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Parcel 032-2027-90-000 01/08/2007 08:53 AM
PAGE 1 OF 1
Alt. Parcel 7.30.19.570B 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 - DAVIS, KELLY R
KELLY R DAVIS
1700 38TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1700 38TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 12.000 Plat: N/A-NOT AVAILABLE
SEC 7 T30N R19W 12A NE NW COM NE COR SEC Block/Condo Bldg:
7; TH S 88 DEG W 2740.48' TO POB; W 361
.5'; S 361.5' W361.5' TH N 361.5' TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
AND ALSO AS DESC IN 666/546 AS FOLLOWS: 07-30N-19W
THAT PART OF E 1/2 NE NW LYING N OF N
LINE OLD HWY R/W SAID R/W RUNNING GENER-
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 666/546
2006 SUMMARY Bill Fair Market Value: Assessed with:
146058 246,400
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 12.000 93,000 93,900 186,900 NO
Totals for 2006:
General Property 12.000 93,000 93,900 186,900
Woodland 0.000 0 0
Totals for 2005:
General Property 12.000 93,000 93,900 186,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 105
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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AS BUILT SANITARY SYSTEM Rl"PORT
OWNER TOWNSHIP, _
ADnIZESS ~Iy"~✓ - SEC T.3~ N, RJ_L W
r^cJ 04,z ST. CROIX COUNTY WISCONSIN.
SUBDIVISION//~~~~~^~~~~Z`~
LOT- LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of II62.20
SHOW EVFRYTIIING WITHIN 100 T-7FT OF SYSTEM
a
y - -f
~ +~K Y1a ter" ' j
\ I ,I
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_jni
Indicate North Arrow
SCALE: 1 '71
SEPTIC TANK(S) MFGR.
~./.~1• CONCRETE STEEL_
NO. of rings on cover Depth - -
PUMPING CHAMBER SILO PUMP MFGR- -
1~,2,_ MODEL NO. -/1 f
GALLONS Per Cycle_ ~ .
TRENCHES NO. of f width length_ ~area '0'
BED NO. of lines width length area
depth to top of pipe ~;)n
NUMBER OF SEEPAGE PITS Outside diameter total pit area
AGGREGATE
PERK RATE AREA 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 that
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
County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM.
INSPECTOR _
DATED-
LICENSE -~l PLUMBER ON JOB
LICENSE NUMBER - ,
z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitary Pets-rn.it;'
State Septic,--
NAME rowna h.cp St. Ctta.ix Caunty
Location / Section -
SEPTIC: TANK
S.ize14?0 gattons. Numbers o6 Compattatents~
Distance Fttom: Wett 1jee' 12% ate gtteaterL 4ZopezQ ~6t
$u.itd.ing it. W et.'Eandh ~ .
Highwatett it.
DISPOSAL SYSTEM
it.
Distance Foam: G1e~..Z 12% otc gtc.eatett 6.Zape_<_5
Bu.if-d.i ny- f Wettands-___- Ft.
Nighwatet it.
FIELD DIMENSIONS:
Width o6 ttteneh it. Depth o6 Aock below tite
Length of each tine J"2 it. Depth o6 teo.,k, overt t.ite C..- .in.
Numbe.t of tines Depth of ti. e betow gttade LO in.
7 it. Stope o~ tneneh in pert 100 it.
YotaZ Zength a6 k'ine_s
Distance between .Zines ft. Depth to bedrock- it.
Tai:aZ rzusattutian attea '856t2 Depth gttoundwa.--'-e
Requited ah.ea it 2 Type o Covett:~~ Papen otz Straw
PIT DIMENSIONS:
Numbe_tt o6 p.itA- e"'avet a,tound pits _-yes no
Outside diamete~~ ' Depth betow in.Zet_ it.
2
To.ta.Z ab.so.,bt~ on tce 6t A
Art e a e q ui to I t 2 6 rn
INSPECTED B%`'" ~TITL
7 DATE 19 7
APPROVED
.41
REJECTED , DATE -197-. 1
~1 .
1
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:'/a, , Section JaN,R-i~E (or) C' Jownship or Municipality =2L 1:20 C_ P- 7-
County
Lot No. , Block No. Subdivision Name
Owner's/Buyers Name: -DA V i 5
Mailing Address: (,r)`9 P +4~) •~~it)A"~C~/!/I~/~, (~c__
TYPE OF OCCUPANCY: Residence 7`- No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW ),,Z~ REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS- -71 7ZIq PERCOLATION TESTS 7 79
SOIL MAP SHEET
-----____----__.___-NAME OF SOIL MAP UNIT .&24Eg V
_ PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES °i
NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL RATE
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
SC.XL-
-
P_;2 (4 0 1,114 9L
P-
P-
d
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- F2N C 'j - S. L . * 1 .
B-,o SL,
B- 4' 41' r-if
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy -mod < /gcD Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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I, 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. r~
Name (print) ~ E F F (10 Q ~ Certitication No. ~ l7 ~
Address L R 1-
Name of installer if known
Copy A -Local Authority CST Signature s.G
I
State and County State Permit #
PLB 67
~G Permit Application County Permit #
for Private Domestic Sewage Systems County
-
*DENOTES STATE APPRDVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
~4 S r
B. LOCATION: %-3560 Section Ta~LN, R E (or) ) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township "&Y1rne 3 T
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _ L 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 Poured-in-Place Steel Fiberglass Other (specify)
New Installation Y~ Replacement
Lift Pump Tank or Siphon Chamber X Total gallons Prefab concrete_ye~-Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate V Total Absorb Area sq. ft.
New A, Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: 24- Length t L WidthIA' Depth1 Tile depth (top)No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land--- Distance from critical slope 7 ~ f
WATER SUPPLY: Private,~4 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 f!onr" .=i - EH 1 15 pfepared
by the Certifie Soil Test ,
NAME 1=,
C.S.T. # ~ „,~d ~,7her ~rrf~rna*.~n
obtained from kaee~ ~',f owner/bwlde
Plumber's Signature W# / 3 9 Phone # 2/,.5-
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.
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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/~ted (date) Issuing Agent Name
Inspection Yes , 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
` I TRANSFER FORM
SANITARY PERMIT
T Permit
PLB 67State
Sanitary Permit #
County
Sanitary Permit Transfer Date Original Permit Issuance Date F'
A. Property Location: _ 1/4 A ~`L y/,, SectionT i' N,R I ~ .E (or)* Lot # -City
Subdivision Name, Nearest Road, Lake or Landmark BILK # Village
Township'-h e B. TYPE of Occupancy: Commercial Industrial Other (Specify)
Single Family Duplex No. of Bedrooms Variance
C. SEPTIC TANK CAPACITY Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab Concrete Poured-in-place Steel Fiberglass Other(Specify)
New Installation Replacement
LIFT PUMP TANK/SIPHON CHAMBER / t,' L Total gallons Prefab Concrete Poured-in-place -Other (Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate _i' L ;~2 'Total Absorb Area ? ¢ sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: ;ZC No.Lineal Ft. Width _'!2_Depth -~Tile Depth(top) fL I No. Trenches
Seepage Bed: Length Width Depth Tile Depth(top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits
Percent slope of land ' Distance from critical slope
E. WATER SUPPLY: fir Private ❑ Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No.
Name Name
Address /3-~ r =G_ ~'-l y> Address
Zip , < Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20,, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Teter and/or any additional soil tests that may have been required.
Plumber's Signature MP/MPRSW # ZZPhone -
/L~~c
Plumber's Address-x,
Information obtained from 1 Creti (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor's propert If well has of begs Ir...p
y - d gleasg. r. ll~ t~ m m. i _ _ a m
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Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green iicopy) rzr)y ?'n~ 1\41^
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