HomeMy WebLinkAbout030-1063-90-000
n N O g 'u n
o w f c o
o o 3 ~y
m ~ m ~ a: e
3 d A
r O
(17 Z 2 cn O A C7 C N o ~1 •
O N m N) r- A
(O N O ~5/li
O D_O (D co O
C- . Q _ to O 7
W O (D W C ~ ~ (O W C
N O- 3 N 3 ? N R
A N Co
O
d O _ _ p Nti1
v 7 N p O O pi\
c _ O C' !V
d ~
G CD
z r m P-
0 w. a _O
a C-
z co co <
<
p
u P _
CL Co ? Z
z co * n r to
o N
o c
0 0 ;u
v v v o ° h.
z O O O
° n r * * * ~N
cz ! n c cn N N
CT -0 v q
Qo
Q
(D (D (D cr
m N c
ti m
m CL
z A N N
Z W 'Y
A z cn z O
D 0 0
CD
O
o' Z o "it
N N
~ N
C (D
a
G
z m -I to
Z m
i~ z o
G.
Cl)
W CD a Z
3 a _
o -
m o
z
O A
W
N ID
N
!C C
(D C-
O <
~ O
~ C T
O 2 G
N ICD
,a
0
a
a
a
0
~c o
<n O r
C) (e
CD a
Parcel 030-1063-90-000 05/18/2007 05:07 PM
PAGE 1 OF 1
Alt. Parcel 24.30.19.228C 030 - TOWN OF SAINT JOSEPH
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 - OMAN, JOHN R & MARGERY M
JOHN R & MARGERY M OMAN
808 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 808 140TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 24 T30N R19W PT SW SW COM 20 FT E OF Block/Condo Bldg:
SW COR SEC 4, TH N 208 FT, E 208 FT, S
208 FT, TH W 208 FT TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
24-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 464/493
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 40,000 116,800 156,800 NO
Totals for 2007:
General Property 1.000 40,000 116,800 156,800
Woodland 0.000 0 0
Totals for 2006:
General Property 1.000 40,000 116,800 156,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 132
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
.j r
Wisconsin Department of Health and Social Services
Plb. #67 10/69 Division o^ Health
- PERMIT APPLICATION
for
PRIVATE DU,1ESTIC SEWAGE SYSTEMS
iT
A. OWNER OF PROPERTY TYPE OR USE BLACK INK
t7ame Address (Street, City, Zip Code)
0 -2 i
ail, et;` X; XGr
County
B. LOCATION OF PROPERTY WH^F~E SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED
Check One:
CITY VILLAGE LEGAL DESCRIPTION: x L l 61,14
C ~ /7 S a :1
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO JJ~
J PERI`'iIT NU`IDER
D. SEPTIC TANK CAPACITY C.' Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUP'JER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence / Commercial Industrial Other
(Specify)
Number of Persons to be Accommodated Number of Bedrooms y
F. APPLIANCES, ETCS Food Waste Grinder YES NO Automatic Clothes Washer X YES NO
Dishwasher YES NO Automatic Potato Peeler YES k NO
Othor (Specify)
G. EFFLMiT DISPOSAL SYSTEM NEW A~ EXTENSION ADDITION REPLACUPENT
Tile Size No.Li.n.Feet Trench Width Depth Number of Lines
Seepage Beds Length Width _ Depth Tile Size No. Lines
Seepage Pit: Inside diameter .,G_-.._ Liquid Depth
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Waver Level Inches I'inutes
Number Inches Thickness to Inches Since Hole in Hole Interval Second to Next to Last To Fall
lst Wetted Overnivht ~in Mirlutes Last Period Last Perio Period Cne Inch
Example I
P- 0 361" To Soil 101" Clay 261" 25 es or no 30 l Z2 1/2 1/2 60
I
•i-. 1
i
: 10
RECORD DATA FROM M!'41MUM OF 3 TEST HOLE'S
I
ompute eize of absorption area in accord with H 62.20 Wis. Administrative Code.
S 0 I L B O R I N G S- Minimum 361" Below Proposed Absorption System on g Total Depth Depth to Ground Water Depth to Bedrock
umber Lnche_s Cbserved Estimated Observed Estimated Character of Soil with Thickness in Inches
Example
- 0 721" 721" Blaok To Soil 12"; Clav 1811; Sand 1811; Gra•tel 24"
7
RECORD DATA FROM MINIMUM OF 3 BORE HO;,ES
COMPLETE OTHER SIDE
I, the undersigned, hereby certify that the percolation tests reported on this forrn were made by me
or under by supervision in accord with the procedures and method spocified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and that the data recorded and location of test holes are oorroct to
the best of my knv+aledge and belief.
i
NAME TITLE
(Type or print) /
REGISTRATION NO. or MASTE PL 1,3ER LICENSE No.
, r
ADDRESS
DATE SIGMAIURE`
MASTER PUJIV5:R MAKING APPLICATION
Signatures I- A M i License Number:
NIP RSW
(To be Completed by Issuing Agent) / n
Date of Application Fee Paid $
Permit Issued
(y(da} Permit N~umber/
Agent (name)/~,~ t, flt For.: ✓ l C'-':
Town, Village, City, County, etc,
(Specify)
Notes The application cannot be considered for filing until all of the above questions are answered
and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
Do not write in space below - FOR DEPART:IENT USE ONLY
DATE RECEIVED D ACCEPTED BY A RETURNED
(Initials) e (Date) See Corres..
FEE RECEIVED VALID. NO. a PEFE-11T NO. f
(Yes or No)
a
REVIEWED BY APPROVED DATE
(Initials) (Yes or No)
COhII°,r'~ITS :