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HomeMy WebLinkAbout012-1021-50-000 B 19 REcEivL0 STC - 104 AS BUILT SANITARY SYSTEM REPORT t~ JUN 2 4 1998 _-i S7 CR00( t''l COUNTY C OWNER ZONING OFFICE ADDRESS r ~ 4 -:041 z SUBDIVISION / CSM# Tag " O LOT SECTIONT~_N-R L,7 W, Town of ~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ys' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: - Liquid Capacity: Setback from: Well 7,11 House Other Pump: Manufacturer ModelfiLaz Size ' Float seperation 7~ Gallons/cycle: Alarm Location /Z - SOIL ABSORPTION SYSTEM Width:_ Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: __JS~j House-,;ZL~_ Other ELEVATIONS Building Sewer ST Inlet- ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR:-- 3/93: jt Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division County INSPECTION REPORT 9 L Cro i 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)]. (~-[q / Permit Hold s "me: ❑ City ❑ Villa ~_Uc- Town of: State Plan ID No.: 7" MG WL CA Pq - , l C ST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK IN ORMATION ELEVATION DATA A9 7 n6 Llk -3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Kept ic tek5 (C00 Benchmark q,2 1,01-6, 90 9-2. Dosing ks 40, CPA * /0,5301 1 105/21 Aeration Bldg. Sewer 1137 214A Holding U Inlet 11 013 cf,;l TANK SETBACK INFORMATION (2) Outlet 12./ 0/3,aS' Verit TANK TO P / L WELL BLDG. A irIto ntake ROAD Dt Inlet , a ~a QJ3 Septic IM 2' IF I Kj/AI NA Dt Bottom osing it NA Header/ Man. oo~ Aeration NA Dist. Pipe 1Dt, fi t~-7 Holding Bot. System 3 PUMP/ SIPHON INFORMATION yy%". cjp"~O. Final Grade p Manufacturer C and Demand Wl&OUe b'Sy ~Dvr. Model Number U)E 20 GPM ---.dg la !FDH Lift S3 L Iction - 3a $ysterrd S- TDH i2.Wt AtA 101461 7J/ 6, 75S e'd orcemain Length Dia. HHa fr Dist. To Well p~ , SOIL ABSORPTION SYSTEM BENCH Width t Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 7 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM L ACHING Manufacturer: SETBACK INFORMATION Type O~A I I t C MBER Model Nu, System I ,5r OR DISTRIBUTION SYSTEM Header / j~ ld , I Distribution Pipe(s), x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nchCenter I Z' Bed/ Trench Edges Topsoil 17-11 es ❑ No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) / ~ 8'~ ~S~~f~ .3S y S41vo z ~ I) 972x, Wb 79.3 St clrn e4v$- n) ( lom was I I-, rree+ a [ On w I4 Borg , Plan revision required? ❑ Yes No ~ Lkw -1 Use other side for additional information. 16b r,<~4 g"CA SBD-6710 (R.3/97) P-t-AR ( ~ 10V( I& Date Inspector's Sig ture ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I~ Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. 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 than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number o1915~ 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 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prop O ner N me propert Location 1/4 1/4, S T , N, R (or) WL Property Owner's Mailing Address Lot Number ^ Block Number Cit tate ) Zip Code Phone Number Subdivision Name or CSM Number a 3 S`~ ( ) ~S.v? I. TYPE F BUILDING: (check one) ❑ State Owned 0 C, !ty Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF /4~40__r r III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) g . 'hej 1 ❑ Apartment/ Condo wb`L 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 Tank Only-------------- Existing System _________Exlsting 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 11eepage Bed 211Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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) Elevation Feet - ,?Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank Z' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 12 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the Li dersigned, assume responsibility f pr inst ation of the onsite sewage system shown on the attached plans. :P1,um ?er' 44 ame: n Plumb 's Si tur . ( to p rP/MPRSW No.: Business Phone Number: Plu ber's Ac dress (Stet, 14 Stat p Code): .C IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee (Includes Groundwater ate Issued tAgent Signatur (No Stamps) )(Approved ❑ Owner Given Init Surcharge Fee) ial ~eyo / 9 Adverse Determination f X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (8.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, owner, Plumber 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III- Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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_ y VIII- Responsibility statement. Installing plumber into 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 to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions,, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations I July 21, 1997 15837 USH 63 Ruul.e 8, Box 8072 Hayward WI 54843 K O CONSTRUCTION KIM O CONNELL 504 THIRD AVE OSCEOLA WI 54020 RE: PLAN S97-20709 FEE RECEIVED: 180.00 MCIR MARA, PAT SW,NE,8,30,17W TOWN OF ERIN PRAIRIE COUNTY OF ST CROIX MOU14D SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown can the plans- This system has not, been reviewed for the code requirements sot forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Adiuiiiit lLral.ive Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inauiries should be directed to me at the number listed below. Please refer to the plan number shown above. Si 4Lppert Carl Wastewater Specialist Sr. Section of Private Sewaqe (715) 6.14-3484 Mondays 4570R/ 1 SBDA-6928 (R. 10/94) Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID Y 1 11 Ze12 I.egal~uescrtpcton o` Addicss 3S7 CiryNillagelPowo C tY , Contents Comments/Special Instructions Page M Included Two copies needed for all plans 1 Plot Plan 2 Plan View a Roturn by Mail 3 4 Tank dt Pump/ Q Fax Letter to (County) (Submitter) Siphon Information Circle One and Provide Fax ( ) 6 Call for Pick-Up: ( ) 1717. 7217'e 7 Other I, the undersigned, hereby eertify that the Seal (if applicable) plans and specifications submitted herewith were prepared under my direction and control. [AS NY Aiklm 4 swim" For Office Use Only Attacbments: Application P.O "W 'T hall S~ t site Walwtion Cvnd><tio Y Y 1 Needed for lieWio` Tuk Submittal: One copy of notarized » dins r+uk p OVER Vt MEN, OF COMMERCE 0 (Or~i~ Cam) U N Q SAFETY p BUILDNGS Needed for At-Grade Submittal: D Origloal aped mad. notarized Wationfw-UrmotmAa SEE CO SPONDENCE GraW county oa-site One addidanxi sot of plans SBD-10268 (N.01/96) RECIiVE® J U L 18 1997 SAFETY & 6LDGS. DIV. ~S i s4 t cja ar' P.4•WT•S' Conditionally 191 r7- PPROVED A TMEN7 OF COMMERCE 4r1)VE f pFETY D BUILDINGS - /Ix , ESPONDENCE, O Ossigner~ Pat*.., Non-Woven Filter Fabric 4' Observotion Pipe /Disfribution Pipe ASTM- C 33 Sond 1 H G Alter. Poe, of ` Topsoll J \ r Force Main 1 ` d 1 p:~ E y: Slope Bed Of %YM 21 Force Main Plowe d Drain Rock From Pump Layer D - /,j~ Cross Section Of A Mound System Using E -J,3Q A Bed For The Absorption Areo F 93 / G 110 1- A y Ft. H B Ft. I Ft. J G•g Ft. K f4,S Ft. Alternate Position L Ft. of Force Main k' Ft. 1 L r4~Observotion Pipe J ` . -1 0 A -5 I Force Main - From Pump c 3 o Distribution @ed Of Ii2n- 2'Z Pipe Drain RocK 4-Observation Pipe PermonenlCMb41Ei'' 2c Ily Pipe or R ED 4 DEPARTMENT OF COM E pIVISI , F SAFETY AN UiLDINGS Plan View 01 Mound Using A Bed For The Ab ONDENCE PAGEC,2 OF'~ PERFORATED PIPE DETAIL „ and DISTRIBUTION PIPE LAYOUT Perforated Schedule 40 PVC Pipe End ✓ f Csp~ Holes Located On Bottom Are Equally Spaced End CAP Q Last Hole Should Be Next To F.nd Cop Owner's Naaws p _..~Q -1) _ feet Plumber/designer's Signatures x + inches y inches Dates License No.s Hole Diameter inch Lateral Diameter inch(es) Force Main Diamtter inches ~~~r#ipf~~t~ateral nElevation DEPARTMENT QF pIV OF SACODErals BUILDINGS FETY SEE 0 SPONDENCE Page Of __SC_... t l va, r• r•YO a 1 o (A ~ R p p V1 M~ ; h R W i 0 O M b M 0 (AGG R M A 14 ~3w•_r_____ O R O ~A v► + r + r + r + r ~ d rr A w 0 a r r Y tir. I~TMENI DE OF SAFE7F CND BUILDINGS SE RESPONDENCE r• a K a 14 a a PAGE .J or PUMP CHtMBER CROSS SECTION AND SPECIFICATIOKLS V E NT CAP 4 VENT PIPE WEATHERPR 00 F APPROVED LOCKING - JUWCTIOM BOX MA WHOLE COVER WITH 25' FROM DOOR, WARNING LABEL WINDOW Olt FRESH 12~MIU. I AIR INTAKE GRADE I y" MIW. I8' /'SIN. COQDUIT I6KIW. PROVIDE ( IWLET _T AIRTIGHT SEAL I III \ I I I APPROVED JOINT A I III APPROVED JOINT II W/ ' PIPE EXTENDPWtL 3' I III ALARM E%TEUDILIG 3' OWTO SOLID SOIL I I I ONTO SOLID SOI B I I I OW C I I fCLEV. FT. PUMP b OFF D CONCRETE CLOCK RISER EXIT PERMITTED OWLH IF TAWK MAIJUFACTURE.R HAS SUCH APPROVAL 3" AfMOVED I3ECDING undcr Tr•NK SEPTIC E SPECIFICATIOfJS DOSE TAWKS MAWUFACTURER: IJUMBER OF DOSES: 1 PER DAM TAWK SIZE : . GALLOWS DOSE VOLUME / IWCLUOIWG BACKFLOW: GALLONS ALARM MAUUFACTURER: MODEL WUM6ER: CAPACITIES: A= INCHES OR .zL~i~yZ GALLONS SWITCH TYPE' B = -2 INCHES OR _-29 GALLOWS PUMP MANUFACTURER: C-~_INCHES OR i33 GALLOWS MODEL WUMCE.R: - 0- S INCHES OR ~ GALLOWS SWITCH T`JPE: J?zz MOTE: PUMP AUD ALARM ARE T~ OE INSTALLED 0 SEPNg~ ABC, Ru1TS MINIMUM DISCHARGE RATCGPM®/S (~1(drl~}FI . t VERTICAL DIFFEKEWEE DETWEEU PUMP OFF AWO DISTRIBUTION PIPE.. I0"10 FEET e° MIIJIMUM NETWORK SUPPLY PRESSURE 2.5 FEE + V L 1~~-- 7,/ DEPARTMENT OF COMMERCE } FEET OF FORCE MAIN X F/oa ►►.FRtCTIOU FACroR.. FEE"V Of SAFETY AND BUILDINGS TOTAL D'J►JAMIC HEAD - ~F T SEE COR OND Nq IWTERWAL MMEWSIOWfa OF TAIJK: LCOGTM ;4/IDTIA ;LIQUID DEPTH - L2 SIGrJEO:~_ _ LICEAISE ►JUMBER: DATE: Performance ciuueni '.Purves Pumps '464 6 METERS FEET 90 MODEL 3885 25 w SIZE 3/4" Solids WE/5H 70 20 WE10H 60 ~ - WE07H 15 50 40 WEO5H 10 30 WE03M WE 0Z 20 S 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 m,/h CAPACITY nGOULDS PUMPS, INC, METE R9 FEET 120 MODEL 3885,1 35 110 WE15HH SIZE 3/4" Solids 30 100 25 4 70 20 \ 14 60 O H 50 WEOSHH 15 40 10 30 20 S 10 0 0 0 10 20 30 40 50 •60 70 80 90 100 110 120 GPM 0 10 20 30 WA CAPACITY •1966 Goulds Pumps, Inc. V%Q*q July. Im 01A A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20 & 21, of the Wisconsin Uniform' Dwelling Code, a soil erosion control plan needs to be submitted and approved prior to the issuance of building permits for 'I & 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. Building inspectors have authority to request erosion control measures not specificatly required by Code when such measures are deemed necessary to `meet the Code's overall performance standard of keeping soil on site. Construction projects that disturb more than 5 acres, or are part of a development that,'disturbs more than 5 acres, are also required to obtain a construction site storm water discharge 'permit from the Wisconsin Department' of Natural Resources. -24/e- 72`%Z Applicant: r eoert- w 3"l 2235 Name/ Daytime telephone number !17'(/' ~lr>01.: GGl //?xs,Cj st~ !st], G _ ~~fi/ 7 Street address, city, zip code Landowner. Name Daytime telephone number • Street address, city, zip code Location of the budding site (complete as appropriate): ,576t) quarter of Section , Town. N., Range - E. 11 Lot a Block Street address Instructions: 1. Complete this plan by filling in requested information, marking appropriate boxes, and completing the site diagram. 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. Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW - Extension publication Erosion Control for Home Builders can be referred to for assistance in ,completing this plan. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608266-3358. Erosion Control for Home Builders (GWQ001) can be ordered through Cooperative Extension Publications, 608262-3346. 4. Submit this plan at the time of building permit application. Check appropriate boxes below, and complete the site diagram ti with necessary information: . a Site Characteristics IZ! 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. 121"' The gradient and direction of slopes before grading operations. LT The gradient and direction of slopes after final grading operations. 3 Location of existing and proposed buildings and paved areas. ❑ [9' Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices ❑ 0"~ 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 or more than 2S 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 Drives should extend from the roadway 50 feet or to the house foundation (which ever is less). M//"*E3 Location of sediment fences (filter fabric fence, straw bale fence or vegetative strips that will prevent eroded / soil from leaving the site. ❑ C9' cation of sediment barriers around on-site storm sewer inlets. ❑ Location of diversions. Note. Although not specifically required by Code, it is recommended that concentrated flow (drainageways) be diverted (re-directed) around disturbed areas Overland runoff (sheet flow) from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. [3 ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note. Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re-vegetation by sodding or by seeding with use of erosion control mats ❑ Location of practices that will control erosion in areas of concentrated runoff flow. Note. Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in-channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip-rap. When used, a given in-channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In-channel practices should not be installed in perennial streams. ❑ 13" Location of other planned practices not already noted. -Site Diagram- Note: Any base map of useable scale can be substituted for this sheet. a I 1,14 'A Y, t _FT Site Diagram Legend Please indicate north direction L OPERTY SILT by completing the arrow. FENCE EXISTING STRAW DRAINAGE BALES TD TEMPORARY GRAVEL ' DIVERSION FINISHED TREE - DRAINAGE PRESERVATION I LIMITS OF STOCKPILED GRADING TOPSOIL VEGETATION tO SPECIFICATION Scale: AREA 1 inch = _ /0 feet Indicate management strategy by checking the appropriate box: ~ ti0 4ti~ ~AO Management Strategies ❑ 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 (between April 1st and September 15th), or by other cover, such as tarping or mulching. kil Permanent stabilization of site by re-vegetation or other means as soon as possible. ❑ Use of downspout and/or sump pump outlet extensions. 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. M/ 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 o$ site. l9 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. Agreement: I hereby certify that I understand the construction site erosion control, provisions of the Wisconsin Uniform Dwelling Code, and that I accept responsibility for carrying out the above erosion control plan as approved by the code enforc~gment authority. *iure o pplicant Date A publication -of the University of Wisconsin-Extension, Ron Struss, UWEX Water Quality Education Specialist (12192). This publication may be freely duplicated Additional copies are available through the UWEX Environmental Resources Center, 216 Ag Hall, 1450 Linden Drive, Madison, WI, 53706. 6081262-3652 ~ L'Ly C Y :1- /GL Wiscortsirt Department of Commerce NO SITE EVALUATION Diva-sion of Safety and Buildings Page of Bureau of integrated Services n a a O ith s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not le to 8 1/ ins an must County include, but not limited to: vertical and taI ref (BM), 'r ct nand percent slope, scale or dimensions, no w, and location and distance to earest road. Parcel I.D. # MAY 2 7 1997 APPLICANT INFORMATION - / e prit4h.91 Wbrmafion: Reviewed by Date Personal information you provide may be used ndamCC3U Law, s. 15.04 (1) (m)). Propener of r . Property Location u Govt. Lot , 1/4 - 1/4,S g T N,R (orb D Property Own is Mailin ddress Lot # Block Subd ame or CSM# City State Zip Code Phone Number ❑ City ❑ illage [2 Town Nearest Road 1 14 19 New Construction Use: 9Residential /Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate 4_bed, gpd/ft2_Z_.2_trench. gpd/ft2 Absorption area required bed, ft2__ _tench, ft2 Maximum design loading rate r.j bed, gpd/ft2 L trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable AZt: ft Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank Unsuitable for system ❑ S [N U ® S ❑ U ❑ S ❑ U ❑ S ®U ❑ S Z u ❑ S ® U [Eu]- SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench s zsr Ground elev. A~ Ah" A124 Depth to limiting fact r in. Remarks: Boring # a y s s Al 7 S Ground S 7 S r _ l . eft Depth to limiting factor in. Remarks: CST Name (Ple a Print C Signature Telephone No. 22 L'a Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER ' Page ®f F PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GVp/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 6 Q 6 Ground elev'./ ~Tft'~'- L S _ , n r 41 Depth to limiting factor -?in. Remarks: Boring # 13 Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground ; elev. ft. Depth to limiting ; factor 'n. Remarks: Boring # Ground elev. ft. Depth to limiting factor \ in. Remarks: SB 8330 (R. 07/96) Ali ~y . s.Fq 8 ~"3a v-~Pi7LJ ~ ~o );o, -6,aido&J 7s ay i ~ 4E 01W 7T lh l - / r ' • o 0 a 31.~7Q~es h 9 CERTIFIED SURVEY MAP Located in part of the NW1/4 of the NE1/4, SW1/4 of the NE1/4 and SE1/4 of the NE1/4, all in Section 8, T30N, R17W, Town of Erin Prairie, St. Croix County, 'Wisconsin:' V N SCALE IN FEET U~V~LATTED LANDS 260 loo 0 200 R~v~R North line of the NW1/4 of the I 50115 171"W SE1/4 of the NE1/4 ~ 1 , 'WILLOW S89°01'47"W 658.18' ' ~ o w fnl r4 o Al a^t„ C QI LOT 2 I r "no r-i o A I Z c Area to Meander lines W z WI LA . :5 o 620,749 Sq. Ft. (14.25 Acres) (n d ~I ai a An ¢1 rn 4) ...J I NU 0 ^4- ~I 4j d H L3 5 F 41 ~I ,f. 958.28' 2181561 68.0 ' 671.70' y N89°11'42"E 195.50' I o o South line of the N1/2 of the S1/2 I o m of the NE1/4 BENCHMARKS I c Top of Iron Pipe at 0 - 100.00 ` U~V~LATTED LANDS Top of Iron Pipe at P = 101.10 ~ ~ ~I ZI of ~I LLI 1 N r ' ~ I-1 Cnl I Z L51 ~z I E:I (DI -1 11 W I o1 U- a °r cnl d.l ~ QI AI or WI ZI =1 CM 1 31 WI :c ! Lot ZI of Col -1 >I I nT I v11 i o FLED F Sp 2 61997 ► 9 Kp,T a%".WALSH Z Register of Deeds , SECIOXCo.,WI 565930 3 Sectionr8er of CERTIFIED SURVEY MAP n- N o Located in part of the NW1/4 of the NE1/4, SW1/4 of o (n the NE1/4 and SE1/4 of the NE1/4, all in Section 8, N10 T30N, R17W, Town of Erin Prairie, St. Croix County, Q _O Wisconsin.' SCALE IN FEET N 200 100 0 zoo Bearings are referenced to the North- ` South Quarter line of Section 8 , assumed to bear S01°42'17"W. Prepared For: Pat McNumara t ~ 1351 Griffin Ave. t~ `~T Mahtomedi, MN 55115 I~ 117- Owner: Culver Anderson Ir P.O. Box 3 jg New Richmond, WI 54017 Ln , O O RIVER ELEVATION ON 1/27/97 = 97,4 CSI ^ 1 t~ I ( K 1 ZI ° Q / i QI o is ~ _ JI NW1/4 - NE1/4RIVED I Qi o. 3 SW1/4 - NE1/4`\ / I-1 0 i i. J I 0 o =t O LOT 1 ^ Lq N m , a Area to Meander line: 758,880 Sq. Ft. (17. ,n Z 4-1 (y N ~ 4-) 0 0 SIP 2 6 '97 U N ' - H N L. 0 _m L. ° L 0 C4 / O i Z 1~ur:?7I'E'~i97)",iS tr ?I?Itf(~ Z L If not recordoo 1017.22' w0lin 3:' days of ° _ 66.06' 95'.161` T N89011142"E 1975.50' rwai shall be South line of the N11/2 o#4148d 90M of the NE1/4 4' .o I v ~I ZI UIVPLATT LANDS CDI -+I - LL_I - ~1 ) 'n, I-1 C/)I LC11 ® Found Aluminum County Monument F wl 66' a ZI WI CA s o LIJJI =1 .--II 0 Found 2" Iron Pipe /ttAZ~ ~41 WI WI Found 1" Iron Pipe DOUGS J• . • CSI DOUG I:0 • o 02 r~at~ 3/•l~7QG/ h IRVO 01 5 C 9 CERTIFIED SURVEY MAP Located in part of the NW1/4 of the NE1/4, SW1/4 of the NE1/4 and SE1/4 of the NE1/4, all in Section 8, T30N, R17W, Town of Erin Prairie, St. Croix County, 'Wisconsin: SCALE IN FEET N UNPLATTED LANDS a 200 200 100 R1v~R North line of the NW114 of the / 50115 171"W SE1/4 of the NE1/4 ~ 5. ' W I LLO_W S890011471 658.18' O w AI \ I Ln LOT 2 ; r JI Z c Area to Meander lines LL' z W I H w a 620,749 Sq. Ft. (14.25 Acres) Ln w ° Ia 3 ^W oM 0w QI JI NU y j ^o ~I ~ ZI H c ~3+s 4j~ =I i .f_ 958.28' 218.56, 68.0 ' 671.70' Z N89011142119 1975.50' I r' o South line of the N1/2 of the S1 /2 1 0 of the NE1/4 BENCHMARKS I c Top of Iron Pipe at 0 - 100.00 I UN PLATTED LANDS Top of Iron Pipe at P = 101.10 ~ ~ ~1 ZI of ►-~I ' w tit 1 o ~I 1 ZI WI 1 2 WI =1 DI ~aO W ~ I WI (-D1 a - CnI G..I r'0 <I =1 s Wl =1 - ELI .I. . . AI Cnl I ' ~ ~ 1-+I C/~I I 31 WI •`9 ~I -I •I CdJI•_JI , (DI ZI >I 1 AT 1 .nl 10 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS ;?130 Z,,5~ 14/j PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE - rj l I - 1 PROPERTY LOCATION _645,~ 1/49 .1/4, Section s T a _N-R_/ ~7W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE 3355, LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: L?~j DATE: 1~-- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property_1/4,1/4, Section ,T~N-R_ Townshipt"A,,nj Mailingaddress 21 3 e- < 11-1,-WA c _ I Address of site oZ - rj llf- rn 7 Subdivision name C~ h\ 3 S f Lot no. , Other homes on property? Yes__,el"_No Previous owner of property 4fok-c1- A/ ~vral _ 1 S©y~ Total size of property _4'o' lqC Total size of parcel 57 fg Date parcel was created S y/ /917 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes y No Volume and Page Number s recorded with the Register of Deeds . 21 1-6~ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the county Register of Deeds as Document No. ,j 7/-/ 7 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. /jSikatu ~fA~pplic`=nt Co-Applicant /I-4/-cl7 Date of Signature Date of Signature + DOCUMENT No. i STATE BAR OF WISCORffiN FORM 1-190 56778 I~ wARnArtnr oMu i. Culver H. Anderson REGISTER'S OFFICE This Deed, made between $T. CROIX CO., WI 1!f'9 W Rtq?,4 r' - aka_.Ra _ __nd__P,_ lfcNamara-- _ - - Grantor, OCT 7 1997 and ...._R,._.I??Atrick__McNamara__ and--Teresa J.Mct amara t 11 •00 A M Husbandand wife ° k Grantee, Witnesseth, That the said Grantor, for a vabosile consideration...... ""OR" 7° conveys to Grantee the following described real estate is __St.___Cr_ o_ix.____ County, State of Wisconsin: Culver H . Anderson PO Box 96, New Richmondtl i . 5401/ II Lot 2,CSM Vol. 12, page 3354, Doc.#565930 Ta:Pare~No____________________________________i Togerther with a non-exclusive easement for Ingress and Egress as I~ described in Vol. 1265, pg. 575 II i ~I a TER FEE ri it ~I ` This homestead property. I~ (is) (is not) i' Together with all and singular the hereditameoft and appurtenances thereunto belonging; ' And...... rantgr------------------------------------------- warrants that the title is good, indefeasible in fee simpie and free and clear of encumbrances except easements and restrictions of record I and will warrant and defend the same. r Dated this ].6 f.h say of October._.......... 1997 i - ..(SEAL) • ..G~1Ver.. H.:.. Andeson i (SEAT) --------.--(SEAL) Ij i c ~rn). , • I ~h. AUTHRMTICATION ACENOWLEDGMBNT i Signature(s) STATE OF WISCONSIN 4i es. _ S t.....CX.0------County. f authenticated this day of 1B- Personally came before me this 6tbday of OSKt9PAr................ _ 19___97 the above named ~lver__ H - Anderson----•-•--------•------•---- TITLE: MEMBER STATE BAR OF WISCONSIN ' (If not, authorized by ¢ 706.06, Wis. State.) to me known to be the person who executed the foregoing instrument and acknowledge the eame~ ,j THIS INSTRUMENT WAS DRArTFn Rv d -