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Parcel 032-1042-95-000 04/20/2006 03:09 PM
PAGE 1 OF 1
Alt. Parcel 15.31.19.213B 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 - KURILLA, MICHAEL J
MICHAEL J KURILLA
2195 CTY RD I
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2195 CTY RD I
SC 4165 SCH D OF OSCEOLA
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE
SEC 15 T31 N R1 9W 10A IN NW NW LOT 1 CSM Block/Condo Bldg:
VOL 2/430
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
15-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill 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 78,400 126,400 NO
AGRICULTURAL G4 7.000 900 0 900 NO
Totals for 2006:
General Property 10.000 48,900 78,400 127,300
Woodland 0.000 0 0
Totals for 2005:
General Property 10.000 48,900 78,400 127,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 127
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquen'
Total 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER~~ TOWNSHIP I SEC. T ( N, R W
P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t
SEPTIC TANK(S)MFGR.1'_ i ; j 1CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
TRENCHES NO. of width length area
BED no. of lines width-LL length L-i area `
depth to top of pipe
AGGREGATE
PERK RATE AREA REQUIRED AREA AS BUILT
Disciaimer: The inspection of this system by St. Croix County does not imply complete
compliance with State Administrative Codes. There are other areas that it is not possible
to inspect at this point of construction. St. Croix County assumes no liability for
system operation. However, if failure is noted the County will make every effort to
determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR
DATED PLUMBER ON JOB - -
LICENSE NUMBER
i
i
1
l • FPOrT OF ITTSPECTIO'l--IIDIVIDUAL SETNAGE DISPOSE~, SYSTEM
R
• Sanitary Permit
>S
State Septic
TOWNSHIP
W. IE t. Croi.- County -
S^DTIC TA'?K
Gize gallons. "umber of. Compartments
!Jell - ft. 12/0 or greater slope," ii.
Distance From: f:
Building ft. wetlands
l;.ig}iwater ft.
Tile Field or Seepage Pit(s)
1 L!e
DISPOSAL SYSTE- I
ft. 12% or greater slope. _-f~
Distance From: j.+ell
. f:
ft. Wetlands
auiluing
ft.
r- TtiFhwater
FIELD
ft. :lumber o` lines Length of
Total length of lines
--.ft. Width of the
each line ft. Distance between lines
sq, ft. Dertt:
trench ft. Total absorption area
in. Cover
of rock below tile in. Depth of rock over the
. i;l• Slope of
over rock Depth of the below grade
trench in Der 100 ft. Depth to Bedrock _-ft. Depth to
n
around water ft.
PITS
"lumber of pits Outside dianeter _ft. Depth below inlet
ft. Gravel around pit: ___yes no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
Oquare feet of seepage nit area required
Title:
inspected by: 197
Date
Approved 197
Rejected Date
c
1H 15
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
` t REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: /j 4~ 1/4, L-'!"/4, Section 1~{, _13 N, R 14}(or) W, Township or Municipality
Lot No. , Block No. Subdivision Name _ County r Clnc~r~-
Owner's Name: 41 ! b r\ -
Mailing Address: ^Inn
TYPE OF OCCUPANCY: Residence No. of Bedrooms 13 Other -
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT -
DATES OBSERVATIONS MADE: SOIL BORINGS- 2 PERCOLATION TESTS 7 7
SOIL MAP SHEET SOI I_ TYPECL` -
PERCOLATION TESTS _
TEST DEPTH OF SOIL HOURS WATER iN TEST TIME DROP ;N WATER LEVEL, INCHESI RATS
CHARACTER
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN IV
3ER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
r
79 NO 41
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)
> 0-4
t., 771. 6-Y 4. x
..AN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Jicate on the plan the location and square feet of suitable areas. Indicate number of square feet of t k~scrr; is 'r.
seeded for building type and occupancy. s- Indicate scait:
or distances. Give horizontal and vertical reference oints. Ind' to slope. Y d r
i
I
t IN
c
fi
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 an elief.
-r>~
Name (print) 4,5wq, .Certification No.
Address
Name of installer if known
CST Signature
COPY A - LOCAL ACTHOi?iTY_
PLB67 State and County State Permit # 01; ~N
Permit Application County Permi #
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:
K iA ~ y L S,
B. LOCATION: Section 15, T3 N, R L7.* (or) 'W Lot# City _
Subdivision Name, nearest road, lake or landmark Blk# Village _
r4\ 0. ti1111-k Township CYAC- Y`Se~-T-
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) Variance-
Single family Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YESC NO # of Bathrooms- .
Automatic Washer X YES NO Other (specify)
1EPTIC TANK CAPACITY /0-CrO Total gallons No. of tanks _
Holding tank capacity - Total gallons No. of tan s
New Installation Addition Replacement Prefab Concrete
Poured in Place Steel Other (specify) -
_FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) y 2)~_3) -Total Absorb Area sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
`seepage Bed: Lengths,2Z__Width J a Depth _!!~OTile Depth-_~___No.. of Lines 2-
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land Distance from critical slope
1, 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 CMU d Soil Tes
NAME L 'n ~19 YES C.S.T. # and other information
obtained from (owner/builder). t Sly
-
Plumber's Signature _ P/MPRSW# Phone #41Y41
Plumber's Address -
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well). O
l
1 ~
~ Z M
f 'C a/ y
~l
Do Not Write in Space Below FOR DEPARTMENT USE ONLY
0
Date of Application Fees Paid: State County, Dat -21
Permit Issue4~8c}os*e date) S' a -Issuing Agent Name
inspection YeseNo Valid# Date Recd
county (w i e copy) 3, owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
ate (pink copy) 4 _