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HomeMy WebLinkAbout004-1048-70-000 ocn0 Kv0 d `+1 o c M o CD m ~ c(DD (D m any U) z N 0 O O N) O 40i 00 z:' Q7• C N C O. IV p 00 CYl j a- - N d N W 3 00 ~ lAl N 3 (D co O C) 0 fT W C 1 N O- 3 O N 0 N-4 O c: (D (D o6 W 3 ° ° 7 y CD O C !t (A go CD m Z D ,p (D (a" O N CD =3 O. CD W N v F ~ 3 p (3) 1 CD ^ 2 z (n co 0 r to 0 - ~ O c N Q z 0 0 0 • z O O O at' o (n-v -N4 n d c N y cn I ~ rf CD 3 CD m m O m 0 90 Q 3 w c Q 3 N N z 0 o ti z~ o z 4 0 n D D O CD N o (D N C S~ N W N d Z CD `A 2 c N z w a A O 0 M N W CD m 00 CL , z 0 3 O z 3 m N N O O S=0.0 a a@ 3 =r > cA o a m 3 (DQF Qm T l< -4o c a 47 c 0 _ cn j n 47 to W U) Ca . ~ ~ CL O y CEO 47 (fin 047 W - O - Z m O < (O In ti O 0 ) uC CL (D Q ~ N 0 (D Q 2 c Er A n '0 fi =r CD N=W o0 0 (D c CL co t-4 N (D O O (D 0 7 O V CD cD F (o 0 N CD DQ 69 0 0 S` C b Wisconsin Department of Health and Social Services Plb. #67- 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION /0 /j-7 Y#r w IJ l~3 Y TYPE or USE BLACK INK 4OLtW, -)7Y 12F A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) a B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY L' Cheek One: / CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP . Z~f P7 zoo _ la' C. IS LOCAL PERMIT REQUIR D FOR THIS WORK? YES _ NO PERMIT NUMBER D. SEPTIC TANK CAPACITY /,~9--ea-d Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete I_-- Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY one: e r Two Family Residence ✓ Commercial Industrial other (Specify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES v NO Automatic Clothes Washer YES ✓"NO Dishwasher YES NO Automatic Potato Peeler YES 1 - NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Name:" Address= License Numbers Signature of ApplicantsI~ MP RSW Address: H. (To be completed by Issuing Agent) f Date of Application Fee Paid Z / Permit Issued (date) Permit Number d Agent (Name) For: Town, Villa, .ounty etc. (Specify Note: The application cannot be considered for filing until all of the above questions are answered and the l fee paid. Agents will forward application, the fee of $I,OG for each septic tarot and the third copy of the permit (oanary) 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 ACCEPTED BY RETURNED (Initials) (Date) See Corres.) FEE RECEIVED _ VALID. No. PERMIT N0. Yes or No REVIEWED BY APPROVED DATE (Initials) Yes or No COMPLETE OTHER SIDE SEPTIC TANK PERMIT NO. C>2 R Y P 0 R? O N S O I L P= R C O L A? I O N ? 8 S T A N D S O I L B O R I N G S TO DIVISION OF HEALTH - PLUMBING SECT1 M P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P E R C O L A T I O N T T S? Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches Minutes Number Inohes Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall let Wetted Overni in Minutes Last Period Last Period Period One Inch Example P - 0 3611 ?o Soil 10N C1 2604 25 Yes or No 30 1 2 l j_? _1Z2 60 RECORD DATA FROM MINIMUM 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- Minimum 3611 Below o posed Absorption System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches Example B - 0 72'# 7210 Black TO Soil 12" C1 18111 Sand 18141 Gravel 2410 r?a 'aid^r 41 RtCCORD DATA FR MINIM= OF 3 ORE HOLES TYPE OF OCCUPANCY: RESIDENCES Number of Bedrooms OTHERS (Specify) Number of Persons s~ FOOD WASTE GRINDERS Yes No L- Dlstmashers Yes No 4_ Automatic Clothes Washers Yes No w EFFLUENT DISPOSAL SYSTEM: NEW I EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Diameter Liquid Depth Gtr•°n It the undersigned, hereby oertify that the percolation tests reported on this form were made by me or under my super- vision in accord with the prooedures 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 may knowledge and belief. NAME 0 1z TITLE Type or Print REGISTRATION,.NO. or MASTER PLUMBER LICENSE NO. ADDRESS DATE SIGNATURE r. CADY T 28 W- R. 15 W 23 J I on • SEE PAGE 37 /r9~ Win soo ~/f~{ F//~~e C a /z?.rfe~ va ba.,/c/fa°~ ate. u97s .fund o v o Z f/ 7 '~NN F o y' 8 je/o/7 u/vane ' O'Me¢~a. y a / Le T e f Tha/c%e ~ ~ .39 ..a w d ~ ~ o .76 67 fo. /7 do °5 fe J Edwa,~ .C ? •n.~/ .i John Faui .mac rz a f/a/ //a/vonro.z C ~Sbh~.t/s .ge~~ ~d b f Q E~ a'` v t~,l C h 17.5 c~''is ~ s/e.mon I x C7 ,.,Cs/e4 i o tl CS vV ~ _ e/u/w W /96..s -.E~uese/ -Toha.°.s en ry ~ ' \ V ~ n .Za 5 \ ~ /a S //ans sH asco f7iic 6 a W " Pobe.t 5' Tcn,Qe/son so Gt/a//esve~-d .DD.2 s 'y0 v % 0TH Gs h `n Z- Fa/de 7r .3/ Bs r3 9~ L.[ Timm • E je.nao~ o e f/~hes. ~ eG o den P\ Z son •ttncis 4/`/~r ✓ .~s 94 /es V Wa/i Gnub e.- P/ahn ~ s Fed a/P6 R. e,r. o~~. 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PHONE: WILSON 772-4764 FACTORY & SHOPPE Open 9-5 Daily VALLEY ELEVATOR The Home Of Fine Cheese PHONE: 778-5734 3 Miles South of 1-94 on 128 Feeds- Seeds and Blackhawk Fertilizer SPRING VALLEY, WISCONSIN 54767 Parcel 004-1048-70-000 01/18/2007 12:23 PM PAGE 1 OF 1 Alt. Parcel 21.28.15.326C 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): 0 = Current Owner, C = Current Co-Owner PHILLIP A & BONNIE L IRWIN O - IRWIN, PHILLIP A & BONNIE L 266 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 266 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.590 Plat: N/A-NOT AVAILABLE SEC 21 T28N R1 5W E 26 2/3 RDS OF S 3/4 Block/Condo Bldg: OF SE NE EXC S 300 FT & EXC PART TO STATE AS IN 638/436 (0.97A) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 756/202 07/23/1997 638/436 2006 SUMMARY Bill M Fair Market Value: Assessed with: 164690 170,800 Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.590 36,700 128,200 164,900 NO Totals for 2006: General Property 5.590 36,700 128,200 164,900 Woodland 0.000 0 0 Totals for 2005: General Property 5.590 36,700 128,200 164,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 08/23/2005 Batch 55-6 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 004-1048-80-001 01/18/2007 12:28 PM PAGE 1 OF 1 Alt. Parcel 21.28.15.326E 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 - INTERSTATE HWY INTERSTATE HWY 718 W CLAIREMONT AVE EAU CLAIRE WI 54701 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.651 Plat: N/A-NOT AVAILABLE SEC 21 T28N R15W SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/04/1997 Description Class Acres Land Improve Total State Reason STATE X2 2.651 0 0 0 NO Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 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 Parcel 004-1048-80-000 01/18/2007 12:28 PM PAGE 1 OF 1 Alt. Parcel 21.28.15.326D Current X 004 -TOWN OF CADY 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 PHILLIP A & BONNIE L IRWIN O - IRWIN, PHILLIP A & BONNIE L 266 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 266 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.390 Plat: N/A-NOT AVAILABLE SEC 21 T28N R15W 2.39A LOT 1 CSM VOL Block/Condo Bldg: 2/356 ORD, ALSO A 3 FT STRIP ON N SIDE CSM EXC PART (0.42A) TO STATE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 05/30/2003 723668 2257/408 WD 07/23/1997 638/430 2006 SUMMARY Bill Fair Market Value: Assessed with: 164691 247,700 Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.390 30,700 208,400 239,100 NO Totals for 2006: General Property 2.390 30,700 208,400 239,100 Woodland 0.000 0 0 Totals for 2005: General Property 2.390 30,700 208,400 239,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04117/2001 Batch 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 004-1048-60-000 01/18/2007 12:16 PM PAGE 1 OF 1 Alt. Parcel 21.28.15.326B 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 - STENSRUD, BRIAN T BRIAN T STENSRUD 290 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 9.369 Plat: N/A-NOT AVAILABLE SEC 21 T28N R15W 9.369A N 1/4 SE NE Block/Condo Bldg: Pwv ~Z~V Tract(s): (Sec-Twn-Rng 40 1/4 1601/4) 6`y/ c J 21-28N-15W Notes: N C►~ G~ ~'f Parcel History: Date Doc # Vol/Page Type 71tO 10/19/1999 612337 1464/296 WD 'YJ j V PD 01/14/1998 571258 1288/182 WD 07/23/1997 1224/106 WD 07/23/1997 571 /3 more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 164689 Use Value Assessment Valuations: Last Changed: 04/17/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 9.369 1,500 0 1,500 NO Totals for 2006: General Property 9.369 1,500 0 1,500 Woodland 0.000 0 0 Totals for 2005: General Property 9.369 1,400 0 1,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00