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Wisconsin Dep%1,Lment of Health Anti Sooi:;l Sorvicos
plt. #57 370 Division of Health
SEPTIC TANY. PER:•1IT APPLICATION
TYPE or USE BLACK INK
A. (T;,n%TZR OF PROPERTY
Name b Address (Street, City, Zip Coda)
JJ
K
B. J OCATION OF PROPERTY W1-N:R1;: SYSTFYI WILL BE CONSTRUCTED, ALTERED OR EXTENDED COUNTY 1'f 'C Gr
Chock One:' I G)
_ CITY VILLAGE LEGAL DESCRIPTION O~" 3 ?O
J P
~L= TOWNSHIP 7 i / - - s L ..TE- .171
Al C- /~V e 5,Y
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Cono.ete Poured in Place Steel Other
WTIBE'R 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 Accocmodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES Automatic Clothes Washer 'YkS NO
Dishwasher YES NO Automatic Potato Peeler YES --NO
Other (Specify)
G. MASTER PLUMBER PEAKING INSTALLATION
Name: ytl L Addressi Lioonse Number:
Signature of Applioant: ' /L c2 MP RSW
Address:
H. (To be Completed by Issuing Agent)
Date of Application Fee Paid $
Permit Issued (date) Permit Number
Agent (Name) Fort
Town, Village, City, County, etc.
(Specify)
Note: The application canno+ be considered for filing until all of 'he above questions are answered and the
fee paid. Agents will for-ward application, the fee of $1.00 for each septic tanx and the third Copy
of the permit (canary) to the Division of Health. Checks and money orders should be mado payable to
the Division of Health.
Do net write in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED 0 ACCEPTED BY RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED VALID. No. PERMIT NO.
es or NO)
REVIEWT O BY APPROVED DATE
(Initials) Yes or NoT
rnMa7_177r. 1".PWP CTni`
SEPTIC TANK PERMIT NO.
R E P O R T O N S O I L P E R C 0 L A P I 0 H T E S T
A N D 3 0 I L B O R I N G S
TO
DIYISIC:I 0? HEALTH - FLU1FJIK,3 SECTI(V
P.O.Box 303, Fad13On, Wis. 5:701
Pur3u°.nt to H 62.20, Wis. 16dnistrativo Codo
P S R C 0 L A T I 0 N T S S T
Test Depth Chiraotar~of Soil Hou-s Water Test Time Drop in T?atei Level. Inores~~ToOns-- anutes
Nur,bor InoLes Thiolmoss in Inohos Since Holo in Holo Intorval Socond is Next 4od Last o Fall
1st Witted Ovornight in Minute+ Last Period Last Peeriod Inch
Exempla
P - 0 361, To Soil 101', Clay 26's 25 You or No 30 1 2 1 2 1 2 60
RECORD DATA FROM MINIPIUM OF 3 TEST HOLES
Computo size of absorption eroa in accord with H 62.20 Wis. A(miniatrativo Code.
S 0 I L B O R I N G S- Mint-min 361' Bolcw Proposed Absorption Syst€m
Borin, Total Depth Depth to Ground Water De th to Bedrock
Number Inohoa Cbservod Estimated Ci)served Estimated Character of Soil with Thiokness in Inoh~,s
Example
B - 0 72" 72" Black To Soil 1211. Clay 18" Sand 18". Gravel 2411
:7L
171
RECORD DATA FROM MINIMUM OF 3 BORE HOLD
YPE OF OCCUPANCY: )
RESIDENCES Number of Bodrooms /q - OTHER: (Specify) ~ Number of Persons FOOD WASTE GRINDERS Yes No L ----Dishnashers Yes No G Auto:~atic Clothes
Washers Yes G No
FFLUEhT DISPOSAL SYSTEM: NEW f EXTENSION ADDITION REPLACiENP
Tile Size No.Lin.Feei, Trenoh Width Depth Number of Lines
Seepage Bed: Length _ Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth 5
I, the undersigned, hereby certify that tha percolation tests reported on this force were made by me or under my super-
vision in accord with the proced_res and method specified in Chapter H 12.20 (13), Wisconsin Adainistrative Coc.e, and
that the data recorded and location of test hoies are correct to the best of my knowledge and belief.
NAME TITLE
Type or Print r'~^
REGISTRATION NO. or MASTER PUMER LICENSE NO. ~
ADDRESS
DATE SIGNArJRr /G~
Parcel 030-2006-40-000 05/24/2007 02:23 PM
PAGE 10F1
Alt. Parcel 34.30.19.372D 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 - WEYER, JOHN W & VALERIE S
JOHN W & VALERIE S WEYER
1277 CTY RD I
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description " 1277 CTY RD I
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 7.370 Plat: N/A-NOT AVAILABLE
SEC 34 T30N R1 9W NE NE LOT 3 OF CSM Block/Condo Bldg:
3/816 & ALSO COM NE COR NE1/4 S 88 DEG W
668.40'S 33' TO POB S 272.14'S 88 DEG Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
W 595.27'N 272.15'N 88 DEG E 593.31' 34-30N-19W
TO POB EXC PT TO HWY PROJ 8939-03-00
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 993/387 QC
07/23/1997 993/387 QC
07/23/1997 855/377
07/23/1997 754/528
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.370 110,300 154,900 265,200 NO
Totals for 2007:
General Property 7.370 110,300 154,900 265,200
Woodland 0.000 0 0
Totals for 2006:
General Property 7.370 110,300 154,900 265,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 10/06/2005 Batch 05-29
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
EAST f
PART ST! JOSEPH T 29 30N.-R. 19 W.
_ SEE GE ,58
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LINDQUIST MOTORS THE IVY SHOP
u 303 S. Main St. - River Falls Wis. 122 S. Main - River Falls, Wis.
GERALD JENSEN - PUREBRED JERSEYS TOWNE SHOPPE
Rt. 2 - River Falls, Wis. 54022 126 S. Main St. - River Falls, Wis.
6 e,
' THE BOOK "SHOP VANDA'S JEWELRY
220 S. Main St. River Falls, Wis. 115 S. Main St. - River Falls, Wis.