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HomeMy WebLinkAbout042-1080-30-200 ny0 3-0 n r~ T n 00 w 3 O G a iv N 0-4 0 d Z fzz N@ 7 p ~f N a d N O~ A W •~t' ° o v W N 0 O 3 UI d -°w O O Q 0 V F~ b Yj W (D co (D W CL Ln -4 -0 CD m N s 1 3 a o cc =r N n Z a u ~~I rt Z rt co co r- x ° rn co 00 rn a n N N 9 N ° a 00 a o 3 ~ r! ao ;a 000` N Z w ~j q I ca to N o D p~y (D ry, V ° m rt CL a 0 H y a 00 O = !~1• y CD U) O H H Z N 0 a ~ ~ z t=i I w m z CCD N 0 00 UQ CL o_ rt rt O N co NCL z N C N y p a C CD N a G '7 C Q O N C Z O N O m ai 3 ry y ~ I ~ O ~C 0 fD O^ 1 d A p~ V O N O ~ O M o ro c~v I ° ~ o CD r v CD ° Q • Form- STC-104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T _,.r~N-R /P W ADDRESS, ST. CROIX COUNTY, WISCONSIN Syo 3 SUBDIVISION LOT LOT SIZE ,7~ a«eJ PLAN VIEW Distances and dimensions to meet requirements of 11148 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7} zev i / y,' 3 3T- ' 3P o~ o rrcr INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: 2 SEPTIC TANK: Manufacturer: G(/cc,E Liquid Capacity: i_.ioo Number of rings used: p Tank manhole cover elevation: Tank Inlet Elevation: QS,9YJ Tank Outlet Elevation: F7, p~ Number of feet from nearest Road: Front 10 Side JoRear, O > smo feet From nearest property line Front 10 Side 10 Rear,0 > ivo' feet Number of feet from: well } 5-e' , building: 6 ` (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE f PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ✓ Trench: Width: x 7 3 Len the - Number of Lines: 2 Area Built: ST~LTu Fill depth to top of pipe: y" - Number of feet from nearest property line: Front, `Side, O Rear, 0 -Ft Number of feet from well: so' Number of feet from building: ~16' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: X Dated: -4;Z46 Plumber on job: License Number: 3a~9 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. Box 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE Sute Plan(, D. Number: r ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (lf e~figned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTI N D E: ~ Harold Peterson 1995 W. Cty Rd. B, Roseville, MN 55113 , la> j BENCH MARK (Permanent reference immt) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. EL V.: CST REF, PT. ELEV NE SE, Section 29, T29N-R18W, Town of Warren Name of Plumber: MP/MPRSW No. Cnunry Sanitary Permn Number Dave Fogerty 3289 St. Croix 83851 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING TT COVER E, PROVIDED. PROVIDED. o-o f7 BEDDING: VENT VENT MATT HIGH WATEI J YES ❑ NO ❑ YES NO ALARM NUMBE R.OF ROAD: PROPERTY WELL BUILDING. FR I FRESH ❑ES NO fEET FROM LINE i A1R VENINLET Y ❑YES NO NEAREST ((p 1 DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY Pl1MV MOUEL PUMP,$ IPHON MANUI AC TI III EH WARNING LABEL LOCKING COVER ❑YES ❑NO PROVIDED. PROVIDED GALLONS PER CYCLE: PumvANOCONrROLSOPERAnoNAL ❑YES ❑NO ❑YES ❑NO (DIFFERENCE BETWEEN NUMBER OF PRQPERrv WE LL BQILOwG VENT TO FRESH FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I F N(,TH InAMF TE H MAT I H11 AI ANU MAHKINC, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTH PIPE SPAOINI. COVER TNENC/IFS MnrE A INSIOL DIA -PITS DLIQUID 3 L' DIMENSIONS IT Z P . EPTH . GRAVEL DEPTH FILL DEPTH DISTIL PIPE UISTH PIPE DISTR. PIPE MATERIAL NO UI$ IH NUMBER OF OF LOW PIPE(( ABOVE COVER F I E V INI I I ELEV ENU PROPER 7y WELL BUILDING V NT TO FRESH 7 Z PIPES FEET FROM LINE AIR NLET NEAREST--. MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURF PfHIANFNIMAHIfI I S OHSEHVA7IONWELLS DEPTH OVER TRENCH BED DEPTH OVER TRENCH HE[) ❑YES ❑NO ❑YES ❑NO CENTER 1111 VT11 OF TOPS(- SnOUf l) SFF UFD EDGES MULCHED PRESSURIZED DISTRIBUTION SYSTEM: ❑YES. ❑NO ❑ YES LINO ❑YES ❑NO BED/TRENCH WIDTH LENGTH NO OF LA TEHAL SPACING (;RAVEL OEPiH HE LUW PIP[ FILL DEPTH ABOVE COVER TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTH PIPE DISTHIBUI ION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV DIA ELEV PIPES DIA DISTRIBUTION INFORMATION HOLESIZE HOLE SPACING FFILLEDCORHFCTtY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS NUMBER OF - vROPERrv WELL: BUILDING: OM LINE ❑YES ❑ NO ❑ YES FEET FR ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE ^ TITLE DILHR SBD 6710 (R. 01/82) /Ld- ZEE ~L R SANITARY PERMIT APPLICATION couN Y In accord with ILHR 83.05, Wis. Adm. Code ' STATE SANITARY PERMIT # 9 3kS/ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION r "ZI ' %4 '/4,S y T N,R Y E(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME vs- ( ; -T.. - CITY, STATE 121P CODE PHONE NUMBER CITY : NEAREST ROAD, LAKE R LANDMARK LIT TOWN ❑ ILLAGE : Oe2 e/ tiv kn 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. E1 New b. LYJ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. 121Conventional b. E1 Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. E1 Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 2'See a e Bed b. ❑ seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): r~ t Feet EiPrivate ❑Joint ❑Public VI. TANK CAPACITY Site in gallons Total # of . Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tan Tanks structed Septic Tank or Holding Tank 1 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) -NW/MPRSW No.: Business Phone Number: 77- c, f 7 t rF !c' Pl~er's Address (Street, City; tate, Zip 130de): Name of Designer: c~ • P-l II. SO TEST INFORMATION Certified S 4 Tester CST) Name CST # 3 3 CST's ADDRESS (Street, 151ty, State, Zip Code) Phone Number: IX. COUN /DEPARTME SE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature No Stamps) A roved Surcharge Fee pp ❑ Owner Given Initial is 0 As S Adverse Determination ,O►/ 6 ~ X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION Y TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your privat-sewage system, contact your local code administrasor c- ties,; State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application muss: include: L Property owners name and mailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. - GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more . commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground r, water - - included the creation of surcharges (fees) for a number of regulated practices which Wisco *in 's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure is used in your building is returned to. the groundwater through your soil absorption:. system°or the disposal site used by your holding tank pumper. _ The monies collected through these surcharges are credited to the grouruiwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring gvourld- 1 V.11ater, grou!~jwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (8.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property 114, Section ;21 T91? N-R_/;~9 W Township J ling Address ASGtiA_Ly~ Address of Site Subdivision Name Lot Number Jy, Previous Owner of Property ~3 Total Size of Parcel Date Parcel was Created Syr ^ Are all corners 'and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes V No Volume 31(.-and Page Number 2t{O as recorded with the Register of Deeds. CIINCLUDE WITH THIS APPLICATION THE FOLLOWING A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ceAtijy that a t btatement,6 on th" 60tcm ane tAue to the but a4 my know-Ledge; that I (we) am (cute) the ownen(,s) 06 the pnapenty desctiibed in h.f~s ) .in6onmati,on Sofrm, by vi tue o6 a waAAanty deed necanded in the 04jice ob the County Regusxen o4 Deeds as Document No. 2q,0 1 and that I (We) pnesentty own the pnopased site fah the sewage disPas -6 y~ em (on I (we) have obtained an eaaement, to nun with, the above described pupeAty, 4an the can/Sth.uction as said Aotem, and the same had been duty neconded.in the 046ice a4 the County Reg.usten o6 Deedb, as Document No. ?V0 SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED L N z H a STC - 105 r' - r • a SEPTIC TANK MAINTENANCE AGREEMENT rH-+ St. Croix County z d WA4WOO~_~ OWNER~ER ~n ROUTE/BOX NUMBER Fire Number .CITY/STATE ZIP -.J PROPERTY LOCATION:,VA2~, Section 4,9 T27 N, R _W, Town of St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into II the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank.is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office withi 30 days of the three year expiration date. SIGNEDC)t .*-DATE St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATI VON SECTIO~T~~ N/R~~E to TOWN~arrCK LOT NO.: BLK. NO.: SUBDIVISION NAME: 1 MAILING A OUNTY: OWNER'S/"' DDRESS: r ) f USE DATES OBSERVATION MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: ❑ - PROFILE DESCRIPTIONS: PERCOLATION/TESTS: Residence L/ New E4 eplace s ' s RATING: S= Site suitable for system U= Site unsuitable for system CON TIONAL: MOUND: IN-GMUNS URE: SYSTEM-I L HOLDING T :RECOMMENDED SYSTEM: (optional) [DS ❑UU fL~.l E]U S U S S 6 9 r If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: C Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF S CAL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 7 ' J~ 1 r r' Iyit B- B- Z > 'Pr B- 3 P9 ? 3 r > 9 . s 9' i~ s B- r y s ~f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERT D 3 PER INCH P- r' S y a .4 2 71 Z-1p 2 P- P- 3 P__ P- 3 2 s- l A14 i L 2 L PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION E 3 : E , f I 9 . - 1 3 ~ t 3 N i E E t , e_ 1 I r > 3 1 1. i f 1 3 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. N E (print): TESTS WERE COMPLETED ON: AD S: CERTIFICATION NUMBER: PHONE NUMBER (optional): o e r 2~ 6 j ZZ9 CST SIGNATURE: ~©6er-~, ~z Sy nL~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRU TIO S F I ° , ARM 16 - S - 6396 r report dude: u~ fS S- TANK ONLY J~ ".?_L. . F ! ,,ompleting t. 7. _ to scale is p - A 8. V .t : -Nn, and a- neat; 9, C t_ v_. cola n emir o a i, the . x; u t U~ w_3 BE FIL__ TH THE `,Y t IN Di FIFp...i S « 7 sro C H( 6 arn tz y -y -lay 4i T • w } I Nt~ V. _ Is ~1 M ~1 ~ ~ ~ a ~ b n ~ ~ ti ~ ~j ~ ~ o i ~o i ~y . 3-- a y s- ' ~ j ~ u ~ ~ ~ ~ ~ i ~ 1 ~ j ~ i - ~ s N j i o ~ ,P ~ ~ ` A Z 1 i I ~ ~ F11 - hN J ~ ~ e' ~ i w 0 Z~ V-~_n~ y _ 1 I i f ~ 4 ~ I i s• ~ F N O ~ +l `n 5 V ~ O 13'x' p~ V I o i i I ~ ~ n 1 ~ Parcel 042-1080-30-200 o2io7i2oo7 11:56 AM PAGE 1OF 1 Alt. Parcel M 29.29.18.457B-20 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/20/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - PETERSON, JAMES R JAMES R PETERSON 737 107TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 735 107TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 4.060 Plat: 5129-CSM 20-5129 042/05 SEC 29 T29N R18W PT GOVT LOT 2 BEING Block/Condo Bldg: LOT 02 CSM 20-5129 LOT 2 (4.060AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/18/2005 800499 2844/402 EZ-U 04/13/2005 792099 2783/015 QC 01/25/2005 785727 2736/292 PR 07/23/1997 190/445 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.060 60,000 20,700 80,700 NO Totals for 2007: General Property 4.060 60,000 20,700 80,700 Woodland 0.000 0 0 Totals for 2006: General Property 4.060 60,000 20,700 80,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 042-1080-30-100 02/07/2007 11:46 AM PAGE 1 OF 1 Alt. Parcel 29.29.18.457B-10 042 - TOWN OF WARREN Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/20/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - PETERSON, JAMES R JAMES R PETERSON 737 107TH ST ROBERTS WI 54023 Districts: SC = School SP = Special rty Address(es): * = Primary Type Dist # Description 777)07TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC L; C s~ Legal Description: Acres: 12.220 Plat: 5129-CSM 20-5129 042/05 SEC 29 T29N R18W PT GOVT LOT 2 BEING Block/Condo Bldg: LOT 01 CSM 20-5129 LOT 1 (12.220AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/18/2005 800499 2844/402 EZ-U 04/13/2005 792099 2783/015 QC 01/25/2005 785727 2736/292 PR 07/23/1997 190/445 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 12.220 80,000 246,600 326,600 NO Totals for 2007: General Property 12.220 80,000 246,600 326,600 Woodland 0.000 0 0 Totals for 2006: General Property 12.220 80,000 246,600 326,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/03/2006 Batch 06-15 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 042-1080-30-000 02/07/2007 11:46 AM PAGE 1 OF 1 Alt. Parcel 29.29.18.457B 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/20/2005 00 5 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RETIRED PETERSON O -PETERSON, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 737 107TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 29 T29N R18W 20A ALL G.L 2 E OF HWY Block/Condo Bldg: EXC LD DESC TO G. W. THOMSON AS IN VOL 190/445 ORD Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 29-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/18/2005 800499 2844/402 EZ-U 04/13/2005 792099 2783/015 QC 01/25/2005 785727 2736/292 PR 07/2311997 190/445 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03121/2006 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00