HomeMy WebLinkAbout006-1001-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 556376 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Alvermann, Wayne & Beverl C Ion, Town of 006-1001-40-000
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown/Range/Map No:
G T 01.31.16.12
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic IzaZ~ Benchmark 2 •
e•J~-' lam' V Alt. BM
e L" , Z 5 • ~s
, f
Aeration Bldg. Sewer 3.193 N0,/
Holding St/Ht Inlet ~~Zc 7 / - 6
TANK SETBACK INFORMATION St/Ht Outlet
~1J • $
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
sflr
All
Septic Dt Bottom
1 ~
Dosing Header/Man. I • Q
Aeration Dist. Pipe C/ 7
Holding Bot. System
All 9. 3, *3 Q / 7
Final Grade
PUMP/SIPHON INFORMATION (i.L7$ 9~• ZZ..
Manufacturer De
GPM mand St Cog ; ` • 2,5 AM .6-5
Model Number
TDH Li Friction Loss System Head 7111~1 Ft
Forcemain Len ist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 1 -3 7
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture
INFORMATION Type Of System: nn CHAMBER T OR Model Numb • `
0 If Po f UN DISTRIBUTION SYSTEM 1( 26t-ZO lJS
Header/Ma.0fold Distribution x Hole Size x Hole Spacing Vent to Air I ake
7 e4A^~ Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Q Bed/Trench Edges \ Topsoil
• Yes [N No r Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 2301 250TH ST Clear Lake, W1 554005 (SE 1/4 SW 1/4 1 T31N R1 6W) 40 acres Lot Parcel No: 01.31.16.12
1.) Alt BM Description = 1 (,jOJt.L~ ; ,~...-1,..o ark
2.) Bldg sewer length
- amount of cover = ?'g
Plan revision Required? ❑ Yes No F/iDT3/]
`
75
Use other side for additional information. /Z - - -
Date Insepcto Signat Cert. No.
SBD-6710 (R.3/97)
County
{ , Safety and Buildiniv n J
201 W. Washington AVvW~:O,' x 162 Sanitary Permit umber (to be filled in by Co.)
p ;•a ' Madison, WI 537D'1-t 2.,
G
55
p, AShrtary Permit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit A)
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.( I Xm , Slats.
1. Application Information - Please Print All Information ~J T1 "Q.L
Property Owner's Name Parcel #
L4J A OD(o -1001' 10 -000
Property Owner's Mail g Address c Property Location
a3ot a S Govt. Lot C• Z
City, State Zip Code Phone Number Se S W%, Section
Z L E A e LA Kc t.J 00 -115 R0 3'a I (circle one)
T
II. Type of Building (check all that apply) Lot # _ N; R Eorw
or 2 Family Dwelling - Number of Bedrooms UL~ - Subdivision Name
Block #
❑ Public/Commercial - Describe Use
P-1 ❑ City of
❑ State owned - Describe Use CSM Number ❑ Village of
'Town of Le>tj
3 61' c ll~ 20 CL..-ipet',
III. Type of Permit: (Check o ly one box online A. Complete line B if applicable)
~ep ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
A. ❑ New System lacement System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number d Date Issued
Before Expiration Owner pu)
IV. Type of POWTS S stem/Com nent/Device: Check all that apply)
'Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) S~+j
V. Dis ersaVrreat nt Area Information:
Design Flow (gpd) Design Soil Application gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System ~Elevation
(y0 i- /0700 /a 17 1e/ / /,aa
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o d t?
New Tanks Existing Tanks I c Y y
(N e5 a U in rn w t7 w
Septic or Holding Tank J zA I ~a CCU _T
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signa a MP/MPRS Number Business Phone Numher
tzJr Jb - ;2S;_ 15-5~1e
Plumber's Address (Street, City, State, Zip Code)
7 / 7a+AAU 4~_ --r-t.L T 6C L4 k4_ 0
VIII. un /De artment Use On
Approved ed Permit Fee Date Issued Issuing t Signature /Jp/~
ven Reason Denial $ /
W. Condi Weasons for Disapproval
'Septic tank, effltlhnt filter and 3,
dispersal ce14 must all be services I Maintain r.
as per management plan provided by plumber.
3. All setback requj fernettts must, be mllintairtAd co
es Pei ei *&Mt 4e tads i Wdin&lkes:
Attach to complete plans for the system and submit to the County only on paper not less than 81/2 a 11 inches in size
SBD-6398 (R- 11/11)
HARDINA SEPTIC SYSTEMS
MPRS/C:ST 824825
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Alverman
Owner's Name: Wayne Alverman
Owner's Address: 2301 250th St.
Clear Lake Wi 54005
Legal Description: SE,SW,S.1,T.31 N-R 16 W
Township: Cylon
County: St. Croix
Subdivision Name:
I
Lot Number.
Parcel ID Number. 006-1001-40-000
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber. Robert Hardina License Number: 824825
Date: 10/26/2012 Phone Number (715) 986-2508
Signature
; ~eZ4
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
HARDINA SEPTIC SYSTEMS
MPRS/CST 824825
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Soil Absog tion System Plan View
ft
3.00 ft
3.00 ft Leaching Trench 1
Chambers
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Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leachkw Chamber_$Qr 2MRAIM
Manufacturer And Model ti1-QCj U-) o 1Z Qu ► le~ 5 j .
EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.50 gpd/sq ft
600.01' gpd Design Flow + 0.50 Soil Application Rate 20.00 EISA = 60.00 Chambers
3 rows of 20.00 chambers each.
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity gal ❑ NA
L,J 14
Permit # Septic Tank Manufacturer ❑ NA
Effluent Filter Manufacturer T ❑ NA
DESIGN PARAMETERS
❑ NA Effluent Filter Model ❑ NA
Number of Bedrooms
$NA Pump Tank Capacity gal -93-NA
Number of Public Facility Units
4
Estimated flow (average) 700 gal/day Pump Tank Manufacturer +3-NA
Pump Manufacturer NA
Design flow (peak), (Estimated x 1.5) 00 gal/day
2 Pump Model 'a NA
Soil Application Rate ~ gal/day/ft
Standard Influent/Effluent Quality Monthly avers9e* Pretreatment Unit -0 NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODO 5-220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) 530 mg/L kin-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) _<30 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 510° cfu/100ml ❑ Drip-Line ❑ Other:
Other: ❑ NA
Maximum Effluent Particle Size Ys in dia. ❑ NA
Other: ❑ NA Other: El NA
Other. ❑ NA
*Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: ,a year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
❑ month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: -C year(s)
❑ month(s) ❑ NA
Clean effluent filter At least once every: W year(s) ~AGz
❑ month(s) -p NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
❑ month(s) ~ NA
Flush laterals and pressure test At least once every: ❑ year(s)
❑ month(s) -0 NA
Other: At least once every: ❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any po g
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 (Y3) 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 service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer A VEet~ A
Mailing Address 66 U I 6i N 5-r- 6 I S q65
S
Property Address
(Verification required from Planning & Zoning Department for new construction.)
yD -bvU
City/State Parcel Identification Number (Do)
1.L6 A G a ~F w
LEGAL DESCRIPTION
Property Location,S6 '/4 , 5cO '/4 , Sec. 1 , T 3) N Rjj~_W, Town of C' ylo,y/
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ 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 yirranty deed recorded in Register of Deeds Office.
Number of bedrooms
zz,
IG OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 09/07)
05
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9:TER'S ®s FIC
REG
ST. cROix CO, .wi
Recd, for Record
` - IN THE UNITED STATES `DISTRICT COURT 0a C 2 's 1g91
at p M
1
00
- - Ct'(1NRIN ~
FOR THE WESTERN ularni~l / 0: ~ V/l _
`IV/ -~ryp r~icq ,vl
-o
Omar nr na . - -
r
-r plaintiff, ) - _
Case No. 91-C 92 C
WAYNE,C: ALVEPMANN,`BEVERLYA. -
~hVERMAN AND,-STATE OF WISCONSIN )
-DEPARTMENT- OF AGRICULTURE TRADE
=P,ND CONSUMER PROTECTION.,
ATTORNEY' GENERA DEPARTMENT
OF : JUSTICE=
Defendants. )
.
UNITED STATES MARSHAL'S DEED
"This Yndenture,` made this =19th-day:-of November, 1919 between the _
` United States Marshal for the Western District of Wisconsin, party of
the first part`, and `Wayne -and Beverly Alvermann, party. of the second
part
WITNESSETH, that whereas, at a term of the United States, District
Court-held in and for t_he:Western District of Wisconsin, in the United
States Courthouse, 120 :North. Henry Street`, -Madison,- -Wisconsin,. ,.,on the
= 27th--day--of March, 1991, it was among other thing: ordered and
- - or a n__ac-t.on then pending in said,
adjudged by the saizi Caurt,
Court, be*ween the United States of America, plaintiff, and Wayne-C.'
Alvermann, Beverly A. Alvermann, and State of Wisconsin; De}aartment of
Agriculture, Trade,-and Consumer Protection, defendants,`Civil:Action.
No. 91-C=92-C
That-ail and singular the mortgaged premises mentioned-
„ed~ant in said action, or so m17ch
- _ .rk
described in the comp~a~
~-71- 928 ~AJE _ _ -
VO►
thereof as rnight be- sufficient to raise the amount due to the
plaintiff for principal, interest and costs in said action and which
he sold-separate,ly- without-material injury to the parties
interested, be sold at public auction by or under the direction of the-
n a*r,~t._.of_wi
ria sconsn,.at "any
V11Jaeu -vt~1`cC Ma~'~ l iVr. ~t.o _ _
time after. sixty -.(-.60)-from the date of said judgment, . unless, previous-"
to such-sale said premises and said judgment shall be redeemed in th'e''
manner, `provided =by law, that the said.-sale- be :Made` ;in t~ce Cosnty_ of
St;. Croix, where the premises are- situated;
That the said Marshal give public notice of the time and place of,
such sale, in the manner provided by-law; that any of-the parties in
said action might purchase at such sale; that the said Marshal-upon
compliance by the purchaser of such premises,_so sold, setting forth
each tract `oz parcel so `.sold and the sum paid therefor;;, that the Clerk
of Court, upon compliance of the -party of.the second part with all the
reguirements •of Section 846.17 Wis. Stats.=, as amended, deliver to: the '
purchase,r,..or purchasers, said deed.
AND WHEREAS, the said united States`Marshal, -in pursuance of the
said, judgment of the said Court, did on the 22nd day of October, 19911.
sell at public auction at the front steps of the St. Croix-County.
Courthouse, in -the--City -of-..Hudson., Wisconsin, at-the hour of 2:30
1 .Y1YC
o'clock in the -afternoon of that -aay, _prem ses in_the said
judgment mentioned; due notice of the time and place of such sale
first given, agreeable to the said judgment at which sale -the-premi%es'
hereinafter described were struck off to the said party of thesecond
part for the sum of $22,000.00, said party of the second part being
Y_
pp
VOL Pb~E l h
the highest and best bidder therefor, and that'~bejng the highest: sum
bid, for the :sane;
NOW, THIS INDENTURE WITNESSETH, -that the said -'Uh1ted States;
Md~~;;al, Lr ; rt„o of tYe said ]ad ent - zrd -of the- statute in such
i -
case made-and provided, and in consideration 6f--the said sum of money,
so' has gran-.eu tea.
y
conveyed- and =by--these presents_'does grant, bargain, , sell, -alien 'and
convey unto the said party of t:he second --part,: and,, its successors
and assigns, forever, all the following -described .lance sittraLedn the
County of St. Croix, in the' State of Wisconsin, `to,-wlit:_
SEE ATTACHMENT A.
-To have and to hold all and singular the premises -above xrentaoned b -
and described and hereby conveyed or intended so to be unto^t'the rsaid- - -
party of the second part, its successors--and assi.gns,._tp its only
proper use, benefit and behold, forever.
IN WITNESS WHEREOF, the said party of the firs-t part, 'the United
States Marshal for.the Western District of Wisconsin, as, afflresad,
hath hereunto set his'hand and seal the day.and year first,abave -
written.
FR_DERICK N. FALK-
United States Marshal.
Western District of `Wisconsin-
STATE- OF WISCONSIN
ss.
COUNTY OF DANE )
VOL
Personally -came- be f ore me this day of /
~G
1991, the above-named Frederica N: - -the. United States marshal
for the Western District of Wisconsin, to me known to be the person
-_and officer described in, and who.-executed the above, conveyance, as
_ _'-such- o.f f icer_, and acknowledged the same.
~u sc*- nd~~rorn o fo me`
ay III
of -9
r 1.
Nonary: Pub`1lc/State of ~ i: c b
My commission expires a ary 29 1995.
_ 4
Vo_ 98 r~"a 09,
ATTACHMENT.
_ USA V.,Wayn.e C Alvermann. Et dl;
CASE NA 91-C92-C
LOCATION: St. Croix County
LEGAL_DESCRIPTION:
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16 West
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Wis. Dept of Safety and Professional Senn IL EVALUATION REPORT Page of
fit `
Division of Safety and Buildings 20
in accordance with SPS 385, Wis. Adm. Code
s, +,r.; .w'
. 0 f~c County
Attach complete site plan on paper nit~ll I~~ z ~1 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 00ko - 100 t, - 40 - O 0 ~ . /
P19
lease print all information. eviewe Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))
Property ner Property Location ,C
Govt. Lot 1(4gU 1/4 S / T 3 N R ~(e E (o&
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Gene mments C d
and recommendations: • J Gw ~CG~a~
❑ ~
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pit Ground surface elev~ ft. Depth to limiting factor in.
Soil Application Rate
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Effluent #1 = BOD > 30:s 220 mg/- and TSS 30 < 150 mg/L ' Effluent #2 = BOO < 30 mg/- and TSS < 30 mg&
CST Na (Please Print) f gnature CST Number
13,~"I7"I A 'ZZIy7 /
Address W Date Evaluation Conducted Telephone Number
SBD-8330 (RI 1/11)
Property Owner. Parcel ID # Page ? of3
F3_1 Boring # ❑ Boring
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' Effluent #1 = BOD e > 30 < 220 mg& and TSS >30 < 150 mg/l. ' Effluent #2 = BOD a < 30 mg& and TSS < 30 mg&
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
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PAGE E I OF 1
Parcel 006-1001-40-000 P
Alt. Parcel 01.31.16.12 006 - TOWN OF CYLON
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): O = Current Owner, C = Current Co-Owner
O - ALVERMANN, WAYNE C & BEVERLY A
WAYNE C & BEVERLY A ALVERMANN
2301 250TH ST
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 2301 250TH ST
SC 1127 SCH DIST OF CLEAR LAKE
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Desc ption: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 1 T31 R16W 40A SE SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
01-31N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/04/2012 957592 WIND
06/04/2012 957591 WIND
07/23/1997 940/57
07/23/1997 928/05
more...
2012 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 05/31/2012
Description Class Acres Land Improve- Total State Reason
AGRICULTURAL G4 38.000 6,500 `0 - 6,500 NO
OTHER G7 2.000 8,400 121,000 1400 NO 02
Totals for 2012:
General Property 40.000 14,900 121,000 135,9000
Woodland 0.000 0
Totals for 2011:
General Property 40.000 14,900 102,000 116,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 512
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00