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Parcel 038-1086-40-000 12/08/2006 12:31
PAGE 1 OF 1
F 1
Alt. Parcel M 21.31.18.357D 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
MARY A HIGGINS O - HIGGINS, MARY A
1101 CTY RD CC
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1101 CTY RD CC
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 0.480 Plat: N/A-NOT AVAILABLE
SEC 21 T31 N R1 8W PT NE NE S OF HWY & Block/Condo Bldg:
RIVER EXC SCH HO LOT & STAR PRAIRIE TN
HALL & LID DEEDED TO ST. CROIX CO. HWY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEPT & STRIP 40' WIDE ALG E LN EXTG S 21-31 N-1 8W
FROM CL HWY C EXC PT TO HWY 996/550
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1216/296 PR
07/23/1997 996/550
07/23/1997 828/549
07/23/1997 597/267
2006 SUMMARY Bill Fair Market Value: Assessed with:
175372 114,300
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.480 22,900 78,100 101,000 NO
Totals for 2006:
General Property 0.480 22,900 78,100 101,000
Woodland 0.000 0 0
Totals for 2005:
General Property 0.480 22,900 78,100 101,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 123
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Departmont of Health and Scoiasl Services
Plb. #67 3/70 Division of Health
5
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK 1/01 A. 014TIER OF _ P_ R0_PLRTY
Name J Address (Street, City, Zip Code)
B. LOCATICN OF PROPERTY WHERE SYST M WILL BE CONSTRUCTED, ALTF-Rq OR EXTENDED COUNTY
Check One:
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP /
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? -/r YES NO PERMIT NUN.BER
s
D. SEPTIC TANK CAPACI'T'Y ~f(C Gallons NEW INSTALLATION REPLACEXENT ADDITION _
.t xq 771~1(',t 1'~e-
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)
Humber of persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES ~ NO Automatic Clothes Washer ~ YES NO
Dishwasher YES NO Automatio Potato Peeler YESNO
Other (Specify)
G. Nu1STER PLUN3ER MAKING INSTALLATIO14
Name: Address= Lioense Number:
r
Signature of Applicsnt: )1 MP RSW
r 1 ) / i
Address
H. (To be Completed by Issuing Agent)
Date of Application Fee Paid $ t
Permit Issued (date) Permit Number L
i1
- h1Form, -
Agent (Name) 'j-
Town, Village, City, County, etc.
(Specify)
Note: The application carno-- be considered for filing until all of the above questions are answered and t)-,t
fee paid. Agents will fora,-.rd application, the fee of $1.0U, for each septic tank 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 not write in space below - FOR DEPARTMENT USE ONLY
1. DATE RECEIVED_ - ACCEPTED BY RETURNED
(Initials) (Date) Sep-
FEE RECEIVED VALID. No. l!~~ PERMIT NO. I
es or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No
SEPTIC TANK PERMIT NO.
R Y P 0 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 0 R I N G S
TO
DIYIS17,4 OF HEALTH - PLLtII3I1KG SIXTI6N
P.O.Box 309, Madison, Wis. 53701
Pursu:arst to H 62.20, Wis. A&dniztr ativo Coda
P E R C O L A T I O N T E S T
Test Depth Chsraotor of Soil Hours Water Test Tima Drop in Water Lavel Inches inutes
Number Inches Thic'mess in Inches Since Hole in Hole Interval Second to Net to Last To Fall
1st Wstted Overnizht in Minutes Last Period Last Period Period Ong Inch
ExRmple
p - 0 3611 To Soil 10" Clay 2611 25 Yes or No 30 1 2 1/2 __.y2 60
4
Iri
RECORD DATA FROM MI34LTJM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. A"dainistrative Code.
S O I L B O -R I N G S-_Minimum 3611 Bel" reposed Abso tion System
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Cbserved Estimated Observed Estimated Character of Soil with Thioimess in Inches
Pxxaple
B - 0 72" 72" Black To Soil 12''• C1 1811; Sand 18"; Gravel 2411
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
YPE OF OCCUPANCY:
RESIDENCE: Number of Bedrooms ---I OTHER: (Speoify) Number of Persons
FOOD WASTE GR L'IDERs Yes No Distrxasher: Yes No X Automatic Clothes Washer: Yes /i No
FFUJENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLAC&'ILNT
/ L•
Tile Size No. Lin. Feat /l! Trench Width ~Z Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth
I, the undersigned, hereby certify 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 Adad nistrative Code, and
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
NAME C' h7~ kp K ! i"!T,<'.~ TITLE C~ ,
Type or Print u
REGISTRATION NO. or MASTER PLUMBER LI MSE NO. l
ADDRESS If~171'1"a
DATE SIGNATURE YZ E t.~L~L"~ J
~I