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Parcel 010-1023-70-000 02/22/2006 09:50 AM
PAGE 1 OF 1
Alt. Parcel 10.30.16.146C 010 - TOWN OF EMERALD
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 - TRIEBOLD, ROBERT A SR & DONNA
ROBERT A SR & DONNA TRIEBOLD
2402 160TH AVE
EMERALD WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2402 160TH AVE
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 1.500 Plat: N/A-NOT AVAILABLE
SEC 10 T30N R16W 1.5A IN SW SW LOT 1 CSM Block/Condo Bldg:
VOL 2/579
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
10-30N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
80071 132,200
Valuations: Last Changed: 10/19/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.500 12,000 109,500 121,500 NO
Totals for 2005:
General Property 1.500 12,000 109,500 121,500
Woodland 0.000 0 0
Totals for 2004:
General Property 1.500 12,000 109,500 121,500
Woodland 0.000 0 0
Lottery Credit:
Claim Count: 1 Certification Date: Batch 204
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 30.00
Special Assessments Special Charges Delinquent Charges
Total 30.00 0.00 0.00
RRRPOI;T OF IIISPECTION--INDIVIDUAL SETIAGE DISPOSAL SYSTEii
_ Sanitary Pei-mit
e i State Septic
T&WNS H I P
• 4F. Croix County
S^PTIC TA'?K _ SO O
Size Elallons. '-,umber of Compartments
Distance From: Tle11 % =l ft. 12% or greater slope 1.
Building l ft. Wetlands r- f
Iiighwater_ft.
DISPOSAL SYSTL,.7 Tile Field or Seepage Pit(s)
Distance From: Well
- ft. 1?l0 or greater slope ft
Building; ft. Wetlands f
FIELD i;iphwater ft.
Total length of lines ft. Number of lines : Length of
each line ft. Distance between lines ft. Width of the
trench .-ft. Total absorption area sq. ft. Depth
of rock below the _ in. Dp-pth of rock over tile in. Cover
over.. rock , . Depth of the below grade in. Slope of
trench in per 100 ft. Depth to Bedrock ' ft. Depth to
ground water / ft,
PITS
'lumber of pits Outsic'.a diameter ft. Depth below inlet
ft. Gravel around pit: .yes no. Total absorption area
sq. ft.
.Square feet of seepage trench bottom area required
Cquars feet of seepage pit area required
Inspected by: Title:
Approved Date 197.
Rejected Date 197
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 TESTS
LOCATIONt~J+s~' ,!JL__I-'/4, Section R/6 E (o W ,Township or Municipality
Lot No. &TO c o. S d~visicin N me D' County ST C V I
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence - ~ No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW I1--, ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS-Y/3 126 ' PERCOLATION TESTS
SOIL MAP SHEET SOI L TYPE''
PERCOLATION TESTS`
TEST DEPTH HOURS WATER IN EST TIME (DROP IN WATER LEVEL, INCHES RATE
OF SOIL i 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-
23
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P_
133 1-
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)
tt
IB-
I
j B-
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soi areas.)
indicate on the plan the location and square feet of suitable areas. Indicate number of square fee o p_ior ,irt
needed for building type and occupancy. 77'~;'O a G' Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
1 -
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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
~ a
Name (prim RI C__ Certification No. 5 5--o o
Address
Name of installer if known.- ?
CST Signature • 1
[COPY A -LOCAL AUTHO:^.! MINNOW
State and County State Permit #
#
~ County Per
PLB#67 Permit Application
r
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
E OF PROPERTY ` Mailing Address:
i
B. LOCATION: '/4, Section l°0 N, RI& E (or) W~ Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms _No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES- O # of Bathrooms
Automatic Washer L/ YES NO Other (specify)
E. SEPTIC TANK CAPACITY Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation -Addition Replacement- Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1 2).~?03)fotal Absorb Area sq. ft.
New ✓ Addition Replacement *Fill System
i
Seepage Trench: No. Lin. Feet / 5-4P Width -j7 Depth e Depth ~ No. of Trenches
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land Distance from critical slop
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 rtfied Soil Tester,
NAME i C.S.T. C70G° and other information
obtained from (owner/builder)
Plumber's Signaturei~ MP/MPRSW# 4 r Phone 46:,yd3? 2
Plumber's Address - VW! - LS'
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H6'-.-,O, including well).
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Do Not Write in Space Below FOR DEPARTMENT USE ONLY
< Fees Paid: Statee'C?- t~l ;-7 County. Date
Date of Application r
Permit Issued/Red- (date) -Issuing Agent Name,--y'Zz / i 7' , ~u,
Inspection YesNo Valid# Date Recd
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 6/1 /76
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