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HomeMy WebLinkAbout040-1012-80-000 a v f a 0 0 r1 "0 3 CD m 0 O 1 d # CD A 3 _ ~ boy Z _ N O N N A A Af O N 0 N O W= O O drl • CCD O (n h"p O O 4D N a A N E Z N N O ►'y `Al V 0- 7 CO N O j ~ N C 1 k W COD N _ C01 (Op ~ 0 n O ~ ~oI d 7 N O (n z D a tD Cfl O N G = W C C C ` d I((~IV v LW (D O W N n lei L O ~ y 0 c z O O CS P C .N-. d M Z O O O O ~1• 0 d Ul Vl In < I (D FA* = N y 'O O 90 C y N O I!,I O 3 m C d CL N Z ZCnZ o O y (D O CD :p :3 CD • N N C C N W d 2- 7 z CD cn Q Z fD N c .n« I ~ a A Z ~ O CnC ~ W (D < 00 CL 3 Z A O Z 3 m O0 N Z I (D p W CL C) CL 3 °o CD cn o m v = 'n m C n CDp o C c7 d O N O. CL = (D T a y SO A N 0 (D a N ti CD a C. N ~ V O N O O a I p 'i W (D DAQ Owo O O ti a 00 d ti Parcel 040-1012-80-000 09/06/2006 03:28 PM PAGE 1 OF 1 Alt. Parcel 04.28.19.51C 040 - TOWN OF TROY 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 SUZANNE M COLEMAN O - COLEMAN, SUZANNE M 549 OLD HWY 35 S HUDSON WI 54016-8145 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 549 OLD HWY 35 S SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.090 Plat: N/A-NOT AVAILABLE SEC 4 T28N R19W PT SW NE BEG INT S LN NE Block/Condo Bldg: 1/4 SEC 4 & E R/W LN HWY 35, N 109'; N 81 DEG E 257 FT; N 47 DEG E 154'; S 5 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) DEG W 247.5' TO S LN NE 1/4 W ALG S LN 04-28N-19W 344' TO FOB Notes: Parcel History: Date Doc # Vol/Page Type 04/10/2006 715454 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 30,800 99,900 130,700 NO Totals for 2006: General Property 1.000 30,800 99,900 130,700 Woodland 0.000 0 0 Totals for 2005: General Property 1.000 30,800 99,900 130,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 301 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 Services f° b. #57 370 Division of Health - r t~({ ~ SEPTIC TANK PEA*1IT APFii;,ATION '32 V 732 TYPE or USE BLACK INK Sr'I' -4 '4- A!~- A. C.?NER OF PROPER71 Name Address (Streeter City, Zip Code) -0 1 B, LOCATION DF PROPF i ,'H REV SYSTEM TWILL BE CONSTRUCTED, ALTEREI OR EXTENDYD COUN Check One: CITY VILLAGE LEGAL DE'SCRIP'TION L I T G TOWNSHIP ./:7 C. IS LOCAL PERMIT REQUIRED OR THIS WORK? YES NO ~c PERMIT NUMBKR D. SEPTIC TANK CAPACITY A000 Gallons NEW INSTALLATION REPLaCEMLENT _ ADDITION MATERIALS: Prefab Concrete ^ Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALL .z j , E. TYPE OF OCCUPANCY Cheek One: One or Two Fa.-i7y Residence Commercial Industrial Other Spet:ify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer kC YESNO Dishnmsh,di YES X_ NO Automatio Pottto Peeler YE.S_~,_ NO Other (specify) G. MASTER PI.IJMER YLkKING/I~NSTALLATION Name: x". C!! -l) /D Address: License Number: Suture of Applicant: MP RSW1 7 Address: /0, 4 H. o be pleted by lssu?nr- Agent) ~T /110m Date of Application Fee Paid Permit Issued (dais) © 2 7 U ~ Permit Number 7 Agent (Name) L~ For= Town, Village, City, County, etc. (Specify) Note: The application cannot he considered for filing until all of the above questions are answered and the fee paid. Agents will forwa-rd application, the fee of $1.00 for sack, septic tanx and the third copy of the permit (canary` to the Division of Health. Checks and money orders should be made psyable to the Division of Health. Do not write in space below - FOR DEPARTYIENT USE ONLY I. DATE RECEIVED ' ACCEPTED BY RETURNED (Initials) ,(Date) -~S-ee Cpcr s~ FEE RECEIVED VALID." No. J, .~7n PERM1IT NO. Yes or Nor' REVIEWED BY APPRCVED DATE (Initials) Yes or No) COMPLETE OTHER SIDE • SEPTIC TANK PER11IT NO. R I P 0 R T O N S O I L P Y R C 0 L A T I 0 N T I S T A N D S O I L B 0 R I N G a TO DIVISION OF HEAT,^H - PLMBIF^ SECTILN, P.O.Box 309, :u~.dison, Wis. 53701 Pursuant to H 62.20, Wis. Administratife Code P I R C 0 L A T I 0 Y T I S T Test Dep+,h Character of y~f? Nn:rs Ws. tar Pest Time Drop Ln Water Level I-%~' utes :+ln er Inches Thiakness in Inches Sinc: Hole in Hole Interval Second to NexO ro Last To Fall 1st Netted Oust'rsight in Minutes Last Period Last Per:ed;Pe: ioc~ Rne< Ine.`i Example P -w0 361, Top Soil 10", Clay 261125 Yes or No 30 112 I 1 2 1/2 ~ 6c) n 7 z- .:fit " - y C) Lich 3_.' N LL J ~6 JCL i .°.E RD DATA FRC:i MINL`PTr1 OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Adainistrative Code. S 0 I L_B 0 R I N G S *L!rim a 3611 Balcw Pr{p^aed AD sorjotion Sy3t _-l BorL;g Total Depth Depth to Ground Watts Depth to Bedrock Number Inches Cbserved E3tima.ted Cbserl Estir t d Character of Soil with T`iio'aes_ in Inohe' Zx<ample B - 0 72'1 7211 BlaC~SC Top 3011 12"; Clay 181'; Sand 181- Gravel 2411 /o 71 RzwZP,D DATA FR4K MISS G^ 3 BOPF HOLES HYPE OF 0=.uPkgCY. RESIDENCE: Number of Bedrooms OTH.R: (Specify) Number of Peroons S D WASTE GRINDER: Yes Nc X DistHTazhard 'as --No ~ Autarsat z Clothes Washers Yes _ No F?UJLNT DISPOSAL SYSTEP4: NE74 X EXTENSION ADDITION REPLitMEN'T Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Disaeter Liquid Depth Is the undersigned, hereby eert'fy that the peroolation tests reported on this form were made by me or under r/ super- vision in accord with the procedures and method specified in Chapter H 62.20 (1.3), Wisconsin Ad+einistrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME~G~~ TITLE LCJ/~ Type or Print REGISTRATION NO. or MASTER PLJ L9ER LI~CF-45F NO. I~ ADDRESS 5a__ae / DATE SIGNATURE ~