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Parcel 032-2045-90-100 11/14/2006 12:30 PM
PAGE 1 OF 1
Alt. Parcel 12.30.19.660A 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
RICHARD A FLANDRICK O - FLANDRICK, RICHARD A
1623 85TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1623 85TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 2.220 Plat: N/A-NOT AVAILABLE
SEC 12 T30N R19W PT SW SE BEING PT OF Block/Condo Bldg:
LOT 1 C.S.M. 7/1937 2.22AC
EZ-UT-1404/290 INCLUDES P659A10 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
12-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 802/610
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 48,000 121,300 169,300 NO
Totals for 2006:
General Property 3.000 48,000 121,300 169,300
Woodland 0.000 0 0
Totals for 2005:
General Property 3.000 48,000 121,300 169,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 219
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 032-2045-80-110 11/14/2006 12:30 PM
PAGE 1 OF 1
Alt. Parcel 12.30.19.659A10 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
RICHARD A FLANDRICK O - FLANDRICK, RICHARD A
1623 85TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 0.780 Plat: N/A-NOT AVAILABLE
SEC 12 T30N R19W PT NW SE BEING PT OF Block/Condo Bldg:
LOT 1 C.S.M. 7/1937.78AC ASSESSED WITH
P660A Tract(s):
(Sec-Twn-Rng 401/4 1601/4)
12-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 802/610
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0 032-2045-90-100
Valuations: Last Changed: 05/23/1989
Description Class Acres Land Improve Total State Reason
Totals for 2006:
General Property 0.000 0 0 0
Woodland 0.000 0 0
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
AS BUILT SANITARY SYSTEM REPORT
OWNER /ydjC~,•~ C° s' /'~OWNSHIP .>ei~-~n S C SEC .l T C I-R-- W
AD DRESS.~_er% k._--(~r• CROIX COUNTY, WISCONSIN.
SUBDIVISION L07' LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
PA,
V
IT- -1
ALI
- - -TT- I di at N r h rrc w
BENCHMARK: (Permanent reference Point) Describe: /-L:e'
Elevation of vertical reference point: rng~ Slope at site:
SEPTIC TANK: Manufacturer: We e.. Liquid Capacity: /
Number of rings on cover Tank manhole cover elevation: i
Tank Inlet Elevation Tank Outlet Elevation: 0
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal pump set for a cycle_ gallons; Total capacity of
distribution lines gallon: size of pump head;
gallon per minute horsepower ;brand name of pump
and model number
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
't'ype of warning device
SEEPAGE PIT SIZE; Number of pits feet diameter_
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width length -tile depth)
l `
SEEPAGE TRENCH: width length
PERCOLATION RATE AREA REQUIRED 3 ~ U AREA AS BUILT
INSPECTOR
DA'Z'ED PLUMBER ON JOB
LICENSE NUMBER
;f
L
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. BOX 7So9 PRIVATE SEWAGE SYSTEMS
DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
) CONVENTIONAL EALTERNATIVE State PI-I,D. Number:
❑ Holding Tank ❑ In-Ground Pressure D Mound (If-,fined)
NAME OF PERMIT HOLDE - ADDRESS OF PERMIT HOLDER:
ff INSPECTION CAT
BENCH M.-ARK Permanent re fe renc fi' 79
e point) DESCRIBE IF DIFFERENT FROM PLAN
: REF. PT. ELEV.: CST REF IT ELEV
Narne of Plumber. MP/MPRSW No.. County:
Sanitary Permit Number:
SEPTIC TANK/HOLDI G TANK:
MANUFACTURER.
LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING VER
f y 9 PROVIDED PRO
VIDE
, _,~z ~9~. / ? ES ENO ~~'(ES ENO
BE DDING : VENT DIA VENT VATIC HIGH WATER NUMBER OF ROAD:
ALAR PROPERTY WELL BUILDING: VENT 70 FRESH
` M FEET FROM LINE- AIR INLET-
EYES ONO ❑ ry !
~ ~O NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMPiSIPHON MANN FACr ER.
fj WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
DYES ONO f DYES ENO DYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. MBE OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN ET F OM LINE IAIR INLET'
PUMP ON AND OFF) EYES ENO EARE T
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENC,TH DIAMETER MATERIAL AND 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 CIA
DIMENSIONS s PITS LIQUID
THE N/ CI/ES MA L: r. PIT _ `"~'T-- DEPT H._
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. ND NUMBER OF
eF LOWPIPE S ABOVE COVER ELEV. INLET ELEV. END PROPERTY WELL. BUILDING. VENT TO FRESH,
PIPES / FEET FROM LIB, / / AI~INLEr
-36 NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope
and furrows thrown Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
DYES ENO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS T08 SERVATION WELLS
DEPTH OVER TRENCH.' BED DEPTH OVER TRENCH; BED DYES ENO DYES ENO
CENTER EDGES DEPTH OF TOPSOIL SODDED SEEDED JMULCHED
DYES ENO DYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF LATERAIPACING EL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
rRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PD MATERIAL. NO. DI STH jDtSTP7IPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV ELEV CIA ELEV PIPES CIA
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
YES ENO DYES E NO
COMME~CS:,, D
v PERMANENT MARKERS: NUMBER OF LINE.
NO OBSERVATION WELLS:
NO F PROPERTY WELL: BUILDING.
t
n
r a DYES E ENEAEET RE FSTROM
i
I G
f
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE
TITLE.
DILHR SBD 6710 (R. 01/82) ,
E::::: APPLICATION FOR SANITARY PERMIT
H R OUNTY
(PLB 67) UNIFORM SANITARY PERMIT #
HUMRn RELPT10n5 /
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPE TY OWNER f / MAILING ADDRESS
C c ! Q !mil c! / / G. ~L' W / 7 5
PROPERTY LOCATION_
I1/4 S,6J , S /,,2_, T3`C? N, R 11 (or) W TOWN OF: _5~9 ~I 2~ N S' er
LOT NUMBER BLOC NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
/ 21 A TYPE OF BUILDING OR USE SERVED d _
y<1 or 2 Family Number of Bedrooms. Public (Specify): AIA
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.
❑ 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 I A 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 L! 0
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
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
33 ❑ 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: #P/MPRSW No.: Phone Number:
/ c L / S_ 1) 1 (7/ 6`) ; z S
Plumber's Address: Name of Designer:
}
COUNTY/DEPARTMENT USE ONLY
Signature/of IssuiVTA ent, Fee: , Date: ❑ Disapproved
z
L1/ t n
= q~~ - 7 Ll Owner Given Initial
Y /-T
I)" Y E~ 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, 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.
L) rul - S 1' L 10 0
Owner of Property,
~
Location of Property, iSection ,'1 _3C N W
Township-
Mailing Address
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel l g1-0 c
Date Parcel Was Created -
Are all corners identifiable? Yes No
Include with c!, t:.,1 It,n nu.' c;
.Certified Survey Map
rte-. Deed
.Land Contract, or
.Other Legal Document which describes the property
PROPERTY OWNER CERTIFICATION
1 (We) certify that all statements on this form are true to the best of my (our)
knowledge; that 1 (we) am (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No. 57027 ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
p E Of OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SI NED
DATE SIGNED
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IND'iAS~°RY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP', 4" ~ TY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
l lhl 1/450/4 12 /T_30 N/R l9 t (or) W s s le~
CIVA
OUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: 1
USE DATES OBSERVATIONS MADE • 3
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence New ❑Replace % /Dy`P -13
~ _ c~~
RATING: S= Site suitable for system U= Site unsuitable for system ! J
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:'SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
Ns ❑U ~S []U S ❑U ❑S ~U DS ~o
[un Pe:rs:.H tion Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
de 63.09( 5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPrH~il, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- qroAl~ s , ~3~-s~ S'~~-sal a•--s
B- 3 , 5_6 n l~~ 7 SO . L - 7 r~ / D 15
B- y C, 5-0 aU e 7 , s a S? _ Z 51- 1, .5- de -_-5 Z 3,7,9.
B- - , SD 3 . 1-3 C. 5L
27,3
IS
B-
C,- S PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER S AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- 1 3, 57~d~t o
P-
P_
PLOT P-
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
13.1
13,M i5 7-d,P v
1l _ E I ~ ~
pile ,6&1- ~_3 5'4
a
y1
N
i
I
3
I I
E 3
i ,
3
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:
---,2 n- g --'?7
ADDRESS: CERTI ICATION NUMBER: PHONE NUMBER (optional):
e- w l ~s 1 1 715- aye ~y~
CST SI NAT RE:
D2d z
L BUTTON: Original and one copy to Local Authority, Property Owner and Soil Tester.
iBD-6395 (R. 02/82) - OVER -
r~~ ~C~ r2tJ(etS? «7~.? st«att7'
3~1p 4`S€°~ts a~ via€ t~PSt r 1fJ°"i`~sis;
Thu cjs(. set 1 €am nt st c e
k4AXl~tt~"4, ( r+.?i(Slber o Lif i"{.C}t ?1lS *,)V f;£i 6?1 tTo.^i t,lf ~ t.t.,,' fit[-i;?4,t
v IaiP r,. _iat.~t. } €t€r~ kux:.s_ A SITE IS StH TABL
OTHER SY `r. L' NI S ARF RULED f UIT BASDD f,,J SO IL CONMT1CINS:
PL, EASE w.., the abbi evi-i6 € , shown he. P, fc, vvr€tirgi i-im k dead iptiens and completing thr,,, plot jaiw
MAKE ,A LEG MI E ',fez g, ,irn iccu ate,!v (f c"tin oU .;i Iciention>. D,ik,vinq to ~caie is °4?<-i1r 1'
L '
apt
t, aF~T
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P t ,rE
~s std rI= ~ e~r 1 t _ih a
itt ,dks m San
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