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Parcel 038-1093-40-000 09/21/2006 09:53 AM
PAGE 1 OF 1
Alt. Parcel 22.31.18.385 038 - 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): 0 = Current Owner, C = Current Co-Owner
O - CURTIN, PHILLIP J & ANNA M
PHILLIP J & ANNA M CURTIN
2029 118TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 2029 118TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 22 T31 N R1 8W NE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 10/05/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 32,000 171,800 203,800 NO
AGRICULTURAL G4 32.000 2,200 0 2,200 NO
AGRICULTURAL FOREST G5M 6.000 15,000 0 15,000 NO
Totals for 2006:
General Property 40.000 49,200 171,800 221,000
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 49,200 171,800 221,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 209
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 038-1093-90-000 09/21/2006 09:53 AM
PAGE 1 OF 1
Alt. Parcel 22.31.18.388 038 - 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 - CURTIN, PHILLIP J & ANNA M
PHILLIP J & ANNA M CURTIN
2029 118TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 22 T31 N RI 8W SE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 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 39.000 3,900 0 3,900 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2006:
General Property 40.000 4,000 0 4,000
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 4,000 0 4,000
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
Wisconsin Departc:ent of Health and Social Services
Plb. #67 3/70 Division of Health
- SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. OWNER OF_PP.OPSR 'Y
Address (Street, city, Zip Coda)
Name
B. Y LOCATION OF PROPERTY WH{,RE SYSMI WILL BE CONSTRUCTED, ALTERED OR EXTENDED COU27TY
Check One: ~l1 /1
CITY VILLAGE LEGAL DESCRIPTION
1 I
TOWNSHIP,,-. r.3 G ✓ iT t ch_i pp
C. IS LOCAL PERPIIT REQUIRED FOR THIS WORK? ! YES NO _ PERMIT NUMBER
D. SEPTIC TANK CAPACITY L r' r Gallons NEW INSTALLATION R£PLACEMbNT ADDITION
MATERIALS: Prefab Concrete 'y\ Poured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED:
A'e X314 i~ Ile.l"/t:,
E. TYPE OF OCCUPANCY
-Cheek One: One or Two Family Residence Commercial Industrial other
Specify)
Number of Persons to be Accommodated 7 l Number of Bedrooms
F. APPLIANCES, ETC: Fcod Waste Grinder YES NO Automatic Clothes Washer /y, YES NO
Dishwasher YES NO Automatic potato peeler YES Y NO
Other (Specify)
G. MASTER PLUP3ER MAK%tiG INSTALLATION
C•;4F'Address, License Number:
Name:
Signature of Applic&nt: MP RSW
Address: H. ((Too be Completed by Issuing Agent)
Date of Application Fee Paid
Permit Issued (date) Permit Number
L
Agent (Name) Fors,=~-~~
Toxn, 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 fom and application, the fee of $1.00 for each septic tanx and the third copy
of the permit (canary) to trio 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 ACCEPTED BY 7 V RETURNE1D
(Initials) (Date) Sgt C-Tres.)
FEE RECEIVED ✓ VALID. No. PERMIT N0. II
Yes or No
REVIEWED BY APPROVED DATE
(Initials) --(Yes or No
'f
' SEPTIC TANK PERMIT NO.
R Z 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
N D S O I L B O R I N G S
TO
DIVISION OF HEALTH - PLUKBM S=TI6N
P.O.Box 309, M Bison, Wis. 53701
P,n suant to H 62.20, Wis. Administrative Code
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 utes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last Lle, Fall
1st Wetted Overnicht in Minutes Last Period Last Period Perio3 In ch
Example
P - 0 X3611 T0.0 Soil 10" Clay / 2611 25 Yes or No 30 __k2 112 1 2 60
RECORD DATA FROM M124DAUM OF 3 TEST HOLES
Computs size 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" Below Pro osed Absorption 5 stem
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Cbserved Esti ztod Ooserved Estimated Character of Soil with Thiokneas in Inches
Example
B - 0 72" 72" Black To Soil 12" C1a 18". Sand 18"• Gravel 2411
RECORD DATA FROM MINL~fUM OF 3 BORE HOLES
PE OF OCCUPANCY: L
RESIDENCES Number of Bedrooms OTHERs (Specify) Number of Persons
FOOD WASTE GRINDERS Yea No Distxashers Yes No ) Automatic Clothes Washers Yes No
FFLUENT DISPOSAL SYSTEM: NEW - X EXTENSION ADDITION REPLACEMENT
Tile Size T- No.Lin.Feet Trench Width Depth 'S. Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth
Ie the undersigned, hereby certify that 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), Wisoonsin Administrative Code, and
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
rl
NAME Ale Ir { Y L~ he TITLE >
(Type or Print
REGISTRATION NO. or MASTER PLUMBER LICENSE NO. /
ADDRESS P_ r , t C Jl I ! 2
DATE / -7 SIGNATURE t G i