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Parcel 020-1091-70-000 05/22/2007 12:18 PM
PAGE 1 OF 1
Alt. Parcel 32.29.19.376E 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 - BLUE JAY PROPERTIES LLC
BLUE JAY PROPERTIES LLC
1353 AWATUKEE TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 661 BAN TARA LN
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.600 Plat: N/A-NOT AVAILABLE
SEC 32 T29N R19W SW NW NW COR SEC 32 GO Block/Condo Bldg:
S 1278'E 889'S 708.75' POB; S162' E
446.2' N162.2' W 443.VPOB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
32-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/11/2006 831933 WD
08/04/2005 802371 2858/285 QC
06/01/2005 796381 2812/431 WD
04/29/2005 793514 2792/474 WD
more...
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 0.000 221,300 38,000 259,300 NO
Totals for 2007:
General Property 0.000 221,300 38,000 259,300
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 221,300 38,000 259,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 109
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
j67 1069 Division of Health
PERMIT APPLICATION
PRIVATE DCiIESTICf SEWAGE SYST "1S 22,0 ~ 7d-L"
3 3
A. CW14ER OF PROPERTY V •V~ / TYPE OR USE BLACK INK
Name Address (Street, City, Zip Code) '
y
B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED County
Check One:
CITY VILLAGE LEGAL DESCRIPTION: yI
TOWNSHIP -
C. IS LOCAL PEFVIT REQUIRED FOR THIS WORK? _f YES
PEfZ"!IT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete e Poured in Place Steel Other
NUridER OF TANKS TO BE INSTALLED: y
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other
(Specify)
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC3 Food Waste Grinder YES NO Automatic, Clothes Washer 'YES NO
Dishwasher -YES NO Automatic Potato Peeler YES NO
Other (Specify) 4^
G. EFFLUENT 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 diameter Liquid Depth
P£ R C 0 L A T I 0 N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches Minutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to I Next to Last To Fall
1st Wetted Overnight in Minutes Last Perio3 Last Perio Period One Inch
Example
P- 0 36" To Soil 10" Cla 26" 25 es or no t 30 112 112
_Y2 60
RECORD DATA FROM MINIMUM OF 3 TEST' HOLES
I
ompute 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 36" Balow Prooo3ad Absorption System _I
Boring Total Depth Depth to Ground Water_ Depth to Bedrock ,
Lumber InchRS Observed Estier.ted Observed Estimated Character of Soil with Thickness in Inches
x?.mple
- 0 72" 72" Black To Soil 12" Cia 18" Sand 181 • Gravel 24"
RECORD DATA FRCM MINIMUM OF 3 BORE HOLES
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 of my knowledge and belief.
i
NAM f- /l t 1-1 TITLE l
(Type or Print)
REGISTRATION NO. or MASTER PLUR13ER LICENSE No.
ADDRESS
DATE f I J 1
SIGNATUi;Z; /
MASTER PLUf13 'R MAKfNG APPLICATION ,
Signatures License Number:
MP RSW
(To be Completed by Issuing Agent)
l
Date of Application Fee Paid $
Permit Issued (date) / Permit Number /
Agent (name) For.
1 / f /'-L tl C,f
Tovni, 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 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 DEPARMENT USE ONLY
DATE RECEIVED D ~Y7 0 ACCEPTED BY RETURNED
(Initials) (Date) 7See Corres.)
FEE RECEIVED VALID. NO. Q `l ~C J PERMJT NO. a~
(Yes-or No)
REVIK4ED BY APPROVED DATE
(Initials) (Yes or No)
COMMENTS: ~f
fk
fE
f
it - Y6
13