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032-2040-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556355 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Jantz, Dean A. & Rebecca Balluff Somerset, Town of 032-2040-50-000 CST BM Elev: Insp. BM Elev: BM Description: SectioNTown/Range/Map No: b 3 11.30.19.632A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark o D/ y ( Alt I Aeration Bldg. Sewer f ` ~Ib `i '77 r v ~ c Holding t/Ht In~" ~ U TANK SETBACK I FORIIp TI N St/Ht Outlet 57 TANK TO P/L ' ~ VVaL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom / i Dosing UG Header/ an. ~7 6 3 75 Aeration Dist~Pi g 6-L FtD Holding Bot. S stem Z _s /0 f Final Grade PUMP/SIPHON INFORMATION Z ~Q Manufacturer Demand St Cover GPM rT l~l t Model Number TDH Lift Friction Loss Syste ad TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length r No. Of Trenches v PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ BID WE LAKE/STREAM ACHIN Man INFORMATION Ty Of System: CHA ER OR 0 T Model Number: /~~J~^~✓U+' G I ~U v I ~v F> DI BUTTON SYSTEM CN (16 Head anifold Distribution x Hole Size x Holaeirtg Vent to Air Int e Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Atw_ 61 Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 0 Yes E No F Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 112- Inspection #2: / / Location: 754 160th Ave. New Richmond, WI 54017 (SW 1/4 NE 1/4 11 T30N R1 9W) >35 acres Lot Parcel No: 11.30.19.632A 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover - I i~ Plan revision Required? [~A_j Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insepcto Signature Cert. No. PLOT PLAN N Project Name: Dean Jantr Legal Description: SW114, NE1/4, S11 T30N, R19W P.I.D: 032-2040-50-000 Subdivision Name: NA Lot* NA SCALE: I"= 40' Township: SOMERSET Parcel Size: 35.0 Acres County: ST. CROIX System Elevation: T1=86.77' Proposed 3'x 75' EZ Flow Trench Slope: 17% T2=84.77' Proposed Y x 75' EZ Flow Trench A BM1 Elevation: 100.00' To of PVC Pipe BM2 Elevation: 103.58 TO of Well 4 inch Sch 40 -ASTM D2665 BaCI(hOe Pits: 4 inch 3034 - ASTM D3034 Geotextile fabrics to meet requirementsof Table TANK SCHEDULE 384.30-12 2 Proposed 1000 all on septic tank w/Pol Iok 525 NOTE: See page 11 for a more complete lot of the parcel. 'j ® / ,v V1, !d a ILI 5; Ic o fR0 Pos e n .$U itpilvc. 1 ~3 (~V)1) 'J~ i 10, ,5C ! 1 0, / S. ~ . w~ 3c:~ y ! I SLS Z6yo I6a -i► Avr County / Safety and Buildings Division -75 r CA01 x 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ~'s fi ' Madison, WI 53707-2162 ~ State Trans i n Number ita jnit Application 4t ern in accordance with SPS 383.23 2 , submission of this form to the appropriate gov /fi ~2 is required prior to obtatiplAIil ary permit. Note: Application forms for state-owned POWTS aze suban to Project Address (if different than mailing ess) the Department of Safety and Professional Servies. Personal information you provide may be used for seco purposes in accordance with the Privacy Law, s. 15.04 1 m), Stats. 1. Application Information - Please Print All Information Property Owner's Name Parcel # ~~AnJ a,4, i Z ©3z-Zc9g0 -.5'U-DDD Property Owner's Mailing Address Property Location ,Z A FO Y -c1-1 q to e101410 k_1 'd Govt. Lot ( l0 City, state Zip Code Phone Number S Wy, NF -/.,Section l (Slrcl on q- W141 T C Jar f2 t N SJ f V T 3 0 N; R -E R. Type of Building (check all that apply) Lot # ` j ~7 Subdivision Name 1 or 2 F~ily Dwelling -Number of BZs - /~n~ / Block # l ~jwyt ❑ Public/Commercial -Describe Use tea" ❑ City of CC vtti/J ❑ State Owned -Describe Use CSM Number ❑ Village of c f/ N Town of J O v C s T III. T it: Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner W. Tvpe of POWTS S stem/Com nent/Device: Check all that apply) LrS Non-Pressurized In-Ground ❑ Pressurized In-Ground A+-rd. Fl Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explai ~ /Pretreatment Device (expl ) V. Dis rsaVrFreatment Area Information: kh - Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation .3 00 V" 0. V ~-s 7,50 75-0 ✓ i = G,- 77 iZ = 8 Y. 7 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units u t? o New Tanks Existing Tanks c o n ~ g a U in H W rjl Septic or Holding Tank 00 Q i~~ W i l= C /Z C0/4J, Dosing Chamber S2 411le VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber'=,rc---, MP/MPRS Number Business Phone Number o14rU 5'cH~' ~ ZZf) 76 Q © V f,6 Plumber's Address (Street, City, State, Zip Code) _ 14 ja < a r Ll S I ! ~~`10 Z VI oun /De artment Use On ai"Approved ❑ Disapproved Permit Fee Date Issued uing Agent Si to ~ /~~7 pU Aj / en ❑ Owner Given Reason for Denial IX. isbwffims a ons fo Disapproval 1 Septic tank, effluent i er anc~ ~ ~AA/ Y! dispersal cell must all be serviced /maintained r U~` 300 r/Yf OGa ~Q~ `1 as per management plan provided by plumber. 2. All setback requirements must be maintained r00 0 c~ 10 xo r~-49 as erapplicable code/ordinances. 00 L, 0 4,t, RNAI 71 Attach to complete plans for the sysr wbmit to the County only on papeMW less than + x It inches ' size SBD-63 (R. 11/ y o o x pr ~ y ~o V ~ C1 z y o ~ , ~ t1 o n O p d ~ ~ yy.,0 ~ CT r7 • ° y a ee "o = ~o y = m < ^o p m v,' c o R a m o o~ o Cr1 O ~ b K m H A y A y U L w m eo es v eo y; A m UOJ o A N y ~ m ~ T G ~ = ~ Vj _ " yr R fD A _ A Q ~ e o o~~ m m B o a c3 Z ~11~ lot; y T m CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Jantz 2 Bedroom Septic System Owners Name: Dean Jantz Owner's Address 3985 Scheunemann Road White Bear Lake, MN 55110 Legal Description: SW1/4, NE1/4, S11, T30N, R19W Township Somerset County: St. Croix Subdivision Name: 35 Acre Parcel Lot Number: Block Number Parcel I.D. Number 032-2040-50-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Septic Tank Specifications Page 5 Effluent Filter Information Page 6 EZ Flow Information Page 7 & 8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM Page 12-17 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 10/8/2012 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 17 PLOT PLAN N Project Name: Dean Janllz Legal Description: SW114, NE114, S11 T30N, 11119W P.I.D: 032-2040-50-000 Subdivision Name: NA Lot#: NA SCALE: 1 s 40 Township: SOMERSET Parcel Size: 35.0 Acres County: ST. CROIX System Elevation: T1=86.77' Proposed 3' x 75' EZ Flow Trench Slope: 17% T2=84.77' Pro osed 3' x 75' EZ Flow Trench A BM1 Elevation: 100.00' To of PvC Pie 4 inch Sch 40 -ASTM D2665 BM2 Elevation: 103.58 To of Well 4 inch 3034 - ASTM D3034 0 Backhoe Pits: ■ equirementsof Table Geotextile fabrics to et2 3X30-r, TANK SCHEDULE 2 Pro osed 1000 allon se tic tank w/PoI lok 525 NOTE: See a e 11 for a more com lets lot of the arcel. i Ob / / © O t n~IVE Lope t~Ro Pos ~ ~ ~ Sclf 140 wLL 1000 GA L 3034 / I?c~~ L d I: (Be ~J SLS `SOUTH \9-AP,0EL LINE 264 R W /(J)O T N /'r V1_ SOIL ABSORPTION SYSTEM DETAIL I GRAVELLESS LEACHING UNIT Project Name: Dean Jantz 2 Bedroom, 0.4 d/s ft septic sstem 2 No. of Cells 7.5 Per Cell 3 ft Cell Width 15 Total No of EZ1203h 75 ft Cell Length 375 sq ft EISA Per Cell 3 ft Cell Spacing 750 sq ft Total EISA Manufacturer Model Laying Length EISA Rating EZ1203H-5ft 5.0' 25.0 Infiltrator EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: Infiltrator Gravelless Leaching Unit Model: EZ1203H Typical Cross Section Finished Grade 89.87 ft Observation Pipe with approved cap or vent Soil Backfill 48 in Geotextile Fabric ■ 84.77 ft Infiltrative Surface 12 in O I 80.37 ft Limiting Factor >36 in Slotted and Anchored Vent/ 80.37 Observation Pipe with Cap Plumber/Designer Signature: License 223760 Date: 8-Oct-12 D z X N m 61" 86" D Z C D 42" A Z ~c m m rs v = 0 UP 41" / TO PI=1 \ z 4" CAS m D x 1 I 1 ~ D 0 v 3" 36" I 4" _ r N N I n m / UP 38" ` r- 0 m;u 4" CAS N N v I -p °m c C K ;a m6) 0 m -V o o -u D C ;0 D-1 (7 z ° 39" m °0>z En r y> 0r-r D 0m> (n m ~~0 r mm X nM x D Z 0 m c ~0 z z o o , -I m0 ;u n D z DOZ ° .g> 0~►D r ~rrn9Frii my0 OD~L► Z >gz 0(N*t XX maZ vFU) v -1 ~A° NA° z -z 2pp~p =_A O (A co cy Am N >m-IZ D rmO0 mDp ~rOr•• ~N m D 7C C7 Z C ~ N m Z 0D t*1 Z =C F C-) ` z DO 4 cn2Ff o l f <R9o'npp.. s=m\ ~a v D OD N o g0 D z =z ~m D -1 > 1 --4 (01*rl~p~s,m~ ~~N O n~ . N cnm m m >m w~°O0 00- zn O -D1 U z O ZN O r N ~ IDD mmN pOV C)w ?1 O ;v m° cn = O N vi'z \ r~ o w m °m r o AA- u, ccp G4 ;9 (I r o m Z 2 -1 W c7 ~O v Z - m D mDm m0 o v'0)m y z E! p D =rz r° c''jy D $ mo H z nm c m -0 m Z n ~v Z4 55 O z 0?I 0;v ~O-4 0 O T1 "1 O D> F O0 m son Z Z r O O O (A N W 0 ° Z A y v A 0 D ~ ~ o ~ o (n m r m w n v z r c M v H z o Ta Z ~ ; ~ z F --I \ m WLP1000-MR MISER CuCAETE DRAW BY. SME R AM- 1/4'=I'-O' PRE-POUR: n -4 SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK. WI 54750 DATE JANUARY 2010 DATE:. POST-POUR: \ ° REVISED JAN. 2010 800-325-8456 FlLE: MlPm" • C Filters PL-525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of accessibility exAccepts PVC tensions handle the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4" & 6" SCHD.40 Pipe` PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ball when filter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,486 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. Installation Instructions for *&EZflEZflow Systems in Wisconsin FILTRwTOR . Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dies and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed : shall make sure the the GEO is positioned upward and is • EZflow Bundles : in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric : der before backfilling. • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered, that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 1203H-GEO down along the sides of the product to a point at least six inches from the bottom of product. Geotex ile Barrier Material 4. When installed in a trench, the trench should be dug to . a width of 36 inches. This not only saves labor in excava- 12' lion, but alp provides better load-bearing capacity after backfilling is complete. 36' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Dean Jantz Tank Manufacturer: Unknown r NA Permit # 115-15- Septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete F NA Number of Bedrooms: 2 r NA E Septic E Dose Holding Volume: al Number of Public Facility Units: F NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 200 gal/day Horizontal Distance Tank(s) to Serivce Pad: tt Design (peak) Flow = estimated x 1.5: 300 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.4 gal/day/ft2 horizontal is > 150 feet. Spec instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok F NA Fats, Oils & Grease (FOG) 530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand (BOD5) 5220mg/L r NA Pump Manufacturer: F NA Total Suspended Solids (TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L r NA r Mechanical Aeration f Peat Filter r NA Total Suspended Solids (TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter I- Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L I- NA r In-Ground (gravity) r In-Ground (pressure) r NA Fecal Coliform (geometric mean) 5104cfu/100m1 r At-Grade r mound Maximum Effluent Particle Size: Ys in dia. 17- r Drip-Line r Other: Other: Other: r NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated m-*Xs) Inspect condition of tank(s) At least once eve : 3 r year(s) (Maximum 3 ears) r NA r month(s) Inspect dispersal cell(s) At least once eve : 3 r year(s) (Maximum 3 ears) r NA r month(s) Clean effluent filter At least once every: 1.5 r year(s) r NA month(s) Inspect pump, pump controls & alarm At least once eve : r year(s) r NA S Flush laterals and pressure test At least once eve : r year(s) r NA mon"s) Other: At least once eve : r yearts) r 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 Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third 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 Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting 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 area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for a code compliant replacement system: ® A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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 may be 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. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name: St Croix County Zoning Phone: Phone: 715-3864680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(0 and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. 2/05) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1=kN -J►'4NTZ Mailing Address 317 J Stff e- w t\) EN1 i1 iv n) l4_ D L/-K- fU A) -57-r/ / 0 Property Address _ :z (Verification required from Planning & Zoning Department for new construction.) City/State or Parcel Identification Number 103 2. -~ZO`~ `f ®-5-® ~ LEGAL DESCRIPTION Property Locations '/4 '/4 , Sec. , T.30 NR I q W, Town of 5o M 0 e S ,ET Subdivision Plat: ) 3 , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # ,S7J 5 3 ~ (before 2007)Volume Page # 10('5' Spec house ❑ yes 14 no Lot lines identifiable ❑ yps ❑ 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 bedt`bo /G/ 6 zo ~Z IJ 4 A U[ _ F AP -NT~S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) f~ SOIL EVALUATION REPO P a DSafety #1697 *a- P Q~~ in accordance with Comm 85, Wis. Adm. Page 1 of 6 w+ Professional ~rVICe Schmitt Soil Testing, Inc. County Attach complete site plan on paper not less thtr¢tyynches in size. Plan must t. Croix include, but not limited to: vertical art 3~ttg~Ftt~~ erence point (BM), direction and percent slope, scale or dimen~jarrow, and location and distance to nearest road. Parcel I.D. 03 040-50-000 Please print all information. Re sewed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Jantz, Dean Govt. Lot SW1/4, NE1/4, S11, T30N, R1 9W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3985 Scheunemann Rd NA NA 35 Acre Parcel City State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road White Bear Lake MN 55110 651-303-0184 Somerset 160Th Ave. New Construction Use: Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Replacement ❑ Public or commercial - Describe: Parent material Outwash Sand (Onamia Series) Flood plain elevation, if applicable NA ft. General comments Area is suitable for a conventional system with a 0.4 gpd/sq ft rate. Possible system elevation for Area 1 is 86.77' (High trench) and recommendations: 84,77' (Low trench). Slope of area is 17%. 1 Boring # F-1 M Boring Pit Ground surface elev. 90.87 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 none fsl 2fsbk mfr Cs 2m,2f 0.4 0.8 2 10-32 10yr5/3 none fsl 2fsbk mfr gw im,2f 0.4 0.8 3 32-37 7.5yr4/6 none fsl 2fsbk mfr gw 1vf 0.4 0.8 4 37-100 10yr6/4 none fS Osg ml 0.5 1.0 L M Boring # ❑ Boring Pit Ground surface elev. 90.87 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr4/3 none sl 2mgr mvfr Cs 2m,2f 0.6 1.0 2 9-17 10yr4/4 none ifs lmsbk mvfr gw 2m,2f 0.5 1.0 3 17-41 10yr6/4 none ifs lcsbk mvfr gw 1vf 0.5 1.0 4 41-68 10yr6/4 none fs Osg ml gw 0.5 1.0 5 68-76 10yr5/6 none Ifs lcsbk mvfr gw 0.5 1.0 6 76-100 10yr6/4 none fs Osg ml 0.5 1.0 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS < 30 mg/L and TSS <.30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/13/2012 715-760-1978 SBD-8330 (R.07/00) Property Owner Jantz, Dean Parcel ID # 032-2040-50-000 Page 2 of 6 [.J Boring F3 Boring # [ Pit Ground surface elev. 88.87 ft. Depth to limiting factor 102+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/3 none fsl 2mgr mvfr as 2m,2f 0.4 0.8 2 9-16 7.5yr4/4 none fsl 2fsbk mfr gw 2m,ivf 0.4 0.8 3 16-23 7.5yr4/4 none sicl 2msbk mfr gw ivf 0.4 0.6 4 23-37 7.5yr4/4 none scl imsbk mfr gw lvf 0.2 0.3 5 37-60 10yr5/6 none fs Osg ml cs 0.4 0.8 6 60-102 10yr6/4 none fs Osg ml 0.5 1.0 37-60" has 11/2' bands of 7.5yr4/6 2msbk fsl, changes rate of horizon. ❑ Boring F4Boring # F- Pit Ground surface elev. 105.22 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 1 0-9 10yr3/2 none Ifs lmgr mvfr as 2vf 0.5 1.0 2 9-28 10uyr5/6 none Ifs icsbk mvfr gw lvf 0.5 1.0 3 28-37 10yr4/6 none gris Osg m) gw 0.7 1.6 4 37-59 10yr6/4 none fs Osg ml cs 0.5 1.0 5 59-64 10yr4/6 none Ifs Osg ml cs 0.5 1.0 6 64-96 10yr5/6 none s Osg ml 0.7 1.6 ❑ Boring Jlr ]Boring # Pit Ground surface elev. 105.22 ft. Depth to limiting factor 97+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Ef1#2 1 0-9 10yr3/3 none sl 2mgr mfr as 2m,2f 0.6 1.0 2 9-30 7.5yr4/6 none grsl 2msbk mfr gw if 0.6 1.0 3 30-97 10yr5/6 none fs Osg ml 0.5 1.0 *Effluent #1 = BODS> 30 <220 mg/L and TSS >30 <150 mg/L " 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 (R.07/00) Schmitt Soil T esting, Inc. Property Owner ]anti, Dean Parcel ID # 032-2040-50-000 Page 3 of 6 E] Boring F6~ Boring # Z Pit Ground surface elev. 103.10 ft. Depth to limiting factor 97+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#a *Eff#2 1 0-10 10yr3/3 none sl 2mgr mfr as ivf 0.6 1.0 2 10-35 10yr5/4 none gris Osg ml gw if 0.7 1.6 3 35-96 10yr5/6 none s Osg ml 0.7 1.6 7] Boring # ❑ Boring Pit Ground surface elev. 85.37 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 1 0-11 10yr3/3 none fsl 2mgr mvfr as 2m,2f 0.4 0.8 2 11-32 7.5yr4/4 none sid 3msbk mfr gw 2m,2f 0.4 0.6 3 32-48 7.5yr4/4 c2d 10yr6/6 sl lmsbk mfr w ivf 0.4 0.7 10yr6/2 9 4 48-67 10yr6/4 none fs Osg Ml CS 0.5 1.0 5 67-74 10yr5/3 m2d 10yr6/8 sil lmsbk mfr Cs 1 r6 2 0.4 0.6 6 74-100 10yr6/4 none fs Osg ml 0.5 1.0 ❑ Boring F8 Boring # Z Pit Ground surface elev. 93.97 ft. Depth to limiting factor 46 in. Soil Application Rate Horizon Depth FDominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. unsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 1 0-10 0yr3/3 none fsl 2fsbk mvfr Cs 2m,2f 0.4 0.8 2 10-17 0yr5/3 none fsl 2msbk mfr gw ivf 0.4 0.8 3 17-26 7.5yr4/4 none scl 2msbk mfr gw lvf 0.4 0.6 4 26-46 7.5yr5/6 none fs Osg Ml Cs 0.5 1.0 5 46-56 7.5yr4/6 c1d 10yr6/8 sil lmsbk mfr g w 0.4 0.6 1 62 6 56-70 10yr5/6 none fs Osg Ml Cs 0.5 1.0 7 70-82 10yr4/3 c2d 10yr6/8 sil lmsbk mfr 0.4 0.6 10yr6/1 * Effluent #1 = BODS> 30 <220 mg/L and TSS >30 <_150 mg/L * 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 (8.07/00) Schmitt Soil Testlng, Inc. Ptoperty Owner Jant; Dean Parcel ID # 032-2040-50-000 Page 4 of 6 Boring F9 Boring # Pit Ground surface elev. ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 none sil 2fsbk mvfr as 2m,2f 0.6 0.8 2 10-19 7.5yr5/6 none sl 2msbk mfr gw 2f,lvf 0.6 1.0 3 19-31 7.5yr4/4 none scl 2msbk mfr gw if 0.4 0.6 4 31-51 10yr4/6 c2d 10yr6/8 A imsbk mfr cs 0.4 0.6 10yr6/1 5 51-60 10yr5/6 m2i 16 2/6 vfs1 imsbk mfr 0.2 0.6 Fl-o]Boring # n Boring 0 Pit Ground surface elev. ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 1 0-9 10yr3/3 none fsl imps mvfr a 2m,2f 0.2 0.6 2 9-26 10yr5/3 none fsl imsbk mfr Cs 1f,lvf 0.2 0.6 3 26-41 7.5yr4/6 c2d 10yr6/8 fsl Om mfi cs lvf 0.2 0.5 10yr6/2 4 41-66 10yr5/6 c2d 10yr6/8 ml cs 0.5 1.0 10yr6/1 5 66-74 7.5yr4/4 m2d 16/2/6 sd imsbk mfr - 0.2 0.3 11 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/3 none A imsbk mfr Cs 2m,2f 0.4 0.6 2 9-23 7.5yr4/4 none scl 2msbk mfr cs if 0.4 0.6 3 23-48 10yr5/3 c2d 7.5yr6/8 Sid imsbk mfi cs lvf 0.2 0.3 7.5yr6/2 4 48-54 7.5yr5/6 c2d 7.5yr6/8 fs Osg MI Cs 0.5 1.0 7.5yr6/1 5 54-62 10yr6/3 m21 16 r26/6 fsl Om mf 0.2 0.5 * T-- Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * 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 (R.07/00) Schmitt Soil TOOV, Inc. Page 5 of 6 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Dean Jantz Thomas J. Schmitt, CST 227429 Address: 3985 Scheunemann Rd 1595 72nd St. City, State, Zip: White Bear lake, MN 55110 New Richmond, WI 54017 Phone: 71 - 60-1978 PID: 032-2040-50-000 s w Lot No. NA 35 Acre Parcel cste Legal Description: SW1/4 NE1/4 S11 T30N R19W ■ Backhoe Pit Township, County: Somerset, St. Croix County A Bench Mark 1 El. 100.00' Top of 2' pvc pipe. Q Bench Mark 2 El. 103.58' Toop of well. Slope= 17% 1"=40' i Pit Elevations W t 131: 90.87' / 1219-3- B2: 90.87 , B3: 88.87' 134:105.22' B5: 105.22' 86:103.10' l lost B7: 85.37' 138: 93.97' l3 )7%5W 62(to PP,oP~A , ":'~0 ~ { L41L61A/6- ~ • J6~ a Y-n WE'LL ~ / ~ spy /a MR. Fr ' F Y ~h • •'<t; y.-✓d:%3'`f.s":`.i'' fir' P' Vii CY ,p' y ' H i ' .F.• • .._':z-a-~.,~d':, `yam F yE` U N. +r'' 40 'r ' j t r ~ s..y . w . d,: ~ ~ fr §iEy . Ai F •f ~ F.g,.:c , ,.v w ~ tgpK~awsS :~~(„„s.. kx'a ~ ~ t,Y ' k~ .!rya- q` • `A * ru? R •f 'p Y::. RED a yyaa i 50 9rs '.ys' ,x f•Yhv."4hp :,[,'~`;'~x." f: ""ryjY'~,S~;f.r <,l•('MV,.~y~.~ ,y Y4•. .S -F ')`YG r JCL 1:307ow'106 STATE BAR OF VJISGONSII4 FORK! 3 - 3-982 WARRANTY DEED DOCUMENT NO. Thomas r(. Breault- and Phyllis J. Breault, REGlSTi eS OFr' it P_ 5T. CROIX Co.. Wi husband and wife , - &i1.5: r'r ftctrd MAR 1 9 1998 con--eys and warrants to _-_I can A. .Tanrz and Rebecca M. 9:30 ~~1~ t -_.D&jjt;f. as joint tenants and not as tenants - j_ri con,non. 1W.S SPA .F or-FaV-_D FOR R£L:8RDR6G DATA UAME A"D aFTUR.`t ADCRESS the following described re-1 esuste in St C'Nj S Doherty, Rumble & Sutler, P.A. St='an' of %Visco,-An. 2800 H_tnnesota World Trade Center 30 East Seventh Street St. Pahl, NN 55101 14Q32-2040-50,- 032-2042-90 PARC~ NUMBER 032-2042-96 SW114 of NE1i4 and I~JW'1/4 of SE1/ = of Section 11 extent railroad right of way and the W 370 feet of the SW1/4 of SE1/4 ref Section 11, ail in Township 30 North, Range 19 West. Grantors, by the execution of this Deed, release any and all interest they have in the easement described in Deets dated 02/17/88, recs. 02118/88, In vol. 830, page 323, Doc. No. 434606. This Deed is given in fulfillment of the Land Contract between the parties hereto recorded February 18, 1988, in Vo!. 803, Page 326, as Doc. No. 434608. TRMIFER Th« is not homestead prope -4*x (LS not) Exception to vvarranues: Easements, restrictions and rights-of-way of record, if any. B}S Dated this -j daffy of 93 (SEAL.) (SEAL) _ Thomas R. Breault (SEAL) Q~4.sg.~.~ (SEAL) _ Phvllis,J_ Breault AUTHENTICATION ACKNOWLEDGMENT Signaturc(s) State o()Wiyfr;t0ity81=K ('.AT IrTNTA ss. r authenticated this day of 19--_ Personally came before me this ;t a day of lGr6 -L Isr 98 , the above named r~h~snas R Breau t ar-^A ads-•3--Biea' 7 t.' h1'A111anr3 TITLE: MEMBER STATE BAR OF WiSCONSIN and Wi Fe, (If not, authorized by §706.06, MAK Stats.) to me krou-n to be the persons who executed the foregoing inarument ad acknowled a the same. 7titS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WS 54016 notar7Puhtic, SP,)La >~aeleat,.a -r'.._ntyyiA- CA- (Signat.ures may ;-e authenticated or acknowledged. Both are not My commission ib permanent. (if not, state expiration date: necessary) 6 _Z:3 .}y ~.ncc.l GA4Y L. EVANS Names of wrsors stgmng in any c.p acne shuald 1Iy t)pcd or primed below their signawrT Comm. 11102472 rp~ STATE BAR O NOTARY PURR • CALIFDRNIA yt w a m t.rNm Star Ca. tnr._ WARRANTY DEED I. No. eouarp of San Benito Lid_aokee• We M. Comm. E7oires June 13. 2000 r Parcel 032-2040-50-000 10/10/2012 08:35 AM PAGE 1 OF 1 Alt. Parcel M 11.30.19.632A 032 - TOWN OF SOMERSET Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner DEAN A,& REBECCA BALLUFF JANTZ O - JANTZ, DEAN A,& REBECCA BALLUFF 3985 SCHEUNEMANN RD WHITE BEAR LAKE MN 55110 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SCH DIST OF SOMERSET (G~~ SP 1700 WITC Legal Description: Acres: 35.000 Plat: N/A-NOT AVAILABLE SEC 11 T30N R1 9W 35A SW NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/04/2007 851832 EZ-U 12/1612002 702294 2080/132 EZ 03/19/1998 575363 1307/106 WD 07/23/1997 803/326 more... 2012 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/03/2008 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 31.000 62,000 0 62,000 NO MFL BEFORE '05 CLOSED W8 4.000 16,000 0 16,000 NO Totals for 2012: General Property 31.000 62,000 0 62,000 Woodland 4.000 16,000 16,000 Totals for 2011: General Property 31.000 62,000 0 62,000 Woodland 4.000 16,000 16,000 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-2042-90-000 10/10/2012 08:36 AM PAGE 1 OF 1 Alt. Parcel M 11.30.19.643 032 - TOWN OF SOMERSET Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - JANTZ, DEAN A,& REBECCA BALLUFF DEAN A,& REBECCA BALLUFF JANTZ 3985 SCHEUNEMANN RD WHITE BEAR LAKE MN 55110 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 11 T30N R1 9W 40A NW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/04/2007 851832 EZ-U 12/16/2002 702294 2080/132 EZ 03/19/1998 575363 1307/106 WD 07/23/1997 803/326 more... 2012 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2010 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 1.000 1,000 0 1,000 NO MFL BEFORE'05 CLOSED W8 39.000 156,000 0 156,000 NO Totals for 2012: General Property 1.000 1,000 0 1,000 Woodland 39.000 156,000 156,000 Totals for 2011: General Property 1.000 1,000 0 1,000 Woodland 39.000 156,000 156,000 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-2042-96-000 PAGE 1 10/10/2012 E 1 OF A 1 1 Alt. Parcel M 11.30.19.644B 032 - TOWN OF SOMERSET Current IX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - JANTZ, DEAN A,& REBECCA BALLUFF DEAN A,& REBECCA BALLUFF JANTZ 3985 SCHEUNEMANN RD WHITE BEAR LAKE MN 55110 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Legal Description: Acres: 11.212 Plat: N/A-NOT AVAILABLE SEC 11 T30N R1 9W SW SE THE W 370' OF SW Block/Condo Bldg: SE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 12/16/2002 702294 2080/132 EZ 03/19/1998 575363 1307/106 WD 07/23/1997 803/326 07/23/1997 803/323 2012 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/03/2008 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 4.212 8,400 0 8,400 NO MFL BEFORE'05 CLOSED W8 7.000 28,000 0 28,000 NO Totals for 2012: General Property 4.212 8,400 0 8,400 Woodland 7.000 28,000 28,000 Totals for 2011: General Property 4.212 8,400 0 8,400 Woodland 7.000 28,000 28,000 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount i Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00