Loading...
HomeMy WebLinkAbout020-1414-60-000 (3)nartment of Comn~rce PRIVATE SEWAGE SYSTEM 'ng Division + ~ INSPECTION REPORT _RAL INFORMATION (ATTACK"TO PERMIT) .,onal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. r'ermit Holder's Name: City Village X Township Sienna Cor Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: ~~~ o ~00~ ~ 5~~ ~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 2 / _ tC/ ~jD Dosing I~ ~ GbD Aeration Holding TANK SETBACK INFORMATION TANK TO ~ WELL BLDG. V~ Air Intake ROAD Septic ~ ~ ~ 1 Dosing ~~ Z 0' Aeration I•t Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPfJV,~n Model Number ~ ~ TDH Lift Friction Los S stem ea TDH Ft Forcemain Len th ~ Dia.„ Dist. o Well ~~,.~ I SOIL ABSORPTION SYSTEM 4~f1 ~- ~ -- ,~..G - County: --___ __ St. Croix Sanitary Permit No: 453134 0 State Plan ID No: Parcel Tax No: 020-1414-60-000 Section/Town/Range/Map No: 20.29.19.2614 ELEVATION DATA STATION BS HI FS ELEV. Benchm ~k~ T ~ , ~ , ~~ /~ Alt. BM l~ Or o?~ 7 ~~ f7 ~ ' ti ~ , Bldgdg=r ~ (~ ~~ S'~` St/H~t I let SUHt Outlet Dt Ir~Jet Dt B~ ~ ~ ~ p/ • ~ Header/ n. ISO 6 1 d ~' ~ OI fj ~ O 3 Dist. Piped O ^ ' J o G~'t y/ ~/ ~ is . ~ ~ ~ Bot ~ ~ - S R'3 . '7 Final Grade St Cover (~t't / ~, / 3 [.-tr 7~S t^,~~.PJty ~_ BED/TRENCH Width ~ Length - No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ~~ ~- SETBACK INFORMATION SYSTEM TO P/L LDG WELL LAKE/STREA LEACHING CHAMBER OR Manufactu .( „_ X" Type Of System: ~ ~ ~ , ~~ U - Model Number: (/_ U„~C DISTRIBUTION SYSTE11~1 „~/ ~~~,,,, /,~p~„ J Header/Manifold i rib ion x Hole Size x Hole Spacing Vent to Air Intake •----rr~I C ` 4 1 L Di h ( Pipe(s) ~ ~ L ~- ~ \ ~f engt a 0 ength Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only -~ r e%CI~Y~~ ~ S~DK'h~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No o~ rya COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: v~ / ~'~/ G ~ Inspection #2: / / Location: 718 Martin Ave Unknown (NW 1/4,,/SE 1/4 20 T29N R19W//)'' ~T~h~e Glen Lot 20 - Parcel No: 20.29~./1Q9.,2-614,, /J~ ,, 1.) Alt BM Description - Sl`~(~til. '"GOr' 0 -rYW~,"1 ~ ~ K- ~, .Sy,S 7""Y'1 -~/~ 2.) Bldg sewer length = 8 i ~/ ~-~ ~..-~ d ~"(,~V,K'jhJ, ~ ~ --f,1.J1/iLO` -amount of cover = ~ ~ i (~ , _ ~ _ ,.. A ~, ,~ 1 lob l~n.ed,_ _, _ __- Plan revision Re uired? es ~No Use other side for additional information. '_~' Zo ~i" ! ~ ` ~ ~ G _. ; _ __ SBD-6710 (R.3/97) ~ ' Date Insepctor's Signat e Cert. No. ,,~j U~ C.exlC ~ •. ~C~1 (/hf ~,I~~9~2•te/v U~..l-~,J~~G~'7!" - Submersible Effluent Pump ~ r~, u 3871 EP04 EP05 APPLICATIONS ;-~ _~ Specfically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/4 maximum. • Capacities: up to 55 GPM. • Total heads: up to 24 feet. • Discharge size: l'/z"NPT. • Mechanical seal: carbon- , ro+ary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3/<' maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'rz' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous . 140°F (60°C)intermittent. 00 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Availahle for automatic and manual operation. Automatic models include Mechanical Float Switch assemhled and preset at the factory. FEATURES ^EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^ EP05 Impeller. Thermo- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplas- ticcover with integral handle 'and float switch attachment points. ^ Power Cable: Severe duty rated oif and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Association (CSA listed model numbers end in "F"or "AC".) ' 1 ' ti~ ~, ~ ! I ` _ ' 1 ~ 1 ___ x. ~ ~ ~ ! ry `''~ ~~ t_ _J-~ 3 ~,- lfY~ ~' ~ f ; ~ i _ c~.~~_ Zvi. ~ ~ i '31.1 I ;• ~ i ~ i . ~ 1 i i / i. EP05 - ' i ~ ~ - - ~ ~ ;EP04 __ ~ _I ~ ~ ~ i 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m'/h CAPACITY ®1995 Goulds Pumps. Inc. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS. FEET 10 9 30 s 2s o ~ a W z _U 6 a z ~ (~ 0 15 '~ 4 F 0 ~ 3 ~- 10 Effective May. 1995 B38~1 ~ ~~ ~ ~. --~~ a~ `~ ~ ~ . t ~~ ~ _. ~~ ~ ~~ d ~ ~ ~ ~ ~ l~ _ ~~ ~°ll ~ 2~' (off /~h.e ~~i ~~ S~-e-Q s 32 ~ ~ ~ fsT t ~ ~3 GU`u c~~.,P~c2.~c.~i~d b-u.~ ~ ( cv~. / ~-..~~~- ,~ ~ 9i~~i~y Safety and Buildings Division County : „ 201 W. Washin a Ave., P.O. Box 7162 .~T' `~~j~~~,~ Madt I ~~ ~-~---.._ D 8) 2 ~ VE Sanitary Permit Number (to be filled ' y Co.) e artment of Commerce LA /..~ ~ 3 ~ 3 l,r ~j~~ Ti Sanitary Permit Applic tio~p State Plan I.D. Number 2 In accord with Comm 83.21, Wis. Adm. Code, personal in tmatton you p Iovide ?~04 ma be us d f d y e or secon ary purposes Privacy Law, s15.Og(;j}(~t~UIX CUUNT'r 1,, I Protect Address (if d' event than mailing address) I. Application Llformation -Please Print Ail Information Property Owner's Na me Parcel X Block X S's`e.c~ a. ~6Y' t2a Property Own~eir's M ailing Address ~ ~ _ ~! Property Location oa0.. ~L`~~~f'D~-~ / ~ ~ r~ v ~ - 't,~ CrJ Ciry, State Zip Code Phone Number -~ - ~k ~-~' ~ ,Section ,~ e~ i t- .(/ ~''s'~J ' ~ j S a~d ~ {circle o ) C ~.~9 r ~ ' ~ ~ II. Type of Building (check all that apply) G~, ~ ~~ ~~ N; R / E or~ T or 2 Family Dwelling -Number of Bedrooms _~ O ~{' a b Su di vision Nance CSM Number i ^ Public/Comtnerciai -Describe Use - c - ! , l (~ ~-` ~ l~ ) _ , . ^ State Owned -Describe Use ~ 15?. l~~S ~n~ CCity DVitlag~ownship of~_~~d~f/ III. Type of Permit: (Check Daly one box oa line A. Complete line B if applicable) `,' ;New System ^ Replacement System ^ TreaunentJHoidmg Tank Replacement Only ^ Other Modification to Exis[ing System B• ^ Permit Renewal Before Expiration Permit Revision ^ Change of L Permit Transfer to New Lnt Previous Permit Number and Date Is/$ued // Plumber Owner ~3I ~ I ( (~ /a~ / J1[ L r y V - IV. Type of POWTS Sys tem: (Check all that ap I I 1 ply) _ ,Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ~.7 Single Pass Sand Filter i ^ Constructed ~detland ^ Pressurized In-Ground ^ Holding Tanl: L Peat tiller ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching C ^ Dri Li::e Gravel- ess i er (exp sin) V. D' rsaUTreatrnent Area Information: S Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Regain (sf) Dispersal Ar sed (s 'System Elevation ~-- VI. Tank Info Capacity in Total Number Manufacturer Prefab i Site SteeE Fiber Plastic Gallons Gallons of Units ~ C C oncrete onstructed Glass New Existing , ~ Tanks Tanks Septic or Holding Tank fO~cT.~ / ~~ G - Aerobic Tttattneru Unit ' , , I / r T (/(/ (~ ~ Dosing Chamber 1 --.. ~'Dd ~ ._~s ~.~ ~ ~_ __ VIL Re5pOnsibility Statement- I, the undersigned, assume responsibility for ' Nation of the POWTS shown on the attached plants. Plumber's Na me (Print) Plumber's Si gnature MP.' RS Number Business Phone Number ~u tuber's Addre ss (Scree[, City, State, Zip Code) / l ~~~ sue- _ ," GrJ~, ,~,~~ VIII. ount /De artment Use Onl _ Approved Sanitary Permit Fee ('ncludes Groundwater ^ Disapproved j ~ !Surcharge Feej CI ~J~ p"D ` ~ Da[ Issued Issuin A en Stn re qm s g /~ ~ F ~ - -` ^ Owner Given Reason far Denial L t7 V ` S l ~ 2 IX. Cor~ of~ ovaUReacoas or DOyL pproval ~ ~ `~ ~ ~ v r ~~~ ~,~ d t~~ r~-sys - 5ys-~ ~ a-a~ d an ~ 6 ~,~~ ~ .l~~la( ~ arm ~- ~,c-~h ~ Gt,~~.~ /4.~ ~A ~ ~ 6.e 6~~~ fz~ti~~ ' S ~ G~i;C.2 ~ leiZ~' t o-~ 6 ~n~ ~ ~3 n ~, ~ ...,, /fin e . i. ,c . .. i . A._ .~i ~-,.. ! Attacd complete plans (to the County only) for the system on paper not le than 8 x 1 i es in size SBD-6398 (R. OI/03) Safety and Buildings Division County ~ ~ 1 2Gt W. Washin ton Ave., P.O. Box 71b2 .~TGf/ j~~j~~s,~ Madis I ~I v~._----~. _ Sanitary Permit Number (to be filled ' by Co.) De artment of Commerce 8) ~ ~t~ ~ ~~ 3 (3 ~ If~~ Sanitary permit Applie tl(~P ~t Q State Plan T.B. Number G ~ In accord with Comm 83.21. Wis. Adm. Code, personal in rmation you provide X004 may be used for secondary purposes Privacy Law, s15.(k}(1)(tp~ ~ Project Address (if d' Brent than mailing address) I . nGiX LUUN `~ I. Application Information -Please Print All Information ~~~"- 7/8 m ATZ"S Z N -AVE. , Property Owner's Na the ~ Parcel !/ L Block >Y Froperty Owner's M ailing Address - ~ Property Location ~afl,~ af~~~~(00„~ City, Stan Zip Code Phone Number -~- ~k ~~_ ~ .Section ' it C- ,'I,~ ~'°.3-'~~~ f~,'J` ~ ,~70 ~~ r {circle o } C . ~t9 r II. Type of Building (check all that apply) ~ ~~~~'`~, T ~ ~ N, R /~ E or~ ~~,1 or 2 Fatttily Dwelling -Number of Bedrooms _`~ 0~~ U ~ S-u-btdi-vision Name CSM Number ^ Public/Commercial -Describe Use _ ~~ J ~_ ~~ ! h ~ ~j-~ ~., N ^ State Owned -Describe Use ~ ~S?• ~~ / '~ G `~. L~,City_^Viilag~ownship of~_~~ III. Type of Permit: (Cheek only one box on line A. Complete line B if applicable) A. ;New System ^ Replacement System ^ TreatrnenUlioidmg Tank Replacement Oniy ^ Other Modification io Existing System ~- - ~. B• ^ Permit RenewaE ~ Permit Revision~~ Change of L' Permit Transfer to New List Previous Permit Number and Date Is/~ued Before Expiration -~-"'-~ plumber .Owner ~/a'~ /O I~V• Type of POWTS System: (Check al! that apptyl ____ ~ -`~` ~, Non -Pressurixed In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 'L4 in. of suitable soil L~ At-Grade ^ Single Pass Sand Filter ~ ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Fitter Leaching C +^ Dri Line Gravel- ess i ther (exp ain) V. Dis rsal/Treatment Area Information: _ S j; Design Flow (gpd)/TDesign Soil Application Rate{gpdsf) Dispersal Area Requir (sf) Dispersal Ar sed (s 'System Elevation ~__ _ VI. Tank Info Capacity in Total Number Manufacturer Prefab Si[e Steel Fiber~plas[ic _ Gallons Gallons of Unit, ~ ~ Concrete Constructed Glass New Existing ~ I Tanks Tanks ._ ( ~ 1 ~ ptie or Holding Tank ,~~.,~ ~`~"-' - r/ __: G.SC. ~ ~ _ Aerobic Treatment Unit ! ~ ~jr"-" -' ff ~~ i Dosing Chamber - - ViI. Responsibility Statement- I, the undersigned, assume respottstbllity for ' Nation of the POFVTS shown on the attached plans. Plumber's Na ma (Print) Plumber's Si gnature MP' RS Nwnber Business Phone )vumber lu/tuber's Addre ss (Stteet, City, Slate, Zip Code) -~ ~ , f ~~~ sue' _ - L-~+--/W~~G,~_~ ~: ` ~~~ I-VIII. aunt /De artment Use Onl _ - ~Approved ^ Disapproved Sanitary Permit Fee ('nciudes Groundwater Dat Issued Issuing Agen Sign re Amps) ! Surchar a Fee) ^ Owner Given Reason far Denial ~ '~~ ~ ~ 2 i g S~ °° so ~~ I~IX. Conrlitions of Approval/Reasons or Disapproval , ~~ ti,'~u,~ d ~ ~ s - u Sys-~--, ~ ~ d ~ ~ 6 ~~ -~ .~.{~to( ~ arm ~-- ~- sL~s~ die ~ ~~~ ~ 6~~-~ iav . t:~~ ,..~.. _ ~ - _L Attach complete pla.as (to the Coonty only) for the system oa paper not le thaw 8 x 11 i ea in size SBD-6398 (R. 01!03} s ~`~ ~ $ L ~( ~3 Gnu ~~~~ ~~l .~z 2 ~ ~ sr ~° -mod ~; ~~~ ..PiYtCh,t~iQd Uin l~l G~~a~ ~Y~~ y~~~ ~,gV%5 i~p~ Scol,-t ~ ` ~~ L1~ ~ ~` „ ~~ ~~ t %~ ~ ~ Sc~~r t O /sue-/ ~~e: d e ~, ~~ ~ ~~ ~ ~ ~~ ~~ ~ ~~ a~ 9 ~'~ ~~ ~ ~~ ~~ ~~,~~ ~, ~~ ~~~ H ~~r . 2~, CAPY G~A~~GG~~'~ ,~i~ ~oz7 ~~'4 e ~~ / 36 ~~ ~~ dl~ ~~~~ o~ g3 ~ or ~Z + ~ gl £3L D^ ~~ w.-,-` NAME JD h'^ SU''~ L # ~ LEGAL DESCF i SCALE: I"= ~~ BM 1 ELEVATION /~ ~ ~ ~ BM 1 DESCRIPTION ~e~ Q..~ ~ ~-~'~'~ ~~~~~ BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION ~~~ b ALTERNATE ELEVATION "- (+nArr('NiR FT.RVATinN -~"- I .~b~ T ,N,R E or W 6 „"" . ~~ ~~~ ,~ , ~ F~;E ~~ ~ ~~~i w,~,~;,,~~,t«~, SOIL EVALUATION POR Pa ~---~--~- nr,.ses,., ..i cam,. s.,.i R..arrix~ ~ d, 9/i 3~ a y .: _ in aooordarroe wflfr conrrrr tss, wis. narrr. woe ~Y ~ - ~ i ~ ~ t Attach oompbos ~ plarr on paper Trot tbsa tharr 81/2 x 11 irciae in size. Pion mwt include. but net 9mited ~ vertical and horiaorrtsl reference Point (8M), dirertiorr and Patoel I.D. ~/ t~ ~ZD ' ~ ~d ~~~U rtortlt artow, and locatlon and distance to nearest road. scale or dimensions ercent sb e I , p , p Please print a8 bdbrmai6on. Dam ParaonN inbrmatbn yar provide nap t» wed for seeorwary papoaes (Privacy Law. s. 15.04 (t) (m)). (~/W+--- PropeAyOwner propertyLocatbrt . ' ~~ In U s'c s~ Cci'Y Govt Lot ,iL/~ 1/4~~..a14 S~~ T rQ N R t E(od P Owner's Maiflng Address Lot # Bbdc # Subd. Name ar CSM# ~~ D ~ i~U Y, / c ,Sa c f°' C.~ City Staos Zlp Code Phone Number ^ City ^ Yilage ®Town Nearest Road New Construction Use: ~ Residential /Number of bedrooms ~ ~ -- Code derived design flow rate ~ / /~ ~ ~ GPD ^ Replacement ^ Public or commercial -Describe: Parent material f lit ~- l~ Q 5 h _ _ Flood Plain elevation i~ appligbie l ~ ~" General oornmeMs ~ ~~~ ~ ~ ~~ / y and recommendations: ~ ~ ~ ~ ~~ ,,/f , L ~ > ~ (~ ~ Jeep [~J c~ `t C~-~- . 'yL~-e 7a U Boring # ~ Borrng J~ ®pit Ground surface elev. _~_ fl. Depth is limiting Tactor _~_ in. Sod lication Rate tion ri D R d Texture Structure Consistence Boundary Roots GP DlfI= Horizon Depth in. Dominant Color Munsell p ox esc e Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Eff#1 •Eff#2 J r-13 i~~~3iL - S" ~ ~•.stic vh~r ~ S c ~3- i:~ -~ r- r s ~ ~ ~ - - . ~- a Boring # ~ Boring © Pit Ground surface elev. ~~SQ.D _ R. Depth Ao fimi6ng facDor ~ in. Soil twn Rate Horizon De th Domarartt Color Redox Description Texture Stnrdure Consistence Boundary Roots GPDff>? p in. MunseU Qu. Sz. Cont Cobr Gr. Sz. Sh. •Eff#1 ~ Z iL'St' )U~ ~ s.'~J arm, d WL-Fr G S J -~ ~ • (o .Sv - l I ~ - S a s~~ ( ~ - ~ ~ / ~ • F_flkrent #9 = BODS > 30 < 220 mglL arrd TSS >30 <_ 150 rsiglL ' tmuent ru. = isvus ~ ~u mgrs: arra ~ a~ ~ .xr .my~ CST Name (Plearie Prirrt) S' re CST Number a i~ w~a~/ __. _-~ _ zs-33o q~~ f ~ J Date Evaluation Conducted " Telephone Number Z (~ 3 lS~~ Jt ' Sc r-~..~~ ..~.7 1,.i ~ ~ .~yG~-~` 9' `~' ~' `7~ '7j -~"- 7G o --~ z ~- 9 Parce110 # ProPertY Owner Pace ~ Borg # [~ Boring ~-•~~~ ft. Gn~tatd surface elev. ~-- i © peps to Cenfn9 factor-~- ~^• Soi x~Ibn Ra P th n De i t P Dominant Cobr Redox Desc«riPtpn Texture Structure Consistence Boundary Roots GPDII 'E~1 ~ft#2 p zo Hor in. t1u. Sz. Corn. Cobr Munseq $ I Gr. Sz. Sh. vv~ ~ / L S ~( / ~ , ~ ~ ~ rrs 1 0 -Iv fv ~ IZ ~ , k r L S d~ - Z to - _ to / ~ 5 Zr~ . ~- I• Z ~ 38 ~ {L(~ ~v , 5 U S tnn -- [~ Boring ^ Boring # ft• Depth fD limiting factor rn• Soil A ication Rai ^ Pit Ground,surface elev ence Boundary Roots GPD1fP Horizon Depth Dominant Color Redox pescaiptbn Texture Structure Consist 'Eif#1 •Etf#2 Qu. Sz. Coot Cobr Gr. Sz. Sh. in• Mansell ^ Boring in. ^ Boring # Ground surface elev. ft Depth to limiting factor - Sod ~~ Rat ^ Pit GPD1fP Hor¢on Depth Dominant Color Redox pesuipdon Texture Structure Consistence Boundary Roots •Eff#1 'Eff#2 Du Sz Copt Cobr Gr. Sz Sh. in. Mansell • ERluent #2 = BODS< 30 mglL and TSS <_ 30 mglL • EtHuern #1 =GODS > 30 <_ 220 mg1L and TSS >30 < 150 mglt_ The Department of Commerce is an equal oppomu-e~ ~ tact the deparlmertt at 0&2166-3151 or TTY 608-264-87~ ~~i~ or need material in an altercate format, p sso•asw rx.mmm SCALE: I"= ~ `l BM I ELEVATION /~ ~ ~ 6 BM I DESCRIPTION ~-e,~j d..l. j ~..I ~n ~' D~ BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION ~~ _ ~ b ALTERNATE ELEVATION "-" CONTOUR ELEVATION ----` -~-~ P,~~~,~n~-~y f~5~~~ ~r~~ ., r ~in~ ~~ 3 3 a-~ __ ..__. __~__.---D-A-'I'E~'~ .. -, 6 N^ l -~ ~~~~~ s~ ,1 __ -~ Safety and Buildings i?ivision i County S~~Y ^~ ZG1 W. Washington Ave., P.O. Box 7162 O r ~S'~~~~~~ Madison, Wl 5370' - 71t2 Sanitary Permit Number (to be filled in by Co.) e tment of Commerce I (608) 266.3I51 ~...--Q'=- ~ • - '' ~j Sanitary Permit Appl><ca iall>~?- Surte Plan I.D. Number ~ . Tn accord with Comm 83.21, Wis. Adm. Code, personal ibfort~iation you provide ''-~ ma be used f P i d L 19 04 l 2~ il d y or aecon nry purposes r vacy aw, s ( ( xttu~ ~ 1 ~ N rajcct Address {if different than ma ing ad res, I. Appiic~tlon inPortnation ~ Please Print Ali Infotntatiott ~-~ )h u Property Owner't Na me _ Parcel rX N Hl •1 S'.- c,vv v~ Gor 3 'sue .?!J Property Owner't M tiling Address _ Property Location Section ~1~ u ~'ni Ci stare tY• 2ip Code Phone N er , . r ~ ~ ~~~ , ~~ - a ~4~ (circle one) II. T ype of BulldinR (cheek all that apply) ~ ~ 9 ~~ ~~s ~ T aq N; R f~,E ot~ ~1 yr 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ^ Public/Commercial -Describe Use "~ ~ n :...1 State Uwned - Deat:ribC USC I S `f ~Ciiy~LJVillage fTownship of ~,r~ 2 ' _ III, Type of Psrmlt: (Check only one box on line A. Compl a li e P applicable) 020- I 14- -tx~(. 2ra !'~ A' New System Ropa~e y ^ meet S stem ^ Treatment/ li Tank Replacement Unly Q Uther Modification to Fatiscittg ystem R• ~ Permit Renewal ^ Permit Revfslan ^ Change of Permit Transfer to Now Ltst ev Perm iru be to issued Aefore F.xptration Plumbt:r ner I '~ , IV, of POWTS stem: {.Check all that a ! Non -Presauriud In-Ground ^ Mound > 24 in. of suitable soil ^ Monad 24 in. of suitable soil At-Grade ^ Sittgle Pans Sattd Piiter ^ Cuutstructed Wetland ^ Pre:surized In-Ground ^ Holding T ^ Peat Fil ^ Aerobic Treatment Unit ecirculaung Sand Filter ^ Recirculatin S ttthatic Media Flltet Leachin Chamber ~ Dri Line ^ Gra 1-less Pi ^ Other (ex la') -~ 9!•90 (~ 3 V. D rsuUTreatment Area I11Po on: ~- . So lhtigo Flow (gpd) Design Soil Application Rate(gpdaf) Dis rsai A rea Required (st) ispersal Area Proposed (t) Syst Elevation ~~~ ' 0 • G a s ~ ~~T 1 ~ VI. Tattle Into Capacity in Total Number Manuracturer Prefab ____ _ Site Steel Fib r Plast Ga llons Gallons of Ut» ~~ ~~ /~--Idfl tr Caturote Conatruc New Ttttict Exlstlng Tankt septic or Holding Tank ~ , ,,,,~ ,,, / .. _ VII. Res lbWty Statement- i, the iutderalgtted, responsibility for talls<ttan of the POWTS showa`u the attached lams. Plumxr's Na tra (Print) Plumber's Si re F PRS Number Business Phone Number ~ ~r:Yl, ~ ~ T pia. m~~r der - ,229 ?per , 7/.S' ~ 3 &' ~ 2/ c- ~ Plumber's Adds a (Street, City, State, Zip Coda) VIII. Cotu>it /Ik latent Use Onl f _ Approved ^ Duapproved Sanitary Permit Fee (includes Groundwater Date Issued sui Agent Signature (No Stampsj Surcharge Fee) DY/2~/ ^ 0 van Reason far Denial 2 ~ ~ D IX. Conditlone st'Approval/ SYSTEM OWNER: ~ 1 Septic tank, effluent filter and ~ dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attatk c~pfete ylam (to the Courtly only? for tbt system oa paper not Lett thta d1r2 x 11 incLts to sire SBD-6398 (R. O1/p3) e -~~~~~- I~ ~.~.-) ~-- ~ B I f g L. i 7/ 1144 page 1 of 3 Steel Soil Service Date Personal information you provide may be used ~ s. 15.04 1) (m)). ~ 2ll Property Owner Pr t_ocation `/ Sienna Corporation ~~ ~ ~ 6 ?~Q -Gout- a NW 1/4 SE 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address Lot# Bock # Subd. Nine or CSM# 494E} Viking t?r, S+;tite-608 ~ X C r~ ~ ~ N i ~~ na The Glen ;~, City ~rYlq State Z'ip C Ph~r lam-` - tty _ ~, Village Town Nearest Road MN 5543 - r 2~8 Hudson Carmichael Rd. Wis~nsinDepartmentofCommerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Courriy Attach complete site plan on paper not less than S%: x 11 inches in s¢e. Plan must St_ CrODC include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale ordimemsions, north arrow, arxi location arm d"stance t6 nearest nrad. Pant t. D. Pending Please print a-l info-mattion. New Canstructiort Use: VIi Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public ~ t~rnmercial -Describe: Parent material Pitted outwash Flood P~elevatiQtt, if applicable na Geaeral comments and recommendations: System elevation 97.20ft, trenches spaced and depth to code 3.5oft bebw strade A~'sh h b r~ mod/ .Q-e- q 1. ~ /~ ~ ~ l-~e r n a~~ ~B 3 ~ 3. ~ s `n~,~ h ~- 6 ~ 6Q ~relev. ~ Boring # Boring 96 /; Pit Ground Suface elev. 100.70 ft. in. Sod Application Rate Depth to limiting factor Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GPD/(t~ *Eff#1 'Eff#2 1 0-12 10yr3/2 none sil 2msbk mfr cs 2c .5 .8 Z 'C2=24 t0yr414 nee sicl 2msbk mfr gw 1c .4 .6 3 245 7.5yr4/4 none st .5 .9 2msbk mfr cs na 4 35-96 7.5yr4/6 none ms ~ osg ml na na ( .7 l 1.2 Cl Z l~"~ g `~ - / l ~ ~ ~~ l~C S'~ ~ s.`p~ ~DU IiP~-r ~ ~-~~GL~Ic rc+~ G LiQ~r~ ~.e r /n~ ms. - ci~.o~ ~ ~eu~~h~~ ->~ deS~c..~~ .S~ ~ees.~f U ~ ~ r Qir-~ ~ '~ -~, etc ~.ei~ ~e z^ ~ti ~~ c~ . ~. ~ ^ Bonrtg # Boring Pit Ground Surface env. 100.70 ft. Depth to limiting factor ~ in- Sod Ap~ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consbtence Boundary Roots GPD/tt2 'Eff#1 'Eff#2 1 0-9 10yr3/2 none I 2msbk mfr cs 2c .5 .8 2 9-32 7.5yr4/4 none sl 2msbk mfr gw 1c .5 .9 3 32-96- 7.5yr4/6 none ~ms ~ osg ml na na ~ 1.2 ~Z~/ ~ 7~ - tttluent ~F1 = 13UU ~ 3U < ZZO mg/L and T55 >30 < 150 mg/L * Effluent #2 = BODS < 3p mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number t?av~ J. Steel ~ 248956 ~ Date Evaluation Conducted Telephone Number Address Steel Sal Service 1564 CR GG, New Richm t 54017 9/19/2002 715-246-5085 / f Property owner Sienna Corporation Parcel ID # Pending Page 2 of 3 Baring # Boring ' x 90 Depth to fl limiting factor 96 i Pit / • Ground Surtace elev. • n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GPD/(C= 'Eff#1 *Eff#2 1 0-8 10yr3/2 none I 2msbk mfr cs 2c .5 .8 Z 8-24 T.5yr4l4 none sf 2msbk mfr cs 1c .5 .9 ~- 3 Z4-~ 7.5yr4/6 none ms osg m1 na na ~ 1.2 „ ~r~ ~a Rnrinn # i Boring Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/~ "Effluent #2 = BODS a 30 mg/L and TSS <330 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Borna # Boring - -- - .. ... _ . Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel CST-POWTSM Lic. # 248956 Sienna Corporation NWl/4,SE1/4,S 20,T29,R19W Town of Hudson, St. Croix Co. The Glen lot # 20 1564 Cty Rd GG New Richmond, WI 54017 (715) 246-6200 (715) 246-5085 This soil evaluation was conducted to satisfy a zoning requirement, 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 soil test was conducted. Legend 1" = 40' • = Benchmark El. 100.00Ft Top of '/z" pvc pipe . =Alt Benchmark E1.105.45Ft `(~ -h~r ~I a'S e~ ~ 7~ { ~, _ ; ,~ ` p', . ""Zi 't"' i T ~ 'T? 1 - - . JSi ~.~ , .., _ - ~ , ... - , . ~ - • . .~,_ .. .`,~ 9 ` 1 Q ~Q J ~~j OJ v~` 1 \ i _ • .~ '. - . ~: ~~. !-+_ _. • 1 ~_`. ,~ r_ ` _ ~t 1 5 ~ ~. I `, ~~ ~ 1 . ~ .,.. ;~ n ,~ ~-~ , . 1 .. ~~!. .a `{ ~ ,1~ {.. •f _ .Y ~ i ~k~ ~ t ~ 1 c n ' . f ~ '\ ~ " ~ ~ e {~ a .'c"4 a3 , .. ~~ ••. ~`_ 7~~ ~ .V 7T - n _ _ .. ``yam ~ ry~j ^ ,. J ty , . ; .1 1 • / • C ,. _ _ _.. _ 208 .. :. _.- 39 " , : ; ~~ _ _ ~~ .. _.. ... 1 -~ ... .1. '~ ~ •.. ~. .._ ... .. ... - .... r~ - ~: i q _,~ .. _.. ,r y. fA . c . . 1 ~ '•• v'. ~' -V~ - - ~ ll ~'-- f` 1-.i a• f ~ - . ~• -.. 293 ' r _ -138 .t~-..~,.i.T_ ~;~q'S kr k ~`f t / , - _ ~, f •. f• f 1 kt 1 ~' , .. \ 1 ' 1jl 1 1 7' ! I /• ~ • / ,. _ ---- .. .. µ / ~' ~ 1 ~ 1 h 1 i : it. 1 f - -, ff 1.11 111 ,II _~ _~,Z4L 11 ,`~~ I 1 ' ~ 1 ~ ~ •• ~ 1 '..~ 'll ' '~ ~ _ ! X11 1: / -. 1 t .: t 1 1 f ~ •, , ! ---- i , , - - - - _ _ - _ - - ' ~ {;, I ' 1 ~ ;: s ~. iii ` ~.... T~ II1 •• ' • \'~.\ • ff -. '. 1•~ /. s~ Ii ( 1 i + f ~• t f .. • -- .., ,. . ~~ Y, 14, .,, _ i,; . ~~ ;r - ~ 1 1 .~ I • i 1{{-- 1 1 11 1 ,111 ,9. I I ~ / 1 .Y~ i 1 1111 ~1 ~ I / /- : t ~.~. 1 1 ' ~ I .' 1 j ' .~i l 11 ~1 1 , . ~ ,/' ~ Ij~ _ .~J „~ - /mss ~' --______ / .. ' - ,21 ,.. i; `y y M!nw~w"a-----.,..r...,,'~"`.'.'".." 1 r~ ~ ~ ~ ~ ~ `- ~ ~, -~ L'~ L .R (, ~ ~ C t• M. n -r . / q /~ ~.~.....~ -.,... ~" ~I U:rTT 'IAE 12" ~'!:~lst, A80V% C+:~AD£ ~ ~ ?~' FRt~M DOUR ~ WIN:~QW OR FR ~ S~H R L&. N,TAKE -~-~----....,,,.,.,,,.. F;NISHE nRAPE--, ~~ ~+" CI RISER a ~ ss ~1 ~ ~~ ` E Se~~{ . r~ • .~'trL r WATER :'IGrir 5EALy ;pPROV~~ -IP~ I, }N'CO S.'7~. i D i sore ?J MP OFF ELEV , x T , ..~..., A ,8 ~ ~„ , ~c t~ D +~EA1'~!ERARp4~ JL'NCZ'Yt3:d 8Gx '~ITx CGNDL'2T ~~ 1 ~' . i GA5• ~ ' TIGHT ~ ', SEAS, { -~ i { , ~! ~~'~?zc r naw~ s`.4:VK MAN~JFACTJI~ER: DOS £ ~" APPRG~i E~ SEbDII~`G J:lD£FC TA?~'1~ s~ECzF:aAT:a~s J ~ 'fir... _L.~'.~..... ~A~ . 4G ~A, !.~ . '=LAR*~ MAidUFAC'YVRER: .._r., MODEL N'~M9ER a -~ ~,~L~... SWITCH TYPE: ~~~ MODEL MIMBER : ,~- ~ ~.._...._..~, SwYTCK TYPE; ~-~r-~- EQ~iiREp DISCHARGE RAT .`~ ~ w .~P~, APPRU'd~D `'SAATN.Qi,E CGV ~~ W ! PADLOCK ~ wa~rrr r~~11 AaE~ tier sfi ~ALM ~ ( aozass ~crr~, i ~j APP~YEO ? IPA i ~ OFi ~ '~ ~' RISER EX: T IFRTXiTED ONLY ANK ~ MANUFACTURER ~ NA5 APPROVAL ~C~NCRETE PAD rr~-~~~~ a4£S PER DAB: l `O~w Y YiM1i .'"l it ~lt ~r G~V~w~~ C ~ INCKES „,~„GA.,. PLrMF' t A:.gnM W'IRiNG ~-SrER ILF3e~ 26.23' '~,'A~ £R TC,pL JigFERENCE $E, ~:INIM~IM NETwCRK SUPPLY PR Gs F AND ~ISTFS8UiI0N PIPE !~ rEET ~„ FEE`T F ORCEMAIN ~~ FEET ~F'd F T/1Q FT, FR. ~ 7:ON FA~T4R . +~OT~L O~'J~AM3C ~EAO ; ' .7 FErT .m r ' d ANAL D2ME':~f~1i~1~J L~ .~~' ~ a ^` If r , ~~M. i~M. .•A.rh i ~EtiGTy „~ Li~ENcs N``4$iR ,.~. , '.~..~. r.A~. r . °/ • V. ~ ~~~'A~.1. r.~ SpeoAfq~y iiee~ed fo-1be tveeeme • tFiwrne • ry~~svy,, duty turttp (~e~e! t X04 -^.y a vim: Yp tip ~ QPAI. ./ ~ ~ YdEll Made: 4j? ~ 21 fe1L ~~~~ e~p~ fwbo 8 ~~ t+ o~~ nt ' ~+Wbte of Nnrt~q ~N:1f~I ~r+o ~~~: ' ~f~Met vv m SG dPM, Y~ ' ~ f0 ii litet erektenrbo onfwy. • ~ ~+NM+soue ~, ~ ,Me ciCUt~ ~•ni~, rrp. • w~enerz: ~ aer~a ~~. o~am~ hfelel: • ~~a`w~`, w ~ ~0 ~ ~A OMl~ Iltth EelM reset, 115 W, d0 ht, ~ ~M P, lwl~ n owr~oed with ~ometlt meet ' ~r ~'d: i 0 toot f~u+d, ttY3 xlTp ~ 4~PdO~ ~ !np ~ i ~ SJTW wttt, ~.~ C M u ~ ~~ +wc treaehr. etfkt~,t ~nuelNe 1rr ewfewdk end ~m~Kt~~ ~~~ x'11• tie • f'~ ~ISr' lt~trma- estteniwi dMi proMUbn. ~ ~~~o- irn for ~"'~nr'° ~~ v~ won ~ Mofnc stew ~ Ciet r~cn t s ~d~ ~! co~ua Th~r-iocew- ' Nelldt ment ~ r/lelr CWIS Seirere 4uey died ce and MpMr nlrewgrri. ^ ifNll~f; Der ei10 town ~~y duty bM1 t+~dnq ~!>IQY ~~ ~' 4rree'MAiaawoa tCSA 4eNd mode! numMr: end to "F ~ •p~•.y e ~ ~e ~ Y .._...~ a/~I(~4~ STANDARD CHAMRF~7 Quick4 Standard Chamber ~1 ~\ ~ _ f - i t ~'~~ ~- ~ ~ SIbE VIEW SlpE VIEW MultiPort End Cap FRONT VIEW Quick4 Standard Chambl:r Ngminal Specifi~atiotfs Size ~N x i x'H~ - 34" x 52" x 12" Effective Length 48" invert Height g• 52"--- - --- ~,) TOP VIEW Mu{tiP.arf End~Cap {~otnnal S~~F-e`cifiCaiiaas Size (W x L x H) - -34" x 16" x 12" Invert Height 8" or 1.25" jNFIl7RATOR SY5T~M~1~,_$T~V(`D~1Rf1 LIMIT~QWARRANTY f•? ?h. ~. ~O~ral t 4 iiy of evh ch;ynoar. onq ptH.e, wodgo and ct11a• acrl;SSnry mnnutact;aed ny h-f Nratnr ; `thtils"j, wl?nn insldlled and olx±raled '.n eachfFlrl ^} - w,6 ;~ ee`plC System in ar`C;pryar,Ga wish in}iaatOr'6 nt5lruurxrs, 5 w lrrnnted 1D Ine OI'gNa purl;IrasPr !"Molder f agalnSt !k}9Gi`Jfi n-,al. r ale and we km nc tip +cr orx: year rrorn ;he date Ihet Iltn septic permd is issued lur the sePf c cysW t ; crntaavng II1H Un3s: pro>R~ed, nnwrwrer. that it 8 Septic pernil 's nnl mgcrrad try apLVkaWe law, the ~warranly porrod wilt ltegin upon the data It>a; instal!allon. of tlta ;eptir, sy5lem ~mr!><3nCes: To fY.a!r£e its warranty rignls. Hckier must n7tiry Infil,rafar in wrSting at its Corporate Haadq,tadnrs In Old Saytxook, Connecticut wdhln }i}teen !15; days or the ailaged datHCt !nfidrator will supply replacement Unds la Vrdts determined by Infiaratw to be covered try this Lurged V/arranty. Indllratw's Irabihly Soar: }!G]IIY exrlutles the rh?St o1 rernrryaf andicr inslallalidn ui the Units. (hi T4F LIMi?f.C'Yy'AHHANT~' AND REMECNC3 dJ SLIL;PAFZAGFIAUN {al nRE E%GLU5`vc 'i III=RF Ai;[ NO OTHER tnlAf-RAN3'IES'WITH RESp~CT TO Tr1E UNI t5, INGLt1DING r+lp Irq~UED WARRANTIES OF MERCHANTAQILI71'' UR i"iTNESS rQR A PArii=.GIJU13i' PURPOSE. jrl 'his Lmdled Warranty Shall 7°~ vnlU If ery gait n4 the dtamber system is n,anufarh:rad'J5r .xryone othx than IMAlralw. Tha ! maw; Warranty [kxc r>,nt ext011d (q urridPnlPl. GnnsaglAIDtial, spncVaE or indirect damages. M(r!2trx snail not Ira liabkl Icr panadrt+s nr liquiri'stetl da+nargtw, ;n~MUdinq loss M i.wxiucllor: ann profit'., labor anC malariafa, rn,~hoad casts, pr Cther bsses nr ax;:mtses "x r~tned try Ilp .adder or arty third „arty 41xxidraiN e~cir.rded 5,xn Untitorl Yv'arcanfy ^• ^rtrrage era darna,re ie Me Urdls due to prcdrrary wear and tear, adoration, acri,7ent, misu.sa, abr.rse or neglerl of ,ha L oils: tho'Jniis Ixemg subirx red to vatix:W traffic cr cthn ca-toltima whirr era not ParmiltHd by the installelkx~ irlaVUCtip?e', tslWrr^ h mainlahr I`e min m~ rm Around Covrxs set tc"th in the irtstdBaa~n instunirorts: the piacdnen( of impnlper ma19r uis tend rho 6yatem a:.Mainirg `Ix" Unitg; Idihtre dl Ilre Urns nr the aapi c ,ryslem due tp improper siim3 pr 'mpror»r sierra, excossne water u„aae, ~nprnper gmFLSe disposal, or improper nperdlial. w arty orhe- ovont rot caused by Indliralor. This L'mHed Waaa, ty ahatl bn wk1 0 the Mdda farm to compry wdh ah nt the terms seA teeth In dtls Limltad W2Y 2rli V. further, in rte event sh2!' L'~.fillmtnr Y resoonsitik for any lobs or damage id th0 Hnldor, rho Cods, ;x any Ihrtd party rxlming Vrtm ins'analkx, or stnp- mraM, cr'rom any oroduct iiatxkly claims of `iddor a any thud pasty. fw this Limilecf 1Narran!y !n apply, the ands must i7e inSiaMerl Nt acmrry-erne with an see condlt!nns requiter.' by slate antl txat codes: all other auplicable laws; antl ImNrrator's inslaifation inslrurlktrlS. !+i1 No represertatlve of ICh'lratcrr rtes rho aulhoiily to change d- ewlertd ;his Lnn'~tad Wananty. Nn wana~ty appGe3lo arty party orhor than ;ho ortg:- nal t1NGC'r. Tire abOb'a ropr06P.nts Itle ,"it4M?dard Lintilar; War"Vlty te}lared by Inrrlre:7. A imilorl nlln7Ver d stalo.9 and cnJntiH.: hTra di!IererN warrant rHrrrire- •nsnls Any pur<I:a,.P.~ nl Cni}s sha,M cM .'tnl nldt+etnr's Cnrporalo HHedqurr'.ore in Olrt Saybra.•lc, C!x'+mr.!lwi. odw W swh purcnaseYto ohta~n a ropy OS T1H app+icabla warranty, and Shdtlld ~:.an3lull,l read that wananry Prior to the n;mc his¢ c' ilnits. t t r,........... _._. • li SYSTEMS 1 N C Environmerrta! Onslte Wastewater Solutions'" 6 Business Park Road • P.O. Box 768 Old Saybrook, CT 06475 860-577-7000 • FAX 860-577-7001 800-221-4436 .._ ._. ... __. _ _.. _ .. .. , ,v, .+r+v r,v;ta, q.pr r,yvo: a,r Inr rt>i1; b.JtsC,!!8; b.839,8A4 Canadian patsitis: 1.329,959; 2.ch74,563 Jthsr patents perd'ing. Irliltr2tor, Equali2er and Sidewinder are reyistored trademarks of tntiltralor SysternS Ifld. Infilhatpr i5 a ragisipted irartelflark in Franc;e;. Infiltrate Systems Inc. i5 a ray':SiBrad trademark in lJlBxiiR. (;pntair. COnIOUr SWh2i ConneGlirXti, MicroLacc;.hmg. PoryTiJH. ;napr_nck. ChamherSpacer, Vnai~ock, QuickCut. QuickPlay ~'"'Mf'fi° ~A and Cuick4 are trademarks of 1nfi1[rator lrsterng Inc ~ 2003 hvftltrator Systerrls Inc. Printed in U.S.,a, Sip11203HP-0 SECTION VIEW POWTS OWNER'S MANUAL & MAI~iAGEMENT PLAN Page ~, cf Z nGQrrarr asissssi"rreiaa rw.r... •...~..-~..~. -..~.~ Number of 8edroof»a ~ DNA Number of Public Facility Units NA Estimated lbw taveraael ,~' gilds Design flow (peak), (Estimated x 1.51 ~ d at/da Sop Application Rate elide lft' Standard tnNuent/Effluent t2uality Monthly average* Fats, Oil f~ Graeae lFOG1 530 mgll. Biochemical Oxygen Demand ISODB) 6220 mall. DNA Total Suspended Scuds tTS5) 5160 mglL Preusated Effluent Quality Monthly average Biochemical Oxygen Demand tBODs) S30 mg/L Tatai Suspended Solids (T5Sl 538 mg/L O NA Fecal Colifonrs tgeomertric maanl S10` cfu/100m1 Maximum Effluent Partiota Size 14 in die. ~ NA Other: DNA "Values typical for dcxneatic wastewater and septic tank effluarrt. BYSTkM 6re~.:trwE. i ~a+*•o 3eptia lank Capacity ,~ (] al DNA Septic Tank Manufacturer ., , DNA Effluent Filter Manufacturer ~ ~ DNA Effluent Fitter Model ~ d NA pump Tank CapacltY al DNA Pump Tank Manufacturer r~,s ~ y. DNA Pump Manufacturer ,~,~,u/ DNA Pump Model ~ ~Pd ~ f7 NA j, Pretreatment Unit O SandlQravai Filter D peal (titer O Mechankai Aeration D Wetland p pisinfection D Other: ~isperaal Csltls) O NA in-Ground tgrsvityl Q ln-Ground tpresaurizedl ^ At•Grade d Mound D Drip-Line D Other: Other: DNA Other: DNA Other: ^ NA MAINTtt:NAMCE 8CFIEDt3LF SsrWae Evem Service Froqusncl- Inspect candk'ron of tank(al At least once every: 3 ~' a iMaximnrti 3 ysarsl eartsl DNA Pump gut contents of tankts) When cornbtned akidge and scum equals one-third tYs) of tank volume DNA inspect dispersal cell(s) At least onoe every: ,~ monthial (lldaxtmum 3 years) euGr1 DNA Clean effluent fEter At least onoe every: Month el O NA inspect pump, pump controls 8c alarm At least once every: ~'~ ~~ s1 d aerie! ^ NA Flush latarah and pressure test At least once every: ~'-' monthts! p earls! DNA other: At least once every: --- ~ M a~rli)~s? DNA Other. D NA MAIAiTENANCS INSTRUCTIONS tnspscrtiona 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 Mabtalner, Septage Servicing Operator. Tan inapeations moat include a visual inspection of the tankts) to identify any missing or broken hardware, identffy any cracks or leaks maasun the volume of combined sludge and scam and to check for any back up a ponding of effluent an the ground surfacE The dispersal csltts) shalt be visually inspected to check the effluent levels in the observation pipes and to check for any pondin~, of effluent on the around surface. The ponding of effluent on the ground surface may ~dtcate a falling condhion and requires th immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equate one-third IYsI or more of the tank volume, the entin contents of the tank shell be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113 Wieconain Admihlatrative Code. All other servicsa, including but not limited to the servicing of effluent filters, mechanical or pressuraed components, pretreatmen units, and any aarvicinq at intan+als of 512 months, shat! bs parfarmed by a certified POWTS MatntaMer. A service report shalt be provided to the local regulatory authwrity within 10 days of completion of any service event •apo~ anile~is{u{utpy uNuaoslM `(E) ~S lLl 'Il)49'E8 pus il)~8(p)tt)iq)IZ-ZL'l;B tuu~o~ ~aideya yi{m •auo(fdwoa ul pai;e~p aeM twumoop S1zll` -~J~ S 1 auoyd uI{viNa~ ~ ~~a~ eweN auoyd ;; -- •- _ -vweN /LL1tiOHlf!1r A1lOlt/`tt1D~k! l11'~Ol 1!l3dWfldl klOlV Sd0'!~N! ASS 30V1d3S auoyd eweN ~3Nrvlr~rw slnnod ~f a,,c~~ ~..~~ ~a '/~~' eweN k~'il1/18Nf S1MOd S.tN~WWOJ 1VNOI.t.IQQtf '~91SSOdW) te1011t~0ldilf! ~9 AVW ~NVl d d0 !lQk131N13Hl WOad NQSSi~d b d0 3t1~3~~f '11t1S3~f AtlW H1V9Q 'S3~NV1SWf-~aiQ ANV aiHONtI ~NVI 1N9W1V9l11 ii3lfl0 !!O dWfFd '~l.Ld3S d kfd1N~ lON QQ •Nd0AX0 1Ti~1~lddtiSN1 Ii0lONV S3SSVO '1VH13'! NIV1N0;~ At/W S~NVl 1N~W11y3!!1 133H10 GNV dWf1d '~Ild3S < <oNlNavM> > •auHi leyi ie ioa;}e u{ salna vyi yi!N+ Afduioo ienw swaisAs vans;o suo(ian.Iisuoo6~( •aoe;ins sn(le~i~u! ayi is iewo(q ayi ;a )enawea Bu{nnopo; aoe(d u( paion~i8uooea aq Aew swvisAs uo}idaosge ({oe epe3tS-ie pue punoyy p S.LMOd u! seouenpe Buuass 'S1MOd pvi!$d ayi aovlde, of i,ose, ise! a se palleisu! eq Raw ~uei Du!pioy a Adolouyaai •suoliei!w!! i!os ,olpue ~aegiea of anp n{ge!!ene iou s! sore iuvwooelds, 0lgtt~ns d p 'aw(1 iey3 ie ioe}•}a ut se~n.- ayi yilnn A)dwoo ienw swaisAs iuaweoe)day •ea3a iuvweaeldel algeilns $ ys({geise of uo(isn)eno of{s pue ((os Mau a ,o; peso ayi w i(neva !!!^^ ea3a iuawaovlda3 ayi ioaio3cl of o3n)(ed 's)(een pue S@UIi 10{ 'a3nion3ls pasodad pue Ou(islxa wo,; s~(osgies pa3)nba3 ~cq uodn pe$uu;ui $q ion P2noys pus ual3~edwoa pue a~ueganisip wad pe~oaio3d aq piaoys ea3a iueweoe)de3 ayl •weisAe UolidloSg6 1108 1Uei~W~B)de1 a ;0 uotieJO( ayl 30~ pe2!(nn aq l~ew Rue peien(ene ueeq say ea3a iueWaoelda3 eigeifns y p :weisAe iuewvoelda3 iuepdwoa epos a apino3d o3 'ua>fe3 eq isnw•,o 'ueaq en¢y sv,nseaw 8u!rno{{o3 syi pa,!ede, eq iouuso pue slle! $1MOd vyi 11 NV'td JlQN3l,NIlNtla '!el3eisw p!{os ueu! 3vyioue 30 lene3B '{!os yiinn papl~ easds pion syi pue penou~e3 s3enoa 3(syi io penowe3 pus peieneoxa aq ((eys si(d pue s~uel !!e •9uldwnd 3ai;y • 3oie3edq Bu(a(n3ag eBeidag a Aq ;o pasadsrp ~t~3adad pue panowa3 aq 11eys szfd pue s~(uel pe ;a siuaiuoo eyl • •pvlevs s8uluedo ad!d pvuopuege ayi pue pe.oauuoaslp aq pays sl{d pue s~usi of Buld!d iltf e :epos entig318!ulu3py u{suooslM '££'£8 wuao~ ,aideya y={nn aaue!{dwoa u! pauopuege Aio;es pue Al3edo,d s{ wais/+s ayi 1e43 a3nsu( of ue~(ei eq ({Eys sdeia 6uinnoi{o; ayi ao{n3ea ;o ins ua~ei Aliuvuew3vd s{ 3o~pue s~(e; S.LMpd ayi uayM 1N3WNOaNd8H 'auuq 3vuei;os,alenn pue :suodwei :su{~deu ~c,eiiues :sap{nlised :sionpo3d $u!iulad :pa auoiigaipew ade3os ienw aap(a(g3ay :asea3B :eul{ose~ a6u{~eed e!ge38Ben pus un3; JaieM idwnd dusns} uie3p uo(iepuno; :ie; :siueiae;u{s{p :s,ede{p :ssoi; leluep :s3esea38ep :sgenr•s uo3lao :swopuco :sunq auv3a6{o :sad{nn Ageq :soiio!q!iue :S.LMOd aui ;0 2;!! ayi $uolo3d pus aouew,o~ad ayi eno,dw! ~(eui weans JeleMaiSeM ayi wo3; BulMOpo; ayi ;o uolieu{uu!}a 3o uolio~pea •ea,e uolid,osge ios eps,s-ie ,o punaw Aue ;o edo~s umop Iva; g 1 ulyilN- care ayi 'loedwoa ,o g3nistp vs!hn,©yia 30 ',eno ~l3ed ,o enl,p iou oa •s{{eo les3eds{p pue s~usi 3vno ealolyvn ~3ed 3o vnup iou oq •~uei du3nd ayi uiyi(M slvne) (ew3ou 93oise3 of s~o33uoa dwnd ayi 9u)isredo A~lenusw u! is(sse of ,au{eiu(eyy S•l,Mpd ,o ,egwnld a ioeiuoo 3o du3nd iuan{;}a ayi ai 3en++od Bul3oise, of ,oud 3ole3adp 8uioin3vS aBvidag a Aq panowa, aluei dwnd ayi ;o siuaiuao ayi aney uo{ieni!s s!yi p{ons of •iuen{~v ;o a63eyosip aox}ins 3o dn~osq ayi u{ i)nsa3 Aew pus (sN~va ayi du{peol3eno 'asop at33e1 auo w (slllao les3adslp ayi of pa83eyas{p eg !!!nn ,aiennaisenn sseoxa ayi pa,oise3 s{ 3ennod uey/N •slene! 3eisnny${y lew3ou anoge p{3 /yew s~usi dwnd seBeino 3ennod But3nq •eos;3ns enlis,i!!;u! ayi ie uvza; as suolilpuoa t1os ueyn~ ,noao iou pays do i,eis wsisAr~ •esn of 3oa3d 3ois,edo du!oln3as e8eidvs a Aq pvnou,a- {s)~ue3 vyi ;o siuaiuoa vyi ansy poiaaiep a3e suo:ienueouoa yBly;1 '(s)Ilao ~es3ads(p vyi eBswsp 3o~pus sseao3d iuewiea3l vyi apedw( Aew iey3 s{eo{weyo ,ayio so sionpo3d Bu{lu{ed ;o aouese3d vyi ,o; {s{~luei iuawlsa3i ~d~yo S1MQc! ayi ;o esn of 30p3d 'uolion318uoa n~-au Sod NQll~itl3d0 akt/ dtt 1ln11S _____ ~o g8ed o v/ ST CROIX CO ~ AORBBMENI' gpPi'IC TANK MAINI'ENAN AND OWNERSHIP Cgg~(',ATION FORM OwuaBuycr ,Sl ~,J,JA Cv ~ Porn o ' .Address ~ VIKr~ ~~= SUi~ ~O~ D ~ /~rJ ~3S Mstrlrn~ Ptvptxty Address 7~ ~ ~ 'r (Vedfic~doa required fzom Plaaaim6 Doparboneat for new tnastntctiora, DSo~ (~t/~ Parcel Tdenfifi~tioa Number o zo - I~~ `-~ ' o -~~ ~ ~~~ C}ty/Staty f-lU ~,r,,cAi n>~sc.~TION ~ ~ AA ``S 0 W Town of ~-/(/DSO Property Location 1V ~ '/•, ~'+`/,, Soc. ? , T 2~ N~R THE --L N Lot # Subdivuiom ~- Volume _ --~ Page # Ccr-tificd Survry Map # _!~ Volume ~ ~ page # t 3 warr~-nty Decd # , Lo (o ~•~- D.~O cs Q no Lot lines idcutifiable ~ y4s ^ Ao Spec house ~ y S~.X TE11~ M~T~N~~ Hue: tilure.to baadlt.rutes. Piop~rmsinteaaace Improper cue and mainit~e of your K,pOc ey~em could result in its p~ R~hax You put into the rytxcm ooasia~s of ptm:piag out tba ccptic Halt every tbrcc yesn° or aooocz\ if oc4dod by ^ licon~ ptrmper- sa affect the fuacrtioa of tlu ccptic tialc as a trcatmoat stage m thc,vaste dirpoal syittm. 'I~e propury owaa a®ecss to cobmic to St_ CYou ~ De~pattm,et-t a etnsi5catioa form. s!P,a~ by ~ owaa and by a lumber ~igodplumba or a licaaaod p~P~ ~~ tlut (1) the onsite wastewater tlispos 1 ~m m~P~~1o`upQS"76dJ°P ,f~cecsary). tLe septic task it less tbaa 1!3 fill of dadbe. is {a Propel opcsatting covditioa and/or (Z) stter~asptxdoa aa~d pumping (• 1/aac, tbo uadotsiy~ud dsve read-the above icquimmco4S ad forth bcrzin, a; set by the Deputment of Comore etstias tbs aeptic systrm boon o>z~ d..Kaf il~f rbroc year cxpiradace. wu tcwa8~ dispose eyeLcm ~vrds the tdndazdt ~} agree to maintain the pri and tho Department of Natural xcaouccesti Stste of WisconaOP~cca30 be comgrlcted and returnod to the Sr. Ckoix CotmRy 7.oni,a$ chat all s acs o thic form m true to thr. best of eryof Doeds Of6oee. abov a aarraCty dad recorded is A,egist _~~~~ DAB Z (~) am (sre) rho owa~s) of r D J~V\~.• ~~/~~t •••••• Icy iarorrnati,a ti: mis-repteseocedmay rcault in tht taaitarYpe[mrtb0m8 r0vokedby-theZoatoB DoP~°G •• Il,ctude w~itb lhls •pplieatlon: a cramped wartaaty dead from tbt I~,eSietet of ~~ otfiee a copy of the ccrdEed survey map if ttifct~ it trade IA the waxranry decd TOTAL P.02 --~ . ~ - ~ ~~~ STATE BA R OF WISCONSIN FORM 1 - 1998 6660~t0 D WARRANTY DEED Vet ~ ~7 P 613 KATHLEEN H. WALSH O~ DEE D3 S7GICROI ocument Number , _ . AGC 1 _ O W X ' _ - _ phis Deedr made betwe en Bane Corporation, , RECEIVED FOR RECORD _ a Minnesota corporation --- 12-21-2001 3:10 PM - _-.^ YARRt'1HTY DEED and Sienna CorporationT a Minnes _, Grantor. ota cor orart„r, i EXEMPT ~ CERT COPY FEE: p - COPY FEE: ---- _~ TRANSFER FEE: 9863.0 _.._ PAC DSDIHO FEE: 7.00 - _ _ _, Grantee. ~ X Grantor, for a valuable consideration, '; described real estate (n St. Croix _ _ conveys to Grantee the fol!owing County. State of Wisconsin ; (the "Property ): 9 ~, Hecaldm re,. See Attached Exhibit A Name and Return Address ' (~ni~r~t.L %~~ ' i 5'1~ 5me+~rr ~ri~ ~ii.i+~. ~nl ' , F~l i vine ~-onk~., UI IU 553' _. U 20-1048-30-000 Parcel Itlanlification Number (PIN) This i9 not homestead property. (Is) (Is not) 20-1048-60-000 20-1048-90-000 20-1049-90-000 20-1050-00-000 20-1050-80-000 j, 20-1052-20-000 20-1052-70-000 Together with all appurtenant rights, title and interests. P Grantor warrants that the title to the Property is good, indefeasible In fee sJmple and tree and clear of encumbrances except See Attached Exhibit B. ;Dated this 20th day of December Bane rporation (SEAL) by Joh M. Nassef Its C ief Executive Offic (SEAL) I Signature(s) AUTHENTICATION authenticated this day of , TITLE: MEMBER STATE BAR OF WISCONSIN (II not, authorized by §700.06, Wis. Slats.) 2001 (SEAL) ' (SEAL) ACKNOWLEDGMENT Minnesota State of iArlS'ti•UTrs7T1- ss. ~' `M~'` "I County. Personally came before me this i u\I ~ day of ' December 2001 ,the above named John M. Nasseff, Chief Executive Officer of Bane Corporation, a Minnesota _ corporation me known to be instrument and at to who executed the foregoing NARRYE~t3ALLAHER THIS INSTRUMENT WAS DRAFTED BY ~~~ ~ -~.. Lockridge Grindal Law Firm -~-.0~---I4La..S ~ - + Minneapolis, MN 55401 No1,tq'~ubhc.StateofWisconstn - 114fy commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not January 31 , 2005 } necessary} 'Names of persoiu signing in any capacity must be typed or printed below their slgnaoux. WARRANTY DEED STgTE BAR OF WISCONSIN wsconsin Legal Blank Co., Inc. FORM No. t - 1998 Milweukey, Wis. W ~..~io. ~~ ~~ < ORANMID DALE: OCibPElt 141N, 2002 REVISED: oEC~raEx 9TN, 2002 __ '~ \ \ ` ~ \ s \\~ `~ ~~ ~ ~: \ \~T \ \'~J. ® so i 0 tso SCE ~~ ~ ~. 130.12' NO ONEWNO FLOOR ELEVAl10NS eaow az7.o 19 ~60~3 S.f. (1.057 AC.) WATER ELEVATIONS: . DATE of svRVeY a17.e' APPR010MA7E LOw MATER ELEVATION: 817.8' , • •~ too TEAR FLOOD ELEVATIpI: a2s.20• 4.lVAADNS RtFp1ENCED TO U.S.Gf. NAW 2P)_~~~ TT1P NUT HYDRANT AT NOR1N SqE a AQ / 1173' EAST of eu1IL oAtc dIRVE_ ELEVAT1aN•a7a.o IIfMCIUARIC 1\ . ELEVA710N . 82827 I ~ OUTLOT 5 NONE 0 " 70 ' ' (1a.z72 AO,) BLOCK 2 TaP I 1 ELEVATION . 824. I 1 ~.p4y~'E 241.69' I 1 .c i ~ 1 I iz 1 1 I N I z 1 ear 1 } o0R EIEVAnoNS eELOw e27.o I i 1 Ic I~ (,n 20 52082 I I : c.) 1$ Sep I 1 1 ~ I 1 ~~'`~ m' ~ ~ \ J. ~ ~. / / \ \ / ~ / ~ ~ / ' • 81 ~r ///•~ ._ / - .A / ~,~. / ~ ~'`~ ~ ~ N_BS'23'4 ""~ f G I I /~. \V I v /``G\ / ~ i~/~~ ~ / ;~ / \ \ ~A ~ ~ N/ ,' / l"A~ / . / ~ ~ / ~' I ~~ / ~ ~ 1 ~ ~%~ _p\~ /1'n.'~ s3w f, (1.217 AC.) t FIB"- / 1 ~ I~~ BOOR ELEVATIONS -- . -/ q 0 1 aELOM u1.o u~s• ~ sa4.os• • ~ N89'S2'10'W 682.86' (Sa9'ta'27'E) ~ r~i - NOR1H UI~S ~ GGM• VO{„ 12, PAQ 3292 ANp C.S.M. VOL. 11, PACE 3128 - _ _ / I H . ~ ~ 1 nT ~, 1 ~ 1 //1I - •1 L.V 1 X9463 SF. h.n3 Ac.) ~MM J a J QR ~w s S. ~ o n -~_ ~ y -~_ ~ °y v w ~) A ``)/~rl >r/~ ~i /'~1\ ~Lly ~L_~_ V VL.. ~1V / 0 N 1 ~~ ~) A )/~rl -)r/~ ~h..~~._h~,,_ vvL.. _) t.,/ (f~ 1 /~\7 L_ ~t~iv O .'----____ ~., BLOCK 3 ~ ~ .\ ~\ w 5 ~~ ~ N ~ ~~~~ ~~ ~ ` ~\\ ~\ ~ \ ~ \ ~ \ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ _ ~ lY l'ICAL UTILITY •CFMENT D TAI I I r-s. r ~~ i ~ ' l EA i T ~^ t E -~-----~ I ~' ----I- I ~ ~ MAY UNE 3 EASEIIENIS ARE AS OEPN:lEO AaovE aasaa oTNERwsE sNOwt ~ A •'1/~rl 1_~h.,L~. Iri„ hL~.._ I t /^) V Vl_. I~ _r 1 v~.tv . ~)A/~f ~ i ' ~~/ ~~ / 1\7~ ti ~i / --- ~ -_ ~) A )/~r'1 ~,h_ c ~. Ir'/~ h c.,_ t x/11 ~ /1 ^ V_VL.. ..tVv _~ 1.,~ . l.V ~ I /~ ^ \ ~ - ~ 1/11 -~ 1 ~~v.IVI. V \./L.w ~ t ~'.A ,.` . I O N O ~ O N m o (D a fn Z y co D ~ W a c_ ~ .. Z O ~ ~ c ~ ~ v ~ m _~ m O 3 N N m m y ~ O ~ a ~ C] d ~ O - .. < 3 3 ~ N ~ N N m Z a~ o o. ~~ ~ y •J ~ O ~ 7 _h r: CD N f~D N N N a? v m m O -O ~ n a~ ~a o a 0 N b9 ~ O ~ °c a n cn p c :: ~ ~ ~ ~ ~ ~ .'. m ~ =r o~cn (D ~ ~ ~ m C7 O r N H ~ ~ c ~ m v a ~ a ~ A N ~ a O N 7 <_ 000' rn N ~ N ~ovv, m •• ~ 3 °1 3 re C ~' Z N ~ n ~ o ? ~ 3 (~ y n y ~ C 7 3 m a' a m ~ cc c n ~ A a 3 °o ^' 3 ~! z A T C a 3 d o ~ n 3 ~ v m ~ m C O N O. IV O O ~ J ~ ~ A_ -{ ~ A O N ~ ~ b ~ °o .~ (Aq O C 3 :'! Q .. o m ~~ -~ -a t~ A Z f0f ...1 'A K A Z O .. ~ ~ ~ ~ o z ~ ~ ~ ~ m ~ A d '~ ~: m Y~i R rO~ R A7 O Cf ~1 fx~ C 1• N ~ fi Q a e N 'V yV N O b ~" A 'r 0'p O. t0 w '+~ O ti a ti