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Parcel 032-1041-70-000 04/06/2005 07:53 AM
PAGE 1 OF 1
Alt. Parcel M 14.31.19.206A 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): = Current Owner
WALTER E & DEBRA C GERMAIN GERMAIN, WALTER E & DEBRA C
2100 HWY 35 N
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 2102 HWY 35
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 10.970 Plat: N/A-NOT AVAILABLE
SEC 14 T31 N R1 9W PT SW SE & SE SE BEING Block/Condo Bldg:
LOT 1 CSM 9/2553 10.17AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/20/2002 687539 1952/588 WD
07/23/1997 979/581 WD
07/23/1997 710/496
2004 SUMMARY Bill Fair Market Value: Assessed with:
10031 Use Value Assessment
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 48,000 167,700 215,700 NO
AGRICULTURAL G4 7.970 1,200 0 1,200 NO
Totals for 2004:
General Property 10.970 49,200 167,700 216,900
Woodland 0.000 0 0
Totals for 2003:
General Property 10.970 49,200 167,700 216,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M 219
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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Parcel 032-1041-70-100 04/06/2005 07:53 AM
PAGE 1 OF 1
Alt. Parcel 14.31.19.206B 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): Current Owner
" GERMAIN, WALTER E & DEBRA C
W EBRA C GERMAIN
2100 HWY 35 N
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 1700 WITC f"~l M I
Legal Description: Acres: 16.913 Plat: N/A-NOT AVAILABLE
SEC 14 T31 N R1 9W SW SE EXC PT TO CSM Block/Condo Bldg:
9/2553 & EXC 032-1041-70-200 & EXC AS
DESC 1264/389 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
14-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1069/253 WD
07/23/1997 872/532 LC
07/23/1997 748/66
07/23/1997 710/496
2004 SUMMARY Bill Fair Market Value: Assessed with:
10032 Use Value Assessment
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 12.913 600 0 600 NO
PRODUCTIVE FORST LANC G6 4.000 16,000 0 16,000 NO
Totals for 2004:
General Property 16.913 16,600 0 16,600
Woodland 0.000 0 0
Totals for 2003:
General Property 16.913 16,600 0 16,600
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
1 Parcel 032-1041-70-000 04/05/2005 11:15 AM
PAGE 1 OF 1
Alt. Parcel 14.31.19.206A 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): Current Owner
WALTER E & DEBRA C GERMAIN GERMAIN, WALTER E & DEBRA C
2100 HWY 35 N
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * ~1D2•lW5 ° ~°J~
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
1-~
Legal Description: Acres: 10.970 Plat: N/A-NOT AVAILABLE
SEC 14 T31 N R1 9W PT SW SE & SE SE BEING Block/Condo Bldg:
LOT 1 CSM 9/2553 10.17AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/20/2002 687539 1952/588 WD
07/23/1997 979/581 WD
07/23/1997 710/496
2004 SUMMARY Bill M Fair Market Value: Assessed with:
10031 Use Value Assessment
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 48,000 167,700 215,700 NO
AGRICULTURAL G4 7.970 1,200 0 1,200 NO
Totals for 2004:
General Property 10.970 49,200 167,700 216,900
Woodland 0.000 0 0
Totals for 2003:
General Property 10.970 49,200 167,700 216,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch 219
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
z - ~ /00 f~GVy 3~
REPORT OF INSPECTION INVIVIDUAL SEWAGE SYSTEM
San.itaAy Petcmit- _ YK,
k State S(,ptic-,.. ~.r
NAME fown.bhip 7 t . S~. Ctco.ix County
Locat.iom ; Section
SEPTIC TANK
Size ) e-z, gatton4. Numb etc oj CompaAtmentz
Diztanee FAOm: Wet 12% oA gneateA ztope ~ ,S it
f
Bu.itd.ing it. Wettandts
HighwateA - it.
DISPOSAL SYSTEM
D.cbt ance FAam: WeU 12% tc gA eateA 4tope
o
i
Bu.itd.ing U/ettands Ft.
• N.ighwate,%
FIELD DIMENSIONS:
Width o6 ttcench' it. Depth o6 tcock below t.iteZ2
Length o6 each 2tin - it. Depth o6 Aock oveA tite 2-- in.
NumbeA a6 tines Depth o4 t.ite below gAade'L in.
Totat length o6 t incs it. Sto pe o j ttceneh in pet 100 it.
Distance between Una (;e~, it. Depth to bed&ock
Totat ab~s oAbt.ion aAea~. St2 Depth to g&oundwateA
2 : a etc o Sttc aw
RequiAed atcea it Type ai Covets p
PIT DIMENSIONS:
NumbeA o6 pit.5 Gteavet atcound pits yeas no
Outside eteA 6t. -.Depth below inZet it.
2
Totat b t " ,n atcea it ~z
AAea t2
INSPEC L ,
PROVED DATE 197~C
REJECTED DATE 197
. 't
R~
EH: 115 _
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 TESTS
LOCATION: Section T31N, R 17E (or) W, Township or Municipality
Lot No. , Block No. County, i !-T
Subdivision Name
Owner's Name: iE 4t't- c~ Y G7, ? i t
Mailing Address: 1 4 7, , E i- VIZ, 1 ~ -
TYPE OF OCCUPANCY: Residence No. of Bedrooms ~7_ Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET , SOI L TYPE
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 MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P_
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)
_ a t
B- ;7 Z/ _
C-
c~ ) z7 - c
' r
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of uitable re _Indicate n ber of square feet of absor tl area
rz -l rca cale
needed for building type and occupancy. ' L
or distances. Give horizontal and vertical reference p in s. Indicate slope.
1 k i
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14 1 i t i E
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) c- 4 cY / cf e /L ilr 5 Certification No. -
Address
Name of installer if known
CST Signature_
State and Count State Permit #PLB 6 y
7 Permit Application County Permit
County r25~- r~ r 5C
for Private Domestic Sewage Systems
"DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
L jVA-"d eo~ M r4 I fo)
B. LOCATION: Section 14- , T,31 N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township 56 y) eiYcF,
C. TYPE OF OCCUPANCY: Commercial "Industrial `Other (specify) "Variance
Single family Duplex No. of Bedrooms 2- No. of Persons 7
D. SEPTIC TANK CAPACITY Total gallons No. of tanks /
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel L----Fiberglass Other (specify)
New Installation L-~ Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate = ~S 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: -s [ ength s Z ' Width / Z' Depth 0 6, " Tile depth (top) No. of Lines Z
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- 62Z Distance from critical slope
WATER SUPPLY: Private ❑ 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 ~L , /I C.S.T. # and other information
obtained fromn (owner/builder).
Plumber's Signature ~ f
MP/MPRSW# Jl' ~ Phone #
Plumber's Address 41: -22["
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 Spacer Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State County/-- ~ C' Date /
Permit Issued/R (date) Issuing Agent Name tX~reC
2?l t~E ~f
Inspection Yeso 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
AS BUILT SANITARY SYSTEM REPORT
OWNER, Z
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 EVF,RYTHIN WITHIN 100 I•T17T OF SYSTEM
I II
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4~ -I
,i
e North Arrow
- I~dicat I C
;SCALE ,r, _ - - -r----
SEPTIC TANK(S) ~MFGR. CONCRETE STEEL
NO. of 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 j. length area Af
depth to top of pipe-----e NUMBER OF SEEPAGE PITS _ Outsdiameter total pit area
AGGREGATE
PERK RATE - 5 AREA REQUIRED ; t r > AREA AS BUILT
Disclaifer: 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-
I)A'I'1?I)- PLUMBER ON JOB
IJ 'NSF NUMBER