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Parcel 016-1048-90-000 03/14/2007 03:54
PAGE 1 OF 1
F 1
Alt. Parcel 22.30.15.353A 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 - MCCLUSKEY, WILLIAM & BONITA
WILLIAM & BONITA MCCLUSKEY
1490 HWY 128
GLENWOOD CITY WI 5401 I
Districts: SC School SP =Special Property Addres-s(es):' Primary
Type Dist # Description " 1490 HWY 128
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 22 T30N R15W NE NW EXC BEGIN 400 FT Block/Condo Bldg:
W OF NE COR; TH S TO NLY R/W HWY 128; TH
NWLY ALG R/W TO N LN SEC 22; TH E TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
22-30N-15W
Ste.
Notes: Parcel History:
Date Doc # of/Pag Type
NIq 7/23/1997 88
v 2 07/23/1997 806/192
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: st Changed: 07/26/2006
Description Class Acres Land mprove Total State Reason
AGRICULTURAL G4 36.000 3,300 0 3,300 NO
UNDEVELOPED G5 1.000 100 0 / 100 NO
OTHER G7 3.000 13,500 189,70 203,200 NO
Totals for 2007:
General Property 40.000 16,900 189,700 206,600
Woodland 0.000 0 0
Totals for 2006:
General Property 40.000 16,900 189,700 206,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 105
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 016-1033-60-000 03/15/2007 11:34 AM
PAGE 1 OF 1
Alt. Parcel 15.30.15.248A 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 - MCCLUSKEY, WILLIAM & BONITA
WILLIAM & BONITA MCCLUSKEY
1490 HWY 128
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 1490 HWY 128
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 35.500 Plat: N/A-NOT AVAILABLE
SEC 15 T30N R15W SE SW EXC 3.1ACRES IN Block/Condo Bldg:
P248B & EXC PT TO LOT 1 CSM 9/2677
EZ-U-1214/210 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
15-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 809/588
07/23/1997 806/192
2007 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 32.500 3,300 0 3,300 NO
UNDEVELOPED G5 2.000 400 0 400 NO
OTHER G7 1.000 4,500 1,000 5,500 NO
Totals for 2007:
General Property 35.500 8,200 1,000 9,200
Woodland 0.000 0 0
Totals for 2006:
General Property 35.500 8,200 1,000 9,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch 116
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 016-1033-20-000 03/15/2007 11:34 AM
PAGE 1 OF 1
Alt. Parcel 15.30.15.245 016 - 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 - MCCLUSKEY, WILLIAM & BONITA
WILLIAM & BONITA MCCLUSKEY
1490 HWY 128
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 38.500 Plat: N/A-NOT AVAILABLE
SEC 15 T30N R1 5W NE SW EXC PT TO LOT 1 Block/Condo Bldg:
CSM 9/2677
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
15-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 809/588
07/23/1997 806/192
2007 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 37.500 3,100 0 3,100 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2007:
General Property 38.500 3,200 0 3,200
Woodland 0.000 0 0
Totals for 2006:
General Property 38.500 3,200 0 3,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
fOOD ~72-qj La-la- 70q - J-7f -
• 49
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Parcel 016-1033-70-000 03/15/2007 11:07 AM
PAGE 1 OF 1
Alt. Parcel 15.30.15.248B 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 - BERENDS, DEAN & DEBRA K
DEAN & DEBRA K BERENDS
3042 150TH AVE
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 3042 150TH AVE
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 15 T30N R15W 3.1A IN SE SW COM 580' Block/Condo Bldg:
W OF S1/4 COR TH N 573'W 150'S 100'
W40 FT TH S 473' TO CL HWY E 190' TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
15-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 915/596
07/23/1997 756/33
07/23/1997 502/99
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 15,000 136,900 151,900 NO
Totals for 2007:
General Property 3.000 15,000 136,900 151,900
Woodland 0.000 0 0
Totals for 2006:
General Property 3.000 15,000 136,900 151,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 107
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER ~i,,.r.. 4 l , TOWNSHIP C-l A,II e"(l SEC . ;L,~. TN, R1,414
P.O: RLSS , ST. CROIX COUNTY, WISCONSIN 7
'"SUBDIVISION LOT LOT SIZE
PLAN VIEW ~ahtt'
Distances & dimensions to meet requirements.of H62.20
SHOW EVERYTHING WITHIN 100FEET OF SYSTEM
S'
A Al 1(.
SEPTIC- -'ANK(S) MFGR. 1 / S t. is' S CONCRETE EEL
N-0.-07: rings on cover Depth DRY WELL
TRENCHES No. of r1 _ width 5 AgIth area BED no. of lines width- length area
dept to top of pipe
'
AGGREGATE / y "
PERK RATE AREA REQUIRED S`c AREA. AS BUILT
DISCLAIMER: The inspection of this system by St, Croix County does not imply
complete compliance with State Administrative Codes_ There are other areas
that it is not possible to inspect at this point of construction. St. Croix:
Co,.n y . sst::r.es no ? 4a1>> lily for s;7stem operation. uc-,e,er fa lure is
noted the County will make every effort to det er:rnji. ecause of 'failure.
GREASES AND OILS SHOULD NOT BE DISPOSED TtiRUU.C;'"TIiI.'S Sy 1.
INSPECTOR
DATED t~ /3 s G" PLUMBER ON JOB z/.../.
LICENSEE
r
REPORT OF INSPFCTION_INDIVIDUAL SEWAGE SYSTEM r-
' San.i.tany Penm.i-t
q State Septic
NAME yt •c w w -Township b j_t v* tpvrrS S~. Cnoix County
Location r1d V Section
SEPTIC TANK
Size f%r~ gattone. Numbers o6 Compan.tments~ I
Di4tanee Fnom: Wet 12$ on greaten a.tope it
Bu.i.Ld.ing /0 it. W ettand.6
- ~ .
H ighwaxen it,
DISPOSAL SYSTEM
D.ietanee Fnom: Wett /~y it. 12$ on gnea en z tope _ it.
Bu.itd.ing 6t, Wettandd Ft.
• N.ighwaten it.
FIELD DIMENSIONS:
Width o6 .then ch S. it. Depth o6 no ck b et ow t.ite__/2- in.
Length o6 each tine Z it. Depth o6 rock oven Cite 2- .in.
Numbers o6 tine.a Depth of ,t.ite below gtcade 2.0 .in.
Totat teng.th o6 tines it. Stope o6 .tneneh in pen 100 it.
Di4tanee between tines _it. Depth to bedrock
Tota.L abzotcbz.ion anea~y ~ 2 Depth to gAoundwa~t'e"t~c'
Requited area it2 Type of Coven: . P~' ap2' on S )caw
PIT DIMENSIONS:
NumIbe& o6 pit, Gnavet atcound pits ye.a no
L [J
Outside d.iameteA it. Depth b et ow .int et it.
s 2
Toza.L ab,soabtion atcea it
z
A
Axea nequ in _ it2 rn
INSPECTED - TITLE t
I
APPROVED C-/ DATES! 197~.J
REJECTED DATE -197-.
L L tJ r w r ~c./c Q S .s e
2.4 5
- X130
EH 11511
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES c4 r>
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
t !
LOCATION: &C%, Nk%, Section ~2~2-, T PN, R L5' r) W, Township orb L t' Ae 4-" c~ d, Lot No. , Block No. _ County
T Subdivision Name
Owner's Name: el ,AN/ f~cl E✓ ,t
Mailing Address: .7z ,Z Cw= L -e A/ 4yv c' o, L~ / k Lv
TYPE OF OCCUPANCY: Residence x No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW -ADDITION REPLACEMENT X
DATES OBSERVATIONS MADE: SOIL BORINGS-=/~ PERCOLATION TESTS
SOIL MAP SHEET SOI L TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL T- 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-
P-
G" 'Z Ale
P
c-
410
SOIL 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.. G > 7-2. -1- 3.9 1 ;7 IC ~7 s7er.L " JH e~cr- S
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 numb r of square feet of absorption area
needed for building type and occupancy. Vie' _.e4l e" 9' Indicate scale
or distances. Give horizontal and vertical reference p rots. Indicate slope.
1
Vj _41
"fi--
11
L f Nei
?
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) Cx e. S M / r// Certification No. 1 Z E
Address 9.- a e-- eIV t., e r d / 1~~ l.1 '6? s, M r CST Signature of installer if known L-
re
®~'Y A -LOCAL AUTHORITY
r - 13
State and County :sa~k16 State Permit # ~7J
PLB-67
Permit Applicatiojr, County Perm t #
71) Z
for Private Domestic Sewage.gystems County
`0
~ 1.
*DENOTES STATE APPROVAL REQUIRED -
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
b1~r9~JtirJ t' . f/e 4,,AR41 0Z f =1 e, IV e,
B. LOCATION: '/4 '/4, Section T_ N, R_ E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township C*tieNwoo c1
C. TYPE OF OCCUPANCY: *Commercial "Industrial *Other (specify) *Variance
Single family X- Duplex No. of Bedrooms No. of Persons 17
D. SEPTIC TANK CAPACITY 4fe 4l Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete XPoured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement X
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area 2 C sq. ft.
New Replacement 9 Alte-~r~nal~t~~e (Specify)
Seepage Trench: Y_No. of Lineal Ft. Li-C' Depth-2-4~Tile depth (top)-0~ '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- Distance from critical slope
WATER SUPPLY: Private 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, ,e. ry
NAME 6!--4 L e 5'M C.S.T. # ~~6 0 and other information
obtained from ,7 (owner/builder).
Plumber's Signature MP/MPR$W# e~ Gaye Phone
Plumber's Address t~ rf- o
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.
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Do Not Write in Space Bel w,,, FOR COUNTY AND STATE DEPARTMENT USE ONI_Y
Date of Application Fees Paid: State Count Date
Permit Issued/Rejected (date) 7~. Issuing Agent Name
Inspection Yes No State Valid# Date Rec'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