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Home My WebLink About032-2167-40-000 Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM 7rSection7rown7-R INSPECTION REPORT o: GENERAL INFORMATION (ATTACH TO PERMIT) c Personal information you provide may be used for seconds 6~ secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: Pine Cliff Partnership City Village Township TOWN OF SOMERSET ICST BM Elev: Insp. BM Elev: BM Description: 8P 032-2167-40-000 e/Map No: TANK INFORMATION 26.31-1 19 9-1420 TYPE ELEVATI ON DATA MANUFACTURE e v^Septic CAPACITY STATION ~ BS HI FS ELEV. r Benchmark Alt. B Aeration t- " Bldg.SewerY., Holding r St/Ht hjpt_4f TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic tL . i ti ~'C7 'lea/' Dt Bottom Dosing t Header/Man. Aeration Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer lT Demand St Cover / Model Number /f GPM s TDH Lift Fricti ?7 n C"~c Loss System Head TDH Ft ForCemain Length Dia. Dist. to Well t~/ CO SOIL ABSORPTION SYSTEM x ~`>_~,v 3`- ~►A BED/TRENCH Width b DIMENSIONS / Length No. Of Trenches w _NkI 7 1 PIT DJMONS No. Of Pits Inside Dia. Liquid Depth lc~ SETBACK SYSTEM TO INFORMATION Type Of System: P/L BLDG WELL LAKE/STREAM LEACHING Manufactur Y ' ,-y 1 L CHAMBER OR Modeumber: DISTRIBUTION SYSTEM 2a , Header/Manifold Distribution Pipe(s) - x Hole Size x Hole Spacing Z)r Intake LengthL~ Dia Length Dia Vent SOIL COVER spacing Onl Depth Over x Pressure Systems y xz Mound Or At-Grade Systems Only Bed/Trench Center / Depth Over Bed/Trench Edges T Depth of xx Seeded/Sodded Topsoil xx Mulched COMMENTS: (Include code discrepencies, persons present, etc. Inspection #1: Inspection #2: Location: 661 196TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 4 ? ~a Plan revision Required? Yes ❑ No Use other side for additional information. `off SBD-671,0 (R.3/97) Date Insepc ignature Cert. No. -qq 6 ~S County i i 0 e Safety and Buildings Division s c 0 201 W'Madison Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) i` R$+ FEB 0 7 WI ,370 71 Crolx Cou, 72A6W1 P1 C1 VhrDO 60 3~ Com (ve State Transaction Number i 0111111 ~,ppiiL,atit 11 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropri~te governmental unit 1rt' is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may used for second pw-poses in accordance with the Privacy Law, s. 15.04(1)(m), Stars. e-sr"t- 1. Application Information -Plea rint All In Cm VLC Property Owner s ' Name j 1AR, 0. r'l Parcel # Property Owner's Mailing Address Property Location 14d u City, State Govt. L t Zip Code Phone Number ~i VV( Section os~ l./ I`J t cucle one)- . II. Type of Building (check all that apply} L T Y31 N; R E or0a 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Q)c aD ❑ A,,~cj :V-~- :Z~ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use ~y q CSM Number ❑ Village of aQTown of K.J 111. Type of Permit: (Check only on box on line A. Complete line B if applicable) New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal El Permit Revision ❑ Chan e of Plumber List Previous Permit Number and Date Issued Before Expiration g El Permit Transfer to New Owner IV. Type of POWTS :System/Component/Device: Check all that apply) ,kNon-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) ent Device (explain) V. Dis ersal/Treat ent Area Information; {C ~ ~ = r Design Flow (gpd) Design Soil qApIIcatu:n Rate(g sf) Dispersal Area Required s ( a jAre roposed (sf System Elevation VI. Tank into X Capacity m I ' / fir r' Total # of ntlfa`turerJ Gallons Gallons Units New Tanks Existing Tanks 525 y A m ca Septic or Holding Tank t A L Dosing Chamber ` VII. Responsibility Statement- I, the undersigned, assume responsibility for installaf n of the POWTS shown on the attached plans. Plumber's Name (Print) P s Signat 7AWRS N [Business Phone Number .:M Fi7 )-COX Z - Plumber's Address (Street, City, State, Zip Code) r ~r 0 60'? VI Coun /De artnlent Use C Approved ❑ tsapproved Permit Fee Date ssu p Issuing AQ tSignature El en Reason for Denial $ 116. ~ Z o IX. Condit' 16 e s Ip fo or, isapproval t tRlt 1 3) c isper. -o cell must dll a sm=s ' nt ac es per mar35ement plan p ,,u licim uv alunner, 2. All sefW.* necl,it-:-! gems mjratue i :-ntJr a as per vNilImbli c:rA!t I. rd!nt1 r,?,, Q , R - 4~ i t C2 Attach to complete plans for the system and sub ,t to the County only on paper not less than 8 12 x 11 inches in size n - , SBD-6398 (R. 11/11) 4 Cow~,M~ ti„ Q mQt 4,~ • 9 r ~ nd c,~.~c.J . s 1 i i .N 1 i A' j :I \ i i T ~y i T teo CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: At KC Owner's Name: Owner's Address: Legal Description: <SV\) I o l IZ let q/ Township: < n tYY C= County: Subdivision Name: Lot Number: Parcel ID Number: . `z.i C, -7 - ~0 - to Page 1 index and title Page 2 Plot Plan Page 3 `System Sizing & Crass-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. A6 F ~ License Number: ~~,5 Date:, s' J~( Phone Number i Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBO-10705-P (N.01/01). Page 1 r ~r ,tom i t 41 i i - j , X- J v 3 A2 J ~ 1 n ti 1 r% VA, 1 TI~ J T r L /Y,~Grade 4m cde Olt Fir lal aPVC Vaunt Pipe With Vent Cap Leaching Chamber 99 f 5 C( ft 3 3 220 m tt 7Vewtt 40bw;m&m ;P*e UM*kq Trench I ChembeM Trench 2 Hea ar chln~ ~ ~lao c../ Manufacturer And Model ('ZO c / EtSA mating Zt` sq ft per ember Soil Application Rate l gpolsq ft Lt 56 Qpd Design Flow + SON Application Rata = Z6 IEISA = Cha t m rw~ of CI chambers each. Page of INSTALLATION U PL-5251PL-425 FILTER B wwrs :11D ,QUQ GP'~3 Feet of vir FftaWn s PL-625 = MG LftWW IW Mravon -625 _ F 4' and it SOM. 40 Am *AccMqAS : in Gas r Arai ye wader normal condftions, re „-it is reoxmwwded #W to Mer be led evely gae1he twk Is pumped or it had e aY *Aiarcn if the kojeW Ow oontakns an op*MW ft owner wa be ELY an obvin when the eAcceptS PVC be done by a tank pumper or koftOw - PROW= 52. - - fiff9ft -~~s.~'Y~- ,~•Tip MW GeV" eKtwjd • `,?+k.•?-~ r'.~ ~a°` ,'.a3~... r.~'=yes P0001 mid 81f~ & 's Pabiak5dWSOMM e r 19 a dMphL SMY ID USS aY asst WW*eaoMar o w m~ s ~r SepwUmentwom ilaft Wvkv by Ad sa~mp. m :r Septic-Dose Tank Cross Section And Pump Performance Specificati( Tank Manufacturer i `ar~ R Pump Manufacturer Cc,U IL Tank Model Number \,o LP Cm ; Lru Pump Model Number 131 Total Tank Capacity r .r" - Alarm Manufacturer )1 Max. Bury Depth Alarm Model Number t3 P i. (j) 6 C'f~ Switch Type U'(C) Filter Manufacturer i Total Dynamic Head ('I'DH) - Feet Filter Model Number Elevation Head I Q Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss 2 `t GPM 1I,- Ft TDH Total Outlet Manhole Min. 4" Above Grade With A~anhole Min. 4" Above G Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight Securely Mounted 3 h' With Loclang Device weather-proof.--► Junction Box Finished Grade 41 Depth of Vent Min. 12" Cover Discorn Ft Above Grade Mean With Vent Cap i J b i ? } J s>>> 1 > J J} J { < { S t i < G < t 44 19; 4.9 { < i t { t { { < 4 i < { < { < i< > > i i t outlt Outlet Filter Inlet Inlet Baffle t< Switch Settings and Reserve Capacity ft A t/4' out" >tY Tank Volume = GPI s< wet < < Hol ass Dimension Inches Volume Gal. B 41.1 P I l (reserve) A L 9 3 0 C C 11 1 t~ 1 ~;s (alarm) B 2 Z Y Off Elevation _ C i{ Ft ;i sis (dose) C Ci E T~> (dead) D 2D is El i J`3 Total 3~1 4 j << >{>f>< <{< S{} b b}>} 3 3} t 3}} S Y> 3 3 3> i t i>}!>> <>< > i { t 4 i S S S t i{ i i i S S i t< t< i t t t; i S t{ i t{<< G i S S<< S i{ S< i{ i G t i i{ 2 G S< i Y> i i>) i> i>>>>? 3} s i s s i a l i> S s i>} y y} 3> S>> i> i f s}> Y Y> S S S S>> GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with manuhtcturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padle installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the t excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comin 16.28 WA( 02/05 U Page of ,r17: 55 FAIL 651 T31 ST87 TOM "/FLOW AN) OWE CLOE UROW t POM MODEts 72 t3 rim. law Fad s"& 77 5 46 2m 2M 70 265 Two IM. 2" a 34 44 Sr at L 25 26 42 mi f s~ 3~ Q i 1t tl. >Q a~ ~ ~ $ Q to uao 3~f3 ' Afld 1' 1 uteri sa -02 20 uwm SP ~ s _ t t [ ~~Y.t~Ols s a ai aVai a~ CM 3L A a i No Z - ~S ; aan a t07i SE,6~~1 ~ no i lid Al i~ S Ado t 3. Y70 or pff Asw ambabowwo max= l POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner N\kl,je- Tank Manufacturer: VAJ ICSC ❑ NA Permit # 6Septic A.Dose ❑ Holding Volume: f (x'<`~t,o~ (gal) DESIGN PARAMETERS Tank Manufacturer: ❑ NA Number of Bedrooms: ,3 ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: ( NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow: ~ (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): j (1 (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: 4 (gavday/fe) Effluent Filter Manufacturer: f =-C I I ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model Ij Fats, Oil & Grease (FOG) <30 mg/L Pump Manufacturer: z~ Biochemical Oxygen Demand (BOD5) <220 mg/L ❑ NA ❑ NA Total Suspended Solids (TSS) <150 mg/L Pump Model: Z High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L &lA NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other: (Boos) <_30 mg/L Soil Absorption System (TSS) <30 mg/L ❑ NA Fecal Coliform (geometric mean) <104 Xn-Ground (gravity) ❑ In-Ground (pressure) ❑ NA ❑ At-Grade ❑ Mound Maximum Effluent Particle Size %s in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scum equals one-third (Y3) of tank volume When the high water alarm is activated Inspect condition of tank(s) At least once eve [I month(s) Maximum 3 ❑ NA ry' 3 Iayear(s) ( years) 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 14 ear(s) Inspect pump, pump controls & alarm At least once every: ❑ 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 ('X) 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. 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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: 0 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). 0 After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, aravei 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 INSTALLER POWTS MAINTAINER Name' F F- t-0 Name Phone .7 (5- Li / / - -3 ~ '5 ; Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ~(p X Cou r. 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 MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer, Mailing Address ( y A + U p S o jv S( U Property Add:re , (Verification required from Planning & Zoning Department for new constructi ) L City/State Parcel Identification Number no LEGAL DESCRIPTION Property Location ~'/a , e "4 , Sec. T ~ ` R__--LW, Town of ':!Sc fto ~T Subdivision Plat: Lot f. Certified Survey Map # Volume , Page # Warranty Deed # (before 2007)Volume . Page # Spec house = yes = no Lot lines identifiable = yes = no SYSTEM MAENTENANCE 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 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 \atuml Resources, State of Wisconsin. Certification staring 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a wa)~anty deed recorded in Register of Deeds Office. NumbAr. of bedrooms / SIGNATURE OF 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. ~ o ~a C O p O U ~ na 0 ~ Q 3 m U W ~ O ~ .J N N d N J. N ~ C ~ p O N rv m N U N N m 'o Z_'i"ti~r N 0 16 2 . LL = d z N N % U N m s m = O 0 N N N ~O ~ o m v E w Q a w m o o w m _ ~ _ ~ o U E Y `m ~ o o E o m o o o = m U s m ? m m y E a C) E m 3 C L ~ ❑l LL ~ O O W LL J N F F U > N N O ~ W' 7 N U ~ LL' ~ ~ LL' ~ ~ t- co 0 0 a Y Z"Vzcl , MaL r% -7 INES16 { a may. %AJ IlL r ~ let" r r` ~ a r ij; t a ~}V~ ~ PV ~ p€ y~ ~ "=ate Aj 4" _ a N V/G3N 3Hl JO'V/I^J 3Hl JO 3NII 1S X X L A&I , ~tr'oooS X- loo ~ _ EO'95Z N 0 J °D Z • F N H Lam' CO o o o L~ O 025 - ~ / ~,e~oo \o~o~ W °ic \ cn O~ LL. Vi / N~ _ 60 'IT ~ ~.n m, / X11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE, AGRFFMENT AND I OWNERSHIP CERTIFICATION FORM Owner/Buyer Pine Cliff Partnership LLC 744 Ryan Dr. #102, H dson, WI 54016 Mailing Addre s ('661 196th Avenue Property Addrs (Verification required from Planning & Zoning Dep ent for new construction.) City/State Somerset, WI Parcel Identification Number 032-21 67-40-000 LEGAL DESCRIPTION Property Location 40 '4 160 4 Sec. 26 , T 31 N R 19 W, Town of Somerset Subdivision Plat: Pine Cliff Lot # 40 Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume Page # Spec house ❑yes(]no Lot lines identifiable ❑yes❑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 §SPS. 383.52(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 and/or (2) after inspection and pumping (if necessary), the septic tank is h less than 1!3 full of sludge. f I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the I' 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE O APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & "Zoning Department. s 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. 04/12) f r, l i 4 -J-1-1v t/~ III, ~ Uloo; Gu.mun S.Uloi N IQOI d /~'y~ VrJ^ J O ~ I IIII I! I Ij II III I ~ 1_ EI I II y,'i l l Illl1j{°I - III O II. e F ~ III 1 I ~ ~ III II I, fl ii°+ i I I Illl II z ~ I~ II ~ I III ill IG , I r ~ I i II > I~I~: I I III I'il I~I~I7 III i.+RV III I~I _ _ ~ IIII I!,l ff ~ yltil~I~,~~.I1 IIII II a ~ , i' L I II r I - x,111' ~ r I, II I I~ - III I I llllpl I. ~ 77771 III a: 11 I 11 I i.i ~ III II - I I i py I ~f a. Ih I I f~ I IIII I! 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I~ ~ I I I I - - - - - - - - - - - - - - - - - - - - - - - - - - - - t L r . . . + - - - i w I ~ I i II I RiOZ ~woo~ 6.nme.,Q s,we;~ 0 ro u I I ao~: J - - ff II ~ n p ~ i - II I 3 e z T 000 I i) I I I I y I ~ - I µ I i i i i d i - fdl OZ -wcoa 6ulnne~C s,wel~ -Ryan Yarrington From: Ryan Yarrington Sent: Friday, March 2, 2018 11:12 AM To: Mike@hartmanhomesinc.com; Doug Zahler <DZahler@authconsulting.com> (DZahler@authconsulting.com) Subject: FW: Lot 40 Pinecliff 2nd Add. Attachments: 20180302104537550.pdf Hi goys, Here is the sanitary permit for lot 40. One of the conditions of the sanitary permit is that elevations must be taken of the existing features, culvert, ditches, and driveway prior to construction. Then this information must be submitted to the Community Development Department (CDD). Upon completion of the project the elevations must match the preconstruction elevations and be field verified with CDD staff. Thanks! '1Zyan A of , riao;t.>r~ Spff c X101 Carmich 15.386.4680 Sr r:st From: Rogney, Michael R - DNR [mailto:Michael.Rogney@wisconsin.gov] Sent: Thursday, March 1, 2018 1:52 PM To: Ryan Yarrington <Ryan.Yarrington@sccwi.gov> Subject: RE: Lot 40 Pinecliff 2nd Add. As long as the existing grade of the structure, provided it was compliant when installed, does not change, additional hydrologic and hydraulic analysis is not required. If significant development or fill is proposed, then the County may request a H&H to determine if the proposal has impacts on the Zone A floodplain. A floodplain permit may still be required for the proposal, which should include verification that the existing structure and elevations do not change. This can be completed with a certified survey. Hope that helps. We are committed to service excellence. Visit our survey at httph~dnr w rJV[cu> to evaluaw how I did. Michael Rogney Phone: 715-839-3735 MichaEcRo i y( Wisconsin eov From: Ryan Yarrington [mailto Yvan.Yarringtnrr(~sccwjRov] Sent: Thursday, March 01, 2018 12:22 PM To: Rogney, Michael R - DNR <Michael.RRo e wisconsiri.QOv> Subject: RE: Lot 40 Pinecliff 2nd Add. Hi Mike, i I was just wondering if I could get a quick email response for the file about our phone conversation from 2/28/18. Since lot 40 of Pine Cliff 2"d Add. already has the driveway and culvert installed and no filling and grading will be done in the mapped Zone A Floodplain except minor driveway surface work and paving that a Flood Study to determine a RFE is not required. I will explain to AC/A and Hartman homes that there may be other lots that could require the flood study depending on construction requirements. Thanks '/1yan yarrington I Land Use Specialist I.':-01 Carmichael Rd I Hudson, WI 54016 5.386.4680 71 From: Rogney, Michael R - DNR [rnailto:Michael.Rogney@wisconsin.gov] Sent: Monday, February 26, 2018 10:33 AM To: Ryan Yarrington <Ryan.Yarrington& cwigov> Subject: RE: Lot 40 Pinecliff 2nd Add. Let's talk this afternoon after 1:00pm. I have a number of phone calls and things I need to catch up on this morning. Does that work? We are committed to service excellence. Visit our survey at http.//dnr.wi.gov/customersurvey to evaluate how I did. Michael Rogney Phone: 715-839-3735 Michael.Rogn ov From: Ryan Yarrington [rnailto:Rvan.Yarrington@sccwi.gov] Sent: Monday, February 26, 2018 10:28 AM To: Rogney, Michael R - DNR <Micttael.Rogr ey Pwisc_onsin_gov> Subject: RE: Lot 40 Pinecliff 2nd Add. Hi Mike, No problem, thanks for getting back to me. Can I give you a call? Ryan Yarrington I Land Use Specialist 1101 Carmichael Rd I Hudson, WI 54016 715.38r6.4680 From: Ro ne Michael R - DNR mailto:Mictrael.Ro ne wisconsin. ov Sent: Monday, February 26, 2018 10:20 AM To: Ryan Yarrington <H_y_an.YarringtogLa~sccwi:Fov> Subject: RE: Lot 40 Pinecliff 2nd Add. Hi Ryan, Sorry for the delayed response, I was out of the office all last week. 2 A stormwater analysis can be a bit different than determining the RFE for a stream. Mainly the design storms and methodology used. With that said, it does appear the area is still mapped as a Zone A floodplain. If there is proposed development in the mapped floodplain, it is likely a study would be required, yes. The objective would be to determine the RFE and whether or not the development has an impact. If you would like me to take a look at existing studies (even the stormwater) to see if they comply with the technical standards, 1 would be more than happy to assist. Hope that helps. We are committed to service excellence. Visit our survey at http.Jjot r_wi.gov/custo,nc,rsui vey to evaluate how I did. Michael Rogney Phone: 715-839-3735 PJIicI~aEI Ra~,rn_ey~a>Wisconsir~-gov From: Ryan Yarrington [madto,ltyar7 Ya-rmgton~Losccwi ~,ov] Sent: Wednesday, February 21, 2018 3:23 PM To: Rogney, Michael R - DNR <Michael.Rogney wisconsin.gov> Subject: FW: Lot 40 Pinecliff 2nd Add. Hi Mike, So this is a situation where the subdivision (Pinecliff 2nd Add. Somerset WI SW,NE, section 26.31.19) was designed in the early 2000s and the driveways were installed with culverts. Then in 2009 FEMA updates the maps and now we have Zane A flood plain on the lot and the developer is looking to build outside of the mapped flood area. Below is a recent site you worked on with Sarah in our office and that one requires a flood study. Then I know we had an old house with Zone A in the ditch but the driveway was already in and the owners wanted to tear down and put up a new house which was all outside the mapped flood area and that didn't require a flood study. This situation is sort of in the middle with no house yet but it does have a driveway. Would this require a flood study? If yes, what are the chances the original cross se(flons and hydrauh( analysis me liods lot storm water would suftic:~~' Thanks! Ryan yarrington i Land Use Specialist ;-101 Carmichael Rd i Hudson, WI 54016 715.386.4680 it Svs:;a.Lh7 4;a From: Doug Zahler [maiIto: DZahler@authcomulting.com] Sent: Wednesday, February 21, 2018 11:44 AM To: Mike Hartman <Mike@hartmanhomesinc.com>; Ryan Yarrington <Ryan.Yarrington@sccwi.gov> Subject: RE: Lot 40 Pinecliff 2nd Add. i Yes, Ryan, those driveways and culverts were all designed and built to the building pads when the subdivision was constructed in 2002. 1 assume you have those plans on file yet. If not I'm sure I can find a set in our archives. Doug Zahler Land Surveyor dzahlerQauthconsulting.com ■ Auth•Consulting & Associates - AC/a 3 9 20 Enloe ;rest, 6dite 10 _ Hudson Office: 715-381-527? jorporate office: 715-232-845" r✓ww.authconsulting.com From: Mike Hartman [mailit~.I~liEc~~(f1~h<3rtin<~i~hot~~s.,,if,t oml] Sent: Wednesday, February 21, 2018 11:30 AM To: Ryan Yarrington <Ryan.Yarrin ton sccwi_ggv> Cc: Doug Zahler <DZahler&uthconsult ng.com> Subject: RE: Lot 40 Pinecliff 2nd Add. Hello Ryan, I have Doug Zahler copied on this email but the driveways are built (at least the first 50 feet or more) on all of these lots with culverts in place per engineering drawings at the time we developed this property. Does that change anything? Doug do you comments? I know we ran into some issues with this on Lot 39 build last year and the septic location. Mike From: Ryan Yarrington [mailto:Ryan.Yarrington sccwi.f covI Sent: Tuesday, February 20, 2018 5:04 PM To: Mike Hartman <M~artma_nhome s_inc. com_> Subject: Lot 40 Pinecliff 2nd Add. 91 ~n 2009 (attached). Since this is a Zone A then a flood study is required to install the driveway. The flood study `rdrmld Ok" two things. First it would determine if filling and grading (building the driveway) would raise the regional flood 1.1levation(not allowed). Second it would determine the size of the culverts required to handle any potential flooding. There are multiple lots affected by the floodplain so I would make sure the study incorporates all of th{ Om f, the flood study i" s_omplf led thee) ft 9 emd ('J to Pf R rm, f(; iill ig and grading within the Flood Plain is require Included below is another situation C'imilar to thku and titE WUN R response. Sarah Droher in our office would lik, handle the LUP if you have additional questions. Thanks Ryan yarrington I Land Use Specialist x_101 Carmichael Rd I Hudson, WI 54016 ;`15.386.4680 From: Sarah Droher Sent: Tuesday, February 20, 2018 4:20 PM To: Ryan Yarrington <Ryan.Yarrin ton sccwi.VoV> Subject: similar floodplain property Ryan, Ifere is some information regarding a driveway and floodplain that sounded very similar to the one we talked about. Hopefully it helps. If the contractor owns more than one lot and there is mapped floodplain, it may definitely be worthwhile to do the study on those lots at the same time. 4