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Parcel 032-1065-40-000 11/20/2006 04:06 PM
PAGE 1 OF 1
Alt. Parcel 24.31.19.324B 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 - BELISLE, ROLAND J & JANET
ROLAND J & JANET BELISLE
719 210TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 719 210TH AVE
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.010 Plat: N/A-NOT AVAILABLE
SEC 24 T31N R1 9W PT NW NW BEING LOT 1 Block/Condo Bldg:
CSM 9/2579 3.01AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.010 48,000 81,600 129,600 NO
Totals for 2006:
General Property 3.010 48,000 81,600 129,600
Woodland 0.000 0 0
Totals for 2005:
General Property 3.010 48,000 81,600 129,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 122
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
!LnER r TOWNSHIP S,_,. SEC.,Y; / T..~'1 N, R
0. ADDRESS , ST. CROIX COUNTY, WISCONSIN.
.-3DIVISION LOT LOT SIZE '
PLAN VIEW
-Distances b dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1 i
F
I r I ~ ~
t I ~ _
"
(
i
Irxdica~ e North' Arrow -
SCALE
tPTIC TANK(S) MFGR.~"i CONCRETE
A e STEEL
NO. of rings on cover Depth DRY WELL
tNGHES NO. of width length area
no. of lines ) width length area
-
depth to top of pipe.-,
aGREGATE
iRK RATE APIA REQUIRED AREA AS BUILT J
itsclaimer: The inspection of this system by St. Croix County does not imply 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
15tem operation. However, if failure is noted the County will make every effort to
;jtermine cause of failure.
,LEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST
`INSPECTOR
DATED r 5' C' PLU [BER ON JOB
LICENSE NUMBER J ~ '
Z -
REPORT OF INSPECT104 INDIVIDUAL SEWAGE SYSTEM
San.i-tany Pexm.i:t
Sate Septic
NAME Townah.ip S.. CAoix County
LOcati0A Section j
SEPTIC TANK
SiZ,e~ gattonb. Numbers o6 Compax.tmen.tz
Diztance Fxom: Wett 6t. 12% on gxeazex ztope it
Buitd.ing a7~ it. wettands
H.ighwatex it.
DISPOSAL SYSTEM
07
it. 12$ on gnea ex zdope b .
D.Lb once Fnom: G/eQt
Bu.itd.ing it. Wettands Ft.
H.ighwatex it.
FIELD DIMENSIONS:
Width ob trench it. Depth o$ tack below t.ite Z"-.in.
Length os each tine ~ it. Depth o6 tack oven t.ite .in.
Number of tines aZ Depth of tite below grade .in.
_7A,_jZ. Sto pe o6 trench in pen 100 it.
To tat. Deng th o6 Una
D.iatance between Zine-6 6t. Depth to bedxock ~ •
Totat ab.aoxbtion area (p.~ jt2 Depth to gxoundwatex ~ .
Requiked axea Type of Covet: /lapex bn Stxaw
PIT DIMENSIONS:
Numbex os pits Gnavet axound pitzs yes no
Outz ide d.iameten it. Depth below -inlet it.
2
Totat ab4onbt.ion area it A
Area qu.ixed j t2 rn
I INSPECTED BV ITLt
APPROVED DATE " 1.
REJECTED DATE 197.
EH 115
r WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BO now PERCOLATION TESTS
LOCATION:+ '~'/4, , Section ~ T33N, R f (or or NFan'i&~ S@~ 2 s4 1-
Lot No. , Block No. County ec, / X -
-~j Subdivision Name
Owner's Name: /pe-14~~f-', ~ 46t4 iS6~' -
Mailing Address: IC-` a aE l S"f Gl.~ Ir
TYPE OF OCCUPANCY: Residence No. of Bedrooms ~ Other
EFFLUENT DISPOSAL SYSTEM: NEW ~ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 7,IFF~ PERCOLATION TESTS - -
SOIL MAP SHEET _9 em SOI L TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHESI RATE
CHAR
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
t
P-' 3Q, sty /'e
P_ 31F 7
P_3 3 0 AAA16 =/0
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)
NuNL R t / - .7 72- AdVL 7 72 0 - CAI it 7- c SFr- s
B-t
t& .4
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of uita I areas. Indicate number of square feet of absorption area
needed for building type and occupancy. n/.$_ Indicate scale
or distances. Give horizontal and vertical reference i ts. Indicate slope.
ar;~N d l I ~ I
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IT
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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 (prim - k-'9'(7j0YZ Certification No. 7 z 7 Z
W t~
Address
Name of installer i known
SAL rT!'?1TY CST Signaturt~~~~„ -
s
PL13 67 State and County State Permit #
u Permit Application County Permit #
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: '/4 Alit.1 Section , T N, R Q (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township s c7-
C. TYPE OF OCCUPANCY: *Commercial "Industrial "Other (specify) *Variance
Single family _ Duplex No. of Bedrooms No. of Persons S
D. SEPTIC TANK CAPACITY &O& 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 or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate + Total Absorb Area W 7~ sq. ft.
New- A" Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: _W_Length S_'~ ~ Width 42 _Depth -3461Tile depth (top)~_No. of Lines
~X
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land_ & 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 Cer ified Soil ter,
and other information
NAME ',,{~/x~l'1sKSr C.S.T. #
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# G,3 Phone
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 C,oU t L Date
Permit Issued/mod ('date) 7 zj Issuing Agent Name "r
, .z t c.- L ! a l
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