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Parcel 040-1073-50-000 06/04/2007 04:11 PM
PAGE 1 OF 1
Alt. Parcel 18.28.19.280F 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 - ZIMMER, NATHAN T
NATHAN T ZIMMER
328 CTY RD F
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 328 CTY RD F
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.760 Plat: N/A-NOT AVAILABLE
SEC 18 T28N R19W.76 AC IN NE SW COM S Block/Condo Bldg:
1/4 COR SEC 18, TH N 1505 FT TO POB: TH
S 83 FT, N 88 DEG W 445 FT, N 83 FT, TH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
E 445 FT TO POB EXC E 45 FT FOR HWY 18-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/12/2005 784854 2730/335 WD
08/15/2002 687154 1949/504 WD
07/23/1997 510/335
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 0.700 30,000 163,000 193,000 NO
Totals for 2007:
General Property 0.700 30,000 163,000 193,000
Woodland 0.000 0 0
Totals for 2006:
General Property 0.700 30,000 163,000 193,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 116
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 Serriees
Plb Alb? 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. OWNER OF PROPERTY
Name Address (Street. City, Zip Code)
I
B, LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY
`
Check One: J '
CITY VILLAGE LEGAL DESCRIPTION
TOWNSHIP `r
~ - ? t l
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NG % PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION _ REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in place Steel Other
NUMBER OF TANKS TO BE INSTALLED: 1
E. TYPE OF OCCUPANCY
Cheek One: One or Two Family Residence Commercial In:strial Other
P (Specify)
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Hasher YES NO
Dishwasher YES NO Automa.ttLo Potato Peeler YES NO
Other (Specify)
G. MASTLR PLUI1ER MAILING INSTALLATION
Name: - Address: License Number:
Signature of Applicant: _ MP RSW
Address:
H. (To be Completed by Issuing Agent)
Date of Application Fee Pe.L'd
Permit Issued (date) Permit: Number
71 /
Agent (Name) For:
Town, Village, City, County, etc.
r' (Specify)
Note: The application cannot be considered for filing until all of the above questions are answered and the
fee paid. Agents will ror~ard application, the fee of 41.00 for each septic tanx and the third copy
of the permit (canary) to tte Division of Health. Checks and money orct-drs should be made payable to
the Division of Hsi--t,..
Do not write in space below - FOR DEPAR.TttC NT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) See Corres.)
FEE RECEIVED VALID. No. 3 I 1~~ PERMIT NO.
-(Yes or w:)
1 REVIEWED BY _ APPROVED DATY
II (Initials) (Yes or No
COMPLETE OTHER SIDE
SEPTIC TANK PERMIT NO.
R E P O R T 0 H S O I L P Z R C 0 L A T I 0 N ? E S T
A N D S O I L B O R I N G S
TO
DIVISION OF HEALTH - PLUMBING SECTI6N
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P Z R C 0 L A T I 0 N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inohes ~Iinutes
Humber Inches Thickness in Inches Since Hole in Hole Interval Ses;ond to Next to Last To Fall
1st Wetted Overnice in Minutes Last Period Last Period Period One, Inch
Example
P - 0 3611 To Soil 1011 Ca•* 261i 25 Yes or No 30 212 1/2 1/2 60
RECORD DATA FROM MIND1UM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L B O R I N G S- Minimum 3611 Below Pro osed Abso tion System
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Cbserved Tatimated Observed Estimated Character of Soil with Thickness in Inches
Example
B - 0 7211 7211 black To Soil 1211CLAX 1811 Sand 18"; Gravel 2411
r
RECORD DATA FROM MINL`UM OF 3 BORE HOLES
i
f
PE OF OCCUPANCYs j
RESIDENCE: Number of Bedrooms OTP.ERs (Specify) Number of Persons Y
D WASTE GRINDERS Yes No Dishwashers Yes No ` Automatic Clothes Washers Yes No
EFFLUENT DISPOSAL SYSTEMS NEW EXTENSION ADDITION REPLACZJT
Tile Size No.Lin.Feet Trench Width Depth Dumber of Lines
r
Seepage Beds Length Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth
I, the undersigned, hereby certif, that the percolation tests reported oi. this for= were made by me or under my super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and
that the data recorded and location o' test holes are correct to the best of my knowledge and belief.
NAME TITLE
Type or Print
REGISTRATION NO, or MASTER PLIM ER LICENSE NO. ~ C
ADDRESS
DATE SIGNATURE -.r_ i`
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