HomeMy WebLinkAbout020-1415-50-000Wiscor„~in Department of Commerce PRIVATE SEWAGE SYSTEM
Safety a!d Buita~ ng Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TG PERIV~IT)
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
Sienna Cor Hudson Townshi
SST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic
a~
Dosing
W l
~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L / ~
1W WELL
,r BLDG. Vent Air Intake ROAD
Septic / ~~ S - ~ / I
S
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Number ---•--
TDH Lift Fricti System Head TDH Ft
Forcemain gth Dia. 'st. to Well
SOIL ABSORPTION SYSTEM / I' /r.,,._ ~
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
429931 0
State Plan ID No:
Parcel Tax No:
020-1415-50-000
Sectionlfown/Range/Map No:
20.29.19.2623
STATION BS HI FS ELEV.
Benchmark t? ~ /
J ~ p
b (~ ~y ~ ~d ` U
Alt. BNJi L,~
Bldg. S , hs~ Q~ G3
su hozvz~ ~o ~ • ob • g~
SUHt Outlet ~^'
Dt Inlet ~ ^--
Dt Bottom / -~
Hem r/Man.
q-
Dist. Pipe
- R~~ -~
Bot. System ~ ~ , Gj' -
Final Grade
St Cover ~'
b •7l
S p,~
~~ e• 1_
BED/TRENCH
DIMENSIONS Width ~ ~ Le~th
/ / No. Of Trenches
~ PIT DI ONS No. Of Pits Inside Dia. Liquid Depth
~ o
+~_
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man ure • / L , /
~~
INFORMATION CHAMBER O ~
/ T Y~~
Typ f System: ~ `~ , ~ i~ ~ ~ ~ UNIT Model Number: / 2 `~
DISTRIBUTION SYSTEM
Header/Manifold
lj l ( ~ 1,
Length Dia ~ Distributi~o/n , f
Pipe(s) 'd ~ t'~j (Q--~' r
Length ~ ~ Dia paang ~ x Hole Size
~ x Hole Spacing
~' Vent to Air Intake
> ~G'I
~
SOIL COVER
x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Only
Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ~ ~ BedlTrench Edges Topsoil ~ Yes ~ No IJI Yes j_~ No
COMMENTS: (Intl de coded c epenciK es persons premise etc.) Inspection #1:~/ /D(aQb~ Inspection #2: /
Location: 770 Marten Avenue Hud~so~n,/~WI 54016 (NE 1/4 S[W~114 20 T29N R19W) The Glen Lot 2S' - ` Parcel No: 20,.2,9,.19Q.2623
1.) Alt BM Description = STt ~y~-`~ ' `~~" ~~~ `~~ /~~ ''~%~~`~- S
2.) Bldg sewer length = ?S/ .~f-c.,r ` ~ /~`'/li ~`•~~ ' ~ S~/fyr ~~
-amount of cover = D li -1'~" ' ~d -yrjt YLO~ /j~~_ ~Z~ ~,~,~~'~
Plan revision Required Ye~+'No ~ ; ~ ~ I~ ~ ~ ~ ~ (/~~ ,
Use other side for additional information. i~_ ~ ~ __ __ _______ _ _ ~'(%~~~ L~ ~ ~~~
SBD-6710 (R.3/97) Date I sepctor's Signatu ~~ Cert. No/n
~~/
bm
V `~
~ ^ 1y fo a ~ ~ 9 y~ ~~~~3~~~
_. -
--`-~~
Safety and Buildings Division' ~ County ~
~~ ~ 201 W, Washington Ave,, P.O. Box 71b2 ~ S~CIId i ~ ~
~~~~~~~~ Madison, WI 53707 - 7162 rSanitary Permit Number (to be filled in by Co.)
(6os~ 266-31 s 1 ~ 9 ~ 3
De artment taf Commerce 1 LD. Number
State Pan
Sanitary Permit Application j
In acxard with Comm 83.21, Wis, Adm. Code, personal information you rov' ~ ~..W°; ~ro act ddress (if diffra'ent than mailing address)
may be used for secondary purposes Privacy Law, s15.04(1)() ~~~.~ k ~ a~a ~~[~ J
I. Application Information -Please Print AU Information ~ ~ ~~Q ~~ill /41l~,
~, ~~~; ~.
Parcel Lot &` Block ~
Property Owner's Na me
.~ ~ , _ ~ a q ----
Location
?roperrygO~wner's M ailing Address
~ < y0 ~ ~~l • `.~ v ' /v w ,~ S6t/ :k ,Section ~ d
City, State Zip Code Phone Number I
~ (circle
~d ~. J~`~y.~- T ~~ N; R~E or~
Ii. Type of Building (check all then apply) ~ S '^'`' Subdivision Name CSM Number
^ 1 or 2 Family Dwelling -Number of Bedraotns ~ (~/ 2~/
~ it~/f.
_I^.Public/Commercial -Describe Use
~ ' k $"~. Sp g 2$ City_^Village'ownship of~o~
i ^ State Owned -Describe Use
2(D 2?
III. Type of Permit: (Check only one box on lfne A. Cornpieie line B if applicable) D -INNS ~ •
~ ' A' ~ New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only IJ Other Modification to Existing System
I
L'sst Previous Permit Number and Date Issued
B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New
Before Expuatton Plumber Owner
IV. T e of FOWTS S stem: (Check all that a 1) -
,~Nan -Pressurized ln-Ground ^ Motuui > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter
(^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Fiker ^ Aerobic Treatment Unit ^ Recirculating Sand Filter
^ Recirculatin Synthetic Media Filter Leaching Chamber ^ Dri Linc ^ Gravel-less Pipe ^ Other (explain}
V. Dis real/Treatment Area Information: ~ ` ~
Design Flow (gpd) Design Sol! Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st'} ';
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site 11 Steel Fiber ~ Plastic
Gallons Gallons ~ of Units Concrete Constructed t ~ Glass
New Existing i
Tanks Tanks
Septic or Holding Tank ~~ ~( ~ E ~f .e e v
Aerobic Treatment Unit
Dosing Chamber ~~G ~ ~ ~ ,eY ~
VII: Responsibility Statement- I, the undersfgtted, assttute t•espottsibility for ' allatian of the POWTS shown on the attached plans.
Plumber's Na me (Pr'tttt} Plumber's Si gnature M PRS Number Business Phone Number
Pittmber's Addre ss {Street, City, State, Zip Code}
Viii. Count /De went Use Qnly
X~ Approved ~ ^ Disapproved 5attitary Permit Fee (includes Groundwater Date Issued I ui Agent Sigttalur (No Stamps}
Surcharge Fee) d~ ~L ~,,..•-~`°'- ~ _ ~
^ Owner Given Reason for Denial ,~.P .~
IX. Conditions of ApprovaUReasons for Disapproval
---~-~..,k-- ~~-~ p ~~,,~ 1,,~.,,..~-- fem. t~~,tu:r„~.~:.,~.~J ~
-~" ~ ~.° ~
Attach complete plans (to the County udy) for the system ou paper not lase than Bill x 11 inches in size
SBD-Er398 (R. 01/43)
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Wisconsin Department of Commerce
Division of Safety and Buildings
SOIL EVALUATION REPORT
in arrrudanrxawith rnmm RS Wic Adm C:rrtP
1109
Page 1 of 3
Steel Soil Service
Attach complete site plan on paper not less than 8%: x 11 inches in s¢e_ Plan must County
St. Croix
indude, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
pending
Please print all information.
~~ B ~ ' ~
Date ,
Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~~ `
3 ~ 3
Property Owner :'r
:
~
u rtY L ion
Sienna Corporation r ~. ,
,~.
a Govt. Lot NE 114 SW 1/4 S 20 T 29 N R 19 W
Property Owner's Mailing Address Lot # lock # Subd. Name or CS M#
4940 Viking Dr, Suite 608 ~~ i~ c `~ ~ Z ~ i~ na The Glen
City State Zip Code Ph ne Number ~ City ~ Village ~ Town Nearest Road
'E~i~r~ MN 55435 Q ~- ~~~=,~$p - 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 ouiwash Flood plain elevation, "rF applicable na
General comments i, ,/
and recommendations: System elevation 99.59ft, Trenches spaced and depth to code 4.66ft below grade
5 ~ ~r~ Yu9'4Z11 ~/ C~n~r~r . 3 ~ -3 ~/
Boring # Boring
`
96
#/
Pit Ground Surtace elev. 104.25 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 0-24 10yr4/4 none sl 2msbk mfr gw 1 c .5 .8
2 24-44 10yr4/4 ~ 7.5yr5/6 ~ 2msb1 mfr di 1c
.4
.6
j~
~
3 44-96 7.5yr4l6 none ms osg ml na na / .7 / 1.2
Ur~l=
S 0~~/ ~' /
~~ ~~ ~' ' ~ / C~~ ~ ~i l nrJ G~~
~~
Boring # . . !~ Boring
9
i!! Pit Ground Surtace elev. 104.25 ft. th to limitin factor
Dep g 6 in. ~(
Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
`Etl#1 `Eff#2
1 0-24 10yr4/4 none sl 2msbk mfr gw 1f .5 .8
2 24-44 10yr4/4 none sicl 2msbl mfr gw na .4 .6
3 44-~ 7.5yr4/6 none ms osg ml na na ~ 1
2
.
so- a ~- ~ S , ~ ~~ f~'vy,., ~-~~ / n'`.(
o h
cnruem ~ ~ = rsvu e' su < z~u mgi~ and i ss >30 < ~ 5o mgi~ `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
David J. Steel M~ 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 540 9/7/2002 715-246-5085
, prgany p„m~ Sienna Corporation Parcel ID # Pending
a Boring # 'Boring ~ '
Pit Ground Surface elev. 100.50 ff. Depth to limiting factor
Horizon Depth Dominant Color Redox Description Textun; Structure Consistena
1 0-12 10yr4/4 none sl 2msbk
2 12-19 10yr4/4 none sicl 2msbl
3 19-30 10yr4/4 none scl 2msbk
4 30-116 7.5yr4/4 none cos osg
~ ~~~
~~
mfr
mfr
mfr
mvFr
Page 2 of 3
116 in. Sod Application Rate
>undary Roots GPD/itz
*Eff#1 *Eff#2
gw 1 f .5 .8
gw na .4 .6
cs na .4 .6
~-
na na ~ 1.2
est Sts~irY. -- ~, ~c.1~~
- - • „_,
~~
y
* Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS <30 mg1L
The Department of Commerce is an equal opportunity service provider and employer. ff you need assistance to access services or
n Boring # 'Boring _ _ ... .. ...
Page 3 of 3
STEEL'S SOIL SERVICE
IV
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 # 29
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.
~,2y ~en~
`//r ~o ~
`= ~G,.na~~ f ~Q~~ ioo .o~~+ j n~ a~' ~ r~S~.ceC ~~~-
~arr~n~ ~ va~l~o~
X32. /a'~~ Z$
R3 = goo. ,Sc~~+
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hod'
~ine
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SEPdiC "'A~iK ~ rL''MP C~:r':I~`?F~i CR~5S S~;CTIUIy' 4ItiD SFICIFICATIG?rS
41° CI VENT PIPE 12" MIN . A80i~' E G:ZADE ~ WEATNERPRO~}F
S' FROM Dt~OR, WINDOW OR JUNCTION BOX APPROVED
FRESH ASR INTAKE ~ WITH CONDUIT MANHOLE C4VER
WI PADLOCK 8
FINISHED GP.ADE WARNING LABEL
4'° CI RISER
~.- ji f' MI h .
18" TN. 6" MAX. i ~~~ +~~+
9 `"~
,f
rNLET ~'~ ~~~
,,
t It
WATER TIGHT SEALS ~ GAS" ~
I~ ~ TIGHT ~ ~ APPROItED
A SEAL ° JGIN75 WI7'Fi
~PPRflVED ~-- ~ ; ALM APPR4YED PIPE
__f__ ~ ~ 3 t}N'Tt~
DN70 SQL.ID C ~ ON 50l.ID SOME.
i4IL PUMP Or x ELEV . ~ --~-- 1
""' FT. qFF ~~ RISER EX:~
D PERMITTED OAiLY
I F TA.'3K
MANUFACTURER
HAS APPROVAL
3" APPROVED B£DDiNG UNDER TAPdK
CONCRETE PhD
SPEGIFIGATIONS
SEPTIC / DOSE
TANK MANUFACTURER: ,tJ~'~"yr~ PdL'MBER DOSES PER DAY: ____~
TANK SIZES: SEPTIC l~~5~ GAL.
~` DOSE g GAL.
Ai~ARM MANUFACTURER:
MODEL NUMBER : ~~ y
SWITCH TYPE: yr~erc
PUMP MANUFACTURER : (~ oq .:r~.S"
MODEL NUMBER :
SWITCH TYPE: _w~
~~. c_~
REQUIRED DISCHARGE RATE ~~, GPM
DOSE VOLUME INGLUD'_'NG
FLOWBACK: l3 ~ GAL.
CAPACITIES: A = ~~ INCHES = ~ ~C~ GAL.
5 = ~ INCHES =GAL.
C = ~ INCHES = (GGAL.
D = __,~__ INCHES = l2 ~ _~A L .
PUMP ~ ALARM WIRING AS P R I LHR 16.2' WAC
VERTICAL DIFFERENCE HET6JEEN PUMP OFF AND DISTRIBUTION PIPE !.~ FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . FEET
+ ,.raQ FEET FORCEMAIN X ;1.6G~ FT/100 FT. FRICTION FACTQR !~ _ FEET'
T.4TAL DYNAMIC HEAD - ,,; FEET
INTERNAL DiMENSI~7NS OF PUMP TANK: LENGTH ~ ___. ; WIDTH ~ T3IAMETER
LIQUID ~ 3~~" _~/~/~-~~ f ~,
~ w ~/
SIGNED: ~c:r~-- ~--.~.~ LiCENSW NUMBER: ,?,~9~ DATE: ~r ,~53
1/~8
t~
+ fasteners: 300 series
stainless steel.
• Capable Of Nnning
dry without damage to
components.
lVlator:
• Ei~a4 s(ngls phase: a.4 HP,
i 15 or 23a V, 60 Hz,155U
RPM, built in overload with
alltomatlR reset
• EP05 S(ngfe~/ph^as+/.~e: /y0~(./~SI~,~HP,
R M ~, ~ ~L, i ~Y~ / i! f~.P
built In Overload with
autonat4c reset.
• Power cord: la toot
standard length,1613 SJTO
wlth?.hree prong grounding
plug~.pOpt~ioMnal ~2°7~~`#toot {.
l®n~ll la 1 Wt7 sJ i YY will l
three prong grounding plug
(standard an EP05).
APPWCIITIQNS
~'1
Specilfic~aliy designed for the
#oibw-tn0 uses:
• Effluent systems .
• Homes
• Farn~e
~ Heavy duty sump
• t~tater transfer
• Devratsrinp
si;P~IGiFICNTlO1iS
Pump: EP04
* so!•~ds handling c~tv:
s1i' maarnum.
• Capacities: up to a5 CPM.
• Total heads; up to 24 #eet.
• Discharga size:l'Es" i~PT,
• Mechanical Seal: carbon-
totatyltu~rantic-stationary,
S~iNA-N elastorrwrs.
• ia4~(4Q°C~ continuous
i 4Q°F ~s0°C) ititet~ittBnt.
• {rZasteners: 3Oa series
8t8litl853 steel.
• Capable of running
dry without damage to
components.
Pump:
• Solids hattdiinq capabii~-:
~'~' maximum.
• ~: up to 6a 6PM.
• Total heads: up to 31 feet.
• Discharge size:l'fi" NPT.
• HdllChYniL&# seat: carbon-
roterylt~ramic-stationary,
SUI~tA-!d slastorners.
• TenljleraXtlre:
1 q4°F ~a cor~nuous
14a°F (f30°C~ irrtern:itteeRt.
~~
~ 199rs Purttl~, kto.
ta~'rERS FEET
f4~
9 ~' 30
za
6 2C
5
a to
< ~
tr
~~uas ~~L. ~ ~F ~
SubmerS~hie
Efffu~nt ~~~np
~~~~~
3871 EP05
• l=olly submerged in high
grade fiurbsne o!t for
lubrica#on and sfticient
heat transfer.
Avs!lalste for autometk end
maaunl operetlaa. Autacnatk
~nor~ls Inaiude mica!
Float $wltah eesernblst! and
preset et the tac~ry.
FEAt~it~
^ EP04 impeller: ?hermo•
plasticSemi-open design
with pump out vanes for
mechanical seal protection.
^ E~ Impeller: Thermo-
plastiG e~afosed design for
improved performance.
• Casing and l3sse: Rugged
thermoplastic design providg&
superior strength end
corrosion; esistance.
^ Motor #bnain~t Cast iron
for etfrdent heat transfer,
Strengdl~ 81f>d durablllty.
^ gMofor Corer. i'hermoplas-
dccover with itftegra! handle
and float svulbeh attachment
Pam
e fl=ower gbie: Severe duty
rated oil and water resistant
~ t~: Upper and lower
Heavy duty ball bearing
COnBtNCtion.
,~~xcx usr~ia
~• d 8tan~da it~saalatltui
(GSA listed mode! numbers
End iR "F" dr "QC".)
~ i ~
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~ k
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~ r~ou
0 2 4 6 e, 40 ~z m,m
. ~ qty, t8A8
PQ9NTS OV'IINER'S MANUAL & MAN,,I#,GEMENT PLAN
FILE tNFOtIMA'1't'aN
Owner ~j t 1, iuN l'~- C.aR P .
Permit ~ ,~2 ~ q 3
w..w,wa~ lfA~.R Ill-CTL'~Q
YCi71'~i1~ r~+1/'e.ni. ww
~ NA
Number of t3edroanes
Number of Puiziio Facility Unhs DNA
Estimated flow lavaragei ~Q ~ ai/da
Design flow (peak}, {Estimated x i .5} _ gallda
Solt Application Rats _
7 elide /#t1
Standard influentlirffluent C2ual'rty Manthiy average`
Fats, Oil & Grease iFO~Gi 534 mg/L
Biochemical Oxygen Demand (BODs} 5220 mg/L O NA
Total Suspended Solids {TSS} 5154 mg/L
Pretreated >wfftusnt Quality Monthly average
Biochemical Oxygen Demand (80Db1 s3Q mg/L
Total Suspended SoCids {TSSI 534 mglL ®NA
Fecal Coll#orm tgeametric mean! 514' cfu/104m1
Maximum Effluent Partials Size Ya in die. Q NA
Other: C] NA
"Values typical far domestic wastewater and saptla tank effluern.
&ervtce lrvsnt
Inspect condition of tankdsl
Pump out contents of rankle(
Inspect dispersal cell(s)
Clean eftluernt fitter
inspect pump,. pump controls & alarm
Flush laterals and pressure test
Paps ~ of
8ervics Frequency
month(s) tMaxhrwm 3 yearsl O NA
At Least once every: ~ ear sl
When combined sludge and scum equals ar-e'third {y,} of tank volume Q NA
At least ante every:
At least once every:
At least once every:
At least once every:
At #east once every:
[~^]
tMaxiimum 3 Years} ^ NA
^ NA
^ NA
p NA
_~;
^NAi~
._.._-.:
^ NA
ihAgiNTENANCE 1NSTRlICTtONS
inspections of tanks and dispersal cells shal9 be made by an individual carrying one of the Sept giegServicie9 Opeeatio catTanl
Ndaster Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer,
inspections must include a visual inspection of scorn and to cheek fo a any back up or Pond RgdQ seffiuent~on t e ground surface
measure the volume of combined stodge and ondin9
The dispersal cell{si shalt bs visually inspected to check the effluent levels in the observation pipes and to check for any P
of effluent on the ground surface. The pond'sng of effluent on the ground surface maY indicate a failing condition and requires thi
imrnediats notification of the local regulatory authority.
the static
When the combined accumulation of sludge and scum in any tank equaia one-third {Yai or more of the tank volume.
contents of the tank shall be removed by a Septage Sen~icing Operator and disposed of in accordance with chapter NR 11
Wisconsin Administrative Cade, Hants, pretrestmer
All other services, .including but not limited to the servicing of effluent filters, mechanical ar pressurized ~ompo
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A :ervfce report shall be provided to the iocai regulatory authority within l4 days of completion of any service event.
Page ~f ~'
START UP ANO OPERATION ~ `
For new construction, prior to use of the POWTS check treatment tank{si for the presence of pairrtinq products or other chemicals
that may impede the treatment process and/or damage the dispersal cell{s1. If high concentrations are detected have the contents
of the tank(a} removed by a septage servicing operator prior to use.
System start up shall not occur when soil oonditiona are fro2en at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restated the excess wastewater will be
discharged to the dispersal cell{s} in one large dose, overloading the cell{sl and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator. prior to restoring
power to the 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.
I?o not drnre or park vehicles over tanks and dispersal cells. Do not drive or park aver, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soli absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance end prolong the life of the
I'OWTS: 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 shalt be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 63.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of alt tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
+ After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soli, gravel or another inert solid material
CONTINQENCY 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
retiuired setbacks from existing and proposed structure, lot lines and walla. Failure to protect the replacement area will
resuk in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that lima.
^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in ROWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
site
~~ ^ tank
e
^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply With the rules in effect at that time.
< <WARNiNii> >
SEPTIG, PUMP ANO OTHER TREATMENT TANKS MAY CONTAIN LETHAL (iA8SES ANDlOR INSUFFICIENT OXYt3EN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER
Name W ~' Z1,' ~ u ~'
Phone ~ ~ --3 l u
POWT8 MAINTAINER
Name
Phone
SEPTAt#E SERVICING OPERATOR (PUMPER) CAL REQULATORY AUTHORITY
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This document was drafted in compliance with chapter Comm 83.22{21(bl{1iid1&ifl and 83.'SM11, {2i & (31, Wisconsin Administrati~~e Cade.
FEB-24-2003 14 24 51ENNA CORP
sT cAOnc co ~ oRi~c
gEFi'fC TAIQK- •~ ~~~r~
I1i~+~ M M
OWNBRSF~ CgR,~GATION FORM
ownerBuycr ,SI ~,J~IA ~o ~ Pa ~-n o
_ ,
M,~ilin~ Address
Propotty Address
~D2:. Su~~ ~~6 ~
74 ~ ~'~ -
(Vedfi~tioa required from Plaaaing Dop~teat for new
~ty~tato ~UpSo~ 1,t/~ Parcel Identification Number
LT,yGAL ES ~' f
U n!
O N~~_W Towta of UAS
Property Y.ocation ~/., ~ %., Sec. ~ . T 2~ ~ •
Subdivision ^ T~~
Y,ot # 2 `~,•
Certified Survey Map # _ .Volume _~--~ Page #
// Vol~une , -z. 4 ~ ,, page # r ~
warntnty Decd # , (y CD~'1•~. D.~O ~ ~7 '
Spec Yyouse ~ yes Q no
z,ot lines identifiable ~ yes O Ao
S
S~~j.S 11~ MA.INI~ENAr~ mj~y ~failuretohaad1cwastes-Prap~z~1Di~~
Ir~rrsper use and ruaintctstace of your peptic eysteru weld result ~ P~ What you put into the syetem
aoasista of pumping out tltie upde tank every tbunx yeana or wooer, if a-.edod by a lieodscd Pumper
era effect the fuactipa of tlu septic task as a treatman[ stage m for xaste disposal ays'~
b tlu: owaa sad by a
'Ilte property owner agrees to tabtai[ to Sc CSrooc Depatlme~-t a cnti5cation form. sip~Cd Y
ouroayman P restzictodplumba or a ticensed p~p~ vesff7~8 that (1) the an~itc eYaSteaatOC disposal ryaoem
mastCrp~h r[mbet, J ~ wodition aad/o~r (2) atter~tusp~aa sad pnatpu~ (if-necessary). ~C uPQc talc it toss then 1~3 full of sludge.
to maintain the private sctvag~ diipotal aYs~ with the etindardt
I/ar~c. tbo nndecsighed lave read the abov~rrcqu>zmnevtS age nt of Nstttnl F eavurcec. Sbte of wiscoaein. Certification
ed fartlt 6ct~in. u cct by We Depattmeat of Cooamc and the Dtpartau Oflia r+ithin 30
~~ that;~+btre septic system b~b«n ma" be cnr~lctcd and retutl~ to tbo St. Croix Coamty Zoning
tbroc cxpaa aau:.
d ~~ a~
~~
;TiT'~'fCA ON am are the otunes(s) of
certify that alit ats o this [orrn arc true to t7u: txa[ o[ wy (our) 1~owledge. I (we) ( )
yen abov a aarraaty dad recorded in Registter of Deeds Office.
~~ ~~
AT8
uav. ••.
revokedby-tbeT.awn6 pePa~°t' ••••••
•••••• Any in[otmatiaa is mis-represented racy navlt 9n the ta,Oitauy perms bo+a6
•• Ipetude ~vitlf tWs spplicatlon: a cramped tsrarraary dead &vm t3u ReS~~ of DLCds office
a copy of the ccrdfind survey wap if rctctooee it made in the wsxniary deed
TOTAL P.02
Xr-GtJ-LCJCK YJJ•GtJ .,.u~V', ,..,.,.v
(
STATE; BAR OF WISCONSIN FORM 1 - 1998
~, WARRA/`N~.TY DEED
• Doctrnenl Number Vnt. ~ ~~7v~5t 613
This Decd, made oetween Bane Corporation. _ ., __
a Minnesota cozporatioa
__, Grantor,
and Sienna Corporation. a Minnesota corporation ___,., _,_,
..- --. .
_.. .... _.... ......, Grantee.
Gra,xor. for a valuable corulderatlon, wnvt:ys to Grantee the foltowlnp
dumbed rra! cxute to St . Croix County. S4te of Wlscoraln
(the "Property'):
See Attached Exhibit A
.i-- v..... ...~- ..._ , ,
6664$4
KATHLEEN H. WALSH
FEGISTEk OF DEEDS
ST. CROIx CO., 4I
RECEIVED FOR RECORD
12-21-2001 3:10 PM
YRRRRIITY DEED
C~T COPY FEE:
COPY FEE:
TRfYSFER FEE: %63.40
S.1NG FEE: 47.00
fioct~,0iy 11rt-,i
is - ..__-... .-. _..._~_.._
Name and {[eb/rn Andress
Uni~r~.l i~}~~
5~~ 5meira.rr Ur~~.
~i.u-t~.'~DI
N(ivtne -E.p~ka~u553'~
--.--:.:_M. __ ~~~ t :.:.~ _._. _ __.. _
20-1048-30-000 0 1
Parcel 1tlaMiatalion Nanbar (POh
Thts is not homestead property
(fY) (ls not)
20-1048-60--000
20-1048-90-000
20-1049-90-000
20-1050-00-000
2o-loso-ao-ooo
20-1052-20-000
20-1052-)0-000
Together wi[h all aplx,r[enam tights. Utle and Interests.
Grantw• warrants that the ude to the Property is good, lndefeaslble in fee simple and free and clear of enewnb,•arxts except
See Attached Lxhibit B.
Dated [nl: 20th - _ day ~ December - 2001
Base rporatlon (SEAL)
by
Jo M. Nassef ~~
Its of Executivt: Offi (SEAL)
Slgrtature(s) _
authenticated this
AUTHENTICATION
tLty of
TITLE: MEMBER STATE BAR OF WISCONSIN
(I! m(,
att[norized by §706.06, wts. Stau.)
(SEAL)
., (SEAL)
ACKNOWLEDGMENT
Minnesota
State oEillft>:tvmTft-
ss.
Personally catn,i bQftxe me rhls ~~+ day of
December •.- 2001 , ~ ~„e rained
John M. Nass~ff, Chief Executiv_e,0£ficer
_of Bane Corporation, a Minnesota
corporation ._-"•-- ~~~
- •~ .._ . __ to
mr tuwwn to be a De~ wlw eaeculed the foregoL[g
irtslrttrnent and _~ ;same.
TH,S INSTRUMENT WAS DRAFTED BY _`
Lockridge Grindal Law Cirtn
inn WAa3,~_,parr.r,,,o c..,,th
1tARAV e. GAt1.AftEFtt
ermwmmrroatan w[aasa
Minneapolis, MN 55401 N~Publtc,StsteotWtscons[n
_ y commicaan 4c penn:utcnt. (If not, ware exNYratiun lout
(SIgt1MU,'es nwy be auuxntlcated w~ xlu,owlsd¢ed. Both am rwt January 31 2005 .)
neClsSafy~ ..~
' Nsnrs W persons s,Aniryt ut ,ny capKNy mwt sr ryPrA or yrLrteu beAnv Ihstil ~.gtnauut.
WARRANTY DEED STATE. RAN OF WISCONSIN Waconun taps fW,rd, Co.. Nc.
POAM No. 1 - 199a MnvaWYe. Wr..
5th'-G~J-~F9b~' 1~7~G1 5:tivivr: uuKr
. Y~I. ~ v ~ 6.14 Fie No: es-04900
797 A,E
EXHIBIT "A"
A parcel of land in the Northeast Quarter of the Northwest Quarter, in the
Northwest Quazter of the Northeast Quarter, in the Southeast Quarter of the
Northwest Quartet, 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 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 the 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 eo 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 ].759.75 feet; thence North 84 degrees 32 minutes 97
seconds East, along said southerly right-of-way, a distance of 7.57 feet to the
west line of Certified Survey Map in Volume 1Z, Page 3302; thence south, along
said west Line, a distance of 703.32 feet to thQ south line of said Certified
Survey Map in Volume 12, Paqe 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 nerth line of Certified Survey
Map in Volume 15, Page 4172; thence South B9 degrees 37 minutes 27 seconds
west, along the north lines of Ceztified Survey Map in volumQ 15, Paqe
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 Eeet; thence South 08 degrees 41
minutes 11 seconds East a distance of 413.63 feet; thence South 08 degrees 43
minutes 31 seconds East a distance of 229.88 feet to the north line of
Certified Survey Map in Volume 11, Page 3128; thence North 89 degrees 5z
minutes 10 seconds west, along the north lines of Certified Survey Map in
Volume il, Page 3128 and of Certified Survey Map in volume 12, Paye 3292, a
distance of 68?.86 feet to the northwest corner of Certified Survey Map in
vor.1797Par,~ 6~ 5
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 fn Volume 12,
Page 3292, a distance of 5.66 feet to thQ Qasterly extension of the north sine
of parcel recorded in Volume 1390, Paqe 163; then South 89 degrees 30 minutes
27 seconds west, along the easterly extension and tha 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 dQgrQas 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 Z7 minutes 53
seconds East, along said west sine, a distance of 193.97 feet; thence south 89
degrees 16 minutes 33 seconds West, a distancQ 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 920.23 feet to the
point of beginning.
SEP-20- by ~ ~ l 51 tlvtvH ~uKr
- : _ . von a 7~17~~~t 6:I 6
Exhibit B
to
Warranty Deed dated December 20, 2001
by and between
Bane Corporation ("Grantor")
and
Sienna Corporation ("Grantee")
lac oaa i r~o r . ~..+
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-ncroachment of Qwest Communications, Inc, fiber optic cable along the northerly
property line;
6. Agreement between Bane Corporation and John and Pearl Gies datcd 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.
TOTAL P.05
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