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Parcel 026-1113-50-000 10/11/2006 04:09 PM
PAGE 1 OF 1
Alt. Parcel 3.30.18.650 026 - TOWN OF RICHMOND
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 - MEATH, JAMES J & CHARLENE M
JAMES J & CHARLENE M MEATH
1239 172ND AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1229 172ND AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.040 Plat: 2021-GREEN ACRES ADD
SEC 3 T30N R18W LOT 15 GREEN ACRES ADD Block/Condo Bldg: LOT 15
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 711/384
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.040 27,500 122,200 149,700 NO
Totals for 2006:
General Property 1.040 27,500 122,200 149,700
Woodland 0.000 0 0
Totals for 2005:
General Property 1.040 27,500 122,200 149,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 135
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin ^epmris+ent of Health and SociAl Services
_ a
Plh: X57 370 Division of Health _
C
SEPTIC TANK PERMIT APPLICATION
~ f or USE BLACK INK
A. EAdNER OF PROPERTY
Name Address (Street City, Zip Code)
B. LOCATION OF PROP_ER_T_Y_WN5_It' SYSTEM W11:, BE CONSTRL,'CTED ALTERED CR EXTENDED COUNTY L~~"'X k
Check One: y -
CITY VI 'JGE LEGAL DESCRIPTION
TE)Wr;sHZP U `l
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION RiPLACK'IEN'T ADDITION
MATERIALS: Prefab Concrete L Poured in Place Steel. :trier
FjZZ%R OF TiYaCS TO BE INSTALLED:
k
E. TYPE OF OCCUPANCY
Check One: One or Two Faa.ily Residence Commercial Industrial other
Specify)
4- Number of Bedrooms ' r
Number of Persona to be Accommodated
y L
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automati. Clothes Washer ~ YES _ NO
Dishwasher YES NO Automatic Potata Peeler YIS,%- NO
Other (Specify)
G. MASTiR PLUTBER MAKY.G IP;S T ALLATIG
Address; Name: License Pirsber:
M?
~!I -
MP RSW
Signature of Applicant: _j
Address: 1
F H. (To be Compi ted by Ig9uir.~ Agent)
Date of Application ' Fee P&td
Permit Issued (date)' f~7' /-~7, 7 /7 ?ermit Number/__2_
Agent (Name) z
Town, Village, City,'County, etc.
(Specify)
Note: The application cannot t„ Noa3iderQ4 for filing until all of the above questions are answered and the
fee paid. Agents will forward application, the fee of $1.OU 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 Health.
Do not write in space below - FOR DEPAR71ENT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED VALID. No. t Z rf PERMIT NO. Q BCD
Yes or No L
REVIEWED BY APPROVED DAn
(Initials) Yes or No
COMPLETE OTHER SIDE
~ y SEPTIC 'FANS: PZRM17 NO.
R E P O R T O N S O I L P T R C 0 L A T I 0 N T E S T
A X D S O I L B O R I N G S
TO
DIVISION OF HEALTH - PLi.?-PI:Q S=71 n3
P.O.Box 309, Madison, Wis. 5'$701
Pursuant to H 62.20, Wis. Admi.nistrativ) Code
P S R C 0 L A T I 0 N T T S T
Test Depth Character of Soil Hours Water Tea: Tim:. Drop to tinter Level Inohes inu+es
Number I In4has Thickness in Inches Since Hole in Hole Inti:val Second to Next to Last To Fall
1st Vatted Ovc:1 41 in liinutes Last Period lAst Period Period lona, Inch
E:c°-~ple
P - 0 36" To Soil 10" Cl- 26" 25 Yes or No 30 1 2 172 1 f 60
RECORD DATA FROM ML*SL`IIJM OF 3 T37ST 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- M'r_i^uim 36" Bel" Pro,)4jed Abeo. tion Systtm
Soria Total Depth Dth to Ground W:ar Depth to Bedrock
Nu.sber Inches Cbservod Es+in ied 63 erved Estimated Charaot-er of Soil with Thio'kness in Ii.ches
Example
B - 0 721e 72" Plank Top Soil {12" Clay 1811; Sand 1811ei i ravel )24"
R-z--CPD DATA FAOM MINL'Ib'IS OF 3 BO?2 HOL
YPE OF OCCUPANCY. -
RBSIDF-NC1: Number of Bedrooms OTHZRs (Specify) ~E Number of Persons
D WASTs GRL'7DERs Yas N7 Di3 mash)r: Yes No r Automatic Clothes Washer: Yes i~ No
FF31J'LNT DISPOSAL SYSTEi'S: NEW EXTENSION ADDITION REPL&CEIENT
Tile Size No.Lin.Feet ! Trench Width Depth ? Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth
I, the undersigned, hereby oerb:fy that the parccZation tests rspcrtad )n th-'s ware made ty me or under 1,, super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisoonsin Administrative Code, and
that the data reoorded and ho- on of test holes are correct to the best of my knowledge and belief.
NAME C id ~611 t`i TITLE
Type or Print
REGISTRATION NO. , or MASTER PLUMBER LICENSE NO.
ADDRESS
DATE SIGNATURE
i