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Parcel 016-1070-10-100 02/28/2006 11:53 AM
PAGE 1 OF 1
Alt. Parcel 33.30.15.490A 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 - FRIEBURG, DONALD & JULIE
DONALD & JULIE FRIEBURG
1284 300TH ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 300TH ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 35.411 Plat: 4424-CSM 16/4424
SEC 33 T30N R15W NE NE EXC CSM 16/4424 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 441/464
2005 SUMMARY Bill Fair Market Value: Assessed with:
89625 Use Value Assessment
Valuations: Last Changed: 06/06/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 24.000 3,700 0 3,700 NO
AGRICULTURAL FOREST G5M 9.411 9,500 0 9,500 NO
OTHER G7 2.000 9,000 98,500 107,500 NO
Totals for 2005:
General Property 35.411 22,200 98,500 120,700
Woodland 0.000 0 0
Totals for 2004:
General Property 35.411 31,700 98,500 130,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 113
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
;tNER &Iywd - l~ f~lyt- '6 TOWNSHIP6'/_e4liveett SEC. j ~ T_20 N, R~W
.0. ADDRESS % 4 C: j_ rN j,,,".rr a ~ ST. CROIX COUNTY, WISCONSIN.
LBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
pflY
s
Ile y Sc° a2 _ 'i' `X !i= ,v e ye 3
3
?TIC TANK(S). MFGR. 6+s / _5 E .~75 CONCRETE STEEL
NO. of rings on cover, Depth " DRY WELL
'.3NCHES NO. ofwidth 0 L' length ' "f"' . areaZ.~z
_D no. of lines width length area
depth to top of pipe
ILI_
:z>REGATE
=-Rt RATE AREA REQUIRED G AREA AS BUILT
.sciaimer: The inspection of this system by St. Croix County does not imply complete
:mpliance 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
..termine cause of failure.
2ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR
DATED PLUMBER ON JOB.'"
LICENSE NUMBER .y E ~J l
kr,popT OF I11SPECTIO.I--174DIJIllUAL SEOJAGE DISPOSAL SYSTE14
Sanitary Permit
r State Septic
1E
f~.LJ~~}+ T0MISHI P
• t. Croix County
Si?°TIC TA711~
Size /00 gallons. `1 ber of Comoartments /
/007- Distance From: Tell ' Aizzy -ft. 12% or greater slope ft.
• Building ft. Wetlands f.
Highwater A~14,'ft.
DISPOSAL SYST2.:1 Tile Field or Seepage Pit(s)
Distance From: Oell V ft. 12% or greater slope--AC-.,Cft
Building; ft. Wetlands f
FIELD Highwater ft.
Total length of lines 1 ft. ;Number of lines Length of
each e 7t5 ft. Distance between lines ft. Width of the
trend ~ft. Total absorption area ' sq. ft. Depth
of rock below tile in. Dp-pth of rock over the in. Cover
over -rock,,, Depth of tile below grade 4j in. Slope of
trench in ner 101 ft. Depth_ to Bedrock ft. Depth to
I
ground water ft.
PITS
Number of pits 0Utsicle'~,diar~e't~rr ft. Depth below inlet
ft. Gravel around p .t : es no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
Square feet of seepage-l'y,iE- a`tea equired
Inspected hy.- ''f '~"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
LOCATION: 'f'Y%4, Nk/4, Section 13,17a N, R 16!ft) W, Township or, htnoW*w6i" ea/
Lot No. , Block No. County
~0~*,4d FA % a '9'W1? 5K Name
Owner'sName: ~7 D / X
n
Mailing Address: !I C-1- 6'/U A./op cy V
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT t{
DATES OBSERVATIONS MADE: SOIL BORINGS P RC CATION T STS Ae 7X
SOIL MAP SHEET C~`5 SOIL TYPE
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IACTERN INCHES SINCE HOLE HOLE AFTER INTERVAL ~BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
F
Vie? ,oq Nc p ,2 l
41
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 A a > It4,
B- ;1:2- A/0 >
B 7~- NO
FLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
dicate on the plan the location and square feet of suitable areas. I irate numb r square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give horizontal and vertical reference points. Indids pe.
1 E
'177
r t
~ 4 P
Ay- - _ ot k,
l
~40
1 i
' '4'1111"__~[] 4-A. 1 1 1 1
r ,
3
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i I
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.
r
Name (print)Certification No. 171f
Address j~l 1c J r7 Z? a / LIT lt✓ -
Name of installer if known /lq % jf/
CST Signature ~L•'
COPY A -LOCAL AUTHORITY
State and County State Permit #
PL B67 Permit Application County Per
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: ection T 31 N, R E (or) W Lot# -City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township & eN+wc or
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _ Duplex No. of Bedrooms No. of Persons T
D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder_)(_YES NO # of Bathrooms-/-
Automatic Washer (YES NO Other (specify)
E. SEPTIC TANK CAPACITY 10 p0 Total gallons No. of tanks /
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement __X_._. Prefab Concrete X _
*Poured in Place Steel Other (specify) -
EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 1-6" 2) _/f_ 3) _7 /L/ Total Absorb Area ~'D sq. ft.
New Addition Replacement *Fill System -
No. of Trenches _
Seepage Trench: No. Lin . Feet Width ~a Depth d" Tile Depth 2 1K
seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land 31, 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 Certified Soil Tester,
NAME 45;!,q4 C.S.T. # and other information
obtained from- eA/ L (owner/builder).
Plumber's Signature - 41 MP/MPRSW# --46~ Phone
Plumber's Address Al +L y o d C f r!i
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
R~rve
V, le N
l--
1 6f J
/opo C,44 r' ~~~N~ S SLOpe
r.4 N t)-
~N
Do Not Write in Space BFlow FOR DEPARTMENT USE ONLY
~I - p
Date of Application _ " .J Fees Paid- State/6.:, G C % Cou Date
r /
Permit Issued/ (date) Issuing Agent Name
Inspection Yes: No Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
state (pink copy) 4. plumber (canary copy)