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HomeMy WebLinkAbout032-1039-70-000 n cn O 3 -0 0 r~ ..y c " o C7 C+1 _ _ C 3 A (D v n c CDi n - ~ O n o N w o rn o? ow `C • rn m o 3 CD n> a o 0 a ~ N N O ~ O ry (D W Co N 'D w n (D = Co -4 A N O N ~ ;p (Z' C m m(D n o ° D o A~ O a o N r+ N O• l~ 3 _ N O O m z D a 3 n O N a N D W 3 n ~ c°~n ° ~ c o O 0 N) m z O 4~ O y 0 C 3 CD ~ -p N-+ ~ 'U ~ (NOD ~ .~i N • 0 V O -N N N (n N O' 0 0 (D VI N 'a (.n CD L> CD M (n CD :3 3 N A ~ N z Ln zwz O D m o 0- :3 v O N (CD d N c CD <D w m a n 3 ~ z CD -1 (n O p A Z n N c ~ .'a n A z 0 R o G) 3 a. W m 1 a m CD z 0 3 a z 3 z (D A W F N CD CD_ V (D ❑l Cn -0 cn (D an T O (D N C 3 ~0 - 0 Cl) o 00 U1 N may., 7, X (D 7 7 F N 2 r-I Om a 0 O < o vD_ ti o 0 A 0 v O D 0 Oho O di O O CD (D Wisconsin Dop^rtnont of Health end S oial Services Plb. r'J67 370 Division or Health SEPTIC TAN'n PERMIT APPLICATION TYPE or USE BLACK IN`. A. f".'NER_ OF _ PROPERTY Name Address (Street, City, Zip Cody) B. LOCATION OF PROPERTY W_fry.RS SYS T 21 WILL BE CONSTRUCTED, ALTERED OR EXTENDED COUN:Y -I Check Ono; CITY VILLAGE LEGAL DESCRIPTION TOWNS W C. IS LOCAL PERPiIT REQUIRED FOR THIS WORK? _ YES r.._.. NO PERMIT NUMBER D. SEPTIC TANK CAPACITYGallons NEW INSTALLATION REPLACEMENT ADDITION A:ATERIALS: Prefab Concrete I poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence % Commercial Industrial other (Specify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO Disksvasher YEs NO Automatic Potato Peeler YES % NO Other (Specify) G. MASTER PLUPBER RAKING INSTALLATION Name: Addressa License Number: Signature of Applicant: !SP RSW Addressa H• (To be Completed by Issuing Agent) Date of Application Fee Paid Permit Issued (date) Permit Number Agent (Name) / ' i / i, For' n Torn, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the a`_.ve questions are answered and the fee paid. Agents will forward application, the fee of $1.OU for each septic tarot and the t!sird copy of the permit (canary) to the Division of Health. Checks and ruoney orders should be made payable to the Division of Hes.lth. Do not :4rite in space below - FOR DEPARTMENT USE ONLY 1. DATE RECEIVED ~.l ACCEPTED BY r - RETURNED (Initials) (Date) See Corres.) i FEE RECEIVED - VALID. No. PMv1IT NO. (Y©s ewer No - REVIEWED BY APPROVED DATE (Initials) Yes or NoT C O.V LEi'.. OTHER{SID E r SEPTIC TAN: PMMIi NO. R E P O R T O N S O I L P E R C O L A T I O N T E S T A N D S O I L B 0 R I 11 G S TO r^9"' DIYISICI OF HEALTH - PLL'I'1r 1':K; SFCTIt'i e P.O.Box J09, hadison, Wis. 5:3701 r11r9Y 11x9 i Purournt to N 62.20, Wis. Ae:!inistrativs Code ''71SICE .1 L" ` 6 P E R C O L A T I O N T T S T EA_ Test Depth Charaotor of Soil Hours Water Test ;'Lao Dro in :1ter -Level Inches Minutes Number Inohos Thio mesa in Irohos Since Hole in 11010 Interval Second to Next to Last To Fall 1st Wetted clorni5'ht in MLiutes Lest Period I.='-st Period Period Ono, Inch Example P - 0 ";611 loo Still 10i1 ClViy 26;' 25 / Yon or No 30 1 2 __112 1/2 60 RECORD DATA FROM MINr,0M OF 3 TEST HOL,F,S Compute size of absorption aria in accord with H 62.20 Wis. Administrativ0 Code. f I S O I L B O R I N G S- MinL~ 3611-Bel". roosed Abso Lion S 19t" Boring Total Depth De th to Grour_d State. Do th to Bedroc% Number Inchon Cbservod F.otimatod C-served Estir._stod Ch,%ractor of Soil with Thickness in Inches Example B - 0 7211 7211 Black To Soil 12t1 Clay 161' Sand 18111 Gravel 2411 r RECORD DATA FROM MINIMUM OF 3 BOIty, HOLTS YPE OF OCCUPANCY: RESIDENCES N=ber of Bedroom,, OTHER: (Specify) Number of Persons u FOOD WASTE GRINDER: Yes No Distzrashers Yes No Automatic Clothes Washers Yes No EFFLUENT DISPOSAL SYSTEM: NEW i EXTENSION ADDITION REPLAC""Sr. ENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size --L No. Lines Seepage Pits Inside Di=ater Liquid Depth Is the undersigned, hereby certify that the percolation tests raported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (13). Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my krowledge and belief. NAME TITLE Type or Print REGISTRATION NO. or MASTER PLJ:~-JER LICDIS. NO. ADDRESS DATE SIGNATURE J Parcel 032-1039-70-000 09/21/2006 11:43 AM PAGE 1 OF 1 Alt. Parcel 14.31.19.196A 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 - WIEDERIN, RONALD & DONNA TR RONALD & DONNA TR WIEDERIN 645 220TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 645 220TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 36.000 Plat: N/A-NOT AVAILABLE SEC 14 T31N R19W NE NW (EZ-U-1141/486) Block/Condo Bldg: EXC CSM 13/3578 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-31N-19W Notes: Parcel History: Date Doc # Vol/Page Type 04/19/2005 792658 2786/413 WD 07/23/1997 454/588 2006 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 95,500 143,500 NO AGRICULTURAL G4 29.000 1,700 0 1,700 NO AGRICULTURAL FOREST G5M 4.000 8,000 0 8,000 NO Totals for 2006: General Property 36.000 57,700 95,500 153,200 Woodland 0.000 0 0 Totals for 2005: General Property 36.000 57,700 95,500 153,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PART NORTH SOMERSET T•31N-R.19W 51 PA Ll OV`e La d Cod .o CM tee h ie s e ay Ge° 9 f s 4 e'Qi hicir.H ~/or~ Ga./ 7z fir ~svtn do f~¢ e t ~4k . ~frn '99'S Qe Lin 0z, cS.~anson ~ p a .41~ ~ i?z sB-re 7o Oc s8 ~7B l ~ y ~i,~58 r'~au,-rce a.r r. ~ d - 7~ fo ary ~z d Cr ~ Ma//h rzo• uses fis Scu f n.o • r eP av S x Ed a d 0 \ /6479 6 f~ E n ben ~ ~ ~o ~o ~ G•~ nt° e c~aiR., V a t' V W sMnt4 /so Vo sha on 4o n ~ /6O Naro/d e 17- ~ j- v ~ Per rs7 s a' 26~ cscncrs Cochror~e _ chachtrie~ vLORc • 97 l C C Tam s Fern a 11 w p o me x.. ® df E raA/L /o. 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Law.so a e` Oer Oeat BOra a C0~~5a y r/rss fs~z, , Mas az a ~4w~ aka ~ \o v ~ l o~ rao Q ~e%~s/e ~V U'~ tTahn ~ F.r~.te / sssnLC e l"r.. f` ~ON- 1 W p p ac/r// r rrs 0~ v) cTame G7 4 / f 'c O ti ve . s a.,.e/ 0 C ya 9° J vN sr-~a,.~ - KQ n ~Ho/comb t Op r~8 C\ T CTS D \ I 4°e¢ 00 /NE R• R• P°°~ 9 b L 454 r9Io9.Qockford.MGx~Pub/s, Ino,/Qev/.979 SEE PAGE 53 StCroae~~rr ws.~' KASTENS BANK OF LONDRY SALES & SERVICE SOMERSET LANDSCAPING New Richmond, Wisconsin Save With Us - Help Barn & Feedlot Build Your Community Black Dirt - Crushed Gravel - Driveways Equipment MEMBER FDIC Landscaping - Fill - Blacktopping Patz-Merrill Phone: 247-3348 247-3480 or 247-3791- Rochester Silos Somerset, Wisconsin SOMERSET Phone: 246-5181