HomeMy WebLinkAbout040-1017-30-000
c M CD 3
CD 1 D) CD A
CD 3
1 ` 1\
A A `C •
n O W 0 O O N CD
CCD E5. C1 O c N A
0) n m a CD -I - o M
O
O 3 CD CO 3 7 III O co
CD
N CL 7 N cn 7 W
W O
c CD CD CD CD O 0 =
N_ N CD O O
N O
u> Z D m CD
O O
m n O a O
W
CD Z
c
c~n =
0 0 ~ °
c
°
i O f ~ a li
OZ (D CJD 7 N O C
O CD v
M -0 -0 41
Z O O O o
c fop N
v CD
Cn
m Q v v v
° <'D H N ~y
m po
m CD
m
7 1 0
N (n 3 R a
3
I ~ ~ Cn
Z Cn z
D CD °
CD :p
v O
CD
m
:3 CD
N
_-0 N
CD C.
l
C CD I
W @ 0-
E- 3 3 _
Z Cl)
:3 C° p Z CD
I ~ N
3 A Z O
CL O
0
1 z N A
m (D ° M IQ
z
0 3 A
O r. M
~ m co
N Z
CD
W F
N
O Q
N
O (D
aD O
N C
(D
o. o a
n J m C
7 d a'
7~ pj f0
(D A
CD
A
I it 00
CL t
CD O
7 a
S
N
~ O
I a o
a
A
0 A
Dro 00
cn O ti o('o
O *
C:) C
O CD
Parcel 040-1017-30-000 09/06/2006 04:34 PM
PAGE 1 OF 1
Alt. Parcel M 04.28.19.61 H 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
O - BOT, JAMES J
JAMES J BOT C - WEBERG JEAN M
WEBERG JEAN M
530 MARSON DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ` 530 MARSON DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.920 Plat: N/A-NOT AVAILABLE
SEC 4 T28N R19W.92 IN NE SE COM 1045.67 Block/Condo Bldg:
FT S OF NW COR NE SE, TH S 200 FT, E 200
FT TO W LN OF RD N ALG W LN SD RD 200 FT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
W 200' TO POB 04-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/04/2002 670273 1830/211 PR
07/23/1997 520/158
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Last Changed: 07/15/2004
Valuations:
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.900 36,000 183,800 219,800 NO
Totals for 2006:
General Property 0.900 36,000 183,800 219,800
Woodland 0.000 0 0
Totals for 2005:
General Property 0.900 36,000 183,800 219,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 208
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
no~~ dr _
s Wisconsin Department of Health and Social Services
Plb. ;67 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
d
TYPr or USE BLACK INK
A. OWNER OF PROPERTY y
Name Address (Street, City, Zip Code)
1Gc /'J r
f5
A'~
IL- Z'
B. LOCATION OF PROPERTY WHERE SYSTEM WILL 3E CONSTRUCTED ALTERED OR EXTENDED COUNTY 5-1 X~cll r
Check One:
CITY VILLAGE LE9kt~"DESCRIPTION
X TOWNSHIP
C. IS LOCAL PERMIT REQUIRED FOR THIS h`Oi - YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATIONi REPLACEMENT 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
Speaify)
Number of Persons to be Accommodated U Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dishwasher YES NO Automatio Potato Peeler YES X NO
Other (Specify)
G. MASTTR PLUMBER MAKING INSTALLATION
Name: l~c~-,L•• f~ Address: lLk/l) S~)p> Lioenss Number:
- MP
i
MP RSW
Signature of Applicants JX
Address:
H. (To be Completed by Issuing Agent)
Date of Application Fee Paid
Permit Issued (dace) Permit Number '~.17
Agent (Name) j ;r For:
Torn, Village, City, County, etc.
(Specify)
i Note: The appliAtion oanno oe considered for filing until all of he above questions are answered and t2-+ .
fee paid. Agents will forward appticaticn, the fee of ;1.0- for each septic taxm and the third oopy
4 of the permit (canary) to the Division of Health: Checks and money orders should be made payable to
the Division of Health.
Do not writs in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) SCo_rre
FEE RECEIVED VALID. No. PERMIT N0.
es or No
REVIXG,TD BY APPROVED DATE
(Initials) Yes or No) j
SEPTIC TANK PERMIT NO.
R L P 0 R? O N S O I E. P I R C 0 L A? I O N ? I S?
A N D S O I L B O R I N G S
TO
DIVISION OF HEALTH - PLUMBING SECTI6N ,
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Otis. Administrative Code
P t R C 0 L A T I 0 N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches ~iinutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall
1st netted Overni in Minutes Last Period Last Period Period Ions, Inch
Example
P - 0 36^ To Soil 10'1 Cla 26" 25 Yes or No 30 1/2 1/2 1/2 60
l n' W
C-
RECORD DATA FROM MIN FEE OF 3 TEST HOLES
Compute 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 System
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches
Example
B - 0 72" 72" 1 Black To Soil /12"• C1 i$111 Sand 1811, Gravel 2411
17
y
tI
PL 3
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
PE OF OCCUPANCY:
RESIDENCEt Number of Bedrooms J OTHER: (Specify) Number of Persons
D WASTE GRINDER: Yes N,3 Dishwashers Yes ~ No Automatic Clothes Washers Yes Ha
FFLUENT DISPOSAL SYSTEM: N i EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
7 Seepage Pitt Inside Diameter Liquid Depth h
Is the undersigned, hereby cert'fy that the percolation tests reported on this form were made by me or under ry super-
vision in accord with the procedures and method speoified 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.
j~
NAME 2 TITLE
Type or Print
REGISTRATION NO. / or MASTER PLUMBER LICENSE NO.
ADDRESS (7-
D A TE
~~7 7 ! % SIGNATURE
,r
1'17
Sc~1v '6~ rave
Cut*