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HomeMy WebLinkAbout020-1415-70-000Wisc~~in Department of Commerce PRIVATE SEWAGE SYSTEM Safe y and Bt;!!ding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Sienna Cor City Village X Township Hudson Townshi CST BM Elev: Insp. B Elev: BM De cri on: TANK INFORMATION County: St. Cr01X sanitary Permit No: 429932 0 State Plan ID No: Parcel Tax No: 020-1415-70-000 Section/Town/Range/Map No: 20.29.19.2625 ~~ 3 Yom"""` "" `'`~`~ ~L' EVATION DATA Gc~ ~~k - (j zi TYPE MANUFACTURER CAPACITY Septic Dosing ~/~ ~ ~~~~~,,u-C~- /~ J ` ~~ !~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L 7 WELL BLDG. ~ Air Intake ROAD Septic 2c~.~-f / ~ (.~,/~.~' ~ / 'h,S ' Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand Model Numb TDH Lift ' tion s System Head TDH Ft Forcemain L h Dia. Dist. to well SOIL SORPTION SYSTEM STATION BS HI FS ELEV. Bench _ b Sdf~ s AIt~~2~ ( J /03. C/ 0 ~ l Bldg 7~ ~~ St/Ht Inlet 3 b3 ~ S 97-Cod St/Ht Outl SG I-~ - ~ / / ' Dt Inlet ,~ Dt Bottom Header/Man. ~l~ Dist. Pipe~l~ ` 1 ~ ~ `) X ~ . Bot. ystem 'g Z a-- ~ F' I Gra e ~~~ t/d.e~ ~ ~ 0 9~',5 St Cover ~ lY'l'~Id -~ ro~- ~ I BED/TRENCH Width ~ Length / / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ~ ~ ~/ SETBACK SYSTEM TO P/L BLDG WELL (h LfAKE/STREAM EACHING Manuf t r ' INFORMATION AMBER _ j Ty Of System: ~ ~ / , ~~U UN Model Number: DISTRIBUTION SYSTEM Hea anifol~l Length Dia Distribution / Pipe(s) n ~ N ~ / Length ~ 1 Dia ~pacing~ x Hole Size x Hole Spacing Vent to Air Intake ~~ ~S SOIL COVER , ,,,,,,, ~Q, x Pressure Svstems Only xx Mound Or At-Grade Svstems Only Depth Over Bed/Trench Center ~ ~' Depth Over Bed/Trench Ed es xx Depth of To soil xx Seeded/Sodded • g p ~ Yes i~ No ~ Yes I~ No COMMENTS: rr~ ~~_~ (Include code discrepencies, persons present, etc.) Inspection #1: / Q / Inspection #2: / / Location: 437 Swift Circle Hudson, WI 54016 (NE 1/4 SVIr 1/4 20 T29N R19W) The Glen L/ot-31 ~ Q Parcel No: 20.29.19.2625 1.) Alt BM Description = ~~(~ U~L ~ `'7'c ~~~2.C.c.2P~ ~~ ~ ~ Z ~l / 2.) Bldg sewer length = 22 / ~~iEl,(~J1/ ~ C~3 -amount of cover = \ 2 L ~~ _ L I 2. !J/ 7 wl Plan revision Required? I ' Yes ~' No i ~ I ~ Z ~ ~3 Use other side for additional information. __ i _____;____ I ___ __._. __ ___ ~_~ SBD-6710 (R.3/97) Date Insepctor's ~~wh/l 8M .~ b ro ~-- ~ i ~ lure Cert. No. ~ a~ bar,~,~.d~ ~-'Fuse-t,~ ~~~~ ~~ Y o~~t,c/ ~-Q'I~ xx Mulched D~ ~~ I Safety and Buildings Division 'f Cu my ~ ~ 5 ~CYD < ~ Box 7152 Q Y A . . ve., ~ 201 W. Washington ~ ~ .Madison, WI 537G7 - 7152 ~ ~scons~n ~._ . anitary Permii Number (to be filled in by Co.) 5 (508) 266-3151 ~z 9 3 z Department of Commerce state Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information o may be used for secondary purposes Privacy Law, s15 ((F °„.~V~ ^'~` project Address (if different than mailing address) I. Application Information -Please Print All Information Fr i`_ a ' I ° ~ ~j~-- Str+ I FT- ~ Q-~- cel # Lot # Block ~ Property Owner's Na me Y Property Owner's M ailing Address Property Location y~ C/i/~..U Y ~~ k,.~!d,Section _~_ City, State Zip Code Phone Number I ? ~".5-y3s 9sa- ~.~s -a Pa ~ e~ (circle o T o~Q N; R~E ot+t~ II. Type of Building (check all that apply) ~ S Subdivisior. Name CSM Number ^ 1 or 2 Family Dwelling -Number of Bedrooms ~ '.J~~~ ~~ ~J ^ 1?ublicr'Commercial -Describe Use ^^~ ~ ~ ~3 g~ 2 3 -"'-~ ^City ^Village ^Township of ,~ ;~~ - c~ X ^ State Owed -Describe Use III. T ype of Permit: (Check only one box on line A. Complete line $ if applicable) O2p - I S" ~ ' ~ - 26~5 A' j~i' New System i ^ Replacement System 1 ^ ?reatment/HoldinQ Tank Replacement Only ^ Other Modification to Existing System I ^ Chan B. ^ Permit Rentwai I ^ Permit Revision gc of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration 4 Plumber Owner IV. Ty of POWTS S stem: (Check all that a 1 > -~ -' l70 ` Non -Pressurized ln-Ground ^ Mound ? 24 in. of suitable sail ^ Mound < 24 in. of suitable soli ^ At-Grade ^ Single Pass Santa Filter I ^ Constructed Welland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatbtg S nthetic Media Filter C~Leach' Chamber ^ Dri Line 17 Gravel-less Pipe ^ Other (explain) V. Dis al/Treatment Area Information: Design Flow (gpd) Design Soii Application Rate(gpdsf) Disperse! Area Requued (sf) Dispersal Area Purposed (sf) - ---;• 'System Elevation GF 9/ 30 ~aa~ ~ 7 ~~2 ~ goo, e VI. Tank Info Capacity in Total Number Manufacturer ~ Prefab Concrete Site Constructed Steel , Ft Glass Plasti Gallons Gallons of Urdu ~ New ~ Existing i ~ Tanks ~ Tanke Septic or Holding Tank fo~s0 ~ /~-~l,oS-~ i Aerobic Treatment Unit I i ~ ~ i Dosing Chamber i a Od / 2S ~N ~ ~( VII: Responsibility Statement- I, the underslgued, assume responsibility for ` tion of the POWTS shown on the attached plane. Plumber's Na me (Print) Plumber's Si gnature MP MP1tS Number Business Phone Number as ?mod ` ~ ?r -~' ~3 ~6 ' .~ /2 LJ, !l a ~7 ~~ia hz-a Plumber's Addra ss (Street, City, State, Zip Coda) i ld~Q s~o 7~ ~ sow = ~~`~/G VIII. Count /De artment Ilse Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui Agem Signatur (No Stamps) , Surcharge Fee) ~~~ ^ Owner Given Rtason for Denial i IX Cauditions of Appraval/Reaso s for Disapproval plans (to We County nnly) for the system on paper not less than 8112 x i1 Gtcltes in size 3~ i SBD-6398 {R. 01/03) Ss ~,vy cc, Ge x'~ ~ d r 3! ~/~ ~.lc.~l T ~~ o ~ ~a-door/ / ~id~Ge /~U. ° ~,~~ 5 ,~ S , ~~ ~~ ~~ ~~~~ ~~`~S~v.P~~~`~ Ss ~,vy cc. Ge x~ ~ o ~ ,~! ~/, ~ ~Z/it et/ T K/.c/ d ~ ~a-d-~o.~/ N ,, / 1h ~ ~~.e /oU, ° ~~, . ~„ 91 3a X00 ~ ~~ .~a~w ~~~ti~ ~~ ''~ ,8~ /~3 , ~ ~ ~~ h~~ °~~ ~~ ~~~;! ~~ ~~ '~ ~ r ~~ ~~ '~% .~/~ ~M~ f n~~ 3 ~/ ,, ~~ ~~? x'96 ~~~~~d 3 ~ ~ 1098 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page i of 3 Division of Safety and Buildings in accordance with Canm 85, Wis. Adm. Code Steel Soil Service Attach com ete site Ian on County pl p paper not less than 8'/: x 11 inches in s¢e. Plan must St. Croot include, but not limited to: vertical and tror¢ontal reference point (BM), direction and percent slope, scale or dimemsiorrs, north arrow, and location and distance to nearest road. Parcel I.D. pemding Pease print al- information. R B~ Date Personal information you provide may be used for lxw; s m)). Property Owner ~ "°" "'°"' ~ ~ ""' Prope Location Sienna Corporation Govt. t_o NE 1/4 SW 1/4 S T N R Property Owner's Mailing Address ~ ~ ',~, ~ Z ~ ~ot # Block # Subd. Name or CSM# 4940 Viking Dr, Suite 608 31 na The Glen City State Zip Cod PhorSl?TNur~~ < < ' ' y _ j ttY Village Town Nearest Road (=.G~~~Nq MN 55435 ,_,y, „~, :!~~ Hudson Carmichael Rd. ~! New Construction Use: /' Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD _ I Replacement Public or canmercial -Describe: Parent material Pitted outwash Flood plain elevation, if applicable na General comments and recommendations: System elevation 93.90ft, trenches spaced and depth to code 4.25ft be~w grade Boring # Boring i/~j Pit Ground Surtace elev. 98.15 ft. Depth to limiting factor 112 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 "EfF#2 1 0-10 10yr3/3 none sil 2msbk mfr gw 1 f .5 .8 2 10~ 10yr4/4 none s~ 2msbk mfr cs na .4 .6 3 26-112 7.5yr4/4 none cos ~ osg mvfr na na ~ 1.6 °IS~ Boring # Boring /' Pit Ground Surtace elev. 98.15 ft. Depth to limiting factor ~ in- Soil Application Rate Horizon Depth Dominant Color Redox Description exture Structure Consistence Boundary Roots GPD/ft2 'Eff#1 *Eff#2 1 0-12 10yr3/3 none sil 2msbk mfr gw 2f .5 .8 2 12- 10yr4/4 none ~._ 2msbk mfr cs 1vf .4 .6 3 28-38 7.5yr4/4 none Is osg mvfr cs na .7 1.2 4 38-96~ 7.5yr4/6 none ms Osg ml na na .7 1.2 ~~ ~~ - tmuent ~~ = tsc~u ~ 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS< 3o mg/L and TSS <~0 mg/L CST Name (Please Print) Sign ure: CST Number David J. Steel -- `~ 248956 Address Steel Sal Servi~`'"~`~~~ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/6/2002 715-246-5085 Property Owner Sienna Corporation Parcel ID # pemding Page 2 of 3 Boring # ~ Boring Pit Ground Surtace elev. 94.55 ft. Depth to limiting factor 96 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cons~tence Boundary Roots GPD/ftz 1 0-18 10yr3/3 none sit 2msbk mfr 2 8-18 10yr4/4 none sicl 2msbk mfr 3 18-27 10yr4l4 none sc~ 2msbk mfr .~~ 4 27-65 7.5yr4/4 none cos Osg mvfr 5 65-96 7.5yr4/6 none ms osg ml S, ~' Boring # ~ Boring *Ef(#1 "Eff#2 cs 1f .5 .8 gw na .4 .6 cs nab .6 gw na .7 1.6 na na .7 1.2 ~-~390~ 'Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS <30 mg/L and TSS <~0 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Borina# -. Boring Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 L1C. # 248956 NE1/4,SW1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot # 31 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. ~(~~~ NE rl-ti ~. o ~" //~~ ~I~/-K ~P~.Qnd t~ ~~ ~b~ Tb~o~` ~,~s~e¢~ ~~~ q, j3orirryS ~ar~ny ~~tdc~1`~~o"S ~ ' ~~ cf Z ,B~ , 4~'./.S ICI- I`~ w.eS ~ ~~ Cj8'~LS~P ~~ SZhFI- h0~ L~9~./5~{- j~GS X33 = 9~•5.5~t f4 4'f,~r ~'` ~ L-• ~ ~, . riL•y~P~ 51' d/ ~ 3 / A~rh r , `~' ~~ ~y`7o I' a~ ~_~_av ~5 ` 97/ ~~~°y~' / ~" .. ~• s. ~~'. %, ,aa i ! I~ .' .may -~~~i 117• -/ , ~.~, ~' 1 1 . I , - ~ ~ ~' _ ~-~ 1 I \ (~ __ a.~C \\a ' ^~_ ~ , la a -- -e0.411 '• - ' ~ wJ.\ ~6. /~~ \ ~'_ -_~---_ VV ' 9 •. ... ~' ~ ~ S81 5 ~ ~ s 60 _ ._ ,1 _ 1 _ ~' 1 _ . • _ 1 .' ~- _ _ .. ~ '. I ~_ .. .. ~ ., J ,7 / .~. .. _ .,,.9 1 .. _ . .. _. , ' r _ ..._ r I Z ~,,, ~ _ ~ I I! t ~qy~q_ r 1 / I i~ _ ~ ~ __ _ ' ~ ~ 1 \ l5 a I " ,~ r \ - ~, I + ! i! ~51..~ Sal •,.'"- i a " -. L .. ~. \\ : ~~ ~~ ~L~!'~ I I +. 11 "....+'• \. \\ 3 .. . . ~i '.. V 1 ':. ~` I 1 ' / ~ 1 a `` 7 + '` ~ 117 ~.%~• ! ~• 1 1 1 • 1 ~ ~+ .. \ . ~ ~ N N '~ .. , /~ I i / . '1 1 / _ .. 0. 208. ~'3g : . (.: - 1 ,. \ ~ 1' ... _. ~_ ~-- '; n ___ _ _ _ _ -35: ,, ._ ._ ._ ~ N vv 1 7.___~__.. .. .. .. i ~ \ ~~ _ , ~ 1 µ. .. ... ~'. ~~ ~ ,...' ~ ', ..ice. .. , ~+' ~ ~" . •~ ~' '' .. ~~ + .. , q . ; , + .. ^. 243 •~ , 138 1 .~, n t -tr..'~ ! •;~' ; 111111 ~/.~ + I'!1.1• 4 • I _. . `t 1 j 1 1 1 I I I r i ~_ .,., I! +'~ ~ ~ ~ I +.I I / + ..a ill 1 ! ; h'.zt ( n _- ~~L 1{~~ ~! t~a '' `'..\ ~1'I~ \~ 11,1 t \, t '.~ II l ' 1 4 .\ I '~ 11,.14.' !+: , ~ , j l l ~- i ;. / : ~, t .1 , 11 ..,, 1 , t i ;, ! 1 1 1 1 ! , „ C~ I III _ '' t I I 1 / I I :I~ { h r \ ~ ~ _ _ I i i N t~ I• J i II ! 1 .1 I I I ' 26 ~ `` ~ n ; , 11, I II I I _ _ ~ .. ~ , ~, ~.\.~~ 1 jj7 ,. I III ~• _5 / :I ~ i .7 ~'I~.' , ( 't'. I III I ,~ ~; .;,,16- ,. ,\ ._~,Ly ,,~_________ N I I iii _ •. ; i~f ' ~ ~ ~ 18 ~. a' ' I ( I .~ _ '/ it f / II ! ~ til t 9 I I ~' 1~ j r~ ~ Fasteners: 300 series St&il'i(86S Steel. • Gapabb of running dry without damage to components, RP~'B~IITiflNS ~`1 Specitscaliy designed far the foiiowarg uses: • ~fflr,~st Systems . • Homes • farms Heavy duty sump • dater t~nsfer • fleWatering SP~1~l6STtilM8 i~Smp: IPfi1'4 • Solids handling c~abhrty. $la" maximum. • Gapacides; up to 55 GPM. • Tate! ids: up to 24 feet. • flist~targe size;l'lz" RCPT, • Mechanical seal: i;arban- rotaryltteramic-stationary, BISNA-kt 8lastomers. io4~Cj canlinuous 14Q°F t~l intermittent. • Fasteners: 3C)0 series Staint~S Std. Capable of running dry stout damage to r~miponasrts. Pump: Ir~6 +- Solids handiir~ capabiiiiy: ~s maadmurn. • ~: up to ~ 6PCtA. • Tod! hSads: up to 31 feet. • Mee t ssaC: carbos2- rotar~rlcteram(c~tionary, 9ttf~AA-~l st~tosrrers. • Tem re: gal (~tlC) ca:rtinuciss 14A°F (t30°Cy bttermiitent $~ /.., .,:, ~ t9fit O~ouklf Pumas. inc. l~or: • F.PE)4 Single base: D.4 liP, 115 ar 2~0 V, 64 !{z, t 55Q RPM, built (n overload with automatic reset. • EP05 Sf ie phase: 0.5 HP, 'S 151, f30 Hz, i a5Q RPi1li, built In overload with automatic reset. • Power ~rd:14 foot startiaara terroth,16/3 S,ira with throe prong grounding plug. Optional 24 foot iength,1513 SJ~1fif witt'= three prong grounding plug {St3nd8rd art EPQS}. titans , ~ x O UVU11lJ PF1GL.. OF `~+ r Submersible Effluent Pump 1~~~'~ 3871 EP05 Fuify submerged in high grade turbine o(i for lubrit~tian and efficient heat transfer. Avatialxia for $etbmfEik and man~t rapetrttioa. A~omafJc models incitufe i Float Switch auambled and preaai ~ >f7e 'tt• FEkTffftSS ^ 1rPQ4 itn~tler: Thermo- pl~tic Sarni-apt design with pump out vanes for mechariic~al ~ protection. • IE:rPEt5 fmpefler: Thermo- plastic ant;fc~d destQn for improved performance. t t;881ng and Rasa: Rugged thermapiastic design provides superior strength ar+d corrosion. resistance. ^ f~tinar Hot~lag; Cast iron far ef5r~ent (teat transfer, strength,• aid dle'8bilily ~ OSa~rr Carter. Thermaplas- tic caverwith irttiegrai hartdie and fiat ~ a~hment pa(~ ^ f'ooter' fsbfe: Secrete duty rated ail and water resista~. ~ : Upper and lower beery duty ba11 bearing construdlat. • iAasao~3aa {CSA fisEed mode! numbers end in "F"or "AG".y T F t ~ ... ' . --------~ ----- ----+ ~~ I ~~ X01 ------? ~., ~~ ~ -! I ~ ~ 1$ ~ ~" .. to i ~ 5 ~n to 2 Q S O 40 5 0 GEPM ~ Z 4 5 e 10 12 ttNfi ~~ ~ AraY, t9RS SEPiiC '.rf~NK ~ ruMP C~AN.?FR CRCS5 SECTIC~lvT AtdD SFFCIF;CAiICN. 4" CS VENT WIPE 12" MIN . ASQV E GRADE ~ ? 2S' FROM DflflR, WINDOW OR FRESI~ AIR INTAKE FINISHED GRADE 4" CI RISER ---+ ~,~" EE IN. 6" MAX. INLET I ~~! .1' WATER TIGriT SEALS tPPROVEp 'IPE 3' ~~Ta sn~ z D 'OY~' PUMP OFF ELEV . FT . SEPT?C ! DOSE TANK MANUFACTURER: TANK SIZES: SEPTIC DOSE WEATHERPROOl~ JUNCTION HOX APPROVED WITI~ CONDUIT MANHOLE COVER W! PADLOCK ~ -.--------WARNING LABEL, ...~.s~a ,~ sr tV ~ti r~, 1 ~ f s ~ GAS- ~ SEALT t t~ti ApPROVEO A ~I ~or~~rs w~T~ -~- ; ALM APPROVED PpPE -~- ~ ~ #oN SOLID SOYL c .-.-~-~.- OFF ~'~ RISER EX I T D PERMITTED OArI,X T F TAN K MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIf~NS ~~I~.~s.~~. ~ NUMBER DOSES PER DAY l;~.~d GAL. DOSE VOLUME INCLUDwNG ~acJ GAL . F LOWBAC K : l.5 `~ GAL . .____.- ALARM MAN'JFACT'JR£R: ~~.~L.a~~;M . MODEL NUMBER: ,~~ ~ SWITCH TYPE: y~e~C PUMP MANUFACTURER : ,~~`ayl,,~.s' MODEL NUMBER ~~~"~o.,,~,_ SWITCH TYPE: J~i~•y r_ REQiJiRED DISCHARGE RATE ~~ GPM CAPACITIES: A = a~ INCHES = _ ._~C,~ GAL. 8 _ 2 INCHES =GAL. C = ,~_ INCiiES = lGc9 GAL. D = ~ INCHES = _~ GAL. PUMP ~ ALARM WIRING AS PER I LHR lfi. z3' h'AC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DIS'IRIB'JTION PIPE l~ FEET + MINIMUM NETWORK SUPPLY PRESSURE . FEET + ! 4 FEET F©RCEMATN K ;Z. GO FT1~00 FT. FRICTION FACTOR /~ FEET TOTAL DYNAMIC HEAD -`FEET INTERNAL DiM£NSIt7NS t~F PUMP TANK: LENGTH W.iDTh ~--' DIAME'"£R LIQUID ISE"P'i'~" 3~.~ ~r~~~~,~y ~ ~, SIGNED. I/_%u!_~~ ,~.~~ LICENSW NUMBER: ~?~9Qf' DATE: .~ c3~~~,_,_ lf~~ Page of sT"Aar uP AND oI"ERATION For new construction, prior to use of the POWTS check treatment tank(si for the presence of painting products or other chemicals that may impede the treatment process andlor damage the dispersal cellist. If high concentrations are detected have the contents of the tank{si removed by a septage servicing operator prior to use. ~~ System start up shall not occur when soil conditions are frozen at the infiltrative surtace. During ~-ower outages pump Lanka may fill above normal highwater levels. When power is restored the excess wastewater wi0 be discharged to the dispersal cell{si in one large dose, overloading the cell{si 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. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 7 5 feat dawn slope of any mound ar 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 isurnp pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesiic'rdes; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the P{JWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and sa#ety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of ail 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 ar their covers removed and the void space f10ed with sal, gravel or another inert solid materiel. CONTINGENCY PLAN !f the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a node compliant replacement system: ~ A suitable replacement area has been evaluated and may be utilized far the location of a replacement sail 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 sines and wails. Failure to protect the replacement area will result M the Head for a new sots and site evatuatian to establish a suitable replacement area. Replcement systems must comply with the rules in effect at that time. 17 A suitable replacement area is not available due to setback andlor soil limitations. t3arring advances in POWTS technology a holding tank may be ~stailed as a test resort to replace the failed POWTS. site ~~ D tank e D 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. < < WARNING > > SEPTIC,. PUMP AND OTHERR TREATMENT TANKS MAY CONTAIN LETHAL QASSES ANDIOR INSUFFiCiENT OXYDEN. DO NOT t.NTER A SEPTIC, BUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUI: OF A PERSON FROM THE [NTERIOR OF A TANK MAY BE DIFFICULT OR fMPOSSiBLE. ADDITIONAL COMMENTS. POWT$ INSTALLER POWTS MAINTAINER Name ~ a 5ofi .~ a- ~v Name Phone ! - _ 3~G ~/~ 7 Phone SEPTAtiE SERVICING OPERATOR tPUMPERi LOCAL REQULATORY AUTHORITY Name Name ~j`t'. C Rk)I1C Phone Phone ' ~' g~ This document was drafted in compliance with chapter Comm 83.22{21ib1{11id)&If1 end 63.54(1), i2) & i31, Wisconsin Administrative Code. pOWTS OWNER'S MANUA! & MANAGEMENT PLAN FILE iNFQRMATiUN owner 5 I ~ tv>k CoKp. Permit ~ z ~ 3 Z pESIGEN PARAMEI Number of Bedrooms ~ NA Number of Publ)c Facility Units ^ NA Estimated flow leverage) al/da Design flow Ipeak}, {Estimated x 1.5) al/da Soil AppNcation Rate al/d /ft1 Standard influentl'Effluent Quality Monthly average' Fats, Oil S Grease (FO(a) 530 mglL Biochemical Oxygen Demand iBODs) 5220 mg/L ^ NA Tate! Suspended Solids iTSS) 6150 mg/L Pretreated Effluent Quaihy Monthly average Biochemical Oxygen Demand (SODS} S;iO mgiL Total Suspended Solids {TSS) 530 mglL ^ NA Fecal Coliform tgeametric mean) 5104 cfu/t00m1 Maximum Effkrent Particle Slze Y8 in dia. O NA Oar; DNA `Values typical for domestic wastewater and septic tank ertwent. ,......~ Page • o[ SYSTEM SPECrricra ~ ~v~w Septic Tank Capacity ,~SQ al ©NA Septic Tank Manufacturer ~,- ~ ^ NA Effluent Pillar Manufacturer DNA Effluent F)Iter Modei p''O' DNA Pump Tank Capacity Q(j a1 ^ NA Pump Tank Manufacturer ;.~,~e~-DNA Pump Manufacturer G / DNA Pump Model ~ ~ O ~~ ^ NA Pretreatment Unit DNA ^ Sand/Gravel Filter ^ Peat Filter p Mechanics! Aeration ^ Wetland ^ Disinfection D Other: pispersal Cell{s) Q NA fl !n-Ground {gravity) ^ tn-Ground ip ressuriaed) t] At-Grade D Mound ^ Drlp-Una D Other: Other. DNA Other: DNA Othw: l3 NA Service FrequertcY $1lrNiCe EVent eve : mont}t{s} (pAa~cimum 3 years} l } 3 DNA Inspect condition of tankts} ry At least once ear s When combined sludge end scum equals one-third tYa} of tank volume ^ NA Pump out contents of tankis) e every: monthls} {tKaxkturm 3 Years) 3 ~ is} Q NA inspect disperse! salt{s! At least onc , sar {s} g Q te ^ NA Clean effluenrt filter At {east once every: y ~ I ea r p month{s} DNA inspect pump. pump controls & alarm At least once every: ^ ear{s} ~ month{sl DNA Flush laterals and pressure test At least once every: O year{s} Q monthtsl ^ NA Other: At least once every: Q earls} ^ NA 1NAiNTENANCE INgTRUCTIGNS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the f~~o4p~wginegs®~ ~$ Qp88 ~~catTanp~ Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; inspections must Include a visual inspecteioe d scum and to check fo~any backgup orr pending ofaeffluenttan the g ound surface measure the volume of combined sludg The dispersal celi{s1 shall be visually Inspected to check the effluent levels in the observation pipes and to cheek for any pon lnl of effluent on the ground surface. The ponding of effluent on the ground surface maY indicate a tailing condition and requires thi immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,} or more of the tank volume, the entir contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113 Wiscansm Administrative Code. Atl other services,, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretrsatmer units, and any serolcing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shah be provided to the local regulatory authority within 10 days of completion of any service event. SEP-19-2002 1? ~ 31 5 ! tNNH I,UKh' 7x ts~~ r ~ r . vac rra~ ~a.u~mnh=r rlufnAiny Fr6~ IJO. 71:~SC3o=,121 map. 17 7pC~J; Oa:08Ff-~ FL s•r c~olx cout.TY SEPTIC TANK MAINTENANCE AGREEWiET'T AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ t ~ N ~ ~ Cow o~ P~-~~o ~J Meiling Address 4°I ~C7 v ~ k~ ~ 172. '#lo0 8 /~i~1~e vii s !'~iV 5'~ S/3.S" Property Address S'c~J, ~~'~ C ~ ~ ~$--`l2 ~.- (Yerification required from Plarmir.$ Departrraeat fcr stew t;otutrttction) ~ry/State Parcel identification Number LEGAL D>~C>~Y~~ Property Location L~ '/., SG/ t/~. Sec. Qd . T~N-R / Q W, Town of fi~~,s a ~ Subdivision ~~~ ~-~.~ ,Lot # •3f .r--___ Cet'tlAed Survey Msp # -- Volume _ '~- -.. Page Warranty Daoct # ~~~ D ~6' .Volume /7g? .Page # _ ~/ Spec ltottse~yes ~ no Lot Imes identi5able,L~yes O no 5YSTEM MATIVTIENANCE Improper use sad maiotananceof your septic system could result io ics premature failure to boodle waeee:a. Propez maintenance consists of ptaatping out the ct;ptic tank livery thrsc years or saoaer, if seeded by a licetued pampa. What You put into the sycteszs as affect rho Yunetiots of the septic tsalc L+ a treatnteat stage in tlu waste disposal tystem. 'tttt: propety owner agteEa to cel:tait to St. Croix Zoning Depar>mtat a ceztifteatioo form, sigacd by the ot+mer and by a master plumber, jotn~naytnanplumber. rectricadplumber or ^ lictntedpuc~er verityiag that (]) the an•siu.v~tewaterdispossl systrna is is proper operating condition and/or (2) abet inspection and pumping (if neucury), the peptic facile is less than ] /3 full of sludge. j/tve, the uedersigned have read the shove tequirernanrs sad sgree to nosintaia the private sewage disposal system with the tcaadsrds sa foetb. herein, ss set by she llepartaceat of Commerce sad the Departcrtcat of Nattsal R~esouroat, Stite of Witeensizi C.Crtilication stating that your 'c system hu been maintained must be catapletnd and returned to rho St. Croix t;oaaty Zoning Office within 30 day of tlu~tree eta expizatioa drtte. . /' SIaNA'IZJRE O ICANT DATE OWl~fE1~CEl~TI_~g'~TO~V l (we) cati that a!1 tsatetrttnrs on chit form are ova to the best of my (our) knowlcd$c. I (we) asn (are) t]tc ov,Rter(s) of the pr scri d above, by virtue of a Warnnty died recorded ir- H.egister of Deeds Office. SIGNATUR>? OF >?LICANT ~ 'bAT'E sy pt:rmit B Y Ptinerrt. "••••• ws•.. ,may ittfnrntation that is tnisrrcpreswtedrnay result in the saaits 6ein t+evoked b the Zoning Depa " Include veldt tLit application: a stamped wasranty deed from the Resister o!' Deeds offcce a copy of the cettifietl survey trap if reference is trade in the ~vaaanry decd TOTAL P.02 5tr-to-trine ny • en 5, u W w ~urcr ~..~ .~.... .....~. .....~ t Sr ~ STATE; BAR OF WISCONSIN FORM 1 - 1998 666~5~ r r WARRANTY DEED KATHLEEN H. W0.LSH Document tutrncnr VOt. ~ I J7PA5C 6~,3 FEOISTER OF DEEDS 3T. CROIX CO., 4I . - RECEIVEI FBR RECORD This Deed, made Detwocn Bane Corporation. _ ...._- 12-21 200! 3:10 PM a Minnesota corporation ___. ... .._ _... ._ _ YARRR)ITY DEED .... _- _.._... __ Grantor, EXEIl:T 1 anA _Sienna Corporation. to 1+ainn@@g a otporatton __,,,, ._, (~y ~e ~~ . TRRIISFER FEE: 9163.10 -v "~ '~"'" kECORDIN6 FEE: 17.00 .._ _.. YA6ES: 1 -.. .... ..... ....... Grantee. Gramor. for a vaG,able wrtslderadon, conveys to Crantse the foltowlrtg I described rral uutr to St . Croix Cnunry. Sate of Wuctmsln I (the 'Property ): rtw.nroig Aren NarAe and aotu(n~'A,a'dras: -_ see Attached Exhibit A ~ n(')~°rr~.4 ~~ ~C~ 5`100 5meiz~r~'i ~~+~- ~iu~,. 'col I~(~nne Enka. U-iJ553'~ 2o-lo4s-3o-o00 ~ ~~ Parcel taornacatan tusnoar tPero .. __- II Thts is not hottuntead property. (ts) (n not) 20-1048-60-000 20-1048-90-000 20-1049-90-000 20-1050-00-000 20-1050-80-000 20-1052-20-000 20-1052-TO-000 Together wi[h all appurtenant tir;hts, UUe and ln[erests. Gron[or warrants that the urle to the Property is good. lnJefeasuAe in fee simple and free and deu of autunb,•arxes except See Attached Exhibit B. Dated [nls 20th - day ~ December 2001 Bane rporatlon (SEAL) .,,,_" _. (SEAL) by Jo M. Nassef ~~ ~ "" """- Its of ExecutivQ Offi (SEAL) _ _ (SEAL) I `I AUTHENTICATION ACKNOWLEDGMENT Slgrtsttue(s) Minnesota ..- -- ~- t ~_._ _.., State o[1Nts:CCfRT11- ss. t^ ,..«ti<.c -} Count. authenticated this ,Jay of ... Personally carer bek,rA the this ' Ly" day ut December 2001 , ~ ~,e „~,,,~ __ Joha M. Nasseff, Chief Executiv_~,Officer - of Sane Corporation, a Minnesota _corporation "_ .-- ~" TITLE: MEMBER STATE BAR OF WISCONSIN __ .-'"' ~~ _ _' to t (Ir nnl. _ me krxnvn to be pe~ wlw exsruted the foregod[g ~ muhortttd by 5706.06. Wts. Stau.) instntrttent and _~ same. T1t,S INSTRUMENT WAS DRAFTED BV ~ - - MARRY E' 19AL1J1F{£R Lockridge Grindal Law Firm t^tmrmwreawur„+e,a inn {1a a1,_~~,piv~.nu.~Snuth~ • ~. • --------- • I Minneapolis, MN 55401 NoytyPubltc,StsteotWtsconstn y commhtlnrt is pcnntuunt. (If not. xrsrA -xpiratiun dau: I (SlQtwtures nruy tx auttw!nneated w xknowlsdQed. Both un: nut January 31 , 2005 ") ~ nix) _ . f .. ... _ ... , .....T.,_ . -- - t 1 __-_-__~-, . __. _ .. N,.no w pa.ons :,anuyt M mY ~W~xY „unt d' rypeA a yfaNarl 4eAnr ,hew :Metuaut. . _ -:.-. ......... _. '-~ WARRANTY DEED STATE, lAA OF WISCONSIN ayxspyyr t.+0~ twrs ~„ pK, POAbI Ne. 1 - 199a Mp,M~.,tp_," Y^~. 79 (PA~f ~14 File No: 85-oa9o0 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 Quartez, 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 B9 degrees 25 minutes 02 seconds Easc, assumed bearing along the East-West Quarter line, a distance of 1319.52 feet to the point of beginning also being the Southwest corner of the Southeast Quarter of the Northwest Quarter; thence North 00 degrees 36 minutes 14 seconds west, along the west Line of said Southeast Quarter of the Northwest Quarter and Northeast Quarter of the Northwest quarter, a distance of 1325.15 feet to thQ southerly right-of-way line of the Chicago-Northwestern Railroad; thence North 79 degrees 56 minutes 29 seconds East, along said southerly righC•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 degzees 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, 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 Quazcor, a distance of 191.71 feet to the north line of Certified Survey Map in Volume 15, Paqe 4172; thence South 89 degrees 37 minutes 2? Seconds West, along the north lines of Certified Survey Map in VolumQ 15, Paqe 4172, and Certified Survey Map in Volume 15, Paqe 4173, a distance Of 1113.42 feet to the west line of Certified survey Map in volume 15, page 4173] thence South 32 degrees 93 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 21 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 Nozth 89 degrees 52 rRinutaS 10 seconds West, along the north lines of Certified Survey Map in Volume 11, Page 3128 and of Certified Survey Map in Volume 12, Pdye 3292, a distance of 68?.86 feet to the northwest corner oP certified Survey Map in 5tF'-GVJ-Gbl~G b7~G1 51c~ww-~ 1.u1[r - ~..L "..... ~....~. ~ .u-. Vor..l / 9~PAGE 615 Volume 12, Page 3292; thence North O1 degree 24 minutes 30 seconds East, along the northerly extension of the west line of certified Survey Map in Volume 12, Page 3292, a distance of 5.66 feet to the easterly extension of the north line of parcel recorded in volume 1390, page 163; then South 89 degrees 30 minutes 27 seconds west, along the easterly extension and the north line of parcel recorded in Volume 1390, Paqe 163 and the north line of Certified Survey Map in Volume 3, Page 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 aeconas west a distance of 2'70.16 feet to the west line of Certified Survey Map in Volume 5, Page 1317; thence South 00 degreses Z7 minutes 53 seconds East, along said west line, a distance of 193.97 feet; thence South 89 degrees 16 minutes 33 seconds Weat, a distance of 533.93 feet to the west line of the Northeast Quarcer of the Southwest Quarter; thence North 00 degrees 36 minutes 14 seconds West, along said west line, a distance of 820.23 feet to the point of beginning. SEP-20-2002 09 ~ 21 51 tNNH (.tlKt' 7~t cs~~ repo r . e~ Yoe 1'7~7~~GtG:I6 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. Gncroachtnent of Qwest Communications, Inc. fiber optic cable along the northerly property Iine; 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 basement Agreement by and between Bane Corporation and Wisconsin Bell Telephone Company a/k/a Ameritech 'Wiscon51t1 dated December 10, 2001. TOTAL P.05 ..... ~ i r ,~ ~ ~ r / / ~~ ~, 1 / , •. • ... D~ ... ~'~ • .r •r ~ r r ~ I ' '~ ~...~ • ~, I f / ~.. K, ~. ~ ~,~~' ~ ~ .r• ~~ ~ i •, • ~ ~ .,. 1, '~ / .. ... ~. ~M`~ I ~ / ~ ~" ;~ \ ,/ / ^' ~. wI /r l /I / 1 !1111 '~ ~ ... _.;. ~~`\\~~~~ \ ~ I ~' v /r rr r .r.r ., •, \ ~ ~ I 1 - -' \~.'~•' ~' ~ her ~` ~\ ~~~\~~~~~~\ r.. ~... .{~~O / r ~ ` ... . .~ ~ r .',.,. 1 • w ~ ~ " .. ~ •.. r^ -.. I / ~ ~ 1 ~ I ! ~, ~ r ! I ~ ~ , ~, 11 tii ~~ ti 1 I ~ 1 ~ • ... ~~ ~ ~ t~ 1 1 ~ I r ~~ 1 r ~ I-I~II `ti t~ ~`~ ~ 11 1~\ 1 ~~ J \ i l l l ~• 1- I- ~ 111 1~ ~ ~ •~ -- 1 ~ ~ \ ~. ,. ~ ~ / ~ ~ ~~' / ~ .• I 1 ~/ 1 / ! ~ 1 1 ~ '~ ~..r. 1 I 0'i i~ ~ i~ / ~ ~~ 1 / ./ / 1 / `. 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OS AC) // // (1.095 AC.) // // // // ~. / / ~•Pi / ;A o vmrtr / / / ^ ~•.\~ \\ '}T / / '.// / EASEMENT // // / / ~ / / // \\ ~.~/ // tii/ / / / / \ ~-, / / 9 ~/ / / \\ \ \'. // / 41334 S.F `~/ / \ \` / // po67 Ac> ~ / ~ \\ \ ~3''~// // // 10 // // X \ ~ / 44543 5f / / 44353 S.G / 7 '.\ / / / / pore Ac) / ti \ '.\ / / ?i ,h '•\ / / ~/ // - / M1 '. \ / / r~/ / SW` / / c`~' / '. / . \ \ / / / \ / / \ / / / (('' ~ / i •s ' r1 // I I \\\ S' \ C\ smi // // ~~ ~ C / ~ ' /_. _. _....g4. / / I \ ~ .•3 \ // // 59076 SF ._.- / \ 42 B, . \ / / (, 356 AC.) _______________ s / I \ \ / s I \ s 'ro' \ / \ J• ~/ / ' ~ nl 1 \ f ~g 66 ~, \ / i \ \ sl I \ as. \ \ I 1 ~` 30 ~! I \ \ \ \ I 1 4556.5E ; I \ \ 55 ~ \ / / i 1 (~ 046 Ac) ~I I 'gi \ ~ \ _~ \ •. \ m 1 I I \ \ ,, rI 1 ; I \• ~ .~` 55232 5f _1 1 I I ~ ~ ~ ! / ~ 11.266 Ac.) s I I 29 \ `~ ~ \ \ ,1 I '~ \ I 1 NO DNELLMG I I 50370 5 f. '.\ ROOp EIEVAT10N5 I (~ 1S6 AG) \ gl 1 9ELOw 6660 I I `~ ;~\ V V \ wl 1 I '. \ i I 1 ~g~5i ,5"E f, I 1 . 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