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- Parcel 020-1067-20-000 03/16/2007 12:52 PM
PAGE 1 OF 1
Alt. Parcel 24.29.19.257D 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 - KVANLI, GRETCHEN M
GRETCHEN M KVANLI
825 BADLANDS RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 825 BADLANDS RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 4.600 Plat: N/A-NOT AVAILABLE
SEC 24 T29N R19W PT SE SW LOT 2 CERT Block/Condo Bldg:
SURVEY MAP IN VOL I PAGE 48 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/04/2001 642073 1613/244 TI
07/23/1997 476/344
03/29/1980 383107 609/627 WD
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 4.600 95,400 223,900 319,300 NO
Totals for 2007:
General Property 4.600 95,400 223,900 319,300
Woodland 0.000 0 0
Totals for 2006:
General Property 4.600 95,400 223,900 319,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 306
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
/SC' Wisconsin Department of Health and Social Services
Plb.*#67 3/70 Division of Health
Olb~(~'~~ 3 SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLA K INX I I Cf _ 3 f~(1 /
A. WNER OF, PROPERTY 7
Name Address (Street, City, Zip Code)
B. LOCATION OF PROPERTY Wh-RE SYS,-M WILL BE CONSTRUCTED, ALTERED JR EXTENDED COUNTY -
Check One:
CITY VILLAGE LEGAL DESCRIPTION
~+n / x
TOWNSHIP -
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? 4 Y YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE IZSTALLED:
E. TYPE OF OCCUPANCY
-Cheek one: One or Two Family Residence Commercial Industrial Other
(Specify)
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 Automatio Potato Peeler YES NO
Other (Specify)
G. MASTLR PLUMBER MAKING INSTALLATION
f f Lioense Number:
Name: Addresss
MP
Signature of Applicant:"', MP RSW
Address: ~/f%
H. )To be / Completed by Issuing Agent)
Date of Application Fee Paid
Permit Issued (date) ' Permit Number . ~f-
Agent (Name) For:__
Town, Village, City, County, etc.
(Specify)
Note: The applioation cannot be consid<:ed for filing until all of the above questions are answered and the
fee paid. Agents will forward application, the fee of 41.00 ::r each septic tanx and the third dopy
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
r
,
I. DATE RECEIVED r - ACCEPTED BY RETURNED
(Initials) _ (Date) See Corres )
FEE RECEIVED ✓ VALID. No. PERMIT NO.
Yes or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
< - ,
SEPTIC TANK PERMIT NO.
R Y P 0 R T O N S O I L P I R C 0 L A T I 0 N T E S?
AND SOIL BORINGS
?0
DIVISION OF HEALTH - PLLPIBLNG SPCTIbN
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P E R C O L A T I O N T R S T
Test Depth Charaotor of Soil Hcurs Water Test Time Drop in Water Level Inohes utss
Fall
Number Inches Thickness in Inohes Since Hole in Hole Interval Second to Next to Last teInch
1st Wetted Overnight in Minutes Last Period Last Period Period Example
P - 0 3611 Too Soil 10"i Cla 260, 25 Yes or No .30 1/2 1/2 1/2 60
i
RECORD DATA FROM M I-Nr!UM OF 3 TEST HOLES
j Compute size of absorption area in accord with H 62.20 Wis. Administrative Coda.
f S O I L B O R I N G S- Minimt:m 3611 Bel" reposed Absorotion S stsm
Boring Total Depth Depth to Ground Water De th to Bedrock
Number Inches Cbserved Estimated Observed Estimated Character of Soil with Thiokness in Inches
E Example
B - 0 721# 7210 Black To Soil 12°• C1 181' Sand 18"; Gravel 2411
RECORD DATA FROM MINIMUM OF 3 BOR-v HOLES
I
PE OF OCCUPANCYs
V RESIDENCES Number of Bedrooms OTHER: (Speoify) Number of Persons
D WASPE GRINDERS Yes Ho Distwashers Yes No Automatic Clothes Washers Yes No
EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
i
Seepage Bads Length Width Depth Tile Size / No. Lines
Seepage Pits Inside Diameter r Liquid Ospth~
Ie 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.
TITLE . / -
NAME
Type or Print
REGISTRATION NO. or MASTER PLUMBER LICENSE NO.
ADDRESS
DATE SIGNATURE