-IN HES RAT INUTES NUMBER I AFTER SWELLING INTERVAL-MIN. -PER I Q1 PERIOD PER IN H P- a .o-~ _ G P a - P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe whet are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 4~ -/,20, SYSTEM ELEVATION alp. 3~3' ~ m L6G 7 cro ~b" 1 t , s CERTIFIED SURVEY MAP N Located in part of the NE 4 of the SA, and in part of the r-3; SEk of the SWa, all in Section 33, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin. 4J 4J Z) U O O N M M O _ r q C> rE ID v;i ro L71 v0L. I ID G. I VO ai aI - - - 7 - - - - s <I f- 4J 0 CD w 41 -1j I - (89°30'W) `d ° v N89034' 26"W 1325.06' > 662.34' b y I-l 1299.40' CO W M ,-,7/ .N ~ W O L Cm M N L d M N C 14- ~ 3 N .t LOT4 H -1 L I N N O d 4- Ut N 4j ° ; 12.79 Acres M a CO I 557,142 Sq. Ft. CL W C\il N T N 1a d 4' I I > > N O L'j av ao ~ O+ 0 N a I- %1 o N88°20'06"E 659.44' 0 OWNER ( J i N L4 -66.00' 593.44' Dean Geh1-am Rt. 4, Box 230 New Richmond, Wi. 54017 M M LOT 3 N O M M M !n N N _ LOT 3 AREAS M M ° i O M 1 -4 4.89 Acres Inc. R/W `O N88020106"E 658.51' 213,066 Sq. Ft. -66.00' 592.51' Z 4.40 Acres Exc. R /W C`m p o I co 191,726 Sq. Ft. _ LOT 2 M O~ ✓1 o ^co N co ~ ~ M C ~ a O rl N 1 N rn 100 ROADWAY SE7BAC 1.INE STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER , 413 ADDRESS SUBDIVISION / CSM# LOT # SECTION T~N-R C _W, Town of //------SCONSIN ST. CROIX COUNT--Y, WI PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i INDITE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. • BENCHMARK: ®o ALTERNATE BM:- / SEPTIC TANK / 11PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: tnleles Liquid Capacity:_L Setback from: Well House Other ~ Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 42 Length Number of trenches Distance & Direction to nearest prop. line: 0 Setback from: well:_ House Other ELEVATIONS Building Sewer 1j/ 4~- ST Inlet: 11D5/, q ST outlet: 119--17& PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: 1 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: J, 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor anti Human Relations INSPECTION REPORT ST. CROIX 'Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 289339 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: NICHOLS, DAVID SOMERSET CST BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: ~GJ la ~Q Q5 s~ /4 032-1090-80-000 TANK INFORMATION ELEVATION DATA A9700155 A3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic S 6 r7 (a- Z .2W Benchmark r~ Dosi n ~ Aeration Bldg. Sewer 1171 Hold St/ Inlet 3, TANK SETBACK INFORMATION St/ I Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic y( NA Dt Bottom Dosing NA Headers A2109 Aeratio NA Dist. Pipe ~p Holding Bot. System ~3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lriction TDH Ft Forcern-aln Length Dia. Dist. To Well oss SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length No.Of Drenches No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S / DIMEN 1 SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA M acturer: SETBACK CHAMB INFORMATION Type O nQ t Moe Number: System: aql r W-Ci t1 A OR IT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) , x Hole Size x Hole Sy pacia_ Vent To Air Intake Length Dia. Length Dia. Spacing C~ SOIL COVER x Pressure Systems Only xx Mound Or rade Sys Depth Over Depth Over xx Depth Of, xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 33.31.19:-32D,NE,SW 1832 45TH STREET LOT 4 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division ~~:~'■~ir"ri SANITARY PERMIT APPLICATION Bureau of BuildinWater Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ' • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revi~ un to previous application [Privacy Law, s. 15.04 (1) (m)]: State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner N# e Property Location v' 1/4 1/4,S T , N, R V(or) W Propert Owner s MV In dress of Number Block Numbe / Cit Sta e I Zip Code Phone Number Subdivision Name or CSM Nu ber ( > CSC /0/010 3~ II. TYPE F BUILDING: (check one) ❑ State Owned o rill a arest Road Public 1 or 2 Family Dwelling - No. of bedrooms n of tip? e -11 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 [A Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min inch) Elevation 7 7 Feet , Feet VII TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App structed Tanks Tanks Septic Tank or Holding Tank - 9 El 1:1 ❑ 1 1:1 1-1 Lift Pump Tank /Siphon Chamber El ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT t, the ndersigned, assume responsibility for ins Ilation of the onsite sewage system shown on the attached plans. Plum r' ame: ~hi7PJ Plumb r'sS a o mps) MP/MPRSW No.: Business Phone Number: Plumber's A dress tree , City, State-Zip Code): IX. COUNTY DEPARTMENT USE ONLY El Disapproved Sa Itary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) #Approve d S urcharge Fee) ❑ Owner Given Initial y~~ y7 Adverse Determination CJ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling- III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),. address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume] elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the-soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. -vs A/I s Wisconsin--Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services i with s. ILHR 83.09, Wis. Adm. Code B, Attach complete site plan on paper not less 2x11 ' as inmate,, an must County include, but not limited to: vertical and ho ' I refer i M), •ct► n and percent slope, scale or dimensions, north a and I istano " arest road. Parcel I.D. # APPLICANT INFORMATION - Pllea a pM Jiff oQtion! Reviewed by Date Personal infomnation you provide may be used r $qc ndary pu acy Law, (t) (m)). Prope Owner Property Location - Govt. Lot 1/4 1/4,S~ T ,,R(or~ PropertyOwners Mailing Address Lot # Bloc Subd. Name or CSM# City Sta a Zip Code Phone Number Ci ❑ Village [Z Town Nearest Road A l~A New Construction Use: rvl Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2~trench, gpd/ft2 Absorption area required bed, ft2-_,-,Z-_trench, ft2 Maximum design loading rate - bed, gpd/ft2__4.S _trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations ' Parent material a6s~ Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system 0S ❑ U RS ❑ U (3S ❑ U ljzS❑ U ❑ S O U ❑ S, 1 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 01-5 RAC < - .s 7n- 5e/ Ground J4-.77 '1A 15el~ Al ev. 1 Depth to limiting factor in. Remarks: Boring # Ground elev. 14L2ft. Depth to limiting factor ' in. Remarks: CST Name (Please rin Signature ' Telephone No. n _ Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GVp/ft2 in. Munsell Qu. Sz. Cora Color Gr. Sz. Sh. Bed , Trench Ground M el f , Depth to limiting facto Remarks: Boring # 13 Ground elev. ft Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; Ground elev. n ' Depth to limiting factor in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) 14C. c"I"t ,ev -lT r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDING INDUSTRY, DIVISION: LABOR BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON W 5370(' O (ILHR 83.09(1) & Chapter 145) LOCATION: _ / SECTION: u e ( OWNSH /MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 5Z-114 )3,3 MAILING ADDRESS: G Y- o IX A a O < arc` 01 - USE DATES OBSERVATIONS MADE Ir~ NO. BEDRMS.: COMMERCIAL DESCRIPTION: R F NS: A ON TESTS: IAResidence r- 44New ❑Replace - / RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S [--]U (9S ❑U S ❑U ❑S ~U ❑S .®U 0 ~orw. If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: 64usI Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. WITH- EST TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) 13- 7 16V B- D - D 5< O --~.0 020' ~~-rt B-3 0 7 17 B- A~ B- 517 - PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER I M&WVS AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RIOD 2 P PER INCH P- o't a''`- G P. ~i P- P P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hor zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percer of land slope. SYSTEM ELEVATION aio' 3s3" rn `66 f a~ y3 ~r fig. b yf v at B l 6-54 o a ~101~ /ll 5 e- I V~o INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point GJ 1, A.) Di' ~Rr~r c rJ tZ(e~.~ Z S ~ - - 5130"70 CERTIFIED SURVEY MAP Located in part of the NEh of i the SA, and in part of the SE'h of the SW4, all in Section 33, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin. Nk Corner of ?Section 33 M to f, C' R I IFILD SURVEY iAAP M v o Nub M/C1L. I, ?G. 106 r N I33 33'I Pro s o C. ~p. v c (N990301W) ` l~lv►..,1994 I -"MY two -4- - - - - N89°34' 26"W 1325.06' - - - - I I " u Se c. L N N V v 637 Oti! r v = " - to 25.66' c. o ' ACCESS EA [4 to i I-►O o N89°34' 26"W 637.27' ,n c 1 o I i . S. t71 •N N ro to WELL GARAGE I r t L.1 I G C7.~ - - co W M o SEPTIC , OWNERS ~ ~ . 771 Thomas E Patty Goepfert i _ - n V []1 AGENT _ Co tn ! ..N CI ' David Bracht I 0 1 Re/Max Realty - WI' i CY.1 103 Main Street LOT I °D ( F-1 IJI i 11~ 3C ;z UJI Somerset, WI 54025 _ M g (-00 i w N r t= tn i-I a z , 20.35 Acres Inc. A/W z i o r1 =1 ~I ~,,Ha 1 886,464 Sq. Ft. o 21 v o d 1 c I 18.23 Acres Exc. R/W z -11 H M 794,203 Sq. Ft. u' C o. M ' un ! r'i,~ci d;?err oc' M .'t N . ,L.EN C ' 8 1 o. 94~ a, r,~ T' 5: C Tr1~. 1 - . _ W ° C r. FIUr' 4 COUNTY 1`3 V, d c W f..4.lztnsivo Planner U H c c o_ c v ° T_Ot;fcg and tit d Crrnmrttas s+J LL.. LA- v •a, , c c V v 4 o: o ai W o c . 7 i r o a a L W r nOt^6COrdcd •,~~Q'~09~~~C. i A . a rn a /ltrtllr J0 days of 0'~~ 3 2I c o o N o 4J M • r .CERTIFIED SURVEY MAP N Located in part of the NE o of the SW 4, and in part of the SEa of the SW's, all in Section 33, T31N, R19W, Town of vo= Somerset, St. Croix County, Wisconsin. u - o ar N M O ~,,1 ~cl~ T Ir-ILA ~L;h~~~~r 1~1ai' I 4- u ~ ~ I ~ ° ° v N89°34'26"W 1325.06' . b ~J~ 662.34' I- I 1299.40' ' mW~ I-I 11 ~ . 2 i ~ (~.yG'"' ~I . ~ ,2~3~ ~~3 ~ N ~ y.. . y., W p , d 10 d M U d C •N C 1 4- p ~ O .N i~ ~ ^ I d W w U L1 c vN `r' N LOT4 ~ s o O d 4- L I " N r..... y ' ~ ° ~ 12.79 Acres ~ .;''!.~~'1('"i~~'~ ~ 'Q c N ~JI l»I 557,142 Sq. Ft. ~ ~ m .u a C S I ~ r c ~ io ~ ~i -i P~~ ~ J~~f; ~ ~ d > H ° _~I CSI r_ v~ .-r W v ~1~' W I -I °p ~ ~ v!'.~::":?rC.:SSiVC ~ai►«wi _ ! 11 _II = ~ ~ x °1'_rrl::::~ and 1 ~ n_-~ J I o N88°20'06"E 659.44' i!~? r~corJ~i ~ 1~ I o w ~ri;'~i~~ :IO daTrs rof OWNER ~ ~ ~ I-66.00' ~ 593.44' Ke}:i~roval dm~t~ Dean Lehrman ~ I W ~ W ;~r~roval shr.31 ae Rt. 4, Box 230 V III o 0 o I ~ :1~:0 & va+cl H U. 2 ~ Neu Richmond, Wi. ~ _ _ = a - ~=W LOT 3 ° M M li W 4' N O M N N N - N V' Ch M N tD 6 2 1 lOT 3 AREAS °O `°I ~ 't 0o J M h.89 Acres Inc. R/W tO N88°20'06"E 658.51' °1 213,066 Sq. Ft. -66.00' 592.51' o 4.40 Acres Exc. R/W ^ s ~ i .91,726 Sq. Ft: ,o t _ ~„!~T 2 °1 rn rn rn~ ao f\'rn H _ ~ N 7 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property )4V/b Allc~toL5,9-wig ~A.Jc72A t~LS Location of property A16 1/41/4, Section 5?>, T 31 N-R_j c Township SOM~s~2$~T Mailing address 3l2 G~ ST 5o S O Z 5 Address of site Subdivision name Lot no. Other homes on property? --Yes X No Previous owner of property ~a-i4t 1 A. 461-fRtyAr! Total size of property Total size of parcel 7°l Date parcel was created Are all corners and lot lines identifiable? Yes _X No Is this property being developed for (spec house)? -Yes _X _No Volume /O and Page Number 2731 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAI. OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County fegister of Deeds as Document No. 5:~z5°lp, and that I (we) presently own the proposed site for the sewage disposal sy:;te,n or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in tho office of the County Register of Deed: a:; Document No. S~S9 33 signature of Applicant -Applicant Date of Signature Datc: o Si nature .3 ~E 1~ca' i ~LUr H.u of N n,.•muI I ,nm I`~t_` J ~i'.iRR~~~\ 11' I)Ef.l) ut>;:u, ' rrt t10 11.1711PAG. 4.37 ~.STcRSOFFICE ST. CROIX CTY., WI Dean A. Gehrman aka Dean Gehrman, a Piled !xPKIY1 single person, JUN 2 6 1 ~96 at 9:30--!! AM run,e,s.unl,salrnuslo David E. Nichols and T. 2,L...-k G.&L Sandra S. Nichol-. husband and wife. Reg•aterof0eeds as survivorship marital property. lm-i ;PAC-.L HESEHVED 004 HEC•iNrn:di n.rA '.A••,E AND HE IUHN ADORE SS the li 11o,%mg described real :,13(e In St.. Croix k mviiv. State of Wisconsin: -`C, ` Part of NE4 of SWk of Section 33, Townshi2 31 North, RangE 19 West, St. Croix Councv, 03~-1090-80 032-1091-80-200 Wisconsin described as follows: Lot 4 of 'Parc~lldentificationNumber) Certified Survey Map Filed April 16, 1975 in Vol.. "1", page'106, Doc. No. 3264G9. Together with and subject to a 66 foot wide road easement as shown on said Certified Survey Yap. Part of NE4 of SWk and part of SE4 of S Wk, ALL in Section 33, Township 31 North, Range 19 West, St. Croix County,, Wi-sconsin described as follows: Lot4 of Certified Survey Map filed February. 15, 1994 in Vol. "10", page 2731., Doc. No. 513070. Together with and subject to a 66 foot wide road easement as shown on Lot 1 of said Cer; iiied Survey :tap. TRAM~KER i'itis is not homesteadproperiv. (Is) (u nolI rsceptit...:o warramles: Municipal and zoning ordinances of record and recorded easements, restrictions and reservations. Daled this 25th day of June 19 96 . iSEAL) iSFALi mean A. Gehrman (SEAL) iSEAL) AUTHENTICATION ACKNOWLEDGMENT Signaiureli6 _ of Dean A. Gehriian t4L{ C1t1?1RL7U{tiE}. i Ss, f~ PAC'- ~ ~~i933 .-AGREEMENT f THIS AGREEMENT entered into by and between Thomas Goepfert and Patty Goepfert; husband and wife, hereinafter GOEPFERT, and Dean A. Gehrman, hereinafter GEHRMAN. ;IT IS-AGREED AS`. FOLLOWS 1. GOEPFERT is the owner of that parcel of real estate described as: Lot 1 of Certified Survey Map record.d in Volume 10 of CSM at page 2731 Document No. 513070, being located in part of the NE 1/4 of the SW 1/4- And 'in part -of -the -SE -1/4 of the SW 1/41 section -33-31-19,•_St.--.Croix County, Wisconsin. 2. GEHRMAN is the owner of that parcel of real estate described as:_ Lot 4 of the-Certified Survey Map referred to at paragraph 1 above. ; 3. There As an easement located along the North 66 feet of Lot 1 of said Certified Survey Map owned by GOEPFERT which provides access to Lot 4 of said,Certified Survey Map owned by GEHRMAN. 4. A private roadway has previously been constructed on and over the 66 foot access easement loca"-ed on said Lot 1. 5. The roadway deviates slightly across the South line of raid 66 foot access easement at various points to conform to the topography of the land. 6. GOEPFERT agrees with and consents to the location of said roadway as it is situated on said Lot 1 and hereby grants an access easement over such portions of Lot 1 which are affected by the roadway as presently laid out and constructed.- 7. This agreement is binding upon the parties hereto as well as their respective heirs, assigns, successors and legal representatives. IN WITNESS WHEREOF, the parties have executed this agreement this a`f_ day of June, 1996. Thomas-'Goepi rt Dean A. Gehrman REGISTER'S OFriC-' ST. CROa CTY, WI Patt •Goe'pfert ' P.VdbrPW71 JUN 2 6 1996 at 9:30 A. h1 P 11.8GPaA"o STATE OF WISCONSIN ) ss. I . L 1c~ COUNTY j Personally came before me.thisday of June, 1996, the above named Thomas Goepfert and Patty Goepfert, and Dean A. Gehrman to me known to be the persons who executed the foregoing instrument and acknowledged the same. "JOY K. TANNER WhrY Pobhc-SUte of WncDn5jn - r Notary_ ublic County, WI _ My Commission Expires: Cc~ S This ;Document Drafted By: Bert D. Petersen Attorney at Law Clear Lake, WI 54005 E STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County / OWNERIBUYER MAILING ADDRESS 3 I2. GE1DA t2 S? Sr'1e 25 ? LJ l S'tIOzS PROPERTY ADDRESS 1 . L ,Er~•:T If~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE S"01y?e-tz5'6T /'j/ '5" ~lo Z 5 PROPERTY LOCATION _ 1/4, $ W 1/4, Section T~_N-R 19 W 'OWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER _ ~A(_ CERTIFIED SURVEY MAP , VOLUMEO , PAGE Z73 , LOTNUMBER__y- Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner artd by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date.. SIGNED: DATE: 19-7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93