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Parcel 030-1006-30-000 12/11/2006 01:01 PM
PAGE 1 OF 1
Alt. Parcel 02.29.19.27D 030 - TOWN OF SAINT JOSEPH
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 - MELLERUD, JENNIE L
JENNIE L MELLERUD C - BAAZARD, JUSTIN
JUSTIN BAAZARD
1107 CTY RD A
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1111 CTY RD A
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.430 Plat: N/A-NOT AVAILABLE
SEC 2 T29N R19W SW SW COM SW COR E ON S Block/Condo Bldg:
LN 285 FT, NWLY TO PT ON S LN HWY 100 FT
E OF W LN, SWLY OF HWY TO W LN S TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
02-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/25/2005 810240 2914/641 WD
03/21/2002 674226 1858/422 TI
2006 SUMMARY Bill Fair Market Value: Assessed with:
168516 82,500
Valuations: Last Changed: 04/26/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.430 32,700 38,900 71,600 NO
Totals for 2006:
General Property 2.430 32,700 38,900 71,600
Woodland 0.000 0 0
Totals for 2005:
General Property 2.430 68,500 48,200 116,700
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
Parcel 030-1013-50-000 12/11/2006 01:01 PM
PAGE 1 OF 1
Alt. Parcel 03.29.19.57 030 - TOWN OF SAINT JOSEPH
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 - MELLERUD, JENNIE L
JENNIE L MELLERUD C - BAAZARD, JUSTIN
JUSTIN BAAZARD
1107 CTY RD A
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 1107 CTY RD A
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.500 Plat: N/A-NOT AVAILABLE
SEC 3 T29N R19W PRT SE SE N 16 RIDS OF S Block/Condo Bldg:
41 RDS OF E 5 RDS
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/25/2005 810240 2914/641 WD
03/21/2002 674226 1858/422 TI
2006 SUMMARY Bill M Fair Market Value: Assessed with:
168566 157,000
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.500 50,000 86,200 136,200 NO
Totals for 2006:
General Property 0.500 50,000 86,200 136,200
Woodland 0.000 0 0
Totals for 2005:
General Property 0.500 50,000 86,200 136,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 119
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
~p T Pi n. ;'=67 to/ss Wisconsin Dep-rtment of Health and Sooiti Servi e,
_ Division of Health
~V D ~d P 1 ~7 PE:IMLIT APPLICATION
for
N r~~ PRIVATE DU'E:STIC SEWAGE SYSTEI:S
A. 04NIER PPUPER-y TYPF Cif USF: BLACK 1vs ~
Address (Street, C-JtL~, Zip Co-do)
C of,,nty
I B. LOCATION OF PROPEr WEER; SY3TE111 '.SILL BE CON Tt?,T LED A.L~rRED OR En ENDLD
Check One; _ - 1 C_. 1 j
_ CITY vII11AGE ~ LEsAL DESCRIPTION:
t TO'n`,~z,1P i ~
C. IS LOCAL PER"IT REQUIRED FOR THIS WORK? _ YES NO PF;~ I N*u-nEa
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACKNEN'T ADDITION
0
MATERIALS: Prefab Concrete _ Poured in Place Steel Other
N.fii3ER OF TANKS TO BF. INSTALLED: - I
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other _
~(Specify)
Nu:tuber of Persons to be Accommodated ~ Number of Bedrooms .3
y i
F. APi'LIANCES, FTC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dishwasher YES A' NO Automatic Potato Peeler YES NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW ~i EXTENSION ADDITION REPLACL-ANT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width _ Depth Tile Size No. Lines
' Seepage Pit: Inside diameter Liquid Depth
P E R C O L A T I O N T E S T
Test Depth i ^ Character of Soil Hours Water Test Time D_roo in Water Level Inches Ninutes
Number Inches i Thickness in Inches Since Hole in Holo l Interval Second to Next to i=st To Fall
1st 4+etted Overnight in Minutes Last Period I Last Perio Period One Inch
Example w._..
P- 0 36" To Son 1011, Clay 2611 25 es or no 30 112 1 2 /1 j
1 2 60
RFCORII DATA FRa`i MI"lI::ul. OF 3 TEST HOLES
=pute aize of absorption area in aeoord with H 62.20 Wis. Administrative Code.
S O I L B 0 R I N G S- Minimum 3611 Balpw Proposed Absorption System
oring Total Death Depth to Grcund Water DDDth to Bedrock
umber InohPs Cbuserved Esti;ated Observed Esti, atsd Character of Soil with Thickness in Inches
'~ple
",Q 7211 7211 Blaok To Snil 12"• Clav 18"• Sand 1811• Gravel 2411
I i
RECORD DATA FROM MINIMUM OF 3 BC-G: .OLFS
COMPLETE O'PHER SIDE
I, the undersigned, hereby certify that the Percolation tests reported on this form wer3 made by me
or under by supe;Jision in accord with the procedures Sld method sp8cified in Cr:lpter H 62.20 (3),
i
Wisconsin Adsinistr.tive Code, and thas the data rcoorded and location of test, holes are correct to
the best of my knowledge and belief,
NA TITLE
{ (Type or Print)
a
f
REGISTIMION NO, or tLASTE4 PL i_3E LICENSE No,
ADDRESS
~ DATE SIGN;:TU-s.
i
MASTER PLUi13~R n;,KiNG APPLICATION
Sigtnature. License `numbers rip
1',P RSW -2
(To be Completed by Issuing Agent)
Date of Application C'' Fee Paid
Permit Issued (date) Permit Number
i
Agent (name) For(_''-{-1 (l
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 will forrxard 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 DEPAFMIENT USE ONLY
DATE RECEIVED -7D ACCEPTED BY /'o' - RETURNED _
/ (Initials) (Date) (See /Corres,)
FEE RECEIVED L/ VALID. NO. PE,%M T NO.
(Yes or No)
REVIEWED BY APPROVED _ DATE
(Initials) (Yes or No)
COM,ENTS: