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Parcel 040-1071-80-000 05/25/2007 08:52 AM
PAGE 1 OF 1
Alt. Parcel 18.28.19.274E 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 - BEEBE, JOHN W & LORIE L
JOHN W & LORIE L BEEBE
355 CTY RD F
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 355 CTY RD F
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.500 Plat: N/A-NOT AVAILABLE
SEC 18 T28N R19W 1.5A IN SW NE COM SW Block/Condo Bldg:
COR NE1/4, TH E 1175 FT, TH N 591 FT, W
225 FT TO POB: TH W 385 FT, S 170 FT, E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
385 FT, TH N 170 FT TO POB 18-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/06/2000 633077 1556/546 PR
02/16/1999 597860 1403/637 TI
07/23/1997 483/151
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 1.500 48,400 186,400 234,800 NO
Totals for 2007:
General Property 1.500 48,400 186,400 234,800
Woodland 0.000 0 0
Totals for 2006:
General Property 1.500 48,400 186,400 234,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 217
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Health and Social Sorvices
: +'=a•,67 3/70 Division of Health
• SEPTIC TANK PERMIT APPLICATION V/~~?~/_--_1
• I~.tt, V WD l
TYPE or USE BLACK INK
A. OWNER OF PROPERTY
Name Address (Street, City, Zip Code)
B. LOCATION OF PROPERTY WI :RE SYST£c'I WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Lf
Check Ore:
CT_TY Vir-I- E LEGAL DESCRIPTION
TOWNSHIP 1 / i : 4 C` ~t c S
C. IS LOCAL PERMIT REQUIRED FOR THIS WOP ? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY tz Gallons NEW INSTALLATION ; REPLACEMENT ADDITION
*IATERIALS: Prefab Concrete a, poured in PI~ce Steel Othei
NUMBER OF TAh;{S TO BE I `iSTALLED:
E. TYPE OF OCCUPANCY
Cheek One: One or Two Family Residence Commercial Industrial Other
Specify)
Number of Persons to ba Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food `Waste Grinder YES NO Automatic Clothes Washer YES NO
Dishwisher j YES NO Automatic Potato Peeler YES- NO
Other (specify)
G. MASTER PLUI"-ZR MAKLING INSTALLATION
Name: 1 f!~ Address:~=Z~~~y~f ("License Number:
1 t
Signature of Applicant: f_ c r r Y MP RSW A"
Address:
(To be Completed by Issuing Agent)
- / ? ~7 , # d
Date of Application _ - / Fee Paid
Permit Issued (dates)/ Permit Number
Agent (Name) Fors _:<-1
Town, Village, City, County, etc.
(Specify)
Note: 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 $1.00 fir each septic tanx 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 space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETURNED
f (Initials) (Date) See C-.•~ra(s.t
FEE RECEIVED VAI,~TD. No. PERMIT NO. Q'--)
es or Na
REVIEWE0 BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
SEPTIC TANK PERMIT NO.
R I P 0 R T O N S O I L P S R C 0 L A T I 0 N ? E S T
A N D 5 0 I L B O R I N G S
TO
DIVISICN 0° HEALTH - PLU-011 ~ SECTION
P.O.Box 309, ra.dison, Wis. 53701
Pursusnt to H 62.20, Wis. Administrative Code
P B R C 0 L A T I 0 N T I S T
Test Depth Charaoter of Soil Hours Hater Tes-; Time Drop `.n rater Level Inches I~nutes 1
Number I Inohe3Thiokno33 in Inohas Since Hole in Holo Interval Second to Next to Last To 4n_.
lst Wetted Over'% ht in tt',tute3 Last Period Last Period Period ~'-3~ Inch
E~ x^pie
P - 0 3611 ?o Soil 10" C1a 26~" 25 Yes or No 30 1 2 1/2, 112 ' 60
~L t1.a:3 ~~1j' <i /t L j
i.J L-
RECORD DATA FROM MINR~R[M OF 3 TEST HOLES
Compute size of absorption area in accord with H.62.20 Wis. Administrative Coda.
I
S O I L B 0 R I N G S- Miilmam 36'f Below Prooosed Absorption 5 st.'m ~
Boring Total Depth Depth to Ground Water 02 2" to Bedrock
N Leber Inchaa Inserved E3-tir tad Oose:^ied Estimated Character of Soil with Thioinness in Inches
Example -
A - 0 72" 72" Black Top Soil 12''; Clay 1811; Sand 1811• a a) 94
14 ~Oit.
~y~ y 4
n , J L' Shce'
RECORD DATA FROM MI'YP,IUM O? 3 BORE HC-1-Z3
YPE OF OCCUPANcyt
RESIDENCE: Number of Bedrooms OTHER; (Specify) Number of Parsons <
D WASTE GRLNDERt Yes No Dlshnashers Yes No Automatia Clothe.t Washer: Yes No
FFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION RF3L1C-1-'-N'
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Linea
Seepage Pits Inside Diameter / Liquid Depth
I, the =darsigned, hereby eert._y that the percolation tests reported zn this fora were ride by me or under n1,• super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisoonsin Administrative Coda, and
that the data-recordad and location of test holbs are oorr_et to the best of my knowledge and belief.
y -
NAME TITLE -
Type or Print ! 1 f`~'
0 / t
REGISTRATION NO. or MASTER PLJMBER LICF?IS£ NO.
ADDRESS
DATE ~~'J- A Lam/ SIGNATURE A -