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Parcel 040-1071-70-000 05/25/2007 08:51 AM
PAGE 1 OF 1
Alt. Parcel 18.28.19.274D 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 - SCHULZ, JOSEPH A & BEVERLY
JOSEPH A & BEVERLY SCHULZ
357 CTY RD F
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 357 CTY RD F
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 7.500 Plat: N/A-NOT AVAILABLE
SEC 18 T28N R19W BEGIN 250 FT N & 75 FT Block/Condo Bldg:
E OF SW COR SW NE; TH N 420 FT, TH E 15
FT, N 215 FT; E 400 FT; S 294 FT TH E 75 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
FT S 343 FT TO CL RD TH WLY TO POB 18-28N-19W
I G 1-. CRIES AS DESCRIBED IN VOL
4 81 PAGE 26
6
Notes: Parcel History:
Date Doc # Vol/Page Type
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/20/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.500 85,000 188,000 273,000 NO
Totals for 2007:
General Property 7.500 85,000 188,000 273,000
Woodland 0.000 0 0
Totals for 2006:
General Property 7.500 85,000 188,000 273,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 122
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 040-1071-50-000 05/25/2007 08:52 AM
PAGE 1 OF 1
Alt. Parcel 18.28.19.274B 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 5
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - ERDMAN, JUNE M
JUNE M ERDMAN
N KA baA vd~f'f
l
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 5.920 Plat: N/A-NOT AVAILABLE
SEC 18 T28N R19W W 1175 FT OF S 1105 FT Block/Condo Bldg:
OF SW NE EXC P274D & E & EXC LOT 1 & 2
OF CSM V4/1122 NKA PT OF DEER VALLEY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
18-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/22/1999 614326 1473/104 TI
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 02/17/2000
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 0 0 0
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
Flb, f}57 1069 Wisconsin Department of Health and Social Services
Division of Health
PEitUT APPLICATION w~
forj
PRIVATE D,a"k:STIC SEWAGE SYSTE"fS _
A. OWNER OF PROPERTY TYPE OR USE BLACK INK
Name Address (Street. City, Zip Code)
County
B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED, ALTERED 03 EXTEINDED ,
Check One: /iC S~
('ft~ i1 f~/',~ c~ 3 tj~)` 7
CITY VILLAGE LEGAL DESCRIPTION; c'/= %r'y~' +t. ' ~l✓i)r: ic'I: CF 1`/+l f'
TOWNSHIP
57
/47
C. IS LOCAL PEFE`YIT REQUIRED FOR THIS WORK? X YES
NO pEFC~IT NUMBER
D. SEPTIC TANK CAPACITY 1!~ ( Gallons NEW INSTALLATION REPLACE" EINT ADDITION
MATERIALS: Prefab Concrete _1_:." Poured in Place Steel Other
NUrJER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other
_ Specify
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETCs Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dish•Taasher YES NO Automatic Potato Peeler YES NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Length Width Depth Tilp Size No. Lines
Seepage Pit' Inside diameter /L Liquid Depth -
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches Ninutes
Number Inches Thickness Li Inches Since Hole in Hole Interval Second to I Next to Last To Fall
Example lst Wetted Overnizht in Minites Last Period Last Period Period Dae Inch
P- 0 3611 To Soil 10" Clay 2611 25 es or no 30 112 1 2 1 2 60
f x;~ r'
' RECORD DATA FR NI MTNIMUM OF 3 TEST HOLES
I
Compute size of absorption area in accord r;iih H 62.20 Wis. Administrative Code.
S 0 1 L B O R I N G S- Minimum 36" Below Pro osed Absoration System
oring Total Dapth Depth to Ground Water Deotn to Bedrock
lumber Inches Cbserved Estimzted Observed Estirated Character of Soil with Thickness in Inches
xample
0 7211 72" ) Black Too Soil 12"• Cla• 18"• Sand 1811, Gravel 24"
RECORD DATA FROM MINI'ILUM OF 3 BORE HOLES
COMPLETE OPHER SIDE
Ip the undersigned, hereby certify that the percolation tests reported on this fonn were made by me
or under by supervision in accord %vith the procedures and method specified in Chk%pter H 62.20 (3),,
Wisconsin Administrative Code, and that the data recorded and location of test hnles are correct to
the best of my knmrrledge and belief.
NAME TITLE _
(Type Tr Print) W
REGISTRATION NO. or MASTER PL;JI'a ER LICENSE No.
ADDRESS
DATE SIGNATURE
MASTER PUjTT3-'R MAKING APPLICATION
MP
Signature: License Number;
MP RSW
(To be Completed by Issuing Agent)
Date of Application Fee Paid $ ,i
Permit Issued (date)" `?/'`•~/i Permit Number
Agent (name) r'` l / ' L1 Z J17 For
Town, 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 for-ward 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 DEPARTMENT USE ONLY
DATE RECEIVED 13 ACCEPTED BY RETURNED
(Initials) / l (Date) See Corrrjers.)
FEE RECEIVED VALID. NO. L1 ~LL? PEFMIT NO.
(Yes or No)
REVIEWED BY APPROVED _ DATE
(Initials) (Yes or No)
a
FcOMENTS: