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Parcel 016-1048-70-000 03/1612007 04:09 PM
PAGE 1 OF 1
Alt. Parcel 22.30.15.352C 016 - TOWN 01= GLENWOOD
Current X ST. CROIX COUNT", 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
RALPH M KERR O - KERR, RALPH M
1458 310TH ST
GELNWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ' 1458 310TH ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 12.000 Plat: N/A-NOT AVAILABLE
SEC 22 T30N R15W PART OF SE NE S 1/2 NE Block/Condo Bldg:
SE NE ALSO SE SE NE EXC P352E
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 786/61
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
RESIDENTIAL G1 2.000 12,000 90,500 102,500 NO
AGRICULTURAL G4 10.000 1,300 0 1,300 NO
Totals for 2007:
General Property 12.000 13,300 90,500 103,800
Woodland 0.000 0 0
Totals for 2006:
General Property 12.000 13,300 90,500 103,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 307
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
f Wisconsin Department of Health e-rd Social Services
c'1*• #67 1069
Division of Health
PEiTIT APPLICATION
~O T for
V'D - ~ p PRIVATE DO?iSTIC SEWAGE SYSTEMS
L ~ ~/l.~ G~T1-CP~►, 5. ~ - SSZ~ -S~~/~ -T'E~~7~ ~6 S-`" ~~s -
A. NINER OF PROP-E- 1Y wD 7f( - 1 0 TYPE OR USE BLACK INK ST,~
Name Address (Street, City, Zip Coda)
County
B. LOCATION OF PROPERTY WHIP SYSTFN WILL BE CONSTRUCTFD, ALTERZD OR EXTENDED
Check Cne: _r L / j . /fs /f r
CITY VILLAGE LEGAL DESCRIPTION: /
TOWNSHIP
C. IS LOCAL PER1IT REQUIRED FOR THIS WDRK? YES NO PEZIIT NLT--ER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT X ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NU1;3ER OF TANKS TO BE INS^IALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence v' Commercial Industrial Other
Specify)
Number of Persons to be Accommodated Number of Bedrooms -
F. A?FLIANCES, ETCs Food Waste Grinder Yr:S ' NO Automatic Clothes Washer YES NO
DisEr,?asher YES NO Automatic Potato Peeler YES NO
Other (Specify)
'
G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACi2IMN7
Tile Size No.Lir,.Feet J Trench Width ,-j- ' Depth Number of Lines _
Seepage Beds Length Width Depth Tile Size No. Lines
Seepage Pits Inside diameter 7F Liquid Depth X1'3
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours Water ]Test Time Drop in-Water Level Inches ; inutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to ` Next to bast '.o Fall
1st Wetted Overnight in M-notes Last Period) Lest Per-. Period (ne Inch
Exampl e
P- 0 36" To Soil 1011, Clay 26'11 25 es or no 30 112 ___.z_12 1 2 _ 60
t _ i
' 37
RECORD DATA FROM MINIMUM OF 3 TEST HOLE'S
Compute size of absorption area in scoord with H 62.20 Wis. Administrative Code.
S O I L B O R I N G S - Minimum 36" Below Pro osad Absorption System
_
oring Total Depth Depth to Ground Water Depth to Bedrock i
umber Inches Observed Estimated Observed EstLmated Character of Soil with Thickness in Inch,-!s j
-xample
- 0 72" 72" ✓ Black To Soil 12", Clay 18"• Sand lE"; Gravel 2411 '
fly
RECORD DATA FROM MINIMUM OF 3 80RE HOL_S
COMPLETE OTHER SIDE
I, the undersi;rned, hereby certify that the percolation tests reported on this fonr. were made by me
or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to
the best of my kna/rledge and belief.
TITLE
(Type or Print) ~J~
REGISTRATION NO. or MASTER PLUt°23ER LICENSE No, r
ADDRr: S r~ r J c 'f
DATE -
r+ :.=t 4 SIGNA^U&
MAS'PER PLiRf3-R MAKING APPLICATION
riP
Signature: r~ License ~W
MP RSW
(T 'be 7Corq,,p`leted by Issuing Agent)
Date of Application r Fee Paid $
Permit Issued (da~e) - %J Permit Number
Agent (name) 4-j. i For. Torn, Village, Cllty; County, etc.
(Specify)
Note. The application cannot be considered for filing until all of the above questions are a.n~sered
and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
Do not write in space belsrr - FOR DEPARTMENT USE ONLY
s ~ J
DATE RECEIVED V i ~~(1 ACCEPTED BY ` RETJRNED
}
(Initials) (Date) See Corres.)
FEE RECEIVED L/ VALID. NO. ~ PER11IT NO.
(Yes or No)
REVIEWED BY APPROVED DATE
(Initials) (Yes or No)
COMMENTS:
I