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O a y Parcel 012-1062-50-000 12/12/2006 10:07 AM PAGE 1 OF 1 Alt. Parcel 29.30.17.434 012 - TOWN OF ERIN PRAIRIE 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 - MICKELSON, JOHN C JOHN C MICKELSON 1183 140TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 1355 165TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 29 T30N R17W 40 AC SW NE (642/108) Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1107/108 WD 07/23/1997 801/478 07/23/1997 750/305 07/23/1997 688/41 2006 SUMMARY Bill Fair Market Value: Assessed with: 156173 Use Value Assessment Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 7,000 0 7,000 NO 00 OTHER G7 3.000 30,000 20,300 50,300 NO Totals for 2006: General Property 40.000 37,000 20,300 57,300 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 36,700 20,300 57,000 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 IMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY , 1 c DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 N WI 3707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: W 1/ 1/ 2-? /T 3o N/R/9 E (o W E/P/ti PV141x1F" X' ~o •!G=~3 - -flk COUNTY: OFFS/BUYER'S NAME: MAILING ADDRESS: rf (',PO/X 12 c,K M6 4,E o (p S 7 /UD • yvl~so J, ~'s USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 t/ 4 ❑New Replace /j~~~"~ 7 T RATING: S= Site suitable for system U= Site unsuitable for system 7- CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑s ®u ©s ❑u ❑s ©u os ®u os,ou 11-16avp 0417Zy v ~2 T~ati oL ST•C•~2o~x c~~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the l under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS /'V 1-)ECi'a4hL. FT- BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ~ or a'*' PI{Ty /6 ' '?'a-9y PLAq Si B (P.D/a3.)or Ael is DeKSE 1?.eQ S I wi MAvy µEp. iSTrNC r B- 02- G /-tot ~ /,p' De I3N PI?ry 57 1.) 1. 17 T3,~ . S { , 1. ~3 OP. Si, . 5 B- Z 0 Q DZ S E _-SrS2. S( w _ n f2 w n~-~c . 'D I'S T ' n o T' S .5' 9041/ cl+y 4a y Ll _Dt'sr• B- OP-6- . I'll 0T S 1, 1 - 7S B-.3 CO•o /o% ay 3' s ' I r. 1~e -Aasa- Eo s w' 2po h+I N y m e r) o!z h O rt 5 p' 6^ X C(4 B- /a,r R-► me) -f -1 Lt L2 5-0,0-0r[ ~/4114roct' 0I ~f_k'~ s PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING NTERVAL-MIN. PERIOD 1 PERIOD 2 PE RI D 3 PER INCH p- 2- Qz3 P- r P- 2 z 102,3 P_ r P- 62.3 O z 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. S~~v /R6-',-*-' 1,V f-C4 l fe-e _ 103-S y0 SYSTEM ELEVATION %v y,-o'7"s ov-r 17'11e.113 v' /e4, /0 _.m . i E m . l a [ r I I , _ E Sep- - { t 3 , E y 6 s , t- i A 1987 • ~ i -I l j , . . , I 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): HOMESITE SEPTIC PLUMbft CU. TESTS WERE COMPLETED ON: RT. 3 O'NEtL RD.. HUDSON: WIS. 54011 7 y' 7 ADDRESS: WIS. (MASTER PLUMBER LIC. NO. 3307 M.P.R.S IC CERTIFICA ION NUMBER: PHONE NUMBER(optional DESIGNER LIC. NO 00"3 2 7 2-- CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Au*.hority, Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) -OVEFi - -of IVhis „t of ;53 . J;. > o'I CW ! Wlc 5 "iti ! Co ~)tF_'_trt"q the nl(,_ I.~'-w, e 3>.i°";. 71 s3f ,}r into . oX'=v , xp do"", p fir =olal ti, n lew t.3;errip_ -we a cd, 11..o I1.,C zt. ,3 ? ii' r, E 6. r;ei~I~t`' 73>ttI.=~~e~E. rt,.3~~~T~ 30""' "Sumbok E Et , E € C ~ S t i .drt kt k ~ c(C ~.~i<a'y 811 r. 3 r 3. It, , i. be, loo pR F t , ="i'. °,t! 6= 1 ,3 <3' ,Ct' s, m ,~.3 .~g2_t . e E t i, ,I3i+3. O o. t; 1. ar ft;:3,. r C,t 'iit_ REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 PLOT PLAN Project I.D. 5-0 A' Sly Tod d, HOMESITE SEPTIC PLUMBING M. LEGEND RT. i O'NEIL RD., HUDSON. WIS. 54016 50PrAc E Elf- lATioti15 ~ ROBERT ULBRICHT PLUMPER LIC. NO. 3307 M.Plt& s Backh oe nits J► (Toe L-" O E O F) MRS. MINN. MASTS ~N9TA UE R ER & Z OESIGNE SiGNfR LIC. IC. NO. MW / 00K8 X s Perc Locations JL, o vN D c`'1 e U . _ /o/. 7d Fr' C . S . T . 2482 Existing Well = Vertical Reference Point : TOP Of 6e1=&O 'P4- Elevation of Vertical Reference Point /00-0 Lot Line M N I , /I SCALE ST d~ d S~ y i C 96 ~y K I / ?3 • 10 _ 31 1 - - _ ~ I Ho(3rIE 1 Noti E VERt RED Pr 13V DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, CC DIVISION LABOR BOX HUMAN REDLATIONS PERCOLATION TESTS (11J)>AT~ MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME: 5,,v 1/ 29 /T30N/R/7E (o W 4401,46) /~v o~ ~o "fuels COUNTY: OW44ZS BUYER'S NAME: MAILING ADDRESS: 401's 5f . C,Po/x 1211CK lWr41C 601 Jo X ' 5-7 111,9'#0 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: IPER AT10N TESTS: Residence 2 W. /1 , ❑New Replace )ell ff 7 lf?Ml 7 .9 7 RATING: S= Site suitable for system U= Site unsuitable for system I `I U'0~'e 4 7,f_W 7-7- 5_/L7_CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) El s ®u © S ❑u E] S ®u ❑ s ©u ❑ s DU .you-~P o4,; Z/ L4'1' v i z T7Gw o ST • C~ o r x c~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:" PROFILE DESCRIPTIONS IA' DEGr~~tL FT- BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 6.0 r /03.z0' . 6~' o,r as P"Ty PLAII Si l., 504 51 /43' DRA.SE k?-e.R St we-}l, Mqu y #%t-p. i S Tw c-T- B- ole- 6_mo'f 1 ' /.o' ye I3,., Pl*ry Si t 17 T3a. S1' , 1.83 0R. S , .5 B- Z /0//0 / o i¢e- t? s w f k.w 4-4 . 'Dl's T . A 0 re, s , 50*/ City o hµ W( -m qy y Lj . J4'5r B- OR-6-, - *-to -r s S 61 B-3 (o . Q r /O/. 0 3. 5 ~ a • y Ir ' 'Eys L- E s( w'/ 144 Mep. 5y-44 h0'{'S, iso' &Afy CAy B- /a A-I SpRf'Kr Fail#rlws of PtkcY PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERS ELLING NTERVAL-MIN. PERIOD t PERIOD 2 PERIOD PER INCH P- 2 0.2, 3 /S/ P- i 2 i 2 P- /02.3 P_ 11 1 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. J!~ R_OC,4C /V f~iL "04 _ 3• S i SYSTEM ELEVATION ley yi,er!5 of ) i - - . I I i • i _ P/0 _ r ;e l' 1 , i r I_ I r -r- i i ~ i - . _r _ - - - - - r- 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): HOMESITE SEPTIC PLWOft CU. TESTS WERE COMPLETED ON: RT. 3 O'NEIL RD., HUDSON: WIS. 54016 af IL? 7 ?,P 7 ADDRESS: CERTIFICA ION NUMBER: PHONE NUMBER (optional): ARRI 2-- WIS. MASTER PLUMDER LIC. NO, C 07 NO OV063 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 PLOT PLANT Project I.D. L/4 A(tils /C~ I~ Vof 5-0 A, S.7/r Ted v, 'e/7 ~ HOAIESITE SEPTIC PLUMBING 00. LEGEND RT. i O'NEIL NO., HUMN. WIS. 51016 50P1rACE 6jf_ VAT/ONS~ ROBERT ULBRICHT Ba. c kh o e fits r r TOE L- 1,a E o F) WIS. MASTER PLUMBER LIC. N0.3307 M.P ft / MINN. 4N9TALLER i DESIGNER LIC. NO.OOKB X Perc Locations o uN D crlE U . = /0/. 70 Fr' C . S . T . 2482 Existing Well e9 = Vertical Reference Point : TOP of GeI:E-IJ 'P4.0,0 t P-eJ- Elevation of Vertical Reference Point /00-0 Lot Line N SCALE: v ~ Z ~ ~',Hi lE o f1P/Qox 9 r i C i '?3 ~ ~l~ Nof3,~E \ 1 I f-{ar~ E V ERT Rrf. ;Dr- } i y ~t i~ Y n c'n O 3 v n d `r1 O CD 3 M. z v c_ ID -0 T 1 Off' CD r^ V, ("D 3 3 U) = N Z N Z m O o• 3 m c o CD C') E3 W m --CO 77 0 d Z E M CD O M l^\ N C 0 O W' L Ei. V "s li N 7 O N N D. N r.C O O Q CS CD CCDD A O o O C N n y O (n O 3 N w ? C) o. a o m 0) Cf) (D D a m fl N N W (D s 3 O O O O 0 0 CD N 0 P 4 -4 CD CD O -0 'a "a Sr Z O O O 3 lt\ill o = o 0 0 ~E CL v j Q ~9 O n O N CD fD N N d '6 Cn Cn 0 fv N O I N m 3 CL Z N 0 D D o O a ~ CD 0 77 c Z CD_ Z (D (D I O A Q m ~ .Z1 n A Z O O < O CD W f9 a Z 3 O Z m g m N ~ CD p W ~ D p N d CD (D cn O= T (D N - ~Q Q a co d N CD N N m Q i ~ c A it i V C/1 S p O 0 O ~2 b 0 3 Q CD CD N = s N O 3 N (D O O I S ~ ti O_ CD 'V I I A I ~ EA O ti o00 p CD rye O CD v y Parcel 012-1062-50-000 09/22/2006 11:16 AM PAGE 1 OF 1 Alt. Parcel 29.30.17.434 012 - TOWN OF ERIN PRAIRIE 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 - MICKELSON, JOHN C JOHN C MICKELSON 1183 140TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1183 140TH ST SC 3962 NEW RICHMOND S SP 1700 WITC l2Y_' Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 29 T30N R1 7W 40 AC SW NE (642/108) Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1107/108 WD 07/23/1997 801/478 07/23/1997 750/305 07/23/1997 688/41 2006 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 7,000 0 7,000 NO 00 OTHER G7 3.000 30,000 20,300 50,300 NO Totals for 2006: General Property 40.000 37,000 20,300 57,300 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 36,700 20,300 57,000 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 Parcel 012-1060-60-000 09/22/2006 11:15 AM PAGE 1 OF 1 Alt. Parcel 28.30.17.419B 012 - TOWN OF ERIN PRAIRIE 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 - MICKELSON, JOHN C JOHN C MICKELSON 1183 140TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 28 T30N R17W 20 AC W1/2 SW NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1226/090 WD 07/23/1997 773/47 LC 07/23/1997 726/58 07/23/1997 484/624 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 17.000 2,700 0 2,700 NO UNDEVELOPED G5 3.000 1,200 0 1,200 NO Totals for 2006: General Property 20.000 3,900 0 3,900 Woodland 0.000 0 0 Totals for 2005: General Property 20.000 3,900 0 3,900 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 l ERIN PRAIRIE T•30N-R.17W. - SEE PAGE 57 I SEE PAGE 59 RD. K s/ 3 LcRESr Ja S n /sN.4 C O PO O y A r fa rt w t ~ n fw,G •R:chf (~i, Ta`>.se.- h .)E ETT[ fZ 7 Nr~~mes f Casa Be /'h rt - ^J o 06Y v Gl/~>ch V N C E 6 : ~C `rp If Beri ,7J/ttrn z.n 7~ Casa F p .Po6 e/t Q y ~ ,lam ~ @ U ~ V ; d9 de so.~ a w d T./¢ / J,Po a /d Ne¢/ rCa.-/ ~ iv ~ qq t, Nom' v e 6 0\ Mont eth ,e r.e y 74 ,9s ` P f s t~YO~t /'/¢c .6aa ti~ eadE • o cToh.> flda ~ y ~'CO a6 C oezt R• sh- sow Ku 3 0 0 " OR y 0 1 63 a Y E s h •/✓ewhous ,9iba tC A>a. 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F OO P NO SCaro/y~ n ' vn: g r~QCe /O '~a~.rmeA the/- M¢rK - C J,°y 40 Be./'tt>a_ G. fJ>r1h°~G. f E e/'1- NcG /'/=/s 40 71. 1e t/ainbuc,~ M7d ed. do //o Ed Le m'Fe obe/-s1s. z4a ya'.La,-,>.Fe • CC'V' //S De.~nisF z'`O ~ / .i3s /BB ,C 0 Qh, ene So~.e ebe~ zQO e,°m L ' ~ ilS\} r, b ~ C ~ cSa ~i ryryr \ C/rfeils ~ v a f- Louis H i ~,3s F d Robert- s,3 O /vo l tl Bp v~ Qo/ i E//'/-,o~ \ 0 .d r` Ss, /ay 80 _ ll to D`a, 0 JV0 F///enf ~ ~~d0 C Tom Ca.~o/ ~/e. 0 e/, 5Ka / C~,O echo C/hai-a/c.,9 a Get ,ea/- 0 /e.sle~ d v r- h~ ~ tl -9 Wv 0 E/Q Karnes Ho//- 0.0 ~.a// >`e~.s W 0 F 40 \f -K 7o-7 3 ,2 °e. X33 Bp BO da r~ . ao FEW ~ aD.~ • h-r/d F.- CA Er KC ~ ~ \V Ph /.p ~ h ~ta-re gf- Ca/./ itowa d C. ~0 t l.~ 0 0 B now ~Da o~ /oc~,cev~~ D sc°e s. Me/v>n° chzO an ada / n -A-- e 63 ~tl r s C ,P r/J oah/Ee f ddac tl p \h~ C~~O /l00 0 eo N \ /ZO /6o W efh /!O /s6s perc m 30¢ C V BoN 16o T /zo vC~h /6Saa S Y L. W Ke~Go;.N C ¢ V \ 0 //M 0 C rOiga ~a~/c a ¢0/6o Gave// Z~l v v ° WMQ C t0.. y' /za ¢oo "I ~ ~Q f✓¢/sh ~d/Se Shen P//✓ 99 5 z Sc d 0 3C~ •L¢nd AAArr //a.hJ l: C ty wC o' /°02 cSam~ I >,e l ~0 • S V'CL W' J h v C~Nyy A Yhu.- 2 'v QO n~ Cllr N Cf~ f/`faCme " ~ 'C ~ l /zo CO yC B3 0 17ora/n'f~' v ~~os. Q >y 4 ll Bo i/ /moo 'a G'a o/y.> 0 OV N y Coa ~ Jea erg /✓cics~or>. 40 Wtl oR o, n V~ ~Pe to rso/> 1Ja/fon 5 z y`tl w\ of /Q-/ Yt JZ • i /2o E \ t~ E P/NE LA' RD.• w _ ~ °/96B R - LINE RD. SEE PAGE 3/ cStf ~ . G'~-o:x u(>fyw s /Poc,Efo~ Ma/o ~,o/s Inc /Pam/9J9 BEING JOHNSON NEW RICHMOND BARN EQUIP. MOTOR PHONE: 246-4238 SALES, INC. RIVER FALLS P. & D. Silo Unloaders Chevrolet - Buick PHONE: 425-7671 DeKalb Seed Olds - Pontiac Freeport Silos Serving You With Sales & LAKELAND PLANT Service Since 1925 in PHONE: 436-8886 or 386-3922 MILTON PETERSON New Richmond New Richmond, Wisconsin 246-2261 SAND GRAVEL - READY MIX CONCRETE AS BUILT PLAN OF SANITARY SYSTEM .PAW. COUNTY ;PTIC TANK PERPIIT # JItiiNER ADDRESS?j~ _ZIP `~i'% LOCATION OF of Section -/Town_~%r N, RANGE F % W Gov. Lot # , Lot # Subdivision PLAN-VIEW Distances & Dimensions to meet Requirements of H62.20(l)(d)(2) SHOW EVEFYTHING WITHIN 100 FEET OF SYSTEM _4 i if -tom ~v K ~ and manhole SEPTIC TAN.{: Concrete Steel Plfpr. 7Lt Depth to SOIL ABSORPTION SYSTEM: Drywell_Depth Inside Dia. Depth Below Inlet TRENCH, No: of Width Length Area Depth to Pipe BED, N16. of Lis Width Length Area Depth to Pipe ,AGREGATE, Inches Area Required AREA AS Built DISCLAIMER: The inspection of this system by.Po1V_T ;tty does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. Polk County assumes no liabil- ity for system operation. However, if failure is noted, the county will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DIS- POSED OF THROUGH THIS SYST 1111 r. PLUbIBER ON JOB LICENSE INSPECTOR DATED-_ x' - - - - - - - - - - - - - - - - REPORT OF INSPECTI 'N INDIVIDUAL SEWAGE SYSTEM • Sanitary Pehmit ` Sate S e p.t.ic . NAME rownehip . S~. Cno.Lx County Location - Sect' kon SEPTIC TANK -~r l Size _ gatton.a. Numb en o6 Compan.tment6 DiAtanee FAOm: W ett 6t. 12% on gnea.teA etope 6 t Building 6t. Wettand.5 ~ . DISPOSAL SYSTEM Highwazen. _ 6z. C Diz tanee FAom: Wett 6x. 12% on gnea.ten stope t. Suit ding_ 6-t. w e.ttands Ft. HighwateA 6.t. FIELD DIMENSIONS: Width o6 then ch 6t. Depth o6 no ck b etow -tile in. Length o6 each tine_ St. Depth o6 noek oven -tile in. Numb en P6 tines Depth o6 -tile b e.Low grade in. To.tat teng.th o6 Q.LneA 6Z. Stope o6 trench in pen 100 6 Di4tanee between tines 5t. Depth to bedrock Olt. Totat abzonbtion anea 6t2 Depth to gnoundwaten 6t. Requited anea 62 Type o6 Coven: Papers on Straw PIT DIMENSIONS: Number o6 pigs GAavet around pits yea no Outzide diameteA_ 5t. Depth below inlet 6t. Totat abz onbtion anea ~t2 , z Area %equiAed 6t2 3Z INSPECTED BY TITLE APPROVED DATE 197 { REJECTED DATE 197 PLBState ~ 6 7 and County State Permit # Permit Application County Per rail. # 7-1 ~ ` for Private Domestic Sewage Systems County, *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: C ~C Section T-',l N, R~ E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township p, , c C. TYPE OF OCCUPANCY: *Commercial_ *Industrial *Other (specify) *Variance Single family I Duplex No. of Bedrooms 3 No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY .-;~l-Z-r' Total gallons No.-of tanks !'~C_ Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber .Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. Nevv L Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth - Tile depth (top) No. of Lines Seepage Pit: Inside diameter_ -Liquid Depth No. of Seepage Pits Percent slope of land.---- Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: _ I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certjfied Soil Tester, NAME -"I/r lam, / CJ l r' , h C.S.T. # and other information obtained from (owner/builder). Plumber's Signature l MP/MPRSW# /l % Phone # Plumber's Address _ ✓ L/, ~l>~.,. , / ; t PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. ,'ee t~ E ) ) e s E E I I h a, I , E E E , i Do Not Write in Space Below F COUNTY AND STATE DEPARTME T USE ONLY Date of Application Fees Paid: State /S, 0,6) oun Q Date-/,C/`-.,,- Permit Issued (date) G~ Issuing Agent Name 'D , Inspection Yes-7 No State Valid# Date Recd 1. county (wh t, copy) 3. owner (green cop) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH ` P.O. BOX 309 MADISON, WISCONSIN 53701 t r REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:) Sect ion_T~ , TAN, R,4,?E (or) W, Township or Municipality 1= /l/ f! ! Lot No. , Block No. County 7- ~ Subdivision Name Owner's Name: ! C 11 e - -rr Mailing Address: a C~ 5 TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WA-, ER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MINiIN P- P- I P- r C r t SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B_ 2 B 3 --7=---- />1 r '7 02 if c i712~ PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.) Indicate on the plan the locationd square feet of suits le areas. Indira, number of square feet of absorption area needed for building type and occupancy. }H! ~G~T, ` A Indicate scale or distances. Give horizontal and vertical reference points. Indicat lose pe. t i I I - - - y~ t I k . - I f - 4--- 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 location of test holes are correct to the best of my knowledge and belief. Name (print) ! h Certification No. L/ tr- Address /cJ ' 1 -1- / 1Z S Name of installer if known CST Signature /C't COPY A -LOCAL AUTHORITY I ~ NSA ~E r ~v~-r,✓ ~ d ~iic ~ " (ors f v~ f (a° rAd~ ~~,M c~rv,C ~ I:f -A Al 2 "'05,39_ r NN, O Ic 1 a ~eONO ppn i I I~ ec-t ai cec" G~~o° t`ce Seri` °k aQQ ~ } t ~Q . v~J ~Oa ~'he `eke A t x~r ~v ~5 I~OP , ti 1 t-++A) ,~e ST. CROI X COUNTY ~f,~ WI SCO N S I N { Z ZONING OFFICE 796-2239 Poz t 0666ice Box 227 I, Hammond, WI 54015 O W N E R P U M P E R A G R E E M E N T PLEASE BE ADVISED, chat unt.i.L you ate again not.i4.ied, 1 //wilt contAact with a6 -Z ~~t ~ ~ir~l7',~rl Wisconsin, ( Pumpers) , JoA the putcpoz e o S nemov,ing att waste 6nam the dan.itatcy system to be .located on the pope-tty and 4ututce home site Qacated in St. C,%oix County, Wisconsin, Township o6 ; yt / bung in the c% ,4 a6 the a6 Sec. t T. i✓; N.-R._W. (Otc me Ae. Gutty desctibed as 6oZZows: ) Dated this day oi 192 . (OWNER) State o6 Wisconsin) County o6 St. Ctco.ix ) Pe.ksonnaZZyappeaned be6one me this 57 Z/ day o~ 19 the above named To,~.s 'r- . , C"~e to me nown to be z he person who execute the 6otcego.ing ,inst&ument and acknowledged the same. atatcy Pu ttc,~ St. C&otx County, l My Comm. (,is pe)tmant) (Exp.ine.s)_ I l=;' heneinbe6otce %e4enned to as Pumpnn, loin Zn the above agAeemen,t to the extent that 1 have a conztc.ac-: with Gwnen as above stated. s -2 October 16, 1979 , k_ w Hopkins Cement Products, Inc. Route 4, Box 81 1 v New Ri chnond, W1 54017 Plan Identification No. 79-05391 Gentlemen: Re: Holding tank - 2,000 gallons James Nickel - Residence Farm SW 1/4, NE 1/4, Section 29, T30N, R17W Town of Erin Prairie, St. Croix County, Wisconsin Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes, and Chapter H 62, Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the following stipulations. 1. Our review of the holding tank plan has not been evaluated for structural stability, only for compliance to design requirements of Chapter H 62 of the Wisconsin Administrative Code. 2. The holding tank shall be maintained and the contents disposed of as required under Section H 62.20 (7), Wisconsin Administrative Code. 3. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. 4. In the event Installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. Hopkins Cement Products, Inc. Pa ge 2 October 15, 1979 In granting this approval, the Division of Health does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Chapter H 62, Wisconsin Administrative Coda, requi rements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county In which this installation is to be constructed. Failure to obtain local permits will automatically void this acceptance. Approved/Issued By The Department of Health and Social Services Division of Health By: Je~rnes r1. Sargent, Chief Section of Plumbing and Fire Protection Systems JAS:KS:bah Enclosures cc: Mr. Dennis Sorenson, 0115 - District ^;css~! 'Mr. Harold C. Barber, Zoning Administrator, St. Croix County MOLDING TANK AGREEMENT This Agreement, made and entered into his day of 101~L and A Y A.D., 19?~ by and between the ~w,U~ P ,~~nlr hereinafter called a ~✓17/~F. 1_/~r±11~~L here it-e-r~ cal )ed the "Owner". - WHEREAS, application has been made for a building permit on the following described property, to wit: / je t or that said property is not located in such a manner as,to be serviced by a municipal sewer system or on site soil absorption system for domestic sewage, and continued use of the premises requires that a holding tank be installed on the property for. the purpose of proper disposal of domestic sewage. NOW, THEREFORE, in consideration and as an inducement to the Town of to issue a holding tank permit for the above described premises, the Owners hereby agree and bind ourselves as follows: 'F 1. Owners agree that they will conform to all the rules and regulations of the Plumbing Code of the Town of in the building of their septic system including the holding tank. f They agree that any time the Town of through its Plumbing Inspector or Health Officer deems it necessary to pum out said holding tank, the Owners shall have same pumped out in p twenty-four (24) hours, or wi l l have said work done and charge same back to Owners and place same on their tax bill as a special charge. The Owners further agree that the Town of E - /~-s4 is hereby granted the right, license and authority a to enter upon their property above described, at any reasonable time, to inspect, pump and haul, if necessary, from the said holding tank. 2. That all charges and costs 'incurred by the Town of for inspection, pumping, hauling or otherwise servicing and maintaining said holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by such holding tank shall be paid by the Owners. shall notify the Owners of any such cost which shalal be paid by Owners. shall notify the Owners of any such cost which a4 shall be paid by Owners within thirty (30) days from date of notice and in the event that Owners shall not pay said cost within thirty (30) days, Owners hereby specifically agree that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by Statute of the State of Wisconsin. - - 25 i az 3. Owners further agree that in the event that municipal sewers shall be installed so as, to make the premises available to such municipal sewer service they will pay all special assessments levied against the premises as the property share of costs of the installation of such sanitary sewer and shall not assert any claim as to lack of benefit or reasonableness as to the installation of municipal sewers by reason of the fact that the Owners have been permitted to install a holding tank, and that upon municipal sewer service becoming available, Owners will abandon use of the said holding tank and connect the premises to the municipal sewer. 4. This agreement shall be binding upon the Owners, their heirs and assigns and shall continue in full force and effect so long as a holding tank remains on the premises. WITNESS our hands and seals this 3/z ~ day of 19/ 1 TOWN OF C-i OWNERS riL - jL~- ,7 a by by -Gds r t aE f: STATE OF WISCONSIN Personally came before me this day of~ 19 the above named c, Owners, to me known to be th persons who executed the foregoing',--. ;?x instrument and acknowledged the same.// NOTARY PUBLIC My commission expires: a" r i€ a -26- HOLDING TANK AGREEMENT This Agreement, made and entered into his day of 4J A.D., 19_~72 by and between the M"C WED hereinafter called an hereinatter called 0 C T a 1979 the "Owner". WHEREAS, application has been made for a building t'Ll►P~,E;I~, r~ r 1 permit on the following described property, to wit: ec 7- 3 11 or that said property is not located in such a mariner as•to be. serviced by a municipal sewer system or on site soil absorption system for domestic sewage, and continued use of the premises requires that a holding tank be installed on the property for the purpose of proper disposal of domestic sewage. NOW, THEREFORE, in consideration and as an inducement to the Town of 10 to issue a holding tank permit for the above described premises, the Owners hereby agree and T- bind ourselves as follows: i~ 1. Owners agree that they will conform to all th .rules and regulations of the Plumbing Code of the Town of I in the building of their septic system including the holding tank. They agree that any time the Town of through its Plumbing inspector or Health Officer deems it necessary to pump out said holding tank, the Owners shall have same pumped out in twenty-four (24) hours, or ~J will have said work done and charge same back to ners and place same on their tax bill Nen-ter peciache. The Owners further agree that the Town of is hereby granted the right, license and authority upon their property above described, at any reasonable time, ' to inspect, pump and haul, if necessary, from the said holding tank. 2. That all charges and costs 'incurred by the Town of s~ for inspection, pumping, hauling or otherwise servicing and maintaining said holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by such holding tank shall be paid by the Owners. shall notify the Owners of any such cost which shall be paid by Owners. J_9 shall notify the Owners of any such cost which shall be paid by Owners within thirty (30) days from date of notice ' and in the event that Owners shall not pay said cost within thirty (30) t days, Owners hereby specifically agree that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by Statute of the State of Wisconsin. - 25 79 0539)'' ` J. Owners further agree that in the event that municipal sewers shall be instai'led so as to make the premises available to such municipal sewer service they will levied against the premises as the property ashareeofacostseofmthes installation of such sanitary sewer and shall not assert any claim as to lack of benefit or reasonableness as to the installation of municipal sewers by reason of the fact that the Owners have been permitted to Install a holding tank, and that upon municipal sewer service becoming available, Owners will abandon use of the said holding tank and connect the premises to the municipal sewer. 4. This agreement shall be binding upon the Owners, their heirs and assigns and shall continue in full force and effect so long as a holding tank remains on the premises. WITNESS our hands and seals this ( day of 19 TOWN OF -C OWNERS T~.: by ? r T 179 f' ~ f STATE OF WISCONSIN Personally came before me this 19 the above named day of _cC Owners, to me known to be th ` ~te instrument and acknowledged thesame. who executed oregoing`~ NOTARY~PUBLIC ~,~~•c%i.z:h-tti.-,I`"~ ~w_.~ My commission expires: / 26 ~z