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' Parcel 038-1135-80-000 06/15/2007 03:52 PM
PAGE 1 OF 1
Alt. Parcel 33.31.18.553B 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
MICHAEL A CALLEJA O - CALLEJA, MICHAEL A
1849 100TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 1849 100TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 33 T31 N R1 8W PARCEL IN SW NW COM W Block/Condo Bldg:
1/4 COR SEC 33 TH N 496.44 FT TO POB: TH
N 165 FT, S 88 DEG E 264 FT, TH S 155.79 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT, W 264 FT TO POB EXC W 33 FT 33-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/02/2000 617791 1487/558 WD
07/23/1997 1218/398 QC
07/23/1997 1138/514 WD
07/23/1997 787/414
more...
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 1.000 25,000 137,400 162,400 NO
Totals for 2007:
General Property 1.000 25,000 137,400 162,400
Woodland 0.000 0 0
Totals for 2006:
General Property 1.000 25,000 137,400 162,400
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
Wisoonsin Department of Health and Sooial Services
Plb. #67 10/69 Division of Health
PERMIT APPLICATION
for
PRIVATE DOMESTIC SEWAGE SYSTEMS
A. OWNER OF PROPERTY TYPE OR USE BLACK INK
Name Address (Streets City Zip Code)
}
S ) ) /
L~
County
B. LOCATION OF PROPERTY WKE RE SYSTEM WILL BE CONSTFrUCTED, ALTERED OR EXTENDED
Check One:
CITY VILLAGE LEGAL DESCRIPTION: Lt.t
TOWNSHIP ~ ~ L. c:, ~/~i ) (i~ ~1--•~. ~ ,f
C. IS LOCAL PE}d4IT REQUIRED FOR THIS WORK? YES NO f
PERMIT NL'MFiER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACFMENT ADDITION
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)
Number of Persons to be Accommodated_ Numer of Bedrooms
F. APPLIANCES, ETCs Food Waste Grinder YES NO Automatic Clcthes Washer X YES NO
Dishwasher YES x NO Automatio Potato Peeler YES _--,C NO
Other (Specify) T
G. EFFLUENT DISPOSAL SYSTEM NEW x EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet ;2 5c' Trench Width Depth Number of Lines
?.Seepage Beds Length Width Depth Tile Size No. Lines
Seepage Pits Inside diameter _s, 2 Liquid Depth
P E R C O L A T I O N T E S T
Test Depth Character of Sail Hours Water Test Time Drop in Water Level Inches Minutes
Number Inches Thickness in Inches Since Hole in Hole Into-val Second to Next to Last To Fall
1st Wetted Overni ht in Minutes Last Period Last Peri Period Jn± Inoh
Example
P- 0 36" To Soil 10" Cla 26" 26 es or no 30 112 1/2 1/? 60
RECOF0 DATA FROM MINIrJM OF 3 TEST HOLES
I
ompute size of absorption area i;: accord Yrith K 62.20 Wis. Administrative Code. ;i
S O I L B R I N G S- Minimum 36" Below Propose, Absorption Sys
tem
tl
Boring Total Depth Depth to Ground Water Depth to Bedrock
umber Inches Cbserved Estimated Observed EstLI-- ed Character of Soil with Thickness in Inches
xample
J /2" 72" Blaok Top Sail 1211; Clay 18"; Sand 18"; Gravel 24"
i 3-7- L
C ,
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 elief. !
NAME TITLE l ZC" lam'
r c
(Type or print) J
REGISTRATION NO. or MASTER PLIJ1,1BER LICENSE No.
ADDRESS
DATE SIGNATUiC
MASTER PLJTT3~;R MAKING APPLICATION
MP
Signatures License Numbers
MP RSW fs S
(To be Completed by Issuing Agent)
Date of Application Fee Paid
Permit Issued (dae) Permit Number
Agent (name) For:
Town, Village, City, County, etc.
(Specify)
Notes 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 $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 below - FOR DEPARTMENT USE ONLY
DATE RECEIVED ACCEPTED BY~ RETUFNED
T~ (Initials) nn ~J (Date) See Corres,
FEE RECEIVED ✓ VALID. NO. PEF41UT NO.
(Yes or No)
FEVIE74ED BY APPROVED DATE
(Initials) (Yes or No)
COMMENTS:
.
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