The URL can be used to link to this page

Home My WebLink About038-1166-50-000 'fisconsin`Departrnent of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ' 6-P-7 0 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OW PROPERTY LOCATION ,!/ C'- GOVT. LOT 1 /4_5ej 1/4,S 26 T .3 / N,R / C'�) 9(or) W PROPER NER':S MAIL G AD ESS LOT # BLOCK # SU D. NAME 0 M # 1 E f �5' IVA �Z& 4 S 7414.4,xs CI STAT ZIP CODE PHONE NU BE R [:]CITY VILLAGE OWN NEAREST ROAD 4 v�1 �dGt) s"1 7 o ,s h t ("r New Construction Use (Residential / Number of bedrooms .3 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate L _ bed, gpd/ft • 8 trench, gpd/ft Absorption area required 4[_ bed, ft trench, ft Manmum design loading rata 7 bed, gpolft , ,9 trench, gpdM. 2 Recommended infiltration surface elevation(s) F "/ A— _7z - 09 ft (as referred to site plan benchmark) Additional design / site considerations Sj c e;�o u �j^&iv7044 •.� -c�S �- Parent material /b t.L 1 r9--S h _ Flood plain elevation, if applicable I/W ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK - 7 U = Unsuitable fors stem El 1:1 S ❑ U -�S 'au ❑ S ,�U [Is U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITtrich -SD 5/ 1i1 D -i'!!< D S D S •,F Ground eleven 9 Depth to limiting factor Remarks: Boring # o , / c o Ground 940 O 5 o elev3s Depth to limiting factor Remarks: CST Name:—Please Print Phone: 41 z 0 0 Address: / 7 Signature: Date: CST Number: - B • 3 OS7 Z z- PROPERTYOWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. 0 f Boring # Horizon Depth iDominant Color I Mottles (Texture Structure (Consistence I Roots GPD /ft I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITmr& Ground Q yn 0 S W,4 v.� I Depth to limiting factor ? 8z,, Remarks: Boring # 0 2 V z- / Ground ; " `Y G L° S Ivi elevo ft. Depth to limiting factor Remarks: Boring # Ground = `2 `� io i✓ S rVl C, 3 7L_ft Depth to limiting factor F7 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel C.S.T. 2298 C�' wG?t�/n G New Richmond, WI 54017 MPRSW -3254 N E /"4 s W VAS S 7 - - 7` 3 .d • / g (715) 246 -6200 w(rr► �N'1�L'�- �' Pr do D' ^ 1 � fi 1 2 .0' �� -��93 � r ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Z xl h �/ �� z �> �t / .. Property Address V' City /State A z go /c r Legal Description: Lot Block Subdivision/CS # -��1! %� -� S �s ' /a, Sec. T2LN -RIW, Town of PIN # jLLG SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PG Setback from: House ,7 WeIQ P/L S� Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: /�� - Width Length Number of Trenches Setback from: House -.;2 , 5 — Well - 7 , - P/L Vent to fresh air intake i o ELEVATIONS / Description of benchmark L � A/ZC -JI ' Al Elevation Description of alternate benchmark -, Elevation to Building Sewer ST/HT Inlet s ST Outlet - ex, PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover 2Z Distribution Lines) ` /�3 G) __�4 � Z ( ) Bottom of System ( y5 7 -5ir Final Grade () () ( ) Date of installation Y / ermit number tate plan number Plumber's signature License number s'� Dated 611 l Inspector Complete plot plan � 1. NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW Ij �0 a f 3 t i i INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ' Safety and Buildings Division Count y ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3Rer 4 418.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). is fi S NarA '6BIN r7 Citv.Cl VPAQ of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: i Parcel T &3W - 1166-50-080 TANK INFORMATION ELEVATION DATA A9900014 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark o Dosing 31 /. 3/ 1q . O Aeration Bldg. Sewer _35/ QS.Y'7 Holding St/ Ht Inlet 7 Y- q5• 5 9 TANK SETBACK INFORMATION St/ Ht Outlet S: D q . a TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ��j 9 ' a 5 NA Dt Bottom Dosing NA Header / Man. y 9 s6 y,75 Aeration NA Dist. Pipe Holding Bot. System j' /c 3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand �, 3 S� Model Number GPM TDH Lift Lricti System TDH Ft os H ead Forcemain Len Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSION S r / J cJ DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer; INFORMATION Type O . ryu ,,_ CHAMBER Mo Number: System: r .• l� �� S "15 7/ L OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 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 /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑Yes ❑ No []Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc. 1,10ICATION: STAR PRAIRIE 28.31.18.797,NE,SW 1930 104TH STREET Plan revision required? ❑ Yes (f No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION Safety and Washington Division Vi sconsin 201 W. Washin ton Avenue P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 vi x 11 inches in size. S "f t_ /1 r- Z> ) • See reverse side for instructions for completing this application State Sanitary Perm U+1 "1 b Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location /, .3 tea.-cy /4l 4 ,5LJ 1/ 4, Sa K T,31 , N, R r E (or Property Owner's Mailing Addre Lot Number Block Number J d.-- City, State ; locJe� (hone Number Subdivision Name or C M Number of r IL PE OF BUILDING: (check one) ❑ State Owned ❑ Ity Nearees Road ❑Vil ��'r Public 1 or 2 Family Dwelling - No. of bedrooms wn of t / 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ag, 9 >Jg� Ck 1 ❑ Apartment/ Condo r t� '56 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1 _ 0"New 2, ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5 []Repair of an ------ System _______,System Tank Only Existing System Existing System 8) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1�eepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Re uired (sq. ft.) Propojed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation f� 4 b� Feet � Feet Capacity VII. TANK in gallo Total # Of Prefab. Site Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete Con Steel glass App. structed Tanks Tanksl Tanks Septic Tank or Holding Tank l ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ I ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb ' Name: (Print) Plumbers -$ignature: (No Stamps) r P /MPRSW No.: Business Phone Number: ;Z, . I 7 Plumb s Address (Street, City, State, Zip Code): , IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) XApproved ❑ Surcharge fee) Owner Given Initial Adverse Determination ��-t i g X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, Plumber PLOT PLAN PROJECT Robin Beauvais ADDRESS 936 Hwv 64 New Richmond Wi 54017 NE 1 / 4 SW 1/4 28 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX 3�. _ ,� z, � .., 1115/98 4 MPRS Byron Bird Jr. 220527 � -� � �� ATE BEDROOM CONVENTIONAL X04C IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 763 # of chambers 24 IL BENCHMARK V.R.P. Top of Lath with Orange Ribbon ASSUME ELEVATION 100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION 92.9 -- Alternate Benchmark Top of Lath with Orange Ribbpn @ 99.00 570' Property Line 100 15' 15' 10'25' 55' -5 35' 0' N ° B- Rep A 5' o0 80' 5 B.M. Vents B -6 5% B -4 Slope CD B -2 2 3' X 77' Trenches with 6' 0' Spacing Between Trenches 10 04 1 edroom System to be designed to avoid B -6 ouse B -10 Alt. ST B.M. 458' Property Line 376' Property Vent Line 270' Property >12" Sidewinder High Line to of Cover Capacity Leaching 192nd Ave Chamber with 31.8 16" ft ^2 per chamber 6' Long 74' 34 Grade at System Elevation Public Road i - 1 wibconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and G AO r percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT F CANT I ORMATION - 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 Z Govt. Lot 1/4��1/4,S T - / ,N,R 15 Property Owner's ailing Address Lot # Block# Subd. Name or CS Ci S!pte Z p Code Phone Number ❑ City ❑ Village [ Town Nearest Road New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow �� gpd Recommended design loading rate _ bed, gpd /ft gpd /ft Absorption area required _ bed, ft 730 _ trench, ft Maximum design loading rate _�_ bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 9 i� _ y ft (as referred to site plan benchmark) Additional design /site considerations ��f✓ 9 Parent material �� L f �. LiGc 1 A,? c' - Flood plain elevation, if applicable 1y ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system `�S ❑ U fi�[S ❑ U 0S ❑ U jj3'z ❑ U ❑ S 2 ❑ S ETU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench h Ground v .� � / 3 ft. Depth to limiting factor in. Remarks: Boring # G7 Ground depth to limiting factor �Qin. Remarks: CST Name (Please Print) Si re Telephone No. Address ate CST Number !/)O�,h �c v�r� SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Q Ground -� G' 1/ . ✓ i %�` ,�'1 Depth to limiting factor ` Remarks: Boring # / o r �c 12 L Ground ele� Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. S Sh. Consistence Boundary Roots Bed ,Trench Boring # e. 0 Ground Depth to limiting factor Remarks: Boring # Ground Depth to limiting factor 7 4'n' Remarks: SBD -8330 (R. 07/96) Soil Test Plot Plan Project Name Robin Beauvais Byron Bird Jr. Address 936 Highway 64 N Ri Wi 54017 CSTM #220527 Lot 5 Subdivision Red Pines Date 1 NE 1 /4 1/4S28 T 31 N/R 1 8 W Township Star Prairie �] Boring ()Well PL Property Line County ST. C ROIX BM or VRP Assume Elevation 100 ft.Top of Lath with Orange Ribbon System Elevation 92.9/89.8 * H R P Same as Benchmark Alternate Benchmark Top of Lath with Orange Ribbon @ 99.0 570' Property Line 100' 15' 15' 10'25' 55' AL -5 35' 0' ° B-3 Rep A 5' 0 80' 5' B.M. 5% B -6 B-4 10 e B -2 Pri A 0 ' o4 System to be designed to avoid B -6 l2 Bedroom H ouse t. 10 B.M. 458' Property Line 376' Property Line 270' Property 74' Line to 192nd Ave Public Road ST CROIX COUNTY SEPTIC - TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i Owner/Buyer Mailing Address Property Address (Verification required from Planning Department for new construction) City/State ��-� J 1 �,�na., Parcel Identification Number e'� I LEGAL DESCRIPTION Property Location ' 1 /4, Sec, T N -R/W, Town of �- c Subdivision Lot # Certified Survey Map # Volume . Page # Warranty Deed # Volume 7 Page # Spec house ❑ yeses_ Lot lines identifiable yes ❑ no SYSTEM 14i4I1'41ENANCE Improper use and maintenanceof 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, jouineymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of 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 o e three year expiration date. SIGNATURE OF APPLICANT 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. '�� zaf�-� / /J3/ IGNATURE OF APPLICANT 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 5800G9 STATE B ,, R OF WISC•)NSiN FORM 2 - 1982 'AARRANTY DEED DOCUMENT NO. Jay C. Hemmer and Gail J. Hemmer, husbarhd ar �rif� ___ ,.____� —__ ST. CROIX Off, W1 - - - -- �_ —_ _ _— - -- -- - - -- R&oy for Ibeor t JUN 01 1998 comrys and warrants to oR b nl A. Beauvais — ' , - a — s ingle p ers on, and Margaret R �a��..� �� S ingle person, THIS SPACE RESERVED FOR RECORDING DArA NAME AND RETURN ADDRESS J the followingdescrilxd real estate in St. Croix State of Wisconsin: 038 - 1166 -50 9 7ARCEL IDENTIFICATION NUMBER j Lot 5, Red Pine Estates in the Town of Star Prairie, St. Croix County, Wisconsin. i RA�ISFER FEE This is not homestead property. AAX Gs not) Exceptiontowarranties: Easements, restrictions and rights -of -way of record, if any. Dated this ? T ' day of May A.o., ly_ 98 (SEAL) �V ` ' (SEAL) Jay C. Hemmer Gai_ J.7 Hemmer i (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Jay C. Hemmer, State of Wisconsin, ss Gail J. Hemmer --7 County. authenticated is Gdayof Ma y 19 9 PersonaliY Mme before me this day of • 19 , the above named Kristina l and TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Scats.) to me k7wwn w - -t the person who executed the foregoing instrumem arse ALimowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson WI 54016 Notary P, bike. County, Ills. (Signatures may be authenticated or acknowledgeu. Both are not My comtmss;o,r IF permanent. (If not, state expiration date: necessary) N.Imes of perwns stgntng in any capacuy should be typed or primed lxlo% their signatures WARRANTY DEED STATE BAR OF WISCONSIN 'Nmi;orw Legal Stank Co — C Form No. 2 — 1982 M,waFee. Ws , a :r..�x. :.aw rt.- - � "+ABds�:.r:..� Y^ +w ;.+c&!^ -�'r' f'L,_�' - „ t'R#'iF,iw', tl� ,ins` .YgIY- _ a— :"" f- 'Si{'£dr.l�'3ii"_9R°` �*.�1� •� - -1M� r N / N Z 108,712 SO. FT. / CD O 217,504 SO. FT. _ 2.50 ACRES / 4.99 ACRES U) ti e do / O 3 � ' U) / W / x so U. 4 ' su s 24 F I '1 i 3 _ I i I sag 145.35' I a ^ o a' U. O o 33.33 I . N W m 0 274.67 (� 1 Z- o o 21.41' I J 2 1 -� n - 270.00' 1 1 1 � w 138,944 SO. FT. I a II 3 3.19 ACRES I �I I �I e� � 4 , � 107,285 SO. FT. 6 . ga 1 2.46 ACRES I ' I �I �! I .1 I ' (' 33' 33' ; 1 NC / — — 624.94'— ( I — 504.94' 120.00' 192.52 - 312.42' 66.00 wi N89°52' 40 "E CA OD WI Wi I 01 I WI Q I �I a I l I f—I • I LOT I LOT 2 NI WI I � CERTIFIED SURVEY M u' I E AP IN VOLUME 6 PAGE 1615 Ot- - - -- - -- I -- - - - - -- - - - -- - - -- m: >! I ai I ZI I L _L -J t0 192ND �o