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HomeMy WebLinkAbout020-1413-10-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORM~rTION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Sienna Cor Hudson Townshi CST BM EI v: Insp. BM Elev: BM Description: ^• cra~~ 2S,' 7 S ~? TANK INFORM~1•ION TYPE MANUFACTURER CAPACITY Septic ~ ~~ ~ Z 5D Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ C 1 ~ ~ oe g ` 1 .----- Dosing Aeration Holding l ~--~~' PUMP/SIPHON INFORMATION Manufacturer mand GP Model Number TDH Lift Fri n Loss System Head TDH Ft Forcemai Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM(- D ) ('X~NwI'.~ars /~f•rtuG1. ELEVATION DATA county: St. Croix Sanitary Permit No: 420748 0 State Plan ID No: ~ -' Parcel Tax No: 020-1413-10-000 SectionlTown/RangelMap No: 20.29.19.2599 STATION BS HI FS ELEV. Benchmar ? `~•(oa o3 • q ~` z~ Alt. M Bldg. Sewer ~ I ,D ~ t' SUHt Inlet ~ SUHtOutlet ~,~~ S Ot Dt Inlet Dt Bottom Header/Man. S Bot. System Final Grade St Cover 2.~0 6b 9S' REN Width ~ Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~Z •~ SETBACK INFORMATION SYSTEM TO P/L LDG WELL LAKE/STREAM LEACHING CHA OR Man facJ+fr ~ - ~~ ~ 4( Type Of System: ~. `w`. ~.I'~ c ~ ~ ~ ~ 03 c ~ `~ ,--- UNIT ~"~ r v Model Number: ' ~~ r DISTRIBUTION SYSTEM Header/Manifol ~, Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) ~ ' C~ Length Dia Leng Dia 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 U No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1~,,~~~3. Inspection #2: T'T"' Location: 791 Martin Ave Hudson,WID~54016 (SE 1/4 SW 1/4 20 T29N R1 The :20.29.1 1.) Alt BM Description = ~j ,?`. N•o...h~~- tle~>'4/•, ~~ ~~ S R t ~^ 2.) Bldg sewer length = 8'~ ~ `~S'.c>~ ~ 8~g5 °~ .~J ~ ~~"v - amount of cover = '~Z,~f y ~„ p.~^"""~ 9y.•.~~ _ (~ ~ S~~ ,0,~{S: ' S 3 •~{O~ 5 3) 5~~~w~+A~6 .+•~.\w•W p__sw±~ ~{,N`:.. 5' :93.03 ~ ~_ i i Plan erosion equire ~. ;Yes No Use other side for additional information. • Z ~ _ ___ C ,t3~ a~ ._ BQ-67 0 (R.3/97) to Insepctor's Signature Cert. No. ~~J~, +~.,,,~ ,,,,,,SQ 3 •~[ ~ ~ ~ c.•l~CC.~.S E S off dom.. ~ ~~q ~*~..0.~~-~~w~ . ~sl~.. ~.. o • z sus, g~~~ fie. SI„~k ~.r ct~plralc. ka,«ak~ Safety and Ylutldtngs Utvtston t;ounty ~ ~~ ~ ,~ „~ 201 W, Wasttingtott Ave„ P.O, Box 7162 Ya t /[ -3 ~~~~~~I~ Madison, VVt 5370? - 7162 Address ue ©e artrn~n of Commerce n Sanitary Permit Agplication sanitary ~o i N g r Ia accord with Comm 83.21. Wis. Adm. Code, potaomal information you provide ^ Cbeck if Revision au be rased for ses Priv I. Application Ynfortnation -Please Print All Iafa an Stara Piaa LA. Number Property owner's Name MAR 1 8 2 0 0 3 Parcel Number S~~e ti C v o2~ - i - o - arov . ~ °1 Property Owner's Mailing S T. C R O I X C O U N 1- Y Property Location ~ ZONING OFFICE y~YQ ~, 1l~;cJ ~/ ~ ~ `7`G l ~ <cI ~k • S d' T N R / Gity, Starr Zip Cade Phone Number Lot Num Block u bcr Subdivis a Name CSM Number ~d,;~d ~s `/ ~ T ~ ~,~,~ II: Type of Btu'Iding {check all that apply) a. ~ sw~ Yw: ~. ^City ~ 1 or 2 Family Dwelling -Number of $edraoms ~1Village II ^ PubliclCommercial - Descn'be Use ~ownsltip /¢7~~~_S'GA/ t ^ State Owned Nearest Road ]'II. Type of Pertttit: {Check only one box oa line A (ntumbering scheme fur internal use). Complete line B iP applicable) A' 1 ~ New 2 ^ Repiacetrient System 3 ^ Replacement of G ^ 'Addition to Fox County use S stem ,Tanis Onl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Cheep all that apply}{numbering scheme is for internal use} . ___ _ .. 44 J~NOn -Prossurized In-Ground 21^ Mound 47 ^ Sand Filter SD ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ HoIdsng Tank 48 ^ Single Pass 51 ^ Drip Line ~ 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ther ~ v. D' rsal/Treatt nent Area Infortnati oa: 3" G .v s 30 Design Flow (gpd) Dispersal Area Dispersal Area Soil Applicadan Perc orlon Ra System Elc lion Final Grade Required Proposedy;~ Rate(Ga1s./DayslSq.Fe.) t'M~.'U-ci-) Elevation ~ woe ~s7 ~ 8s~ ~3~> ~ ~ ~~ ~~~ 6 ~ 9~ ~~~ 1 VI, Tank Info Capacity in .Total Number Manufacturer Pre a Steel Piber Plastic Galioas Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tsnka 5epds or Holding Tank v 1~~--~ ~ ~~ ~ y Dosing Chamber VII. Responsfbility Statement- I, rite uadcrsipted, assume respoasibWty for iastallatiaa of the POWTS shawa oa the attached plena. Plumber's Namo (Print) Plumber's Signature PRS Number Business Phone Number Plumber's Address (Street, City. Stara. lap Code} 1~7cf .~'co ~ ~°c .~0~ l VIII. Coun IDe artmeat Use 0 Approved ^ Disa roved ~ S~nrY Permit Fec {iaeludes Groundwater Data Issued Issuing Agent Signautre {No Stamps) Surcharge Fee) ^ Owner Oivea Initial Adverse ~~.. ~ ~ ?~3 - De rminedoa oaditigns~at~APproval/Reasons for preagp_rp IX C ~ ~ ~--* /~ . a~~vvCe~o' t ~ v ~ ~ o.~ . n o S¢ @a-~d~ ~unt~-n7 ~- ~ LQ /1 ~C,~ , i o,, ~~,,a,~ Attach pieta pleas to the C V o¢yy ror flu paper net less rhea 81/2 s u taehas m else °~j SBD-6398 (R. 05!41) f ~~~ `~ 5ca~~ ~ '^ y4 ` 1~h~,2 SOD'- 87 ~~ ~ ~. ~~ -.~ ~- r ~ ~ \~.V~ ~ ~~ • \~ Sys s-- ~ ~ r 3~ d~~~ ~~ r~.. J~~ ~~~ g'K~2 s.~.,~~ ~`~ I \1`~ ~ ~~ •v J `~ 5ca~l~ ~ `~ yQ ~- qs-~ S .~ 5 ' 4 ~ ~ 4i, `~3~ ~ ~' ~r ~- a~ ~~a~ y 4. ~~~ x ~ ~~ ~ ~~ r~ ~ ~ ~g . r~- VLF ~~~ 8'k~Z S.k y~/ s`E t~ ~e ~~~ ~, ~~~~s •v Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in aaordance with Cornm 85, Wis. Adm. Gode Attach complete site plan on paper not less than 8!g x 11 inches in size. Plan must County include,. but not limited to: vertical and horizontal reference point (BM}, direction and Parcel t:D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print a-l irefonr-ation. Personal. mfom~ation you prove may be used for Lmd, s. 5.(14 (1) (m)l. ~~ Property Owner operty Location St. Croix 1073 Page 1 of 3 Steel Soil Service Sienna Corporation vt. Lot SE 1/4 NW 1f4 S 20 T 29 N R I9 W Property Owner's MaTng Address ~ ~~ `~ 6 200 L Block # Subd. Name or CSM# 4940 ~Iking Dr. Suite 608 5 na The Glen UN"f Y City ~c~iQ~( state Z' Cade~Ph6ii~~r~r~lCE <> City Vdlage Town t~arestRoad MRI 5 3 z R ~- 8 Hudson Carmichael Rd: ~~ New Constructi~ Use: /: Residential !Number of bedrooms 4 Code derived design flow rate 600. GPD Replacement Public or corr-mereial -Describer Parent material Pitted outwash Flood plain elevation, i# applicalsle na General comments d d~i t S l #i 95 6 h - d ~ d 3 50ft b k n ~"'`a'r`/ ~ an reaxnmen ons: em e ys eva on . es spaced and 5ft tenc ~ iwgra _ e . e depth tQ e~ Q Boring # Boring ~ /. ~n Ground Surface elev. 99.15 ft: in. pepth to limning factor Sod Application Rate Horizon Depth. Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz *Eff#1 *Eff#2 1 0-6 t0yr3/3 none sit 2msblE mfr gw 1c .5 .8 2 6-19 10yr4/4 none sicl 2msbk mft gw 1f .4 .6 3 19-26 7.5yr4/4 none sf 2msbk mfr cs na .5 .9 4 26-96~' 7.5yr4<6 none ~ osg ml na na ~ / .7 J 4.2 ~~ ~ 2 <,~g~ ^ B~utg # Boring. 1 ~2 Pit Ground Surface elev. 99.15 ft. in. Depth to limning factor Sod Application Rate Horizon Depth Donir~arrtDolor Redox Description Texture Structure Gorrsistenee boundary Roots GPI~#t? *Eff#1 *Eff#2 1 0-6 10y~3/S none sl 2msbk mft cs 1e .5 .9 2 6-28 7.5yr4/6 none ms osg ml cs 1f _7 1.2 3 28-107 7.5yr4f4 none cos osg mvfr ns na r~ 1.6 (OD ~/0.21~/LU S 5 ~l'k Gl tttiuent ~~ = i3oD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS< 30 mg/L and TSS <30 mg/L CST Name (Please Print} S' nature: CST Number David J_ Steel ~ 248956 Address Steel Soil Service ~ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/16/2002 715-246-5085 /5 ' Property Owner Sienna Corporation Parcel ID # pending Q ~~# !Boring J4 Z5 ft th fo D timin factor 96 . . ly. Pit Ground Surface elev. ep g in. Horizon Depth Dominant Cotor Redox Description Texture Structure Consistence Boundary 1 1114 1Qyr3/3 ooce sit. 2msbk mfr. guv 2 14-39 10yr4/4 none sl 2msbk mfr cs 3 39-96 7.5yr4l6 none ms ~- osg ml ns j~~~~~ ~j / Y ~ w~~ , - ~(,L/ d ~}6 LC G~~2~L~4~ 96, 2s. ~~`~~~ ti Page 2 of 3 Sod Application Rate :Dots GPD/ft' •Eff#1 *Eff#2 1 c .5 .8 1f -5 .9 na U 1.2 B~xina # -Boring - - -- - - 'Effluent #1 = BOD 5> 30 < 220 mgiL and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS <330 mg/L "Ft~ u~.t~-!^^ri's± o€Coxc~ is a$ ec}~at ~portt~ril~ s~i~ grouider a~ ~nplayer_ t€youneed assista~e to aEe~ss services or Boring ~ Boring - - - - - - - Page 3 of 3 STEEL' ~ SOIL. SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 L1C. # 248956 SE1/4,NW1/4,S 20,T29,R19W (715) 246-6200 Town- ofHud.son, St: Croi~c: CQ. (715)-246-5085 The Glen lot 5 This soit evaluation was=eend~te~ to satisfy a zoning retirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established=at the time the seif test was eonduet€d: Eegend 1" = 40' t =Benchmark El: 108:~OFt Top of '/z" pvc pipe s =~41t Benchmark E1:100,~7Ft Top of 1/z" pvc pipe r~ =Borings Boring Elevations Bt =99.15Ft B2 =99.15Ft B3 =94:25Ft B4 =OO.OOFt N i~~~~~ / / ~ I f ' , • -~ 54 ,: . ;' , - ,r , i ~~ i _ 5 • 3 a i -_ `. ,_ ., . _- ,i- .~ r ~_ _. .. f '•, -- - - , - I r , :. • 'r ~ ~ 1 ~ 1~ ~ ,~~+7 i `, / / '~- S 417 ,~ ~`i~~a .. , ~ , ~ / ~ :. t X84_ i - ~ t , s • ~S~ ' ~- - - - . ;;CC I pp~~ r - .` • • r r _^`\1 _ 8~- I 83 ;~ ~ ~+ ; 1, ~ ~ ~ 'I , '1 ' . ' _ , _. . ~ 1 ._ 1 ! ~ ~ ~~-.d 0811 - 'i Yfl \l~8'- r' i , 1 : ,_ .... ~~. .~ t 1. i ,. 1- -. r ~s• ,` 5 _ .. - -~' ` ...~ • ~ I ~' 1' lire ~` -Qwr J l,- ~. J r. _ , •, .. _._ :, A ~- .. ~ .„ r 1 ~ ,. __ ~,,'11~ r~, 11~~r rte- \ `\._ _ '.7~A f ;F. a~ +'~/ ~i'M ~~`.. ~.. ill tl .~ ,SaSrr ~' .1 ':y._. • '. .._, I ~ ~ ~ r' 1 i 1 ` ._" .: \1 ~~ ffir• - ., ~• . \\z ; 4 I ', ~ . rr r 11\ ;- 3 _ 96 i. 1 ,. _ .r, r , ,~ , . 5 III I . ~ 1~ •~.. :' ~ ,. ,, -' . I~.~ • c ~ - e 1 ~.., ~. , _.. - ~ • 1-'.. .. _..... ~ ~~ ~--. ~' - a •~ ~. ..` Y . \ .... _. ._. . ~~ N l ~. ~~ . .. --_.. _. _.-_ ~ 1/V~+. ."., ~'. O• ~ ~ I 1\\ `.~\ ~ ` \ I ~ 1\l l {.ice v 3~7 l~T. . I ' . .... i i _~ ,.. ..- ,, ,. _ '~ ...,. r n' .., ,~. , .a7 • s - t r .. f ~ I ~ }\ ,1' 1 ' ~. '~ ~ ~.'~ ~'. 233 _ ~ r ' __ .~ t .1 1 c \ r.. .~ yM~ i A 1 v 1•. ~ 1 1 ~~: t..' .. '- t r r / ~ ' 1 1' i n. '~'t.. > 7 /mar 1. ~r r ~ -. ~ ~_ 1. r, 1 - p~'N: I r. I1 ~~ ~ e..' I.`, \ ~ I1 kl a r. ~--- \ t,. l \1 ! fr. : .'~iin r f 11' t 1 ~-. 11. ;,a11 ,/~''1j it +~,~ rc \ ,i et • t 1 ~ .i7 ," \\ `,'~ 2~ lip ~!F_`~ i ~ ` r ;+S t ' I - 1 ~ • lti r: ~i ~ ~ ; \ r; ,, ~ , .. . ,. -- ~ 1,,;; , . 111 ,', ;1 , µ `, ,;~t1__ 4 t ~ +~ r i ~' 11 I ~. 1 t-. ~ ~. 4.c~4 ~'~ -.L 411 1 \ '•` li \ \~- 1 l \\, - `' _ \ • 1 f (~)~ : ~7 ~ ~ ~i ''111 1 ~ .1 111 ~. ~ ; (' ~ i 1 .413 ~ 1 /-.Inh' 1 ~ , ~ ~ i ~ . 1.. r. 1:1_ ~ 1 -~ ' ') iV y 1 r ~ lr i ~: 1 9 ~ ~ ~ - - art:`: ~ r ,~ . , _ _ .~~ _. Z~. ~: - - Private Onsite Wastewater Treatment System Management Pian Septic Tank And Gravity In•Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include infom~ation and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the fn-Ground Soil Absorption Component Manuai for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanita Permit Number o Number of Bedrooms Design Fiow -Peak ( pd) Estimated Fiow - Avera a (gpd} cn~ Septic Tank Capacity ( al) 2s-D Soil Absorption Component Size (ftz) SSA T e of Wastewater Domestic Table 2: Soli Absorption Component -Limits of Reliable operation Septic Tank Com onent Soii Absorption. Component Desi n Flow -Peak ( pd) 12~ q33 Maximum Influent Particle Size {in) 118 Maximum BODa (m /L) 220 Maximum TSS (m /L 150 Table 3: Maintenance Schedule Se tic Tank inspect and/or service once every 3 ears Outlet Filter Inspect once a year and clean at least once every 3 years Soil Abso Lion Component Inspect once every 3 ears $eptlc Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease -' interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se and outlet filter shall be assessed at least once every 3 years by inspection. The utlet filte shall be cleaned as necessary to ensure proper operation. The filter cartridge shou not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Mar'ta~ement plan for a Septic 7ari~ ~*d So': Acs~rptiflr~ Compansrtt ,filter !$ equipped with art alarm, the filter aha1E be serv-red It ih® alarm ~s activated ~ntir~vausiy. intrf~r~zilttertt inter alarnta may lndirate surer ilowa or an Irnp~mdinQ c~nt'nuaus alarm. Tho saptlo tank :hall have Its oont•rste removed wi'-en fhe v~oiurrrfee of scum and sludge irs the tank exoeede t./3 the liqufd vofttrne of the tank, I! the vantertts ~ tho tank aro not removed at the tlrM of an a,~saasmant, m3lntanance personrr~ai shelf advise the owner of urban the nr~xt service needs to be pe~'ortned tv maintain leas than maximum acorn and sludge accumuhtJon in the tank. Manhole risers, accsas risers and oovera ef~auld be Inspected !or water tlghtrteas end 64undneaa. ~oes$ opfnirlga used !qr slrlrlp :ttd easawmortt st»ll ba waled t+V~taht upon thi rompletlc~i of servis~. Any openln$ demtned ~cc~aaund, dafact#ve, ar aub~ot to ffsi~tr9a rrsust be repia~ad. , Exposed access oponinas greater than ~-inches to dlam~er' et~l1 be secured t,y, an efieCtfve locking dsvloi to prevent aocldentsi or unauthorised entry ir-to the qnk. rwo one a~hoatd tni~ar s sep!!c or odrar trwanent or l~oldMg~ ernk !~ any mason wnhoyt befr,~ in ~1i' eompltsnoe w!!h o~ +sfenal~+da ~-or ur~rl~ a oonlMad spsoa. The ~rtmo~p!»1~- wt~ln tea ~ a~ oflter lit c-f h~ ~,y,ea~lt~n ; end nec,~r at a ~ f~. ~a~~ o~~,. asp niyb~ d+-n a l~»posalb~i. Tank abartdorament shall be fn aooordance wtdt Comm 43.33, wla. Adm. Cade whery the tank Is no fort' used as a feOVtITB campon+trtt. The soil absorption compQnertt sacvlnQ this structure is d®signed to accept dame~stio wastewater from a rasidentiarl taciifiy. The Limit: a! open~on of thfs component are shown Irt Table 2. " longevity Q# a sot! absorption Component depend: preatiy on proper and timely rrtaintertariae, and sy use within or belew tf'ta ffmlta of nllebie operation, ~aod water ConaeNatlC~1 practises by ail oc~s:panta and the ir~tailetfort of water conserti+lnp piumbina f'Ixtur~c ar+~ ley iac~ors In extending tna ualtui life oitltls oampor~t~ 'The ao11 absorption ~mportent`s opsradon moat bt ~tssaased by lnsg~,c~on at keast 4t1g9 every three yeara~, Thi ins.pe~lon shall fnafude ncorsiing the fevele of pondlnQ, if any, in the ~a~rz pipes, attd a visual fnapetel0~ft !or any evidence of surlat~ se®paye or discharge frc~rrt tf~e oorrtport~trtt. tan steeply elopinji sites. era of ereslan shoufd be identitted ar+d nsport+rd i+o thwr owner for repair. The eurfaa discharge of domestic wastewater or aewade from ttte ,system le prohibited and considered a hur~n health hoard, Traffic around of over the sol! ebsarption component should be e~volded partlcuiet`ly during winter rtanths, The campacdon or removal of snow saver over the oor±tponerzt Wray lead to hydraulic lailun by freeting. Th1a type o! ialfurs la usually tsmpanry, but l: dlf<lcult or fmpossible t0 repair until weather cor'iditlot'te fmprave. f n perleraf, sQti rompactian over this cortitportent will redus~ diffusion of oxygen Into the soli end dispersal all, which may lead ~ m~e lntsnse, and earlier, organic clogging o! the sell. 7. Manargrmrnt Pian fora Septic lank and $oll Absorption Camponrnt Piarntin8a of deep-rooted iraas and shrc~be dlractly aver of w#t~in ten fsrt at thr component should be avoided winos root Intruaian into the campnnen# may aiastruct watta+aatsr slow. CaMingency Plan In the svsni of system hiiure, a Haar syatem could be Inzta#ied in an alto area. V11ith the ir~otatilatian of a divarrtsr vaiva, tF+a arxisting aystem could alas ba reward after a period of three tc i'our years. it iu the property owners rsspansituiity to maintain the alternate use froa from any piantlnq of treri, shruba, rtc. in case of fallurs of the oripina! ayetrm, thr altrrnsta arse wilt br na~drd. lr any trees, ahn~bs, etc. have been plantar! on the atterltata sraw, thry wlii hams to br rwriovrd at property ow+~rs rxpsnsr. l# attarn'rate erne is destrayard, therr a!s othrr a4armatlve systamar that can bs us~rl, In whlc#~, oouid rssr~t irr arched axp+u+sa t4 +.hr property ownrr, Any tank ab+t,ndanmsnt eha14 be one in accordance wish Wfec. Cody 83.33. ~+ queations ngardk~ Chia ands, plaaa oontaot your lanai Zoning Q~1ior or contact the fnataltinp plumber, Sc~,w»rA op1lE,..,r~, ~1. ~.e~, ~ e arcs ~ Z 1 s`) 3 $ !w' 3 4 ~ Z aT cttonc co ~ a>~rrr SEPTIC TALK AND OWNERSHIP ~~GATION FORM owuerisuya Sr~I~A ~' ~e~°e~-n o --~ MAiling Address ~ V (K fit.) ~ 2: .SU l i~ ~O ~ D -J /`~1 /~-J ~3 S Pmporty Address ,/ ~'~ (ycrlfiutioa required from Plana,img Dop~eat for new ~aasttncdon) /` G~tylStato la~/DSo~ (~t/~ Parcel Identification Number . ~ Z,E,GAL FS f 2 0 2~ N~R~~w• Town of {-l (/D~S~ nI property Location '/., ,~ %,, Sec. . T ~, Subdivisioa ^ ~~E Lot # ~ ~• Certified Survey Map # Volume _ -~ Page # warr>znty Deed # _ (y (o~•~-D.~O ,Volume '~ Page # T 3 Z,ot lines identifiable ~ yes ^ no Spec house ~ yes Q no SY~'t'g11'f MA.INI'E~~ true: failtrrc to handlewastes. Pzvpumarnteaaaa Improper rue end mainxaaaae of your stpdc system could tcailt i>i its perms QVhat You yett into tfu ryeum oor6iSta of pttmpittg out the ceptiC fink t;very these yt~ or eooacr, ~ o,cedod by a licoaccd pumper- sa affect the fuac,•tioa of the septic task u a o~eatment stage is ~ avaSte disposal ayst~ Tie prvputy owacr a to enbozit to S`t. droiu ?.vnia~ DcpartmeAt a cerri5cation fotns. eiP~a4 by tluu ot~ and by a E~ lesmba or a licanaed permpar ~~ t6st (1) the an~itc an4stcwatac dispose ~m m~p~JoumayrnanPtumbu~ rea~rictodp ~ ~ p~ opQating arodidoe atsd/or (2) attcr~asptxb+o~u aced PympisC (;i~eeecsary). tare septic ads is less than 1!3 fell of al Vac. t>,o eradorsi~ed hsve read theat~we: seQv~~ set fotttt here:ul, as ect by the Dcpu~-ent of Commc s~ ttta septic sysum bocn ma~ dart_af f~(c thnc Y~ ~~date. eau sewage disposal fY°~ nth tbs a~r~ ~} sgcne-to nsaintain ttie Dn ~, Certifiatioa and tho Dtpattment of Natural 8 eaourres„ Slue of WiscooaOf'&cc ~~ 30 be comq,Ictcd and returned to the Sti (~oix Cotmty Zoning 'iVA.FiVl~ that all s ats o Chic forth arc true to thy: txst oC>nY (o~) knowkdgo. abov a evarranty dad rocordcd in R,egiatu of Deeds Oftiee. DAB l (~) am (ere) rho owaer(c) of r ATB u.v. ~• t boiag revoked by -tbt?Aaia6 Dep~~- •••••• •••••• Aay informatis~ is mss-eeptatented racy result 9n the tsaieuY P~tm .. tkatlon: a wamaty decd fromtlse llegictet: of ikcdsr office Ireetudt ~vitb this app `tBL~°'d ma if P~fa'orux it tttade iA the wazzsnry deed a copy of the ccrt{fiad ctuvey P TOTRL P.02 I • STATE; BAR OF WiSCONSiN FORM ! - 1998 • WARR''jAQNT]Y DEED Doctmarrt NtanptV t VP~. ~ I J 1 PA,[ 613 This~ecd.rnadeDetwccn' Bane Corporatiott, _ ....__ a Minnesota corporation ..... __ .,... _,._.. _ ._~, Grantor. anA Sienna Corporation. a llipn@@Q a corporation ,__,., ____ _.. . .... .._ . _.. ....... Grantee, Grantor. for a valuable conslderadon, conveys to Grantee the following ) dcsu'ibcd rul tsuu lr, St _ Croix _ County Stste of Wisconsin ) (the 'Property'): . See Attached Exhibit A ~• +~ 666050 KATHLEEN H. WALSH REGI87Ek OF DEEDS ST. CROIx CO., WI RECEIVER FOR RECORD 12-21-2001 3:10 PN iNIRkBNTY DEED ~T CWY FEE: COPY FEE: TRRASFER FEE; 9A63.10 RECORDING FEE: 17.00 6A6ES: / fircn<a.+q Aran .....r.. . -.... .. __ .... _. .._.__..:._. Nprty anti Ratrn Addrasc U ~i~r~tl - ~~ 5~~ 5 me+ar~'i ~~ ~ Sui-t~. col ' I~litilne ~o~nka ~u553~ 20-1048-30-000 Parcel IdeNiat:alidt IJUntbar (Pfd) Thu is not homestead properly. (13) (lx nol) zo-lo4s-bo-ooo 20-1048-90-000 20-1049-90-000 20-1050-00-000 20-1050-80-000 20-1052-20-000 20-1052-70-000 Togemer with au ap}wrtenant rights, Utle and Interests. Grantor warrants that the utle to the Properly Is good. InJcfeasu>!e in fee simple and hee and clear of autunbrarxes except See Attached Exhibit B. Dated t>U: 20th - ` day ~ December _ 2001 Baas • r oration (SEAL) by o M. Nassef _ Its of Executive Offi (SEAL) AUTHENTICATION ii Slgruture(s) ~I it _____. _ _..., I' auttxnucatcd this _. , o,ty of i ~~ TITLE: MEMBER S?A1E BAR OF WISCONSIN ~~! (Ir mt. i - `~ ~{ authorized by §706.06. Wis. StauJ 0 (SEAL) (SEAL) ACKNOWLEDGMENT Minaasoca State ofiNt'sta7nciff- as. Persorwlly carne t,eftxe me this ~~. day of December - _ 2001 , rise above ttameti John M. Nasaeff, Chief Executiv_e,OEficer -of Bane Corporation, a Minnec•ot_a corporation me tuwwn to be pC~ wlw exccutMt the forepoLlg irulntment and .~wY same. ,~ TwS INSMUMCNT WAS DRAFTED 8~ "' HAARY E. GALLAFtER II Lockridge Grindal Law P'irm \~ ta'0011m01~N"~ II inn Wa c h i r,,~,_ Av anue_S ntl t h- • .,~ ~I Minneapolis, MN 55401 No• Publtc,StateotWlsconstn ... _ .. y commitUOn Ls pennancnt. (If not. sr.re .xpir,titm dau• i'~ (Sty~atwns stay br autrwtncated w~ xknawledQed~ Both an nut Jsnuary 31 .. , 2005 .) ;, ~~) 't . _ . _.~_ ,._r~.,_ ----- --- . ,.. _~ _ ~~ • N.nr, W pe-aa ugnuyt ut anY up•cxy rraot e. ..._ .. ........ ~ ~_.:...- ryry'A p Jr4dal 4rlw' tA.w .gtirer~rt< (I WARRANTY GEED STATE. aAR Of WISCONSIN wpwnwt ~ Ay,y Qo„ vK, POAM No. 1 - 199f Mwvatwa., wr.. Y~~. ~ 797PA~f ~j.14 File No: 85-04900 EXHIBIT "A" A parcel of land in the Northeast Quarter of the Northwest Quarter, in the Northwest Quarter of the Northeast Quarter, in the Southeast Quarter of the Northwest Quarter, in the Southwest Quarter of the Northeast Quarter, in the Northeast Quarter of the Southwest Quarter, in the Northwest Quarter of the southeast Quarter, in the Southeast Quarter of the Southwest Quarter and in the Southwest Quarter of the Southeast Quarter, all in Section 20, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin, rgore fully dc,Cribed as follows: Commencing at the west Quarter Corner of said Section 20; thence North 89 degrees 25 minucea 02 seconds Easc, assumed bearing along the East-West Quarter line, a distance of 1319.52 feet to the paint of beginning also being the aouchwest corner of the Southeast Quarter of the Northwest Quarter; thence North 00 degrees 36 minutes 14 seconds west, along the west line of said Southeast Quarter of the Northwest Quarter and Northeast Quarter of the Northwest Quarter, a distance of 1325.15 feet to thQ southerly right•of-way line of the Chicago-NOrthwesCezn Railroad; thence North 79 degrees 56 minutes 29 seconds East, along said southerly righC-of•way, a distance of 451.00 feet; thence northeasterly a distance of 807.03 feet, along said southerly right•of-way, along a tangential Curve, Concave to the northwest, having a central angle of 09 degrees 54 minutes 03 seconds and a radius of 4670.25 feet; thence North 70 degrees OZ minutes 26 seconds East, along said southerly right-of-way, a distance of 429.09 feet; thonce northeasterly a distance of 445.52 feet, along said southerly right-of-way, along a tangential curve, concave to the southeast, having a central angle of 14 degrees 30 minutes 21 seconds and a radius of 1759.75 feet; thence North B4 degrees 32 minutes 47 seeond~ East, along said southerly right•of•way, a distance of 7.57 feet to the west line of Certified Survey Map in volume 12, Page 3302; thence South, along said west line, a distance of 703.32 feet to tho south line of said Certified Survey Map in volume 12, Paqe 3302; thence Easc, along said south line, a distance of 593.00 feet to the east line of the Southwest QuartQr o£ the Northeast Quarter; thence South 00 degrees 26 minutes 06 seconds East, along said east line, a distance of 1127.21 feet to the southeast corner Of said Southwest Quarter of the Northeast Quarter; thonce South 00 degrees 26 minutes 55 seconds East, along the east line of said Northwest Quarter of the Southeast QuartQr, a distance of 191.71 feet to the north line of Certified Survey Map in Volume 15, Page 4172; thence South 89 degrees 37 minutes 27 Seconds west, along the north lines of Certified survey Map in volumQ 15, Page 4172, and Certified Survey Map in volume 15, Page 4173, a distance of 1113.42 feet to the west line of Certified Survey Map in volume 15, ?age 4173] thence South 32 degrees 43 minutes 57 seconds East, along said west line and its southerly extension, a distance of 591.64 feet; thence South 07 degrees 13 minutes 18 seconds East a distance of 323.01 Feetr thence South 08 degrees 41 minutes 11 seconds East a distance of 413.63 feet; thence South 08 degrees 43 minutes 31 seconds East a distance of 229.88 feet to the north line of Certified Survey Map in volumQ 11, Page 31?8; thence North 89 degrees 52 ~Rinutcs 10 seconds West, along the north lines of Certified Survey Map in Volume 11, Page 3128 and of Certified Survey Map in volume 1Z, Paqe 3292, a distance of 68?.86 feet to the northwest corner of certified Survey Map in V01. ~ ~7~PAf,E ()~ 5 Volume 12, Page 3292; thence North O1 degree 24 minutes 30 seconds East, along the northerly extension of the west line of Certified Survey Map fn Volume 12, Page 3292, a distance of 5.66 feet to thQ easterly extension of the north line of parcel recorded in Volume 1390, Paqe 163; then South 89 degrees 30 minutes 27 seconds west, along the easterly extension and the north line of parcel zecorded in Volume 1390, Page 163 and the north line of Certified Survey Map in Volume 3, Paqe 776, a distance of 508.92 feet; thence North 00 degrees 07 minutes 56 seconds East a distance of 1003.x7 feet; thence North 89 degrees 54 minutes 15 seconds west a distance of 270.16 feet to the west line of Certified Survey Map in Volume 5, Paqe 1317; thence South QO degrees Z7 minutes 53 seconds East, along said west line, a distance of 193.97 feet; thence South 89 degrees 16 minutes 33 seconds West, a distance of 533.93 feet to the west line of the Northeast Quarter of the Southwest Quarter; thence North 00 degrees 36 minutes 14 seconds west, along said west line, a distance of 820.23 feet to the point of beginning. ,, . von 17~)7~~~t 6:I 6 Exhibit B to Warranty Deed dated December S0, 2001 by and between Bane Corporation ("Grantor") and Sienna Corporation ("Grantee") 1. Building and zoning laws, ordinances, State and Federal regulations; ~ 2. Restrictions relating to the use or improvement of the premises without effective forfeiture provision; 3. Reservation of any minerals or mineral rights to the State of Wisconsin; 4. Utility, drainage and roadway easements which do not interfere with Buyer's proposed development of the property; 5. Cncroachtnent of Qwest Co-ntnttnieations, Inc. fiber optic cable along the northerly property line; 6. Agreement between Bane Corporation and John and Pearl Gies dated August 22, 1997 to exchange property following final determination of the location for Carmichael Road; and ?. Ameritech General Non-Exclusive irasement Agreement by and between Bane Corporation and Wisconsin Bell Telephone Company a/k/a Ameritech Wisconsin dated December 10, 2001. TOTAL P. t~5 "~" Ir ~ y l / ~ .. ~, . 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