HomeMy WebLinkAbout040-1073-60-000
OqO 10'73_ 60 -GCS
~ee~~OaSeS Col /y.
32'1 .5-. CoA P,d.
!-/udS any t,J 5510
,LoE d/ CSM}~of. ~ Rj,Z2~
S r%s~ 3 will, .Sae . i 8, T. 28 n•,
/9~.J• 7A. e, Troy 56cf-oixC
o+e ~ Knewrc.~ lo~,~,~s^I
~JJt 4 G~
h.oKSe.
EX~Sfno~ (I~!~,Q
~o.,Crt~e 5e~tic~x
.,rte. 'to S. Co~`C.,Qcl.- ~a bC l ctr; of u.?r~}.
m .1
C
Z C
d N
m 3 - 1\
3- O
) O
7 W (D Co A •
O W (n
i= a O M `OG N O
(D p O co
A (D O. O -1 O ^
O O
W N (n W O \ 1
W 4
N Cl
11
I~_ S O N C
m ~ CD O (D 6 w
( a O O r~
3
En C O
m 3 N
O a m _!y
W z n (D
O A
Ia ~ N Cn
z 4 V O O C '~1
O O < F~syl
m -0 N
z O O O = tr
a N EC < z ti
N N C O D
0 v c v v v c~:2
o' D IcD ~ m N ~ ro°
m cn
0 Z
O y A N
N = 3 - O N
(D
O A
a ~ W N
z ~ o
~ z cn z
D N ° r
O N
W
O'
N
D •
m
C N
O
W ~ a
(a 3
A Z
O
U E3
C r +
CO.. A Z
Iw3 _
W M N O~
(D (D W
z z
O 3 A
(3n, Z
(D,
Cl)
W zo D
(D 0
OD F
9
COD
O a n
'p W IW C
O (D a - 7
(D z
((DD 3 (D O
W a H
O 7 ~ rr.
m a ~
W
E3 Cl) W
(D
p S
~ t
N --A
O
O A.
p
O ~
L ?
O W
23
C
Iu
O
C
{
m yq
o a
m b
00 a
(
Parcel 040-1073-60-000 05/18/2007 04:59 PM
PAGE 1 OF 1
Alt. Parcel 18.28.19.280G 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 - NELSON, SHIRLEY
SHIRLEY NELSON
324 S COVE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 324 S COVE RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.310 Plat: N/A-NOT AVAILABLE
SEC 18 T28N R19W 3.31 AC PT NE SW & SE Block/Condo Bldg:
SW LOT 1 CSM 8/2242
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
18-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 483/207
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 3.310 63,000 135,900 198,900 NO
Totals for 2007:
General Property 3.310 63,000 135,900 198,900
Woodland 0.000 0 0
Totals for 2006:
General Property 3.310 63,000 135,900 198,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 217
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
Fib. #67 10/69 Division of Health
s
PERMIT APPLICATION
for
PRIVATE DO1'IESTIC SEWAGE S'YSTEI`LS
A. OWNER OF PROPERTY TYPE OR USE BLACK INK
Name Address (Stree~t$ City, Zip Code) /
County
B. / LOCATION OF PROPERTY WHF;E SYSTEM WILL BE CONSTRUCTED ALTERED ^R EXTENDED
J Check One: - - - ✓ /1'/ "r/ / Ct '
CITY VILLAGE LEGAL DESORIPTIONt T j C
A TOWNSHIP
-7 6d.
C. IS LOCAL PEW1IT REQUIRED FOR THIS VnRK1 _ YES NO PEFVIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACE,1ENT ADDITION
MATERIALS: Prefab Concrete X Poured in Place Steel Other
NUMJER 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 Number of Bedrooms J
F. APPLIANCES, ETC$ Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dishwasher YES NO Automatic Potato Peeler YES NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEIMENT _
Tile Size No.Lin.Feet ^rench Width Depth Number of Lines
Seepage Bedt Length Width Depth Tile Size No. Lines
f Seepage Pitt Inside diameter / - Liquid Depth I
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches t inutes
Number Inches Thickness in Inches Since Hole in Hole (IInterval Second to Next to Last To Fall
1st Wetted Overni ht f in Minutes Last Period Last Perioj Period One Inch
Example
P- 0 36" Too Soil 10" Cla 26" 25 es or no 30 1/2 1/2 1/2 60
3 LL
F - / ; -
RECOcFD DATA FROM MINIMUM OF 3 TEST HOLE-S
I
ompute eize of absorption area in accord with H 62.20 Wis. Adninistra+ive Cods.
_
S O I L B O R I N G S- Minimum 36" Below prop osad Absorption System
oring Total Depth Depth to Ground Water Deptn to bedrock
umber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches
Example
0 72" 72" Black To Soil 12"• Cla 181#• Sand 18"• Gravel 24"
r 12
LM 7 O i
RECORfl DATA FROM MINIMUM OF 3 BORE HOLES .
COMPLETE OTHER SIDE
r
•
I, the jmdersigned, 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 belief.
NAME /J l 7~1~ = y Z ri Yl -TITLE -47
(Type or Print)
REGISTRATION NO. or MASTER PLUMBER LICENSE No.
ADDRESS
DATE J S IGN„^! U RE
MASTER PUit'L3ER MAKING APPLICATION
~ MP
License Number:
Signature:
MP RSW
(To be Completed by Issuing Agent)
Fee Paid
Date of Application 2'~7 /
Permit Issued (date) 47C. Permit Numbers
Agent (name) ~r:.~ i' For:
Town, Village, City, County, etc.
J (Specify)
Note: 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
r. 7
DATE RECEIVED ACCEPTED BY - ' RETURNED
(Initials) (Date) (See Corres,
v
FEE RECEIVED VALID. NO. L PERMIT NO.
(Yes or No)
REVIEWED BY APPROVED DATE
(Initials) (Yes or No)
COMMENTS:
G` 10