HomeMy WebLinkAbout032-1020-20-100
s G
ocnO 3-0 o d
O - d r O
7 CD n A M A7 H~
Z 0 1 L # C
M CD
3
3
cam) N N uNi O D A C)l 0 0o O 1
0)
N
CD o' o o w FN
CL Cl o. :Z N cfl 3 m o
a) cn
co
- 7 CO CO O > CD CO N C
-0 0 CD CD cr 3 -n -4
n (3 O D O
O
C7 U] C, a :E
3 O N N cn O O O.
C CT lV
CD b
F~ (
D N G G
C>
7 (D U]
CD La T N rat Z a N IW o o D
O
rt V
O m _
CD F~
Q F- In H L~J C o
t7 Z cn cn 3 n r cA
CO 00 0 C
lJ~ z Ln I o a o N r a Z
rl) C/) rt "WA
In H Z
cri 0
tyiy n a can can o N
CD rr3:
-0 o v <D U
D a
I m o-
a)
00 N 7 3 a
00 a - y N
Z
zcu z
D CD 0
w F41 C 0 O a
r D
Z ° m '
Cl)
N
-1 (n
(D S~
m (Op IV.
Cl) m m
n (D co a
n a
rt N fn
d !D Fl. Z ;Z Z O
c O O N p Eft
+1 ;o
fD a A z 7
00
Cl) rt Z j co
C
(D CD
CL z z
0 3 A
3 m co
N z
(D A
W
LA S S O
~')O~
N a
N n a
3CD (D17 o -
=r = v c
_?3. z a
N N O
O on c:)
N a N
7 a CD N
z
(D a) -O 0) zz
-N O
O_ ~ C A
(D
O `
Q S
C 5.0
N co fi
A
O co o
O
(D 7 3 pp
o a N
m CD3 7 N
o
3 o. o
CD
m o
• N
7 Dq
O
A
EA O 00
o (D b
C) (D
O i S
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
A OX r/)/
OWNER TOWNSHIP ➢K.,*, SEC. = T N-R `W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
4..
i
i
;
I
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
1
SEPTIC TANK: Manufacturer: ,Xl~;~,,,, fin iquid Capacity: 'J;L
Number of rings used: - Tank manhole cover elevation:
/
Tank Inlet Elevation:Tank Outlet Elevation:'
Number of feet from nearest Road: Front,~Side 10 Rear, O feet
From nearest property line Front,0 Side,0 Rear, 0 feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to sc•pric rank)
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: Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear, O Vt ~
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:
f
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 job: f
License Number:
3/ 84 :mj
DEPARTMENT OF INDUSTRY,
INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. FAX :`369
M/,~DISON, WI 53707 BUREAU OF PLUMBING
CONVENTIONAL EALTERNATIVE State Plan LD Number
ed
❑ Holding Tank El In-Ground Pressure 1:1 Mound (If assign ) / TA YA~M 7y
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Fred ogman Estate Somerset, WI I - .s 4? !Y f
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: JCST REF. PT. ELEV.
NE VW, Section 8, T31N-R19W, Town of Somerset
Name of Plumber. MP/MPRSW No_ County. Sanitary Permit Number:
Cal Powers 1563 St. Croix 54939
SEPTIC TANK/HOLDI TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
ft o PROVIDED
v ~C fto I DYES ENO DYES ONO
BEDDING: VENT CIA.. T f~ATL. HIGH WATER NUMB OF ROAD: PROPERTY WELL. BUILDING. VENT T?F
ALARM FEET FROM _ E IAIRyaL y
EYES ENO DYES NO NEAREST T - /
DOSING CHAMBER:
MANUFACTURER. 71 NG. 71PUMP PUMP MODEL PUMPiSIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
ES ENO EYES ENO DYES ENO
GALLONS PER CYCLE: AND CONTROLS OPERATIONAL NUMBER OF PROPERTY JWELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ENO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing NGTH DIAMETER MATERIAL AND MARKING;
or excavation. (If soil can be rolled into a wire, construction shall cease until T FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH. LENGTH NO. OF DISTR. PIPE SPACING. yQUER' INSIDE DI A. -PITS LIQUID
DIMENSIONS TRENCHES ~r AyE
FA PIT DEPTH.
GRAVEL DEPTH FILL DEPTH UISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO Of R NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH
BELOWPIPFS AH VER ELEV INLF1 ELEV. END LIN At
IN FjT.
Z 2 -7 2 y PIP FEET FROM
NEARESTs
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-
D YES E NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES ENO DYES ENO
DEPTH OVER TRENCH BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL SODDED - SEEDED MULCHED
CENTER EDGES
EYES "DNO OYES ENO DYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTR JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.. ELEV.. DIA.. ELEV.' PIPES CIAJ
DISTRIBUI ION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL 1 VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ENO EYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS'. I NUMBER OF PROPERTY WELL. BUILDING.
E.
,3 Z S ❑ YES 1:1 NO ES ❑ N FNEET FEARESROM LINT
Sketch System on Re in county file for audit.
Reverse Side.
SIGNA TITLE.
DILHR SBD 6710 (R. 01/82)
wlsconsln APPLICATION FOR SANITARY PERMIT
COUNTY
DILHR OEPRR=EnT OF (PLB 67)
UNIFORM SANITARY PERMIT #
In OUSTRV, LRBOR 6 HUMRn RELRTIOnS
1-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
PROPERTY LOCATION CITY:
VILLAGE:
1/4[' 1/4, S , T N, R (or) W TOWN OF:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED JOtoi~l • Ileo 0D
1 or 2 Family Number of Bedrooms. Public (Specify):
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
El Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Fft Pump/Siphon Chamber
anufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
/ ❑ Private E Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name-of Plumber (Print),' Sig re MP/MPRSW No.: Phone Number:
Plumbers Address: / Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
~y~ Disapproved
~l/p ❑ Owner Given Initial
r "f J Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLS 67 - SBD 6398 Ilk
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 P!?RM0
S T C - 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, p
( sec
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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
f4wner of Propert W_1~
Location of Property 4 _t Section % T N - R -Zy W
Township .rC~o -
I.Mailing Address
Subdivision Name r _ - - - -
Lot Number - - - -
Previous Owner of Property
Total Size of Parcel
Date Parcel_ was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes ~T No
Volume and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOKbOWING:
7 Warranty Deed 0
Land Contrac U lI
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 CF_RTIFICATION
I (Wo) eeht4l y .that OX ~-ta..teme_n,th on -th.,s Konm ate -true to t6i-e. best of my (ot h )
Onowtedge; that I (we) am (ate) the ownet (h j o{ the pnopenty doscti,bed in ttiiA
4onmatton loom, by vintue o{ a wantan. deed neconded in-the OAA tee of the
County Regis ear ol Deeds as Dueumen o. and that I (we)
pnesentXy own the pnopoded site lot e. 5ewago d sp Viyotom (on I (we.) have
obtained an easement, to nun with the a ave JANd ptopehty, lot .the.
cons.0tuct4on of said system, and ,the same has been duty neconded in the 0111c.e
oo ,the County Regi6ten oA Weds, as Document No. ) .
-7 ldl~
SIGNATURE OIL OWNFR,06y-40-IAO-i- ljk~, SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE, SIGNED DATE SIGNED
H
H
y
r
j STC - 105
H
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County t4
c7
H
OWNER/BUYER /Z/,, ROUTE/BOX NUMBER/ Fire Number i
' - _
_
CI'T'Y/STATE Z L P
PROPERTY LOCATION: Section N, R --W,
Town of `__L 1- St. Croix County,
Subdivision Lot number-
.
I
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 ILcensed septic tank L_um~L)er. 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 maxi _m_um 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 stems agree to keep their systems properly
maintained.
The property owner agrees to submit to St-. Croix County Zoning a
certification corm, 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. o
I/WE, the undersigned, have read the above requirements and agree cn
x
to maintain the private sewage disposal system in accordance with r,
the standards set forth, herein, as set by the Wisconsin Depart- 'v
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.
Si ~i
ll AT L -
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.
i
OMMEdom wrsconsxn SANITARY PERMIT
County ~DILHR .
GROUNDWATER SURCHARGE 'IYA VV3USTAV,LR30P6MXT1pflgELwTg1'ls Sanitary Permit No.
,5-11193f
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com-
monly 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 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 is used in your building is returned to
the groundwater through your soil absorption system or the disposal site used by your holding
tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground-
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
Ground * fey -
Groundwater Fee: Date: WIsco ( `S
Signature of Issuing Agent:
r lac buried ,.A a Urs,
DILHR SBD-7289 (N. 05/84)
6
DEPARTMENT OF SAFETY & BUILDINGS
INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION
LABOR ACID PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 7969
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
L09ATION: SECTION: pp TOWNSHy/MU{W1C11P_X_LITY: LOT NQ.: BLK. O.: SUBDIU SION NAME:
/T; NCR. (orlW = -
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: i
USE DATES OBSERVATIONS MADE
/
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
QResidence / QNew ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑S ❑U CIS ❑U ❑S ❑U ❑S E]U ❑S ®U
If Percolation Tests are NOT required DESIGN RATE:
I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 7
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH 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.)
K
1210
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P_
P-
P -
P-
i
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensib n f suitable soil areas. Indicate scale or distances. Describe what are the hori
zontal and vertical elevation reference points and show their location on thep an. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
1 r
E
,
,
yn e _ _
,
-
(
,
I k/ -
(`f F
/
r
i
,
...E ~ v. . € _ _ .
I
3
,
,
,
4
li
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the pro edures and metho s 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:
- S~ -
A D D R S/S:' CERTIFICATION NUMBER: PHONE NUM ER(optional):
ll
CS IGMt4TUR
b
ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
I-lR-SBD-6395 (R, 02/8?) - OVER
s. awn0tw _ ' ~6 V0.0; a 0 Oka: UM,
.
, _ s _clcura no wr vs 3 P IM! E ! ,r c 0
se
v Orly Aed. m. het1.e r !n &a Tfw Y .W,. M's r, A s ,s,Q,
`4, t s 4a a ° ri3f7£)~,3"g c3. ne I ld' . e 'awi ed;
c~t La CC£F, aMy WO MY M_, tat WOMse lht?E_g 10 smile to a.k.taF'5.`i
E"_., as to _ t<t t'€ aC7;1¢x _ ..`;ii-:. n dvar i"." x-,.i'-p-
10. it "(vs vun
fm ra and M, yow w! . W zadlhs'~'~~'~ ,E. S E~" is .3
7 77 t~ 43t 2'iEy ~f_.7~f;':
ALI °&I, ti TN Wi7i !T
t_.,.
RR
:s S At =rye
3 u: 3 f
SW t.. (n it
p.. o"e s e p
CPO Arpr -E--e"rdlea
_ a. war8 Swat > d, nr
r ' E
Low, kE 0 _ 3.
SO 11mm H1 No k-
SM s y - G r Molj
,
Vwlo ( ,:.r,3 "InA
SAO 1 0 Fi
.
Sky 7.
ve1 F, 'r v 00
nil
rf,
d Oak,
~I
S, ' ~3;!, 't , j. IS -;i 0 11 N1 w y E, j ' 0; nn A r L,AV 01 15 3,.o-4<,,...wnt,#1ia t .{.1~...est
E. _ E. l'n l ontl he v~~"__:,.s" ;9;:' .t,. :n_,l €z,-tzlm , V ul
1
_ f
I
~ I
1
L
i ,
i
i
PAGE OF
GruSS ur, Cj'- l~ ~r0 -):rs
~
Fresh Alt Inlelc And Obcsrvatlon Pipe
L= Approvea Vent Cap
Minimum 12" Above
Final Grade
2U- 42° Above Pipe _ 4° Coat Iron
To Final Grade Vent Pipe
Marsh Nay Or Synthetic Cover ing
m1n 2° Aggregate -
Over Plpe
Oletrlbullon
Pipe 0 0 0 0 0 - Tee
b° Aggregate
Beneath Plpe o Pertoraled Pipe Below
o _ Coupling Terminating At
Bottom 01 System'
Pru ode ~ ~'t~w) c~r~.~l{
~ICJo~ f tGfl
SOIL FILL
DISTKiBLITIOI.I PIPE SINTN
• APPROVED ETIC COVER
'e"--MATF-RIAV OR 9'' OF STRAW
2-OFAGGREGAIE OR tAARSH H4,.J
(o 0 F%z-2I12 AGGREGATE
ELEV. OF f
- EEZ'_-e,_
DISTRIF~UTIrDJ PIPE TO BE AT LEAST i1JCHES BELOW ORIGIIJAL GRADE
AIJU AT LEASTZO IIJCHES BUT KIO MORE THAI) tit INCHES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXCAVATioo FI(oM oKIGINA4 &KADF- WILL BE v' IIJCHES
MIMMUM QP
E rki OF FACAVATImN FibO/+t!. C4~►6laAL (39dnI` WILL BE `f INCHES
SIGLIED. r
LICEIJSE AJUMBER:
i
DATE: I
Parcel 032-1020-20-100 01/08/2007 12:19 PM
PAGE 1 OF 1
Alt. Parcel 8.31.19.97A 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 - POTTING, DEBRA
DEBRA POTTING
355 230TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 355 230TH AVE
SC 4165 OSCEOLA
SP 1700 WITC
Legal Description: Acres: 19.820 Plat: N/A-NOT AVAILABLE
SEC 8 T31N R1 9W NW NE EZ-UT-1197/250 EXC Block/Condo Bldg:
PT TO CSM 15/4120
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-31N-19W NW NE
Notes: Parcel History:
Date Doc # Vol/Page Type
11/10/2004 779601 2693/378 QC
07/23/1997 932/135
07/23/1997 716/362
2006 SUMMARY Bill Fair Market Value: Assessed with:
145079 Use Value Assessment
Valuations: Last Changed: 08/09/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 48,000 80,800 128,800 NO
AGRICULTURAL G4 16.820 2,100 0 2,100 NO
Totals for 2006:
General Property 19.820 50,100 80,800 130,900
Woodland 0.000 0 0
Totals for 2005:
General Property 19.820 50,100 80,800 130,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 10/21/2005 Batch 05-40
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 032-1020-60-000 01/08/2007 12:19 PM
PAGE 1 OF 1
Alt. Parcel 8.31.19.100 032 - 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
DEBRA POTTING O - POTTING, DEBRA
355 230TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 4165 OSCEOLA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 8 T31 N R1 9W NE NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/10/2004 779601 2693/378 QC
07/23/1997 932/135
07/23/1997 716/362
2006 SUMMARY Bill Fair Market Value: Assessed with:
145088 Use Value Assessment
Valuations: Last Changed: 08/09/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 19.000 1,900 0 1,900 NO
UNDEVELOPED G5 1.000 100 0 100 NO
AGRICULTURAL FOREST G5M 20.000 40,000 0 40,000 NO
Totals for 2006:
General Property 40.000 42,000 0 42,000
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 42,000 0 42,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00