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Parcel 016-1038-40-000 02i28/2006 11:11
PAGE 1 OF 1
F 1
Alt. Parcel 17.30.15.279A 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 - ANDERSON, TIMOTHY C
TIMOTHY C ANDERSON
2846 150TH AVE
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2846 150TH AVE
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE
SEC 17 T30N R15W SE SW EXC W1/2 OF SE1/4 Block/Condo Bldg:
SW1/4 AS IN 646/582
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1115/548 WD
07/23/1997 891/311
07/23/1997 796/280
2005 SUMMARY Bill Fair Market Value: Assessed with:
89325 Use Value Assessment
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 18.000 1,800 0 1,800 NO
OTHER G7 2.000 9,000 88,100 97,100 NO
Totals for 2005:
General Property 20.000 10,800 88,100 98,900
Woodland 0.000 0 0
I
Totals for 2004:
General Property 20.000 10,800 88,100 98,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 145
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
X" 11:11 INS.r1 l1I\1
'aER TOWNSHIP SEC. f T N, R W
J. ADDRESS , ST. CROIX COUNTY, WISCONSIN.
'?DIVISION LOT LOT SIZE
~L
~
PLAN VIEW
Distances & dimensions to meet requirements of H62,20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
\ 0
:'TIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
.NCHES NO. of width length area
no. of lines width length area
depth to top of pipe `
,REGATE
_K RATE AREA REQUIRED AREA AS BUILT
.claimer: The inspection of this system by St. Croix County does not imply complete ;
pliance with State Administrative Codes. There are other areas that it is not possible /
inspect at this point of construction. St. Croix County assumes no liability for
tem operation. However, if failure is noted the County will make every effort to
.ermine cause of failure.
i-SES Ah'D OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSPECTO
DATED PLUt1BER JOB
LICENSE NU:iBER
.0
Z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM J
Sanitan y Penmit7 ' /
State Septic
NAME Tawnshi St. Cnaix County
Location % o6 Secttian T N, R CU
SEPTIC TANK
Size gatton1s. Numbe). a6 Campvttments
Di,5tance Fnam: WeU 12% m gneateA stope it
Building (r te it. WetZand/s
- ~ .
DISPOSAL SYSTEM Hig.hwaten
Di,5 Lance Fnam: W ett 12% an gneaten 15 f.a pe: it.
Building / GIe 2and~s Ft.
Highwatet it.
FIELD DIMENSIONS: s
Width a6 thench it. Depth Z6 na.ck betaw tite /'--in.
Length a6 each tine'-, -c'it. Depth a6 nack aveh tite in.
Numbers aj Zinens ~ Depth a6 tite be.Eaw gnade in.
Totat .length a6 .roes i it. S2ape ai ttc.ench in pen 100 it.
Di,s lance between tines it. Depth to b edrea ck ~ .
Tatat absoAbt.ian anea 6t2 Depth to gnaundwatet --tt.
2
Requitced anea
PIT DIMENSIONS:
Numbers o6 pit/s G A.h v%2 r anaund p~ ~s yep no
Ou rs ide dame en epth be.Law intet it.
Tata.E abzmbtian anea it 2
z
Anea nequ~A it2 rn
INSPECTED B - TITLE-'~
APPROVED% , DATE % 19 7 r
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 TES/T~
LOCATION: /4 VV /4, Section 4, T] 30N, R I E (or)QTownship or Municipality
Lot No. , Block No. ~ County
Su ivision Name,
Owner's Name: fS
-
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW I/ ADDITION REPLACEMENT /
DATES OBSERVATIONS MADE: SOIL BORINGS/- 7 ,{ate PERCOLATION TESTS/
SOILMAPSHEET°- SOIL TYPE-
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL 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-
"3 t x 0
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)
B-
B- A T,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 number 9f square feet of absorption area
needed for building type and occupancy. C' C Indicate scale
or distances. Give horizontal and vertical reference points. l&cate I 1
1
` 5 i I I I I
I ! { S , ~ I , ~ y I
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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
l
Name (print) Certification No.
Address :a~ 1~Q
Name of installer if known
~ ~ / •
COPY A -LOCAL AUTHORITY CST Signature
I
State and County State Permit #
PLB67 Count Per t #
Permit Application Y
for Private Domestic Sewage Systems County~}~
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. # _
A. OWNER OF PROPERTY Mailing Address:
1~ uP
B. LOCATION: ~S '/4 Section T~ N, R_1, (or) ~ot# City,
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPA *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms oZ No. of Persons /
D. TYPE OF APPLIANCES: Dishwasher YES 1-`NO Food Waste Grinder YES O # of Bathrooms
Automatic Washer ✓1(ES 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. EFFLUE , DISPOSAL SYSTEM: Percolation Rate 1) 2) (cam3) 6Total Absorb Area _5,jn sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width _ Depth j ~Tile Depth ( 20 No. of Trenches-S-1
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 slope _
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 C rtified Soil Teste
c'-
NAME - C.S.T. # ST5-O 0 nd other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# Phone #
Plumber's Address L?.
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below FOR DEPARTMENT USE ONLY
Date of Application- g Fees Paid: State (rJ , 0 U County, Date
Permit Issued/Rejeeted (date) j' 7 e Issuing Agent Name U
Inspection Yes No 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