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'i ~ x o' 0 Cr CL cCL e (D' v Ch a by N CD aro a CD O 0o fl b Parcel 030-1057-40-100 02/09/2007 10:45 AM PAGE 1 OF 1 Alt. Parcel 23.30.19.201C-10 030 - TOWN OF SAINT JOSEPH 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 ROBERT W SWANSON O - SWANSON, ROBERT W TAMMY WOULFE C - WOULFE, TAMMY 1489 N BAY RD SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary - 1 ( d Type Dist # Description " 1489 N BAY RD SC 5432 SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC 1 # »k !J 1;'~ Legal Description: Acres: 3.180 Plat: 4585-CSM 17-4585 030/03 j/ SEC 23 T30N R19W PT GL 5 LOT 2 OF CSM Block/Condo Bldg: LOT 02 3/861 (3.000AC) NKA CSM 17-4585 LOT 2 (3.180AC) Tract(s): g ) (Sec-Twn-Rn 401/4 160 1/4 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/13/2003 735396 17/4585 CSM 08/04/2003 733491 2345/069 QC 07/23/1997 1225/302 WD 07/23/1997 1194/455 SD more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/27/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.180 273,500 166,600 440,100 NO Totals for 2007: General Property 3.180 273,500 166,600 440,100 Woodland 0.000 0 0 Totals for 2006: General Property 3.180 273,500 166,600 440,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/06/2005 Batch 05-29 Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 Parcel 030-1057-40-100 02/24/2005 05:09 PM PAGE 1 OF 1 Alt. Parcel 23.30.19.201C-10 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner ROBERT W SWANSON " SWANSON, ROBERT W WOULFE TAMMY WOULFE TAMMY 1489 N BAY RD SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1489 N BAY RD SC 5432 SCH D OF SOMERSET I SP 8040 BASS LAKE REHAB DIST SP 1700 WITC I Legal Description: Acres: 3.180 Plat: 1765-CSM 17-4585 030/03 SEC 23 T30N R19W PT GL 5 LOT 2 OF CSM Block/Condo Bldg: LOT 02 3/861 (3.000AC) NKA CSM 17-4585 LOT 2 (3.180AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/13/2003 735396 17/4585 CSM 08/04/2003 733491 2345/069 QC 07/23/1997 1225/302 WD 07/23/1997 1194/455 SD more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 5211 428,500 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.180 273,500 148,100 421,600 NO Totals for 2004: General Property 3.180 273,500 148,100 421,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 637.26 Special Assessments Special Charges Delinquent Charges Total 637.26 0.00 0.00 0(n0 K-00 p G1 o m f c m o cD :3 0 (D CD I v m # c 3 v o -4 (0 cl) O D A W W O i--i a n N I O Q W N (p C CD cn N ~ n"4 O I -n O O O O ' N Oo (n a n j O f'3 N A O O C N_ N co v m O ~ l~Vi o "t cc N ul d CD a- C) o O A W _ N (\ND Z7 Chi ~ 0D o a ~ r T O O O I7 K N Z ry~~ IE- J v vvv~, (D•. E. 'a O J O .(ID (D N !1 01 !!VV OD N z . . ZOOZ c ° D Q a C. Cl) N v , N L CD CD IZ ~ N O l0 A Z CD c A Z 7 IC '0 W W (D O (D O (D <Y Z O 3 O O c0 cn C N Z (D W CL. > (o (D N CD- (D I^ °o z a (n o m v c = N 67 O CD a (D Q cn N CL a ~ v v a Oo c f, x (D W CD cn d N ((D c n O d O ~n A Ic O 0 < tr N r A O 0 ti w O 5 LL ~ 0 Parcel 030-1057-40-100 03/02/2005 03:46 PM PAGE 1 OF 1 Alt. Parcel 23.30.19.201C-10 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner ROBERT W SWANSON * SWANSON, ROBERT W WOULFE TAMMY WOULFE TAMMY 1489 N BAY RD SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1489 N BAY RD SC 5432 SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 3.180 Plat: 1765-CSM 17-4585 030/03 SEC 23 T30N R1 9W PT GL 5 LOT 2 OF CSM Block/Condo Bldg: LOT 02 3/861 (3.000AC) NKA CSM 17-4585 LOT 2 (3.180AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/13/2003 735396 17/4585 CSM 08/04/2003 733491 2345/069 QC 07/23/1997 1225/302 WD 07/23/1997 1194/455 SD more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 5211 428,500 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.180 273,500 148,100 421,600 NO Totals for 2004: General Property 3.180 273,500 148,100 421,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 637.26 Special Assessments Special Charges Delinquent Charges Total 637.26 0.00 0.00 T ! TOWNSHIP AC►= SEC. *n T.` JN-RdW ' ADDRESS 4 ,r y L j,. `TtDI ~ ST. CROIX COUNTY, WISCONSIN. ( G SUBDIVISION LOT'~ LOT SIZEi PLAN VIEW Distances and dimensions to meet requirements of H63 tits cc~~ff SHOW WITH N 100 FEET OF SYSTEM ly -1 k f d 3 !'L ~i r , I di a e o th Arrow Sc LL BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: /0 SEPTIC TANK: Manufacturer: ~ Liquid Capacity Number of rings on cover Tan manhole cover elevation:- G(- / r << Tank Inlet Elevation: Tank Outlet Elevation: fCti° , - PUMP CHAMBER A/ A Manufacturer: Number of gallons Number of-gal. pump set or a cycle_ gallons; total capacity o distribution lines gallon: size o pump head; gallon per minute horsepower ran name of pump and model number Type of warning evice P HOLDING TANK: Manufacturer Number of gallons , Elevation of manhole cover Type of warning device _ SEEPAGE PIT SIZE: °A um er o pits eet iameter~_ feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation - feet. SEEPAGE BED SIZE: number of lines =e_width ' length S 5' tile depth SEEPAGE TRENCH: width A length E~ C" PERCOLATION RATE ss ~~r REA REQUIRE REA AS BUILT INSPECTOR at,~►¢a e 4 DATED- PLUMBER ON/JO LICENSE NUMBER i J L~4 ~ Fx o S ~ } Srt=f":J L pPi ZS >t 4. ! y z i I EH ^.1.1 Rev. 9/78 ' REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 C1f, 40 LOCATION: '/4, '/4, Section N,R lqA (or) ownshi r M y p Lot No.7_ , Block No. C . . AA , YQ L - 3 lac !5G 66-1 County -Subdivision }dame Owner's/Wu;=.,..Name: _ ~►L~.ex.' 1 S-t-oo- - Mailing Address: --~'r Z ( © 3 q b Lj C4 Sra✓I \-,v I j Y~1r~p TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW 1" REPLACEMENT ALTERNATE SYSTEM I OTHER _ DATES OBSERVATIONS MADE: SOIL BORINGS ~03/8I -PERCOLATION TESTS SOIL MAP SNEET!_~__ NAME OF SOIL MAP UNIT e _ PERCOLATION TESTS (0 V1 CL Vv) i c<---, TEST HOURS WATER IN TEST TIME DROP IN NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL WATER LEVEL, INCHES RATE MIN/IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P ±(5 , y : ) S r L' S r S O Z_ q ~ wc, c I P-Z 1~'1 s )1 "c v P-_3 30~~ "''r a f I 1~'GS C1 t tJ`Fc 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 pct OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- I / / ~r /Uo~1g 7 c1~ y 1% S. ti sit Z~CS ~r S B-~ /S u . 5 1 1 '9 Si " IGS r " Mtrl S 196 3 -7 7 6-7 9 .s B- r S Si 0 S Gr 44 C) S X c~vt 19 44 B- it /U0vti-,e- IF e~ C-s 39 AA s e- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable ar.p-- Indicate number of square feet of absorption area needed for building type and occupancy 5 ,Indicate sc< Give horizontal and vertical reference points. Indicate slope. C .S./`rt ~c~ l 3 h 6- 15 ~3y'7'7 _ x • A 1 l3cne.k wee. rK = 100.60 sv i- Vic, t 33 49' 3g, Ae ) AR I r `7'7 ( c+ S S ~ 6 J.c' K c--, L r~~w0 N P Gor.,n 'dr arc, ~V _ t3~r,v •1-'.t it r Z 13av~v► . ra C. V% GC)r y _ _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) Al IeA C AV ,1 !3 CA-~'. ✓1 Certification No. Address 2 • Q 3 j Sc7 &q S 401 (c, Name of installer if known CST Signature Copy A - Local Authority QQ-~- -Y REPORT OF INSPECTION - INDIVIDUAL SLWAGE SYSTEM Sang tart y Perim<t _ • Stat" septic_- NAME _Town,~ hI(p St. CAOEx County Lc,ca.ttior< prof ( ,S" Secti an 3Lo.t Subdi vion SEPTIC TANK - Size gaUon.5 NumbeA of eompaAtmentA_ ~ - - Awl Di'~tanee. ()AOm: WeU Buitd~ng '_~1 120 ~2ape_ PUMPING CHAMBER Size 9aeeonh. Pump Manu( ctuAeA Model Numbe-n. HOLDING TANK Stze. gaPPon/s Numbed. o~ CompatctmentA PumpeI Ataftm System D-i.6 tanee O cwm: Wv,f~ Nape------------ - Ff.i ghwaten. ABSORPTION SITE Bed JTAench. DtiAtanee fAOm: LUe 'c s~ Buting_~_ _1'20 dope-.~ H.~ghwateA 14 ABSORPTION SITE DIMENSIONS Width o tAene.h--- ~t Re.qu.j'.Aed ateea- - l Leng=th of each eine ~3 0 6t Depth o6 Aock befow ti. e_ NumbeA o(I U-net Depth o4 Aock oven. ;tiZc, n C> 'Ta.tcU ee-ng.th o(~ tine.5 ~t Depth o(j tite below gAade ,,?V n V ~'Dtihtance- between Unes_ 67 ()t Slope ofi t~Le.neh. ~ in. pew 100 (t ~'Totaf a6aaApt~_on area of Type o6 CoveA: Pape_n.aw {I~ PIT DIMENSIONS NumbeA o o G1Lave e aAOUnd pits yep no Outaide diameteA _ (I t Depth below in2e_-t ft. Total ab6 oApt~ on- area ().t AA.e.a Aequ4.Aed ~t INSPECTED By TITLE, APPROVED _ DATE C. 19 8 REJECTED DATE 198 REASON FOR REJECTION PLB 6 7 State and County State Permit # v eP Permit Application County Permit # 7 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 ~J Mailing Address: B. LOCATION: ' C%, Section j, T ' N, R)01 W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village A )1,3 ,fir1 b GL C 0~c1 S ` ~0. ~ e Township S7 Ir ~ J9~ C. TYPE OF OCCUPANCY `Commercial "Industrial 'Other (specify) 'Variance Single family t~ Duplex No. of BedroomsNo. of Persons D. SEPTIC TANK CAPACITY 4!7'O Total gallons No. of tanks HOLDING TANK CAPACITY_ Total gallons No. of tanks Prefab concrete- r.~ 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 T..~~ / Total Absorb Area -sq. ft. New Replacement Alternate (Specify) Seepage Trench:---No. of Lineal Ft. -Width_ Depth Tile depth (top) No. of Trenches Seepage Bed: Length ~_Width._ Depth 10 it Tile depth (top)36 ~~No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land--- -Ko Distance from critical slope WATER SUPPLY: Private 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 ~~p, C.S.T. #and other information obtained from jx(builder). Plumber's Signature M PRSW#t~ / Phone # 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. E , . € e , E s , 3 E i E E i I ~ . F 1 E r a J > i f e i gym. e_ ; Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY -0~-F1 Fees Paid: State .141,4'-t" County Date V" - (date) Ll -,2 ~ci - ZZ Issuing Agent Name State Valid# Date Recd 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 4. plumber (canary copy) Revised Date 7/1/73 0 No "i ::toA L REPORT ON INSPECTION OF SANITARY PERMIT # -(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Name, Address, License NO. o ns a iIng plumber Time of Inspection (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BEN Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO ; 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? OYES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: REPORT ON INSPECTION OF SANITARY PERMIT # -(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Name, Address, License No. o ns a ing Plumber Time of Inspection (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank Seepage Trench Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BEN ermanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: 1