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Parcel 020-1016-30-000 05/18/2007 03:57
PAGE 1 OF 1
F 1
Alt. Parcel 12.29.19.72C 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 - OLSON, GERALD & BEVERLY
GERALD & BEVERLY OLSON
898 100TH AVE
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ' 898 100TH AVE
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.900 Plat: N/A-NOT AVAILABLE
SEC 12 T29N R1 9W 1.9A E 165 FT OF S 510' Block/Condo Bldg:
OF SE SE
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 600/349
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.900 66,700 141,800 208,500 NO
Totals for 2007:
General Property 1.900 66,700 141,800 208,500
Woodland 0.000 0 0
Totals for 2006:
General Property 1.900 66,700 141,800 208,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 216
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 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK 020-1616-
A. ~COMER OF PROPERTY L
Name ~J Address (Street, city, Zip Code)
n
B. LOCATION OF PR0?E_R_T_Y_Wiz:R-E SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY ~j
Check One:
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP
C. IS LOCAL PERtiIT REQUIRED FOR THIS WORK? ~ YES NO PERMIT N'O.BER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION iY REPLACEMEN'T ADDITION
MATERIALS: Prefab Concrete ` Poured in Place Steel Other
NUIDF-P, OF TAINTS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Cnaok One: One or Two Family Residence Cozmercial Industrial other
~j Specify)
Number of persons to be Accommodated Number of Bedrooms
F. APPLIAN~ES, ETC: Food Waste Grinder YES J NO Automatic Clothes Washer YES NO
Dishwasher YES X> NO Automatic Potato Peeler YES r NO
Other (Specify)
G. MASTIR PLL'*3 ER MAKING INSTALLATION
Name: Z /f.. f{,a`r,' li f1~JZ't~,' Addresst License Number:
HP
Signature of Applicants MP RSW
Address: i, ~ i
H. To be Completed by Issuing Agent)
f n
Date of Application °7- / Fee Paid $ / ' <
Permit Issued (date) ` A, Permit N er
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 applicaticn, the fee of $1.00 for each septic tarot and the third oopv
of the permit (canary) 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
I. DATE RECEIVED ACCEPTED BY \'`IU RETURNED
f (Initials) (Date) See Corres.)
FEE RECEIVED b VALID. No. t s/,; 3 PERMIT NO.
71
es or No
REVIEWED BY APPROVED DATE
(Initials) (Yes or No
COMPLETE OTHER SIDE
` SEPTIC TASK PERMIT N0.
R T P O R T O N S O I L P Y R C 0 L A T 1 0 N T E S T
A N D S O I L B O R I N G S
TO
DIYISI0 OF HEALTH - PLU'MP': SL-CTI62N
P.O.Box 309, A'.adison, Wis. 53701
Pursuant to H 62.20, WiS. Ae--dnintrative Cods
P E R C O L A T I O N T E S T
Test Depth Charactor of Soil Hours Water Test Time Dra in W, ter Level Inches Vitas
Number Inohas ThioVnese in Inches Since Holo in Hole Interval Second to Nact to Last To Fall
1st Wetted Gvorni^ht in minutes Last Period Last Period Period Onoz Inch
Exalsple
P - 0 361, To Soil 10" Clay 2611 25 Yes or No 30 1 2 1/2 1/2 60
1 RECORD DATA FROM MINDxUM OF 3 TEST HOLES
Compute size of absorption area in aocord with H 62.20 Wis. Ad-sinistrative Code.
S O I L B O R I N G S- Minim 36" Bal« ropes ed Absorption S stop
Boring Total Depth Depth to Ground Water De th to Bodroc!t
Number Inches Cbserved Estimated Observed Esti aced Character of Soil with Thiokness in Inches
F.x aple
B - 0 721+ 72" Black-To Soil 12" Clay 18" Sand 18"• Gravel 2411
RECORD DATA FROM MINL,[UM OF 3 BORE HOT-ES
YPE OF OCCUPANCY: r
RESIDENCE: Number of Bedrooms OTHER: (Speoify) Number of Persons 1
FOOD WASTE GRINDER] Yes No D1shNasher: Yes No f Automatic Clothes Washer: Yes No
FFLUJENT DISPOSAL SYSTEM: NEW J EXTENSION ADDITION REPLAC~NT
Tile Size No. Lin. Feet Trench Width Depth 36, ' Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
I Seepage Pits Inside Diameter _;_I_ Liquid Depth`
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under m:r super-
vision in aooord with the procedures and method specified in Chapter H 62.20 (13), Wisoonsin Administrative Code, and
that the data recorded and location of test holes are oorrect to the best of my knowledge and belief.
NAME C TITLE ,I
Type or Print
REGISTRATION, NO. c~ or MASTER ?LUMBER LICENSE NO.
ADDRESS /'r✓ << ' 1Gi✓ij~
DATE f SIGNATURE
V3 S
E "ism
3
77