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~ Wi sccr°.;n n rtmer:t of Health a-nd So:i•Ll SP•;ice
Plb. X67 10/69 Division or H-alth
PE;V,I'P APPLIC 'I'IU?i
for
PRI'VA'i`E DU-IFSTIC SE t,'uE SYSTEMS /
vib
r tT
A, C+dPir:R OP PZ»'a ;Y TYPE On USE FiL.4C{, Z."~K
p; ~t Address (Street, Citvi Zip Cede)
t i c
COU71ty
B. L7:A i I iJ O FPROP ii f WH'S SF) ; EX 4ILL R CONS-"JC_-TED, AL tiR 7 02
Cntc"k One:
CITY VILLAGE LEiAL D'SCRIP ION: 1
TOWNSHIP C. IS LOCAL PEr, IT REQUIRED FOR THIS WO-Y? YES NO
D. SEPTIC TANK CAPACITY Gallons N1. INSTALL.' I IJN ADDITION TERIALS: Prefa:o Concrete Poured in Place Steel Other
N i~R OF TANKS TO BE IrJ>TALL`:Dz
E. _ TY?:: OF OCCUP°_,CY_-~_ ____.._..a_. _ <-_r-~.__~ .r , ,
Check One: One or Two Family Resid,'rice ~ Commercial Indus~rial Other
(Specify)
Number of Persons to be A cormodated Number of Bedre=7 -
F. A?:'LIANCEES, ETC: Food Waste Grinder YES NO Autocratic Clothes Masher, !YES _ NO'
Disasher YES NO Automatic Po;ato Peeler YES NO i
Other (Specify)
G. EFFL Ei: DISPOSAL SYST7_X NE7d _ EXTENSION ADDITION REPLACF_"~FNT
Tils Size No.Lin.Feet Trenc'r. G:idth Depth Number of Lines -
Seepage Bed: Length _ Width _ _ Depth Tile Size No. Lines
_ Seaoe:,e Pita Inside diameter Liquid Dept:
P E R C O L A T I O N T E S T -
Test D<nth I Character of Soil Hours Water-ITe.t Tim- Pro:
_ii Water Level Inc e i.^.i
Number Inches i Thickness in Incises Since Hole in Hole iInterval Second to i Next to Lr3t To F 11
13t Wetted Cri-nniant in Mi-ut® Last t Period Last Per ioq Period ?:j. Tnch ~
Exa.aple
P- 0 35" T° Soil 13"Clay 26" w 25 or no 30 1/2 1/2 1~ 6J
- -
j
R:CO. DATA "r?C`I 2I`!I"wi'i OF 3 T-_-SP hDL:a
wmpute size of absorption area in accord with H 62.20 Wis. A.?ninistne.tive Code,
I
S O I L B O R I_N G S - Minimmun 36" Ba1a*r PreHoaed Absotion System
oring Total Death Depth to Ground Water L'e~ n to Bedrook -
umber lncI'?s Cbseryed I Estiv',tedl~Ooservcd Es-,L-rated Character of Soil with Thickness in :nch,~s
xaTple - - - -
24"
0 72" 72" _ Black Top Soil 12"; Clay 1811L Sand 18"I Gravel
'i
RECGRD DATA FROM h1I'.I 7M OF 3
COMPLETE (7PHER SIDE
I, the ander-;J;med, hereby certi:y that, t':e pemolatior, tests reported on this fore: wer-a made by mo
or under by supervision in accord with the procedures and method specified in Cnapter H 62.20 (3),
~Iisconsin Ad-iinistrativr. Code, and that the data recorded and location of test hole.-, are correct to
the best of ^,y krurrrledeo and '.relief.
- r'--- TITLE
(Typo or Print)
or I~STEt' PLJ°"3F~t L1Cc No.
UGISTR:?TION NO. N
DATE SIGN" 'Urr:
II
r~
MASTER ri;Fltic~~~i
r1p
I
Sign cur-• ~ ' .._...f t License N,r.n per;
(To be Co-:lpleted by Iss:aing Agent)
Date of A•> >icatior. Fee Paid
Per-rilt ssue'd (date) Permit Nuumber
Agent (nun ) For
Torm,~Village, City, County, etc.
(Specify)
Note; The application cannot be considered for filing; until all or the above questions are answered
and the fee paid. Agents will for-hard application, the fee of $10.00 and Copy (b) of the
Permit (ye.llo•.+r copy) to the Division of Health. Checks and money orders should ba made
paya'ole to the Division of Health.
Do not write in spr-ca below - FOR DEPA-R:-ENf USE ONLY
DATE RE;Cr,IvE'D ACCEPTED BY RE1URNID
(Initials) (Date) (See Corms,)
FEE R PERMIT NO.
w r _ VALID. NO.
(Yes or No)
RE'lIf~ED hY APPROVED DATE
(initials} (Yes or No)
COr:~MraTS
l E
i
Mwy zY
3 '3
'Parcel 032-2026-10-100 04/30/2007 11:48 AM
PAGE 1 OF 1
Alt. Parcel 7.30.19.567A-10 032 - 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
JOHN A & BRIGITTE TERHAAR O - TERHAAR, JOHN A & BRIGITTE
1682 38TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1682 38TH ST
SC 5432 SOMERSET
SP 1700 WITC
I
Legal Description: Acres: 6.560 Plat: N/A-NOT AVAILABLE
SEC 7 T30N R19W PT W1/2 NE 1/4 COM NE Block/Condo Bldg:
COR SEC 7, TH W 1028' TO INT HWY SWLY
550' TO E LN NW NE & POB; TH SW ON CL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
1130'S 56 DEG E 330'N 33 DEG E 330'E 07-30N-19W NW NE
159'N 850.64' POB EXC.44 AC TO HWY
PROJ 1559-08-21
Notes: Parcel History:
Date Doc # Vol/Page Type
08/28/2000 628909 1538/27 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.560 65,800 100,800 166,600 NO
Totals for 2007:
General Property 6.560 65,800 100,800 166,600
Woodland 0.000 0 0
Totals for 2006:
General Property 6.560 65,800 100,800 166,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 542
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00