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HomeMy WebLinkAbout020-1414-80-000ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / ,, OWNERSHIP /C~ERTIFICATIrON~ FORM ~I OwnerBuyer ~f~'N ~ M 19'~ ~ ~,~J S7n tom-, J`~ o ~'h ~~ e~y l`2G ~~~cH~ Mailing Address ~ S~ 1--A'K-~ ~ ~~ Property Address ~o?~.~/~'1~T1~ ~}'V I ~ (Verification required from Planning Department for new construction) CitylState 7 1 yl~Sb ~ ~~ Pazcel Identification Number o 2 D'!y/~-~Q OUP LEGAL DESCRIPTION o Location .~ '/. ~ % Sec. 20 T Z N-R~_W, T wn of ~'jy~ ~~ON Pr perry ,,'' Subdivision ~F"I ~ (ate .Lot # ~ Z Certified Survey Map # .Volume ,Page # Warranty Deed # ~b ~~~ ,Volume 7 Page # ~~ Spec house 'yes ^ no Lot lines identifiable ld' yes ^ no SYSTEM 1~'IAAINTENANCE 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 tnasterplumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Lwe, 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 o the three year expiration date. - - ~~ ~ Si,!laS SIGMA OF APPLICANT 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 owner(s) of the pro erty scribed above, by virtue of a warranty deed recorded in Register of Deeds Office. /` A PLICANT DATE ****** Any information that is nus-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 Wisconsin Department PRIVATE SEWAGE SYSTEM Safety and Building Divi INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ~~~~ City Village X Township Hudson Townshi CST BM Elev: /~ Insp. BM Elev: BM Description: ~ 6 ~ D ~ ~ Z~Jrtn-Gt- drTe~ s j Gi± TALII! ILICl1~11A ATlflhl CI C\/ATI/'-I~1 1'IATA TYPE MANUFACTURER CAPACITY Septic 2 Dosing ~GO W ~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELJ.., _/ BLDG. Vent to Air Intake --~ ROAD Septic `~ r ' / Dosing ~~ Aeration Holding PUMP/SIPHON INFORMATION ( ~A/.C~v Manufacturer Demand GPM Model Number TDH Lift Friction Lo System Head TDH Ft Forcemain Le Dia. Dist. to well County: St. Croix Sanitary Permit No: 453045 0 State Plan ID No: Parcel Tax No: 020-1414-80-000 Section/Town/Range/Map No: 20.29.19.2616 STATION BS HI FS ELEV. Benchmark Alt. BM /~, 2 t- B~ g. S wer cF~~O o 3 ~ 5. ~- UHt Inlet •~ SUHt Outlet / 1~• ~O ~Jt.~O Dt Inlet ~~ ,~-_ Dt Bottom ~ -~- Header/Man. ~. ~ /~S 6,S Dist. Pipe~b ~ ~S~ b-~" ~ Cf (.~- ~~ Bot. Systems/ g q ~ j. S~ Final Grade ,~r,{ ~,,, o~ P 2 , ~- ,- 5.3 ~ -~ -r S St over ~ ~~` ~ ~rj" ~ p p, b 2 ~ -1- ~. U~- ~I SOIL ABSORPTION SYSTEM G ~~ w,/-I'G~ 'h Z 3 ~,r,A~l. BED/TRENCH DIMENSIONS Width Length ~/ ~ Z, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~ ~~ ~ SETBACK INFORMATION SYSTEM TO P BLDG WEL LAKE/STREA LEACHING CHAMBER O Manefaeta -~ T f S stem: yp y 1 ^ ~ i ~ ~~ \ Model N r: / ~ I l DISTRIBUTION SYSTEM 0~ ~h~n0 ~iLr. ~ 0-f' ('D .C I/S Head anif d ~~ ~ ~ Distribution Pipe(s) /~ ~ ~~ ~i ~ / x Hole Size x Hole Spacing Vent to A' n Len th Dia Len th Dia S acin g g p g SOIL COVER ~ , Y Prassura Svstems only YY Mound Dr At-Grade Svstems ~nlv Depth Over `~ An Bed/Trench Center ~ J~- D pth Over ed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched ~ O a Yes No Yes No ^ .' COMMENTS: ~c o e discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 726 Martin Avenue Hudson, WI 54016 (SW 1/4 SE 1/4 20 T29N R19W) The Glen Lot 22 ~ Parcel No: 20._29.19.2616 1.) Alt BM Description = ~~ S~2jVi.Gv-~' ~S f~ ,Q~t?.U'~,., '`- 2.) Bldg sewer length = ~ ~ ~ ,/ /I ,/„ /n), (n~/_ ~ ~,~ -amount of cover = ~ ~ ~ ~~ i~ ~, ~ ~ ~ h~ ~1.~ (.~1~t'QX.(T ~''`'~ l i ~ ~~ ~,,n`f s2~ W ~4 -71't~G~ "J" r ~~ .u ~r -- ~ ---- - _ - _-- - - _ - - ___ . Plan revision Required? o I ~/, I ~ D~~ ~~ _ ~~~ ~/ _ __ Sy Use other side for additional inf rmation. __~ _ SBD-6710 (R.3/97) Date Inse ctor's Signature Cert. No. ~ f dG~~,~ take V'~. Safety and Buildings Division ~'r~ 201 W • W ashington Ave., P.U. Sox 71 Madison, V G® I~ /~~~J~S~~ (608 266- ~.----____ Department of Commerce ~ 005 Sanitary Fermi ' ~ plicate n ~ , . ~ ~ 2 ~q~~s inf rman n you provtde CC~N~ to accord with Cetnm 83.21, Wis. Adm. w ~5 1)(m)S~ , CRUtX FILE may be used for secondary purposes Pr OF ,..__.... v_a,,. ett information ~y ary permit Number (to he fitted . by [r n ~53d~` :Plan 1.D. Number t Address (if different than mailing address) 1. AppllCatron iniorr.ua...,.. - , ._...._ - - ---- - ~ Block q Parcel # Lot # _ /~ Property Owner's Na me / /j ,`~ d/~ d(', ~ .~/llC. / !'N L ~,2 ago-i~ _ ~o- , f ~ _/ . L Location rt p y rope Property Owner's M ailing Address ~~~ `(/~1,. ~ ~ ~ Section ~~ ~'k ~~ 'k 6 City, State ~ Zi~od'~C-~ Phone Nu ~e~O J~ ~ ~~' ~ _ , .. , 1 i ~r ~p~clrcle v 1 T ~7 N~ R- ! -Eo ~ II. Type of Building (check all that apply) ?~ i ~~ 1 or 2 Family Dwelling -Number of Aedrooms ` a5 - Q ~ ~- Subdivision Name CSM Number_T~ U ~~~ ~ ^ Public/Commercial -Describe Use ~, .._~.-~-- ~. ~4 - ~ ' r~,,, { ^City ^Village ~ownship of~~,~ /~ ',~ State Owned -Describe Use _ ,_ - III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A" ~ Iv'ew System ^ Replacement System ^ TreatmenUlioluing Tank Replacement Only { ^ Other Modification to Exis[ing System ansfer o N List Previous Permit Number and Date Issued Tr e of ~ ermit it Revision ~ ^ Chan B ^ P l P i R g . { erm enewa erm t ,, r ~ Before Expiration ------ Plumber Owner /~ d ~~ ? ~~ ~ ~ ~ J N. T of POWTS S 'stem: (Check all that a ly) I`J~Non -Pressurized In-Ground ^ Mound _> 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constnrc[ed Welland ^ Pressurized In-Ground ^ Holding Tan[: ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin Synthetic Media Filter Leaching Chamber - r Line ^ Gravel-less Pipe Other (explain) / _ V. Dis rsal/'T'reatment Area Information: ~ ~ Z >( % % __ ~ g _ Design Fiow (gpd} Design Soil Application Rate(gpdsf) { rsai Area Required (sf) ispersal Area ropased (sf) System Elevation ~ i, VI. Tank Info Capacity in Total Number 'vlanufacturer Prefab Site Steel Fibers PI StiC Gallons Gallons of Units Concrete Consvucted Glass New Existing Tanks Tanks _ Septic or Holding Tank ~ ~~ - sd ----- --~~, -i Aerobic T'rea[men[ Unit ~~ ~~C~ / - ~ ~ ;,,,t! V ~~ Dosing Chamber ~ ~ f I .__.... ~.T..-.. _~ _._.- ' ---i V IL Responsibility Statement- [, tht~ titrdersigned, assume responsibility for ' llation of the FOWTS drown on the attached plans. Plumber's Na me (Print} Plumber's Si gnature ~ P! PRS Number Business Phone Nwnber ,'!!r a r-,. Scs!"ytatr-~L C ~ oZe'~ 7Gl I d / `..f`"~ 3~~' 3ro?> 'i Plumber's Addre ss (Street, City, State, Zip Codei ,AJ ~ / , - CCU VIII. Coun /De artment tise On! ~ Approved ^ Disa Sanitary Permit Fee (includes Groundwater Date !ssu-d [suing ent Signa r ( o S ~ps) Surcharge Fee) ^ O en _ son for Denial _ ~ _ 5 1 ~5 _ IX. Conditions f Approval! easons for Disapproval f~ ~~ ~ ~"' - ~Y~S OWNER: ~YoJS.~_ l.Jo~ i ,rte. ll' fNter sod ~ , ` ~~ 5 JI t. d' So, b+tn, ll' ~a ~ ' ~a v~ ervices ~ maintainer /~e U , s ik.i must a as management plan rovided by plumber. ~' AM ck regwrements must be rr[aintsined \ t ~ ~ , ~,(~ r 1 ss per applicable code / txdinantxs. 3J ~j- ~ ~„ ~b~- O ~ ~ a 1 ~ t/~r. Attach complete plans {to the County only) !or the system oa paper not !-ass than 81/2 x 11 inches in size ~ r ~~~! ~ b~Ce~ U; ~748P 336 Document No. II STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED SIENNA CORPORATION, a Minnesota corporation, conveys and warrants to LANDMARK, INC, a Minnesota corporation, the following described real estate in St. Croix County, State of Wisconsin. ~g734r7J KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 02/14/2005 09:40AM WARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 294.30 COPY FEE: CC FEE: PAGES: 1 t~ FRE'ttmtte: 'n Saite•BGS-- 4 M' , cording Requested by & ~` ~(~~ en Recorded Return To: v w , US Recordings, Inc. 2925 Country Drive Ste 201 St. Paul, MN 55117 ~~~j~~~ _ Tax Parcel No: 020-1414-80-000 Lot 22, Block 3, Plat of The Glen, in the Town of Hudson, St. Croix County, Wisconsin I~ 'I~( ~Iq p~~I' pp y~NII This is not homestead property. IIIIN~II~INYININWII~IIIIINAN~Y~~All~l~llUl US8551534-O1CI81 Exceptions to Warranties: Easements, reservations, and restrictions of record. wnRRANTV neEo REF# 1030778 _ y _// jj~i~i~ rte/ 2,,, n~ US R~eordlnps Dated this ~ da of ~ C.dJ :6G/yl 17~-~ AUTHENTICATION Signature(s) (SEAL) SIENNA CORPORATION,~Minnesota corporation By CY1c-~~~M Q o . r'o (SEAL) Marsha A. Pierce Assistant Secretary authenticated this day of 20_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06 Wis. Slats.) This instrument was drafted by: Sienna Corporation ACKNOWLEDGMENT STATE OF MINNESOTA } }ss. Hennepin County } P~ ovally came before me this ~~ day of ~ , 20f1,~, the above named Marsha A. Pierce, the As slant Secretary of Sienna Corporation, a Minnesota corporation, on behalf of the corporation, to me known to be the person who executed the foregoing in~ument and acknowledge the same. _ , „ Catherine M. Thornhill, Notary aublic 4940 Viking Drive, Suite 608 Notary Public of Hennepin County, Minnesota. Edina, MN 55435 My Commission expires January 31, 2010 Signatures may be authenticated or acknowledged. Both are not ~.re~ CATIIERN~IEML7MOFVrFNLL necessary. (¢~ NaTAMf PUBLIC-MIriNEBCTA Names of persons signing in any capacity should be typed or printed below their signatures. S"'r ~~/.vo- ~JS~IJ 1 d ~ 2:L- ''j/~. ~~`~. ~,y~ ~G~~,s OsdJ ~~ ~~ p~~ ~~ ,..~, v ~~ ~~ ~` 'n ~. ~,ti ~~ ~`~, rG ~~~ S~, -~- ~~gv~" ~~ ., ~% y~ ~~~ a' 6 /// ,t~d~'d YS. l~ ice! 1 ~• (~,..~ `1 ~ • ~ ,~ ~ ~~ ~ ~~ee ~ ~~ ~o~ ~~~ ~~y ..;~~,~~~ ~~. r<, ti Oe ~S ~ys~ ~3 .t M-~ ~~ ,_ .3°4~/?J a ~ o ~IZI,N" C~ ~ ~~ ~ ~,v ~~ ~ rG~ ~~ ~ ~L~ ~ ~~~ s "~-~ F~~~ ~" o , ,~ .~ 9-~ - ~~i Y \rc~ SC ~`° ~' v ~A ~~ r „, L /~/~ i /~ ~^-VI ~~s ~ r~ i ~~-~ - 13 ~ ~ s ~ s's U~ N ~~ ~ 3 ;s ~ gv's~ ~ B ~ 1~~~~'~~~~~~~Fy~ ~~~s' ~-c~zc~Q Sys-{~'k--~ r $'~ e..~/.va. ~d5/~CJ ~ a ?~ 2.Z ~fiE ~~~.. ~e.G' ~a-O~,.S o ~U ~~ DDS G ~~~ ~~,5.~ S/ 7-~ L~~b d h ~° ~~~;~ i~' ~Y ~~i ~ ~ s~~~ , ~`~~ art. ~~~~ ~~ 0' ,B3 r Wisconsin Department of Comrrrerce Division of Safety and Buildings in accordance with Comm Attach ~+pleta site plan on paper not less than 8 1/2 x 11 inches i include, twt not pmited to: vertical and horizontal reference point (BI Percent slope, scale or dimensions, north arrow, and location and di P/easa print ell lnformat/orr. Perspnil information You Provide mw ho ,~...~ ~...._-_-~_-- _ Boring # ~ Qit Ground surface ®ie~. G 9, ~~ h Page _.~__ of Horizon Depth Damittant Color a Redox Description ~-. __ _...._..a .___. _.. Texture Strurxure Consistence Botuxiary Roots ~ icatiort Rafe. G ~. Munsep Qu. Sz Cont. Color Gr. Si Sh. 'Eff#1 'EtT#2 t, 2 .- ~' U sro ~~ * ~ Pit Ground surface elev. rt~~ ~G R. Depth l0 limit~g faG10r T~ in. Sop lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence 8ourrdary Roots GP D11~ ~. Mtrnsep Qu. Sz. Cont. Color Gr. Sz. Sh. 'E(fltl 'Eff#2 v - ~ 6. i L , ; l ~ ,~ssic - c 5 ~ -~ ~ S ~ 1 ~ ~ ~ c. ! ,.~ c v~ -~ ~ C -. , ' i c c~ s t ~' --~ EtTluent #1 = BOD > 30 _< 2Z0 rrrglL and TSS X30 ~ 150 rrrglL ` EAluent 1412 ~ BOD ~ 30 mDll. and TSS <_ 30 rngrL CST Mama (Please Prirrty lures csT Nurrrber SG /Y~cn - Z O q,g Date Evaluatlon Conducted T Ntmber ,.liGw,~'- ld,rtv.?d ,~~ ~~ F r ~ r ~ ~- ~+'~, X14 .. 1W/!'7UOCttOaS 'LGL8-1b9Z•809 A.i.L ~o t S [ £-99Z•809 is iuauti.redap otp soeivoa aseatd 'isuuo~ nsuiaitg ua uc tauoi~tu p»a Jo sa~i~uas ssoaos of ~u~stass paau na~C31 •sa~toldcua pvs ~opinoid aa~n~os ~1~uti~ioddo Esnba us st aaiowwo~,{o ~uau~da4 atU, ~ OE > SSl P~ U~ OE > 9408 ^ Z41E i~W3 . ll&L 04l '> QE< SSt p~ 'U~ OZZ ~ 0£ < =408 ; l# iu~-183 . Z#l13. L#113. 'US 'zS 'uJ ~J 'i~J 'zS '~ pos~'-W 'u! ~IO dJ gi~2! ~W~_ 8 ~~Isvo'J em~x-AS ex~xel 'uQAd~gsu4 ~t iuuulu~o4 41d8Q uoz~ alga uoli~4 tlo9 .~ ~l~~~~d~ '» '~~~~ ild o ~o o Z#113. ~#~13. '4S ~S '~0 ~ 'WQJ 'zS '~ gesunW 'tn ~JlO dJ si~a ~Pu~B aoue~suo0 am~ltgS e~rgxe j uo~seq ~a bump 41de4 sig?! ~S 'u! mgei Bupl~ull of tgdsp '!} 'Hale eoa~ns puno~ i!d Buuog ~ # ~~ a Z#l13. ~#3i3. '4S 'zS •~0 ~op4 •iuo4 'zS 'n0 II~nW 'ul dll4 d'J sib tietrilnog eouaislsuo~ exu~MS em>xel uolid!pb'e0 x~2t ~~'J iueu!uai] 41de4 ~N ei~ uopQal IloS •~p ~- ~i0a16u!ilu~l of yidep 'g ~~ •nele e~e~s puna0 ild~ Buuog ^ # Oupoy ^ is e8ed # 41 i~ad "~- ~eunn4 ~edo~d PAOa _~or 3 AME lsrrdta'it~*~ 'SCAB: 1f° a ~(~ ~ BM i E~.evaT[oN fC)~ ~ y ®M ~ DESCR[rT[oN '~~ulGz BM 2 ELEVATION ~.. BM 2 DESC[e[rrloN -- SYSTEM ELEVATION ~ ~, O `~ SY8Tt<M TYrE ~ ~ ~1V~k +'~ ~ ~ ~~~ n-G~, ~9 SIZiNATUl~E ..'~~ :.,......~-°.~"G_.--_.----°.,,_..._.---~~ UATL ~C..' - ..5~-O r~----- r ~, - ..t --- ( .~~_ ,__--__._._.--~-, - _ Safety and 13uiidings ivisiu ~^- ` _.--__ my ~' ~ 2111 W .Washington Avt:. , .0. $ux 7 i 6 GYo ~ ,x i s~~~~'~ De artment of Commerce ~ Madison, WI 537 - 71~~l~i , (~S) 266.3 S1 ~~ .`~ ~ _ Sanitary Per it Num (to be filled in by Co.) ,~! ~~~ ~ Sanitar Permit A lication ~<t~~ ;~~~~~~ Y PP ~ ~ P' l.n "'"'ter ~,,,, ~~ In acr"ard with Comm 83.21, Wis. Adm. Code, personal information you provide ' ~~r~ ~ ,,, ~ ti may be used for sevotydary purposc^s Privacy Law, s15.04(1)(m> _ _ Projev ress {iY diffrrenr than mailing address) f I. Application information -Please Pritte A11 Information Property Owner's Na one ~ aril ,~ Lot N lock t+ i ~, Property Owner's M ailing ress -~-_• _ Property ovation -~ Y9_Ll D ~, ~' ,~r.'~1-e Sa ~'~~ ~6 ~ S'~,J s~S G~ ~ ~ e)' ~ s i i City. State Zip Ctxle Phone tvumber ,. , , et;t on , ~,'.v a~- ~ v?.5- ~ 9S'~ - ~ ~D (circle ny~J '~ 9 r II T e of B il li ( h k ll T . N; R~ E ort~J . yp tt t ng c ec a that app ~ S ~ c _ ,~l or 2 Family Dwelling -Number oY Bedrtwnu - -~_ 1 Subdivision Name _ _ -- ^ PabliclCommercial -Describe Use p,~Qp~ ~ _.._ i [ ' S O ~_ i,,,~,/ i Jr~ / ~I-~~- ~-~-~l'_V_ _ __ _ _ _ _ ' - tate wned -Describe Use _____- ~ ^Cuy ^Village~iPownshipof III. Type of Permit: (Check only one box on line A. Complete line f applicable) ~p . ( to 210 ( ~ ~ ~ lew Sysizm ^ Replacement System ^ '1' tmenVHoldi Tank Replacement Unly !- Other Modification to Existittg 5ystcm B• ~~ Permit Renewal ~ ^ Permit Revision ~ ^ Chang f '~i Permit Transfer to New 4 Lt r ious Pee Nu ber • Aare issued -- - _.. Before &xpiration ~-_..._._ _ i ~ Phamtxr Owner ~ 1 ~ - -- ~____.__~ IY. Tvpe of.PQWTS System: (Check ail that a 1) -- -- -" ion -Pressurized In-Ground ^ Mound > 24 in. of suitable s ti L .Mound < 24 tat, of suitable soil ^ At-Grade ^ Sit[gle Pass Sand Filter J Constructed Wetland ^ Pressu>'fted !r.•Grouttd ^ Holdi g Tank _ Pea[ Filter ^ Aerobic Treatment Unit ~) Racircaiating Sand Filter ~ J Recitculatin Synthetic ivtedia Filter caching Chambe ~ a Drip Line ~'' Gravel-less Pipe ^ Other (ex lain} _ V. Dis ersal/Treatment Area Information: _ ._- Z 3 X _ __ _ __ Desig n Flow (gpQ) Design Soil Application Rate(gpdsf~ Dispersal Area Reyuir (sf) Dispersal Area Proposed (sf) System Elev~on i / ~S7 ,, GZ- ~_G ~~ _ ~ 7 -j~~J~_`~ _ ' _ Vi, Tank {nfo Capacity in Towl I umber ~ bianufacn, r --"-I prefab Sita Steel Fiber Plastic Gallons Gallons of Unirs ~ CUncrete Constructed ~ Glass New Existing _ Tanks ~ Taetks L Septic or Holding Tack f~ ~ -~"" --' - - ---- cs ` ~ s ~ Aerobic'Tream,ent t:nlt-~- -" '--~ --- _ _ _ r _ ___r_-.._.~_ ---------- - " `t)osing Chamber . _ -l~= ~'/, ' _.___ ~ w~ e ~x - 1 ,~ ~ _ _-__..___ .....~--,----~ VII. Responsibility StatemeDt- [, the tta rsi;ned, assurnr resputsslhillty Por ' Nation of the PO "C_S_slwwn a~ thY a[iached plans. _ Plumher's Na irx (Print) -~ ~ Plu •r's Si gnature ` - MP PRS N b ~ -`- ' , um er Business Phone number ,t ~~~~ ~ w~4 c a2 7 y y~ G Plumber s Addre ss (Street, Ciry, State, 7.' Code) - ~ l~~ ~~ ~ ~ j a l VIII. Count l_ y Department Use On ".~ ~'\pprovetl ~ G Disapproved Sanitary Permit Pee (includes Grouaxiwarer ~ Date Issue Is in A ent Si na g g (No Snnrps)~ ~ Surcharge >'by ~ ~.. '~ Own _ n Reason for l7enial _ _ 2~ -- Zq ~ '- i IX, Conditions p rav _ l SYSTE 3 f 7~~ ` ~~ ~ t,.,,~bRp, 1 Septic tank, effluent filter and e-r ~ I t dispersal cell must all be serviced /maintained ~'~"^ '~~ ~ . h,~ ~,1~ ~~~ .(;'. as per management plan provided by plumber. ~, ~ S ~~, vt.tn... t =-`~_ 2. All setback requirements must be maintained ~/ I as per applicable code/ordinances `~ f~Tt. ~u~.x. pt"~ a,,,,~ ~lS AtwcB complete pleas (to tie County only) for lie sys~ts , pape~~ t e~~~jrY„` ~„± 11 ~ s n_ ~ SBD-b398 lR. ~1 ~~~1 ,R,, '~ ~ '"~~~ co•t~~~,Q~- ~ _~ b ,~ d b i1 J v ~ a 6 v ~~ ~ ~ P 0 Q v . `~ Yi ~ b 3 ~U any +~ ° ~ ~ h~ ~ N b / ~ ~ ~` s 'r~~s~~ S 'L,BX~`_a ~i\ ~ \V ~- s ~`~' ~\ _~ 'E1 V b ,~ ~ ~ I1 ,b ~~ ~ b 3 , v ~. ~~ 1-- 8 ~qq~ r `~ i _~ V1C~sconsin Department of Commerce SOIL- EVALUATION REPORT f}ivision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Mach complete site plan on paper not-less than 8'/: x 11 inches in size. Plan must County include, but not runded to: vertical and hor¢ontal reference pant (BM), direction and Parcel C.D. percent slope, ssae or dnnerrrsiorrs, north an~v, and location and distance to nearest road: Please printall information. ~ Persoru~ irtferrnation provide be used-for serxM 1150 page 1 of 3 Steel Soil Service St. CroDc pending} Date yoe `r'ay f.:M F- , s _ ~ L p Property Owner `" t ion Sienna.Corporatron Govt. tot SW 1/4 SE 1/4 S 20 T 29 N R 19 W Prope-tyOwner's nAaitirrg ~ P~; ~ ~ subd. Name or Csaa~ 4940 Viking-Dr, Suite-608 22 nor The Glen City ~sfMk Slate Zip Code P e 1~~iitiet~0.'% ~ iT~ City Village Town Nearest Road MN 55435 g' `'' '~ Hudson. Carmichael Rd. W';' New Construction Use_ ~ Residential 1 Number of groans 4 Code derived design flow rate 600 GPD Replac~nertt Public a carrmercial -Describe: Parent material Pitted outwash Fkxxi plain elevation, ff applicable nor General comments and recanmendations: System elevation 93.62ft, trenches spsaced and-depth to code 4.08ft bebw grad ( ~ ~ ~Y ~ ~ ~ ~ Z ^ g~ # ~mmg ~ +~ Pit Ground Surface elev. 97.70 ft. pepth to limiting factor in. Sot Application Rate Hor¢on .Depth Dominant Cnla Redox Description Texture Structure Consistence .Boundary Roots GPDIRZ 'Eff#1 `Eff#2 1 0-10 1Dyt3/2 none sil 2msbk mr cs 1f .5 .8 2 10-27 10yr414 none sicl 2msbk mfr gw nor .4 .6 3 27-37 __ 10y1r414 c2d7.5yr5/6 sicl 2msbk mfr gw nor .4 .6 4 37-64 7.5yr4/4 none ~ cos osg mvfr cs nor ~ 1.6 5 64-84 7.5yr4/6 Wane ms osg ml cs nor .7 12 6 84-1 t0 7.5yr4l4 none cos osg ml nor nor .7 1.6 `~ / `' a~. 2^ B«tn9 Boring M Pit Ground Surtace elev: 97.70 ft. Depth to lim iting factor ~ in. Soil Application Rate Horizon .Depth Dominant Gffior Redox Description .Texture Structure .Consistence Boundary Roots GPD/ft= 'Eff#1 'Eff#2 1 0-8 10yt3/3 none sil 2msbk mr gw 4f .5 .8 2 8-15 10yr4f4 none sict 2msbk mfr cs 1vf .4 .6 3 15-26 Syr414 none cos. osg mvfr cs nor 1.6 4 6-96 7.5yr4/6 none ms osg ml -nor nor ~ 1.2 - ttrruent~~ = ctc~u ~ :SU < ZZt) mg/L and TSS >3() < 15t) mg/L `Effluent #2 = BODS<3tl mg1L and TSS <30 mg/L CST Name(Pleaseprint) Signature; CST Number David J. Steel- ~L ~ ~ 248956 Address Steel Sal Service ;~",~/~~ Date Evaluatiwt Conducted Telepha~e Number 1564 CR GG, New Richmond, WI 54017 9/19/2002 715-246-5085 Property Owner Sienna Corporation Parcet tD # pending Page 2 of 3 Boring # Boring }3 ~ ~ Depth to factor limitin 96 i /; Pit. Ground Surface elev. . - g n. Sod Application Rate Horizon Depth- Dominant Cobr Redox Description Texture Stnxture Consistence Boundary Roots GPDlftz "EtT#1 *Eff#2 T D-13 10yr3/3 none sl 2msbk mr cs 1f .5 .8 2 1.3-27 1t}yr4/4 none siel 2msbk mfr gar na .4 .6 & 27-43- 7.5yr4/4 none U osg mvFr cs na ~ 1.2 4 43-9ti 7.5yr4/6 none ms , osg ml na na ~ 1.2 n Borin4 # i Boring _ _ * Effltrenf #'i = BOD 5 3fl < 2P(3 mgfL -and TSS ~3f3 < 150 mg1L ' Effluent #2 = BODS <30'mg/L and TSS < 3(} mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or ^ Boring # Bairtg P~ Ground Surface elev. ft. Depth to limiting.factor in. Soil Application Rate Horizon Depth Dominant Color Radox Description Texture Sfiuctun; Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 L1C. # 248956 SWl/4,SE1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715} 246-5085 The Glen lot # 22 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 El.101.25Ft Top of'h" pvc pipe a =Borings Boring Elevations B 1 =97.70Ft B2 =97.70Ft B3 =93.90Ft ~ B4 =OO.OOFt N ~3,eio,¢r- ~~ l 9 7, 70-x+ .~ ~~~? ____ ~, ~6~`~ ~~5~~ s ~~~ ~ ~ ~ ~ ~,r~ L ~ ~ r7~ i~ 3 ~---, ~o C ~'~ -~' 1~~' 30/ t3 rn ~ s~ lr~ ~ ~,~, ; , ~, ~~v '1 - ' (t; t ~~ r .' ..I, .~ y ~•~1 417 - _, .~ r .~{'ati~ ~'~/~ ., , • t ~ ~ _ ~. ~ ._ + r !1 : `l 1 ~~ fs . ~ 1 .~ _ J -i ~~ fN p~q ..` . 1 p ,.. ` ~f ' ~ ~ OJ' V i. 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As~vE G.~a~E ~ F'RE~ AI&.~-. ~ W?~~_~.W. OR 1":1~'Ic~C~ r. r""' JL`N~T1'O.ti` L°~X Ar"PRO'~~.,~ ~~ .. ~ ~ ~ ~ ~ W,~NI NG LAB. a l~. ~at +~ X { ~ 6 ~ ~~ 1 ~!~~r.r ,P~7 ' t W "s"R ~ ~ isr ,~~Ray~~ ~ ~ ~` rxGxr ~ : . ~N1`0 St?~YD ~ t $ ~ ~AL1-f S i~ST~ F~MP OFF ELL1r . ,,,~,114FT. ~ ~ ~ ? ~ ~ 54L110. St?ZL ."""{'~i ~ ~w"'OFc ~ f '~~ ll2SElt EX: i 7FRM~'T4~,'D c~v;. ~ TANS{ ~~` APFI~'vV~D $~DD~NG U~'DER TAtirK NUFACT'J.~ER NAB APPRQVAi ,...,,s~ECZF:CAT:Ci~'S ~ON~RrTE P~J ~~°TIC r DOSE :'A!VK MAJ~nJF~jCTJ1~,~R: ~.+~i« x---- ~"~M~£R ~,D~ a v. ,. _ ...,,,_...,..,r,,,~. S ~'r . I C ~DO$,~ ~ d GAL. r0~w V C:dJ1'~E .°~,A'C::JOrNG 4o G?.~.. FLO~v'BACK: t~....~... GA:.. ~~R~ Mp~~'pC'It?RER: M~EL NvMBEl~: ' CA~'pC3«I ES: p . SW=TCN TYrL : .~.., iwCHSS • ..,..~,,,,,,,_aA L . MODEL NuM~ER : C ~ tNC~IES SWITCH TYPE : -~..~....~A:« . ~ Q~ + R ED ~7I 5 ~ ~ .,.,~~,,,, 3 2VC h E3 = ~ .• CKARG~ R.A.T ~ ~~AL I ~~~. ~RT'GAL JIFF .Rah AS ILHR 2~.t3' ~A~ ~YN'''~UM NEB LMCE BC. Oi F ANL ~iSTRYStlTSp ,...I..r. FED"'D~ORCAtu XXESS~RE N P~P~ !.~ r££:~ ~, '~.. CN FACTOR FEET ~~~xHAL D1 `~ +oT.~~, r~'~pr~zc rt~nD : ' ~'~rr sV~ 1 ~ rrr~'tG~ .......~....1.. ~.( ~j 41a.~(~r~~ ~.. 1. i ~ ~Tii~~M, alit +w~~~ '""'° ... ;~ ~+~GERE~ ~:"j` !~C"Iw, ~~faG ~y GCu~ds t'~s~ `? a ~ E~~~ ~'~A ~~ _.J .~~~~" ~a~~ ~' ~'"~o ~!4 w .. N~ ~ ~ FPM. ,~ T~ AYds; ~ b ~1 i>k . 4M~ ~1 fM N~'T: ~ ~bA1~s, •t ~ 'm M .~ ~ m ~~ t~b~~M, ~was~~ • .~~~ t~' w-r. .~~ ~~ r ~ GIRL fr er,y ~ h.~, ~^a. wan«r goo H,~a ~ ~. ~~ tD Mille: t o.~ ~R -~. ~sao° . rs~ -tare ~ ~~~ ~ ~~ ~5 hP. buitii oN b,Id ~A~M, ~ n~c ~eWd:10 toot ~ ~~,1d+~ &i*0 ~OrounC~n4 ~ s,-rww~n . ~~~ p~ ~d ~rtt ~w f+aM ~ M^u~rw p~ ~ ~ ~~ III ~- ~~~~ ^ E' 1~. ~ Ana. ~~ ~~~ '~flQA t1~ Md ' w~~,, ram. ~~~ ~ oto!' ~' ~n duty ~1Ani. hMirvy~~ iowtr ~ ~~ ert~4nt~~ "~ lM,.., •i W11Wf'1r ~~~ iii The Standard Infiltrator° Chamber The Standard Infiltrator Chamber T L. - 75' Effective Length Chamber End View PosiLock'" End Plate O OO O O®po D 0 OO 0 Oo Q O~O O~O~O OHO®O' m in c ~ Size (WxLxH) :...............34'x75"x12" (85 cm x 191 cm x 31 cm) Storage Capacity ..... .::..77:5 gal (293 L) Weight........: ................:......26 Ibs-(11.8 k9) Louvered Sidewall' Height ..........6" (15 cm) INFILTRATOR SYSTEMS ING STANDARD LIMITED WARRANTY MJf~TRATOR SYSTEMS. INC., rkmlhec«~ STANDARD LIMITED WARRANTY FOR SEPTIC PRODUCTS lal The stnrchrd kaegrity d each cheobe and end plate rretwdaaued bbyy hditrat« (cdlecwNy referred to as'Unrts~, when NtstNled and operated n a leactileld d an arlsNe septic system in tlrxordence wNh ktNtrat«5 IrtstaAatkn Ir6bucliorts, 's waeattted m the odgkral puchase ('Flolder~ a9anst Oelec- dve materieh aM workrrrertship for one (1) year ham the data upon whirh a septic permit's issued 1« [he septic system ,braakxng Me lJrds: provided, ttoaevec that r a septic permit k not regtired for dre septic system by appNrxble law. the one Il) year warranty pexd wit begin upon the date the irtstaMdon d the septic system c«ranavas. M «de W exetlse warranty ngfxs. Hdda must ndhy hrfilhat« n wrxxg al xs carp«ate headquarters in Od Seytxodc, Comeaicu4 wiWn fifteen Il s) days a the staged defect. kddhat« ova supply replacement Urns rot those urns detemined M Maoat« to he tiefectlve end covered by thB LinNted Werreay. hfarat«§ febiky spedf~caNy excludes the cost d removal anN« IrWauetion a the Urws. ml THE UkXTED WARRANTY AND REMEDIES XJ SUUPARAGRAPH W ARE EXCLUSNE. THERE ARE NO OTHER WARRANTIES WRH RESPECT TO THE UNITS. INCLUDING NO aAPLIED WARRANTIES OF MERCHANTAEIILITV OR FITNESS FOR A PARTICULAR PURPOSE. W The Limited Warranty does ndl extend to Tridental, consequereial, special « kdiea damages. kfihrat« shah na tie fable f« peneNies « Nquidated damages, Trcfdirg loss d production and prdxs, labor and rreteia5. overhead costs « other losses « expenses Trcured by dre Holder « any tlxrd party Specf'icaly ezduded ham Limited WartaMy coveaga is damage to the IMTS due to «dnary wear and tear, akeeton, accident, misuse, abuse « rx+.glect d the UrrTS; the Urvts DeTg subjected m vehkde haRx: « other cordxipis vdvch are na permxted by the TrstaNatiarr nshuRi«ts; laitre to rnain- tain the mxwnum ground coves sal forth in the Yislalatkn Yt Wwuaions: the pNCemett d Tnprope materials No the system corxairvng dre Urns: faMae d the UrYts « the septic system due to 4npra{>ar sing, Ytrproper sttTg, exrxssive water usage, Ttprope grease disposal « imprope+ opeadon « arty alhe event riot caused by ktaaat«. TIPS LTrNted wenanty sheN be vad r the Holds lal5 to o«npy with al d me terms sal kith T, dos LTrfted Wananry. FuMe, Tt no event shat hgNtret« he resporNble ~ arry Wss «demaga to the Holder. the Urws, « arty ttrd party resukTg hom TtstaNauon «shipnertL « horn ary product ialtiYty darns d Holder « erry third pety. F« eYs LTNIed Warranty to apply the Units must he Nlstafed M accordarxx wlh al site corrdhiala regtred by state and goal codas. 61 olhe appicahle laws and kiltrator5 TtstaNatbn Ttstrucnorrs. k$ No represexative d hlNhat« has the tkettorMy to dletge this LYrlhed Wartarlty h any rrla«ler NTSlsoeve, « to extend tltis LTrrNed Wartexy. No werartty apples to any party ache than the,xigiruY Mdde. Tire above lepesents the startled LTratad Werr«xy oRaed by ktflbamr. A Nnrited number a votes and counties have d+feed warraty repwerneds. Airy purritese d txdts mould coaact Wbat«Y c«p«ale Iwadquerters in oa sayorook. con,ecliwt, prbr to surh pudrase. to olxain a copy a dre appkcable weranty and should cseluly read that wananly pri« to the purdase d lxrTS. • SYSTEMS I N C Environmental Onsite Wastewater Solutions'" 6 Business Park Road • P.O. Box 768 Old Saybrook, CT 06475 860-577-7000 • FAX 860-577-7001 1-800-221-4436 www.infiltratorsystems.com ktaoet« Systems does not recamntarrd TtstaNTg oltsite systems urde pavenerx. Chambers must be irWaNad atc«dkg [o merx/aduerS YtshucYbrls. feaue to iretad eccor6ng to manaacwe5 inwucti«e: vAI void warranty. klRlhel« Systems recannrerxls the use d SeptiL tank feter5 end le,ardry fillers widr aN onsi[e Septic systems. Syvem slung k deterntlned by goverrrneti rerylations. Fortechnicai assistance, installation instructions or customer. service, call Infiltrator Systems at 1-800-221-4436. U.S. PateMS: 4,759,661;.5,017,041; 5,156,486; 5,336.017; 5,401,116; 5,401,459; 5,511,903; 5.716,163; 5,588.778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infittretor, Equalizer and SideVYxtder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered traderrtaAl in France. Infiltrator Systems Inc. is a registered trademark in Mexico. Crnttour, MicroLeaching, PdyTuff, SnapLlxk, ChamberSpacer, PosiLock, Ouidlcut 1' Overlap at Latching Mechanism LM POWTS OWNER'S MANUAL & MANAGEMENT' PLAN pees ._,_ ~ of ~ FILE fiNfOitMAT10N ' Owner Permit ~ ~530`fS DES!©N PARAME'1~'ERS Number of 8sdrooma ~ i7 NA Humber of public Facility tJnita C~NA Estimated flow {average) ~ al/da Design flow (peaW, iEstimated x 1.5} ~~ Q at/da 5oU Application Rate elide Iftz Standard intluentlEffluent Quality Monthly avarape~' Fate, Oil 8c l3rease fFOGi S30 mg/L Sioohemical Oxygen f3emand {BOOB) 5220 mg1L 1~ NA Total Suspended 5otida {TSS} si 5O mg/L Pretreated Effluent Quality Monthly average l3iochemicas Oxygen Demand {t30DBi 53fl mg/i Total Suspended Solids {TSSi 530 mg/l. DNA Fecal Colitorm {geometric meant St0` afuliG Ornt Maximum Effktent Particle Size Y,r in die. n NA Other: C7 NA rValuea tyl~ for dawneetic wastewater and septic tank effluent. SY8TEw1 $PECtfICAT10N8 Septic Tank Capacity ,~ J a# DNA Ssptfc Tank Manufacturer r O NA Effluent Ffiter Msnufscturer ~ ~ f0 NA Ef#k~ent F11tar Model dd C1 NA Pump Tank Capacity Q' el O NA Pump Tsnk Manufacturer ~~c°.5 ~, d NA Pump Manufacturer ~,~,~ / Q NA Pump Model ~ p DNA Pretreatment Unk O Sand/f3ravel Fitter ^ Meahar,ka) Aeration n i?Isinfectfon D Peat Fllter o Wetland f~ otner: ~NA Dispersal Celtlsl 1~1n-Ground tgravityl O At-Grade D Orlp•Ltns CI NA Q fn-Ground tpressurizedi ^ Mound O gther: Other: ©NA ~" DNA ~~ ^ NA iVG41NTf~iAN+CI? SCfitllDtJi.E Sarvloe Ewnt >3ervice Frequsnoy inspect t:ondhion of tanklat At least once every: ,3 ear r) s {Maximum 3 years) ^ NA Pump cut contents of tanks! When combined skrdge and scum equals one-third {ygl of tank volume DNA inspect dispersal ceil(si At feast once every: ~ monl~lai lNAtudnx~m 3 rears! O NA Clean affluent filter At ?oast once every: ~ ~ ~trbn~ e1 ^ NA Inspect pump, pump controls b. alarm At least once every: ..--- ~~{il o ear{al O NA Flush laterals and pressure test At feast once every: .-- mor4 tai O tartsi 0 NA other: At least once every: -- monthlsl ^ earls) 0 NA Other. ^ NA MAMI'tENANCE i'N8TRUCTION$ inspactlona of tanks and dlapersai cells shall ba made by art individual carrying one of the following i7cenaes or oeriificatlons: Master Plumber; Master Plumber Restricted Sewor; POWTS inspector; PAWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankfs~ to identify any missing or broken hardware, identify any cracks or leaks, measure the vafurne of combined aludl}e and seam and to check for any back up or ponding of effluent on the ground surface. The diapersel ce~llei shall be visually inspected to check the effluent levels in the observation pipes and to cheek for any ponding of effluent on the ground aurtsce. The ponding of bffluent on the ground surface may krdicata a failing condEtion and requires the intmadlate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third SYz1 or more of the tank volume, the entire contents of the tank shah be removed by a Septage &ervicing Operator and disposed of in sccordana with chapter NR 113, Wisaoneirt Administrative Cods. Atl otter services, including but net limited to the earvicJng of effluent filters, mechanical or pressurized dornponents, pretreatment units, and any servicing at intervals of 512 months, shelf ba performed by s certif"isd POWTS Maintainer. A service rspdK shelf be provided ttib the fora! regulatory authority within t O days of completion of any sorvias event •apoa an{te13s{u{wpy ursuaosiM '!£} 4 AZ} 'ltM-q'EB Due ti}~!p}(t}fgilZlZt'E8 uJwo~ ~s3deyo ypn+ vouslpwoo u! peueJp ssM wrumeop s{y,~ . , ,N i °~. ,~ I N nc~ X~ a2~ '.15 aweN ~ _ / aus;N JLLRiOH111V A»0111"If'103~! '1VaOl (}l3dWfld! klO1V!l3d0 pN101ARl38 ~QVtd~S puoyd aw@N b3iWViN#VW S1MOd rld' ~ .rc -.. .r ~ aura F!~'171/1SN1 g1MAd S1N~WW00'n/NOLLkWV '~']818SOdW} 3!O l1fl~l3d1Q ~8 J1VW ~1NV.l b 90 li01a3iN13Hi WO!!3 N08213d b d0 3f1~SSkt 'i1f~S3a /lVW H11~0 '83~N1f1SW~1~tll~ ANd !l~QNil kNVI iN3W1~11~3N10 d0 dWtld '~l1d3S d FJ31N3 lON OQ 'NS~1AX0 iN3i01ddttSN! ~t0/QNb S3SSV01VHi3'! 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(s}ilea les.rodslP sy3 03 ppSJeyosip aq ~~lM 193ennelS@M SSa3Xe sy3 paJ03$@J st Jennod UayM 'S{8na{ Ja3sMy91y !@usJOU pADQe 1{I; Asw 8~U83 duand sa8s3t1o IpMOd BuU11~ '90@;Jn6 an{3e13{ICU! Ayl 3@ uex01~ e1B SUpi31PUa0 (IOfi veyM ~naao Sou {days do 1Je3s ula3s/lg •esn of ~oi~al ~a3g~ado 9ulo~n~ss a84sdes a nq panoure~ tt)~uel •yi ;o s3us3uoa ay3 aney psiaplep pJe suolla~uaauoa y8ly ;I 'lslil8a les~edslp ay3 pBswsp ~o/pue sseaald 3uatu3@aJi syl ppadwt Asw 3ey3 slealweya ley3o ~a s3anpo~d Bul3uled ;o aouese~d ay3 .o; {s}~{ue: 3vaurieeA ~asya S1MOd eyi ~o ssn o3 JolJd 'uol3o-u3suoa nnau Jod -.--- -o .~-.-_ seed NOIldM3d0 QNt~ d(1 .LaV1.S .'Z 'Z ST Pr'ROTX CO ~ pQRBBMENT gP,P'I'lC TAIZK • AND O~ggS~ Ogg~CATION FORM ownaBuycr Si ~J~I A Co ,e Pa ~-n o --~ Mailit~ Address ~ V ~ K its _D 2.:. Su t i~ 106 ~ ~1 /"1l~ ~3 S Proporty Address 7a ~ r U (Vcditcatioa required from Pbaai:tg Dopartmeat for new enatttttction) -~7-Qty 1.2~ Ib~ G5ty/Stato NvnSo~J u/~ Parcel Ydentification Number 02d' 1 I LE,GAL~~~T'ION ~~ 5 ~ ToWty of Nv1~sU,J property L.ocation.S,~_'/•, '/,, Sx. Z~ . T 2~ rI~R ~ ~~/, Subdivisiota ~- Ccrtiticd Survry Map # ~- Volume _ --~ Page # ~ page # 13 warranty Decd # _ _ (y CO~••- D.~O ~ Volume spec boost: ~ yes Q no Lot ones identifiable ~ yes ^ no ~X~M MA-ay'r~N CE a,n: failure to haaale.vastes. Propu~maintt~aacc Improper use and mainteASn~ce of your K.pdc system could rcculc in its ptetns ~~ You P~ into tote tyRcaa aoaslsta of pumping out tb,e optic tznk every throe yearn or sooaex, if ncedad by a lieoo_scd pttatpes- on affect the fuac,-tioa of tlu eeptie task as a aeatmeat stage im rye xaste ditpoaal ays~ 'ibc property owns agje:a to cabmit w Se Ckaiz Z-oai~ Dcpartm~tat a c~5catioa form, rip~-od by tlu; owns and by a lumber tcsCtictodplumba or a lieernsed p~p~ ~fYsOB that (1) the aa~ite wastevntot disposal ~m murtCrPhaabrf, joumaymarsp sfa4cecarY). the =eplic tank it less than 1!3 f~Jl of eludse. ~.{A proper apaatin8 eaoAitioa tad/ot (2) attcr~aspecmaa sad Pun'P~ ( ll~. tbo vadotsi8aed lssve ecad clue =bore requir<meoCS tcd fottl>, herein, as cct by the Dcpartuunt of Commc eta tba teptie system boon tas' .t. ~f tlfE ebxae mar expiia'date. ..,• •+ ~~ the rate eew~8e ~~ *neh the srandssdt and the Ikpastment of Natural Reaoucca. State of W~sO~CO ~a30 be coa~lctcd and returnod to the St Croix t;otmty 7•onir,8 iVA L1Vl~ that all s acs o this form arc true to tlu: best of my (our) know(cdge. abov a aarraaty dad recorded in g,ogister of Deeds Of6ee. ~~ ~~ A~ i (~) aaD. (are) the owrur(c) of 3 ATB ~.~..,. •••••• Any informati.o is mis-eepr~sented nay rcavlt in the uaituS+pe'[mtt boiag rovokedby,tbeZaatn~ D°P~cmeat. •••••• •• Trretude with this apptieaNoa: a etarapod warraDry decd ftvm the ~5~~ of Uccdt office a copy of tha ccKifind storey map if trictaoee ~ n°ade ~ the wcrisnty decd TOTAL P.02 STATE; 8AR OF WISCONSIN FORM) _ 1996 - WARRANTX DEED tit NvrKw vnt, ~ ~~?PE~~ 61~ This need, made between Bane Corporation. _ a Minnesota cozporatioa ~ ~~- .,... _- ,..,._. -.._... _ ... __-, Grantor, and _Sienna Corporation. a 141nnt<R3g);a corporation ___, _,~ ..- -- . . _.. ...- ---.. ......, Grantee. Granror. for a valuable corulderulon. wnvcys to Cnntee the following dcsu•ibcd real axtata In St . Croix Crnmry. Srate of Wucoruln (the 'Property`): See Attached Exhibit A 666450 KATHLEEN H. WRLSH REGISTEk OF DEED5 ST. CROIx CO., WI RECEIVE6 FOR RECORD 12-21-2001 3:10 PM YRRRRNTY DEED ~T co~Y FEE: COPY FEE: TRANSFER FEE: %63.40 IN6 FEE: `7.00 1' Rrenrong Aren Mame antl Rawn Atklrass Uni~r~.l ~-}1~ 5`1Gb 5 me+nu~'i ~ ~ ~. ~'tia.i+e. 'col MIVI.ne ~kaL Nu553'~ . _._. ..._-.-1 0 20-1048-30-000 ParenttdonGacaSon aamDerlPavl This is not homestead property (fs) (ls rwt~ 2o-1Des-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 Togctlur with all aplwrtenant rights. Ulle and Ltterests Grantor warrartts that the line to the Property !s good. InJrfeastlrle in fee simple artd free and clear oC a[cwnbrancei r:xcept See Attached Exhibit B. Dated tnlz 20th - _ dar ~ December _ 2001 Bane r oration (SEAL) by Jo M. Nassef ~~~ Its of Executiv¢ Offi (SEAL) AUTHENTICAT1oN aUttlenllCated this [!ay of ,. , TITLE: MEMBER STATE BAR OF WISCONSIN (Ir ml, _ authortzed by §7QG.06, Wts. Stars.) TMrS INSTRUMCNT WAS DRAFTED B~ Lockridge Grindal Law T'irtn inn Wa~>_~~p~,..,~.o c„r,th- Minneapolis, MN 55401 ACKNOWLEDGMENT () (SEAL) Minnesota State oC'Wt7CCVits111- ss. ~- ""'~`'r `1 Count .. ~ PCrsortaBy CarTnt twftrrre me IhiS "°" day u( December -,_ 2001 , ~ ~„e r~~ Joha Pl. Nasseff, Chief Execut=v_~,Officer _ of Hane Corporation, a Minnesota - corporation _ •~~ __ ~~ ..... __ to me krxrwn to be Pe~ _ vAw executed the foregolt[g inslntrner[t and _~wi' same. J HARNY E. GALWIER ~~\ wtxwtavartpttata~ [-Hama • f) .~ NoL'[4Publk, State of Wluonstn y commicUen u pcnnrulent. (If not, xrare atpiro[ivn dau~ 1atPnuw'es Hwy Ur autrrmncated a uknowledQed. Both wt not January 31 , 2005 ) necessary) - - Pa' iT rat H N mwt tr ... ..........._ ... ......... .... ......... _. .. y~q' rylrA Or ,wr.r..r nrbw tl><r. :gateu~rc. WARRANTY DEfD STAiF, aAR OF WISCONSIN tya~ tpy ay,~, Ca.. yK, PORM Nn. 1 - 1991! AArwaWae yA, ^~ 14 F~IeNo: as-o49o0 Yn;, ~ / 9 ~PAf f 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, Flange 19 West, Town of Hudson, St. Croix County, Wisconsin, more fully described as follows: Commencing at the West Quarter Corner of said Section 20; thence North 89 degrees 25 minutes 02 seconds Easc, assumed bearing along the East-west Quarter line, a distance of 1319.52 feet to the point of beginning also being the southwest 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-Northwestern Railroad; thence North 79 degrees 56 minutes 29 seconds East, along said southerly right-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 02 minutes 26 seconds East, along said southerly right-of-way, a distance of 429.04 feet; thence northeasterly a distance of 445.52 feeC, along said southerly right-of-way, along a tangential curve, concave to the southeast, having a central angle of l4 degrees 30 minutes Z1 seconds and a radius of 1759.75 feet; thence North B9 degrees 32 minutes 47 seconds 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 th¢ south line of said Certified survey Map in volume 12, Page 3302; thence East, along said south line, a distance of 593.00 feet to the east line of the Southwest Quarter of the Northeast Quarter; thence SOUth QO 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; thence South 00 degrees 26 minutes 55 seconds East, along the east line of said Northwest Quarter of the Southeast Quarter, 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 Voluma 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, Page 4173; thence South 32 degrees 43 minutes 57 seconds East, along said west line and its southerly extension, a distance of 591.64 fe¢t; thence south 07 degrees 13 minutes 18 seconds East a distance of 323.01 l:eet= ChenCe South 08 degrees 41 minutes it seconds East a distance of 41].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 Volume 11, Page 3128; thence North 89 degrees 52 minutes 10 seconds West, along the north lines of Certified Survey Map in Volume 11, Page 3128 and of Certified Survey Map in volume 12, F?dye 3292, d distance of 682.8,6 feet to the northwest corner of Certified Survey Map in vor. ~ ~~~Par,E 6~ 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 in Volume 12, Page 3292, a distance of 5.66 feet to tha easterly extension of the north line of parcel recorded in volume 1390, Page 163; then South 89 degrees 30 minutes 27 seconds west, along the easterly extension and the north line of parcel recorded in volume 1390, Page 163 and the north line of Certified Survey Map in Volume 3, Page 776, a distance of 508.92 feet; thence North 00 dagraas 07 minutes 56 seconds East a distance of 1003.47 feet; thence North 89 degrees 54 minutes 15 seconds F1est a diatance of 270.16 feet to the west line of certified Survey Map in Volume 5, Page 1317; thence South 00 degrrses 27 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. SEP-20-2002 0921 SIENNH CUKh' von ~ ?~~7~~~t 6:I 6 Exhibit B to Warranty Deed dated December 20, 2001 by and between Bane Corporation ("Grantor") and Sienna Corporation ("Grantee") 7~~ w7 r-~xs r . ru 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. L-ncroachtnent of Qwest Communications, 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 7. Ameritech General Non-Exclusive >~sement Agreement by and between Bane Corporation and Wisconsin Bell Telephone Company a/k/a Ameritech Wisconsin dated December 10, 2001. TOTAL P.05 m cD ~~ N NOU"U/ DSO E ~ ~ / /~ M°~yv• ~o N'cnnz° 35.47 ` ~ ~ ~!/ /if/~ ~~ ~J'~ ~ ~ p 1'~'' 1 / / / t g ~ ~i _ "I ~1 ' / ~ / ~ II mZ ;' 1 1` 1 / /~ ~ 00 r ~ ~ O ' 1~~ ` / / / / i i' .ra , N~ i 1 1 / \J1 i t ca r~ ,~~ S00°07'50,"W ~~ C / vO<~+ % % .. ' ~`-- ~ 31.22' ~ ~~ i i ~ t rN 1 ~ i i / Cb / o d ~~\\~ `11,1 \ ~~ ~ %~ ~ %~ ~ f ~~ ~Ir ~ Q ~ ~~\ 1 ~ ~ ~ v 11 ` ~i i ~/ /I~'I Q~O ~~\\\ 11111 / \ % ~ ,/ r ~ ~ ~~ ~ tse S ~ \ ~~~ _ ICJ ~ ~~ 59.03' 6~~'~e0 5~~~ ,~ ~ ~ N02°06'35'W ~'~" G, ~ ~j:~6`4 ; ~ r' 0 \ F ~ T~-~ Z w -*, z ~ ~ V r*1 r 0 ~ i "o ~ (jt' oo m E '~ ~ ,~ 00 -' ° ~ ~ ~ .'~~ I, N NO ~ `` / ~\ ICJ n '~ ~ U ~(~) zv ~ ~ 'r. J N N ~ ^ cT /~ o ~ < ~ ~ ~' ~ / \ ~ " :~ < ~ ~. \ / ~~ \\ D ~ ~~ L` / / O~ ~ `_ r/, ~~~ d ~ 1 _ 'i_N '~ , ~ ~ ro NTT SECTION CORNER ~ 4 1' o D STeeL PIPe rouND N IL SET N PI tM Nwin.rsl Ouwlw. +~ lM Swlnrral i N '3 ~ A P K. it Ine Nwlne°al Duwlw RI lne Swlnrrsl _ ~ ,~ 2' % SO- ROUND STEEI• PIPE NEIGHING SET T r Me 5w.lnresl Oualw wle n the SauMresl w vn [ , .~ + . 965 LR. PER 100 ERS ' ~acan eu"1 y, To." rl rwasa". Sl Cfa. 0 _; 0 o i CORN ALL OTHER LOT AND OUTLOT 1' O.D. % Y•' R°uyMD STEEL PIPE NEIGHING 19 Id PTR PDOT. SET 1 -___-_-__ _ . - .. - ... M ~ ~ ¢ ~ . I (NO'0'O'E 1.00) PREYK/IISLY RECORO60 DATA u~~ ~ -SBL-- SeTSACK IINe ~'<~ ` 1 I r--6 ~ i~r0 ' ~ 61 ~~~~ O J,.. r' A uMlix I EASENENi I !N~~ o V: UnUTr I EASEuENT.- mWn< ' i OjO, LNE _~--- -J L ---_J_ _ O SO 100 1SO i n m y aG1T MAY LRA: W ~ EASEMENTS ARE AS DEPICTED _ N °~ ABOVE VNLES$ OTMRwISE SNWw. SGOIe 1' SO' G+" GT Te ~ . E WATER ELEVATIONS'. O GATE OF SURVEY 817.8' APPROy111ATE LOW WATER ELEVATION-. BIT.B~ 1 - I `)A `y/~t'1 )r~Y ~`/"tlS~~-L.y~\L_v~ - - - - - - 100 YEAR 8000 ELEVAnON~ 825.20' ~ `~ NAVp 29) C t to I v `I - _ _ _ - - - .S ( ELEVA710N5 REFERENCED TO US TOP NUT HYDRANT AT NORTH SIDE Of CAR41CNAEL y vL., - - - - - - - - 2175' EAST Gi BURL OAK CURVE. ELEVATON-878..0 ~ ~ I _ ~) n / ~ ~ r ~ i ~ n. $g.h 5'05'w 130.tY ~nt T T G I VV 1 L~ 1 J 1 _ " I PARU AND OPEN SPACE _ I 709922 Sf I (16,172 AC.} m~ I I in1 ~^v 1\/ ` .. YVL.. . _ -,--- -- _ - - NO DNELUNG .-~ o FLOOR ELEVATIONS I _ I HE 22169 ~) n i7 r ~ 71; ` T'Y\7 L_ 1 t_\/ -- BELOW 827.0 ,Di I N82 I --------- ~ I m lJ1 l 19 i ; i ~ ABO43 SF. I N ( ' J N (1.057 AC.) I 1 NO DWELLING = 1 FLOOR ELEVATIONS I = o ~ 1 1'ry BELOW 827.0 m i \ I to ~ ~_ _~ _~ \ I i~, 20 ~ ~~ I iry 5282 $.F \ \ (1.186 AG) l W o \ ~" I I. CI i ~ \ I Iz la a \ \s. ~ \$• I 1 I I ` \ ~ ~ \ \v. ~' ~ ...~- - - T / ~.~ L ~ - - _~- - \ \ / d~ ~ ~/ 515685 F. g \\ \ / ~ \ ~ _. \ ~u N83_23 at_E!9~ 2~ r 1 _ _ - _ _ \ - ' - \ _ r-- ,, ~ , ; ~. , ,- / P ,, z~ / aeA63 5 i .. - _ ~ / 5~ / ` ,,/ ~ _ 'J. / ..p Al /J i ~ Illl L+r\-r - - V V L.. J\/ ~ 1 I ~-1=7L_ -1 ~'~ 1 ---\vL_L. 1\L_v~ 1/'^ 1 I ~ ts: ~' V VI.. D ~ h 5Q~ ~ W ' \v. ~ ~ t :pia S. 'f7 ~s9F PJ g e 7L9.~p~_(, l / /hy~~ I N ~ 31 5F ~ / ~ I _ .M' (1.117 AC) w (Y~ ~~ ~•N EP`'1'~ / 'N~ 0 DwEILB+G ~ 57.171 G I OOR ELEVATION \ ~ i hnl / T"7~ `~ \ + E.sT0.l0YE 93 5' _ ~ N89°52'10"W 682.86' / o__ (589.18'27'E) ~ \ _--- _ . I=-^ is -1./~1 --~ _ - NORTH LINES OF CS.:A vOl 11. PAGE }191 AND C.S Y. vOL 11. PAGE 3128 --.--..- ,".IYI. V VL.. , - - - 1nH nslyymeni b°NW Dy NevM T BM]M - - - - JAMESR.H ~L~L, INC THE Cat_t SEE SHEET 7 as°~: °~ IM /".°~ «°.i a «. ~ IM 5"°,,,`M `t a ~% yl InM. 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