HomeMy WebLinkAbout026-1137-04-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
405026 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 Vilfage X Township Parcel Tax No:
Perkins, Bob I Richmond Township 026- 1137 -04 -000
CST BM Elev: Insp. BM Elev: BM Description:
/0 0 Car r D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic V I A Benchmark i
Iar�O (oZ oG• /oo
Dosing `'� — � � � Alt. BM Sr -
�i
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO 9LDG. Vent t it Intake ROAD Dt Inlet �-
W,? Sto
Septic /� n Dt Bottom
> 127 77 v
Dosing Hea r /Man.
T � � g7•
Aeration Dist. Pipe / q. /
Holding Bot. ystem
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Dem d St Cover p
GPM �� 3 - 3 / D Z ,
Model Number
TDH Lift F ' ion Loss System Head TD Ft
Force main Length Dia. ist. to Well
SOIL ABSORPTION SYSTEM Z Z ,is.?�✓S
BEDITRENCH Width t Length No. Of Trencfj PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS to l l l ) L ��
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI Manuf er: ,
INFORMATION CHAMBER _ lC t
Type f System: / & . I ( > I L r n UNIT Model Number:
/
DISTRIBUTION SYSTEM n a/
Header /Manifold Distribution 1 I x Hole Size x Hole Spacin 1 z Vent to AA,ir� take Q�4f dr
/ h Pipe(s) Pt j� � � 7 N�"c
Length Dia Length Dia pa ing _3_
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 i / I Bed/french Edges Topsoil Yes ; I No =1 Yes �16, ]No
� ` /_Q Inspection #2:
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:17/ y
Location: 1120 148th Ave NeW Richmond, WI 54017 (NW 1/4 NW 1/4 21 T30N R1 8W) Golf View Acres Lot 4 Parcel No: 21.30.18.960
1.) Alt BM Description = 9r,Co� P l j Y f�� / k� Imo"' QA_/ Ai4tU_t QlteRY
2.) Bldg sewer length = 7 "'1'l9- 133 • �dY�, 0 f ,y,<4ej r-7 ,1 hIPA -2 j btc t h2 v`rl�C��
- amount of cover = 2 C'k��►w i s �H nrned Se d
Plan revision Required? 1�',j Yes s , No
Use other side for additional information. � _ - - --
- - _ � l�/1/�i�.
Date Insepctor's ignature Cert. No.
SBD -6710 (R.3/97)
4
I
� I
Safety and Buildings Division County i
201 W. Washington Ave., P.O. Box 7162 ✓C ! C Yv • X
® iseonsin Madison, WI 53707 - 7162 Site Address
Department of Commerce - 01 1 10 //y� //a U
Sanita Permit Number
�Y
Salutary Permit Application 4 s54
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for secondary purposes Privacy Law s15.040)
I. Application Information - Please Print All Information RECEIVED State Plan I.D. Nymber
Property Owner's Name Parcel N ber
� ,-. S APR 19 2002 �- l 3 "-7- a - 066 7 41G
Property Owner's Mailing Address S CROIX Property Location . 30 • 19- %-0 G
vL° ZONING OFFICE COUNT l 'A 'A: S (T N, R 10
City, State Zip Code Phone Number Lot Number ley" Block Number
Subdivision Name CSM Number
e m><'t/Sc 3yd� l5'ay7��/�1� ielj cv'e�S
H. Type of Building (check all that apply) /7 ` Dory �`k X
�1 or 2 Family Dwelling - Number of Bedrooms 2�'� �
R -9-U'ZTLZ ❑Village
❑ Public/Commercial - Describe Use dUrn.�h� 3 dit Township r �ox jn
❑ State Owned Nearest Road
M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A For County use
1 New 2 ❑Replacement System 3 ❑Replacement of 6 ❑Addition to ?
System I Tank Only Existing System I
B. ❑Check if Sanitary Permit Previously Issued
Permit Number Date Nsued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) tit
44A Non -pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland �lGYkLGwn Z "�
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 5� 3/• S.
45 ❑ At - Grade 46 ❑ Aero 'c Tr tment Unit 49 El Reciiculating 30 11 Other 3 / X 69 ' 75 � � �' <�
V. DispersikMeatment Area Information: .2 S, e
Design Flow (gpd) Dispersal Area Dispe oil Application Percolation Rate System Elevation Final Grade
R ' (_4-1 posed T' �te(Gals./ Days /Sq.Ft.) (Min./Inch) Elevation
�l,�d e l V.2 6r --/A - / ,>,)a-- Ili e- 0 � 917,
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing l /Z/�zll� /7 Ad Al-14
Tanks Tanks
Septic or Holding Tank j/ ®� / • eS y
Dosing Chamber �
VII. Responsibility Statement- I, the undersigned, assi� responsibility for ' tion of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number
Zt1�'1! G�ldl►�e ,--� - ?a7�PrJ 7!S ��G - 3l� 1
Plumber's Address (Street, City, State, Zip Code)
County/Department Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued mg gem Signature (No Stamps)
Approved ❑ Disapproved Surcharge Fee
❑ Owner Given Initial Adverse
Determination # Y�
Conditions of ApproovaMeasons f9r Disapprov
'` U i cGR 6 tZc7t ' aww ct t )50° Fnrn� Sf�S - ✓r,� t� 4(�4�- iufh {t�uwn-&��cZI 1
I �6Y►�CU? t4J f �, C`Gl� �rt f �6 vn f CQc�u -ru ✓nu c�zfr�2 r,
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size
SBD -6398 (R. 05101)
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vuisoor>sin Department of Commerce SOIL EVALUATION REPORT Page of 3
Dwelon of Safety and Buildings
in acoordance with Gomm 85, Wis. Adm. Code minty C r Ul
Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must S I � • C
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Lti rr'� , GOB
percent slope, scale or dimensions, north arrow, and - 3 --7 locabgrL and distance to nearest road. Qot(� /
' R Date
Please pri►rt all i M n: ` by
Personal information you provide may be used for mdayy purposes (?dvacy Law, s= 15-04 (1) (m))•
prooe Location
Property Owner ,,1 , ,
R tv t[ L1rd e 5 r` Gqa L. of (/� 1/4,V 1/4 S Z i T N R / X E (or) 10
Property Owner's Mailing Address - . Y, 6 � L Block # Subd. Name or CSM#
►�. 0 . C ox 10 (o
Sr f�W)IX t1 Gg1(:vievj Acres
CAY State Zip Code c N NTY ity ❑ Village Town Nearest Road
. 'e ZONMIG OFFIC Y
Mona I
® New Construction Use: ® Residential/ Number r�or n Code derived design flow rate
415 C GPD
❑ Replacement ❑ Public or co men�ti -al - Dgscribe: '
Parent material C3v Fw g j1 S1/� Flood Plainelevatwn if applicable ft
General comments Sy S4 w. a (t . C7
and recommendations: L� . e 1 t J • of (p. O
❑ Boring F-1 Boring #
® Pit Ground surface elev. W, L 70 ft. Depth to limiting factor 110 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I o -/o t yL 31 2- �� m Cy -5 .8
Z C- 5
3 34, -1Ao 1 6 yC l 01,5 C5 rn ►
2 b M t
Boring # El Boring ,
® Pit Ground surface elev. / W • 1 o ft De iht g factor [ / S in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Str Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
I
0 -lb ID (31Z 5 1 1 Z rmb k mPy- . Ivy' .5
8
2 ID- q !O r 911 2rn e-b k
y- 4S 18 ry / rns s m 1 - 7 l• Z
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgll. " Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Ads 2533o9
Address Date Evaluation Conducted Telephone Number
2k13 8UT S� . - o r C 15) Zy - tioox
C
Properly Owner N e ISor Parcel ID # F -e V �( 6- rl I �Vit c v ,' Y� -S Page 2 of 3
❑ Boring H 0 ?, - // '7 - 0 V
a Boring # L- c
Pit Ground surface elev. ��,� ft Depth to lanibrxl factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPD/ffF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Ef(#1 *Eff#2
I o I0\ .3 Z- —' Sri -E c5 )V�
Z 1Z 34 �y��l 5� IC c — $
34 -/i f
Borin g
F-1 Bonng #
❑
❑ Pit Ground surface elev. ft. Depth to Igniting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP-
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # ❑ Boring
Ground surface elev. ft Depth to limiting factor in.
El Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture SMx;ture Consistence Boundary Roots GPDlffl
i in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = B013 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- 030OL07ro0>
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PAGE 3 - OF 3
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NAME //-,t I So ✓, LOT# ( - / LEGAL DESCRIPTIONNuJ' /4Ax t/4 S z t T 3c) N R 1$ E (or 9)
SCALE: I"= y6
1
BM I ELEVATION 100 d
BM I DESCRIPTION 19 S fo v� o a_
�`�rrvp r Pi E
BM 2 ELEVATION /00 • 6 e G. Z
BM 2 DESCRIPTION �a r0 a 1 Pure P D e
SYSTEM ELEVATION
ALTERNATE ELEVATION
CONTOUR ELEVATION h o b \
1 Ai- }. f3 - I
C
C3-
� 51 P
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4 U
I
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FPOPA Schumaker P1umbinq FAX MO. : 7153863121 Mar, 13 2002 04:05PMf P2
ST CROIX COUNTY
SUTIC TANK MAINTaNANCL AGRUMRNT
AND
OWNWHIP CBRTIFICA'I'ION FORM
OwmarAbyer
Mdit Addraag
propez4y d mw d
(vaif"tin "kw AM Ptaat Dopameet f" ow aoauwe Q n
C ty►1I3 � oZ .0 ' v7w /161 ?a=
I MeWfinim Ntttnbac
x tao titon y,, �QL yti Sac. W, Town of
S.W11. evo Lc-e-7>
ones
IM hom 0 yo fit= Lot U. wldlftw ( 0
fo�MOp +satard��7►a�att+oo�d��ara�t�p eme.w�aais.Proper�
omiirl� of oaths Isfauk""76+ waft%ita..iMi<'tw 4l Wb�you �tl �p1 t!a< `
�; a<siri s�pWttool�st,a lartlo�oets�ii� Sn �lssis�lMlL;�m■
'�. p�opacQr ooaMr sees � �ti� !it t� toaiat D�oesat ti � � �'� �aet asd iq t
l d ► wWodjhwb c"l�o�med�ecwe�i�t� ?�
p r aa�odltiao►imdlor( t!larlOr�+eotienstidp .(If .tbe taoplkaakto 1�'ti dlsbd�a
ma ire + da ►AMXegaioaiaoh"ISSM1oM&Clkftpd" WOW Mrod wi*do
both, at eot b� o! ss�d tba oinbW aMMM a* o *
egnr �7� �
I v� sea �a tha owoad+�3 at
I (We) MW t o s1I M this few► W on % As bso of air (*a* koWbedW t � t )
�a si�rr, +rime of a �raonaiy 4wid seoa" is ft&w of Nab Olaos.
DOE
•,• «� �, � is mai�aapc+voe�mttF in dr.miherps�it a by � *'••••
rr *1* ttsia arliteaWq: a tad ham dw asawa oCb=6 am"
s G"? of AS OUV.W lsovay SW it 10hMM is W& is tine wseri* d"d
FROM :''$chumaker Plumbing FAX NO. : 7153863121 Apr. 19 2002 09:38AM P3
Management Plan for a Se tic 7anK 3rd Soi` Aosorption Cornponent
filter Is equipped with an alarm, the filter shelf be serviced if that alarm 4 activated contiMU0U$Iy.
Intermittent filter alarms may indicate surge flows or on impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge In the tank
exceeds 113 the liquid volume of the tank. If the contents of the tank are hot rsnVVed at the
time of an assessment, fn penance personnel shall advise the owner of when the row service
needs to be performed to maintain less than rmaxlmur+n scum and sludge accumulation In the
tank.
Manhole risers, acaass risers and covers should be Inspected for water dgntness and
soundness. Access openings used for servlee And Womment shsli be sestet watertight upon
the completion of service. Any opening deeit►ed unsound, defective. or subject to falluns must
be replaced.. Exposed some openings groater than 1111-inches In diameter shell be secured by
an affective locking device to prevent eaddental or unauthorised entry into the tank.
No one should enter a septic or other lresbneW or holding lank Aw
any roasan wi 0out bWag in AM cornpilenoo with OSHA standarda for
ees►tarino a eoaomw specs. The ilfnrosphere wit hln the 04FINo or other
ftehowt of halving tank easy eertUln Nihsl yeas„ Wild Mcrlo of e
person the le hwar of tleo ank May bR dffftvit or Impoaalblo.
Tank abandonment steak be in aawrdanoe• with Comm 83.33, We. Adm. Code when the
tank Is no longer used as a POW's$ component,
Sesl_I Absotstion Copt
The soil absorption eom;onent salving this structure is designed to ecoept domestic
wastewator from a residential facility. The limits or operation of this component are Shown in
Table 2.
The longevity of a soil absorption mponent depends greatly on proper and timely
maintenance, and system use within or below the limits of rabble operation, Good water
corwenint pri praotleres by all o=pants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this contponarit.
Tine soli absorption eompenem`s operation must be assessed by insAsot#on at least
once every Was years. The Irmpection shall include recording the levels of ponding, If any. in
the observation pipes, and a visual Inspeedon for any evidence of surface seepage or discharge
from the componont. On steeply sloping sites, areas of erosion should be Ident{fted and
reported to Me owner for repair. The surface discharge of domsatio wastewater or sewage
from the system Is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided partticuiarly
during winter months, The compaction or removal of snow cover aver the wmporient may lead
to hydrautio failure by freezing. This .ype of fallur® Is usually temporarys but is difficult of
impossible to repair until weather ewdlUa+s Improve. in general, soil rorripa cdon over this
component will reduce diffuslon of oxygen into the soil and dispersal Gels, which may lead to
more Intense, and earlier, organic clogging of the soil.
2
FROM :,8chumaker Plumbinq FAX NO. : 7153863121 Apr. 19 2002 09:37AM P2
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83 Wi s. Adm, Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 64, and the conditions of approval by the departmem agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis, Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567 -P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Nunber S
Number of Bedrooms
Design Flow - Freak ( pd)
Estimated Flow - Avera a (gpd)
Se tic Tank Capacity (gal) � 11 - 160
Soil Absorption Comp onent Size ( )
Ty of Wastewater Domestic
Table 2: Soli Abso Lion Component - Limits of Reliable O aticn
Sept! c Tanis Co mpo nent 1 S oil Absorption Component
Design Flow - Peak ( d
Maximum Influent Particle Sias (in' 1/8
Maximum BOD (m ) 220
Maximum TSS (m /L) 150
Table 3: Maintenance Schedule
Septic Tank ins act and/or servi once eve 3
Outlet Filter - Inspect once a y ea r , nd clean at least once eve 3 years
Soil Absorption Component Inspect once eve 3 y ears
Septcic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.46, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of th septic tank an o t et filter s hall be as;s at Was
once every 3 years by inspection. The lter small be cleaned as to ensure proper operation. The filter cartridge should not be removed unless prove re e
rs am so ids in the tank that may slough off the filter when removed from Its enclosure. If the
r -
FROM :,,`$chumaker Plumbinq FAX NO. : 7153863121 Apr. 19 2002 09:38AM P4
A+tanagerrient Plan for a Septic Tank and $oil Absorption Component
I*tantings of deep-rooted tress and shrubs directly over of wKNn ten feet of the component
should be avoided since root intrusion into the Component fMy obstruct weetw*Wor flow.
Contin$ancy Plan
In the event of system talture, a new system could be Installed in an aNerr*o area. W th the
Installation of a diverter vawiive, the existing sys could also be roused eta a period of three to
tour years.
It Is the property owners responsibility to maintain the aitemato area free fhn any planting of
Van. shrubs, etc, In case of failure of the original system, the sl*rwte area will be needed. If
WW tries, shrubs, etc. have been planted On the alternate area, they will have to be remorsd at
propw v owners axpen
If aitsrnats area is destroyed, there are other alternative systems that Can be used, in whict:,
could result In added excpense to the property owner.
Any tank abandonment shall be done in accordance with Wisc. Code 63.33. Any questions
roparding this cods, please Contact your local Zoning Office or contact the installing plumber.
Zn.%3%"V.� b�,..«. {zts)as IV - y lot C)
�`r�^"►x'^ °`�� -0. 1?1,. V1,,.,r, 6 � wc� (� i5� 3 � 6 - 3 t � �
03/18/02 MON 14:34 FAX . 1 115 3$6 6560 ESTREEN&OGLAND Q001
1 14PA 288
c::;,
STATE BAR car WISCONSIN FORM 2 -1
WARRANTY DEED
Documem Number 7 f. i" F!(J! X 14'1�0- W.(
This Deed, made between Hillvalg Development Limited, a
Minnesota Limited Liability Partnership, Rri
Grantor, R obert A. Perkins and Shirley J. Perkins, husband and =E:: A'y FEE:
wife,
TRPS, FEE: 70.64
RECORD- FEE: 11.00
., _...�_. __ � GAGES: 1
Grantee. Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
lk Arca
Lot 4, Golfvlew Acres, To of Richmond, St. Croix County. Wisconsin. :1 Name and Rmuarn Address
KSIS" OGLAND
A AT LAW
p -)X 359
HUDS�,i WI 54016
Pt or 026-1060-80, 026-1063-95 026.1064-10
i�
um T
arccl ldcrti 'C ion P
n Number (PIN)
property,
This is no homestead property,
X Us 1100
Exceptions to warranties: Easements, restrictions and rights -of -way of record, i " any,
Dated this - dayof 2001
Hillvale Development Limited
Richard $., Nelson
AUTHENTICATION ACKNOWLEDGMENT
Signatura(s), !U1 Ivall Development Limited, a Minnesota STATE OF WISCONSIN
Limited1j *jIh by Richard S. Nelson ) ss,
County
k$ L gust ......
a U, � 11 day or Au _2001
— -- I"crsonally Game before ire this day of
the above named
TlT fta 1 .— STATE BAR OF WISCONSIN I 1 -n c - known to he the person(s) who executed the foregoing
instru mcnt and acknowledged rite same•
authorized by 4 706.06
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristin$ Ogland Notary Public, Slate of Wisconsin
Het on, WT14 My Commission is permanent. (if pct, s tate expiration date:
(Signatures may be authenticated or acknowictijed. Both arc not necessary.)
• Names or persons siping in any capacity mus b t or printed below their 3ignalofe, w1iormatim P(desilw*5 Camow, FWW 4 WK. %M
STATE BAR OF W ISCONSIN
WARRANTY DEED FORM No, I - 1999
BOB PERKINS
763 205TH AVE
SOMERSET, WI 54025
715 -247 -4778 HOME �. .
612- 581 °1147 CELL' �
60'
14' BDRM i BDRM 14'
14' ----tom \ -*-- 10'
n
6112 8' W BATH WIC BATH 81 36'
FLITCH 42'
nwnar
BKFST NOO
BDRM
14' W D � 14'
KIT
F UT11 4
` -" 6'
WIC STORAGE
PORCH
36' ----°— - - 3/12 PITCH
28 ' GARAGE
C4`
---- -- 60'
6/12 PITCH
PRELINAIlVARY PLAT
ACRES
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NOTICE TO ALL UTILITY COMPANIES:
N G01 17VIE
/4 Corner (ALL UfILJTY •
21 -0.
3ect,on
' R18W u:: 1f A-)
(steel S.-Y) b-g ill be Icl Located in that part of the NW 114 of the NW Mall'
eir
0 lfWnd Southeasterly of the Chicago. St. Paul, Minnea7
4 of the NE 114 of the NE 114, part of the SE I
LID
UNE�LATIE CERTIFIED the Chicago, St. Paid, Minneapolis and Omaha
D WRVEY MAP
k' --- - I of Richmond. St. Croix County, Wisconsin
UNPLATTEQ ' DOCUMENT N0. 594J58
4P! Ti� iiii
--- East line of the of the NW
L 1/4 of the NW 1/4 of Sec. 21 _UzM ST
n to - SOO*4 1'43"R - Dedicate I,
500*41'43*E
0- FWD. 3/4-MMO ___ - __ --I 1 66100.
J -------------- - - - - -- 217.00' - - 2i6:9ir
216.50' 217.00'
' OF REBAR -867.34'- 1 L
v); ELEV-964.63 18
0-
In : 100 Q IN
-100
.0
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GENERAL NOTICE STATEMENT: \ 1 SEE SHEET 2 OF 3
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Project No. 610.002FP Park. c—itt•e. This instrument drafted by