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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579043 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: Haa , John St. Joseph, Town of 030-1054-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: (00.00 P 04-e' kU-t 23.30.19.198C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 3-15(e 16-3-51, /4NC2::- Septic ' L-J Benchmark t Z• 577 1G>t •sa C / ~ ov D"M Alt. BM J ltL~ 7Cn. e~ .1116 1717, W t Z e„J W e5.c~. Aeration Bldg. Sewer r 6 IMF a b%&, e S •J t (l Holding / St/Ht Inlet 5 l r., G L TANK SETBACK INFORMATION SUHt Outlet G. tb(c -7 7. '5 TANK TO 05 P/{ WELL BLDG. Vent Air Intake ROAD Dt Inlet Q ~S . 3 U Sept' Dt Bottom 115,1 I Z. 75 Z►a, t, t Dosing / 7 Z~ Header/Man. 3.7 Aeration Dist. Pipe 3.761 -Tc~ -8'Q0 Holding Bot. System 3~ i PUMP/SIPHON INFORMATION Final Grade -Z-Ac/0j Manufacturer Demand St Cover , [ t1 4 d 0k- __5 GPM L S v1CJ~- T~ I S ' T~ Model Number / /I xC TDH Lift~t /I Friction Loss System Head TD~~, i Forcemain Length / Dia. i I Dist. to Well $6 Z- SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Tre es PIT DIMENSIONS No. its Inside Dia. Liquid Depth DIMENSIONS 35 e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typ O System: CHAMBER OR UNIT Model Number: 71 146' 6-V 56 DISTRIBUTION SYSTEM S J ! e; o Header/Manifoy 4 Distribution L x Hole Sizel x Hole Spacing / Venn Air Intake Pipe(s)~J Length Dia Length J Dia Spacing U SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ct" , w. Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center J O Bed/Trench Edges Topsoil ❑ 7 Yes t~ No "Yes g No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1450 Ridge Run New Rich nd, WI 54017 (Gov't Lot 2 23 T30N R19V11j~ et & buns rot Parcel No: 23.30.19.198C 1.) Alt BM Description = "~1`_ S puw plow `~je. 2.) Bldg sewer length = T -t,-, ; ~DC.I~-5 - amount of cover = 6~1 511 /'l Plan revision Required? ❑ Yes No 1 Use other side for additional informat' n. SBD-6710 (R.3/97) Date Insepctor's Si nature Cert. No. RECEIV County St. Croix n.Aj, s Division Ds 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) JUN 2 9 2015 -7162 IN ps s79oy~ ' T. UROI COUNTY r~ 'I 7 6 qqO Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 2554188 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l m , Slats. L Application Information - Please Print All Information 1450 Ridge Run Property Owner's Name Parcel # John & Deb ah Haag 03040.04-10-000 Property Owner's Mailing Address Property Location , !f 9 . M6 1450 Ridge Run G? (0!2> of lS- Govt. Lot 2 City, State Zip Code Phone Number % Y4, Section 23 New Richmond Wi. 54017 1 t r 2Y/o - 7,e 7` (circle one) T-30 N; R 19 E or W II. Type of Building (check all that apply) Lot # IN 1 or 2 Family Dwelling - Number of Bedrooms 4x Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned -Describe Use OW Number oe CSA4 ❑ Village of Do(_ 101(.N&7 L7•Town of St. Joseph III. Type of Permit: (Check only one box on line A. Complete line B if applicable) -7- ooe A- ❑ New System [X Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Iss ❑ Permit Transfer to New Before Expiration Owner Z 1/0 $W (Q-(Z ' 1995 IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil [(Mound < 24 in. of suitable soil ❑ Holding Tank IJ Other Dispersal Component (explain) gPrew tment Device (explain) .6 BIo-Microbics ATU V. Dis ersaVIrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600 1.0 300 420 98.90' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units -Po o v New Tanks Existing Tanks 0 U w U v~ m ~ iw C7 Q. Septic or Holding Tank Weeks 1200 1200 Weeks X Dosing Chamber 975 149 Wieser VII. Responsibility Statement- I, the undersigned, assume res nsib' ' r installatio f the POWTS shown on the attached plans. Plumber's Name (Print) A r' Si MP/MPRS Number Business Phone Number Keith Knudtson 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts Wi. 54023 VIII. County/Department Use On Approved 11 Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial $ 7? 0 8~s''!~ ~Z(o/~S?~ IX. Conditions of Approval/Reasons for Disapproval I~~- ~!o! 30.1 Attach to complete plans for the system and submit to the County only on paper not less than 8 1R x 11 inches in size ~(rNo'~ • ©wN~ 2 vov►~ ~IAJi,=*t.> Lo7S, So c or1~~v~JE-vrS cl1rrx,~ .va- BE sPur gE'Twe~60 SBD-6398 (R. 11/11) DIVISION OF INDUSTRY SERVICES nacre Rrsryr 10541 N RANCH ROAD HAYWARD WI 54843 Contact Through Relay (3i S P IK http://dsps.wi.gov/programs/industry-services S lG~ www.wisconsin.gov °~ssror~LS~ Scott Walker, Governor Dave Ross, Secretary June 15, 2015 CUST ID No. 224059 ATTN. POWTS Inspector KEITH E STONER ZONING OFFICE KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/15/2017 Transaction ID No. 2554188 Site ID No. 813549 SITE: Please refer to both identification numbers, John & Deborah Haag above, in all correspondence with the agency. 1450 Ridge Run Town of Saint Joseph St Croix County Government Lot(S) 2, S23, T30N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1539800 Maintenance required; Replacement system; 600 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12); Aerobic Treatment Unit, Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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: As discussed, please see corrections to TDH made in red on the plan. 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. KEITH E STONER Page 2 6/15/2015 , Sincerely, [Feehis Required $ 250.00 Amount Will Be Invoiced. Carl J L pert hen You Receive That Invoice, 4A Wastewater Specialist , Division of Industry Services lease Include a Copy With Your (715)634-5035 , M-f 7AM - 12PM Payment Submittal. carl.lippert@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Index and Title Sheet Project Name: John and Deborah Haag Mound System with an Aerobic Treatment Unit Property Owner: John and Deborah Haag Address: 150 Ridge Run New Richmond WI 54017 Phone: Legal Description: Parcel in Gov. Lot 2 Sec. 23 T30N-R19W Township: St. Joseph County: St. Croix Comp.#/Parcel ID: 03 0-9ft4-10-000 10vt CONTENTS Page: 1 Index and Title Sheet Page: 2 Plot Plan Page: 3 Two Cell Mound Cross Section and Plan View Page: 4 Lateral Layout Diagram Page: 5 Dose Tank Cross Section Page: 6 Pump Curve Page: 7 Bio-Microbics Micro Fast 0.6 Specification Sheet Page: 8 Wieser Concrete W1425- BIO 750 GPD Microfast 0.75 Tank Specifications Page: 9 Management and Contingency Plan Attachments: Copy of Soil Test, Bio-Microbics Maintenance Agreement Form, Aerobic Treatment Unit Servicing Agreement to County, Discussion of Drive within 15ft. of Mound and Field Inspection Report. Pressure Distribution Component Manual Used = Version 2.0 SBD-10706-P (N 01/01R.10/12) Mound Component Manual Version 2.0 SBD-10691-P (N.01/01R.10/12) Designer: Keith E. S` Designers License # 1575-007 Signature: Phone # (715-653-2324) Date 5-27-15 ~N E. s CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE eNWE'SPONDENCE O N C , ~ m V O U 33, v 3 c 5 C-i ? N D U 43 ;v ty y N m b p0 O LL O Q G 00 N W CZ N ~ N LC J a Ol w 3 w 43 Vj Q ° O ~ ~ ~ ~ c Lx~ o U ~O y - ova U N O 3a ~ ~ ~ ~ aqw o ~ w o ~ M all O ~ H `,q RK u ~o ~GQ~u o~ h A z N+ OR O h O W c a O N p N y t1.~ y f•1.~ wE°C7Go vg ~ N 1 .e7 O Page 3 of 9 Cross Section of a Mound System Using Two Cells for the Absorption Area J 1/10 Observation Pipe A B O Force Main w A O O B K l I L A 6. E H K 8' B F 1 5.38' L 48.76' C 4ft. G J 5.38' W 6 D (ft. sq.) Dispersal Cell Area 936.60 (ft.2) Basal Area Available $ 5 ] (gpd/ft) Linear Loading Rate 5 (ft) 1/10 B Obs. Pipe Placement Note: K-Slope on east end of Mound Cross Section View mound where the slope falls of Aggregate Dispersal Area will be extended to approx. 10 ft. or 3:1 slope ratio. Finished Grade 100.50' I rd, G1 - d H % 8.90' F O O Aispers Cells _ O L (ft) Dispersal E . D Lateral Invert Cell Elevation for each cell. <I% to Level Site Slope 8.40' (ft) Contour Elevation Detail of Typical Dispersal Cell Geotextile Fabric Shading Key Cover ® Topsoil Cap 00000000000000 ®Subsoil Cap 0000000000000°000 0 ASTM C33 Sand o0 0 0 0 o °00 Typical Lateral °000 F Tilled Layer 0000000 00000° 000000Mo0000 ® Aggregate 00000000000000 J!Lr a 0 0 A Note: Prepare Mound Site per Component Manual Constuction Procedures. Page 4 of 9 Lateral Layout for the Typical Cells 1 + 2 End Connection Lateral Layout Diagram 00 I .50' P S Laterals and Force Main of PVC Sch. 40 I per Comm Table 84.30-5 X Turn- p w/ball valve or clean out pl g ~-X 50' Laterals centered over the A&B dimension Number of Laterals Orfice Diameter .125/l/8" in. Lateral Diameter 1.5 2.00 in. Orifice Spacing (X) ft. Lateral Length 18 (P) ft. Orifices per Lateral Lateral Spacing (S) 3.0 5.83 ft2i ft. Orifice Density orifice Lateral Flow Rate 738 gpm Manifold Length 3.00' ft. Cell Flow Rate 14.76 gpm Manifold Diameter 1.5 in. System Flow Rate 29.52 gpm Total Dynamic Head 17.75 ft. Lateral Turn-up Detail Finished Grade Threaded Cleanout Plug or Ball 6" to 8" diameter Lawn Sprinkler Box Valve 000000 Long Sweep 90 or Two 45° Bends Same 00 0 00 0 0 0 O Diameter as Lateral 000000 O O O Distribution Lateral Note :Lateral ends at last orifice where variable length to cleanout begins. Pg. 5 of 9 Dose Tank Component Cross Section Approved Manhole Covers With Warning Labels and Locking Device / 4" Min. Above Final Grade Weather Proof Junction Box Electric per NEC 300 & SPS. 4" Sch. 40 Vent 316.012 WAC > or = to 12" Above Final Grade Disco ct Alternate Outlet Location ATU Tank W/Approved 4" Sleeve Inlet Simtech STF 100 L.=Force Main Diam. = 2 " Filter or Equivalent Weep Hole or Anti Siphon Device Note: Pump switch and alarm to be A wired to separate circuits. B Pump Off Elev. 89.81' C Tank Mfr. Wieser W1425/975 BIO D Dose Tank Elev. 88.81' Vertical Difference Between Pump Off and Distribution Pipe = 9.59' Minimum Required Supply Pressure = 6.50 60 FT. of Force Main x 1.94 Friction Factor/100FT.... = 1.16 Min. Dose = 62.56 gals. Total Dynamic Head -,4. Max Dose = 120 gals. Number of Doses _ 7 Per Day Gal. Per Day/ #of Doses = 86.94 Gal. Volume of Backflow = 9.78 Gal. Total Dose Volume = 96.72 Gal. Pump Tank Capacity 789.88 Gallons Dimensions Inches Gallons Pump Tank Volune 16.12 Gal/Inch A 29 467.48 Pump Mfr. Goulds B 2 32.24 Pump Model EP05 C K12 9 D 1933.4.44 Minimum Discharge Rate = 29.52 GPM Alarm Mfr. S.J.E. Rhombus Total= 49 789.88 Alarm Model Tank Alert Bed Tank per SPS 383.45(5) Anchor Tank as necessary to negate buoyant forces per SPS 383.43(8)(g). KES 17 21 W Page 6 of 9 RGOULDS PUMPS Submersible Effluent Pump EP04 3871 EPO5 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. v!6' Canadian 5tandarcJs Amodadw • Heavy duty sump matic models include • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or "I"'.) factory. strength, and durability. SPECIFICATIONS N Motor Cover. Thermoplastic Garlds Pivs is ISO 9om flKjored FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 14" maximum. ■ EP04 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1'h" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (4090) continuous 140OF (60cC) intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel. 9 30 • Capable of running s GPn4 dry without damage to s z s rr components. zs; a° y Motor: _ • EP04 Single phase: 0.4 HP, v_ a zo 115 or 230 V, 60 Hz, 1550 s RPM, built in overload with o s automatic reset. • EP05 Single phase: 0.5 HP, o 4 Eros 115 V or 230V, 60 Hz, 1550 3 10 _ RPM, built in overload with automatic reset. 2 EP04 • Power cord: 10 foot s standard length, 16/3 1 SJTOW with three prong Optional 20 11 grounding plug. o 00 10 zo 3 ~ ~ GPM foot length, 16/3 SJTW with three prong grounding plug o 2 a s B 10 12 r►an (standard on EP05). CAPACITY Goulds Pumps 0 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 Page 7 of 9 m~91 r+ ~F N 0- N n -i N-0 O -I W P F N~ IU to O e+ N V P n n v n co o n n^- --j Q. 3 N w N -1 M-SP~ S 3S~ At SO 3C O ~S P Al P n P SS 0 •h0`< ~13 O O PO P v0 30 A S Z ro'< p`< Ln S M N ECAltp MICNP 3N'a Al 3 n3 rFNPM C3 IS 0003333 (•A30 N PAlN I N,4.N rF ro •0 r O (p . 0 o l O N co < = -0 e+ h -Wo N -0 O N C F S2 r+ 3 h p y~cr I u 30 L(O 3.3 3 •N 3(O D U31 3 3 E a 3 m N N 0' 3 SLp = 3 rp 3 A7 Al n N ~n Z O M n~ rp ro 7 O co n A M 3 0 3 m co SL 3 3 O E n SL Z m •D S Q O Q r•F S2 V1 D N M P AI D N n a• 3 rF O e+ 3 v 7 3 n10 p OA r+ 3 P A1~.O-'I 'D -ntA p -I •*1npnm M i n NmtA0p-4 p 'FD n SO 3 n O N ~m <3 -3 3 p s' 0 D Z N+Q. 00 n 0 3 33 4 S3 p e+(nU 3 c P nN 30 F N SS-Ni P 4-~O O p`Sr30 (7Q CL IL 3 P13 O ~ ~3 hQQ p ~p `F3 P 0-~ 3 -IC SL3 O n + 3W O P o STQ~ N Q3 ^333 P hvSG o Z 3 0 r3Tp w p 3 IV3 sP~ O N rho -U 3 r0 3 C'0*11 n~••~ 33.~1v p3fFN(0rpr0S2`<3- ^ 0 C VC 4 • TUIT3MZp:3 +3 Al'+n- pDN Y r~ 0- MCA 3 P M r-U PnOUI VI O 3NNrpN n to p rQp rho C SL A/ O O S O O M 3 Q 3 3-.C) 3 3 rN+ co N N 3 0 N 3 fnl- P :3 0 -N 4-1 ^S<r3p `+ep+~rp F NVi a' ~CNlIX e+~Cf= N y N c+ p c+ P N 3 A crr•(•3 0. 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Usw • M -9 Rl z r cn :N CQ o~ m u n V DN Z pp ~o► D~ ~O~ a N°- 1 (n 0 n° z w v X `O o o ~N > m m r- m r- W N D D ' O s oo m 3 m ° > z c m r C) ;lD cn o ;v p D D -i 0 m w H O >0 -z1 N p 0 r- m m -n n m ED ;10 ;u m C z z N n v N 0 (J7 Cl1 3 m o o o- n V) m v -D 0 ;D H n r m m 0 A Z n D r m M RE-POUR: \ = W1425/975 B16-750 GPD WIENER 11111ET m E DRAWN BY. SME SCALE: 1 4"=1'-0" [POST-POUR: ° ~ SEPTIC MANUAL REV. Z W3716 US HWY 10 MAIDEN ROCK, NA 54750 DATE JANUARY 2010 DATE:. PA"9a, b,+eof9 I Private Onsite Wastewater Treatment System Mound Management Plan Pursuant to SPS 383.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System(POWTS) Shall Include information and procedures for maintaining the system within the parameters of SPS 383 and 384, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for the system will be filed with the county zoning or health department. This management plan complies with SPS 383.54, Wis Adm. Code, the Mound Component Manual for Private Onsite Wastewater Treatment Systems (Version 2.0) SBD-10691-P (N.01/01) and the Pressure Distribution Component Manual (Version 2.0) SBD-10706-P (N 01-01) E-Z Flow Mound Component Manual (8.8/07) if applicable. Table 1: System Design Specifications Sani Permit Number Number of Bedrooms 4 Design Flow GPD) 600 Soil Absorption Component Size (s q. ft. 420 retreated Effluent) Septic Tank Capacity Gal. 1200 al. Pump Chamber Capacity Gal. 789.88 al. total Type of Wastewater Pretreated Domestic Pre-Treatment Unit Installed Bio-Microbics -Microf ast 0.60 Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow-Peak (GPD) 600 600 Max. Influent Particle size NA < 1 /8 Inch Maximum BOD 5 (mg/1) NA 530 mg/1 Maximum TSS (mg/1) NA < 30mg/ 1 Maximum FOG NA NA Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Dose Tank In-Filter Should inspect once a year and clean eve 3 ears Pum Chamber Inspect once eve 3 ears Soil absorption Component Flush laterals every 18 months. Bio-Microbics Micro Fast Service every 6 months for first 2 years. Then annually 0.60 there after per maintenance agreement. See attached. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under sec. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall 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 scum and sludge 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 an 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. Pump Chamber The pump chamber also requires monitoring once every three years or the time of problem, complaint or failure. Inspection should include checking the dose rate, volume and frequency. Warning: The dose chamber may fill due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have problems. In this situation, the pump chamber should be pumped by a licensed pumper before pump cycling begins or other measures shall be used to dose the component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. Septic tank and Pump chamber 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 to the tank Warning: No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be accordance with SPS 383.33, Wis Adm. Code when the tank is no longer used as a POWTS component. Soil Abso trp ion Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every 3 years. Lateral turn ups are provided at the ends of the laterals for the purpose of flushing the lines of any solids. Flushing these lines should be done every 18 months. The inspection shall include recording levels of ponding, if any, in the observation pipes, and visual inspection for any evidence of surface discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, clogging of the soil. Planting of deep rooted trees and shrubs directly over or within 10 feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the case of septic or dose tank component damage, measures shall be taken to repair or replace the tanks to there original operating condition. Problems with the pretreatment unit should be addressed to the POWTS Maintainer.Annual inspections should prevent any complete failure. Should failure of the distribution cell component happen, the system shall be inspected to determine the cause of failure. Steps taken to repair or replace the dispersal cell may involve the removal of a bio-mat which would require cleaning or replacement of the distribution network as well as replacing the aggregate system and clogged portions of the sand fill. Component Owners Contact List Keith Knudtson / Plumber 651) 470-1737 St. Croix Coup Zoning (715) 386-4680 Wieser Concrete Products Maiden Rock WI 800 336-3416 Septic Pumper Powers Sanitation 715 249-5738 Petersen Supply Microfast 0.60 Pretreatment 888 455-6864 . Limited Activities 15 feet down slope of basal area. A linear distance of approximately 5ft. tol 1.50 feet of the proposed mound cells toe slope is less than 15 feet to the existing driveway for this mound site. This mound is on a level site to drive edge. Table 3 Other Specifications of the Mound Component manual for private onsite wastewater treatment systems (version 2.0 SBD 10691-P(N.01/01,R10/12) states under limited activities. Unless otherwise specifically allowed in this manual, vehicular traffic, excavation, and soil compaction are prohibited in the basal area and 15 feet down slope of the basal area, if there is a restrictive horizon that negatively affects treatment or dispersal. The soil profile descriptions for this site do not include a soil horizon, which would be considered restrictive within 12 inches of the fill material. These restrictive soils have been defined as soils having a<_ 0.3-gal/sq. ft./day within 12" of fill material. 6 inches of sand fill is being applied to this site the required basal area for this mound is 600 sq. ft. using a H.T.E. soil loading rate of 1.0 for a sandy loam soil moderate medium sub-angular blocky structure. A total of 936.60 sq. ft. of basal area will be provided based on the sanitary design. As the soil conditions onsite would not be considered restrictive the 15 foot setback from the basal area does not apply per component manual. However it is a good design practice to follow when possible. As we are applying highly treated effluent to this site I feel the soils onsite will readily accept the wastewater produced and should not form a clogging mat that might otherwise become a problem in the future. Keith E. Stoner Cst # 224059 Page 4 of 11 POWTS INSPECTION AGREEMENT The c^.rrect operation of the below equipment significantly influences the life of the wastewater system. Periodic inspections will help extend the life of the system and prevent the need for costly repairs. This agreement authorizes access to your P0VVTS equipment by a trained and authorized technician during daylight hours to provide regular inspections and routine maintenance to help assure the equipment is wonting properly. It is hereby agreed by and between Purchaser and L.3 (Service Provider) that in consideration of the payments provided for herein, Service Provider W provide the services of a factory-trained representative to perform periodic inspections of the equipment described below. Service Provider will prepare a written report after each inspection and provide a copy of the report to the Purchaser. This report will contain recommendations for any operation and maintenance deemed appropriate by the inspector. This agreement does not assume any responsibilities or obligations that are normally the responsibilities of Purchaser and does not extend to cover any costs that may be associated with any recommendations made under this agreement In no event shall Service Provider be responsible for any special or consequential damages, including but not limited to, loss of time, injury to person or property or incidental economic loss due to equipment failure or for any other reason whatsoever. Service Provider may supply additional services, parts or labor only after authorization by Purchaser. This agreement shall remain in force for a period of cZ years, beginning i 6" 20-Z 41' and will automatically renew each year thereafter for one year unless canceled by r pa with at least 30 days written notice. This agreement may be canceled by the Purchaser only if replaced by a service agreement with an authorized service provider for the equipment listed below. Service Provider may delay or cancel future inspections if payment becomes at least 15 days past due. Periodic Inspections: The Purchaser agrees to pay Service Provider $ 1 la D per inspection for flour (4) inspections for the first two years at six month intervals and one (1) inspection each year thereafter. Payment for the first two years of Inspections is due at the time of installation; additional payments are due upon inspection. Any additional testing or services required by Purchaser will be billed based on time and material amounts. Date Service Provider a---v Signature 0 Phone "7 r s - -7 Y ~ - 332Z , Address 9G--1 I (off City. R011_~ States-C~~ Zip ~">;t Equipment Covered Under This A reement Desicrip0on Node" No. Serial No. Inst ff Dale Location if difilWa t from Owner System Owner: companyr No": Signature; Privit Now Sheet: Fax: i CILY, Ste. ZIF E-Mdl; Payment Type: a Check a Cash 0 American Express ❑ Visa ❑ MasterCard o Other Credit Card No. Exp Date security Code Amount Name on Credit Card (print) Signature: FSPUNM $B MCEPOOkIX t=AUM domawt "re°hy Tel: 888-455-6864, 262-692 2416 Petersen Management Co., LLC Fax. 800-66'9-1232,262-M-2418 PO Box 340,421 WheelerAve., Fedonw WI 53021-0340 USA E-Mail service@petersen.cc ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer John & Deborah Haag Mailing Address 1450 Ridge Run Property Address (Verification required from Planning & Zoning Department for new construction.) City/State New Richmond Wi. Parcel Identification Number 030--10-000 LEGAL DESCRIPTION Property Location '/4 , '/4 , Sec. 23 , T 30 N R 19 W, Town of St. Joseph Subdivision Plat: , Lot # Certified Survey Map # to t 6t!&7 , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 13yesEho Lot lines identifiable ByesOno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a 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. Uwe, 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of b roo s 4 ~ S NA RE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 1450 Ridge Run located at: '/4, 1/4, Section 23 , Town 30 N, Range 19 W, Town of St Joseph , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 6/15/15 Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1200 Construction: Prefab Concrete x Steel Other Manufacturer (if known): Weeks Age of T (if known): 20 yrs. Permit be if 4080 Keith Knudtson censed umber Signature) (Print Name) 648448 (Title) (License Number) MP/MPRS 06-23-2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 7 17' u - - i N C 0 R P 0 R A T E 0 8450 Cole Parkway ■ Shawnee, KS 66227 ■ Phone: 913-422-0707 ■ Fax: 913-422-0808 e-mail: onsite@biomicrobics.com ■ www.biomicrobics.com ■ 800-753-FAST(3278) I FIELD INSPECTION & SERVICE REPORT FAST@ wastewater treatment systems INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address Name Owner Name Street Mail Address Mail Address city state ziCi State zip phone Fax Phone Fax e-mail e-mail INSTALLATION INFORMATION Model No- Blower Brand and Serial No. Date of Installation Date of last pump-out Size EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS - OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating ( present) Bower(s): Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment Unit(s): Unusual Oda System Vent Pum nt Required.- Primaxy Settling Zone Aerobic Treatment Zone EFFLUENT: LIMIT RESULT Estimated i Flow II tandard Units 6-9 S.U. Color Clear Tem ratum Dissolved Oxygen c loent 2 mg/L Odor Slightly Musty odor (not septic) /l~li7N~'7? Ciff_NATiTDF - VTWWfTAN Ci(_'NATURF. CF.RVFVR nATF. MM9 Wsconsin Department of Safety and Professional Services Division WbiEVED SO ~I 1 REPORT #1304 Page 1 of 3 n in accordanrea"SPS Code Keith E. Stoner Atta~I)~ ch ZO~p' l 9 ban on paper not less than 8% x 11 inches in size. Plan must County St. Croix vertical and horizontal reference point (BM), direction and imensions, north arrow, and location and distance to nearest road. Parcel I.D. :O MUN! DEVELop%ge print all information. 030-~0gf10-000 Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 -7- Property Owner Property Location o+ John & Deborah Haag Govt. Lot 2 1/4.1/4, S23, T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1450 Ridge Run Cri' State Zi Code Phone Number Y P ❑ City ❑ Village ®Town Nearest Road New Richmond WI 54017 St.Joseph Same ❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Loamy Alluvium over Sandy Gravelly Outwash Flood plain elevation, if applicable NA ft. General comments Propose two 6 x 35' mound cells with a system elevation = 98.90'. "Note: Highly treated effluent will be required to apply downsizing and recommendations: for a four bedroom system. 1 Boring # F-1 F-] Boring ❑ Pit Ground surface elev. 98.50 ft. Depth to limiting factor 39 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ;Eff#1 •Eff#2 1 0-7 10YR3/2 - sl 2msbk mvfr Cs 3f-m 0.6 1.0 2 7-19 10YR4/3 - sl 2msbk mvfr gs 2f-C0 0.6 1.0 3 19-33 7.5YR4/4 - sl/sd 2msbk mfr gs 2f-m 0.5 4 33-39 5YR4/4 - Is/Sl lmpl/m mvfr gs 2f-m 0.2 5 39-74 5YR4/4 c2d~/8 sl m/lmpl mfr 7.5YR6/3 - if 0.2 OF. #4 - inclusions of 7.5YR4/4 sand ❑ Boring 2 Boring # ® Pit Ground surface elev. 97.56 ft. Depth to limiting factor 51 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-8 10YR3/2 - sl 2msbk mvfr CS 3f-ml 0.6 1.0 2 8-18 10YR4/3 - sl 2msbk mvfr gs 2f-co 0.6 1.0 3 18-33 7.5YR4/4 - scl 2msbk mfr gs 2f-co 0.4 0.6 4 33-51 7.5YR4/4 - Is Osg ml gs 2f-co 0.7 1.6 5 51-76 7.5YR4/4 c2d5YR5/8 sil m mvfr - if 0.0 0.2 #5 - inclusions of Is Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L • E uent #2 = BODS < 30 mg/L and TSS s 3O mg/L CST Name (Please Print) Signature: CST Number Keith E. Stoner 224059 Address Keith E. Stoner ate Evaluation Conducted Telephone Number 23220 Wood Creek rd. Siren, WI 54872 5/5/2015 715-653-2324 SBD-8330 (8.07/13) Property Owner John & Deborah Haag Parcel ID # 03011O5rr{ 10-000 Page 2 of 3 ❑ Boring F Boring # ❑ Pit Ground surface elev. 98.46 ft. Depth to limiting factor 36 in. 3 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10YR3/2 - sil 2msbk mvfr cs 3f-m 0.6 1,0 2 7-15 10YR4/3 - sl 2msbk mvfr gs 2f-co 0.6 1.0 3 15-32 7.5YR4/4 - sd 2msbk mfr gs 2f-co 0.4 0.6 4 32-36 7.5YR4/4 - sl 2msbk mvfr gs 2f-co 0.6 1.0 5 36-45 7.5YR4/4 f2d5YR5/8 Is Osg ml - if 0.7 1.6 #5 - with bands of sl ❑ Boring F4 Boring # ® Pit Ground surface elev. 99.66 ft. Depth to limiting factor 54 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10YR3/2 - sl 2msbk mvfr cs 3f-m 0.6 1.0 2 5-17 10YR4/3 - Sil 1fsbk mvfr gs 2f-co 0.4 0.6 3 17-29 7.5YR4/4 - sd 2msbk mfr gs 2f-m 0.4 0.6 4 29-41 7.5YR4/4 - Is Osg ml gs 2f-co 0.7 1.6 5 41-54 7.5YR4/4 - s Osg ml gs if 0.7 1.6 6 54-90 10YR6/3 m2d5YR5/8 sil m mfr gs if 0.0 0.2 7 90-94 5YR4/4 c2d5YR5/8 sa m mfr - - 0.2 0.6 ❑ Boring F1 Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent ?BOD5 < 30 mg/Land TSS <30 mg/L ` p A ~ ~c~ ~o bd~b~d~t~1 CD 0 CD 0 II II II II CN O~-PNIJi tA d n CD CD II CLOD aN ~ II b'a 00 b H II ~ O k II ~ V rn w 0 c r e b v_ ti o ~ b C ~ ti ~0 0 r~ II o 04 0'Zy ti Oh _a" V oos _ • Ct ~ o b0 ~ ~ k n ~ N I- A go lo, I y m to C k Cl) O ~ 60 o bd o o ° O A v 'oo j o ti A. C l.R p ~ o K N A A N A O w w SOIL PROFILE DESCRIPTION Owner: 1,446,, 1-6kAJ i C3 b9414 CST: d-. 5W iA ER- System Elev. Proposed:fS. 91,W)ft Syst. Range ft to ft Ld Rate: # t Elevation: # 3 Elevation: 1'8• y~ # 2 Elevation: 97 Slo o Boring o Boring o Boring Af Pit Pit ;v Pit 4W . ~ $ sEPAr2 - S 11S i ~j, q 9t. - ZOA) _ y c ~ °o 'S o O 6 N M; o c cz 0 0 N N N I s I v i c h d h c z c6 LL c I E Q m CL a> EE a, N E Q _q O o a m N H (7 C ~ O O Z :!t v d Z 0 H N E 72 ~ ch N O , O • N a°'i c (n L O O Co z N N C ~ 47 l c N E E (\1 0 Y ~1 of - y w d N C `l ~ O G 0 a ~ ao 'N 000 Z a \ d B 0 U) ~ p N m rn N U 22 rn rn N \ d ~J (D Z~ - EE C: CD R - m c a'a (n 0) 2 Q) ' m 'd ~ d c~ ca O O C O N C O O 0) co O r~ p O H C CL O r f„ir p) C U _O -7 0 O ~ y N O N V L L _ O -0 U, U Sir O O m W .d. N C N W • ~ M Mc? Cl ? 0 C) O N O U cO 3.~ O N U) 2 N 0 Z S Z (Q M IL • CL AIL r A V a I', O U) U Parcel 030-1054-10-000 03/22/2005 03:24 PM PAGE 1 OF 1 Alt. Parcel 23.30.19.198C 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * JOHN M & DEBORAH ANNE HAAG HAAG, JOHN M & DEBORAH ANNE 1450 RIDGE RUN NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1450 RIDGE RUN SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 23 T30N R1 9W PRT GL 2 COM E SH BASS Block/Condo Bldg: LK 99.5 FT S OF N LN, E 290 FT, S 100 FT, W 290 FT MOL TO LK, NLY ON LK, NLY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ON LK TO POB 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1129/423 WD 07/23/1997 486/451 2004 SUMMARY Bill Fair Market Value: Assessed with: 5179 590,200 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 193,600 387,000 580,600 NO Totals for 2004: General Property 0.000 193,600 387,000 580,600 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 90,000 284,100 374,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 210 Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 771.86 Special Assessments Special Charges Delinquent Charges Total 771.86 0.00 0.00 Parcel 030-1054-30-000 03/22/2005 03:24 PM PAGE 10F1 Alt. Parcel 23.30.19.198E 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HAAG, JOHN M & DEBORAH ANNE JOHN M & DEBORAH ANNE HAAG 1450 RIDGE RUN NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: 1784-CSM 17-4603 SEC 23 T30N R1 9W PT GI-2 COM 1300 FT W & Block/Condo Bldg: 199.5 FT S OF E 1/4 COR, TH W 326 FT TO SHORE BASS LK, SLY 70 FT, E 326 FT TH N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 70 FT TO POB 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 09/04/2003 738845 17/4603 CSM 07/23/1997 1140/54 WD 07/23/1997 492/390 2004 SUMMARY Bill Fair Market Value: Assessed with: 5181 13,100 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 12,900 0 12,900 NO Totals for 2004: General Property 0.000 12,900 0 12,900 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 20,400 0 20,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 10.92 Special Assessments Special Charges Delinquent Charges Total 10.92 0.00 0.00 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT P e of 3 ` l.Oo• and Human Relations ag _ Division .;Safety 3 Buildings in accord with IL.HR 83.05, WIS. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in an must include, but ~r not limited to vertical and horizontal reference point (BM), direction % of slope, scale or ARCEL I.D. dimensioned, north arrow, and location and distance to nearest r ad. f 0~ d APPLICANT INFORMATION-PLEASE PRINT ALL INF RMATION I W UY- 6,1 DATE PROPERTY OWN R: PROPERTY TICf1 1J o 9A-A4 GOVT. LOT Z. 1/4 1/4,S13 T 36 N,R /9 E (or) W P OPERTY OWNER':S MAULING ADDRESS LOT # BLOCK S BD. NAME OR CSM K ` O] !QL2jE&-K3S leaky tAi AY ? 740. CITY, STATE ZIP CODE PHONE NUMBER OCITY ~1I,ILLLAGE (TOWN N RO , Qa(j New Construction Use Residential / Number of bedrooms GINK (j Addition loexisting building j j Replacement [ j Public or commercial describe Code derived daily flow gpd Recommended design loading rate O S bed, gpd/ft2 0.4 trench, gpd/ft2 Absorption area required bed, ft2 trench, S Maximum design loading rate O,S bed, gpd/ft2 Q trench, gpd/ft2 Recommended infiltration surface elevation(s) R It - (as referred to siilan benchmark) Additional design / site considerations GN ^16 Parent material Flood plain elevation, if applicable it U= Unsu~itaeble for system c~3 O I MW g° p U ~UOPuRESSURE S 11 u a s O IN 0 11 O SAX SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxkvy Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Twich 0-s /OVk 3/ - S L r- rn l Z 44 i s 2l avk i- rj. SL r- w Zrn Ground elev~ 7.S J01 e it g-,o 7sv 3 5 L M m ~P sP Depth to limiting Remarks: Boring # A 3 to 5 ! C. 3 n, sb~ ~r C 5 0 S 0.6 Z Sr 3-31 Itive- S/3 M 15V I Cw / o. Ground 8z T vie 4 4 5 r n, / ,5X0.6 Depth to limiting ~ (aptor. Remarks: CST Name.-Pleas Print A VEY O ,UP S ON Phone: 7 S~ 6' O d yen. ~O~ ~Sdh/ ~vt5~d 7 2/ 9~ Spn Date: 9~ CST Number:3 7 '4 r' k 1AG • . • ` ~4 .4 N SOIL DESCRIPTION REPORT Page? of 3 Depth Dominant Color Mottles Structure GPD/ft ,,wing # Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bm rdary Roots Bed rench 3 ©`g bye cr 3 s rn l r, S S 'j-Z7 1o-%12 +/a SL © r M r CS Z-~ 0.4 d.S Ground $ 6-7-71 Y 4 S rh j,- w S 0.4 elev. /03 1-95~ s y~e 3 5 rh /ny; N >Q Depth to limiting Remarks: Boring # A O JOYr2 3 2 C v- r+•►~r Cs 0.5 0.6 g ~-1 j - S, L 1 M suk rn- ~ C w 1 .2 n.3 Ground 4 "~o IDY l3 S , f' rti s bK M CS 1 ~.Z o IOZI 'q ft g a S'S S Q r r'► CS 1 Sh 0.5 d -SAL Depth to Z S ,2 S /h~- N tP N>Q limiting C LL rh r►•r ~~i• C s NA NA Remarks: Boring # S 16 kl a Z S Z /h cv- n~ C Z~ , 6 67 je~(je 4- Ground $i 4 S Q r m C w - O,S elev 0-71 Viktl-Y Depth to limiting factor. Remarks: Boring # i Ground elev. It. Depth to limiting factor Remarks: S6D-9330(80"2) i « M 3 U P d N z rIL 3 b Z U O r to i ~ ~ p op z - p. D l1` , b G~ lj ~ 1 -p 6~ 1~ 8 ~ ~ 'p p n f LAI w , N W - Qcc~ssx~s~n,d ~Ir N W , d l ~ r ST. CROIX COUNTY WISCONSIN ~r~rrN~~■ ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER • 1101 Carmichael Road Hudson, WI 54016-7710 - (715) 386-4680 January 16, 1996 Hartman Homes P.O. Box 326 Somerset, Wisconsin 54025 ATTN: Becky RE: Septic Inspection for John Haag Property Located at 1450 Ridge Run, New Richmond, Wisconsin Dear Becky: An inspection of the septic system for the above address was conducted on November 16, 1995. This property is located in the NEh of the SE; of Section 23, T30N-R19W, Town of St. Joseph, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. Should you have any questions, please do not hesitate in contacting our office. Sinc ely, mes K. Thompsdn Assistant Zoning Administrator St. Croix County, Wisconsin mz a F ~ r STC - 104 AS BUILT SANITARY SYSTEM REPORT -f OWNER ADDRESS SUBDIVISION / CSM# LOT # SECTION _T Y) N-RW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ho~s~ s-7G .may + m -1o INDICATE NORTH A ROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i BENCHMARK: ALTERNATE BM:;~ SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches i Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet, ST outlet / PC inlet PC bottom Pump Off Header/Manifold Bottom of system l~ Existing Graded Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR:! 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Perm itt HCo=Ider"JOHN ❑ City Village p Town of: State PI i x CST BM Elev.: T Insp. BM Elev.: BM Description: St. jesep4 Parcel Tax No.: TANK INFORMATION ELEVATION DATA & TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6J33e: Cr, C'~ Benchmark J ~ Dosing Qf¢~C ,11/~. 3 6 * ~.e 16 r Aeration Bldg. Sewer S~ ~S St/ kit Inlet TANK SETBACK INFORMATION St/ kOt Outlet TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header-#Vaa jo, 17 ~1 31 Aeration NA Dist. Pipe 6 -3 517 Holdin Bot. System (o 52.3 PUMP/ SIPHON INFORMATION Final Grade Maifto turer errand Model Num G M TDH,- ift I Loss Friction System TDH Ft Forcemain Length EDia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 7 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS d D N Per SYSTEM TO P/ L BLDG WELL LAKE/STREAM ING u acturer: SETBACK INFORMATION Type 0 11 C0 AMIT Mo a Num er. System: j1e N DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) leSize x Hole Spacing Vent To Air Intake Length ZL Dia- Length VP' Dia. Spacing S~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S s Only Depth Over Depth Over r. / xx Depth Of x Seeded /Sodded xx Mulched Bed fah Center - Bed /dr Fdges 4 a2 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.23 30.19W, NE, SE, Ridge Run ( 6cJl~- 2 Oil ,Dim/ v _.G/: , otii 1-c~r~ rrl %`l~ CR l e l~t~.✓, CZ/ Plan revision required? ❑ Yes [moo Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Sig ature Cert. No. SANITARY PERMIT APPLICATION BureauofBuildi g WaterlSystems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. -:3iXL0,1Z • See reverse side for instructions for completing this application State sa?re nitarryy Permit tNNumber The information you provide may be used by other government agency programs ❑ Chec~fc d isio~to previo application [Privacy Law, s. 15.04 (1) (m)j. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Propert Owner Name Property Location 1/4 - 1/4, T , N, R )E/(or& Property r~'s a g AOdress,2 Lot Number Block Num er J , Cit State Zip Code Phone Number Subdivision Name or CSM Number I. Y F BUILDI : (check one) ❑ State Owned E] C Nearest oad Public 10 1 or 2 Family Dwelling - No. of bedrooms _ ToVII(age wn OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ozo - 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box online A. Check box online B, if applicable) A) 1. ❑ New 2. gd Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Jig Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade GQ~ Required (sq_ ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (MI ./i ch) Elevation Feet 9ZY Feet TANK Capacity VII. INFORMATION in gallonTotal # of Manufacturer's Name Prefab: CoSite n- Steel Fiber- Plastic Exper. Gallons Tanks concrete glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank r 29 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the ndersigne ,assume responsibility for i tall do 0 onsi a sewage system shown on the attached plans. Plumber' Nam . (P Plum er' gna am s) MP/MPRSW No.: Business Phone Number: P tuber' Address (Street ty, St Zip C IX. COUNTY/ EPARTMENTUSE ONLY ❑ Disapproved Sangpry Permit Fee (includes Groundwater ate ssue sluing A nt Signare (No a(No a AA/pproved E] Owner Given Initial Surcharge fee) 41I Adverse Determination X. CONDITIONS OF ~POYALIREASWJS FOR DISAPPROVAL: _ SBD-6398 (R. 05/94) DISTRIBUTION: original to county. One copy To: Safety & Buildings Divu ion, Owner, Plumber INSTRUCTIONS , 1- A sanitary permit is-valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems-must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator-or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),", address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. a The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i A~a xz~~elllllv IJT-S-li~11'7 4 /w. 'a", -L"Lc-, Tel zZ7 / 3o sc~r,~r J ,~xts~ 3 G G - 3 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page Of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY "S) - i V Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but • not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPER OWNER: PROPERTY LOCATION GOVT. LO 1/4 1/4 ;73: _ 22 T N,Ro PROPERTY OWNE ' ILING AD SS LOT # BLOC # SUBD. NAME OR CSM # i CITY STATE ZIP CODE PHONE NUMBER ❑CITY ILLA EffOW NEAREST ROAD [ ] New Construction Use Residential / Number of bedrooms [ ] Addition to existing building K Replacement [ ] Public or commercial describe Code derived daily flower gpd Recommended design loading rate _,_~_bed, gpd/ft2_trench, gpd/ft2 Absorption area required , bed, ft2 trench, ft2 Maximum design loading rate „~~bed, gpd/ft21'7- trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material _ Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem Dn S ❑ U 0S ❑ U JX S❑ U [Z S0 U ❑ S ~I U ❑ S RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt Color Gr. Sz. Sh. Bed Trench =;2 4e2 Z~ Ground / elev. ft. Depth to ely limiting factor Remarks: Boring # 2~ 4Z /0- 1 C e_' 1.,)C- '7 '19 Ground elev. Z' 4/1 !2~2 ft. Al,* 00 Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: i Signature: Z ,4f4 4/Z r Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT PagqS;,2 of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bourx* Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. C-pnt Color Gr. Sz. Sh. Bed Tmrch on' s lee Ground elev. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) "j ' N B 3.3 I I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OV NERBUYER MAILING ADDRESS PROPERTY ADDRESS (location f septic system Please o in from the Planning Dept. CITY/STATE 1 PROPERTY LOCATION F 1/4,~ 1/4, Section?_. , T-2 .O_N-R--l 9 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION , LOT NUMBER CERTIFIED SURVEY MAP _,VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three ye expiration date. SIGNED: _Z lq~ DATE: tl7 i St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property - 1 3&d ~be6,r-ck 1 4 Location of property. All 1/4 1/4, Sectioq-~:~~,T_ N-R/6W Township Mailing address Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes _ No Is this property being developed for (spec house) ? Yes _ No Volume 142-2 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form; by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 5~Z44j 2 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. gnature of 4p15-1 icant Co-Applicant A~ of Date f Signature Dat Signature DOC,1j'VNT NO. II STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECOROiNIi O4T 4 WjjTjY DEED a 5.3 002 g23 This, indenture, Made by Jack D. Haag and i „UL 10 1935 Sh iron D Haag, Husband and wife F„ 9:45 A. and , ,J ! conveys and warrant to John M Haag Deborah Anne s ~ - Hasa, husband and wife as joint tena_n_tsir RETURN TO YJ i _ Ci loll .;l •l 6.. L the following Described real estate in cl, rrrniv -County. I &.:s of W iponsin: Tax Parcel No: Part of Government Lot No. 2, Section 23, Town 30 North, Range 19 West, described as follows: Commencing at the Northeast corner of Government Lot N0; 2, Section 23, Town 30 North, Range 19 West; thence West along the skid North line of said Government Lot No. 2 for 1300.0 feet; thence South and 9"h parallel to the East line of said Government Lot No. 2 for 90.5 feet to the 'POINT OF BEGINNING of this description; thence South and parallel with said. East line of Government Lot No. 2 for 100.00 feet; thence West parallel to said North nine of Government Lot no. 2 for 326. feet; more or less, to the Easterly shoreline of Bass Lake; thence Northerly alcng said Easterly shoreline of Bass Lake 110.0 feet, more or less ~o its intersection with a line which is parallel to the last mentipned line and at a distance of 100.Ofeet North therefrol,.; thence East 4nd parallel to the North line of said Government Lot No. 2 for 328.00 feet, more or less to the POINT OF BEGINNING. Also khe right of ingress and egress on a road as now laid out to the above described property over and across the Northeast Quarter of the Southeast Quarter and the Northwest Quarter of the Southeast Quarter of Section 23, Township 30 North,. Range 19 West, St. Croix County, Wisconsi . Subjept to the provisions in the quit claim deed to the grantors recorde i in Bgpk 355, page547, document 257159 that in the event the above road i is wj0ened to 4 rods or less, patties of the second part shall donate th This, --t homestead properly. land on the East end for that purpose. (la) (is not) Exceplion to warranties: h Dated thy, Eic th day of July 19 45 (SEAL) -(SEAL) i I (SEAL) -(SEAL) I Sharon D. i i AUTHENTICATION ACKNOWLEDGMENT i Slgnatur'1F) STATE OF WISCONSIN -County. I' Sit authentlpRted this day of Personauy came before me this 8th day of iTU1V .199_ the above named Jack D Haag and Sharon D. Haag, Husband and wife, TITLE: ?A AMBER STATE BAR OF WISCONSIN j (It not, to me known to be the person who executed the authoFlied by § 706.08, WIS. Slat!.) foregoing instrument and acknowledge the same. I THIS INFTRUMENT WAS OPAFT~O 9Y Deborah Anne Haag @a~G • .y i. Individual •~I Vslitfi NOlar Public County. WIsISgnatuF~s may be authenticated or acknowledged Both My Commasiexpiration I~ are not rl~essary.) date' . 19 _.1 ~ s C ~ y\ 1 •Names of Deno v am caoxl snowtl e, t nw or or•+laa oaww their n natures ' ~~y p S82 NTF 0021 e1 emne m v r e pNO a J W ARMA41Y DEED STATE OAR OF WISCONSIN Nelco Tax Forma. P.O. Box 10206. Green Sav. WI 54307-0209