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HomeMy WebLinkAbout020-1415-20-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division t s INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1• Permit Holder's Name: City Village X Township Sienna Cor Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~ C:/L-z~~ ~ ,JL' C~ Aeration ~~.. Holding TANK SETBACK INFORMATION TANK TO P!L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~> > ~ vT ~ _ Dosing Aeration ~ Holdi "~~ _, PUMP/SIPHON INFORMA710N'C~ rL Manufacturer Demand G Model Numb TDH Lift ' tion Loss System Head •.. TDH Ft For ain Length Dia. SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. C~OIX Sanitary Permit No: 430190 0 State Plan ID No: Parcel Tax No: 020-1415-20-000 Section/Town/Range/Map No: 20.29.19.2620 STATION BS HI FS ELEV. Benchmark y ~ ny.6 ~~G. G - Alt. BM Bldg. Sewer ~ ,~"~ 9 ~ , 23 St/Ht Inlet ~ ~ 9 $ . ~ SUHt Outlet ~ ~ 9 $. Dt Inlet ..1- Dt Bottom Header/Man. Dist. Pipe 5 nj [, . S g G.. 9 4 Q7. l q?. ~. ( Bot. System ~ ~ ,J~; t3 • ~ a. ~v ~ - ~' 9` . { Final Grade t~ ~ /00. /o St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ c~ _ ~_ ~._. SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manuf turer:..,~ r { ~'~' ~ - T S ~ ~. ype Of ystem: }~ v ii ~ ~vr~ i fi'r'. ~ .C C `_, ~ J / ~ ~ • r1~G ~ . ~-..._-.__,... UNIT ~ Model Number: ~~ , .. . ..~. ' --.` e t~ ~i~ DISTRIBUTION SYSTEM 1/c-,,, / s- ~ - :, G '_ Header/Manjf>7t~--=-- 'stribution ,F x Hole Size x Hole Spacing Vent to Air Intake LengtDia ngth Dia Spacing _____.__._ l0 SOIL COVER __~..-_~ pressure Sys~sQal~--.,. xx Mound Or At-Grade Systems Only ,~~ s ~. i p e t ver De h Over ~ xx P e th of xx Seeded/Sodded ~ u c e ~ v ~ ~ Bed/Trench Ce ter ~, Be rench E es To so I Yes ~: i No - -, vJ Yes (~] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: >a / ~/ / l= ~ Inspection #2: / /. Location: 746 Martin Ave Hudson, WI 54016 (NE 1/4 SW 1/4 20 T29N R19W) The Glen Lot 26 Parcel No: 20.29.19.2620 I f ~ ~O.c- 1.)Alt BM Description = ~, ~ ~~"' `~ 3 ~ Sti5 ~ ~~ ~ ~ t""'~ ~ ~ ~ t ~ ` ~ c) 2.) Bldg sewer length = I.3 '~ ~ Y'O ' I ~ - amount of cover = _3'~ • ~ '~C ~C ,~ a~ .~.~~ ~ r- ~ `~ S'` /- ~ H L ou.~ °Z ^f-~..,.- K.. ~ _ ___ _ ~ I ~ i `~ n revision Required . Yes No ~-+ ~ p ~„~ - ~~ ~• ether side for additional informat n. ____' __ ~ _ II ~ ____ __ _/ ~ '0 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 ~ WI 53707 - 7162 Madison /~ M ~ County T ~ ..~/ ~?~~J' ~ Sanitary Permit Number (to be filled in by Co.) i , ~~o ~ ~ ~~8) 2b6-3151 a De artment of Commerce Sanitary Permit A~ 'cation State Plan I.D. NuFn r /,V/ ~t+y onal ortnation you provide A ida -C Wi d , t ~ a w In accord with Comm 83 21, [nay be used forsecq~6ltarYP~ Prr~acy Lai, s15.04(1)(m) •. ~~, Projre7ct~fAddress if different than maili~n]g~,add~ress) l G ~ ~-GZ~ TJ U-~- I. Application Information - Pease Print All,l~oS~-a v . ~ i PropertyOwner's Na me ~ ~ ~ Parcel N , I ~ t Block N ~ p 2 0 1 '~t ~G .. ~ S:'e,~.t~at... a r Property Owner's M ailing Address y~ „y...~.--- Property Location ~ 2 (p 2 ~ qc~ r ~t C~ Y! 7 d r ~° "' Y ~i / C ~v O ~ ~,~~k,Section ,2a City, State Zip Code Phone- Number ~ ~cl ~ t2 SS~S^ Q~,ja - ~'3S- ~ T ~~ N; R ~ q, E cl~) I l ll h at app t II. Type of Building (check a y) ~~ lc~r_- Subdivision Name CSM Number ^ 1 or 2 Family Dwelling -Number of Bedrooms ~ ~ ^ Public/Commercial -Describe Use _ 7 ' W~ ~ ^Village~'ownship of ~~$'d~ ^City ^ State Owned -Describe Use _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Btfore Expiration Plumber Owner IV. Ty of POW'TS S stern: (Check all that a I ) Non -Prsssuriud In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ ing Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Constructed Wetland ^ Pressurized I - ^ Recirculating 5 nthetic Media Filte eaching Chamber Dri Line Gravel-less Pipe ther (explain V. Dis rsal/Treatment Area Infer ~ 3 I. Design Flow (gpd) Design Soil Appllcadon Rate(gpdsf) Dispersal Area Reyuired (sf] Dispersal Ar ~ ystem Elevation ~ ys6 ~ ~ 7 ~<<3 ~"~ ~~y ~' ~ ~ VI. Tank Info Capacity in Total Number Manufacturer Pre a Site Steel Fiber Plastic ~~ Concrete Constructed Glass Gallons Gallons of Ut»ts ~ ~~~ ~ New Existing Tanks Tanks Septic or Holding Tank jdd~ f ~e ~ ~„ Aerobic Treatment Unlt Dosing Chamber Gs~a ~~ VII.' ResponsfibiIity Statement- I, the undersigned, assume responsibility far allation of the POWTS shown un the attached lass. Plumber's Na me (Print) Plumber's Si gnature MPRS Number Business Phone Number t ,~~;r~~Q ~ ~ ~ ~g ~s- ~~ - 3ra i Plumber's Addre ss (Street, City, State, Zip Code) I ~ 6 ~ ~~ 4 s ~ .~~ GC6 VIII ount /De artment Use Onl d Sanitary Permit Fee (includes Groundwater Dat Issue I uing Ag nt Si tur tamps) i ^ sapprove .D Approved Surcharge Fee} ~~ ~'~ ~i ~~3 /~~ 3 ~~~ttisy !! ^ Owner Given Reason for Denial IX. Conditions of A proval/Reasons for Disapproval ~ ~ ~.~~,,,~ ~ ~~;~~,~~ ~,~,,_°~ -~o l ~J- a a~ ~ r-' ~U~o Z ~ ~~~ C'o-,z~,,,, . ~' 3- .5'Z n ~ , f ~ ~- ~ , ~ 7R'~o ~ G~u~ c{3 ~3 • ~ ~~ t!~n~. Attach Complete plans (to the County aNy? ror ute system ou paper nog Bess wuu o.,~ ,... ,...,«w ... SBD-G398 (R. O1/03) Si ~.y a CG v~ ~ o -~~ 6' Tai -e ~~~~' Tai./ D ~ l~~~iy .~ ~,~ S ~~~ G'~-P. SGT ~ e ~y0 % ~-~/~ ~ ~ Y/d i~ O ~~o~ ~ _ ~~~ SGT ~e ! = y~0 .. v SEPTIC TANK ~ PUMP CHAMBER CRASS SECTION AN'~ SPECI:FICATI 4" CI VENT PIPE 12" MIN• ABOVE GRADE 8 wEATHERPR00F JUNCTION BOX APPROVED ? 25' PROM DOOR, WINDOW DR WITH CONDUIT V~R WA NPAD FRESH AIR INTAKE LflCK / WARNING LABEL FINISHED GRADE 4 " C I RISER ------- __} ~____. ~ ++ MIN . ie ~k 18" IN. 6" MAX. :•~ ~ NL.ET ' ~ ~~ WATER TIGHT SEALS -~-~ GAS , ` TIGHT ~ `, T E p SEAL ~ WITH S JOIN _!__ ; ALM APPROVED ?IPE PPROVED ~ B ~ ~ ~ ON 3' ONTO IPE 3' -"i"" ~ , SOLID SOIL N70 SQLIp 4IL PUMP OFF ELEV . ~ FT. ~ ' OFF ~~ RISER EXIT PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECYFICATIONS SEPTIC / DOSE TANK MANUFACTURER : ,~I.~i °~5~.=._ NUMBER DOSES PER DAY TANK S~ZES : SEPTIC ~,Q 1~! ,^ GAL. "-"'~ DflSE!„Sd ,_ GAL. ALARM MANUFACTURER: 1~el~vm "~"- MODEL NUMBER: n ~. v SWITCH TYPE: ~„ y~i~eYc. PUMP MANUFACTURER: L~~~/ ~ ,_,.. MODEST NUMBER : e r/ SWITCH TYPE: nr,~~^c REQUIRED DISCHARGE RATE ._..~sz- GPM DOSE VOLt]ME INCLUDING GAL. F LOWBAC K : !~ CAFACITIES: A = ~ INCHES = ,,, c~.'..L GAL B 2 INCHES = ~~ ~AL~ C ~ $ INCHES =~~GAL. .~. D ~ ~ INCHES = _~GAL. PUMP E ALARM WIRING AS PER I LHR ~I6.23' WAC VERTICAL DIFFERENCE BETWEEN PUMP GFF AND DISTRIBUTION PIPE •~ FEET . . . .--- FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET + G~~~ FEET FORCEMAIN X~ ~G FT/ I00 FTQTALIDYI3AMICAH£AD ~ - ~ ~pEET INTERNAL DIMENSIONS DF PUMP TANK: LENGTH ; WIDTH~„r„r~ DIAMETER ~, . LIQUID b'E~I`A- ~ •• ~~',' ,~ /~.~ ~ ~ „ SIGNED: LICENSE Nt,1MBER: 0?~79~G~ DATE: -,~d.~, 1/88 C~ ~~ a~) AP~LIO~AiIOiI~ ~~± cle~gned for the fot~ow&rg Dees: ~~~~ kian6S • l: ierbtq S1P~i~'lCA~Qf18 .~..,_._ Pwnps X04 • So~4s harrdting i2ity; 't~ r~admtrm. • Capecides: up to S5 GPM. • Tod heads: +~ to 2a fem. Mechar-iaai seal: ca~+n- rota /c~amlc-statlar~ry, SISN~-td ab$tcmers. f tt?4 ~4a°Cj Continuous i ~ 60°C~ ~termittent. Fa~ere; 34q ~r~s stel3rtten . Ceptb~ Of natnln~ dry watt dame t0 Cpr11~Cln8rEtt, Flrrttp: ~6 • sans hendiinp cepabiiitar: ~• mma~xximum. r Citiee: up ~ 6g GPNI. '€'a4~ heads: ~ m 31€eet . • G~harge ~x:1~t` fdPT. Mechtnlc~ t0ei: carbcm- !'~! /I~B~1~~lif$tl0niry, $~ e~stomers. ~ T8m~ ryl: 1 t1+~°~ ~tinUaus 14Q'F ~fit>°~j ~r'r-tit#ettt. ®ttOS Pun~pa, ina. l~bnerg; 8G0 series ~ steel. tale of running dry without damage to components. fi~or: • ~PQ4 Sirr !6 l~a3e: d.4 HP, 115 or 2~ V, 6Q Nz,1550 RPM, befit in overiosd with automatic resat • Single phase: 0.5 }iP, 115 V, 80 Hz,1550 RPM, built !n o+rerlc~ad with automatic reset. ~ Power card; i0 feat st+d fertgth, i6/8 SJTf~ with tree prom prowtd'.np plug. Optiortdl 2~ foot lenpth,1613 SJTW with three prong prounding plug ;standard on EPf?5), ~ea'ra~, I~e:t r ;' Submersible Eftiuen# Pump ~~~~ 3871 Fuf!y submerged ~ high grade turbine oil for tutue~ation arxf ef~t~er~t heft trar~ier. Avefisbie br eutamslic and ttlaillt#~ Q~eAtlQd. AtitORlaf~f0 madfstt tttatude tact ftaat $WttGb tseembted and prey et tfle faday. t~~d ~... _ .. ~. ~.,.....,. r. eY lmpatNr:1'hermo- p4estic Serr+i~opert des~n with pump riot canes for mechanical seal protection. ~ s~ lmpNi~; Fhermo` pia5tlc eacl~d @esign for improved performance. • Casing a»d late: Rugged thermoplastic design provid~ee su~rlor strongth and co:rosion~r~~ce. ^ ~otur ~ulnp; Gast iron for et"5dent htlat transfer, sb~tgthk ersd durability. ffe t ~owr: '~hermapias- tic tom' whh integral handle aAd WVttCh t+~`11t p0~s. ^ Poauer Ca6N: Sw+ere dui reed aN and war tti315taf}t. ^ Beu~; upper and lower heavy d bat! bserir~ constru on. eel Slapd~ At~ool~lo~+ (CSA i~#ed model numbers end ir. '1:" or "AC`.) ~~ } ' ` p~ 4 ! ~ ._! ..._. Q ~ ' ~ , ~~~ 5 ` _ r,., """~ 0 ------ i j i t ! ~ i 6 I ~ ~ o n ~ w e opt o d iz m=M a;.4. ;. CAFACRY ~ ~'- 5 `~ ;. .. ~ kYhativa ~'9SY~ 1~iB r Z DI~,H6 1106 Page i of 3 Steel Sal Service St. Croix pending Date Personal information you provide may be used for ary p~ac~iilrac~ ~04 (1) ( ). ~' - 3 Property Owner Property ocation Sienna Corporation ~ ~ ~ d (j 2 ~~vt_ Lot NE 1/4 SW 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address lot # Block # Subd. Name w CSM# 4940 Viking Dr, Suite 608 ST. C;O~~: COI±~ T ~ 26 na The Glen City State Zip Code ~( ' `~r ' ' r_ Village Ip?~ Town Nearest Road i:U',•n~ MN 55435 452-~a9'-~~g Hudson Carmichael Rd. Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Cornm 85, Wis. Adm. Gode County Attach complete site plan on paper not less than 8%: x 11 inches in s¢e. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all in Revie .,~ k..,. ,; a c 9 r ..:... /_ ,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 elevatign, if licab ' ~ ~ ' na General comments `~ .(~¢ ~Zt,~.C~z- 1'~/ ~ bw L ~0 ~i ~ /i7q;~- Gf~+7.v~ 5/G~1~-- Oh c:C ri-~ ~ ' and recommendations: System elevation 99.64ft, trenc ed and depth to code 4.66ft below grad ~~ hes spa -~ w~~ c/ ~. , .S~ S~i{-r~, ~'$.~ So`Lt~~i ~ ~ ~{~d~~ ~ C ~7~-G`Q/Ij~I~.- ~ Boring # Boring V Pit Ground Surtace elev. 104.30 fl. 96 in. Depth to limiting factor Sal ication Rate Appl Horzon Depth Dominant Color Redox Description Texture Structure Consisterxe Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-10 10yr3/3 none sil 2msbk mft cs 2f .5 .8 2 10-20 10yr4/4 none scl 2msbk mfr gw na .4 .6 3 ~0-9t] 7.5yr4/6 none C ms ~ osg ml na na ~ 12 Boring # r~ Boring 9f' Pit Ground Surtace elev. 104.30 fl. 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 0-10 10yr3/3 none sil 2msbk mfr cs 2f .5 .8 2 10 2~ 10yr4/4 none scl 2msbk mfr cs 1f .4 .6 3 ^ 25-96 ~ 7.5yr4/6 none ~~ osg ml na na ~ 1.2 jai. o ` _ _3 ~ . ~'' -~S ;~, r~ tttwent;F~ = tsw 5> 3t) < zzU mglL and TSS >30 < 150 mg/L * Effluent #2 = BODy< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 154017 9/7/2002 715-246-5085 ~~ Property Owner Sienna Corporation ~ Parcel ID # Pending Page 2 of 3 Boring # --~ Boring 100 6 De th to li ft mitin factor 96 i Pit Ground Surtace elev. . p g . n. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Cor>,s~tence Boundary Roots GPD/ft~ *Eff#1 *Etf#2 1 0-12 10yr3/3 none sil 2msbk mfr cs 2f .5 .8 2 12-30 10yr4/4 none sicl 2msbk mfr gw 1f -4 .6 3 30-44 10yr4/4 none sa 2msbk mfr cs na .4 .6 4 44-9 7 5yr4/6 none ms osg ml na na 7 1 2 . . ~ r~~~~~~ ~- ~~.~ ~ {~.~ ~~ (sue% ~ ~ {Boring # _I Boring " Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Boring # _.~ Boring - -- - -- --- - - 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 NE1/4,SW1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot # 26 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 N established at the time the soil test was conducted. i3~- Ua~~ . ~-° F ~y s ~~,,,._. ~(3~ ~^~ (~i ~ ~ ~~~ 7 /Z~ S/o~v l 1 ~,bo ~~. ~ • IoZ~, 3~F~ c, ~7b' ~oy~, to r x&,1.3! ~ So~~ ~o ~ /J ~,..; a... ~C-Ey{n U! / ` , ya' ~enctir,,,~c~f; £~ /oo.oof=l~ %a~of~ ~~SfuL~~~- app= as ~,-hy s Do('c Ll~ ~~'e /li'fi~dh S F32= /d`f~3G~F` ` ~3 = boo, bo p'` ~-7 oZ w~ ~~ .. - . ~ '` 57 r ~ . . ~~ `: . t _ 1 1 .a ~';r~ \` •r 1 ~~ ',a ~ '~I~ ~ y ~'~.~~ 417'. .`~ ~.~.. .+.. ~~_L .. .. s _ ~ - ~-~ 1 y r i /~ fis~,.~.~ ~ ~'• ~ ~ 1 . _... Q /fir ~ r r 1 .e.... , fIi/ ' a ~~ t I.S !ilia \ 1 a _ _ ... t ~ I r aT 60 _ ~ ~ ~ \ al i 1 pA J Ira: ~ __ ` OV .. ~. ~ ~ ~ 1 '-- , ' - , .. , ; ! - _ _ ~.. ",y ~ 1t6 117 ~ I :. 2 t._.a- :~ _ .2 . - ~ -y _~ ~ - \ 1 l 1 :- ,. .-• - ` , 5' ., ~ ~7 _ _ . 1 I 1 ~ I ,~ ;.^ i a \ , ~~ \ .~ ., 1 1,. 6S ~:~ ,, 1:ft _ l ~ ~T.,I- 1! i ~ 3a. l ~t't \. t ~ 1 ~:P ; ~.~ .. ` 11t ~ .., ~~` .._ , ~ 111./,. ~._.~ __ l \. fit. i ,' ~n_~-_. '.1 1 a'~ ... i u I '-w'ti"~m-er, ... -- ' ~'•\ \a~ ~ 1 i7i3 - _ ~ V~a. n ,_- ,t ~ \ P -- .._ ~~ ~ , a. ~ ..6V-'-. ~_t1 .. , a a \ ,I P_ a 4 n ~. ~~ 1 1 , ''', - •- ~ 1 1 1 1 ~ ''s ~ - ~. ' . ~ ... I .~ - 4` ~. 1 ~-~ a ~' ` I ' T ` ~, _ . _. __ _. _ \ \ , e P ~_ s~ .- -.. -' - ,` .: .. ~ - _.. ' ~ r , , 1 a \ ' , r ~ ~ 243 - -138 . r .. f 1 ~ 1 1 I'~`I r 1~ '- .. 1 1 II r i ~ \` - 't' ., 1. ', ;. _ h-~,~ :, ','' 1;11, II:,' %' ,;,,., , ,••.•:;~;;Itt;r. ~------ _ st, ~' t a __ il, `1 `~~3~ ~ ~ ., k. } , r ' - J 1 r ~ _ - - _ _ - _ ' _ _ _ t I 1 1 i I ,- 1 1, I It i \ -- ! - , /1 I r 1 1 ' u~ I,..r .' t ...~ r, ~ ~' ~ ~, , 'a\ .. ` - ~ \: a, a ` ~\ eta \aa ~ , ~, ,, , : ~~ ,~' j, ~ , (__ ~„... I Ir .•~ , ,: / ~„ ~. 11 t x'11, ,, '~; 1' _- ~ '~ ~ _ r t l r ~ r N •. 1 ~~I f f~l 11 t11 a\ ~ I i Yw ~ ~.\ ~_ r ~ I r YEr~., , ,10 ~, ' -~ - '^, k a\ I~ fll 1, 1 1 1 f 1 e. ~ 1. 1 1 1 1Nt -_ I t r r I '. r ~1 r ~• a I ,. ~$1 II a• r j I r I ~ g 16-- ',, ~. -,'-- - .r ~-.+.-.~-~~.~~..~~.+. r ~ _~__~__~ - I ~_~ I '~~'_~__~ ..\ .fir: : __~_____~~_~__~ r r I '' - t ~' -~ " ~ :'~ 1 1 , III ! f" , ' ~ !! f . '~,,, ' . ~ . - ~ r . p , I FROM Schumaker Plumbing FAX N0. 7153863121 Jul. 18 2003 12:10PM P2 - . ~~ u • ~ wi ~~ ~.JC 4. iJ r rJ¢:K7 f•' . Ciro L'/L' ' ~ 8T CItOY~C GoV,I~'1.Y $EYi~C TAB CS ApR88M~'T ArTD ov~*NaRS~ ~~c~-Ttox FoANr o~-¢erlsaycr Sr~J~1A ~ ~PQe~-n o Mexlzag Address ._~-' z'~ V~ K r ~,1~ ~ ~ Su t~ (0~7 ~b trJA . /"tl~ ~' ~{3 S- Propeety Address (`-e(~fiel.ReO. tequfred $om P~~g Deppctsnmt fer a~ C'~ty/5tat~ f-lUI.3SD~ lv~ Parcel Idaatificatioa Number d°Z~' ~y~s ~ 02~ ~lX~ ~,,_ ALx1,E4 ~~~,,~~ ~~ 0 9 x~ 1 W Z wo of NUt~so~ ~iopczty ror~liaa '~,1__"`; ~b Ste. Z - T-Z ~ ~ Subdi~i~sioat TNT : 1_ N Lot # ~. Cc~~d S~ttvey Map # . Volume _ ~.p~ # ----~ r~r Warsa-niy Deed # +~ (~~_ O.~O . Volutae 1 ~ ~ . page # ~ 3 Spec ltieuse ~ yes O ao Irax Linrs ide~ifi8b1C ~ yes ^ as S~'j~RIEM 1V~TNT~~~~41~ eu:efatYtaeeeba~cwastrs_Piopr~Cma~s~et ~ptvper use std mriale~cace eEyova ac~do sytRem could ~v],tin its pesos ~ of p~piag oe{t the teptsG laa~c every thers y~ oc aouarX ;f aeeAe+d by a firmsed PueapaC ~ YO° ~ ~° ~ ~ es~ affr~t tie fuaetjeQ o~'tifo teplie eaak as a Rea~eme ltsge m fht d+asbe d'ISpnasl ~~ "[be ow~c aBscs b eobmit to S"~ (5roiz Zaoing ~pattast~st s r~cd~atioa form. ~~ by ~ v~raa ~ by a p~~ Wmber.tesmciadphtm6socslitee~dp~p~~Y+nS~t(1)4eee4i~c~c~'m' m~rpb~+e:r~ joritneyms~ap ~~~ P .tea,..) the atptb: O~dc li lcss tl~aa V3 t~ ~ eludgr. is is PeoP'e= ajsrasts48 ~tiop aadlor (Z) .it~r tad ~+~ (it:.~---_-~ . (lva; die Vador+~ad Lave evd tl~rc tberz:~r~tealc aeZ fob b~ as eet by ~e Depnitmeot of l,:e ~~ ~ app ~.~,,, r,,,et~q - - dava.ef tbeae ~~fc a~a3~a•"' ague to asafetstiia the privtti satYi~ d+sl~ ~`~ ~riQz doe asa~ds a~ dtho Department of 1~laetsal ~eseuerss. Ststo °f ~ ~aa~~ t,,e ~a~lerrd ss+~d eetLn~ed to tha S1t l~o~ C~tmy Ta~6 ~~~~~~ DATE GRTfk'iCA~IOI~I ~tii£y chat a!1 ars o t5is fans ase teuo to the trae of mY (oe~ 1gne+wkdgd. i (we) am, (are) t}ye owneKe) of sct7 llbov i a+a~anty decd recorded is Auer Qf ~ersls Offsae. Z ,Z ' ~ DATB // *4rsas way infoevsatioa is mis-eopteaence~l essay etstlt to the srsiauy yet'atit ~ rovokad by doe 7i+aiag nQP~°t " Iaeiude with thra •ppGcatloa: a stamped aratraah~ drd fivRO, the >;Legittet of Deeds office a cagy of r>s,a etedt~ eutvay map if:cCcseoce it maeio in the ~ry dcr.~1 TOTAL P. G.12 PQWTS OWNER'S MANUAL & MANAGEMENT PLAN Paae ~ of ?~ .~,,..~ Owner ~ t .~ ~ u ('~. ~ ~-~ ~ ~-", Permit ~ ........,.. ewnwuirreo~ VCOnan rn~v+n.`. ~.,.~ ^ NA Number of Bedrooms Number of Public Facility Units ^ NA Estimated flow iaveragei ~ '(~ allda Design flow (peaki, (Estimated x 1.51 ~ ~ (~ allda Soil Application Rate al/da /ft~ Standard lnfiuent/Effluent Qualky Monthly average` Fats, Oii & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (SOD6i 5220 mg/L DNA Total Suspended Solids (TSSi 5180 mglL Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand {BODsI 530 mall Total Suspended Solids (TSSi 530 mg/L DNA Fecal Coliform !geometric mean! 510' cfu/100m1 Maximum Effluent Particle Size Ye in d'sa. ^ NA Other: ^ NA SYSTEnn ~rC~rrrvr. ~ ~~.~~ Septic Tank Capacity ©~'~ al O NA Septic Tank Manufacturer DNA Effluent Filter Manufacturer '2 ~-~, O NA Effluent Filter Mode! fl 1 'iJ O NA Pump lank Capacity ~~ al 0 NA Pump Tank Manufacturer ~ O NA Pump Manufacturer D O NA Pump Model ~ O NA Pretreatmani Unit DNA Q Sand/Gravel Filter ^ Peat Filter p Mechanical Aeration ^ Wetland ~ Disinfection ~ Ocher: l7ispsraal Celt(si ~ NA D In-Ground igravityi ^ In-Ground (pressur'aedi Q At-Grade O Mound D Drip-Line ^ Other: Other. ^ NA Other: O NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cartificat~ons: Master Plumber; Master Plumber Restricted Sewer; POWTS {nspector; POWTS Maintainer; Septage Servicing Operator. Tan4 inspections must include a visual inspection of the tank(si to identify anY missing or broken hardware, Wontify any cracks or teaks measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface The dispersal cell(si shat! be visually inspected to check the effluent levels in the observation pipes and to check for any pondin{ of effluent on the ground surtace. The ponding of eff{uant on the ground surface may indicate a failing condition and requires thi immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any,tarsk equals one-third (~ i or morn of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and. dispgsed of in .accord"ante with chapter NR 113 Wisconsin Administrative Code. ~ -" A11 other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmen units, and any servicing at intervals of 512 months, shall be pertormed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion cf any service event. •Vaiuea typical for domestic wastewater and septic tank effluent. Fags ~f C./ START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tankis! for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal ce(lls). If high concentrations are detected have the contents of the tankls! removed by'a septage servicing operator prier to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the ;dispersal cellis! in one large dose, overloading the cellls! and.may result in the backup or surface discharge of affluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to tho effluent 'pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. _. Do not drive or park vehicles over tanks and dispersal calls. Do not drive isr park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump! water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails andlor is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Camm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shalt be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Saptage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINfiENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and walls. Failure to protect the replacement area will result in the need for s new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may ba installed as a last resort to replace the failed POWTS. ~~ D T site site tank e ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Recanatructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. DO N07 ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OP A PERSON FROM THE INTERIOR OF A YANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ~ ~ \~ ~ ~ ,~,~ ~ e, ~ Name Phone ~s' - 3 $ b > 31 a 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL AEOULATOAY AUTHORITY Name Name S'1`~ G ! . , ~ / G1i Phone Phone / s ' 3 ~(~-~ rro d This document was drafted in compliance with chapter Comm 133.22(2!(bittlidiS(fi and 63.Salli, lZl ~ (31, Wisconsin Administrative Code. ~~ ' '! .STATE BAR OF WISCONSIN FORM 1 - 1998 6660$0 , WARR~A7(N~TY DEED KATHLEEN H. WALSH Y ' ~ I c7~ A rC kEGISTEk OF DEED5 DocumenlNtxribor p•. p ( 6~3 -, Sr. ckolx co., WI -- kECEIVED FOk kECOkD This Deed, made between Bane Corporation, a Minnesota corporation -'- 12-~3-2001 3:10 FM ----- ~ ~ WARRANTY DEED '' - ~, Grantor, EXEMPT N ~' and Sienna Corporation a Minneso a r•orporarinn CERT COPY FEE: COPY FEE: - -- 7RAHSFER fEE: 9863.0 _ -- DAGE6DIHO FEE: X7.00 -- - -_, Grantee. Grantor, for a valuable consideration, conveys io Gran[ee the following I, ', described real estate In St. CrOiX _ ~-_ County. State of Wisconsin (the "Property") tic_uur~~g .:~c:~ - -- __ See Attached Exhibit A 'Name and Rewrn Address l~nitkrst.G %~ ~-!~ S'1Cb 5me+~r~'i -Dr+~ ~i.Li+~ ~ni I~(i ~ ne $U~n h~,._ ~ ~ 553`43 __ O 20-1048-30-000 Parcel Idanligcation Number (PINj This iS nOt homestead property (ls) (Is not) 20-1048-60-000 20-1048-90-000 20-1049-90-000 20-1050-00-000 ii 20-1050-80-000 i 20-1052-20-000 20-1052-70-000 j' '•, Together with all appurtenant rights, title and interests. ~' Grantor warrants that the title to the Property is good, indefeasible In fee simple and tree and clear of encumbrances except ' See Attached Exhibit B. Dated this 20th day of December 2001 Bane rporation (SEAL) (SEAL) by ( , Jo M. Nasaef i Its C of Executive Offic (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) i authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by §706.06, Wls. Stars.) THIS INSTRUMENT WAS DRAFTED BY Lockridge Grindal Law Firm l n n--bias _ Minneapolis MN 55401 Minnesota State of i+YtStroTrstrt- l! ~ } ss. k' `r~~'c `I County. J Personally wme before me thts Z c,ll ~ day of '. December 2001 ,the above named _John M. Nasaeff, Chief Executive Officer of Bane Corporation, a Minnesota corporation to me known to be a pens ~_ who executed the foregoing instrument and a nt~ 'same. '~ • ~. _ ~ HARRY E. CiALLAHER ~ ; s N ¢~ a olary ubhc, S[ace of Wisconsin commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not Januarv 31 , 2005 ) necessary) _ _ _ _.. _ ' Names of persoru signing in any capacity moat tx typed or printed below [heir slgnan[rc. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Lepa1 Blank Co., Inc. FORM No. 1 - 1998 MdwaukE9. WIS. yni. ~ 79~pA~E6~ ~ File No: 8s-04900 EXHIBIT "A" A parcel of land in the Northeast Quarter of the Northwest Quarter, in the Northwest Quarter of the Northeast Quarter, in the Southeast Quarter of the Northwest Quarter, in the Southwest Quarter of the Northeast Quarter, in the Northeast Quarter of the Southwest Quarter, in the Northwest Quarter of the Southeast Quarter, in the Southeast Quarter of the Southwest Quarter and in the Southwest Quarter of the Southeast Quarter, all in Section 20, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin, more fully described as follows: Commencing at the West Quarter Corner of said Section 20; thence North 89 degrees 25 minutes 02 seconds East, 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 the southerly right-of-way line of the Chicago-Northwestern Railroad; thence North 79 flegrees 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 feet, along said southerly right-of-way, along a tangential curve, concave to the southeast, having a central angle of 14 degrees 30 minutes 21 seconds and a radius of 1759.75 feet; thence North 84 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 the 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 00 degrees 26 minutes 06 seconds East, along said east line, a distance of 1127.21 feet to the southeast corner of said Southwest Quarter of the Northeast Quarter; 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 9172; thence South 89 degrees 37 minutes 27 seconds west, along the north lines of Certified Survey Map in Volume 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 feet; thence South 07 degrees 13 minutes 18 seconds East a distance of 323.01 feet; thence South 08 degrees 41 minutes it aeconda East a distance of 413.63 feet; thence South 08 degrees 43 minutes 31 seconds East a distance of 229.88 feet to the north line of Certified Survey Map in Volume 11, Page 3128; thence North 89 degrees 52 minutes 10 aeconda West, along the north lines of Certified Survey Map in Volume 11, Page 3128 and of Certified Survey Map in Volume 12, Page 3292, a distance of 682.86 feet to the northwest corner of Certified Survey Map in von. ~ 797PAf,E 615 Volume 12, Paqe 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 the easterly extension of the north line of parcel recorded in Volume 1390, Paqe 163; then South 89 degrees 30 minutes 27 seconds Weat, along the easterly extension and the north line of parcel recorded in Volume 1390, Paqe 163 and the north line of Certified Survey Map in Volume 3, Paqe 776, a distance of 508.92 feet; thence North 00 degrees 07 minutes 56 seconds East a distance of 1003.47 feet; thence North 89 degrees 54 minutes 15 seconds West a distance of 270.16 feet to the west line of Certified Survey Map in Volume 5, Page 1317; thence South 00 degrees 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. . . T ~ 7~ I v~c;t ~1. ' VOL . Exhibit B to Warranty Deed dated December 20, 2001 by and between Bane Corporation ("Grantor") and Sienna Corporation ("Grantee") 1. Building and zoning laws, ordinances, State and Federal regulations; 2. Restrictions relating to the use or improvement of the premises without effective forfeiture provision; 3. Reservation of any minerals or mineral rights to the State of Wisconsin; 4. Utility, drainage and roadway easements which do not interfere with Buyer's proposed development of the property; 5. Encroachment 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 Easement Agreement by and between Bane Corporation and Wisconsin Bell Telephone Company a/k/a Ameritech Wisconsin dated December 10, 2001. -~ : ~ x,° ~ : .~ ~ ~+'s oww tlk'" ~~~ SEE SHEET 7 27 +satt S.F. p.ou nc.) n n I~ r n ~ Q I$ 2 I 1 _ ~_ «) I .I~ ,i i~_I I 1 I t-1''i~ I OI I ~ (:) j ~~ I ~~ 1.,_ I I ~ ~ ~~~.~~~~.~~ MS939'18'M Z6Q'~~~~~ 4{399 S.F (1.019 ---____-- IId939'1a'W 261.35' -^_-- ---------------------- 25 4s29s s.F ~ (1.oa n~c.f ~ BLOCK 4 ,- ~~~~ ~~- _~,.~- 24 44192 S.f. (1.O1S AC.) # i ~ i I •~ ~~ ---~ 1 i I I I 1 I I I I 1 j ~~~~ i I i I I 1 1 1 I I 1 ___J --- i I I I I I i so~ I t ~ 1 I . ! I i I i i I f I I ,ar 1 ~`'~ ~--- ---- I 1 1 1 .1 ;I ~ .I 1 I I 1 1 I ~--- ---- i I I I ~1 ~ I . I 8 i I I r__ __+- I 1 I i ;I .I I 1 I I ~. I I ~ ,, . i -' ~! .,`, ~- ~ ~ ~~-"1 ~. 1 1 :~ ~ '~-. •. ~ ~ `~ ~ i ,~ \\ ~ •. `.\ \, .~ \ ~ ~~ , ., $ ~~~ ~~~1 ~ ~ I ~ '' \ 23 ~~ ` i ~~~-' ~~~~ slat s.r. `~ .~' ~ , ~' ~ NO C>rELlN1C (1.2M AC.) •` Fwo11 c~1-~nona 4 ~ -- eQOa e~3.o `~