HomeMy WebLinkAbout032-2072-30-000
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Parcel 032-2072-30-000 01/28/2005 07:56 AM
PAGE 1 OF 1
Alt. Parcel M 13.30.20.779A3 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): Current Owner
* KIEKHAFER, DAVID J
DAVID J KIEKHAFER
1502 23RD ST
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es)- Primary
Type Dist # Description ` 1502 23RD ST 1
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
L
Legal Description: Acres: 3.000 Plat: /A-NOT AVAILABLE
SEC 13 T30N R20W 3A IN SW SW LOT 3 CSM Block/Condo Bldg:
VOL 3/709
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/06/2003 733990 2349/373 WD
957/116
938/527
852/523
more...
2004 SUMMARY Bill Fair Market Value: Assessed with:
11192 165,800
Valuations: - Last Changed: 07/24/2003
Description Class Acres Land mprove j Total State Reason
RESIDENTIAL G1 3.000 48,000 92,60 ' 140,600 NO
Totals for 2004:
General Property 3.000 48,000 92,600 140,600
Woodland 0.000 0 0
Totals for 2003:
General Property 3.000 48,000 92,600 140,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 145
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
10
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Form-STC- 104
AS BUILT SANITARY SYSTEM REPORT 632-aa-7~
/7
OWNER -~GBOr" eP4 TOWNSHIPS SEC. 41 T N-R Zd W
ADDRESS c,_ ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT J LOT SIZE 6~2 a;c_)23
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/3'g~ Sr
sit
C*Ldl
(I
53 f
f
1
r
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used X .0j4
/Nay,
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: U)GuLiquid Capacity: 1c~ljn
Number of rings used: &D[e T er elevation : a
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side, Rear, V AP! feet
.From nearest property line Front,OSide,®Rear,O feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
l SEE REVERSE SIDE
PUMP CHAMBER A)lk
j D 1-7
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: i
Leng't'h: Number of Lines Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side
Rear, opt. Number of feet from well: $'p
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: ~T Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: ~E.1S~Cd
Dated: 1
Plumber on job: r(,~u S4(z~
License Number:
3/84:mj
DEPARTMENT OF4NDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
CABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
Ilf assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
/
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Scott Ritzer Rt. 1 Box 429, Whitetail 7
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: _REF. PT. ELEV.: CST REF. PT. ELEV.
SW SW, Section 13, T30N-R20W, Town of Somerset, Lot #3
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
John Sykora, III 3212 St. Croix 88415
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LABEL LOCVKING COVER
^ ~ ~Gy PROVIDED: PROIDED:
r /•3 YES ONO DYES ~KNO
BEDDING: VENT DIA.: VENT TL./Y HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: TO FRESH
r~ t ALARM FEET FROM LINE (3 / AIR INSET
OYES LS1NO \ DYES bd'NO NEAREST a Sail _25f IVENT
DOSING CHAMBER:
MANUFACTURER: [BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SINU F ACTOR E R. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO OYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PR OPERTV IWELL- BUILDING. VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO OF DISTR. PIPE SPACING COVER JI NSIDE CIA SPITS LIQUID
S . TRENCHES / H ERIAL: PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH JDISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING. VENT TO FRESH
BELOW PIPES. ABOVE COVER E} V INLET EL ti: p 2 PIPES. LIN ~ AIR INLET
C c c 1 C//lam ..FAa FEET FROM c%
~z ~ NEAREST-► ~-S 2-5"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-
DYES NO meets the criteria for medium sand. TIONS MEASURED.
O
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES ONO DYES ONO
DEPTH OVER TRENCH/BED ]DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED
CENTER: EDGES.
DYES ONO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH: NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.. PIPES DIA..
DISTRIBUTION
INFORMATION 0L _SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ONO DYES ONO
COMMENTSD PERMANENT MARKERS: J OBSERVATION WELLS NUMBER OF PROPERTY WELL, BUILDING.
r /V7 FEET FROM LINE:
DYES ONO DYES ONO NEAREST
U
~ a
Sketch System on etain in county file for audit.
Reverse Side.
SIG TITLE
DILHR SBD 6710 (R. 01/82) " C
md*~ wrsconsin APPLICATION FOR SANITARY PERMIT
r, DI L H R OUNTY
~ DERRRTTEnT OF ~ ~ 67)
0 mousTRV,LRBOR&HUmRnRELRTIons UNIFORM SANITARY PERMIT #
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
Ze j%r- qZ W I` ~T OS i vrvQSL
PROPERTY LOCATION CITY:
sWi/4SLUO /4, S /3 , T30, N, R20 E (or OWN o - cSo"' w-r-e-1-
OL j*[EMM=GZ=
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): ,v/A
THIS PERMIT IS FOR A:
X New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
El Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued -
D An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity OD ,
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: S
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
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):
z 9 76' 955t Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: MP RSW
Phone Number:
Z (715 )568-1F9*9
'41, ip Z_91111~~
Plumber's Address: Name of Designer:
14
e~
COUNTY/DEPA T UtE ONLY
Signature of Issuing Agent: Fee: Date:
~ ❑ Disapproved
T,~Q 7 E] Owner Given Initial
Approved Adverse Determination
Reason for Disapproval:
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 Section T_N-R W
Township
Mailing Address )"U / d x Address of Site /P l
c1Sr
Subdivision Name CSI C~
Lot Number 3
Previous Owner of Property
Total Size of Parcel
Date Parcel was Created ` p
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes _ No
Volume and Page Number q12- lassrecorded 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 (We) centi,6y that att s.tatement6 on this 6onm cute tAue to the but o6 my (oun)
knowledge; that I (we) am (ane) the owner(s) ob the pnopeh ty descA bed in -thd.6
in6onmation 6onm, by viAtue o6 a waAAanty deed tecmded in the 066ice o6 the
County Reg-i sxen o4 Deeds as Document No. / / ; and that I (We) pneb enemy
own the pnoposed site Son the sewage dizpos system (on I (we) have obtained an
easement, to nun with the above d6cA bed pnopehty, bon the constcucti,on o6 said
system, and the same has been dut kecotded in the 046ice o6 the County Regi4ten o6
Deeds, as Document No. ~Il ~S 7 ) .
SIGNATURE ^OP 0 ER/ SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
` i
' H
z
a
STC - 105 r
r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
cy
a
OWNER/BUYER (iA 9 ZZ /_.Z
ROUTE/BOX NUMBE Fire Number
.CITY/STATE ZIP .S :;/U~i J
PROPERTY LOCATION:, `s.11u1, Section , T0 N, RU W,
Town of St. Croix County,
Subdivision S /V ; 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 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 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
E
I/WE, the undersigned, have read the above requirements and agree x„
to maintain the private sewage disposal system in accordance with ac
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
DATE ~0
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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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUST~R.Y, DIVISION
``'B AI*° PERCOLATION TESTS (115) P.O. BOX 7969
HUMA'eZtA1`ICNS \ / MADISON, WI 53707
• (H63.0911) & Chapter 145.045)
LOCATION: SECTION: TOWNS MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME:
/SW/a 13 /T N RZ~ E (o Sow sue" S,i4w
COUNTY: OWNER' b*UUY ER'S NA n~ INAon ADDR
S/`° Cd'Ot -'cal-* if%7'LZ'BV^ J~'~'1 .:9 t 71k►. a
A 40 2
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USE
SE NO. BEDRMS, : COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE
LY~Residence PROFILE DESCRIPTIONS: PE~rR OI TT`ION TESTS:
New ❑Replace 7/q/9 G /`/$/19 r
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 [I W 1S ❑U ®S DU ®U ❑S ®U (40~ 'c' Ks3
If Percolation Tests are NOT require DESIGN RATE: ~
If any portion of the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
OE PROFILE DESCRIPTIONS Lag e, 33 &L W BORING TOTAL P pS e
NUMBER DEPTH IN, EVATION PTH TO GROUNDWATER-INCHES CHARACTER OF S IL H THICKNESS, OR, TE URE, AND DEPTH
OBSERVE=EH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- Dr~ ~ s;l r~/ sows f"~dF, zS*'/L3N go- Z; f/
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B- 15 Pj'%'f-y Si/ i8 //o.,
B-
PERCOLATION TESTS
NUMBER INCH S FTER SWELOL NG INTERVAL-MIN. DROP IN WATER LEVEL-INCHES
ES
PER
IOD 1 PERIOD 2 PE R I D RA PER INCH
P-
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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
of land slope.
SYSTEM ELEVATION 97 l "
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Admen strative Code hereby certif that the soil tests reported on this for were
g y made by me in accord with the procedures and methods specified in the Wisconsin
and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print)..
TESTS WERE COMPLETED ON:
7-6 L 6M -
ADDRESS:
CERTIFICATION NUMBER: PHONE NUMBER (optional)-
} JC E:
c
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
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If JCTIONS FOR O PLETI B 115 - SBD -
T .urate soil test, your report mu
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