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Parcel 032-1034-60-025 12/12/2006 08:59 AM
- PAGE 1 OF 1
Alt. Parcel 12.31.19.170A 032 - TOWN OF SOMERSET
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
01/07/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - QUINN, ELAINE M TR
ELAINE M TR QUINN
708 220TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 708 220TH AVE
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 41.680 Plat: N/A-NOT AVAILABLE
SEC 12 T31 N R1 9W W 1/2 OF SW 1/4 COM SW Block/Condo Bldg:
COR SEC 12; TH N00' W 1358.19 FT; TH
S89' E 1339.95 FT; TH S00' E 1353.46 FT; Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TH N89' W 1340.78 FT TO POB 12-31 N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
03/22/2004 757166 2530/468 WD
01/07/2004 750934 2487/96 WD
07/23/1997 789/75
2006 SUMMARY Bill Fair Market Value: Assessed with:
145221 Use Value Assessment
Valuations: Last Changed: 08/09/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 48,000 93,200 141,200 NO
AGRICULTURAL G4 23.000 900 0 900 NO
AGRICULTURAL FOREST G5M 4.680 9,400 0 9,400 NO
MFL BEFORE '05 CLOSED W8 11.000 22,000 0 22,000 NO
Totals for 2006:
General Property 30.680 58,300 93,200 151,500
Woodland 11.000 22,000 22,000
Totals for 2005:
General Property 30.680 58,300 93,200 151,500
Woodland 11.000 22,000 22,000
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
y
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T N-R14W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
z
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
tnt__EVEIYTHING WITHIN 100 FEET OF SYSTEM
D
I F
C- -1
I di a e o th, Arrow
- -t--a
SC
BENCHMARK: (Permanent reference Point) Describe:/-c,t /J 4°4.
Elevation of vertical reference point: j,241') C2'' Slope at site:
-
Liquid Capacity:
SEPTIC TANK: Manufacturer:
jam, .L
Number of rings on cover 'an-- manhole cover elevatio "
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cyc e gallons; total capacity of
distribution lines gallon: sized pump head;
gallon per minute horsepower ran name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: Number o pits feet diameter _
feet liquid dept seepage pit in e-t pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines e_width lerYgth C the depth,"
SEEPAGE TRENCH: w'dth length
PERCOLATION RATE AREA REQUIRED ~~6 RE AS BUILT
INSPECTOR
DATED -I&I 1 _ PLUMBER ON JOB
LICENSE NUMBER
KI VOKI Of INSI'l CTION - INDIViOUAI_ StWAGL SVSII_M
SaYI4 ral,ccl I'e1ckil
Srard Sepr<c ea
Nn,~I
-4p "Ik---
I,' u r c (l vc S (j_ -L4S c ti o n j. Lot # S u b d1(v,i.,5 < o n
I I'1 1C 1ANK
,c a ga4',konb Numbers oA cornpan mentb
P(6 Lance (nom: wetf Bu('din. ,
Flighwa.te4
i'UMPING CHAMBER
S4 e ga.YZons Pump Mana6a'ctune,,c MudeX Numbe.~c
IWLDING TANK
S<ze - gaQYonb Numbers oA Campantmo.n t5
Ur tavcc( 8uiZd. ny 12~ tYape
AI 1o N SITE
7nench ~J
~r(clcc Axiom: LUe~( cYd~n
Ili ghwa.terc
ABSORPTION SITE DIMENSIONS
W.( d.th oA trench A Requ4 red area A ~
Len<4th oA each ktne_ At Depth oA ',ocfz beYow t.i4'e. in
Numbers o 6- f4 ceb
D e p t h ci A n. a e. h o v e rc =t e r vd
To tae Ke.n.g,th 0A fi_neti Depth of ti,Te bveow grade <n
Uititr<v(cbetwvc,V1 nen Ar Skopc n( aIL cnch cn. I-~cir 100
I,'rfi' rY1) (1C~)r(-(ln Cl*Iva 11r 1(f pv (I (I CUvet(: I'l(C)cti (!'I
NSION S
Nuui}I,id (I
A K)<t6
GrLave aiw nt -tb yeb n.,
Oc, tv d e d~ arytc terc A r Depth betow ivrY -e t A t
fdto ab6orLp-t-(-an area At
A'i I'( '!t'1I(1(rle - t
Liys~ TITLE
APPKOVL~-- DATE 19 h
ill I II CTL D DATE 1 9 n
I;I AS-ON I OR Rt 7ECTION
V
PLB,67 State and County State Permit #
Permit Application County Permit #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Z / Y4
B. LOCATION: /4 Section [L, TN, R ' E
(or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family 4 Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Y Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E- EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New Replacement ,-Alternate (Specify)
Seepage Trench: No. of Line I Ft. Width _ Depth Tile depth (top) No. of Trenches
Seepage Bed: -Length.-WidthA Depth e, Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME C.S.T. # and other information
obtained from (owner/builder)./
Plumber's Signature z MP/MPRSW# /S✓L Phone # / e
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
4
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ems. ,z. ..m w. tt
1 f
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i
w. mm ..-.e_ . a ~ - as
3
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w.. . _ _ . a. _ . -
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Do Not Write in Space Below OR COUNTY AND STATE DEPARTMENT USE ONLY
Date of ApplicationFees Paid: State County ~Z Da
Permit Issued/Rej=t*d (date) / Issuing Agent Name
Inspection Yes X_No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revised Date 7/1/78
EH ' 115 Rev. 9178
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
r
LOCATION: Section
~N,R-L V (or) W, Township or Municipality '
Lot No. ,Block No. County
Subdivision Name
Owner's%Buyers Name: ` ~r h
Mailing Address: s - 6
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW -REPLACEMENT- ALTERNATE SYSTEM. F OTHE
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS L /
SOIL i+,1AP SHEET NAME OF SOIL MAP UNIT - t
I
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCITES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN, 'IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- 911
1, '6111- 1 1A e- P-
13
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B-
B
B- - ` u + n "
B /
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the ~geation and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy , Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
_ mow.
57 r ;
4
J F.
E
j.J ~ A E - L q t 1
x
e
E r r/7
E .
a ,
1, the undersigend, 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 location of test holes are correct to the best of my
knowledge and belief.
Name (print)
Certification No.
Address - '_/yd )e'VA)
Name of installer if known +
Authority ty CST Signature
Co A-LocoI
' A
CJE u. iA.
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