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Parcel 016-1046-80-000 02/28/2006 11:36 AM
PAGE 1 OF 1
Alt. Parcel 21.30.15.338B 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
ANN M LE OHMAN O - OHMAN, ANN M LE
1489 290TH ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 290TH ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
N/A-NOT AVAILABLE
Legal Description: Acres: 13.000 Plat:
SEC 21 T30N R15W PT NW NW BEGIN SW COR Block/Condo Bldg:
SD 40; TH N 955 FT; E 673 FT S669 FT; W
200 FT; S 286 FT TO S LN; TH W 473 FT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
POB 21-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/12/2004 768497 2614/276 QC
08/14/1998 585066 1348/414 QC
2005 SUMMARY Bill Fair Market Value: Assessed with:
89408 179,700
Valuations: Last Changed: 10/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 12,000 121,800 133,800 NO
PRODUCTIVE FORST LANDS G6 11.000 17,600 0 17,600 NO
Totals for 2005:
General Property 13.000 29,600 121,800 151,400
Woodland 0.000 0 0
Totals for 2004:
General Property 13.000 29,600 121,800 151,400
Woodland 0.000 0 0
Lottery Credit:
~ Claim Count: 1 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
;,NER 1110 4A/ , TOWNSHIP&v c SEC. T N, R /n W
0. ADDRESS-__) ST. CROIX COUNTY, WISCONSIN.
3DIVISION , LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
)rq /V
~A
1
?TIC TANK(S)MFGR. L , t. s c l~'3 CONCRETE_.2L_ STEEL
NO. of rings on cover I Depth DRY WELL
3NCRES NO. of width ~ lefigth f! ' area J;£
"J no. of lines- width_ye _ length area .
depth to top of pipe L ft
3REGATE
K RATE' AREA REQUIRED AREA AS BUILT
7t
sciaimer: 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
stem operation. However, if failure is noted the County will make every effort to
--ermine cause of failure.
"'ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSPECTOR
DATED PLUMBER ON JOB L z
LICENSE NUMBER
e
' w
REPORT OF I1ISPEC'TION--I1DIJIDUAL SET,,JA(',E DISPOSAL SYSTEM
Sanitary Permit
t State Septic j'D Z~/
T&WNSHIp L<
Croix County
St~.DTIC TA711:
Size
) gallons. `lumber of Conpart:nenta
Distance From: WeII ft, 12% or greater slope ft.
Building `.{1 ft. Wetlands ft
Highwater ft.
DISPOSAL SYS77:4 Tile Field or Seepage Pit(s)
Distance From: i1ell ft. 12% or greater slope" 7 ,S ft
Building ft. Wetlands f:.
FIELD Nighwater ----ft.
Total length of lines ft. Number of lines. Length of
each line 4 ft. Distance between lines ft. Width of the
trench ft. Total absorption area t, sq. ft. Depth
of rock below tile _L,- in, Depth of rock over the in. Cover
~ ~ , ,ter
.over. rock, Depth of file below grade
< < ° in. Slopo of .
trench _if# per 100 ft. Depth to Bedrock ft. Depth to
ground water ---°T` ft.
PITS
I
Number of pits Outsihe dia4ter ft. Depth below inlet
ft. Gravel around it~ ^'.s, no. Total absorption area
`P
sq. ft. v'
.Square feet of seepage trench bottom area required
`square feet of seepage pit .~rea,~required .
Inspected by Title
Approved -Date 197 f
Rejected Date 197
EH 1 15
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
LOCATION: Section., 1*0 N, R6'91111111111P W, Township or`~~~~~
Lot No. , Block No. County Re I A
C :7-e ~N ~ Subdivision Name
Owner's Name:
Mai Iing Address: RA ,2- ~~~-+IL y0C/ ty A-,i,
TYPE OF OCCUPANCY: Residence No. of Bedrooms ;2- Other
EFFLUENT DISPOSAL SYSTEM: NEW- X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS ¢ G E- 175' PERCOJ-ATION TESTS )7-
SOIL MAP SHEET ~ ) SOIL TYPE
PERCOLATION TESTS
TEST ]DEPTH CHARACTER OF SGIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
Zv ~1y s'
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-
ad- Ne -5
B- S en i
lye >
B-
PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of itable areas. I irate number of square feet of absorption area
needed for building type and occupancy. _ I e Indicate scale
or distances. Give horizontal and vertical reference points. Ind a e slope.
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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. U
Name (print) A L S M/ /y Certification No. d
Address c- 70 &`Z
Name of installer if known d
Signature
COPY A LOCAL AUTHORITY CST Sign
1
State and County State Permit #
PLB67 Permit Application County Perm
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:
B. LOCATION:'/&f Av '/4, Section, T-70 N, R11$
r) W Lot# City
ANOW
Subdivision Name, nearest road, lake or landmark Blk# Village
Township GhGC3.fA/KlO~d
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family ( Duplex No. of Bedrooms aL. No. of Persons 2-
D. TYPE OF APPLIANCES: Dishwasher __X_ YES NO Food Waste Grinder-kYES NO # of Bathrooms-/-
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY~0 Total gallons No. of tanks /
Holding tank capacity Total gallons No. of tanks
Jew Installation X Addition Replacement Prefab Concrete
'Poured in Place Steel Other (specify)
-;FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) _4t 2)-r 3) _7-Total Absorb Area sq. ft.
lew Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet - $/o Depth Tile Depth r No. of Trenches -&V
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land 07 V, Distance from critical slope'
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
'':%isconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
iw the Certified Soil Tester,
t,i.AME 6-+,4,9 S-Mj_/ td C.S.T. # 176 and other information
o stained from (owner/builder).
s'lumber's Signature / MP/MPRSW# Phone #:~65'
Plumber's Address (A j2 /j
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
G"'te?tL
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Do Not Write in Spac Below FOR DEPARTMENT USE ONLY c G,
Date of Application - _Fees P id: Stater, c7c County Date
Permit Issued/Reiee~sd (date) - Issuing Agent Name G -u~ -
Inspection Yes_,f 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