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HomeMy WebLinkAbout032-2146-10-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538821 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: 032-2146-10-000 Jor enson, Richard & Charlotte Somerset, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: GS" T" 15.31.19.1272 TANK INFORMATION ELEVATION DATA TYPE MANUFACTU R Z~~ L CAPACITY STATION BS HI FS ELEV. J Septic l , t 3 Benchmark 1a7. s 7, Alt. BM Al. 91 / 6Z • 7 (O -&.64- 6r-/d Aeration tation Bldg. Sewer 5 97 ~Qt~ " Holding St/Ht Inlet S~ 14 9$9L TANK SETBACK INFORMATION St/Ht Outlet TANK TO - P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet _ Septic 6, '7 , r/)- Dt Bottom Dosing 7 /V~~" Header/Man. 13 911 39 Aeration Dist. Pipe 13 'Tel - 37 Holding Bot. System /IA, 3 93.31 6K, Final Grade /oI g 7 z~ PUMP/SIPHON INFORMATION Manufacturer GP nand St Cover lb2t. 7(C Model Nu TDH Lift Friction Loss System Head TDH Ft Forcemain ist. to well r SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS v w0 /rG SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: _w INFORMATION CHAMBER OR =A d'1' r 7' ///111''' Type Of System: 6,6" J~ 7 A56 UNIT Model Number: C~ ~yJS Ganve~ v~ N c.~- T take DISTRIBUTION SYSTEM 44-1 Header/Manifov Distribution \ x Ho Size x Hole pacing Vent to Air IS Q Pipe(s) ` Ems, 6 Length y Dia Length Dia ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 7 Seeded/Sodded Mulched Bed/Trench Center ? 5~ BedlTrench Edges \ Topsoil Yes No Yes No JI COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 544 210th Ave~S,OM RSET, Wl 54025_ (SE 1/4 SW 1/4 15 T31 N R1 9W) Oak Haven Lot 1 Parcel No: 15.31.19.1272 1.) Alt BM Description = " ' ` 2.) Bldg sewer length = 32-1 - amount of cover = Z/ Olt Plan revision Required? FOR Yes No Use other side for additional information. ` Cert. No. Date Insepcto s Signat SBD-6710 (R.3/97) Q o M 'ti 03 ova I d 00 yj0j o a I C o N h I I ~ I Q I 9 c I o I ~ II I z I c c LL O v a3i M w I , Z pj y CD E c 3 U) 1 p `O O N ' Z N d X c cn w a m H U) ! O N O L U) O Z c C-6 c r a~i Z a O` tx c Dui to 4' v, a) (D c o E c)- N N N p ~l1 N > > '0. A Q m o a rn 0 0- Q O c atS O Z c Z N a I w " O d p H F H 2 v ai333 a`" I •%ftib aaaa L I. a 0 ~ N (D N V O a' z z o w I, r m c I V U) (D ¢ n cn p p W 0 U O ° 9 (14 3: ~N~ (D O N C p y C C 7 N V C N ~ N ~ N 00 (D 0"4 N M co w • o c°n n~ o z° y a z Q ~ .a 4) V ~ v .V d ° c m ~~ww as )(L 0ai _1 A L v -JQRGEN$GN-P; LOD'-P-LAf ---r- I I ~ I I I Els oni - 1p0~ ' _tob of 2" .QV'C-pipe - 4 B02 IEI Iva io 09A Tap of 2 P%JC pipe. ackho pits I I ~ I i - te~r~Iea lon~-T1 X9432 -2=s3 32--- - - - - lot Ne 1 Oak Haven ; 1 - L ' Dow ri tion SE1 /4 SW114, ~ S15, T31 N, R19rIV gal 'P 1 - - op Somerset -ounfy: ScCroix ~ j I I I I - I , i I , : I I I I ~ : i i I I - I I~A>sE I I j I j I j ROOe~, 01 OR0005i0 ' P 146 I I -I I I ! I I _ _ ~ c'~ d O_~_~4 U S ~ TALI ~ I Q U ivi & e~l - - - fSM~ \I - - : eAl 14 ,ZV I 1 : : I : : I y CZommercen .wl.gOv Safety and in ~ oun _ 201 W. Washi n AvC ` 71D / , C C ~.t X t(IDISW~' `adtson, 53707-7162 nary Permit Number to be filled in by Co.) 2 011 IV- to Transac tion Number Sanitary Perml scat on ST. CF?OIX COUNTY In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fo toOt ww"tEaWK0p C unit is required prior to obtaining a sanitary permit. Note: Application fo oject Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15. 1 m , Slats. 7'9 t✓E 1. Application Information - Please Print All Information Prope Owner's Name Parcel # icj4A)et) AN O CH AR L©7'Tt<' ^orz artlS ©nJ D Z - Z ! 5/lm / (9- O0 e) Property Owner's Mailing Address Property Location / ` / 17Z ! S tJ~}- K c /r C RQ ~ Govt. Lot c/ / IZ 72- J\ City, State t Zip Code Phone Number y,, Section S 4,01 L /4 K Vl1 7 © T N; R ~irc1E one ALII. Type of Building (check all that apply) Lot 19 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Bloc / &A K- )4 .4 of ❑ Public/Commercial - Describe Use V ❑ City of El State Owned - Describe Use SL)~ r -,r~ l CSM Number ❑ Village of Town of J ® I'1'1 45 es 46 r Z ~ t III. Type of Permit: (Check on one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. type of POWTS S stem/Com nent/Device: Check all that apply) kNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank 11 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) ~r5 V. Dis rsal/IYea ent Area Information: Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Required ( Dispersal Area Proposed ystem Elevatio L15-D 0. 6y.3 S®. -3 z' X3.32 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U New Tanks Existing Tanks W U rn is C7 w jelf. Septic or Holding Tank Dosing Chambe i000 0 /GOO / CsC2 W NC, VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. r Business Phone MP/MPRS Numbe / Number Plumber's Name q(Print) e- 1-t M Plumbe ' _J o Plumber's Address (Street, City, State, Zip Code) , q VIIICoun /De rtment Use On Approved isapproved Permit Fee Date issued uing Agent ignatur ner Given Reason for De $ IX. Conditeasons for Disapproval 1 1~- Ip i ti. 1 Septic tank; 3.l/ effluent filter and 1 -dispersal cell must all be services / maintained a's per management plan provided by plumber. 100 2. All' k ret)u(re !nts must be maintained Gk- '-Attach to complete plans for the system an submit the County only on paper otks tha t J /inches full- 7~ o SBD-6398 02/09) - / ~22u / 4,- cI . CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Jorgenson Conventional In Ground i Owners Name: Richard Jorgenson Owner's Address 1921 Baker Road Balsam Lake, WI 54810 Legal Description: SE1/4, SW1/4, S15, T31 N, R19W Township Somerset County: St. Croix Subdivision Name: Oak Haven Lot Number: 1 Block Number Parcel I.D. Number 032-2146-10-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Septic Tank Specifications Page 5 Septic Tank Cross Section Page 6 Filter Information Page 7&8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 8/8/2011 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 11 , _ JflRIGEN$ONV 'PLOT PtAN- ! ' I - Elevation~ =.40 'QQ' Top of 2" PVC pipe I I ~ - AB 2 va of 2 PVC pipe. - Pe 'o - 99.,h4' Top - ■j Back le ~ ~r 93 $2 l ~ ' I I a#~on l-TI 94 32' -T2 - ~ L t a D scri OtionH SE114 SWIM, S1, i - gwr~sTi~p:-Somerset Co`unfy$t. Croix t I ~ I L-- 1 1 j --'il i i - I , I - - pR' I , 6a - - t ---1 - - - - - 116E - i I ~ osi- y. a T 1000_e.au S. aN w~kl y \ \ T. I i , - - - q - 444 I k / W q vE Pg2ofII Soil Absomtlon System Cross Section 97.50 ft 4' Schedule 40 FU>aPSMde wm Vent ~ 728.43ft 94 3 93.32 ft Trench Elevation & Tmnch Elevation 3 ftJ >3 ft Soil Absorotion Svstem Plan View 64 ft 3 ft Leaching Trench 1 3 - ft Vent Or Observation Pipe Chambers Mal 4' Dla Trench 2 Header Leaching Chamber Specifications Manufactuer and Model INFILTRATOR Quik 4 PLUS Standard ESIA Rating 20 sq. ft per chamber ESIA Rating 5.1 sq. ft per endcap DWF 450 gpd Soil Apiication Rate 0.7 gpd/sq. ft 450 gpd DWF t 0.7 Soil Aplication Rate= 642.9 sgft 642.86 sgft - 5.1 sgft x2 endcaps x U# of rows= 622.4571 sgft 622.46 sqft/ 20 sgft per chamber- 31.12 Chambers rows of 16 chambers each. Page 3of11 D z X N D m > 61" 86" z c 42" ~ z r M N -a 0 ~ I m ~ UP 41" / ~ N l \ 4" CAS ~s x ( D 0 3" 36" 4" i I D p m r- r4 N UP 38" ~ 4" CAS ;u / N V I g Tr' T1 - > N0 O OE ? z v 39" m p D z D V/ mD> m > 00 m D D 0 1 N r0 O m 00 r m O Z7 C7 2 D Z O m A -I 0 0 r 2 r I _xA x z D C m m ; -I ;u > Z v -a -4 z D ^r-4 mZ Zr- X 6) OCO c) p~z > z oopoz m>0C -0>*- Z c0 vx ~W Orfn m ~r~*r> > ~A0 X00 xp0~0 xxm -If-z C o> 0° r- <D - 0 ANC -4~C ~<mZ~ ~ X 0.- N~' N r x~ ZO XQ xm z DO ~Zm A >1-1 ~r1* m~pPo.. -0 a> a v so rv DZ ap D a r- Rr N Dw -I ND~ oE~0 a-~m v~r~ O v a z o z m o - 0 ~mm m rw~v7000 z0 n 0 D< z w can O U) O N m ' < c W rn v'' D r CD 0 00 v G) TI O C/) z r v m z W n ~0 <<? A (A Z ~m W G) rm+1~m m0 0 D m 3 mm Z nm r~1 O D pOpO r nr> r0 0 ~Olm _ m o m ;0 H Z D ~ m z E! u, z >~k w i> > 4 'j 0;0 -n 0 ~Om v O Z Z4 0 <A > r 0 (n 0 ;u O r sv r m BOA v Z O 3 m m 00 v z ;u ;v °o D M o r5* o C/) m r m 0 z ;u r O r~ OD H c v 0 o r- Q ;u z ~ m m M z r m \O m WLP1000-MR OBER COOCAETE DRAWN BY: SME SR 1 4"=1'-0" PRE-POUR: m I SEPTIC MANUAL DATE: JANUARY 2010 DATE:. POST-POUR: \ z W3716 US HWY 10 MAIDEN ROCK, NA 54750 P REVISED JAN. 2010 800-325-8456 FlLE: RMWD-0 Page 4 of 11 SEPTIC TANK DETAIL / SINGLE COMPARTMENT Project Name: Jorgenson Septic System Tank Manufacturer: Wieser Concrete Tank Model: WLP1000-MR Construction Type: Concrete Tank Volume: 1000 gal Effluent Filter Manufacturer: Bear Onsite Effluent Filter Model: ML3-916 96.32 ft Inlet Elevation Outlet Elevation 96.07 ft 23" Minimum Manholes w/locking devices ^ < - and warning labels > q V c ao Baffle 111.Effluent Filter Clear Space s ' 3" Bedding Under Tank Plumber/Designer Signature: "/-L Lic 223760 Date: 8-Aug-11 Page 5 w~ oNsf~ FILTER CARTRIDGE INSTRUCTIONS 2008 TM jV ! VI A' Installation STFP I. Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet 3 s { `s While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the 7j optional supplemental side support. If side support method is not utilized, , . proceed to step four. For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case.` If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 900 and cleaned with water only. F'. 71 While holding the cartridge on its side (large flat surface facing" down) over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back into the tank.*- 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until , the filter locks into the bottom of the case. - 10. Replace and secure the access opening on the tank. %r", troiWte.c*j n 877-MILFUM (653-4583) POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Richard Jorgenson Tank Manufacturer: Wieser Concrete F NA Permit # P, Septic E Dose EHolding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer. R NA Number of Bedrooms: 3 FIA Septic - Dose CHoldin Volume: al NA Number of Public Facility Units: 0 fr A Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivce Pad: ft Design (peak) Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Bear Onsite r NA Fats, Oils & Grease (FOG) s30 mg/L Effluent Filter Model: MI-3-916 Biochemical Oxygen Demand (BOD5) 5220mg/L F- NA Pump Manufacturer: rv- NA Total Suspended Solids (TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) s30 mg/L Manufacturer. Biochemical Oxygen Demand (BOD5) 5220mg/L r NA r- Mechanical Aeration r Peat Fitter i✓ NA Total Suspended Solids (TSS) :5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r- Sand/Gravel Fitter F Other Biochemical Oxygen Demand (BOD5) s30mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L f✓ NA I• In-Ground (gravity) r In-Ground (pressure) F NA Fecal Coliforrn (geometric mean) 510acfu/100m1 r At-Grade Mound Maximum Effluent Particle Size: % in dia. F NA F- Drip-Line Other. Other. F N Other. F NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated r (s) Inspect condition of tank(s) At least once every: 3 • yeaKs) (Maximum 3 years) r NA Inspect dispersal cell(s) At least once every: 1.5 yea0s) (Maximum 3 years) f- NA 1 myews f NA Clean effluent filter At least once every: 3 gF reacts) F morn(s) Inspect pump, pump controls & alarm At least once every: r YWS) NA monffl( Flush laterals and pressure test . At least once every: yearcs) NA Other. r ar($ At least once every: r year(s) ~ NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page 7 of 11 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Apostle Septic Service Name: St. Croix County Zoning Phone: 715-497-5929 Phone: 715-386-4680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. 2/05) Page 8 of 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Tot? a, E SON Mailing Address l q Z 1 134 120. ,-4ZSpk1,1 L/a-K~ IrVC j 0 Property Address .may 4/ z / p 714 V,c (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number F03 Z _ 2 t 4(& -/0 "©OD sorVl E~s~T W t LEGAL DESCRIPTION Property Location $ r %4 Sec. /S , T 3 / N R /9 W, Town of $O M ,F 42St 7 Subdivision Plat: r} tr )4A v6 N , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes Xno Lot lines identifiableVG yes C no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 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 Planning & Zoning Department within 30 days of the three year expiration date. 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. N ber of drooms 3 M a- -I/SL S AT OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) Page 9of11 " U 2 5 9 3 P 3 2 0 -7 655Qs4 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1998 REGISTER OF DEEDS ST. CROIX CO., WI WARRANTY DEEM RECEIVED FOR RECORD This Deed, made between Mark W. Kelley and Debra K. Kelley, 06/10/2004 18:00AN husband and wife, and Jesse J. Kelley, a single person, Grantor, and Richard A. Jorgenson and Charlotte R. Jorgenson, husband and wife as survivorship WARRANTY DEED marital property, Grantee. EXEMPT * 3 Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: li. 00 the following described real estate in St. Croix County, State of Wisconsin (The TRANS FEE: "Property"): COPY FEE: CC FEE: PAGES: 1 Lot 1, Oak Haven, St. Croix County, Wisconsin. Recording Area Name and Return Address e-7'e t>-c b I'1 / 1 i L h~R A cTd /p fj.~ls.cw. L1Kt ~ ltt•X S 9~/a~ Part of 032-1043-80-000 and 032-1043-90-000 Parcel Identification Number (PIN) This is not homestead property. This is a CORRECTIVE WARRANTY DEED to correct the spelling of the Grantees names in that certain Warranty Deed dated and recorded September 26, 2003 in Volume 2421, Page 42 as Doc. No. 741544. Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this JO " day of May, 2004. W. *Mark W. Kelley *De ra K. Kelley *J Kelley AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF W48GQ44WN ) >V-r- ss. sh Si.QFeitt County ) ~ ,~syue~,, Personally came before me this o70~/ day of authenticated this _ day of May, 2004. May. 2004 the above name * ~-esse to me known to be the TITLE: MEMBER STATE BAR OF WISCONSIN person(s) who executed the foregoing instrument and (If not, acknowledge the same. authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Ronald L. Siler VAN DYK, O'BOYLE & SILER, S.C. N ry Public, State of Wiscans}n P.O. Box 118, New Richmond, WI 54017 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not 'Z necessary.) A " - w.~n.~u.... f 'Names of persons signing in any capacity should be typed or printed below their signatures i ~V~IAB'Y New MBINESOTA WARRANTY DEED,;'.' STATE BAR OF WISCONSIN ! _ - rM C®iflflf15610~'•Y' Am,;), FORM RM No. 2 -1998 .r_,~..- :~Y..Y'~O•xyyp. 'W 200 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800-655-2021 N 1 t L \Sl HAL o x~ $ j ~ N89'15'22'" , _ 66.01 o i 15'22"W 345.82' .005-le 1~~-_ ~ HN[ 4W --N8915'22"W--634.27' it FOR LOTS 4 AND 5 33.005 15'22"W 345.82' N89'15'22" 66.01' \ 0 I Z Q~ JI I LOT 3 w 131,183 SO. FT.. I .101 ACRES LOT 4 Q I MIN. fF£=906 0 P * 131, 002 SO. FT. a rn N 3.00 ACRES o Z I M MIN. fFF=916.7 d z I zz I 4~. ~-HOX \ 2 -`tdS°I'7a~ J osse' 297.12' A 363.30' ---N89'02'17"W --697.75'--- LOT 1 3 1 130,797 SO. FT. N 3.00 ACRES N M/N. FF£=905.0 M M a N M ...............y...... rT e4 ~ t 0 J a 1%i /MF ---440.37'------4~-- '02'17"W 854.12' I ~o i7 SOUTH LINE OF THE SW 114 ~O SOUTH QUARTER CORNER LOT _1 S£Cnav 15-31-19 VOL. (FOUND ALUM/NUM 4 COUNTY MGINUMENT) I PAGE 1095 I #1655 14sconsin SOIL EVALUATION REPORT w Department of Commerce in accordance With (jMm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings A jr Schmitt Soil Testing, Inc. County Attach complete site plan on paper not less than ' x 11 inches in si an must St. Croix include, but not limited to: vertical and horizont re TaW point (BM), dire i ft-m percent slope, scale or dimensions, north arro , and I IWOR4nd distance to nearest ro d. Parcel I. 032-,2146-110-000 Please print all i ormation. ~ Revi d By Date Personal information you provide may be used fo seconds purposes (Priva DN, S. (1) (m)). et Property Owner A Pro Location v Jorgenson, Richard pCq SpC V ~?Q Go Lot SE1/4, W1/4, S15, T31N, R19W Property Owner's Mailing Address Gcg CO Lo Block # Subd. Name or CSM# 1921 Baker Rd. zON/NG1 Oak Haven City State Zip Code Phone Nu CF F ] City ❑ Village ❑ Town Nearest Road Balsam Lake WI 54810 Somerset 210Th Ave. ❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable fora nventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area 1 is 94.32 (high trench) ow rent. . Slope o ar"' ea is 8%. F-11 Boring # ❑ Boring ❑ Pit Ground surface elev. 98.16 ft. Depth to limiting factor 102+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-24 10yr3/4 none sl 2mgr mvfr gw 2m,2f .6 1.0 2 24-34 10yr3/3 none sl 2msbk mfr gw 2m,2f .6 1.0 3 34-80 10yr5/6 none Cos Osg mi Cs .7 1.6 4 80-102 10yr6/4 none s Osg ml .7 1.6 If, L3 T Boring # ❑ Boring Pit Ground surface elev. 98.16 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •EfW 1 0-10 10yr3/4 none sl 2mgr mvfr gw 2f,2vf .6 1.0 2 10-19 10yr3/3 none sl 2fsbk mfr gw 2vf .6 1.0 3 19-30 7.5yr5/6 none Cos Osg ml gw ivf .7 1.6 4 30-55 10yr5/6 none Cos Osg ml Cs .7 1.6 5 55-74 10yr6/4 none s Osg ml CS .7 1.6 6 74-100 10yr6/4 none cos Osg ml .7 1.6 4},32 'Effluent #1 = BOD 5> 30 < 220 mg/L and TS TVS6 < 50 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 8/3/2011 715-247-2941 SBD-8330 (8.07/00) Property Owner Jorgenson, Richard Parcel ID # 032-2146-10-000 Page 2 of 3 Boring # Boring ~ ❑ pit Ground surface elev. 95.08 ft. Depth to limiting factor 104+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef#1 •Eff#2 1 0-10 10yr3/4 none sl 2mgr mvfr as 2m,2f .6 1.0 2 10-16 10yr3/3 none sl 2fsbk mvfr gw 2m,2f .6 1.0 3 16-38 10yr4/4 none Is icsbk MA, gw 1vf .7 1.6 4 38-49 10yr5/4 none cos Osg ml cs .7 1.6 5 49-73 10yr6/4 none s Osg ml cs .7 1.6 6 73-104 10yr5/4 none cos Osg ml .7 1.6 ❑ Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~a Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Richard Jorgenson Thomas J. Schmitt, CST 227429 Address: 1921 Baker Rd. 1595 72nd St. City, State, Zip: Balsam Lake, W154810 New Richmond, WI 54017 Phone: 715-760-1978 PID: 032-2146-10-000 Signature .cr~.~.. , Lot No. 1 Oak Haven Data Legal Description: SE1/4 SW1/4 S15 T31N R19W ■ Backhoe Pit Township, County: Somerset, St. Croix County Bench Mark 1 El. 100.00' Top of 2" pvc pipe Bench Mark 2 El. 99.14' Top of 2" pvc pipe Slope= 8% amp ~2 \ ~ \ Spy Coe X33 r (0 31-1' 060 939 q2 • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page -1- of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must St- Crc)ix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. D 3 Z - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ;?1 ylo - ,~6 a) i~ Please print all information. Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Ji 5 Property Owner Property Location Govt. Lot SE 1/4 SW 114 S 5 T 31 N R 19 { (or) W (176- h -T Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 11160 190th. Ave. 1 na Oak Haven City State Zip Code Phone Number ❑ City ❑ Village Q Town Nearest a aT 'r Elk River MN 55330 (61~ 441-8888 Somerset 210th. Ave. New Construction Use Residential / Number of bedrooms 4 Code derived design flow rate 77 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable General comments (4C~F` and recommendations: trenches @ el. 101.30', spaced code 3.50 belwo grade c G ~OF ❑ Boring # Boring 104.80 88 1] pit Ground surface elev. ft. Depth to limiting factor / / So' li on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary o D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 1 Boring # ❑ Boring F-21 a Pit Ground surface elev. 1 04.80 ft. Depth to limiting factor 84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 10-8 7.5yr4/6 none ms osg ml na na .7 1.2 Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L ' ffluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gar L. Steel 02298 Address Date E aluation ndu ed Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6-4-2001 715-246-6200 ~I Property Owner Gerald J. Smith Parcel ID# pending- Page 2 of 3 Boring # ❑ Boring F-31 Fxj Pit Ground surface elev. 102.4 ft. Depth to limiting factor 99 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `E02 _ 1 2csbk mvfr w 1f .5 .9 13-31 2csbk mvfr W if 85 .9 none sl m na gw na .4 .6 ms Os ml w na .7 1.2 4- nc)np- fs Os mvfr na na .5 .9 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ` Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6100) STEEL'S SOIL SERVICE Gary L. Steel Gerald J. Smith 1554 200th Ave. CSTM2298 SE'SW' S15-T31N-R19w New Richmond, WI 54017 MPRSW-3254 town of Somerset (715) 246-6200 lot #1-Oak Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1"=40' 13M.= ,top of mid-lot survey stake @ el. 100.00' alt. BM.= top of 1" pvcpipe @ el. 105.90' (e`5 YY Gary L. Steel 6-4-2001 Parcel 032-2146-10-000 06/01/2007 08:39 AM PAGE 1 OF 1 Alt. Parcel 15.31.19.1272 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - JORGENSON, RICHARD A & CHARLOTTE R RICHARD A & CHARLOTTE R JORGENSON 503 ALBEE FARM RD 25 VENICE FL 34285 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 544 210TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: 2232-OAK HAVEN 032/01 SEC 15 T31N R1 9W SE SW LOT 1 OAK HAVEN Block/Condo Bldg: LOT 1 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-31N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/10/2004 765504 2593/320 WD 03/23/2004 757308 2531/476 QC 03/23/2004 757307 2531/475 QC 09/26/2003 741544 2421/042 WD more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 0 48,000 NO Totals for 2007: General Property 3.000 48,000 0 48,000 Woodland 0.000 0 0 Totals for 2006: General Property 3.000 48,000 0 48,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Q~ -AR 93q • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1-of3_ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1 /2 x 11 Inches in size. Plan must St- rrc-jix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 5 z Property Owner Property Location Gp-ralrl -T- Smith Govt. Lot SE 1/4 SW 1/4 S 15 T 31 N R 19 ff (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 11160 190th. Ave. 1 na Oak Haven City State Zip Code Phone Number ❑ City ❑ Village Q Town Nearest Road Elk River MN 55330 ( 6121 441-8888 Somerset 210th. Ave. ] New Construction Used Residential / Number of bedrooms 4 Code derived design flow rate 4%a I GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable ft. , General comments and recommendations: trenches @ el. 101 . i30' spaced code 3.80' belwo grade CRS Boring G~ ❑ Borin # 1 g :k] pit Ground surface elev. 104.80 ft. Depth to limiting factor 8 o' ' li on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary' D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 12-8 7-5yr4/6 none MR risa ml na na -7 12 Boring # E] Boring 2 g [J' , pit Ground surface elev. 104.80 ft. Depth to limiting factor 84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 2 10-8 7.5yr4/6 none ms osg ml na na .7 1.2 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30:5 150 mg/L (fluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gar L. Steel 02298 Address Date E aluation ndu ed Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6-4-2001 715-246-6200 f Property Owner Gerald J. Smith Parcel ID# pending Page 2-of 3 7 -1 Boring # ❑ Boring 3 ® pit Ground surface elev. 102.40 ft. Depth to limiting factor 99 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 D-13 10yr413 none S1 2 bk mvfr w if .5 .9 9 13 - 3 1 csbk Mvfr W I f :5 t9 ne sl m na gw na .4 .6 5w-A44 nontm ms Os ml w na .7 1.2 na .5 .9 mvfr na fs os 5 -9 2 El Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Effluent #1 = BOD, > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BO05 < 30 mg/- and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-6330 (RAM) STEEL'S SOIL SERVICE Gary L. Steel Gerald J. Smith 1554 200th Ave. CSTM2298 SE4SW S15-T31N-R19w New Richmond, WI 54017 MPRSW-3254 town of Somerset (715) 246=6200 lot #1-Oak Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1"=40' BM.= top of mid-lot survey stake @ el. 100.00' alt. BM.= top of 1" pvcpipe @ el. 105.90' Le (e '13 ~Iv Gary L. Steel 6-4-2001 ST CROIX COUNTY J PLANNING & ZONING September 15, 2011 File#: LU87314 Richard & Charlotte Jorgenson 1921 S. Baker Rd. Balsam Lake, WI 54810 Re: Land Use Permit Addendum to a Special Exception for Filling & Grading >10,000 sq. ft. in the Shoreland District, Town of Somerset Code Administration Parcel 15.31.19.1272 Lot 1 of Oak Haven Subdivision 715-386-4680 Land Information d- Dear Mr. and Mrs. Jorgenson: Planning 715-386-4674 This letter confirms zoning approval according plans submitted by your agent, John Schmitt Real Propern of Schmitt & Sons Excavating, on September 2, 2011 of an addendum to allow filling and 715-386-4677 grading an area <10,000 square feet on slopes less than 25 percent to prepare a site for the construction of a single-family dwelling, driveway, and Private On-site Wastewater Recycling Treatment System (POWTS) on the property referenced above. The proposed disturbed area 715-386-4675 is part of a larger project area for which you have also submitted a special exception application. The property is located on Lot 1 of Oak Haven Subdivision, which is within 1000 feet of two unnamed ponds. Both of these ponds are on the south side of 2104, Ave., which intercepts any stormwater runoff from Oak Haven and directs it easterly along the road ditch and does not discharge into either pond. Staff finds that the proposed project meets the spirit and intent of the St. Croix County Zoning Ordinance and Shoreland District with the following findings: 1. Filling and grading less than 10,000 square feet in area on slopes less than 25 percent is allowed with a land use permit in the Shoreland District pursuant to Section 17.29(2)(c) of the St. Croix County Zoning Ordinance; 2. Filling and grading any area equal to or greater than 10,000 square feet shall require a special exception permit in the Shoreland District pursuant to Section 17.29(2)(d) of the St. Croix County Zoning Ordinance; 3. Pursuant to General Zoning Section 17.12(7) any construction or land disturbance of >10,000 square feet on slopes from 12% to 19.9% requires a land use permit; 4. The proposed building site is on slopes of less than 20 percent; 5. The grading limits for the proposed construction area is >500 feet from the OHWM of two unnamed ponds/wetlands to the east and south and stormwater runoff does not drain directly to either pond; 6. The erosion control plan utilizes extensive vegetative buffer and perimeter sediment control measures to prevent sedimentation of a drainage easement on the southeast portion of the lot that provides stormwater management for the subdivision. With conditions for maintaining sediment and erosion control measures during construction until self-sustaining permanent vegetation is established on all disturbed areas, prohibiting the use of phosphorous fertilizer to establish and maintain a lawn on the disturbed areas, and implementing any conditions in the special exception permit for long-term storm water management, there will be no negative impacts to the water quality of navigable waters in the area; w Sr..CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W/ 54016 715-386-46861 PZCaC0.SA/NT-CR01X.WL US WWW.CO.SAINT-CROM WI 7. TWA and and Water Conservation l7epaffiment has rc.Ma `the Richard Jurgensen` land use permit and special exception permit application and find the stormwater and erosion control plans adequate for the site. The LWCD recommends a condition for the special exception permit that no grading and filling or vegetation alteration is permitted in the drainage easement, this would include mowing. The deep rooted vegetation established in the drainage easement is a key component in controlling on-site runoff and promoting infiltration of stormwater; 8. The Wisconsin Department of Natural Resources has been sent a copy of the application and will provide their- comments and recommendations prior to the public hearing for the special exception request. Based on these findings, approval of this land use permit is subject to the following conditions: 1. The applicants shall contact the Zoning Administrator prior to commencing construction and when the initial phase of construction has been completed. The filling and grading may not exceed 10,000 square feet until the applicant has obtained approval by the Board of Adjustment for a special exception permit. 2. Prior to commencing construction, the applicants shall install erosion and sediment control measures in accordance with the approved plans and shall provide additional erosion control measures as necessary to ensure that sediment is not allowed to be transported into the drainage easement area or beyond the applicant's property boundary. All erosion control measures shall be maintained until permanent, self- sustaining vegetation is successfully established on all disturbed areas of the site. Prior to commencing excavation for the driveway and house foundation, the applicant shall secure and comply with any other required local, state, or federal permits and approvals, including but not limited to a building permit. 4. No phosphorous fertilizers shall be used to establish and maintain a lawn on the disturbed areas of the site, unless a soil test confirms that phosphorous is needed. 5. Upon completing the initial filling and grading proposed for the land use permit application, the applicants shall submit to the Zoning Administrator photos of the excavated area and erosion control measures as viewed from all angles. This approval does not allow for any additional construction, grading, filling, or clearing of vegetation beyond the limits of this request. Any remaining site work above and beyond the 9,999 square feet identified as part of this land use permit application shall be addressed as part of the special exception permit application and shall be subject to the additional conditions of that permit upon approval by the St. Croix County Board of Adjustment. Your information will remain on file in the St. Croix County Planning and Zoning Department. It is your responsibility to ensure compliance with any other local, state, or federal rules or regulations, including but not limited to obtaining a town building permit, County sanitary permit, and any permits that may be required by the Wisconsin Department of Natural Resources. Please feel free to contact me with any questions or concerns. S' re y, am Quinn Zoning Specialist/ Zoning Administrator Eric: land Use Permit Card Cc: John Schmitt, Schmitt & Sons Excavating Clerk, Town of Somerset Brian Wert, Somerset Building Inspector Steti e Olson, St. Cruia Couut} Land and Water Conserv ation Department Mike Wenholz, Wisconsin Department of Natural Resources -a o o CD ch SEEM * Al. n n CD 0 O C O Z V 1 cep ` ~ MENEM o < 411M W 0 0 0 ~ O y MO. W 0 n dmmmw Now O O to (D M n h y 2 ` N z M MIN = d /0\D n '0 mml Z. CD CD .Y CD - O - O X CL Cn fmilL -h CL N CD ~ O' O ~D CL 3 ~D 0 V ■ O O -I 0 o ~ N vim Q d MUNIS U) y M :M O 40 rMIL CL Auft N A y vim PIOL • M rMIL ~ n 0