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Parcel 008-1040-60-000 05/29/2007 02:23
PAGE 1 OF 1
F 1
Alt. Parcel 14.28.16.204B 008 - TOWN OF EAU GALLE
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 - NORVOLD, TELFORD M & BETTY
TELFORD M & BETTY NORVOLD
354 CTY RD B
WOODVILLE WI 54028
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 354 CTY RD B
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 2.940 Plat: N/A-NOT AVAILABLE
SEC 14 T28N R16W 2.94A IN SE NE E 500' Block/Condo Bldg:
OF S 256' OF SE NE
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-28N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 456/33
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/09/2000
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.940 26,800 144,500 171,300 NO
Totals for 2007:
General Property 2.940 26,800 144,500 171,300
Woodland 0.000 0 0
Totals for 2006:
General Property 2.940 26,800 144,500 171,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 513
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
' I
r
Plb. #67 Wisconsin Department of Health and Social Services
Division of Health
PEFtaT APPLICATION
2 G V /F for
PRIVATE DCMESTIC SEWAGE SYSTEMS
A. OWNER OF PROPERTY J~ f~, e~~j TYPE OR USE BLACK INK
Name / 1I V Address (Street, City, Zip Code)
!
B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTFD ALTERED OR EXTENDED County
Check One:
C`l uU~l
CITY VILLAGE LEGAL DESCRIPTIONt
TOWNSHIP ; L•~ f~~ G. St' i Ci tC Zr
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES L- NO
i
3
D. SEPTIC TANK CAPACITY tft~rJ Gallons NEW INSTALLATION Z, REPLACEMENT ADDITION I
MATERIALS: Prefab Concrete Poured in Place Steel Other
NiMBER OF TANKS TO BE INSTALLED;
E. TYPE OF OCCUPANCY f
Check One; (9e or Two Family Residence Commercial Industrial Other
Specify
Number of Persons to be Accommodated
F. APPLIANCES, ETC: Food Waste Grinder YES i/ NO Automatic Clothes Washer i, YES _ NO
Dishwasher /.-YES NO Automatic Potato Peeler YES L- NO
Other (Specify)
i
G. EFFLUENT DISPOSAL SY T&M NEW „
EXTE.~SION ADDITION REPLACEMENT
Tile Size ffr No.Lin.Feet Trench Width Depth Number of Lines
r
Seepage Bedt Length Width Depth _ Tile Size No. Lines
Seepage Pitt inside diameter Liquid Depth
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours Water Test Time prod in Water Level Inches Minutes
Number Inches Thickness in Inches Since Hole in Hole (Interval Second to j Next to
F.xamplo Last To Fall
1st Wetted Ovorn17h- Iin Minutes Last Period) Last Periodl Period One Inch
P•- 0 3631 Ton Soil 10" Cla- 26" 25 es or no 30 1/? 1/2 1 2 60
If C>
RFOOM) DATA FRC11 MINIMUM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wiz. Administrative Codo.
_ S 0 1 1, B 0 P I N G S Mini=m 36" B.,l cn; Prc~uosad Absorption System
oring Total Depth Danth to C3 ur d F a.±P3 I`c.ptn to 1 rr c. "i
-I Y~ber Inrshes cb!~erv d R:stiin.ed Ob: r4td ° t d }anrctoter o," Soil with Thickness in Inches
Ixcmpla
0 72"
72't B'aa'c To Soil 1212• C)r:.v 18'+• Sand 1810 Graval 241+
le,
e
R~COr,D I)A"A F<JA1MINI` M OF ? ?Ct' HOIA:5
I, the undersigned, hereby oertify that the percolation tests reported on this form were made by me }
or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3),
Wisoonsin Administrative Code, and that the data recorded and location of test holes are oorreot to
the best of my knowledge and belief.
NAME rlf TITLE
(Type or print) ~^1
REGISTRATION NO. or MASTER PLUMBER LICENSE No.
ADDRESS
DATE Of SIGNATUFZ -e
s
i
MASTER PLUMBER MAKING APPLICATION - t
License Numbers
Signatures
MP RSN
(To a Comm eted by Issuing Agent)
Date of Application C* ~111 Fee Paid
Permit Issued (date)d / ~ Permit N,urmbbor~
Agent (name)t ✓~'f)( ~G(~e._'.~ i.l.! For:__i/~
Town, Village, City, County, eta. a
(Specify)
Notes -The application cannot be considered for filing until all of the above questions are answered 1
and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
w
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i
Do not write in space below - FOR DEPARTMENT USE ONLY
DATS RECEIVED L ACCEPTED BY RETURNED
(Initials) (Date) See res.)
FEE R1;CEIV0 _ VALID. NO. PERMIT NO. _ ! CJ
Yes or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No)
COI-¢'"TS: