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Parcel 0201045-60-00(1 09/19/2006 02:36 PM
PAGE 1 OF 1
Alt. Parcel 19.E 9.19.177P 020 - TOWN OF HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Histori Da Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - HOOPER, WILLIAM R
WILLIAM R HOOPER
871 TAMARACK LN
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 871 TAMARACK LA
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.750 Plat: N/A-NOT AVAILABLE
SEC 19 T29N R19W PT SE NW OF Block/Condo Bldg:
NW COR, TH E 11 7T-, S7DEG E 201.7 FT,
SWLY 126.5 FT TO ELY RAN PROPOSED TN RD, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
NWLY 64.6', TH NLY 229 FT MOL TO POB 19-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/29/1998 587879 1360/387 WD
, -
07/23/1997 1141/63
07/23/1997 918/45
07/23/1997 708/54 S ~fe
2006 SUMMARY Bill Fair Market Value: Assessed with:
0 0 S
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.750 79,100 128,200 207,300 NO
Totals for 2006:
General Property 0.750 79,100 128,200 207,300
Woodland 0.000 0 0
Totals for 2005:
General Property 0.750 79,100 128,200 207,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 311
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
?lb. #67 ,l:?/63 Wisconsin Department of Health and Social Services
Division of Health
PEFQ'IIT APPLICATION
for a
PRIVATE DOKESTIC SEWAGE SYSTEMS
3
A. OWNER, OF PROPERTY TYPE OR USE BLACK INK
Name Address (Street, City, Zip Code)
t 1i 1. 4 H~ County
B. LOCATION OF PROPERTY WHERE S1-,TEM WILL BE CONSTRUCTED, ALTERED OR F-XT 11DED
Check One:
CITY VILLAGE LEGAL DESCRIPTION:,
TOWNSHIP S 1 ~ 1 %
u c C:
C. IS LOCAL PEFMIT REQUIRED FOR THIS WORK? YES NO -j i
PERMIT NUCIDER 4
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete X Poured in Place Steel _ Other
NUMBER. OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other
Specify 9
Number of Persons to be Accommodated_ Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer _X YES NO
Dishwasher YES NO Automatic Potato Peeler YES NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Length Width Depth Tile Size No. Lines
Seepage Pits Inside diameter ti Liquid Depth
"7
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours EWa Test Time Drop in Water Level Inches Minutes
Number Inches Thickness in In(>hes Since Hole Interval Second to Next to Last To FaV.
13t Wetted in Mirrutes !Ast Period Last Peri Period One Inuh
Exa p e
P- 0 3611 To Soil 10'1 Cla 261, 25 30 1 2 1/2 1/2 60
r 4,
t
tip<~ 4. 6O
R.COPD DATA FROM MIYIMUM OF 3 TEST HOLES
Compute size of absorption area in a;oord with H 62.20 Wis. Administrative C)de.
S O I L B 0 R I N G S- Mintnum 36" Below Prop sad Absorption System _
oring Total Depth Depth to Ground Water Depth to Bedrock
umber Inches (b served Estimated Observed Estimated Character of Soil with Thickness in Inches
xample i
- 0 7211 72" Black To Soil ¢12"• CIaav 18'x• Sand 1811• Gravel 2411
RECORD DATA FROM i`IINIMUM OF 3 BORE HOLES
c
COMPLETE OTHER SIDE
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me
or under by supervision in accord with the 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 o my knowledge and belief. , s7
f ~ / fY ft',/
NAME / TITLE
(Type or Pint) ;
3
REGISTRATION NO. or MASTER PLUCIBER LICENSE No. / /17
ADDRESS
flu)
DATE,
SIGNATURE
MASTER PUiMBER MAKING APP TION
r MP
Signatures License Numbers
MP RSW I
(To be Completed by Issuing Agent)
Date of Application LZ ~C l
L ~ Fee Paid $
Permit Issued (date) Permit Numb r
Agent (name) A ~z✓ For:
Townp Village, City, County, etc.
(Specify)
Notes The applica on 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 ) RETURNED
ACCEPTED BY
t (Initials) %Date) See Corres.
FEE RECEIVED VALID. NO. p£RMIT NO.
(Yes or No)
REVIEWED BY APPROVED DATE
(Initials) (Yes or No)
s
4