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Parcel 030-1080-10-000 05/23/2007 08:26 AM
PAGE 1 OF 1
Alt. Parcel 28.30.19.290D 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 - COLLINS, PATRICK J & L J MCNELLIS
PATRICK J & L J MCNELLIS COLLINS
1309 53RD ST
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 1309 53RD ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 0.650 Plat: N/A-NOT AVAILABLE
SEC 28 T30N R19W PT OF GL 3 COM 1071.2FT Block/Condo Bldg:
W OF NE COR, S 388.43 FT, SWLY DEFL >
11 DEG 132 FT TO POB: CONT SWLY 132 FT, W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
216 FT MOL TO LK NLY ON LK TO PT W OF 28-30N-19W
POB, E TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
11/05/1999 613386 1468/572 WD
07/23/1997 918/523
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.650 113,000 103,800 216,800 NO
Totals for 2007:
General Property 0.650 113,000 103,800 216,800
Woodland 0.000 0 0
Totals for 2006:
General Property 0.650 113,000 103,800 216,8000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 114
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1
Wisconsin Del>srtment of Health and Social Services
I P'-b. n'•;T 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
i
TYPT or USE BLACK INK
ri-
A. amme OF PROPERTY
Name Address (Street, City, 41p Code)
N 7 ~ _
/LC
R-t
-
B. LOCATION OF PROPERTY WHERE SYS;:.,*S WILL 3E CONSTRUCTED, ALTERED OR EXTENDED COUNTY
III
Check One:
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP/
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY 1'f'Gallons NEW INSTALLATION REPLACE"ENT _Z,._ ADDITION
MATERIALS: Prefab Concrete y Poured in Place Stew Other
NUMBER OF TANKS TO BE INSTALLED`:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence / Coamercial Industrial Other
~q (Specify)
Number of persons to be Accommodated Number of Bedrooms 21
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automata, Clothes Washer YES NO
Dishwasher YES f NO Automatic Potato Peeler YES ,Y NO
other (Specify)
G. MASTER PLUMBER MAKING INSTALLATION
Name: Address: <;7f License Number:
E
MP
Signature of Applicant MP RSW
Address ' ~Cf/~':(
H. (To be Completed by Issuing Agent)
Date of Application %4 ~ Fee Paid $
Permit Issued (date)- Permit Number
Agent (Name) For: Li.,ii
Town, Village, City, County, etc.
(Specify)
Note: The application canno' be considered for filing until all of the above questions are answered and the
I fee paid. Agents will fo m and application, the fee of $1,Ou for each septio tank and the third copy
{ of the permit (canary) 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
1. DATE RECEIVED ` 76 ACCEPTED BY \rl j- RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED ` VALID. No. - PERMIT NO.
es or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No)
COMPLETE O`PWR SIDE
E
SEPTIC TANK PERMIT NO.
J/
R Z P 0 R T O N S O I L P I R C O 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
DIYISICN OF HEALTH - PLUMBING SRCTI~N
P.O.Box Z09, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P S R C 0 L A T I 0 N T T S T
Test Depth Character of Soil Hours Water Test Time Drop Water Level Inches mutes
Number Inches Thickness in Inohes Since Hole in Hole Interval Second to Next to Last LO
Fall
let Wetted Overnight in Minutes Last Period Last Period Period o.
Inch
Exsmpls
P - 0 3611 To Soil 10" Cla 26" 25 Yes or No 30 1 2 1 2 1/2 60
P s%
RECORD DATA FROM MINIMUM OF 3 TEST 'MOLES
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- Minimum 36" Bela: Pro osed Absa Lion S st."
Boring Total Depth De th to Ground Water Depth to Bedroc%
Number Inohoa Cbserved Estirr_ated Observed Estim%ted Character of Soil with Thiokness in Inches
Example
B - 0 72" 72" Black To Soil 12"• Clay 011; Sand 18"• Gravel 24"
2 7
r r_ .
RECORD DATA FROM MINIMUM OF 3 BORZ HOLES
3 PE OF OCCUPANCY:
RESIDENCE: Number of Bedrooms OTHER: (Speoify) V Number of Persons
FOOD WASTE GRINDER: Yes Ago ~ Dish"asher: Yes No . Automatic Clothes Washer: Yes A N-EFFLUENT DISPOSAL SYSTEM: 4W EXTENSION ADDITION REPLACEMENT
Tile Size NO.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pit: Inside Diaaater Liquid Depth _ '
I, the undersi3ned, hereby certify that the percolation tests reporter on tnis fora were made by me or under ,y super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and
that the data reoorded and location of test holes are oorrect to the best of any knowledge and belief.
NAME TITLE
Type or Print
REGISTRATION NO. _ or MASTER PLUMBER LICENSE NO. ADDRESS k F Z IC / .1
DATE SIGNATURE r T I-)