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020-1416-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building 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: City Village X Township Glen Johnson Construction Hudson, Town of CST BM Elev: Insp. BM Elev: escription: BM D /gym r UhC,cr~Zt~' ~,~t-. l TANK INFORMATION U ELE~/ATION DATA TYPE MANUFACTURER CAPACITY Septic L ~~ ~~ Dosing ~~- , r ~ / s Aeration _ Holding TANK SETBACK INFORMATION TANK 70 /L WELL BLDG. Vent to Air Intake ROAD Septic ~ - J r ~~~ / Dosing Aeration ,.,. d~ j holding PUMP/SIPHON INFORMATIONC~/'lAA~ ~t~-I , Manufacturer Demand GPM Model Number TDH Lift Friction L System TDH Ft Forcemain Le Dia. Dist. to Well SOIL ABSORPTION SYSTEM ~~k ~3 ~ 4~ County: St. Croix Sanitary Permit No: 506400 0 State Plan ID No: Parcel Tax No: 020-1416-90-000 Section/Town/Range/Map No: 20.29.19.2637 STATION BS HI l.. FS ELEV. Benchmark ~-- 3. ~ 1030 ~ Sao • d Alt. BM~ .j l` S~l ~Qd/9 g. Sewer l'ti0 f „r f" rye SUHt Inlet SUHt Outlet ~~ S• (,j' ! 7 Dt Inlet .~----- Dt Bottom ~,./ Header/Man_/- 1 ,~ ,' • ~D 3 5„` o J Dist. Pipe jh ~ ,' ?~ n~.V~ I Bot. S~m ~. • ~ ~ ~ , `.~ Final Grade ~~ ~--- ~ 3• St Cover / ~ . .' S' /D~, BEDITRENCH Width Lengtpf t No. Of Trenches PIT DIMENSIO o. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3' k~2 SETBACK SYSTEM TO P/L S BLDG WELL LAKE/STREAM EACHING anufa r~ t INF0;3MATION CHAMBER OR ~A~V Type System: ~ / ' ~ ~ UNIT odel Number t ~T IBUTION SYSTEM ~~ i Header anifo~d Distribution Q ~ ~ Pipe(s) ~ 2 / x Hole Size x Hole Spacing Vent t e Length Dia a v Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only c,Q,~'.,yt,~ Depth Over ` Depth Over xx Depth of xx Seeded/Sodded xx Mulched 3ed/Trench Center ,.. Bed/Trench Edges Topsoil i ~~ Yes r~ No ~ ~ i~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~~/_~/ 4 /~j~ Inspection #2:__/ /___ Location: 808 Martin A.wenue Hudson11,//W~~ 154016J(SE 1/4 NW 1/4 20 T29N R19W) The Gfen L_otL43 ~~~~"TTT~(,.~' Parcel No: 20.29.19.26;57 1.) Alt BM Description = !~ slll^" S~V~~WY fi ~ ,lj~~j/V1,~ l~J~ ,,~~/fy'v'W+ „Q~,(/~(,(j}.. ~` QK 2.) Bldg sewer length = ~^~r~,,~,j~/~Q,d "'Q 1'Q~G• a~.~ ~ ~~/' /~, ~ _.¢- ~/ - amount of cover = ~~ ~~<~~Y~f' / ~G~-- A SaLt..~• r'1 ~0~'.X~Y+X ~ 5 ,. ~'Y) SJ ~i /z-v~y ~!c!~?"hGr~~-- ' uc~:lCG~ -- 4 _ '~ I Plan revision Required? i 'Yes __; No Use other side for additional information. i '- ~' SBD-6710 (R.3/97) Date Insepctor's Signature Cert, No. . ~• ~' ~ ~ ~ `~ j v ~~,~ U ~~ ~ 0 f~, G,f ~~ {`-~ Sim - M '; , ~~ ~ JT3 ~ ~ ~~~ ~~ I L r~~ `-~ Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 SE]/4,]WV]/4,S2o,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (? 15) 246-5085 The Glen lot 43 This. soil evaluation was conducted to satisfy a zoning regnirement, 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. Legend ]" = 40' ~ =Benchmark F.L. LOO,OOFt Top of %2"pvc pipe • =Alt Benchmark E1.99.40Ft Top of %2" pvc pipe /1 - a =Borings Boring Elevations B1 =100:1OFt 9.3 _o Z B2 =100.]OFt B3 =94,20Ft B4 =00:OOFt r ~ Z(~(o ". ~`"y~S~`~'`' ~Va ~,,~, 6~ ~ z, ~ r~ ~ 1 S~o~ 9Sl io~y ~Z v ~ ~ ~" ~~~ ., Zl ~s3,,~ ,-, z3, ...b ~~~, ~~ ~ ~~~ Cep evmmerc~,Wi.gov Safety a+~ t3uildiags Division ~ a 2Ut W. Washington Ave., P. ox 716"~ ~~ ~ ~' n ~ Madison, W 15370 Counry ~ yy .' Sanitary Permit Numoer (to be ftlted in by Co.j Department a1 Comrnetres ~ sp (p t~/~~ Sanitary Per nit Applieatian In accorda ith C &3 Wi 21 ~' S`~tateTTransaction umber v~ nce w unam. s. (2}, . s. Adm. Code, submission at this form tv the appropria vernn t _ / unit is required prior ro ~"+btaining a sanitary permit. Note: Application terms 'a• state-owned W'TS • subtmued to the Deps+~ment ow C•wnmerce. Persona! mformat,on yuu prov+;ie may be used fors ndary Project Address (if different than mailing address) ,jam ~u x+scs in accordance ~vi,tr thi Privacy Law, s. 15.t)~lr t)(m), Slats. .~L/ • ~ ~( r-~ 'n t A f li ti I i !' ' ' ~ ~ `~ Y J/~ / ~~ l` . np ca cn tt grmat an-Please r it i anon !t`/~CI\/C~ 1 j ____ ~ 11'rolt r y rJwner's Nanse / ~~ ~ y _ j Parcel p 02o I yJ(o- Rio - aab _S~, . _ ._.~,~q.~ Property C?+vner's Mai4ing Address lY U v ~ _-a Propetty Location a _ ~ r P~ _~ X ~ ~ .-~LGfi01X BOUNTY ` ~ r L.V/ L 3 Govt. Lot ___~ ` r C+ty, State Zip Code Phune Number S~ y., ,/~l'~ Y., Section ~ v ~/ ,p ~ _. 1. Type of Building (check all that apply) pk, a+.0 _ Lot ?r~ or 2 Fami9y Dta^elt~t;g Numhrr of Bedronnn i ~ " ~ Icirclc on Subdivision Narrx _ l (! ~= 1 I^ PubliaComntere~al -Describe Jse ~ J~/IC. ~ s I I - ~ r f ^ U ~ ~ ~ ~ + C'^;M Number ^ State awned -Describe Use '- ti ty o _~ __._.. I ^ V+flage of ~l'awn of D Ill. Type of Permit: (Check only o e box on line A. Contpkte title B tC applicable) i A. B New S stem y ^ Replacement System ^ TrtatmtovHatding Tank Replacement Oniy ~ ^ ' ' ^ Other;vloditicatiun to Catering System (explainj List Previous Permit Number and Date sued • Pr+tttit Rtnewa! ^ Permit Revision ^ C ^ Permit Transfer to New hange of Plumber [fete+re Ex no i ~ /S x ~ ~ p ra n ~ Ovtiner I V t~~~l I V. " T~_ f1'pe of POW"fS Systent;'ComponentlDevice: (Check alt that al>nly) _ ____ _ _,-._._._._.__ - _______ Non-Pressurized In-Ground ^ Pressurized In-Ground ~.~., i1t-tirade ^ Mound ? 2A in. efsuitabfe soil ^ Mound < 2.4 in. of su+[able soli L ,~ ldi ^ N T l h ^ •~ ~7~ f (~ ny, o ank C t er Dispersal Component (explain)~___-___,-_~___~_ Pretreaunertt Dovice (explainj_ _ e 1'. Dis ersal/Treatment Area [ni'ortnation: ~- ~ t ~ Design f low (glxl) s~Design Sail Application Rate( st~~) ~t~tispersal Area Required (s Dispersal At•ea Propo {sf) System Elevation ~VL Tank Info Capacity in "Coral it of Manufacturer ~ e Gallons Gallons Knits .0 2' ~ ~ ~ i New Tanks Existv+b Tanks ~ j> _ ~~ u ~ at ~ ~ ~b ~i A D ~~ c. U n ~ rn t:. C7 a Sapcic or Holdutg Tank ! •~~ ~1 ' {{ Do +s n+s ng Cl+ambcr dC~ ~~ . ~ VII. Res onstbility Statetnertt- I, the undersigned, assuntt respoaslbtilty for instattalloe of the POWTS awn on the attached plans. s'lumber's Name (Print) Plumber's Signature ~ ~ P MPRS Number Business Phone Number Plumber's Address (Sweet, City, S~tate/, Zip Co~d!/e) ~ - / _ J G~ Vtll. Count /De arttnent Use ni! Approved isapprovtd ~ Pemttt Fee Date !s ued~lssuit,g A Signature r s 5p ob /~~/9 67 ~ , _ ^ er G+ven Reason for Denial __ _ ~tX. Conditions of Aphrovat/Reasous for Dtsapl.rovat 3~ ~~` / • t~ ov ~ ~°.kl O+wt~?tne~. SYSTEM OWNER: 1 1. Septic tank, effluent filter and w G t~,A.o~.t,. ~~ ~ 4. ~.G , dispersal cell must all rte services /maintained / ~ j as per management plan provided by plumber. l 2. AN satbaclt ret~tltrerrtents must be mattRairted tw PR •PP~Ai !~h(p01t01~tiCM.the s}"ste+n sad submit to ttm County only ou paptn• not less tlsan 8 tai x t t inches in size SE3D-6398 (R. Ut/07) Valid thnt U1/09 ~~ ^^,,I Y Y ~N `VV ~, 6 o 6.. L ` ~'' o _ ~ cv k L1'?, = u. ~ O ~7 -~ L ~}~ tl ~ ~~ i ~ - ~~~ 1~ V ., ~ z 1084 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Camm 85, Wis. Adm. Code Steel Soil Service Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County St. C(ODC include, but not limited to: vertical and horizontal reference point (BM), direction arrd percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. parcel I.D. pending Please print at- information Reviewed By Date Personal information you provide may be used for second purposes (~Y Law, s. 1.04 (~'(m)j"'' ~ ~,~/~ m. Properly Owner Property L ion Sienna Corporation _ Govt_ Lot SE 1/4 NW 1/4 S 20 T 29 N R 19 W Property Owners Malting Address " --' Block # Subd. Name or CS M# 4940 Vilking Dr. Suite 60$ _ 43 na The Glen ~ ~ ` City State Zip Code P one Number ' _; City ~ Village Town Nearest Road ~ ~1l%a^a MN 55435 952-83 - ~~ Hudson "° °' Carmi chael Rd. +~; New Construction Use: y Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial -Describe: Parent material Pitted outwash Flood lain elevation, iF livable P aPP~_ na_. --~-.--_____ _ General comments and recommendations: System elevation 96.60ft, trenches spaced and depth to code 3:50ft bebw grade ~ Cl~~~ ~~~ k ~d h t~2 l d~ G) ~ G~tG ~• '~ ~ ~ u ~ Q `~ ~-il ; L" ~i~ / ~~ 2 .' ~a~rr~.~ ` ~J o ~, u c r~rn s , Boring # __:: Boring 96 ~ Pit Ground Surtace elev. 100.10 ft. pepth to limiting factor in• Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 `Eff#2 1 0-7 10yr3/2 none sl 2msbk mfr cs 2f .5 .9 2 7-13 10yr4t4 none ~ osg mvfr gw na .7 1.2 ! 3 13-961 7:5yr4/6 none ms osg m! na na ~ 1.2 ~rl ~G' /j_~/A /.~// ~v Boring # __ Boring 96 iI; Pit Ground Surtace elev. 100.10 ft. Depth to limiting factor in. ~ Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 `Eff#1 `Eff#2 1 0-9 10y-3/2 none sil 2msbk mfr cs 1f .5 .8 2 9-16 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 16-96i 7.5yr4/6 none ~s~ osg ml na na ~, 1.2 3 ~' ~- ~ ~' ~~ ~,~ - 7 ~-'~ ~v tmuem ~~ = rsw ~ su < zzu mgrs ana I SS >3U < 150 mglL * Effluent #2 = BODS< 3p mg/L and TSS <13p mg/L SST Name (Please Print) Signature: CST Number David J. Stee! ~ 248956 4ddress Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 154017 9/3/2002 715-246-5085 Pro~perty~owner Sienna Corporation Parcel ID # Pending Page 2 of 3 I 3 I Boring # Boring " Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Boring # 'Boring - - .. .. _ Boring # Boring _ ... .. ... _ Page 3 of 3 STEEL'S SOIL. SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 L1C. # 248956 SE1/4,NW1/4,S 20,T29,R19W (715) 246-6200 Town of Hndson, St. Croix Co. (715} 246-5085 The Glen lot 43 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. legend 1" = 40' ~ =Benchmark EL LOO,OOFt Top of 'h"pvc pipe ~ =Alt Benchmark E1.99.40Ft Top of/2" pvc pipe a =Borings Boring Elevations Bl =104 IOFt 9.3 _~ ~ B2 =100.1OFt B3 =94,20Ft B4 ~O.OOFt a-G~. Sc-~ a v~ ~ 1~' u ~~ ~ `~~ ~g'~'y ~~.~6. ~aF~- c ~Z ~ ~. y~f.Zot'r 3 s3,. z3' -/v c~;n~e/ ~ %'~u ~C `1 ~~ ~ z.3~ s~ S~o,~l-- ~ ,u- ~ ~'~~ ~ F.. • - - 551._ :- ~~ 54h' -- _ . _ .. . --i: _. . 'I I ~. - ' ,, ~ - _ _, _ 52 . I .~ ~~ ,i •.. _ _ ! •~ ,, "' / .- ~ '! , ~ r~ T~ * .-_ '`,•, ~ 417• . ~".,~.^ III + ... ,` ~ ~~``•\.• ~, ,~ ~t~._._a~ 1 __. .. ._ .__. 5 t 3,'~.~ r • .... 1 r .. + t ~. - _ • ~ ~ `1 N ~ i ~~ ~' •1 ' ~. " _. I .. _ ~ a, t 0/1 l ~1SJ l~ ~Ol l ~ _ _ _ s r 0~/ • ~ t ~ , ~, ! TT ., r s t ~. .. ... _ r ! ~ ' _ .. +~ , , ~ _ _ ~ / . s W._ a.,, , , l • __.. --~-_~. , - ~ ~ . -.- ,,,.~-'- ~,. ' }! : ;' ,.. _ ; .v •. t ; ; ~ v t 438 .., • y .._ _ - _ _ ' 5' ._ -~ 1 , _~_ , ~ ;, t '. , Ali *~ - ` ,~ .;'- ~ i ~~~+ _ - 34 T l ' 24 7 t .'i~. r', •t ~ \. y_' • ! +'. " ~.'i, ~-~ ~ - _.... ~i~ ~ p r~ ~ ~ 3 4777 ' ~ . _ .208 .. - __ . , .. ~ r^ ... ~ . C, r ~ r C~ ~ V'J • (~ _. t. ' ~ . .. .. -~ ^.~ -. Y .._ . .......... ,, ~ ~•. •~ _ ,7 7 ._. ;, ~ .- , , ~. 5 - ~. ~ ,\ , - _ - =; .- - ~ _ - -.. '~ E a r'.. ~ ~ ~ ,, r ,.. ,~ , l ~ , •. ,,~ a E r. ~ ~ •~t , : , ~ ! , ~ ~ ~ i , : ~41 '';, , ,1 ' ' ; r r i t ~t '~,, 1, ! .,' '1: ,, ~ , , ;1$.. ,,. ~ ~ ~~s~ ., ., ,.~. -------~--~__._.._.._.----- ~ III --------- _ ; ~, : - --- , a~ ` ' I a ~ ~ --------._. . "r • 6t ~R. i i1~, ~_y~~~.... THE GL ~~ ~ loeataa N Mo NorMwN Oawlr of Ma NoNAaaat Ouertor. H lM N6rMwoal Oaartor el lM NarMaaal Qyartor, to t,/'~' Ouortr. in M~ NalMal Ouertr W IM SwMw~t Qwtw. Y, tlH NaMwN Ousdr N lM Sa~Mnt Owrly~ SoutM6M Ouorltr. Be4Jnq purl eT lot 1 W Mal CartMy SurwY MaP neerlW In VMaIN 17. a~ 310E al In ~ 9 SEE SH ELY _ ~~~ ~_ ~ f S~a~2932 t`I~~ ~ sr A~ __ '~ $ Imo' ..-' /~ ~ ,\1 ~ 1~~~~~ ~ S, aM27 S.F ~ ~ Y' \ _~ 1 1. ) a ~ \~ ~ .t ~' ~ 77 \ %J_ ~~ ~ ,,\ - ~, x ~~ \ ~ ~ \ \ ~ ~\ ~~ ~ // \ \ ~'' \ \ \ // ~ \ / ~~ p.o13 AC.) ~ ~' ~ ta0 DwELLNG ~' ' d \ .; FlooR ELavAnaNS ~ ~',~0.1 \ v ~, a eElor esao ~ ~ ~~Syo \` C~. ?• \ I ? ~~ i \ DI Q I ~r i~ /~ \• / ~I J I tea! ~i'~ '~ \ ~ I ~) ~ & x ' ~ ~ A5-9~' t`yt~ NO owEt1110 s3xi S.F. ~ ~' ^ ~'• \~', / ~j ~ I g~ ~o ~, ~l~ow aso~ (l.ooo AC.) '~~' ~. \\ ,• ~~1 W 4 i QI~ dti i' BOOR ELEVATIONS PONDa1G EASEMENT eELOw 850.0 \ ~g'S ~ ~ $ 54031 S.F. :J N (1.413 Ac.) 6ENbIMARK ~ sl 66 ^~ TOP STEEL PIPE -..: ' 16129 S.F. •~ ~' ° / ELEVATION - es1.9o (1.059 AC.) ' ~ ~( 4 ,, BLOCK 5 ,,~~ ,,- \ i i'~ ~/ \ TOP S _._ i'~p i ~~ ~ ~ 'p \\\ ELEVAl10N . e31.76 i' ~ ~ ~~ /1CCE55 AMD l1RAMACE ~, oy ~ ANO U11Utt EASEMENT Ne6sr26'E 499.7r ~ \ I °___9 _~~ ~ \ 406.76 1 ~1, \ ~' \ ~ wEST WAITER cartNEll of I 1 1 ?~f NFl00ROAEIEV 11oN5 39 \ I SEC. 20. i. 29 N, R. 19 M. I I I -`~. sauntvcsr coRNER 1'; I I sa eElow esso ~i ~ ~) \\ 1 of T11E SE t/1 a-. Im ' iNE Nw tp a SEC. ~ I1D I I ,' 20. T. 49 N. R. w w. I 1 I _ _ _ _ _ ~..7/ u19.u ~- -- = _.._ - - - - - - wt t - - - - - ,~~ Neq'23'02~E s309.1s' ,~ EAST-wEST_ 1 al I ' ~ q/ARiER 111E NO OwEWNO «I 1 NO 0aEt1110 py' ~/ I FlooR ELEVATIONS tI I BOOR EIEYA110NS ~dai I 6Elow esa.o SI i eElow esao , // I I $ I I ,' ' k I I /' ~ 1 I 36 /// n / .~ I^ 5>q" 13851 S.F. I I 52067 Sd. / /~ ~ (t.oo7 AC.) I ) (1.195 AC.) , //~' ~~ ~_^ I I / ,~~ ~3 i /~~~ ~~\\ ~ 1 Isar ~~/5'1'0 ( / \ ~ 1 1 ~ / / / 16210 S.F. tQ L/ -_4 ~` I I _` \ ~1/ // (1.107 AC,) 17 _ J L__~ ~~/ / aep. ei,~ craw i+u ..~aru ~ r c S7r. CRout- CVUIVTY SEPTIC TANK MAINTTENANCE At3REEMENT AND OWNFRSNiP CERTIFICATION FORM owricrBuycr Mailing Address ~0 3'~ CorY~Y~ e~'C~'-~ ~r- ~- +-JU~ SO V~ , (1J ~ _ ~~ ~ l ~' a~ ~' ~l ~~ Property Address ~~8 ~~'~•t~ ~V,e- ' -- (Verification requirod fmm Planting & Zoning Department for new ooastiuctivn.) City/State ~ U ~56~ Parcel [det,tification Ntunber ~ off- Q ' ~`7 ~ ~'_ ~ ~ ~ d ° ~ Property Location ~ '/. , /~GJ '/. ,Sec. ~~ , T ~9 N R ~ 9 W, 'I'owa of ~ l-~c~so n Subdivision l Lot #~~. Ccrtlti~d survey M>Ap ~ Volume . ._ • ,.,,~,~ Page # warratnty Deed # ~ /~~,,,,,~~ , Volumo _„_,,,,~_, ag Spec house yes Lot linos identifiable yea no $YS'i`EM MAINTENANCE AND Q ER CE$'~~~AT~ lmproper use and tnaint~anance of your aepdc system could result in its nrrmature fhlhae to handld wasua. Proper tnaintcnatice wnsists of pumping out the aeptlc teak every thrrc years or sooner, ii heeded, by a liccnsod pumper. What you put imo the system can affect the functiva of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities arc speeifreQ in §t;onirn. 83.52(1) xn<~i in Chapter l2 • St. GYvix County Sanitary Ordinanco. T'hc property uw+wr agtvess to submit to Si. Croix County Planning dt 7c+ntttg Aepartraetit a ~;creiflaatioa form, signori by the owner and by a tnabter phuaber, jourr3vytnan plumber, +nstrictod plumber or s Ueot~sed parapet vusilying that (l) the on-sift wastewater disposal system is in proper operating condition andbr (2) after inspoctiou and puzitping (if aoeossary), the septic taak• is less than 1/3 full of s}udge. Uwe, the uhdersigued have read the above requirctneats and agree to maintain the private sewage disposal system with the standards set forth, herein, xs sd by the Department of Commerce and the Department of Natural Roaotucos, State of Wisconsin. CcrtiScatioa stating tizst your aoptlc system has bean maintained must be complatnd grid returned m the St. Croix t^aurtry Platting & Zoning Department within 30 days of the three yoar expiration date. llwr certify that all statoaxnu oft this form are ttuc tv the beat of my/oar knowledge. liwe arn/are the owner(s) of die property described above, by virtue of a warranty dt:ed recorded in Ropster of Deaeda OtBce. ~ ~;. Numhe of bedrooms SI 'A OF APPL,ICANT(S} HATE •••Any information drat is mimpresentod may result in the sanitary ptrtrtit being revvla4 by flu Planning do Coning Depaitment. "' Include with thin application a rocotded wartartry deoci from the ILegister of Ueeds Office xrid s copy of the certified sun'ey map if reference is made in the warranty doed. ca.EV. ova POWTS OWNER'S ~lPANUAI. & IIElANAGEMENT PLAN a}ace _____ or _____ FIIwE INFORMATION owner Permit Jf ~.____~ F.7CSiCifli PARAMETERS Number of Bedrooms ~] IVA Number of Public Facility Units __ _ L7 NA Estimated flow leverage} ~ ~ p 0 alYd~ Design flow {peak}, (Estimated x 1.5) U Cti a1! at Sail Application Rate ailld Lft? . y, Standard influentlEffluent Ouallty ~ Monthly ayeraf~e" Fats, Oil & Grease (FOG) S3Q rnglL Biochemical Oxygen Demand IBOD~M i <220 mgr'L Cl NA Total Suspended Soiida ITSSp 515p mgli- Pretreated Effluent C2uaGty Monthly average Biochemical Oxygen Demand IBODu) ~a30 rr:gl4 Total Suspended Salida (TSSi S30 my/L Q NA Facai Coliforn~ (geometric meant s 1 QQ cful1 QQmi figaximum Effluent Particle Size ..-_ Y8 in die. ~ p ~A Other: Q ~~ ``/aiues typical for dornasstiG west®watar and septic tank affl4gnt NRAINTENANC>!r SCHEDULE Y$'FBM SPfC~ICATIONS S11ptiC Tank Capacity I~,,,S" d al O NA ,Septic Tank Manufacturer W i e..S~..R,- ^ NA Effltfertt Ffltar Manufacturer Z~ ~~ DNA Elfluarrt Filter Model ~ S~Q Q NA Pump lank Capacity g Q i7 .__.. R.a! ^ NA ~. Pump lank Manufacturer ~ Vie- se ~ ^ NA Pump Manufacturer G ~ y`, ~ _ ^ NA Pufr-p Made! ._.~~ DNA Pretreatment Unit IQ 15antilGravel i=filter C7 IVler~hanical Aeration Q Risinfection O Peat Filt©r O Wetland ©Other: ^ NA I~iepersal Cell{s) Q In-ground Ipravityl A At-Grade (;~ l;1r;p•Line ^ NA D fn-Ground ipressurizedl D Mound Q Other: Othwr: _ _... DNA CltFi4r~ ^ NA Otheri ____~__.___ O NA $srvice Event f3ervtoa Frequency ;aspect condition of tank{sl ---- _.~.~._._._. At least once every: .,~ monthlsl {Maximum 3 years) pearls} ..~. - - - r. CJ NA Pump out contents of tankls} When cQrnbined slgdp~ and a~cu m equals one-third I%,) of tank volume ^ NA Inspect dispersal celltsl At least onto every; ~ O month{s) (Maximum 3 years! DNA Clean effluent filter _ _ At least onor- every; C a ___ C] month(s) ~_-- ~_.~aarla) ~~~_r__ ^~ NA Inspect pump, pump controls & alarm ~At !dotal unot3 every: ---• ~ Yea~n~ls) Q NA Flush laterals and pressure test At lea8t ones every; ~-... d months} D yearls} ^ NA Other: ""_ _ -~-- At leffelt nnc+a evaFy: --- Q monthltrt Q year(s) ~... ^ NA other: _._. . _.____~_. ~ ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Itldlvidual oprfying ane of the following 1)censes or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS InsReetor; POW~'S Maintainer; Septaga Servicing Operator" Tank inspections must include a visual inspection of the tank(:a} to'idelltlfk any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum ~d tq tshel:k for any back up ar pondinA of effluent on the grouird surface. The dispersal cell(s) shall be visually inspected to chpt:k the rtiff{cant levels In the observation pipes and to check far any ponding of affluent on the ground surface. The pending of effluent on tt-a ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum. in any tank equufs .one-third {Y31 or more of the tank volume, the entire contents of thcs tank shall ba removed by a Septage Servicing Qperetor and disposed of in accordance with chapter NR t i 3, Wisconsin Adrnir.istrative Coda. All other services, including but not limited to the servicing of stfluerlj filters, mechanical ur pressurized components, pretreatment units, and any servicing at intervals of St 2 months, shall be perfprm4tl kY a certified POWTS Maintainer. A service report shalt be provided to the local regulatory authority within 10 daYS of camp#etion of ar:V service event. Nugp __ -- of START UP AND OPERATION For new construction, prior to use of the Powys chigOk trpetm+sflt taRkle- far the presence of pointing products or othel Cilt3micai~ that may impede the treatment process and/or dame~o;thstl t~iepQrsal GII~a}. if high concentrations are detected have the contents of the tanklsi removed by a septage servicing operatcar prlcir iQ r]~r. System start up shall not occur when soil conditions arty frozed bt the Infiltrative surface, louring power outages pump tanks may ti!! above nor'rltel hiQltvyet4t levels. When power is restored the excess wastewater will iar+ discharged to the dispersal cell(s) in one forge dose, ovArlpading t{hp cal({s! land may result in the backup or surface discharge o~ rt4ttuent. To avoid this situation have the contents rtiE tie p~rrta teflk ~sm4ved by a Septage Servicing Operator pr±or to restcrir,q power to the effluent pump or contact a Plumber or POVif'r~~ MaUttaktar ~a assist in manually operating the pump controls ? restore normal levels within the pump tank. Ro not drive or park vehicles over tanks and dispartAl tells, s3o not drive or park over, or otherwise disturb or compact, the arFa within 18 feet down slope of any mound a at-grade tlpil si~tapf~tion erect. Reduction or elimination of the fallowing from tf-a +~eat~w~tet lrti'tiam may improve the performance and prolong the iifo of thc= POWT$: antibiotics; baby wlpas; cigarette butt, oS~tie~brt~et ,~pp~t ayiyabs; degreasers; dental floss; diapers; disinfectan,s, `a?, foundation drain (sump pump) water; fruit and vegetii[~ls pei~lingb; ~~lktet grease; herbicides; meet scraps; medications: ;;~~ painting products; pesticides; sanitary napkins; tampon); sllltd wv~tle isoffYrrbr brine. ABANDONMEJVT When the POWTS fails and/or is permanently taken put dl! tterwii7e the failpWng steps shall be taken to insure that the systen, ~s p-operly and safely abandoned in compliance with ohapter Goitlni 83,3, 1lViipconsin Administrative Code: AB piping to tanks and pits steal! bs dlsconnActAd ~d;ha abandoned pipe openings sealed, The contents of aH tanks and pits shall be r+arriavpt! And ~rapprfy disposed of by a Septage Servicing Operator, • After pumping, all tanks and pits shall be ~x~>aveter;! i3nd removed ar their covers removed and tho void space filled w th soil, gravel or another inert solid material, CONTINQENCY PLAN tt the PCWTS fails and cannot be repalrad the falloririn8 riaiiisuces have been, or must be taken, to provide a node compliant replacement system: D A suitable replacement area has been evaluated Mid may be utilised for the bcation of a replacement soil absorptior-~ system. The replacement area should be protdoted ttgtn diatufbence and compaction and should not be infringed upon by required setbacks from existing and proposed etfuCturp; IQt ))flea end wails. Failure to protect the replacement area will result in the Head for a Haw soil and site evtlluatign to ~eeeWith a syitsbte replacement area. Replacement systems must comply with the rules in effect at that time, ^ A suitable replacement area is not avaiiablef .due t(a set k pedlar soi! (imitations. Barring advances in PO~rv7~~; technology a holding tank may fee installed !ta a ~i1/t redprt #Q ep~t'ice.tffe failed POWTS. N1A° The site as not en evaluated to klentifY i# rvi~able ~piep~l7tent area. Upon failure of the POINTS a 'i evaluation be performed to locate a auftst .~ r ~ soi and site ~Nt ~~litlnt prUid. If no replacement area is available a holding tank may b fella s a last resort to replace the fa}I~d l'~?WT$. O Mound and at-grade soil absorption systerl,a may b1i rit0itn¢ttucted fn place following removal of the i infiltrative surface. Reconstructions of such aY9tsma moat itomply wjth ihs rules in effect at that time, b omat at the < < WARNNMO> > SEPTPC, PUMP AND OTHER TREATMENT TANKS ENTER A SEPTIC, PUMP OR OTHER TREATMENT tAh~K ~~~ A!~! ~~ ~~$SES anlo~oR rNSUfiFrcrENT oxY(3EN, l~0 PERSON !=ROM THE INTERIOR OF A TANK MAY t3E i'~IFFIG.Gt,1" ~~ mABl~ilti~ MOT ~ a ~~GI~fy18TANCES. DEATH MAY RESULT. RESCUE pF q Lf~GITIONAL COMMENTS PO1NT8 INSTALLER Name l Phone \ \ i !~""~` 5 SEPTAf3E SERVIClNp ~``~ 1 a / OPERATOR (PUMPER) Name ~ Phone ( _-'-.~"'."-,~-- Jl.,a `~' rhis document was dreheU rn corr)filie;yCe with chaMor Comm ~, ~fb,i f -ri7,~ f ~ ~ 3~G - y6 ~ ~.k. (1 and e~: s4f, i, 8' _. f2) & {31, Wisco Hain ga,r„n;strar+ve~` . 'Page _-,.~.1 oL__... START UP AND OPERATION ' For now construction, prior to use of she POWTS check treatment tank{s} for the presence of painting products or other chemicals that may impede the treatment process andlor damage the4dispersat cell{si. if high concentrations ate detected have the contents of the tank(s) revnaved by a aeptage servicing operator prior to use. System start up shalt not occur when soil conditions ors frozen at the intilt-atlve surface. Mound and at-grade soil absorption systems may be roconstructad in place following removal of the biamat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. During power outages pump tanks may fill above normal highwatar levels. When power is restored the excess wastewater will be discharged to the dispersal celllsi ~ one large Base, overlaadinQ the cellos) and may result in the backup or surface discharge of effluent. Ta avoid this situation have the contents of the pump tank removed lay a Septage Servicing Operator prior to restorinS power to the effluent pump ar contact a Plumber or PpWTS Maintainer to assist 6n manually operating the pump contrail to restore normal iavels within the pump tank, iJo not drive or park vehicles aver tanks and dispersal ceiis. i)o not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soft absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain {sump pump{ water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil, painting products; pesticides; sanitary napkins; tampons; and water softener brine. ASANDONMf~N'1r When the POWTS faits andlor is permanently taken out of service the fallowing steps shall be taken to insure that the system is property and safety abandoned in compliance with chapter Gomm 83.33, Wisconsin Administrative Code: • A41 piping to tanks and pits shall be disconnected and the abandoned p"spa openings aeakd. • 7'he contents of ail tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, ail tanks and pits shah be excavated and removed or chair covers removed ant! the void space fitted with soli, gravel or another inert solid material. CONTINGENCY PI;.AN If the POWTS faits end cannot be repaired the following measures have been, or. must be taken, to prowide a code compliant replacement system: ~~, ~ A suitable replacement ar has been evaluated and may be utilized for the location of a replacement soli absorption ' system. T lac meet ar should be protected from disturbance and compaction and should rot be infrin ed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will reau t n Me need for a new soil amt site evaluation to establish a auitabie replacement area. Replacement systems must comply with the rules in affect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations technology a holding tank may be installed as a Isar resort to replace the fatted POWTS. Barring advances in P4WTS ~~ ^ sit h sit e tan d < < WAANIN(;i > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANQ/OA INSUFFICIENT OXYQEN. I]O NOT l=NTI~i A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR Of A TANK MAY SE DIFFiCtILT OR iMPOSSISLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~/.~vflr~G( ~~ ~h~Q.i~ Phone ~ C _ ~ ~ ~ POWTS MAMIT ER Noma `S C.Ow ~ ~ Phone ! S@PTAGE SERVICINt3 OPERATOR 4PUMPERI LOCAL REt3UlATORY AIfTHORfTY Name S Phone Name ~-. ( CC9-~.l I Phone ~S ~. ~(p~ Tins document was dratted in compliance with chapter Gomm 83,I~i2lobliti4di&4ft end 83.5441{, 42t ~- (31, Wisconsin Administrative Code. ,, ~. C-- ~~,~~,~ POWTS OWi\{ER'S MANUAL, & MANACtiEMENT PLAN Page . of _~ OIESiQN MRAYlTti4RS Number of bedroom: y p fy~, Number of PubNo Rao}iity tAyita NA Estimated fbw !average) ~ ai da ~esipn Lbw {pea{tf, tEsZimetsd x 1, bl G~ G a/de ~ ~-pipllca:ion flare Standard InffuentlEifkieryt W,egty ! Monthly avaape• ~ Fete. Oil ~ Orease IFOGJ tG30 me/t. 8ioohemioal Oxygen Demand tBCip~1 s2ZO ryy9rt. O NA Total Suspended 6oltda tT6$1 5160 mg/L Prstnated Effluer-t Oua~ty Manthiy average atochembal oxygen oemand {eoa~t >w3a mgrs Total Suspended Solids {TSS? S30 mg/i, d NA Yeoal Conform tfleometric Mean) 510• afu/1 OOrnI Maximum Effluent Particle Sus yi in die. O NA C1 NA 'Vetoes typbal iar dorrMyatic wastewater and aaptk tank effluent. SY TEM iPECifICAY'10NS 't3eptb Tank Capio}ty ,2` ~J ai ~I NA Septic Tank Manufacturer d NA Efftuant Filter Mafrufacnrrer ~' ,~ C3 NA Effltwrtt FUter Model e' d NA Pump Tank Capacity al Q NA Pump TaMc Manutaotursr r ~, ^ NA Pump Menufeotunr ~,.,,c~ / Q NA Pump Model ~ C] NA Pretreatment lJry}t a O l'landJGrawl Rita ^ Peat Filter ^ Maohanicat Aeratkyn ^ Wetlaund G ~++ O Other: C.ut:f C~ Na round {grav}ty> ^ tn~around {praasurizedi O Mound d Grip-Una ^ Other: Otitar: C~ NA other' O MA ah«: a NA a~ ~cl~tout~ ti.~yriee ~ s«vlee ~+•ney Inspect condkbn of rankle} At Nast once every: ~ ~^ • ;Matdyrum 3 years! O NA Pump out contents of tanklsl What oonylltlned sludge and arum aqua}t one•third IYa} of tank volume ^ NA inspect dfspereal oNlts) At least aryoe every: 3 U 1m 3 yearo~ C] NA Clean effk~eryt fNter At least once way: ~ e! el Q MA Inspect ptunp, pump controls do alsrra At least once every: .~- ~y • O NA Hush taterata aryl pressure lest At !calf one ovary: ~--- f3 ~ s) ^ NA Other: Otltar; At }cart onw every: Q Ir101Mh~i} _,,,r p Nq D NA MAINTdd/WCE MfSTRUCTIONH Inapeoticne of tanks end dispersal aelb shall be made by an indlvidua! carrying one of the tollowiny ficenaee or certificattona: Master Pkrmber, Mastw Plumber Restricted Sewer; POWTS {napaator; POWT6 fua4ntainar 13eptape Ssrviotnq Operator. Tank inepeotione moat lnalude s visual inapsotion of the rankle) to identify any misting or broken hardware, }dentify any cracks or leaks, measure the volume of cared efudge and scum and to check for anY beck uo or pondtnp of effluent on the ground surface. 'rhs dispersal odiie} shill be visually inspected to chuck the effluent levels M the abaerve4ton pipes and to check for any ponding of effkiertt on the Around surface. The pondktg of effluent on dte grotxyd wrface may indicsta a felling condition and requires the immediate notifieatbr- of tfte food regulatory authority. When 'the combined aoournulatlon of skxlse end scum in any tank equals ane-thad ;KI or tt+oro of the tank volume, the entire oontrnta of tM tank shell be romowd by a tieptaps Servicing dpKator and dlspoaed of in accardanw with chapter NR t 13, VYlaoorysirt Adrytinietretiy-e Code. • AI! ether seNlor,, ;ng but not i}rrtited to the aervic}nq of eKluent filters, rryecltan~cs! or units, crud any servicing ~ q-teryaEs of ~! ~ maryttts, shs11 be partormed ay a certlfiad pay{/Tg }yfabt~ ~ oontponenta, pretreatment A service, report shut be provided to the loco ngufatary authority within 10 days of aomptetbn of any service event. $£PTSC TANK £ Ft1MP CHAMBER CROSS ~ 4WL L; SEC}I3N Al'~D 5PECIF~ CFi.TI04S ~"' CI VENT PIPE 12" MIN. A$~J~E ~R,AQ~ 5' ~ WEATHE~iPRQOF 2 FROM DOOR, WINDOW OR FR:SI? ASR INTAKE ~TUNCTION BOX APPROVED WITH CONDUIT MANHpLE CCViR FINISHED GRADE " '+~/ FAD LOCK ` WARN_NG LABEI ~ GI RISER , `.`..-.'° ~ Z1 et MI ~ . 18" iN. 6" MAX. i~ ~ _`_` ~'~ ~ ~ 1 h i, E T ~ ~. F 54 WATER TIGHT SEALS ~ GAS- t , ' ~'TGHT + `~ ~PpROVED ~ SEAL ~ y JOINTS 4JITN ~ :PPRQVED ~ ~- --• ; 'ALM APPRgYED PIPE 'IPE ~~ ..~.,. ~ ~ ON ~ 3' 4NT0 INTO SQ~Ia ~ SOLID SOII. :OIL ~ ~ ~ PUMP QFF ELEV . FT. ~~ ' -~-- OFF' a* RISER EXIT "" ~ PERMITTED ONLY SF TANK MANUFACTURER HAS APPROVAL 3" AFFROVEb BE&1~TN4 UNDER TANK CONCRETE PAD SFE~I~'ICATION ~EPTiC f DOSE . mA?~ K MANUFACTURER : ~ ~..~ TANK S I DES : SEPTIC 1 ~;+"j Q GAL . '~ DOSE ~ GAL. AiaAR,M MAN'JFACT~fRER: ~~,~x.~.~-g,~'''~ MODEL NUMBER: ~,t,,y SWITCH TYPE : ~"'c1~.0.C ?~.:MP MANUFACTURER : ~ ~ __.__._ MODEL NUMBER : P ~ SWITCH TYPE: ~j~gC t~E~L IRED DI SChARGE RATE ~•"~ ~ GPM N~M~EA ROSES ?ER DAX: ~` *DpSE V ~I~IME INC LUD_TNG FLOWBACK: j~ 9 GAL. CAPACITIES: •~ = ~'~ INCHES = ~I ~~,~,_GAL. B x 2 INCHES = ~~- GAL. -__.d_~_ ___._-.___.. C = O INCHES = ~$ GAL. D = __~__ INCHES = ~wGAL. PUMP ~ ALARM WIRING AS PER I??LHR 16.23 WAC '%:.kT1CAL DIFiERENCE BETWEEN P~JMP C?FF AND T3ISTRIBUTION PIPE /~ FEET ~ MINIMUM NETWORK SUPPLY PRESSURE . 2.5 FEET FEET FORCEMAIN X ~,~bFT/~t~4 k'T. F1~ZCTiON FACTOR -~~~,~_~'j FEET T•A~'~-~ T~YNAMIC HEAD = FEET rt.NTERNAL DIMENSIONS OF FUMF TANK: LE~tCxH .r i WIDTH t--~' DIAMETER :SIGNED: _~,~f,~,~~'~'~,..~..- _ LICENSE NUMBER: ~,~,,.1',~.. rATE: ~.-- 1/88 ~~GOUlDS PUMPS Submersible Effluent Pump ~~ 3O~ ~ EP05 APPLICATIONS Spedfically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Oewatering SPECiF1CA710NS • Solids handling capability: '/4" maximum. • Capaaties: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'!i' PIPT. • Mechani®l seal: carbon- rotarylceramit-stationary, BONA-N elastomers. • Temperature: 104°F {40°C) continuous 140°F (60°C}intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- rrtatlc medals indude Mechanical Float Switch assembled and preset at the factory. FEATURES ! EP041mpeiJer- Thermopias- tk Semi-open design with pump out vanes for methanical seal protection. METERS FEE^ to 9 s x t~ 6 ~ s 8 ~ a 3 z t 0 ^ EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. • Motor Cover: Thermaplastk cover with integral handle and float switch attachment points. ^ Power table: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' Canadian standards Assodatia~ (CSA listed model numbers end in "F" or "C".} Csoukls Pump b !so 9001 Registered. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, b0 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, bulb in overload with automatic reset. • Power cord: l0 foot standard length, 1613 SJTOW with three prong grounding plug. Optional 20 foot length, 1613 SJTW with three prong grounding plug (standard on EP05}. ~ 2000 Goulds Pumps affective February. 2W0 a387t 0 2 4 6 B cAPacm GPM 10 12 m'1h Goulds Pumps ITT Industries Document No. U. 2776P 211 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED 7'9 1 1 78 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 04/04/2005 10:30AI1 UiARRASTY DEED EXEIPT # REC FEE: 11.00 TRAMS FEE: 266.10 COPY FEE: CC FEE: PAGES: 1 \~ SIENNA CORPORATION, a Minnesota corporation, conveys and warrants to GLEN JOHNSON CONSTRUCTION, INC, a Minnesota corporation, the following described real estate in St. Croix County, State of Wisconsin. This is not homestead property. Return to: Sienna Corporation Suite 608 4940 Viking Drive Minneapolis, MN 55435-5318 Tax Parcel No: 020-1416-90-000 Lot 43, Block 5, Plat of The Glen in the Town of Hudson, St. Croix County, Wisconsin Exceptions to Warranties: Easements, reservations, and restrictions of record. Dated this 3 I day of __~tZ.-1"'C~ , 2005. (SEAL) ATION, a~nnesota corporation R SIENNA CORPO ` , By ~~ ~ r~ ~~,c~ Ci ,~ •t~ 4 - (SEAL) Marsha A. Pierce Assistant Secretary AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA } )ss. Hennepin County } authenticated this day of 20_ Personalty came before me this 3 I ~"~ day of ~/y~p~l~ , 2005, the above named Marsha A. TITLE: MEMBER STATE BAR OF WISCONSIN Pierce, the Assistant Secretary of Sienna Corporation, a Minnesota corporation, on behalf of the corporation, to me (If not, known to be the person who executed the foregoing authorized by § 706.06 Wis. Stats.) instry~nent and acknowledge the same. This instrument was drafted by: Catherine M. Thornhill, N tary public Sienna Corporation 4940 Viking Drive, Suite 608 Notary Public of Hennepin County, Minnesota. Edina, MN 55435 My Commission expires January 31, 2010 Signatures may be authenticated or acknowledged. Both are not a .. CATFIERINE M. TF104iNHlLL necessary. NOTA4iYPt,16UC-MMNESOTA My Camisaon ~,pn.31, 2010 Names of persons signing in any capacity should be typed or printed below their signatures. t r wiscor++r•in Department of Commerce PRIVATE SEWAGE SYSTEM Safety 21nd Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO,PERM*) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(ri)]. Permit Holder's Name: Sienna Cor City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding F, PUMP/SIPHON INFORMATION ~'' Manufacturer De G Model Number TDH Lift Friction Loss System Head DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM .~ ELEVATION DATA county: St. Croix Sanitary Permit No: 453318 0 State Plan ID No: Parcel Tax No: 020-1416-90-000 Section/Town/Range/Map No: 20.29.19.2637 STATION BS HI FS ELEV. Benchmark Alt. BM ~; .. Bldg. Sewer SUHt Inlet St/Ht Outlet Dt Inlet ,~ , Dt Botto Hea ~r/Man. st. Pipe Bot. System Final Grade St Cover sr~ 1 \ BED/TRENGH Width Length No. renches PIT DIME IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM / \ Header/Manifold Distribution x Hole Size Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes L"_~ No r•_cl Yes I- No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 808 Martin Ave Unknown (SE 1!4 NW 1!4 20 T29N R19W) The Glen Lot 43 Parcel No: 20.29.19.2637 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Use otherlside foruadd tional information. No ~~--~--~I' ~_-- - _ ____ _____-- ~ I~~ ~~ _ SBD-6710 (R.3/97) Date Insepctors Signature Cert. No. s r ~ + ~~~ Safety and Buildings L)ivisiun ~ Cuunty ~ T b 26I W. Washington Ave., P.O. Box ?162 ra r ~ S Madison, Wl 537,07 - 71{52 ~sconsln Sanitary Permit Number (to be filled in by CoJ {6a8, 266.3151 3,g De artment of Commerce -~~ Sanitary Permit Applicatio ~~,~~:=m~~~ `_-~" = S`~" Ian .D. Number , l In accord with Comm 83.21, Wis. Adm. Codo, persona[ information u provide 15.Q4(1}t } ~ ~ may be used for secondary purposes Priva ]project ddress (if different than nutiling address) ~ I, Application Information - Pieaie Print Ali Infor ti ,}, , Proptrty Owner's Na me - '" "' ``" eel N Lot N Block ~ { Property Owner's M ailing Address aperty Location - ~~'Y~ <%/,'~ ~ S• <'y`G G~ S~ u,~y4,Sectian o10~ City, State Zip Code P her <` ~(/ ~/ .~. ~ - ~.~ - ~O cam(' (circle T a?q N: ~~~ ~ ~ ~ II. Type of Btaildia~ (check sli that apply) S w~. „_ ~ Q~1 or 2 Fatally Dwelling - Humber of Bedrooms S, , CSM Number Subdivision Namo ^ Pubiic~Cornmerciel -Describe Q.~/ ~i ~ ,iFJfi ~G.iJ ^ State Owned -Describe Ust " " LCity ^Viltage i~ownship of2i~~.r'y~.r/ III. Type of Permit: [Check only one on titre A. Cotnpiete Hne IB if ap cable) 0 0 - `{/b ' `I~ -~ . ~~ 3~ A' ,New System ^ Replacement Syste ^ Treatment/Holdinp T Replacement Only ^ Other Modification to Existing System B. ^ Permii Renewal ^ Permit Revision age of ^ Permit Transfer to New List Previaua Permit Number and Date issued &foro Expiration Plum ~ Owner i t I i:V. T of POWTS 3 stem: Check all that a 1 ) i ~1Voa -Preasuritsod Itt~round ^ Mound > ~ in. of suitabl ii outxi < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter --- ^ Constructed Wetland ^ Pressurized In-Ground ^ H ng Tanic ~, t Filter ^ Aerobic Treatment Urtir ^ Reeircu 'ttg-Sant! Filter r-- ^ ReCirculatip S nthedc Media Fiitat ^ Leaching Ch ~ Dri _ rave s Pi ~ ^ Other {ox in} QI ~` V. D rtltUTrestment Area Informations ~$ ~~ ikaige Flow (~ Design Soil Application Rate( Disperse a aired Area Proposed (s!} Sy cm on („ e ~ tae ~ ~ ~ $57 + ,j'7 ~4. ~D ~'~ VI. Tank Info Capacity is 7 Number Marrafacturer Prefab Site Stec er PlastiC Ga llons ons of Uttita Corserett Conatru led I Glass New iutiadag , Tattles Tanks I Septk or HoldinII Tank -.~ ~., ..s a / ~ ,_ , . . ~ VIL Res nsibWty StaYtement• I, lira uttderstgaed, aeatttrte res onslbWty for Nation oi' the PCIWTS shown an the attached i Plumber's Na the tint `~ (P ) Plumber's 5i gnature P~ PRS Number Business Phone Number , ~l/; a ~ 3~u- m ~,i,>'~r o?~ ~ ~r"~ ~ lS- 3 ~~~ ,~JaT Plumber's Addre sa (Street, City, State, Zip Cade) Id74 Sc ~ t~ ~~ ~~- dam, ~.ti lJ,~' ~'1/~/~ VIII, Count /De nt vac Onl -! Appravgd ^ pproved Sanitary Permit Fe (includes Groundwater Date Issued is uing eat Signature ( 00 5tam~ Surchatgo Fee) ^ Owner Crt on for Denial 2s~ ~' (~ 7,~p e IX. Conditioa~ of ApprovaUReasmis for aPProval ~~ ~ ~~0,lSfZva SYSTEM OWNER: ~J~ ~iZ,,,~ ~(.Q,,.~ ~,~, ~ / ~t ` 1 Septic tank, effluent filter and ~ ` ~ ~""~~ dispersal cell must all ~e s~rvic~d t t~ii~ined J ~ S ~ p~~ as per management plan provided by plumber. 2. All setback requirements must be maintained u 2 tt.~,i as per applicable code/ordinances. ~~ ----- ~~~ ~---~------~ C.e .e~~ua-1' Auadt eeayhae yfaaa (to the County only) for tlu eyeless on paper not Ices than d2/2x:1 ieceea la alas SBD-6398 (R. f11 /(?'~1 ~~ ;;-__ 6 J N ~ d- 0 N ~ ll. I ~ ~~= ~ ^~ ~~ G~ ?~ 7 - ~\~ -._w._...~~___~.l oI ~ ~ ~ ~ ~~ ~ ~ J ~ ~~ M ~. e u ~~~~ ~ ~ ~ ~ ~~~ ~f~ ~~N N ~ 3 ~ 8~ ti `~ q b 1084 WisconsinDepartrr~ntofCommerce SOIL EVALUATION REPORT P~ 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Sat Service County Attach complete site plan on paper tat less than 8%z x 11 inches in s¢e. Plan must St. Croix include, but rat limited to: vertical and hor¢ontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. pending Please printer// information. Reviewed By Date Persons information you provide may be used for secondary purposes (Proracy Lew, s.15.04 (1) (m)). Property Owner Property Location Sienna Corporation Govt. Lot SE 1/4 NW 1/4 S 20 T 29 N R 19 W Property Owner's Meriting Address Lot # Block # Subd. Name or CSM# 4940 Vilking Dr_ Suite 608 43 na The Glen City State Zip Code Phone Number ~ City " ~ Vi{tage Tam Nearest Road ~i n~ MN 55435 952-835-2808 Hudson Carmichael Rd. New Construction Use: ~ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD '' ~ Replacement _) Public or commercial -Describe: Parent material Pitted outwash Flood plain elevation, if applicable na General cmmments and recommendations: System elevation 96.60ft, trenches spaced and depth to code 3.50ft below grade Boring # 'Boring 96 Pit Ground Surtace elev. 100.10 fl. in. Depth to limiting factor Sod Application Rate Horzon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPD/(N 'Efi#1 "Eff#2 1 0-7 10yr3/2 none sl 2msbk mfr cs 2f .5 .9 2 7-13 10yr4/4 none Is osg mvfr gw na .7 1.2 3 13-96 7.5yr4/6 none ms osg ml na na .7 1.2 Boring # ' ' f Bering Pit Ground Surtace elev. 100.10 ft. Depth to limiting factor 96 in. . Sod Appication Rate Horizon Depth Dominant Color Redox Description Texture Structure Cor>sistence Boundary Roots GPDJftz *Etf#1 "Eff#2 1 0-9 10yr'3/2 none sil 2msbk mfr cs 1f .5 .8 2 9-16 10yr4/4 none scl 2msbk mfr cs na .4 _6 3 16-96 7.5yr4/6 none ms osg ml na na .7 1.2 'Effluent iF1 = BOD ~ 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS < 3p mglL CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel Sal Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W15401 9/3/2002 715-246-5085 P(ro~pert~y Owner Sienna Corporation I I 3 1 BorinU # : Banng Parcel ID # Pending Page 2 of 3 * Effluent #1 = BOD ~ 30 < 220 mg/L and TS5 >30 < 150 mgJL * Effluent #2 = BODS <30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. ff you need assistance to access services or Boring # ~ Boring - - ... .. ... Boring # !Boring - -• --- - - .• . ~ Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 SEt/4,NW1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot 43 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 tot lines were not estahlished at the time the soil test vvas conducted. Legend 1" = 40' ~ = Benchmark EL 100.00Ft Top of %Z"pvc pipe s =Alt Beachmazk E1.99.40Ft Top of/z" pvc pipe a =Borings Boring Elevations B1=100aOFt 9_ ~ _O Z B2 =100.1OFt B3 =9420Ft B4 =00.OOFt 2 z.3~ ~~, ~oo.ro-1'~ S 6 ~Z~ ~~` ~. S'f•Zo~r l\ ~.~ w, s3.~~ ,~-z3, F~EH--24-2ti7ta3 14 ~ ~3 :; : ~FyJrS l,Uttt~' . ~ 9T Ck0 ~ AG,RSSt~NT ~pT'iC TAPII~G M~AND ~~~~' ~.~~'i'IOI~I Po1tM awuerBuyer ~t ~~1f~ Co ~ PeQA'-~`t a ~ ~ Cyi6 b /"t~~f3 S ~ t r ~ fz- ~u t~ AdeUeas _ g~p g /7` ~' ~ v -~ Property pddress ec,t far na+v cQastc~tfony N~~aeei„oarequ4ed $om P4eainy DaP~ qo , oz~o . 2(0 3 ~> ~ Parcel Ydeattfication Number' Oz ° _ 1 ~~ b r CStylstata ~ ~ 1~.Sdr~ L'J W ~. Sec. ~a , T Z~ I~I`~-s-L--w' ToWr- of ~fJC~S p~p~,y ~acadoa ~'~~~ ~ t # ~3 . subdir-tisiaa _ ~--~-- Volume r____--- ---' ~p~ # Chad survey Msp # ,~ Pty ~ ~ 3 wansnty Deed * tv ~. 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'r ~ „'°~ ~•Ni PIPE 32" r M,.N. ABJVi G.'~iA~E ~ F~AE5Fi A2RMiNT~K ~ ~ihLt3W CR ~EA~'t~FRpR~f t/T 'QA ~1 E - JUNCI'I/0~.'v' /SCX APP~tO'~i~ FaKZ~H~~° i~A~~~ ~~wt~ C+~`NDY+T v n .ANt'.OLE ..0 ~ .."_,~"~""~-.r. ~ ~~ C ~ R 15 ER ~--•..~ ! i~ ~ PAD LOCK i WARNi u~, ;,,AgE X. ~ ~• »~, ~~ ~6 ~ ~ ~~~~ ~ ~ ~~ ~ ~ Ir A i~ ` +t..., i WA~I`R TIvei T 5 EALS ~ ` ~ : t ' TxGH fi ~ ~; ,~PRflV~D ~ A SF.~IL ' ~i ' ~`RaVEO 3 ~ ".!c"" -~ALrt ~ OIIVTS itf ?y ~~'0 3,?#.IC1 ' ' R APP~IQVE~ prP~ ya:~, '` ~ "i` ~ i0N ~ ~ 3' ONTO PvMP vF~ ELE~P . ~.~T . ~ ~ C ' _ ~ ~ S4LI0 SOIL ~{ ~~~` r""'-SFr . { '~~' 1lISElt EX*. j ~ ~ ~~RMYTTED c~L TANGS ~NUFACT'JRER ~" APPRvi~'~~ BEDDING UX3ER 1'A!~7K liAS APPROV,~? .,._~PECSF:GAT:CN5 OON~RETE PIU ~MP7IC i D45E `~,NK MAN'JFACT'J1~ER: ~ ~ ~~.,,,,..~.... h"•+''!3ER ~gSES ?~R DAY: ' -~~`~~'-~:... j.. DES ; SEP :`I C ~ ~! ""'".~„"' DOSE ~ GRt , LOSW VC:"tJ!~E xkCwUD_NG e L~,Ru MAN<J~'AC~R„r,R : FLGSvBACk: !~~ GA:~ . MObEL M1N~LR: L'+K~.i!'L..~. 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