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HomeMy WebLinkAbout032-2035-10-200 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1) (m)]. 363920 Permit Holder's Name: ❑ City ❑ Village ❑ T&vn of: State Plan ID No.: Lone Oak Construction, Somerset Township CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: ��{{�� t7O.a� w"a r e S _ �r B►� ( 032 - 2035- 10:A(36 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic 2 Benchmark D 11 q.1 Dosing Alt. BM ) f `f. 4N 1 0. 9 3 t, 3.17- ( Aeration Bldg. Sewer Holding St/ Ht Inlet .` 16 • t0 TANK SETBACK INFORMATION St/ Ht Outle ) x.19 t 3•`{3 t TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > b �� / -_ NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe S ` J Qk S 4t" Holding Bot. System 13.3 101. S3 f PUMP/ SIPHON INFORMATION Final Grade ` M nufacturer Deman St cover �� It�f.�Z 3 • /D ►I�.SZ Model ber GP �, �.� z -�l b 1 2 .0 / TDH Friction System TDH Ft Forcemain Length D► H Dwell SOIL AB RPTION SYSTEM RENCH I Width % Len I No Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIM DIMENSION SETBACK SYSTEM TO P/ L BL WELL LAKE/STREAM LEACHING Q` er: INFORMATION S 1. _" � �7 `r �"�' --- OR UNIT R M (� Number Stem DISTRIBUTION SYSTEM Header / M ni old Distribution Pipes) x ize Spacing Vent To Air Intake t Length Dia. Le Spacing _� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (include-code discrepancies, persons present, etc.) Inspection #1: D ZZ/ N Ins • Location: (NW 1/4 SW 1/4 9 T30N R19 ) 0930 9607 -Lot 2 4 c9 • i, S"- �,�"""� 1.) Alt BM Description = � t�o� ���. `�� ` - 2.) Bldg sewer length = 5 k` u 1 - amount of cover = } 41 I • t l °2'Qg 0 1 L S Plan revision required? ❑ Yes 4 No JL Use other side for additional information. j SBD -6710 (R.3/97) i Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: I T tt t i 4 #j � O j � S t4 i L V Y ' '�-� Sanitary Permit Application Safety & Buildings Division 201 W. Washington Ave. In accord with Comm 83.21, Wis. Adm. Code �•� PO Box 7302 See reverse side for instructions for completing this application �►-. Madison, WI 53707 -7302 N i sconsin Personal information you provide may be used for secondary purposes (Submit co pleted form to county if not Department of Commerce (Privacy Law, s. 15.04(I)(m)] state owned. / Attach corn lete lans to the county co only) for the stern, on a er not less than 8 -1/2 x I I inches in size. County State Sanitary Perrnit Number ❑ Check if revision to previous application State Plan 1. D. Number Location: I. A lication Information - Please Print all Information P Location Property Owner Name / ` d4 bK j0Q^✓., E o h. t Lot Number Block Number Property Owner's Mailing Address _ Zip Code Phone Number g!Bdt�sip 19a c� t� SM Np r -P City, State P ��D ✓� Sip ` {r- SI �{ '60 2 We' ✓ /1t) ❑ Ci II. Type of Building: (check one) ❑ village ❑ l or 2 Tamil Dwelling No. of Bedroom _ f XTown of Y g- c ❑ Public/Commercial (describe use):_ ` 'T ❑ State - Owned Nearest Rooa / l { / _717 p �• ' ,� 3 r+ • •� Parcel Tax Number(.) 3 z— ZA3 5- <' e B if a linable 3 d• O III. T se of P mit: Check oni one box on line Clt$e1 St 5 6. ❑ Addition to A) 1, ew 2. ❑ Replacement 3. C1 Re 4• System System Tank O nly Existin S stem y Date Issued Permit Number B) ' ❑ A Sanity pr Permit w eviously issued �T� L ��d t F /� �� S IV. ype of POWT System: (Ch ck all that apply) 3g � S ❑ Sand Filter ❑ Constructed Wetland P OAt- n- pressurized In-ground 'E` /-F / ❑ Mound ssurized In-ground � TT4FPCH � 49 1', 2S C Bolding Tank ❑Sin ,,ss ❑Drip Line ❑ Aerobic Trea t de - ment Unit L1 Recirculatin ❑Other. spers al/Treatment Area Information: 1. Design Flow OF) __ 7 Dispersal Area 3. Dispersa{ Area 4. So MiJich it Application 5. Percolation Rate 6. System Elevation 7. Final Grade Rate (Galslda /s ft.) nn Elevation Required Pr oposed IZBQ.'� Y q ( ) Zoe 1 Site Steel VI1. Tank Capacity in Total # of Manufacturer Prefab gla Plati Gallons Gallons Tanks Con Con- Information cretc structcd New Existing Tanks Tanks ❑ ❑ ❑ ❑ •-� 12 �v w��5�✓ VIII. Responsibility Statement I, the undersi ed, assu res onsibilit f installation of the POWTS s hown o th e attached plans. pines. Phone Number Plumber's Name (print) PlumbeQs Signature (no stamps): M1'.UPRS No. �— !K�Z_ Plumber's Address (Street State, Zip / S `7 Iv O 7 O - ALi t l - r— IX. County /Department Use 0111 l Sanity Permit Fee (includes Groundwater Date Issued Issuin Agent Signature (No stamps) ❑ Disapproved '3 7 — i =Approved ❑ Owner Given Initial Adverse Surcharge Fee) DetcrtninatJon d X. Conditions of Approval /Reasons for Disapproval: ak I�td�S:oh Sa6w.i4ti 'fib /���tc� a G�w�e � G�..�un��r; ta..er,K�tR �tGd ✓ev - a Colt Si'8e+�s t2ao 4 l 4 I I Bi S Cmftw two End Chamber 11" Stan• 14" High 16" High Av aflable SizeS Dimensions dard Capacity Capacity a � Safety and Buildings Division PE IT A 201 W. Washin Avenue Asconsin P O Box 7302 Department of Commerce In accord with ILHR 83.05, W �. � fed Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) for the system, s cou than 8 1/2 x 11 inches in size. � -,t _ Cep • See reverse side for instructions for completing this application to Sary[ar Permit Number 2 6 36 39,z,o Personal information you provide may be used for secondary purposes r ST �eck i r Dn to previous application [Privacy Law, s. 15.04 (1) (m)]. 2 C(}�Nn State PI � � Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF ATi *Q� Property Ow er Na Pr9PQ Location 4 T 30 , N, R j ! 'Low) W Pro perty Owner's Mailing Address Lot Numb Block Number � Cit tate Zip Code Phone Number Subdivision Na CSM Nu ber d,w Ca gle a� � (6si) - �z s �.. 387 II. TYPE BUILDING: (check one) ❑ State Owned ❑ C it y V Nearest Road Public or 2 Family Dwelling - No. of bedrooms % villag OF So•ner' 60 6 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ? 1. 3o, 1q &O 1 03 Z—z'� / 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 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 2-5bw 2 ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an ------ System -------- System Tank Only System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed ;✓ 21 E] Mound 30 ❑ Specify Type 41 E] Holding Tank 12 Bleepage Trench 3 CL 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit ms s' *39�+' 43 ❑ Vault Privy 14 ❑ System -In -Fill .,A., �b d �t� ts 11 VI. ABSORPTION SYSTEM INFORMATION: GooL_rz /,Zoo 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) E�e atign 1 420-20 O. V9 as /O /. $'7 Feet � �— Feet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App Tanks Tank Septic Tank or Holding Tank W g5tr C077I12— . ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ 1 ❑ ❑ ❑ ❑ 1 ❑ VI11. 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 tamps MP /MPRSW No.: Business Phone Number: c GC. 2.,Z503(o Plu ber's Addr ss (Street, Ci , State, Z): 1470,.►� d A � Cad, i4 IX. COUNTY / DEP ARTMENT U SE ONL ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin gent Signat a (No Stamps) Approved [:]owner Given Initial Surcharge Fee) Adverse Determination $ oZ b'�" X. CONDITIONS OF APPROV L/ EASONS FOR DISAPPROVAL: �) sue• �s-E --P►� s e ms-- cs Kk SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid forjwo (2) y#arsr. 2. Your sanitary permit maybe. renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative tode will beapplataible. 3. All revisions to this permit must t 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 properIVrrraintained. 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 and Buildings Division, 608 -266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide thedegal 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /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. VIII. 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 81/2 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; 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; 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 contamination investigations and establishment of standards. l i I I NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. h a rt'1. CoE[.Gne yr q ILAN VIEW V r `iJ d cs o 0 i ��ZSU .•ie5e/ CS. a•�•' 13c�;E.am o�'S�di � a ().E Cv�ner t��aia�e. ale✓-= INDICATE NORTH ARROW ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Lone- ©cz 1e Ce,17,5 ru ci&6l,, i cS h �.►� �r E Property Address City /State Legal Description: n Lot Z Block — Subdivisior - t1 t /4 t /4, Sec. , T N -R W, Town of PIN # X10 - /o39 -60 - SEPT TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 1.�► e�i Cane. Size ST/PC /, 2501 \ Setback from: House Well P/L Pump manufacturer Model �---- Alarm location (HOLDING TANKS ONLY) Setbacks: Service road V esTi air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width Length Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark /o E 5 &;0 ae Ste, Ca rne r / f Elevation Description of alternate benchmark of is Elevation Building Sewer ST/�ff Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover I Distribution Lines () () () 4 Bottom of System Final Grade Date of installation S //9/O/ Permit number State plan number Plumber's signature License number Date Inspector Complete plot plan a oP c� /o-+E -ta E �-n a Q / 3 L 6q � 4;�sr�t 3o3s/ p ✓� Pro po3t. -4 , I.60 �aP cArlu c & ,7 e . SePf; cta n�! Proposc wc.CL - ,c�6t ctroOM y `S�. yoA.d e— re- 5, Van ce p 3877 •3 04. 1 rP. i9 u,., Tn, 0 f &Mu5 44, 56. Cr61jr Co., <,O/ SO` ee .3oA3 9 ¢ncil l : 700 of z lion /oE S Xe . 561 Obserl/oo&a Gar l�r� Sh •`ll�nq Prop. �OC:Gtc2C�P/d� /0 PrePose-d e rig SfA e n WSW S. 9, T. 3a4 .P 19u9, Scale: T aF.kv►xrs L�, St • C r (1, c0/, ,. ; X3 ,± Safe. igce v,, �� S S�Ex m,g, ec 353.c� S /8.14 ' r/e% - =io9OP R e p y b Z, 6 3 pr irn a-r� 5 5-to ,i A/'ect Yj 6/4( 4s II� Y3s� lee -r t . D. 4222 GL S. �Oor c � ` LE.. b, : T oF'1' i'aba SL b q fi N I �j �' ,,� ut 17�;n8 ktyl� CQ�oat:�► � � az.... -- � S a � ` ■ �„ 5 � dt i,.9�ndei' " in l,'%t�- 'fi,,,' 83 ctn; t5.. a Soo -S tv 0 -� T C) 0 /A) F l4A.A400-S l hA- IlArAt #177. SePf� cta..n�! SD Sfr /'e n S.dacc l aT �i M4 �ot z, C �/►t deC. /y , ��. 3877 R. Tn, 0 y &MuSZ:6 Sty. f'r6,)C a, u l III Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20& 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa- tion needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting ! this requirement. Instructions: ! 1. Complete this plan by filling in requested information, completing the site diagram and marking ( ✓) appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: 1 inch = feet f EROSION CONTROL PLAN LEGEND PROPERTY LINE i _ EXISTING DRAINAGE -� TD TEMPORARY DIVERSION FINISHED -' DRAINAGE LIMITS OF GRADING SILT FENCE ♦ +� STRAW BALES GRAVEL O VEGETATION SPECIFICATION TREE PRESERVATION STOCKPILED SOIL Please indicate north by completing the arrow below. I —N— I PROJECT LOCATION`' ' k BUILDER t1� �-. Q < e 1, OWNER /4Z. -/ WORKSHEET COMPLETED BY L 'rte GG� DAT EROSION CONTROL PLAN CHECKLIST `tea Q� Check (✓) appropriate boxes below, and complete the site diagram with necessary information. Q QQ V o F = o Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. �] ❑ Location of storm sewer inlets. Location of existing and proposed buildings and paved areas. Z The disturbed area on the lot. e Approximate gradient and direction of slopes before grading operations. l( Approximate gradient and direction of slopes after final grading operations. ❑ Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices � ❑ Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be II I covered with a tarp or more than 25 feet from any downslope road or drainageway. Location of access drive(s). Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). ❑ / Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre - vent eroded soil from leaving the site. II` Location of sediment barriers around on -site storm sewer inlets. L/ F-1 Location of diversions. Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than 1 10,000 sq. ft. should also be diverted around disturbed areas. .�I ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or by seeding with use of erosion control mats. ❑ Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In- channel practices should not be installed in perennial streams (streams with year -round flow.) ❑ Location of other planned practices not already noted. a Indicate management strategy by checking ( ✓) the appropriate box: � p `RC Q . Management Strategies I ;k-" Temporary stabilization of disturbed areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment). r Indicate re- vegetation method: Seed.;;�<Sod ❑ Other ❑ Expected date of permanent re- vegetation: Re- vegetation responsibility of: Builder Owner /Buyer Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Yes )l No ❑ ❑ Use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. ❑ Trapping sediment during dewatering operations. Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until v most of the sediment settles out. l� Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook and UW— Extension publication Erosion Control for 9 � P Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266 -3558. Erosion Control for Home Builders (GWO001) can be ordered through Extension Publications, 608/262 -3346 or the Department of Commerce, 608/267 -4405. EROSION CONTROL REGULATIONS UNIFORM DWELLING CODE (DEPT. OF COMMERCE) PROJECTS AFFECTED • Straw bales, filter fabric fences or other barriers to • All new 1 and 2 family dwellings in Wisconsin started protect on -site sewer inlets on or after December 1, 1992. • Additional controls if needed for steep slopes or other • Additions to dwellings built after June 1, 1980. special conditions MAINTENANCE AND WASTE DISPOSAL APPLICATION PROCESS • Sediment controls must be maintained until the site is • Erosion control measures must be included on the plot stabilized by mulching and seeding, sodding or plan submitted with the building permit application to landscaping the local building inspector in communities where the • All building waste must be properly disposed to pre - dwelling code is enforced vent pollutants and debris from being carried off -site • Plot plan must show: ENFORCEMENT — Location of the dwelling, other buildings, wells, sur- face waters and disposal systems on the site with .Erosion control inspections will be made during other respect to property lines regular inspections (footing and foundation, rough con- - Direction of all slopes on the site struction, final, etc.) — Location and type of erosion control measures • Violations must be corrected within 72 hours • Stop work orders may be issued for noncompliance CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT • Silt fences, straw bales, or other approved perimeter • Local building inspector measures along downslope sides and side slopes • Department of Commerce, Safety and Buildings Divi- Sion, P.O. Box 7969, Madison, Wisconsin 53707, • Access drive (608) 266 -2128. STORMWATER PERMIT (DNR) PROJECTS AFFECTED — Proposed erosion and storm water pollution control • Any grading or construction project that disturbs 5 practices during and after construction acres or more and is not covered by a building permit — Documentation that an erosion control and storm • Smaller sites that are part of a planned development water management plan which meets DNR standards involving 5 acres or more of land disturbance has been prepared (plan does not need to be submit- • n w or continuing Effective October 1, 1992 for any e g ted with the application) project —Other information related to site location and per - • Exceptions: Indian tribal lands and work done by local mit holder government staff CONTROLS REQUIRED APPLICATION PROCESS • Erosion control measures specified in the Wisconsin • File a "notice of intent" application (Form #3400 -161) Construction Site Best Management Practice Handbook with the Department of Natural Resources (DNR) 14 • Measures to control storm water after construction days before construction begins FOR MORE INFORMATION, CONTACT • Application must include: • Department of Natural Resources, Storm Water Per- - Timetable for land disturbing activities and installa- mits, P.O. 7921, Madison, WI 53707 -7921, (608) tion of erosion control measures including project 266 -7078 start and completion dates LOCAL ORDINANCES Check with your county, and city, village or town for any local erosion control ordinances including shoreland zoning requirements. Except for new 1 & 2 family dwellings, local ordinances may be more strict than state regulations. They may also require erosion control on construction projects not affected by state or federal regulations. A publication of the University of Wisconsin— Extension in cooperation with the Wisconsin Department of Natural Resources and Department of Commerce, Ron Struss, Water Quality Educator, UWEX Western Area and Carolyn D. Johnson, Urban Water Quality Educator, UWEX Southeast Area. UW— Extension provides equal opportunities in employment and programming. This publication is available from county UWEX offices or from Extension Publications, 630 W. Mifflin St., Madison, WI 53706, (608) 262 -3346. Copyright 1997 by the Board of Regents of the University of Wisconsin System doing business as Cooperative Extension, University of Wisconsin— Extension. Send inquiries about copyright permission to Director, Cooperative Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Drive, Madison, WI 53706. GWO001A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites DNR: WT- 458-96 R -02- 97- 2M -10—S Wisconsin rtmentof.Commerce SOIL AND SITf EVALUATION Page 1 _of 3 Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 15% x 11 inches in size- Plan must County mckide, lnd not wed to vertical and tmr¢o" reference point (W, drr!ection and - - -- - - - -- - .St._ Croix____ _ _ perc ent slope, scale or dirnerrsiarrs, north arrow, and location and distance to nearest road. Parcel l.fl.# 032-203540 APPLICANT INFORMATION - Please print a - eve B - - -- - g te - - - -- Personal information you provide may be used r secondary 31) — e Property Owner Property L.ocahor Ga 1en Schittin BUYER: Gre Soh `` Govt Lot NW 1/4 SW i/4 S 9 T 30 N,R 19 W jr '.1 a , .� ...._.... - - - - -- - - - -- - - -- -----------_-------------- Property Owners Mailing Address Lot # B1ock # Subd. Name or CSM# 4 150th Avenue --- -- - Z - -- - - - _. - -- Proposed CSM - - -- - - - - -- City ___ slate Zip C ThIcKi"(nw �] Gty, , [� Village ZTown Nearest Road k >' 50Th Street Somerset W1 540 ;? ,11.5 -549` Somerset Z New Constructors ts Use: z tlaull of bedrool� ; 4 ��Addition to extsbN building Rte# Public of Code Dived daily Dow 600 gpd tied design loading rate gpor .5 hendt, gpdffl Absorption rea fequifed 1500 bed, fF 1200 trends, ftz Maximum design wing rate A bed, gpdr .5 b ench,gp dtW Recommended tnfilfration surface elevabon(s) /P/ S7' - -- it (as referred to sile plan benchmark) Addif anal desig / site consideration Install trenches using high capacity infiltrators. Parent maw Glacial tilL Flood elevation,1 NA ft S- Suitable for system Conventional Mound !n- Ground Pressure AT -Grade System in Fill Holding Tank U- for system ®S E] U ❑ S 11 U ❑ S ❑ U ❑ S ❑ U I EIS E U ❑ S ❑ 11 SOIL DESCRIPTION REPORT nth Dominant Colo' Mottles Texture Shucture Consis Boundary Rood - - -- GPDr Botisg# won i Munsell Qu. S7- Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -10 1Oyr3/3 None sl 2fsbk t as 2f 0.5 0.6 2 10-20 1 Oyr4 /3 None A 2 msbk cs 1 f 0.5 0.6 Ground 3 20 -51 7.5yr4/4 None sl 2msb aw if 0.5 0.6 elev 105.78 it 4 51 -77 5 yr4/4 None gr. sl lcsbk cw - 0.4 0.5 --- - - - - -- fleyth to 5 77 -93 7.5yr4/4 None sl lcsbk - - 0.4 0.5 linAng facer ------------------ _ __ _ -- --- Remarks: -- 2 1 0 - 10 10yr3/3 None sl 2fsbk mvfr as #fO.5 0.6 — - -- - - - 2 10-25 7. 5yr4/4 None sl 2msbk mvfr cs 5 0.6 Ground 3 25 -39 7.5yr5/6 None scl 2msbk mfr aw .4 0.5 elev 105.23 ft 4 3 -79 5 yr4/4 No gr.lfs Om mfr cw - 0 4 0 5 Depth to 5 79 -90 7.5yr4/4 None A Icsbk mfi - - 0.4 0.5 limiting i factor �o�. 5 - - — - - Remarks: CST Name (Please Print) Signature. Telephone No 715-248-7767 James K Thompson - - -- - CST Number Ref # Address A.C.E. Soil & - S'rie Evaluations Date 340 Paulson Lake Lane, Osceola, WI 54020 5/2100 3602 1222 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/]Buyer Ldne cAye tt cbm Z, dairr6ei� Mailing Address / 8.30 SS` 5i , cam. n ve� ; ao(6 M /1 6 77 Property Address , (Verification required from Planning Department for new construction) C� ' U City /State Parcel Identification Number 03Z' Z ° 3 :5 - 10 LEGAL DESCRIPTION Property Location /7 4) '/4, -5tJ ' /a, Sec. 9 . T - N -R Town of ,5amerSk16 Subdivision , Lot # 1. Certified Survey Map # (v 2 y 98� Volume IV Page # Warranty Deed # , Volume J52 Page # Spec house O es ❑ no Lot lines identifiable Elyes ❑ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Itwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a year expiration date. SPWIPCOF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property ed above, by virtue of a warranty deed recorded in Register of Deeds Office. ' C /-1-9 /yc� F APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Vol. 30 6232+06 STATE BAR OF WISCONSIN FORM 2. 1999 KAT14LEEH H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., WI This Deed, trade between Nottingham Development, LLC, RECEIVED FOR RMN byGreg Johnson, its sole member, 06 -22 -2000 9:30 AM WARANTY DEED EXEMPT M Grantor, and Lo Oak Construction Company CERT COPY FEE: COPY FEE; TRANSFER FEE: 126.70 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area That part of N W 1/4 S W I/4, Sec. 9- T30N -R 19W described as follows: Lot 2 Name and Return Address of Certified Survey Map recorded in Vol. 14 of Certified Survey Maps, Page DAVID J. ESTREEN 3877, as Doc. No. 624984, St. Croix County,Wisconsin. 304 LOCUST ST. HUDSON, WI 54016 s sa 032- 2034 - 95;032- 2035 -10 Parcel Identification Number (PIN) This is not homestead property. 00 (is not) Exceptions to wan Easements, restrictions and rights -of -way of record, if any. Dated this y[/ of June 2060 Nottingham Develo a LLC + + GregJohason, ole e M + AUTHENTICATION ACKNOWLEDGMENT Signaturc(s) Nottingham Development, LLC, by Greg Johnso STATE OF WISCONSIN ) Its peitl ) ss. �•• County ) qq yy,, f'►� ? sittpt nd Aed'�},y's. day of June _ 2000 personally came before me this day of the above named ulna nd�� R STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY « Attorney Kristina Ogland Notary Public, State of Wisconsin Hu son, My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) .) Names of persons signing in any capacity must be typed or printed below their signature. trdoRnmjon v rorasioMb comc.m, Fond ddU t�w N WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 �Vop0 � of 624984 CERTIFIED SURVEY MAP -EGA 'ED IN PART OF THE NW1 /4 OF THE SW1 /4 OF SECTION 9 T30N, R1 9W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. SCALE IN FEET 1" = 200' PREPARED FO R: 200 0 200 400 NOTTINGHAM DEVELOPMENT L.L.C. GREGJOHNSON UHpLQttfi CED RAHp,(B 324 S MAIN STREET _-- _- - -_ - -- STILLWATER,MN OO �GI]CDD l7 4G�CG3� (651) 438 -2 414 W 11 4 CORNER EAST - WEST 1/4 LINE OF SECTION 9 S TION 9 6'+/- N 89 W 165TH AVE N 89 27 08 W 62 3.00' S5►2 Ol' 4644.51' 2 of °o LOT 4 ' E1 /4 CORNER � w, no H.V.L. ca cv SECTION 9 w p Q -p a,i I ti $SI .G 004 ACRES cu: a7 T — 2 130,633 SQ F T p w V o� tiJ I o LL `-^n r4 ii q F - S :89 E. 59 :Q1... W / wrc ���V i0:. N w c�'n I^ 3 U13 ACRES `r 4, �° / Q O Q A IN ru = °O / Z » w a 6.0 'S 89 E 518.10' JJ 1 �/ ED 3 0i 80 17'8" J 152 . 4 7oC — 397.Zl� / (n2 4983 } 898 O El CONTIGUOUS BUILDING AREA LOT 1 1.4 AC W( e i v LOT 2 1.3 AC q LOT 3 1.3 AC �I Co OI N) m LOT 4 2.5 AC p rn v I o I 154,221 ` F: a �I I _ Q/ CURVE DATA W LL CI a' NUMBER I I W I W / RADIUS 233.00' aI �I DELTA ANGLE 08 CHORD DIRECTION S 84 E �I OI I_, 8980 CHORD LENGTH 36.16' ARC LENGTH 36.20' z 3 3 Imo_ = TANGENT IN S 89 E Io TANGENT OUT S 80 E cn ri o. � �� LEGEND Q AGR:ESi:i >:? OWNER I :.l 675..' :: Q;:; ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND GAYLEN SCHILLING 33.00' j 488 7 BOTH AVE. s�3 0 1"X 24" IRON PIPE SET WEIGHING SOMERSET, WI 54025 8 4,18 P E 386112 1.13 LBS. PER LINEAR FOOT SOUTH LINE OF THE NW1 /4 OF THE SW1 /4 . . . . . • . • • 100' ROADWAY SETBACK LINE EXISTING DRIVE — — — — — 12 'UfILITYEASEMENT APFKUVtU a PROPOSED DRIVE ST. CROIX COUNTS o cif– EXISTING FENCELINE Planning Zoninq and Parks C to STORM WATER RETENTION AREA TO JUN 16 2000 ' O H.W.L. = XXX.X HIGH WATER LINE H H.W.L. = HIGH WATER LINE ELEVATION If not recorded within 30 days of NOTE A GRADING THAT WOULD ALTER THE CAPACITY approval date approval shall be ' OF THE STORM WATER RETENTION AREA null and void 1 Q ' IS PROHIBITED SW CORNER �� �� NOTE B BUILDINGS ARE PROHIBITED WITHIN SECTION 9 Op I THE STORM WATER RETENTION AREA 1 THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB NO. 99-153 DATE 5;15/00 I VOL. 14 PAGE 3877