HomeMy WebLinkAbout030-2120-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. C roix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
430058 0
(ATTACH TO PERMIT)
GENERAL INFORMATION 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:
Youn , Paul I St. Joseph Township 030 - 2120 -60 -000
CST BM Elev: Insp. BM Elev: I BM Description: s l ( µ Section/Town/Range /Map No:
)!� • d �lsD.0 CS - r Qt ( I & Pky—_ 25.30.
TANK INFORMATION E VATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic I t Benchmark • ! D oS, `O ' L70 O l
Dosing Alt. BM O /
i
Aeration Bldg. Sewer
Holding St/Ht Inlet • 2 R� •8S 1
0
TANK SETBACK INFORMATION St/Ht Outlet (oo 9 1
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic SO Dt Bottom
Dosing Header /Man. 1 2 • V
Aeration Dist. Pipe R.1? Z •
Z �
Holding Bot. System D f
Pup/SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
1 fj /
GPM i(dsi le
Model Nu ber
TDH Lift Friction Loss System Head TD Ft
>06main Length ia. Dist. to well
SOIL ABSORPTION SYSTEM
CH Width Length No. f Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMEITSIUNS 'i Z
SETBACK SYSTEM TO P/C BLDG WELL LAKE /STREAM LEACHING N=r
INFORMATION Type Of stem: / CHAMBER OR
V 2D /} �7 r UNIT Model Number:
DISTRIBUTION SYSTEM
Header/ anifold II Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia n 1 �SV
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over TBedp/ Over xx Depth of xx Seeded /Sodded xx Mulched
BedfTrench Center rench Edges Topsoil „ I Yes No Yes J No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:AA&tX. 1 Inspection #2:
Location: 813 134th Ave Huds W401j (NW 1/4 SW 1/4 25 T30N) Bass Lake Ines Lot Parcel 25.30 18
s('1101D r ` 1 - ,p ��,,�
1.) Alt BM Description = - `\ • , �) W �^
2.) Bldg sewer length = + 7. / -
- amou t of cover = 2q f
3) �,.�Q Ar — c 14-,
--
Use otherls Re de for additional
information.
Yes No
formation. 1 ''
SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No.
6 , Safety & Buildings Division
\7� _
Sanitary ermit A p p lication 201 W. Washington Ave.
- _ isc6ns rY PP PO Box 7302
>,n In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707 -7302
Qepartment of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not
(Privacy Law, s. 15.04(1)(m)] state owned.
Attach complete plans to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number
0b 5S
I. Application Information - Please Print all Informat n - G V Location: ti Property Owner Name Property Location
P a l' /5 O JUN f 2 2003 44) 1/4 01 /4,SZST30,N,R/ W
Property Owner's Mailing Addres ! Lot Number Block Number
0 , 9 0 70 ,-r � (o
S r r
City, State Zip Code Subdivision Name or CSM Number
l'1 Qut.) ort
r " 11. ss' ( & ) /529- 838fr &5S 44ee A; Ae.5
II TT pe of Building: (check one) 5,.,�, ��w� •tits. ❑ City
Csl 1 or 2 Farrtily Dwelling — No. of Bedrooms: 3 ❑ Village
• Public/Commercial (describe use):
liwn of
• State -owned 5*_
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road
A) 1. G? ew System 2. ❑ Replacement 3. ❑ Replacement of 1 4.. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System O 30— &U,70 4, CM
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
G; on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade P Aerobic Treatment Unit ' ^ ❑ Recirculating ❑ Other:
2 v_ A - —rao e -`(tom
V Dispersal/Treatment Area Informatio : 32 d "r a t .20
1. Design Flow (gpd) 2. DispersalArea 3. D er al Area . Soil Application 5. Perc tion Rate System Elevation 7. Fina rade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
�/ �► �s1,2. 8� zo 0.7 r.r rts9 9/ so " 9f,04 %- :To y
VI Tank Capacit n Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑
"C Sri G22� / Alt) l !,J " & c.
VII Responsibility Statement
I, the undersigned, assume responsibility f r installation of4e POWTS shown on the attached plans.
Plumber's Name (print) Plum is Signature( ): ps): MP/MPRS No. Business Phone Number
w oe' S�a -.-, o�-c ?-.Z 3�TS (�/5� 48� S /`G
Plumber's Address (Sere ity, State, Zip C e)
/`: a
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 1 sVng Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination ro �3
IX. Conditions of Approval [Reasons for Disapproval:
se Atk
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JUN -10 -2005 01:16 PM A.C.E. Soil M Sio! E"al. 713 246 7764 P.02
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JUN 10 2003
ST. ChG:X COUNTY
r ZONING OFFICE
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JUN -10 -2003 01:15 PM A.C.E. Soil & SiLe EVaI. 715 248 7764 P.01
C.R. B09 sue Eval "
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"OAVdWd .Ld1k*L ..
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map �"&ffdr
To: %'►
From: �i / Ry►rtPsy�'�
Date: _�� 0�a 3
# pages including cover sheet: a'
If facsimile is incomplete or illegible, please contact Jim 'Thompson at telephone number listed
above,
1644
` Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
030 - 2120 -60 -000
Please print all information. awed EkY e
Personal information you provide may be used AM , ) (m)) /�+ 3 ' ,� JlAm,..
Property Owner - - Pro rty Location
Paul & Kris Young Govt. of NW 1/4 SW 1/4 S 25 T 30 NR 19 W
Property Owners Mailing Address ! ( 2 [ 003 Lot Block # Subd. Name or CS
2070 Barry Drive Bass Lake Pines
City State Zip ode Pho�t Ndhib4J� j ,' City Village [! Town Nearest Road
��'�� `�� I� 134Th Ave.
Newport MN 55 St.Joseph
✓_{ New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate 1 450 GPD
J Replacement J Public or commercial - Describe:
Parent material Glacial outwash Flood plain elevation, if applicable na
General comments
and recommendations: Install two trenches at elev. = 91.50' using 22 leaching chambers. Reduce grade 2'- Tin the area of B -1
prior to system construction to facilitate installation.
a Boring # 1 Boring
i/ Pit Ground Surface elev. 98.39 ft. Depth to limiting factor >124" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr32 none sil 2fcr mvfr as 2fm,1c 0.5 0.8
2 10 -21 10yr4/6 none sl 2fsbk mfr cs 2fmc 0.5 0.9
3 2143 7.5yr4/6 none s 0 sg ml gs 1fm 0.7 1.2
4 43 -78 10yr5/6 none s 0 sg ml gs - 0.7 1.2
5 78 -124 10yr5/4 none s 0 sg ml - - 0.7 1.2
e ll+ 9 111- so
9 (0 e t- (a%
Boring # I Boring
0 Pit Ground Surface elev. 96.57 ft. Depth to limiting factor >119" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -8 10yr32 none sil 2fcr mvfr as 2fm,1 c 0.5 0.8
2 8 -17 10yr4/4 none sil 2fsbk mvfr cs 2fmc 0.5 0.8
3 17 -26 10yr5/4 none sl 2msbk mfr cs 1fm 0.5 0.9
4 26 -35 9
7.5 r4/6 none Is 0 s ml cs 1fm 0.7 1.2
Y
5 35 -119 10yr5/6 none s 0 sg ml - - 0.7 1.2
O RY
T - ' /
* Effluent #1 = BOD ? 30 < 220 mg/L and T S >30 < 1 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L
CST Name (Please Print) ignatur . CST Number
James K. Thompson 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 5/302003 715- 248 -7767
Property Owner Paul & Kris Young Parcel IDS 030 - 2120 -60 -000 Page 2 of 3
` ] Boring # j Boring
e Pit Ground Surface elev. 94.8 ft. Depth to limiting factor >115" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
1 0 -13 10yr3/2 none sil 2fcr mvfr as 2fm,1 c 0.5 0.8
2 13 -21 10yr4/4 none sil 2fsbk mvfr cs 2fmc 0.5 0.8
3 21 -35 10yr5/4 none sl 2msbk mfr cs 1fm 0.5 0.9
4 35-45 7.5yr4/6 none Is 0 sg ml cs if 0.7 1.2
5 45 -115 10yr6/6 none s 0 sg ml - - 0.7 1.2
F-1 Boring # I Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. F Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
❑ Boring # Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2
i
Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD .5_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.
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Conventional Septic System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD- 10567 -P (R.6/99). All local and/or state rules pertaining to system maintenance
and maintenance reporting shall be complied with.
Septic Tank
The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The
septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The
contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to
service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment,
maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge
accumulation in the tank. Th ut et filter s �iall be cleane as necessary to ensure proper operatio The filter cartridge
should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed
from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank
manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for
service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective,
or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank
as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with
Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or
chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be
approved for septic tank use by the Department of Commerce, Safety and Buildings Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface
within the system and will promote frost penetration during cold weather months. Cold weather installations (October -
February) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing
biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a
new soil absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to installing plumber; Mikeld onell at
248 -7767, or the St. Croix County Zoning Department.
ST CROIX COUNTY
• ' SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerfBn�eer A Lj n ! !a
Mailing Address D 70 &r44 /� "!J4 r PY74. SSOS�
�
Property Address 8� �•
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number 030 - ,84PD - &Q - 6 W
LEGAL DESCRIPTION
Property Location 17W 1 /4, 6 C ' /a, Sec. r 26 - , T 30 N -R_ZW, Town of N'_. J
Subdivision Aa. S Lake. Nines , Lot # (o
Certified Survey Map # , Volume f , Page # —
Warranty Deed # 17r(o f , Volume aA to1 , Page #
Spec house O yes P"no Lot lines identifiable 21"Y'es O no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix 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
n 1/3 full of sludge.
an pumping if necessary), the se g
is in proper operating condition and/or (2) after inspection d p p g ( ary), tic tank is less than septic
Uwe, the undersigned have read the above requirements and agree to maintain the p rivate sewage g 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
Zoni staring that your septic system has been maintained returned to the St. Croix Coun must be completed h' g Office within 30
days of the three year expiration date.
y 3__ / /
SiGNAfURt OFA PLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
X >( s" l Z � l °3
SIGNA F APP CANT DATE
* * * * * * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
o �
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J 2210 P 563 717664
STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN H. NALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., MI
RECEIVED FOR RECORD
Document Number
This Deed, made between Greaory L. Barnes and Lanette E. Barnes. 04/21/2003 09:00Alt
husband and wife Grantor, and Paul B. Young and Kristine E. Young, WARRANTY DEED
husband and wife Grantee. I EXERT 3
Grantor, for a valuable consideration conveys to Grantee the following
described real estate in St. Croix County State of TRANS FEE: 11.00
TRA FEE: 201.90
Wisconsin (the "Property"): COPY FEE:
CC FEE:
PAGES: 1
Recording Area
Na and Rat Address
Pau .You
Kristin oung
Lot 6 Ridge Pines
St. eph wnship, WI 54016
Gar ��
r5 / cwo s
030 1066 20
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Lot , B ass Ridge Pi nes, In the Town of St. Joseph, St. Croix County, Wisconsin.
Together with all appurtenant rights, title and interests. none
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
Dated this 15th day of April 2003.
(SEAL) (SEAL)
t Gl�
regory Bar es and braes
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wlsconsln,
WENDY SWATZINA ) ss.
Q ARY St. Croix County
authenticated this
— ST Personally came before me this 155th day of
April 2003 the above named
Gregory L. Ba and Lanette E. Barnes to me known to
be the person who executed the foregoing
TITLE: MEMBER STATE BAR OF WISCONSIN I from t and acknow 7ct4-Z. 1 e same.
(If not, a-,
authorized by §706.06, Wis. Slats)
THIS INSTRUMENT WAS DRAFTED BY Notary Public, Statd of Wisconsin
Coldwell Banker Burnet
1301 Coulee Road My com ission is permanent. (If not, state expiration date:
Hudson, WI 54016 S b
3 -27862 )
(Signatures may be authenticated or acknowledged.
Both are not necessary.)
Names of ersons sig ning in an ca aci must be or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No. 1 —1998 Milwaukee, Wis.
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Wislonjin Department of Commerce SOIL AND SITE EVALUATION
Divisi of Safety and Buildings Page of
Bureau of Integrated services in accordance with s. ILHR 83.09, Wis. A xp
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print aH information. R iewed by Date
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)).
Property Owner Property Location
�., � R Ci � 6 Govt. Lot 1/4 �� 1 /4,S ��T 30 ,N,R q E (or�N
Property Owners Mailing Address Lot # I Block# Su . ame or CSM
City to Zip Code Phone Number ❑ City 0 Village N rest Road
e ' 6/ ? �y�3 33 r�
New Construction Use: ( Residential /Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 1' gpd Recommended design loading rate �_ f �t
, Z bed, gP— trench, gp�
Absorption area required �� bed, ft trench, ft Maximum design loading rate - bed, gpd/ft trench, gpd/ft
Recommended infiltration surface elevation(s) Zfi g �� 3 /S�T/1' / ft (as referred to site plan benchmark)
Additional design /site considerations
Parent rnaterial Flood plain elevation, if applicable
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ,� S❑ U S 11 U .� S U S El U El S ,� U ❑ S
SOIL DESCRIPTION REPORT
Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft
Boring Texture Consistence Boundary Roots
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
r / es
AF
Ground 1 J
g el v.
t.
Depth to , �r
limiting p7� -tt2,j
t fin.
Z Remarks: k
Boring #
Al s
Ground
C
Depth to
limiting
factor
zs in Remarks:
CST Name (Please Print) nature Telephone No.
Address Date CST Number
SOIL DESCRIPTION REPORT
rPROPEIYYOWit E Page of
PARCEL I.D.#F
Horizon Depth Dominant Color Mottles Structure 2
Boring # P Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground A10 7 11 7 ,0
Depth to
limiting
factor _-
Remarks:
Boring #
Ground
Depth to
- --
limiting
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P0/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring #
k J
Ground
e ev.
n.
Depth to
limiting
factor
21-'l n. r1emarks:
Boring n
Ground
elev.
ft.
Depth to
limiting
factor
-- -in. Remarks:
SBD -8330 (R. 07/96)
r
Soil Test Plot Plan
Project Name Dave and Arla Railsback Sha it
Address 845 133rd Ave
New Richmond Wi 5 CSTM #226900
Lot 6 Subdivision Date 6/4/99
NW 1 /4 1/4S T 3 0 N/R 1 9 W TownshipSt. Joseph
Boring ()Well PL Property Line County ST. C ROIX
BM VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon
System Elevation 92.3/91 * H R p Same as B
Alt. BM Top of Nail in Tree with Orange Ribbon @ 101.3
Pro Town Road
f-2
170'
70' 0' B -1
Pri A
Rep A
Soil Test done to satisfy
5 not - Alt. 60' \61%7ol -5 zoning requirements, may o
be suitable for buyers
M•- desir ed building site.
pe
c�
b
r
265' Property Line