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Parcel 016-1025-90-000 10/12/2006 03:55 PM
PAGE 1 OF 1
Alt. Parcel 12.30.15.195 016 - 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 - JOHNSON, ROWLAND & WHYNELDA
ROWLAND & WHYNELDA JOHNSON
1678 CTY RD X
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1678 CTY RD X
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 12 T30N R15W SW NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 821/538
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/26/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 15.000 1,500 0 1,500 NO
UNDEVELOPED G5 21.000 10,100 0 10,100 NO
OTHER G7 4.000 15,000 115,600 130,600 NO
Totals for 2006:
General Property 40.000 26,600 115,600 142,200
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 27,100 115,600 142,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 103
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
I%JER k?6I) e}jyID :40W N 0/1' , TOWNSHZF/ ,.sV SEC. T n N, R J S~ W
0. AZ)DRESS ~aa~u7 , ST. CROI OUNTY,WISCONSI .
_LDIVISION , LOT LOT SIZE
PLAN VIEW
-Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1~ ~ I I i I i ~ ~
r
r I
I I I I j I I
-t--T-
In'di'cate North; Arrow
~ j SCALE: tPTIC TANK tai) MFGR. Al,' p Ld1 _ S j ` 13 to o C, jam CONCRETE,- STEEL
NO. of rings on cover Depth DRY WELL
+NCHE$ NO. ofwidth length
area
r no. of lines widthlengthy area '
depth to top of pipe
~CREGATE /Q
`.W, RATE % AREA REQUIRED AREA AS BUILT
iisclaimer: The inspection of this system by St. Croix County does not imply complete
.G;pliance 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
ystem operation. However, if failure is noted the County will make every effort to
:itersine cause of failure.
.fEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
``INSPtCTOR
DATED
PLUMBER ON JOB
LICENSE NUMBER S
~`J
z • I'
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.i.taAy Pe- tm.i t
State Septic_
NAME r_ rowndhip S Croix County
Location Section
J ~
SEPTIC TANK
1
Size gattonb. Numb en o6 CompaA.tments j
Distance FAom: Wett 12$ oA gneateA 4Zope 6t
Su.itd.ing it. we.ttand.6
~ .
H.ighwa.teA~6t.
DISPOSAL SYSTEM s
Distance FAom: Wett 12% oA gneateA ztope ~ .
Su.itd.ing it. We.ttands Ft.
• H.ighwateA it.
FIELD DIMENSIONS:
Width o6' t&ench ~ it. Depth o6 Aock be.Eow ,t-i.Ce .in.
Length o6 each tine S it. Depth o6 Aock oveA .t.ite in.
Numb eA o6 tines Depth o6 ,t.iQe b etow grade in.
Tota.Q. teng.th o6 tined it. SZope o6 .tAench in pen 100 it.
Di4 tance between Zane, 6.t. Depth to b edAo cn it.
Totat abdoAbt.ion area 6t2 Depth to groundwateA it.
Requited atcea 4t2 Type o6 Covet: Pape.A oA StAaw
PIT DIMENSIONS:
Numbers o5 p.itd GAavet around p.itd yed no
Out.6 ide d.iameteA 6t. Depth below .inlet 6t.
2
Totat absoAbt.ion atcea it
z
A
Area Aequtted ~t2 3Z
INSPECTED BY TITLE
APPROVED DATE 197
- 5 -
REJECTED DATE 197
v
tLr:33iivd:*•Jx+wn aJrv'8a.r.:. e:roest'i" ,M65Yb4L',...a..g.,x '
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
6~ LC lV G~ z 1 i~
LOCATION: ` k %,N,'= '/4, Section TAN, R €-(ef4 W, Township OF Munipipalit,
Lot No. , Block No. i County S' i I~C'I X
Subdvision Name
J f fV S
Owner's Name: 14.4V D
Mailing Address: l t
TYPE OF OCCUPANCY: Residence No. of Bedrooms ,7~ Other TIc xj R
EFFLUENT DISPOSAL SYSTEM: NEW- x ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS AL PERCOLATION TESTS See statement below.
SOIL MAP SHEET SO I L TYPE tf f~ !-f ` L - t ,4 n/ r
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 AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- 1 See bore hole data Sandy c arse textured scil. 114 <10
2 Procedu e conforms to Wisconsin <10
P- 3 Administrative Code H62 (20) (b 1. <10
5 <10
P-
X- - Instal l drainfield at a~ inches. SOIL BORING TESTSS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B- J-- 77L lvo lyk- _>7^' T> 9-- . f i 6 - 7 Z 3 a 4 Plit r- / 2 - e
2 72. 26-
B
-
7 z- 0 F_ -2
Z
l •W bY- 11 3'HI 46- s1vrAxc-+Y4 0, °;-72.
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 of6- uare eet'of absorption area
needed for building type and occupancy. _5 le" f r'bNc'z-i s 1 X ~C Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
£ 4 _
Notes'
wl_ ~Red~ f bags! at bore
holes, 1, 2,,, Indicate C I ! Imo; !'I j
to ation of pr4mary I ti
d15pOa1; site. ( ! a
I
i 1 I
2 le~rat,Ion reference I £ r k
L 4 it
poi n t TTT
1
111{ i
3-Meai;urment for sktc
4 1 I I I I I I
1-e obtained 'acing I ~
we Y -
. ,
i I ✓ J C, n 11 I
-4
4stl_ma1e',~ ~q ft- sItb1
_S.,OJ 6.re, for_ each_ of _pr_ I mbry t
,
and. alt ..rnato_ d i sposal i t6.i _ a___
a
5-('1evat on C, Is;gr6un syrf~ce at1bore Ilol~ 1 yo
j
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 and belief.
Name (print) Gordon N. Wing Certification
Address 3508 Nimitz Street, Eau Claire, WI 54701
Name of installer if known
Signature
COPY A -LOCAL AUTHORITY CST -
67 State and County State Permit #
y
-'l
Permit Application County Perm~y,#
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:
l
/car <vC
B. LOCATION: A'tk' Section i T ;c- N, R /_S' E (or) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _ Duplex No. of Bedrooms No. of Persons Z_
D. SEPTIC TANK CAPACITY Tota 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 ~~~5` Total Absorb Area sq. ft.
New X Replacement Alternate (Specify)
Seepage Trench: X No. of Lineal Ft. - Width Depth ~ Tile depth (top) -2 Z/- No. of Trenches
Seepage Bed: Length Width Depth Tile depth (top) No. of Lines
Seepage Pit: Inside dia~mfter Liquid Depth No. of Seepage Pits
Percent slope of land- /c
Distance from critical slope
'vVATER SUPPLY: Private K 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 Certifie Soil Tester,
NAME L C.S.T. #and other information
obtained from cit. :mot
(owner/builder).
Plumber's Signature MP/MPRSW# k (L~ Phone #
1,2 Plumber's Address /f 4 e- - /J F f`
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.
E
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01
t~v, a~
~J /01
Ir" 41 C A..60 6.
7 i
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State
Permit Issued/FWj e (date) Issuing Agent Name ..A/ O
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