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Parcel 030-2051-20-000 05/23/2007 08:58 AM
PAGE 1 OF 1
Alt. Parcel 27.30.20.516B 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 - JOHNSTON, WILLIAM G & JENNIFER L
WILLIAM G & JENNIFER L JOHNSTON
193 ANDERSEN SC'T CP RD
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 38 CTY RD E
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.920 Plat: N/A-NOT AVAILABLE
SEC 27 T30N R20W PT LOTS 1 & 2 OF BLK 1 Block/Condo Bldg:
VIL HOULTON COM NE COR LOT 3 TH W 296 FT
TO POB: TH S 12 DEG E 79.8 FT, TH S 39 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG E 101 FT TO CL RD, S 52 DEG W 226.7 27-30N-20W
FT N 293.2 FT TO N LN TH E 99 FT TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1180/439 WD
07/23/1997 464/346
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.920 50,000 74,000 124,000 NO
Totals for 2007:
General Property 0.920 50,000 74,000 124,000
Woodland 0.000 0 0
Totals for 2006:
General Property 0.920 50,000 74,000 124,000
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
r Wisconsin Department of Health and Social Servloes
p1b. #67 10/69 Division of Health
PEPMIT APPLICAT1-N
for
PRIVATE D0,"IESTIC SEWAGE SYSTEMS
13
0WNER OF PROPERPY TYPE CR USE BLACK INK
A. =Address (Streets City Zip Code)
Name County
D4D / -
B. LOCATION OF PROPERTY WHER . SYST WILL. BE CONS T R'JC'TED, AL D OR. EXTENDED
Check One:
LEGAL DESC RIPTIGN t
CITY VILLAGE / ✓l '
TOWNSHIP •~-7• 3"i GCS
C. IS LOCAL PEr34IT REQUIRED FOR THIS hO'X? L_ YES NO - PER"IT NLZER
D. SEPTIC TANK CAPACITY Gallons dEW T`iS T AL? ATION RE?LACE'E'T L ADDITION
I " t
MATERIALS: Prefab Conor--,te Loured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence C~ Commercial Industrial Other
Specify _
Number of Persons to be Accommodated 57 Number of Bedrooms
0 Automatic Clothes Washer ~ YcS NO
F. AP,,LIA?ICES, ETCs Food Waste Grinder Y S
Dis crasher YES_ NO Automatic Potato Peeler YES 10
other (Specify)
G. EFFLUEN^1 DISPOSAL SYSTEM NV EXTENSION ADDITION REPLACE,[ENT
Tile Size PIo.Lin.Feet Tile Width Depth Number of Lines
Seepage Beds La-:h Width Depth -Tile Size No. Lines
Seepage Pit: Inside dia.-nater Liquid Depth
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours Mater Test Time Drop in Water Level Inches Minutes
Number Inches Thickness in Inches Since Hole in Ho1• Interval Second to Next to Last To Fall
1st Wetted Overni It in Mi-rotes Last Period Last Perio Period One inch
E=nple
P- 0 36° To Soil 10" Cla• 26" 25 ` es or no E 30 1/2 1/2 1/2 60 II
RECORD DATA FROM ,,MINIMUM OF 3 TEST h0l,~'S
ompute size of absorption arch in acoord with H 62.20 xis. Adn inistr°.tive Code.
-i
S O I L B 0 R I N G S- Minimum 36" Below Proposed Abso. tion System
bring Total Depth Depth to around '.later Depth to Bedrock ,
umber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches
xample
- 0 721' 72" Blaok To Soil 1211• Clay 18"• Sand 'le"- Gravel 24"
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
a
t
k
I, the undersi,,med, hereby certify that the percolation tests reported on this form were made by me
r
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 oorrect to
the best of my knowledge and belief.
NAi~ l-tT-:.~:Z -Z" Z~vt^-mil TITLE U w ~t''L i
i
(Type or Print} ~
_ S t
PLUi3ER LICENSE No.
REGISTRATION NO. ~tS S / or MASTER
ADDRESS
ZU i
DATE ~L~ f 7 O SIGNATURE L~l c
7
7
1
MASTER PLUi'B-W-R Nu:KING APPLICATION
Signature: t~~+ll~~ZtJ License Number:
MP RSW
(To be Completed by Issuing Agent)
A location / I A, G^ Fee Paid $ /1-0
Date of pp
Permit Issued (date Permit N/umlber~
Agent (name)I,/ For1 / I "
Tosco, 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 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.
E
Do not write in space below - FOR DEPAxP:ENT USE ONLY
DATE RECEIVED 70 ` ACCEPTED BY RETURNED
(Initials) ll (Date) See Corres.
FEE RECEIVED ✓ VALID. NO. 3 U PERMIT NO.
(Yes or No)
i
REVIEWED BY APPROVED DATE
(Initials) (Yes or No)
COMMENTS: