HomeMy WebLinkAbout038-1118-20-050
n cn o K n
O y O
o 3
ID y •
v m m m
a. Q
Z S rn O A D N O ~~y,' •
O N w J 0 N W r~y~ll/
~C~ Q O ~ 'ts A 3 ~ i-r
I O
V ! O W N AW ^S <
o O Q ~ 00 O p
C) (D
m i~ 0 _ _ 7 O (7 p <-;
Il a a p cn
CA N N Ul O O
N o _
N O
0 O D O D
C: 3
O O r1
` J N V
4
O o o W N p Cl) n 0 N
0
Z O O O m (ttNt~)t l))
p o z
icl~ -v y N fA 3 D
i~ .0.. N
N N N
v
~J _
0 m !V
O 2) N
3 m l~V'l+
O 0 C) 1 CTI
z p
~Q Z m z cn
D Cl 0
10
3
O 0 0 CD
\y
CD
@% CD N ( N
N
C (D 0
a
o o A Z CD
`p Z o
t-.
;o
z N
v m w co
CD fD z
o z
N ~
w v
m
m Co D m
a
a ,3
A v v c
m Cm z a
0 ' O O
-o 0
n 0 N
N O
a 00 0
m ~
(O N
o
N 6
(D (D
0 0
0
O
3 `
O
O P
O
D (D
CL
N Q
N
co
A W
10 Ic
O ~
O m.
0 icl
Parcel 038-1118-20-050 06/15/2007 01:49
PAGE 1 OF 1
F 1
Alt. Parcel 29.31.18.460C-05 038 - TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
01/05/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - HARBOSKY, LEONARD W & ROSEMARY
LEONARD W & ROSEMARY HARBOSKY C - ST CROIX COUNTY
ST CROIX COUNTY
1977 93RD ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1977 93RD ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 0.984 Plat: 5141-CSM 20-5141 038/06
SEC 29 T31 N R1 8W PTS NE NW & SE NW; Block/Condo Bldg: LOT 01
BEING CSM 20-5141 LOT 1 (0.984AC)
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
29-31N-18W NE NW
29-31N-18W SE NW
Notes: Parcel History:
PT IS IN ST CROIX CTY NAME; A TAX Date Doc # Vol/Page Type
DEED-ATTEMPTING RESOLUTION 1/31/07 SMC 01/05/2006 815781 CSM
01/05/2006 815781 CSM
12/27/2004 783469 2721/415 QC
07/23/1997 707/208 more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 01/31/2007
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
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
Parcel 038-1118-20-000 06/15/2007 01:50 PM
PAGE 1 OF 1
Alt. Parcel 29.31.18.490C 038 - TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
01/05/2006 00 6
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - HARBOSKY, RETIRED
RETIRED HARBOSKY
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 29 T31N R1 8W PT SE NW COM NW COR SE Block/Condo Bldg:
NW TH E 165 FT S 132 FT, W 165 FT, TH N
132 FT TO POB INCLUDING ANY ADDITIONAL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
PROPERTY KNOWN AS AND INCLUD ED IN THE 29-31N-18W
RIVERDALE SCHOOL PROPERTY NKA PT CSM
20-5141 (038/06)
Notes: Parcel History:
Date Doc # Vol/Page Type
03/28/2005 813262 2936/352 QC
03/28/2005 790673 2772/36 QC
12/27/2004 783469 2721/415 QC
07/23/1997 707/208
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 01/31/2007
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
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 Department of Health and Social Sainria "
r'S7 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK d
A. OWNER Ot PROPERTY
Name Address (Street, City, 'lip Codo)
.1
Be ~ LOCATION OF PROPERTY W IRE: SYSTEM WILL BE CONSTRLICTED, ALTERED OR EXTEI;D/E,DD-,~j COUNTY
Check Ones '//h
CITY VILLAGE LEGAL DESCRIPTION N/. `7J r/~ /7J" s ~ _
TOWI3SHIP s
- - j r.
C.' IS LOCAL PERMIT REQUIRED FOR THIS 'W'ORK? / YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACErIN'T ADDITION
MATERIALS= Prefab Concrete Poured in Place Steel Other
NL,ffiER OF TANKS TO BE 7NSTALV-D:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other _
_ Specify)
Number of Persons to be Accommodated Number of Bedrooms J
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dish-asher YES NO Automatio Potato Peeler YES-_ / NO
Other (Specify) _
G. MASTER PLUMBER MAILING INSTALLATION
Namo Address: Lioense Number:
C MP
Signature of Applicant: - MP RSW /
Address: -
H. (To, be Completed by Issuing Agent)
Date of Application J 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 will forward application, the fee of X1.00 °or each soptio tank and the tnird dopy
of the permit (oanary) to th% Division of Health. Chacks and money orders should be made payable to
the Division of Health. -
r
Do net write in space below - FOR DEPARTY.ENT USE ONLY
r
i
I. DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED VALID. No. C c, PERMIT NO.
es or No
REVIEWED BY APPROVED DATE
(Initials) Yea or No
COMPLETE OTHER SIDE
SEPTIC TANK PERMIT NO.
R E P O R T O N S O I L P Y R C 0 L A T I 0 N T L S T
/A N D S O I L B O R I N G S
TO'
DIVISION OF HEALTH - PLLFi3M SS-.'NIC~*I
P.O.Box 1{09, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Achainistrati-vo Come
P E R C O L A T I O N T S S T
Test Depth Charaotor of Soi ~Hcu s Water Taut Ti.-ae _ Dron®in Water Level Inches Tutes
Number Ir:ohes Thickness in Inohos Since Hole in Hole 1:tervai Second to Next to Last To Fall
1st Wotted Ovonii,?ht in Minutes Last Period Last Period Period C'nt- Inch
Example
P - 0 361, Tu Soil IO" Clay 2611 25 Yes or No 30 1 2 1 2 1/2 60
_ i
RECORD DATA FROM MrIE-lLri1 OF 3 TEST HOL:.a
Compute size of absorption area in accord with H 62.20 Wis. Adrinintrztive Code.
S O I L B O R I N G S- Minimum 3611 Belo: reposed Absorption Systolla
Boring Total Depth Depth to Ground hater De th to Bedroc;
Number Inches Observed Estimated Obaerved Estiza.74 Character of Soil with Thickness in Inches
Example
B - 0 721f 72" Black Top Soil 1211; Clay i8l'~Sand 18,11 Gravel 24"
RFCORD DATA FROM MINDIUM OF 3 BORE HOLD
TYPE OF OCCUPANCY:
c>
RESIDENCES Number of Bedrooms OTHER: (Speoify) Number of Persons
FOOD WASTE GRINDER: Yes ro Dishwasher: Yes No Automatic Clothes Washers Yes No
FFLULNT DISPOSAL SYSTEM: 41W EXTENSION ADDITION .~s R£P1AC1-21ENT
c'
Tile Size No.Lin.FJeet Trenah Width Depth Number of Lines
Seepage Bad: Length
Width . y Depth Tile Size No. Lines
Seepaga Pits Inside Diameter Liquid Depth
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under ry 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 my knowledge and belief.
NAME TITLE i
Type or Print)
REGISTRATION NO, or MASTER PLUMBER LICENSE NO.
ADDRESS
DATE / SIGNATURE 7 / ;
-TV
Sao-s-v ~