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Parcel 032-1054-30-000 04/30/2007 04:08 PM
PAGE 1 OF 1
Alt. Parcel 21.31.19.270A 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 - WELLNER, THEADORE E & MYRNA
THEADORE E & MYRNA WELLNER
465 210TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE
SEC 21 T31N R19W 10A NW NE LOT 2 CSM Block/Condo Bldg:
2/446
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 765/611
07/23/1997 457/563
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
PRODUCTIVE FORST LANDS G6 10.000 40,000 0 40,000 NO
Totals for 2007:
General Property 10.000 40,000 0 40,000
Woodland 0.000 0 0
Totals for 2006:
General Property 10.000 40,000 0 40,000
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
Wirsoansir. Department of Ifealth and Scaial Scr-✓ioes
Par, 1C!, Division of Health
i
vie PERMIT APPLICATIX1
for
j PRIVATE Da,,ESTIC SEWAGE SYS'I`ENS
A. OWNER 0 PZ,)p .;.'Y T iTE 0- USE 6LACK I?IK
l Psme AdPress (StrE~r~ City, Zip Code)
5
B. L0- "I Or 0W c 1 w r 5~ C c;my
~J1: ?L. B v0"y r << 1 t ;;Rr Cr; L.f IF`:D:r1
a
Chcocl- One:
CITY w.._._ VILr.A_E LE1AL
t C. IS LOCAL PE11.IP "EJUI:RZI) FOR T,:US M J::--? YES NO PE u.I1 ti ,:IER 1
D. SEPTA TN:v< CAP OI iY Gallons N E19 INS`iALLATI0i7 RFPU,-,E -.:N ADDI:: 4
M A T E R I A LS: Prefab Concrete k Poured in Place Steel Othe.
N ucR OF "'AN{S TO BE INSI'ALLE TN~~ - ~'tl'
E. TYPE OF OCCU?A'_vSY
Chem One: One or two Far;ily Residence f _ Cor=oroial Industrial Other
~Speci"y)
^:urnb-r of Persons to be A.ccorraod!te? Number of Bed-oof3s
F. AP~LIAtiCES, E'iCS Food Waste Grinder YrS _ NO Automatic Clothes Washer YES NO
Dis:;:Nt_sher YES N0 Automatic Potato P..eler W YES NO
Othar (Specify)
G. EFFLUENT DISPOS..L SYSTEM NEW EXTENSION ADDITION _ REPIACE;'WNT _
Tile Size No.Lin.Feat Trench Width Depth ~Number of Lines
eepade Beds Length Width Depth Tile Size No. Linea i
eecage Pits Inside diameter h Liquid Depth
P E R C O L A T I O N T E S T
iTest~ ^e0th I Character of Soil :ours Water~Test Time Dro Wate
Leve
r l Inh ea i i:utes
"urberY' Incnes ( Thickness in Inches Sinoe P° in ^ "Leve -
j H016 in Home In:.=cva1 Secon-2 to Next to hF.st, To Fall
1st ;Jetted Overnight ~ in Iinutes La st Period i Last PeriO' Pe_r. c Inch
P- 0 36" Top Soil 10" Cia 26"
25 ~yzs or no ~ 30 12
1~2 ~ b0
'i -A
K- C 0PD DATA FRQM ;iINII"U ` OF 3 TES? H L S
I
oWpute aize of absorption area in accord with H 62.20 Wis. Adn nistrative Code.
S 0 I L B 0 R I N G S- Mini:-um 36" Belcw Proposed Ab3o.-Ption Systam
orind Total Depth D_aph to Ground Mater D9oth to Bedrock
umber LnchPs Observed Estimated ! Obse-✓ed Estimated Character of Soil with Thic:cnsss in Inches
xa.ple
- 0 72" 7211
r B11i4 c Too Snil 12n• Clay lb+. Sa ad 1:~ o. Gra✓e1 24"_
.
2 L
RECORD DATA FROM i`IINTIMUM OF 3 ;CRE' HOLL:S
COMPL--.TE OTHER SIDE
,t
It the undersiloned, hereby certify that the porcolation tests reported on this fora were made by r,e
or under by supervision in a.ocord with the procedures rind m-shod scecifie<1 in Ch'lpter H 62.20 (3),
Wisconsin Ad:ninistrr=ti.Ja Cede, and that the data recorded surd location of test holas are correct to
the best of my i:nowledHa and belie('.
NA257 f Y , 1 TITLF:
~ - - - _ -
(Type or Print)
REGISTRATION NO. or IIkSTER PL lER L• r"' No. -
' ASU"rS-5
C
LATE Sir,N'TUC"--'
i
i
r
i
I PER PT 7~'R MAKING A LI%. IGN
MP
SiF;nat,._ License Nu..,,ert
Nu' RS W ~w -
(To be- Completed by Issuing; Agent)
Date of Application ! ' ry^ Fee Paid $
Permit Issued (date} - - Permit Nl.cD9r
Agent For: =C-
Tosco, Villa;a, City, County, et.,.
(Specify)
Notes The application car not be considered for filirg until all or the above questions are an.,'Nered
and the fee paid. Agents will for-v., rd application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders sho.:ld oe made
paya'ole to the Division of Health.
Do not write in space below - FOR DEPARTf,E'NT USE ONLY
DATE RECEDED / ACCEPTED BY RETURNED
(Initials) ~ (Date) (See Corres,) z-1 3,1
FEE RECEIVED VALID. NO. PE21IT NO. i
(Yes or No)
riEVIElED 6Y APPROVED DATE
Y L (Yes or No)
_ (Initials)
CMIENTS
E
I~
G
Parcel 032-1054-40-000 04/30/2007 04:05 PM
PAGE 1 OF 1
Alt. Parcel 21.31.19.270B 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 - WELLNER, THEADORE E & MYRNA
THEADORE E & MYRNA WELLNER
465 210TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description * 465 210TH AVE
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 10.200 Plat: N/A-NOT AVAILABLE
SEC 21 T31N R1 9W 10.20A NW NE LOT 1 CSM Block/Condo Bldg:
2/446
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 605/214
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 10.200 84,000 104,800 188,800 NO
Totals for 2007:
General Property 10.200 84,000 104,800 188,800
Woodland 0.000 0 0
Totals for 2006:
General Property 10.200 84,000 104,800 188,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 138
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00