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Parcel 032-1062-20-100 02/22/2005 12:01 PM
PAGE 1 OF 1
Alt. Parcel 23.31.19.314B-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): Current Owner
ADAM D & WINIFRED VIELLIEUX VIELLIEUX, ADAM D & WINIFRED
634 200TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 634 200TH AVE
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.275 Plat: N/A-NOT AVAILABLE
SEC 23 T31 N R19W THE S 393' OF THE W Block/Condo Bldg:
363' OF THE SE SW
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-31N-19W SE SW
Notes: Parcel History:
Date Doc # Vol/Page Type
07/30/2002 685414 1936/156 QC
07/23/1997 461/81
2004 SUMMARY Bill Fair Market Value: Assessed with:
10213 141,600
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.275 49,300 70,800 120,100 NO
Totals for 2004:
General Property 3.275 49,300 70,800 120,100
Woodland 0.000 0 0
Totals for 2003:
General Property 3.275 49,300 70,800 120,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Winoonsir, D^y,X :en, of Health and Sooi.1 Services
.=lb. 07 10 69 Division of h...%ltn
~ PET-T"IT APPLICATION
for ~Q
PRIVATE DCS':ES'TIC SEWAGE SYSTEMS V 32 aG-!~ J1
A. CWN::R 0111, PE? o~'if7 TYPE OR ',SE: INK
Name Address (Street, City, Zip Code)
County
B. LCrF'~0?i_OF Pi;JPERIY W".- S STF.t•i aIL,i. SE CONSTn'C'.ED} ALTERED 1R
-Cne.k. . e - r - - l
- VILI_'' ;E LFG.AL DE3CRIKICN;
i OW'TSHI P
C. IS Lr3'CAL PE :11 T P-SQUIRED FOR THIS WORD YES NO p`t;F ".i1' tiLi FR
SEPTIC TAN CAPACSTY Gallons NEW riS`i'ALLATION REPI,A- . _
Mi+TER1ALS; Prefab Conoret.s Poured in Place Steel Other
Ni~X?ER OF TANKS TO BE I~STALL5D: ~ -
E. TYPE OF OCCUPANCY
Check One; One or ao Family Reside=nce Corv,,='_•cial Industrial Omar _ y
Nurfi~)er of Farsons to bo Accommodated Nu-ether of Bedrooms
F. AP.'LIA.NCES, ETCa Food Waste Grinder -YES NO Automatic Clothes Washer Y---S NO
Dis',:raasher YES r NO Automatic Potato Peeler . YES yT NO
Other (Specify) - - -
G. EFFLUF," DISiIOSAL SYSTEit NEW EX TENS1O;I ADDITION REPLACE r`:'i
Tile Size _ No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Len th Width _ Depth Tile Size No. Lines
. -Seapage Pita Inside diameter r Liquid Depth -
777
P E R C O L A T I O N T E S T
Test Uenth r Cha =r,tet of Soil Hours Water Test Time Dron in Wae_r Level Ino:nes P'an-Iles
Numb e r Inc'rss I Thicr;.nass in Inches Since Hole in Ho?a }Interval Second tc Next to L'st c 'c'all
1st Ovarniv ! in M ;nttp; Last Period Last Parioc Period One Inch
P- 0 36" To Soil 10" Clay 2011j 25 es or no ' 30 1 2 1/2 1f2 I 60
t 7 _ I
-:21-11-1 -57'
RECOM DATA FRal OF 3 TES?~
Iq ~
oc:Pate aiZa or . absorption arc ~ i ~
in accord with H 62.20 Wis Co
de.
i
S O I L B O R I N G S- MLiimun 36" Below Prooosad Absorption System
oring Total Depth Deo.h to Ground Water ~ Ono-, to Bedrock ~
t muer Inches Cbse--,ed EstiTa ed O'oserved Estimated Character of Soil with Thic'tiness in :n,.h:os
xsmple
- 0 72" 72" _ Blank Top Soil 12"; ClaX ld"; Sand 1°"; G„P _a1 2d"
-
~LSS
RECO~@ DATA FRCM MIVI' 1M '02 3
CO'N,PLETE OTHER SIDE
I, the and{rsi;ned, h reby+certify that the po col'-tion tests reported on this form were made by me`
or under by supaiiision in accord with the procedures and met-hod specified in C,,.apcer H 62.20 (3),
Wisconsin Adninistr-itive Code, and that the data recorded and location of test holes are correct to
the best of ~:iy '.,nor,le,lge and belief.
NA`-v ( , r- f ' TITLE ( y-
-C
(Type or Print)
REGISTRATION NO. or MASTER PLUI°~ER LICENSE No.
I ADDRESS
DATE C7 / O SIG`: C!~ r s.
t~
NIASPER PLC 2 NA ! j~ YEN
5i.-ntiture. Liaanse Nlnm~ er;
_ _ 1 y _
Nya ~ ~ ~
(To'be Cor;ipleted by Issuing Agent)
i
Date of Appliee,tio:'i Fee Paid
Permit Issued (d te) Permit Number
Agent For
Toim, Village, City, County, etc.
(Specify)
Note: The application cannot be considere: for filing until all of the above questions are answered
and the fee paid. Agents will fonrard appli:;ation, the fee of $10,00 and Copy (b) of the
Permit (yellow coot') to the Division of Health. Checks and money orders should be ir:ade
payable to the Division of Health.
Do not write in space below FOR DE:'A,71 EWNT USE ONLY
DATE RECEIVED ACCEPTED BY 1`~1 RF JP.NED _
(Initials) n~ / - (Date) (See Corres/.)
FEE RF;CEiVED VALID. NO. J t? PE~'IiT NO. j
(Yes or No)
REVIEWED BY APPRO"v3D DAiw'
(Initials) (Yes or No)