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Parcel 032-2068-10-000 08/14/2006 05:19 PM
PAGE 1 OF 1
Alt. Parcel 12.30.20.764A 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 - CLAYTON, CYNTHIA M
CYNTHIA M CLAYTON
252 ANDERSEN SC'T CP TRL
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 252 ANDERSEN SCOUT CAMP TRL
SC 5432 SOMERSET
SP 1700 WITC
i
Legal Description: Acres: 26.000 Plat: N/A-NOT AVAILABLE
SEC 12 T30N R20W 26A IN SE SW NORTH 25 Block/Condo Bldg:
ACRES OF SE SW ALSO 66' STRIP BEING E
66' OF SE SW Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
12-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/13/2002 670984 1835/39 QC
07/23/1997 865/267
07/23/1997 581/280
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 48,000 139,700 187,700 NO
UNDEVELOPED G5 13.000 26,000 0 26,000 NO
PRODUCTIVE FORST LANDS G6 10.000 40,000 0 40,000 NO
Totals for 2006:
General Property 26.000 114,000 139,700 253,700
Woodland 0.000 0 0
Totals for 2005:
General Property 26.000 114,000 139,700 253,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 312
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
IWIER / , TOWNSHIP SEC. T N, R ~ W
Q. ADDRESS. „ ST. CROIX COUNTY, WISCONSIN.
:3DIVISION LOT LOT SIZE
PLAN VIEW
-Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
- , -T
i
177,
I a
4 -44
j Indicate North;Arrow
I i SCALt .
- -r
OPTIC TANK(S) ' MFGR.'. - / =`CONCRETE STEEL
NO. of rings on cover- Depth - DRY WELL
ANCHES NO. of width length area
no. of lines width length - % area, -
depth t'D top of pipe
aGREGATE - ,rte .
RATE AREA REQUIRED AREA AS BUILT
liccaaimer: The insce_tion of this system by St, Croix County does not ` t~mp1y complete
,o,pliance with State Administrative Codes. There are other areas that it is not possible
p inspect at this point of construction. St. Croix County assumes no liability for
ystem operation. However, if failure is noted the County will make every effort to
;iterm_ine cause of failure.
,:EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
`INSPECTOR
DATED PLU', IBER ON JOB
LICENSE NUMBER f,
z
REPORT OF INSPECTION 'TVIDUAL SEWAGE SYSTEM.
Sanitatty Pvun i..t 1131
State S(jptic
1
NAME _i ownah cp_ S~. Ct<oix County
Location_ Section
S
SEPTIC TANK
J~ I
~
a.2.lons. Numbet o6 Compan.tmendb
,
Si z e 9 r
Diztanee Fstom: WeU 6t. 120 ott gtteatest zf-ope it
~ .
Bu.itd.ing it. Wettand/s
H.ighwatet it.
DISPOSAL SYSTEM .
D.ietanee Fnom: weU 6t. 126 ott gttea.ten stope it.
Bu.iZding fit. W ettandss Ft.
• H.ighwaten it.
FIELD DIMENSIONS:
WiRh o6 tttench it. Depth o6 ttoch below Cite .in.
Length o6 each tine it. Depth o6 tcock overt tiZe .in.
Numbest o6 tine.5 Depth. o6/ tiZe below gstade ,in.
Totat length o6 Zinez it. Stope o6 ,tsteneh in pert 100 it.
Distance between Z ines 6t. Depth to b edtto ck
Total abss ottbtion attea it2 Dept- tic gr~oundcla en it.
T ~e o Coven: Pa etc ott StA.a~1t
Requited area it yi ~ p
PIT DIMENSIONS:
Numbett o6 pit/s GstaveZ astound p.itz ye's no
Out,s.ide d,i.ame-tet it. Depth beZoui ,i.ntet
2
TotaZ abzottbtion area it
A
Attea tteq uiAed 5t2 m
INSPECTED BY TITLE
APPROVED , DATE 1 19 7~.
REJECTED DATE 197
f. 1
EH X15
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TES S
c LO-O_ SM
CATION-5 __%,5~' '/4, Section iZ, T N, R AE (or) W, Township or Municipality 5
Lot No. , Block No. County
1 Subdivision Name
r ' _
Owner's Name: 05A)-x. (21 ►Z
71
Mailing Address: , i /~ne ~
TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW A ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS' .
SOIL MAP SHEET SOIL TYPE ~w PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME 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
P-1 3
31-14, r r
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)
7 ?
?
-s 7 <
c LIN 4, j
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable area. Indicate number of square feet of absorption area
needed for building type and occupancy. /1,S Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
14-
1{
c A ~ I ~ i Y I ~ 1 E
.
I
N
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are. -
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a 1
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 (print) t. _ , • / <S ~x ' Certification No. ' 71
Address 1 - 4 k
Name of installer if known
CST Signature''-''
COPY A - LOCAL AL;`i',D?lTY
7
;RYA
State and County State Permit # ~
PLB 67
f W ' Permit Application County Perm
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:
B. LOCATION: &e Section , T_jn_ N, R_,~ft U (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township SGtigeziEI'
C. TYPE OF C UPANCY: *Commercial *Industrial *Other (specify) *Variance
Single fa y _ Duplex No. of Bedrooms 3 No. of Persons
D. SEPTIC TANK CAPACITY 1,QQQ 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 X Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate ~r y~•• Total Absorb Area sq. ft.
NewX Replacement Alternate (Specify)
Seepage Trench: No. of Linej~I,Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length. 9 ' Width. Depth It Tile depth (top) ~No. of Lines c:~?
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land fQ Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
1, the undersigned, do hereby certify that the information 1 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 C tified Soil ester,
NAME d C.S.T. # and other information
obtained from r* (owner/builder).
Plumber's Signature MP/MPRSW# / Phone S-
Plumber's Address F„1 tu/. n a `S-~ 7
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. W i
v
t
910
3
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.T
44100
4 E
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~_.mm m _,e., aa. ...,w., m _ e
i
Do Not Write in Spa 13elow - FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State r Q Count Date- 17q
Permit Issued/RE (date) Issuing Agent Name
Inspection Yes No State Valid# Date Rec'd
1. county (whi e 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 ,