HomeMy WebLinkAbout022-1020-70-030 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
33afety and Building Division. Sanitary Permit No:
INSPECTION REPORT
(ATTACH TO PERMIT) 420372 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. -# 7` eaKS . /h
Permit Holder's Name: City Village X Township Parcel Tax No:
Schone, Don I Kinnickinnic Township 022 - 1020 - 70-030
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing It Alt. B /
a -to ,/C, [10-2-0
Aeration Bldg. Sewer O f
Od . ► 0
Holding St/Ht Inlet
la. 30 *.V
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic } / 65-1 Dt Bottom (�•S� Q'l u
Dosing t t f Header /Man. '� p I't t
`` 1,` ^' � S � 1
Aeration Dist. Pipe
l2
Holding Bot. System 3 3 • 1
Fin Grade
PUMP /SIPHON INFORMATION �i .--tit [Z`+ sei
Manufacturer Demand St Cover
GPM Z. g6 ps•2`f IVA
del Number
° fl y P& - O —
a� 5: o /o Z.
TDH Lift Friction Loss System Head TDH Ft
, 4!v
Forcemain Length c Dia. It Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Ts o �. PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS r:� f I (I a ^ _ �
SETBACK SYSTEM TO JBLDG IWELL LAKE /STREAM LEACHING Manufa ure
INFORMATION CHAMBER OR
Type Of System:
,,y► .� I �t � 6 ) UNIT ModeW umbe .
DISTRIBUTION SYSTEM {� f7(c �
Header /Manifold Distributio3h x Hole Size x Hole Spacing Vent to Air Intake
r It Pipe(s) t Or r II�' �� ll ��-
Length (o •� Dia 2 Length 31' is `� Spacing 3 a JJ
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 Bed/Trench Edges Topsoil
® Y l No FA Yes
COMME TS: j I � ncl A u n de ode discrepencies, persons present, etc.) Inspection #1:�/ I /v Inspection #2: od / r}d
Location: 1004 Coulee Trail River Falls, WI 54022 (SW 1/4 NW 1/4 8 T28N R18W) NA Lot 2 �Q � Parcel No: 08.28.18.119A30
1.) Alt BM Description = T(9(1 4UJ ` �¢(�rt,
2.) Bldg sewer length = 00
amount of cover =� f' 170, GOB-` 0 1
3.) Contour X02 -$d C $ S -- / -5
Plan revision Required? [j Yes No
Use other side for additional information.
SBD 6710 (R.3/97) Date Insepctor's Signature Cent. No.
i
A AN Safety and Buildings Division County
,, 201 W. Washington Ave., P.O. Box 7162 4— C to tic
sconsI n Madison, WI 53707 - 7162 Site Address �+
Dep artment of Commerce q � L O /00 [)L tYTeA - 1 I--
Sanitary Permit Application Sanitary Permit Nu
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide El Check if Revision / . ��
may be used for secondary purposes Privacy Law, sl5. 1 m
I. Application Information - Please Print All Information State Plan I.D. Number
R
Property Owner's Name Parcel Number 2 / — 3
a- a PJ SG NZG A I I G ZQ 2Z !
Prog rtj wner's Mailing Address Property Location
D �i ST. CROIX COUNTY l4 iR; S T b N. R
City, State Zip Code Lot Number 2 Block Number
®-
b U# st - 71 7. /6
SubdiuWmi.Name CSM Number
II. Type of Building (check all that apply) ❑Ci
A_ tY
Xl or 2 Family Dwelling - Number of Bedrooms Ci� Q 12t ❑Village
❑ Public /Commercial - Describe Use , p ��i41AIle t
L�ct' Ol/AD w �" ownshi
11 State Owned ��- � 1 Gc�c q X (O 7 Nearest Road
au -Vd 0-t an dun.- I Oa. S ` s /( d D = :7 ' GO EE
III. Type of Permit: (Check only one box online A (numbering scheme for internal use). Complete line B if applicable)
A. 1 )(New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use
S stem Tank Only
Existing S stem
B • ❑ Check if Sanitary Permit Previously Issued Permi Number Date Issued
IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use)
44 ❑ Non - Pressurized In- Ground 21% Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
✓ Required Proposed R� (sis. /Daysq:� (Min./Inch) Elevation
0 A4,
� �116
VI. Tank Info Capacity in Total Number anti acturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks d� Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank z4v _ fit 1 e5?X
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume res o do a OWTS own on the attached plans.
Plumber's N e (Print) PI her's 15ignature MP/MPRO-Number Business Phone Number
o bin- �f 9 v7 3 6 `K
,
Address (Street, City, State, Zip Code)
SLR laWl
VIII oun /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Da Issued 1s g Signature (N tamps)
Surcharge Fee) a
El Owner Given Initial Adverse . 2 J
Determination J 1- r
Ix. Conditions of ApprovaljReasons.for Disa�p7l -,e ESC / Ct�rnfr, leI4 ,X
o l�i2EY' - " MounrA
!' Mewl /t2p+F 7�.IT 4�b r , fY4TAU3nlT i� gr[ft✓ OY'
Attach complete plans (to the County only) for the system on papa not less than 8112 x U inches in she
d muaf ��t.�.�leE/
�"• BD -6398 (R. 05.01)WW ff/I rqi� e - w� . n u� b e > 2 b� f-u- 7 *"-' !�� > 6-6
Safety and Buildings
. 1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
TDD #: (608) 264 -8777
Visconsin www.commerce.state.wi.us /sb
Department of Commerce www.wisconsin.gov
Scott McCallum, Governor
Philip Edw. Albert, Secretary
August 12, 2002
CUST ID No.691727 ATTN: POWTS Inspector
RECEIVED
ARTHUR L WEGERER ZONING OFFICE AUG 16 2002
WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SP
PO BOX 74 1101 CARMICHAEL ST. CROIX COUNTY
RIVER FALLS WI 54022 HUDSON WWII 54016 ZONING OFFICE
CONDITIONAL APPROVAL ` °
PLAN APPROVAL EXPIRES: 08/12/2004 Identific on ' ers
Transaction ID No. 77627
SITE• Site ID No. 649042
Don Schone Please refer to both identification numbers,
Coulee Trail above, in all correspondence with the agency.
Town of Kinnickinnic
St Croix County
SWI /4, NWI /4, S8, T28N, R18W
FOR:
Description: Mound System for Don Schone
Object Type: POWT System Regulated Object ID No.: 865601
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation /operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
r
Fee Received $ 175.00
Balance Due $ 0.00
Keith A Wilkinson
POWTS Plan Reviewer, Integrated Services t1G�";
(715) 524 -3630, Fax: (715) 524 -3633 , M -F 7 am - 3:45 pm
kikkinson @commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist (715) 726 -2544
I
TITLE SHEET Page of �]
MOUND SYSTEM
Q �06
FOR
A L4 BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD- 10691 -P and the Pressure Distribution Manual SBD- 10706 -P
(N.01 101) (N.01 101)
LOCATED ITNT THE Sal 1/4 OF THE Nom 1/4 OF SECTION 8 ,T Z - - N,R 18 W,
TOWN OF Pi Q-\2L� N `C S'T', �L~ '`Y COUNTY, WISCONSIN.
L,�T Z vF Cswl V OL lS, �g 41 OZ
INDEX
J
PAGE 1 of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUMPING CHA11BER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
2. t� q IV . 17 u 17 G E: S`T1Z�T
B V SZL.1 rv G`rDIU � hJ I s31 � S
PREPARED BY
WEGE EFR SO I L TESTS !VG
AND.
33ES I CStq SEFRV 3: CE
P.O. Box 74 421 N.�fain St. 40�
River Falls, WI 54022 �`' ,HS/
Phone 715 - 425 - 0165
Fax 715- 425 -6864 r'' AR*M/fi.
wgGEWa
F-O, M.T.S. �swoRT- j
Coll didonally
Ali IKUVE D
DEPARTMENT OF COMMERCE �1emw
DIVISION OF SAFETY -0ID BUILDINGS
SEE CORRESPONDENCE
JOB N OZ-
.-Mound System Management Plan Page Z of
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of
the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and
Buildings Division.
Pumo Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (October - February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mg /L BODS, 150 mg/L TSS, and 30 mg /L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each
lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual and local or state rules pertaining to system maintenance and maintenance
reporting. , �gU -1D 691 -P
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Continaencv Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions about the operation or maintenance of this system should be directed to:
The County Zoning - Office at 1 46 80 S I • IZ UX
The system installer at -- is
The tank - manufacturer at l�r_al�lz
The effluent filter manufacturer at $011 - - Lzi - S Z
The pump manufacturer at -- ` 4 VT_ -Lee
PLOT PLAN
Scale l"= - Page -1 of 7
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NOTES:
I. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation ipes with approved caps. ( Z required).
3. Septic tank to be 1
O �80 pgallon capacity manufactured by
1.v uzs zz CON C2.� w / PP1j c -
4 . Bench marks ; S p30V
5. Divert surface water around system to prevent ponding at the uphill side.
Page r 7
Approved. SJilthetic Coverlllg
AST-H C33 "
• oS Oistribution Pipe
Kodiism Sand
Topsoil jc `
F
3 E
b
L/ - % Slope 162.
Distribution Cell of" Force Main Flowed
z" to 2- Aggregate From Pump Layer
0
E Z - H Ft.
CROSS SECTION OF A MOUND SYSTEM F O•g Ft.
G 0 • S Ft.
V i
(p t• H `• F�.
Linear Loading Rate= gc �GPD /LN FT B b1 t.
Design Loading . Rate = p . GPD /SQ FT j 1 Ft.
4u4 _ �—
J 9 Ft.
K lZ Ft.
FR Position L of 1 Ft.
ar
Force Main W 3 Z Ft.
I
- Observation Pipe
A o— -- - --- 8 - - --
W
-- - - = - -- -------- - - - - -- --- - --
o---L - -�_ - - -- - - - - - -- -------------------- - --i--0
�oist
ution ` 1 „
Pipe Cell of 'z to Z 2
aggregate
Observation Pipe
(Anchbr sec=ely)
PLATT VIEW OF A MOUND SYSTEM
Distribution Pipe Layout Page of - 1
Place the holes at the bottom of the distribution pipes
at equal spacing. Remove all burrs from the pipe and 'holes.
Extend the end of each lateral up with the use of long turn or 45 fitting to a point within six
inches of the final grade. Terminate the ends of the laterals with a valve,: threaded cap or
. threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug.
-
77`7t P- 5:1� L. �:\ �S S s'�L t1V?y u
PVC F\1C P Lateral Manifold
X x x x x12 I x/2 x x x I x
Lateral Lenath L Lateral Length —
Distribution Line
IT
` Rc �s sox
-�
S
I
O— _ _ c. q
ti'v C 1"oACt V'1 Al /�
P 3 L.S Ft• Hole Diameter Inch -
S Ft. Lateral Inches)
X Inches Manifold " Z• Inches
Force Main " 2 Inches
# of holes /pipe ! 1
Invert Elevation of -Laterals lo4.1 SFt.
L 1 y_a. 41= 4 3 1 x�= In- 6 PA
: wOOW OR FRESH j wAti r.Jlu�. LP.6EL .
t+�sPQU �tp` AIR INTAKE cor.�tw�r
' W �N'I.CLS16 ttT �' fib
FI 1Q Is�
IVAIII
G RfiD E
t
IIULET PROVIDE I —
'' � AIRTIGHT SEAL I I t
^, \ \!/
8l�� -C I I I
Approved Zr�B�. >�� i ill Approved
joint I joint w/
J w/ l� -1 (6C)d I
I
PVC pipe � ALMA PVC pipe
-
. I I
I I ou
C I
q.3.� � I
LLE F __�
PUMP � pFi•
D -
COLICRETE
t ct 3 .a o I ct.oCK
- RISER EXIT PERMITTED OQLy IF TAW MAL:UFACTURER HAS SUCH APPROVAL 3"ADPRo+t<.
UDO t Hr,,
SEPTIC F SPECIFICATIOUS
DOSE
TAWKS MAW U FACT U;L9 :F. I / �� COyG��� -� ►JUM BER OF DOSES: _S - PER DAw
TAM SIZE: NZ-0 ! B GALLOWS O
D St< VOLUME r
ALARM MAWU FACTURCA: S•S . ELK 1_ 0 5Lt3`i"L IMCLUOINE, 6ACKIFLOW . \Y° 'o G ALL ONS
P%ODr_L .►.LUMBER: W 4w CAPACITIES: A= � F�) ILICHES OR pp Z GALLOUS
SWITCH TtIPC: 1�1�ZL°U{Zy 8= Z I►JCHES'0R `'`t' s
PUMP PkAQUFACTURER: M� - o _3 6 ' Z " GA LLO
_ C = S INCHES OR 13 �' GALLOWS
LIS
MODEL NUMBER: r'1 - O - )s Z .
D= INCHES OR a GALLOLIS
5WITCH TYPE: �(_-_J`2Sl IJOTE: PUMP AUD ALARM ARE TO 6
MIMIMUM DISCHARGE RATE ''
GFM
INSTALLED OQ SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEU PUMP OFF ALLD..DISTIZIbUTIOQ PIPE 1Q• Ct FEET
+ MINIMUM NETWORK SUPPLY PRESSURE , , , b- SO FLET �5 -0YL t•3�
+ - L — 1 - S FE 6 Z Ft
ET OF FORCE MAIN X 0FLFKICTIOIJ FACTOR_, i I R FEET
TOTAL DyAJAMIC HEAD = L -- I. FEET
As per manufacturer Z-Z.ZY gal /in. Liquid depth 3( �
J
J c e
M E40
Series ym
4/10 HP Effluent
and Drain
Water Pumps
Performance Curve
J
MODEL ME40 EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40
12
35
10 in
W 30 W
LL F
�' "Z 25 8
Z
� H
Q
= 20 I q.&3 6
)�•o� J =
.A. 15 J
o Z-7.o6 4 0
10
5 2
0 0
0 10 20 30 40 50 60 70 80 90 100
CAPACITY GALLONS PER MINUTE
�Yt •.
.. 1101 Myers Parkway, Ashland, Ohio 44805 -1923
419/289 -1144 FAX 419/289 -6658 Telex 98 -7443
K3326 7/91 Printed in U.S.A.
EROSION CONTROL PLAN COMMENTS:
For 1004 Coulee Trail, Kinnickinnic Twp. Plan — owner(s) Don Schone
1. The main source for construction site runoff will be the house foundation excavation and
any soil stockpiled until final grading and stabilization is complete. Mound construction has
minimal impact, but apply seed and mulch as soon as grading is done to minimize erosion.
2. Divert runoff away from adjacent Lot 3 (to the east) by creating temporary earthen berms
ALONG CONTOUR between construction activity and property line. Maintain existing
vegetation between excavation for house & mound septic system and road drainage ditch.
3. Construction equipment and vehicles must use only one stabilized driveway access that is
designed for heavy equipment; this will avoid muddy, rutted conditions that allow
contaminated runoff into the road ditch.
4. Stabilize new mound septic o system with seed and mulch immediate)
p Y Y after installation — do
not wait for final stabilization/landscaping of entire site to cover exposed soils on the system.
5. If builder /excavator grades the site to create temporary berms as recommended to contain
sediment and leaves adequate vegetative cover between work area and neighboring property
and/or road ditch, installation of silt fence MAY not be necessary. Use mulch or other cover
materials to prevent erosion. Silt fence will be required if sediment cannot be contained on
the property with diversionsiberms. Septic system inspector will evaluate ESC plan
effectiveness and make recommendations accordingly.
Please feel free to contact me with questions or ask for assistance with erosion & sediment
contro ' stallation.
amela Quinn, Soil E sion Inspector #665054
Standard Erosion Control Plan
for 1 & 2 Family Dwelling Construction Sites
According to Chapters II-HR 20& 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa-
tion needs to be included on the plot plan which is submitted and approved prior to the issuance of building
permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the
Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting
this requirement.
Instructions:
1. Complete this plan by filling in requested information, completing the site diagram and marking ( ✓) appropriate boxes
on the inside of this form.
2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading.
Water runoff patterns can change significantly as a site is reshaped.
3. Submit this plan at the time of building permit application.
Site Diagram Scale: 1 inch = feet
EROSION
Ci , . CONTROL PLAN
LEGEND
PROPERTY
LINE
EXISTING
' DRAINAGE
TD TEMPORARY
DIVERSION
FINISHED
-' DRAINAGE
LIMITS OF
GRADING
SILT
FENCE
STRAW
`{ BALES
GRAVEL
f 7 "
VEGETATION
SPECIFICATION
10 TREE
PRESERVATION
STOCKPILED
r SOIL
° ' r,
Please indicate north
" by completing the
arrow below.
PROJECT LOCA e rir\k�r n C SS (A. TI N
BUILDER --Ahoy &MJ S i0--' CQ OWNER �ow2 r - \(\pr1� 0 1 -
V.
WORKSHEET COMPLETED BY 1 A V—C uc,f' DATE 07 I 10 'Z
EROSION CONTROL PLAN CHECKLIST
`ob Q7 Check (%/) appropriate boxes below, and complete the site diagram with necessary information.
Q
Q
F �
4 = o Site Characteristics
X North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways.
❑ V� Location of existing drainageways, streams, rivers, lakes, wetlands or wells.
❑ 9X Location of storm sewer inlets.
Location of existing and proposed buildings and paved areas.
The disturbed area on the lot.
® Approximate gradient and direction of slopes before grading operations.
It Approximate gradient and direction of slopes after final grading operations.
❑ VT Overland runoff (sheet flow) coming onto the site from adjacent areas.
Erosion Control Practices
fA ❑ Location of temporary soil storage piles.
Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be
covered with a tar or more than 25 feet from an downslo a road or draina ewa
p Y . P 9 Y
it Location of access drive(s).
Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick.
Drives should extend from the roadway 50 feet or to the house foundation (whichever is less).
V ❑ Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre-
vent eroded soil from leaving the site.
❑ lW Location of sediment barriers around on -site storm sewer inlets.
❑ Location of diversions.
Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be
diverted (re- directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than
10,000 sq. ft. should also be diverted around disturbed areas.
❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade).
Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions,
and re- vegetation by sodding or by seeding with use of erosion control mats.
❑ �D Location of practices that will control erosion in areas of concentrated runoff flow.
Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of
such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap.
When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved
area, or one acre of paved area. In- channel practices should not be installed in perennial streams (streams
with year -round flow.)
❑ 1� Location of other planned practices not already noted.
r
EROSION CONTROL REGULATIONS
UNIFORM DWELLING CODE (DEPT. OF COMMERCE)
PROJECTS AFFECTED • Straw bales, filter fabric fences or other barriers to
• All new 1 and 2 family dwellings in Wisconsin started protect on -site sewer inlets
on or,after December 1, 1992. • Additional controls if needed for steep slopes or other
• Additions to dwellings built after June 1, 1980. special conditions
MAINTENANCE AND WASTE DISPOSAL
APPLICATION PROCESS • Sediment controls must be maintained until the site is
• Erosion control measures must be included on the plot stabilized by mulching and seeding, sodding or
plan submitted with the building permit application to landscaping
the local building inspector in communities where the . All building waste must be properly disposed to pre -
dwelling code is enforced vent pollutants and debris from being carved off -site
• Plot plan must show:
— Location of the dwelling, other buildings, wells, sur- ENFORCEMENT
face waters and disposal systems on the site with •Erosion control inspections will be made during other
respect to property lines regular inspections (footing and foundation, rough con-
struction, final, etc.)
— Direction of all slopes on the site
•Violations must be corrected within 72 hours
— Location and type of erosion control measures
• Stop work orders may be issued for noncompliance
CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT
• Silt fences, straw bales, or other approved perimeter • Local building inspector
measures along downslope sides and side slopes • Department of Commerce, Safety and Buildings Divi-
• Access drive sion, P.O. Box 7969, Madison, Wisconsin 53707,
(608) 266 -2128.
STORMWATER PERMIT (DNR)
PROJECTS AFFECTED — Proposed erosion and storm water pollution control
• Any grading or construction project that disturbs 5 practices during and after construction
acres or more and is not covered by a building permit — Documentation that an erosion control and storm
• Smaller sites that are part of a planned development water management plan which meets DNR standards
involving 5 acres or more of land disturbance has been prepared (plan does not need to be submit-
• Effective October 1, 1992 for any new or continuing ted with the application)
project —Other information related to site location and per-
• Exceptions: Indian tribal lands and work done by local mit holder
government staff CONTROLS REQUIRED
APPLICATION PROCESS • Erosion control measures specified in the Wisconsin
• File a "notice of intent" application (Form #3400 -161) Construction Site Best Management Practice Handbook
with the Department of Natural Resources (DNR) 14 • Measures to control storm water after construction
days before construction begins FOR MORE INFORMATION, CONTACT
• Application must include: • Department of Natural Resources, Storm Water Per-
- Timetable for land disturbing activities and installa- mits, P.O. 7921, Madison, WI 53707 -7921, (608)
tion of erosion control measures including project 266 -7078
start and completion dates
LOCAL ORDINANCES
Check with your county, and city, village or town for any local erosion control ordinances including shoreland zoning
requirements. Except for new 1 & 2 family dwellings, local ordinances may be more strict than state regulations. They
may also require erosion control on construction projects not affected by state or federal regulations.
A publication of the University of Wisconsin- Extension in cooperation with the Wisconsin Department of Natural Resources and Department of
Commerce, Ron Struss, Water Quality Educator, UWEX Western Area and Carolyn D. Johnson, Urban Water Quality Educator, UWEX Southeast Area.
UW- Extension provides equal opportunities in employment and programming. This publication is available from county UWEX offices or from Extension
Publications, 630 W. Mifflin St., Madison, WI 53706, (608) 262 -3346. Copyright 1997 by the Board of Regents of the University of Wisconsin System
doing business as Cooperative Extension, University of Wisconsin - Extension. Send inquiries about copyright permission to Director, Cooperative
Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Drive, Madison, WI 53706.
GW0001A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites DNR: WT -458-96 R -02- 97- 2101-10-S
a
c c� Indicate management strategy by checking (✓) the appropriate box:
ob a, = o Management Strategies
-VQ ❑ Temporary stabilization of disturbed areas.
Note: !t is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized
by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching.
Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment).
Indicate re- vegetation method: Seed Sod ❑ Other ❑
Expected date of permanent re- vegetation:
Re- vegetation responsibility of: Builder ❑ Owner /Buyer*
Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Yes ❑ No ❑
❑ Use of downspout and /or sump pump outlet extensions.
Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage
pipe to stable areas such as established sod or pavement.
❑ Trapping sediment during dewatering operations.
Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until
most of the sediment settles out.
�K Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water.
Maintenance of erosion control practices.
• Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to
half the barrier's height.
• Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be
replaced (typical bale life is three months).
• All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday.
• All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday.
• Access drives will be maintained throughout construction.
• All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized.
For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code,
the DNR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erosion Control for
Home Builders.
The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available
through State of Wisconsin Document Sales, 608/266 -3558.
Erosion Control for Home Builders (GWQ001) can be ordered through Cooperative Extension Publications, 608/262 -3346
or the Department of Commerce, 6081267 -4405 .
i
Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3
` uwisia "rtof safety and Buildings
t in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper notless than 8 112 x 11 inches in size. Plan must County S 1 . CEO t X
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. '1�)D1/� 6
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 02; - 70- 0
Please print all information. R by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f/ 23/41-
Property Owner Property Location
Z GQIA- oL SW 1 /0JW 1/4 S P,) T Za N R E (or )F
Property Owner's Mailing Address l Z ity Block # Subd. Name or CSM#
Eb c_ g. A4 _
City State Zip Code Phone Number ❑ Village Nearest Road
sr. �t'cu L >✓t N 6 c Z) *7 Z3 - 10 8 - 7 lt1 NM 1 C 1z.1 ti �j 12, - 12 wE-zr `TTc. L L.
®, New Construction Use: ® Residential / Number of bedrooms Code derived design flo to Op GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material _ t, L 1 h�'L �� l.l. Flood Plain elevation if app cable r7 ft.
General comments
and recommendations: W1 UU» 1 J/ ° l ' X- 6 'f 9C� - V1 0)J C.' 0-
KA1 ov 1.mu ZI Or` S PILL. � �L 5� '0�
F-1 Boring # ❑ Boring L p�
® Pit Ground surface elev. 10 u ft. Depth to limiting factor S in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftZ
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2
p 6 _ — Sit - Z M` CS l-P . S .43
Z 1_� l0`�2 - std ZFsbk mP>r e9 - S
3 1s 39
Boring # ❑ Boring
® pit Ground surface elev. 3 V fL Depth to limiting factor l 8
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /11
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
0 -g
vO-i NZ- 31Z — Std Z'Nk Wt'FI C% . -'b
10't 41 W1 — Sit z ' - s 6►
3 lg 3 6 `� � S ` - � 2 313 l � l . S `T 1Z S !� p Y,•1 '�t- � � . S
• Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) ZS,* nature CST Number
Arthur L.- Wegerer (3k - sct Q 220254
Ad dress 4i e g e r e r Soil Testin & Design Service ate Evaluation Conducted Telephone Number
421 N. Bain St. River Falls, WI 54022 y_Z, 715 -425 -0165
F
Property Owner Parcel ID # p exM 1 fu G Page Z of 3
Boring # ❑ Boring
® Pit Ground surface elev. 10 - ft. Depth to limiting factor r-i 3 n.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
In. Munsell Qu. Sz. Cont. Color Gr. Si. Sh. •Eff#1 •Eff#2
6 -9 1O`tft- jl Z — st l 11 sb�- • 5 , 8
Z q - to KQ ) � — s i 1 Z'�
8 t
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
- Boring # ❑ Boring
❑ Pit Ground surface elev. ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •E1f#2
•
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L '
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or '
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
sen -9330 trt6/00i
I I
PLOT PLAN Page 3 of 3
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CST Signature Date Telephone No. CST No. Job NO.
FROM : MSSI FAX NO. : 262 763 3831 Aug. 21 2002 08 :23AM P1
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ST CROIX COUNTY
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can ante[ dye i*iwdan of Go mptio ttmk ai a UMMOO arse is die waste dnpo 4 eysaewo,
'lac p4petty owaer *V= is z4beoit to IL Cmis 200162 DepulkOW a lea forte. Girded by the ewer -And by
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I ad W ate Oat: to The WA of my (our) heaadcd2e I (vrc) am (are) tit aWttet(s)
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•••••• Any iedfenossiaa met is ms•tepmasi td may zw alit in die "my pamit bob% re" ked by the Zoaing Depsrtmedt. •"•'
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9 "" caul6ee stnew —p if nera@,r is male is ube w4moo 4eed
STATE BAR OF WISCONSIN FORM 1 - 1998 6.EaS01.6
WARRANTY DEED KA THLEEN H. WALSH
REGISTER OF DEEDS
11 Q�1 PAGE 5T. CROIX CO., WI
Document Number t 7 L RECEIVED FOR RECORD
This Deed, made between Lenertz Farms, Inc., a 01 -11 -2002 10:45 AM
Wisconsin corporation WARRANTY DEED
EXEMPT N
Grantor, CERT COPY FEE:
and Donald R. Schone and Doris A. Schone, husband and COPY FEE:
TRANSFER FEE: 119.70
wife RECORDING FEE: 11.00
PAGES: I
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in — St. Croix County, State of Wisconsin
(the "Property "): Recordine Area
RETURN TO: 4V Name and Retum Address
Burnet Title o l s ho �`,'� co\`Q
7550 France Ave. S. r s A S h n
First Floor nt n a \�
Edina, MN 55435 e Fa s, 5 22
ATTN: Post Clo n ntral
aQ t Q a 022 !ow — 7o
Parcel Identification Number (PK
This is ) not ���homestead property.
Lot Z in Certified Survey Map filed as Document No. 647126, lo part of the SW
1/4 of the NW 1/4 of Section 8, Township 28 N, Range 18 W, Town of Kinnickinnic, St.
Croix County, Wisconsin.
Together will all appurtenant rights, title and interests.
none
Grantor warrants that the title to the Property is goad indefeasable in simple fee and free and clear of encumbrances except
Dated this 27th day 0f August 2001
(SEAL) (SEAL)
V Q� +
Lenertz Farms, Wisconsin Corporation
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGEMENT
Signature($)
,` �. , .. , • �r''�, State Of Wisconsin,
tt
? �P•�� �� J ss.
- •r 's
z St, Croix County.
authenticated this dal of • * • = Personally came before me this 27th day of
-�
\ August , 2001 the above named
J
Lenertz Farms Inc. a Wisconsin
'PLI '09rE OF 444 �` ` corporation
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Slats.) instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Coldwell Banker Burnet 01 -27564
_ 1301 Coulee Road
tary Public, Stpt of isconsin
Hudson Wl 54016 My co unission Wpermanent. (If not, state expiration date:
( Signatures may be authenticated or acknowledged. Both are _tCG[ i o
not necessary.)
Names of Pe rsons signing in any capacity must be Med or printed below their Signature.
SYNrE ISA R OF WISCU SIN Wisconsin Legaffilank Co., nc.
WARRANTY DEED R0ILN1 No. 1 .1998 Milwaukee, Wis.
03.20.'2002 20:39 FAX 7154260780 kruger- thoner builders 10001
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Safety and Buildings
�� a 1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
� � www.wisconsin.gov
#: (608) 264 -8777
,sconsi n , - 2 2007 www.commerc
.state.wi.us/sb
of Commerce gov
Scott McCallum, Governor
Philip Edw. Albert, Secretary
August 12, 2002
CUST ID No.691727 ATTN: POWTS Inspector
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN ST CROIX COUNTY SPIA
SERVICE
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/12 12004 Identification Numbers
Transaction ID No. 776278
SITE: Site ID No. 649042
Don Schone Please refer to both identification
Coulee Trail numbers, above, in all
Town of Kinnickinnic correspondence with the agency.
St Croix County
SW1 /4, NW1 /4, S8, T28N, R18W
FOR:
Description: Mound System for Don Schone
Object Type: POWT System Regulated Object ID No.: 865601
The submittal described above has been reviewed for conformance with applicable
Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been
CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10),
Wisconsin Statutes, is responsible for compliance with all code requirements.
A copy of the approved plans, specifications and this letter shall be on -site during
construction and open to inspection by authorized representatives of the Department,
which may include local inspectors. All permits required by the state or the local
municipality shall be obtained prior to commencement of
construction /installation /operation.
In granting this approval the Division of Safety & Buildings reserves the right to require
changes or additions should conditions arise making them necessary for code
compliance. As per state stats 101. 12(2), nothing in this review shall relieve the
designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number
listed below, or at the address on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others
who are responsible for the installation, operation or maintenance of the POWTS.
ARTHUR L WEGERER Page 2 8/12/02
Sincerely, Fee Required $ 175.00
Fee Received $
175.00
Balance Due $ 0.00
Keith A Wilkinson
POWTS Plan Reviewer, Integrated Services
(715) 524 -3630, Fax: (715) 524-3633, M -F 7 am - 3:45 WiSMART code: 7633
pm
kwilkinson @commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist (715) 726 -2544
i