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Parcel 040-1019-90-000 07/21/2006 11:44 AM
PAGE 1 OF 1
Alt. Parcel 04.28.19.64C 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 - ANDERSON, DAVID R & JACQUELINE M
DAVID R & JACQUELINE M ANDERSON
522 MARSON DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 522 MARSON DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.690 Plat: N/A-NOT AVAILABLE
SEC 4 T28N R19W.69 AC PT SE SE COM Block/Condo Bldg:
1745.67 FT S OF NW COR NE SE, S 150 FT,
E 200 FT TO W LN OF RD, N 150 FT, TH W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
200 FT TO POB 04-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/01/1999 611337 1460/228 WD
07/23/1997 884/460
07/23/1997 713/294
07/23/1997 554/49
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 0.600 35,200 190,800 226,000 NO
Totals for 2006:
General Property 0.600 35,200 190,800 226,000
Woodland 0.000 0 0
Totals for 2005:
General Property 0.600 35,200 190,800 226,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 125
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 040-1019-90-000 02/16/2006 04:56 PM
PAGE 1 OF 1
Alt. Parcel 04.28.19.64C 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 - ANDERSON, DAVID R & JACQUELINE M
DAVID R & JACQUELINE M ANDERSON
522 MARSON DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 522 MARSON DR
SC 2611 SCH D OF HUDSON - -
SP 1700 WITC 1 U
V~
WI- S
Legal Description: Acres: 0.690 Plat: N/A-NOT AVAILABLE
SEC 4 T28N R19W.69 AC PT SE SE COM Block/Condo Bldg:
1745.67 FT S OF NW COR NE SE, S 150 FT,
E 200 FT TO W LN OF RD, N 150 FT, TH W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
200 FT TO FOB 04-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/01/1999 611337 1460/228 WD
07/23/1997 884/460
07/23/1997 j__713/294--,'
07/23/1997 _ 554/49 !
2005 SUMMARY Bill Fair Market Value: ,As essed wi
102160 234,800 /3olk " 1q~ I~ ~J (~6bJ►is
Valuations: Last Changed: 07/15/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.600 35,200 190,800 226,000 NO
Totals for 2005:
General Property 0.600 35,200 190,800 226,000
Woodland 0.000 0 0
Totals for 2004:
General Property 0.600 35,200 190,800 226,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 125
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
//11 f~ j C~ Wisoonsin Department of Health and Social Services
Plb. #G7 10/69 ~~V r IU 1 `a" Division of Health
r PE_V1IT APPLICATION
t for
PRIVATE D(i"-vSTIC SEWAGE SYSTEMS
A. OWNER OF PROPERTY TYPE OR USE BLACK INK
Name Address (Street, City, Zip Code)
County
B. LOCATION OF PROPERTY WHERE SYSTf11 WILL BE CONSTRUCTED, ALTERED OR EXTENDED
Check One:
_ CITY VILLAGE LEGAL DESCRIPTION:
77TOWNSHIP
C. IS LOCAL PEFMIT REQUIRED FOR THIS hDRK? YES NO PEtu`1IT NLTIBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION \ RE?LACEMENT ADDITION
KA TERIAIS: Prefab Concrete Poured in Place Steel Other
t
NU1fi3ER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence ~ Commeroial Industrial Other
Specify)
Number of Persons to be Accommodated ' Number of Bedrooms
F. APPLIANCES, ETCt Food Waste Grinder _YES NO Automatic Clothes Washer YES NO
Dishwasher YES NO Automatio Potzto Peeler YES NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT
Tile Size +No.Lin.Feet T rench Width Depth ~r Number of Lines
Seepage Bedt Length 1 Width r ~J Depth a~ Tile Size i" No. Lines
/ Seepage Pit: Inside diameter Liquid Depth
! P E R C 0 I, A T I 0 N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches Minutes
Number Inches Thickness +.n Inches Since Hole in Hole Inter':al Second to Next to - Last To Fall
1st Wetted ~Overnivht in Mi;mtes Last Period Last Period Period Oie Inch
Example
P- 0 3611 Top Soil 10". Clay 261t 25 es or no 30 112 1 2 1 2 I 60
' RECOP,D DATA FROM MINIMUM OF 3 TEST HOLES
Compute eize of absorption area in acoord with H 62.20 Wis. Administrative Code.
S O I L B O R I N G S- Minimum 36" Below Proposed Absorption System _
Boring Total Depth Depth to Ground Water Depth to Bedrock
umber Inches Observed Estilmated Observed Estimated Character of Soil with Thickness in Inches j
:Knp1e ~ j
- 0 72" 72" p. Black Too Soil 12"
Clav 18tt Sand 1811, Gravel 2411
%
N
RECORD DATA FROM MINI'HUM OF 3 BOR~: HOLES
COMPLETE OTHER SIDE
v
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me
or under by supervision in accord with the procedures and mothod specified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and that the data recorded and lccation of test holes are correct to
the best of my knowledge and belief.,
NAME ?jam d i j f'_ TITLE
(Type or Print)
i
REGISTRATION NO. or MASTER PLUMBER LICENSE No.
ADDRESS j I i i; i _ i~` r t 11 f /r s-~ r
DATE F 1 r€ f~ /Jt SIGNATURi~
MASTER PLUI;D:iR MAKING APPLICATION
MP
Signature: < p License Number:
MP RSW f, j
(To be.Completed by Issuing Agent)
Date of Application % , 7~" Fee Paid $ L C
Permit Issued (date) Vxlo Permit Number ~r•
Agent (name) For Tovm, Village, City, County, etc.
(Specify)
Notes The application cannot be considered for filing until all of the above questions are answered
and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
Do not write in space below - FOR DEPARMENT USF; ONLY
2
t
DATE RECEIVED O ACCEPTED BY RETURNED
f (Initials) (Date) (See Corres.
FEE RECEIVED VALID. NO. PE91IT NO.
(Yes or No)
REVIEWED BY APPROV3D DATE
(Initials) (Yes or No)
rC0.u1ENTS:
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