Loading...
HomeMy WebLinkAbout004-1043-60-000 n ti p K v n O v C O m o v fD m m m 3 1 a: co z= F o O n' o r n o m A N m 0 O N 1' 2, I W? CO ' C., D Q ' O R% (D CA y C O W N r N N N 1 O U" O O (D O A O r Q O CD O- ~O Sp p d ((D O O N A z N O (D O Ir ~ d N O = W 3 N ~ n C) O z u +u1 z N s C~ C~ ~ ~ ~ ~1• G G 0 A 1E (D ? (n (n cn c o h W y (O L u. A y ~I CD 1D N 0 d y ON O d v N p ~ 3 Z C- N z Cn z o N D _0 c (D A+e . CD r« N (D (u In' O. G. I~ O Z ((D -I (n da Z (D lui =O ~ ~ fT c: ~ A Z O O Cn -i M N O (D N co CL ' Z 3 A O - z M ul m z O w ~ N y J LL CC Q G O O O T (D co C N Z a 7 O Q (D O (n (D O N O CD ID ~r (D iV v N O O b O w CD 7p b Efl ~ tv O S ~ 00 } v Wisconsin Department of Health and Social Servicss Plb. #67 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. OWNER OF PROPERTY Name Address (street, City, Zip Cods) rr>; k A. S SP.: , _ /17..1- k*~✓ _ . B. LOCATION OF PROPERTY WFL AE SYSTEM WILL BE CONSTRUCTED ALTERED -R EXTENDED COUNTY -s-7% C'Rai ~ Check One: CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP ~M 4 .y ~4 le-1 C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? _ A _ 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 INSTALLEDs I E. TYPE OF OCCUPANCY Cheek One: One or Two Family Residence Commercial Industrial other (Specify) Number of Persons to be Accommodated Number of Bedrooms 3 F. APPLIANCES, ETC: Food Waste Grinder YES 14 NO Automatic Clothes Washer YES NO Dishwasher YES X NO Automatia Potato Peeler YES NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Name: ~~cn'~'2~ f7h QS:,~;/ Addresss License Number: !Q Signature of MP RSW .1' Addresss H. (T be Co leted by Issuing Agent) Date of Application 1,76'17 0 Fee Paftcd Permit Issued (dateX^ J~© Permit 'lumber Agent (Name) W-~,,OV Gt For: C Town, Vtilage, 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 wil' forwa-rd application, the fee of 41.00 "or each sceptic tanK and the third copy of the permit (canary) to the Division of Health. Checks and money ortters 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 t (Initials) (Date) See Corres.) FEE RECEIVED VALID. No. PERMIT NO. es or No REVIEWED BY APPROVED DATY I (Initials) Yes or No COMPLETE OTHER SIDE SEPTIC TANK PERMIT NO. r R Z P 0 R T O N S O I L P I R C 0 L A T I 0 N T 9 S T A N D S O I L B 0 R I N G S- TO ' DIVISION OF HEALTH - PLLMING SECTI 1 P.O.Box 309, Madison, Wis. 53701 _ Pursuant to H ~:2b; KiI. Administrative Code 2 a o A ~ T A(\W P Z R C 0 L A T 1 0 N T E S T Test Depth Charaotsr of Soil Hours Water Test Time Drop Water Level Inches utes Number Inches Thickness in Inches Since Hole in Hole Interval Second tcP( 'Next to Last EOZ& Fall 1st Wetted Overnight in Minutes East Period Last Period Period Inch Example A P - 0 36111 To Soil 10" Clay 26n 25 Yes or No 30 1/2 1L2 1/2 60 j Y'l RECM DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Cods. S O I L B'B,R I N G S- Mini-, 361111 Belo+t*Pro osed Absorption System Boring Total Depth Depth to Ground Water De th to Bedrock Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches Example K B - 0 72111 72111 Black To Soil 12111 C1 1811 Sand 1811, Gravel 2411 Y' c .✓~t c ff .f~ .,C C.<n -C~ .fll-f ,7 ~ . RECORD DATA FROM MINIM OF'3 BORE HOLES Pr(W1M=UPANCYt RESIDENCES Number of Bedrooms 1 OTHERS (Speoify Number of Persons [FOOD WASTE GRINDERS Yes No X Dishwashers Yes No Automatic Clothes Washeri 'Yes -a' No ~r EFFLUENT DISPOSAL SYSTEM: NEW /C EXTENSION ADDITION REPLACEKENT Tile Size_ No.Lin.Feet 7) Trench Width . ?L Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pitt Inside Diameter j 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 acoord 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. NAME ~"e /?A=/t i /5'i1. TITLE "V1 /-"4 5, . Type or Print p REGISTRATION NO. -1 c 7 or MASTER PLUMBER LICENSE NO. PI ADDRESS /o .-'14 i7 DATE SIGNATURE 0 Parcel 004-1043-60-000 06/25/2007 10:34 AM PAGE 1 OF 1 Alt. Parcel 19.28.15.294 004 - 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 SANDRA D BIBEAU O - BIBEAU, SANDRA D 266 CTY RD NN WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 266 CTY RD NN SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 19 T28N R1 8W 40A SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 09/27/2006 835439 QC 07/23/1997 902/02 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/09/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 98,400 126,400 NO AGRICULTURAL G4 19.000 3,000 0 3,000 NO UNDEVELOPED G5 4.000 2,000 0 2,000 NO AGRICULTURAL FOREST G5M 15.000 22,500 0 22,500 NO Totals for 2007: General Property 40.000 55,500 98,400 153,900 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 55,400 98,400 153,800 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 SEE PAGE 37 _ i ~"n . smo„ ,P,cha~d e /9s s ao.ran ~ Tff r fi/icy C 1PS/e~ ~ va Nan y /9717 ~~^NN ..if .119 67 ~do. 7~~~ .~Yemm>n_9s° lhnh--f~-r ham,{ Q l /96 s -r<,f_~es e/ Tohar.„o» d. a .//sfo < o C'~(~ b ~ ,1 Huns x' r • ~_7a /Q Qua //i rte, 0 11oa° a/y -s TcrFe/son K/ //e v<~xd > C ~ Fa/de 7i aido d h/ 9z ,na e v A ex 40 9, F"•, 3aa bs 4 a n ~ ter ' J 9 / ~3Y5 vec/cs_ P/~c.. ~a~ ~6s6o - ~N~ 3.3 F/ ~,z t ub f/eYa y z<. . ✓ ~/ae h G v s F< z< ~4 'tf~/i AlzB77 a - -39.By 7 7~. - f 36 n°ca !if'6,fe rP69 z9 iz Pe .ass _ 19G e'Z- d C ,E~ ~s_ten h is o \ E /7./lc, •0 hex q r = 7hamysoi cTOhnsox~ C /10 Wi/ >2 / 0 6.ZJo /hy 7s C . Bo h<i fies 7<- .FcF,o~d ° C Geo~ a~ZJ s/oc.,Emari ,~asf ch •`C C ruin N L/a /u'ex ~ v y s Pete~sa.7 ~ v //e>r5e / ~ o Q ° o 11774 mussc< w p 197 - /60 /60 G eQ" /60 Gera/dine C •v'~hno/s cfi aow /as- L F ~ ~ e e Bs ~ v c5>en a_ • s M- '.J ~0>9~>~i ~e.>der c,F /f ~ Em e~oor/ ' >~4JP/i ~ 0 V `n • L EJwin>~ B Tr~~F Cir be ~Tahnson fend ick3 on ti 10obe,7- N Lo ,06.8 ~2scan 9a Eo4va-Z (-~a✓/c a kv"-, ~:nd-c!>y SFC ~~j'ieenty / /is ~a~o/vo/d ~Sfe ve -o- <aa O G /3ekset/i O ~~r,Ear~be<- o .SLh 21-7 79 So Bo on oaeon i7ofinsen 41 40 . . >cs 7 _eon Ne/ on Pam/s ' c ~be~Y4 G3eff Ph,/ o .P,~ha„~ 7. .DaueZaEr exvsk/ ~ C de 1, 41 v 0 v f ~'O/et j ~ xan duo L o/Cen 79 >.monson Q O ~Moxnson .17 ,Q v e/exsoo do _6 `/60 > < awe/- do U~ l 0 C ~'/axe Ce flr°one /iankv/%~k tly l • • V l4r /moo = Osboxn~ _ . N Q a qn ScLiibe J oC ~n 16o S th l Sa}h r~ ec~ O y C o 71' 97 /oo U v ' `C Ba U N ,yens 14 e Q ~ L~~r ~e~h/o ~ CJ ~/o~e~ce ~ ~ lsoM l` ° ~•l` ~ H v 0 n~ersax> C C h X"/ <Y U 0 e C° i. H Iy ~~~o'~.X ^ Ct CF 60 ga / h~0 W~~ •~d o~ C 7- 9~ `l, /moo x1C r R M CX° • .TOan //F Ft H. 9 s J 0~ p~C ui~~ / ve 3 ° O o c ~ a~ ~ ~ ° PF c' M n,e 4 x %~s M L ~ ~ F cress ~ ~ • v F 0 ~ nu C ~ x s Beve.-/ <9/e//a_ O~:on c ~///ate ~shc+~on °`7 ,2a ~o Wai/e. S' r o ? h p so h Fab Tim/T, •c%nse~ wen- we// \ 0 \ \ Ohl . 'C V o en eppa_• Bo 6o Mi//e/- 7" won 41 b y ° • 0 \ \ • p ~'9 a 0 c Caro//. \ Zz o. 7s .Da>/ > • / ' Eugene C1 I v Q C F v y J/ix~>on .Le/man e 0 C Q' ~Q t /6o Bo G nom O 0 ~o ry ~ ~ tl s ~ .Lyn u» BO Bo \ hay~v Lon en bs y \ l O/sox? e/h Bass- M~9axe7L/os ~o Dona/d ~ ~ Mssions, IXan ~ C ° (~P• d an > n 10/ a /-~xczns on ,ZO \ ~iande~ro~ Inc. • Fox ti. 5 J n~ do 4o a° 0 BO v 80 p~~ of CS F /a 'Q V L79nc>s f)exri. 4 ~C'./a. p~ Rcvj ~nds 4 iTamcs k cen'ro MeaYon 5 f/e/mex- £ VV !/arn /off • /za CY E a (i'r~,/na_ f v ✓e~nh l La eme Z' l/ern f Ma vus A7 0 7 ~Bo h' •J ~9=~P-on- No%~nd •.ss x7 \O Lamb ~T'♦\ • Tmm c/a/ T x7 ~o Sevensom v //:9h 41Edova.-d Geor e 3 Derzn NN . iE'od e-./7ann2 //a -711740 r7 ~o/denhcz ex- • I ~7 nee Tiea/~ f 77 Neubac>e>~ ' o ~ ~ e yr ~ ~ /~`O Tmm ' . < Bo des do 2oB 4C~ O 7a~»ss Fi,=d Bo z3s Jn ,P. 06/ Oxve/S ,C uns e; f 30 x /9O ~S~an/e F yo/erud h- _ ~ T ve4"o f// ce !3/e/ _Tjcchms h u ~9o Bo O/s o 4o do Tho(n~s h! O~ 0y Go.don 4 ,no pie- Da/e ~u ust ~ c% 7 ° M vvP/ qq f/a e/ux d ans~ Timx ` 70 ~ a~ h /i6_¢ \ C~ h n Gen efa/ ei0 .zoa _ _ c lNi// 7 \ ~ /_3xa/i> fJ e 36 4o BO Q) V \ Q• \ zoo 86 9no/ f/2v2 Danca/d9 Limon- _ ° v~ C 0 do ° V o Ci Rde /moo ebo~ az v ~v C CN an7 G\~v a R. E/.3.Lee y, x~ t C~ T C E]f 4o •rf 6xah ne //6 3i»/n o, I~jJ \G~ Gt0/o f7l F7 C. S €l l 0 /Uei/ IUm. e t~a'~ • v ' `r. I• W • ?9 ~Tas. 4 • e C 4 'X W C p ~y~ ~5'h:r/e s f un> y~ i l Frahm e~ ~ y 43 9 Y L o 0 Ma.ya~ef C y \0' o t\ W C 4, ~(~tl pine L3 xow>~ - a C ,y0 4 a.7 Bo < of Ql v W a 0 ° o F r„1 0 4o CTam cs ,f' 76 e Zoo err Vy 0 C ° l o \ Ce v Or Ve/c B, Wr7 ~e ria/d /Brn grahmerLbyce' tl F ~ ~ , 0 ~ C v 31' ' r~ I~tl{~VQ y ~ taw, d~ ~ R/Ice die/ x6o ,~3row~ 117 r 3 Ca J V A V 62_S BD V y s •OR-/a eves Li/// /66 z8 ERV ddnP/a/in• ueh~ F7r' n °"v h Ea./sf/nn way"e /zo \ E✓a- 29 Quen 4o T• So fri > . ` W 0 //B ` go P P .Ea9i`%ne f ~enx/ef Amuna/so0 /2e /jerrnan /60 .~6' On6. '~o v~y~a % Mveanene 'F" - h /60 77 " ,7)on Lee F ,l \S Q. •~4oeed /~iiffoeo K X40 ©/97z Ro fo-d p,,6/,, 6/S, IPIERCE COUNTi' .5'>` Croixn y WAS. ERICKSON HARDWARE I VERSON LUMBER COMPANY GENERAL CONTRACTING i BUILDING CONTRACTOR 6ENERAI HARDWARE - TELEVISION - APPLIANCES POLE BU DEALER IN ALL KINDS OF Sales Backed By Dependable Service BUILDING MATERIAL WOODVILLE, WISCONSIN 54028 PHONE: 698-2471 CALL: 698-2467 WOODVILLE, WIS. 54028