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HomeMy WebLinkAbout026-1126-03-000 Wisconsin Department of Commerce ~4 ri ` 1~ PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Lpj tN Sanitary Permit No: Qom, INSPECTION REPORT 572871 GENERAL INFORMATION /0% (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: Burke, Michael & Patricia Richmond, Town of 026-1126-03-000 CST BM Elev: Insp. BM Elev: BM Description: N96r G/~E /.l S. E aR.WW Section/rown/Range/Map No: !f DESTQ 0 y61J !oo • ov PRoP St at/ /ryG1I of GoT 12.30.18.764 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark w1C5ER- 10a1~ NEVJ 81VL- S yY losyy <oo.oo Dosing Alt. BM Aeration Bldg. Sewer 7. ~z 97 Holding St/Ht Inlet $ ZS q,, r4 TANK SETBACK INFORMATION St/Ht Outlet g$ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet AIM Septic t .0 916 ' i Dt Bottom yS , > K Dosing Header/Man. 90 Aeration Dist. Pipe Holding Bot. System 9. 3 J Z 8 047 Final Grade 7j.5L ~0% 9-2 PUMP/SIPHON INFORMATION Manufacturer Demand St Cover 2 ~pZ $Z GPM OvEQ O Wits r Model Number TDH Lift Friction Loss System Head T DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7~ 90 ' J Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: / INFORMATION CHAMBER OR EZ Flow Type Of System: % ' UNIT Model Number: e Z FGa &j j omV. (o' -T `lS y 7S > 7S DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length D Dia Length Dia Spacing /W' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 'f' (c)r Bed/Trench Edges Topsoil ® Yes 06 No =Ur COM MENTS: (Include code discrepencies, persons present, etc.) Inspection #1: S' / /i Inspection #2: / / Location: 1665 Waters Edge Drive New Richmond, WI 54017 (SW 1/4 NW 1/4 12 T30N R1 8W) Water's Edge Lot 3 Parcel No: 12.30.18.764 1.) Alt BM Description tEILS CYCL 175 ~X AUAY l?G?TX oi' 47V 2.) Bldg sewer length =15 Prater ,2a1~6 s f r ,rps in"A4i Lb"C* s ~ ,4 - amount of cover = :ef ` ,v1: fEL77oatl, 3 CF $b/L -662 ~ N dal. 504E 6-AS A %77U f tgAeSw SAvP WITI~ Aft-64 ZSX 6k~'~i SANS ~ ~y G /Ln1J }(kT t.JE>QE GQ Elt7' Nb 5~/rMr /~roDE2fiw $ST " /P1 9LA L . 5`rXe 47 b..L Plan revision Required? f Yes ®No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) 4 fi C2 II s~s (fg ~ at s ~ pr' -4 LL Iz. 2 AGE sfc, ~ r r~+ l I 01 r < ~ cY -t'4 n1 i Lo cro r u t`r ~ } / 4' A r f i i ~ o., 1 rI r` 6 ~ . 911 Or s I P 6 Z# ~IUVNRONSS LTOtg IM `C[NOI,,HOIa MaX SAING aoaa SXRIVM 599, ~xxng VIOI2 ,1Vd 3 133 OINd asn County Safety and Buildings Division ST. CROIX p F v 201 W. Washington Ave., P.O. Box 7162 Sa ' Permit umber (to b d in by Co.) ' s $ P $ 6014 Madison, WI 53707-7162 f G Unit Appll ri State Transact n N er , L In accordance with , WiS. Adm. Code, submission of this form o e appropriate governmental unit is required ltR~ obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Addr s if different than mailin ress) submitted to the Department of Safety and Professional Servies. Personal information you provide may be used lb65 WATERS EDGE DRIVE for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Information - Please Print All Information NEW RICHMOND WI 54017 Property Owner's Name Parcel 1l MICHAEL & PATRICIA BURKE 026-1126-03-000 Property Owner's Mailing Address Property Location t + 1548 A GUNSTON DRIVE Govt. Lot 3 City, State Zip Code Phone Number SW Y<, NW '/a, section 12 NEW RICHMOND, WI 54017 N/A (circle one) T 30 N; R 18 E or W II. Type of Building (check all that apply) Lot Subdivision Name i_ ® 1 or 2 Family Dwelling - Number of Bedrooms 3 N/A l7 t (✓ILI~ ~j 'I l3 ~ 5}~((-t ~ Vil /lU CS-e Block# WATERS EDGE ❑ Public/Commercial - Describe Use N/A ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of N/A K7 Town of RICHMOND III. Type of Permit: (Check only one box on line A. Complete line B if applicable) New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued B• El Permit Renewal El Permit Revision Before Expiration Plumber Owner IV. stem/Com nent/Device: (Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: i, c Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (s Dispersal Area Proposed (s System El on liz 450 ~ .5 ~ 900 900 ✓ 95.65 ~ VI. Tank Info Capacity in Total N of Manufacturer y Gallons Gallons Units _ U v N New Tanks Existing Tanks o Septic or Holding Tank 1000 0 1000 1 WIESER Dosing Chamber N/A N/A N/A N/A N/A VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number PAUL KOEHLER 225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII. ount /De artment Use Only Permit Fee Date Is;su Issuing Age Sigtt~tgtre PProved ❑ Disapproved $ i L' / L/ El Owner Given Reason for Denial ) ' IX. Con~itio of A~p royal/Reasons for Disapproval A2 [ ~ > 2 Uc e1 lL° 8YST OWg 1. Septic tank, effluent filter and (yt(L.1'~rt 3LU dispersal cell must be serviced / maintained as per management plan provided by plumber. " 2. All setback requirements must be maintained i, y ! C-OL6- 01,r` s for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size od 4,Llt~ - 4 ~ t' (,,J-/ 14,„ C&t; n~ f~ r E j 5) A, OU SBD-6398 (R. 11/11) Dpi 4- B 4 4 C2 v ~ ~ 0 3 M J O U 6(j 1-- 7 ~ -t LL 4 j S S 1~ SL r"~ ~1°-_ r~M Qt) / Ira r~ ~ Q LL, N I ` Cpl Lo % - C v L) a j r j 1*96 - Z# ~ s X2I5NHONdg 001 - T~~ ION~g LT0+75 IM `QNOXROId MaN HAINcr aOQa sual M 9991 axulI ff VIOI-alVd 3 'IRVHOIR i' CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: DERRICK/BURKE Owner's Name: MICHAEL & PATRICIA BURKE Owner's Address: 1665 WATERB EDGE DRIVE, NEW RICHMOND, WI.54017 Legal Description: SW 1/4 NW 1/4 SEC 12 T 30 N R 18 W Township: RICHMOND County: ST. CROIX Subdivision Name: WATERS EDGE Lot Number. Parcel ID Number: 026-1126-03-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: PAUL KOEHLER License Number. 225410 Date: 02/17/15 Phone Number 715-246-2660 Signature Designed pursuant to the in-Ground Soil Absorption Component Manuel for POWTS Version 2.0 S8D-10705-P (N.01/01). Page t t 3 Cl. _ ~ v c CV a a -4 LL SL r`- 4 ~ M v r o x.11 I / SR J t1J + o° Q. LO L - ~ a cal rfit fl j Q /,f 1, 1 l [ d f 9*86 - Z# ?HVNHONag / C S s 0 - T#? UVNHHDMaq e c) LT09 IM `aNONH0I'd MgN anlxa a0aa SdalVM 999T axing FlIORTlVj '3 gaVHOIId SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page-of Project Name: B No. of Cells Per Cell 3 ft Cell Width Total No of 3 b It Cell Length ~fS6 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EEZ1203H-10ft 1203H-5ft 5.0' 25.0 10.0' 50.0 Gravelless Leaching Unit Manufacturer: rot' Gravelless Leaching Unit Model: r:,2 Typical Cross Section Finished Grade f Observation Pipe with approved cap or vent Soil Backfill Geotextile Fabric Infiltrative Surface 12 in ft Limiting Factor in Slotted and Anchored Vent! Observation Pipe with Cap b ! ! ■ ! t ■ . b . b b . b . b / / . b ! b b . • ■ . t . ■ b • ! ■ ■ . ■ ■ t . ■ . • ! b ■ ! . • ■ ■ ! f ! ■ ! ■ ! ! ■ t b . ! ■ Plum berlDesignerSignature: License S/% i Date: W'0D0IM 31U 99tv8-SZc-008 OIOZ 'Nv 03SLA38 0 \ anOd-1SOd =31V0 OIOZ AaVnNtlP 31V009L49 IM 'NOOa N30Idw Ol AMH Sn 9lL£M z ~ W O n3a `dnNdW OLLd W anod-3ad .o-,l=.i a-Ivos 3ws -AS NMdaa 313031 M-000WIM IV) = \ H z W 0l~: W Z ~ w 0 O a o z H 0: Z i-. U W F- 0 ~ J U) N F- O i W W Q <x 6~ V) M O O Cr O o > N M W z 1: 62 U Wr w ~ w o? J O O p y0~ 0O ~Ow 0 O ~0: U LL O p m p~ Z Q Z w O > .Qi U t7 F'J ZJm 00 Q O~ mV z H w °w m ¢ CC wlOm OQ QQU Q W0 N F- a ~O 00 Zo o 0 G Q a 0 MM p mvWi WF-W C9 0 z Z O OK U m E w w U a s o C.'Ww c~ D W ?3, \ zul m o Z 'o > Q LL l7 U' p O> p ° s m Nm J Q lip rn M p`p^i Y O =1 0 w oe O z a- CC < OR O U? -UV OOd.MJ L L, mw aU O W Ej Qo Fa° Q (1) La n o ¢ a U c F 9 d uj p . O N (n }N Q Oo Z Q p J ~ F- ¢ F- 0 - Z~ I-- 2 V z = N 2 in - z 0 O LLI \ N=° N on n 0. LL4 O^O F- a U F 2- Qo LLI H . Coco ~ ( 20 OF- U) V) N ~ QW OOW Q zh WL) pW ~V1 M 3: 3:p= UY ¢ W mF p p0 (ri ..O Y OQO OQW WZ0WU~OI Q~ < Qr00 U C9 V (D YJz Qfw/1 ~2 N0 Q W3m UM= mJ3 I- p Q~Q 0 Z~Q Y WY J 'W>' ~ 0 Z Z S Z J zz H U►Q- U w c9 z Q 0 W X > W ¢ O O W ~ IL. N I ~JO ¢ m W to W QJO w F- 0 O>p .,6£ p W D m 0Nw O aCL w Ix D a~ W CL w I r N / o J\ Sdo ' I w L~ .9C do ( N co l 3 LLJ I a o Q 5 a- ui X I U W svo „4 0 \ O -er It do W. \ / I m 0 F- ww N w J Z_ U < LL- D Z Q „98 l9 m w 0: Q N Y z Q F S f INSTALLATION INSTRUCTIONS .~hszeta PL-525/PL-625 FILTER & Was!Fwa:erFeoCu:is A IFvision of 9aty}ek Yc. PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: r:< a Rated for 10,000 GPD a PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 . PL 625 e Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently a Built in Gas Deflector for several years under normal conditions before .Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every, time the tank is pumped or at least every e Alarm Accessibility three years. If the installed filter contains an optional alarm,. the owner will be notified by an alarm when the .Accepts PVC Extension Handle filter needs servicing. Servicing should. be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Filter Extension Handle Risers & Riser Covers Extend & Lokym Riser Safety Screens Fitter Alarm Panel and Polylok risers bring your Polylok Extend && LokTm Polylok safety screens Switch FilterTM' Control septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nesting digging to find tank installation a snap. impending filter and tank entrance. Fits. 3" and 4" pipe_ servicing. For a full fist of Polylok products please visit our web site at: www.polylok,.corn POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of '2, FILE INFORMATION SYSTEM SPECIFICATIONS Owner ' Pif41C`- A (j e- Septic Tank Capacity 1000 al ❑ NA Permit # / l - Septic Tank Manufacturer WIESER O NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK 0 NA Number of Bedrooms 3 0 NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units )P NA Pump Tank Capacity gal X3 NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer X3 N.A Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer V NA fjto~andard Application Rate . 5 al/day/ft2 Pump Model jP N,N InfluenUEfiNuent Quality Monthly average' Pretreatment Unit E] N,% Fats, Oil & Grease (FOG) 530 mg/L E3 Sand/Gravel Filter ❑ Peat Filter ochemical Oxygen Demand (GODS) 5220 mg/L ® NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: _ Pretreated Effluent Quality Monthly average Dispersal Cell(s) O N4 Biochemical Oxygen Demand (BODS) S30 mg/L 0 in-Ground (gravityl ❑ (n-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L IR NA ❑ At-Grade ❑ Mound fecal Coliform (geornstrio mean) 510' ofu/100ml Q Delp-Line ❑ Other: Maximum Effluent Particle Size Y in dia. ILl NA Other: ❑ NA7 Other: ❑ NA . Other_ ❑ NA *Values typical for domestic wastewater and septic tank effluent, Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (MaxmMUM 3 years) Nit 3 IM year(sl Pump out contents of tank(s) When combined sludge and scum equals one-third (YI of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 to year(s) Clean effluent filter At least once every: O month(s) ❑ Nit 1 )0 year(s) Inspect pump, pump controls & alarm At least once every. ❑ month(s) @ W, ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) KI W, ❑ .ear(s) Other: At least once every: ❑ month(s) ❑ NAB O year(s) Other: ❑NA, 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. Tank 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 ponding of effluent on the ground' surfacs, The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending 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, mechanical or pressurized components, pretreatment 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. WJ V, Page 2 of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contec 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 I discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori r power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the ar( li within 15 feet down slope of any mound or at-grade soil absorption area. Reduotion or.elimination of the following from the wastewater stream may improve the performance and prolong the life of th POW'TS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; disinfectants; ti, foundation drain (sump pump) water, fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; al 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 ti properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative. Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings scaled. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. a 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 replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkin 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 fines; and wells. Failure to protect the replacement area %ill 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. f y]l N/~rj~1 al a. ' fat e i >QOKIBTTL~A fbR-Alt%✓ a&ISTR(lGT11 0r/ ~k ❑ Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the. infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T 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 13E DIFF4CUI,T OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS (NSTAU ER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATING INC PAUL KOEHLER 1:9715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHOfM Name POWERS LIQUID WASTE MANAGEMENT Name S'T`S C49 ( ?4DDAf i A i Phone il5--246-5738 Phone '7/S- 3W'= & Q This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(11. (21 & (3), visconsin Administrative Code. ST. CROIK COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer mi c-+ A,t-40 c.~ t t~ tic Mailing Address (,.-4,4 t-i Da- , [2-14-4-3 mat LD G40 i-I Property Address_ \4~'> Ac-~ D rt.-'. 0F, ~Y (Verification required from Planning & Zoning Department f6rnbw construction.) City/State V` V 44 f~~ w( parcel Identification Number Sca - I I-(IC - 03 --<313Q LEGAL DESCRIPTION Property Location 5V,/ '/a , t4W %a , Sec. I L , T N R ~ ~5 W, Town of ~1 ~U ✓~l© Subdivision Lot # . Certified Survey Map Volume Page # Warranty Deed Volume , Page # Spec house yes no Lot lines identifiable yes p no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, 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 ieptic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this fa are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty/deed recorded in Register of Deeds Office. Number of bedrooms l A / 1 SIGNATURE '617 APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) 111111 IIIII IIIII 11111 IIIII IIIII IIII 111111 IIII IIII * 8 7 7 3 1 4 1 ncumant Number WARRANTY DFFD 877314 THIS DEED made between Brushy Mound Partners, LLP, a KATHLEEN H. WALSH Wisconsin Limited Liability Partnership ("Grantor") and Michael J. Burke REGISTER OF DEEDS and Patricia L. Burke, husband and wife, as survivorship marital property ST. CROIX CO . , WI ("Grantee"), RECEIVED FOR RECORD WITNESSETH, that the said Grantor, for valuable consideration 06/24/2008 10:45AM conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: WARRANTY DEED EXEMPT # REC FEE: _.11.00 Lot Three (3), Plat of Waters Edge in the Township of Richmond, St. Recording Area TRANS W-L.-~0 Croix County, Wisconsin. Name and Return Address PAGES : 1 Brushy Mound Partners r~ PO Box 445 New Richmond, WI 54017 026-1126-03-000 (Parcel Identification Number) This is not homestead property. The seller, Brushy Mound Partners, LLP, agrees to sell this lot to buyers on the condition that Derrick Homes, LLC will be the builder of the home to be constructed on this lot. Dated this Oft day of June, 20QE. *erri MENT AUTHENTICATION Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 20th day of June, 20083, the authenticated this _ day of , 20_ above named Michael R. Stevens and Ronald L. Derrick, as partners of Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership to me known to be the persons signature cuted the fo of instrument and acknowledge the same. type or print name PAMELA J. UTLEDQE Haft" TITLE: MEMBER STATE BAR OF WISCONSIN nature (If not, type or print name ela e ~ of authorized by' 706.06, Wis. Stats.) Notary Public St. Croix County, Wisconsin. My Commission Expires: I 27th, 2008. THIS INSTRUMENT WAS DRAFTED BY Brushy Mound Partners 'Names of persons signing in any capacity should be typed or PO Box 445 printed below their signatures. New Richmond, WI 54017 State of Wisconsin Scott Walker, Governor DEPARTMENT OF NATURAL RESOURCES Cathy Stepp, Secretary 1300 W Clairemont Ave Telephone 608-266-2621 WISCONSIN Eau Claire, WI 63702 FAX 608-267-3679 DEPLOFNATURALRESOURCES TTY Access via relay - 711 January 12, 2015 Kevin Grabau St. Croix County Zoning Administrator 1101 Carmichael Rd Hudson, WI 54016 Subject: Brushy Mound Lake, Town of Richmond, St. Croix County - Floodplain Analysis Approval, Dear Mr. Grabau, The Department of Natural Resources has reviewed the floodplain analysis submitted by Matt Hieb, P.E. of Auth Consulting & Associates, for Brushy Mound Lake located in Section 12, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin. The hydrologic and hydraulic analysis regarding the Regional Flood Elevation for Brushy Mound Lake was submitted to the Department on January 6, 2015. The Department will consider the assumptions . applied in the analysis sufficient, therefore approving the study as complying with State Administrative Code NR 116 technical standards for application of St. Croix County's Floodplain Zoning Ordinance. The analysis determined the Regional Flood Elevation for Brushy Mound Lake to be 977.3' using NAVD 88 as the datum. If you have any questions or concerns about this approval, please feel free to contact me at Michael.RogneyQwisconsin.gov or 715-839-3735. Sincerely, G~Y~ CJ Michael Rogney Water Management Engineer Eau Claire Service Center Cc: Matt Hieb, P.E. - Auth Consulting & Associates d nr.wi.gov wisconsin.gov Naturally WISCONSIN Z n4~ lV1 JA J i 3 N 1 / r ~ 1M 4M \ 0 ~ ~ I t 3 w~ a~~-sue. . x~ 10/10/20 PM Parcel 026-1126-03-000 P PAGE E I OF 1 Alt. Parcel M 12.30.18.764 026 - TOWN OF RICHMOND ST. CROIX COUNTY, WISCONSIN Current ❑X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - BURKE, MICHAEL J & PATRICIA L MICHAEL J & PATRICIA L BURKE 1209 CTY RD C NEW RICHMOND WI 54017 Property Address(es): * = Primary * 1665 WATERS EDGE DR Districts: SC = School SP = Special Type Dist # Description SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST Notes: SP 1700 WITC Legal Description: Acres: 2.240 SEC 12 T30N R1 8W PT SW SE & SE NW WATERS EDGE LOT 3 2.240AC Parcel History: Date Doc # Vol/Page Type 06/24/2008 877314 WD 09/29/2000 630775 8/13 PLAT Plat: * = Primary Tract: (S-T-R 40'% 160% GQ Block/Condo Bldg: * 08-013-WATERS EDGE LOTS 1/49 2000 12-30N-18W SW SE LOT 03 2014 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/27/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.240 60,200 0 60,200 NO I Totals for 2014: General Property 2.240 60,200 0 60,200 Woodland 0.000 0 0 Totals for 2013: General Property 2.240 60,200 0 60,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PROPERTYOWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT -Page 2'. of 3 PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-10 10 r 3/3 none 1 2msbk mfr gw 2f .5 .6 b- 2 10-22 10 r 4/4 none sl 2msbk mfr gw if .5 .6 .5~ Ground 3 22-38 7.5 r 4/4 none sl 2msbk mfr w if .5 .6 •S- 99e1ev5 ft 4 38-65 7.5 r 4/4 none is os mvfr na .7 .8 Depth to 5 65-80 5 r 4 4 none sl 2msbk mfr 9w na .5 .6 .S^ limiting factor 6 80-96 7.5 r 4/4 none cos os ml na na .7' .8 , +96" Remarks: Boring # 1 0-9 10 r 3/3 none 1 2msbk mfr 9w 2f .5 .6 .S 2 9-30 7.5 r 4/4 none sici 2msbk mvfr if .4 .5 { Ground 3 30-84 7.5 r 4/4 none is os mvfr na na .7 .8 elev. 99,65 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-16 10 r 3/3 none 1 2msbk mfr gw 2f .5 .6 S 5 2 16-30 7.5 r 4/4 none sici 2msbk mfr if .4 .5 ,Y Ground 3 30-84 7.5 r 4/6 none ms os mvfr na na .7 .8 7- elev. 98.65t. Depth to limiting 36 factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: L SBD-8330(8.05/92) Wiscon. Dagartment of Industry, SOIL AND SITE E V A L U AT 6N R EtR Page 1 of 3 Labo`rf nd Hwiman Relations ' Ksion of S9fety 8 Buildings in accord with ILHR 83.05 Wis.`AdmjPod NTY ~E1~:~, Six Attach'complete site plan on paper not less than 8 1/2 x 11 inches in size ft~ must Priclude, but not limited to vertical and horizontal reference point (BM), direction and oflope, scale cf 3 X60 P 4L dimensioned, north arrow, and location and distance to nearest road. o ~1. gS Oix 1 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIO , ,po iGE r/ WDAB 0 PROPERTY OWNER: OCATION Derrick Const. Inc. GO T 1 4` 1/4,S 12 T 30 ,N,R 18 lg(or) W PROPERTY OWNERS MAILING ADDRESS LOT # UBD. NAME OR CSM # ~~R S 1505 Hy. #65 3 na a CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [3$OWN NEAREST ROAD New Richmond WI. 54017 (71$ 246-2320 Richmond 140th. St. [Iq New Construction Use [x ] Residential ! Number of bedrooms 4 [ ] Addition to existing building I ] Replacement [ I Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _9 ed, gpd/ft2_trench, gpd/ft2 Absorption area required 1200 bed, ft2 100 roriph, ft2 Maximum design loading rate__. 5_bed, gpd/ft2_,E_trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.65 It (as referred to site plan benchmark) Additional design / site considerations Parent material outwash Flood plain elevation, if applicable na It i S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S 1:1 U ®S ❑ U I] S ❑ U ®S ❑ U ❑ S ®U ❑ S a U SOIL DESCRIPTION REPORT N4,, uk. oza Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots B P DTft2 Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. S 1 0-7 10 r 3/3 none 1 2msbk mfr 2f .5 .6 1 2 17-32 7.5 r 4/4 none S1 2msbk MVfr gw if -9 .6 'S Ground 3 132-80 7.5 r 4/4 none ms OS Q mvfr na .7 .8 - elev. 99.35 ft. 4 80-84 5 r 4/4 none 2 . S Depth to limiting factor or.{ eS +84" Remarks: Boring # 1 10-8 10 r 3/3 none 1 2msbk Mfr 5 2 18-23 10 r 4/4 none sicl 2msbk mfr w if .4 .5 Ground 3 123-60 7.5 r 4/4 none is os mvfr if .7 - .8 ~I elev. 4 160-75- 99.45 ft. Depth to 5 75-96 7.5 r 4/4 none cos os ml na na .7 .8 } tr limiting S p S S fa+t96 I / Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200 ve. New Richmoqd, WI 54017 Date: 5-30-2000 CST Number: m02298 Signature: / PROPERTYOWNER Derrick Const In SOIL DESCRIPTION REPORT Page 2 . of 3 PARCEL I.D. # pending a Depth Dominant Color Mottles Texture GPD/ft Boring # Horizon Structure ConsisUence 1Bouncl3y Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tiendi • L: 1 0-10 10 r 3/3 none 1 2msbk mfr `'.....3.;`'.' 2f .5 .6 b' 2 10-22 10 r 4/4 non e sl 2msbk mfr 9w if .5 .6 .5~ Ground 3 22-38 7.5 r 4/4 none sl 2msbk mfr w if .5 .6 S' 1gelg5 ft 4 8-65 7.5 r 4/4 none is os mvfr na .7 .8 Depth to 5 65-80 5 r 4/4 none sl 2msbk mfr limiting na .5 .6 S~ facto r 6 80-96 7.5 r 4/4 none cos os ml na na .7` .8 +9611 - Remarks: Boring # 0-9 10 r 3/3 none 1 mfr 2msbk yw 2f . 5 .6 . S r; 4 2 9-30 7.5 r 4 4 none sicl 2msbk mvfr if .4: .5 Ground 3 30-84 7.5 r 4/4 none is os mvfr na na .7 .8 elev. I9,. 65 ft• Depth to limiting ~g factor +841, Remarks: Boring # 1 0-16 10 r 3/3 none 1 2msbk mfr 2f . 5 .6 5 h>. 2 16-30 7.5 r 4/4 none sicl 2msbk mfr if .4 .5 Y Ground 3 30-84 7.5 r 4 6 none ms os mvfr na na .7' .8 elev. 98.65t. Depth to limiting factor 36 Remarks: Boring # 1`6 Ground elev. ft. Depth to limiting factor Remarks: BD-8330(8.05/92) r ~ r r' , STEELS SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SE4NW4 S12-T30N-R18W New Richmond, WI 54017 MRRSW-3254 town of Richmond (715) 246-6200 lot #3-Brushy Mound LaKE evaluation was conducted to..satisf a zoning requirement, it may or may This soil wa y y not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. 1 11 =401 - (N.=top of 1" pvc pipe @ el. 100.00' . top of 1" pvcpipe C el. 98.15' I~lo N 8.1 46 355 Gary L. Steel 5-30-2000 • _ _ r_:.::,_. _ SQ. FT. 1.31 ACRES 9 4 30 83,874 SQ. FT. 1.93 ACRES 31 71,893 SQ. FT. 1.65 ACRES 32 69,124 SQ. FT. 1.59 ACRES 992.4 B-x1 33 95,365 SQ. FT. 2.19 ACRES 34 78,680 SQ. FT. 1.81 ACRES 4 FUWRE 10- RO10 35 43,693 SQ. FT. 1.00 ACRES TM SZRF~T 36 52,451 SQ. FT. 1.20 ACRES 37 46;092 SQ. FT. 1.06 ACRES R= 3p+ 38 46,940 SQ. FT. 1.08 ACRES 39 43,560 SQ. FT. 1.00 ACRES 40 44,483 SQ. FT. 1.02 ACRES 997.8 41 43,560 SQ. FT. 1.00 ACRES 99R-311 6 6 9 42. 45,962 SQ. FT. 1.06 ACRES 3 B- I o 99.. ( POINT 43 45,081 SQ. FT. 1.03 ACRES 902~ T X 95.0 44 68,413 SQ. FT. 1.57 ACRES 102-227 S T. -4 ® 45 58,984 SQ. FT. 1.35 ACRES O 2.~ C ES _ 46 44,474 SQ. FT. 1.02 ACRES 977 O ® 3 47 93,779 SQ. FT. 2.15 ACRES 9k48 -2 48 96,187 SQ. FT. 2.21 ACRES X -1 49 88,035 SQ. FT. 2.02 ACRES / 996.3 ? /9 99 . / X / x / 9963 LOT 2 991. / 4343 SQ. FT. / 2.17 ACRES 993.5 B-2* X B-1 ( 992.7 B-4 B~3 0 -mater Elev. B-5 7_6.5 4/19/96 LO OF RAINAGE EASEMENT OHUVM SET x 97 02 SQ.FT. 3 28/00 .23 ACRES _2 991.3 YEAR H- B-4 BW c o o/ 0/ D-/ B-5 /h 2 B-3 v ^Yd -R~'RQ~ Page Wiscon)w Department of Industry, _ 1 of 3 SOIL AND SITE EVALUA (a Lawkr/nd Hyman Relations ' i +ision of Safety & Buildings in accord with ILHR 83.05/VVIs; Adm;~odg NTY St 11 inches in size ft must I cl ude, but Lt.D, # Attach complete site paper . Croix not less than 81/2 x 'te pl an on no ~ ~~t0 not limited to vertical and horizontal reference point (BM), direction and of, ope, sole O dimensioned, north arrow, and location and distance to nearest road. . ~1_. S1 GKa~ ' 1 WED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIO +,OS ~FF~GE Eg p PROPERTY OWNER: O' 41 Const. Inc. GO 1/43 2 T 3 N,R IK(or) W Derrick PROPERTY OWNER':S MAILING ADDRESS LOT # . NAME OR CSM # S 1505 H . #65 a fx6- CITY, STATE ZIP CODE PHONE NUMBER OCITY (]VLAGE OWN i NEAREST ROAD New Richmond WI. 54017 (71S 246-2320 Richmond [x[ New Construction Use (x J Residential / Number of bedrooms 4 Addition to existing building j ) Replacement [ J Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate --5-bed, gpd/ft2_6__trench, gpd/ft2 Absorption area required 1200 bed, ft2 1000 trench, ft2 Maximum design loading rate ~5 -bed, 9Idm2_&_trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.65 It (as referred to site plan benchmark) Additional design / site considerations Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for s stem ®S O U ®S O U ®S O U 10 ❑ U ❑ S ®U 0S C RU SOIL DESCRIPTION REPORT N&w CjA_A t6 --t. Depth Dominant Color Mottles Texture Structure Consistence Bourt~ry Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertdt J- , 1 0-7 10 r 3/3 none 1 Zmsbk mfr 2 .5 1 2 7-32 7.5 r 4 • S Ground 3 32-80 7.5 r 4/4 none ms os mvfr na .7 .8 elev. S 99~.Uto 35ft. 4 80-84 5 r 4 4 no q'S 'S 73' l A Y limiting factor ovf- J +84++ Remarks: Boring # 2 bk mfr aw .5i .6- n'lz1 0-8 10 r 3/3 none 1 2 2 if .4 . 8-23 10 r 4/4 none sicl 2msbk mfr qjp. j 3 23-60 7.5 r 4/4 none is os mvfr 1f •71 .8 elev. 4 ' S 60- 99.45 5 75-96 7.5 r 4/4 none cos os ml na na '7 .8 3 Depth to limiting S S fa 96++ Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200 ire. New Richmo WI 54017 Signature: / Date: 5-30-2000 CST Number: m02298 PROPERTY OWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT .Page? Hof 3 PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Cortsisbence Baaxfary RootsGPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& 1 0-10 10 r 3/3 none 1 2msbk mfr 9w 2f .5 .6 y- x. 2 10-22 10 r 4/4 none sl 2msbk mfr if .5 .6 .5^ Ground 3 22-38 7.5 r 4/4 none sl 2msbk mfr w if .5 .6 S1 9965 38-65 7.5yr 4/4 none is os mvfr cfw na .7 .8 Wtoth 5 65-80 5 r 4/4 none s1 2msbk mfr na .5 .6 .S limiting factor 6 80-96 7.5 r 4/4 none cos os mi na na .7':. .8 +96" e6 Remarks: Boring # Mw 1 0-9 10 r 3/3 none 1 2msbk mfr 9w 2f .5 .6 .S' 4 2 9-30 7.5 r 4/4 none sici 2msbk mvfr if .4 .5 Ground 3 30-84 7.5 r 4/4 none is os mvfr na na .7 .8 99 65 ft. • , th to limiting ~g factor +84" I Remarks: Boring # ?ti 1 0-16 10 r 3/3 none 1 2msbk mfr 2f .5 .6 . S Y 2 16-30 7.5 r 4/4 none sicl 2msbk mfr if .4` .5 3 130-84 7.5 r 4/6 none ms os mvfr na na .7 .8 Ground elev. 98.6 P to i7- factorg +84, Remarks: Boring # x tam . Ground elev. ft. Depth to limiting factor Remarks: SRD-e330(R.05/92) Aff . • I . 1505 HIGHWAY 65 P.O. BOX 445 • NEW RICHMOND, WI 54017 PH. 715-246-2320 FAX 715-246-4948 DATE JOB NO. ATTENTION PAr/\ TO RE: cvov"xq zc X110 ~ . 'K $JOE: RltlsIvln~ WE ARE SENDING YOU ATTACHED UNDER SEPARATE COVER VIA THE FOLLOWING ITEMS: SHOP DRAWINGS PRINTS COPY OF LETTER SAMPLES SPECIFICATIONS CHANGE ORDER O PLANS COPIES DATE NO. DESCRIPTION 3 ~v►J -off 1~~~~ ~~CD REASON FOR TRANSMITTAL CHECKED BELOW: 0 FOR APPROVAL 0 APPROVED AS SUBMITTED 0 RESUBMIT COPIES FOR APPROVAL 0 FOR YOUR USE Q RETURNED FOR CORRECTIONS SUBMIT COPIES FOR DISTRIBUTION 0 AS REQUESTED FOR REVIEW AND COMMENT RETURN CORRECTED PRINTS 0 APPROVED AS NOTED 0 Q FOR BIDS DUE PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: PLEASE NOTIFY US AT ONCE IF ENCLOSURES A E OT AS NOTED. NTy LAND USE PERMIT FileM ST. CRO "?~t Only APPLICATION OfficeU Revised 022-2014 -2014 PropertJTD~rner: co t K Contractor/Agent: L'" z9( (.e Mailingd~gsk. 1N Mailing Address: - '~DX 'j IoM OyJ r2 LAyADwD i U-)\ F_IW`MU*JU~ Wt. S41bl'7 Daytime Phone: (St2 ) -70\ - `721'6 Daytime Phone: Cell: Cell: ) E-mail: E-mail: csmf 1~ GVL-i", Cdr., Site Address: ID(os Property Location: 5) 1/4, KJW 1/4, Sec. r 2 , T. 3t> N., R. W., Town of ~IYJ~ Computer - - - Parcel m ~2 ~iD 1 12 p3 0C>0 Zoning District (Check one): D AG. D AG. II D AG. RES. IR RESIDENTIAL D COMMERCIAL D INDUSTRIAL Overlay District (Check all that apply): D SHORELAND D RIVERWAY D FLOODPLAIN D ADULT ENTERTAINMENT Type of Land Use Permit Request (Check one): D Lower St. Croix Riverway District $350 D Wireless Communication Tower (Co-location) $350 Il Shoreland $350 D Temporary Occupancy $350 D Signage $350 D Nonmetallic Mining Operation $550 D Floodplain $350 D Animal Waste Storage Facility $1,000 D Grading & Filling, 12-24.9% Slopes $350 D Livestock Facility $1,000 D Other: D Permit processed in conjunction with a Land Division, Special Exception or Variance $50 State the nature of your request: L~~~ l P~Q,r n IT +oAZ 06-~ 90„~ Zoning Ordinance Reference I attest that the informatio contained in this appllc 'a true and correct to the best of my know1 edgf W Property Owner Signature: Date 9 6 Contractor/Agent Signature: Date ('D G - `A Complete Application Accepted: By: Fee Received: $ Receipt 715-386-4680 St. Croix County Government Center cdd@co.saint-croix.wi.us 715-386-4686 Fax 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.us/cdd APPLICATION: Applications will not be accepted until the applicant has: • Met with the Zoning Administrator to review the application; • Submitted Original plus 2 conies of the entire Racket including all supporting information, maps & diagrams; • Resolved any land use violations and paid any outstanding fees owed to the Community Development Department; • Signed the application form (the signatures of the property owners and agents acting on their behalf are required); and • Submitted the appropriate application fee (nonrefundable) payable to: St. Croix Countv. REVIEW: The Zoning Administrator will review the application for completeness and assign a file number to the application. The Zoning Administrator may require additional information and will notify the applicant of this within 10 days. Upon receiving a complete application and supporting documents, the Zoning Administrator will: • send copies of the applications to the appropriate reviewing agencies for comment. Applicants are encouraged to contact their town to discuss their application and inquire about necessary building permits and approvals at the town level; • schedule a site visit to the applicant's property, at which time the applicant shall flag all applicable property/project corners and label the flags accordingly; and • review the file and prepare findings for approval or denial of the permit within 60 days. Upon approval, the permit will be mailed to the applicant or to the applicant's agent. If approved, the land use permit will be valid for one year from the date of the permit issuance. The applicant may also be required to apply through the Town for a local building permit. All site plans, pictures, and other materials submitted with the application become the property of the Community Development Department and will remain in the file. ❑ Completed and signed application form with fee. ❑ Original plus 2 conies needed of the entire packet including All supporting information, maps & diagrams. ❑ A general written statement that specifically explains the request. ❑ A statement indicating whether or not a private water or sanitary system is to be installed. ❑ Recorded Warranty Deed (may be obtained at the Register of Deed's office). ❑ A complete site plan showing: • project location in the town; • lot/parcel dimensions with total lot area, property lines, and all applicable setbacks; • location of existing access roads, right-of-way, road setbacks, and recorded easements; • location of all existing and proposed structures with their square footage and distance from setbacks, • location of existing and proposed POWTS ,wells, driveways, parking areas, access, signs, and other features; • location of slopes 12% and greater (minimum contours to be determined by the Zoning Administrator); • all blufflines and slope preservation zones (Riverway) and setbacks from blufflines; • location of the OHWM of any abutting navigable waterways and all setbacks from the OHWM; • location and landward limit of all wetlands, specifications and dimensions for areas of ro osed wetland alteration; 0 on, existing and proposed topographic and drainage features and vegetative cover; • location of floodplain and floodway limits on the property; and • any other unique limiting conditions of the property or information deemed necessary by the Zoning Administrator. For projects that involve land disturbance requests, the following additional information may be required: ❑ Detailed drawings (scale should not be greater than 1 inch to 200 feet). ❑ Grading plan showing grading limits and pre and post contours. ❑ Project schedule and contractor list. ❑ Erosion control plan (Best Management Practices). ❑ Storm water management plan stamped by an engineer and including all runoff calculations. ❑ Vegetation plan including schedule, seeding rates, and species size, type and location. ❑ Other documents: NOTE: All maps, plans, and engineering data shall be no larger than 11x17. No covers, binders, or envelopes. Staple or paperclip your application in the upper left-hand corner. Page 2 of 2 I IJ 66 4-11 V_ fi _ ► - tai _ . __Pr" _ _ r-r -17 t I i a g •lz~`• m W! _ .Qn 1'J3fOHd PI ' ~ 4a W Q W O V. N SN G~ d Q uY , X81 u _ c L `_.5~ °i of \ 11: L ~ 2 iyV wa. .>tY _pi~ d ill, y 1.4. JJ'y~ \F~ 9-E71~ j 4i ~ ~ ay~1 ~ 11 a ~45=V3~ .l±Zl 7: sr ~ ~ ° 0 o t¢ n Ild-p t ~ MLL]Il>A M.d1Cn /'~llVq ~ al 1 I 1 N ,7 J a 'rs iD c i~ 'G 21 r ~ ~~''+ryn ~ r ~aa Ana I ~ R Pr ~ \a~ 6~~'2 . ~3i 4~ A •g O . A~ .n 4 ~ .A i Ssst•~Ric v+ '.s+ vy `~P "'a~'. s "f V U A 0 L 4 m , 41 J ~nl Z?K3 o~rl s -R a \ M ~ aO sd ~ n y ~ \ J u ~W N VV 9s i All -8z'° \ I 1 Y ~I ~u OT W a.~ e W4 Ma vip AWL t f li w r 190, d F~ous 978 c17 2''`~t f3UI~l ( R6 icy' Arta 'Ib tAP5W r~ r rc, u+ s t, t f3~k ^-y~~qz / a R ~Si-1Y Gov Mrs ~M L 1 Nt 'I T'Ci2~ EDG,~ -I ~SlO - ~,(TeO L. DERRICK HOMES, LLC 038419 STCZ 01 ST CROIX COUNTY ZONING Check Date: 10/09/14 Check No.: 038419 INVOICE NO. INVOICE DATE REFERENCE GROSS DISCOUNT NET AMOUNT 100914 10/09/14 BURKE, MIKE & FATTY 350.00 .00 350.00 TOTAL 350.00 .00 350.00 DERRICK FIRSSONWISC NN 79.1825/918 038419 HUDSON, WISCONSIN V HOMES, LLC 1505 HWY. 65, PO SOX 445 Vendor No. Check No. Check Date NEW RICHMOND, W154017 ST C Z01 038419 10/09/14 PH. 715-246-2320 THREE HUNDRED FIFTY DOLLARS AND 0,0 CENTS*********************** r ~ $350.00 Pay ST CROIX COUNTY ZONING h SECURITY FEATURES INCLUDED. DETAILS ON BACK. ~Jt 00384 L911' 1:09 L8 L8 2561: 140 2650li' I