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HomeMy WebLinkAbout020-1415-00-000Wisconsin Departmento;,Commerce PRIVATE SEWAGE SYSTEM Safety and Building Divi~on -~ INSPECTION REPORT (ATTACH TO PERMIT) ~` GENERAL INFORMATION Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Sienna Cor Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: . p r lS0 . p ~ -- S W ~p+u.~a2 tA~L~t1/ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ l5~ 2 Do m~ ,,,,,~. r•ee , , s,lJ (~~""""" Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic t > 50 ~ r ________, Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer mand GP Model Number TDH Lift Fric ' Loss System Head TDH F Forcemain ngth Dia. Dist. to Well SOIL ABSORPTION SYSTEM ~f) ~ 17,..-r ,IL , Q,.... ,,r ELEVATION DATA ounty: St. CroiX Sanitary Permit No: 453360 0 State Plan ID No: Parcel Tax No: 020-1415-00-000 Section/Town/Range/Map No: 20.29.19.2618 STATION BS HI FS ELEV. Benchmark AI BM ey~ `~ G , i~• 0 BI g. Sewer SUHt Inlet ~o-'~ q~-~o~ SUHt Outlet ~~ SI ~ Dt Inlet Dt Bottom Header/Man. ~• I~- `~'~'Z3 Dist. Pipe /~) S .o'}- °1Jv • 33' •!9~ eot. System 9. fz 9.'~M ~'S 2$' Final Grade Sao 9q.eo Cove -~ .,..r~w.. ~ Z • c e, y,.*ta7C ` ~1.~ ?.b; c - sow 1 r CD C RENCS idth i L e~n~hSg ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth D 3 ' , t~ .,.:~ 92 2 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man• e . ~ ~ INFORMATION CHAMBER OR ,-~-.r~ `F+~ Type Of System: t S ~ g ~ ~ ~ 1 UNIT Model N bye er: r DISTRIBUTION SYSTEM / -~., d., ~,.,~1.. Plt-.\ Header/Manifold tl Distribution x Hole Size x Hole Spacing Vent to Air Intake ~ Length ' ~ Dia Pi e(s) Len Dia Spacing ~ ~S i 7 SOIL COVER x p-PRRIIrP Svstams Only xx Mound Or At-Grade SvstemS Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil J Yes No ~] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ Inspection #2: Location: 738 Martin Ave Hudson, WI 54016 (SE 1/4 SW 1/4 20 T29N R19W) The Glen Lot 24 Parcel No: 20.29.19.2618 1.) Alt BM Description = t we~ A ~ n ' 2.) Bldg sewer length = ~ ~ ~~ o•~a. v.~1-d.tlltr(~+Q. i~e~.~Q~ 4 - amount of cover = 16 .{-, S~(4(e~ti.. -- w ~~ >~•~.. DT ~ . P~ ~J~ACX~ '~S CD•w~ CM'dR.~ i `~-~~~ -- S~'- - - t_`i-~B~K~--- ---- an revision Required? I J No ~ ~ i ~ ~ Use other side for additional information. _ . ~ i_.. __~_~___ _ __.___. __ _____ __.._ ________ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) X O S~ I~ r (~ 1 n' Safety and Buildings Division County ! ` ~~ ~ 201 V1r'. Washington Ave., P.O. Box 7162 ~ ~Cl'v~r)C ' ~onsin Madison. WI 5370? - 7162 Sanitary Permit Number (ta be filled in by Co,) 4e aftrnen*. of Commerce _(~1.266~131 ~S 3,3~~'' ~S • ~' ~~ •. ''` '' State Plan LD. Number Sanitary Perini ~R~1~~a~ron , ~:. In accord with Comm 83.21, Wis. Adm. Coe, personal infotmatiop, ~ro ~e ~, ~ ~ _ \" may be used for secondary purposes~Privacy Law, siS.Q¢(t` Project Addrese (if different than mailing address} I. Application Information -Please Print Ali Wo anon Property Owner's Na rrte ~ - Parcel ar I~et- Block +Y Property Owtter's M ailing Address Propern Location 07.E ~~~r ~ Ci ,state GC/ ; h' Zip Code I Phone Number ~'4~ ~.5ection ~ ~ ~ ~~ ~~ ~`" ~'~~ ,5',f"<(3~ (circle o II. Type of Building (check aII that apply) .P~~,~~ T ~q N; R f Q E or ~/ ^ 1 or 2 Faintly Dwelling -Number of Bedrooms _ ~ 6L '_ O ' - ~`~ Subdivision Name CSM Number ^ Public/Commercial -Describe Use ` ~~ ~G~ ^ State Owned -Describe Use ~,~V ~l SJ ~Gf-- ~i~~a a-. a 3 ~tyet,~eQj~o ^City_^Village ~ownship of4 fG'~1~~~~ ' -7` III. Type of Permit: (Check only one box on line A. Ctxnplete line B if applicable) -7- A' ,~ New System ^ Replacetnettt System ^ Tresttment/Holdin Tank lacement Only f g Rep ^ Other Modification to Existing System B• ^ Permit Renewal ~Permii Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date issued Before Ez iration P Plumber Ow~r ~~ ~ ^ ~ ~) ~~ 6 IV. T~~e of POWTS System: (Check all that apply) s V Non -Pressurized in-Grout-d ^ Mourtd > 24 in. of suitable soil ^ Mound < 24. in. of suitable soil ^ At-Tirade ^ Single Pass Sand Filter ~'^ Consttvcted Wetland ^ Pressurized n-Ground ^ Holding Tank ^ Peat F11ter ^ Aerobic Treatment Unit ^ Recirculatin Santa Filt R er ^ Rectrcula ' S nthetic un& Y Media Filter leaching r Drip Line Gravel-less Ptpe ^ Uther (explain) V. Dis rsa!/Treatment Area Info anon: V Design Flow (gpd) tgn Soii Application Rate(gpdsf) Dispersal Area Requ red (sf) Dispersal Area Proposed (sf) System Elevation I VI. Tank Info Capacity to Total Number Manufacturer Prefab Site Steel Fiber Plastic ~--~ Gallotes Gallons of Units ~ Concrete Constructtd Glass New Existing Tanks Tanks Septic or Holding Tank ~GD ~ Aerobic Treatment Unit Dosing Chamber ~ I ~~~ ~ e? _ VII. Responsibility Statement- i, the tutderslgned, assume respottsibi[ity [ter Ration of the POWTS shown on the attached plans. Plumber's Na mt (Print) Plumber's Si gnature / PRS Number -! Business Phone Number ,~ s~u~ ~~ Plumber's Addre ss {Street, City, Sate, Zip Cade) ~71~91~ ~ 7~~ ~~~ .~/ ~ l ---• VIII, unt /De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date tssu I ing Age t Si antre tams ~ Surcharge Fee) , S(j r~ ~ ~j P) G Owner Given Reason for Denial _ `tf' J ` ~~ q 2 9' b y ~/IZtA~/A ~~f,~- Conditions of Approval/~asons for Disapproval - ~_~ e~~d ~ ~~~~ ~/~~~~ ~~~ I ~' _._.~ 4ttach complete pions tto the County only) for the system oa paper oot less titan 81/2 x 11 inches in size SBD-6398 (R. 01!03) Safety and $uildings Division 201 VV. Washington Ave., P.O. Box ?162 js~jf~~~,~ Madison, WI 53707 - 7162 De artment of Commerce (~S)_266-3i3f ` Sanitary Permit~Agpr~~ation ~ _ In accord with Comm 83.21, Wis. Adm. Code, personal information tyqur~ro e ~~. may be used for secondary purposes Privacy Law;, s15.44(I~(tr1j~' I. AppUcation Information -Please Print All Information -~-T~, County Sanitary Permit Number (to be filled in by Co.} `r S ~3G~'' !S State PIanI.D.,Number /-"I ? I Project Address (if different than mailing address) Property Owner's Na me 7.~~ ~i~Y~"f/ ~G'L '- Parcel /{ Let Btock # S. G,~/.dGL- ~ i/ a Property Owner's M ailing Address Property Location v` ~~ ~ ~ ~ , rty, tate ~~ Zi Code __T~,~-`_ ~'4~w h4,Section ~~ i ~ ~~ P ~ Phone Number ~~~ ~~ ~~ ~ ~~~-~~ ! (circle a II. Type of Building (check alI that apply) ~6L~`- U ' -~~ T ~~ N; R f Q E or ~/ ^ 1 or 2 Family Dwelling -Number of Bedrooms ~`-~ Subdivision Name ^ PubliclCommercial -Describe Use _ '~~ __ i~ - ~o ^ State Owned -Describe Use ~~ ~l S~ '~j o~02 ~- a 3 -~~~ ~ ^City ^Vlllage IhI. `Type of Permit; (Check only one box on line A. Complete line B if applicable) A~ I ,New S stem p y ^ Re lacement System ^ Treatrnent/Holding Tank Replacement Gnly $• ^ Permit Renewal permit Revision ^ Chan e of Before Expiration g ^ Per mit Transfer to New Plumber Owner IV. Type of POWTS S stem: (Check all that apPIY) Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil 7^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Recirculating Synthetic Media Filter Leaching C m r D: V. Dls ersal/Treatment Area Infor aEion: _ Design Flow (pd) D Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Peat Filter ^ Aerobic Treatment Unit CJ Recirculating Sand Filter p Line ~ Gravel-lei Pipe , ^ Other lexnlainr A 8 t Sotl A ltcatton Rate ~ '-"~-• ~' ~--=~"pj,~ -~ ~~ P~ (fpdsf) Dispersal Area Requ'~red (st) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number [~^ Manufacturer Prefab Site Steel Fiber -{ Z Gallons Gallotu of Ututs ~ PfastiC I } ---~---~~---~'~--- ~ ~ Concrete Constructed Glass ~ ~ New Existinn Septic or Holding' Aerobic VII. R Plumber VIII. --~~ GD Treatmen[ Unii -~--+~--si: 'hambe. ----1 .__t ~G~ l ~~ esponsibility Statement- I, the undersigned, assume responsibility far 's Na me {Print) Alumber's Si gnature ~~ S'G~ia ~ jJ ~ , 's Addre ss {Street, City, Sate, Zip Code? n of the POwTS shown on the attached plans. Number ~ Business Phone Number ''--~~~.~i a ~ proved ^ Disapproved Sanitary Permit Fee {includes Groundwater Date Issu I ing Age t Si tore tam Surcharge Fee} (~ (1D y ps) ^ Owner Given Reason for Denial _ ~7" ~(~ - -~" ~ 2 ~ b (~ ~~, ~;~v~ I#. Conditions of Approval/~asons for Disapproval ~~ ~ / -- _~ v ~ ~~ ~ l~~'u/~.~2- ~th.Q, ~~~~f/W Sl C ~ ~1'Z~dr' lire ~ / ,, Attach complete plans (to the County only) ror the system on paper oot less Oran 8112 x l I inches in size CSM Number of ~oi,i~ ^ Other Modification to Existing System Previous Permit Number and Date Issued ~~ 3 3 ~ U 7~~/6 SBD-6398 (R. O1 ~Q3) X 4 3 `J, V ~J s~ 4 n' ~~ ~1 Q ~t' w,~,si„„e„«~„~ SOIL EVALUATION REPORT Page ~ or~ rli.ieS.w wt Q " ~nei Q..sAern~ _ _ _ in aorardanoa with rorrwn as, ws. 7avn. uvae, ~~ ~ ~ w k • , ! ~t Plaaa sib plan on papernotfeast~iran 81/2 x 11 irdtas in nnacn oompleos inducts, but not BtrtGsd ox, vtsrt(cal and horixorttal $rt (BM), l1N+ectlorr and ~ Paroel I.D. 0 d -C~ ~ 2 ~ " ~~~5' distance to nearest north arrow scale or dimensions l e t . , . percen s op Please print ad ht rm ~n R ~ ~ Date R 2R D Paraond tnromwrlon t~ pia ~Y t» wed for (Wivaq Lary. a 75.lH (1) (m)). l,~i//1~~ property owner _ ~ ~ ~O h ~ Sd /1 - -~ - ProRsRV'4ot~'tba Govt. Lot ,S" ~ 1 /4,5"GJ 1 f4 S ~' ~' T ~ y N R E (at~ ~ ~ Properly Owner's Mei6rrg Address Lot ~/ Block # Subd. Na~ a CSM# ~ 5 . / v~ Oily S Code Plane Number ^ City ^ Yllage Q'Town Nearest /Road ' -- ('qGr ( S ) -Z Ud ^ f7~tlC~SO ~'1Gt/7`. ® New Construction Use: ~ Residential / Number of bedrooms -~ ' Code derived design flow rate ~/.S-O /~ O ~ GPD ^ Replacement ^ Public or commercial - Oesrxft7e: ~~~ ft • Parent material /~ y-~-cA, ct S I,~. _ Fbod Plain elevation ~ applicable General oommertLg and recommendations: 5 y~~ P Yl'~ ~ ~ Z ~/ • yJ • S U Boring # ~ ~9 ® Pit Ground surface elev. ~~ S, L O ft' Depth t° limiting tailor- ~ ~ U in. Sod liption Rate Horizon Oepth Dominant Color RedoxDescriptbn Texture Swdure Consistence Boundary Roots GPD/Ef in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •FEf#t 'Efi#2 ~-z ~0 3iZ _ ',`I Lw-sblC ,~~ e S iv .s ~f ~ - i !v .~ S~ d , L Boring # ~ Boring ~ ~~ Pit Ground surface elev. ~ ~ fl. Depth >n limiting factor in • Sol tron Rate Horizon Depth Dominant Color Redax Descriptbn Texture Stmdure Consistence Boundary Roots GPDtft= Gr. Sz. Sh. •E~~ ~~ sell tlu. Sz. Cont Cobr in. M~n U_ 2 3 3 ~~ ` 7 ~r~~~ ., M ` V• `'T r ~ S // ~V~` I II • Eflklent ~ a gpps> 3p < ~p mgll era TSS >3U <_ 1x17 ~L ccrwerrn x~c.- ova,s_ w ,..y,~,a„u ...... _ .......~.- CST Name (Please Prnrt // S' nature CST Number ~Gwr~r ~' O A~~ Date Evaluation Conducted Telephone Number property Owner 5--e i' Y` /~ `~ Parcel ID # ~b f Z ® Boring # ~ Boring (J Z CP 6 ft. Depttr to Crmifm9 tactor L-~- in. Pit Ground surface slay Page Z- of ___,L Boring ^ Boring # Ground surface elev. ft. Depth to limiting factor - rn• Sod lication Ra' ^ Pit Horizon Depth Dominant Color RedoxDescxiptbn Texture Structure Consistence Boundary Roots tE~GPD Etf#2 in, Mansell Du. Sz Cont Cobr Gr. Sz Sh. > < 220 and TSS >30 <_ 150 mglL ' Effluent #2 =GODS <_ 30 mglL and TSS <_ 30 mglL • EfdueM #1 =GODS 30 _ rr-gll. The pepartment of Commerce is an equal opportunity service Provider and employer. If you need assistance to access services or need material in an alternate format, Please contact the department at 608-266-3151 or TfY 608-264-8777. san-asw ra.m~om Boring ^ Boring # ft. Depth tiD limiting factor in. Sob A ication Rate ^ Pit :Ground surface elev. ~~ Horaon Depth Dominant Color Redox pascriptan Texture Struchue Consistence Boundary Roots ~~GPDIft?E~2 Du. Sz. Cont Cobr Gr. Sz. Sh. in. Mansell I'nGe~or 3 • AL DGSCRIPTION~I/35~~~~4,5 ,ZQI'~ i`I,IL,?! C(ur)i NAME:_C~ ` n ~cT LO"l~#~LCG - - SCALE: 1 "_ ~nn1 ELEVATION: ~CS~ ` 0 - BM 1 DL•SCRIPTION:~~ald O-1~ ~ydncx~T~7~~ BM 2 ELEVA'I (UN:_ -- BM 2 DESCRI!'"PION: `~~" SYSTEM ELEVA"1'Ic1J:_-~/$~~ ~-- SYS'T'EM "1'YI'1~: G /L ~~ ~~'° /`_°~ ~ .--- ~~2.Sb \o $_3 la~•5~ ' 1` 1~ .~ L 0 ~~-I u ~-+ ~- 5 ~ ~,~~ __.. _" ,....~ DATE: ~/ Z~J ~ f SIGNATURE; -.- - G :Sb-.°r,osow (~~~~-~ Safety and Buildings Uivisiun t County ! 2t~1 W, Washington Ave., P.O. Box 7162 S~G~o Ju ` ~!~'~~~l3'~!"I I Madison, WT 53707 - 7162 Sanitary Permit Number (to be t511ed in by Co.) !, Department of Commerce ~ ' (~,oe) 266.31s1 ~f '533 O r ' Sanitary Permit Application state PUw LD. Number I In accord with Comm 83.21; Wis. Adm. Code, personal information you provide tray be used for secondary purposes Privacy Law, ~5t~r;--•--~--•~•.--. Project Tess (if different than mailing address} I. Application Intorntation -Please Print All Info 'otl i '~.'3 8 ~ ~I i~ ~{-1t ~ i q Property Owner's Na me ~~' ` ~ ~ ~~ ~ r ar el ~ Lot >Y Block A` Property Owner's M ailis~ Addrec .~ ~ :~~ ~r~ ~JF rli~<_ - Property Location ~_ St, .S~ ~R,Section o?~ Ciry, Stag Zip Code Phone Number I /~'~~1~'~ ~ ..t/ ~~ ~ ~~,~'S~ aP,~s~~ (circle ) l T ~9 N; RJ~„E o II. Type of Bttilditt~ (checle all that apply) ~l or 2 Fatally Dwelling - Number of Bairooms ~ Subdivision Name CSM Number `: Public/Commercial - Describe Uae " _ _ _ ~~ e ~~J~~ • ^ State Owned -Describe Uae _~~,,,,~ ~ ~ ^Ciry~^Vil{agownahip of~ ct III. Type of Pernllt: (Check only one box on line A. Com to line B if app able) p20- S - [so ^t~ .Zlol i A' New System ^ Replacement System U TreatmenU idittg Tank placement Only ^ Other Modificadan tq~xisting yttem B. ^ Permit Renewal ^ Permit Revision ^ Change of ' P mil Transfer to New at revioua Per N ate Issued 8eiore Expiration 1 Plumber r i ~ Iv. Ty oP POWTS stem: {Check all that a 1 ) _~., Non -Pteaturixed In~Cirouttd d Mound > 24 in. of suitable soil Q M nd in. of suitable sail ^ At-Grade ^ rtd-F' v I ^ Constnrcted Wttland ^ Pressurized In-Ground ^ Holding Tarix Peat Filt ^ Aerobic Treatment Unit ^ ircula ~' ,S,a/n~d, ~F~ilter ~ ^ Reoircuiatia S ttthetic Media Filter ^ Leaching Chamber CJ Dri ne ^ Gra t-leas Pi ^ Other (ex lain) 3'D ~ ' v. nie rsauTY'eattnettt Area laenrastation: ~ .~ Dt:si Flow esign Snit Application Rate(gpdsfj Dispersal a Required (sf} ° persal Ar mewed (afl S see Eleva n VI. T k Into Capacity in Total Number Manufacrlrer Prefab Si ~ ~ r c Gallons Gallons of L'ttits 1 ~~ ~, _~~ ~ CorA.rete Constructed ;Glass j New >:xiatitts ~ ~I Tanks Tanict ('Fe!` I Septic or Hokling Tank ~~ /• ~ /`E.' C' Y Aerobic Treatment Uait ~~ Charnbcr ~~~ ~ ~J: E'S"ey ~ .~ VII. Respo»sibility stsitetaent- Y, the ulttderal ed, aaa rea onstbilit ror allation of the POWTS shown a the attached ions. ~ Plumber's Na me (Print} Plumber's Si gnatur P MPRS Number ~ Business Phone Number Plumber's Adds sa (Street, City, State, Zip Cade) VIII. Count IDe artment Uste Onl ~ ~Appravpd ^ Y>isapproved Sanitary Permit Fee {includes Groundwater Date Issued Is inQ sett Signature ! Stamps} i Surcharge Fee} ~~ ^ ~ ~ ~ ^ Owner Given Reason for Denial 02 IX. Condlttan~ oC Approval/iteasons for Disa roust 3)~ S~ Mus'k' ~...h, ~4 SYSTEM OWNER: t~ ' 1 Septic tank, effluent filter and a dispersal cell must all f~ti,aQrviced / rvtaintained ~~ ~~~~'~ ~L~ S~~ t ~' I as per management plan provided by plumber. I } 2. Alt setback requirements must be maintained as per applicable code/ordinances. A~aCt eoatplete pears lto the County only) for tba ayaam oa paper aot loo ehaa il/i x 21 ins6ea In aim sA1~-C~9fi rR ni m~~ ' "~-- d 0 'p ~ 'O `~' ~ 'O I \ J ,, v ~~ ~\ _I U ~ c~ i .~ V~ ~ ~ _ X21 ~v ..~ ' ~ ' d o "~ < e ~ p~ "" .o ~ ~ ~ - ~ i v ~ ~ ~ ~` R V ~ ~ ti ~~ ~9 I°~_ ~~ .~ D I' W ~~ ~Y ~ SOIL EVALUATION REPORT Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Cornm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8%: 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 or dimemsions, north arrrna, and location and distance to nearest road. Parcel I.D. pending P- ' t 11 ' ton» tion~'.~._ "' _ ._..,___,,,~ 1104 Page 1 of 3 Steel Soil Service ease pnn a rn ~ 1 ~~ Date ~)~tx`~x....... , Personal information you provide may be used for second purposes (Privacy Law, s. 15_(~l ~ (m)). ~ Z~ O_ Property Owner ;_.b ,- ~ „ ~; P,Tc~erty Loc ion Sienna Corporation "~-` '~ " t5a~lr'ot SE 1/4 SW 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address Lot # lock # Subd. Name or GSM# 4940 Viking Dr, Suite 608 24 na The Glen C~ity/I State Zip Code Phone Number Village Town Nearest Road ~r/f~f MN 55435 9,y~-~3s ,2808' Hudson Carmichael Rd. New Construction Use: /; Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial -Describe: Parent material Pitted outwash Flood plain elevation, if applicable na General comments ~- N~-~A,Q~, .1-° and recommendations: System e~vation 93.25ft, trenc hes spaced an d depth to code 5.OOft below grade ~ ~ ~ _ S~~ ~ ~- S ~ ~ ~ ~ Yo 1,.~ aY sr ~~~~ o D G- C ° ts`~ v ZS Borin Boring # . - g ~i Pit Ground Surtace elev. 98.25 ft. Depth to limiting factor 102 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ "Eff#1 'Eff#2 1 0-10 10yr3/2 none sil 2msbk mfr gw 1f .5 .8 2 10-20 10yr4/4 none scl Zmsbk mfr cs na .4 .6 3 20-102 7.5yr4/4 none cos osg mvfr na na ~ 1.6 b '~ ~~,.,,~' ~ ~ few.) ~ Z `~ .h, ~ ~ a " s-~ah ~z~-.-~~, ' ~vQ rr ~ Sc~~s~ ~ r~-,saw .fe~:Qs . ^ Boring # _ Boring 96 /! Pit Ground Surface elev. 98.25 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 `Eff#2 1 0-28 10yr3/2 none sl 2msbk mfr cs 1 f .5 .9 2 28-9 7.5yr4/4 none ms osg ml na na ~ 1.2 ~S ~ 3~I ~i~~u~ ~5 bl i - tmuem ~~ = csvu 5> s~ < «u mgrs ana r s~ >3u < ~ au mgrs - tmuent ~~ = tsuu5 < su mgrs ana I ss < Su mgrs CST Name (Pl~se Print) Si~nature: CST Number David J. Steel ~ _/ / ~ 248956 Address Steel Soil Service ~./ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 17 9/7/2002 715-246-5085 '-(t-t i S ~~ ~-~ Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 SE1/4,SW1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot # 24 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. '* ~ ~= ~5~~~°~ i~3 ~ ~ 3 ~ br ~ ~. B ~a ~6 G-~'"`~ ~ s {-< f~46. ~- f~, 9~6 p'~. gz.c ' r jd ~,sZ' ~~ z Saw~~tl ~ ~~'^. f,~s~c~lry~~y.~ ~~' lbb,D07r~' TaPos~ ~/2n ~de. ~~Dd.[_ ~1 % 13ar~hys ~3Z- 5t- zs~~ (f 3 : Viz, G SFf-- ~ _ ~_ o ~ ._ . ! I-_ V ' 1 ~1 •r ! r 1 1 - ! ' \ '! - 1' irl ~! ti d.-.-,. ~1~ ~A/ 1 _ - \ - / n eh., ~~ I 4Q, J , I~ r ^f.~. • .. X717 .~ , , r' .. . i , ~• . , , t ~, i :. ., r 1 . J ~i 1 ~ • :. _ 1 s ..- / 1,, 1 ..,, ! t 31 / n~ i''1 \ I i' ' t . _ ; ;"'111. ! ;: 79 / ~ •i ...t. ! 111 ~ ~ .; . 1. '', /.~ll ~ ~ I •~ ' '~ - __ N .. .: ,- - ! , _ .. .... ~ ; r tJJ 1 ; ; r 3Jy.. 78 1 1 !! ! ' 1 r ., j -_._~ ~~ 1~ ,,....-.. ~4 ~ ~ ! 1 -. 1 r •, 1.1 .. ! •\ ~ .•, . , ` a _l • { •• _ r - -n - ~ ~ 6. 41• .. ~C\j ~'. J a. .~ .fir"' ! LLt is - r., 1 r .,a .` - ,`, ` -..._ .. a .. ! ,¢~. , _ _ 6 a 8' ,, ,, t Cr 1 .• - ' ,'~-- l - :o~ 39 - ~ • , ~' - 1 _.. ; ! it _ .. .. ... .- ,. ,, r ., --- _• ~, t ._ - ,- ~_ ._ , . . . • ~~ c li ~ N - V9 'y .- r ... ... _.. ___ .. __.. ~ .... tJ * '. ~p r'. ... ., ~ \ ` - • .. • • •• 7..... ~ ~ ..._ , r' ' e . 22..yy ,.._ ,17/~' ./ ~.' - "~ - _.n ,` .; . ,\ , t ~ • 293. ~' --- ~ - -- / ~.. ~:' 1 '~ T. 1q r;l :~ r t '`may ~ ~It! -. `, at,~, : ,1 r,~,-. ... ~~ ~ I ` ~,~;~ iii , / ' ,,. i ' ' - 4 I ,. •. ,, ,• , , I ,, '~. _` "^F,, i~; ~ :,'\ ;,. t;'1+/ '1 ,~,! ~~.:,, ,,~ 111 ~u-;. ~-__---- !' ..y.,.. !tiM ``~, 1 ~` ~ ~. r ~ I '1 t '• ~~ 1' ~ r 1 t. t. t\ ~~~, L~ 1't~. ,\! I*i i,~ l 11 . r y{A 1 I ~, i '1-, , ~ a i. I I t. ~j~ L ! r ~• 1 ,, Via` i 1~;` ~ ,, .~. • a~ ~ ~\ i 'a, ' 14'1 1 a ~ t / I'II 1 4 •1 1 1 :1111 ~y!J r - / I I 1 1 1 I I r a+ ~ j 1, % tV l '• _.- I ' 7 1 I{ I { ~~ ~~ •" r ! ~ 1 Y I 1 •~ r,. r f ~ 1 a, f • ! 1„ 1 ! 1 { t ..,1 ~ - Jr .r ..._ , -ry- • .. ~ 4, ~ N I I . _. I 1 I { 1. `_.. 1, ~ a~ i1`~_,,, ~ ~ ~~~~.~~~~_ 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner ~ , ` Permit # Z9 J ?(Q o OESIf3N PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units Estimated flow (average! al/day Design #low Ipeakl, (Estimated x 1.5! aUda Soil Application Rate al/da /ft~ Standard Influent/Effluent Quality Monthly average' Fats, Oii & Grease IFOG} 530 mg/L Biochemical Oxygen Demand (BOOS) 5220 mg/L ^ NA Total Suspended Sol'ads (TSS) 6150 mglt pretreated Effluent Quality Monthly average Biochemical Oxygen Demand {HODS) 530 mg1L Tatal Suspended Solids {TSS) 530 mg/L C NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Y8 in die. ^ NA Otfier. ^ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE ~..~T~., zorrr-~FrcerieNs Septic Tank Capacity d'd~„1 al ^ NA Septic Tank Manufacturer irCs@ _ ^ NA Effluent Filter Manufacturer 1j` ~ O NA Effluent Filter Model ~ ©"d ^ NA Pump lank Capacity al ^ NA Pump Tank Manufacturer Sey ^ NA Pump Manufacturer ~jdA ^ NA Pump Model ~ ~a ^ NA Pretreatment Unit ^ Sand/Gravel Fifter ^ Mechanical Aeration ^ Dis(nfection ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cell{s) n-Ground (gravity} ^ At-Grade ^ Drip-Line ^ NA ^ In•Ground {pressurized! ^ Mound ^ Other: Other: Other: ~A other: J~'`A Service Event Service Frequency Inspect conditron of tankfs) At least once every: ~ month{s) (Maxknum 3 years) e~tsi ^ NA Pump out contents of tank{s} When combined sludge and scum equals one-third (Y3! of tank volume ^ NA Inspect dispersal cell{s} At least once every: ~ ~month{s! (Maximum 3 years} ear(s) ^ NA Clean effluent filter At least once every: months! ~' ear{al l ^ NA , Y _ _ _ _ _ _ !nspect pump, pump controls & alarm At least once every: ,,.~ ^ month(s) ^ ear{s} ^ NA Flush Laterals and pressure test At lease once every: ' ^ rnonth4sl ^- ^ year{s! ^ NA Other: At least once every: ^ month(s) ^ year{s} ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operators Tank inspections must include a visual inspection of the tank4sl to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of affluent on the ground surface. The dispersal cell{s! shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the irrrmediate notification of the bcal regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3! or more of the tank volume, the entire contents of the tank shall be removed by a 5eptage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the coca) regulatory authority within 10 days of completion of any service event. 4 y •apo~ enlis~is!u!wpbr wsuoas!M '{E) R {t1 'IL14S'E9 Pus I11'BIp11l-tq}{ZIZZ'£8 wwo~ ~eideya y}lnn eouelidwoa ut peTie~p seen iueulnaop s!y~, v0 ~! 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'° T ~,.. ~,. ~ "~ ~' i~ N LET ~ ~~ GA5• ~ ' WATER TIGHT SEALS ~ TIGHT ~ '~ A SEAL _ ~ PPROVED H IPE 3' _'~"' ~ , 1VT0 SOL I0 C I OIL PUMP OFF ELEV . FT . D ,~„~.,~" LM N OFF APPROVED MANHOLE COVER W/ PADLOCK 8 WARNING LABEL 4" MITI. fi i'i air----- ~APPROVED JOINTS WITH APPROVED PIPE 3' ONTO SOLYD SOIL ~~ RISER EXIT PERMITTER ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. SEDDZ NG UNDER TANK CONCRETE PAD SPECIFICATIONS ~~.... - SEPTTC ! DOSE TANK MANUFACTURER: „j , ~s~,,,~- lNMBER DOSES PER DAY: ~,. TANK SIZES: SEPT'ZC JOGS' GAL. .DOSE ....~.~- GAL . ALARM MANUFACTURER. _ ~~lg~~ MODEL NUMBER s ~ ~ „~ SWITCH TYPE. ~crc_, PUMP MANUFACTURER: oa~,~ MODEL NUMBER : e ..._.. SWITCH TYPE: /yr,~,^~ ... REQUTRED DISCHARGE RATE ~_ GPM POSE VOLUME INCLUDING F LOWBAC K : ~'~.?rf = GApLy. CAPAC I DIES : A = „~„ INCHES = ~,~~:~,._.._GAL H = ~ I NC HE 5 =~,,, ~„~ AL . C ~$ INCHES =L~GAL. p = ~ INCHES = _ ~~A~. PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP GFF AND DISTRIBUTION PIPE ~~ FEET + MINIMUM NETWORK SUPPLY PRESSURE -ir~'FEET + ~ _ FEET FORCEMAIN X ~, FTl1Q0 FT. FRICTION FACTflR r~ FEET TOTAL DYNAMIC HEAD = ,,,~,,~,.FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WZDTH~; DIAMETER ~_, LIQUID ~~ •• ~~,~/,~~~- ~ .~ SIGNED: ~` ,c~r~ _ LICENSE NtlMB£R: r?~77y'Q, l~ ~ DATE: .,,s;~,~,~~~~~~ 1/88 ~GOULDS PUMPS Submersible Effluent Pump 3871 EP05 APPLICATIONS Specifically designed for the following uses: Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Oewatering SPECIFICATIONS • Solids handling capability: '/~' maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • bischarge size:l'Ji' f+tPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (4040) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, ] 15 or 230 V, 60 Ha, 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: 10 foot standard length, 16/3 5JTOW with three prong grounding plug. Optional 20 foot length, 1613 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available far automatic and manual operation. Auto- maticmodels include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. METERS FEET 10~- 9 s g ' W x v 6 5 0 ~ a 0 ~ 3 z 1 0 ^EP05 Impeller: Thermoplas- ticenclosed 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 durabifrty. ^ Motor Cover: Thermopf~stic cover with integral handle and float switch attachment pants. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construQion. AGENCY LISTING ~' Canadian standards Assodadon {CSA listed model numbers end in "F" or "C".) Goulds Pwnps is iso soot Registered. "------, i z.s rT '. 0 2 4 6 8 10 12 m~/h carac7Tv Goulds Pumps ®2000GoWdsP~mps ~ ITTOndustries Effective February, 2000 83877 ,.,~._ l//Ck4r~ STANDARD CHAMBER Quick4 Standard Chamber Mu1tiP4rt End Cap FRONT VIEW ------ ------'-- ~2'----- ---~' --- 48' ------ -~ ~ (EFFECTIVE LENGTH] Q,f lip ~~ - - ~ ~ 1 ~ ~ ~_ ' ~+ i= I f 1 ( ~t 1 SIDE VIEW i-~ 'JI r C~ ~; i ~, ,, --` y fi\ ~ ~~ ~ r~-- --'-~:: stogy vJSw .';a ~ ~ ~~w u, P Y ' *Quick4 Standard'Cteamber f~arninal Specifications ; Size{WxLxH} ' r 34i'x52'x12" Effective Length 4$^ lrlvert Height g° ToP v1Ew <MulilPort End'Cap`Noiriinai Specifications "~•'-fi - ..Size WxLxH~ ~ `34"x16"x:~2, Invert Height 8" of 1.25' tn-~~. RL +~TQt3.;;Y~s~~lNC. STANDARD LIIMITED WARRANTY Inr lrw t ;tutu tt ly ct narn chamtlBr, Cnd Plafa. 'wady n d N•.er arx ~txv man to;4rred W 11 ~ Y 1':~rit ) vunen install d a- 1 txrmrai t n IbN fekl i:t en t seplk. 5ybtern in af,GardallQa wiHl In rkatnr'S ,^St t I'Uns. 5 wa r t. C l.. 11 ) ru il:fai p+xChase hiti~nr: I a 1- 1 deNyetiva 'tale nl. aw +w. krna sr rp r[,r ore year (nun In6 da!p Ih:L tl>E pr-µ1c per t 1 y tisuea ku trre s_ufi~ aV;lBm ~Nain;ng t31p l M;; 4 ruv"1r+rL tKrv ~, th.,t a sgrllc per ^ s rkM rB~Ured Dy apCNCable iaw. Iha warranty aarlrxl t fin. upe hod to That nerellalkn o the sBp'Jc sy I.. rs exe se Ns w a t ghts. Holdw mu:a notiry Infrltraca wr1ng at it: ('<rparala HBadq arty. 'n liln Siyrxonk C•nrr,edicW wp 5ryoen t157~ Uay nl lha allexJBtl Uofeel Infrllralrx wJl supply repyoamanl Ltr nfs lar Ur-rls datarn iinoil ry Inld!.akv la ~n Cove~83 M Ih'„ LrnNenl •Na,ranty. Inf I.ra Or's Gehil?y Spe;:NiiARy BxGIUU66 th6 G0.9(W 'Ernuval andfpr Instal'okCn C' trip, L1rh15. pN 7 HE L:M?Fp WARHANTV ANi) RCMF.GI[S W Si113pARA nAF'li ;al ARf- LX%~I1SIb'E. Tl-iFRE ARtZ N;i Ll HF,H WARAAN7JE;~ WITH R@SPEJi TO THE LiN7 (5, Ptt JiJING NU MApUED WAFRANTIES OF MERGHANTAeI 111 OR F1TNE ' r~ I=, A f-M TICULAR F't1RPOSE. d Tr I inJndd N.a my ehall b6 vr~xl it any f'arl rN the cnanrbP 5 •SIBm IS nardarl~.:m ny anyon6 e.her Uwn N1tiNralRr. ThB Linr,t2,d Warranty does ~'i01 ax er tl to InC de rtal, conspquon'ial, epacial r r 1nRrpc:t darnages infntra,~ slldil rp: GB Lolltl ku pane, Lne a Ilgwdated tlamagea, nnF. rrNrtrj InsS Gf 4xaA .For and proms, tabor and ba16r1A1s, ov~nead costs, or othe~ NaSSes or expNnsos nolmrad by Ire ~icuduv yr any (bird (arty b;ax:mcelly escludect ?rtun ~rnaad WananlV cowNage are damage to Iha JrNls tJtla t0 :;•nA?ary wear and tear, alieratinn. acrldant, misuse, abuse or rregbot d IP~e tlnl:3; Ihs; Units be+ry sutba:iBd to rretvcb 1raNic w oN& alncAlions w'ucu are wr IaprmNtFxt by the ^tnlaliation bl.IrUCltbrS. faAUr6 to mairMaiC rho min;rnum yrCUrd c wBts $al terlh ur ir:e installatlpn instrucpons; (h6 ~raaamenr p'rrnprcq,er malerlals nNV the Syslern wntam:rty eta UnNS; faihre of !nr Units IX tiro sap;ic system drx to impn~ar siting or anprOpar ;Jri:g, mcossve water Usoyp, 'ImpmXxrr groaao disposal, x in+prupnr Upara;iP^.., a any Cpxv ayEn; not causM by Lrfarator 71,is Limiial Warta:~ly stwli Ue void N the rlrrl[lru IdiIS b ronpry with al W the leans Set ronh In rNc tim,tai UlarrantY_ Furtr r., ir, no eve ,1 shall ICIIH alw he rusp<nsiUla !ar any loss yr damage to 'ha Harie!, :he Units. yr any third party restating hoer lnsraikllion or ship. mBr r from any Gxak~cl !'rabilrt; ~auns o+ Fkridar or arty Third Potty. Fcr to 5 Limi!ed War: anly to aPPh• thE- txuts rrn+si ua inSFtu'Gxl in accordanrrl with aii $tte crxvJirivns rBClurcad M sure, antl Ipcal Cnrles, all Othor apPliraoie laws; and kNlq!WVrS arsuilaliun N1StrUCtionS~ (dl Na ropr652nia:ivp of Inletratw has the aWtk1MY to change a exhagi t>u L^niten 'Warranty. No warranty applBS l0 2ri4 party rAtvJr Than Iha vrgr rut tioklEr. The abcwa reprBSents Iha - lartdard Limited WtNraMy vNtxad try I .a;tratcx A LmNrxt ru.:mt?B? of s1,Mps and cauntips rrnva diHerarv wararNy req:pre, mentS. Airy purdlascr of Un!s ;Jlpu~d cerAacl VJNrralUr's Cw{w aie Hcadrpaartus n7 CJkl Saybnx+k, Cc rr:Br;trCUt. fmpr ?q such pl at,'hase, to olJtaan a copy of the appktable w - ranty, and Shwld CarBfuNy read ttyt wanan'y prig iv the pixuhase of Units. U.S, Palerts 4J51y.6F;1; 5,D17,041; 5.156,4A8: 5.338.D17: 5AOt t eF~ .5 ant aFO , ~, . rv,~. ~ ,.~ .~.,. < <,... • SYSTEMS I f~1 C Environmentsl Onsite WastewaFter Solutlorts'" 6 Business Park Road • P.O. Box 768 Chid Saybrook, CT 06475 860-577-7000 • FAX 860-577-7007 8oa22 y -4x36 „u~ era-ans. I ..ua,yoa ~,ou~,btin Other patents Pending. _ -~ --. _ -.. ..... ",...,' °'" Intillra,o Egiaalizet' and SkieW,ndar are registered trademarks of infiltrator Systems ,nc. Inrilt~aiw is a registered trademark in France Infiitra!or Syslerru Inc. s a fey fared traoamark In Mextco. iontour, CcxJtow SWivet Correction, MiuoLeacranG r'ofyl"uft, Snapi.ock, ChamberSpacef. Posd_ock, QuickCut, tZuickPlay and C)uick4 are trademarks of lnGitralor rysSems Inc. ®2tJS3 inlilhalor Syslen c Inc. F'nnlad rt: tJ.S_A, rucrcteoptrrn StC:I IVN V1FW 8T GI~IX ~ ~ AGRABt~N`~ SP,gi'iC TAIL Mlw'A~ OWNBRSHIl' ~ GTiQIS PQRM Mai]~a~ Aed~reus P:z-pt~ty wddscac ~~ ~ ~~ ~] ~.- . Su t~ ~ ttLred ~m Pbieeia~~ ~apaetiaeat far env ~3S (veeii~at~,oa ieq (z(o l8 ) 020 - I IS - o~ - oao c~trrsti~ Nur~so.~ ue~ ~~~ aa~h~~s~ xu~a , ~s~r_~r 'n1~~r'~1lrDTr[1N Y.ncatiao ......._.. ~/., ~'/., Se+c. 2~ .. T 29 Td-1c~.L..L-W ?°'QVD of ~(1LZ3"~ ~+P~Y --r „r i' , ~.-- ~ -Lot # °_,~._..' .,.: Subdiviaioo ~ nc ~- r Cert~led Surrey Map ~ , ~- . Volu:zte ~- .p~° r '~ ~hSa ~ ~ 3 vvamety Deed * .~, lv Ca . 0~ ~ _ ~ Vnt~ume s~ ~w~ ~ yep ^ Aa Lat i8nr~:ele~.8iable ~ Ym C3 00 c emaontdss~+iitis~rcpt~amant~~•~•~°~""`m~iat'°"'°c` ~vp~tc tsae tmd ~ ~ Y~ ~ of toot. if nr+edod by a liraared y°u' ~'°~ ~e the ey~m matiMir of p~it~ out +tbr reptb- eealt zv~y t~tae Y~ cart a~ dre men of e'ha t~ Smlt +ac a eca~aat Nage m ~* '~ ~f0'~'~O°a' t a estibeatiam tass0. t'~ ~ ~ tip ~ by ; 'i'ba grrrpe~Y o+wrocc agave is ~baalt ~a Shc ~tois Loniug ~lktat(i)1ba~~ ~ ~P~i°'~°'y°°e7apiueabar~~r4cuaadP~a6~ars tiao~P'~'~' ~ ledcu teams tau 113 f~11 of t'l~- ia b* P~ opacatit4g cettdition wd/or (7.) sitar ~ pv®p~ (~ ~-°'~' ~Pd° ~~ ire. tia v~odetaig~ itar-a toad ~ ebaMC ~ set [a$. bombs, si act by the a ~ Ge atadeP ~ ttepdia ~~3~dr~ dam!' 16 tb~s ~ol+c t~ ague to msir~n ~ p~vtata eel ~Po^at A~r° a s~ ebie a,q,„~at of I~at~aal ~wecea„ State e! ~~~o ~ eo~letad eed eat+s~ t+o tb~ St tS+oi~t CotmQ- Z~s~ ~`~ DAB uK 11x 14/'- asvi~ OrVGG tt• trEttffy that i11 two L1ai5 iatsn att tt+sa to for Mt o[ as ~np Off. rer,'I~e~d~e a rwansnty decd cesatdslt in I ~~) am (ase} t~ ohs} of Z~~ DA'I'S OiVi~~ ~4tsY• •+'~••w Aoy Sataratv-tion ie tasie-eageartata+l mar:cn~lt tQ. th+e tan[tu~r gcct~t b~efn6 rtrvoiud by doc Iee~ Dap~t' •• ~cluda w3tb tb3s sppucatloa: • scta~+ed wutaatY tde~d ~araa tbtr jLe~litR Ot ~~ 0l~ve s aapy aE e4re ee:ot8od ~aY +cn+P tf eetet.~. ii tt3a~de itt tlic wst~nty decd TOTf~L P . ~? -_. ___ . 1 205'' S~ STATE BAR OFWSSCONStNFORM i ~ 1948 nocuarrac iNuttatars WARRAI~''I'Y DEED . This Deed, made between 3tDhn Gies and Pear{ Gies, husband amd wife, C3raatot, told 5{sans Corporatiao, a wrporation under the laws of Mianeslyia, urantee, (3ralltor, for a valuable coruideration conveys to Grantee the fallowing described real estate Sn the Catrnty of St. Croix, State of Wisconsip: See Exhibit A, attached hereto '7 -~-BO es D Pearl Calea The parcel shown on this documartt is being added to the parC+9! shown on the dot:ument recorded in Volume 1787, Papa 813, Document Number 888080, deau~ed as a petrel of land located: to crests on parcel, and thin Uanaedlon in thereby exempt from Chapter 18 ar tM ST. CROIX COUNTY LAND USE REOULATIgNt3 pursu®nt to Section 18.03 (A)(9). Together with all appurtenant rights, title and interests. Grantor warrenls that the title to the Property is goad, indefeasible in fee simple and free and clear of cncumb[ances except: restxietions, covenants, conditions and easements of record, if any. Detect this ~jday of November, 200.2. • AUTHENTICATION Signaturr(s) authenticetrd this „r, day oP _ ,~.~, TITLE: MEMBER STATE BAR OF WISCONSIN (tf t1ot, authorized byg706.46. Wis. Stets.) TIi1S rNSTRU,yt;NT WAS I)RAPTI?D BY Fredrikson & Ayron, P.A. (SMM) 4000 Pillsbury Center 240 South Sixth Street Mtnneapoiia, MN 354x'2 612-492-7000 2682096 (Stantcuree may 6a a,prunticated et acWwwtedaed. 9ou+ an rot trecetcary.) 699H66 KAT1iLiiCR fi. yALS1t ST~iG~IX~CO~.`~ REGEIVt"a0 FOR RBGORn is~aa~awa itsa~ta~tr fflt~T 1 RSACA FEET 13.10 CppTfiF~s t 87.90 GBRT C P~ P6lR c PAG1iS c Fredrlisoa ~ 6yrda, P.A. 1000 Paaebury Ceoles 200 South Sixth Street Mleuwapdie, MN !S/DI Porcel rdsntlrcation Number (PIN! 040. SOAl.3t1,000 Thir (i41(ix Hari horneuead property. ACKNOWLfiDGMENT STATE OF WISCONSIN i 1 COUNT? OF ST. CRODt i Persorully came before mr tLis ~• -.. -day of ho.ember, 2002, the about named John Glea and Pear{ C,its, husband and wife, to me known to be the person who rttxtitxd tIx foreBoinH icutn+menr and acknowled8e ;lte same. •Nrnatjr Public, State of ,~.~~~„or'W.ta.~ . i~j1-pet (N trot, state r+cpintion date: M~halla Back Notefy Public Stets of WI nsl t~ •Yamee of perconc ~eing in Ley capeti:y ftWultl Oe ry1>ed or printed Uetow Wste nerwturec wARAA.'rrY DiaD e7A7a aAi Or wucOMaIIr FORM An. 1 • 141a Ir!oraytion PrUeeyanals Cn+'oonY Fend de LiC, WiaCen9n atq~e5S•4C21 • ~.. I STATt; BAR OF WISCONSIN FORM } _ 18pg WARRANTY DEED t)ae,n,en, ~ vnt. ~ 197r~.c 613 _~. _ ~~ _:.,. _ t.~.~ _ ,... _~ __..., _ I - Thiibecd,tnadeoetvvecn lfane Carporatio - r-~Y a.Minneaotes corporaeioa - r, Crentor and SlenAa ~Oj,~Or81;,j,on 7 Mfnn~Qgte coroarat ~Oll_~-... _..-. --~~ Grantee. Ctan[ar. for r va}v~bie roraiderarlon. wnvcyi to Grantee the folluwtnp ecaer,bcd red) eras rr, St. Croix Cnunty Sate of WtKOnstn See Attrched Exhibit A Togrthrr with aU ap}wrtenent rights, Utle end Innresu b6tSt'~8t~ KATNL£EN H. WALSH REOI3TEFt DF bEEDB 3T. CRDYX CD., MT RECETVEI iBA REOORG t2-21-2001 3.10 Ps! YNitft(WTY DEED ~ coFY FBE: CaPY FEES DER FEf s 9163.10 IlEfsi_OtMG fEf: ,7.00 n.caavnq AW211 Name and Awwn Attarees ~..._+^... .. Un~~r~ti i~~N~ 5`100 5 me.~'ri L~ ~ ~- i Su~~. col ~(~nne -b~nka d~fJ553'~ ~rm-:.:._ _r.. _+. .:ate ~:,s^.-.r_ - = .. _-_ 20-1048-30-000 PmcdtdorgiecaaenNUR1EYtPer1 __•- ~! Thts ie noe homestead propsrty. t~ (tip (lx noQ so-iD4e-ba0oo Ci 20-1048-90-000 ~ 20-1049-94-000 2o-loso-oo-oao 20-1050-80-000 20-IQ52-20-000 ZO-1052-70-000 Grants' warrmsr that the utlr to the Property u good. inJefra+tly;r m lee slmplr and free anti eku d atcwnbrarxci except See Atta~had Lrxhiblt $. ~ natorl rMx 20th _.. ~ ~,y of Decsuber _ _, 2001 Bane r Oratiop (SEAL) ,,,_... (SC•AL) by 7a M. Nasisef - ---- Itg of S:ecutive Offi ~$pAL~ ~W 1, AUTHENTFCATION ~~ SiRneture(s) auttxrtticateG thB ~ Jxy a( TITLE: MEMBER STAIE BAR OF WISCONSIN (Ir r,r,t, authorized by §706.06, Wis. Stacs.} ACKNOWLEDGMENT Mittae so to Slate ot'4YttsCetnt?4, .s. 1, .-..tic ~ ~ Crwtx , Pcreorully carne 6efnre rrfe shit: ~~ day of December 2001 , ~ spa„ t rwmoA John M. 13usseff. Chief Executive Officer of Eane Coi ora[ion a Mineesota cnrpotraiion .. _..... ^., ..,.. - .~ ..... __ to me krrwn to be a per wlxt executed th[r forapo4tq tnStnaYtent and ratna, THrS 4N6MUM6N7 WAS pAAFT~1 By ~ NA1119Yl,6AllA1~sR ~-ackriclge Grinda2 Law I'irtn ~ aeea.tmotia>wtw+et+.e ---1.aQ-.WRC~~C~»J~.1tClfitiQ Cn.~th~.._ ~~- r~rw~a.nrx~------ -- -- - Mlnneapolis, MN SS401 cyaey'Puulte.SuceotWtsconsu~ ~~ /may commtcgnn 1s pCn7f0ncnt (Ir no[. xrixw •xpirautrrr data'. 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