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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 - HOOSER, LOUIS J JR & BEVERLY L LOUIS J JR & BEVERLY L HOOSER 2992 175TH AVE GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 2992 175TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 4 T30N R15W GOV LOT 7 40ACRES Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 04-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 518/412 QC 07/23/1997 437/475 2006 SUMMARY Bill Fair Market Value: Assessed with: 165094 Use Value Assessment Valuations: Last Changed: 07/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,000 187,800 199,800 NO AGRICULTURAL G4 38.000 4,000 0 4,000 NO Totals for 2006: General Property 40.000 16,000 187,800 203,800 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 16,500 187,800 204,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 130 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 d 3~ 3. co~ C.) r ~ Q cn~ -0 z vz -0 z Azm z mho . 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N > CD CD CD < m o 7C d (n N CD N W m S Q C- 0 CD O 'I 3 CT `G FT Z C 7 3 7 D CD a) N S N fD fD Q f l a O O CS m p O CD ' cn co 0 m a Z1 S O~ p a I ca N RL ~ CD 0.a = ° ° 3• ~aN m a n wl< CD c 5- CD CD N O O CD N '2J . m m$ of a c-o 3 o v, o~ a°~ 3 D ACD m' m m a3 N CD a o m m CD U) m cn e 0 3 j m o f m o.CD 0 =r am ~m n p O p O A 7 O Q a~ a C m j CD (D CD to O CD CD CO Q1 m c ? A CD 'o -0 CD m m~ m a~ a ~3 v N u0i N co N (c CCD CD a a ::t Co •QS~ :LC :a :Up (q am N 7 W CD V °=)N CD 0 CD N 3aCDC) CD CD 'CL m o (p~a~ o a~ S lip a N ~ v b o D oa m a 0 0 0 0 0 a A a 0 0 0 0 C. a AR BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ADDRESS R) 1 ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of. H63 4,j_.E_VFRYTHING WITHIN 100 FEET OF SYSTEM L _ a I S iv - 71 iI S It- Y Ivy I di a e o th Arrow L E: BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: j Liquid Capacity: %i- Number of rings on cover : )y,., k,.= Tan manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: )'/t7/ PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower ran name of pump and model number' Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits feet diameter feet liquid dept seepage pit in et pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines wi th length tile depth SEEPAGE TRENCH: width length re - .PERCOLATION RATE y &R-EA--- REQUIRED 74_ RE UILT IN~PE~fiOR DATED PLUMBER ON J B LICENSE NUMBER r `Il s U PORT OF INS PI CT ION - INDIVI DUAL StWAGL SVSItM d1h Statr, Svptic 6 v v1!1t ~oals__/V/-&- e-Town.6 h 4 ' p ~-St. C1tr,4 x Cuunlit 1 ;r (r ti S~/ /r _ S(.ct-('0YI- L0 SIII)dtvi/5 YI i'1 IC IANK +j gaf..Y.ons Number uA compantmentA I~rstance kom: went f BulUding-' ---_12 s A gape. H.Eghwaten PIMPING CHAMBER SA"ze__ gaE~avrb Pump Manu~ae.tune~i Mude.t Numbejt HOLDING TANK S~ t' ------goff(In's Number( o6 Compartments r,rtrf ct 1 AEanrn SgAtem D( tao,(arum: UIekI't3u.i Pdiv(g~--- 11 n_ Pope - H.i.ghwa.te4 ANSOKPTION SITE I1 d Trench Dr tit.rrrcc ~torrn Wete - - BU4,Zfit n.g 120 Akope. Itghwate4 ADSORPTION SITE DIMENSIONS Width o6 thench 6t R e (t ti,( ~t v d a n e. Ivngth oh e.ae.h tone_-~~~ ft Depth (16 ~(ock bveow t~.kv in Nurrtbv7 oA, einv.,s Depth oA itoch overt t.ifc in -f taf YeY(gth oh UneA-r ----__._At Depth ()6 t4. 4e bv.eow grade Dratan0e betwvevi Pdneb {t S,' o p v of t~Lv.yivh (n. pc 11 100 (t Iu taC (lb!, of l.pt-i,oYt a~te.a t type o f Cov(,h: I a )e t o)t A t raw 1' ( 1 1) 1 MI NS 10 NS Nnmbr h u j pi to Git av(~ P rlloak t~eA no oil to i Ic di arnc-test ~t vvp0l be(' 4-ylect (~1 Irlr(P abAoA1)t~on anva r" A,t c a ,t e rI a i( L e, d 6t INti1'1 CTCD`~$Y__ TITLE ' AI'I'RDVED DATE 19 RI II C I 1 0 DATE 19 6'L AS(~N I (?1. RI JI C II ON State and County State Permit # PLB 67 w u Permit Application County Perm # _ for Private Domestic Sewage Systems County ja& - ~l *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: '/'/4, Section) T.,N, RE (or) W~ Lot# City Subdivision Name, nearest road, lake or landmark Blk# 1441V 1,7f Village Township eTL t°/V 4zG+ad C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family- Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY k 47,0, Total gallons No. of tanks / HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete- X Poured-in-Place Steel Fiberglass Other (specify) New Installation ,X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New X Replacement Alternate (Specify) Seepage Trench:- A No. of Lineal Ft. 43-41 Width 'if © of Depth -.Z;LLTile depth (top) ~ No. of Trenches ~ Seepage Bed: Length Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter, Liquid Depth No. of Seepage Pits Percent slope of land 114- - l 1 - Distance from critical slope ,gia= ~ 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 A-L y / ~H C.S.T. # 17~~ and other information obtained from 0e s' c--7- (owner/builder). Plumber's Signature L J s,~X MP/MPRSW# -5-1efe Phone #1~ ~ Plumber's Address Rf 2- ew 4.?y r rr & 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 F ~ 3 i s ~ E t I 1 { . ,~.u«, ®.a ems.: e. me ~.e. ~ ee ~ m m _ € E E t fie. a.,n . ; _ _ _ . e,,.... _ a nP d a t ~ 3 ym. .-,..~..-gym =..o. u- e e_~ _ e ~ F f a p E ' ..e. .ate _ n -..F.. ~ S i Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application ;~4V Fees Paid: State C unty `Date / Permit Issued/RejBCtEd (date) L `1--?--:2-06 Issuing Agent Name ~ f Inspection YesA _No State Valid# Date Recd 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 l DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; c DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS LOCATION: SECTION: TOWNSHIP LOT NO.: BILK NO.: SUBDIVISION NAME: /4 a /T,74 N/R>, 19r) W,~ COUNTY: OW ER'S E: MAILING ADDRESS: USE DATES OBSER A ANS MPhE (9 NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE D T Of~S. A TESTS: Residence 3 New ❑Replace ~ ~r+ RATING: S= Site suitable for system U= Site unsuitable for system ~11J CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED TEM:(o tonal) ©S E:]u ZS E]u XS ❑u ❑ S ❑u E :]S ❑U If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL If any portion of the lot is in the under s.H63.09(5)(b), indicate: 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. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 4,44, 6~ B- Vic B- 3 le, AX B- A PERCOLATION TESTS G /S ` 4 TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P C G I / P- le, -74 k ~Z 0 P_ j 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 4 P> g; i+- t v lee ~4✓~ G~AIG H 1lltJ' . Me Na VN pq,~ . x . lee 7A 0 f 0e, w l Sty' -71Y.0 -51610 live K5 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in 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: i / el ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): CST SIGN TURF: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 IN. 03/81) Smith Plumbing PHONE (715) 265-4838 GLENWOOD CITY, WISCONSIN 54013