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HomeMy WebLinkAbout016-1021-20-050 o n cnp 3- c o o c H~ 3 Cn -I 2 u Z o rn o o o s ° c o o m m rn w ~.-i 3 n z a N con ° O = N C 3 CD O O Ut O O_ D) p~ N U1 a) d ~'S C) 0 =3 CD C) C O O O 3 a f W Cn ? 7 (n O) 7 0 0 O d O CD W O !V CD N a v ' U W N C O CL = 3 00 rn O G 7 CD F4~ N,C N o c a C a 1, Q 0 000- ~ cn o aQ 3 N N cn O- D O CD (D vi o ~ ~y N v d_ co 3 o Cl) Z z -i z O D 5 m _O 0 o :T s lr m , m (D (D M. v[1 C N CD ~I O n a 3 z CD -j to z m in c - ~a O N o. A m m o 0 z 0 3 p X < z H C (D A G co n CL o I v C z o a CD m I i z A I ` A A A N I tv O i O V A O b N O CD trp ft Fn O ye O ! y ti Parcel 016-1021-20-050 01/12/2007 12:49 PM • PAGE 1 OF 1 Alt. Parcel 10.30.15.16513-10 016 - 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 - VOELTZ, MARTIN L & COLLEEN A MARTIN L & COLLEEN A VOELTZ BOX 66 GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1623 HWY 128 SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 10.160 Plat: 4503-CSM 17-4503 016-03 SEC 10 T30N R1 5W NE SW LOT 1 CSM Block/Condo Bldg: LOT 01 17-4503(10.16 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-30N-15W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 11/17/2003 746828 2457/621 EZ-U 04/30/2003 719398 2224/208 WD 04/24/2003 718731 17/4503 CSM 2006 SUMMARY Bill Fair Market Value: Assessed with: 165228 Use Value Assessment Valuations: Last Changed: 07/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.160 20,000 172,600 192,600 NO AGRICULTURAL G4 6.000 800 0 800 NO Totals for 2006: General Property 10.160 20,800 172,600 193,400 Woodland 0.000 0 0 Totals for 2005: General Property 10.160 20,900 172,600 193,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 212 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r M 7 0 ~ n ~ ray. 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SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 W-Y'VERYTHING WITHIN 100 FEET OF SYSTEM ti fi l~ w 1 / r 'f y r✓' ~ Ly - I di Je o th Arrow sc L,: BENCHMARK: (Permanent reference Point) Describe: Sc'MeA't Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer : lr• i _'.S E li Liquid Capacity : Number of rings on cover Tan ck manhole cover elevation:,y Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Nlunber of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size o 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 eet iameter SEEPAGE PIT SIZE: Number of-pits feet liquid dept seepage pit in e-t -pipe-elevation bottom of seepage pint elevation feet. SEEPAGE BED SIZE: number of lines width length SEEPAGE TRENCH: width length ' ` PERCOLATION RATE iy A RE7;9C A BUILT DATED LICENSE NUMBER l; t' r CN C) RI PORT 01 1NSI'ECTION INDIVIDUAL SIWAGI tivtiTI M tiapt .4.taofy I'r~I mit 8 S to tSep t-i c A 1~ / l r 7 I r, w n n It 4' re. - © ----5 t. C ~t o t x C r, u n tit ,tttat Sect-iovt Lot N St4bdiv,' _ 6 4 01, I f'1 IC TANK Si : c la 7(3 gaI'('uvt~ Nurnben oA corrtpauttmenth t't ti trtrare (~~urn: GIeYf I~ai.~d.i-n9-- ~-----120 6eope Htighwa test 1'(1MPING CHAMBER e q I'P ,vb Pump ManuAactalwl Modek Numbest 1101 DING 1ANK gak4',nh%rt uA Corrtpahtal entb I'rtnipi>>r - - , Ta. It Sy!, tern - - e l~ t t << I c v A4 o rn B u lc' e 12 0 5 il o p e.- Hi phwa tvn X11; ; (J I; I' I I ON S 1 T F 1~'d T~tencIt trrtrr Aht rn (VeYI' Bu<Idinq 12`0 ~eope Highwateh T 012I'TI0N S[TE DIMENSIONS i width oA tneVteh At Requined ait.ea D~ I rvtgtIt oA each (',inc c - At Depth o6 stock bveow tie(, 45, <vt Nombelt oA ('ineb Z Depth oA n -oc.k o ven t41,v Z ivt I t'ae ('vngtit o6 P_ine -e At Death oA ti.ke below .(Meade ~n 11t h fakir(, betwe -en Pi-ne-,~_-- At Mope oA tnenelt p(I ,t 100 h t I ~ti((' a1)b )ohptic,n ah_ea-- -_At Eypr oA Crave Paper n h tIt(m) 1 I~! MI 10 NS N+trtil,r A pi (;have P around pits 11 (1 kl (I ttttttirtlr diarnete~t -At D epth bekow meet At I , tai' abAwlpttoyl apt At A,trrl ~n<quitted INSPI C _1 B TIT'LI Z71-7-7 OAft P) i lI C I I U V A TL 19 :A k)N I OK' RI J1 CI ION State and County State Permit # PLB 67 f Permit Application County Permit 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: T/N e el-rte' 7~G Cx e rV 'l o o d B. LOCATION: _ _''/4 surer Section 1Q, Ty7z9 N, R Z VWor) W LoOf City Subdivision Name, nearest road, lake or landmark Blk# Village Township C>LH~lfiydaf C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family 9 Duplex No. of BedroomsNo. of Persons D. SEPTIC TANK CAPACITY - a V V 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 / .Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-PlaceOther (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate -Total Absorb Area ~ sq. ft. New-Re~pl/acement ernat pecify) Seepage Trench: No of Lineal Ft. 4, Width Depth-ZLf Tile 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- ~dje Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community 1-1 Municipal ❑ Owners name as listed on EH 115 if other than present owner: 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 Certified Soil Tester, J NAME 6.&Ae, SM /r// C.S.T. # /7Z and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# le'6fe Phone #ka 3 Plumber's Address - -t- 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. t 3 3 . E i Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE NLY Date of Application Fees Paid: State///, G" County Date 46 41 Permit Issued/RTIs' (date) l Issuing Agent Name Inspection Yes 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 E K 115 Rev_ 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:'/4, /'l4, Section /19 A__e N,R W, Township or•htNoWiptibW ~ 0 ® d Lot No. ,Block No_ Count Subdivision Name Owner's%Buyers Name: A,4,6 tl_Ae ke e. 1'z Mailing Address: f.2 4:5-:1- 4e 6d G-✓p O Gf TYPE OF OCCUPANCY: Residence X No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS' PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT SA Al O :SQL d 2 . 17 PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN,'IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- e' P- r P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- B- r' B- t, -1 42 M /Y B_ X41 > B- vii - R • I►'~ i 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 zgQf 161" .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. d(W-0 O M v R 0 P-O t' .4 -Ma 3- z S`14 t/ ~p 4,9 !s-Ro uNc✓ _ Qft tRe N Q ' 40 LJ l J v " J* c~Ay ~.A yed R_ Ele-A M c3c►,q~/f~Ae A— et 3 1, the undersigend, hereby certify that the soil tests reported on this form were made by mein 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) 'gAl'Z e Certification No. 7d it' Address- 9 t a 6: 4 es A/ G/lF~ a C j tY Name of installer if known 6A L- de 5-M i 2 -H Copy A -Local Authority CST Signature-f<5`GZ-'CE'- L,~ r i z' rith Plumbing PHONE (715) 265-4838 rl N ©G1 GLENWOOD CITY, WISCONSIN 54013 6:z.~ e, dl ry ire Ar' Mee ,6'e me f/ O ~ei~r~`~ t9N~ i jp0 q~ i i i \ ~7 9'O ---1 a , r a a ~ ~ ~ i a i 7-2 re I3~ R P ~ o v E~ qt 'r