HomeMy WebLinkAbout012-1030-60-100
O Cl) O v
o d d o d 0 G y1
3
~ m m ro a ti
m o x* o
v ~ w CD f pA
a; O
(n z x U o D m j o _
n O ro m N ro N 'I ty~' •
O Q O ro rn D- O N C l~~lll
)
C ~
w (p W (I=i C7 V O C r
O r_0 7 N Cy -4 M
(D O
rn 3 Q
CD a l o D 0
7 N O O O O
° z ID m a
~n~ o I`~ a rn
w
o o ID
'C w o 1l
Z
p -4 O
- n r fn !y
O O o a Pi
'D
•
z O O O ~
co o ~~-4U, <~z GQ
a cn fn cn o o D
. p- -0 O 0 v O
m ( N O
.r y
(CD (0
N 3
O v
I C:. 7 Cl)
c Z cn z
D (D o
O ro ro
p s T
ro !tit •
N
-0 cn
C
ro r.
~ N
C ro
w a
O ~ O
ro _ O --j cn
z Z <D
0. U OC O
r, p Z O
p ~ ~ O
10
i~
Z -i
W (D m w N
M (D 0
OL
z
O Cf)
3 m
Q
a
w
o'
O (D (n N
X. N (D
2
N 3 N Q C
(D ro N
O cc IG O C -n
N N D C
O N ro 7
(D O N' 2 O.
(D ro O ; S=
cc C' U
N_ < ro
(D
O O p v
O T 6
O N
N N N
cn p
(D - n `
N
O Q S
N 7ro O
~ ~O N
O ro N
ET N ro
N ,
tV
N ~
O
Wisconsin Department of Health and Social Services
Division of Health
Flb. 57 3/70
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. UWNER OF PROPERTY
Name - Address ~ /(Street, city, Zip Cods)
A 2 L- rn r' /Y c v pi l c.14 n7
B. LOCATION OF PROPERTY WE_-.RE SYST i WILL BE CCNSTRUCTED, ALTF.R:T OR EXTk L'ED COUNT Y 0
Check- One: Y ~ s T 1% ti ~
CITY VILLAGE LEGAL DESCRLpTION I-
TOWNSHIP l 71~ ~C'C-~ • ~ -Z- ~ /3 S' J'-
C. IS LOCAL PERINIT REQUIRED FOR THIS WORK? X YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY 1 0 Gallons NEW INSTALL4TION REPLACEMENT ADD IT ~011
-6-1 A7"
MATERIALS: Prefab Conorete X Poured in Place Steel Other
NUMBER OF TANU. TO BE INSTALLED: /`pro,u e - ~ A~ ciY ~~/✓S ~'q Ile .i
E. TYPE OF OCCUPANCY
Check One: Cne or Two Family Residence X CoTnMercial Industrial other
Specify)
Number of Persons to be Accommodated z/_ Number of Bedrooms
g, APPLIANCES, ETC: Food Waste Grinder YES X NO Automaatic Clothes Washer /-YES NO
Dishwasher Y1.5 NO Automatic Potato Pcelar YES X NO
Other (Specify)
G. VdLSTER PLI:r23ER MAKL`IG INSTAALLATIO'
Na me: ✓ C l,. - L Address: License Number:
r>
GC
Signature of Applicant:
Address:
H. (To be Completed by Issuing Agent)
i
Date of Application ~r f Fee Paid
920
I~ ' Permit Number
Permit Issued (date)
Agent (Name) /i. Fort
Town, Village, 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 will forward application, the fee of $1.00 for oath septic tanx and the third copy
of the permit (canary) to the Division of Health. Checks and money orders should be a:ade payable
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) ~O res.)
FEE RECEIVED VALID. No. PERMIT NO.
Yes or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTIMR SIDE
r SEPTIC TANK PEIL-11T Y.O.
R Y P 0 R T O N S 0 1 L P Y R C 0 L A T I 0 N T E S T
A N D S O I L B 0 R I N G S
TO
DIYISICN OF HEALTH - PLLMING S XTI&N
P.O.Bax 309, f,'.dison, Wis. 53701
Pur=,'At to H 62.20, Wis. AcW.inistrativc, Code
P; R C 0 L A T I 0 N T E S T
Teat Depth Ch.:racte2' o~? Soil Hour--.-~...
Number Inohas Thickness in Inches Since Hole in Hole Iitervale Second tin Level o t Next to InoLas
La st To Fall
Fall
Example 1st Wetted Overni ht in Minuto. Last Period Last Period Period C*.,qo: Inch
P - 0 3611 To Soil 1011 CiP°v 2611 25
Yas or No 30 1Z2 1 2 1~2 60
/ ~ r. ~1 r. Cc-,nl •
V G"' [J RECORD DATA FROM MINL"NM OF 3 EST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Adminiatrative Code.
S 0_ L B 0 R I N G S- Minl=vn 3611 Below Pro~osed_Absorption Systsc s
Boring Total Depth nth to Ground Watar De th-0 Bcdro - -
Number Inehaa to c'c -
GOsorvad wstirata3 tbaervad Fsti Atod
Sxa.:;ple Character of Soil with Thioicness in Inchas
B - 0 72'1 72n
Bla_ck_ Top Soil 1211- Cllr 1817 • Sa :1 n18'1• _Gravel 2411 .
(J lU
72- 616-
RECORD DATA FcRG', MIYL".UM 0? 3 Boaz,
.YPE OF OCCUPA;( I:
R%SIDENC£s Number o: Bodroc+zs r OT~ER= (Speoify)
Number of Persons ~ M
D WASTE GRLNDEts Yes No _ Dishmashers yes +
- No 2<- Automatic Clothes Washsr: Yes X No
FFWEM DISPOSAL SYSTEM: NEW EXTENSION X ADDITION
' Rc PLACs?i-YT
4
Tile Size T No.Lin.Feet la-5 Trenoh Width
Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pitt Inside Diameter '.Liqu dDepth- ~ rr
Is the undersigned, hereby certify that the percolation tests reported on this form were made by me or under er
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative C de,uand
that the data recorded and location of tes holes arel correct to the best of my knowledge and belief.
NAME e L CJ !
Type or Print TIT LE
REGISTRATION N_ I
q
or MASTER PLUMBER LICENSE NO. [I ez f) /
ADDRESS ! rJ S
DATE
3 0 - SIGNATURE 1'~
Parcel 012-1030-60-100 07/03/2007 01:46 PM
PAGE 1 OF 1
Alt. Parcel 12.30.17.176A-10 012 - TOWN OF ERIN PRAIRIE
Current ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
0211212007 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
JOHN J & JEAN M DALTON O - DALTON, JOHN J & JEAN M
1660 HWY 63
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description " 1660 HWY 63
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 15.268 Plat: N/A-NOT AVAILABLE
SEC 12 T30N R1 7W PT SE NE & PT NE SE Block/Condo Bldg:
BEING LOT 1 CSM 9/2473 15.268 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 983/123 WD
07/23/1997 979/348 TI
07/23/1997 972/525
07/23/1997 971/421
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/06/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 45,000 199,900 244,900 NO
AGRICULTURAL G4 12.268 1,300 0 1,300 NO
Totals for 2007:
General Property 15.268 46,300 199,900 246,200
Woodland 0.000 0 0
Totals for 2006:
General Property 15.268 46,100 199,900 246,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 210
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00
0.00
0 to p n
0 F O C
0 .r
CD -0 #
3 `
# sv
O
0
z =
~ ~ o v m ® ° nCOi - °(D 7 a N 6i) Qpj 6 7 W N H" ` 1
CL (h O
V N N a
0
f J p
O O O_0 n 3 co . U CD N V Z
W N O) C m CD m Q O O O
3 a o rn p D fy
rn o
CA N ° 7 ° ° O
Q y
U D (CD F O `.7
a
(D z
m ~j p CD
N a t
C Q C W
N N 3 O O (D !'~1
(D CD
o ° s r fn 11~
J J
0 o 3 cn O c ~i
Q
7
a _
O O O
E -1 a ti ti o o_ D
M JCD my o ~ p
m N (O
flJ
D
i
D)
3 N
(D J
W N
Zcnz
D m Q O
O m 7
a
N U
(OD N •
((D C
C N
CD
m a
3 E
m
7 a _Z m
n O f)
C
O
a Z
7 A
~ 7
z -i
W M W N
CD m o
0 3 A z
o^. cn
3 m
D
a A
CL
W
O
o (nQ m D 7
3- ITD a
v a
v m CD O
a3 ~(O N 0 0
Qa N~~ N SU
m
(D O N Z Q
3 -a ° m o
(cOZ N
-o m „ * m O
=r CD U)
O O N U
Q C p ~ Q
CD N p -
m m ~ Qm
7 0 L
a f7l ID O
ID 7 O
m a y
m S Q Q S ~
C m
7(O
7C'
7 O m (v
N Q N O
N f~
W
p
CD a
Oro
f/) O %
O * a
°p ~
v
.ERIN PRAIRIE
v ~ K SEE PAGE S7 T 30 N.-R. ~ 7 W. 4s
ti GOOSE iyp SEE PAGE 59
y ETT ~f
y ~ , - rf, ~•«>s~~s ~ "/yam .z r-.
tl: -•39 Fn < • i C V~9
v i6o !7`fJ~/ao~ P ~P-5. y Ni a/df S.E 7/v d ~ 60 _ G~ 91
d \ Q
• • /66 k ~~se 13J T /60 Ael~
-3 - ¢p r q C{ ` ~ ~ ~ ~ w4 •
ol. `°q rt - - - J
~~'qe/ - ~0 9 ~ii~y cobs C cC+• 40 • ,i/.~z J V -
~f7 d~CP ti<zU '7z/~ ~ ~ - > ~ ~o .Doc./d ~ 0 4'~ii " • ~ .ws,i~
h'a worth ~ iPue6ar~ :-°c/ ao F v S ~ /o ~ V 'A ra
Na~c 0 G ¢o
/9o iGo 9 de won cS'ch2?, ~a -
do
/y ~ iza /`1/f ~ z¢o Janes H. e My t/e zoo t~4 C ~ \ ~
rre.sf a
efersori n~
y ibo~ cS ci
Z61 L da
_ \ O
-
He/eo is8 Bo G1G/.5ei ~E/c¢~zo e Q~i an~`i~ eC sf
G G ~ s ~a.n Ptt~ U ae o~ \ ~
DSO /l /60~ //B eJ 4a i~Q[isc_
K ]3 t
,°o ~ ~ ~ • c ~h.~ ~Z"oQ 9 de so~7 ~o Q i ~
0 0 ~ v ~T do ~ atche ao 9ibe~-f Q~
-S za Sv ~Ser
e.•.~`~ ~1a c iso6fQ7 1
zoo T ~o
y ¢-nes c ~ -
H na/d f ~ o~¢fiue yes/ y~ -
'4~ Perm- ~ ~z °
do w o ~ r mss
66
15,
V go zoo ~ ~ Tee-~ c zoo
Q b rio¢ fi ~ ~efe rsor~ ~ fcvms S c . T/~o ¢s
° Q9 Fmk: Paz os Bo ~ed~ c rem- Q 4/z 69
p Ca- ha/ei r ~ ~l~.n ~ Totes i7 ,8 rro i.
G io9 ~'9 0 - U ~'er¢ hf is9~ C%yf =60
h !L wrenca O oc 6o h/ ¢o -ERIN COINER G is
~ p ~ 80 ~ d . A n ~ '1~ ~ 9 ® •9 f~5~~- ~
Jofi~ aFo cc- Bo .4 ~l p Q P Q.h c Eve/ Bo
C 0 0 8o y~ ~t=us;:a// W
/GO " 4 v F~ -9 /hu. Emmerf e ~ V
'~O ~ ~ ~ F 60 ~ m r/ /60 oe sd~ G'hFrf ~
GYa~~e.~ f ~are~ red E~ea/ T.So ,2s ~ ~ 6 ~ z 90
cSin~z//id~e ~~6~ov✓ izo E1q ¢ ~ Z~ori ~ C.~ ~ U ~ R h
/gyp ~ C
3d.~73 3 0 ~✓a~2 ~c-E John 4 i ~ ~ do 'mar'e-~ p ~ Dona ucz~
~/arar ~O / o Q d •~~dm~> y~ ppF" po Q i(ara.~ -
¢/~q ~ ~ //00 ~ C l ~ /~CI m A d. So rJ
ao \ 0
• Q ~ ~ /moo ~3ro s.
o v Fr, ate - eo
9/her/ q~ Z.
~o id Be f/z¢ G~/d ~ ~ ~ So ~ Emme17'
es h~ D ~ ~ 9 ~c ~'e~a
f/e ~.6ue.~ ~hcrsf~ ~ ~U 8o w ~ .Be¢m ~ ~ ~ ~ 9u~e
~ so • z oo ~ 4 z 9o zoo ~ ~ 4iU mo
y~ n \ 7s I) 1 ?0 3R l Q 4
~ ~ e o oC.
6
efa Bo C 3 2i9.3~• o~ Le ~d ~e%~d SEe ko / Cv Get
.s
• ' • VlEq J o0 6 s Bo cS~odO'or ¢~re /fer v ~ ~ hre/ds
X ¢o V
~ A- G e~, Gv//o~ 3 Ph./.,o ~ 41 y M chore/ ~ - ~
i6o eftt/ ~ y. Norm¢~ T U ~ ~ ~ /ene /i/c%.• C¢r/• Howara'G
~ l ~l • ~t~tie 0 C o ~rro.,~ ~ ~ C n o' „ : ' ~-s/m4~ £ Es a
d loo ~ ~ ~ 0 <Sc/,ro// U a 3 ~~ei/ kcrs_
d /moo Z o /zo l~ a v GUaike~-
/GO d 4~tp, i~o zoo A _Y ~oed G'¢../ Aso
2 \ V J
~ Q Edw-~ ~//Q m ~ U 0 izo "7 n C Sfir~ , G% ~ ~ •
e ~ cTah~ 4~J¢r
sus C • /zo < o. C /z d ~h
F.o cis 8o L¢.~
v U W7/ia m, J T h~ 4 ~h.~ ~ ioo p
~/`>4 y ? d- Q ° C ° C _ - i o ,Q 6er~ moo
/e~f-zap 'iGO 'l ~l ~ 0 S tJa~y C'°~-o ~.7 G°fh ~ n hti 9 fh~ ~F' l~ d~e~ -
L a.~ c, 1~¢ /f /s~s .9 ti o Je Q e C 0 `q yOr .B os
/9/s oc,Efo d/yo~o ~6/. L.->c A A SEE PAGE E 3/ ~z~. 0 i~4 y .
sfC oi:r C ~y - s
JOHNSON MOTOR
HARRY'S RACK & BUNK FACTORY
SALES, INC. HONEY HOUSE
BALE THROW RACKS -HAYRACKS
Chevrolet We have honey available the GREEN CHOP BOXES HAY BLINKS
Buick year roand•
O HARRY & Lots WOLF PICNIC TABLES COLUMBUS WAGONS
PHONE: 684-2895
6a4 Racla isaedd 9d /3,,"
246-2261 R. i - Box
120 . S - Baldwin Wis.
1 1/2 Mi. S. of Baldwin PHONE: 796-2724 - Hammond, Wis.
NEW RICHMOND, WIS. on HWY. 63 ,
F. R. OSTRUM
l