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Parcel 032-2076-60-000 08i02i2006 04:57 PM
PAGE 1 OF 1
Alt. Parcel 14.30.20.790B 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 - HENNE, NICHOLAS E
NICHOLAS E HENNE
173 ANDERSEN SC'T CP TRL
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 173 ANDERSEN SCOUT CAMP TRL
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.300 Plat: N/A-NOT AVAILABLE
SEC 14 T30N R20W 3.3A IN SE NE LOT 1 CSM Block/Condo Bldg:
VOL 4/974
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.300 49,500 104,000 153,500 NO
Totals for 2006:
General Property 3.300 49,500 104,000 153,500
Woodland 0.000 0 0
Totals for 2005:
General Property 3.300 49,500 104,000 153,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 138
Specials:
User Special Code Category Amount
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP,5
ADDRESS / G~dXS ST. CROIX COUNTY, WISCONSIN.
rvg
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
.9 0 ENE THING WITHIN 100 FEET OF SYSTEM
x(i
fi~E
I di a e o th Arrow
BENCHMARK: (Permanent reference Point) Describe: hhli- !fv' 9wFltO r~cE=
,,2,-~ cr
Elevation of vertical reference point: i,0, Slope at site:
SEPTIC TANK: Manufacturer: _[(l~~~ 'S Liquid Capacity: &-vo
Number of rings on cover : - Tank manhole cover elevation:
Tank Inlet Elevation:Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cycle- gallons; total capacity o
distribution lines gallon: size pump head;
gallon per minute horsepower bran 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: um er o pits eet iameter
feet liquid dept seepage pit in etpipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines~_width ~leitgth~tile depthjg_-
SEEPAGE TRENCH: width length
PERCOLATION RATE 8-z/- eL AREA REQUIRED (-j,AREA AS BUILT
INSPECTOR
DATED PLUMBER ON JOB- e)liee.~"
LICENSE NUMBER-- -
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit-Arz
/C State Septic &,azav
JAMS TOWNSHIP C50 / St. Croix County
1.0CA110N - ' `Section] /Lot # Subdivision-
,EI''l,IC TA NK
Size I ) gallons Number of compartments-
Distance from: Well Bui.Idi.ng_ 12% slope
Highwater_
i'UMP-INC -CHAMBER
_ _ -Model Number_
Size gallons Pump Manufacturer i------Model
IIOI.D 1 NG TANK
Size gallons Number of. Compartments
Pumper Alarm System _
1~istance from: Well Building 12% slope
Highwater rr
AKSORPTI.ON SITE
Bed Trench
o i stance from: Well Building-- 12% s].ope,_
Highwater
ABSORPTION SITE DIMENSIONS
Width of trench _ ft Required area___ y, ft.
Length of each line ft Depth of rock below the In.
Number of lines Depth of 'rock over tile- in.
Total length of lines ft Depth of tile.below grade L/ in.
Distance between lines ft Slope of trench---in. per 100 ft.
Total absortption area ft Type of Cover:- j
11 IT DIMENSIONS'
Number of pits G avel around pits yes-_ no
Outs si-de diameter Depth below inlet- _ ft
'T'otal absorption area f
Area required ft
INSPECTED B Y TIT :L L: _ N
APPROVED DATE 198a
RF. IECTE1) DATE-------------- 98
R I A S O N FOR REJECTION
EH 115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION:=L c %,x=%, Section Z a ,T~N,R •zOt (or)OWownship or qty
Lot No. , Block No. ° °-s n County Q, T-' C, r4 T°
/ Subdivision ame
Owner's/Buyers Name: c_? v= .a )1 I tom, va
Mailing Address: Q? Q 1 L ek - ~ J- ~<~n,- A/1 S
TYPE OF OCCUPANCY: Residence t''- No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET NAME OF SOIL MAP UNIT
PERCOLATION TESTS f~ ' ` it ~n
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
i1'3' a
P- t-1 T ~Q' Si G ly Z !6 Z i6
P- ,a T S. q0
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- I e' ~ (P- 68 ~ i,~. ~3' s I y7 s ~Y cob
B- ' 6u 3 014OE-- Qa.,~. -3U -L C..c Zu ,I-"S ,
B- AJ 0 -0 4>- LC (3
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the Ipcation and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy C6 / .Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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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. )
PJame (print) I I ~ e /I Certitication No.
Address -10 i3 Vic, I n . i f t° f-l~ clr C> h ~(I i `.w 'y 0 l U
!Name of installer if known
j~
-Local Authority CST Signature = ;
J
l
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTR , FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/2 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. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address:
Property Location: City, Village or Township: County:
'ir t/4 L='/aS iT: NiR E (or t - fir
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(If assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required. J
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY ,0047
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: 1 ;y
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): IXNew ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Nam as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public 2 -
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signa MP/MPRSW No.: Phone Number:
lid
Plumber's Address: 3 Name of Designer:
/
COUNTY/DEPARTMENT USE ONLY
E~l gnatur of Issuing Ag nt: Fee: Date: A .APPROVED Sanitary Permit Number:
-601 ❑ DISAPPROVED
Reason for Disapproval:
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
Dlt_;-iR-SBD-6398 (N.03/81)
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