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o cn o 0 cn 0 '''' g o d v� Q d f Q d F a, cD C 3 r► C n m O ' Cl) - u - 0 o W cn z T z W W o . n , Cy N O v 0 %� O 07 Cn 0 m 3 3 c N J rn m 3 CD oD ° O 0 a° v p n `° C`7 CD B J J . N w 90 W Cp �. N Ro CD V O, ! NO �J 7 7 CJ CD O ) J CD O ° c cD n Z 1 c D n < O D O 3 O 7C 3 is C0 V O I W N N CO ID O I, O Ch � CD v; v v D se CCr j IW d CC: d N c \° o c ° ° 3 (C) go :.i 0 0 0 ivt O N y CD -^` Z Q v? L "^ Z W (O =r C- O C O N N C lll���fff CD CD O o CO O ((D 0 0 O O G Cn U1 A -0 co W C w C w N N !V m 10 CL o o o °^ n o 0 o° �• T Q o g r c y N N c�D N N N 4 D a 6 T o o y v o o o m m v CD m CD 0 CD 01 =$ m 3 ( 00 m m D D o° \ D D o N) O O c rT K O c -4 J c J ? C1 CD (DD �r • ro fD N O O @ N O O w c. C j Cc 7 3 0 3 CD a O O y a I I -� -i Ch N C J CD N C . Q (n Q C J CD N O CD Cn CD en N Z W of W -0 m � rn J z O ' z O O Q N N Z CD CD y < CD A w n F W j J CD cn O y O O O T N N 0 T �1 0 p S ili C a 0 N C p CD W O �• p Z J J CD CD . O CD m N O C. N J O d CD aC �O� °3 c, �.y O y a� ? cD o o 0 y 'O fD O J, O O � �° o � y 1 � � oo v � - S n N Cn O �' O t 3 S 1 3 J ID C N N C r: O N 0 7 C °- 7 N 0 J v CD J J I o c o Q- � wo C J C N a to COD [..t CD n j D CD J O =3 3 O a S 0 n 00 3 a 0 CD CD a ti do 1 < < ts3 O 6e O a o CL o CL Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: � �. r, - 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: Brandt & Hoivik, Breanna & Joshua I Springfield, Town of 034 - 1037 -30 -025 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 16.29.15.250A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t sm &j Benchmark Dosing t / �\ Alt. BM Aeration ( Bldg. Sewer n' ' g' Z Holding St/H Inlet r,+ (v 'run • 7S b SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom • Z Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION 1S771JG' Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head r DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM 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 Type Of System: CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size I x Hole Spacing Vent to Air Intake Pipe(s) L Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil a r Yes E] No 0 Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 943 290th Street Wilson, WI 54027 (NE 1/4 SW 114 16 T29N R15W) NA Lot 1 - Parcel Vo: 16 1.) Alt BM Description = 40 Cv i 2.) B ldg cpwar lanath = I - amount of cover = 1't-uJ NWvt,a� - �°� I O j. / lM { �1tJ1� l�/o S T Plan revision Required? F Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No. t ii ' l �.J .S 4 Tt 9 2�6 s sP Vq S f(� 7 2 g�J PS P5 w G J l i F1 ti � A N S �f L e co PY v �tiy County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN Fo� In accord with Chapert 12 St. Croix Count Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be us secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04 A 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax (715)386 -4686 Attach complete plans for the system on a not les /2 x 11 inches in size. County Sanit Permit # ❑ Check if revision t vious lication 9.7-/ 3 I. Application Information - Please Print all Information Location: Property Owner Name /� 1/4 SG41 1/4, Sec / Vi /mss SEP 2 9 2008 N, R 1 -&*)® Property Owner's Mailing Address Lot Number Block Number T. CROIX 9Y3 2 90 ��� .5-74 S C OU NT Y ZONING OFFICE City, State Zip Code Phone Numer Subdivision Name or CSM Number (s Z_e -s u-%� (&-.ry , ,.v i 5gol 3 7 i5-- 92 X- 0 37? �'��'�5� Ty 7 I a of Building: (check one) ocity ❑ Village own of 1 or 2 Family Dwelling - No. of Bedrooms: 19 El s Pie- //,( ��`� Public /Commercial describe use): ❑ State -owned Nearest Road II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) ;2-go f- Parcel Tax Number(s) A) 1 1.0 Repair 2 Reconnection 3. ❑Non- plumbing . ❑ Rejuvenation 6 341- /v 3 7 1 3 Sanitation B) Permit Number Date Issued )State Sanitary Permit was previously is Z 3 0J IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground ❑ Mound 2t 24 in. suitable soil ound 5 24 in. suitable soil ❑ Mound A +0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At - grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade ,[�,✓fj Required 1 Pr / o p pose (Gals. /day /sq.ft.) (Mindinc q7 .�/ Elevation VI. Tank Information Cap ' ty in Total # of Manufacturer Pr ab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks ❑ ❑ ❑ 1 ❑ _ ❑ ❑ ❑ ❑ 1 ❑ II. Responsibility Statement I, the undersigned, assume responsibility for repair /reconnenction /rejuv nation/ installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plumber's Name (print) Plu er's Si nature (no mps): MP /MPRS No. Business Phone Number Ilk <<kQ Q / v /k -rr�+ %zG ? 8 - 1 1 5- 0-6. 5 Plumber's Address (Street, City, State, Zip Code) Z 9 VLr 6 �� { GE .✓ fit/ C ! 9'`/ GU / S Dl VIII. Coun Use only Disapproved Sianitpry Permit Fee D to Issued ssuing Agen Si at o stamps) Approved Owner Given Initial Adverse �.') ��� W2 L9 Determination (/ IX. Conditions of Approval /Reasons for Disapproval: Jai do- 9��3 '24 fy-sf G 1-0N wCV- � Cy,', w r c3 fF- 4ls6, b rwri & w i J� i f o s rrl L l !v 4t Site plan d Page 8 of 8 For: Theodm n.. Lot 1 of Csm Pending NWl /4 -SWl /4 Sec. 16 T29N -R15W x Town of Springfield - St. Croix Co. > 75 To Road Proposed 3 Bedroom Home 1 0 20 40 X setbac 1 � soal (� 20' Proposed 4 " ) B1d�� 290th St. PropajWles �te Note: Maintain well and waterline 10001600 Gal. ombinadon Ta w /Zabel ks (() A -100 Filter x Pte' Comm 83.43 8 � i Hill O Proposed 360' of2 "Sch. 40 x Force Main Old Fence Line r t Nil -c Note: Mound area scaled only. ;O 92.60' Proposed 6x75 Mound Cell w/a 11 System Elev. of 97.07' 94.60' 96.60' 565'Approx. " 90110 BM #2 98.60' - BM #1 ABM = Top ofl 1/4" PVC Pipe Neat to Lathe w /Orange Ribb a * HRP = Same ASSUMED ELEV. = loo #2 P BM = Top of 1114" PVC Pipe Next to Lathe w /Ora nge Ribbon � /�` ). /_ PIL Z m Z z m .. X r O s C/) CD X - O wo 1 o - U) • C7. < Z Fu r 0 r m D�j �O - n n O X x �� o D n o C z m � _ > r y G) m z O m n n a? m X Q N Co z C Z O C m c 0 �' n O cn Z < —I u' U) — 1 T M Z� m Z _ I - M ° 3 ov oa maw& m mm y c a 'O• m o a �� �C7 Vim-, r C D 8� m m = o m m °' 3? o s O o o ui w o C < o y lD m j c y N C y fD O I m n N O t0 = O 3 M S ct O O D m o �� a o o N o _ y v v Fr 3 CD D A 7 C N N. cr y \ \� \ 1 / y N CD `� y N 5 N CD CID, N L. Cr m �. m °O �, Q' 06 ° p a Sri co CD D 3 N O. _a (D •p Q O m w =3 . o :U Z m rl �• .». 3 cp O O p> y N c Uf Z 6 o - m E v, N= a c a < D Z ° o �_ o o c m Z C m CD m m "1 o= N m= -_•I -i _i T CD m ° n O O Z O D m v 0 3 D,,' v o o Z Z O Z (D CD N fD p fD El 1 El CD O_ _ ��� u. 2 e s 1 P 21 WALSH State Bar of Wisconsin Form 2 - 2003 KATHLEEN H. REGISTER OF DEEDS REEDS WARRANTY DEED ST. CROIX CO.. MI RECEIVED FOR RECORD Document Number Document Name 09/19/2005 10:45AM WARRANTY DEED THIS DEED, made between Theodore E. Bergum an d Shirley A. Berg EMPT # 17 husband an d w __ REC FEE: 11.00 — �— —^ TRANS FEE: ( "Grantor," whether one or more), and Bmanna R. Brandt, a single person, and CCPFEE -. Joshua P. Hoivik, a single person PAGES: 1 ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more Name and Return Address space is needed, please attach addendum): Lt 4 S- -,- , Part of the West Half of the Northwest Quarter of the Southwest Quarter (W K of NW '/. of SW '' /.), (y O S � n b oy, a 9 y and part of the West Halt of the Southwest Quarter of the Southwest Quarter (W % of SW '/. of SW '/4) of Section Sixteen (16), Township Twenty -nine (29) North, Range Fifteen (15) West, Town of Springfield, St. Croix County, Wisconsin, more particularly described as follows: Lot One (1) of Certified Survey Map filed October 26, 2004, in Volume 19 of Certified Survey Maps, at Page 4867, as Document No. 778156, office of the Register of Deeds for St. Croix County, Wisconsin. 034 - 1037 -30 This deed is given in full satisfaction of that certain Land Contact between the parties dated 225/05, Parcel Identification Number (PIN) and recorded 3/4/05, in Volume 2759 of Records, at Page 265, as Document No. 788811, office of the This is not homestead property. Register of Deeds for St. Croix County, Wisconsin. Eis) (is not) Exceptions to warranties: Easements and restrictions of record, and except any liens or encumbrances created or suffered to be created by the acts and defaults of the grantees, their heirs, successors, or assigns. Dated �c.>a -� t. � . � ( (SEAL) (SEAL) * Theodore E. Bergum f, ,O (SEAL) (SEAL) * * Shirley A. Be rgdm - AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on ST. CROIX COUNTY) Personally came before me on - 3 zws * the above -named Theodore E. Bergum and Shirley A. Bergum TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. )n.0 JOIL THIS INSTRUMENT DRAFTED BY: * 7 Thomas A. McCormack Notary Public, State of WISCONSIN Baldwin WI 54002 My commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED STATE BAR OF WISCONSIN FORM NO. 2-2003 *Type name below signatures. 0 State Bar of Wisconsin 2003 INFO -PRO' Legal Fortes - (900)655.2021 • Woprotorms.00m I - FORM NO 985-A ier - 7 '7 LS 1 S 6 Stock No. 26273 VOL 19 PAGE 4867 KATRL K. WALSH REGISTER OF DEEDS RECEIVED FOR�hECORD CERTIFIED SURVEY MAP NO. fA17Ae 4 04:30 VOLUME , PAGE CERTIFIED SURVEY KAP REC FEE: 13.00 THE WEST HALF OF THE NORTHWEST QUARTER OF THIPoPY FEE: AGES: 2 SOUTHWEST QUARTER, AND THE WEST HALF OF THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER . SECTION 16. TOWNSHIP 29 NORTH, RANGE 15 WEST, TOWN OF SPRINGFIELD, ST -CROIX COUNTY,WISCONSIN. a N89'39'19 "E 660.71' _ e I: �rnOO °� n) 1 627.71' ro o ro a v ro z • O Z�, :I I W g ,OC a T O N O .� C O I i o ° v+ rT1 0 ° o o wN e? O afro O u fD O 7 T r4 7 r f- r°v 1 OD 2 r o �' ~ a a `< r-'o rs D W I m N Cl_ Q� -3 I 100 ?y'b' �'" - r fir �� ? rrrl F x r rT_1 Ir I I I f N i rn r r un < n I I I - ° O C z w .. 1 °' o co rD CD m Co (m o./ o I I rn I z 0 0 C3 = Io I� i 9 ro �- rID I I IV - � -, I I po f r• m a, rD N I I w O n. o= it71a - ? (_n I 1 N89'28'35 "E 659.06' I"' I i I 1 630 -01' 5- N (/) IC 3s s3' e O - I i (.n w w Iw s •,. _1 OD 2. CA �0o O� in CID m �o c s I rn 40 line ro m' I N 2 �o a I `" ; N89 28 35 "E 658.08' • ro a 631.45' .F �' O � c s o a m I I l X56 N Y - X ] ] � ' - 01 Y > p ru C ("1 � I 1 < � 0 .. � ' p = A a d D a? I x � w a1 i o w rr'1 1V' I O = ^_ n m o 1 ^ rn~ - C/1 E CD ::E: Z 0 0 i I N I rs In r ro a s O_ I 1 <� O N8928'35 "E 656.91' Q In o rc `„ `c' FD ro O -" Iv c^ E a i z 628.41' C T° :° r- Z �m m a oTa rn � oaow �yoA^ I� Cl r rnvl� n moo, � o o �i I to ° TLn 3wcn O IZI� _, x l o a OIL �o O ^ � �c I I cr� �� Ivdi�� N - ^ W O 7 N Z I -, w H i w r Cn O7 ' I G v'1 r 7' F to ( t �: ro c `-a v a l o l y to I ° `\ rn 3 1 - a L '+ca - v I I I v ID ca. CD m io 'C^ °-' �o I I co I ,.�ttx)ck . r,r._ - a - R Ip 7 ° a vv° � — — - °__- -- - - -- 0 1967 -12' 3 �� 90th Aye — — , <—„ 655.70' - -� 12. � o m � o Page 1 of 2 Vol 19 Page 4867 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT sanitary Permit No: 479293 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: Village X Township Parcel Tax No: City Hoivik, Joshua Springfield, Town of 034 - 1037 -30 -025 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 7. q-1.6— 1 I v M il Z Cs 16.29.15.250A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS ,}iI FS ELEV . 6 q. Ito � 1G Septic `' Benchmark �j 3. 4 1- . (op Dosing /' _ I- v - Alt. BM We f Aeration � ynv Bl N�$, vi er f � -k-v . 1 1 �• rZ 6• Holding St/Ht Z �L / 7-7 48 ` o f (J St/Ht Outlet TANK SETBACK INFORMATION TANK TO P W BLDG. Vent n�ir Intake ROAD Dt Inlet LON / Bottom Septic IO / D Yl M I I -'t 3 Z-7 (G Dosing HeaderlMan. 3 7 - pV Aeration D ist. P ipe , -7' gV 4 Holding B System 9- YV 17-1 7' Final Grade J PUMP /SIPHON INFORMATION Manufacturer Demand St Cover 1 -7 d /.7� GPM Model Number We 0 -3L � - Z(7 ,)(0 / N �� f „ C ':?5 i� TDH L� �. (d iction Loss System He d TDH t �� Z.l �j S Z l� ��� 3 / Forcemain Le Dim �� Dist. ttoWell 7 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 SETBACK SYSTEM TO P/L BLD WELL LAKE /STREAM EACHI Manufacturer. INFORMATION CH B OR Type stem: t3 f \ I '> ��� r / Model Number. DISTRI ON SYSTEM / t Head anifold Distribution x Hole Size x Hole Spacing Vent to Air take 3 , of Pipe(s) ^� . / Z �.l 1 . Length Dia Length ! �' Dia Spacing 0 lurl SOIL COVER x Pressure Systems Only xz Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes No ,I Yes _j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / S Inspection #2: / Location: 943 290th Street Wilson, WI 54027 (NE 1/4 SW 1/4 16 T29N R15W) NA Lot 1 � ` u%-) Parcel No: 16.2 1 . 50A10 LbV Jse� / 1.) Alt BM Description W O ((;Z,- = � 2.) Bldg sewer length = * /7 v D �`� / O - amount of cover = _ - -- - Plan revision Required? i =_',I Yes No _ ��`` Use other side for additional information. - - Date Insepcto s Signature Cert. No. SBD -6710 (R.3/97) f Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S- <Za Madison, WI 53707 - 7162 Sanitary Permi ro be filled in by Co.) Department of Commerce (608) 266-3151 q Z 9 3 Sanitary Permit Appli_cat on RF°FN s man I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal on you provide I = 7 s • 1 t? / may be used for secondary purposes Privacy y/; �s„L lxm) Jul- ! ;'(!. ject Address (if different th mailing address) I. Application Information - Please Print All Information �, ;�N 1 9 2 Property Owner's Na me - Parcel # Lot B ( Block # 1 3 1operty Owner's M ailing Address Property Location .t 577 i _ . � Sf.Section City, State Zip Code FPhoneNumber ' f aJ — 7 _ (circle one) H. Type of Building (check all that apply) T N; R ot� @I or 2 Family Dwelling - Number of Bedrooms b Number ❑ Public/Commercial - Describe Use Y• • 7 7D ❑ State Owned - Describe Use []City _ []Village Q'lownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) O — c3 T — O . 2SDA A ' oaNew S ❑ Replacement System yytem Rep y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner i i X 5 0 Q = zo , G 7 ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable so' (W,l ound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized Mround ❑ Holding Tanlr ❑ 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: — S. D Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation f'o l I V - V 1ls . 7 9�- ° 7 VI. Tank Info Capacity in • Total Number Manufacturer Prefab Site Steel Fiber S IC Galkuu Gallons of Units ncrete Constructed Glass New I Existing Tanks Tanks --t! Septic or Ho� Aerobic Treatment Unit 6 Dosing Chamber /a) VII. Responsibility Statement- I, the - undersigned, assume " M6 for installation of the POWTS shown on the attached plans. Plumtier's Na me (Print) Plum 's Si gnaNre� -Ivff'/MPRS Number Business Phone Number Fogerty Plum ibing � f ? /.i — .�s— 9X,0 Aildce Plumbe�g 1ptp &m. zip Code) 7 /.S —�i3S = S =2 ��o /�X Spooner, WI 54801 VIII. Co se Only Approved ❑ ` DyS,4p roved e t Fee ( ndes�ro Date Issued Issuing gent Signature (No Stamps) ❑ OWn `' en Reason for Denial Surchar IX. Conditions Approv /1 SYSTEM OWNER: 3 � �L�"`"^"`°� � �`� y 1 Septic tank, effluent filter and � # Z c f dispersal cell must all be serviced / maintained P as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable cede /ordinances. Attach complete plans (to the County only) for the system on paper not less than 3112 x 11 inches in size r Site Plan Page 8 of 8 For. Theodore Bergum Lot 1 of Csm Pending NWl /4 -SWl /4 Sec. 16 T29N -R1SW X Town of Springfield - St. Croix Co. > 7S' To Road Proposed 3 Bedroom Home 1 0 20 40 X G -phte Seale (F�set) 1 inch = 40 R 20' Proposed 4 "Bld�� 290th St. Z Propose des o crete 10001600 Gal. ombination T w / Zabel Note: Maintain well and waterline A -lOD Fitter setbacks per Comm 83.43(8)(1) X Hill O X Proposed 360' of 2 0 &h. 40 Force Main Old Fence Line R5� -c r Note: Mound area scaled only. ;O 92.60' Proposed 6x75'Mound Cell w/a 11 System Elev. of 97.07' 94.60' - r 96.60 565'Approx. X BM #2 9•� 98.60' , BM #1 BM = Top of11 /4" PVC Pipe Next to Lathe w /Orange RIM n \ HRP =Same ASSUMED ELEV. = 100 X #2 P BM = Top of l 1/4 "PVC Pi Pe Next to Lathe P w /Orange Ribbon P/L Safety and Buildings commercemi. ov 10541N RANCH ROAD g HAYWARD WI 54843 TDD #: (608) 264 -8777 i s c o n s i n w ww.ce.wi . gov/sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 23, 2005 CUST ID No.221180 ATTN: POWTS Inspector DAVID B FOGERTY ZONING OFFICE FOGERTY PLUMBING & PERK TESTING INC ST CROIX COUNTY SPIA 28288 MCKENZIE RD 1101 CARMICHAEL RD SPOONER WI 54801 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/23/2007 Identification Numbers Transaction ID No. 1145158 SITE: Site ID No. 700152 Theodore Bergum Please refer to both identification numbers, 290TH St above, in all correspondence with the agency. Town of Springfield St Croix County NW1 /4, SW1/4, S16, T29N, R15W FOR: Description: New mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1023700 Maintenance required; 450 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes.t ' 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. t The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. DAVID B FOGERTY Page 2 6/23/2605 ` • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. • Provide frost protection per COMM 83.43(8)(c). 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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 o amten of the POWTS. Since Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Theodore Bergum Mound Owner's Name: Theodore Bergum Owner's Address: 927 290th St. Glenwood City WI 54013 (715)772 -3450 Legal Description: NW1 /4 -SW1 /4 Sec. 16 T29N R15W Township: Springfield County: St. Croix Subdivision Name: Csm Pending Lot Number: 1 Block Number: NA R Parcel I.D. Number: Pending Plan Transaction No.: Page 1 Index and title « �s Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan I Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Dave Foe License Number: MPRS # 221180 Date: 06/03/05 Phone Number: (715) 635 -9609 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.11 (R. 06/01) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 11.00 Site Slope ( %) 95.40 Contour Line Elevation (ft) 16,00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.25 Estimated Orifice Spacing (ft) = 7.03 fe /orifice 2.00 Forcemain Diameter (in) 360.00 Forcemain Length (ft) Does the forcemain drain back? Y 69.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 58.72 Forcemain Drainback (gal) 27.82 Vertical Lift (ft) 67.41 5x Void Volume (gal) 5.49 Friction Loss (ft) 126.13 Minimum Dose Volume (gal) 39.81 Total Dynamic Head (ft) 26.36 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 1 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser ConcretI Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 602.82 Dose Tank Capacity (gal) JZabel __ Filter Manufacturer 11.82 Dose Tank Volume (gal /in) A100 Filter Model Number Wieser Concrete Manufacturer Project: Theodore Bergum Mound Page 2 of 8 Mound Plan View t :�: J . / ' . ' Observation Pipe _ K A Wt .. ........................ B �. _.: .._ .. Mound Component Dimensions A 6.00 ft E 27.92 in H Aft ft K 11.37 ft B 75.00 ft F 9.50 in z ft L 97.73 ft D 20.00 in G 0.50 ft J ft W 28.87 450.00( ) Dispersal Cell Area 1665.11 (ft) Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.86 (ft) C F ; ::::: Dispersal Cell 97.57 (ft) Lateral 97.07 (ft) — 1111 0 - — Invert Dispersal Cell . . . t Elevation E D ' . ; j 95.40 (ft) Contour Elevation 11.0 % Site Slope Geotextile Fabric Cover Shading Key d o. T Dispersal Cell See lateral details on 10 Topsoil Cap c = 1.5 ft Page 4 for number, size, © { { { {{ Subsoil Cap w G a d and spacing of laterals. © ASTM C33 Sand a f F Laterals are equally Tilled La er d 0.5 ft Typical Lateral spaced from the Y = distribution cell's 05 0 Aggregate ; o - centerline in the �---- A — distribution cell (AxB). Project: Theodore Bergum Mound Page 3 of 8 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical I P � •= Turn -up wlball valve or 4<-X---->1+x?2 I Laterals & force main of PVC Sch 40 cleanoutplug per COMM Table 84.30 -5 Hales drilled on the bottom of the latera Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.37 ft Lateral Length (P) 36.74 ft Orifices per Lateral 16 Lateral Spacing (S) 3.00 ft Orifice Density 7.03 ft /orifice Lateral Flow Rate 6.59 gpm Manifold Length 3.00 ft System Flow Rate 26.36 gpm Manifold Diameter 1.50 in Total Dynamic Head 39.81 ft Forcemain Velocity 2.69 fUsec Dose Tank Information Locking cover with warning label and locking device and t sealed watertigh Electrical as per NEC 300 and - 0— Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E Akemate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 602.82 Gallons Volume 11.82 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 29.33 346.67 B 2.00 23.64 C P ump off elevation (ft) C 10.67 126.13 —t 69.75 D 9.00 106.38 D Total 51.001 602.82 il Dom se tank elevation (ft) 3" Bedding uncTer tank. 69.00 Alarm Manuafacturer S. J. Electro Alarm Model Number 101 -01H Pump Manufacturer JGoulds Pump Model Number 1#38 WE07H — � Pump Must Deliver 1 26.36 gpm at — 8 - 11 ft TDH Project: Theodore Bergum Mound Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Tri -County Sanitation Phone (715) 386 -0114 POWTS Regulator's Name St. Croix County Zonin Office Phone (715) 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ............... Grade 6 -8" Diameter Lawn ... Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral �► Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Theodore Bergum Mound Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ]SBD- 10691 -P (N.01101) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte sh be cleaned as necessary to ensure proper operation The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Theodore Bergum Mound Page 6 of 8 Page 7 of 8 MGOULDS PUMPS Submersible Effluent Pump � 44 11 3885 Fi PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant Single phase: ■ Bearings: Upper and stainless steel. Threaded • Built -in overload with lower heavy duty ball bearing Specifically designed for the design. Locknut on three phase automatic reset. construction. following uses: models to guard against • All single hase models •Homes g g g P ■Power Cable: Severe duty component damage on feature capacitor start rated, oil and water resistant. • Farms accidental reverse rotation. motors for maximum • Motels ■ Fasteners: 300 series starting torque. provides secondary moisture • Schools stainless steel. •' /3 and 1 /2 HP -16/3 STTOW barrier in case of outer jacket • Hospitals ■ Capable of running dry with 115, 208 and 230 Volt damage and to prevent oil • Industry without damage to three prong plug. wicking Standard cord is 20'. • Effluent systems components. • 3 14 -2 HP - 14/3 STOW with Optional lengths are available. bare leads. ■ 0 -rim Assures positive ■ Designed for continuous Three phase: g' P sealing against contaminants SPECIFICATIONS operation when fully • Overload protection must submerged. be provided in starter unit. and oil leakage. Pump • '/1 -2 HP -14/4 STOW with • Solids handling capabilities: /4 maximum. MOTORS bare leads. AGENCY LISTINGS • Discharge size: 2" NPT. ■ Fully submerged in high- ■ Designed for Continuous • Capacities: up to 140 GPM. grade turbine oil for lubrication Operation: Pump ratings are Tested toLIL778and • Total heads: up to 128 feet and efficient heat transfer. within the motor manufacturers QD can 22.2108 standards TDH. recommended working limits, By Ca"acka"sta"dards • Temperature: ■ Class B insulation. can be operated continuously ci us F ile#1�38549 104"F (40`C) continuous without damage when fully 140OF (60cC) intermittent. submerged. Goulds Pumps is ISO 9001 Registered. • See order numbers on METERS FEET reverse side for specific HP, 40F 130 3885 voltage, phase and RPM's WE15HH S ERIES: SOLIDS available. 120 SERIES: RPM: 3500 & 35i 1750 110 WE20H _► f —SGPM FEATURES 30 100 90 WE15H 5 FT ■ Impeller: Cast iron, semi- w zs open, non -clog with pump -out 80 E10H vanes for mechanical seal a 20 7 we07 protection. Balanced for > 6 smooth operation. Silicon ° bronze impeller available as o t5 so EosH an option. i 40 ■ Casing: Cast iron volute type toi 30 WE03M for maximum efficiency. 5 Z0 WE03L 2" NPT discharge. 10 ■ Mechanical Seal: SILICON 0- 0 CARBIDE VS. SILICON 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM CARBIDE sealing faces. 0 5 - - 10 _ ti5 - - - - 20 30 - -- 5 35 01 /hr Stainless steel metal parts, CAPACITY BUNA -N elastomers. G oul d s Pumps D 2001 Goulds Pumps ITT Industries Effective November, 2001 www.goulds.com 83885 Site Plan Page 8 of 8 For: Theodore Bergum Lot 1 of Csm Pending x NW1 /4 -SW1 /4 Sec. 16 T29N -R15W Town of Springfield - St. Croix Co. > 75' To Road 0 20 40 Proposed 3 Bedroom Home x Graphic scab (Feet) 1 inch s 40 R 20' Proposed 4 "Bldg. Sewer 290th St. Proposed Wieser Concrete 10001600 Gal. Combination Ta4k w /Zabel Note: Maintain well and waterline A -100 Filter setbacks per Comm 83.43(8)(1) Hill O X Proposed 360' of 2" Sch. 40 Force Main Old Fence Line Note: Mound area scaled only. 92.60' Proposed 65r75'Mound Cell w/a 11 System Elev. of 9 7.07' 94.60' 96.60' 565' Approx. " 9'0 ALBM #2 98.60' BM #1 \ A BM = Top oft 1/4 PVC Pipe Neat to Lathe w /Orange PtibbK n HRP =Same X ASSUMED ELEV. = 100 # A BM #2 = Top of 1114 - P VC Pipe Next to Lathe w /Orange Ribbon P/L Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _L of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 57- C 01Y Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must CA 01Y but not limited to: vertical and horizontal reference point (BM), dlrectl Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance t neare� d• b Please print all Information. [ Revi ed y Date o .S Personal Informstlon you provide may be used for Pro rty Location Property Owner i _ ,, ,, 11 Th e O A C 13 e �_ ILL Govt , 'Lot IV ik/ 1/4�L1)1/4 S 16 T I. N R E ( VI► Property Owners Mailing Address '��� ; I Lot #? 7 CC] Sutxi. Name or CSM# �petid,� an State Zip Code one ❑ ;Ci ty � .vt age own serest Road _ � ��� t W [D _ wC o=nr*uct1o C4 Wt S Y013 ( 7u) n Use: LI�-0esldendal / Number of bedrooms 7 Code derived design flow rate �D ❑ Replacement ❑ Public or commercial - Describe: R Parent material S S n y« 77/ —Flood Plain elevation it applicable �C A / General comments 066 I e ) 0 r �4� �kc� r �� a' trOALS -C- °.0 and recommendations: V D� C o� -�.-Eo r c•r 9G• lv r Boring # Boring 97 BPit Ground surface elev. _1 _ n• Depth to limiting factor In. � Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *081 MIN S t �. LJ ak • / 0 l� - Z k oy I F (1 Boring `, ❑Boring # Cm ft. limiting factor r a In. gop (cation Rete pit Ground surface elev. � • _ Depth to GPD/fE Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 *EM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I --- I� f k '� yy 10 2 • Effluent #1 = BOD > 30 220 mg1L and TSS >30 150 mglL 'Effluent #2 = BOD _< 30 mglL and TSS 30 CST AXr4W CST N e (Please Print) / Signature 2a 4 e n h Telephone Number Address ((�J / Date Evaluation Concluded Sy 7Z7 l 46 < Pape -.=2- of - e 2 (,uV✓L Parcel 10 # Pro Own er Pent [] Boring in. Boring # n, Depth to limiting factor sop icaVon Rate it Ground surface elev. GP Texture Structure Consistence Boundary Roots Dlf! Depth Dominant Color Radox Description •Eff#1 *011#2 Horizon P Gr. Sz. Sh. In. Munsell Qu. Sz Cont. Color 6 S ft o �E ._- � bk (t � ' ,� c o aLj s S S [] Boring # Boring qy, o h, Depth to limiting factor � Von Rate p Ground surface elev. GPD/ff Horizon Depth Dominant Color Radox Description Texture Gr. Structure Sz. Sh. Consistence Boundary Roots •E�1 *EM in. Munsell Qu. Sz. Cont. Color 0 -/0 o � �- 1 io a lo- 1 �'` U� r -C-2 o k IJ a Boring in. Boring # Ground surface elev. _._._._— n• Depth to limiting Factor S ication Rate ❑ Pit PD Dominant Color Radox Description Texture Structure Consistence Boundary Roots •Eff#1 'Effaif2 Horiz on De Gr. Sz. Sh. in. Munsell Qu. Sz. Cont. Color > and TSS >30 150 mglL ' Effluent #2 = BOD _ 30 rrtglL and TSS _< 30 mglL Effluent #1 BOD 30 < _220 mglL T he Department of Commerce is an equal opportunity service department at at 08- 2ti6y3151 aTT1' 608-264-8777. -87. services or need material in an alternate format, please contact SOD-8330 (R.6I00) I x CQ / U `r of � y Lx� t J 8.M . q7. o r Y oIP pip v ° �1eu1 4o yak 0 2 . 11 h d v �y 9�7 r - ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerMuyer- �' J`J of Mailing Address 7 Z fV ST e t Property Address 9 3 7— (Verification required from Planning Department for new construction.) City /State /',FA4trej!5 c.&rr/ Parcel Identification Number d3 /037 30 — eOrj LEGAL DESCRIPTION Property Location,4/t / '/4 , _ S�✓ '/4 , Sec. / , T 4f N R/, - W, Town of �t.�rti•�t'ier�L Subdivision , Lot # Certified Survey Map # 7 7j Volume / , Page # YO 17 LA j.D - # 7 Or// ,Volume 2 7 s9' , Page # 2-0 Spec house yes ® Lot lines identifiable (9) no SYSTEM MAINTENANCE 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 Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed 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 Zoning D arpnent within 30 days f three year exp' tion date. SIGN OF AP ANT DATE OWNER CERTIFICATION I/we certify that-all tements on s orm are true to the best of my /our knowledge. Uwe am/are the owner(s) of the d s 'bed a o ty deed recorded in Register of Deeds Office SIGNA OF APPLICANT DATE_ * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. U 2759? 265 788811 1'1 KATHLEEN H. WALSH State Bar of Wisconsin Form 11 -2003 REGISTER OF DEEDS LAND CONTRACT ST . CROIK CO., MI (TO BE USED FOR NON - CONSUMER ACT TRANSACTIONS) RECEIVED FOR RECORD Document Number Document Name 03/04/2005 09: 45AN LAND CONTRACT EXEVT # CONTRACT, by and between Theodore E. Bergum and Shirley A. Bergum, REC FEE: 17.00 husband and wife TRANS FEE: 135.00 ( "Vendor," whether one or more), and B R. Bran a s ingle person, an d COPY FEE: Joshua P. Hoivik, a single person CC FEE: PAGES: 4 "Purchaser," w ether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this Contract by Purchaser, the following real estate, together with the rents, profits, fixtures and other appurtenant interests ( "Property"), in Reooraing Arta St. Croix County, State of Wisconsin Name and Return Address Part of the West Half of the Northwest Quarter of the Southwest Quarter (W '/2 of NW %. of SW ' /.), and part of the West Half of the Southwest Quarter of the Thomas A. McCormack Southwest Quarter (W' /2 of SW' /. of SW 1 /4) of Section Sixteen (16), Township PO Box 2120 Twenty-nine (29) North, Range Fifteen (I5) West, Town of Springfield, St. Croix Baldwin Wl 54002 County, Wisconsin, more particularly described as follows: 034 - 1037 -30.000 � � ! Lot One 1 f Certified Survey Map filed October 26, 2004, in V olume 19 of Parcel Identifi ti Number (PIN) Certified Survey Maps, at Page 486 7, as D_ u ent No. 778156, office of the Register of Deeds for St. Croix County, Wisconsin. This is not homestead property. 0s) (is not) This is a purchase money mortgage. (is) (mat) Purchaser agrees to purchase the Property and to pay to Vendor at a pla ce designated by Vendor the sum of $ 45,000.00 in the following manner: (a) $ 5,000.00 at the execution of this Contract; and (b) the balance of $ 40,000.00 _ _ , together with interest from the date hereof on the balance outstanding from time to time at the rate of — 5 % per annum until paid in full as follows: monthly payments of $263.34, commencing one month from date hereof, and on the same date of each month thereafter. provided the entire outstanding balance shall be paid in full on or before February 25, 2010 ( "Maturity Date "). Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. CHOOSE ONE OF THE FOLLOWING OPTIONS: IF NO OPTION IS CHOSEN, OPTION A SHALL APPLY ® A. Any amount may be prepaid without premium or fee upon principal at any time. F1 B. Any amount maybe prepaid without premium or fee upon principal at anytime after C. There maybe no prepayment of principal without written permission of Vendor. State Bar Form 11 -Page I I U 2759P 266 CHOOSE ONE OF THE FOLLOWING OPTIONS; IF NEITHER IS CHOSEN, OPTION A SHALL APPLY ® A. Any prepayment shall be applied to principal in the inverse order of maturity and shall not delay the due dates or change the amount of the remaining payments until the unpaid balance of principal and interest is paid in full. ❑ B. 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 prinicpal) is less than the amount that said indebtedness would have been had the monthly payments been made as specified above; provided that monthly payments shall continue in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded from this Contract. Purchaser shall pay prior to delinquency all taxes and assessments levied on the Property at the time of the execution of this Contract and thereafter, and deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved by Vendor, in the amount of the full replacement value of the improvements on the Property. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of Vendor's interest, and evidence of such policies covering the Property shall be provided to Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided Vendor deems the restoration or repair to be economically feasible. ® Purchaser is required to pay Vendor amounts sufficient to pay reasonably anticipated taxes, assessments, and insurance premiums as part of Purchaser's regular payments [CHECK BOX AT LEFT IF APPLICABLE). Purchaser shall not commit waste nor allow waste to be committed on the Property, keep the Property in good tenentable condition and repair, and free from liens superior to the lien of this Contract, and comply with all laws, ordinances and regulations affecting the Property. If a repair required of Purchaser relates to an insured casualty, Purchaser shall not be responsible for performing such repair if Vendor does not make available to Purchaser the insurance proceeds therefor. Vendor agrees that if the purchase price with interest is fully paid and all conditions fully performed as specified herein, Vendor will execute and deliver to Purchaser a Warranty Deed in fee simple of the Property, free and clear of all liens and encumbrances, except those created by the act or default of Purchaser, and: CHOOSE ONE OF THE FOLLOWING OPTIONS; IF NO OPTION IS CHOSEN, OPTION A SHALL APPLY ® A. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination, at the time of execution of this Contract. B. Purchaser states that the following exceptions set forth in the title evidence submitted to Purchaser for examination, at the time of execution of this Contract, are unsatisfactory to Purchaser: ❑ C. No title evidence was provided prior to execution of this Contract. State Bar Form 11 -Page 2 i1 27Z9 P 267 CHOOSE ONE Of THE FOLLOWING OPTIONS: IF NEITHER IS CHOSEN, OPTION A SHALL APPLY ® A. Purchaser agrees to pay the cost of future title evidence. ❑ B. Vendor agrees to pay the cost of future title evidence. Purchaser shall be entitled to take possession of the Property on Time is of the essence as to all provisions hereunder. Purchaser agrees that in the event of a default in the payment of principal or interest which continues for a period of 60 days following the due date or a default in performance of any other obligation of Purchaser which continues for a period of 60 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), the entire outstanding balance under this contract shall become immediately due and payable at Vendor's option and without notice (which Purchaser hereby waives), and Vendor may singly, alternatively or in combination: (i) terminate this Contract and either recover the Property through strict foreclosure or have the Property sold by foreclosure sale; in either event, with a period of redemption. in the coures discretion, to be conditioned on full payment of the entire outstanding balance, with interest thereon from the date of default and other amounts due hereunder (failing which all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property); (ii) sue for specific performance of this Contract; (iii) sue for the unpaid purchase price or any portion thereof; (iv) delcare this Contract 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; (v) have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits; or (vi) pursue any other remedy available in law or equity. An election of any of the foregoing remedies shall only be binding on Vendor if and when pursued in litigation. All costs and expenses including reasonable attorneys fees of Vendor incurred to pursue any remedy hereunder to the extent not prohibited by law and expenses of title. evidence shall be paid by Purchaser and included in any judgment. The parties agree that Vendor shall have the options set forth in this paragraph available to exercise in Vendors sole discretion. Following any default in payment, interest shall accrue at the rate of 10 % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. Purchaser may not transfer, sell or convey any legal or equitable interest in the Property, including but not limited to a lease for a term greater than one year, without the prior written consent of Vendor unless the outstanding balance payable under this Contract is paid in full. 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 may mortgage the Property, including the continuation of any mortgage in force on the date of this Contract, provided Vendor shall make timely payment of all amounts due under any mortgage, and the total due under such mortgages shall not at any time exceed the then remaining principal balance under this Contract. If Vendor defaults under such mortgages and Purchaser is not in default hereunder, Purchaser may make payments directly to Vendor's mortgagee and such payments will be credited as payments hereunder. All terms of this Contract shall be binding upon and inure to the benefit of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. State Bar Form 11 -Page 3 U 2759P 268 Dated auatK :�� 001 VENDOR: PURCHASER: (SEAL) (SEAL) * T eodore E. Bergum * eanna Brandt (SEAL) (SEAL) * hirley A. B m * J ua P. H AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF W authenticated on ST. CROIX COUNTY) Personally came before me on i+��aJaS �OII� * _ the above -named Theodore E. Bergum, 9hirley A. Bergum, TITLE: MEMBER STATE BAR OF WISCONSIN Breanna R. Brandt and Joshua P. Hoivik (If not, to me known to be the person(s) o ex uted the foregoing authorized by Wis. Stat. § 706.06) instrument and ackn wledged th ame. THIS INSTRUMENT DRAFTED BY: Thomas A. McCormack Notary Public, State of WISCONSIN Baldwin WI 54002 , My commission (is permanent) (expires: ,4 i ?AT (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. LAND CONTRACT STATE BAR OF WISCONSIN FORM NO. 11-2003 'Type name below signatures. m State Bar of Wisconsin 2003 INFO -PRO- LftW Forms • (800)656-2021 • kiapraforms.com State Bar Form 1 I -Page 4 FORM rr N OO . �� 9885 , -A io3 i'1L.I�ill _ ,r — .... ��� � 2 J 5itock No . .... 26 273 VOL 19 PAGE 4867 KATRUEM K. REGIS_TE_R_ OFDEEDS RECEIVED FOR RECORD CERTIFIED SURVEY MAP NO. 101 / 79 / 2004 04:30PK VOLUME , PAGE CERTIFIED SURVEY KAP REC FEE: 13.00 THE WEST HALF OF THE NORTHWEST QUARTER OF THfoPY FEE: AGES: 2 SOUTHWEST QUARTER, AND THE WEST HALF OF THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER. SECTION 16, TOWNSHIP 29 NORTH, RANGE 15 WEST, TOWN OF SPRINGFIELD, ST.CROIX COUNTY,WISCONSIN. rN T. 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D Q E X a ° CD o n a o c v m ° m`wo Z a CD w � arnm ° a 5 -* 3 y am o �w 'a ° 5 0 ° n A I _ 3 m (D 3. O fi M6 U) CL 0 c 3 a •° o O Ci C I S �.. • w 4A Q N O CD a Parcel #: 034 - 1037 -30 -025 06/18/2007 04:41 PM PAGE 1 OF 1 Alt. Parcel #: 16.29.15.250A -10 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/26/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BRANDT, BREANNA R BREANNA R BRANDT C - HOIVIK, JOSHUA P JOSHUA P HOIVIK 926 290TH ST GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 943 290TH ST SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 13.140 Plat: 4867 -CSM 19 -4867 034 -04 SEC 16 T29N R1 5W PT NW SW CSM 19 -4867 Block/Condo Bldg: LOT 1 LOT 1 (13.14 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 16- 29N -15W NW SW Notes: Parcel History: Date Doc # Vol /Page Type 09/19/2005 806820 2891/217 WD 03/04/2005 788811 2759/265 LC 10126/2004 778156 19/4867 CSM 07/23/1997 1002/464 C�C 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations Last Changed: 06/15/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 12,700 43,400 56,100 NO PRODUCTIVE FORST LANDS G6 12.140 42,500 0 42,500 NO Totals for 2007: General Property 13.140 55,200 43,400 98,600 Woodland 0.000 0 0 Totals for 2006: General Property 13.140 28,300 30,600 58,900 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I _