HomeMy WebLinkAbout038-1004-70-000
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Parcel 038-1004-70-000 06/15/2007 04:37 PM
PAGE 1 OF 1
Alt. Parcel 2.31.18.7D 038 - TOWN OF STAR PRAIRIE
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
GENE G & A ELAINE GOVE O - COVE, GENE G & A ELAINE
PO BOX 636
HASTINGS MN 55033
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 1700
WITC
SP 8055 CEDAR LAKE/N R
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 2 T31 N R18W LOT 4 CSM V 1 P15 PRT GL Block/Condo Bldg:
1 COM NE COR SEC 2, W 2580.5 FT, SLY 225
FT TO POB: SLY 80 FT, SWLY TO SHORE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
CEDAR LAKE, NWLY TO PT S 73 DEG W POB 02-31 N-1 8W
NELY-POB
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 725/443
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 127,200 109,400 236,600 NO
Totals for 2007:
General Property 0.000 127,200 109,400 236,600
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 127,200 109,400 236,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Health and Social Sarviees
Plt 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or LSE BLAOK INK
A, OWNER OF PROPERTY
Naate Address (street, city, Zip Codo)
_ SYSTPI WILL BE CONSTRUCTED, ALTEREL OR EXTENTiED COU?7'y
B. LOCATION OF PROPERTY WF-,'RE
Check One:
CITY VILLAGE LEGAL DESCRIPTION
+ TOWNSHIP i
C. IS LOCAL PERt;IT REOUIkED FOR THIS `dORK?~ YES NO PERMIT NLi1BER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION A REPLACEMENT ADDITION
MATERIALS: Prefab Concrete x Poured in Place Steel Other
NU?SER OF TANKS ?0 BE INSTALLED: C
E. TYPE OF OCCUPANCY /
Check one: One or Two Family Residence / Cos;mercial Industrial Other
(Specify)
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dishwasher m Y NO Automatic Potato Peeler YES__,~_ NO
Other (Specify)
G. KASTER PLUtBER MAKING INSTALLATION
Name: 4-f,,' z-/-7- Address: R, Jfi License Number:
Signature of Applicant: RSN
f t
Address:
H, q(7-~ a Completed by Issuing Agent)
/ ~
Date of Application / 1 L Fee Paid
Permit Issued (date Permit Number 17_L,'
Agent (Name) Fors e I
T Town, Village, City, County, etc.
(Specify)
Note: The application cannot be considered for filing until all of the above questions are answered and the
fee paid. Agents wi:l forward application, the fee of $1.0i` for each septic tanx and the third oop;-
of the permit (canary) to the Division of Health. Checks and money orders should be made payable to
the Division of Heai,th.
Do not write in spare below - FOR DEPARTMENT USE ONLY
1. DATE RECEIVED? ACCEPTED BY RETURNED
(Initials) (Date) 5ee_Corres.)
FEE RECEIVFD VALID. No. PERMIT NO.
(Yes or No
I REVIEWED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
w _
SEPTIC TANK PERMIT NO.
R E P O R T O N S O I L P E R C O L A T I O N T E S T
A N D S O I L B O R I N G S
TO
DIVISIOW OF HEALTH - PLUFMIrG S XTIN
P.O.Box 309, F.,,dison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P Y R C 0 L A T I 0 N T E S T
Test Depth Character of Soil Hours Water Test Timc Drop in W-Iter Level Inches inute3
Number Inches Thio~'ne3s in Inahas Since Hole in Hole Interval Second to Next to Last To Fall
lst Wetted Overni; t in Minutes Last Period Last Period Period On3<Inch
Example
P - 0 3611 To Soil 10"Cla 261, 25 Yes or No 30 112 1/2 1 2 60
-r
RECORD DATA FROM MINL`:UM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L B O R I N G S- Mini.aum 361, Belcm Pro osed P.bso tion S stsm
Boring Total Depth De th to Groundn Water De th to Bedrock
Number Inches Coserved Estimated Observed Estir~-.,3ted Character of Soil with Thiokness in Inches
Example
B - 0 72~ 72'1 Black To Soil 12" Clay 18" Sand 1811, Gravel 24"
70
2 7,
RECORD DATA FROM MIVL'IUM OF 3 BOBS HOLES
YPE OF OCCUPANCYs
RESIDENCE: Number of Bedrooms "~51 OTHER: (Specify) Number of Persons
D WASTE GRINDER: Yes No Distmashsrs Yes No Y Auto. silo Clothes Washar: Yes No
EFFLUENT DISPOSAL SYSTEM- NEW ~ EXTENSION ADDITION REPLACE`IE:r'T
Tile Size NO.Lin.Feet T Trench Width Depth t' Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
1 Seepage Pits Inside Diameter ,Y ! Liquid Depth 7-:
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Adainistrative Code, and
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
NAME TITLE C",; ' Nye %=i?
Type or Print
REGISTRATION NO,. or MASTER PLUMBER LICENSE NO.
ADDRESS 4 A
DAB' SIGNATUR& ~TT
,