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HomeMy WebLinkAbout016-1073-20-000 C)cno I~vo C G1 O c m O CD c c 3 f4 c ~ c v n1. 3 A: to O c o v N o Q, c N.-D w C, 9 D ° CD CD N o 0 o M ,j CD ou :3 N CD 7 3 DI N co, CD a f1 N O N 3 d O Off" 3 N D C) O (A (n 0 Q d N ~ O m cn z D a (D (CI O N O. w ~ ~p o c CD r_ 3 oo~o oo~o C~ i ° o (0 (~o n o c V to 0 0 ~ a o m CT co c CD to G1 v cn N ty d N w CD- z 00 ~ 3 N ° `rl o z D z o I ? ~ m • m Z) N N C N (D w ~ Q O 3 7 -I N z CD Q O ? Z CCD (n c n :3 A z O v O_ C) 0 Cl) W A CD .D M O C , z 0 4 3 o z 3 m_ C~C N ~ s < N w N N O O a (3D I a CD j 7 T O cl, O O O C z :3 O G O 7 ~ S =O N y 7 (D O E O CD N O N 7 (D 3 a o0 3 CD y N .00 O ~ N O O N O a A ti O O CD Qq O O A ~ 0 ti N O O i Parcel 016-1073-20-000 08/28/2006 09:43 AM PAGE 1 OF 1 Alt. Parcel 34.30.15.507 016 - 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 DEAN M & JENNIFER R TEIGEN O -TEIGEN, DEAN M & JENNIFER R 3087 130TH AVE GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 3087 130TH ST SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 34 T30N R15W SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 01/24/2005 785706 2736/177 WD 07/23/1997 1184/176 QC 07/23/1997 1167/570 QC 07/23/1997 1033/126 TI more... 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/27/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 2,800 0 2,800 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 9,000 133,200 142,200 NO Totals for 2006: General Property 40.000 11,900 133,200 145,100 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 12,900 133,200 146,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 136 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 016-1073-30-000 08/28/2006 09:44 AM PAGE 1 OF 1 Alt. Parcel 34.30.15.508 016 - 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 - TEIGEN, DEAN M & JENNIFER R DEAN M & JENNIFER R TEIGEN 3087 130TH AVE 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: 40.000 Plat: N/A-NOT AVAILABLE SEC 34 T30N R1 5W SW NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 01/24/2005 785706 2736/177 WD 07/23/1997 1033/126 TI 07/23/1997 852/430 06/13/1996 545260 1184/176 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/27/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 18.000 2,200 0 2,200 NO UNDEVELOPED G5 1.000 100 0 100 NO AGRICULTURAL FOREST G5M 21.000 15,800 0 15,800 NO Totals for 2006: General Property 40.000 18,100 0 18,100 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 18,700 0 18,700 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 GLENWOOD S SEE PAGE 60 T30 NI R :-.15 W Me/~.:~ L¢'"cenca ch9 E Joan iN. 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Th H/becl'E LouS4 .r Z1. • S..n meson N v ry I c~ e Bono. 2O Ma f 0 b~ C Curt ~.r3°oth °7-~ zoo b K 3a~. ¢fi/ a tl;To n 3 0 9 rJ¢.-v//~ f -fo _nowse - /s8 rYa/ Boris C t o o fie/d I~W ~y q ry TE.9er~ UST/~ t~ ~j5c3 L auren ca F Q'0 @~ ~i¢ ooM r.e ° /zo ' Hbb.a Na.. erv .B fh C Q~r ~T JV p / aJ~ do /z/ 71 ~ m a ~C C tl Gee 3 seP/tye mQ ~o np 0~0 oe~ r rya„ chi zzB ~ 0~3y /l./fog • ° .Do°av Ctl O~ vet' CBo 6'y 0~.~, C Y y Mart nsoa t;Berec%y o F ry W~ /U'6' 12B "/Dn- uJ~~ • ~ o4`iW do .c ~h wa /o'f ~wT ~0 Jo d~ 1.3373 •~°6erl-~ ~ ~~~°a~~u- J hem C shy t° c /96B ,Q c,(cf P DD c°P - mac' Ro. BO r / " ,ec W C cd Ma 6/s,7 c P /yr SEE PAGE 37! O ~St C/-o xo Co°afy tv/~s. GLENWOOD GLENWOOD CITY GLENHAVEN, CITY AUTO CO. CO-OP SERVICES INC. GLENWOOD CITY, WISCONSIN 54013 Your Home - a Away From Home Phone: 265-4224 Intermediate Care Mill: 265-4827 - Fertilizer Plant: 265-7212 Facility PHONE: 265-4877 . • GAS * FUEL OILS * LUBE OILS Phone. 265-4555 TIRES * LP GAS ACCESSORIES GLENWOOD CITY, UNIVERSAL MILKERS * FERTILIZER 612 East Oak WISCONSIN L ERR GRASS SEEDS * FEED, BAG $ BULK Glenwood City, Wisconsin 54013 Wisconsin Depmrtment of Health "d Sooial Services Plb. j967 3 70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. Ct.,PNER OF PROPiRTY Name Address (Street, City, Lip Code) Be LOCATION OF PROPERTY Wtr:RE SYST"z,'; WILL BE CONSTRUCTED. ALTERED OR EXTENDED COUNTY Check One; CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP t s / iG'C / t ~ ZS~~~ C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? X YES ~ NO ~ )C PE IT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEIEh`(-, ADDITION MATERIALS; Prefab Concrete Poured in Place Steel Other NLniiBER OF TIONKS TO BE INSTALLED: E. TYPE OF OCCUPANCY -Check One; One or Two Family Residence Commercial Industrial Other Speclfy) Number of Persons to be Accommodated_ Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES X NO Automatic Clothes Washer n YES NO Dis'rnasher YES NO Automatic Potato Peeler YES~P NO Other (Specify) G. MASTER PlaaER MAKING INSTALLATION Name: 1 1 f~~ Addresst ~J~~k X7(1 j) t V License Number: G\-j MP Signature of Applicants ~MP RSW 1r. Address: j L ; r/' r(, t~c T H. (To be Completed by issuing Agent) Date of Application r. Fee Paid Permit Issued (date) Permit Number S Agent (Name) / r Fort r Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above q,-:Pstions are answered and the fee paid. Agents wi.~ forward application, the fee of $I.Ou for each septic tanx and the third copy of the permit (oa^.a.ry) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY RETURNED (Initials) (Date) See rjrres.) ~~I ~ FEE RECEIVED VALID. No. _ PERMIT NO. 11 Yes or No REVIE`'aD BY APPROVED DATE (Initials) Yes or No COMPLETE O^ti[&R SIDE . SEPTIC T&NK PERMIT NO. f R E P O R T O N S O I L P E R C O L A T I O N T E S T A N D S O I L B 0 R I N G S TO DIVISION OF HEALTH - PLLFSHIN3 SR.CTIN P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P 8 R C 0 L A T I 0 N T E S T Test Depth Character of Soil Hours Water Test Time Drop in V top Level Inohes inutos Number Inches Thieltness in Inches Since Hole in Holo Interval Second to Next to last To Fall 1st Wotted Overnight -in Minutes Last Period Last Peried period Onr Inch Example P - 0 36" To Soil 1011, Clay 26" 25 Yes or No 30 __k2 __A J2 1/2 60 7F n RECORD DATA FROM MINIMUM OF j,~ ST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B 0 R I N G S- Minimim 36" Belot Pro osed Absorption Eaton Boring Total Depth Depth to Ground Water De th to Bedrock Number Inches O'oservod Estircated Observed Esti-_sted Character of Soil with Thickness in Inches Example B - 0 72" 72" Black To Soil 12111 Clay 18°;Sand 18"; Gravel 2411 0 RECORD DATA FROM MINDIUM OF 3 BORE HOLE: TYPE OF OCCUPANCY: RESIDENCE: Number of Bedrooas OTHER: (Specify) Number of Persons FOOD WASTE GR LNDERs Yes No Dislwasher: Yes o Automatic Clothes Washer: Yes No \ --/-7" EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION LDITION REPLAC~NT Tile Size No.Lin.Feet Trench WDepth _ Number of Lines ~ Seepage Beds Length _ Width Depth/ Tile Size No. Lines Seepage Pit: Inside Diameter Liquid Depth I, the undersigned, hereby aerti y that the percolation tests reported n this form were made by me or under m~ super- vision in accord with the procedures and method speoified in Chapter H 62.20 (13), Wisconsin Adrunistrative Code, and that the data recorded and location of test :holes are correct to the best of my knowledge and belief. i NAME R C'i. TITLE Type or Print) REGISTRATION NO. or MASTER PLU11,13ER LICENSE NO. ADDRESS 1 f., r~ ~r f t~ DATE SIGNATURE