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Parcel 018-1051-20-000 05/03/2007 10:51 AM
PAGE 1 OF 1
Alt. Parcel 23.29.17.356 018 - TOWN OF HAMMOND
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 - DRINKEN, WILLIAM H & REBECCA L
WILLIAM H & REBECCA L DRINKEN
897 190TH ST
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 897 190TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 23 T29N R1 7W 40 AC NW NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1061/329 WD
07/23/1997 1051/166 LC
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 14,600 94,400 109,000 NO
AGRICULTURAL G4 33.000 4,100 0 4,100 NO
UNDEVELOPED G5 4.000 2,000 0 2,000 NO
Totals for 2007:
General Property 40.000 20,700 94,400 115,100
Woodland 0.000 0 0
Totals for 2006:
General Property 40.000 20,700 94,400 115,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 219
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 018-1051-10-000 05/03/2007 10:46 AM
PAGE 1 OF 1
Alt. Parcel 23.29.17.355 018 - TOWN OF HAMMOND
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 - YANG, KAO & XA NANG LOR
KAO & XA NANG LOR YANG
1933 90TH AVE
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1933 90TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 23 T29N R17W 40 AC NE NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
23-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/05/1999 600511 1415/447 WD
04/01/1999 600440 1415/271 WD
04/06/1995 5274791 1116/632 LC
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/06/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.500 27,500 188,500 216,000 NO
AGRICULTURAL G4 20.000 2,700 0 2,700 NO
UNDEVELOPED G5 17.500 15,700 0 15,700 NO
Totals for 2007:
General Property 40.000 45,900 188,500 234,400
Woodland 0.000 0 0
Totals for 2006:
General Property 40.000 45,900 188,500 234,400
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
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L41
FA RMERS
Proudly Serves You And Offers These Services
FERTILIZER: BULK AND BAGGED - TRUCK OR TRACTOR SPREAD
BULK FEED - GRINDING - MIXING
CHEMICALS - CUSTOM WEED SPRAYING - COMPLETE LINE OF
HOMIX FEEDS - SEED CLEANING & TREATING
GARDEN TRACTORS - SNO TRAVELERS - CAMPING EQUIP.
PHONE: 684-3371 BALDWIN, WISCONSIN
i
Wisconsin Department of Health and Social Servioea
Plb. #67 3/70 Division of Health
S
SEPTIC TANK PERMIT APPLICATION
TYPB or USE BLACK INK 50,( DYl h. Ohio
A. a*!&R OF PROPERTY ~ -2
/ / D STS
Name ddress Street, City, Zip Code)
#AM Me,
A~V~~✓ Cl r»r}N Olemc~ ow,-cjef/
B. LOCATION OF PROPERTY Wt!FAE SYST',:M WILL BE CONSTRUCTED, ALTERF-'r, OR EXTFNDED COUNTY X,
Check One;
CITY VILLAGE LEGAL DE.SRIPTION c /
TOWNSHIP _ `-J ✓L~C 7 ~Z /VYY
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? _ YES NO PERMIT NUrBER
D. SEPTIC TANK CAPACITY L/000 Gallons NEW INSTALLATION X REPLACE-11ENT ADDITION
MATERIALS; Prefab Concrete Poured in Place_ Steel Other
NUMBER OF TANKS TO BE INSTALLED: r" /Y e
E. TYPE OF OCCUPANCY rn0,b! IL
Check One: One or Two Family Residence / Cos-.nercial _ Industrial - Other do /-7 C
(Specify)
Number of Persons to be Accommodatedr Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES X NO Automatic Clothes Washer YES NO
Dishwasher YES! NO Automatio Potato Peeler YIS NO
Other (Specify)
G. M ASTIR PLUI33ER ?LAXING INSTALLATION
Ns-me: 24' / Address: Lioense Number:
mil' S - HP
Signature of Applicant: MP RSd
Address:
H. (To be Completed by Issuing Agent)
Date of Application / Fee Paid $
Permit Issued `(date) Permit Number -e-
Agent (Name) Fors
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 forNard application, the fee of 41.00 for each septic tanx and the third copy
of the permit (canary) to the Division of Health. Checks and money orders should be made payable to
the Division of Health.
Do not writs in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED -7 n ACCEPTED BY ' RETURNED
(Initials) (Date) See rorres.)
FEE RECEIVED VALID. No. a 7 71r6 PERMIT NO.~
es or No
REVIEWED BY APPROVED DATE
(Initials) Yes or NoT
COMPLETE OTHER SIDE
d
SEPTIC TANK PERiIT 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 - PLLPWING SECTId?:
P.O.Box 304, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P X R C 0 L A T I 0 N T t S T
Test Depth Character of Soil Hours Water Tost.Tima Drop in Water Level _Irahes rT~", utes
Number Inches Thickness in Inohas Since Hole in Hole Interval Second to Next to Last all
1s t Wetted ovarni7ht in Minutes Last Period Last Period Period Inch
Exsreple
P - 0 36" To Soil 10" Cla 26" 25 Yes or No 30 __j L2 1/2 1 2 600y~
If 6 'f~ U-2
7
RECORD DATA FROM MINL`MUPi OF 3 -I :ST HOLES
Compute size of absorption aria in accord with H 62.20 Wis. Administrative Code.
_ S 0 I L B O R I N G S- Mi.ni",m 3611 _Hsla-i Proposed Absorption System
Boring Total Dopth Depth to Ground Nate, UaZ h to Rodroc%
Number Inches Cbservad Estimatod Observed Estirn3ted Character of Soil with Thickness in Inches
Lxaaplo
B - 0 72" 72" Black Top Soil 12"; Clay i6l' Sand 1811• Gravel 2411
/ a2rr 410N /Y t" ~r!! rr L!d - rJY't~
-r--
it 12-e r q
RECORD DATA FROM MINaUll OF 3 BO.RZ HOLES
TYPE OF OCCUPANCY: f):1 b i ,
RESIOXNG,: Number of BAeroo;as ~ OTHE : (Specify) Number of Persons
FOOD WASTE GRINDER: Yes No X Dis2mashsr: Yes No X Automatic Clothes Washer: Yes _X_ No
FFLUENT DISPOSAL SYSTO: NEW X EXTENSION ADDITION REPLACeXENT _
i~
Tile Size No. Lin. Feet /6)0
n / Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter r Liquid Depth , or
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
-1/ e P e, I 7 ~G 4 TITLE
Type or Print p
REGISTRATION NO. / or MASTER PLUMBER LICENSE NO. Y C
ADDRESS to/ j /-t / S
DATE Z O SIGNATURE
J,