HomeMy WebLinkAbout010-1007-80-000
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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
a[.apd Human Relations INSPECTION REPORT ST. CROIK
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 289364
Permit Holder's Name;ff ❑ City ❑ Village own o : State Plan ID No.:
P ON, J EmERA v
CST BM E ev.: Insp. BM E ev.: BM Description: Parcel Tax No.:
Od , /Oo a ~O ~t~ (?Q 7-
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark / 03a~ /00 04)
Dosing i
Aeration Bldg. Sewer yy
Holding St/W Inlet / g S
TANK SETBACK INFORMATION St/ W Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet '
Air Intake U Q!. S
Septic ~~v • > Q~ NA Dt Bottom ,S.a3g.Ga_~
Dosing 16 `30 r 16- NA Header/Man.
Aeration NA Dist. Pipe x. LT 99 gq,
Holding Bot. System 99-a3
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer 2, A Demand
Model Number
7 8 GPM
I
TDH Lift//,6_1'1 Loss Friction Syste
Forcemain Length / Dia. a Dist. To Well O/
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / 60 DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER model Number:
System: Y / / >lpp ,J q OR UNIT
DISTRIBUTION SYSTEM
Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length 6P ' Dia. Length 50' Dia. Spacing ff / y 9 -5- O '
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of T xx Seeded /-Sedded- xx Mulched
Bed /Trench Center. /r Bed / Trench Edges 12-le- Topsoil (R'S'es ❑ No Dyes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION; EMERALD 03.10..16.44,SE 21,463 C~TY RD S
Plan revision required? ❑ Yes [g No
Use other side for additional information. N (o a L
SBD-6710 (R 05/91) Date Ise or's Signature Cert No
L
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83 05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County 0 jx
than 8 112 x 11 inches in size. ,
• See reverse side for instructions for completing this application State Sanitary Permit Number
d 9C 5&
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)I.
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION %7-a0-35Q
Property Owner Nam Pr pe y Location
i4 1/4,S 3 T'50 , N, R 66 k(or W
53
Property Owner's Mailin Address Lot Number Block Number
City., State / Zi Code Phone ;umber Subdivision Name or CSM Number
( 5 0
11. TYPE O BUILDING: (check one) ❑ State Owned E] city Nearest Road
C] Village
❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF
111. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s)
010--100-7-
1 ❑ Apartment/Condo
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. ❑ New 2. j~ Replacement 3. E] Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
______System-___--System-------------Tank Only --___--___--__Existing System _-Existing System
B) 'E ]A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11171 Seepage Bed 21,kMound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage 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
(45D Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 3 7_5 7 Feet Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Plastic Exper
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank SOW /0&0 1
❑ 1:1 El 1:1 1:1
41,
Lift Pump Tank /Siphon Chamber 661,11, ❑ ❑ ❑ ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumb ' Signatur (No St m MPRSW No.: Business Phone Number:
AZ=
Plu tier's A rpjs~t reef, City, St te, zip C d
r e):
IX. COUNTY / DEPARTMENT USE ONL
❑ Disapproved San ry Permit Fee (includes Groundwater ate Issued Issuing A nt Sign No S
)
p/)
Approved ❑ Owner Given Initial GO~ Surcharge f ee)
(///A
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
RESIDENTIAL MOUND DESIGN
INDEX AND TITLE SHEET
Project JAMES PEARSON PRIVATE SEWAGE SYSTEM
Owner JAMES PEARSON Conditionally
Address 2463 VED NAPPRn
EMERALD WI DEPT. OF INOU
aAFEn ~ Nunn AUTIONS
54012
Legal Description NW SE S3 T30 R16W COAAE$ D CE
Township EMERALD County ST. CROIX
Subdivision Name Lot No.
Parcel ID Number 010-1007-80
Plan ID Number S97-20350
INDEX SHEET PAGE ONE
MOUND CALCULATIONS PAGE TWO
MOUND DRAWINGS PAGE THREE
PRES. DIST. CALCS. & LATERALS PAGE FOUR
PUMP TANK DRAWINGS PAGE FIVE
PUMP SPECIFICATIONS PAGE SIX
SITE PLAN PAGE SEVEN
Designer BRADY UTGARD License Number MP-7456
Signature 14L~ Phone No. 715-268-6995
Date 5-14-1997
Notice: Tampering with this file by unauthorized persons Is prohibited.
Deliberate modification will result in disciplinary action under s. 146.10, Wis. Slats. RECEIVED
SBD-10,W-E (N.05MM Pagel of 7 MAY 14 1997
SAFETY & 8L=- DIV.
,J_2p350
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' Wisconsin bepartment Industry, Sol A L U A T I O N REPORT Page 1 of
Labor and Human n Relations -1_
Division of Safety & Buildings . acco9with 1 05, Wis. Adm. Code
0) D COUNTY
Attach complete site plan on paper not I s an 8 f/2 x Inches in s Ian must include, but St. Croix
not limited to vertical and horizontal ref r e point BM), di r and slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location ista o ~(ela road. 010-1007-80
APPLICANT INFORMATION-PLEA RINT A A REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
James & Sara Pearson GOVT. LOT NW 1/4 SE 114,S 3 T 30 N,R 1G or) W
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR GSM #
2463 CITY, STATE ZIP CODE PHONE NUMBER QCITY FIVILLAGE XrOWN NEAREST ROAD
Emerald, WI. 54012 (715)-265-4590 Emerald C
[ ] New Construction Use [ j Residential/ Number of bedrooms 3 [ ] Addition to existing building
k ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd/112,5_trench, gpd/ft2
Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate ---4--bed, gpd/ft2--5___trench, gpd/ft2
Recommended infiltration surface elevation(s) 99.85 ft (as referred to site plan benchmark)
Additional design / site considerations system el. based on contour line of el. 98.85'
Parent material bitted g1 aci a 1 dri ft- Flood plain elevation, if applicable a ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system 1:1 S :E1 U 152 S El U EIS O U El S ®U S ] U ❑ S 13LU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
y."tititi In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tretldl
1
1 0-12 10 r sl if .4 _9
R, lcsbk -mfr_ az
2 12_31 10 r4/4 none
sl lcsbk. mfr crw .5
Ground 3 31- 1
elev.
99' 59t. 4 41-60 5 r4
Depth to
limiting
factor
Remarks:
Boring #
1 0-12 10 r3 4 none Mfr
2
2 12-29 10 r4 4 none sl lcsbk -.mfr aw if
Ground 3 29-45 10 r5 4
elev. 4 45-55 5y /4
99.55 ft.
Depth to
limiting
factor
29"
Remarks:
CST Name:--Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 200th. v . New Richmond, WI 54017
Signature:
Date: 4-18-97 CST Number: m02298
James & Sara Pearson SOIL DESCRIPTION REPORT Page--2,- of-~4 `
PROPERTY OWNER
PARCEL I.D. 010 1()07-80
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
YY fi'
.,..3 1 1 -
.
2 12-31 10yr4/4 none sl lcsbk mvfr gw if .5 .6
Ground 3 31-50 10yr5/4 2p7.5yr5/6 sicl m na na na n .2
elev.
9Z, 55ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
facto
Remarks:
Boring #
ti
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
t
• ~ Ste` : t.
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 James Pearson
MPRSW 3254 NWaSE4 S3-T30N-R16W New Richmond, WI 54017
town of Emerald (715) 246-6200
t
N
1"=40'
BM.= top of 2" pvc pipe C el. 100'
Alt. BM.= bottom of steel siding of shed @ el. 103.35'
6& r 121
I , ~Ir
l3
1
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y 1 j
Ro o " {
~~'3 ~ ~ ~~51 any
~b
S-1
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5
Gary L1 Steel
4-18-97
• 5 3684 STATE BAR OF WISCON IN FORM -S2
W,V F,Y D E
DOCUMENT NO. Yr~ aPACE~
Allen LeRoy Behrens a single man
Psc'¢:~ ?xtxa
- ~ ~ ,~lyr
conveys and warrants to _J ames S Pearson and Saba B• DEC 6
Pearson.
..a/k/a James Pearson and Sara Pearson - _ )t 10:05 A
THIS SPACE AF S:'V.J.;'.c ;ZECCRD-NG DATA
- NAME ANO RETURN s::Q:SS
the following descrthed real estate In St Croix
,t~.
State of W'tsconsuT. - - " Liver Val!,: ~
p r.:~. ~r.zLt 't ~c, Inc.
A parcel of land located in part of Government Lot 2 p-0- Box 149.206 2nd St.
and Government Lot 7 and the NW} of SE} all in Section Hudson, Nf 54016
3, Township 30 North, Range 16 West, Town of Emerald, -tL - Z
St. Croix County, Wisconsin described as follows:
Commencing at the N} corner of said Section 3; thence N if 010-1007-`0 Xk X*"X
on an assumed bearing along the N-S} line, .S01*27' 38"E PARCEL IDENTIFICAT :N N(;MBER
a distance of 1440.14 feet to the point of beginning; 0VRONE" 9-9-X U
thence N88°32'22"E a distance of 773.17 feet; thence S01°27'38"E a distance of 2253.58
feet; thence S88°32'22"W a distance of.773.17 feet to the N-S} line of said Section 3;
thence along last said N-S} line, N01°27'38"W a distance of 2253.58 feet to point of
beginning. Containing 1,742,400 square feet (40.00 acres more or less). Subject to
all easements, restrictions and covenants of record.
Together with a 66 foot wide easement for ingress and egress located in part of
Government Lot 2 in Section 3, Township 30 North, Range 16 West, Town of Emerald, St.
Croix County, Wisconsin being 33 feet distant on each side as measured perpendicular
to and parallel with the following described centerline: Commencing at the N} corner
of said Section 3; thence on an assumed bearing along the North line of the NE},
N88°31'58"E a distance of 698.98 feet to point of beginning of said centerline; thence
S03°01'08"E a distance of 1440.75 feet to the North line of the above described parcel i'
and there terminating.
This is -homestead property T
Exception towarranues: Subject to all easements, restrictions a - venants of record. .,y.
r
Dated this 20th day of December:
.•t. D . I g 96
I G SF
(SEAL) t ti
• Allen LeRoy BehUn
(SEAL) i.SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Silnaturr(s) State of Wisconsin,
St. Croix County )
authenticated this _ day of 19.- carne before me this 201 h day of
aeeenber 19 96 the above named
:Alen LeRoy Behrend
TI TLE: MEMBER SrAl E BAR OF \\'ISCt 1Q M -
llf nut. • VulliXSOn -
authorized by 9706 06, \1'i s. Scats') Lary Public - - :
State of Wiseonsir to P_riwn t`' he the person Lthu exr.uted the foregoing
1r-31:-rra :f,41 .T.•ktto%~edge the stme. A
THIS INSTRUMENT WAS DRAFTED BY
REINSTRA 6 VAN DYK, S.C.
- r.