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Parcel 032-2030-50-000 01/08/2007 09:03 AM
PAGE 1 OF 1
Alt. Parcel M 8.30.19.585 032 - 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
CHARLES J & GLADYS HANSEN O - HANSEN, CHARLES J & GLADYS
1670 50TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1670 50TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 8 T30N R19W SE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
146081 Use Value Assessment
Valuations: Last Changed: 08/09/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 35.000 2,300 0 2,300 NO
UNDEVELOPED G5 2.000 200 0 200 NO
OTHER G7 3.000 45,000 64,200 109,200 NO
Totals for 2006:
General Property 40.000 47,500 64,200 111,700
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 47,500 64,200 111,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 139
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 032-2030-30-100 01/08/2007 09:03 AM
PAGE 1 OF 1
Alt. Parcel 8.30.19.584A-10 032 - 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 - HANSEN, CHARLES J & GLADYS
CHARLES J & GLADYS HANSEN
1670 50TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 19.400 Plat: N/A-NOT AVAILABLE
SEC 8 T30N R19W 29.97A SW NE EXC CSM VOL Block/Condo Bldg:
3/897 AND EXC P584B & P584C EXC AS DESC
1592/253 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-30N-19W SW NE
Notes: Parcel History:
Date Doc # Vol/Page Type
02/27/2001 639292 1592/253 WD
07/23/1997 706/599
2006 SUMMARY Bill Fair Market Value: Assessed with:
146079 Use Value Assessment
Valuations: Last Changed: 08/09/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 19.400 1,800 0 1,800 NO
Totals for 2006:
General Property 19.400 1,800 0 1,800
Woodland 0.000 0 0
Totals for 2005:
General Property 19.400 1,800 0 1,800
Woodland 0.000 0 0
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
AS BUILT SANITARY SYSTEM REPORT
OWNER
TOWNSHIP ;f SEC. T N , R W
ADDRESS ST. CROIX COUNTY WISCONSIN .
SUBDIVISION _ LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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I di ate ozthj Arroi7
SCALD : i-' f i I I
SEPTIC TANK(S) MFGR., CONCRETE STEEL
NO. o rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of -width - length area
BED NO. of lines_ width = length ' - area i..r'
depth to top 017 pipe
NUMBER OF SEEPAGE P~TS 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 PLUMBER ON JOB
LICENSE NUMBER
z .
.REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.i-tany Pen.m.i-t s1 A
State S e p-t.ic _
NAME rawnsh in r.:. S$. Cnoix County
Locat.ioic)f.( Section ;
SEPTIC TANK
Size ~'d~} ~ gattone. Number o6 Compa,%tmen-ts
DiAtance Fnom: Wett it. 12$ on greaten at ope. Sti
Buitd.ing it. Wettand.6 - ~ .
H.Lg hwatet 4
DISPOSAL SYSTEM
Diatance Fnom: Wet a+?9✓ it. 12% ot greaten ztope
Buitd.ing f it. We.ttanda Ft.
• Highwaten it.
FIELD DIMENSIONS:
Width of ttench it. Depth oS rock below t.ite .in.
Length of each tine ~ it. Depth o6 %ock oven z.ite in.
r
Number o j tines Depth of Cite below g,%ade in.
To#at. .length o6 tines it. Stope of trench Z in pen 100 it.
D.iatance between tines-Lat. Depth to bedrock
Ta#at absonbion axea 6.t2 Depth to gnoundwaten
Required areait2 Type o6 Coven: Pape on Shaw
PIT DIMENSIONS:
Numb en o6 p.itz Gnavet around p.it.5 yea no
Outa-i.de d.iame.ten it. Depth below .intet ~ .
2
To#at abdonbz.ion area it
A
Ahea )qu ined it2 rn
INSPECTED BY TITLE
APPROVED , DATES 19&VD . G
REJECTED DATE 191_
S-A
PLB State and County State Permit #
67 C I; Permit Application County Permit #
Y - for Private Domestic Sewage Systems County IL c %LC.T
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: milt' '/4 '/4, Section , T_>l N, R~9 E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township ~ivJ~c ;-S c
C. TYPE OF OCCUPANCY: *Commercial *Industrial `Other (specify) *Variance
Single family G Duplex No. of Bedrooms 3 No. of Persons_
D. SEPTIC TANK CAPACITY I CZ'7 Total gallons No. of tanks e,
-c
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel c 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 l S sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: 2- Length S5~ Width Z•2 ' Depth - e " Tile depth (top) t No. of Lines Yf-
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land C l.. 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 Lim zk ` 4 , C.S.T. # / 4/ and other information
obtained from (owner/builder).
Plumber's Signature; *z 144 1 t _ MP/MPRSW# Phone
Plumber's Address 1 i i .
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 STAT(EPEPARTMENT USE ONLY
Date of Application Fees Paid: State'`, Count
y Date ;
Permit Issued/Rejected (date) -1 1 j Issuing Agent Name
Inspection Yes_ No f 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
J
~EH"115,.
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
n REPORT ON /SrO;IL BORINGS AND PERCOLATION TESTS
LOCATION: 4_6%, Section 5, lit N, R I E (or) W, Township or Municipality
Lot No. Block No. L l c% ~ ~E 7 g'c- County ~T 17 -
Subdivision Name
Owner's Name:
Mailing Address: lzk/ 5 -
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW L ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS 7
SOIL MAP SHEET C SOIL TYPE Ci- a >ry~
PERCOLATION TESTS
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
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- i
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B_ if
B
21- L5
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable as. dicate number o squ re feet otA sorption area
needed for building type and occupancy. 1=~-- / F Indicate scale
or distances. Give horizontal and vertical reference p ints. Indicate slope.
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I, the undersigned, 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 (pt) Certification No. / J j
Address: Name of installer if known
CST Signature