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HomeMy WebLinkAbout006-1008-30-000 G 1 0 3 y m n N -0 v m v Z 2 cn O A O A O ~ s N cn O CD CD 0 (D CL N m O `3 0 0 C N W O G 0 =5 M N CrD. O O a N O a o 0 cn a o !J d CD z D Q C N z I a CA o c _ N N N CD r) z ? O ~ O C O O !V P~1 • (D O O O m S a it fn N N v m a O O CD C7 w m N Qo (1 7 (D - C, N A O d p C .1] (D O Q l`~~~~`1 O z cn z O O D -vo 0 N v ~ ht • rn ~ m ~ N n N _ O O_ 10 (o Iv C A Z 5 n 7 p z O O C) Cn A W - w CD CD a z 0 3 ? ;o 6 o " Cl) N z (D w ~ co a Cl) ° T (D O Cv' C 0, 3 O (n Z fl- O O N n ~ C -o a C v 3 'G ^ (D N W a (D o m _ co v o ~ o a ~a a b (D o, x rfl O ~ 0 O 0 Wisconsin Department of Health and Social Services Plb. #67 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION 4YPY or USE BLACK INK A. OWNER OF PROPERTY Name -/7 Address Street, C ty, Zip Cods) B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Check One: 7 CITY VILLAGE LEGAL DESCRIPTION L TOWNSHIP VV wa C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER ) G D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION ~i REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: I S. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial other E ~ (specify) I Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES ~A" NO Automatic Clothes Washer ~ YES NO Dishwasher YES T' NO Automatic Potato Peeler YF:~__T_ NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION, Name: ~1 ~~~r Addresst //x. License Number: MP r- Signature of Applicant: MP RSW 5 r ' I✓ Address: L H. (To be Completed by Issuing Agent) Date of Application Fee Paid Permit Issued (date) Permit Number Agent (Name) For Town, Village, City, County, etc. (Specify) ,rote: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will fo:Aa_rd application, the fee of $1.00 or each septic canx and the third copy of the permit (canary) 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 -7 G ACCEPTED BY Y RETURNED FEE RECEIVED (Initials) Z_ (Late) See Corres. ) VALID. No. ~ PERMIT NO. es or No REVIEWED BY APPROVED DATE (Initials) Yes or No) COMPTYTE CM47P gTnr SEPTIC 'TANK PERMIT NO. R Z P 0 R T O N S O I L P I R C 0 L A T I 0 N T I S T * AND SOIL BORINGS TO DIVISION OF HEALTH - PLLJKBING SECTI6M P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. ►dainistrative Code P I R C 0 L A T I 0 N T I S T Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches nutas Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall 1st Wetted overnight in Minutos EAst Period Last Period Period Cner Inch Exa-"0" le p- 3611 To Soil 10" Clay 261, 25 Yes or No 30 1/2 i/2 __I L2 60 4/1 RECCIPM DATA FROM MINIPSUM 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- Minima.- 3611 Belcw Pro osed Abwarotion System Boring Total Depth Depth to Ground Water De th to Bedrocks Number Inches Ob3ervad 113til-rated Observed Estimated Character of Soil with Thickness in Inches Example B - 0 72" 72" Black To Soil 121* C1 181' Sand 18" Gravel 2411 f i' RELOAD DATA FROM MINI.*fUM OF 3 BORE HOLES TYPE OF OCCUPANCYt RESIDENCE: Number of Bedrooms OTHER: (Specify) Number of Persons D WASTE GRINDER: Yes No Dishwashers Yes No Automatic Clothes Wa3hert Yes, ~ No EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pitt Inside Diameter J quid Depth !I, the undersigned, hereby certify that the percolation tests reported on this fora were made by me or under Rjr super- lvision in accord 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 TITLE J , • ; I/f X T' t Type or Print REGISTRATION NO. or MASTER PLUMBER LICENSE NO. /i ADDRESS DAiE SIGNATURE Parcel 006-1008-30-000 04/25/2007 04:15 PAGE 1 OF 1 F 1 Alt. Parcel 4.31.16.59B 006 - TOWN OF CYLON 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 - WILLIAMS, JAMES F & GERALDINE JAMES F & GERALDINE WILLIAMS 2301 220TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 2301 220TH ST SC 0119 AMERY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 4 T31 N R1 6W 5A IN SW COR SW SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-31N-16W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 25,000 126,000 151,000 NO Totals for 2007: General Property 5.000 25,000 126,000 151,000 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 25,000 126,000 151,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 C; Y LO N POLT 31 N---R. 16 W. 59 Thos- F COUNTY John /~9F~«~ pia ietsc 7m ~ ~j~ e 1 G ha • B6 ~7 9z 9i~ `SOn ~ h ~a/czi~~J' r3~ ~~O~~y ~ 5 ~~z9 e °9 ® L/oyd s c V v y 176 Ilk- Bo ti ~,(e ~ C B/( Thor, . ,a p _ _ L ~ hoe t ~ ~ ~ ~fl ~ o v Tam/ s s` a ao 'o be°~ 4U f 2f~/ 3 f ~ C ~ Oe~ o >,y ~o v v h C/ z - i~oi7 Jay ~~O 5 y 0. 46 TiSom~ozo _ i, es 7h<~ 17 k~o.i J~/mss /dc i rl s ~h ✓~o~. 63 ' So szo i~~,// et/e ,yeryfo~ uo ~ 1 ILUjE^ 7 .e 6' 1 / /zo ~ ~ /zo n/ 1t., Lehman vidy o ~a,x ~~rU 60 ~ :ARK Do n T F 84 40 `moo C,pNW ;tee//re m Pna t H v ~t I ~ ~vP~~ ~✓3 s .%vu~'E' k ~fca Bac - --7 f i /ue s zoos i1 y LY > 3 7 Da/e 9 ~ p ~ so :6~~e<- go 0 ~ o mo f 0 96~ei- ~ es~ eo d C ' ~ 9 ~ ~ Sd9 ~ ~o ~~s ~ ~ N h'Q~.so~ cS/~ e o ~e3 'P c w V , ~W do f ,u 4 ~e ~ /'I/Q~id¢ ~/fog ~ l E • /Lbnen i ° ~ ~ s unty o~~ ~ ¢0 3 93 s • - Spa.,/e ~o ~ i/9 zoa efa/ m,-,c cDo~ .Lc ,ne/h Y ' W 0 5~e a T s so Grebe s~ Fouks ~I ~ 0, cToh i f7 //O/f L,// an Esfc°s ~QS/ ~o / % ~~o ao ~ ~ ~ B~ ,9//ate ~ -moo /os ~o¢~ e Bobb y~QCe ce F~ sso e G d ~ ch ~ ° G'r~o c/j riavvP ,zao Ne//a~ ~ /Yo -24- W /¢.~s 1 ~ ~o g° vvdc: RIVE, c7ac,Fso~~ zoo ~ H ~ Yde.. 2~s zf U _ 9/na o0 f/, r~"~z,~' sv~ ' ec¢~vF s~,E• E/i~,~o d /zo e I • 40 3 /F1 / a //9(~3 v 4,J 3zc ~O - ~ /GO Q 171 I ~ Ga/dc ,Iz fs ~•-I" ~V 4- .Ta c~san ~ M f aJ ~o p ~ ~ a ~,~f Lfe lns. Co_ _ b~, mss 46 ~u~e<- .B ~nJ e O/sow d Cl zs<o . < so ~ ~ h/¢/fFi- ' c,Q %sp ¢6 7 C /to C1 C ~ W. e 7] 6 > ~ v /2s ~ ~ 79 .~0~~/2,5 ,T ~ C ~ G ~ /a ~ ~ s< ode 3 C f cz !i; ~ V ~p V/eason 6 ~ q ~ ~ ~ ~ood iai5 /`/e- ffj ~ 9 ~ 0 `Y V ~ ~ fG od Bch ,S 0 ~7u//wa/d / - -y . - zqo do zo ' ~ "~y E/d 71 j 64 © /s T -S /ran< ~Sf c~cei- fla l~on`9 1 -1 I. 40 izo 1¢~so~ 63 ~a 64 FJo ~ ~0 4Y/[COj 'cu Li ee¢~de ~ w ~5 as. ~.C'L~,P 63 _ 9/.cc n Ec • e sow 13 3 Fz i/f q r h<, /mss M. > `7 35 i y wv `i" C¢se /-~c°~~~- ,Fo a f ¢ s d ~.%ffa d FJ.~Sas Q \ cTornes t Zl- ~ / f' ' v./d S'•, f • ~ 5 a d 0 C ~ 1-70 a3 z 3z7 ~eY ~ ioo ~ y / \ zss ~ E/¢s ~i~ e e. SEE PAGE CS SEE PAGE 47 c- y S PLAT BOOK COMMITTEE SALES COMMITTEE Contd. on page 61 Mr. James Ray Mrs. Charles Smith Mr. Jim Ruemmele Mrs. Gordon Mueller Mrs. Ross Pierson Mrs. Miles Casey Mr. and Mrs. Bob Phillips Mr. Robert Harer Mr. Al Franko Mrs. Guy Wilbur Mr. Don Matysik Mrs. Judy Ferguson Mr. and Mrs. Merton Vrieze Mrs. Joe Lohmeirer Mrs. Willard Johnson Mrs. Robert Gardner Mrs. Robert Hanson Mr. and Mrs. John Steele Mrs. Freida Fellinger Mrs. John Lavelle Mr. Leon Holle ~ Mr. Robert Condon Mrs. John Glassbrenner Mr. Del Polzin Mr. Steve Thompson Mrs. Harlan Johnson Mr. LaVerne Karastes Parcel 006-1008-40-000 04/25/2007 04:04 PAGE 1 OF 1 F 1 Alt. Parcel 4.31.16.60 006 - TOWN OF CYLON 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 - JONES, VERNON W JR & MICHELLE J VERNON W JR & MICHELLE J JONES 2240 CTY RD H DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 2240 CTY RD H SC 0119 AM E RY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Z 30 I 2Z044` STS Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 4 T31 N R1 6W 40A SE SW Block/Condo Bldg: 7 Tract(s): (Sec-Twn-Rng 40 1/4 1601/4) 04-31N-16W Notes: Parcel History: Date Doc # Vol/Page Type r✓G ~ b ~v Z- 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/26/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 210,000 225,000 NO AGRICULTURAL G4 17.000 2,600 0 2,600 NO UNDEVELOPED G5 2.000 1,400 0 1,400 NO AGRICULTURAL FOREST G5M 19.000 22,800 0 22,800 NO Totals for 2007: General Property 40.000 41,800 210,000 251,800 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 41,800 210,000 251,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00