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Parcel #: 034 - 1055 -80 -100 12/19/2005 04:31 PM
PAGE IOF1
Alt. Parcel #: 25.29.15.392A 034 - TOWN OF SPRINGFIELD
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
CAVERN R & NOLA J JOHNSON O - JOHNSON, LAVERN R & NOLA J
3216 75TH AVE
KNAPP WI 54749
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 25 T29N R1 5W SE NW EXC PT TO CSM Block/Condo Bldg:
14/3925
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
25- 29N -15W SE NW
Notes: Parcel History:
Date Doc # Vol /Page Type
08/21/1998 585566 1350/412 WD
07/23/1997 832/150
07/23/1997 831/267
07/23/1997 816/556
More...
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
82313 Use Value Assessment
Valuations: Last Changed: 05/26/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 12,950 189,950 202,900 NO
AGRICULTURAL G4 11.500 1,750 0 1,750 NO
UNDEVELOPED G5 26.500 21,100 0 21,100 NO
Totals for 2005:
General Property 40.000 35,800 189,950 225,750
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 35,800 189,950 225,750
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 563
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
Parcel #: 034 - 1055 -70 -000 12/19/2005 04:32 PM
PAGE 1 OF 1
Alt. Parcel #: 25.29.15.391 034 - TOWN OF SPRINGFIELD
Current X', ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
CAVERN R & NOLA J JOHNSON O - JOHNSON, LAVERN R & NOLA J
3216 75TH AVE
KNAPP WI 54749
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 25 T29N R1 5W 40A SW NW Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
25- 29N -15W
Notes: Parcel History:
Date Doc # Vol /Page Type
08/21/1998 585566 1350/412 WD
07/23/1997 832/150
07/23/1997 831/267
07/23/1997 816/556
Moro...
2005 SUMMARY Bill M Fair Market Value: Assessed with:
82312 Use Value Assessment
Valuations: Last Changed: 05/26/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 38.000 3,000 0 3,000 NO
UNDEVELOPED G5 2.000 100 0 100 NO
Totals for 2005:
General Property 40.000 3,100 0 3,100
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 3,100 0 3,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Commerce County: '
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
399592 0
GENERAL INFORMATION (ATTACH TO PERMIT) State P ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. (40302- Z T • IA-
Permit Holder's Name: City Village X Township Parcel Tax No:
Johnson, LaVerne I Sp Townshi 034 - 1055 - 70-000
CST BM Elev: Insp. BM Elev: BM Description:
017.0 ( 1 U -0 vw.�.Q csTeau'�/
TANK INFORMATION IF 4F 1 ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION rBS N HI FS ELEV.
3
Septic Benchmark
ao.o
Dosing / ^ Alt. BM ( u 3. OY.9Z
Aeration V � L Bldg. Sewer
Holding St/Ht Inlet 1 . b svr
St/Ht Outlet t D
TANK SETBACK INFORMATION 0 �• `a. YZ
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1� 35
Septic y`oof v L 1+ 1 Dt Bottom
Dosing i Header /Man. , v
� IOV ~ �8 6•�� 92•sg
Aeration Dist. Pipe •bT
Holding Bot. System fly ;• T �¢ 1
Final Grade T/
PUMP /SI HON INFORMATION
Manufacturer �(� De and St Cover
�tK.�Ck- . ►' GPM
L01 Model Number �D 33
TDH Friction Loss , System Head TDH Ft
111 . O •SZ 2 - _ 10 . Z
ftf Length i Dia. Dist. to Well
OIL ABSORPTION SYSTEM Z
RENC idth Length No. Of Trenches PIT DIMENSIONS . Of Pits Inside Dia. Li u'
D S c C�
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI w acturer.
INFORMATION CHAMBER O
Type Of System: _ '!� / Mo U er:
V Y
DISTRIBUTION SYSTEM
Header /Manifold IDistribUtion r It x Hole Size x Hole Spacing Vent to Air Intake
Length Dia Length I 06 Dia 2 1) Spacing S /16I 2-f N
SOIL COVER x Pressure Systems Only x Moun 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 discrepencies, persons present, etc.) Inspection #1A0y/'V_! 0 -4 —' Inspection #2:
Location: 3216 75th Ave Wilson, WI 54027 (SW 114 NW 1/4 25 T29N R15W) NA Lotto Parcel No: 25.29.15.391
1.) Alt BM Description =
2.) Bldg sewer length= 2� /
- amount of cover = P 11D tow ,
3) Ta,,,.k Gam.) c a► • �° CZ) S -s • -Q„�, "!�° , UNAW -- -
Plan revision Required? _Yes ❑ No
Use other side for additional ation. J ___
SBD -6710 (R.3/97)� Date Insepctors Signature Cert. No.
4A56
- 32
Sanitary Permit Application ^ Safety & Buildings Division
r X 201 W. Washington Ave.
In accord with Comm 83.21. Wis. Adm. Code
r. PO Box 7302
See reverse side for instructions for completing this application
i Personal information you provide may be used for secondar purposes Madison. WI 53707 -730
Department of Commerce [Privacy Law. s. 15.04(1)(m)] (Submit completed form to county if r
state owner
Attach complete plans (to the county cop) only) for the system. on paper not less than 8 -1/2 x I I inches in size.
County �1 State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number
C 3 9 L ' � < 4- �' 3 d Z.
I. Application Information - Please Print all Information _ , ., Location:
Property Owner Name Property Location
A. \ v� 1/44/4)/4.s-X'�Pr - or
Property Owner's Mailing Address MMLLI 1, Lot Number Block Number
City, State Zip Code e ne N j Subdivision Name or CSM Number
LAJI-cen -I l - l� L ST C X
II Type of Building: (check one) '-f !! ❑ City
1 or 2 Family Dwelling — No. of Bedrooms: t� per ���n �� 0 Village A Town of
O Public/Commercial (describe use): 0 r
❑ State -owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nef restR a
A) 1. ANew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System — ld 6$ — 70 —lso 1
B) Permit Number LS. L 9 (S. 4� Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
❑ Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
ed In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
At -grade ) x /Uo� ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V Dispersal/Treatment Area Information: Q �
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate b. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
300 7 1'Sa 9g. Y( ✓ vo. $j6
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
_*jQ ❑ ❑ ❑ ❑
❑ ❑ ❑ 1- 0
VA e
Resp nsibility Statement
I, the undersigned, assume responsibility f ^r installation of the POWTS shown on the attached plans.
Plumbe s Name (print) Plumbe ' Signature (no s ps): MP /MPRS No. Business Phone Number
Plumber' rd dress (StreYt, City, State, Zip Code) /
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Lng Agent Signature (No stamps)
A Approved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination $ 3Z S, OCR t A (P /
IX. Condi tions of Approval /Reasons for Disapproval / :
�eI w,aP fa r YPt reLowm
•�S
SBD -6398 (R. 07/00)
Safety and Buildings
10541N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
�sconsin www.w
w ww.cornrnerce.state.wi.us/sb
isconin.gov
Department of Commerce
Scott McCallum, Governor
Philip Edw. Albert, Acting Secretary
October 30, 2001
CUST ID No.226524 ATTN.- POWTS Inspector
ZONING OFFICE
ROGER L TIMM ST CROIX COUNTY SPIA
3128 20TH AVE 1101 CARMICHAEL RD
WILSON WI 54027 HUDSON WI 54016
CONDITIONAL APPROVAL
Identification Numbers
PLAN APPROVAL EXPIRES: 10/30/2003
Transaction ID No. 684302
SITE: Site ID No. 637817
Laverne & Nola Johnson Residence Please refer to both identification numbers,
75TH Ave above, in all correspondence with the agency.
Town of Springfield
St Croix County
SW 1/4, NW 1/4, S25, T29N, R15W
FOR: New at grade system, 300 GPD
Object Type: POWT System Regulated Object ID No.: 817306
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Conditions:�
• This system is to be constructed and located in accordance with the enclosed approved plans and with the "At
Grade Component Manual, SBD- 10570 -P (R.6/99)" and the 'Pressure Distribution Component Manual for
Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99).
• In the event this soil absorption system malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans. In addition, the owner must insure that the
operation, maintenance and monitoring duties as described the At Grade Component Manual are complied
with. A copy of this information must be given to the owner upon completion of the project.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The maintenance plan for this system must be given to the owner of the POWTS.
Site Specific Conditions:
• The orientation of the at grade system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual.
• Surface water drainage shall be diverted away from the system area.
• Materials shall conform to the requirements of COMM 84.
k:
y
ROGER L TIMM Page 2 10/30/01
• Insulate buildi sewer per COMM 82.30(11)(c).
• Provide frost protection per COMM 83.43(8)(c).
• Maintain well and waterline set backs per COMM 83.43(8)(i).
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the res 1 r designing a safe building, structure, or component.
Inquiries concerning this corre ondence may b made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
' Balance Due $ 0.00
icia L Shand
POWTS Plan Reviewer, Integrated ervice WiSMART code: 7633
(715) 634 -7810, Fax: (715) 634 -515 7:45 am - 4:30 pm
pshandorf@commerce.state.wi.us
cc: Laverne Johnson
Laverne & Nola Johnson - At -grade System
Transaction #
Construction Materials and Techniques
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manuals:
At- grade, SBD- 10570 -P (6/99)
Pressure Distribution, SBD- 10573 -P (6/99)
Location: SW 1/4, NW 1/4, Sec. 25, T 29 N, R 15 W
Town: Springfield
County: St. Croix
Date: July 5, 2001
Owner: Laverne & Nola Johnson
Address: 2585 CTHW E
Woodville, WI 54028
Plumber: Ro er Timm
Signature:
License # MPRS 226524
Attachments: 6748 -Plan Approval Application
SBD -8330
page 1: cover
2: design criteria & calculations
3: plot plan
4: plan view, system cross section
5: lateral detail
6: pump tank exit detail
7: pump curve
8: system management
page 1 of 8
I
v Design Criteria
Residential Wastewater Contaminant Load: 30 mg/L < BOD < 220 mg/L
30 mg/L < TSS < 150m /L
Anticipated septic tank effluent g _ g
P P
Fecal Coliform > 10,000 cfu/100 ml,
Fats, oils, grease < 30 mg/L
Bedrooms x 100 gal/bedroom/day x 1.5 3 `� gallons /day hydraulic load
Design Calculations
In situ designed loading rate 0.4- gallons /sq. ft. per day
Depth to estimated high ground water ? 4-1 in.
Depth to bedrock � in.
Cross slope at system t %
Force main length ft. of Z in.
Manifold/header length N ft. of in.
Drain -back Z d' gallons
Lateral length Z @ 4 r 9 . 0 ft. of Z in.
Lateral elevation C ( Q . 41 ft. @ bottom of lateral
Lateral hole size 3 � l e i @ Z4- • o in. ( ft.) Spacing
D. S holes /lateral holes total
Lateral volume k;, c l gallons
Total lateral discharge rate 33 • ° gallons /minute @ Z �� ft. head
Network pressure compensation losses ° '� s� ft.
Elevation difference �'' �5� ft.
Friction loss 0 ft. @ b gallons /minute
Total dynamic head 9 • Z ft.
Pump /siphon V gpm @ ` ' � ft. of head
Manufacturer G ° w �Q-s g t Model #
Dose volume g 3 gallons
Lift/si * n tank w ' °'�'`' `�`9 6 ` gallons
Septic tank 1 ` o gallons
Effluent filter �"` CA `k
Measurement pump on and off in.
Height alarm from tank bottom �^ ° in.
Reserve capacity y' ^ 'S� gallons
specs.calcs.res
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11... �+-� v. � t o L tom �"•"
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"���•C�Fabri Distribution Lateral
Observation �-- Soil Cover
Well 12••
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♦ �� � b \ h..o 1 i"S O '� 1 � � �'V � CS�..._� Q� �3c I S G " \ �• �.. JL.1 � �� •� " M'Y \ � . Q �
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awcK 0�•co•I�ItGY --�
IL
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4° PIPE 3'
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SOIL. 24" 2.D. �I
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SKET 3�M'J �_ W FL E;
AL
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Flev, QIV :h Ow�t1,..�" o
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Pw1P
COMCRETG .
LFV, b�oGX
SEPTIC f PE FI'CATION
DOSE
TA►J,S MA►JUFACTUR R: (JUM6ER OF DOSES: PEK DAB
TAWK SIZE: ls L ' i ALL S ..DOSE VOLUME
59 '1
ALARM MMJIJFACTUf�CR; S �` INCLUDING 6ACKFLOW: ONS
^ODEL WU" \ ° �� ``� CAPACITIES; A= � WCHES OK �2r GALL0u5
SWITCH T Bc Z IW CMESOR � CGALLOV5
PUMP /'1AWUFACTURCR: � �"` G • 4 ' 0 IULHES OK $� CGALLCLJS
MODEL ►NUMBER: - (
D INLHES OR GALLON.,
SWITCH TI;IPE: `� " MOTE: PUMP AWD ALARM ARE TO CE
M 1101, MUM DISCKAPt" RATE 3 GPM INSTALLED OW SEPARATE CIKCL r.)
VERTICAL DIfFERC1J 15ETWEEW PUMP OFF AWO OISTRIbUTIOW PIPE.. !" FEET
+ MWIIMUM WETWORK SUPPLY PRECCURE . . . . . . . . . . . FEET
+ M 2 .! 8 F
�� T,� FEET OF CORE[
MAIN X /ppptFRICT1o1J FACTOR. c9.3 3ra FEET �
TOTAL DyWAMIC. HEAD = �' FEET
IIJTERWAL DIMCWSIOAJC OF TAWK: LEAIfiTH \o !� ;WiDTH LIQUID DEPTH
t' AL,.0 6 � a $
_�
r
i
M ODEL •
Vertical • Pump .0, EP0
• •
IR
` . ' [[55 GOULDS
a 'iM y
Pump Specifications::
METERS FEET
1 /3 H P 10
Up to 40 GPM — ODES 3a»
Discharge size 1 NPT 9 30 �
Solids: 3 /e" maximum 6
Motor T 25
Single phase: 115V 6 20
Materials of Construction - r — r — - - Y
Brass /thermoplastic 4 ,5 EP05 _
Features and Benefits - -� -- —�— -T_ Y
3
*Top suction eliminates a
impeller clogging. 2 6 EPO4 T
• Corrosion resistant 1 — -
construction. 0 0
0 10 20 30 40 50 v5 �
• Float actuated switch. 0 2 4 6 6 10 12 n�tr
CAPACITY
METERS FEET
' is MODEL DVP03 Pump Specifications Features and Benefits
' /,0 and'/, HP • EPO4 impeller- semi -open vies gn
6 20 With ' um Out vanes to p rotect
6 Up to 60 GPM mechanical seal. p
4 4 , Maximum head to 32' • EP05 impeller - enclosed design
Discharge size 1 /2 NPT
I o 3 10 Solids: 3 / maximum for improved performance.
Motor • Rugged glass- filled thermoplastic
r 2
5 -- casing and base design provides
All motors feature ball superior strength and corrosion
° 0 bearing construction.
0 5 10 15 20 25 30 35 40 U.S.GPM resistance.
G 2 a s e ,onantl Single phase: 115V .Cast iron motor housing for
CAPACITY Materials of Construction efficient heat transfer, strength.
Cast iron
Thermoplastic and durability
I
Stainless steel • Corrosion resistant threaded
stainless steel shaft.
• Available fu; automatic and
manual operation.
• CSA listed models available.
�I
All Models are designed for continuous o ration and feature stainless steel hardware.
System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the homeowner, and the homeowner must be provided with a complete set of plans including this management section.
If problems develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715- 772 -3214,
or the St, Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance.
General
Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and
contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or
compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water
in a manner to protect ground water quality and public health.
I . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal residential use begins
to ensure adherence to contaminant load design criteria.
2 Install water - saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5. Garbage disposals are not recommended; if you must have one, use it sparingly.
6. No paper products other than tissue should go into the system.
7. No chemicals should go into the system.
8. Avoid surge flows of water; try to spread laundry throughout the week.
Maintenance
I . The septic tank must be inspected every three years by a properly licensed person.
1 If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume.
3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into
the septic tank to remove accumulated material.
4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6. The purnping components for this system include an alarm which must be installed and remain on a separate circuit from the pump.
If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve
capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
two days should pass before any necessary repairs can be made.
7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system.
8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area.
11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient
oxygen.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for residential systems; such monitoring may become
necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping
and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation
of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
ORIGINAL
. 1342
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing
ounty
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 034 - 1055 -70
Please print all information. R ie7d By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2
P rope rt y Owner Prope Location
Johnson, Laverne & Nola Govt. Lot SW 114 NW 1/4 S 25 29 N R 15 W
Property Owner's ailing ddress Lot # Block # Subd. Name or CSM
2 585 CTHW E
City State Zip Code Phone Number Cit Village id Town Nearest Road
Woodville i WI i 54028 715- 698 -2773 Springfield 75Th Ave.
New Construction Use: Residential / Number of bedrooms 2 Code derived design flow rate GPD
Replacement Public or commercial - Describe
Parent material till Flood plain elevation, if applicable NA
General comments
and recommendations: install 7.5' x 100' effective rock (9.5' x 100' overall) unit at -grade system w/ laterals following 98.9 contour
1-9 Boring # j Boring
Pit Ground Surface elev. 97.1 ft. Depth to limiting factor 45 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 ! 0 -5 7.5YR 3/2 - sl 2 m gr mvfr cs 2fl m .5 .9
2 5 -34 I 7.5YR 4/4 - sl 1 f -m sbk mvfr cs 1 m .4 v .6 ✓
3 34 -45 10YR 5/4 - s 0 sg ml cs ..1r -- _.7 ✓I 1.2
4 45 -68 10YR 7/3 c1d 7.5YR 4/6 fs 0 sg ml �4 -�--- % 6 '� 9 ✓
IL
—� orizon 4 has s l i ie s, r s
3 -64'It .
❑ Boring # Boring - FFtCE
Pit Ground Surface elev. 98.4 ft. Depth to limiting factor i Soil Applicati n Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun 6*01$° "I ' GBdlft'
l
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r
1 0 -5 7.5YR 3/2 - sl 3 m gr mvfr cs 1 Urn .5 9�
2 -! 5 -15 10YR 4/3 sl 2 f -m sbk mvfr cs 1m .5 ✓ 9 ✓
3 15 24 10YR 4/3 - sl 1 m sbk mvfr cs if .4 i 6 ✓
4 24-42 7.5YR 4/4 - sl 1 m sbk mvfr cs 1 m .4 r .6 ✓
5 42 -44 10YR 4/1 f1 d 7.5YR 4/6 fs 0 sg ml cs - i .5 ✓ .9 ✓
6 44 -50 10YR 6/4 f2d 7.5YR 4/6 s 0 sg ml - - .7 ✓ 1.2 ✓
Effluent #1 = BOD 30 < 220 mg /L and TSS > 0 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name ease rant) Sign e: US I Number
Henry F. Grote 222774
Address Certified Soil Testing Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave., Menomonie, WI 54751 5/29/2001 715- 233 -0398
Property Owner Johnson, Laverne & Nola Parcel ID # 034 - 1055 -70 Page' 2 Of -' 3
7 Boring # Boring IN Pit Ground Surface elev. 99.9 ft. Depth to limiting factor . 41 in,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh.
1 0 -6 10YR 3/1 - sl 2 m gr mvfr cs 1f /m .5 i .9
2 6 -23 10YR 4/3 - sl 2 f -m sbk mvfr cw 1 m .5 ✓ .9 ✓
3 23 -41 7.5YR 4/4 - sl 1 m sbk mvfr cs if .4 ✓ .6 ✓
4 41 -47 10YR 7/3 c1d 7.5YR 4/6 fs 0 sg ml - - .5 ✓ .9 ✓
L 7
I
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
I in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh.
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Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
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Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
M -8330 (R.07/00) Certified Soil Testing
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• ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address 3 7-1 `7 5 T A yt
Property Address _? 2 4 L 7 5 T it A V
(Verification required from Planning Department for new construction) &a&A -0
City /State Li , 1&" Parcel Identification Number 3Y r /0 SS " 70 •O m
LEGAL DESCRIPTION l
Property Location fa) 1 /4, Al) 1 /4, Sec. S , T N -R 5 W, Town of C r t
Subdivision Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # ' 46 ( 4 Volume 15:5 . Page # 1 12-
Spec house ❑ yes J9 no Lot lines identifiable 0 ,yes ❑ 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
masterplumber, journeyman plumber, restricted plumber or a licensedpumper 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 Zoning Office within 30
days of the three year expiration date.
J / / I dl
IGNATURE 6F IgPLICANT 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE 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
t ( VOL
STATE BAR OF WISCt)ti51ti 1'OR% I 1 - i
WAkRANty 1)1'1.1)
O()(,t1MENT NO ... r � �,
R
. i ,
This Decd, ma,ic , „•.t, 0re1 Baierl an)d _Law�'wice_
Bair(, hus "k�att�l _ar,d •) ift_ 1J)d ea�.h tu__their own right AU" 1 1998
.n La-Vern R.. Juhnsun and .Hula. J____Juhaisnn., husband.._ -
_ - _anal wife —as- sul /ur hip _utarital praperty
� tlrleSSe th It rit �rta.�r. �,r.!c,uuanle i ratt;ut_ -_ _
-- _ __. _ "rll""tnR t Y"ihe i real cst.tle to St. Croix__ - - --
oncc�s u l,ranter the , ,, ., , , - •
Count), State of Wl—onstn
Richardson Law Office
The South Half of the Northwest Quarter (Si of NWt) P.O. Box 399
of Section Twenty -ti%— (25), Township Twenty -nine (29) spring Valley, WI 54 67
North, Range Fifteen (15) West. G`Jf"�
034-1055-80
LS, ZQ, (�, 39z __U34 -_1Q5� '%
3 � �a�E� _ CAT N ti _ 1�Ea
Lawrence Baierl joins in the execution of thi- deed for the sole purpose of agreeing to to
convey any ws o
Property La the State of have
as bsaid l w may exist a the date Marital
of
execution of this deed.
TRANSFER
FEE
This _ —_!� nO homestead property .
not)
' - together with all and singular the heredttaments and apr irtenances therewitu he gin .
And
Ili that the tole is good, .t:d a,ihle in fee sunplr and Lu• and ar of . t
1
all easements, restrictions and rights of way of record.
t and will warrant and defend the same
tik
da }' ul f>,U�USt - — --
Dated this -- - - - "
(SEAL)
- Or el Baierl
- --
_� iSEAL) a
(SEAL)
• Lawren Baie rl_------ - -- - -
AUTHENTICATION A(_KNOWLEDGMEN- T
State of Wisconsin. l
nature(s) O rel Baierl a L awre nce
Jut d h, 4 Agpst
l