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Wis,:onsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
~ ~ r INSPECTION REPORT
GENERAL INFORIVIAT(ON (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: Insp. BM Elev: BM Description:
i v~ , b!~ ~~"~ j$
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic I . ~
V~~ t~ ~>r ~ 2 ~-~
Dosing 'Zd,, j,~ .- i a ~
Aeration
Holding
TANf( SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic .~+- ~O , !.~ G T
i ~\ ~ 5 ~ ~_ --
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufac urer Demand
GPM
Model Numb , _
TDH Lift I oss System Head TDH Ft
Force In Length Dia. ' t. to Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County: SI:. CroiX
Sanitary Permit No:
430249 0
State Plan ID No:
Parcel Tax No:
020-1430-30-000
Section/Town/Range/Map No:
20.29.19.2681
STATION BS HI FS ELEV.
Benchmark
Alt. BM
Bldg. Sewer ~ ~ , D y -
SUHt Inlet
Y.~S
ro~.3~'
SUHt Outlet
y.7
lost.
Dt Inlet
Dt Bottom
Header/Man. /0 3Y 9 $ .yL
Dist. Pipe
Bot. System ~
N~ ~~•
/L`~ q7.3
7.
Final Grade
~.~+r
102.3
St Cover
BEDRRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~ ,~/ `7 ~ ~
(( --'~"
SETBACK
INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING
CHAMBER OR Manufacturer: ~. l~ ~o
~h. t Ys•~
Type Of System: N CST Model Number: ~ T
DI UTION SYSTEM
Header/Mani Id Distribution x Hole Size
~
Length ~-„ Dia ~"~ Pipe(s)
Length Dia Spaci ~ ~ / 1
SOIL COVER _ ~ I .. ~ ,.) x Rces9ure Systems Only ` x Mound Or At-Grade Systems Oniv
Depth Over epth Over
~ r xx Depth of xx Seeded/Sodded xx Mulched
BedlTrench Center
__ Bed/Trench Edges
~t •---.....,.. Topsoil ____. _ . ~ ,
f l Yes L',~I No
~S_.! .JI No
COMMENTS: ~n~ude code disc ply-envies, persons present, etc.) Inspection #1: ~o / / ~ / ~3 Inspection #2: / /
Location: 431 Wren Lane Hudson, WI 54016 (SE 1/4 NW 1/4 20 T29N R19W) The Glen Lot 87 Parcel o: 20.9.19.2681
1.) Alt BM Description = ~a `P ~ ~°~ ~ ' '~`' bn„a.t r'",.--Ti S~7_'"' ''~" ~ C(!Q` lf~ r3~O // ~"(O
2.) Bldg sewer length = f 5 r
- amount of cover = ~~ ' ` ~ ~ ,,t~tsr .~ 6 p ~j ~~ T ot,,T ~4~~ ~U -..~~ PG,/1 L' y,C ~G
Plan revision Re uired~ G - i ~I ~ G T '
' q ~ Yes ~ No ~ I'O ~/~ ~ 3
Use other side for additional infor Ion. l ___~ ____ ,'
Date Insepctor's Si ature Ce . No.
SBD-6710 (R.3/97) ~ ~ ~ ~ ~~ ~G r ~ +.. f ~ S. ~Q n G y~~
1' j
x Hole Spacing Vent to Air Intake n,
,$~r ~,,~..v a_ ~ o rp ~ ~ ~" ~ 7 ~il ~ ~,~~~,/ ,TaW~ s r fi~a fro.-r/
.,
~/1~/q~~GG 160 `V
-r
~`~J
~~~~~~r
~~
~~~
Safety and Buildings llivision County
~ T~
~ P.O. Box 7162
Washington Ave.
201 W .~._
,
.
~ ~
~ ~
~~~ Madison, WI 5370? - 7162
/Q-
~ Sanitary Permit Number (to bt: fill:d in by Co.)
~
~
(~$) 266-3151 ~.
De artment of Commerce
D Static Plan I.D. ~ r
Sanitary Permit Application
ro '
ou
tion
] i
f
p
y
orma
n
In accord with Corttm 83.21, Wis. Adm. Code, persona
may be used for secomlary purposes Privacy Law, g15.04(i)(m). _ __ Project Address (i different than mailing address)
I. Application Information -Please Print All Information x ~ 3 ~ ~~~ ~~~
Properly Owner's Na tine ~ Parcel ~ ~ Block /!
~
~~/
~~~~ ~ ~ 7
~~
Froperty Owner's M ailing Address .~
...~.
_ ._ Property Location I ~~~
l9yd ~'k~ ~ ,~ su1' G G ~ £ ~ ,~ ~t4,section ~ ~
City, State Zip Code Phone Number
~~~~ ~/
~iS c
q~s~3~ -a~11o
T~N; R~Eor~
iI. Type of Building (check all that apply)
' `
Subdivision Name CSM Number
d
~1 or 2 Fatr»ly Dwelling -Number of Bedrooms 7 /~'>~~
~~ ~~~
G
~ ^ Public/Commercial -Describe Use
~ ~ ~~"t~~~J ^City_^Viilage Township of .~G~i/
^ State Owned -Describe Use v
III. T ype of Permit: (Check only one box on line A. Complete Une B if applicable)
A' New System ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System
B. ^ Permit Renewal ^ Permit Revision ~ ^ Change of ^ Permit Transfer to New
List Previous Permit Number and bate Issued
' Before Expiration Plumber Owner
FV. T of POWTS S stern: (Check all that a 1 )
Non -Pressurized ln-Ground ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Singlc Pass Sand Filter
^ Convttucted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter
^ Recirculatin Synthetic Media Filter ping Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (ex lain
-Fts YS
V. Dis rsaUTreatment Area Infor atlon:
Design Flow (gpd) Design 3oi1 Application Rate(gpdsi) DispersalpArea Required (sf) Disperse! Al re'a Proposed (s System Elevation
VI. Tatlk Info Capacity in Total A'umber Manufacturer Prefab Site Steel Fiber Plastic
Concrete Consuvcted Glass
Gallons Gallons of Uttits
~' D i)
~~
New Existing i
'~-'^"'~
I
Tanks. Tanks '~
Septic or Holding Tank ~ ~ S Bt
~~~~ Aerobic Treattnant Unit
Dosing Chamber (•~ •~
VII.' Responsibility Statement- I, the tmdersigned, assume responsibility for talIation of the POWTS shown on the attached plans.
Plumber's Na me (Print} Plumber's Si gttature M PRS Number Business Phone Number i
~~ yy ~ 7 9~d ~/5-.3SG - /~/ ~
J~t:G o .~
Plumber's Addre ss (5trett, City, State, Zip Code)
Q
7 d ~ Or ~d r
VIII. oust /De tment Use Onl
roved Sanitary Permit Foe (includes Groundwater Da Issu d Issuing A nt Si tur ( mps)
d ^ Disa
A
pprove
pp
Surcharge Fee) ~ ~ ~~ ~, g 1 ~ O
ou
^ Owner Given Reason for Denial
~
. Conditions..pof_Approval/Reasons for Disapproval ~J,,~ ' ' (_ ~,~ , _ < / qp « G G~~~~,,,, /
JQX~ li~''t,~.~`~/`TeJ /0 Q)'t~-~/' ~~ --ere ei1/~
YWT
1~iV4h-
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c.
,
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~~ ~~~ ~ ~~~ c~e~ ~d~~t:~,
er not less than 8112 x 11 inches is size ,-~
Attach completepl (to the ty only) for the stem on pap ~3~
~)
~ lf~,a.~y a.. ~ o rp ~ v ~ ~ 7 Zi~ ~ ~~~.~ ,TOwti / r f~a ~so-~1
~~~q~~~-~ e 'V
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'~~„'
1~;-
SEPTIC T.A.NK ~ 'r''UMF CHA~'1?%R CR~Sw SLCTIUN At~D~IFICATICNS
---~----
4" CI VENT PIPE I
SOVE GRADE ~ JUNCTIONHHJX APPROVED
•
OR
WINDOW
>_25 FROM DOOR,
"'- WITH CONDUIT MANHOLE COVER
FRESH ASR INTAKE --- `~ WJ PADLOCK ~
WARNING LABEL
FINISHED GRADE
~" CI RISER _,}~,~,r~" MIN.
~~
18" IN. S,r r,q~ , ~, ~
C NLEfi ~ +
WATER TIGHT SEALS GAS- ; '
-~- TIGHT ~ ++
T
~
A SEAL t ~ JQYN
WIY~I
S
...,3_. ~ ALM APPROVED PYPE
,PpR4YED 3' ONTO
ON
'tPE 3' SOLID SOIL
~"" ~ ,
DhITO 5(}LIQ
~OII PUMP OFF ELEV . ~ T . ~ ~ ~~ RISER EXIT
OFF PERMITTED ONLY
D I F TANK
MANUFACTURER
HAS AFPROVAL
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE
TANK MANUFACTURER: ,,J, ~s~~ _____ _ 2~ .
NUMBER DOSES ?ER DAY
"'ANK SIZES: SEPTIC 1a5 d GAL.
~ DOSE VOLUME INCLUDING
FLOWBACK: !5'9~ GAL.
"" DOSE ~~ GAL.
ALARM MANUFACTURER: ~~ CAPACITIES: A = .INCHES =_,~G GAL.
MODEL NUMBER; ~ U B ~
2 INCHES =GAT..
SWITCH TYPE: ~~rw -- .~
'
~
'" INCHES = (G8 GAL.
~
C =
vu:
~
PUMP MANUFACTURER: G ,
,_
_..__._ MODEL NUMBER : ~_~!•~,,,,,-,-.. D ~
f~~~AL
INCHES =
SWITCH TYPES ~!l?~,- ~ __ _
_
REQUIRED DISCHARGE RATE "~J GPM PUMP ~ ALARM WIRING AS PER ILHR 16.23' WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE l~ FEET
+ MINIMUM NETWORK SUPPLY FRESSURE FEET
+ ~ tl3 FEET FORCEMAIN X 2 6tl FT/10a FT. FRICTION FACTOR / 7 FEET
•------`~ T.OTAL DYNAMIC HEAD = , z~FEEm
INTERNAL DIMENSIONS OF PUM? TANK: LENGTH -----' ; WIDTH ''"- DIAMETER ''-'
LIQUID ISEPfiif 3k " -~ ~ /~~I ~GG~y ! "
SIGNED: ~~J~ ;~C~~ LICENSE NUMHi~R: ~~' g,~D DATE: .~ ~_.~,__
,..
1/8~
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abdr~a a~beel~
• {~A~ a>s NAninp
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Pump' ~1
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up tr- ~ l3PM.
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14t1'~ ~~°~~ ~ht.
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RPM, split in overload with
acrtomatlc roast
• ` 6~np~a phase: Q.$ Hp,
115 V, 8i3 HY,165Q RPM,
built IA pv~ttload with
• Pam Moot
eta~d lertpth,16/3 5.3TC~
vv~ three proms pr~txtdinp
p1tf5.Optlonal ~~ foc#
lenpth,1813 SJTW with
three pprOnp Qroutfdin0 l~~A
~atandard on Ept~57.
rya Q~~~
Effluent Pump
~~~~
3$71 E
• Wily aubmer~pad In hit
grade turbine ou for
I~~ erx! ~Ider+t
had't tnrpi#!r.
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m 1 #~~
ft0~t $N-lt0~h gaambfrd 1Uld
prrat at ~ .
t~l'CWttS
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p! Slmi"aprrt daslpn
wrth pump ~ vur~ea for
mectiu~~ ae~ prottdio+n.
t lropNilr T~errno"
plastic ~nwlegd deR~~ ~
improved performa~+c;e.
• i~~ ~d 1Mar: Rugped
tharnlopiaaBC din provMeea
suparbr atron~ end
c~asrasl~n~ niisi~ce.
{~/~dlor~n~r`l/~l~outln~: ~a~t Iron
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~ , ~ 1103
WisconsinDepartrnentofCommerce SOIL EVALUATION REPORT page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service
County
Attach complete site plan on paper not less than 8%: x 11 inches in s¢e. Plan must St. Crooc
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
~Z -~i/3~, p~~ing ~l~
Please print all information. _ _ _ _._,._ -°, R awed y Date
Personal information you provide may be u ary {lrnposefv'c~lAw s. t5_~4 (1) (m)).
~tn •G
i ~a.a,.~
Property Owner Pr rty Location
Sienna Corporation _,~ y ~b 2r,`;~ Go . ~o SE 1/4 NW 1/4 S 20 T 29 N R 29 W
Property Owner's Mailing Address :3 ~~-' `°` `1 lock # Subd. Name or CSM#
4940 Viking Dr, SuRe 608 „ _, ~ , ~, 7 na The Glen
City State Zip a P~I'rbftejy~rarber ,~~ ity Village Town Nearest Road
>r~rh~ MN 554 =°~3S 2&oY Hudson Carmichael Rd.
New Construction Use: ~ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD
R~lacement Public or commercial -Describe:
Parent material Pitted outwash Flood plain elevation, iF applicable na
General comments
and recommendations: System elevation 99.79ft, trenches spaced and depth to code 5.16ft below grade
Boring # -_.: Boring
/
98
, Pit Ground Surface elev. 104.95 ft. Depth to limiting factor
in- Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt2
*EfF#1 *Eff#2
1 0-12 10yt3/3 none sil Zmsbk mfr gw 1f .5 .8
2 12-28 10yr4/4 none sicl
~' Zmsbk mfr cs na .4 .6
3 28-98 7.5yr4/6 none ms ms ml na na .7 1.2
^ Boring # _! Boring
98
Pit Ground Surface elev. 104.95 ft. Depth to limiting factor in• Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ttz
'Eff#1 `Eff#2
1 0-27 10yr3/3 none sil Zmsbk mfr gw 1c .5 .8
2 27- 10yr4/4 none sicl Zmsbk mfr cs 1f .4 .6
50-98 7.5yr4/6 none ms ms ml na na 1.2
~/
~~
crrruem ~ i = rsyu 5> su < zzu mgrs ana r ~~ >su < ~ ~ mgiL `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) /Signature: CST Number
David J. Steel ~ ~ 248956
4ddress Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 5401 9/7/2002 715-246-5085
~~
Property Owner .Sienna Corporation Parcel ID # pending Page 2 of 3
Rnrinn it ) BOring - - -- - -
' Effluent #1 = BOD S> 30 < 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 =GODS <30 mglL and TSS <30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access servir~s or
Borina # Boring _ - .. _ _
Borina # Boring - .- - .. - -
STEEL'S SOIL SERVICE
u~
~3
~n
Page 3 of 3
David J. Steel 1564 Cty Rd GG
CST-POWTSM Sienna Corporation New Richmond, WI 54017
Lic. # 248956 SE1/4,NW1/4,S 20,T29,R19W (715) 246-6200
Town of Hudson, St. Croix Co. (715) 246-5085
The Glen lot # 87
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
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~,p'IiC TAIL- A~
OWNSR3f~ C'SR'~~TION FORM
u ear ,Sl ~J~1 R Co ~ pQ,P~~r o ~ IJ ~f3 S
OwtlarB Y b r.3 /`~
a Vt K ~ ~- ~~ ~~ ~~
lul~ilinS Address
~a~~t~Q~u~ ~*~ , ~
X20' ~
C~tYIS~~ uV D"'O~ G~~ Ya=cel Ideohfiaation Number
~~ sc~YPTICIN ~ ~.(p S ~ p
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~°~ 1 _ Lot # ~f ...--
Subdivisi~ ._-. ~}=~
Certified Surtsey Map #
Warranty Dead. # U! ~' .. ~~~ .
~ ~,,~ ~ ya ^ ao
Volume „~.--------'.page #
Volume ~ Pt~,ge # ~ ~
Lot lines identifiable ~ Y~ ^ ao
~~'~E11~ 1VIA~iNT~r1AI!L~ nc emwutdresultiaitspremanuafe3lt~m~~~`~-~°~"r~~~aacc
~ptoperttsa ~ ue~ ery ~ Ye ~ ar sa~anct, it' aKbded by a liroase~ Pte~PoG Wit Y°u ~ mto the
ottt the a~~ caste disposes sY~TM
~0~° °f ~~ scale ps a cKatmeae stage m the
rsrl affect t'he fut;ctioa of the trptic n fotm. ri~~ ~ ~ tip ~ hY a
t a care
Tito P °'~°~ ap;ea to spbm3t to S'~ Gtaiu Zotuszg AaPattme~~ ~t (1) tlse on-tats ~ ~
otxtsaya~nP1v~r ~s~i°dPiumberoralite~+edP _ y),~ ~~ t~sa 1~3 Rti' of =1nd8~
m~ptoo+be~.3 ~ tank. uG less
is la ~ ~S urpd~nan aad/ot (Z) aRcr iasp~ ~ P'~'~ t
D aPas i~1 ~~.4tidc t'h,e starsd+Y~
a tD ma~t~ 1!~ ~KtG ao'W~ ltiaA
I/at. tlsa aedncsipa~ have toad the slto~-c requfta~et~ ~ t of Nstmrat p~avi~ StYte of W o~,~~- 30
set foctb~ bctein. ~ ~ by ~P' ~ °t a F Ca t be compl R~ to the 5i Ctoix COY Z°1°'~
stag t'ba ~ ~
DA-L'E
_ e. I wo am. (aie) tho owa~6~ °f
FICA ~ to tht best ai my (o~)1mOakd$ ( )
that all t-ts o this form roe~otded it1 R,pg3stet of 1yo'ds OfS~-
abov a vauaaty ~
_ DA'1~
a'[ A pX" sr~' s~•~•
t b°~ tevaloed by the ZatuaB DG1'
••+••~ A~uy intosmatioa tis mis-~Qtasc~ated may rcavlt 3n t33e uuitsri t?~~
.. t;~,uaa:: warcaatY dead &°'m' the jtegttte~r of lx~ o1'ficc
Ypcludc ~vitb this ^pp c cagy of the cettt~ CNri1~ ~P tEtz[c[o~~ ~° ~ the ~nry ~'~
TOTS. P.82
POWTS L~WNER'S MANUAL. & MANAGEMENT PLAN Pag® ~ of ?!
Fii.E iNPORMATlON
Owner ~:~ ~~ _a~.=__=__L...~~i ~~- _
Permit ~ ~
DE8K~N PARAItiA@TtERS
Number of 8edrooma ~ 0 NA
Number of Public FaoUity Units NA
Estimated flow !average) at/da
peeign flow Ipeskl, (legitimated x 1.bi ~ • ~ al/da
Soil APp 8~" ~ al/da Jft~
dard intluentlEffiuant tluafity Monthly average'
---~FiLa,~ll~-0raasa-ti~ y S30 mgiL
t3iochembel Oxygen Demand (t30D`i 5220 mg!!. DNA
Total Suspended Solids 1Tt381 s1 BO mg/i.
Pretreated Effluent tlusiity Monthly average
ioChemiCa) Oxygen Demand t90D'1 s:3O mg/t.
Total Suspended Solbfa tT8Si s30 mgll. NA
Fecal Ca!lform (geometric meant 5-t ` Om
Maximum Effluent Partials 8ise Kin die. DNA
Othe-: 17 NA
"Vacua typical for dorneatio wastewater and septic tank efrlusnt.
SYSTF,N[ SPEC[Flca-7~[vnea
Sapt}c Tank Capacity ,Q (J ei O NA
Septic Tank MMUfecturer ~ ~ ^ NA
Effluent Filter Manufacturer ~,~ DNA
leffks;er+t. Fester Model S' 0 NA
Pump Tank Capacity ai O NA
Pump lank Manufaotursr rUO ^ NA
Pump Manufacturer ~..,c~ / O ~
Pump Model ~ 0 NA
Pretreatment Unit
Ci 8ar[d/t3ravei Filter
D Mechanical Aeration
D Dlsinfecticn
O Peat Fliter
D Wetland
D Other:
Dispersal Cellts!
!n-Ground (gravltyl
^ At-C3rade
O Drip-Una DNA
firrOro[u[d tpressurizedl
D Mound
^ Other:
Others DNA
Other: DNA
Other. DNA
MAiN E 6Gt1EDUi.IE
t3ervke Evart 8ervior Fraquatcy
inspect oot[dkion of tanklal At least once every: 3 a s tMaximum 3 ysasf DNA
Pump out oontenta of tanklai When combined sludge end scum equals one-third tYyi of tank volume DNA
lnepsot dispersal eellts) At lsagit once every: ~ sv{~Isi tMwbnuM 8 ysan} DNA
Clean effluent flksr At least once every: ~ fey e ~ NA
inspect pump, pump controls & alarm At least once every. ..~ monthlai
d aortal Q NA
Flush Irs-terals and pressure test At least once ovory:
.--- D i~rtal ai O NA
At least once every: _.-• myth{al
O earls) DNA
her: Q NA
MAN~IANCE tWSTRUCTIONS
inspeetlone of tanks and dispersal cells shall be made by en individual carrying ana of the following Ueaenaes or certifications
Mastet Plumber; Mash Plumber Restricad Sswsr; POWTS inspector; POWTS Maintainer, Septaga Servicing Operator. Tan
lnspectlons must include a visual inspeotian of the tank(s) to identify any migieing or broken hardware, identify any cracks or leaks
measure the volume of oombktad sludge and arum and to check far any bank up or pondb[g of effluont on the ground surface
'Flee dlspersat cslltal shell be visually inspaoted to cheek the effluent levels in the observation plpea and to check for any pondin
of effluent on the ground surface. The ponding of affluent on the ground turtace may indicate a failing condition and requires th
immediate notitioation of the local regulatory authority.
When the combined eaeurnulatian of sludge and scum in any tank equals one-third tYsl ar more of the tank volume, the entir
canlenta of the tank shell be romoved by a Septage Servicing Operator and disposed of in aacordsnoa with chapter NR 1 t
Wiaoonsln Administrative Code.
Ali othK Nrvlaes, including but not limited to the servicing of affluent tfiters, mechanical or prsaaurixsd components, pratraatmer
unite, and any servicing at intervals of sit months, shalt be performed by a eertitrad POWT$ Maintainer.
A service report shalt be provided to the local re~ulatary authority within 1Q days of aampieticn of spy serWce event.
Pogo _ ~of
START liP AND OPERA'CION inducts or other chemicals
For new conatruation, prior to use of the POWTS check treatment rankle} for the preae~ce of painting p
that may impede the ueatment process and/ar damage the dispersal ceil(si. if high concentrations are detected~l5sve the contents
of the tank(si removed by a reptage serviain8 operator prior to use.
System start up shall not occur when soft canditiana are lroxen at the infiltrative surface•
Ouring power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
disoharged to the dispersal cellist in one large doss, overloading the collie! and may result in the backup or surface discharge of
effluent. To avoid this eimatio~co tact a Plumbe$ or POWTSpMaintalnest dassist~n manually operating therpumptcontrolslto
power to the effluent pu p
restore normal ravels within the pump tank.
Qo not drive or park vehicles aver tanks and dispersal cells. Do not drive or park over, or atharwiso disturb or compact, the area
within 1 b feet dawn slope of any mound ar at-grade soil absorption area.
Rsduation or elimination of the following from the wastewater stream may improve the p®rformance and pf0s d sinfectantsf tat
pOWTS: antibiotics; baby wipes; cigarette buts; condoms; cotton sawscbnadg~~se rherbic'dea,' meatiacAaps; medications; oil;
foundation drain (sump iwmp} water; fruit and vegeiabte peelings; g
painting RroduCte; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWT5 fails and/or is permanently taken out of service the following steps shalt be taken to insure that the system +s
properly and safely abandoned In compttance with chapter Comm 83.33, Wisconsin Administrative Code:
e All piping to tanks and pits shall be dlsocnnected and the abandoned pipe openings sealed.
• The contents of ail tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
e After pumping, all tanks and pits shall be excavated and removed or their covers removed end the vcid space filled with
soli, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must ba taken, to provide a node camphan~
repiaoerrtet-t system:
® A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptior
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon b~
required setbacks f o a new soil and strte evaluation io establish a sultabieseplac~ement area~Repkacement systems must
result In fire need
campty with the rules in effect at that time.
Q A suitable ~ holding tank rmay,be inatat odlasla last resort to aepiacedthe failfedkPOWTS e " Bring advances in POWT!
technotopy 8 d sit
D T sit tan
•
q Mound and at-grade soil absorption systems may bo reconstructed ~ place following removal of the bbmat at th
infiitrativa surface. Reconstructions of such systems must comply with the rules in effect at that tune.
< <WAtaMIINO> a
SSPTiC. PUMP AND OTM1bR TREATMENT TANKS MAY CONTAIN LETHAL QASSF.S ANDlOR INSUFFICIENT OXYdEN. DO N
ENTER A BEPTiCH~UIMl~OR~OV FA T~ MAY t3E DIFFICUII" OR MPOSS BLE.TANCF.S. OEATH MAY RESULT. RESCUE OF ,
Pt;RSON FROM
AI)OtTIONAL COMMENTS
POWTS INSTALLER POWT8 MAINTAINER
Nsme Name
Gtr ~1~'u .,-, ~ a~
Phone 7 ~ -, ~ ~,~ ~ ~ Phone
SiEP7AGE SERVICINf3 OPERATOR !PUMPER? LOCAL REGtJ1ATORY AUTHORITY ~~
Name ~ ~"6rv l ~ ,,.~.r.
Name
Phone Phans ~ ~`~ '
This document wsa drafted in oornpliancs with chapter Gomm 83.22i211b}ii lid}&{fl end 83.54f11, (2! & (31, Wisconsin Adrniniatrative Code.
~~
t !! STATE BAR OF WISCONSIN FORM 1 - 1998
~' ~ ' 666080 ,
' WARRANTY DEED
j
KATHLEEN N. WALSH
~ ~
n
Doctxnent NUmoer ~; Y~l. 9~PAG[6~3
.
!~ STGrCROIX0CODEEWI ,
-. -.
,_.
kECEIVEO FOR RECORp
This Deed, made between Bane Corporation,
a Minnesota corporation 12-i'1-+2001 3:10 PM
- ~ WAkRi1NTY DEED
~ -- Grantor,
'and Sienna Corporation. a Minnnant-
n i EXEMPT Y
CERT COPY FEE:
;
nn -_
orpo ;
~, ~~
TRANSFEk FEE: 9AIi3.40
RECORDING fEE: 17.00
- --, Grantee. ~S' 4
Grantor, for a valuable consideration, conveys to Grantee the following
dexribed real estate in St. CTOix _ ^ County, State of Wisconsin
{[he 'Property': ' Nee oKlmy Ma,
See Attached Exhibit A i' --- - -°: :- - - - -
~"~~iriAdd'eS'
(~r~i~r~.L +~ ~~
'i 5'1(X~ 5me.+~rr Ur+~
~i.~i-1~ SDI
~.liv~ne ~tmkaf__ ~1~ 553'3
.... __..
O
20-1048-30-000
Parcel klantlication Number (PiM
This i8 riot homeuead property.
(ls) (Is not)
20-1048-60-000
20-1048-90-000
20-1049-90-000
20-1050-00-000
20-1050-80-000 i•
20-1052-20-000 i,
20-1052-70-000 ~~
Together with all appurtenant rights, title artd interests.
Grantor warrants that the title to the Property is good, indefeazlble In fee simple and free and clear of encumbrances except
See Attached Exhibit B.
Dated this 20th day of December 2001
;I Bane rporation (SEAL)
i by ~
Jo M. Nassef
Its of Executive Offic {gam)
Signature{s)
AUTHENTICATION
i~ authenticated this day of ,
~ TITLE: MEMBER STATE BAR OF WISCONSIN
(If not.
authorized by §706.06, Wis. Stets.)
ACKNOWLEDGMENT
(SEAL)
(SEAL)
Minnesota
State of-WistrolrsrlR-
7 ss.
P `
`t ~
ersonally wtrte before me this =
•
day of
December 2001 ,the above named
John M. Nasseff, Chief Executive Officer
of Bane Corporation, a Minnesota
corporation
to
me known to be ~te pe+~tl;~~_ who executed die foregoing
Instrument and ay
HARRY E
THIS INSTRUMENT WAS ORAFTEO BY ~~ ~ -~. +K~
Lockridge Grindal Law Firm
l_00_ IeTashin tnn Ova nP S0LLt1L _ '
Minneapolis, MN 55401 No~ry'~uWlc,StateofWixansin
IIVt'y cort+misston is permanent. (If not, state expiration date:
{Signatures may be authenticated or acknowledged. Bolf+ are not JanuB_y 31 , X005 ,)
;' necessary.)
.. :.-.
... ,..__
' Flames or perwts slttMt~ In ury eapacxy n+un be typed err printed below their slgnanue. .:.... .. ..... .. ~ .. .... _.. ..
-` WARRANTY DEED STATE BAR OF WISCONSIN w„c,,,a;, I.apY gunl, Co., rnc.
~~ FORM No. 1 - 199(1 , tyy.
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