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Parcel 032-2003-40-000 05/30/2007 10:23 AM
PAGE 1 OF 1
Alt. Parcel 1.30.19.474B 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 - SUTHERLAND, PERRY & CATHERINE
PERRY & CATHERINE SUTHERLAND
PO BOX 295
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 1779 85TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 1 T30N R19W 5A W660' OF S 330' OF NW Block/Condo Bldg:
NE BEING CSM VOL 4/1037
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
01-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 58,000 101,500 159,500 NO
Totals for 2007:
General Property 5.000 58,000 101,500 159,500
Woodland 0.000 0 0
Totals for 2006:
General Property 5.000 58,000 101,500 159,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 304
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
a~ a 00 3 _cy6_ a
AS BUILT SANITARY SYSTEM REPORT
OWNER •1~I1
ADDRESS TOWN S H I P , S E C. T N, R~
~
ST. CROIX COUNTY ySiZIE) CONSIN .
SUBDIVISION LOT LOST d~ 3 j
Di stances & dimensions to meet requirements W
of H62,20
SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM
j y1
4 1
/
I di a e vx`th Arrvw
SCAL = I ` i C
SEPTIC TANK (S) MFGR. CONCRETE $ STEEL
N rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. -ffnTL NO.
GALLONS Per Cycle _
TRENCHES NO. of widtFi _ length area
BED NO. of lines width f length L1J` area
depth pipe
NUMBER OF SEEPAGE PITS Outside ameter total pit area
AGGREGATE
PERK RATE RE REQUIRED AREA AS BUILT
Disclaimer: The inspection of this system by St. Croix County does not imply
complete compliance with State Administrative Codes. There are other areas thn
it is not possible to inspect at this point of construction. St. Croix County
assumes no liability for system operation. However, if failure is noted the l
County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH /HIS SYTEM.
INSPECTOR
DATED; PLUMBER ON JOB Y r <
LICENSE NUMBER
RI PORT OF INSPECTION - INDIVIDUAL SLWAGE SYSTf M S a vr-.i- ,t an y P e it m i t 0421.-
State Se.pt~c
I r_ 9-4 lei
1C Township St. Cno c'x County
at~io-n-_/~d~Section-/_ Lot # Subdivi64'on.
VTIC TANK
i zc gal'ton.6 Numbers o6 compaAtmen,ts /
ti tance {nom: (Ve~.~ ~C U Buitding 120 6tope
H.ighwaten
APING CHAMBER
St zee ~ga~~on5 Pump Manu6aetune_4 Model Numb
e.n
(DING TANK
ti~ ze - gakfon6 Numbers o6 Compantmen
P(<mr)e'`------- Atanm Sye.tem
ti Lance 6AQm:" ding 120 -6zope
H.i.ghwa.te.
`:ORPTION SITE
TAench r,
s
tan(,P Anom: WeQY~_1 G c Buitdin' g__ ~ t2 o s pa ~e
Htighwa,ten.
,,ORPf1ON SITE DIMENSIONS
Ul i d th o the neh _6,t Req u-i n.ed anea~ f ~t
I ~nq.th o 6 each. f..i-n.e_ 6.t Depth o6 hock bek-ow ,tite
Numbers oA Depth. oA noclz oven .t-ilc i.n
71z
,iTu tak tong th o A e nee 6,t Depth o6 -tite, befow gnade _ c.n
~ ;'D,-ih"Lance between ti.ne.b_ ' _{t SEope o6 tAe-nch -Vt. pen 100 6t
~JO(tAt a1,"su)(rd"t.,un anew (It Type o6 Covey: ~Papen oh- 501aw
C ~~I DI MVNS I ONS t~
Numbers o{ GnaveT abound pl"t,5 yee's
Ou t) de diame.t,e.n _ 6t D~.pth beeow kntv.-t
To tak absonp,tion ane.a 6;t
Aniea 4cqui4ed 6,t
PECTED By A~,jt TITLE_ CI'ROVLD DATE--- 19 k
IrCTED DATE 19n
ASON TOP REJECTION
REPORT ON INSPECTION OF SANITARY PERMIT #
(1) ,,Name and /",Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
ame, ress, icense NO. o ns a ing Plumber Time of Inspection
(3)INSTALLATION CONSISTS OF: ❑ Septic Tank I ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BENCHMARK: (Permanent re erence 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:
(7)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 TREN H: 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:
. ti.oa.wez
PLB 6 7 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:
5~.
B. LOCATION: A/al /4 NL- /4, Section T~j N, R (or) 13L Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial `Other (specify) *Variance
Single family X Duplex No. of Bedrooms No. of Persons R
D. SEPTIC TANK CAPACITY 11,)[,10 Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete _X 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 X Replacement Alternate (Specify)
Seepage Trench: No. of CLineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length o CJ Width Depth Tile depth (top) No. of Lines-
Seepage Pit: Inside dia eter Liquid Depth No. of Seepage Pits
Percent slope of land- ~ Distance from critical slope
k,VATER SUPPLY: Private tX 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 0,11J,It/ ' C2g.' 4 J~ C.S.T. # and other information
obtained from 0&)A/`_ ' (owner/builder).
Plumber's Signature P/MPRSW# Phone ##y~%'S
Plumber's Address -L_ ~L%-
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
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application - - Fees Paid: State County Date
Permit Issued/Rejected (date)-/~ -/(fl Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (white opy) 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
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