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Parcel 030-2055-40-000 06/14/2007 11:41 AM
PAGE 1 OF 1
Alt. Parcel 27.30.20.545A 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 - TEED, DEBORAH K REISINGER -
DEBORAH K REISINGER - TEED
1362 STATE ST
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1362 STATE ST
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.300 Plat: 2111-HOULTON
SEC 27 T30N R20W S 88 FT OF LOT 1 BILK 5 Block/Condo Bldg: 5 LOT 1
& N 10 FT LOT 2 BLK 5 VIL HOULTON
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1076/184 QC
07/23/1997 733/333
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 0.300 50,000 61,500 111,500 NO
Totals for 2007:
General Property 0.300 50,000 61,500 111,500
Woodland 0.000 0 0
Totals for 2006:
General Property 0.300 50,000 61,500 111,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 127
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wiscon3in Department' or Health and Social Services
Falb, X57 3170 Division of Health
SEPTIC TANK PERMIT APPLICATION
T'M or USE BLACK INK
A. MIER OF PROPERTY
Name Address (Street, City, Zip Coda)
P, LOCATION OF PROPERTY Nf-.F.E SYSTR'M WILL BE CONSTRUCTED, ALTERED OR EXTENTED COUNTY
Check One:
CITY LLAGE LEGAL DsSCRIPTIO,N /J Vic- 2-'7 . 3Cp, Ze.
Tot..
S ST ` rbf~fl
C. IS LOCAL PEP1i FOR THIS WORK? - YES NO PERMIT YUI'B%F'
D. SEPTIC TANK CAPACITY 1 O D O Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE I4STALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence f Co=ercial Industrial Other
Specify)
Number of Persons to be Accommodated ✓ Number of Bedrooms
F. APPLIANLES, ETC: Food Taste Grinder YES NO Automatic Clothes Washer /rte ._S NO
Dist4vasher YES A _ NO Automatic Potato Peeler Yis_~ NO
Other (Specify)
G. MASTIR PLliU(3ER tIAKING I\STAL TION
jfV, :fame: ~11~;'~.i~ Address: 1-~~i j _ Lieenso Naz!)ers I
C
Signature of Yu' RSW
Address: r/"
H. (To be Completed by Issuing Agent)
Date of Application z) Fee Paid $
Permit Issued (dale) Permit Number
Agent (Nam a) For; L' t!2
Town, Village, City, County, etc.
(Specify)
Notet The application cannot be considered for filing until all of the above questions are answered and the
fee paid. Agents will for-ward application, the fee of $I.Ou for each septic tanK and the third copy
of the permit (canary) to the Division of Health. Checks and ncney orders should be made payable to
the Division of Health.
Do not write in space below - FOR DEPARTMii;l USE ONLY
i hJ
1. DATE RECEIVED 111A0 ACCEPTED BY 0 1 RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED VALID. No. J ~ PERMIT NO.
es or No
REVIEdED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
C
SLriIL TANK PL:RniT NO.
R E P O R T O N S O 1 L P E R C O L A I I O X T E S T
A N D S O I L B O R I N G"
TO
DIVISION OF HEALTH - PLUMING SECTI N
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P X R C 0 L A T I 0 N T E S T
rTest Depth Character of Soil Hours Watery Test Time DIJo~in "ter Level Inches ~T~-o ru;ds
Number Inches Thie~e33 in Inches Since Hole in hole Inte,-~val Second last Fall
1st Jetted Overni kt in 'iinu.es Last Perod Period ne, Inna'^_
Example
P - 0 36" Top Soil 10", C1?.y 26" 25Yes or No 30 I 1~2 1/2~ I 1/2 60 _
o' _01
~Lj
RECORD DATA FROM MLN PUM OF 3 T -ST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Coda.
S O I L B 0 R I N G S- Min^ 3611 Belvw Prc_~- Absorption Sys-
Boring Total Depth Depth to Ground Water Depth to Hadrock I
Number Inonos Cb3w,va; Es-tira.tsd Observed Esti..-Ated Character of Soil with Thickness in Inches
Exaaple
B - 0 721# 72" Black Top Soii 12"; Clay i8" -Sand 18"; 21+"
~2_ It
70
REC?RD DATA FROM MINLwbDI C° 3 BOPS HC ,vS~
TYPE OF OCCUPANCY:
RESID 07CEi Nu=ber of Badrocaas OTRLZR: (Specify) Number of Persons
D WASTE GRINDER: Yes I«a Dis"wash3r: Yes No Autona.tic Clothes Washer; Yes No
FFLJJENT DISPOSAL SYSTe~'ii: NW EXTENSION ADDITION REPLA.CLMENT
i
Tile Size No.Lin.Feet l/at~ Trench Width_ Depth Number of Lines
Seepage Beds Length Width Depth Tile Size _ No. Lines
Seepage Pits Inside Diameter Liquid Depth .j
I, the undersigned, hereby certify that the perooiation tests reported in this form were made by me or under l.super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Adainistrativs Code, and
that the data recorded and location of test hole3 are correct to the beat of q, kanowledge and belief.
NA - A U"qp- l-) TITLE G1 ~iL7ct
Type or Print
REGISTRATION NO. or MASTER PUMI ER LICENSE NO.
ADDRESS tJ z6C///:7/-
DATE D D SIGNATURE l
I
Parcel 030-2069-90-000 06/14/2007 11:28 AM
PAGE 1 OF 1
Alt. Parcel 36.30.20.611C 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 - PETRUCELLE, NICKLAUS M
NICKLAUS M PETRUCELLE I
1302 27TH ST d ~jU~ 0~ • l 6~~
HUDSON WI 54016 /3(` 2-
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1302 27TH ST S 0 d U/~ ~T
SC 211 HU
SP 1700 WITC ON a4 /4'L
Legal Description: Acres: 2.770 Plat: N/A-NOT AVAILABLE
SEC 36 T30N R20W NW NE COM N 1/4 COR SEC Block/Condo Bldg:
36, TH E 1247.3 FT TO CEN TN RD, TH S 66
FT TO POB: W 570 FT, S 231 FT, E TO CEN Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TN RD, NELY ON CL TO POB EZ-1-1162/329 36-30N-20W
Notes: Parcel History: A
Date Doc # Vol/Page ~G Vl~Type
06/30/2005 798974 2833/123/ WD
07/23/1997 7L~04
07/23/1997 4867!~) M I
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 2.770 86,800 104,000 190.800 NO
Totals for 2007:
General Property 2.770 86,800 104,000 190,800
Woodland 0.000 0 0
Totals for 2006:
General Property 2.770 86,800 104,000 190,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 115
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00