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Home My WebLink About018-1013-00-000 n cn O m 0 o :E c v o (D 0 K 'a M fD m (D U ~q ri, a~ ICII Z 2 m 3 O N Cy) (D 7 N 1--i c, o a m ° (D cn a m c _o q (D CD 0 (Z) O (D CD ir; O D. O O w 0 oo C. v (D o N o o w o > o a w O p O Ul =7 (D _ ro w < Z jZ m o 1= m e ~ N o c 3 s 3 N V V O Z O O O a ~r c; cn cn to (D 4t O. v _v vroi I~ < ~~yo Cn 07 C - 0 ~v N N O c N 7 3 n Z3 CD N 0- z 0 . z Cn z D m o V (D 4 (c lr • (D cn ro r. N i~ ro I C)J p ( .P Z N n O A Z O CL O 3 z V W M N (D (D Co 0 3 z O Z 3 m CVC z (D A W q a CD (D n 3 m n - T Q O j Z Q N N crop a ~ Co O (D p> a_ - ((DD a a v 0 N ~ x N ti cn O O O v O Jy \ lo~ ^J w C) 10 o O 0 a * WisoonsiEa Del'irtmont of Health r d 50oial Srrvices Plb. k67 370 Division of Health SEPTIC TANK PERPdIT APPLICATION TYPE or USE BLACK INK Ol f/~ /CJn/ 3 A. CMIZIt 0: PROPERTY N sae Address (Street, City, Zip Cod,9) R R ~ sirs S ' / f ✓9 rr1 ~ ,v l~L, ~ ~ S r B• IACATION OF PRO?FRTY WIfi'.RB SYST M WILL BE CONSTRUCTED, ALTERED OR EXTEND.D COUNTY Chock One: _ CITY VILLAGE LEGAL DESCRIP ION _ TOWNSHIP LAJ C. IS LOCAL PERMIT REQUIRED FOR T:IIS WORK? _ YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY C7 Gallons NEW INSTALLATION X REPL4CEMENT ADDITION MATERIALS: Prefab Concrete X Poured in Place Steel other 14IMER OF TANKS TO BE INSTALLED: {7/V P E. TYPE OF OCCUPANCY Cheek One: One or Two Family Residence Commercial Industrial other (Specify) Number of Persons to be Accommodated Number of Bedrooms 55 F. APPLIANEES, ETC: Food Waste Grinder X YES NO Automatic Clothes Washer X_ YES_ NO Dishvrasher _ YES NO Automatic Potato Peeler YLS>,' , NO Other (Specify) G. NG4STLR PLUMBER MA%ING INSTALLATION Name: L / C-- Addresss License Number: ~J ~ l r s ~ ~~~~y MP RSW Signature of Applicant: Address: !\1~ x v~: ~~E-L~ L H. (To be Completed by Issuing Agent) Date of Application / Fee Paid Permit Issued (date) Permit Number f S / Agent (Name) Fors Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of tts above questions are answered and the fee paid. Agents will for-+a-rd application, the fee of $1.00 for each septic tanx 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 Heaith. Do not write in space beic-rr - FOR DEPARTMENT USE ONLY 1. DATE RECEIVED ACCEPTED BY RETUR2+'ED ( (Initials) (Date) See Corres.) FEE RECEIVED _ VALID. Ni. PERMIT NO. Yes or No REVIEw'ED BY APPROVED DATE (Initials) Yes or No S',:FiIC TANK F1__'P IT NO. R E P O R T O N S O I L P S 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 r- DIYISf I Or UZALTH - PLU-012.:. S237-16N P.O.Box 309, Madison, Wis. 53701 ~►~1/ ~ ~4Yr'1 , Pura=nt, to If 62.20, Wis. Administrativo Code ".ISIOr~ t1°'I C.. 6 EA. c~ P E R C O L A T I O N T E S T Toot Depth Charaoter of Soil Hours Water Teat Tima Drop in V%ter L~:vel Inches ILnutes N=bor Ir01133 Thio":moss in Irohos Sinco Hole in Hole Interval Second to Nest to List To Fall 1st blotted Ovornight in Minutes I-%.it c-ri,)d [^st Period Period cn.e Inch Example P - 0 3611 o Soil 1011, Cl^ 2613 25 Yes or No 30 I 1 2 2 2 1/2 60 0-L "-I,/ 2 619 RECORD DATA FROM MMIM M OF 3 TEST HOLES Compute size of absorption aroa in aocord with H 62.20 Wis. Administrative Code. S O I L B 0 R I N G S- Minim-L?m 3611 Belc:r pro osed Absorption Systs..l Boring Total Dopth De th to G?ound W-.,~tar Depth to Badroc', Ntnber Inahno Gbso vod Estir-ltod C:onerved Esti~dtod Character of Soil with Thio=.ness in Inches sx;Ea:ple B - 0 7291 72t1 Blaok To Soil 1211 C1 1811• Sand 181/• Gravel 2411 1 z lvt) 'Al Z :;?-z' RECORD DATA FROM MINP:UM 0' 3 BOR.'. KOLA'S YPE OF OCCUPANCY: RESIDE2ICEs Number of Bedroens 5' OTHER: (Speoify) Number of Persons POOD WASTE GRINDM?s Yes X_ No Disl=ashors Yes No Automatic Clothes Washer: Yes X _ No FFLUENT DISPOSAL SYSTF.ti: NEW X EXTENSION ADDITION REPIAJCE,W'~ Tile Size 7L(( No. Lin. Feet C 5'0 Trench Width n Dopth / Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seopago Pits Inside Diameter _57-'Tt/Liquid Depth, I, the undersigned, hereby certify that the percolation tests roported on this fors were made by me or under my super- vision in acoord with the procedures and mothod speoified in Chapter H 62.20 (13), Wisoon3in Adainistrativa Coda, an.: that the data recorded and/location-05 test holes are correct to the best of my knowledge and belief. Ntu~ ~ ✓ e l? 7 I C O I t -TITLE Type or Print ~(l REGISTRATION NO. or MASTER PLUMiER LIC-74SE NO. 41- ( C~ / ADDRESS _Z__ l t/ .u~ C L S 7 _ r-. DATE .27- 7/ SIGNATURE ~a ,4Q ~l s 0 "i~ Parcel 018-1013-00-000 05/03/2007 10:57 AM PAGE 1 OF 1 Alt. Parcel 07.29.17.97B 018 - TOWN OF HAMMOND 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 - SIPPL, JOSEPH J & ELIZABETH A JOSEPH J & ELIZABETH A SIPPL 1573 110TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1573 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.250 Plat: N/A-NOT AVAILABLE SEC 07 T29N R17W NE NE COM NE COR SEC 7 Block/Condo Bldg: TH W ON CL TN RD 669.7' TH S 33' TO S R/W & POB TH S 260.06'; TH W 335' TH N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 260.06' TO R/W E335' POB 2.25 AC 07-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 10/27/2006 837550 WD 09/02/2004 773327 2649/22 PR 09/02/2004 773326 2649/20 DM LT 07/23/1997 711/539 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.250 28,100 95,700 123,800 NO Totals for 2007: General Property 2.250 28,100 95,700 123,800 Woodland 0.000 0 0 Totals for 2006: General Property 2.250 28,100 95,700 123,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 w Parcel 018-1013-10-000 05/03/2007 10:57 AM PAGE 1 OF 1 Alt. Parcel 07.29.17.97C 018 - TOWN OF HAMMOND 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 - SIPPL, JOSEPH J & ELIZABETH A JOSEPH J & ELIZABETH A SIPPL 1573 110TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1573 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.170 Plat: N/A-NOT AVAILABLE SEC 07 T29N R17W 2.17A NE NE LOT 1 OF Block/Condo Bldg: CSM 3/668 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 10/27/2006 837550 WD 09/02/2004 773326 2649/20 DM LT 08/02/2004 773328 2649/23 WD 07/23/1997 738/350 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/24/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.170 26,500 600 27,100 NO Totals for 2007: General Property 2.170 26,500 600 27,100 Woodland 0.000 0 0 Totals for 2006: General Property 2.170 26,500 600 27,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00