HomeMy WebLinkAbout040-1105-40-125 (3) County Sanitary Permit Application ST.CROIX COUNTY WISCONSIN
In accord with Chapert 12 St.Croix County Sanitary Ordinance • PLANNING&ZONING DEPARTMENT
w'r Personal information you provide may be used for secondary purposes ST.CROIX COUNTY GOVERNMENT CENTER
l ' '\ 1101 Carmichael Road
[Privacy Law.S.15.04(1)(m)]
0 s �� �,'3 i"'4! ,'. '{ Y Hudson,WI 54016-7710
P 1 Ox ( N f.,. t1 (715)386-4680 Fax(715)386-4686
GRO\�GO Op Attach complete plans for the system on paper not l s5 than 8-1/2 x 11 inches in size.
5'(, „.4 County Sanitary Permit# ❑ Check if revision to previous application
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I. Replication Information-Please Print all Information Location:
Property Owner Name t� //�� � ' _-1 1/4 1/4,Sec Ti 7
$Y{� ica per la a,r) C rSk T Z 8 N, /9 R A) E(or)W
Property Owners Mailing Address Lot Number Block Number
— —
1b5 S • GT1®vev - - -- - ;�- - - -
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City,State Zip Code Phone Numer Subdivision Name or CSM Number
River FttAIS WI 5Y4 2Z 71r-'-P- !_ ZloteD zz-s-yoo,
II T e of Building: (check one) Q I�ity ❑Village 1,21-Town of
I1 or 2 Family Dwelling-No.of Bedrooms: '9' NO ffr9B/T02-ic"47/
❑ Public/Commercial(describe use): 7/��o y
❑ State-owned Nearest Road
II.Type of Permit: (Check only one box on line A. Check box on line B if applicable) 43 S 644 RD
Parcel Tax Number(s)
A) 1.0 Repair 2.❑ Reconnection 3.Non-plumbing 4.❑Rejuvenation I ow -11p,{;. y0- /2b
Sanitation
B) Permit Number Date Issued
❑ State Sanitary Permit was previously issued
IV.Type of POWT System: (Check all that apply)
❑ Non-pressurized In-ground ❑ Mound a 24 in.suitable soil ❑ Mound 5 24 in.suitable soil ❑ Mound A+0
❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line
❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass pl Other — Gaifte°SrA"
❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating 7P74.&"(—
V.Dispersal/Treatment Area information:
1.Design Flow(gpd) 2.Dispersal Area 3.Dispersal Area 4.Soil Application Rate 5.Percolation Rate 6.System Elevation 7.Final Grade
Required Proposed (Gass./day/sq.ft.) (Min./inch) Elevation
___________ ,----
VI. Tank Information Capaicty in Gallons Total #of Manufacturer Prefab Site Con- Steel Fiber- Plastic
New Existing Gallons Tanks Concrete structed glass
Tanks Tanks
❑ ❑ ❑ ❑ ❑ _
❑ ❑ ❑ 0 ❑
VII.Responsibility Statement
I,the undersigned,assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A
lice licerxAM5required for terralift repair r he i lation of non-plumbing sanitation system. 1
Ps ame(print) Signature(C tam s): ° MP/MPRS No. Business Phone Number
13rerda & S+cr)d- gwev d� 1
Plumbers Address(Street,City,State,Zip Code)
CSAN
Ill.County Use Only
❑Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature(No stamps)
[k Approved ❑ Owner Given Initial Adverse _ p / _- •// `4
Determination ��� �� Z �o /-� �* / i9ø
[X.Conditions of Approval/Reasons for Disapproval:
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2015 Property Record 1St Croix County, WI
Assessed values not finalized until after Board of Review.
Property information is valid as of FEB 172015 10:26PM .
OWNER CO-OWNER(S)
EVAN W&BRENDA L CARSTEDT
163 S GLOVER RD
RIVER FALLS,WI 54022 FORMER OWNERS
PROPERTY INFORMATION PROPERTY DESCRIPTION
Parcel ID: 040-1105-40-125
SEC 27 T28N R19W PT SE NE CSM 22-5406 LOT 1
Alternate ID: 2728.19.4198-10
Property Address:
School Districts:
SCH DIST RIVER FALLS 163 S GLOVER RD
Municipality: TOWN OF TROY
Other Districts:
CHIP VALLEY VOTECH
Section Town Ranae Qtr Qtr Section Qtr Section DEED INFORMATION
Volume Paae Document#
Block: 885288
Plat Name: 857639
CSM 22-5406040-2007 22, 5406 852380
Plat History: 2840 799924
1583 4.1.Lt 638052
(2015)CSM 22-5406 040-2007 02 434390
231 194 428754
Z a 428340
TAX INFORMATION
Net Tax Before: .00
Lottery Credit 00 LAND VALUATION
First Dollar Credit .00 Valuation Date: 20120820
Net Tax After •00 Code Acres Land Value Improvements Total
Amt.Due Amt.Paid Balance s 1.000 50,000 258,400 308,400
Tax .00 .00 ,00 N 5.470 1,000 0 1,000
Special Assmnt .00 .00 .00 s 1.000 100 0 100
Special Chrg .00 .00 .00 M 8.106 32,400 0 32,400
Delinquent Chrg .00 .00 .00 15.576 83,500 258,400 341,900
Private Forest .00 .00 .00 Total Acres: 15.576
Woodland Tax .00 .00 .00
Managed Forest .00 .00 .00 Assessment Ratio 0.0000
Prop.Tax Interest .00 .00 Mill Rate: 0.000000000
Spec.Tax Interest .00 .00 Fair Market Value: N/A
Prop.Tax Penalty .00 .00
Spec.,Tax Penalty .00 .00
Other Charges .00 .00 .00 INSTALLMENTS
TOTAL .00 .00 .00
Over-Payment: 00 Period End Date Amount
PAYMENT HISTORY(POSTED PAYMENTS)
General Specie
Date Receipt# Source Tvoe ¬ Tax Status Assess.Status Interest Penalty Total