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AS BUILT SANITARY SYSTEM REPORT
TOWNSHIP •rs SEC. T= N, R_w
. ADDRESS. ST. CROIX COUNTY, WISCONSIN.
'2
;DIVISION i LOT LOT SIZE Cr~ I/ 2 ~f~
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
TIC TANK(S)` MFGR. CONCRETE X STEEL
NO. of rings on cover Depth DRY WELL
'.NCHES NO. of width length area
no. of lines width ' length area .
depth to top of pipe
_REGATE
.a RATE AREA REQUIRED AREA AS BUILT,..%
claimer: The inspection of this system by St. Croix County does not imply complete /
;)liance with State Administrative Codes. There are other areas that it is not possible j
inspect at this point of construction. St. Croix County assumes no liability for
tem operation. However, if failure is noted the County will make every effort to
.ermine cause of failure.
ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSP
DATED j 7 PLU11BER ON JOB
LICENSE NUMBER
REPO 1%T OF INSPECTION--I71DIJIDUAL SE07AGE DISPOSAI, SYSTEii
Sanitary Permit /~S=
r State Septic
7A1 1E TOWNSHIP
tt~: Croix County
- -T-L s4-f✓1_~1 x.1.4 L.
Sr.PTIC TA' 711
size gallons. `lumber of Compartments ,
Distance From: Well ~rQ+ ft. 12% or greater slope ft.
Building ft. Wetlands f
Highwater ft.
DISPOSAL SYSTL:1 Tile Field or Seepage Pit(s)
Distance From: Well
ft. l2% or greater slope ft
`Z
7 Building; ft.
We t-l ands f
1
FIELD Nighwater ft,
-I .
Total le i of lines . ft. Number o£ lines Length of
each line -7 ~ft. Distance between lines fi ft. Width of the
trench __£t. Total absorption area sq. ft. De th
p
of rock below the 1-2,_in Dp-pth of rock over tile r- in. Cover
nver.Tock,, Depth of tile below grade in. Slope of
trench in ner 100 £t. Depth to Bedrock `r- ft. Depth to
Around water ft.
PITS '
.lumber of pits s'd darseter ft. Depth below inlet
ft. Gravel a-rou t: dyes no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
Oquars feet of seep e it rea required .
Inspected h Title:.
Approved Date 2,,0 1978.
Rejected Date 197
N .
it •
EH 115 (11-74)
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: '/4, '/4, Section T_N, R _ E (or) W, Township or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
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
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-
P-
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)
B-
B-
B-
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable.areas. Indicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give reference point. Indicate slope.
tN
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) Signature
Certification No.
Name of installer if known
Copy C - Local Authority
3
State and County State Permit #
PLB67. Permit Application County Per t# .S-
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. LOCA ION: Y4 Y4, Section 30 N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Com rcial *Ind stria) *Other (specify) *Variance
Single family Duplex No. of Bedrooms __3 No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms
Automatic Washer OYES NO Other (specify)
E. SEPTIC TANK CAPACITY /,6VM Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition _ Replacement _ Prefab Concrete ____Z~
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1 2) 3) _5~Total Absorb Area
A sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. ,gf Trenches _
Seepage Bed: Length Width Ik Depth Tile Depth p ~ No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land Distance from critical slope
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
>n cR .e r C.S.T. # %~t.0 and other information
obtained from (owner/builder).
Plumber's Signature M /MP,.RSW#~ Phone
Plumber's Address
PLAN VIEW: Provide sketch below of system (i clude direction of slope and all distances in accord with
H62.20, including well). '
r
I
f
l
c circa _ i
Do Not Write in Space B ow F DEPARTMENT USE ONLY c, J/
Date of Application Fees Paid: ate Oe 0 0 unt 0-0 Date / j
Permit Issued/Rcjaote0l- ( (ate) ssuing Agent Name
Inspection Yes No Valid# Date Recd
1. county (whit 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 6/1/76
Parcel 032-2071-70-000 04/11/2006 10:53 AM
PAGE 1 OF 1
Alt. Parcel 13.30.20.777C 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
DAVID J & HOLLY A HATCH O - HATCH, DAVID J & HOLLY A
1543 23RD ST
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1543 23RD ST
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.050 Plat: N/A-NOT AVAILABLE
SEC 13 T30N R20W 3.05A IN NE SW LOT 2 Block/Condo Bldg:
CSM VOL 1/285
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1170/136 WD
07/23/1997 814/571
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.050 48,200 132,900 181,100 NO
Totals for 2006:
General Property 3.050 48,200 132,900 181,100
Woodland 0.000 0 0
Totals for 2005:
General Property 3.050 48,200 132,900 181,100
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