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HomeMy WebLinkAbout032-1064-90-000 s~ c 5* r fu ° d con 'o 3 r~ a CD d N 3 - 3 m y O N N O O41 0 41 W x - N M-w (D CD I v Q Z a N O CD C- co O A r.~ \ 7 C N W N N O @ 0 CD CO CL W o M 7 CD (D 'O Q N O C ~D n S W O ti r O Sp C) 3 N N O O C lri CD a ° m n (n W a 2 m Z ° (D o o m o°\o J m ((~~r CD O O O Do W n N O C 0 0 0 ID z O O O co o O m CD 3 5 v cr v v v CD ° m N CD - 'um a Z K, r O 3 O 4, Q 7 N 3 N Cn N z z o ° z z D D o. ~ a I~Ny • CD `i I ° c I C,> m CD -I to z ° ~AZCD A Z O p ° m j co (D CD z I a 3 ~ ~ o ;w z o m CD N n CD m D 3 o w m o N a0 o a o N r N o. 00N~ N > T O C 0 O N C =~cn°3n p CD N 0' O- fOn CD CD 7 o x 7 0 p 7 N O O U) N N O O S _ - < O 3 `G 3 : CD (D O d s- Z CL CD C) 0 N Q A C N r- 5° o m CD CCD - O 0 cf) m j CL N ° CD M (n QOM do ~d a CD a n ~ w (D ° a O r N o (D 0 CL Nor Wisconsin Department of Industry, INSPECTION REPORT Labor & Human Relations FrL-1 Safety & Buildings Division Bureau of Plumbing a e an No. Name o remises It;i-, . et- oun y Sanitary ermit Master Plumber Firm ame dress t~ fy7 i t R -r r t~ L -t Aft6 i t t j 1 I~IJ Journeyman Plumber ress wner ress X 1-1 t Z A,A ,.ten p. Q ~_e..... ..,,.P...~.m ,6t?... .aw . ► o,,,,r. ; `r a - ' Z- i vi ti,- taP- To _ . Y_.. _ cKCA r 13 E Spruce Street r~~ 7•_;~~ ` t`1~ Nit,+~ . ~~ippewa Falls, Wf 54729 -1-7-154-723€7% Discussed with igna ure )See Attached. DILHR-SB➢-6192 (R. 1 1 /83) Signature of 1 s um i ng Sup . n ire-GTas a pgci a s C N O r m -0 D) 0 d C (D 7 (D (BOG '06 -0 n O _ a • (D O o cn --l 2 IF Z ° 0, o ~ ww `C N • 7 o v a m 3~ N r~ fl Z fl N C° l m° N p A (n M (n NO -0 0 7 Q N "O 0 N Q O "~0 N C) S co O K 0) O S?° 7 O 3 N ~ o ° ~r E a R, m CD " CL. CD (n W c CD C: ° 3 ° 2 (oo O O N m (D 00 j N (1 O W O -z fH n cn cn s" Q_ (D t7' >1 9 Z a b z O L-4 3 (D (D d rt ° a) ~ o v N cQ n C)" ~d CD CD a' m cn El ~ o a r n rt a 3Cn N N N) z a zz~ o D D o !r Z v O N a t►r cn o CD H a Z U ~y C~ 0" I N v ~ trJ N c -3 CL 3 U, W td Oz = A Z (o I Z z Oo O 7d ? G7 r W h O U-1 U) n W m ~ ~ n rr CD (D CL ::t z (D 1 3 . x o a z m _5 N cf) PC rt N O ~ N ~ wCD m a ~N 3 m (D 5 0 Z T C o v c 01 6 °3~ oz c N O_ m "O 3 3 X N NO N Z O (D y O C S -OO uC c p Q N a C) C ~ CCD (D ~O A a n _ . 7 0 m A Gi (n 0 CD M N 0- O O O [n d ~ (D A O O b to CD ~ W O a O ~ as o~ 's Parcel 032-1064-90-000 01/24/2006 08:40 AM PAGE 1 OF 1 Alt. Parcel 24.31.19.322B 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 % DIANE-M-RtVARD O - MILLER, JOSEPH G & DIANE M TRUST JOSEPH G & DIANE M TRUST MILLER E ) SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 796 205TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 24 T31 N R1 9W 5A E 466.8' OF S 466.8' Block/Condo Bldg: OF SE NE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-31 N-1 9W Notes: Parcel History: Date Doc # Vol/Page Type 06/16/2004 766013 2596/584 EZ-U 03/06/2002 672759 1848/45 QC 02/14/2002 671223 1837/114 TI 2005 SUMMARY Bill Fair Market Value: Assessed with: 77149 229,100 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve 1 Total State Reason RESIDENTIAL G1 5.000 58,000 126,400 = 184,400 NO Totals for 2005: General Property 5.000 58,000 126,400 184,400 Woodland 0.000 0 0 Totals for 2004: General Property 5.000 58,000 126,400 184,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 308 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 .JW NORTH 'PART SOMERSET T• 31N-R.19W 5 POLK-ST CRO/X POLK COUNTY /f wood fg G .U /a ce G Q I . 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Ge ~ ° tToFiri f f F ed F B Dam, wed \ moors Lo~~ d- IF' LyT w K hash f er- ,D dye ¢ 0• ¢on 4 /s nV~ Ha /e/%P I v~ i3/9 NORTHCRrf /,5-6 SMALL ~`m~ ~ ~ ~y 3 7~ "RKS £STS - ~nnVITRACrS Y c~~}/ Ql 0 Cec/ 2/0TH qV cR ' rR Cjermain h p H I Mt /~Ma~~d aJro45on e¢/ ~ w 5:.. 14~ 41 z. ` ego ,l/e/%c ux ~D GO Leona art' sen C foh f M o0 2 \ ~s Wo/f t Hib e.-t o 7~•pp ~C Ha z7o/-/:® L~.edttce Iona pCp~o Tws.Pobf oS ros.f Co o.F Y Qa r.F~s 6o v /f I W 0~ Gtr- Mar- o: u Sy/~. 0 h'aro/d W ~ oh.~ W QI y r `3 h 1 ~ - i~~ ~pp o fe// ~0 Tel Ba~,.~ /4o./z F!'rude/Q 3E q /6o R~ ~`.~0 ¢o O ` It r J ~ a3 . ao f W(T~ ~ am tl,' ao ~n p lp I V ow i °11 ~ ~ W a Dona/de • 6z Wa/ en ' ~ Ba ` ~ VE ~ r N o? F h a /Zcnee Debra. 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S. - 5 \ 11 200•T ar ° o v Orr r_ n,a s V n 'A C CCCIy fE /een r y'~ tix yyl Denn/s 4 t / ° ~X C ntl.tly Ale vma F.C ~tls S v,~ f DawrJ 9 ` = E ~ l o F Q pro E w v ; v Neu moan R ® yo Leo„a~d gO vb ~ 'A ~ ~ eo anse.. 5 .~/,r Ja/».Ee ~ ~ ~ ~CjEOr e T ~orxz„ C/ar_ E¢r/ L k a dy ~ ~ ✓ord //9 , ~n N Per/r~ock Bu~~' areas ~ /l/ewm ~ /:3abrrfi. f Cl/Qn 4i / I.Q m~ >o / ¢s /sy Lida F v G, (X {f/i s/o y~ Q Pe.s 2dT~y Remie enr> - 'jd wand i~C v 9 zz £c sn V z /so e - ~d IY. /oa d ~ ° y ¢o d~ ~ La 77s F /edQ f7 • s°d`✓ as ~ ~Tofin /s s qw~ of cSa ~a.~ NTH a-o Zw eke ~.y • EQ ire V' ti r 'v .ao /o s ~ Decmof Bo y H 1 y z BO 8o G~_ ~ N ~ ..3 a ~ F o >a Fiaac,.s .a ne° 0 4 o r' ~ 4a fY11 `s 49 n9/-o w rio do U= z W q 4 /~0 H ¢ti~ `~0 eta/ v\~ oy~ % r• t1l, a h .L 2 V m.Ontt ee6 tl rN ~ ~ tl 9° 77u s f Mar/ q V, 0 / F 0 5 m f a f 2 Morf~// Lem-n ~ 0 ~tl G✓a//ace ldo~ E I _ r i s2 e2 . s 0 srnA ~ e//s/e N Cif st t ~q, 80 ~J r ass .y V yLoan ^ 0 ores v5 \1, of ~ 6 Thni fro ~b ~PPQ q^+ o~~;. ~ 2 ti ~ o ~S /sz tl ~ m 35~ss 2~3 F tl~ - Bids ~d -s ~r/a}AOC 9° v~~ ~ coo t J yi ~ MA (66J s c . Kon ° U o P Q p r cTS k STwP se? ~I~~ n /¢B WN 1: 35 55 ''YY C _ 00 /NE R. R. _ ai 99 j ~i9BS ,Pock~/z"L Maop b/s I~~ •n /BOTH ~6 AVE Trz~S C,~ SEE PAGE S3 64 Stc °;X u~ 64 0 BANK OF SOMERSET LONDRY SOMERSET jal*- 9 LFNDSC „~~1NG - - FLEA MART Save With Us - Help STOP & SAVE Build Your Community New & Used Items Tools MEMBER FDIC Black Dirt -Crushed Gravel -Driveways Appliances Clothing ><n Sporting Landscaping Fill - Blackto Furniture Phone: 247-3348 pp' g Household 247-3480 or 247-3791 Antiques Somerset, Wisconsin Open 7 Days A Week q-5 SOMERSET Highway 35/64 Somerset, Wisconsin 54025 ' (715) 247-5269 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT SEC. / -21 T/ N-R 1 i W OWNER- TOWNSHIP ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILH.R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i~ f~ ~jl / N Iro INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used' Elevation of vertical reference point:- Proposed slope at site: '1 SEPTIC TANK: Manufacturer: ~L ~`Liquid Capacity: J F_)n Number of rings used: fu! 'A Tank manhole cover elevation: Y~ Tank Inlet Elevation: vl Tank Outlet Elevation: Number of feet from nearest Road: Front, Side, Rear, O feet From nearest property line Front,0 Side,0 Rear, O feet Number of feet from: well building: L (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER i Manufacturer: ~~~1 Liquid Capacity: 1d to 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: r Number of feet from nearest property line: Front, Side, Rear O , F~ Number of feet from well: G~ Number of feet from building: (Include distances on plot plan). /SOIL ABSORPTION SYSTEM l fj 4,- CA IS 4' I - ~)tL.-t-1! 61 f Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: 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). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on .ob:- License Number : 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 MADISON,WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL NNALTERNATIVE IS-1PI-ID_N-be, (lf assigneal Holding Tank ❑ In-Ground Pressure Mound 8503149 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE Joseph Miller Somerset, WI 54025 BENCH MARK (,P~r en[ :eler - po,nU DESCRIBE IF DIFFERENT FROM PLAN FEE. PT. ELEV. y ~S T REF PT. ELEV. SE S ,~~Sectzon 13, T31N-R19W, Town of Somerset Nerve of Iur ber. MP/MPRSW No.. County Sanitary Per-i[Number. Gary L. Steel 3254 St. Croix 64919 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED DYES ONO OYES ONO BEDDING'. VENT DIA.. ENT A~}~.. WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH A M FEET FROM LINE AIR INLET ❑ YES ❑ NO YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP,SIP ON MANU FACTUREH WARNING LABEL LOCKING COVER [[I PROVIDED PROVIDED. ~DYES YNO C)QQ P/f a S ~jCJl C.tY YES ONO ES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BULL INO VENT TO FRESH (DIFFERENCE BETWEEN a?! LINE q AIR INLET PUMP ON AND OFF) FEET FROM 2 0 / U C YES ONO NEAREST . SOIL ABSORPTION SYSTEM. Check the soilmoistureatthe depth ofplowing IEtiarH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN Z FORCE 5 L T J the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER NDIA nPITS LIQUID TRENCHES MATEHIA L: DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. 7FDISTR UMBER OF PROPERTY WELLVENT TO FRESH BELOW PIPES ABOVE COVER ELEVINLFT ELEVEND PIPES EET FROM LINEAIR INLETEAREST-i 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- YES O meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS i4 I N1 YES ONO L~-Y ES ONO 1111PTH OVER TRENC H:BED DEPTH OVER TRENCH: BED 11111TH OF TOPSOIL SODDED SEEDED MULCHED. CENTER / EDGES I~ I~, DYES 0NO L~LYES ONO LGPYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES: DIMENSIONS' ~p x Z. /S MANIFOLD PUMP MANIFOLD DISTRU. PIPE MANIFOLD MATERIAL. NO. DISTR jD:STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVELEV DIA ELE,V PIPES DA ELEVATION AND y~ / I~%' / DISTRIBUTION ~r INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED M YES /H I M6'V LSIYES ONO (YES NO COMMENTS: (PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROF ERTV JWELL. BUILDING. FROM ❑ NO YYES ❑ NO NEARESTO- Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. , ITITL - . DILHR SBD 6710 (R. 01/82) M1 Wisconsin APPLICATION FOR SANITARY PERMIT n1~ ~'YblX COUNTY DILHRA OEPggTTEnTOF (PLB 67) mousrq EnTgsHUmgnqELqnans UNIFORM SANITARY PERMIT # Ez: complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP TY OWNER MAIL JJVG ADDRESS PRO TY' _ T N VvE 1/4 1/4, S , T3 N, R J' 6( (or) W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, L~I1Cf OR L~cPdBA4ARK STATE PLAN I.D. NUMBER err ti TYPE OF BUILDING OR USE SERVED K 1 or 2 Family Number of Bedrooms. Z ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement 'S=Abs6rM- is Stem ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ 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 # issuea ❑ 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 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEfJI 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 ©o Manufacturer: C PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 6~ WATER SUPPLY: TO L L?:"5'-) D( Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: /MPRSW No.: Phone Number: & / 07 ell (7~ 1Z4~Ui- (a2cap Plu r s Addres : ( Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: El Disapproved C", El Owner Given Initial jLxa" Approved Adverse Determination Reason for Disapproval: 4 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 l Location of Property , Sectiory T 3/ N _ R / W Township Mailing Address /,-~2o /yj y Subdivision Name Lot Number Previous Owner of Property J .-11 r cG Ll 4.~Y Total Size of Parcel Date Parcel was Created 4-; Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes x No Volume ~ .-"-sit and Page Number _ as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 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. PROPERTY OWNER CERTIFICATION I (We) eeAti6 y that aU 6.ta tement6 on .th i,6 6wun ane t uue to the but o6 my (oun ) hnowtedge; that 1 (we) am (ane) the owneA (6) o6 the pnopexty du cA i.bed in -th,i.a kn6onmati,on 6o1cm, by viAtue o6 a waAAanty deed xeconded in the 066ice o6 the County Regiz ten o 6 Deeds ab Document No. 61 ,rte and that I (we) pneeentty own the ptopo6ed bite bon the 6ewage dizposat .6ya.tem (on I (we) have obtained an e" emen.t, to Aun with. the above deb cA bed pnopen ty, bon the const Auction o6 6ai,d 6y6.tem, and the Game ha6 been duty necon.ded in the 066ice o6 the County Regi4 ten o6 Dee4, a.4 Document No. ,3.- I f ~~r a SIGNATURE OF OWNED SIGNAT RE OF CO-OWNER (IF APPLICABLE) i,i k DATE SIGNED DAT SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, ~ DIVISION LABOR AND PERCOLATION TESTS (115) ~AD P. O. BOX 7969 HUMAN RELATIONS L ISON, WI 53707 ~ rj\ (H63.090) & Chapter 145.045) LOCATION:- C ON: / TLOT NO.:BLK. NO.: SUBDIVISION NAME: G /a /3 T31 N/R (o r) W COUNTY: WN S/961-) ER'S NAME: MAILING ADDRESS: ~F US .4 USE DATES OBSERVATIONS MADE NO.BEDRMS.: RCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence COMME ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ISYSTEM-1 N-1 I L LIHOLD ING TANK: RECOMMENDED SYSTEM: (optional) as®u off osZu os~u os~u1<< If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: 5 a( PROFILE DESCRIPTIONS Jv BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS- COLOR, TEXTURE, AND DEPTH NUMBER BEPTH-M,- ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 Sc~ Vic- 5y '0'/ , 13 ~3y B 0C) /o L 71 ~77 /rtr(C>C-) Jam' .3Jz B- oo /0a /t1 ~,l.l~ Paz-~ l~s,~. / w ~Ei-~ BZ SZ vii-( vC ( ate Y 7~r Oil. 51 oinlo B- B- B- PERCOLATION TESTS rn TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 4AlettE!S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD3 PER INCH P- J, _31j; 319 go P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION /0/ E E . / / . F app cam--- 2 ' /ooa ) t 3 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proce 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: n ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 188~rJ !h ` 6~ z z y8 - i~ z~~ - zoo CST SIGN TU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DII HR-SBD-6395 (R- 02/82) - 0\/F - a F_ ~ ~ a a fl E.. 3 _ b t E_ x_ 5; he a COMM" and lo, LQ}e.. c : 0nmy to , , . A , T SWAM AM CITHER K)"STEKAS ARE RUG 1) GLYT GAITO ON SOIL CONDITION EASE k. e 14 00.00A MS ray , 4 twn ?r V"runl p ily MAKE A m E " r w. You lot 'Rusurons. in 10A A f. wJ ed- F M,~ .4„a y ow , b,t. ,,ar,. <a,to v w&i invNeon , ,n Fri a -v clux3ry ;13,,. air.! ar: perqQnn }I ?4 oc- z , don, na x3. 13.x k dw r , ..aloWn w sr Np~ it aprooln we' eiwornation he E as MY rie?a, w, x,k r S d: tom,. nn! rtx, L#'s, it C 3;u°t a.,p1_ . 1-w pie f°r, and M. as ,f,."`s' r1p.1 Cooke 0 - 1 W", SS AIM, VA Man Sam"'~ Pac law F me S.0 Bog BKWA MY= MV, VV MP Loam v MY E i, m R o 54 Lawn lQl i'3;:~ r - ii COO So my ch", - - .t MY H - Nx c Fish ov, w m it the ;7:':`t xfi p :F; [ s.:i.. 4 t4:3 ,.i t f= a. 1 n e LJ ..tee t [n.E [n.. r 2 = _ iN O kK _ 7;ro in Ow -"!r=E=tL , v ~ ~ m x ~ x _ :3 m c O m m m co o a3 E :T 2. 3 =a co (o o v c m cOn ° yi vi m 0 0 CL 0 W° =w CD CO ` CD NA ~ r! CD 0w~m CD < CIF Er a r n 3 a CD nCD C' 0 A 0 c0 0 0 C- r- Z oc3oEL OD w w CCDD Ai C u, - CD :3 ° O 80 a -ono-,~~ D Q o CND N o D C: c N o c 0 - w e co " w 0 CD CD. MO O --w"N0 _v pi = 7 (A w a N m ~ cn (D CD w !n Z =r w 0 Z w CD ~ w 0- CD 0 3 C,m OCADN?°a a (n F E~ :E to w o0 m 0 ma cD V~ Oa (a a c " 0 y C n W N CD C X71 CD a 5 CL CD =r rm N CD (On O N n o. co n~ N Q w = 0 (n. lo > 1 (7 Q o w (n c r- C W j Ri a 2: C a0 CCD Q~'f acv) ' C < N 1• -w w =r CD co 0 N 0 C CD CD 3 d p m O c f0 7 0 v 0 m O a° " CL C CL w " CD CD C CD m ' C "",r to m a c= OD o As a7 3 0 ~ 0 ° 3 ~m a 3 a ° o CD a o CD 3 z E; o H UJ H ST C- 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT . H St. Croix County z F OWNER/BUYER a ROUTE/BOX NUM R~ Fire Number CITY/STATE- 71./ r f, t Z <l ZIP b V/ PROPERTY LOCATION:4k 14, Section, T N, R W, Town of j L 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 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 O I/WE, the undersigned, have read the above requirements and agree £ z 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 i - DATE.// i 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. PLAN APPROVAL Safety and Buildings Division L1 L H R Bureau Plumbing P.O Box 7%9 ❑ General Plumbing Plans Madison, WI 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 \ v \ Cdr OFFICE USE ONLY "r G Plan Identification No. ooh c9 Q Gallons Per Day PRIORITY PLAN REVIEW ONLY Plan Review Petition For Modification Project Name Project Location - Street No. or Legal Description County i ❑ City ❑ Village ❑ Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. ❑ FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact S cc: ❑ OWS ❑ DPS ❑ H&R & Rec. San. Section ❑ County ❑ Local PI ❑ Facilities Need Analysis Sectiar ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBA-6099 (R. 01/84) ❑ Owner ❑ Other _So -Y"5,f,4 -7/vwos1-) 'S v 1~ e ra 'te RECEIVED JUN 1 1985 42 4 PLUMBING SOREAU 850 3149 PILiJ MNNG Conbw-na4 l A 0"Ro"ED pto v 1 -065 ; oo L" / 1 /}'?t'1 b 6 DEPAATIAENT W-JNDUITRY LABOR AND HUMAN RELATIONS - VOid ~ETY !D SJiLDfNGS SEE C&RRESPCNDENCE Ll /V, r7- 1~7 s _ STATE OF WISCONSIN DILHR D OF SAFETY & RIEAUNOF PLUMBING BUILDINGS ® I L H R PRIVATE SEWAGE SYSTEMS B 201 E. Washington Avenue, Rm 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 608-266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this fofm describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266-3358. 1. PROJECT INFORMATION (Type or print clearly) Revision To Plan Number: Name o ,Submitting Party (Plans return d to same) Project Name Street & o. or Ru al Route Project Location - Street & No. or Legal Description City or Village State Zip City ❑ County Village ❑ OF:'In Ii! Town lp srlp r CJL.~~ elephone No. (Include area code) Designer Telephone No. (Include area code) Owners me Telephone No. (Include area code) !J &s - Street & No. Stre No. J / City or Village State Zip City or Village jj State _ Zip 2. APPLICATION FOR: ❑ New Mound System (3a) ❑ Groundwater Monitoring (7) (Ll Conventional System - Public Building (1) Replacement Mound (4a) ❑ Holding Tank (2) ❑ Replacement Pressurized System (4b) ❑ System in Fill (1) ❑ Petition For Modification (6) ❑ New Pressurized System (3b) ❑ System in Flood Fringe (1) ❑ Other Alternatives (5) OFFICE USE 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED 8,501,3149 MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 - 1,500 gallon septic tank - 50.00 4a. SO 3h. 1,501 2,500 gallon septic tank - 60.00 4b. 3c. 2,501 5,000 gallon septic tank - 80.00 4c. 3d. 5,001 9,000 gallon septic tank - 100.00 4d. 3e. 9,001 - 15,000 gallon septic tank - 150.00 4e. 3f, Over 15,000 gallon septic tank - 250.00 4f. RECENED 3g. 500 - 1,000 gallon dose chamber - 30.00 4g. © r t 3h. 1,001 - 2,000 gallon dose chamber - 50.00 4h. JUN 1. 2,001 4,000 gallon dose chamber - 70.00 4i. 3j. 4,001 8,000 gallon dose chamber - 90.00 4j. PLUMBMI ~~-IRSEAU 3k. 8,001 - 12,000 gallon dose chamber - 110.00 4k. 31. Over 12, 000 gallon dose chamber - 150.00 41. 3m. 500 - 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 - 10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank - 100.00 4o. 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal 3r. Priority plan review: walk through) 4r. Submittal of plans in person, by appointment, with double fee 3s. Petition for Variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee Note: Fees pursuant to Wis. Adm. Code, Chapter Ind. 69 may be subject to change annually DILHR-SBD-6748 (R. 03/84) Effective July 1, 1984 -OVER s 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 /KYtKXMX11X0 SEISE Z IS 13 T 31 N/R 19 X RjCW Somerset St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Joseph Miller Box 120M Somerset, WI 54025 I (ale), 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. R n O 111149 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. RECEIVED JUN 14 19E S PLUMBING BURR ~ ign re o Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF St- Croix This 15th day of May. 1985 . a e of sconsln Notary Public rfAVU? J. PEDER593'I i A Notary u 1 , State of Wisconsin Z My Commission Expires: 16 March 1986 DILHR-SBD-6413 (N. 05/81) ST. CROI X COUNTY t r r WI SC0 N S I N ` rwtcz , ZONING OFFICE I~ ^Y 796-2239 (HAMMOND) _ 425-8363 (RIVER FALLS) HAMMOND, WI 54015 May 13, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Joseph Miller property located in the SE'-4 of the SE4 of Section 13, T31N-R19W, Town of Somerset, St. Croix County, revealed suitable soils at a depth of 2.0 feet, below which seasonable high ground water was noted, This site should be suitable for a mound system. 8503149 Should you have any questions, please feel free to contact this office. Sincerely, , RECEIVED Thomas C. Nelson / JUN 1 ~ 1985 Assistant Zoning Administrator PLUMBING BUREAU 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 SE 1/4, SE 1/4, Sec. 13 T 31 N, R 19 fix) W Town thx r Somerset Street Address Lot No. Block Subdivision Landowner's Name: Joseph Miller The application for this site is for: RECEIVED ❑ new construction use. JUN 1 i 195 IM replacement system use. PLUM-iBING B!!fiEAU If this is NEW CONSTRUCTION USE, the alternative private sewage system is: lto have one of the first five approvals guaranteed for this year. This is numher - - of those applications. (Use one of the first five quota num ersissueU to you.) -Ione of the applications needing a quota number. The quota number assigned to this application is - - [_]for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [.Jfor 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. 8503149 (_Jfor 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: EN failing conventional soil absorption system. ❑ 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. R I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Si re County Official Title Assistant Zoning Administrator Date May 13, 1985 DILHR-SBD-6158 (R 12/82)