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HomeMy WebLinkAbout038-1062-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CCOIX Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600209 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No Scott Thell TOWN OF STAR PRAIRIE 038-1062-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /G1~ (J Co,~U 'C 15.31.18.271 C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ~yS CAPACITY STATION BS HI FS ELEV. ll.:y 7Z Septic 1'.~+ /QOa Benchmark enscC lJ • ~p a /alb, S2S Alt. BM 6) y -1 . r Aeration Bldg. Sewer 71 C ~5~ Holding SUHt Inlet ~7• ~ ~Q v TANK SETBACK INFORMATION SUHt Outlet 769 7. 8 TANK TO /L WELL BLDG. n! Air Intake ROAD Dt Inlet etA 10 Septic / '94 f 7 Dt Bottom Dosing Header/Man. Aeratio Dist. Pipe 7z8 9~ 74 Holding Bot. System v-28 9'` • S q <c `6a PUMP/SIPHON INFORMATION Final Gra ` Manufacturer Demand St Cover 1 / 77 GPM V75- Model Numb 5 Vir i TDH Lift Friction Loss System He T Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION a CHAMBER OR Type ✓11~te j~Y1A.7~• 43 15 6 ✓ 5-4 UNIT Mod~[Jumbe~ DISTRIBUTION SYSTEM Dedilt- At,A61* L& Header/Manifold/ It Distribution ix Hol ize ole Spacing en it Intake Pipe(s) Length 16 Dia Length Dia ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 4- -L) Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 5-4/2-1 B Trench Edges Topsoil Yes U No Yes F-] No J 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1. Inspection #2: O 1~ Location: 1156 CTY RD C 1I~ cL, 4jb 4- / 6<" 1.) Alt BM Description Dl~ 3Q~►eI/0n~ 2.) Bldg sewer length = 7 Y - amount of cover T. 70' 6 JA_ Plan revision Required? Yes _56o b ' 1 8 fi~ Use other side for additional information. SBD-6710 (R.3/97) Date nsepctor's Si ature Cert. No. 30 3 REC-EIVED County Safety and Buildings Division j P 'gyp 2 b 2011 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 ~ R= COUNTY 499 ' NITY DEVELOPMENT Sanitary Permit p _PG4ND3PCG7GYR State Transa do Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the app-,__ „ t is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ur oses in accordance with the Privacy Law, s. 15.04(1 m , Slats. 1. Application Information - PfNse Pr' All Information Property Owner's Name Parcel # h' ( ~0 ) ( U5K-)C~)~-~c Property Owner's Mailing Address Property Location 5 1 i G f~ - Govt. Lot City, State Zip Code Phone Number Y< y, Section (circle one) II. Type of Building (check all that apply) Lot # T-31 N; R E or 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial -Describe Use WIML)VIg - - V ❑ City of State Owned - Describe Use umber ❑ Village of 015V 0-no/ 1, w 11 ~lI l1 c~'°` I D U0101 0 Town of _on 0 III. Type of Permit: (Check only on ine A. Complete line B if applicable) A. ❑ New System Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previou Permit Number and Date Issued Before Expiration Owner 3 fX y(~' omionent/Device: Check all that apply) Non-Pressurized In-Ground ❑ essurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 . o mtab sjl er Dispersal Component (explain) ❑ Pretreatment Device (explain) AI ! V. Dis ersal/Treatment Area Information: V'sor J. Design Flow (gpd) Design Soil Application Ra e(gpdsf) Dispersal Area Required (sf) Dispe Ara Proposed (sf) System levation J-~ VI. Tank Info Capacity in Total # of Manufacturer d Gallons Gallons Units i9 -o f`' f to New Tanks Existing Tanks 19 ' Wl J o . n a _ VV V///~~ a U v) y yr 1-.3 ri Septic or Holding Tank C, Ilk , I Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume respon ' ility for installation of the POWTS shown on the attached plans. Plumb 's ame (Pri t) Plumber's ignat MP/MPRS Number Business Phone Number 7, / i ? 1 -3 ~ Plumber's A ress (Street, City, tate, Zip U VIII. Coun /De artment Use Only roved ❑ D roved Permit Fee Date O2sued Issuing Agent Si a e yen Reason for Denial $ K ~ S.00 IX. Cotl)il~ i@ft M f> Disapproval W-VS TJQ ~N"P, ICJ~(~~ WI 1V ~~'Z vvel dispersal cell must be serviced /maintained ' as pe. anag :ment plan provided by plumber. S 2. All s 'taa ck requirements must be maintained ` Q~0 as per NI I.cacle code/ordinances. qt~ ~ be ab~'( I&M.4 e/r Attach to complete plans for the system and sub t to the County only on aper not less than 8. z 11 inches in size Q 51 . o~ ~ ~ pe 6cvo( 'art too" ors CSM~ ~~e SBD-639 (R. R11/1;1~1_tv COnd t 1i 011 In U~ 2017 r 0qq fit! 0-m c f W/ f ~1 S CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: Legal Description: Township: County: `~~J4F Subdivision Name: Lot Number: Parcel ID Number: 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: , License Number. Date: Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 AZ/ . 3 - 7 Sys 3 a- --a 3c i ell Section Soit Absorption System Cross tt 4° Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching _._.p, c ~ Chamber System Elevation ftft ~ft Soil Absorption System Plan View ft I Leaching Trench 1 Chambers ft 4' Dia. Trench 2 Header Vent Or Pbservation Pipe M4 r Trench 3 Leachinq Chamber Specifications Manufacturer And Model EISA Rating sq ft per chamber Soil Application Rate ~ 7 gpolsq ft <°7 gpd Design Flow ~ 7 Soil Application Rate EISA = Chambers 3 rows of chambers each. aQ~ v~' lh 1/6 Page - of Q n V~ r~ s '0 t PL 525 FLUENT FILTER ( j' e w Pafylo , lnc is pleased to add its new commercial filter to its existing fine of quality effluent filters. The PL-525 is rated for over 10,000 GPDI Alarm Accepts PVC (gallons per day) making it one of accessibility ~ extension handle the largest commercial filters in its class. It has 525 linear feet of 1=16" filtration slots. Like the Polylok° r P6122, the new Pofylok PL-525 has an automatic shut off ball installed 525 fin ear feet with every fitter. When the filter is of 1/1V* removed for cleaning, the ball will fittrati on slots Rated for over 10,000 GPD float up and temporarily shut off the system so the effl uent won't 4 leave the tank. No other filter on the market can make that claim! Accepts 4" & 6" h SCHD. 40 Pipe ` - PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional s alarm, the owner will be notified by an alarm when the filter needs Gas deflector servicing. Servicing should be done by a certified septic tank Automatic shut-off pumper or installer, ball when filter l is removed 1. Locate the outlet of the u.`',_ Patent NG# 6,015,433 septic tank. 5,371,640 Y 2. Remove tank cover and pump tank if necessary. PL 525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mereial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6" outlet pipe. If the tank, Make sure all solids fall filter is not centered under the bade into septic tank access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 5. Replace the septic tank cover. 7. Replace septic tank cover. W POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page '„Z.f FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer:; ❑ NA Permit # I Septic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer: KNA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: ,91 NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Design (peak) Flow = (estimated x 1.5): (gal/day) Specific servicing mechanics must be provided if vertical is >15 feet or y) if horizontal is >150 feet. Specific ins ructions to be provided on back. In Situ Soil Application Rate: (gal/day/ft2) Effluent Filter Manufacturer: f ~Vjlc~ ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) <30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) x220 mg/L ❑ NA lNA Total Suspended Solids (TSS) x150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L NA _'NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other: (BOD5) <30 mg/L Soil Absorption System (TSS) <30 mg/L J4 NA Fecal Coliform (geometric mean) <10^ Of In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA Maximum Effluent Particle Size in dia. El NA El At-Grade ❑ Mound ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) l© When combined sludge and scum equals one-third (%3) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once eve El month(s) every: ) year(s) (Maximum 3 years) El NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA 9 year(s) Inspect pump, pump controls & alarm At least once every El month(s) ®NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (%3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) 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 <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) Page 1~4 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). • 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 absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTA LER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). • 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 absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTA LER POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name J Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK M,pI~ANCE AGREEMENT OWN-ERsj-ffp CERTIFICATION FORM pwnerBuyer J Mailing Address . ~ n Pro erty Address & Zoning De p for new construction.) p (Verification required from P g p o '6- I DcQa- o- parcel identification Number City/State LEGAL DESCRII' gION i ) ~4 s Sec- T,_d -1 -N R /'~7- W , Town of nom- Property Location.~r t4 ~ _ Lot Subdivision Plat: Volume ...Page Certified Survey Map # (before 2007)-Volume Pap Warranty Deed Spec house D yesXno Lot lines identifiable 0 yes 1-i no S S'FEIyI PENANCE AND OWN CEg'I~ ICATION tenance of your septic system could result in its premature failure to handle PropYou Put improper use and main three yew or sooner, if needed, by a licensed pumper What into maintenance consists of pumping out the septic tank every ~ ~ the disposa}system. Owner maintenance the system can affect the function of the septic tank as a treatment Stan responsibilities are specified in §SPS. 383-52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. a & Zoning, Q DePartment a certification form, signed by the The property owner agrees to submit to St Croix County Planning an lumber, restricted plumber or a licensed pumper verifying that (1) the on-site owner and a master plumber, proper rn p operating condition and/or after inspection and pumping (if necessary), the septic tank is wastewater disposal system is in proper less than 113 full of sludge- Ilwe, 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St Croix County Planning & Zoning Department within 30 days of the three year expiration date. that all statements on rm are true to the best of my/our knowledge. Uwe amlare the owner(s) of the Uwe certify virtue of a ty deed recorded in Register of Deeds Office. property described above, by Number of bedrooms DATE SIGN OF APPLICANT(S) permit be revoked by the Pianning& Zoning Department. rrt --**Any information that is misrepresented may result in the sanitary p ~ Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the ceriffled survey map if reference is made in the warranty deed- ,.-..-.ir n_t nft Parcel 038-1062-70-000 Valid as of 06/19/2017 07:46 PM Alt. Parcel 15.31.18.271 C TOWN OF STAR PRAIRIE ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: Co-Owner(s): SCOTT THELL 2133 54TH ST Physical Property SOMERSET WI 54025 Address(es): * 1156 CTY RD C Districts: Dist# Description Parcel History: 3962 SCH DIST NEW RICHMOND Date Doc# Vol/Page Type 1700 WITC 03/14/2017 1044755 / PRD 05/20/2002 070465 1884/17 QC Legal Description: Acres: 0.700 07/23/1997 ~682/393 SEC 15 T31 N R1 8W PT SE SW COM 585 FT N OF 07/23/1997 771/616 SE COR SE SW TH N 200 FT, W 150 FT, S 200 FT, more... TH E 150 FT TO POB Plat Tract (S-T-R 40'/41601/4 GL) Block/Condo Bldg * N/A-NOT AVAILABLE 15-31 N-1 8W 2017 Valuations: Values Last Changed on 09/13/2011 Class and Description Acres Land Improvement Total G1-RESIDENTIAL 0.700 35,400.00 92,600.00 128,000.00 Totals for 2017 General Property 0.700 35,400.00 92,600.00 128,000.00 Woodland 0.000 0.00 0.00 0.00 Totals for 2016 General Property 0.700 35,400.00 92,600.00 128,000.00 Woodland 0.000 0.00 0.00 0.00 2017 Taxes Taxes have not yet been calculated. Key Primary cri 'ifp '9j 3 k- . . . . . . \-Aft A "w It,- T MIN • r A'qq ~ i ~ yr ~ ~ S~~L'~ v°, '+.a, ~ • ate, ooz • s. , . . ..k w M cn ti 2 lko' r ~ k. m r Ili -Nz t S g ~ rv°~ y ~ M . R 200 z 175, 4.0 .00.08 t . ~ ' fit! Ef, C° m ! 'rn s a E- ~t a o ~ m V11 *4 ~wro ow t 3 VIV, oo~ e c .w+ "fie .a `o to- RECEIVE Wis. Dept of Safety and Profestb6nal1 e^~~ 1 i r1RT Page ' of Division of Safety and Buildings ST, CROIX CGIUb"ance with PG4N D3PCG7GYR ~•ty DEVELOPMENT Uounty Attach complete sit; QA r not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ' wed by Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 6VI Property Owner Property Location Govt. Lot 114-)-i: l 1 /4 S N R E (or Property Owner's Mailing Address Lo B # Subd. Name or CS rty 7 Zip Code Phone Number ❑ City ❑Vliage Town Nearest Roams ❑ New Construction User Residential / Number of bedrooms Code derived design flow rate 7 GPD 0 Replacement ❑ //Public or commercial - Describe: Parent material f~ rs: Flood Plain elevation if applicable ft ~j~j~ General commentsbq IUA and recommendations: fc ~L~y !7~ S~V• , "11 S tip 1 !C/ - - 1 0 n Boring # ❑ Boring L l < pit Ground surface elev. ft. Depth to limiting factor a//; in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ t z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 f ❑ Boring Boring # ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Hooon Depth Dominant Color Redox Description Texture Structure 3onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Si. Cont. Color Gr. Sz. Sh. * ff#1 ff#2 ~t 4, 0 V 4 i * ffluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = Boo < 30 mg/L and TSS < 30 m9n- CST N e (P Ptin~'~' / ~l, Srgnatutt' CST Number Address j r Date Evaluation Conducted- Telephone Number SBD-8330 (R)1111) Property Owner # Parcel ID # f~: Page , of _j_ Boring # ❑ Boring 0 Pit Ground surface elev. 1=~ R Depth to limiting fsctor,l in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 . 02 C _ <i j • `i q 91 Q Boring # Boring ❑ pit Ground surface elev. ft Depth to limiting factor in. Sof1 Appfication-Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots Gf Q/(t Z in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ffi€1 * 02 o Bon, # El Boring Ground surface elev. R Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture structure onsistence Boundary Roots GPD/ft x in. Munsell Qu. Sm Cont. Color Gr. Sz. Sh. * ff#1 * fP#2 * Effluent #1 = BOD 6 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = SOD s < 30 mg/L and TSS 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 605-266-3151 or TTY through Relay. M-8330 (R11/11) Property Owner Parcel IQ # f - /fly ' 7%i' Page of ® Boring g 7 Burin # Pit Ground surface elev. A9 . : ft. Depth to limifing factor in. Soli p6cation Rate s Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsef! Qu. Sz Cunt Color Gr. Sz. Sh. ff#1 fW2 , :J imasc I Q Boring Boring # ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPDIft Y in. Munselt Qu. Sz. Cont. Color Gr Sz. Sh. ffi" t tt#2 i Boring # F1 Boring Ground surface elev. R Depth to limiting factor in. F_..1 ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. ffi#'l ` ff#2 Effluent #1 = BOD b > 30 < 220 mg/l. and TSS >30 < 150 mg/L ` Effluent #2 = BOD s < 30 mg/L and TSS < 30 mg/L The Dept, of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 605-266-3151 or TTY through Relay. M-8330(R11111) .r{~ l 96V \ i l r2'Ck' o I I I . rya ~'a s s~ s ~cur~ Dart C f G,~Q UN Y ,e- ST. °I ~ 1Zes~trEce ~~r~tgr~err.rs; -nunity Development Department 9/11/2017 _ Scott Thell 2133 541h Street Somerset, WI 54025 RE: Conditional Approval: Land Use Permit, File# I' UP-2-01.7-04!4 Project Address: 1156 Count! Road C Project Location: 15.31.18.2710; Town of Star Prairie Dear Scott Thell, Community Development staff have reviewed the Land Use Permit application for the construction of a new accessory building (post frame shed) and for land disturbance more than 2,000 square feet within the Shoreland Overlay District, Chapter 17.30. The existing Private Onsite Wastewater Treatment System (POVtrFS) has failed and will be replaced as a part of this permit approval. The request has been conditionally approved based on the application submission and the following findings: According to FEMA Firm Map Panel No. 55109C0062E, a portion of the property is mapped Zone AE. The Base Flood Elevation (BFE) upstream is 868'; the proposed accessory building and replacement POWTS will be located above this elevation. Erosion and Sediment Control plans have been submitted that meet Wisconsin Department of Natural Resources Technical standards. The Private Onsite Wastewater Treatment System (POWTS) will not connect to the proposed building. Impervious Surface was calculated according to Chapter 17.30 J. and resulted in 12.5%; therefore, Mitigation is not required. Vegetation will not be disturbed within 35-feet inland from the navigable water body. I Based on these findings, approval of the Land Use Permit is subject to the following conditions: 1. The proposed silt fence shall be relocated down slope of the proposed POWTS drainfield location. An edited site plan is attached to this approval letter. 2. St. Croix County reserves the right to require additional sediment and erosion control measures to be installed if found necessary due to site-specific concerns. 3. The 1-1/4" iron pipe that is marled on the Certified Survey Map (CSM#1053200) with the top of pipe elevation = 867.96 should be flagged prior to inspection of the replacement POWTS. i i Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686 y-mvv -CCv v d. ; Ci-1, ~i1JWyJ '1 ;(`i1rJik . LJ(1"t,- Of) (""?.,I(7'",/''i CI'r ~ 'r • L R ~r ~p Land '.rf i I i'ic{ xrPr c +C 7< Pc4 xxx<~t nzcx r r r m L. ,2 , % t. 4. All proposed structures shall meet setbacks, including 5' from the side yard, ~rear yard and 10' between buildings, measured from edge of roof overhang to edge of roof overhang. 5. The proposed structure shall meet the 20-feet height requirement by measuring the vertical distance from the average ground elevation to the average height of the highest gable of a gambrel, hip or pitched roof. 6. Permanent vegetation shall be established once final grade is reached. k temporary cover crop such as oats, winter wheat or rye shall be applied on all disturbed areas if seeding cannot occur prior to September 15th'. Dormant seed and mulch should be used from November 1 - freeze up. 7. Sediment and erosion control shall not be removed before the project site reaches a point of at least 70% perennial vegetative cover. 8. it is the applicant's responsibility to secure any other required local, state or federal permit(s) and approval(s) prior to land disturbance activity. 9. Failure to comply with the terms or conditions above may result in the revocation of this permit by the Zoning Administrator according to Chapter 17.30(13). This approval is subject to the conditions listed above; it does not allow for any additional construction, structures, grading, paving, filling or clearing of vegetation beyond the limits of this request. Your information will remain on file at the St. Croix County Community Development Department suite. It is your responsibility to ensure compliance with any other local, state, or federal permitting or regulations, including contacting the Town of Star Prairie and the Wisconsin Department of Natural Resources to inquire if additional permissions are required. This permit is valid for one year, with the possibility of up to two (2) six-month extensions if the applicant submits the appropriate permit extension fee and documentation to the Zoning ,administrator. A copy of the Land Use Permit placard should be submitted to the local Building Inspector for the town upon application for the building permit. The orange placard must be posted on the job-site and visible from public view. Please feel free to contact me with any questions or concerns; I am typically available Monday- Friday from 8:00 a.m. - 5:00 p.m. Respectfully, Sarah Droher Land Use Technician II cc: File ec: Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 wwv% ,v vv; cdd,~ce. ;ciir~± rra;r.VVI I and V 'se f- I X.€,. J NL Y ~ 7 ti c t , l13't1if7ClJti i .ra'~. '"~i'StriFY~E' i~~iallCfClf,f't28f3i _ =z> > E?_ L, r, ; Town of Star Prairie Clerk enclosure: Site plan I i Phone 715.386.4680 Government Center, 1101 Carmichael Road Hudson VVl 54016 Fax 725.386.4686 ~ uvw" ~4V~,U' " _,Or C4~t CC~CI( ~~~~S~l [ G?IY.Wi.t1S i i~ - x i r 171, F C: i P i ~ t ~ i w- ell e CL M Gf~B v .Wft o Y. ..c Ala CL C: M~