Loading...
HomeMy WebLinkAbout016-1061-20-000 d o C7 ~ d o f c a o 3 -0 0 v o c 3 -i z (D 4, 0" O D.1 3 N ~ N = w L ICI (D 3 (p O l o a z 0 y m m o O ` 1 A O l C C) 0 c !D N O W O co :E cn 3 3 m 00 zi o 'a cn CA cn d c n_ CD O N C G D N W G Q 3 a c V o o 3 p 0 ? w O s -41 o w F--' o co co g o r to m t~ N w m o to o c v w w ~ (D F'd .d. (D o C7 z O O O r a CJ ° (n v * * E 3 o r• rt n v D v o o~ (ODD N Fl- C7 0' O m w ° (n ~Q W `C :3 a 'D w v " D N (D (D (D 1 - o ON m Z oo v N 3 °1 Q rD oo Q :3 N H Z H O Z Z W Z O CD 0 0 p D a 9 a m cn m N• N Ci f = CD t o I H H c (D C CJ - O W C-J w m a W z 0- Z CD n Z f 0 1 Z 1 t~7 W O ~ - a n A +n In co G7 (D o 00 F- ' 00 m C o fD rt A c9 G7 £ a o p p p * Z m a N N m r N rt Dpi o o y p a C 0 0 0 0 (D Q G N O d Q S -n j Q - 0) 0 N 7 N m - C, a d C CD O N cn y N 3 N I a ~ v c: I a, CL o a ? a s Q o x =r 3 Pam CD W N 3 (DD o m a (CD < ❑ N N. 1 O N 3 CD c o (D O 0' ? H I m_ a o Op (D 0 O *L i S a O Cl r y Parcel 016-1061-20-000 11/18/2005 05:31 PM PAGE 1 OF 1 Alt. Parcel 29.30.15.426B 016 - TOWN OF GLENWOOD 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 - SCHULZ, ROBERT A ROBERT A SCHULZ 2885 CTY RD G GLENWOOD CITY WI 54013-4225 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2885 CTY RD G SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 15.000 Plat: N/A-NOT AVAILABLE SEC 29 T30N R1 5W N 60 RDS OF W 1/2 NE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 08/25/1999 609221 1451/458 QC 07/23/1997 1111/223 QC 07/23/1997 919/491 07/23/1997 756/305 Bill Fair Market Value: Assessed with: 2005 SUMMARY Use Value Assessment Valuations: Last Changed: 06/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,000 60,500 72,500 NO AGRICULTURAL G4 4.000 700 0 700 NO UNDEVELOPED G5 9.000 6,800 0 6,800 NO Totals for 2005: General Property 15.000 19,500 60,500 80,000 Woodland 0.000 0 0 Totals for 2004: General Property 15.000 19,500 60,500 80,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ' AS lily I L'I' SAN ITAI:Y SYST1 1'M REPORT OWNI?h am ;CrL Q-'.---- TOWNMIAP l! lyG~-"EC7!!~ SEC. CN-1~1~<'W r ADI)I.I,.`~ti CKULX COUNTY, WiSCONSiN. >LIl3Ul.V !_S LON LO'l LOT SIZE 1'L.AN VIEW I)~ stances ;IIId (I i IioIIs Cu 11w I- e. quiretit ents of H63 SIIOW f?VIsRYTII I-NC WITHIN 100 FEET OF SYSTEM i- I /c' L e. i 00, w P1 JT N Indicat - N r h rrcw IS1,:NCII.MARK: (Perin i -inert r eference Point) Describe MAYk Slope at site: I,:levation of vertical :reference point: SEP'T'IC TANK: Manufacturer: -Jfs~> i IS Liqu=id Capacity :-ZC l _ Number of ri.ngs on cover Tank manhole cover elevation:- - `l'ank I u 1 ct I! I_eV<i I_ i (>II : `l'ank Outlet Elevation: PUMP CHAMBIP. Mant.r f:ac t rtrer : Number of gallons___ Number of gal. pump Set for a cycle -gallons; Total capacity of (list ri-but-i.on lilies gallon: size of pump head; t,al l_oII per n,-i_ntrte horsepower----_____-___;brand name o pump aIII c.l 1110Cl01 number 't'ype of warning de- v'ic- e H OLDING 'T'ANK: Manufacturer Number of gallons Elevati -on of manhole cover 'T'ype oI~ warring device ;I:l?I'ACE P['1' I_'l.l - Number of pits--------- feet diameter _ feet liquid dept-t1 seepage pit inlet pipe-elevation bottom of seepage pit elevation _ feet Sl?1.PACE Mi'D SLGE: nunabe~r of 1-Ines : width to length J the depth -~_r-_- 1,`I? P A C, E' C R l, N CH : length__ 'I;RCOLA`T AT I_u!v R~~. I'I'. ARL.A RI?QU LRED_ AS T [NSPECT0 -IJ Un'I T?D PLUMBT,,< ON JOB 0"~ LICI~NSP: NUMBER DEPARTMErvT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LAI~JR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 C-NCONVENTIONAL ❑ALTERNATIVE statePlanl.D.Number (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER. INSPECTION DATE. Eldred Moe RR#I, Glenwood City, WI G/, BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT. ELEV.. NE NE, Section 29, T30N-R15W, Town of Glenwood Name of Plumber JMPIMPRSW No. IC11,11V. Sanitary Perini[ Number. Gale Smith 5690 St. Croix 43688 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIOUID CAPACITY. TANK INLET ELEV. . TANK UTLET ELE V.. WARNING LABEL LOCKING COVER _ PROVIDED: PROVIDED. L. 7 DYES ENO DYES ENO BEDDING. VENT DIAVENT MATE HIGH WA Eck - NUMBER OF ROAD PROPERTY WELL. BUILDING. VENT TO FRESH ALARM FEET FROM LI AIn INLET: DYES ENO ❑YES"LJNb NEAREST j > f UJ DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. EYES ENO DYES ENO DYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PH OPERTV WELL BUILDING (VENT TO FR ESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing e GTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH 11_E7TH NO. OF DISTR. PIPE SPACING COVER j JINSIDE DIA. =PITS LIQUID BED/TRENCH TRENCHES ' , - M'AX ERIt1 ' l~ PIT DEPTH DIMENSIONS j L' S r GRAVEL DEPTH F ILL DEPTH IDIST PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DIS R. NUMBER OF PROPERTY WELL. "BUI LDIN VENT TO FRESH T BFLOW PIPES ABOVE COVER ELEV. INLET ELEV. END PIPE LI E_ I 1 r} 4 J i AIR INLET FEET FROM 0 C~•~(~I.) L 1 NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ENO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS YES ENO DYES ENO DEPTH OVER TRENCH BED IDEPTH OVER THENCHiBED DEPTH OF TOPSOIL, SODDED SEEDED JMULCHED CENTER EDGES. DYES ENO YES ENO DYES ENO D PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BL,COW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMAN'IFJOLD MATERIAL. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. EEV.. PIPES. DIA.'. ELEVATION AND . ' DISTRIBUTION I/ I INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. DYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINE OYES ENO ❑4ES ENO NEAREST Sketch System on Retain in unty file for audit. Reverse Side. SIGNA TITLE. DILHR SBD 6710 (R. 01/82) ~..Q~ f 1 .,7 yl pf1 ° PLB 6 State and County State Permit # - w Permit Application County Pt # for Private Domestic Sewage Systems County Y!~ *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required _ State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: '4FLa1 g ed /Woe A' Rf / 6L eey woo d c i ;v 4"i; B. LOCATION: Nj /r4a Section 2~, T~?a N, R 43-t (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Co A&I (5 Township lr CN wood C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms 2 No. of Persons D. SEPTIC TANK CAPACITY I&O-&V Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete-_ Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate- 9 Total Absorb Area X0 sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: _X_Length /-Width /0 Depth IS Tile depth (top)-,;2 XNo. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- 8 ~D Distance from critical slope- 30 WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: 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 G s},, e SM//`// C.S.T. # / ] 6Q' and other information obtained from ~L d (owner/builder). Plumber's Signature .64!f~ 42 MP/MPRSW# 1410-5 '!~90 Phone #-ZZL6- Plumber's Address-- 1 GL Cpl/ Lsro 0 d C /f' L, i PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. , , i ~ s ~ a. w. m , , . E i F s , k E 3 ~ i i ~ i , i a € i , . Do Not Write in Space Below FOR COUNTY AND ST~TE RTMENT USE ONLY Date of Applicat on Fees Paid: State ✓ County Date Permit Issued/Reje ed (date) Issuing nt % Inspection Yes No - - "State Valid# ate ec'd 1. county (white 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 7/1/78 Form - 5 1' C 100 Owner of Property .Location of Property _~4 ~J'X-'Section 'per N R/ W Township-__ ~E/- z`!Y 4,,,Ii-1-cl Mailing Address > r- Subdivision Name Lot Number Previous Owner of Property ~jTotal Size of Parcel ~~41 Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 341 E J--Z ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. 4I/(NATURE OF OWNER SIGNATURE OF COOWNER (1F APPLI OLE)` DATE SIGNED DATE SIGNED IN DUS i yE, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUSTRY, DIVISION LABORAN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 LOCATION: SECTION: TOWNSHIP/SPY; LOT NO.: BLK. NO.: SUBDIVISION NAME: a /T o N/R,(s-fbo W GL a ~r w o Q A ,4 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: cRa i x FLd a q7`/ GL c N woe o/ C % / o/ USE DATES OBS RVATIONS MADE N0. BEDRMS.: ICOMMERCIAL DESCRIPTION: I PROFILE TONS: PERCOLATION TESTS: ,Residence ®New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ISYSTEM-1 N-FI LLIHOLDI NG TANK: RECOMMENDED SYSTEM: (optional) ©S ❑U ©S ❑U ©S DU ❑S XDU DS ❑U_ CaN vetiiyNaL If Percolation Tests are NOT required DESIGN RATE: SYSTEM ELEV. I If any portion of the lot is in the under s.H63.09(5) (b), indicate: 9 7 I` Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) _3, /7 If B 8 O ♦2 N /Wed S ,40 N CS 80 SC 11 -l <l ♦ 1 B- 3 a' ♦3 a - 7♦ 4 n ` n II n N ~41 • , / / l/ B- ` 6♦ ae~~ O ~ -57 2, ♦ B -7 J., Ai S- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- / 0 D / L / LP / P P- 2 ♦D P- / 0 P- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION L cgsi/vaq ~eNcN /a0 e V, X 3 0' 31 h oAf -ve j 1 ' y9 x 8 7 I ~l9oSLeFeey 5 309 I, the undersigned, hereby certify that the soil tests reported on this form were made by mein accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: G I/ e. s7 o - (r.3 ADDRESS:y~- CERTIFICATION NUMBER: PHONE NUMBER optional): / ~rL e GtJ o " d 122 /7 8 CST SIGNATURRE:/ DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) Smith Plumbing PHONE (715) 265-4838 fl- d R& d M p e R t/ G./- e /v 14, o v d C/*l"y GLENWOOD CITY, WISCONSIN 54013 7-.~v R is' /YO y N y sec .2,7 N~ IVeLL rop ao CASiivjo o em /'pa ~-/o NSe io, S 6 ~ ~ooo GftL Se~t~c t~l ~iK y . lot N, O . y,-Yet f Bo 7` fe m o ,t' Qe d PeAl DM:Cte tH )d AAPG R e B e • o G e °o • e D a o° Ophot m ~ `J RoGK ° o ~,i m ° O ° v o l a. /vt ~ .s6 90