Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1419-70-000
Wisconsin Department 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: Heiti, Robert & Penn City Village X Township Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: $t. CfOIX Sanitary Permit No: 515272 0 State Plan ID No: Parcel Tax No: 020-1419-70-000 Section/Town/Range/Map No: 20.29.19.2665 HI I FS Ig. Sewer Ht Inlet Ht Outlet Inlet Bottom I Grade Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No ® Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 852 Chebek Lane Hudson, WI 54016 (NW 1/4 SE 1/4 20 T29N R19W) The Glen Lot 71 Parcel No: 20.29.19.2665 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ~ Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. eommerce.wf.gov Safety and Buildings Division County ~ ~G' ~ 201 W. Washington Ave., P.O. 71~b12 } B J X J ^ ^ /, ' ~ Madison, WI 537 1 ~ (to be filled in by Co.} r • Hilary Permit Numbe ' ~~ ~~ Departtnertt of Cornrnerce + 7 5~ Z / Sanitary Permit Application State Transactio N tuber • submission of this form to the appropriate governmental Adm Code 21 2 Wi 83 , . ( ), s. . In accordance with s. Comm. unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal informatio __ . dart ur oses in accordance with the Privae Law, s. l 5.04 I m , Slats. ~ ~~ ~ ~~ ~ J_ ~j~L,,, I. A lication Informal' n -'Please Print All Information Properly Owner's Name,- e~ Parcel # ~ ~ ~~ Property Owner's Mailing Address . •~ a ~ G~c S~. ~K~~ ~~~~,~ 55~ w ~ Property Location ' ~~~ L t G t ~ , F ov . o __ City, State /~ Zip Code / ~~ y,, ~ ~ %, Section 20 le , ,~- ~ ~[n~ „ 77''`~~ w one cuc ~ ' ~ FJ S ors. !•1/ J-- E or V T ~ N; R i ~~ ly} (check all that a ildin f B II T Lot pp g u ype o . q ~l or 2 Family Dwelling - Number of Bedrooms J 7 / Subdivision Name / C ? ~,,~ Block # .g,. ~ t ~ir ~ ^ PublicJCommercial -Describe Use _ ^ City of CSM Number ^ Village of _ ^ State Owned -Describe Use ~/ ~ I Town of ~~T LAS" e . /1/ I _ 2 d-tS t' ~~ ~ S t./ ~ ~'j" ~ ~ G~i.~ C -- III. Type of Permit: (Check o ly one box on line A. Complete line B if applicable) A' V9-IVew System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POWTS S stem/Com onentlDevice: Check all that a I Non-Pressurized In-Ground ^ Pressurized Iri-Ground ^ At-Grade ^ Mound? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Disperse{ Component (explain) ^ Pretreatment Device (explain) V. Dis ersal/TreatmentAree Information: 2 w:'e $ ~ Design glow (gpd) Design Soil Application Rate( sfj al Area Required (s Dispe sal Area Pr osp,~ (st) System Elevation 5 ` ~ / . 7 ~~~3 ~ ysa a,s ~~. ~a~ , VI. "Conk Info Capacity in Total # of Manufacture ~ ° Gallons Gallons Units N U ~ V V _ L. v1 .a New Tnnks Existi Tanks ~ C ~ 5 ~ ~ ~ ~ w V ~ n ~ ~ ~ .~ ~ u. C~J `~ ~- D d Z Saptic or Holding Tank ~ I ~~ ~ • ~ r ~, Dosing Chamber G.~ ~ ~ .4 ~., x VII. Responsibility Statement- I, the ugdersigned, assume responsibility for installation of the POWT wn un the attached plans. Plumber's Name (Print) Plumber's Signature M PRS Number Business Phone Number ~~~ ,~= T a?"Q a rs- 3~c 3 z iu md ~ti ~ c Plumber's Address (Street, City, State, Zip Code) '7 s' VIII. Coon /De artment Use Onl Permit Fee Date [ ued Issuing nt Signet e PProved Disappr $ , M~ ~ ~ / ~ ~ /Q ^ tven Reason for ial IX. Conditi A~~pp ~/~easons for Disapproval ~~~M t;7Wt~ER: '1: Septic tank, effluent fitter and dispersal cell must all be services / maintaing j atr{~ managernent plan provided by plumber. 2 ~tll atck~gttt(ements must be maintained ntrAtnzu-eontprerepmnsrvrrae sysrem auu suumn w ,uc .,v...,.r ~.,,r ,,., r...~.......-..~ ...- Q., . 2" SBll-6398 (R. 02/09) Valid thru U2/11 ~~1 Q~ 0 ~` ~ 3 ~~ ~~3.Ze~t-~;~~.~ Ys oTd/ v ~` ~ ~ v~ ~ , oy ~~~ ~~ ~ `~~ ~ n3 0.0° ~ ~" G~Q~ /4aa.e /'T ~et"~-r>' ~,~7`" Z! Tie ~~ ~z~ TG ~v,v ~~ FFa,~.~c~..r/ ~~1 ~` ~~~ y ~~3.2®c~~G~ YsToTal a°.~a4 Yr,-~.~.~h~s n3 v ,`U ~+~ ~~, ~~~ ~ yo ~~~ ~~ \bc~ <~~ S~ 3 3 m ~!~/~~' e CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: ~/~2 ~60i..uS'6~ ~~-~s'~ Owner's Name: ,~d~,s ~'~ ~~~ ~i~ Owner's Address: Legal Description: ~Gt/ ~ S~ % S~ 4 ~~ ~ ~ ~ ~ ~ Township: ~~~Srj~y County: ,~"~~'c~ a` ~ Subdivision Name: ~~1 ~- ~//~- i°~ Lot Number: 7f Parcel iD Number: C3~~ Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans DesignerlPlumber: GCI,"1~~~~,nv 3c~Gc.'~~~rLicenseNumber: 2 27 G'4'd ~~s 3~G 321 Date: l'/~.~%16 Phone Number Signature ~ i- ~/ Qesigned pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 ~, 1123 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Sal Service County Attach complete site plan on paper not less than 8%2 x 11 inches in s¢e. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and ~ ~ ~ ^ G percent slope, scale or dimemsions, north anovv, and location and distance to nearest mad. Parcel I.D. ~~=~~ ~_~~,`~' t:.r ~ l; ~ j P/ease print all information. e ' By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1} (m}}. ~ I' 3 -~y Property Owner Property Location ~~/ Sienna Corporation Govt. Lot NW 1/4 SE 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # ~. Subd. Name or CSM# 4940 Vilk~~l1ing Dr. Suite 608 71 ~ ~ The Glen ~~ ~~' ~'~ City ,E~x,h4 State Zip Cale Phone Number City Vdlage Town Nearest Road MN 55435 952-835-2808 Hudson Dorwin Rd. New Construction Use: y Residential /Number of bedrooms 4 Code derived design flaw rate 600 GPD _ ;Replacement Public or commercial -Describe: Parent material Pitted outwash Flood plain elevation, if applicable na General comments and recanmendations : System elevation 97.60it, trenches spaced and depth to code 3.50ft below grade Boring # ._-' Boring 96 ~' Pit Ground Surface elev. 101.60 fl. Depth to limiting factor in- Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-12 10yr3/4 none sil 2msbk mfr gw 2f .5 .8 2 12-19 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 19-96 7.5yr4/4 none Is osg mvfr na na .7 1.2 ~ l~' ~~ c~ od • `~~~gY ^ Boring # 'Boring 96 Pit Ground Surface elev. 101.10 ft. Depth to limiting factor in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-14 10yt3/3 none sil 2msbk mfr gw 2f .5 .8 2 14-28 10yr4/4 none scl 2msbk mfr gw na .4 .6 3 28-37 5yr4/4 none cos osg mvfr cs na .7 1.6 4 37-96 7.5yr4/4 none Is osg mvfr na na .7 1.2 ~,2/~ Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS< 30 mg/L and TSS <30 mg/L SST Name {Please Print} Signature: CST Number David J. Steel ~~/~ 248956 4ddress Steel Sal Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 154017 9/13/2002 715-246-5085 Property Owner Sienna Corporation Parcel ID # Pending Page 2 of 3 Boring # Boring 97 90 Depth to ff limiting factor 96 i . / Pit Ground Surface elev. - n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-12 10yr3/4 none sicl 2msbk mfr gw 1 c .4 .6 2 12-24 10yr4/4 none cos osg mvFr cs 1f .7 1.6 3 24-96 7.5yr4/4 none Is osg mvFr na na .7 1.2 T ----~' _ C~+~~M V~ Borina # - -Boring * Effluent #1 = BOD ~ 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an eclµpi opportunity service provider and employer. If you need assistance to access services or Borina # _ =Boring _ ... .. ... _ Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, Wl 54017 L1C. # 248956 NWl/4,SE1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715} 246-5085 The Glen lot 71 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 esta~lishedat the time the soil. test was conducted. Legend ~ 1" = 40' Benchmark Ei. 100.00Ft Top of 'h"pvc pipe ~- A1tBenchmark E1.100,70Ft ` Top of/2" pvc pipe ~- a =Borings , „ . IV I / Soii Absorption Svstam Cross Section ~'q•° tt Final Grade A" Schedule 40 Svc vQ~t P~ ~, d ~ With Vent Cap .~----- Leaching ,,.,.~~ ~ ~,S c {t Chamber "~"' System Efeuatton `___~_..r----~ ~_ ~ ~ ft Soii Absorption Svs~m Pian View ~ ~/ ft 3 ft } ~.ft 4a Dia. Header Leaahinn Chamber Snecifiaations Mapufacfiurer And Model E1SA Rating ~2 a sa ft per chamber Soil Application Rate ~_, gpd/sq ft ? Soil A iication Rate ~: ~`a'3 EISA = ~_ Chambers ~~ gpd Design Fiow ~ __.___.,,, pp - 2 rows ofi~ Chambers each. Page _____~, of I SEPTIC TANK ~ PGMP CHAN:H%R CROSS SLC~IU:V ANA SPLC:lr1L'hllvly~ 4" CI~ VENT ~ PIPE ' 12 "~ MfN. 'ABOVE GRADE S WEATHERPROOF JUNCTION BOX APPROVED >_ 25' FRAM D4AR, WINDgW OR ~ --' WITH CONDUIT C C V~R WANPADL FRESH - AIR INTAKE ~--------~ O I C WARNING LABEL FINISHED GRADE -++' C I RISER _,,,,} ~r.,. ~ ++ MIN . ~~ 1$" IN. 6„ MAX. :;~ i 'NLET s ` `~ WATER TIGHT SEALS p j , GAS• , TIGHT ~ +~ W SEAL ~ ; jpi~s IrH ._.!_. ; ALM APPRpYED PIPE PPROVED ~ 8 , ~ ON ~ 3' ONTO IPE 3' -i""' ~ , SOLIl3 SOIL. NTO SQLID pll. PUMP OFF ELEV . ~,FT. C --~ I + OFF ~~ RISER EXIT P£RM2TTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPAOV ED, BEDDT NG UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE N~,fMBER DOSES PER DAY: „_,_,~. TANK MANUFACTURER : /,1, TANK SIZES : SEPTIC ~J„-- GAL. DOSE G,w,,, ~D _ GAL. ALARM MANUFACTURER: MODEL NUMBER: SWITCH TYPE: PiTMP MANUFACTURER MODEL NUMBER: SWITCH TYPE: REQUIRED DISCHARGE ~~ y~~ ~ r c. L9O ~+~~ _ .~ a ~ ,._ ~~~~ RATE ~_ GPM DOSE VOLUME FLOWBACKG~_ GAL. CAPAC ITI£S : A = INCHES = ~, ~~ GAL . B s 2 INCHES = ~*~ GAL. _~._.. - C = $ INCHES =GAL. D ~ INCHES = _.~GAL PUMP >; ALARM WIRING AS PER I LHR 16.23' WA{ VERTICAL DIFFERENCE BETWEEN PUMP GFF AND DISTRIBUTION PIPE • + MINSMUM NETWORK SUPPLY PRESSURE + ~~_ FEET FpRCEMAIN X ,~.FT/IOO FTATALIDYNAMICAHEAD •'. .~ ~ FEET _~' FEET ~~~ FEET _1~~FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; wTDTH~,,,_____: DIAMETER ~,_ LIQUID ~. ,. `~~/,~L~ `„ ~ LICENSE NUMBER: ,~?.27~~4 _ DATE: 3 ~'~ . TGNE~ c ~~ ~- 1/88 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capabil'Ity: 31a'"maximum. • Capacities: up to 60 GPM. • Totai heads: up to 31 feet. • Discharge size: i'li' NPT. • Mechanical seal: carbon- rotarylceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C~ intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard {ength,16/3 51TOW with three prong grounding plug. Optional 20 foot length, l 613 S1TW with three prong grounding plug (standard on EP05). ~ 2000 Goulds Pumps Effective February, 2000 63871 • Fully submerged in high grade turbine oll for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP041mpeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. ^ EP051mpeller: Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. METERS FEE °° ' 10 4... :_... .... _...... 9 30 -....... ~4~ ,.. ,__.~.. 25, ~ o W ~ , __.. _ __. v 6 20 "'" ~ , ._. 5 ~ _._.. Y .~ __...... F 4r __ . o 3 _.__ _... -; 10 _.. z ,..._._ :. _ _ _. s.... . t _ , O _. o- - ___.. 20 p 10 30 p 2 4 6 CAPACITY ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' Canadian Standards Aasodation (CSA listed model numbers end in "F" or "C".) Goulds Pumps is ISO 9001 Registered. GPM :.._._ .._...EPOS...__-~ _...,...... EP04 ....... _..... _._... POWTS OWNER'S NiANUAE. & M,aNAGEMENT PLAN Page of 11.E INFORMATION Owner ~a6Q~,.~' ~~~ Permit # IAINTENANCE SCHEDULE Service Event Inspectrcondition of tankls) Pump out contents of tankls} Inspec- t dispersal cel4ls) Clean effluent filter Inspect pump, pump controls & alarm Flush laterals and pressure test SYSTEM SPEGiF14A r svna ~,SQptic Tank Capacity Q~®C~ al ^ NA Septic Tank Manufacturer jr C,S~ ^ NA Effluent Filter Manufacturer ~1i,/+J ~'-~~~ ^ NA Effluent Filter Model '~,ii!,j ^ NA Pump Tank Capacity Q al ^ NA Pump Tank Manufacturer seY ^ NA Pump Manufacturer t/du ~ ^ NA ^ NA Pump Model Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ .NA ^ ln-Ground (gravity) ^ In-Ground (pressurized} ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Frequency month{s) {Maximum 3 years} ^ NA At least once every: ear{s) and scum equals one-third {y3} of tank volume d ^ NA ge When combined slu ^ monthts) {Maximum 3 years} ^ NA At least once .every: ~ year{sl monthts} ^ NA At least once every: ~ earls) ^ month{s) ^ NA At least once every: r'-"' ^ year(s) - ' ^ monthls} ^ NA At least once every: ~'- ^ year(s) ^ month(s) ^ NA At least once every: ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made WTS Insp'ectorl POWTS Maintainers Sept gegServic8ng Operator.atTan Master Plumber; Master Plumber Restricted Sewer; PO inspections must include a visual inspection of the tank{sio°check for any back up or pond ng ofaeffluentton the ground surface measure the volume of combined sludge and scum and The dispersal cellls) shall be visually inspected to check the efihe n round) surface may ndicate a fail ng cond tion and ae4u res th of effluent on the ground surface. The ponding of effluent on g immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any taOnke aiol and d'sposed)ofrin accordance with chapter NRei 1l contents of the tank shall be removed by a Septage Servicing p Wisconsin Administrative Code. retreatme All other services, including but not limit; ~ n°onths, shall ~ perfo medfby a ~ rtified POWTS Ma ntainercomponents, p units, and eny servicing at intervals of 5 A service report shall be provided tc~ the local regulatory authority within 10 days of completion of any Service event. *Values typical for domestic wastewater and septic tantc ernueni. Pt+gr __.~_ of ...._.__... START UP ANO OPERATION For new construction, prior to use of the POWTS`ghifis~4 frpAtlt111ae~t ts~ttklel far the presence of paintln$ ~~oducts or outer ohemicafs that may impede the treatment process and/or ditthp,~+! +I~ftl dlp~!'II~Ii d!f ~{{~). If high concentrations are detected have the contents of the tanklsl remaved by a aeptage servicing opeltr~~br prlclr t ° u~l~, System start up shah not occur when soil condifiotilai firs #rbter~ 4t the ~fil~rettve surface. During power outages pump tanks may fill above rldf~i~el tlf~hwtl~I~r lil+~-~~r 'iWflen power is restored the excess wastewater will be discharged to the dispersal ce111s) in one large do9di"q~~lerli~gdln~ t~1~k4~1{3 ~y~ dby ay5${~tagenServlcingkOperstor~pror tloc es oaring effluent. To avoid this situation have th® contartta t~~ ~I~4~ f11~ ~! , , power to the effluent pump or contact a Plumber ~l` l~~'f~ '~tl~tlta~ilnltit 1a ®ssist in manuaEy operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispaPq~i Gplia, po ridt ~~1va wr=perk over, ar otherwise disturb ar compact, the area within 1 b feet down slope of any mound or at-grads ~~P~F l~~a~~tialt e~dk~ „ , Reduction or eiirttination of the #ollowing from the ~e~~p~!e#dr, 1-'kK+l ~~'~' Improve the performance and prolong the life 4# the b call ~1Nill~!4};degreasers; dental floss; diapers; disinfectants; fat; POWTS: antibiotics; baby wipes; cigarette butts; 4+~I~d,~~p`ISi :, a'~ ~ralllliwf grease; herbicides; moat scraps; medications; oil; foundation drain Isump pump) vaster; fruit. and vrt~+obi4 gi+,~A11h ~~ painting products; pea#Icides; sanitary napkins; tarn~d#r1!(<; a>'11l iM1ilif Ap'~i~M1ir ~rine' ABANDONMENT fg) steps shall be taken to insure that the system is When the POWTS fails and/or is permanently taken I9Ut til$ eel's{l~l>M !~ (Il~eg properly and safely abandoned in compliance with ~tl~trir $~dt`~If'Y~~r~~ ~{~!~ipnsm Administrative Code: e Ati piping to tanks and pits shall ba disconriat~lz~d llrld the ;~~~l4~dNad pipe openings sealed. d Deed of b a Se tags Servfcing Operator. • The contents of ail tanks and pits shall be rbt'n4.v~ld tih~l ~}I'lit~lllriy flip.,.. Y P • After pumping, all tanks and pits shall bs al7~l~pt-»f~1 ~f1d kdm!~~ pr -their covers removed and the void space filled with soil, gravel or another inert solid material. CONTlNQENCY PLAN Ve en or must be taken, to provide a code compliant If the POWTS fails and cannot be repaired the fcillbyitllll,~ ~i~Nllllaf~ii h~ ..: replacement system: D A suitable replacement area has been evalif~t~gld Ain~l ma~yT .~~R U~1{l+~i~{ for th® location of a replacement soil absorption system. The replacement area should be pt#~tlky~.+~d f~Pm a-~f~~~e~'~nWellamFailu a to protect the eplacar{mern areanrrvill required setbacks from existing and proposl~"-,tft~iDtliptir Ibt ltlna~'±~~ result in the need for a new soii and site eu~~u~l+~tt t~ pgltppl,l-~+ ~! ~~~i91bie replacement area, Replacement systems must comply with the rules in affect at that time. Q A suitable replacement area is not availat~i,~ dUd ts~ ~g;`Ibl~~k ~I~~~Or soil limitations. Barring advances in POWTS technology a holding tank may be instaDed ~~~ ~it#i: r~iaprt' Vii? 1'~q{gli~l l~ha failed POWTS. Q1p The site' as not en evaluated to identlit~!,tl gfait~ble FApl~l~~+~'~!~'area• upon failure of the POWTS a soil and site ~~ evaluation be performed to Ivcate a s~i1~ {jp r1~plAa3liltlir!I1t ei'Md~ If no replacement area is available a holding tarsi may b tails s a last resort to replace thlb ~e~1~rtl ~E~V4t1'~. In lace following removal of the .biomat at thr D Mound and at-grade sail absorption systelf'~ Cp~y~ :'kid riMpal~i~il+~1l~ P infiltrative surface. Reconstructions of such ~i'y41i~-tn'Akfl rtluiyt peP't~l'il ~~t~ ~g raise in effect at that time. < G WARN1NiS 7 ? S1~ ANp/QR iNSUFlFICIENT OXYtiEN. DO NO" SEPTIC, PUMP AND OTHER TREATMENT TANKS Mf/~'~ 1~~, `~, It ~ '`~~TANCES. pEATH MAY RESULT. RESCUE OF 1 ENTER A SEPTIC, PUMi' OR OTHER TREATMENT 'I'Jf1 ,li; ~ ~ , IrERSON FROM THE INTERIOR OF A TANK MAY SE ~~~., ~ ~ , N. ADWTIONAL COMMIc151TS pOW'I'S INSTALLER C'' ~ Name `iA~ S C.~» ~t3.~a.R~. - Phone ? ~ ~' '~ ~ g --.~.~ J a ~ _~,: ' SEPTAQE SERViC1Nt3 OPERATOR {PUMPER! Name Phone ._. '-: ~a~ S~', - 3S~- .'.t This document waA dr»ftad in rnmpliance with chaptor Comm ~~1~~H/tt~~iis?if J•Ilf~k;f.1 erid d~.64(t}, f21 & i3J, Wisconsin Administrative Cod©. OwnerBuyer ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP (CERTIFICATION FORM n,.~.a f1.o,t~-,nv' ~I-~i~l Mailing Address ~~~ ~~~ l ~~ ~~f ~t r~z'~~ Property Address S~~ (Verification required from Planning & Zoning Department for new construction.) City/State ~~ x~-S~ 1't G~ Parcel Identification Number D ~ U - l ~l `~I ' ~ 6 ~: 6d d LEGAL DESCRIPTION ~. .San Property Location ~ t/a , J~. '/a ,Sec. _~, T ~N R ~ C1 W, Town of ~ ~ ) i Subdivision ~ ~'~,l Q. Y1 - ,Lot # ~. Certified Survey Map # ~ ~ • ~ ~ - 1 ~l - .~,~(~ ~ ,Volume ,Page # Warranty Deed # ,Volume ,Page # Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a liceatsed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources,.State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the. St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. - Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num r of edr ,~- d GNATURE O PPLICANT(S) .~/ ~' / /~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 48/05) State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document N umber ~ Document Name THIS DEED, made between Bane Corporation, a Minnesota corporation ("Grantor," whether one or more), and Robert V. Heiti and Penny L. Heiti, as Trustees, or the successor Trustees, of the Heiti Revocable Trust Agreement dated August 1, 2006 ("Grantee," whether one or more). Grantor, far a valuable consideration, conveys and walTants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 71, Block 7, The Glen in the Town of Hudson !11111 VIII VIII VIII VIII III{!III{ If IIII IIII IIII * 9 1 6 0 1 i 7? 1 ~~~~ 1 t BETH PABST REGISTER Of OEEOS ST. CROIX CO., WI RECEIVED FOR RECORD 05/13/2010 04:20PM WARRANTY DEED EXENPi t REC FEE: 11.00 TRANS FEE: 404.70 PAGES: 1 Recording Area Edina Realty Titie 400 South Second Street, #115 Hudson, W~ ~f~ 1974 Eile # 020-1414-70-000 Parcel Identification N~unber (PIN) This is not homestead property. (is) (is not} Exceptions to warranties:!) municipal and zoning ordinances and agreements entered under them; 2) recorded easements for the distribution of utility and municipal services; 3} recorded building and use restrictions and covenants; 4) general taxes levied in the year of closing; 5) Terms and Conditions of Notice recorded December 12, 2002 in Vol. 2079, Page 38, Doc No. 702098; 6) matters shown on the recorded plat; and 7) restrictions and covenants recorded in Vol. 2079, Page16, Doc No. 702097. Dated May 5, 2010 Bane 'on (SEAL) (SEAL) * b ohn M. Nasseff It Chief Executive Officer * (SEAL)* (SEAL) AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT ~l~ y Ilrry E. Gallaher ~~SN~^~Y/~~~,/ ~V Lockridge Grindal Nauen P.L. ~'"'}8f ~ AQ 7r~ lU0 Washington Avenue South uite 22 Minneapolis, MN 55401 J~138A111S 'tl ~Q1 Tel: (G 12) 339-6900 A IQVOWLEDGMENT STATE OF ) } ss. ~. ~~-~~ COUNTY ) Personally came before me on May 5, 2010 , the above-named John M. Nasseff, Chief Executive Officer of Bane Corporation_ to me known to be the person(s) who executed the foregoing instrument and aclrnowledged the same. State of Minnesota ~~~ ~n (is permanent) (expires: (Signatnrea may be authenticated or aclmowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 ' Type name below signatures. /~~' 1 of 1 n ~ W S ~~ THE GLEN ww r w wort Mrr w w MMrfd a.w, w w MMI wa+w w~M.a Me., ~ w r•Iwrll M•r A w MrwM Inlr, F w Wwtl OrW Y w wwr Ir•Ir, M M INwM OMr rf w an.r Mrr, I r lrMrr Mh Y w MJMr M.r.l w rlMrr MIIN Y w wr Mwwwwwran+wl.M.~o»w, Mrl~lf+wtaafwlw~ w xw.f a MN 1AL w ~ xfwr ffi r. M MT wlr~'din ~,r r,.l w ww, x or owr 1~ ~{ 81 SEE SHEET B ~ ~~ 73 I 11 ~ `; i i , xw u. Iss u. P.we) y 11 l i 11 t p.ww) a O~mel ~ ~ ._j I 11 ! 1 1 1 111 \I ~ ; I ~.,,, plus _ - - I r 1.{ r i r p~.:' u>owolriri I I etMtm • wa " uml I c~marcw -j----- ----I- .i yr us 'L ux1o~M Ml w maim rvri wts afar[ MINL •~,• "", - - - -ai>smtilad - - - - ounot s rMM Mo.m 9xt a ~f~alrl nun KI BLOCK 2 aarr m ~ r W N ~, v F ~ ~4 1 ._ alMlll rR: OLImp I14 wr e>,~ MMIr [faMm Ill M71 all.Yi 'IIfMISrlYjafiraYlYl.~gMf~ I \~. ton lli.If,Df.if,lADr17NJ111) rIR1 wr~u. n!N MI 0® SEE SHEET 8 ~i 1• . 7tl _~ , \I; 1 I ~;, Il, r 1 1 \ \ ~ I •rl ~.. r '^ 1111 ~ /I \\`\` ~ ~ ~ ~ l~,l N (,~ rrr rr ~\\ I r \\\ /71M Y. ~ ~ 1 N M ~~ I 1,1 ~ ~y \ owkl kkR I ~ : S frn 111 %~ \ ~~ 11 ~P 1 W I~ !~ ~`I r (q\ F~ ; ;; ~ 9z ~ g l ,~I I ; ,,, I /~/~ I a x wau. I m l 3' ~i~l ,1 ~ p.m fcl I pr ~ `~ N I Q 1\ ~ I vl rJ I I u I a L~.11 ~ r ~ ~I ( ``~\ ~ ____ ___ __ an1Ar~+la __ ________J ~ !~A ELI fl f 1I - „~~ i i ~ 11 ~~` I ~ Mt~ lA• ~ ~ 11 ~ p I I -- wiG. ~--'--'- I ~ I ~ p.ue ~ 11 ~ I l ~ I ~ 69 I -.I ,~~ ry~ f i~ 1~ Ki i I O ) i 1 ~ ~ F-~ ~f 1~ ,' '11" BLOCK 7 ~I ~ ~:,, w i Z ° pl / r/ ~ 111111 ~ lrwatl ~ i ~ ~ ~~~ I I / ,N FrI ~ /J / II 11 I C] N" '1 X11 ~ I, I 0 ~ ,J~1 I I q --I ~ ~ , u.l it 11 I ~ I f ~ I I amMlMSUmxs'rsrxaax I " waa I 1 ~sanui"~ipnw°rroKml~i[~ \I :~; (;1~ ~,l I MSr' I I IAa' art r1 I ist f ~ S89'J/21'W 111147 ~~ ~~1 .~I I yM7lirinur7 I byS (.I I rylnronmlfsl I I fit k~~ I~'I I-wMaaacaarxu.rM[IMna~LLra¢xn_____--- ' I I CdF ~I --------'~ / ~' 3 1 i An ~ ]f' ilia n ^ u uni ,: I OI o_ni, rvL_ "- - --- ~I V .,;enr A 1•f^~, I l~l la _rna[ Y~l = ~r ® Yripl fella xClr arp ~~'' N ~ faII amra[far ~ 1 ~~.1 ~ d axl~m i n l tl u.l =--- ~uF I C ux06lYrYa1116f1[ I A, ~ AA Vifni As ~ )I aopMa lm LLS lm w[>, .J.ni. rV1.. f eb ~ MtOM1~lwaoyn~mtaloM ,)An[ AA ~~ Y~~ I I.IJ LLI~Irl>!1 11I i4MK ~ nvL 't l f ~i 7i .- ___ Js '07d[I.On /Rlgm/aNYl rx ~i A- xmpll[ I y L ` aewaM Mmmml s awa~ls sl I iw~Q 1m MRNNar1 a IaIM w rPH>L^M rAll 0! M MN fr[ -_ ~~~~ aft Mate I~ L_..._.. ._.__._.. _ `\ ~/'I~~tf1 • -_~ ~ I ' e/ dal i ~~ i 4'. `i ~i~iili1` lQQ \ \` ^~- -'- i.. 1'~~~ ,a~~ir i .\St-•• ; ii ------ I 1 , {Flit 1 .M~1,,.. t~ ~ ~' -- --~.'- ! 1+ 1 ,r3:. ` , -' - •. _ - ! ., t ~6)•~_ t.l { 1.11 , r ! 1 1 ~~ ~ •l , , , :; f ~ _ , !. i i /! / ~ 1 ~ ~ ..II fr ~ ~.r•',q} ~i Vii' tA,cr' ,i• - {-::a`;,• ! ~ ~ ! 344+_ ..+e___ __.. 1 4 1 1 _- •.~ t ....~ `~.4 r , .~ i 1, 1Jl _-t ^-.-y l l l ; p 1 ~ ~ ! '1!!..-.. --'~ 1 { ". 1 •` T~ 1 X11 !' I !5 ~h \ t 1: li i ~i~ ~ .- Q -n _.. - .. :,'~•. '~~',.•3e" \t `, ` 4~ '!'Il '1 L~., -qS lr, .. .. I \`. ,`~+,• Y_. _' 'J {~~"r-'-~..n----. \~ , .•'" - \.. + 1 117 ~ ` ~ • •t 1 / ~ ,~ _- ~-2:4-~~, i"~ -- . ,, .;~~~ ~ r , l l i a 1 ~ 1 { ,111 ~ . r - .1 \ •. ~ N ~l~ ` +/f l' Q ~ fl:(ala,~ f _ 1 f' ~ ~ t `. 1,•..` '~l at- -- r ,_ 208. _ .t: ~'_-~ ."` 'r , !•~ 7-1. t.".`~ `^~• _ - _ -_ ..m...~sv Grt'- ---..-_ i~e `, r-.ai ~ •+.--~Z \ 1 -Lrt ~'+r ,- ~•:.~. ~ --~ - - ~_.~-_ - ~_ - - .. .• ~' • /:~' i r ~ i _ .. _ ' • ~`'.~ ~~r~ i' :~•:...; 1'1.`,, . •l'. 243 / 138 - :. _ .1~~. { .. _ n .., •, • :, ~ : , _ ,I ~ .4 ..:...1:1.;1•. ..• -~ - - _, ~r - .... ^\ t ~ :.. ~ '. ':Ill ~i t'!!' ! r a \` '.ice -... .- r,l r'~/t; .iii' *r; ' ,.-. l';'l+ ,'i~j:. ~~ ~• -'.'•i~liir'll , _yv._ Jli.. • N'.. ` rrl, ~` ~i •. •.`` 111+ 1 ~ s`.- .'~, `` 1 .1 '; i it ~ •.. '~~~.ip: ~.-- t~?:7. att~ •.- 1 fi a'rr' ..~-- ~ ! * i 1 , . t , ~, •: _ ! + S r~ r!n~a. i'1 VrC ;,•C G.. •....-._.»; •l'"1 ;raf:i I,~r . '' Ai 1 ! ~ ' ' i N t '\ : ~ ,a;j4:.• ~ Ir: ?. / It+Cli Ii~e . J7 ~leaa: !; M ; Iii ! ~' ~ • \` ... ` ,~1'I r., ~.' ! `'1 •.•1. •, '. f -, ryli ! • ~ 1 1 7:, ~ ~w ,~/`.l/ jilt ':tl ' '1 -\~`ijJf .~..~s` I + i.~~i\: ,iV,/r:''+J'' -`~•ial~~~~ tl.~,'~1'. ' ~t ~ ^~` t•N ~'`g l`..~; :. 4.: t1'.11. .1.F wA ~- _ ..1., . 1 ~ ..l •~~.:• :.l•." ~~," i r a' `; ,-~>~ ~ ,, .j 141:.::,}•.Ni;: ~•';' ~.-^~~' - _ Iir f' I ~ 1 ~It !'. Pi ::ii:ln!!:~ ;: 1 ri~ ___ [~/i-yy)., 1 il. i;~liftllll ur~••'.i. `-!1V-,t •, ' ~I' I - _ 1l I .i ! '' 'f+.i !! r,'p1 ~,~1l,F1. i t ;:: II~~QQ s N \ ! ! I: ~'!!! it 1 • 11 i F.q-~ rll, ' II •!.V .t0 1' ~rl ../':•,.:ti it 1. ! 1 - y i t. %v.l. `: rl f,' fr,ii{•.:•.'1 t' .y.l , :. /: ~ r: -y=--- (.; • 1 .d,`l ~4 l7n. ~ ~~! ~ ;!