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002-1003-20-000
Vllisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and $uilding Division ~ s • ~ INSPECTION REPORT GENERAL INFORMATION • (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Hurt en, Joe Baldwin, Town of ;ST BM Elev: Insp. BM Elev: BM Des~qption: a -1 ~ ~ ~ /6D ~b+M ~ G5"' cJ' ~ ; SANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY J ~ sr--- Dosing -~' L Fit i n~' i n,~ ~ ,r`22.- ~: Holding i TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ,~ Dos' g / t0~' ~5 5 f ..._ Aeration Holding PUMP/SIPHON INFORMATION ~ 1/ Manufacturer ~ (( ~ Demand 6C:1-\'~-~ GPM ~ Model Number ~ , /~ TDH Lift Friction Lr~ System Head a Ft TDH ~ ~ l 1 S , Forcemain Lengt~ Dia. ~~ Dist. to Well 1 ~ ~ D Z SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 479203 0 State Plan ID No: Parcel Tax No: 002-1003-20-000 Section/Town/Range/Map No: 02.29.16.25 STATION BS HI FS ELEV. Benchmark ~ , b ~~~ /~ Alt. BM Bldg. Sewer Gx< •~-- SUHt Inlet ~ x'i ~ ~ ti St/Ht Outlet ~1,~,rj 9z ~ 5 Dt Inlet `~ •~ ~ `Z Dt Bottom Z! ~~ 5 Header/Man. z . ~ ~~ ~ Dist. Pipe z .~ e ,~ Bot. System Z ~ ~~~-~ Z Final Grade D, /~ ~ • S St Cover a~,~-a~~ ~~ 3 /~Z ~`7 BED/TRENCH Width Length ~ No. Of~renc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ [rc~J ~ ~ ~ ~ SETBACK SYSTEM TO P/L ~ BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHA LINER OR Type ystem: . ~ t~Z / z~~ / 7~~~ Model Number. ,~ ~~ DISTRIBUTION SYSTEM .~ Header/Manifold f/ Length Dia_ Distribution ~ t I pipe(s) -'7 ~ Length Dia L~ Spacing x Hole Size .,~ 11 x Hole Spacing Z / Venj.~o Air Intake v ~n~ ok SOIL COVER Y Procm~rn Rvc4eamc only YY Mnnnrl nr Of-Grade Systems Only ~J,~ a'.M..f~'-"~ Depth Over ' Depth Over xx Depth of xx SeededlSodded xx Mulch d Bed/Trench Center ~ ` ~ BedlTrench Edges ~ Topsoil ( ~ ,-~ es ~ ~ No es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~'/ y/ Inspection #2: / / Location: 2522 110th Avenue Woodville, WI 54028 (NE 1/4 SE 1/4 2 T29N R16W) NA Lot P'D~ ~~~ '' llParc o: 02.29.16.25 L} Alt BM Descrlpton ~,{t{~-~ n„G 2.) Bldg sewer length = ~X ~5~ ~) - amount of cover = I I Plan revision Required? ~ . ;Yes o T i ~~ Use other side for additional information. L __~_1___~ _ __; Date S$D-6710 (R.3/97} I_$z -~ Cert. No. and Buildings Division County ~ . 201 gton Ave., P.O. Box 7162 )~~~~~®~ n, I 707 - 7162 Sanitary Permit Number to be filled in by Co.) ^ Department of Oommerce ( -3 ZO _ Sanitary Permit Applicat' ~~ an LD. Number , Wis. Adm. Code, personal informat~ pra71iQ4, • In accord with Comm 83.21 , 04( m) ~IYY~I fH~ fr ~ ~ s15 oses Privac Law be used for seconda ur ma Pr j Address (if di Brent than mailing address) ~ . , p y y ry p ~~ ` ~ Z52z /la ~ ~ I. Application Information -Please Print All Information ZONI ~~k Ltd`, ~~,' ~ s n.~~/ Property Owner's Name Par I # Lot # Block Property Owner's Mailing Address Property Location ~,Q.~ ~/ s ~~ [~ ' i "' 7 ~~ % .st'V'/, Section Ci State - ~ 7' tY, ~V 1 I ~,/ '.'l./ ~i Zi Code J y~ {~ ~ Phone Number , , rcl one) T ~N; ~E o pe of Building (check all that apply) ~ H- II ~ ~~ ~~, e~r . CSM Number bdi S i i ~ Family Dwelling -Number of Bedrooms one u v s O ^ Public/Commercial -Describe Use ~ / C ^7 ^ State Owned -Describe Use K S / a n ^City ^V illage ship of III. Type of Permit: (Check ly one box on line A. Complete line B if applicable) A' ^ New System acement System ^ TreatmentlHoldin Tank Re lacement Onl g p y Other Modification to Existin S stem g Y B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: (Check all that a 1 ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil o d < 24 in. of suitable soil _ ^ At-Grade ^ Single Pass Sand Filter ^ -~ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ ~ / c Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) ~ (~, r V. Dis ersal/I'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal~Required (sf) U Dispersa~ea oposed (sf) [ [. Syste ~ evat ~ ~ (/ / ~ o ~ VI. Tank Info Capacity in Total Number Manufacturer ~ T ~ Prefab Site Steel Fiber Plastic Gallons Gallons of Units --. n.~. ~- Concrete Constructed Glass New Existing s~~~ l~~L~ . Tanks Tanks ~ ~^-' Septic or Holding Tank x ~..~ t,.. Aerobic Treatment Unit Dosing Chamber ~ ~ Q VII. Responsibility Statement- I, the undersi ,assume responsibility- r installation of the POWTS shown on the attached plans. PI Br's Name (Print) Plumbe ' Signature MPMIPRS N er Business Phone Numb r ct.~ Plumber's Addr ss (Street, City, State, Zi 1p~ ~ ~ ' ) ~ ~~ ~ ~ ~ J ~ VIII. C /De artment Use Onl pproved ^ Disa Sanitary Permit Fee (includes Groundwater Surchaz e Fee) Date Issu Issui g gent Sign a Stam ^ g ~ / f~ ~ " ' s z .7 O er Giv easo Denial r IX. Conditions of ApprovaVReasons for Disapproval ,n~ 3J ~-av~,~d-~o i v~, S~-a,~ ~pfo ~e-~'C.(' cc. ~~ ~~ SYSTEM OWNER: 1. Septic Hank, effluent filter and I /`, E~ec~, C,.J / ~~S p Ve(',Iw.~ {' . dispersal cell must all be services /maintained / as per management plan provided by plumber. , 2. All setback requirements must be maintained as per eppliceble code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD-6398 (R. 01103) -• ~ PLOT PLAN PROJECT Joseph Hurtaen ADDRESS 2522 110th Ave Woodville Wi 54028 NE 1 J4 SW 1 /qS, 2 ~ /T 29 N/R 16 W TOWN Baldwin COUNTY ST. CROIX SYSTEM ELEVATION 104.6' 1.5' Lift 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND ~~ SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100° ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 110th Ave 300' 6- 104 103. 103' 102' B~ 101' 9% Slope Scale = 1 " = 60' B-1 DT Area 15' Below System to remain undisturbed Tank is to be properly bedded and provided with lockdown cover with approved warning label Grading is to be done to divert run-off away from system 1320' Property Line B.M. *. ST Well O Filter Sim-Tec (inline) Existing 3 Bedroom House DW To be pumped and buried PER coN+e-1 83.33, IN•a. ~. B-4 \\ 1 ,PLOT PLAN PROJECT Joseph Hurtaen ~ ADDRESS 2522 110th Ave Woodville Wi 54028 NE~ i%4 SW 1/4S' 2 /T 29 N/R 16 W TOWN Baldwin COUNTY ST.CROIX SYSTEM ELEVATION 104.6' 1.5' L'Ift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX)C SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100° Filter Sim-Tec (inline) ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 110th Ave ' Scale = 1 " = 60' Well 300' B-3 p J W~~ ~r~` 104 1003' 102 B.M. * Existing 3 B - 2 Bedroom House 1 1 g% S{ope DT Area 15' Below System to remain undisturbed Tank is to be properly bedded and provided with ST lockdown cover with approved warning label DW To be pumped and buried PER Grading is to be done to ~ eoMn~ 83.33, ~N•A• C. divert run-off away from system 1320' Property Line B-4 s a Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page of in accoraance n t;orpgi„t~ ~{t County ~ ~-~ an mus Attach com lan on a er not Tess than 8 1/2 x 1 inches in size lete site p p . p p indude, but not limited to: vertical and horizontal referen point (BM), direction and parcel I.D. ~~ ~ ~ -~ ZO percent slope, scale or dimensions, north arrow, and I tion ar~rdr n ne~~t road. I~IFt~ ~~ ~UU;? Please print all info~ma ion. Reviewed y Date ~~--rr Personal information you provide may be used for secondary p posesy+Tiv~~, ~l1~tDU~1'y`(m)). Properly Owne ~ ~ "~ . ~ 4 S T N ~ E ( `~ ~ ~ ~~ 1 /4 / Govt. Lot / , Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Z -Z ~ ~- v P City State Zip Code Pone Number ^ City ^ Vi la a own Nearest Road ^ New Construction Use 'dential /Number of bedrooms Code derived design flow rate SU GPD eplacement ^ Public or myie Describe: ___-____ j -- Parent material Flood Plain elevation if applicable ~/~ ff. General corrur,en<s j~ f ~ ~~/~ yG~ /D ~i / and recommendations: / / / -- ~~~,~ Boring # ^ Bonng n~ pit Ground surface elev. (r' / ~. Depth to limfing factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 22 Q /~ S ~ ~'m -~ / / ~ ,~ . I ' ~ 1 Borinv # ~ Boring /~7. / 7~ I °~-I pit Grouno surface eieY~ `~ ~` ~ i tt. ueptn to ummng ractor +n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 o ~ / ~--- s ~ ~ ~ Z ~Z ~ ~ ~ ~ z~ ~ f / ~ ~ 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 `Effluent #Z = BOD < :i() mg/L and i ~ < su rT-9ru CST Name (Please Print) S' ~ CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~.~~~ _ 0J~ 715-246-4516 Property Owner ` Parcel ID # Page of ® ~~ # ^ Boring D~~ tft. r~_ . ~Rit Ground surface elev. Depth to limiting factor ` ~n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fft in. Muruell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 D U 3/ ~' ~S ~ J~ ,.- ~ f D ~ ~ ~ rte,- i~ ~9- . Boring # ^ Boring Qr Pit Ground surface elev. y J' Qt. Depth to limiting factor ~n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Efffa:2 l p ~ 3l T-- ~ ~ ,~. .,~- ~ ~8 Z o~ i ~~ ~~ ~ gym- ~ i p D Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ica8on Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 'Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mglL • Effluent #2 = BODS < 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 (8.6/00) ~- ` ~ ~ Soil Test Plot Project Name Joseph Hurtgen Address 2522 110th Ave Woodville Wi 54028 Lot ------ Subdivision -------- Date 5110/05 NE 114 S W 1/4S 2 T 29 N/R16 W Township Baldwin ~] Boring ~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Shed Siding System Elevation 104.6' *}IgpSame as Benchmark 110th Ave B- 104' 103' 10 2' 10 13 20' Property Line Scale = 1 " = 60' Well O ^.:_~:_g 3 ~m House commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com m e rce.wi. g ov/s b/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 23, 2005 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/23/2007 Identification Numbers Transaction ID No. 1136540 SITE: Site ID No. 698595 Joseph Hurtgen Please refer toboth identification numbers, 2522 110th Avenue above; in all cones ondence with the a enc . Town of Baldwin St Croix County NE1/4, SW1/4, S2, T29N, R16W FOR: Description: Three Bedroom Replacement Mound System Object Type: POWTS Component Manual Regulated Object ID No:: 1018577 Maintenance required; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. P.O.t°~.T.S. Cc~~ditio~~ialh ACn~ nr.. ~.. SI-IA1IN R BIRD Page 2 5/23/2005 • Comm 83.22(7) - A copv of the approved plans, specifications and this letter shall be on-site during ` construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. . The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 5/10/05 Cover Page Owner: Joseph Hurtgen Location:NE1/4 SW1l4 S2 T29 N,R16W 2522 110th Ave System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and plan 9-11. Soil test Shaun Bird Signature License wrViNiEF2GE DIV-SIQN OF ETY AND BUILDINGS SEE CORRES NDENCE ~~~~~v~° MAY ~ 31p05 & ~~1~.~~r~GS SPF~ i 'Designer No Date r Non-Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric AS12i C-33 S o n d --~ t~ " Topsoil ~ li < ~~ ~~ w~~ f Plowed Laytr ~ols :.E ~~ F ~~r ~ ~~ ti /~ J - L -, - - rvolion Pipe--~ ~.Obse ~~ f{ J ~ ~ -e ----._~_-------- ~~ - a A " ~ ~ i Force Mpin ~° ~---- r/r ------------- --------------------- ~ From Pump w ~~ -r. rl _. ~. __ -_. __ r- r. .-_ _ _ .~_ i • ?} r ~ ' f ~ ° Distribution Bed Of /2 - Z'2 ~ -Drain RocK Pape i ~/.4 Obf-ervotion Pipe '-~C`~~.~c~ Permonent Morktr 1/5~~-.-- ~~,~.~~^~ ~ ;`r~,rn-~ .~~-t~~t po or Rods Plon View Oi Mound Uc1nQ A Btd For Tht Absorption Areo ~•~ Slope iJ t E Bed Otjl~-2'r Qrain Rock pistribuf ion Pipe ~..i'i~5c~?` - - f ~~ = ° G Force f?~a~n From Pump Cress Section Of A Mound Systtm Usin A Bed For The AbsorptioQn Area A O_ Ft. s ~7 Ft. • I (~1 Ft.- ~ ~ ~t. . L ~~~t . >r~33~1 Ft. ~'- PAGE_„OF' .orated Oa 8a,so+n• ERyaRy gpoteo C/~¢, K3T t-otL *icx~ •te CattfltC}ti Ft. Signed License Norther Date: Jt ~ ~ ~ t4Gh@S ~~~ ~ _.___~_ TnChe5 Hole Diameter~Inch Lateral ." _.Z._.Inch{es~ Manifold ~ InchES_ Fgrce Main ~-- Inches ~ of halesiAi~e ~. ~ Invert Elevation ~f i.ater~al~~lFt.-. Pe~¢CtotEd Dip; DEtO1~ ~; L/ C.:. rt~~ MMt ~ ~ ~~ ~fii ria;+- OOCit. #n1 t~~t~'R~l+; (~ r LI~•e,.~•++~/CI-iT LAP ~F i ti,rtwtKt Rr~.os~ 7 s G~~ ~~~:~s~aL~ate~~ iu~ ~!~ ~ :_ ~ ~f'lM11~. i -- '~"`~ 4~t;OViCi ..+r wz~ct~~~' ~-~ a~~4vF.a JOt~ ~fITi+ ~~ ~~~~ '~ ~ a1~~ S4t,1D *~Oi~ #jt{'S~ CO~iCRiTi lLOC~ ~ ~~i Z s ~~~ t t ~ s~t.,r-1er~ ~ ~t ~ a~ t t t' f ~I~ ~t#ilt ~![iT s;,~l~ii'1r~O t•11r1i!! i*'lAfitR #aG~ii~~tt~~i 3t~M R*~oit,~i. j ~, .~ y~. ~r,~ ~ ls~~s~~z~~r~~ M1-rtiii~ACTYRI~ 3 v Twr~e sips<< swia.o~-ss na3c vt~w~ee . ~il~tltR?~ ~r. NtlSG1t '1'MKi r ~ ~,, /3% t'.r i s~ ttrC~s 01t / ~MiiOiL #IYMtiR: c - / ...,,,......,..........~•~ ~s,L,~....tliiG~ OR ~i+...ifi.~ O~L401i~ i~,riTtM Ttl1it ~" P r ai4~ ~ A~ !g ~ .~C~fi~P,T~i 6iRl•4~'~ ru~tMNA 0lsCwn~i~ ~ ~..L~...-•f-tx ,e~ru~. a~ns~awat •er+~~ ~rr- mss, wya- ~r~rTeta~n':fui ~i,c.. ~ v ~~tT ~/~~~ ~ M~+a1i!''t #lzTMfQRtt tilpti.'f ~tfirltiRt ..... • . • ~` ~ •n~ +~~ rcts ec ra~eee e~w~r x ,... 3.~~.,~.*r~se~r,o~ ,+-~~neR. ° ac T~wL Q~M1G Nt4D : 07 7- rt'iR~ ~- ~~ ~/ ,-- ~ aE,tski~MUS ar rawtK: ~.ct-~es~+ ~.,.... ~ -;~rtDZx ~,.; i.~~~t0 pflTM .. ~...~ G'~'~1t1~lA 1 ¢ ~ t ~ W W, tr.. 14 45 t2 40 O = 6 20. U_ y 15 J 4 Q H o io 2~ 5 U.S. GALLONS 10 LITERS r CiUR V C iI4140° TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT ANp DEWATERING Ft. Meters Gol. Ltrs- 5 '.52 97 34a SO 3.05 84 318 t5 s.57 76 286 140 14(3 Z0 6.to 68 zs7 25 30 7.62 9.t4 59 49 223 785 35 {G a5 10.67 72.14 13.72 38 27 5 taa 79 19 Lock V° We: 4 ~ nl~ 4'0~ s0 60 { 70 ~ r5p 240 FLOW PER MINUTE 90 320 ~~E~SULT ~~~T~~~ ~~ ~PE~~A~ ~.P~~I~A • E-ectrical attemators, for duplexsysiems, ars available and supplied with an alarm- - Mechanical alternators, for duplex sysl3ems, are available with orwithout alarms. - Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732 • Variable level control switdzes are available f~ controlling single phase systems. . Double piggyback variable level float switches are available for variable level long cycle controls. • Seated (2wik-Box avalable for outdoor installafions. See FM4420. • (firer 1311°F. (54°C.) special quatafion required. • Refer to FM0806 far 200° F. applications. 140 Series - 53 tbs. 4:40 Series - 73 lbs 140!4140"` MODIIS Corsbnor Selection dal M Model Vans-Ph Node angrs SimP~ Dup~c o N140 N4140 115 1 ~ S0 2 or 3 ~4 E140 E4f40 230 1 Nal 7 15 5 1 or 1 & 5 1or1&5 Zor3>f~4 BN140 BN4140 175 1 idon No . ~~ 1 a 1& 5 2 or 3 84 BE140 BE4140 n 230 1 SELECTI{3t~ GtilDE € 5ingie Seal Desigl?;. tJltt ~~ 11)5: 7 t/2 - 71 t/2 /rT a t/2 !P7 SKS524A sKSSZae 1. Single piggyback variable level float sNrihdT or double piggyback variable level float svritch- Refer to FM0477. 2. Mechanipl attemator tJt-Pak 10-0072 or 14-0075. 3. See FM0712 rot correct model or Electrical Afhemator E-Pak. 4. Variable level control switch 10.0225 used as a control ac6vab°r, spe~fy duplex (3) or (4} float system. d CAtrrION sil inshana'aon of control; grotectior devices acrd nnrin9 sbouid be dons by a Lleatified licensed etechitaan. Alt electrical and safety codes 5<'ronld be fol{axed ittdud'mg the most kart Na'uoraE Electric Cade tNEC} and the Gccapatianal Safety and H..atttt Act tpSEiAI. For unusual conditions a reserve safety factor is engineered mto the design of every Zoeller pump- MNt70: P.O. &LY }6347 ":." . i - ~~~ lat,gsv>iie, KY 4026611347 ManuFadurers ~.. , Sf8AT0: 3fi49 Cane Rtm Road ~ ~Q/jQ,v ~p ® /„oce XY 40211--1961 ,~~~jy~d/~/VL/V 7t0 e. - ~- 3 7/8~ 5 t/4 s s/s n .. 3 7/8 to 73/32 © Copyright 2001 Zoeller Co. All riQhl5 l~,rua./1 _, " p1NNER'S MANUAL $~ MANAGEMENT PLAN - POIAt"I'S SYSTEM SPEC[FICATIOAIS CJRMATION Septic Tank, CaP~ ,G Septic Tank ~n~acturer e~ _-._._---- - Effluent fitter Manufacturer DESIGN PARANiET~~ [] NA Number of Bedrooms ~-NA Commerda! Un'ds Number of ~-~ aVda Esfimabed flaw tavetage? ~J~ aUd ~- ,~ pesign tiow (peak), tEstrmated X ~ •5) .., , ,/, ~ aUda fft2 Soil App~°f1 ~~ Monthly average. tnftuent/Etfluent Quafity FOG) ~~ mgr" Fatsr Oi18~ Grease GODS} ~~ mglL Biochemical Oxyg~ Demand ( SS s1 ~ m ~ Total Suspend Solids ZT } N,q Monthly average" Pretreated Effluent Quality BODs) S30 mg/L B'~hernicat Oxygen Demand ( 530 mg/L Totat Suspended Solids {TSS} 510' cfu/400m1 Fecal CoGform (geometric mean) yB inchdiameter Mtacimutn Effluent Parade Size Service Event tns~ nn ition of tank(s) Pump out contents of rank{s) lnsped dispersal cell(s) clean effluent fitter Inspect pump. Pump controls S alarm 17ush gals and pressure test Page of Effluent Flter' Model "~ -i Pump Tank CaPadtY ~ ~ , ~ `~ purrtip TanK M~u{acturer Manufacturer . Pum~„_., ~ `~ Pump Model pro~atinnent Unit ~ SandlGrdvet Filter !] Peat Fltter ^ Mechanical Aeration ~ Wetland Q Other p Disinfection Uisp ~ it(s) - C] in-ground (gravttY) Q At-grade ^ Drip-line .. ^ tjlA D NA D NA DNA ^l:7 NA ^ NA ^ NA [7 in-ground (pressurized) '?~~(ound p O er ~ for dotnest~ (non.~mmerda>1 ~rrastewater an0 v~~ ~~ik etfluenL Values typal ror P~~ted waste+nrater- - Service Frequency O months ar{s) (Maximum 3 yrs.} At least once every ~ of tank volume When combined sludge and scum equals one-thud ,~}1M~mum 3 yrs.) At least once every At least once every At (east once every At least once every At least once every At least once every D ~ ~ ^ monmsy~~'~°`~'~ ~^ months r(s} DNA p months s} ~ p months D Yews) 0 NA p months ^ year(s) l3 NA one of ilia fdlowtng j1Genses or MA,INTEN~~ 1NSTRUCTiONS an ind'~vidual catryin9 car: POWTS Maintainer, Septage lnspedbns of tanks and dispersal cetis shalt be made by an rtiissing or broken k s to idenffY Y bade uP t5ons:. Master Plumber, Master Plumber Restricted Sewer P01A~TS ~ d scum and W c~edc for any t levels Servicing ppefator. Tank inspections must indude a visual inspection of the tan () ~ chedt the effluen hardware, identiifiy any ~d~ or leaks, measure the volume of combined sludge an of effluent on the round surface- The dispersal Ceti{s) steal( be visua[ty inspected ponding or ponding of effluent on the g nding of effluent on ttte ground surface, ulatory authorihv_ in the observation PiPeS and to check for any Po uires the immediate notif-MC~bon of the local rag ma ind'uxte a failing condRi°n and req or more of the tank volume, the ground ~~ Y min any tank equals one-third (]~ NR fnula6on of sludge and scu erator and disposed of in accordance with ch. When the combined aaxr a Septage Servicing Op entire contents of tt-e tank shaft be removed by ~ retreat+pment components, and any 113. Wisconsin Administrative Code. fessurized POVYTS components. 'P Maintainer. rforcned ay a certified POyvTS The servicing of effluent filters, mechanical or p ~ service event. other maintenance or mon'Roring at intefvais of 12 months or less shall be p? of completion of arty A se report shall ~be Provided to the locat regulatory authority within 10 days ~ or other for the pfesence of painting produar START UP ,4N0 OPERATION For new construction, prior to use of the POWYS check treahnent tank(s) ersal cell(s). if high cancentmti0ns are chemicals that ma)r impede the treatment process and/or damage the lisp detected have the contents of the tanks} removed by a septage servicing operator pnor to use_ '~``- ~ ° ~ ~ • th infiltrative surface- Page o(______ R u shalt not occur when sot{ ~nditions are frozen at a is ~~~ ~ ~~ System eta P ~{ above normal highwater levels. When p°wef m result in the es Pump tanks tnaY over{oading the ceC(s) and aY pur+n9 Pier o~g to the d•~persa{ cell(s) in one large dose. dmp tank removed by a ~~ ~ ~ disehart~ed To ~~ his situation have the contents of the p backup ~ su~`~ dlsd'~Je of effluent. wer to the effluent pump ar contact a P{umber oc pOVYTS Maintainer to e Setvidn9 OPere~ priOt.tA-~~ Via. ~ ~u~ Qp~~ng f~ pip c~ntnot~ restos~e norms! tenets wiu~in the ppmp assist over tanks netts. too not drive or parfc over, or otherwise disturb or compact, and dispersal bon area. po not drive or park vehtd~ o f any mound or at~rade soli absorp the ~a within 15 feet dav~m slope ter stream may improve the performance and prolong the life n from the wastevra - deQreasets; dental floss: diapers: Reduction or-e{iminatiort of the followi J tie butts, condoms; oottan swabs. asotine* grease; herbiddes; meat of the POWTS: antibiotics: -traby~ 1 ~ F~) ~,~r merit and vegetable peeCrngs: 9 d~s~irtfeclvanis~~o~ ~ ~ tenting products, f~st~des: sanrtary naPk~ns; tampons; and water softener brtne. scxaps; AgpNDOI~N{ENT ,taken out of service the following steps shalt ~ taken to insane tftat the When the POWTS falls and(or is t~~n~oomPtiance mirth ch_ Comm t33-33, Wisconsin Administrative Code: sys~ is proP~Y and safely abandoned nln s seated. tanks and pits shaA -be disconnected and the ahand ~~~PSed ~Y Septage Servicing Operator. AiI piping ip ~ shat! be removed and property .. The contents of ai[ tanks and P excavated and removed or their Qovers removed and the mid space • After pumping. al( tanks and Pits shalt be ~}}~ y~ soil, gravel or anotiaer inert solid material- to provide a code CpNTlNGEBICY PLAItiI aired the following measures have been, or must be taken, if the POWTS fails and cannot be rep compliant replacement system= be utilized for the lacatian of a rept~n and should not ^ A suitable ~piapernent area has been evaluated and may at~sorptipn system. The replacement area should be protected s~ s~~~ jot !Ines a~rtd welts, Failure to aired setbacks from existing and propo be infringed upon by Tec{ will result in the need for a new soft and site evaluation to establrsh a suitable terns must comply with the rules in effect at that time. prated the replacement area replacement area- ReptaceCrtent sys e lacement area is not available due to setback and/ aroe~ mfailed pOW'rSng advances in POWT p A suitable r . P be installed as a fast resort io rep technology a holding tank. may n failure of the POWTS a sod and _,,-site has not been evaluated to rdentrfy a suitable replacement area- Upo iacement area is available a_ ~~i" jte erdluation must tie perfarm~ to locate a suitable replacement area- tf no rep be insYdlled as a last resort to replace the failed POyY'!'S- removes! ~ the biomat at aiding tank may stems may be reconstructed ~n place following rid and at-grade soil absorption sy with ifie rules in effect at that tune. the infiltrative surface, R~nsb-u~ons of such systems must wmPtY <NYARNING>y 'TANKS MAY CONTAIN Lt~THAL GASC RC MSTpNCESF DI.:ATFi MAYG~ SEPTIC, PUMP AND aTH~ Ti~F~TMFNT DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TATtK UNOER AHD` SULT. RESCUE OF A RERSON FROM "C'F-lE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. RE ADDIl70NAL COMMENTS . POWTS lNSTAt1.ER Name r i.~~../ i ~' l/ ' Phone ~~ ~ ° ~ G ~ ~l --~~ POWTS MAINTAINER Name ~ r.~u ~-~ ~/ / Phone ~~.3 `~ Locat_ REGULATORY AtJTHOR~ SEPTAGE Si~RYtCtNG OPERATOR PUMPER agency ,~`~~,~ ~'~~-- Name ~~ Phone ~~,~'"~'" ~0~ Phone -~ f r`'" ~ ~~ ~ 'T'ttls document meets the staffs ~ ~ Goren ~~. Marquette and Watrshard County Zoning and Sanitation a9en~- merit does not This document was Qtatted try t ~ and 83.54(1 }. (2) & (3). W+sasnsin Admtntst~~ Cade- Use of this doss uirements of cit.. Comm ti3.22(7)(bx K~ (~ ~un^'tvp1t the tnlnimum riDQ guarantee the performance of the pOV1rCS_ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ' OWNERSHIP CERTIFICATION FORM OyynerBuyer oS~ ~ r~ P ~ , aZ SL Z ~/~~ ~'rr~-~ ~~ ~J'~~~,/ lil/ J s'`~c~ x-17 Mailing Address Property Address ~~^~~--~ (Verification required from Planning Department for new construction) Parcel Identification Number 4 d Z ~0~ 3 ~ °? ~ ^ O7~ City/State LEGAL DESCRIPTION ~ ) Property Location~~ '/4~f~/ 1/4, Sec. Subdivision v T~~N-~~ W, Town of ~~'~'` ~t~i i/. Certified Survey Map # Warranty Deed # ~ ~ ~ l~ ` ~.- Lot # ._ ~_ - Volume ,.Page # Volume ~ `~ ~ Page # S house ^ y no Lot lines identifiable ~ yes~no P~ SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handl~t y u put int~the system consists of pumping out the septic tank every three years or sooner, if needed b sa licensed pumper. can affect the function of the septic tank as a treatment stage in the waste disp ate owner a to submit to St. Croix Zoning Department a certification form, signed by the owaer and by a The Property ve that (1) the on-site wastewater disposal system masterplumber, journeyrnanplumber, restrictedplumber or a licensedpumper rig the tic tank is less than 1/3 full of sludge. is ~ proper operating condition and/or (2) after inspection and pumping (if necessary), sep m with the standards Ilwe, the undersigned have read the above requirements and agree to ~ent~of Naptural Resources, S~~°f w ~~' ~~~~on set forth, herein, as set by the Department of Commerce and the Dep Zoning Office within 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County days the three ear expiration date. s~o ,o.~ DATE S A OF APPLICANT OWNER CERTIFICATION tle owner(s) of I (we) certify that all b~aveirmtue of a warran deeds eco dedem Registmer of Deeds Officee. I (we) am (are) the roperty escn'bed above, y tY 5 a ~o ~ DATE GNA OF APPLICANT artment. ****** «sssss Any ~fortnation that is mis-represented may result in the sanitary permit being revoked by the Zoning Dep «s Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ST. CR02X CCtAJ'~'Y ZONING CSFFICE CI3RTIrICA~ION STAZ'SMBNT FQR UT.LIZA?roN oi~ nri ExlsTirTG SEPTIC TAi~R This is to certify that I have inspected the septic tank pre+aantly r`erv ng the ~ ~ .2.,.r~ residaace la aced at s /V~ it, 3 ~, Sae . „~_. T N, R W, Town of „i, a,~*^-',,.. St . Croix County, Wiscotxain. ~I1pon inspection, I certify that I have found the tasilc and baffles to be ~,a gcod cosiditian, and it appears to be funvtioriirtg properly. mast tune serviced ~/~~~~ did f3ow hack occur from absorption system? Yes DT{if no, skip next line . A,pproximxta volume ar length of time. ~ gallaA~i ~,,,,.,. minutes Capacity:. ~ .~,~° Constzvotia Pre a~ Concrete ~\ Steel ~., Other M~.n! . ,toter (~ f known) : ,rL Age a~f T ' f knc~wn~ : 7 tuna ;Name Please Pr nt .: __.__: it e _ ~ (License A7t~n~er ~ ~~ ~~~ Date) Form to be cowplated by iiCtriSE1d piumbez t`s. 145.06, wa.aeOrisin statutes or liCenesad disposer {NR li3 Wiscor~izt Administxative Code) Plum}aer (applying for sanitary permit} Certification: In acteptiag the abcxve mtaze:nent regardir~-g axietiag saptia tauak candiCion, Y certify that the tank, to the best of my kaowla qe, will ccnfora~ to the re~remants of ILHR 63, wis_ Adm. Code {except r inepeetion opening Ove= outlex baff f. Name ~~-~ ~„~i' ~~ Signature . MP/MPRS '~~~ („~.r a s°d vor_ .~`~~_trkc-~~~9 TERMINATION OF DECEDENT'S PROPERTY INTEREST Betty Ann Hurtgen a/k/a Betty A. Hurtgen 2522 llOth Avenue Woodville WI 54028 ~ 12/11/99 ~ 395-28-4678 ~ PRESENTATION OF DEATH CERTIFICATE t cart=~ have pd~ a decedent's da~ cart ~~ ~~ / io ~~ R ISTER OF OEED'S SI ATURE DATE T- Interest In properly Is terminated under (please check appropriate statute): RI{ s. 867.445 which pertains to property in which the decedent was a joint tenant,' had a vendor's or mortgagee's interest, or had a Ilfe estate. '(You must provide a copy of the document establishing joint tenancy or tits estate.) s. 867.046 which pertavis to (1) property of a decedent specified in a marital property agreement, and also to (2) surviwrship marital property. (You must provide a copy of the document establishing survivorship marital property.) Prsaentatlon of recorded document establishing joint tenancy, Ilfe estate, survivorship marital property, vendor interest, or mortgsgee interest In real estate. X 6 0 1 S 1 I',A"fHLEEN H. WALSH F:EGISTEE: OF DEEDS ST. CF:OIX CO. , WI RECEIVED FOR RECORD f0-25-2001 2:00 PM TERM OF DECEDENT PRO EY.EMPT If CERT COPY FEE: COPY FEE: TkHNSFEk FEE- kECORDIHO FEE: 25.40 RAGES: 9 Name and return address: Joseph L. Hurtgen f 2522 110th Avenue Woodville WI 54028 002-1003-20-000, 002-1003-30-000; PARCEL IDENTIFICATION NUMBER 002-1003-40-000;002-1003-50-000; 002-1022-50-000;001-1022-60-000 This document number is 496009 , ~pwTe 996 Page 508 of (check one) Records RX7C heeds This document number is 307237 , vowme 477 ,page 157 of (check one) Records ~XDeeds DescWption of the root estate. /nc/ude ors/v the extent o/ownetshdo (or vendor or moitvaoee's lnterestl in /ate at the 8me o/ehe decedent's death. /1 dhe extent offend Is exacty the same as on the docum~snt, a copy of that oocument may be attached ro descrlobe the rea/ estate. Attach fax bN/(a) /bryear imrnedlate/y preceding death, If appHcab/e. (See d/mcttons.) The /ego/ descdpbon of fhe pt+vperty and the persons iec~h~g Ahe properly are as fo/%ws: (/1 mong space is needed, attach pages.) See Attached. Description of personal property (K any) being transferred. You may /ist savings aocounfs, check/ng aracounts and securities on attached pages. /nd/cafe person(s) recelv/ng property. DECLARATION: I (W e) declare that this document is, to the best of my (our) knowledge and belief, true, correct and complete and is in conformity with the provisions and fimi[ations of the Wisconsin Statutes. (/fmorr~ space is Headed, affach pages.) Warne and addrsse of Person s RscNvin Pro Relatlonshl to Decsdertt Sl,trtature Hotarfz (>ete Joseph L. Hurtgen o-~~ :G /'v<~ ~(J_. aS- o / 2522 110th Avenue se Woodville WI 54028 _ ~ . C: This document was drafted by: _ Q' ~ / TE~~dF WISCONSIN, County of ~ 1r) 1 X (print or type name below) W and sworn to before me on /~, O f by the above named person(s). Z _: Joseph L. Hurtgen y~ ot~notary or other person t/ ~. l~O r... t r 1 r1 f tyeitraff~~~ddadministeranoath ~--"-'j~i?dti•!Q--- ~Lr W~LXGVt NOTE: SEE DIRECTIONS. p~r7eP406.06, 706.07) Wisconsin Registerd Deeds ~, /~ Association Form HT-t 1lT Print or type name: `~n 7TH 1 lD P -7 i~ - 1~~ ~s ~1 weoslee ve.slon v2ooi 1 2 ~ g ~ ~ ~ Title Y' Date commission expires: ~T , Parcel #: 002-1003-~~-000 ° 05/27/2005 10:05 AM ~ PAGE 1 OF 1 Alt. Parcel #: 0'2.29.16.25 002 -TOWN OF BALDWIN 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 * HURTGEN, JOSEPH L JOSEPHLHURTGEN 2522 110TH AVE WOODVILLE WI 54028 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 2 T29N R16W NE SW TOWN BALDWIN Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1 /4 160 1 /4) 02-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 10/25/2001 660181 1746/399 TI 10/07/1971 307237 477/157 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/25/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 40.000 4,500 0 4,500 NO Totals for 2005: General Property 40.000 4,500 0 4,500 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 4,500 0 4,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ ' ;i3At'`,4 ~', ~- ~ ~ } '~'Y- .. - 3' : P ~_. s~ r ~y1 y~Tw ~*~' , r ~` c A + 9 Vol G I ^ ~~, .htin~r.. `' "~ .ice.., r"°~ r ,1 t~~^•t . ~[::rr r .: .2 ,, .' .~.~i~-°°~ bb`~,~' ' "«-~ ~.~ >~t~tq~ '~~stonairtti f~t'C~d 'h5::.... .}iv } :~i. ., L :~. ~ ...r : w. i'r. ,j ~.r~.~yG+~1', •, a wri.,., , ~~Y+.1 }r~.'S'a+"'..-7~~ ' ~ ~ aii GUS+..~. >.~ ~ 1f.J.7~ w ~. qy : u~1.....~ - ,... .. y ....,:~ 1'^ i "1 ~ v.,~~trw«., ~ ter: wMk,~~~ ~" ...~. ~.. ,„ ,~;.,.x ..~~„ ... ......:w.,.,.grantee ....,.. bf ~ ~~ ~ ~'; ry,.~,r.w ~. ..:w .~.~ w~ ~ M ~,.:~:.,~.;,~•`~:C~4~nt~, V~'yst~it ~`br xl'it sum `tiF ~', s T~ ~ a~ a u~, .'~ Dh~''F~~ ~ tM ;M4j Y • ~ ~~: P ~ ~iounty l -.-......,_ i ~ ~"- r M~~ ot: the Sat~tl'i~rst .t~a~~x^'o-f Section ~ 1'ortr~el2 ~ Nn , M ~ e ~b Neat ,~ _~ ~ s - ° 7 ~} '#~~r ~ :~rsa-r£~'&1~€'~ of ~ +°~q~wth'~ Qua~`t,e~ of ~~i~ ~ ~, ~'ow~~h~.~a 29 North, Range ; ~ f ~~6.~~.~~'~e~:er~, ,,~ I~or~hx*~st z~be~+ of the Northwest ~ar~et~ ~~ S~et~.oyi ll, Township ,1 . ~: ~'; I~•r,~$ ~:6 l~~est; ~ecept ing :therefrom; the parcel: co~anar~~ing at a point 300 feet ~ ~ + :" ,~ :: N4z~,htamCt~ C~I't'a~~` off' 'Sac't;a.on lI, thence sd'~th 8 dis~~nee~> of l~62 feet, thence ~. µ~: ,t~~ ~:,~.~$`~~et; '~he'nc~a north 4b2 fey t~iex,ce west ~.7~~ feet to point of beB~?.~.zi~, }, -~~ ~n '~®1 inclvd~e the b~.d~.nga t~sezenn:in a plat of 5 acres, ~a~` orc~, lea: U' ~. ~- , *~ ~~ ~ ~ _ ~~ ;[ ,, .; _ T~~.e deed is given ~r~ cQrr-s~uriat~.on of that certain land contract e~ou.tad by and between the part~.ea .fin A}a~.l 1, 195, .and recaorcl®d on the lst dad of Jam, a96~, i.n UaluinQ ~,~ of Raaoreta at i?a~s ~,,, 3~ocxm~x~t ~ ~> 2622 ~n the office of t~3r3~~eg~:stc~r of Deed ' ~~r ~t . Cx~~r O,ci'unt~r, w~$ti~~i3~.Tl a + k ,` i .. .i i K. ~~ l~ { ~ r ~ ~~~[ I r , ~~ ,_~ i; t • ~~~~r~ ~~ a .} ~' `+~+ ~ ;l ~~ ~~ - ~f i '{ ;; 1' I _ ~ t: Ia ~, Cht said grantor... ha.Y.b._. hereunto set_........ ... ... ha d8.._ and seal..s- this , ; day aF ..Sapt~amhax....:......_...._., A. D., 19 ~! ... .. ~s ~ - d ~ IN~ J?ftID6mZdt:~ OF - ,. „ ,~ i , ., ~ ,s ._~C~[.-5-_G3c.... .~~ .r~~'~rfl... (SEAL) ............ .. ......................... ...... C ?~ , ~, p , ~ ~ . ... F1B1F ` " 'YL' ~~e ~1 I1 F .. ..... ...................................... __ ,-,. ~' i-` #rrs~ ...,...-;~" ~~ ~tp, ~ 'P413y cx~oric btfote mc, this....`~.Zt~.... day of...s~13?~re.~:.... A. I>., I9.7~..., r i ~ ': ~e ~oxq .srAmtcf :~.:~F;~Y~''l.,#tztd.. ~.~„~ ~ ,. 1 d_ ,arui..red.f>a..as ,~airit twnant,~ ~. .~ ) Yy ~1yf ~4t: ;fl ti ~1t 1 r~.. ....... .~•~') a .~;V x~. ..~.,~. .. , [ ~`' ~1t, ~M ~ ~b~ ~ ._Qt~ 3~d, C.~7 . ,. 4 ~ ~,~- a ` /. ~4 ~ Y~ lw. ~ ~- r a - `~'~ ..a.~P.~c,e...~, .. ..Cau~tp, Wis. .. ~ ~ t r - ~ -. h S 7 A 5)+ y .f n" - a. ~ .,: ~. y ' y ,,.-.Y.-. .. ~ ,. i;a or typewtttteq t6ereop ;~"'~'° r ~ ~ y,Sk - ~ra'of;° [w+«i wl~o or govern. k c.. ,.. c:> , i ~yr-~N Cb,AI~pA~ ,acou ~[b t l+egibk manner) ~~~~A~Ri4 ~!}D4y @ ~~'.1~A~, Wtecon6ln Legal Blauk Company .~, ., O bi 7db~ ''~ Mtlwaukee, Wle, (JobY0686 Parcel #: 002-1003-50-000 o8izo/2oo7 01:23 PM PAGE10F1 Alt. Parcel #: 02.29.16.28 002 -TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - HURTGEN, JOSEPH L JOSEPHLHURTGEN 2522 110TH AVE WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description ` 2522 110TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 2 T29N R16W SE SW TOWN BALDWIN Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 10/25/2001 660181 1746/399 TI 10/07/1971 307237 477/157 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/16/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 38.000 5,000 0 5,000 NO 00 OTHER G7 2.000 8,600 191,500 200,100 NO Totals for 2007: General Property 40.000 13,600 191,500 205,100 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 13,300 191,500 204,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 -. ~_~pGa~°C~ commerce.wi.g v ~ ~ z== _ Wisconsin Fund - isconsi Jib 1 ~ Z~0 ~ ners Private Onsite Wastewater Treatment System Department of Comme a p lieation Replacement or Rehabilitation Safet and Buildings Di isionST.C OIXCOUNT~` Financial Assistance Program Instructions For Property O TO BE COMPLETED BY COMMFRC You may apply for a grant award for up to three years after you have received a determination of failure and after you have obtained a sanitary permit. Complete Part A of this form, attach evidence of your annual income explained in Section #7 and return those , items to the sanitation or health department office in the county where the property is located. f1 ~l1T ~ TA ...r ww~~w• -~-- -~- ~..- ~~ rr-rc ~ H. r ~ tst wiwr~t i to t31f 1 Mt F'KCJPERTY OWNER Please print. Owner Owner Owner 1J0 ! ~ c ~, c.~ 4 Owner Owner Owner Address City, State, Zip Code Telephone Number *Grant awards will be issued in the name and address of this If there are additional owners, attach documentation listing all owner. owners. 1. Is this application for a principal residence or a small commercial establishment? Principal Residence (Complete both if applicable.) Srfrall Commercial Establishment If applying as a principal residence, do you occupy this residence 51 % of the year? Yes No NA If applying as a small commercial establishment, do you own and occupy the small commercial establishment? Yes No NA 2. If applying as a small commercial establishment, what is the name of the small commercial establishment? Description of Small Commercial Establishment restaurant, etc.): 3. Has there been a change in ownership of the principal residence or small commercial establishment served by the failing system within the last three years? Yes No If es, lease ex lain: 4. As the owner, are you a licensed plumber or contractor engaged in the business of installing private onsite wastewater treatment systems? Yes 5. Will a portion of the replacement system be funded by another program? Yes o If es, ex lain: 6. How d' you hear about the Wisconsin Fund-Private Onsite Wastewater Treatment System Replacement or Rehabilitation Program? 6~~ c~~~R ~~. 7. Evidence of income. If you are applying as a principal residence, attach a copy of your federal income tax return for the year of or prior to the determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of income for each owner and for each owner's spouse. If you are applying as a small commercial establishment, submit a copy of your federal profit and loss form for the year of or prior to the order or determination of failure. If you or any owner listed above did not file an income tax return, contact your governmental unit for further instructions. Evidence of income will be ke t on file at the overnmental unit and is sub'ect to verification b the De artment of Commerce. Property Owner's Certification. I certify that, to the best of my knowledge and belief, the information I have provided on this form and all attachments are true and correct. Owner' Signature Date Signed ~~- i 2 -- 6 S Co-Owner's Signature Date Signed a~ oral information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)). SBD-9163 (R. 02/2005) m PART B. TO BE COMPLETED BY THE GOVERNME AL UNIT 1. VERIFICATION OF OWNERSHIP On the document used to verify ownership, do the names match those on Part A of this application? If no, please attach additional documentation explaining. Q es No If the applicant answered yes to question 3 on Part A of this application, did the applicant(s) own the property when the order or verification of failure was issued or the system installed es No and incur the cost of replacement? ~pp~ T- rm - nab ar Document or Page Document used to verify ownership: -2Cx ~ c Number: vc~pe I>~Y ~- CQ o t 8'/ 2. Is a public sewer available to this property? Yes 3. Has a previous grant been awarded for this property under this program? Yes ~ 1 i 4. Principal Residence evidence of income. Please indicate applicable annual family income: $ °'""' 1 ~ QJ ~ 1 Federal income tax form 1~~ , Line, Year ~ OR Affidavit of ,Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross revenue: $ Profit & loss form used: ,Line ,Year 5. Date of the Order or Determination of Failure: ~P (L 1(. ?.O~ 5 When was the existing failing system installed? Prior to 12-1-1969 19~Z -1-1969 to 7-1-1978 Vertical distance from the bottom of the existing infiltrative surface to a limiting condition: 0 to Less than 24" 24 to Less than 36° Equal to or greater than 36" 6. Private onsite wastewater treatment system failure caused by discharge of sewage to (check all that apply): Surface water or groundwater ............................................................................................................... Category 1 A zone of saturation ......................................................................................................................~('~ A drain i e or zone o bedrock .............................................................................................................. Category 2 The surface of the ground ..................................................................................................................... Catego 3 Back-up of sewage into the structure served ....................................................................................... At-grade 7. This request is for what type of replacement system: Conventional If this request is for a system not listed at the right, please explain: Experimental Holding Tank - and Pressure Moun 8. Uniform Sanitary Permit Number ~~ ~ o~v ~ Date Issued ~'o~ ~ ! ye.~ Plan Approval Number ~~ 3 ~ S~ =~'~S • ! ~ • ~/ Date Approved MA"~ Z ?i + ZwS~ -------~ E eriment A royal Number ~ Date A roved 9. After reviewing this application, I have determined the applicant to be: Eli ible Ineligible If ineli ible, reason ineli ible: 10. Govemmental Unit Representative's Certification. I certify that I have reviewed and verified all information provided on this form and attachments and that the are true and correct to the best of m knowled a and belief. Signature o Authorized Governmental Unit Representative Title Date Signed ~ / nJ a~u Ac.i j IPr^~ • ~ 3 Zcp (o commerce.wi.gov Wisconsin Fund - SCa nS ~ n GrBrlt Private Onsite Wastewater Treatment System Depactmetn of Commerce Worksheet Replacement or Rehabilitation s and Buildin Division Financial Assistance Program Owner's Name: Govemm e ntal Unit: T / l f ~ ~~ - l.. ~l..tJ PART 1. GRANT fUNDING TABLES In Sections B-F, the number of bedrooms determines the grant award. To use the grant funding tables for small commercial establishments divide the , estimated dal wastewater flow rate in Ilons dab 150, round off to the next h' est whole number and use the result for the number of bedrooms. A Site evaluation and soil testin Grant amount $250. $ B. Installation of a replacement anaerobic treatment component. Number of Bedrooms Grant Amount ..... , 4 ..............................................................:.................................:.............................. 650 5 725 f; 9~ ~ '` .. 6 .......................................................................................................................... 750 7 ~' ...................................:............................................................................................875 8 or more y- ................ ........950 .................................................................................................... $ C. Installation of a dosing component, lift pump or siphon: Number of Bedrooms Grant Amount 1 or 2 .........................................................................:..................................................$1 3 or 4 ........................................:................................................................................. 1 2 5ormore ...............:...................................................................................................... . $ l~~ ~ D. Installation of anon-pressurized and in-ground pressure POWTS treatment or dispersal component. Percolation Rate Design Loading When Properly Filed Rate in Gallons with the Governmental Per Square Each Additional Unit Before 7-2-94 Foot Per Day 1 2 3 4 5 Bedroom: Minutes Per Inch 0 to less than 10 0.7 or more $ 925 $1,200 $1,400 $1,450 $2,100 $250 10 to less than 30 0.60 to 0.69 925 1,200 1,400 1,800 2,175 250 30• to less than 45 0.50 to 0.59 1,375 1,550 1,650 2,000 2,225 300 45 to less than 60 0.49 or less 1 375 1,900 2 00 2,250 2,275 300 $ E. Installation of an at-grade or mound POWTS treatment or dispersal component. Each Additional Tvoe of Design 1 2 3 4 5 Bedroom: At-Grade $1,975 $2,350 $2,350 $2,925 $3,025 $275 High Groundwater Mound 2,600 3,150 3,525 4,250 4,775 300 High Bedrock Mound 3,300 3,850 3,975 4,500 4,725 350 ''Slowly Permeable Mound 3,250 3,600 3,600. 3,975 4,775 375 Mound with less than 24" of suitable Soil or reater than 12% slo 3,050 3,450 4,000 4,550 4,550 375 $ ~ ~~ "A slowly permeable mound may be designed using percolation test results property filed with the county before 7/2!94. A slowly permeable mound is defined in s. Comm 8323(1xb) as having a percolation rate of greater than 60 minutes per inch and less than or equal ~ 120 minutes per inch, or having a sal loadin rate of 0.3 or less. F. Installation of a POWTS Holding Component. Each Additional 1, 2 or 3 4 5 6 7 8 Bedroom: -~-' Grant Amount: $2,500 3,150 3,225 3,625 4,200 4,750 $400 Dn'c..n~l is.,...,~a,.., ....... _.... a.~_ ~_.. ~_ .._ _ ~ ~__ _ _ .. $ .__.... ,.,.. p........, ..,a~ vv wcu nn acwi n~ni Y Nu1NUJ~s Lrnvacy haw, 5. 7.7.1141 ~ Ilm)1• SBD-9167 (R. 02/2005) PART 1. GRANT FUN .DING TABLES continued G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity. Gallons: Up to 1,249 1,250-1,499 1,500-1,749 1,750-1,999 2,000 or more GrantAmount: $550 $650 $750 $800 $900 ~---- $ Amount Requested H. Installation of an Experimental System. For Installation: tf you are requesting funding for an experimental system, please submit a copy of the. Wisconsin Fund $ .. pn3-approval letter along with a~ copy of the plan approval letter and experimental approval letter r containing corresponding identification numbers. Amount Requested For Monitoring: List the total cost of the experimental system and monitoring that is being requested separately at the $ ,_ ' ht. Co ies of id invoices must be submitted with this uest. I. Installations not Covered by the Grant Funding Tables. The Department on acase-by-case basis reviews installations not covered by the Grant Funding Tables. ff you are requesting funding for an installation not covered by the grant funding tables or listed in Sections A H, please explain your request here, attach a Dopy of.the paid invoice showing the cost of the item, and request 60% of the cost of the installation at the right. ~- . $ ~'~SZ~ TOTAL PART 1. $ -- PART 2. GRANT AMOUNT CALCULATIONS A Enter the total from Part 1. •- _ $ B. Is the applicant a licensed plumber or contractor who installs private onsite wastewater treatment systems? ff yes, enter 2/3 of the amount from section A or $4,667, whichever amount is less. ,~.. If the a leant is not a Ncensed installer, ca the amount forward from Section A. $ C. If this application is for a small commercial estabi'~shment and the annual gross income of the business that owns the small commercial estabC~shment is less than $362,500, this is the total grant award, Cany the amount in Section B forward to section F. 8 this application is for a prinapal residence and the annual family income of the owner(s) is less than $32,001, this is the total grant award. Carry the amount in Section B forward to section F. ff this application is for a principal residence and the annual family income of the owner(s) is beM-een $32,001 and $44.999, list the amount in Section B here and go onto section D. ~- If this a lication is for an a rimental tem, ca the amount in Section B fonnrard to section F. $ D. Enter 30% of the amount by which the applicants annual family income exceeds $32,000. Annual Family Income subtract - 32 000 Subtotal X .30 = $ ~-- E. Subtract section D from section C. This is the maximum grant amount for this applicant. Carry this amount forward to section F. (The amount in sections E & F must be at least $100 to be eligible for any grant award. ff the amount calculated is less than $100, ---- enter $0.00 in section F. $ ,! J~7 F: Total rant award re uested for this a licant u to the maximum of $7,000. $ ST c ~~~ utv~y PLANNING & ZONING NOTICE OF VIOLATION April 11, 2005 JOSEPH HURTGEN 2522 110T" AVE WOODVILLE, WI 54028 Code Adrrunisrration RE: Failing POWTS at 2522 110th Ave. 715-386-4680 Land Information & Town of Baldwin - St. Croix County, WI Planning Computer # 002-1003-20-000 Parcel # 2.29.16.25 715-38b-4674 Dear Mr. Hurtgen: Real Pro~terty As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in 715, 4677 violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 12.1.F.4.d of the St. Croix County Zoning Ordinance. This POWTS (Private Onsite Wastewater Recycling Treatment System) has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (Category I). 715-386-4675 This violation was first noted on April 11, 2005. '~~ - The violation noted is septic effluent discharging to zones of saturation. An on-site inspection on April 11, 2004 did reveal the septic effluent discharging to the zones of saturation, and to the ground surface. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of April 11, 2005 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING POWTS ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION! REQUIRED ACTION: A sanitary permit must be issued through this office. You must contract with a certified soil tester to have a soil evaluation conducted. The soil evaluation determines the type of septic system needed, the required sizing, and it's location. You must then contract with a licensed plumber who will design the replacement POWTS and apply for the sanitary permit. The POWTS must be replaced by October 03, 2005. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. ~~ - Sinc ely, ~- evin Grabau Zoning Specialist cc: file ST. CRO/X COUNTY GOVERNMENT CENTER 1 1 O 1 CARM/CHAFE ROAD, HUDSON, Wi 54016 715-386,4686 F,qx PZ@CO.SAINT-CROlX. W!. US W W W .CO. SAI NT-CROIX. W I. US \~ \