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HomeMy WebLinkAbout032-1065-50-150 / o I 7 f k G 0 m % \ } \ N § �2J % % §2 > � E (D) £ $ @� \ \ �§\ W R).0 Ee] j CL E?/ ] EJ2 § ° mat , ) f \k-0 2 a0-( 8 o - = � $ ° k/ � z & / § IL % 0 z 2 ) U) k 7 j W z E % cc W 0 , § f / § � / - � Q z) z \ .. \ S� k , E ƒ ES £ k 3 � Z r / ■ ■ k k ) 4 b § § z CL f e CO = 2 -i v j E / $ 0 . mom � -_ � � � \ \ % _ � \ � \ d I § ' R 2 # ƒ a ) _ 2 \ q � r � I E Q § § } / u 0- � ^ k \ § § @ _ ) f ] j . , 2 4 Q § ik § $ { _ g % 3 o ° o k / / \ kC - , © * .. L - - 2 C 2 � c / \ CL \ 0 k ) MROL�_9 _PAGE4834 2 12005 RMIISSTERR OF Drim ST. CROIX CO. MI RSCEI VSD FOR.fiSCORD ST.CRCIX CCU11fTY 09/14/2004 10sSQA1I Sf1�r'�f?YC?'S RCCCRD CERTIFIED SURVEY MAP FEE t 19 � AUGUS t 2 # CIC) Imp h ~r{11t{77 x �Jj SS�1 y t�! NJ Au. N Z LL 1- J � �G En Cl P/T MN 3Nl 30 is/T MS s- N to OR Q' Cl 3Hl 30 3NI-1 3 O31N3W INOW � ,t, R 1 � cn _ _ .6rTO8 M.LS►BEoros I 3 tl" 'sd 'ZT "lOA WI dVN .13Alif1S C) rc mx3L1 — N3d J�N3H— SS3JOV 3pIM bE:'YE 12 ss W d N o C,-,3 I I v N~ ~ U7(n H na 0 o ca DI 89'494 I I W N v ^ T Z'EM 3.85.BT coos `u of ., LT'LZZ + I I .T5 Ot•5 : .E5 VE t I NI 1 LLJ �g o NI J SI �I O Q �x 1 z c�t J ��� 8 • gt I f -� �� . . .... ..� _ . ... ...3►'a� �vel�s era .oo En —— .EZ'E9T saa1M av3Ha� .LB'8E I l OI 3t• , o \ 6E'� 3.ZE.ZTeZON \ -----------5 oLN lVB Ol [3YSY tI SV'M.SQ L \ A-ls(IDIA3FJd 'YZ NDI1338 d0 3 *l N0I103s /——--———- ir T 1S3M-1SY3 3H1 Ol -mv semtlY3H _ Z""�"�► SMI HOW SlBVIS Q , VZ NOII IG UM V/T M — Vpl 19 Page 4834 Form - STC - 14 AS BUILT SANITARY SYSTEM REPORT OWNER V I?Z aL TOWNSHIP ��® L>�S T SEC. 2 T 3, N-R / W ADDRESS 1E 7-, l ST. CROIX COUNTY, WISCONSIN SUBDIVISION �/� LOT /} LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y®� �aac57- �4U� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /00� 6 Proposed slope at site:. SEPTIC TANK: Manufacturer: W&��—_t--5 Liquid Capacity: /doo Number of rings used: a(/0&/:F;' Tank manhole cover elevation: 10) , 93 Tank Inlet Elevation: Q ,, Tank Outlet Elevation: Number of feet from nearest Road: Front, Side, Rear, O 160 feet From nearest property line Front,0 Side, Rear,O feet Number of feet from: well building: 5 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE F ' 1 � � 1 PUMP CHAMBER Ma ufactwcer: Liquid Capacity: ,+ Ab Pump Mo Pump/Siphon Manufacture Pump Size Elevation of inlet: Botto of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Switch Type: Number of feet from earest property line: Fron , Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 1/E$ Trench: Width /B f Length: Number of Lines: Area Built: _ Fill depth to top of pipe: 7 /( Number of feet from nearest property line: Front, M Side, O Rear,O Ft .. � Number of feet from we4 Number of feet from building: 17V (Include distances on plot plan). PAGE PIT S e: Number of pits: Diameter: Liquid epth: Bottom of seepage pit elevation: i Area Built: Has either a drop box or distribution box O been used on any,.6f the above soil absorbtion sytems? (Check e). HOLDING TANK Manufacturer: Capad-i'lty: Number of rings used: Eleva 'on of bottom of tank: Elevation of inlet: Number of feet from neares property line: Fr t, O Side, O Rear, O Ft. N er of feet from well: n.� umber of feet from building: i Number of feet from nearest road: Afarm Manufacturer: Inspector gyp Dated: 2,3`0 0 Plumber on job PZC License Number: 0A 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION PA.BOX 7989 MADISON,WI 63787 BUREAU OF PLUMBING SWII!; -NW11AjS24,T31N—R19W CONVENTIONAL ❑ALTERNATIVE State Plan LD.Number: Town of sSomerset (If assigned) ❑Holding Tank ❑ In-Ground Pressure Mound 205th Avenue NAME OF PERMIT HOLDER! ADDRESS OF PERMIT HOLDER: INSPECTION DA E'. Vern Dufresne Route 1, Somerset, WI 54025 -2 egg 2 � BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN, REF.PT.ELEV.: CST REF.PT,ELEV.. Name of Plumber: MP/MPRSW No County Sanitary Permit Number: Donav$n Schmitt 3205 St. Croix 106068 SEPTIC TANK/HOLDING TANK: MANUFA TUR ER. LIQUID CAPACITY. TANK INLET ELEV.. TANK�`T�T ELEV.. WARNING LABEL LOCKING COVER ,, J�y PROVIDED. PROVIDED: `j°`/�y�\l b YES 1:1 NO OYES NO BEDDING T DIA.. VENT MATT HIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILDING: VENT T FRESH ALARM FEET FROM LIj NE._ 'r AIR INLET (Jon : DYES IVIN OYES O NEAREST' I�G�./,�"\i DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL jPUMP,1IPHON MANUF AC1111IEH WA ING LABEL LOCKING COVER PROV D. PROVIDED: ❑YES ONO OYES ONO ONO ❑YE GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF -;PHOP N WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN ET FROM LINE ` AIR INLET PUMP ON AND OFF) ❑YES ❑NO --0► SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of lowin t i N(,TI+ a AMF TE H or excavation. (If soil can be rolled into a wire,constructions all cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH O F 1111STH PIPE SPACI N(I COVER T NSIDE UTA aPITS LIQUID BED/TRENCH NHOCE DEPTH. DIMENSIONS 5-1? „_• .�.. GRAVEL DEPTH FILL DEPTH UISTH PI F UISTH PIPE DISTR.PIPE MATERIAL NO DI, I NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BE LOW PIPES ABOVE COVER Et EV.INLfI EnnEV ENU ^ PIPE' .LINE AIR INLET . II „r _I��� C� NEAREST— MOUND �� MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE JPIHMANINI MARKERS OBSERVATION WELLS DYES ❑NO ❑YES NO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH BEU UEPiH OF TOPSOIL SODDED SEE UFO MULCHED CENTER EDGES ❑YES. 1:1 NO EYES ONO ❑YES El NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES'. LATEHAL SPACING GRAVEL DEPTH BE LOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP ZRI FOLCOP DISTR.PIPE IMANIIOLDMATEIIIAL NO UISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV. ELEV. JPIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING LED HECI L COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO OYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF ::PROPERTY WELL: BUILDING: FEET..FROM LINE: S L1 YES ❑NO ❑YES ❑NO NEAREST 67 � . a Sketch System on Retain in county file for audit. Reverse Side. Zoning Administrator DILHR SBD 6710 (R.01/82) TITLE. DILHR SANITARY PERMIT APPLICATION COON Y In accord with ILHR 83.05,Wis.Adm.Code .o. .�,�....�...a. STATE SANITARY PERMIT# —Aftach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES .K NO PROPERTY OWNER PROPERTY LOCATION '/4 IV014, S Z,Ll T,3 N, R / E (or PRoPETITY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME I'VA &A CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK i S .+ ❑ VILLAGE: C ep O Tft 11. TYPE OF BUILDING OR USE SERVED: C Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. A New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ® Seepage Bed b. ❑Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): �r A;re 3 Feet E1Private ❑Joint ❑ Public ` VI. TANK CAPACITY Site / in g allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ,� ❑_X+_ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plum is Signature:(No Sta ps) P/M SW No.: Business Phone Number: SC 7 Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# E,E L CST's ADDRESS(Street,City,State,Zip Code) Phone Number: . , oce /OizU f® e 51 - _1040 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved F-1 Owner Given Initial cc�� rcharge Fee Adverse Determination 'Ol `� X. COMMENTS/REASONS FOR DISAPPROVAL: SBO-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 1 INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT t" APPLICATION , TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed= rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be,properly maintained.,The septic tank(s) should be pumped by a licensed - pumper whenever necessary, usually every 2to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. I Complete plans and specifications not smaller than 8'h 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; dosing or pumping chambers; 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. ------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground &tBr included the creation of surcharges (fees) for a number of regulated practices which Wisco in'S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rE�SIlf43 is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- T water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) 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 (, . a 2 If Location of property tU 1/4 '41/� 1/4, Section — , T_jj _N-R19W Township Mailing address PE4 J'0-P7e1?S,-,F r Address of site rHjo,/ �0P74 /j l Subdivision name (' Lot number Previous owner of property y� Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes 5C No Volume and Page Numbers 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 SEAL 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 Register of Deeds as Document No. 1.Z,7,f V ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. 332 79 l ) . Signature of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature l J ; DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 1 r " WARRANTY DEED 3'32784 :VOL. 536 PAu1540," THIS SPACE RESERVED FOR RECORDING DATA THIS DEED, made between Lee, D. Dufresne, aka DuFresne; REGISTERS OFFICE. 1 l ob in G. Dufresne, single: Theresa A. Martell: lane ST. CROIX CO. 1B___!ufresne. single: Nona Mae Dufresne, now Nona Ma w�S• nd Norman J Dufresne Recd, for Record t;;;s and. Vernon E. ---Grantor Dufresne and Betty Jane Du resne day of Ma husband and wife a-s ki of nt tenants at `- -----A•D. 1976 • A., M. Grantee, �{ W i to e s s e t h, That the said Grantor for a valuab a consid ration Of , _ _ Fcurteen Thousand Six Hundred ($14,900.00 Dollars Reg----7f7F,ad, conveys to Grantee the following described real estate in—St . Croix ___County, RETURN TO S' to of Wisconsin: R in tra & Van• D k Atto 1 n 2�1 outh Knowle� Avenue New Richmond WI 54017 Tax Key N This is not homestead property. The Southwest Quarter of the Northwest Quarter (SW� of NW , and the Northwest Quarter of the Northwest Quarter (NW4 of NWT) of Section Twenty-four (24) , Township Thirty-one (31) North, of Range Nineteen (19) West. TRANSFER $A. 0. FEE Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except none and will warrant and defend the same. Executed at New Richmond, Wisconsin this ftee . d 19 76 u resn (SEAL)i' SIGNED AND SEALED IN PRESENCE OF (SEAL) _R II X- t- '.,=J_(SEAL) Theresa A. Martel S.. (SEAL) AL) N na Mae r . u sne (SEAL Orman Signatures of Lee D. Dufresne. aka DuFresne• Robert G. Dufresne, single;_ `rherese LA._ Martell: Elaine B D fresne single: ona ae resne, now —_ V-ongg ae agne z Yrm n r ne aut'nedficated this ay o 9 6 c Wm. W. Ward Title: Member State Bar of Wisconsin Ot-M?rbr711rrty- A tkariead. Wac-Saa.-7C646-v4a. I I STATE OF WISCONSIN 1 } County. JJJ as. Personally came before me, this day of 19 the above named to me known to be the person_ who executed the foregoing g ng instrument and acknowledged the same. This instrument was drafted by Re' nstra & Van D k, Attorneys y Notary Public County, Wis. Te r- is On , 5 !j I The use of witnesses is optional. My Commission(Expires)(Is) Names of persons signing in any capacity should be typed or printed below their signatures. K Millo'cpmp" WARRANTY STATE BAR OF WISCONSIN, FORM NO. 1 — 1971 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER (' P,fJj F/1 ROUTE/BOX NUMBER„ A FIRE NO. CITY/STATE S& f- �"/�l�' ZIP ,x 02 5 PROPERTY LOCATION: L2gL1/4 /V V _1/4, Section , T , N, R_a_W, Town of L U N/c 5-Z_7 , St. Croix County, Subdivision NA- Lot No. _1SC4 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 a 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 $3000 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED s d DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION HUMA ,R PERCOLATION TESTS 115 P.O. BOX 7969 HUMAN RY,FIrATIQNS MADISON,WI 53707 (H63.0911)& Chapter 145.045) LOCATION: SECTION: TOWN SHIP/giWK1A+be&IXRY: LOT NO.:BL NO.: SUBDIVISION NAME: Sw �1 �4 /T31N/R19f(or)W Somerset n/a n/a n/a COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St . Croix Vern Dufresne R.R. #I . Somerset Wi . 54025 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPT ONS: ER ATION TESTS: Residence 3 n/a New ❑Replace I 4_1-88 n/a RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSUR_E: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) CAS 0U � EA ®S �U F]S EA1 ❑S K41 conventional Funnde�rs.H63.09(511(b),lation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the indicate. class 2 Floodplain,indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS a e 10 BxB BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL TH HICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPrtK ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 6 .83 101.64 none >6 . 83 . 83bl .1 . . 92bn. sil . 1 .00bn. s . 1 . 4.08bn. l . s . B- 2 6 .42 101.43 none >6 .42 . 92bl . 1 . . 75bn. sil . 1 .00bn. c.gr. 3 . 75bn. . s . B- 3 7 . 59 101.43 none >7 . 59 83bl . 1 .1.17bn.sil. .75bn.s.l. 2.92bn.gr. 1.92bn.s.1 B_ 4 7.08 101.81 none >7.08 .83bl.1. .75bn.sil. .75bn.s.1. .83bn.c.gr. 3.92bn l.s B- 5 7.17 102.20 none >7.17 .75bl.1. .75bn.sil. 2.17bn.s.1. 3.50bn.l.s. B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P PER INCH P- P- se dQsign rte P- P P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate s dista s. scribe w the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevatio at I b {the diLectio y percent of land slope. i SYSTEM ELEVATION 98.03 r 3 '� 13 3 _.4 tN F I t L __._._._.. _.� ,... E _..,_y, ........:.�..................__... __....,.._ _...._....._.� __i_ 1. „�. ..�.� __. ...,..._. _ _. _. y� � E _ f E t ! ( t€ E I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print F— TESTS WERE COMPLETED ON: Gary L. Steel 4-1-88 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional►: 988 N. Shore Dr. New Richmond Wi. 54017 2298 171&-246-6200 CST SIGN RE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SD - 6395 To he a complete and accurate soil test,your report must include: 1. Complete legal description; 2- The use section must clearly indicate whether tills is a residence or commercial project; 1 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 RASED ON SOIL CONDITIONS; 6 PLEASE rue the abbreviations shown here for writing profile descriptions and completing the plot plan; 1. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be rased if desired; S. NIaI<e sure your benchmark and vertical elevation reference point are clearly shown,and are Permanent; 9. Complete all appropriate boxes as to dates, narnes,add .sses, flood Plain data, Percolation test exemp- tion, if appropriate; 10. If the information (sunh as floor! Plain,elevation) does not apply, place N.A.in the appropriate box; 11. Sign tfre form and J)Iace yOur e£arrent address and your certification nun7ber; 12. Make legible roPies 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 - swne (over 10") 13R -- Bedrock colt - Cob1)1e (3 - 10") SS -- Sandstone car -- Gravel {re)der 3") LS Limestone x.s ..- Sand I-1GVIJ - High Groundwater cs __ £ oals'e Sa=,rd Perc Percolation Rate coed , ._ Mledil-mo, Sand VJ .-. We fs Fine`x t:c3 E3 tit; Build;;ig Is - Loamy Sand - Greater Than 'sl Sandy Loam < Less Than .I — Loam Bn - Brown s i I Silt Loani Bi Black si - Silt Gy Gray cl - Clay Loarn Y - Yellow scl - Sandy Clay Loarn R — Red sicl - Silty Clay Loam mot mottles sc; Sandy Clay s�it3a sic - Silty :lay P[f __ fever, tine faint -e -- cl a'Y CC _ Cornmon,coarse pt - f,a tarn — Malay,rt edlurn in d distinct---- �?1 a e.4� P prominent H'WL — High water level, Sax general soil t£',Xtu reS surface water for liquid waste disposal BM — Bench Matk VRP - Vertical Reference, Print r' w, • TO THE OWNER: This sail test report is the first St Cl})irr securing a sat°ritary permit.The county or the Departrnerrt may request vcr flfi'I,ation of this ,n°, tent 0) dils field prior to permit issuance. A complete set 0 plans for the private ".vvaq�e system€ and a Perrn`st application must he submitted to OW aptar0ljN,-l1= local ;Wthorily in order to oota n a poi rlt _. The,anitarf pi= resit: rinust be ohtaLo'cI and posted pi for to tnc, start of any constmetion. .ate= i � ■■■ ■ Sao■■■■■■ ■■■■r■�r =■■ .e ■ kk Rol 1-0 fPM ■ MOM mom No No t ' ■ I INN 0 ri • it r �Y r , ■■■■� ■■■ ■ ■ III ♦ /1 Sri � �■ ■■ ■■ ■ ■ - t t { - - -- ----- - i • Parcel #: 032-1065-50-150 06/28/2005 03:16 PM PAGE 1 OF 1 Alt. Parcel#: 24.31.19.32513-20 032-TOWN OF SOMERSET Current X,' ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 09/14/2004 00 0 Tax Address: Owner(s): *=Current Owner HELON M TRUST FRIANT "FRIANT, HELON M TRUST 718 205TH AVE SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *718 205TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 9.308 Plat: 4834-CSM 19-4834 032-04 SEC 24 T31 R1 9W PT SW NW FORMERLY LOT 1 Block/Condo Bldg: LOT 03 CSM 11/3175 FKA LOT 3 CSM 12/3266(18.43 AC)NKA CSM 19-4834 LOT 3(9.308 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 24-31N-19W SW NW Notes: Parcel History: Date Doc# Vol/Page Type 09/14/2004 774299 19/4834 CSM 11/08/2001 661533 1758/86 QC 07/23/1997 1207/434 TD 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/13/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00