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HomeMy WebLinkAbout004-1049-95-000 0 cn o K m 0 w m 1 m ~ m v a: ice' v m w 7i, U z= i 0 2; o C) O W U C, O N O % O d O (p 0 CD N C2 CD (1 C7t C .~3 O (D W Q Cn A O 1 cr co :3 c) N O N ` ~ W 10 r.t O h Q p N W 00 t~00~ N o O ~!~y N (D < O !r z > a D O w CL Q Q m c o o N ATV O A rJ "%MIA Q 0 (D (.0~ ~a~ 0 0 0 z o 0 0 C/) 0 3 CD ~ v v v N O v a Qo qty CD o cr N N J O Q CD C1 i A O - D W o Q- :3 wi n o 0 N to "1eq h N cD m N C CD (D W D C1 3 7 z CD -i N p Z CD O N C 0 n A Z o C Z I N W v m m fD co a z o - z 3 g N z (D A ~ CA j + D C) c- Q 0 CL QC, O N -n SU C Z ~ m U N CD a CD - CD v CD - a N CL O O A X ID ~ tv Ef3 iO o o iro o c Wisconsin Departc.ent of Health and Social Servicos Plb, #67 370 Divi€ion of Health SEPTIC TANK PEI.t,MIT APPLICATION TYPE or LSE BLACK INK c A. CWNER OF_ PROPERTY Name Address (Street, City, Zip Co B. LOCATICi OF PROPERTY Wf{'.RE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDED COUNTY Check One: CITY VILLAGE LEGAL DESCRIPTION 1V~ TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANX CAPACITY Gallons NEW INSTALLATION REPLACRIENT ADDITION MATERIALS: Prefab Concrete -.Poured in Place Steel Other _ NUMBER OF TANKS 70 BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial Other i; (specify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Wasto Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potstc Peeler YES NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Name: Address: f f / f License Number: f Mp Signature of Applicants ! np{{ Address: H. (To be Completed by Is~uinz Agent) Date of Application - - Fee Paid $ Permit Issued (date) permit Number Agent (Name) For: ' Town, Village, City, County, etc. (Specify) Note: The application cannot be ^.nsidered for filing until all of the above questions are answered and the fee paid. Agents will fon,ard application, the fee of $1.OG for each septic tanx and the third copy of the permit (canary) to the Division of Health, Checks and honey orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY RETURNED J (Initials) (Date) See,Cerres.) FEE RECEIVED VALID. No. PERMIT NO. ~ es or N~ REVIEWED BY APPROVED DATE (Initials) Yes or NOT COMPLETE OTHER SIDE r SEP-PIC TANX PZP.ISIT 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 DIVISION OF HEALTH - PLU-191N: SZ0716N ~f 1 ea4-* P.O.Box 309, Madison, Wis. 53701 ('I . 1 Pursuzuit to H 62.20, Wis. Administrative Code " IS101" ~r 6 L EA- P E R C 0 L A T 1 0 N T E S T Test Depth Charaoter of Soil Hours Water Test Tiao Drop in W ter Level Inones nutes rtrabor Inchon Thio`azoss in Inches Since Hole in Hole Into.-Val Second to Next to Last To Fall 1st Wattod Ovo.--licit in Minutea Last Period i^st Period Period On's, Inch Example { P - 0 36" Top Soil 10" Cln 26" 25 Yes or No 30 112 1 2 112 60 is RECORD DATA FROM MINE-nrlI OF 3 UST HOLES Compute site of absorption aroa in accord with H 62.20 Wis. Administrative Code. S O I L B O R I N G S- Minimum 36" Belch reposed Absoation System Borinr, Total Depth Depth to Ground Water Do th to Bedroc, Number Inches 63ervod Estir-3ted Observed Esticated Character of Soil with Thio'_,.ness in Inches E.xauplo B - 0 72" 72" Black Top Soil 12"; Clams 18111 Sand 181, Gravel 241' n RECORD DATA FROM MINIMUM OF 3 BODE PIOLFS YPE OF OCCUPANCYs RESIDE'NCEs Number of Bodroomr OTHER: (Specify) Number of Persons FOOD WASTE GR LND?Rs Yes No Dishwashers Yes No Automatic Clothes Washers Yes No FFLUEhT DISPOSAL SYSTEM- NEW / EXTENSION ADDITION REPLAC;.."4ENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Di=eter Liquid Depth Is the undersigned, hereby eertify that the peroolation tests reported on this fora were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisoonsin Administrative Code, and that tho data recorded and location of test holes are correct to the best of my knowledge and belief. NA VI-6 TITLE Type or Print REGISTRATION NO. or MASTER PLUMBER LICENSE NO. ADDRESS _ DA^E SIGNATURE' s Parcel 004-1049-95-000 06/26/2007 12:43 PM • PAGE 1 OF 1 Alt. Parcel 21.28.15.335B 004 - TOWN OF CADY 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 - OBERMUELLER, ROBERT B & ELSIE M ROBERT B & ELSIE M OBERMUELLER 232 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 232 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 8.040 Plat: N/A-NOT AVAILABLE SEC 21 T28N R15W PT NE SE COM 340 FT S Block/Condo Bldg: OF NE COR, TH W 220 FT, S 465 FT, E 50 FT, S 165 FT, TH E 170 FT, TH N 630 FT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TO POB. EXC PT TO STATE (0.52A) 640/516 21-28N-15W ALSO PARCEL DESC COM NE COR NE SE; TH W 542'; TH S 500' TH E 220'; TH S 230'; TH more... Notes: Parcel History: Date Doc # Vol/Page Type 04/22/2004 760371 2554/517 WD 07/23/1997 1006/446 QC 07/23/1997 971/363 WD 07/23/1997 640/516 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 14,000 75,700 89,700 NO COMMERCIAL G2 6.040 43,200 58,700 101,900 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2007: General Property 8.040 57,300 134,400 191,700 Woodland 0.000 0 0 Totals for 2006: General Property 8.040 57,300 134,400 191.700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 uHuy r SEE PAGE 37 z6 N.-R. 15W 2 /9 ~S %t f~/.~ Fi dE c EVa_ • ~9/s, NN 39 L v ^ o N y .5ra~ <r 128 3e ? / e Xe - _ ✓~s> ` .rte ~7 'o 17 1 _ F-fla/ h<> ~ /aa~ r>p c.., ti. ~ vt C; ~ ~ J K ioh~ ~ ra roc°r U o, er. /e o rn i vo L~ ~9C za s ~tV~ /96-5 i{,due e% ~„ron fans h Qf ~ t g \ c\I y9 h~./i7 -4as Ten~2/so s k"/ lr1/a /t weed l7~„ D- 1 - , a c ,nn e~ Fa/de a Bs r3 ~ ~ L L m • ~ ~ `ems 40 es 7i >v t J 9(f ' Y / ~ ~ s/~z, f G 94 3,3,11 P Peler o n ~ ih er P/ ~ n - Fed ~cyP/i Jo Es ,7~~c ~ ce,a, _ .3a B9 9 7s. a6 rre6.Ee d aB_/7 r- Hag ; C'/.ffo~de ~ _ v /d:e ~s dd9 sr- ~ Pis ass ~ ~ ~Easm sen L /1.9 e,Tanc~ /'ex 7 - r< Thom °'r ~J E V cTOhnso~ /`~//o~ P-ha.d o C /zo w.'/ r~ / sD fiy a u C 71- o f/r es 117 ~S/oc.Ema~ as. u< L,/a / e~ v Ge ~ afn s Pete sa, K / sh ~ ~ r177a ~ ¢s n.~ SP ~ ~ 9 r ~ ~r //a hem/ s • a o C p p 197 < rho rho h, /6a Ge a/one v C .Cr~O E~w~ir V ZoY / ~e e Bs J) Q~ hh :moo>cF c:s s M y f/e d , r ~O _ Gr 6 e ~r ,9~, ck h~ r, Fvi dory ~ .2a/~fi ~ r8 ~7ahnson fired ckso evs ~ Bo ii6. 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C W / eTean ene a"F. tl. r - /36 ) La oo /60 4 M///e,/ 77 -7)6n Lee F r`y 'PBed 1f117 '~aP/° tlC p; - - Bo "'940 01972 rQo .ford M p Pub/s, Inc PIERCE COUN ~1 S~ C/aix n ~ l'v~• ERICKSON HARDWARE I VERSON LUMBER COMPANY 6R AOwA'St~AFS GENERAL CONTRACTING GENERAL HARDWARE - TELEVISION - APPLIANCES POLE: BUILDING CONTRACTOR DEALER IN ALL KINDS OF Sales Backed By Dependable Service BUILDING MATERIAL WOODVILLE, WISCONSIN 54028 PHONE: 698-2471 CALL: 698-2467 WOODVILLE, WIS. 54028