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Parcel 026-1108-70-000 10/11/2006 03:51 PM
PAGE 1 OF 1
Alt. Parcel 4.30.18.605B 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
JANE A BALL O - BALL, JANE A
1189 174TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.120 Plat: 2573-VIEBROCK'S RIVER VALLEY VIEW
SEC 4 T30N R1 8W LOT 6 EXC ELY 62' Block/Condo Bldg: LOT 06
VIEBROCK'S RIVER VALLEY VIEW ADDITION
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 988/367 WD
07/23/1997 521/85
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/20/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.120 4,500 0 4,500 NO
Totals for 2006:
General Property 0.120 4,500 0 4,500
Woodland 0.000 0 0
Totals for 2005:
General Property 0.120 4,500 0 4,500
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
Wisconsin Department of Health and Social Sorvicem
Plb. #'67 3/70 Division of Health -
SEPTIC TANK. PERMIT APPLICATION
TfPE or USE BLACK. INK
A. OWNER OF PROPsRTY
Name Address (Street, City, Zip Code)
B. LOCATION OF PRO?ER7Y W4:.RE SYSTEM WILL BE CONSTRUCTED ALTER OR EXTRiDE'D COUNTY S ~
Check One:~
CITY VILLAGE LEGAL DESCRIPTION
r~ TOWNSHIP j
C. IS LOCAL PERMIT RFCUIRED FOR THIS WORK? - YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TA KS PO BE DiSTALLED:
i
E. TYPE OF OCCUPANCY
Cheok One: One or Two Family Residence r Comercial Industrial Other
(Specify)
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES; ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES --NO
Dis:-.rasher YES , NO Automatic Potato Peeler YES NO
Other (Specify)
G. MISTER PLUN3ER MAKING INSTALLATION
Name: Address 1 } ✓ License Number:
Signature of Applicant: = MP RSW 3
Address:
H. (To be Completed by Issuing; Agent)
-saw
Date of Application M M Fee Paid ~ CrZ~
y~
Permit Issued (date) 22() Permit Number
Agent (Name) For:
Town, Village, C ty, Cou ty, etc.
(Specify)
Note: The application cannot be considered for filing until all of the above questions are an ered and the
fee paid. Agents will fornard application, the fee of $1.00 for each septic tarot and the third copy
of the permit (oanarj) to the Division of Health. Checks anJ money orders should be made payable t4
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED l - -7 C ACCEPTED BY RETURNED
(Initials) -(Date) ~e (C
FEE RECEIVED VALID. No. 72 -7 7 PERMIT NO. l
es or No
REVIEWED BY APPROVED DATY
(Initials) - (yes or No
COMPLETE OTHER SIDE
SEPTIC TANK PERMIT NO.
R T P 0 R T O N S 0 1 L P Z 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
DIVIS XN OF HEALTH - PLUMING Sn TIN
P.O.Box 309, Madison, W1!. 5VO1
Pursuant to H 62.20, Wis. Adrinistrative Code
P X R C 0 L A T I 0 N T E S T
Test Dapth Charaoter of Soil Hours Hater Test Time Drop in Water Level Inches ~Iimutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall
1st Wetted Overnight in Minutez Last Period Last Period Period Cairo Inch
Example
P - 0 36+1 Top Soil 10" Cla. 2611 25 Yes or No 30 1L2 1/2-__ A/2 60
fr/~ .t Y J
RECORD DATA FROM MINIMUM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Adainistrative Code.
S O I L B O R I N G S- Minimum 3611 Belm Prooosed Absorption S stew
Boring Total Deptla Depth to Ground Water D* th to Bsdroct
Number Inches Cbserv•sd Tsti*n:ated C+oserved Estiea.od Character of Soil with Thickness in Inches
Example
B - 0 72+' 72" Black To Soil 12l'; Clay 18"1 Sand 1811-. Gravel 24"
cs.
RECORD DATA FROM MINLbTi OF 3 BORE HOLES
TYPE OF OCCUPANCY:
RESIDENCE: Nmber of Bedrooms OTHER: (Specify) Number of Persons ~
FOOD WASTE GRIND Et: Yes NO Dishrashort Yes No ---Automatic ylo.has hasher: Yes No
EFFLUENT DISPOSAL SYSTEM: NEW ~ EXTENSION ADDITION REPLA.CLIENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pitt Inside Diameter Liquid Depth
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and .
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
NAME TITLE A
(Type o Print
REGISTRATION NO. _ or MASTER PLUMBER LICENSE NO.
ADDRESS 4_/ I 1 + / T
DATE - 7 SIGNATURE
l