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Z n n' `p Z O l~ d ~o Cn -I rn w v m CD ° z 3 A Z1 O ;w 0 00 N D ~ A W N O CD W O (D 2 O (D m a 3 ° ° - ° -n 5-3 L: c ° ? ° c z y c Q n N j' a (n (D ° A CD ID a 3 (n ~ r 6 X ~ (D p co cc a (n c ti Oo (D N t J CD O X O A O CD 6p O Efl 0 J o 0 a y Parcel 038-1027-50-000 06/18/2007 10:33 AM PAGE 1 OF 1 Alt. Parcel 6.31.18.122 038 - 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 - NELSON, GREGORY L & LINDA K GREGORY L & LINDA K NELSON 2320 CTY RD H NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 2320 CTY RD H SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 6 T31 N R1 8W SE SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1090/206 QC 07/23/1997 843/420 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/05/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 29.750 3,700 0 3,700 NO UNDEVELOPED G5 6.250 6,300 0 6,300 NO OTHER G7 4.000 35,000 183,000 218,000 NO Totals for 2007: General Property 40.000 45,000 183,000 228,000 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 45,000 183,000 228,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 00,0 00,0 00,0 lelol seBaeyo;uenbullaa soBaeyo IeloadS s;uawssessd leloadS junowy fuoBeleO apoO Ieloads aasn :sleiaadS uojes :Oleo uol;eol;RaaO 0 qunoO wlelO :}Ipaao 0 0 000,0 puelpooM OSt7`Z L 0 09t`Z L 000'Ob A}aadoad leaauaD :9002 Jo; sleWl 0 0 000,0 puelpooM 09t`ZL 0 09ti`ZL OOO'Ob A:padoad Ieaaua9 :LOOZ ao; sle3ol ON 00t,`6 0 00t`6 000,E W9J 1SE2jOE id~jni~noi2jev ON 09 0 09 092,0 99 QEdOIEnEaNn ON 000`E 0 000`£ 09L'9E to -id~jnl-Inoi2io f uoseaa a;e;s Ie;ol anoidwl pue-1 saaod sselo uol;dlaosad 900Z/90/0l :pe6uego ;se-1 : suOljen leA tuawssassy anIcA asN :y;lnn passassy :anlen;a)IaeW a!eJ We kuvwiNnS LOOZ n-ZE ZES/9E9Z L9bLLL b00Z/ZL/80 adAi a6ed/10A # 30a a;ea :/uo;slH Iaoaed :sa;oN M8 L-N LE-90 (b/L 09L b/L Ob 6u~j-um-L-oaS) :(s);oe.il :BP18 opuoomoola MS MS Mg 12A NLU 9 OES 3~OV I` AV lON-d/N field 000-0t, :sa.iov :uol;dlaosaa Ie6a-1 OlIM OOL L dS GNOWHOI2J MEN Z96E OS uol;dlaosad #;sla ads jL iewud - , :(so)ssa.ippV A:padoad leloadS = dS IooyoS = OS :s;ou;sla LLOt,9 IM aNOWHOI~J MEN H GH AiO OZEZ 110OS'81?jvf11S `J.230JEHJ `NOS~EN - O NOSIENilOOS8 i2jvn1S`Aljoeajo aaumo-oo juaiino = o `1auMp LuaainO = p :(s).iaumo :ssaappv xel 0 00 adAl;lwaad #;Iwaad # uol;eollddy eeiy sales # delN a;ea Ieolao;slH a;ed uol;eeJO NISNOOSIM `AiNf10O X102f0 ,1S X ;uanno EI~IIVHd HViS :JO NMOl - 8E0 LZL 8L LE 9 Iaoaed 1IV L JO L 39Vd wv sv:OL LOOZ19l190 000-0V-LZU-8£0 laaaad STAR PRAIRIEK T 31 N--R. 18 W 5y h couNrr S o ~T y C n h V 1~e k«~ o f ~y / CEDAR "c HH ~y Sf o~iGe e/J - ~ ~ ~ ~ It ~ SMA: • i ~v ~ . ~ 'F' a y e~EA. izo - Q <.F ~y~/ ~ 3•~m4v~ s~~;t ~h nh bG \a ~w •I 1 ~E,/ stomas- S 9~¢~d . 4_ ~ v v y I,p h lhp s ~ ~ ~ - Le ~ beef l ~ C ~ 0 ) ~ n o s q f' s: > ~ y,h ~ C ~ ~ C~ e ~ ~ ad ~>ii/e~ m~ ~ 4 ~s 4z i ~ ~ G U g h I H ~d Q~0 VA .I v vc~ ~v ooa avi ST h a v° 4a C o ~aeck o s~ Qom, HUNTING I C 1 the ) 41~ ~O oe_~ ,7 c 60 .~Po~-c X70 ~'6 Hz 1~ A I ~l l ~ 4 r C L--. 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E I x niy~.. 11`LR i' t~ Fien~y s t3 flePueH v,~ a it 3 05 ei N ei 9 p t o ° quaw tiVO37 n 1 stlono4 ~ 9 L II~4dc M .i~ Z ~ ctnNfM -a i X+ai s ~o~ o - 3 0[ Lda i P?ei1EYhI Z ~a at as xloa~ LsM7od" 006 o e 00H 002t ~ - v0 toll 1.IN 10)1IlOd { d pp 'PT7 'saoysggnd auutl3 N uue S ~-g 1-~I • I~-i ~ 1. -W I ` I x Wisconsin Department of Health and Social Service& Plb. #57 370 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. CWNER OF PROPERTY J Name Address (Street, City, Zip Code) B. LOCATION OF PROPERTY WF :RE SYSTEM WILL BE CONSTRUCTED ALTEREL OR EXTENDED COUNTY. Check CITY VILLAGE LEGAL DESCRIPTION TOWPI HIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEC'.ENT ADDITION MATERIALS: Prefab Concrete ( Poured in Place Steel Other NUMBER OF TANKS TO BE I NSTALLED z ( E. TYPE OF OCCUPANCY Check Ones 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 Dishrrasher YES _ NO Automatic Potato Peeler YESk_ NO Other (Specify) G. MASTER PLUr1BER MAKING INSTALLATION 7 Name: Address: Lioense Number: MP Signature of Applicant: MP RSW Address: H. (To be Completed by Issuing Agent) Date of Application Fee Paid Permit Issued (date)'Permit Number 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 w U forhard application, the fee of $1.00 for each septic tarot and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do net write in space below - FOR DEPARTMENT USE ONLY 1. DATE RECEIVED -.7 G ACCEPTED BY i. RETURNED (Initials) (Date) See Corres.) FEE RECEIVED Li VALID. No. J S U PERMIT N0. 7~ cJ es or No REVIEWED BY APPROVED DATE (Initials) Yes or No) COMPLETE OTHER SIDE a SEPTIC TANK PERMIT NO. R E P O R T O N S O I L P I 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 - PLUMBING S3CTIN P.O.Box 309, Madison, Wis. 53701 Purmtant to H 62.20, Wis. Administrative Code P Z R C 0 L A T I 0 N T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches inutes Number Inches Thiokness in Inches Since Hole in Hole Interval second to Next to Last To Fall lot Wetted Overnight in Minutes Last Period Last Period Period Cre Inch Example P - 0 361, To Soil 1016 Clay 26" 25 'Yes or No 30 1 2 1/? 1/2 60 71 w RECORD DATA FROM MINDIUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Cods. S O I L B OR I N G S- Minimum 36" Belcsi Pro osed Abso tion System Boring Total Depth De th to Ground Watts De th to Bedrock Number Inohoa Observed Estimated Observed Estimated Character of Soil with Thickness in Inches Example B - 0 72" 72" Black To Soil 12111 C1 18111 Sand 1811• Gravel 241 r RE,c:ORD DATA FROM MINLMUM OF 3 BORE HOLE'S PE OF OCCUPANCY: - RESIDENCE: Number of Bedrooms OTHER: (Specify) Number of Persons FOOD WASTE GRINDER: Yes J- Dishrrashar: Yes No Automatic Clothes Washer: Yes No FFUJENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length.,-'. Width Depth Tile Size No. Linas ~ Seepage Pit: Inside ;7a ter Liquid Depth I, the undersigned, hereby eer-ify that the percolation tests reported on this form were made by me or under y sups,,-- vision in accord with the procedures and method speeifiAd in Chapter H 62.20 (13), Wisconsin Adxinistra.tive Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME TITLE Type or"Print REGISTRATION NO. or MASTER PLUMBER LICFNS£ NO. ADDRESS DATE SIGNATURE Wisconsin Department of Health and Social Services P.'.b. #67 Division of Health PERMIT APPLICATION for PRIVATE DOMESTIC SEWAGE SYSTEMS A. OWNER OF PROPER'T'Y TYPE OR USK BLACK INK Name Address (Street, City, Zip Code) County B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDED Check One: CITY VILLAGE LEGAL DESCRIPTION: _.1-_--TOWNSHIP, ~I{ C. IS LOCAL PEFNIT' REQUIRED FOR THIS WORK? -YES NO D. SEPTIC TANK CAPACITY i'L" Gallons NEW INSTALLATION I---- REPLACEMENT ADDITION MATERIALS: Prefab Concrete G Poured in Place Steel Other NUQ`IBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commeroial Industrial Other Specify Number of Persons to be Accommodated j F. APPLIANCES, ETC: Food Waste Grinder YES 4~ENO Automatic Clothes Washer ! YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines No. Lines +J Seepage Beds Length 5L) !Width Depth y Nile Size 1-/ I Seepage Pits Inside diameter Liquid Depth P E R C O L A T I O N T E S T Test Depth Character of Soil Hours Water Test Time Dro in Water Level Inches Minutes Number Inches Thickness --n Inches Since Hole in Hole Inteival Second to Next to Last '.o Fall 1st Wetted Overni ht in Minutes Last Period Last Period Period Lne Inch Example P- 0 36" ( To Soil lot's Clay 26" 25 es or no 30 1/2 1/2 1/2 60 REC:OFD DATA FROM MINIMUM OF 3 TEST HOLES rmpute aize of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B O R I N G'S - Minimum 36" Balmr Pro osad Absorption System Boring Total Depth Depth to Ground Water Depth to Bedrook umber Inches Cbserred Estimated Observed Estimated Character of Soil with Thickness in Inches xample 0 72" 72" % Black Too Snil 12"• Cla 1811• Sand 18"• Gravel 24" RECORD DATA FROM MINIMUM OF 3 BORE HOLES COMPLETE OTHER SIDE I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME AL--/,, 2= ' Z'c _ TITLE e' Type or Print) REGISTRATION NO. - or MASTER PLUMBER LICENSE No. l % ADDRESS DATE SIGNATUF`E MASTER PLUMBER MAKING APPLICATION 3 MP Signatures License Numbers MP RSW (T/oa C/o/mpeted by Issuing Agent) Date of Application Fee Paid $ Permit Issued (date) Permit Number Agent (nama)/'~ For Town, Village, City, County, eta. (Specify) Notes The application oannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space belorr - FIR DEPARTMENT USE ONLY DATE RECEIVED ACCEPTED BY RETURNED (Initials) / (Date) See Corres. FEE RECEIVED VALID. NO. V ~ C1 PEFfiLTT NO. Yes or No) REVIEWED BY APPROVED DATE (Initials) (Yes or No) COMMENTS: