HomeMy WebLinkAbout034-1056-90-175
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
556308 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)i.
Permit Holder's Name: City Village X Township Parcel Tax No:
Johnson, Phillip F. Springfield, Town of 034-1056-k-TSO
CST BM Elev: Insp. BM ev: BM Description: Section/Town/Range/Map No:
rv\ I GS 25.29.15.397A15
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER 1114 T-1 CAPA TY STATION BS HI FS ELEV.
c r..
Septic Benchmark e'j" 6t- 7600 Dosing 6 Tao Alt. BM- I 'L!/ef~ /
-
Aeration Bldg. Sewer Z
Holding St/Ht Inlet
2a .Z $5 • 7
TANK SETBACK INFORMATION St/Ht Outlet Z6, ~S
TANK TO + r'PiL WELL BLDG. ent Air Intake ROAD Dt Inlet
76.7 7 S.
Septic Dt Bottom 71 75a g7 Z7 ~ 231
~z• Z
Dosing Sd V f 36 Header/Man.
-7, z5 ~?s • $
Aeration Dist. Pipe 7~ ZS • 8
Holding Bot. System q 7
8 . to 7 • y
Final Grade Z
PUMP/SIPHON INFORMATION
Manufacturer De/maand St Cover
GPM
Model Number 6 A
TDH Lift,. Friction Los System Head U- TD H ~ i 1F
~j NrT"
I . L
Dia.Zl t Dist. to Well
Forcemain Length, 1 94
SOIL ABSORPTION SYSTEM
BED/TRENCH Width i Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia.~ Liquid Depth
DIMENSIONS 3 / n 17 `
SETBACK SYSTEM TO (l~U P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER
IT Model Number: Ez ~~d
Of System: UN OR
t
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Verg Air Intak
\ Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Vi„f - /.6
De th Over Depth Over xx Depth of xx Seeded/ odded xx Mulched
Bed/Trench Center r Bed/Trench Edges Topsoil
s/ ®No Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: D 3 /'3_j 1 Inspection #2: / /
Location: 3296 72nd Ave. nape, W 749 (NE 1/4 SE 1/4 2,5 T29N R1 5W) NA Lot 2 Parcel No: 25 9. 3 7A15
-F t
1.) Alt BM Description=
2.) Bldg sewer length = 17Z z b PAC ('0'5
1 ~0 w'~ c7 vim'
- amount of cover
Plan revision Required? Yes
Use other side for additional informati nNo
SBD-6710 (R.3/97) Date Insepctor's Sig ure Cert. No.
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Safety and Buildings Division county
2x71 W. Washington Ave., INA
7162 St-Croix
Madison, WI 53767=71 sani
ol+ ~ ~ tart Permit Number (to be filled in by Co.)
A4
YR it A SS .3 OP
In accordance wi SPS 31a2 Application State Transactionumber
is required prior t o ssion of this form to the appropriate governmental unit N A
the Department o S ote:
ssional Servie Application forms for state-owned POWTS are submitted to
o es. Personal information project
ores in aceor ce with the Privac Law, s. 1s- 1 you provide may be used for secondary
L A lication Information - please Pmt All 1 >rmaaon Address (if different than mailing address)
Property Owner's e 3 2- R 72 t) d
Milli Johnson Parcel # t/,/~'j~t`p
Property Owner's Mailing Address a /CIO
~j
Location/
3275 70`'' Ave Property
City, Star Govt. Lot ( . 3 ~7/4 3T7.97
Knapp Zip Code Phone Number _NE_'/~ SE_ Section 25
IL Type of Building 54749 715-772-4691 - (circle one) - -
n(check all that apply) T -29_ N; R_15- west
XI or 2 Family Dwellin Lot #
gumber of Bedrooms 1 GI '
riLCP~C
\jU
L
This p o e system will serve a one r--=a L_ - _ bedroom
l • Block #
~~G~Lu4,~ ~(.~tivY/ Na 'iL SS ❑ City of
CSM Number
- / n p ❑ Village of
V
III Type of Z T. 50 s3 X Town of S
Pe (Check only one boa on line A. Complete line B if prang Field
A. New System Replacement System Treatment/Holding Tank Repplicable)
lacement Only
❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal
Before Expiration El Permit Revision El Change of Plumber
❑ Permit Transfer to New List Previous Permit Number and Date Issued
N. Owner
Com nenum.evice; (Check all that apply)
Non-Pressurized In-round Pressurized In-(hound
E] Hol mg At-Grade ❑ Mound > 24 in. of s table soil 11 er Dispersal Component (explain) Ji/V1.1f C ` Pr
/r yc~~Mound j 2q in. of suitable soil
V. Dis rsal/Treatment Area Information. 60 ( xp
1
Design Flow (gpd) Design Soil App1i 50 cation Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System E evation
VL Tank Info 3 0n r' too
Capacity in
Gallons TOW # of Manufacturer
New Tanks Gallons Units ~Q
Existing Tanks
Septic or Holding Tank
X
Dose TANK 600 1 Huffcutt
X 600 X
VIL Responsibility statement- the uncle 1 Huffcutt X
Plumber's Name (Print) t~s for
Plumb anon of the POWTS shown on the attached plate,
Lewis Bjork i e
i MP/MPRS Number Business Phone Number
Plumber's Address Stree \ 25397 53976 715-231-7375
E781 oun (Street,
Road E Menomonie W154751
Coun /De artment Use Ohl
Approved ❑ Disapproved Permit Fee
$ ~ Date Issued Iss ng ent Si
El Owner Given Reason for Denial L17 ~ ( 20
t,
SYSTEM OWNER:
1 Septic tank, effluent filter and 3 5U
dispersal cell must all be serviced / maintained /
as per management plan provided by plumber. r9A;UA1 4,ajyt cy1 2. All setback requirements must be maintained Q
-
_as per applicable code/o d`nances., - q,7,7, N 7 AC4-e 14 ( 00
Private Onsite Wastewater Treatment System
Index and Title Page
Project name: Phillip Johnson New pOWT
S
Owners name: Phillip Johnson Ave Knapp
Phone 715-772-4691 WI 54749
Legal Description: NE SE 25 2915 West
Town Of Springfield, St. Croix County, Wisconsin
Subdivision:,ANA U) .7-- 2- Parcel I.D. Numbered-
Page V. P.
1 plot plan -/o-_~_----------
Page 2 Plot Plan Legend 13. Distribution cell Media Layout
Page 3 EZ-Flow sizing data 14. Elevation Cross Section
Page 4 EZ-Flow Parameters 15. Pump camber
Page 5 Septic and Dose Tanks
Page 6 Effluent Pump
Page 7 Effluent Filter
Page 8-10 Soil report
Page 11 Management Plan
Page 12 Start up and operation
Designer: Lewis 8jork Credential #253976 Signature
Date4-11-2012
Design in pursuant to the fallowing in ground non pressure Manual for POWTS
( er. 2.0) SBD-10705-P
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Plot Plan Legend
O 4" PVC ASTM D 3034.42"Mi
n. Cover where snow is not removed.
O 24 inside diameter concrete manhole brought min.4"above
surrounding grade. Concrete covers chained and padlocked
O Precast concrete septic tank.
O Effluent filter location.
O 4" PVC ASTM D3034. 18"
Min. cover .Effluent piping or building
sewer where tank is within 30.
O Precast concrete dose/pump/filter
tank.
O 12-2 OF-B Power conductor.
14-2 OF-B alarm circuit conductor.
Both wires are UL listed A-2057
O 2" PVC ASTM D-2665 -09 Schedule 40 Pipe Force main.
O 4" PVC ASTM D-2665 -09 Schedule 40 Pipe .Entering and exiting
concrete tanks min 10' in length.
10 Carlon All weather pvc junction box. UL listed # A-241
11 Ez- Flow Cell treatment/dispersal cell
12 Inspection wells
Project AJ ~0
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Installation Instructions for
Ufiov Systems in Wisconsin vnEZJ9
wTM
. I.....ATOR
Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall
Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and
product and determined it to be in compliance with chapters '
the Permeability for the site. If certain criteria is met, the
Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40%
145 and 160, Wisconsin Statutes. All sites must meet the
Site smaller drainfield.
& Soil Conditi0 & Locations & Isla n distances as noted in
local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap-
The approved products are 1203H (3-12" bundles with in proved by system design permit specified for the particu-
pipe lar site. The top or center-most bundles containing pipe
center bundle in 5' or 10' lengths) and 1203HP {3-12" bundles
with pipe in each bundle in 5' or 10' lengths.. - are joined end to end with an internal pipe. couplet Any
additional aggregate only bundles that may be required,
A sin le bundle contains a four inch should be butted against the other aggregate-only bun-
g pipe Perforated pipe sur dies and do not re uire an
rounded by EPS aggregate and is held together with poly- q y type of connection.'
ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre-
only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The
Materials and fabric is inserted to prevent soil intrusion. The installer
Equipment Needed shall make sure the the GEO is sitiioned
• EZflow Bundles po upward and is
• EZflow Bundletile Fabric ; in contact with the fabric contained in the adjacent cylin
• EZflow Internal Pipe Couplers ' der before backfilling.
• Pipe for Headerand Inlet •
• Backho Head vat ; 8. The EZflow Drainfield Systems should be installed in a
level trench in all directions (both across and along the
Installation Instructions trench bottom) and should follow the contour of the ground
The instructions for installation of EZfow products are given surface elevation (uniform depth), with all continuous
9i adjoining 10-foot cylindrical bundles placed end to end,
below. This product must be installed in accordance with state
• with central bundle distribution pipe ..interconnected,
rules defined in chapters Comm 82 through 84, Wisconsin Ad- '
ministrative Code, and Chapters 145 and 160, Wisconsin Stat-
utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not
manual. pond. Backfill should be seeded or sodded immediately
1. After the local health department has determined sizing, after completion to reduce erosion.
configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved
or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or
careful to set correct tank, invert pipe, header line or dis- other obstacles.
tribution box and trench bottom elevations before instal-
lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might
2. Remove plastic EZflow shipping bags prior to be expected that natural buoyancy forces would tend to
9s P Placing cause EZflow assemblies to float out of ground when
bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field e
trench before system is covered. experience has shown, however,
that this is not a problem when systems have a minimum
3. This product must have geotextile fabric that meets re- of 6" of soil cover as recommended by manufactures
quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extending
down along the sides of the product to a point at least six 1203H-GEO
inches from the bottom of product. .
Geotextile
4. When installed in' a trench, the trench should be dug to Barrier Material
a width of 36 inches. This not only saves labor in excava- ~7 .
lion, but also provides better bad-bearing capacity after -
backfilling is complete: - ° :ti;•
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PUMPS UN = w/ Float In Box
M = Auto Float Attached (verticaQ
N = Non-Auto (manual) I~ s
E = 230V Non-Auto (manual) PUMP ~Q"
"FLOW MATE" 98 4m/~.~ SN~E /y3~'"
Prder-# Model NP ph Type D9SCriation
ZBN98 BN98 1/2 HP 115/1 List_P~ice
ZN98 Automatic cast iron 1/2" Solids, 1-1/2" Disc. Tethered Float (15) 358.95
W98 1/2 HP 115/1 Manual Cast Iron 112" Solids, 1-112" Disc.
319.45
FEATURES:
BN98 The "Flow-Mate" is constructed HEAD CAPAWY CURVE
of durable cast iron, carbon 3o MODEL `98" 112 HP
ceramic seals and a non-
clogging vortex impeller. 25
15' Cord
zo
APPLICATIONS: ,s
The "Flow-Mate" is ideal for
septic tanks, dosing, low 10
Pressure pipes, large mounds
and step systems s
0
0 10 20 30 40 50 60 70 ro
"DOSE-MATE" 151, 152, 153
Z e _model,, HP Vo VP T3C e
~ rol~ - Description
BN151 BN151 1/3 HP 115/1 Automatic Cast Iron 1/2" Solids, 1-1/2" Disc. Tethered Float (207 322.08
N151 1/3 HP 115/1 Manual Cast Iron 1/2" Solids, 1-1/2" Disc.
281.16
ZBN152 BN152 4/10 HP 115/1
ZN152 Automatic Cast Iron 3/4" Solids, 1-1/2" Disc. Tethered Float (20) 355.08
N152 4110 HP 115/1 Manual Cast Iron 3/4" Solids, 1-1/2" Disc.
314.16
ZBN153 BN153 1/2 HP 11511
ZN153 Automatic Cast Iron 3/4" Solids, 1-1/2" Disc. Tethered Float (20') 498.95
N153 1/2 HP 115/1 Manual Cast Iron 314" Solids, 1-1/2" Disc.
ZE153 E153 1/2 HP 230/1 462.00
Manual Cast Iron 3/4" Solids, 1-1/2" Disc.
462.00
i' FEATURES:
The "Dose-Mate" is constructed of ~ cuavE
BN152 durable cast iron, carbon ceramic "lslnsz~153
seals and a non-dogging vortex
impeller. n .
20' Cord 35
APPLICATIONS: e a
The "Dose-Mate" is ideal for septic s . „
tanks, dosing, low pressure pipes,
mounds and step systems 4 10
4i 2
m
Row~wrtE
14-2
~~ls_
FILTER CARTRIDGE
INSTRUCTIONS
Installation , w
STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is
centered under the access opening. If not, then either insert tank through the outlet or solvent weld (glue) additional pipe onmore pipe into
to the outlet the
pipe.
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3A-inch pipe needed to brace the filter to the tank end wall if utilizing the
optional supplemental side support. If side support method is not utilized,
proceed to step four.
STEP 3 For installations utilizing the optional supplemental side support:
solvent weld the IA-inch pipe onto the filter case. If side support method is not
utilized, proceed to step four.
Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the fitter locks into the bottom of
the case.
If a VRS switch is utilized: insert into the filter and lock by turning
clockwise 900.
Maintenance
1. The effluent filter should be cleaned every time the septic tank is
serviced.
2. Open the outlet access opening to inspect the tank and filter.
3. Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and effluent.
4. Once the effluent level has been lowered below the invert of the
outlet pipe, firmly pull up on the filter handle to dislodge the
cartridge from the case.
S. Slide the cartridge up and out of the case for cleaning.
6. If a VRS switch connected to an alarm is present, the switch
should be removed by turning counterclockwise 90° and cleaned
with water only.
7. While holding the cartridge on its side (large flat surface facing +s•.
down) over the access opening, rinse off the cartridge with water
only, making sure all septage material is rinsed back into the tank.
8. If VRS switch is utilized replace b
by inserting into filter and fi.
turning clockwise 900.
9. Insert the filter cartridge back into the case, pressing down until
the filter locks into the bottom of the case.
10. Replace and secure the access opening on the tank.
F4d 4c; P:M a i EIS' '7FF.f5-it'zE
%wwbearonsite.com 877-MLFILTERS (653-4583)
-7-15-
Uflow® Distribution Ceti Media Layout
3.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft)
Distribution Cell Cross-section Arrangements
3 ft Wide
Component Le end
SRI-7A Bundle - 5 ft or 10 It lengths
SRI-12A or EZ 1201A in 5 ft or 10 ft lengths
SR3-12H or EZ 1201P or SR3-12H in 5 ft or 10 ft lengths
a 4" Perforated Distribution Pipe With Pressure Lateral Inside
Bundles are covered with approved geotextite fabric as per the their product approval.
Distribution Cell Plan View Layout - Typical
3.00 Cell Width - A (ft) ®Celi Length - B (ft)
GO. C>0
Force Main
3 ft Wide
End
Connection -
Project:
/3' /57"
Elevation Cross Section
MOO
Surface grade elevation
r2" OO 6q11
r q " V, 7
Most restrictive pit in proposed area
I~
Project- Page_
l~-~s
Dose Tank Information Locking cawv with warning
label and be" device and
sealed watertight
Electrical as per NEC 300 and ll~~~
Comm 16.300 WAC Disconnect 4 in. min.
Tank component is property vented Alternate outlet
location
Forcemain diameter
huffcutt Manufacturer 2 in.
Capacity 600.00 Gallons
Volume 15.20 gattinch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 29.37 446.46
B 2.00 30.40 C PLLnp off elevation (ft
C 4.10 62.34 86.33
D ~T W 4.00; 60.80 D
Total 600.00
tank elevation (ft)
Bedding And BacWill As Per Manufacturer 86.Q0
Alarm Manufacturer -_Rombus _
Alarm Model Number 520-002A
Pump MManufacturer odel Number r1 oehler
Pump
P
Pump Must Deliver 7.88 gpm at 18.32 ft TDH
Project: Phillip Johnson
POWTS OWNER'S MANUAL AND MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ; Septic Tank Capacity al ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS 3 01f Effluent Filter Manufacturer XtW 2 ❑ NA
Number of Bedrooms (100 m) Effluent Filter Model ❑ NA
Number of Commercial Units / Pump Tank Capacity al ❑ NA
Estimated flow (average) / 57(3 0 0 gal/day Pump Tank Manufacturer q, J,fL ❑ NA
Design flow (DWF), estimated x 1.5 ,5 gal/day Pump Manufacturer c c✓l, ❑ NA
So' lication Rate Pump Model N ❑ NA
a Pretreatment Unit NA
Influent/Effluent Quality (NA❑) Monthly Average ❑ Sand/Gravel Filter ❑ Peat Filter
Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BOD5) ❑ Disinfection ❑ Other:
Total Suspended Solids (TSS) 220 mg/L
m Manu cturer: Model:
_I50 Soi sorption Component
Pr _ Mon y Average n-ground (gravity) ❑ In-ground (pressurized)
Biochemical Oxygen Demand (BODO < 30 mg/L ❑ _ ❑ Mound
Total Suspended Solids (TSS) < 30 mg/L ❑ Dri -line ❑ Other:
Fecal Coliform (geometric mean) <10 cfu/100m1 ❑ Dispersal Units - Manufacturer
Maximum Effluent Particle Size 1/8 inch diameter ❑ Aggregate Cell(s) Model
Calculations:
Soil Dispersal (E1SA) or
DWF - Application rate = Area Required _ (Aggregate Trench Width) _ # Units or Total Lengtth of Aggregate Trench(s)
/so - .-S - 300
DESIGN CRITERIA
❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual)
❑ "ICC Flowtech Mound Component Manual" Version 1.2
❑ "EzFlow Mound Component Manual" Version 8/20/2007
❑ SBD - 10854-P (R.1/12) "At-Grade Component Manual Using Pressure Distribution" Version 2.0
❑ SBD - 10705-P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0
❑ SBD - 10691P (N.01/01) "Mound Component Manual" Version 2.0
❑ SBD - 10657-P (R.6/99) "Drip-line Effluent Disposal Component Manual"
❑ SBD - 10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0
❑ Other -
MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT
Service Event Service Fre ue c
Pump /inspect tank(s), inspect dispersal cell(s), clean filter At least once eve : ❑ 13 months 3 ears ❑ Other -
Inspect um & um controls, alarm, pretreatment unit At least once eve : ❑ months ears ❑ NA
Flush and pressure test laterals At least once eve : ❑ months 3 ears ❑ NA
START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) for the presence of
painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations
are detected have the contents 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.
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity
and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving
appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water
softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface
whenever possible. Note: this does not include laundry waste, showers, dishwater, etc.
This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit
peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only
paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins
condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint,
Pag & of iT,
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer In g e) k2
Mailing Address 7S ~(5 74 ~ L) e-, LILa " t1d
Property Address 2 I ~ 7J Y~ q/• 14 •
(Verification required from Planning & Zoning Department for new construction.)
City/State 6add W~7 _ Parcel Identification Number
o 3 y -/0S--& , 0--1
LEGAL DESCRIPTION
Property Location IV W 1/4 , ='/4 , Sec. T ~N R~'W, Town of T,~ r• ; n r~ ~°e f~
Subdivision Plat: ~J Lot #
s
Certified Survey Map Volume 2- , Page #
p - (v aVC Zo/z
Warranty Deed # 2- fore 2007)volume , Page #
Spec house ❑ yes Lino Lot lines identifiable /yes ❑ no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 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 Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
' s/aglId
S'IGNATURt OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
I
11111111lII IIIIIIIII
8 0 5 5 8 1 4
Tx:4041564
955596
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
CERTIFIED SURVEY MAP RECEIVED FOR RECORD
05/03/2012 10:54 AM
EXEMPT
PART OF THE NW 1\4 OF THE SE 1\4, AND PART OF THE NE 1\4 REC FEE: 30.00
OF THE SE 1\4, OF SECTION 25, TOWNSHIP 29 NORTH, RANGE 15 COPY FEE: 3.00
WEST, TOWN OF SPRINGFIELD, ST.CROIX COLINTY-WISCONSIN PAGES: 2
UNPLATTED LANDS East I14 Corner
Section 25-29-15
75th Ave. NOO'45'26"W 2' Iron Pipe
2646_01' N89 '14.3J "9.00 33.00'
1995.34' N8914'34'E 33.00 44.170.19 N89°14'34'E N89.14'34"E 3'
WE'St I/4 Corner building seSection 25-29-15 ° 8x8 sq. ft.
14- I' Steel Nail OT acres UNPLATTED N
incl. r-o-w o _J C
3 LANDS 1 ed M N 298,661 shouse rn6.86 acro o UNPLATTED N mcl. r-o-well Cn LANS NB6.25'12"E 425.34' 2.85' 253.69' 21'58"w
N IEn
S89.27'46"W LOT 2 2
8 p v
I ~ LA 229,515 sq ft.
N° L~ 5 27 acres m d
I- UNPLATTED ! w" cn r i I
- - - - - r;" incl. r-o-w LO
m I LANDS
sq. L't
9~s3 225,962 ft.D N I c-a
PREPARED FOR: ` L
5.19 acrees s 32707 ~ I p
Phillip L Johnson \ flr " 4% not i I. r-o-w o I c
3275 70th Ave. 3~Z ° ° I ~
Wilson, WI 54749 8.52' building etbock line _ I
south line ~ S_89.12'5 W _0_428.49'
Note: of NE/SE --ss9o 3"W--428.54'--X8.07
-(S88'53'32"W) - - - - - -I- -
A violation of the St. Croix County Code of
°Iw
Ordinances, Chapter 17, will be created if any 72nd Ave_ N 1 N
livestock structure, animal waste storage facility or c'_1iD
UNPLATTED Ln I w
other structure housing one or more animal units is - - rn 1
LANDS m
located at a setback distance less than allowed by the Ordinance of such structures. Southeast Corner
Section 25-29-15
Aluminum Monument
Note: Each parcel on this map is subject to State and County laws, rules and regulations
(i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing
any parcel, contact the St. Croix County Zoning Office and Town Board for advice.
DRAFTED BY:~SCQ./y~4j~
Joel A Brandt
JB SURVEYING LLC : • BR/11i0T =
S-20W
SCALE: 1" 250'
0' 2 0 500'
LEGEND
(a.........Fd Government Corner (as noted)
North is referenced to the oSet 31,4" x 18" Iron Rebar weighing
East line of the SE quarter 1.50 lbs. per lineal foot
of Section 25-29-15 Found 1" Iron Pipe
which bears S01°13'56"E (0.00') ....recorded data
(St. Croix County Grid System) Sheet 1 of 2
1 of 2 Vol 25 Page 5853
A ® • •
CERTIFIED SURVEY MAP
PART OF THE NW 1\4 OF THE SE 1\4, AND PART OF THE NE 1\4
OF THE SE 1\4, OF SECTION 25, TOWNSHIP 29 NORTH, RANGE 15
WEST, TOWN OF SPRINGFIELD, ST.CROIX COUNTY,WISCONSIN
DESCRIPTION
A parcel of land located in part of the Northwest quarter of the Southeast quarter,
and part of the Northeast quarter of the Southeast quarter, of Section 25,
Township 29 North, Range 15 West, Town of Springfield, St. Croix County, Wisconsin,
more particularly described as follows:
Beginning at the East quarter corner of said Section 25, thence S01°13'56"E,
along the east line of said Southeast quarter of Section 25, a distance of 781.94
feet; thence continuing S01°13'56"E, a distance of 548.00 feet, to the Southeast
corner of the Northeast quarter of said Southeast quarter; thence S89°09'13"W,
along the south line of the Northeast quarter of said Southeast quarter, a distance
of 428.54 feet; thence NO0°50'47"W, a distance of 527.70 feet, thence N86°25'12"E, a
distance of 425.34 feet, to said east line; thence N01°13'56"W, a distance of 781.94
feet, to said East quarter corner; thence S89°14'34"W, along the east-west quarter
line of said Section 25, a distance of 1995.34 feet; thence S08°33"42"W, a distance of
486.68 feet; thence S79°21'58"W, a distance of 292.88 feet; thence S89°27'46"W, a
distance of 253.69 feet, thence NO0°32'14"W, a distance of S29.52 feet, to said
east-west quarter line; thence N89°14'34"E, a distance of 619.00 feet; thence
continuing N89°14'34"E, a distance of 1995 34 feet, to the point of beginning.
The described parcel contains 528,176 square feet (12.12 acres), and is subject to
easements of record and as shown.
SURVEYOR'S CERTIFICATE
I, Joel A. Brandt, Registered Land Surveyor, hereby certify: That I have Surveyed,
Divided, and Mapped the above described parcel of land in full compliance with the
provisions of Chapter 236.34 of the Wisconsin State Statutes, along with the
provisions of St. Croix County and the Town of Springfield, in surveying, dividing and
mapping the same. That such map is a correct representation of the exterior
boundaries of the land surveyed and the subdivision thereof made. Said survey was
done under the direction of Phillip L. Johnson.
Dated this 2(o day of AP{`; 2012.
• JOEL A.
* • BRANDT
2003
Joel A randf, R.L.S S-2603 S-
•
. a~+nrOOD ooo cm..
JB SURVEYING LLC
tio.s
CERTIFICATE OF COUNTY TREASURER
STATE OF WISCONSIN )
COUNTY OF ST CROIX ) SS
1. -Tilicla. Gerwlain , the duly elected, qualified and acting
treasurer of the county of St. Croix, do hereby certify that the records in my office
show no unredeemed tax sales and no unpaid taxes or special assessments as
of rj-3-QplZ affecting the lands of this Certified Survey Map.
2 - 11.c a~ c
2 OVED Treasurer,~ir_S4 71erxc
2 2012
Date LPLANNING&ZO--
COUNTY Sheet 2 of 2
OFFICE
of 2
Vol 25 Page 5853
1
Parcel 034-1056-8 -100 ( 04/18/2012 04:32 PM
PAGE 1 OF 1
Alt. Parcel M 25.29.15.397A ~j 034 - TOWN OF SPRINGFIELD
Current ❑ ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - JOHNSON, GERALD D & PEGGY J
GERALD D & PEGGY J JOHNSON
!KNAPP 59 75TH AVE6VL~.
WI 54749
Districts: SC = School S = Special Property Address(es): Primary
Type Dist # Description
SC 5586 SCH DIST SPRING VALLEY Z ?~~d
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres- 37.960 Plat: N/A-NOT AVAILABLE
SEC 25 T29N R15 NE SE EXC CSM 14/3954 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-29N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/03/2003 707912 2127/640 QC
1062/547 PR
2012 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 08/31/2009
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 36.960 5,100 0 5,100 NO
UNDEVELOPED G5 1.000 500 0 500 NO
Totals for 2012:
General Property 37.960 5,600 0 5,600
Woodland 0.000 0 0
Totals for 2011:
General Property 37.960 5,600 0 5,600
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
IL EVALUATION I D page off
Division of safetyr arrd a h M V& Adm. Code corr<rty St. Croix
`
Attach complete site plan paW not in side. Plan "rust nt direction and Parcel
1.0
include, but not limited to: 1 Pa (
percent slope, scale or d" ; and location and distance to nearest road. Date
all k1t on. ! 8 Z t
Personal information you Provide may be used for sawndwy purposes {Pdvac y Law, s. 15.04 (7) (M))-
Property Owner Party Location '
h-b 6, f1P4r- - Phillip Johnson Govt Lot NE 114 SE 114 S 25 T 29 N R 15 E (or) W
f ~y
-Property erty owners ding Address Lot # Block # Subd. Name CSNW
S79 ~
3275 70th Ave. Road
City State zip Code Phone Number ity
Knapp Wl 54749 ( 715-772-4691 72nd Ave.
l Code derived design flow rate 150 GPD
New Construction Use Residential / Number of bedrooms
® Replacement D Public or commercial - Describe:
outwash Flood Plain elevation if applicable ft
Parent material
General s will be a small in-ground non . One cell on th~e~~ north end slope of ridge toward back of proposed out lot.
and mmendations: ~X (l ~ ~Y~ V I't dL rl~ f 1-Z Gtr ~A"', r I~ ~ T
~7 Qh lacy
Gl
u Boring 64 in.
P-1 Boring # Pit Ground surface elev. 100 ft Depth to Wniting factor Soil ion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
Ott#1 'Etf#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
fls lfsbk ml a 2f 5 •8
lap 0-10 7.5yr3/2 -
ml as 2f 1.6
2b 10-38 7.5YR5/4 matrix grl gr>grls Osg
7 1.6
.5 /5 gr>50% grs Osg ml as -
3c 38-64
4r 64+ 10yr6/2 e -
E Boring 98 68
P2 Boring# El Pit Ground surface elev. ft. Depth to limiting factor in. Sol Rate
Horizon Depth Dominant Color Redox Description Texhm Structure Consistence Boundary Roots GPDW
`Eft#1 -EtT#2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
lap 0-8 7.5YR3/3 - is 1 fsbk ml cs 2f .5 10 - 1.6
Osg
2b 8-40 7.5YR5/3 ~ ~s dt as 2f
ml as ,7 1.6
-
3c 40-58 7,5YR5/5 grS Osg
4r 68+ _ sandstone - - - -
tit . BOD < 30 mglL and TSS 30 mglL
'Effluent #1 = BOD > 30:< 220 nlgfl. and TSS >30!s 1
re CST Number
CST Name (Please Print) Number 253976
Lewis Bork Telephone Number
Date Evalu Conducted
Address
E7818 County Road E, Menomonie, W154751 4-2-12 715-231-7375
nrr m+n min"i"m
y
2 3
Property Owner Phillip Johnson Parcel ID # Page
B. -U Boring 66
F 3
, # E Pit Ground surface elev. 100 fL Depth to limiting factor in. Sod ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJIf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •EW -092
lap 0-10 7.5YR3/4 - 1s lfsbk ml as 2f .7 1.6
2b 10-42 7.5YR5/4 - is Os ml gs 2f .7 1.6
3c 42-66 7.5YR5/4 - Us Osg ml - - .7 1.6
4r 66+ - - - - - - - -
~ g( g2
Boring# Boring
F-1 Pit Ground surface elev. IL Depth to limiting factor in. Sal App1ca W*
Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
❑ Boring # H Boring
Pit Ground surface elev. I Depth to Bing factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 *Eff#2
Effluent #1 = BODS > 30 < 220 mg/1- and TSS >30:S 150 mgA- ' Ef krent #2 = BODS < 30 mglL and TSS 130 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330Test (R.07/00)
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