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Parcel 012-1056-10-000 o7/o3i2oo7 03:30
PAGE 1 OF 1
F 1
Alt. Parcel 25.30.17.393 012 - TOWN OF ERIN PRAIRIE
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 - WARNER, DUANE R & JOANNE
DUANE R & JOANNE WARNER
1332 HWY 63
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ` 1332 HWY 63
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 25 T30N R1 7W 40 AC NE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
25-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 853/269
07/23/1997 695/451
07/23/1997 455/601
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/07/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 30,000 105,500 135,500 NO
AGRICULTURAL G4 9.000 1,500 0 1,500 NO
AGRICULTURAL FOREST G5M 29.000 46,400 0 46,400 NO
Totals for 2007:
General Property 40.000 77,900 105,500 183,400
Woodland 0.000 0 0
Totals for 2006:
General Property 40.000 77,800 105,500 183,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 117
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Health and Social Sorvioes
3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
/ LClvh.e,~ ~
TYPE or USE FLACK INK;I,
A. OWNER OF PROPERTY
Name Address Street, City, Z1 Code)
Be LOCATIC11 OF PROPERTY W1::.RZ SYST`21 WILL BE CONSTRUCTED. ALTERED OR EXTENDED COUNTY
Check One:
CITY VILLAGE LEGAL DESCRIPTION
~GZ~/ll~y
TOWNSHIP, j ~
1, it,t';_;, i;• y /~C,f'/-J1~t{~
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK?L j_ YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY l t~ Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE 'NSTALLjD: 1
E. TYPE OF OCCUPANCY
-Check One: One or Two Family Residence Commercial Industrial Other
Specify)
Number of Persons to be Accommodated 7 Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dishraasher YES NO Automatics Potato Peeler YES= NO
Other (Specify)
G. MASTER PLUMBER MAKING INSTALLATION
Name: Address=<.-~r'% License Number:
G
Signature of Applicant: MP RSW
Address:
H. (To be Completed by Issuing Agent)
Date of Application Fee Paid /
Permit Issued (date) Permit Number
Agent (Name) '71 _ ~a'/- 7 Fort
Town, 'Pillage, City, County, etc.
(Specify)
Note: The application cannot be eonsic3~red for filing until all of the above questions are answered and the
I fee paid. Agents iii- for~,.ard application, the fee of X1.00 for each septic tarot and the third cop,
of the permit (canary) to the Division of Health, Checks and money orders should be made payable to
the Division of Health.
Do not rrite in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED -7
ACCEPTED BY
RETURNED
(Initials) (Date) See_Cgitea.)
FEE RECEIVED VALID. No. ~t O PERMIT NO. `
Yes or No
REVIEWED BY APPROVED DATE
` (Initials) ( Yes or No
COMPLETE OTHER SIDE
SEPTIC TANK PERMIT NO. R I.P 0 R T O N S O I L P I R C 0 L A T I 0 N T E S T
A N D S O I L B O R I N G S
TO
DIYISIC V OF HEALTH - PLLP7RL+.''r SECTIC 7
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P I R C 0 L A T I 0 N T I S T
Teat Depth CILIraoter of Soil Hours Water Pest Time Drop in Later Level Inches Hinutes
Number Inches Thiclm ess in Inohos Since Hole in Hole Interval Second to Next to Last To Fall
1st Wetted Overnight in Minutos Last Period Last Period Period On 3,Inch
Example
P - 0 361, To Soil loll, Clay 261+ 25 Yes Or--N - o30 1 2 1/2 1/? 60
J'e
RECORD DATA FROM MDiRIUM OF 3 %.S 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 3617 Bele°x Proposed Abso tion System
Boring Total Depth Depth to Ground Water Ree drock
Number Inches Observed Estimated ldated Character of Soilwith Thinness in Inches
Example
B 0 72', 72t7 Black To Soli 12" C1 1817 Sand 1877• Gravel 24'7
/Zj
t F'i
7 < /i 111 % ~ .v . /r
1J
RECORD DATA FROM MIN11MUM OF 3 BORE HOLES
YPE OF OCCUPANCY:
RESIDENCE: Number of Bedrooms OTHERS (Specify) Number of Persons
POOD WASTE GRINDER: Yes X No Dialzrasher: Yes J' No Automatic Clothes Washer: Yes No
EFFLUENT DISPOSAL SYSTEM: I~EW y EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet,~. F Trench Width Depth ,7' Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pit: Inside Dia-m r Liquid Depth
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under ray super-
vision in accord with the procelures and method specified in Chapter n 62.20 (13), Wisconsin Administrative Ctda, and
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
NA;_`
TITLE
Type or Print)
REGISTRATION NO. or MASTER PLUMBER LICENSE NO. ~7~`~.>{ l
ADDRESS + f ?1 r. / /
DATE
SIGNATURE i _ I/
- i