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Parcel 012-2004-10-000 09/14/2006 03:00 PM
PAGE 1 OF 1
Alt. Parcel 04.30.17.578 012 - 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 - SHILTS, RODNEY G & JULIE M
RODNEY G & JULIE M SHILTS
1774 176TH ST
NEW RICHMOND WI 54017-6738
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1774 176TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 4.610 Plat: N/A-NOT AVAILABLE
SEC 04 T30N R17W LOTS 1 THRU 28 BLK 86 Block/Condo Bldg:
VIL JEWETT MILLS
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 948/390
07/23/1997 723/596
l 1/ If
r4
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 4.610 51,400 169,400 220,800 NO
Totals for 2006:
General Property 4.610 51,400 169,400 220,800
Woodland 0.000 0 0
Totals for 2005:
General Property 4.610 51,400 169,400 220,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 207
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
May 16, 1980--Copy of this report to
Citizens Bank and Trust, First Avenue
and Stuart Avenue, Wausau, WI 54401
AS BUILT SANITARY SYSTEM REPORT
~i iEF~ LA A-2 1%t r r~ , TQTTNSHIr Cf'/A/ SEC.3 _ T_sLN, R W
Ci. ADDRESS , ST. CROIX COUNTY, WISCONSIN.
3DIVISTON ~ ~ S• f~ Lrr_'(~-- ~ Y
LOT 'LOT SIZE
PLAN VI EW
,Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
:~-L4
K , 1 I _
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i - T idicate North Arro~1, - Y~~
--j 1-._-----t- ! -4
i
SCALt
~r 'IIC TIJyK`S)jLeej~ A:F'G'R. COINCRETE STEEL
NO o rings on cover j _ Depth DRY WELL
A7NCHES NO. ofwidth length area
no. of lines width_ e length S y area
dept:`: to top of pipe 1 ,GIIEGATE - - % 1 ~ 'rl1 /'1L=1?
RATE AREA REQUIRED _5r AREA AS BUILT
ll,sciaimer: The inspection of thhis system by St. Croix County does not imply complete
ca:K)liance with State Administra,.ive Codes. There are other areas that it is not possible
k;) inspect at this point of construction. St. Croix County assumes no liability for
tem operation. However, if failure is noted the County will make every effort to
ieermine cause of failure.
:L ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST~i.
~'INSPECTO
/ Llt~-
DATED PLUIMER ON JOB_
LICENSE NUMBER ee
I
z
REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.i•taxy Pexm.i-t
State Septic ~
NAME rownah.ip S.~. Cxo.ix County
Locatiox Section
SEPTIC TANK
S.ize1,~ O gattona. Numb eA o6 CompaAtmen.tz j
D.iz Lance FAom: Wett 12% oA gxea,teA ztope it
Suitd.ing l~ it. Wettands _ 6t.
H.ighwazex it.
DISPOSAL SYSTEM
D.ib#ance FAom: Wet it. 12% oA gxeatex stope it.
Bu.i.Cd.ing_ it. Wettands w Ft.
• H.ighwateA - it.
FIELD DIMENSIONS:
W.id#h o6 txen ch it. Depth o6 Ao ck b etow tite..-tiz_in.
Length of each tine it. Depth o6 tack oven .t.ite _ .in.
NumbeA a6 tined Depth o6 t•ite below gxade,_,1, in.
To#at teng.th o6 tines/--' l it. Stope o6 tAench in pen l 00 t:
Distance between tines -o it. Depth to bedxock
Totat abboAbt.ion axea_4L_t2 Depth to gxoundwatex ~ .
RequiAed axea it2 Type of Coven: Papers oA Stxaw
PIT DIMENSIONS:
NumbeA ob p.itz GAavet aAound pits yeb no
ra
Out6 ide d.iamet~ex ;it. Depth below .inlet it.
r J 2
Aa
Totat abzaxbt- 6-h' axea it
Axec( )LequkAed it2
INSPECTED Br TITLE
APPROVED 1 , DATE 19?z~7 .
REJECTED , DATE 197.
i
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ASCONSIN DEPARTMENT OF HEALTH ANU SOCIAL SERV s:
P.O. BOX 309, MADISON, WISCONSIN 53701
I_OCAT; . _ '!A..:~-'~•, Swionr _ Tr41N,R F (or) W, Township or Municipality
r
Lot 'T Block No. u wislon Name County
fjwner's/Bi,p.-ers Name:
Mailing Address:.
No. of Bedrooms =.a-COMMERCIAL
TYPE OF OCCUPANCY: Residence -
REPLACEMENT ALTERNATE SYSTEM OTHER
EFFLUENT DISPOSAL SYSTEM: NEW
l.+ PERCOLATION TESTS
DATES OBSERVATIONS MADE: SOIL BORINGS
3011- MAP SHEET NAME OF SOIL MAP UNIT,-
PERCOLATION TESTS
TEST HOURS WATER IN TESTTIME DROP iN WATLK LE`/LL, !t+ ~
DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL ~
j NUM' INCHES THICKNESS IN INCHES , ISTWETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 !PERIOD 3 MIN'
r BfR - -
4P-
P
P
SOIL BORING TESTS -
._ST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
IMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
e ararea+
AN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plalt> , the~locationand sIqundiare cate feet s of f suitable
,irate number of square feet of absorption area needed fqr building type and occupancy
e horizontal and vertical reference points. Indicate slope.
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thevundersigend, hereby certify that the sod tests reported on this form were made by me in accord with the procedures and methods
_,,,acified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my
V-*wledge and belief.
Certification No. '
I $ (I ) x
le,
Adrd~sr.~ f -
1-ni o o installer if known
CST Signature
C Pimparty Owner
Via: a~
1-7
- - State and County State Permit # t;
-
P ~f w Permit Application County PermZ-1
for Private Domestic Sewage Systems County L <L
*DENOTE'S STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: N4.F% jl/i.~_ Section , T_7('_ N, Rj~7 E (or) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *G mmercial *Industrial *Other (specify) *Variance
Single family X_ Duplex No. of Bedrooms _j No. of Persons J
D. SEPTIC TANK CAPACITY `f Total gallons No. of tanks J
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify)
New Installation ~4 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 f`~ 7 sq. ft.
New X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: ~ _Length 7 Width 1 Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- ~y 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 Certified Soil Tester,
NAME _ CA/_Z Z& C.S.T. # and other information
obtained from /,,V e' %~i"i' ~ i✓~-~~ (owne uild
Plumber's Signature
r-.
Plumber's F.ddress
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.
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Do Not Write in Space Belo FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application '/'/-Fees Paid: State C "-1 D - `
Permit Issued/R (date)
Issuing Agent Names c-C, U
41 )'171 7j
Inspection YesX/_No State Valid# Date Recd
1, county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78