Loading...
HomeMy WebLinkAbout036-1002-70-000 n N p K-0 0 w G m o c v m w m m 3 - ~ 3 - Z S F ° N D cn o o ~i r► • o O w a m ° j rYl N a C-) 7D N O 7 vi a m a ? o o co ro N CO W -Z3 v N C` N a U: -I N J 't O C) W 0 CD N CD 0 O 9~^. D c _ a N o O i 7 to O C O N O f. a z i> m a v O O W Z1 m D Ry o 4 -,J CD ° O c h~l v v v w "WA z N ~ ~ CC CC < C G G ~ ~ O N au vvv 0 (D p N 3 N _ m N C la * N .z co ' ° o z cn z h. D m v G 0 a c m !r. N N T ro (1Y'1 O N `r (D a aY 3 Z cD -i to 4 4r- z m V a - h :3 iP z O 4 a u (<n N co - < O. z ~ A O z N z m N ~ 0 i O 7 a C (D fx C CD O. 4< N y T N CJ C S ~p O w O Cu Q ~ U (D a CL 6 (D O s R N F cn C j x- N ~ d O N ~ V C7 ~ t O w JQ V n E!a O 00 O Y O O ° 4- ` y Wisconsin Department of Health and Social Services Plb. #67 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. UWNER OF PROPERTY " ' " Name Address (Street, City, Zip Code) I , B. LOCATION OF PROPERTY W :..RE SYST-21 WILL BE CONSTRLCTED ALTERS OR EXTEf:DED COUNTL_ - Check One: hzC~ CITY VILLAGE LEGAL DESCRIPTION (N (fit/ !w TOWNSHIP—- / r C. IS LOCAL PERMIT REQUIRE:) FOR THIS WORK? YES NO PER211IT NLM~sER D. SEPTIC TANK CAPACITY £ Gallons NEW INSTALLATION REPLACE".ENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NUMBER OF TA2VKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Cheek One: One or Two Family Residence Commercial Industrial Other C Specify) Number of Persons to be Accommodated Number of Bedrooms / F. APPLIANCES, ETC: Food Waste Grinder ~ YES NO Automatic Clothes Washer ~ YES NO Dishrasher YES NO Auto.s.tio Potato Pea!?r YES NO Othe: (Specify) G. MPSTER PLLMBER 2Q..AKUG INSTALLATION Name: Address: Lieanse Number: r tip ~ Signature of Applicant: MP RSW Address: H. ~o be ,Completed by Issuing Agent) Cate of Application Fee Paid Permit Issued 7dt PermiNumber/j ,Agent (Name)For:. _ / .c1 Torn, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will fo ma-rd application, the fee of $1.00 for each septic tanK and the tnird 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 smite in space below - FOR DEPARTMENT USE ONLY 1. DATE RECEIVED _ - O ACCEPTED BY RETURNED ~ (Initials) / (Date) See orres.) FEE RECEIVED VALID. No. PERMIT NO. Yes or No REVIEWED BY APPROVED DATE (Initials) Yes or No) COMPLETE OTHER SIDE I SEPTIC 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 O R I N G S TO DIVISION OF HEALTH - PLUMI]MG SsCTI=%d P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Otis. Administrative Coda P E R C O L A T I O N T E S T Test ~Depth Character of Soil }lours Water Tes Tima Drop .n Water Level Inches In. tas Number Inches ?isioknos3 in in~nes Since Hole in Hole Int•a.val Second to Next to bast To Falt 1st Netted G~~e;nisht in tiinutas Last Per1c3 Last Period Period a: Inc Example - P - 0 36" To Soil 10" Ciao 265, 25 Yes or No 30 1/? 1/2 1 2 60 / RECORD DATA FROM MIN LUM OF 3 -SST 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- Minim-um 3611 Belcw Proposed Pbsorption Systen Boring ctal Depth Depth to Ground_'Fater Dapth to Badrock N s<ber Inches Cbservad F.s*ima 3d Caaerved Esti:,ated Character of Scil with ThiejJn ss in Inches B - 0 72" 72" Black To Soil 12"; Clay i8"; Sand 18"; G •'v:~l 2411 RECORD DATA FROM MINIMUM OF 3 Bot?Z HOLE) YPE OF OCCUPANCY: ri RsSZD CEs Number of Bed:ocros OTHE (Speoify) Number of Parsons D WASTE. GR LND _Rs Yes No Dishwashers Yes No Automatic Clothes Washer: Yes No EFFLUENT DISPOSAL SYSTE'f: NEW ~ EXTENSION ADDITION REPLACEMF'NT Tile Size / NO.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Leneth Width Depth Tile Size No. Lines Seepage Pit: Inside Dizetar _ Liquid Depth Is the undersigned, hereby eertify that the peroolation 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), Wisoonsin Administrative Coda, and that the data reoorded and location of test holes are oorreat to the best of my knowledge and belief. NAME TITL1 ! > - a/ 7- Type or Print REGISTRAT10N NO. or MASTF.R PLUMBER LICeiSE NO. ADDRESS IGNATURE DAB S STAN ON T 31 N.- R. 1 7 W 5 POLK 65 Xy /1/e /{ju,5 r,> ~ Q/e ro COUNTY z - /a/7a sc.a % ba~e~ 0 ~Poy c7a7-°h_ior~ ~ ~o Lama ~ ~O ~ru~e ya .63 iss6 ~ New zz6 'vim ~ ~ti 1~/~ d4~~~ r~ 'f 00 0~~~.~ ~7~s O NE zo/7 L nq a.r ~ ~ Fl~'ohe>N ,P fe~f W ~ C yy~''' a~ F/oy`~ e o ~ h 'ohn eMar - C l` b 7 ~,r Q qo /60 9es= Qoche c v 40 Hanter7 {-t/ind3 er- ,C%cha.d U /L- y v Cl - 9c A J y ti Bo IJ bar fou.E~s l 1 ~ • y ~e ~W , ~ /40 _ KG i o 3,~ a h acs V ~ E'e ,c ~ o //o cuard~ ~ /60 i6 k ~~y ao F/ y~ oQl /e 40 N s C o'1~ y /cro.T r N ryO Ua.nes cTohnso E/m ~rr.n . ~ ~ V o O/so,/ ~ C ~ JI/f Hein zoo ~a~/ ..Qan s9>q IJ ~V ~ W ~ /zo ~Q y V ~ b - lz wee -t94 do - ~e{/„Fe u,Bo/s u~c i a /60 /6s do _ 0~ 0 0 ~ .7~ furs 4 r/ v .5 Cines 197 ~~~X~ ti~ Bo da ~ ~GOAKP? DG$~, L. 1/o/ke.h 40 .5/en.y /s7 of / C /9 ~ hiUeOe/' • I~ 'z'S 4 D SE/- ~ / JJJJ ~ n 0/' //R /J G 6a fQr'm IJC. !~Y//~a/rl ~ y .9f F /~/e/v~r7 d Ca / La ✓ere 7- FJmsch/er Losrad~//ar~~c her ~ l/er~ ~ v /e Va /,Ec'r-t /60 ,Ge,v/ike ~ ~ 's ~ h~ c7a /`3 4r~ /z° 1Jucz.ne s /6B %1o.r-/s /6o cTa cobso~ v r.~a6 aQ~ Q~ E'Q~ ~y, 40 _ ys C, Edwa d Larson 6¢0 cobsor/ /6o u o ~Q° <ferma„ P? V K~sch.Fe 160 ~V R /oo /I • W/6erh ENO v ~ •~9ei'cp /'/a LeoE TR. W ~ ~ Bo chmid~ ~`Q0 o HP,Fins79 Fia~,~/ ~ 'f/arnmes 6 eau/~ 40 y o /60 V v N R 7on~ es fibs /sy ' ° /o ward a h ~1 fepher~s 16o do cTp/i r/s fo /7 Bo z6o v o . e h Charm/eS ~ - _ h//ate iY~ ~u 3e Bo 6efy do< ~~yi .Z~~z Fe ` .Pa/ h ~znzs~ ~ v of U ~ a ~~a vJ 0 7% s. E//e~ Me// ri 40 ¢o I /iB ° F ~Se fe ~ M ~ ° ~ ~ ° ~ ~ We/%s /Poberr ~r ~ ~r a„ ~ie7a/d Pam/ L~ ~C~ /s6 Ql h E3ar ~ h w ~ ~ ~/ZL)/c ~aa fe/rs 77 G 3 eft ~ C U ~ Weimar C c~ v m w W ~ ~ /60 /sc s efur tee/ e ~C - /6a r.r~ ~o%Yid rf'O/rznd V ~ o /L,o \42 Fiv~ C_ ~E'firi6.~ ~e nd Q tl ~ 6' c1 Edwa.d S Zsa y ~eq Z /i~ay Ga y fKath. .l~ F k, l/v~c.Ee17e- L no /ire rh/aid ~j/easor~ H lW,.se 97 / cS/ePh er/s y, /iousei- f/oyd (9 ra~ ~i zoo -Da/6 e.7-s /l`-Na.z,ar-s a mart G o~~ • go /90 /6a Jo%i/sfor7 Lum yy P/"ryi /6o Etch en F / ~0 Edw. 7B ,9 dR,-= 7,1 - Leman y~ Q Frda ME 12o a 2 • °eta 4a • L¢evre~ce ~,Fe I _ f/ci/c/v d 0 c C % 65 cti y - /zo h N 9j ,Be/ e,9nn E~~ Ba /Lo /t/-`/U~vor -r Ba/er/ • ~ - ~ n /~o chrsha„ ~ v e ,na.~ ydrn spat w • Love/t l \ //afch IVR/' £ /°rehand w v ; 410 Bi lea/ c~ /s6 c C W E- o o Eu ene /~e/h Ee k;P ~ic,E- k c o ~ir•e ax v L4von f l y. J/iri f7. 4° saw Er•,~E.~o.~ a ~ v .eQ 6 c d " GY.S/fe •37 4°0/~ .zoo r~aF3'~~°0 ~ ~ Bo do ~o~ kirz `C\ U///ns - `C~~y ea_ °'FUc` o'e>~ ~qJ i R/ • 3/6.x7 ~9 /zo Nea/£cTea • /9/ a f e 64 09 ~/mo3 • • . 4° ~ Fiar>co/s Pede,cson 79s Tam ~ o /20 Wade/ Bras, Way,, T <ar/ ' S Qo~ /zo ~V~v7 5 Loriise `J h' /an g Leo NE RICH OND Fran es we/is eo ~r~ J ~3zo Mark famcs4- /6o P r ,8eas~ ,~o,ssea~ 6er~a -93 A / SS O y L. Jt~L 45 3 ~L/ rc/7 Cod Y' yfR- ® 240 %B /S7 240 bran c/S Ca _ sun ffa ve/t~fE/de// p 0 m fire Po /?r/ys C.'4/ 4 F~fiy//is ~'9.s. 1. ' QiD6 C'firi {ian so/7 `C l ~ ~/6o y ~ar./in rs. o~n P we S q f i a B /60 GaO /'1-`f7vams GOOSE - T/aiser ckc /ZO an/, ~s ° k d 1a f y Bo POND Tia/ser- Taiser 16o C/areri e ~O fus °n R. SEE P,,99GE 43 K /zo /zo • 7¢ ' WIL O~ ©/97z P c~' ord yap 6/s., I c. /zo 40 SEE PAGE 4 s/ coo/, o~ y u/%s. Now n Richmond POLFUS IMPLEMENT INC. 571 Granite Works CANNING CORPORATION PHONE: 246-2011 PHONE: 246-6565 MAHKEHS - MONUMENTS NEW RICHMOND, WISCONSIN BRONZE TABLETS 54017 NEW RICHMOND, NEW RICHMOND, WISCONSIN 54017 WISCONSIN Parcel 036-1002-70-000 06/27/2007 11:29 AM PAGE 1OF1 Alt. Parcel 02.31.17.23 036 - 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 - AUSEN, BLANCHE E BLANCHE E AUSEN 1686 W CHURCH RD STAR PRAIRIE WI 54026 Districts: SC = School SP = Special Property Address(es): = Primary I , ~.Jl Div(. Type Dist # Description ' 1686 W CHURCH RD k~ nY aL t~ SC 3962 NEW RICHMOND Vrl SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 2 T31 N R1 7W 40A SW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-31 N-1 7W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 951/355 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 RESIDENTIAL G1 1.000 12,000 ` 60,400 , 72,400 NO AGRICULTURAL G4 38.000 6,800 L~ 6,800 NO UNDEVELOPED G5 1.000 700 0 700 NO Totals for 2007: General Property 40.000 19,500 60,400 79,900 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 14,400 60,400 74,800 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 Parcel 036-1005-40-000 06i27i2007 11:30 AM PAGE 1 OF 1 Alt. Parcel 3.31.17.36A 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 - AUSEN, WAYNE E & PAULA M WAYNE E & PAULA M AUSEN 1796 235TH AVE DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ` 1796 235TH AVE SC 3962 NEW RICHMOND SP 1700 WITC /q I Z rymj Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 3 T31 N R17W 20A E1/2 SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 03-31 N-1 7W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 944/64 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 RESIDENTIAL G1 2.000 20,000 199,700 219,700 NO AGRICULTURAL G4 18.000 3,200 0 3,200 NO Totals for 2007: General Property 20.000 23,200 199,700 222,900 Woodland 0.000 0 0 Totals for 2006: General Property 20.000 22,800 199,700 222,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 204 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00