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Parcel 030-2067-20-000 05/24/2007 02:31 PM
PAGE 1 OF 1
Alt. Parcel 35.30.20.609H 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 - MACDONALD, ELIZABETH A
ELIZABETH A MACDONALD
PO BOX 72
STILLWATER MN 55082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 175 RIVERVIEW ACRS RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.520 Plat: N/A-NOT AVAILABLE
SEC 35 T30N R20W PT GL 4 COM SE COR SEC Block/Condo Bldg:
35, TH N 1034.68 FT, W 939.5 FT TO POB:
N 83DEG W 145 FT, TH S 54DEG W 251.24 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT, S 61 DEG W 316.21 FT TO LK, SELY ALG 35-30N-20W
SHORE 100 FT, TH N 64DEG E 316.58 FT, TH
N 52DEG E 333.55 FT TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
09/27/2005 807667 2897/021 TI
07/23/1997 462/196
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 1.520 220,000 125,900 345,900 NO
Totals for 2007:
General Property 1.520 220,000 125,900 345,900
Woodland 0.000 0 0
Totals for 2006:
General Property 1.520 220,000 125,900 345,900
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
Wisconsin Der,-rtnent of Health and Sooip.l Services
PIU, 1167 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. 0,114ER OF PROPERTY
(e Address (Street, City, Zip Code)`
Name
4a ki
'l jib f
B, LOCATION OF PROPERTY Wlt:RE SYSTEM WILL BE CONSTRUCTED. ALTFRPIjb OR EXTENDED COUNTY
Check One: G~✓~y
CITY _ VILLAGE LEGAL DESCRIPTION
TOWNSHIP
C. IS LOCAL PF.P.I•IIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE NSTALLZDt 7
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence / Commercial Industrial other
- Specify)
Number of Persons to be l,ocomaiodated Number of Bedrooms
YES NO Automatic Clothes Washer r YES NO
F. APPLIANCES, ETC: Food Waste Grinder
Disluasher C YES NO Automatic Potato Peeler YES Y NO
Other (Specify)
G. MASTER PLI`3ER t;AKING'INSTALLATION
Name: `,k-,,, ~ Address: ✓'j License !lumbers
Signature of Applicant: MP RSW
Address:
H. (To be Completed by issuing Agent)
Date of Application Fee Paid
Permit Issued (date) 'i Permit Number /
Agent (Name) Fori ~ i._. •f f.
Town, Village, City, County, etc.
(Specify)
Note: The application cannot be considered for filing until all of the above cu-stions are answered and the
fee paid. Agents wi.. fortard application, the fee of $i.0u "or each septic taruc and the third copy
of the permit (canary) to the Division of Health. Checks and money orders should be wade payable to
the Division of Health.
Do net write in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) See rj'rce5~
FEE RECEIVED VALID. No. PERMIT NO. N
!Yes or No
REVIE'w:,'D BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
+ SEPTIC TANK 11M'Irii NO.
R E P O R T O N S O I L P E R C 0 L A 7 I 0 N T E S T
A N D O I L B O R I N G S
TO
DIYISICU OF F?F.ALTH e PLU-Ialts SnCTIN
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrativs Code
PERC0L1,TI ON TFST
Teat Depth Ch9ract +r of Soil }iow s Water Past Time Drop in i:'~teryl,evel_ Inches •Iinute:
Number Inches Thickness in Inches Since Hole in }dole Lntorval Second to Next to Last To Fall
1st Wettcd OVeriiL" t in Minutes Last Poriod Last Period Period On- Inch
Example
P ' 0 36" To Soil 10" C1.~'x 26 25. Yes or No 30 1 2 1 2 1/2 60
RECORD DATA FROM MINIPTLTI OF 3 TEST HOLES
Compute size of absorption erza in accord with H 62.20 Wis. Administrative Coda.
S O I L B O R I N G S- Mini--nim 36" Belo-ii Pro osed Absorption Systsm
Boring Total Dopth Depth to round Water Popth to Bedrock
Number Inches Observod VEstim'~.tad Observed Estimated Character of Soil with Thiokness in Inchon
Vvuap1e
B - 0 72" 72" Black Top Soil 12"; Cl, 1611; Sand 1811; Gravel 2411
RECORD DATA FROM MIYL"IIU OF 3 BORE HOLFS
YPE OF OCCUPANCY:
RESIDENCEt Number of Bedrooms OTH R: (Specify) Number of Persons •
ROOD WASTE GRL14DERt Yes No Dislmasher: Yes Y No Automatic Clothes Washer: Yes K No
FFUJENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REFLAC:121FNT
Tile Size No.Lin.Feot Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pitt Inside Diameter r Liquid Dept~t ! ~A
I, the undersigned, hereby eertily that the percolation tests reported of this form were made by me or under my super-
vision in acoord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Ad:-ainistrative Code, and
that the data recorded and location of test holes are correct to the best of wy knowledge and belief.
NAME TITLE f (1 j t : i
Typo or Print}
REGISTRATION NO. or MASTER PLUMER LICENSE NO.
ADDRESS / ~DATE / !a SIGNATURE V v~ C it
jq~