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Parcel 002-1041-90-100 03/29/2007 03:21
PAGE 1 OF 1
F 1
Alt. Parcel 18.29.16.272B 002 - TOWN OF BALDWIN
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 - HESSELINK, LARRY J & GERALD H
LARRY J & GERALD H HESSELINK
1947 190TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 948 220TH ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE
SEC 18 T29N R16W NE SE 2 AC COM NE COR Block/Condo Bldg:
SEC 18, S 335' TO POB, S 326', W 267', N
326', E 267'-POB Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
18-29N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/28/2004 783552 2722/089 QC
12/28/2004 783551 2722/086 TI
10/25/2004 777846 2681/403 PR
07/23/1997 752/632
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 25,100 163,200 188,300 NO
Totals for 2007:
General Property 2.000 25,100 163,200 188,300
Woodland 0.000 0 0
Totals for 2006:
General Property 2.000 25,100 163,200 188,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 09/16/2005 Batch 05-15
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Health and Social Services
Plb. #67 10/69 Division of Health
PERAIT APPLICATION
for
PRIVATE DOMESTIC SEWAGE SYSTEMS
Z-11
A. OWNER OF PROPERTY TYPE OR USE BLACK INK
Name AC « Address (Street, City, Zip Code)
County
B. LOCATION OF PROPERTY WK RE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDET)
Check One: t~- yJ f~ .S [
CITY VILLAGE LEGAL DESCRIPTION: f!
y_ TOWNSHIP
C. IS LOCAL PEPMITY REQUIRED FOR THIS WORK? YES NO PERMIT NUMER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NIYJER OF TANKS TO BE I1(STALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence_ Commercial Industrial Other
(Specify)
Number of Persons to be Accommodated 1Z~ Number of Bedrooms
F. AP?LIANCES, ETCs Food Waste Grinder YES X NO Automatic Clothes Washer k YES NO
Dishwasher _YES NO Automatic Potato Peeler YES >c~_ NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW Y. EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet C'i?` Trench Width ,Depth Number of Lines
Seepage Beds Length Width Depth Tile Size No. Lines
Seepage Pits Inside diameter Liquid Depth --C
1;3 c', a 1r- -4`-
P £ R C 0 L A T I 0 N T E S T
Test Depth p Character of Soil Hours Water Test Time Drop in Water Level Inches linutes
Number ,,Inches Thickness in Inches Since Hole in Hole lInte^val Second to Next to 11 iT t ro Fall
lst Wetted Overnight (in Minutes Last Period, Last Period Period, One Inch
Example
P- 0 36" To Soil Clay 26" 25 es or no 30 1/2 1/2 112 60
41
P_O'OIFID DATA FROM M-L^II :UM OF 3 TEST HOLES
I
Compute size of absorption are in accord with H 62.20 Wis. Administr tive Code.
I
S O I L BORINGS - Minimum 36" Below ?rooosed Abso. tion System
_
Boring Total Depth Depth to Ground Water Depth to Bedrock
umber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches
Xample
- 0 72" 72" Blaok To S21112"; Cla 18"• Sand 18"• Gravel 24"
1-
/1
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
COMPLETE OPHER SIDE
7thebest rsigned, hereby certify that the percolation tests reported on this form were made by me
supervision in accord with the procedures and method specified in Chapter H 62.20 (3)s
dministrative Code, and that the data recorded and location of test holes are correct to
my knowledge and belief.
NAME 1j7 R3 '7ii ~/r i) = R ~f r_ TITLE r
(Type or Print)
REGISTRATION NO. or MASTER PLUMBER LICENSE No.
ADDRESS
DATE rY /`T alt SIGNATURE
MASTER PL1,11aE2 MAKING APPLICATION MP
- - License Number:
Signature: MP RSW ~A
(To be Completed by Issuing Agent)
Date of Application Fee Paid
Permit Issubd (date Permit Number
Agent (name). For: 1
Town, Village, City County etc.
(Specify)
Notes 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 $10.00 and Copy (b) of the
Permit (yellow copy) 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
DATE RECEIVED TFPTED BY RETURNED
(Initials) (Date) See Corres.)
VALID. NO. J C PERMIT NO. ~
FEE RECEIVED
(Yes or i7o)
REVIE:4ED BY APPROVED DATE -
(Initials) (Yes or No)
C=iENTS :