Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
014-1066-40-000
commerce.wi.gov isconsin Department of Commerce ~~~ Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 30, 2006 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/30/2008 SITE: Tremont Hotel LLC 2609 State Hwy 64 Town of Forest St Croix County NW1/4, NW1/4, S31, T31N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1083202 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 ~ Identification Numbers ~ Transaction ID No. 1286040 Site ID No. 714831 Please refer to both identification numbers, above, in all corres ondence with the a enc . • 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 ' SHAUN R BIRD Page 2 6/30/2006 that impact the treatment and dispersal are prohibited. • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. • This pressure distribution system is designed with a minimum distal pressure of 3.0 feet and a network pressure compensation of 3.9 feet. • 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 • Comm 83.22(7) A cony of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number 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. SHAUN R BIRD Sincerely, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charlie.bratz@wisconsin. gov Page 3 6/30/2006 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 WisconsinDepartmentotCommerce PRIVATE SEWAGE SYSTEM Safety and Building Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Tremont Hotel, LLC Forest, Town of CST BM Elev: Insp. BM Elev: BM Description: r ~ ~ ~'-~ I G T' TANK INFORMATION TYPE MANUFACTURER, ~~f-5S CAPACITY 4 ~1 .Y,ryp Septic (`~' ~ ~,,,~ F.1 A ~ " J~7 a ti . r- v i t Dosing // .~w l0 FAe~a4~n ~ ~GS~ ~+. ~ Holding TANK SETBACK INFORMATION TANK TO S P/L WELL BLDG. (~a f' Vent to Air Intake ROAD Septic ~tD t O ~ Z. /g ` g' ~ ... Dosing ~~t I ~Z / ~ , g, / ~. Aeration Holding PUMP/SIPHON INFORMATION Manufacturer i I~ t ~ Demand Q-, ~ ,,~> - GPM Model Number ~~~~ TDH Lift Friction Loss System Head TDH Ft I ,~ 3. Forcemain Length i Dia. . r Dist. to well t 5o z ~6~ SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 488263 0 State Plan ID No: Parcel Tax No: 014-1066-40-000 Section(town/Range/Map No: 31.31.15.4868 ELEVATION DATA STATION ~~S HI FS ELEV. Benchmark '~ • to /~3 . tp r aer, Alt. BM ~ ,3 •~ /~ • Bldg. Sewer 7 . coZ ~~ ~~ SUHt Inlet /0 • t ~,3 SUHt Outlet t 1 Dt Inlet \ .` Dt Bottom Header/Man. * Z • ~ ,~~ ~.' Dist. Pipe Bot. System ~, ~ . ~ d0 I Final Grade '~ I , `7 /az • `? St Cover ~ 3 .°t /oa . 5 ,r C.:or~-o~ f ~. ~ /0 ~ .~ is BED/TRENCH DIMENSIONS Width ~ Length ~ 7 No. Of ren s ~ PIT DIMENSIONS ~~ No. Of Pits ~ Inside Dia. ~- Liquid Depth ~ 5 ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR \ Typ~Qf System: ~ a ~,,,~ ~Q.• t ~ t / ~ ) UNIT Model Number. ~ J /~ DISTRIBUTION SYSTEM ~,,~ (~irK~ Header/Manifold ~ / ~, / Z Distribution t,i~Z~ t ~ ~ Pipe(s) S~ ~ x Hole Size ~ ~ / , x Hole Spa ~ng ~ Ve t to Air Intake,, i a~/ C~l~r.-. Length_ • Dia Length Dia Spacing ~ /CO . SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only i Depth Over I Depth Over xx Depth of xx Seeded/So ded xx Mulched Bed/Trench Center / ~ ,(~ Bed/Trench Edges ` \ Topsoil f• ~., ;. Yes ~ No es Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / f I / ~~ ~ Inspection #2: / / G ~, ,-s.e.~c~ Location: 2609 Hwy 64 Emerald, WI 54013 (NW 1/4 NW 1/4 31 T31N R15W) NA Lot 1~C~ Parcel No: 31.31.15.4866 F:'t~ Catae.,._ ,Plow V 1.) Alt BM Description = ~ 6\ ~ W ~"b ~ a~v~o~ 2.) Bldg sewer length = ~~ - amount of cover = lye- 61d~ d ~ ~'°'° roee s. ~'`°~`r"~ Plan revision Required? Yes ~No -7 t ~ ~ / ~ $' G~ C Use other side for additional information. ~P ,J Date Insepctor' Signatur Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County ~~-1 ~ ~Tl , L ,raj ~~~~~~~~ Madison, Wl 53707 - 71 62 Sanitary Permit Number (to be filled in by Co.) (608) 266-3151 ~,.1 ~~ Z (0 3 Department of Commerce Sanitary Permit Application State Plan T.D. Number ~ Z'g ~ ~~ personal rnformation you provide Adm Code Wis 21 cord with Comm 83 I . , . . , n ac may be used for secondary purposes Privacy Law, s15.04(1)(m) dress (if diff~ t Than mailing address) Pro ~ ~ o~. /t/LW ~ ly T. Application Information -please Print All Information Property Owner's Name Par ~ Lot # Block # ~~ Property Owner's Mailing Address ~ 6 Pro arty Location 3 ~ / '/.,~~~, Section _~ City, State - Zip Code Phone I 1 ".mot C/li ~ .. / N~ R /,) g W t -~- l II. a of Building (check all that app y) ~ i - L I ~ J J~ CSM Number ame Subdivision N - or 2 Family Dwelling - Number of Bedrooms ~l r---~ ^ Public/Commereial -Describe Ilse ~ ~ 5 7 0 //~ ^City_^Village wnship o G ^ State Owned -Describe Use TIT. Type of Permit: (Check o one box on line A. Complete line B if applicable) A' ^ New System p t System ^ Treatment/Holding Tanl: Replacement Only ^ Other Modification to Existing System B. ^ Perrait Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Pemtit Number and Date Issued / Before Facpiration Plumber Owner IV. T e of pOWTS S stem: C k all that a 1) ', i ^ Non -Pressurized In-Groan and > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constnrcted'Wetland ^ Pressurized In- ound ^ Holding Tank ^ Pear Fiber ^ Aerobic Treatment Unit ^ Rxircula g S d Fi ^ Yt Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) q, 1 v V. Dis ersal/rreatment Area Information: Design Flow (gpd) / Design Soil Application fj Dispersal Area Requ~ s Dispersal Area Proposed Sys/tam Elevation ' ~~ ~~r~ I ~~ J J 7~ V /~ ~ D ~ S~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fber Plastic Concrete Constructed Glass Gallons Gallons of Units QQ ~I ~ ^ New Existing h/ O~ ~ ~~ ~"f~ Tanks Tanis Septic or Bolding Tank Aerobic 11•eanmeni Unit Downs cnambar - ~ - VII. Responsibility Statement- T,.the uncle assume responsibility for installatiwn of the POWTS shown on the attached plans. bet's Name (Print) Plum gnature MP/MPRS Number Business Phone Nwnber Pl ! ~ ~(S / C~ State, - • /1 _ % `r `~1..~/ P~..C~~' ~-'V ` S V ~'iy-~/ VIII. Coun /De artment IJse Onl ^ Sanitary Permn Fee (includes Groundwater Date Issuin t Signs Stain Pproved Snrchargc Fee) L~~ ~ O{~ 7 ~ ~0 6 ~ ^ van Reas for Denial ' I7~. Conditions ofA ' aeons forDisapproval ~ / )~~~ `' ,~.~ ~~,~ SYSTEM~~NER: ,3 (i1/ 50 ~ St~u~-I~C. 1. Septic tank, effluent filter and ~ ~, 6 (~ St dispersal cell must ail ba senrices !maintained Cp~-~, I r ~' /"' "°~'`"~' r ~ o.iv`. as per management plan provided by plumber. ~ ~ d~^ Ge must bs rrlair>ainsd l~ • M d . .. s 2. AN ssilbsck npuirstrle 5 ao per ~ppwcslois Dods / ordintnoss. . ..._.. .______._-.-Y..... N..... Qlflrll inn{,~e Sv, eL>ti. Atr9CR C[Impleie p1a6Y tW [uC l.uuuay away) aua we ara.w..... p-y.,....,..- SBD-6398 (R.. 01103) J 9 TROJECT Tremont Hotel LLC NW 1/4 NW i/4S 31 /T 31 SYSTEM ELEVATION 101.5' PLOT PLAN ADDRESS P.O. box 381 New Richmond Wi 54017 N/R 15 W TOWN Forest COUNTY ST. CROIX CONVENTIONAL AT-GRADE CONVENTIONAL LIFT BEDROOM 3 HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Bottom of garage Siding ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark Hwy 64 Scale =1 /4" =10' 350' Property Line not to scale Overflow to ditch Alt. B.M. House Siding C~ 100.0' Existing 3 Bedroom House ~ Area 15' Below System to remain undisturbed B M 2% Slope 100' B -mot, 100.5' Grading is to be done to ~\ divert run-off away from ~ system g _ 3 350' Property Line (not to scale) To be insulated as per code Garage ~~ =~ B -1 ~ Huffcutt Combo Tank ~ WEII ~"ank is to be properly bedde and provided with lockdown covers with approved warning labels PLOT PLAN p1120JECT Tremont Hotel LLC ADDRESS P.O. box 381 New Richmond Wi 54017 NW 1/4 N1N 1/4S 31 /T 31 N/R 15 W TOWN Forest COUNTY ST.CROIX SYSTEM ELEVATION 101.5' 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING~TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Bottom of garage Siding ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark Hwy 64 Scale =1 /4" =10' 350' Property Line not to scale Overflow to ditch Existing 3 Area 15' Below System to remain undisturbed B M 2% Slope 100' B -~. 100.5' Grading is to be done to ~'\ divert run-off away from ~ system g _ 3 350' Property Line (not to scale) Bedroom Alt. B.M. House ~ House Siding \ @ 100.0' To be insulated as per code Garage B -1 ~ Huffcutt Combo Tank ~ WEII Wank is to be properly bedded and provided with lockdown covers with approved warning labels Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m ac:wruanc;e wun wrnm oa, VYIS. AOfTI. l/uuC County ~~ X ~ Plan must Attach complete site plan on paper not less than 8 1/2 x 11 inches in size t • . indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ~ ~ ~ 6 ° ~ ~ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ( ~ C> d -- Please print all information. Reviewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7 7 b Property Owner Property Location ~?_ ~,.~~ ~j ~ ~ ~ Govt. Lot ~ 1/4~/~1/4 S ~ ~ 3 N R J E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# . v. 3 ~ ~ ~- --- City State Zip Code Phone Number ^ City ^ Village Town Nearest Road Je~J ~ ~ ~ ~ .~ ~ ( ) ~ r ~.~ ^ New Construction Us esidential / Number of bedrooms ~_ Code derived design flow rate GPD eplaoement ^ Public or commer Describe: __.____ _____~___.__ ___ Parent material X~.r ~i~~r}~TP.n~~f-~ Flood Plain eleva5on iflap~plicab'le 1 General corrurter>ts 1~~ /~ ~ !J¢., v a l,~ 2.~ and recorrunendations: w 5V (~ ~` ~~~ nod cel I System Type f~~.,-c-~--~ X C Sov"`~ System Elevation /lJ~ ~~ # ~ Bonng pit Ground surface elev,/ G~G~ • ~ ft. Depth to limiting fador G~ ~ in. Soil lication Rate Htxizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. MurTSell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 1 'Eff# •Eff#2 ,~1 ~l / ~•. ~~ # ^ Boring _) pit Ground surface elev~,~(~ ft. Depth to limiting fador C~ ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh., 'Eff#1 •Eff#2 }- • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 'Effluent #2 = BOD < 30 mg/L and TS5 < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ ~ _~- ~~ ~ 715-246-4516 Property Owner _ Parcel ID # Page of ._ ^ Boring Boring # ~it Ground surface elev/~~ ft. Depth to limiting factor ~n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Efi#2 .Z ~~1 I _~ - s m e. 3 _ ----- L' ~? NI ~ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil licetion Rate Horizon Depth Dominant Odor Redox Descxiption Texture Structure Consistence Boundary Roots GP D/fiz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Ong # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon 'Iepth Dominant Cdor Redox Description. Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 720 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL 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 ai 608-266-3151 oc TTY 608-264-8777. sen-saw ~rt.eroo) Soil Test Plot Pla Project Name Tremont Hotel LLC Sh Bird Address P.O. Box 381 ,y ~- New Richmond Wi 54017 TM #226900 Lot ------ Subdivision NW1/4NW1/4S31T31 Date 6/20/06 Township Forest N/R15 W Boring ~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Garage Siding System Elevation 101.5' *HRpSameasBenchmark Hwy 64 Scale =1 /4" =10' Scale is 1" = 40' unless otherwise noted Overflow to ditch Alt. B.M. House Siding C~ 100.0' 2°/ SI 1 100.5' Existing 3 Bedroom House ~ B.M. Garage 350' Property Line not to scale 0 ope 00' B-2 5a ~ Sr~oa~t.. ~ ~~ WEII B-3 350' Property Line (not to scale) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address 1~ 1 ~~ )1Z~ Property Address O~ ~ (Verification required from Wing & oning Department for new`construction.) Cit /State Parcel Identification Number ~/ ~ ~~ ~ ~ __ ~~ y `,y~~,a~ LEGAL DESCRIPTION , ~ ,~ _ "" ] 1 ~~ 1/a Sec. ~, T ~ ~ N R~W, Town of ~~ Property Location~/~v ~ > > _ ,Lot # ~-~ Subdivision ~-- Certified Survey Map # ~ ,Volume ~- ,Page # Warranty Deed # ,Volume ,Page Spec house yes no Lot lines identifiabl yes o 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 cerrificauon 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. Uwe, 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 0 days of the three year expiration date. Uwe certify s menu on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described a , by of a warranty deed recorded in Register of Deeds Office. A OF APPLICANT(S) ~~~,~ `. ~ ~ DATE *i`* Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED This Deed, made between Fern S. Anderson, a single person, Grantor, and /emont Hotel, LLC, a t~'tOILS/!'L_ limited liability company Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): 8~ 7 9 3 3 REGISTER OF DEEDS ST. CROIK CD. , NI RECEIVED FOR RECORD 06/21/2006 10:30A1[ MARRANTY DEED EXEFPT II 11.00 E: 260.70 Name an the s T. M. Title ervt a§, Ir~. 315 E. LaSalle Avenue Barron, WI 54812 014-1066-40-000 _ _ Parcel Identification Number (PIN) This is homestead property. (is) (sixxrat) A parcel of land located in the West Half of the Northwest Quarter of Section 31, Township 31 North, Range 15 West (in the Town of Forest) more particularly described as follows: Commencing at the center of the town road and State Highway 64 intersections; thence proceeding due South down the center of the town road 350 feet; thence Easterly in a straight line 760 feet; thence Northerly in a straight line 350 feet to the center of the highway; thence Westerly in a straight line down the center of the highway 760 feet to the place of beginning. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Highways, easements, restrictions of record, and any acts and/or omissions committed by grantee. Dated this _~ J ~ day of June - ~~ch.r., ~ SS~~- ,_0. A _ ,..._. , . Fern S. Anderson ^ AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) TIiIS INSTRUMENT WAS DRAFTED BY Mark O. Dobberfuhl; Wisc. State Bar No. 01014036 PO Box 137; Barron, WI 54812 (715) 537-5636 (Signatures may be authenticated or acknowledged. Both are not necessary.) 2006 ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. BARRON Cuunty.) Personally came before me this day of June, 2006 ~ihe`~r~r f[>ltngd Ir ~~ Fern S. Anderson, a single persoJr,~SCj~ ......,. ~.~-.~ to me known to be the person(s) Wtuuf dxecytedt(~foYeg~t~ instrumen n acknowle g the etne.~~ ~ ; .~'p;C ,' Qty , ~~= Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. I - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAG'. WI 8UU-655-2021 1of1 commerce.wi.gov ~isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 30, 2006 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING ]NC 1008 192 ND AVE NEW RICHMOND WI ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/30/2008 SITE: Tremont Hotel LLC 2609 State Hwy 64 Town of Forest St Croix County NWl/4, NWl/4, S31, T31N, R15W Identification Numbers Transaction ID No. 1286040 Site ID No. 714831 Please refer to both identification numbers, above, in all corres ondence with. the a enc FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1083202 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. Conde • 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 ~pp dispersal are prohibited. p RTMEN N OF ~ The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. SEE CORR • This pressure distribution system is designed with a minimum distal pressure of 3.0 feet and a network pressure compensation of 3.9 feet. • 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. SHAUN R BIRD Page 2 6/30/2006 • 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 Comm 83.22('n A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall.relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made tome 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 charlie.bratz@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code:-7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 6/ 20/06 Owner:Tremont Hotel LLC Cover Page Location:NW1/4 NW1/4 S31 T31 N,R15 W 2609 Hwy 64 Forest System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Co intigency plan 9-11. Soil test ~ A Shaun Bird Signature License numkfe~f 226900 ~ 9~~'cci /% sq,~ ~ti2 .o F~~ r X006 b'~~`~/ ~~s ~o'a~rdly o~~ OF CON,•,°.ERCE ~ LDItV -SPONDEN . ~.~---- ii'~~ Date 4" Observat:i~t Pipe Perforated Below Filter Fabric . AS1~i G-33 ~ Q ~' ~ `~~ r ~ " T~pLOff ` Non-Woven Filter Fabric ,Q+stribuiion. Pipe l -~ ~=_- ----- F ,._ r Q E c _ .., 7. grope ,Bed dt ! ~- 2 % Farce ~F~in _ ~~ I Fram Pump train Rack Crass Section Ot A 1~aundt an5~rtaUsfn p Se6 For The AbsorQ . A ,~ Ft. g Ft. ~ l ~~~ tt. ,f ~ -- ` %~'~ r r of 3.~' / _ ~ \_F fowe d Dyer/ ~'~ _: ~ F _ ,~ -~ . &' ~ ~j~ f't ~1~- - f_ '~'if.~ ft. . - - . _ . - ~' ~'~ '~rt - ~~ ` ~"dbser~aiion Pi~se-~ iK ~ ~ - j Forst MOirt -° ~ ~ ___ ---------- --_. -_------------------- f From Pv~D t _ l . ~- ~ Bed Off - Z' . ` DiStrib~tion 2 = ~ -Drain Roc~L E'ipe 4 a~tsrvaiic+n Pipit=-i~C~.~ Permanen{ N[orker ~St~ei f ~ ~ ~ ~~~~ ~'~ '~.sP"; Pe or Rods t~ Pt~n Vitw Ot..t~tound Utt~ A Bed .far Tnt Atistsrptian Ares PAG Ei F..-- ~~ Lcra~eQ Qa Botsosg. Eq~~Y spoct~ ~= stfli.L t~.X'C sa G~}'ost r Ft . Si gnec! i.ic~nse Huffer: ~3~te: ~.'' X Irtt~+es ~- '~ • ~nCh25 _a Hole Di~a~eter ~~16 Inch iaterai -p ~ . - inci~{es~ manifold ~ -Z iarthes Force 1Y}87 A " ~ ~ttc~eS ~ of ho~esiA~€~ .avert ~~e~rat~on o~ laterais~`~~~"t,-- . Pas#Cea#%d ~iDe i7t;a`si ~; r Cr~.t?SS S£~TiCN ~'`~~ SP£C~F FLAT=DDS SEPTIC TR~iK ~ P~3*iF CtiAMfi..R ~~TN~~PR~}tI~ ~,__ ~~. u£NT PIPE I2'= HIS. ABOVE GRADE ~ Ji3NCT~~~€ $OX AFFR$V£D ~dIA3I}fI~ €1R MOLE COVER > ~` ~`Rtki t3CflM, wIT~€ £p3+I~3tIIT ~1 PADL~x ~ ,~I~t IirtTfiiCE ~ WARMING iA$E~ ~~ v _ -_', ~$ ~8° /i~. - ~ = s :• `, I#LET ~ :. GAS- _ '~pp~tpYEO ieiATER TIGHT 5£ALS -~-' .rI~HT, A ~ ,)t?I1iTS 1i;7'~i PfLTFc~ SF~sL L j ALI"~ ~P Pik _-~___ ~~nn $ = s ~ .7fA~~i7 ~i~ KQ~~~ ~ ~ PI?E 3` C : t FF OHO $Qf,ID ~ ~ ~ ~T _ -~`"" . ~~' AppRpYEi~ $Ei3I7ING UiJDER "~AN~C ~ CDi~Ci~£>TE PAfl SP£CIFIC.A;IaTaS st DOSES ?~ i7AY = ~.`.~ gEpTac ~ nasE ~Ma~ :. Tf~iK I~A2~1U~'ACfi3R£R = .; ~ ' ' ?~. / DAI,- ~.~~-~~- GAi.. . i3flSz, itO~~~ FNL~~c~ TAli1C SZZ£S: g~PTIC _QJd ~ -~ - ~L. ~i ~.~d[) CRPi+~C ITi IIS ~ A ~4L. AI.AR2"E MA~~'ACZ~3RER,a ~ c ~ 2 yHCH£S . = ~Z.1-~--- ~~~ 1~ _ ~ p0'I~JR£R s J ~ '! GAL. - HoDEL ~uHS£R : - s~ .~ 15.23 r~-c Sietl'~CH 3'~i'PE= ~ i~IIFt~AiG AS P£R ILHR Pi3TfP ~ Ai~iK GPri _ ~(~ FEET R£QUZR£D DIgCKARCiE RATE ~ _ ~--FEET VERTICAL DIFF£R£NC£ g~7EEN pgJt4P t3F£' ANF:-flISTR€gUTION PIP£ T~-~--~----- S€~PPLY PR SS RE - ;CTIaN FACTflR ~• ~ FEET + MII~I~M M£T~T~3~K rT~1€3i3 F'I- £R ~ ~ Fi ET FOgCF~IM X ~ ' ~TAL 7Y,~"~C ~i£AD~ =d' . +~ .~' - DiAt'1£TER .------ AL DZME3~SIGM~ ~tF p~M? '~~~= LIQi~ID ~_~- I ~1T£~ S FOAfED 1f$S Sent aY~ fiP taser.let 3100; 7 715 552 8827 ; May-5-U6 1:56~1N; Nape 11:i 9EH SERIES SUNtPIEFFLI.IENT PUMP Specifications ,19ia ca 1~ssa>i ti c rant+~~iwp~ ~ ~s1 n~eaa ..rR ~ratara tM. ~ 1~9ri B- 11US pf4.hq AIUS$I QS q tf 13' ~ /L1 RI flkl BFstxt$ 8F}Ft7hf 588380 OLASA 4t:0 tt5 3'4 t3A ttkAl 70 54 55 41 32 t3.B 2tt 24 9.H x11.5/xB.94 ~{.~ ~3q0 0lRSA ~".$ 23D 3A 6.5 1008 70 6d 55 41 32 1&$ 20' 2t 9.41:11.64x$.94 ~{.~f$S $~0 B11C54 6"8 7t5 314 t3A 1000 78 _64 55 dt 32 13.$ ~' 27 9.11 x itbtx6.~ ere 509ffi(f Itlm'A N'0 230 3t4 S.S 1000 70 fi4 55 tt 32 f 3.$ 37 27 9.11 x 11.ti4 x 8.94 Con>n4ous DutYRa4N-'1.~4 Fi~WU4ewaeerp~SFeraeOwn~awus4ufvaSbnOastaeY4-4runwMUS ri4W~h4dafnDslarf~ese wnros. fLQW- L[TERS/NQR °< wwtiwLittleGiantPump.co>n Motor Houatng Imgelter lytateriat t0 aua u. '^ ~'~ W Power C:orQ ,,, Nlechanic:al Shaft Seat a Fasteners Shaft 2.g - ------~- --- Heazings o ... .. i Epoxy Coated Cast Iron Poly Carbonate . Closed Vane ...-. _. . -ABS ~~ -----... Nitrite with carbon and ceramic faces Stainless Stcef ...i. Stainl~ Steel Upper Sleeve and Lower tiatl Bcariags I,ittie Giant Pump Co. PO Sax 12U1U • (Ndarosa CSty, 0!C 13I57 Phonr. N5 +14').2511 • Fax: ~05.228.155U E-m.il: eas4ooettdegiaateoo fatrrt 945235 - 07(03 FLQw- GALLONS/!eINUTE PUMP PERFORMANCE CURVE 115V 60MZ -- ER'S NSANUAL $c ~[ANAGEME~~T~oxs ~o~v~rs awN stsT"Eltill spECll+r ,~Git PAtr~ " {~ N ~,~ of Bedr+ t~umb~'+~Comrn~ Units ~ alld~ ~ flaw 4a,ne~ag~? a: ~~"~' X 1~ ~n tbuY (peak, ~ • _ 1 l ~ d Soe APP~b° Ram onthtY svera3e_ M >r,ttsrentl~~ Quafity ~ _ ~ ~. lL p~ ~ (BODs} ~ ~ 42t7 mg , Seeds ~tSS) ~~ S't 5Q m IL " s Monttsty average Eff[t~ Qua~Y Demand tg00s? ~ . S30 m~ n tcai pacygen $~ oral SaSP~ded SaT~ds ~~7 ~c tne~) S30 mg - s~ t2` dpi QOmi Fecal CoGfocsm (9~7e ya inchd<ameter Ma>~-~ ~fluerst parade Site Septic Tassic CsP~`r ~• •.•. ~pfic Tanis Mangy ''t- ~~ ~ Matttttsc~lrer ~tuent Ft7ter~l~iodet /~- "" L Tank Capat~tY Pumg• pump Tank Manor pum Maricsfa ~ `~ Pump Model ~ Pretn~trr~~n~mF~ II p Peat Fler>~.r t7 wetland ~echanic~l II Disinfection pEher. 8age~ of ..> ~ n lva ~~ IdA iVA t7'~~ ©tYA D NA • ~--~ NA ~Ilurac..w-~ 5 -- t3ispe~ ~C 7 ~ ~ t:1 round (pressurtzedT a In-9~ryd (g~RY) ice" © 'other_ p ~-gcade -- tot far daenestie (twnmct'me~f yr yshses~~~~ ... vatues tytsi~ for P~''~°a U Seririce F~c!_ u_ e` Seivitx gent At least once every D 1 ~ won of tanK(s3 Purng out contents of tank{s~ ensued dy~~ ceU{s)_._____ Clean si3iuent filter t~pect pump, Pip controls ~. aia~ Flusf+ lam a~ 1e test when combined stodge and scum eGyP'° At Least once every At least once every pt least once every At least onus every At least once every At isast Once eVesY ^ rctonths .) {Mapmusn 3 yrs.l {s;) of tank votus'rae ~~ {lst[axtmum 3 yrs.3 O NA p rrianu ~, - `------ CI months - s} ~ t~A p months II Yea~fs) O NA II ~~ Q its? ^ NA one of ttie ~ iieexsses or >idAtNTH+fAl11CE i~pCT[ONS i Ue made by an individual carrying ppytitr5 Maasta~ SeP~ liypec6ons of tanks ar~d Ma~ i' Piurnbes E2estricted Sewer, ~ ~ e ~ idenSTY any or uP Master Plumber: sndude a artsuat inspe~ scorn an>i m check fiot any S ns must -ore the tirotume of apmbined 5lud3s eftilct~st revers r. Tatttic inaP~f° u,spe~c~bed fo check the or teaks, ~~ hardwar8. tdent7jr any 7'tse dispel Ceti{s) shall be viscraily ent ors e oracles d surface- ralind srlrFaCe_ The porsd'ing of eRiu ~, ~-~g pi` ~tuetst on the gam' for any porsdirsg of efftuent an ttse 9 fion of ttie tvcaJ ^~~' ~°~ in ffse v~ p~ and bo ctsedt tt3on and fe4~cres the irnmediabe notifica of tisElre Of ~ i2nk volume, the gnst~ may ind~caEe a fasin9 coed min any tank egs~ats one-third ~? ~,~, ~h. NR When the combined accurrs~ be moved ~ ~~. Se~ng p~~tQr and dlspo~ ar ~' ~ of the tanks ent oampon and any ~ttite t~ot+tients ~ - eras; 113. Wise Administraf~ Cod ~ p©IAtT•S oompanents. Pam fainet anicai or pressurrz~ a F01A1't-S Main Ttte ~9 °f ~uent igters. meth tefion of any service ~,rtnt. oe or manitprin9 at intttvsis ~ ~ 2 months or less shalt ~ of ct~mP oiflerrrlail'ttenan tabu suthanty wlthln A reps sisaR ~ ceded to ttse Joni Lego ~' of pantfing ~dut~s ~ °~'er sTaRr t!P RAtO OPERA770N treatment tanks} fore P~ are Eor new oonsbrutxion, prior bQ use of the PD~S ~ s if high conou- rm a the t~eatrn~t pto~ss arsdlor damage #f sa ~isg~ ~ ~ to use_ chemicals that ~Y ~ P~ s removed by a septage servicing operator p dt hays the ovntents of the tank{ } ,-; .• _ Page pf "'~~ ~"conditions are frozen attlZe infcitratnre surFaCe_ g start up snail not ocair vvrieri son is tes~oed the excess Dcxring o~ges t~P tanks ~Y ~ abov~C } ~ a e is ~e hose, osre~ (s} acid maY resuFt m Ltie .mac-+nrIIt be ~ Lo ilae cC~~ ~qup or sclsfacs age ~ ~~_ t Ta av~aid~s~ah~'orf~F ~~p contents of the primp fa»k removed by a age Ser~g OP~~ ~•~ r~ Pow ar ~~ a Pitttribes or POYIITS b~aintainer m SSSiStiti titarllE3lljr ~ ~;p ~t7pf5 to restore normal Severs aviffiirz the grump tank. pQ not dmre or park ~ per- and dfsp~ ifs- Do riot dive at panic over oro~etwise dist~ui~ oi•oaltpac~, ~ at~a wiHittt 15 feet down sbpe of any tno~tF'Id at at-~'rade sa't absorp~4n area- Re;1~R or>eianinati~ of fhe ~otiowinJ from the wastewater stream may improve #lte peFfemranoe and prolol3g ~ dganette baits condoms; mttoa swabs; degi~asers: deFtlal ASS; drapers of the P01A(f'S= Ott ~3' ~ vsrater; fltlit artd vegetable pee~9~ 8~% 9 ~~ ll~eat dam- t~ fotutdatiori diain ~scarip PumP3 - n~ olfi g ~~° Pest des` sattr~ary napkins: tampons: and water s biine_ ASANE}ON~ENT taken out of service rt,e fnIIa~vrng steps shalt ~ taken fa insure that fie Vllfien the POV1t'F'S fails andfor is perttlarierttlY ~n is pmpetiy~rt~ safety abandoned in compliance with ch_ t:orrim 83.33, SA~csaorisin Admhiistative Code= ~[ ptpittg to tanks and Pits shall-L>e disoonriected and tfie abarxfonesi pipe opens The contents of ail tanks and f~ shall 17e rerrsoved and prnperiy d"csposed of f+Y a $eptdge•Serviatig • After pvmp~g, atC tatiKs and pRs shaft be excavated acid removsd or weir caY~ers rrma+.>~-mss ttas space filled with sail, gravel vranother inert so&d material CDNTiNGENCY PL/~I If the PDVYTS fairs and cannot be repaired the fol[rnwing measures have been, ar must be takerk to przrn+ide a code cx>mpGant neplaoeriieni sysfiem: . D A suitable rspiaoernent'ariea has been evaluated and may be utFlized for tiie foc~tion of a repisoerrierit soil absorption system- The nePrant area should be protected from d~isfztrbance and coriipac~3on and should rtoL setbacks from e~ng and proposed structure, Fot lines and virelrs. Failure th be infiuiged upon by requu~ed protect the replacement area w~ r+esutt in the need for a new soil and sits=evaluatioti to establish a suGabie repFacnement area Replacement systems must carnply with the rotes in effect at f3sat'ficsie_ D A suitable repfacemerit area is not avar7able due to setback andlor soil [imita4ians~. San'ln9 advancers rn P4YYTS technology a hotdiitg tanlcn~ay tie ynsiaFJed as a last resflrt to replace the fa[~ed PdWTS_ site has nest been, evaluated to identify a suitable replacecnerrt area. Upon bu'Tufe of the POVYTS a soH.and /~srte evaluation must be ~ to Iocate a suitaLsTe replacement area- ff no r+ePtacersierrt area is ava?jabte a, JQirig tank maY tie iristafled as a last resort to replace 'the failed POVY'1"S_ ip~riotirai of the broiirat at and at-grade saT absotP~n penis n~a}' be recons7ructed fn pfaoe fnrravsrinS the in~ti'afine surface. of suet; sjrstems must comply vrith ;fie nrter ;!lfi etiGCt at ttiat• 5me. <cVtfARI+1iN©? SEPTiC, PUMP AND OTHER TRF.ATNIENT TANKS FSIIA~ (:O~T7'Attrt LETHAi_. GASSES APi1310R INSUI"I=IG[ENt 130 HOT ENl'1`R A SF.PTiC, PtJJN[P QR QTHER TRFATMEI+fT TANK t;IIStDER AItiiY CiRCIJMST1ti+iCF.,S. E3EATii MAY RESULT_ . RESCUE.QF A PERSOl1I FROM THE INTERIOR t3~ A TAt+1K iVfAY BE DIFFICULT OR iMPOSSIF3L1=. ADDITIONAL COMMENTS POYY3 S INSTALi.ER ~taFne Phone / ~ ...- ~--~ ~~ ~' PC~S l~ikllsii'AiAiFR lYame - s~~-Lt%~ Ptl~ne ~/~ j ~° ~ J.- SEPTAGE SERVICING: OPERATOR M Lt)CAL RFGU1J~TaRY hE1~HO~I'IY l~tame jam'> Phone //~ '' Z' . L ~-' , ~'' i~hons / f'..~ ~ ~_ rt:a coaar~t aras dratted bY. trie siafl§ of the 4(~p [.atre, Marquette and Waushara Caurrty ZanIng and Saniratioti - Thy d0~ iiteets ttze mitdmcars requi~err~entx or cit. Cagan Ss}Ct}Cfiadi} acrd Eli.56(1}. (23 & (3j, Wssrxxtsin fldnilnl5trative Conc. the of fhrs t d005 floc gtiaiarRee the performance of the POw'rS. t~~t 1 Parcel #: 014-1066-40-000 o~io~i2oos 04:39 PM PAGE 1 OF 1 Alt. Parcel #: 31.31.15.4866 014 -TOWN OF FOREST 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 -ANDERSON, FERN S FERN S ANDERSON 2609 HWY 64 EMERALD WI 54013 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 2609 HWY 64 SC 1127 CLEAR LAKE SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 31 T31 N R15W 5A TRACT BEG NW COR OF NW NW S 350' E 760' N 3 0' W 7 ' Block/Condo Bldg: , , 5 60 TO POB Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-31 N-15W Notes: Parcel History: Date Doc # Vol/Page Type 04/11/2003 716901 2203/253 TI 07/08/1976 334073 539/538 WD 7i111R CI IMMdRV Bill #: Fair Market Vatue: Assessed with: - - - - - - ------- -- - - 0 Valuations: Last Changed:. 10/18/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 30,000 61,400 91,400 NO Totals for 2006: General Property 5.000 30,000 61,400 91,400 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 30,000 61,400 91,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00