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Home My WebLink About032-2082-80-000 n cn O g T 0 ID c 3 ~ K o O N cn W (D O ? N m 'D Q O (D 3 O N O d G iz~ N (D Q W O O in N n G CO N O @ s N O N O O N 7 2 0 N CO "C) (D 1 O O O C C d (G C F 00 a* !\e :D era to (A m a o o N ar Z D ~ a . !y, Ot C N O m Q Z 0 a 0 p N CD z O O O a Y (yr.~r E ai co o w to ti 13, v v q 3 CD L5 00 CD 2) ut ~ N (D cn 0 z 0 l c Z W Z N O D D O Q O h. c o (D (D m N ~ CD c,, a '.C, ! < z J cn O ~O A z n N C ~ ~ C A Z O a O ~ W (D o fD o z 0 O Cn N N z (D A N r Ia Q' ~ T z p. O CD O O N O O to o b w CD J,^, w Efl V O 4~, o IQ ~ Wisconsin Department of Health and Social Serviors Plb, 07 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. VWNER OF PROPERTY. Name / Address (Street, City, Zip Code) i B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTc`2rTED COUNTY Check One: CITY VILLAGE LEGAL DESCRIPTION S O ~2 Z-K S L T X TOWNSHIP G C. IS LOCAL PERMIT REQUIRED FOR THIS 'WORK? ~ YES NO f7~~ PERMIT NUMBER D. SEPTIC TANK CAPACITY='! C Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS; Prefab Concrete Poured in Place St:el Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence X Commercial Inda:strial Other Specify) Number of Persona to be Accommodated Number of Bedrooms ' F. APPLIANCES, ETC: Food Waste Grinder V YES NO Automatic Clothes Washer YES NO Dishwasher V YES NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLUIBER MAKING INSTALLATION Name:. Addresss License Numbert % MP RSW Signature of Applicant: i...- Address: i -i Z H. (To b/e~ Completed by Issuing Agent) Date of Application 1 % ' Fee ?aid = ( Permit Issued (date /i C - Permit Number Agent (Name) ~'i•' ` 1j(1~ Fort Town, Vii;a,,e, City, County, etc. (Specify) Note: The application cannc to considered fcr firing until all of the above questions are anssnered and t:e fee paid. Agents will fom and application, the fee of $1.OG for each septic tanx and the third copy of tha permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY RETURNED _ (Initials) _ (Date) fee Corr s.) FEE RECEIVED VALID. No. PERMIT NO. Yes or No). REVIEWED BY APPROVED DATE (Initials) Yes or No SEPTIC TANK PERMIT NO. R I P 0 R T O N S O I L P I R C 0 L A T I 0 N T L S T A N D S O I L B O R I N G S TO DIVISION OF HEALTH - PLLMBIkG SDCTi6?L P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P t R C 0 L A T I 0 N T T S T Test Depth Chas aoter of Soil -FHours Water Test Time Drop in Water Level Inches inutes Number Inohas Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall 1st Wetted OvarniZLt- in Minutes Last Period Last Period Period Cn-, Inch Example P 0 3611 To Soil 1011, Cla 2611, 25 Yes or No 30 1/2 1/2 1/2 60 j y N s i r j R.4 RECORD DATi FROM MINIMUM OF 3 TES'.' HOL~.S Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B O R I N G S- Minimum 3611 Below Pro osed Abso tion S atem Boring Total Depth Depth to Ground Water Depth to Bedroc!t Number Inohas Observed Estirrs:ated Observed Estinatod Character of Soil with Thickness in Inches Example B - 0 7211 7211 Black To Soii 12" C1 18l' Sand 1611, Gravel 2411 ell 77- a PI' RECORD DATA FROM MINIMUM OF 3 BORE HOLD YPE OF OCCUPANCYs RESIDENCES Number of Bedrooms 7 OTHERS (Specify) Number of Persons D WASTE GRINDERS Yes Lie Distnrasher: Yes l No Automatic Clothas Washer: Yes No EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION R'r:YLACEMM Tile Size No.Lin.FeetTrench Width Depth Number of Lines Seepage Tile Size No. Lines Bed: Length 10 Width _2.I' Depth Seepage Pits Inside Diameter Liquid Depth I, the undersigned, hereby certify that the percolation tests reported on this f3.-m were made by me or under my super- vision in accord with the proc,.dures and method zpecif ied in Chapter n 62.20 (13), Wisconsin Administrative C,.Je, and that the data recorded and location of test holes are correct to the bast of my knowledge and b?ief. zz77 NAME Z: / ! 5 i~ !l_:~ ZC zl~- ' TITLE l:. l ~Z-- Type or Print REGISTRATION NO. or MASTER PLUMBER LICENSE NO. ADDRESS F.' j-, tt DATE L'y/~ ~7/ SIGNATURE i "COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 CROTX COUNTY REP%I DA'i"L1+ 9/011, COURTHOUSE DATE RECETVED -'.1DSOdJ, WI 54010 2 32 -,2 ff -70 1 L/,' 30. z~ g 1 3WHERS William Nettkoven :;F SAMP'LE1 Outside faucet 14 0 1100 ml 'NTERFRETATION± BacteriotogicaLLY SAFE 41TRATE°N: < 1 ppsw Under 10 ppm is safe for human consumption. '._~=,x~ ~ECi-3i►.TCTAN: l'am Oas~e O p1DECENpEH Means "LESS THAN" Detectable Level Approved by! F PROFESSIONAL LABORATORY SERVICES SINCE 1952 Parcel 032-2082-80-000 04/30/2007 04:27 PM PAGE 1 OF 1 Alt. Parcel 14.30.20.822 032 - 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 % WM S NETTEKOVEN O - NETTEKOVEN, WM F & ARLENE WM F & ARLENE NETTEKOVEN 7815 LAKE ELMO AVE N STILLWATER MN 55082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 1502 TWIN SPRINGS RD SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2566-TWIN SPRINGS LOT 26 TWIN SPRINGS ADD TOWN SOMERSET Block/Condo Bldg: LOT 26 INCLUDES P823 & 824A Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 458/151 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 50,000 198,900 248,900 NO Totals for 2007: General Property 0.000 50,000 198,900 248,900 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 50,000 198,900 248,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-2085-80-000 04/30/2007 04:27 PM PAGE 1 OF 1 Alt. Parcel 14.30.20.850 032 - 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 % WM S NETTEKOVEN O - NETTEKOVEN, WM F & ARLENE WM F & ARLENE NETTEKOVEN 7815 LAKE ELMO AVE N STILLWATER MN 55082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2566-TWIN SPRINGS LOT 54 TWIN SPRINGS ADD TOWN SOMERSET Block/Condo Bldg: LOT 54 ASM'T INC 032-2085-90 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 11,600 11,300 22,900 NO Totals for 2007: General Property 0.000 11,600 11,300 22,900 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 11,600 11,300 22,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch 210 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00