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HomeMy WebLinkAbout032-2063-70-000 Q -0 G _ " ~ - 0 CA r 3 O n K N n !D 'p o o'o °w << . 0 0) 0 0) 0) 3 0= N 0 ° Cl) 0 7. 3 O CD A ' N 3 O V py d. A Z 0_ N IO r0'►. A p N C m C- ca Ch ca CA 0 -4 N Q 7 0 V O r O CD CO O p O Q DO O (7 O C) 0 CA go 0 CD -w O v 3- I I a y I m Cn ID Co a ~ W w' 3 a 3 0 o o D _ c~ cn m pd (n CD w to tQ rt rt H p z co OD co S C m rn y N P (D rro~ c , v) 3 (D 0 N B N w OOOo''', " • rt 'o O C i O C /vim fn ~ cS C t~t~l1 r'3' SC ~G y 7 I,, f3D 1\ x n O 1-31 Nam 00 0) CD m Cl) 00 "E 4- Z o_' 'yt~ 90 Z F I O 0 Q ~ lD ,t R O li C (D In F, N 70 3 N CL 00 Z - O Z cWO o o' O D a Z = ~ • m CD Z C CD co W C (D w m a V 01. a. 3 H H (n CD -4 CO) A o o o z M o rh ~ I Ln (D 00 rt CL O O • fn ' ca 3 (D Z ( rt CD co w g H cn 0. O 3 N CL CD CD I ~ y n A OI B. Ry ~ t O 7 a CCD N °o O V 7 h 0 A CD a 69 ~ w O CL Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Tka; ~✓'C1SCr TOWNSHIP Sd~.eP~if`5 SEC. /10 T _W_N-R i / W ADDRESS l A?*x T~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT I /A- LOT SIZE 2x) acv-as PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ fI I i sm zzY° ' INDICATE NORTH ARROW tl BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Ldp Proposed slope at site: J-/176 SEPTIC TANK: Manufacturer: 5KAW kk'4-5'_F y(kiquid Capacity: %goo ep-t Number of rings used: hptLe, Tank manhole cover elevation: ~f Tank Inlet Elevation: Q 'rt Tank Outlet Elevation: Number of feet from nearest Road: Front,®Side 10 Rear, o feet From nearest property line Front, Side,O Rear, O feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: ` Number of Lines: <,-7 Area Built: -30 Fill depth to top of pipe: Number of feet from nearest property line: Front, 0 Side, 0 Rear,0 Ft. Number of feet from well: > 1,06 Number of feet from building: OAZ (Include distances on plot plan). SEEPAGE PIT )V~~ 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 V+ 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: 0 ~l Ayp~~~U Dated: ///Z6/640 /6~ Plumber on job: D 5- License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUI, LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIX • BUREAU OF PLUN, P.O. BOX 7969 MADISON, WI 53707 • (CONVENTIONAL ❑ALTERNATIVE State Planl.D. Number: (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: John Strese Rt. 1, Box 440, St. Joseph, WI 54082 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SW SW, Section 18, T30N-R19W, Town of Somerset Name of Plumber: INIFIMPHbW No.: County: Sanitary Permit Number: John Sykora, III 3212 St. Croix 88414 SEPTIC TANK/HOLDING TANK: MAN`JFA,:TURER: - LIQUID CAPACITY: TE t E V.: TAN,C OUTLET E LEV.: WARNING LABEL LOCKING COVER PR VIDED: PROVIDED,~c YES ONO OYES I,,.~NO BEDDING: ENT DIA VENT MAT LATER NUMBER OFROAD: P- WELL: BUILDING: VENT TO FRESH a ALARM' FEET FROM LINE: AIR INLET. OYES O DYES''= O NEAREST DOSING C MBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. PRWARNING OVI EDLABEL JLOCK:NED COVER DYES ONO ❑ NO DYES ONO FRESH GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROP L BUILDING. VENT LET FEET FROM LINE AIR IN. (DIFFERENCE BETWEEN PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LE"GTH DIAME ER M ERIAL D 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 DISTR. PIPE SPACING. COVER INSIDE DIA. SPITS. LIQUID TRENCHES: MAT' QIAL• PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL D DISTR. IPE DISTR PIPE DISTR. PIP ATERIAL: N - I PR NUMBER OF PROS TV WELL BUILDING. V NT TO FRESH BELOW PIPES ABOVE COVER EIEVWLE7 EL, VEND FEET FROM LINE AIR INLET g e es~ - NEAREST--► 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. OYES ONO SOIL COVER TEXTURE: PERMANENT MARKERS OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH/6ED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED CENTER: EDGES: OYES ONO DYES 1:1 NO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. No. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/ TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING i ELEV.: ELEV.: DIA.: ELEV.'. PIPES CIA I ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VE NSCAL LIFT CORRESPONDS TO APPROVED DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY JWELL. BUILDING: FEET FROM LINE: ✓rJ OYES ONO OYES ONO NEAREST V f t III I s f Sketch System on Retain in county file for audit. Reverse Side. SIGNATUR TITLE. 'g y DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COU Y ~i DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # I zwJ 00 411 Al `-Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8'/z x 11 inches in size. -See reverse side for InStfUCtIOnS for completing this application. PETITION 11 FOR VARIANCE ❑ YES NO 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY LOCATION p PROPERTY OWNER Sa) aS 1 t~ TAD , N, R J! E (o W S~r~s LOT NUMBER BLOCK NUMBER SUBDIVISION NAME PROPERTY OWNER'S MAILIN~GADDRESS 0- 1 O " [0 CITY AD KE OR LANDMARK lie CITY, STATE ZIP CODE Z PNENU~~6 I-] VILLAGE TOWN OF %:A71 -7 00 II. TYPE O BUILDING OR USE SERVED: 0' "-,91a113_11111__~ } ' OR Public (Specify): A i - Number of Bedrooms if 1 or 2 Family Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) OV64* nt c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an 1 • a. jZsj New b' Septic Tank Only an Existing System Existing System System Date Issued 2. ❑ A Sanitary Permit was previously issued. Permit # 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 OFF SYSTEM: (Check only one in #1 and only one in #2) 1. a. KConventional b. ❑ Alternative C. ❑ Experimental ❑ Mound f. ❑ IGP 2. a. ❑ System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e• In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑ see pa e 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): cy~,~4 Feet fVI Private ❑ Joint El Public s s- ZS CAPACITY Prefab. Site Ex er. VI. TANK in allons Total # of Manufacturer's Name Concrete Con- Steel glass Plastic APp INFORMATION New xistin Gallons Tanks structed Tank Tanks ~C0 ❑ ❑ ❑ Septic Tank or Holding Tank / ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. M P S Business Phone Number: Plumber's Name (Print): Plumber's Signature: No Stamps) g~ 1 ":r zit Z a k"11, r -07- ~ ame of Designer: Plumber's Address (St , City, State, Zip Code N Z Vlll. SOIL TEST INFORMATION CST # Certified Soil Tester (CST) Name Z -7 Phone Number: CST's ADDRESS (Street, y, State, Zip Code) iQ*Z -7S' w. rtnr^ fJJ IX. COUNTYIDEPARTMENT USE ONLY Issuing Agent Signature (No Stamps) ❑ Disapproved Sanitary Permit Fee Groundwater r;7 T S rcharge Fee Approved ❑ Owner Given Initial / O Z) a-~ Adverse Determination 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 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 State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owners name and mailing' address. Provide the legal description where the system is to be installed; Il. 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 a// 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%i 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 1 result'of over 2 years of steady negotiation and publiq debate: The groundwater bill Ground, Water included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that Wisconsin's is used in your building is returned to the groundwater through your soil absorption buried (teasure system or the disposal site used by your holding tank pumper. The monies collected'; through these surcharges aye credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring water, groundwater ground- contamination investigations and establishment of standards. GroundwatF r; il's worth ,protecting. r `?31J-6398' .03/86) 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 SW 1Zw, Section T, N-R4_ W Township Mailing Address CAL, s 0- Address of Site Subdivision Name /A- Lot Number _ ' " z~ Previous Owner of Property4C~ Total Size of parcel Date Parcel was Created L Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume 95~1- and Page Number 3 2-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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION I (We) cexti.by that att2 AtatemenU on thdvs bo&m au trcue to the best ob my (ours) knowtedg e; that I (we) am (ane) the ownex (,s) o6 the pxo petr t y de s CAib ed in th.%s inbotcmation bokm, by viAtue ob a wavrAanty deed %eco,%ded in the Obbice ob the County Register o6 Deeds a3 Document No. 56q and that I (we) pttes entty own the pnaposed site ban the sewage di.6T5sa Sy,67em (on 1 (we) have obtained an easement, to nun with the above descxibed ptcopeAty, bon the convsthucti.on ob said system, and the same has been duty necottded in the Obbice ob the County Registers ob Deeds, as Document No. 1. ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) lo / -7 ~ DATE SIGNED GNED I OO~9- c8Dr•(OO N Z` tG r• 'S fD CD n C N (D =3 rt rr C W Cr cA a n. rr rt -t 7 O :7 CT (r 2 r V. (D •S N rr, N tr. 1 W 'S ` t *t rn CD r \ r cr O I--A~ ~ r Z 0. r-n K r• ^t rn .P rr 1-r K K rt ~ r• to O to Sy • ~ K N (D r r N p, p r• l.- rr rr 0 O 0 t~ K ~ r a o "raa o a t»w m V r•CD o m N (D pTM..rn0~w r N 0- CA x Cr n £ O N ac a) "-to N a (p r C1 0 O W w ~C o• ~O l< A c%T► n n ti K `S = K K ' ~'ty O 2) rr O Oor rpnO rt rr 0- G rr r• O rn - :3 En EI K r:~ ~ r _ Wrt(D CT r rK 9) C O O A+ r' tJ (D rt. r•K O f ~ (D :3 rr ONO (Ir r.r u r• I m A Cn ~~pp (D A rr CD ~ r• co to (D C Z r• D) O E rtSr~(D A) ccrr• ~~O rr O~ Ito r~ rr r• (D N n (D (D -1 K W rpt, N N :3 C~ r• A A) r- r r " C OZ `S (D a N to (D 0 a, LT r• N rn~ tp 'I m "S N tp-n rr (D m pt ((D K r•e, < rt- OK ~ m R "t r : d (D r... = (D (D J (D ' N :3 CD F- p r. r. , C) r rn a(A to <O r~,.~~'G rY,~ 3v~.2 sr- X r rt n R r S O 0) o~ tr r~ R d a :D (D (D (D rn K O tD~ -rys \p Er. U) (~D rr r• C K O rr < r• 0 2 rn N (G r• rn M ((D a ON rr 0- 0 0 F.. p G ? (D T r. r• yGi tlw (D (D :3 rr (D O (D IJ z rt. CL O :3 t- o II rr N O N 13 (D fD pr. m rr ~D 0 Q G 0 U: Pb rr N N N N~ pro G1.C p cow rr r• 0-r 0 rn~ ::3 0 r (D ~ K (70oO 3 t ~7 m L. r" o w • c a 7 p a n N K 'g (1j O.( ON r r to r 1.0 Z E Z Ci lD W. 7 I.- tG C (D N O p rrr Cn I- {1 . rT r• (D rr a) E Ln 7 w 010 rn G O tC N rt :E hNi 0) rh rr c aCD n.a sl r-C r rTM' o CD N aarT,(D wO, O (B (D (D O r \ G1. • ~ K .P H z N - r ST C- 105 r' 9 • H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z tv 9 OWNER/ UYER( ROUTE/BOX NUMBER/ Fire Number .CITY/STATE 111c.~Q,t ~C~ l' ZIPL((`°,Q PROPERTY LOCATION: Section 9 T36 N, R_ W1 Town of~O~NS , St. Croix County, Subdivision WAS 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 H three year expiration. H z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 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 Cam, DATE CJ ~2CP L h St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION LABOR ANG BOX HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 7969 . (H63.09(1) & Chapter 145.045) CO CATION: SECTION: OWNSHIP MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY: WNER'S UYER'S NAME: MAl LING ADDRESS: USE DATES OBSE VA ONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: IPROFILE DESCRI TIONS: PERCOLATION TESTS: Residence New ❑Replace LL~I~°f1 © c7 eL RATING: S= Site suitable for system U= Site unsuitable for system CTI❑~ . MOUND: IN-GROUND Pa URE: SYaSTEM-IN-FULHO[LDING TANK: E,O,MM OVE R4 6%W4 T"I l opt~+M~CA/') S S'V~~tM IfL ~ Perrcolation Tests are NOT required DESIGN RATE: e If any portion of the tested area is in the A under s.H63.09(51(b), indicate: Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED -EST. HIG14EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- dL v B- B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES" AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P-4.1 P- G~ aC C/ P- P-_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Nicatillg e_qr F !9a c-~ Desc ' e hat are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface eleDa ' n a~'bIZb ction and percent of land slope. Q 9y. ° f0 0 CS 5 reo-(a;,~e~.aclktl~"~ 98 ! ~1 SYSTEM ELEVATION /11o-w,, A F € t E J'ar ~s7t r I/~ 5 /4 4, Y 1 ` ` .fir w ~ - _ t , E a 1 _4 1 _ 7. - Imo- _ A I i E I 3 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: a(.--. ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 5- SAkamew- S'F? 7"7 W5' s69-fEg`i B tit ? CST GN TU~: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - U TIONS FOR COMPLETING FOPM 115 - SBD - 5395 . T(I accurate soil tE tt, )ort must 4e: 2, ly ' is is a res.- !nce or corer >ject; 4. ALL 6 ' f rci. d~ f are permanent; test exemp- u, F r'iate box; 12. i FILED WITH THE 0 BI Is rra of - c rr e to f DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION 1 P.O. BOX 7969 LABOR ANp PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN,RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: OWNSHIP UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: S 1/4AJ/4 J T3v N1R/9' E (o ) So so COUNTY: NE BUYER'S NAME: MAI ING ADDRESS: Grp! Sd~res ! BOiX vieo -S5(1682 DATES OBSERVATIONS MADE USE NO.BEDRMS.s ICOMMERCIAL DESCRIPTION: IPROIL~D~E~RIPTIONS: Q IONTESTS: Residence N/A Ill 0/ 88 ~a 7 / 918r.-M Ar 44. Lcawr (.441-a dope. Z9e 'La RATING: S= Site suitable for system U= Site unsuitable for system be I -A 644-Q_ I( CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IWFILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) WS ❑u s ❑u s ❑u El s r~u 0S Au Ca 94JI&J- i keA f- /IX DNRATE: pl/~ If Percolation Tests are NOT required ESIGIf any portion of the tested area is in the IV under s.H63.09(5)(b), indicate: Floodplain indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) if . 9•. s1! -by off BNs~, co(0, q B- 79 /7 / hOc~i? 7~ inin e- i . me B- 9gr~. Hakl°_ 8'~ Y"B1s l Tsi 38" Pb 6as l/ Plt"*a SG(lf ZD ~ QBN B-3 7(p /7'~,I ~"$~S~ ! S~ 7'~a,~ Q ~'r ~tr aµ ~I: SC~ B-'~ <gnC-1 ~t ,f9r.~ s$~~ 8.. g•; s 1 i B-5' ®Q 97'`fN 90 9",s/ x r-1 - s, to B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI01) 2 PERIOD 3 PER INCH P- 3S nave ?,.p 30 P_ z -y0 A6%&C- 30 % ZV P_ ko .1L 30 3 S P- k 6.4- e- 30 L- Vie Z.Aj P- ? C7 F_ dd -3 P= 19A _ i i~ P-- EIP- 99 ._70 y PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicat 40 cLQljsRiL~~w re the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevati&eit fall boring a direction and percent of land slope. sxye~ SYSTEM ELEVATION 9 N 3 , beg. i 3 Z , r E 3 3 ! • a ~ ~ red v~ - ( O E ? t S f o , 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): TESS WERE COMPLETED ON: of f -z R s as z TESTS WERE COMPLETED ON: ION NUMBER: PHONE NUMBER (optional): ADDR SS: j:CSTT U LGI N: Original and one copy to Local Authority, Property Owner and Soil Tester. DISTRIBUTIO DILHR-SBD-6395 (R. 02/82) - OVER - v i f -"F'--TI S FOR COW- F'f ING FORM 11 - SBD - 6396 a a = soil test, Y, Host include: ial project; c IF ALL ,ED O[_7 .wn flan; ai I ent; r, rpp_ fl b H THE P t co C p t C sc sic! Y h' 1 CC Poit,t TT( I rel in sec pie F r4- VI 41, t3_ B o 23 ~ ~ O W N r 1 fn h Q~ o p ?w h g 1 C' ¢ f'J n jqr •A A f \ ` .gyp ~ ~ pf x~ p f . X r 02/06/2007 04:32 PM Parcel 032-2063-70-000 PAGE 1 OF 1 032 - TOWN OF SOMERSET Alt. Parcel M 18.30.19.750C ST. CROIX COUNTY, WISCONSIN Current X Application # Permit # Permit Type Creation Date Historical Date Map # Sales Area App 00 0 Owner(s): O = Current Owner, C = Current Co-Owner Tax Address: O -STRESE, JOHN E & SUSAN R JOHN E & SUSAN R STRESE 314-A 150TH AVE HOULTON WI 54082 * =Primary Districts: SC = School SP = Special Property Address(es): Type Dist # Description * 314-A 150TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 20.090 Plat: N/A-NOT AVAILABLE SEC 18 T30N R19W SW1/4 SW1/4 20.09A COM Block/Condo Bldg: SW COR SEC 18, N 33.01' POB, N 797.20', Sec-Twn-Rng 40 1/4 160 1/4) S 89 DEG E 1154.18', TO WTLY R/W CO HWY Tract(s): V, S 589.21' TO NTHLY LN PARCEL DESC IN 18-30N-19W DEED 359 PAGE 530 N 89 DEG W 204.18', S 196.28', S 89 DEG W 958.19'-POB Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 752/532 07/23/1997 629/414 2007 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Last Changed: 08/09/2005 Valuations: Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 191,600 239,600 NO AGRICULTURAL G4 15.090 600 0 600 NO 2.000 200 0 200 NO UNDEVELOPED G5 Totals for 2007: General Property 20.090 48,800 191,600 240,400 Woodland 0.000 0 0 Totals for 2006: General Property 20.090 48,800 191,600 240,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 160 Specials: Category Amount User Special Code Special Assessments Special Charges Delinquent Cha 0 00 0.00 0.00 Total 4 02/06/2007 04:31 PM Parcel 032-2058-90-000 PAGE 1 OF 1 032 - TOWN OF SOMERSET Alt. Parcel 17.30.19.731B ST. CROIX COUNTY, WISCONSIN Current X Application # Permit # Permit Type Creation Date Historical Date Map # Sales Area App 00 0 Owner(s): O = Current Owner, C = Current Co-Owner Tax Address: O -STRESE, JOHN A JR &EVELYN C JOHN A JR & EVELYN C STRESE 1553 42ND ST SOMERSET WI 54025 • =Primary Districts: SC = School SP = Special Property Address(es): Type Dist # Description * 1553 42ND ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 17 T30N R1 9W 5A S1/2 OF SW1/4 SE1A Block/Condo Bldg: NW1/4 OR S 330' OF W 660' OF SE NW Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 17-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Last Changed: 07/23/2003 Valuations: Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 58,000 120,600 178,600 NO Totals for 2007: General Property 5.000 58,000 120,600 178,600 Woodland 0.000 Totals for 2006: General Property 5.000 58,000 120,600 178,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 207 Specials: Category Amount User Special Code Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00