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HomeMy WebLinkAbout032-2099-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561099 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Pinecliff Partnership LLC, C/o Michale J. Hartm Somerset, Town of 032-2099-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 1 6~ VVl 1 G 5 26.31.19.953 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 1,,5 CAPACITY STATION BS HI FS ELEV. Septic 2- I Z6 ~\CJ Benchmark Z~ ~5 162., g ~ 4. f Dosing Alt. BM Co.,,,~b WOC~ /6112 (S~ F~~a I.73 Aeration Bldg' Sewer Y .7 "57 3 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO ^P/`L t WELL BLDG. ent it Intake ROAD Dt Inlet \ Septic /~d-sb 5y Dt Bottom IZ.o 8 a t Dosing 7 5v / 5 ,7 / Z Header/Man. 4-16 c7t, / Z Aeration J Dist. Pipe L_,-75`1 °.s Holding Bot. System S `/3 Final Grade 1 PUMP/SIPHON INFORMATION 3 • '7Z. S B' Manufacturer Q ` Demand St Cover I Qv GPM `t. L3 y Model Number L~~ '45 9 TDH Lift Friction Loss System Hear pA_ T TD t p 7, ra r~ Forcemain Length Dia. I 1 Dist. to Well 50 z SOIL ABSORPTION SYSTEM BED/TRENCH Width Length) No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 \ J!Q ~J SETBACK SYSTEM TO v~ IPP//L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR,tit^. t ~~ca Type Of System: UNIT Model Number: AJA- Goy 0 O w 361 ~ 1-2- JA- 4 DISTRIBUTION SYSTEM I# ~L /t-f-+-/j lay..! ~uS o Air Intake Header/Manifold 1 Distributiork, x Hole Size Ix Hole Spacing 17-) PipLength Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only c~ Depth Over Depth Over xx Depth of xx Seeded/S xx Mulched Bed/Trench Center S(G Bed/Trench Edges Topsoil 1; es Q No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1964 62nd Street SOMERSET, WI 54025 (SW 1/4 NW 1/4 26 T31 N R1 9W) Pinecliff Lot 8 Parcel No: 26.31.19.953 1.) Alt BM Description = C G~~ ; ~s j^ Lo C_/Z-5 C3 2.) Bldg sewer length = - amount of cover Plan revision Required? ❑ Yes o 3b 13 ~ 7 Use other side for additional information. L_. SBD-6710 (R.3/97) Date Insepctor's Kiature Cert. No. n a, 14 UN12TlY\A IJ sw llq otiJ vt-/ S z 73 i k) III i~a h1 P , ol Li -F ~ Z`1 Z .~fJC~I N~AQK., TF OF La'f isTA(4- .[~L = t v© ec SO L G~O(zl 3S I L/0' y IE ~C- 0 E~ G CMILY SOMY wd BMI&VO Owmilios 201 W. Wit Ave., P.O. B= M2 SMjwyPmn~t {~t~eGdin byCAL) fit, 7'!62 SPAlb 5610 1 Sa 'y Permft Applcati;on ` r~ VI&M30MMVr Ad- caft oft& RMm~ wa me<x,o,raae~ccwbh~c ~~i JI- I jewmiMn -RUMXTMAUMUMM iM Nam P o ZT eJ _ A r2, Mt -P 032- ZC6q ~ Sb - f" -"Y ftUPCqYLwww p=peciy Op6atr'S MaAdrb= 11 ~ -j ~ cR 95 3~ y/ C may: Sta6e r7 7 _'h, Jv W _ A-77- T -:~j It Rjl~t~l) IL Type aft (check sU Baaf appb) I~t= 01 or2 Faudyl7areWB%-. -NMbardBed== Spa Hame CSI ~ DPub& -rx=bc dK #~y 75 2~ a car ham p ~ ~y~ n stems Oafloa-nom use I SZB 7 COTO= V6[. 1121 P(,, l3 III. of {C~eckenty ear boat an fine A. Cbnq* a line B Mi"HMMO) A- 0 RqM=nM3ffl= ❑ Tr-8 1 STMkRe.618--folly n OB~ar buEt SJ~( Z., 4 IL n P=z&Reamd n RamftR a n C e&PIMW nPam TaM5&rtDI4Vw i~cr~.;ooa x ®an~ Om a Cbeckan that _ a ~~a n it a°ea> "ir e S- 1 2 n tip Fly D;epead MM piapas~ A~mRvpowd SysbM McWdOR GM cvac TOW got VL Tsek lab owl= itrift Galkw Un is a r di - Near E T=U I a ~ oc roQrss ss< vII. Wnplady stasement- 16 Plt~bet'sNaatre t Pik' BCOM PbGaGNn ::7P7 z PWmbeas cRMeK CI%9MftZiPCD&) y~q/- ,3sf5S' Lae Pamxtifee Ddahmd A nOMWOMReM~orDaM ~3 b--e- F; - - 6 1 1 1. Septic tank, effluent filter and -4%M.Y-. dispersal cell must be serviced / maintained ~Y~'t n~l.C t / ~d J~2~~ as per management plan provided by plumber. ' j 2. All setback requirements must be maintained 0-2 fermi ledle aaWMNWECIMOUN IfflWhaftAft J) PUBLIC, D ~ u Zoo , rri Ci l ~ , u Cl) rTt tv, ITI W cn , O m m X - U) C) w j % . N I T OD C4 IOD D m 1 OD r n n D N / U) / i M m O J CD x U) CD n W r~ W D 1 V `b(fQT ~o CD i 'Li D I 6£ n s •I ~ o N D U'I U D w oN I p_~L N W D I Z lD ~ I ~ i OD D I J n ~ N m W CA O X / / -TI O> i / Cf) m O b4 _ L -TI •69 is` ~.L ~ U OD 0&, I0 o0~S Oi W 0. - 03 3„~~,~~'aon~N W V ~ t l~ CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE', l n Project Name: 6-dTk owners Name: . _ C 1.1 N~ /t~ r S td 1 49 L I~ owner's Address: lp~ ~~~-C+I t \V sy©~.s Legal Description: f;V4 `Iy N wliy S '2(0 3 I R 1C( N\J T ownship: J6 ~A - County: - - T C(;~01 Y, Subdivision Name: Iy iJ~ 0,L EE Lot Number. Parcel ID Number. b3Z-- Z09q _ n~o -COD Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page & Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page g Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. J=F!- License Number. 2 y /Z- Date: Phone Number ZWof I Signature Designed Wwjwd to the in,,C3roand Sol Absorption Component Manual for POWTS version 2-0 SOD-10705-P {i OIJDt ~ Page 1 1`to-rit AUE T'D`B SdE s c Q~6 rnE RSA-- yv~ 5 yC~~j w2 4,--l S7-. v7 SoILRI1.ll, 40 , ~L = loo ' CAA-,05 WP. S2fj LIO P, K - Wieser Q Zv a~ 1. X30 r ZL -f a lv lo+c~ce C7 LT 03 1301 f, V-1 x Wisconsin Depa-tment of Industry, SOIL AND SITE EVALUATION Page of 3 Labor and HumJn Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. / Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must county include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. 03 APPLICANT INFORMATION - Please print all information. Ravi Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property, ner / Property Location ~~~'lnl Govt. Lot S 1/4 #je~; IhITY GE E (or)~dl Property Owner's Mailing Address Lot # Block# Subd. Nam r Y - Ci State Zip Code Phone Number El Nearest Road ~ ) Ci.>v t Town sT, f . . _ Y New Construction Use: Q Residential / Number of bedrooms :Z Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow Z~ M gpd Recommended design loading rate -7 bed, gpd/f? trench, gpd/ft2 Absorption area required bed, ft2 7S"?7 trench, ft2 Maximum design loading rate bed, gpd/W trench, gpd/ ft Recommended infiltration surface elevation(s) R 3 YOX 7~- ft (as referred to site plan benchmark) Additional design/site considerations R Parentmaterial Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system VI S ❑ U ff ❑ U ®S ❑ U Z S ❑ U ❑ S ®U ❑ S 91 U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure Consistence Boundary Roots GPD/ft2 Boring # in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Bed Trench S of - Ground _ o s @lev. 74- Depth to 71 limiting ` f ]EE I I ) or in. 2L&.6~~ 71v Remarks: Boring # J S l _ Ground lev. 2 « ~Ift ' ~ • Depth to limiting f for in. Remarks: CST Name (Please Pr' t Signature Telephone No. ' " Date CST Number Address ~ - tit PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# 3Z Z71 -0 6 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed , Trench < 3 S Ground elev. 94--ft- Depth to - `c - limiting 3 SE'S factor p LZin. ; Remarks: Boring # 3 _qJ7 Ground 7~S G 6 elev. sa6 3 - ~ft• ' Depth to limiting factor Sin. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to l/ limiting ; factor 12-in. Remarks: Boring # s , Ground - S Al Z1 y~ft. Depth to limiting factor min. Remarks: SBDW-8330 (R. 08/95) i3 Soil Absorption System Cross Section ft Final Grade 4" Schedule 40 PVC Vent Pipe With Vent Cap ft Leaching Chamber ft System Elevation ft ~ft Soil Absorption System Plan View ft ft { ft Leaching Trench 1 Vent Or Observation Pipe Chambers 'for i 1- 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model -+P1--1(TR V4Z EISA Rating Z(-) sq ft per chamber Soil Application Rate ~ 7 gpd/sq ft gpd Design Flow - #7 Soil Application Rate - 20 EISA = Chambers 2 rows ofLZ4 Z4 chambers each. 11V Page of INSTALLATION INSTRUCTIONS PL-525/PL-625 FILTER PL-5251PL-625 FEATURES & BENEFITS - f Features & Benefits: e Rated for 10,000 GPD e PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 9Accepts 4" and 6" SCHD. 40 pipe ~ Built in Gas Deflector The PL-525/625 Effluent Filter should operate efficiently for several years under normal conditions before eAutomatic Shut-Off Bali when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every o Alarm Accessibility three years. If the installed filter contains an optional Accepts PVC Extension Handle alarm, the owner will be notified by an alarm when the e filter needs servicing. Servicing should be done by a ertified septic tank pumper or installer. RECOMMENDED PRODUCTS - x - . Polyiok PVC Filter x < - t Extension Handle f v 5 '.R, f. t .l 3: s v> 1EP - E 1 Riser Safety Screens Filter Alarm Panel and Risers & Riser Covers Extend & Lokn" SmartFiitef~" Control Polylok risers bring your Polyiok Extend & LokTm Polylok safety screens Switch septic tank cover to grade. is a simple, easy to use prevent tragic accidents This allows locating and solution that can extend from happening by children Polyiok filter alarm panels and switchs provid a visual S servicing your filter easier the inlet or outlet pipe and septic ndpets f iliintrinto aspen and audible notification of nd time saving by elimi- make filter and/or baffle impending filter and tank ating digging to find tank installation a snap. servicing. entrance Fits 3" and 4" pipe. For a full list of Polylok products please visit our web site at www.polylok.com i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION 1 C [-CF~F A'~71~( (P SYSTEM SPECIFICATIONS Owner 01\~ Septic Tank Capacity ( al El NA Permit al 61 Septic Tank Manufacturer _ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer p _ J.)* NA Number of Bedrooms ❑ NA Effluent Filter Model 8 ZS ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer 13 NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate , al/da /ft' Pump Model El NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit VA Fats, Oil & Grease (FOG) s30 mgiL ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD,) 5220 mg/L ❑ NA ❑ Mechanical Aeration Ci Wetlarid Total Suspended Solids (TSS) 5150 mg/L E7 Disinfection ❑ Other; Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) S30 mg/L la-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grada ❑ Mound Fecal Coliform (geometric mean) X10` cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Yo in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: 0 NA Other: ❑ NA *Valves typical for domestic wsa#awater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: El month(s) (Maximum 3 years) ❑ NA .arts} Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA '3 ❑ month(s) (Maximum 3 years) EI NA Inspect dispersal call(s) At least once every: _ Year(s) Clears ejffiuent At least once every: ❑ month(s) E3 NA fitter ear(s) ❑ month(s) 7155 NA Inspect pump, pump controls & alarm At least once every: gear(s) <,NA Flush laterals and pressure test At least once every: ❑ month(s) , ❑ year(s) Others At feast once every: 13 month(s) nsA ry: ❑ year(s) ::k._ . Other: A 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 inspector; POWTS Maintainer; Septage Servicing Operator. Tani inspections must include a visual inspection 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 to check for any back up or pending of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondinf of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority, When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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 Administrative Code. All other services, including but not limited to the servicing of effluent filters, rnechanica( or pressurized components, pretreatmen 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 10 days of completion of any service event. GMW (4-/01) Page of START UP AND OPERATION For now construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the 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 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, overloading the cell(s) and may result 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 calls. Do not drive or park over, or otherwise disturb: or compact, the area within 15 feet down slope of any mound ❑r 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) water; 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 $3.33, Wisconsin Administrative Code: + All piping to tanks and pits 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 a code compliant replacem system: 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 that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 0 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 fbiled POWTS. ❑ Mound and at-grade soil absorption. systems may be reconstructed in place following removal Hof the biomat at thd infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER )C - Name Name ,-sF_F'C= no Phone -71 S- SS- - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY V Name Name ego to Phone Jam--. ~BCj V Phone This document was drafted in compliance w1th chapter Cornen 83.22(2)(b)(73(d)&(f) and 83.540), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTANNANCE AGREEMENT AND OWNERSHIPCERTFCATEFORM ay ~yh ar'► ' o Y- P~ Vie- G ( 4 Ph'V- r\)0 -'5 k L l-C- own uyer / 1 i Ve ' I MailinsAddress l ld ~V I~ J Property Address (Ve fication requiml from Phoning Department for new coashudim) - p po0 LT q 8 W arcel identification Number ~ 3 2 _ Z D City/State 0 Y►~Gr LEGAL DESCRIPTION Property Location ';W '/a Sec:? LT10I NRAW, Town of 7 2.1' Subdivision P'". t Lot# Iha G iGvt/~r~PiYS !/l Certified Survey Map# 5`17S 4,q,Volume Page Warranty Deed# ~ ~?7 Volume 1 Zj Page 3 Spec house yes _X,,._no Lot limes identifiable __&,es no SYSTEM MAINTENANCE Improper use and-maintenance of your. septic system could result 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. Whatyou put.into. the.system can affect the fimction of the septic tank as a treatment stage in the waste disposal system. The property owner agrees tosubmit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on- site wastewater disposal systemis.inpmper.operating condition and/or (2) after inspection and pumping (ifnecessary), the septic tank is less than 1/3 full of sludge. Itwe, the undersigned Laveread-theabove requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by th Department of Commerce and use the Department of Natural Resources. State of Wisconsin.Ced*dcationstatmg that your.septic system has been maintained must be completed and returned to 1.-0 ce within 10 days of the three year expiration date, the St. Croix 7 - /Z-O- t 3 SIGNATURE APPLICANT DA #of proposed bedrooms `T OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office SIGNATURE OF APPLICANT DATE Any information that is result m the son txy per=m bang revoked by the Zasmg DePa= miarepreamtnd may i include with this application a wed warranty deed from the Register of Deeds c6ice a copy of the certified auvey map if reference is made iarhe wammty deed. D z Lnn 72j" 86" m r. 53" D Z Z r c m m D N 0 m 0 p Um 4" CAS m -I F O N ;0 p O N m M 3" 47' I 4„ -0 0 o 0 < X D ~ M v 1 m N UP 49 m ~ 4" CAS \ 1 / EI N N v ;a -Tl NO O O ~D-0 46 50" ~ 0 D Z mm> D m co-n r I N 0~> D ~~0 D mA r OX D Z C) m I ?Z z °D ° c Fn FnF, m D m z Or. D p -1 w_~n O~z mX Z Z x O 0C0 0 0 Om X m > %Z -r`cr-oz?1D0 OHO ~v Nm 0 ca N DrrnZ D m00 mD0 -1a*. =I =O ANN (n ~N ZO \ C =A Z A=7C C) ~Zm 0 'nV jRilTl('ONN~0 2U1~ m Z O m p 17m D -1 D I -1 Nr-- O0t r-0 n D t r a D Z 0o D N ~N NN O \ s 6~ 0 -u a) m a) 20 v v a U) z cZi N Am ~r. SD ~nm~ ID> ~vwOV~v O(,, ;0 M U) C) -q I M m w w W Z cm p-1 Z ,m D rnDm mo OD va D v v my 3 0m A° D Wv OFZ >0. 0 D rn< v m a H 0 ~v ru z A i1 Z ;%k 0 CD 0 N 0 O Z r 0 N D D v O?I 0;0 0 z -n m 20 r r --1 m C) w to C O r0 D O O 3 A m 0 m to z ;0 ;0 D 0 ;a 0 C) =O --1 O I m r m D ° z ;0 c H 0 O O m A m z r A ;0 z r m \ W1250-MR m DRAWN BY. SME SCALE: 1 4"=1'-0" PRE-POUR: MISER 011CRETE REV. I SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR: \ ° REVISED JAN. 2010 800-325-8456 FILE: W1250-MR gay ~ ~ ° ~ pyr Y~ N N D pro v a V m m Pp' ND \ \ - -~>rorcar~o ~ \ ~ wo \ ~y ~j ♦ cb•• S. k \ 11 '_1 01 ~ 2 Fc9' \ 30SR 3~2 \dB ~ s5 1 6Z5 / a J^-'- 4 0 OOStla ~1m X20 o \ STt. ~~0 2 G u g ~F ♦ \ O ♦ ; d0~i 00 sL` • 1 Q~`titi y4,e` •63, 44. / a'i ACA' ^ ,~~iV m o N cJ `s o i ♦ ♦ ~ v~ m u p ~ 24'• S A N t1"/ ~ ♦ W n 1 I rob 1 m ~ N f~ N O~.i9` ~ N A w ' ~ ~ m two WA OD z; co R QL~ i '1) v' y m u n U A N m -1 y l O ' cn (D n n 4o pv M ;T j O V1 W to 2Y tffl ~ C'r ~ ~ fd no K J1 D W N ! W A O % Y O. co ~i G E m ( r7 (p W ~w ! ! mO m O n 0 ti, CD P. Vl m a LO M M K '1S m O ~ Ml 9 rS2 CD C ,ss n n H-ja :4 AL- -".!oo osr£.rooors Q ,~e~`a w m 0 10 LQ H. ,Sq'!s~ 3„L£,IDaO1Nw Y 'n oy (D Gmp a " o E Cf tKD N C(D u. T (D O -"'0 t to H L Oro O ; +a~2n y~ o W nt°i o O 04 CO ID M o" N O 'o a aro z -4 r:' _ ~s Mpg ~~r 0 ha li i t i! ii r State Bar of Wi-wonmr% r-orn- 2 983 A• ~ i RVARRANTY DEED ! Gis. 'Erb L,I.-s= r CRM r,) DOCUMENT NO. It ; f1. V F , Rec J till' f .l f7~~ 4 t! I MAY 9 199.5 t' 'i George_T. _Pr•.pnock._a/k/a G_eorge_Pennock, 1 r ~nj I! conveys and warrants to -RinaQ1liff _F-ar-tner-ship ' T~rIS Si VEV }UI }t[I.U I~UINri UAIA 7 I NA.M ~ AND VRN ADDnE SS ~ the following describe( Tral estate to ~I Covnty, State of Wisc•.Tnrin: 't ! (Parcel identification Number) I 11 it I W1/2 of NW1/4; SF1/4 of NW1/4; NE1/4 of SWl/4; all that part of NW1/4 of SW1/4 lying El of Apple River and that y part of SE1/4 of SW1/4 lying Ely of Apple River; all in Section 26• and all that part of NE1/4 of SE114 lying Ely of the Apple Raver of Section 17; All in Township 31 North, Range 19 West, St. Croix County, Wisconsin. ! I ' Il ii II .-~-.•rtar !i l l i. I1' This is nOt homcsn~ad property. it K(W !i (is not) II Exception to warranties: Easements, restrictions and rights-of-way of record, if any. !i Dated this day of . 19 .5_ I I (SEAL) li • _ • _ GeorQe____ Penstock,-1kJa_ George_ Pennock i' (SF:? i_.) (SEAL) ii I AUTHENTICATION ACKNOWLEDGMENT T Pennock a/k%a STATE. OF WISCONSIN :t O s 1~Q6~ County. Ma 95 IR r ed rs .a day of Personally came before me this day of M ' 19 the above named Tr`lft33s' land b"ksBti`R STATE BAR OF WISCONSIN (tfnaT r authorized by §706.06. Wis. Still to me kno%%n to he the person who executed the foregoing instrument and acknowledge :he game. THIS INSTRUMENT ,VAS ^4eFTEU SY Kristina Ogland Attorney at Law Notary Public C'ount%,. Wt, i Seioabll c. coati ia>; ans iec nii~:;i eai an aria u,e.,. it Up;rai. i+uiia arc m ..,,Inn„~niun r~ t:Ca, n -l;. iaaat, cKp io...:, .,a,... rccc,sarc ) , n. n,• n n. . ,r. 1i1.kk♦1IN irk it -,R"i i.I-ONii`. Parcel 032-2099-80-000 06/07/2007 04:49 PM PAGE 1 OF 1 Alt. Parcel 26.31.19.953 032 - 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 - PINE CLIFF PARTNERSHIP PINE CLIFF PARTNERSHIP 744 RYAN DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1964 62ND ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: 2311-PINE CLIFF SEC 26 T31N R1 9W SW NW LOT 8 PINE CLIFF Block/Condo Bldg: LOT 08 3 AC II Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-31N-19W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 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 57,000 0 57,000 NO Totals for 2007: General Property 3.000 57,000 0 57,000 Woodland 0.000 0 0 Totals for 2006: General Property 3.000 57,000 0 57,000 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 o 'I a~ o I p u°4 M o M 06 v N N N x 0 ti two a c v v 0-0 C a cOi ° m ~ I O N 0 CL cn ~ ~x VU) °O 0 N I 00 b Y a C M 2(n rM- y 7 O Z LO N-o c C 7 f0 ~2 (C6 LL C N J .O o N E '0 m N ~o Q > U C I I ~ I Z o I rn z o ~ v z € m N F- fn I O Z d LO c N N U O 4) z H r 01 O C 04 N • L 0 a O Q O O C c a z z N d c m E y ~ rn ~ O a EI ~ n o 3 3 3 a LL •N~v =aaa M 7 0 N iA? v) J U m o N Z _ U_ N O . C-4 ti~ p (O O ~ w Z O V O O U m c ~ -J ~ 4) Q A in I N a ~ O O y N H N C 0 0 3 o°o 'M F - ca o, ~O 1 t rn 0 N N U CD .yd. y` CY Op ce) C O co U) d Lo O Z N d z aII CL CL l ram„ a 2 'c I c rrww E s A 0 a 2 j 0 ai V ST. CR O T Y Land Use Planning & Land Information Resource Management Community Development Department June 14, 2013 File#: LU87898 Michael J. Hartman JAL Pinecliff Partnership LLC 633193 r, Ave. Somerset, WI 54025 Re: Filling & grading <10,000 sq. ft. within 300' of navigable water OHWM Parcel #26.31.19.953, 1964 62nd St., Lot 8 of Pinecliff Subd., Town of Somerset Dear Mr. Hartman: This letter confirms department approval according to plans submitted on June 3, 2013 for the following activities that require a land use permit: To fill and grade <10,000 sq. ft. within 300 ft. of the Ordinary High Water Mark (OHWM) of an unnamed navigable waterway in the Shoreland District pursuant to Section 17.29.(2)(c) of the St. Croix County Zoning Ordinance. According to the plans you submitted, the proposed filling and grading will be necessary to construct a principal structure with attached garage, a Private On-site Wastewater Treatment System (POWTS), and a driveway access from the subdivision road. The land disturbance will be on slopes <12% and will exceed the 2,000 sq. ft. allowable without a land use permit. Staff finds that the proposed activities meet the St. Croix County Zoning Ordinance and Shoreland District based on the following findings: 1. The property is located on lot 8 of Pinecliff Subdivision at 1964 62nd Street, is zoned Ag/Residential, and is located in the Shoreland overlay District of a navigable waterway as shown on the recorded plat; 2. The proposed construction will result in -5000 sq. ft. of land disturbance within 300' of the water's OHWM, but construction will be outside of the 75' setback and will meet required side and rear yard setbacks from property lines; 3. The proposed house is intended for use as the principal structure on the property and may not exceed the maximum height allowed in Section 17.13.(3) of the ordinance; 4. The applicants site plan did not include specific erosion control and storm water management plans. There is approximately 2400 sq. ft. of impervious surface planned, which will require a 300 cu. ft. rain garden or similar structure to infiltrate runoff. With conditions to install appropriate sediment control measures e.g. silt fence or sediment "logs" below the Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 www.sccwi. us/cdd www.fdcebook.com/stcroixcountyw i cdd@co.saint-croix. wi. us Community Development Department Page 2 construction area in a vegetated buffer, to maintain erosion control measures until self- sustaining permanent vegetation is established on all disturbed areas, to prohibit the use of phosphorous fertilizer to establish and maintain a lawn, to submit and implement a storm water management plan, and record a maintenance and monitoring agreement against the property for the runoff infiltration device(s), negative impacts to water quality of the pond will be minimized; 5. A conventional POWTS will provide wastewater treatment for the proposed dwelling; 6. The Town of Somerset building inspector will review the submitted plans and land use permit prior to issuance of a building permit for the town; 7. A minimum 35-foot vegetative buffer must be maintained along the OHWM and tree cutting must comply with Section 17.28 of the ordinance; 8. The Wisconsin Department of Natural Resources Shoreland Specialist, Mike Wenholz, was sent the application for review on June 5th. The DNR typically is satisfied with these projects as long as the plans for stormwater and erosion control plans are implemented and compliance is verified by county staff; 9. If constructed as proposed, this project will meet the spirit and intent of the Shoreland overlay District. With conditions for installation of erosion prevention, sediment control, and long- term stormwater management devices, it will not degrade the water quality or scenic value of the wetland, nor will it negatively affect the public health, safety and welfare of County residents. This land use permit approval is for filling and grading <10,000 sq. ft. within 300' of the OHWM, as indicated in the plans submitted, and as provided in the conditions below: 1. Prior to commencing construction, the applicants and/or their agent shall obtain any other permits required, including but not limited to a building permit from the Town of,,.R!; p ; 2. Prior to commencing gny excavation on the site, the applicant shall submit plans to the county for review and approval of specific locations for installation of erosion/sediment control and stormwater management devices. The applicant shall contact the Zoning Administrator and schedule an on-site meeting to review construction schedule (the Building Inspector may want to attend) and verify installation of acceptable erosion and sediment control measures as indicated in the approved plans. 3. Sediment and erosion control measures must be maintained until all disturbed areas are fully stabilized. No phosphorous fertilizers shall be used on the disturbed areas of the site, unless a soil test confirms that phosphorous is needed to establish permanent vegetative cover and must be limited to areas that do not drain directly into surface waters. 4. The finished principal structure shall not exceed the maximum roof height allowed in 17.13(3), will remain outside the 75' setback from the OHWM, and will meet the side yard setbacks required in 17.27(1)(c); 5. The stormwater management plan must be implemented as part of the project with runoff infiltration devices (rain garden or equivalent method) installed according to approved plans. The applicant shall record an affidavit on the deed to the property within 30 days of Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686 www.sccwi. us/cdd www.facebook. com/stcroixcountywi cddCako.saint-croix wi. us • Community Development Department Page 3 installation that provides for long-term operation and maintenance of the approved infiltration device(s). 6. Within 30 days of substantially completing the proposed house construction, the applicant shall submit to the Zoning Administrator: a copy of the recorded stormwater affidavit, certification from the contractor(s) that the construction has been done in compliance with the approved plans, and photos of completed stormwater management structures. 7. All activities approved as part of this land use permit shall commence within one year from the date of approval and be substantially completed within two years, after which time the permit expires. Prior to expiration, the applicant may request extensions of up to six months from the Zoning Administrator. The total time granted for extensions shall not exceed one year. 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 what is identified as part of this land use permit application shall be subject to the review and approval of the Zoning Administrator. It is your responsibility to ensure compliance with any other local, state, or federal rules or regulations that apply to this property. Your information will remain on file in the St. Croix County Planning and Zoning Department as a matter of public record b. Please feel free to contact me with any questions or concerns. (:amela n ely, Quinn Land Use Specialist Eric: Land Use Permit #LU87898 Stormwater Mgt. Plan Affidavit form Cc: Town of Somerset Building Inspector Mike Wenholz, Wisconsin Department of Natural Resources Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686 www.sccwi. us/cdd www.facebook.com/stcroixcountywi cdd@co.saint-croix. wi. us tl!~N.l Im r~ o ST. vvs) LAND USE PERMIT032p File#: Z, ji ST , Office Use Only APPLICATION Revised 08-24-12 p~~~*~T~~"~& A APPLICANT INFORMATION Property Owner: III/ /IA47;,a/4 i✓ Contractor/Agent: Mailing Address: f ~ .14 .4a t Mailing Address: 7C/4'- OVA--~ i'40 -5 jn!!J_;&t Et w / . ter) Daytime Phone: ( ~ rS" r1 Daytime Phone: ( f- ) 6 ' ? Cell: O Cell: E-mail: t~ <s ,.F ~4 is r,~1 ~,.x Co 6 E-mail: o„S C SITE INFORMATION/ Site Address: Cl $ ~eM S c Gu Property Location:5W 1/4, lJOJ1/4, Sec. 7' , T. j N., R. _Lq__W., Town of Computer - 1<i - _ - D Parcel 7 31 • LAND SE INFORMATION Zoning District (Check one): O AG. ( ) AG. II (r"~AG. RES. ( ) RESIDENTIAL O COMMERCIAL O INDUSTRIAL Overlay District (Check all that apply): (~HORELAND O RIVERWAY O FLOODPLAIN O ADULT ENTERTAINMENT Type of Land Use Permit Request (Check one): Animal Waste Storage Facility $550 ( ) Wireless Communication Tower (Co-location) $550 O Nonmetallic Mining Operation $550 ( ) Lower St. Croix Riverway District $350 Signage $350 ) Shoreland $350 Floodplain $350) Temporary Occupancy $350 Grading & Filling, 12-24.9% Slopes $350 Livestock Facility $1,000 ( ) Other: Permit processed in conjunction with a Land Division, Special Exception or Variance $50 State the nature of your request: )-Ar^JD _1C>1S'U 4 .,5.-Ai6 a 2-0e 04- 1504-- kJ U SI Cc ~JJ b~ 46UJ -~_5 11 ETA UA1711 J Zoning Ordinance Reference 11, 2 SIGNATURE I attest that the information contained in this applica ' n is true and correct to the best of my knowledge. Property Owner Signature: l f Date, Contractor/Agent Signature: Date 6 .5 OFFICE LY Complete Application Accepted: a j / I By: Fee Received: Z/ 3 /,(Z $ Receipt SD 715.386-4680 St. Croix County Government Center 715-386-4686 (Fax) PZ000.SAINT-CROIX.WI.US 1101 Carmichael Road, Hudson, Wl 54016 WWW.CO.SAINT-CROMMUS