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HomeMy WebLinkAbout002-1084-40-100 Jisc~nsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Jensen, Lance Baldwin, Town of SST BM Elev:~ ~ Insp. BM Ele ~ BM Description: .o y U y ~~ f AN INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~~, lDUD ~ 6 v Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO ~ P~ WELL BLDG. Vent to Air Intake ROAD Septic , ~5D I- / 3~ ~.~,~ Dosing v ~ l ~ 3 / Aeration Holding ,- PUMPISIPHON INFORMATION Manufacturer ~ Demand ~ GPM Model Number ~~ , 7~ TDH Lift Friction Loss System Head TDH Ft 15.E b .~ ,5 ZS.Sto Forcemain Length ~ Dia. ~~ Dist. to well i 9p Z /J~` SOIL ~4gSORPTION SYSTEM County. St. Croix Sanitary Permit No: 506136 0 State Plan ID No: Parcel Tax No: 002-1084-40-100 Section/Town/Range/Map No: 33.29.16.489A1 STATION BS HI FS ELEV. Benchmark .____-- 3.1 ~ ~ 0 3-~ ~ oo. a Alt. BM //~~ ~1 Bldg. Sew ~G ~ (/ T ~ g0 •~ Ht Inlet ~ Pyo SUHt Outlet /~' Dt Inlet /, Dt Bottom k..~ti.-~ , rs- ~2. b . b Head an. 3.03 99 • 1 Dist. Pipe 3 03 qq• BS Bot. System 3.73 `'~9. ~S Final Grade Z ,a3 ~~ ,~S St Cover ~•• t ~ .~.----- ~ / ~ Z ` ~~p„ ~ t ~9 io 3. q q'7- s_ BEDlTRENCH DIMENSIONS Width ! ~' Length ~ ZcS No. Of ~nche ~ PIT DIMENSIONS ~/'~ No. Of Pits 11 Inside Dia. ~ Liquid Depth \ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHIN CH OR Manufacturer: ~ Type. Of,joystem: f1/~~/~ 33 ~ /,3 c O ~,/~ rQ' ~/ Modet Number: ~. I~ISTRIRlIT10N SYSTEM Header/Manif ~l, Length_~_ Dia I ~ N ~ Distribution Pipe(s) Length C(lll (`GIVER „ o..,~~...e c..~~s..,~ n.. i., .... Mnnn~1 !)r At-C:rartP Svstamc (7nly Depth Over f BedlTrench Center Depth Over Bed/Trench Edges xx Depth of Topsoil ~ ~ ~ xx Seeded/Sodded N Y xx Mulched Y ~r No ~ • ~ \ es :!, o es COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: S/ ~ /~ Inspection #2: / / Location: 649 230th Street Woodville, WI 54028 (NW 1/4 SW 1/4 33 T29N ~~~16Vy) AA/LWot I~ ~ ~~ / arceJ No: 33.29.1a~ "T~ 1.) Alt BM Description = ~ ~t~'l~'y,b~e~ ~ ~'~"W`~ 'I I C~ ~ ~f'-" h~ 2.) Bldg sewer length = 3~ I~ ~ ~ ~~ rf _ ~ A~ Q "~.., I~ (((/Ill ~ y~~ "~~r~- amount of cover, ~rS 0~ G~+ 4Q~. ~~ r~ryL,~' ~ """"' / ~ Plan revision Required? -= Yes o ~ ~ '~ j ~ 3 Use other side for additional information. d Date Cert. No. SBD-6710 (R.3/97) .~ 4E ~./~~t.+ ~ T YO m` ~ 6'T ~~`-t'° ~I'~~ s~"(-~rl l2 ~ n, ~ ~ J ~t , i x Hole Size ~r x Hoie acing f ~~ V~t to Air take ~ S~ Dia ( 4 Spacing 3Z a. r..- Gg11'll'r1txF'G8,tllr~.~OV Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST. CROIX ~~ ~ ~ ~ ~ ~ Madison, WI 5 3707-7 1 62 Sanitary Permit Number (to be filled in by Co.) De}sa~rtment at Ccrmmerca 50 (~ ~ 3 LP Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropr tal 82651 unit is required prior to obtaining a sanitary permit. Note: Application forms for a-owned PO oject Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be secondary oses ;n accordance with the Privac Law, s. 15.04 1 (m), State. Z 3b ~ S~-, ~ ~ ~ I. A lication hlformatio Please Print All Information / I Property Owner's Name ~ LANCE JENSEN Parcel # OOZ-49e4a4E;+B8 ~ 2 ^ ~b`1J'~{ ' CIO `- Property Owner's Mailing Address 633 230TH STREET 1 6' APR 1 Property Location ~~ t~ ~~ /t} - l /1 Govt. Lot City, State Zip Code PF6i n NW '/<, SW '/., Section 33 WOODVILLE WI 54028 715/68 - (check one) T N R IL Type of Building (check all that apply) OhC ~ Lot # ; 16 ^ E ^/ W 29 ^ 1 or 2 Family Dwelling -Number of Bedrooms 3 NIA Subdivision Name N/A L~ 1^ titJ~GM; ~}t~ ~o ~a i ^ ~ Block# ~ `J Public/Commerc al -Describe Use / N A ^ City of ^ State Owned -Describe Use ~ CSM Number ^ Village of ^n /X 5(p. ZS /~'l ~uti~ ~, NIA /^ Town of BALDWIN III. T ype of Permit: (Check only one boa on line A. Complete line B if applicable) A' /^ New System ^ Replacement ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) System B. ^ Permit ^ Permit Revision ^ Change of ^ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Ex iration IV. T e of POWYS S stem/Com onent/Device: Check all that a I (, OJ ' ^ Non-Presswized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound >_ 24 in. of suitable soil ^/ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component {explain) ^Pretreatment Device (explain) / , V. Dis ersal/1'reatment Area Information: a ' ' Design Flo (gpd) Design Soil Applica ' Rate(gpdsf) Dispersal Area quired (sfj Dispersal Area osed (sf) System Elevation 450 ~ 1 ~ ~ 450 ~ 5 a 450 D~~ 99.17 .~ VI. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units New Tanks Existing Tanks ~ ~ ~ la L ~ y C• Septic or Holding Tank 1000 1000 1 WIESERCONCRETE Prefab Concrete Dosing Chamber 600 600 1 WIESER CONCRETE Prefab Concrete VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Printl Plumb Signatwe ......~ ~ MP/MFRS Number Business Phone Number BENNIE HELGESON -° 220292 715-7723278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VIII. Cozen /De artment Use Onl Approved _ D' d Permit Fee Date sued Issuin gent Signatu _ ner Given a enial $ / ^h Do [0(JV ~ / ,, ~ -7 IX. Conditions of Ap roval/Reasons for Disapproval dJ.~d-~ a.,~~ svstFrur~rnnuE+r 3) Ge~ oro~~. ~t ~. Sd- . 1. Septic tank, effluent filter and ~, ~,~, servlce~/ maintained ll b t l ll /~/ ~ ~C Lf w l d-~^~~S ~E'r'""' ~` mus a e ce dispersa as per management plan provided by plumber. 2. 'All setback cet~uirernents must be mahttairted OD F+a "IT9S'l~l7RA't'~pAgl2plg115f61'lHe system and submit to the County only on paper not less than 812 x 11 inches in size are %s SBD-6398 (R. 01/07) Valid thru 01/09 i ;' ~ ~ ~ M ~ ~--- J ~ ~ ~ ~ '~ ~ r~ ---1T~ ~ ___ ~~.s 3 --17' ~ ~ c1 ~ 1-- . ~I -_'"' 1 ,-~ ,L ~ ~U ~\ 4J !~ ,t ~ ~ f ~-1.+ ~i+ I 1 f ~! /,' ~'; ~ y. r~.~ I-~ - ~~ ~ S; '~+ ~ J ~ ~; ~' _..J , ~~ J .~ c -+s- i L v -~ J" i„ ~w o o j ~ ~~ ~~ ~1- ~ 0 ~ L ~J ~- V1 ~i ~ '1 } --~ II J +~ f __~ ~; , '= ~- ~ ~ ~ ~, v ---~ ~~ ~~ a ~' v '~1 T ~ ~ ~n ~ r 1 -tz-~ F~ ~ 2 i ~~ ~ ~ ~ ~, s~ ~ ~ ~~ ~~ ~ G- -- - ~/ ^ ~ ~~ A ~L ~ CL. (Yl ~. , ~~%~ ~l'~S~zi i 4~ 1 ~1 ~' __._, ^~ ~~~~ ~~ v ;, ~~ ~~ ~ ~ ., ~ -~ ~~ ~''~U~ ~3 Jl d 1. `J' i V ~J~~ T. ~, ~~ v u x ~~ ,~ ~ ,,. ~' ., ~, .Y E~ t ~ v M M v J ~ ~ ` ~ v ~ Q ~; --X7'_.9 N i 1 ~ V~~:S ~ ~ ,~3 { -~7 ~ ~ J ~_ ~ .~ ~~~~ u ~W C /„ o ~ O j ~ Q. ~~ I ~, ~1 Q ~ ~ 4. G'~ L '~ ~ v~ ~S .~ ~ ~, s ~ ~_ ~~ j y~j i / / V ~ I:.~ 1' ~ ~ [ I; T V, ~~\ ~` te-' ~ j f~ r \y `` QJ \ 1~ , ~ I ' ~ -~ c~ ~ ~ ~ jc ~' a ~ .~ i ~~ ~ i ~ i -- -t-- ,~ Ci ~- . ~ _ _ ~ N~ --~--- <~, '~J1 - _~ ~. - SW s 141 490A-1 ~~~~ , ~: JC), ~~~~~ 847717 0 og 489/93 I ~ 489A-1 W-SW 489A-1 2656.99 49OA-1 141 847717 commerce.wi.gov i ^ iscansin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54604-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 28, 2007 CUST ID No. 220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIl2ES: 03/28/2009 SITE: Lance Jensen 230TH Street Town of Baldwin St Croix County NW1/4, SE1/4, S33, T29N, R16W ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1382651 Site ID No. 723634 Please refer to' both identif cation numbers, above, in all corres ondence withthe a enc . FOR: Description: Mound /Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1124005 Maintenance required; 450 GPD Flow rate; 16 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 beenCONDITIONALLY 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: Reminders • This system is to be constructed and located in accordance with the enclosed- approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption 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. • Inspection of the POWTS 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. Stat Core ~PP~ DERARTMENl /dj~l N 0 SAF1 SEE CORRi BENNIE W HELGESON Page 2 3(28/2007 • Comm 83.22(7) A copy of the approved~lans specifications and this letter shall be on-site durine 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 maybe 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, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ .0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. INDEX SHEET PROPERTY OWNER: LANCE JENSEN 633 230TH STREET WOODVILLE WI 54028 PROJECT NAME: LANCE JENSEN PROJECT LOCATION: NW 1/4, SW 1/4, S 33, T 29 N, 16 W MUNICIPALITY: TOWNSHIP OF BALDWIN 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 RECEIVED Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: WLP 1000/600-MR ZABLE Tank Specifications MAR 2 6 2007 Page 6: Pump Specifications SAFETY & BUILDINGS Page 7; POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W 1229 770th Avenue Spring Valley, WI 54767 Signed 1 Credential Number: 220292 Date: March 23, 2007 ~~~nalty ~'~'D F COMME~ NG8 SPONDENC ~~c:0:n .~ ; L~.v,c ~ SeN 5 eh Synthetic t;overing ;'~STN~1 L 3 Medium Sand -~ ~ f ~•. age ~ - .~_. Distribution PiP` G Topso(I ~~ o _ _~ i E 3 ,~ ~ ' V Con Slope ' i~ ~ ~ f 2'_ 2 ,2 Force Mai n From Pump g99regate Cross Secti~~n Of A Mound Signed: License Number: --- pate: L -_- w p /.~ 7 Ft . E /,1 Ft . F _,` C~ Ft. G , ~ Ft . Plowed Lcyer H _/ Ft• q ~ Ft. Q ~'`a~-Ft. is %D. ~ Ft . ~ ~,y t. d ~. ~~ Ft . j ~. 1 F t . w ~,~.s--Ft . _ Observation Pipe ~ K .,._._ _... a--- -- - -- ~-_-- - _`_- _- r~ -- ~ r ----- ---------- o I~------------ - -- - --.__---------- - ------------------------------_-_ _ J T . - -- -- -- -- -. _._. - - - - - ~~.~ N //Distribution E~t.~ Of ? _ 2'2 Pipe Aggregate i Observation Pipe ~a5a.l ~r~'p.. '~~~ ~~~ ~ Plan View Of Mound Perforated Pipe Detail Clcanout Access , ~' i~ ~_~ Threaded i Cleanout j ~ _.. `\oo `~~. ~~ c4- ~ -. End Manifold .u ,~ , , ~, ~` ' ~ Holes Located on Bottom -~~l ~ % ~~~ Are Equally Spaced ,'I` j/,~- / ~C ~.~~~ \~\ Force Main From Pump First Hole Next to Manifold `~ '~~ / ~ \~__ Cleanouts P ~f ~_i / c/ n R S ~_~ ~ ~~~~ ~ 7it Y ~! Hole Diameter ~ lnch Lateral "~ Inch (es) Signed: License Number: Date: ~~ .~ ~ \ ~ End Vle/ ~ % Manifold " ~ Inches Force Main " ~ p Inches Invcri Elevation % /• rio _ Holes Per Lateral Number of Laterals _ "rota] Holes ~_ Distribution Pipe Lavout ' Page `~ Of ~'~. , ~n~r cah~~ ~Phsen E PUMP CHAMBER CROSS SECT ION AND SPECIFICATIONS • SEPTIC TANK 4 ~~ ~lK.. V ENT PIPE 12 " MIN . ABOVE GRADE E WEATHERPROOF JUNCTION BOX APPROVED > 25' FROM DOOR, WINDOW OR WITH CONDUIT WgNPp V~R L FRESH AIR INTAKE AD LOCK /'' OC chC~C 1 ~ CJ WARNING LABEL , r ~7 , t "'-'_ 4 " MIN . 1 ~~~ '~ -,- z'1 S. D. u 18" IN. '~~ 18 rniN• INLET ,~ ~ GAS- , ` WATER TIGHT SEALS ~ TIGHT ~ ~~ APPROVED A SEAL JOINTS KITH FILTER _ ~ ° k ' ~_ ~ ALM APPROVED PIPE APPROVED ~ ~~ ~ B ~ ON 3' ONTO PIPE 3' ~S ~ ~ ~ ~ SOLID SOIL ONTO SOLIO C I ' SOIL PUMP OFF ELEV . l,~~FT. -~-- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS I~~.S' Y tc~ l (mac.-l s I:~. SEPTIC / DOSE ~~ "" ~~ /0,3J X 's S/. ~S- (3cYf. TANK MANUFACTURER: ;,V -~ TANK SIZES: SEPTIC DOSE ALARM MANUFACTURER: MODEL NUMBER: SWITCH TYPE: PUMP MANUFACTURER: MODEL NUMBER: SWITCH TYPE: REQUIRED DISCHARGE lP S~° ~- ~DDO GAL. GAL. S~ ~ r C~ 1 o t I-1 tc~ c r ~-~" / ._.,, /= r.~ ~/f'Ir' ~uc~ M r K ~vz-~ ~l ae~ ~- IATE ~,~~GPM DOSE VOLUME INCLUDING ~1 3'y.S C~;IS-~FLOWBACK: ~~, 35 GAL. CAPACITIES: A = ~~ INCHES =,~'b/. ~ GAL. g 2 INCHES = _S -: ~~ GAL. C ~ INCHES = I~-S~, GAL. D = ~~ INCHES = 1~~7, GAL. PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE + MINIMUM NETWORK SUPPLY PRESSURE ' f ~~ FEET FORCEMAIN X c~~FT/100 FTOTALIDYNAMICAHEAD ~= g, / FEET ~~ FEET ~: FEET =~~~F E ET WIDTH DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LIQ-UID 61`pPy~- ~/,, '~« / (l' C. I . L. ~/~'CFSC SFC ~:~«~~ S,~~C . S G~-c''t'~ LICENSE NUMBER: DATE: SIGNED: i/Q8 ro ,50" ~ , ---- I P ! ~ ! ~ ~ ---------- ~, ~, --- --- ~ --------- ~, ------------- ! ! , i ! ~ i . - s _;_ -- -- .!J T~= T -d i 'r~ i i i dLET _r ~ a Pc~ c; C_ ~~ v 4- ~' 1P+1L.P1000/600-MR ZABLE TANK SPECIFICATIONS DIMENSIONS: WALL: 3" 90TTOM: 3" COVER: 5" MANHOLE: 24" i.D. HEIGHT: 56" 0.0. !_ENGTH: 150" O.D. `MDTH: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL 36" `:VEIGHT: 14,795 !_BS. INLET ANO OUTLET: 4" BORE ~"JITH STOP FCR QUIK-TI ~.E, FER~~,~C~ GASKET, CAST-,4-SEAT. 900 T 0~ ~ CJ L INLET AND OUTLET BAFFLES: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEA C;-BART) LIQUID CAPACITY: 27.88 GAL~IiJ (SEPTIC;! 10.75 Gt~L~IN (PUMP) LOADING DESIGN: 7' 0" U'dSATURATED `.C'!I_ ,~ p t i 14 it 1C QD W = E U z 0 a a r- O 0 U.S. G LITERS `Y ~- z w ~ HEAD CAPACITY CURV MODELS "140/4140" TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING Ft. Meters Gal. Ltrs. 5 1.52 91 }a4 a5 l0 3.05 ea 31B IS a,57 76 288 40 4140 140 20 6.10 6a z57 , 25 7.62 59 223 35- 30 9.14 a9 185 35 10.67 38 Idb 30 40 12.19 21 79 72 13 5 19 25 45 . Lock Vol va: 4 6' 20 15- ~ALL 10 5- ONS 1 0 2 0 3 0 40 50 60 70 80 90 100 110 80 ibU [vv acv .-- 0 FLOW PER MINUTE 01°g°q ~ON5l'~- i. FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Mechanical alternators, for duplex systems, are available with or without alarms. • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. • Sealed Owik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. • Refer to FM0806 for 200° F. applications. :u Series - 53 Ihs. 4140 Series - 73 lbs. 14014140"' MODELS Control Selection Model Model Volts-Ph Mode Amps Simplex Duplex N140 N4140 115 1 Non 15.0 1 or 1 8 5 2 or 3 8 4 E140 E4140 230 1 Non 7.5 1 or 1 8 5 2 or 3 8 4 BN140 BN4140 ~ 115 1 Non 15.5 1 or 1 8 5 2 or 3 8 4 ~ 'I BE140 BE4140 1230 1 Non 7.5 1 or 1 8 5 2 or 3 8 4 i6 SELECTION GUIDE ~o ~- I I/2 NPt SK1524A 17/2 NPi SK7524B 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. Mechanical alternator M-Pak 10-0072 or 10-0075. 3. See FM0712 for correct model of Electrical Alternator E-Pak. 4. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. O CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. _ --- MAIL T0: P.O. BOX 18347 ~ Louisville, KY 4025fr0347 t` SHIP T0: 3649 Cane Run Road Z~ n ~ ~~~ ~ " ® Louisville, KY 40211-1961 ' ,r (502J 778-2731. 1(800) 928-PUMP http:/lwww.zoelletcom PUMP rO FAX (502)774-3824 ©Copyright 2001 Zoeller Co. All rights reserve . Manulaclurers ol. . QVAL/TY PUMOB J~NCE ~~dd POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 ILG II~IvI•~~•~• Owner LANCE JENSEN Permit 1! lJCA1V1. r/1. 1I'N~•w.• 3 ^ NA Number of Bedrooms Number of Public Facility Units Q NA Estimated flow (average) al/day Design flow (peak), (Estimated x 1.5) 450 al/da Soil Application Rate al/da /ft2 Standard Influent/Effluent Quality Monthly average ` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L ~ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ®NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. ~u w wine C/+L~Cf1111 F Service Event Inspect condition of tank(s) At least once every Pump out contents of tank(s) When combined slu Inspect dispersal cell(s) At least once every Clean effluent filter At least once every Inspect pump, pump controls & alarm At least once every Flush laterals and pressure test At least once every Other: At least once every Other: ~r/~I r1A ATIA111C ~IV• ____ Septic Tank Capacity 1000 al ^ NA Septic Tank Manufacturer~Jieser Concrete ^ NA Effluent Filter Manufacturerpol lolc ^ NA Effluent Filter Model pL-525 ^ NA Pump Tank Capacity 600 al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer Zoeller Pum Co ^ NA Pump Model 140 ^ NA Pretreatment Unit ~ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Ce(lls) ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade t'~ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Frequency 2 ^ month(s) (Maximum 3 years) ^ NA ® earls) dge and s cum equals one-third IY3) of tank volume ^ NA ^ month(s) (Maximum 3 years) ^ NA 2 ®year(s) ^ month(s) O NA 13 ^ year(s) Q month(s) ^ NA 13 ^ year(s) ^ month(s) ^ NA 3 ~ year(s) ^ month(s) ^ NA ^ year(s) ^ 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 Bond ng The dispersal ce(lls) shall be visually inspected to check the effluent levels in the observation pipes and t'o check for any p 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 lY,l 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 512 months, shall be performed by a certified POWTS Maintainer. A sorvice report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/Otl ., • •~ ~ OWNER: Lance Jensen 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 .vastewater will be discharged to the dispersal cell(s) in one lazge dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to Assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, The azea within 15 feet down slope of any mound or at-grade soil absorption azea. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life Of the POWTS: antibiotics; baby wipes; cigazette butts; condoms; cotton swabs; degreasers; dental floss; diapers; Disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat Scraps; medications; oil; painting products; pesticides; sanitary napkins; tam(ions; and water softener brine. ABANDONMENT When the POWTS failsand/or is permanently taken out of service the following steps shall betaken to insure that the System is properly and safely abandoned in compliance with ch. 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 azea 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 azea. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank maybe installed as a last resort to replace the failed POWTS ® Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «W ARN ING» 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 ~IAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OP A TANK MAY BE DIFFICULT OR IMPOSSIBLE. AllDITIONAL COMMENTS POV~TS INSTALLER Name Helgeson Excavation Inc f Phone 715/772-3278 SEPTAGE SERVICING OPERATOR PUMPER ~ Name John n i n • Phone 7 _ G Lak tt and Waus POWTS MAINTAINER Name Johnson Sanitation ' •Phone 715/273-5811 • LOCAL REGULATORYAUTHORITY Agency • Phone hen County Zonlnp end Sar>aaUut spentige. TNe doaYtlertt a»efi This document wss dotted by the stsHs o(ths teen e, I.tarque e ine minimum reQUuemenls of ch. Comm 83.22(2)(b)(t)(d)6(Q and 83.5e(1), (2) d (3), Wisconsin AdminlstroWe t;,od0. Ui1 OlTthle dOCtlAtetl~d0ee AOt quaran~ee the psriorrnenu of the POWTS. ~WQp>> l Wisconsin Department of Commerce SOIL ,VALUATION REPORT Page ~ of .~ Division of Safety and Buildings ~ '~ in axordance with Com 5; Wis. Adm. Code ~~'~ count,, ~-(- Attach complete site plan on paper not less than 81/2 x 11 inc in si Ian rryust include, but not limited to: vertical and horizontal reference point ,dire 'nand Parcel I.D. ~I l percent slope, scale or dimensions, north arrow, and location and dis a to n" rest Yoad. C/~~ ~ Q y- Q - Please print information. ~" Reviewed Date Personal information you provide may be use for sec~~ry 15. 1) (m)). '~ ~y Property Owner ~-~-'' roperty Loc ' Ya ~l~ oJe~ s ~ ~1 M ovt. Lo ~ ~ 1/4~IN1/ S T N R E (or W Property ner's Mailing Address Lot # ame or CSM# ,J-~rnt~ afilo33. 3 ~_ ~~. o f-dL .f sr. cROI ~ rr City .~ State Zip Cod Phone Number ^ City ^ Village own Nearest Road ~lew Constructio Use; esidential ! Number of bedrooms Code derived design flow rate S~S^U GPD ep acement ^ Public orcommercial -Describe: Parent material ~ C~cS~ 45( P~~l ~ Flood Plain elevation if applicable ~l/A- ft. General commertts / o ~ ~~L ~/~~ ~ O `~ 52K~ Cl. (o'~ Lcsa c~G~ and recommendations: (,,CS,~ ; 6 ~ ~ (~ U>r C.~ ~JD cr cod ~ .~ o v~ C O vt o oc r-' /~ 7 ~ ~LGt/ s ~ s frm,,. ,~l~e~, 99. i ~ ._- 02., d ~__ © Boring # CJ ~- ~ ~ / ~ ~l,~,vy rte2~ C, ~'~~G>/r! Pit Ground surtace elev. ~ ft. Depth to limiting factor in. 0 Soil A 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 *Eff#2 3 ~ L ~ ~h C W ! w.lU • to 8 s'. ,~ ~ iF-IuF (P ~ - 5- ~ c L G -~'t- ~ ~ . ~ , 3 Boring # ~ Boring ^ 7 Lf /It Ground surtace elev. CL,J/_. +_~ft. Depth to limiting factor ~~ in. Soil A plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EH#1 *Eff#2 g-l ~ ~ ~- ~/~ ,-~ ~ ~ ~ r , ~ • g ~ -ya a ~ m - J ~ , 6 'Effluent #7 = BOD > 30 < 220 mg/L and T55 >30 < 150 mg/L " tmuent fFZ = tsUU < su mgit_ ana I ss ~ ,w mgiu CST Na (Please Print r Si ure CST Number Address Dat aluation Conducted Telephone Number ~~~ 7'~" - w~, >~ ~ J / (P Property Owner t,t. ~~5~ r-L Parcel ID # Page on1 of~_ Boring # r^~Boring ~7 u Pit Ground surface elev. ~_, ft. Depth to limiting factor j ~S in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 1 ~ _q © ~ ~ ~ e w r - u ivy-rcu . ~ ~ ~. a -ig b ~' ~ ~sb ~ l ~ t, • ~ - Boring # ^ oring ~ L~J Pit Ground surface elev. 9~~! ft. Depth to limiting factor ~ in. Soil Ap lication Rate Horizon .Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eif#1 *Eff#2 i. ~ tJ 1 bYCZ ~ r t c.J r~ - ~ .~ ~' , r ~ c~ ~ Sb ~ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eft#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 =GODS < 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 (R.07/00) Piof ~t~h 4~an~e~-; ~Q~a ~n ~enS~/~ /J..~--~ ~~/ l-J ~99~~~ ~ay~ ~ o~ 3 ~3.~.s' ~~ a~ l~" {~~~. P ~ p~ ~/tom--~~ ~- a~5 ~ 12 ~ bbo h .~ti. s / ,~ \ ~5~~~-~~~~~ ~ g ~ ~ ~-{~ ~ ---- ~~ ~g~r ~9^ 7,S i _ ~- ti1 a~~~~ g ~ ~ 9~,~ ~~~ S, o~ e. i Nay ~,:~1 ~ i~ F _ «I~ [ _ ~~ ~xC ~ ~~ ~S ~S h o cvv~ ~~~~~~ a ~ ~~ ~~~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~n~ Mailing Address ~~ ~3©~ ~~r~~F ~om~~. ~~ ~~ `~`~°~~ Property Address City/State LEGAL DESCRIPTION Parcel Identification Number w ~ -~~~~' 7G-6!/~ Property Locatior. 1, rl~ '/ , ~cc~ ',!~ ,Sec. ~_, T ~c~N R~~W, Town of ,~a.lc,~w~ h Subdivision Certified Survey Map # ~~a Warranty Deed # ~~F7717 Spec house 0 yes ~ no 3 S~G2YL~/ .Lot # Volume ,Page # Volume ,Page # Lot lines identifiable !~ 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 of bedrooms .3 G~c.1~-Gat SIGN URE OF APPLICANT(S) ~/ 75/ ~~ ~ 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. (Verification required from Planning & oning Department for new construction.) (REV. O8/OS) Parcel #: 002-1084-40-000 05/07/2007 12:43 PM PAGE 1 OF 1 Alt. Parcel #: 33.29.16.489A 002 -TOWN OF BALDWIN Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/04/2007 00 0 Tax Address: Owner(s)' O =Current Owner, C =Current Co-Owner O -JENSEN, VAUGHN C & JUDY E VAUGHN C & JUDY E JENSEN 633 230TH ST WOODVILLE WI 54028 Districts: SC =School SP =Special P erty Address( s),: ' =Primary Type Dist # Description ' 633 230TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 35.000 Plat: N!A-NOT AVAILABLE SEC 33 T29N R16W NW SW EXC S 675 FT OF W Block/Condo Bldg: 141 FT Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 05/25/2006 826107 TI 11 /02/2001 661079 1754/443 QC 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 32.000 6,400 0 6,400 NO 00 UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 8,600 30,500 39,100 NO Totals for 2007: General Property 35.000 15,100 30,500 45,600 Woodland 0.000 0 0 Totals for 2006: General Property 35.000 14,700 30,500 45,200 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 Tota I 0.00 0.00 0.00 Parcel #: 002-1084-50-000 o5io7i2oo7 12:45 PM PAGE 1 OF 1 Alt. Parcel #: 33.29.16.4898 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 -JENSEN, VAUGHN & JUDY VAUGHN & JUDY JENSEN 637 230TH ST WOODVILLE WI 54028 Districts: SC =School SP =Special roperty Address( ): ' =Primary Type Dist # Description " 637 230TH ST SC 0231 BALDWIN-WOODVILLE AREA l~~ SP 1700 WITC ~ ~. / ~^-' ~ oCwflc d ~~--~~~ Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 33 T29N R16W S 675 FT OF W 141 FT OF Block/Condo Bldg: NW SW AS IN VOL 489/93 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 25,100 131,100 156,200 NO AGRICULTURAL G4 3.000 500 0 500 NO Totals for 2007: General Property 5.000 25,600 131,100 156,700 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 25,600 131,100 156,700 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 State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Number ~ ~ Document Name THIS DEED, made between Vaughn Jensen and Judy Jensen, husband and wife ("Grantor," whether one or more), and Lance C. Jensen and Kathleen A. Jensen,__ husband and wife ("Grantee;' whether one or more).. . Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): 1. The Northwest Quarter of the Southwest Quarter (NW I/4 of SW I/4), EXCEPT the south Eight Hundred Seventy (S870') feet of the west Five Hundred (W500') feet thereof; and 2. The east Three Hundred Twenty (E320') feet of the west Eight Hundred Twenty (W820') feet of the north Eight Hundred Seventy (N870') feet of the Southwest Quarter of the Southwest Quarter (SW I/4 of SW I/4). All in Section Thirty-three (33), Township Twenty-nine (29) North, Range Sixteen (16) West. Dated _~ .~ . ~'~ Signature(s) AUTHENTICATION 111111 IIIII 11111 Illll !1111111111111 Illill 1111 Ill! * s a 7Q 7-7 2 ~}7 ~ V~! ~ l7 KATHLEEN H. 4VALSH REGISTER OF DEEDS ST . CROIX CO . , VdI RECEIVED FOR RECORD 04/04/2007 09:OOAM QUIT CLAIM DEED E%ENPT x 8 REC FEE: 11.00 PAGES: 1 12ecording Area Nmne and Return Address Thomas A McCormack PO Box ZIZO Baldwin WI 54002 002-1084-40,-60 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) (SEAL) ~ ! z.-. ~ 2,~..,.-- -(SEAL) • Vau Jense / (SEAL) ~~~.'Llf ~ / (SEAL) • J y Jense authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Star. § 706.06 ) THIS INSTRUMENT DRAFTED BY: Thomas A. McCormack Baldwin WI 54002 ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST. CROIX COUNTY ) Personally came before me on '~~ ""(.G~ , the above-named Vaughn Jensen and Judy Jensen to known to be person(s) who executed the foregoing ins nt the same. 1L # - ~~ ~- - Z ~ S'.'~-. - Notary Public, State of WISCONSIN My commission (is permanent) (expires: (~(~ I p ) (Signatures may be sothenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM NO.3-2003 •Type name below signatures. ®St2Ae Bar of Vllsconsin 2003 INFO~RO"' Legal Fama • ~900~55-2021 • inropraortna.oom 1of1 Pa"rcel #: ~~2-1084-40-'I ~0 04/17/20Q7 11:48 AM PAGE 1 OF 2 Alt. Parcel #: 33.29.16.489A-1 002 -TOWN OF BAL Current OX ST. CROIX COUNTY, WISCONSIN. • Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/04/2007 00 0 • ~] Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -JENSEN, LANCE C 8~ KATHLEEN A LANCE C & KATHLEEN A JENSEN C -JENSEN, VAUGHN C & JUDY E VAUGHN C & JUDY E JENSEN 202 190TH ST 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: 0.000 Plat: N/A-NOT AVAILABLE SEC 33 T29N R16W PT SW SW DESC AS THEE Block/Condo Bldg: 320 FT OF W 820 FT OF N 870 FT OF SW SW & THE NW SW EXC S 870 FT OF W 500 FT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 33-29N-16W Notes: Parcel Histo VAUGHN C & JUDY E JENSEN TOOK TITLE WITH a e Doc # Vol/Page Type QC 661079. WHEN DEEDING OUT TO LANCE C 2007 847717 QC & KATHLEEN A JENSEN THEY DID NOT USE 05/25/ TI THEIR MIDDLE INITIALS. THEY WILL REMAIN 11/02/2001 661079 1754/443 QC AS CO-OWNERS UNTIL A CORRECTIVE DOCUMENT more... 9(1Af2 CI IMMdRV Bil! #: Fair Market Yalue: Assessed with: 0 Valuations: Description Class Acres Totals for 2008: General Property 0.000 Woodland 0.000 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Last Changed: 04/13/2007 Land Improve Total State Reason 0 0 0 0 0 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00