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HomeMy WebLinkAbout012-1021-20-200 \ 0 2 $ $ $ _ j 2 � . j 2 k e o / ) 0 a / R (D . 2 §_ § & ( / ) $ k ƒ/ c 2 U. c £2 ® 3 \ f 3 \ 12c J [ J )0 « z z f E E i z 0 8 \ j IL m IL m m e z E k § !t :3 n 3 \ k K 7 7 f z / E / E \ . (D § ] 7 ) f 7 } 0 D \ � ƒ f f k 4) < k 2 < Q z = z z m z .. .. z 0 } 2 u § § % co S ; 12 0 a ) 2 0 a a ) / 2 8 \ k k k L \ k $ / k_ \ E w E e z § o - WAWA k § a 2 a E m m a IL E A o B � 2 2 0 E 2 2 0 u ; » a z » a e z = o o 2 B e § § a o \ \ { (D _ co § « o 2 a 2 ) z m 2 J » m % G 2 7 7 s 2 ° « o ) I \ ] o } a ) 2 a ) . E Cl) ° § ) I a § § 2 { 2 \ \ k § ® § § / $ $ k / I ) E 2 = 2 k o m o - ° ° a i o c . \ z 'D z z = - & ] 'r ; 0 § $ $ k 2 / / 0 § § k k f f3 o w : _ o z _ w z o z _ e w ■ m J 2 § E I B 2 . — , : " a » " � » E ' : k a § k a § _ / J a 2 0 3 v o U) J f Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 4&_1ej_ � TOWNSHIP SEC. T 'J 0 N-R r? W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION 14 LOT LOT SIZE (J/4 PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM , n Od 4 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point Elevation of vertical .refefAnce point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Roads Front,$?)Side 0 Rear, 0 feet From nearest property line ' Front,OSidegRear,O feet Number of feet from: well , building: (Include this information of t e above plot plan) ( 2 reference dimensions to septic tank) PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model:: Pump/Siphon turer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevatio Gallons per cycle: Alarm Manufacturer: Alarm- Switch Type: Number of feet om nearest property line: Front, O Side, O Rear,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: 4 Width:_ ,N t Length: Number of Lines: Z Area Built:� Fill depth to top of pipe: Z, Number of feet from nearest property line: Front, Side, () Rear,O It 44 Number of feet from well: /9� t N� Number of feet from building:' `7 (Include distances on plot plan). SEEPAGE PIT , Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: I Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Af Dated: �— l � Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAIN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: NE%,NE%,S&,T30N-R 17LU (If assigned) CONVENTIONAL ❑ ALTERATIVE Town o Etr%n Pha cJt e Q 1:1 Holding Tank In-Ground Pressure L] Mound A E R: ADDRESS OF PERMIT HOLDER: INSPECTION CIA BtL an John.6ton Route 3, Box 139D, New Richmond, W1 54017 11-14 — �k ;vv BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Gary L. Steel 3254 St. ctoix 119370 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER y PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST----* DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF [--]YES ❑NO NEAREST--* SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET:I ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST----1111- MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: 3 `9 El YES E]NO ❑YES E]NO NEAREST' 3g x,,37 (,.14 Sketch System on Retain in county file for audit. Reverse Side. slcNAruRE: TITLE Zoning Adm.%v�%S�j�, h G SBD-6710(R.06/88) SANITARY PERMIT APPLICATION COUNTY � DILHR St. Croix In accord with ILHR 83.05,Wis.Adm.Code STAZESANITARYPERMIT# // 9'3 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—.PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 1;2 NO PROPERTY OWNER PROPERTY LOCATION Brian Johnston NE % NE %, S 8 T30 , N, R 17 XMor)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME R.R.0, Box 139D n/a n/a n/a CITY,STATE ZIP C DE PHONE NUM R CITY NEAREST ROAD,LAKE OR LANDMARK New Richmond, Wi. 54017 175 2�+Fb-7287 O VILLAGE : Erin Prarie 170th.st. MxTOWN OF II. TYPE OF BUILDING OR USE SERVED: 01 — Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a.)E] New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tan Onl an Existing System Existing System 2. A Sanitary Permit was previously issued. Permit## � a�t"3 Date Issued 47— m— Frg 3. An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. Monventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e.❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. wee a e Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 1 495 500 96.34 Feet RiPrivate ❑Joint ❑ Public VI. TANK CAPACITY Prefab. Site Fiber- Exper. in alIons Total #of Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New Existing Gallons Tanks structed Tanks Tanks ❑ Septic Tank or Holdi no Tank X 1000 1 Weeks L1 El ❑ Lift Pump Tank/Siphon Chamber ------ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for insta at' n of the privates wage system shown on the attached plans. Plumber's Name(Print): Plumbe lure:(N S mp PRSW No.: Business Phone Number: Gary L. Steel 3254 715 246-6200 Plumber's Address(Street,City,State,Zip Cod Name of Designer: 988 N. Shore DR. , New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Gary L. Steel CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. Shore DR. , New ARa Richmond, Wi..aS�CD ' 715 246-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate is wing Agent Signature(No Sta ps) rcharge Fee Approved ❑ Owner Given Initial a ` I Adverse Determination 1 1 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed- pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Prcaerty owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks.; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points;' C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer;.D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. --------------------------------------------------------------------------------------------------------------------=_------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground ate[-- included the creation of surcharges (fees) for a number of regulated practices which Wisco int.S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasute' is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. ° 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) Brian Johnston NE4NE4 S8 T30N. R17W Erin Prarie, township 1v0 40 mss'sP ` ! 150 7i- r� 03 `i s Gary L. Steel 988 N. Shore Dr. New Richmond, Wi. 54017 MPRSW 3254 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IND'USTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63.09(1) &Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BILK.NO.: SUBDIVISION NAME: -NE 1�4NE1/ 8 /T30 N rW /1117 ) Erin Prarie n/a n/a n/a COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Brian Johnston R.R.0, Box 139D, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO.BEDRMS : COMMER IAL DESCRIPTION: PROFILE DE RIPTIONS: PERCOLATION TESTS: Residence 3 n/a fRNew ❑Replace 15-13-88/10-17-88 10-17-88 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSUR :SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ❑U lff�s ❑U ❑S nU conventional If Percolation Tests are NOT required DESIG RATE: If any y portion of the tested area is in the n/a under s.H63.09(5)(b),indicate: I Floodplain, indicate Floodplain elevation: decimal' PROFILE DESCRIPTIONS Page 29 JSB BORING TOT/�L_ DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTII�__ ELEVATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B 1 7.0� 101.64 none >7.08 1.33bl.1. 1.50bn.sil. 1.00bn.s.sl. 3.25bn.l.s. 101.63 1 1 2 1 bn l.s. 2 2 b.n 3 7.34 100.85 none >7.34 1.42bl.1. 1.00bn.sil. 1.42bn.s.l. 3.50bn.l.s. s.l B- 4 7.08 100.45 none >7.08 .83bl.1. 1.00bn.sil. 1.25hIn,:as.l. 4.00bn.l.s. 5 7.25 none >7.25 1.58bl.1. .83bn.sil. 1.17bn.s.l. 3.67bn.l.s. B- 6 9.19 `-99: 5 none >9.19 1.42bl.1. 1.75bn.sil. .50bn.s.1. 5.50bn.l.s. 7, 8.84 99. none >8.84 .75bl.1. .75bn.sil. .92bn.s.1. 4.42bn.c.s. .92b -- B-8 9.50 100.00 none >9.50 .83bl.1. 2.58bn.sit: .42bn.s.1.5.67bn.c.s. 1• ' S. 9 8.09 none >8.09 6b11 • .50bri.�il .=.75bi� s.la 6.17b'L s. B10 9.08 99.95 none >9.08 .83bl.1. 1. 3 n fin.c.s. .75bn s.l 6- 11 8.17 99.90 none >8.17 1.00bl.l. 1.92bn.c.l.s.&gr. 4.00bn.c.s.&gr. 1.25 decimal' PERCOLATION TESTS •29 JSB EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVE CHES-I RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P, ,1. 4.00 none 3 4%2 4 4 1 P- "2 3.56 P- P P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation refernce points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 96.34 � _ _-,_ 13y -- r E 1 QLr ( - _ _ - _ I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: Gary L. Steel 11-7-88 ADDRESS: CERTIFICATIO NUMBER: PHONE NUMBER optional): 988 N. Shore Dr. , New Rithtoond Wi, 54017 229 715-246-6200 CST SIGNAT RE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. -)ILHR-SBD-6395 (R.02/82) -OVER- , . . INSTRUCTIONS FOR COMPLETING FORM 115' SB[} ' 6395 Tobea complete and accurate soil test,YOU" report muStindude: I, Complete |ona| description; J, The use section must clearly indicate vvhotho'this is residence or commercial project; 3, MAXIMUM numbmmf Ued,vomsorcommercial use planned; 4� |o this o nnw or run|uvmment system; 6, Complete the �uitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED 0N SOIL CONDITIONS: 6. PLEASE uoozhn mbbr,vimions shown he,e for writing profile descriptions end completing the plot plan; 7� MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to ma|c is preferred. A oeuarmesheetMay bm uSod ifd,oimd� nd me permanwnz�8. Kmko �ur:vour bonchmn,k and vo,dco| dovutin^ rofmmnce point are c!mr{y shovn'a O, Complete all appropriate boxes as tudmtes' nomes.adVmsnes'flood plain data, percolation test exomp' dpn' ifapp,oprimo; }D |fjhe info,motion (such as flood n|ain'c|emnion) does xcx apply, place NLA� in /h*apmnnphmte box; 1]� SiQn thm fornn and place your oonem address mnel your certification numbc,; 12, Nbko |ogib!e cupkm and diSli-ibute as mnuimd� ALL SOIL TESTS MUST BE FILED WITH THE LO�ALAUTHOR|TY WITHIN 3O DAYS QFCOMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols, w — Stone (over lO^) RR — Bedrock oob — [boWe (3 lO'') 3S — Sandstone B, — Gravel (under 3") L5 — Lime,tnnn °o — Sand HGVV — HighG,ound"wac^r uu — CoarsmSand Pv/o — Percolation Rate mod — 1`811divm5ond VV — VVeU fs — Fine Sond B|dn — Building |s — Loamy Sand — Greater Thin Sandy Lomm ( — Less Than Loam B — Brown Silt Loam B| — B!aok oi — [i|t Sy — Gray °c| — Ch y Loam Y — Yellow oc| — Sandy Clay Loam R — Red oic| — 9UtyC|ay Loam mot — mottles `c — Sandy Clay «»/ — v!ith ) . 'ic — Si|-tv Clay fff — few' fino' faint ~c — Qnv oc — cvmmon' coao° p" _ PmI mm — Mm^v' nwdivm m — Muck d — distinct ~ ? , P — pmminvnt HVVL — High 'vvoz r !m=|' BxqPnara| soil lemures su,-face wate, fo.liquid vvast�djsposa| BM — Bench Mark ` VRP — Vertical Reference, Point / -/ .. ' ` . ` TO THE OWNER: This mzi| tesl u+porl is the fie:step in oexring o sanitary purmb, Thu county or the OeportmAm mayroquou verification of this soil test in the field Prior to »emit A oomp|mm :eA of plans for t h e private � maaogm system and o penmil application muat bosubmitxod to /heapn,oprimm local autho,by in onie, uo oblai^ a pc,m.t. The sanitary permit must be obtained and pouod p,iorto thc start ofonv ronot,uetion� s i i t i r 3 z E �- f 77 co f r M I r DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 State Plan NE'-4, NE4,S8,T30N-R17W gCONVENTIONAL ❑ALTERNATIVE Ili assgned)D.Number: Town of Erin Prairie ❑Holding Tank ❑In-Ground Pressure ❑Mound 170th Street NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Brian Johnston Route 3, Box 139D, Ne wRichmond, WI 5 017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: IMPIMPRSW No. County: Sanitary Permit Number: Rick Troff 3225 St. Croix 112663 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.. IWARNINGLABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO OYES ONO BEDDING. VENT DIA.. VENT MATL: HIGH WATER NUMBER OF ROAD', PROPERTY WELL: BUILDING.JVENTTOFRESH ALARM FEET FROM LINE AIR INLET OYES ❑NO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BN G LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED'. PROVIDEDYES ONO ❑YES ONO I DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING JVENTTOIRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) —]YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING COVER INSIDE DIA 11IT1 LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV INLET ELEV.END'. PIPES FEET FROM LINE AIR INLET NEAREST— MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS IOIISIHVATIIIN WE 11 OYES 1:1 NO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. DYES ED NO OYES ONO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL f_0DISTR DISTR.PIPE UISTH IBUT ION PIPE MATERIAL&fIAHKING ELEV. ELEV.. DIA.. ELEV. PES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO 1:1 YES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE ❑YES ONO 1:1 YES 1:1 NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE. DILHR SBD 6710(R.01/82) Zoning Administrator SANITARY PERMIT APPLICATION COUNTY (� ®ILHR In accord with ILHR 83.05,Wis.Adm.Code ST C o STATE SANITARY PERMIT# i/a 10 6.2 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO PROPERTY OWNER PROPERTY LOCATION 13 "� *E '/a F'/a, S T , N, R *(Or W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER 1 VILLAGE , NEAREST R AD,LAKE OR LANDMARK a Sol e o II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. M New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. �Conventional b. El Alternative c. El Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) i 1. a. W seepage Bed b. ❑Seepage Trench c. ❑ Seepage Pit oc S 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: `` (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): C`ass • 945' CPU' q7�3� Feet U Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons I Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1 DOo wiesek Lift Pump Tank/Siphon Chamber ❑ 1 ❑ I Li ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): P amb Sign ure: o Stamps) W/MPRSW No.: Business Phone Number: o�� 3a�5' 7 S a�g- Soo Plumber's Address(Street,City,State,Zip Code): Name of Designer: O n ^ 2 Box 70 �!!J I}— VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# 9 6 G e CST's ADIDRESS(Street,City,State,Zip Code) Phone Number: 90 1 R1,CJ%M0wA 5�© i �►5 �-toaoa IX. COUNTY/DEPARTMENT USE O LY ❑ Disapproved Sanitary Permit Fee Groundwater M Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Jb (2o.M ur`c�hS_'. Fee Adverse Determination / W �7'Uo O X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revissons,to.this permit-must be approved:¢y the.permit issuing authority. A new permit may be needed,- if there is a change in your building plans, system location, estimated wastewater flow(nuhnber of bed- rooms, etc.), depth of system, or type,of system; 4. Changes in ownership or plumber�0'1'uires a Sahifary Permit Transfer/Renewal Form (SBD 6399) td be submitted to the county prior to installation; 5. Private sewage systems must be properly maintain4k' The septic tank(s) should be pbmped by`a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Prcaerty owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Install irxg.plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if ' applicable; VIII. Soil test information: Certified soil•testgr's name, certification number, address, and phone number. . IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following:.A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and4pump manufacturer; D) cross section,of the soil absorption system if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984,`1983, Wisconsin Act 410 was signed into law. This legislation is more < commonly known,as the groundwater protectinn law. This change in statutes was the result of over 27 years of steady negotiation aAd-publid debate'.IThe groundwater bill -Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco irtrS '' a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- i water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property Bran Paul Johnston and i;hciryl. Jean Johnston Location of property 1/4 NE 1/4, Section 8 , T N-R 17 W Township ERIN PRARIE Mailing address Fit• 3 box 139 Ii. New Richmond. tiI 54017 Address of site Rt. 3 . New Richmond. n41 54017 Subdivision name N/A Lot number NSA Previous owner of property Michael and Teresa Peterson Total size of parcel 21 Acres Date parcel was created September 17, 1987 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume 791 nd Page Number 232 as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 430 s2,�k5 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document o. l N/A Signature of 0 er Sighcamure of Owne If Applicable) a 8� S 3 Date of Signature Date of Sig atute I DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 430245 BOOK 791 PACE 232 KEGISTERS OFFICE Michael L. Peterson and Teresa D. Peterson ST. CROIX CO., WIS. ------------- ' 17th his wife, a s J o i n t t e n an t s ' Reed. irx Record this - day of Sept. A.D. 19 87 --- ---- ----- --- •--- --- - t 8:30 _A_ ---------------- conve�s and warrants to B.....an Pau - _J.0 h.ns t•o n and C h e r y 1-_.. .............. Jean _J-ohnst•on , husban_d_..and---wjf.e_,.._a- _-marit.d.l....... property with ri-ght"s of 5grv_i-vo_rsh_i.p-_- " - •moo••+• .......... ...................................................... ........ .... RETURN TO BAKKE , NORMAN $ - .......... ---- ----- --------------------- .................. ------•------- --- SCHUMACHER, S . C . . ... . ..... .. .. .......................... -------------- .......... .............. .....--• . the following described real estate in ..S.t.__.CrALX----------........"..."--County, State of Wisconsin: Tax Parcel No: ........................ That part of the Northeast Quarter of the Northeast Quarter (NE4 of NE%) lying North and West of the Willow River, Section Eight (8) , Township Thirty (30) North , Range Seventeen (17) West , Except the North 66, feet thereof. Grantor gives a permanent easement for ingress and egress over the North 66 feet thereof. = 1• o �w This 1S not ....... homestead property. (is) (is not) Exception to warranties: Dated thi - 1 day of Septemb-er . - 19. _8.7. --- ----- - - ------ ------(SEAL) .._ . .... _ .(SEAL) Mi ha I. L. Pet son ' ...... ..... .... ._."......."......__..._... . _.._ .__._.._. ..._..._........._.. .... ......... _ .--..- ` (SEAL) .... _(SEAL) Teresa D. Peterson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Michael L. Peterson and---- STATE OF WISCONSIN ------------------•------------ Teresa D. Peterson ss. -------------------------------------y--••-•-•----•--•-•......-•----........... -----------.County. > ut en I 11t- a of Se t . 19 8.7 Personally came before me this ................day of ------------------------------------------ 19........ the above named --------- -------- ' ThomasR. Schumacher -----------------•-------------------------------------------------------------- --•-•---------- ----------------------•-------•------------------------------- ---------------------------------------------------------•---------------------- TITLE: MEMBER STATE BAR OF WISCONSIN ...................... ----------------------- --------------•••----- ------• -• (If not, ----........................................................authorized by § 706.06. Wis. Stats.) ------•------•------------------•-•------•--------•.------.---- -- ----------- to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY BAKKE, NORMAN & SCHUMACHER, S.C. --••....-------•------ ......................................................... -•-----•---•------------------•-----......----..........------•----••----------- New Richmond, WI 54017 ........................................................ - -----------•----•-•---••-•----•------ --- - ---------•_.........-•----•---- Notary Public ....----------------------.---------------County, Wis. (Signatures may be au4enticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) P date: *Names of persons signing in any capacity should be typed or printed below their signatures. ••--• - STATE BAR OF WISCONSIN to-1. &I— L STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Brian Paul Johnston and Chervl Jean Johnston ROUTE/BOX NUMBER Rt. 3 FIRE NO. CITY/STATE New Richmond. Wisconsin ZIP 54017 PROPERTY LOCATION: NE 1/4 NE 1/4, Section 8 , T 30 N, R 17 W, Town of `iIN PRARIE , St. Croix County, Subdivision NSA , Lot No. N/A Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. -&�� SIGNED r DATE ' MAC g$ St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND C P.O. BOX 7969 HUMAN'RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/CITY: Va T NO.:BLK.NO.: SUBDIVISION NAME: NE 1/4 NO/ 8 /T30 N/R 17 4* rarie n/a 1 n/a COUNTY: OR'S BUYER'S NAME: MAILING ADDRESS: Brian Johnston lip.R.4/3 Box 139D New Richmond Wi. 54017 USE DATES OBSERVATIONS MADE COMMER AL DESCRIPTION: PROFILE DESCRIPTIONS-: A TESTS: Loeeside"°e 3" n/a ®New ❑Replace 5-13-88 5-13-88 RATING:S=Site suitable for system U=Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) LQ S ❑U. �U ®S ❑V ❑ F]U [I S �U conventional If Percolation Tests are NOT required DESIGN RATE.-- [Floodplain,y portion of the tested area is in the under s.H63.09(51(b),indicate: ClaSS 2 indicate Floodplain elevation: n/a decimal'' PROFILE DESCRIPTIONS Page 29 JSB BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE,AND DEPTH NUMBER DEPTH}fV, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.08 101.63 none >7.08 .33bl.1. 1.50bn.sil. 1.00bn.s.1. 3.25bn.l.s. B. 2 7.42 101.63 none >7.42 .00bl.l. 1.00bn.sil. 1.00bn.s.l. 12.17bn.l.s. 2.25 B. 3 7.34 100.85 none >7.34 .42bl.1. l Mbn.sil. 1.42bn.s.1. 3.50bn.l.s. B_ 4 7.08 100.45 none >7.08 83bl.1. 1.00bn.sil. 1.25bn.s.1. 4.00bn.l.s. B- 5 7.25 100.34 none >7.25 1.58bl.1. .83bn.sil. 1.17bn.s.1. 3.67bn.l.s. B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 PERIOD PER INCH P P- seE desijm rate P- P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent - of land slope. SYSTEM ELEVATION 97.34 6 I/ -1_-- - i IT 8 , v �1 . 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: Gary L. Steel 5-13-88 ADDRESS: CERTIFICATION NUMBER: PHONE NUMB ER(optional): 988 N. shore Dr. New Richmond Wi. 54017 2298 15-246-6200 CST SIGN T DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — PLOT PLAN - P5 7 5— — N.E. lot Scale 1 = 60 corner Bor inq = B f Bench Mark = ♦ 1 7 0 • BI T- H. S T. /8�' r B4 eQNg ,� Up" ,'B �� A T 3% s lope -, 52.5 WELL4• Z28 • B5 1,000 gallon i4- bench mark , Wieser septic marker at 100 tank OWNER PLUMBER Brian Johnston Rick Troff mprs 3225 RI*3 " Bo x 139D R 02 , Box 170 A New Richmond , WI 54017 Deronda , W1 54008 NE V4,N E I/4, S 8 , T30N , R 17W 1 -715- 268 -2800 Prarie Township 6 /7/88 ST. Croix County h� �- PAGE OF • CrUSS � �.c �' 1Vr'� O � �l �r0 ��� 5 �1'n'� w Fre4h Air Inlalc And OOOarvallon Pipe C�—Approved Vaal Cap tt Minimum 12'Aoove Final Grade 20-4 2'Above Plpe —4*Coal Iron To Final Grade Vaal Pipe Moen Noy Or Synthetic Covering •IIO 2'Aggragale Over Plpa Ole Pipe — Vlpe •— 0 0 b`Age,alot a Parloreled Pipe Below 0 Too Beneath Plpe —Coupling Taminaling At Dallas 01 Sy•lam Prp�o)Cp �If1A' 9r�.d< SOIL FILL DISTRIBUTIOM PIPE APPROVED Sylll'(NETIC COVER ""--NIATEI 14. OR 4" OF STRAW r of AGGREGATE —�r // OR MARSW HAS ,J In (o OF%2-21/2 AGGREGATE op ELF-V 0F913 FEET— F-3' I 3' 6 .- 6 . <__ 12�--� OISTRI15UTI(DU PIPE T() BE AT LEAS-1 Qb IIJCHES BELOW ORIGIMAL GRADE AMU AT LEAST ZG IAIC14ES BUT WO MORE ThAL) AZ INCHES BELOW FWAl. GRADE • MAXIMUM QGPTI•i OF EXCAVATIDO FKOM oW wu 6KADE WILL BE 42 INCHES MUKIMWM AEPt-N of EXCAVATIOW MOM OIKIGIMAL GRAD€ WILL sE 3 6 INCHES SIGIJEO: LIGEQ5E. WUMBER: DATE 110 Parcel #: 012-1021-20-200 09/07/2006 11:49 AM PAGE 1 OF 1 Alt.Parcel#: 08.30.17.109C 012-TOWN OF ERIN PRAIRIE Current X11 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 BRIAN PAUL&CHERYL JEAN JOHNSTON O-JOHNSTON, BRIAN PAUL&CHERYL JEAN 1698 170TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description 1698 170TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 21.000 Plat: N/A-NOT AVAILABLE SEC 8 T30N R1 7W NE NE THAT PART OF NE NE Block/Condo Bldg: LYING N&W OF WILLOW RIVER Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-30N-17W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 791/232 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 33,000 247,600 280,600 NO UNDEVELOPED G5 19.000 30,400 0 30,400 NO Totals for 2006: General Property 21.000 63,400 247,600 311,000 Woodland 0.000 0 0 Totals for 2005: General Property 21.000 63,400 247,600 311,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 118 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00