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Parcel 032-1005-30-100 01/11/2007 11:02 AM
PAGE 1 OF 1
Alt. Parcel M 02.31.19.278 032 - TOWN OF SOMERSET
Current 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
WARREN J & JANET F RIVARD O - RIVARD, WARREN J & JANET F
604 230TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 604 230TH AVE
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 2 T31N R1 9W SW SW LOT 1 OF C.S.M. Block/Condo Bldg:
6/1607
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 731/370
07/23/1997 728/247
2006 SUMMARY Bill Fair Market Value: Assessed with:
144932 291,800
Valuations: Last Changed: 07/22/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 58,000 163,300 221,300 NO
Totals for 2006:
General Property 5.000 58,000 163,300 221,300
Woodland 0.000 0 0
Totals for 2005:
General Property 5.000 58,000 163,300 221,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 114
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form-STC- 104
AS BUILT SANITARY SYSTEM REPORT
OWNER &n cJ&C4 TOWNSHIP C-d SEC. a T njLN-R T W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION :5- qj Y4Li4r G.ti_ LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•IZHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
s-
r
C0
QV
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used '/7 r /zt
Elevation of vertical reference point: U-'n` Proposed slope at site: J
C
SEPTIC TANK: Manufacturer: l ~E~(S Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: f~,::q~
Number of feet from nearest Road: Front 10 Side,0 Rear, O ~ feet
From nearest-property line Front 10 Side,0 Rear, 0 7e feet
Number of feet from: well 5014 - building: 2~~
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
PUMP CHAMBER •
Manufacturer: Liquid apacity:
Pump Model: Pump/Sipho nufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Alarm acturer, Alarm Switch Type:
Pump !(Include itch elevatio Gallons per cycle
Numbeee from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
r
Width: S Length: Number of Lines:- Area Built: Soot
Fill depth to top of pipe:
V Rear, 0Ft.
Number of feet from nearest property line: Front, O Side,
Number of feet from well: ~s
r
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid de h: Bottom of seepage pit elevation:
/eher uilt:
Haa drop box O or distribution box O been used on any of the above soil
ab sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number tof Elevation of bottom of tank:
ElevatNumber st property line: Front, O Side, O Rear, 0Ft.
f feet from well:
eet from building:
rom nearest road:
Alarm Manufacturer:
Inspector:
--l 3 P lumber on Job:
Dated:
License Number :
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. PRIVATE SEWAGE SYSTEMS
BQX 7969 DIVISION
MADISON; WI 53707 BUREAU OF PLUMBING
JR CONVENTIONAL ❑ALTERNATIVE Slate Plan l.D.Number:
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (lf assigned)
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTI DATE.
Warren Rivard Rt. 1, Somerset, WI 54025 G~/ , /
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: JCST REF. PT. ELEV
SW SW, Section 2, T31N-R19W, Town of Somerset, Lot #1
Name of Plumber: MP/MPRSW No.. Cnunry' Sanitary Permit Number,
Gary L. Steel 3254 St. Croix 79152
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID TANK INLEj ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED PRVIINT / i 7 7 ❑Y
BEDDING: VENT DIA: V VEENT "AT I ES NO YES ❑NO
IHIIH WATER NUMBER OF ROAD: PROPERTY WELT -9 . BUIL ❑ DING. VENT TO FRESH
ALARM
T__.),~
FEET FR L AIR INLET:
❑YES NO ❑YES ❑NO NEARESOM
DOSING HAMBER:
MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMP; SIPHON MANUF ACTIIHEH WARNING LABEL LOCKING COVER
PROVIDED: PROVI DED
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CON TROLS OPERATIONAL NUMBER OF PR(IPERTV JWELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO _ NEAREST-0.
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1,11AMF TE IT 111ATI RIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF UISTH PIPE SPACING COVER INSIDE UTA -PITS LIQUID
r~ f_ THEyf:~1E5 MHIAL PIT DEPTH.
DIMENSIONS ~BQJ L
G F'. L DC E FH FILL DEPTH UISTH PIPE UISTH PIPE DISTR PIPE MATERIAL NO DI + NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPES AB E C VE7 ELgEj Vry. INL.F ! ,7 ELE V. END 6, S ~ 1 PIPES FEET FROM
Ll l A LE
t r / ~ / 7(Otl'7
NEAREST Z7
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-
meets the criteria for medium sa TIONS MEASURED.
❑YES ❑NO
SOIL COVER TEXTURE PE H%1 ARKFHS oBSEHVArIDNWE LLs
_ ❑YES ❑NO _❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSOIL m )F I) SMULCHED
CENTER EDGES
YES. ❑NO 1:1 NO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BE AVIDTH LENGTH NO. OF LATERAL SPACING (TRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL ND UISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.. ELEV.' DIA ELEV. PIPES DIA.
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO _ ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING:
FEET FROM LINE:
❑YES ❑NO ❑YES ❑NO NEAREST
Y
Sketch System on , ta. In county file for audit.
Reverse Side.
SIGNATURE: TITLE.
DILHR SBD 6710 (R. 01/82)
w ~ wlsconsln APPLICATION FOR SANITARY PERMIT (
COUNTY
- UNIFORM SANITARY PERMIT #
p 1 L H R (PLB 67)
pEpgRT LR OF /J
- InOUSTRY`.r, LABOR 6 HUTRn RELFiT10n5 -
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY WNER MAILING DRESS
C _
PRO ERT LOCATION
o501/4d 1/4, S o2 , T , N, R (Dr) W TOWN OF: "YY1 SC~/f~.
LOT NUMBER BLO~3N MB ER SUBDIVI 10 NAME NEAREST ROAD, LAKE OR LANDMARK STATE QL N I.D. NUMBER
TYPE OF BUILDING OR USE SERVED 30 /
:~J_1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑
91-New System Tank Replacement El Repair
El Privy
El Replacement Soil Absorption System El Revision
❑ Reconnection ❑ Petition for Modification
❑ Alternate System
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
El Seepage Bed c ►~Y+Seepage Trench [J Seepage Pit ❑ Holding Tank
~
1:1 System-In-Fill El In-Ground Pressure El Vault Privy El Pit Privy
issued
❑ Existing, For Which A Previous Permit Is On File, Permit #
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: 5 '
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber.
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installa ' n of the private sewage system shown on the attached plans.
Na f Plumber (PrintSignature: MPRSW No.: Phone Number:
Name of Designer:
PI tier's A ress: ~
r
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Di:a: ved
F J ❑ Oiven Initial
FA Approved AdDetermination
Reason fo isa r
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
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 of Property
Location of Property `D k/' 14 '~':>V4 1, section 2- , TZ1 N-R W
Township ~nMF~t~,ET-
Mailing Address 0SC_~acD Ci40Z~7
Address of Site
-
'Dor~'~
Subdivision Name VA /A.
Lot Number C-e SUt yexi -F,y .
Previous Owner of Property
Total Size of Parcel !L~
Date Parcel was Created t Z - Z - $
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes ✓ No
volume -12j ( and Page Number 5 1 p as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and pa&e 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 (we) eenti.6y that att dtatements on th-i,6 6ohm ahe th.ue to the but o6 my (ouA)
knowledge; that I (we) am (ane) the owneA (.6) o6 the pno peaty du eh i.b ed in thd,6
in6onmati.on 6o4m, by v.chtue o6 a waAAanty deed %ecotded in the 066ice o6 the
County Reg.csten o6 Deed as Document No. q 3 ; and that I (we) pnesentty
own the pxoposed z to Son the sewage d Epos system (oh I (we) have obtained an
ea6ement, to nun with the above de6cAibed ptopehty, bon the con6tnuction o6 aa.id
.6y6tem, and .the.6ame has been duty tecokded in the 046ice o6 the County Reg"teA og
Deed6, a6 Document No.
SIGNATURE OF 0 SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
L
H
a
STC - 105 r
` a
SEPTIC TANK MAINTENANCE AGREEMENT ~H+
St. Croix County z
a
~J a
OWNER/BUYER A-A1Zn Et4 -Y KCc%42Q
ROUTE/BOX NUMBER Fire Number
CITY/STATE ~0061L5f--77 ZIP 5'/Q ZS
PROPERTY LOCATION: Std , SuJ &y, Section 2- , T 77~ N R1 W
Town of S~c/LS~ j , St. Croix County,
Subdivision Lot number /
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 septic 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 606 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 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. H
0
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- b
ment 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 QL
DATE S--Z~ -~to
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.
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N O
F, ? TMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
i NDUS USTRY, DIVISION
HUMAN RANDELATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 769
HUMAN
N WI 53707
(H63.090) & Chapter 145.045)
LOCATIO S E TION: TOWNSHIPfAAa+6iP,461TY: LOT NO.: BLK. N SUBDIVISIO NAME:
LO 1/u~1/ z /T31 N/R /9Nor► W
!COUNTY: OWN S AME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS : COMM DESCRIPTION: PROFILE A I TESTS:
Residence ;RLNew ❑Replace
- a & -e96-
RATING: S- Site suitable for system U- Site unsuitable for system
CONVENT NAL: MOUND: IN-GROUND-ESSURE: SSEM-IN-FILLEIOL ING TANK: RECOMMENDED SYSTEM: (optional)
0 S DU ,~1S HE11 DU (r1},~+ UU SSA SOU A~lx
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09151(b), indicate: ~ 3 Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS 'j--_ a O
BORING TOTAL -QLLTHTOGROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER ELEVATION OBSERVED E CHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B ;7j-y~ Ak:L)L
75 t4_ & ~
B' 60 7 7S !
B-3 ~59 ~~73 } / S9 f~7 fX) ,75 7
T 4L
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERI D t PERIOD PER INCH
P-
P-
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
znntal 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.
SYSTEM ELEVATION q
I
i
I
.
t N
f
7 E
1 a 19 L ~,~.~~a
7-1 f
30~ i 1
1, 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.
r AME (print : TESTS WERE COMPLETED ON:
9- z
z4"ev V
ADDRESS, CERTIFICATION NUMBER: PHONE NUMBER (optional):
Z l15'- 2r,GG ~Gzoo
CST SIGNAT E
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
C I LHR-SBD-6395 (R. 02/82) -OVER -
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