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Parcel 036-2002-40-000 09/11/2006 08:45 AM
PAGE 1 OF 1
Alt. Parcel M 31.31.17.624 036 - 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 - SLATER, ANDREW P & BARBARA TRUST
ANDREW P & BARBARA TRUST SLATER
1817 147TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1817 147TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.402 Plat: 2238-OAK RIDGE ESTATES
LOT 4 OAK RIDGE ESTATES Block/Condo Bldg: LOT 04
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-31N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/27/2000 617544 1486/556 WD
07/23/1997 433/323
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.402 20,000 159,000 179,000 NO
Totals for 2006:
General Property 0.402 20,000 159,000 179,000
Woodland 0.000 0 0
Totals for 2005:
General Property 0.402 20,000 159,000 179,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 118
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
parcel 036-2002-30-000 09/11/2006 08:45 AM
PAGE 1 OF 1
Alt. Parcel 31.31.17.623 036 - 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 - SLATER, ANDREW P & BARBARA TRUST
ANDREW P & BARBARA TRUST SLATER
1817 147TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1821 147TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.402 Plat: 2238-OAK RIDGE ESTATES
LOT 3 OAK RIDGE ESTATES Block/Condo Bldg: LOT 03
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-31N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/27/2000 617544 1486/556 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/27/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.402 10,000 0 10,000 NO
Totals for 2006:
General Property 0.402 10,000 0 10,000
Woodland 0.000 0 0
Totals for 2005:
General Property 0.402 10,000 0 10,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
.,..w, ,m. Sui mZ pun Bumuotri .gmuq unaa~f~~fs
Wisconsin Department of Health and Sooial Services
pit. #67 370 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. OWNER OF PROPERTY
Name Address (Street, City, Zip Code)
B. LOCATION OF PROPERTY Wf--ERRE SYSTEM WILL 3E CONSTRUCTED, ALTERED OR EXTENDED COUNTY a I
Check One:
CITY VILLAGE LEGAL DESCRIPTION
11 -
TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO E' 7 PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACE111ENT ADDITI~
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence ~ Commercial Industrial Other
Specify
Number of Persons to be Accommodated _ 7 Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES X NO Automatic Clothes Washer YES NO
Dishwasher YES_ NO Automatic Potato Peeler YES NO
Other (Specify)
G. MASTER PLUNBER MAKING INSTALLATION
/ - 4
Name: ( ?c7L r y Address: Lieense Number:
HP
Signature of Applioants MP RSW j~ -
Address:
c ~
H. (To be Completed by Issuing Agent)
Date of Application Fee Paid f `1
Permit Issued (date) Permit Number
Agent (Name)
Pori / i
Town, 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 fonNard application, the fee of 41.00 for each septic tanK and the tnird oopy
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 DEPARTMENT USE ONLY
I. DATE RECEIVED ~F\ } ACCEPTED BY RETURNED
C s.
(Initials) , (Date)
-T-- )
FEE RECEIVED VALID. No. TPERMIT NO. f)
es or No
REVIEWED BY APPROVED DATE
(Initials) (Yes or No
SEPTIC TANK PERMIT NO. ~
• R E P O R T O N S O I L P= 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
DIVISION OF HEALTH - PLUKBING SSCT1-6N
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P Z R C O L A T 1 0 N T E S T
t.it Depth Character of Soil Hours Water Test ?ime Din Water Level Inches utes
Fietor Inches Thickness in Inches Sine Hole in Hole Interval Second to Next TO Last r Fall
13t Wetted Dvernight in Minutes Last Period Last Period Period , Inch
Lcsa,~le'
0 3611 To Soil 10" Cla 2611 25 Yes or No 30 1/2 1/2--- 1/2 60
C 1S r~~ I
? z jG Rio .21
RECORD DATA FROM MINE", OF 3 TEST HOLES
Caepute size of absorption area in accord with H 62.20 Wis. Administrative Coda.
S O I L B 0 R I N G S- Minimum 3611 Below pro osed Abso tion System
briny Total Depth Depth to Ground Water Depth to Bedrock
*Mbgr Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inohes
LiLAA R I e
9 0 7211 721f Black To Soil 1211 C1 1811 Sand 18"; Gravel 2411
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
`"s?i OF OCCU?A.4CY1
R:SIDLNCEt Number of Bedrooms OTHER: (Specify) Number of Persons
1-r0 ',(A-S7& GRL4DF12: Yes No Dishwasher= Yes NoAutomatic Clothes Washers Yes No
e
EtT, Ly,* DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT
Tile Size No. Lin. Feet Trench Width ? Depth Number of Lines
Seepage Bad: Length Width` Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth
Ir tta undersigned, hereby certify `.hat the percolation tests reported on ;his fora were made by me or under my s per-
risl:n In •;cord with tha_ ocedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and
j
the dos=s recorded and to ation of test holes are correct to the best of my knowledge and belief.
3
Y I l C /A ' ',7 . 1
1 ! ~ 7 TITLE
(Type or Print y
1;" (Amm X0. or MASTER PLUMBER LICENSE NO.
SIGNATURE