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Parcel 030-1062-10-100 05/21/2007 04:54
PAGE 1 OF 1
F 1
Alt. Parcel 24.30.19.218A 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): 0 = Current Owner, C = Current Co-Owner
0 - BRINKMAN, MARLENE J
MARLENE J BRINKMAN
897 150TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 150TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 36.770 Plat: N/A-NOT AVAILABLE
SEC 24 T30N R19W NE NE EXC PT TO CSM Block/Condo Bldg:
15/4230
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-30N-19W NE NE
ill
Notes: Parcel History:
Date Doc # Vol/Page Type
07/18/2001 651479 1682/546 TI
07/23/1997 1219/235 QC
07/23/1997 432/53
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 04/16/2007
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 33.000 5,000 0 5,000 NO
UNDEVELOPED G5 0.770 100 0 100 NO
OTHER G7 3.000 30,400 99,300 129,700 NO
Totals for 2007:
General Property 36.770 35,500 99,300 134,800
Woodland 0.000 0 0
Totals for 2006:
General Property 36.770 35,300 99,300 134,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 126
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 Services
Plb, ,~67 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. OWNER OPP PROPERTY 'YISC-
Name Address (Street, City, Zip Coda)
B. LOCATION OF PROPERTY WK,RE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY l~ N
Check One:
CITY VILLAGE LEGAL DESCRIPTION ~f
TOWNSHIP
S
to /
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? ,I YES NO ? PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Cheek One: One or Two Family Residence Commercial Industrial Other
Specify
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES X NO Automatic Clothes Washer YES NO
Dishwasher YES __N~C NO Automatic Potata Peeler YLS -NO
Other (Specify)
G. MASTER PLU ER MAKING IN AL TI ON
Name: Address: License Number:
MP
Signature of Applioant: 211 L MP RSW S E,
Address$
H• (To be Completed by Issuing Agent)
Date of Application Fee Paid j
Permit Issued (date) / Permit Number
Agent (Name) For:
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 will forward application, the fee of $1.00 for each septic tanic and the third copy
of the permit (canary) 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 DEPARTMENT USE ONLY
1. DATE RECEIVED 1,a I ACCEPTED BY RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED ✓ VALID. No. s
PERMIT NO. es or No)
REVIEWED BY APPROVED DATE
(Initials) + Yes or No
COMPLETE OTHER SIDE
r
SEPTIC TANK PERMIT NO.
R I P 0 R T O N S O I L P I R C 0 L A T I 0 N T E S T
A N D S O I L B O R I N G S
TO
DIVISION OF HEALTH - PLUMBING SSCTI6N i
(,J.~~0.~}c~tPfadison, Wis.
I
Pursuant to H 62.20, Wis. Administrative Code
P I R C 0 L A T I 0 N T Z S T
Test Depth Character of Soil Hour3 Water Test Time Dr6•-In-5~t2t r Level Inches Number Inches Thiolaiess in Inches Since Hole in Hole Interval
Second ' o Next to Last ~T!nuFtes
all
lst Wetted Overni ht in Minutes Last Period Last Period Period ne Inch
Example
P - 0 3611 To Soil 10" Clay 26$1 25 Yes or No 30 1 2 1 2 112 60
\ RECORD DATA FROM MINr,1UM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S 0 I L B O R I N G S- Minimum 3611 Below Pro osed Abso Lion System
Boring Total 5ppth Depth to Ground Water Depth to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches
E>~aplA
B ' 0^ 72" 72" Black To Soil 1211 C1 18111 Sand 1811• Gravel 2411
o' 7
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
YPE OF OCCUPANCYs
RESIDENCES Number of Bedrooms 3 OTHERS (Specify) Number of Persons 1POOD WASTE GRINDERs Yes No L Dishwashers Yes No U~ Automatic Clothes
Washers Yes No
EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Z6-0 Trench Width Depth J _ Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines ,
Seepage Pits Inside Diameter 7 Liquid Depth
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 Administrative Code, and
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
J\ c`
NAME r, ✓ r r ! CN P_ t > r TITLE ~i r x,)
Type or Print
REGISTRATION NO. or MASTER PLUMBER LICENSE NO.
ADDRESS `~CiC/ I G.!~ it _f1 / ; I L
DATE _ SIGNATURE G~ ~rL y, % _