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Parcel 040-1019-10-000 09/15/2006 07:53 AM
PAGE 1 OF 1
Alt. Parcel 04.28.19.63E 040 - TOWN OF TROY
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 - ROMUNDSTAD, MICHAEL S & JEAN M
MICHAEL S & JEAN M ROMUNDSTAD
507 OLD HWY 35 S
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 507 OLD HWY 35 S ~7y
SC 2611 HUDSON /1 g
SP 1700 WITC
.K ~b
Legal Description: Acres: 6.000 Plat: N/A-NOT AVAILABLE
SEC 4 T28N R19W 6AC IN SW SE COM 556.4 Block/Condo Bldg:
FT N OF SE COR SW SE, TH S 183 FT, W 350
FT, S 58 DEG W 357.7 FT S 70 DEG W 160.2 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT NWLY ALG E R/W HWY 35 495 FT E 1051.2 04-28N-19W
FT TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
03/14/2001 640409 1601/28 WD
07/23/1997 1025/292 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/23/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.000 77,000 187,700 264,700 NO
Totals for 2006:
General Property 6.000 77,000 187,700 264,700
Woodland 0.000 0 0
Totals for 2005:
General Property 6.000 77,000 158,000 235,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 132
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 040-1019-10-000 02/17/2006 08:26 AM
PAGE 1 OF 1
Alt. Parcel 04.28.19.63E 040 - TOWN OF TROY
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 - ROMUNDSTAD, MICHAEL S & JEAN M
MICHAEL S & JEAN M ROMUNDSTAD
507 OLD HWY 35 S
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 507 OLD HWY 35 S
SC 2611 SCH D OF HUDSON
SP 1700 WITC
C ~~d
Legal Description: Acres: 6.000 Plat: N/A-NOT AVAILABLE
SEC 4 T28N R19W 6AC IN SW SE COM 556.4 Block/Condo Bldg:
FT N OF SE COR SW SE, TH S 183 FT, W 350
FT, S 58 DEG W 357.7 FT S 70 DEG W 160.2 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT NWLY ALG E R/W HWY 35 495 FT E 1051.2 04-28N-19W
FT TO FOB
Notes: Parcel History:
Date Doc # Vol/Page Type
03/14/2001 640409 1601/28 WD
07/23/1997 1025/292 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
102152 244,200
Valuations: Last Changed: 07/15/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.000 77,000 158,000 235,000 NO
Totals for 2005:
General Property 6.000 77,000 158,000 235,000
Woodland 0.000 0 0
Totals for 2004:
General Property 6.000 77,000 158,000 235,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 132
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
f
it
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III
Parcel 040-1019-10-000 07/24/2006 10:37 AM
PAGE 1 OF 1
' Alt. Parcel 04.28.19.63E 040 - TOWN OF TROY
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 - ROMUNDSTAD, MICHAEL S & JEAN M
MICHAEL S & JEAN M ROMUNDSTAD
507 OLD HWY 35 S
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 507 OLD HWY 35 S
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 6.000 Plat: N/A-NOT AVAILABLE
SEC 4 T28N R1 9W 6AC IN SW SE COM 556.4 Block/Condo Bldg:
FT N OF SE COR SW SE, TH S 183 FT, W 350
FT, S 58 DEG W 357.7 FT S 70 DEG W 160.2 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT NWLY ALG E R/W HWY 35 495 FT E 1051.2 04-28N-19W
FT TO POB
I~
I
Notes: Parcel History:
Date Doc # Vol/Page Type
03/14/2001 640409 1601/28 WD
07/23/1997 1025/292 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/15/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.000 77,000 158,000 235,000 NO
Totals for 2006:
General Property 6.000 77,000 158,000 235,000
Woodland 0.000 0 0
Totals for 2005:
General Property 6.000 77,000 158,000 235,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 132
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Departm.3nt of Health and Sooial Seryiaas
3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
r02~- 29~
TYPt or USE BLACK INK
rte v
A. OWNER OF PROPERTY
Name Address (Streets Citye Zip Coda) O.
S. LOCATION OF PROPERTY WERE SYSTEM WILL BE CONSTRICTED ALTFRE3, OR EXTEN'DEP COUNTY -:114
Check One; F7,
CITY VILLAGE DESCRIPTION
TOWNSHIP,,/'
C. IS LOCAL PERMIT REQUIRF'T FOR THIS WORK? YES NO PERMIT NUMBRI
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACKIINT ADDITICN
MATERIALS: Prefeb Concrate Porred in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Cheek One= One or Two Family Residence / Co=E)rcial Industrial Other
(Specify)
Number of persons to be Accommodated h Number of Bedrooms
F. APPLIANCES, ETC; Food 'caste Grinder YES *IO Automatic Clothes Washer YES_ _ NO
Dis2or3sher YES , i4o Auto,--ttio Potato Peeler YES ~ NO
Other (Specify)
G. MASTER PUJT BER MAKING INSTALLATION
Name: 11-~l Address= _~'-ti, ` License I.r
Signature of A olic[aant: M° RSW 7
Address: % kJJ
H. (To be Completed by Issuing Agent)
Date of Application 140 1-2 ] //7 O Fee Paid $ ew
Permit Issued (dat 1'~'7 A, 0 Permit Number
Agent (Name) !=ew~ C~ t1~AJ Fort
Town, Village, City, County, etc.
(Specify)
Note: The application cannot ce considered for firing until all of the ab we questions are answered and the
fee paid. Agents will forward application, the fee of ;I.Ou for each septic taUK and the third copy
of the permit (canary) to the Division of Health. Checks and money orders should be made payable to
the Division of Health.
Do not write in apace below - FOR DEPARTMENT USE.ONLY
1. DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) (S" CorrRS.)
I! FEE RECEIVED VALID. No. (o~ S ~ PERMIT NO.
'es or No
REVIEWED BY APPROVED DATZ
(Initials) Yes or No
COMPLETE OTHER SIDE
SEPTIC TANK PFAHIT NO. 'C7
R E P O R T O N S O I L P E R C O L A T I O N ? E S T
A N D S O I L B 0 R I N G a
TO
DIVISION OF HEALTH - PLL'"'31:Z S=TI N
P.O.Box 309, Madison, Wis. 53701
Pur:su:uit to H 62.20, Wis. Ad;-xinistrativo Coda
P E R C O L A T I O N T E S T
Test Daptlt Character of Coil irc Water Test Time Drop in Hatcr LT ei Lzoiies _ alas
:F=ber Inohes Thiebcno33 in Inohes Since Hole in Hole Interval Second to Next to Last To Fall ~
1st fretted Oveani ht in Min.rtea Mast P riou List Period Far:od C" Inch
Exempla
P - 0 3611 Too Soil 10"; C2 6" 25 Yes or No 30 L
1~2 1/2 1~2 00
1 '7 C2J JG 'SX / C~ /G ~D ~•a ~r i .
' H ~ •%E 7 ' ~ ~ ,LIZ/ , ~ ~ _
1o y%
~
---ar-
RIyOnD DAT:k FROM MI l U`S C? 3 'L'E'ST HOLES
Compute size of absorption &rsa in accord with H 62.20 Wis. Administrative Cods.
S O I L B O R I N G S- 36" Belc-r Pr,oc•oed Abaorction Sy td
Boring Total Depth Dep»h to Ground Wa er Depth to Bedrock
Number Inches Coserved Eatimated Observed Estir bj3 Character of Soil with Thio;ness in 17eh33
Example
B - 0 720 72" B_-.c'.* Top Soil 1'?"• Clay 1811; Sand 1811• ..,ravel 2="
RAT-'`?.D DATA :^M hi-N-T UM. 0? 3 BCR-v ?773
1~'YPE OF OCCUPANCY:
RESIDENCE: Nursber of Bodrooms / OTH3R: (Specify) Nunbar of Persons
FOOD HASTE GRINDER: Yes A- No Disharashnrs Yes No n Aut=a.tic Cloth99 Washers Yes NC
FFLJJP.47 DISPOSAL SYSTEM: NEd EXTENSION ADDITION RZPL CnSNT
Tile Size No. Lin. Feet Tronoh Width ✓ Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth 5 -
I, the undersigned, hereby cert.fy that the percolation tests reported on this form were made by me or undar r.; super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Adainistrative Coda, and
that the data recorded and location of test hole3 are correct to the best of my knowledge and belief.
NAME 16 b TITLE 1 L`-
Type or Print
REGISTRATION NO. or MASTER PLUMBER LI MSE NO.
ADDRESS /
~iS! 7 U SIGNATURE
DATE 0 1,V /
i