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Parcel 020-1061-60-000 03/16/2007 01:10 PM
PAGE 1 OF 1
Alt. Parcel 23.29.19.233A 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 - GEISLER, STEPHAN E & MOLLY K
STEPHAN E & MOLLY K GEISLER
779 HWY 12
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 779 HWY 12
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.180 Plat: N/A-NOT AVAILABLE
SEC 23 T29N R19W PT NE1/4 NE1/4 & PT Block/Condo Bldg:
SE1/4 NE1/4 LOT 1 CSM 8/2298 3.18 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/10/2002 689860 1973/63 QC
07/23/1997 1089/491 LC
07/23/1997 888/354
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 3.180 76,100 197,600 273,700 NO
Totals for 2007:
General Property 3.180 76,100 197,600 273,700
Woodland 0.000 0 0
Totals for 2006:
General Property 3.180 76,100 197,600 273,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 112
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Health and Seoial Services
Plb. #~67 3/70 //J. ~ ~ 6(i0 Division of Health
3
f dG SEPTIC TANK PERMIT APPLICATION
TYPE. or USE BLACK INK
A. C+.'NER OF PROPERTY O&u,, q6 7.12I
Name / Address (Street, City, Zip Code)
L. o/S Sal - 3~s
B. LOCATION OF PROPERTY_ WHERE SYS'ITM WILL BE CONSTRUCTED, ALTERED OR EXTE'N'DED COUNTY,, l
Check Ones
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP i
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS 70 BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One; One or Two Family Residence Commercial Industrial Other
(Specify)
Number of Persons to be Accommodated Number of Bedrooms i
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer L YES NO
Dishwasher YES NO Automatio Potato Peeler YES NO
Other (Specify)
G. MASTER PLUMBER MAKING INSTALLATION
Name; Address; Lioense Numbers
MP RSW i~
Signature of Applicant:
Address;
i
i
H. (To be ompleted by Issuing Agent) '
Date of Applicati^n Fee Paid
Permit Issued (date)" Permit Number -Y~
Agent, (Name) For:
Town, Village, City,'County, etc.
(Specify)
Note: The application cannot be considered for filing until all of t'ie above questions are answered and the
fee paid. Agents will forHard application, the fee of $1.00 for each septic tanic and the third oopy
of the permit (canary) to the Division of Health. Checks and money orders should be made payable to
the Division of Health.
Do net write in space below - FOR DEPARTMENT USE ONLY
1. DATE RECEIVED ACCEPTED BY ` RETURNED
(Initials) (Date) See Cor a
VALID. No. PERMIT NO.
FEE RECEIVED es or No
REVIE''-'ED BY APPROVED DATE
` (Initials) Yes or No No
COMPLETE OTHER SIDE
SEPTIC TANK PERMIT NO.
R I P O R T O N S O I L P I R C 0 L A T I 0 N T E S T
A N D S 0 I L B O R I N G S
TO
DIVISION OF HEALTH - PLUMING SECTIdN ,
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
PIRC0L1,TI ON TEST
Test Depth Character of Soil Hours Water Test Time Drog in Water Level Inohes utes
Number Inohes Thickness in Inohes Since Hole in Hole Interval Second to Next to Last To Fall
lst Wetted Overni t in Minutes Last Period Last Period Period Ono= Inch
Example
P - 0 3611 To Soil loll Cla 2611 25 Yes or No 30 1 2 I Z2 _j J2 60
4
-S
- RECORD DATA FROM MINIMUM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S 0 I L B O R I N G S- Minimum 361f Belot Pro osed Abso tion a stem
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Observed Estirulted Observed Estimated Character of Soil with Thiokness in Inches
Exaasple
B - 0 721# 720, Black To Soil 12" Cla 1811 Sand 1811, Gravel 2411
RECORD DATA FROM MINPILM, OF 3 BORE HOLES
YPE OF OCCUPANCY:
RESIDENCE: Number of Bedrooans OTHER: (Specify) Number of Persons
FOOD WASTE GRINDER: Yes No Dislrrashar: Yes No Automatic Clothes Washer: Yes - No
FFLLJENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width " Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pit: Inside Dia:ioter Liquid Depth
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 61,20 (13), Wisconsin Administrative Code, and
that the data recorded and location of test holes are correct to the best of nay knowledge and belief.
NAME TITLE j `
Type or Print
/
REGISTRATION NO. or MASTER PLUMBER LICENSE NO. ~i
ADDRESS
DATE SIGNATURE