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Parcel 038-1011-20-000 PAGE 1 OF 1
Alt. Parcel 2.31.18.31 G 038 - TOWN OF STAR PRAIRIE
ST. CROIX COUNTY, WISCONSIN
Current X
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Owner(s): O = Current Owner, C = Current Co-Owner
Tax Address:
O -WILSON, WILLIAM R & CONNIE M
WILLIAM R & CONNIE M WILSON
1259 CTY RD H
NEW RICHMOND WI 54017
=Primary
Districts: SC = School SP = Special Property Address(es):
Type Dist # Description " 1259 CTY RD H
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 0.370 Plat: N/A-NOT AVAILABLE
SEC 2 T31 N R1 8W PT SW SE COM W LN CO TR Block/Condo Bldg:
HWY H 150 FT NLY OF S LN NLY ON HWY 220 Sec Twn Rng 40 1/4 160 1/4)
FT TO CREEK SWLY ON CREEK TO PT W OF POB Tract(s):
E TO POB TOGETHER WITH 20 FT BY 150 FT 02-31 N-1 8W
STRIP ASSM'T INC 038-1011-10-(31F)
Notes: Parcel History:
Date Doc # Vol/Page Type
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Last Changed: 10/12/2004
Valuations:
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.370 41,500 101,400 142,900 NO
0
Totals for 2007:
General Property 0.370 41,500 101,400 142,900
Woodland 0.000 0
Totals for 2006: General Property 0.370 41,500 101,400 142,900 Woodland 0.000 0 0
Lottery Credit: Batch 106
Claim Count: 1 Certification Date:
Specials:
Category Amount
User Special Code
Special Assessments Special Charges Delinquent Charges
00
0.00 0.00
Total
Wisconsin Depart4wnt of Health esid Sooial Servloos
Plb, #67 370 division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK `3
A. U-0FR OF PROPERTY
Naz o _ VVII) Address (Street, City, Zip Co~'a)
t
B. LOCATION OF PROPERTY WH M' SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNT`f_
Check Ones
_ CITY V LLAGE LEGAL DESCRIPTION (ilJ C~
TOWN jlr,-
C. IS LOCAL PERMIT RECUIRED FOR THIS WORK? Y YES ~yr NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS- Prefab Conorete J Poured in Place SteAl Other
NUMBER OF TANKS TO BE LISTALLED-
E. TYPE OF OCCUPANCY
Cheek Ones One or Two Family Residence / Commercial Industrial other
~ (Specify)
Number of Persons to be Accommodated Number of Bedrooms 1
F. APPLIANCES, ETC: Food W ste Grinder YES NO Automatic Clothes Washer _t YES NO
Dishwasher _ YES - NO Automatic Potato Peeler YES__,tL NO
Other (Specify)
G. MASTER PLIM ER MAKING INSTALLATION
Name: .8r.~~~> Address: / License Number:
Signature of Applicant; XCf
= ! ! r~ MP RSW ~j
1Z
Address:
H. (To a Ccap eted by Issuing Agent)
Fee Paid rr
Date of Application 7 7_7
; / '`k o
Permit Issued (date Permit Number
Agent (Name)/ ,L.' l f. ! . Fors?ltl
Town, Village, City, County, etc.
(Specify)
r:o e: 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.OO or each soptie tanx and the tnird copy
of the perwlt (canary) to the Division of Health. Checks and money orders should be made payable to
the Division of Health.
Do not write in space belcw - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED 1,1-7 0 ACCEPTED BY RETURNLD
' (Initials) (Date) See Co res.
FEE RECEIVED r VALID. No. PERMIT NO. L 1
(Yes or Ho
REVIFW'ED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
' SEPTIC TANK PER'iIT NO.
i
R E P O R T O N S O I L P E R C 0 L A Y I 0 N T E S T
A N D S O I L B O R I N G S
TO
DIYISICQ OF HFALTH - PLLkc.BIAG SI-.VT1614
P.O.Box 309, 1,:dison, Wis. 53701
Purculmrt to II 62.20, Wis. Adsinistrctivo Code
P E R C O L A T I O N T T S T
Test Depth Chz%1'u rar of Soil ours Water Test Time Dro,~ In Water Level Inches irutcs
Number Inohas Thickness in Inches SiHnce Hole in Holo Interval Second .o Next to I,'st To Fall
1st Vattod Overnight in Minutes Last Po:,iod Last Period Period One, Inch
Exa:rplo
P - 0 361r Top Soil 101°, Cl. 261- 25 Yos cr No 30 1 2 1L2 1 2 60
-i~~/" ;/~i• ~ ~ =jig ,i
RECORD DATA FROM MINIP{UM OF 3 TEST HOLES
Computo size of absorption area in accord with H 62.20 Wis. A&,inistrative Coda.
S O I L B 0 R I N_G S- Minim= 36" Below Pronosed Absorption 5 stcmj
Boring Total Depth Depth to Grcand Water Do th to Dc+drock
Number Inches observed 9stir_.ated Observed Estimated Character of Soil with Thio!zness in Inches
Examplo
B - 0 7211 72" Black Top Soil 12"; Clky 18rl Sand 1811; Gravel 24"
'ZI ;74
RI-CORD DATA FROM MINIMUM OF 3 BORE HONES
YPE OF OCCUPANCY:
RESIDENCE: Number of Bodrooras OTHER: (Specify) Number of Persons
OD WASTE GRINDER: Yes No
Distasasher: Yes No Automatic Clothes Washer: Yes ~ No
FFLUE'TP DISPOSAL, SYSTEM: NEW EXTENSION ADDITION REPL4C%'M N^t
Tile Size No.Lin.Faet Trench Width Depth Number of Lines
Seepage Bed: Length Width ! Depth Tile Size No, Linea
Seepage Pit= Inside Diameter Liquid Depth
I, the undersigned, hereby certify that the percolation tests reported on this fc:u were made by me or under my super-
vision in accord with the proceu.ires and method zpaoified in Chapter H .2.20 (13), Wisconsin Administrative Coca, and
that the data recorded and location of test holes are correct to the best of cV knowledge and belief.
1 1 _
NAME h't1 TITLE r Type or Print
REGISTRATION NO. or MASTER PLUMBER LICENSE NO.
ADDRESS
DATE i ~ ' SIGNA?iJR✓ .~...a':;,;..._.L...~S.cd:...~ i
Parcel 038-1010-50-000 06/15/2007 04:28 PM
PAGE 1 OF 1
Alt. Parcel 2.31.18.30B 038 - TOWN 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 - WILSON, WILLIAM R & CONNIE M
WILLIAM R & CONNIE M WILSON
1259 CTY RD H
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 1700 WITC
SP 8055 CEDAR LAKE/N R
Legal Description: Acres: 22.000 Plat: N/A-NOT AVAILABLE
SEC 2 T31 N R1 8W 22AC LOT 2 OF CSM V Block/Condo Bldg:
4/1130 PT NE SW&PTNW SE ALLSEC2
T31N R18W AS DESC IN 656/254 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
02-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 654/254
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/18/2004
Description Class Acres Land Improve Total State Reason
PRODUCTIVE FORST LANDS G6 22.000 22,000 0 22,000 NO
Totals for 2007:
General Property 22.000 22,000 0 22,000
Woodland 0.000 0 0
Totals for 2006:
General Property 22.000 22,000 0 22,000
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