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HomeMy WebLinkAbout020-1417-30-000I I I Cif p~j N N O w ~ ~ ~ ~ N ~- ~ N ~ O ~ ~ ~ 3 O m U> Z D ~ m c6 D W ~ ~ a c I ~ O L m I I rt o ~ .D ~ c ~ c 3 ~ -' 3 0- ~ ~ m N ~ a of ~ o ~ I ~ ~ O o' ~' ~ ~,p (D C ~ w m a 3 Z fD o ~ y ±i i A N O~ I ~fD•~c~ic~o a ~ o < o. I n m ~ N I o~iCDO~o ~ v~v~~~ o ~ vv~ 0 3. m ~ O N ~ G<i ~ ~ d I ~avCDi>> I vro~~ y'N »~ D~ rn d 3 N ~ .OP ~ ~ 3 ~ d ° ° a .~ ~ yo~o i ~,~_- -n,~~ <..~ ~ m o ~ N I O O i o:. o ~ ~ ~ ~ ~ ~ ~ 3 :: O W (_p O ~ rn A ~ N N N OC i d ~ G a a ~', m o ~ ~ p -+ CD W J C N O A W ~ 000 ~' ~ 0 0 '~ A ~ ~' N ~ ~~ 3 °= ~ .. ~ ~ o ~ ~ ~ o w ~ O N N C C n N ~ a d ~ ~ C CD in a ~ ~ a ~ O :'~ 3 tR Z A c a ~ v o ~ n B ~o ~ ~ *~ o = N O C O O O. O ~ '~ ~ ~ ~ O N ~ ~ O y ~' O ~ °o 'O N O C 3 ;» ~ .. v ~ m N 7 -• -i cn A Z n ~ ~ M A ~ 7 m ~ o Z A ~ t0 l A d h~f R O ~U 0 .~ ~1 0 ~• 0 ~• e q VC ba I w I o° a b Oq N A ~ v ~ `, a ---.T.....~...____~_..._ __ _ t ` ~ ~_ ~ SafCty and Buif~iinas I]ivi:iun C`nnnw ~~~~~~ ~ j 2Gi W. Washya~ton Avg , P O. Sax 7ib~ ' ' ~ ,j ~G}/`~f ~ ~)C ~~ ~ Madison, w I S 3TO7 » T162 De artmentatCommerce (b08)"W66-3161 5snitary Permit Number (ro ba filled in by Co ) ~-~~~--~,~ Sanitary Permit Application !. 5~~ Plea I.D. Number In arxord with Comm 83.ZI, Wis. Adra. Code, porsonai infortttation you provide b d f ~ razy e ttae or secondary purposes Privacy Law, s1S.Q4(1 j(m} Prajoet Address (if differtnt dean maiimg address) I I. Applicatlott inrosauttca _ 34'le~are Prlut ~,u Ittt'armation Protxxty (3vrttar'a Na me -----= 2 ~ l~Y~'-~/ ~i/~- P ' Parcal M Lot M Htock /' ~ roperty Owaor s M ailittS Address Properq Locatiatt -~---~ ~~ City, Sam f ZipCode 'T phone dumber i•:= '~,.~..;.'A,5ection .Cry ii ll r •, j t_ ~A~tif/~ ~,sL~ '. J~S4~~j',3`~ ~ (circle oyt~ II. Typo at 3~tsWlia~ (cheek all that apply) ~1 or 2 8amily T~weltin8 - Ntunber of &,droonts ~ Subdivision Name C5M Number ~- __ ~ ^ 8ub1iclGotrtsttercitl - Aeacribe Ust _ _ ~. T~.~ ~ f .~J Stafa l)wned - Aeacribo L'ae ,~_~~__ _ , .~. ^City~I~ViliaSe~['ownshtp of~..(~ i 31I. ~ of Pu'mitt (Check attly ostt lwlt on Kato A. Comalata late 3~ ii appllcttltle) ~~ A' New S tem /~-, Ye ^ R sptacement System Q TreatmantrHaldln~ 7'artk Raplacem:nt Only ~ G Other Modifuacion to Futittin5 System 8. 0 Permit Rrnawal List Previous Permit Number and Date Issued' Permit Revision ; ~ ChanSe of C Permit Traneftr to New Before Expbation I 'Flambe: Owner a ~. Id. T 'vw Ot 3~OWTS 3Y8 _ i , j tl111! r('!t~aak alt ~ha- ennt..5 -"'~-" s-.. ~ ,f ~-Non -Preaturized !a-0round [~ lywipd > Zq in, of swabk soil ~; Mound c Zak in. of auitahk Soil Q At-Grads Q Siny{!!e Pass Sand Fittor Q Constructed Witeland Q Pretsur'rzod In•G:ound Q idolding Tarilc i~ Peat Filter ^ Aerobic Traaur:ent Unit I Reaireulatina Sand Filter j ^ RscircYla ~ S taltetic Medit Siltor ~exhi Chtmber ~ Orrp Line ~~ Gravat-leas Pi C Ot11er (ex lain} ! Y. D raaUTreattnlertt Ar+w Iipilorsnatlon: c ~ S' lhsign Plow (~ DoaiStt SOii Application Rate(Spdsf} 'Dispersal Area Required (sf) ~ Dis;penal Area Proposed (at) i Syssem Elevation ~~ i VI. Tatsyc l;:tfo Capacity in 'f'atal t Number Manufacturer i Prehb Site Steel ~ Fiber Plastic Gallons Gaifons ~ of Units ; Conc;rere Constructed ~ i Glass or ji Ni1. i;tatpoxuihtlity Sttttetmesx ~ Plutrwar's Nt rlia~(^P~rlttt) I Plumber's Acldee a (Barest, City, i 7d S~ ~ ~' via. ctau~-rte t w Approved O isapprnvad j ~ [} Owner Given 3X. Cdltdltf011i Of Dpt'OVtW~ i i~~o~ItllitY ror u~ Ration of the rs~ a~ tz~e Snature ~tPFLS Number Strntsry Permit Fee {includes Graundw~ater - !ss ed~issuinB ASent SiSttature Surchar5e fisu) M t Por Dellis! B fOC D3C8pp1'tnral .__._ Sl _ I " ~~ ~ ~ ~ CemMY ~Yl R-r tb~ eYstem cn paper riot lace than ~l/7 x Il iaehu to at.. SBD-6x398 (R. Ol/031 S~ ~.~~+-- :~ d ~-~' ,lam ~` y? ~.(~ .~it- -~ ..~~ ~~~r.,~. d ~=' ~~ ~.~'a~c~' S~B~~C r%-ttO ~~ ~~O t^ `.,..fir ~!l /Q9t d Gl/~"9//a /r t Wisamsin Department of Commerce Division of Safety and 8uildinps SOIL EVALUATION REPORT Page _ ~ of in 8txxsrosnoe wrtn t:omm tsa, W 18. Aom. 4ao6 j Gounty ~ ~ r 0 f t Pl i ` _~_ -' i an mus n size. Attach complete sloe plan on paper not bas then 8 112 x 11 irecffe6 include, but not limftsd to. vertfoai end hortzontat rebrenca poMt (BM), direction and percent slope, scale ar dimensions, north arrow, and location antl distance to nearest road. il Parcel I.D. P/ease pr/n! a/l lrtt'drrrtatYort. Reviewed by Date F'rraonel infortnatan yai provide may Ds used rot sttcoadwy purpotvs (Privacy Lew, s. 15.114 {1) (m-}. Perty Pro p~r ~ ~ -- •~~~e~w/a Property Location 5°~ f!4 (~(,11l4 S .~8 T ~~ N R f Q E (ar~ Govt. lot ~ ~ ~ . T „ '~ Property Owner's Mar~ng Address City State Code Lot # Bloch # Subd. Name or CSM# °`'°" "~~""` ~o]Town Nearest Road .~,/Jj~~' ~] New Constr~dion Use: ~ Resid ^ Replacement ^ PubiG Parent matenat _~ t~U ~~ ~ flow rate _~ ~~~_~~ ____.-_-_ GPD ___...._...__.._.^___ _~_.._____~~_ j i Clcable ___~~L ~ _-..--_____ h. i General cortxrtents J and recommendations' -~ l ~~~' ~ ~ s ' ~-~~ t3oring # u ~~ Pit Ground ~ Horizon l)ep>h Dominant Coiar j ir,. M~seil S ~ _ 0~" _ an p // 01-~ ._i to ~ ~~- Soll icabon Rate ~ ice Boundary Roots GPDIfF I ~ n ~ 'Ef~i 'Eff#2 , ~ { I '/ I a..~~~ ~e ~ Bortng ~~ ~:,~~ inn ~~"J (~{ Pit Ground surface elev. L! '~ ~__ R. Depth to Itmrnng raaor _! ~..... M. Horizon Depth DominantCobr RedoxDescription Texture Structure Consistence Boundary Roots in. MunseN Qu. Sz. Cont, Gobr Gr. Sz. Sh, Soil ica6on Raie GPOitt= 'Eft#1 •Eff#2 ~ ___ i _ ,_ ~ ~~ ' Effluent aMt = 90D > 30 <_ 220~mg/l and TSS ?30 :150 m9/L ' Eflluetrt 1~ . 13(~D < 30 Lena i SS ~ :w mgrs.. __~~ CST Name (Piece Print) /~/Signature ~'=" _CST Number Address Data Evaluation Telephone Number 715-7~oy_ JZTc ~ ` ______'~,- ~ OF 3 NAI~'iE: Srsin.~t o r _L(~'['~. _ ~~~i;E4:4L DI; wC~ f PTiON~ ? ~~~I4YSG~~,~;,IZ,~ (o~ ._ y .~...--._...., ~ Il ~jm ~ F.LI;V.ATI4N: U- cJ ____ _._-____ ~ `~' -' . \~--~ I3M 1 DESCRIPTIOi : r a ~ ~,C~,' /~ I3M 2 ELEVATI4N:__~,___,___ ____- _ BM 2 DESCItIPTI(3ivr:,~_ `~'~___. SYSTEM ELI;VA'I'I~7Rr:___µ__~~ ,~.U ..~.____..~._.._ ` ~~~ SYSTEM TYPE: ~ov ~ [1~?Fr~ ~ .._..~_..__ ,;;' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety end Buildir~l 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 Sienna Cor Hudson Townshi CST BM Elev: In . BM Elev:-%. ~......~ ~ BM Description; ~x~r S r t TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 1~~ ~S~.r L ZSV Dosing Aeration Holding "~~~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic SJoi >r,31 21 2~ ~ItX~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufa urer Demand PM Model Numb TDH Lift n Loss System Head TDH Ft Forcemain Length Dia, is . ELEVATION DATA ~.~, ~ r 2 ~.t f ~ ~ STATION BS HI FS ELEV. Benchmark Z. CIS ~cZ.y /ou.oc:~ Alt. BM Bldg. Sewer ~ ~ ~8. i v SUHt Inlet ~ I_9 C1'.~ SUHtOutlet jZ.vS 109. S- 13 c17 .3 Dt Inlet Dt Bottom Header/Man. Dist. Pipe N s G.SS 3 95 Bot. System ~' 7.9 S ?- 3 q ~ -7 - 3 Final Grade St Cover ~',~ ~ ay. 3~ SOIL ABSORPTION SYSTEM (~~'~n'c,~/t/J ~`" o~ --~I~sSG ~~ S a t' '~~ 9CS ~ BEDITRENCH Width Length No. Of Trenches PIT DIMENSION No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ C9 ~i V C•' SETBACK SYSTEM TO PIL LDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ~~'~- Y Ty Of System: ~~^^ 1 UNIT Model Numb DISTRIBUTION SYSTEM \. v Header/Manifold Distribution x Hole Size x Hole Spacing .. Length Dia ~"t Pipe(s) Length Dia pacm "~ ~ h V i 94 gs ~. 95 4R 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 Bed/Trench Center ,`. t ' L{ Bed/Trench Edges ~ „"' ~ Topsoil "~i `~ ~ No ~~~ Yes T~ No COMMENTS: (Include code discrepencies, persons present, etc.} (~ Inspection #1: ~ /Z~-~ Inspection #2: / / ~A- ~t v . ~ : v"v.- ~ cr-S lo.a~a,v`_ SS ~--sA~ ~ ~p'~S ~.,- Location: 428 Wren Lane Hudson WI 54016 (SE 1T4 NW 1r%4 20 T29N R19W) The Glenlot 47~~ r~~ el No: 20.29.19.2641 1.) Aft BM Description = ~ T- O v ~~ ~ I v 2.) Bldg sewer length = 3'Z /~~'~"'Z©~ ~con~ r„''~'25'f ~' ~/Q' ~~Y P~ - amount of cover = .r. ~ ~ ~~ l~r~' ~~ } ~O ¢ ~1 .9 ~ ~ ~ ~o ~ __ t /~ -- Plan revision Required ~ No _ ~--~Z%y~ ------------ Use other side for addit al i rmati y 3 ! ~ I ~ ' F/- _-~ i __ _ _ _-_ _ _-- -- Date Insepctor's Signature ~ 1~~~ Cert. No. SBD-6710 (R,3/97) c°"nt''~ St. Croix Sanitary Permit No: 430516 0 State Plan ID No: Parcet Tax No: 020-1417-30-000 Section/Town/Range/Map No: 20.29.19.2641 ', .ti PAir Intake r ~~ `' t I ~ 1 Safety and Buildings Diviy;on v , ~- I 201 W. Washington Ave., P.O. Sox ?1 , ' Y ~~County „S~G' Q ~ r ~~O~g ~n + Madison, WI 53707 - 7162 ~ Hilary Permit Number (w be filled in by Ce.) de artment of Commerce 08)266.3151 pA ~-~®~-~,~ Sanitary Permit Application ~~ Plan I.D. Number In accord with Comm 83.21, Wis. Adra. Code, p clot information you provide ~ may ba used for secondary purposes Priv cy L ~~~ ° °-l Pmjeet Address (if different than mailing address) . i. Application Iatorrnation - Pleare Print All Information ` ' ~2 ~ G~Y ~,~ ~-N ~ Properly Owtur's Na me Parcel N Lot N Htock N / .t/~ ~- S LE G©~~ ~~, i~Vi~'.+.,~JU Properly Owner's M ailing Address _T - ~_ ~ ~_~~ 3 property Location i ty ~ ~ ul ` Ci State ~=Section ~=-- ~~ Zip Coda Phone Number ~~~,q/~ ~~ ~'S 4~3,~ ~.~'J`' =a?~G~ ? ~ (C ~ II. Type of SupdisiR (check all that aRP1Y) ` ~ T o N: R % q B or ~ ,c ~.1 or 2 Family Uwellittg - Number of Hedroat~s a`" w ~ Subdivision Namt CSM Number ^ Public/CommerciU -Describe Use v ~~ /~,C- ~.~„r/ ^ State Owned -Describe L'se D ^City'L,.Villxge~.`I'ownehip of ~-~~.,1~ i III. Type of Permltt (Gheck oatly one box on lice A. Complete line H if applicable) A' p, New System ^ Replacement System ^ TreatmentlHoidittg Tank Replacement Only ~ ^ Other Modification to Existing Sysum ]!l, ~ Permit Renewal Permit Revision Lisr Previous Permit Number and Date Issued ^ Change of G Permit Transfer to New } Sefore Expiration Plumber Owner i f IV. Type of POWTS 3yatemt (Check ttli that ap ply) I ~Noa -proaauriud ta-Ground ~1 Mound ~ 24 in. of suitable soi! ^ Mound < 2~ in. of suitable soil 11. At-Grade ^ Single Pass Sand Filter f Q Coaetzucted Wetland Q pressurized [n-Ground Q Kolding Tanis ^ Ftat Fiite ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ ReGlrcuL- ' Synti-etic Madly Filteraching Chamber is'~Hrip-t~t;ravFl-less ^ Otht (ex lain) V. D rsaUTreatment Area Information: Y `c G{ S , Design Ftow (gpd) Design soi! Apptlcation Rate(gpdsf) ~1 Area t?eoytirtd Dispersal Arta Pro ed ( ~ v ystem scion -d I d'~ ~ 1 7 ~7 ~,s ~ ~ ~G ,•$ VI. Tank Info Capacity in ll G Total G l Number Manufacturer f U i ' re b Site Steel Fiber Gl Plastic a otta al ons o n ts Concre Constructed ass New ExistittY i i Tanks Teaks Septic or ilotdinQ Tank ~ Aerobic Treatment Unit Tlosine Chamber VII. Respor,albility Stateraeat- I, th! iaDO ed, aasurue r~onsWilit for L ilatlon of the POWTS slwwn oa the attached rte. ~ Plumber's Na me (Print) Plumber's 5i gnature tPI2S Number Business Phone Number ~ %'a~ .~-~-=- ~~r7 ~ Qom' ~~L'~~~~~G ~ l2P Plumber's Addre sa (Street, Gity, State, Zip Code) VI , Cotmt !De ariment Use Onl t ApprovQd ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcluuge Feu) y~ ~ Aare Issued h ing Ag t S re (Na Stamps) ^ Owr>cr Given Reason for Denial ~ `tf' U IX. Conditions at Approval/Reasons for Disapproval , / 2 3 d ~ ~/~-- S `~~ ~ ~ (/I~- ~S_~ '4 ~'/~- Gam! ~-r` /~~ "` `~ v' Q %~~i ~ [r C/J A b em., nl... n1... n...ti., r.. _,.., s- • - ~-- •-- '-- -- ~ '...~. --....~ -~........ .... 1"=1"'• rv. ww r.w va,• n as wcuy ul i7Y0 v ~~ / // _. SBD-6398 (R. O1/031 Y/••JIC_~ .S'ie,vc~ G ©~ ,~G ~~-~~! `~-- Y p ~~ ~~s r„~,'~l h9~ d Wisconsin pepa-tment of Commerce SOIL EVALUATION/R~PORT Page _ ~ of _`-?__ n:..:~:..., .,t Cofoty antt R~rtktinas / ,,,.,,, ..... ............ _.._ __.._...a_ in accordance with Comm 85, Wis. Adm. L ~ 1 ~nty I ~ ~ r~/ Attach complete site plan on paper not leas than 9 1/2 x 11 inches in size. Plan must but not limited to: vertical and horizorrtal reference point (BM), direction and indude Parcel LD. , and locatlon and distance to nearest road. north arrow nsions di l , , me e or percent slope, sca t D Please prfnf all InfbrrtraNon. a e viewed by ! ~~~~ Z7 ~ Personal information yov provide may bs used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). l~ Property O ~ r ~ ~ /~~rv/~-- Property Location ~,(~ Go t „~~ 114~(,L1U4 S ,2B T i~~ N R /Q E (°r~`"' Property Owners Mailing Address Bock # Subd. Name or CSM# City State ~ Code Ypt~ Number ^ ^ Village {~ Town Nearest Raad y~j&'' ~ New Construction Use: ~ Residential 1 Number of bedrooms ~y _ Code derived design flow rate _-/_~.'<~-GCJ _-_ GPD ^ Replacement ~ ~ ~^ P~ub~ic or commercial -Describe: _ _-- ----- -- [~- ft. Parentmaterial _-1~~3;~' ~t~=.~ ~^ -------- Fbod lain elevation it applicable --- -L ~ -- , General comments s. s 5 ! _ ~ v ~ C~ ~ ~ ` aZ" Z/( and recommendation y t'~-f^^ f ~' ~ X' ~ *~ C~ ~ a ~~ ~ ~h' . ~ r ,r ~ e~ L Boring # ~ Bonng r C ~ ft. Depth to limiting factor _~~- in. Pit Ground surface elev. ~~_ Sod licatirxr Rate Horizon D~ih Domintmt Color Redox Descriptiar Texture Structure Consistence Boundary Roots GPDr'f[~ 'Eff#1 'Eff#2 in. Munseh t1u. Sz. Cont. Cobr Gr. Sz. Sh. 7 I.2 -- -- ~ _~ j ~ ..-.- S D , ~,(/n~ Boring # pUp~~ Bonng \ /~ Z tpi Pit Ground surface elev. ~ ~ ~~' _ ft. Depth b limiting factor ~ _ y in. 5oa ~twn Rate Horizon Depth. Dominant Color Redox Descriptbn Texture Strotxure Consistence Boundary Roots GPDlfiz in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 1 l~IZO Ip `~ ~ S O~ m I --- - . ~ I . - , ' Effluent 1f1 = BOD > :i0 <2LO rng/~ aria f.~.`~'Or7 ~ ~av r~yra. ..•••••~••• ••~ --- . - ---~ - - - - - ,CST Name (P Print) Signature CSST Nurrtber ~~ aluation Conducted Telephone Number Address Property Owner _U I~ I `! ~ Vn Perrel ID # Page _ ~ of _~ ~1 ~ Boring ~p y ~ ~ ~ ILL-~ ii Boring #, Ground surface elev. ZI ' =-- ft• DeP~ to 9 ~~Df -~-- in. Sod ication Rate Pit Horizon Depth Dominant Color Redox Description Texture Structure Cons~tence Boundary Roots fE~GPDIfFEft#2 in. Munsefl Qu. Sz. Cunt Cobr Gr. Sz. Sh. 1 ~--~20 ~0 - S d ~ m ~ - . ~? r . 2. Baring # U Boring --- ^ Pit Ground,surface elev. ft. Depth to limiting factor __ rn• Sod A ication Rate b Texture Structure Consistence Boundary Roots GPD/ft~ HOrTZOn Depth in. Dominant Cobr Mansell n Redox Descrpt Qu. Sz. Copt Cobr Gr. Sz. Sh. 'Etfi#1 'Et1#2 [] Boring D Boring # Ground surface elev. ---.__~__ ft• Depth to timfing factor __,.__ in. ^ Pit Sod ication Rate Horizon Depth in. Dominant Cobr Mansell Redox Description Qu. Sz. Cori Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/lt2 'Eft#t 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg1L and TSS >30 <_ 150 mglL "Effluent #2 =GODS < 30 mglL and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access serv-ces or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-X130 fR.07l001 P GE OF 3 NAME: ~h hSOr _,L T# L AL DESCRIPTION- L'4 I/4,S T,,N,R,~ (or)W SCALE: P'= ~U ,_.~ .,_ , ~m ~ ELEVATION: lO O • ~ BM 1 DESCRIPTION: ~l,.n , f ~ ~ d ~Yovr ~` ~~ BM 2 ELEVATION: BM 2 DESCRIPTION: "== T: s: SYSTEM ELEVATION: Qt , S~ ~, r.~, SYSTEM TYPE: ~oy1u-e d'~~'b ~~*- ( ~~ ~~ ~~. Safety and Buildin s Divisio County O1 W. Was of >~t(7~162 7~G'YQ %r ~ isconsin Madis n, W ~jj 6 Sanitary Permit Number (to be filled in by Co.) ~ 1D $)266-3151 ,r~~~~((o j Department of Commerce ~ start. Plan LD. Number Sanitary Permit Applie flea In accord with Comm 83.21, Wis. Adm. Code, personal inf marl crg{~pt~kCeOUNI Y ;. ` ma be d f d E ! y use or secon ary purposes Privacy Law, 5- J4(~jJING OFFIC Project Address {if different than mailing ress) I. Application Information -Please Priut All Information 2 $' WP_bv ~?E i Property Owner's Na me arcel !/ Lot!( Block Il Property Owner's M ailing Address Property Location 4' G~` ~ ~~ ~ , ~~ ~ ~?l.~ k, i4,Section City, State Zip Code Phone Number 1 ~~ l~~/J,2 ~.~ -~~~1..9~~ ~3S-°" ~ ~ t~ T N R ~ (~cle o - ; ~ II. Type of Building (check all at apply) ~ ~ S .w~ -t-L-- ~,/ Su wis%on Name CSM Number ilst`1 or 2 Family Dwelling -~ Number o edrooms f ^ Public/Commercial -Describe Use ____- ^~ ~L e rC ~j~ ^ K 2 State Owned -Describe Ilse ~ __ CQJC~L ^City_^Vi#Iage,~iTownship of ,/,r.~~~~t/ _ III. Type of Permit: (Check only one box line A. Complete line B if applicable) O ~ ~ ~~. _ 3®_ pip . 2io~ A. New System '' ^ Replacement 5yste C1 TreatmenUHalding Tank Replacement lily - ^ Otlt Modification to Existing System B • ^ Permit Renewal ~ ? Be+ore Expiration ^ Permit Revision + _~ Change of ~I ^ Permit Tra er to New P her ;Owner L ~ 1 List ev 't rt>~f Da is ed ~ J )V. Type of POWTS System: (Check ail that a _ __ 1) - C!a _ ,~ Non -Pressurized In-Ground ^ Mcwnd > 24 in. of suitable s ' ^ Mound 4 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter { ^ Construc[ed Wetland ^ Pressurized Tn-Ground ^ Holding Ta '~, Pea 'filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter l~ R i l i S i ec rcu at ng ytuhet c Media Filter Leaching Chamber J Dr Line ^ Gravel-less Pipe ^ Other (explain) ? V. Dispersal/Treatment Area Information: _ ~ _ ez~s Design Flow {gpd) Design Soil Application Rate(gpdsf) Dispersal Area equired (st) ~ Dispersal Area Proposed (sf) Syst Elevation 1 ~lv (Jr~ m ~ ~' "= i VL Tank Info Capacity in Total Number Mx t'acturer Prefab Site Steel r Plash ~ Gallons Gallons of units Concrete Constru Glass New Existing _ ~ ~ r Septic or Holding Tank Tanks Tanks ~~~~ ! f,~t`~s'e r ` aerobic Treatment Uni[ I - ~ I Dosing Chamber ~o •,' ~ - - ? VII. Responsibility Statement- I, the undersigned, as me rrsponsibility for ' Nation oft P0~1'TS shown ou the attached plans. ' I Plumber s Na me (Print) P~lu/tuber's Si gn re )\9P/ PRS Number ?Business Phone Number Plumber's Addre ss {Street, City, State, Z ip Code) ~~` Q VIII. Count /De artment Use Only Sanitary Permit Fee f includes Groundw Approved ^ Di D sapproved ater ate Iss d lss in gent Signature { Stamps) Surcharge Foe) Z ~ ~ ~ ^ Owner Given Reason r Denial ~'"' _ i IX. Contlitions of Approval/Reaso for Disapproval ' ~, .~ ~ ~, SYSTEM OWNER: ~ ~ ~~~'a „ ~a ~~ ~~ a~~. 1 Septic tank, effluent ~Iter and Q~"""`' ice- dispersal cell must all be serviced /maintained ~ lt~ ~ ~ ~~,N,` as per management plan provided by plumber. ram„ o„ ~~~ ~.~ f 2. All setback requirements must be maintained ,""` I as ner anolicable cnde/ordinances. ~ Attach complete plans {to the Cowtty only) for the system on paper not less than 8212 x 22 inches #n size SBD-6398 (R. 01/03) ~ ,. ~j~ ~ ~~vG %1~, a.~ ~- `!/ ~~~, ~~b ~~ ~ d y b~~ ~~~ tia ~y~ ; ~ 1 ~ o~~ ~ ~ 1~, ~ ~ ~ u ~ ~ Q .~1 J ,~,~,~, C~-~ ~' ~~~ 3+x8 ' ~~~' `.~' s ~~~ ~ ~~ gym( r'~ ~- -.-_ ~ wiz-car L ~C- ~ ~.~/~~~- ~ O,(1 ,~ O ~ ~? ~/e ~ .~`/.~ ~~ ~~/,y ~~ plc ~~~°~-~ ~ ,_ y . Scv~~ / ~ d ~1~ ,z- ~~OG j~~, Q~ j -- `!/ ~ U~~66 L~ ~ t ~ y e" 1c~6 ~a ~~~ ,~ 1 ~' /~ o0 f7~'~`S-~ ~Y t ~. ;~ :~ i ~~ q,~,., (~-`~.~' C2~ 3' x g - S~'~. C..~, .s ~~~ ~A ~~ ~m~ zn~ ~ ~ ~~~ ~ mac- - ~ .~ Wisconsin Department ofCommerce SOIL EVALUATION REPORT Division of Safety and Buildings m aecexdancewith Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8'/: x 11 inches in srze- Plan must include, but not limited to: vertical-and horizontal refen:nce point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest. road. Parcel I.D. Pleas- print all informatho-r. 1 Personal information you provide may be used for ; s ~ .Property Owner ~ a-_ °`~ ~ ropertyL ion 1148 Page 1 ~ 3 Steel Soil Service St. Croce Date 7 /~/O Sienna Corporation Govt. Lot ~ SE 1/4 NW 1/4 S 20 T 29 N R 19 W Property Owner's Mailing-Address c:. ~ ;~ ~ ~ Bock # Subd. Name ~ CSM# 4j :_ 1 fr 3 q}d1 4940 Viking Dr, Suite 608 47 na The Glen City ~d ba State Zip Code P one ~~'r ` ~ ~!~ City Vtllage Town Nearest Road AIfN 55435 ~-~` .~•.--°' Hudson Carmichael Rd. yIi p,~yy Construction Use: V' Residential. /Number of bedrooms 4 Code derived design flow rate 600 GPD ', ReplaGernent Public or canmercial -Describe: Parent material Petted ouiwash Flood plain elevation,rf applicab na General comments and recommendations: System elevation 95.12ft, trenches spaced and depth to code 4.58ft below grade (~q p ~ a (- L °~ Z.Sj Off. B( BZ -G~+ ~-5 '~a r B3 vLr Fj~ m. l Q Boring # Boring /` 96 Pit Ground Surface elev. 99.70 ft. pepth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots. GPDHtZ *Efi#1 *Eff#2 1 0-11 10yr3/4 none sl 1 csbk mutt cs 2f .4 .6 s_.- 2 t1-24 7.5yr4/4 none cos osg mv€r cs ~- na .7 1.2 3 24-96 7.5yr4/6 none ms osg ml na na ~ 12 ~ ~~ 30~~ ~( ` ~ ~, f~g~,c~.~ ~.~. -~>, Sys.>~- -~~-- ~~/p iii ~-~tu.?~-- i~j 1 t;{ I~ 'L Boring # _ Boring ~ PiE Ground Surface elev. 99.70 ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cons~tence Boundary Roots GPD/tt= *Eff#1 *Eff#2 1 0-12 10yr4/4 none sl 1 csbk mutt cs 2f .4 .6 2 _._--.' 12-96 7.5yr4/6 ~~ ms osg mf na na ~ 1.2 'Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 1.50 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <~0 mg/L CST Name (Please Print} Signai~, re: CST Number David J. Steel ~ 248956 Address Steel Soil S DateEvaktation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/20/2002 715-246-5085 ' Property owner Sienna Corporation Parcel ID # Pending Page 2 ~ 3 Boring # ; Boring ' ~ ~ ~ De th to limiting factor 96 i / Pit • - Ground Surface elem. p n. Sod gpplrcztion Rate Horizon Depth Dominant Color Redox Description Texture Stnrcttxe Consistence Boundary Roots GPDlft= •Eff#1 'Eff#2 1 0-22 10yr3/4 none sf Zmsbk mfr gw 1c .5 .9 2 22-43 / 10yr4/4 none scUsl Zmsbk mfr cs 2f .4 .6 - 3 ~ 43-96 7.5yr4/6 n~ ~ osg ml na na ~ .7 1.2 ~,~». 1'.Qlitru~'{2~tsv~- -~'o t.~%~ ~``7 -"PJ SiZ2. Sy.S-~/h'-- ~~.°I;~j~16~, Borinsr # Bwmg Effluent #1 = BOD ~ 3f7 < 2217 mgt and TSS >~ < 150 mg/L 'Effluent #2 = BADS a 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 # Bwmg 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 SEi/4,NW1/4,S 2o,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot # 47 This soil evaluation was conducted- to satisfy a zoning requirement, it ma~1' 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 Mme the st-i1 test was conducted.- Legend 1" = 40' • =Benchmark El. 100.00Ft Top of '/z" pvc pipe • =Alt Benchmark El.100.O5Ft Top of'h" pvc pipe o =Borings Boring Elevations Bl =99.70Ft B2 =99.70Ft B3 =9`~.40Ft B4 =OO.OOFt L /00,05 F L f~ mfr '~ ~ ~ ~F~ q~.4b~r .~ , ~~ , 0~ ~~~m\ ~ ~ ~~ 1.~ `S6 ~. o ff ~~'~ ,~~. n~ ~~-%~~ 9-~-0z 0 ~.- i '. 1- I I 1 i -- _ 1 ~~ ._ ,, . 1 1 ~~ - 1 - ~ _ :; ~. ... ::.... . i ~ - ry RT' • 1~ -- Cc - -~c t p7• ~ •. ' r: _ _ .. - JAN" ,! ~.1}~.~r,, a •r _-- / •//i ../'~f/ r• a r IJii • 'r r/ ~ _~ ~.,:.;~a~; ~ ~ t 1 I~ -_ -jam' ~~r _ \i~•' 1 f~ ~ -~ a``4T `il ~e ..^ ttl 1 _ •/Y7~ ~_ mat;- r~r _.• ~Ij. /\ r 1 1 ~ ' ~~.. 4 _.. ._. e ..-~. ' r . \ . . ~" ~• .. . " ~ '• .t r ry. her • r . ~ I 1 .. ^ .~.. . " 1 Q: ~ a '. ;i. ice, ~ a :,2 -.- ~ ,: , 1 ' 1 - :'ta'i ~. ~ ' l _ i r ~'•_~ ~ ',T'1 l l~ ,/ ~ 'P' ~F. 1 _ :•,\.t.'.~:: ~ i r~'-,' /''~~ j 'fie ~~ 1~ -. •. .t ~' ~/% .\ '~ ~: a ` ~~' ~ 1 i. i1. - ,~, _ ~ a ,.~ ~ R,.i . ; ~ 67-x.. _ I~ . 1 _ i .t- ~ _ t 3 1 - l 1` ~\ a ~ .`~. w,, / .riiy t -~ ~`~. as t •~~ _ _ Ord _ ~ , .` \ ia` a `/- ~ { ~ `a' a ~ ~~.~ ~. - 1 It ~ . ~~_ _. Py,; a`._ `tea _ a - :~. •• \ i.• / ~ a _ 1 '. _ 1. _ zoa.. _ ,...39'~.- _ .: -' 6== I ~ ~ •'t a~~;. 1 ._ _ -- _ _ r z _ . '_ - - -_- .. '-- - ate----f---- - 'T yam' +' "v _ t i ._ _ - - 1 /• ~ " 1:: . 1 it o. _ /:: 1 . I , ~ / ~ ~ tt. ~ a\ _i '. -ps 1 ; ,.~--. -c_.'-r.•,\• -if I - r !~`` t 1 i 1 - - \ as ~aaa a t- ~^ 1 ,Il: ra:•.~ ~ ~• .. t 1~ .~ ~.-- 1 i 1"'i t .i ~ .. f t'~. -l / - ___~ ~ 1 i \ ji'• ~ I fl.-f ;~ 1It s ',: _'Ir 1.~ I ,~1 t ~~, 1 ,,. ~-- ' i' ~ ~ t ',:'.. .i I ~ ~ ,, a •,, a a~ 1 t: b r Page 3 of 3 STEEL'S SOIL SERVICE David 3. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 SEl/4,NWil4,S 2o,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot # 47 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. 10(}.OOFt Top of t/z" pvC pipe • =Alt Benchmark El.100.O5Ft Top of %2" pvc pipe ~S d ~~ .yd~o~ V 1 P~~-¢,c,~,i-v~~ y tw.1 r U °+.r..r ~ ~ i+w ~...~. ~~, ~1 Ci G . Vr1 ~ ~ ~. :l i5. M i i. ~ ~ ^ ~ r; ' ~ ^ ~ 7 r r ~ e "~ '+ N I.. ~ ~r~.+, ...'.nrs 4" CI VENT TYPE 12" -MIN. ABOVc G:~ADE E 2:' t b.,.. FROM" DDJR ~ WyNJQW OR FRESH AIR INTAKE __ FyNISHE~ rgRADE .~. ?8" ~lN. ~„ r aPPR0YE0 'iP~ 3' 3~P!'O 5,7L T~? iQ:i~ A;ER TIGHT SEALS PUMP vFF ELEV . ....~...FT . Sw:'TIC r D0~`E fiAtiK MANUFA~TJRER I'itVX. SIZES: SEF':'IC DOSE ~r 8 '.~"' C "~„~ 3} i~ERI'HSRPROt~F JUNCTION LuX WITH CQNDUIT A P PR 0'•1 ED ~+.NHOLE CG'S Eta W / PAD LOC ~ ~ WARNIMG~.ABE~, ...... u" NS;:.N, ~: `.1,, t , ,, r GA5- ~ ~ ~' TIGHT ~ ~, SEAL ~~AS:M ' i0N ~ +~ ~ OFi' 2" A?FRu~'£D $£DD~NG U;1DER TANK ~/r ~ t a. ,.~,S'd ,,.,,, GAL , ov GAS. . ~L.aFc'~ MANUI'ACTURER: • ~~ MODEL NUM $ ER : ~.~--~..~.,.M. SWITCF~ TYPE: ~._t~7+er~ _~ MANtJf ACTURER ; MOD£;, NUMBER SWITCH TYPE Eau iREA Di SCHARGE RAT ' GP:~ ~r JOINTS WITt# APP~VEa P IAL 3' ;O~ttO SOLID: SOi~ '~~ RI`SER E~:T PERMr T TEl? ONLY .rF TA?v'i~ MAt~UFACTiJRER HAS APFROVA; 4o{~'M~M~iTE ~f'ii.~ lv'L'?!BER DpS£S 'ER DAY : - «OSL' V C:.~JME YNC;~~3n?'NG FLOf+vBACx: r GAI,. CApAC :I ES: A : ~` i:vCF?E5 ~ ..M..~_.....aAL. ~ ~ ._.~.2 , 11iC HE S r ~~ ~A i., . G = ..,,~.,,, INCHES : z `~ l_....GA ~, . p r..~ i'ti'~HES . ~ ,,, j,,,_GA ~ . P'~MP E ALARM k'SRSNG aS : ER ILHr`t I~.23' wAC ERTICAi. DIFFERE~SCE BE_ ~. MINIMUM NETWORX SUPPLY PRES$UREOr ~ AND WZSTpIBUTION F2PE ~.~ rEET .~„~,~... FEET FORCEMASN X ~ CO FT13~0 QF~, . ~ F££T i'R• v TION FACTOR / _~ FEET xo~.aL aYNAM:c HEAD F ~Mfi .~T£kNAL b2MEi1'SIQ1~S 0~' F~;Mp ':AIr'k: LEh'GiH ~.~~.,;« '".~'.~ ~ WIDTH ~ ~ D.T. ,4^'ER .M--. rGhED, ~/ ~° ? iCENSf NMSEP.: ', ~ 8 £t ... , __ . ~~-- P81NTS OWNER'S MANUAL & MANAGEMENT PLAN Page cr .~-~° Permit F ~~ S/ Li~$fQN PARAME?ERS Number of Bedroams ~{ d NA Number of Public Facility Unite Eatimatsd flow {average} geslgn flow tpeakf, tEstimated x 1.5} Soil Appliaation Rats 5tandanf Influent/Effiuent Quality ~~ elide ~~ ~ al/da al/da lftt Monthly average' Fats, Oil if Qrease (FOQ} 530 mgit. BiachemicN Oxygen Demand {gpp$) 5210 mg/t. DNA Total Suopanded Solids iTSSi 5160 rttig/L Pretreated Effluent Quality Monthly average Biochemioat Oxygen Oemand t130Dsf 530 mg/L Total Suaponded Sobs (TSSf S30 mg/L ^ NA Fecel Coliform (geometric mean) 510° cfu11 tJOml Maximum Effluent Partials 8izs Kin die. p NfA Other: ^ NA "Vatuea typlaal far darrls8tic wastewater and septic tank effluent. Sy TEM SPECfFlCATIONfi Septic Tank Cepaoity X7 ~ al p Np Septic tank Manufacturer p Nq ~ Effluent Filter Manufacturer ~ p Nq ~ ~ Effluent Faker Mode! dQ' d NA Pump Tank Capacity al DNA Pump 7aMc Manufsoturer , r ,s L7 NA L r ~ Pump Manufacturer ~,R,~ / DNA Pump Model O NA Pretreatment Unit Q NA ^ 3and/Gravel Filter D peat Filter D Mechankal Aeration ^ Wetland O Dislnfsotlon D Other Dispersal CeUlaf ~ Nq O !n-Ground (gravltyi L7 En-Ground (pressurized) O At-Grade O Maund D Drip-Line l7 Other: 0~' O NA Other: Q NA Other: ^ NA f1AlOfN E SCHEDULE Service Event f5ervioe Prequenay inspect condk"wn of tar-k(a} At least once every: 3 ale {iMaxlnwm S years) ^ NA Pump out contents of tanktst When combined sludge and scum equals orw-third tYsf of tank volume ~ NA Inspeat dispersal ce1Ha} At least onoe every: 3 ~~tsf (Maximum 3 yearal O NA Clean effluent filter At least anae every: ~~ e} DNA Inspect Pump. pump contrais & alarm At least once every: ,r-. montlf{sl D car(e) ©NA flush latsrab and pressure test At least once every: -- ~~{s) d tsl 17 NA Other: At least once every: O monthisf .~- ~ eer(si 0 NA Other: a NA fuaNT~lANas ~fsTRUCTIONs Inepeationa of tanks and dispersal cells shalt be made by an indivKiual carrying one of tho following licences or oertificatlons: Master Plumber; Nester Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servioing Operator. Tank inapectiona must include a visual inspection of the tank(s) to identify any mise'cnq or broken hardware, identify any cracks or leaks, rneasun the volume of cornbinod sludge and scum and to aheck for any back up or ponding of effluent on the ground surface. The diapsrsal c~lf(s} shall be visually inspected to check the effluent levels in the observation pipes end to check for any ponding of affluent an the ground surface. The ponding cf effluent on the ground aurfaco may indioate a faiitng condition and requires the immediate notification of the local regulatory authority. When the aombinad accumulation of sludge and scum in any tank equals ono-third lY„} or more of the tank volume, the entire contsnta of the tank shell bs removed by a Septage Servicing Operator and disposed of in accordance with chapter NR f t 3, Wisaonain Adminbtrative Cods. All other services, including but not !'united to the servicing of effluent f(iten, mechanical or pressurized Components, pretreatment units, and any servicing at Mtervals of 51 Z menthe, shall be performed by a certified POWTS Maintainer. A service report shalt bs pravidod to the local regulatory authority within 10 days of compteifon of any sorviae event •apaa snllonalulwP~-~unQugoo~slM 'E!:) 9 (Z) 'Sthq'£$ P~ it)StP'!f l)t4-IZILL'£8 wwo~ ~e~asyo yunn aaus~huoa w pskap s¢M 3us~un.~oP s!yl ""J i1' ~~, -.S suoyd euot~ lY /nrer~ ~ ~ t~1-l'~J X/C>~ . ~stV - _ owsN AilaOHlf1V 1l~JOtM1f103a reoo~ fa~awndl ao1 aado oNl~fn~s 3f~ld3s euoyd awsN ~~JNR/INfVW S1MGd rl~' °. ~c -.. ~ c a„aya f~3'17V1SNf 81MOd 81N3WWOQ 'iVNO111aGV '9'161SSOdWf !i0 11f1Qldsf)Q 39 AVW XNVl d d0 fi01>:I~JlAfi 3Hl WOfdd NOS~13d {f d0 3EiQ59>~ '1"1f188>i AtlW f#1V30 '$3QNti11SWf1QlIIO Af+111 a3ONff SN~II tM3WiV3~.-1l3H10 fi0 dWf1d 'QIld33 d lH1.N3 30N t3t1 'N3DAK0 9.N3fQfddStSNI IlO/ONt/ 93SSV0 ldHl~'1 NIYINOQ AdW S?INVI 1N3W1V3~11 li3N10 dNtl dWfld '~Ild3S e e ON1N>eIVM> > •awli iayi is iaa}}a ug saln~ .y3 lpgm rigdwoo isnw ewe;sRs vans }o suogi~nnsuoaoa •aae}~ns engeaifl-ug ayi ;e iswolq ayi }o genowe~ 8uimollat easgd ug poionlisuoaoa eq rctsw swais~(s uolidaasgs glas apeaf3-ie pus punogly p -s ~Ius; a ells P t O ~~ 'S1MOd polls} syl sasldo~ ai isase~ lssl a ss Pollsisw oq rtaw ~gus;l Bulpgoy tt rtBalouyaol S1M(3d ut seauenps Bul~leg •suogvsigwq llos x~~pue ~losgles of anP slgsllene lou rl ears iuswoaside~ slge;uns d g] •ewgi isyi ;e iaeNe u! selna ¢yi y;gm ,tgdwoa lsnw swais~cs iuewaaafdaa •eo~a 3uewsaefda3 a{gelgns s ysllgeisa o; ualenisno a;ls pus llos nnau a ~o} peau oyi u{ ignsol II!nn seas iuew¢aeidos oyi laslo~d of anllod 'alism pus ssury ioI 's~nion~is posodad pus Bwislxo wad s~losgles ps~lnbe~ ~cq uadn peeuu}u~ eq lou p{nays pue ua3aadwoa pus aoueglnlslp wog; palosioad oq plnays Boas lusweoafda~ syl •urs3sAs Uolld,osge yos iusweasgde~ a }o uoliaaol ay1 ~o} P821I11n aq ~Isw pue paienlene usoq sgy aale iuswaaiTldB~ elgs3gas V :weisAs iuowa~eldoi iuslldwoa apoa a apino.td of 'ue~lsl eq ;snw ~ ~o 'ueaq envy so~nseaw S3urx~o{!o} ayl pa~l¢ds~ aq iouusa putt :lge; g•a,Mpd oyi }) NV1d A~N30NilNfaQ •lsus3ew p:Ios veal aayloue ao i®nsaB 'llos 4i!~n pal!!} saeds plop syi pus panoure.t s,renoo rlsyl io psnowa~ pue paleneoxa aq !lays slld pus s~lu¢i Il$ `9uldurnd aeiaV o •~olelsdp Bulo}nrag sBwdas s tiq }o posodslp Ai~odord pue panowa.r sq !lays s1ld pus s~luel Ilg }o siueluoo oyl pslsss eBuluado sdld psuopusge ayi pue. palaauuoaslp eq hays sled pue s~Iusl of Bufdld IIt/ s :epa~ anlisaislugwpy ugsuoaslM 'Eg'gB wwoa ~aideya yilm saueggduioo ul pauopuege rtI®tas pue M~adad s! wals~cs ay; isyl s.rnsug al us~Iei eq llsys sdals Bulnnailol; syx ealruss }o ino us~Isi ~cllusuewaod sl ~o~pua slle~ g•l,Mpd syl usyM 1N~WNOON~/8b- •ouuq ~vual}os ,aienn pug :suodwal :sur~ideu Iuellues :ssplal~ssd :slanpo~d Buliulad •'Ito :suollea!paw :sda~as ieaw :saplalq~®y :asasaB :eullose0 :sBullead elgelaisan pue 3In1I; .',-e3¢nn {dwnd darnel uts~p uollapuno} :1e; a~ustos;ulslp s~edeip asol; leiuop a~esaa~Bep aganns uo3~oa awopuoa a=.1nq elasjsB-a asdlm Ageq aatlolgliue :S1MOd ayl ;o a}lI ay1 Buolold pue aauswlo}~ad ayl eno~duq ~tsw weaJrs raienna3seM oy1 wog} Bulmolla~ oyl }o uolisulutlle ~o ualionpr3l~ •es~e uolid~osge Ilos eps~D-ie ~o punour rcus }o odols umop ieo; 9t wyi{nn eels oyl 'lasdwoa jo ganislp eslnn~pylo .ro '~sno ~laed ao snap Sou ar, •allea les~adslp pua a~iusl nano sslalyon rlavd ;o snap iou oa •~lusi dwnd oyi wy~m sgenal Iswaou •loiso, of sloaluoa dwnd eyl Buliekedo Allenusur w islsss o3 aoulelulalry g,~pd ~o ~agwnld a lasluoa ao dwnd lusnl}3a syi of ~emod Buuoxsa~ 03 lard ~a3a~sdp Bulalnleg aBaides a Aq penowar ~luei durnd eye ;o siua;uoo syl ansy uollenl!s sly3 plona of •iuen!},Ia ;o a9~eyoslp saepns ~o dnxosq sup uE ~lnser tisw pus !s)E;va syi Butp~tolsano •esap ab~el suo u! {slilaa los~edslp ayi o; paB~eyoslp a$ Illm ~alemoxsem sssaxa ayl pa~oise~ sl ~emod ueyM •slenel re3ennyBly Iswrou anoga lII} stew s~lusl dwnd ssBa;no •amod Bulanp •eaa}sns enlle,-3Il}u{ ayl xa vozoi} oae suol3lpuoa llos usym .~naao iou !lays do iaais wslsrts •osn of ~oljd ~oigredo Oulo:ruas sBsldas a Aq ponowoa {s)~lusl syi }a swsiuv7 ayi aney pelaeiep sae suolienusauoa y8ty }I ' gsgpsa Iss~edslp oyl oBewep oo~pus sseoo~d iusw;sell syi opsdwt Asw ley! stealwaya ~®yio xr slanpoxi 8uliuled }o aauaseld ec;3 lo} {sl~lusl 3usurlasl3 ~lasyo S1MOd s41 }o asn o3 laid 'uallanlisuoa mou lod _ NOfltl>33d0 aNV dil L3ib1S '~;0 `~" a8ed c~~--.•v-~c~~~ i a: 2.3 ~ ~ ~Nf~H ~uKr' . n ST CRA ~~ p'~~3t ~G TAKK. ~1,IN~ O+~,iT~tBH~' ~~~TION ~ORI~ uy~ ~`i~.J~1R Co ~ePa~-rr o ~ UwinocB rr ~~~ r ~- ~ p~~j, gddre~s D „went ('Vet'If~o~oataga~ed¢v~m 6 +'~ ~#3 S t~ty/Stata (-l iJI~So~ t~~ Pagel Idaatificalion Number ~~ r~c~'r~ a ~J ~~ Z~ T 2~ rt•R~„~~'~~ Town of ~tlC~-S pt~opesty r ~ Lat # ~. Suladirsiass, ~ rr~ - c... • - ~_ ---~ _ -~ vole -. # Pogo ~ ~ 3 to .. D p ' volute ~ R-arrsetY Deed os O no lt,at l;.x~ts ;a~,5able ~ y~ ^ ao 8pex ~~ ~ y ate and swiah~~ of your eepdc syateas could eta ~d~pt~ , ~ ~ put into the +"y~'o4 of ~ doiG ~ ~'~ mkt sd,Eemtbe' ,i+e~sW dirP~ ~' ~ by a ar- a~ ~ l~matiaa a ~ . ~ by ~ owesx ,~ p~ agie~ ~ wit b St t,'a~oix Zoais~ ~ . tbat tt~ do aa~tie ~ i~a ~~ ~°`u°°i'~'upedphseabaoc~Gteated ~ ~ t~cie 1~ than 1~ full of dnd~ ` eepdidoa eadJac (Z) aRer P'~°'p evils for iri0p~~~ ~ va+a ~'MSEe ~'~ ors Ihre. ie tiwda~ Nava r~tad tlrs tbt~rvc o f°o1s tad 1iw ~ a!' N~tasal ~ ~ ~ (a f~ G to facth, b~~+. is act by ~ Daprrtaaoa _ bs ~ t,`~d to tiye at. ~ad~g'~ ~~ tYs~ da tb~ ~`~ . _ ._. .. ~ DAB v v am Late) tha owars~63 of 1'WNF~.G~T~''Y ,~. bterv+k~e' i (ae) X ) rrcdify that all t-rs o Cbis iot=a arc true to the bets of fay (~c'1 0~. fitted abo a .uarrrtlty decd recorded itt A~~ of Uerds DA'I'H ~ A sstst• t bofng r.wtrad b~- tf~ ?.os~B DaP~nt .....t ~yy irsformatio:s ~ eait.tepttisented rosy rc~vt! to the vaitary P~~ lip fire AeSictes of Dcoda oE~ R~ taetude with t3>Cs spptiezttass: `star ~~~~ NNGY ~P ~~e~~ ~° ~ ~e ~gry ~e''1 TCITRL P . f32 .. S'CATE BAR OF WISCONSIN FORM 1 - 1998 ' 6660$0 WARRANTY QEED KATHLEEN H. WALSH document nkrnaer '~ :., .. ' ~(~"7 v~~ Ypt PA6t kEOISTEk OF DEEDS 6T. CkOIX CO. , 4tI .. '' ~ ed, made betwet:n Bang Corrosa This De tion. RECEItIED FOR RECORD a Minnesota eoraoratioa _ 12-21-2001 3:10 PM ---- ..- .~.-.~~ ~I tT Y DEED __.._ __._., a»d Sfena~Corooration, a Mannes .~, Grantor. e i T R ~T ~' FEES xa~~yprat p,~______ -. _-. ---_ ..._...._ TRANSFER FEES 9853.40 ..._ DtM6 FEES RE COR 7,00 _~ _, _ _ __ X ~ B -• ••---- .." Grantee. Grantor, for a valuable consldention, S described real estate to t • Croix ' conveys to Grantee the lollowin 8 r _ , - County State of Wisconsin (the "Property"}: iat;;,av~:g.wa See Attached Exhibit A AtldfAB° (tn~~r~.t r.~ ~~ ~1C,r3 5mt2~rlq Uri ~. ;' I~inrie fonka} ~~ b53~ o: 2o-104a-so-ooo Percy IdMtigGtlen Wumbar {PIN) This is not homestead property. ~. (ls) {IS not) ~ 20-1048-60-000 20-1048-90-000 20-1049-90-000 20-1050-00-000 20-1050-80-000 20-1052-20-000 20-1052-70-000 l'ogether with all appurtenant riglau, rule and interests. ~~ Grantor warrants that the title to the Property la good. lndefeastble In fee simple and free and clear of encumbrances except Ses Attached Exhibit B. i Dated this 20th day of December 2001 s ;~ Bane r oratior. __ (SEAL) ~~) by ~ o Neaee ,Ira„C of Executive Offic' (SEAL) (SEAL} AUTHENTICATION Signature(s) ' authenticated [hls deyof , 'fITLF.: 61Eh1BER STATE BAR OF WISCONSIN (Cr' not, autharized by §706.06. Wis. State.) ACKNOWLEDGMENT Minnesota State of'Wt>irtmstn' aa. 1~....:.«...•.c ~l Gount .. JIB` Personally came before me this r ~`r t+~. day cf December 0~ O1 ,the aboverramed _ John M. Nasseffa Chief Executive Officer of Bane Corporation, a Minnesota corporation .~ to me known to berrths pe,ts~ ~~ who executed ttte foregoing instrument and agknawtt+delf the~aame. rHls INSTRUtaENT wns DRAfTEt7 BY i~ `~ -\: ,}C-~FWIRY E, fiALLAHER Loclcrid a Grindai Law Firm ~ weoarMawwtttwaaahet.uaa -_.... t nn _ • ~~ Minneapolis, MN 55401 Nofarp~ubuc,suteorwlsconstn commission is permanent (if net, state expirallon date: (Signatures may be authenticated or acknowledged. Both are not January 31^ 20~ ) necessary) _, _ ' Nomes of persons signing In any tapestry must M typtd or printre! bNow their slgneuve WARRANTY DEED S7A FORM No it~-t 1996 s N 'r`'1C0"6'^ Lagei 6~ank Ca., Inc' kaiwraukea, wii. ~~, 1 1 1,,,,,~„~.. t ~~ ,~ t,,...,..,,..-~-.~ ~/~~',~,,rr _,~,w.' ram„... •r