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Parcel 038-1087-90-000 12/08/2006 11:49 AM
PAGE 1 OF 1
Alt. Parcel 21.31.18.361 038 - TOWN OF STAR PRAIRIE
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 - LARSON, ROBERT L & PATSY A TR
ROBERT L & PATSY A TR LARSON
1021 210TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1021 210TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 37.990 Plat: N/A-NOT AVAILABLE
SEC 21 T31 N R1 8W NE NW EXC PT TO CSM Block/Condo Bldg:
9/2699
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/05/2000 622492 1508/314 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
175386 Use Value Assessment
Valuations: Last Changed: 10/05/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 32,000 127,500 159,500 NO
AGRICULTURAL G4 26.990 2,500 0 2,500 NO
UNDEVELOPED G5 1.000 100 0 100 NO
AGRICULTURAL FOREST G5M 8.000 20,000 0 20,000 NO
Totals for 2006:
General Property 37.990 54,600 127,500 182,100
Woodland 0.000 0 0
Totals for 2005:
General Property 37.990 54,600 127,500 182,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 309
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wi>c is D r r`:ant of Ht3a th and Soei-,l Servi~er
i Flb. ) ~7 lo/o9 Division of Health
( 't
PE:-;vIIT APPLICATION
for
. ! PRI'JATE DCk':ESTIC SEWAGE SYSI'PNS
.
A. G r+` it OF P4'-) ti'Y ,I TYi'ls OR USE FLACK I
„am. , Address (Streets Cityd//Zip oae}
B. Lry,'kTION OF PROPERLY n- Si U, vILI BE COi~ ~'^tD~ fir. bpi
Cheo''k O-e: _
CIif ViUi,5E I L 1, DZSCRlP1I0? J_, a
TO v raui
C. IS LOCAL PER11T RLaUl?_:D FOR THIS YES
D. SEPTIC TANK CAPACITY Gallons NcW INSTALLATI3N' RE?Lr.CF ANT ADDITIOiI
- _ -
s MIA-1:R!AIS : Prefab Concrete _ Po-fired in Place Steel Other
j NJt'L3E,., OF 7,"4N-KS TO BE IPSTALI'D:
,
E. TYPE. OF OCCU?ANCY }}i _ f
Check One: One or Two Family Residence Corm.+rcial Industrial Other
J Number of Persons to be Acco^anodate.d Number or Eadrooc,s N _
F. A?: LIA.NCES, E'ICa Food Waste Grinder N YES NO Automatic Clothes Washer YES _ NO
Dis,Tasher YES NO Autork%tic Pots o Peeler YES NO
Other {Specify}
G.. EFFLUENT DISPOSAL SYSTEM NEW \ EXTENSION AL'DITIO`J REPLACFa`TN
Tile Size - No.Lin.Feet Trench Y;idth ~ Depth Number of Lines a
Seepage Bedi Len~-;th Width _ Depth _ Tile Size No. Lines
Seepage Pit: Inside diar:eter Liquid Depth i~
E
P£ R C 0 L A T 1 0 N T E 5 T
Test Depth`i --Character of Soil HVal's _ Water !Test Time Dro i,i k'a.er Level Inc inutps
N:urbar Inches ! Thickness in Inones Si i e Kola in Hole _nta Hal Second to Naxt to Mast To Full.
1st Wetted Over i ht in Mi-mtsJ Lxs'. Period Last Per io-" Paris" Onma In,:
P-• 0 36" Top Soil, 10", Cla: .26'~j 25 ~~yas or no ! 30 1/2 ~ 1/2 __1/2 60
i _
RECO.~Fil DATA FR-a, MINIh'Uli OF 3 TEST HOLES
jCoapute aize of absorption arse in accord with H 62.20 Wis. Administ.--'ive Code.
S 0 1 L B O R I N G S Minii= 36" Balm Prooosad Absar%ition System _
bring Total Depth Depth to Ground 'H'ater Deotn to Belroc!t
iuLnoer Inch=.s Cbspr✓ed Estimated Observed Es ii~ated C~racter of Soil with Phickness in Inches
xambie
- 0 72" 72" Black To Soil 1211; Clay la"; Sand 12"; Grviel 24"
RECOr0 DATA FROM MI`.IL[IUM OF 3 BORE: P.OLuS
COMPUTE OTHER SIDE
:j-
` I, the undersi"ned, Yi-rahy certify ih.,,t tine peroolation teats reported on this fore, were m.=dy by me
or under by suparvlsitn in accord ,vith the procedures and method specified in C.,.'ipter H 62.'0
Wisconsin Ad:aini.strative Code, and that the data recorded and lo,a.tion of tes mules are corr,,~~t to
the best of c;y knowledge and belief. r-
J t `y TITL'
(Typo or print)
PhUi°liEk Lice sS 1
REGISTRATION NO. or KASTER o,
DATE ! SIGNATUPF' c
i
KAS Ea PLi!i'Ei PiA{INS=A?PLI A ION Z' '
Signaturt: License r:
U '
'I
(T be ,Co ~pleted by Issuing Agent)
Date of Application ~1 Fee Paid
Permit Issued (da'e) Z/ 1 r_____- Permit Number
Agent (panne) For:
Town, V+llae, City, County, et...
(Specify)
Note: The application cannot be considered for filing until all of the above questions are Rnefered
and the fee paid. Agents will forward application, the fee of $10.00 and Cony (b) of the
Pem,d t (yellow copy) to the Division of Health. Checks and money orders should be trade
payable to the Division of Health.
Do no; write in space beloe+ - FOR DF.PA[ME::`:T USE ONLY
DATE RECEIVa;D ACCEPTED BY RETJP,,ED
(Initials) (Date) (See Corres.) i
FEE R..,..1VED VALID. NO. PE?i'iIT N0.
(Yes or No)
F1EVIEWED BY APPROVS'D DAPS
(Initials) (Yes or No)~
CONL L.F.-NTS
. E