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Home My WebLink About182-1020-80-200 n cn p o 0 o CD CD ~ a CD m ` 1 `I 3 I o N O ID m a (D (D C) ~ m W~ o co N O rn v m m p a CL Cl) 00 o O N ro N ts~ rn Q a W o 7 N V O O N_ ~ p N ~ 3e• CJ (D CD ro r ` ro 1> O a (D a C C Iro O W ^uy A O I z C7 r o cn -4 N o c m a_ W ~ !~el cn '9 v. h • C 'q * G* o < N z ~(~y.,~.~ 0 C f/) N N O D `l4 Gov c~ in CC W N A v IC ~ ~ N ~ c0 N ~ N N N C O O 3 C Z M Z Cl) z D (D O_ O N m -D Pa • o' (3D a ID N N ro i v CD N C (D W (C Q a ED K Z ro t -I N C p A Z CD C: ;o D p Z O W a Z i cov m, (D ; z a a o r. o c m co N z (D A N O =r O CL c C ro ID ca G_ ID. N 0 0i 7 U O O 3 7 J (D ro ~ t C7 ,A c O v ti 3 C Z, CD 7Q ao 69 0 0 v Wisconsin Dor-%rtslent of Health t±rd Scoial Servieoa Plb. #67 3/70 Dlvision of Health (j SEPTIC TANK PERMIT APPLICATION _ Cj TYPE or USE BL tZK I11K A. f 4lNER OF PROP: RT_Y }tem® Address (Street, City, Zip Coca ~ r 4•` B• LOCATION OF PROPERTY W17,tE SYST M WILL BE CONSTRUCTED, ALTERED OR EXTENDED COUNly Check One; CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP'• C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? _S YES NO PERMIT NUMBTR D. SEPTIC TANK CAPACITY;.? Gallons NEW INSTALLATION REPLACEMENT ADDITION YATERIALS: Prefab Concrete e~ Poured in Place Steel other KUMBER OF TANKS TO BE IN)TALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial Other Speoify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothss Washer ` `YES NO Dishwasher YES NO Automatic potato Peeler YES ~ NO Other (Specify) G. MAS11R PLUMER MAKING INSTALLATION ± e ~ Name: Addressa License Number: Signature of Applicants a D MP RSW Address: ell, H. (To be Completed by Issuing Agent) Date of Application Fee Paid Permit Issued (date) Permit Numbed Agent (Name) Fort 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 forward application, the fee of $1.00 for each septic taruc and the tiiird Copy of the permit (Canary) to the Division of Health. Checks and money orders should be ¢ads payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY 1 RETURNED (Initials) (Date) See Corres.) FEE RECEIVED VALID. No. - PERMIT NO. es or No)" REVIEwTD BY APPROVED DATE (Initials) - Yea or NCT COMPLETE OTHER SIDE SEPTIC TANK PZRMIT NO. R E P O 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 DIVISIU OF 11EALTii - ; LL ;BII,'G S-CTIt.d P.O.Box 309, M:uiison, Wis. 53701 Pursul3nt to H 62.20, .as. Administrativo Cods P E R C O L A T I O N T E S T Test Depth Character of Soil Hour3 Water Test i'i.`ae Drop in « ter Level Iaoh,~s inutes Number Inches ThicL-ness in Ir_ohes Since Hole in Hole Interval Second to Next to List To Fall 1st Wetted Ovorni7ht in M1.nut•c3 La3t Period L•^st Period Per iod Cr.:Y Inch Exe ❑ple P - 0 3611 Tan Soil 1010 C.tay 26" 25 Yes or No 30 1/2 1 2 112 60 RECORD DATA FROM MINInJM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Adsinistrative Code. S O I L B O R I N G S- Minizum 3611 Be1t:: Pro ossd Absorption S,ystnn Boring Total Depth Depth to Ground Tutor Depth to Bedroc% Number Inchon Cbservad Estimated Cb3erved Estimated Charactar of Soil with Thickne3s in Inches Example B - 0 721, 7201 Black To Soil 12" Cla 18" Send 18"; Gravel 2411 r RECORD DATA FROM MINIMUM OF 3 BG,W HOLES TYPE OF OCCUPANCY: RESIDENCE: Number of Bedrooms OTHER: (Speoify) Number of Persons ` 3. D WASTE GRINDER: Yes No Distcasshart Yes No A'Autoaatic Clothes Washer: Yes No EFFLUENT DISPOSAL SYST. NEW EXTENSION ADDITION REPLACE`1iENT Tile Size f~ No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pit: Inside Diameter --7 ' Liquid Depth I, the undersigned, hereby oertV' trat 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 jV knowledge and belief. g TITLE NAME Type or Print REGISTRATION NO, or MASTER PUJM3ER LIC-tSE NO. ADDRESS DATE ry ' SIGNATURE L ; Parcel 182-1020-80-200 06/22/2007 04 45 PM PAGE 1 OF 1 Alt. Parcel 311801-41-02-02-00-000 182 - VILLAGE OF STAR PRAIRIE 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 - GEVING, PRISCILLA K PRISCILLA K GEVING C - KRAUSS, MARK M MARK M KRAUSS 709 JEWELL ST STAR PRAIRIE WI 54026 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description " JEWELL ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.279 Plat: N/A-NOT AVAILABLE SEC 1 T31 N R1 8W PT NE SE BEING LOT 2 CSM Block/Condo Bldg: 11/2986 1.279 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 02/18/2004 754584 2512/083 WD 10/05/2001 658407 1732/616 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.279 64,000 91,200 155,200 NO Totals for 2007: General Property 1.279 64,000 91,200 155,200 Woodland 0.000 0 0 Totals for 2006: General Property 1.279 64,000 91,200 155,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 182-1020-80-000 06/22/2007 04:44 PM PAGE 1 OF 1 Alt. Parcel 311801-41-02-01-00-000 182 - VILLAGE OF STAR PRAIRIE 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 - JOHNSON, THOMAS & JOAN THOMAS & JOAN JOHNSON 711 JEWELL ST STAR PRAIRIE WI 54026 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ` 711 JEWELL ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.539 Plat: N/A-NOT AVAILABLE SEC 1 T31N R18W PT NE SE BEING LOT 1 CSM Block/Condo Bldg: 11/2986 1.539 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 06/15/1999 605000 1434/329 WD 07/23/1997 1026/43 TI 07/23/1997 716/252 07/23/1997 676/559 more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/25/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.539 70,000 177,700 247,700 NO Totals for 2007: General Property 1.539 70,000 177,700 247,700 Woodland 0.000 0 0 Totals for 2006: General Property 1.539 70,000 165,800 235,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 519 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 182-1020-80-300 06/22/2007 04:29 PM PAGE 1 OF 1 Alt. Parcel 311801-41-02-03-00-000 182 - VILLAGE OF STAR PRAIRIE 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 - METTLER, MELVIN E & THOMAS J MELVIN E & THOMAS J METTLER 669 DEERWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.230 Plat: N/A-NOT AVAILABLE SEC 1 T31N R1 8W PT NE SE BEING LOT 3 CSM Block/Condo Bldg: 11/2986 1.230 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.230 33,700 0 33,700 NO Totals for 2007: General Property 1.230 33,700 0 33,700 Woodland 0.000 0 0 Totals for 2006: General Property 1.230 33,700 0 33,700 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