HomeMy WebLinkAbout022-1033-30-120 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 515113 0
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 X Township Parcel Tax No:
Cievering Homes LLC, C/o Kenneth J. Oeverin I Kinnickinnic, Town of 022 - 1033 -30 -120
CST BM Elev: Insp. BM Elev: BM Description: Q Section/Town /Range /Map No:
`7 'c7 A Z GS( 12.28.18.179A30
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
I
Septic / Benchmark � �DZt 9—/
QUA, Dosing G O�M,� (�� ,•, 3/ Alt. B o� �� 7Z.-
Ae -t i Bldg. Sewer /�'
Holding St/Ht Inlet
B 7 4►3
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO ,.j ` /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septi p �—+ , I /� Dt Bottom
75 N Z I Z 1 �
Dosing / AA Z Z I i i Header /Man.
3• `�' b
Aeration Dist. Pipe
Holding Bot. System 8. 97
v c
O ••7 f
Final Grade Q�
PUMP /SIPHON INFORMATION Z • D /p6 , to
Manufacturer Demand St Cover 9�, 7
e ` GPM
Model Number P � n - T7
TDH Lift p Friction Ls System Head TDH
Forcemain Len) / Dia. Z Dist. to weu /►
SOIL ABSORPTION SYSTEM �^-
BED/TRENCH Width , Length No. Of Tjen4es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS t1
SETBACK SYSTEM TO T P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR �\
Typ Of Sy em: Z7 �� , / UNIT Model Number:
DISTRIBUTI N SYSTEM
Header/ anifold Distributions +� /� x Hole Size /1 x Hole Spacing Ven Air Intake
Pipes) / /, (0 5 `-�. v
Length � Dia Length Dia /� Spacing �
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over / Depth Over xx Depth of xx Seeded /So ed xx Mulched
Bed/Trench Center I '$ Bed/Trench Edges Topsoil, es [E No es No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Z!Y/ 9 Inspection #2:
Location: 466 Division Av Roberts, WI 5 023 (SW 1/4 NE 1/4 12 T28N R1 8W) NA Lot 2
' k' Ms Parcel No: 1 8.18.179A30
1.) Alt BM Description i n = P. / �
i �bV- ti •C C�,. V_C P10,J L
2.) Bldg sewer length = 3b ,r t,.& JA. IS ✓�
- amount of cover =
'I Plan revision Required? Yes wo E L
-'
i
Use other side for additional information. _
Date Insepctor's Sig ture Cert. No.
SBD -6710 (R.3/97)
li
commerce fety and Buildings Division County
P A 1F1 #Washington Ave., P.O. Box 7162 �� a i
'sco n s' adison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
Department of Comore 51 511.3
Sanitary Permit Application State Transaction N
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental " t ✓
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if di erentt.* mailing cress)
submitted to the Department of Commerce. Personal information you rovide may be used for sec 0 t Z ' t l �t 1�i O
purp oses in accordance with the Privacy Law, s. 15.04 1 m , Stars. Y�"L,.0
I. Application Information - Please Print All Information D i v i i d n a G
Property Owner's Name Parcel #
><Lfc. ►�� v,�,zr aC_.. JUL 152009 0 4 2 - luj3 j 0 -1 v
Property Owner's Mail Ing ?j ST CROIX COUNTY Addres Property Location
/ ! 4 f�G �v � p tc $ � /
�� . PLANNING 8 ZONING OFFICE Govt. Lot • `
City, State Zip Code Phone Number sL 4-.# jy � _ %, Section 6 Z
Cw /01+1 J/_ � + , o l 7 ( circle one)
II. Type of Building (check all that apply) ft. g6) L T 7-6 N; R 1 Y! E or�V
P K 1 or 2 Family Dwelling -Number of Bedrooms Z__ Subdivision Name
st WOE. Bock #
❑ Public /Commercial - Describe Use ❑ City of
❑ State Owned - Describe Use c� V. CS Number 11 Village of
/ ' � P d 'Town of �NN- C IL" Nov � C-
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A, ew System ❑ Replacement System y p y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B. ❑Permit Renewal ❑Permit Revision El Change of Plumber El Permit Transfer to New
List Previous Permit Number and Date Issued Of
Before Expiration Owner
IV. Type of POWTS System /Component/Device: 1
❑ Non - Pressurized In- Ground ❑ Pressurized In -Gro Mt -Grade ound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pr sed (sf) System Elevation
S lJ E7`
VI. Tank Info Capacity in Total # of Manufacrurer
Gallons Gallons Units
New Tanks Existing Tanks
Y o ty
epti r Holding Tank Q0
D mg Cham er
"go
V esponsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS sho on the attached plans.
lum er's Name (Print) lumber's Signature M /MP Number Business Phone Number
a C7&t f- A 1.11 s 1 ZLZ 87L Y7Z -Lq7_ I
PI ber's Address (Street, City, State, Zip Code)
VIII. Coun /De artment Use Onl
Approved =�7. Permit Fee Date Is 1 �j Issuing t Signature
ial
IX. Conditions of Approval/Reasons for Disapproval
c d ( v ! -r^, -_ M -N u &L l s )S • - ,J X7 J - �11e. L/ 99
S eptic OWNER:
1. 3� 40 J: �)
1, Se tic tank, effluent finer and
as per ma r 1 y) Qf 6V AS I N. d submit to the County only on paper n - less than 81/2 1 inches in size t
2. An setbsck Wo
requirents must be maintained W ,- �-.r �"�+� Y►��.: ' AA r ° O �-
a per applic" cork / ordirwI ae.
SBD -6398 (R. 02/09) Valid thru 02/11
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Safety and Buildings
10541N RANCH ROAD
commerce.Wl.gov HAYWARD WI 54843
Contact Through Relay
i sco ns i n www.commerce.wi.gov /sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Richard J. Leinenkugel, Secretary
July 14, 2009
CUST ID No. 222872 ATTN.• POWTS Inspector
JACQUE M HAWKINS ZONING OFFICE
HAWKINS SOIL TESTING & SEPTIC SYSTEMS ST CROIX COUNTY SPIA
2659 150TH ST 1101 CARMICHAEL RD
LUCK WI 54853 HUDSON WI 54016
CONDITIONAL APPROVAL Identification Numbers
PLAN APPROVAL EXPIRES: 07/14/2011 Transaction ID No. 1684373
Site ID No. 749693
SITE:
Oevering Homes Please refer to both identification numbers,
i
above, in all correspondence with the agency.
Division Ave
Lot 2 vi
Town of Kinnickinnic
St Croix County
SW1 /4, NEIA, S12, T28N, R18W ll
(;Op7l•I
FOR:
Description: At grade, 3 bedroom residence
Object Type: POWTS Component Manual Regulated Object ID No.: 1233255
Maintenance required; 450 GPD Flow rate; 42 in Soil minimum depth to limiting factor from original grade;
System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual, SBD -
10573 -P (R.6/99); Effluent Filter
SE
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative C s SEE C
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s)
• In the event this soil absorption system malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans. In addition, the owner must insure that the
operation, maintenance and monitoring duties as described the At Grade Component Manual are complied
with. A copy of this information must be given to the owner upon completion of the project.
• The designer proposes to install an effluent filter to achieve the requirement of wastewater particle size.
Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic
tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations.
Reminder
• The orientation of the at grade system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual.
• Surface water drainage shall be diverted away from the system area.
JACQUE MHAWKINS Page 2 7/14/2009
• Materials shall conform to the requirements of COMM 84.
• Maintain well and waterline set backs per COMM 83.43(8)(i).
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.
Beginning October 1", 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are
based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit
and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22,
Wis. Adm. Code for further information.
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.
Sincewy I ? Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Patricia L Shandorf
POWTS Plan Reviewer, In ated Services WiSMART code: 7633
(715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm
pat.shandorf@wisconsin.gov
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.
1
JACQUE M HAWKINS Page 2 7/14/2009
• Materials shall conform to the requirements of COMM 84.
• Maintain well and waterline set backs per COMM 83.43(8)(1).
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.
Beginning October 1", 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are
based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit
and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22,
Wis. Adm. Code for further information.
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 $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Patricia L Shandorf
POWTS Plan Reviewer, I&e-grated Services WiSMART code: 7633
(715) 634 -7810, Fax: (715) 634 -5150 M -f 7:45 am - 4:30 pm
pat.shandorf@wisconsin.gov
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.
I
i A
RESIDENTIAL AT -GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
i
Project Oevering Homes At -Grade
Owner Overing Homes
Address 1433 Cemhouse Drive
New Richmond WI 54017
Legal Description SW1 14 NE1 /4 Sec. 12 T28N -R18W
Township Kinnickinnic County St. Croix �� f -: V
Subdivision Name CSM 16/4428 Lot No. 2
Parcel ID Number 022 - 1033 -30 -120 t'
Plan Transaction Number S (AND
ORRE. P
Index sheet Page 1
Page REGEPVE Pa 2 Calculations g / !�
At -grade drawings Page 3
JUL - 3 2009 Laterals and dose tank Page 4
SAFETY & BUILDINGS Management Page 5
Management & contingency plan Page 6
Pump Curve Page 7
Plot Plan Page 8
Designer Jacque Hawkins License Number MPRS# 222872
Signature �� Phone Number (715) 472 -2421
Date 091/09 1 /09
Designed pursuant to:
At -grade Component Manual for POWTS SBD- 10570 -P (R.6/99), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81)
Version 3.11 (05101) Page 1 of 8
PRESSURIZED AT -GRADE DESIGN
At -grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
300.0 Estimated wastewater flow (gpd)
450.0 Design wastewater flow (gpd)
7.00 % Site slope
98.50 Contour elev. below lateral (ft)
th to limiting factor (in)
0.6QVvieslitu soil application rate (gpd/ft "2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
10.00 Linear loading rate gpd /ft
8.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
94.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) a Center or end lateral connection
1 Number of laterals
0.125 Orifice diameter (in) e.g. 0.188
Not a final 2,00 Estimated orifice spacing (ft)
calculation
2.00 Forcemain diameter (in)
2.021 Forcemain flow velocity (ft/sec)
110.001 Forcemain length (ft) y or n y Does forcemain drain hack?
88.00 Pump tank elevation (ft) y or n y Are laterals at highest point?
NA
6.5 System head (ft) x 1.3 17.9 Forcemain drainback (gal)
h 6 10.00 Vertical lift (ft) 42.0 5x Lateral void volume (gal)
0.99 Friction loss (ft) 59.9 Minimum dose volume (gal)
17.49 Total dynamic head (ft) 19.8 System demand (gpm)
Lateral Diameter Sel Gallonslinch Calculator (optional)
P" diameter Design options Design choice Total Tank Capacity (gal)
Designer 1 in Total Working Liquid Depth (in)
must select 1.25 in Gal /in (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
3 in x 1000 Septic tank capacity (gal)
Skaw Concrete Manufacturer
Effluent Filter Information Dose Tank Information
Best lFilter manufacturer 642.01 Dose tank capacity (gal)
GF -10 Fitter model number 16.51 Dose tank volume (gallin)
Skaw Concrete JManufacturer
Project: Oevering Homes At -Grade
Transaction Number: Page 2 of 8
AT -GRADE PLAN VIEW
1/6 B Observation pipes (2 typical) A 8.00 ft
D B 94.00 ft
1/6 6 15.67 ft
C 10.00 ft
W c o 5.00 ft
E 2.00 ft
L 104.00 ft
B W 20.00 ft
A x B 750.00 ft^2
L
�.- Cap
Typical obs. pipe.
: � = Total aggregate cell A x B slotted in the lower
6 ", and anchored
Plowed area L x W
securely.
6 *
AT -GRADE CROSS SECTION
Synthetic fabric cover Finished grade
100.29 ft 9
Lateral elevation
invert elev. 99.00 ft '
.i-- Observation pipe
at aggregate toe
E 7 % Slope
Surface contour 98.50 ft C A
and system p
elevation
® = 12 in. topsoil and subsoil plowed layer
over aggregate and tapered to toes. y
_ below L x W
6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project. Oevering Homes At -Grade
Transaction Number: Page 3 of 8
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - End Connection
s P
Last hole dlrilled next to end cap 14- x Laterals b force main of PVC Soh 40
Holes drilled on the bottom of the lateral (per COMM Table 84.30 -5)
equally spaced • = Turn- upwlball valve oroleanoutpfug
Lateral Specifications
0.125 Orifice diameter (in) End Lateral connection point
X 1.95 Orifice spacing (ft) 1 Number laterals
48 Orifices /lateral P 91.65 Lateral length (ft)
19.8 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
19.81 Sys. discharge rate (gpm) 110.00 Forcemain Length (ft)
17.49 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather -proof �- warning label and locking device
Final grade
junction box
4"
disconnect
Tank component is Alternate
properly vented outlet
- ^ location 18" min.
Electrical as per NEC 300 and /k Approved outlet
Comm 16.28 WAC joint
Tank full
C Inches Gallons JA Provide 1/4"
A 21.3 351.1 Alarm on weep hole or
antisiphon
C 3.6 59.9 Pump on f3 device.
G D 12.0 198.0 89.00 ft C
Totalsl 8.9 642.01 pump off
D
3" Bedding under tank 88.00 ft
Goulds Pump manufacturer ISJ.Electro Alarm manufacturer
EPO4 Pump model number ITank Alert Alarm model number
Project: Oevering Homes At -Grade
Transaction Number. Page 4 of 8
At-a rade System Maintenance and Operation Saeci#ications
Service Provider's Name Sanitation I Phone 715 - 386 -0114
POWTS Regulator's Name St. Croix County Zoning Office Phone 715- 3864680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L
Soil Absorption Component Size 750.0 fe Maximum FOG 30 mg /L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Freauencv
Septic and Pump Tank Inspect and /or service once every 3 years
Effluent Filter Inspect and clean at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test monthl
Pressure System Laterals should be flushed and p ressure tested every 1.5 ears
Mound Ins ct for ponding and seepage once every 3 ears
Other
Mimillanoogg Construction and M& - 1%12 Standa s
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the at -grade component manual.
2. Dispersal cell aggregate confiorms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at -grade component manual SBD- 10570 -P (R. 6/89).
Lateral Turn Debit
Finished ...............
Grade
6-8" Diameter Lawn .� Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution - -
Lateral
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: Oevering Homes At -Grade
Transaction Number: Page 5 of 8
At -grade System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
Germwal
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals ]S1313- 10570 -1 (R. 06199) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance
and maintenance reporting.
No one should ever eater a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shag be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWrS 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 84nches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
c Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, State. 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 fifier 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 tows or an impending
continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such
products are used they shall be approved for septic tank use by the Department of Commerce.
Pumr, Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent tinter is installed within the tank it shall be inspected and serviced as necessary.
grade 4nd Preewre QWbution Systm
No trees or shrubs should be planted on the at- grade. Plantings may be made around the at-grade's perimeter, and the at -grade 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 at -grade 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. Colt weather installations (October - February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at -grade system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or
30 mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 10 du /100 mL for highly treated effluent. 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 Dogging 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.
Con#PA* tcv 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(s) shall be immediately
repaired or replaced with a component of the same at equal performance.
If the at -grade 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 renovating the biologically dogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWfS regulator and service provider.
Project: Oevering Homes At -Grade Transaction Number: Page 6 of 8
Page 7 of 8
GOULDS PUMPS Submersible
Effluent Pump
w
EPO4
3 871 EP05
AMMiL
;.
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance, construction.
following uses: heat transfer, ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and
• Farms manual operation. Auto- superior strength and corrosion Canadian �A��
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "C or 1")
facto rY strength, and durability.
SPECIFICATIONS ■ Motor Cover. Thermoplastic Gm" ftnPs is ISO 9001
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
'14" maximum, ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated o it and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: V12" NPT. seal protection,
• Mechanical seal: carbon -
rotary/cera mic- stationary,
BUNA - N elastomers,
• Temperature:
104°F (40T) continuous METERS FEET
140°F (60cC) intermittent. fo
• Fasteners: 300 series
stainless steel. 9 30 sGPM
• Capable of running
dry without damage to a zs ET
components. 25
° a 7 —
Motor: _
• EPO4 Single phase: CIA HP, `-' 6 zo
115 or 230 V, 60 Hz, 1550 s -
RPM, built in overload with o 15
automatic reset. a
• EP05 Single phase: 0.5 HP, o EP05
115 V or 230V, 60 Hz, 1550 - 3 70
RPM, built in overload with EPO4
automatic reset. z
• Power cord: 10 foot 5
standard length, 16/3 1
SJTOW with three prong
grounding plug. Optional 20 °
11 0 10 30 ao 50 GPM
foot length, 16/3 SJTW with
three prong grounding plug
(standard on EP05). ° z a s a 10 12 m /h
CAPACITY
G ould s Pumps
0 2001 GOUIds RJR)PS ITT Industries
Effective May, 2001
B3871
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page, of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner fti -A, ,.yy►! r Septic Tank Capacity f 0&4 to al D NA
Permit 11
Li Septic Tank Manufacturer .5 CA w ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 13 6 a ! L O 13 NA
Number of Bedrooms !Xn'N Effluent Filter Model �� S 0 O NA
Number of Public Facility Units P ump Tank Capacity c d al 17 NA
Estimated flow iaveragel S p aVda Pump Tank Manufacturer w , O NA
Design flow speak), (Estimated x 1.511 3 g avday Pump Manufacturer ,s O NA
Soil Application pate jj a al /davife Pump Model ePp O NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 0 NA
Fats, 08 & Grease IFOGJ s30 mg/i. 0 Sand /Gravel Filter 0 Peat Filter
Iiodmnical Oxygen Demand IBODJ 5220 nng/L 6-NA O Mechanical Aeration O Welland
Total Suspended Solids (TSS) S1 50 mg/L O Disinfection O Other:
Pretreated Effluent Duality Monthly average Dispersal Cellist O NA
Biochemical Oxygen Demand (SOD 530 mg/L 0 in- Ground (gravity) O "round (pressurized)
Total Suspended Solids (TSS) := MOIL &WA *At -Grade 0 Mound
Fecal CoNform {geometric mean) :S 1 W cfu /100m1 O Drip -Line O Othe
Maximum Effluent Particle Size Y in die. M-WA Other- O NA
Other: &NA Other: 13 NA
'Values typical for domestic - wastewater and septic tank affluent. Other: O NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tankis) At least once every: D y eart s ) aw( sl (Maudmum 3 Y om) O NA
Pump out contents of tankis) When combined sludge and scum equals one -third (Y of tank volume 0 NA
Inspect dispersal cellts) At least once every: 0 mont i s) (Maxinwm 3 years) O NA
Clear effluent filter At least once every: / (p this) O NA
O +erisl
Inspect pump. pump controls & alarm At least once every: month(s) O NA
saris)
Flush laterals and pressure test At least once every: mon(this) O NA
Other. At least once every: monthds) 0 NA
0 airier
Other.
0 NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal caps shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual Inspection of the tankis) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent an the ground surface.
The dispersal cents) shell 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 tank equals one -third W or more of the tank volume, the entire
contents of the tank shag be removed by a Septage Servicing Operator and disposed of in accordance with chapter NA 113,
Wisconsin Administrative Code.
AN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at Intervals of S12 months, shall be performed by s certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMw (4/01)
wisdonsin Department of Commerce SOIL EVALUATION REPORT Page � of 3
Division of Safety and Buildings
> in accordance with Comm 85, Wis. Adm. Cods
E1 V E[)
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must L i
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 ro id. G - 0 33-
Please print all information Reviewed by Date
Personal information you provide may be used for seconds ST. CR i1X. CUIJ
Property Owner
secondary purposes (Privacy Law, s. 15.04 (1) (m ). i _ v
CQ -f Z�5 Property Loc 1 o
,So nt S�13 114 N E114 S } Z T N R E (o W
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
lyS3 c�3vN�N° N
Z — , TZ'uposo cswi /6 y
City State Zip Code Phone Number
❑City ❑Village E0 Town Nearest Ro
R�3BQTq-S wl s�oZ� (�1S) - D1 VLS /0/V
New Construction Use: ED Residential / Number of bedrooms Code derived design flow rate 0c) GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material _ (S l-Pc- Nu `n l_L Flood Plain elevation if applicable fV A ft,
General comments � ��� S r
and recommendations: T�"'t GV/ 10 X ZZ-0 D1.ST�Z1 QVZ'7. �E;2C�
a Boring # [] Boring
® pit Ground surface elev. a� ' 3 ft. Depth to limiting factor 2 �� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1
C) si I Z+5 b Z �n`�1- �S Z •S -4a
Z 1p z� 1 l�`16Z 316 -- s i I Z b s 6T cS l .S _ g
3 Zy -30 �s72 L� s \ c.sbk YY1\)it�
`FS
F71 Boring # Boring
® Pit Ground surface elev. --) • O ft. Depth to limiting factor 7 C1 Q
P 9 m.
Sail Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2
o -�� )o�� 3iZ - sil Z�sb �� cs z� -s •8
C3
3 3S 5 )x'142 S �3 In u1� cw - d . Z-
5� -40 lS`i
• 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) $Wnatmre CST Number
Arthur L. Wegerer C�Z- L�4_Z _ 220254
Address W e g e r e r Soil T e s t i n g & Design Service Date Evaluation Conducted Telephone Number
421 N. Hain St. giver Falls, NI 54022 6 -Z([-0 Z _.715 -425 -0165
Property Owner V S C3 N Parcel ID # � � G +
Page 2 - of 3
F�] Boring # ❑ Boring
Pit Ground surface elev. a - - 7 ft. Depth to limiting factor '2 8 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
10 1 �'�162 31 SL 1 Z�'s 11 `m l� C-S
s
FY-1 Boring # I❑ L�1 Boring 1
pit Ground surface elev. (3 . 0 ft. Depth to limiting factor Z 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
� -1 � 1 p`12 3 ? Z -- �l � Z Sb�'L `M`fl� CS `� r S • �'
Z ►�`lZ �ti -1 iz. s i I 2.wlSbk rn IT . S �1
3 TZ - fib 10`? f2-j Cl '1.S`22 `��� S ` (� �m `F +� _ o • Z
F-1 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 /1`11
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#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.
SBD- 8330(R.6/00)
Property Owner _ � 1 S IV Parcel ID # �F'Y'J'Z�� I N G Page 2 - of 3 -
Boring # ❑ Boring
Pit Ground surface elev. Q • - 7 ft. Depth to limiting factor ? �J' 8 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
) % -ttz 31 - si1 Z�'s tinF� C-S S 8
R- - 31 b — s � 1 Zen s hk m 't- e g C_
- 3 4 to -I 2WiS " - •� -Z
Fq_1 Boring # ❑ Boring 1
Pit Ground surface elev. l3 Q . 0 ft. Depth to limiting factor Z in.
SoU 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
0 -1 10 'i 231z Zo I 2 .sbk yy�
Z wl 3 h m�r e.,,v l •S
3 �fZ -�0 to7RSf6 C.1T �,S't2S /� s �` O Yn 1 0 • Z
F-1 Boring # ❑ Boring
El 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
Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 m /L ' Effluent #2 =
_ 9 BOD < E _ 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.
SBD -8330 (R.6/00)
- Wisconsin Department of Commerce SOIL EVALUATION REPORT 1 of 3
Division of Safety and Buildings Page
in accordance with Comm 85, Ws. Adm. Code
County _
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must S r �7-DlX
include, but not limited to: vertical and horizontal reference point (8M), direction and Parcel I.D. 7
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �D
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
p-AiD PF)MC� -F� ��SON C;ovt I nt S�N3 1/4NC1/4 S T Z N R l E (o W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1qS 3 LOU rv` " N Z --
p OS� c s
City State Zip Code Phone Number [ City ❑ Village Town Nearest Road
Tz.I�B�S I�v s�vz -� ( �LZS -S1�.q `ct.�►�1�1. `rL))..� tv1 HIV t SIOIv �v�,
® New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate 00 GPO
❑ Replacement ❑ Public or commercial - Describe:
Parent material (S LFIf if i - ' 1 L_L Flood Plain elevation if applicable A ft
General comments
and recommendations: ' S't2�T� w/ ) p r x �. Zo DLS�IZC pv T} U►J e
�>✓y p�-,CZ N't�'U. X18. s '
FTI Boring # ❑ Boring
® pit Ground surface elev. a� ' 3 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2
1 0.10 10 -3t3 — si I Z--s z •S -b
Z l0 z� Lk�)'m :3 I b — s i ! Z W. S h k wl cS 1 -S
171 Boring # ❑ Boring
® pit Ground surface elev. Ct 0 ft. Depth to limiting factor 7 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
0 -!l�
10 , 19- 3!Z - Sl! Z- y�n1f1- CS Z� •S •F3
Z 10- 3 S J 1) `12 3l 6 - S i Z ►M. S b yyl' 1 (- -s l� • S . `3
3 29'S4 tovrz S /t3 �stsi c�r> In uiF-
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) S' na re CST Number
a t-
Arthur L. idegerer ()Z -L')Q -Z 220254
Address 4i e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number
421 N. Hain St. River Falls, UI 54022 6- Z(( ..715 -425 -0165
PLOT PLAN Page 3 of 3
Scale 1'= SO'
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CST Signature Date Telephone No. CST No. Job NO.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer Gcv f,c.,'„ �o s
Mailing Address 3 ��',c,�,`,, d �c l,c . /Le-,,,,
Property Address ! 1p } ] V 0 � ye .
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location 57Lu '/, / f '/, Sec. i Z , T Z- 9 N R 4 W, Town of �J. Iytii C k � N,v,'C
Subdivision Plat: , Lot #.
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house yesXno Lot lines identifiable/eyes, no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is
less than 113 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County 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
/ /Y /a
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.
(REV. 08/05)
{ illlli {Ilil Ill lli {i 1111! VIII IIII I {1111 {III !
*69861 I!
8988111 1
STATE BAR OF WISCONSIN FORM I - 2000 BETH PABS T
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
THIS DEED, made between C & J Builders, Inc., a Wisconsin RECEIVED FOR RECORD
06/[3J2009 08:45Ahi
corporation, Grantor, and Oevering Homes, LLC, a Wisconsin limited WARRANTY DEED
liablility company, Grantee. EXENPT I
Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 1 i .00
described real estate in St. Croix County, State of Wisconsin (the TRANS FEE: 156.00
"Property„): PAGES: 1
Lot 2 of Certified Survey Map tiled December 19, 2002, in Vol. 16 of
C.S.M., pg. 4428, as Doc. No. 703057, being located in the SW%of the
NE' /. of Section 12, Township 28 North, Range 18 West, Town of
Kinnickinnic, St. Croix County, Wisconsin. `
TOGETHER WITH a private driveway easement for ingress and Recording Area
egress over and across Outiot 1 of said C.S.M. Name and Return Address:
Loberg Law Office
359 West Main Street
Ellsworth, WI 54011
Together with all appurtenant rights, title and interests. 022- 1033 -30 -120
Parcel Identification Number (PIN)
This is not homestead property.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, covenants, and conditions of record.
Dated this 17`" day of June, 2009.
�* P ,
* By: Jeffery J. Husby, as President on behalf of
C & J Builders, Inc., a Wisconsin corporation
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
COUNTY OF ST. CROIX. ) ss.
authenticated this
Personally came before me this 17' day of June, 2009 the
above named Jeffery J. Hush
* rY Y, as President on behalf of
TITLE: MEMBER STATE BAR OF WISCONSIN C & J Builders, Inc., a Wisconsin corporation to me known
(If not, to be the person(s) who executed the foregoing instrument and
authorized by § 706.06, Wis. Stats.) acknowledged the same. G�.
THIS INSTRUMENT WAS DRAFTED BY 4 Q�
Robert L. Loberg
Loberg Law Office *Lip g . Green ;. b
(Signatures may be authenticated or acknowledged. Both are not necessary,) Notary Pu lc, State of Wisconsin T 1 .•� �' -
*Names of persons signing in any capacity must be typed or printed below their signature My commission is permanent. (If not, state expfrs QD
dpi 02 -17 -2013 STO )
SFA7245
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000
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RTIFIED SURVEY MAP
Gerald and Kathleen Benson, etal.
Located in the Southwest '/e of the Northeast %4 of Section 12, Township 28 North,
Range 18 West, Town of Kinniclannic, St. Croix County, Wisconsin.
OWNERS ADDRESS
651 150TH STREET
ROBERTS, W1 54023
NORTH 114 CORNER
SEC71ON C 1Z T 28 O BER R IB w NOTE REGARDING NOISE LEVELS
� (FOUND CONTY NTSEN NAIL)
"The lots of this land division may experience noise at levels exceeding the
NORTI+sourH levels in s. Trans. 405.04, Table 1. These levels are based on federal standards.
a fasFCnoNLINE The Department of Transportation is not responsible for abating noise from
existing state trunk highways or connecting highways, in the absence of any
>-' increase by the department to the highway's through -lane capacity."
m;
W; 3 D.O.T. Ai,proval NO. 55 -94 -3231 -2001 T
N
O'
BFIIRMYGS ARE D
2 SJNPLA7TED _LAN_ DS TO TWNOR FI•sottrH 1/4
SECTION LINE OF SECTION 12,
CO; T"9 R IS W, ASSIMIED AS
Q. OWNED _BY PLATTER N00V944'W.
1 1- N 88°41'32" E APPROVED
205 -49' tal SCALE IN FEET 1.-200- ST. CROIX COUNTY
+\ o sr Planning Zoning and Parks Committee
t2 160 6 1 0 2 0 MAY 2 9 2001
IWO
If not recorded within 30 days of
LEGEND approval ae
^ � a shmr
jI O INDICATES 1' x 24' IRON PIPE SET
(M/N. WT. - 1.13 LBA)N. FT.)
a SOIL BORINGS (PROPOSED SEP77C SYSTE"
I `,�� 0 SECTION CORNER MONUMENT (AS NOTED) I � I
LOT 9 p x — INDICATES FENC �'
212,420 SO. FT i� ' � �
?, OR4W7AC. p_ 1� <: 2:
g' g :Q PRIVATE DRIVEWAY EASEMENT r3 '!33 I f mi
PER VOLUME PAGE EASTLWE I 1 of
Z OF ST. CROIX COUNTY RECORDS sw1,w nrE1/4
I I ,,, "''
SW CORNER
x� SIVIAWFt/a — — — — — — — — — — — — — S 8 8"58'43"E 960.85' — — 07 I O;
-- _ - v
395.69' sss4' o— — — — — — — — —
927.84 — — — — — — — —° 81
SOILTHL 906.90' °p �M•_
Z 2.0' N88 °58��93991' 5'-; _•
33.01' `-
�; _LIN_PLATTED LANDS SE coRNER
O, NORT H+ OWNED BY_OTHERS SWI x}14 `" Z'
1.N SECTION LINE � c�nG N$ .. Z� 33133
�� OI�U
° ° LAUR
PHY O
S 1713
SOUTH 114 CORNER to ° RIVER
S ECTIO N 1�B�1BW ., Q_ I � I
wl.
DATED.
MARCH 6, 2001 GpoFO uai+o
`�6opnn.cp00
THIS INSTRUMENT DRAFTED BY JERALD L LARSON SHEET 1 OF 2
Vol. 15 Page 4094
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VOL 1f PAGE 4428
KATHLEEN H. WALSH
O E C 1 9 200? REGISTER OF DEEDS
ST. CROIX CO. WI
RECEIVED FOR ECORD
12/19/2002 04 : 00PK
approval date approvai srr,,ir b REC FEE: 13.00
nc4�;r grid COPY FEE: 3.00
PAG661 2 -
CERTIFIED SURVEY MAP
Theodore P. and Pamela R. Benson
Located in part of the Southwest 1 14 of the Northeast % of Section 12,
Township 28 North, Range 18 West, Town of Kinnickinnic,
St. Croix County, Wisconsin.
OWNER'S ADDRESS
1453 COUNTY TRUNK HIGHWAY "N "� ' LO rFrBJ 2 4 2"
ROBERTS, W1 54023
F
t.SURVEYOR'S 1)
ECORD I
NORTH 1/4 CORNER
SECTION 12, T 28 N, R 18 W
(FOUND COl1NTY BERNTSEN NAIL)
N
BEARINGS ARE REFERENCED
TO THE NORTH-SOUTH 114
SECTION LINE OF SECTION 12,
T 28 A R 18 W, ASSUMED AS
N00°0944" W.
UNPL ATTED LANDS I I �
SCALE IN FEET 1.=M.
S 88 °58'43" E 504.39' , 1 I
160 6 1 0 2 0 471.38' -
33.01' ' "
LOT 2
N OTE-
OUOT 1 CONTAINS 15,840 SQUARE 174,349 SQ. FT. OR 4.002 A ioo'
TL
I FEET OR 0.384 ACRES. (13,882 SQUARE M (16940 SQ. FT. OR 3 C r
b FEET OR 0.314 ACRES EXCLUDING EXCLUDING ROAD , I y
z I ROAD RIGHT OF WAY.) N RIGHT OF WAY)
OUTLOT 1 IS A PRfVATE DRIVEWAY o
BUILDING SETBACK
EASEMENT FOR INGRESS AND EGRESS o o - N 88 W 5 '33' -- I W
TO LOTS 2 AND I THE DRIVEWAY MUST z $ - 471.32' -
8 ENTER ONTO LOTS 2 AND 3 A MINIMUM = 264.33' ° _ 33.01"
OF 200 FEET WEST OF THE CENTERLINE N 88 0 58'43" W o o a5
LOT_ 1 OF DIMION AVENUE. S 8 0 5843" E z O g' (_ Z
t a 264.32'
CERTIFIED S - S 88 ° 58 43' E1504. _ 33.01 • 33
- - UNPLATTED.L — w
SURVEY P MA `o OT a' 3 �' w s
_ L � W
A 174,330 SQ. F OR 4.002 AC. �j 100' `�'
VOLUME _15,
(162,920 SQ. FT. OR 3.740 AC. co ol
° OCC ROAD RIGHT OF i �
P E 409 �f ,�i PRIVATE DRIVEWAY EASEMENT o WAY) BUILDING SETBACK 3
- -- 11 PER VOLUME 1674 PAGE 463
b f OF ST. CRODCCOUNTYRECORDS z
N 88_5843' ' W 456_57 471.27' 33.01'., , $•
SW CORNER I g c
C.S.M. LOT 1 ffi — — — — — N 88 °58'43" W 504.28' ?
_ 395.69 —��. �b — — — — — — — - 906.90' — 33
SWTHUNESWI /4IVE1 /4 — ----- S88 °5843'E 1335.60 ----- - - - - -- --
SE CORNER
UNPLATTED LANDS SW1144E1Af
� D. i
�. s c. oN S , ti LEGEND '�
DATED. 7 2002 INDICATES 1- 1 /4 "O.D. x 18 "IRON PIPE I '
• LAURENCE O SET (MIN. WE -1.13 LB�IJN. FT.)
W. : 1
MURPH Oi ;
8 * : s 3 : * • INDICATES f -1/4' O.D. IRON PIPE FOUND
:rc
SOUTH 114 CORNER FALLS, A SOIL BORINGS (PROPOSED SEPTIC SYSTEM) j� a
SECTION 12,T
(FOUND 1AWO.D. IRON PIPE7 1 • �••.••�, SECTION CORNER MONUMENT (AS NOTED)
.p J
Fp L.°, ND 5
THIS INSTRUMENT DRAFTED BYJERALD L. LARS N SHEET 101: 2
Vol. 16 Page 4428
l �'
/='APP OVEL). 710 3 O)l S 7
PianN11 : -11 ,. , VOL. PAGE 4428
KATHLEEN H. kALSR� --
DE.0 1 REGISTER OF DEEDS
ST. CROIX CO., III
RECEIVED FOR RECORD
Ir not recoraau .v;M.+, ,., ,. 12/19/2002 MOM
approval date approval W4111 ti.; REC FEE: 13.00
na4,s'zimi COPY FEE: 3.0
PAG66 2
CERTIFIED SURVEY MAP
Theodore P. and Pamela R. Benson
Located in part of the Southwest 1 %, of the Northeast %4 of Section 12,
Township 28 North, Range 18 West, Town of
St. Croix County, Wisconsin.
OWNER'S ADDRESS
1453 COUNTY TRUNK HIGHWAY "N"
ROBERTS ' W154023
lid � _•` i RD
NORTH 114 CORNER �T D
SECTION 1$ T 26 N, R 18 W
(FOUND COUNTY SERNTSEN NAIL)
N
BEARINGS ARE REFERENCED
TO THE NORTH -SOUTH 114
SECT10N LINE OF SECTION 12,
T 28 N, R 18 W, ASSUMED AS
N 00°09'44" W.
UNPLATTED LANDS
SCALEINFEET 1" =200' ._. I .133
IMEEMIN S 88 °5843" E 504.39' I
1 0 r 67 0 2 0 471.38'
N � 33.01'
NOTE- LOT 2
I OUTLOT 1 CONTAINS 15,840 SQUARE 174,349 SO. FT. OR 4.002 A 100' I
FEET OR 0.364 ACRES. (13 SQUARE co �I
( 940 SQ. FT. OR 3. C. .
g N FEET OR 0.314 ACRES EXCLUDING 3 EXCLUDING ROAD CrA
Z I ROAD RIGHT OF WAY.) - RIGHT OF WAY)
BUILDING SETBACK
OUTLOT 1 IS A PRIV DRIVEWAY a - I ,
EASEMENT FOR INGRESS AND EGRESS °c -- N 88 °58'43' W 5 33' - W
TO LOTS 2 AND 3. THE DRIVEWAY MUST z $ -47 1.37- `
ENTER ONTO LOTS 2 AND 3 A MINIMUM 264.33' _ 33.0 = g
OF 200 FEET WEST OF THE CENTERLINE N 88 0 5843" Woo Q�
LOT 1 OFDMSIONAVENUE. S 88 °58'43" E z • O 9 , -
264.32' – 24 – ,
CERTIFIED � o - 471.31' - 33.01'•`
— - S 88°58'43" E 504.
UNPLATTED.! t4N_�S s — — — — - W wl g
SURVEY MAP OT 3 L �., WW
174,330 SQ. FT. OR 4.002 AC. z' 100' � . �' � �
VOLUME 15, �, ° �� g
(162,920 SQ. FT. OR 3.740 AC. °oI
�r /f EXC ROAD RIGHT OF _
PAGE PRIVATEDRIVEWAYEASEMENT o "WAi BUILDING SETBACK �+
A ` PER VOLUME 1678, PAGE 463
OFST.CROIX000NTYRECORDS Z g
_ N 88_58'43' W 456_57
SW CO 33.01' .�
RNER — — _ _ _ 471.27' 8 0
C.S.M. L 3ss.e9 88 °58'43" W 504.28'
"_ _ _ _ 906.90'
—�..� 33
SOUTHUNESWi/4 -NEi/4 -- - - - - -- �S88 ° 56'43'E 1335.60' - - - - -- -- -
CIS UNPLATTED LANDS S
� II�
s� °NSA LEGEND 33IW
DATE 17, 2002 • • INDICATES 1 -114" O.D. x 18 "IRON PIPE ' '
LAURHNCE O SET (MIN. WT. -1.13 LBAJN. FT.) Z I �i
MURPH •
z * :
S17 3 : * a INDICATES 1-114' O.D. IRON PIPE FOUND
•• FALLS, 0 A SOIL BORINGS (PROPOSED SEPTIC SYSTEM)
SOUTH I14 CORNER wl.
SECTION 11 T O . D . RIB W •. • • • • • • •. •' �� SECT7ON CORNER MONUMENT S NOTED
(FOUND 1.1/4'.. IRON PIPE) A
�.p y J � ( )
LAND � i
THIS INSTRUMENT DRAFTED BYJERALD L. LARS N SHEET I OF 2
MEOW
Vol. 16 Page 4428 M
09
I o
CROIX COUNTY
PLANNING & ZONING
EROSION & SEDIMENT CONTROL PLAN
Site location: 466 Division Ave, lot 2, Town of Kinnickinnic
Owner(s): Oevering Homes LLC
Parcel ID #12.28.18.179A -30
Code Administ� "
715- 386 -4680 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may
n= attach reasonable erosion prevention conditions to a permit approved for issuance. In
Land Information addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit
Planning applicant and /or landowner to follow erosion control procedures and maintain them until
715 386 - 4674 fi t' the site has been stabilized (Uniform Dwelling Code Comm 21 is available on -line at:
www. commerce. state. wi .us /SB /SB- DivCodesListing.html)
Real Property
715 386 - 4677 The Owner of the above parcel is responsible for notification of all contractors performing
construction activities on this site that an Erosion & Sediment Control Plan is in effect and the
Recycling �; following activities will be required in order to maintain compliance with the plan:
715 - 3865
1. Maintain existing vegetation wherever possible to minimize erosion and sediment
movement. The primary source for construction site runoff will be the house
foundation and driveway excavation, well drilling, and soil stockpiled until final grading
and stabilization is complete. Septic system installation adds to temporary disturbance,
=N but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as
}x recommended in #5 below.
2. Install construction entrance before any excavation begins!! Construction
I wt equipment and vehicles must utilize a stabilized driveway access off public road for
heavy equipment; this includes cement trucks, well drillers, and other contractor's
vehicles that require access to the property during construction. Avoid muddy, rutted
conditions that may allow contaminated runoff to reach waterways and /or drainage
ditches. Property owner must repair damage to ditches resulting from multiple access
points and sediment tracked on public roadways must be removed at the end of each
workday.
3. Do not allow contaminated runoff to be directed onto neighboring property or into
surface water conveyances. Create temporary diversions graded ALONG CONTOUR
between excavated areas and any potential receiving waters (this includes driveway &
road ditches) by routing contaminated runoff into vegetated buffer areas on owner's
property. (A specification sheet for temporary diversions is available from county).
4. It is likely that contaminated runoff will not be contained with temporary
diversions, so installation of approved sediment control products (straw wattles, silt
fence, etc.) as shown on engineer's site plan will be required. The POWTS inspector
Ag and /or building inspector will evaluate ESC plan effectiveness and recommend
additional action required to comply with applicable regulations. Control measures
should be installed prior to mound plowing.
y
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A@IIPR ,..ds. itii cxi m� ,.. �wAp`AFfiG¢e::- ,W11aAF4YdPi.. .aawAimdiibrfi .`£,X.9 m;mnmwa. �a fu'. 'nmwwroc. e4 2^Y `lu4'PIVPk9dN;� -- ^- .a�.�:. .nc"� „W,�k£c .�
e h�muwwe"_ x.c.m�s.'�w -*^k a'Jfi.WmamM
ST. CRoix COUNTY GOVERNMENT CENTER
1 101 CARMICHAEL ROAD, HUDSON, W/ 54016 715- 3864686 FAx
PzPCO.SA /NT- CR01x. w /.us WWW.CO.SAINT-CROIX.WI.US
I
Page Two — ESC Plan Acknowledgement Form
5. Stabilize exposed soils (septic system included) with seed and mulch immediately after installation - DO
OT wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site.
n late- season weather conditions will not permit seed germination, a heavy straw mulch cover will
prevent ,erosion until vegetation can be established. Erosion control matting can be applied any time of year
and , ii tailed properly, will provide protection even if seed germination is delayed.
yn;
The owner rd during site construction will be responsible for compliance with state and county code
requirementsiM ecified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions
regarding eroi't h & sediment control product installation.
PLAN PREPA BY: RYAN YARRINGTON, SOIL EROSION INSPECTOR #683475
F ,
Owner ac wiled ement of ESC Plan requirements:
_ _/2009
(Please, tf j and return original ESC form to Planning & Zoning Dept. A copy is attached to the owner's permit and
maii#'hance agreement, which is given to the plumber at time of permit issuance.)
"Provide copies for excavation contractor, plumber, and town building inspector as needed
p
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M_E
Win nrm
Wit
V&
I .m .
ST. CRO1X COUNTY GOVERNMENT CENTER
110 1 CARMICHAEL ROAD, HUDSON Wi 54016 715386-4686 FAX
PZ0C0.SA /NT- CROIX.W1. US WWW.CO.SAINT- CROIX.WI.US