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Parcel 032-1038-30-000 04/11/2006 03:43 PM
PAGE 1 OF 1
Alt. Parcel 14.31.19.194A 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 - RIVARD, ROGER A & PATRICIA
ROGER A & PATRICIA RIVARD
661 215TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 661 215TH AVE
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.360 Plat: N/A-NOT AVAILABLE
SEC 14 T31 N R1 9W 3.36A IN SW NE LOT 19 Block/Condo Bldg:
CSM VOL 1/115
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 685/118
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 3.360 49,800 115,500 165,300 NO
Totals for 2006:
General Property 3.360 49,800 115,500 165,300
Woodland 0.000 0 0
Totals for 2005:
General Property 3.360 49,800 115,500 165,300
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 +
:DER , TOWNSHIP SEC. T -N, R b7 ,
0. ADDRESS , ST. CROIX COUNTY, WISCONSIN.
'3DIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
• : . I ti. J
TIC TANK(S) MFGR. CONCRETE 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
.;?LEGATE
a RATE AREA REQUIRED AREA AS BUILT r~'.
-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
inspect at this point of construction. St. Croix County assumes no liability f,cr
tem operation. However, if failure is noted the County will make every effor;~co
.ermine cause of failure.
ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR
DATED PLUMLBER ON JOB
LICENSE NUMBER
z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
SanitvLy Penmtit-_'4~-C/'
State Septic'
~ St. Ctcoix County
NAME 1.,C, ~Township
L:22~
Location.vb Sectivn~Ti/ N,UI
SEPTIC TANK
Size gatton4. Number of Compattment4
D,it6tance Ftcvm: Wett 12% on gtceatetc tstope it
Bu.itd.ing it. Wetfandts it.
H.ighwatetc
DISPOSAL SYSTEM
D.i4tance Ftcom: Wety- d.1 12% otL gtceatvt 6tope it.
Bu.itd.ing ✓f it. wet ands Ft.
Highwaten it.
FIELD DIMENSIONS:
Width of ttcench it. Depth of tcock below t.ite .in.
Length o6 each tine it. Depth o6 rock oven tite n.
Numbetc o6 tine,5 Depth o6 tite betow gtcade in.
Totat tength of tinez it. Stope o4 ttcench in pen 100 it.
Distance between tines it. Depth to bedtcock it.
Total ablsonbt.ion atcea/ jt2 Depth to gtcoundwaten it.
2
,R'e,quitt.ed area it
PIT 'DIMENSIONS:
} Numbetc ob p.it6 Gtcavet around pits _yes no
Out,S.ide diamete r it. Depth below inlet it.
2
Az
Totat ab/sotcbti'in''atcea it
3Z
A&ea tcekftin d it2 r"
INSPECTED By TITLE
APPROVED a° Y ,DATE_197_j
' r
REJECTED `Y DATE 197.
J
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: C`'''/aJV i ~-'/a, Section -ZX, T-A, R 41W(or) W, Township or Municipality
Lot No. Block No. County
Suf~ 'vision Name
Owner's Name: a G `tt-•/1 ( j-'t"1
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
._:OIL MAP SHEET ..OIL TYPE r
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE
CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL
i'JUM- INCHES THICKNESS IN INCHES MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-3 X30 / ~C•
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)
I
> JAC G)
-7 c - O
y ~ ~ S S-t V S L
3- 3L Sc- f L
YC'
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
?rndicate on the plan the location and square feet of uitable reas. Indicate nur, }er ~)f sup f. ;t-et cf abso pl :c n red
needed for building type and occupancy. a ~ Indicate sca5e
or distances. Give horizontal and vertical reference oints. Indi to slop-
s I
.4
_ I
I
/ ,p I N
I
I, the undersigned, hereby certify that the soil tests reported on this form were made by me i, ord 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 knpwledge and hye
Name (print) Certification No. S S J
..rsY Cam:
Address J'e-
Name of installer if known
CST Sionature
COPY A - LOCAL AUT -tO iTY
State and County State Permit
{t~#
PLB67 Permit Application County Perm
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:
n) C-
B. LOCATION: Section' / T3_1 N, R1_r- E (or) Lot# City _
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPA Y: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLI~S: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms--
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY 16" Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition- Replacement- Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFL ENT DISPOSAL SYSTEM: Percolation Rate 1) tZZ-C,. 2) E 3) Total Absorb Area_ Z sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
No. of Lines 2_
Seepage Bed: Length j y /Width j 2-/ Depth 4/L.."" Tile Depth - e-1
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 y=-1-/- L ~d~'~~yC3 C.S.T. # ~~~S 5 31 and other information
obtained from wn9r/builder).
Plumber's Signature MP pRSW# Phone me-4 AW
Plumber's Address c /s' '
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well). i/
f
G~ *N1 _
4ti
fl~ -1 , e-
Do Not Write in Space Below OR DEPARTMENT USE ONLY `
Date of Application e, Fees P 'd: State'} C o y G~ Date - /J
Permit Issued7te (date) r Issuing Agent Nam ~F .C 6
Inspection Yeo Valid# Date Recd
1. county (w y) 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