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Parcel 020-1094-80-000 03/19/2007 01:37 PM
PAGE 1 OF 1
Alt. Parcel 33.29.19.386B 020 - TOWN OF HUDSON
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 - BAST, KERNON J
KERNON J BAST
948 LABARGE RD
HUDSON WI 54016-7710
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.500 Plat: N/A-NOT AVAILABLE
SEC 33 T29N R19W FRL NE NE OLD HWY SHOP Block/Condo Bldg:
EXC PT TO HWY PROJ 1022-02-21
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/31 /2001 655345 1710/602 WD
08/18/1998 585238 1349/169 WD
07/23/1997 1194/463 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 2.500 293,700 82,400 376,100 NO
Totals for 2007:
General Property 2.500 293,700 82,400 376,100
Woodland 0.000 0 0
Totals for 2006:
General Property 2.500 293,700 82,400 376,100
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
V
Plb 60
NAME OF BUSINESS
LOCATION ` T 1_)ia_6.s .5L~
street or highway city or township county
LEGAL DESCRIPTION
1 ~
OWNER C, I X t'_ l) f U f - 1-114 1;-i
Mailing address ?/i/!~ 1 ZIPS
ARCHITECT OR ENGINEER Address
ZIP
/ ,
PLUMBER Address 11/
ZIP S-
1. Check appropriate building usage(s) and fill in the information requested opposite each usage listedt
Existing building New building Addition
If addition to existing building attach detailed memo for each.
( ) Drive in restaurant . . . . . Car spaces
( } Restaurant . a . e . e . . Seating o&pacity 10 sq. ft./person)
( ) Dining hall . . Per meal served Toilet waste Yes No
( ) Motel ( ) Hotel ( ) Cottages e . . Number of unites 2 persons/unit 4 persons unit
TOTAL NUMBER OF UNITS
( ) Churches . . Number of persons Kitchen Yes No
( ) Bar or cocktail lounge . . Seating capacity (10 sq, ft./person)
( ) Nursing or rest home . . . . Number of beds
( ) Mobile home park e . e . Number of units - dependent (Gamper trailer)
- nondependent (mobile home)
( ) Retail store e . . Number of employees Number of customers (10 sq. ft./person)
( ) Service station . . . Number of oars served daily)
( ) School . . . Number of classrooms Meals served Yes No
Showers provided Yes No
( ) Factory or office building . . Number of persons (total all shifts-
( } Residence . . e . e . . . . Number of bedrooms
( ) Apartments . . . . . . . . . , Number of bedrooms
77-
(X) Other . . Specify
2. Indicate whether or not the following facilities are oonnectedt Food waste grinder . . . . . Yea No
Dishwasher . . . . . . . . . Yes No
Automatic clothes washer Yes No
3. Fill in the appropriate information for the following as indicateds
Septic tank capacity planned TOTAL Septic tank capacity required
Percolation test results • ATTACH PERCOLATION TEST REPORT SHEET
Seepage trench bottom area planned width linear feet depth
Seepage bed area planned width linear feet depth
Seepage pit planned outside diameter l depth below inlet depth
Seepage trench bottom area required width linear feet depth
Seepage bed area required width linear feet depth
~ f outside diameter i§5:7, i depth below inlet
Seepage pit required
Signature of person completing forms STATE DIVISION OF HEALTH, PLUMBING SECTION
P. 0. Box 309, Madison, Wisconsin 53701
Address: 6) f ~7 Approved:
ZIP
Date t ~ 'Data s
a'
THIS APPROVAL IS BASED ON STATE PLUMBING
CODE REQUIREMENTS AND DOES NOT EXEMPT THE
INSTALLATION FROM CITY, VILLAGE, TOWN-
SHIP OR COUNTY 'REGULATIONS OR PEiCIT
(OVER) REQUIREMENTS.
INFORMATION REQUIRED FOR SUBMISSION OF PLANS ,
1. Legal description of property on which septic tank and effluent disposal system
is to be installed.
2. Percolation test data from a minimum of three test holes. Tests are to be conducted
in the area and to the depth of the proposed effluent absorption system. Where ground
water and/or bedrock conditions exist, the vertical depth from grade level to same shall
be indicated.
3. A detailed plan of the proposed installation specifying the location of the building
served, size and design of septic tank, effluent absorption system with location and
numerical identification of percolation test holes.
4. Indicate on plan lateral distances between septic tank effluent disposal system and
building, well and lot lines.
5. Include complete data on expected use of the building. See Section H 62.20.
O A K 0 R S T R EA M 5 G
~3
. p#,
S P A G E X50
0
THE NCH I z
75' S
S - P A G BED\
25 ~o0 25
VV ELL
J L T
II--6---a BLDG.
i 31 6, 4 F`79
~ot
looo
GAL
50~ 25~
m, 5 0 is 5
WELL SE E P G E I TS
P P
LOT LI NE
O'-- P ■ Peroolation test hole
SAMPLE PLAN DEPICTING SEEPAGE TRENCH, SEEPAGE BED AND SEEPAGE PIT
Plb.'#43 SEPTIC TANK PERMIT NO.
R E P O R T O N S O I L P E R C O L A T I O N T E S T
A N D S O I L B 0 R I N G S
TO
DIVISION OF HEALTH - PWMBING SECTION
P.O.Box 309, Madison, Wis. 53701
Pursuant to HH 62.20, Wis. Administrative Code
NAMQ\-) J PROPERTY ADDRESS
LOCATION (Check One) City Village Toren ' county
City or Township
WATER SUPPLY FROMs Public Utility Cooperative Private Well v
SEWAGE DISPOSAL INSTALLED BYs i # L l Q~ress k; 1 Date
SEPTIC TANK SIZE d Material
D Percolation & Soil Borings Test Date
EFFLUENT DISP.t Tile Size No. Lin. Ft. Trench Width Depth of Tile
Seepage Beds Length Width Depth of Tile
Seepage Pits Outside Diameter % Liquid Depth
TYPE OF OCCUPANCYt RESIDENCE: Number of Bedrooms OTHER: (specify)" r7, ~ X~~lt.2 Number of Persons
FOOD WASTE GRINDER: Yes - No x Dishwashers Yea No -41 Automatic Clothes Washer: Yes No
P E R C 0LATI ON TEST
Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches Minutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall
lst Wetted overnight, in Minutes Lest Period Last Period Period One Inch
Example
P- 0 3611 To Soil 1011, C18. 261, 25 es or no 30 1 2 1 2 2 60
s.
RECORD DATA FROM MINIMUM 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- Minimum 36"Below Propose d Absorption S atom
Test Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Soil with Thioknasa in Inches
Example
B- 0 72" 72" Bla Vo Soil 12" Clay 18E' Send 18N Gravel 241,
i,
i
RECORD DATA FROM MINIMUM OF 3 TEST HOLES
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
NAME I fa / f ! L19 TITLE l / a~1f
Type or Print)
REGISTRATION NO. or MASTER PLUMBER LICENSE NO.
ADDRESS
DATE l~ ~ay ; SIGNATURE
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