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HomeMy WebLinkAbout032-2139-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division - INSPECTION REPORT Sanitary Permit No: 463366 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Larson, Ryan Somerset, Town of 032 - 2139 -00 -000 CST BM Elev: Insp. BM Elev: BM Descrrtion: Section/Town /Range /Map No: 14.30.19.1227 TANK INFORMATION ELEVATION DATA j TYPE MANUFACTURER CAPACITY STATION �B§ `n HI FS / �E V 6 Septic � Benchmark Dosing �/ V, 0 '16 Alt. BM .5, Aeration w / r Bldg. Sewer t y � qD - p - _._._ -wer 1� 0 Holding St/Ht I I • t TANK SETBACK INFORMATION St/Ht Outlet I�{• g TANK TO P/� WELL BLS Vent to Air Intake ROAD DtDt Inlet S l Septic 71 1 Z 3 Dt Bottom ( Z �- , •q l Dosing 2-0 , Hea rlMan. U . 'I& . Aeration Y Dist. Pip e p, Holding Bot. Systernt qs 7 G 7•UJ �• �. PUMP /SIPHON INFORMATION Final Grade +0 2S� Manufacturer Demand St C GPM Model Number 0 9 ', / 5 p •Z ( �l TDH Lift ^ Fric ion L ss Syste eaj TDH Ft Forcemain Lery - Oia .. y Dist to SOIL ABSORPTION SYSTEM � BED/TRENCH Width Length No. Of Trenches PIT DI NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS —7.o &(f • - SETBACK SYSTEM TO 1 P/L > BL WELL LAKE /STREAM L CHING Manufacturer: INFORMATION CHA R Ty System: � � w �. ! i � UNI � Model Number: DIST TION SYSTEM 4 /C� Heacler/Mklifol Distributi n x Hole Size x 3(o Hole Spacing Vent to Air Intake Pipe(s) ICJ 2 ' 0 Length Dia Length Dia Spacing Z- / SOIL COVER x Pressure Systems Only xx Mound or At - Grade Systems Only / Depth Over Depth Over xx Depth of xx Seeded /Sodded xx M & j Bed /Trench Center I BedfTrench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: - 1_62!5 inspection #2: Location: 1596 72nd Street New Richmond, WI 54017 (NW 1/4 NW 1/4 14 T30N R19W) Rock states Lo arcef N : .�3 Q 1.) Alt BM Description =` 5;r C�(dG V G 2.) Bldg sewer length = Z31 - amount of cover = 3 I L Use 9 e other side for additional in Yes No formation. Date Insepctors i ature Cart. No. SBD -6710 (R.3/97) l I Safety and Buildings Division County N viscon s ',rwn ' 201 W. Washington Ave., P.O. Box 7162 T Q X Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co) (608) 266 -3151 6 3 3C G ` Department of Commerce / l Sanitary Permit Application +SwePlan I.D. Number �) j _ S. �• In accord with Comm 83.21, Wis. Adm. Code, personal information you prov Q ` S Rt­ Ill may be used for secondary purposes Privacy I aw. m Project Address (if different than mailing address) 1. Application Information - Please Print All Information /� / 5 96 7 Q S i . ea) /f / C/i v �% Property Owner's Name MAR 2 9 2005 Parcel k Lot q Block - 00- , &V,0 Property O er's Mailing Address ST. CROIX COUNTY Property Location ZONING OFFICE � Qd � 1VW v, AL& I., Section C ity, State Zip Code Phone Number circle o ) L. [_ G D T _3 N; R4E or� II. Type of Buildin g (check all that apply) o-0 Subdivision Name frstatNaanbec S ' ' n n ,--- lid 1 or 2 Family Dwelling - Number of Bedrooms '- - �_ �"�" ` ❑ PublidCommercial - Describe Use t• h lloC ❑State Owned - Describe Use ❑City_ ❑Village likownship of 56rN -- a Sr III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ❑ Replacement System g P Y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal El Permit Revision ❑ Change of El Permit Transfer to Nov Before Expirat'i'on Plumber Owner ` t / 11 IV. T e of POWTS System: eck all X 0' f ❑ Non - Pressurized In- Ground Mound > 24 in. of suitable soi n t ❑ At -Grade ❑ Single Pass Sand Filter ❑ f Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sfy System Elevation 50 y� o VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic e; Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks t Septic or Holding Tank 400 4 3 Aerobic Treamrent Unit Dosing Chamber 60 & e e:-- C/- VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signatur MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zi e) S - VIII. County /Departmefit Use Onl Approved ❑ Dislpprov Sanitary Permit Fee (includes Groundwater Date Issued Issuing Ag t Signature (No Stamps) ed G r Denial Surcharge Fee) ❑ Owner Given Reason IX. Conditions of Approval /Reasons for Disapproval 30 No SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in sirs SBD -6398 (R. 01/03) hLr,. $ h\ . N L OT - 13 M EC , Soiae HOLES cent_rocc_ Aje 'fe 9s_. szoje _ / - - -- — . - - -- t � FRS - _ l� E 0 /00 GA L Bo�cA - - - y - - - - — c a3 _ 79. �y n�ou P N,» -- - -- - - r , a RAN A6 8 - - -- i ; 1 .5 oU deg Ee — - - - -- - -- - s o ' r� � c i LAi?5 °'v 1 7,300 t i i -/ in f1 04 A J � .�nZ/-) cr/ Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD ' g LA CROSSE WI 54601 -1831 a t TDD #: (608) 264 -8777 iscons i www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 07, 2005 CUST ID No.223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 586 VALLEY VIEW TRAIL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/07/2007 Identification Numbers Transaction ID No. 1114687 SITE: Site ID No. 695487 Ryan Larson Please refer to both identification numbers, 1596 72nd Street above, in all correspondence with the agency. Town of Somerset St Croix County NW1 /4, NW1 /4, S14, T30N, R19W Lot: 16, Subdivision: Rockamora FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1006996 Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.0 1 /0 1), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.O1 /O1). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)" • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. R OA1 Conditionally P omic n JOHN F SCHMITT Page 2 3/7/2005 Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption . system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 SCHMITT & SONS EXCAVATING 586 Valley View Trail f?ECEIVED Somerset, WI 54025 715 - 549 -6651 44 AR _ 3 2005 MOUND SYSTEM oWcTy& BUILDI For: Ryan Larson Address 12300 Maraness Way, Lake Elmo, MN 55042 Legal : _ NW a NW 4 S 14 T 3 0 N, R 19 W Township: Somerset County: St. Croix Rockamora Lot 16 Conten Page] Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page 5 Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Deport Attachment Map , Tank Anch oring Mound Component Manual (Version 2.0) SED -10691 P(N. 01/01) Pressure Distribution Component Manual (Version 2.0) SED - 10706 -P(N 01 /01) B MPRSW 223760 Date: 2/23/2005 COMMERC DEPARTM ANp ILD► `GS piV►S�pR OF SAS • SEE G�RRES ON ©ENGE ©cr: err► ©�2�) LE /� - _ A Au. BM - t4 CRN R Nt\Vi_GJgcLe W Er c.awID _ - i.�.1,1) 0 C CM rC U k AJC EL ' _7c�►o�G .S /— 0 = L/% — ti PROP45FO / © Fu-_. - -- /00C) Gay y; S.To t4 - -- i ' 463 �ORCF_ ►yluiJ -- -- a 'R A6 EAs6Xe - s_m - quo - - -- - -- - -- - - -- S L0, W O ,6 A P-5 _ 1Z300 /V l R9 N,5SS `� . _ � �, /SDI H 4v,- - L. I Lm o — _ ypl a,i � s"OY� ..S'�frir= , eS•L W i _ �"�c�?) - - -- - - ; Ail iM a1 q -% ••7 Page 2 Cf 6 1 Straw, Marsh Hoy, Or Synthetic covering ASTMC33 Distribution Pipe wum Sind ►+ a 6" Topsoil x:3 __ice: F 3Y& Z LEV. 95.9 _ + a 0 Y. Stops Bed Of 2 1S force Main Plowed Aggregate Layer (6 Below Pipe) D 0.66 Ft. E 0.95 Ft. Cross Section Of A Mound System Using F 0.79 Ft. A Bed For The Absorption Area G 0.50 Ft. A 7.0 Ft. H 1.00 Ft. 'G'�� 64.3 Ft. 8 Signed: z ----- 223760 K 7.80 Ft. License Number: l 79.9 Ft. Date: 2/23/200 j 5.23 Ft. Alternate Position I 7.66 Ft. of W 1 85 Ft. Force Main L tltet3o� Pipe ' V ?b i /i0 B From End at Bed K Force Main A - - -- - --�� _ ---------------- - - - - -- - ged Of �� cistribution Aggrega Pipe 1 Perrr►anent Markus Obyeryation Pipe 1!!S To 1110 B From End of Bed Pion, Vlew 01 Mound Using A Bed For The Ab Area Page 3 Of 6 Turn -up w{kh C{eanout Acvess B Plug or Ball Vaive `--,-► PVC Foroe Main Distribution Lateral .s LL -W PVC Manifold P 'x-1"x i x xa Distribution Lateral Layout P 31'5 Ft. • S 4.0 X 336 , Inchps Hole Dia 3/1 Inch Signed: tii - o� Inch(es) ---- Lateral 1 � License Nu ber: 223760 Manifold 1 Troches Hate: 2123/2005 Force Main `� inches # of holes /pipe 11 Invert Elevation of Late rels 4 rt. FA6C 4 Of 6 PUMP CHKMLER CROSS SECT ?OW AMO SPCC1FICAr1QW i VEUT CAP -- 7 4 VENT PIPC WCAT11ClR *RQO/ APPROVED LOCKIIJG • ' �' r rrnr♦ wrr�ll. _ .IUrUGT101J A01( �MAWHOLC COVCK d(AIUUW UM iltaill to - Maki. 1 AIR NJ TAKC I C►RAD C I M' MI1J. COWCUIT -- IAILC T PROVIDE wIRTI4N7 SCAL 1 AfP1tOYED JGft V IR A I 1 `� APOM JDIU w /c.t. rips. /// I I w /C. rip[ EMIJDIWti 3' I 1I ALARM C)<TC tYG 3' f 0QY0 Q610 %OIL i ONTO >wu0iot 21776 Gal. /Inch it L C I I ow i GLCK 86.44 PUMP -` •__J O f i O LT COUCKETE BLOCK 1 R15CK EXIT PCKMITTCD CAJLy Or TAWK MAAJUFACTURrIt HSS SUCH APPp ovAL 3 "Ar�Pli �8a`D4 SEPT1t SPECIPICATIOWS DOSS TAW3 MA►NViACTURCR: --- Week ' s C.P. W MbCA OF 00&rS* +or -5 PER o" TAJIJK LtzE: -_ 800 GALLOWS DOSC VOLUME I LARn P"urrmrux ii: _Septronics Tankmate IOUCLUDIN(o OACKP60WS 87.04 C#AL#. ow M00C1. hIUMDtK: TM - CAP• ACITICSI A - 1 9_ WCHE3 O�t41_ 3 ' 44 rJALLOW1 SwtTG1i' THrc: Mercury F~ d� ..2.._. IUaNti OR 43.52 AWUP P UMP MAC.TURCR: Zoeller C" 4 IUCNCS Olt 8 7, - 0 DAI.60N ,04 00CL IJUA l6toL. - 9 D- 12 IAICIIES OR2 6 1. 1 2 GALLOW SWITCH 'rWPC; Mechanical u2T':: PUMP AND ALr►RM AR¢ TO dC • MINIM UM D15Ct ARGE KATG 29 • 04- GPI INSTALLED Oki SEPARATG CIRCUIT6 VERTtW D1ffr6SLEM(A CETWCC/J PUMP OFF AIJD.0)5TRibUT►OIJ PIPC.. • 0 L FE + sKiLIMUM NETWORK SUPPWS PILE&SURC . . . . . .. 3. 25 FLET + —12 FEET Of FORCC M1Al" X 1.83 t Y o /LFKICY {Okl FMYOR. � 3 FEE T T OTAL DyWAMIC Nt:AO c 15 - 08 L FEET IIJTLKtJ DIMLW&;QWA Or_TAWK: LEMC.TH -- - - - - -- -- ;wiDTH ;LIQUID DLPTH 3 .....�._ / Ltceuse WuMOC� 7< 0 Di►TC: �3 "� HEAD /CAPACITY CURVE AFFLUENT and DEWATERING D CAUTION I Model 185/4185 should not be subjected to less than 30 feet TDH. 53.55, 140. 161, 16 165. 1 186, t88, 189. 191 ,MODEL 42 48 57.59 98 1,57'139 4140 4161 x163 4165 4155 1 4186 4188 4189 V) FT 'i'i?y.';;' CAL. LiRS CAL, L7RS CAL. L7RS GAL. LTRS CAL. LTRS CAL. L CAL. LTRS CAL. C CAL. Lt CAL. t7 CAL. t7 GAL. Li CAL. tT GAL. t L,,,1 5 !1:52`" 15 "!57 32 '121: 43 1631 273' 93 : 2` 91 344'` 100 .370 61 - 2315 61 `23 55 420 145 5:401 14s .5 W W '0 3.03 : 11 '42 25 '04? 3. 129 61 231 79 290 9. 318= 93 ;362. 61 229:. 61 t2310 3'2'x,1 SB ]203 140 .1 05 140 0,101 4y LLj 15 4.57T:� 6 '23'. 15 1,57` 19 172'' 45 .170- 64 242! 76 286= 85 1322 60 '2271! 61 -2_l 56 Q2Q 134 135 R 45 X?fM 20 76.10 1MS."'S ' "1,t 25 #05% J6 ':136' 58 267, 79 ',299; 59 223' 60 427r 58 ]20 128 131 45 140 25 ;37.621 '_'x'. ?!r1'. J!CF '$'. a -,M 59 221:: 70 57 . 1Q' 59 58 122 125 45 42 30 5:904. "" *01.1 Z':4: {ti4,rr.: y; w, ,'x, 49 X&V 62 ]6r 55 5e 65 58 116 ' 120 45 135 .0 41YI9 rx;1' ue 94 'P" = 9{, 21 p 45 m; 46 55 70 ae w4 09 .s so Y15.'24 ;a ^drtx Fw"',, 0 1. 1 , , :Y'1 .: 1 ; 20 4q 33 50 '1 51 58 90 97 .5 40 60 ` +.IS.19 •tg L Y Pill 15 1 39 .1 32 58 71 85 $ 45 130 70 = - 21J4 eM p' 1Na`,'SS ,M%' &d'.t,1 4i?.N¢ WA 23 i 9 52 y 51 59 .5 ' 80 i 24 "v ;"»4! : + .v l V 10 45 28 51 3 45 90 1'27:43•' >^: k'1 '; 1 . ±'.!..: 31 ' 2 34 •5 38 125 100 +WLW 0•::si 16 160 17 9t .o 110 ; '; F 11 rS' 3 ..xXdY.- +l= -:.`.; CFi?v 4 15' _ J0 120 "' -36.a8 tfli:lt r+ Img: - .-y „?1 1 :tl1 4'JnY; 3f6. r. »4Y11 10 120 13o x39.62 d'1. w 9 : uF9 1 St 0 36 191 LOCK VALVE: 19' 19' 19.25' 1 23' 26' 46' 56' 66' 86.5' 73' 4' 91' 0' 137 115 34 110 32 105 30 100 95 28 90 186, 26 85 4186 24— 80- 165, 416 — 75 0 22 w 70 x 20- 65 z z 0 18 60 163, 4163 189, 55 4189 0 16 50 14 45 12 40 140, 188, 35 4140 4188 10 30 137, 185, 8 139 4185 25 g 20 15 4 10 42 161, 2 5 48 4161 53,55 98 57,59 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 LITERS 80 160 240 320 400 480 560 640 0 FLOW PER MINUTE 009922a POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of 6 FlLE INFORMATION—SYSTEM SPECIFICATIONS Owner R an Larson Septic Tank Capacity 1000 g a l 13 N4 Permit * Septic Tank Manufacturer Week C . P , 13 NA DESIGN PARAMETERS Effluent Filter Manufacturer Zabel c3 NA Number of Bedrooms; 3 ❑ NA Effluent Filter Model A -100 ❑ NA _ ' m,NA Pump Tank Capacity 800 al ❑ NA Number of Public Facility Units Estimated flow (average) al/day Pump Tank Manufacturer Week's C. P. b NA Design flow (peak), (Estimated x 1.5) 4 5 0 j a!tLay Pump Manufacturer Zoeller ❑ NA Soil Application Rate .5 al /da y/ft" Pump Model 98 ❑ NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit ®_NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand IBODJ 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetiand °r Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 8 NA ❑ At -Grade 0 Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Una ❑ Other: ' Maximum Effluent Particle Size Y in dia. ,E ❑ NQ other. 13 NA Other: ❑ .NA: � •'�` Other: ❑ NA 'values typical for domestic wastewater and septic tank effluent. Other: ❑ NA± MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) 13 N. Inspect condition of tank(s) At least once every: 3 ® ear(s) - t_ Pump out contents of tank(s) When combined sludge and scum equals one -third (Y�) of tank volume ❑NA; ;.. ❑ month(s) (Maximum 3 years) ❑ ; NA Inspect dispersal cell(s) At least once every: 3 ® year(s) ❑ month(s) ❑:NA Clean effluent filter At least once every: 1 yearls) ❑ month(s) ❑ NA: Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA` tom,• Rush laterals and pressure test At least once every: 1 M year(s) . ❑ month(s) C3 NX � Other: At least once every: ❑ year( i Other: ❑ NA : r MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cartifications ; N Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank* Inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks_or leaks,+. measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the g round aurface Tftx The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for anyponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires , 9 immediate notification of the local regulatory authority. e When the combined accumulation of a and scum in any tank equals one -third IY,) or m oj e of the tank volume, the'enWe'� with cha ter:NR +113'x' disposed of in accordance w p tank shall be removed b a Septage Servicing Operator and disp •..` "°' contents of the t Y .� Wisconsin Administrative Coda. t} All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment s _ units, and any servicing at Intervals 512 months, shall be performed by a cert ified POWTS Maintainer. { s of completion of any service event. A service report shall be provided to the local regulatory authority within 10 day j �: Page of START UP AND OPERATION For new construction,. prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do-not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater, stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; ctton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out 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 Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement. area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to ' setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. W The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER e Name John Schmitt N 549 -6651 ame Owners choice e Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Owners choice Name St. Croix Cty. Zonin Phone Phone 7 15 386-4680 f and 83.54(1), (2) & (3), Wisconsin Administrative Code. 'n compliance with chapter ter Comm 83.22(2)1b)11)(d)&() . di c m was drafted P s This document P Ytsconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 ) meon of Safety and Buildings in accord with Comm 83.05, Wis. Adm.. Code Tom Scbraitt znaclt complete site plan on paper not less than 8' /z x 11 inches in size. Plan must F iclude, but not 9mfted to: vertical and horizontal reference point (BM), direction and St. Croix iercem slope, scale or dimensions, north avow, and ration and distance to nearest road. art of 032 - 2049 -7G -0 SPPLICANT INFORMATION - Please print all Information. Cate 'ersord, intorrraion you provide rn.-, oe usad for secondary purposes (privacy Law , s. 15 04 (1 ) (m)1. Property Owner Property Location Riv _H arold And B Roland Govt Lot na NW 114 NVV 114 S 14 T 30 KR 19 W ;'Property Owner's Mailing Address Lot r ( Block # ` Subd. None or CSM# 812 150th Av _ 16 na Rockzmora _ s city State Zip Code PhoneMnber E] City ❑ Vilaaae XTown Nearest Road ' New Richmond WI 54017 715 -246 -5291 Somerset l 160Th Ave New Construction Residential t Number of bedrooms _ 3 � j kddition to existing building - 1 Rep Use. ( — J Public or commercial describe _ I � Code Derived daily flow 450 gpd Recommended design loading rate_ • bed, gpdtft 5 trench, gpdV Absor ion area required 375 bed, ft 37 5 trench, ft Maximum design loading rate --- A — bed, gpdtft= _ 5 trench, gpW Recommended infiltration surface elevation(s) 96.28 ft (as referred to site plan benchmark) :4ddikional design !site eonsideratians System Elevation based on C:ontoor Line established at Elevation 95.28' Parent material pitted Glacial Drift __ Flood plain. elevation, ff i�cable na ft S= Suitable for system i Corwa-. Tonal I Mound in- Ground Pressure AT -Grade Systen in Fill Molding Tank t U= Unsuitable far system p S p u S❑ U iJ S 0 U ❑ s� U t J s� U L s� u SOIL DESCRIPTION REPORT Horizon I Depth Bed Trench ! Dominant Color i Mottles Texture j Structure Cansistence� Boundary ` Roots I— GP Trench -- Boring# in. Munseli j Qu. Sz. Cont. Color I fir. Sz. Sh. ; + : 1 0 -8 loyr + none sil 2tngr mfr es 2m .5 • • 2 8 - 29 i 10 yr4/4 none sici 1 2 msbk mfr g ` 1 f .4 .5 --}-- -- ;round —�-- ! - -- -- -- 2 9 -5 �7. 5yr416 m ��6 sil + lmsbk mfr - rl� I __ 95.43 It ­7� 'epth to ---•r— miting 'actor W { °— Remarks: - - r 1 01.3 i 10yr3 /3 none s + 2fsbk mfr cs } 2m 5 6 .5 .6 1 9/4 on 1 2fsbk mfr gw if 13 -28 0yr ground 3 28 -50 I 7.5yr4/6 rE12p 10y�3 /6 sicl 2 msbk mfr - - - - -- 4 i 5 elev —� - l :repth to rniting ! ; I factor I I Remarks: CST Name (Please Print) Signafurw _ Telephone N0' 715.549 -665 Thomas 1. Sct - - -� --� — 7 7 R 7 ef# Address Torn Schmitt Date CST Number 586 ti� alley View Trail, Somerset, W 54025 5!12100 227429 13 R;� �, Hecotd And Belialo, Rolena SOIL DESCRtP� IUM Ktr%Jm I ROPERTC , ; 41. J L � Otj�R: Tom Schmitt ARCEL kD:# Pait of 0 2 2049 -70-0 GPD1ft' Structure Consistence y ; Roots Depth Dor unapt Color Mottles Te�Qwe ! Boundary - Fo Mansell Qu. Sz. Cont. Golor { Gr. Sz. Sh. Bed ;Trench 1(1yr3/2 sil 2n�g mfr cs 2m 3 6 3 none 2 j 8 -1_5 7. none si 2msbk mfr lw if 3 6 — Grotx�ti sl l lms bl: ? - - - -- l 4 5 aiev 3 26 -29 7.Syr416 none _, - --�— n,3pp w pyr &'6 sl rZ� I .... i - - - - -- ; .3 A 04.348 29 -SO 7.5yr4 /4 IO Depth to factor 4 Remaecs: -- Ground elev_ _ ' ---- -- Depth to knifin I Jam. factor I — - i ReTT18rkS: --- -- x : I __ - ---7- -- Ground elev l — Depth to knft factor =7 - Remarks: ---- -- - - — 77 Ground elan Depth, to =fl �r Remarks: 74 i I �� CL IW' ✓ f I t , } ' I i 1 } J A 1 - I - ' I , 4 - -- - -� -- C74 It , -- , i i , I j ( � i - I w l-- y r 7. Q IZI co N � ^ W I ^ d V M dA'0WIH5 - �A IN _ o N -- I r -Z �'"?• 3AV _ H1�91• 9lL w Oo* 00 1 0 1 R 1 /� 2 +00 I + / N klz) I I t CP LIQ di m 01 C14 -fOl I o WI O I I (� O p O C�� Nr 2 m w ?� 3 `.: W - w 01 �j I I I O O h 'OC S I I 1 _j 01 I Q CSI �, O\ O � O C O O r C O cnb r D p = i 4A CD Q Lij I C, C) c r�� 000 W I OI IppOC -�C t`0(I1� -'c' C�00 � / j U c O '.��'�� p ts c}� it I / CIUCr� 0 $k: i t IZI U ,p�� -,' p JC�C O' `ol I i / bLC _ ggy •A3�3 P483 0350 0 o ooh d-1 Z I L,J WI InI LY_I OI to 0 = W I I n- I .. �* Of � Q I I a s W' 'WI'(nI ZI CSI I Q �� W m —— ��'_L.. f WEEK'S C. P. 800ga1. PUMP TANK Tank Anchoring: Per Comm 83.43(8)(g), Wis. Adm. Code, all tank(s) must be anchored whenever they are at risk for being installed in an area where they may be located in saturated conditions all /part of the year. Using soil as the anchor has become an acceptable alternative to concrete. • Flotation potential is the displacement of the tank calculated by its volume in cubic feet. Line A: Calculate cubic feet of tank. 50 inches high, x 3.14 X 42 r = 276948 c ubic inches. Divide this number by 1728 to equal 160 cubic feet. Line B: Convert the displacement to the weight of water. 160 (from line A) cubic feet x 62.4 (weight of 1 cubic foot of water) x l.5 (safety factor) _ 1 5001 lbs. of lift potential. Line C: Calculate weight needed to counter buoyancy. 1 5001 lbs. (Displacement weight from line B.) - 6054 lbs. (weight of tank per manufacturer) = lbs. of soil needed to anchor tank: 8947 lbs. Line D: Weight of the soil media including safety factor needed over the tank to anchor the tank adequately. Tank cover radius 2 x 3.14 42 3.14 inches, divided by 144 = 38 . 5square feet x 0.083 (l inch in foot decimal) = 3 . 2 cubic feet (volume of I inch of space over the tank cover). Line E: Calculated weight of 1 inch of space over entire cover. 3. 2 cubic feet of space ( from line D) x 100 lbs. /cubic foot of = 3 2 0 _lbs. /inch space above cover. Line F: Calculate inches of soil needed to counter buoyancy . 15 lbs. (from line C) divided by 320 lbs. per inch of soil (from line E) = inches need over tank cover. 47 inches of cover needed i WEEK'S C. P. 1260 gal. SEPTIC TANK Tank Anchoring: Per Comm 83.43(8)(8), Wis. Adm. Code, all tank(s) must be anchored whenever they are at risk for being installed in an area where they may be located in saturated conditions all/part of the year. Using soil as the anchor has become an acceptable alternative to concrete. • Flotation potential is the displacement of the tank calculated by its volume in cubic feet. Line A: Calculate cubic feet of tank. 71 inches high, x 3 -14 X 42 r = 393266 c ubic inches. Divide this number by 1728 to equal2 2 7.6 cubic feet. Line B: Convert the displacement to the weight of water. 227.6 (from line A) cubic feet x 62.4 (weight of 1 cubic foot of water) x /.5 (safety factor) _ 213 lbs. of lift potential. Line C: Calculate weight needed to counter buoyancy. 2130 lbs. (Displacement weight from line B.) - 6870 lbs. (weight of tank per manufacturer) =1bs. of soil needed to anchor tank: 14433.4 lbs. Line D: Weight of the soil media including safety factor needed over the tank to anchor the tank adequately. Tank cover radius 3.14 , 42 3.14 inches, divided by 144 = 38. 5 square feet x 0.083 (1 inch in foot decimal) = 3 . 2 cubic feet (volume of I inch of space over the tank cover). Line E: Calculated weight of 1 inch of space over entire cover. 3. 2 cubic feet of space ( from line D) x 100 lbs. /cubic foot of = 320 _lbs. /inch space above cover. Line F: Calculate inches of soil needed to counter buoyancy . 144 .4 lbs. (from line C) divided by 320 lbs. per inch of soil (from line E) = inches need over tank cover. 45.1 inches of cover needed a Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings In accord with Comm 83.05, Wis. Adm. Code Tom Sctmtia Attach complete site plan on paper not less than 8 x 11 incf� sit. Plan must County Include, but not limited to: vertical and horizontal referen gird BM), direction and St: Croix percent slope, scale or dimensions, north arrow, an atlott and distance to nearest road. parcel I D.# ,�'4 Part of 032 - 2049 -70 -0 APPLICANT INFORMATION - Pleas p fit all Tn. awed By Date Personal infonnalion you provide may be used for secon rposes ( ° ! �a1(1 „. 15.04(l)(-)) . Property Owner t r. roperty Notation Rivard, Harold And Belisle, Roland ,._ '_, ' 2� vt Lot na NW 1/4 NW 1/4 S 14 T 30 RR 19 W Property Owner's Mailing Address COUNTY Lot # Block # Subd Name or CSM# 812150th Ave ' .� 0PPIG na Rockamora City State Zip Code neN�mber ❑ Village ®Town Nearest Road New Richmond WI 54017 ;5 Y Somerset - 160Th Ave ® New Construction Use: Residential / Number o edrooms 3 ❑Addition to e.)asting building ❑ Replacement N Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate • bed, gpd/ft' • trench, gpdffl Absorption area required 375 bed, ft' 375 trench, ft' Maximum design loading rate •4 bed, gpd/ft' .5 trench, gpd/ft' Recommended infiltration surface elevation(s) 96.28 ft (as referred to site plan benchmark) Addi Tonal design / site considerations Sy st e m Eleva tion based on Contour Line established at Elevation 95.28' Parent material Pitted Glacial Drift Flood plain elevation, if 6cable na ft FMUnstulabie itae for system Conventional 7 und In.-Ground Pressure AT -Grade System in f" Holding Tank for system CIS ®U D U D S 0 U ❑ S N U ❑ S O U El S 0 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft' Borin j Honzon Texture Consistence Boundary.... Roots 9# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench „;. y °z 1 0 -8 1 3/3 none sil 2mgr mfr cs 2m 5 6 «. 2 8 -29 10yr4/4 none sicl I 2msbk mfr gw 1f .4 .5 , Ground 3 29 -53 7.5yr4/6 �1 yr/3 6 S/3 sil lmsbk mfr ---- t- - -- .2 .3 — alev 95.43 R Depth to limiting factor 29' Remarks: l 1 0--13 10yr3/3 none sil 2fsbk mfr cs 5 6 ;w2 v vY 2 13 -28 10yr4/4 none 1 2fsbk mfr gw if .5 .6 , Ground 3 28 -50 7.5yr4/6 "'��py /3 6 sicl 2msbk mfr - - - - -- .4 i .5 Slav - - -- 95.28 ft Depth to limiting factor 28' Remarks: CST Nano (Please Print) Signature: _ r Telephone No. Thomas J. Schmitt Date Address Tom Schmitt Date CST Number Ref # 586 Valley View Trail, Somerset, W1 54025 5/12/00 22742.9 1013 PROPSM OWNER: Rivard, Herold And Belisle, Roland SOIL DESCRIPTION REPORT 1013 Page 2 of 3 PARCEL I.D.# Part of 032 - 2049 -70 -0 TOM Schmitt E rizon Depth I Dominant Color Mottles Te)dure Structure Consistence Boundary Roots GPD/V in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench xr 3 1 0-8 10yr3/2 none sil 2mgr mfr cs 2m .5 .6 , 1p 2 8 -16 7.5yr4/4 none sl 2msbk mfr gw 1f 5 i 6 Ground elev 3 16 -29 7.5yr4/6 none sl lmsbk mfr gw - - -- .4 .5 94.34ft 4 29 -50 7.5yr4/4 map 1 SOy/r36/6 sl Om m& - - - -- .3 4 Depth to - knifing factor 29' Remarks: LLJ Grour,a elev Depth to r factor Remarks: Ground elev Depth to knfig factor Remarks: k Ground elev Depth to fmi6ng factor Remarks: I I i I II I I I a I I I I I I i I ; I I I i ' I I S7 I i I is yr Z I i I I , k1 : I� - � — ,.. i '. �. � I � ' I , , �, � i i _ I1 �._ i l i '. , I � � • f c J i ,.. ' �' I _. i i ,, I, I I I i i. i � � v - i i i t i �i { �� i � r r- _ � - - — _ _. I _ - � --- � .. i � I � � � i - __ _ i i . i I i I �, ',, i I I i I j j. �r I I_ _ ,_ { I f— � �- � � , i � , I ! i i �, � I _ �._ ____.. — - — _ __ __ J — - 4 -- � ,.. __ � � � _- _ � I a I � I i j- � � ,� I I 1 I _ '. _.. _.— A L ' I � I __ �____ I i ! , i - I . I _. __ - � __ _ _ -_ � - _ _ ' i � � r� �� ; _ _ _ i ! � I I I __ __ _ _ _ _ ' - I _ ,.._ __ _ }. ,_ -_ i� ��_ I ? � � � � i � _ - _ _ I i I � I , � 1 . I -- - -- I I i � _ _ _ � _ - - - - -- - -- - .._ - � � �� � '� � � - -- I - +._ - � � l t _. r- I _ _ { I � ! i i I ,_ � I i � -, j-- �- !- ,_ i I — � f i I — — — -- . I _ r � __— �— — r � _ I _ 1___ —. r i__ � i.. " �. � I i I _. � ; .__ � I � � ,. ,, � I ! �� i � i �� !. '; i . I i � i I j �, - - 4 - -- - - -- I ,. i _ � _ I :_ 7 .� � �. � _ � � .. _ I � �.. i � � I _�. _ � _ �_ I �_. 1 __ I - _ - I ; _ �- - - I- �, �, ,' I t I �' r -._ � �_ . L ... I i � � I �� r i 1 � � 1 _ � 1 I _ _ .... I __ _ _ ._ _..__ �, '. �. i 1 � _. _ _ � _ _ L -- i - __ I_. _ I_— _ _. 4_ I I _ _ I.. _. _ _._ — I i I � �, i � �, i__ -__ �' .� i _ �. �. , i '�, i I i � � - I I i i � ' � � '. I !.. I . , i �� i ' � -� I - - _ _. i � , — _ � l 1 �� , ,. i �� �, -- �, _ _ , _; i ,_. _ _ . �_ �I - � _ , �� - -- _ � � � � � _ �. - _ f -_ i I -_ _ � -- ;__ _ r _ _ _ � j__ I �. - �� �I I ' I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � � Mailing Address /A 300 177A u u��Zcl LAS � � mU /A � Property Address (Verification required from Planning Department for new construction) City/State i�(/Fji� frr`G�r�a.voJ Parcel Identification Number ���" / �> 2 7) LEGAL DESCRIPTION Property Location N 'Y,, Sec. T N -R _W, Town of �oh't ell- Se Subdivision , Lot # Certified Survey Map # , Volume , Page # # e Warranty Deed # T7 7.3 3 9 , Volume Y �/ P � Spec house ❑ yes 24 no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrplumber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system E is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. s Itwe, 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 septi stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days oTthe three.: 'f .ezpiratfgn date. ► IGN PPLIC DATE ,e OWNER CERTIFICATION I (we) cerRhat all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of e of Deeds Office. th perty dese¢ abovsr, by virtue of a warranty decd recorded in Regist r 0� S16 , A 4F, �1?'LICANT DATE t l .q information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. 1 •k Include with this appliCRtion: a stamped warranty deed from the Register of Deeds office 4 a copy of the certified survey map if reference is made in the warranty deed t i s ' U 2649P 263 STATE- BAR OF WISCONSIN FORM 11 - 1982 7 7 3 3 9 2 LAND CONTRACT KATHLEEN H. WALSH Individual and Corporate E ISTER OF DEEDS ( TO BE USED FOR ALL TRANSACTIONS WHERE OVER CROIX CO.. Document Number $25.000 IS FINANCED AND IN OTHER NON - CONSUMER ACT TRANSACTIONS) RECEIVED FOR RECORD CONTRACT, by and between Harold K. Rivard and Roland J. 09/03/2004 Le-- LOAM Belisle ( "Vendor ", whether one or LAND �CO T CONTRACT more) and R an Dean Larson and Andrea L nn Larson husband and wife ( "Purchaser , w ether one or more). endor sells an agrees to convey to REC FEE: 13.00 Purchaser, upon the prompt and full perfomance of this contract by Purchaser, TRANS FE2 2 1`JS• the following property, together with the rents, profits, fixtures and other COPY FEE: appurtenant interest (all called the "Property"), in St, Croix Count State of CC ES a 1 2 PP Y. PAGES s � F1 jymK onsin: 6 Rockam St. Croix County, Wisconsin Recording Area Name and Return Address Kristina Ogland Attorney at Law P.O. Box 359 Hudson, WI 54016 L . 32- 2139 - 00-000 Parcel Identification Number (PIN) This is not homestead property. (is not) Purchaser agrees to purchase the Property and to pay to Vendor at a place from time to time determined the sum of $ 65.000.00 in the following manner: (a) $ 7,065.85 at the execution of this Contract; and (b) the balance of $ 57,934.15 , together with interest from date hereofon the balance outstanding from time to time at the rate of 66 % percent per annum until paid in full, as follows: Commencing October 1, 2004 and continuing on the 1" day of each and every month thereafter monthly payments of principal and interest in the amount of $488.94. Provided, however, the entire outstanding balance shall be paid in full on or before the 1st day of September , 2009 (the maturity date). Following any default in payment, interest shall accrue at the rate of 12% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be appl ied first to interest on the unpaid balance at the rate specified and then to principal. Any amount maybe prepaid without premium or fee upon principal at anytime after, nissionofVeidon In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: None Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on September 1 , 2004. • Cross out one. STATE BAR OF WISCONSIN Information Professionals Company, Fond du Lac, Wl LAND CONTRACT - ladividual and FORM No. It - 1982 800 -655 -2021 Corporate U 2649P 264 Purchaser promises pay when Jue all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Ptneliftse shall keep thekinpl— ......... ... th- Pla i k3tited a 103,, ar de a, occa led b� Fi extcnded e�verage p ,. !1hall at requi e mirr" tore thali t! e balance coved ti 2de tliis 63oi tract. Purchase shall pay tile pen dtic. 'Ri- Pei ic Sha Cc! rtai I tl�e standard e in fav at of tire Vend0l'S i tttCIC9t and, UnIC33 VC IdOt Ot M. Mile 6SIeCS i t C cove in tire P o Shall be deposited Mill Vc Ide . Parcl asel 3111211 P rom p tly g ive notiec of: less to MI suran­ --d Venden H ilcs- Purel "et mid Ycndom othica a if vnitin i istirm ce p roceeds shall be applied tore9tomatiot o epee 0 Purchaser covenants not to corm iit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free frorr liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, ofthe Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: casements, restrictions and reservations, if any, of record Purchaser agrees that time is of he essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 30 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues fora period of 30 days folio , ving written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract hall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also lave the following rights and remedies (subject to any limitations provided by law) in addition to those provided by taw or in equity: (i) Vendor i nay, at his option, terminate this contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclos ire with any equity of redemption to be conditioned upon Purchaser's full payment ofthe entire outstanding balance, with interest thereon from the d ite ofdefault at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be for Feited as liquidated damages for failure to fulfill this Contract and as rental for the Property ifpurchaser fails to redeem); or (ii) Vendor may sue for sp cific performance of this Contract to compel immediate and full payment ofthe entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contrac t at an end and remove this Contract as a cloud on title in a quiet -title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession ofthe Property and have a receiver appointed to collect any rents, issues or profits during the pendej icy of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election ofany ofthe foregoi ig remedies shall only be binding upon Vendor ifand when pursued in litigation and all costs and expenses including reasonable attorneys fees of V ndor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited bylaw and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver ofthe Property, including homestead interest, to collect the rents, issues, and profits ofthe Property during the pendency ofsuch action, and such rents, issues and profits when so cc fleeted shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits ofthe heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner ofthe Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in thc execution of the deed to be made in fulfillment hereof.) Dated this day of 2004 (SEAL) / Cr (SEAL) * Harold K. Rivard �R ' n Dean Larson (SEAL) _- - (SEAL) * Roland J. Belisle * Andrea Lynn Larson AUTHENTICA IrION ACKNOWLEDGMENT Signature(s) Harold K. Rivard, Roland J. Belisle, STA'L'E OF ) Ryan Dean Larson and Andrea Lynn Larson ) ss. _ County ) authenticated this day of 2004 Personally came before me this day of L j � the above named * Kristina Opla id TITLE: MEMBER STATE BAR OF ISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Slats.) THIS INSTRUMENTWAS DRAFTED BY Kristina Ogland, Estreen 8s Ogland 304 Locust Street, Hudson, WI 5401f Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknom ledged. Both are not necessary.) .) *Names of persons signing in any capacity should be typed or printed below their signature. Information Professionals Co., Fond du Lac, wl STATE BAR OF WISCONSIN 800 -655 -2021 LAND CONTRACT - Individual and Corporate FORM No. It - 1982 CL LGT.-,.2 z Qi ,OT 3 Q-URVEY MAP CERTIFIED SURVEY_ MAP PAGE 24,08 -- - VOLU , M , E - 9 PACE 2408 160-7'-H-,.--A-VEI - ------ NORTH LINE OF THE NW 1/4 SECTION 14 S89'11 9'41 "E 2630.93' S89 "1 41 *E 1171.21 EXIS' 7.73' In I ---- - --- - -- 36.73' -N89*08'51 408.00'-, +N - --- 311. 66' 357.63- IGA TED %e— 96.54' • OD 81 84 12 K 33' z 31: r DRAINAGE EASEMENT H,W.E,-488.0 Of V) .0 (Q� 0 T7 L-o r 16 133, 086 50. f '. 12 5V F 3. 06 A CRES J 6) �C . VF 492.0 276.26' 298,04' i 20' )MOE DRAINAGE EASEMEN T F.F.E. OF 4920 ci lo / c4 N84'09'37-W 66' LOT 15 1 N z eq in J. A CRI S ui J -DS- 41( S 89'17'39' E 500.01' 1 I I : mlt