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HomeMy WebLinkAbout036-1001-50-000 0 0 0 E-0 n r 3 a 3 m m _ rz t!, z S cn o o cn o 0 1 n+. c o W 0 v rn CTI tD n o is 0 3 rn m n m o h o N N ~ v CD C N O O C CD C _ _ l~ ~ .Oi n ~Q O o O 3 N D O N C 0 d n,, Z D ID F' n_ 0 0 O- O (D E-) :::t co C_7 CL ON 00 z O O CD Q N p C pal IU. 'p Nary Iz O O O o W-IJ ~a ~ fA N fn W o a O 0_ C~ CO ° I N O D o d a (n 7 m = Nrl N CD m CD CL 4 = "N z a z (n z D CD O W O D O N " W C (D C. o. 7 2 I Z C C C P ;o n n" Q .p Z O W O cl) W " a Z 0 3 a ~ o Cn 3 m z (D A W N co D D < ~a O O Q C W O T N - W C Cl) C m 2' W CL o m N tv O O V A v o ab ti CD by v~ G,a Ef3 i~ V p. W13oonsin Department of Health +ahd Social S6.. :.ca P1b..#67 3/70 plvition o7 Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK / 03!x- as • 52~ - o~-o i,/S S. CWTNER OF PROPERTY Name Address ^ (Scree-t(, City, Zip Code) B. LOCATION OF PROPERTY WF-RE SYSTFIM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY_,- Check One: CITY VILLAGE LEGAL DESCRIPTION _ X TOWNSHIP' C. IS i.iriAL FERriIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION J' REPLkCR-TNT ADDITION MATERIALS: Prefab Concrete /X" Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Cheek One: One or Two Family Residence Commercial 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 Dishwasher YES NO Automatio Potato Peeler YES r' NO Other (Specify) G. MASTER P 'I',BER MAKING INSTALLATION Name: Address: License Nu-ber: Signature of Applicant; MP RSW ~ Address: - H. (To be Completed by Issuing Agent? / i Date of Application - Fee Paid Permit Issued (date' Permit Number Agent (Name) For: Town,l Village, City, Cc-nty, etc. (Specify) NoLa: The application cannot oe considered for filing until all of the above questions are answered and the j fee paid. Agents will forr:ard application, the fee of $1.0U for each stptic tart and the third copy 1 of the pert (canary) to tha Division of Health. Cho-,Hs and n=ee orders should be -'-de P!ynbls to the Division of Heath. i i Do not write in space below - FOR DEPARTMiNT USE ONLY 1 1. DATE RECEIVED n l n I ~ ' ACCEPTED BY ± RET -R:oID _ (Initials) (Date) (See Qorres.) FEE RECEIVED VALID. No. PERMIT NO. i Yes or No) RE711"410 9Y APPROVED DATE (Initials) Yes or NOT COM?LETF 0'2.;R SIDE SF.P;IC TANK PERMIT NO. R Y P 0 R T O N S O I L P E R C O L A T I O N T E S T A N D S O I L B 0 R I N G S- TO DIVISION OF HEALTH - PLU*131NG S=TIC;I P.O.Box 309, F°idison, Wis, 53701 Pursuant to H 62.20, Wis. Administrative Code P E R C O L A T I O N T T S T Test Depth Charaoter of Soil Hours :inter Test Timo Dro2 in Water Duel InoMs Sinutes Number Laheo Thio'lmess in Inchas Since Hole in Hole Interval Second to Next to Last To Fall 1st "tt-1 CTforiti ht in Minutes Last Period Last Period Period Caste Inch Exempla P 0 3611 Too Soil 1011 Clay 2611 25 Yea or No 30 I 1 2 2 2 1 2 60 RECORD DATA FROM MIivRMA OF 3 TEST HOLFS Compute size of absorption area in accord with H 62.20 Wis. Adainistrative Code. S O I L B-0 R I N G S- ainizran 3611 B,-lc;-.y reposed Absorption S• st< Boring Total Dapth Depth to ,round iattr Dept to Badroc% Number Inohas Cbservad Estimated Cvaerved Estir..ated Character of Soil with Thio'tness in Inchas Example B - 0 7211 7201 Black To Soil 12" Clay 1811• Sand 1811, Gravel 2411 RECORD DATA FROM MINIMUM 0? 3 BO?:? HOLES YPE OF OCCUPANCY: RESIDENCE: Number of Badroo,73 OTHER: (Specify) Number of Persons rwD WASTE GRINDERS Yes Nc Dishnasher: Yes No X Automatic Clothes Washar: Yes No FFUM'T DISPOSAL SYST 1: NEW EXTENSION ADDITION REPLAC_1ENi' Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pit: Inside D=tar Liquid Dapta Is the undersigned, hereby eertVy that the peroolation tests raported cn this fora were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisoonsin adainistrstive Coda, ani that the data recorded and location of test holes are eorract to the bast of my knowledge and belief. NAPC TIME Type or Print) REGISTRATION NO. or MASTER ?1;.N3sR LIC 167E NO. ADDRESS - DA:E SIGNAMiR Parcel 036-1001-50-000 06/27/2007 11:22 AM PAGE 1 OF 1 Alt. Parcel 01.31.17.15 036 - TOWN OF STANTON 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, LOIS LOIS WARNER 1958 CTY RD H DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1958 CTY RD H SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 1 T31 N R1 7W 40A SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 01-31N-17W Notes: Parcel History: Date Doc # Vol/Page Type 10/05/2001 658443 1733/64 TI 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/16/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 6,600 0 6,600 NO OTHER G7 3.000 15,000 897200 104,200 NO Totals for 2007: General Property 40.000 21,600 89,200 110,800 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 20,800 89,200 110,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 138 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STANTON COUNTY T 31 N--R. 17 W S ~ 65 7v~i✓ei/{/c.3 POLK iac 7, s L z /e 16 -e- _ .mac cJ / - U iss 44~0 b 7a/fh ~ 9 ~ ° h ~ o ysbl O ~~o . - ~ e ~`henon~~ N ~Q \ \ ~i~~de 7 oni> ~ 'j v a¢ d5 ~ 'li n ~ d Q ~ n / -21 eri ~/oy~ ~ e ~ e. v e C g ` l 4o 16 o h „ ohn F Ma. t i%/ei7 u_s'E Bo r h ~ f/oyc/ C.~, 7 H 76 ~ Ma.v~ GUgynP lea ..~~u~er-6o 9 l !r° 4O 90 f/a e h Q ~J U/~,S / H e T / 40 • Ua nes P/y - - - - Bo C J p O/sore 4 n ~ ~ o J ~ i6o o ~ 60 ~ o ~ ~ Buis _ 0' wis Cioe. /97 ~Yox~ ~~t,~ Bo sCOAK ?~OG$ L. Mew Vl ~y h - - ?Coon{ % /Go U ~9 C a' s ~.~c/ I 11 z¢ 7co6so~ ^ 3,- rL~a/Fe.f X40 ~f/en~y /s7 et / C ~ Peed 1-9 k ua9er . 1s4 Gi~sdho,~~e ~ kei/en 6a Farm, IOc (~i/.~a~ ` 76 \ d Me/v.n a Ca / [a were v 9msch/e r- C'o~.-ad ~r/arna_ .C3er L C v Sa is I/a /,Eert .Qe t,S,Fc r l/err~ v~ %lonnis /6o c7aco.bsoi7 ~ ~ 6 C n~ clams/ 17cia.nc 5 h /6B ~ /6o Cow Sa6 eon Q o E'QQ ~y, o _340 i2o MQ / s ~ /c7r~son ~ ~¢o T cobso~ /60 ~ o c~ ~Q o yerma.~ Kn P Edward V ~usch,Fe /60-_~.~ 7y ~J8 LCLrs an i6o /6 4 ioo I W/her/ wo e'9o e~ Lead R W iL 4C,~ _ do ch nid~ a`0~ o HcP.<-ins/9 Fa~~,F/~ •fi/ammes T Beau/~ ao 0- J n7 es f/o qua.-d • ~ /ephe~s /6° Bo sl has fob • • • BO • 26 o V Ch4rfe5 ® G. S L //a C n e Be _ a BO fn 0' H ' W .DI-aFe 9fal-aS v l da< E C o h 0 /~/s. E//e~ ~9e~/iii - 40 4p nB ° F Setfe M o a o^ Pobe.r r s bera/d We /s6 v h /'3 7Z z6 0 ar P/f C /6o We mar FirznR was/ergs w v isc s C'~se /Po/a d Po,/end /Co v~2 /6o cfur s~ Fri f {/efrs Be nd Q ~ ~ a ~ ~ Edward S ao - r~ /r6 ~r _ 'V d ~a /e ibo /Cq ~~e Pria/q~ 117 Gqr s C`0 Q ( roe c-ficcrd p Za97 cS/e a/6c.Y-s ~h en.s fioriser F/o d P 0Qy Z¢o D Bo /~/-~cur~a.-a_ /60 ~h ~/an /n~A ~iu. serf Ly dcz. E/mr~- ~ Q g 7 Bo '~'Pf' /6o EfC~Sen i Leweren~ 78 Fitj ~~'~o • • ~ Fdw. i~o ~ c) i 40 y 4iNrence pp use( 65 ar y izo N -97 ,Bern- e9nn o~ ' Ba • oeta/ /60 ~/arrmr ¢ O vaJ ~ Baier/ e/ a U/ioh ~d~ ~o O e.~a.~ <I densPa}- ~ ~ w 0 ~ 7 /6o Chrisf an ~ VI ~ F.-chu , Z"'f f/afcf,B/ Ivor F is6"d U ~ \ v ; ~ oy ric,E- ,C3ea t~ c~ o, c k! E. x e Lq von £ ` p Euyenc 3 40 K,do'P san Erieori v ! o- ,C v moire oil ° ,6a 6 a l` ` C7//~i~ _ .?~36 `C ~y ,37 ^~'Oo r -z4o~,`aa ~t~ h o l~ Bo do i o ,~i m 'lam W,s~te ~`~G f a'c so M o- r7 c. °ifc; a ~ QqJ 75y/ 47 ~ ,Sy !o Nea/scTea Hi~o ,9mos 64 s 09 m ~'//s j Fgncois Pede,csa ~TQ/n 4 40 ~1 i i-zo n Wef e/ Bros. 79s ~o~ izo {1/aync g .Laiise Cody T ,Car/ FJ//an Leo NE RICH OND 3za s~nces we/is 6a 4 ~.amPer an, 5 ~ - Mo k eel- riz isg.a mss /60 .Senses a ve sE/c%rj 0 -~¢o co '~1 I suo 'we o h p fire fin' s C ~L ~ /.shy//is ~ l Q~fl6 - Cfiii Tian sor/ `C ; P6o /~arf n ~So P we s f- a B _ /60 ~ieo ly-`f7oams GOOSE cke izo do - Bo POND /larfi~ /ya y y Tiaiser' a,-i/ Trgi.s er Tccis er /6a ~✓arer7 e Po fus if*/m an R, SEE~PgqGE 43 K izo /=o • 7g o l~~ W/L O~ ©/97z iPoc E a.d iya /L6/s. 1 c . Qo SEE PAGE 4 /z ~Sf. COOT¢ ooay Wis. Now POLFUS IMPLEMENT INC. 57"4f Gra Richmond Granite Works CANNING CORPORATION PHONE: 246-2011 PHONE: 246-6565 MARKERS MONUMENTS NEW RICHMOND, WISCONSIN BRONZE TABLETS 54017 NEW RICHMOND, NEW RICHMOND, WISCONSIN 54017 WISCONSIN