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Home My WebLink About006-1061-95-000 ~ O c 0. ° I t3 t3 I o I N ~ n ti y I ao tt I Q I n h i ~ I ti I a I z° I c LL o ~ ~ I II I i I I z ~ I d d N z (L co o I o z v a~i z a o ° zz a~ N N ` M N a = c o a~ c d 0 L C C O U z f' z w z N o w c C Q) N W O 0 C - }~i N O _N N ` N O O O v c c a U N N 3 RQ FL z o 0 wail i~000 N y co M 11a ~ O (n vl N J U ° rn rn ~ I ~l N O O m o N m N O C~ d N m C ~ N ~ N N -0 m N O r n~ Q r cn N I o ° N N O H O 04 O N C V a 0 0 0 r N N N a) 0 V O Cp O °L C C E C N M M u F~~1 6 M O O Z" Z' ~ C - O E j o co N U O O z U 2 W O lQ t v C~ CL +Q+ E c t 3 t A ciao '',Ov~c°~ W ismish Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Hurnan Fleladons Division of safety & Bindings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Sr: C~aY x Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (13", direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION rO1Vir-1 6200,OR /G 17` GOVT. LOT 111W 114 SW 1/4,S 2?T 31 N,R E (ar~V PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # .7-/, 2-7 ff-WY G y r- of zed 4e,6~5; CITY, STATE ZIP CODE PHONE NUMBER C)CITY OVILLAGE QF6WN NEAREST ROAD AAEW eleAft vD 4~)I, 5yo17 (~~5)Z'~G-lvS7~ GyLON :2 z0 Tl1 (/i}'tVew Construction Use ( residential / Number of bedrooms (J Addition to existirg building l 1 Replacernent [ 1 Public or commercial describe Code derived daily flow ~0 G gpd Recommended design loading rate bed, gpolft2 trench, gPW Absorption area required bed, ft2 750 trench, IR W)dmum design loading 0e bed, gpd/It2 trench, WW Recorrin*nded infiltration surface elevation(s) S 'P 5 • 3 ft (as telerred b site plan bendy wIQ Additional design/ site considerations ZiS~ 7pE,c~cG,~ s s/o~ ~o,~ Tom 4-,1A aPO /o - 1?0 DI'S 7-P(8 . Parent material SL'S z 2- eh-- rE,e - 01V4 y,;9- Flood pWn elevation, if apomble Nff' It Pf tT vTti S a Suitable for system CONY ~ ❑ U BPRESSURE AT-GRADE SYSTEM N FILL HOLDING TAN( U. 1 21 ❑ U U as-- O U 01-o u ❑ S SOIL DESCRIPTION REPORT Boring * Horizon Depth Dominant Color Mottles Texture Structure Consisjqrtce Bo miry Roots GPD in. Munsell Qu. Sz. Cora Color Gr. Sz. Sh. Bed rerldt 0--7 /o ,e 31.-x- S :2 .T, sbK nm trFP- s zf 13 Bt 7- iY 10 VA 313 /s :1 -F,5 jP- cs i~ Ground f33 7-S vie y 7 51 2 f, SJ,& '7.,jr,4~ e s S yG fL C 2~ (oo 7, 5 'l yl Co S 0, tm S GQ~ C S _ -7 Depth to C z 0 _ 119 y/P 41 S d, C'S aQ Q _ _ _ Smiting factor Remarks: Boring 0-// /OYX' 312 51 2j 1L M., f CS z El E 11-2-7 f0 Yk y/ y 3 , Ib k rw. -F ; c s I f . S . G t3 -3y 7s ye y 51 .2- 5-hk fR eS , S Ground - elev. C 13? -9p 7 S VR 16 ae- .7 ?'f- oy - tL /0 YR D,c, s Q~ "2 Depth to limiting 7 ~y L Remarks: m 'Qv(3EQT- Zt/,BRI•ctiT- "wZt o: 71s 386- 918S ress: &55 O' lamer L- 'RD• NUDSO,J COOS- Sya id OCT. 2-,?-q3 csTrt 2-48 z- Signature: Date: CST Nurrter l 1'Z L{XX~I I Li(jl~ pROPERTYOWNER ~ooD~P~r-G~ SOIL DESCRIPTION REPORT Pape Z of _ PARCELID.0 Boring ! Horizon Depth Dominant Color Mottles Texture Structure casist ne Boundary Roots GPO In. Munsell c" Sz. Cont. Color Gr. Sz. Sh. Bed rerr- 3 ©-8 /0 Ylf 3 s/ 1. f , c 5 Z~ /!3,-( 8 - Z2- / o Y/e Ground 3 z- ~ 5 YR C. cS Deo io Remarks: Boring # FV- /05/ 7 f ) f /2 e s y /oye y 3 15 2.f,Sb& ~►vfP, CS 73 3 N-60 s ye - /s C, s 1---fsz r5; Ground S O, c, S cQ-~ 7 y ~53Slew.~ C l~yP ~aYie Depth to iartlng Remarks: ,Boring # o o Y~ S~ .2, Af,e _ CS 2-f- A -9 31z i i /0 Yle Y13 6-,6& 4417~e 21- E3 !33 3y /o 511 2.A", bk /M-f, es l f • s ' •r Ground elev. 3 y %o 75yllp 0/ - 5 9,e vfe fG,f~~. yo ~s y p G/ S O • -2 Depth to factor Remarks: Boring # E3 Gramd Slow. R. Depth to limiting facba Remarks: COf~ 070I\/O AG M7\ ~ zo -P zp L co IT Ul l W N CZ' ~1 .,Q a N L N r o W N H l!~ ~ Q m o ± r G ~ , F vz- 0 R rn m Z o ~ z i ~ o y, o o ~ ~ a O i ~d ~ I i x W o _ W ,i ~s yS'T-E-4, .~sf~-<~~o j g 3 • S i' TF ~4l~D~ESS I y 4- Z z d dti.. S 7- • e4ls • S1007 STC - 104 AS BUILT SANITARY SYSTEM REPORT i OWNER D14U/D OIL? ADDRESS .2-1-L-7 ~f C•6"1,` CO A Y 4 YO r P-QO Ce-6 )Lt0AJ L7 40 I .S . .5 SUBDIVISION / CSM# LOT SECTION.. 2.8 T 3( N-R 14 W, Town of C/ L O ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S.e~e. Trh- LAP66r- GINAL ORI INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tanE; manhole cover. Lc i TO P of Se f- A /o~ G.- ~o BENCH ARK : ~ I'•V vA r►b.) O O . O ALTERNATE BM: T D CO.V 0,CI-Q. j%LOG e 4_9a SEPTIC TANK / -Pump eE-- ER / HObOING Manufacturer: Liquid Capacity: 1000 Ivo?' Setback from: Well IIVSI'AIW House 17 Other -ro Pump: Manufacturer ModelI Size Float seperation ' Gallons/-cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Sf Length 5 9 ' Number of trenches Distance & Direction to nearest prop. line: 7C - NOpftp. Setback from: well: N House 5y Other Yom. ELEVATIONS s~'v~ti" 0 Building Sewer ST Inlet: ~Y SO ST outlet 9~' ZZ PC inlet PC bottom Pump Off Header/Manifold Bottom of system 9 2• S"D ode. Tt°~-c~~lS Existing Grade g Final grade !4• o DATE OF INSTALLATION- d l 173 PLUMBER ON JOB: 9613EIe7- -U1bR(CJ-v7F LICENSE NUMBER: A4. pS 3307 INSPECTOR: J IM (QOM. $au► 3/93:jt o c ~ I c ay 3 `c Q Q Ilk v1 w~ 1i e r r, n N %A H V' kA ' 77, I---------- 1 Z~~ Z y y o i O ~ ~ IN r N ~ O 4 t ~ ~ L C N R; ~ i m Csl b \ m N a ' C ~ n O S ' L N O o i zt n o AT + n w C~ o R Z n ~ . Wisscornssipgepartmen o~Pridustr8y' 33 .16. 436IVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) sanitary Al it GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village (Town of: State Plat GOODRICH DAVID CYLON CST BM Elev.: ` Insp BM Elev.: BM Description: Parcel Tax No.: -Dec - 006-3:061 95 0010 TANK INFORMATION ELEVATION DATA A9300353 !s TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~t GCS Benchmark 06/ Dosing 56 Aeration Bldg. Sewer 5.53 Holding St/ Inlet ~,8 fLSs-~ TANK SETBACK INFORMATION St/ Outlet / 5! Vent TANK TO P/ L WELL BLDG. Airlnta to ke ROAD Dt Inlet Ar I Septic p17 J__ NA Dt Bottom Dosi NA Header / Man. Aeration Dist. Pipe Holding Bot. System X6.9 5z.S3 PUMP/ SIPHON INFORMATION Final Grade 9~•`°~ dam' ' Manufa urer Demand 761,° 5,~8 ,430' Model Number GPM ~j ~j> n~a SSA ~3 $(Q I Friction S stem c,7 TDH Lift L 3, 7-5 Forcemai Dia Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width , Length No. Of Trenches PIS------ No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S ~S_ DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACH41111 Manufacturer: SETBACK CHAMBER Mb4QLN umb INFORMATION Type of cn S~, OR UNIT System: 4~, DISTRIBUTION SYSTEM Header-LPdFanMld ~r Distribution Pipe(s) f/ , , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 55 Dia. Spacing -17 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems On y Depth Over Depth over ~ ,t Olt xx Depth Of xx Seeded/ Sodded ulched qgP-rTrench Center YQ - 7 S~f'Trench Edges r0 7 Topsoil ❑ Yes ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION. CYLON 28.31..4;1 L~ Plan revision required? ❑ Yes No p Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signatu e Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i I SANITARY PERMIT APPLICATION COUNTY 70IL14R In accord with ILHR 83.05, Wis. Adm. Code ` Gam!` OMMMMMEME11111111 5; STATE S 711IS -Attach complete plans (to the county copy only) for the system, on paper not less than l 8% x 11 inches in size. ❑ cf ecli if to r ious application P -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER , PROPERTY LOCATION S 2-ff T 31 , N, R E ( ) W PROPERTY Z OWNERff" A141 'S MAILING ADDRESS LOT # A,~ BLOCK # CITY, STATE IP CODE PHONE NUMBER SU DIVIISION NAME OR CSM NUMBER ,~v /~iGGt ,Kp v~ Z S~YD!? s'( (o S & , fij -1 ` of 2-.90 Aeu 5 . TYPE OF BUILDIZor heck one CITY NEAREST ROAD 11 ❑ State Owned q O LLAGE : G~~~~✓ 2 2-0 ❑ Public 2 Fam. Dwelling-# of bedrooms PARCEI TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 00& l0 ce- 5 7 000 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE 0 PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2.0 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fill 2- 1Z 1a VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 16. SYSTEM ELEV. 7. FINAL GRADE C REQUIRED (sq. ft.) PROPOSED (sq. ft.) (G day/sq. ft.) (Min./inch) ELEVATION 7J d '563 5•9C 73.5 Feet 17i S Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name ncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ! 14 Lift Pump Tank/Si hon Chamber l CI67 El I El Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature- (No Stamps) MWMPRSW No.: Business Phone Number: R r I(Ao°l~C47- 330 715 Plumber's Address (Street, City, State, Zip Code): es S % G pre / SAO IX. COUNTY/DEPARTMENT USE ONLY Y❑ Disapproved Sanijary Permit Fee (Includes Groundwater Date sue I Surcharge Fee) Approved ❑ Owner Given Initial _ 'fig C Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS R 1. A 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division,. 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s)of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. 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. IX. County/Department Use Only. X. County/Department Use Only. 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; pump or siphon tanks; 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; close 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) soi(test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) Fresh Air Inlets And Observation Pipe A-) C. Approved Vent Cap Minimum 12" Above Final Grade Fi'• d iSt-eD ~v Z7 3(0 ' Above Pipe _ 4" Catl Iron to Final Grade Vent "t ' Synthetic Covering min. 2" Aggregate Over Pipe Distribution - Tee Pipe 1_00 0 0 0 , ~o Aggregate o Perfbroled Pipe Below Beneath Pipe 0 -Coupling Terminating At Bottom 01 System sysr~-~ Fresh Air Inlets And Observation Pipe ~~So Approved Vent Cap Minimum 12" Above Final Grade ~a r,0 3 Cl -7,,so f36 4" Cast Iron Above Pipe - Vent Pipe' 'To Final Grade Synthetic Covering Yin. 2" Aggregate Over Pipe Distribution - Too Pipe 0 0 0 0 0 Aggregot• 0 Perforated Pipe Below Beneath Pip• 0 -Coupling Terminating At i S Bottom Of System 9 3 .~'p 4 ` i v ~O o ~ off' y' - Y~e o 'R d • - b i 00, 17 ~rS %ol r ~ r) o~ wq IN. VN ) + Ilk N ~ U,► J N ILA a a n, lu M ? p co C C " SOIL AND SITE EVALUATION REPORT Page of 3 Lai" WwmiDow j Division of Safety Bukirgs in accord with ILHR 83.05. Wis. Adm. Code COUNTY 5r, Cleo"( Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BA), direction and % of slope, wale or PARCEL I.D. _ dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 'A'SV Jr,, GooOR 1 G h`' GOVT. LOT Nw 114 S~ 1/4,S 2?T N,R /G E010 PROPERTY OWNERS MAILING ADDRESS LOT 8 BLOCK s SUBD. NAME OR CSM s 2-11-7 ffrv 6v AjteT of 280 fe,P 5 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE GIM NEAREST ROAD AIEw fleAft vo G~J/, 5,10 7 (7/5) Zy'(o -Co57Co GYGON 220 Th. Construction Use I Number of bedrooms Addtiott b ebs'g building 11 Reps [ 1 Public or connate ciel describe Code derived daily now &64) go Recommended design loading role bed, gpolft2 trench, gp W Absorption area required - bed, ft2 73-0 trwh, II2 Mabmum design loafing rate bed, gpolft2 ' g trench, gp W Reoormlereded irdiliration steriace elevation(s) 'P 5 3 ft (as referred b site plan ben*nark) Addtional design / sNe cortsideralians Z/SE' ~pE',ucG~~s o v S/o4 E-/ l'o- Ta u ~ 14d,4 ZWO /o ' /30 X ~1'S TiPi ~3 . Parent material SCS z z ChE TEi~ - dtif}.~1ii~ Flood plain elevation, d appnW* Nf~- It ~rrT w S - Suitable for System WOK ! ~ ❑ U r-~PRESSURE AT GRADE SYST9d N FILL Hd.DtlVG TAM( U a Unseilable 1Of 0 p U [~J $ B U CI-3~ ❑ U Gt-0 U ❑ S SOIL DESCRIPTION REPORT Boring i)t Horizon Depth Dominant Color Mottles Texture Structure Cortslstel'tce BolrldBry Roots GPD/ft in. Munsell Ou. Sz. ConL Color Gr. Slz. Sh. Bed inch o /o ,e 31.37 S :2 S, s bK nm V-F p- S :-F Bfi 7 /Y 10 VA 313 15 :Z -f Slbe v" off- CS -Lt, • , Ground f33 /t~. 7'S ylc' y y Sl Z.f,Sb~ es . s elev. ft C lca -1, S y~ y/lo S 0, S CO e- C s ~ Depot b C z ~0- ~D yk L s O, c,S a21L _ bCI0r Remarks: Boring 10, /0 Kc J/2- f P- 2 /0YlQ :5W AA., bk 4 s Z f, 5-6,C u f R CS . S I Ground 13-7-39 75 Y-e / elev. C 1*47? 7 S VR 16 7 /0 M b limiting 7 Remarks: Name:-Please Print . e?vC3ERT- 2 j_SIZI•CkT- Phone: 71.S 390- 9/2 S !05S 4,' Qt L- 'RAC, :HOPS ,4' Lois. sway OCT. Zg-q 3 csTM Zyg Z- e: Date: CST Number: I 1 } . I i ,f 1 I 1 oDOti°~ L DESCRIPTION REPORT Pape Z of SOIL PROPERT1f OYYNER PARCEL ID.4 Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ftz Bor ft # Horizon in. Munsell Qu. Si. Cont. Color Gr. Sz. Sh • Bed wick /0 yX - ~5i/ 3.,►~, ,6,C /144 ZfF S . Depth b Remarks: Bo now ring A 0- /0 % 3/~- .5/ f , iw► f /2 CS 2'F y 3 /s 2.f, s,b& 1~, v f P, •J0 1~ 13 - 1 y /o y k Boas s ye /S 69, C S :5Pje61 5 Ground 133 y60.~ elev. tc C , ~~y ~o Y~ 4/y l' 2, d moors Depth b funding bcw Remarks: Boring # A 31i S~ nMf C S 2~ i Bt lo y~e 3,Y /0 83 Ground elev. 3 y yo 75/,x f, y,~ ufe ~s 7 Ya 7-Y Depth lo ;ear imitirg hew Remarks: firing # 13 Ground elev. K Depth 10 limiting (actor , , Remarks: con oeenio ne~nn~ . ;t to s w N rTt n v~ ~ o N i r m li _ H o + m C Q -ko, k~A c m o rn m Z o rtl d o ~ ~ o M ~h~y ~ ~A 1 ~ I ~ x W 0 W STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS Z l FIRE NUMBER- CITY/STATE- OV4t~ 1V6(4~a e ZIP S• 7 e~ 17 PROPERTY LOCATION: N 1/4,- 1/4, SECTION 2Y , T& N-R ~ ee~ W TOWN OF St. Croix County, SUBDIVISION;, LOT NUMBER 4I/ 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 60% 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration ~l date. SIGNED:,.,L ' ~t1it e ~r~c. DATE : St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 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 ~n delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), thenia 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 David W. Goodrich and Kathleen G. Goodrich Location of * property NW 1/4 SW 1/4, Section 28, T 31 N-R_16 W Township Cylon Nailing address 2127 Highway 64, New Richmond, WI 54017 Address of site"2827th Street New Richmond, WI 54017 Subdivision name none. nQne Lot no. Other homes on property? ves x No Roger L. Goodrich, Bernice V. Goodrich, Previous owner of property David W. Goodrich & Kathleen G. Goodrich Total size of parcel 40 acres Date parcel was created Are all corners and lot lines identifiable? _j _Yes No Is this property 4)eing developed for (spec house)? _Yes _.L No Volume1049 ' and Page Number 639 as recorded with the Register of Deeds as Document No. 509227. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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... XQ we) certify that all statements on this form are true to the best of aX (our) knowledge that X13 ( we) XiYi (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. 509227 • , and that AX (we) presently own the proposed site for the sewage disposal system or AX (we) obtained an easement, to run the above described property, for the construction of said system,. and the same has, been duly recorded in the office 'of County Register of deeds as. Document No. Signature of applicant. Co-applicant David W. G6odri.ch Kathleen G. -Goodrich Date of Signature Date of Signature pocutMdiNT NO. STATE BAR FORM 1- I= TM1s GPALa a Foe W*eeso'NG "-tw WF WISCONSIN p y0t 5509227 - . ' i ' ♦ ti _ This Deed, made becwson ;Or ttesaw RP_rxaira_V...6s.obr gh.,..h'k5band..4A 'f NOV 19 1993 as.--maxital_.pxuptT'ty- -as1,...G.. I a.~A ~ fib,. 8 ~ 3 Y ~ 1 and. .David...W_..Gaadr ah_.&nAA xbL]. hushan,d..~nd..bti~e..._.as-.msx..toJ---1•XQFGx.................... , ,,~_n~ir._~•~ - - - • ---.........a anuta, l I?@s~eth, That the said Grantor, for a valuable eovsi&wxtion...... etrURN TO conveys to Grant" the IeUving described real estate in ...,at•--..LrQJ-.4r comty, state of WiseMs M. An undivided one-half interest in the Northwest 1/4 of the Southwest 1/4 o T::.pattdNo: Section 28, Township 31 North, Range 16 West. Exempt No. 8. This .-J_%_.AC1_t homestead property. (is) (is not) Together With a11 and singular the hereditaments and appurtemneea thereunto belonging; And GXATl..' 0r_d ._.__~ra eacei warrants that the title in ,good, indefeasible in fee simple and free and clear o enc P municipal zoning ordinances and easements of record and will *%rrant and defand 't1Lli~atm. Dated this - -1 - day of 19...93. - k , . TdT~ !J^yo ...or'AL) ....(SEAT.) offer L_. cooarich •e * - - - - . - - . . - _ -14 3 -----1 FAT.) .___.....-----(SEAL) » er ice Vt,._Goodrich- ' AUTITNXTICATION ACSNOWABDGMANT Signai~se(e) STATE OF WISCONSIN .5~~. ~"iX1R~....-•--------Colmty /~t~.:d~Y suthouticstod tide day of_ 19------ Fearsonally come before ms this _ of November • _ , 19. g73_ the oboe apmed - _g,~_.t--QgEzch_-and„ * _ xnas _ Y.~__cooa ; cii~........... TITLE: MEMBER STATE BAR OF WISCONSIN - suNthno b7.4 706A6, W7%9tatsJ to me known to be the person s___ who executed the t and aekmewho the same- . /Ur _f. TN18 INSTRUMENT WAS GRARTBO DY ...Bl.4K, K._NQJRMAN.._§ : - . . i ph~,aAi9 ~ r 4.-- - - New Richmond . . ..WI-_ 54017 NPU07 1?unt - r --County, Wis. (Signatnras may be authenticated or wA:n*wrledged. Both My Qomuumion -is permanent. (Tf not, state sorpfration are not noaeseary-) dMfi :.....................Janu$7cX;_-5_r........_ 19-97 exond d poMM sknfM ilk a=y o&Padb rbwld be ftWd ur peWA bCQWW Unk aaYaex pdft~ o hwam sTAIJ BAR da' WI9COMMV Wh mft Loons 91 mk Co. Ira WAlatMNT! DBRn ORas Ne. I- 1"2 vawauke4 Wb.