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HomeMy WebLinkAbout020-1001-10-000 C_ m z Z cu m ♦y m p O mm O 0 m J r O ~r c b (J) M. ~ ~ m N N m 00 g o o z %%.I O T D O off' m O ° c C D r Z 2 c = -.I m z 0 m n 00 Zd m Z v C z z i W C: 0 - ~ T ~ c 0 Cn 00 ;u G) C) -i z z) Z m o O ~ G) m z I© m a) CD - m4 3° 3& 5-6 -a m CL T > m a C m W D 8o a~ = ow gmm o~ :cm s 2 v o T O O y N f^ N C O fD O O y 417 C N N O: 'co; w m =3~_ 4 pp~ X. 'ED Z) m Q' N r. y y N y. 7 41 y d _ g)m ~n` nom. a~ d ;w N g _ = y o m D ? p a m. cr - - (O D C m g N m y m ,ay CD < -0 a 0) y (p}~b gyp O O N y a Q f0 Y7 Q. ~7 ~7 ~ z v o c ;u Z m T z r y y 7 C o m ° OZ z C m (D m N m 7 o y -D_i _DI m0 m y (D 0 K W O O Z O D =r m o (D flL , m C- Z 2 O Z X m 0 Q N = - Ol j (D - l O' = 0 d a ❑ 11 11 ,~IAI County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN `p In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT ~b Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road $ Hudson, WI 54016-7710 (715)386-4680 Fax (715)386-4686 Attach complete plans for the system on p er not less than 8-1/2 x ches in size. County Sanitary Permit # cation 5 3 Application Information - Please Print all Information Location: Property Owner Name SEP 0 4 2008 114 NE 1/4, Sec c e, S2- z N, 7 R I't E (o Property Owner's Wiling Address ST. CROIX COUNTY Lot Number Block Number ZONING OFFICE ,Z© City, State Zip Code Phone Numer ubdivision Name or CSM Number JJ o S^Y~ t(6 'f ; t I 1 Type of Building: (check one) IMity ❑ Village own of ❑ 1 or 2 Family Dwelling - No. of. Bedrooms: ❑ Public/Commercial (describe use): N J ~6 ❑ State-owned Nearest Road 1. Type of Permit: (Check only one box on line A. Check box on line B if applicable) CA XS rceli Tax umbers J A) )~Repair . ❑ Reconnection .pNon-plumbing . Q Rejuvenation Sanitation bZ0-1 OQI - d ` dOO B) Permit Number Date Issued j~ OA/ate Sanitary Permit was previously issued g CJ IV. Type of POWT System: (Check all that apply) Non-pressurized In-ground (~(J/ ❑ Mound a 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter / ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other At-grade Aerobic Treatment Unit ❑ Recirculating Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Ai5plication Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required _L Proposed (Gals./day/sq.ft.) (Min./inch) Elevation o 4S oU -6 2g 0_7 1. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks t / ❑ ❑ ❑ ❑ 75V ty 11. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenaliort/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift re it or the installation of non-plumbing sanitation system. Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) 574 0 1 ?o r III. Count Use Only Disapproved Sanitary Permit Fe ate I ued Issuing ent Signal No stamps) Approved Owner Given Initial Adverse Z PRO ! b - IX. [Determination p Conditions of Approval/Reasons for Disapproval: S GfiGr~E !/H 97A G~` ~ SYSTEM OWNER: Q ~ QQA 1 Septic tank, effluent filter and `~'W dispersal cell must all be serviced /maintained - as per management plan provided by plumber. 5C Ll ~Q aex - :A h All setback requirements must be maintained as per applicable code/ordinances. ! " n N O n cn O y v 0 r w o f o d c d o ® "'1 p ro m p ro m .B a; ~~"*1. 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M Z- 2 (n O ~ II v ~ E a> M a 3 # ° a ww_• c~ a N ° 0 N 7 E A U 0 (n u on a Parcel 020-1001-10-000 05/18/2005 10:33 AM PAGE 1 OF 1 Alt. Parcel 07.29.19.1 K 020 - TOWN OF HUDSON Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HARKCOM, DONALD K & MARY KAY DONALD K & MARY KAY HARKCOM 1083 GOLDEN OAKS DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1083 GOLDEN OAKS DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.710 Plat: 1200-CSM 14/4018 SEC 07 T29N R19W PT SW NE SLY 250 FT MOL Block/Condo Bldg: LOT 201 OF LOT 20 AS SHOWN ON CS THIS CSM IS IN T SEPH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 030-1028-95 (108 ) 71, OF LOT 201 CSM 07-29N-19W SW NE 14/4018 Notes: Parcel History: Date Doc # Vol/Page Type 01/05/2001 636346 1572/584 WD 07/23/1997 940/112 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.710 53,300 188,100 241,400 NO Totals for 2005: General Property 0.710 53,300 188,100 241,400 Woodland 0.000 0 0 Totals for 2004: General Property 0.710 53,300 188,100 241,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00