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HomeMy WebLinkAbout030-1045-40-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430301 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Houle, Helene I St. Joseph Township 030 - 1045 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CID . 0 l ob -a f N _ T n,� ( 21.30.19.166 C ask TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' Benchmark 4z b 1b$b I M, O ! Dosing W Alt. BM D' ! � 3 ' os. � 2 Aeration Bldg. Sewer V Holding St/Ht Inlet 00 ! TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 1 ! Dt Bottom Dosing Header /Man. 13 . a I 1 I� °I1•91 Aeration Dist. P' � Z Holding Bot. S m 14 Wee ,zo 13. Yz ' Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM o .1 5 3 3 Model Number TDH Lift VrictionlQ ss System Head TDH Ft Forc ain Length Dia. SOIL RPTION SYSTEM Zo REN Width Length ! No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN NS I b2 per Z.� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR 97 &Ve J / S � � — UNIT Model Number: �' n . Cl&" I � 9s .. - - - DISTRIBUTION SYSTEM LP {,;, S,. r&,) ? }S Header /Manifold rr Distribution x Hole Size x Hol Vent to Air Intake V e . Pipe's) e Spacing > � Lengt Dia Lengt Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes No CO� ( clud c e discrepencies, persons present, etc.) Inspection #1: B ✓f 2 /, l Inspection #2: -- � --`— Location: 14544 60th Avenue Somerset, WI 54���1025 (SE 1/4 NE 1/4 21 T30N R19W) 40 acres Lot Parcel No: 21.30.19.166 1.) Alt BM Description = "ro P pk_ 4U-hA�. 2.) Bldg sewer length = 2 Z ! amount of cover Plan revision Required? uired . Yes No ov. Use other side for additional information. � T 2 3 SBD -6710 (R.3/97) Date Insepctors i e Cert . No. Safety and Buildings Division County 1* m 20 t W. Washington Ave., P.O. Box 7082 01 seonsin Madison, WI 53707 — 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261 -6546 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide I may be used for secondary purposes Privacy Law, s1 5.04(1)(m) Project Address (if different than mailing address) L Application Information — Please Print All Informat n °q y' �*� i�a fN � / y y - 60 �T I Property Owner's Name i Parcel # Lot # Block # 2003 C:," C Property Owner's Mailing Address I Property Location e T� _S� /., Q/ ' /., Section City, State Zip Code °" - 5 10 circle one) II. of Building (check all that apply) T � N; R _dE or® or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ PubliclCommercial - Describe Use YO AC1 P1+A' E" L ❑ State Owned — Describe Use ❑City ❑Village I�1 ownship of S�, �c S/O /j III. Type of Permit: (Check only one box on line A. Complete line B If applicable) A * 10 New System ❑ Replacement System ys ep ys ❑ Treatment/Flolding.Tank Replacement Only C1 Other Modification to Existing System B. C1 Permit Renewal ❑Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl M Non -Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter thing Chamber p Line ❑ Gravel -less Other (explain V. Dispersal/Treatment Area Information: I�Yt Design Flow (gpd) Design Soil Application Rate(¢pdsf) Dispersal Area Required (sf) emal Area Proposed (so System Elevation 00 • 5S iITT 600 3. 9f,-0 ' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units w/ -16 / �{ Concrete Constructed Glass New Existing (J Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Clamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI 's Signature M S Number Business Phone Number Plumber's Address (Street, City, State, Zip ode) A 662 G ° r- viil;tountyibe artment U e Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Dat Issued Is tng Age t Signatur t ZMps) Surcharge Fee) 'D1 a g ❑ Owner Giv en Reason for Denial v ° 0_3 a IX �ill1 1 9f ovaUReasons for Disapproval hOT Gp x 1 eptic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 14 2. All setback requirements must be maintained as per applicable code /ordinances. 44S3.94 Attach complete plans (to the County only) for the system on paper not less than 51/2 x t 1 Inches In size SBD -6398 (R. 08/02) cwr S,oEcT /o�' - 9 ' y _ - �3l - riv 3_ y TEJ�f, Lit. 9y-o �p�_ cr 0 - -- - - - - d L 4_ ' By �- - -- - - l �: 14Gt 2 le - - y- -- o '- 9� - l l _ _ � -�_ - `-�� _- Win_ �NL � • - - _ - _y J'T ,/IN S Wiz, 7y1 o IT Vt- r � �L = /©O.O__ l�rr TP � / $ Tod r lily /, /, !o 0 UG � O Al 1360 ...AGR _ Ake EL . (/ / t o ysrt�i �� 9Y o 101 / / / </ N J 9y' _ Acr 13M JJ� YT" S'l. _ 556 CI y LlfeCU 1168 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8'/: x 1 f m e � —1 County include, but not limited to: vertical and horizontal refers St. Croix ce point 8(rrti>o parcel I.D. percent slope, scale or dimensions, north arrow, and t 'on and distance to nearest road. 3r7 `pZ Please print all inform . ition. ; i ie 131 Personal information you provide may be used for second purposes (Pnvacy Law, s. 15.04 (� L). 0 Property Owner fikdperty Loc#tion Donahue, John e eaC au > of SE 1/4 NE 1/4 S 21 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1145 W 8th St. Acre Parcel City State Zip Code Phone Number City Village ✓ Town Nearest Road New Richmond WI 54017 1 715 - 246 -4251 St.Joseph 1 60Th St. New Construction Use: ✓ Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area i suitable for a conventional system with a 0.5 gpd /sgft rating. Possible system elevation for Area I is 94.0' ❑ Boring # Boring ✓ Pit Ground Surface elev. 98.42 ft. Depth to limiting factor +90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/tt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 1 0 -11 10yr3/3 none I 2csbk mfr gs 2f .5 .8 2 11 -20 10yr5/3 none sl 2csbk mfr gw 1f .5 .9 3 20-39 10yr4/6 none sl 1 csbk mfr gw - - - - -- .4 .6 4 39-90 7.5yr4/6 none grsl 2msbk mfr — 5 .9 ❑ Boring # Boring ✓ Pit Ground Surface elev. 98.12 ft. Depth to limiting factor +89 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 - Eff#2 1 0 -7 10yr3/3 none sl 2csbk mfr cs 2f .5 .9 2 7 -21 10yr4/3 none sl 1csbk mfr gw 1f .4 .6 3 21-48 7.5yr4/4 none sl 2msbk mfr gw 5 9 4 48 -89 5yr4/4 none grsl 2msbk mfr - - -- - - -- 5 .9 3 Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD <30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt - - 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 7/29/03 715 - 247 -2941 Property Owner Donahue, John Parcet ID # Page 2 of 3 i ❑ Boring # Boring ✓ Pit Ground Surface elev. 95.37 ft. Depth to limiting factor +90 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -13 10yr3/3 none I 2msbk mfr cs 2f .5 .8 2 13-28 10yr4/3 none sil 2msbk mfr gw 1f .5 .8 3 28 -56 10yr5/4 none sl 2msbk mfr gw - - -- .5 .9 4 56 -90 7.5yr4/4 none grsl 2msbk mfr -- ---- .5 .9 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 F-1 Boring # Boring Pit Ground Surface elev. it. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stlucture Consistence Boundary Roots QP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 800 < 30 mg/L and TSS <30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or nPPil matPriol ;n — f-4 -1— —f—* .iPnor/.nPnt •f l./1R_7!.!._21 G 1 nr'r'TV AnR_')4A_2'7 7^! i . ; PQ.ye 3of3 4 ` • /un► y Inap 103. 68 yo � r �O i bin a - 712 F'[, 1 0 3, 6 8' 1,ru�'��+ - � �, �`ot�n f �,.,.a6+�c. p�a�o�y by ; 7��as T► S�c�.., :11� �/S G✓ fq 0 7.27-429 IV °To,,.; h S 4,�v o sep ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address r1f Property Address 1 5q 71"F (Verification required from Planning Department for new construction- City/State 1 76 ,eA: �T /.Ui Parcel Identification Number v '30 /D V 5 Vo LEGAL DESCRIPTION Property Location 5E V4, ' /4, Sec. Z I T ,W N -R __W, Town of 7, 'p sin l( . Subdivision V /D AC /2,g Lot # A� 14 . Certified Survey Map # , Volume . Page # Warranty Deed # 0 !1 , Volume 1IYO'2 . Page # 7e� Spec house ❑ yes 8 no Lot lines identifiable ■ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a maswplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. l 6 11,23 IGNATURE OF PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. S GNATURE OF APPL CANT DATE * * * * ** A Formation that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of h r• FILE INFORMATION SYSTEM SPECIFICATIONS Owner L _ _ Septic Tank Capacity / ga l ❑ NA Permit it O Septic Tank Manufacturer E r ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model _ pp ❑ NA Number of Public Facility Units ! NA Pump Tank Capacity gal ■ NA Estimated flow (average) gal/day Pump Tank Manufacturer i NA Design flow (peak), (Estimated x 1.5) O gal/day Pump Manufacturer N NA Soil Application Rate al /da /ft2 Pump Model ■ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit WNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ■ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L It In- Ground (gravity) ❑ In- Ground (Pressurized) Total Suspended Solids (TSS) 530 mg /L ■ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ j �. 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ MAINTENANCE SCHEDULE Service Event Service Frequency NA Inspect condition of tank(s) At least once every: ❑ month( (Maximum 3 years) 4 ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tan e ❑ NA ❑ month(s) (Maximum 3 years) ❑ A Inspect dispersal cell(s) At least once ` every: M year(s) Clean effluent filter S At least once every: ❑ month(s) NA ■ year(s) ❑ month(s) ! NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ' ❑ month(s) ! NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; 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 combined 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. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y3) or more of the tank volume,. the entire Servicing Operator b aSetae g r and disposed of in accordance with chapter NR 113, P contents of the tank shall be removed y p g , Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, Pretreatment units, and any servicing at intervals of 512 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. t. ~ Page �2' of 7/ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cellls). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) 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 cells. 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 properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly 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. ❑ 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. ❑ 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. ❑ 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 AND /OR 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 INSTALLER POWTS MAINTAINER Name — Name Phone s _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name I E -� Phone Phone - 3 - 4 1 2 & 3 Wisconsin Administrative Code. This document was drafted in compliance with chapter Comm 83.22(2)lb)11 fld► &lf) and 83.5 1 ). (f l 1, r - - a LO C K R I D G E G R I N D AL N A U E N ROBERT J. SCHMIT CHRISTIAN M. SANDE RICHARD A. LOCKRIDGE HEIDI M. DREWES- SILTON P. L. L. P. CHARLES N. NAUEN' GREGORY J. MYERS ATTORNEYS AT LAW H. THEODORE GRINDAL KATHERYN A. ANDRESEN HUGH V. PLUNKETT I I I MARTIN A. CARLSON W. JOSEPH BRUCKNER YVONNE M. FLAHERTY SUITE 2200 PATRICIA A. BLOODGOOD' RACHEL C. DELICH CHRISTOPHER K. SANDBERG DARLA JO BOGGS 100 WASHINGTON AVENUE SOUTH J.MICHAEL SCHWARTZ MATTHEW R. SALZWEDEL HARRY E HER MINNEAPOLIS, MINNESOTA 55401 -2179 A. GEN WILLIAM A. GLER GOVERNMENT RELATIONS TELEPHONE (612) 339 -6900 ERIC C. TOSTRUD DENNIS M. MCGRANN "' ROBERT K. SHELOUIST KATHLEEN K. MICHELETTI FACSIMILE (612) 339 -0981 HENRI G. MINETTE ALLYSON J. HARTLE GREGG M. FISHBEIN REBECCA K. KLETT SUSAN E. ELLINGSTAD RACHEL R. ZAGRABELNY SUITE 301 KAREN HANSON RIEBEL MARA B. HUMPHREY JAMES M. GENIA NORA C. STEWART 660 PENNSYLVANIA AVENUE, S.E. ALSO ADMITTED IN WISCONSIN ANDREW M. TANTILLO WASHINGTON, D.C. 20003-4335 JENNIFER A. SWEENEY OF COUNSEL t NON— TORNET LOSSriSTS TELEPHONE (202) 544 - 9840 DANIEL A. FARBER•* •• DIRECTOR Or F EDERAL PU-C AFFAIRS ELIZABETH A. SNELSON FACSIMILE (202) 544 -9850 KATHLEEN F. YOUNG MILDA K. HEDBLOM "AOMITTED IN WIS111-1. I.C. ONLY WWW.LOCKLAW.COM July 21, 2003 Father Jack Donahue 1145 West Eighth Street, #221 New Richmond, WI 54017 Re: Lease Agreement �� a 14 Wrx�� ) x a.- Dear Father Donahue: �� -� 4�_ Q '7 � A Enclosed please find one fully executed original and one copy o he Lease Agreement dated July 17, 2003 between yourself and Helene Houle concerning the ten acres of property you are leasing from Ms. Houle in St. Croix County, Wisconsin. If you have any questions please do not hesitate to contact me. Sincerely yours, LOCKRIDGE GRINML NAUEN P.L.L.P. j Harry E. la her HEG /ctj Enclosures 319809- 1 LEASE AGREEMENT THIS LEASE, made and entered into as of the 17 ch day of July, 2003 by and between HELENE A. HOULE (hereinafter referred to as "Landlord'), and FATHER JACK DONAHUE (hereinafter referred to as "Tenant "). WITNESSETH 1. Premises. 1.1 For and in consideration of the covenants, conditions, agreements and stipulations contained herein, Landlord hereby leases to the Tenant, and the Tenant hereby accepts from the Landlord approximately 10 acres of vacant land (the "Premises ") owned by Landlord located in St. Joseph Township, St. Croix County, Wisconsin, more particularly described in Exhibit A attached hereto. I I 2. Term and Option to Extend. 2.1 Initial Term The initial term ( "Initial Term ") of this Lease shall be for a period of ten (10) years commencing July 17, 2003 ( "Commencement Date ") and terminating July 16, 2013 unless sooner terminated as herein provided. 2.2 Renewal Term Conditioned upon the full performance of the terms, covenants and provisions herein contained, Tenant shall have the right to extend this Lease for one (1) additional term ( "Renewal Term ") of five (5) years following expiration of the Initial Term of this Lease by giving Landlord written notice of Tenant's election to renew this Lease at least six (6) months before the expiration of the Initial Term of this Lease. If Tenant does not so exercise his right to extend this Lease, this Lease shall terminate at the expiration of the Initial Term. The Renewal Term if any, n the same terms coven h y, be o e s ants and conditions as the Initial Term as set forth in the Lease, except: (i) Tenant shall not have the right to extend the Term of this Lease; and (ii) Rent shall be at the then current market rates. Landlord shall notify Tenant of the Rent for the Renewal Term within 30 days following Tenant's notice of Tenant's election to renew. As used herein, "Term" shall refer collectively to the Initial Term and the Renewal Term, if any. 2.3 Early Termination (a) Notwithstanding anything in this Lease to the contrary, this Lease shall automatically terminate without further action of the parties upon the death of Tenant. (b) Landlord shall have the right to terminate this Lease upon written notice to Tenant upon the occurrence of any of the following: (i) Tenant being placed in a assisted living or nursing home facility for a continuous period of six (6) months or more. In determining whether a period is continuous, stays within such a facility separated by ten (10) days or less shall be considered 319239-3 EXHIBIT A LEGAL DESCRIPTION The South ten (10) acres of the Southeast Quarter of the Northeast Quarter (SE 1/4 of NE 1/4), Section 21, Township 30 North, Range 19 West, St. Croix County, Wisconsin. 319239-3 14 IN WITNESS WHEREOF, the parties have executed this Lease as of the day and year first above written. TENANT: LANDLORD: Father Jack ona a Helene A. Houle Date: _ Date: --3" t z 3 319239-3 13 DOCUMENT NO. WARRANTY DEED��� _ KATHLEEN H. WALSH VOL 1401 r w[ 170 ST. REGISTER OF DEEDS 5T. CROIX CO. John T. Schottler and Georgine M. Schottler, Grantors, convey and RECEIVED FOR RECORD warrant to Helene A. Houle, Grantee, the following described real estate in St. Croix county, State of Wisconsin: 03 -02 -1999 10:30 AM WARRANTY DEED The Southeast Quarter of the Northeast Quarter (SEX of NEW of Section EXEMPT D Twenty -one (21), Township Thirty (30) North, Range Nineteen (19) West CERT COPY FEE: St. Croix County, Wisconsin. COPY FEE: 372.00 RECORDING FEE: 10.00 PAGES: 1 ............... NAME AND -fET[TRN ADDRESS S 52 3 � !30 !( 139 Ivey �a / /s, Svod 030 This is not homestead property. Parcel Identification Number (PIN) Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this ( day of rc 1999. (SEAL) 'r (SEAL) JOP T. Schottler (SEAL) (SEAL) Georg Abe M. Schottler RL7 IO:i ACKNOWLEDGMENT Signatures) CJp�h �• .�G.�b QM� STATE OF WISCONSIN ) �r y� ) ss . V i l l e Ll LEr COUNTY ) authenticated this L�day of _o Y`C 19a Personally came before me this day of 19 the above named John T. Schott er and Georgine M. Schottler to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY: Notary Public County, Wis. my-commission is permanent. (If not, expiration date: Stuart J. Krueger Rodli, Beskar, Boles & Krueger, S.C. ) P.O. Box 138 River Falls, WI 54022 1168 wisconsin Department of Commerce SOIL EVALUATION REP Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Ton Schmitt County AUach complete site plan on paper not less than 8% x 11 uncles in size. Plan mud St. Croix include, but not limited to: vertical and horizontal reference pond (BM), direction and Parcel I.D. percent slope, scale or dmrnshms, rant arrow, and location and distance to nearest road. Please print all information. Reviewed By Date Pen offal Wwmation you provide may be used for mcondary pwPow (PrW7r Law, s. 15.04(1) (m)). Property Owner Property Location Donahue, John Govt. Lot SE 1/4 NE 19 S 21 T 30 N R 19 W Property Owner's Mailing Address Lot # Btodc # I Subd. Name or CSM# 1145 W 8th St. I 10 Acre Parcel City State Zip Code Phone Number City Village ✓ Town Nearest Road New Richmond WI 1 54017 1 715 - 246 -4251 St.Joseph 60Th St. ✓ New Construction Use: ✓ Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Replacement Public or commercial - Describe: Parent material Glacial Ti11 Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.5 gpd/sgft rating. Possible system elevation for Area I is 94.0' a Boring # s oft fie Pit in. Sall Application Rabe Pit Ground Surface elev. 98.42 R. Depth to limiting factor Horizon Depth Dominant Color Redox DescrOw Texture Struckm Consisterm Boundary Roots GPD/le in. Munsett Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-11 10yr3/3 none I 2csbk mfr gs 2f .5 .8 2 11 -20 10yr5/3 none sl 2csbk mfr gw If .5 .9 3 2G-39 10yr4/6 none sl l csbk mfr gw ----- .4 .6 4 39-90 7.5yr4/6 none grsl 2msbk mfr --- --- .5 .9 Ong # Boring ✓ Pit Ground Surface elev. 98.12 ft. Depth to limiting factor +89 in. Sou Application Rate Horizon Depth Dominard Color Redox Description Texture Structure Consistence Bomdary Roots MR in. Munsd Qu. Sz. Cord. Color Gr. Sz. Sh. - E - E 1 0-7 10yr313 none sl 2csbk mfr Cs 2f .5 .9 2 7 -21 10yr4/3 none st lcsbk mfr gw If .4 .6 3 21-48 7.5yr4/4 none sl 2msbk mfr I gw ---- -- .5 .9 4 48-89 5yr414 none grsl 2msbk mfr -- -- .5 .9 Effluent #1 = SOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ^ Signature: CST Number Thomas J. Schmitt ,._, ,, 227429 Address Tan Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 7129/03 715-247 -2941 p over Donahue, o Donahue, John • ParceliD # Page 2 of 3 ` 1 Boring # gorin ✓ Pit Ground Surface elev. 95.37 ft. Depth to limiting factor +90 in. Sol gpolcallon Rate Horizon Depth Dominant Color Redox Description Texture Sinxsure CArsistemca Boundary Roots 'Efr#1 'Eff#2 in. Munsed Qu. Sz. Cont Color Gr. Sz. Sh. 1 0-13 10yr3/3 none 1 2msbk mfr CIS 2f .5 .8 2 13-28 10yr4/3 none sil 2msbk mfr gar 1f .5 .8 3 28-58 10yr5/4 none sl 2msbk mfr gw — .5 .9 4 5690 7.5yr4/4 none grsl 2msbk mfr — ---- .5 .9 Boring # Bones Pit Ground Surface elev. R Depth to limiting factor in. Application Rate Horizon NO Dominant Color Redox Dw a;t7a, Texture Str chn Consbterm Boundary Roots GPDffe in. Munsd Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 'Eft#2 F-I Boring Boring # Pit Ground Surface elev. R Depth to limiting factor in. Sol gpOk2fiDn Rate Horizon NO Dominant Colo Redox Description Texture Structure Consistence Boundary Roots in. Muffed Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg& • Effluent #2 = 800 S.30 mglL and TSS -S.30 mglL The Department of Commerce is an equal opportunity service provider and employer. Ifyou need assistance to access services or nnn,1 m. viol i" on olf~nofn fi—h s•Is.ocn iv+-#-4 #; iinnorl+nw+1 of Ang-' !•!_1 / i 1 — IJIA_ 11.A_fr'7'77 7,f- ♦ Ali 6M= UlGiniS/ 1 � t r 9� Q'� X39 i �r r..t p A t - 'T.?oni /1/ tY'.f' < < l_