HomeMy WebLinkAbout020-1416-50-000Wisco artment of Commerce PRIVATE SEWAGE SYSTEM
Safety ng Division ,
INSPECTION REPORT
GENERAL INFORMATION (ATTAChbTO PcRMIT)
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
;ST BM Elev: ~ Insp. BM Elev: BM Description:
9Z . 0 92 . l0' ef~l' G33 tabO.IIQ
rA \11/ ^•IrAl1\\ ATIA\1 T1A\I A ATA
1/11~If~ 119rVRnll/'111V19
TYPE MANUFACTURER CAPACITY
Septic r ~ ~
~'t 2 ~ Z
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~
~ Z 0
,._.__~,
Dosing
Aeration
Holding
PUMP/gIPHON INFORMATION
Manufacturer Demand
GPM
Model Num r
TDH Li riction Loss System Head T Ft
rcemain Length Di
SYSTEM
~Ktnc vviacn ~e m ~
DI Ns 3 ~ 2 ~
SETBACK SYSTEM TO
INFORMATION
Type Of System: ~ n
1']ISTRIRl1T1(~N SYSTEM
'/L BLDG WELL
51 t (q ~ C-~E
GLG Yf111V1r VMIM
County: St. Croix
Sanitary Permit No:
453405 0
State Plan ID No:
Parcel Tax No:
020-1416-50-000
Section/Town/RangelMap No:
20.29.19.2633
STATION BS HI FS ELEV.
Benchmark
S1~
9'2,, a
Alt. BM
Bldg. Sewer ~. `} -/ ~r 0 t
St/Ht Inlet
St/Ht Outlet ~ ~ ~ ~~
Dt Inlet
Dt Bottom
Header/Man. ,,. ~. ~ ~p ~O/
Q ~
Dist. Pipe
Bot. System N p ' 3~
Final Grade
,toD
q!• p~
St Cover ~'b ~ CS ~
CHAMBER OR
~_, UNIT
Header/Manifold
t~ Distribution x Hole Size x Hole S cin Vent to Air Intake
~
~,[
Length'-"'" Dia Pipe
Length Dia Spacing ' ~~ t
"f
SOIL COVER
x Prascura Svstpmc Only xx Mound Or At-Grade Systems OnIV
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bedfrrench Ed es
g To soil
p
L~ Yes [I No
~ Yes 'ril No
COMMENTS: (Include code discrepencies, persons present, etc.) inspection #1: ° ~~~v~ Inspection #2: --~"f'~~
Location: 786 Martin Ave Unknown E /4 NW 1/4 T28 1 W The len Lot 39 r Parcel No: 20.29.19.2633
S.T. w+.+~~~ csw Cm~ )sr~tt. /~ _- ~_ D ~(~- ~~~ ~ Q ~ ~ ~,~,t -
1.)Alt BM Description = t ~) W~+~" r ~ ~d~' ` r"""'r"~_r~ ~k 2
2.) Bldg sewer length = x~ it ~~~~*~ ~ ~,,,, ~ ~,~.D
-amount of cover = ' !!~~
73b VP moo. .for ~~.
3) ~E~ttQa17~'S r{G.~ .j.,.~. ~~~` s• ~ ---~- ---~,+u,~ed1. 5~.~ _ ~ -
Plan revision Required? ; ~ Yes °- N ~l~ V r ~ - /I ~
Use other side for additional information. ~~•+~~ _ ~ ?°`~.~-~ L~ !Qr- __--
~ ~ ~'v~-lei. --- -- -
nse cto s Sie _
p
S -6710 R.3/ ` sa ~' ~
( )
Safety and Buildings Division Counry
201 W. Washington Ave., P.O. Box 7162 L !moo
~r~jo,~s~~ Madison, WI 537Q7 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608)~b6.31~1 ?
~` Sanitary Permit Application ~~ °1~~ f k State plan I.D. Number
In accord with Comm 83.71, Wis. Adm. Code, personal information you provide
may be used for secondar
ur
s
P
i
y p
po
es
r
vacy Law, s15.04(1)(m) Project Address (if different than mailing address)
I, Application Information -Please Print All Warmation
e
Property Owner's Na me
~~~~~,~~~:~ ~, Y QP-~~ .~ ~~~.~ w ~~ %a
u arec N Lot ,f gl~k k
~~
Property Owtler's M ailing Address
~ ~ r ~ , , _ ro ry Location
City
State Zip Code
Phone Number ~g !~`.L_'k.Section ~
dc
,~
~~. ;N« Y~~ ~ sl..~ ,~ ~ ~',~_`i '~ ~c~~
II
T
e of $uil
li
h
k _
(circle o )
R~E
~
T ~`~ N
.
yp
c
ng (c
ec
all that apply) ~ ~ 't1~~
run ;
o
I~.1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CShI Number
^ Public/Commercial - Describe U _ ~ ~ / ~, ~
^ State Owned -Describe Use ~ (~
- ~ ^Ciiy_^Village,~ownship of ~- ~~
III. Type of Permit: (Check only one box on line A, Complete line B if applicable) OZO - '(p - S0 - at17~. ?_(03 3
A. ~ ,New System ^ Replacement S stem
y ^ Treatment/Holding Tank Replacement Unly ~
^ Other Modification to Existing System
g• j ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date issued
Before Expiration Plumber Owner
IV. T of POW_TS S stem: (Check all that a I) 2
Non -Pressurized In-G
o
d ^
r
un
Mound > 24 in. of suitable soil ^ Mound < 24sn. of suitable so
^ Constr
t
d We
l
^ il ^ At-Grade ^ Single Pass Sand Filter
uc
e
t
and
Pressurized In-Ground ^ holding Tank ^ Peat Filter ~ 1 Aerobic T
^ R reatment Unit ^ Recirculating Sand Filter
ecirculating Synthetic .Media Filter Q Leaching Chamber ^ Drip Line ^ Gravel-less
Pipe ^ Other (explain)
_
V. Dis rsal/Treatment Area Information: .,, ~D ~
Design Ftow
(
gpd} Design Soil Application Rate(gpdsf) Dispersal Area Required (st? Dispersal Area Proposed (sf} S em Elevation
J
~
L~Gi
~ /~ ~ E~.I CC-/
~ ~~ C~` N~~e v s~
VI. Tank Info Capacity in Tots] Number Manufacturer
G
ll Prefab Site Steel Fiber ~ plastic
a
ons Gallons of Units
New Existing Concrete Constructed Glass
I
~ Tanks Tanks
Septic or Holding Tank ~ ~ f
'
E
E
l t'S
f'% -/
f Aerobic Treatment Unit
Dosing Chamber ~
C7 l ~r.t? ET
VII. Responsibility Statement- I, th+' undersigned, asstune responsibility for Installation of the POWTS shown an the attached plate.
-
'
~
Plumber
s Na me (Print) Plumber's Si gnature MPRS Number Business Phone Number
'
Plumber
s Addre ss (Street, City, State, Zip Code)
i~d ~ -
~licL! U~ ..
VIII. Count /De artment Use Onl
~pproved ^ Disapproved Sanitary Permit Fee includes Groundwater Date Issued lssuin Agent Signatu (No Stamps)
~ ~
Surcharge Fee)
-----~ ^ Owner Given Reason for Denial 2~ r-..
' ~
11~
Conditions of Approval/Reasons for Disapproval -
SYSTEM OWNER:
1 Septic tank, effluent fitter and
dispersal cell must alt btr sereiced /maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances.
Attach complete plans (to the County only) Por the system on paper not less than gill x 11 inches In slze
SBD-5398 (R. 41 /Q3) '
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1096
SOfL-EVALUATION REPORT pa
e 1 of 3
~
g
Wisconsin Department of Commerce.
Division of Safety and Buildings. in accordance with Comm 85, Wis: Adm: Code- Steel Sal Service
County..
Attach complete site plan on paper not less than 8h x 11 inches ins¢e. Plan must St. CfODC
include,.but not Iimited.to_.vertical and.horizontal reference.point (BM), direc6on.and
Pa~cell
0.
.
percent slope, scale or dimemsions; north arrow, and location and distance to nearest road:
Please. pint all Infonmatlon. Reviewed By Date
~ ~
Personal information you provide maybe used for secondary purposes {Privacy Law, s. 15.(14 jt) (m)). ~~~
'/~ ~ 3
Property Owner i"`"""'" .x"~ ..,_ .. _- ~ ~ Propertt Locai~on
Sienna Corporation g ~`` Gavt_ Cat SE 114 NW 1/4 S 20 T 29 N R 19 W
ProperiyOwner's Mailing address Lot# Buck # Subd; Name or CSM#
4940 Viking Dr, Suite 608 ~ :M k ~ ~~'~ 1 na The Glen
City State. Zip Code Ph .Number City ~ Village ~, Town Nearest Road
~o~it'r~j -MN 55435~/.5~z ~S3y`~~ G~'' ~ludson CamtichaelRd.
~ -
Use: Code derived des' n flow rate 600 GPD
/' New Construction ilk; Residential /Number of bedrooms- 4 r9
_..
Replacement Public or commercial- Describe;
Parent material Pitted outwash Flood plain elevation, if applicable na
General comments /~ / ~ ~) rC~~ ~
"
~ ~~ -
/
- ,
and recommendations: Sys#em elevation 92:10ft, trenches spaced and depth to code4:50ft below grade /
1 Bpi # Boring `'~ co-5
~
may/
~
Soil Ap lion Rate i
YI Pit Ground Surface elev. 96.60 ft: Depth to limitingfactor 114 in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz '~
*
*
Eff#2
Eff#1
1 0-7 10yr3/3 none sil Zmsbk mfr es 1 f .5 .8
2 7-14 1Oyr414 Wane scl Zmsbk mfr- _gw 1vf .4 .6
4
~ 7.5yr4/4 none. cas osg mvfr na na .7 1.6
3 14-11.
.~
~~~~ ~
~/ 11~t~ -~~~ tit,. ~ ~G1 ~~.~ S ~~ ", / j~s ~~ ~~.~0~ -~o ,~7~u~-~ ~~' !.
Boring # --- Boring
[/' Pit
Ground Surface elev.
96:60 ft.
_ Depth to limiting factor
114
in.
Sod Application Rate
Horizon Depth Dominant Odor Redox Description Texture Structure Consistence Botxrdary Roots GPDlftz
*Eff#1 *Eff#2
1 0-7 10yr3/3 none scl Zmsbk -mfr es 1 f .5 .8
2 7-12 7 Oyr4/4 none- Is osg mvfr _ gw 1 of .7 1.2
3 12-11.4 7.5yr4/4 none. cos. osg mvfr na na U 1.6
~~~~~~~~~~r
Effluent #1 = BOD ~ 30 < 220. mglL and TSS X30 < 150-mglL * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
SST Name (Please Print) Signature: CST Number
David J. Steel 248956
4ddress Steel Sal Service ~ Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, W 1540 9/5/2002 715-246-5085
Page 3 of 3
STEEII' S SOIL SERVICE
David J. Steel
CST-POWTSM
Lic. # 248956
Sienna Corporation
SEl/4,NW1/4,S 20,T29,R19W
Town- of Hudson, St. Croix- Co.
The Glen lot 39
1564 Cty Rd GG
New Richmond, WI 54017
(715)246-6200
(715)246-6085
This-soil evaluation- was conduFted to satisfy a zoning requirement, it may er may not be suitably 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 wascondusted. fiend
1" = 40'
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3" APFRCVED $EDD.NG L';1DER TAhK
SPECIFI4AT:Cti5
".~:VK MANUFACTURER: ~,, ~•~cr
~lV,t! SIZES: SEx~~IC _r~ GAL.
OS E ~~ G~'
..., .
~LA,R?~ MAI~'~1PACTUR,ER:
---....M. M t~7 E 1~ N~M9 ER a ~'~'~1~~.,,-,
SWITCH TYPE: ,~_ msrc
' ~~'FAC'I'tJRER s
SwITCH TYPE, _ __~
~Qw :RED D2SCl~.ARG£ RAT r ~
.~ P: ,
A PPRC'J c,D
W/ pADLQCK 8
WARNINa LABEL
.....1~" I:h.
as
JOINTS i~ITN
APP~gY«E~ ACP~'
1 ~' ~H~Y
sa:ro~ saiz
'~~ RI5ER EXI?'
~'ERMYTTED CNL
IF TANi~
MANUFACTURER
MAz APPROVA!
Y ~NvRW1L+ FAD
1~~MBER u05ES ?ER DAY: ~~
DOSw VC:.~tI?~E INCi.:JDrNG
FLtiS~BACiC; !~ GAI,~
C~.Pf1"I:'IES: A . ~ a.'tic1:E5 '~ ...:~E:~,.....,,a~~.
C ~ INCHES = (G~Gp.:~.
D ~ ,,,,~ INCHES : ~~''~~j/ ~~A t
~j~Lir~rn...Vft .,s .
P4~MP E AWARM 1v'IRING RS ER IL~3r~ 16.23' ~~t~;~
ERTiCAL DIFFERENCE BE, s
MINIMUf~ NE~CRK SU~P1,,Y PRE Gr P.A~;A r",iSTP,IBUi+ON FiPE ~«?
.~...~.,.,,. FEET FaRCIrMAZP7 X ~ ~ I"EE:'
,~,,,~D FT/1C0 F:`. FR.C~MCN F'ACTQR ~~ I'EET
T.0'*a,L DYNAMIC MEAD FEET
h 1 ~,r 11,,~~ '1 ~Lr t ~ r
„'; ANAL DZMw•1~J~~~i,~ Lii :'V ~+'~ ~~~y~~ ; wr*
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~,? G ~ I ~ ~".~'* ;q---' ~ D NTH„-~._ - D w E'+'ER ----~.,
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"~..__.
~GOULDS PUMPS
Submersible
Effluent Pump
„'
3 V / ~ EP05
APPEICATIONS
SpecificaAy designed for the
following uses:
• Effluent s`,~tems
• Homes
• Farms
• Heavy duty sump
• Water transfer
• Dewatering
SPECIFICATICINS
• Solids handling capability:
;Ia" maximum.
• Capacities: up to 60 GPM.
• Total heads: up to 31 feet.
• Discharge s'sze: 1',i" NPT.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BONA-N eiastomers.
• Temperature:
104°F (40°C7 continuous
140°F (60°q intermittent.
• Fasteners: 300 series
stainless steel.
• Capable of running
dry without damage to
components.
• Fully subrnerged in high
grade turbine oi! #or
lubrication and efficient
heat transfer.
Available for automatic and
manuat operation. Auto-
matie models include
Mechanica4 Float Switch
assembled and preset at the
factory.
FEATURES
^ EP04 Impeller. Thermoplas-
tic Semi-open design with
pump out vanes for mechanical
seal protection.
^ EP05 Impeller: Thermoplas-
tic enclosed design for
improved performance.
^ Casing and Base: Rugged
thermoplastic design provides
superior strength and wrrosion
resistance.
^ Motor Housing: Cast iron
for effident heat transfer,
strength, and durability.
^ Motor Cover: Thermoplastic
cover with integral handle and
float switch attachment points.
^ Power Cable: Severe duty
rated oil and water resistant.
^ Bearings: Upper and lower
heavy duty ball bearing
construction.
AGENCY LISTING
~~ t.anadian Standards Assodation
(C5A listed model numbers end
in "F" or "C".)
[moulds PumRs u !SO 9001 Registered.
Motor:
• EP04 Single phase: 0.4 HP,
1'I5 or 236 V, 60 Hz, 1550
RPM, built irr overload with
automatic reset.
•EP05 Single phase: 0.5 HP,
115 V, 60 Hz, t 550 RPM,
built in overload with
automatic reset.
• Power cord:l0 foot
standard length, 1613
S1TOW with three prong
grounding plug. Optional 20
foot Length, 1 b(3 SJTW with
three prong grounding plug
(standard on EP05).
0 2 4 6 8 10 12 m~1h
CAPACITY
Goulds Pumps
~ 2000 Goulds 4'umps ~ ITT Industries
Er{EC1iv0 February, 2000
83871
~Qui~k4~
STANDARD CHAMBER
~uick4 Standard Chamber
MultiPort End Cap
i ,~ '~ 1 ~ .
z. f ~ I j
~ - -~
1--- -- - 34" ---------•-j SIDE VfEW
FRONT VIEW
~` ~ : - Quicka St
Size (W x L x H) ° `34` x 52` x 12"
Effective Length 48°
Invert Height gr'
INFILTRATOR SYSTEMS INC STANDARD LIMITED A ANTY
e i Tt t ,,ctu al nt gilY ut e cf har;lher, anti d~ala. wedge and otne acnassexy ma - -. awed try ~' Tatar ('lt^its"), when ir~tallcrt and operateo
a I arhl end of an nn tc~ sapt c ys~.am hl an;ordance with of Rr ,tdr's ..irucligrs, f, wanarllod td the xdnal purchaser I'Rolder'") against dekx~tnre
rnteruAa anC wok >,¢h,p o• tyre year Tram thr. date that 11>e „mplK pe mrl is Issuer) fur tiro soutic sYSlerl: avrtahtiln,T the Unds; pruv!dad, hrnvevor,
Ihat f a sapllc pennil is not ,egwrHd by applicabW law, Lha waranty pe.IW will begin upon ins date thaf nsallatron W Inn septic system commences.
To excr(:isb R5 warcanly ngLfs, Holoer rrwst ndtiry mtritrahx in vxiUny a; its Corlxxele NeadquarlL s in Old Saybrook. G;nnecllcW wi:nin fiheerl (15j
nays of the alioged del(x;r klftlhator will suP9H rat'~arrrant Unns Idr Urnts tleterrnined by Infkra0.ir to be c~weraY by this Linnled Y6ar; anry,
Inrdtratcx~ lialulity speriricalrv eacWdas the au! of mrnoval ant or IrstafaUar of the Units.
(bl ?fiF- LMMT/a7 WARRAN'Y ANO REMEpIES W 3UBH4WIGRAPH ;ai ARE EXCLUSIVE. 1NF77F ARE NO OIFIEH WAERANTIES WITH RfSP[Cf
TO 1 HE UtJfrS, INCLl0.7!PIG NO IMPLIED WAFEUINT!ES OF MERI;tIANTA91l,ITl'' CW F~fNF55 FON A 1'fYiT!C11LAR FURpOSE.
j l n s Ll tai tai ttv shall t a d t o~ y pare N Ina chamber sYStem is manuRaa s t v anyana z Int>~ Uttnn Infiurnta. 1rn I in,ilatl Warr:xrty doer
, 1 o tc d w , ue Iar, nonwq n1im, ayr. ~ rat or rrnlrect danay7os. rnlel star sh„II n01 be -aria t.n Cenail rs w Ipwdaled damayas Ineiud,nq joss n!
i Deli I'on ant p otl tabor a d naleryls ine hyatl costs, Or other loss+sa ur expans y n unc 7 uy Ine HoLJer or any thircl party SlxrcAica+y
exauclact from L-nvtad Warranty cweraga are demaye tc Ine Un't due is ordinary was- a xi tear, afarelior , xudant, misuso, at,use w negiacf !~f
Utir Jr T5; the . Alils being subjected to veniGO IraHlc or other Cor,dl;ion5 wi11Ch are not pe rrliltFle4 by [tre rneta`ral on rnGt:uclion5; fddure t0 maintain th0
inn mum ground WVErS sot lash in Ihe, installation instruciione; ±he placement of improper materials in:C the System srnN(Unirg tM iMits: lailure d
fha Unts or t±te SeGIiC system dua 1o improper siting or vnpmper sizing, nxCasSiva wets. usage, improper grease tlispdsal, or improper opsraticn: !x
env ether event not caused by Ulftlhator. This limAetl Warzarlty Shag C`e vole If fha Holder tails to ;amply with ail o} the tarots sat forth !n Inis Llmilryd
Warranty
Fantle!, in nc event stlail InTitlralor be ra5twnsilLe for arty 1lSS Cr damage to the I-loldw, the Unlls, c" any third pany rasuNmy Irdln inatai13110n W ship-
,nent, Or Irpr any prddu:,l IiaGlky claims of Mddsr a arty IhIM pa!ty. For ibis Limited NJarranly to aHply, [he Urats must be installed ''n ae^.prdance
witn all site conditions ranuireci GY state antl iacal cads; all other andtidable !aws: and InfiUraln',<. Inslal'IaGOn usttuclioes.
idl iJU represenlalrve W h+tnrratur ha; fha authnnty tc ehanyc a axrwra Ih,s l.;, nite!I Wananry. NC warrnty applies to arty party other Ihan Ih0 onyx
Ikll Itbldar
nTe aGrva represents Iha StanWr;f Lim,lc+d Wan.,xy u}kxed :ry tr;fiitralur. A h•rntod nurnbar of .ra!eS aruJ r/J,aN &s baba dirfereru warraN
ar^5. Arry nwchea~ pr Units snpp.Y nontar;t adarator's C.uroarala y`aa,~Wlners m Ole Y'64uire-
C4Py Ol tM applidahie warranty, and Should careful read Nat wanan Sayorauk. Cianna(;licul, pr,Cr to stk^h parch .,e, to obtain a
ry ty Ixla to the pwctlasa W UniIS.
SIDE VIEW
TOP VIEW
>`Size (W x 1 x H~ ;, - `` 34" x 16":.x 12'
Invert Height 8" ar 1.25"
J.S. Pnititnfs: 4,759.Ci6k 5A?7.041 F 75RGRA 5'3.F. m'r c, enr ,ice. ~ .,r,r .~~.: ~.. ,.
' • f~
0
SYSTEMS 1 N C
Envitronmental Onslte Wastewater Solutions'"
6 F3usiness Park Road • P.O. Box 768
Old Saybrook, CT 06475
860-577-7000 • FAX 860-577-7001
80~-221-4436
CanadanPatonts: T,329,959:2,004,5nA Other tents "'~`'~~`.r,.rGp,rro.o,aJ~J,tfA9
pa pefldltly
Ir,tiitr~tor, Equalizer and Sidewinder are reyislered trademarks Cf !nt orator Svste+ns 'nc Infiltrator iS a mytsterert trademark in FranCH. Inrdtrator Systems Inc.
Is a rcyistered trademark in Mexico. Canhwr, Contour Swivel Connection MiCrl~aching ?oiyTuft, Snap~ock, ChamberSpacer, PosiLt~ck, OuickCUt, puickPlay HECYCLEBPAPER
aid puick4 are trademarks of Infitrator Systems Inc. ~i 2t)03 tnttltralpr bysterns Inc. Printed in Lf S.A.
SEGTlON VIEW
POWTS OWNER'S MANUAL. & MANAGEMENT PLAN saga of
LkI~E fNPOgMAT10N
Owner -
Permit ax " T ~ OS
DESff3N PARAMETitPttS
Number of Bedrooms Y p NA
Number of Public Facility Unite NA
Estimated lbw leverage! ~ al da
Design flow speak}, tEstimated x 1.5i ~~ $Ilda
Soil Application Fiats at/da ifts
Standen( inffuent/Effluent Quality Monthly average'
Fats, Oit A t3rease {FOG} 530 mgJL
d3iochemicai Oxygen Demand IBODai 5220 my/L ^ NA
Tetai Suspended Solids tTSS} Si 60 mg/L
Pretreated Effluent d.'luatity Manth}y average
Biochemkal Oxygen Demand i800s} S30 mg/L
Total Suspended Solids tTSSI S30 mg/L ~ NA
Fecal Coliform igeemetrlc mean? 510` cfu11 C?Oml
Maximum Effluent Particle Sire Yo in dia. p NA
~~: p NA
"Valuer typical for dpmeetic waet~weter and septic tardc effluent.
SY>iTlrlitl SPECiPfCATiQN8
Septic Tank Cspacity ,~ rJ ai DNA
Septic Tank Manufacturer ~ ~~, p NA
Effluent Filter Manufacturer ' ~ ,~ DNA
Effluent Filter Model ~~~~' Ci NA
Pump Tank Capacity al p NA
Pump Tank Manufacturer rrBS ~ DNA
rump Manufacturer ~,~,,~/ ANA
Pump Model ~ t7 NA
Pretrestn~ent Unit
^ Sand/Gravel 1=rlter
^ Mechanical Aeratbn
^ Disinfection
D Peat Fliter
f7 Wetland
^ Other; A
D srsal Cants}
-Ground tgravltyi
At-Grade
D Drip-Line ^ NA
C} in-Ground ipressurizsd}
O Mound
C.i Other:
0tfwr: A
~~ A
~~~ A
MAdial'i1NANCE SCHEDUd:E
derYioe Event tfiervioe Freytunoy
Inspect condition of tankts} At least once every: 3 e~al'ts} s (Maxiltwm 3 years} DNA
Rump out contents of tankls! When combined sludge and scum equals ono-third lYs} of tank volume DNA
Inspect disperasi cefllsl At feast enct every: 3 mond~la} {Maxinwm 3 years} ^ NA
Clean effluent (filter At least once every: monthtel
• Sd'' ear{s} DNA
inspect pump, pump controls ~ alarm At least once every: enonthtsl
r U} DNA
Flush Isterals and praasure test At least once every: ,.-- ~ ~ mdr+ s ts} p NA
~~' At [east once every: ..-- p earls} DNA
0tfwr:
D NA
MAINTdS11ANCiE MfBTRUCTlONS
inspections of tanks anti dispersal cello shell be made by an individual carrying one of the follow~g licensee cr csrtificatlans
Messer Rtumbor; Master Plumi,~er Restricted Sewer; POWTS lrspector; POWYS l'.~iakttainar; Septage Servicing Operator. Tani
inapeatlons moat include a visual inspection of the tankds) to identify any missing or brcksn herdwste, identify any cracks or teaks
measure the volume of combined sludge and scum and to check for any back up er pending of effluent on the ground surface
The dlapereal celltei shall be visually inspected to check the effluent levels in the observation pipes and to check for any patdin~
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires th;
immediate notiticatlan of the local ragsrletary authority.
When the combined sccumulatlon of sludge and scum in arry tank equsls one-third dY} or more of the tank volume, the entire
cantenta of the tank shad( be removed by a Septage ;servicing Operator and disposed of 'sn accordance with chapter NR 113
Wieoonain Administ-ative Code.
Aft other services, including but not limited to the servicing of effluent fitters, mechanical or presaura*sd gomponents, pretreatmen
units, and any servicing at intervals of 512 months, shall be perfermed by a certified POWTS Mai{ltatner.
A service report shall be provided to the iocaF regulatory authority within 10 days of campietion of any service event.
Page ~ pf ~~
START UP ANb OPERATION '
For new construction, prior to use of the POWTS check treatment tartk(s} for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell{sl. If hjgh;concentrations are detected have the contents
of the tank{s} removed by a septage servicing operator prior to use, _.
System start up shall not occur when soli conditions are frozen at the infiltrative surtace. -
During power outages pump tanks may fill above normal hiphwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell{s} in one large does, overloading the cell{s} 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 tc
restore normal levels within the pump tank.
Oo not drive or park vehicles over tanks and dispersal cells. Do not drive or park aver, or otherwise disturb or compact, the area
within 15 fast 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; tat;
foundation drain (sump pump} water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or 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 Comm 63.33, Wiseonein Adrinistrative Cods:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
The contents of all tatzks and pits shall ie removed and properly disposed of by a septage Servicing Operator.
After pumping, al! 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.
CONTINENCY PLAN
If the POWTS fails and cannot be repaired the fallowing measures have bean, or ~ must be taken, to provide a Dade compliant
replacement system:
~3[ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soh absorption
fr' d b
~~A
systert-. The replacement area should ba protected from disturbaltce and compaction and should not be ~n mge upon y
required setbacks from existing and proposed structure, lot lines and wells. Fsilure to protect the replacement area w#ll
result in the Head for a 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 duo to setback and/or soil limitations. Barring advances in POti'VTS
technofogy a holding tank may be installed as a last rosort to replace the failed POWTS.
C'
d
< <WARNINa> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL (3ASSF.S AND~OR iNSUFFiCIENT OXYdEN. DO NOT
ENTER A 8EPT1C, PUMP OR OTHER TREATMENT TANK UNDER ANY +CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE dIFFICULT Oft IMPOSSIBLE.
At1DiTI0NAt COMMENTS
POWTS INSTALLER
Name ~, `!1~'~c ~.~-~ w~Q ~
Phone ~ r -„ ~. ,~ „~~„~
PQWTS MAINTAINER
Name
Phone
SEPTAt3E BEFtVIClNO ® <:RATOR i PERI LOCAL REflULATORY AUTHORITY
Name -~ Name r _ LQ,p ~N/~~jl -.--
Phone Phone
This documen was drafted in compliance with chapter Comrn 83.22I2itbi{l }{dl&{f} end 83.54111, i21 & 131, Wisconsin Administrative Code.
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.
sT CROTX CO ~ Ao~MENT
- ~ gP.p'I'[C TANK
AND
OWNBRSH~ OggCAT'ION FORM
OwuedBuycr Sr~J~JA (,o ~PaP~-n o
Mailing Addrt~s ~ VI K r t~ ~ ~ ~ . Sv I ~ ~ ~ ~
property Address _~ ~ ~ ~~ Y~' .'r/ artraea~or new
(Vertficatioa required from Plaaaiag Dop
~3 S
~ty~tate N(IDSoiJ (,t/~ Parcel Ydentification Number
LTGAL~_~TIDN r~ -
20 2~ N-R1t~~• Town of ~Up'SU
property I,ocadon '/., h, Sec. . T
Subdivision ^ ~~~
Y,ot # ~_•
Volume __.~.i-• Pie #
Certified Survry Map #
0 ,Volume ~ Page # ~ ~
warranty Decd # , LO ~O~•• D~ ..
cs Q no Lot lines identifiable ~ yes ^ no
spec boost ~ y
~Xr~rt~r Mwny'1'ENAI!iCE tort failure.to haadle~s• ~°pc=~i~~c
Improper use sad maintcnaace of your septic system could result in its p~'eoascd pumps- Wlsat you yto into the tyetcm
ovoSisla of pumping out th+o optic tank every thtt years or t0o'DCL if naedod by
as aScct the func:tioa of the ccp6c tank as a ercatmeat at:ge im the xnste ~~ _~~'
t a certification form, cip~cd by ~% owats ~ by s
"[tte pmpcrry owacr agrees to cnbmit to St. (~oiz ?~oafa~ Dcp+~'a that (1) the oa~ite aattnwatecdisposal aysoem
mta~P~, ~cume5'~nFt~r, ccstzictodplumbes or a licaa:odp~p~~fyr~ the tic talc it less theta !!3 full of eludes
~.~ P~ ope~ting waciidoa and/or (2) ^ltcr-tnspu~a sad pumping (it~ecetsarY). ~P
van icw~Ec ~Po~ ~m with t>ss t~nduds
l/we. tbo uadorsi~ed lave read the.=bout tcquir<meats ag:xx to maintain the Tm
~ fad ~~ as cct by the Dcpartauat of t;.omrne and the Department of Nattml Resources. Sbte of w ~ OTC ~a30
costing ttsa septic sysecm Ixcn tas' Ix campletcd and rettatlod to the St Croix CottatY
I ~ IA.r.~ ~ ~aa date. DA'~~ d~
;1Q'I'T$"fCA~ON octr kuowkdgo, Z (we) am (tee) the owsur(r) of
certify that all t ass o this fo ~ arc true to tlu: best of uyof Deeds Office.
yen abov a warraa dad recorded in A,ogiet
/.~
' DATE
J1V [~/~
•••••• Any iaformatia ti: mis-repcesenced may result in the tttritar3+Pe[tart },omg rovokedby-tbeTiaatng pCP~°t' ••••••
.. GcaUon: ^ wamary dcod lia'at the ReBirtet of l~ office
Inctudc ~vitb this app ctamP°d ma if t~cfci~ u tuado lp the wary decd
a copy of the ccrt{find nuvey P
TOTRL P.02
JGt--LU-LYJkK NJ•Gk/ .l~UVV~ ~..u~~
f
STATh' BAR OF WISCONSIN FORM 1 - f998
j ~ WARRANTY DEED
• Doc;.n«„ PYanoty Vnl, ~ ~~77a~,T 613
This heed, madebetwecn Bane Corgozatiori, _ __
a Z'11t1n880C3 COZpOratlOn
.,... _- ,, ._ _.._.. _ ^__, Grantor,
and _Sienna Corporation. a Nipn~Q$Ca corporation _~,.,.._.,_
... _.. .
_.. .... ..-.. ...... , Grantee.
Grantor. for a Valuable corulderadon, conveys to Grantee the following
described real estatr to St . Croix Cnunty. Srote of Wlscoruln
(the `Property`):
See Attached Exhibit A
(SEAL)
2o-lo4a-3o-o00
Parcel Idontillcafion Mntbar tf'9J)
Thts is not homestead property
(!s)-(Ix not)
20-1048-60-000
20-1048-90-000
20-1049-90-000
20-1050-00-000
20-1050-80-000
zo-IOS2-2o-000
20-1052-TO-000
Together with atl ap}wr[enant rights. Utle and Interests.
Grmrta• warrantt that Ihte title to the Property is good. Indefeasible in fee simple and free and deu of uxwnbrarxcs except
See Attached Exhibit B.
Dated thix 20th - _ day ~ December 2001
Bane r oratiot~ (SEAL)
by
Jo M. Nassef
Its of Executive Offi (SEAL)
AUTHENTICATION
Stgnsture(s) .. ...- --..-
atrthlertlicated this _ Jay ~ _...
TITLE: MEMBER STATE BAR OF WISCONSIN
(It nnt, _
authorlud by §T()F.O6. Wts. StatsJ
„ (SEAL)
666054
KATHLEEN H. WALSH
REGISTC:k OF DEED5
3T. CROIX CO., WI
RECEIVER FOR RECORD
12-21-2001 3:10 PK
YARkANTY DEED
EXgIFT i
CERT COPY FEE:
cavr FEE:
TRR,ISFER FEE: sesz.~o
ING FEE: `7.00
1 1
\_
. y~~~
Rrcrno.y Ar(~,
IVa1rt0 a11d RMWII A[xYaxs
Uni~r~.l %~~~
S~Gb 5 me+r,~xx'i Vr~ ~.
~i.~.i+e, 'col
!~(inne -b~nka. ~1u 553~C3
- - .--- ._:j.. ~ .._~ ~--- = 011
ACKNOWLEDGMENT
Minnesota
State ofiNtrt'vftstll-
ss.
Pcrsortally carne before the this > ~~. day of
December •._ 2001 , ~ above ,~
John M. Nasseff, Chief Exeeutiv_~,Offieer
_ of Bane Corporation, a linnesota
corporation +~-
_ .~ .._..~. _....__to
me luxswn to be - p0~ wiw executed the foregOlnf~
instntment and ._~wC same.
THr$ INSTgUMC•NT WAS DRAFTED 0~ J - ~Y E' ~aALLA~~R
Lockridge Grindal Law Firm `'~ t^raOMia°1ON~*+t~
1f1f1 WAC}f.~ in~l,aVnnrtn Cn,rt~_ • •
Minneapolis , MN 5 5401 Noyry'Publtc, State of Wlsconssn
y commictlnn It pcrrnturcnt. (Ir nol, xrxn expiration lout
(Slgttatwros nray be suUxnrleated a at:knowiMged. Both an nut January 31 _ , 2005 .)
necessary)
pc:w~s :,poop u1 in G x rrxat br ~ ... ....... ...:.__ _:..__... , .~.. ..:.. _.. ........ _. ...._
Y D~ Y rypA or ,uwrar farrow thti. sp,w~rtr.
STATF. DAR Of WISCONSIN Wtscpnxxf wpai a4ru~ Co.. Inc.
WARRANTY GEED YORM N.. 1 - t99a Mxwaaarea, Wr:.
Y^~• ~ 79 / PArC l,•~ 4 File No: es - 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, ail in Section 20, Township 29
North, flange 19 West, Town of Hudson, St. Croix County, Wisconsin, more fully
described as follows:
Commencing at the West Quarter Corner of said Section 20; thence North B9
degrees 25 rtv-nucQa 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 cornet 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 607.03 feet, along said southerly
right•of-way, along a tangential curve, Concave to the northwest, having a
central angle of 09 degrees 54 minutes o3 seconds and a radius of 4670.25 feet;
thence North 70 degrees 02 minutes 26 seconds East, along said southerly
right-of-way, a distance of 429.04 feet; thence northeasterly a distance of
445.52 feeC, along said southerly right-of-way, along a tangential curve,
concave to the southeast, having a central angle of 14 degrees 30 minutes 21
seconds and a radius of 1759.75 feet; thence North 89 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 Iine, a distance of 703.32 feet to chQ 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 north line of Certified Survey
Map in Volume 15, Paqe 4172; thence South B9 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
feeC 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 11 eeconds East a distance of 413.63 feet; thence South 08 degzQes 43
minutes 31 seconds East a distance of 229.88 feet to the north line of
Certified Survey Map in volume 11, Paqe 3128; thence North 89 degrees 52
minutes 10 seCOnds West, along the north lines of Certified Survey Map in
volume 11, Paqe 3128 and of Certified Survey Map in Volume 12, Paye 3292, a
distance of 682.86 feet to the northwest corner of Certified Survey Map in
YOl. ~ ?~ (PACE U~ 5
Volume 12, Page 3292; thence North 02 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 thQ easterly extension of the north line
of parcel recorded in Volume 1390, Paqe 163; then South 89 degrees 30 minutes
27 seconds west, along the easterly extension and the north line o[ parcel
recorded in Volume 1390, Page 163 end the north line of Certified Survey Map in
Volume 3, Page 776, a distance of 508.92 feet; thence North 00 dQgreQS 07
minutes 56 seconds East a distance of 1003.47 feet; thence North 89 degrees 54
minutes 15 seconds West a distance of 27Q.16 feet to the west tine of Certified
Survey Map in Volume 5, Paqe 1317; thence South 00 degrees 27 minutes 53
seconds East, along said west line, a distance of 293.97 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 820.23 fees to the
point of beginning.
SEP-20-2002 09.21 51 ENNH t;1JK1-'
. ~ von 17~7~~~t.6:I6
, ,
Exhibit B
to
Warranty Deed dated December 20, 2001
by and between
Bane Corporation ("Grantor")
and
Sienna Corporation ("Grantee")
y~e w7 r~ r. eu
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 oz mineral rights to the State of Wisconsin;
4. Utility, drainage and roadway easements which do not interfere with Buyer's proposed
development of the property;
5. L•ncroachtnent of Qwest Comtnunieations, 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.
TOTAL P.05
~ . *
... ': » r
w /r~~{ rIW AIR VV4 ,, .. ,/- .` ,~ 'tT~ ~` ~ ... ~ •. •.\ ~ ~.'~ / , / ; ~ ~ `1
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4 ~ ~1 ~~_ 66 ~ ~
' ~ ~ ~ 461 S.F. . ~, / / O \
~ ~, ~ \ !
.- `~° ~ ~ \
/ ~ ~• / ~'+ ACCESS AND DRAINAGE '~ \\
' oy JwD UAUTY EASEI~IF~1T , /~,
^~~ '~i
r ~~ ~ ~
~ ?~• No owEwNC 39 ~\
I r?Q, BELpylf 830.pTtONS 476$7 S.F. \
E eb. (,.ovs Ac.) \
t ~ 40
~ ~
FLaaR E>u~v~na+s .t„4nn.Q,.,~' ~. ,d'i ~ ~ ~ \~
eEllaw a5s.o
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52067 S.F. / ~Sp '~.
(1.195 AC.) r ~,~'
/ ~~
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5Eil. ~ r' y~
~~,~ 37
~ / 4x240 S.F.
~ '`~ .~i. f . / (,.ins ~r_ ~
.. '
Jessie Nve
~ti~
Subject: #45.
Location: T of
Start: Tue
End: Tue
Recurrence: (none)
020-1416-50-000
20.29.19.2633
Schumaker -Sienna Corp.
ion, Lot 39, The Glen
1:30 PM
2:30 PM
~~,
~'~
/~'
~~~
~z,~~
~ -~~
~' ~
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