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` Parcel 020-1058-90-150 03/22/2007 11:48 AM
PAGE 1 OF 1
Alt. Parcel 22.29.19.223A-10 020 - 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
DONNA M BRENNAN O - BRENNAN, DONNA M
I
1341 CTY RD A
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Ad-dress(es): Primary
Type Dist # Description ' 1341 CTY RDA /41 S SC 2611 HUDSON
SP 1700 WITC -
r
Legal Description: Acres: 18.429 Plat: N/A-NOT AVAILABLE
SEC 22 T29N R1 9W PT NW SW N 693' OF NW Block/Condo Bldg:
SW EXC PT TO HWY PROM 8949-02-23
(1.510AC Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-29N-19W NW SW
Notes: Parcel History:
Date Doc # Vol/Page Type
03/31/2003 715141 2187/402 WD
07/23/1997 1148/196 QC
07/23/1997 1148/195 AF
07/23/1997 838/248
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: - Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 16.929 3,300 0 3,300 NO
OTHER G7 1.500 51,000 0 51,000 NO
Totals for 2007:
General Property 18.429 54,300 0 54,300
Woodland 0.000 0 0
Totals for 2006:
General Property 18.429 54,300 0 54,300
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
Wisconsin Department of Health and Social Services
Plb. }67 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
?YPE or TEE BLACK INK
A. OWNER OF PROPERTY
Name Address (Street, City, Zip Code)
B. LOCATION OF PROPERTY WHERE SYSTKM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY
Check One:
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP ' J J
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK?_ YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT I ADDITION
MATERIALS: Prefab Concrete Y Poured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY
Check Ono: One or Two Family Residence Commercial Industrial Other
Specify)
Number of Persons to be Accommodated X75 Number of Bedrooms ~T
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dishwasher YES_ NO Automatic Potato Peeler YES - NO
Other (Specify) !`r
G. MASTER PLUMBER MAKING INSTALLATION
Name: ✓ h`~~-7 Address: License Number:
I ~il J _ r ! •c~ MP
Signature of Applicants A_. MP RSW
Address: I
H• (To a Completed by Issuing Agent)
Date of Application - 1-7 Fee Paid
Permit Issued (date / _ Permit Number
Agent (Name) For:- ~24~~i~~
Town, Village, City County, etc.
(Specify)
Note: The application cannot uo considerid fcr filin,7 until all of the above questions are answered and the
fee paid. Agents will forward application, the fee of 41.00 for each s-,tie tank and the tnird copy
of the permit (canary, to the Division of Health. Cheoks and money orders should be made payable to
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
1. DATE RECEIVED 7/-76 ACCEPTED BY RETURNED
(Initials) (Date) j~ee Cgr~as.)
FEE RECEIVED _ VALID. No. PERMIT NO. ( L4
es or No
REVIEWED BY APPROVED DATE
(Initials) ( Yes or No
COMPLETE OTTER SIDE
f
- SEPTIC TANK PERMIT NO. i
R Z P 0 R T O N S O I L P I R C 0 L A T I 0 N T E S T
1 A N D S O I L B O R I N G S
TO
DIVISION OF HEALTH - PLLtWING SEZTI.7N
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrativa Code
P Z R C 0 L A T I 0 N T Z S T
Test Depth Character of Soil Hours Water Tes. Time Drop In Water Level Inches nutes
Number Inches Thi*kness in Inches Since Hole in Hole Interval Second :o Next to Last To Fall
1st Wetted Overn
i~ftt in Minutes Last Period Last Period Period Cola, In^h
Example
P - 0 36t' To Soil 10" ,_Clay 261, 25 Yes or No 30 1/? 1/2 1/2 60
RECORD DATA FROM MINrTJM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L B O R I N G S- Minimum 3611 Below Pro osed Abso tion S stain
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Soil with Thiokness in Inchas
Example {
B - 0 721t 721t 1 Black To Soil 12" C1 18" Sand 18"; Gravel 2411
RECORD DATA FROM MIN DIUM OF 3 BORE HOLES
YPE OF OCCUPANCYs _
RESIDENCE: Number of Bedrooms OTHER: (Specify) Number of Persons `
POOD WASTE GRI.NDERs Yes No Dishwashers Yes No Automatic Clothes Washers Yes _i No
EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEKENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Length Width Depth Tile Size No. Lines
l~ Seepage Pits Inside Diameter_ Liquid Depth
Ia the undersigned, hereby certify that the percolation tests reported rn this form were made by me or under m-- super-
vision in accord with the procecures 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 ~4- '-i TITLC
Type or Print
REGISTRATION NO. or MASTER PLLMER LICENSE NO. ~!a~ f
r
ADDRESS i 2 4 /,?15
DATE / r l..~ 7 ~~Ji ) S IGNATURE