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HomeMy WebLinkAbout028-1042-95-500 0 vi O I � - 0 n o d f c d o m CD m v CD D1 V, C D 3 K rr � O 7 W 07 N C A� w N I.y I N O N N A N 7 0 a I c �� m m� -� < -4 N O N Q. 3 N O Q ' (D N Q Cn O � CS C C n O. � W G1 O O A O W o ^; > > 7 N O C N C Cr O r� y m C1> v D m Q N d CA c _o m C ci p O O CD r . A CD Z c o t1i 0 W CL { O N N a III 0 0 CO co ao N ° a c Z CD cn °' • O O O A o Z fQ N cr 0 N (1 O Ip .�. N W D) C W � � m IQ CD N CD L CIAO CD O O I .. N D D o O O Z 3 N) � N A yZ CD ° (• �1 I � 3 N O 3 CD w �_ -I U1 O A Z o (D 0 W Cl) cwi1 OD a j Z 3 H Z CD N N O CD Q < o O O O CD CL T N C w m Z a 7 0 O CD CD - n y' y m_ D a CL a s m N CD m� O n ' � O CD 7 N c CD N N b � b A CD Oo I LA O ~ CD `� a I o CL `r I Jennifer Shillcox From: Alex Blackburn Sent: Tuesday, November 13, 2007 12:06 PM To: Jennifer Shillcox; 'Edwin Flanum ; 'bakke10 @hotmail.com' Cc: Tamara Wittmer; Becky Eggen Subject: RE: Bakke CSM in Rush River Hello everyone, Tammy and I walked this site last Friday. We have our Technical Review Committee (TRC) tomorrow and we'll be sending our comments out on Thursday or Friday. For now, we think this lot could be built on without the structure being in the floodzone. However, based on my experience flood insurance will be required since part of the lot is in the floodzone. These flood insurance requirements are usually required by the lender and then determined by FEMA. The County doesn't have any input on those decisions. Alex Blackburn Saint Croix County Zoning Specialist - - - -- Original Message---- - From: Jennifer Shillcox Sent: Tuesday, November 13, 2007 9 :08 AM To: 'Edwin Flanum' Cc: Alex Blackburn; Tamara Wittmer; Becky Eggen Subject: RE: Bakke CSM in Rush River Hi Ed, All that we have are the old FEMA Flood Hazard Boundary Maps, which do not show a regional flood elevation for that section of the river. I have attached an e -mail I sent to Todd last week, FYI. Jenny - - - -- Original Message---- - From: Edwin Flanum [ mailto: eflanum @northlandsurveying.com] Sent: Tuesday, November 13, 2007 8:36 AM To: Jennifer Shillcox Subject: Bakke CSM in Rush River Hi Jenny Have you had any conversations with Gary Lepak in regards to the proposed Bakke Certified Survey Map in Rush River? I believe he had told Todd Bakke that he did not have any different information than the county had in regards to flood elevations on the Rush River. From what I could determine the county did not have any valuable information. Do you know if you have any elevation information on the Rush River? Thanks Ed 1 M Jennifer Shillcox From: Jennifer Shillcox Sent: Tuesday, November 13, 2007 10:35 AM To: Tamara Wittmer; Alex Blackburn Cc: Becky Eggen Subject: RE: Bakke CSM in Rush River Hi Tammy, Todd wants to know if he'll need to do an engineered analysis to determine the regional flood elevation in order to create the proposed lot. It might be best if you correspond with him and /or Ed Flanum directly, but please copy me on it. Thanks, Jenny - - - -- Original Message---- - From: Tamara Wittmer Sent: Tuesday, November 13, 2007 10:27 AM To: Jennifer Shillcox Subject: RE: Bakke CSM in Rush River Hi Jenny- Alex may have shared that we did a site visit last Friday. I moved some pictures to the following folder... they may be hard to interpret, but it does seem that the 1020.xx elevation would be the conservative OHWM elevation. Y: \zonshare \Subdivisions \CSMs \2007 CSMs \Concept Bakke LD0233 Let me know your thoughts, -Tammy - - - -- Original Message---- - From: Jennifer Shillcox Sent: Tuesday, November 13, 2007 9:08 AM To: 'Edwin Flanum' Cc: Alex Blackburn; Tamara Wittmer; Becky Eggen Subject: RE: Bakke CSM in Rush River Hi Ed, All that we have are the old FEMA Flood Hazard Boundary Maps, which do not show a regional flood elevation for that section of the river. I have attached an e -mail I sent to Todd last week, FYI. Jenny - - - -- Original Message---- - From: Edwin Flanum [ mailto: eflanum @northlandsurveying.com] Sent: Tuesday, November 13, 2007 8:36 AM To: Jennifer Shillcox Subject: Bakke CSM in Rush River Hi Jenny Have you had any conversations with Gary Lepak in regards to the proposed Bakke Certified Survey Map in Rush River? I believe he had told Todd Bakke that he did not have any different information than the county had in regards to flood elevations on the Rush 1 i Jennifer Shillcox From: Jennifer Shillcox Sent: Tuesday, November 13, 2007 9:08 AM To: 'Edwin Flanum' Cc: Alex Blackburn; Tamara W ittmer; Becky Eggen Subject: RE: Bakke CSM in Rush River :1 RE land.txt Hi Ed, All that we have are the old FEMA Flood Hazard Boundary Maps, which do not show a regional flood elevation for that section of the river. I have attached an e -mail I sent to Todd last week, FYI. Jenny - - - -- Original Message---- - From: Edwin Flanum [ mailto: eflanum @northlandsurveying.com] Sent: Tuesday, November 13, 2007 8:36 AM To: Jennifer Shillcox Subject: Bakke CSM in Rush River Hi Jenny Have you had any conversations with Gary Lepak in regards to the proposed Bakke Certified Survey Map in Rush River? I believe he had told Todd Bakke that he did not have any different information than the county had in regards to flood elevations on the Rush River. From what I could determine the county did not have any valuable information. Do you know if you have any elevation information on the Rush River? Thanks Ed 1 Jennifer Shillcox From: Jennifer Shillcox Sent: Thursday, November 08, 2007 10:15 AM To: 'TODD BAKKE' Cc: Alex Blackburn; Gary LePak (E- mail); Becky Eggen Subject: RE: land :h 17 SUBCHAPTER IV Floodplain... Hi Todd, Gary and I have been playing phone tag. I'll let you know when I've had a chance to talk to him. Just so you are aware, Gary usually works with County staff, at our request, to review permit applications for proposed development that appears to be within a floodplain. According to the St. Croix County Floodplain Ordinance, in cases where the regional flood elevation has not been determined, County staff can request technical assistance from the regional DNR office (Gary) to establish or confirm the regional flood elevation for proposed development. If neither he nor the County has sufficient data to make that determination, then the applicant must do an engineered analysis before any development can occur. See Sections 17.40 E.3.a. - b. of the attached Floodplain Ordinance for more details on how this works. What's unusual here is that you're a little ahead of the game. The lot on which you plan to build hasn't been created yet, and you're not sure where you're going to put your house. You are gathering information to help you make good decisions as you plan all of this out. Without a permit application that provides more specific information on the proposed development, the most that Gary can do at this point is give you a very general idea of what the regional flood elevation is in that vicinity, provided historic data or nearby bridge construction data is available. Incidentally, I spoke with Alex Blackburn regarding the concept for your proposed CSM. He said that he and staff from our Land and Water Conservation Department will be out on site visits tomorrow and will try to stop by the site to take a look. Generally, floodplain elevations have to be shown on CSMs for newly created lots to ensure adequate net buildable area, so you may have to do an engineered analysis to determine the regional flood elevation before you can create the lot. Alex will know more after observing the site conditions. I hope this helps. Feel free to contact me with any additional questions. Sincerely, Jenny Shillcox - - - -- Original Message---- - From: TODD BAKKE [mailto:bakkel0 @hotmail.com] Sent: Thursday, November 08, 2007 9:15 AM To: Jennifer Shillcox Subject: land Hello jennifer, I was wondering if Gary Lapak got a hold of you. When I called him, he said that you would have any maps he would have. I don't know if I caught him on a bad day or what. 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safe`y an ° J Building Division INSPECTION REPORT Sanitary Permit No: 514843 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: Bakke, Todd I Rush River, Town of 028 - 1042 -95 -500 CST BM Elev: Insp. BM Elev: BM Description: Q, Section/Town /Range /Map No: 160 U ( G5 35.28.17.268B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t CAPACITY STATION BS HI REV. Septic /a Benchmark 3. 1 f• � f W Dosing Alt. BM , r z. /6 .1 C . 3 Q6 Bldg. Sewer --- " 1 � k sz . - z /aa.31 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet NOC � Septic � 7 � Z � .� Dt Bottom ♦ +�1 Dosing 1 Z � Z / Header /Man. Q� 3S J Aeration -- - - - -- Dist. Pipe ----� � - Holding __ --- _ Bot. System r 75 Final Grade d ' P UMP /SIPHON INFORMATION 3. D� AZ ► 3 b Manufacturer Demand St Cover GPM -7 � �•S 1(S4.Z1 3.� '77. - 7 i(o 06 Model Number �I� Il 36 / `s TDH 1 Frictions Los Z System H ad �� TD)I , /O j j Forcemain Length Dia. •/ Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width I Length No. Of rent PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS O �/ .6 —, SETBACK SYSTEM TO iP c IPP BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type f ystem: CHAMBER UNIT OR Model Number: a 0 251 /�D 7 /66 --� DISTRIBUTION SYSTEM Header /Manifold 1 l Kps e(s qth tributioonn J f x Hole Size �� x Hole Spacing V o Air Intake LL Length Dia tn J Dia / Z11 Spacing r p Z -7 v SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only •� w Depth Over Depth Over xx Depth of xx Seeded /Sodded A !)� Mulched Bed[Trench Center f 3 Bed/Trench Edges ` Topsoil 1 �4_ No s E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / Z9 / 6 s e tion Location: 14 195th StreetgWdyin, WI 5P02 (SE 10 SW /4 35 T28N 17W) NA Lot 1 P IAL..) �k Parcel No: 35.28.17. 68B 1.) Alt BM Description = 2.) Bldg sewer length = z amount of cover (1 e Ian revision Required? Yes No 1 :e other side for additional information. __ Date Insepctor's ignatur Cert. No. •6710 (R.3/97) commerce.W11.90V afety and Buildings Division County a 201 W. Washington Ave., P.O. Box 7162 sco n s i h Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) tr epartment of cotnnteree 5 f ' 9 4 13 Sanitary Permit Application State Transaction Number In accordance with a. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 1507245 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address submitted to the Department of Commerce. Personal information yo purp oses in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. I. A lication Informs ' — Please Print All Information Property Owner's Name / Parcel # o n- 16*2 -, 9 — AID Todd Bakke MAR 312008 Part of Property Owner's Mailing Address ST. CROIX COUNTY Property Location , Z Or $' 34 191st Street ZONING OFFICE Govt. Lot City, State Zip Code Phone Num cr , ��.'. /a, , /., Section 3_ Baldwin WI 54002 715 -760 -2082 (circle one) II. Type of Building (check all that apply) Lot # T 28 N; R 17 E or W ❑ 1 or 2 Family Dwelling - Number of Bedrooms fr 1 Subdivision Name he Bloc ❑ Public/Commercial — Describe Use t+ h. ❑ City of CSM N b urp�� �CI El Village of State Owned — Describe Use tt�� Town of Kush River $ X 45 IIL Type of Permit: (Check only one box on line A. Complete line B if applicable A. ® New System ep Y 8 P Y g Y (explain) ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only El Modification to Existing System ex lain ) -- B. ❑Permit Renewal ❑Permit Revision El Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System /Component/Device: Check all that app-1 ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade [R Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) LJ Pretreatme Device (explain) V. Dispersal/Treatment Area Information: a O. 7 Design Flow (g d) Design Soil Application pdsf) Dispersal Area Requu s Dispersal Ar d (sf) System Elevation i 45U 1 t � 450 7 450 96.75 ✓ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 22 c '$ � New Tanks Existing Tanks L c .4 i/ P �O IZ , ; e,� 4 U � w a Septic or Holding Tank 1000 I) UUU 1 Wieser ' Concrete X Dosing Chamber 600 600 1 1 Wieser Concrete VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber:a, Signature MP/MPRS Number Business Phone Number Bennie Helgeson 220292 715 - 772 -3278 Plumber's Address (Street, City, State, Zip Code) W1229 770th Avenue, Spring Valley, WI 54767 VIII. Coun /De artment Use Onl Approved ❑ pp Permit Fee Date Is ed Issuing t Signatur isa ro S n nn R ❑ O rven Reason for nial V� ` So / V " IX. Condit "AAWWWWeasons for Disapproval \ C , a ; A , 1. Septic tank, effluent fitter and d M dispersal cell must all be services 1 mai heed Gi+^�� wl N"'• �-'• as per management plan provided by plumber. 2. All setback requirements must be milikltaihed `ti F A.,xa. /o[r�,�,�cr�, or SG fi /��• r %o'^ , s Attach to complete plans for the system and submit to the County only I e, on per n t less than 8 in x 11 Inches in size GI,. �o,�.. w �n.c, - / 5 15 0, I SBD -6398 (R. 01/07) Valid thru 01/09 +- ,o,,.—Q. Or re 6k.'rJ - ;6 r 66,AJ I lo+z v: r [.I s he J k l 6o— am co J+-S b 5+-. 60" .A ^ r'v4. ,U 0 Ct, M _ .i 3 r 72 O� 4 a ^� V °�7 0,\j 1 S c� Ji t.l 'r �a Q a 0 �1 v 'j � cc M� �U Q / Q c0Py � � W IT nt a Li M IVI 3 r o va u 04 o V - ? w �3 1 S fj 0 r z G � v vt p 4 i a v � .sC O ./ Safety and Buildings 38249CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 r www. me ce)w6govtsbl sco n s n www.wisconsin.gov epartment of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary February 14, 2008 CUST ID No. 220292 ATTIC• POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/14/2010 Identification Numbers Transaction ID No. 1507245 SITE: Site ID No. 73 4609 Todd Bakke Please refer to both identification numbers, Town of Rush River above, in all correspondence with the agenc St Croix County SETA, SWIA, S35, T28N, R17W FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1171217 Maintenance required; 450 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. P q 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. i • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component arer. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and • dispersal are prohibited. (,'p11(� The bench mark as located • is in an area that will be disturbed during he construction of the component. A new w p e AI?I)R( bench mark is needed that is located outside of the disturbance area and still accessible for the construction of EMT o the system. DE • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorptio sEe_ CO area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. i BENNIE W HELGESON Page 2 2/14/2008 • Inspection of the POWTS installation is required. Arrangements for inspection shall bemade with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 lited below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. I J INDEX SHEET RECI-IvIiD 2 2DOs PROPERTY OWNER: TODD BAKKE 34 191 ST STREET BALDWIN, WI 54002 PROJECT NAME: TODD BAKKE PROJECT LOCATION: SE 1/4, SW 1/4, S 35, T 28 N, R 17 W MUNICIPALITY: TOWN OF RUSH RIVER COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD - 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: WLP 1000/600 -MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Sig e d Address: W1229 770th Avenue Spring Valley, WI 54767 "all Credential Number: 220292 Date: February 7, 2008 NED COMMERCE 0 >PONDEN r OIA y : Page 0f� Synthetic Covering Distribution Pipe �� STNq L 3 3 Medium Sand H G Topsoil - = - - -- �=*s F D 3 E / b �'O/lt v • ex Slope CEtLof i 2 Force Main Plowed From Pump Layer Aggregate D o 7 Ft. E /. /S Ft. Cross Section Of A Mound F ,90 Ft. G 5 Ft. A �1 Ft. H _ /, D Ft. Signed: B License Number: K Ft. L 7-), g SIFt. Date: J J Ft. I 7 Ft. W 22 Ft. L F Observation Pipe f Forc c— g ` -- ---- - - - - -- ---------------------------- W _ �—, - - - --- Distribution 1 - 1 - Of 2 -- 2 2 Pipe Aggregate Observation Pipe 6 asa -1 Area ?37 7 b ' Plan View Of Mound f�C � Perforated Pipe Detail Cleanout Access Threaded Ed V14w Cleanout PVC Pip( End Manifold Holes Located on Bottom Are Equally Spaced R Force Main From Pump S First Hole Next to Manifold Cleanouts Distribution Pipe La out P / R S �� X Y �� Hole Diameter Inch Lateral " Inch (es) Manifold " Inches Signed: Force Main" Inches License Number: Invert Elevation Date: Holes Per Lateral �f Number of Laterals Total Holes i k e Page_j Of 8 SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" .P(K„ VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF JUNCTION BOX APPROVED >_ 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E g9oa WARNING LABEL 4 " M I N . 2'/" 1 8 " IN. `: 18 MIN• 1 � INLET WATER TIGHT SEALS GAS- T TIGHT 1 �� \/APPROVED A SEAL ' ' JOINTS WITH FLYER _ I j ALM APPROVED PIPE APPROVED � "� I ° k B 1 ON 3' ONTO PIPE 3'� 1 1 SOLID SOIL ONTO SOLID C 1 ' SOIL PUMP OFF ELEV . aLTT. --1 rjjOFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: Lk)lescf Z —X TANK SIZES SEPTIC IOoo GAL. DOSE VOLUME INCLUDING DOSE �— GAL. �FLOWBACK: __3 7 GAL. ALARM MANUFACTURER: C .T. FI�c-�c� CAPACITIES: A = INCHES =, - GAL. MODEL NUMBER: _ *% ( /-I L SWITCH TYPE: �/t✓I�rc�r�. FI B{- B = 2 INCHES =3 S�_ GAL• PUMP MANUFACTURER: C = �c INCHES = j OC�.S� GAL. MODEL NUMBER: i I= D = INCHES = GAL. SWITCH TYPE: L -tV-tl r– _ ( �– REQUIRED DISCHARGE RATE JCZ6` PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . • • • • • • . • FEET + � FEET FORCEMAIN X ,0 FT /100 FT. FRICTION FACTOR _8 FEET TOTAL DYNAMIC HEAD = lq,6 g FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID 6EPTff 36 SIGNED: LICENSE NUMBER: DATE: 1/88 � _r CL 0 a� LL Z LO m LLJ c) W Q s+ CO N Q U- Y LC) W Z � _ O J U E N O a: 00 m LLJ � V Fo aM O �plf7 C) V -ix f1n�o I o CL c N ClV) W WV.1 00 : � ?r cn0 m O N 00 CO c � � J < Ow _�oo NCD in ¢wN go r O r� � ow CID 0. o m w w N co n < IA — q - — r 0. WW ~ N C) � � v i °D? — I h- O O W Q U5 Q Z ..30= OmY O� a wo Z��� o V) o� Q ~,'� V mmc m� Z. c ¢�� o z J J O Q 0 Z Z J O ui Zt� Z s — r7 .. - - - -_— -- - - - - -- is 1 1 1 I i I � u w 1 1 w I 1 1 y w Lj O Q Lf) U j - - •, ; i W i i - I 1 I 1 1 I W J H . -O8 0 6� W Z .,95 3 MODEL: 3871 Su bmers ib le S IZE. 3/4 SOLIDS, RPM: 1550 Effluent PUMP HP 0.4 METERS FEET { d 25 7 O = g 20 U 5 z 1 4 D J O 3 10 h- 2 . 5 1 • 01 00 10 20 30 40 50 GPM. 0 2 4 g g 10 12 m'/h CAPACITY GOULDS PUMPS, INC -I so r�aus �w x�ac otee Ellocdvo WOW. IOU I^r ,,,Ru^i rr LIAT11V PRWTED W U.SA.'. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page --3— of �$_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner Todd Bakke Septic Tank Capacity 1000 gal ❑ NA Permit # Septic Tank Manufacturer Wieser Concrete ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Polylok ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model PL-5 ❑ NA Number of Public Facility Units Q NA Pump Tank Capacity 600 a l ❑ NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer W7t 0 ser ❑ NA Design flow (peak), (Estimated x 1.5) 450 al /day Pump Manufacturer Pumps Inc ❑ NA Soil Application Rate 0.5 g al/day /ft' Pump Model 3871 EPO4 ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L M NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 51 mg / L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 9) NA ❑ At -Grade ® Mound Fecal Coliform (geometric mean) :510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 2 ❑ ea�(s)(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2 ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: C� month(s) [J NA 13 u year(s) Inspect pump, pump controls & alarm At least once every: 13 Cat m onth ❑ ye ar(s) ) p NA Flush laterals and pressure test At least once every: 3 �Y ❑ ear(s)(s) ❑ NA Other; At least once every: 11 month(s) ❑ NA ❑ year(s) Other, ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :02 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. i OWNER: Todd Bakke Page _$ _of 8 START UP AND OPERATION .For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other Chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the Contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the • degreasers; dental floss; diapers; disinfectants; fat; POWTS: antibiotics; baby wipes, cigarette butts; condoms; cotton swabs, g rease; herbicides; meat scraps; medications; oil; gasoline; foundation drain (sump pump) water; fruit and vegetable peelings; g 9 painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil {imitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding may be installed as a last resort to replace the failed POWTS. E) Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO. NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER me Name Het s n Ex Na Phone Phone 2 — 278 71 77 3 5 715 273 -5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Johnson Sanitation Name Q+- ty Zoning Phone 715/273 -5811 Phone 715 386 -4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. f - Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County -7^ Attach complete site plan on paper not less than 8112 x 11 inches in s' Plan must include, but not limited to: vertical and horizontal reference point (BM do and Parcel LD 1S �� percent slope, scale or dimensions, north arrow, and location and dis . 0ZO v ta t rest road. - o� Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes P .04( Property Owner " 'rhowLpSp r P ope �c ation Toc�c� �� �� G vt, Lot 1/4s}t/4 13� TDR N R (7 E (o W Property Owner's Mailing Address f V o L t # Block # Subd. Na e o CSM# Y I kA 23 5 City State Zip Code Phc W GQLJN City E] Village n Barest Road Lot' IOT ,�,/ 19� }ti Sit New Construction Use: L7 Residential / Number of bedrooms _� Code derived design flow rate �� GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Ov e Flood Plain elevation if applicable General comments and recommendations: us� ccer- (epz�- 1_cQ�L e Cr l k F-/1 Boring # Boring Q p t Ground surface Bleu. ` _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I `Eff#2 / a -C m � -- L 0 -Sbk IPA laic •� � --V L 0 wt s t, l.f) if l. O S ( L c s -6 1, L.c) (p r L 51 Boring # n� /Boring j�j l5d Pit Ground surface elev. In ft. Depth to limiting factor 2 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I `Eff#2 L b a f � CO • 0 -�2 R-Q, jo R `— f, I V f- f 5 4 -F S na c ` Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) S'Oature CST Number Address ' a aluation Conducted Telephone Number t �� 9 _77D f �� �Y Sir, �► �� t /� .��- 77a- - ?�7 �{ PropertyOwner ALtAre`y T oLrK f ow Parcel I D Ar ) Page of 3 V ✓ Boring # ❑ F pit G+ /, Ground surface elev. ftw to limiting factor in. Soil A plication Rate Horizon Depth Dominant Color Redox Takrure, Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -t toY 1 I' w I I/ r C 6 /`� g S S to coo 7s 5 s � 5 Boring # Bg ��yy�� Pit Ground surface elev. 77i ® ft. Depth to limiting factor �_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#11 *Eff#2 y� a L k H 1t o kb fah 7. I L kx P I c, Ud �, d lVfIf 8 t w- (� -3j -3' faD c L F-1 Boring # ❑ pit Boring . ft. ❑ Ground surface elev . Depth to limiting factor in. r*Effff# A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cora. Color Gr. Sz. Sh. 1 *Ef f#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) Property Owner /lttt�he`9 l Vl� St7t ��� Parcel ID '- Page of 3 M Boring # F] Boning' L� pit Ground surface elev. �rd� C� ft ,w D to limiting factor in . Soil Application Rate Horizon Depth Dominant Color Redox Descelpljoe 10 Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 rT — ►� 1 � ` :5, L u % sbk l� coo 7,S 5 s v 51 Boring # � BO - g Ground surface elev. / �`i ft, Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 .9 Anto �k D 7.. S It d 2 r - C;� b c 1, L t,✓ r , -7 - y v a pit Boring # Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WWI? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (11.07l00) • �ro�JoSec� ' - ST. C R ©1 X Coci-Af Y poaYY, sE y of s w j 3 6 Ta8 R)7 ToLor� o R ) V cr X9 4 o r ` r r TOP o� i 4 F vc � o r \ tr} In � 4 -� e B4 40 01 �Qtc .l7 Iro u-"A rIev. asp' Q' ray. L 0-�I y pecyoSe J ' ReI 6 h-okAK d ' Parcel #: 028- 1042 - 95-000 03/11/2008 03:36 PM PAGE 1 OF 1 Alt. Parcel #: 35.28.17.268 028 - TOWN OF RUSH RIVER Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/11/2008 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BAKKE, AUDREY M AUDREY M BAKKE 11 CTY RD Y BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 35 T28N RI 7W SE SW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 35- 28N -17W Notes: Parcel History: RETIRED 2009 - -NEW CSM RECORDED WITH LOT Date Doc # Vol /Page Type 1 028 - 1042 -95 -500 (2686) AND LEAVING A 02/11/2008 868685 23/5499 CSM REMAINDER AS PCL 028 - 1042 -95 -100 (268A) 12/18/1989 454286 859/138 TI 06/06/1989 448500 842/429 QC 01/01/1989 420/554 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/13/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 26.000 4,700 0 4,700 NO UNDEVELOPED G5 1.000 100 0 100 NO AGRICULTURAL FOREST G5M 13.000 22,800 0 22,800 NO Totals for 2008: General Property 40.000 27,600 0 27,600 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 27,600 0 27,600 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 ` IIIElllillll' � �'lllllllVllllll!l1111lI11llli! 868685 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Om o RECEIVED FOR RECORD co Z z 'v o m 02/11/2008 11:30AM o; CERTIFIED SURVEY MAP O c 0 / c T VOL: 23 PAGE: 5499 m � 0 BEARINGS ARE REFERENCED TO THE ST. REC FEE: 13.00 o p o CROIX COUNTY COORDINATE SYSTEM COPY FEE 3.00 m ° = mm PAGES: 2 4 T 5 N Z m D O O ti O ro p p m 0 go z N �o =zcN°°m -* z - - _ R►y,F 0m 0 �a� W O.H.W.M. 0 ELEV. = 1016.7' Zi C2 mom Z S00"28'5 'E 244.40• N Q a Z m � M£ANDER LINE Q p m C Z 75' SETBACK FROM OHWM + 00 1 z 0 m Q '� I N ► o o �O N r X m '= m m 300: LINE FROM OHWM •• ... • N � c 71m' M m fi m cl) v" Z (9� m y 0 i `-1 11 PROPOSED m j Z 0 BUILDING SITE -b'- 1 cg r^ 8 m ~m oT n c m ♦/ ' � �_ y m A m 0 O N v, -o No " N o� c 0 r N If p O w -F m m 0 [ o Z A IJ y Oo y y Z w p \ ? = x cn Z m O J Q Q Q v m m X _ 9 N i Z ZZN m D C) Zoo 0 Z M z n z Z ca m N� _. 5 N g Z N II ......... ...�... Z .& 01 w m c A C i EXISTI G CENTERLINE g 2 0 N 01 ° 10'2 9 "E 484.70 �m NOO °01'4 "E 586.09' NORTH - SOUTH 1/4 LINE N 00 0 01 '45 " 48 �3 NO "Ea 1sa.3a' Z _ 195TH STREET n �. m . � m MG`.I]C� ►C�la`u�LD L�,La nMDD `''~ . «. .'` lye 2 I �oc�n - — — — — — — — — — — — — — — — - =GJf �]► m .N� ?; � y �z 0m-0-Z SOS ca co rZ� y� 1 of 2 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM -- J ), Owner /Buyer 4' r p Mailing Address Property Address S� (Verification required from Planning & Zoning Department for new construction.) City /State a J u;7,, , (.L) Parcel Identification Number Pe" o F LEGAL DESCRIPTION Property Location SL — '/ , SLo 1 / , See. -- 2>S , T ZZ_ R 1 W, Town of (L" RI V C?�r Subdivision , Lot # Certified Survey Map # ����� , Volume Page # S y 9y zap rl c©� + - IyaCr` # _�� , Volume 3 , Page # Spec house 0 yes;9no Lot lines identifiable 0 yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix county Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a 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 Planning & Zoning Department within 30 days of the three year expiration date. I /we 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 b dro s 3 �?�e SIGNATURE 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. 08/05) * 8 7 0 1 4 Bar of Wisconsin Form 11 -2003 870 40 4 LAND CONTRACT KATHLEEN H. WALSH (TO BE USED FOR NON - CONSUMER ACT - rRANSACTIONB) REGISTER OF DEEDS Document Number Document Name ST CROIX CO., WI RECEIVED FOR RECORD CONTRACT, by and between Audrey Thompson a /k /a Audrey M. 03/06/200$ 10:OOAM Bakke LAND CONTRACT ( "Vendor," whether one or more), EXEMPT I and ° a e an o e akke - -- REC FEE: 17.00 ( "Purchaser," whether one or more). TRANS FEE: 162.00 Vendor sells and agrees to convey to. Purchaser, upon the prompt and full PAGES; 4 performance of this Contract by Purchaser, the following real estate, together with the rents, profits, fixtures and other appurtenant interests ( "Property"), in St. Croix County, State of Wisconsin: Recording Area 1 pp dd�� Q [aldwin, me and Return Address Vo 2 (J -� 1� drey Thompson Cty Rd Y WI. 54002 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) This is a purchase money mortgage. Purchaser agrees to purchase the Property and to pay to Vendor at (is) (is not) 11 Cty Rd Y, Baldwin WI. 54002 the sum of $ in the following manner: (a) $ 5, -000.00 at the execution of this Contract; and (b) the balance of $ 4 4, 000 -00 , together with interest from the date hereof on the balance outstanding from time to time at the rate of 3 % per annum until paid in full as follows: provided the entire outstanding balance shall be paid in full on or before January 1, 2013 ( "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: 0 A. Any amount may be prepaid without premium or fee upon principal at any time. ❑ B. Any amount may be prepaid without premium or fee upon principal at any time after ❑ C. There maybe no prepayment of principal without written permission of Vendor. State Bar Form 11 -Page 1 0 2003 STATE BAR OF WISCONSIN s - Dated November 3 2007 VENDOR: PURCHASER: (( SEAL) / � '` 6 SEAL * u rey Thompson a Audrey M. Bakke. * Todd R. Bakke - ( SEAL ) (SEAL) o e a e (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on %. `, C OUNTY ) ss. v� ) * Personally came be a me on O o o-) above- named Ud f^ TITLE: MEMBER STATE BAR OF WISCONSIN k j� (If not, to me known to be the person(s) who fe e a file 1 authorized by Wis. Stat. § 706.06) instrument and acknowledged the sat> Z "`, .„ ° s► THIS INSTRUMENT DRAFTED BY: Todd Rakkc Notary Public, State of Wisconsin My Commission (is permanent) (e Expires Oct. 107 yd C (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. 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