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CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT Owner R ae- 13.4. 5 AP7 TR � _ Property Address 82,1 16 5 - ALt � � OX A City /State — ��'Gfft&ArQ UZ • 3 VO /7 '� �� � Legal Description: E, 1 - Lot _ Block &4 - Subdivision/CSM # _Ale & S S L ��� �"S 1ATES 7 SW '/4"'/4, Sec. /1, TJ-N -RAW, Town of ^ 0mgEf sc-T PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer W & E/ CS S Size ST/PC " Setback from: House -22- Well &W� P/L �Z !C Pump manufacturer NAB Model IVA Alarm location A14 J � (HOLDING TANKS ONLY) �' WEIVEQ Setbacks: Service road Vent to fresh air intake Meter location X99 - Alarm I ST t , zonl�n�6Q< SOIL ABSORPTION SYSTEM f stern; es Width Len �� Number of Trenches Type o s �— YP Y T� Setback from: House / 3 21 Well /00 t P/L Z&_ Vent to fresh air intake /00 ELEVATIONS Description of benchmark Zap 5, �F Lo T S Ar-Cf Elevation 420 LO Elevation Description of alternate be nc hm ark 0 Building Sewer ST/HT Inlet �7,7 - 6? ST Outlet . PC Inlet PC Bottom ffA_ Header/Manifold Top of ST/PC Manhole Cover Distribution Lines (F) _ �� • 7 (2) ®- 2 ( ) Bottom of System Final Grade U) (2) 9 ( ) Date of installation j f1171 Permit number 3 State plan number NA Plumber's signature A License number 2 I- f 7 y_/ Date Inspector 6:�� Complete plot plan �+ 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. PLAN VIEW /Y ff0 5'c , 4 cC . J a 0 r n a °'4" r3 y ICATE NORTH ARROW �Wisconsirt Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit 90 IX you rovice may be used for secondary purposes [Privacy La s.15.04 (1)(m) 3 38906 Personal information Y P Y rY P P [ Y Perrq tJ Ipl er �jl�gt�:' WILLIAM ❑ City Town of: State Plan ID No.: CST BM Elev7 Insp. BM Elev.: BM Description: M tC5 Parcel Tax No.: 41 A 032- 2106 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Zee Benchmark , 3 7 /0231- Dosing , aw 15 Aeration Bldg. Sewer 9 3. 91 Holding St /Ht Inlet 9,7(, `72 -4 If TANK SETBACK INFORMATION St/ Ht Outlet 4, 92 TANK TO P/ L WELL BLDG. Air I to ntake ROAD Air Septic Q /app �Z -- NA Dosing NA Header/ Man. C� 23 9/. /Y Aeratio NA Dist. Pipe � I� 3 4 g0, C 7 Holding Bot. System 71 E 2.4 6 fir' . .7 PUMP/ SIPHON INFORMATION Final Grade �: �,� g -6Z Manufactur Demand CI8. -+8 Model Number GPM TDH Lift F* • n Sys TDH Ft oss m ead Forc In Length Dia. I Dist. To Well SOIL ABSORPTION SYSTEM S `'�` 4 n 4 ' TRENCH Width Len th No. f Trenches PIT No. Of Pits Inside Dia. Liquid Depth W DIM S DIMENSION SYSTEM TO P / L I BLDG I WELL LAKE/STREAM LEACHING Manu a t rer: SETBACK CHAMBER INFORMATION Type Of t r * model Numher: System: A I a $ >1 OR UNIT t DISTRIBUTION SYSTEM Header/ ani old µ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake � r Length �tQ� Dia. Lengt ia. pacing 1 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.) LOCATION: SOMER ET 12.30.19.996,SW,NW 822 165TH AVENUE ©S � r�J t w s-- L tom 7 . S,4- � o 0 > `� u cow 1 - aw•� ST caw V Plan revision required? ❑ Yes A No ' 6 Use other side for additional information. 1 20 1 q� SBD -6710 (R.3/97) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH s SANITARY PERMIT NUMBER: e m.a .. ._ E m .¢ e s , , • � -- ..,. ... o s _m� m • I E .. . i E p E s . ..... .... .... .e__. ,.-.ems a ". _...... ........,...... . �.,. ,,,..... .�. . ........._ _ ,. ...... L... ... ....... .. _ .,., ....§, ,..... §— f s J, .,.,,. ......E.... �.�.. ... m. ...�w.. .... .m ... ,s .a ...a., _. ., .m �m r i 4-- ,. ams..z ... a f § a e ae. � e 6 . s � ° E ,.. .... ...�. .m.. _.:.. ..� .., �„s ..ate. my ,... m.... . F t E _ • e a - .. a e v . _ . . __ ........... ..:u,_ .,.�... ' .,.r.... ,.. , ,..... _ c..,.,.._� .a _... �_ SANITARY PERMIT APPLICATION 01 E W and ashington A on sCo nsin In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County 5T G e Q than 8 1/2 x 11 inches in size. • See reversei side for instructions for completing this application State Sanitary Permit Number 33F-C7 n The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location iW , S o 1 /4 AW14,5 Ig T O, N, R E (or Property Owner's Mailing Address Lot Number Block Number T# E 02 /¢ City, State Zip Code Phone Number Subdivision Name or CSM Number a44 ��rygsl K61114 - A S - II. TYPE F BUILDING: (check one) ❑ State Owned ❑ It Nearest Road Public 1 or 2 Family Dwelling ❑ Village - No. of bedrooms _ Town OF a 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 032 - 2tob- ?.•o-floo l2.3.0_ 1 [] Apartment/ Condo 02 Z '40a 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. [['New 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an System ________ System____ _________TankOnly______________ Existing System ________ E x is ting --- 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure + Y 7� 42 ❑ Pit Privy 13 Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill yl � " i 4� 1 5 VI. ABSORPTION SYSTEM INFORMA N:, 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. S stem E v. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) ,(d Elevation p 1 0 , Feet 3P,8 Feet Capacity VII. TANK in Ca allon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existing structed Tanks Tanks e EE 0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ ❑ 1 ❑ ❑ 1 ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu s Signature: (No Stamps Business Phone Number: A L • P umber's Address (Street, City, State, Zip Code): 5S 6 111aw yv �` IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin ent Signature (No Stamps) A roved surcharge Fee) L9" pp ❑ Owner Given Initial 2 ��• 0 7 �c Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildngs Division, Owner, P'kmdw INSTRUCTIONS 1 _ A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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 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 the legal description and parcel Lax numbec of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. IIL 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 a// 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 orefix (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 8 112 x 11 inches must be submitted to the county. The plans must I or with complete dimensions location of holding tank se include the following: A) plot plan, drawn to scale g (s ), tic p 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. i ---------------------------------------------------------------------------------------------------- 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. I , f ! I r � , � I i 4 I ve - , - --; r ' r ; I o ,p G _ ' - - - _ r i �0 �v TF ---- i - G %- &rl'+-'r* 1 MWT 2 �E c -' T t_-- �U- �--- J-.__+ - ,l 'S!. I � } r I r 4 I I - i , f r , , s 1 } , , I - d q i s i : i i i f i — I , a i • ' i S [ r i E 7 , F d f , s I t ; i I Revs'se,4 4 � j_ 6' COPY/ mNnm " no SOIL AND SITE EVALUATION REPOR I rap- L- p sbrT of gamy a Buildrpa in accord with ILHR 83 ,d s KY ST. Croix Attach complete we plan on papa rat less than 81/2 x 11-inehes i � PARCEL I.D. N not 11mited to vertical And horizontal reference point (BEM), direction 'tie at � �; dimensioned. north arrow, and reaction and distance to nearest redo: 3 7 ^ 2 U APPLICANT INFORMATION - PLEASE PRINT ALL INFORIIIIATION)IR! ," Y REVIEWED BY DATE - ; - - - -- - tAA law. s Sa w►o re [ E ta "' Lal�rSl J. u4 ',., INA 12 T 30 ,N,R 19 ft(a1 W PROPERTY OWNER':S MAILING ADDRESS OCKe BD. NAME OR CSMe , N. Hass Lake Estates CITY, STATE . ZIP CODE PRONE NUMBER ILAGE OWN . IMEARES�ROAD ( 8 rset (d New ConetrucSon Use k I ReeidOU / Number of be* ms 3 E I Addition b exis*V buNdNtg I I Replacement I I Pudic or conraM T load describe 7 bed, gpd/ft .8 trench, gpdAt f w 450 Recwmmm*d design► loading Tate • tAOe derived 9hd AW&Pfion area; required 643 bed, ft2 563_ trench, ft um desir baring rate _.2_ bed, QP0 .--& -- trench, gp w Gr Reoonwrreeded NMIUallon surface elevation �4 __M 0 R (as reterr to sits p�t benchmark Addillond delign t ails corgi Wafts alt. area system el . =93.80 -_ f o _ Parent material UN butyas Flood Plain etevatlon, if app�csbie na� �- A CONVB�ITIONAL MOUND Y q�F-C�O p D AT N -CMDE SYSTEM � HO ��AW (� a UrISlsiable 10r M S 0 U ❑ u IJ U S ❑ U t SOIL DESCRIPTION REPORT Depth Dominant Color Motu$ Structure Roots GPD! In. Munse Boring # Horizon Texture tar. Sz. $tl. Corrsistenoe BOtaxialy 7 4- ll Cl Sz. C orn. Color 1 - �. 2 1 -3 ] /4 1 att>u<td 3 - etev. i 9&..6- 4 37- gmitirt +84" f /sy Remarks: - Boring 0 i 2 11 -30 1 VQM L2 r 4 na Ground — �811 6 CDs 9MIt• IBM +84 4- IS-y Remarks: WCSTHia Print G L. Steel Phone: 715 - 246 -6200 th New Ric W15401 CST Number: mO229-. Date: 4 -15 -97 ..s .. - SAIL DESCRIPTION REPORT Pap -2.._of PIRiiCELIAN c BOianQ Horizon 2e� Dorninant Color Mopes. Texture Sinmre � �� �� GPD /ft. In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed T� Li , t>Sround 3 29 -38 7a5Yr4 si /4 none al icsbk mvfr r if . .4. .5 . �'/ • 8 n 4 38-84 7.3 r4 6 none Cos os mi na na .71 .8 Depth to / C iador Az Remarks: Baring a 1 2 -9 1 r3 3 e '' VIEW" 4 9 1 r4 4 noxus .__.....____ c 1f _!m f� d 3 - _one - - _saw.- - Sty+ E Nw. 4 9- 7.5 g�j tt . 7 � . Cos "V L.- J D s i. Remarks: 5 2 2-30 LOIX914 ncm mici lmbk --af r-- if C�rvmd 3 ' 30 -39 7.5 r 4 none is OBQ mfr aw na .7 .8 Ira ft 7.5 6 Cos mm MfX VA na 7 bag +84" rT 1 Remarks: aw. n. s WE I OEM bwrwwd.w. A 5 K STEEL'S SOIL SERVICE Gary L. Steel Gerald :with 1554 2001h Ave. CSTM2298 SW%NW% S12- T30N -R19W New Richmond, W154017 MPRSW 3254 town of Scmereet: (715) 24"2O0 llama I,wkn I#d 1%l:ww 1 "=40' EM.= top ofSE lot stake 0 el. 100' Al.t Srf.= top of SW lot stake a el. 101.40' � 5 r Gary L. Steel 4- 15-97 I 1 � I OVA i I Il 1 I I ( I I I i I Cot 4,70 3 1 1 ` I , 1 , I 1 I I �G _ + } I i I � w I I � I I I rAot Tap Jar -- WSconsin.Department of Industry SOIL AND SITE E V A AT I O N O R T Page 1 of 3_ Laoor. and Humbn Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. G 3 Z O 4 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IM DATE , Cc PROPERTY OWNER: PROPERTY LOCATION Ili Gerald J. Smith GOVT. LOT SW 1/4 NW 1/4,S 12 T 30 N,R 19 j(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 11160 190th. Ave. N.W. 2 na N. Bass Lake Estates CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Elk River MN. 55330 (61J 8 Somerset I 85th. st. [ New Construction Use k ] Residential / Number of bedrooms 3 [ ] Addition to existing building ] Replacement [ J Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate ___L bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 94.60 ft (as referred to site plan benchmark) Additional design /site considerations alt. area system el . = 93.80' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND 7 1aN7GR17UND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem IDS ❑ U KI S El U S El U ®S ❑ U ®S ❑ U EIS O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed lTrench .................. ................. .................. ................. 1. <<_ 1 0 -11 10 r3 4 none sil 2m 2 11 -31 10 r4 4 none Ground 3 31 -37 7.5 r4 4 non elev. 9 _ h ft. 4 37 -84 7.5 Depth to limiting factor +84" a� gar Remarks: Boring # 1 0 -11 104r3/3 n one mfr rq ?f 2 11 -30 10 r4/4 none cl 2msbk Ground 3 30 -84 7. 6 nc)n M1 na elev. 98.6 ft. Depth to limiting factor 84 , Remarks: c U CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200' Z� Address: 1554 200th e. New Ric and WI 54017 Signature: Date: CS 2298 4 -15 -97 PROPERTYOWNER Gerald J. Smith SOIL DESCRIPTION REPORT Page 2 of 'I PARCEL I.D. # 2© 0 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 14 -29 10 r4 4 Ground 3 29 -38 7.5 r4 4 none s1 lcsbk mvfr aw if .4 .5 elev. 97. ft. 4 38 -84 7.5 r4/6 none cos osg m1 na na .7 ': .8 Depth to limiting factor +84" ^ A. , Remarks: Boring # 1 0 -9 10 r3 3 none sil 2msbk mfr cs 2f .5 .6 2 9 -19 10 r4 4 none sicl lfsbk mfr Cfw if .2 ': .3 Ground 3 19 -29 7.5 r4 4 none is osa mvfr crw if .7 .8 elev. 4 29-54 7.5 r4 6 none cos 0SQ ml na na .7 .8 9 6.3 ft. Depth to limiting - 30 factor Remarks: Boring # 1 0 -9 10 r3 3 none 1 2msbk mfr cs 2f .5 .6 5 ..... 2 9 -30 10 r4 4 none sici lcsbk mfr qw if .2 .3 Ground 3 30 -39 7.5 r4/4 none is I oscf mfr qw na .7 .8 elev. 96 ft. 4 39 -84 7.5 r4 6 none cos 0SQ mfr na na .7 .8 Depth to limiting factor +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Gerald Smith 1554 200th Ave. CSTM2298 SW 4NW4 S12- T30N -x19W New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246 -6200 lot #2 -N. Bass Lake Estates 1 =40' BM.= top of SE lot stake C el. 100' Al.t BM.= top of SW lot stake C el. 101.40' Leh W 2 �yj� 2- r G� Gary L. Steel 4 -15 -97 I� { , I i - -- -- i ' t ! T � �_ - - - - - - - - - -- _ A f2 V/ I , _ t t ! , b -- V f ; D - -- - - - Y , , _ I jj�46 . - i cr e _ _fir_ , : : T�f , , : r } r 3 E r 1 t ! 6 ! f I ' t ; f l Y � f r I e � r 4 - t 4 1 . F' o � ' I 4 1 ' 1 . _ . i t E 1 # I _ s I d t a ' I i Y 1 i t i T i _ E . I r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /�o`LL l� A ss.�r iok'� Mailing Address 7* i�C /� Leor��.va.7� S5 Property Address a c?K (Verification required from Planning Department for new construction) City /State S ET 111i , Parcel Identification Number Q_ — 10 ys - .'1'0:::/W LEGAL DESCRIPTION Property Location S49 '/4, _&I& '/4, Sec. /a? , T , N -R _Lf_W, Town of Subdivision NAq;r# aA LAlfjF r-S?ATF S Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 58 86-27 , Volume 13 4 3 , Page # 6 0/ Spec house ❑ yes I no Lot lines identifiable X yes ❑ 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 wastewater disposal 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system vrith 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 the three year expiration date. _ a- b a4 ar►-� s / to / Cl 9 SIGNATURE OF APPLICANT DATE'S 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 prop described above, by virtue of a warranty deed recorded in Register of Deeds Office. :I Y k b L (7 lAn eue S l 4 l 6 f ! 3 SIGNATURE OF APPLICANT BATE * * * * ** 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 /v do /J DOCUMENT NO. State Bar of Wisconsin Form 2 -1982 WARRANTY DEED REGISTEW9 bf!^ ICE ST. CROIX CO.. WI Rensj Crr Rnnord OCT 0 7 1998 Forest Oaks Condos, Inc., a Minnesota Corporation, conveys and j0:00 M warrants to William A. Bassamore and April M. Bassamore, `9�a.a,�°Ik husband and wife as survivorship marital property, the following Register of Deeds described real estate in St. Croix County, Wisconsin: p7/ v Na P 1 C11 wlp l cL4 Parcel ID No. 038 - 2106 -20 -000 TRANSFER Lot 2, North Bass Lake Estates in the Town of Somerset. 6 70 This is not homestead property. i Exception to warranties: municipal and zoning ordinances, easements and restrictions of record. Dated this day of September, 1998. FOREST OAKS CON OS INC. By: �� 96r"aldJ ith,President ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. ST. CROIX COUNTY ) Personally came before me this 30 day of September, 1998, the above -named Gerald J. Smith as Pres;dent of said Corporation to me known to be the person who executed the foregoing instrument and ackno edge the same. Notary Publi , St. Croix County , Wi . My commission expires: I +� THIS DOCUMENT DRAFTED BY: Judith A. Remington REMINGTON LAW OFFICES �y ` P.O. Box 177 New Richmond, WI 54017 (715) 246 -3422 Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dpelltng Code, a soil erosion contr ol plan needs ,to;be submitted and. a Pp roved prior to the issuance of building permits for 1 3c 2 family dwelling uatts to those�urisdictions where the soil erosion control provisions of .the Uniform .Dwelling Code are enforced This Standard Erosion Control Plan u provided to assist to tnzeung this requirement Building inspectors have authonry to jpquest erosion control measures not speufically required by Code when such measures are deemed necessary. to meet the Code s overall performance;standard of keeping soil on site Construction o ecis that disturb e an 5 acres, oc are part of a development that disturbs more than S P .! acres, are alsd'!required to obtain a construction site storm water discharge permit from the Wisconsin Departrl[ent of Ivatural Res�urc� ;. Applicant: '�► I rr>,Y� 6A S5E m0Ce-- C (r12 - ) 85' 3 o Name Daytime telephone number ON Aj Street address, city, zip code Landowner. � �. ` � 1 y � y, � # C) I' � 1� ; l � f1 � `) (a YY1c:: � � � &1;4 � O S S "" L ��1 �5 Daytime telephone number Name Street address, city, zip code Location of the building site (complete as appropriate): quarter of Section Town �>Q_ N., Range _ E. Lot Block -- a AL) Street address Instructions: 1. Complete this plan by filling in requested information, marking (./) appropriate boxes, and completing the site diagram. 2. III comp leting durin the site diagram, give consideration to potential erosion that may occur before, g, and after grading. Water runoff patterns can change significantly as a site is reshaped. Chaotern ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management tr l or Home Builders can be referred to for assistance in L k and U�V - Extension publication Eros ion Control f completing this plan. The Wisconsin Uniform Dwelling Code and the lirtsconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266 -3358. Erosion Control for Home Builders (GW0001) can be ordered through Cooperative Extension Publications, 608262.3346. 4. Submit this plan at the time of building permit application. . , r ` fi I Plan �Contro nd ar d E rosion' Standard 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. I 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 EROSION CONTROLPLAN LEGEND PROPERTY LINE _ EXISTING ' DRAINAGE TO TEMPORARY - - DIVERSION FINISHED -' DRAINAGE - - - - - _ - LIMITS OF SI GRADING SILT FENCE - - ! STRAW BALES -- -- - - GRAVEL - - O VEGETATION - - SPECIFICATION TREE l - -- -- - - PRESERyY.T10 C1 4 _ STOCKPILED - SOIL T . Please indicate north by completing the arrow below. PROJECT LOCATION S as ��� PUe BUILDER L'` LL, ra •-r, (a OWNER ' WORKSI IEET COMPLETED BY L,.�r I �� m 13f+ S y1 My t" DATE pdie3te management strategy by checking (,) the appropriate bow — Management Strategies 6 j D Temporary stabilization of disturbed areas. Note: Although not specifically required by Code, it is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (beta een 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. p Use of downspout and /or sump pomp outlet eate_siois. Note: Although not specifically required by Code, it is recommended that flow from downspouts and sump pump outlets be routed to stable areas such as established sod or pavement. O Trapping sediment during dewatering operations. Note: Although not specifically required by Code, it is recommended that sediment -laden discharge water from pumping operations be ponded behind a sediment barrier until most of the sediment settles out- 5 Proper disposal of building material waste so that pollutants and debris are not carried off -site. 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. Gravel access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. AgIeemenL I:hereby;certify - that I understand the construct ion s ate erosion control provisions of the Wlsconstn Uniform Dwelling Code, and that I accept responsibility for carnina outthe above erosion controlptan as approved by the code enforcement authority Si acute app can A publication of the University of ilrisconsin- Extension, Ror, Struss, OPEX Water Quality Education Specialist (12192). This publication may be freely duplicated Additional copies are c�- cilable through the UWEX Environmental Resources Center, ') I < A,, v- r! 7 f Cn I :..,I... rl„'„o !_ I ,a cnn IfW S 7 MA 6OR1262 -3652. Cbeck (.appropriate boxes below, and complete the site diagram evith necessary informadon- x l �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. [ The gradient and direction of slopes before grading operations. 1 The gradient and direction of slopes after final grading operations. (� Location of e and proposed buildings and paved areas. ❑ overland runoff (sheet flow) coming onto the site from adjacent areas. / Erosion Control Practices ❑ r7 Location of temporary soil storage piles. Note: Although not specifically required by Code, it is recommended that soil storage piles be placed behind a sediment fence cr more than 25 feet from any downslope road or drainageway. 6a Location of gravel access drive(s). Note: Recommended gravel drive design is 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 (which / ever is less). ❑ l Location of sediment fences (filter fabric fence, straw bale fence) or vegetative strips that will prevent eroded / soil from leaving the site. ❑ Ga Location of sediment barriers around on -site storm sewer inlets. ❑ N 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 adjaeent'areas greater than 1 sq. ft. should also be diverted around disturbed areas. ❑ 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. ❑ L'1 Location of practices that will control erosion in areas of concentrated runoff flow. Note: UnstabilLed drainageivays, ditches, diversions, and inlets should be protected front erosion through use of such practices as ir. channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. Fi'hen used, a given in- channel barrier should not receive drainage from morc than two acres of unpaved area, or one acre 6f paved area. In- channel practices should not be installed ir. perennial streams. ❑ 2" Location of other planneu practices not already noted. 04/26/99 18:32 FAX 2475086 JERI*KOESTER.... Q01 TOWN OF SOMERSET SOMERSET, WISCONSIN 54025 April 26, 1999 Mr. Rod Eslinger St. Croix Co. Zoning Fax: 715- 386 -4686 Rod: I'm faxing you four pages of erosion control plans for Gary Peterson's i.ot on North Bass Lake Estates. I will mail you these copies also. I will also mail you William Bassamore's erosion control plan. The Town Board did not have any problems with these erosion control - glans, neither did Bob Pierce. I don't know if Bob Pierce visited the sites or not. If you have any further questions or problems, please call Bob Pierce at 549 -6708 or Ed Schachtaer at 247 -3269 or 247 -5982. Thanks for informing me of the plat requirements. 4 kki V&.&4tk Jeri Koester, Clerk Phone: 247 -3519 Fax: 247 -5086 TOWN OF SOMERSET SOMERSET, WISCONSIN f 54025 � April 26, 1999 Mr. Rod Eslinger St. Croix Co. Zor Fax: 715- 386 -4686 Rod: I'm faxing you four pages of erosion control plans for Gary Peterson's lot on North Bass Lake Estates. I will mail you these copies also. I will also mail you William Bassamore's erosion control plan. The Town Board did not have any problems with these erosion control plans, neither did Bob Pierce. I don't know if Bob Pierce visited the sites or not. If you have any further questions or problems, please call Bob Pierce at 549 -6708 or Ed Schachtner at 247 -3269 or 247 -5982. Thanks for informing me of the plat requirements. Jeri Koester, Clerk Phone: 247 -3519 Fax: 247 -5086