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HomeMy WebLinkAbout032-2074-80-000 1 0 c o o go e~ m m m CD cf) m o m O o N o cOnn c °J r'' o OO fl' tip z L co m N N O A N C 3~ v 'i ~ o ~ 0O ~ ~ CL 0 o,W y 0_ o O ~o O 3 y v °o p c w o aL (D (n z D O m o. p 3 m p cp° ' V CD cn -0 C O O n r C co 00 N O a a 0 0 0 I O O O O ~ o * * *o aQ z c- J -4 --1 --1 a < M O o:E o : CD CD ID ~ fo j Co N' w Q'I a 3 a Z r N O D D o v O Er ° C z ~ o j -i co iZ Z co (n C 0 A Z O i W O W 0 CL Z 8 r c W C. Z I w ~ ~I om a (n m~ C~ -n N ~ N 00 Z a. N co CD o N S n fl. =r N ~ A 7 N 02 0 I p CL ~e ~ o 'a CD I ~ h o = A O I ao ;+a ti b O CD b O i p i ti DEPART1VIENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS `LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION UREAU OF PLUMBING P.O. BOX 7959 MADISON, WI 53707 IT- CONVENTIONAL ❑ALTERNATIVE 777 teals L ) O.Numer: /~y//~ Imo ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound /000 NAME OF PERMIT HOLDERI ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Tom Dacunha 410 S. 6th, Stillwater, MN 55082,.~~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.' CST REF. T. ELEV. NE SW, Section 14, T30N-R20W, Town of Somerset Name of Plumber: MP/MPRSW No.. County. Sanitary Permit Number. Henry Nechville 3258 St. Croix 83858 SEPTIC TANK/HOLDING TANK: ~0` tJ MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE V.. PROVIID DLABEL PROVIDED OVER / YES ❑NO ❑YES ❑NO ZBEDDINGVENT DIA.VENT MATT HIGH WATER NER ROADPROPERTY WELL BUILDING JVENT TO FRESH LINE AIR INLETi' ALARM FEFRO/~o /DD ES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEEL PUMP;SIPHON MANUF ACTIIHEH WARNING DLABEL LOCKING OVER YES ❑NO t+ YES ❑NO YES ❑NO PROPERTY WELL BUILDING JVENT TO FRESH GALLONS PER CY CLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF LINEp AIR IN ET / GC r(~J (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ❑NO NEAREST 1 SOILABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE UI"METEH MATE HIALAND MAHKING 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 ,'JIDT9VE LENGTH NO. OF UISTR PIPE SPACIN(, COVER INS ICE 1)IA -PITS LIQUID TRENCHES MATERIAL' PIT DEPTH. DIMENSIONS GH ,`iELDFPTH FILL DST HPIPE ISTH P IPE DISTR. PIPE MATERIAL NO DISTH NUMBER OF OPERTY WELLBUILDINGVENT TO FRESH BE LOW PIPES ABOVEV.INLFT ELEV END PIPES FEET FROM LINE. AIR INLET. NEAREST 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- E~l`~ meets the criteria for medium sand. TIONS MEASURED. LJ~ ES ❑NO PEHNIANF NT MA1111 HS OBSERVATION WELLS SOIL COVER TEXTURE / Sf 11YES ❑NO ~'S ES ❑NO MULCHED DEPTH OVER TRENCH BED 7777 BED DEPTH OF TOPSOIL SOO CFI) F DF1) CENTER ~ ❑YES. LYNO SE LJ`SES ❑NO ]YES ❑NO TRIBUTION SYSTEM: PRESSURIZED DIS`VIDTH. LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BE LOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH c TRENCHES , DIMENSIONS 3 O S MANIFOLD PUMP MANIFOLD DISTR. PIPE JMNO DISTH DISTRPIPE UIS TRIBUTION PIPE MATEL & MARKING ELEVELE~j DIAELEV PIPES CIA J ELEVATION AND /v 2 33 3y Id :33 (o DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE r HOLE SPACING GRILLED COHH E(TLY COVER MATERIAL PLANS /Q! 2-0 ®YES ❑NO YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL IBUILDING. / FEET FROM LIN v ' YES ❑No 6KES ❑NO NEAREST Sketch System on Ret county file for audit. Reverse Side. SIGNATURE - TITLE' DILHR SBD 6710 (R. 01/82)/~/ YCfi`_~. 6 ' DIL R SANITARY PERMIT APPLICATION CX _ In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT 9 -3 -Attach complete plans (to the county copy only) for the system, on not less than paper STATE PLAN I.D. NUMBER 8'/ x 11 inches in size. 84- S3 y 2-.. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION C c,. r- &_n A)F-%SUJ '/4,S IY T3o,N,R -;:k ®E(o PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER S BDIVISION NAME / &7%, / C: -32874'9 CITY, STATE ZIP CODE PHONE NUMBER 71 CITY 1:1 VILLAGE NEAREST ROAD, LAKE OR LANDMARK 51i'~u'af~r i*[ A~ S SE1$ hC3 -7l Y~ OWN • S orn s -r T' ~ i•i,v o 11. TYPE OF BUILDING OR USE SERVED: - o?07 Number of Bedrooms ifillor 2 Family 3 OR ❑ Public (Specify): /v'1 , III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. e 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. LJ Mound f. ❑ IGP / In-Fill Tank V. ABSORPTI9N 8 _ TEM INFORMATION: (Check one) 1716 1. a. See a e 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): 9-1, Xs- Feet 13 / ate ❑ Joint ❑ Public VI. TANK CAPACITY Site in alions Total of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed tic an r Holding Tank /Qn~ u _SEIp Ao Lift Pump Tank/Si hon Chamber 750 /Jc~ 7 sa r'ES ICJ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) M PRSW No.. Business Phone Number: Plumber' Address (Street, City, State, Zip Code): Name of Designer: VIf SOREST INFORMATION Certified Soil Tester (CST) Name CST A44-V)4 UL 8,,;,k-- --Z 3Z CST's ADDRESS (Street, City, State, Zip Code) Phone Number: l , IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) v e Fee pproved ❑ Owner Given Initial charg e- 7 Adverse Determination ` V s X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber 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 bV a1icensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your privat : sewage syster,i, 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: 1. Property owner's name and ;nailing address. Provide the legal description where the system is to be installed; 11. 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; 111. 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; Vl. 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. Complete plans and specifications not smaller than 8'/z 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 Groundwater included the creation of surcharges (fees) for a number of regulated practices which Wiscort<sin's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried lteas,srer~ is used in your building is returned to the groundwater through your soil absorption (G f' system or the-disposal site used by your holding tank pumper. ~ RRR The monies ~Gollected through these surc:`jarges are credited to the groundwater fund adminis- tered by the Department of Natural F asource~=. These funds are used for monitoring ground- t water, groundwater contamination ir: estigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) PROJECT IND'.,-X 3111,, FT - - g6m05322 ObVNER : ADDRESS : IO SD ~y S r S7-1'11&M r , /"f// v v, y ,~~E% w r . i r'ao.v ,C l o w y/f AAA /o r ~ SITE LOCATION: ~ T6lvv 0~ PROJECT DESCRIPTION: ~30~i.J S jr:~,e A x4,,14 EST-47e- /'V*6 i'yrt o v 4'~ovE /07 t:; SDiL (r 47- 2 , 00 fT vi' L~wyr~►'S7A~E JP A~~ '•~/~f,QGt r~ ; NOT S~-4-r"-4 e Ly 5~47viP~tT O Soils AAOUE /3 foR ar le,4s7- 2 /ate New f fa y E 3 Se1)E'M9 J's P D r~/ &4#S s E A4 Ir A3) Asa Al. o Y PAGE 1. PT)OT PLAN VIE19S PAGr 2. MOUND CROSS SECTI:OU & )'YSTEM I') AN I kVS PAG 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBI,',R CR0);i;! 10, 'PTCINS PAG'I~ 5.: PUMP PER F ORT;IANCI? SPI',CS Olt ;;'PECS PLUMBER : I V , ,U h.TM or DESIGNER HOMESITE SEPTIC PLUMBING CO. Az,(~D eipTS 11. A YNEIL RD., HUDSON, WIS. 54016 ROBERT LIBRICHT MIIB. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 00663 DATE : l SIGNATURE jgA Y-1-1-41;L~ 'q"/ RECE`v~~ A\) G 1 g 19x6 86-05322 o ` y v y yJ ' ~3 - 0 Yk to t. VO X. j~Ik4k O r v h V 3 fiM W 71 r > ~S RECEIVED Z AUG 18 1986 J u PLUMBING BUREAU . , ~ boo J ~ ~ oc OL 3 - 4 5 2 - Page ? Of Synthetic Covering Distribution Pipe Medium Sand H -~G Topsoil F D E u % Slope p~ . S Be Of 2M (Force Main Plowed gregate Layer AM@IhL D L Ft. p,0 E Z'Z Ft. Cross Section Of A Mound System Using F .75 Ft. A Bed For The Absorption Area G / Ft. A 10 Ft. H AS Ft. O~ Si B Ft. L ' cen a Number: K / Z Ft. L (cL Ft. Date: Ft. position 13 Ft. of W Ft. Force Main L Observation Pipe j 6 K N ~I A~- Bed Of %N Distribution 2 Pipe Aggregate Observation Pipe Permanent Markers yN PUG $fEEL ~~S Plan View Of Mound Using A Bed For The Absorption Area RECEIVED AUGIS1986 F'~-UMDING BUREP`U Page •3 0f _ 8 6..05322 `A s 7' hi /r .seT v/}CGL''f Perforated Pipe Detail p ORIA)&- End View )Perforated I Enid Cap \e PVC Pipe Holes Located On Bottom, • 0~4 I S Are Equally Spaced I S Q f ~~`1'gve~JY .DOS Q PVC Manifold Pipe Distribution Force Main Pipe , . 3 j SG y0 Last Hole Shdeald Be Next To End Cop End Cap Distribution Pipe Layout P Ft. R 6 Fr },yO ~~QNS S 3 Fr 004 sR~ X 30 I nchPs Y 17 Inches t Hole Diameter /Y Inch Signed: Lateral / Inch(es) Z Inches Lice e ber: v . Manifold " ~uv Date: Force Main 3 Inches # of hales/pipe S 2, Invert Elevation of Laterals Ft. aisTlel80,0410 liPg- Dlsehm, C, 1-?07r- ; gpgog. /a. ~0~A/ vas>~i8 . ~,solhp~ ~•4TE Fob Co /~~u~s 72.- yq~S. /Li/~ • 3, ' 3 s~~ ya pac = SA~s . RECEIVED A11 G ~ 8 1986 pLtjMj3jNG EuREAD i . y S PAGE OF PUMP CHAMBER CROSS SECTION AKJD SPECIFICATIONS VENT CAP 8 6 _ O 5S 24/67•)9 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 9Oellpl - JUNCTION BOX MANHOLE COVER J ~ ~ 25~ FROM DOOR, /OO■D WINDOW OR FRESH AIR INTAKE GRADE I 4° MIN. I • IB"MIN. COWDUIT-/ IV I1~T/OV ~~l PROVIDE INLET A13ardT SEAL APPROVED JOINTS APPROVED JOINT/ A • iooaffq as 114 W/C.=. PIPE W G.T. PIPE LAR EXTENDING 3' EXTENDING 3' ONTO SOLID SOIL OIJTO SOLID SOIL oN. I ELEV. FT. J OFF r f M E/~vrl~ a CONCRETE BLOCK ~ o ~7 0.1 of Fr F~MER EXIT PE.RMITfED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFl CATIOUS DOSE PER DAy TANKS MANUFACTURER: WMBER OF DOSES: TAtJK SIZE: 750 GALLO►JS DOSE VOLUME /So Intl. t 13 fn/. GEV&L A1,4jeM INCLUDING BACKFLOW: /(y 3 GALLONS ALARM MANUFACTURER: D. V. L CAPACITIES: A= ZJ / INCHES OR GALLONS / MODEL IJUMBER: SWITCH TYPE: M"tolgy ~~/oA~ B= y IWCHESOR GALLONS ZOE//ne / C o - C= IMCHES OR 1&%3 GALLONS PUMP MANUFACTURER: I MAA/Vif4_ / MODEL NUMBER' y eZ D= G INCHES OR /0/ GALLONS SWITCH TUPE:r~G 4AC& 1-)ME,PCvey flOAT5 MOTE: PUMP AND ALARM ARE TO BE INSTALLED OW SEPARATE CIRCUITS MINIMUM DISCHARGE RATE-56p GPM. /D, 15 'f,4N)t sp~Gs • VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET of + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 2.5 FEET 64a., ~h `Ow, TAI.VS 17 y ~Ilr~S ~_S FEET OF FORCE MAIN X torQ " F>I/oo FLFRICTION FACTOR.. ' 3(o FEET TOTAL DyIWAMIC HEAD FEET ~E ovuv y INTERNAL DIMEWSIONS OF TANK: LEN ;WIDTH ---~;LIQUID DEPTH A SIGKJE D: LICENSE HUMBER: DATE: RECEtUE® AUG1g1986 Ip LUMBING Eu*AU 86-05322 T D H HEAD, CAPACITY CURVE W I- W W W /U. 30 V V TOTAL DYNAMIC HEADICAPACITY PER MINUTE EFFLUENT AND DEWATERING 95 SERIES 53-55-57-59 97 137-139 163 165 FT. + M (:SAL'' LTRS LTRS LTRS LTRS LTRS 28 5 f 152 63 248 394 231 231 90- EFFLUENT AND DEWATERING 10` 305 34' 129 zls 300 231 231 15 4.57 ; 1, 72 163 242 227 227 % 26-85- \ SEWAGE AND DEWATERING 610 104 136 223 227 `25.9 7.62 30 216 223 \ 13p'. 9,14 206 220 24 80 401219 172 206 - so V, 24 125 191 75 \ 86`'. 16.29 ar_- x 57 ,61 22 \ 70 21.34 114 \ 24.38 70- 53 -MODEL MODEL Lock Valve: 19' 24.5' 26' 66' 8T 20 65 163 1165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SEWAGE AND DEWATERING \ SERIES 267 268 282 264 293 O - FT. j M GAL - LTRS ' LTRS LTRS LTRS LTRS 18 5 1.52 '108' 408 1. 386 492 681 GG 10; 3.05 227 273 360 598 16 ,lV 57 76 ^ 163 238 511 ` 20 6 ,0 30 125 50- 25 E' 401 1t 7 62 266^ 14- ` 914 163 292 45 35 10 67 227 .a ..n>•• _ 174 40 12 19 45 13.72 - 106 12 4Q 1 15.24 r , 45 i M O D E L Lock Valve: 18' 21' 26' 35' S3' 10 35 ` 293 It I 30 MODELS I 8 25 137 139 - z - I 6 20 . ` 1%_1 il - ' MODEL 11- 284 4 15 MODEL MODEL 10 268 I 282 2 MODELS 1\ 5 53,555 MODEL MODEL 0 57,59 97 267 U.S. GALS. 10 20 30 40 50 60 7Q , 80 90 100 10 12 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of . O~/ 01 Box 16347 LL Louisville, Kentucky 40216 ~ qp (502) 778-2731 , L'a'in PUMPS SiVV- 1.941;1 8 RRCENED AIJG 18 1986 R6_LkMBI EAU, /9z U~ AeV,675To sac. ZONE AE-A0,eTS 0 fF Ayzo, If deo DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, LABOR AND P.O. BOX 7969 PERCOLATION TESTS (115 DIVISION HUMAN RELATIONS MADISON, WI 53707 p (H63.090) & Chapter 145.045) LOCATION. SECTION: TOWNSH Y: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1 A7P 1/4 1 IT30 NCR 2-OE (o S,0A16A C7- C; •M 3 7ff NO/ 92 7 y1 p s COUNTY: OWNER'S S NAME: MAILING ADDRESS: S'r• G Qp i Y, -76M J0'440VN AA-- s... 6-4v S7////`eAlJ 7Ze 101W-0. 6 Ye USE NO.'BEDRMS.: COMMER IAL DESCRIPTION: DATES OBSERVATIONS MADE Residence A p PROFILE DESCRIPTIONS: PER ICOLATION TESTS: Z r /V XX New ❑ Re lace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL: TANK: RECOMMENDED SYSTEM: (optional) oS ©u ©S ❑u ; aS au oS R EIS au ~oaw STS If Percolation Tests are NOT required DESIGN RATE: .S If any portion the tested area is in the under s.H63.09(5) (b), indicate: Cf~/h S .'r indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION AND EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- s-ez ~ge,r D,~ 1n Z B- B- PERCOLATION TESTS -X A100-A.) y ipS TEST DEPTH WATER IN TIM NUMBER INC ES FTERSWELOLING INTERVA MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES ! PERIOD 1 PERIOD 2 PER OD PER INCH P c3 0 ~ G P_ / /G L P- 2- 30 i s P_ X30 P ~3 G ,3 4 , 1011 1 P- 3 Y/ s PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe hat 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 1NvfRT °f ®ll - /O2 • Z s 1-?/,Poi a T F _r , N C ~ , , E f ( E i , , 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): TESTS WERE COMPLETED ON: ADDRESS: HOMESITE SEPTIC PLUMBING CO. ROBERT ULBRlCHT CERTIFICATI0 NUMBER: PHONaNUMB R(optionaq: /e2 MINN. INSTALLER & DESIGNER LIC. NO. 00W CST GNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FCC ~ 'T1 FORM 115 - R k - ~ r ,r +r ,c rt must include: is is a re pla 4 NL°f IF ALL 5 6 z _ , 1e iE 12, TESTERS si - s T ' ~vyEie 1~ev(/4- h4 /i /y w 0,t•'~ D s~ I/W * 7M,- /`1i,vV . 70,.1 ~gc ~,c> DEPARTMENT Y, OF d REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS 1151 P.O. BOX 7969 HUMAN RELATIONS / MADISON, WI 53707 (1-163.090) & Chapter 145.045) LOCATION: 5 O TOWNSHIP/~: OT NO.: BLK. blO.:1 SUBDIVISION NAME: /V~ T/ / / %T3o N/RZ°E (0,fm Somt,P,frT' ~s OI,v G- COUNTY: OWNER' NAME: IM-AIILNG ADDRESS: 5,7 c)eo/X &A157- By ys/ aT,",f/ USE DATES OBSERVATIONS MADE ~JQ NO. B COM A D R PTION: DESCRIPTIONS: PrA-COLATION TS: Residence i/ ,New ❑Replace 4 01101 /V oAv 1 y 1.30/'e - °WT;EA° e-dAj.S.C J 7- ?o RATING: S- Site suitable for system U- Site unsuitable for system /~n'O ~G~EV 46.1 / /410 VWj> S S 7- Al ONVENTI NAL: MOUND: IN-GROUND•PR E: S TEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S IR S ❑U • ❑S ©U ❑S EU ❑S ©U 14-1Dz1AJP ow 4'y If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.091511b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ~LS W~Jr9lf~ Ce7f-eAJ BORING TOTAL PTH TO GROUP DWATER-INCHES CHARACTER OF SOIL WIT ICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES HE TO BEDROCK IF OBS RVED (SEE ABBRV. ON BACK.) B- 30 7,•~, b I ' 67 ' ArAj T•' Sd ' ,v - f y, P /.,S' d, (S - N . A 7- 3 • ' 9p~ of ' 3. ~3 ' l~. s,/ ~ S~' ~ , B- 2- Li.q-e S vL /eC oed 2 2 5 0 BJ A41 J1 j B- feid" .''•O ' -/0 7 Fr. -y 0,4--1Dr Of vU6~ {k..., .5 Li,y.j J,S,,,,-4- R - iP ' -47- 7- ' P3'AedO- 01 - 67' v-f~ Xe , J dp SD If 71 3-J- ~d4 ,,t Y. F f. a/e .tieY.t PERCOLATION TESTS 4 e U& Ck" 4 f•Q ' hLT)INVER DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-INCHES RATE MINUTES INCHES AFTERSWELLING INTERVAL-MIN. PERIOD P RI D PER INCH Lim S O Co e! 1 4 0 de, EJ Q.@E Aze C X / S v 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. WiOA(tl C~lot : 9 -SiTa ND 1-0406"e- 13-014 Ace SYSTEM ELEVATION AX sE-A-)c 'Nvt'.rrs - /aZ. sA„ 1,4 -4ce EvEv a Plel" ;P4~tr /0 J/ j J)D 93 SFr _ OdS US f $ • - QQ , a „.B 7 By 6 Q1 ~ G~ / -0 ji1v srT. UExr RcF• for s.~tvE/lad. Ir/mu0104, ioo . a ~ 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 th SjWpElU"NrtlBcation of the tests are correct to the best of my knowledge and belief. RT. 30'NEIL RD., HUDSON, WIS. 54011 NAME (print : TESTS WERE COMPLETED ON: 'SAS. MASTER PLUMBER LIC. N0.3307 MAIM *,4 L O - 19416 -INN INSTALIJA 2, DESIGNER LIC NO OW ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1 y~L 3006 CST SIGNATURE:^ C'pp~E- !oi// ¢ u ~,rF DfFiG•!/ oN-f ~ yf' A/'/li«-T~o.~ f ~ I' sx. ~orx Y z f rr~ •~rr ~A~~iF ~~~1 ✓eAi t~ T ~s/ B C cd v.>> v~ iv o / i^ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. (V L7OLD //~QRj 8,e-- lt'DDQ _ nil uD QDr r"Mr, Ip 07/R') I - r)VFR - / H z cn H a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z C) l a OWNER/BUYER '0"?2-cz ~ /1-cC~/y 2 r•~ /L y ROUTE/BOX NUMBER Fire Number CITY/STATE Et~►t ~~Ci,~„z , ZIP-5-~~ PROPERTY LOCATION: Section /y T 3 e7 N, R W, Town of ~~~j EFSc~ St. Croix County, SubdivisionLot 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. y 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by thie Wisconsin Depart- It 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 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. 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 C 0- Location of Property 11f~ S Lt~ 14, Section , T •-3 d N - R `Z r W Township _Se as Eh-sE L Mailing Address 410 use, , 6~ -1h- _7 Subdivision Name m Lbj/ Lot Number Previous Owner of Property Y/If s ~,6 y Total Size of Parcel Date Parcel was Created D~ / Are all corners and lot lines identifiable? `Yes No Is this property being developed for resale (spec house) ? Yes 4- No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1 Warranty D 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION 1 (We) eeh ti.6 y that a t statements on thiA 6o4m ane tAu.e to the best o6 my (oun ) hnowtedge; that I (we) am (are) the owner(s) o6 the pnopehty de cAibed in th.i,a .in6o4mati,on 6onm, by vi&&e o6 a waAAanty deed neeonded in the 0 County RegiAten o6 Deed6 as Document No. asmemw,-E ; an that I (we) pneb entty own the p4opob ed Aite bon the 6 ewage cUApos 6 ystem (on I (we) have obtained an easement, to nun with the above descAi.bed p4openty, bon the eonbtnuati,on o6 said 6ystem, and the dame has been duty neeonded in the 066.iee o6 the County Reg.caten o6 Deed6, a6 Document No. ) . SIGNATU OdF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED I ST. CROIX COUNTY Y WISCONSIN ` ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 ,.i U.I. Y r e. r .L f , , tµs c r;::! i r" w tit i~ t i.! d'.:t ~.i s..L !a .C ita An or--[ •W-:I.'t'e iI'i'1F':."s't.:;.t-#a`L1 iI...P fo-r- .t-i'1t_ Iie{=.-t 1"1 E,1bY is r"s-'Pi=. r "Yp :isEl:- itl"'{-?t:i r.:t . i s i a C....s, `:I• s ~i 'I' t h l ::r uW I 1. ! i} i s 'i. . I ..e fit.) 11d ! , a: 0 ~ p i+l-s sr~1 f "P t.. c .I_ ! , G." : P "i L::t t c! 4 .l t : : "i: a i:1 t:' ~:i a '1 1 »=t.., 1 y p a L-:. V _ ._..l.L .L ~i ~•:_'L"'t at _sf~ieLl:.1.L L' l I''1 9r sWsi..llPt:.i w<L Vi i" .j;:aa ris.si.t: C:I s s't .t .i. ca i'i s_! !_i .r. i : i.i fi:' J. 't: r s_s Y' i'tl {~s ti l u _ ;a!"i j s~ ~ i"i ~ i::7 1 s:~ tt :i i..:.' i' i•= i:' .i. Y_ cF~ ! ~ s._: s_ s;"s ! 1 t- ac- 'I T'-': En C l'i ~ ~'ti i~! :a i-:: w Cd r.•! l ~.i•-s r"t a 1-1 't d_ t_sll i. I I t4 P•i!.s il!.i. i"i I_ iia STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township *RiR NE 14 SWIL S 14 T 30 N/R 20 JXtMV Somerset St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Ernest Melby 451 Centennial, St. Paul MN 55113 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19~ Notary Public, State of Wisconsin T)TT.14R-SRT>-AA13 fN_ (15/R11 My Commission Expires: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NE 1/4, SW 1/4, Sec. 14 T 30 N, R 20 XL W Town orXXmftApx3 x Somerset Street Address i Lot No. , Block , Subdivision Landowner's Name: Ernest Melby The application for this site is for: O new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num errs issue-Tto you.) one of the applications needing a quota number. The quota number assigned to this application is 59 - 10 - 7 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. Fl for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. L] for an application on file prior to February 1, 1980. (_]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. U a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here.0 I certify that the above information is true and accurate to the best of my knowledge. Name ,Ihomas C. Nelson Si ure County Official Title Assistant Zoning Administrator Date July 25, 1986 DILHR-SBD-6158 (R 12/82) 4✓ ' ,yra /`i ;pf_X{1 AV a~trGD 'Tf ' I !/ld/N• DEPARTMENT OF ~04( REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS 1 MADISON, WI 53707 (H63.090) & Chapter 145.045) TOWNSHIP/ OT NO.:BLK. O.: SUBDIVISION NAME: NE 1/s / / %T Mel N/R 2 0 E (o SSOArt`,~ s ~ o~N G-- 000NTY: O NE AM MA N A S: $,r coo/X &#57- MEI. BY ysr 4NT4N,,1 sf /y/vv s~„3 USE DATES OBSERVATIONS MADE NO. BE 1COMMERCIAL DESCRIPTION: DESCRIPTIONS: 1PERCOLATION TESTS: Residence i/ f x New ❑Replace M4)( ZO 0 ~d /~C le 10A_1Jt- I YA 4-J 7- 7'0 RATING: S- Site suitable for system U- Site unsuitable for system OG&;e 1T D rlN,P S ,S7-o ONVE L: MOUND: IN-GROUND: S S - -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) LEI S ©U S ❑U 0 S ZU El S [DU EJ S ©U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ,A/,~, under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /vo PROFILE DESCRIPTIONS s6S `iJ`j~l~f~ / BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WIT ICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HES TO BEDROCK IF OBS RVED (SEE ABBRV. ON BACK.) B- / .2 3e ' s; / . • is >ba ~~~f~+ ale If r B-Z 3• ''~~Di ~3' ~~'(►.s~/ ,S~' N~ S~/ 1.0 94 tr z s a c, sat ee c 1 2S r • S, /O '1 - ,u0:~✓ r O 0 • , 3 •-Pf' /JAY. X,, S • ,~,o - f~ s% , l y~ a..~ S: ; i Ls B- 70 9Q ~o ~o v -f. 4af)~ DU, cr S/ hhM 570 ' -/0 7 te r. 3,4-,Pr O f {w.. S S J A. A- 3 . iP A 7- 7- PERCOLATION TESTS ZED.dOck*' 47- f•O I DEPTI4 WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AF'rERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD3 PER INCH P_ Z'-f [ r 1d .0j NOT APPRO Ack P_ IS @S site le I'lu ~bGyf T.e.r/ D~ e O W-of 1 i} fI f P- vqfar i *Ii~ Eo ~°E /-tS P-. 1 40 P_ e .f / S TV Tt el , t..)T PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori rontal 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 slope. 6vi , f1 ' 9 S/rtiD IIAOZZ-Pi 8-0-4t Acl TEM ELEVATION _60IsZ-A -PC e- ~NVEir~s - /D/ .Z& " sA.v/,decv(' /,d /A-41Ce _ Ifiv ~ ' spvi.,~ ~ ~ I i , I I., w ~/c ! A,P~ !~•e w~}J/ / 0 O , ~(Q i i Ilk t 1 srT USTRef. 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 th%dkl> Uip ftMNVGIIDcation of the tests are correct to the best of my knowledge and belief. R1.3 O'NEIL RD., HUDSON, WIS. 54016 NAME print : TESTS WERE COMPLETED ON: WIS. MASTER PLUMBER LIC. NO. 3307 M.P.RS. */f y L O - i 9C'6 ADDRESS: CERTIFICATION NUMBER: rPHONE NUMBER (optional): 2 y~i ^ -alas ;rp owo /&,&t A&T ADF,C) - Pex^ ~ f CST SIGNATUR ✓ i'ii'etT~iu Br St 400fY C-1000>y DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nu D d L~ fl>4oQ Iys: ~~~s Lin con aonc In nnloe1 ' DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUST DIVISION INDUSTRY LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7 HUMAN RELATIONS N WI 3 69 (1-163.090) & Chapter 145.045) LOCA:FION: SEC ON: TOWNSHIP! fO~ N4LK. :SU BDIVISION NAME: N~ 1/ / / %T30 N/R 1 ° E (o SoHt,IPS~T' S Oi~v ~r- 000N TY: W A : MAILING ADDRESS: sr ~~oiX ~~~vsr Etasy ys~ N~~N,~►/ .sf A(A/ If %vv ,ss„3 USE DATES OBSERVATIONS MADE OMMERCIAL D R TIO PROFILE DESCRIPTIONS: N TESTS: 10 [~Resldence i/ New ❑Replace I/~/2O ' Dj_ 11 ~O _ lV ~,v AWO ~ - dzA-rE~ CeQ•utSt J7- 70 13 RATING: Sin suitable for system U' Site unsuitable for system eee-A7 461' !lN,a S j s• 7-,Al ONVE )NAL: MOUND: IN-GROUN : S S -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) D s ©u 15as ou a s au a s ou EIS ©u 14fev-JO 0,0 /-y If Percolation Tests are NOT required DESIGN RATE: L"fzdplain, y portion of the tested area is in the ~under s.H63.09(51(b), indicatindicate Floodplain elevation: /v0 PROFILE DESCRIPTIONS BORING TOTAL P H T GROUP DWATER-INCHES CHARACTER OF SOIL WIT ICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED E GHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B. ie L,.a f S Td tJ z/,r. v%ffif ~Q/rr B- 3 • ' DL ~3 ' /3~• s%/ S~ ` N S.0 L 4Q L/ Li.yt S E, id ed e 2 2 • 9~ .u . f; ,j • ~ie -f~; si , 1. ; 443 7 0 forty yo A0 J ~A U'dhl- co e.?- si `t;-- f o • -/O 7 FT. 0A-✓Dr Of S B- ` Li,•yd JAa wt- 22 - '451 - A T 7• PERCOLATION TESTS 1~EDti°e ck-f .47 ,,f•0 ' TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PER INCH P- L i i'+.C S fj A C4< P- IS eS Site ,Ptit ~:u ~bG•~r ~,e.t/ P- 0'4-- Go r 0//-c 'fO 6e- for P-- EO IA.) A-5 P- C r / S TV 7t P- Pt OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori f A 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 C" I slope. Gvi , d2 fI - S/f ND ',-e/// gA t Ace TEM ELEVATION ~~aE~vc ~NVE~rrs - zCQ ' s,# 6'k- 1A) ~-a :e - W r/L fr, e crJly / o o . 7tP 1.. Irv sr r. ; _ _ U 3 ~'6 J P71 /00 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 th%**te dPVkW1W"tion of the tests are correct to the best of my knowledge and belief. AT. 30'NEIL RD., HUDSON, WIS. 54014 NAME print : RUOtIll 1.11.1111112`11 TESTS WERE COMPLETED ON: WS. MASTER PLUMBER LIC. N0.3301 M.PItt t*lf y L O - / f<f6 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1 y~z 3^' CST SIGNATUR A/eft ' 7G Houva !lilut f- ewr GJi/~ ~2 Q o iee Dff/C~J~ eN- f i 7F 81' 57. mofx cavo rY zv r. %tf o ff~r r /r' ~A if~F adit°~J _ n DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. W o vi b `l.'vp 4n /Q~ Ae -P> DP~C~ oCA 01 c- o Cy r1 o m f c m 3 u~g Z °p 0 °w • n Ct O3 N N 0. Cl) 00 n O w N h..l m m y ~ o No a N C 7 7 N N C A K N F N J 00 C, O V°pi 7 N cOi C) C7 O 0 CD O y N N ; O ° ~ ~1 ~ ~ ~ ~ !!fir v to m N C a a N QJ D I c . c H o f o 3 p o co 7 _ CD N C` "~~1 W rt h 9 o m C5 0 N o O H. CL T -0 -0 M 0 (D Z O O O c ryM CD Q r CA U) cn 0 C] rt n = _ 00 7 d UAi 7. ~1 F~ ' ffl 7 !r O W m W° w F5 F-i (D 00 Ul CD r C O Z N rt N D D o O N n lu) m a M -A~ o CD cn 00 00 Z Z (DD O~ F,, W .O' i ;a ~ti. Z En A G) R I~ 1 0 (~v ~v G) w x M I W-0 Z CD co co Z O C 3 r 7 rt O ° ro n n 0 9 w to m Z C tD m N• rt r w f cD CD ° _s n CC O O N G O n 0 C N C d f a Z a (D S a O N N CD N y N c y y = N N N O O 7 N l a N O A 0 O N n ON CO < N Oo O O _ O N N O\ N ~ A 7 r„ O O b w ti fD A ~ O O ° L ~ Parcel 032-2074-80-000 01/26/2006 11:11 AM PAGE 1OF1 Alt. Parcel 14.30.20.7860 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 O - DACUNHA, THOMAS J THOMAS J DACUNHA 1549 TWIN SPRINGS RD HOULTON WI 54082 Districts: . SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1549 TWIN SPRINGS RD SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 4.500 Plat: N/A-NOT AVAILABLE SEC 14 T30N R20W 4.5A IN GL 3 LOT 1 CSM Block/Condo Bldg: VOL 2/334 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 752/343 07/23/1997 626/215 2005 SUMMARY Bill Fair Market Value: Assessed with: 78117 322,400 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.500 55,500 204,000 259,500 NO Totals for 2005: General Property 4.500 55,500 204,000 259,500 Woodland 0.000 0 0 Totals for 2004: General Property 4.500 55,500 204,000 259,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 501 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00