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Home My WebLink About020-1417-10-000y Wiscon3iri Department C` Cor~m~rce ` Safety and Building Division • PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit. Holder's Name: City Village X Township Sienna Cor Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic ~4.~. Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO p/L J a WELL BLDG. Vent to Air Intake ROAD Septic ~ / j(~ ~ /~ ~ (O / ~~-- .. Dosing Aeration ~ Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Friction Loss System Head H Ft Forcemain Length Dia. e ELEVATION DATA County: St. CroiX Sanitary Permit No: 420616 0 State Plan ID No: Parcel Tax No: 020-1417-10-000 Section/TownlRange/Map No: 20.29.19.2639 ~~~ STATION BS HI FS ELEV. Alt. B w~~- ;ri s• ~s ~ c . ~s BI~~ ewer 30 3 • YS ~_. St/Ht Inle ~. ~ °~S ` / SUHt Outlet s~ ~ ~ v 7.9s ~- ~ ~-~5 Dt Inlet ~' Dt Bottom ( mar./ / / Header/Man ~, ~] ~ L IT'3 Dist pipe S~~ d~~ o ~ ~, Bot. yste . ~i3~3 Final rade 1 2 - d'h ~ h, ,~ S;y 3. Gov. / I SOIL ABSORPTION SYSTEM // /'Gi/iivi,_jipi7~ /•.Glo.,y pL = ZZ -Fa-{zrX BED/TRENCH DIMENSIONS Width 2 / ~ J Length ~ / _~ IQ No. Of Trenches ~~ PIT DIMENSI NS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL ~~" V LAKE/STREAM LEACHING CHAMBER O Ma etvreJ^, i7 '~'~ S Ty Of System: ~ ~ ~ / - ~ ,+/ UNI Model Number: DISTRIBUTION SYSTEM ~ ~ Header/Manifolr~ Distributio x Hole Size x Hole Spacing Vent 'r In~ ke / 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 0 No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ / / 0 Location: Hudson, WI 54016 (SE 1/4 NW 1/4 20_ T2-9r~ R19W_) T~~.61en Lot 45 l b' !N~ ~ 1.) Alt BM Description =~(/~`~~~-~ r S~~ 2.} Bldg sewer length = 1 /_ ~ -amount of cover = / 10 ~ > 3 ~~~- tiw( ~eGz. c _ -~ ~--- Plan revision Required? [J Yes No 7 3 ~ ~ 3 ~ ~ Use other side for additional information. SBD-6710 (R.3/97) Date ~v Inspection #2: / / Parcel No: 20.29.19.2639 ~// f7 ~d l~ ~ rt,, n~.ed scr,~,d. o . ~ .~ In~e~ cto/S-'s S~~ ~at~u~r ~~%Z3_ l'~_ Cert. No. ~~J ~~-~-~.,~.e- t33 Safety and Buildings Division County ~ ~ <,,, 201 W. Washington Ave., P.O. Box 7162 -~~~~''a ~'` K I S~®i~S`'®~ Madison, WI 53707 - 7162 Site Address ~/~' De artmen~. of Commerce /a-~ -0~ 3 ~/~L Sanitary Permit Application Sa~tary Permit N Ober ~ ~ r In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ma be used for seco ses Privac Law, s1S. 1 m I. Application Information -Please Print All Information . State Plan I.D. Number `~ Property Owner's Name Parcel Number o~o-~yi~-~ 5"~ ~,~~~ ~~~ Property Owner's Maili g Address n Prope Lion , `` / `~9~~ //c~~,U ~~" ~o ~ ROIXCOUNTY .5E'k ~'k;S T N,R 9 City, State Zip ode ZONIN 1=aA6fiad`(umber Lot Number ~ Block Number Subdivision Name CSM Number ' y~cc ' c~ ,'s ~1 v~SY3S- Tf!~ ~.~ ~e.r/ II. Type of Buildmg (check all that apply) euL ~,. S.~uu.~ ^Ciry ~1 or 2 Family Dwelling -Number of Bedrooms ~ S ^Village ^ Public/Commercial -Describe Use ownship ~/~~~~ ^ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' 1 New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use- S stem Tank Onl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)~_ .. I~--(cN 44~Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter SO ^ Constructed Weiland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass Sl ^ Drip Line 4S ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersaUTreatment Area Information: Design Flow (gpd) Dispersal Area Dispersa! Area Soil Application Percolation Rate ystem Elevation Final Grade Required Proposed ~{.Z Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation ~~~ ~~~ 1 `~ r~ ,/ N ~ C/~~ /, yr / dr O ~ ~~P_ ~~ VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Sleet -Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank A/ _ /fJ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for lion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature PRS Number Business Phone Number ~~lrie-/~c iZ~ ~ ' d ,~lS''-~- ~Z Plumber's Address (Street, Ciry, State, Zip Code) ~ ~ !-~~ D~ l J`-- VIII. Corm /De artment Use Onl ~, Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ruin Agent Signature (No Stamps) • Surcharge Fee) J ^ Ownet Given Initial Adverse . ~~- ~- ~b/a Z .. Determination IX. Conditions of Ap rovaUReasons for D' approval ~~ - ~ ~ ~ ,.. /NN~xfyl.~~,i +~. ~.Pp~c C. "~D-~-~- -t~`~ l 7'~ dd 1 _ .~- ~T S t'.t ~s complete phuu (to the County )for the system on papa not raa rnaa ales z as mesa W atze ~ c,~.eQQ ~ ~'~. tom.. ~ ~~le.d~..~..,. N.2, 81~ ~~-Z SBD-6398 (R OS/Ol i J ,V i st`a~ =~ __ s ~ :t,-,v,y o. L a Yom' ~a t y..~ ~{i -c ~,C.tzr~ ~/~-dsvr~ 1 /y7 ~ Q~ ~5~ ~~ V~ ~~ A 8~ ~b \ x ,~, \ 6y~ DI " 3 .Q.S -~~ ``mss 7~SD s ~p ~, ~ y ~~ ~~~-,4~~a ^ ~/ .1 /~, ~' c~a ~6 a,,~ ~ j~~~~~~~~~~ ~, ~ ,~ ~ ~~u~ _~ pr. `dL w~J ~v i /.~lyi~ ~~ ~ (` ~- ~,, ~1~~ ~~ir~ 10d'. ° S ~3~1l1 .~ Q ~5 2 t Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8%: x 11 inches in s¢e. Plan must St. Croix include, but not limited to: vertical-and horizontal reference point (BM), direction and Parcel I.D. percent slope; scale or dimensions, north anaw, and location and stance to nearest road. pending Please print all infon»at~on 1086 Page 1 of 3 Steel Soil Service _ Date Personal information you provide may be used secon~aj~ purposes (Privacy taw ~.15.i)4 1) (m)). ~ ~ 2 ~ 6 r0 2 A J Property Owner Pr rty Location Sienna Corporation Govt. of SE 1 /4 NW 1/4 S 20 T 29 N R 19 W Property Ovmer's Mailing Address a -- .~~ •% ~ ~ ~~ ~ Lot Block # Subd. Name or CSM# 4940 Vilking Dr. Suite 608 , , _, na The Glen ~~ City State Zip C e Ph'oii®~fdumb~r,_ . 4~ City Village Town Nearest Road iFC(,'h~ MN 554 - 808"~ ~ Hudson Carmichael Rd. f!i New Construction Use: ~ Residential /Number of bedrooms 4 Code derived design fbw rate 600 GPD - Replacement Pubtic or commercial -Describe: Parent material Pitted outwaSh Flood plain elevation, if applicable na General comments and recommendations: System elevation92.85ft, trenches spaced and depth to code 3.50ft below grade i ~ ~ ~ 71~/ i -t C~ . Boring # -__; Boring 1 P 96 I it Ground Surface elev. 96.35 ft. in. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tN *Eff#1 *Eff#2 1 0-8 10yr3/2 none sil 2msbk mfr cs 2f .5 .8 2 8-13 10yr4/4 none sicl 2msbk mfr cs 1f .4 .6 3 13-96 7.5yr4/fi none ms osg ml na na .7 12 ~21 -{0 Boring # _ Boring / 9 _ _, Pit Ground Surface elev. 96.35 ft. pepth to limiting factor 6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-10 10yt3/2 none sil 2msbk mfr gw Zf .5 .8 2 10-16 16yr4/4 none siel 2msbk mfr gw 1 f .4 .6 3 16-26 7.5yr4/4 none. is osg. mufr gw na .7 1.2 4 26-55 7.5yr4/4 none cos osg mvfr cs na .7 1.6 5 55-96 7.5yr4/6 none ms osg ml na na .7 12 ~2/ - tmuem ~1 = ~sw ~ ;su < rzu mgfL aria TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 mg/L and TSS <30 mg/L CST Name{P1~sePrint) Signat CST Number David J. Steel ~ 248956 Address Steel Soil Service pate Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 a/3/2002 715-246-5085 Property Owner Sienna Corporation Parcel ID # Pending Page 2 of 3 I 3' I Boring # ' B°nng * Effluent #1 = BOD ~ 3D < 220 mglL and TSS >3D < 15D mg/L * Effluent #2 = BODS a 30 mglL and TSS < 30 mglL 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 Lic. # 248956 SE1/4,NWl/4,S 2o,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot 45 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 l 1" = 40' • = Benchmark E1. 100,OOFt Top of 'h"pvc pipe • =Alt Benchmark E1.9995Ft ~ N Top of 1/z" pvc pipe o =Borings Boring Elevations Bl =96.35Ft B2 =96.35Ft ,~~ ~ B3_°92,75Ft _ B4 =OO.OOFt ~~~ sz f~. F ~, 9~. 7y FF- ~.~~,~s ~~o s~o~ -~~ iqs, ~zs' ~, ~ , ~6~~~ ~~ ~.~ ~ ;o~,~~~~ 1 ~- _ , 'E+~ ~.A:r .I`. ~f• - by' ~ ~ .: ., _ J1 I ~ -'- i i _ i..r ~' A ~ .. ... _ _ - 53 t~ '- - *J ~ b 1..,,,. , ~, ,~ .- t 8 - /,. a t .` f.~- ` 1~ ~ 1 f ~ \ ~. .. ,• / t S] t i ~ 1 as ~ .` ` ~' Qppp! y! t _. a . ' , . ~ ~ 1 ~~ r, l f tom' t • ~1 a ~) 'a~' r 60' ' : ( - .. ~ / ~ j t . ~ ~ ~ ~~' I_.R ~ 1 .~ _ a '` ~_ .. ,,, .. a i' 1 _ 1 `/ a 1[ 1: ti .; 1 r `` ,.. I/ I, 3 ~j _T7 r t ~6` ~- 5;' ~ 9 ~' ... - ,f f . r'~ / .. .tom ~-. _',,` i 1~ 5 a is ~ - ~ - ~\ 7d ~ e i' . _._ „t ! 1 a~ - -_ .345 \ a ,~ _ ;'I 1 t , `, ~ _ a _ , • ._ t , .: _1 , __ f, , ., , . ~, ,a _. -/ . . '~!! i ~ '., .:. Ali'' ~ ~'.~ ~ -` ~ ` `~ ~:J'- `' j ~ 344 -- t. ... 4 \ - ,i !~ . d, . ~ ~~ \ ~ `a ~ + 1 {' ~ / ; / .,1..: y~ / as ~ 1 ,,,f - , - a. .\ 7Z , - 6~ •~ , a }, ~ 1 1 a , ~~ --- a~ 1 ' .. ,. y' t t ~ e / a , \ ~ '. a ~ a' 1 ~~ __ _._ - ,_ __ _T.e~ ______ .~5. ~t ~er1 a '.} _ as i to _L:r- 1 _ ~..~y,f~ _. __-_ _____/__ ,~ 1 a :' 1, .. a !~ - ;!~ ,~ a < - . ~ a a ` ,. 1 ~ at . ~ ~ '. . ` ~ 2g3 •, r '138 ;,..' ~ ,y may' %~-~n.\ ~ . r`9+~ ~r t.. \,` r ~ t - `~~a . . ,~a t . 1 ` , ~ r~ ' ~ - . .. . 1 _, ,:-_ -, Q r ,~~ r f~~ ,., ,. } a~ ;; ~/ I r a ... ~, ~r. - ~,• . ,=. ., ,1~.. L - - - - 1; 4 '~ .. d I f~ \\at ~ ~,i ~ ~ _ ~~ ~ r ~ i ' .p tl .. a'~~I as / , ~ ~is~.,ri :. 4q1 ~ - - f i ir. 1 a'IVI:,t . r ' ~ a '~ ,2~~ ,~' 12~ ~1 , :! ,. ~,~ t ~''~••~ ~ \\\\~ ? F t to ~V' .s c f ';- \ rr / - ':I ' ~ `~,~ I to y I.a • j _^a ~ r a aa~ ~~ !:. r i li, I,, a ,114, :, o a ;' ,~ ,~ 1 , „ .. ~{ I~ :4t 1, t „ 1 t ; ~ , t -a - t _~ , r . . Z'-1 .. f ~ ' r rY Y ~ .. ~ _ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity in-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS} shah include information and procedures for maintaining the system within the parameters of Comm 63 and &~, and the conditions of approval by the department, agent, or govemrnentai unit. The approved plans and permits for system are on file at the county zoning ar health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the in-Ground Soli Absorptjon Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Soeaifications San Permit Number Zo 6 (lo Number of Bedrooms best n Flow -Peak d ~ Estimated Ffow • Ave d 3 Se c Tank Ca aci ai ~ Soil Abso Lion Com anent Size ft } ~~t3 ~z ~ T of Wastewater Dom tic Table 2: Sot! Abso on Gom onant -Limits of Reliable O eratfon Se tic Tank Component Soil Ab tion Con onen Des n Fiow -Peak ~ z ,tire Maximum influent ParBcie Size in 1/8 Maximum BOO 22fl Maximum TSS m i.) 150 Tabis 3: Maintonance Schsdale 8 tic Tank ins ct and/or service once eve 3 ears Outlet Fliter ins act once a ear and clean at least once eve 3 ears Soli Absa Lion Component ins ct once eve 3 ears The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Scats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wls. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, grease interc~ptars, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Partabie Restroorns}. The operating condition of the se~~~~agk and outlet flter shall ba assessed at least once every 3 years by inspection. The tlet f shall be cleaned $a necessary to ensure prapercparatdon. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. if the Management Plan for a Septic Ta^k era Sol: Adsorption Compp~ent f#itsr•is egulpiamd with an alarm, ttte filter ehalf be serviced i! the alarm +e aativstea contirtiuaus~y. intermment tiller >tlaltrms may #ndioats sur~4 iia~uw or an impending continuous alam't. The septio tank shall haw its aontante romovad when the vofunts of scum and siudg+t in the tank excess 'it3 the !#quld volume of the tank, tf the oontants of the tank era not removed at the time of an at:eessment, matirttanance personnel s#taii advise the owner of when the next service needs to be pertom~ed to fiafntaln less than maximum =corn and sludge aceumutatlcn In the tank. Manhole risen, access risen snd covers should be inspected far water tiplttnesa and soundness. Acosa open-ngs a~sed for servtt~ and assssssment shsttt bs sealed wstertlght upon the rorrtpietla~n of attervlGe. Any apasning daematd unsound, dafeotiver or submit to fain must be replaced, , ~xpoeed aoaaa~e openings greater then 8-iarta~hes to diameter shall ba secured by sere effecdive ia~dn,Q dwlce tQ prevent aoaldental or unauthorised entry into the tank. No ore should enaier • ss~ptlc or ofher trwttment or ho1dM~ tank albr any saran wlthoe~at bsin~ iss lull ooreipllNnae wlalh a?!NA artenakrrdrr a!~or enllia~lt~ a aoonlali'~d . that ~~b»oaph~ wtthln ifie anptfa ar atRer tnDaitq~Mt' o:r t~ tarty 1~y a~~R/n h~1 ~teas~ and naae~afae eat a petards t~+orn That b-tttala~ of pia tannk eniy bat dI1I M~uft ~' Impo~tllbJae ,. Tank abandonment ahsil be In aoaardanoa with Comm ~Q3.33, wle. Adm, Cads when th~0 tank is na bngar used as a PQWT3 component, The soli alaaorptlon component senring ~tls struua~tua~e ie designed to eac8pt domeastsc wastewater frem a retldintJai faail;ty. The limit: of apasra#ion of the oomponent are shown #n Table Z. 'the iongsv#ty of a soli absorption oornpanent depends grea#ly on proper and timely maNiintananae, and system war within or beicw the tirnits at rellaiale operation, Goad water cot~aervatlon practices by ail ooca~pants and the instaiiattor~ o~ water conserving plumbing fixtures era key factors In extending the usetui life of his aampoa»ni. The sail at~orptlon ~nponent's operation muait be asseatsed by lnspecbon >ttt least once every threat years, The Inspection shalt include recording the levels of ponding, if any, to the abeervadon RIPw. and a visual lnspsCbon for any evidence of surface seepage or d~acharge from the aoarponlnt. Crt stapty moping eites- areas of erosion ehauid be Identified str+d reported to ttte owner for repair. The suafisos discharge al dorrtestia wsstewatar ar sewage from the ay:tem Es prohibited and considered a human health hazard. Trsf~C arour3d or over the sal! absorption component si:outd be avoided psrticufarly daarirtg winter months, The coanpactlon or removal of snow cover over the cxtmpor~trtt may Issd to hydrauifc failure by Ong, This type of !allure Is usually temporary, but is difficult or impossible t4 reps#r until weather odnditiarrs improve. 1n general, edit compaction over this aamponsnt will reduce diifuston of oxygen into the soil and dispersal aa!, which may lead tc moro intetnsa~, and eaxrlier, organic clagQing of the saN, 3 MeneSement Plan for a Septic Tenk ertd i3oi! Absorption Component Piantin~i o! deep~ated tr+eee and sRrubt directly aver of w{thin ten fs~ of the campanMt should be ivaided Nr~oe root intfwlon into the component may obstruct arastewalter flow. Contingency Plan In the event of system fsllvn, s new syfiwm could be instilled in an illternMe cues. with the lo~s#sil+~tlon pf s diverter valve, the existing system could oleo be reused after a period of thus to ro~ yNrs. I# is dts property ae+rt~e reepanelbiiity to maintain the iitemste uei fire from any plantlnQ of trees, shrubs, eta. !n case of failure of the orfQlrtil system, the aitsrnate wit wl# be needed. ii arty trees, elm, etc. hive bean piartted on tits ilterrrate ales, they wlll hive tabs rsrtitowd at ~ oeRlers ~~ if Ntemate urea is destroyed, there an other aitemiWw a that an be upd, in which, Qould tewlt in sided expense to the property owner. Any tank ai~rndonmeM shill bt done In .ooord~,oe wlsi•- wlsc, code e~.~. Any queetlons ra~atdlnp this c+ade, plece_ere aorttsat your la0al Zoning t~fiCe or canbct the irtetsilinQ plumber. ~Cf th11 N t~ 'a~'7 tCl. ~~ ~ ~ ~,~ $ ~r " L'~ ~i ~ ~ J . canv-.r~, o.1it..,0. ~l v~eY, ~ ~,N~ (~ ~ S~ 3 ~ ~ , 3 ~ ~ ~ SEP-19-2002 1'?~31 SItNNH (.UKh' y~e ts~~ rew~n r.r~c rrr~•~ ,~aru.mdk=r ~lumDiny F~~i~ NO. f1JJBOJIZS Se~+. 17 ~09~ O~r:08F1'I F1 s•r cc~olx courTv SEPTIC 1'AIr`K MAIMENANCE AGREE!viEl\"r AND OWNER.SHIp CERTIFICATION FORM OwnerBuyer ~'~~ N ~~ Cow o~ (~~-~-o ~ Mailing Address Property Address 4°l 4 n y ~ k~ rJ De. ~~a 8 N1.N,~e v~l s mN ss ~~.r (Verification required fr luruirg Dopartmtnt fcr new cotutruction) City/State Parcel Identification Number ~ LEGAL D~~P~~ property Location ~~ '/., ,NCI '/., Sec. ~d . T~N-R~W, Town of ~So_,,.rJ ~ -e ~ ~Cz ,Lot # ~/S Subdivision Certltled Survey Map # Volume _ ~ -.• Page # Warra4ty Deed ~ ~ 6 6 °~ Volume ~~~"~ ,Page # (o t3 Spec lzottse 1~' y~ ~ no Lot lines identi5able,~yes O no SYSTEM CE Imprope:use atsd maintenance of your septic system could result iD ict premanue failure to handle wastes. Proper maintenance coasisti of ptampiag out the septic tank Gvtry ebrse ye:rs or sooner, if needed by a licensed pumper. What you put into the system as atT'ect the tunetioa of the septic rank a, a treatasent stage in the waste disposal system. 'The propery owner agrees to ccbmit to St. Croix Zoning Deputaoeat a ccttifieaaoe form, signed by the owner and by a maser plumber, jouraaytrunplurnber, mstticudplumberor ^ licecsedpttctpet verifying that (1) the on•siu wa,tewaterdisposal system is is proper opeaatiag condition and/or (2'/ after inspection and pumping (if naceseary). tht septic tank u less than l/3 full of sludga• Uwe, the undersigned bout rrad the about requirauztru sad agree to RisintaiA the private sewage dieposat •yetem with the standards set forth. hvcia, ~ set by the Dtputmeat of Cotamarce and the Depatttneat of Natrral R~eaouroW, State of Wisconsin Certification stating that your 'c system hsa bees maintained muss be corapletnd and returned co rho St. (~oix County Zoning Office within 30 day of thej~uee ear espintiotr date. SIONA'IZIRE O ICANT D~`~ O'WI~IER CE~'X`IFICATIOri l (we) certi that afl statements on chic form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of \ t'he pr scri d above, by virtue of a warnnty dead recorded in Register of Deed+ Office. X s ~,.~~ j/~ S.c..~n/r,~. ~~• Jam?/ /J/ Dz~ / SIGAIA'[VRL OF pLICAI~IT DA'tz ~..... ~•••~ Any infnrmalioa thzt is mis~tepreseared may result in Utc saainty permit being revoked by the Zoning Aepartmenc. " IIIC1ude vrltb tLte applioatlon: a samped urotsanty deed from the Register o!' Deeds offcce a copy a# the certified survey map i! reference is made in the ~vaaaary decd TOTAL P. 02 ' STATE BAR OF WISCONSIN FORM ! - 1998 ' WARRANTY DEED 666080 KATHLEEN H. WALSH eocumemNUmoar Yh!.' It~~PAG[613 ST GICRQIXOCODEENI This Deed, made between Bane Corporation RECEIVED FOR RECDRD a Minnesota corporation ,- 12-21-2001 3:10 PM ____ ---~_ YARRAIff)' DEED " and ienna a~n-`- ~ --• Cramor. ~ ~T FEE: _-- - coPr FEE: -- TRANSFER FEE: 9A63.y0 ' -• __ RECORDiN6 FEE: 17,06 - ~. Grantee. PAGES: y Grantor, for a valuable consideration, conveys to Grantee the following ', described real estate in SC. Croix ^ ~ County, State of Wlsconsln ; (the "Property'): ~~ RecoldhtyArea See Attached Exhibit A ~' ~ Name and Return Addrosa S'1(,1~ 5me~ ~'ri~ I~(ivtne fbnka Uu 553`(3 O 20-2048-30-000 Parcet Identiscatiun Number {PotV) This 19 not homestead property (15) {Is not) 20-1048-60-000 20-1048-40-000 20-1049-90-000 20-1050-00-000 20-1050-80-000 20-1052-20-000 20-1052-70-000 Together with all appurtenant rights, title and interests. Crantor warrants that the title to the Properly is good. Indefeasible In fee simple and free and clear of encumbrances except See Attached Exhibit B. Dated this 20th day of Decetaber Bane C rporation (SEAL) by ~ Joh M. Nassef ICs C of Executive Offic (SEAL) 2001 AUTHENTICATION Signature(s) authenticated this day of , TITLES MEMBER STATE BAR OF WISCONSIN (!f not. _ __~_ authorized by §706.06. Wls. $tats.) (SEAL) (SEAL) ACKNOWLEDGMENT Minnesota State ofiyft'stCTrstn- 1 ss. Pers n ll _. CounVy. ~ o a y tame before me this _ Z t day of ' Decetnber 2001 ,the above named John M. Nasseff, Chief Executive Officer of Bane Corporation, a Minnesota corporation to me known to bee persgrf;~_, who executed t}te foreguing Instrument and a na dti~samn rlit$ IN$7RUMENT WAS DRAFTED BV ~ -,; - ~YE.t;fALL,l~tgq Lockridge Grindal Law Firm ~~`` ..t-OO..~el.a.s _ ~ W~•tteaR • -- Minneapolis, MN 55401 Nopry~ubilc.stateorwlsconsin (Signatures may be authenticated or acknowledged. Both are not ~anuatrY 531 is permanent. (<f not, state expiration date: necessary} , 2005 } ___. .. .. ' Nsme+ of pmom ~, nln n sn a cu must M 1 _. _ .. ..:. ~ .. ~..... .. .. -. _.. _.. .. _. 8 6 I Y W~ Y YWd a pringd Oelow tAek slanauue. "~ WARRANTY DEED STATE BAR OF WISCONSIN w~scons,n ttgai Blsnk Cv Inc FORM No. ! - )998 MWAUka. WR. ~~, ` VOi• ~ 79~PA~E 6~ ~ File No: 85-04900 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 Southweat Quarter and in the Southwest Quarter of the Southeast Quarter, a21 in Section 20, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin, more fully described as follows: Commencing at the West Quarter Corner of said Section 20; thence North 89 degrees 25 minutes 02 seconds East, assumed bearing along the East-West Quarter line, a distance of 1319.52 feet to the point of beginning also being the southwest corner of the Southeast Quarter of the Northwest Quarter; thence North 00 degrees 36 minutes 14 seconds West, along the west line of said Southeast Quarter of the Northwest Quarter and Northeast Quarter of the Northwest Quarter, a distance of 1325.15 Eeet to the southerly right-of•way lire 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 Peet; 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; [hence northeasterly a distance of 445.52 feet, along said southerly right-of•way, along a tangential Curve, concave to the southeast, having a central angle of 14 degrees 30 minutes 21 seconds and a radius of 1759.75 feet; thence North 84 degrees 32 minutes 47 seconds East, along said southerly right-of-way, a distance of 7.57 feet to the west line of Certified Survey Map in Volume 12, Page 3302; thence South, along said west line, a distance of 703.32 feet to the south line of said Certified Survey Map in Volume 12, Paqe 3302; thence East, along said south line, a distance of 593.00 feet to the east line of the Southweat 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 19i.71 feet to the north line of Certified Survey Map in Volume 15, Page 4172; thence South 89 degrees 37 minutes 27 seconds West, along the north lines of Certified Survey Map in Volume 15, Page 4172, and Certified Survey Map in Volume 15, Page 4173, a distance of 1113.42 feet to the west line of Certified Survey Map in volume 15, Page 4173; thence South 32 degrees 43 minutes 57 seconds East, along said west line and its southerly extension, a distance of 591.64 feet; thence South 07 degrees 13 minutes 18 seconds East a distance of 323.01 feet; thence South 08 degrees 41 minutes it seconds Easc 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 il, Page 3128; thence North 89 degrees 52 minutes 10 seconds West, along the north lines of Certified Survey Map in Volume 11, Page 3128 and of Certified Survey Map in Volume 12, Paqe 3292, a distance of 682.86 feet to the northwest corner of Certified Survey Map in von. 7 797PAGf 615 volume 12, Paqe 3282; thence North O1 degree 24 minutes 30 seconds East, along the northerly extension of the west line of Certified Survey Map in Volume 12, page 3292, a distance of 5.66 feet to the easterly extension of the north line of parcel recorded in Volume 1390, Paqe 163; then South A9 degrees 30 minutes 27 seconds West, along the easterly extension and the north line of parcel recorded in Volume 1390, Page 163 and the north line of Certified Survey Map in Volume 3, Page 776, a distance of 508.92 feet; thence North 00 degrees 07 minutes 56 seconds East a distance of 1003.47 feet; thence North 89 degrees 54 minutes IS seconds West a distance of 270.16 feet to the west line of Certified Survey Map in Volume 5, Paqe 1317; thence South 00 degrees 27 minutes 53 seconds East, along said wear line, a distance of 193.97 feet; thence South 89 degrees 16 minutes 33 seconds West, a distance of 533.93 feet to the west line of the Northeast Quarter of the Southwest Quarter; thence North 00 degrees 36 minutes 19 seconds West, along said west line, a distance of 820.23 feet to the point of beginning. ~ .. , a •f r ~~~ 1797r~~ti f 16 Exhibit B to Warranty Deed dated December Z0, 2001 by and between Bane Corporation ("Grantor") and Sienna Corporation ("Grantee") _ 1. Building and zoning laws, ordinances, State and Federal regulations; 2. Restrictions relating to the use or improvement of the premises without effective forfeiture provision; 3. Reservation of any minerals or mineral rights to the State of Wisconsin; 4. Utility, drainage and roadway easements which do not interfere with Buyer's proposed development of the property; 5. Encroachment of Qwest Communications, Tnc. fiber optic cable along the northerly property line; 6. Agreement between Bane Corporation and John and Pearl Gies dated August 22, 1997 to exchange properly 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. ~ 1 ~ 1 '" 1 1 1 ~ ~' p ~ 1~ 1 ~ ~ 1a ~ , r 1 1 "00 1 1 ~ N 1 ~ ~ i z ~ 1 cD ~ 1 ~/ 1 ~< ~ _J ~ 50 ~]I N~ • - M <[ 11- 1 ~ U ~ ~! ~ ~ . 1 1 ~ o r. 1n ' ~ 08•Q03~ ~ W~ !'' 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