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Parcel 032-1061-70-005 05/11/2005 12:45 PM
PAGE 1 OF 1
Alt. Parcel 23.31.19.3126-10 032 - TOWN OF SOMERSET
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
08/06/2004 00 0
Tax Address: Owner(s): Current Owner
STEFFEN, DAVID A & CAMILLA R
DAVID A & CAMILLA R STEFFEN
29137 JUST A DREAM TRL
PARK RAPIDS MN 56470
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 629 205TH AVE
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 4.031 Plat: 4803-CSM 18-4803 032-04
SEC 23 T31 N R1 9W PT NW SW CSM 18-4803 Block/Condo Bldg: LOT 01
LOT 1 (4.031 AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-31N-19W NW SW
Notes: Parcel History:
Date Doc # Vol/Page Type
0$LQ&2W4-------
'623/199_--7709.&4 __18/48?3 CSM
7/ 7 762/231 ) a
07/23/1997 728/28 /
' J 7 07/23/1997 694/537'
iir
2005 SUMMARY Bill Fa
Mark Valu : Assessed with: ~~97 b~ W % of s~~
Valuations: Last Changed: 04/13/2005 y~
Description Class Acres Land Improve Total State Reason ~~d
Totals for 2005:
General Property 0.000 0 0 0
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
Parcel 032-1061-70-001 05/12/2005 10:56 AM
PAGE 1 OF 1
Alt. Parcel 23.31.19.312B 032 - TOWN OF SOMERSET
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
08/06/2004 00 4
Tax Address: Owner(s): = Current Owner
RETIRED STEEPEN - STEFFEN, RETIRED
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres--.----.,. 15.000 Plat: N/A-NOT AVAILABLE
SEC 23 T31N RI 9W 15A NW SW THE E 49T OF Block/Condo Bldg:
NW SW (NKA CSM 18-4803) -
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 762/231
07/23/197 728/28
07/23/1997 694/537 I~ 1
2005 SUMMARY Bill Fair Market Value: Assessed with: d
0
Valuations: Last Changed: 04/13/2005
Description Class Acres Land Improve Total State Reason
Totals for 2005:
General Property 0.000 0 0 0
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
T (N) T.31N. - R.19W.
W E
ORS q
a /nc. Sc. Cloud, MN 56301
Polk Count
3 Clarence 1.8 SL Raymond William Charles& Arthur& 4 3 Robert 3 31.83 3 Michael
Wa & Opal Catherine 3 & Debra Wilfiam & Alice
e Morten 44.67 yne Nordin Patricia Blair & Pioneer
e ti~ Haase Pinkerton Smith &Shirle Demulling
Lyle & 10 4 H Peterson 58.18 35 155 35 Bork JR 9.45
71 4 3 28.88 gri s y 39 Eleanor Dai
40.59 ry
& Beverly R & E Gar Harold & Leo & ( 76 T'K 3 3 Gerald & Dollery
Palmsteen &crlo.sa Stephen Farm Inc
Martin Margaret Darlene - CC 9.65 ennifer
66.84 120 Justus & Craig & Anne Schieflbein Schachtner Crotty 40 Tangen DS Laventure Butzer 80 165.79
Darlene Arndt zo .Richard &
etal Louis
80 R& M Richard & Eaward & Patricia W&M 20
J` Jerry Sittlow Mart40 in t & Mary Crot 20 Florence Mildred 116.16
t v Patrick Laventure Cole Gregory Grubbs
& C Christenson &s zo Schaar C114 4 CB LE Howard
Coochrane 3 40 . 4.134.5 s 37.5 81 Traiser & Linda nm,ner20
369.63
J o BR D&N Mark
ames & N ~ ❑ M&S Nelson N
Barbara N a9. 2 T 9.6 Cro 24 x w Chas & M'✓ D&L
Miller 80 80 a E 10
Nelson 40 KS RR 20.85 TS D&H 35 Mary Ann 10 34 14
43.6 00 w" 8.58 9.46 8 H 3 ¢ 3 117 Traiser Fam Tr ya 2U a 10
N Charles J&TR G Terry & Margaret A .1 1 .79 3 3 m 9.55 2 LK
i & Debra N c Lederer & r 12.27 v 40 Cook 41 13,7 LB 3.95 CF Traiser 52 Arvin b4'
a Kath Paul & Sherrill v t. 39 10.65 eta] 78.5
Itting eo y m iebrock y~
gQ +tl 4c Jones p &MH 12.43 n: stee y>
•.1 Schottler I W R R&pS 41.11 - VIK 10 72
Mary d1 m JR s x F PI rd Joseph R&r B Donald & 80
Lorraine 0 rj U) v11 IJ Plourde
Hi1de- 94.32 B'rt Doroth
Kro gm. .4 ach er 24 Daniel Y 40 40 Brandt 40 ass 1 Gregory 42.5 t20 Bemis Martin
ke 50 3
J&D 20 A Plourde 2
rch Martin'` yg s David & Edward M 160 Daniel
Schachtner s.e Elaine Richard
~y G Clemas a 40 3 x 3 3 116 Richard Baillar eon 2s
q+ etux 20 77 Michael 81.12 Quinn Quinn g
Syoc D&D 20 & Jane GBS 6 sB Plourde Rev Tr 155.08
i)¢ Belisle Casto K 3 34.47 158 Mildred 80 O
0 or LYM Cook 5 C 2 151.2 Holen Tr 80
V 20 3 66 KGB KK m.. erawa
ra.es
EG HH Wilma MK JO Mitchell o Robert & O
10 3 Schachmer 10 Kn k 20.1 vy Richard Robert & John
00
10 1 -A LS M 3 Wilma LE Walsh 10 Germain Barbara O Harmer Lorraine
10 1U Sehaehtner etal 40 77 William 5 Ronald & Donna 40 B 4isle F Trust 70 Pellet C
Rice Lake BR & Lois Wiederin KP N B B&JD R&B in
QM eadows b Fam Prtshp Northern 3 Sommerfeldt 103.37 ' a 5 9.1 B EM . eiso Edward & Ann o
3 a. Germain v
st 3 5. 270.69 Oaks Estate s u M~ c s. s o o Q
R 4.69f.. 118.95 4 w 5 3 5 JH 6 S H5 100 P4
1 &M
Stawl Cecil Sara Gary & parsons Michael & 79 Li I %j C Derosier.
Margaret 20 Donna & M
Deborah Leona John 116.32 Mary zo
DNR & Alba Weiner Paulson Albert I " D Michael Michael Luedtke Michael &
- ~ Murray 60 Wolf Cook ,x Gerald N 20 M6:D 15.9
34 27.9 51.1 Cook 6. & Harmer Germain 60
g artinsen etux Michelle De oun Kmhn Michelle J20
2A 67
Robert Brendan Robert E o
Q
11 m TB LE etal w 3 Germain Trust
, & Jean g c o etal Dav]d 4 39.81 James Germain Melvin
Wirhelman & Kay Martell a $'98 61.19 Dauager Richard & Frances
Germain Carufel
40 40 40 4 s R 79.02 etal 80 3 6039 FA h~
our zo Germain Breault
3 80 40
19 N70.31 a V&D T& ^ LM 3 3 a
Mw to Donald & y Walter & Debra 3 3 3
D&JG m 20 20.2 a Zi; SO
.9 .a ~ Robert 1 Germain 145.42 4 Betty r~ ~45
14 3 ~
A 12.215 Renee
1 David lw' Martell Dufresne Lurille
5 Baillargeon
] 40 Otto & Lynn z 8.65 155.87 Carufel Des & Dawn Trust U 64.58 l 0U1S
Raddat Lynz V 10 80 Nuemann Son B 3 Rivard
J Silha &
3.99 EF 10 160 54.98 Tr 70.97 U 4 55[7,
- -1
11 5
1*1 00
275.97 40 iiB Eu ene & John
State of D A fC •U r g u M944 ~ t. 19 .c N WS 3 3 St Res 1
p Angela x
4VI 10 Ba Anela ZW1Ckey F o oµD&D ss 43.85 5119 St Hansen's
DNR BM StateofWl Faal rs 37. 5.32 7~ Helget (7O 2 6~ a Addition
DNR C&A ' o5.3 Joseph & 1 ,y
10 IS 65.63 , 011 Sherman Ib N ber 20 w > Donna Ki 39 Louis & Lorraine
120 5.55 S Cichy B' A
T 4'ti Belisle & L Drill 40 K 20 SP m = DC Spartan Germain
artel 4 34.25 22 Vanasse 3 10 d c4 ^ O 4 12.4 B&G 19 St 104.85
68
125 DNR - Alan & 3 Roger Bz 4.57 Dennis & Dawn
Robert, Patricia 9.6 DH
BB F 4rlVanasse Newman y 60 SAS Neumann
.y 123 0 3 119 2 Thomas, w Q S 46.79 TM
0
y Z 5 91.4 7N
15 80 & James 75
s 40 RH 12.6 A 8
Leonard Land b Pinecliff Anthony Clarence & Elizabeth
aR
°3 a ry ' Muriel & D'Arcy Helen
Pehx PR a t Jahnke 80 I] Partnership Teasley Parent Neumann etal ,
Wegge
Land 4 5 7
36.04 159
Steven & sager lz Ro & Thomas James Ctai 3 34 Recite ger 64 M Neuman & P Scott
te 8.13 ta & Plourde Linda Sr US-
Sager Frieda 40 JDhn
of 27'39 n AGm ennessey and Landry 238.55
Michael •d ri 40 ry' 101.4
& s a McDermtott~ 40 Zwickey 80
Rivard 40 40 40 Sam air
Linda vl Q p
Sager RH MP Hartman ca s RB Victor & ° 3 RL Vir inia LH 105 Lindale Francis & JO ce
37.45 9.45 10 Homes 8 Elaine o„ 9.6 g 7.4 Meadows y
Thomas 61.45 Martinsen ^4J 6.96 Lawson Tr c Hecht y Donald Sm Mondor I
PB 9.9 K 20 Inc a 15 etal Bl E A ww 80
VM Earle 40 Belisle 40 23.97 Martell etal 48 Tr 6 5 5 7
It Z
4 GC Bernard
3 Roger & Remie M 1 Duane '
& Louise Thomas & Pamela 18 D& J & o
JM Martell Julie 40 & Marlyn
Belisle Plourde 54.75 N V 72 L& d USA 106 39.99 Sanders 40 40 A 1D1 PB 5 3 17.5 Lemire
3 Nanette Gerald
8.27 3 3 StArlene 50 Carol & Cecil Clemas ~ Kelly 5. N SO M E RS ET "
Plegge CB LB 5 Belisle Plourde etux Montpetit ao
Roy 40 9.79 u, u~ m N70 40 62 38,44 rn 35
o, 6 11,
W7
2 Koester c&PSun 36
etux 15.03 T 5 6 u 3 O Q> James Jr
4.96 4 v 'D
& Joseph
82.04.96 BW R RS H&B 8~ N
N 6.7 5 Dani 1 1 o GB Vargo
100^76 G KP M l~ LS E - 9,9 Caroline Q Douglas & St Croix village t7l
/j Vill-,
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER j TOWNSHIP SEC. T N-R / W
ADDRESS ST. CROIX COUNTY, WISCONSIN
i.
SUBDIVISION LOT LOT SIZE `
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r
j
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: !l Proposed slope at site:
SEPTIC TANK: Manufacturer: Jr Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side,O Rear, 0 feet
From nearest property line Front,0 Side,0 Rear, O feet
Number of feet from: well building: _
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
l
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, 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: T
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.-< c
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
i
Has either n drop box O or distribution box O been used on any of the above soil
absorbtAon 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 buildin<<:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
i
License Number: i,
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISOA iii'53707
®XONVENTIONAL ❑ALTERNATIVE IS,,,, PI- ID Number.
Ilf assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
Gary Platt R. R. 1, Somerset, WI - ,?,I - 1-'30
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
NW SW, Section 23, T31N-Rl9W, Town of Somerset
Name of Plumber. MP/MPRSW Nn.. County Sanitary Permit Number.
Gary Steel
3254 St. Croix 54979
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUID CAPACITY. TANK INLET LLEV.. TAN OUTLET ELEV.. WARNING LABEL LOCKING COVER
pp , PROVIDED- PROVIDED.
G' 2 YES ❑NO ❑YES ❑NO
BEDDING. VENT DIA.: VENT MATL. JHIGH WATER NUMBER OF ROAD PROPERTY WELL: JBVENT TO FRESH
d ALARM , LI AIRIN4-ET-
FEET FROM l , I YES ❑ NO ❑YES ❑ NO NEAREST r-' 1 it
D ~ I /
DOSING CHAMBER:
MANUFACTURER. T71NGS
LIQU
ID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACT URENWARNING LABEL LOCKING COVER
PROVIDEDPROVIDED❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: 7D M P A ND CONTROLS OPERATIONAL NUMBER OF PROPE HTV WELL BUILDING (VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check thesoilmoisture at the depth ofplowing IL FN(JH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF DISTR. PIPE SPACING COVER INSIDE DIA. UPITS LIQUID
BED/TRENCH - ( TREyeHES / MAJeRIAL. PST DEPTH
DIMENSIONS
GRAVFL DEPTH FILL DEPTH DISTH. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. N TH NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV. IDLE T LEV_ END PIt~ FEET FROM LINE 1 AIR INLET
.
r ~i 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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH. BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL . SODUED SEEDED MULCHED.
CENTER I EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
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 JNPIPEISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV. ELEVDIAELEV.PIPA.'.
DISTRIBUI ION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. _7_]TIFTLE.
DILHR SBD 6710 (R. 01/82)
wlsconsln 10 APPLICATION FOR SANITARY PERMIT _
®1 LHR COUNTY
(PLB 67)
oEaRRrmEnTOF UNIFORM SANITARY PERMIT #
rM InOUST R4+, LABOR 6"unnAn RELRTIOnS
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
KI
rKI C:.
PROPERTY LOCATION CITY.
IM LL A GE :
li(I ,1/4 Li: 1/4, S._ Tai N, R % E (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
1 or 2 Family Number of Bedrooms: ❑ Public (Specify):
THIS PERMIT IS FOR A:
1-1 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.
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 nn~
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: '2 7
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
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
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: MP/MPRSW No.: Phone Number:
R.
Plum~er's Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
❑ Disapproved
,liL J 0 7 El Owner Given Initial
ij 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
L___ A
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.
I
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY,
LABOR AND PERCOLATION TESTS DIVISION
P.O. BOX 7969
HUMAN RELATIONS (115) MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: 5 SECTION: TOWNSHIP/ 4P,4L-ITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
i~ VJ V4 '/a z 3 /Ts) N/R , r E' (or) W S V fn
COUNTY: 6Vtl1 ~'S/BUYER'S NAME:
11~' MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence ,MNew ❑ Replace z
,e f j
_1
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUNDPRESSUR E LL HOLDING TANK:RECOMMENDEDSYSTEM: (optional)
E] S [23
colation Tests are NOT required ]DE GN RATE: I If any portion of the tested area is in the
Lun:ders.H63.09(5)(b),indicacat,
: ✓
' Floodplain, indicate Floodplain elevation: `y
ryj'5'51 r" a / PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
1 _ I
l' 7 F KJ fj _ S • J I ~'~11 .c~T, ,G. J /moo
7~
1/7
7 t~ tY - n ? 11
7 ( fC p rJ
B- : C r~ Irk ~f l f l a i1 i a ' • h
f r
00
'IF
B-
_r~ I W,(4 ~ PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER FNe+hE5 AFTERSWELLING INTERVAL-MIN' PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- 2
P- 3 (_J
J ~
P-
P-
L
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
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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:
ADDRES~_. ) 1 CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGNAT R
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) -OVER
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APPLICATION FOR SANITARY PERMIT
S T C - 100
This application form is to be compLutcd in lull 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 decd recording.
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Owner of Property - c ( -
Location of Property ~40 Section T N - R W
Township 07
Mailing Address E 7---t4e'YA CA S
Subdivision Name
-
Lot Number _ -
Previous Owner of 'Property ~s `V 1E; u-x
Total Size of Parcel SAID C>L, 1Grcr S
Date Parcel was Created
Are all corners and lot lines identifiable? i/ Yes No
is this property being developed for resale (spec house) ? Yes No
Vo 1 time
and Pale Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
Q) 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 Mai; shall also be requi red-
i'ROPER7 Y OWNER CERTIFICATION
I (Wd anyti.6y that aft Vatements on this foram aAe -tnue to the best of my (out)
WwCedge; that I (we) am (ate) the owner (d) of the psopen,ty desc bed in ,thIV
kJonmatiLon 6osm, by viAtue of a wantan-ty deed neconded in the Office of the
County RegloteA of Deeds as Document No. and that I (we)
pamentty own the proposed site JoA the Isewage disposal hyhtem (on I (we) have
obtained an ea6ement, to nun with the above desenibed pnopenty, ion .the
cun,stnu.ction of said system, and the scone has been duty seconded in the Office
o6 the County Registak of Deek, ah Voeument No.
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SIGNATURE OF OWNER SIGNAYURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
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SEPTIC TANK MAIN'T'ENANCE AGREEMEN'T' o
St. Croix County z
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OWNER/ BUYER
ROUTE/BOX NUMBER - -Fire Number
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CI'T'Y/STATE G1P n -
PROPERTY L OCATION: sec tiun 1'~- N, R 4 W,
Town of St. Croix Coun1v,
Subdivision Lot number
I
Improper use acid maiit teit ait c~ of your scl)L it ;system cou_Ld rusuLt in
its premature failure to dandle wastes. Proper maintcuauCe 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 fUuCt iorr 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 Tor
it 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 ar,ree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County 7,oninT; 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; (i.f nec-
essary), the septic tank is less than 1/3 fu11 of sludge and scum.
CertifiCaCian corm will be ticnt approxiuurtely '30 drys prior to
three year expiration. o
l/WE, the undersigned, have read the above reyuireusents and agree U,
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- v
ment of Natural Resources. Certification lorm must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED 5 a' ez U
DATE
St. Ci,oix C.runty Zoning Office-
P.O. lox 98
.
Hammor`d, W1 54015
715-7L6-223:1 or 715-425-8363
Sign, date and return to above address.
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ST CROIX COUNTY CERTIFIED SURVEY MAP LOCATED
IN PART OF THE SW 1/4 - SW I/4 OF SECTION 23, T. 31 N., R. 19 W., TOWN , 0~
SOMERSET, ST. CROIX COUNTY, WISCONSIN
44MV-S _OWNEP_8Y
NORTH LINE OF THE o
SW//4-SW1114, SECT/ON 23
~`9o O~ SEE OETA/L
TAIL 00,
N. 88058'14"W. 10
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NOTE: THE TRUE FORTY ~G
CORNER LIES S. 880.58'14"E.,
n
7. /5 ' FRO f THE NE CORNER t
OF LOT I.
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SCALE ONE INCH EQUALS ONE-HUNDRED-FIFTY FEET N w rl to. Y N h I-i
100' 50' 0 100' 200' 300' 400' m l2 ` ~A Al g ~O
LOT ~lS
LEGEND AREA 2
h. TOTAL 439, 083 SO. FT.
O I" X 24" IRON. PIPE SET WEIGHING 1:68 LBS. D /0.080 ACRES
PER LIN. FT.
ly EXC. R/W :fJ2^9; 0-3t9. Fr.. ILl
• I" (OUTSIDE DIAMETER) IRON PIPE FOUND 9.86,- ACRES
~ -----M-- EXISTING BARBED -WIRE FENCE
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N N
THE SOUTH LINE OF THE SW 1/4 OF SECTION '12~ N
23 - 31 - 19 IS ASSUMED TO BEAR S. 88 54'39" E. can J
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C EN C~y
AGEN 1407 SON, °i l S. Q`- °
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SOUTH LINE OF THE SW//4
OF SECT/ON 23 -3/-/9
S I/4 CORNE
COON T
334.19' _
SW CORNER 27'44'
COUNTY MONUMENT 29.26
S. 88° 54' 39" E. 1003.12' S. 880 54' 39" E. 334.37'
l?/lN LINE
_UNPLATTED _ LANQ•5~
SIGNED DATED I O 8 66' TOWN ROAD
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ALLEN C. NYHA N R.L.S. 1407 L~
VOLUME / PAGE--- 0
b?'c Cr"+~e,S~rrtc a!uaa!a,•.rw?,r gpe,Ki-'~~
i
' )OMERSET `N' PLAT W,~ T-31-N • R~-<20-19-
~ q,::. Fi~ r:; ? y. r..:,s 75 <s Y)s Ytt~, Z x< < Ss D< < 2 ~27?;t ,r ~ Yr7'S2 ~~'<r s.~~~+~
ga e 1? ..5
1Z For Additional Nam
;Landowners) See Pa
POLK CO. 800
400 POLK/ST CROIX RD 500 600 700
300 e: A&P a' m 3 3 Michael O o
oel & n g C arence SL William camerne d 1y & Alice 00
Pioneer o
Y c~ T ~ 31 David Wayne & opal Pioter- 17 ~ ~ ~ ~ & snhler 'Demul- Dairy
° z Susan Dee ° Morten n Peterson Haase Vii" r R 9 8 =188 3z 'n
C Mahle 8 44 3z 1 as 8 41 ,8 0
Farm Inc
r 3 18 9 & lorunn O > Kowski y : Di lene & to n Gerald & q °8 ro~ m M n
Farms Inc
&B l&D Svanoe ro 0 45 &f m35 r g 2 `O Jennifer Ix "'C a, 167
s F
R 41 euben &M c venture W&M 20
R5 15 Martin j u Iv m a U ao Grubbs
5 & s Donovan Jerry Sittlow 36 l~ William s a ° 04 ro Ro s<nv m °-t r Morrls
i9 3 F 6 & Karen & C & Opal ~ ~ tr a u C 9 z 1C . & arQndyn 154 , & M Knai-
thy WV id -en Christenson l & C 20 Haase Pa '<t 3' ro
t U~ J& Cochrane B&6 0 ° 'd o D&L
T 10 Jr 40 120 &c 232nd a zd M 24 Chas & Trust ^ t m ° N E 10
--r~ sue- ichael 294 AVE Crotty r N Ma er 117 11 .5 c7dS-4 WK
Barbara & Susan m 21 11, 6614 Neiman qq tr 230th AVE 3 F r 40 a s _ 8 H r m ~atntlY
° y JR o. ear<, TS U1 1 H 3
' I L s o
o Donald & ° c &s N a ° w 4 m d00 coot at v C& M AVE °
a0 1 12 r•• 14 B Margaret oo .
Debra m T~ sq v p p m Mazy re& t Talser Family L & Iviebrock
Potting B A&M o o u q" 40 seharna« ao x z Trust 79 N 1o ss tt~y. N F
60 K 10 > Mai O PR, i 16 tr P12 3z 'O _ Donald& la O y+'.
'a Kevin & ry 3 o a LA de loom 'III E ° ° o Dorothy I S Ca •g y
xe I x Christine Hilde- v_U n w w
" Martin 4' oJf F F t 72 ODO7
:..s` 45 Bw ymnn
Ann 0 23 P M-.
Hanson s
40 s 8 126 so 40 3
40 RD Brandt INE David & 0 Gregory I DM
T_& D al DB Edward 35
o Martin F-- aaa s Schachtner<
E%
Elaine
~ I Baptist ^ L 20 ° etas v Richard s r 2
i 1 811 114
Alst Church a Cook L u 'O e
Plourde Mildred JQulnn 2
arch ~ D&D o ro ~ o I Holen
P 222nd Schachtner I
Belisle Z0 'rc,J c a AVE Family LP Trust I
ip I 5 ro
at 34
221st a -C-20 oJf U B e 151 160 8040
74 AVE 210 a° la 17 Cook 74 _<:::< E 11 . o
g O
t a' G' HH arU..' MK John Kna hell 31 D&v 4 Richard John Robert
F
- 10 Wa15h N, &Sharon O Hanner x,10 &Lorraine
Peuer I
2 tr Schachtn hach40 70 o xonata10 Germam ~,q Trust 50 01.S
LS r a m
2 t
4 40
U Family L T' h & Donna . RB a 1 Ps & [
..:ry. 217th 3 wied<rln D t DM Rg Michael C
x. a 216th I 0 8 5 an s 4 Germain \ y yo
t tr 3AVE = 271 99m tr s&L s 6 50
u
s
13
x Y 10o Louis & J & M zo Ge d Iohri 215th AVE U A
w ba 3 N a Pa sons Hanner M& G
S i v array , g Maaar 513 I Leona, F.. Mari Trust N zo M&D Inc 150 ash 20
Thomas a tae 79 Devonng 16 Kohn
) David Richard & elvin
to D €u Ro bert Brendan Robert a ° tr ColOk Linda
rances
3< & Jean & Kay Martell 7 9 ° L & C LE fs € Carufel tr Sharon
Wichel- ermain it etal r o Germain tr reanlt 40
40 j
:r an 40 8 e o h etal 79 80 116 c_nnam 85 80 p 40 r
v tr o n °o
F 14 Rio 2 N b 3 3 210th AVE Walter & I Melvin
n a Robert Donald & Debra to 141 o
& Frances
- \V 8 ° of Martell Germain Ls 01 a Breanit
C' > 3 a o „ m ro .a 45
Renee
David & >w Carufel m r~ x u Lows
Lynn 3 9 9 H aaaF, Rivard
I sin Otto Raddatz u s 160 #~steudl 1 tr
rrrl O 40I Silha 54 v 10 156 205th AVE 2 80 7 .ni 18 tr 55 M s
1 - Trust 21 m e d ' 72n Ex N
I D 3 tars u .3 y9 e; John ~ Dennis 9 <
2 1 0 o er t ro Zwiekey 4 N RV ~'S 44 & Dawn t
'r''' tw O y a) m a~% Q 14 U O Neumann 48
40 g SOW
20 s O a o 0 oseP
' ,Z LOUi$ &
0d't' ta'„t a 5 anasse - m s ~ KI 39 Lorraine R c
r 8 „ M Cichy jr- i'
' t 16 & L c &w 3 a T 19 tr- ermain E a" 3 ffl
_ 40 40 120 _279 r I„ Drgi_ z3 1a U Belisle o
o 0 0th AVE o o e
L. N +t Pk~ & Linda ° ro n e O er ^ N D&c Dennis & o
/1 4 ;rM ~a ~t ' Cti n s I a' ewman t, O z N , Dawn t ;
IU) + D&D - Iahnk Neumann
&
vMts B i:`,:u. 40 S r6~ 5 w> 47 TM 8 Earl 91
RH ' 13 Roland Ear &
o ~ ^ s ~ Pine Cliff a " ~s ~ Elizabeth
4 D s JJahnkc40 p 8 I a $ a Partnership 8 3 N 9 Neumann 159
' e' as 40
. y .e tk a:.. Matt & Paula
k &L T_i~ 37 Rogerhomas 6
emle Linda & U. James N39
Plourde Hen_ unary Landry Edward loKaJO}lrl ym~a 192nd essey t.....40 40 P& $ampair Parrnt 40 Zwickey
Michael AV-
1H B &SR&K ulr nia LH 99 tr wrence Dame
& Linda &B aE:3: 3 7 5 B e °-'Viictor & i t JJ' g{E;
s a tr to - Elaine Lawson Donald r r, J3g ondor & Lisa
49 Al x 3 ^ 4o 40
P&C 10 ~~C 24 Martin- 17 17 Trust 101 GH y149 eettal ell G
sen
B Earle cn -{r 51 I
_ 40 N Mil
G&P 00 Bemard 4 L - ' o°o DM 0 3 ° eemlre B
J&K s s
C 9 & Louise Thomas 14 v' 3 z> Q o
'n\ IM artell Belisle 80 . a mI n Dl \ ,T L 13
t, 11 ,$amUe(0 B ar0 ' John & O ERS17
tr Kelley M&s L&R Belisle I „v a ,3 Moot- ' v C 36
e I rjy
M sl I 40 010 s 1o AV th 65' o u z v peat 38
xo a7Sdd 0U
n a{,. ~u°~. 141St 155 &L tr t,183rd JKRC a I WPa
a°G ~°G1t ,ST 40 1 ,o s H_D AVE
n LLC
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& nP/M&B ~,f , County Of Village Of
&N r. _ O 10 _ P ~ James & St Croix n SomersctLL