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Parcel 016-1076-60-000 10/12/2006 04:06 PM
PAGE 1 OF 1
Alt. Parcel 35.30.15.526 016 - 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 - ROTHSTEIN, ROSALIE M
ROSALIE M ROTHSTEIN
PO BOX 355
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 3137 130TH AVE
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 38.480 Plat: N/A-NOT AVAILABLE
SEC 35 T30N R1 5W NE NW EXC PT TO Block/Condo Bldg:
1123/318
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
35-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/21/2003 718251 2214/16 QC
1123/318 WD
790/72
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 12,000 112,600 124,600 NO
PRODUCTIVE FORST LANDS G6 36.480 63,500 0 63,500 NO
Totals for 2006:
General Property 38.480 75,500 112,600 188,100
Woodland 0.000 0 0
Totals for 2005:
General Property 38.480 75,500 112,600 188,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 502
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
GLEN WOOD 49
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I
GLENWOOD Lundeen LEON LEE'S
CITY AUTO CO. Frame & 81R£NSCHOT DRUG STORE
INSURANCE
a . Body Shop AGENCY Glenwood City, Wisconsin
INSURANCE & LOANS Congratulations to
PHONE: 265-4877 GLENWOOD CITY the 4-H
GLENWOOD CITY 54013 PHONE: 265-4080 Program
WISCONSIN GLENWOOD CITY 54013
I 4"W
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
t
Sanitary Pe.Am it G
` State Septic
NAME t' St. Croix County
i ownshi
Locatrioa Section _ R
SEPTIC TANK
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SizeT gattons. Numbers o6 Compartments 1 I
Distance FAOm: We.e.e 6t. 12% on gneateh 4tope ,4/'~ S,t ~
Buitding 6t. Wettand.s h•, - 6 •
R
Highwater ,A 6t.
DISPOSAL SYSTEM
s
Distance Picom: W e Z t 6t. 12% on greater 6.eope ~ .
---F~'--
Bu.iZd,ing 34I`g! it. Wettands 1%, 1'1 Ft.
N.ighwateA 6t.
MELD DIMENSIONS:
W id•th o6 trench 1 w 6t. Depth o 6 ro ck b etow t.iZe_ kn.
Length o6 each Z,,',ne 6t. Depth o6 Aock oven t.i.ee in.
NumbeA o6 Zines_ f Depth o6 t.i.ee below grade in.
Total' length o6 titine.~s l 6t. Scope o6 tAeneh in pen 100 6t.
Distance between L in2~_ 6t. Depth to b edAO ch 6t•
Totat absoAbtion aAea j ~ ~t2 Depth to groundwateA_ _6t•
Requ.iAed area 6t2 Type o{ CoveA: Papers or StAaw
PIT DIMENSIONS:
Number obi pits Grave.e around pitz yes no
Outside d.iameteA 6t. Depth betow intet _bt.
2
Totat abzoAbtrion area 6t
2
AAea requited 6t R'
INSPECTED BV-.- TITLES
APPROVED DATE
REJECTED DATE 197.
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Plb. t-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES
Division of Health
Section of Plumbing & Fire Protection Systems
ON-SITE WASTE DISPOSAL INSPECTION REPORT
Name of Premises
Street City County
Master Plumber Address
Owner Address
❑ County Permits ❑ Appropriate State Permits
Type of Building: ❑ Public ❑ Single Family or Duplex
CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM
❑ Building Sewer ❑ Conventional Soil Absorption System
❑ Septic Tank ❑ Conventional System-in-fill
❑ Holding Tank ❑ Alternate Mound System
❑ Seepage Bed ❑ Holding Tank
❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System
BRIEF, FACTUAL COMMENTS AND SKETCH:
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❑SEE ATTACHED
[DISCUSSED WITH PLUMBER ( ) Yes ( ) No SIGNATURE (Voluntary)
)ATE OF INSPECTION
Signature of Inspector
,f}hite - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Fatty
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 TE3T
LOCATION: ,Vr '/44-141/4, Section- , TZ'N, R 43 1 .W, Township or 1>IhoftpoW
Lot No. Block No. County
Sdivjsion Name
Owner's Name:
(~/tom Lc ' s
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X Q ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS J 1,-2 - 7`5~ PERCOLATION TESTS
SOIL MAP SHEET z~ SOIL TYPE c3 2ie~
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
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-
All
/yr
Ive
P-3~
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61/7 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)
-7 .2~2_ o
B- ~y i6 Se A-, y~,
PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. .indicate numb of square feet of absorption area
needed for building type and occupancy. y Indicate scale
or distances. Give horizontal and vertical reference po s. Indicate slope.
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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) s .S /✓1 i rtAl - Certification No.
Address e- N &1 0 L'
Name of installer if known C^> A4 E?
CST Signature *
" AUTHORITY
State and County State Permit #~d
PLB'67 Permit Application County Per ' # z~
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:
B. LOCATION: 1►/ _'/4 tv '/4, Section , T lea N, R 43'- ¢Mr) W' Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township l~Lc~ N~~yt`d
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons ._i
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder Y YES NO # of Bathrooms-/-
Automatic Washer _X___YES NO Other (specify)
E. SEPTIC TANK CAPACITY /p 470 Total gallons No. of tanks /
*Holding tank capacity Total gallons No. of tanks
New Installation X( Addition _ Replacement _ Prefab Concrete X
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft.
New_X Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet l p cl Width _~i-_ Depth ?Z.." Tile Depth ;Z No. of Trenches
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size J
Percent slope of land ~p Distance from critical slope 9!,'
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 C ~t C- SM / t# C.S.T. # / j 4 f and other information
obtained from ? (owner/builder).
Plumber's Signature MP/MPRSW#Phone
Plumber's Address
PLAN VIEW: Provide sketch bellow of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Sp BeJow, FOR DEPARTMENT USE ONLY
Date of Application
IC? 11 Fees Paid: State D Cou L Date L
Permit Issued/1'" (date) - Issuing Agent Name
Inspection Yes No Valid# Date Recd _
1. county (w i copy) 3, owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
TRANSFER FORM
PLB .67-T SANITARY PERMIT
State Permit #
Sanitary Permit #
County
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location: Section G T C N, R Z - E (o W~ Lot # -City
Subdivision Name, Ne est Road, Lake or Landmark BLK # Village
Township
B. TYPE of Occupancy: Commercial Industrial Other (Specify)
Single Family Duplex No. of Bedrooms 3 Variance
C. SEPTIC TANK CAPACITY ? 57" 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/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New Replacement Alternate (Specify
Seepage Trench: i No.Lineal Ft. Width f2 Depth Tile Depth(top)_- No. Trenches
Seepage Bed: Length Width Depth Tile Depth(top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits
Percent slope of land Distance from critical slope
E. WATER SUPPLY: rivate ❑Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No.
Name Name y rC ~cza.,etf
Address .7 ~.,otr•, Address
Zip Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Tester and/or any additional soil tests that may have been required. Y3
f
Plumber's Signature f 1 ~1 r1 ~ h _ e-~ ~ ~ MP/MPRSW # Phone X44/ -
Plumber's Address 6 ? ( ,t~r-~-- .
/j
Information obtained from (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor sproperty If well his of been frilled jndjc_ate
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Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green !copy) P.O. BOX 309, MADISON WI 53701
TRANSFER FORM
SANITARY PERMIT
PLB 67-T State Permit #
Sanitary Permit #
County
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location: Y4, Section T N,R E (or) W Lot # -City
Subdivision Name, Nearest Road, Lake or Landmark BILK # Village
Township
B. TYPE of Occupancy: Commercial Industrial Other (Specify)
Single Family Duplex No. of Bedrooms Variance
C. SEPTIC TANK CAPACITY 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/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches
Seepage Bed: Length Width Depth Tile Depth(top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits
Percent slope of land Distance from critical slope
E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No.
Name Name
Address Address
Zip Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Tester and/or any additional soil tests that may have been required.
Plumber's Signature MP/MPRSW # Phone # -
Plumber's Address
Information obtained from
(owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor s jproperty. If well has_not been drilled pease
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Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701
TRANSFER FORM
SANITARY PERMIT
PLB`6 7- T State Permit #
Sanitary Permit #
County
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location: '/4 '/4, Section , T N, R E (or) W Lot # -City
Subdivision Name, Nearest Road, Lake or Landmark BLK # Village
Township
B. TYPE of Occupancy: Commercial Industrial Other (Specify)
Single Family Duplex No. of Bedrooms Variance
C. SEPTIC TANK CAPACITY 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/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other(Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches
Seepage Bed: Length Width Depth Tile Depth(top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits
Percent slope of land Distance from critical slope
E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No.
Name Name
Address Address
Zip Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20-, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Tester and/or any additional soil tests that may have been required.
Plumber's Signature MP/MPRSW # Phone # -
Plumber's Address
Information obtained from (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor's propert If well has not been dulled oaease_i di t
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Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green 'copy) P.O. BOX 309, MADISON WI 5370: