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020-1417-60-000
o N 0 3 c d c w y c ~ ~ ~ ~ ~ ~ ~ ° I ` 1 ~ '~ I ~ 7 Z G w~ C O N ~ ~• ~ m ~ 3 ~ ~ y $ ~ N ~ P ~ ~ ~ I~n•~y An ° ~ ° , n O a n ~ O p Np~~ O O ~ C A ~ ,gyp ~ yy 3 ~ ~ ° c I ~ y ~ ~ o ~ o I a m ~ ° m co D w I ~ 3 ~ Q ~ r ,o~ N V C ~ O I ~ 3 ~ o ~ ro ~ ~ ~ ~ c N N N~ o S m I "' ~ ~ ~ v v ~ m ~ ~ ~ A ~ ~ •• I < ~ N I n I Z 3 ° cv~z I ~ 7 5i ~ I ? rn ~ n I ~ ~ y C I ~ ~ N I to C ~ _ o~ n O j I a ~' ? `Di o ~ ~ c -• A C! ~ a ~ ~ ~ .. I ~ Z N O ~ ~°a~° Z ~ ~ A ,~ I ° °'' Z <o y ~ ~ Z F A ? n fFD V fD ~ O' fn N j (D O~ ~ p d o ~ coo c~ o ~ ~ ~ o ~~ p av m c ~' I ° "~ o~ o m Oa~ ~ o w c sp ~ a W ~ ~~ so ~ ~ m a y 3~ Q°~ , o O° I aufD, ~~~omNCNO>>m y~~, ~ mNN I 'O 'C N j~ `< W (D p~j 4~ c C O fD O _ ?' 'i I v o~~ a~O ova ° Dm ~ m ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ O ~ c'D d C A ~ I °° ~ m a ~ ~ ~~ Sam b u i Q ~ - I ° a~,m m ~~ -•~ ~ m a~ 01 ~ c I c c 3 0 ov ~~ a . ~ ~ N f~D 0 0 0 y. N j" O 07 1 " a ~ j y 7' d V O I ' • ;; N a ~~ ~~ o ~ n3 0 ~ . ~ f~D ~ .... o N N ? y a ~ W O I a x a m a .. ~ ~ b ~ I ° ~ ti v I c 'r v ° 0 o ~ ~ wisconss-~ ~~~iient 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 Sienna Corp. Hudson Township CST BM Elev: Insp. BM Elev: BM TANK INFORMATION ~ w~~~ ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ / ~~ Dosing ~ x~ ~'/ /e j' -C Aeration Holding TANK SETBACK INFORMATION TANK TO ~~ ~~ Pp/L VU~St" WEL BLDG. Vent to Air Intake ROAD Septic ~ ~ Dosing ~~~- Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss ead TDH Ft Forcemain Length ia. Dist. to Well county: St. Croix Sanitary Permit No: 430451 0 State Plan ID No: Parcel Tax No: 020-1417-60-000 utap No: 20.29.19.2644 STATION BS HI FS ELEV. Benchmark ~ /~ 3 ~ ~3 /~~ ~ Alt. BM ~ 3 ~ / ~ ~ / Bldg. Sewer ~---- ,~/ 9 - ~9 S t Inlet ~ , L~ T SbHt Outlet - 5cy a lo• ~ ,G. Dt Inlet ~/ ~" Dt Bottom / ~~ Header/Man. ~~~ /1,~. ~,~3 ~--~,7 Dist. Pipe B3 ~ v •~/,-~'~ S Bot. System ~ !3Z ~~p~ '~_~ Q~ f~ ~ f - 3 S Final Grade S ` St Cover ~ / 1 ~Qa , / //~ SOIL ABSORPTION SYSTEM l C.L /',Gt 1.rn /Asi~il//~i~i(•~ BED/TRENCH DIMENSIONS Width ~ I LengtFj_, ~ t No. Of Trenches (~~/ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/ BLDG WELL LAKE/STREA LEACHIN Manufa er// / __~ ~~~ INFORMATION CHAMBER O ~ ~"Y~ Type f System: ' ~~ '~/ tr ~,.,_ Model Number: IBUTION SYSTEM Header anifolcy $_~(J ength Dia Distribution ~ Pipe(s) ~ Length Dia ~ Spacing x Hole Size __ ~~ x Hole Spacing - /.. Vept to Air Int e ~/L"] 0 ~7 SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over .r ~, Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ Bed/Trench Ed es g To soil p ~ Yes No -- ~^`j Yes ~ ; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~~ ~ Inspection #2: / /, Location: 442 Wren Lane Hudson, WI 54016 (NW 1/4 NW 1/4 20 T29N R19W) The Glen Lot 50 ,~/ f ~rcel No: 20.29.19.264C4t,~~jo~ 1.) Alt BM Description =~r ~~~-. ~ ~~~~,~~ (/t^- /~ J!~"~'~+ 2J Bldg sewer length =~~ / ~~ ~/ cSIC.Lr4~U'-"~ ~-D -p~LCa1L - amount of cover = ~ _ ~,.~ ~lD~fE-fo l n off- sc~,l~d _ ~. "~ r ~ b A.,~---~U.dJI.-~-~rt~t,~. ~ ~~'t~'l ~ ~raY+-~ -Fra,~,,-f` o ~- la3 ~ ~ ~.~~-h-f `-''-- -- ---- - -- - - - r-------- - -, _ Plan revision Required? [-'' Yes No ~ ~~ , i ', Use other side for additional information. ~ ~ ~~3 ~ _..-. ~~~"' __~ ~ ~~~ %___L-----J Date ~~d~ lnsep^`tor~gnat~ ~/^ - ~~ ~ n ~ Cert. No. SBD-6710 (R.3/97) G~-(%ti ~yL// L~ S.u BL ~(B3 ~. ~c`~ ~ CSr,~°`'~ ~<~~ s~~f- ~-Z ~ 6.~~ ~~~-~-f ~~ !d ~~v~ red i ~~ ~ ~ ~ ~~~ s ~'~~ ~ ~ ~ .gv 3 J~ ~B3 • ~~~ ,~~ a~ ~~w~ ~~ fir`" -~° ~' .~ ~ .sue'` ~a ~~ ~ ~ 5 ~~ 5~ S d Z~ S ~~- ~~ ~ h'~ ~~' / J~ V , oc, r ~~~ ~ ,~ ~ ~- ~'~ v ~ ~o r~,, ~- ~` n_t_.n~~._~.s..~. ~~ ~- ~''' ~ j ~ Vw ~ r ~~' s~` ~ ~ ~ ~ ~ ~ I`~ ~~'~ ~ a ~ ~~ ,~- ~ ~~' ; Zwl ~ ~ ~ ~- ~2 ~ ~~ ~ ~ ~~ i ~ ~ sy~ r~ l o ~" ~~ h 3°~~ Wisconsin.DepartmentofCommerrse SOIL E1/AtUATWN REPORT Division of Safety and Buiid'mgs in accordance writh Comm 85; Wis. Adm: Code Attach complete she plan on paper not less than 8%: x 11 inches in s¢e. Plan must County includi;, tart na limited to: vertical and horizontal feference point (BM), direction and percent slope, scale or dffnemsioru; oath amwv; and location and distance to nearest road: Parcel I:D_ Please prlntall /niormaLiort. R i Personal information you provide may be used taw, s. 5.04 it) (m)J. ~ Property. Owner `°` roperty Location 1152 page 1 of 3 Steel Sal Service St. Croon lX rim e ~l/~' Sienna Corporation. u<Lot NE 1l4 NW 174 S 20 T 29 N R 19 W Properly Qaa~er's Mailing Address ~ `,~~ ~ 2d ti ~ Block # Subd. Name or CSM# 49411 Yrking Dr, Suite 608 ,, _,, 50 na The tSlert City'/ State Zi Cod~PhArt~~iVurtlfjQr ` a~ City Village Town Nearest Road ' .~c(t'/?ot MN Z- Hudson Garrrtichael Rd. /_ ~ New Cortsiructiort lJse: / Residential /Number cf bedroans 4 Code derived design ftarv rate 600 GPD Replacernertt Public ~ corrrmercial -Describe: Parent material Pitted. outWash Flood .plain elevation, # applicable na General comments and recommendatiars: System-elevation 90,74ft, trenches spaced and-depth to code5.66ft-bekwv grade ski-~.- ~6 ~ ~rrrd~x~. - ~~~ .Bl ~`~~ $~~ 105 Pit Ground Surtxe elev. 96.40 ft. pepttt to in. limiting facts Sod Application Rate Horizon Depth Oaninant Color Redox Description Texture Stnxture Consistence Boundary Roofs GPD/ftZ *Eff#'f *Eff#2 1 0 36 10yr32 none sit 2msbk mfr gw 2e .5 .8 2 36~fi 1Dyr4/4 one ~ 2msbk din cs na .4 _6 3 56-1{15 7 ~yr4f6 none rr-> U osg ml na na .7 1.2 l ~'I~ ~6Se ~ o-~ S~ G ~ 0~ 0 ~ ~i /0~{ `~ ga~2y~_ 73. IZ~, /v~ ~2~ B~ # Boring 105 Pit Ground Surface elev. 96.40 ft. Depth to limting factor in. Soil Application Rate Horizon .Depth Dominant Color Redox Description Texture Structure Consstenxe Boundary .Roots GPDtftz *Eff#1 *Eff#2 1 0-12 10yr3/4 -none sl 2msbk .mfr cs 1c .5 .9 2 12-1f1~ 7.5gr4/6 none ~ osg ml na na ~ 1.2 ~~~~ >~ fir., ~ ' ~ l !0 ~' ~'1~~--~ °~s ~ trrtuent ~i = tsv~ ~ :iv < ZZtr mgrL ~ TSS >3O < 15o mg/L * Effluent #2 = BODS <30 mg1L acid TSS <30 mg/L SST Name (Please Print} Signature: CST Number David J_ Steel Se~v / :~ 248956 4ddress Steel Sal ~~ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 154017 911912002 715-246-5085 Ppy~rn~Sienna Corporation p~~ lp# pending page 2 of 3 1 ~ 1 Bo~,ing # ~ Baird ~~~ 1r Pit Ground 5urfane elev. 90.20 ft. Depth to limiting facts 105 in. Sod Application-Rate Horizon IIepth ©orninarrt Calor Redo Elescnption 7extitte Stiuctuee Consistence Boundary Roots GPD/lt' 'Ef~F1 "Eff#2 ~ 0-5 ?Oyr3/4 .none st 2rnsbk mfr cs 'ic .5 .9 2 5-2 7.5yr4/4 none osg mvfr cs na ~ 1.6 ~/ 3 21 7.5Xr4!& none ~ asg m! na na ~ 1.2 J r y Z ~o~ ~° H h ~~ -~, ~ 9 ~~ Borina # B~n9 " Efftuer>t #1 = BOD ~ 3f} < 22p mgll and TSS >3t) <_?50 mg/L ' Efifluent #~ = BODE ~ 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 Bornc # _ Bing 11~ 1 ~ ~~ ,J ~ ~~ ~` ~ ~ ~c~ ~ ~ i ~~ ~ ~ ~ , v~, / 1 11~ ~ J ~ j. / / i ~ ~ i~ ~ 4 . ~i~ ~ ~ ~ ~~.~ f~ ~ ~ ~~~'~/~~ ~~ ~ r o 11 ~ i ~ ~ ~ 1 } ' ~ cn r ~ '~ ~~ z ,, - o . 8 ~~ m ~ __ i ~ ~ ~. =.1~ ~ i i ~ ~~ ~ ~ \ ~ Irk\1~i~ I 11 b ~~ ,~ `1 -.-. ..-Z,9 i 1 ,, ~ ~ r I ==~~ ~ ~/ .~~„~ 1 ~ ~' J J \ 8 -n^Q i- f ~, :;\ , ~! \ YYV Sys E ~ ~` ~ ~` -. ~ . ~ ~ ~ ~~~~: '~ ~, ` .Q Z ~ ~ ~1, ~ ~ i =9L~=~-' ~ \~ _. // ~ ~/ ~ W Y° ~ `, 1 ~ ~~ ~~ ~~~~~ ~ ~~ ~ j / ~/_~i~ / y. _~ ~` ~. r -t- ~~ ,/ / '~ / p ~. A Page 3 of 3 'FEEL' S SUIL SERVICE David J. Stl~l 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 5401? Lic. # 248956 NEl/4,NWi14,S 20,T29,Ri9W (715j 246-6200 Town of Hudson, St. Croix Co. (715} 246-5085 The Glen lot # 50 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 atthe time the soil test was conducted.- Legend 1" = 40' = Benchmark El. 100.00Ft ~p of '/z" pvc pipe = Alt Benchmark E1.100.60Ft ~p of 1/z" pvc pipe = Borings Boring Elevations Bl =96.40Ft B2 =96.40Ft B3 =90.20Ft B4 =OO.OOFt ~~~..~ q-,s-ov ~F ~.,~ IV I I _ --~- I { ,,. - ~- { 1 -,~ ,- 1 -6' ~ ,- _ ~ - - 1 _ ~ - CCIA~_ .r I ' r~ . ^t 1 -~'-- _ ~ ~ • I 1 1 r ~, „ \. '' - 1 s / ro I~.7 :~ ~ f y -~-• ~ 417• • ,. C 's.. ` ~. T_~ 1/ T 1 1 _.a ~s •- Z 1 1 ~1 ~~~~~-/ ~ X82 1 •` .. 1 lii •TJ- `* 1i'f $\ 1 :1 r l` a W. ~ ^p~~q_~ :~~ l J 'BJ .' .. 1 1 1 • '~ ~~ I Q^Ii I l _ ~ 1 _= f/~~ l1iB- r 1 - ~ '_ • _ _ 1 I . ^65-- ~ ~ 1 1\i ~ I _ ~5 ` 111 , `I,#,~ • ~~ ~~ 3. J . { Il .!° ' ~ _ ~ _ 3.4 . . t • 1 `y ~. 4 ,: ,. 1: ;, ~- ;. . . ., ,1 - ~- 1 .. , , ... ..... •~ ~ - 1 . . a ``a 1 - ~i7 ~ l ~ '1 E _ I• , ~~ ': '~ •~ .. ; ~. _ .,1 , ,~\ :,~ ~..~~, :mot . 293 ; f _ n~~ • r -.:.. , ~9L~ j'^ , `*A,1, ~ r' i 1,,~ l\ ('~`1 I 11 t /{~ •_ l'Fl ,4_ 111j i 1 i 1 is .; ~ 1 ~; _ , `.I ~ _l" ~~ r I V ~ I ~ 1, '~ i .\ ~• '? ~ • ~t~.. !I tf~"~'.{,; ~ `l \~'•- 1 t 1 r { 1l~ . 1 71-~ ~ ,~ .,L. J e 1 1 \ ! f~ f 1 `-~ ,FV ``t •. l \ {. A \ Ate, I ~__ _.c.r.I -~~... 111 ' ~ f \ . •. •_a • `\ \ { t _ •. `,` t i. - t-, b t --------~-.._._r RECFnilcl~ . _.~ _ S fety and $uildings Division County ~~ ~ ~ 20,2Q1 W. ashington Ave., P.O. Box 7162 UU33 _S_'l cyo r~ ~~~~~ , adison, WI 53707 - 7162 Sanitary Permit Number {to be filled in by Co.) Department of Co me$~eCRpl (608) 265-3151 N7,pcC~-I T TT~, ~a ~ Iieation state; P lan I.D Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide b may e used for secondary purposes Privacy Law, s15.U4(1)(m) Project Address (if different than mailing address) I. Application Information -Please Print All Information `f`F2 ~,.~ ~~n! Li4NE Property Owner's Na me i arcel # ` Lot # Block # ~ e « C o~oD /1 SD -- Property Owner's M ailing Address Property Location ~ , I Ci State h'~ Zi p Ccde ~ Phone Number ~'k,_~ tk,Section I C . / ,- r r CL ~ /~ G / - L~ J j~ 7 ~_j (~% J~,j` r, ~(J Q (circle o e) ~ II. Type of Building (check alt that apply) - E or~ T ~ N; R %'/ CC/J ~1 or 2 Family Dwelling -Number of Bed ooms ^ 'fl~ g~ - ~Z Subdivision Name CSM Number ~ .~ .Public/Commercial -Describe Use -- $ t~L•~ LQ~. 3 X ~ e~ „~ ~ i_] State Owned -Describe Use G ^City ^Village ~'ownship of ~{~ - III. Type of Permit: (Check only one box on line A. Complete line B if applicable) oZo - / I -(Qp _ ~D ~ A' ~ New S stem ^ Re lacement S stem Y p y ^ TreatmenUHolding Tank Replacement Orrly ^ Other Modification to Existing System $. ^ Permit Renewal ~ Aermit Revision ^ Change of ^ Permit Transfer to Now List Previous Permit Number and Date Issued Before Expiration Plumber Owner j ~3o~S./ /~~~/03 ~(' N. T e of POWTS S stem: (Check all that apply) Non -Pressurized In-Ground ^ Moutu] > 24 in. of suitable soil V Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter '~J Constructed Wetland ^ Pressurized In-Ground ^ Ilolding Tank ^ Peat Fitter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ~.eaching Chamber ^ Drip Line ^ Grave]-less Pipe ^ Other (explain) V. 13is rsal/Treatm Area Information: Design Flow (gpd) _ Design SoiE Application Rate(gpdst) Dispersal Area Required (st) _ Dispersal Area roposed (s#) System Elevation p~ r. ~ _S7 ~ •~ ~ 89.Dd i VI. Tank Info Capacity in ~ Total Number Manufacturer Prefab r Site Steel Fiber Plastic j Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tattks ~ Septic or Holding Tank ~ ~ ~ , c?S~ r/ t Aerobic Treatment Unit - Dosing Chamber __....._ -- ~- i VII. Responsibility Statement- I, the undersigned, assume responsibility for illation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature I 1P PRS Number TBusiness Phone Number ~~ !'~• Lt vh ~ /~l+E sake r ..1~~ ^~/' ~ s2~7Y'~~ ?/ S =3P~i •- '~/ 'Z f P.umber's Addre ss (Street, City, State, Zip Code) . i ~~~ ~ ~,~d ~ dsd~ ~/ , . ~y~o/~ 'VIII. Count /De artment Use Onl ~, Approved ^ Disapproved Sanitary Permit Fee (in Ludes Groundwater Date Issued Issuing gent Signature o Stamps) Surcharge Fee) ^ Owner Given Reason for Denial ~~ '- , 1X. Conditions of Approval/Reasons for Disapproval SYSTEM OV~'NER: 3) ~ l S v i1)f~ ~j n A ` Crc..~cf~-•~X d~~~U"v" - - _ w 1 Septic tank, effluent filtor and 1( dispersal cell must all >~ serviced /maintained ~.~ ~ as er r w~,~ ,iq~ . S ,,,t S ~ ~2 `i , p mllnagement plan provided by plumber. I r _ .~ Y. All setback requirements must be maintained ..tom ~ dot ~ Cv..~ ~ ~tl~Ju. ~~o-lam ae nor ~nnn.... b.t.. ,....a_r__~~_-- rr••`"-`••~ ~vu V. v1 u111g111A~. ` r S ~ A'~t~~wl Attach complete plans {to t5e County only} for [tee system on paper no Tess than 81/2 x SBD-6398 (R. O1/03) ~ I^^ ~' > ,;~ 1~ rip ~,~~~~,~J~7.~..~ /~~ ° ~ ~~ ~ ~a ~, ~s , ~ ~ ~ s' ~ ~° ~ 6~~,J ~~~ ~cl. ,~ ~ ~~ d~~ (~ B ~~~"b ~ ~s ~ ~' ~ ~°•~v G /~ ~ ~~~~ S ,'Tc ~~ ~~~ ,~~ - s~ ~ ~ ~' 3 c~a u a ~p~ Q h o-~-1'- z) S ~''-9 ~ a~ ~~ ~5~~ - - C~pY ~~ ~ Y ~ ~ W /~ 1 ` ~-~ PAGE 30F~ ~~ ~G~` r 1~~~ NAI~;Jar~ ~,,,-~ LOT#~~ LEGAL DESCRIP'I`ION:,1/4 1/4,S T~,N,R, E(or)W SCALE: 1"'~ ~D ~ 6,M~ ELEVATION: ~~D ~ O BM 1 DESCRIPTION: -~ ~~^ l ~~ 111 ~-~ !~~ ~ BM 2 ELEVATION: ~ BM 2 DESCRIPTION; SYSTEM ELE NATION: ~ ~ ~ 6 U Gow e ~ $ ~. ~`~ SYSTEM TYPE: ~'~~.c1'~~'ll~ (~ Cl~ a QZ'~ a~s~ yy,.~ .,; ~e ~~~ ~~ ~~~` 5~°~ ~~ I3~` DATE: /~-/y_ 0 3 ------ G~~ P ~ I g ~-,,t .5~~'~~-~~~- ~U,r~ ~ ~ ?~ 50 ~~-~-Y.~/ti arc/ ~~,y~~ ly~ads'd~ S~~ -~-- i Y~' ~P ~ ~~~~~~~~~1~ /~~ ~ ~----- ~~ I ~ z~ S ~ ~~.- ~~- ~~ ~ ti ~~.~ Wisconsin Depaidnent of Commerce n:..:~:,., of Cafofv and A~ iitrtinas RECEIVED S~I~~VAI. ATiON REPORT Nov 2 Page t of _~, arxo-darree mm ~ County ~ } ' r rze. n must - s ~~ni Attach compete stte plan on paper not ttra~~~t but not limited to: vertical and ho Dotal r~NYldfa ~t~ ~d,._ ~ n and include pal -,D. , Wort oca on and distance to nearest road. scale or dimensions tslo e , p , percen Please print ati lnforntatton. R viewed by Date Pcrsonat intartnalion yov provide may be used for secondary purposes tPrivacy lew, s. 15.04 (1) (m)). - OV . ZS Property Dwner ~ % " Property Location Govt Lot ~~ 1!4 X1/4 S ~~ T ,y14 N R ~Q E (or)~ ~~ ~ ~ Pro rty t?wners Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Cod® hone Number ^ City ^ Vflage (~ Town Nearest Road New Gonstruction Use: (~ Residential I Number o€ bedrooms .~=G~ Code derived design flow rate ~~~d GPD ^ Replacement ^ Public orcommercial -Describe: _ Fbod Plain elevation i1 applicable ___.~ ~ ft• l t ri t ~ ~`ts~ ______.~ _~ a ma e Paren General comments S, /s~,e y~ ..Q~ 2~ . ~ ~J ~C~'r Q C7 ~OC.~ ~!" ~~• SOU and recommendations: l` Boring # ~ 8pnng ® Pit Ground surface elev" _.~ j~~t. Depth to limiting factor _~ in. Soil titm Rate i ti D Texture Structure Consistence Boundary Roots GPOffF Horizon Depth in. Dominant Color Munsetl p on escr Redox Du. Sz. Cont. Cobr Gr: Sz. Sh. 'Eff#1 'Eff#2 o-~~ 3t' --- Sr'1 ~. ,~ ~ ° ~-~ , Z r' ~6'Jr~ ~--Ilo d y ~Dy ~ ~ ~.~- r G' os-~ ~(~ v-~ I C r ' ~° I 9.a ~ ~-- 6~- 2 03 . Z- ~ Boring # ~ Boring Pit Ground surface elev. ~ 3~~P.. Depth to (inviting factor ~f~_ in. Spa A lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence I Boundary Roots GPDIfP in. Mansell t7u. Sz. Coot Cobr Gr. Sz. Sh. ( ~ 'Efl#1 'Eft#2 ® ~ Effluent ff1= 80D > 30 < ?_2t) mg/L and TSS >30 < 150 mgrL ' tmuem ru ~ aw, ~_ au myr~ c~ w ~ ~.~ - .n..,~y.. CST Name (Please P ' t) Si lure - CST Number 33Q A~~ Date Evaluation Conducted Telephone umber ~ i l ~ - g~~S~ ~vrf~ Gil r ~~~.-~ ~/- 9 -0 3 7~s _ 7~a-6Z.,~ q _ 7 ' - ParcellD# j0~ SZ~ Page Z of,,, Property Owner ~d ~1.01'~ ~-y Boring Z, Z v g, OeQth b ~ortittrtg factor ~~ in• Spa ica6on Ra Bonng # ®Pit Ground surface elev. Horizon Oepth Dominant Color Redox Description Texture G tructus Consistence Baurdary Roots .E~GPD/PfEti#2 in. Mansell Qu. Sz. Cont Color / C w j ` ~_ d ~G ~l ~L Zm.s~ m ~- C S - ,~~ -~ Z /y-zY o /y ~ _ ^ Boring # ~ Boring _ Pit Ground surface elev. _ ft. Depth b limiting facLOf )n• Soa Apolicatian Rate Horizon Depth Dominant Color Redox pe,cription Texture Structure Consistence Boundary Roots lE~GPD/tfE~2 in. Mansell Du. Sz Cont Cobr Gr. Sz Sh. LJ Boring Borng # Ground surface elev. R. Depth to limiting faC.or in. Pit Sofl Application Rate Horizon Depth Oomarant Cobr Redox Desaiptbn Texture Stntcturz; Consistence ~ ioundary i Roots GPD1fF in. Mansell du. Sz Cont Cabr Gr. Sz Sh. 'Erf#1 ~ 'EFf#2 f _i .__-= C 1 I I ~ i ~ ! I I I I I ~ ~ 'Effluent #1 =GODS > 30 < 220 mglt and T5S >30 < 1 v0 mgtL `Effluent #2 = GODS <_ 30 mgJL and TSS < 30 mgiL 7'he Department of Commerce is an equal opportunity service. provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-26b-3151 or TI'Y 608-264-8777. 58D•0.1JOIR.09t00) 6 ~ ~i PAGE 30F~ NA~;Ja ~ ~,~ LOT#~_LEGAL DESCRIPTION:,,_1/4 1/4,5 T___,N,R, E(or}W SCALE: 1"~ LfD ~ ----------- ~y,~~ELEVATiON: IOO~ ~ BM 1 DESCRIPTION: ~~' n ~ y 9 ~~ I~' ~'~ BM 2 ELEVATION: ~ BM 2 DESCRIPTION: ___- SYSTEM ELEVATION: ~ ~ ~ 6 U ~' e ~ a ~ ~~ '' SYSTEM TYPE: ~v~cJ~~~l°?~l Ci~ ~1 i~ ~~ 9`/ n „ ' ~ ~~,~ ~-~ ~ ~ ~, ~ I3 o C y s-~ e ~ / J ~G „ Q /t'`' /~ / ~ ~" '\' ~ / ~ V ~~ ~~~`e, ~~~~ 6""~ i 1~~~ ~'`' ~" - - :4~~ ,3 . ~. SIGNATURE: r ------- .TE: /~ /~/-0 3 r-- ~~// P h. ~ g ~. ~ Safety and Buildings Division County l 201 W. Washington Ave., P.O. Box 7162 ,~'"/''~CYp ~,~ ~~O~~~~ M di a,, a son, WI 53707 - 7162 De artment of Commerce (60g) 266-3151 Sanitary Permit Number (to be filled in by Co.) Sanitary Permit Application State Plan I.D. Nu m ber In accord with Cornet 83.21, Wis. Adm. Code, persottai information you rovide ~ ( N p may be used for secondary purposes Priva L cy aw, s15.04(i}(tn) Project Address (if different than mailing address) I. AppLtcation information -Please Print All Information ~- - . 711 Z ~~~ ~~ Pr~~perty Owner's Na me L ~.~ 3 1 Si~°..r/~~ Gor/° Parcel ~ Lot tr Block >r ' Property Owner's M ailing Address r .~D _ _ ,. ~ ~ ~ Property Location Z~ , /~ City, State P ~-~ Zi C od e ~ tt , ~~ ~lK/ k,Section ~~ ,,~~ / / G~e~i.~/~.- -~~~ •~ `~S 8`,~S'~ ~~~ (circle one} II. Type oP BuiltiUin ~t g (check all that apply} ~ ~ T ~ N; ~ E o~ ® ' ~l or 2 Family Dwelling -Number of Bedrooms ~j Subdivisio ame CSM Number ^ Public/Commercial -Describe lise ~ ~ ~ , - ~ E ~ ^ State Owned -Des be Use _ ~ ~ ~ ty_^Village~fownship of ~a~~ III. Type of Permit: ( eck only one box on line A. Complete line B if applicable) ~ A. f New System Re lacement S stem P Y ^ Treaunendliolding Tank Replacement Onl ^ Other Modification to Existing System B • ^ Permit Renewal ^ Per 'Revision ^ Change of ^ Permit Transfe New List Previous Permit Number and Date Issued Before Expiration Plumber ~ Owner V - I Type of POWTS System: (Check a ha_ t apply) _ _ Non -Pressurized In-Ground ^ Mound > in. of suitable soil ~ i Mound ~ 4 in. of suitable soil - ^ At-Grade ^ Si ass ng Sand Filter j U Constructed Weiland ^ Pressurized In-Grcw ^ Holding Tank ^ Pe filter ^ A is Tre nt U ^ Recircutati Sand Filter I I ^ Recirculating Synthetic Media Filter Leaching amber U Drip Lin ^ Gravel-1 ~ e lai • V. Dis ersal/Treatment Area Information: n ~/ - n 0 Design Flow (gpd} Design Soil Application Rate(gpdsf} Dispersal Required (sf} Area Proposed {s ~ Elevation j VI. Tank Info Capacity in Total Number - Manufacturer a to reel er P1asUc Gallons Gallons of Units New Existing C~{~-(:(' I !~~~„ / _ /) A -7 b ~ c Cons Glass Tanks Tanks ~ / ~eptic or t{o!ding Tank ~- Aerobie Treatment Unit ~ Dosing Chamber f "` - ~ _ r/ ~r ~i.sf ~.. VII. Responsibility Statement- I, the tln signed, assume responsibility for ' a an of the POWTS shown the c ed plans. i Plumber's Na me (Print} ' P ber s Si gnature /MPR umber Bu ess Phone Number r~ /'mar ~ S~r-~-ol'~ _ ~2? - ' 71'5= ~~'~ ~ ~/s~~ _ Plumber s Addre ss (Street C i ty, 5 ,Zip Code) . ~, , ~ ~~ /~~' ~'~7 < _-____~~~~G..~/ LCD ~ __ ~5 VIII ount /De artme se Onl Approved ^Dis roved Sanitary Permit Fee Includes Groundwater Da slued Issuing Agent 'g re ps} a I rv ~__~.... ^ caner Given Reason for Denial Surcharge Fee} ~~ ~>1 ~ C/ -o,re-- _ ~ ~ I Q ~ -- nt+p^v.aunoaeu[tx car u,sapprova, ,L~~,~ SYSTEM OWNER: ~a-E- Z ~' 7 1 Septic tank, effluent filter and ~/ 3 ~ it ~ ~Zd~ G~ y,~~~~L ~,~t{ dispersal cell must all be serviced /maintained ~~ ll '" U ~~~ ~ ~~ s~~ as per management plan provided by plumbef• -T~. ~ ~C~ 2. All setback requirements must be maintained 3 (~ ~ ~,XxQLw ~ d• 2~ " .~~ f ~~, as per applicable code/ordinances. __ ~ ~1~~ ~ ~~~ ~~~~1~ I Alta complete plans (to the County only) ror the system o pap n les an 81:2 x 11 inches in size SBD-6398 (R. 01/03) s°,~ e,~~~ ram P ~ dT .~ d r~ ~ ~,C~ ,/li~~v of- ~~~~G~ ~s~~.~ ~~ loo ~ 4" CI vyNT PIPE ~,2" MIM, ABOVE G:~ADE ~ ~ 25' FROM DOOR, WI.~iDpW aR FRESH ASR INTAKE F'NISHED.-G$AL!E -. :~!' ~'"SIIV~. ~ Gs~ ALET _ _~ ""` iU F_7 '~ '--~ WATER TIGiiT SEALS '~ _ A t~RP~flY~~ , ~...t_. iNTfl S•'1t X D "~" 0: i. G ~D i~~I~Y~~Rp~{QQ~ 3L'NC~'IO:3 H^x WITH CQNDG'IT -~ ~~1 ~~.~ !f ~ ' t' GAS- ~ ~ ' T1GH2 ~ `~ , SEAS +~ ~ALM i !oN ~ , i ~f ,. _ ~Or r f APPROVED `iANHOLE CGV ER W1 PADLQGK ~ WARNING LAB£~, ...... ~" I~ih (t b vAPPROV~D aoir~s wrr~ ~PPROV~O PiP~ 3' ONTO Sot I p, SO I ~ '~* RI`5ER EXIT ~~RMx 1 TEn cN~,Y IF TAhK MANUFACTURER HAS APPROVA? 3" AFFRut~ED BEDDING U`DER TANK ~PECIF?CAT:CA`5 ~Oh'~R~TE PAD ~£PTIC r' DOSE MANX MA?riUFACT'JRER: 'c' ~L'._~_ Iv"u?:BER DOSES FER LAY: "ANX. SS~ES: SEr"+TIC ~~d GAL. DQSfi VC;,.UME ZAQ~JD?NG DOSE B,_,_ v~ GAL, FL4~ni8ACK: !~ GAi,. -L MANUFACTURER: ~~.~! MODEL NUMBER: ,..,.lZ~.~......,.,...._. SWITCH ,.TYPE: _„ l~~r~~ 'U1 P MANt~FACTiJRER MODEL NUMHER: sw2TCH TYPE; CAPACi:IES: A »,~.~~ i;,iC:?E5 = ~.:~,...`..GA1.,. 8 z ~.. IN'CHES tt ....Y~~. GA.i. C = ~ INCHES = t_ G8 G~,:~. D ,,,,,~.. i:v'CHES m GAL. EQUiREA DiSCHA.RCaE RP.T ~O GPM PU:~:P £. ALARM k'iRihG AS : iR ILHr~ 1b.x3~ Wt~C ERT~GAL DiFFER£NCE $E. t~F ~' AND DiSiFIBUTICN FIFE 1.,2 FEET MINIMUM NETV~pRK SUFFLY PRESSURE FEET ,,,~,~ FEET rORCEMAi~S X ;Z~d fT1I30 FT, fR:CT.QN FACTOR FEDT T.OTgi. DYNAMIC HEAD ~ F E;'" ;tTERNAL DIM:,'A' IGtiS CF FUMP :A,;t'k: LEh'Gi~i ~--° ; WIaTH ~"' ; ~I ,;„TER ~'""~ IGIdED: ~/~,/,~~,~.r• ~sr I.iCENSD N'~MBiR: ~~fJ~d _ DA';: t J-- •~ __ /~8 C '` ~ a) ~PUa-no~ for tiw • Fume • Mr-eteur~ • CewsterN>Q ~ ~~, +k'ttnacimum. ~~sar~. • ~' he~le; up So 2e i~ ~ DteOher~e eine;1'h` tom, • MedWUt~ei Iql: ce~'bOn• rota /CM~tt1lQ~rti~N, sll~%N eaacmera. f ~tiw4 ~t~'Cj raontinuQUs i~"F ~~ iftes<tr~ttent, F~I/nere: 30Q eerles stsMeea etret. • dwl~ud to p~~~ tf ~ ~ g gpebllhy: ~ Ltee: up to 80 6PM, • Tatd her<de: ~ t0 ~~ ~ . • GtQe 1pr~e:1'~' NPT. M1leoilflll011 eat: clrbtm• ~ ~~ 1a~ moue 1~10"F.~o'Gj itd9!'{l~Itlt. A!~ ~tlllrlA. X10. ~ Fe~ere; ADO senses ele~NM ernes. ~ at Nnning drywl~ou#domageto aom~. ~ ~! SIB phase: 0.4 FlP, 71~ or 2~ Y, 6o Hr,15s0 RPM, butit in overbed wrth sutomwlc rapt ~ ~ Bin k phase: 0.~ }iP, 1 i ~ ~~Nz,1~5o APM, ~~ ~ Power OOtd:10 ~o0t eteneera te~tt+, ~~ s,i~'a with ti~rre Pra~q Ground!np psup. opti0csii ZO foot ienpth,1813 S~TW with thrll pprong grounding plug ;egltti~tid Ott EP05}, r .. n\ 5abmersible Eftluen# Pump ~~~~~ 3871 E • ~I ~bme~ed >n hiQi1 ppr~ tuttbtne dl for !u itt~ OfRtdestt h~t't Mater. Aveiisbls br •u3oa~a end aper~laa. Aatea+rego ntade~ Ia~e Iwl Pion aa~ial end preps et 1be ~ot1-. ~-rwua s ~ ImpeEMr: Thermo- ~laas'o semi~pai with pump 4tlt Wtlec tOr mer~tsnls~ sees A-otectton. ^ EPO>s Mtpetfers Thermo- phdstiC M16tOMd design'to[ imarowd parta'm~ce. • G»~aq end t#ea: RuQped therm~Ne~ic design grovltlea BtaperlOr ~?enpRtl ~tid CCtrQelx!• reeista~ce. .ice ~lt~; Cret iron for et!tloMnt h11d trenger, ehd dutebtlttly. t TherntQpias- ~coaro~w~h integr~ r~ndle ewls~ch es'~ment ~ Pawn Ce~th: SeNe-e dutyr n>e~ oit end wrt~r nta~dutt ^ eppt~: Upper mtt bwer a~Orl. (bed SASMOY LIS1'IN~ ~ ~ (C8A i madei numbere end In "F" or'AC`.} 3A ~+ ~. i ...~..._... ~.~ ~ , ' ~ ~ i t6 Eo ~ ~ ,~ 8 ~ ~ 0 ~M C ~ 1 Itf~/h ~, ~,,,~~ CAhACI'x'Y , ~,,;~t;,~ . ., M . . 1ASY. I~fiB '4 ~hll ~ ~~ l0/~ ~ ,~~ ~-~I~GG 144~~~ ~M ii X ~~ ¢0 r M X ~•r Q M j,~ N 4m ~ Of ~~!' !~: ~ • .o ~~ ~S ~ ~ ~" ~.~ $. S V ~x ki . r: ~Q ~~ ~~ ~~ ~j A -i r~ - s~ V ~} ~ y ~~ ~~ ~t~ ~y ~~ _ PQ __ M ~x s • N 0. K a` N m n ~m 4 r N • ~~ VJ ~ d e a ~] i A ~ K G m 7 N .~ ~, Q ~. li..[ r~ r x 1 CJt ~ ~ ~ V ~' 1 `~ u, x w aw ~: '~ • ~ ~ ~ ~ I hh ~/~ }~ ~/~ ,4 ~ Y ~ W / ~ Y~ (G+ ~ ~' p `C ~ n ..J ~ ~ C ~ ? . ~ ~ ` ~ . Q. ~ .-. C rn Q-p~ ~c ~ r~~gn~ ~ c~' a' -~ ~' c`-, a ~ m ~ x ~ ~ ., ~~ ~~0~ ~ ~. cn Q0.) ~ ~ ~ ~ ~ a~~ .~ m fD ~ W ~~`~ ~~~~ C ~"' ~ ~. cy ~ ~: ~~ O ~ ~ ~ ~ g; a i Invert 11 `--~ r ~~ nAG~ ~ pF .S S~ =r ~~~ ~ n ~ ~ ~ ~~i Z ~~~ C1 ~ ~ ~ o a (D .,~~ ~~~ !t ~i' t1°ll ~~ ~~ '~.:-.. • ~ ..~ ~~ POWTS ©W(VER'S MANUAL. & MANAGEMENT PLAN Paso ~ of~?i FILE 1Niti0lAMATION Owner ~' r Permit ,~ ~---/ DE81QN PARAMETERS Number of 8edrooma +~ p NA Number of Public FaciNty Unite NA tcetimatsd fbw {average) ~ ~}'D al da Oesign flow {peak}, {Estimated x 1.5) ~~ d al/da Soil Application Rate t7 . ei/da !<~ Standard }nfluent/Effiuent wsakry Monthly average" Fats, Oil ik Grease IFOG} S30 mg/L 13ioohemiCal Oxygen Demand (BOOB} 5220 mg/L ^ NA Total Suspended Solids ITS$} 5160 mg/L Pretreated Ef#tuent Quality Monthly average Biochemical Oxygen Demand {BOO,} fatal Suspended Solids ITSS) x30 mglL 530 mg/L ~NA Fecal Coliform {geometric meant x10` cfu/1 OOrnI Maximum Effluent Partlole $iza Yt in die, O NA ~~' O NA "VNuas typical for dorneatic wastewater and septic tank affluent. SY8TEM BPECFFICATlONB Septic Tank Capacity ~ d al [] NA Saptlc Tank Manufacturer O NA Effluent Filter Manufacturer ~ ~ O NA Effluent Filter Model ~~' C3 NA Pump Tank capachy .i o NA Pump Tank Manufacturer r S ~ d NA Pump Manufacturer ~,.,u, / DNA Pump Model ~ D O NA Pretreatment Unit ^ Sand/Gravel Flher O Mechanical Aeration O f~einfection ^ Peat Filter O Wetland D Other. NA sal Cstils) n-Ground lgravityi © At-Grade D Drfp-Line O NA Q tn-Ground (pressurized) ^ Mound ^ Other: Other: 0 NA Other: O NA ~~ O NA IwtAINT~lANCB SCHEDULE Ssrvke Everrt t3ervia Fregttsnoy Inspect condkion of tsnk(s1 At asast once every: 3 ~. a s (M~Mturn 3 years! ^ NA Pump out Contents of tankls} When combined sludge and scum equals one•thfrd (Y~} of tank volume ^ NA inspect diaperaal cellfs) At !seat ante every: ~ ear{s} e) (Max[rnuen 3 years) O NA Clsen effluent fiksr At least once every: ~ rri~otil ~ el 0 NA inspect pump, pump controls E~ a{arm At least once every: ~" ~~(e} R ar(a} O NA Flush laterab and pressure lest At least once avert': '~` ~ (a} O earls! O NA Other: At least once every: ,,, monthta} O Ks} O NA ~~ t] NA MAINTHIIANCE EYSTRUCTtONB lnspectiona of tanks and dispersal cells shall be made by an %ndivdual carrying one of the following licensee or csrtfficatlons; Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank k-spections must inelude a visual inapaction of the tank(s) to identity any missing or broken hardware. identify any cracks or Isaks, measure ~+e volume of combined sludge and scum arxt to check for any beak up or pending of effluent on the ground surface. The dispersal ~~lils) shall be viwaily inspected to check the effluent levels in the observation pipes and to check far any pending of effk;ent on the ground surface. The pending of effluent on the ground surface may Mdicate a falling condition and requires the immediate notification of the Local regulatory authority. When the combined accumulation of stodge and scum in any tank equals ono-third tY,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordsnos with chapter NR 113, wiaconatn Administrative Code. Att other servbes, including but not limited to the aervicinp of effluent filters, mechanical or pressurized Components, pretreatment unhs, end any servicing at intervals of S22 monMs, shat! be performed by a certNied POWTS Maintainer. A ssnrics report shah bs provided to the local regulatory authority within 10 days of completion of any service event. apo~ an{teJis!uturpy uesuonalM 'IE} 8 iZ} 'll}b4'E8 Pus l~}~iP)itNgltZ?tt'68 wwo~ Jeideyo yvm eaus{{dwaa ul peusJp teM iusuptioop o~l~, Q -~ °~ A ~ "~ 1 ilUat~ '~, awety auoga su~N )111aOH,LnV Aa01Vln09a 'rifga'7 ia9dWfldl a01~1a3d0 ONI~IJ'1aa8 SE1V1d3S euoyd ~N ~ISNIVJ.NIVW S1MOd x".~d' '~ ~ - .f G suoyd !!d7"IVISNI $1MOd S1N3WW00 'IYNOI11agV •S'191SSOdWI 2i0 ,L'ih0lddlq 38 A1/W iiNV.t d do aOla3lNl SHl WO»3 NOSa~d V d0 ~119s9a '111'133a AdW Hid30 '830Nd1SWn~a10 AM'I a3C3Nfi ~NV11N3W1V3a1 a3Hlo ao dwnd "~Itd~s v aatN~ lON Od 'N3t7AX0 1N3101ddn8N1 Z•!OlONV ~SSdO 1VH13i Ni1f1N00 AVW 8?INVi 1NSWid3lll a3H1a GN ~ <~NlNfddM>S> •aw!i {syi ie iaa;;a u! sa1nJ •yi yilM Aldwoo isnw sweis~cs yons ;o suolionJisuoaaa •eas;JRS •>1lisJii~ui ayi is iewolq ayi ;a lsnawaJ 9utMOpo; •aeld ul peioruisuooaJ aq ~(sw swais~ts uolidJOSgs {{os spsJB•is pue puna~y p ~{uei s ails ys ~ ~+~ 'S1N10d Pale; •yi aostdsJ of 3JasaJ asst a se papeisw •q ~ta1a ~{uei Bu{Ploy a ItBolouyo•i S.LMOd uc saauenps Bu1JJag •suot3s31uJq Iloa Jo~pue ~aegies o1 anp aigettsns iou sl saJe luaw•osldeJ •Igetlns d [] •Aw{i {-syi is ios~}a ul ss{nJ ayi yi1M JilduJao isnw swaisJts luswaosldaa •saJe iusuJSasldsJ elgsi!ns a ys{lgeisa of uolivnlens airs pue l{os Msu a Jo; p•eu ayi ul 3lnseJ il!M saJe wawaasldaJ syi ioalaJd of eJnlled 's11sM pus sour{ io{ 'aJnionJis pasodoJd pue 8u{is!xs woJ; silasq;as p•J1f1bsJ ~tq uod~ psButJ;ut eq iou p)noys pus uolioedutoa pus souegJnis!p woJ; pelasioJd eq plnoys seas luawaoeldaJ syl •usaisAs uotidJOSgs floe luawsosldeJ a ;o uo!isaol ayi Job patlinn eq dew pus psien{ens usaq say sole lusuJaas{dea elgeilns y p :uJSisJts 1u•wsasldeJ iuetidwoa apoo s aptnoJd o3 'us>Isi aq isnw Jo 'usaq aney ssJnseaw 8uin+ojlo; ayi paJledeJ aq louusa pus ells; S1MOd s43 -I NVld JlON3°J' NIJ1N0~ •le{Jaisw p{los 3JSw Jedlioue ~ {aneJt3 'tl~ yi!~++ Pell! sands pion syi pus penouJ•J sJenoo Jleyi Jo panowaJ pue pelaneaxs aq 1{eye si!d pus s~lusi N8 `t3u{dwnd Jsi;y • •JOisJedQ Bu!al~aS sBsids$ a ,tq ;o psscds±p AlJadoJd pue panoweJ aq {{eye si{d pue s~{ue3 {le ;o slue#uoo syl • •pslass s@uausdo adld psuopusge ayi pue paiaauuoaslp eq {lays s>!d pus silusl of 8wd{d per • ;apo~ en!is.us{u{wpy u{suoos{M 'EE•Eg ua~uo~ Joideyo yilM sous{}dwoa ut pauopuege /its;es pus ~{JBdoJd st wBis+ts ayi ieyl esnsul ai ua~le3 eq tleys sdais Bu~Malto; ayi aa!nJes ;o ino ua~ei ~ttiusuewJad st Jo~pus site; S•Ly~pd ayi AIM 1N3YyN04Nti/8tr •aulJq Jatsei;os sa3eN+ pug :suodusei :sut~deu l+Jeitues :saptatlsad :alonpoJd 13ufiutad :I!o :suo!iealpaus :sdeJas ieaw :sspla{gJay :ssesJB :suliose6 :s6u!lesd algeia$sn pus i!nJ; :JeiaM (dwnd dwcts} u!s1p uolispuno; :is; :siusios;uls{p :sJade!p :ssol; lsiuep :sJSSSaJBap :sgsMS -JOiioa :swapuoa :sunq au•JS8!o :sad1M ~lgeq :so!lolgliue :g1MOd ayi ;o a;{{ ayi Buo{oJd pus aausuua;Jed vyi snaJdwl ~SeuJ wea»s JaisMaiseM syi waJ; 6u!MOllo; ayi ;a uo!leww!{a Jo uwior-paa -ease uo{idsosgs t+os opsaB-is Jo punow ~(us ;o sdo{s urotop ins; g t usyi!M eeJe ayi 'iosdwoo Jo gsnistp ssinnJVyio Jo 'Jeno ~1JSd ~o encJp iou oa •s1iao tessedstp pus s~}uel J•no setotyan ~lJed Jo ontJp iou oe;l •~{usi dwnd ayi ulyi!M s{anal IswJOU 9JO3saJ of sloJwoo dwnd ayi 9ulieJ•do Allenusw u! is!ss@ of Jaulsiu!ey~ S1MOd so Jagwntd a laeiuoo Jo dwnd luen~;e ayi of JeMOd tau{JOisaJ of Jolsd :oissadp Bu!o{nsag a8sidag a Aq panoweJ ~tuei dwnd syi ;o siueiuoa ayi envy uolisni!s s!yi pone of •luenlldo ;o a6Jeyasip eae~ns ~o dn~laeq syi ul llnseJ tiRw pus is}{lao syi t)utpeol,eno 'asap aDJel suo ul (s}pso lesJedslp ayi of peDJSyos{p 8q 1lIM JeisM8lSSM SS•1Xa ayl peJaiSaJ St JBMOd Usy/H •s{anal Jalenny${y lewJOU anoge lil; slew silusi dwnd ssBeir-o Jannod Buun~l •aos;Jn6 entle1111;u1 ayi i@ UaZOJ; 8Je SUOiitpu0a (toe ueyM Jn8a0 iou {lRys do iJSis walsJlg •esn of JotJd so3BSedo Bu{atnses adeidas a ~lq p•nouuoJ isl~luei •1{i;o siueiuoa ayl aney peiosisP aJe sua{isJiuaouoa yt3ty;l •Is}flea Issseds{p ayi eBewep Jo~pus ssaoad 3uawiesJl ayi spedw! JleuJ {syi siealweyo Jsyio so sionpoJd Bu;iuled;o eou•seJd ayi Jv; {st~}usi iueuJis•Ji -l~ya SiMOd aui;o esn of Joud 'uolionsieuoo Mou Jod N01111ta3d0 qNV dt11.>lld1S 2 io~ a6ed ST CROIX CO ~ R,~ SP1'T'[C TA11K AND. OWNgRSHiP ~~t/ATION FORM tJwuec/Buyer ,Sr~1~JA Co ~ePae~-n o ~ Mai]ing Address ~ V I K i ~ ~ ~ ~ . SU l i~ to ~ D n1 /`~ IJ ~{3 S Proporty Address L~~~? ~!ra ~ ~ -~. (Vedfiutioa required trom PLaaiag Depsrttneat for new eaacttuction) ©Z o- / •~-~G av~ t~ty~tats E./UD.So~ Lt/~ Parcel Identification Number LTGAL~~C' itII'T~ o Z ~ yy 1 ZO ?.~ N~rC_L~.~• TOWfl of l~(/L~SU~ property L.ocntion '/., /., Soc. . T Subdivision Lot # sa Volume _ J Page # Certified Survey Map # -q ~ Page # 1 ~ Decd # ~ ~D~••- ~~O ~ Volume R'arr+enty Spec hpuse ~ yes Q no Lot lines idetrtifiable ~ yes ^ Ao S~jr'I'E11x M1~.IN'I')/ ~ nut:failure_to4saa~llewastes.Pr'op~rmu°Iwaacc Improper rue and maintcaa~ of your Kpdc eysteiu could result irl its preens ~Vhai you ~ into t!u ~ oo~lsb of pumping out tbn tcptic tank every three years or wooer, i[ aGed~od by a liconsad ptettrPer. can atTcct the fttac-tioa of the septic task as a trutment ataQe m the *rnste ditpotal syL~- 'Ilse propary owaa agsca to tnbosit ~ Sc CYoiu 7 ~artmettta ceciification fotta. ciEued by ~% o~ ~ by s lumber resizietodplumbes or a licaa:edp~p~ `~~ that (!) the an~site wastowatocdiap~ eys~ta maseCrphetnbtr, joumeymanp ~ dmececs~ry). ~ septic tatdc is less thorn 1/3 ix)1 of eludae. it in Proper ap~SbaB wndidon tad/ot (2) ^13er~nsputioa and gumPint• (• 1/a~, tbo vadorsi~ed Gave read the abovr rcQuirrrmeaCs eet fortlti h~i4 s: ect by the Ucpartu-eat of Comore et;ting ehs septic ry'tcmtxea m' d.ve_nf t~E thr~c v~ar c~iia dace. vale eo~8e ~P°~ ry°t`m *nth tbs ttlandaids ~} agme to maintain the pea and the Department of Natural Reaaurca. State of Wiscaa~O~ua}0 be camplctcd and returned b the S~ t~0ix CamtY 7.oniug iVAf ivy ~ that all t ass o this forth arc true to the best o[ meryof Deeds OfSce. ^bov a aarraaty dad recocdcd is Regisf ~Q l ~~ DAz'E I (we) am. (ere) the otvaer(c) of l3 ~.3' DA JlV ~ ~!~ tbo' revoktdby-tltt.?.oain6 Aapatmsctst. •••••• •••••• /may intormatt;::u is m;s-repcaseneed may result in the saaituy P~ ~ •• Ypctudc aitb Was ^pplicaUon: a ctaraped waitsary decd favor tbt ~5~~ of ~~ office a copy of the ccrdfind Hovey map if rcfeiooee is tttade is the wazranry deed TOTAL P.02 Str-LYYLYXJG YJ7•GVJ ~l~(JW V~ wiu- I ' STATE: BAR OF WISCONSIN FORM 1 - 1998 -,. ~ WARRANTY DEED DeCt/rlertl NuntMV Vni. ~ ~~7ne,t 613 This bead, made Detwcen Sane Corporation, _ .,.._.v a Minnesota corporation .,... __ ..,..._. -.._. - .__, Grantor, and _Sienna Corporation, a MiJlnt~ggta co,~roration __-.,, ._,,,, ..- - . .... .... ..... ......, Grantee. Grantor. for a valuable conslderadon, Convcyi to Grantee the following des(xtbed Yea! CYWLM in St . Croix County State of Wisconsin (the 'Property`): See Attached Exhibit A Together with all appurtenant tights. Utle and Interesu 6660.80 KATHLEI:N~H. WALSH RfcGIST6k OF DEEDS 3T. CROIX CO., MI RECEIVES FOR RECORD 12-21-2001 3:10 PM YARk{WTY DEED EXERT i CERI co~r ~: COPY FEE: TRANSFER FEE• 9b63.40 kECORDING FEE: 17.00 6A6ES: f nrcnrdotg Ht+i .r ...,..~~,-:..~ .~-.:::- NOtne and ROturn Arldrasa Uni~r~ i~-N~ 5~Gb 5 me+l~i ~~ ~- ~i~ col I~livtne -EO~nk4 ~~ 553 0 20-1048-30-000 Parcel IdeMiatalian NnlDar l~tl ~,~ is not homestead property (IS) (h not) 20-1048-60--000 20-1048-90-000 20-1049-90-000 20-1050-00-000 20-1050-80-000 20-1052-20-000 20-1052-TO-000 Gramor warrants that the Utle to the Property u good. tntlcfea+ible in !ee simple and tree and clear of axwnbrazxes except See Attached Exhibit B. Dated tot: 20th _ - d,y ~ December 2001 Bane rporation (SEAL) _.._... (SEAL) by ~ 3o M. Nassef ~~~ Its of ExecutivQ Offi (SEAL,) _.._._ __. ,, (SEAL) __ _.. AUTHENTICATION ACKNOWLEDGMENT I Slgnattue(s) ...- --~- State oflfVinn~a lI as. ~.__ - •-• t~ .~.~~.< Count ` J authentit'atcd this ^. , aty o! _.... Pcrsorwlly carne rrte tNs ' "~+ day of December .. __ 2001 the shove „~,,,~ _ _, John M. Nasaeff, Chief Executiv_E,Officer of _Bane Corporation, a Minnesota corporation _ TITLE: MEMBER STATE BAR OF WISCONSIN __ ''" ~ ..... __ to (1f mt, _ me krtuwn to be Y pE~ wttu ex~YUted the foreRolltg authorized by §706.06, Wts. Stttu.) instnttttent a`/nd _ same. TIa+S INSTRUM[NT WAS DaAFTEO By C J ~y E' Lockridge Grindal Law firm -~ 1d°0M1a0M~~~ 111!1 Wp~`I'--==v===-AV-anus-South.` a Minneapolis, MN 55401 NoytyPuDltc.$tateofW[sconstn .. _ y t:ommisalon is pcttin:uunt. (If not, xran -xpiratitm dau: (SlYnatw•es nmy br autnen~leeted w xiurowtsdQed. Both an: rwt January 31 , 2005 J necessary.) - .... _ .. w..«<, w Pd:.«~ npntrta ~ any capucey aunt t,r ryp A « pr~tw t~w~ tn.:.:gt„+u~rr. STATF. lAR Of WISCONSIN WLSCpwN WDM e4rd Co.. Inc. WARRANTY DEED POIiM Ne. 1 - 199a blswaultsa, Ms:. JL~-GV-GC./VG ~..I~• ~l 5It(VIVM I.UKY' ~ JJG VJJ , V6.IU , . ~~ ' Y^~• ~ 797P ~ ~'~} ~ File No: e5-oa900 A.,E 1 EXHIBIT "A" A parcel of land in the Northeast Quarter of the Northwest Quarter, in the Northwest Quazter of the Northeast Quarter, in the Southeast Quarter of the Northwest Quarter, in the Southwest Quarter of the Northeast Quarter, in the Northeast Quarter of the Southwest Quarter, in the Northwest Quarter of the southeast Quarter, in the Southeast Quarter of the Southwest Quarter and in the Southwest Quarter of the Southeast Quarter, all in Section 20, Township 24 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin, more fully dc,cribed as follows: Commencing at the west Quarter Corner of said Section 20; thence North 89 degrees 25 minutes 02 seconds Easc, assumed bearing along the East-West Quarter line, a distance of 1319.52 feet to the point of beginning also being the southwest corner of the Southeast Quarter of the Nozthwest Quarter; thence North 00 degzees 36 minutes 14 seconds west, along the west line of said Southeast Quarter of the Northwest Quarter and Northeast Quarter of the Northwest Quarter, a distance of 1325.15 feet to the southerly right•of-way line of the Chicago-13orthwastern Railroad; thence North 79 degrees 56 rtinutes 29 seconds East, along said southerly right-of•way, a distance of 451.00 feet; thence northeasterly a distance of 607.03 feet, along said southerly right•of-way, along a tangential curve, concave to the northwest, having a central angle of 09 degzees S9 minutes 03 seconds and a radius of 4670.25 feet; thence North 70 degrees OZ minutes 26 seconds East, along said southerly right-of-way, a distance of 429.Oa feet; thence northeasterly a distance of 445.52 feet, along said southerly right-of-way, along a tangential curve, concave to the southeast, having a central angle of 14 degzees 30 minutes 21 seconds and a radius of 2759.75 feet; thence North 84 degrees 32 minutes 47 seeond~ 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 Easc, along said south line, a distance of 593.00 feet co the east line of the Southwest Quazter 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 SS seconds East, along the east line of said Northwest Quarter of the southeast Quazter, a distance of 192.71 feet to the north line of Certified Survey Map in Volume 1S, Page 4172; thence South B9 degrees 37 minutes 27 Seconds west, along the north lines of Certified survey Map in voiuma 15, Page 4172, and Certified Survey Map in Volume 15, Paqe 4173, a distance of 1113.42 feeC to the west line of Certified Survey Map in Volume 15, Paqe 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 Eeet; thence South 08 degrees 41 minutes 12 seconds East a distance of 413.63 feet; thence South 08 degraQS 43 minutes 31 seconds East a distance of 229.88 feet to the north line of Certified Survey Map in Volume 11, Page 31?6; thence North 89 degrees 52 minutes 10 seconds West, along the north lines of Certified Survey Map in Volume 11, Paqe 3128 and of Certified Survey Map in volume 12, Page 3292, d distance of 68?.86 feet to the northwest corner of Certified Survey Map in 5tr-m-~e-x von. ~ 7Q7var,~ fj3 5 Volume 12, Paqe 3292; thence North O1 degree 24 minutes 30 seconds East, along the northerly extension of the west line of Certified Survey Map in Volume 12, Page 3292, a distance of 5.66 feet to the easterly extension of the north sine of parcel recorded in Volume 1390, Paqe 163; then South 89 degrees 30 minutes 27 seconds west, along the easterly extension and the north sine of parcel recorded in Volume 1390, Paqe 163 and the north line of Certified Survey Map in Volume 3, Page 776, a distance of 508.92 feet; thence North 00 dagrQas 07 minutes 56 seconds East a distance of 1003.47 feet; thence North 89 degrees 54 minutes 15 seconds west a distance of 270.16 feet to the west line of certified Survey Map in Volume 5, Page 1317; thence South 00 degrees Z7 minutes 53 seconds East, along said west 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 Quarcer; thence North 00 degrees 36 minutes 14 seconds west, along said west line, a distance of 820.23 feet to the point of beginning. SEP-20-~2 by~~1 51tNNH ~uKr • ~ - ' Yoe 17~~`r~~~t 6:16 Exhibit B to Warranty Deed dated December 20, 2001 by and between Bane Corporation ("Grantor") and Sienna Corporation ("Grantee") 7JG oa:~ i r~o r . t.l,.r 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 Wisconsir-; 4. Utility, drainage and roadway easements which do not interfere with Buyer's proposed development of the property; 5. L-ncroachment of Qwest Cotnmunieations, Inc. fiber optic cable along the northerly property line; 6. Agreement between Bane Corporation and John and Pearl Gies dated August 22, 1997 to exchange property following final determination of the location for Carmichael Road; and 7. Ameritech General Non-Exclusive )/asement Agreement by and between Bane Corporation and Wisconsin Bell Telephone Company a/k/a Ameritech 'Wisconsin dated December l d, 2001. TOTAL P.05 t CJ 1 ~ 1 a ,+ :Z , ~ \ 1 N - ~. - _ ,. ~ , . l ~.. ,~ ~ ~~ o ~ ~~ M ~' ~ /. .. i' ~ '1 ' \J ~ ~~' ' ~O. VJ ` ~ ` ~ , ~ ~ ~ \ ,\ ` ~ ~~ ` ~ ~ 1 \ ~ 1 t ~ ~ , :` \ m ~ ~' ,o. \ ~ J 1. ~ 8~ ~ ~ .~ rn ~; ,. \- ~~ ~ J t. ., .•)• .y~•, ~ ,` , /,, 1 1 1