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016-1060-20-000
\ 04 @ � & ; � \ 7 § C k k§ Lk 2 T ) kk$ 0 ■ aE= .. J =$ � o � «_ 7 R z .. \ � m $ k o CO j § (L m (D E 3 k � 2 � 7 G k 7 2 J ) & �� § n 2 @ § .610 ) \ z \ £ 1 _ k . $ C co E § co ~ CL 2ma{ e a # o o a k§ & } _ \ k / k t .. , 0 0 0 } a § IL a a m � - B ■ o o j v § k k 2 Lo co C') 0 o = \ k / 2 @ a k�k 2zf I k \ < ( § , § g LM & < @ -0 0 4C 1 4) \ - Cl) C) ` 4 ¢\ q j R/ o 2 /)) . � k «m �C IL E, k k a i $ J a 2 ,o U) U VViAconsin Department of Commerce PRIVATE SEWAGE SYSTEM Y' Count Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) SanitnEgrQ}itNo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). / /44 �yJJ 1 1 Permit Holder's Name: ❑ City ❑ Vi ge ❑ o of: State Plan ID No.: Doornink, Aaron & Spring 8lenwoo ownship )p CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Ta o.: c7O.O ' a, a a Q �� 0 �`6 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 100 PO4---c�* /Ono Benchmark 2 1 f S Dosing t ' VtA t 6 ks �q r1J P6z.G —Gpsf �5� Aeration Bldg. Sewer (a) ! (a.8g U3.2pr Holdin St /Ht Inlet .8Z pZ -Z(o r TANK SETBACK INFORMATION St/ Ht outlet TANKTO P/L WELL BLDG. Aelntake ROAD Dt Inlet 3, q' 9 q8 Septic >50 C�J� tJ r NA Dt Bottom ( -g 93.2 ?' Dosing > 5'0 ` w /0-1 h t (� NA Header / Man 3 zf 3 g8,gb r Aeration NA Dist. Pipe ' TF Holding Bot. System - • °`� 9 g. 30� PUMP / SIPHON INFORMATION Final Grade Manufacturer G &LLL - bs Demand St cover Model Number o �( I I 31 GPM ►mil %d I s s 11 6b D TDH Lift,, a 9 Friction System z . L , Head TDH jq. Ft Q,w, o2,3q 2. CFO.� Forcemain I Length Dia. Z Dist. To Well SOIL ABSORPTION SYSTEM (BE / 1`$ENeM Width r Length , o. Of ren es PIT No. Of Pits Inside Dia. th MNI N DIM SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACH anuacturer: INFORMATION TypeO r rr T Mo m er: System: MWj ^- (Z3 l�� OR UN DISTRIBUTION SYSTEM P 4 Header! Manifold a Distribution Pipe( x Hole Size x Ho a Spacing Vent To Air Intake Length 3(o Dia, 2 Length 2 Dia. Spacing 3(o 14 q 2 4 It SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of T x Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil CI C1 No [I Yes ❑ COMMENTS (Include code discrepancies, persons present, etc.) t s sp Inspection #1: ©°I /off/ 0 Inspection #2: 05/ 0 8 / oD Location: 2930 130th Avenue, Glenwood City, WI 54013 (SE 1/4 SW 1/4 28 T30N R15W) - 283015421A -Lot 1� 1.) Alt BM Description = &A�_ 2.) Bldg sewer length = 2(. -O _ - amount of cover = (� C&+ y+x� 00 N' .r" 3.) contour= ' n( r,04%-- ; 1�.ec4i;-, Al u&e Plan revision required? ❑ Yes No Use other side for additional information. Ff I I I SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety & Buildings Division VA Washington Ave. _ Sanitary Permit Application 201 W. PO Box 7302 W isconsin In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707 -7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned. Attach com lete tans to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. . 5/ 1 4, > County State Sanitary Permit Number ❑ Check if rev' ' revious application State Plan I. D. Number ST CROIX - 2 1 _rr I. Application Information - Please Print all Information '� - % . Location: Property Owner Name 41 Property Location AARON & SPRING DOORNICK � rt�U � SE 1/4 SW 1/4, S 28 T30 ,N, jj5je W Property Owner's Mailing Address _ WI Lot Number Block Number 2938 130TH AVENUE 2C00 — City, State Zip Code - Phone ti r, / Subdivision Name or CSM Number UN?'Y GLENWOOD CITY WI 54013 74�'IdG�Ef�6i =7 �� 620491 II Type of Building: (check one) ' i , _ _ xc ❑ City ® 1 or 2 Family Dwelling — No. of Bedrooms:. ❑ Vivage ❑ Public /Commercial (describe use): 1 _ 00 Town of GLBNWOOD ❑ State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road 130TH AVF.NITF. A) 1. ® New System 2. ❑ Replacement 3. ❑ Replacement of 4.. ❑ Addition to Parcel Tax Number(s) System I Tank On Existing System 016 - 1060 -20 $) Permit Number Date [ss ed ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 6.7 F ❑ Non - pressurized In- ground it Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic T eatment Un' ❑ Recirculating ❑ ter: C Elt q - T D 6" i V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation 450 450 450 1.0 N/A 98.33 100.12 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 1000 1000 1 MIDWESTERN PRECAST 750 1 1 750 1 1 IMIDWESTERN PRECAST VII Responsibility Statement 1, the undersigned, assume responsibility for installation of the P WTS shown on the attached plans. Plumber's Name (print) Plu is Signature (no m MP RS No. Business Phone Number BENNIE HELGESON 220292 715/772 -3278 Plumber's Address (Street, City, State, Zip e) W1229 770TH AVENUE, SPRING VALLEY WI 4767 VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) $,Approved ❑ Owner Given Initial Adverse Sur arge Fee) Determination f3 as. ( V IX. Conditions of Approval /Reasons for Disapproval: vvaLz� 1-4 Pell- COA.Q- Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 visconsin ,rew�n,. commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 29, 2000 � �2L � CUST ID No.220292 1 ' ATTIC• POWTS INSPECTOR �� R1 C< c � `ft /1 2PN1NG OFFICE BENNIE W HELGESON � ! + St IX COUNTY SPIA N7649 HWY 128 �� 1161 ARMICHAEL RD SPRING VALLEY WI 54767 .� TC;iox N WI 54016 =� •: ON1N �' Z G OF:Icc RE: CONDITIONAL APPROVAL > PLAN APPROVAL EXPIRES: 08/29/20` Cli Identification Numbers I C Transaction ID No. 421155 Site ID No. 197148 SITE: Please refer to both identification numbers, Site ID: 197148, Aaron & Spring Doomick above, in all correspondence with the agency, St. Croix County, Town of Glenwood SETA, SWIA, S28, T30N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 756174 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A septic tank filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. BENNIE W HELGESON Page 2 8/29/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 08/08/2000 a 94.e FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:15 AM to 4:00 PM jswim@commerce.state.wi.us WiSMART'code: 7633 I Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 A www.commercestate.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 29, 2000 CUST ID No.220292 ATTN.• POWTS INSPECTOR ZONING OFFICE BENNIE W HELGESON ST CROIX COUNTY SPIA N7649 HWY 128 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/29/2002 Identification Numbers Transaction ID No. 421155 Site ID No. 197148 SITE• Please refer to both identification numbers, Site ID: 197148, Aaron &Spring Doomick above, in all correspondence with the agency. St. Croix County, Town of Glenwood SEl /4, SWIA, S28, T30N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 756174 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (8.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A septic tank filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Slats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. I BENNIE W HELGESON Page 2 8/29/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 08/08/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:15 AM to 4:00 PM jswim@commerce.state.wi.us WiSMART code: 7633 INDEX SHEET PROPERTY OWNER: AARON & SPRING DOORNICK 2938 130TH AVENUE GLENWOOD CITY WI 54013 PROJECT NAME: AARON & SPRING DOORNICK S• PROJECT LOCATION: SE 1/4, SW1 /4, S 28, T30 N, R, f l Ljttjl ►y i ° rt��' l MUNICIPALITY: TOWNSHIP OF GLENWO00 ., - �j'�F COUNTY: ST CROIX o���si0� aE Ge CONTENTS: GG � R ESP� N SSE Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Cross Section & Specifications of Septic Tank & Pump Chamber Page 5: Pump Specifications Page 6: Mound System Management Plan Name: Bennie Helgeson Signe Address: W 1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: August 3, 2000 1 Cl- Cvvt EleV. 47.73 .iq � A �n c s � t000 L o J 1 l Pro o6ec� Mob� i - lovke, 1V �i i i �w &-O =y0 Cep 0 Lh i1e.,^ ` Page _ Of Synthetic Covering Distribution Pipe Medium Sand - Topsoil _ _ =_ F E y D 3 / b CbN Owr 7 % $IOp Bed Of 2 2 %2 Force Main Plowed Aggregate From Pump Layer 0 dk Ft. E /, C %Z Ft. Cross Section Of A Mound System Using F � Ft. A Bed For The Absorption Area G c ,5 Ft. A l> Ft. H j, 0 Ft. Signed: B ZS Ft. License Number: K Ft. L C( Ft. Date: �;,(�� d � Ft. T_ Ft. Force Main W 5, Ft. L Observation Pipe y B _ K - - - -- i ------------ - - - - -- ---------------------- -------------- - - - - -- j Distribution Bed Of 2 - 2 Pipe Aggregate I Observation Pipe r e c Plan View Of Mound Using A Bed For The Absorption Area I n� _.� h 111 -- �•1 r trrt 17Y n C) 1/Q Ste' ✓1 I C leap, Acc c-ss Porforolnd Pips O nloll End Vlew PC( (0101 C d — / PVC Pipe G' fech e4s L �e4ttor_J s ue' Holes Located on Bottom are Equally Spaced X P �Ir PVC Force Fdoln Fiom Pump PVC Mo nllold Pipe !" PVC C lea" 6 �Oitlrlbullon... PIPO Distribution Pipe L ayout P 37 R S x �! a' Y _ Signed: Hole Diamete Inch License Number: Lateral �_ Inch (es) Date: Manifold a__ Inches Force Main " Inches 19 t��l�s Pe r �a -��►�� 7� l�U lr� �►� ' ►lfxr n;n �nr� nra /Ony ►� 16 PAr.F ;F CHAM'E_R CRO�S �E - 'C' A�JG PEC!F! F IC "c r VEV7 CAP 6 1 L..T.. `�� PIPC T 1 w' CAT HERPROOF I APPROVED LOCA!' ,;G JUIJCTIOiJ BOX MANHOLE COVEn. 2.5 = ROB CCOR. wINCOW OR FRESH 12 "MIU. I AIR INTAKE GRADE I 4" MINI. I `— 18" /'A'l ),j COAJDUIT — _ — _ _ PROVIOE I - - -- IIJLET AIRTIGHT SEAL I I APPROVED JOINT A I I APPROVED JOIN W /C.=. PIPE II I W /C.I. PIPE EXTENDIAIG 3' I I ALARM ONTO 3� ONTO SOLID SO OWTO SOLID SOIL I I ON ELEV. FT. PUMP - -� OFF D COAICRETE BLOCK RISER EXIT PERMITTED O►JLy IF TANK MANIUFACT�LlRER HAS SUCH APPROVAL SEPTIC E SPEC IFICATIOKIS DOS I MANUFACTURER: � t�?c °;�t'v �` t �f'�" z NUMBER OF DOSES: 12 ` _PER DAy TANK SIZE: GALLONS DOSE VOLUME ALARM MANUFACTUR.GR: '� � < Tr <:= �c,.S Pays C; IKICLUDING 6ACKFLOW: j 3 GALLON; � . •� 4 G4 +. MODEL IQUMDER: � � / "� ��' CAPACITIES: A= ��' ILICHES OR ' GALLON: SWITCH TY " 7 PE: 1 4.4 4 , ' �-� I- �oc�` B = -a INCHES OR .�� GALLOAI; -c PUMP MANUFACTURER: ^� �_ (! C = u .., — INCHES OR 5 GALLOU! MODEL NUMBER: r� �� 1� D - I � � INCHES OR 53 ALL0U! SWITCH TYPE' L -x^� �� -� ��Y L_ EL o NOTE: PUMP AND ALARM ARE TO BE MIMIMUM DISCHARGE RATE , / C? GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEELl PUMP OFF ANID OISTRIBUTIO�J PIPE.. S` 33 FEET + MIN IMUM NETWORK SUPPLY PRESSURE /. . . . . . . . . . . � 6'S + FEET OF FORCE MAIN X L. F/ ooFL FRICTIOU FACTOR. - F' /I_ FEET TOTAL OyNAMIr_ HEAD = / � FEET 1 '7 4 INTERNAL DIMEWSIOWS OF TAUK: LEtJGTH ;WIDTH _.— .L-- ;LIQUID DEPTH 91G►`JED: LICENJSE IJUMBER: DATE: 4 Gam.( 7 � rl I la , C Y) tc _ -Fb ( I MODEL: 3871 S ubmersible S IZE: 3/4" SOLIDS RPM: 1550 Effluent Pum p HP: 0.4 METERS FEET 8 25 o .. a 20 5 i z 15 H 3 O H M• 2 5 1 — 0 O p 10 20 30 1 40 50 GPM p 2 4 g g 10 12 M c , CAPACITY GOULDS PUMPS, INC. SENECA FALLS NEW 10W Di48� lY} 4 �l Effective October, INS O 1988 Goulds PUmps, I iC. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRWTED W U SA `d Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s, 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BODS, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. f w sconsin Department of i SOIL AND SITE EVALUATION Division of Safety anti Buiid r gs Page of Bureau of Integrated Serv-:;:es ;: r n it . ILH 09 is m. Code acco , p Attach complete site plan on p �Ies ?s 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizoruai rE-terence point (BM), direction and S C� d percent slope, scale or dimensions, north an c . _,n vocation and distance to nearest Parcel I.D. # APPLICANT INFORMATION - Please print all information. Rev' we b Date Personal information you provide may oe used for secondary purposes (Privacy Law, 1.5,04 (1) (m)). 7 g Property Owner � �(� O P�perty Location _ ct �oX Govtt. Lot 5f 1 /4_5 iJ , 1/4,S T 30 ,N,R (5 E (or6l Property Owner's Mailing Address ii,pt Block# Subd. Name or CSM# I3 n - �4V City AA State Zip Code Phone �' City [I Village L� I own Nearest Road (ertUk Wt Li(dl ('7/S 83I 'e n [9'N Construction Use ;residential , f4 m,t t-ef bectro_oms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow Z /SQ gpd Recommended design loading rate • s bed, gpd /fe / trench, gpd /f1 Absorption area required _ bed, ft — trench, ft Maximum design loading rate S bed, gpd /ft /ft : fo trench, gpd Recommended infiltration surface elevation(s) . 73 B1tjb y - x 0�1 Qe k ft (as referred to site plan benchmark) Additional design/site considerations U • X 6, _?S /3 eo( Parent material /, Flood plain elevation, if applicable "6 � ft S = Suitable for system Conventtiio�naal m ou l M In- Ground Du AT -Grade System in Fill Holding Tank U = Unsuitable for system [:Is LJ U S ❑ U El D U ❑ S E?T) ❑ S 9 [:Is P-tj' SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench J ` r t r VJ t A 1 5 Ground _ O elev. 1°j_ s U S u r tv A Depth to 1C/ © S S c�`1 2 437. t C_ �( limiting factor , zi ), in. Remarks: Boring# 1 6 -6 l0 `1(� 3 6) 5blr L s , — -5/ ryt s r t,� " S Ground c7 y lo R f 0 ' D elev. -3 5 C 3 d - 7• 511P S T �. o ft. 1 Depth to limiting factor 2P- in. Re marks : CST Name (Please Pri �� ignature Telephone No. - Be n -e �e� es ®� 32�� Address ` Date Number PROPERTY OWNER ch Cdti (e�� SOIL DESCRIPTION REPORT Page , of._j% PARCEL I.D.# Horizon Depth Dominant Color Mottles Structure 2 ,Boring Texture Consistence Boundary Roots in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Y I C elev. nd X41— (yl.t� /o'f !� 9113 ft. y Depth to limiting factor 40 in. Remarks: Boring # C �4, . ail- �a Grou elev. nd 3 _y I i A O l • SA /P S Ct1 S vi. r S 91�ft. Depth to — limiting factor 33 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring# Cc.') ivy S L� -F' 3 1 o R z r rb k s U S vKU t Ground eiev. ft. Depth to limiting factor �in. Remarks: Boring � g # Ground elev. ft. ' Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/96) ELL 7 Ca va 7P, *,,- (d � S. enAIi P s o P cba9,- r �E q7. b'8 B,M uQ.p ( o 7 �-op o� �,� pVc Elegy. 97 7 3�ti s P�p �- as \ II S • s� , 7 7 P % Area- Sao i J ti J IJ Ac �1 Wisconsin artfrleni ui O IL AND SITE EV•AL IAT t'ON' Page -___ of Divisior; .-of Satery and Bui:::;;: : Bureau •ar integrated Sen! tccore7arce with S. ILHR 83.0 9, Wis. Adm. Code Attach complete site plan on uapet not less trn .1._ ,2 x 1 1 inches in size. Plan must County include, but not limited to: venical ano noii«u; io -rance point (BM), direction and j d C� ( /� percent slope, scale or dimensions, nosh �1 ( and distance to nearest road. Parcel i.D. n APPLICANT INFOR - Pleas•_ jrirt �IIrlBtloi�: -.- Review by Date Personal information you provioe may ue used lot sea; ,r s (Privacy Law, s, 1.5.04.1) (m)). Property ner - a �' •' Pto rty Location 1 _ Go4tt of 1/45W 1/4,S �� T 30 ,N,R S E (or N �1 11.1 Property Owner's Mailing Address ;' LbF k Block# Subd. Name or GSM# Nearest Road City Stale' Zip Code r Phonp�ry' � ity ❑ Village L� 'own �lc nr��odCl uJt 540 �t'�l� �' en�vG� "N Construction .ise ! �esiu nia; ; fvumbe � rns Addition to existing building ❑ Replacement ❑ Puoli, ; un irnercial - Describe: — Code derived daily flow — C� gpd Recommended design loading rate S bed, gpd /ft trench, gpd /ft Absorption area required �_7S bed, 1`1 trench, ft Maximum design loading rate S' bed, gpd/fl - trench, gpd/ft Recommended infiltration surface elevation(,) - 7 (3 ft (as referred to site plan benchmark) �s' «' Additional design /site considerations K G ___ u /3 / 9� ft Parent material T %� Flood plain elevation, if applicable �J S = Suitable for system s Mound In- Ground Pressure AT Grade System in Fill Holding Tank u = Unsuitable for systern ❑ S `✓ I ❑ U El 93-"u ❑ S 0'0 El P-G E3 S - SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Coi Mottles Texture Structure Consistence Boundary Roots GPD /tt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench l y s l S b 2 5 �l �� tt s .2 — y., --- s 5 Ground 3 _ O - - -- v `7 elev. " — n. `- 3 -��' -� .._ io1R_��dJLo� U -0 S C r C3A AIR S y , Q) i i n -i - 2 d 7, Depth to ; limiting factor -'2 in. Remarks: Boring# 1 6 -6 /0' 3 - hk Ground y R } O elev. ` 5- c 3 7• 5-JA s Depth to limiting factor in. Remarks CST Name Fleas Pr ignature Telephone No. stn t l`lC_ ( �.s0 5) 77P -- - -- CST Number I Adarass pp / SOIL DESCRIPTION REPORT PROPERTY OWNER _v �,a�`T . -- -- Page 01 PARCEL ).C.,7 Horizon Depth Dominant Color Mottles Structure 2 ,Boring Texture Consistence Boundary Roots in. Munsell I Qu. Sz. Cont. Color Gr. Sz. Sh Bed , Trench U-8 oY Ground _3 ' „ — S�� � /✓ ! , elev. ----- -..__— __ /r YN U i A f S ' . sb YntJ 1 r (o Depth to limiting factor 40 in. Remarks: Boring # a Lj t S Ground 3 'y rr py 5-v (t/ S I/tn r — elev. • Depth to — — - -�— limiting ; factor 33 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 # b - � �° ,- (k 3 S <2 Sb�C v- 4 - Cc.v (�3 S :? tM 6 �' µt �� L Ground m , Depth to limiting � fact r in. Remarks: Boring # i Ground elev. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) awn e r'. Su A 4- -� ecine- C n 1p« f d a evxnll�- He Z c S.03 q7, bt8 PQC Elea. 97. 7 3 -7 � SroP pi p-e S l 3 &1 4 tj i s I Sl�owv- 04c / 3C7 7 /�oc, Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According o Chapters IL HR p HR 20& 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa- tion needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking ( ✓) appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: ' ch = � feet EROSION CONTROL PLAN tar LEGEND PROPERTY LINE _ _ EXISTING p ' DRAINAGE TD TEMPORARY DIVERSION I FINISHED - � DRAINAGE V' LIMITS OF GRADING SILT FENCE STRAW BALES GRAVEL O VEGETATION SPECIFICATION 2- �c TREE PRESERVnTION � I j STOCKPILED SOIL t lease indicate north by completing the arrow below. N— PROJECTLU_f', - F1ON ��' t� [�A Tb �BtA wgA BUILDER OWNER WOR'<`_'-HEE `IIAPLETED BY DATE ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer C r6 n I'I,D V , 1 2 k Mailing Address (�1e1�1jj1� , , Ct1; '_:�qvd 3 Property Address (Verification required from Planning Department for new construction City /State Parcel Identification Number LEGAL DESCRIPTION Property Location _ V4, SW `/4, Sec. R) , T -R � � - W, Town of Subdivision , Lot # Certified Survey Map # L-�?Q L/9 / , Volume 1Y , Page # ' J Warranty Deed # v2/ , 3 , Volume . 2-560- , Page # � Spec house O yes M no Lot lines identifiable O yes 0 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system 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 Zoning Office within 30 days of the three year expiration date. A, l 0/ IGNATURE OF APPLICANT DATE 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 Rroperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. ll wt4 �r / Q / a U NATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i I I � i I � I i l6, 'I T I I I I I 1 I I I ; I I I - CJ Q p 1 IJ- �I �s 1 I I I I j - - --*_ -- - - - _ - _ - - _- I �i —�� --- *-- -�- I i !I vv I I I I � I VOL i502 593 6212b3 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD William E. Canfield and Jeane E. Canfield, husband and 04 -14 -2000 10:45 AM wife as survivorship marital property, Conveys and warrants to Aaron J. Doornink and Spring M. Doornink, husband and WARRANTY DEED EXEMPT A wife, holding as survivorship marital property, the following CERT COPY FEE COPY described real estate in St. Croix County, State of TRANSFER FEE: 21.0 Wisconsin: RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address Thomas A. McCormack 1020 10"' Ave. Baldwin, WI 54002 016 - 1060 -20 (Parcel Identification Number) Part of the Southeast Quarter of the Southwest Quarter (SE % of SW %) of Section Twenty - eight (28), Township Thirty (30) North, Range Fifteen (15) West, Town of Glenwood, St. Croix County, Wisconsin, more particularly described as the South 940 feet (S940') of the West 336 feet (W366') of Lot One (1) of Certified Survey Maps filed March 31, 2000, in Volume 14 of Certified Survey Maps, at Page 3821, as Document No. 620491. The retained portion of said Lot One (1) is being added to the parcel shown on the document 1 recorded in Vol. 14 of Certified Survey Maps, Page 3821, as Document No. 620491, i described as: Lot Two (2) of Certified Survey Maps in Volume 14, Page 3821, to create one parcel, and this transaction is thereby exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05(A)(3). Exception to warranties: all easements and restrictions of record. This is homestead property. Dated this /9`"'- day of O�7 , 2000. 'William E. Canfield r Jeane E. Canfield AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY /� Personally came before me this I � , day ofjj 2000, the above named to me known to be the person(s) authant cal.2d this _day of who executed the foregoing instrument and acknywiedge the s e. „ G signature LL signature cr- type or print name type or print name TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wiscon' j (If not, My commission is permanent. (If not, state•'>Eplr aIEC authorized by §706.06, Wis. Stats.) �/�7 - _) THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing in any capacity should be typed or Thomas A. McCormack printed below their signatures. Baldwin, WI 54002 Information professionals Company Fond du Lac, Wisconsin WD4552021 CERTIFIED SURVEY MAP William and Jean Canfield Part of the Southeast 1. of the Southwest 114 of Secttott 28, T. 30 X. R 1S W., ]\[ ?'(mtt ofG1enxooct, St, Croix Count),, W9sc'onsrn. OXAANNC! Age Rrreffl~£p To rHr JOYr/r LIN[a /THf.}w / ". SEE Q ee. SURVEYORS NOTE SHEET? est. as .900 100100"r. W. w, A99vNC O RE OARDINO POND BERM ELEV, L OWNER'S ADDRESS - 1 4 2998 40M AVEN04' WaRrH 1/4 call**'" Ore. of, rJON.Rrl w s4rvw000 cirr ♦ w/540/3 /I7Vp /lawgrNNAK1 SCALE 4V FFEr I ""300 0.:t w w t N 0 w am n � I no ; It 4if1f 4AQ 'Z S POND r S Of 44'30'£ IJf6. 47' 4h p w ���• Wes, NOR rH L/Nl IEUJ - JW F/I •. tic- y 9ll /t -9wr/! >r< /A1• [ w•/r. M ji JrrJACA 1.1NL' ,' • ` LOT e CONTAINS 1, //S,69t 50. Fr. OR ?3.567 AC, h 1`/,090,205 S0. Fr. OR 05.211 AC. E'XCLVO /NG R040 as " 81910' OF WAr1 •� O � " r h trPr/C A 'J 00 00 M' BI .B6' W + SSO.OS PBI utV.asar rR, I u p tiff LOT 2 0 it 8 A CONTAINS 135,940 SO ry y 1 Fr: OR to. 00e AC. A � o /4PO,E/4S0.FT.OR ►�� O M 9.647AC. EXC. R040 " "'tt d F RIGHT OF wAr) Z c. •;I / N � i MI l� �. N M, a S N vnn��vvlr ' J' J "� AMI NrNOVI rOJ g �I a; �•I q i0o •rWCayo 9�Ta�C.K. .. =�/.S'. g °• M 27 ` ♦•� a ,4 r9 0r � ,,^�� �- - !/NOf•�'!9 "W �i IO61.O1 " lMr /t Ll razAr — .92u. QV lOprHMrlrCMNA•R - Jproo•OO "w /160. /s• ;, IOWTH I/I CORNER "' Ire. ". r90 N. R /JW !w CDR. lit. t1, rso m,,* to w r /14N ►9[NWO&M#r#r- [lrN-7Wr/1 NAAWP96W AL4#A0N✓Ar IAM1O AL"IAW& CAP aim A � CONY Aq HLAfENri LEI ,��W�Nllty, o SET / "X 24 "1RON P /PE (Ae N.Wr. /. /3La/L.F.) GOVERNMENT CORNER AS NOTED 276 ( LAUR Ce f � FE" LINE � M VY RPHY O -- - 0R1VEW4r5 1 S �,' l 1713 y /, =• Dated: Sept. 6, 1999 1 �- + � A VfA FALLB•., "Revised this 25th day of Oct. 1 91", �� SJ ••• • 0LIUI t.N rN/S /NSTRI1NEN7 DRAFTED Br JER4L0 4 4AR.40N sW / of P ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer N6-r6 Y, 12Qn r -A Mailing Address A q S�-3 / 3G A 0e n A Property Address (Verification required from Planning Department for new construction City /State Parcel Identification Number LEGAL DESCRIPTION Property Location '/4, SW 1 /4, Sec. R6 T 6 3 R Town of Subdivision , Lot # Certified Survey Map # GAG Ll g / , Volume / , Page # - �3K,;) - , I Warranty Deed # e 'll _ , Volume //, Page # �3 Spec house ❑ yes n no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system 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 Zoning Office within 30 days of the three year expiration date. IGNATURE OF APPLICANT DATE 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. NATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office n deed certified serve ma warranty a copy of the y p if reference is made in the warra A 4A"bn . • 7.y i . l..itJ S I T ) {. b [)eV. g7.73� � aq � A � A 90.l� I s l i00 � t - T �I I J CERTIFIED SURVEY MAP William and Jeans Canfield Parr of the Southeast 1./4 of the .Southwest 114 of Secrion 18, T. 30 N., 9 15 W., N Town of Glenwood, ,St. Croix County, Wzwonsin, #fA^W2 ARC RrlCR£NC£D " rnr JOVfor L fNe W rN£ sw/ 14, SEE SURVEYOR'S NOTE SHEET? sa a ooR�sw,AUrONea R EOAROINO POND BERM ELEV, L OWNER'S AXRESS - 7938 I!0/h AVENt/E NORrN //•f CORNCR• ere. m. rso N.RI! w 64 ENW000 C1rr, W154013 //%0. ttRNIYN a i o 4 o to ao AW loo ow n' j L'h_ ° L/.'__Tf_ �'�'$ POND 119.44'30 'E /5!6.17' � t s p.A �'!• wCOR. NoRrN L/Nf rFN'O•JwI /4 ••NQCAf ,, SF 114 -SWl 14 fF NW- y'IrIA t N V �ji ` t' JtMACA' 41NF LQT l a A � CONUINS I, //3,691 S0. Fr. OR 15.567 AC. bf h h t /,098,205 SO, fr.OR 9$_?// AC. EXCLVOING ROAD , j R /GM I T Of WAr ; J sr�r/e AREA S 0 00'00 "Ir � a tal ✓. dsll . � L `� ti LOT 2 - c �I 8 1 CONTA 435,940 $0. W I o y fr.OR 10.008 AC. A "i) a� I 1489, 214 $0, F7, OR . a 9.647 AC. fXC. Roo w 't Rl6N r Of WAY) Z O `ti °A N' 4 � r� -- Nerar•ta "w R loti.ot• -- � sI/.ot• _ sro.Ot ' �t� tt/�rie _ - - -f $Sol tOt/riYRe'lrCCRNFR � `� -- I eG'PO w tte0. /6• •� w t0Y/7N III CORNER "' Ire. ti. r70N.R /tw SW COR. ter. N, riaN, R to w f RFRN rSlM 400N"AWP- te" - swl e4 1,/ ac /89" ?TAW ALVA0AVAF FA/Yr0 AL OM/AWN CAI 90410 A/ONYNCNr� LEGEND 0 SET 1 ".Y 24 'IRON PIPE (MIN. Wr. I.1J Ltt. /L.f) r ' 4 10 COVERN&ENr CORNER AS NOrEO LAUR Ce * +� PEACE LINE W 1R P3HY +Y - -- ORIVEw4rS = ..Aft ICAIIB I • Dated, Sept. 6, 1999 � � , ., Wt "Revised this 25th day of Out. 1 9. "�j • "' a� ;AND ° ° �° rw$ MISTRUNENrORAfreD BY /ER4LO L L ARSAN SHEET t OF February 27, 2000 St. Croix County Zoning Department 1101 Carmichael Road Hudson, WI 54016 Dear Sir or Madam, This letter is in regard to our conversation in December concerning our property in the Township of Glenwood. The house is being lived in but the mobile home is not. We have moved out of it, therefor the field driveway is no longer used as a residential driveway. As soon as the lot division is signed, the sanitary permit can be granted and the mound system completed. Then we can drill the well, get electricity and establish a residence on lot 1. As soon as our son and his family move from the house to lot 1, the house will be empty. We will begin remodeling it for our own use. The mobile home will be moved as soon as the ground is solid. We have enclosed an erosion control plan for lot 1. Thank you. Sincerely, William E. Canfield 2938 130th Ave. Glenwood City, WI 54013 PS- We are sharing the address with our son on lot 2 since that will eventually be our permanent address. We are currently residing at 2524 10th Ave., Woodville, WI 54028 , Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20& 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa- tion needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting i this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking (✓) appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after gradin . Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. ND s'CA� ,� V Site Diagram Scale 1 inch = feet l ©0r� gL EROSION CONTROL PLAN z ° LEGEND PROPERTY LINE A `+` _ — EXISTING DRAINAGE ,/c —+ TD TEMPORARY ,C I G DIVERSION p QL FINISHED DRAINAGE - / N GR ✓ _ _ LIMITS OF b SE GRADING L a _ SILT FENCE STRAW p j BALES ( D Q �" ±:= GRAVEL S p O VEGETATION SPECIFICATION TREE 1 14 � PRESERVATION '7�� STOCKPILED 0 SOIL S U �- Please indicate north by completing the arrow below. —N— PROJECT LOCATION secRON 2„g 7ouyN of 4�1_9A/kl000 BUILDER OWNER 11 W WORKSHEET COMPLETED BY WILL 4:�7 ���f/ 'LI DATE ��� a F ?�U0 EROSION CONTROL PLAN CHECKLIST `�a - Check (v') appropriate boxes below, and complete the site diagram with necessary information. 4 Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ X Location of storm sewer inlets. Location of existing and proposed buildings and paved areas. The disturbed area on the lot. ,i Approximate gradient and direction of slopes before grading operations. Approximate gradient and direction of slopes after final grading operations. ❑ j Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices ❑ Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. ' Location of access drive(s). Note: Access drive should have 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 (whichever is less). ❑ Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre- vent eroded soil from leaving the site. ❑ Location 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. ❑ 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. ❑ -X 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 (streams with year -round flow.) ❑ Location of other planned practices not already noted. ♦ 'v j c� Indicate management strategy by checking ( ✓) the appropriate box: - c��a r ., I� Management Strategies j ❑ Temporary stabilization of disturbed areas. Note: 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. Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment). Indicate re- vegetation method: Seed` Sod ❑ Other ❑ Expected date of permanent re- vegetation: 4 5 3 0 v W A S /" uNP /-s flwwlsli z D Re- vegetation responsibility of: Builder ❑ Owner /Buyer Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? YesX No ❑ ❑ [ Use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. ❑ �X\ Trapping sediment during dewatering operations. Note: Sediment -laden discharge water from pumping operations should 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 off -site by wind or water. 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. • Access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to 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. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266 -3558. Erosion Control for Home Builders (GWO001) can be ordered through Cooperative Extension Publications, 608/262 -3346 or the Department of Commerce, 608/267-4405.