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261-1084-52-021
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578938 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: ^ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. « 0 /0726Permit Holder's Name: city Village X Township Parcel Tax No: Alire Rod & Jan Richmond Town of 261-1084-52-021 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Q~~ tl SI P 12.30.18.168A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic GX~ i ilt 1,660 & Benchmark 7 -97- 164 Dosing wee n Alt. BM 5.6,' 16oy"N A I; ~ ~J~w/ ~ aX. Bldg. Sewer 90, 5 a Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet (nom 'zz TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet / Z Septic ,7 /S 7 v, y ~ Dt Bottom $.q Dosing Header/Man. LIB 7 Is "7 Aeration / Dist. Pipe Holding Bot. System f 0 L`11 ~j, e 10 Final Grade PUMP/SIPHON INFORMATION 3.(3 Manufacturer / Demand St ver GPM 7 Model Number AA S(j ~s.~.e~'✓ ~Pa~J TDH Lift/ 0 7 Frictions~~ System He~CI~ TDH F Forcemain I Length / Dia. / Dist. to Well Zo 2 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2- ~if e SETBACK SYSTEM TO IV ✓ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR G Type O stem: ; O 7 7b UNIT Model Number: 5 DISTRIBUTION SYSTEM L L'S JV Z (`J Header/Manifojd I I Distribu 'on \ Ix Hole Size x Hole Spacing JVPipe(s) _.J~ ~ Length Dia Length Dia Spacing /1011-In G~0# SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 0109 /a Depth Over Depth Over xx Depth of xx Seed /Sodded xx Mulched Bedrrrench Center Bed/Trench Edge s\ Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1712 Royal Lane New Richmond, WI 54017 (NW 114 NE 1/4 12 T30N R119W) NA Lot 1 ^ Parcel No: 12.30.18.168A10 1.) Alt BM Description ~1^ G~~ ; ^~j {~aGa(G~j / u~ ✓C p~u 2.) Bldg sewer length = L nL - amount of cover = / / Jalt~e, f t }-ov~~ Z t'~/ ss F ~t' ` 4~D~GQC 4 or' Plan revision Required? Fm Yes XNo =13i5 U se other side for additional information. Date Insepctoe Signatur Cert. No. SBD-6710 (R.3/97) t77l 7") County Safety hod Buildings Division ST. CROIX ' © MAY 201 W. Washington V 162 Sanitary Permit Number (to be filled in by Co.) S P Madison, WI 53707-7162 UN N'DEVELOP NT 57 S 9 3 9 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for seconda 1712 ROYAL LANE purposes in accordance with the Privacy Law, s. 15.04 1) m , Slats. / 1 ~ 1. Application Information - lease Print All Information NEW RICHMOND, WI 54017 Property Owner's Name 7 Parcel # 9('01- '3- 5 _ ti 1 OD & J #N A IREv 026-1037-20-100 Pr pe wner s Mailing Address Property Location ` I G% A- 1712 ROYAL LANE Govt. Lot 1 ' City, State Zip Code Phone Number NW NE Section 12 NEW RICHMOND, WI 54017 N/A (circle one) T30 N; R 19 EorI& r1I1.. Type of Building (check all that apply) Lot # IN or 2 Family Dwelling - Number of Bedroom 3 Subdivision Name Block # El NSA El Public/Commercial - Describe Use P1 c. J,,e - City of CSM Number ❑ Village of El State Owned - Describe ppUse / / / 2 5~- C (,tJ & ; 5 L - EZ 0th S ' 1~ / 3 3 El Town of III. Type of Permit: (Check only o e box on line A. Complete line B if applicable) ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) A. ❑ New System ~ Replacement System date Iss ed B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber. ❑ Permit Transfer to New List Previous Permit Number an .q Before Expiration Owner 376 3)~ 6 2 IV. Type of POWTS System/Component/Device: Check all that apply) J] Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil C c ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) /3 C;_7 ~ow J `c1 V. Dis ersal/Trea ent Area Information: 4 /11 Design Flow (gpd) Design Soil Application Rate(gpd Dispersal Area Required (sI) Dispersal Area Proposed sf) System Elevation 450 :7- 642 650 95.6 VI. Tank Info Capacity in Total # of Manufacturer U r_ .1 Gallons Gallons Units 6 U 1 New Tanks Existing Tanks u o Po l a k- 5Z a U nn u V a Septic or Holding Tank 1000 1000 1 WEEKS X Dosing Chamber 800 800 1 WEEKS X VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' ignatur MP/MPRS Number Business Phone Number PAUL KOEHLER 225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII un /De artment Use Only pproved Permit Fee Dat Issue Issuing ent Signatur - 75 5 ~ teen Reason for Denial asons for Disapproval IX. . Cond tl""T!"= ~w,%* 3) ! maintained maw s1i PAS / -12 111, 11 a'~'~/on ~a t n iilll I~~ WW Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) JOB /4, L c r SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE SCALE i : - _ : : r...... t . _ _ . . \ * . y... _ _ - 2. - y a .40 i 1 .......:i.......... _ y `S lY` . i - . - t if . i.... L... ...Q ~ - gr/~ + 3 _ . Sc GanLY . X0.3 . x... . _ . Y ...`~.Y~..7S p pr . a. . ~c . . - 7V J r r.. t....... r- - .i....... .....i................... i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: ROD & JAN ALIRE Owner's Name: ROD & JAN ALIRE Owner's Address: 1712 ROAL LANE, NEW RICHMOND, WI 54017 Legal Description: NW 1/4 NE 1/4 SEC 12 T 30 N R 19 W Township: RICHMOND County: ST. CROIX Subdivision Name: N/A Lot Number: 1 Parcel ID Number: 261-1084-52-021 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: License Number: /~fjd 2 2~' 6 Date: 9 ?e/ zvl Phone Number 715-246-2660 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBO-10705-P (N.01/01). Page 1 I JoeG r SHEET NO. T Of CALCULATED BY -6 DATE CHECKED BY DATE SCALE j i ' ! i r : ; ;.......y..... . ! 1 : : ! i\ i i ' e : ..........4 1 K ...F..........• ....>........_.:..........i..........: i. t 1, ! : i i i : ; i i i : : ..i....... ....i.......... .;......................i.......... s.......... i................ . ...y....... ....v: D' .........j..........q........... 1 '1........ i. ....e......... w...... r........... w L t.......! : :.......x.. r ; _ 3 : i. 3 ll /y : V ! , x i r... ~1 . i 1.. gyp." Arp ~C.: i ~s t~^ .....3~~ ;c-ant Y . _ Loa 4 v4 r f r1~' ...1 r`..~. _ ti . ° . . "t . j.. ...9 _ 1 ...._f.... y.. v i.... - r . 1 t....._ SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page of I Project Name: ~oa1 iIh Jg'h No. of Cells Per Cell ft Cell Width Total No of L ft Cell Length sq ft EISA Per Cell ft Cell spacing sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator E71203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 I Gravelless Leaching Unit Manufacturer: K2 f /&,P) Gravelless Leaching Unit Model: f Z f 2, 0.r' Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent ■ Soil Backfill -L" in ` ` Geotextile Fabric ■ . 1 'O/ft Infiltrative Surface 12 in 0 Oi e/ n Limiting Factor ls~ all Z in Slotted and Anchored Vent/ Observation Pipe with Cap j Plumber/Designer Signature: License C 71a Date: ZZ 3o /z d/ 4 INSTALLATION INSTRUCTIONS Inc, Ttl'nrvatecns in Gra:asa +~raieaQt{~y`~1 Zabel' Q PL-525/PL-625 FILTER § Wasrewa7r ProEuds A .ristoer of . atykk hc. PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: e Rated for 10,000 GPD • PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 • Accepts 4" and 6" SCHD. 40 pipe The PL-5251625 Effluent Fitter should operate efficiently • Built in Gas Deflector for several years under normal conditions before .Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the .Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Filter Extension Handle 7. Risers Riser Covers Extend & Lok- Riser Safety Screens Fitter Alarm Panel and Polylok risers bring your Polylok.Extend & LoV4 Polylok safety screens smartFilterTm Control septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch. This allows locating and solution that can extend: from happening by children Polylok fitter alarm panels servicing your fitter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending filter and tank entrance. Fits 3" and 4" pipe. servicing. For a full list of Polylok products please visit our web site at: www.polylok-com D I V ERTER AND BACKWATER VA LV ES Diverter Valve Here's the simplest, strongest, and most economical diverter valve ever invented for septic tank leach fields. It is made of tough molded plastic that will not shatter, bend, rust or corrode. It is lighter in weight, easier to handle and less expensive to ship. Functional The diverter valve stem flow may be controlled to individual or multiple fields (up to three) in any combination. With a three-way valve stem, flow may be diverted to any two outlets. To allow flow through all outlets, the valve stem may be removed from the assembly. Easy To Install Connect 4" plastic sewer and drain pipe to inlets and outlets on the four way distribution box. (Unwanted outlets may be sealed by installing caps). The Diverter shield which houses the diverter stem may be cut to desired length. 6.305 Pkg. M. Ea. Product Part No. Description Color Qty. Obs.) Class PVC 575P 4" PVC Diverter Valve White 4 9.50 35PV A BS 575 4" ABS Diverter Valve Black 4 7.50 35AB CLOSED 1 2 3 m 0a TANK 1ANK 1ANK _ 4 5 6 4.125" O.D._ o TUFN 10 _ #2 O # `IAPMO Listed ~ e 0 O #2 R4 LLI 11" 6-7 LLLJJ COVE caP cnv 1ANK TANK INN62S1EM TANK Gravity Backwater Valve The NDS gravity flow Backwater Valve is designed to protect low areas or basements from the backflow of waste from street sewers. It is available in 2", 3", 4" and 6" sizes PVC material. It is a cost effective and a chemically resistant alternative to cast iron valves. Backwater Valve The quick action flapper allows unrestricted uni-directional flow. Elastomeric gasket in the flapper ensures a watertight seal. Flapper can be easily removed and replaced if required. Threaded access cap is designed for hand tightening. Access cap neoprene gasket provides a positive seal. Valve hub outlets fit 2", 3", 4", or 6" DWV pipe and may be adapted to 2", 3", 4", or 6" sewer and drain pipe with NDS DWV to Sewer & Drain Adapters. Lightweight, easy to install. Horizontal installation required, with arrows on top of the valve hub pointing in the direction of the flow of water. Access riser with cover offers a simple, economical Item Number A B C Riser Height Riser Dia. assess to the valve for inspection and 275P,275 2.18 5.03 3.53 16 4 maintenance. The riser may be cut to 275PR 2.18 5.03 3.53 16 4 the desired length. 375P,375 3.51 7.56 6,10 16 6 375PR, 375R 3.51 7.56 6.10 16 6 475P,475 4.47 11.18 7.18 16 8 5R 4.47 M18 7.18 16 8 675P, 675 5:50 15.25 9.90 16 10 l' f 1 ; MEMBER IN ipr Approvals applicable to valve only. B Note: All dimensions are nominal. All weights are for shipping purposes only. Availability is subject to change. 2 r N 00 S. For customer service, please send your fax to: 1-800-726-1998 or call 1-800-726-1994. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of FILE INFORMATION SYSTEM SPECIFICATIONS _ Owner ROD & JAN ALIRE Septic Tank Capacity 1000 al ❑ NA Permit # - Septic Tank Manufacturer Wl );kG O NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK d NA Number of Bedrooms 3 13 ]NA Effluent Filter Model 525 ❑ Nc1 Number of Public Facility Units lp Pump Tank Capacity 800 gal ❑ N 4 Estimated flow (average) 300 gal/Pump Tank Manufacturer WEEKS ❑ N.4 Design flow (peak), (Estimated x 1..5) 450 gal/day Pump Manufacturer GOULDS ❑ NA Soil Application Rate .7 al/daY/ft2 Pump Model EP05 ❑ NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg/L E3 Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSSI 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) 530 mg1L 13 In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Col form (geometric mean) 510' ofu/100ml ❑ Drip-Line 0 Other: Maximum Effluent Particle Size Y in dia. 0 NA Other: ❑ NA Other: ❑ NA Other. 0 NA *Values typical for domestic wastewater and septic tank effluent. Other ❑ Nil MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 0 month(s) (Maximum 3 years) NA 3 10 year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y► of tank volume ❑ N/~ Inspect dispersal cell(s) I At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NEB IV year(s) Clean effluent filter At least once every: 1 r t 0 ear( )(s) ❑ NA Inspect pump, pump controls & alarm At least once every. 3 8 month(s) 0 W, year(s) Flush laterals and pressure test At least once every: ❑ month(s) CX W, ❑ year(s) Other: At least once every: 0 month(s) ❑ N<, O year(s) Other: ❑ W. I -A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surfac a. The dispersal cell(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113. Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Z of Z' START UP ANb OPERATION Pago For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic3 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conten• of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge c effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the are within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.elimination of the following from the wastewater stream may improve the performance and prolong the life of th4 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation drain (sump pump) water, fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail. painting products; pesticides; sanitary napkins; tampons; and water softener brine. AaANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: a A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkin system. The replacement area should' be protected from disturbance and compaction and should not be infringed upon 11y required setbacks from existing and proposed structure, lot lines and wells- failure to protect the replacement area a III result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWI'S technology a holding tank may be installed as a last resort to replace the failed POWTS. slue. ' 1`r m ing jam' ~ ear ~Ri7F'lt8 TTi~ ~R- A/ ~fVSTRflG~l~ rk ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY 13E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATING, INC Name PAUL KOEHLER Phone 715-246-2.660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPERI LOCAL REGULATORY AUTHORITY d9 11 2badmf Name POWER LIQUID WASTE MANAGEMENT Name ~-•r G Phone '715-246-5738 Phone ~'!-~~p (v O This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and a3.54411. (2) & (3), Wisconsin Administrative Code. uoi u r i uu "nL ta: uo rAA i to 400 4686 5'1' CKA W WNING 10001 ST. C:ROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWN ERSLIIP CERTIFICATION FORM Owner/Buyer. ROD & JAN ALIRE Mailing Address 1712 ROYAL LANE, NEW RICHMOND, WI 54017 Property Address k 1712 ROYAL LANE, NEW RICHMOND, WI 54017 _ (Verification required front Planning & Zoning Department for new construction.) City/State NEW RICHMOND, WI Parccl Identification Number 261-1084-52-021 LEGAL DESCRI.P'I'ION Property Location NW '/4 , NE , Sec. 12 , T 30 N R 19 W, Town of RICHMOND Subdivision CITY OF NEW Rj.. HMOND , Lot # Certified Survey Map # 628624 , Volume , Page # Warranty Deed # , Volume , Page # Spec house 0 yes [kno Lot lines identifiable byes 0 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 duree 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, sighed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as Set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & 7oning Department within 30 days of the three year expiration date. T/we certify that all statements on this fo are true to the best of my/our knowledge. I/wc am/are the owner(s) of the property des d above, by virtue of a warranty eed recorded in Register of Deeds Office. Numbe of edro 3 4~ 30 /2015 SIR ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. M Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey roap if reference is made in the warranty deed. (REV. 08/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 46z..&J 4hY- loc d at: IYW 1/, AIA 1/, Section )~7, Town_ap _N, Range Town of St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will cohform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes Note,- (if no, skip next line.) ~~►r dS -4, , Approximate volume or length of time: gallons•J/ minutes Tank Capacity: P00 Construction: Prefab Concrete Steel Other Manufacturer (if known): r, tx--XP Age of Tank (if known): Z. , r ®p Permit number (if known) 10090, -00 411-ee (Licensed Plumber Signature) (Print Name) 1~745A4- /d/ -&"430- Az L) z sy~~ (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 illllillll11i1111fllllfiillllll 8185426 State Bar of Wisconsin Form 7-2003 Tx:4153589 TRUSTEE'S DEED 986684 BETH PABST Document Number Document Name REGISTER OF DEEDS 11 ST. CROIX CO., WI THIS DEED, made between Marc M. Lybeck and Lizabeth A. Lybeck, 09/27/2013 2:39 PM as Trustee of the Marc M. and Lizabeth A.Lybeck Living Trust dated EXEMPT#: NA July 10, 1997 ("Grantor," whether one or more REC FEE: 30.00 and Roderick R. Alire and Janice Alire, husband and wife, as survivorship TRANS FEE: 1545.00 PAGES:2 marital property ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant St. Croix County, State of Wisconsin ("Property") (if more space is Recording Area needed, please attach addendum): Name and Return Address a See attached Exhibit A for Legal Description AllianccTitle 7380 France Ave South 4250 Edina, MN 55435 File # 10792 026-1037-20-100; V Parcel Identification Number (PIN) For Ref only: Property Address = 1712 Royal Lane -New Richmond, WI 54017 Dated September 17 , 2013 (SEAL) G Zt&Z ~V (SEAL) * Marc M. L beck. TCLIS Li eth A. L beck T to (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) KA%n GS STATE 0 F-~#1SCOTdS~3d-~~ ) authenticated on y COUNTY ss. A&hi n&m * Personally came before me on C1 -1 ri-La TITLE: MEMBER STATE BAR OF WISCONSIN the above-named DA - (If not, -A I L17. L authorized by Wis. Stat. § 706.06) to -e *.no be the pe son(s) w o executed the foregoing st u t and ac nowledge4the KAMI TEISCHOMI THIS INSTRUMENT DRAFTED BY: COMM. #6160915 Notary u ' Redmon Law Chartered (Richard Lau) * I s State of M*nnesota 401 Second Street, Suite 200, Hudson, WI 54016 ~aryub ic, State of iscCommission-Expires 1131/2016. My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. ~ RW EE'S DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 7-2003 Ipype name below signatures. Exhibit A Legal Description of Property Lot One (1) of Certified Survey Map as recorded in Volume 14 of Certified Survey Maps on page 3933 as Document No. 628624, being located in the Northwest Quarter of the Northeast Quarter (NW 1/4 NE 1/4) of Section Twelve (12), Township Thirty (30) North, Range Eighteen (18) West Town of New Richmond, now being a part of the City of New Richmond, St. Croix County, Wisconsin. Together with an easement for ingress and egress over all of Outlot One (1) of Certified Survey Map as recorded in Volume 14 of Certified Survey Maps on page 3933 as Document No. 628624, being located in the Northwest Quarter of the Northeast Quarter (NW 1/4 NE 1/4 ) of Section Twelve (12), Township Thirty (30) North, Range Eighteen (18) West Town of New Richmond, now being a part of the City of New Richmond, St. Croix County, Wisconsin. 10792 2 of 2 ROIN AL0 JoHmSON << FILE 6-t 18(s D AMERY WIS. j%UG 2 2 rr~" KATHLEEN H'%49M t Reiiistef of Deeds v '4No suR1f E CfolxCo.,Wll t. !RIP *"*at CER URVEY MAP Located in part of the Northwest Qu f ortheast Quarter of Section 12, Township 30 North, Range 16 West, Town of Richmond. St. Croix County. Wisconsin. Prepared for and NOTE: The owner of Lot 1 shall annex the property to the City of New Richmond at the request of: when sewer and water are extended to the Peninsula Heights subdivision. The owner of Lot 1 shall also maintain and remove snow from a driveway it will OWNER: use across Royal Lane. The driveway will extend from Peninsula Road to Lot 1. Kevin Earley 660 North 4th Street NOTE: AN EROSION CONTROL PLAN WILL NEED New Richmond. VA. 54017 i~ TO BE SUBMITTED AND FILED PRIOR TO BUILDING Drafted by. Jason M. Gustafson CONSTRUCTION. NORTH QUARTER CORNER - - - - - - 2 I SECTION 12-30-18 -o FOUND ALUMINUM COUNTY MONUMENT I I I tf] Q; ;C)il ao ao O U TL O T T FOR EASEMENT PURPOSES TOTAL AREA: to r- 1 IV)I Crlii mj ~o o UNP FT OWNERNDS O406ACREST L,_ 1 I fn IF.._I I-1! 66' EASEMENT FOR I--~Vi a~rl-INGRESS AND EGRESS 11 N89'42'36"E 240.11OYAL LANE r-- _---~1 3 66-00' o_ /NOT BUILT S Ml ` NP ATTED LAN S Mi / - N---~--/ N89'42'36"E -I~~w'-x- F OWNER R MI 262.94' ~ OF OWN Mi r l ~ ~ l $ 00 .L O.T.. i...... ` 1~., to TOTAL AREA: \tZ M 20J,462 50.F7. r u Ir ,Ss 4.67 ACRES AREA TO MEANDER LINE.- A~` m 114.087 SO. FT. tom" \ O FLOOD LINE 2.62 ACRES PER 1984 CITY g o \ jam, t OF NEW RICHMOND o uNE ro", ORTHO/CONTOUR MAP. \ Zj Z 5 5*, PppSfS OF S 399 -11'r • ` r t 100 YEAR EVENT FLOOD I~ tt--•x-`~ ELEVATION =985.00 FEET -x V ttll 57-' 49 V- l N O TH _i -FLOW t~- SHORE-~, 00 586'22'15" W P f -e, ~o - 124.18 ' ROX/ Ma 7,E. - - - - _ _ A/y77 ~ ~ 3j3 34 F CREfk NORTH L/NE DF 7JYE _ SOU17-I OUARTER CORNER - PENO/NG PLAT OF LOT 1 PROPOSED BUILDING: SEC770AI 12-30-18 BRUSHY MOUND LAKE FINISHED FLOOR FOUND 7- IRON PIPE I1N~l ~TTED LANDS` Jr- ELEVATION=998.00 FEET BASEMENT FLOOR LEGEND: ELEVATION-988.00 FEET NOTE: IS SET 1" IRON PIPE S101 HOWN Corner Monument AS THE SOUTHEAST MEANDER CORNER OF LOT 1 Set 1" x 24" Iron Pipe weighing ELEVATION=991.06 a minimum of 1.13 pounds per linear foot. NOTE: The parcels shown on this map are subject to • • • • . • Building Setback Line 100' from R-O-W. State, County, and Township lows, rules and regulations 75. Setback Line from Navigable Water (i.e. wetlands, minimum lot size, access to parcel, etc.). Denotes Wetland Before purchasing or developing any parcel, contact the APPROVED St. Croix County Zoning Office and the appropriate Town -x --x - X Denotes Existing Fence ST. CROIX COUNTY Board for advice. R-O-W Right-Of-Way Planning Zoning and Park&Committee 150 0 150 JOB # A00043 AUG 2 2 2000 Prepared by. GRAPHIC SCALE A & E SCALE IN FEET: 1 inch - 150 feet LAND SURVEYING & CIVIL ENGINEERWW recorded within 30 days of Phone No. (715) 245-4319 approval date approval shat) be BEARINGS ARE REFERENCED TO THE NORTH/SOUTH 1 /4 109 East Third Street, P.O. Box 325 null and void LINE OF SECTION 12. TOWNSHIP 30 N., RANGE 18 W. New Richmond. WI 54017 WHICH IS ASSUMED TO BEAR N00'16'21"W. Sheet 1 of 2 VOL. 14 PAGE 3933 Wisconsin of cormence 10 RT Page 1 of 3 Division of So" and Bdk*Vs in accordance ,a Co ~ OM St. Croix Mach aornplete site plan on paper not less Clan 8112 x in size• I.D. incNrde but not tirrited to: vertical and horfmrrtal refs (BM ~~Idd~ ~ et percent slope, scale or dimensions, north arrow, wW nd in dis CA ~oFF~ - viewed by Date pion" print all informa persorA* dbmwe n you Prov mey be used fornooedwY t tw 5.04 (1) Propertyowner _ NW 1/4 NE 1N s 12 T 30 N R 18 2MO) w Kevin # Block # Subd. Name a CSM# ftqmV ~'~s 1 na csm 660 N. 4th. St. city State JUP Code Phone ❑ City ❑ VlYa9e ® Town Nearest Road New Richmond, WI. 54017 (715 ) 246-4939 Richmond Ro al Lane ® New Consnucuon Use: ® Residential I HurnI er of bedrooms 4 code derived design new rate 600 OPD ❑ Replacbment ❑ Public or canenerciW - Desalts: Parent nmbw al not u a sb Flood Plain elevation If applicable C,eneral ootrMnents and rooorrsrrendallorca: Bo*v n . F-1 1 eoft # ® Pit cwmw sum elev. 100.1 It Depth to In. Sag Rate Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots GPOW in. Munseg Qu Sz. Cont. Color or. Sz StL 'Elf#1 'Eff#2 1 0-10. 10 r4/3 none 1 2msbk mfr cs 2f .5 ✓ .8 2 10-21.7.5yr4/4 none sicl 2msbk mfr w if .4 .6 3 21-9 •7.5yr4/4 none 1s Osg mvfr na na .7 1.2 s sy" 0 eon Rats Boring * ® Pit Ground wrfeoeelev. 100.9fL Depth to limiting factor +97 ' in. Soll Maimn Dep11 DornfiwA Color Redox Description Texture Smjc*" Cor>sbitance Boundary Roots GPDIW in. MunseN Qu. Sz. Cont Color Gr. $z• Sh. 'EWI 'Eigf2 1 0-9• 10 r4/3 none 1 2msbk mfr cs 2f .5 2 9-25. 7.5 r4 4 none suet 2msbk mfr if 3 25-9 -7.5 r4 6 none ms Os mvfr n ✓ i qS 3. v • Emuent #1 = BCO > 301220 nrglL and TSS >301 150 RgIL ' EAluerd #2 = BOD 30 mylL and TSS 5 30 mglL CST Name Planes P" CST Number Num Gary L. Steel Teleptano WanbW Address Date Evaluation Cortdiactad 1554 200th. Ave., New Richmond, WI. 54017 7-6-2000 715-246-6200 Kevin Early Parcel ID # ~endino of 3 PropertyOwner a Bof # ~ p Ground surisoe elev: 100.2 tt: Depth to __:I g 'In Sop Applodbn Rate co erce Boundary Rods. OPDAE Horizon Depth Dominant Colo Redox Description Texture Stnxouure Qu. Sz. ConL Color Gr. Sz. Sh. 'EW-1 'Ef#i2 in. Munsap 1 0-8 10yr4/3 none 1 2msbk mfr cs 2f .5 ✓ •8 j if .4- 2 2 8-17. 7.5yr4/4 none sicl 2msbk mfr gw 3 17-34 7.5yr4/4 none is Os mvfr W na .7 1.2-~ 4 34-92 '7.5yr4/6 none ms Osg mvfr na na .7 ✓ 1.2 f 9S SS.Z„ li -1 t Sop Rate F4] Boring # ® pith Ground surleoe elev. 99.8 R Depth to rmiting factor +96_ in. Taurus's Sinx Lure Consistence Boudary Roots GPDW Horizon Depth Dominant Color Rsdox Description •E##1 •e1M2 In. Munn p Qu. Sz. Cont. Color Gr. Sz. SK 1 0-16 10 r4 3 none 1 2msbk mfr cs 2f .5 .8 2 16-36'10 r4 4 none sic 2msbk mfr aw .4 -.6 3 36-96.7.5yr4/6 none ms Osg mvfr na na .7-/ 1.2 i i1 ❑ + D 6airrg # 13 pBodre it Grounnd surface elev. 99.40- Depth n•Wd&V factor -55-- Sop Rate Horizon Depth Dmdnent Color Redox Description Teak" Sbucture Co amence Boundary Rods O Gr. Sz. SK 'E-8#1 VIM in. Murwep Qu. Sz. Cont. Coto 1 0-11- 10 r4/3 none 1 2msbk mfr cs 2f .5 .8 2 11-3 •10 r4/4 none sic 2msbk mfr if .4 .6 3 36-9E- 7.5yr4/ none ms Osg mvfr na na .7 1.2-( II ~ EMwnt #1 = SOD, > 30 < 220 mWL and TSS >30 150 mgA. • Emuent #2 = BoD, 30 mplL and TSS 130 mplL 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. aeoa»opaweot j STEEL'S SOIL SERVICE Gary L. Steel Kevin Early 1554 200th Ave. CSTM2298 NW4NE4 S12-T30N-R18w New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #1-csm N 1"=40' BM.= top of 11, pvc pipe 2 el. 100.00, Alt. BM-= top of 1" pvc pipe @ el. 99.10' o ~~v 4j 7.9. Gary L. Steel 7-6-2000 %[Ct~'~ BSc I~ JOB SHEET NO. Of / T ,..a. CALCULATED BY DATE CHECKED BY DATE SCALE / 1 Yb' - i i . 4 1 t... i.........., ` .......1...".......r... IF p. i i..........., v........"".ln.~-...... ...~....,.....r.. f.. "..........j i........... : i : i i t i - t i ...........a : i - 1 • .......1 i..........:........-b. i i l _ r - : . _ F t p~ AW" . i 1 8y a f 1 aR ~ . zed " . . . . _ ✓ALI x ~u i " pr f ti a~ 3► . .G. { .i a _ r .....................s.......... " T Ems- W~ O • U T as c WEE a W N S W d ?i v ~ o W bb N > N T ; N y r 4D O W E a N N N ° C K f° T ; L N 'C W 2z 8 W o c N U 'o °c m 3 O1 = o ° g = Z E v W N y c x U W 361 °W U E° W IX 2 d m a E m o U t x W m= p° E B ~ O sew _ r W U S U1 fA s J - 7 U J K R' K > ~ m LL ~ O ~ W LL (n 0 Ir J ❑ S Wd= E, m~ a w fay , „ xf•,.. f Yn ` ''%M w y Q ~ ~ II t'c1 41 p O w K ry a t r u Y T U.I G ~ ~ r O N ~ , it . N+T ! C d~ESC 1n T ~ _ ~ i 't 'fit ~ rv ~Q N N N Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County ' Safety'and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,%Tdeo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ VigQ ❑ Tot{v of: State Plan ID No.: Lybeck, Mark kin M11onc Township CST BM Elev.: I Insp. BM Elev.: I BM Descriptio n:p ,i_1 Parcel TM~IoT037-20-100 .p 6U. > le 11ILP► _ ~sT-,s M,'N'_ b TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Jec,,S avn Benchmark I03•5-?> erz),v Z sr) I~p.l~ Dosing W~-S Alt. o3•~fl Aeration Bldg. Sewer F~„r,,~( 92 •S 1 Holding St/Ht Inlet l3~ Ilf.Z~- 9Z.31' D TANK SETBACK INFORMATION St/Ht Outlet rl. a l ~o / ° 92. 8 t Vent TANKTO P/L WELL BLDG. AirIto ROAD Dt Inlet ntake us" qz'0z~ ` Septic ~((mp Y30 I (9 NA Dt Bottom 3,r I ~.Ob Dosing >4,9 ' > ► iv p~ Mr.P Header / Man. a Aeration I Dist. Pipe ~s~ ' bZ ~b •9l, ► Holding Bot. System $ 8 IV, $•0`{ qS.S4' PUMP/ SIPHON INFORMATION Final Grade 3.25 aD , 33` Manufacturer St cover 6C%e_4L6 Model Number erero g -(o q(v •`1 I 115`~Toss mead DH Lift a l Lrictiorb ,24b System TDH ~.ZO Ft ' (y,°i'1 Forcemain Lengthti Z S# Dia. /c Dist. To Well > I SOIL A ORPTION SYSTEM BENCH Width ( Lent N .Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 3 I (a 8- ~ DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK ~~~*Tbe ' Sit~Wt INFORMATION System: Cow/. 1> ,ZD S, } (OD ) 6.0 r OR UNIT CHAMBER Mo el Num er: System: - Gt- kU DISTRIBUTION SYSTEM Header / ni old Distribution P (s) H x Hole S acing Vent To Air Intake Length C-' Dia. L Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~LZ u epth Over a th Of xx Seeded / ded xx Mulched Bed /Trench Center 3(O 'TT Bed /Trench Edges Topsoil ❑ Yes ❑ No N COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1•.02-/O'*D ( Inspection #2• ' t Location: I'l 12 gojaA 1,winc. NtW ki'A wl,*t ,ar 5401') (NW 1/4 NE 1/4 12 T30N R19W) - 123018168A10 -Lot 1 1.) Alt BM Descrip ion op ohs gR `e'" ~NE ca'~*°^r) 2.) Bldg sewer length = 30.0' V -amount of cover = 1 ~f2 Soi Uh> 3) ~w -tam OAW-J %A- Plan revision required? ❑ Yes X No Use other side for additional information. 0 2. off- 0 SBD-6710 (R.3/97) Date Inspector's Signature Ce ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I i s i j--t 3 r f t E 1 o - t - r Sanitary Permit App a ion Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. 9odg0'~ 201 W. Washington Ave. ~ t I PO Box 7302 See reverse side for instructions for completing thiSa licatiopF , ' iseonsin Personal information you provide may be used fors~~on` ry Madison, WI 53707-730' Department of Commerce y y qj - -t purposes (Sub itico pleted form to county if r [Privacy Law, s. 15.04(I)(m)] I'r : s 5 2, I state owner 19 Attach complete plans (to the count), cop), only) for the System, on a not less Irn( lax I 1 inc es t size. County - ro^ / State Sanitary 2e Number Check if revision to p vi s applica to Plan I ,DL Number law =f p Zt k41Ni OFF-CE 1. Application Information - Please Print all Information Property Owner Name !P o cation ( ' l r,c- )VW) 1 /4 JVC 7/4, S 12 T:~O N, ROFt o W Property Owner's Mailing/Address Lot Number Block Number / 5 4 City, State Zip Code Phone Number Subdivision Name or CSM Number IT Type of Building: (check one) ❑ City Jet 1 or 2 Family Dwelling - No. of Bedrooms:S ❑ Village 13 Public/Commercial (describe use):To n of/ ❑ State-owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Near st Road A) 1. %New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel axxNNumber(s) .eN 4-1 System Tank Only Existing System Permit Number Date Issued A XSanitary Permit was previously issued 7J C> IV. Type of POWT System: (Check all that apply) tNon-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: 2, Z GA a. ,9,/Ar., J~ 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation 3?,5 3-7 q 08 t.z > 7 /Ch.D VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks u1~ h Con- Con- glass New Existing Crete structed Tanks Tanks K'0 r, ov El ❑ ❑ 11 I VII R PonsibilitY Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no tamps): MP/MPRS No. Business Phone Number 772 - r-154 Plumber's ,Address (Street, City, State, Zip Code) i aokb uJ,~l z 40 VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued IssSignature (No stamps) I;fAv ❑ Owner Given Initial Adverse Surcharge Fee) 6 I Determination IX. Conditions of Approval /Reasons for Disapproval: ~o . SBD-6398 (R. 07/00) /%e "t-- I b t L 1~'~ JOB TIMM EXCAVATING SHEET NO. OF / Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY - DATE (715) 772.3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ...i....... [ i 1~-d T . 3 ! i i i • .........i. ~:..............e.......... ..........!...........i..................... { i i I i ? i i i i ! ! ...........v...........a..........»........ «.....................,...........!...........!.....................y.................... i i i ` ! ! .J..... i i v........ ..r.......... , ! j ! ! ! i e i i i i , ! ; ! ! i 's v i T F e i F', , I ' ...........a ..........e.........«......................,...........,........ ..i... ...t... ...i.... ...T... ...3.... v ; t ! i i ! i i . ! 0 li I ! i ! ...i.. ! ~i , j.......... • < : i s t , .z ! l i I a .....{?....3........ . i i I ! 3 i i i ! t ! a ..1, . .t......'. ...............i.......... ........-.........,-.........e....... ~r~h.. i. c. .........i..........i..........i a....................-e i e ! ! - i' ! i :a ! ! i ! i i - -A: . zpm . . . 4 G~ ~c . vsk . p► . ~ V ~ V i . . jg~ . PRODUCT 206-1 AW MC.. OrddL Mat 0471.7o Order MM TOLL FREE 1400~Z!F, 0 milk L y~ 7. 1. Y 'Y ~J e A %.7,\ t ~ 4.,r 4 Z-6 It aen 6 Z- 86 z4i VW' py pad 3~~3 VEW7 CAP ~wn ► Cr'✓~ 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIfQG JUAICTIOU BOX MAIJHOLE COVER 25' FROM DOOR, `fin w/ `a V4 c WIMDOW OR FRESH I AIR IMTAKE I GRADE I 4,~ COIJDUIT ~ PROVIDE I AIRTIGHT SEAL ( III ~r I I' I v '3q5 CrR~-S , i3S ~?Ry I III APPROVED J011JTS II W/C.I. PIPE I III ALARM EXTEMDIIJG I I I ONTO SOLID SOIL I I - ! I om . -7,13 I I I -PUMP OFF 2~Q,v, ~l7p ov r BLOCK j ' 1ht K ~.:T. 37 ('o ' G'outd i i 3b r n a pl/c ~ A3 PAO. vir U I Goulds Submersible -4 Effluent Pump 3871 EP04 EP05 d ~pF'PLICIIYIONS • Fasteners: 300 series • Ftk4y submerged in high ■ Motor Housing: Cast iron stainless steel, grede turbine oil for for efficient heat transfer, pecrfi~t designed for the . Capable of running luLdcation and efficient strength, and durability. followht~'ste dry without dE mae to he, t transfer. ■ Motor Cover: Thermoplas- HomEfflueesttsystems components. Avai able for automatic and tic cover with integral handle • ~ • Farm& 11 Motor: and float switch attachment man Jai operation. Automatic EP04 Si le nase 0.4 HP points. F • Heavy ,11fy sump n9 V 1550 models include Mechanical Watertransfer 115 or 230 , 60 Hz, Flo& Switch assembled and ■ Power Cable: Severe duty -RPM, built in overload with • bewatering preaN.tt at the factory. rated oil and water resistant. automatic resot. SECIFICgTIgNS • EP05 Single phase: 0.5 HP, heavy duty lower 115 V, 60 Hz, 1550 RPM, FEA`T'URES g Pump, EP04 built in overload with ■ EP04 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plasl`c Semi-open design { 3/4 maximum. • Power cord: 1)foot with rump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard prog grounding ding mec :apical seal protection. , p Canadian standards association 4~ Total hOdg: up to 24 feet. with three ro°ig grounding ■ EF~DS Impeller: Thermo- . • Disc size: 11/2" NPT. plug. Optional 20 foot plastic enclosed design for (GSA listed model numbers A.l ihl seal: carbon- length, 16/3 S JTW with end in 7" or "AC".) rotar0eramic-stationary, three prong grounding plug imprNed performance. y BUNA-N elastomers. (standard on FP05). ■ Casing and Base: Rugged Temperature: therrloplastic design provides 1040F (400.C) continuous supe for strength and 140°F (WC) intermittent. corrosion resistance. Fasteners: 300 series METERS FEET stainless steel. 10 •e Capable of running J dry without damage to 9 30 - - sc3PM components. $ 2 Fr Pump: EP05 • Solids handling capability: 0 7 25 3/4" maximum. _ • Capacities: up to 60 GPM. s 20 Total,teads: up to 31 feet. g " •Discharge size: '1'/2" NPT• z 5 • Mechanical seal: carbon- rotarylceCamic-stationary, _ 4 15 :BUNA-N elastomers. x Tp p iture: 3 10 Y{ 00C) continuous 140 60, C intermittent. 2 ~ Sri Y V02 5 0 oC 10 20 30 40 50 GPM i C 2 i 6 8 10 12 W/h CAPACITY 1995 c~oulds Pumps, Inc. Effective May, 1995 83871 IA)- - Llo~ZZ ~ r ) Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 `~SCOnS1n Personal information you provide may be used for secondan, purposes Madison. WI 53707-730" ' Department of Commerce [Privacy Law, s. 15..91 ~ (Submit completed form to county if r f , state owner r ess than 8-1/2 x 1 1 inches in size. Attach complete plans (to the count), co only) t e , tem. o`n e 4mqN County State Sanitary Permit Number r ck if revis o previ 9p ication State Plan I. D. Number ~ 030 I. Application Information - Please Print all Informatio . ` Location: Property Owner Name Property Location qAe ' !-KGs ,S T CROIX 1\ N~ 1/4 1[/4-1/4, S / ZT 3b,N, R/ or W G Property Owner's Mailing Ad ress a couNTY Lot Number Block Number , x OFFICE c~,, City/, State Zip Code n Subdivision Name or CSM Number /V ~(j Ea~ 0 , kmm~ ~ k ff8 ~ °7 (7 ~ - ~cg 7 Z ~'S~t to ZBi~ 2 II Type of Building: (check one) ❑ City J6 P9 _ 3 4.33 J4 I or 2 Family Dwelling- No. of Bedrooms: ,3 ❑ Village ❑ Public/Commercial (describe use): f $ Town of ❑ State-owned flr III Type of Perrnit: (Check only one box on line A. Check box on line B if applicable) Neare Roams A) 1. VNew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) p t•.~~ ~9 System Tank Only Existing System B) member &o Date-lssned 1 ❑ A Sanitary Permit was previously issued G2.(- lO 3"1-20 -e IV. Type of POWT System: (Check all that apply) 1(08 A -10 Non-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: -2 2 ff ~ C r r r C~` 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation' 7. Final 'Trade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 2L~ 6/a ❑ ❑ 0 ❑ ❑ J- L a- _g VII Responsibility Statement I, the undersigned, assume res onsibilit for installation of the POWTS shown on the attached plans. Plumbe' Name (print) Plumber's Signature (no stain s): MP/P[jM- $bllo. Business Phone Number 2 5 2 51 7r5- 77 Z - 3z/ Plumber's ,Address (Street City, State, Zip Code) 0 t a$9 v)I Ape k) 1 z VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination 0 2 2 r_OV Q Z 200 a ,k IX. Conditions of Approval /Reasons for Disapproval: I / 00 S+rraC6 rcS 14tcts F ~ S rOw. or~~'hary higl, Wattt~ «yDtrd` ; hA- ike WA~er- I,'nG. 7-)PA4rr4S skaf( 6e- Go,re_C,+ee( otne. e,~y S~r«{ s Gorki~o(~fea( S~~t 15YderA Q~Cd4;0l (s lbW~fe j d ~2r:n9 JAIr`ll Aer0l ~i ~ ~>c7lCnGr✓aP~ ~v Uerr`>(y SCpar0.~f SBD-6398 (R. 07/00) JOB tL r~ f ..l_ P J1L k TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE °1 Yb , . i i ~L7 , 4 . . a , .i..... ~i.s V tt i--. Air ~ X . , : a. , ~{J t.. . . : l D z' - t k °~C >o . . I ~~r _ r , PRODUCT 205-1 Nt Inc.. Groton, Mass.01471. To Order PHONE TOLL FREE 1-80225-M Wisconsin Department of Commerce S A~{J 10 RT Page i of 3 Division of safety and Buildings ^ r" in accordance m 81Z m. CociA 0% St. Croix Attach complete site plan on paper not less than 81/2 x as in size. P u include, but not limned to: vertical and horizontal refers (BM djir + I.D. percent slope, scale or dimensions, north arrow, and d dish end in v FZG Date please. print all lnforMatf 0' 0!~ Personal intomration you provide may be used for secondary Pu Lsw 5.04 (1) PropertyOwner v i- n NW 1/4 NE 1/4 S 12 T 30 N R 18 =or) W Kevin Property owner's Mailing Address Lot # Block # Subd. Name or CSW 660 N. 4th. St. 1 na csm City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road New Richmond, WI. 54017 (115 )246-4939 Richmond Royal Lane ® New Construction Use: ® Residential I Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material rn~twa ch Flood Plain elevation if applicable Fla General comments and recommendations: Fi~ Boring # Q Boring Pit Ground surface elev. 100.1 0. Depth to limiting factor +96" in. Soil NNfication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E GPD +E in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-10, 10 r4/3 none 1 2msbk mfr cs 2f .5 .8 2 10-21.7.5yr4/4 none sicl 2msbk mfr w if .4 .6 3 21-96.7.5yr4/4 none is Osg mvfr na na .7 1.2 s sy" 0 a Boring # ® pit B ling Ground surfee elev. _ 100.9 ft. Depth to limiting factor +97 in. adort Rate Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D/fE In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r*Efffnr#i *EN# 2 1 0-9. 10 r4/3 none 1 2msbk mfr cs 2f .5 ✓ •8 2 9-25.• 7.5 r4/4 none sicl 2msbk mfr Crw if .4 3 25-9 -7.5 r4/6 none ms Os mvfr na na .7 v' 1.2 f, G Effluent #1 = BOD > 30 1220 mgk and TSS >30:5150 mgA. * Effluent #2 = BOD < 30 mgiL and TSS :5 30 mg(L CST Name (Please Print) CST Number Gary L. Steel 02298 Address Date Evakladon Conducted Telephone Nu rtw 1554 200th. Ave., New Richmond, WI. 54017 7-6-2000 715-246-6200 Property Owner Kevin Early Parcel 1D # peridirig _ Paget of 3 ❑ Boring # ❑ Boring 3 FL] Pit Ground surface elev. 100.2 ft: Depth to limiting factor 2!' in. Soil Application Rate Boundary Roots. GPDRf Horizon Depth Dominant Color Redox Description Texture Stricture in. Munsell Qu. Sz. Conn Color Gr. Sz. Sh. 'Eft#1 'Eff#2 1 0-8 10yr4/3 none 1 2msbk mfr cs 2f .5 ✓ .8.i Z 8-17 7.5yr4/4 none sici 2msbk mfr if .4 .a6.✓ 3 17-34 7.5yr4/4 none is Os mvfr w na .7 i 1.2 4 34-92'7.5yr4/6 none ms Osg mvfr na na .7 ✓ 1.2 ~ 9S Ss. Z " 9l. 2 F41 Boring ❑ Boring # ® Pit Ground surface elev. 99.8 ft. Depth to limiting factor +96 in. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-16 10 r4 3 none 1 2msbk mfr Cs 2f .5 .8 2 16-36`10 r4 4 none sicl 2msbk mfr w if .4 3 36-96'7.5yr4/6 none ms Osg mvfr na na .7-/ 1.2 ❑ a Boring # gyring Ground surfaceelev. 9 .4 ft. Depth to limiting factor +96 in. ® Pit Soil AnDlIcallon Rate Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Mur sell Qu. Sz. Cont. Color Gr. Sz- Sh. 'Eff#1 'Eff#2 1 0-11- 10 r4/3 none 1 2msbk mfr cs 2f .5 ✓ .8 ✓ 2 11-3 •10 r4/4 none sic 2msbk mfr if .4 .6 3 36-9E- 7.5yr4/ none ms Osg mvfr na na .7 1.2,/ Effluent #1 = BODE > 30 5 220 rnglL and TSS >30:E 150 mgA- ' Effluent #2 = BODS 30 mgll and TSS 5 30 mglL 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. SSD4330 (R.6W) i STEELS SOIL SERVICE Gary L. Steel Kevin Early 1554 200th Ave. CSTM2298 NW4NE4 S12-T30N-R18w New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #1-csm N 1"=40' BM.= top of 1" pvc pipe 2 el. 100.00, Alta BM. = top of 1 11 pvc pipe C el. 99.10, 40 -Av 7Y' Gary L. Steel 7-6-2000 ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1'y4 e" it z- 14 Mailing Address 3a 7 Property Address (Verification regrnred from Plnnnino no-arrn,e..+ fn. ,.e... City/State Ac-4Y,.1 x G ) tJ 37- ze Qoo LEGAL DESCRIPTION Property Location /VAJ vyu✓ Subdivision pp~`v IY~ i S I _,Lot # LT kA 4-0 Certified Survey Map # Z 6~ ,e # 3F 33 Warranty Deed # Z,2 ,e # / Spec house ❑ yes U no ] no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a three year x ua n date. Ll-t CA I ATURE P ANT DATE OWNER CERTIFICATION 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 ro described above, y virtue of a warranty deed recorded in Register of Deeds Office. S ATURE I T DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' t629373 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CD., WI Document Number RECEIVED FOR RECORD f~ This Deed, made between Kevin P. Early, a 1 2Qec; 4A 09-05-2004 1:30 PIN EXEMMPTTI DEED Grantor, CERT COPY FEE: and Marc M Lubeck and L- ' zo In'A4 A Lvlk" '4NAALL C FEE: TRRAN ANSFER FEE: 120.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Part of the NW 1/4 of the NE 1/4 of Section 12, Township 30 North, Range 18 West, Town of Now &o:ording Area Riehmond,now known as Lot 1 of Certified Survey Map Naneand ReturnAddrm - recorded in Volume 14 of Certified Survbey Maps, Ttl~o~~}7 v/ Page 3933 as Document No. 628624 -N j-m&~-vn / cx-sUao 26-1037-20-000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Exceptions to warranties: easement, roadways and restrictions of record Dated this day of s sKevin P. Early s AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss• St. Croix County. rso ally came before me t ' day of authenticated this day of a above named Kevin Early w TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person who executed (If not, the foregoin.; instrument acknowledged the same. ~ A ~ authorized by § 706.06, Wis. Stets.) r,M THIS INSTRUMENT WAS DRAFTED BY f 1VI'1'(Q V *Tracy L. Turner Michael H. Foreeki Attorney Notary Publ c, State of Wisconsin ERau Claire Wisconsin My ComSion is ent. Ifn t, state expiration date: (Signatures may be authenticated or acknowledged. Both are ) not necessary.) Tracy L. Turner Notgry IiC 4Names of persons signing in any capacity must be typed or printed below their signature. State of Wisconsin STATE BAR OF WISCONSIN WARRANTY DEED FORM Na 2-1998 Produmd with 21pFtrrn ' byVaniedl YIC 18025 FIMan Mfrs Road. Clinton Town". MehOen 46035,1600) 757-MM Amory Mirh.el H F-W 1330 Br ek. Ave. E. Ctu,e Wt 54701.4541 Phm : (715) n5-3029 F.. (715) 8154112 Ro1JALO JOHNSON FILED 6-1 1 FIG AMERY W19. ~ QV~ 2 2 2000 1, ~ p LEEN K. 40 *SW 01 CTQiX Go.,~► its lt C E R s URVEY MAP ~ft R• Located in part of the Northwest Qu f ortheaet Quarter of Section 12, Township 30 North. Range 18 West, Town of Richmond, St. Croix County, Wisconsin. Prepared for and NOTE: The owner of Lot 1 shall annex the property to the City of New Richmond at the request of: when sewer and water are extended to the Peninsula Heights subdivision. The owner of Lot 1 shall also maintain and remove snow from a driveway it will OWNER: Kevin Earley use across Royal Lane. The driveway will extend from Peninsula Road to Lot 1. 660 North 4th Street (~j t1N1. NEED New Richmond, W. 54017 YI£;11 AND FB_E0 I FMI TO 811.11 M1~ INV Drafted by. Jason M. Gustafson I 1 COINSTIN)OO I. i 1 NOR7N OUARTER CORNER SECAON 12-JO-18 i I FOUND ALUM/NUM COUNTY MONUMENT Jj t<I' l 3 OUTLOT 1 FAR EASEMENT PURPOSES Zi J1i_ ip 1 m TOTAL AREA. V It t.- I p r-)t r 17,261 SOFT. 2 JI o UNPLATTED ----------LANDS iii mil rn OF OWNER 0.40 ACRES 66' EASEMENT FOR -irJi INGRESS AND EGRESS Qi- to iI ii ai II o'` 240.11' CL a- r-- --------'0--- i / ROYAL SANE ni 66.00. _ 0_ W N ,I- / N89'42'36'E Y' ~4P. t~fJPI~AT TEp LAN4S ti m i 282.94' - ,Gtp t ` OF OWNER "ii r o I I .1 r> AIL L O T 1 r i10. ~j 6 'd TOTAL AREA. ' it in 20J,462 SOFT. N~? \,~Y~2` ~Ll 3 4.67 ACRES $ ~:.'qi. > g' N i AREA TO MEANDER LINE: % - e m N 114,087 SO.FTO J. r- fema 2.62 ACRES ~ tea, s \ ° PER 11164 -.bTY OF WW RICHMOND S 8 Fos ~ " ~N CWTHO/CONTOUR MAP. ? Z 000 VoF IR w 7ti, `1tj~ 100 YEAR fi; . tkDD i L5.5t' p~1Rt+osES 39 1 Its "VA f tT k A If No TH t s=- - , - ' \N FLOW - SHO 586'22'15"W APP 124.18' ~ ~ - - ~ -tt- - - 4 - - ~ ~ N7 7g 4 CEjyIFRCINe - n W J7~34 OF t ' f£k _NORTH L/NE OF 77/E - SOU774 0UAR7FR CORNER _ PENDING PLAT OF LOT 1 PROPOSED BUILDING: SEC770N 11-30-18 BRUSHY MOUND LAKE FINISHED FLOOR FOUND 1" IRON PIPE 1NeTTED NQS ELEVATION=998-00 FEET - BASEMENT FLOOR LEGEND: ELEVATION-988.00 FEET Section Corner Monument TE; ARK IS SET 1 IRON PIPE SHOWN ib, XT MEANDER CORNER OF LOT 1 Set 1" x 24" Iron Pipe weighing EkE1f a minimum of 1.13 pounds per linear fool. NOTE: The parcels shown on this map are subject to • • • • • • • • B ilding Setback Line 100' from R-O-W. State, County, and Township laws, rules and regulations 5' Setback Line from Navigable Water (i.e. wetlands, minimum lot size, access to parcel, etc.), Jk Denotes Wetland Before purchosing or developing any parcel, contact the APPROVED St. Croix County Zoning Office and the appropriate Town x-x --x- Denotes Existing Fence ST. CROIX COUNTY Board for advice. R-O-W Right-Of-Woy Planning Zoning malParks Commmee iso 0 150 JOB # A00043 AUG 2 2 2000 Prepared by. GRAPHIC SCALE A & E SCALE IN FEET: 1 inch - 150 feet LAND SURVEYING & CIVIL ENGINEEf7R101 recorded within 30 days of Phone No. (715) 246-4319 approve) date approval shall be BEARINGS ARE REFERENCED TO THE NORTH/SOUTH 1 /4 109 East Third Street, P.O. Box 325 null and vold LINE OF SECTION 12, TOWNSHIP 30 N., RANGE 18 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR NOO'16'21"W. Sheet 1 of 2 VOL. 14 PAGE 3933 Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 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 CONTROL PLAN LEGEND PROPERTY LINE EXISTING DRAINAGE TD TEMPORARY DIVERSION FINISHED DRAINAGE LIMITS OF GRADING SILT FENCE STRAW BALES GRAVEL O VEGETATION SPECIFICATION ® TREE PRESERVATION STOCKPILED SOIL Please indicate north by completing the arrow below. -N- 9 PROJECT LOCATION BUILDER OWNER M4 PC- ~4 n,14AC WORKSHEET COMPLETED BY DATE - Z2-dam 1 EROSION CONTROL PLAN CHECKLIST V Check appropriate boxes below, and complete the site diagram with necessary information. Q QQ UoF Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ 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. DA Approximate gradient and direction of slopes after final grading operations. ❑ Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices X ❑ 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 tarp or more than 25 feet from any downslope road or drainageway. 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). ❑ 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. ❑ X Location of sediment barriers around on-site storm sewer inlets. ❑ bg 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. ❑ X 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.) ❑ ~ Location of other planned practices not already noted. 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 carried off-site • Plot plan must show: ENFORCEMENT -Location of the dwelling, other buildings, wells, sur- 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- -Direction of all slopes on the site struction, final, etc.) -Location and type of erosion control measures • Violations must be corrected within 72 hours • Stop work orders may be issued for noncompliance CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT • Local building inspector • Silt fences, straw bales, or other approved perimeter 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. GWQ001A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites DNR: WT-458-96 R-02-97-2M-1 0-S a c~a Qcc°' Indicate management strategy by checking the appropriate box: =o Management Strategies ❑ Temporary stabilization of disturbed areas. Note: It 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? Yesl< 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. 4,~Z_ ❑ 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. Proper disposal of building material waste so that pollutants and debris are not carried off-site by wind or water. i Maintenance of erosion control practices. i • 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 I replaced (typical bale life is three months). i • All sediment that moves off-site due to construction activity will be cleaned up before the end of the same workday. I • All sediment that moves off-site due to storm events will be cleaned up before the end of the next workday. I • 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 (GWO001) can be ordered through Extension Publications, 608/262-3346 or the Department of Commerce, 608/267-4405.