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Parcel 016-1046-95-000 12/18/2006 01:14 PM
PAGE 1 OF 1
Alt. Parcel 21.30.15.340 016 - 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
MYRON H KRUEGER O - KRUEGER, MYRON H
N7848 210TH ST
KNAPP WI 54749
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1431 290TH ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 21 T30N R1 5W NW SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/14/2006 834530 QC
06/12/2006 827204 QC
07/26/2001 652160 1687/531 WD
07/23/1997 441/324
2006 SUMMARY Bill Fair Market Value: Assessed with:
165473 Use Value Assessment
Valuations: Last Changed: 07/26/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.000 3,100 0 3,100 NO
UNDEVELOPED G5 1.000 100 0 100 NO
OTHER G7 2.000 9,000 63,800 72,800 NO
Totals for 2006:
General Property 40.000 12,200 63,800 76,000
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 13,000 63,800 76,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 315
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisoonaln Depart^ent of Health eaatt Scoieal Services
Plb. X67 370 Division of Health
s
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. EdNER OF PROPERTY
Name Address (Street, City, Zip Code)
B. LOCH ICIN OF PROPERTY WFiRE SYS,7--l WILL BE CONSTRUCTED, ALTERED OR EXTENDED COUNTY
Check One:
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? / YES NO PERMIT NUIMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEtIENT ADDITION
MATaRIALS: Prefab Concrete ` Poured in Place Steel Other
NUTCDER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check one: One or Two Family Residence ( Cosmercial Industrial Other
Specify)
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES y NO Automatic Clothes Washer YES NO
Dishwasher YES NO Autoratio Potato Peeler r YIS NO
Other (Specify)
G. MASTER. PLUI-DER MAKING INSTALLATION ~ Name: ' Address: License Number:
Signature of Applic4nt: MP RSW
Address:
H. To be Completed by Issuing Agent)
Date of Application t` Fee Paid
;
Permit Issued (,date Permit Number % .j
t
Agent (Name)/ r r f'--j~.~/_>
Town, Village, City, County, etc.
(Specify)
Note: The application cannot be considered for filing until all of the above questions are answered and the
fee paid. Agents will forward application, the fee of $1.00 for each septic tanx and the third oopy
of the permit (canary) to the Division of Health. Checks are:: money orders should be made payable tc
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
1. DATE RECEIVED l U' U ACCEPTED BY RETURNED ~-T- _
(Initials) / (Date) (S C Rr es.)
FEE RECEIVED ✓ VALID. No. PERMIT NO.
- Yes or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
J
SEPTIC TANK PM1IT NO. . r.
R L P 0 R T O N S O I L P I R C 0 L A T I 0 N T E S T
A N D S O I L B O R I N G S
TO
DIVISION OF HEALTH - PLi31BING SSCTI6N
P.O.Box 309, Madison, Wis. 53701
Purmtant to H 62.20, Wis. Adai.nistrativs Code
P S R C 0 L A T 1 0 N T T S T
Test Depth Chsreoter of Soil ~Hostrs Water Test Time Drop in :t ter Level In3nas L rT~. utt f
Nmzber Inches Trioknoss in Inches Since Hole in Hole Interval Second to Next to Last Fell
1st Wetted Overnt in Minute3 Lod Last Period Period : Inch
Example
P - 0 36t, To Soil 1014 Cla 26" 25 Yes or No 30, 112 1/2 112 60
-
sn s fa 'sue
r7
RECORD DATA FROM MINL'NM OF 3 TEST HOLFS
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code-
S O I L B O R I N GS - Mini-m-at 36" Bel" Proposed Absorption 5 sttm
Boring Total Depth De th to Gro:Lnd Water Depth to Bedrock
Number Inches Cbserved Esti-m- ed Observed Esticczted Character of Soil with Thickness in Inches
Ex=ple
B - 0 72" 72" Black Top Soil 12"a C1_X18"; Sand 18"; Gavel 2411
.1 l t. ~ ~i E
rRECO,.D DATA FROM MINiMUNI OF 3 BORE HO;''S
I
I
TYPE OF OCCUPANCY:
RESIDENCE's Number of Bedroaas OTHZR: (Specify) Number of Persons
D WASTE GRINDERS yea NO ' Disl-Lyazhers Yes No Automatic Clothes Washer : Yes YJ No
FFWENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACE'-i, F_NT
Tile Size _ No.Lin.Feet 'Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
f Seepage Pits Inside Diameter 2 Liquid Depth /
Ia the undersigned, hereby certify that the percolation tests reported on this form were made by me or under My supor-
vision in accord with the proceuures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and
that the data record~e'dy and location of test holes are correct to the ,best of my knowledge and belief.
NAME 74
l U-'~4 it TITLE
Type or Print
REGISTRATION NO. or MASTER P14MER LICENSE NO. ` v
ADDRESS
11 7 r ,r
DATE ~ SIGNATURE