HomeMy WebLinkAbout038-1133-90-000
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Parcel 038-1133-90-000 06/15/2007 03:32 PM
PAGE 1 OF 1
Alt. Parcel 32.31.18.546D 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 - THIEL, DAVID C & SHAROLYN
DAVID C & SHAROLYN THIEL
1822 100TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ' 1822 100TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.120 Plat: N/A-NOT AVAILABLE
SEC 32 T31 N R1 8W 3A N 160 FT OF E 300 FT Block/Condo Bldg:
OF SE SE
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
32-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 467/401
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.120 25,800 128,900 154,700 NO
Totals for 2007:
General Property 1.120 25,800 128,900 154,700
Woodland 0.000 0 0
Totals for 2006:
General Property 1.120 25,800 128,900 154,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 216
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Departmant of Health and Social Services
Plb, #67 370 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK Wb /f 7,0 631-
A.
OWMER OF _ PROPERTY_
Name/// D~ AdZ:.:ss (Street, City, Yip Coda)
Be LOCATION OF PROPERTY WF~RE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY
Check One:
CITY VILLAGE LEGAL DESCRIPTION L, V
TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? Ii YES NO 7 ~I PERMIT N024BER
D. SEPTIC TANK CAPACITY - - Gallons NEW INSTALLATION e,-REFLACETIENT ADDITION
MATERIALS= Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLZID:
E. TYPE OF OCCUPANCY
Check One: Cne or Two Family Residence Commercial Industrial Other
(Specify)
Number of Persons to be Acco=odated -21 Number of Bedrooms _
F. APPLIANCES, ETC: Food ;waste Grinder YES 1---'NO Automatic Clothes Washer ~/gE5 NO
Dishwasher YES f~NO Automatic Potato Peeler YES --NO
Other (Specify)
G. MASTER PLU-BER ?L=NG I1YET LLA CN
Name: r d! ° ` - r _y Address License Numbers
Signature of Applicant:?! MP RSr1
r
Address:
H. (To be Completed by Issuing Agent)
Date of Application / A7 Fee Paid 1 v
Permit Issued (date Permit Number -117
Agent (Name) n 1~fr G For; '-K &~Z
Torn, Village, City, County, etc.
(Specify)
Note: The application cannot oe considered :c: fiiing until all of the above questions are answered and the
fee paid, Agents will forward application, the fee of 41.00 for each scizio tanx and the third copy
of the permit (car_ary, to the Division of Health. Checks and .coney orders should be made payable to
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
1. DATE RECEIVED fTy ( - ALCEPTED BY J~ RETURNED ~]Orres.)
(Initials) ('Date) FEE RECEIVED v' VALID. No. PERMIT NO.
es or No
REVIEWED BY APPROVED _ DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
SEPTIC TANK PERMIT NO.
R Y P 0 R T O N S O I L P E R C O L A T I O N T E S T
A N D S O I L B 0 R T_ N G S
TO
DIVISI^N OF HEALTH - PLUMBING SECTIrN
P.O.Box 3C9, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Ad*.ainistrative Coca
P E R C O L A T I O N T E S T
Test 1; 4pth Charaoter c° °oil Hours Water Test Time Dropin Rater Level Inohes utes
Number Inches T:.icknoss in Inches Since Hole in Hole Interval Second to Neat to Last ITo Fall
ist Wett9d r4Vt 11 Yrt in 111nutes Last Period Last Period Period! Ons, Inch
Example
P - 0 3611 To Soil 10" Clay 26,11 25 Yes or No 30 1 2 12 1/2
ou
i
v
RECORD DATA FROM MINIMUM 07 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L _B 0 R I N G S- 'minx= 361' Belmar Proposed Absorption System
Boring Total Depth Depth to Grouna Water Depth to Eodroc%
N,xuber -Inches Cbserved Eatiwated Obaerved Esti ated Character of Sail with Thiokness in Inches
Example
B - 0 I 721f 72i1 Black To Soil 1211; Ciay L811, Sand 18"• Gravel 24"
RE1:0?D DATA FROM MINL'N;1 0? 3 BoF H%js
YPE OF OCCUPANCY; ~z P
RESIDENCEs Nursber of Bedrouts J OTF.ER: (Specify) Number of Persons
FOOD WASTE GRI'NDER' Yes No .--Dishwashert Tes No (----.Cutomatio Clothes Washert Yes 6-No
FFLNJENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLA.,'`SE.N'P
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
1 Seepage Bed: Length Width _ Depth-;A-L- Tile Size No. Lines
Seepage Pits Inside iameter ' Liquid Depth
I, the undersigned, hereby certify that the percolation tests reported nn this form were made by me or under my super-
vision in accord with the procedures and method speoified i.n Chapter H 62,20 (13), Wisoonsin Administrative Code, and
that the data recorded and location of test holes are correct to .he best of my knowledge and belief.
NAME TITLE
Type or Print)
REGISTRATION NO. or MASTER PLUMBER LICENSE NO. f J
ADDRESS
DAiE ~J /T Q SIGNATURE _ • ~~rr ~ 7r_ i 77",
1
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