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HomeMy WebLinkAbout038-1086-80-000 n Cl) p 3 -0 o o d M c .r O Cl)~ Z=N Z ° o o m y o ~ v (D o c j CO V Q. Q. CCDD y = j CD ~.~C o CD CD :3 rA (n o n 10 FD (j, 6 00 wc CD 1=6 a = O O = 7 N OW 7 O C O C1 O u> Z D a- m cn o y W a ~ 0 ~ o CD 07. ~2 a I l~ i 3 0 o z 0 r N 0 0 CD C o c O D 0 h . Z O O O 3 ~r o 0 E * * * D ai t1n t1n a N m v v v CD eQ U) O N (D ' L p C) _ o m o (D a Q N 7 V O ~ CL Q y z zco z Q 7 p D CD CD 0 o ID y CD N y N. (I C CD CD W (p d Z CD 1 Cl) z O p Z CD N C') z ill CL G Z j ~o ~ m z CL , a 3 O " Z 00 e 3 m N CD A 0 O Cy ' pQ v o m D 3 3 c Cv ~5, a CD - 7- CD CD a _ J O N N d 7 :E ~L E:t (n = q ' Z) T < =r CD L a f. f ` moo z a ) va c a~ a o v 0 c c{ c < y m CD(O v \ a ~l O C N CL C52. y c0 0- C-D :E :3 a =r CD M j C S En C~, C7 CD O p_ o to a co CD :E O ?c O CJ7 'O O 0 7 O CD C CD A K b D'0 b '69 < A p O O C Parcel 038-1086-80-000 09/20/2006 05:12 PM PAGE 1 OF 2 Alt. Parcel 21.31.18.357H 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 O - JENSEN, JANIS G JANIS G JENSEN 1327 146TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1098 CTY RD C SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 0.240 Plat: N/A-NOT AVAILABLE SEC 21 T31N R1 8W PT NE NE COM 33'N OF Block/Condo Bldg: CL HWY AT E BK RIVER TH E 150 FT, TH N 60 FT M/L TO RIVER, W 150 FT, S 60 FT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) M/L TO POB EZ-UT-1226/283 21-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 01/11/2006 816210 WD 01/11/2006 816209 LC 03/07/2003 712493 2165/49 LC 04/12/2002 676231 1872/219 WD more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 0.240 57,500 220,500 278,000 NO Totals for 2006: General Property 0.240 57,500 220,500 278,000 Woodland 0.000 0 0 Totals for 2005: General Property 0.240 57,500 220,500 278,000 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 PAGE 05:12 PM 2 OF 2 • ' Parcel 038-1086-80-000 09i20i2006 Parcel History: cont. 07/23/1997 1079/05 WD 07/23/1997 1079/04 WD 07/23/1997 814/583 07/23/1997 807/350 09/11/1995 533590 1139/233 LC Parcel 038-1086-50-000 09/20/2006 05:10 PAGE 10F 1 Alt. Parcel 21.31.18.357E 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): 0 = Current Owner, C = Current Co-Owner O - JENSEN, JANIS G JANIS G JENSEN 1327 146TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 0.088 Plat: N/A-NOT AVAILABLE SEC 21 T31N R18W PT NE NE COM 33' N OF C Block/Condo Bldg: HWY ON E BK RIVER, E 205', N 70' W 205' TO RIVER, S 70' TO POB ALSO PARCEL AS IN Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 449/444. 434/85 & 442/467 EXC P357H 21-31 N-1 8W (ADDITION LEGAL 646/55) EZ-UT-1226/281 Notes: Parcel History: Date Doc # Vol/Page Type 01/11/2006 816210 WD 01/11/2006 816209 LC 03/07/2003 712493 2165/49 LC 04/12/2002 676231 1872/219 WD more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/05/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 0.880 1,500 0 1,500 NO Totals for 2006: General Property 0.880 1,500 0 1,500 Woodland 0.000 0 0 Totals for 2005: General Property 0.880 1,500 0 1,500 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 r November 17, 1972 rir.`at 2018 Lindale J,venues Minneapolis, Minn. 5540-- 11 Dear Mr. Scalzo: -'_1:~r; Bar In reply to your call to our office owned by Mr. Elmer Cook. The last dance ball inspection was made the sewer system was functioning properl'v. I am enclosing a copy of the inspection the sewer was up-'gated in 1970. If we can be of any further assistance to you in this matte:-, ~ir.a~ E' feel free to contact this office. Sincerely yours, 1-"A C. BARBER toning 1,dministrator FLCB;ih Encio^ut e f. ~ ctat)er 26, 1971 o V,1 0i~i F i a1` Y C.01, a;2 December 19, 1969, I inspected the newly installed sanitary facilities for the Stanton Star Bar, Mr. ; ,eo Cook, owner. The sanitary system consisted of 2-1000 gallon septic tanks, 3384 sq. ft. erl maintained, it should function of seepage bed. If this system is prop y for some tirae. Sincerely, JCL Harold C. Barber Zoning dministrator 1 CB/jh Evelyn Grosskreut 1777 Marshall Avenue St. Paul, Minnesota y r /REPORT OF IMS ;CTICN---INDIVUAL STEInIAGE-DISPOSAL SYST.11 PRII~i2Y TR.:,.`Mv1ENT consists of ~ Septic Tanky, Cther (Describe) SEPTIC TANK : Distance from: Well I ~ft . , Lot Line ;fir ' ft. Building t. High watermark-' ft. 12% or greater slope ft. Wetland ft. Cistern ft. No. compartments Liquid capacity: gal. EFFLUZINT DISPCS' L ~Y~T"M consists of LTi.le field. Seepage pit (s). Seepage Pit or Tle Field: Distance from: Well ft. Buildingyft. " Lot Line ft. Cistern ft. Hirsh Watermark of water course ft. Slope 127or great,.-.r ft. Wetland ft. G i Total length of the lines ft. Number of lin ~s Length of each line',' ft. Distance between lines % ft. Width of"trench.LLin. Total effective absorption area of trench bottom Sr. ft. Depth of filter material below tile: 1.yin. Depth of filter/ material over tile in. Cover over filter material tr; Depth of tile below finished grade j in. Slope oft ench b~~m min. per 100 ft. Depth of bedrock --ft. Depth to groundwater, _ft. Number of Pits Outside diameter ft. Depth below inlet ft. Lining material Gravel around pit: Yes. No. Total sbsorption area so. ft. Square feet of seepage trench bottom area required ~f. Square feet of seepage pit area required w. t.K,c. i~~ _ ~ f ~ " _ 1• 1. L ~-rw'~L'j r -C, i/ Inspected bysft Title: r: Approved / Date - r 1 Rejected , Date ,19 ;County, Town of Owner Sanitary Permit No., Pronert address;' ~ Septic Tank Permit No. Subdivision,/ Plb. # 60 3/70 PROJECT DETAIL DATA SHEET NAME OF BUSINESS LOCATION street or highway city or township county LEGAL DESCRIPTION _ OWNER,Mailing addres, ARCHITECT OR ENGINEER Address _ ZIP _ PLUMBER Address Tllvze5_'" Z I P + u i : i:y uSoy~ ~o / and tier G : requested oppos i to each usage listed: Existing building New building _ Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant Car spaces ( ) Restaurant Seating capacity (10 sq. ft./person) ( ) Dining hall Per meal served Toilet waste Yes No ( } Motel ( ) Hotel ( ) Cottages Number of units: 2 persons/unit 4 persons/unit TOTAL NUMBER OF UNITS ( ) Churches Number of persons Kitchen Yes No Bar or cocktail lounge Seating capacity (10 sq. ft./person) ( ) Nursing or rest home Number of beds ( ) Mobile home ark Number of units - dependent (camper trailer) , /I/vc^ ' /~~41, • 1,,4'0 r- ,;le/nondependent (mobi le home) ( ) Retail store Number of employees _ v~nb of customers X10 sq. ft./person) J; /'~~-~,(~~F~° Ct' Nr _ ( ) Service station m e of cars served (daily) ( ) School Number of classrooms Meals served Yes No _ Showers provided Yes No Factory or office building Number of Persons (to*_7lall shifrt-z) ( ) Apartments . Number of bedrooms Other Rt',5,j (71/, . Specify 2. Indicate whether or not the following facilities are connected: Food waste grinder Yes No ~ Dishwasher Yes _ No Automatic clothes washer Yes 4-o- 'X/_- Automatic potato peeler Yes Other (Specify) No 3. Fill in the appropriate information for the following as indicated: j Septic tank capacity planned i Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPORT SHEET COMPLETE OTHER SIDE 40 Seejsage trench bottom area planned width linear feet depth Seepage bed area planned width C~ r linear feet depth Seepage pit planned outside diameter depth telow inlet depth 4. See approved plan for specifications and details. Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION P. 0. Box 309, Madjs'on, Wisconsin 53701 ~'t / g✓ Approved _IC Address: Date. ZIP THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: INSTALLATION FROM CITY, VILLAGE, TOWNSHIP OR COUNTY REGULATIONS OR PERMIT REQUIRE- MENTS AND SHALL BE VOID IF REVISED WITHOUT THE WRITTEN APPROVAL OF THE DIVISION OF HEALTH. / DEPARTMENTAL USE ONLY 4 44 6 St a a Wisconsin Departient of Health and Sooial Servioes 'plh. #67 370 Division of Health _ SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) B. LOCATION OF PROPERTY WFyRE SYSTS_M WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Check One: CITY VILLAGE LEGAL DESCRIPTION r TOWNTSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY"- / Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete Y Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLZD: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial Other % (specify) Number of Persons to be Acco=odaTed Number of a ooms F. APPLIANCES, ETC: Food Waste Grinder YES / NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLUFBER kUKLNG INSTALLATION Name: Address: t Lioense Number: 4 J V ~ Signature of Applicent: MP R.S,1 . Address: ,11 To be Completed by sung Agxeent)e , K Date of Application Fee Paid = Permit Issued (date) Permit Humber Agent (Name) Fors Town, Village, City, County, etc. (Specify) Note: The application cannot a considered for filing until all of a above questiors are answere :d the fee paid. Agents will forward application, the fee of $1.00 fo each septic tank and the ird copy of the permit (oanar;) to the Division of Health. Checks and mone ers should be a payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY 1. DATE RECEIVED - c' - 7-' ACCEPTED BY RETURNED (Initials) (Date) (see Co7es.) FEE RECEIVED VALID. No. PERMIT NO. es or No REVIEWED BY APPROVED DATZ (Initials) Yes or No COMPLETE OTHER SIDE : f..: . 7 7 7- 7, "7w 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 t S T A N D S O I L B O R I N G S TO DIVISION OF HEALTH - PLLnM SECTION P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wig. Administrative Code P B R C 0 L A T I 0 N T T S? Test Depth Charactor of Soil Hours Water Test Time Drop in Water Level Inohes mutes Number Inches Thiokness in Inches Since Hole in Hole Interval Second to Next to Last To Fali 1st Wetted Ovemi;ht in Minutes Last Period Last Period Period One, Inch Example P - 0 3611 To Soil 10" Clay 261, 25 Yes or No 30 1 2 1/? 112 60 RECORD DATA FROM MI14BIUM 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- Minion 3611 Below Proposed Absorption S stem Boring Total Depth Depth to Ground Water Da th to Badrock Number Inohas Cbservod Eatim~ted Observed Estimated Character of Soil with Thio?cness in Inches Example B - 0 72") 72" Black To Soli 12"• Clay 18" Sand 182• Gravel 24" } RECORD DATA FROM MINiIUM OF 3 BORE HOLES TYPE OF OCCUPANCY: RESIDENCES Number of Bedrooms OTHER: (Speoify) Number of Persons FOOD WASTE GR LNDERt Yes No Dishxasher: Yes No Automatic Clothes Washer: Yes No i EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACE:`_-NT ~ Tile Size No.Lin.Fest Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pitt Inside Diameter 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 aeoord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and locat~on of test holes are oorrect to the best of my knowledge and belief. NAME TITLE (Type or Print) 1 REGISTRATION NO. or MASTER PLUMBER LICENSE NO. l ~ e" ~ ADDRESS DATE SIGNATURE,/ _ o ~ \ \ Lo ° v w E O \ ` o1 ° O \ I \ m OO 0 ` r~ - - - - - - - - - - a n o 4 +0 Z m m r~l ~ C 4- -P P a o ~ N ° oQ m m o W cx: o a a m - < 10 - asp w ¢ 4-1 r-4 0 -4 C) 4-3 D: 0 0 • 2 0 W N U in N H P- E- E- a ° A O m a - _ - _ - _ _ _ 3 E-A W a .I EH -P E>`z Cl) c~W H Fa N TS 'C5 vi E r°a m~z s,b 'ix) E -i - - - - - - - - O K zz d] O e c Q V) A H ~ H \ m ~ 4 ~ m c H z. C ► CO 4j UcoW] a ami 0 0-1 p q LTa ~ Q m U E - -a - o - - - - - - - - H Sm. W E- HUHN 8 y.~ W El mow'qW ~ ~ ~y H o ~ z m H vE]0C Pmi O 4 j H O O O {}}~]i] d • U - - - - - - - - c PL4 0 -0 CIA O O 110 a m o m b H 18 CD 0 Z H +o o 0 +1 c}n m o > UEr, co a4 o o a Cd 4-) ri o d C Q. r e o ~e • a~ N can z co a~ 0 0 4 HH e O C F O •r~ v A A p vv~~ m e F. C -7 O V+ I a. t: co -4 -H 4 d V C O Z? Ci . yy.~ Sri 4 N a m ,i Un Ei r1 H w-i CO ~a - o ~o 0 v s, ~1 H ,a U2 QO m a U d o o w ~ ^ H tm c o~ A o q y O A 1 U E1 Q m ~14. Lo. EH-~ • o Y o cn w F • (D 4. 0 C3 4- .0 H H V3 ca m w c`s m a H W U - - - - - - - - - - - o e f d UW] ~y E» x o a a s y , r- ~r ® ~J c~ AUG 2 • ` LL a. Lf.4 L, .~'~~S lI'a UR vU~u'NI1 iACUL; lUlyj ~s FtR°Jll ~ 1I~ 1I ithTS. E ~'OiD IF REVISc© APP F L SF rROVi+i TH OF E I►` ~ t1cr,L~s,~ rof if TJ 14 -P /1 C '1 1 I. 14 ~t _t Y r Pit .50 NtiM~AF tsUIrr~ss _ 1r.~/^° ~f- I.0dATI0°, / > ~__~m- s~ street or higlreay city or tot'aship county Z y ~ nti G-A .",CRIPTION l J `j r c aj OVNER -.a j•~ f taR ra E"? °r~~ - Mailing addrers ZIP - AXHITECT OR ENGINEER Addres:3 Zip P LLTO ER a re e ' I fir' 1.- Address 1. Chock appropriate building ur<aga(s) and fill in the infomcation requested opposite each usa9oe listed: Existing buildin; New building Addition _ If addition to existinZ building attach detailed memo for etch. ( ) Drive in restaurant . . . . . . Car spaces Restaurant . , . . . • . . . Seating oapacity 10 sq. ft./person) ( ) Dining hall . . . . . . . . Per meal served Toilet waste Yes No ( ) Motel ( ) Hotel ( } Cottt..gos • Number of unitst 2 persona/11nit ~ 4 persons unit TOTAL NUMBER OF UNITS ( Churches . . . • . . e Nuirber of persons Kitchen Yes No Bar or cocktail lounge . . . . Seatin capacity (10 7. ft./person) ( } Nursing or rest home . . . Number of beds ( ) Mobile home purl: . . . . . Nurber of units - dependent (camper trailer) - nondependent (mobile home) ( )'Retail store . . . . • Number of employees Number` of customers (10 sq. ft./person) ( ) service station . . . . . . . . Number of can served (daily) ( ) School • . • . . Number of classrooms Meals served Yes No Showers provided Yes No ( ) Factory or office building Number of persons (total all shift Residence . . . . . . • Number of bedrooms 09 Apartnents~s t Number of bedrooms Other • Specify r' ;'bf+_~! 2. Indicate whether or not the following facilities are eonnectedt Food waste grinder . . . . . Yes No ~ Dish:ra.her . . . . . . . Yes No Automatic clothes washer . . Yes No 3. F1.11 in the appropriate information for the foll~lowinr, as indicated: Septic tsx:k capacity planned TOTAL Septic tank capacity required a~ a/ Percolation test results - A:TAC}I PEFCOLATION TEST REPORT SHEET ~fS Seepage trkneh bottom area planned width linear fact d--pth Seepage bed area. planned width linear feet depth Seepage pit planned outside diameter depth below inlet depth Seepage trench bottom area required width linear feet depth Seepage bed area required e'A°.rxWKK- ridth s+ linear feet depth Seepage pit inquired outside diameter depth belom inlet Sig:at•are of person completing forms STATE DIVISION OF HEALTH, PLUM'.BING SECTIU1 P. 0. Box 309, .Ladiso"ynn,, Wisconsin 53701 Address t Approved: is ZIP Date: Dater 0,1,., THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIr'tZYXNTS AND DOES NOT EXKIJIT TILE INSTALLATION FROT; CITY, VILLAGE, TO11- SHIP OR COUNTY REGULATIONS OR PEr'iIT (OVER) REQUI RE;IENTS. ll 0E G, k i f a I ! ~ r THIS AFFRCV,A.L IS BASED 09 STATE PLUMB- ING CODE REQUIRENIENTS AND DOES NOT EXEMPT THE INS(ALLATION FROM C!Ty, V!L- tk,~E, TOINNStI:'D 0 C•;UPiTy REGULATIONS V~ r'E4t;?IT ACQJIf; ~r'Ei'~i S. 1r,1 _ , ` ~1 1111 } 1 . T i .S REPORT OF INSP 7C TIC N---INDIVUAL S 7-1rdAGE-DISPOSAL SYSTal PRIMAXI TR,"ATMENT consists o Septic Tank% Cther (Describe) SEPTIC TANK: Distance from: Wellj" ~'ft., Lot Line ft. Building ft. High watermark ft. 12% or greater slope ft. Wetland ft. Cistern ft. No. compartments Liquid canacity._gal. EFFLU 7 D?SPCS,L SY"T M consists of ,Tile field. Seepage pit (s). Seepage Pit or Tle Field: Distance from: Well ,r.,', ft. Building1~ft. Lot Line ft. Cistern ft. High Watermark of water course ft. Slope 1? or great -r ft. Wetland ft. Total length of tile lines c_ ft. Number of lin,~s Length of each line;`ft. Distance between lines ft. Width of trench in. Total effective absorption area of trench bottom S-. ft. Depth of filter material below the .-l in. Depth,of filter material over the v in. Cover over filter material Depth of tile below finished grade_~Ltin. Slope of trench bottomt.? in. per 100 ft. Depth of bedrock ft. Depth to ground water ft. Number of Pits Outside diameter ft. Depth below inlet ft. Lining material Gravel around pit: Yes. :ro. Total sbsorption area sco ft. Square feet of seepage trench bottom area required Square feet of seepage pit area required Inspected by: ('1 ? t Title: Approved Date Rejected , Date ,19 County, Town ofs,` Owner < refer x ti - /~!1 Sanitary Permit Nor, Pronerty Address N1 Septic Tank Permit No ` T_1Subdivision~ -'7~' REPORT OF INST-OTICN---INDIVUAL S7EIAGE-DISPOSAL SYSTEM PRIi~TY TR,Ey:TMENT consists 1eptic Tank% Cther (Describe) SEPTIC TANK: Distance from: Well ft., Lot Line ft. Building ft. High watermark ft. 121S or greater slope ft. Wetland ft. Cistern ft. No. compartments. Liquid canacitO1¢ 0 gal. L FFFLUE 1T D?SnCS:,L SY` T'7K consists of Tile field. seepage pit (s). Seepage Pit or Tle Field: Distance from: Well ft. Building Lot Line ft. Cistern ft. High Watermark of water course ft. Slone 1q~ greatt-x ft. Wetland ft. Total length of tile line ft Number of lines Length of each lin~~ft. Distance between lines k ft. Width of trench in. Total effective absorption area of trench bottom Sr. ft. Depth of filter material below the in. Depth,,o~ filter material over tiled in. Cover over filter material Depth of tile below finished grade,.Z~~, in. Slops of trench bottorrL~in. per 100 ft. Depth of bedrock-ft. Depth to ground water L'-g'ft. Number of Pits Outside diameter ft. Depth below inlet ft. Lining material Gravel around pit: Yes. No. Total sbsorption area so. ft. Square feet of seepage trench bottom area requireq Square feet of seepage pit area required Inspected by: Title: l / Approved Date Rejected , Date ,19 ~-X' County, Town oL owner -Ll Sanitary Permit No. Property Address 6 % ~J l.-7 Septic Tank Permit No, Subdivision)'ZG 'L/ Ze'.,y.~~;~ 'r • 4. ✓ 1 i AP:'LIC AT ION FOR SA iITARY PE U 1IT for IIJ TAL]LATICN OF A `'4,PTIC T,, ]K (`ec. 144.03, i.s. State.) A. 0- W~ OF PRCPy~tTY Na 1 " Address (Stree, Cit~ ~ip Code) B. LOC 'TICN OF P;:2CPE TY H~~S S: PTIC TANK IS TC B' INST >LL.'M Check 1. _City Mai- ddress County one: 2. Villager_...,. 3. Town 7'- 7 C. ItT,TALIGive License number held: Wisconsin Restri:r,.; Licensed Sewer Plumber Servic: Name, . ; Address D. SP 4,-FI"CnTICN3 OF Sr,PTIC TANK Size in gallons: (check one) 1. y1,000 Gal. 5. _ 4,000 Gal. 2. 1,500 Gal. 6. _ 5,000 Gal. 3. 2000 ,Gal. 7. If over 5,000 gal., give capacity. 4. i3, 000 Gal. _ M-tterials: 1. Prefab concrete 2. Poured concrete 3. Steel TYPE OF OCCUP.kNCY 1. _ Sin,le Family residence 3. yCommercial establishment 2._ MT?itiple family residence 4. J Industrial establishment F. APP-KXD1.JE Mi4B Tlz OF P ~SCNS STIWED DAILY jf''` I y f f G. PJiCUATIC a TE"'71iADE 1."Yes . 2. No Date By wr.om~ L_.;--1 t , ~y r (To be completed by County Clerk) Date a -plicaticn is filed and f paid Permit issued (date) , Permit Number County- Clerk (t' . a - t . Percolation :late Minimum Absorption Area in Square Feet per Bedroom Minutes aequired Normal 1,,Tith Tith 71ith Both For 'rater to F:,11 Plumbing Garbage Automatic Grinder and One Inch Fixtures Grinder Washer Automatic iJasher 2 50 65 75 85 3 60 75 85 100 4 70 85 95 115 5 75 9o 105 121, 5 - 10 100 120 135 165 10 - 15 115 140 1f0 190 15 - 30 150 180 205 250 30 - 45 180 215 245 300 45 - 60 200 240 275 330 60 - 90 240 290 325 400 . P1b 60 srj" &CDF VINESS ~l.L~ L(La!.~. V LOCATION" s~0, T'1se_T+ SO d? ~ S r i y0~ eS ~ ~ ~O/~ street or highway city.or township county LIVAL CRIPTION WNER-9 cap 0 Mailing address / ZIP AFB HITECT OR ENGINEER Address ZIP PLUMflER Address 71P 1. Check appropriate building usages) and fill in the information requested opposite each usage listeds Existing building New building Addition If addition to existing building attach detailed macro for each. Drive In restaurant • • Car spaces ( ) Restaurant . . . . • • • • Seating capacity 10 sq. rt./person) ( ) Dining hall . • • • • • • • . . Per meal served Toilet waste Yes No Motel Hotel ( ) Cottages • • Number of unites 2 persons/unit 4 persons unit TOTAL NUMBER OF UNITS ( Churches . . . . . . Number of persons Kitchen Yes No Bar or cocktail lounge . . . . Seating capacity (10 sq. ft./person) ( ) Nursing or met home . . . • . Number of beds ( ) Mobile home park . . Number of units - dependent (oamper trailer) - nondependent (mobile home) O Retail store . • . • Number of employees Number of oustomers (10 sq. ft./person) ( ) Service station . . . Number of cars served ly) ( ) School . . . . . . . . Number of classrooms Meals served Yes No Showers provided Yes No ( Factory or office building . Number of persons (total all shifts~- Residence . . . . . . . . . . . Number of bedrooms Apartments Number of bed Other rooms ~g . •l Speoity 1 per/ 2. Indicate whether or not the following facilities are oonneoteds Food waste grinder . Yes No~ Dishwasher . . Yea No Automatio clothes washer Yes No 3. Fill in the appropriate information for the following as indicateds Septic tank capacity planned C07-/0001#94 TOTAL Septic tank capacity required "'y &'S? '6 ✓ 'Ve Percolation test results - A°TACH PERCOLATION TEST REPORT SHEET Seepage trench bottom area planned width linear feat depth Seepage bed area planned width linear feet depth Seepage pit planned outside diameter depth below inlet depth Seepage trench bottom.area required width linear feet _ depth I Seepage bed area required 4006 3~ .;24 24 linear feet depth Seepage pit required outside diameter depth below inlet Signature of person completing forms STATE DIVISION OF HEALTH, PLUMBING SECTION t7 1 P. 0. Box 309, Madison, Wisconsin 53701 Addresss cg 73? Approved: l~ ZIPC r~- Dates Dates DEC - }'~U:j THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIREMENTS AND DOES NOT EX E'1PT THF. INSTALLATION FROM CITY, VILLAGE, TOWN- SHIP OR COUNTY REGULATIONS OR PErtMi'r (OVER) REQUIREMENTS. P. , t lull ~ U u 'SIA3~~~t!!!;038 liY'~83.? L~ MI~V1(193M A1Nf1GJ SO dikSY.M01 `3^,'7 -11A Al,3 YGOa3 NOIIV11V1SNI 3Hl LdPt3X3 ION S300 ONV SINM381(tOMN 3093 ewl -HWIIId 31VIS NO 03SV8 St 1VAO QV S!F!1 .3d ~ ~ i n ran r `c ~ ~ - - f Hoibn - mewnu 6961 , 010 WILLIAM W. WARD ATTORNEY-AT-LAW Phone (715) 246-2368 NEW RICHMOND, WIS. 54017 i : l_ Tl r" i• l la 11 l S 1, t' r' ~ r Ho i i ) f,~: j)LU11-11)! 11 sr 1'lc f:).~ ~ :t t• 1.',1 ~i7'opert" 1S he111 r lull so l967 { Mr. Las ON& ltrMrs am fm aid w d o wis""Im floss fire- soon Mo gut same to srstis an isrpseetlm Now art ewe astsltilsbatast sat Jms no t967. is efts esepoW of MM two Qtas1. fir. iwtrj L. *stems. !M isil+ariy "M wars daub" as Mly is mrtwsr lui vuh mores , Matwl ad ffaalMt MUM ad s4splaRlatws 1. !M maw wvWV to sat seasptabto bosasos of do Last ad a asst bolrsss be" st pop art elm" of Walt araty. lswlis a seat as as watt aasly. t. flwys affluent is MUM dissfrst Wd ewe S i swa a~swdessest~ 160 rods ties twss+a. i! 11 it 111111 it ftd ►laosl inw a tonal trill tiasltnpd is We ams wi, if U eslaeatss. Its will be easarI I i I I !M ym two diasseetirwr abl a rerastlas all pwids a sways disparat sum a - in ssaae«tatass wltlr des stars no bty Qa/a, 0&0. Go* istlaatsi Mart a am "tiassessl" bat be= pcowl" dreft lira lpriy of 1967. f!Usoss be atvisrt Mtw aaaspasis we rat fss iMi. Mil ~sr $"*A" some s wd4 be sd sr pariah a ►Larin and see e 9. ffea■ssrras ~titsliy •!s►tatiAreas suss astM>f s a. ftH maw liars a sm of do bas sidae asrista of sssppvovM ptasUa pips. go bw sinft so ved by tits lies is we asswastM so firs waata dt O"I SPUN. mum" lies ptmua pt" ad suit. sae as as aleawastlwg babe tills tustlilsataa M is ear pbwbft es". J b. no am" bwr aria saaef aaawliser~la irai. !cope s to be pw- ~Llri all ail trrspI N m, }lauds watsrriat go=*". s. MW O wriest to we aseoptiia. Impla w do pfe+aaant ariMsllests~ rowel vralas WM ar 14 ft VA east. !M 9106 fusty w t ok "'sift og aet`ts" to to be traplassef. fMesset Unift spaWa wte Gaels !laser. fsaesMS do w obbertr Not" Aub b w be" so" . to 0*0 wepaitrs. "do Lmftatiasia to " be WON** y so ►1061y aria. 1. Else's eailat sort to be mWlasM. WA" !shat seat a be tepiasM. Dstlr ales is M Opw-ftwt, wuh we list.