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Parcel 030-1009-70-000 12/11/2006 10:43 AM
PAGE 1 OF 1
Alt. Parcel 03.29.19.47B 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
JEFFREY M & MICHELE A GRATZ O -GRATZ, JEFFREY M & MICHELE A
1173 CTY RD I
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1173 CTY RD I
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.640 Plat: N/A-NOT AVAILABLE
SEC 3 T29N R19W PT SE NW COM NW COR SW Block/Condo Bldg:
NW, TH E 2426.2 FT TO ELY LN HWY "I",
THE POB: TH E 213.8 FT, TH S 485.1 FT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
NLY LN HWY "I", NWLY ALG HWY 569 FT TO 03-29N-19W
POB EXC HWY PROJ 8939-03-00 (0.162AC)
Notes: Parcel History:
Date Doc # Vol/Page Type
01/12/1999 595504 1394/544 WD
07/23/1997 1223/516 WD
07/23/1997 456/485
2006 SUMMARY Bill Fair Market Value: Assessed with:
168535 222,300
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.640 63,400 129,500 192,900 NO
Totals for 2006:
General Property 1.640 63,400 129,500 192,900
Woodland 0.000 0 0
Totals for 2005:
General Property 1.640 63,400 129,500 192,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 110
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisoonsin Department 'or Health and Social Servieos
P1'0- 167 3/70 Division of Health `
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK V(/ 7~ 70 j / C
A. OWNER OF PROPERTY
Name Address (Street, City, Zip Code)
B. LOCATION OF PROPERTY WRi.RE SYSTEM WILL BE CONSTRUCTED. ALTERED OR EXTENDED COUNTY v'✓
Check One:
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO (J PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACE~-TNT ADDITION
MATERIALS: Prefab Concrete y Poured in Place Steel Other
NUMBER OF TANKS PO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two eamily 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 e YES o NO Automatic Potato Peeler YES NO
Other (Specify)
G. MAST%R PLU-3 ER MAKING INSTALLATION
ber:
Name: - f , * a Address f.' License Nu
Signature of Applioant: MP RSW
Address;
H. (To be Completed by Issuing Agent)
Date of Application Fee Paid
Permit Issued (date)- Permit Number
Agent (Name)'%? For:
Town, Village, City, County, etc.
(Specify)
Note: The application cannot oe considered for filing until all of the above questions are answered and the
fee paid. Agents will forward application, the fee of $1.00 for each septic tanx and the third copy
of the permit (canary) to the Division of Health. Checks ark money orders should be made payable tc
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED !U - ' - ACCEPTED BY 1J RETURNED
(Initials) _ (Date) SSf} Corres.)
r FEE RECEIVED VALID. No. J) 1 7 PERMIT NO. 7 / Q
(Yes or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
l
j SEPTIC TANK PERMIT NO. C /
R= P O R T O N S O I L P I R C 0 L A T I 0 N T E S T
A N D S O I L B O R I N G S
TO
DIVISION OF HEALTH - PUtMING SECTI&
P.O.Bcx 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P S R C 0 L A T I 0 N T E S T
Test Depth Cnaract.r o' Soil Hours Water Test Time Drop in Water Level Inohes KLnutes
Number Inohas Thickness in Inches Since Hole in Hole Interval Second to Ne- to Last To Fall
1st Wetted Overnight in Minutes Last Period Last Period Period Cna Inch
Example
P - 0 36" To Soil 1011, Clay 26" 25 Yes or No 30 1 2 1 2 112 60
" J,
RECORD DATA FROM MINII'!U,'S 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- Mini== 3611 Belex Proposed Absorption Systozt
Boring Total Dopth Depth to Ground i~,ater Depth to Bedrock
Number Inohss Cbservod Esti'~ztad Observed Estimated Character of Soil with Thio!rness in Inohas
ExaztpIa
B - 0 7214 72" Black To Soii 121• Clay L8111 Sand 18"• Gravel 24"
17
RECORD DATA FROM MINLMIR? 0? 3 BORE HOI.£S
YPE OF OCCUPANCYs
RESIDINCBt Number of Bedrooms OiH R t (Specify) Number of Peraons
FOOD WASTE GRINDFRt Yea 1 Yo Dishwashers Yes No Autoratic Clothes Washar: Yes No
EFFLUENT DISPOSAL SYSTEM: NEW ' EXTENSION ADDITION REFLACiMENT
Tile Size ~t r NO.Lin.Feet Trenoh Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
t,` Seepage Pits Inside Diameter, 9 Liquid Depth
Is the undersigned, hereby certify that the percolation tests reported on this fora were made by me or under my super-
vision in accord with the proce~'ures and method specified 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 may knowledge and belief.
NAME TITLE Ci1i7~I~~ 7
Type or Print
REGISTRATION NO. or MASTER PLUMBER LICENSE NO.
ADDRESS __119 DATE J 7 1 7 S IGNATURE