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Parcel 032-2089-60-000 07/22/2005
PAGE 1 OF 1
Alt. Parcel 15.31.19.883 032 - TOWN OF SOMERSET
ST. CROIX COUNTY, WISCONSIN
Current X
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
NERBY, TERRY JEAN
TERRY JEAN NERBY
549 UPPER 216TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 549 UP 216TH AVE
SC 4165 SCH D OF OSCEOLA
SP 1700 WITC
Legal Description: Acres: 2.711 Plat: 2224-NORTHERN OAKS ESTATES
LOT 6 NORTHERN OAKS ESTATES TOWN Block/Condo Bldg: LOT 06
SOMERSET Tract(s): (Sec-Twn-Rng 401/4 1601/4)
15-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 885/370
2005 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.711 43,400 86,300 129,700 NO
Totals for 2005:
General Property 2.711 43,400 86,300 129,7000
Woodland 0.000 0
Totals for 2004:
General Property 2.711 43,400 86,300 129,7000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 211
Specials:
Category Amount
User Special Code
Special Assessments Special Charges 00 Delinquent Charges
00
Total 0.00
- ®i
U0~1ng ~ _mL~""
T~ _V2G
Location of buildina served
Vertical reference point
Septic tank ~
ryoint
Building sewer Horizon--_1 p Dint
_ well
Bf i lu_nt system o? sys te,:
ones 50'
~eplace;,,ent system area
or di r?nSior,ec
S c e ' .
_ c_ Fox Ce
and co-;``rols
- -
i_> ;`_I ?1~r. 0 2i00e1 IvC, VErC_
_ Gal.
~ per yc
Vol Dist. Pipe Ca_ r ]-'-I
,;ction Loss T. D. H.
- e chec}: mark in appropriate box, indicating item is she-w- on plot plan be-low:
aac
~o~SE
AV
I ~
G I
i
~J . W6 st sl
'j ToP of 3/y p1 PE
i 1
Jl 7 R~ j~ ?R P h 6 r+z s
J
X01 c i vLE~ ,JT 12' Q I
or approving "of the above plan, or upon the event of a subsequent
the granting County and the sTCaoix County zc`-ing Administrator, does
being issued, detects in plans cr specifications, ply
assume or hold itself liable for any
construction, or any damace that may result in or
«do , examination oversight,
Pllll~ii+ c c 1 C:Iir.-. _
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7909 , BUREAU OF PLUMBING
MADISON, W! 53707
EX CONVENTIONAL ❑ALTERNATIVE State Plan L)D. Number
n
El Holding Tank El In-Ground Pressure ❑ Mound (If assiged
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER. INSPECTION DATE.
Jeff Nerby RR#I, Box 40, St.Joseph, WI /0---7-0 4,3
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT. E V..
SE NW, Section 15, T31N-R19W, Lot 6,Northern Oaks Estate
Name of Plumber. MP/MPRSW No. Sanitary Permit NumberPaul Cudd 2739 TZty
. Croix 43.691
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
Z1, t~'^i 1 PROVIDED. PROVID~,,E~~""~
XS ENO ❑ DES NO
BEDDING. VENT DIA.. IVENTMATL HWATER NUMBER OF ROAD: PROPERTY WELL. _ BUI LDING. TO FRESH
AIR IN LET
ALARM FEET FROM J . l./ LINE/, i,'/ IVENT
EYES ENO EYE ` NO NEAREST
DOSING CHAMBER:
MANUFACTURER REDOING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUF/{GT'CiRER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
EYES ENO EYES ENO DYES ENO
GALLONS PER CYCLE: PUMP AND CONTRO OPER IoNAL NUMBS- OF PROPERTY WELL BUILDING. I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑ S ENO NEAREST 30 1
SOIL ABSORPTION SYSTEM. Check the soil moisture ayth eptIT of p win l [ NcrH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, const on shall ce a it FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NDISTR. PIPE SPACING COVER JINSIDE DIA. UPITS. LIQUID
BED/TRENCH TRENCHES ! MATERI 'L( DEPTH
DIMENSIONS 1'2- 5 Z V (j PIT
GRAVEL DEPTH FILL DEPTH IDISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER. OF PROPERTY WELL. BUILDING. IV ENT TO FRESH
BELOW PIPFS ABOVE COVER ELEV. INLET ELEV. END. PIPES LINE 1 AIR INLET
~-7 J2- Z7 ZCj NFEET EAREST--►
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-R ERSE SIDE. SHOW ELEVA-
meets the criteria for dium sand. I IO MEASURED.
EYES ENO
SOIL COVER TEXTURE PERMANENT MAR RS JOBSERVATION WELLS
❑ ES ! NO EYES NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL ISODD/D SEE D MULCHED
CENTER EDGES.
OYES ENO EYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF L TERA SPACING. G VEL EP H BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD D TR. PIPE KNIFOL ATERIAL. N. D TR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV.. DIA. / LEV.. PIPE DIA.:
ELEVATION AND .
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLS C RECTLY COVER MATE IAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
YES ENO EYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE
O EYES ENO DYES ENO NEAREST
/2 Y,
t
551
57.30
12-
8
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE.
w a.
D I L H R S B D 6710 (R. 01/82) 'rr9 P
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT I P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mail' Address:
Pro ty do City, Vilal o owns ip: Cou
6L~/aS ~T Aj~ NCR E (or) 50'eTL~~~~c%C~%
Lot umber: Blk No.: Subdivision Name: ear 't Road, Lake or Landmark: tate Plan I.D. Number:
r~/ -~F_ (If assigned)
T PE OF BUILDING L
Number of
❑ Public* ❑ Variance* ❑ Other (specify * -A -4~0-6nn Bedrooms:
1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY G/
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
, ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
X Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
a of Plum r: S nature: 1 ib1R/MPRSW No.: Phone Number:
:
Plu er' Address: Name of Xr-,
TY/DEPARTMENT USE ONLY
COUN
Signat re of Issuing Agent: Fe D/ate: APPROVED Sanitary Permit Number:
C 'n
✓
J~'~~/ ❑ DISAPPROVED
Reason for Disapproval:
l~
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81)
pp-
Forty - 5 1' L 100
Owner of Property i L /1./.r1~~ ✓ /C,//~~L(~''(/~(,
.Location of Property =L=4, Section 45-- T.17/ON RW
Township ~L tyke-
Mailing
Address
i /
Subdivision Name
Lot Number ~2
Previous Owner of Property
Total Size of Parcel SCE X c~2L'C~
Date Parcel Was Created
Are all corners identifiable?` Yes Nu
Include with this application one of the following
.Certified Survey Map
.Deed
.Land Contract, or
.Other Legal Document which describes the property
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in this
information form, by vir L101 of a warranty deed recorded in the Office of the
County Register of Deeds as Document No. 3 7(v 2-S ; 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.
SIC}MAT - F OWIjjR SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE NEX~ DATE SIGNED
DEPARTMENT OF REPORT ON SOIL BORI ri 6(.' 11 11 SAFETY & BUILDINGS
DIVISION
INDUSTRY,
LABOR AND PERCOLATION TEST (11 P.O. BOX 7969
I O~~~NC J9~~ } MADISON, WI 53707
HUMAN RELATIONS
IV k) (H63.090) & Chapter 145.04 ` Z
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: T NO.. K. NO.: S ISION NAME:
s c 1/ 1/ /5 /T3/ N/R /I E (or W Q~F~Psr ~J 0~9~s" si~% s
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDR S:
Sf I/t,~t S yvT Z
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PRO FILE DESCRIPTIONS: PERCOLATION TESTS:
XResidence 4p N New ❑Replace r~ Z1/~
RATING: S= Site suitable for system U= Site unsuitable for system 64,k4CR/ L S C / JS1JbSj r~
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
~ZS ❑U [~IS ❑U ®S ❑U ❑S ®U [:]S RU c'wc,~.yi/a.u/ 615 sQ, jf.
If Percolation Tests are NOT required DESIGN RATE: Q[ ~ If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAI DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPPTHH-~ ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) • p
, J•V / f ' •33 rlJi(/./'L~' ~GstGLgC LS 6 7'46~ 13,0.4$,
B-
16 7, 'P1f3v CS . •P3 TA.V.
>
7~C yL ~vk.~v..recs. •sd'' ~3N.~s; iD
.6- y > ~1 ' ® cue -.60 _ cis ; •r,1.0. d cS
B-3 ;to-
B ' O , ` Z ' . L S D~ '1U. Cd G S' t '7 ` aIP. ~"5~
t " C
B 33 Au aN.4- 15- - -AV. s
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHESRATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERI0 D3 PERINCH
P-
P_ /-06041) tv ,dam 56.5; Se 1'4, 4-4A)03
P_ EU rltw 2 L
P_ /W
P_ - C Tt° -
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. /30 77-0 M O/- 13" ~YCy1 /,~,9Tip~1 cY LA _4_Q AF e7 d-6 "".7 1'to
SYSTEM ELEVATION /A . l - ir' o w 1/E~TiC,fL /'t`j~,c~ •u Doia r _
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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 thoecgr,~cj,'api j Wion of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
RT.3. O'NEIL ROAD S-3 =Dj' y_? 2_
HUDSON CST SIGNATUR
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
and aeCur,aE, e
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L s~t_~7 L i 7 3 ,D~ aCcLt4'za4sdv loo` Y PS of _aons. 'I awing I_';3 SC ak, is prt,fe,~ red.
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H0M-ESITE TESTING CO.
M 3, ®'NEIL ROAD BOB of 1,1 t 1,
A:. usol1, WIS....- 5401 CST - (1Z ~a~.Z
pRopo5ED mwsE mor LIE 2.~ Fr• o,~ "oov gLt r"EST /mz-,45.
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CROSS SECTIDIJ OF A BED SYSTEM
Roov~ F1N15N~-G2,t~~
_ 2" OF AGGREGATE
4--- 501 L FILL DISTRIBUTIOU PIPE APPROVED 59QTHETIC COVE
=o✓ o ~ MATERIAL OR 9" OF STRAW i
S~ OR MARSH NAB
` 0 F%Z-2~1 `AGGREGATE
ELEV. OF FEET___._._
60T?DH OF
IUC HE5 BELOW DRIG11JAL GRADE
DISTRIBUTIOIJ PIPE TU HE AT LEAST
A►JD AT LEAST20 IIJCHE5 BUT IJO MORE THA?J tit IUCHES BELOW FIIJAL GRADE
I►JCHES
MAXIMUN~ DEPTH OF EXCAVATIOU FROM ORIGWAL GRADE -JILL BL `
INCNES
MWIMUM DEPTH OF EXCAVATIOU FROM ORIGIUAL GRADE WILL BE
SIGUED:
LIGEU5C UUMBCR: