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032-2022-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 648422 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Al Wittstock TOWN OF SOMERSET 032-2022-90-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionfrown/Range/Map No: 06.30.19.558 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic .Vms r, I IO no Dosing Aerationrlik n9 V •��/� 1 �/ TANK SETBACk 11 FORMATIO TANK TO P/L WELL BLDG. Vent to Fir Intake R D Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer IIIPM emand odel Numb Friction oss Syste Head TD Ft Wam th Dis—Wt.11 F-1071 IF -Al -1-1010 2 01010 I &Y&i 0 =4 PI BEDITRENCH DIMENSIONS IVVitltn 3r ILen ,t INFORMATION DISTRIB !/M©- 1 � 1 == i -- l Outlet --MMM -. . "A WAr -I Ri w,_==� CHAMBER OR UNIT Header/M nifold I Distribution Pipes) x o e x Hole ing Van it Intake Length Dia� Length Dia Spaci SOIL COVER x Pressure Systems Only s�nd Or At -Grade Svstems Onh Depth Over If Depth Over xx Depth o xx S Sodded Mulched Bed/Trench Center( i --JJ Bed/Trench g Topsoil 0 Yes 0 No Yes No S COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Vol� Inspection #2: Location: No Address Available A ` O `. ,(i`` 1 ' 1.) Alt BM Description 1v uV`\ �c���urr rr�,✓1 S 2.) Bldg sewer length= � ]R' /(S I Il�t� ri� Q -amount of cover =7 19 � 7V N— WWt! " tw ` , �, I(A aX I Plan revision Required? 0 Yes No Ak&�, �-�y` Use other side for additional information. SBD-6710 (R.3/97) In Date ctor's Signature Cert. No. Industry Services Division 7f APR 04 2023 p= 4822 Madison Yards Way Madison, WI 53705 '' fit p f .O. Box 7162 ,Fw«.a_..• St. Croix Count„ Madison, WI53707-7tb2 o m m u .t Application In accordance with SPS 383.21(2X Wis. Adm. Code, submission of this form to the appmpriate gove mmeaW unit is mpired prior to obtaining a y permit M tz: Application forms 1b r state-owned POWTS are submitted W the Department of Safety and Professional SEtvias. Personal infonaatiom you provide may be used for secondary r!a oars in accac+do a with the privacy Law. s. 15_M I xm), Sam& i AnnUeattnn Informstion _ P4"v&• Pr&%# an r...,.. .1..,. Property owtnar's 7"/ r , property Owve SlWing Address � c -- -2 �2 City, Stale Zip Code Phone Number Ile H. Type of Buditg (ebeek all tbat apply) Lot # �I or FaroaY Dwelling-- N ' tfBEdroonns---� a.S Swb�-r Block Dubwciommercial— USE s 5XN-:2 6)2 3-a2-2 Sanitary Permit Number (to be Mod in by State Tram cdon Number Project Address (if dii%rent then reading s Parcel p GovL� Lot _J ( Y. / X, Section _ T JC N R19 Eo(W/ h .;1 r ti ity of we Owned _ Dube Use CSM Number iitage of A t/` M own of III, Type of POVVTS Permit: (Chuck eitber "New" or "Rephmement" aed other applicable on ire A. Cbe& one box on roe B. Complete Use C i a ble. ' KIRM System IrlWacument System L.Ddw MoMcation to Existing System (m oain) MAMMond Prdreaunent Unit (explain) B. Eluaw ng Tank In-Gmtuvd pf Mound Individual Site Design OtherType (explain) C. Renewal BeforeRevision f Plwnber Qi'rar�frrr to New Previous Permit Number and Date Issued Expitatiorrg�zz -1 [D,,=,gn . D restmeat Area and Tank In�raoratioa Flow (Spd) Design Scd ApplicationRatc(gpd/si) DispersalArea Requited (si) Dbpend Area Propomod (SO System Elevation 4L�-' `� i 9iCatty in Total !i of atwfacturar nk Information Gallons Gallons Units New ram Tnim ,_,,...: �,. , , ._� �� r� i••�c M- tom r. Rewotmtnmty btaiement 4 the nadendvwd, assame respeasilift for lwaalledon of the POWi"S store on the Attached phmL Plumber• ) PteumbEr' . l j MP/MPRS Ntunber Bulb= Phtant: Nwrrbar 's'Addness (Sired. City, Zip ) /z 17 Approved ❑ D' Permit Fee Date Issued Issu, Agent Swolure er i S to Conditions ofMNPPM SYSTEM OWNER: t� 2.1,t_) r l -�...2 -�—e �j�,m-� 6Za� LS. 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per �D + �� r� � management plan provided by plumber. re&o�(r 2. All setback requirements must be maintained t as per applicable code 1 ordinances. d Gs VL� .�......... �� puma *W we sys:ea ■na sammw eo me a:ounty *my an paper not lees th" s m a x Is theses M same D-6348 M 0)21) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name Owner's Address: Legal Description: ,�� —�S kJ . 2,�Z 2_3F;°,t% Township: r�5L L County: Subdivision Name: Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat ttachments: Soil Test & House Plans Designer/Plumber:C License Number: __9 Date: �-- j Phone Number �jSignature , Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 �iQ 20 .988 PENING EASEMENT LENT X T LL I, Douglas J. Zahler, Wisconsin, Professional land Surveyor, hereby certify that this Stake -out Plan was prepared by me or under my direct supervision and is correct to the best of my knowledge and belief. C i I COPYI i { 1 SHARED DRIVEWAY EASEMENT rI O: 2a/ 2025 �iQ 20 .988 PENING EASEMENT LENT X T LL I, Douglas J. Zahler, Wisconsin, Professional land Surveyor, hereby certify that this Stake -out Plan was prepared by me or under my direct supervision and is correct to the best of my knowledge and belief. O: 2a/ 2025 C i i { 1 SHARED DRIVEWAY EASEMENT IML e SO*" 40 P vc Vent Pips With Vent Cep Chambw R �ft nuur.•:iiiiiiimiimumimmmimmimimmumimmmmi 01 rt sytem Ebvauon '1'rondh 2 Header Manufacturer And Model } EISA Rating sq ft per chamber Soil Application Rafe ;-7_ gpolaq if gpd Design Flaw +,._ Sol Appilon Rats ♦ EISA i Chambers 2 roars of chambers each. Page of____�.. -1/&-Y n L*M[Inc. Prftw, Droinige Zabel• i'roduds A Division of Pdylok W PL-525 Effluent Filter PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Bunt in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank IA6" Filtration Slots 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing the 4" or 6" outlet Accepts 4" & $ tlinl�• If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank, not into filter housing. 6. Insert the filter cartridge back into the housing malting sure the filter is properly aligned and oomplekely inserted. 7. Replace and secure septic tank cover. m Switch tional) :cepts 1" PVC tension Handle Rated for 10,1W GPD 525 Linear Ft. of 1/16" Filtration Slots Certified to NSF/ANSI Standard 46 Gas Deflector Automatic Shut -Off Ball Outdoor SmartFiIter® Alarm Extend & LokTM Polylok Zabel & Best filters accept Easily installs the SmartFilter® switch and alarm into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, Cr 06492 lbll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com POVVTS 01NNER'S MANUAL & MANAGEMENT PLAN Fey 'of I EStQtN PARAMErEN Nor of Sedroonu _3 © NA I NumJw of Publo Fsdky Unks O NA Eadmated flow (avaraga) soft Oeefgn flow (peek). (Esdrrnawd x I M usudav Sol Apt Rate a 1w Standard lnfluent*ffkwn Quaflty Monthty avemeo Fats, oa & cram WOW saO a*& Bioal niod Oxygen Demand (l3 DJ 5220 n%OL Q NA Total Suapen�ted Soft(TSS) s<1So mgIL Preba ted Effluent Quality Monthly M M, aw rnioal Oxygen Demand tee Sao m k Tatsd Suspettdad ids tTSSI S30 fii(NA Fecal CoNfam lgsometric mean) T1O` CW100n'd Mau nun Effluent Partials Sits Ye in die. Cl NA Otfwr: Cl NA *Varuss tVPW for donlesda wastwow and aspdo tart offitswit SYSTEM SPN'CNgCAIXM Septic Tank Capacity 13 NA Septic Tank Manufacturer Q NA Effluent Felber lanufaotwer Q D NA Effluent Pifovr Model 10— 0 NA Pump Tank Capacity al ANA Pump Tank Manufacturer "A PUMP Manufecpner NA PUMP Model �► t'retreaan int tk* 13 SwuU&ravel 11 Mec �i�i Aeration 0 oisinfeation Q Peat Rtw Ct Wetfsnd Cl over: Pf NA Dispersal Cell(af el kwso,nd (UWAM (3 At -Grade Ci one ` © NA o around )pressurised) Cl Mound 0 Othw. COW. D NA Ober: Q NA Ott: t3 NA Sendce event $prWoir Fraqusrtat/ Inspect oondit%n of ft*(s) At least ores every: arinm 3 "sw) DNA Pomp out conterm of tank(st VVhen combined siurdgs and worn sgmds otw-thkd (4) of tank vokmw O NA bwpect ! Deals) At least once every: month(s) 3 yam) 0 NA Clean offhrent-Aw At kwt once evaty: At IeYat once evwy: . L7 month(s) n NA ANA Inspect pta»p, pump oormrQis A aixm Rush taaerats and pressure cast At feast once every: El vewW MNA At feast once every: D month(s) 0 NA ' to NA MANVT0UWM wl. n PIONS Ineps�.►tions of tanks and dbpaval Delta shad be, shade bV an Individual carrying one of the fo lowing Nosnse s or oertffioations: Master Per, MwW Pkar" Restricted Sewer; POVVTS hupector; POYM MsinrtaAtar: Septspo Servicing Operator. Tank knspsations meet include a visual kwpectian of the tsrnk{sl to identify MY missing or btoW hardware, ideaft Wy CrwkS or teaks,p msaew+e the -vokww of oo mbbied skidgo and scum and to d► w* for any back up or pondbg of sWkw* an the wound surface. The d *slW shed be, visually bi pints chedt thrt effluent tsvels in tlw obserr►etiar� pipes and to oheak fat anv pondkV of o fuenrt on the Wound sud bm the po nding of of kw* on "ground s u rfiai may indi m a felting owWkion and requires the k msediaku turt)flcsrtiors of the food rowde oty may. When tlw combined aocunalt#on of slttdgs and sourn in any tank equals ono-tldrd (Q or more of dw tank vokinw. 'the entire contents of the tank shad be removed by a Sep"s Servicing Operator and disposed of I aceadance wkh chapter NR 113, ilVieoonsin A hdsti �a Coda. AN adter serviom kw* ding but not N r^W to the servk*V of of k tMt foram, nnadltnicat or pressurked conrperremb�, pnrtres�rsrent units, and any swvWnp at intervals of S12 months, shed be performed by a cerdfied POWTS Mahtaincr. A esrAoe report shall be, prwvided to the load rep ktoty w*wky wWin 10 days of oo *bdon of any service, Went. am ("ll Page of 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 condinions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safety abandoned to compliance with chapter Comm 83.33, Wisconsin Administrative Code: s All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. 0 The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: E- A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. E3 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. C] The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFiCULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS iNSTA Name Phone c ? POWTS MAINTAINER Name Phone SEPTAGE SERV1Ci U3 OPERATOR tPUMPt-ni LOCAL REGULATORY AUTHORITY Name Phone Name Phone C1 This documer t was drafted in compliance with chapter Comm 83.2421(b)(11(d)&M and 83.54(1), (2) & 13), Wisconsin Administrative Code. ST. CRo ti �JNTY. SANITARY SYSTEM File #: �VINCY irSr,r 1 Office Use Only OWNERSHIP/ADDRESS FORM Created 2/2021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Address /" City/State/Zip Phone Number (required) Email Address (required) Parcel Identification Number —o�', 032— 2-02Z-ct0--000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location �/a ,'/a ,Sec. �, N RZ�9 W, Town of Subdivision Plat: 14 r.�5 l�P6;� ,Lot Certified Survey Map # '- ` Volume Page # Warranty Deed # 1 (before 2006)Volume Page # Number of bedrooms ly Spec house ❑ yes j2(no Lot lines identifiable ❑ yes ❑ no f OFFICE USE ONLY L New Property Address 336 /? 2/ v m &k- s --J5/ O 2 5- (Verification of new address required from Community Development Department for new construction.) 20 Z� (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office fcce and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cddQSccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.00v THIS INSTRUMENT DRAFTED BY: Jennifer A. O'Neill, O'Neill Elder Law, LLC 2424 Monetary Blvd., Suite 201, Hudson, WI 54016 (SEAL)_ (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN TIFFANY . PETERSEN NOTAR s PUBLIC COUNTY OF ST. CROIX b DIVE OF ISCONSIN Personally came before me on March 1, 2022 , the above -named David M. Wittig, as 'Trustee State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number II Document Name THIS DEED, made between David M. Wittig as Trustee of Miles and Audrey Wittig Irrevocable Family Trust dated April 13 2011 ("Grantor," whether, one or more) and St. Croix AR, LLC, a Minnesota limited liability company. ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures, and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): 1149701 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/ 10/ 2022 12:22 PM EXEMPT#: REC FEE 30.00 TRANS FEE 3,600.00 PAGES: 2 "The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address Guaranty Commercial Title, Inc. 465 Nicollet Mail, Suite 230 SEE ATTACHED ADDENDUM FOR LEGAL DESCRIPTION. Minneapolis, MN 55401 SEE ATTACHED ADDENDUM Parcel Identification Number (PIN) Dated March 1, 2022 (SEAL) (SEAL) * *David M. Wittig, Truste AUTHENTICATION Signatures) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing 4i' e and o ed ed the same. *n P A. tersen Notary Public, State of Wisconsin My Commission (Is -per tet3e 0 (expires: 08/09/2023 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDEN'rIFIED. TRUSTEE'S DEED m 2003 STATE BAR OF WISCONSIN FORM NO.7-2003 * Type name below signatures. St. Croix County 1149701 Page 1 of 2 ADDENDUM TO TRUSTEE'S DEED GRANTOR: DAVID M. WITTIG AS TRUSTEE OF THE MILES AND AUDREY WITTIG IRREVOCABLE FAMILY TRUST DATED APRIL 13, 2011. GRANTEE: ST. CROIX AR, LLC, A MINNESOTA LIMITED LIABILITY COMPANY. PIN: 032-2023-90-100; 032-2022-90-000; 032-2023-20-000; 032-2023-95-100. LEGAL DESCRIPTION: The Northeast Quarter of the Southwest Quarter (NE 1 /4 of SW1 /4); AND the Southeast Quarter of the Southwest Quarter (SE1/4 of SW1/4); AND the Northwest Quarter of the Southeast Quarter (NW1 /4 of SE1 /4) EXCEPT that parcel described in Volume 1832, Page 236; and the North Half of the Southwest Quarter of the Southeast One -quarter (N1/2 of SW1/4 of SE1/4) EXCEPTthat Parcel described in Volume 1832, Page 236; All in Section Six (6), Township Thirty (30) North, Range Nineteen (19) West, Town of Somerset, St. Croix County Wisconsin. SUBJECT TO all easements, restrictions, and rights -of -way of record, if any. St. Croix County 1149701 Page 2 of 2 Lt`- ELEVATION i,6 T N cci C N REAR ELEVATION I/e• - I'-O" FRONT ELEVATION 1/4" - 1'-0' 4'_CV'POURfD CCNC. FOUNDA.ICN 9.1 1/8' CEILING Fj MAIN LE�TL ICY I 1 /8- CEILING @ WTO-M. DINING • C'Y!CE 12' a CECING @ GRfAT 1 T-O' Cc1UNG P FOYER A FOR BIDDING ONLY NOT FOR CON51RUCTION oa 0 r a 822-168 .vg - w L_ ol lam's Drawnj Room. LLC ?Q2 2 7J 3. 4q, 4 LA lain' s Drawing Poo - White Pine Ridge Model Z_- Lot 29, White Pine Ridge, fomermet. W1 Z 0 0 x 00 -4 Z C (i i O Z IV A ` ';� "y avoen< r,P QAir _� lain' Drawing Room "� Ri White Pine dge Model ,yx z Lot 29, White Pine Vidge Jomer,%et• WI ® . ^ 7 Dr.awina Rc-xn, LLC 2n22 Z T� 00 00 a nz 0 -4 Z 7� C) 0 Z A A c z k Qvrxn� e r p lain's Droving Room White Pine Ridge Model,. 29, White Pine Ridge WI ""`•" Lot fomerset, ,� e�nm rrsc. RECE-HEM i APR 11 2023 Dept. of Safety and Professl sion oftS-iWW,6hi ngs Cornmunity Development Services SOIL EVALUATION REPORT 00 PMO—/ of -� c57-2o23-� In accordance with SPS M. Wis. Mm. Code County �� Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must 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. Please print all Information. Reviewed by Date Peaaal kdomuftn you provide may be used for secondary purpoen (Prwwy Law. s. 16.04 (1) (m))- Property Property Location Govt. Lot 710 U !� ;:� 1/4 ��/114 S 36, N R E (a j OwrWs Mailing Address Lot # Block # or CSMt/ PMpe-d J ` 9 )/a FCVY/ Zip Phone Number ❑ City ❑ Village own Nearest Road State N� (A New Constntdion Use: 0 Residential / Number of bedrooms Code derived design flow rate GPD ❑ Reptawnent ❑ Public or cornmercial - Describe: Parent material Flood Plain tnV applicable ft. General comments �V/IVMZ and recommendations: e Who L$Jaelo V*Ap*- P&AMax- Ile% 64to,06 # ❑Boring F/ S i 1Gy Pit Ground surface elev. R. Depth to W&V factor in. andamtjm gate MMM=iWOR Rol, Rc �M structure Sz Sh. soft # 0 Boring ® Pit Ground surface elev.ar-'5' f. Depth to limiting factory --_-- QM e.,.,w-nfinn RAta -40" •84wt #1 = BOD > 30 < 220 mg/L and TSS >30< 150 mg/L ' Eftent #2 = BUD < 30 mg/L and I � < sU mg/L CST YA) - s CST Number / -lee_ Address V Date Evaluation Corxiuc&ed Telephone Number e+nr� o� e n rnn f Lea I Property Owner L ❑ Boring Parcel ID # Bonn # g ❑ pit Ground surface elev. �� ft. Depth to limiting factor_ in. Page of Sail Annliratinn Rate Uu. bz. Cont. Color �==_ sl�.�i■AI�A��� IWA MMM Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft 2 ff##1 * ff#2 1 ❑ Boring Boring # Ground ❑ surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft 2 ff#1 ff#2 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 < 30 mglL and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (R 1 I/11) -z: W-1 /6 C_ 1�� �Y_ // IJ 29\- 169,606 SO. F\ \ \ \ \ \ �- �-✓' j \ �`` 3.894 ACRES L B.O.=4864.5 S° / l 10 988 r / I, Douglas J. Zahler, Wisconsin Professional Land Surveyor, hereby�- certify that this Stake -out Plan was %�' RAD VE PENING prepared by me or under my direct ,'' ( EASEMENT supervision and is correct to the best EASEMENT of my knowledge and belief. 1 1EN7 J C c4 r $ , �. DOUGLASJ.�N�� ZAHLER j s s-2145 t1721VD AVENUE; HUDSON, a 0 Urfj\I \ / APR '04 2023 of Ww and P0 lmkxw Services SOIL EVALUATION REPORT Pap / of Soft, in accordance wfth SPS M. V&. Adm. Code =V==on Paper not few than 8112 x 11 kwhea in size. Plan mom veftol and horizontal mfowm point (SM). direction and I Para w I.D. percent ok*w, scale or dkymmokm north wrow, and location and distance to nearest road. Pkmw pint all ln&madoa. Reviewed by Date Pl*r,,O III Y, W"Wo to" W used for aewgxiwy pMwm (ftvacy Lm. *. 15.04 (1) (m)y. Property► Owner P""00"m 12TN R -I Gmt. Lot 1jZ 114 S ,;, ,2, E (or &)W�L Properiyownees --Address Lot # Subd. M�mor C" ,y r:23 kAw b-M rip Gme "Mme Number 11 Ckf ovmwe wows Nearest Road J 4— New Constmction Uw*UftWdW*M/Number ofbedroo= Code decked design flow rase 0 Replacement 0 Pt6k or cmwnwcw - Desam. Flood PW WavMm ft A General cwnmuft Mcuov%k FerVA.X WkAggai IMM j _A2___, _ and 169 aigsoce �. > 3857.. es Cp 6-r P4N�r Clot 0 Bong ja pit Ground surbee elev. ft. Depth tobv&Vfactor In. SM Annfimfim P.Wa 01 W.A WAFd WAMM �r�a�eara��ss��i M� pit GroundsurfaGeelev. _2�1, 5' ft. CWpM to WnWV toctor .J/ _L -_ In. I_Rra AnnMaMm RaW I wm a1�991?��J■�����I WAV.0 /Z FAW.AWT4=MwMm1 *Ef&wd#I=BOD &>30;S220mqfLand T8S>30:5160nV/L *Efluwt#2=BCO ,:530n1WLandTS5;5Wff1WL CST Name Si$natune CST Number Address WFe Ev*-ia-dm Conducted Telephone NMW WD 0 Property Owner Parcel ro soft #.❑so*v ® Pit +aroma wime ebv. R. DsrA to kniwv Wor -L2,2-Im pap O Sol A wkwdon Rate OBE WA M EPA MO MOMM'M W. Mt. 7A WA Mv . M mmm wig 0 0 Tr - - "2-1 BItw d #1 x WD f> 30- j 2M nV& and TW 3-30 < 150 nV& " Mot #2: WD , s 30 nv& and TW g 30 ffv& The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TI'Y dm msh Relay. ssoaMMinn PENING EASEMENT 1ENT X T LL I, Douglas J. Zahler, Wisconsin Professional Land Surveyor, hereby certify that this Stake -out Plan was ?'' SNARED prepared by me or under my direct ,'r i EA E ENT supervision and is correct to the bestof my knowledge and belief. t Y of wrs D0Ut3LAS J ��s� ZAHLER * _ 8-21 45 0172NDAVENU,, s 0-�-" 291202-5 MIESEInnovation, Quality and Service Since 1965 R GIRGRETE wieserconcrete.com f�,2 l ,32 �PV 77 Maiden Rock, WI (800) 325-8456 Fond du Lac, WI (800) 641-5937 Portage, WI (800) 362-7220 Spooner, WI (800) 336-3416 Roxana, IL (618) 251-9210 m N 4 4� 39Z39' - 286.75' 105.64' - 29 169,606 SO, FT. n SSS, yo'' 3'SMACRES L.B.O. = 8 .5 Ols�, i tit �,t � � �� \ ��� F �• 99V5 4SF � N77 5039"W sS31: R & r4 Ln a o �a1 y°1.61 S 93.61' N87.51'22"W 28 133,844 SQ. FT. 3.073 ACRES L.B.O. = 864.5 LOCATED IN PART OF THE NORTHWEST QUARTER OF THE AND THE NORTHEAST QUARTER OF THE! 309.28' _ 866.44 294.26' 177.94' - 60.15' F - 71.19' - 75.08' 1 79.29' 0. 139. p , v -1-114. OUTSIDE DIAMETER IR vw` 60' J v A S56'19'22"E 80.62' N85'33'58"E 287.65' 268.78' * "---7.75' 585-33'58"W-� N56'19'22"W--r 74.00' g> Q 2 41.95' 23.36' - W 185.68' i 585.33'S8"Z r ch `'� �41 30 �, h g h 31 w 139,451 SQ. FT. �s� �r- N I 135,052 SQ. FT, to 3.201 ACRES 3.100 ACRES tp� 10' R c Ln -10' �N86'44'09"W 20.00' e M 1q� g ga S89'52'26'E 107.68' , DEDICATED _TO_ r THE PUBLIC ARC LENGTH N89'52'26'W 107.E 52 =25.06'-----=�— .04,17.E 4 Vol N77 i C`s 27 134,797 Sa Fr.�- 3.095 ACRES L.B.O. = 863.0 S68. / h N68� S9 �3S�F e 25 ' 140,448 SO. FT. .� M e •s�i •rorr s,�,U-�az3-D11. Industry Services Division 4822 Madison Yards Way County. j ? Madison, WI 53705 Sanitary Permit to be filled in b Co. : � � MAR 6 202� P= P.O. Box 7162�^ umber � c y ) \ WI 53707-7162 Ip Croix CounY ,, , Madison, S Tary`Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, subnussion of this form to the appropriate governmental unit pp POF p323 D© 3D O G Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. YJ 336 17-7 2-� Ave . I. Application Information - Please Print All Information Property Owner's Name Parcel 4 O e rA _JLJD 62 -Property Owners Mail g Address perty Location Govt. Lot '/,, Section City, State Zip Code Phone Number ^ o� T N R E H. Type of Building (check al at apply) Lot it Subdivision Name � 1 or 2 Family Dwelling - Number o edrooms � ublic/Commercial - Describe Use 11P Block # City of ❑State Owned - Describe Use 'illage of CSM Nu m r G 0 Town4 t'CW_0A1Mez-, 2 /C 1 1 Zo v ChA one �boxe . Complete line C i llt. Type of POWTS Per . (Check either" w" or "Replacement" d othe applic 1 1' applicable.) 000 A.Vve_w System) []Replacement System Cher Modific on to Exts tng System ( �Addit' Pret ent Unit (explain) B' Holding Tank ❑In -Ground !__Y' Grade Mound Indiv 1 Site Design Other Type (explain) (conventional) 4 2 C. ❑ Renewal Before Revision ha e f Plumber Transfer to New Owner List Previous Permit Number and Date Issued Expiration I I' IV. Dispersal/Treatment Area and Tank Informatio 7 t - Design Flow (gpd) Design Soil Application Rate(gpd/sf) Disp 1 A Required (sf) Dispersal Area Proposed (sf) System El�v oq ^ '?'? ) �D 4�D q5b WrAn, Tank Information Capacity in Gallons Total Gallons of its Manufacturcr DJ�„/,q� 97y-��1 a� , ❑ U b 4 Y Ncw Tanks Exist g Tanks 0 in C7 a a`. cA w Septic or Holding Tank f ) i Dosing Chamber V. Respon ibility Statement- 1, the un rsigned, assume respons iility for installation of POWTS shown on the attached plans. Plumb ame (P t 1� Plumber's igna e I MP/MPRS Number Business Phone�N}umberr / Plumber's <ddiess(Street, City, State ip Code) / VI. County/Department s my .Approved ❑ Zg!��asono Permit Fee Date Issued Issui g Agent Signature ❑ al Conditions o Approval 13 �l CrfiY\ �5 �� �StQs �Et,l�Vl� CL--w,. l lQ SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell 4&er* W t+C-1 s p�Dvl'r must be serviced / maintained as per G management plan provided b 9 P p Y plumber. C/ 2. All setback requirements must be maintained c as per applicable code 1 ordinances. �ctqw, Attach to complete plans for the system antsubmit to the County, only on pap Inot less than 8 1/2 x II ►ncnes in sue F � SBD-6398 (R. 03/21) r Wisconsin Department of Safety and Professional Services yam, Division of Industry Services t' - 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 March 14, 2023 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2025-3-14 Plan Review: PWTS-032300308-C Kim Oconnell 504 3" Ave E Osceola, WI SITE: Wittstock 172" d Ave Town of Sumerset St Croix County NE % SW % S6-T30N-R19W FOR: Description:3 bedroom-450VPD mound-22" to limiting factor- Effluent Filtk - Maintenance required. Phone: 608-266-2112 Web: httn:i/dsps.%k'i.gov Email: dsps(a,)wisconsin. oo Tony Evers, Governor Dan Hereth, Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES � W W SEE CORRESPONDENCE Mound Comprent Manual —Ver. 2.1, SBD- 10691-P (5/ -5/27) Pressure D* tribution Component Manual — Ver. 2.1 (May 022-2027) Verify proper dose is achieved and system is\the ver d ed. The submittal described above has been revonfor ance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittaCO ITIONALLY APPROVED. This system is to be constructed and located in accordance with d proved plans and with any component manual(s) referenced above. The owner, as defined in 1. 1(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbie unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construltion or ir\stallation and prior to occupancy or use: Reminders • The site shall be properly prepared prior to p owing. Any grasses I er than 6" shall be cut short and removed. To avoid matting, any leaves or to se organic matter shall raked up and removed. Cut trees and shrubs flush to the ground and leave s mps. Avoid operating equip nt on the Mound site. If necessary, use only tracked quipment, during dry conditions, ith minimal passes, to avoid compaction. • Components and soil removed from an a isting drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 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. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cle1ning of the filter is required. • A copy of the approved planAspecifications and this letter shall be on -site during construction and open to inspection bV authorized re re entatives of the Department, which may include local inspectors. Owner Responsibilities • The current owner, and each subse ent owner, shall rec ve a copy of this letter. Owners shall also receive a copy of the appropriate operation an maintenance ma ual(s) and be responsible for ensuring that POWTS is operated and maintained in accordant with this chap r and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or an of itt omponent parts malfunctions so as to create a health hazard, the property owner must follow the co tinncyplan as described in the approved plans. • The owner is responsible for submitting a mainte Ace verification report acceptable to the county for maintenance tracking purposes. Reports shall be ub fitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Se r ices reserves e right to require changes or additions should conditions arise making them necessary for code co pliance. As per to stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for d igning a safe buildin structure, or component. Inquiries concerning this correspondence may be m�de to me at the telephone rNmber listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ") 0J n "-ez / �T 0 V Z oy, Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 634-5124 Joshua. rowley@wisconsin.gov APPLICATION FOR REVIEW ir =p jjj„� -Complete all pages- `r�� �� NO�i1=: Personal Woffnationyou � u proVidem 1 xm , Slats.] iSecondary purposes [Privacy f�77t7!Lw� Private Onsite Wastewater Treatment Systems Division of industry Services ❑ Plans to be E- led. Provide SharePoint User name below. For plan status, check our website at http://dsps.wi.gov Email technical code questions to mailto:DSPSSBPowtsTechrcDwi.gov Several counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those counties and their designation check our website at http://dsps-wi.gov 1. Project Information - Fill in all 5 1 inform. 7 Confirmation of assignment to a reviewer. Project/Site Name: / ' Ttaresactlon d7 Location, Number & Street of (K indicated nearest road) �• Previous Related Trans. ID: %� Estimadted Completion Date: Assigned Reviewer_ Legg! Description: :.S1:)/ 'IF- ele _ Z-7�1f .-7i/9, -/ County Assigned Office: ❑ Clly ❑ ViMege m Town of bail to your office of choice below: LaCrosse, Green Bay 2. After plans are reviewed, piaaae: (abseh al GM appm ❑ Call customer 1, 2 (circle number)` NOTE: We reserve the right to re -distribute plans to another office it ❑ Requesting party will pick up needed to reasonably balance turnaround times. Ctme k Mail plans to customer 1, 2 (circle number)` http://dsps.wi.gov for next available ruview date - 'Refers to customer number from below. 3. Coepleft the following ciasi9 mdownedriequesting infarnmflmL UtiQm the ctwcik boxes when designer, owner or requesting party is tho same to avoid repeating Information. Desigrw In (Customer 1) DSPS other Please Spediy BNOw (Customer 2) DSPS First Name Name / Number Fist ' Na Customer Number 1 !7�f /, (_-. Company Name - -- — - Address ,�.�, / A city �- Slats zip+4 (9 dkjft) CAty (9 digits) )5��e--4- - Phone Number E-nCell phone Phone Number E-mail addressCell phone (area � L (area code) ,��^� r^�i.✓t" /I tL�. [�tt // � � �/ %��% Check if applicable r Check if applicable or specify relationship ❑0 Owner ❑ Outer - specify relationship Information and Plan Submittal Checikl'rsts. To request electronic plan review complete the appropriate application form and e-mail it, along with your registered SharePoint usemame to DSPSSBPtanScheduleP-Wisconsin.gov. if plans are being submhled via paper, they will be assigned to a reviewer after receipt at a DSPS office_ Submittal checklists can be found in each applicable component manual appearing on the POWTS program page under Publications POWTS Com22nents Manuals Holmen/Onaiaska Area DSPS Green Bay Dgpg 2850 Midwest Or Ste 104 2331 San Luis Place Onaiaska. Wl 54650 Green Hay. WI 54304 609-785 9334 920-492-5601 Far- 608-785-9330 Fax 92a-492-5604 Email: DspsShPlanSchedulegDwi.gov Eme&: DspsSbPlanScheduleCa�m.gov Make Checks Payable to: Division of Industry Services OR ❑ Check box to invoice designer and sign below TOTAL AMOUNT DUE $ue_ " Designer signature Review Code 7633 SBD-10577 (R 3/19) 5. POWTS SUBMITTAL (check all that apply — Incomplete forms may result In processing delays) NEW ❑ Aerobic Treatment Units) ❑ Chlorinator ❑ REPLACEMENT ❑ Commercial System❑Tank Replacement Only ❑ UV Disinfection Unit ❑ Add Effluent Filter SYSTEM TYPES) NOTE: Submit separate sheets for each system If submitting multiple systems on the same site ❑ Revision to previously approved plan $88.00 ❑ Miscellaneous Review (I.e. replacement of a septic tank, addition of an effluent filter or pretreatment device to an existing system, etc.) $80/hr Component Manual Design ❑ At -Grade Component Manual - Ver. 70, SBD-10854 (N,03/07, R. 1/12) Wastewater Flow In ❑ In -ground Component Manual - Ver. 2.0, SBD-10705-P (N.01/01, R 10/12) Gallons Per day Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 10112) gPressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) Other - Please specify ppp ❑ Soil Based Individual Site Design' ❑ At Grade ❑ Non -Pressurized In -ground ❑,Pressurized In -ground ❑ Mound ❑ Drip -line ❑ Constructed Wetlands ' Documentatlon must be provided to support treatment and dispersal claims. In a separate Statement, provide rationale for the project and attach supporting documents (code sections, test reports, technical papers, research articles, etc.) State-owned facilities: ❑ Holding Tank Component Manual, Ver. 2.0, SBD-10855-P (N.03/07, R1/12)' ' Non -state owned Commercial and Residential Holding tanks that completely utilize this manual and have an estimated dally flow of less then 3000 gallons per day must be submitted to the appropriate governmental unit for review Instead of the Department. (see SPS 383.32(3)(e)) ❑ Holding Tank Individual Site Design', (I.e. site constructed, <5 day holding capacity, Co - mingled wastewater, etc.) Please specify. Documentation must be provided to support the rationale for the project. In a separate statement, please Include all code sections, test reports, technical papers, research articles, etc.) Design Wastewater Flow In Gallons Per day GPD Design Wastewater Flow In Gallons Per day GPD Design Wastewater Flow In Gallons Per day GPO ❑ Soil Saturation Determination Report (using observation pipes) ❑ Interpretive Determination ❑ Experimental System (One time additional fee). Submit fee for Individual system as per appropriate above system type) SBD-10577 (R 3/19) All treatment components are previously approved under s. SPS 384.10 (2) or (3): Design wastewater flow of the proposed system: 1,000 gpd or less $ 260.00 1,001 — 2,000 gpd $ 325.00 2,001 — 5,000 gpd $ 400 00 One or more treatment components are not previously approved under S. SPS 384,10 (2) or (3): (individual site design/deviatlon from component manuals and use of components withoit product approval): Design wastewater flow of the proposed system: 1,000 gpd or less $450.00 1,001 — 2,000 gpd $600.00 2,001 — 6,000 gpd $760.00 greater than 6,000 gpd $900.00 plus $0.08 for each gallon over 5000 gpd Holding tanks previously approved under S. SPS 384.10 (2)(3), Design wastewater flow of the proposed system: 6,000 gpd or less $ 90.00 6,001—10„000 gpd $160.00 greater than 10,000 gpd $226.00 Holding tanks Including site constructed tanks NOT previously approved under s. SPS 384.10 (2) or (3). Design wastewater flow of the proposed system: 5,000 gpd or less S180.00 5,001 — 10,000 gpd $300.00 greater than 10,000 gpd $460.00 $240.00 Experiment Number $400.00 Enter Foe Priority Review (enter same amount as normal review fee listed above) $ C� Enter Total (rounded to the nearest dollar) MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Conditionally Project Name: Al Wittstock APPROVED DEPT. OF SAFETY AND PROFESSIONAL Owner's Name: Al Wittstock SERVICES Cll /ICE In ^f1G IAIfl11CTGv CGR1i1rrc Owner's Address: P O Box 395 Somerset WI 54025 SEE CORRESPONDENCE Legal Description: NE -SW sec6-T30N-R19W Township: Somerset County- ST.Croix Subdivision Name: White Pines Ridges Lot Number: 29 Block Number: Parcel I.D. Number: Plan Transaction No Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot P! n Page 10 ATT soil evaua n Designer: Kim A Oconnell Date.- 02/22/23 Signature: - License Number ,Phone Number: 224263 715-381-7917 Designe Pursuant to the Component Manu Design References: Mound Version 2.1 (May 2022-2027) & Pr ssure Distribution Version 2.1 (May -2027) Version 7.0 (R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information cR or C) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 3.40 Site Slope (%) 98.00 Contour Line Elevation (ft) 22.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/ft2) Distribution Cell Info mation 75.00 Dispersal II Length Along Contour (ft} _ 1.00 Dispersal Ce Design Loading Rate (gpd/ft� 1 Influent Waste ter Quality (1 or 2) / Pressure Disribution InformaXon (C or E) el Center or End Manif d 3.001 Lateral Spacing (ft) 2 Number of Laterals 0.166 Orifice Diameter (in) 2.60 Estimated Orifice Spacing ( _ 2.00 Forcemain Diameter (in) 50.00 Forcemain Length (ft) 91.00 Pump Tank Elevation (ft) 4.55 System Head (ft) x 1.3 8.00 Vertical Lift (ft) W' 1.11 Friction Loss (ft) 0.00 In -line Filter Loss (ft) 13.661 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. options I choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000 6-0 Septic Tank Capacity (gal) Wieser Manufacturer Note: Sand fill (D) calculations assume a Table 383-44-3 in -situ soil treatment for fecal coliform of <= 36 inches 6.00 Cell Width (ft) Are the laterals the highest point ;n the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. 7.50 1 ft2/orifice Does the forcemain drain back? I Y %, Enter Y or N N.16 Forcemain Drainback (gal) 67.3 5x Void Volume (gal) 75.48 'mum Dose Volume (gal) 32.31 Syste errand (gpm) Manifold Diameter Selection in. dia. options I choice 1.25 x I 1.50 x x 2.00 3.00 Gallons/Inch Calculator 1000.00! Total Tank Capacity (gal) 36.00 1 Total Working Liquid Depth (in) 27.78 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter_ Information 600.001 Dose Tank Capacity (gal) Pol lok -Filter Manufacturer lq.76t Dose Tank Volume (gal/in) PL-525 Filter Model Number Wieser I Manufacturer Project: Al Wittstock Page 2 of 9 Mound Plan and Cross Section Views T . . ...... -t 1 / 10 B Observation Pipe .. . . _ . — I K . O O ~.. A W I �� B 0 : . .. .:.. .." I x T- A 6.00 ft Cif`` C B 75.00 ft i L Mound Com onent Di ensions E 16.45 in H F 9.50 in G 0.50 ft 450.00 (ft`) Dispersal Cell Area 6.00 (gpd/ft) Linear Loading Rate 1.00 ft K 9.18 ft 8.89 ft L 93.36 ft 6.69 ft W 21.59 ft 1117.07 (ft) Basal Area Available 7.50 (ft) 1 /10 B Obs. Pipe Placement Mound Cross/Section Vi Aggregate Dispersal Area Finished Grade 100.96 (ft) 10 AA. G F D persal Cell 99.6 (ft) Lateral 99.17 (ft) --► Invert Dispersal Cell Elevation D 98.00 (ft) Contour Elevation 3.4 %Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on it Topsoil Cap o a 1.5 ft Page 4 for number, size, 21 :" Subsoil Cap U) 0 © 0 and spacing of laterals. Laterals are equally ©0 ASTM C33 Sand Z F spaced from the ®0 Tilled Layer 0 5 ft Typical Lateral distribution cell's © [ Aggregate o 0 centerline in the A * distribution cell (AxB). Project- Al Wittstock Page 3 of 9 Project End Connection Lateral Layout Diagram Laterals centered over the A V" e. dimension • = Turn -up -MbaII v3ble or cle3nout piuQ P All laterals are identical L- X— I Holes drilled on the bottom of the Iiteral = equally spaced Fore? main connection via tee or cross to manifold at anu Doint. Laterals sforcemain Sch 40 PVC per SPS Table 384 30-0 Number of Laterals Lateral Diameter Lateral Length ( Lateral Spacing (S Lateral Flow Rate System Flow Rate Total Dynamic Head 2 Orifice Diameter 1.50 in Orifice Spacing (X) 73.37 ft Orifices per Lateral 3.00 ft Orifice Density 16.16 gpm Manifold Length 32.31 gpm Manifold Diamet 13.66 ft Forcemain Vel ity Dose Tank Informatio Electrical as per NEC 300 ands SPS 316.300 WAC Tank component is properly vented Wieser Manufacturer _� Capacity 600.00 Gallons Volume 16.76 gal/inch A / Dimension Inches Gallons A 20.30 340.16 B 3.00 50.28 C 4.50 75.48 D 8.00 134.08 Total 35.80 600.00 x Discorihect 3" Bed ng uncTer tank. Alarm Manuafacturer SJE Rh om us - Tank Alert Alarm Model Number 101-01 H _ Pump Manufacturer JiGoulds Pump Model Number PE 51 Pump Must Deliver 32.311 gpm at 13.66 ft TDH Al Wittstock 0.156 in 2.53 ft 30 7.50 ft2/orifice 3.00 ft 1.50 in 3.30 ft/sec Locking cover with warning label and locking device and sealed watertight 4 in min. E-- Alternate outlet location Forcemain diameter �1 2 in. Weep hole or anti - siphon device ump off elevation (ft) �—F 91.67 Dose tank el ation (tt) 91.00 Note- Switches containing mercury may not be used in this system. Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Phone POWTS Regulator's Name St Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Estimated Flow - Average 300 gpd Septic Tank Capacity 1000 gal Soil Absorption Component Size 450 ft2 Type of Wastewater Domestic 2 3 4 5 Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Maximum Influent Particle Size 1/8 in Maximum BODS 220 mg/L Maximum TSS 150 mg/L Maximum FOG 30 mg/L Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Inspect and/or service oncyevery 3 years Should inspect and clean at le t once every 3 years Test once every/3 years Should test onthl LaterA should be flushed and pr ssure tested every 1.5 years In ect for ponding and se age once every 3 years SN� Observation pipes are slotted and materials conf\(6, and are secured in as shown in the mound comp Dispersal cell aggregate conforms to SPS 384.3All gravity and pressure piping materials conform Tillage of the basal area is accomplished with a mold be The mound structure and other disturbed areas will be s and help reduce frost penetration. Finished Grade 6-8" Diameter Lawn Sprinkler Valve Box Distribution tSPS 384.30-1, have a watertight cap, al. Adm. Code. uirements in SPS 384, Wis. Adm. Code. or chisel plow. 9%d and mulched to prevent soil erosion Lon gg Sweep 90 or Two 45 De ree Bends Same Diame�er as Lateral Project: Al Wittstock Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.64, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01, R. 11/12), SSWMP Publication 9.6 (01/81). and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, N such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (Ocher -February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD,, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice Dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your kacal POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: AI Wittstock Page 6 of 9 9 rn Tii c ut o N $' v ,9 d z 4� OI TOTAL DYNAMIC HEAD 0 � fill O Vi O N O �jj 1 {, F.....:, iI j i i .J..,,� r i•, .,� . . TIP!! Incinnovido&W,Rstnwtok Inc. PL-525 Effluent Filter PL-525 Filter The PL-525 Filter is rated for 10,000 GI'D (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). Locate the outlet of the septic tank. 06" Filtration Slots Alarm Switch 10,000 GPD c (Optional) 4Hr--� Accepts 1" PVC i Extension Handle 2. Remove the tank cover and pump tank if necessary. Accepts 4" b 6" 3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the P1--525 filter into its housing. 5. Replace and secure the septic tank cover. ` PL-525 Maintenance, DO NOT remove filter if water level is above h sinst, The PL-525 Effluent Ft ters will operate efficient17 or several vears under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three vears. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic talk pumper or installer. 1. Locate the outlet of the septic tank. Rated for 10,000 GPD 525 Linear Ft. of 1 / 16" Filtration Slots Certified to NSFIANSI Standard 46 rtse tV, ra 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank, not into filter housing. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. Gas Deflector �matic Off Ball Outdoor SmartFilterg, Alarm Extend do Lok-"4 11olylok, "Label & Best filters accept Easily installs the SnuirtFilteraD switch and alann. into existing tanks. Polvlok. Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com SOIL EVALUATION REPORT Page of � Wis. Dept. of Safety and Professional Services Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code - County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must limited to: vertical and horizontal reference point (SM), direction and Ic Parcel [ D �nciude, but not slope, scale or dimensions, north arrow, and location and distance to nearest road. Date percent Reviewed by Please print all information. personal information you Provide 'nay be used for secondary purposes (PRvacy Low. s. 15.04 (1) (m)). Property Location Propertyveer Govt. Lot !, :- 1/4 : 114 S T N R `! E �a W Property Ovmer's MaVtirig Address Lot # Block # _� Subd. Name or CSM# City ❑ Vlilage Town Nearest Road City State Zip Code Phone Number } New Construction Use: Residential / Number of bedrooms -_� Code derived design flow rater GPD i ❑ Replacement ❑ Public or commercial - Describe: 4 Flood Plain elevation if applicable N • Parent material � � 7: %�' } �% General comments , and recommendations r----r M G nnnn _ j Boring # " Pit Ground { surface etev. l� , ft. Depth to lirn}ting factor? in Soil A licabon Rate Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence oundary Roots GPD/ft Horizon Depth In, Dominant Cotor Munseli ff#1 - U Boring Boring # C�)�� Depth to limiting factor m• ' Ground surface etev. Soil !!cation Rate Horizon Depth Pit Dominant Color __1__L��—ft• Redox Description Texture Structure insistence Boundary Roots GPD/ft" fi#1 in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. ,41,: r }l v J mn11 anti TOR < :30 mo1L Effttt8nt = �UL! > SU LLU 11191L UTAU rtat>ure., CST Number CST Name._(Pfease Prints f Address , Date Evaluation Conducted Telephone Number / > r - / SBD-8330 (RI 1/11) Property Owner�%- - I n R,,inn Parcel ID # Page • at '�-- Boring # J p Pit Ground surface elev. / Horizon Depth Dominant Color Redox Description in. Munsell Qu. Sz. Cont. ColorGr. -OP fi. Depth to limiting factor�f !n. Texture Structure onsistence oundary ffQ Sz. 5h. - ; il A lication Rate GPD/ft 2 1 f%`f2 Boring Lj Boring ❑ Pit Ground surface elev. fi. Depth to limiting factor in. Horizon Depth �DontColol Redox Description Texture Structure onsistence oundary Roots in.Qu. Sz. Cont. Color Gr. Sz. Sh. Soil Application Rate GPD! ff#1 f2 i Boring rt (J BoringGround surface elev. ft. Depth to limiting factor in. ❑ Soi pit l licat;on Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots ff#1 GPD/ in. Nlunsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BOD y > 34 < 220 mo/L anri TSS >30 < 150 mglL ' Effluent #2 = BOD , < 30 mg[L and TSS < 30 mglt_ The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. if you need assistance to access services or neea material in an altemate format, contact the department at b0�-?66-3151 or TIY through Relay. M4130MI111I Effluent #1 = BOD y > 34 < 220 mo/L anri TSS >30 < 150 mglL ' Effluent #2 = BOD , < 30 mg[L and TSS < 30 mglt_ The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. if you need assistance to access services or neea material in an altemate format, contact the department at b0�-?66-3151 or TIY through Relay. M4130MI111I ST CRO LUNTY. SANITARY SYSTEM Office FileSANITARY� rs�cncvn Use Only OWNERSHIP/ADDRESS FORM Created 212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addre, City/State/Zip Phone Number (required) Email Address (required) Parcel Identification Number , o� ! 032- 2-0Z.2.-- et0-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location '/a ,'/a ,Sec. Subdivision Plat: RZW, Town of Lot # Certified Survey Map # -------- � ' Volume Page # Warranty Deed # 114 q `�-O I (before 2006)Volume r' Page # r— Number of bedrooms 1—:? Spec house O yesJ12(no Lot lines identifiable E3 yes ❑ no /�OFFICEUSE ONLY L New Property Address ?36 172/A r `z/) ALfE: Sol'�'ek-s--24 J�1025- (Verification of new address required from Community Development Department for new construction.) 3 / Zq/ 2o23 (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form 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. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd(absccwi gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov LEFT ELEVATION 1 /8" = 1'-0' a= a 3 t O �Tr-ylr rur cyn,,,tr,W -g..+ e•.•ee ay i. r, r.-:M,y kx,r+. � upo� �>yna.: a :. raa.,gaco .•�. n-,.,�w �c.:+.. , r,R�� _ cew,e a q.>�•red to .sa cuss M, to r.ik o-a w-cati tan a D.•,,vrg :o:n re,r>rxe s rgas. T •ax ,b k, r..r .� �^ .e re-.W la ,M ,de Cw•al uvc:.-es. my not 4 aY+•y.^d ® a �ap.en, a.� �• �nu r �,�r,c- u- -%e� r a' y r�-,:w, REAR ELEVATION 1/8' = 1'-O" FRONT ELEVATION 1/4" = I'-0' 4'-0' POURfD CCNC. FOUNDATION 9'- I I/8' CEILING @ MAIN LEVEL 10'- I 118" CEILING @ KITCI"EN, DINING c CFFICE 1 2'-0' CEILING @ GREAT 7-O' CCILING (a COYrP FOR BIDDING ONLY NOT FOR CONSTRUCTION A .3 0 D -c D II I I 1 I RIGHT ELEVATION 1 /8" = 1'-0' n1 n J.Sfi /,c—cm m MCA w TOM #22-168 v« , w 1 1 " ONLY :r.Ir A "• ,.:. ,..,. �..,. +.r -:r � � �, '.rl ,,.. 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M 1 .,a., rrcm l` E ■ I I ..,;,,,r� ..•., il7�N' M� rn : 'c t.�,C3 O ■ 1 I p rorw 'I ,a .. � x. -n xr _ O`FICC ■ Ir_______________________�I � ..r.• - nn>.nof ur'.r v:. ■ II 11 tY a 'rC.,oq ■ II II C� 1 22,IC Ily,e Dv-.' I ■ 1 __---_ I a) d N c�Az • .. CC NC. 70,7n I ,vwrrD v •A.z _ _ nl _ _ !tax w•M �- ('V ��i■ ■ i ■Is ammusaos ■ Zj 3 J c ♦t -G r c worcr, n r Nn x.sxs MAIN LEVEL PLAN I!4" = 1'-0' Mr[cm CDi °7 L C11 !1 0 �•rjy�aw- I.x t1c.t drayg+ w �.w-cd ry la r• f},�'"'`7 knm' a f„w'•Y>; I �w0' f.O.n•,r w.L.9 i . D O-r fltt0 Tt)q .L111 up- °:nrr�:>:.le° a-tk W°,r,:,;...reca. —A `- - ---- - --- — - - - 90-1 1!8 CEILING @ MAIN LEVEL ��i N cenx n ted w .ee Lmse PL— rc >x o-e ntrxve W.LQ lsr I,, rn,v �r x rrer,Wee. r.* T--a ,, o: 10 I I/6" CEILING @ KITCHEN. LINING d OFF�CF IN -FLOOR -HEAT W! L" RIGID M_ .e rb. vm rn - r xdc W al unxc:_ e9. wry wt w >es ® .s t,T.• a..-�ry�yr•-_. 12'-0` CEIUNG @ GREAT BELOW SLAB (a, MAIN LEVEL :µ L ,.., c.y,yr., „ 17-0` CEILING Q FOYER #22-168 m, w -5 of Ao Tat ONLY NOT FOR C N5TRUCTION -------------- -- I I I I 1 I 1 I 1 I I I I I I I I I I I I I I I I I I I I I I I _______________J I II l i r--- I I I I I —_ __ _______ ____ I I S I I I I I I I I I i I I I UNtYCAVATCU I I I I I I I;N�'kCAVAfCC I I I I I I I I I I I I i I I I I I I I I I 1 - F 1 I I I I I I I I I 1 L_____________J I I I 1 1 51'(JRT �JUKT I I I a8 .�7' CiM1 W I II I I _______________ I I I IL ------ 1 --- ————————_J I I I I II L_________________________- a••—� I I I — -_. I F I I---------r'-----------------------------, r--------- 1 --J--- i II _____- I I I I I I 1 I I I � I I UNEJ(!'Al'AT[0 I , - I I IL — — — — — — — L—__—__—, I UN[kLhyAlED 1 1 I 1 I I I I I a 1 I I I I I r--------- 1 I IL — — — — — — — — L----__—_ — — — ----------------J I I I I I I 1 I I I I I I 1 f_____ 1 N Nc, JNU'fCAVA�[J I I i_ _______________________ I �.) I I , l______________________________J J____________________________________ JI L____ ________________________ _ L_______________________ LOWER LEVEL PLAN 114" = 1'-0' r.. :- 4 -0' POURED CONC. FOUNDATION J C centne A.firICA W '.K t"ase Puna W f.k O'6'b.C.YC lan! CTvur, VX� rdVve'.! laJml. T'bC N'! rVY -J: u rb.sed I.�r my a4 W'al rw.•uc:: cz, my tit k r:eyxd ® u :�.Taen. an• n5 •wrYNA J- .'.fA n a'Y r". 1 a� rry nun �wR :K ?�.� arrrt••1a r56arr,y A: tt�-16 t^n , : - Jf,2YT O• 3 ° J wortT,� r 11_!H r TJTA I., u O O c 3 L �,�Tr'�ah�h+rttvr drw.-N^n,x'W ty la r. fi. a..+q Krn.. � UP-x� -wrv: r a. tw+ d. to Un. f;ra.anr k.•ar, a M+rtc.1 _ ian- .•arrg wxl remove>> rgrca. T-ae el:ro ry 'o: � x rc. wi In aM ldc tw >f s.vc:.'es. mry n:t k a;qy.� mn•TR :hc v~ " wnttan - la rS L awuyyK>._t. b ROOF PLAN 1 /4" — 1 '-0a FOR BIDDING ONLY NOT FOR CONSTRUCTION s 3 a� II_!M 9I T' in VIM :ruz ur #22-168 vn, w 4 or THIS INSTRUMENT DRAFTED BY: Jennifer A. O'Neill, O'Neill Elder Law, LLC 2424 Monetary Blvd., Suite 201, Hudson, WI 54016 (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN TIFFANY . PETERSEN NOTAR S�'UBLIC COUNTY OF ST, CROIX I s �ATC nF l��nNG1N Personally came before me on March 1, 2022 , the above -named David M. Wittig, as Trustee State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number 11 Document Name THIS DEED, made between David M. Wittig as Trustee of Miles and Audrey Wittig Irrevocable Family Trust dated April 13 2011 ("Grantor," whether, one or more) and St. Croix AR, LLC, a Minnesota limited liability company. ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures, and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): 1149701 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/ 10/ 2022 12:22 PM EXEMPT#: REC FEE 30.00 TRANS FEE 3,600.00 PAGES: 2 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address Guaranty Commercial Title, Inc. 465 Nicollet Mall, Suite 230 SEE ATTACHED ADDENDUM FOR LEGAL DESCRIPTION. Minneapolis, MN 55401 SEE ATTACHED ADDENDUM Parcel Identification Number (PIN) Dated March 1, 2022 • � 7 (SEAL) (SEAL) * * David M. Wittig, Truste (SEAL)_ * * AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing * and d ed thesame.s e tersen . Notary Public, State of Wisconsin My Commission (is-parmanefto (expires: 08/09/2023 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED ® 2003 STATE BAR OF WISCONSIN FORM NO.7-2003 * Type name below signatures. St. Croix County 1149701 Page 1 of 2 ADDENDUM TO TRUSTEE'S DEED GRANTOR: DAVID M. WITTIG AS TRUSTEE OF THE MILES AND AUDREY WITTIG IRREVOCABLE FAMILY TRUST DATED APRIL 13, 2011. GRANTEE: ST. CROIX AR, LLC, A MINNESOTA LIMITED LIABILITY COMPANY, PIN: 032-2023-90-100; 032-2022-90-000; 032-2023-20-000; 032-2023-95-100. LEGAL DESCRIPTION: The Northeast Quarter of the Southwest Quarter (NE 1 /4 of SW1 /4); AND the Southeast Quarter of the Southwest Quarter (SE1/4 of SW1/4); AND the Northwest Quarter of the Southeast Quarter (NW1A of SE1/4) EXCEPT that parcel described in Volume 1832, Page 236; and the North Half of the Southwest Quarter of the Southeast One -quarter (N1/2 of SW1/4 of SE1/4) EXCEPTthat Parcel described in Volume 1832, Page 236; All in Section Six (6), Township Thirty (30) North, Range Nineteen (19) West, Town of Somerset, St. Croix County Wisconsin. SUBJECT TO all easements, restrictions, and rights -of -way of record, if any. St, Croix County 1149701 Page 2 of 2 oI ZI QI JI oI uiI �—I ~I JI al ZI Di LOCATED IN PART OF THE NORTHWEST QUARTER OF THE AND THE NORTHEAST QUARTER OF THE - 392.39, - 309.28' _ 866.44 294.26' 795.16 286.75' 105.64' - 177.94' - 60.15' - 71.19' - ^ 75, 08' 79.29' 8 139 11-114" OUTSIDE DIAMETER IR Jw� 60 -4 4 -�556'19'22"E 0 lN 80.62' N85"33'58"E 297.65' 268.78' 585.33'58"W_ � N56°19'22"W- - /* 0 41.95' 74.00' o > Q = 23.36'- r CC 169ZD ,605 SQ. fT =hM`b ytt� 585'33'S8"W 185.68' + 3.894 ACRES n'rss. y6�� L.B.0. = 8 .5 to o?sF ; �01� ya w a �, h 30 �, �� �, $ 31 139,451 SQ. FT. �, t�j 135,051 SQ. FT. �o A co 3.201 ACRES lz : N 3.100 ACRES 3 in N77•'5 1 „ Wsp. y, ,y q J 10, �m 39 W 9? N w zo: C9 y ul .1 Ln ao ypa, c -10, Ln Z 41 d ��N86.44'09"W Q1.61 S 41 SA, 20.00' o� N p67y 93.61'• m M� N87*51'22"W Ali 1°9 O I)o r 28 19 133,844 SQ. FT. — 3.073 ACRES 1 L.B.O.=864.5 � �---- ti— S89"52'26 "E 107.68' DEDICATED TO--, U r THE PUBLIC �\ N89*52'26"W 107.68' -� ARC LENGTH \ N77104'�7 361a '10 N0o ti3' = — — _X 27 / 10. \ \ 134,797 SQ. FT. a � �- 3.095 ACRES L.B.O. = 863.0 .•tip 523a S68. / N N6�9 59 Z�3 ,, / •' cc 25 f� Mai 140� A SQ.T. HEC�,C�M(�SDD C5r�a3'o�, J AN '0 3 2023 S wls. Dear of sty and Pr+o�essiottai services SOIL EV LUATION REPORT Division of and � o u r� t y Community Develop with SPS 385, Wis. Adm. Code COlrlty Attach c )mpiete site plan on paper not less than 8112 x 11 inches in size. Plan must Include, but not fsrnited to: vertical and horizontal reference point (SM), direction and Parcel I.D. 1 " percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information: R wad b Personal information you provide may be used for secondmy Purposes (Privacy Law. s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot _ 114,-51 /114 S T "' N R E (or W, Prooert�Owner`s Mang Address Lot # Biodc # Subd. Wrro or CSM�# City Stake Zip Code Phone Number _ City ❑ Wage OTown Nearest Road (� New Construction Use:(,( Residential 1 Ntrnber of bedrooms Code 0 _ rived design flow rate �4, GPD ❑ Replacement ❑ Public or - Describe- l �� Parent material a Flood Plain elevation if ft. General corntnents and reconvnendabons: p,M � � .C� /�S,r.,� O.�J L-o,J -tcRs.0 • ,�.�,� ��1 �� - 1�► � �U� � l � ' � � Q { ® Pit Ground surface etev. � ft. Depth to fimif;ng factor ;-. 3 1n. qM Anr&-Atcon Rate 00 1 MrA soruv;m a Boring 171 ® Pit Ground surface elev. _9—Z-6L ft. Depth to uniting factor-,--;L/ in. -Qm e.,nmr-Atinn R>atA Redox Description Structure ewe ���ss■�w� * E #1 = BOD 30 < 220 rngJL and T5S >30 < 1'S0 mglL z1' EnNtent iF1= tfUtJ 3u mgrL anv 100 = rttyt►. CST CSTNkrnber Awdrml Date Evaluation CorxWed TW"*K m Nw ber 4L\ ,-2 la,-;�,-LL OWN 012niott111� Parcel ID # (3 Pit GF0und $0160e eiev. , ,i ! it- Depth to krAW facior�,c2 IrL Pop of Sew AeeInsfim Rate mug ME m4m 'MOO M, MM'O I VA AMP M 1 f # � i*nn."%A ser4ana alam0 R flsrdk in "wi.sinet fmpbw }n LJ L-1 Pit S� Rate Hortw Depth Dominant Color Redaoc Damon Texda+e Sbuct<u�e Roots GPa 2 in. bAurae� Qu. SL Cont. Color Gr. Sz Sh. ' Efliuent #i - BW > 30 < 2M nV& and TW >30 < 150 nV& • EffAw t 02 it Bt3D E _< 30"L and TSS 130 ffg& The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an aitemate format, contact the department at 609-266-31 S 1 or TI Y duough Relay. SW4"(s11111) �O D M �411Il'i' 11 , ..�/ --may < •- h' \( l r �' 1\KQ•c! t �1 1 ' •• • - \ •\ ,l % ' _ \ \ \ _ . 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VOL. 7 PG. 1662 ��\ `1 I \ ��✓ ( ` N LA Now nzw 31 boom-- 1w mt)V \6 *LW.LA7'1.0 29\ \\ \ t .\ \ _-35- �-3-89 aC \ 1 tl 30 \ s (� .}4.orACJvoo qA lop r \ e34— L6.0.-�` NIZ 1 � . 28 ?r o7ac 1 0 aru•2in , r- 3STH BEE33 � 3.20AC t: J 27 f ( 3.09 AC / �� ; / /�' ! �\ \ 4 ma's. \ \ 03 ac 245 In AC H.W.L•d610 J 1 \ ISJAC / /4.06AC \ INI 23/ ti 3.05 LIDPIECEWED APR 14 2023 t. FR, 5;44 lonal services SOIL EVALUATION REPORT�`G5 (20 23 — (OQ C o m m �_� n i t in accordance with SPS 386, Wis. Adm. Code Canty t Attach complete site plan on paper not less than 81/2 x i 1 inches In size. Plan must indude, but not limited to: vertical and horizontal reference point (SM), dkection and panel I.Q. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print ell InAvMs oly. Red by Date Personal krform don you provide m$y be used for necond$ry owpo"s (Privacy Law, s, 15.04 (1) (m)): , � ��� I 1023 Property Owner Property Locdikx+ S C i 11, Gout Lot _ 1121 vas T. i N R E (a Prope ee Melling Address q Lot # # 8ubd. or I City Slats I ZP ityr Village Town Nearest Road 1 l� New Construction Use: Resittuutaal / Number of bedrooms Cade derived design flow rate. GPD [i Replacement Publio or commercial Demx►be: Parent material FL Flood Plain elevation if applicable ft, General comments r and reoorrrtrrerrdattona: 5 dam.�o K. he,rf &s Ll n Lj Borttrg # Pit Ground surface elev. - i S ft. Depth to NMI" factor,„ fn. • Soil iba faa Horixon. '. Depth Dominant Color Redox Qss art Texture Structure slstsncs Boondery Roma OEM_ in. Munson Qu. Sz. Cont. Polor Gr. Sz. Sh. Vft#1 11.02. 2 3 tl ®Pit. 'Grrwnd aurfati;o elev. ft. Depth to IGrridr►g factor fn. car ennrrn,nn., r7nra 'r t #1 '4'80D > V <220 mgil. 8nd T&S>30 <_ 150 rT�gll. " tr fF2 BQt7 < :iv rrrcy6 aW t55A W mgr4 CST Na y� �/ Signat CST NL09W Address ' Ve—juadmiConducted Telephone Number non open mt u,t� PropertyOwner Parcel ID # Page of Boring # ® Boring E Pit Ground surface elev. ft. Depth to limiting factor, In. Snii Anniinatinn P;AA Horizon Depth Dominant Color Redox Description Texture Structure 3onsistence boundary Roots GPD/ft 2 ff#1 02 in. Mansell Qu. $z. Cant Color Gr, Sz. Sh. 1 1. t7L Boring # ® Boring ❑ pit Ground surface elev. -ft. Depth to limiting factor in. Soli Annflm inn FWA Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. $z. Sh. onsistence Boundary Roots " GPD/ft 2 ff#1 " 02 El Boring # Boring ❑ Pit Ground surface elev.ft. Depth to limiting factor In. .Soil. icF►tion Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence oundary Roots GPD 2 In. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. " ff#1 102 !Affluent #1= BOD G > 30.5 220 mg/L and TSS >30 a 150 mg/L * Effluent #2 = BOD, e 5 30 mg/L and TSS _< 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. S411$3351{R4Sllt) !Affluent #1= BOD G > 30.5 220 mg/L and TSS >30 a 150 mg/L * Effluent #2 = BOD, e 5 30 mg/L and TSS _< 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. S411$3351{R4Sllt) a 120 988 PENING EASEMENT LENT X T LL 1, Douglas J. Zahler, Wisconsin Professional Land Surveyor, hereby certify that this Stake -out Plan was prepared by me or under my direct supervision and Is correct to the best of my knowledge and belief. H— D"'VEWAY EASEMENT S, -3 tri '-Ckoix couNnr 0-'4 sTATE SANITARY PERMIT 336 Z KAgd - � , 7rn / T T 1 i l _ fir; cieo,x tq2 � OWNER a, Vj ►-TT� �L4. PLUMBER ��w1. U�tANaEUL LIC.# 2z1F2�a3 TOWN OF „n6PISGT— SEC ,TAN, R / �V AND/OR LOT 25 BLOCK _��rt� �,._� Q►���s suBnivisloN ,a" THIS PERMIT EXPIRES 202-5�' UNLES9 [DE1 - 9 A% VISIBLE D-06499 R11/20 v v b x CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. 3/z7 Zo2.3 I 9A 01121 Wxym •