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HomeMy WebLinkAbout032-2090-30-000 o ^ O 4 0 � I o I o I N I y ' U Q h o I (n c� aD o w- z o I c c as E LL C O O � a7 a •O Cl) 3 rm : z y rn z E °o Lo Cl) w) am 0 o z c 0 z o z ) c v E co ` N a) O p�fJ1 c m a> y N y •� d c L 0O O O o (D a LP m z _ N z 0 E N Lo N C,4 r _ C �. C E c w Z rN rN �N o ,c a� 333 as o e000 z 0aaa y IL 1 C) � N J V j j 0) co z }mil r I-- co .. E O O N ca C d J 0> a fn n � M O 00 H H 00 to N! c ` O ° ° N U E co M ° F- c. o o � c u d ° O y' N C d O .0 z r N T C O a) OD F0 N E O O N 7 O _ _ � O O f4 Oi O z 1 U) € d I � ica � CL d 1 a) E ` c c :: r A u IL 2 I0 U) � ' PUMP CHAMBER ` Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size . Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: ,' j Len9(th:1p (p Number of Lines: Area Built: 3 Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, ( Rear,0 Pt . g� Number of feet from well: /110 f�•�-Q '�( Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. �( Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: G Dated: �' � " o ;1 Plumber on job License Number: 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER VC k7 TOWNSHIP om (mss SEC. /S7 T�K(_N-R�W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT f LOT SIZE I PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C�V lbo INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point useds�tex/ ( Elevation of vertical reference point: 6Q0 Proposed slope at site: S SEPTIC TANK: Manufacturer: iWe e Cs Liquid Capacity: &D Number of rings used: _�_ Tank manhole cover elevation: 9 ,ej 9 Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Rear, O feet From nearest property line Front,0Side,QRear,O 4 S feet Number of feet from: well Ad ILWO, building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) �- SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS 'CABOFI$k HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P,.O.BOX 71969 BUREAU OF PLUMBING &}IA D I SOI,*W l 53707 CONVENTIONAL ❑ALTERNATIVE State Planl.D.Number: SE%, NWT, S15,T31N—R19W (lfassigned) Town of Somerset ❑Holding Tank ❑ In-Ground Pressure ❑Mound ot 13 Northern Oaks Estates Tg : ,y NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION g �/'1 J'f � y? Roy Warren Route 1, Box 103A, Webster, WI 54893 VVI V t 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: illiam Pfannes 6222 St. Croix 99023 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROV DED: PROVIDED. YES 1:1 NO ❑YES tNO BEDDING: VENT DIA. VENT MATL: HIGH WATER NUMBER(�F ROAD: PRNNry�OgPP����ERTY WELL BUI DING. VENT TO FRESH uI ALARM FEET FROM Q LI AIR INLET: 1-1 YES NO I ` ❑YES NO N AREST I }v( DOSING CHAMBER: MANUFACTURER: BEDDING. ILIQUIDCAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO ❑YES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER..OF PROPERTY WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIDE CIA.. #PITS. LIQUID , /TI ENCl1 TRENC ES M RIAL' PIT f OFPT. t7�iME�#S°iC1N5 � �� � — GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI TR NUMBER''OF PROPERTY WELL: ]BUILDING: VENT TO FRESH BELOW PIPE ABOVE COVER: ELEV.INLET ELEV.END PIPES LIN AIR INLET:FEET FRaM � (a//� 01 2 90 95 2 NEAREST N 2� Z f MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES 1:1 NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SOIY ES SEEDED: MULCHED. CENTER. EDGES. ONO ❑YES ONO OY E S ❑NO PRESSURIZED DISTRIBUTION SYSTEM:11 +RB� r1N�:H a WIDTH: LENGTH. TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: 4 MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: =FeLE'VAl•ff}1�1 AND OTR �.UwIN, HOLE 512E HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED iFR'� I +1R' PLANS OYES 0 N OYES ONO COMMENTS: PERMANENT MARKERS: JOBSER WELLS: NUMBER©F LRIOE ERTV WELL: BUILDING: FEE I FRAM O S ❑YES Q NO ❑YES ❑NO NEAREST 0o Sketch System on Retain in county file for audit. Reverse Side. TITLE. SIGNATURE: `',, / Zoning Administrator DILHRSBD6710 (R.01/82) /�/ INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT 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 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the i State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Prcperty 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 star-- included the creation of surchar es fees for a number of re regulated practices which g ( ) g p Wisco tft 5 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r6asuCB 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. �. b 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) ' COUNTY �ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# q ,�3 —Attach 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. [FORIVARIANCE TION I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. ❑YES K NO P ERTY OWNER PROPERTY LOCATION r>°l7 '/a (J'/a, S S' T.3 3/ , N, R E (O P ER Y OWNE�j S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVI OIL NAME rJO� Eeh��Y, TATE ZIP CODE PHONE NUMBER I �^ NEAREST ROAD,LAKE OR LANDMARK ❑ VILLAGE: II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) I 1. a. aNew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an ystem 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.AConventional 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.X seepage Trench c. ❑See age Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM LEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):!j , 1 9y — a, — fi2- Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App ITankslTanks structed Septic Tank or Holding Tank ❑ ❑ 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): PI tuber's Signature:(No S amps) MP/MM'43tlIFhb.: Business Phone Number: umber's Address(Street,City,State,Zip Cd de): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Ud• VL6 T's ADDRESS(Street, State,Zip Code) Phone Number: o �' loll 2, 111. C ISE ONLY ❑ Disapproved S itary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) t4Approved Owner Given initial Su harge Fee PP ❑ Adverse Determination �� X. CO NTS/REAONS F�1$APPROVAL: kle SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber J a � . APPLICATION FOR SANITARY PERMIT STC - 100 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 I f Property' 130 11'AII-C 1C1�9�ieltl, ytu y NF .)yy 7j su;.�. ar AI:1,0 Location of P' fropert� y 14 yit, Section /5 , T / N-R /L W Township Mailing Address —n�f )3 K' r k 5- '/k 3 Address of Site L> �� �` `'- Subdivision Name Lot Humber JD Previous Amer of Property /�« �� '� r� L 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 _ No Volume and Page Number 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I tatementa on .thiA 60&m ane -tAue to the best 06 my (0uh) know, (ahe) the owneAk ) 06 the phopehty de�sc i,bed in this 06 a waAAanty deed rceeonded in the 066ice oA the i J 1� .f i DOCUMENT NO. STATE BAR OF WISCONSIN — FORM 2 ; WARRANTY DEED 1+3` 785Pr�rE THIS SPACE RESERVED FOR RECORDING DATA �J REVVERS OFFICE John E. Walsh ST. CROIX CO., Wis. Rec'd. for Record this 21st doy of July A.D. 1987 conveys and warrants to Roy Neal Warren and Bonnie Bea Warren. at 11:55 A ■A husband and wife, as joint tenants and not as f tenants in common amen O'Connell -•..4 owsm Dow@ Kathleen H. Walsh, deputy RETURN TO the following described real estate In t• Croix County, State of Wisconsin: Lot Thirteen (13) , Northern Oaks Estates in the Township of Somerset, according to the plat thereof Tax Key No. on file and of record in Book 4 of Plats at page 92 as Document #372339. is not This homestead property. 0MIS not) Exception to warranties: Dated this 16th day of July. , 19 87 i 1 (SEAL) (SEAL) ' John E. Walsh . (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGEMENT Signatures authenticated this day of STATE OF*WM MINNES TA , 1s Washington Count y. Ss. Personally came before me, this 16th day of July 1s 87 - r i; TITLE: MEMBER STATE BAR OF WISCONSIN the above named (, (If not, authorized by§706.06,Wis.Stats.) John E. Walsh This Instrument was drafted by John E. Walsh Attorney at aw Sti 11 water, MN 55082 to me known to be the person_who executed the foregoing in- _ strument an cknowled a the s e. ' _ . (Signatures may be authenticated or acknowledged. Both are not ' necessary.) 'gfrace K. Wakeling Notary Public as 1 ng on County, s. •Names of persons signing In any capacity must be typed o GRACE K. pr�i ion is permanent. (If not, state expiration date: NOTARY PUNILIC--MW WASHINGTON COUNTY_ "MY toritmis>uen expi�a July 31.1991 CL ci- /. J �0C t-��, y f, q,)- S T C - 105 r SEPTIC TANK MAINTENANCE AGREEMENT F-' 0 St . Croix County OWNER/BUYER G �� # ROUTE/BOX NUMBER Fire Number I CITY/STATE 'LIP � I PROPERTY LOCATION : , , Section /t) T / N , R -W , f I Town of St . Croix County , Subdivision)�''ZCcc,,c 6W a Lot number . I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed by a licensed se p tic tank _ pumper . What you put into � the system can affect the function of the septic tank as a treat- ment 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 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 1t•censed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , 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 . 0 I/WE, the undersigned , have read the above requirements and agree Ln to maintain the private sewage disposal system in accordance with x the standards set forth , herein , as set by the Wisconsin Depart- v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County 'honing Office within 30 days of the three year expiration date . SIGNED `� � CC LLC i D A'I'E 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 . INSTRUCTIONS FOR 011 PLETING FORM 116 - SRI - 6395 <` • t To be a complete and accurate soil test,your report must include= 1. Cornpiete legal description; 2. The use section ` ust clearly indicate whether this is a residence or commercial proiect; 3_ MAXIMUM nu ben of bedrooms or cornmercial use planned, 4� Is this a new or eplacernent system; 5. Complete the s itability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER YST MS ARE RULED OUT BASED ON SOIL CONDITIONS; S- PLEASE use th :abbreviations shown here for writing profile descriptions and completing the plot plan; 7, KE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A �r�pa to sheet a ay be used if desired; gals , u benchmark and vertical elevation reference point are clearly shown,and are permanent; 9 rnplete al propriate boxes as to dates,names,addresses, flood plain data,percolation,test exemp- n,if appro riate; 1Cf. l e infer m .ion (such as flood Blain,elevation)does not aptly, place N.A.in the appropriate box; 11. Sign the fOrIT and place your current address and your certification number; 12. r e legible opies and distribute as required, ALL SOIL TESTS MUST BE FILED WITH THE 0CALAUT' G)RITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS -- it Separates and Textures tither Symbols .�S a�/ X� '-�,st Saone {over 10") B13 Bedrock *, /cob Cobble {3- 10"} S Sandstone gr Gravel (under 3") LS Limestone *s Sand HG W High Groundwater, cs — Coarse Sand Perc Percolation Rate reed s - Medium Sand W — Well fs — Fine Sand Bldg -.. Building Is. --- Loamy Sand > — Greater Than s Sandy Loam < Less Than "l — Loam inn Brown 'srl - Silt Loam BI — Black s1 — Silt Gy Gray *cl Clay Loam y — Yellow scl -- Sandy Clay Loam fit Red sicl Silty Clay Loarn rnot — mottles sc _.. Sandy Clay vv;' ..._ with sic Silty Clay ff1 few,fine,faint *c Clay cc corlrmon,coarse pi — Peat warn -- Many, rnedium In — MUCk d — distinct p prominent HAIL — High water level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP Vertical Reference Point TO THE OWNER. This soil test report is the first step in securing a sanitary permit.The county or the Department may request verification of this soil test yrfi the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDtjS�RY, DIVISION '}CprBCC AND PERCOLATION TESTS (115) P.O.MADISON WI 53707 HIUMAN F f LATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: ECTION: OWNSHI MUNICIP 41TY: LOTNO.:BLI< NO.: SUBDIVISIONNAME: 5€ 1/ 4)V4 ZS_/T3i N/R/I E (or C NT OW R'S/BUYER'S NAME: MAI LtNG ADDRESS: og USE DATES OBSERVATIONS MADE NO.BED�RMS.:1COMMERCIAL DESCRIPTION: ��%!� IPR ;E D �(/IP � P O TION TESTS: Residence �Ll.New El Replace —`� 7 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-I -FILL HOLDING TANK:RECOMM�ENDED SYSTEM:(optional) ®S U ZS ❑U RI S U Os 2U ❑S A)L),-h,�,IvvA ,4,'l1) i 1< 6 ,Ac,te If Percolation required DESIGN RAT t.' n Q If any portion of the tested area is in the uder s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:ests are NOT re/) 'V - PROFILE DESCRIPTIONS BORING TOPHI N DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER D N, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- Z ,!� 9q,921 A1142A) >7 0` c 87. 9z bkdv! TI W42 G' B,1i ,9 ' 1 news 41 d 7` B-� 7 ZS q3,�3� ,n'�N� 7.Zi < �,5�' /ST o,v.2 G BN�s i;75 e-Fav s va,z rB,vs v ' B- �/ , S / 96, yz' zliW& B- p' cab, d8` �,� >7,v' <89.��� Dk G ! c�,va' B.vL d'08'' tBNS zi.S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AF ER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER 1 D 3 PER INCH P- 1 -�� ��, v /0 a? '//v 1)Y .1 7 P- 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 hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direlII&n and percent of land slope. 6� e3 SYSTEM ELEVATION 6 z 9 0.1 ' Co F E E r E E � 1 - S ZCT P 'A Gba� yy ( 2� 14 Q� E 3 _ PL 130: I' Rt J, ,.4 lmm s � l Zy� ( E °um ° r P(_ / t t)d � _ ,d, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods speci ed in the Wisconsin and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TESTS WERE COMPLETED Z/24 / Zj ON: CERTIFICATION NUM PHONE NUMBER(optional): CST SIGNATURE: kA ,e copy to Local Authority,Property Owner and Soil Tester. —OVER — 1e® � j,�AYre�'1 CP S6 m kk-5--1 IV W rl e to cy'` r + l7z SkPc on 9\Pf- i �erJ o� -Z M d � O a i� o � j �� Parcel #: 032-2090-30-000 12/12/2006 11:43 AM�j PAGE 1 OF 1 Alt. Parcel#: 15.31.19.890 032-TOWN OF SOMERSET Current I X' ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner MYRNA J WEYER O-WEYER, MYRNA J 2168 LO 217TH AVE SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): •=Primary Type Dist# Description *2168 LO 217TH AVE SC 4165 OSCEOLA SP 1700 WITC Legal Description: Acres: 2.775 Plat: 2224-NORTHERN OAKS ESTATES LOT 13 NORTHERN OAKS ESTATE TOWN Block/Condo Bldg: LOT 13 SOMERSET 2168 LOWER 217TH AVE SOMERSE T WI Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-31 N-1 9W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1034/636 WD 07/23/1997 866/331 07/23/1997 785/612 07/23/1997 736/328 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 146540 183,800 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.775 44,400 95,000 139,400 NO Totals for 2006: General Property 2.775 44,400 95,000 139,400 Woodland 0.000 0 0 Totals for 2005: General Property 2.775 44,400 95,000 139,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/07/2005 Batch#: 05-7 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00