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W N E It ~i~LrL ~U~, - L'OWNSll1.P - SEC: ~'I.;;~N-R/" W
e ~
ADUI:I;S`; ~ ~ 5 ST. CROIX COUNTY, WISCONSIN.
111)1) 1 V I S I UN I-.tJ'I LOT SIZE
PLAN VIEW
I) i ~;tr~nc c it11d d i ill i ii:i C~? litc- et r.equiret tit ents of 1163
S11 Ui 1?VI?RYTII I N(. WITHIN 1.00 FEET OF SYSTEM
I
G
e Ir die at Nr h rra w
hi NCIIMARK: (Ile rni:iiwnt re1cr-~it~ c Poi.nL) Mt-~scri_be
Slope at site:
L'I~.-v<tLlun ul verLtcitl relrrenc~ huliit:
J-
i
I;I ('IC 'T'ANK: Mal)tjklc-Lurer: Liquid Capacity:
' •~C=,t~~~,,~rLl~,r,~~ ~ Liquid Capacity r~.
~Vumber of r-ings un cov~.r Tank manhole cover elevat-lon:-7~z
Cat~k Itti~t. 1,'14,v.It_in: ?U~ Tank Outlet Elevation:
PUMP CHAMBI•:I~
Mit nufit ct(_ir,.r: Number_ of gallons
Number of gal. puutp set for it cycle gallons; Total capacity of
d.i_str:Lbution lines gallon: size of pump head;
},,i.t.l l-on per m-i.nt_ite horsepower ;brand name of pump
a_ n d m o d e I- it wn la e r ;
I'yp g d e v i c e
e o war na_ it
Ilt)I.I)INC TANK: Manufacturer _ Number of gallons _
I -:levat _i_on o f lit anho Ie cover
Type of warning device
';1,J:PACE PIT S:LZF; Number of pits feet diameter
feet Li_clui.d depth seepage pit :inlet pipe-elevation
bottom o1 seepage pi-t elevation _ feet.
SE E 11 AGE 15HD 51Z1(1, nuntber_ of lines - width 4;2length i'` - tile depth
-126-
S1,'EPACE TRENCII: width length j~
PCIICOLATI:ON ItA'CE-~~ ~ ~4,% AREA REQU:IRED~~ AREA AS BUILT i INSPEC'COR
DA'Z'ED PLUMBER ON JOB Xiy p '
LI_CENSE NUMBER Z
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS
P.O. ROX 796y DIVISION
BU
MyDISON, WI 53707 BUREAU OF PLUMBING
CONVENTIONAL ❑ALTERNATIVE State Plan l.D.N-b-
D Holding Tank ❑ In-Ground Pressure ❑ Mound (If as signed)
___j NAME OF PERMIT HOLDER . ADDRESS OF PERMIT HOLDER INSPECTION DATE:
David Durand 72 N.2 St. , Bayport, MN ~~D
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN
REF. PT. ELEV.: CST REF. PT. ELEV.
SW SE, Section 27,T31N-R19W, Town of Somerset
Narne of Plumber. MP/MPRSW No.. Count
y Sanitary Permit Number.
Cal Powers 1563 St. Croix 43695
SEPTIC TANK/HOLDIN TANK:
MANUFACTURER:
LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: W R G LABEL LOCKI G ER
i , PR IDED. PRO DE -
b~'l . /c~ZZ YES LINO YES LINO
BEDDING: VENT DIA.. VEN7A TL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT TO FRESH
ALARM FEET FROM 9 LINE ~t LAIR INLET
DYES NO _ DYES LINO NEAREST /
DOSING CH MBER:
i
MANUFACTURER BEDDING. JLIQUID CAPACITY PUMB MODEL RUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
DYES LINO DYES ❑No OYES LINO
GALLONS PER CYCLE: PUMP AN ONT oLS ATIONAL. NUMBER OF PROPERTY WELL BUILDIN_17-1177-IN-1 FR E S
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET'
PUMP ON AND OFF) ❑Y LINO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture a he dep of plowing I FNC;TH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, constr ctio[n shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH. LE NG TH J~R O. OF DISTR. PIPE SPACING; ER
BED/TRENCH ENCHES. COV INSIDE DIA. #PITS. LIQUID
DIMENSIONS (J l MAT$F{TAU PIT zu
GRAVEL DEPTH FILL DEPTH DIST. PIPE DISTR. PIPE MATERIAL. IN DIL PROPE R TV WELL'. BUILDING'. VENT TO FRESH
BELOW PIPES j ABOVE C vER ELEV FT NO_ NUMBEROF
/ Z p 7"Z 3 l~ Z , L PIPE FEET FROM 1 L •7 AIR INLET
MOUND SYSTEM: 4
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-
DYES LINO meets the triter" -medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMAN T MA KEHS O7ERVATIONWELLS
DYE LINO ES NO
DEPTH OVER TRENCH BED DEPTH OVFH THENCH/BED DEPTH OF TOP IL. SODDED
CENTER EDGES SEEDED MULCHED
f ES NO DYES LINO DYES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF if ATERALSPACI G GRAV DEPTH BELOW WE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS ,
MANIFOLD PUMP MANIFOLD DISTR. PIPE MA FOLD MATERIAL. O. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MAHKING
ELEV.. ELEV.. DIA ELEV.. IPES DIA:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED ORRECTLY COVER M TERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
I PLANS
DYES LINO DYES NO
COMMENTS: PERMAN ENT MARKERS: OBSERVATION WELLS: FEET FROM OF PROPERTY WELL: B
.
LINE
e_f ~1 DYES LINO DYES LINO NEAREST
' v 2 1
0 -0
_ - -
12) lG
- if
Sketch System on
R ain in county fil for audit.
Reverse Side. i
SI RE TITLE
DILHR SBD 6710 (R. 01/82) •
Wisconsin APPLICATION FOR SANITARY PERMIT .
D I L H R COUNTY
(PLB 67)
~ oEaARTmenTOF UNIFORM SANITARY PERMIT #
InouSTRV, LABOR 6 HUmRn 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
PRC 1 ERTY OWNER MAILING ADDRESS
;
PROPERTY LOCATION ChTY:
r VIL-LAGE:
1 /4 ~E 1/4, S- T N, R E (orY TOWN OF:
LOT NUMBER BLOCK I UMBER SUBDIVISION NAME NEARESTPOAD,.~AKE OR LANDMARK L STATE PLAN I.D. NUMBER
/v
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
F4 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.
Z 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 i
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):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installatio o e private sewage system shown on the attached plans.
Name of Plumber (Print4:i Sign u~e: MP/MPRSW No.: Phone Number:
J of i ~ %J 17 c ) ~ S?
P um is Address: Na of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
/~7 ❑ Disapproved
V" ❑ Owner Given Initial
ApproveJ 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.
Form - S 1' C 1 00
Owner of Property 1AV1D t/tA►t~D►N~
.Location of Property K" =t, Section S1 ,T 3 N R W
01
Township p_1~AEp,~S,~r
Mailing Address
5b MIC~2.SraT' ,~f< rj~-o2la .
Subdivision Name A
Lot Number 1
Previous Owner of Property MtA1CAek-
Total Size of Parcel AC_W,4E7 5
Date Parcel Was Created - (
Are all corners identifiable? X% Yes No
Include with this application one of the following:
V/ Ce fied Survey Map
. Deed
...Land Contract, or
.Other ega 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 virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No. 1101 l435 ; 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 recur ad in the Office
of th County Register of Deeds, as Document No. 3g l y''+ )
SIGNATURE Of OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
/o -/t-_83
DATE SIGNED DATE SIGNED
,)EPARTMENT OF y REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, , ~ 1 1 C DIVISION
HUB AN REDLATIONS tea/ PERCOLATION TESTS (115) MADISON, WI 3707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOI(VLIN H)P/Mt tCTPAMY: LOT NQ.: BLK. `O,: SUBDIV. SIGN NAME:
- /T , N/R I (or) W lJ7
COUNTY: OWNER'S/BU ER'S NAME: MAILING ADDRESS:
USE DATES OBSERV 1 NS MA E
NO. BEDRMS.: COMMERCIII L DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TEST
Residence /J / KINew ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEMM-IN-FI''ILLHOLDIcNG TAINIIK: RECOMMENDED SYSTEM: (optional)
4c2)v I ~V 'J oh[z s I
❑J ~V ❑J ~V
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:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH W, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B~ ~r 7
B:
9
B < 0'j Z'
Z - z.n g") l
B- 7,9 7
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 PERIOD 2 PER IO ) 3 PER INCH
P- x' ~r 67q :~g
Q r a
P-_2 A10 TK
P_ je'
P- -
P_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or cistances. 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.
i
SYSTEM ELEVATION
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I, the undersigned, hereby certify that the soil tests reported on this f Tfsts 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 are correct to the best of my knowledge and belief.
NAME( int): TESTS WERE COMPLETED ON:
Z i 3
ADD S: y CERTIFICATION NUMBER: PHONE NUYBER(optional):
L
CST SI T RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) - OVER -
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Wisconsin Department of Industry,
PLB:1 INSPECTION REPORT Labor'&*Human Relations
Safety & Buildings Division
Bureau of Plumbing
Name o remises Date an No.
6
County Sanitary Permit
Master um er, & irm ame dress
~~fi l_'✓~ ~ ' ...,zs
s,
Journeyman Plumber ress
Owner Address
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Discussed with 1 na U
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( )See Attached.
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DILHR-SBD-6192 (R.10/82) Signature o is Plumbing Sup.-On-51i, 42 as e, pecia is
Inspector Local Inspector Plumber or Responsible harty Yl Dwne~
Parcel 032-1076-80-000 01/08/2007 12:05 PM
PAGE 1 OF 1
Alt. Parcel 27.31.19.381B 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 - DURAND, DAVID W & ROSEMARY-TR
DAVID W & ROSEMARY-TR DURAND
1921 CTY RD I
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1921 CTY RD I
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 27 T31N R1 9W 5A NW SE LOT 1 CSM Block/Condo Bldg:
5/1338 676/94
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/07/1998 576662 1312/574 QC
07/23/1997 1153/460 QC
07/23/1997 956/356
07/23/1997 676/90
2006 SUMMARY Bill Fair Market Value: Assessed with:
145632 229,000
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 58,000 115,700 173,700 NO
Totals for 2006:
General Property 5.000 58,000 115,700 173,700
Woodland 0.000 0 0
Totals for 2005:
General Property 5.000 58,000 115,700 173,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 107
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00