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Parcel 032-2017-80-000 11/17/2006 10:52 AM
PAGE 1 OF 1
Alt. Parcel 5.30.19.536C 032 - TOWN OF SOMERSET
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 - HALFEN, HENRY J & DEBRA J
HENRY J & DEBRA J HALFEN
483 CTY RD V V
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 483 CTY RD V V
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.260 Plat: N/A-NOT AVAILABLE
SEC 5 T30N R1 9W PT OF SW NE 1.26A THAT Block/Condo Bldg:
PART OF LOT 3 CSM VOL 5/1373 ALSO COMM
E1/4 COR SEC 5; TH N 523.85'N 88 DEG W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
1304.47 FT-POB N 88 DEG W 218.20 FT. S 05-30N-19W
100'S 88 DEG E 218.20FT N 100 FT-POB
ALSO A PARCEL DESC AS COM E1/4 COR SEC
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 888/570
07/23/1997 791/482
07/23/1997 696/294
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.260 20,200 66,600 86,800 NO
Totals for 2006:
General Property 1.260 20,200 66,600 86,800
Woodland 0.000 0 0
Totals for 2005:
General Property 1.260 20,200 66,600 86,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 309
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisoonsin Department of Health and Social Services
Plb. #67 370 Divlsivn of Health t f-
SEPTIC TANK PERMIT APPLICATION Ic+ `f0 ~m Ci-f,
?YPE or USE BLACK INKS V, 5el-'
. tY
A. OWNER OF PROPERTY 1
Name y~ Address (Street, City, Zip Code)
B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED. ALTERED OR EXTENDED COUNTY r l..Jl.
i
Check One:
CITY VILLAGE LEGAL DESCRIPTION n i
TOWNS HIP ( 6, T2 l ~fi ' C/ V V i
b
r /
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? L_ YES NO E- ( P ~ NUMBER I
i
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION R&PLACEMENT DITION le-
MATERIALS: Prefab Concrete Poured in Place Steel Other
NU?TER OF TANKS TO BE INSTALLED:
s
E. TYPE OF OCCUPANCY
s
Cheek One: One or Two Family Residence -Z- Commercial Industrial Other
s~ Specify)
Number of Persons to be Accommodated S Number of Bedrooms
I
F. APPLIANCES, ETC: Food Waste Grinder YES X NO Automatic Clothes Washer _ YES NO
Dishwasher YES NO Automatic Potato Peeler YES_4, NO
Other (Specify)
G. MASTER PLUMBER MAKING INSTALLATION
Name: Address: f\ d~l~t ' i\ D A.rl r License Number:
Signature of Applicant:_ MP RSW (S~~
Address: Z~ ~_r __i 3 ~.r" ~t y l•~~ , - l_i t . C
l
H. (To be Completed by Issuing Agent) ?
Date of Application Fee Paid
Permit Issued (date Permit Number
Agent (Name) For: i I
Town, 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 $1.00 for each septic tarot and the third copy
of the permit (canary) to the Division of Health. Cheoks and money orders should be made payable to 1
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
"
f I. DATE RECEIVED ACCEPTED BY \,V RETURNED
(Initials)
/ (Initials) _ (Date) See C -r
FEE RECEIVED v VALID. No. y PERMIT NO.
es or No)~
REVIEWED BY APPROVED DATE
(Initials) Yes or No
SEPTIC TANK PERMIT NO.
R Z P 0 R T O N S O I L P Z R C 0 L A T I 0 N T Z S T
A N D S O I L B.0 R I N G S
TO
DIVISION OF HEALTH - PLUMBING SBCTI64
P.O.Box 309, Madison, Wis. 53701
Parsuant to H 62.20, Wis. Administrative Code
P Z R C 0 L A T I 0 N T K S T
Teat Depth Character of Soil Hours water Test Time Drop- in Water Level Inohes utea
Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Falt
1st Wetted Overnight in Minutes Last Period Last Period Period One. Inch
Example
P - 0 361' To Soil 1011 Clay 2617 25 Yes or No 30 1 2 112 112 60
_jo
RECORD DATA FROM MINIMUM 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 Proposed Abso tion System
Boring Total Depth Depth to Groundwater D_e~h to Bedrock
Number Inches Observed Zatimated Observed Estimated Character of Soil with Thiokness in Inches
Example
B - 0 72" 7211 Black To Soil 1211C1 18" Sand 1811• Gravel 2411
-70
Z J~
RECORD DATA FROM MINL-RIM OF 3 BORE HOLES
YPE OF OCCUPANCY:
RsSID 0CEs Number of Bedrooms _ OTHERi (Speoify) Number of Persons
D WASTE GRI2NDER: Yes No Dishwashers Yes No Automatic Clothes Washers Yes No
P? '*'i1~' DISPOSAL SYSTEM; NEW EXTENSION ADDITION REPLLCEMENT
r
Tile Size No.Lin.Feet C T' Trench Width _ Depth Number of Lines -~2
Seepage Bed= Length Width Depth Tile Size No. Lines
i 5eeP°3e Pits Inside Diameter ?,i~uid Depth t-
`
Is Me undersigned, hereby certify that the percolation tests reported on this form were made by me or under my suer-
vision in aaoord with the p
procedures and met thod specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and
the data recorded and }o tion of test holes are correct to the best of my knowledge and belief.
j 1 TITLE
Type or Print
+ZE:.IST:q:TIJN N0. „
f or MASTER ,_PLUMBER LT :r'CdSTs NO.
^j 5
+ DA -Z --2- _ f_17 C ) SIGNATURE
Parcel 032-2018-40-000 11/17/2006 10:53 AM
PAGE 1 OF 1
Alt. Parcel 5.30.19.537D 032 - TOWN OF SOMERSET
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
MARVIN D SAYRE O - SAYRE, MARVIN D
7016 13TH ST N
OAKDALE MN 55128
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 5 T30N R1 9W PT S1/2 NE 1/4 LOT 4 CSM Block/Condo Bldg:
5/1373 3AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
05-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/15/1998 577276 1315/255 WD
07/23/1997 894/347
07/23/1997 685/114
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 3.000 60,000 40,700 100,700 NO
Totals for 2006:
General Property 3.000 60,000 40,700 100,700
Woodland 0.000 0 0
Totals for 2005:
General Property 3.000 60,000 40,700 100,700
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
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