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032-2073-90-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], Permit Holder's Name: City Village Township CHARLES NOCOSIA TOWN OF SOMERSET CST BM Elev: Insp. BM Elev: BM Description: � o0 • o TANK INFORMATION TYPE MAN U FAC U R. E R T� CAPACITY Septic ZCID Dosing L77 « Aeratipn- 19 JH3. oldi f ` TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic )EI I �, , Dosing � L L . � 53 r� Aeration--, Holding PUMP/SIPHON INFORMATION Manufacturer GPM /� ` Model Number ZgD TDH Lift c Friction Loss System Head TDH Ft tp.b 2-o4 4+01(9,6q Forcemain Length Dia. << Dist. to We V) 2 De nd 'ELEVATION DATA County: St. Croix Sanitary Permit No: 648468 State Plan ID No- PLxn - 0 5�3 80-fq2_ � Parcel Tax No: 032-2073-90-200 Section/Town/Range/Map No: 13.30.20.784B STATION BS HI FS ELEV. Benchmark L ,� 1 l D`� . 3 � D-o Alt. BM 60goP,crpo -� �q Bldg. Sewer St/Ht Inlet 113a � St/Ht Outlet Dt Inlet Dt Bottom a Header/Man. Ze�c� 101,�Dl Dist. Pipe Z,�a � orC�{o Bot. System 3, iEo.7b Fin Grade r� St Laver 5�C30 f T'IEN6Id WIENSIONS Width '6* Length �� S No. Of T� 1 -Jm� (2) PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L B WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufac Type Of System: V� > �,� C �, � I Mod umber: DISTRIBUTION SYSTEMcrere� k Header/Manifold r U Length q-D Dia Distributi Pipe(s) ( tt ! Length �12 Dia Z Spacing__q x Hole Size r r �/ 32- x Hole Spacing 1 2 q Vent to Air Intake SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 296 150TH AVE z_�_w Inspection #, �a12oz3 Inspection #2:10/10/2023 v K_� f 1.) Alt BM Description = t 2.) Bldg sewer length = i0 � 1 4� - amount of cover = c Plan revision Required? ❑ Yes V No r Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) -.•,. era r- t%�' �l� fir\ D ,,•� . rf, - '� inausCiy services lilvtsion �> t � '- 4822 Madison Yards WayC ' \.,V L1111 y ''"SAN-2023-071 / N Sanitary Permit Number (to be filled in by Co.) 3 Madison, WI 53705 %r .: MAY 1 0 2023 P.O. Box 7162 _ ,;,y"` I WI 53707--7162 �fwS 40V _-, 4 -Madison, ' L SLn1 as Tar It Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 0 2 q �/ Project Ad ress (if different than mailing address) 2. 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 be for you provide may used secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. Parcel # I. Application Information -- Please Print All Information P p Pra erty Owner's Name � rGr ID 0 32 - 2o��, 70 —Zoo Property Location ------ _ Property Owner's MailMing A ress M, b,�r a . C Govt. Lot j /4 /4 Section i T N R2L_ E or City, State e_56l&f Z Zip Code �" i'hone Number � / ?,- - 2,11 11. Type of Building.(cheek all that apply) — FM • 1 or 2 Family Dwelling — Number of Bedrooms?" Lot # Subdivision Name []Public/Conimercial Describe U �� _ ��. j� Block fi City of VAUCCSM .State Owned — Describe Use _. Numbcr-3 Z� �S� Village of 9 DCK�.f Oro 2- MTown of!5c�MC4�,c* III. Type of Powirs I'er-niit; (Check either "New" or "Replacement" and other applicable on lime A. Check one box on line B. Complete line C ii A(rNelw System Y Replacement System P 5 El they Modification to Existing System(explain)Additional g Y Pretreatment Unit (explain) ( p ) 1:11 lolding Tank In-GroundE-]At-Grade (conventional) Mound 2 q ) Individual Site Design --]Other Type (explain) 11 C. � Renewal Before r_1 Rev 1 si o ii ahange of Plumber Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information, k '�1010 CAQZ == l% = j2YX 0 Design Flow (and) Design Soil Application Rate(gpd/sf) Dispersal Area Required (so Dispersal Area Proposcd (st) System Flevation ux = + . 0J A -- Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units • o'+�i� L a.> c New Tanks Existing Tanks p' c% U cn n w, C CLa Septic or Holding Talk Dosing Chamber SLID. j V. Responsibility Statement_ I, the undersigne 01 ,ass responsibility for installation of the POWTS shown on the attached plans. lu nature MP/MI'RS Number Business Phone Number r Plumber's Name (Print) 15 10.O� ) q ""&; _ .. Plumber's Address (Street, City, State, Zip CoK�-.q, z 7 7, _if le &4 li5qe 411, ounty/Department Use Only )(Approved ❑ ved Permit Fee Date Issued Issuing Agent Signature s 3 > CJ ell Reason or 3 WO)l C'oilditTns � Wc d,l E4YTS OWNER: Le off � Septic keffluent filter ndispersal IS -V�'7Q-4S/ -p 1. dust be serviced / maintained as per _ � QJl2 � � I `� ��� �� .gyp manrr�t Ire �ror��dd bplumber. . All setback requirements must b maintained n ' (.0 @ per applicable t1 vw, O�� { ��Np�caa :)v oil Attach to complete plans for the system and submit to the County only on paper not I ss tha 8 1/ x 11 i che. i We f [) "6e SBD-6398 (R. 03/21) P..�� C 1 Sae6r,�_ A System PLOT PLAN PROJECT Charlie Nicosia ADDRESS 6956 Meadow Circle. Centerville MN 55038 SE I/4 SE I/4S 13 /T 30 N/R 20 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 100.7' DATE 4/28/23 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANI{ MOUND Xxx SEPTIC TANK SIZE 1200 LIFT TANK SIZE800 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of Chambersnone BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE WELL * H . R . p . same as benchmark Poo - Property line �Gclle I =�FV COPY p' 40' SO' To future 4 Bedroom House 650' Wieser Combo Septic l B - 2 B. w ,P 180' .1 OGPD Pole shed accessory to 150th Ave building Well is to meet all WDNR setbacks Property Line 5% Slope Grading to be done to divert runoff away from system ,00, 99, 98 Area below mound is to remain undisturbed COPY MR MAI Oti4 ARTMTT Wisconsin Department of Safety and Professional Services Phone: 608-266-2112 Division of Industry Services �a� Web: http://dsl2s.wi,.ggy 4822 Madison Yards Way Email: dsps cr,-wiscansin.gov PO Box 7302 Madison, WI 53707 7, Tony Evers, Governor Dan Hereth, Secretary ION May 10, 2023 OUST ID NO.: 226900 SHAUN R BIRD 1432 120TH ST NEW RICHMOND, WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/10/2025 MUNICIPALITY: TOWN OF SOMERSET ST. CROIX COUNTY SITE: CHARLIE NICOSIA 150 AVE SOMERSET, WI 54025 SE1/4 SE1/4 S13 T 30 N,R 20W FOR: Design Wastewater Flow Value: 600 Bedrooms: 4 Limiting Factor(s): 24" Maintenance Required: Effluent Filter Identification Numbers Plan Review No.: PWTS-052300742-C Application No.: DIS-042319978 Site ID No.: SIT-115349 Please refer to all identification numbers in each correspondence with the Department. Mound Component Manual - Version 2.1 (May 2022-2027) Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) SITE REQUIREMENTS • A full size copy of the approved plans, specifications, and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it roils into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments. tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off' at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. OWNER RESPONSIBILITIES • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval and Wis. Admin. Code SPS 383.54 1 . • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval, the Division of Industry Services reserves the right to require changes or additions, should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, Fee Required: $250.00 Fee Received: $250.00 ZW V.4t�0&40e Balance Due: $0.00 Tim Vander Leest Refund Expected: $0.00 POWTS Plan Reviewer Division of Industry Services Phone: 608-516-6134 Email: tim.vanderleest@wisconsin.gov Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246.4516 Date: 04/28/2023 Owner: Charlie Nicosia Location: S E 1 /4 S E 1 /4 S 13 T 30 N, R 20W 150th . Somerset Manuals Used: Mound Component Manual Version 2.1 (May 2022-27) Pressure Distribution Manual Version 2.1 (May 2022-27) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications and cross section 8-9. Maintance and contingency plan Attachments: soil test Shaun Bin Signature License n+ Page 1 of 9 System PLOT PLAN PROJECT Charlie Nicosia ADDRESS 6956 Meadow Circle. Centerville MN 55038 SE I/4 SE I/4S 13 /T 30 N/R 20 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 100.7' DATE 4/28/23 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANI{ MOUND Xxx SEPTIC TANK SIZE 1200 LIFT TANK SIZE800 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of Chambersnone BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE WELL * H . R . p . same as benchmark Property line Scale 1 "=40' 04 40' 80' To future 4 Bedroom House 650' OGPD Pole shed accessory building Property Line Wieser Combo Septic B - 2 B.M. 180' B-11 to 150th Ave Well is to meet all W D N R setbacks Grading to be done to divert runoff away from system ,00, 99, 98 Area below mound is to remain undisturbed Mound System Cross Section and Plan View ,� .i •i. �# �i. i....i. !' ..�. ,i• .i i- •i !� •i ! 'i ..�6. i..! -#...F��., is •i..�Ii/M ...i• i' ��. !.. ! •M Ar ! J + A t' uV t t• t i .t l r ` w ,�iM • '� �1 �A i wlr �+IY .� M� M� �1 rrr !� ' i� r w win Wig rl� i 1rs # on wrs rrr K B L Dimension Feet A B 7� Topsoil : :::: ; _ ASTM C-3 3 -- Clean aggregate 4 in. sch. 40 pvc L.Ca Material sand fill /Z to 2 /2 in. dia. observation pipe P �r .. . r titititi��»►ti�tititi»���ti�titi�»motif.' �. _ . ti:��'►iii�i�►titi�*�.,.... . Plowed Surface Ft Contour Slope Direction "-W GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x w) is plowed with a moldboard or proceed if the soil is wet enough at the plow depth to form a 1/4inch soil wire chisel plow. Plowing m aY not p the alms of the hands. 'ASTM C-33 quality sand is placed immediately when a sample 1s rolled between p laced with a tracked machine keeping after plowing. Sand is p 12 or more inches of sand under the tracks or is placed overhead by a bp ackhoe. Special care must• be used when placing sand of less than one foot ' ion of the lowed surface. After the topsoil cap is placed, the entire mound thickness to minimize compact p o promote vegetative growth, limit erosion and protect from freezing. The is seeded and mulched t p g o pip es i es are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page __3 - of Man Pressure Lateral Layout Two Laterals — End Manifold Force Main T I. 3� or`i�icu, Per �.o�cra� 03/05 Im Pressure System Construction led out ng Sweep 90 Bend La terals are constructed of Schedule 40. PVC i e. Orifices are drilled perpendicular to p P ' drill bit and face down. the pipe with a sharp dry Lateral turn -ups terminate with a threaded anout plug and are enclosed in a 6_8 inch cle p g diameter lawn sprinkler valve box accessible from finished grade. _ Page q__ of __4..____. y • • icatiolls orinance Specif Septic -Dose i'ank, Cross section And Pump Perf purnp Mmufacturer Fankmanufacturer L�l 69� .......... Pump Model Nwnber Fank. Model N'umber 12.11111111 1111�11: o,"", — anufacturer in�� LZL Ye,4(-� '-fank Capacity. � ....,� _ _�Alarm Model Numbel' Max. ury Dt.� �,� lipth I_ �.�w Switch .f�`iiter Manufacturer Filter Model Number Minimum Pump ferformwice Required () CJ 'N.1pI I Ft I D11 @ Outlet Manhole Min. 4)3 Above Grade with Locking De'vice. Inlet Maiihole < 6" Below GrOde Sealed Watertight F i 4841mv new Finished Grade am r% Head (IDH) - Feet Total Dyn Elevation Head 11 1 U -bistal Pressure Network Loss .�---_i Force Main Loss I Securely Mounted Weather-proof Junction Box is" --w 11"M NNW &OW Manhole Min, 4" Above (grade With Locking Demo 'Vent: Min. 12" Disconnect Above Grade Means With Vent Cap 1 4 Outlet Filter 1'4:4: ' 'Wet Baffle Trilet X": 4 P, witch Settrigs and Reserve Capacity 4 =I- ZZ. �2 Tank Volume GPI Dimension,— Volurne Gal. (reserve) A-, — (alarm) B' 2 (dose) C; " 2�9 (plead) D. ' ��IJ L—Total ' 1 24 Weep Y$' B Hole ';,;� Off Elevation C Ft Bottom D r-11evation 'T ri t J 4 1 't 41 1 q L h 4 4 1 4 4 ♦ 4 44.0 4 1 - =X1401it X% 1 444 A'k I GENERAL INSTALLATION: The scptWdose tank is bedded and back filled in accordance with the manufaoturor's product approval specifications, Maximum depth of bur'y as Specified by the manufacturer- may not be excee(;'Ied without prior Approval, Manhole covers exposed to grade have an effective locking device (padlock) installed, Piping at the inlet and'outlet is of approved material, connected to the tank with watertight. fittings, and laid on stabi I soil to prevent settling or sagging. The force main is shoved with 4" Sch. 40 PVC to bridge the tank exuavaticiii and the sleove is sealed watertight. 'Electrical s.ervice complies with NBC 100 and Cornm 16-28, 02/05 U' Page 5 280-SERIES 1/2 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature; 9 Vortex style impeller permitting passage of solids Up to Y4" * 416 stainless steel rotor shaft * Permanently lubricated upper and lower ball bearing e Epoxy powder coat finish * All fasteners - corrosion -resistant stainless steel 9 1 Y? Discharge 9 Stainless steel bottom screen - easily removable 9 Maximum fluid temperature: 140* F. 280-Series Cord Lengths Model 101 251(-2) 351(-3) 5 01 I 280 Standard Optional Optional Optional 281 Standard Optional 0 tional Optional 283 Standard Optional Optional N/A _ 287 Standard Optional N/A N/A 10' cord length standard on all models. For optional lengths, add "-2,-3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications 1/2hp 60 Hz 3450 RPM Oil filled, thermally protected (PSG) Permanent Split Capacitor 8.0 amps (11 5V) 4.0 amps (208/230V) 9 W RO0 oO M=M11EMMOSM19 10 FMOINEEM MEN 35 30 0 U_ 20 TZ 10 5 0 11 9 5 3 2 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 U.S. Gallons Per Minute I . �� ... i I--- _1 - i --ii-11i... 1 ........................... I I I ........... , —I 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29 lbs. Height: 13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281,283...14" Model 287 VMF ... 1011 Factory switch Model 281, 283 Model 287 settings VMF Turn on level 1311 9.511 Turn off level 711 4.016 The Model 283 features a fully adjustable wide-angle float. Differentia adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point. Vertical float model 287 is not adjustable. rTl_ Model280 Model 281 Model 283 Model 287 VIVIF-Series Manual, Wide angle no switch float switch Wide angle 5 float switch Vertical mag with quick- 6% with series netic float for smaller pits - disconnect (piggy -back) will operate in plug 4k a 10" diameter sump SS CE FIE D icp C us Certified Specifications are subject to change wIthOLAt notice. Liberty Pumps • 7000 Apple Tree Avenue * Bergen, New York 14416 9 Phone 800-543-2550 Fax (585) 494-1839 vnvw.1ibertypumps.coM Copyright 0 Liberty Pumps, Inc. 2017 All rights reserved. LIT 2000 R05/17 101 A SECTION A -A 00 ?J 59 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page — of FILE INFORMATION Owner f O.WT 11'o r Permit # I)ESIGN PARAMETERS Number of Bedrooms 0 NA Number of Public Facility Units NA Estimated flow (average) lyj gal/day I Design flow (peak), (Estimated x 1.5) Soil Application Rate Q Standard InfluenUEffluent Quality -gal/day/ft2 Monthly average* Fats,' Oil &Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD,5) 5220 mg/L 0 NA Total Suspended Solids (TSS) sl 50 mg/L ,Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) :530 mg/L Total Suspended Solids (TSS) :530 mg/L NA Fecal Coliform (geometric mean) sj 04 CfU/1 OOM, iMaxImum Effluent Particle Size X in dia, 0 NA 10ther: 11 NA *Values typical for domestic wastewater and septic tank effluent, MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity gal 0 NA Septic Tank Manufacturer ArA '' 0 NA Effluent Filter Manufacturer T FT, hy Me/ 0 NA Effluent Filter Model 0 NA Pump Tank Capacity gal 0 NA Pump Tank Manufacturer 0 NA PLIMP Manufacturer 0 NA Pump Model 0 NA Pretreatment Unit NA 0 Sand/Gravel Filter 0 Peat Filter 0 Mechanical Aeration 0 Wetland 0 Disinfection 0 Other: Dispersal Cell(s) DNA 0 In -Ground (gravity) 0 In -Ground (pressurized) 0 At -Grade )Mound 13 Drip -Line 0 Other: Other: 0 NA Other: 11 NA Other: 0 NA i Service Event Service Frequency M1 !inspect condition of tank(s) At least once every: 3 month(s) ear(s) (Maximum 3 years) C3 NA jPump out contents of tank(s) When combined sludge and scum equals one-third of tank volume 0 NAI -i linspect dispersal cell(s) At least once every: 0 month(s) 7� yea r(s) (Maximum 3 years) 0 NA i','3'Iean effluent filter At least once every: 'D month(s) 0 year(s) 0 NA Inspect pump, pump controls & alarm At least once every: �0 month(s) .year(s) 11 NA 1::Iush laterals and pressure test At least once every: ® month(s) )kyear(s) 0 NA -Other: At least once every: 0 month(s) 0 year(s) 0 NA -ether: I Cl NA MAINTENANCE INSTRUCTIONS Onspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master lPlumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must !include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of i-.ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface, The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 'rhe ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local I-egulatory authority. IVVhen the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of : I:he tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, lend any servicing at intervals of �l 2 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service -event. Page ..' of _" n roducts or other demicals tht It START UP AND OPERATION reattlient tankM for -the presence of painting P ed have the contents of thi: For new construction, prior to use of the r llamaWTS check t ells . If high concentrations are detect Bit recess and/or damage the dispersal C may impede the treatment process tank(s) removed by a septage servicing operator prior to use. ve surface. r when soil conditions are frozen at the Infiltrative �,,� excess wastewater will by System start up shall not occur Wien power Is restored t may fill above normal hlghwater Levels, in the backup or surface discharge of effluer'1t� During power outages pump tanks Y riot to restoring power to ti I one iar a dose, overloading the cell(s) and may result cin operator p discharged to the dispersal cell(s) in g tank removed by a Septage Servicing p contents of the pump the tamp controls to restore normal levels To avoid this situation have the erating p effluent pump or contact a plumber or PC3wTS lllialntainer to assist in manually op ' the um tank. otherwise disturb or compact, the area wlttl�n within pump d dispersal cells. Cho not drive or park over, or of Do not drive or park vehicles ever tanks an soipabsar flan area. down slope of any mound or at -grade p performance and prolong the life of the POVv1"�1J: 15 feet p rove the erfor firom the wastewater stream may Imp p disinfectants; fat; foundation dralin Reduction or a lm4netlan of the fol owing . cotton swabs; degreasers, dental f 1oss, diapers; dicatlons; o►�; patnting produc:lls, antibiotics; baby wlpea; cigarette butts, condoms-, gasoline-, grease; 'herbicides; meet scraps, me sump pump) water; fruit and vegetable peelll1gs, gbrine. (sump pesticides-, senitery napkins; tampons; and water softener ABANDONMENT s shall be taken to insure that the system Is prapellY permanently taken out of service the following step five Coda; When the PCVVTS fails and/or Is compliance with chapter Comm 83,33, Wisconsln Administra and safely abandoned In p s sealed. s shall be disconnected and the abandoned pipe opening • All piping to tanks and pit ro • The contents of all tanks and pits shall and properly diseased of by a Septage Serviclng operator. be removed p p veld space filled with s�I�iL� • After pumping, all tanks and pits shall be excava ted and removed or their covers removed and the p gravel or another inert solid material. ust bra taken, to provide a code compiitltnt CONTINGENCY PLAN If the PC�WTS fails and cannot be repaired the following measures have been, or m replacement system; he location of a replacement soil absorption systeirn• 0 A suitable replacement area has been evaluated and may be utlli ell for d should not be infringed upon by re�quirled not area should be protscted from disturbance and compactlon act the replacement area will result In the neied The replacement with the rulE::l In ' � and proposed structure, lot Imes and wells. Failure to prof setbacks from existing p p replacement area, Replacement systems must comply for a new soil and site evaluation to establish a suitable rep effect at that time. and/or soli limitations. Barring advances In POVI�T�S techno 09If a C] A suitable replacement area Is not available due to setback and) r soil p holdingtank may be installed as a last resort to replace the failed P S a Soil and site evaluailion Identify a suitable replacement area. Up011 t,��lure of the PC' tank may be installed) as The site has not been evaluated .to Id fy .arse. if no replacement area is available a holding must be performed to locate a suitable replacement a last resort to replace the failed POINTS. ace following removal of the blomat at the Inflltra-ilve Mound and grade tads sell absorption systems may be reconstructed to +pL .that time. surface, Re constructions of such systems must comply with the rules in effect at «WARM NG>> SES ANWOR INSUFFICIENT OXYGEN. DO NJOT SEPTIC, PUMt� AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GAS NOES. DEATH MAY RESULT. RESCUE Ca A ENTER A SEPTICPUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMST , PERSON FROM THE INTERIOR OF A TANK MAY FEE DIFFICULT OR IMpoSSIBLE. ADaiTIONAL COMMENTS POWTS MAINTAINERw-- POWTS INSTALLER r-- N a m e -.�--- ----� Name- Phone Phone LOCAL, REGULATORY iWTHORITY-.�.--- SEPTAGE SERVICING OPERATOR PUMPER .. Name" ---- Name- �„� Phone Q Phone -.�5-1 Mon d & and 3g3.54('t ), (2) & (3),1/t)isc:ansin Administrative Coda. This document was drafted In compliance with chapter SPS 383.22(2)(b)(1)() (� � File #: S-r. Crzo" � ��� -, SANITARY SYSTEM Office Use Only 1`s"�""�,�",, 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 Pror)e[ty Files Scanned weblink. �RN OVQ`ON N. Owner/Buyer Mailing AddrE City/State/Zip C-CuifoorV�I'{i � /"NjS Rj3!j Phone Number (require( Email Address (required) Parcel Identification Number 2 20 C) (found on the property tax bill) N-EW SYS� EM. L GAL._DESCRIP '10N Property Location 1/4 SE. 1/4p Y ,Sec. � T N R Wr Town of �r Subdivision Plat: , Lot #, Certified Survey Map # Volume 32, Warranty Deed # �1 �� before ( 2446}Volume ,Page# Number of bedrooms Spec house ❑ yes 4 no Lot lines identifiable Xyes ❑ no 0F..F:ICEIUSE- N Y New Property Address p Y (Verification of new address required from Community Development Depart ent for new construction.) S,12- 02, 3 (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 s w' v 1101 Carmichael Road, Hudson, WI 54016 www. c wi v STATE BAR OF WISCONSIN FORM 7- 2000 TRUSTEE'S DEED Document Number Shirley M. Orf, as Trustee of the Orf Revocable Trust for a valuable consideration conveys without warranty to Charles F. Nicosia, a single person, Grantee, the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Dated this July 1411, 2022. Trustee AUTHENTICATION "o Signature(s) authenticated this TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Larry S. Mountain, Attorney at Law (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature 1155976 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 07/ 15/ 2022 08:50 AM EXEMPT#: REC FEE 30.00 TRANS FEE 630.00 PAGES: 2 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address: Land Title Inc. 2200 W County Road C, Suite 2205 Roseville, MN 55113 i#663297 A part of 032-2073-90-100 Parcel Identification Number (PIN) y * Shirley M. Orf Trustee ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY ) ss. Personally came before me this 14th day of Jul , 2022 the above named Shirley M. Orf, as Trustee of the Orf Revocable Trust to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. I J. Bune Notary Public, State o isconsin My commission is permanent. (if not, state expiration date: 10/ 17/2025 ) TRUSTEE'S DEED St. Croix County 1155976 Page 1 of 2 STA'rE BAR OF WISCONSIN FORM No. 7-2000 LT File No. 663297 �MA0 Lot Two (2) of Certified Survey Map recorded in Volume 32 of Certified Survey Maps, page 7115 in the office of the Register of Deeds for St. Croix County as Document No. 1153209, Town of Somerset, St.Croix County, Wisconsin. St. Croix County 1155976 Page 2 of 2 Wsoonsin Department of Commerce SOIL EVALUATION REPORT Page — of Dlvisiont of Sate�l and Buildinos in a=rdancs eth Comm 85, Wis. Adm. Code . County AtLeoh oompleto site plan on paper not iess than 6 1/2 x I I inches in size. Plan must include, but not limited to: vertical and horizontal reference pin( (BM), direc-Ation and percent slope, scale or diniensions, north arrow, and location and distance to nearest road. Please print all Information. Reviewed by Date Penongl information you providF, rna), be used for se=noaf), purposes (Piivracy Lxw, e. 115.04 (1) (m)). Property Owner Proper, Location C1/4 1/4 S T //vj2ZZ1,f A-4 �a Go4 Lot Dtq R E (o <1tv Property es Mallino Address Lot # 8 1 oj-,- # Subd. Name 0.- CStM C41 State Zip Code Phone Wrnber C3 city CJ Village 54,Town Nearest Road �9 thew Construction Use: ZResidenba! / Number of bedrooms 4 Cade deHved design fiow rate �� Q..0 GPD C3 Replacement Public or commercial - D"cdbe: Parsit material Oje Flood Plain elevadon If applicable jL/.1 ft. Genaml cxrvns,-its System Type Systern Elevation—WIL #- Q Boring azy Li pit Ground surface alsvuai ft. Depth to limiting factor in. Soil Application Rate Hcrtzon Depth in, Ckxninant Cdor Munself Re Desa iption Qu. Sz, Cont. Color Texture Structure Consistence BoundaryRoots Gr. Sz. Sh. j- GPOM "Eff#1 *Eff#2 122 # 13 Boring Z ".2 E�Oong pit Ground surface elev. Zazo Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz, Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDtff *Eff#1 'Eff#2- 22- qy 21 S tj r ��L 2aA C J * Eftient fti = BOD, � 30 5 720 M9& W10 I %5b ),;YJ < - tmuent ffz - ovw, z jw 11rt#6- al Tv a ww ---* - CST Name (Please Print) ignature CST Number Bird Plumbing, Inc. Shaun Bird Za - 226900 Address cll.-� Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, W1 54017 2,.a 715-246-4516 Page —___--- of pare! iD # property Owner nn �` in, tication Rate "� Boring # � Bo � ft. Depth to I'rtnitirxl #actor Svi! Pit Ground surface elev. GP01ft re Consistence Boundary Roots Color Redox Description Texture Structu •Eff#1 *Eff#2 Horizon Dept# Dominant Col Qu. Sz. Cont. Color Gr. Si. Sh. In. Munseii - Lq [� Boring Boring # v ft. Depth to limiting factor in. Sail A lication Rate [� Pit Ground surface ele Roots GF'D Texture=Gr. e Consistence Boundary Depth Dominant Color Redox Description•Eff#1 *Eff#2 FHorizon �P h. In. lUlunseii Qu, Sz. Cont. Color Boring Boring Depth to limiting factor In. Soil Application Rate # round surface ft. G rfaca also. Pit GPDIif Roots Horizon 'lepth Dominant Coicx Relax Cyescrrp don Texture Structure Consistence Boundary •Eff#1 *Eff#2 in. �unsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Effluent #2 = BODE � 30 �- and TSS < 30 rTVL * Effluent #1 = BC)D8 > 30 < 220 mglt. and TSB >30 < 150 rn91L . employer. If you need assistance to access services or t of Commerce is an equal opportunity service provider and The Department department at. 608-266,3151 or TTY 608-264-8777. P lease contact the p need material in an alternate format, p sea•g330 (RAM) Soil Test Plot P Project Name Charlie Nicosia Address 6956 Meadow Circle Centerville, MN 55038 Lot 2 Subdivision SE 1/4 SE 1/4S 13 T 30 N/R20 W D Boring 0 Well PL Property Line L 13M or VRP Assume Elevation 100 ft System Elevation 100.7 ) n Bird V-'O"CSTM #226900 Date 4/28/23 Township Somerset County ST. CROIX Top of 3/4" Pipe * H R pSame as Benchmark 1153209 BETH PABST REGISTER OF DEEDS CERTIFIED SURVEY MAP ST. CROIX CO., WI LOCATED IN PART OF THE SE I/4 OF THE SEI/4 OF SECTION 137 T30N, RECEIVE] FOR RECORD OS/ 16/ 2022 03:14 PM R20W, TOWN OF S OM ERSET, ST. CROIX COUNTY, WISCONSIN. CERTIFIED SURVEY MAP VOLUME: 32 0 BEARINGS REFERENCED TO THE SOUTH PAGE. 7115 • of a �/ LINE OF THE SEY4 OF SECTION 13, .•• *0 a LINE BEARS S89'38a13"W, ST. CROIX REC FEE: 30.00 J H W°`: COUNTY COORDINATE SYSTEM. PAGES: 3 s BER�+.� w nA 91 r N RICHMOND ; E� CORNER, WI �: : SEE SHEET 3 OF 3 FOR MORE DETAIL AND � SECTION 13 *�• s�4. EXPLANATION OF NET PROJECT AREAS, REQUIRED LOWEST BUILDING OPENINGS AND PROPOSED DRIVEWAY LOCATIONS. (ALUM. CAP FND.) j $ U R% r UNPLATTIED LANDS J�Ts� r r NORTH LINE OF THE SE Y4 OF THE SEY rr� r � G� N89034'59"E 1064.43 ` r r 2 "14.28' 422.06' 41 428.09' ,+ f f f � `�•` ' CURVE INFORMATION RADIUS- 0020.50' �r r � CENTRAL ANGLE - 03°31'3$" CHORD- 370.61' , �o •;� ARC LENGTH-370.67' J 3 C6 TANGENT IN -- N42°54'55"E Mom, WETLAND= �26" TANGENT OUT-N39n23'17"E cO 1TouR j w u) f_ LL. co a 922' LOT 2 u-3 A LOT 3 � = CONTOUR Uj � ' 557,760 SQ. FT. (12.80 AG.) 566,778 SQ. FT. (13.01 AC.) Q t7-,��•� U') INCLUDING FR.1 W © INCLUDING R t W u.3 W c�v 5441337 SQ. FT. (12.50 AC.) qt- ? 552,813 SQ. FT. (12.C9 AC.) _ � t� EXCLUDING R t WCr.)E}CCLU V" CV j DI hIG R 1 Wf.,.. c[ LOT f 1 Q 567,959 SO, FT. 0 3.04 AC.) r.0 AND = s 7' s NCLUC?I NG R t !!V C IN TOUR LLj i �t M rn 553,840 SQ. FT. (12.7"1 AC.) av � � w o ti �� EXCLUDING R 111V o ``�C4 � r TLANO--=5.2' '� �3 CONTOUR CD C�p M LU / 1 `� CV �' 1(ETLAND= b27' N E �ONTOUR -- :z o14 r o cv nt co D== Qr O7 co E- �`• r�o -a. SOUTH LINE OF THE SEY LO 00 C � �', a t r #� r p �- S89 3213 `W � 13t32a86 �,,� � 420.77' _ � _ _. _ 'f ..,-..,. ......,-. � cq►! w.m.. _. _ _..—. 428. i o, � _ � .. _4.53.99' _ f� ti' ....�.. ..-.� ....-,... .-...... 453.928 .."l'2O a i a7, Tfw V aQ V' .� ». . .�' . _.S89'038,13"W 1302.73ff _ S CORNER, L.. G !"V �] 7J�DTI"'>� I�4'L i�1� �' SE CORNER, SECTION '13 SECTION CORNER (AS NOTED) _ - " - _ _ n _ _ _ _ _ _ ---- n M�GD�L��GD LANDS SECTION 13 (ALUM. CAP FND.) - - - (ALUM. CAP FND.) Section comers shown hereon ® 0.75" X 18" IRON REBAR WEIGHING have been found and verified 1.502 LBS. ! LINEAR FOOT SET. with ties of record and published ■ 0.75" IRON REBAR FOUND, SCALE IN FEET St. Croix County coordinates. 1" OUTSIDE DIAMETER IRON PIPE Field work completed January FOUND. q100' 2000 18, 2022. FENCE I" -- = 200" LAM SURVEYOR: PREPARED FOR: 5 SOLUTIONS JOSEPH GRANBERG ORF REVOCABLE TRUST DRAFTED BY: JWG 1428 134-T'H AVENUE C/O WAYNE ORF 603 RIVER ROAD JOB NO. 100--770 SHEET S[7 Elwlr4 NEW RICHMOND, WI 54017 HUDSON WI 54016 DATE: 11 /09/21 1 OF 3 � —7 St. Croix County 1153209 Page 1 of 3 do] CERTIFIED SURVEY MAP LOCATED 1N PART OF THE SEl/4 OF THE SE1/4 OF SECTION 13, T30N3P 1220W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN DESCRIPTION: A parcel of land located in the SE Y4 of the SE Y4 of Section 13, T30N, R20W, Town of Somerset , St. Croix County, Wisconsin, further described as follows: Beginning at the southeast corner of said Section 13; thence S89038'13"W 1302.73' along the south line of the SE Y4 to the west line of the SE Y4 of the SE 1/4 of said Section 13; thence NOO"22'25"E 1045.77' along said west line to the southeasterly right-of-way line of State Trunk Highway "35" / "84"; thence northeasterly along said southeasterly right-of-way line 370.67' along the are of a 6,020.50' radius curie concave to the northwest whose chord bears N41 "09'06"E 370.61' and has a central angle of 03°31'38" to the north line of said SE Y4 of the SE Y4 ; thence N89034'59"E 1064.43' along said north line to the east line of the SE Y4 of said Section 13; thence S00032'12" W 1324.36' alone said east fine to the southeast corner of said Section 13 and the point of beginning; Containing 1,692,487 square feet: (38.85 acres) more or less and being subject to any easements, restrictions or covenants of record. SURVEYOR`S CERTIFICATE TE 1, Joseph W- Granberg, Professional Land Surveyor, hereby certify that by the direction of Wayne orf, representative for the Orf Revocable Trust, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision ordinance and the Town of Somerset Subdivision ordinance and that this map is a true and correct representation to scale of that survey. •mains We .w J 0 S E P H W. J Z O O G I ANBERG :4 J❑ E GRANBERG DAT G-295 0' G& LAND SOLUTIONS, LLC. : NEW RiB #HMOND ; .- pprovecll 1428 134TH AVENUE NEVV RICHMOND, WI 54017 "'q ""` 000#00*000 -�C] My 715�-245-7529 �� .3 U ft* � St. . Croix County Community Development TREASURER'S CERTIFICATE 1, ❑ENISE ANDERSON, BEING THE DULY APPOINTED, QUALIFIED AND ACTING TREASURER, OF THE COUNTY OF ST. CROIX, DO HEREBY. CERTIFY THAT THE RECORDS IN MY OFFICE SHOW NO UNPAID TAXES OR SPECIAL ASSESSMENTS AS of VNA COD , AFFECTING THE LANDS INCLUDED IN THIS CERTIFIED SURVEY MAP. BY: Geat stsn DATE t 0aL TREASURER GENERAL NOTICE STATEMENT EACH PARCEL SHOWN HEREON IS SUBJECT To STATE, COUNTY AND TOWNSHIP LAWS, RULES AND REGULATIONS (i.e., WETLAND RESTRICTIONS, ACCESS To PARCEL, MINIMUM LOT SIZE, ETC.). BEFORE PURCHASING OR DEVELOPING ANY PARCEL CONTACT THE ST. CROIX COUNTY COMMUNITY DEVELOPMENT OFFICE AND THE APPROPRIATE TOWN BOARD FOR ADVICE. 5SLANDSURVEYOR: PREPARED FOR: SOLUTIONS JOSEPH GRANBER �3RF REVOCABLE TRUST DRAFTED BY: DWG 1428 134TH AVENUE C/O WAYNE ORF JOB NO. 100 -770 SHEET N �RGc�SF] ' f1iT� NEW RICHMOND, W1 54017 603 RIVER ROAD DATE: 11 /09/21 2 OF 3 HUDSON WI 54015 St, Croix County 1153209 Page 2 of 3 3 CERTIFIED SURVEY MAP LOCATED IN PAIN OF THE SE1/4 OF THE SEI14 OF SECTION 134 T30N, R20W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN NOTE: THE AREAS SHOWN AS N.P.A. (NET PROJECT AREA) ARE ABOVE THE PROJECTED HIGH WATER ELEVATIONS SHOWN FOR THE WETLANDS AND EXCLUDE ANY SLOPES GREATER THAN 12%. THERE MAY BE OTHER AREAS SUITABLE FOR CONSTRUCTION THAT ARE NOT SHOWN HEREON. ADDITIONAL SITE PLAN WORK WOULD BE NEEDED TO DETERMINE THE FULL EXTENT OF THE NET PROJECT AREA FOR THESE LOTS. DUE TO S V RA G C] ED- PSiQIVS AND Y E3E DEM E) iG �' _; sm., �—-• 1 API •f ,' /J EJ 5 f K�1111 JrF r� � ' r f ` � 1 1 �• ' .•r � ••- � r. f � f • --ter~, � L 1 � r J �_ �-� i ` � J � �� t f•^--- : c .�—r�� �-"r `� = s + {�ri tC'/CD 6 1 �tti ffi —Y�+ ��+�,(r■ [ij j • `` r ,# r ti r '� s. `� _ s] �� (,t' j r [ tT� ,i -1 . r �� r % tti C.�_1 t1 .,,-. � E-,,,�+ ti C� tT•� _ _ y v � 'r 71 � , �---w`ti�i ^r�•.� � i\ y r ram-•. ••` ��. _ ti_ '�,•�/`92�t r� � � �• � �- �t �t t 1��r•�+-'"'•"I `J] } � � • 'r !1 � ���...._-- _ '�``'1'a; t' �N n,� � � /teC� flY�� f;�yt `�`. �,'�\\ +J � •-"'--r ] 11 � � ""# • _ � _ , � ,� n f .CONTOUR r- � � �---- - _. - {{� 1 ' } ` j �_ -�'.-_.,,,.ter" L • y y .3 + •r; 13 coLUUJ ' f �� bus 7 ► = `''• [ti (NETLAN C1 -•- m J ri� 929.. CONTOUR ND 925. UR 00 ~L'7 - r.�i.�] f. c•.� •, , { `� "� . ' ETLAN � �-J _�`, Cy; rr � r ,•._ � a� '�_. ^-.....� � CONTDU.� -� \ f� 9� ;� f R 'rY' wr � � -• - ti y . t { J - �r+! , I �j� � JV cv 1 � 948 oe Lh •tip [3'.'.�- /�� /w� ��ryry■. � � „r t � J '2 y r r •-T C .,� 1'.!"1�-AE3VU 1✓�.J�Jt�, .. y +�• _ 31+ ~ i� ] P s : l rtr r +r�� jjj a tr ��:1 �LgC393'`'.929 3_ `— �{ f �» — ' , i g 92i' C Q R r: paw' �fCs 1.4,:�t3C. �" : f ` r• I y F cn _ ■ yrrrrrra_�� ~t�Z.�7� �jr,3� y _r ��TV.+IW,,.� '`�`- -�N - HA1E8EE � : F O Sk7p( t _ � S i� BASED ON 1 *mil i 0 =-7l<fP- L PCCC�TL 1L7 �n� l� E.i -CflULD �Ck N1�111[G EAS BEin �I• SD THPiTTHE �� .r-- --_ s ` S L� I 5 i [71~ TH -17�E1ltlAY�'Si BE �[L��-fIB0VE�THE � 1`4 AND fCAR -= r p •�7■ ='" CULVERTS BE PLACED AT THE LOWEST GRADES ENCOUNTERED. � � �'� �` 0' 1001, 200'N 1 " _ 2001 r LAND SURVEYOR: PREPARED FORm. S SOLUTIONS JOSEPH GRANBERG ORF REVOCABLE TRUST DRAFTED BY: JWG 1428 134TH AVENUE C/O WAYNE ORF Jog No. 1 Uo•-770 SHEET NEW RICHMOND, WI 54017 603 RIVER ROAD DATE: 11 /09 f 21 3 OF 3 HUDSON 5401 6 St, Croix County 1153209 Page 3 of 3 3 - -7 1 1 Document Number t Document Title �tI 1 f I�II1f1� DocI�:8976755r r Tx:5160661 1166620 BETH PABST REGISTER OF DEEDS . ST, CROIX CO., WI 05/11/2023 08:47 AM EXEMPT#: REC FEE 30.00 • PAGES: 3 Recording Area Name and Return Address ' had e 06 ('0'e'*' q Mead 0 LAJ �e�f6 (eon- v, Ile, M �j 675'03 Parcel Identification Number (PIN) THIS '.AGE IS PART OF TIUS LEGAL DO CUMENT — DO NOT REMOVE, This information must be completed by submitter: document Title name & return address and PIN cif required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/22/201 o St. Croix County 1166620 Page 1 of 3 Doctulient Number Docutneiit'ritie St. Croix County Affidavit for a single POWTS sel"vicing Two Structures via Private Interceptor .{ Main z . Name — (Owner) moped or printed being duly sworn , states, tinder oath, that: He/she is the owner/co-owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume, Page ZZ1515ocument Numberjjj��t, Croix, County register of. Deeds u Office: `rr-64W5 P� �X • 1165C'-71k� A parcel of land located in the , 614 of the_!; ' �/4of Section , TV,R w, Town of e.St. Croix County, Wisconsin, being duly described as follows (include lot number and subdivision/CSM or detailed legal description): ' oo6 r SD rd� kv� Recording Area Name and Return Addross 6e7b C_ t Ate. C_ 1r,&rrer- 5YO � & �?32,2-oZ2?_3 10 Parcel Identification Number (PIN) As owner of the above described la operty+, I acknowledge that a Private tan -site wastewater Treatment System (POWTS) serving the priinary residence is sued for bedrooms) with a design wastewater flow o4a�allons/day (DwF is b9sed, on I50 gpd bedroom c@ 2 persons per bedroom). A inaximurn of 46occupail ts are permitted; if the number of occupants. exceeds the maximum for POWTS design, the system will be undersized to accoinmodate increased wastewater flows and/or contaminant loads and inay be subject to premature faiture. An accessory Structure to be used as a 2"d dwelling has been connected to the POWTS via Private Interceptor Main Sewer (DIMS) in compliance with SPS 382.30(12), l understand that disclosure of this information_ will be made to any parties interested in purchasing this property in the future. Dated this day of , K AUT NTICATION AMNOWLEDtsMNT Signature(s) STATE OF WISCONSIN } St. Croix_ Colt A=Sdthis day of Personally came before me this 0day of (Year) ear* the above nained LYNN M ZIMMER NOTARY PUBLIC • MINNESOTA MY COMMISSION E?(PiAE6 01131127 to me known to be the person(s) who executed the foregoing instrument and � �l e�,-, M�vwY,,o.�.. 5 1 0_6 1?16 Z_3 11THIS PAGE IS PART OF TIItS LEGAL DOCLiMENT -- DO NOT REMOVEll This Fr foient tllon must be cowploted by sabrnitten dncrifflel l title. uatne & rvirrm crdd =, and L'E { f r-equir ed). Oilier i1 foi inarion such as the granting clauses, legal descr-iption, etc, "tail be placed orr this fir-sl gage of the docinnent or may be placed on additional pages of ilia docionent. &= Use of dais cover. page adds one page to your document and S2, 00 to tire_n.ic Wgfee. Wisconsin Stattties, 59, d5, -- St-rGroix County 1166620 Page 2 -of 3 n 1 1153209 13ETH PABST REGISTER OF DUDS CERTIFIED SURVEY MAP ST. CROXX CO., WI LOCATED IN PART OF THE SEIl4 QE TT-E SE1/4 OF SECTION 137 T30N RECExVI2 RECORD R20W, TOWN OF S OMERSET, ,ST. CROIX COUNTY, WIS CONSIN. 05/ s�/ �oz� v3: 14 PM 2 CERTIFIED SURVEY MAP VOLUME. 32 � C7 BEARINGS REFERENCED TO THE SOUTH •■�� LINE OF THE SEY+ OFSECTION 13. FAGS: �'x�.5 REC FEE: 30.00 LINE BEARS S89'3813 W, ST. CROIX �": COUNTY COORDINATE SYSTEM. * : A BERG PAGES. 3 5-- 95 N I~I1BHMDND ; EY4 CORNER, 100T 3 OF 3 FOR MORE DETAIL AN D W1 PLLSEE SFFNET SECTION 13 � " "'" EXXPANA-n NOPROJECT AREAS, REQUIRED 41 LOWEST CAP FNtD.) •�arrarM+r� BUILDING OPENINGS AND PROPOSED DRIVEWAY LOCATIONS. (ALUM, [ rW 41 Cti! 13, /�t� �� NORTH LINE OF THE SEY OF THE SEX ` % N89'034'59"E 1064'.43' 1 ���� -.. •�,r� . ............ 214.28% 2= 422-00' .... . 428.09' r L.1► CURVE INFORMATION' �� •� RADIUS- 6020.50' � [ Q f CENTRAL ANGLE -- 03a31138E' n CHORD- 370.61' N41 09 06 E C:) • •� ARC LENGTH- 370.67' TANGENT IN -- N42°54'5511E WATLAND-126' f� TANGENT OUT-N39 23'17"E CONTOURLLI "- VJ 00 ~~ f ...,........ "" .,r�1� O W / WETLAND= 922 LOT 2 LO r ~ LOTSLLI : CONTOUR 55r,750 SQ. FT. (12.80 AC.) � ij-t— � �`��� r-- 566,778 SQ. FT_ (13.01 AC.) U_ ���-'� 0 � _ ,� INCLUDING RI VV c) INCLUDING R 1 W � p "� co544,337 SQ. FT. (12.50 AC.) r a 552,81,3 SQ. FT. (i2.B9 AC.) � � W r EXCLUDING R I VV � co EXCLUDI NG R l W i L O T � 567,959 SQ. FT. (13.04 AC.) WLLI s~ TAN D 9 7' INCLUDING R 1 VII JCNL Tat „� 553,840 SQ. FT. AC.) t (12.71 pp ` W �t o IwXCLi. DI NG R 1 W �� v7 s LANn hENTTOUR CD a Jju CO \KF.TLAND=N27' CZ) FONTOUR j :Z �--•f�i 1 a CD © ' z ' C\I E F rn �r r , U f CV 1 L(j ;�, SOUTH LIFE OF THE SEY °' � 589°32''13' W '1302.86' c0r .^ — 420.77' _ ...�....._. .�. .� .� .�. � ..�.....�... 428.1 ❑' c� .-...., .MM....._. _._.428.U8' �.... ._._. �. _453.99' ._._ �-53.92' o �i.20.73' � S 89c38` 13"W t 302.73' SYd CORNER, L ,E C F N D 50TH AVENUE �_ SE CORNER, SECTION 13 Q5 SECTION CORNER (AS NOTED) �������a ����� SECTION 13 (ALUM. CAP FN D .) (ALUM. CAP FND ) Section comers shown hereon E3 0.75" X 18" IRON REBAR VVEIGHING have been found and ve Med 1.502 LBS. / LINI-AR FOOT SET. with ties of record and published r 0.75" IRON REBAR FOUND. SCALE IN FEET St. Croix County coordinates. ! Iry OUTSIDE DIAMETER IRON PIPE Field wort completed January FOUND. 0' 1000 200' 18, 2W. FENCE 1" = 9-00" . LAND SURVEYOR: PREPARED FORat i. $OLTIMONS JOSEPH GRANBERG ORF REVOCABLE TRUST DRAFTED BY: JWG r �►�e- hso Iry , 14.28 134-TH AVENUE C/0 WAYNE CRF NEW RICHMOND, Wi 54017 603HUDRIVER WIROOAD JOB NO. 100--770 SHEET DATE: 11 /09/21 s 1 OF 3 --- -7 St. Croix County 1153209 Page 1 of 3 St. Croix County 1166620 Page 3 of 3 �jj .' � 'L 8 2023 `—`gGY1n GS7'-zdz3-((i o, n t SOIL EVALUA7'10N RE'ORT VVISCOnwn, Depar� flIj , � I I ao c- 0� f:sior of n-Ity Deveiopment Sourltv ktadh c*mpiete site plar, o7 paper iess tt-z x inches in size. Plan must bLA rVot firnitat t,,-,- ve..tca! and honzontai, reference Doit (SVII direction arc Pam percent nape, scaie or dimensions,, no.--M arrow, o-nf.,' location and distance tc nearesi road. I I , Flease print all informReOe%ed bv , atior Date -�D jF;- P. intonnstkx. yck: of-ovide rrvev be use6 to, w�on3ar� purposes `Privaccy- Law. e. �rnl'� ersorm KWL Property Locabo,- t 11-e A/1 a G.M. LcK r R E Pwe S Mailin: o -es, I Lot # B1, k # SLbd ,. Na7* or CSN# -7 CA-Y stal Zip 7 N -arest F-exad 5; r t�V :,XztrjCt0°+ .4,-6,ZF,,esicientali'Numtero"b&j,,,00. s- Cone derived desigin kcm, rate Replaoernenf publi- or oom-rne-a-Describe-_-��-_ - - - --__ . �- _ ' Parerft mmer,8111 7-,/ Ficcxoc Plair, eievabor, if applicabie jA,/ fL Genara` = rv, f FW11 UZ and rtia-us: Svsterr, Elevation Lr—� F--11t I W IV I nul r%%4 ra�.,u�" If 4. Soil icafion iinant C-Nor Qunseli Rabox Descnpbon TexLre I C�u. Sz Cont Color I Str..#�j-e Gl,. Sz, Sh. Co7tsistence Boundary Roots GPDIff Jp I- rjr— 7 0 J -V Z4— i /V 14 iA- -4- Boring Esohng 12 pt t Ground surface elev, /A T(w, 2ft. Depth to limiting `actor Soit Ap;)fic;abon Rate Horizon Deptil Domirant CNOH Munsell r Redox Description Qu. Sz. Cont. for Texture Structure Gr. Sz. S!-... Consistence! Soundary Roots *Eff-# I 'E' -7 1 �. _ C' - F f l �. �� "7 17 14- s V^n 1p �4 E. kient #1 = B067�;, > 3< ZK ivng�L art.- -73S > 30 < CST Name (Please Print) f Signature igratue Bird Plumbing, 'Inc. Shaun Bird Address 1432 120th St, New Richmond, W1 5401 Effluent #2 = BOO. < 30 mgA- and TSS < X-1 mg/L .-.,-;T Number 226900 Date -valuation %0onducted Telephone Number --? 715-246-4516 Property Owner Boring # Boring Pit Parcel ID # Ground surface elev. ft. Depth to limiting factor _ in. 2 Page of 3. SM AnNicatinn P eta ffiwmm Redox Description Structure - v lowliJ�lJOI_J»��[3��J� ��fL�`Ak�I�C9l��1//Q���/7��tr��� 1:1Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Redox Description Structure Boring # ❑Boring Ground ❑ surface elev. ft. Depth to limiting factor in. Pit - So# Application Rate " Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 c 150 mgA- t Effluent #2 = BODs 130 mg/L and TSS 130 rng/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-8330 (R.6100) Soil Test Plot Project Name Charlie Nicosia Address 6956 Meadow Circle Centerville, MN 55038 Lot 2 Subdivision ----- SE 1/4 SE 114S 13 T 30 NIR24 W F-1 Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft. '�CSTM #226900 Date 4/28/23 Township Somerset County ST. CROIX Top of 3/4" Pipe System Elevation 1 00.7' *H R pSame as Benchmark �3 STATESAN ITARY PERMIT 296 /So five . 1�� 7 D►�/ mom:[�a OWNERCRf��S Lac.# Zzbioo TOWN VY o vvLea gc,-, T - - --------------------- ---------------------- - - - sr-ju '3c.> Nq m 2D 13 AND/kjxx L%j'11' 0"V�& (32 /IT) 1150,3207 �� Y 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. f c The sanitary permit is valid and may be renewedor a s �� YP Y 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: 1f you wish to renew the permit, or transfer ownership of the permit, lease contact the coup authori P tY tY. to His M. am J. Q I IN .... . . ... 0 47.142114 lei ROM 8311 ..... ..... . ... ... . ... . .. ..... AM ...... . .. SBD-06499 (RI 1/20)