Loading...
HomeMy WebLinkAbout020-1420-40-000i I I I 3 m m a ~ N c tD fD ~ ON a of i O Q v ~ W I ~ I I ~ I I I I o I I o I I N Q Z ~_ 0 I W °- Z I ~ M v I S' I I I I I I I I I d a ~ N w O t ~ ~ N c n O 3 o m p n N cn o~ Q~ c ~ o m p n N ~ C, p ~ N ~ ~ C. O N ~ ~ N 7 C O ~ N C ~ N Z N Z D N Z N Z D c`o' D co D ~' m w' D ca D y a o W ~ a a W . 3 O O O O = O O O O C cn v_ c ~ c ~ o ~ ~ ~ ~ m C1 Q Z 0 o' N a Z Q P~1 W_ C cn v_ c ~ c 3 ~ m ~ x- m d O m c m m Ul Q~mD N 7 ~. ~ N fl- y 7 ~ O . ~ (D cp ~P ~ V1 y ' N 7 m ~p ,~ m m v v~o oZ ..~cmmm ~ ~ 3 ~ v0, 0 o n. ~ ~ ~ y N v °_ A O N ~ d ~ -" ~ m o m a ~~ ti o 0 ~ _ O cD ~• a 0 O O O ~ O O ~ W n Z 0 uni 0 m c m m N m 6~ m D N 7 C.-N fl- 'O 7c p_ ~ O_ ~. n N ~ ~ ~ .~ p O N ~ 7 y ~ ~ ~ ~ m ~.xmmm ~ ~ ~ 3 ~ m 0 0 0- ~ ~ y ~ 01 ~ A ~ ~ a m ? ~ n v, O o 'G to - ~ O ~ O O Q 7 O O ~ O O *- n N O $ ~ n ~ C w ~ ~ ~ ~ C '~' O 3 C! ~ ' ~1 r1 ~ ~~ ID ~ ~ p n fD ~ C ~ ~ `. A ~~ ~~ ~ ~ , ~ ~ R gin ~o O W~ C O N ~ ~• w ~ ~ ~' ~~C111 Oo N I ~ i 7 , A p M .a ', ~ _ W ' N O I ~ ~ 3 N ~ '~,,,, c b i .6 o p R m e D o i I I a a ~. ~' ' ~~ ~ N _ N CO p O O O O. 0 0= c> r to N o c A W C 3 .~ C • a ~ ~ ~ ~y.,~ O O O -' '~ `~ ~+I ~voo~ a m '~ °> ~ ~ ~ ' I ~ ~ H 3 °-' ~ .. 3 M ~ ~ O - O O ~ p N c ~ (~ N ~ a s ~ m ~ ~ -I fA (D C a v ~ ~ .' A ~ i ` W ~ N N O m ~ ~ `D z O ~ :* ? ~ Z ~ ~ ~? Z A I i ` C ' l a i A b I 0 ~ A N O A 1 A ti i N Wisconsin Department of Comme PRIVATE SEWAGE SYSTEM Safety and Building Divisic~i , , ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ~ "p Permit Holders Name: City Village X Township Sienna Corp. Hudson Township TANK INFORMATION 3.M.1~- a<<5'~''o ELEVATION DATA'+O" TYPE MANUFACTURER CAPACITY Septic ~ ,t , ^t ~^~_ Vim-' IZ,pV ~ 8pv Dosing Aeration Holding _ra U TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic -~ Id , a6~ a r. f ~ r r" Z ~ Dosing ~ / ~ ~o-i, + P-- ____ Aeration Holding PUMP/NFORMATION~~2%~~ ~ Manufacturer Demand --- t: c G Model Number ~P o TDH Lift Friction Loss System Head TDH Ft ~. -Z(o - Forcemain Length Dia. Dist. to Well t v ' Z'' N o~ ' '~ SOIL ABSORPTION SYS~TEI~I----- -}o ~ d p a~ ~ t ~.. - ~i~.a.~ ~ ~ c.~.^' St. Croix x•30238 0 020-1420-40-000 Town/Range/Map No: 20.29.19.2672 STATION BS HI FS ELEV. Benchmark p~Q~} ~ Alt. BM dg. Sewer }©• OZ t/Ht Inlet ~o.too 9 SUHt Outlet Dt Inlet Dt Bottom ~~ /09 ~ qQ ~ ~`~~.1 95.86 Header/Man. Dist. Pipe / "~ .S'~w / o. C~ ~ Final Grade ~ ~ ~- N,. D.' [t3.r~ St Cover ~"3 / 08 8 vw~ t.0 ~ Ja 8. ~ `~ .r': ,r' 13 -+- °1-3 !'7-5 BED/TRENCH DIMENSIONS Width r ~ Length ~ ^~ f No. Of Trenches .~_ PIT DIME SIGNS No. Of Pits Inside Dia. Liquid Depth - SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~^~' ' ~~ ~~o T O ype f System: G..~J'e~{+u~ ,,~,lGi ~~~~ Ne? ~- N~ {, UNIT Z 4 ash Model Number. : ~~ S DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent Air Intake Length .~ Dia Pipe(s) Length Dia Spacing ~- ~ ^~ ~~~ SOIL COVER ( x Pressure Svstems Only xx Mound Or At-Grade Svstems Only Depth Over ~ ' Depth Over xx Depth of xx Seeded/Sodded roc Mulched Bed/Trench Center ~Z - ~ ~ Bed/Trench Edges Topsoil ` ~; ~ Yes No [ j Yes ~ No _ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1. ~ Inspection #2: ~~ l I O ;r // Location: 865 Carmichael Road Hudson WI 54016 SE 1/4 NW 1/4 20 T29N R19W The Gl~ Parcel No: 20.29.19.2672 aJ( 1.) Alt BM Description = ~ ~~ Y'~+`~"`~ ~~~•, ~~'~i~ ~,Q,(,~,~ (~l~j .~/G(L~ ~~/~/~.°,,~~ ~ ~ 2.) Bldg sewer length =~ ~ ~~ (~'SCIiyLGYs,~~ ,Sj'C/ ~~ l/`t"~ -amount of cover = 7~6 ~p ~ ~~~ ~~ ~~ Ji~tr ~/. BU / ~~~ __ --~ _aCe ,-- _ _,. T -, - r __, Plan revision Required? Yes I ~i No 4 ~ ~ ~ ~ .-- ~ ~ / ~ _L.~P)~ I Use other side for additional informati ~-`-J-Da~ L/ I ~~~sepctors Signature - ~ ~~ ~ ~o. J SBD-6710 (R.3/97) . aJ -, L ~~ ~ ,~ r ~,,, . a.. :~~ ~ %~.vyd Ca r~ ~a~T 7~ Ti(c- ~/,l~,r/ Tw,.~~.f a~~~s6~ -~ !n g Z ~ ~ Z fn ~ T. "o ~ Z 3 ~. < ~ O y u 7 ~. ~ N ~ N O ~ Q .O-. _ ro ~ ~ d. .O. _ N y N ~~ c_ ~ ro N ~ m ~ 7 O N N C ~ ro ~ ~ N p O V w 7 O l A N O O n N o ~ ro c ~ ~ ro c ~ ~ I ~ v I tnz cnz D cnZ cnZ D m co D cci D ~' m co' D cfl D ~' I A a I W ~ a a 3 . . .. I O Q Q O i ! O O O O I a Z Z I O j ~ ~ O j A ~ 7 C ~ O 7 C I p j ~ ? ~ m ~ j ~ m ro ~ m y C < ~ N ~ fl. _ of N ~ n _ .... m ~ O O M M O --1~ M I ~ S ~ ~ 3 ro ro ro C c I W CD W CD Q ~ a. Z ro ~ Z ro ~ O N O N =i N ±i N ~. o. ~ I O I i ~'~ a~ cD D a ~ ~ ~ o- co D Q ~ N N o a ~ N o o. C1 ' 7 N O O ro ~? O 7 n ~ d~ O ro 0 7 O O N ~~' N O O > N ~~ N I % 0 ro N (D f0 D O % ~ I ro d CD N O I . 7 . C ~ _ x 3~ y . . ~ ~ 3~ N ~ ' I o ~ ~ ~ o ~ m ~ ~ ~ 7 N 0 7 ~ N CI d ~ N N O O O U. ~ ro ~` 7 O N ~ ro ~` 7 O ro d .0.. < ~. ,O-. y O N O 3 ~ ~ ~ I a. ~ 0 0 O O 7 7 t0 ro I ~ O O O O ~ I O O ~ O O L c~~nOi o m ~ i ~ ~ A II ~ ~ ~ ~ 3 ;: °Y owcni, CD O ~ W N '', a 00 '' 3 f/1 ~ d ~ ~ a ~ a m ~ ~ ~ N tD '~ O O ~- '~' W c a 'O ~ b j O O O - ~~~~ -oo_v,a ~;,~ °' ro ro ~ H A 3 M 7 -.^1 O ~ ~ .7 Q O ~ .f..I N C c n N ? p, N O Q O ro C N O. ~ ~ lD 1D a 3 °o :' B !~! Z ro A ~ G T C 7 C. 3 ~ o 3 ~ 3 ii N v m ~ A = N O C O N N N O O ~ ~ '' N ~~o O ~ ,Q .,1 O N p ? O 'O ~ O C ~ ~ ~ .. ~ m ~ ~ N A Z n -- ~ ._~ A Z O •' ~ 7 m N O t0 Z a ~ ~ ~ d ~ !~ ::. ~ ~n es '.: ~ ~• '3 n ~ O O b 0 ~• _ ~K A ~^ A b O" A N rA ti °o a A Op d0 H ~ W N ~ N y --_.._.. ----~ T- ~ ~. ~druy+ ,,n;l Bcldings Di, isiun I C:.~unty a ~~• i 2U. W Washirgtor. 2~C1~3o x'162 S~G~_4^~~ ~~l~j~~s~ ~,~' ' ~ Matfisor, VYI 37G7:~+ '°` Sanitary Pennil Number ito he fined rn ay Co.~ e~~w~ . _ _DeAarttrtent of C'pmmer ~, (608);: 6-315{ ~ -.~~ ~,~ f Sanitary Permit r'1 liedti n ~~`~ ~~ ~Plan1•ll.:Vurnber~..~_ _ --'. ~~~~ ~ In aceord with Cwnm 83.~.J. WIS. Adrsl. t;cede, t p~ ! ;nfortnat' n you,~~ra~rde ¢1 ~ ~ ~ may h:: +sscr.J &m st;:urwary purposes Privacy I.aw, s15. (1 lttfY .' -~ ~°-~---- __ _.__..._ ._ ~P~jtct Address (if difs en tha.r :nailing address} F'~ +r ~ I. Application Information -Please Print Ail 1ltiPormatiou -~~~ -~~ ~ -'~ ~~ _ ..., O~.~ G'drv~y!/,'C~ct~l ~~~ G i'toperry Owntr's Na me .~ •-"--°-_----°-------.- _ Parcel ;d ;,t -- --- 13itxk it Property owner's M aaiing Address ~-+------~-- ~~ ~~ ~ Property l.ocatzou ~ ~ ~ ~ ~ ~ i ~~~ tom- ~ t Ciry, State -"~.. !~~ ` S'~~~ ~~a S. ~k ~ ,SECtion 2!~ ~iP C'ocJc Phone Number I I1. Type of ~uiltlin~ (check all that apply) ~~_~`_ ~ ~~7 .~.-'± T -1 ~ N; R~ E ~~ I - - ~ Sa~-~ ati ~'`ic ~ - _-- _ _ I or 2 Family UweJ}ing - Numtxr of Bettr;wms ~yn-7'`u-r ~ 5uh',livisian Name ~' ~ - CSivl ~tunuer 1 ~~~~~~ ~ . Yublie~Comnlerciai - 1lescrib,; {;c ?~~-~~,~ _ - - -- -- /-~/( ,/ _ _ __ _ ' ' StBtc (>wned f)esoribe Lsc D lST+ CCl~C~d __(N 22, ~{- 2.3 i~ ` ~ - r, f ~ ~ r --_ ..,_, ..______ _ Ciry L)Villabe uws. hr,7 u,~~ ~~ t illy Type of Permit: (Check only one box on line A, Cantplete line B if appllrable) ~j~~r~~~~~ ~ -- ~ "~ I ~'~ew 5ystetn ~.~ Replactmetlt System ~ Treauarenvllolding "rank ?titplactment Only ~ Otl•~r ~laiificatton to Lxistitl stern j B• ~ ~_, Perrnir Renewal ice' Permit Revisiu I L~_ t'i.aage oC ~_ Nerm+t'I'ransfer to New ~''t Previ~:us Y~rmit Number and :~~;+> 1ssu~d rr { Before Fxprraticm ~ `~~ ~ FlurnFx;r gwner ~ l~ ! ~/ I tti'•_~ of POWTS S~stent: (Check all that a !vj - I -~ --`--- - -- _ ____... _._ ,. __..__....~ _ _„_.,; Non -Fressurszed In-Ground 1 ' LI in. of suttabie uitf i_! Mourld < ~q +7 :>f s;~itable soli [ At-Grade ..I Singfe : ~:s Sand Filter ~' (:unstru:ted Wetland L Pressurized ln-Gn>ut~'i C~ I{oiling 3atilc C Peat Filit:r i_~ Aerub:c Treatment E)nit ~ ~ kccircutating Sand I'i[tor ~' -._ ~ fi' Ra~,ireulating Synthetic :Yirdia Filter ,~Luacilin ~hambet ~ 1 Drtp Iatr '~ Clravri less Pi ^ Outer (ex lain) ~~Drc~ye_r_sal/Treaitnent Area Informat~u~, ~ _ ~~ !' - ---~- --•- - ---~ 70 Dcv r. Flow ( ~"~ - ~..., _. _._ - - _ _ 8 Spol is ~n iotl Application 'f)~~~~~i Arva crt ~ircq] sf~1 Dis ~al Art:; Plod l'sfl -Steam Fltivat~ic.n j ~~~ r I 3 'fit ~'' Vl. Tat-k {ttfa ~ Capacity in Total T~Numlxr :~t;inufucrurer Prefah Sitc J!tci T :'iher plas[iC I Gsallons Gallons of Uuta ~ I~ Connect Consou:aed (rias New £xisiing t _.~ __ _I Tank, ~ Tanks ' ~~ S .pt c or HOidiP.~ "i ,uth _ i •..,_____~._ ~.T_,..___.._...__. _._~ ---- ____._ ., _ f ..~.__~-_ _ .._.~_..._~._ I c' 1' Ac:roL•+c ]'reaptA~nt Unit ~ T~ ~i ----~--}- -- "--•-..~._...,., , ;___ . ~..~~~-G~ ~~ ' '~ ~--~-- II ---- Dr,s;l~t Chamber __._.._~..._~-- ~ _ _^~..._ .~- ---~ ~____ _ r- _ _ _ _ .~ __ _. _ ~ .._ __- - ~ _ ~_ i I VII kesponsibitity Statement- [, the urtdersltpted, assume retiponstbrhty for t llati_u_:r of thr POWTS shr+wn un the attached plans.. y i 1'lusnher s Na me (Print) __...__-+- Piumbt:r s Sr gnarrrt M.- M PIiS 4',;r?rixr~ -~"t""`-_'~~ _.______- '• IIusiness Phone ~:utn!,er ir~ %/.tee ~i. S'~ ~~ ' ~. ~~ ~~~__.~---.t-.. ;.,~is~~~M3/mar I ~ Plumber's Aldre ss (Strctt, City, State, Zip Code) ..~~~ ~ ~?7l~_--------_. i ~. 'Vii , ount~lbepstttrrient LJse 0~~ '~ ~~_ -___ _. 1------ ------ _ __ _ _ __ ------- r Sanitary Perrnir Fec (+-clu:lc .-~ruu+uiwarer ~ ~ •--f`- _ ~ _ I ~ 'dpi°roved ~; L)isal,prvveci llat Issu d I u;n~ Age ,fir. +re (*' mps) ~ - + Jurcharge Pee) ~ ~ Y ~~ ~_~~~ lJ Owner Given Jieasar: far Drniai I _- I ~ ! IX. C.s2nditiioa~c of Approvai;'lteasons for Disapproval ~ 2 ~ 6 ~ !Z~Z~~ ~ vvu ~ ~2~,a-u.c~Ce-1~ v~/cM ~ cam- ~ ~ou~T~ ,~ :~~ .._--- ~ I '~ eptiS c tank, effluent filter and ~ ~ ~,1~-Ca~~- S~ ~~e ~~h dispersal cell must alf be serviced /maintained ~:/ / / !/ ~ ~~ ~ , as per management plan provided by plumber. ~'`'~~ ~~ d~-c~ ~` !~` ~ ~ I ~0-~ec/ -~.(GE'N~' ~ 2. All setback requirements must be maintained /~'~/C~it ~/-(v `~ (/yl~ SG~~ ~..I?'l~ as per applicable code/ordinances. `S'(~,e G~~~ QUV!° ~'S i Attach completr pltins ('c: the ('o~ Drily! for the sysaem ou paper not less ttbttt jf2 Il,.inches sn size SAD-398 (k, 01 /03) ~ ~ ~ `-./~- ~~ ---~~-~ • 'r, ~~ ~~'.U.r/~- ~c3 J',~ ~4'~ ~~ ~A G- ~/ ~C ~'~ TtJ't1 ~ 1~i~G~.~`a-~/ ~a~.t ~ ~ = 4'O ~li''l / ~~OfIG /s~/'- a .-- „ W. Department ~ ~~~ T„-„ION. REPORT Page _L of ~ Division of 3afuly and Buildings (.~ 7t~~de ..- 2 in aa;ordanoe comrn e's, tt County ~ Crv ~' p~cry sMe P~ an than 81/2 11 ' size. Plan rtrust include, but not Bmi6sd ox P~~). ~. Parosl LD. p~ D - ~7 2 0 - ~v - OQ d percent sbpe, scale or dimensb s, n~lt arrow, and and distance to`n roe / ;1T. +.;ri~~ ~ ~ ~ R Pleas ~ lnfb OnzON~N ^ ~'~~~~,, , U~w~ Z Panond inrormatlan you prwidr+ nor bra uwd for xi' A~WoNS ~~1~b~ (1) (m ~ • Q Property Owner Property lion , Z (P ~ ~- S i t ~ h u C~ t Govt Lot S j 1/4 ,(/(,t/1/4 S ~ T z N R E (or) I Property Owner's Mai6rtg Addre Lot # Block # Subd.-~N-dam"e ar CSM# I City State p Cade hone Number ^ City ^ Village [~ Town Nearest Road ~~~~ r~ct ~tM~ ~5 ` ( ~-z oils a ` .~ New Construcsion Use: ~ Residential /Number of bedrooms --F- Cade derived design flow rate 7~ ~ ~ D d GPD ^ Replacement 1 ^~ Public or commercial - Descrbe: Parent material /I C) ~ ~ ~ ~ ? _ _ _ Flood Plain elevation it appl'icabie l / ft• General comments Sy~~ m ~ I .p V. ~3~ ~d - ~ ~~ (/y{~J .SR.~G~ ~ Q ~ Q/b~ d and recorrnnerxlations: ~` ST ~f r - - n Boring # ~ Bonng ® pit Ground surface elev. ~~ ft. Depth to limiting tailor l~_ in. Soa lication Rate i tion D d Texture Structure Consistence Boundary Roots GP D/ff Horzon Depth in. Dominant Color Munseli escr p ox Re Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 Q~~ ( 1j Z .._ 5 t~ Zwt L ~L tM. C r L S ~ V - lrr ~yl ~ - S,G1 3 ~~~ Cw _ ,(o C~~ ~ Boring # ~ Boring - ^ Pit Ground surface elev. ~ ~ l • ~~ ft. Depth to fimitirtg factor 1 Z ~ in. Soi tan Rate H i D th i t C b D Redox Descriptbn Texture Structure Consistence Boundary Roots GPDIftT zon or ep in. om nan o r MunseU Qu. Sz. Cont Cobr Gr. Sz. Sh. ~Elf#~ ~ i i 'l~ftlueftt #1= 80D > 30 <_ 220 mg/L end TSS >30 < 75tJ rnglL - tmuerrt iu = ewu ~ ou mgr~,nnu ~ a~ - a, ,,,y,~ CST Name (Please Prirtt) j~re ~C,ST Number ,~' "`" Date vabatbn Conducted Telephone Q er Address Z it ~' ~~ r -~ t U y ' 111 ~ov ~ - ~.. U .°z 3q ParcellD # property Owner 3 ^ Boring ~~~~ ~~~~~..// ~~)) n Boring # Graxrd surface elev. (1L~ ~ ® Pit Depth to 4rnitmg factor 1?_ ~ in. .• t Page _~ of ^ Boring R Depth to limiting factor in• ^ Boring # Ground surface elev. - Soil ication Ra ^ Pit Roots GPDffP Hor¢on Depth pombant Color Redox Desuiptbn Texture Structure Consistence BandarY •EtT#1 •Eff#2 Qu ~ Cont Cobr Gr. Sz Sh. in. Mansell > < 220 and 7SS >30 <_ 150 mglL ' Effluent #2 =GODS <_ 30 mgll_ and TSS <_ 30 mglL * E~uerrt #1 = BODS 30 _ n~ -Ihe Department of Commerce is an equal opportunity service provider and employer. If you nxd assistance to access services or need material in an alternate format, Please contact the department at 608-266-3]51 or TTY 608-264-8777. sso•~w ca.o'uooi ^ Boring ^ Boring # rGround,surface elev. _.._--R• Deptti t° tumhng facer cn• So0 A ication Rate ^ Pit GPDIfg Redox Descxiptbn Texture Sbucture Consistence Boundary Roots lior¢on Depth Dominant Color Gr. Sz Sh. •Eti#1 •Etf#2 in• Mansell Qu. Sz. Cunt Cobr ~ ~ PAGE 30E~ NAIvtE:C.,~ 1~~Q LO"I'fJ ~7j LGGALDLSCRII''1'ION:SrI~`t~~a~SZO~I~~Za'.1`1,It,~C(°~)~ SCALE: 1 "= y0 r - Btv! 1 DL-SCR1P'I'IOi`I: ~rir v~- 1 d re +~ ~' ~ ~ Bht 2 ELEVA'I IUN:_ -' - -- BM 2 DESCIZII''1'fON: _ p2~ d S~'STETvI ELEVn'I~iC)17:__ l3 ~ - Sl'S"1'EM "1'Y I'I;:_ /'_„T .~ ~~u ,.tea.. ( -- --- , ~,~.aai~ n ~ ~ SIGNATURE; SEPTIC fiA,'yK £ rL'MP CN.AM?iR CK~~SS SECTTUN A;~D SPECIFICA%ICIv:?~ _~-= 4~" CI VENT PIPE 12" MIN. ABOVE GRADE ~ > 2 S' FROM DQOR, WINDOW OR FRESE3 AIR INTAKE FINISHED GRADE ~ ~~, CI RISER INLET ~/'.~' WATER TIGHT SEALS -PPROVED 'IPE 3' DhiTO 5QLIQ SOIL PUMP OFF ELEV . _-.__ ~T . WEATHERPROOF JUNCTxON BOX AFPROVED WITH CONDUIT / PADLOCKV~R ~•~- --WARNING LABEL ~c ~ .` i• 1 ~ , w~ 1 1 1 k 1 GAS- ~ ' TIGHT ~ `, APPROVED A SEAL ~ JOINTS WITH ..~._. ~ ALM APPROVED PIPE B ~ ON 3' ONTD "'~'-` ~ , SOLID SOIL ~ ` OFF ~+~ RISER EXIT p£RMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED $£DDING UNDER TANK SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: •~i~_/ ~,,,. TANK S i ZES : SEPTIC 1or5 d __ GAL . DOSE dc~ GAL. ALARM MANUFACTURER: _•,~~.! ¢r.~ "~'"~ MODEL NUMBER: L U SWITCH TYPE: er _~,,,,_„ PUMP MANUFACTURER : _ /~ val 3' _-__._ MODEL NUMBER : ~' SWITCH TYPE: ~r r_ REQIdiRED DISCHARGE RATE ~~J GPM CONCRETE PAD NUMBER DOSES PER DAY : .____~ DOSE VOLUME INCLUDING F LOWBAC K : _ 159' GAL . CAPACITIES: A = a~ INCHES = yG~ GAL. B 2 INCHES =GAL. .~ C s ~_ INCHES = tGS ~~-I+• D = ~ INCHES l~('--,,,•_GAL. PUMP £ ALARM WIRING AS PER ILHR ib.23' WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 12 FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET + ~ (~ FEET FORCEMAIN X 2.6d FT/100 FT. FRICTION FACTOR ._. ,~?' FEET ---- TAT.4L DYNAMIC HEAD - ,,~ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH - ~; WIDTH; DIAMEmER ~' LIQUID ISEP'TF~"_ 3~ • ar~~/~.eY 1 •, SIGNED: ~~,~~~.1~ LICENSE NUMBi,R: ~??9~r~ DATE; .~ ~ .Q3 1/88 f f Safety and Buildings Division County ~ P.O. Box 7162 Washington Ave. 241 W , . S,~ ~ Madison, WI 33747 - ~S~~~ Sanitary Fermi Number (to be ftlled i~y Co.) r {608) 26b-3151 ~ D ~~ pe artment of Commerce State Plan 1.D. Number Sanitary Permit Application - i rovide ou al information C d 1 Wi Ad 3 y p e, person m. o , s, .2 In accord with Comm 8 may be used for secor-dary purposes Privacy mow. sl.5.il4ii)(m)- ..,._, ~.'"'.. Project Address (if different tban mailing address) I. Application Information -Please Print All Information ~ ~ s l~ ~"' ~ L.~.#.~ L Rp Property Owner's Na me 2 ~ ~ _ .._ ' Pa'~rcelDQN Lo N Block N ~~ C r /~ "~ ~ / Gt. C.i Property Owner's M ailing Address Property Location ~! ~ ~~ ~/i '~' ~-(/ !/Y .SLC ~ ~7LG ~v0.8' ~ u,~ti,Section ,~_ City, State Zip Code Phone Number T 2 ~ N ~ R lL_E l ' „ S vw~ y) ~ [W II, Type of Building (check all that app 11 S ivision Name CSM Number 1 or 2 Family Dwelling -Number of B Dome U se ^ Public/Commercial -Describe ~ IC ~- ~ $ ~ ~ 2 ^Villagt~I'ownship of1`y~~~ ' ^City . ^ State Owned -Describe Use _ III. T ype oP Permlt: (Check only oae box o line A. Complete line l3 if applicable . 0 2 ~ - I ~f 2.D - - ~ ~~ ~Z A' (,~ New System ^ Replacement System ^ TreatmentiHolding Tank Replace ent Only ^ Other Mo t lion to Existing System 'l List Previo r 1B. ^ Permit Renewal ^ Permit Revision hange of ^Permi ransfer to New Before Expiration Plum 1 Owner rv. T of PCIWTS S stem: (Check all that a 1) _~ `Non -Presstuized ln-Ground ^ Mound > 24 in, of suitable soi Mo d < 24 in. of suitable soil ^ At-Grade ^ Single Pass SanLLd I'~l~r ,, s ~il~ ^ Constructed Wetland ^ Pressurized ln-Ground ^ Holding Tank at Filter ^ Aerobic Treatment Unit ^ R g 0' ^ Recirculating S nthedc Media Fitter ^ Leachi Chamber ^ Dr' n ^ Grave!-less Pipe ^ Other (ex lain) V. D1s rsallTreatment Area Informations art ~' ~ 6 e Design Flow (gpd} Design Soii Application Rate(gpdsf) isp rsal ea Requt d (sf) Dispersal Area Proposed (sf) S Q evatio { ~Qv , ~ji~~ ,v ~ ~ 7 / L Q „' ' l~s asiic VI. Tank Info Capacity in Total Number Manufact er Concrete Cons tt cted Steel Gallons Gallons of Uttits New Existing Tanks Tanks Septic or Holding Tank ~~ t ~ .e V ~~~ Aerobic Treatment Unit Dosing Chamber ~U / C~Jr`~'~e~/' x VIL Responsibility Statement- C, the~ttndersigned, ume responsibility for tallation of the PO TS shown on the attached plans. Plumber's Na ttu (Print) Plumber's Si re P PRS Number Business Phone Number I ~/. Pea i'+t 5'c`ia lr+,r6(~v ~a 7 J Q` ~; - 7 ~ J"- 3 d'G^ 3/~ l Plumber's Addre ss (Street, City, State, Zip Code) ~. ~~ ~ '~ ` ' ,~ , ~ 7d ~co~ u 5' ~ ` `~ ~ VIII. Count /De went Use Oni ` Approved ^ Disapproved Sanitary Permit Pe (includes Groundwater D~ayte lss}~ed ssu' g Agent Signa (No Stamps) e Fee) ~ - ~/ / Surchar 7 ,.-yam ~ ~ ~3 g '7 / ^ Owner Given Reason for Denial 1--.~ v IX. Conditions of Approval/Reasons for Disapprov `,1 1 ~ / ~ ' dst. (,M (~ ~~~ ~ ~-y~ ~ YV` ' a.4 ~ V ~ ,f~ nn II F~'~ SR~ - SBD-6398 (R. OIl03} ANaep coarplete plain (t0 ate [:ounty omy~ rot mo system on pupor nv. acas ...w, o=.... •• ., , .-- ,PM x~~yG ~935~ a-4 ' 1157 V+Cscansin Depaitrr~ent of Commerce ~ SOIL EVAUlATtON REPORT Page 1 of 3 Division of Safety and Buildings ;,, nrrnrri~nro..a-r, rr....,...a4 terK e.im r.~,rro Steel Soil Service County Attach complete she plan on paper not less than 8'/: x 11 inches in size. Plan musk St. Ct'oi)C include, bur rrof Gmdedto: verficafand horizontal reference point (tom, diiecfion and Parcel I D percen(.slope, scale-or dimen~sio~, north arr~, and location anct distance to nearest row . . pendiFk9 Pieaseprintaliinformation: R gy Date Personalinformation you prmridemay be used for secorx}ery purposes (Privacy Lear; s. 15.04 (1) jm)). PrapertyAwner ,, ", .t ~, ~ operty Location SiennaGorporation .", "'"'" ,. .tot SE 1/4 NWtt4 S 2(i T 29 NR 19 W Property Ownnes`s~ A~iciress ~ etc# ~ubd. fVame ~ ~SM# 4940 Viking Dr, Suite6O8 , ";~ ~ ~ r !; ~;; 78 na The Gin City State p Code Phone Number City Village ~ Town Nearest Road ~di?~ ;: NtM 3~; ; ~',~j ~~P' Hudson - t~rrtichael Rd. i~ New Construction Use: +/' -Residential l Number of bedroans 4 Cade derived design flow rate 600 GPD _ Replacement Public or commercial -Describe: ParEnt material Pitted oufinrash Flood {lain elevation, ff applicable na Generale comments ~"~.,, and recommendations: S~sfem~levation94.fiflft, frertches~paced~nd depth-to- ~ 4.5011-below~rade ._r" Boring # Boring. ~ Pit Ground Surface elev. 99.1 O ft. pepth to in. limiting factor Sod Application Rate Horizon Depth Dominant Color Redox Description Tezture Structure Consistence Boundary Roots GPDIftz *Eff#1 *Eff#2 1 0-19 1Oyr3/2 none sil 2msbk mfr cs t# .5 .8 2 19=27 tOgr4/4 ~~ sick 2msbk ntfr gw tvf .4 .6 3 27-41 1Oyr4/4 none scl 2msbk mfr gw na .4 .6 4 41-52 5yr414 none cos osg mvfr cs na 7 1.6 5 52-96 7.5pr4/6 none ms osg m1 rta na .7 1.2 Boring # _., Baring v! Pit Ground Surface elev. 99:10 ft. Horizon Depth Dominant Color Redox Description Texture 1 D-10 1Oyr3/2 none mil 2 t9-2t 1Oyr4t4 ~e sicl 3. 21-35 1Oyr4l4 none scl 4 354 5~rr4/4 none cos 5 44-96 7.5yr4/6 none.. ms Depth to limiting factor ~ in. Soil Applicat~n Rate Structure Consistence Boundary Roots GPD/ftz *Eff#1 ~ *Eff#2 2msbk mfr l:s tf .5 .8 2msbk mfr gw 1vf .4 .6 2msbk mfr gw na .4 .6 osg mvfr gw na .7 1.6 osg ml na na .7 1.2 * Effluent #'l = BCD ~ 30 < 23Omg1Land TSS >30 < 150 mg[L * Effluent #2= BODS< 30 mg/Land TSS < 30 mg/L CST Name(Pl~sePrint} Signature:. CST Number David J.-Steel ~ 248956 Rddress Steele Sale Service- Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 1540 7 9M 7/2002 715-246-5085 - ~ ~ ` .. - ~ - , 111,_ .. _~..-~• f./ ~ , \ , ~ ^ " ., n„ .. \ . . , t + -- / 1 \ \ \ , \ 1" r 1 t { I /~r' Iwo /~ \I I 1 ~~ / V \ T i \a , ~ \ _.. r ..- ,. ." ~ - 1 , 1t r 1 . ' i 1 5 .r '-1 / _.~ •~ •. ~ •/ / ,~r Mir \ '•r .a L~,1'/ -~ ,'e, ''y _.. _ '~y r ' i' 1 ' I .. ._ .. • ~_ a, y rl 1•i/, I r._ .~f`' .n ryr ,~ ,`\'•:'\~• f/~ ~ 3 V~7...... f'I- - 1 . g >- I \; \ •: . .._ .~...... !r~. 1 `~ ~ . _ . . , _ \ ~ ,. ~: ~ . _ • ! c t \ ' •' •' \ ~ -''~ -- 2oa _ ~ . -. - ..39 ., ~ ~ ~ - \ ,. _ ~ ~.---i--y 6 \ '. r ~ ,, 9 .i ~ 7.. ... a V/ •' r ~..-'~. ,... ~/ - - 1 ~a \`I \n.. ~\ i __ __ __ r ~ ~ ,, , . r r i \ ".111 ; .\ ~ _ r I . ~ .243 r~ - t38 - t,' ~ , ,t_'-s.~' X97 i' ., 1 \\L.i ~ I ~\ ~ .~ a 1 1 ~ t rl a ', 1 I~'; ... ! •' / I .' J + 4 _ it - ! T ~! t \ '1 ~: ~~/ r~f ' iii a~~\'~ 1 S 11'•I. 1_~~~-__ _.. .,~'„ , 1 '. t ,, / 11.. , :I r I i ~.1 \ 1 1 •'r' .It i ' I r ; '' - ~--•-'s2'faL„ 11 `., ~7L 1 I 1',~ ~ \ ., \ ~ \ I i r *,pr\ ~ \ /.li 1 1 i ~ ., . . ;r '/ ;rr ~\ r a7} 1 ' t `a\ .Z~ '' ~ IL ` \ a -- 1 is 1 • i ', rl '1 \~ - \ 0 1. t \. ' ;-- r , _ 11 / ~ 1 I~ I C I I `':y ~ ~ 5 L \ '- ~ a\. ~; l a \ i P \ A i I \a-~ ,,% 1 i I, , ` / ~~ , ' ~ \,` 14,,E ~ d,' : ~ ~ ;'i ^~~. . _ . If 1 r 1 111 I fll r ' :141 ~ i i 1ii;1 ° ~- g;n .,: _ . _. _ ~, I .. 1 ~1I .. I .vN ~. \ ~~, t + 1 1 '1 ` 11 r r ~/ ~!` ~:1 'I ~ 1 I I ^- ~ ,S ~~ I 1 1} 1 1 - ~ - I I (I I . / 1' ~ rI i ~~~ /, 18 /1 ~ rj ~ ~ 1 n, I I I ~ ~ - - Z~ Ili -_._- 'I ~ I III ' 1 '\ 1' '' i ,1 y ~ -~,--._-~ 1 I j ~ I II ~ 1 1 1 ( 1 - L . C~; '~ r~, ~~,a'.: w ~ ~,: w ~. Submew8ible Effluent Pump ~~~~~ 3871 E ~~ ~r ~,'~ ~ ~ X11 Frrmr •'~ ~ i~~ ~~ g .~ ~~ ~~ !;~ ~t~udmtrm. • up t~ g6 t'3PM. T~ Vim: up to 2~4 fpt, D41ohr ~ t°h"N~1', • M~~ri fwl: c~r6osr ~~+ 7 e~omlcs. rti~~l~) rx~nua~e . earl ~ ~~ ~ ~~~ • 8pNd1~tR~ t;rpagiffly, ~ iel: t~l?1o f~ i~PM. a~hted~ ~ ~ 3i f8et, • pia~e~pe r~ t',4` NP7a ~ ~ i0~101t1ry~ , 8~~~~~ . •. '#OIOI~F ~~ Cf~tlft>wCisr 1~~~ if1~Yq~t'1~. i; :i: Frfa; 300 serfee ~~a c~omp0aln~~~ ~ I51'1~01: / 1~4~ pt~?~~ p 6 hlz~ ~0 RpM, bt5it in overlord with rutomrtlc meet Sinoie~p~ Q RpM ~, fig V, bt~it ~ ourrEord with ~ Powrr ootld: ~C foc~tt e~ierd a i$J3 5170 u~th three pratr~ pround!np pl~~. Optiottti ~~ fopt fen~t,1813 81?W wfih ~~~0 9roundtn~ plu8 ~ on EP05a, ti ~~ i e~ e f ~r~~ror ~ fubrf~oA ~ rim ftlli tnMtb. ~reftrbie br eutamollo ti~ mm ~ #fort lwriab auuabNd ~ prrat et Uu irolory. f'i0tfliAtf ~ ~ Yhermo- wiU~R mp Wt ~ meoiw+fdsf reef pratet~ion. p~tritt~Jc ~w~~ d ~n ~r imprOVed pl~• ~ red ~ f~up~ed the~~ deeiln ptov4dre sdpa~or e~ aA~ t~rro~n•nstce, ~ ; Crrt irr~n for e~foiMnt ~ tnrr, ~r~pth, Intl tlttr+. ~`~or~; 7hrrmoplrs• ~ errf~~~t~ p ~~ ~Sft'e~ ^ r i~ ~OWrr d~r b beerfnp ~ation. Y L~'INO At~odatlom m ~ ~ umbers f i I ~ Y~ f ~ I 1 1 s ! ~ i ~ ~ i , --~--+ 4 ~ +, ~~ D ~ ' ! ~~_ 6 1 a ~ f 0 V ~ IN, ~ "~'~5'~,~' , a a~~, • .y . , POWTS OWNER'S MANUAL & MANAGEMENT PLAN Prsga or ~_ Fii.E INFORMATION owner ~~'~~ p. ' . _; Permit !~ {~ 22> DESlQN PARAMETERS Number of 8edroame y 0 NA Number of Public FaoUity Unite 0 NA Estimated flow !average) !M'O'd alJda Design flow !peak), !Estimated x 1.5} G* C3 d al/da Soil Application Rate elide /ft' Stande-d lntlwntlEff(uent Quality Monthly avarage• Fate, Oil l~ t3reaae iFOG) 530 m9iL Biochembel Oxygen Demand tetaD`) 5220 mg/L ^ NA ToUI Suspended 6olids tTSS) 5160 mp/L Pretr®stad Ef#k»nt Qualky Monthly average Biochsmioal Oxygen Demand i80D') s30 mg/L Tate Suspended 6o1&Is I'!'5S) 530 mg/L 0 NA Fecal Coliform tasamstrto mean) 510` cfu/tOQml Maximum Effluent Partials Size Yi in die. DNA ^ NA '"Vaiws Lypksd for domestic ~veirtewatar end septic tank affluent. SYSTEM SPECiFicArrvnrs $eptic Tank Capacity ,,2 J al 4 NA Septic Tank Manufactwar r O NA EfNusnt Filter Manufacturer ~.,,g l0 NA Efflulmt. Filter Modal ~' ^ NA Pump Tank Capsoity al DNA Pump Tsnk Manufacturer r ~ ^ NA Pump Manufsctunr ~..,~ / Q NA Pump Model ~ DNA Pretreatment Unit ^ 9andlt;4ravel Filter ^ Msohanicai Aeration a Dlalnfection ^ Peat Filter O Wetland a other: ^ NA Dltpersal Celt(s) ^ In-Ground (gravity} 0 At-tirade O Drip-Line O NA O to-0round tprassuri:edl D Mound Q Other: Otlar: Q NA Other: DNA MAiNTENANGE iCt1EDU1.S service Event service gngtratoy -~ inspect cottdltiort of tankts) At least once every: 3 a a (Ma>rbetunt 3 Years! O NA Pump out aorttents of tankts) When oambined sludge and scum equals one-third lYe) of tank vakame [] NA In:peat dispersal oslltsl At least once every: 3 mont~ia) fsMAaadnwns g yam! p NA Clean affluent Piker At least onoe ovary: ~~ °! DNA inspect pump, .pump controls & alarm At least once awry: _.-- rrWrtthi,i! d aNs} ^ NA Flush laterals and pressure teat At least onoe Query: mo ts! --- a earls! O NA Ottier: At least once every: _..- monthly! O rls) DNA other; Q NA MAINTE111ANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying ana of the following liasnses or osrtification: Master Plumber; Msster Plumber Restricted Sswsr; POWTB Inspector; POWTS Maintainer; Septage S~srvlcing Operator. Tan inspections must include a visual inspection of the tankte) to identify any missing or broken hardware, identffy any cracks or leak: measure the volume of combined sludge and aoum and to check for any book up of pondinp of effluent on the ground surfac4 The dispersal oeiits} shell be visually lrnpsatod to check the effluent levels in the obaarvatlon pipes and to check for any pondin of affluent on the Around surface. The pondinp of effluent on the ground surface may indicate a failing condition and requires th immediate notifioatian of the local regulatory authority. When the combined aocumutstlon of sludge and scum in any tank squats one•thtrd lye} or more of the tank volume, the entir contents of the tank ehaN be removed ~by a Septage &srvioing Operator and disposed of in accardsnoe with chapter NR 1 t Wiaoon~n Adminiatrative Code. AR Other SerVloea~~ in0ludina but not limited to the servicing of effluent fitters, mechanical or prsssurfzetl pomponents, pretraatmer units, and any servicing at intervals of s12 months. shall be performed by a certifrad POWT6 Maintainer. A service report deli be provided to the Local r~ulatory authority within 10 days of completion of any servico event. ,Page _...~ cf _..~._ START IJP AND OPERATION For new construction, prior to use of the POWTS check treatment tas~klsi for tl~e presence of painting products or other chemical's that may impede the treatment process and/or damage the dispersal caUial, if higt} concentrations are detected have the cantants of the tanks} removed by a septage servicing operator prior to use. Syatsm start up shall not occur when soli conditions are frozen at the infiltrative aurtace• Ouring power outages pump tanks tray till above normal highwater feve{s. When power is restored the excosa wastewater will be discharged to the dispersal cellts} in one large dose, overloading the csil(s} and may result in the backup or surface discharge of effluent. To avoid thin eitnuatiortoont ct a Plumbe$ or POW1'SPMaintalne~t Bassist in mla wally operatingrtherpump controls~to power to the effluent pu p restore normal levels within the pump tank• Dc not drive or park vehicles aver tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, tho area within 18 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the foflawinq from the wastewater stream may improve the performance diapers` d ainfectantsf tat pdWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental fines; foundation drain (sump pump} water; fruit and vegetable peelings; gasoline; graase; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ASAND011iM$NT When the POWTS fails andlor is permanently taken cut of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administt'ative Code: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of ail tanks and phs shall be removed and propatly disposed of by s Septage Servicing Operator. • Alter pumping, ail tanks and flits shaii be excavated and removed or their covers removed and the void space filled with soli, gravel or another inert solid material. CtMiTINOENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must bs taken, to provide a coda compltan~ repieoemeni system: A auiteble replacement area has been eva}uatad and may be utilized for the location of a replacement soil abscrptior system. Tha replacement area should be protected from disturbance and compaction and should not be infringed upon b~ requirorJ setbacks from existing and proposed structure, lot linos and wells. Failure to protect the replacement area wll result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems mus~ oompiy with the rules 'tn effect at that time. C3 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTi teohnology a holding tank may be installed as a last resort to replace the failed ROWTS. d stt r 1 ~ p it tar: ~M e p Mound and at-grade soil absorption systems may be reconstructed M place following remgva( of the biome( at th infiitraiiva surtace. Reeanatructiona of such systems must comely with the rules in effect at that time. < <WARNING> a SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN I„BTHAL aASSEB ANQlOR iNSLIFFlC1ENT OXYGEN. DO N ENTER FROM HEIiNTERIOR OFA A K MAY RE bIFPiCiJLT OR lMPO88lel.E.T~C~, NTH MAY RE$iJLT. RESCUE OF . PERSON AowTIONAL coMMIrNTs ~W,f,$ INSTALLER POWTS MAINTAINER Name ~ ~ ~y~1~ ~ do ~.-~ .~ Q Y• Name Phone 7 C ~ ~ ~ ,,~ ~ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REOUTATORY AUTHORITY Hama Name ((, ~~ Phone ~~ s' ~~' This daoument woo drafted in carr~plianca with chapter Comm 83.22t24tbitt}ldlStf} and 83.54(1}, 121 & 131, Wisconsin Administrative Code. ST CROIX C~ ~ ~~ ~EP~T7C TAIL OHIp ~ C„~,TIOl~ FORM O-waarlBW-~ J`! ~~A too ~eP~es~~r o _~. t _ prc~ptnty Address ~ 2. u t~ ~ ~3S ab+ f-rursso,,.1 u~~ Pa:u1 Ydantificstion Nwabac z:irr~.i. b~CRYP'~ ~,n,~ ~OCatioa 'u, rLY..~ ~'~ Sae:. ~, T 2~..~~K. ~..L--~' =owin of ~uL7S krup+~Y ----~ 9ubdiv~.~a~ T~~ ~ to eaNhR drtP°°~3'ey~m Coed ~ ~, potent a N'aca~t~ ~ 10~ s~i+~ta 30 be ~~,,,id ssuswad b the se t~ Como~- wed Suri-ey &iiP ~ Volumo ~,.,.~.~--= .per ~ -- -- 8 ~'~ Y~ O II0 Lot tines idtible ~ 3'~ ^ so ~.~,ea.,au ~r~rnrr~l~TA~C~ ~~~.ptopamsiatetu~~ csz~s~~~~-~rserP.~. lt~tapet' use and mafuekeaar~ of Your ~opdc cystetz- could raltik ~a ~ ~~eease~ ptuap~ Wit ~°y ~ ~a ~ ~ of~ out rba ~t~et tsalc erary three yang ar eoooet~ ~' need Y our r~ fi~on of tbe. eepdc tr~alc es a ~teaaat fbp im the +w~atre die+~oeai ~' a eeccti5ccatiAa tbt~- t by ~ o~ Ord hY a 'tea ptt~r ow~c a$ea m eobmn ~1>s~loes v s L'~aNad,p~~ ~t fit) ~ aa~i~a ~ ee~-tehprp'I+smba'rr~ p ~Qeedp if aeaae~rs-)~ ~ ~' ~ ~ ~ t1~ !4~ ie is ~~ aoadidaa and/or (2) e~Rar and pvmpb~ ( ,, tee ~ se~atds ~, the stadecai,~d haves tt~d the abate tetjn~eamat-!e ae~t ~oet4. barn. ac set by rho tlpt~mmaf of Go ~ ~~ ~~~ ~~ tluae y~r ~ thu eu way f~atoceees~t}aa ~~~ n~-rg ~thi5 farm are free to Cat bear of mY {our) b~e~b=~a. a Wattealy docd recorded is A4S~~ of Deeds D~• ~..~~~ j (~) axon (eta) tlzs owa~r} of DA'i~ ` L beuag teYnkad by the; Zat~i DaP~°t' e.rsrs ~.~plesaaeed easy renllt ~ the emit'ari- PRA •• >awluda .vtli~ chit appiiexflen: a WttA3ty dCi~ ~ ~ j~~~itQ Of ~~ hs flee ry ~~ a +q~Y of thee er.tal8od iusvcy peep tttLi~aer T07AL P.~2 (V'adl~*sdaa:+egatead lea Pleiottiag F~~p°"~ """ .. ~ ~~ Ancttmeat Number ~; ? 205?' S?6 9TAT8 $AR OF WISCONSIN FOAM 1 • 1498 WARItAIV'TY DEED Thla lamed, trade between Johtt Gies and Pesr1 Gies, htffiband and wife, Grantor, and Siearta Corporation, a corporation under the laws of Mitutesota, Grantee. ---* Grannor, for a valuable consideration conveys to Grantee dte following described real estate in the Ctwnty of 5t, Croiz, State of Wisconsin: See Exhibit A, attached hereto ', ias Pearl dies Fredrataoa 4: 8yroa, P.A. 4000 PNahury Canter 200 South ShM Street MlnDSapotis, MN 55402 parcel Identification Numlxr tPIN) O10.E4s8.30.000 This (isl (is not; homestead property. The parcel shown an this document Is being added to the parcel shown ore the document recorded in Volume 1797, Page 613, Document Number 688080, described as a parcel of land located: to create on parcel, and this transaction in thereby exempt from Chapter 16 of the ST. CROIX COUNTY LAND USE REGULATIONS pursuant to Section 18.05 (Ay(3). Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: restrictions, covenants, conditions and easements of record, if any. Dated this day of November, 2002. AUTHENTICATION Signature(s) aurhertticated this ,~ day of TITLE: MEMBER STATE BAR OF WISCONSIN (!f not, authorized byQ706.06. Wis. Slats.) THIS INSTRUMENT WAS DRAFTED $Y Fredrikson & Byron, P.A. (SMM) 4000 Pillsbury Center 200 South Sixth Street Minneapolis, MN 55402 r 6l x-asp-~ooo 2b82096 (Signantres may tx euthendcated or acknowledged. oath ue not necessary,) 699666 KATHLEEN H. MALSH REGISTER OF DEEDS 5T. CROIX CO.. MI RECEIVED FOR RECORD 11/25/2002 10t00Alf EIEMPT i REC FEEL 13.00 TRANS FE£r 87.90 COPY F£E• C£R7 CAP1f FEE t PAtiES t 2 ACKNOWI.EAGhiENT STATE OF WISCONSIN ) COUNTY OF ST. CROIX ) Personally carne before me this emu. day of November, 20U1, the above named John Glee and Pearl Gies, husband and wife, ro me known to be the person who executed the foregoing instrument and acknowledge the same. ~~ •Notar Public, State of _ _ M Commission is perttunetu. (if noi, slate expiration date: ~-. ~) Michelle Beck Notary Pubtk: State of Wisconsin ,3 •Nan>es of parsons si;nirtg in my capacity snat44 Or typed or prktud rietow 4rair stgmrtum wAStaA'P[Y DECO 87AIE aAR OF WLSCq`6m rY1Ri,1 N0.1 • lf9e Inior,rylgn PrOlBarianl~. CariCeW Fmtltlu UC. W;argnMn ltCa.655.202r r y y ~ ST9TE BAR OF WISCONStN FORM 1 - 1958 WARR~]AQN''TfY DEER Document Number YRI, ~ f V 1 PAS( s~,3 .. This Deed, made between Sane Co_poration, ____ _ _ a Minnesota corporation ___ _ __ ..._____.. _..__T`~--~~ _, Grantor, and iSiLgn,~C~o go~a;ion a Mi,>;Peso~georpo a iRiL_^~ 666080 KATHLEEN H. WALSii kF_GFSTEk OF REEDS ST. CkOIX CO., WI kECEIUED FOR RECORD 12-E1-^c01l1 3:10 PM EXE)~TTN DES CERT COPY fEEs CDPY FEE: TRANSFER FEE: 9d63.4Q RECORDING fEE 17 00 `' 1 _.___..,._. _____ _..._ _ PAGESs ~ ___._... ~.__ ~______ ___.~. Grantee. Grantor, for a valuable consideration, conveys to Grantee the followJng I ': descr{bed real estate In S C . Croix ,^ ~ _ County, State of Wisconsin , (the "Property")' ~ ltt;cc,dn.y,:;ea See Attached Exhibit A Name andriewr"Ad°' ~- (~ nitkr~tt l l ~~ Si.l.i-~ ~ni ~-(~nrte ~o,nk~,--- ~u55~~3 . __ _ _. O 20-1048-30-000 Parcel WanUlirefion Number ipIIVJ This 19 npC homestead property. ~. (is} (ts not} r 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 Together with all appurtenant rights, title and interests. i' Grantor warrants that the title to the Property is good, indefeasible In fee simple and free and clear of encumbrances except ' See Attached Exhibit B. "Dated cats 20th dayaf December 2001 I Bane r oration (SEAL) b_y ~ Jo M. Naase Ita C fef Executive Offi {SEAL) AUTHENTICATION ' Signature(s) authetaicated this day o[ , 'CtTLF: h9EMBER STAi'E BAR OF WISCONSIN (It' not, ,~ authorized by §706.Ofi, Wls. Siats.) ;v v~ ~~~~ (SEAL) (SEAL) ACKNOWLEDGMENT Minnesota State ofiMirtvTtartn- lI ,~ y sa. 1~ ... r.'-~ c~ County JJ^ Personally came before me this t ~ t ~ day of ' Deeembez ,2001 ,the above named John M. Nasaeff, Chief Executive Officer of Sane CorpoTationr a Minnesota ~_ corporation to me known to be ~ie perayrf;'~T who executed th¢ foregoing Irutrumant and ao r THlS INSTRUMENT Wq5 DRAFTED BY yF~` 2 Lockridgge Grindal Law Firm 1DQ.~lashi.a~t.O.n. a•,a^,rp a~_ ---~--- NAfigy I?. t;IALLAfiER Minneapolis , MN 5 5401 Nolary'ISublic, State of Wisconsin _ iisfy commission is permanent. (If not, stale expiration dato: (Slgnalures may be authenticated ar acknowledged. Both are not January 31 ~, ~_,) necessary} -.. _ . • Nomes of persa~s agning in any capacity mw, be typed ur printed bnbw their afgnau,rt. wAattANTY DEED STATE 8AR ON WISCONSIN Wisconsin Lapel eiana Co., ine, ~DRM No. 1 - 1998 sRwautea, Wia. b ', ~ ~~ Local°o in tM NaIA°ott Ouart°r of lM NorthrNt Ouorto, in iM NWlwrtlt OuarUr of iM N°rM°ast O SEE SHEET 2 s°i'Ofa,ei :o i `a`",o.-"«°f. ~a~ p °`pa`r°+` d st i o ~`c::-1y su :.y ~ a` ~ „ `rw.°fM s. ~.,`.~3.7 87 46264 S.F. I ( ~ 1 ~ I p~ _._--_.--._-----_--J L_---- 475805.F. \ 1 85 \\ \ o`r 1 - - - - - - - _ - J ` _ _ - - 46466 sF. 1 I asz44 5F. \ 41.n• ---- _._._. lso.ol' ------------~ `--- -------- 12 ~ . - - CARMICHAEL ROAD ~ _ __-- 14 ~ r------------------~ \~ { ~ ~ I 1 1 11 I 11 I 1 1 I 1 + \ 1 I ---- ~ SaL I 1 1 s9L --~ 1 IN 1 1,~ 79 \ \$ 1 \~ 47780 S.f. ~ {1.097 AC.) ; 1 % \ i~u~ 1 1 1°• ~~- 1 1 ~ \ 1 0\ ~ ) ~ 1 \ \ 1 1 i 1 1 \ i 1 1 i 1 ~iV~ i 1 1 i 1 1 n r ~ - i I ` i ~ .c i i S / ^ ~ ~ : 1 1 / .. 9 (~ •i ~ ~C i / J/ / / \ ~Z~ ~\ 1 I ' r ~ iii / 69.97 (' r, ~ ,/ ,~ </ '$ r~ / ,- >~ A rJ ~/ ~ / ~4C./// ~ ~C i~ J ~ CO a (~~/ ~ ~/ // ii (~ ~ / ~ O~. ~~ ~ // ~ ~/ ~ •7 / M / ~~ ~~ / / i ~ 'c / \ .' / \ 5 / / / . / . / 57391 S.F. / / (1.318 AC.) / / / / r / / / / / / / / / S~io //// ~,~v/'~-i / / M~// !~ 511228 F. (1.212 AG.) BLOCK 8 ~~ I { I I I ~ { s ( I ~ I { I { ~ s~ I I ssL I I la In { >n I; I~ 77 61665 SF. (1.416 AC.) ( I I I r { { l I i 1 { 1 1 i 1 1 1 I I~ I I I I f I I t 1 I I I I 9i88•}3'48'W 376.61 OUTLOT 5 PAID( AND OPEN SPACE HOMEOWNERS' ASSOCIATION 708822 S.f. (16.272 AC.) BLOCK 2