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C C 07 Z (D ~ A N (n < T> O_ D 10- Q O Q p r n Ti O (nD I[J c rn Z a : O n Iv O Q O y ti S ~ A 7° ~C O ~ N Z O n. 6 N O C ~ (v S ~ N .:.1 7 a ~D y~ N Ef3 C 4 O y a O Q 00,0 00 ,0 00 ,0 lelol se6jeya juanbullaa soBaeya leloadS s;uawssassy leloadS ;unowV ftJo6olea apoo leloadS Jasn :slel3adS M Id 40le9 WOZ/L0b0 :a;ea u0l;e3l;!;a00 0 :;unoa wlela :IIpBJo AJ01101 0 0 000,0 pUelpooM OOL'SZ 0OL'06 000`96 SL6'9£ A:padoad Ieaaua0 :9002 Jo; sle;ol 0 0 000,0 pUelpooM 00L`9Z 00L'06 000'96 9L6'9£ f%:padoad Ieaaua0 :LOOZ a0; sle;ol ON OOL'ZZ 00L`06 000'Z6 000'6 LJ 2]~]H10 ON OOZ 0 ON 000'Z SO 03d0ld]A]C]Nn ON 008'Z 0 009'Z SL6'££ tE) -id~jni~noibAov uoseeN a;els Ie;ol anoadwi pue-1 saaod sselo uol}dlaosaa 9002/L 6/tl0 : paBueya ;set : suo ije n l eA juawssassy anlen asfl :y;lan passessy :anleA 101 MY J!ed Me J1mvwwnS 1002 60Z/HZ L66 6/£Z/LO ads _L abed/lon # 00a ale(] :AJOIslH Iaoaed :sa;oN M9 6-N8Z-OZ (b/6 096 t,/6 Otb 6u~j-umj-oes) :(s);oeij Sa2J M N d0 :Bp18 opuoamool8 Sa?J 9 3 OXd MS MN `dS'6 M9 62J Wi OZ OES 9OVTbnd lON-V/N :3eld 9L6' £ :saaoy :uol;dlaosaa leBa-l HO~IlOA A33~ do dlHO 0060 dS .1EMVA ONI2JdS 9899 OS 8Z6 AMH 66Z uol;dljosaa #;sla adA_L tiewud :(sa)ssaippd AljadoJd leloadS = dS IOOuOS = OS :s;ola;sla LZOb9 IM NOSTM MAMH66Z 1d 13 1 Ntfl?J8 `JNdM - O JNVM -IV lD 1 NVI1 JS JauMO-03luaiino = o '1aumo lua»no = p :(s).iaunnp :ssa.ippv xel 0 00 odA_L 3 wJ9d #;!wJBd # uol;eoliddV eaay sales # deV11 ale(] IeolaoIslH a;ea u0l;eaaa NISNOOSIM '.l1Nnoo XI02i0 ,1S X ;ua.i.ina AGV3 JO NMOl - t,00 `d96£'96'8Z'OZ laoaed III 6 JO 6 39Vd wv Zo 6 6 Looziozi£o 000-05 9tiWti00 I03Jed I Parcel 004-1046-60-000 03/20/2007 11:05 AM PAGE 1 OF 1 Alt. Parcel 20.28.15.316B 004 - TOWN OF CADY 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 - LOREN SON, HELEN HELEN LORENTSON 2823 25TH AVE SPRING VALLEY WI 54767 Districts: SC = School SP = Special Property A dress(es): Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.025 Plat: N/ NOT AVAILABLE SEC 20 T28N R1 5W 2 RODS OF THE Block/Con o Bldg: NORTH 22 RIDS NW1/4 SW1/4 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-28N-15 Notes: Parcel His ry: Date Doc # F7430//266 ge Type 07/23/1997 ~ ~1 07/23/1997 J U , 2007 SUMMARY Bill Fair Market Valu Assessed with: 0 Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.025 35,200 63,700 98,900 NO Totals for 2007: General Property 3.025 35,200 63,700 98,900 Woodland 0.000 0 0 Totals for 2006: General Property 3.025 35,200 63,700 98,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 4/17/2001 Batch 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 Parcel 004-1046-50-000 03/20/2007 11.00 AM PAGE 1 OF 1 Alt. Parcel 20.28.15.316A 004 - TOWN OF CADY 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 - WANG, BRIAN T ET AL BRIAN T ET AL WANG 219 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 219 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 36.975 Plat: N/A-NOT AVAILABLE SEC 20 T28N R1 5W 39.5A NW SW EXC E 8 RIDS Block/Condo Bldg: OF N 10 RIDS Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-28N-15W Notes: Parcel History: Date Doc # (Vol/Pag~ Type 07/23/1997 726/209 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: - Last Changed: 04/17/2006 Description Class Acres Land IM~pTotal State Reason AGRICULTURAL G4 33.975 2,800 0 ~ 2,800 NO UNDEVELOPED G5 2.000 200 0 200 NO OTHER G7 1.000 12,000 Ll 22,700 NO Totals for 2007: General Property 36.975 15,000 10,700 25,700 Woodland 0.000 0 0 Totals for 2006: General Property 36.975 15,000 10,700 25,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 004-1052-50-000 C 03/20/2007 10:59 AM PAGE 1 OF 1 Alt. Parcel 22.28.15.349A 004 - TOWN OF CADY 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 - WANG, BRIAN & GAY C BRIAN & GAY C WANG 219 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ' 219 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 38.100 Plat: N/A-NOT AVAILABLE SEC 22 T28N R15W 38.1A SW SW EXC PART TO Block/Condo Bldg: STATE AS IN 635/93 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 08/27/1999 609396 1452/295 WD 07/23/1997 635/93 03/06/1986 409796 734/016 LC 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: - -Last Changed: 04/18/2006 Description Class Acres Land Qt;~) Total State Reason AGRICULTURAL G4 36.100 4,300 4,300 NO OTHER G7 2.000 24,000 116,600 NO Totals for 2007: General Property 38.100 28,300 92,600 120,900 Woodland 0.000 0 0 Totals for 2006: General Property 38.100 28,300 92,600 120,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 914 Wisoonsin Department of Health Social Services Plb. X67 3/70 Division of Health Nom- / SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. QIWNER OF PROPERTY Name Address (Street, City, Zip Code) i _C B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY ! - - Check Ones CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP T- q, I 4L C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY `Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALSt Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Cheek Ones (One or Two Family Residence Commercial Industrial Other Specify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Name: t~{ _ Addressa License Numbers - Signature of Applicants- MP RSW Addresss H. (To be Completed by Issuing Agent) Date of Application Fee Paid fi { Permit Issued (date) r/ Permit Number Agent (Name) For: Town, 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 $1.00 for each septic tarot and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be :lade payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY RETURNED (Initials) (Date) See Corres.) FEE RECEIVED _ VALID. No. PERMIT N0. es or No REVIEWED BY APPROVED DATE (Initials) Yes or No COMPLETE OTHER SIDE SEPTIC TANK PERMIT NO. REPORT ON SOIL PERCOLATION TEST A N D S O I L B O R I N G S TO DIVISION OF HEALTH - PLUMBING SSCTIdN P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code PERCOLATION TEST Test Depth Character of Soil Hours Water Test Time Drop in Water 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 Last Period Last Period Period Onew Inch Example P - 0 361, To Soil 10N Cla 2610 25 Yes or No 30 1/? 1/2 1/2 60 RECORD DATA FROM MIND= 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 361• Below o posed Absorption System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches Example B - 0 72" 7210 Black To Soil 12" C j8111 Sand 1811• Gravel 241 ) ter;. 117 16 7T RECORD DATA FROM MINIMUM OF 3 BORE HOLES TYPE OF OCCUPANCY: RESIDENCE: Number of Bedrooms OTHERs (Specify) Number of Persons ' FOOD WASTE GRINDERS Yes No Dishwashers Yes No Automatic Clothes Washers Yes No ' FFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Fset Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Diameter Liquid Depth 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 TITLE Type or Print REGISTRATION NO. or MASTER PLUMBER'~CENSE NOr, ADDRESS DATE SIGNATURE