HomeMy WebLinkAbout032-2121-20-000 ST. CROIX COUNTY ZONING DEPARTM NT
AS BUILT SANITARY REPORT
Owner S�
Property Address
City /State
Legal Description:
Loth Block `— Subdivision/CSM # '
'/a YL ' /a, Sec. 4-2, T
k N- R,[LW, Town of ., &.6a. _ PIN # - -
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
Tank manufacturer Size ST/P / Setback from: House �?_c2 Well P/L ^�
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: &, Width Z-,:? Length > Number of Trenches
Setback from: House 11Z Well ,--27- P2 _ Vent to fresh air intake /
ELEVATIONS
Description of benchmark } - Elevation , lev- p
Description of alternate benchmark Elevation 11j$, o
Building Sewer ,/fsl ST/HT Inlet ,i.�s ;��/ ST Outlet �� >� / �Q_ PC Inlet
PC Bottom Header/Manifold ,/ , 9 Top of ST/PC Manhole Cover 5
Distribution Lines ()
Bottom of System () () ( )
Final Grade
Date of installation // /goo / Permit number _ J/�/ %4 State plan number
Plumber's signature License number / _-? Date
Inspector C ,
Complete plot plan Or
NOTICE Please provide the following:
_R111-1
• 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
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11
30'
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INDICATE NORTH ARROW
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y
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)]. 344618
Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.:
Thell Scott I Town of Somerset
CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.:
Ig o /d d I Alw
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 'wee f` 5 � p Benchmark �Q
o. a
D s� Alt. BM 2. G /Q�- 0
Aeration Bldg. Sewer (0
Holding t Ht Inlet
TANK SETBACK INFORMATION Cy/ Ht Outlet r, /O
A <9990
TANK TO P/ L WELL BLDG. en to ROAD
Septic l Gai ZG Z� NA
Do � NA Header/ Man. - Co 0- S
Aeratio NA Dist. Pipe q, /DU. dp
olding Bot. System /� �I'
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand St cover
Model Num PM
Prcem L' L r System TDH t
ain Length Dia. Fi t. To well
SOIL ABSORPTION SYSTEM
BE TRENCH Width Leh No.Of Trenches PI No. Of Pits Inside Dia. id Depth
N I N Z_ I n t DIMEN I
SYSTEM TO P/L BLDG WELL LAKE /STREAM LE Manufacturer:
SETBACK
INFORMATION Type O AMBER I f Mo ber:
System: / 57'
— �� OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Length � Dia. r � Length Dia. Spacing Y Z Z Gj Z Z �Od
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: l( / f f Inspection #2:
Location: 834 165th Avenue, New Richmond, WI (SE1 /4, NW 1/4, Section 12 T30N -R19W) - 12.30.19.1094
Z) hl/ sew 3 Z-
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Plan revision required? ❑ Yes [�P No
Use other side for additional information. Z 7 ham.
SBD -6710 (R.3/97) Dat Inspector' i ature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
Itisconsin SANITARY PERMIT APPLICATION 2 1 Box Washington
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code
Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this a, plication `� � State Si nitary Permit Number
Personal information you provide may be used for secondary purpos �!! // �Crllco ❑Check if revisi t� previous application
[Privacy Law, s. 15.04 (1) (m)]. �2 q ) Q 6 State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRIN ' L IN N 91
Property Owner Name QN . ! operty L � n
t /a , S T , N, R or
Property Owner's Mailing Address Lot Nu r Block Number
City, Sta Zip Code Phone Number on ame or CSM Number
J / /7 ( )
II. TYPE OF B I DIN : (check one) ❑ State Owned ❑ it Nearest Road
E] Village
Lj Public C& 1 or 2 Family Dwelling - No. of bedrooms Town of
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
via— pia/ - — boy
1 ❑ Apartment / 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 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. P New 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure / 42 E] Pit Privy
13 E] Seepage Pit x 7 3 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
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) Elevati n
Feet Feet
VII. TANK Capacit g Total # of r Prefab. Site Fiber- Exper
Manufacturer S Name
INFORMATION g Gallons Tanks concrete con- Steel glass Plastic App
New Existing structed
Tanks Tanks
eptic Ta rFfeldTRgiattk A 66 — f" ❑ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for instal lation of the onsite sewage system shown on the attached plans.
Plumb ' ame: rint) Plumber' Sign r :(NqS s) MP /MPRSWNo.: Business Phone Number:
Plum er's Address - t et, Cit , State, Zi ode):
L Z.
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuin Agent S' na ure No Stamps)
ZVA / p proved ❑ Owner Given Initial Surcharge Fee) X 1 9 I a �
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
ii
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be 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 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.
Ill. 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 isto 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 1/2 x 11 inches must be submitted tot 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 man factures; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and ) 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.
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Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
tkbor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
0 ?, Z•s FPARCEL
�„
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 .D. #
dimensioned, north arrow, and location and distance to nearest road. 032- 2045 -20 -200
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
7 A
PROPERTY OWNER: PROPERTY LOCATION
Gerald Smith GOVT. LOT SE 1/4 NW 1/4,S12 T 30 N,R 19 )¢or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
11160 190th. Ave. NW 4 na N. Bass Lake Estates First Addn
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ ZrOWN NEAREST ROAD
Elk River, MN. 55330 ( 612 441 -8888 Som erset
i ] New Construction Useit ] Residential / Number of bedrooms 4 ] J Addition to existing building
(] Replacement ] ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /0 .8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate gi bed, gpd /ft ,8 vench, gpd/ft
Recommended infiltration surface elevation(s) 100.00 alt. area =98.6 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem I ®S ❑U ®S ❑U ®S El iE]S El IRS ❑U El 0U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 -9 10yr3/3 none 1 2msbk mfr if .5 1.6
1 <;
................. 2 -22 10yr4 /4 none scl 2msbk mfr 9W if .4 .5
Ground 3 2 -31 10yr5 /4 c2d 7.5yr5/6 sil lcsbk mfi gw na
103 ft. 4 1 -84 7.5yr4/4 none co s Osg ml na na .7 .8
Depth to
limiting
factor
+84
� ?. i
Remarks:
Boring # l -14 10 r3/3 none
y 1 2msbk mfr gw if .5 .6
2 ? 2 14 -26 10yr4/4 none scl 2msbk mfr gw if .4 .5
3 26 -28 10yr5 /4 none sil lcsbk mfi gw na .2 .3
Ground • 8
elev. 4 28 -84 7.5yr4/4 none co s Osg ml na,-- , :7,�
1 04. O ft.
Depth to �,• ��
limiting
factor
+8 4 " Q
Remarks: ' ' ` t ` "` "n
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200 e. New Rich and WI 54017 i
Signature: �,, Date: 12 -1 -98 CST Number: m02298
PROPERTYOWNER Gerald S mith SOIL DESCRIPTION REPORT Page 2
PARCEL I.D. # 032 - 2045 -20 -200
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouid3y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTrench
1 0 -10 10yr3 /3 none 1 2ms bk mfr gw if .5 .6
3
2 10 -22 10rr4 /4 none sicl 2msbk mfr gw if .4 .5
Ground 3 22 -29 10yr5 /4 none sil lcsbk mfi gw if .2 .3
elev.
10 ft. 4 29 -84 7.5yr4/4 none co s Osg ml na na .7 .8
Depth to
limiting
factor
+Ra"
.i
Remarks:
Boring #
1 0 -10 10yr3 /3 none 1 2msbk mfr gw if .5 .6
`< 4 > 2 10 -19 10yr4 /4 none sicl 2msbk mfr gw if .4 .5
3 19 -28 10yr5 /4 none sil lcsbk mfi gw na .2 .3
Ground
elev. 4 28 -84 7.5yr4/4 none co s Osg ml na na .7 .8
101.3 ft. -
Depth to -
limiting
factor
+84
Remarks:
Boring #
1 0 -10 10yr3 /3 none 1 2msbk mfr gw if .5 .6
5 >_ 2 10 -24 10yr4 /4 none sicl lcsbk mfr gw if .2 .3
3 24 -31 10yr5 /4 none sil lcsbk mfr gw if .2 .3
Ground
elev. 4 31 -84 7.5yr4/6 none co s Osg ml na na .7 .8
1 02.2 ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. i
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Gerald S ith 1554 200th Ave.
7n
CSTM2298 SE4NW4 S12- T30N -R19W New Richmond, WI 54017
MPRSW -3254 town of Somerset (715) 246 -6200
lot #4 -N. BAss Lake Estates First Addn.
1 =40'
BM.= top of NW lot pin C el. 100,
Alt. BM.= top of 1 pvc pipe C el. 102.90'
7 )
OA
Olt
Gary L. Steel
12 -1 -98
ST CROIX COUNTY
SEPTIC 'TANK MAINTENANCE' AGPH
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer �f ��►r // ____ -- —
Mailing Address ?y rc,", 7 S_
Property Address T -- v
(Verification required from Planning Department for new cui:struction)
City /State �'�,� ,��r,�n >Ar��[ Parcel Identification Number
LEGAL DESCRIPTION
� � GLA T ?0 N -R �ti', i,i�"n iii ��
Property Location .� /4, a, Sic. - - - - -- - --
L S'r( S VJIL Lot It V 1 04 /- 25
Subdivision /U ,(�.rs 4 ` � �;
Certified Survey Map # Volurue Page ti
Warranty Deed # rf1 -�,�1� , Volume _MY� ____ Pagc 1 f __ ,
Spec house K yes 0 no Lot lines identifiable X yes L7 do
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its prcni,,ti is 1, 11 1 urc to lian,1 c wastes. Proper naintenance
consists of pumping out the septic tank every three years or sooner, if ncedcd by . i ii, cn;ed puniprr "Vilat 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 Dcpartincnt a ccrtitic.iuun Corm, signed by the owner and by a
master plumber, journeyman plumber, icsn a licensed punii,rr vent}n�: ilj.it ( t ) �hc on r,itc w"stc water disposal system
is in proper operating condition and,'or (2) after inspection and pumping (it necessary t, the puc tallk is Tess than 1/3 full of sludge.
I /we, the undersigned have read the above requirements and agree to niauitaiii the in i�.itc sc\�,'a5c cir posal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Naiw,d hr;uniccs, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and rcturnca tip [Il �;t i 'roix County 7.0111119 Office within 30
da o the three year ex ate. q
SIGNATURE OF APPLICANT llA 'I'L
OWNER CERTIFICATION
I (we) certify that all statements on this torsi arc title to the best ()1 uiy (��ui t ,,',c i (we') aiii (,lie) the owner(s) of
the described abov irttic of a warranty deed recorded in Register of Dceds (thee
7/
SIGNATURE OF APPLICANT DA f L
• �• * *• Any information that is mis- represented may result in the sanitary permit hcinz' icvokeii h) the "Zoning Department. •'* "
•* Include with this application: a stamped warranty deed from the Register of Deed otticr
a copy of the certified survey map if reference is ui the � ananty deed
STATE BAR OF WISCONSIN FORM 2 - 1998 60 ?9Es6
WARRANTY DEED KATHLEEN H. WALSH
/�
REGISTER OF DEEDS
Document Number . V01. 1446 PAGE 426 ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed made between Forest Oaks Condos, Inc., 08-03 -1999 10:30 AN
a Minnesota Corporation,
WARRANTY DEED
EXEMPT A
Grantor, CERT COPY FEE:
and Scott C. Thell and Ann A. Thell, husband and COPY FEE:
wife, TRANSFER FEE: 85.20
RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate in St . Vrnix County, State of Wisconsin:
Recording Area
Name and Return Address
KRI"'TINA OGLAND
UZ, Estreen & Ogiand
P.O. Box 359
Hudson WI 54016
032 - 2045 -20 -200
Parcel Identification Number (PIN)
This i G nest homestead property.
X (is not)
Lot 25, North Bass Lake Estates First Addition in the Town of Somerset.
TOGETHER WITH AND SUBJECT TO a joint driveway in common with Lot 24, North
Bass Lake Estates First Addition, as the same appears on the recorded Plat
thereof.
Exceptions to warranties:
Dated this day of August, 1999
ForeseO Con (SEAL) BY (SEAL)
ith, President
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature( Forest Oaks Condos, Inc., by
State of Wisconsin,
Gerald J. Smith, President ss.
• �l County.
authenticated this 3 VOL day of August, 1999 Personally came before me this day of
the above named
Kristi a Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Stats.) instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney K r i s t ina Ogland
Hudson, WI 54016 Notary Public, State of Wisconsin
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.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wis.
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applicant_ N ame Daytime telephone number
Name
Street address, city, zip code
downer. r a Daytime telephone number
Name
Street address, city, zip code
Location of the building site (complete as appropriate):
=art e /! N., Range Eof Section
Lot r Block
lAe 57/.
Street address
Instructions:
app boxes, and completing the site diagram.
n F
atio markin g (� a pp ro
1. Complete this plan by filling to requested information, g g radin g .
2. In completing the site diagram, give consideration to potential erosion that ma y occur before, during, after g 8
Water runoff patterns can change significantly as a site is reshaped.
3. Chapters IL M cousin Construction Site Best hfanagernent
HR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR
Handbvok, and UW - Extension publication Erosion Control for �° he Wucor sin Construction Site Best Managtatnt
completing this plan. The Wisconsin Uniform Dwelling Code an
p nt S al e s, 60
60 3346. E rosion Control
Handbook are available through State of Wisconsin Docum f Horne Buil rrs
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Ck `approPtiate bones btlocv, and asmjlete the sictiagra wiiti ney fnfo'rtaatiatt:
a
:P �► °� Site Characteristics
g North arrow, scale, and site boundary. Indicate and nacre adjacent streets or roadways. .
1 Location of existing drainageways, streams, rivers, lakes, wetlands or wells.
i Qt Location of storm sewer Inlets.
I The gradient and direction of slopes before grading operations.
The gradient and direction of slopes after final grading operations.
Location of e.isting and proposed buildings and paved areas.
0 Overland runoff (sheet flow) coming onto the site from adjacent areas.
Erosion.Coatml Practices
0- Location of temporary soil storage piles.
Nate: Although not specifically required by Code, it is recommended that soil storage piles be placed
behind a sediment fence or more than 25 feet from any downslope road or drainageway.
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- Dives should extend from the roadway 50 feet or to the hpuse foundation (which
ever is less).
17 Location of sediment fences (filter fabric fence, straw bale fence) or vegetative strips that will prevent eroded
soil from Ieaving the site.
1 Location of sediment barriers - around on -site storm sewer inlets.
Iff Location of diversions.
;Vote: 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 10 s¢ fr. should also be diverted around disturbed areas.
11 Location of practises that will be applied to control erosion on steep slopes (greater than 12%b grade).
Nate' 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.
1V Location of practices that will control erosion in areas of concentrated runoff flow.
Note: Unstabilized drainageways, ditches, diversions, and inlets should beproteeted front 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 »core
than two acres of unpaved area; or one acre df paved area. In- channel practices should not be
installed in perennial streants.
CHECK LIST FOR PERMITS
OWNER OR BUILDER
PERC TEST OF SOIL PROFILE
BLUEPRINT OF HOUSE
WARRANTY DEED WITH SEAL; DOCUMENT NUMBER;
VOLUME AND PAGE NUMBER
TAX NUMBER OF LAND
CERTIFIED SURVEY MAP (IF AVAILABLE)
COUNTY FORM, SEPTIC TANK MAINTENANCE AGREEMENT
AND OWNERSHIP CERTIFICATE FORM -- FILLED OUT AND
SIGNED.
NAME* ADDRESS *PHONE NUMBER *IF NOT ON PERC TEST
PLUMBER
ALL OF THE ABOVE
PLB 67
PLOT PLAN
CROSS SECTION
CHECK FOR PERMITS
J
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idic2te management strategy by checking (.) the appropriate boss . =
Management Strategies
1f C3 Temporary stabiliratioa of disturbed areas.
Note: Although not specifrcallyrequired by Code, it is recommended that disturbed areas and soil piles left
inactive for a Trended P eriods. of time, be stabilized by seeding (between April Ist and September 15M), or
by other cover, such as tarping or mulching,
10 Permanent- stabilization of site by re- vegetation or other means as soon. as possible.
Use of downspout and/or sump pamp outlet extensions.
Note: Although not specificallyrequired by Code, it is recommended that flowfrom downspouts and sump
pump outlets be routed to stable areas such as established sod or paventent:
1L 0 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.
Proper disposal of building material waste so that pollutants and debris are not carried ofd site.
Msaintenanc a of erosio3 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 to sediment fences and barriers will be repaired imfnediately. aecotnposing
straw bales will be replaced _(typical bale life is three months).
• All sediment that moves off-site . due to construction aetivitywill be cleaned up before the end
of the workday.
• All sediment moves off -site due to storm events will be cleaned up before thcend of the
next workday.
• Gravel access drives will be maintained throughout construction.
All installed efosion control practices will be maintained until the disturbed areas they
protect are stabilized.
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