HomeMy WebLinkAbout040-1067-60-000
o (n o K v 0
m o 3
m (D -0
v ij c
o 3 m
m _
O
cn z 2 N O A (7 -I O n ~+d •
0 O N N N p~ V A Sc Jl
I O Q N
ID a @ _ A -I C)g
(D - C)
..w;
(D CO O 1
CD O
~ p7 (n ~ N V ^t
00 O O J O O
V 0 3 C _ 'O
CL ~ O T
7 N N O O
v d N
Z D
C Q
cD s
o a
Q7
C O O O
3 V
O O N Icy
Cl \ co :
Z N
0 (D
4 m n (A O U)
O O m ! a
2 b z
r-
O O O o
` Q C (n (D
_ w v v o
U1 N
O M N A
( m O N
N
CL K
z
Z Cl) Z
D ID o
v O ID 7
ti T N
C N
CD
G: ~ Q
(D (6
o 'p z m
z o
W C N) V
ID CO
Q Z
0 3 a ~
o z
3 m
t/l Z
(D A
W
N y
N O- CC
N G
(D
"O O_
N T1
O C
(D - 7
-p Z O
r: O
N ~
U
Z,a
r
R
O
N
O
O
J
A
O y.
O
CD n 1
O
O ~ ~ V
Parcel 040-1067-60-000 06/01/2007 04:52
PAGE 1 OF 1
F 1
040 - TOWN OF TROY
Alt. Parcel 17.28.19.2570
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 - EDWARDS, SARAH L
SARAH L EDWARDS C - BECKMAN NORMAN D
BECKMAN NORMAN D
467 W OMAHA RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 467 W OMAHA RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.500 Plat: N/A-NOT AVAILABLE
SEC 17 T28N R19W 2.5 AC IN NW NE COM Block/Condo Bldg:
N1/4 COR, TH S 52 DEG E 696.4 FT,S 81
DEG W 33 FT,S 7 DEG E 303.7 FT, TH N 78 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG E 283 FT TO POB: N 78 DEG E 59 FT, N 17-28N-19W
81 DEG E 217 FT, S 6 DEG E 487 FT, TH S
78 DEG W 230 FT, TH N 12 DEG W 458.3 FT
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
04/21/2003 717822 2210/421 WD
08/05/2002 686029 1941/147 EZ
578/74
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/20/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.500 54,500 213,600 268,100 NO
Totals for 2007:
General Property 2.500 54,500 213,600 268,100
Woodland 0.000 0 0
Totals for 2006:
General Property 2.500 54,500 213,600 268,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
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
Plb. #67 370 Division of Health
SEPTIC TANK PEFMIT APPLICATION
4YPE or USE BLACK INK L! 7&/
~
A. MIER OF PROPERTY LIda)
~Ic
Nama - • - Address (Street, City, Zip ~l
B. LOCATION OF PROPERTY WrERE: SYSTEM WILL BE CONSTRUCTED ALTEREj OR EXTENDED COUNTY
Check One.
CITY VILLAGE LEGAL DESCRIPTION /
TOWNSHIP
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Corerete Poured in Place Steel Other
NUMBER OF TAjTKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Cheek One: One or Two Family Residence Commercial Industrial other
(Specify)
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES ` NO Automatic Clothes Washer YES NO
Dishwasher YES NO Automatic Potato Peeler YES NO
Other (Specify)
G. MASTER PLUnER MAKING INSTALLATION
Name: Address: License Number:
MP
Signature of Applioant: MP RSW
Address:
H. (To be Completed by Issuing Agent)
i
Date of Application Fee Paid $
's
Permit Issued (date) Permit Number
r
Agent (Name) For:
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 wi..l forward application, the fee of 31.Ot for each septic tanx and the third cop
of the permit (canar'r) to the 'Division of Health. Checks and money orders should be made payable to
the Division of Heait
Do not write in space below - FOR DEPARTMENT USE ONLY
n1
I. DATE RECEIVED ALCEPTED BY RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED VALID. No. h L4 PERMIT NO. ~ i
es or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
SEPTIC TANK PFA'1IT NO.
R Z P 0 R T ON S01 L PIRC0LATIQN TEST
A N D 5 0 I L B O R I N G S
TO
DIVISION OF HEALTH - PLUIBIING SSCTICa
P.O.Box 309, tizdi~on, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P E R C O L A T I O N T I S T
Test Depth Charactor of Soil How's Water Teat Time Drop in Water-" Level Inches Rlb~ut
Number Inches Thickness in Inchos Since Hole in Hole Iatervai Second to Next to Last LI Fall
1st Wotted 0%rorni ht in Minutos Last Period Last Period Period x Inch
Example
P - 0 3613 To Soil 10" Cla 261, 25 Yes or No 30 1/? 112 1/2 60
RECORD DATA FROM MINLI'JM OF 3 TEST HOLES
Computs 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 3611 Belr"r Pro osed Absorption 5 stem
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Sril with Thickness in Inches
Example
B - 0 7211 72" Black To Soil 12" Cla L811, Sand 1811, Gravel 2411
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
TYPE OF OCCUPANCY:
RESIDENCES Number of Bedrooms OTHER: (Specify) Number of Persons
D WASTE GRINDE'Rs Yes No Dishwasher: Yes No /utomatic Clothes Washer: Yes No
FFLIJENT DISPOSAL SYSTEM: NEW i~ EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth - Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth
r
I, the undersigned, hereby eertity that the peroolation tests reported on this form were made by me or under my 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
Type or Print
REGISTRATION NO. or MASTER PLUMBER LIC0SE NO.
ADDRESS
DATE ? - SIGNATURE
'k,