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Parcel 014-1003-80-000 07/03/2007 03:36 PM
PAGE 1 OF 1
Alt. Parcel 2.31.15.22 014 - TOWN OF FOREST
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
CRAIG M & DIANE K PAULSON O - PAULSON, CRAIG M & DIANE K
3021 POLK/ST CROIX RD
CLEAR LAKE WI 54005
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 3021 POLK/ST CROIX RD
SC 1127 CLEAR LAKE
SP 1700 WITC
Legal Description: Acres: 52.010 Plat: N/A-NOT AVAILABLE
SEC 2 T31 N R1 5W NW NW FRL Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-31 N-1 5W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1040/329 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 10/17/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 43.010 5,600 0 5,600 NO
UNDEVELOPED G5 2.000 200 0 200 NO
PRODUCTIVE FORST LANDS G6 5.000 10,000 0 10,000 NO
OTHER G7 2.000 10,000 163,500 173,500 NO
Totals for 2007:
General Property 52.010 25,800 163,500 189,300
Woodland 0.000 0 0
Totals for 2006:
General Property 52.010 25,800 163,500 189,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 106
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
PI'1 fd67 Wisconsin Dap,rt::nant of health and Socir:,1 Services
Division of Health
Pi SIT APPLICATION
S for
PRIVATE Dui'i;;STIC SEWAGE SYSTLTZ
a~ -
A. C4-NER OF PROPERTY TYPE OR USE BLACK INK
'Name [[Address (Streets City, Zip Cjod)
3 B. LOCATION OF PROPERTY Wr^.~ SYS`Prdt 4;IL!. BE CONSTRUC'PEi7, ALT::'FiED OR EXTENDED, County
Check One
CITY _ VILLAGE LEGAL DESCRIPTION:
17-
C. IS LOCAL PErrfIT r:EL'UIRED FOR THIS W01:X? L YES NO
D. SEPTIC TANK CAPACITY Gallons NZW INSTALLATION REPLACr a2,T ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUTTBER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: ri?ne. or No Family Residence ` Cornproial Industrial Other
Specify r--
Number of Persons to be Accommodated
F. APPLIANCES, ETCs Foot: Waste Grinder YES L NO Automatic Clothes Washer YES NO
Dis'-nvasher _ YES NO Autcmatie Potato Peeler YES ~V NO
Other (specify)
G. EFFLT MIT DISPOSAL SYSTEM NEW EXTENSION ADDILICN REPL:CE:T
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Len~-th ? 6 Width 30 Depth Tile Size `f fr No. Lines
Seep-ge Pitt Inside diameter Liquid Depth
P E R C O L A T I O N T E S T
1
Test Deoth Characte^ of Soil HOUrs Water Test Time Drop in Water Level Inches mutes
`umber Inches Thickness in Inches Since Hole I in Hole Inter-,-I St to i Next, to Last To Fall
1st Wetted Over
ni -'nt in M-.rotes LisPeriod ! Last Peric Period Cne L ch
Ey-ample - _ y
P- 0 36" Too Soil 10"'.2 1a 2ti" 25 _ es or no 30 T 1 2 1/2 1 2 60
RECORD DATA FROM MINIMUM OF 3-TEST HDL
omp'rte size of absorption area in accord with H 62.20 Wis. Administrative Code.
i
S O I L B 0 R I N G S- Minimua 36" B®1-w Proposad Ab3otption System
oring Total Depth Depth to Ground Hater Depth to Bedrock
umber LnchRS Observed Estimated Observed Estu^ated Character of Soil with Thickness in Inches
xa.mpie
i
0 72" 72" Black Top Soil 121•; Clay 18"• Sand 1P,"; Gravel 24" '
71 ?~it'~ SCE' y
77,
RECORD DATA F'ROPt MINIMUM OF 3 BOR,' HOLES
COMPLETE OTHER SIDE
r
I, the undarsigned, hereby certify that the percolation tests reported on this form were made by me
or under by supervision in accord with tha procedures and method specified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to
the best of my knwvledg3 and belief.
L
NAME /I / S TITLE
Type or Print)
REGISTRATION NG& or MASTER PLUMBER IICENSE No.
ADDRESS -1 Ji fj
DATE SIGNATUF,a
MASTER PLUMBER MAKING APPLICATION
~ f MP
Signatures _ c' . _ License Numbers
MP RSW / C
(To be Completed by Issuing Agent)
Date of Application /i 17 Fee Paid $
Permit Issued (dat Permit Number ~
Agent (name) For:
Town, Village, City, County, etc.
(Specify)
Notes The application cannot be considered for filing until all of the above questions are answered
and tha 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 r FOR DEPAR,i;ENT USc ONLY
DATE RECEIVED I` ACCEPTED BY RETURNED
(Initials) j (Date) See Corras.
FEE RECEIVED VALID. NO. 1' J~ J PERILIT NO. Yes or No)
REVIEWED BY APPROVED DATE
(Initials) Yes or No)
COMMENTS:
a
I